Laser in situ keratomileusis after automated lamellar keratoplasty and penetrating keratoplasty

We present three patients who had laser in situ keratomileusis (LASIK) after corneal surgery as follow: 15 months after automated lamellar keratoplasty (ALK) for hyperopia, 6 months after ALK for hyperopia, and 2 years after penetrating keratoplasty (PKP). Although the first case was uneventful, intraoperative complications arose in the second case because the connection of the ALK-related flap to its stromal bed was insufficient. In the third case, the refractive error caused by PKP was corrected as shown by corneal topography and visual acuity measurement. In conclusion, LASIK after PKP can be considered a precise and safe procedure if 2 to 3 years pass between the procedures. An interval of 6 months between ALK and LASIK was too short, whereas 15 months after ALK for hyperopia, LASIK was performed without problems and delivered a good result.     

Laser in situ keratomileusis for moderate and high myopia and myopic astigmatism

OBJECTIVE: This study evaluated the predictability, stability, and safety of laser in situ keratomileusis (LASIK) in myopia and myopic astigmatism. DESIGN: The study design was a prospective, unmasked, nonrandomized clinical trial. PARTICIPANTS: Participating were 25 patients with myopia (37 eyes) with astigmatism of less than 1.00 diopter (D), divided into 3 subgroups (-5.00 to -9.90 D, 8 eyes; -10.00 to -14.90 D, 10 eyes; -15.00 to -29.00 D, 19 eyes), and 37 patients with myopia (56 eyes) with corneal astigmatism of 1.00 to 4.50 D, divided into 3 subgroups (-5.00 to -9.90 D, 12 eyes; -10.00 to -14.90 D, 24 eyes; -15.00 to -29.00 D, 20 eyes). INTERVENTION: LASIK was performed using the Automatic Corneal Shaper and the Keracor 116 excimer laser. MAIN OUTCOME MEASURES: Visual acuity, manifest refraction, central corneal islands, ablation decentration, and patient satisfaction were measured. RESULTS: At 12 months, predictability, regression between 1 and 12 months, uncorrected visual acuity (UCVA), loss of two or more lines of corrected visual acuity, and patient satisfaction of the spherical (toric) groups are reported. Subgroups -5.00 to -9.90 D: 100% (75%) +1.00 D; regression less than or equal to 1.00 D in 100% (91.7%); UCVA greater than or equal to 20/40 in 87.5% (70%); none lost two or more lines; 100% (84%) highly satisfied. Subgroups -10.00 to -14.90 D: 60% (78.3%) +/-1.00 D; regression less than or equal to 1.00 D in 100% (87%); UCVA greater than or equal to 20/40 in 77.8% (86.4%); 10% (4.3%) lost two lines; 90% (91%) highly satisfied. Subgroups -15.00 to -29.00 D: 38.9% (21.4%) +/-1.00 D; regression less than or equal to 1.00 D in 72.2% (64.3%); UCVA greater than or equal to 20/40 in 33.3% (40%); 5.6% (7.1%) lost two lines; 78% (50%) highly satisfied. Differences of predictability and change of manifest refraction between subgroups of -5.00 to -9.90 D and -15.00 to -29.00 D were statistically significant. Central islands (decentrations) were observed in 17% (5.6%) of eyes of the spherical and in 16% (4.1%) of the toric group. Overall, the corneal interface was visible in 8.2%. CONCLUSIONS: The LASIK method used in this study showed stability of manifest refraction and adequate uncorrected central visual acuity in a large percentage of patients with myopia up to -15.00 D. Corneal stability was not as uniform. Central corneal islands were observed in a sizable minority of patients despite pretreatment. For myopia greater than 15.00 D, accuracy and patient satisfaction were sufficiently poor to advise against using the authors' treatment technique in these groups. Visually significant microkeratome and laser-related problems were noted in a smaller percentage of patients. Patients with astigmatism correction were less pleased with results than were patients who received spherical corrections.     

