Partial lacrimal carunculectomy: a simple procedure for epiphora.

OBJECTIVE: To evaluate the effect of partial surgical excision of enlarged lacrimal caruncles, termed megalocaruncles, in patients with epiphora from functional lacrimal drainage obstruction. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: From May 1995 through December 1999, 88 patients (46 women and 42 men; mean age, 68 years) with epiphora, patent lacrimal drainage system on irrigation, and a megalocaruncle underwent a partial lacrimal carunculectomy procedure. In 26 patients, a bilateral partial lacrimal carunculectomy was performed. INTERVENTION: Lacrimal caruncular tissue, with its overlying mucosa, was partially excised, and the wound was closed with interrupted sutures. MAIN OUTCOME MEASURES: Symptomatology and patient satisfaction. RESULTS: After a partial lacrimal carunculectomy procedure, epiphora was subjectively improved in 77% of the patients, ranging from complete relief in 33% to significant improvement in 44% of the patients. Twenty-three percent of the patients had no change in symptoms. The mean follow-up was 12.7 months. CONCLUSIONS: Megalocaruncles can be the cause of epiphora in patients with functional lacrimal drainage obstruction, for whom a partial lacrimal carunculectomy is an effective surgical procedure in 77% of the cases.

A modified Jones tube.

A modified Jones tube was designed and this new model was implanted in 33 cases with severe canalicular or common canalicular obstruction. The tube, with a length of 24 mm, has a 130 degree angulation in the middle. The insertion of this Jones tube can be performed with or without dacryocystorhinostomy. Despite some problems in the beginning, the results seem to be very promising, with a 80% success rate.

Silastic intubation for Canaliculus communis stenosis.

Silastic intubation was performed for Canaliculus communis obstruction in 32 cases. Two eyes showed additional impatent nasolacrimal duct and were not treated. The silastic intubation was performed by aid of a long, hollow blunt injection needle which allows us to check the patency of the lacrimal system once the stenosis of common canaliculus is perforated. The success rate for isolated silastic intubation was 70%, which is similar to the results of other often more invasive surgical techniques for Canaliculus communis stenosis.

Surgical treatment of eyelid retraction by cautery.

Recession of levator aponeurosis and Muller muscle by hot cautery is a simple and reliable method in case of thyroid disease. The operation is performed under local infiltration anesthesia. The advantage is less bleeding and immediate control of the height of the eyelid.

Dacryocystorhinostomy: indications, operations, results and some variants.

The efficacy of the dacryocystorhinostomy (DRC) procedures, as performed at the University Hospital of Louvain, has been evaluated by means of a retrospective study on 165 consecutive patients. The overall success rate was 94%.

Silicone intubation for congenital obstruction of nasolacrimal ducts.

In children aged 3 months or older lacrimal probing was performed to cure nasolacrimal duct obstructions. In 56 cases where this procedure failed a silicone tube was inserted. The results were favourable in 47 cases. Children with facial malformations and those with a narrow nasolacrimal duct however proved to be poor candidates for silicone tube insertion.

[Computer analysis of the vectorcardiogram]. / L'analisi automatica del vettocardiogramma.

A computer method analysing Frank VCG recorded on rest and on exertion, is presented. Electrical noises due to exercise are eliminated by averaging 8 complexes. The pattern-recognition of every wave is carried out by analysing a particular function obtained by translating the X, Y, Z leads on the line joining the T-P, P-Q, ST and subsequent T-P segment. The following parameters are evaluated: maximal and mean vector, linear, areolar and tangential (our original method) spatial velocity, half-area vector, area described by the spatial vector and oriented according to X, Y, Z polarity.

[The atrial vectorcardiogram at rest and during exercise. Comparison, by computerized analysis, of normal subjects and patients with mitral stenosis]. / Vettorcardioramma atriale a riposo e durante esercizio. Confronto, mediante analisi computerizzata, fra soggetti normali e pazienti con stenosi mitralica.

