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Medical Diary Official Publication for the Federation of Medical Societies of Hong Kong
VOL.12 NO.9 SEPTEMBER 2007 ॷġ෫ġᚂġଉ THE HONG KONG MEDICAL DIARY OFFICIAL PUBLICATION FOR THE FEDERATION OF MEDICAL SOCIETIES OF HONG KONG www.fmshk.org Editorial Editorial Dr. Timothy YY Lai Medical Bulletin Management of Tearing in Adults Dr. Alan CK Ng Dr. Dylan DN Chan Ocular Allergy in Children Dr. Koon-man Lam Neuro-ophthalmology for General Practitioners: A Revision Dr.CarmenKMChan Normal Tension Glaucoma - a Sick Eye in a Sick Body Dr. Dexter YL Leung Retinal Complications of High Myopia Dr. Timothy YY Lai Amblyopia: An overview Dr. Wilson WK Yip Prof. Dorothy SP Fan Surgical Correction for Near Sightedness Dr. Arthur CK Cheng Traditional Chinese Medicine and Ophthalmology Dr. Jane CC Yeung Special Feature Rosiglitazone and Risk of Myocardial Infarction: Clear Danger or Dr. Norman Chan Media Hype? Clinical Quiz Clinical Quiz Dr. Helen KS Tung Society News Medical Diary of September Calendar of Events ISSN 1812 - 1691 ᚂᖒԙষΙড়ᒑȅᩧҕஶቆᜰЖ VOL.12 NO.9 SEPTEMBER 2007 Contents The Federation of Medical Societies of Hong Kong 4/F Duke of Windsor Social Service Building, Contents 15 Hennessy Road, Wanchai, Hong Kong Tel: 2527 8898 Fax: 2865 0345 Editorial President Dr. FONG To-sang, Dawson 方道生醫生 1st Vice- President Editorial 2 Dr. CHAN Chi-kuen 陳志權醫生 2nd Vice- President Dr. Timothy YY Lai Dr. LO Sze-ching, Susanna 盧時楨醫生 Hon. Secretary Dr. LO See-kit, Raymond 勞思傑醫生 Medical Bulletin Deputy Hon. Secretary Dr. CHAN Sai-kwing 陳世炯醫生 Management of Tearing in Adults 4 Hon. Treasurer Mr. LAM Lop-chi, Nelson 林立志先生 Dr.AlanCKNg Deputy Hon. Treasurer Dr. Dylan DN Chan Mr. -
Hereditary Nystagmus in Early Childhood
J Med Genet: first published as 10.1136/jmg.7.3.253 on 1 September 1970. Downloaded from Journal of Medical Genetics (1970). 7, 253. Hereditary Nystagmus in Early Childhood BRIAN HARCOURT* Nystagmus is defined as a rhythmic involuntary clinical characteristics of various types of hereditary movement of the eyes, and as an acquired pheno- nystagmus and the techniques which are available menon arising in later childhood or in adult life is to differentiate between 'idiopathic' nystagmus and usually a symptom of serious neurological or laby- nystagmus as a symptom of an occult disorder of the rinthine disease; in such cases the movements of the visual apparatus in early childhood, some descrip- eyes commonly produce subjective symptoms of tion of the modes of inheritance and of the long- objects moving in the visual panorama (oscillopsia). term visual prognosis are given in the various Nystagmus may also be 'congenital', or, more categories of infantile nystagmus which can be so accurately, may first be observed within a few weeks defined. of birth when the infant begins to attempt to fix and to follow visually stimulating targets by means of Character of Nystagmus conjugate movements of the eyes. In such cases, Though it is not usually possible to arrive at the nystagmus may persist throughout life, but even an exact diagnosis of the cause of nystagmus by ob- at a later stage there is always a complete absence of servation of the eye movements alone, a great deal of the symptom of oscillopsia. Nystagmus which useful information can be obtained by such a study. -
Treacher Collins Prize Essay the Significance of Nystagmus
Eye (1989) 3, 816--832 Treacher Collins Prize Essay The Significance of Nystagmus NICHOLAS EVANS Norwich Introduction combined. The range of forms it takes, and Ophthalmology found the term v!to"[<xy!too, the circumstances in which it occurs, must be like many others, in classical Greece, where it compared and contrasted in order to under described the head-nodding of the wined and stand the relationships between nystagmus of somnolent. It first acquired a neuro-ophthal different aetiologies. An approach which is mological sense in 1822, when it was used by synthetic as well as analytic identifies those Goodl to describe 'habitual squinting'. Since features which are common to different types then its meaning has been refined, and much and those that are distinctive, and helps has been learned about the circumstances in