Thyroid hormone correlates of sensation seeking and anxiety in healthy human females. The present study explores the relationships among a number of personality measures (the Sensation-Seeking Scale, SSS; the State-Trait Anxiety Inventory, and the Susceptibility to Punishment Scale) and some parameters of the pituitary-thyroid axis. The study was carried out on a group of 37 physically and mentally fit female volunteers, none of whom had a personal history of psychiatric or endocrinologic illness. The subjects were controlled for the menstrual cycle. The most relevant result was a significant negative relationship between the SSS score and plasma basal levels of thyroxine (T4) and thyroid-stimulating hormone (TSH). Interaction between T4 and TSH levels with trait anxiety was also observed.


Influence of quinidine on the pharmacokinetics of trimipramine and on its effect on the waking EEG of healthy volunteers. A pilot study on two subjects. The pharmacokinetics and pharmacodynamics (waking EEG) of 75 mg trimipramine taken orally were determined in two healthy volunteers on two separate occasions, once without and once after comedication with 2 x 50 mg quinidine. Quinidine, a potent cytochrome P-450IID6 inhibitor, is used as a pharmacological tool to mimic a lack of this enzyme in man. In this study, it markedly altered the pharmacokinetics of trimipramine, almost doubling its plasma half-life and decreasing its apparent clearance and volume of distribution. These results strongly suggest that trimipramine is a substrate of cytochrome P-450IID6. These modifications of trimipramine metabolism were accompanied by measurable changes in some EEG variables, most notably with regard to the relative power in the alpha and theta bands, which showed higher and longer-lasting effects of trimipramine. Since cytochrome P-450IID6 is deficient in 5-10% of Caucasian subjects, this may have consequences in trimipramine-treated subjects, especially with regard to the effects of the drug on the EEG.


Effect of carbamazepine treatment on EEG changes induced by different cortical activation patterns in newly referred epileptic patients. Sixteen epileptic patients suffering from focal epilepsy who underwent antiepileptic drug treatment with carbamazepine (CBZ) for the first time were studied. The EEG was recorded at rest with eyes closed, during blocking reaction (BR), fixation (FIX) and mental arithmetic tasks. The computerized EEG study, performed before and after CBZ therapy, utilized spectral analysis. Data underwent statistical evaluation through Anova and correlation analysis. The parameters evaluated were the mean frequency and the mean absolute and relative power. The results have shown that after CBZ treatment there is a decrease in the alpha reactivity during BR and FIX, while a significant increase in beta activity was observed during all tasks. The effect of CBZ therapy on EEG activity during cortical activation patterns are discussed.


Where have all the captains gone? A comparison of active and reserve MC ranks and ages, Vietnam to Desert Storm. An analysis of ages and ranks of hospital-based physicians in one area of the Persian Gulf War was used for a comparison with similar data from the Vietnam War. Mean age in the latter was 33.4 years; rank was Captain (0-3.24). In Desert Storm, mean age and rank significantly increased to 46.0 years and close to Lieutenant Colonel (0-4.73), respectively. The large proportion of Reserve Component Physicians (75%) in the Persian Gulf War is the probable explanation for these findings. Medical Corps recruitment and retention problems may result from this most recent war and pose potential threats to success in future U.S. conflicts.


Ten leadership steps to a smooth facility upgrade. Leading a medical treatment facility (MTF) through the construction phases of a major upgrade, repair, or any sizable facility project is a challenging and complex endeavor. The Executive Staff can make the process easier on everyone and ensure the final product is in tune with the MTFs needs by taking positive leadership actions. This article describes the effective actions discovered during a 2.5-year-long total MTF upgrade of the 52 Tactical Fighter Wing (TFW) Clinic. These actions involved promulgating a broad systems view of the process, establishing philosophies and criteria, promoting team work, involving customers, and building consensus among the staff.


A descriptive analysis of urine cultures: pure versus mixed isolates. Out of 5,670 urine cultures performed in 1989, 1,448 positive cultures with unique results were analyzed. Of these 1,448, 67% were pure cultures, and 50% had at least one isolate with a colony count greater than 100,000 colony forming units/ml. Pseudomonas aeruginosa, Enterococcus faecalis, Proteus mirabilis, Klebsiella pneumoniae, Staphylococcus aureus, and diphtheroids were more likely (p < 0.01) to occur in mixed than pure culture, while Escherichia coli was more likely to occur in pure than mixed culture. The most common organism combinations were diphtheroids-coagulase negative Staphylococcus (30 cultures), E. faecalis-coagulase negative Staphylococcus (28), E. faecalis-P. aeruginosa (13), K. pneumoniae-P. aeruginosa (9), and E. coli-P. aeruginosa (9).


