1/3. West African crystalline maculopathy.OBJECTIVE: To report new observations in West African crystalline maculopathy. DESIGN: Retrospective, observational case series. PARTICIPANTS: Three patients drawn from a private retina practice. methods: review of clinical charts and photographic studies. MAIN OUTCOME MEASURES: Distribution of intraretinal crystals and changes after laser photocoagulation, and history of ingesting foods typical in a West African diet but atypical for an American diet. RESULTS: All patients were older than 50 years, had diabetic retinopathy, ate green vegetables not found in American diets, and showed no deleterious effects of the crystals. Kola nut ingestion in 2 patients was remote and sparse, and was unknown in a third patient. The first 2 affected patients originating outside the Ibo tribe of nigeria are reported. The pattern of retinal crystals can be changed, and the quantity of crystals reduced, by laser photocoagulation of associated diabetic retinopathy. CONCLUSIONS: West African crystalline retinopathy is distinguishable from other causes of crystalline retinopathy. It may reflect a component of the West African diet, seems to have diabetic retinopathy as a promoting factor via breakdown of the blood-retina barrier, and can be modified by laser photocoagulation of diabetic retinopathy. Increased awareness of the condition will allow physicians seeing West African immigrants to make the diagnosis and treat the patients appropriately.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/3. When a physician harms a patient by a medical error: ethical, legal, and risk-management considerations.Errors that harm patients are infrequently brought to the attention of these patients. The full disclosure of such medical errors is in the best interest of patients because it allows them to understand what has occurred, and to gain appropriate compensation for the harm that they have suffered. physicians have been given little guidance regarding how to conduct a relationship with the patient after such an injury. We argue that the physician must continue to respect the patient, and communicate honestly with him or her throughout their relationship, even after the patient has been injured. It is painful to admit our errors, especially to those who have been harmed by them. Nevertheless, offering an apology for harming a patient should be considered to be one of the ethical responsibilities of the profession of medicine. Monetary compensation alone is not to be offered as a charitable gesture; rather, it should be accompanied by an apology to demonstrate the responsibility of the physician to the trusting patient. Full and honest disclosure of errors is most consistent with the mutual respect and trust patients expect from their physicians. Clearly, physicians' ethical responsibilities sometimes differ from their legal and risk-management responsibilities.- - - - - - - - - - ranking = 8keywords = physician (Clic here for more details about this article) |
3/3. endophthalmitis in eyes following vitrectomy.The authors describe two patients who underwent pars plana vitrectomy for nonclearing vitreous hemorrhage. Both patients had severe pain, increased intraocular pressure, and orbital swelling. The anterior chamber became flat in a phakic eye. The infection progressed rapidly, and ultimately evisceration was required in both cases. The presence of a flat anterior chamber in gas-filled, phakic eyes and a severe orbital inflammatory reaction in the early postoperative period should alert the physician to the possibility of endophthalmitis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |