Use of "Near Middle East Antivenom" to treat African bush viper envenomation.

Venom from an African bush viper is primarily hemotoxic and potentially life threatening. Existing, commercialy available antivenoms may not neutralize venom of this genus. A 25-y-old male was brought to the emergency room diaphoretic and hypotensive (70/40 mmHg) after a bite from a pet African bush viper. A puncture wound on the left thumb was leaking slightly, but there was no evidence of blood loss, edema or bruising. Approximately 100 min after exposure, the patient experienced a small amount of proximal swelling. Six h after envenomation, he was admitted to the intensive care unit for monitoring. At 10 h after the bite prothrombin time (PT > 100 sec) and international ratio (INR = 9.2) were elevated. The patient was unable to coagulate. He received fresh frozen plasma, cryoprecipitate, and Near Middle East Antivenom. Improvement in clinical status and laboratory parameters were observed after each of 3 doses of antivenom (d-dimer > 1000 and fibrinogen = 137 mg/dL). The patient was monitored overnight, did not require additional antivenom and was discharged as laboratory parameters, vital signs and spread of the necrotic lesion stabilized. Near Middle East Antivenom appears effective in treatment of the hematologic sequelae secondary to African bush viper envenomation.

Mammography screening and breast self-examination among minority women in public housing projects: the impact of physician recommendation.

This exploratory study examined the impact of physician recommendations and other factors on mammography screening and breast-self examination (BSE) among African American and Hispanic women in public housing communities. We surveyed a randomly selected sample of low-income households from three low-income communities (n = 291), which included both African Americans and Hispanic women. Data for this paper are reported only on women who were 40 years and older head of the households (n = 120 women, including 74 Hispanics and 46 African Americans), since they meet the age criterion for mammography screening. Our analyses indicated that only 46% of women obtained mammography in the previous 12 months, with no significant differences between the Hispanic and African American women in mammography rates. Physicians' recommendations were among the most significant and substantial predictors of obtaining a mammogram or performing BSE. Further, odds were also higher for those who had insurance coverage. In addition, our data also indicated that almost one out of four women, aged 40 and older participants in this study, claimed that their health care providers never told them they needed a mammogram or never told them that they should perform BSE, with no significant differences between Hispanic and African Americans. Our analyses points to an urgent need for intervention to inform and motivate the service providers in underserved communities to motivate breast cancer screening (BCS) among minority women. Additionally, our examination points to the need for urgent interventions targeting minority women, particularly women with no medical insurance for breast cancer screening.

Multigroup discrete ordinates modeling of 125I 6702 seed dose distributions using a broad energy-group cross section representation.

Our purpose in this work is to demonstrate that the efficiency of dose-rate computations in 125I brachytherapy, using multigroup discrete ordinates radiation transport simulations, can be significantly enhanced using broad energy group cross sections without a loss of accuracy. To this end, the DANTSYS multigroup discrete ordinates neutral particle transport code was used to estimate the absorbed dose-rate distributions around an 125I-model 6702 seed in two-dimensional (2-D) cylindrical R-Z geometry for four different problems spanning the geometries found in clinical practice. First, simulations with a high resolution 210 energy groups library were used to analyze the photon flux spectral distribution throughout this set of problems. These distributions were used to design an energy group structure consisting of three broad groups along with suitable weighting functions from which the three-group cross sections were derived. The accuracy of 2-D DANTSYS dose-rate calculations was benchmarked against parallel Monte Carlo simulations. Ray effects were remedied by using the DANTSYS internal first collision source algorithm. It is demonstrated that the 125I primary photon spectrum leads to inappropriate weighting functions. An accuracy of +/-5% is achieved in the four problem geometries considered using geometry-independent three-group libraries derived from either material-specific weighting functions or a single material-independent weighting function. Agreement between Monte Carlo and the three-group DANTSYS calculations, within three standard Monte Carlo deviations, is observed everywhere except for a limited region along the Z axis of rotational symmetry, where ray effects are difficult to mitigate. The three-group DANTSYS calculations are 10-13 times faster than ones with a 210-group cross section library for 125I dosimetry problems. Compared to 2-D EGS4 Monte Carlo calculations, the 3-group DANTSYS simulations are a 100-fold more efficient. Provided that these efficiency gains can be sustained in three-dimensional geometries, the results suggest that discrete ordinates simulations may have the potential to serve as an efficient and accurate dose-calculation algorithm for low-energy brachytherapy treatment planning.

Leptin in the ovine fetus correlates with fetal and placental size.

