Laser photocoagulation for macular soft drusen. Updated results

PURPOSE

To update the results of a study on the disappearance of macular soft drusen after laser treatment in the natural evolution of age-related macular degeneration.

METHODS

A total of 46 patients with confluent soft drusen and pigmentary changes were studied prospectively. Group 1 was composed of 30 patients with bilateral drusen; the authors randomly assigned one eye of each patient for treatment and the fellow eye for the control. In 16 patients a choroidal neovascular membrane was present in one eye, and treatment was applied to the fellow eye (group 2). Argon green laser treatment was applied directly to the soft drusen in the temporal macula.

RESULTS

All treated drusen disappeared in a mean of 3.5 months after treatment, and untreated drusen disappeared in all but three patients in an average of 8.5 months. After an average period of 3 years, only one control eye and none of the treated eyes in group 1 developed a choroidal neovascular membrane (P = 0.500). In group 2, neovascularization occurred in 18% of the patients. The initial improvement in Snellen acuity after subfoveal drusen disappearance diminished as a consequence of cataract progression.

CONCLUSIONS

Although no definitive conclusions should be made because of the small number of patients studied, results seem to show that this treatment does not reduce the risk of choroidal neovascularization in the treated eye of patients with a history of exudative disease in the fellow eye. It may be effective in patients with high-risk bilateral soft drusen, that is, in less advanced stages of the disease.

Diagnosis of adenovirus conjunctivitis by enzyme immunoassay

The diagnosis of adenovirus conjunctivitis using a commercial enzyme immunoassay (EIA) was investigated and compared with virus isolation in cell culture. Of 53 eye swabs previously shown to be adenovirus-positive, EIA was positive with 33 and isolation in PLC/PRF/5 cells was successful with 49. Isolates were typed by serum neutralisation. Adenovirus types 3 and 4 were most common, with 14 and 12 isolates respectively. Nine isolates were found to be type 8 and eight were classified as untyped following unsuccessful neutralisation by antisera to types 1-8 and 14. The potential of EIA, and possible modifications to increase sensitivity, are discussed.

LIM-kinase1 hemizygosity implicated in impaired visuospatial constructive cognition

To identify genes important for human cognitive development, we studied Williams syndrome (WS), a developmental disorder that includes poor visuospatial constructive cognition. Here we describe two families with a partial WS phenotype; affected members have the specific WS cognitive profile and vascular disease, but lack other WS features. Submicroscopic chromosome 7q11.23 deletions cosegregate with this phenotype in both families. DNA sequence analyses of the region affected by the smallest deletion (83.6 kb) revealed two genes, elastin (ELN) and LIM-kinase1 (LIMK1). The latter encodes a novel protein kinase with LIM domains and is strongly expressed in the brain. Because ELN mutations cause vascular disease but not cognitive abnormalities, these data implicate LIMK1 hemizygosity in imparied visuospatial constructive cognition.

Mapping the meanings of novel visual symbols by youth with moderate or severe mental retardation

The word-learning ability of 12 school-age subjects with moderate or severe mental retardation was assessed. Subjects had little or no functional speech and used the System for Augmenting Language with visual-graphic symbols for communication. Their ability to fast map novel symbols revealed whether they possessed the novel name-nameless category (N3C) lexical operating principle. On first exposure, 7 subjects were able to map symbol meanings for novel objects. Follow-up assessments indicated that mappers retained comprehension of some of the novel words for up to delays of 15 days and generalized their knowledge to production. Ability to fast map reliably was related to symbol achievement status. Implications for understanding vocabulary acquisition by youth with mental retardation were discussed.

Acquisition of the novel name-nameless category (N3C) principle by young children who have Down syndrome

Acquisition of the novel name-nameless category (N3C) principle by 22 children with Down syndrome between the ages of 2.42 and 3.33 years was examined to investigate the generalizability of a new approach to early lexical development: the developmental lexical principles framework. Results indicated that, as predicted, the N3C principle (operationally defined as the ability to fast map a new word to a [basic level] category), is not available at the start of lexical acquisition. The predicted link between ability to use the N3C principle and ability to perform exhaustive categorization of objects was supported. Children who used the principle had significantly larger productive vocabularies than did those who did not and, according to maternal report, had begun to acquire new words rapidly.

Porphyromonas gingivalis outer membrane vesicles promote bacterial resistance to chlorhexidine

Porphyromonas gingivalis has been frequently associated with some types of periodontal diseases and possesses various mechanisms favoring the pathogenic process. It has been recently observed that vesicles elaborated by P. gingivalis are able to protect bacteria from the bactericidal activity of human serum. The aim of the present investigation was to evaluate the ability of vesicles from P. gingivalis in protecting oral bacteria against chlorhexidine. Data indicate that vesicles released by P. gingivalis may bind chlorhexidine, thus allowing protection for itself and for other oral bacterial species. It has also been demonstrated that lipopolysaccharides are the major component involved in the binding of chlorhexidine by vesicles. The mechanism of resistance reported in this study indicates that bacterial interactions in the oral cavity may influence the sensitivity of microbes.

