Objective: To investigate the effectiveness of hot water immersion for the treatment of Physalia sp. (bluebottle or Portuguese Man‐of‐War) stings. Design: Open‐label, randomised comparison trial. Primary analysis was by intention to treat, with secondary analysis of nematocyst‐confirmed stings. One halfway interim analysis was planned. Setting: Surf lifesaving first aid facilities at two beaches in eastern Australia from 30 December 2003 to 5 March 2005. Participants: 96 subjects presenting after swimming in the ocean for treatment of an apparent sting by a bluebottle. Interventions: Hot water immersion (45°C) of the affected part versus ice pack application. Main outcome measures: The primary outcome was a clinically important reduction in pain as measured by the visual analogue scale (VAS). Secondary outcomes were the development of regional or radiating pain, frequency of systemic symptoms, and proportion with pruritus or rash on follow‐up. Results: 49 patients received hot water immersion and 47 received ice packs. The two groups had similar baseline features, except patients treated with hot water had more severe initial pain (VAS [mean ± SD]: 54 ± 22 mm versus 42 ± 22 mm). After 10 minutes, 53% of the hot water group reported less pain versus 32% treated with ice (21%; 95% CI, 1%–39%; P = 0.039). After 20 minutes, 87% of the hot water group reported less pain versus 33% treated with ice (54%; 95% CI, 35%–69%; P = 0.002). The trial was stopped after the halfway interim analysis because hot water immersion was shown to be effective (P = 0.002). Hot water was more effective at 20 minutes in nematocyst‐confirmed stings (95% versus 29%; P = 0.002). Radiating pain occurred less with hot water (10% versus 30%; P = 0.039). Systemic effects were uncommon in both groups. Conclusions: Immersion in water at 45°C for 20 minutes is an effective and practical treatment for pain from bluebottle stings.

Background:  With the increase in the prevalence of diabetes, rural optometric clinics stand to increase their patient load and assessment of diabetic eye disease. This study aimed to assess whether automated identification of diabetic retinopathy based on the presence of microaneurysms is an effective tool in clinical practice. Methods:  We analysed 758 fundal images of 385 patients with diabetes attending the clinic obtained using a Canon CR5 with an EOS10 digital camera through a dilated pupil. Five optometrists employed in the clinic assessed the diabetic retinopathy using binocular indirect ophthalmoscopy. The sensitivity and specificity of the automated system used to analyse the retinal fundal images was determined by comparison with optometric and ophthalmologic assessment. Results:  The optometrists achieved 97 per cent sensitivity at 88 per cent specificity with respect to the ophthalmic classification for detecting retinopathy. The automated retinopathy detector achieved 85 per cent sensitivity at 90 per cent specificity at detecting retinopathy. Conclusion:  The automated microaneurysm detector has a lower sensitivity compared to the optometrists but meets NHMRC guidelines. It may impact on the efficiency of rural optometric practices by early identification of diabetic retinopathy. Automated assessment can save time and be cost‐effective, and provide a history of changes in the retinal fundus and the opportunity for instant patient education using the digital images.

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Supplemental intravitreal gas injection was used in the early postoperative period in an attempt to achieve long term retinal reattachment in 11 cases of failed scleral buckling surgery. Success was dependent on the presence of a correctly placed scleral buckle underlying all breaks. Surgical revision was thereby avoided in these patients. However, when the scleral buckle was inadequate the technique failed.The incidence of failure of retinal detachment surgery is 5-10%.' Failure of the primary surgical procedure may have several unfavourable consequences, most notably the development of proliferative vitreoretinopathy (PVR), which is the main reason for long term failure of reattachment.2 Surgical revision increases the risk of complications, lengthens morbidity, and is itself implicated in the genesis of PVR.A simple method of restoring retinal attachment following failure in the early postoperative period may avoid surgical revision, lessen the risk of PVR, and should therefore improve the success rate for long term retinal reattachment.Intravitreal gas injection is a widely used method of retinal break tamponade. 'Pneumatic retinopexy' is considered an alternative to scleral buckling surgery and may be used in the management of established failure of scleral buckling surgery.3 Bedside intravitreal air injection has been successfully used for persistent subretinal fluid (SRF) in seven patients after non-drainage scleral buckling procedures. 4 We have reviewed our use of a technique of supplemental intravitreal gas injection for redetachment in the early postoperative period after scleral buckling surgery. Our aim was to reattach the retina by the simplest effective method as soon as progressive redetachment was observed.Patients and method