- Email: [email protected]
Radiotherapy in Ophthalmic Conditions
BOOK REVIEWS thought that "the inaccurate responses of the child under the age of 6 or 7 need not concern the clinician too much, since few children are doing sustained periods of close work until the third grade or beyond," later quotes from Weymouth, "There is no sub stitute for an accurate neutralization of the refractive error and proper traditional treatment of anomalies of binocular vision." Many of the other chapters are merely compilations from the ophthalmic literature. In the appended bibliography of 16 pages, three fourths of the references are from scientific and ophthalmic sources. Though most of the material presented is already in every ophthalmologist's library, the reading of this book should help the optometrist gain a broader insight into the visual problems of children. James E. Lebensohn. RADIOTHERAPY
IN
OPHTHALMIC
CONDI
By B. Boles-Carenini, E. Balestina, and A. M. Podestà, M.D. (Genova). Pisa, Nistri-Lischi, 1962. 216 pages, 19 illustrations, chapter references, index. Price: Not listed. The authors of this fine book have based their studies on patients treated in the De partments of Ophthalmology and Radiology of the University of Genova, Italy. When ever necessary they have supplemented this knowledge from their vast survey of the medical literature pertaining to this subject, as evidenced by their index of 58 pages. The opening section of the book deals with general information pertaining to Xrays, such as biologic effects, types of radio therapy, types of applicators (radon, radium D, SR90, cobalt), technique of administration and dosage. The various types of eye shields are shown in detail. In a very clear, concise and orderly fash ion they discuss radiotherapy of lesions of the eyelids and conjunctiva, cornea, lens, uvea, vitreous and the retina and optic nerves. This information is presented in the most minute detail and includes total dosage, dos TIONS,
331
age per sitting, number of treatments re quired, distances, portals and filters. The section on retinoblastomas is particularly good. They discuss the complications which can occur following X-ray therapy to the eye, and I believe it is well to keep these in mind particularly when using X-ray therapy for benign conditions. They feel that radiother apy to the lacrimai gland area results in a reduced secretion of tears and can lead to all of the complications usually associated with a "dry" eye. The eyelids may show a hyperemia of the margins with edema of the lids, which usually subsides over a period of several days. If the dosage is marked, how ever, there may be a persistent edema and redness of the lids, desquamation of the skin, loss of eyelashes and eyebrows and alteration of the pigmentation. Late lesions of the lids which can occur include telangiectasia, pigmentation, depigmentation, ul cération and malignant degeneration. The conjunctiva may show a reactive hyperemia with a mucopurulent discharge associated with photophobia and blepharospasm. These effects usually persist for a period of two or three weeks and resolve without sequellae. Late conjunctival lesions which may develop include keratinization of the conjunctival epithelium, conjunctival at rophy, telangiectasia, radio-necrosis and symblepharon. Corneal complications may include super ficial punctate keratitis, filamentary keratitis and superficial ulcérations which usually re solve with no sequellae. Late corneal compli cations may include corneal opacification, cor neal vascularization and a picture resembling interstitial keratitis. Complications of the iris are not common, although some evidence of an iridocyclitis with or without secondary glaucoma may appear. Iris depigmentation and atrophy are known to occur. The sclera may show some evidence of scleritis or necrosis. The lens, as is well known, usually reacts by opacifi cation.