Picosecond laser in situ keratomileusis with a 1053-nm Nd:YLF laser

BACKGROUND: Excimer laser in situ keratomileusis requires a microkeratome to generate an anterior corneal flap, plus an excimer laser to ablate the underlying stromal tissue. In this paper we introduce the concepts of laser flap formation and in situ keratomileusis using a picosecond laser. METHODS: A neodymium-doped yttrium-lithium-fluoride (Nd:YLF) laser with a plano-plano quartz applanation lens was used to generate various patterns of intrastromal photodisruption in human donor eyes to fashion anterior corneal flaps and generate intrastromal lenticules. RESULTS: Smooth intrastromal dissections, 6 mm in diameter, were generated 160 microns below the corneal surface when the laser delivered pulses at 1 kHz with energies of either 40 microJ/pulse or 60 microJ/pulse, placed 20 microns apart in an expanding spiral. This enabled us to fashion anterior corneal flaps. The ease of the surgery and quality of the dissection corresponded well, and it was evident that both deteriorated noticeably when the laser pulses were separated by 25 microns or 30 microns, regardless of pulse energy. Using 40 microJ laser pulses placed 20 microns apart we also created a 5-mm diameter, 320 microns thick (130 microns-450 microns deep) stromal lenticule below a corneal flap that was easily extracted when the flap was raised. CONCLUSIONS: Anterior corneal flaps were easily fashioned using a Nd:YLF laser. Picosecond laser in situ keratomileusis with a Nd:YLF laser could offer a favorable alternative to combined microkeratome/excimer laser in situ keratomileusis.     

Voyeurism: a review of literature

The most striking thing about the literature on voyeurism is the relative lack of material in print. In the present work, the author was able to find only 15 articles and no books that deal specifically with voyeurism. Of the 57 references compiled for this review, not one involves an experimental manipulation of variables. An attempt is made to review as many aspects of voyeurism as possible, giving illustrative case material whenever available. The areas of troilism and coprophilia are covered in some detail to establish to what degree they belong to the deviation of voyeurism. Theory of perversion has centered around the psychoanalytic and behavioral schools because of the lack of material from other approaches. The voyeur is found to be a relatively young man of low socioeconomic status, who sociosexually is said to be "not retarded but a late bloomer." He is prone to minor crimes and not major offenses. It is suggested that moyeurism be considered a deviation from normal sexual behavior and that deviations are not in and of themselves criminal behavior. At present, punishment is genera-ly mild but highly variable and unpredictable. Treatment is usually analysis or group therapy, but other forms of therapy such as aversion and avoidance conditioning are being attempted with increasing success.     

Removal of flap striae following laser in situ keratomileusis

Androgenablation is the therapy of choice for the treatment of advanced and metastatic prostate cancer. However, in more than half of the patients the disease will ultimately progress within 2 years. Intermittent androgenablation through medical castration maintains the apoptotic potential. By periodically changing phases on and off treatment the quality of life of the patients is improved. Apart from reduced toxicity treatment costs are lowered and tumor progression is possibly delayed. In how far survival is influenced is presently not clear and remains to be evaluated in further clinical trials.     

Endotracheal suctioning: a literature review

Endotracheal suctioning (ETS) is a necessary practice carried out in intensive care units. In involves the removal of pulmonary secretions from a patient with an artificial airway in place. All intensive care nurses should be aware when performing this intervention of the potential hazards a patient is exposed to, and should endeavour to prevent or minimize these. This literature review explores the criteria available to indicate a need for ETS and discusses the potential adverse effects of ETS and how these can be avoided during the procedure. The question is raised as to the frequency with which the procedure should be performed. The current dilemma facing nurses is the overwhelming view that ETS should be performed only when indicated as necessary by assessment, to minimize the exposure of the patient to the hazards of ETS, but also recognition that ETS is a necessary procedure to maintain a patent airway and clear secretions. As nurses are accountable for all aspects of their practice, they need to be able to make an informed choice about the frequency with which ETS is performed. It is hoped that this review will increase nurses' awareness of the potential hazards surrounding ETS, and enable them to question their practices regarding their ability to assess individual patient needs and determine the frequency with which ETS should be performed.     