Early lexical acquisition and the vocabulary spurt: a response to Goldfield & Reznick

Vocabulary development of three children (aged 1;6-1;8 at the start of the study) who had not begun to evidence a vocabulary spurt even though their productive vocabularies already included well over 50 words was followed to determine if these children eventually would have a vocabulary spurt. All three children evidenced a spurt, beginning at a mean productive vocabulary size of 112 words. The vocabulary spurt occurred at about the same time as the children first demonstrated the ability to sort objects exhaustively and to fast map new object names. Results are discussed in the context of Goldfield & Reznick's (1990; Reznick & Goldfield, 1992) argument that a substantial proportion of children never evidence a vocabulary spurt.

Quality of care in family planning services in Morocco

This study was conducted to heighten awareness of quality of care as a programmatic issue in the Moroccan governmental family planning program and to test modified Situation Analysis instruments for measuring quality of care. Data were collected from 50 service-delivery points in five provinces to measure six elements of quality in accordance with the Bruce/Jain framework. A procedure for calculating quality-indicator scores is presented. Although facilities varied by province and within provinces, most had the equipment and supplies needed to deliver services; service personnel were trained and regularly supervised; the service-delivery points scored well on mechanisms to ensure continuity of use. Notable shortcomings included a dearth of materials for counseling and a widespread unavailability of the Ovrette pill. This study raises issues regarding the complexity of measuring quality, the ownership of results, and the appropriateness of a centralized study of quality in a decentralized program.

Acquisition of the novel name--nameless category (N3C) principle

Toddlers' acquisition of the Novel Name-Nameless Category (N3C) principle was examined to investigate the developmental lexical principles framework and the applicability of the specificity hypothesis to relations involving lexical principles. In Study 1, we assessed the ability of 32 children between the ages of 16 and 20 months to use the N3C principle (operationally defined as the ability to fast map). As predicted, only some of the children could fast map. This finding provided evidence for a crucial tenet of the developmental lexical principles framework: Some lexical principles are not available at the start of language acquisition. Children who had acquired the N3C principle also had significantly larger vocabularies and were significantly more likely to demonstrate 2-category exhaustive sorting abilities than children who had not acquired the principle. The 2 groups of children did not differ in either age or object permanence abilities. The 16 children who could not fast map were followed longitudinally until they attained a vocabulary spurt; at that time, their ability to fast map was retested (Study 2). Results provided a longitudinal replication of the findings of Study 1. Implications of these findings for both the developmental lexical principles framework and the specificity hypothesis are discussed.

Ethmoid sinus carcinomas: results and prognosis after neoadjuvant chemotherapy and combined surgery--a 10-year experience

From June 1982 to June 1992, 144 ethmoido-sphenoido-orbital tumors have been referred to the neurosurgical department of Ste Anne Hospital. One hundred five of them were malignant lesions, among which 83 were included into our therapeutic protocol (1) neo-adjuvant chemotherapy (CDDP + 5-FU), (2) combined surgical procedure (subfrontal and transfacial), (3) postoperative radiotherapy. Fifty nine percent of the patients had no response to chemotherapy; 19% had a partial response (reduction of the tumoral volume > 50% and < 100%), 22% had a complete response. One patient had an immediate and transient postoperative rhinorrhea responsible for meningitis (acinetobacter) that was cured after a 3-day treatment. Four patients had postoperative meningitis without any cerebrospinal fluid leakage; they were also cured. Five patients had a local suppuration that was treated by subcutaneous drainage (n = 1) or the removal of the cranial basis graft (n = 4). Oncologic results are presented for only adenocarcinomas (n = 63) because they represent the only population of this series large enough to assure significant statistical figures. The global actuarial survival rate was 53% at 3 years and 42.5% at 5 years. The 5-year actuarial survival rate was 80% for T1 tumors, 60% for T2, 40% for T3, and 25% for T4. Patients with an intracranial extension had a 3-year survival rate of 19%; none survived after 4-year follow-up. Neo-adjuvant chemotherapy seemed to influence the survival: 100% survival rate at 5 and 10 years for the complete responders. We discuss the opportunity of intraorbital exenteration, the indications, and the limits of combined surgery. We emphasize the importance of neo-adjuvant chemotherapy and of combined surgical procedures, even when the patients are complete responders to chemotherapy: complete responders who had only a transfacial approach have a 5-year actuarial survival rate of 80% (instead of 100% when a combined procedure was performed). Those who were not operated primarily recurred within 3 years and then had to be operated. We propose to follow such a combined surgery for all large ethmoidal cancers (T3 and T4) and for small tumors (T1 and T2) developed superiorly and posteriorly. Anterior T1 and T2 tumors should be operated through a single transfacial route.

Two-year-olds readily learn multiple labels for the same basic-level category

2 basic frameworks for lexical principles have been proposed (Golinkoff, Mervis, & Hirsh-Pasek; Markman). In many types of situations, these frameworks make the same predictions regarding 2-year-olds' interpretation of novel terms. However, the predictions diverge in some cases. 3 experiments were conducted to address 1 such situation: the case in which the child hears a novel term but already knows a label for each of the objects present. Results of all 3 studies converged on the same outcome: The new term was most likely to be treated as a second basic-level name for the category to which the object belonged. Analyses of individual patterns of responding revealed that, of the 58 subjects, 50 made more basic-level responses than part responses, 1 made equal numbers of basic-level and part responses, and 7 made more part responses than basic-level responses. Implications of these findings for models of early lexical development are discussed.

