Seasonality of brown recluse populations is reflected by numbers of brown recluse envenomations

A significant seasonal correlation was recently shown for brown recluse spider activity. Vetter (2011) observed brown recluse spiders were submitted by the general public predominantly during April-October. For patients with suspected brown recluse spider bites (BRSB), we have observed the same seasonality. Among 45 cases with features consistent of a BRSB, 43 (95.6%) occurred during April-October. Both the Vetter study and our study serve to demonstrate seasonal activity for brown recluse spiders.

Temporal and seasonal variation in the occurrence of chemical incidents

AIMS

To determine whether there were temporal or seasonal patterns in the occurrence of chemical incidents reported to the West Midlands Chemical Incident Surveillance System, UK.

METHODS

A retrospective analysis of reports maintained on a computerised database was carried out for information received from January 1997 to December 2001.

RESULTS

Annual numbers of events increased significantly from 77 (7.5%) in 1997 to 282 (27.4%) in 2001. Compared to the average of other seasons, proportionately more incidents occurred in the summer (29.3%). Compared with the average of other days, incidents were more likely to occur on Thursdays (17.1%) and least likely on Saturdays (8.9%). When grouped together on a six hourly basis incidents were most frequent between 12 00 and 17 59 (31.1%) and least frequent between 00 00 and 05 59 (21.2%).

CONCLUSIONS

The surveillance system shows that chemical incidents do not occur randomly but have marked temporal and seasonal variation. These results have implications for service provision, training, and the development of preventive strategies.

Reducing the progression of myopia with atropine: a long term cohort study of Olmsted County students

BACKGROUND

Myopia is an important public health problem because it is common and is associated with increased risk for chorioretinal degeneration, retinal detachment, and other vision- threatening abnormalities. In animals, ocular elongation and myopia progression can be lessened with atropine treatment. This study provides information about progression of myopia and atropine therapy for myopia in humans.

METHODS

A total of 214 residents of Olmsted County, Minnesota (118 girls and 96 boys, median age, 11 years; range 6 to 15 years) received atropine for myopia from 1967 through 1974. Control subjects were matched by age, sex, refractive error, and date of baseline examination to 194 of those receiving atropine. Duration of treatment with atropine ranged from 18 weeks to 11.5 years (median 3.5 years).

RESULTS

Median followup from initial to last refraction in the atropine group (11.7 years) was similar to that in the control group (12.4 years). Photophobia and blurred vision were frequently reported, but no serious adverse effects were associated with atropine therapy. Mean myopia progression during atropine treatment adjusted for age and refractive error (0.05 diopters per year) was significantly less than that among control subjects (0.36 diopters per year)(P<.001). Final refractions standardized to the age of 20 years showed a greater mean level of myopia in the control group (3.78 diopters) than in the atropine group (2.79 diopters) (P<.001).

CONCLUSIONS

The data support the view that atropine therapy is associated with decreased progression of myopia and that beneficial effects remain after treatment has been discontinued.

Carrier detection and rapid newborn diagnostic test for the common Y393N maple syrup urine disease allele by PCR-RFLP: culturally permissible testing in the Mennonite community

The turnaround time for diagnosis of maple syrup urine disease (MSUD) by classic serum amino acid analyses often requires 3-4 days. This is due to the need for branched-chain amino acids (BCAA) to accumulate in the serum of the newborn before testing. The accumulation of BCAAs in infants with MSUD during this time increases the risk of the infant becoming clinically symptomatic. We have developed a noninvasive DNA-based mismatch PCR-RFLP assay for the Y393N BCKDHA allele (E1alpha gene of the branched chain alpha-keto acid dehydrogenase complex), the primary cause of MSUD in Old Order Mennonite communities. The homozygosity and high frequency of this mutation in the Mennonite community and its prevalence in compound heterozygote non-Mennonite MSUD patients is of significance. We describe carrier testing, present the results of nine newborns diagnostically evaluated for the Y393N BCKDHA allele, and demonstrate the efficacy of this PCR-RFLP assay for determining clinical status within 24 h after birth. Analyses within the first 24 h of life allow for immediate diagnosis and treatment of infants homozygous for the Y393N MSUD defect. This is a significant improvement over the time required by current serum amino acid analysis methods.

