Oral imipramine and acute angle closure glaucoma.

OBJECTIVE: To document acute angle closure glaucoma temporally related to ingestion of oral imipramine hydrochloride. PATIENTS: Four patients with narrow angles received routinely prescribed doses of imipramine that triggered acute angle closure glaucoma. OUTCOME: Laser iridotomy was successful in all patients. CONCLUSIONS: Psychoactive drugs should be prescribed cautiously in patients with known narrow angles and should be monitored by an ophthalmologist.

[Studies on wedged hepatic venous pressure, hemodynamics and pulmonary function in patients with chronic liver disease, with reference to the differences between liver cirrhosis with chronic hepatitis].

In 17 compensated liver cirrhosis and 8 chronic hepatitis cases (no histories of cardiac or pulmonary disease), wedged hepatic venous pressure (WHVP), hemodynamics, and pulmonary function were measured and their clinical significance and interrelations evaluated. Both diseases were comparatively analyzed. WHVP was determined by wedging a catheter from the right femoral vein into the right hepatic vein. Hemodynamics was measured with a Swan-Ganz catheter. Spirography, flow-volume curve, closing-volume curve and pulmonary diffusion capacity were measured and aortic blood gas analyzed to assess pulmonary function. Esophageal endoscopy was used to diagnose the presence or absence of esophageal varices. The results showed that the group of liver cirrhosis patients featured elevated WHVP and a hyperhemodynamic pattern and a positive correlation between WHVP on the one hand and cardiac index and right left ventricle stroke work indexes on the other; there was a negative correlation between WHVP and the systemic vascular resistance and pulmonary vascular resistance indexes. The results showed an increase in oxygen consumption in the group of patients with esophageal varices. In all chronic hepatitis cases, findings were normal. Pulmonary function was characterized by abnormal %VC, PaO2, and pulmonary diffusion capacity in both groups along with abnormal PaCO2 in the liver cirrhosis group; no significant differences were noted between the two groups. These results indicate that liver cirrhosis elevates intarahepatic pressure, affecting systemic hemodynamics and resulting in a circulatory distribution disorder, leading to right and left ventricle overload and a decline in potential cardiac function. The results also indicated that mild pulmonary function disorder can occur as early in a state of chronic hepatitis.

Ocular lubricants and corneal injury during anesthesia.

Seventy-six patients undergoing general endotracheal anesthesia were studied prospectively to determine whether simply taping the eyelids closed during the surgical procedure as opposed to taping the lids after instilling a bland lubricating ointment had any different effect on corneal or conjunctival epithelium. No significant difference was found.

Argon laser trabeculoplasty in black and white patients with primary open-angle glaucoma.

The effect of argon laser trabeculoplasty (ALT) on lowering intraocular pressure (IOP) was studied retrospectively in 68 black patients and 42 white patients with uncontrolled primary open-angle glaucoma on maximally tolerated medical therapy. Patients with the diagnosis of pigmentary or pseudoexfoliation glaucoma and those having previous intraocular or laser surgery were excluded. While the mean age of the black patients (66.9 years) was lower than the white patients (72.2 years), the prelaser IOP was similar between the two groups: 26.2 mmHg for the black patients and 25.5 mmHg for the white patients. The mean IOP one year (18.4 mmHg for black patients and 18.4 mmHg for white patients) and two years (19.5 mmHg and 20.3 mmHg, respectively) after ALT was the same between the two groups of patients. A similar percentage of black (85%) and white (83%) patients showed more than a 15% decrease in IOP from their prelaser values one year after treatment. The IOP lowering effect of ALT decreased during the second post-operative year; but the diminished response was identical in patients of both races, with 71% of patients of both groups still showing greater than 15% reduction from their pre-laser IOP. We conclude that ALT is equally effective in lowering IOP for black and white patients with medically uncontrolled primary open-angle glaucoma.

Reopening filtration fistulas with transconjunctival argon laser photocoagulation.