A descriptive study of mentoring relationships experienced by Army nurses in head nurse or nursing supervisor roles. Mentoring relationships experienced by Army Nurse Corps officers in head nurse or nursing supervisor roles were examined via a survey questionnaire. Findings indicate that career development relationships are occurring among these nurses, but less than half of the relationships consist of mentoring. Nursing supervisors comprised the largest group of career developers, while head nurses were the second most likely group to assist with the development of a novice nurse. Approximately half of the nurses indicated that the career development relationship had a "substantial" influence on their personal lives, and a "very great" influence on their professional lives.


The effect of intermediate altitude on the Army Physical Fitness Test. Official physical training records of personnel stationed at intermediate altitude (elevation 5,280 feet) for at least 1 year were reviewed to gauge the effect of altitude on 2-mile running performance. An average of 48 additional seconds (a 5% increase in time) was required to complete the run compared to sea-level values in the same subjects. Run times gradually diminished during the first 9 months of assignment to altitude before stability was established. These data indicate that acclimatization occurs over several months. Even with acclimatization, substantial loss of performance is associated with habitation at intermediate altitude.


Serum gentamicin concentrations in postpartum endomyometritis. Gentamicin in combination with other antibiotics is frequently used in the treatment of postpartum endomyometritis. The need to monitor and maintain therapeutic concentrations, however, is controversial. To assess the role of monitoring, serum gentamicin concentrations were prospectively studied in an obstetric population treated for postpartum endomyometritis. Clinical course was correlated to serum gentamicin levels obtained using a 1 mg/kg/dose regimen. No patient demonstrated therapeutic concentrations. Sixteen of 18 obstetric patients (88%) exhibited a clinical response despite subtherapeutic serum gentamicin concentrations. The two failures included one case of septicemia and one wound seroma. Serum gentamicin levels of this obstetric population when compared to those from a gynecologic population treated for benign disease demonstrated no statistical difference. These data suggest that clinical response provides an accurate indication of the efficacy of therapy and that gentamicin doses of 1 mg/kg/dose provide sufficient antibiotic coverage in most cases. These results do not support the use of increased gentamicin dosages and the need to attain therapeutic levels in the obstetric patient, as previously suggested.


Thirty years of experience with infectious hepatitis prevention in the Israel Defence Forces. Infectious hepatitis is endemic to Israel. Large outbreaks of infectious hepatitis were common in the Israel Defence Forces (IDF) before 1970, at which time post-exposure prophylaxis with immune serum globulin was introduced. It caused a decrease in the incidence of infectious hepatitis from 10-14/1,000 to 3/1,000. A further reduction in incidence was achieved after 1978 when a policy of pre-exposure prophylaxis was established. The number of yearly outbreaks and cases per outbreak also declined as a result of this policy. Worldwide studies have shown that a policy of pre-exposure prophylaxis and/or post-exposure prophylaxis with immune serum globulin is effective in reducing the incidence of infectious hepatitis. The experience of the IDF is that a combination of both pre-exposure and post-exposure prophylaxis is more efficacious. This policy should be worthwhile in other areas where infectious hepatitis is endemic.


Emotional distress in chronic medical illness: treatment with time-limited group psychotherapy. Time-limited (12 sessions) group psychotherapy was provided for 14 patients with a variety of serious medical illnesses. All patients were referred for psychiatric assistance and most had minimal or no psychiatric disorder. Patients not terminally ill, in continuous pain, or cognitively impaired, but otherwise unselected, were offered treatment. Emphasis was placed on validation of feelings, interpersonal understanding, and problem solving. Increased sense of well being was noted in all patients by self-report; this was contrasted by findings on the Millon Behavioral Health Inventory indicating generally sustained somatic concern. A moderate reduction in the number of visits to other clinics was noted during the treatment period. Although outcome data are incomplete, this appears to be a useful and cost-effective treatment for mixed groups of emotionally distressed medical patients.


Anthropometric, psychomotor, and hemodynamic changes during twenty-one continuous days of eating only meals, ready-to-eat (MREs). This study investigated anthropometric, psychomotor, and hemodynamic changes in young adult men during 21 continuous days of eating only meals, ready-to-eat (MREs). The MRE diet group lost more weight and bodyfat (significant at abdominal site, total skinfolds, and total bodyfat percent), and had significantly greater gains in hand grip strength than did controls. Results support the contention that, when eaten as designed, MREs are nutritionally adequate for maintaining body weight and muscle strength without adverse effects.