OBJECTIVE: The purpose of this study was to detect the presence of leptin and its receptor in ovine fetal tissues and to examine the relationship between circulating leptin concentrations and fetal and placental weights on gestational day 138 (GD138) of ovine pregnancy (term, 145 days). STUDY DESIGN: Pregnant sheep (n = 18) were instrumented on GD 110 to facilitate measurement and chronic reduction of uterine blood flow and produce intrauterine growth restriction. Four animals that served as controls were euthanized on GD 138 to obtain fetal tissues to determine the presence of ovine leptin and its receptor by reverse transcriptase-polymerase chain reaction. Seven instrumented animals were randomized into the control group, and 7 instrumented animals were randomized into the uterine blood flow restricted group (reduction equaled approximately 50% on GD 138). Maternal and fetal blood samples were obtained on day 138 to measure plasma leptin concentrations, and animals were euthanized for the determination of fetal morphometrics and placental weight. RESULTS: Expression of RNA for ovine leptin and its receptor were observed in fetal liver, skeletal muscle, kidney, heart, and placenta. Fetal body weight, ponderal index, and placental weight were significantly decreased by approximately 40% in the blood flow restricted group as compared with controls. Fetal leptin concentrations were increased by 45% in the uteroplacental blood flow restricted group (P =.01). Maternal leptin concentrations were not significantly different between the 2 groups and did not correlate with fetal concentrations. Fetal leptin concentrations had an inverse relationship with uterine blood flow (r = -0.73; P =.004), fetal body weight (r = -0.78; P =.002), and placental weight (r = -0.68; P =.01). CONCLUSION: Ovine fetal tissues express RNA for leptin and its receptor. Circulating leptin concentrations in the ovine intrauterine growth restriction fetus were significantly elevated on gestational day 138 compared with controls. Fetal leptin concentrations were inversely related to uterine blood flow and fetal and placental weight. These findings suggest that fetal leptin may be involved in an adaptive response to intrauterine growth restriction.

Sensory impairments and subjective well-being among aged African American persons.

The limited number of studies concerning the prevalence of hearing loss and vision impairment and their causes, and the lack of strategies to prevent or treat the deleterious effects of hearing loss and vision impairment, point to a significant gap in the knowledge base concerning aged minority populations. This cross-sectional study evaluated the relationship between vision and hearing impairment and psychological well-being among a sample of 988 elderly African American persons. Fair or poor vision or hearing was reported for 36.5% and 26% of our sample, respectively. Reported prevalence rates for these impairments are considerably higher than rates previously documented in comparable studies of elderly people conducted in general (i.e., predominantly White) populations. Eighty-four percent of our study participants attempted to improve their vision through the use of eyeglasses. By contrast, only 4.3% of individuals in the study who described their hearing as poor reported using hearing aids. Using multivariate analysis and other related variables that have previously been identified as common predictors of psychological well-being, the findings of this study suggest that poor vision is independently associated with a lower level of psychological well-being among aged African Americans even after adjusting for sociodemographic characteristics, functional limitations, perceived health status, and cognition. Poor hearing was also found to be associated with a lower level of psychological well-being; however, this relationship was not independent but was mediated by the effect of hearing on functional status. These data indicate considerable potential for improved psychological well-being for African American elderly people through visual and audiological rehabilitation.

Hemodynamic response to tibolone in reproductive and nonreproductive tissues in the sheep.

OBJECTIVE: We sought to determine the hemodynamic effects of tibolone in reproductive and nonreproductive tissues in the nonpregnant ovariectomized sheep. STUDY DESIGN: Six ewes were chronically instrumented for measurement of mean arterial pressure, heart rate, cardiac output, and coronary and uterine blood flow. A dose response curve was generated for intravenous tibolone (1.25, 2.5, and 5 mg) and compared with intravenous 17beta-estradiol (1 microg/kg body weight). To determine whether tibolone-related cardiovascular responses were estrogen receptor mediated and produced by nitric oxide, animals were treated on separate days with either estrogen receptor antagonist ICI 182,780 or the nitric oxide synthase inhibitor, L -nitroarginine methyl ester. RESULTS: Tibolone significantly increased coronary blood flow in a dose-related fashion by 5% +/- 3%, 9% +/- 2%, and 11% +/- 2% for the 1.25, 2.5, and 5 mg doses, respectively. Uterine blood flow was also increased significantly in a dose-dependent manner by 98 +/- 15, 216 +/- 59, and 303 +/- 56 mL/min, for the 1.25, 2.5, and 5 mg doses, respectively. L -Nitroarginine methyl ester attenuated tibolone-induced increases in uterine blood flow by 84% +/- 4% and abolished the increase in coronary blood flow. ICI 182,780 inhibited all tibolone-induced cardiovascular responses. CONCLUSION: Tibolone significantly increases coronary and uterine blood flow in ovariectomized ewes. The coronary and uterine vascular responses are mediated via an estrogen receptor-dependent mechanism and are produced mainly by nitric oxide.

