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 29,165 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The controversy as to the relationship between the degree of control of diabetes and the progression of the complications of the disease has not been solved. However, in this review, various studies suggesting a relationship between the metabolic abnormality and the diabetic complications are examined. The disadvantages of the uncontrolled diabetes mellitus can be divided into two major categories-short-term and long-term. The short-term disadvantages of controlled diabetes mellitus include the following: (1) ketoacidosis and hyperosmolar coma; (2) intracellular dehydration; (3) electrolyte imbalance; (4) decreased phagocytosis; (5) immunologic and lymphocyte activity; (6) impairment of wound healing; and (7) abnormality of lipids. The long-term disadvantages of uncontrolled diabetes melitus include the following: (1) nephropathy; (2) neuropathy; (3) retinopathy; (4) cataract formation; (5) effect on perinatal mortality; (6) complications of vascular disease; and (7) the evaluation of various clinical studies suggesting the relationship of elevated blood glucose levels and complications of diabetes mellitus. It is suggested that until the question of control can absolutely be resolved, the recommendation is that the blood glucose levels should be controlled as close to the normal as possible.
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PMID:Why control blood glucose levels? 81 31

A personal series of 6780 patients with diabetes mellitus is reported. Of these 1410 were thought to have insulin-dependent (Type 1) diabetes and 4926 non-insulin-dependent (Type 2) diabetes. Among the former, 128 patients were only diagnosed when in severe ketoacidosis or coma. In 116 patients the diabetes was diagnosed in pregnancy. Chronic alcoholism was an aetiological factor in 75 patients; in 52 it led to the diagnosis being made, and it complicated treatment in 129 additional patients. In the patients with Type 2 diabetes whose treatment was stabilized 23.5% were having insulin injections, 44.5% tablets, and 32.0% diet only. Sight-threatening retinopathy developed in 21.3% of patients with Type 1 and 7.9% of those with Type 2 diabetes. The rate of developing sight-threatening retinopathy was 1.1% of patients per year. Blindness occurred in 0.28% of patients with Type 1 diabetes per year and 0.097% per year in Type 2 diabetes. If the mean survival of patients with retinopathy going blind is 7.5 years, this would mean 7500 people in the UK blind from diabetic retinopathy. There was a striking drop in the annual incidence of blindness after 1970 coinciding with the introduction of specific treatment for diabetic retinopathy. Juvenile cataract developed in 1.7% of patients who developed Type 1 diabetes before 30 years of age. Clinically important diabetic neuropathy developed in 17.4% of patients with Type 1 and 11.6% of those with Type 2 diabetes. The main features were paraesthesiae and numbness (49%), neuropathic ulceration (37%), pain (5%), autonomic symptoms (5%), and amyotrophy (4%). Oculomotor palsies and mononeuropathies were noted. Foot ulceration occurred in 81 patients with Type 1 and 279 of those with Type 2 diabetes. Charcot changes in the feet were noted in 21 patients. Major amputations were needed in 18 patients with Type 1 and 60 with Type 2 diabetes. Proteinuria believed to be due to diabetic nephropathy developed in 12.8% of patients with Type 1 and 4.7% of those with Type 2 diabetes. The prevalence of early renal failure was 4.6% and 1.4%, respectively. Coronary artery disease was noted in 9% of patients with Type 1 diabetes, and was more common in those who developed diabetes after 20 years of age. Myocardial infarction was as common in women as in men. In Type 2 diabetes coronary artery disease gave rise to symptoms in 19.1%, and myocardial infarction was more common in men.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Diabetes in the United Kingdom: a personal series. 182 47

Recent changes in the medical system have resulted in a significant increase in the number of surgical procedures performed as day surgery. Therefore, a safe and short postoperative recovery period has become increasingly important. In the present study we investigated perioperative cognitive and physiological functions after oral premedication with low-dose midazolam (3.75 mg). The study was carried out on at total of 55 women (age > 60 years, weight 50-90 kg) scheduled for elective cataract surgery under retrobulbar anaesthesia (RBA), who were randomly assigned to either group 1 (n = 35) receiving 3.75 mg midazolam p.o. or group 2 (n = 20) receiving placebo p.o. 30 min prior to RBA. We measured the following parameters: sedation (modified Glasgow Coma Scale); anxiety (visual analogue scale); numerical and verbal memory (digit span and reproduction of previously presented words); concentration (revision test of Stender/Marschner). To identify depression of ventilation, pulse oximetric oxygenation and end-tidal PCO2 (nasal) were monitored intraoperatively. In the midazolam group anxiety was significantly lower and patients were significantly more sedated than in group 2. At a check 30 min after premedication with midazolam the scores for concentration and numerical memory were significantly (P < 0.05) lower. No differences between the groups could be found 2 h after the operations (2.92 +/- 35 min after premedication). Intraoperatively there was no significant difference in end-tital PCO2 and oxygenation between the groups. Oral administration of low-dose midazolam (3.75 mg) seems to be an appropriate form of premedication for ambulatory surgical procedures in elderly patients.
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PMID:[Perioperative follow-up of physiologic and cognitive functions after oral premedication with midazolam 3.75 mg in women for retrobulbar anesthesia]. 886 63