The value of dental radiographic equipment in a Navy field hospital. The portable dental X-ray machine has been used to augment standard field x-ray equipment. This allows for more rapid assessment of combat casualties. The data presented describe the use of the portable dental X-ray machine during the 100-hour ground war against Iraq.


Soldiers' dental complaints compared with clinical findings in the Military Hospital in Bologna, Italy. There is no previous data published on the frequency and reasons for dental emergencies in the Italian Army. In this study, all the 329 soldiers who sought dental help during a 5-month period in the Military Hospital in Bologna were investigated. Prior to clinical examination, the soldiers filled out a questionnaire concerning their subjective perception about their dental treatment needs. Data from the questionnaire were then compared with the actual status findings. The results showed that endodontic problems comprised the majority of the cases (37.1%), followed by surgical problems as the second most frequent emergency (33.1%). The subjects' own perceptions showed good agreement with the clinical record in cases with endodontal or surgical problems, excluding problems related to wisdom teeth, while those related to caries and periodontal disease were less frequently correctly assessed by the soldiers.


Establishing a neurology service in support of Operation Desert Storm. As a result of Operation Desert Storm, a neurology service was established in the Fort Leonard Wood MEDDAC. Between January 1 and April 30, 1991, a total of 315 new neurology patients were seen in consultation. This number plus all the follow-up visits add up to a total of 750 clinical encounters during that period. The characteristics of this service (population served, reasons for referral, and diagnoses) were not significantly different than has been previously reported. The level of activity, by MS3 standards, qualifies this MEDDAC to have two neurologists.


Behavioral differences of irradiated persons associated with the Kyshtym, Chelyabinsk, and Chernobyl nuclear accidents. Three nuclear accidents besides Chernobyl have occurred in the former Soviet Union. The accidents occurred around Kyshtym and Chelyabinsk in the Ural Mountains between 1949 and 1967 and contaminated over one-half million people. The health ministries are now interested in the data previously collected on these irradiated populations in order to examine the health (e.g., psychological, hereditary, genome damage, etc.) implications of long-term radiation exposure.


A retrospective analysis of open fractures sustained by U.S. military personnel during Operation Just Cause. A retrospective analysis was conducted of 37 open fracture cases sustained by U.S. military personnel during the recent low-intensity conflict in Panama (Operation Just Cause). The etiology, location, classification, and management of open fractures sustained in combat is presented. A significant difference was noted in the infection rate for type III open fractures that were debrided in Panama (22%) as compared to those that were debrided only after transport to CONUS (66%). This study supports the critical importance of adequate battlefield surgical support in low-intensity conflicts, and reemphasizes the crucial role of early surgical debridement for the prevention of wound infection.


Carpal tunnel syndrome associated with histoplasmosis: a case report and literature review. A case of localized Histoplasma capsulatum flexor tenosynovitis causing a carpal tunnel syndrome is presented. Carpal tunnel release, with tenosynovectomy, was performed followed by antifungal therapy. The symptoms did not recur. Tenosynovectomy followed by antifungal treatment is recommended.


Kaposi's sarcoma of the gallbladder.

Kaposi's sarcoma of the gallbladder. A 30-year-old man with symptomatic acquired immunodeficiency syndrome presented with abdominal pain and disseminated intravascular coagulation. Radiographic studies revealed thickening of the gallbladder wall. Following stabilization of the coagulation disorder, the patient underwent a cholecystectomy, and the gallbladder was found to contain Kaposi's sarcoma (KS). There have been no previously published reports of KS found in the gallbladder of a living patient in the absence of cutaneous manifestations of KS. The current case illustrates that KS is a multi-focal systemic disease which may have extracutaneous primary manifestations.


Idiopathic renal hematuria in a military working dog. A 1.5-year-old male Belgian Malinosis Military Working Dog presented with a 1-month history of intermittent hematuria. Diagnostic ultrasound and contrast radiography demonstrated large blood clots in the urinary bladder and a filling defect in the right renal pelvis. At surgery, clotted blood was present in the right ureter and bladder. Following right nephrectomy, the dog returned to training. One month later, elevations in urea nitrogen and creatinine were noted. Hematuria recurred at 3 months and the dog was found dead in its kennel. Necropsy showed a blood-filled left renal pelvis and ureter.