Investigations of the pathway of incorporation and function of lamin A in the nuclear lamina

Cell-free extracts of Xenopus eggs were used to investigate how differing lamin sub-types are incorporated into a lamina and how lamina composition influences DNA replication. Purified recombinant human lamin A (HlaminA) was inoculated into egg extracts, which support in vitro nuclear assembly. The route of incorporation of Hlamin A into the lamina was compared to Xenopus lamin B3 (XlaminB3), the major endogenous lamin sub-type in egg extracts. While Xlamin B3 was incorporated into the lamina directly, HlaminA first accumulated at nucleoplasmic foci, before entering the lamina. When HlaminA was inoculated into extracts depleted of XlaminB3 it entered nuclei efficiently and was incorporated into nucleoplasmic foci. However, in the absence of XlaminB3, HlaminA remained in the foci and did not enter the nuclear envelope. When HlaminA entered the nuclear envelope, it did not influence DNA replication. Nuclei containing HlaminA initiated DNA replication on queue and in addition the spatial distribution of replication centres in these nuclei was identical to controls. Taken together, these results suggest that the incorporation of A-type lamins into the nuclear envelope is dependent upon the presence of B-type lamins. However, the presence of A-type lamins alone is not sufficient to influence the spatial and temporal order of DNA replication.

When acculturation hurts: the case of immunization

The study examined the relationship between the acculturation of Mexican American mothers in Texas and immunization status of their children between 3 and 24 months of age. Mothers' acculturation, demographic characteristics, and immunization status of their children were assessed in in-person interviews with a sample of Mexican American respondents representative for Texas (n = 2193). Acculturation was measured with ten scales assessing oral and written language use, proficiency, and preference, music and TV viewing preferences, ethnic identity, place where a person was reared, and contacts with Mexico. Immunization status, defined according to the recommendation of the CDC Advisory Committee on Immunization Practices, was determined from official shot records obtained directly from respondents or, for respondents without records, obtained from their health care providers. Regression analysis revealed that acculturation significantly contributed to inadequate immunization status, even when socioeconomic status and other demographic covariates of acculturation were statistically controlled. Mediational analysis revealed that acculturation contributed to inadequate immunization through less positive attitudes toward immunization, a diminished sense of parental responsibility for children's immunization, and more perceived barriers to immunization. It is concluded that culture-specific beliefs encouraging childhood immunization should be fostered among Mexican Americans.

Immunization status and sociodemographic characteristics: the mediating role of beliefs, attitudes, and perceived control

OBJECTIVES

This study examined how immunization-related beliefs, attitudes, and perceived control mediate up-to-date immunization among various sociodemographic groups.

METHODS

Statewide estimates of immunization rates among children up to the age of 2 years were obtained via a multistage cluster sample. In-person interviews were conducted with 4832 parents. Information about immunization was obtained from official records or from health care providers.

RESULTS

Differences in immunization among sociodemographic groups were mediated by beliefs about objective barriers to immunization, protection, medical contraindication, safety concerns, distrust, and natural immunity. Protection beliefs contributed to positive attitudes toward immunization; beliefs in natural immunity and safety concerns contributed to negative attitudes. Beliefs about objective barriers, distrust, safety concerns, and medical contraindications influenced perceived control over immunization. Positive attitudes and a strong sense of control contributed to higher immunization rates.

CONCLUSION

These findings provide a basis for efficient educational campaigns by specifying which beliefs should be bolstered (because they facilitate proper immunization) and which should be targeted for change (because they hinder proper immunization) in various sociodemographic groups.