We present a hyperopic patient with a decentered line of sight in whom the residual refractive error after toric phakic intraocular lens (TP IOL) implantation was improved by displacement and individualized treatment. A 35-year-old woman presented with asthenopic complaints 2 months after bilateral TP IOL implantation and IOL rotation 4 weeks later. Examination revealed the line of sight to be nasally and inferiorly decentered in relation to the center of the pupil. A more nasal reenclavation of the TP IOL decreased the coma, and the uncorrected visual acuity was 20/20. We conclude that line of sight should be measured before TP IOL implantation, especially in hyperopic eyes.
J Cataract Refract Surg 2004 Aug
PMID:Impact of the line of sight on toric phakic intraocular lenses for hyperopia. 1531 11

The importance of quality of vision (QOV) along with quality of life (QOL) in medicine has been recently widely recognized. We have conducted studies to quantitatively analyze factors related to QOV. Irregular astigmatism can be a significant obstacle for achieving satisfactory QOV. Videokeratography data were broken down using Fourier harmonic series analysis into spherical power, regular astigmatism (second harmonic component, n = 2), asymmetry (n = 1), and higher order irregularity (n > or = 3). The irregular astigmatism component calculated by the Fourier analysis significantly correlated with best spectacle-corrected visual acuity. Software was developed to display color-coded maps for the four Fourier indices. The normal range was defined for each Fourier index, and eyes with pathologic and postsurgical conditions were evaluated using the normal range. Progression of keratoconus over time was quantitatively described by Fourier analysis of the videokeratography data. Using the Fourier method, changes in corneal topography following suture removal after penetrating keratoplasty were evaluated. Fourier analysis of videokeratography data significantly facilitated determination of refraction and measurement of best spectacle-corrected visual acuity in eyes with corneal irregular astigmatism such as post-penetrating keratoplasty eyes. Higher-order wavefront aberrations of the cornea were calculated by expanding videokeratography elevation data into Zernike polynomials, and coma and spherical aberrations were computed. For ocular aberrations, the data obtained with the Hartmann-Shack sensor were decomposed into Zernike polynomials. Coma aberrations of the cornea significantly correlated with age, while corneal spherical aberrations showed no age-related changes. The time-course of changes in corneal higher-order aberrations was reported for photorefractive keratectomy and laser in situ keratomileusis (LASIK). For ocular aberrations, the degree of tilting of the suture-fixed intraocular lens significantly correlated with the amount of coma aberration of the eye. In normal eyes, the ocular coma increased with age mainly because of the increase in the corneal coma, and the ocular spherical aberration increased with age because of the increase in spherical aberration in the internal optics including the crystalline lens. The conventional LASIK significantly increased ocular higher-order aberrations, which compromised postoperative contrast sensitivity and low contrast visual acuity. Both corneal and ocular wavefront aberrations were analyzed in cataract, pseudophakic and aphakic eyes, and the equilibrium of spherical aberrations between the cornea and the eye in those conditions was investigated. In pseudophakic eyes, coma aberrations of the cornea, along with the corneal multifocality, significantly contributed to apparent accommodation. Computer simulation indicated that a focus shift of 0.5 diopters deteriorated the retinal image significantly more in eyes without higher-order aberrations than in eyes having a moderate amount of coma aberrations. Clinical results of aspherical intraocular lens were reported for wavefront analysis and contrast sensitivity measurements, and retinal images were analyzed by simulation. For the assessment of vision-related QOL, National Eye Institute Visual Functioning Questionnaire 25 (NEI-VFQ 25) was translated into Japanese. After the validation study, the influence of cataract surgery on QOL was investigated. The QOL score was severely impaired in patients with bilateral cataract, which was significantly and dramatically improved by surgery. Forward scattering, backward scattering, and wavefront aberration induced by the crystalline lens were quantified, and the impact of these factors on visual function was analyzed according to the type of cataract. The degree of QOL improvement by surgery was assessed in relation to the type of cataract and intensity of scattering and aberration. By comprehensively analyzing these factors, quantitative parameters could be developed in the near future to describe progression of cataract and determine the indication for cataract surgery.
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PMID:[Quantitative assessment of quality of vision]. 1565 87