Intracellular early and late modifications of human apolipoprotein A-II. Effect of glutamine- +1 to leucine substitution

It has been shown previously that apoA-II undergoes several intracellular modifications in HepG2 cells (Hussain & Zannis, 1990). In the present study, we have generated permanent cell lines in mouse C127 cells which express the normal apoA-II gene and a mutated form in which Gln+1 was substituted with Leu (Leu+1). This modification was designed to prevent cyclization of the N-terminal glutamine of apoA-II and thus identify the isoproteins which are precursors and products of the N-terminal cyclization reaction. The C127-expression cells were also utilized to study the cellular compartments where the apoA-II modifications occur as well as the importance of the modifications for apoA-II trafficking and secretion. We have found that apoA-II (Gln+1) synthesized by C127 and HepG2 cells had similar isoproteins. In both cell types, unmodified pro-apoA-II, designated isoprotein 3, had a similar isoelectric point as the cell-free translation product of apoA-II mRNA, suggesting that isoprotein 3 results from cleavage of the signal peptide. Isoprotein 3 represents an unmodified apoA-II isoprotein and undergoes an early modification into a more acidic isoprotein 1, which differs from isoprotein 3 by two negative charges. Brefeldin A treatment of the cells did not prevent the formation of isoprotein 1, suggesting that this modification occurs in a pre-Golgi compartment. Neuraminidase treatment of secreted apoA-II isoproteins did not affect isoprotein 1, indicating that it is not sialylated isoprotein. Isoprotein 1 undergoes further modifications which are consistent with cleavage of the propeptide, N-terminal cyclization and sialylation most likely resulting from O-glycosylation.(ABSTRACT TRUNCATED AT 250 WORDS)

Laser photocoagulation to treat macular soft drusen in age-related macular degeneration

PURPOSE

To evaluate the effect on subfoveal and nasal drusen when laser treatment is applied only to the soft drusen located in the temporal macula.

METHODS

A prospective pilot study of 20 patients with confluent soft drusen involving the fovea was conducted. One spot of argon green laser (100-microns spot at 100 mW for 0.1 sec) was applied to each soft druse in the temporal macula.

RESULTS

Treated and untreated drusen disappeared in all patients after mean times of 2 months and 10 months, respectively. The treated temporal drusen disappeared first, followed by the subfoveal and then the nasal drusen. Superonasal drusen persisted longer. Visual acuity improved by one line or more in 6 (30%) patients, remained unchanged in 13 (65%), and worsened in 1 (5%) patient. No treatment-related complications were observed after an 18-month follow-up period.

CONCLUSION

Treatment with laser photocoagulation caused resolution not only of treated soft drusen but also of untreated soft drusen located far from the laser scars in the nasal macula.

5-HT1A receptor blockade increases penile erections induced by indirect serotonin agonists

Indirect serotonergic agonists, whether promoters of 5-HT release such as fenfluramine (5 mg kg-1) or inhibitors of 5-HT uptake such as fluoxetine (10 mg kg-1), elicited in rats penile erections at a modest but significant level. Their effects were markedly potentiated by the beta-blocker tertatolol, (0.6-5 mg kg-1) which displays 5-HT1A receptor blocking activity, but not by the beta-blocker labetalol (6.25 and 25 mg kg-1), which lacks such activity. In addition, tertatolol, but not labetalol, potentiated penile erections induced by meta-chloro-phenylpiperazine (1 mg kg-1). Thus, it appears that increasing serotonergic transmission increases only moderately penile erections because of the functional opposition exerted by 5-HT1A (inhibition) and 5-HT1C (activation) serotonin receptors on this response.

Testing for cervical Chlamydia trachomatis infection in an inner city practice

The aims of the study were to find the prevalence of cervical Chlamydia trachomatis infection in women attending for a speculum examination, to examine possible risk factors, and to see if we could develop a rational policy for testing for chlamydia in our deprived inner London practice. During 18 months 409 women aged 17-45 (mean 28) who attended for a cervical smear or vaginal examination were tested for chlamydia using the direct immunofluorescent test. They were assessed for possible risk factors: age less than 25, more than one sexual partner in the previous 3 months, sexual contact with men with urethritis, past history of chlamydia infection, purulent vaginal discharge, cervicitis and abnormal cervical cytology. Thirty-six women (8.8%) were chlamydia positive. Chlamydia infection was significantly associated with the presence of purulent vaginal discharge or an inflammatory cervical smear. In view of the prevalence of chlamydial cervicitis, the lack of symptoms and signs, and the potential consequences of untreated infection, ideally all young women in this population should be offered screening when they attend for a speculum examination. If this is not practical, chlamydia testing might be offered to women thought to be in high-risk groups including those with purulent vaginal discharge or an inflammatory cervical smear.