ABSTRACT
BACKGROUND: Repetitive self-injurious behavior (SIB) is a dangerous and often treatment-refractory syndrome encountered frequently in clinical practice. The authors sought to determine if oral naltrexone could decrease SIB in a sample of adult psychiatric patients. METHOD: Seven female patients with SIB accompanied by analgesia and dysphoria reduction were administered oral naltrexone (50 mg/day) in an open-label trial. All patients demonstrated persistent and clinically significant SIB prior to receiving the drug. Mean follow-up period was 10.7 weeks. RESULTS: SIB in six of seven patients ceased entirely during naltrexone treatment. Two patients who discontinued naltrexone briefly experienced the rapid resumption of SIB, which again ceased after resumption of naltrexone therapy. One patient exhibited superficial cutting on two occasions while receiving naltrexone, a rate that reflected a significant reduction of SIB. CONCLUSION: These preliminary observations are consistent with the hypothesis that the endogenous opioid system is involved in cases of SIB that are accompanied by analgesia and dysphoria reduction. Additional placebo-controlled studies that explore the effectiveness of naltrexone in treating patients with this syndrome are warranted.
Subject(s)
Mental Disorders/drug therapy , Naltrexone/therapeutic use , Narcotic Antagonists/therapeutic use , Self-Injurious Behavior/prevention & control , Adolescent , Adult , Borderline Personality Disorder/drug therapy , Borderline Personality Disorder/psychology , Dose-Response Relationship, Drug , Emotions/drug effects , Female , Follow-Up Studies , Humans , Mental Disorders/psychology , Middle Aged , Naltrexone/administration & dosage , Naltrexone/pharmacology , Narcotic Antagonists/administration & dosage , Narcotic Antagonists/pharmacology , Pain Measurement/drug effects , Recurrence , Self-Injurious Behavior/drug therapy , Treatment OutcomeABSTRACT
Various risk factors contributing to contact lens related infectious corneal ulcers were tested. These factors included the presence of infectious organisms, loss of corneal surface integrity, and corneal hypoxia. High concentrations of Pseudomonas bacteria were applied to rabbit corneas under the following conditions: normal, intact corneal surface; "mild" corneal hypoxia with extended-wear soft contact lens and eyes closed; "moderate" corneal hypoxia with daily wear soft contact lens and eyes closed; "severe" corneal hypoxia with daily wear aphakic soft contact lens and eyes closed; corneal abrasion and eyes open; corneal abrasion and eyes closed; corneal abrasion with soft contact lens and closed eyes. No infectious ulcers occurred in normal intact corneas. The frequency of infectious ulcers increased with increasing degrees of corneal swelling. No ulcers were found in corneas with a mean swelling of 10%, whereas a mean swelling of 20% resulted in ulcers in half the group, and a mean swelling of 43% resulted in ulcers in all eyes. The three groups of abraded corneas resulted in infectious ulcers at a 20 to 30% frequency. The presence of infectious organisms alone does not lead to infectious corneal ulcers in rabbits. Corneal abrasions are a risk factor for infectious ulcers, but moderate and severe degrees of hypoxia are more significant.
Subject(s)
Contact Lenses, Extended-Wear/adverse effects , Contact Lenses, Hydrophilic/adverse effects , Corneal Ulcer/microbiology , Eye Infections, Bacterial/etiology , Pseudomonas Infections/etiology , Animals , Cornea/microbiology , Corneal Injuries , Corneal Ulcer/physiopathology , Disease Models, Animal , Hypoxia/complications , Rabbits , Risk FactorsABSTRACT
Recent reports documenting central keratometric changes after removal of failed epikeratoplasty lenticules, compared to preoperative keratometry measurements, suggest that the annular corneal wound alters corneal curvature. Central corneal steepening has also been reported following circular and hexagonal keratotomy. We performed standard epikeratoplasty trephination with a Hessburg-Barron suction trephine followed by a peripheral lamellar spreading keratotomy on seven human eye bank eyes to determine the effect of these incisions on corneal topography. In seven human eye bank eyes, the mean acute central keratometric flattening from the shallow trephine incision was 2.81 D (SD 2.28, P = .017), with no significant change in keratometry due to peripheral lamellar spreading (P = .916). Computerized numeric and three-dimensional graphic analysis of the keratographs demonstrated this central topographic flattening. Further studies are needed to investigate the reversibility of host corneal changes induced by epikeratoplasty procedures.
Subject(s)
Cornea/surgery , Cornea/anatomy & histology , Eye Banks , Humans , Image Processing, Computer-Assisted , In Vitro TechniquesABSTRACT
A 34-year-old woman developed a crystalline retinopathy after 2 years of inhalational abuse of methoxyflurane. After the woman developed renal failure, a renal biopsy showed multiple birefringent crystals in the renal tubular lumens, epithelial cells, and interstitium compatible with calcium oxalate. Multiple bright yellow-white crystals were deposited throughout the retina and at the level of the retinal pigment epithelium with a retinal arterial and periarterial predilection. This is the first reported case of methoxyflurane abuse with secondary hyperoxaluria in which there was a widespread retinal distribution of crystalline deposits, especially along the retinal arteries and arterioles.
