LASIK enhancements.

As the field of refractive surgery continues to evolve, an increasing number of surgical options are available for LASIK enhancements. Nonetheless, older methods such as AK continue to play an important role in enhancement procedures. Improvements in instruments and techniques allow for previously made LASIK flaps to be safely lifted for additional myopic or hyperopic ablations. Newer methods such as Intacs placement provide an effective option for patients who are not good candidates for further ablative procedures. These advancements allow refractive surgeons to treat a wider range of myopia, hyperopia, and astigmatism effectively in eyes with a history of LASIK surgery.

Intacs After Laser in situ Keratomileusis: A Preliminary Report.

PURPOSE: To assess the corneal topographic and refractive results and feasibility of placing Intacs in eyes with a history of previous laser in situ keratomileusis (LASIK) surgery. METHODS: This was a prospective study on 25 eyes with residual myopia between -0.75 and -3.00 D. Residual myopia in these patients was secondary to regression or planned undercorrection due to preoperative thin corneas. RESULTS: Main outcome measures included uncorrected visual acuity, preservation of best spectacle-corrected visual acuity, refractive predictability, corneal topographic changes, and evaluation of surgical complications. CONCLUSIONS: Initial Intacs procedures after previous LASIK were performed uneventfully. In addition to correcting residual myopia, these procedures may improve night vision symptoms in some patients. These cases may improve our understanding of the ideal corneal shape. [J Refract Surg 2000;1 6(suppl):S236-S238].

A high index of suspicion: the key to an early diagnosis of Wilson's disease in childhood.

BACKGROUND: To study the clinical features of Wilson's disease in childhood. METHODS: Retrospective review of the clinical, laboratory, and histologic features and prognosis of Wilson's disease in 26 Spanish children. RESULTS: The first medical visit, at age 9.8+/-3.4 years (range, 4-16 years), was prompted by liver dysfunction detected accidentally (61%), symptoms of liver disease (27%), family screening (8%), and extrapyramidal symptoms and personality changes (4%). There were laboratory data of hepatic failure in 27%. All copper metabolism test results (total serum copper, 24-hour urine excretion, serum ceruloplasmin) were abnormal in 62%, two in 27%, and one in 11%. All patients in whom extrahepatic involvement was found at diagnosis had severe liver disease. Histologic findings were portal fibrosis with steatosis (29%), cirrhosis (21%), portal fibrosis (17%), chronic active hepatitis (17%), and minimal changes or normality (17%). Penicillamine was administered to all but one patient. Four children underwent liver transplantation, three of them having received penicillamine for 12, 45, and 70 days. Three other patients recovered from liver failure after 1 year of treatment with penicillamine. After a follow-up of 4.5+/-3.3 years, all the children survived. Penicillamine caused severe toxicity in one patient. CONCLUSIONS: Wilson's disease in childhood is generally detected by maintaining a high suspicion of liver disease in patients who have no or nonspecific hepatic symptoms. Kayser-Fleischer ring is rare in childhood. Drug therapy is effective and well tolerated, even in some cases of hepatic insufficiency.

[Lhermitte-Duclos disease in a ten-year-old child: clinical follow-up and neuroimaging data from birth]. / Enfermedad de Lhermitte-Duclos en un niño de 10 años: evolución clínica y de la neuroimagen desde el período neonatal.

INTRODUCTION: Lhermitte-Duclos disease is a rare lesion characterized by enlarged cerebellar folia containing abnormal ganglion cells. It typically affects young adults, and reports in the pediatric age are exceptional. CLINICAL CASE: This case report describes a child with slowly progressive macrocephaly, which was already present at birth, delayed motor development, and clumsiness. At 7 years of age a mild ataxia appeared, which remained stationary until 10 years of age when he developed signs of intracranial pressure (headache and papilloedema). A CT scan at 2 years of age showed an enlarged posterior fossa with asymmetrical cerebellum; another study at 7 years of age disclosed mild ventricular dilatation. IRM at 10 years of age showed aqueductal obliteration by an enlarged cerebellum. The cerebellar lesion consisted of abnormally thickened folia with abnormal hyperintensity of the central cerebellum on the T2-weighted images. The lesion did not enhance with gadolinium. The histological findings were typical of Lhermitte-Duclos disease. CONCLUSIONS: In our patient the lesion behaved like a slowly growing mass, but both neuroimaging and pathological studies were suggestive of a hamartomatous rather than a true neoplastic disorder. Furthermore, there was clinical evidence that the disorder was already present at birth. All the evidences in our case support the concept that this growing lesion represents a congenital abnormality.

[Fairy tale drama--an inpatient group psychotherapeutic method for patients with ego disorders]. / Märchendrama--eine psychotherapeutische Stationsgruppenmethode für Ich-gestörte Patienten.

Patients with "early disturbances" partly display considerable resistance to treatment methods that promote regression or aim at uncovering inhibitions, since they themselves lack emotional differentiation. In an inpatient setting such patients are able to transfer their non-experienced share of feelings and references to the treating personnel. If these transferred feelings are not properly processed and managed, therapy blockades and communication blockades arise, resulting in considerable frustrations of all concerned within the therapeutic community. Against the background of these experiences we developed a ward group method inviting both patients and staff to join hands in creative playing (e.g. by acting a fairy tale on the stage); within this framework it is possible to shape latent group, ward and team conflicts on a metaphorical level. As a result we achieve a reduction of the emotional tension level within the ward, a reduction of team conflicts, and hence an improved therapeutical climate and better possibilities to translate into reality appropriate strategies for a fair solution of problems. The overall framework, the therapeutic concept, as well as the individual stages of work-in-progress in the realisation of the fairy-tale drama are described in detail (e.g. phase of birth of the fairy tale, phase of fairy-tale recital, phase of casting, actual performance phase and subsequent discussion phase). These steps are described both as regards their form and their contents; they are compared with other group techniques of a similar nature.