Case management: a literature review

There is considerable evidence that the hemostatic system is involved in the growth and spread of malignant disease. There is an increased incidence of thromboembolic disease in patients with cancers and hemostatic abnormalities are extremely common in such patients. Antihemostatic agents have been successfully used to treat a variety of experimental tumors, and several clinical trials in humans have been initiated. Although metastasis is undoubtedly multifactorial, intravascular coagulation activation and peritumor fibrin deposition seem to be important. The mechanisms by which hemostatic activation facilitates the malignant process remain to be completely elucidated. Of central importance may be the presence on malignant cells of tissue factor and urokinase receptor. Recent studies have suggested that these proteins, and others, may be involved at several stages of metastasis, including the key event of neovascularization. Tissue factor, the principal initiator of coagulation, may have additional roles, outside of fibrin formation, that are central to the biology of some solid tumors.     

Thermafil obturation: a literature review

A review of the literature pertaining to the use of Thermafil Endodontic Obturators is presented in this article. Addressed are such concerns as apical microleakage, biocompatibility, coronal leakage, post space considerations, retreatment issues, surgical factors, and clinical evaluations of Thermafil; included are the authors' conclusions concerning its clinical use.     

Swinging: a review of the literature

No review of the topic of swinging has been done in the last 20 years. This review is intended to update the literature. Studies estimating the incidence of swinging, the demographic and personality characteristics of swingers, along with how swingers are perceived by nonswingers are reviewed. Numerous theories explaining this behavior have been presented with a social psychological model being the primary focus here. Major reasons for getting involved in swinging, initiation into the lifestyle, effects on marriage, and dropping out of swinging are also covered. Finally, the literature dealing with some of the major problems with swinging, focusing on AIDS, are also discussed, along with the current state of swinging and suggestions for future research.     

Trends in dental education: a literature review

The dental literature for the past 30 years, with emphasis on recent publications, was reviewed for articles on trends in dental education. A keyword search of the MEDLINE database identified 6,055 papers, from which those most likely to predict future trends are considered in this article. Particular emphasis is placed on the Institute of Medicine of the National Academy of Sciences 1995 study, "Dental Education at the Crossroads: Challenges and Change." Reactions to this U.S.-based study are also detailed. Trends in curriculum analysis, curriculum change and reform, curriculum length, dental school financing, dental student costs, dental school and university relationships, dental school patient care, dental research, accreditation, oral health and trends from outside North America are documented. In addition, a series of predictions are made, and a brief bibliography of the 51 most relevant references is included.     

Central focal interface opacity after laser in situ keratomileusis

BACKGROUND: The acute onset of a focal central interface opacity with visual loss following LASIK has not been described in the peer reviewed literature. Non-peer reviewed reports of various inflammatory lesions have been recorded. METHODS: We describe three cases in which an acute focal stromal interface opacification was identified within 1 week of laser in situ keratomileusis (LASIK). Each case was performed by a different surgeon on a different day, but using the same method, materials, and the Summit Apex Plus excimer laser. Immediately after surgery, all eyes were normal with good unaided vision. The appearance of the central stromal opacity was associated with acute visual deterioration. Preoperative and postoperative cycloplegic refractions, videokeratography, and postoperative slit-lamp biomicroscopy were performed. Each case was treated with intensive topical corticosteroids. RESULTS: Each case demonstrated a central circular opacity in the interface between corneal flap and stromal bed, with associated variable stromal thinning. Resolution of the pathological process followed 2 to 4 weeks of treatment with topical corticosteroids and subsequent improvement in slit-lamp biomicroscopy, corneal topography, and vision. Etiology was uncertain. CONCLUSION: Central interface opacification is a rare but visually important inflammatory complication of LASIK.     

