Fluoxetine-induced SIADH: a geriatric occurrence?

After major depression was diagnosed in a 83-year-old woman, fluoxetine was prescribed. Six days later she became delirious and weak, necessitating hospitalization. She was found to have hyponatremia secondary to fluoxetine-induced syndrome of inappropriate antidiuretic hormone secretion (SIADH). Recovery was complete after discontinuation of the medication.

A prospective, randomized, double-masked comparison of a zonal-progressive multifocal intraocular lens and a monofocal intraocular lens

INTRODUCTION

Multifocal intraocular lenses (IOLs) have been designed to provide improved near visual acuity without spectacles compared with monofocal IOLs. Early studies have reported variables amounts of decreased visual acuity and contrast sensitivity with multifocal IOLs, and some patients have experienced halos and glare.

METHODS

The authors performed a prospective, double-masked, multicenter evaluation of 62 patients randomized between a new zonal-progressive optic multifocal IOL and a monofocal IOL.

RESULTS

Mean postoperative spherical equivalent, astigmatism, and uncorrected and best-corrected distance visual acuity were similar between the two groups. Patients with a multifocal IOL achieved significantly better uncorrected near visual acuity than patients with monofocal IOLs (J3+ versus J7; P less than 0.0001). With distance correction only, mean near visual acuity was J2 versus J5- (P = 0.0001). Best-corrected near visual acuity was J1 for both groups, with 1.36 diopters (D) for the multifocal group versus 2.37 D for the monofocal group (P less than 0.0001). Regan contrast sensitivity was lower for the multifocal patients at all contrast levels, and achieved statistical significance at very low contrast (11% contrast; P = 0.0024). Fifty-two percent of patients with a multifocal IOL reported that they did not need spectacles at all or used them only for their fellow eye, compared with 25% of the patients with monofocal IOLs.

CONCLUSION

Both monofocal and multifocal implant patients were very satisfied with the results of their cataract extraction and IOL implant surgery. A small loss of contrast sensitivity with the multifocal IOL was demonstrated, consistent with theoretical predictions. The functional significance of the loss of contrast sensitivity appears to be small and counterbalanced by the advantage of improved uncorrected near visual acuity.

Silicone intraocular lens implants and circular anterior capsulotomy (capsulorhexis)

Anterior circular capsulorhexis is used to guarantee accurate placement and stability for the flexible silicone intraocular lens. The smaller wound needed for this procedure allows for immediate postoperative bending by the patient. The visual results achieved with this implant are excellent.

Dentists who practice with spouses or relatives: a pilot study of practitioners in Iowa

Of 130 practicing dentists in Iowa surveyed, 73, or 6% of the practicing dentists in that state, responded that they worked with a total of 108 relatives. Half of the relatives were the dentists' spouses. One to ten relatives worked in each office. Overall, the dentists were satisfied with the associations and expected them to continue. Most dentists had informally defined associations, and 10% had written contracts. Dentists named "office policy and organization" most often and "finances" least often as motives behind the associations and "personal growth" most often and "recognition" least often as a satisfaction with the association. The respondents suggested 567 ideas for other dentists considering such associations.

Effect of proteolytic enzymes on caries lesion formation in vitro

This study investigates enzyme degradation of collagen at various pH levels and is designed to obtain information pertaining to the effect of proteolytic enzymes on caries-like lesion formation and progression. One hundred and eight sections of human teeth with exposed areas on enamel and root face, were placed into an enzyme/buffer system maintained at pH levels of 4.0, 5.5 and 7.0. Periodically, throughout the experimental period, sections were removed and examined histologically for caries-like lesion formation. Results showed consistent surface erosion occurring on the root face only at a pH level of 5.5 in buffer containing enzymes. Sections placed in pH 5.5 buffer only, which served as controls, showed obvious lesion formation on the root face, but with histologically intact surfaces. This interaction occurring between enzymatic activity and acid demineralization suggests that enzymes may have a contributory effect on caries lesion formation in root surfaces.