332
BOOK REVIEWS
Retinal complications include pigmentary degeneration, vasodilatation, exudates, hem orrhages, circinate retinopathy and retinal venous occlusion. The bibliography is excellent. I believe that, if this book were translated into Eng lish, it would go a long way toward eliminat ing the wide gap which exists between the ophthalmologist and radiologist when treat ing lesions in or about the eye. Joseph E. Alfano. HUMAN AGING. Edited by J. E. Birren,
Ph.D., R. N. Butler, M.D., S. W. Green house, Ph.D., L. Sokoloff, M.D., and M. R. Yarrow, Ph.D. Washington, D.C., U. S. Government Printing Office, 1963. 328 pages, chapter bibliographies, author and subject indices. Price: $3.00. For a clearer understanding of the normal process of aging, 22 scientists of diverse interests investigated, at the National Insti tute of Mental Health, 47 healthy elderly men, whose age range was from 65 to 92 years. In the group, the 27 without any stigma of major disease differed but little medically from a control group of young healthy men. They were alert, mentally flexable, deeply involved in everyday living and significantly superior to the young men in verbal intelligence. The remaining 20, who revealed a symptomatic evidence of disease, chiefly vascular in type, had distinctly lower verbal abilities. No differences were noted between smokers and nonsmokers. With ad vancing age, regardless of the state of health, glucose utilization was reduced without a corresponding change in oxygen consumption and the EEG spectrum showed a shift to slower activities. Slowing of psychomotor responses occurred with both auditory and visual stimuli. Blood pressure did not in crease except with concomitant arterio sclerosis. Psychologic depression accompany ing cultural displacement, lack of income and
especially the loss of intimate persons tended to amplify, if not initiate, changes in the nervous system and the rest of the organism. Well-adjusted individuals, who retain their health, stay remarkably young in spite of advancing age. The great Edward Jackson, at the age of 87 years, gave a course at the Academy. Quoting Longfellow: "Goethe at Weimar toiling to the last, finished his Faust when eighty years were past." In statecraft, Churchill, Adenauer and Clemenceau "serve to show how far the gulf stream of our life may flow." James E. Lebensohn.
CYBERNÉTIQUE DE LA CONSULTATION.
(Cy
bernetics in Medical Practice.) By Fran çois Paycha, M.D. Paris, Gauthier-Villars, 1963. 192 pages, 13 figures. Paperbound. Price: $4.75. Cybernetics is not only a means by which a machine based on the feed-back concept can control machines, but cybernetic machines such as the digital computer are already tools of research and can be found in almost every major university. Paycha, who dedicates this volume to three outstanding French ophthal mologists (Viallefont of Montpellier, Jayle of Marseilles and Dubois-Poulsen of Paris), is fascinated with cybernetics as an aid to medical diagnosis and treatment. In his method the question-mark serves for matters of doubt. The substantial literature on the logic of decision-making under uncertainty goes back to Pascal, Bernoulli and Bayes. Eventually medical centers may utilize com puters to supplement the medical judgment gained by knowledge and experience. Further investigation may supplant speculation in re gard to the cybernetics of the human machine. The writings of D. Stanley-Jones, which in clude the cybernetics of ocular movement, are an interesting beginning in this field. James E. Lebensohn.
IN
OPHTHALMIC
CONDI
By B. Boles-Carenini, E. Balestina, and A. M. Podestà, M.D. (Genova). Pisa, Nistri-Lischi, 1962. 216 pages, 19 illustrations, chapter references, index. Price: Not listed. The authors of this fine book have based their studies on patients treated in the De partments of Ophthalmology and Radiology of the University of Genova, Italy. When ever necessary they have supplemented this knowledge from their vast survey of the medical literature pertaining to this subject, as evidenced by their index of 58 pages. The opening section of the book deals with general information pertaining to Xrays, such as biologic effects, types of radio therapy, types of applicators (radon, radium D, SR90, cobalt), technique of administration and dosage. The various types of eye shields are shown in detail. In a very clear, concise and orderly fash ion they discuss radiotherapy of lesions of the eyelids and conjunctiva, cornea, lens, uvea, vitreous and the retina and optic nerves. This information is presented in the most minute detail and includes total dosage, dos TIONS,
331
age per sitting, number of treatments re quired, distances, portals and filters. The section on retinoblastomas is particularly good. They discuss the complications which can occur following X-ray therapy to the eye, and I believe it is well to keep these in mind particularly when using X-ray therapy for benign conditions. They feel that radiother apy to the lacrimai gland area results in a reduced secretion of tears and can lead to all of the complications usually associated with a "dry" eye. The eyelids may show a hyperemia of the margins with edema of the lids, which usually subsides over a period of several days. If the dosage is marked, how ever, there may be a persistent edema and redness of the lids, desquamation of the skin, loss of eyelashes and eyebrows and alteration of the pigmentation. Late lesions of the lids which can occur include telangiectasia, pigmentation, depigmentation, ul cération and malignant degeneration. The conjunctiva may show a reactive hyperemia with a mucopurulent discharge associated with photophobia and blepharospasm. These effects usually persist for a period of two or three weeks and resolve without sequellae. Late conjunctival lesions which may develop include keratinization of the conjunctival epithelium, conjunctival at rophy, telangiectasia, radio-necrosis and symblepharon. Corneal complications may include super ficial punctate keratitis, filamentary keratitis and superficial ulcérations which usually re solve with no sequellae. Late corneal compli cations may include corneal opacification, cor neal vascularization and a picture resembling interstitial keratitis. Complications of the iris are not common, although some evidence of an iridocyclitis with or without secondary glaucoma may appear. Iris depigmentation and atrophy are known to occur. The sclera may show some evidence of scleritis or necrosis. The lens, as is well known, usually reacts by opacifi cation.