Cell cycle changes in A-type lamin associations detected in human dermal fibroblasts using monoclonal antibodies

A new panel of anti-A-type lamin monoclonal antibodies was generated. Epitope mapping was performed by immunoblotting against GST-lamin fusion peptides. Epitopes were mapped to four different regions of human lamin A and three different regions of human lamin C. The distribution of A-type lamins was compared with the distribution of the proliferation marker Ki67 in proliferating and quiescent cultures of human dermal fibroblasts (HDFs) using a double indirect immunofluorescence assay. Antibodies that had been mapped to a region of the lamin C tail stained the nuclear envelope of proliferating and quiescent cells equally brightly. In contrast, antibodies recognizing epitopes in the head domain and rod domain of lamins A and C and the tail domain of lamin A stained the nuclear envelope of quiescent cells strongly but reacted poorly or not at all with the nuclear envelope of proliferating cells. Changes in the level of expression of lamins A and C were not detected in immunoblotting assays. However, epitope masking was revealed, and this occurred by two distinct mechanisms. Epitope masking in the head domain of lamins A and C occurred as a result of protein phosphorylation. Epitope masking in the rod domain of lamins A and C and in the tail domain of lamin A occurred through a physical association between the lamin and chromatin and/or other nuclear proteins. The cell cycle timing of epitope masking was investigated in HDFs that had been restimulated after serum starvation. Extensive epitope masking in restimulated cells only occurred after cells had passed through mitosis. These results are consistent with the hypothesis that rearrangement of A-type lamin filaments, as cells progress from a quiescent to a proliferating state, results in altered lamina associations.

Selenoprotein gene expression during selenium-repletion of selenium-deficient rats

Selenium repletion of selenium-deficient rats with 20 micrograms selenium / kg body weight as Na2SeO3 was used as a model to investigate the mechanisms that control the distribution of the trace element to specific selenoproteins in liver and thyroid. Cytosolic glutathione peroxidase (cGSHPx), phospholipid hydroperoxide glutathione peroxidase (PHGSHPx), and iodothyronine 5'-deiodinase (IDI) activities were all transiently increased in liver 16 to 32 h after ip injection with selenium. However, only cGSHPx and PHGSHPx activities increased in the thyroid where IDI activity was already increased by selenium deficiency. These responses were owing to synthesis of the seleoproteins on newly synthesised and/or existing mRNAs. The selenoprotein mRNAs in the thyroid gland were increased two- and threefold after the transitory increases in selenoprotein activity. In contrast, there were parallel changes in selenoprotein mRNAs and enzyme activities in the liver, with no prolonged rises in mRNA levels. The organ differences suggest that increased thryotrophin (TSH) concentrations, which are known to induce thyrodial IDI and mRNA, may control the mRNAs for all the thyroidal selenoproteins investigated and be a major mechanism for the preservation of thyroidal selenoproteins when selenium supplies are limited.

Visual problems of the aging musician

The presbyopic musician presents the ophthalmologist with an often demanding set of visual needs. Many modalities, some necessarily creative, are available to aid older musicians in their vision-dependent art.

Tissue-specific regulation of selenoenzyme gene expression during selenium deficiency in rats

Regulation of synthesis of the selenoenzymes cytosolic glutathione peroxidase (GSH-Px), phospholipid hydroperoxide glutathione peroxidase (PHGSH-Px) and type-1 iodothyronine 5'-deiodinase (5'IDI) was investigated in liver, thyroid and heart of rats fed on diets containing 0.405, 0.104 (Se-adequate), 0.052, 0.024 or 0.003 mg of Se/kg. Severe Se deficiency (0.003 mg of Se/kg) caused almost total loss of GSH-Px activity and mRNA in liver and heart. 5'IDI activity decreased by 95% in liver and its mRNA by 50%; in the thyroid, activity increased by 15% and mRNA by 95%. PHGSH-Px activity was reduced by 75% in the liver and 60% in the heart but mRNA levels were unchanged; in the thyroid, PHGSH-Px activity was unaffected by Se depletion but its mRNA increased by 52%. Thus there is differential regulation of the three mRNAs and subsequent protein synthesis within and between organs, suggesting both that mechanisms exist to channel Se for synthesis of a particular enzyme and that there is tissue-specific regulation of selenoenzyme mRNAs. During Se depletion, the levels of selenoenzyme mRNA did not necessarily parallel the changes in enzyme activity, suggesting a distinct mechanism for regulating mRNA levels. Nuclear run-off assays with isolated liver nuclei showed severe Se deficiency to have no effect on transcription of the three genes, suggesting that there is post-transcriptional control of the three selenoenzymes, probably involving regulation of mRNA stability.