Dosimetric modeling of the microselectron high-dose rate 192Ir source by the multigroup discrete ordinates method.

The DANTSYS multigroup discrete ordinates computer code is applied to quantitatively estimate the absorbed dose rate distributions in the vicinity of a microSelectron 192Ir high-dose-rate (HDR) source in two-dimensional cylindrical R-Z geometry. The source is modeled in a cylindrical water phantom of diameter 20 cm and height 20 cm. The results are also used for evaluation of the Task Group 43 (TG-43) dosimetric quantities. The DANTSYS accuracy is estimated by direct comparisons with corresponding Monte Carlo results. Our 210-group photon cross section library developed previously, together with angular quadratures consisting of 36 (S16) to 210 (S40) directions and associated weights per octant, are used in the DANTSYS simulations. Strong ray effects are observed but are significantly mitigated through the use of DANTSYS's stochastic ray-tracing first collision source algorithm. The DANTSYS simulations closely approximate Monte Carlo estimates of both direct dose calculations and TG-43 dosimetric quantities. The discrepancies with S20 angular quadrature (55 directions and weights per octant) or higher are shown to be less than +/- 5% (about 2.5 standard deviations of Monte Carlo calculations) everywhere except for limited regions along the Z axis of rotational symmetry, where technical limitations in the DANTSYS first collision source implementation makes adequate suppression of ray effects difficult to achieve. The efficiency of DANTSYS simulations is compared with that of the EGS4 Monte Carlo code. It is demonstrated that even with the 210-group cross section library, DANTSYS achieves two-fold efficiency gains using the the S20 quadrature set. The potential of discrete ordinates method for further efficiency improvements is also discussed.

Premarin-induced increases in coronary and uterine blood flow in nonpregnant sheep.

OBJECTIVE: Menopause is associated with an increased incidence of cardiovascular disease among women, and estrogen replacement therapy is thought to reduce the risk of coronary artery disease. The mechanism by which this occurs is unclear, but coronary arterial endothelial and vascular smooth muscle cells have been shown to contain estrogen receptors, and their stimulation appears to increase nitric oxide synthesis. One conjugated estrogen preparation (Premarin) is widely used in postmenopausal hormone replacement therapy, but little is known about its effects on cardiovascular hemodynamics. STUDY DESIGN: This study was designed to determine whether Premarin, like 17beta-estradiol, has significant effects on cardiac output and coronary and uterine blood flows at doses used clinically (0.625, 1.25, and 2.5 mg). Nonpregnant oophorectomized sheep were implanted with instruments to measure cardiac output, left coronary (circumflex) artery blood flow, uterine blood flow, heart rate, and systemic arterial blood pressure. After recovery from surgery, the animals received intravenous bolus injections of either 17beta-estradiol (1.0 microg/kg), Premarin (0.625, 1.25, or 2. 5 mg), or vehicle on different days. RESULTS: The 1.0-microg/kg dose of 17beta-estradiol significantly increased coronary blood flow by 15% +/- 2% from baseline (mean +/- SEM). Premarin also increased coronary blood flow significantly at the 1.25- and 2.5-mg dose levels by 12% +/- 3% and 14% +/- 4%, respectively. As expected 17beta-estradiol increased uterine blood flow from a baseline of 15 +/- 3 mL/min to 169 +/- 19 mL/min. Premarin treatment was associated with a significant increase in uterine blood flow, which increased from an average baseline of 14 +/- 4 mL/min to 46 +/- 10 mL/min, 95 +/- 18 mL/min, and 135 +/- 20 mL/min at the three doses tested (0. 625, 1.25, and 2.5 mg, respectively). 17beta-Estradiol also increased cardiac output by 12% +/- 3%. Premarin increased cardiac output 2% +/- 3%, 9% +/- 4%, and 11% +/- 3%, with only the highest dose producing a significant change. 17beta-Estradiol also increased heart rate by 12% +/- 1%, whereas Premarin at doses of 0.625, 1.25, and 2.5 mg increased it by 4% +/- 3%, 7% +/- 4%, and 10% +/- 2%, respectively (increase significant only at the highest dose). Neither 17beta-estradiol nor Premarin altered either stroke volume or systemic arterial pressure. CONCLUSION: Premarin, like 17beta-estradiol, has significant systemic, coronary, and uterine vascular effects. These vascular effects may help to explain in part why these compounds are cardioprotective.

