The contours of informed consent
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side effect of tamoxifen is the deposition of small refractile or crystalline deposits in the retinal nerve fiber layer and inner plexiform layer. Macular edema may accompany the retinal deposits, the number and size of which do not change with cessation of tamoxifen. Keratopathy associated with the drug includes subepithelial deposits, whorls, and linear opacities. The corneal changes are not visually signif- icant and typically improve or resolve when tamoxi- fen is discontinued. Ocular toxicity associated with tamoxifen usually occurs in patients who receive high daily doses (>180 mg/day), with total cumulative doses of greater than 100 g. Because "it is not reasonable to expect a nonophthalmologist to detect early tamoxifen ocular toxicity," the authors encour- age baseline ophthalmologic examinations and fol- low-up monitoring of any ocular symptoms that develop during therapy.—George B. Bartley * Division of Cancer Prevention and Control, National Cancer Institute, Executive Plaza Notth, Room 201 A, Bethesda, MD 20892. • Use and interpretation of rheumatologic tests: a guide for clinicians. Moder KG*. Mayo Clin Proc 1996;71:391-6. N RECENT YEARS, SEVERAL NEW AUTOANTIBODY TESTS have been developed and are being used in the field of rheumatology, including the antineutrophil cyto- plasmic antibody (ANCA) and myositis-specific anti- bodies such as anti-Jol. Positive test results for ANCAs reveal one of two basic staining patterns: cytoplasmic (c-ANCA) or perinuclear (p-ANCA). The Jol antibody test is often helpful at the time of diagnosis of a new case of idiopathic inflammatory myopathy. Herein this article reviews the clinical utility of the new tests in conjunction with the established autoantibody tests including antinuclear antibodies and extractable nuclear antibodies. Both the antinuclear antibody and extractable nuclear antibody tests are helpful in diagnosing connective tissue diseases. Before the results of any of these tests can be interpreted, the physician must consider the sensitivity, specificity, and negative and positive pre- dictive values. Positive results must be analyzed in the clinical context and in relationship to other autoanti- body test results.—Author's abstract * Division of Rheumatology, Mayo Clinic Rochester, 200 First St. S.W., Rochester, MN 55905. • Laser safety features of eye shields. Ries WR*, Clymer MA, Reinisch L. Lasers Surg Med 1996; 18:309-15. P ATIENTS UNDERGOING PERIORBITAL LASER SURGERY wear protective eye shields during the procedure. Six commercially available eye shields were tested with four different lasers (a Nd:YAG laser, a carbon dioxide laser, a flash lamp-pumped dye laser, and an argon ion laser) at three intensity settings. The laser was focused on the shield and the intensity and exposure duration required for visible damage to the shield were determined. The temperature on the undersurface of the eye shield was measured. Thermal response curves and rates of warming for each of the six eye shields were generated. Plastic shields showed significant thermal damage with most of the lasers tested, whereas metallic shields warmed more slowly and to a lesser degree. The authors recommend that plastic shields not be used for eye protection during periorbital laser surgery.—George B. Bartley *Medical Center North, Vanderbilt University Medical Center, Nash- ville, TN 27232-2559. • The contours of informed consent. Lanckton AVC*. Surv Ophthalmol 1996;40:391-4. T HE DOCTRINE AND CONTENT OF INFORMED CON- sent are discussed. General guidelines, which apply in most cases, are summarized. Requirements for providing informed consent vary when the pa- tient's age or mental status do not allow complete understanding, or when an emergency situation pre- cludes following the usual procedure.—Author's ab- stract *Craig and Macauley, Federal Reserve Plaza, 600 Atlantic Ave., Boston, MA 02210. 146 AMERICAN JOURNAL OF OPHTHALMOLOGY JULY I 996
Transcript of The contours of informed consent
side effect of tamoxifen is the deposition of small refractile or crystalline deposits in the retinal nerve fiber layer and inner plexiform layer. Macular edema may accompany the retinal deposits, the number and size of which do not change with cessation of tamoxifen. Keratopathy associated with the drug includes subepithelial deposits, whorls, and linear opacities. The corneal changes are not visually significant and typically improve or resolve when tamoxifen is discontinued. Ocular toxicity associated with tamoxifen usually occurs in patients who receive high daily doses (>180 mg/day), with total cumulative doses of greater than 100 g. Because "it is not reasonable to expect a nonophthalmologist to detect early tamoxifen ocular toxicity," the authors encourage baseline ophthalmologic examinations and follow-up monitoring of any ocular symptoms that develop during therapy.—George B. Bartley
* Division of Cancer Prevention and Control, National Cancer Institute, Executive Plaza Notth, Room 201 A, Bethesda, MD 20892.
• Use and interpretation of rheumatologic tests: a guide for clinicians. Moder KG*. Mayo Clin Proc 1996;71:391-6.
N RECENT YEARS, SEVERAL NEW AUTOANTIBODY TESTS
have been developed and are being used in the field of rheumatology, including the antineutrophil cyto-plasmic antibody (ANCA) and myositis-specific antibodies such as anti-Jol. Positive test results for ANCAs reveal one of two basic staining patterns: cytoplasmic (c-ANCA) or perinuclear (p-ANCA). The Jol antibody test is often helpful at the time of diagnosis of a new case of idiopathic inflammatory myopathy. Herein this article reviews the clinical utility of the new tests in conjunction with the established autoantibody tests including antinuclear antibodies and extractable nuclear antibodies. Both the antinuclear antibody and extractable nuclear antibody tests are helpful in diagnosing connective tissue diseases. Before the results of any of these tests can be interpreted, the physician must consider the sensitivity, specificity, and negative and positive predictive values. Positive results must be analyzed in the
clinical context and in relationship to other autoantibody test results.—Author's abstract
* Division of Rheumatology, Mayo Clinic Rochester, 200 First St. S.W., Rochester, MN 55905.
• Laser safety features of eye shields. Ries WR*, Clymer MA, Reinisch L. Lasers Surg Med 1996; 18:309-15.
PATIENTS UNDERGOING PERIORBITAL LASER SURGERY
wear protective eye shields during the procedure. Six commercially available eye shields were tested with four different lasers (a Nd:YAG laser, a carbon dioxide laser, a flash lamp-pumped dye laser, and an argon ion laser) at three intensity settings. The laser was focused on the shield and the intensity and exposure duration required for visible damage to the shield were determined. The temperature on the undersurface of the eye shield was measured. Thermal response curves and rates of warming for each of the six eye shields were generated. Plastic shields showed significant thermal damage with most of the lasers tested, whereas metallic shields warmed more slowly and to a lesser degree. The authors recommend that plastic shields not be used for eye protection during periorbital laser surgery.—George B. Bartley
*Medical Center North, Vanderbilt University Medical Center, Nashville, TN 27232-2559.
• The contours of informed consent. Lanckton AVC*. Surv Ophthalmol 1996;40:391-4.
THE DOCTRINE AND CONTENT OF INFORMED CON-
sent are discussed. General guidelines, which apply in most cases, are summarized. Requirements for providing informed consent vary when the patient's age or mental status do not allow complete understanding, or when an emergency situation precludes following the usual procedure.—Author's abstract
*Craig and Macauley, Federal Reserve Plaza, 600 Atlantic Ave., Boston, MA 02210.
146 AMERICAN JOURNAL OF OPHTHALMOLOGY JULY I 996