Arthroscopic surgery of the knee on the U.S. Naval Hospital Ships during Operation Desert Shield. Between September 1990 and January 1991, while deployed to the Persian Gulf for Operation Desert Shield, 118 patients underwent arthroscopic surgery of the knee on the U.S. Naval Hospital Ships USNS Mercy and USNS Comfort. There were 113 men and 5 women, with an average age of 28 years (range, 19-59 years). The most common findings at the time of arthroscopy were meniscus tears (53%), anterior cruciate ligament tears (29%), and normal arthroscopic examinations (9%). There were three complications, two hemarthroses and one superficial portal site infection. Seventy patients (59%) were able to be returned to duty at an average of 6 days post-operatively, obviating the need to evacuate these patients out of the Middle East theater to Europe or the United States, thus avoiding additional delay, expense, and loss of the service member to his military unit.


Medical limitations of gas masks for civilian populations: the 1991 experience. Using a gas mask (GM) may involve considerable inconvenience, impairment of respiration and communication, and serious psychological reactions. The medical literature is primarily focused on the occupational aspects of using the GM by young and healthy workers. In contrast, there is hardly any information concerning the use of GMs by large, unselected populations, including children, the elderly, and the sick. Issuing GMs to all residents of Israel prior to Operation Desert Storm created an urgent need to define the populations whose health might be jeopardized by using the standard GM. Adding an active air supply system (AASS) to a standard GM may ease the burden on this high-risk group. We evaluated the physiological aspects of breathing with a GM, with and without AASS, in respect to pathophysiology of diseases, and reached a set of criteria for identifying those who may be endangered by a GM and are expected to benefit from the AASS. The method used to sort and identify those entitled to the AASS is described.


Physical and psychosocial impact of activation and deactivation on Army Reserve nurses. Reserve mobilization training focuses on specialty skills and soldiers' common tasks, but does not prepare individuals for the physical and psychological realities of activation. The purpose of this descriptive, multiphasic research was to systematically examine, as it was experienced, the impact of activation and subsequent de-activation on 81 Army Reserve nurses. The variables measured included somatic symptoms, psychosocial effects, stressors, coping strategies, and positive aspects of the experience. Some nurses experienced physical and psychosocial symptoms consistent with post-traumatic stress disorder. Lessons learned from this study will help Army Reserve units to be more proactive in mobilization preparation and training.


Research priorities of VA nurses: a Delphi study. The purpose of this study was to conduct a Delphi survey of a sample of Gainesville Veterans Affairs Medical Center staff and head nurses. The study consisted of three rounds of questionnaires completed by the nurses as they identified and narrowed the most pressing nursing research questions. Results indicated that in five of the six clinical settings, despite investigators' instructions to identify clinical nursing research questions, administrative research questions were identified and ranked consistently higher in priority than clinical research questions. The single exception was in home care, where clinical questions received the highest priority. This phenomena may suggest that institutional constraints interfere with nurses' full expression of their clinical practice.


Efficiency in the pediatric orthopedic clinic and the effect on the parents: a comparison of military and civilian medical centers. In a short-term comparison of similar pediatric orthopedic practices at a military and a civilian institution in the same geographical location, it was found that total appointment time, waiting time, and travel time were longer in the military setting. It appeared, however, that there was more leniency toward time off from work to accompany children to appointments in the military population. These factors may have considerable impact on time lost from the job for service member sponsors.


The efficacy of medicine during the campaigns of Alexander the Great. This paper examines the various factors that may have determined the efficacy of physicians during the campaigns of Alexander the Great. Such general variables as the adequacy of preparation, the nature of the medical profession, and the extent of preventative measures are all discussed at the outset of the paper, followed by a more detailed examination of the specific wounds, illnesses, and treatments of Alexander as described in the accounts of the Alexander historians Plutarch, Curtius, and Arrian. Where no remedy is given by these writers (as is usually the case), this paper speculates on the efficacy of possible treatments as advocated in the contemporary Hippocratic corpus. Casualty statistics of the campaigns are compared to a similar review of Homer's Iliad. From these examinations, this paper concludes that wound treatment efficacy was significantly greater than that of illness treatment, and that Alexander lost many more men to disease than to the wounds of war.


Noise-induced low- and high-frequency hearing losses in Finnish conscripts. Thirty-nine otologically healthy military conscripts were examined at the beginning and at the end of their 1-year service. On entry, they all showed normal findings during clinical otolaryngological examinations. The test battery included both conventional (0.25-8 kHz) and high-frequency "electric bone-conduction" (0.5-20 kHz) audiometry (EBC). The median pure-tone right ear thresholds at the end of service were 5 dB worse over the frequency range of 2-8 kHz compared with the thresholds at the beginning of the service. The difference was statistically highly significant (p = 0.00035). The median left ear pure-tone thresholds at frequencies of 0.25, 2, and 8 kHz were 5 dB worse at the end of the service compared to the thresholds at the beginning of the service. However, the difference was not statistically significant (p = 0.23). The median curves for the high-frequency (EBC) thresholds measured after the service showed worse thresholds over the whole frequency range compared to the median curves measured before the service. The greatest difference was seen in the highest frequencies (15-17 kHz) in both ears. The differences were statistically significant in both ears (p = 0.03 in the right ears; p = 0.01 in the left ears) when threshold values over the whole frequency range were analyzed. Since the otolaryngological history of these conscripts was uneventful during their service, the hearing deteriorations were considered to be caused by shooting practice.


Epidemiology of soft-tissue/musculoskeletal injury among U.S. Marine recruits undergoing basic training. We determined the incidence of soft-tissue/musculoskeletal injury occurring during 8,076 recruit-months at risk among recruits undergoing basic training at Marine Corps Recruit Depot, San Diego, California, between January and April 1990. We analyzed International Classification of Disease codes relating to initial visit for injuries, and calculated recruit-months from weekly strength figures. Training-related injuries occurred at a rate of 19.9 injuries per 100 recruit-months. Within the sports medicine clinic, iliotibial band syndrome (22.4%), patellar tendinitis (15.1%), and mechanical low back pain (11.4%) occurred most frequently, with rates per 100 recruit-months of 2.1, 1.4, and 1.1, respectively.


The medical challenge of military operations in the Mississippi Valley during the American Civil War. The prevention and treatment of disease was as important as combat operations in the campaigns along the Mississippi River during the American Civil War. Throughout the Vicksburg campaign, many more soldiers were disabled by sickness than by combat injury. While this held true for both sides, a greater proportion of the Union army was healthy than of the opposing Confederate force. In the last 2 years of the war, the North tried to occupy the Confederate states in the Mississippi Valley. The failure to accomplish this goal was partly due to the deteriorating health of the Union army. Medical knowledge and action taken to prevent disease were of major importance in the success and the failure of military campaigns in the Mississippi Valley during the American Civil War.


USAR Nurse Referral and Retention Program. In 1987, the 804th Hospital Center made alleviating the shortfall of registered nurses in the Command a priority. The Command had only 79% of its registered nurse positions filled at the time. Using the recruitment strategies of an employee referral program and a mailing list, the Command reached 100% fill in 2 years and maintained those gains for an additional year. Retention strategies were also implemented which lowered the attrition rate. This paper describes the Army Nurse Referral and Retention Program developed and implemented at the 804th Hospital Center that relieved the shortfall of registered nurses in the United States Army Reserve in New England.


High-grade immature teratoma of the testis in infancy. Teratomas of the testis in infants are rare tumors which often display immature elements, disturbing in their histologic appearance. Although the presence of similar histologic features worsens prognosis in testicular teratomas in adults and in teratomas of infants and children presenting at other anatomic sites, the presence of immature elements in testicular teratomas of infancy does not appear to affect prognosis. Therefore, orchiectomy alone is adequate therapy for these neoplasms. The case of an 8-month-old infant with a teratoma of testis is presented.


Acute trauma and hypnosis.

Acute trauma and hypnosis. Hypnosis is a valuable adjunct to the management of acute trauma. This is a case presentation of the management of severe burn injuries after fire and explosion on a United States Navy vessel. Hypnosis was used to calm one patient and facilitate intubation. Further suggestions of rapid healing and anxiety control were given. Hypnosis is not only helpful for management, but can be used to decrease the perceived severity of the incident. Patient well-being may also prevent sequelae of stress.


Distribution of 5-HT1 binding sites in cat spinal cord. Quantitative analysis of high affinity [3H]5-HT binding to 5-HT1 receptors in the cervical, thoracic, lumbar, and sacral spinal cord of the cat revealed specific binding throughout the grey matter, with the highest levels of binding in laminae II and III, and the lowest levels in laminae I and VII. Relatively high levels were also observed in the thoracic intermediolateral cell column. There were no significant differences in the degree of binding between various segmental levels. Comparison of these data with published maps of 5-HT immunoreactivity reveals--with the exception of lamina I--a close correspondence between the degree of immunoreactivity and the degree of 5-HT binding. These results suggest that 5-HT plays an important role in a variety of spinal cord sensory, motor and autonomic functions.


