[Acute angle closure : An ophthalmological emergency in the emergency room]

Hintergrund

Die Symptome des akuten Winkelblocks, ein Notfallereignis, das ohne rechtzeitige Therapie zur irreversiblen Erblindung führen kann, sind vielfältig. Diese können initial als internistische oder neurologische Erkrankungen gedeutet werden, wenn Kopfschmerzen, Pupillenstarre oder Übelkeit im Vordergrund stehen. Ziel unserer Studie war es, die Rate belastender und invasiver Diagnostik durch primäre Vorstellung bei Nichtophthalmologen bei akutem primären Winkelblock zu erfassen.

Methode

Retrospektive Single-Center-Studie von Patienten mit akutem primärem Winkelblock. Zur Identifizierung dieser wurden alle Patienten erfasst, bei denen im Universitätsklinikum Freiburg, Klinik für Augenheilkunde im Zeitraum 2014–2018 eine chirurgische Iridektomie (5-133.0) oder Iridotomie durch Laser (5-136.1) durchgeführt wurde. Anschließend erfolgte durch Akteneinsicht die Datenanalyse zur Prüfung der Ein- und Ausschlusskriterien sowie des Krankheitsverlaufs.

Ergebnisse

Eingeschlossen wurden 91 Patienten mit akutem primären Winkelblock. Davon stellten sich 28 % (n = 25) initial bei nichtophthalmologischen Fachdisziplinen vor. In dieser Patientengruppe erhielten 56 % (n = 11) eine nichtzielführende Diagnostik, wobei bei 32 % (n = 8) eine kraniale Bildgebung und bei 8 % (n = 2) eine Lumbalpunktion durchgeführt wurde.

Schlussfolgerung

Bei akutem primären Winkelblock zeigt sich eine hohe Rate an nicht wegweisender Diagnostik durch Nichtophthalmologen, weshalb dieses Krankheitsbild fächerübergreifend präsent sein sollte. Bei unspezifischen Symptomen, wie Kopfschmerzen, Übelkeit und Erbrechen sowie Pupillenstarre, muss an die Möglichkeit eines akuten Augeninnendruckanstiegs durch einen akuten Winkelblock gedacht und das frühzeitige Hinzuziehen eines Ophthalmologen erwogen werden.

In vitro antiviral susceptibilities of isolates from cytomegalovirus retinitis patients receiving first- or second-line cidofovir therapy: relationship to clinical outcome

Blood culture isolates from patients receiving first- (peripheral retinitis) or second-line (relapsing retinitis) therapy with intravenous cidofovir were obtained from three clinical trials for in vitro antiviral susceptibility analyses. Isolates from 6 patients obtained after 14.3 weeks (mean) of first-line cidofovir therapy showed complete susceptibility to cidofovir, ganciclovir, and foscarnet. Isolates from 20 patients were obtained after 17.3 weeks (mean) of second-line cidofovir therapy. Ten showed complete susceptibility to all inhibitors, 3 showed low-level ganciclovir resistance (<6-fold) but were sensitive to cidofovir and foscarnet, and 7 showed moderately reduced susceptibility (<8-fold) to cidofovir and high-level resistance (8- to 23-fold) to ganciclovir in vitro. Four of these 7 isolates showed reduced susceptibility (4-fold) to foscarnet. Notably, there was no difference in time to retinitis progression in patients that were on cidofovir therapy when sensitive isolates were compared with those showing reduced susceptibility to cidofovir in vitro.

Pain control with morphine: Evaluation of prescriptions for oral morphine for outpatients at King Faisal Specialist Hospital and Research Centre

With the rapid improvement in living standards and health care delivery in Saudi Arabia, people are expected to live longer, patterns of illness will change, and the chronic illnesses which now dominate medical care in the West will develop here. Among these is cancer, which is already the third most common cause of death in Bahrain and Kuwait. Many cancer patients experience considerable distress, particularly pain. Management of symptoms in advanced cancer is now a medical and nursing specialty called palliative care. The most common and most feared symptom in advanced cancer is pain, which can only be effectively relieved with morphine in 60% of such patients. Prescribing narcotics such as morphine for cancer pain in Saudi Arabia has been severely restricted legally because of the fear of addiction, but there is no evidence that the medicinal use of morphine for treating cancer pain causes addiction. This paper describes a review carried out at King Faisal Specialist Hospital and Research Center, one of the few centers in the Kingdom that can prescribe morphine to outpatients, to review the appropriateness and effectiveness of morphine usage, and to monitor any misuse. The review confirms that morphine usage was appropriate and effective, but that procurement of adequate narcotic supplies from year to year causes severe problems due to the stringency of both national and international regulations. Also, better monitoring of patients on morphine and recording of their level of pain control is required. In general, this survey shows that morphine usage in this hospital is appropriate and that limitations on supplies could be improved by changes to the Ministry of Health regulations.