Altered colchicine-binding capacity in chick brain regions: relationship to intensity or information content of visual input

The binding of [3H]colchicine to postmitochondrial supernatant fractions of chick brain has been studied, absorbing colchicine-bearing proteins on DEAE-cellulose filter discs. This was assayed at several times after unilateral enucleation of day-old chicks. Binding was unaltered in optic lobes or anterior dorsal forebrain regions contralateral to the removed eye, relative to the corresponding regions contralateral to and thus directly or secondarily innervated by the intact eye. Colchicine binding was also assayed after training chicks to suppress pecking at a metallic bead coated with aversive-tasting methylanthranilate. At 4 but not 24 h after the one-trial training, binding was selectively elevated in the anterior dorsal forebrain roof. Results are taken to imply that alterations in tubulin content of chick brain may reflect stress-related changes, possibly mediated by systemic endocrine flux, rather than a more localized learning experience.

Crown repair with a cast post and core

A technique to make a post and core pattern that can be used to save an existing crown has been presented. The technique should become an additional tool in the treatment armamentarium.

Hyperplastic primary vitreous with microphthalmos and ocular communicating orbital cyst

A 4-month old child with findings of persistent hyperplastic primary vitreous was also noted to have an ocular communicating orbital cyst in the same eye. The ocular component of the cyst was observed to move.

Suppression of postoperative pain by preoperative administration of ibuprofen in comparison to placebo, acetaminophen, and acetaminophen plus codeine

The analgesic effect of preoperatively administered ibuprofen was evaluated in 107 dental outpatients undergoing the removal of impacted third molars. Subjects were given 800 mg ibuprofen prior to the procedure and 400 mg ibuprofen 4 and 8 hours later. Comparison was made to groups receiving either placebo at all three doses, 600 mg acetaminophen administered on the same schedule, or preoperatively administered placebo followed by two doses of postoperatively administered 600 mg acetaminophen plus 60 mg codeine. Ibuprofen pretreatment resulted in significantly less pain than placebo or acetaminophen pretreatment as the local anesthetic wore off. Ibuprofen also resulted in less postoperative pain than acetaminophen plus codeine following the second dose. Side effects were similar across drug treatments and placebo with the exception of greater reports of drowsiness following the opiate-analgesic combination. These findings indicate that pretreatment with a nonsteroidal antiinflammatory drug, such as ibuprofen, results in a suppression of postoperative pain when compared to standard therapy without an increase in side effects.

Removal of partially loosened fixed partial dentures

The technique described offers maximum safety for the abutment tooth and the probability of salvage of the existing restoration. The options of reusing the restoration or recementing it as a temporary restoration are both attractive.

Sensitivity and specificity of early diagnostic tests of lung function in smokers

What are the relative sensitivities and specificities of the "early" tests of lung dysfunction? We describe the findings from a study of virtually the entire population of a rural pollution-free community. Using abnormal spirometry as a marker of obstructive disease, we evaluated the two tests obtained from the single-breath nitrogen curve, closing volume (CV/VC) and the slope of the alveolar plateau (delta N2/L), as well as combinations of the two tests. While CV/VC is highly specific (92.3 percent in male and 94.0 percent in female subjects), it lacks sensitivity (36.8 percent in male and 13.3 percent in female subjects) and is abnormal in only 10.0 and 6.5 percent of male and female smokers, respectively, a percentage not dissimilar from the percentage with abnormal spirometry. However, delta N2/L, abnormal in 24.1 percent of male smokers and 28.8 percent of female smokers, rates reasonably well with regard to both sensitivity (63.2 percent in male and 66.7 percent in female subjects) and specificity (79.3 percent in male and 74.0 percent in female subjects). The group of smokers with abnormal delta N2/L did include fair numbers with abnormal spirometry (20.7 percent in male and 16.1 percent in female subjects). A combination of the two tests (abnormal in either delta N2/L and/or CV/VC) has good sensitivity (68.4 and 80.0 percent for male and female subjects, respectively) and specificity (74.3 and 69.0 percent for male and female subjects, respectively).

Cavernous hemangioma of the optic disc

Cavernous hemangioma of the optic disc and retina is a vascular hamartoma composed of clusters of thin-walled saccular aneurysms partially filled with dark venous blood. It is now considered a neuro-oculo-cutaneous syndrome whose mode of inheritance is probably autosomal dominant. This report describes a cavernous hemangioma of the optic disc in a patient without skin or neurological findings. Its clinical appearance, generally benign ocular nature, and occasional association with central nervous system or cutaneous lesions is emphasized.

Temporomandibular joint marking for radionuclide bone scintigraphy

Anatomical marking of the temporomandibular joint has led to a practical method of delineating and evaluating the temporomandibular joint and glenoid fossa by radionuclide bone scintigraphy.