332
BOOK REVIEWS
Retinal complications include pigmentary degeneration, vasodilatation, exudates, hem orrhages, circinate retinopathy and retinal venous occlusion. The bibliography is excellent. I believe that, if this book were translated into Eng lish, it would go a long way toward eliminat ing the wide gap which exists between the ophthalmologist and radiologist when treat ing lesions in or about the eye. Joseph E. Alfano. HUMAN AGING. Edited by J. E. Birren,
Ph.D., R. N. Butler, M.D., S. W. Green house, Ph.D., L. Sokoloff, M.D., and M. R. Yarrow, Ph.D. Washington, D.C., U. S. Government Printing Office, 1963. 328 pages, chapter bibliographies, author and subject indices. Price: $3.00. For a clearer understanding of the normal process of aging, 22 scientists of diverse interests investigated, at the National Insti tute of Mental Health, 47 healthy elderly men, whose age range was from 65 to 92 years. In the group, the 27 without any stigma of major disease differed but little medically from a control group of young healthy men. They were alert, mentally flexable, deeply involved in everyday living and significantly superior to the young men in verbal intelligence. The remaining 20, who revealed a symptomatic evidence of disease, chiefly vascular in type, had distinctly lower verbal abilities. No differences were noted between smokers and nonsmokers. With ad vancing age, regardless of the state of health, glucose utilization was reduced without a corresponding change in oxygen consumption and the EEG spectrum showed a shift to slower activities. Slowing of psychomotor responses occurred with both auditory and visual stimuli. Blood pressure did not in crease except with concomitant arterio sclerosis. Psychologic depression accompany ing cultural displacement, lack of income and
especially the loss of intimate persons tended to amplify, if not initiate, changes in the nervous system and the rest of the organism. Well-adjusted individuals, who retain their health, stay remarkably young in spite of advancing age. The great Edward Jackson, at the age of 87 years, gave a course at the Academy. Quoting Longfellow: "Goethe at Weimar toiling to the last, finished his Faust when eighty years were past." In statecraft, Churchill, Adenauer and Clemenceau "serve to show how far the gulf stream of our life may flow." James E. Lebensohn.
CYBERNÉTIQUE DE LA CONSULTATION.
(Cy
bernetics in Medical Practice.) By Fran çois Paycha, M.D. Paris, Gauthier-Villars, 1963. 192 pages, 13 figures. Paperbound. Price: $4.75. Cybernetics is not only a means by which a machine based on the feed-back concept can control machines, but cybernetic machines such as the digital computer are already tools of research and can be found in almost every major university. Paycha, who dedicates this volume to three outstanding French ophthal mologists (Viallefont of Montpellier, Jayle of Marseilles and Dubois-Poulsen of Paris), is fascinated with cybernetics as an aid to medical diagnosis and treatment. In his method the question-mark serves for matters of doubt. The substantial literature on the logic of decision-making under uncertainty goes back to Pascal, Bernoulli and Bayes. Eventually medical centers may utilize com puters to supplement the medical judgment gained by knowledge and experience. Further investigation may supplant speculation in re gard to the cybernetics of the human machine. The writings of D. Stanley-Jones, which in clude the cybernetics of ocular movement, are an interesting beginning in this field. James E. Lebensohn.