This study on rest and exercise atrial vectorcardiogram (Frank method) was carried out on a group of 27 healthy volunteers (Group A) and on a group of 24 patients with mitral stenosis (Group B). All 51 subjects were women. Our original program was performed using a Hewlett Packard 2100 computer. The pattern recognition of every wave was carried out by analysing a particular function obtained by translating the X, Y, Z leads on the line joining the T-P, P-Q, ST segments. In the group B on rest a significant correlation between atrial vectorcardiogram parameters and pulmonary capillary wedge pressure was not present. Between both group A and B the vectorcardiographic data were greatly superposables. It is difficult, because of the great interindividual variability of results obtained, to have very discriminant vectorcardiographic parameters between group A and group B on rest and during exercise, performed in the supine position with a bicycle ergometer. In the both groups A and B the exercise induces a significant increase of spatial magnitude of maximal P xyz vector (max P xyz) and maximal P amplitude on frontal and sagittal planes, with P loop shifting towards a vertical position. The following significant results were observed only in group B of mitral patients: 1) an increase of P wave duration; 2) an increase of the interval between the two peaks of P wave (measurable only in group B); 3) an increase in the amplitude and backward rotation of max P xyz azimuth and of the maximal vector backward directed on horizontal (H) plane; 4) an increase of P loop linear, tangential and areolar velocities. The P loop anterior and posterior area on H plane and of the spatial P xyz vectors changes during exercise were directionally similar in the normal group and in the patients with mitral stenosis. These results suggest a little diagnostic power of the P wave area changes during exercise. In both groups maximal atrial T vector increases with exertion, but only in group B migrates backward on H plane, suggesting an atrial gradient directed towards the left atrium.

Cardiovascular effects induced by the injection of a new nonionic contrast medium (Iopamidol): experimental study in dogs.

The hemodynamic effects induced by the injection in the pulmonary artery of the new nonionic water soluble contrast medium Iopamidol were compared with those obtained by the injection of two other currently used contrast media (meglumine diatrizoate and sodium iothalamate). The experiments were carried out in nine mongrel dogs. Hemodynamic variables were continuously measured prior to, during, and for 8 minutes after injection of the contrast media. Injections of iopamidol produced significantly smaller decreases in aortic pressure (p less than 0.01), contractile indices (p less than 0.01), and peripheral resistances (p less than 0.01), and changes in heart rate and in cardiac output were less pronounced. At 3-4 minutes after injection, an increase in Vmaxd was observed with all three contrast media, but it was significantly lower after injecting Iopamidol. The role of hyperosmolality in causing cardiovascular changes is discussed. The less significant changes induced by Iopamidol appear to be the result of its lower osmolality, which is about a third that of meglumine diatrizoate or sodium iothalamate.

Simultaneous radioimmunoassay of serum testosterone and 5 alpha-dihydrotestosterone without chromatography.

When characterization of the specificity of an antiserum for radioimmunoassay (RIA) is performed by the conventional method, the conditions under which interference occurs are not respected because of the lack of specific antigen. We have studied the behavior of antisera reproducing the real environment existing in unknown samples, in which antigen, interferent and tracer complete simultaneously. A testosterone (T) antiserum and a 5 alpha-dihydrotestosterone (D) anti serum were characterized by setting up two distinct hapten recovery tests in the presence of both the hapten and the crossreactant added to steroid-free serum in various concentrations in order to reproduce multiple concentration ratios. These samples, together with the standard curves samples (prepared by 'spiking' steroid-free serum with known concentrations of T or D) were extracted and subjected to T-RIA and D-RIA without purification. The results have shown that the interferent-induced incremental ratio is a linear function of the ratio of the levels of cross-reactant and hapten via a proportionality factor inversely correlated to the antiserum specificity. By means of this function, the overestimated T and D levels found in samples after 'extraction only' have been corrected and the resulting values have shown acceptable correlation with the corresponding levels determined after column chromatography.

[On-line analysis of the exercise electrocardiogram]. / Analisi on-line dell'elettrocardiogramma da sforzo

A programme of on-line automated analysis of ECG exercise graphs relative to the CB5 derivation is described. The various operations may be subdivided into the following phases: 1) performance; 2) mean complex; 3) identification; 4) calculation and print-out of parameters; 5) filing. Automatic analysis of exercise ECG's eliminating artifacts present in graphs and obtaining parameters that are not respectively assessable, facilitates the development of rigorously objective diagnostic guidelines. The filing of indices on magnetic tape opens the way to subsequent statistical analysis of extreme usefulness in testing extensive populations.