The role of nitric oxide in mediating adenosine-induced increases in uterine blood flow in the oophorectomized nonpregnant sheep.

OBJECTIVE: Adenosine administration to the uterine vasculature of the nonpregnant oophorectomized sheep results in dose-related increases in uterine blood flow. This study was designed to determine whether these adenosine-induced increases in uterine blood flow are mediated in part by nitric oxide release. STUDY DESIGN: Five nonpregnant oophorectomized ewes had catheters placed in the femoral artery and vein and in the lateral branches of the right and left main uterine arteries. Adenosine dissolved in isotonic sodium chloride solution was infused into the uterine artery at sequentially increasing doses (1, 3, 10, 30, 100, and 300 microg/min), and a dose-response curve was constructed. After determination of control responses to adenosine a 10-mg/kg dose of the nitric oxide synthase inhibitor N omega-nitro-L -arginine methyl ester was administered into the femoral vein; the dose-response curves to adenosine were then determined again. Responses after N omega-nitro-L -arginine methyl ester administration were compared with those obtained before nitric oxide blockade. RESULTS: Adenosine increased uterine blood flow in a dose-related fashion, from a baseline of 11 +/- 2 mL/min to 140 +/- 19 mL/min. No further increase was seen with adenosine doses >300 microg/min. There were no significant alterations in systemic arterial pressure or heart rate in response to uterine infusion of adenosine. N omega-nitro-L -arginine methyl ester administration increased baseline blood pressure 24% +/- 4% and decreased heart rate 13% +/- 4%. Responses to adenosine after N omega-nitro-L -arginine methyl ester administration were significantly reduced, from a maximum at the highest dose of 140 +/- 19 mL/min to 95 +/- 13 mL/min (P <.001). CONCLUSION: A significant portion of adenosine-induced vasodilation in the uterine vasculature appears to be mediated by the release of nitric oxide.

Effects of chronic reduction in uterine blood flow on fetal and placental growth in the sheep.

Pregnancy is associated with a significant increase in uteroplacental blood flow (UBF), which is responsible for delivering adequate nutrients and oxygen for fetal and placental growth. The present study was designed to determine the effects of vascular insufficiency on fetal and placental growth. Thirty-nine late-term pregnant ewes were instrumented to investigate the effects of chronic UBF reduction. Animals were split into three groups based on uterine blood flow, and all animals were killed on gestational day 138. UBF, which began at 851 +/- 74 ml/min (n = 39), increased in controls (C) to 1,409 +/- 98 ml/min (day 138 of gestation) and in the moderately restricted (R(M)) group to 986 +/- 69 ml/min. In the severely restricted (R(S)) group, UBF was only 779 +/- 79 ml/min on gestational day 138. This reduction in UBF significantly affected fetal body weight with R(M) fetuses weighing 3,685 +/- 178 g and R(S) fetuses weighing 2,920 +/- 164 g compared with C fetal weights of 4,318 +/- 208 g. Fetal brain weight was not affected, whereas ponderal index was significantly reduced in R(M) (2.94 +/- 0.09) and R(S) fetuses (2.49 +/- 0.08) compared with the value of the C fetuses (3.31 +/- 0.08). Placental weight was also significantly reduced in the R(M) group, being 302 +/- 24 g, whereas the R(S) group placenta weighed 274 +/- 61 g compared with the C values of 414 +/- 57 g. Fetal heart, liver, lung, and thymus were all significantly smaller in the R(S) group. Thus the present study shows a clear relationship between the level of UBF and both fetal and placental size. Furthermore, the observation that fetal brain weight was not affected, whereas fetal body weight was significantly reduced suggests that this experimental preparation may provide a useful model in which to study asymmetric fetal growth restriction.

Coronary and uterine vascular responses to raloxifene in the sheep.