Environmental considerations of disinfectants used in agriculture

Using disinfectants in agriculture increasingly requires consideration of the indirect effects on the environment and human health. At present, only limited information is available on post-application effects of disinfectants, and such data therefore needs to be gathered in order to assess potential effects. In addition, a basis exists for establishing precautionary guidelines using current information. Optimum handling and application procedures require a knowledge of the specific features of each type of disinfectant. A need to establish product standards through efficacy tests has also emerged. The benefits of disinfectants for disease control must also be weighed against any environmental consequences. Emergency application of a disinfectant carries different implications from routine use on farms, and any large-scale application should undergo an environmental impact assessment.

Lack of global vagal propensity in patients with oculocardiac reflex

BACKGROUND

Profound bradycardia during ophthalmic surgery is a rare but potentially serious event. Little is known about the predictability of the oculocardiac reflex.

METHODS

Four vagotonic maneuvers were performed on six patients who had profound oculocardiac reflex (3- to 10-second asystole) during eye surgery, the results of which were compared with 30 previously studied control subjects. Electrocardiographs were monitored during the following vagotonic maneuvers: diving response (apneic facial immersion), Valsalva maneuver, ocular compression, and carotid sinus massage.

RESULTS

The degree of heart rate slowing as a result of diving response, Valsalva maneuver, and, notably, ocular compression did not differ when these patients were compared with the 30 previously studied control subjects. Carotid sinus massage produced significantly (P = 0.01) more bradycardia in the six patients (mean +/- standard deviation, -24% +/- 6%) than in the 30 control subjects (-12% +/- 7%). The heart rate response to pressure on the eyes did not correlate with prior intraoperative oculocardiac reflex.

CONCLUSION

The discrepancy in heart rate sensitivity between surgical extraocular muscle tension and ocular compression may be due to different sensory receptors and brain stem processing for the trigeminally mediated oculocardiac reflex. Carotid sinus massage may help predict low heart rates during eye surgery.

The high-monounsaturated fat diet as a practical alternative for NIDDM

OBJECTIVE

To examine the dietary preferences of and metabolic effects in patients with non-insulin-dependent diabetes mellitus (NIDDM) of a home-prepared high-monounsaturated fat (HM) diet compared with the recommended high-carbohydrate (CHO) diet.

RESEARCH DESIGN AND METHODS

Ten men with mild NIDDM prepared HM and high-CHO diets at home alternately and in random order for 2 weeks each with a minimum 1-week washout. Before and after each diet, 24-h urine glucose, fasting lipids, fructosamine, and 6-h profiles of glucose, insulin, and triglycerides were measured. Dietary preferences were assessed by questionnaire.

RESULTS

In the HM diet, patients consumed 40% of energy intake as CHO and 38% as fat (21% monounsaturated) compared with 52 and 24%, respectively, in the high-CHO diet, with equal dietary fiber content. Body weight and total energy intake were similar in both. The HM diet resulted in significantly lower 24-h urinary glucose excretion, fasting triglyceride, and mean profile glucose levels. The fructosamine levels, the fasting total, low-density lipoprotein, and high-density lipoprotein cholesterol, and the prandial triglyceride concentrations did not differ significantly as a result of the diets. The two diets did not differ in ratings for overall acceptance, taste, cost, ease of preparation, variety, or satiety.

CONCLUSIONS

Prepared at home, the HM diet was, in the short-term, metabolically better in some aspects than the currently recommended diet for NIDDM. It also provided a palatable alternative.

