Unrecordable pulsatile ocular blood flow may signify severe stenosis of the ipsilateral internal carotid artery.

AIM: To examine the relation between stenosis of the internal carotid artery (ICA) and pulsatile ocular blood flow (POBF). METHODS: In 57 eyes of 30 patients who were referred for Doppler ultrasound examination of the ICA we measured POBF and analysed the correlation with degree of ipsilateral ICA stenosis. RESULTS: There was a significant negative correlation between POBF and ipsilateral ICA stenosis (Pearson correlation coefficient, r=-0.516, p<0.0001). In 14 eyes POBF could not be measured by the OBF tonometer, and in 11 of these cases (79%) severe stenosis (>75%) of the ipsilateral ICA was present. When these eyes were excluded from analysis, there was no correlation between POBF and ICA stenosis (r=-0.02, p=0.91). Among these 43 eyes in which POBF could be measured it ranged 667-2095 microl/min with a mean of 970.72 microl/min. CONCLUSION: Low or unrecordable POBF may signify severe stenosis of the internal carotid artery. POBF is not a direct reflection of ipsilateral ICA blood flow.

Granulomatous kerato-conjunctivitis as a manifestation of Hodgkin lymphoma.

PURPOSE: To report atypical kerato-conjunctivitis as a manifestation of Hodgkin disease. METHODS: Case report. RESULTS: A 19-year old woman presented with conjunctival nodules and corneal infiltrates. Diffuse lymph node enlargement occurred, but not in the preauricular or submandibular areas. Extensive microbiologic examination was negative. Conjunctival biopsy showed noncaseating granulomas. Inguinal lymph node biopsy showed Hodgkin lymphoma, and chemotherapy was instituted. Ocular signs resolved after 6 weeks, but a corneal scar remained. CONCLUSIONS: The appearance of conjunctival granulomas and corneal infiltrates may represent a clinical manifestation of Hodgkin lymphoma.

Laser eye injuries.

Laser instruments are used in many spheres of human activity, including medicine, industry, laboratory research, entertainment, and, notably, the military. This widespread use of lasers has resulted in many accidental injuries. Injuries are almost always retinal, because of the concentration of visible and near-infrared radiation on the retina. The retina is therefore the body tissue most vulnerable to laser radiation. The nature and severity of this type of retinal injury is determined by multiple laser-related and eye-related factors, the most important being the duration and amount of energy delivered and the retinal location of the lesion. The clinical course of significant retinal laser injuries is characterized by sudden loss of vision, often followed by marked improvement over a few weeks, and occasionally severe late complications. Medical and surgical treatment is limited. Laser devices hazardous to the human eye are currently in widespread use by armed forces. Furthermore, lasers may be employed specifically for visual incapacitation on future battlefields. Adherence to safety practices effectively prevents accidental laser-induced ocular injuries. However, there is no practical way to prevent injuries that are maliciously inflicted, as expected from laser weapons.

Prehospital stabilization of the cervical spine for penetrating injuries of the neck - is it necessary?

The purpose of this study was to assess the specific indications, benefits and risks associated with cervical spine stabilization during pre-hospital care of penetrating neck injuries. We retrospectively reviewed hospital charts and autopsy reports of 44 military casualties in Israel with a penetrating neck injury during a period of 4.5 years. A review of the literature was also carried out. In eight of 36 hospitalized casualties (22%) a life-threatening sign was diagnosed in the exposed neck - large or expanding haematoma, or subcutaneous emphysema. Surgical stabilization of the cervical spine was not performed for any of the casualties. It was concluded that life threatening complications due to penetrating neck injury are common and may be overlooked if the neck is covered by a stabilization device. It is extremely rare for a penetrating injury to result in an unstable cervical spine. New management guidelines concerning pre-hospital stabilization are suggested.

Prehospital blood transfusion in prolonged evacuation.

BACKGROUND: Prehospital blood transfusion for hemorrhaging trauma patients has been used infrequently and is controversial. Currently, there is no satisfactory nonsanguineous fluid therapy for use during prolonged transport, such as in military or rural trauma. METHODS: We retrospectively reviewed prehospital data and hospital charts of all trauma patients in Israel who had received prehospital blood transfusion during a period of 30 months. RESULTS: Forty patients received 60 U of Rh-positive type O packed red blood cells. Mean time from injury to hospital admission was 120 minutes. Twenty-one of 31 patients admitted to the hospital alive (68%) received additional blood transfusions during the initial resuscitation phase, justifying the prehospital transfusion. Of nine documented admissions with hemoglobin of less than 7 g/dL, one patient died of exsanguination. There was one case of a minor adverse reaction that could be attributed to prehospital transfusion. CONCLUSION: Prehospital blood transfusion is justified in certain trauma patients, especially when long prehospital transport is required. Blood may be safely maintained and used by physicians with little experience in care of major trauma.