Displacement of fovea toward optic disk after macular hole surgery with internal limiting membrane peeling

PURPOSE:The purpose of this study was to demonstrate a displacement of the foveal depression toward the optic disk after idiopathic macular hole (MH) surgery with internal limiting membrane (ILM) peeling.METHODS:Two patients with a unilateral MH developed an MH in the fellow eyes. Vitrectomy with ILM peeling was performed on the fellow eye to close the MH. Images of spectral-domain optical coherence tomography (SD-OCT) were used to measure the disk-to-fovea distances pre MH formation, after MH formation, and 6 months after the closure of the MH.RESULTS:The disk-to-fovea　distance was shorter at 6 months than after the development of the MH (4,109 µm and 4,174 µm in Case 1 and 4,001 µm and 4,051 µm in Case 2).CONCLUSION:These results indicate that the fovea moves nasally after the MH surgery with ILM peeling

Retinal Angiomatous Proliferation in an Eye with Cuticular Drusen

Purpose: To report the presence of retinal angiomatous proliferation (RAP) in an eye with cuticular drusen detected by fluorescein and indocyanine green angiography by confocal scanning laser ophthalmoscopy and by spectral-domain optical coherence tomography (SD-OCT). Methods: Case report of a 65-year-old Japanese woman with cuticular drusen. Results: At her first ophthalmic examination, her visual acuity was 20/20 in both eyes. An ophthal-moscopy showed many small subretinal pigment epithelial deposits in both eyes. These de-posits had a ‘saw-tooth pattern’ in the SD-OCT images. During the follow-up examination, retinal hemorrhages were observed, and fluorescein angiography showed a ‘stars-in-the-sky’ appearance and intraretinal neovascularization. The patient was diagnosed with cuticular drusen associated with RAP. Conclusion: We suggest that the cuticular drusen were associ-ated with RAP, so periodic follow-up examinations are needed for patients with cuticular drusen for the early detection and treatment of RAP

Transient Increase of Retinal Nerve Fiber Layer Thickness after Vitrectomy with ILM Peeling for Idiopathic Macular Hole

Purpose. The purpose of this study was to determine the long-term changes in the circumpapillary retinal nerve fiber layer (RNFL) thickness following macular hole surgery with internal limiting membrane (ILM) peeling combined with phacoemulsification. Methods. Thirty-eight eyes of 37 patients who had pars plana vitrectomy (n = 36) between 2010 and 2014 were studied. The average thicknesses of the global and the six sectors of the RNFL were determined before and at 1, 3, 6, 12, and 24 (n = 22) months (M) after the surgery by spectral-domain optical coherent tomography. The postoperative mean RNFL thickness at each time was compared to that before the surgery by paired t-tests. Results. The RNFL of the operated eyes was significantly thicker at 1 month (1 M) and 3 M in all but the inferior-nasal sectors. The significant increase remained until 12 M in the superior-temporal and superior-nasal sectors. In addition, the RNFL was also significantly thicker in the temporal-inferior sector at 12 M based on the findings in 38 eyes. Conclusions. The postoperative RNFL was thicker in all but the nasal-inferior sector for at least 12 M after surgery. This prolonged increase of the RNFL thickness may indicate damage and mild edema of the RNFL

Perfusion 123IMP-SPECT shows reversible abnormalities in GABAB receptor antibody associated encephalitis with normal MRI

A new subtype of autoimmune encephalitis associated with antibodies against GABAB receptor was recently identified. Although immune-mediated functional abnormalities are suggested for the pathogenesis, functional brain imaging such as perfusion SPECT has not been documented. A 62-year-old woman with anti-GABAB receptor associated encephalitis underwent 123I-IMP SPECT in the beginning and after methylprednisolone pulse therapy. Three-dimensional stereotactic surface projection analysis was used to evaluate the cortical distribution of perfusion abnormality. The patient presented with clinical features of subacute limbic encephalitis. Antibodies to GABAB receptor were identified in her serum and cerebrospinal fluid (CSF), but no tumor was detected. Despite normal magnetic resonance imaging (MRI) findings, the first SPECT revealed hypoperfusion of the frontal, parietal and medial temporal lobes, as well as thalamus, and cerebellum. These areas are known to contain high levels of GABAB receptors. In contrast, the SPECT revealed hyperperfusion in the motor strip and left temporal lobe, which are areas related to some of the patient's symptoms, including seizures, orolingual dyskinesia, and Wernicke aphasia. After treatment with pulses of methylprednisolone, the neuropsychiatric symptoms resolved and the SPECT findings showed substantial improvement in most of these regions. In conclusion, the findings suggest that immunotherapy improved the cortical dysfunction mediated by GABAB receptor antibodies

The ideas about nursing course of senior high school teachers.

近年、4年制大学の増設をはじめとした看護課程における教育の変革が進められつつある。これは質の高い看護の人材を必要とする社会のニーズに応えたものである。著者らはこれらの看護課程に対する意見を、岡山県下の高校で進路指導をしている教師に尋ね、郵送による質問紙法を用いて33名の回答を得た。その結果、以下のことが分かった。1. 51.5％の教師は、看護大学が増えると進学希望者の関心は呼ぶとしており、36.4％は、学生数の一定の増加があるだろうとしている。また、36.4％は教師の立場から看護課程への進学を勧めやすくなると考えている。2. 高校の教師は看護婦不足の理由として労働条件の厳しさを指摘している。3. 高校教師は進路として看護課程を勧める理由を仕事の専門性と奉仕性を多くあげていた。これらは、高等教育化と看護職のイメージの改善の両方が必要であることを示唆している。Currently, improvement of nursing curriculum has been done in Japan, including the establishment of a four year course at universitiy, responding to the social needs for man-power for high quality nursing. A questionnaire survey by mail was done in 1993, to get ideas about the nursing course of high school teachers giving advice to students wishing to go on to university or college. Thirty three high school teachers out of a total of 76 schools in Okayama prefecture responded. The results were as follows; 1, Seventeen teachers (51.5%) answered that the increase of a four year course at university would be an incentive to students. Twelve teachers (36.4%) said that it might increase the number of students choosing the course. And also 12 teachers (36.4%) thought that they could recommend this course to students more easily than before. 2, They pointed out the harsh working conditions as the reason for a shortage of nursing manpower. 3, Their reasons why they recommend the nursing course to students were firstly the specialty and secondly devotion to people

Comparative study of the work load between one-man buses and two-man buses.

The differences in physiological and safety conditions of one-man buses and two-man buses were examined from the view point of occupational fatigue. This survey consisted of a work load study which included a time study, study of subsidiary behavior, auditory task, memory test, Galvanic Skin Response (GSR) and physiological function tests and a self-administered questionnaire which involved items concerning safety and subjective fatigue complaints. The visual and postural restrictions in the one-man bus were greater than in the two-man bus. The mental capacity of the one-man bus drivers was found to be less. Greater mental fatigue and stress were observed in the one-man bus. More subjective fatigue complaints were observed in the one-man bus. More cases of near accidents were observed in the one-man bus. From these results it was concluded that the one-man bus caused bus drivers a greater mental and physical work load.</p