Ocular complications in renal transplant patients

One hundred and seventy-six patients who received a renal transplant between 1982 and 1988 were examined for ocular complications of steroid therapy. Posterior subcapsular cataracts (PSC) were present in 60 patients (34.1%). Patients were classified into three groups (HS, LS, NoS) depending on their maintenance immunosuppression therapy. The HS group received high doses of steroids after renal transplantation. LS had low steroid doses, and NoS had no steroids. The incidence of PSC was 21 of 38 in HS (55.3%), 33 of 117 in LS (28.2%), and 1 of 16 in NoS (6.2%). The difference between HS and LS was statistically significant (chi 2 = 8.1, P < 0.01). Grading the severity of PSC (PSC 0, PSC +, PSC > ++) showed a significant correlation between the degree of PSC and the steroid therapy. In the HS group, five patients had PSC +, and 16 had PSC > ++ (76%), compared to 19 patients with PSC +, 14 patients with PSC > ++ (42%) in the LS group (chi 2 = 4.6; P < 0.05). There was no correlation between the incidence of PSC and use of steroids for more than three months before dialysis. Comparison with the results of our earlier series (1973-1981) using high doses of steroids showed a similar incidence of PSC with HS (40.7% Series 1; 55.3% Series 2) but a lower incidence with LS and NoS.

Phospholipid hydroperoxide glutathione peroxidase: full-length pig blastocyst cDNA sequence and regulation by selenium status

We have isolated and sequenced an apparent full-length cDNA clone for phospholipid hydroperoxide glutathione peroxidase (Genbank accession number L12743) from a pig blastocyst cDNA library. The sequence encodes a polypeptide of 170 amino acids, including a TGA-encoded selenocysteine at residue 46, with a calculated M(r) of 19,492 Da. Use of this clone in Northern blot analysis of Se-deficient rat liver revealed that phospholipid hydroperoxide glutathione peroxidase mRNA levels were little affected by Se deficiency, whereas classical glutathione peroxidase mRNA levels were decreased by 90% in the same samples. Lastly, liver phospholipid hydroperoxide glutathione peroxidase mRNA levels were not elevated in female rats, in contrast to classical glutathione peroxidase.

Torsional diplopia after transantral orbital decompression and extraocular muscle surgery associated with Graves' orbitopathy

Graves' orbitopathy can be associated with horizontal, vertical, and torsional diplopia. Of 428 patients treated with transantral orbital decompression, 21 had incycloduction (mean, 12.8 degrees; range, 5 to 20 degrees) and five had excycloduction (mean, 12 degrees; range, 5 to 20 degrees). All 26 patients had had recessions of the medial or inferior rectus muscle (or both) before onset of torsional diplopia. Mean recession was 5.5 mm (range, 4 to 10 mm) and 5.3 mm (range, 2 to 10 mm) of medial rectus muscle and inferior rectus muscle, respectively. An A pattern was often associated with the condition. Superior oblique tenectomy and inferior oblique myectomy were performed most frequently for incycloduction and excycloduction, respectively. Superior oblique tenectomy induced a mean incycloduction decrease of 7.1 degrees (range, 0 to 12 degrees). Exotropia in downgaze was decreased, and a small ipsilateral hyperdeviation was induced. Bilateral inferior oblique myectomy in one patient decreased excycloduction 10 degrees without inducing new deviation. At follow-up (mean, 63.7 months) after last strabismus operation, 15 patients with incycloduction and two with excycloduction had no diplopia.

Sensitivity to vasovagal maneuvers in normal children and adults

In 15 male and 15 female healthy subjects who were 10 to 48 years of age, we studied alterations in heart rate and finger blood flow in response to the cold pressor test and four strong vasovagal maneuvers: diving response (apneic facial exposure to an ice water bag), Valsalva maneuver (forced expiration against a column of mercury to 40 to 50 mm Hg), unilateral carotid sinus massage, and oculocardiac reflex (inflation of a Honan balloon against one eye). Peripheral vasoconstriction as a consequence of the diving response paralleled the vasoconstriction from the cold pressor test, but it preceded the bradycardia that resulted from the diving response maneuver. In contrast, the rate of finger blood flow was high during the bradycardia that followed stage 4 of the Valsalva maneuver. Changes in heart rate correlated with age for the diving response, the Valsalva maneuver, and the oculocardiac reflex. Changes in heart rate and finger blood flow were not dependent on sex. The change in heart rate noted with the diving response was significantly correlated with that noted with the Valsalva maneuver and the oculocardiac reflex. Changes in finger blood flow did not correlate with changes in heart rate for any maneuver. This study provides a response profile of relative sensitivities to strong vasovagal maneuvers in normal children and adults.