describe the relationship between eye move which the eye oscillates, the components of ment and vision in nystagmus. nystagmus, and its neurophysiological, Nystagmus is not properly a disorder of eye neuroanatomic and neuropathological corre movement, but one of steady fixation, in lates. It occurs physiologically and pathologi which the relationship between eye and field cally, alone or in conjunction with visual or is unstable. The essential significance of all central nervous system pathology. It takes a types of nystagmus is the disturbance in this variety of different forms, the eyes moving relationship between the sensory and motor about one or more axis, and may be conjugate ends of the visual-oculomotor axis. Optimal or dysjugate. It can be modified to a variable visual performance requires stability of the degree by external (visual, gravitational and image on the retina, and vision is inevitably rotational) and internal (level of awareness affected by nystagmus. -
Cory Newman Thesis 5-2021 Signed.Pdf (1.303Mb)
DocuSign Envelope ID: 4851A328-CF63-4770-A833-B4246E7E5D23 Simulating Homonymous Hemianopsia for the Care Team by Cory Newman May 2021 Presented to the Division of Science, Information Arts, and Technologies University of Baltimore In Partial Fulfillment of the Requirements for the Degree of Master of Science 5/25/2021 Approved by: ________________________________ [name, Thesis Advisor] ________________________________5/25/2021 [name, Committee Member] i DocuSign Envelope ID: 4851A328-CF63-4770-A833-B4246E7E5D23 Abstract Homonymous hemianopsia is a visual impairment that involves the bilateral loss of a complete visual field. While research has been done to ascertain the details of cause and prognosis of homonymous hemianopsia, an obvious disparity arose in the research on how to educate the supporting care team of a person with homonymous hemianopsia to maximize the creation of educational and rehabilitation plans. This research presents two studies focused on closing that gap by providing an alternative method of understanding. In the initial study 16 participants with a confirmed caregiver relationship to one or more persons with homonymous hemianopsia were surveyed on their personal knowledge of the visual impairment. These participants were asked to express any visual obstacles they have encountered, and to ascertain the availability of a device or program that could provide an interactive interpretation of how their homonymous hemianopsia patient views their surroundings. Survey results confirmed the need for a program that could easily simulate homonymous hemianopsia for the care provider. An additional usability study was completed by eight of the 16 previous participants on a mobile homonymous hemianopsia simulation application prototype. User tests showed that participants gained a significant increase in understanding of how those with a homonymous hemianopsia visual impairment view the environment. -
Pupillary Disorders LAURA J
13 Pupillary Disorders LAURA J. BALCER Pupillary disorders usually fall into one of three major cat- cortex generally do not affect pupillary size or reactivity. egories: (1) abnormally shaped pupils, (2) abnormal pupillary Efferent parasympathetic fibers, arising from the Edinger– reaction to light, or (3) unequally sized pupils (anisocoria). Westphal nucleus, exit the midbrain within the third nerve Occasionally pupillary abnormalities are isolated findings, (efferent arc). Within the subarachnoid portion of the third but in many cases they are manifestations of more serious nerve, pupillary fibers tend to run on the external surface, intracranial pathology. making them more vulnerable to compression or infiltration The pupillary examination is discussed in detail in and less susceptible to vascular insult. Within the anterior Chapter 2. Pupillary neuroanatomy and physiology are cavernous sinus, the third nerve divides into two portions. reviewed here, and then the various pupillary disorders, The pupillary fibers follow the inferior division into the orbit, grouped roughly into one of the three listed categories, are where they then synapse at the ciliary ganglion, which lies discussed. in the posterior part of the orbit between the optic nerve and lateral rectus muscle (Fig. 13.3). The ciliary ganglion issues postganglionic cholinergic short ciliary nerves, which Neuroanatomy and Physiology initially travel to the globe with the nerve to the inferior oblique muscle, then between the sclera and choroid, to The major functions of the pupil are to vary the quantity of innervate the ciliary body and iris sphincter muscle. Fibers light reaching the retina, to minimize the spherical aberra- to the ciliary body outnumber those to the iris sphincter tions of the peripheral cornea and lens, and to increase the muscle by 30 : 1. -
