t’s the brain, after all, that devises experiments and interprets their results. How the brain perceives, how it makes decisions and judgments, and how those judgments can go awry are at least as important to science as knowing the intricacies of nonbiotic experimental machinery. And as any brain scientist will tell you, there’s still a long way to go before understanding the brain will get crossed off science’s to-do list. But there has been progress. A recent special issue of the journal Neuron offers a convenient set of “perspective” papers exploring the current state of understanding of the brain’s inner workings. Those papers show that a lot is known. But at the same time they emphasize that there’s a lot we don’t know.

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Phacolytic glaucoma usually is associated with a mature or hypermature cataract and typically occurs in elderly patients. Today, phacolytic glaucoma is rare in the United States, found primarily in areas where access to care is poor. Will the increase in the number of under- and uninsured patients lead to an increase in this condition? Evaluation and Diagnosis Signs and symptoms. Patients typically report acute-onset pain, decreased vision, tearing and photophobia. Examination will reveal injection, corneal edema, elevated IOP, anterior chamber reaction with or without pseudohypopyon, particles on the lens capsule and anterior capsule wrinkling. Patient history. The duration of symptoms should be elicited; a delayed presentation of more than five days since onset can result in glaucomatous disc damage and poorer prognosis.¹ The ocular history may reveal that the patient decided against removal of an advanced cataract. Prior intraocular surgery or trauma may have left residual lens material that could cause phacoanaphylactic glaucoma or exacerbate infectious endophthalmitis. Visual acuity and visual potential should be assessed. Exam essentials. A complete ophthalmologic examination should be done. The eye should be inflamed, and the cornea may be edematous due to the high IOP. The anterior chamber will demonstrate massive inflammation and/ or pseudohypopyon. Gonioscopy is essential; it will help rule out angle closure due to phacomorphic glaucoma or neovascularization of the angle. Assess ment of the posterior pole should be performed to rule out vitreous hemorrhage (which can result in ghost-cell glaucoma) or vitritis (which may be associated with infectious endophthalmitis or panuveitis). If the view to the fundus is obstructed, B-scan ultrasonography also should be performed. Differential diagnosis. The differential diagnosis includes infectious endophthalmitis, phacoanaphylactic glaucoma, inflammatory glaucoma, glaucoma secondary to intraocular tumor, phacomorphic glaucoma, acute-angle closure glaucoma and neovascular glaucoma. Management Medication. Medical management is used to temporarily control the glaucoma and inflammation. Initial treatment consists of hyperosmotic agents, aqueous suppressants, anti-inflammatory drugs and cycloplegics. Surgery. Definitive treatment is removal of the lens via extracapsular cataract extraction with or without an IOL. Some ophthalmologists defer placement of an IOL until after the inflammation subsides; however, there is no significant difference in final visual acuity between those patients who did receive an IOL and those who did not.¹ If the phacolytic glaucoma is of long duration (more than seven days), a combined trabeculectomy may be needed to prevent postoperative IOP spikes.² In eyes with hypermature Morgagnian cataracts, one must be especially careful, as the capsule is fragile, the zonules are weak and the view is difficult due to the white, milky cortex. Vision limited to light perception on presentation is not a contraindication to performing cataract extraction. Surgical Tips For a planned extracapsular cataract extraction with a posterior chamber IOL, fashion a superior fornix-based conjunctival flap.³ Make a partial-thickness incision along the sclerolimbal junction superiorly for 120 degrees with a No. 69 blade. Forty-five degrees away, a paracentesis should be done to decompress the eye. The anterior chamber fluid can be withdrawn for analysis, to look for macrophages and high molecular-weight proteins. Inject balanced salt solution in a cannula to wash out any residual particulate matter, then inject Healon or viscoelastic into the anterior chamber. Make an incision entering the anterior chamber at the 12 o’clock position with a keratome. A 26-gauge cystotome mounted on a syringe is then introduced through the 12 o’clock incision and used to puncture the capsular bag. The milky cortex should be aspirated as much as possible, until the nucleus is visible. Withdraw the needle through the keratome incision, then inject Healon through the 12 o’clock incision into the capsular bag. Next, enlarge the corneoscleral keratome incision with curved Westcott scissors to 120 degrees. Perform a partial V-shaped capsulotomy; this can be done either with the cystotome or with an angled Vannas scissors. Place viscoelastic under the nucleus to float the nucleus and sever any adhesions between the nucleus and the capsule. The nuclear portion of the lens can then be removed with an irrigating vectis (lens loop) with or without gentle pressure at the inferior limbus (6 o’clock). Irrigate and aspirate the residual cortex with the Simcoe cannula. Inspect the capsular bag; if it is intact, place a posterior chamber IOL into the bag. Close the incision with several interrupted 10-0 monofilament nylon sutures and reattach the conjunctival flap. Potential Sequelae and Prognosis Postoperatively, the patient should be managed with topical steroids and/or aqueous suppressants and hyperosmotics if necessary. Vitreous opacification behind the posterior capsule occurs in a small percentage of eyes. These vitreous opacities are typically absorbed by one to two weeks postoperatively. IOP usually is controlled without antiglaucoma medications after the cataract removal. A detailed glaucoma evaluation (including repeat gonioscopy to assess for peripheral anterior synechiae, visual field and optic nerve status) should be done to assess the extent of glaucomatous damage. The prognosis is dependent on the duration of elevated IOP, PAS and optic nerve damage. In one study, patients who were older than 60 and whose glaucoma was present for more than five days did significantly worse than a comparison group of younger individuals with shorter disease duration.

ESCLEROTERAPIA

Fibrodysplasia ossificans progressiva (FOP) is a disorder in which muscle tissue and connective tissue such as tendons and ligaments are gradually replaced by bone (ossified), forming bone outside the skeleton (extra-skeletal or heterotopic bone) that constrains movement. This process generally becomes noticeable in early childhood, starting with the neck and shoulders and proceeding down the body and into the limbs. Extra-skeletal bone formation causes progressive loss of mobility as the joints become affected. Inability to fully open the mouth may cause difficulty in speaking and eating. Over time, people with this disorder may experience malnutrition due to their eating problems. They may also have breathing difficulties as a result of extra bone formation around the rib cage that restricts expansion of the lungs.

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Medical technology continues to advance and help doctors continue to treat patients. From face transplants to LASIK eye surgery watch the video below for 8 medical procedures that are improving lives.

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8 Medical Procedures That Are Improving Lives

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aricose veins are gnarled, enlarged veins. Any vein may become varicose, but the veins most commonly affected are those in your legs and feet. That's because standing and walking upright increases the pressure in the veins of your lower body. For many people, varicose veins and spider veins — a common, mild variation of varicose veins — are simply a cosmetic concern. For other people, varicose veins can cause aching pain and discomfort. Sometimes varicose veins lead to more-serious problems.

Examination of different gaits

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Loyola Respiratory System Exam Part 1 A video from Loyola Medical School, Chicago showing the medical and clinical examination of the respiratory system.

Part 6: from Loyola Medical School, Chicago showing clinical examination of the neurological system.