Crossed-quadrant homonymous hemianopsia

This case report illustrates the clinicopathological correlation between the anatomic defect of bilateral occipital lobe infarction with crossed-quadrant homonymous hemianopsia that resulted from a cervical spine injury. Routine ophthalmological and neuroradiological investigations were undertaken, including magnetic resonance imaging scanning, that demonstrate some important characteristics of this rare field defect.

Effect of silicone elastomer contact lens wear on endothelial cell morphology in aphakic eyes

We prospectively evaluated the effect of extended silicone elastomer contact lens wear on the endothelial mosaic of aphakic subjects. Endothelial cell photography and central corneal thickness measurements were performed on 23 eyes of 15 aphakic subjects (mean age 60 +/- 10 years). These measurements were made before lens wear (n = 23) and were repeated after 1 year (n = 19) and again after 5 years (n = 10) of lens wear. No statistically significant change in mean endothelial cell size or coefficient of variation of cell size was found. Central corneal thickness was significantly decreased at 1 year and hexagonality was significantly increased at 5 years. Thus, the changes in endothelial morphology usually associated with contact lens wear did not occur with silicone lenses, which are highly permeable to oxygen.

Atypical amiodarone-induced keratopathy in a patient wearing soft contact lenses

Antiarrhythmic therapy with amiodarone hydrochloride may produce a pattern of vortex corneal epitheliopathy or cornea verticillata. The vortex keratopathy typically occupies the lower third of the cornea, extends superiorly, and is graded according to the degree of extension. Grades I through III describe the amount of vortex change, whereas grade IV describes a generalized granular dusting in addition to the vortex pattern. Grade IV amiodarone-induced keratopathy has been reported from Europe, but no North American series have reported this more advanced epithelial change. We describe a patient who developed grade IV amiodarone-induced keratopathy while wearing soft contact lenses. Of 686 patients treated with amiodarone at the Mayo Clinic and undergoing routine follow-up, this is the first case of grade IV keratopathy we have observed. To our knowledge, this is also the first report of a patient who wore contact lenses and developed this uncommon corneal change while taking amiodarone.

Neurochemical studies on quinolone antibiotics: effects on glutamate, GABA and adenosine systems in mammalian CNS

Quinolone antibiotics, which can be proconvulsant in susceptible patients, were found to inhibit the specific binding of the adenosine receptor ligands L-3H-N6-phenylisopropyladenosine (L-3H-PIA) and 3H-N-ethylcarboxamidoadenosine (3H-NECA) to rat brain synaptic membranes. The inhibitions were concentration dependent, and for both ligands the order of potency was rosoxacin greater than nalidixic acid greater than oxolinic acid greater than or equal to ciprofloxacin greater than norfloxacin greater than enoxacin: IC20 values (concentrations causing a 20% inhibition of specific binding) ranged from 30-35 microM to 1-3 mM. Hill coefficients were approximately 0.5, suggesting that the compounds are probably antagonists at these sites. Most of the compounds did not alter 3H-diazepam binding directly, although rosoxacin showed relatively strong, and enoxacin weak, concentration-dependent inhibition. At 50 microM the compounds enhanced the maximal gamma-aminobutyric acid (GABA) activation of 3H-diazepam binding to varying degrees, without altering the EC50 of activation, whereas at 200 microM they tended to reduce GABA activation. Most noteworthy was the large increase in GABA-stimulated 3H-diazepam binding caused by 50 microM nalidixic acid. The compounds did not alter the Ca2+/Cl- -dependent binding of 3H-glutamate, nor of the binding of the glutamate site-selective ligands 3H-kainate and alpha-3H-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (3H-AMPA); the uptake of the non-metabolized glutamate analogue D-3H-aspartate by cortical homogenates was also unaffected. The CNS side effects of these antibiotics may result, in part, from interaction with sites which mediate the inhibitory neurotransmission of adenosine and, possibly, GABA.