Accommodation in the Holmes-Adie Syndrome by G
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.21.4.290 on 1 November 1958. Downloaded from J. Neurol. Neurosurg. Psychiat., 1958, 21, 290. ACCOMMODATION IN THE HOLMES-ADIE SYNDROME BY G. F. M. RUSSELL From the Neurological Research Unit, the National Hospital, Queen Square, London In 1936, Bramwell suggested that the title response to near and far vision respectively. But it "Holmes-Adie syndrome" be given to the clinical has also been noted that the reaction to convergence complex of a slowly reacting pupil and absent tendon may be remarkably wide in its range, considering reflexes in recognition of the descriptions by Holmes that it often follows a stage of complete paralysis (1931) and Adie (1932). Both authors had empha- (Strasburger, 1902). Not only is the reaction to sized the chief clinical features-dilatation of the convergence well preserved when compared to the pupil, apparent loss of the reaction to light, slow reaction to light, but it may in fact be excessive constriction and relaxation in response to near and (Alajouanine and Morax, 1938; Heersema and distant vision, and partial loss of the tendon reflexes. Moersch, 1939). In assessing the degree of tonicity Although the syndrome had been recognized wholly there are, therefore, two criteria: slowness ofguest. Protected by copyright. or in part many years previously (Strasburger, 1902; pupillary movement and preservation of the range Saenger, 1902; Nonne, 1902; Markus, 1906; Weill of movement. and Reys, 1926), credit must go to Adie for stressing Adler and Scheie (1940) showed that the tonic the benign nature of the disorder and distinguishing pupil constricts after the conjunctival instillation it clearly from neurosyphilis. -
Homonymous Hemianopsia
Source: CLEVELAND CLINIC OHIO USA FACTSHEET Homonymous Hemianopsia Homonymous hemianopsia is a condition in which a person sees only one side - right or left of the visual world of each eye; results from a problem in brain function rather than a disorder of the eyes themselves. This can happen after a head or brain injury. What is homonymous hemianopsia? Homonymous hemianopsia is a condition in which a person sees only one side―right or left―of the visual world of each eye. The person may not be aware that the vision loss is happening in both eyes, not just one. Under normal circumstances, the left half of the brain processes visual information from both eyes about the right side of the world. The right side of the brain processes visual information from both eyes about the left side of the world. A visual world of someone with normal vision A visual world of someone with homonymous hemianopsia In homonymous hemianopsia, an injury to the left part of the brain results in the loss of the right half of the visual world of each eye. An injury to the right part of the brain produces loss of the left side of the visual world of each eye. This condition is created by a problem in brain function rather than a disorder of the eyes themselves. What causes homonymous hemianopsia? The most common cause of this type of vision loss is stroke. However, any disorder that affects the brain—including tumours, inflammation, and injuries--can be a cause. Source: CLEVELAND CLINIC OHIO USA It is estimated that 70% of the injuries leading to hemianopsias are due to an obstruction (blockage) of the blood supply (stroke). -
Neuroophthalmology
Neuroophthalmology MAREK MICHALEC, MD PHD Clinic of Ophthalmology Faculty Hospital Brno and Masaryk University Version 12/2019 Content • Visual pathway affection • Diseases and affections of optic nerve • Optic chiasm pathology • Pathology of retrochiasmic part • Eye movement disorders • Binocular diplopia • Pupillary reaction abnormalities • Anisocoria • Combined disorders Examination - part I • Medical history • subjective (visual loss, diplopia) • When it started/ how long lasts it? • Does it change in time/ during the day? • Any progression? • What about the fellow eye? • Other signs? • Personal medical history? • Pharmacological history? • objective (pupillary dysfunction, eye movement disorders, ptosis of upper eyelid, red eye) Examination - part II • Visual acuity • Without and with correction • Monocular vision / binocular vision • Basic ophthalmological examination • Anterior segment (by slit lamp) • Posterior segment - arteficial mydriasis is essential (indirect ophthalmoscopy) • Visual field examination (static / kinetic perimetry) Examination - part III • Basic examination (GP) • Neurological examination • Intracranial conditions (including MRI) • neurological signs • Endocrinology • Thyroid associated orbitopathy / ophthalmopathy • Pituitary dysfunction Examination - part IV • Imaging techniques • Ultrasonography (eye bulb, orbit) • X-ray of skull (orbit, paranasal cavities) • Computerised Tomography of head (brain, skull bones, orbital bones) • MRI of head (brain, orbital structures) Optic nerve disorders Clinical signs • -
Fluids Hypertension Syndromes: Migraines, Headaches, Normal Tension Glaucoma, Benign Intracranial Hypertension, Caffeine Intolerance
Fluids Hypertension Syndromes – Dr. Leonardo Izecksohn – page 1 Fluids Hypertension Syndromes: Migraines, Headaches, Normal Tension Glaucoma, Benign Intracranial Hypertension, Caffeine Intolerance. Etiologies, Pathophysiologies and Cure. Author: Leonardo Izecksohn. Medical Doctor, Ophthalmologist, Master of Public Health. We have no financial interest on any medicament, device, or technique described in this e-book. We authorize the free copy and distribution of this e-book for educational purposes. The 1st. edition was written at the year 1996, with 2 pages. There are other editions spread at the Internet. This is the enlarged and revised edition 65-f, updated on May 24, 2016. ISBN 978-85-906664-1-7 DOI: 10.13140/2.1.3074.5602 www.izecksohn.com/leonardo/ [email protected] Fluids Hypertension Syndromes – Dr. Leonardo Izecksohn – page 2 Abstract A – Migraines, Headaches and Fluids Hypertension Syndromes – What are they? - Answer: Migraines and most primary headaches are the aches of the pressure increase in the fluids: - Intraocular Aqueous Humor, - Intracranial Cerebrospinal Fluid, and - Inner ear’s Perilymph and Endolymph. We denominate the fluids’ pressure rises and their consequent migraines, signs, symptoms and sick- nesses as the Fluids Hypertension Syndromes. Migraines and headaches are not sicknesses: they are symptoms of the sicknesses. B – How many Fluids Hypertension Syndromes do exist? - Answer: There are three Fluids Hypertension Syndromes: 1- Ocular, due to raises of the intraocular Aqueous Humor pressure. 2- Cerebrospinal, due to raises of the intracranial Cerebrospinal Fluid pressure. 3- Inner Ears, due to raises of the inner ears' Perilymph and Endolymph pressures. Each patient can present one, two, or all the three Fluids Hypertension Syndromes in the same time. -
Neuroanatomy Crash Course
Neuroanatomy Crash Course Jens Vikse ∙ Bendik Myhre ∙ Danielle Mellis Nilsson ∙ Karoline Hanevik Illustrated by: Peder Olai Skjeflo Holman Second edition October 2015 The autonomic nervous system ● Division of the autonomic nervous system …………....……………………………..………….…………... 2 ● Effects of parasympathetic and sympathetic stimulation…………………………...……...……………….. 2 ● Parasympathetic ganglia ……………………………………………………………...…………....………….. 4 Cranial nerves ● Cranial nerve reflexes ………………………………………………………………….…………..…………... 7 ● Olfactory nerve (CN I) ………………………………………………………………….…………..…………... 7 ● Optic nerve (CN II) ……………………………………………………………………..…………...………….. 7 ● Pupillary light reflex …………………………………………………………………….…………...………….. 7 ● Visual field defects ……………………………………………...................................…………..………….. 8 ● Eye dynamics …………………………………………………………………………...…………...………….. 8 ● Oculomotor nerve (CN III) ……………………………………………………………...…………..………….. 9 ● Trochlear nerve (CN IV) ………………………………………………………………..…………..………….. 9 ● Trigeminal nerve (CN V) ……………………………………………………................…………..………….. 9 ● Abducens nerve (CN VI) ………………………………………………………………..…………..………….. 9 ● Facial nerve (CN VII) …………………………………………………………………...…………..………….. 10 ● Vestibulocochlear nerve (CN VIII) …………………………………………………….…………...…………. 10 ● Glossopharyngeal nerve (CN IX) …………………………………………….……….…………...………….. 10 ● Vagus nerve (CN X) …………………………………………………………..………..…………...………….. 10 ● Accessory nerve (CN XI) ……………………………………………………...………..…………..………….. 11 ● Hypoglossal nerve (CN XII) …………………………………………………..………..…………...…………. -
Retinitis Pigmentosa Precision Panel Overview Indications Clinical
Retinitis Pigmentosa Precision Panel Overview Retinitis Pigmentosa (RP) comprises a complex group of inherited dystrophies characterized by degeneration and dysfunction of the retina, affecting photoreceptor and pigment epithelial function. RP can be an isolated finding or be part of a syndrome that can be inherited in a dominant, recessive or X-linked pattern. This disease presents as progressive loss of night and peripheral vision, leading to a constricted visual field and markedly diminished vision. The clinical presentation of these findings is highly variable, some patients being affected during childhood while others are asymptomatic well into adulthood. There is an increase in mortality rate due to psychiatric comorbidities. The Igenomix Retinitis Pigmentosa Precision Panel can be used to make an accurate and directed diagnosis as well as a differential diagnosis of blindness ultimately leading to a better management and prognosis of the disease. It provides a comprehensive analysis of the genes involved in this disease using next-generation sequencing (NGS) to fully understand the spectrum of relevant genes involved. Indications The Igenomix Retinitis Pigmentosa Precision Panel is indicated for those patients with a clinical suspicion or diagnosis with or without the following manifestations: - Family history of RP - Night blindness - Progressive constriction of the visual field, usually peripheral - Cataracts - Sensation of sparking lights (photopsias) - Headache Clinical Utility The clinical utility of this panel is: - The genetic and molecular confirmation for an accurate clinical diagnosis of a symptomatic patient. - Early initiation of multidisciplinary treatment in the form of medical care with vitamin A and other antioxidants and surgical care for potential cataract extraction or retinal prosthesis. -
Ministry of Public Health of Ukraine Ukrainian Medical Stomatological Academy
Ministry of Public Health of Ukraine Ukrainian Medical Stomatological Academy Approved At the meeting of the department of neurological diseases with neurosurgery and medical genetic "__"__ ____________20___ Protocol №________ Head of department _______________ prof. Delva M.Yu. METHODICAL INSTRUCTIONS FOR THE INDEPENDENT WORK OF STUDENTS FOR PREPARATION TO PRACTICAL CLASSES AND DURING PRACTICAL CLASSES Academic subject Neurology The module № 1 General neurology Topic Syndromes of defeat oculomotor nerves. Pathology of olfactory and visual analyzers. Year of study IV Faculty Foreign Students Training (Medicine) Poltava 20___ 1.Relevance of the topic: the olfactory and visual analyzers play a role in receptor function of the nervous system. With the functions of these disorders analyzers, as well as with oculomotor disturbances faced by doctors of different specialties - neurologists, ophthalmologists, neurosurgeons, pediatricians, phthisiatricians, endocrinologists, internists. Violations of the functions of these analyzers is observed in a variety of inflammatory, demyelinating processes, tumors, trauma, endocrine disorders. The correct methodological approach to the study of functions, pathological changes of the olfactory and visual analyzers, oculomotor nerves makes it possible to deliver topical and clinical diagnosis and treatment in a timely manner. 2. Specific Objectives: To investigate the function of I, II, III, IV, VI pairs of cranial nerves, identify signs of a lesion of the nerve disorder Examine the identification functions