Three patients (a 15-year-old girl, a 45-year-old woman, and a 61-year-old woman) with previously successful full-thickness filtering procedures developed pigmented tissue in the fistula sites and uncontrolled intraocular pressures despite maximum tolerable medical therapy. The filtering procedures in the first and second patients spontaneously failed two and four years after surgery. The filtration bleb of the third patient, after successfully controlling intraocular pressure for six years, failed two months after cataract extraction. Argon laser therapy was applied through the conjunctiva to treat visible subconjunctival pigmented tissue within the sites of the previous surgical filtration blebs. In all three cases, there was an immediate and significant decrease in intraocular pressure associated with reestablishment of the filtration bleb (from 44 to 16 mm Hg in Case 1, from 40 to 15 mm Hg in Case 2, and from 25 to 12 mm Hg in Case 3). Long-term follow-up showed well controlled intraocular pressures without glaucoma medications (Case 1, 5 mm Hg after 18 months; Case 2, 17 mm Hg after one year; and Case 3, 9 mm Hg after five months).

Inexpensive device to reduce surgical light exposure.

An inexpensive device that reduces light exposure to the retina during intraocular surgery is described. This disposable cap, which shields out 75% of the light, is cut from brown, rubber, surgical gloves by a 9.0 mm corneal trephine. The rubber cap is readily available, easy to use, and an inexpensive solution for surgeons concerned about possible retinal phototoxicity from the operating microscope.

Hana kai ii: a 17-day dry saturation dive at 18.6 ATA. III. Body fluid balance.

Comprehensive studies on body fluid balance on 5 divers were conducted during the Hana Kai II dive (17 days at 18.6 ATA and 7 days of decompression). Daily urine flow increased from about 2000 ml at 1 ATA to 2600 ml at 18.6 ATA, at 31 degrees C. This diuresis was accompanied by a reduction in urine osmolality (from 650 to 500 mOsm) and a slight increase in osmolal clearance. Endogenous creatinine clearance remained at about 173 ml/min throughout the dive. Despite such a sustained diuresis, neither daily water intake nor total body water volume changed significantly. The plasma renin activity changed little, while both plasma aldosterone concentration and urinary aldosterone excretion increased significantly during the first week at 18.6 ATA. The plasma prolactin concentration showed a significant decrease during the first 3 days at 18.6 ATA. The daily excretion of antidiuretic hormone (ADH) decreased significantly (by 40%) 4 days after compression and remained low throughout the rest of the dive. Insensible waterloss at 18.6 ATA was 35% lower than that at 1 ATA. It is suggested that the observed hyperbaric diuresis is due primarily to suppression of ADH as a result of suppression of insensible water loss.

Hana Kai II: a 17-day dry saturation dive at 18.6 ATA. VII: Auditory, visual, and gustatory sensations.

Five divers were tested for alterations in auditory, visual, and gustatory functioning during a 17-day saturation exposure to He-O2 at 18.6 ATA. No evidence of permanent hearing loss was disclosed. Critical flicker fusion was not affected, but peripheral visual thresholds were significantly increased during the first two weeks at 18.6 ATA; this was interpreted to be evidence of severe psychological and physiological stress. Foveal vision was unaffected across testings. Magnitude estimation techniques disclosed changes in taste sensitivity, with sweet sensitivity increasing over time and sour sensitivity declining over the course of the dive. Subjects were more sensitive to bitter stimuli at maximum pressure than at sea level, and less sensitive to salt at maximum pressure. The results indicate that appreciable alterations in sensory functioning can occur during saturation exposures, although the sense modalities were differentially affected by such environmental stressors as pressure, psycho-social stress, fatigue, and perceptual deprivation.

Diffusion of water vapor in binary and ternary gas mixtures at increased pressures.

Diffusion of water vapor was measured at 25 degrees C in the binary systems water vapor-He and water vapor-N2 at approximately 1, 4 10, 20 and 50 atm. Diffusion was also measured in the ternary system water vapor-He-O2 in both 2%O2-98%He, and at 1 and 20 atm. At 1 atm, comparison of binary diffusion coefficients (delta) shows that water vapor diffuses 3.3 times more readily in He than in N2. Values of delta at elevated pressures were reduced in proportion to 1/p, the absolute pressure, in qualitative agreement with Chapman-Enskog theory. However, the reduction in Delta was less than predicted at pressure above 4 atm in water vapor-N2 and above 20 atm in water vapor-He. The deviations from theory are more pronounced in N2 than in He, and become larger at higher pressures. When 26% O2 is present in the ternary system water vapor-He-O2, diffusion of water vapor is reduced to about 60% of its rate in pure He. In contrast, 2% O2 in He has little effect on diffusion of water vapor.