OBJECTIVE: We sought to determine whether raloxifene increases coronary and uterine blood flow in ovariectomized ewes. STUDY DESIGN: Twelve ewes were chronically instrumented for measurement of mean arterial pressure, heart rate, cardiac output, coronary blood flow, and uterine blood flow. Sheep received 17beta-estradiol, Estrace, raloxifene, or KY Jelly vehicle on separate days. RESULTS: 17beta-Estradiol increased uterine blood flow from 21 +/- 3 to 254 +/- 36 mL/min and coronary blood flow by 21% +/- 2% within 2 hours. Estrace increased uterine blood flow from 30 +/- 7 to 260 +/- 62 mL/min and coronary blood flow by 8% +/- 4% within 3 hours. Raloxifene increased uterine blood flow from 20 +/- 3 mL/min to 220 +/- 53 mL/min by 6 hours and coronary blood flow by 22% +/- 5% within 24 hours. To determine whether hemodynamic responses were mediated by nitric oxide, L -nitroarginine methyl ester was administered and produced an approximate 50% decrease in uterine blood flow for all 3 compounds. L -Nitroarginine methyl ester attenuated increases in coronary blood flow induced by 17beta-estradiol, Estrace, and raloxifene. CONCLUSION: Raloxifene has significant coronary and uterine vascular effects in the ovariectomized ewe. The coronary and uterine responses are partially mediated by nitric oxide.

Focus groups: a qualitative method complementing quantitative research for studying culturally diverse groups.

CONTEXT: Focus groups are becoming an important method for conducting qualitative research in health care. This strategy enables information to be gathered on the perceptions, beliefs, and values of a group's participants and is particularly well suited to addressing cultural characteristics that impact on a population's health status. As nations become more culturally diverse, qualitative research will likely play a growing role in helping health professions educators develop appropriate educational programs and in helping researchers better understand the needs of minorities and other vulnerable populations who are experiencing disparities in health care. OBJECTIVES: The purposes of this paper are to introduce the usefulness of a qualitative research strategy as an adjunct to quantitative survey research, and to describe briefly how researchers and educators at the Charles R. Drew University of Medicine and Science (Drew) have utilized this strategy when conducting combined qualitative and quantitative research. DISCUSSION: Focus group research has been successfully used to develop culturally adapted surveys, to develop educational programs, and to conduct needs assessments at Drew, which serves a culturally diverse urban population.

Carcinoid metastasis to extraocular muscles: case reports and review of the literature.

Carcinoid tumors are slow growing, low-grade malignant neoplasms that are believed to originate from neuroendocrine cells, usually in the gastrointestinal mucosa. Metastasis of carcinoid tumor to the orbit is a rare occurrence. When metastasis does occur, the choroid is the most common ocular structure involved. We report two cases of unique involvement of extraocular muscles.

Optic nerve edema as a consequence of respiratory disease.

The authors describe a patient with bilateral papilledema, visual field abnormalities, poorly reactive pupils, meningeal enhancement on cranial MRI, and diffuse brain parenchymal hypervascularity. The opening pressure at the time of lumbar puncture was normal, and results of other CSF studies were normal. All abnormalities resolved with home oxygen therapy.

A population-based survey of hospitalized work-related ocular injury: diagnoses, cause of injury, resource utilization, and hospitalization outcome.

Occupational injury is a major source of ocular trauma and is often preventable. A statewide population-based survey of severe work-related ocular injury was generated by using the California Hospital discharge database to identify hospitalized ocular injury and workers compensation as principal payor to identify work-relatedness. Information concerning diagnoses, procedures, causes of injury, length of hospital stay, total hospital charges and disposition at hospital discharge were obtained for injuries occurring during the calendar year 1988. A total of 455 admissions for work-related ocular trauma were identified. The most common work-related ocular trauma diagnoses associated with hospitalizations were open globe injury (46%), adnexal wounds (20%), orbital fractures (11%), and traumatic hyphema (11%). The most common causes of work-related ocular trauma were foreign-body or projectile objects (19%), transport vehicles (18%), cutting or piercing objects (17%), and assaults (9%). Approximately 8% reported other than routine disposition at time of hospital discharge, including long-term nursing or rehabilitation services and death. Mean hospital stay when ocular trauma was the principal admitting diagnosis was 3.7 days. Results differed significantly for admissions reporting ocular trauma as the principal admitting diagnosis compared to admissions that did not. Hospitalized work-related ocular trauma is represented by a wide spectrum of injuries with substantial morbidity and economic costs. Projected to the United States population, these data indicate annual hospital charges excluding professional fees of $14.6 million when work-related ocular trauma is the principal admitting diagnosis and $40 million for admissions where ocular trauma is either a principal or secondary diagnosis.

Evaluation and classification of pediatric ocular trauma.