Astigmatic keratotomy (AK) was performed in a patient after penetrating keratoplasty (PKP) for keratoconus to reduce high post-PKP astigmatism. The procedure led to a significant decrease in astigmatism, but corneal higher-order aberrations (HOAs) increased. After PKP, the patient was scheduled for 2-step laser in situ keratomileusis (LASIK) to correct myopia and astigmatism. One day after the microkeratome cut, a decrease of -2.75 diopters in the spherical equivalent (SE) was noted. Although subjective manifest cylinder and corneal spherical aberrations were marginally affected, a marked decrease in coma and other HOAs could be observed. One month after the cut, the SE was unchanged. Excimer laser ablation was not performed as the patient was satisfied with the result and refused further treatment. This case shows that AK cuts can induce HOAs and a single microkeratome cut performed in corneal grafts can have strong biomechanical effects on lower-order aberrations and HOAs. If LASIK is planned after PKP, a 2-step approach is recommended to anticipate biomechanical effects and avoid overcorrection or undercorrection.
J Cataract Refract Surg 2005 Jan
PMID:Corneal first-surface aberration analysis of the biomechanical effects of astigmatic keratotomy and a microkeratome cut after penetrating keratoplasty. 1572 11

We report on clinical, histological and genetic findings in two patients carrying novel heteroplasmic mutations in the mitochondrial cytochrome c oxidase subunit genes COII and COIII. The first patient, a 35 year-old man had a multisystemic disease, with clinical symptoms of bilateral cataract, sensori-neural hearing loss, myopathy, ataxia, cardiac arrhythmia, depression and short stature and carried a 7970 G>T (E129X) nonsense mutation in COII. A sudden episode of metabolic encephalopathy caused by extremely high blood lactate lead to coma. The second patient developed exercise intolerance and rhabdomyolysis at age 22 years. A heteroplasmic missense mutation 9789 T>C (S195P) was found in skeletal muscle, but not in blood and myoblasts pointing to a sporadic mutation. Our report of two patients with isolated COX deficiency and new mutations in COX subunit genes may help to draw more attention to this type of mtDNA defects and provide new aspects for counselling affected families.
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PMID:Mutations in mtDNA-encoded cytochrome c oxidase subunit genes causing isolated myopathy or severe encephalomyopathy. 1628 75

Three patients (5 eyes) presented with complaints of monocular diplopia and no history of ocular trauma or surgery. The patients had comprehensive neuroophthalmic evaluation including manifest refraction, anterior segment and dilated fundus examination, and corneal topography. All patients also had wavefront analysis using the LADARWave system (Alcon). Two patients (4 eyes) also had hard contact lens overrefraction. The patients had a normal initial examination including corneal topography. One patient (2 eyes) did not experience resolution of diplopia with pinhole. No eye improved with manifest refraction or hard contact lens overrefraction. However, each patient had a significant amount of coma on wavefront analysis. Moreover, eyes with horizontal diplopia had horizontal coma and eyes with vertical diplopia had vertical coma as measured with the wavefront device. Higher-order optical aberrations such as coma may be associated with monocular diplopia. Wavefront technology may be useful in the workup of monocular diplopia.
J Cataract Refract Surg 2006 Mar
PMID:Comatic aberration as a cause of monocular diplopia. 1663 Oct 71

We report a paradoxical increase in visual impairment after punctal plug placement despite improvement in corneal epithelial damage caused by mild dry eye. Ocular higher-order aberrations (HOAs) were measured sequentially with a wavefront sensor before and after punctal plug insertion in a patient with mild dry eye. Although postblink HOAs tend to increase in normal subjects or patients with dry eye, after treatment there was a maximum spike in HOAs for a few seconds that decreased gradually. Excessive retention of tear film by punctal occlusion may cause inferosuperior asymmetrical distribution in precorneal tear-film thickness, possibly leading to slower wavefront on the inferior cornea and increased coma-like aberrations. Increased visual impairment might occur paradoxically despite improvement in the corneal epithelial damage caused by dry eye.
J Cataract Refract Surg 2006 Apr
PMID:Paradoxical increase of visual impairment with punctal occlusion in a patient with mild dry eye. 1669 99

We report a case of unexplained bilateral corneal endothelial decompensation after a coma. A 71-year-old man with no medical history presented with bilateral endothelial decompensation that required penetrating keratoplasty of the left eye combined with cataract surgery. This coma was caused by septicemia originally due to staphylococcus infection following catheter placement in preparation for a CT scan. Visual acuity of the left eye was 20/400 and 20/100 in the right eye when the patient awoke from the coma. After examination, we noted only stromal thickening and Descemet membrane folds causing corneal edema predominating OS. The rest of the exam was normal. Six months after surgery, visual acuity improved to 20/25. The most probable physiopathological mechanism of this decompensation is an iatrogenic complication from drugs administered during the patient's stay in intensive care (oxacillin), but we cannot rule out direct aggression of a bacterium or its toxin or the decompensation of a preexisting pathology.
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PMID:[Bilateral corneal endothelial decompensation after postsepticemia coma]. 1688 31


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