Adolescent childbearing in developing countries: a global review

A strong relationship between hypercholesterolemia and atherosclerosis has been established through epidemiological, experimental, and clinical trial data. Traditional theories on the pathophysiology of this relationship involve the deposition, modification, and cellular uptake of cholesterol, and the release of inflammatory and growth factors resulting in smooth muscle cell proliferation and collagen matrix production. The vasculature has recently been found to be an active and complex organ, with the endothelium playing a controlling role in vascular tone, lipid breakdown, thrombogenesis, inflammation, and vessel growth. In the presence of risk factors such as hypercholesterolemia, the endothelium promotes vasoconstriction, monocyte and platelet adhesion, thrombogenesis, and growth factor release. A high-fat diet also directly impairs endothelial function and increases coagulation factors. Endothelial dysfunction is associated with decreased availability of the predominant vasodilator nitric oxide, possibly by increased destruction by oxygen free radicals. This dysfunctional state appears before the earliest anatomic evidence of atherosclerosis and may represent an important initial step in its development. Several studies have shown improvements in endothelial function with cholesterol lowering in both normal individuals and those with coronary heart disease. Short-term improvements in endothelial-dependent vasodilation and adhesion molecule expression have also been reported with antioxidant therapy. These observations suggest that atherosclerosis is at least in part caused by endothelial dysfunction that favors cellular proliferation. This new understanding helps to explain the early and substantial reductions in major cardiovascular events associated with cholesterol lowering.     

Corneal wound healing after laser in situ keratomileusis in rabbits

BACKGROUND: The aim of this study was to characterize the cell biology of wound healing in rabbit corneas subjected to laser in situ keratomileusis (LASIK). METHODS: Rabbit corneas underwent LASIK with various multizone photoablations or only a lamellar keratotomy followed by repositioning of the flap. We looked for indications for an active wound healing process. Immunohistochemistry for the extradomain A cellular fibronectin (EDA-cFn) or tenascin (Tn) and routine histology were examined. RESULTS: Four days after LASIK or lamellar keratotomy followed by repositioning of the flap, epithelial plugs and prominent keratocytes as well as Tn and EDA-cFn immunoreactions-indicative of a wound-healing process-appeared in the wound margins. Epithelial plugs were less conspicous, and prominent, presumably activated, keratocytes were no longer identified at the wound margin at 2.5 and 5 months after wounding. However, EDA-cFn and Tn immunoreactivities could still be observed. Only the stromal cells located in the periphery of the flap and in relatively close contact with the epithelium were surrounded by scar tissue expressing immunoreactivity for EDA-cFn or Tn. The central corneal stroma was devoid of scar tissue. CONCLUSION: Results indicate that the wound healing reaction after LASIK takes place only at the periphery of the microkeratome wound, leaving the central optical zone clear.     

Care of skeletal pins: a literature review

Using the literature reviewed in this article, the author explores the issues surrounding wound care management in relation to care of skeletal pin sites. In this way, an evidence-based protocol for care is developed.     

Caries prediction: a review of the literature

Since Jenner and Pasteur, various vaccines have been developed and administered in immunization program conducted by WHO in order to diminish the circulation of pathogenic agents and eradicate some diseases. Risks associated with immunization are revealed by the collection and assessment of adverse events reported after the use of these drugs. They vary according to the type of vaccines. With high rates of immunization and a low incidence of infectious diseases, adverse events receive increasing attention. Frequent and mostly expected adverse events are reported in clinical trials. Unexpected rare adverse events are reported after marketing authorization by spontaneous reporting and post marketing surveillance studies. Post marketing surveillance should be adapted to vaccines (vaccino-vigilance) and should take into account the risk linked to the disease they may protect against. Adverse events are often temporally associated with vaccines, that does not mean they are causally related. Specific studies should be conducted to assess the causal relationship between vaccines and post immunization adverse events. In order to reduce the risk associated with immunization, a strict follow-up of recommendations, warnings and contraindications in addition to appropriate information being delivered to both vaccinees and physicians are required.