Acquired divergent strabismus: presumed metastatic gastric carcinoma to the medial rectus muscle

A patient with rapidly progressive metastatic gastric carcinoma developed diplopia and diminished adduction of the right eye. The right medial rectus muscle belly was enlarged, as shown by computed tomography. This case is unusual, because gastric carcinoma comprises only 1% of orbital metastases and less than 5% of all orbital metastases localize to extraocular muscle.

Marginal myotomy of the medial rectus with lateral rectus resection as a secondary procedure for esotropia

Between 1964 and 1982, 89 marginal myotomies were performed, 70 on the medial rectus with lateral rectus resection as a combined secondary procedure for esotropia. Successful realignment was attained in 51% of the cases (for both distance and near measurements); undercorrection occurred in 34% (either distance or near), and overcorrection in 14% (either distance or near). Further operation was required in 17%, of which 4% were for overcorrection. Initial postoperative alignment was maintained at subsequent follow-up. The degree of change in deviation did not correlate with the degree of resection of the lateral rectus or the degree of medial rectus myotomy. Marginal myotomy of the medial rectus with lateral rectus resection is a useful procedure that should be part of the repertoire of all strabismus surgeons.

Strengthening the weak superior oblique muscle

Tucking of the superior oblique tendon is an effective strengthening procedure, but it invariably results in at least transient postoperative Brown's syndrome. This complication may be avoided by using a modification of the Harada-Ito procedure, in which the entire superior oblique tendon is advanced anterolaterally without disinsertion or resection. The operation is easy to perform and may be used with adjustable sutures if desired.

Psychological correlates of unemployment among male parasuicides in Edinburgh

Variations in clinical features associated with unemployment among a sample of male parasuicides were examined. Employed and unemployed persons did not differ in mean scores on the Suicidal Intent Scale, but the unemployed were rated significantly worse on measures of depression (Beck Depression Inventory) and hopelessness (Hopelessness Scale). A covariance analysis showed that hopelessness, rather than depression, is the important discriminator. Different patterns of relationships between the three clinical measures were observed in the two groups. Hopelessness may be a key social-psychological variable for inclusion in any model of the pathways which link unemployment with parasuicide.

Ophthalmic manifestations of narcolepsy

We reviewed the records of 755 patients in whom narcolepsy was diagnosed between 1979 and 1983. In a subset of 405 previously undiagnosed and untreated patients, the following variables were assessed: the subspecialty in which the condition was diagnosed, age and sex of the patients, family history, expressed symptoms in the total group, symptoms in patients whose condition was diagnosed by ophthalmologists, laboratory aids used for diagnosis, treatment, and outcome.

A 48-year clinical and epidemiologic study of keratoconus

From 1935 through 1982, keratoconus was newly diagnosed in a total of 64 residents (35 males and 29 females) of Olmsted County, Minnesota. There were no significant trends in incidence rates over time; the overall average annual rate was 2.0 per 100,000 population. The age-specific incidence rates were greatest in the younger groups. The incidence rates did not differ significantly by sex. On Dec. 31, 1982, the overall prevalence rate was 54.5 per 100,000 population. At the time of diagnosis, keratoconus was unilateral in 26 patients (41%) and bilateral in 38 patients (59%). Follow-up of the patients showed that survival did not differ significantly from that of the general population. The cumulative probability of survivorship without corneal transplantation for more than 20 years after diagnosis was greater than 80%.

