The Friday Funny: Happy Halloween
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Cornea Transplant Lasts 123 Years
A fascinating story from Reuters (h/t Dr. Wes):
Bernt Aune’s transplanted cornea has been in use for a record 123 years — since before the Eiffel Tower was built.
“This is the oldest eye in Norway — I don’t know if it’s the oldest in the world,” Aune, an 80-year-old Norwegian and former ambulance driver, told Reuters by telephone on Thursday. “But my vision’s not great any longer.”
He had a cornea transplanted into his right eye in 1958 from the body of an elderly man who was born in June 1885. The operation was carried out at Namsos Hospital, mid-Norway.
“I wouldn’t be surprised if this is the oldest living organ in the world,” eye doctor Hasan Hasanain at Namsos hospital told the Norwegian daily Verdens Gang.
In the 1950s, doctors expected it to work for just five years, Hasanain said. Such cornea operations date back to the early 20th century and were among the first successful transplants.
One Pupil Dilated
I received a panicked call from my younger sister today. She is the mother of one-year-old identical twin girls, born slightly prematurely. During her pregnancy she had a problem with twin-twin transfusion syndrome and had to lie on one side for many weeks to ensure that both girls received an adequate blood supply. She delivered by Cesarean section and fortunately both girls have been doing well. That is, until a few hours ago.
My sister described an episode in which her daughter was in the bathtub and suddenly had one of her pupils become very large. It remained dilated for several minutes, which caused her to call her husband in to take a look. He confirmed that the eye was dilated and they decided to call me right away because they’d heard that a dilated pupil might have something to do with concussions or head injuries, though the little girl had not had any recent trauma to her head.
I tried to get a full history from them – they said she was acting “totally normally” – the usual peeing, pooping, eating checks were fine. They said she was sleeping well, not vomiting or lethargic, and that her pupil had now (after several minutes) returned to normal size. They said her fontanel was not bulging, and when I asked them to shine a light in her eyes they both constricted immediately.
My sister asked me, “what could this be?”
Ugh. I’m not a pediatrician, nor an ophthalmologist, but I do know that asymmetric pupils are usually an ominous sign. All I could think of was “space occupying lesion” but I didn’t want to scare my sister unnecessarily. All the other history sounded so reassuring (the child was well, with no apparent behavior changes, the eye had returned to normal, etc.) that I had to say that they should get in touch with the pediatrician on-call.
And here’s where things got confusing. My mother called me by coincidence just after I hung up the phone with my sister. She had been visiting with the babies for a full week, and slept next to their cribs during their vacation. I told my mom about the pupil issue, and she started relaying some potential “symptoms” that she had witnessed over the past week or so. She claimed that the baby had indeed vomited recently, that her behavior was different than her twin (more irritable and emotionally labile) and that her sleep patterns were also disrupted.
Now I was more concerned – was this early hydrocephalus or maybe even brain cancer? Would I be responsible for missing a diagnosis? I was thousands of miles away from the infants and trying to piece together a story from historians with different observations. So I called some pediatrician friends of mine and asked what they made of this. One said – “anisocoria is a concerning symptom in an infant, she needs a CT or MRI to rule out a tumor pressing on her eye nerve. She should go to the ER immediately.” The other said that since there were no other current symptoms, and the eye was back to normal, it should be worked up by an ophthalmologist as an outpatient.
What a bind to be in – I have some witnesses describing very concerning symptoms, others suggesting that everything’s fine except for a fleeting period of pupil size mis-match. I have dear friends suggesting everything from an immediate ER visit with sedation of the child and a head CT or MRI to watchful waiting and distant outpatient follow up. And I have my sister relying on my judgment (as a non-pediatrician) to tell her what to do.
Here’s what I did – I got my sister and her husband on the phone and explained to them that I take their observation of pupillary dilatation very seriously. I explained that this is not a normal event, and should be followed up by an expert to make sure that there’s no underlying cause of the eye symptoms. I also said that the fact that the baby is acting normally and the eye is no longer dilated are reassuring observations. I told them that they should keep a close eye on the infant, and that if they see any hint of recurrence of the pupil problem, or anything out of the ordinary like vomiting, inconsolability, lethargy, swollen fontanel, fever, or strange body movements or seizures, they should go to the ER immediately. In the meantime they should alert the doctor on-call to the situation and discuss everything with their pediatrician during her next available office hours.
I hope that was the right approach. I will not rest easily until the baby has been fully examined by an expert. Being a doctor carries with it a lot of anxiety and personal responsibility – at any time of the day or night your peace of mind can be uprooted by an abnormal finding relayed to you by friend, family, or patient. And if anything goes wrong – or if interventions are not achieved at an optimal speed and accuracy, this question will forever plague you: “Should I have done something differently?”
Who knew that my relaxing Sunday afternoon would be turned upside down by a dilated pupil?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
Bungee Blindness?
There was a very interesting case report in the New England Journal of Medicine this week. A 25 year old woman went bungee jumping and wound up with sudden decreased vision in one eye. As it turned out, the sudden yank of the bungee cord (while being upside down) caused an increase in pressure in her eye ball (kind of the way the Heimlich maneuver can), and broke one of the blood vessels in the back of her eye. Luckily she had surgery to remove the blood and recovered nearly normal vision in that eye a week later.
If I ever felt tempted to go bungee jumping, this case cured my curiosity. How about you?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
Eye infections caused by parasites
There’s a new contact lens solution scare this week. Last year it was fungus, this year it’s parasites. Apparently there has been an increase in amoebic infections in the eyes of those who use a type of moisturizing contact lens solution. These amoebas are pretty common (and relatively harmless?) in the water supply, but put them in your eyes with a few moisturizing drops and you’ve got yourself a dangerous infection that can even result in blindness. Scientists are puzzled as to why this mixture might increase the risk for infection – some speculate that the moisturizing chemical sticks to the amoebas and keeps them in the eye (rather than having them drop out in your tears). But at this point, no one really knows why there have been increased infection rates, or what the contact lens solution has to do with it.
I guess my advice would be – never put tap water in your eyes or on your contact lenses, and switch to a different brand of contact lens solution than Advanced Medical Optics, Inc.’s Complete Moisture Plus until further notice.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
