Methods of assessment of patients for Nd:YAG laser capsulotomy that correlate with final visual improvement

BACKGROUND: This paper attempts to clarify the usefulness of various simple pre-operative measures in estimating the potential for a visually successful capsulotomy. METHODS: 24 patients attending for capsulotomy had pre-operative measures of glare with BAT tester, visibility of posterior pole and grading of posterior capsular pearls and fibrosis seen at slit lamp. Visual function was measured before and after standardised capsulotomy. Correlations of the various preoperative measures with eventual visual function improvements were calculated. RESULTS: Pearls at slit lamp and poor posterior pole visualisation were all correlated with improvements in visual acuity and contrast sensitivity after capsulotomy. Amount of fibrosis visible at slit lamp and glare assessment were not correlated with vision improvements after laser. CONCLUSION: Of the various measures that are taken prior to Nd : YAG capsulotomy, some correlate with eventual visual improvement but for others no clinical utility was found. Practitioners should note these findings as they are especially of use in more questionable or high-risk cases to help determine whether referral for PCO treatment by Nd: YAG capsulotomy is likely to benefit the patient

Tactile Afferent Input Influencing Motor Coordination During Precision Grip

The remarkable capacity and versatility of the human hand in precise manipula-tory tasks is undoubtedly dependent upon a number of neural factors. One such factor is the tactile sensory innervation of the glabrous skin area, i.e. the hairless skin of the volar aspect of the hand. Indeed, Mott and Sherrington [22], dealing with the motor effects of various patterns of dorsal root sections in Macacus rhesus, found that "afferent impulses, both from the skin and from muscles, espe-cially the former, as related to the palm and sole, are necessary for the carrying out of 'highest level ' movements. " Likewise, Denny-Brown [5] wrote extensively on the capacity of tactile stimuli in eliciting prepatterned integrated hand move-ments in clinical and experimental material. In patients with frontal lobe lesions, automatic prehensile movements of at least two types could be distinguished: the "grasp reflex " and the more complex "instinctive grasp reaction". In contrast, during parietal lobe lesions, "tactile avoiding reactions " of different complexities were described. The pathological feature of these reactions was considered to be an inability to adequately suppress the first phase, i.e. the reactions appeared t

Thresholds for the perception of hand-transmitted vibration: dependence on contact area and contact location

The detection of vibration applied to the glabrous skin of the hand varies with contact conditions. Three experiments have been conducted to relate variations in the perception of hand-transmitted vibration to previously reported properties of tactile channels. The effects of a surround around the area of contact, the size of the area of contact, the location of the area of contact, the contact force, and the hand posture on perception of thresholds were determined for 8–500?Hz vibration. Removal of a surround around a contact area on the fingertip elevated thresholds of the NP II channel (FA I fibres) at frequencies less than 31.5?Hz and reduced thresholds of the Pacinian channel (FA II fibres) at frequencies greater than about 63?Hz. When no surround was present, thresholds reduced systematically as the contact area increased from the fingertip to the whole hand at frequencies from 16 to 125?Hz, although the decrease was not inversely proportional to the increase in contact area. The results are partly explained by spatial summation in the Pacinian channel (FA II fibres) and the involvement of the NP II channel (SA II) with some influence of biodynamic responses and contact pressures. There were regional differences in sensitivity over the hand within the NP I channel but not within the Pacinian channel: the NP I thresholds (less than 31.5?Hz) decreased from proximal to distal regions of the hand, whereas the Pacinian thresholds (125?Hz) were independent of contact location over the hand

First spikes in ensembles of human tactile afferents code complex spatial fingertip events

It is generally assumed that primary sensory neurons transmit information by their firing rates. However, during natural object manipulations, tactile information from the fingertips is used faster than can be readily explained by rate codes. Here we show that the relative timing of the first impulses elicited in individual units of ensembles of afferents reliably conveys information about the direction of fingertip force and the shape of the surface contacting the fingertip. The sequence in which different afferents initially discharge in response to mechanical fingertip events provides information about these events faster than the fastest possible rate code and fast enough to account for the use of tactile signals in natural manipulation

Complicating infectious foci in patients with Staphylococcus aureus or Streptococcus species bacteraemia.

Contains fulltext : 53587.pdf (publisher's version ) (Closed access)Complicating infectious foci resulting from haematogenous or local spread of microorganisms are observed frequently in patients with Staphylococcus aureus bacteraemia (SAB) or Streptococcus species bacteraemia (SSB). The aim of this study was to compare the epidemiology of complicating infectious foci during SAB and SSB in a university hospital in The Netherlands. The charts of all adult patients diagnosed with SAB or SSB (except for Streptococcus pneumoniae bacteraemia) from July 2002 until December 2004 were reviewed retrospectively. Overall, 180 immunocompetent patients were identified, 127 with SAB and 53 with SSB. The percentage of patients with complicating infectious foci (39% of SAB patients, 25% of SSB patients) did not differ significantly between the groups. Endocarditis and cerebral involvement, however, were significantly more common in the SSB group. Of all complicating infectious foci, 32% lacked guiding signs or symptoms and 10% were detected only at autopsy. Factors associated with the development of complicating infectious foci were a delay in treatment for more than 48 h after the onset of symptoms, community acquisition, persistently positive blood cultures, congenital heart disease, and the presence of foreign bodies or prosthetic valves. Infection-related mortality was 18% in SAB patients and 11% in SSB patients and was significantly higher in patients with complicating infectious foci (29 vs. 9%). In conclusion, complicating infectious foci develop in approximately one-third of all patients with SAB and SSB. An active approach that entails searching for the complicating infectious foci is warranted in these patients, because only two-thirds of complicated infectious foci have guiding symptoms or signs, and infection-related mortality is significantly increased in patients with complicating infectious foci compared to patients without these infections.9 p