Characteristics of recession-resection and bimedial recession for childhood esotropia

Of 367 unilateral medial rectus recessions-lateral rectus resections and bilateral medial rectus recessions performed for childhood esotropia from 1960 through 1980, a total of 206 met the requirements for a comparative study. Preoperative and postoperative amblyopia was more prevalent in the recession-resection population and was attributed to the more common occurrence of monocular esotropia in patients undergoing recession-resection. Postoperative ocular alignment was better and the need for subsequent strabismus surgery was less in patients who initially underwent recession-resection. Because preoperative esotropia was found to be significantly greater in three of the four categories recorded among the bimedial recession population, we could not state that recession-resection was the "better" operation. Contrary to our previous recommendations for graded recessions, we now believe that maximal (5-mm) bimedial rectus recessions should be performed initially.

Inferior oblique surgery. Experience at the Mayo Clinic from 1960 to 1981

Three hundred thirty-seven patients underwent inferior oblique disinsertions at the Mayo Clinic Rochester, Minn, from 1960 to 1981. Versions and hyperdeviations in the primary position were recorded preoperatively and postoperatively. The criteria of a successful result were (1) correction of diplopia, (2) correction of hyperdeviation in the field of action of the inferior oblique, and (3) correction of versions in adduction. Clinical failure was reflected in persistence of hyperdeviation in primary gaze and persistence of overaction of the inferior oblique muscle in adduction. A successful result was found in 88% of primary inferior oblique disinsertions. For secondary inferior oblique overaction, a successful result was found in 72% of patients. We have found that inferior oblique disinsertion is a safe, fast, reliable, and effective weakening procedure with good results.

Surgical treatment of lateral rectus muscle paralysis

We conducted a retrospective study of 55 cases to investigate the effectiveness of three different surgical procedures (medial rectus muscle recession and lateral rectus muscle resection in 16 cases, the Hummelsheim procedure in 27 cases, and the Jensen procedure in 12 cases) in the treatment of lateral rectus muscle paralysis. All three procedures were equally effective. Shorter duration of lateral rectus muscle paralysis, greater preoperative lateral version, less contracture of the medial rectus muscle, and a traumatic origin for the sixth cranial nerve damage had a significant effect (P less than .05) on the final results of surgery.

Hopelessness, depression and suicidal intent in parasuicide

Previous work on the inter-relationships among depression, hopelessness and suicidal intent in parasuicide is reviewed. Our own study of 120 hospital-referred parasuicides confirms previous findings that, while both depression and hopelessness correlate with the degree of suicidal intent as measured on a Suicide Intent Scale, the relationship between depression and suicidal intent is dependent on that between hopelessness and suicidal intent. Some practical and theoretical implications are discussed.

Bilateral medial rectus muscle recession and lateral rectus muscle resection in the treatment of congenital esotropia

In a retrospective study of 36 patients with congenital esotropia treated surgically by bilateral medial rectus muscle recession and lateral rectus muscle resection, we found that 22 patients (61%) had not required further surgery and that 14 patients (39%) had required further corrective surgery. Seven of these 14 patients had overcorrections and seven had undercorrections. Patients who required a second operation were significantly younger (mean age, 12 months) than those who did not (mean age, 23 months). The most common second surgical procedure was bilateral tenotomy or disinsertion of the inferior oblique muscle. Bilateral medial rectus muscle recession and lateral rectus muscle resection is useful in severe (50 prism diopters or more) congenital esotropia. The surgical success rate may be improved with bilateral inferior oblique muscle disinsertions or tenotomies in patients with inferior oblique muscle overaction. Accurate preoperative examinations in patients old enough to cooperate may help avoid overcorrection and undercorrection.

Role of cyclopegics in progressive myopia

Atropine sulfate 1% was instilled in both eyes of 86 children (172 eyes) on a daily basis for a period of two to eight years. No untoward changes in intraocular pressure, pupillary response, accommodation, or appearance of the ocular fundi were noted. A comparison with a similar group of children having only glasses prescribed during a similar time span revealed that atropine is effective in reducing theprogression of myopia in children; a permanent reduction in the degree of myopia may be achieved. Relaxation of accommodation by means of cycloplegic drugs may be a safe and effective treatment of myopia.

Ocular muscle surgery in Graves' disease

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The oculorotary muscles in Graves' disease

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