Food security is related to adult type 2 diabetes control over time in a United States safety net primary care clinic population

Background/Objectives:

Successful Type 2 diabetes management requires adopting a high nutrient-density diet made up of food items that both meet dietary needs and preferences and can be feasibly obtained on a regular basis. However, access to affordable, nutrient-dense foods often is lacking in poorer neighbourhoods. Therefore, low food security should directly impair glucose control, even when patients have full access to and utilize comprehensive medical management. The present study sought to determine whether food security is related longitudinally to glucose control, over-and-above ongoing medication management, among Type 2 diabetes patients receiving comprehensive care at a Midwestern multi-site federally qualified health centre (FQHC).

Subjects/Methods:

In this longitudinal observational study, we completed a baseline assessment of patients’ food security (using the US Household Food Security Module), demographics (via Census items), and diabetes history/management (using a structured clinical encounter form) when patients began receiving diabetes care at the health centre. We then recorded those patients’ A1C levels several times during a 24-month follow-up period. Three hundred and ninety-nine patients (56% with low food security) had a baseline A1c measurement; a subsample of 336 (median age=52 years; 56% female; 60% Hispanic, 27% African American, and 9% White) also had at least one follow-up A1c measurement.

Results:

Patients with lower (vs higher) food security were more likely to be on insulin and have higher A1c levels at baseline. Moreover, the disparity in glucose control by food security status persisted throughout the next 2 years.

Conclusions:

Although results were based on one multi-site FQHC, potentially limiting their generalizability, they seem to suggest that among Type 2 diabetes patients, low food security directly impairs glucose control—even when patients receive full access to comprehensive medical management—thereby increasing their long-term risks of high morbidity, early mortality, and high health-care utilization and cost.

Factors influencing success of clinical genome sequencing across a broad spectrum of disorders

To assess factors influencing the success of whole-genome sequencing for mainstream clinical diagnosis, we sequenced 217 individuals from 156 independent cases or families across a broad spectrum of disorders in whom previous screening had identified no pathogenic variants. We quantified the number of candidate variants identified using different strategies for variant calling, filtering, annotation and prioritization. We found that jointly calling variants across samples, filtering against both local and external databases, deploying multiple annotation tools and using familial transmission above biological plausibility contributed to accuracy. Overall, we identified disease-causing variants in 21% of cases, with the proportion increasing to 34% (23/68) for mendelian disorders and 57% (8/14) in family trios. We also discovered 32 potentially clinically actionable variants in 18 genes unrelated to the referral disorder, although only 4 were ultimately considered reportable. Our results demonstrate the value of genome sequencing for routine clinical diagnosis but also highlight many outstanding challenges.

[Uterine torsion in cattle--therapy and consequences for calf and cow]

AIM

To summarize the available literature on the therapy of uterine torsion in cattle and the consequences for cow and calf.

MATERIAL AND METHODS

Analysis of the literature using electronic libraries (PubMed, Medline), German veterinary medical journals and obstetrical textbooks.

RESULTS

The therapy includes the attempt to rotate the uterus back into its physiological position. Direct and indirect methods of retorsion are available and applied according to the case conditions. Subsequently, the extraction of the calf can be performed via vaginal delivery or caesarean section. The presence of uterine torsion always leads to dystocia. Following a successful retorsion, the time and degree of uterine torsion strongly influence the progress of the birth. The prognosis also depends on the aforementioned factors and varies between good to unsuccessful. The vitality of the calf displays great variation depending on the literature (14-90%), however, is generally greater under field than clinical conditions. Focussing on the puerperal development of the cow, all grades from mild irritations of the uterine involution to fatal complications occur. The influence on fertility depends on the progress of the birth and existing secondary complications. The risk for electrolyte disturbances is increased (approximately 50%) as is the risk of birth-associated injuries (approximately 20%). The incidence of placental retention varies widely between different authors (3-52%).

Torsio uteri beim Rind – Therapie und Folgen für das Kalb und die Kuh

Ziel dieser Arbeit ist, den derzeitigen Stand der Literatur über die Therapie der Torsio uteri sowie die Folgen für Kuh und Kalb darzustellen. Material und Methode: Ausgewertet wurde die Literatur, die in Online-Suchportalen (Pub Med, Medline) und veterinärmedizinischen Fachzeitschriften sowie einschlägigen Lehrbüchern zur Verfügung steht. Ergebnisse: Die Therapie besteht zunächst im Versuch der Retorsion des Uterus, wobei direkte und indirekte Retorsionsmethoden zur Verfügung stehen, deren Anwendung nach Lage des Falles entschieden werden muss. Danach erfolgt in der Regel die Entwicklung des Kalbes, die entweder per vias naturales oder per Schnittentbindung durchgeführt wird. Das Bestehen einer Torsio uteri führt immer zu einer Dystokie, wobei Dauer und Drehungsgrad einen starken Einfluss auf den Verlauf der Geburt nach erfolgter Retorsion haben, sofern diese gelingt. Die Prognose ist ebenfalls maßgeblich von den beiden genannten Faktoren abhängig und kann zwischen günstig bis infaust variieren. Die Vitalität des Kalbes schwankt je nach ausgewerteter Literatur stark (14–90%), wobei die Überlebensrate unter Praxisbedingungen höher liegt als in Kliniken. Bezüglich der Folgen der Erkrankung auf das Puerperium kommen alle Facetten zwischen geringgradigen Involutionsstörungen des Uterus bis hin zu tödlichen Komplikationen vor. Der Einfluss auf die weitere Fertilität betroffener Tiere hängt vom Verlauf der Geburt und bestehenden Sekundärkomplikationen ab. Das Risiko für Störungen der Elektrolythomöostase ist erhöht (ca. 50%), ebenso das für Geburtsverletzungen (ca. 20%). Die Häufigkeit einer Retentio secundinarum nach einer Torsio uteri wird sehr unterschiedlich angegeben mit einer Rate zwischen 3% und 52%.

Topographical distribution of choroidal naevi in the ocular fundus

OBJECTIVE

To analyse the topographical distribution of choroidal naevi and to visualise their location in the ocular fundus.

METHODS

Data on the size and location of 210 choroidal naevi were converted into a database of two-dimensional retinal charts by means of computer-drawing software. The geometric centre of each lesion was entered into corresponding sectors of the retinal chart. The location of the naevi was computationally visualised by merging the fundus drawings and displaying the number of overlapping lesions on colour-coded contour maps.

RESULTS

Five naevi were located exactly between two fundus sectors, and were therefore excluded from the distribution analysis. Ten naevi (5%) were located anterior and 195 (95%) posterior to the equator. A total of 104 naevi (51%) were located in the temporal and 101 (49%) in the nasal hemisphere, and the distribution between the superior and inferior hemisphere was 104 (51%) and 101 (49%), respectively. The distribution did not differ significantly between genders, age groups, or between right and left eyes. More naevi with a diameter of >3 mm were located in the temporal hemisphere (P=0.0004) and anterior to the equator (P=0.006) compared with those with a diameter of </=3 mm. A similar distribution was found for naevi with overlying drusen.

CONCLUSIONS

Choroidal naevi are uniformly concentrated in the centre of the posterior pole without any significant nasotemporal or superoinferior asymmetry. However, large naevi occur significantly more often in the temporal hemisphere and more anteriorly compared with small lesions.

Posterior uveal melanoma. Distribution of the sites of origin and patterns of tumour extent in the ocular fundus

AIMS

To analyse the distribution of posterior uveal melanoma origin sites and to visualise the patterns of tumour extent in the ocular fundus.

METHODS

Data on the size and location of 110 posterior uveal melanomas were converted into a database of two-dimensional retinal charts by means of computer-drawing software. The initiation sites (geometric tumour centres) were entered into corresponding sectors of the retinal chart. The extent of the tumours was visualised by merging the charts and displaying the number of overlapping tumours on colour-coded contour maps.

RESULTS

Seventy-one initiation sites (65%) were located in the temporal and 39 (35%) in the nasal hemisphere (p = 0.002). Seventy-six initiation sites (69%) were located posterior and 34 (31%) anterior to the equator. More initiation sites anterior to the equator were observed in large versus small/medium tumours (p = 0.0003), in tumours with a largest basal diameter/height ratio <2 versus > or =2 (p = 0.002), in tumours with a ruptured versus intact Bruch membrane (p = 0.03), in tumours with a mixed/epithelioid versus spindle cell type (p = 0.02) and in tumours leading to metastatic disease (p = 0.003).

CONCLUSION

The temporal hemisphere posterior to the equator is the preferential area of melanoma occurrence and growth. For larger and more aggressive tumours, there is a shift towards more peripherally located initiation sites.

Posterior uveal melanoma treated with I-125 brachytherapy or primary enucleation

PURPOSE

To study the incidence, clinical findings, and tumour characteristics of posterior uveal melanoma in Western Norway, and to report the results of a consistent treatment strategy (I-125 brachytherapy or primary enucleation) over a 13-year period.

METHODS

The clinical records of all patients with posterior uveal melanoma referred between January 1993 and December 2005 were reviewed. Clinical data, radiation parameters, visual outcome, and mortality were analysed in a dedicated database.

RESULTS

The study included 111 consecutive patients. The annual age-adjusted incidence (per million population) of posterior uveal melanoma was 8.5 for women and 8.9 for men. Fifty-six patients underwent I-125 brachytherapy, 52 were enucleated, and three received no treatment. The median follow-up time was 36 months (mean, 52 months; range, 2 months to 13 years). In the brachytherapy group, two eyes were enucleated owing to tumour recurrence and two because of neovascular glaucoma. A visual acuity of 0.1 or better, present in 87% of the patients before brachytherapy, was retained in 40% after a median follow-up of 61 months. After brachytherapy, the 5- and 10-year melanoma-specific mortality rates were 13.4 and 23.8%, respectively. The corresponding mortality rates for patients treated with primary enucleation were 49.5 and 49.5%.

CONCLUSION

After brachytherapy, many patients lost useful vision due to radiation-induced complications. The probability of retaining the eye was high and only two patients experienced recurrent tumour growth. The mortality rates compare well with published series, and the differences in tumour size explain the difference in mortality between the two treatment groups.

Dosimetric verification of a dedicated 3D treatment planning system for episcleral plaque therapy

PURPOSE

Episcleral plaque therapy (EPT) is applied in the management of some malignant ocular tumors. A customized configuration of typically 4 to 20 radioactive seeds is fixed in a gold plaque, and the plaque is sutured to the scleral surface corresponding to the basis of the intraocular tumor, allowing for a localized radiation dose delivery to the tumor. Minimum target doses as high as 100 Gy are directed at malignant tumor sites close to critical normal tissues (e.g., optic disc and macula). Precise dosimetry is therefore fundamental for judging both the risk for normal tissue toxicity and tumor dose prescription. This paper describes the dosimetric verification of a commercially available dedicated treatment planning system (TPS) for EPT when realistic multiple-seed configurations are applied.

MATERIALS AND METHODS

The TPS Bebig Plaque Simulator is used to plan EPT at our institution. Relative dose distributions in a water phantom, including central axis depth dose and off-axis dose profiles for three different plaques, the University of Southern California (USC) #9 and the Collaborative Ocular Melanoma Study (COMS) 12-mm and 20-mm plaques, were measured with a diode detector. Each plaque was arranged with realistic multiple 125I seed configurations. The measured dose distributions were compared to the corresponding dose profiles calculated with the TPS. All measurements were corrected for the angular sensitivity variation of the diode.

RESULTS

Single-seed dose distributions measured with our dosimetry setup agreed with previously published data within 3%. For the three multiple-seed plaque configurations, the measured and calculated dose distributions were in good agreement. For the central axis depth doses, the agreement was within 4%, whereas deviations up to 11% were observed in single points far off-axis.

CONCLUSIONS

The Bebig Plaque Simulator is a reliable TPS for calculating relative dose distributions around realistic multiple 125I seed configurations in EPT.

Effect of endothelin and BQ123 on ocular blood flow parameters in healthy subjects

PURPOSE

To characterize the role of the endothelin system in the blood flow control of the optic nerve head and of the choroid in humans.

METHODS

Two studies were performed in healthy subjects. Study 1 was a randomized, placebo-controlled, double-masked, balanced, two-way crossover design and study 2 a three way-way crossover design. In study 1 twelve healthy male subjects received endothelin (ET)-1 in stepwise increasing doses of 1.25, 2.5, and 5 ng/kg x min (each infusion step occurred over 20 minutes) coinfused with BQ123 (60 microg/kg x min) or placebo on two different study days. In study 2 twelve healthy male subjects received two doses of BQ123 (60 or 120 microg/kg x min over 60 minutes) or placebo on three different study days. Measurements of optic nerve head blood flow (ONHBF) and choroidal blood flow (ChBF) were performed with laser Doppler flowmetry in both studies. In study 2 mean flow velocity (MFV) of the ophthalmic artery was assessed with Doppler sonography.

RESULTS

In study 1, ET-1 significantly decreased ONHBF (-22.8% +/- 4.3% at 5 ng/kg x min, P = 0.003 versus baseline) and ChBF (-21.7% +/- 3.2% at 5 ng/kg x min, P = 0.0001 versus baseline). The effect of the highest administered dose of exogenous ET-1 on ONHBF was significantly attenuated (P = 0.04, ANOVA) by coinfusion of BQ123. Effects of exogenous ET-1 on blood flow (2.5 ng/kg x min ET-1 or higher) also were attenuated in the choroid by coinfusion of BQ123 (ChBF: P = 0.03, ANOVA). In study 2, both dosages of BQ123 significantly increased MFV in the ophthalmic artery (60 microg/kg x min, 12.5% +/- 7.3%; 120 microg/kg x min, 17.2% +/- 9.2%, versus baseline; P = 0.001), but did not change blood flow in the ONH or the choroid.

CONCLUSIONS

BQ123 antagonizes the effects of exogenously administered ET-1 on blood flow in the ONH and the choroid. The data indicate, however, that ET-1 does not substantially contribute to the regulation of basal vascular tone in these tissues.

Salvage intravesical therapy with interferon-alpha 2b plus low dose bacillus Calmette-Guerin is effective in patients with superficial bladder cancer in whom bacillus Calmette-Guerin alone previously failed

PURPOSE

We determined whether combining low dose bacillus Calmette-Guerin (BCG) interferon-alpha 2B would be effective for patients in whom previous BCG failed.

MATERIALS AND METHODS

A total of 40 patients in whom 1 (19) or more (21) previous induction courses of BCG failed received 6 to 8 weekly treatments of 1/3 dose (27 mg.) BCG plus 50 million units interferon-alpha 2B. Additional 3 week miniseries of further decreased BCG (1/10, 1/30 or 1/100) titrated to symptoms without changing the interferon-alpha 2B dose were given at 5, 11 and 17 months. In 12 patients a second induction course was given with 1/10 BCG plus 100 million units interferon-alpha 2B. There was multifocal disease in 39 patients, previous BCG had failed within 6 months in 34, disease was aggressive (stage T1, grade 3 or carcinoma in situ in 31, there had been 2 or more previous recurrences in 25 and disease history was greater than 4 years in 13.

RESULTS

At a median followup of 30 months 63% and 53% of patients were disease-free at 12 and 24 months, respectively. Patients in whom 2 or more previous BCG courses had failed fared as well as those with 1 failure. Of the 18 failures 14 occurred at the initial cystoscopy evaluation. Of 22 patients initially counseled to undergo cystectomy 12 (55%) are disease-free with a functioning bladder. Combination therapy was well tolerated.

CONCLUSIONS

While longer followup and larger multicenter studies are required to validate these encouraging findings, intravesical low dose BCG plus interferon-alpha 2B appears to be effective in many cases of high risk disease previously deemed BCG refractory. However, early failure while on this regimen should be aggressively pursued with more radical treatment options.

Transillumination for accurate placement of radioactive plaques in brachytherapy of choroidal melanoma

PURPOSE

To present a technique for accurate plaque placement in episcleral brachytherapy of choroidal melanoma.

METHODS

The tumor margins are marked on the scleral surface, and a dummy plaque is temporarily sutured to the globe. A fiber optic light pipe is then wedged into the space between the sclera and the plaque. Because of the reflecting inner surface of the plaque, the perimeter of the plaque can easily be observed during indirect ophthalmoscopy as a circle of light surrounding the tumor. By this method, it is possible to determine the exact position of the entire plaque in relation to the tumor and make the necessary adjustments. When the correct position is found, the dummy plaque is replaced by a radioactive plaque.

RESULTS

Since 1993, we have routinely used this procedure in episcleral brachytherapy.

CONCLUSION

This modified transillumination technique facilitates a correct positioning of episcleral plaques.

Simultaneous, bilateral rhegmatogenous retinal detachment

PURPOSE

To examine the incidence, the preoperative findings and the surgical outcome of patients presenting with simultaneous, bilateral retinal detachment.

METHODS

A retrospective analysis of the medical records of patients undergoing surgery for rhegmatogenous retinal detachment between 1990 and 1998.

RESULTS

During this period a total of 827 operations for rhegmatogenous retinal detachment were done in 791 consecutive patients. Eighteen patients (2.3%) had simultaneous, bilateral retinal detachment, giving an annual incidence of 0.35 patients per 100,000 population. They all presented with unilateral symptoms. Compared with the group of unilateral or consecutive, bilateral retinal detachments, patients suffering from simultaneous, bilateral retinal detachments were significantly younger, with a mean age of 40.3 years. Thirteen patients had multiple, round retinal holes associated with lattice degeneration. Sixteen patients were myopic, ranging from -3 to -9.25 diopters. The retina was reattached in 35 (97%) of the 36 eyes operated on during the study period.

CONCLUSION

Simultaneous, bilateral retinal detachment is usually found in relatively young, myopic patients with round, atrophic retinal holes, presenting with unilateral visual symptoms.

Expression of factor VIII-related antigen in human aqueous drainage channels

PURPOSE

Previous studies have indicated that there are preformed channels at the inner aspect of the anterior sclera, capable of draining fluid from the suprachoroidal space into scleral veins. The aim of this study was to characterize the cellular lining of these channels, and to compare it with the endothelium of Schlemm's canal, the collector channels and the scleral blood vessels.

METHODS

Histological sections from the angular region of human eyes were prepared by an immunoperoxidase method to evaluate the expression of factor VIII-related antigen in different aqueous drainage channels.

RESULTS

The cellular lining of the scleral channels showed a weak immunostaining to factor VIII-related antigen. Factor VIII-related antigen was also detected in the endothelium of the collector channels and Schlemm's canal.

CONCLUSION

The positive immunoreaction to factor VIII-related antigen indicates that the previously described scleral channels, the collector channels and Schlemm's canal are all lined by an endothelium derived from a vascular origin.

Iris cyst associated with topical administration of latanoprost

PURPOSE

To report an adverse side effect associated with topical latanoprost usage.

METHOD

Case report. A 76-year-old woman with primary open-angle glaucoma developed an iris cyst 5 weeks after beginning treatment with latanoprost. Clinical examinations and slit-lamp photographs were performed.

RESULTS

Latanoprost was discontinued. Periodic examinations disclosed that the iris cyst gradually diminished and finally disappeared within 3 weeks.

CONCLUSION

The formation of an iris cyst is a possible complication of topical latanoprost therapy.

Light microscopy of uveoscleral drainage routes after gelatine injections into the suprachoroidal space

PURPOSE

To visualize the suprachoroidal space and to study the morphology of possible uveoscleral drainage routes in the human eye.

METHODS

Indian ink stained gelatine was injected directly into the suprachoroidal space of 7 human donor eyes. Those quadrants where gelatine appeared in the episcleral venous network were cut in their entirety in consecutive sections and examined by light microscopy.

RESULTS

Gelatine was observed in the connective tissue surrounding scleral vessels and nerves. Gelatine was also traceable in fine, endothelium-lined channels at the inner aspect of the anterior sclera. These channels seemed to originate at the inner surface of the sclera, close behind the scleral spur, and communicate with the intrascleral venous plexus.

CONCLUSION

Fluid is drained from the suprachoroidal space through the perivascular and perineural spaces of scleral blood vessels and nerves. In addition, this study indicates that there are preformed channels at the inner aspect of the anterior sclera, capable of draining fluid directly into scleral veins.

Exudative retinal detachment in nanophthalmos

PURPOSE

To report the treatment of exudative retinal detachment in a patient with nanophthalmos.

METHODS

A 46-year-old man with bilateral nanophthalmos suffered from acute angle-closure glaucoma in his left eye. The first day after a peripheral iridectomy an exudative retinal detachment was observed. Two months later a partial thickness sclerectomy with a central sclerostomy, covered by a thin film of absorbable gelatine, was performed in each quadrant of the left eye.

RESULTS

The retinal detachment gradually resolved and after eight months the retina was completely reattached. Vision, which had been limited to hand movements, improved to 6/18 with correction.

CONCLUSION

Scleral resections are effective in the treatment of nanophthalmic retinal detachment. The use of absorbable gelatine film to cover the sclerectomized area may prevent regeneration of scleral tissue and recurrence of the exudative retinal detachment.

Cryotherapy in the treatment of cyclodialysis cleft induced hypotony

A 26-year-old man with juvenile glaucoma developed persisting hypotonic retinopathy after trabeculotomy ab externo. An unintended cyclodialysis cleft at the site of the trabeculotomy was suspected, but visualization of the chamber angle was impossible due to a shallow anterior chamber. Seven months after the trabeculotomy the patient was treated with transconjunctival cryotherapy at the presumed localization of a cyclodialysis cleft. Eight days later an episode of acute ocular hypertension occurred, otherwise the postoperative course was uneventful with reversal of the hypotony and complete normalization of the visual acuity. The diagnostic and therapeutic problems of a hypotonous cyclodialysis cleft combined with a shallow anterior chamber are discussed.

Corrosion casts of the suprachoroidal space and uveoscleral drainage routes in the human eye

Human cadaver eyes were studied by corrosion casting technique. Batson's mixture No. 17 (methyl methacrylate) was injected through a sclerotomy into the suprachoroidal space. Following polymerisation of the injected mixture the surrounding tissue was dissolved with 10% natrium hydroxide. Macroscopic and scanning electron microscopic findings in casts of the suprachoroidal space are presented. Due to transscleral drainage of resin from the suprachoroidal space, different types of branches deriving from the outer (scleral) surface of the casts were found. Some of these branches corresponded to the perivascular spaces of both ciliary vessels and vortex veins. In addition, we found branches probably representing channels deriving directly from the suprachoroidal space, communicating with the intrascleral venous plexus. Such channel systems have previously not been described, and their possible relation to the uveoscleral drainage of aqueous humour is discussed.

Corrosion casts of the suprachoroidal space and uveoscleral drainage routes in the pig eye

Eyes from pigs were studied by corrosion casting technique. Batson's mixture No. 17 (methyl methacrylate) was injected through a sclerotomy into the suprachoroidal space. Following polymerisation of the injected mixture the surrounding tissue was dissolved with 10% natrium hydroxide. Macroscopic and scanning electron microscopic findings in casts of the suprachoroidal space are presented. The outer (scleral) surface of the casts was rough, with a fish-scale-like appearance caused by fine lamellas between the sclera and choroid, running from the inner layers of the sclera traversing the space anteriorly to the choroid. Frequently, irregular, Y-shaped branches deriving from the outer surface of the casts were observed. They corresponded to the perivascular space of the vortex veins and represent a possible uveoscleral drainage route for aqueous humour.

Retrobulbar anesthesia with and without adrenaline in extracapsular cataract surgery. A prospective, randomized, double-blind study

Seventy-five patients with senile cataract underwent a planned extracapsular cataract extraction. They were randomly divided into two groups, receiving retrobulbar anesthesia (4 ml lidocaine 2% and 250 IU hyaluronidase) with or without adrenaline. Patients in the adrenaline group had the lowest mean intraocular pressure after the retrobulbar injection (p < 0.02) and they required a shorter time of digital bulbar massage to reduce tension before surgery (p < 0.01). They also appeared to have a deeper anterior chamber during the first part of surgery, although the difference was not statistically significant. The duration of postoperative analgesia was significantly prolonged in patients receiving adrenaline. Different mechanisms explaining the effects of adrenaline in retrobulbar anesthesia are discussed.

[Primary intraocular lymphoma]

Primary intraocular lymphoma can arise as an isolated clinical entity or in combination with lymphomas in the central nervous system. The symptoms are usually floaters in the visual field and reduced visual acuity. The condition is commonly misdiagnosed as chronic uveitis in spite of unresponsiveness to corticosteroids. The authors discuss a case of primary intraocular lymphoma diagnosed in a 65 year old male patient. He had bilateral intraocular lesions in addition to two brain tumours. He went into complete remission after radiation therapy, but experienced later a recurrence in one eye. A course of chemotherapy using cytarabin (cytosine arabinoside) intravenously has kept the patient in remission for four months. The authors also discuss the diagnostic and therapeutic problems connected with this rare condition.

Retrobulbar anesthesia with and without hyaluronidase in extracapsular cataract surgery. A prospective, randomized, double-blind study

Eighty patients with senile cataract were subjected to a planned extracapsular cataract extraction (ECCE) with implantation of a posterior chamber intraocular lens. Retrobulbar anesthesia was administered by injection of 4 mg lidocaine 2% with adrenalin. In 40 patients 150 I.U. hyaluronidase (Kinetin) was added to the anesthesia. The hyaluronidase group had a significantly lower frequency of iris prolapse, and deeper anterior chamber, both before and after expression of the lens nucleus. Possible mechanisms explaining the beneficial effect of hyaluronidase in extracapsular cataract surgery are discussed.

Repair of a Cerebral Artery Aneurysm in a Patient with Persistent Truncus Arteriosus

We describe the anesthetic management of a 19-year-old woman with persistent truncus arteriosus who presented for cerebral artery aneurysm clipping. The anatomy and pathophysiology of persistent truncus arteriosus are reviewed to provide a basis for the choice of anesthetic agents and monitoring devices in this patient. The hazards of induced hypotension in the patient with truncus arteriosus are also discussed.

The nature of the Oedipus complex in the Dora case

In this paper we sought to study, through a detailed review of Dora's analytic material, the specific nature of her oedipal conflict and its expression in her treatment with Freud as manifested in her dreams, associations, and transference. We found that while Freud was surely correct in considering Dora's positive oedipal conflict as an important source of her psychopathology, the implication of her early regression to a phallic-oedipal position was not fully appreciated or interpreted, leading to her eventual premature termination. While Freud analyzed, largely following the end of the treatment, Dora's erotic love for Frau K., he did not see this love as deriving from an integrated phallic-oedipal complex which included competitive and castrative strivings toward men as well as wishes to love a woman from a phallic position. Thus we sought to extend Freud's analysis of the case by delineating the specific form of Dora's homosexual love, the genetic sources for it, and the aggressive wish toward men as they derive from a particular substage of the oedipal phase for females, the phallic-oedipal phase. We conclude that Dora's hostility toward Freud, her father and Herr. K. resulted not only from injured pride but, more basically, from her jealousy and rivalry with father for mother's love. In her treatment Dora's phallic-oedipal wishes became increasingly dominant. They were manifested in the transference with her first acting to engage Freud's interest and then thwarting his interpretive efforts, ultimately by leaving the treatment altogether. The case well illustrates the importance of understanding the role of the phallic-oedipal phase in female hysterical patients.

Investigations on connective tissue metabolism: ageing of the human heart

In any given phase of the age process, the rates of synthesis and degradation of collagen and other macromolecules are diversely influenced by changes in the respective enzyme activities. This naturally affects and reflects the contents of the intracellular as well as extracellular macromolecules. In our studies, the total contents of desoxyribonucleic acid (DNA), hydroxyproline, hexosamines and uronic acids of the four compartments of the human heart were estimated and plotted against age. The results obtained for DNA showed an initial rapid decline in its content to about the middle of the third decade of life, i.e. around the end of the maturation period. Thereafter, the DNA curves showed a relatively slower decrease until the fifth decade, after which a slight increase was observed during senescence. This holds for both the left and the right sides of the heart. Hydroxyproline levels, on the other hand, remained unchanged in all the different compartments except in the left atrium, where the initial phase of the curve showed a significant drop until the middle of the fourth decade. Hydroxyproline values in the atria were twice as high as in the ventricles, which in turn showed higher levels of hexosamines than uronic acids. Both hexosamines and uronic acids in the atrial walls showed an initial decline followed by a gradual rise during ageing. Contents of uronic acids in the ventricles showed a gradual but steady rise throughout life.

[New results on ageing of connective tissue (author's transl)]

Some new results on ageing of connective tissue are demonstrated, regarding not only mesenchymal, but also parenchymal organs of human and rat (both sexes). These results show that ageing of connective tissue is more a dynamic process (with measurable metabolic parameters of the several connective tissue cells and their products) than a passive or so-called degenerative connective tissue process. The bradytrophy concept of connective tissue cannot be accepted any longer. Then connective tissue cells can produce metabolic rates of the same level like parenchymal cells. The different organs possess partly common basic processes partly differences in connective tissue ageing, dependent on the composition and patterns of proteoglycans resp. of GAG and collagen types, furthermore dependent on localisation, structure and function. The results on ageing of connective tissue are useful for better understanding of ageing processes of parenchymal organs. Then their ageing is influenced essentially by the ageing of the own connective tissues. The turnover, more than the number of mesenchymal and parenchymal cells, decreases with ageing. More old than young cells seem to exist in old tissues and organs. The performance of ageing connective tissue cells can be constant or increase or decrease. Many mesenchymal and parenchymal organs develop a so-called "ageing-fibrosis".