PURPOSE: To offer to the pediatric emergency physician consistent and unambiguous terms for the description of pediatric ocular trauma, based upon an adapted version of a standardized classification system. To show the potential effect of this reclassification system in a tertiary care emergency department. METHODS: The authors reviewed a new classification system of ocular trauma and adapted it for use by pediatric emergency physicians. In addition, a retrospective analysis of the records of pediatric patients presenting over a 2-year period to a tertiary emergency department with ocular complaints was performed. The diagnoses related to ocular trauma were reclassified according to the new classification system. RESULTS: Over a 2-year period, 117 pediatric patients were evaluated for ophthalmic complaints. Sixty-seven (57%) of these cases involved an ocular contusion or ruptured globe; however, six disparate diagnoses were given. The cases were reclassified into an adapted, unambiguous, classification system. In some cases, the reclassification altered the indication for immediate ophthalmologic referral. CONCLUSION: There is currently no standardized system of terminology to describe pediatric ocular trauma. This may lead to confusion in communication among the pediatric emergency physician, the pediatrician, and the ophthalmologist. Consistent, unambiguous, terminology will assist in this communication, facilitate the writing of peer-reviewed articles and case reports, and increase the level of accurate documentation in the medical record.

Eyelid kinematics following blepharoplasty.

PURPOSE: This study characterizes the effects of blepharoplasty on blink dynamics in subjects with dermatochalasis. The authors evaluate the hypothesis that orbicularis oculi removal and the consequent alterations in blink are potentially harmful consequences of blepharoplasty. METHODS: Sixteen patients were studied, before and after laser blepharoplasty, by a modified scleral search coil technique. Changes in lid position during blinks were recorded before surgery as well as 2 months, and 1 year postoperatively. Off-line analyses assessed blink down-phase amplitude, peak velocity, duration, and main sequence (peak velocity versus amplitude) relationships. RESULTS: Despite muscle resection, there was no significant compromise of mean blink down-phase amplitude, peak velocity, or main sequence following blepharoplasty. Mean blink duration was likewise unchanged at either follow-up session from the preoperative state. Our data show that upper lid blepharoplasty does not cause any lasting decrement in lid function in blinking. CONCLUSIONS: Blepharoplasty includes resection of a portion of the orbicularis oculi. It appears unlikely that the purposeful resection of preseptal portion of the orbicularis oculi that accompanies blepharoplasty is responsible for any functional complications such as dry eye.

Corneal topographic changes after extraocular muscle surgery.

PURPOSE: Changes in refractive error have been reported after strabismus surgery. The influence of extraocular muscle tension on corneal topography is thought to be an important mechanism contributing to this alteration. This study investigates topographic changes after strabismus surgery in human beings. METHODS: The corneal topography of 63 eyes of 43 patients who underwent either strabismus or optic nerve sheath fenestration (ONSF) surgery was measured before and after operation. The ONSF surgery involved removing and reattaching the medial rectus muscle, thus acting as a control for the strabismus procedures. Corneal power was measured centrally and at 1.5 and 3.0 mm in 8 meridians. Analysis of variance was performed to compare the difference in preoperative and post-operative corneal power for all procedures and comparing recessions, resections, combined recession and resection, and ONSF as grouped procedures. RESULTS: All groups showed a significant change in preoperative to postoperative corneal power (P< .01). A significant change was seen between all grouped procedures except when the resection was compared with ONSF and compared with recession. CONCLUSIONS: Change in the tension of 1 muscle does not produce a change in the adjacent quadrant as much as it produces a significant change in the entire corneal surface, which illustrates the interaction and interdependence all corneal positions have with respect to each other.

Orbital pachymengitis secondary to Pseudomonas aeruginosa.

Pachymengitis is a very rare disorder that can present with multiple cranial neuropathies. The etiology can be inflammatory, infective or a combination of both, resulting in a thickening of the cranial dura and an obliteration of the individual layers of the meninges. We present a rare case of Pseudomonas aeruginosa pachymeningitis in the orbit that resulted in severe and permanent visual loss, in a patient after extensive sinus surgery.

Ophthalmoplegic migraine with unusual features.

We report the details of a patient with an unusual form of ophthalmoplegic migraine resulting in permanent vertical misalignment of the affected eye. The presentation, history, and ophthalmologic examination are reported as well as disease course and follow-up complications. We review the literature on ophthalmoplegic migraine with discussion regarding typical presentation, methods of diagnosis, and other diseases which may cause diagnostic confusion. In light of current case reports on ophthalmoplegic migraine, this is the first documented example with a permanent deficit.