L-threo-3,4-dihydroxyphenylserine enhanced ocular dominance plasticity in adult cats. We studied whether ocular dominance plasticity can be restored to the aplastic visual cortex of the adult cat by peripheral administration of L-threo-3,4-dihydroxyphenylserine (L-threo-DOPS), an exogenous precursor of L-noradrenaline (NA). We found that NA output in the visuocortical dialysate was significantly increased by a single administration of L-threo-DOPS (200 mg or 1 g, i.p.). Single unit recordings revealed a significant reduction of binocular cells (binocularity = 0.30) in juvenile cats (7-8 months of age) that had been monocularly deprived for one month in combination with L-threo-DOPS (200 mg/day, per os). These results suggest that peripheral administration of L-threo-DOPS enhances ocular dominance plasticity, presumably through activation of the central noradrenergic system.


Pyruvate dehydrogenase dephosphorylation in rat brain synaptosomes and mitochondria: evidence for a calcium-mediated effect in response to depolarization, and variations due to ageing. The phosphorylation state of P42, the phosphorylated, catalytically inactive, alpha-subunit of pyruvate dehydrogenase (PDH), decreased markedly (42.4%) in response to K(+)-depolarization of synaptosomes. The dephosphorylation was rapid (5-15 s), calcium-dependent and could also be observed in isolated mitochondria exposed to a rise in extramitochondrial calcium, suggesting that P42 dephosphorylation may act as a calcium sensor in the mitochondrial matrix. The depolarization-dependent dephosphorylation rate of P42 was decreased in synaptosomes derived from 24-month-old animals with respect to 3-month-old adults. The relevance of these results in terms of PDH activation during ageing is discussed.


Reduced and oxidized glutathione in the substantia nigra of patients with Parkinson's disease. Reduced and oxidized glutathione concentrations in post-mortem brain tissue from the substantia nigra of control subjects and patients with neuropathologically confirmed Parkinson's disease were measured by a coulometric method using high-pressure liquid chromatography and electrochemical detection. Reduced glutathione concentrations were decreased in the substantia nigra of parkinsonian patients compared with controls. Differences in the concentration of oxidized glutathione and in the percentage of oxidized glutathione of the total glutathione were not observed between parkinsonian and control subjects. The finding that oxidized glutathione is not decreased in Parkinson's disease suggests that the decrease in reduced glutathione is not exclusively the consequence of neuronal loss in the substantia nigra but may indicate a state of oxidative stress.


Soybean agglutinin binds commonly to a subpopulation of small-diameter neurons in dorsal root ganglion, vascular endothelium and microglia in human spinal cord. Soybean agglutinin (SBA) was used to identify the location of N-acetylgalactosaminyl glycoconjugates in human dorsal root ganglia (DRG) and spinal cord. SBA bound to a subpopulation of small-diameter neurons in DRG and their central projections. It also bound to microglia and vascular endothelium. Vascular endothelium, DRG neurons and microglia do not originate from the neural tube, but penetrate into the neural tube in the embryonic stage and thereafter are located in the spinal cord. SBA binding glycoconjugates may be responsible for cell-cell interaction between these three cell types and tissues in human spinal cord.


Nuclear localization of estrogen receptor-immunoreactivity in the preoptic area of female rats and its reduction by intraventricular colchicine treatment. The subcellular localization of estrogen receptor (ER) was investigated in the preoptic area of ovariectomized female rats by electron microscopic immunohistochemistry, using a monoclonal antibody to ER. ER-immunoreactivity was localized in the nuclei of neurons of the periventricular preoptic nucleus (Pe) and the medial preoptic area (MPA). ER-immunoreactivity had a speckled pattern in the nucleus, but was not observed in the nucleolus or cytoplasm. After intraventricular colchicine treatment, ER-immunoreactivity within the nucleus was reduced drastically in neurons of the Pe and the MPA. The possible mechanism by which colchicine alters ER-immunoreactivity is mentioned.


Late appearance of parvalbumin-immunoreactive neurons in the rodent cerebral cortex does not follow an 'inside-out' sequence. Parvalbumin (PARV), a Ca(2+)-binding protein believed to play a role in neuronal excitability, is contained in certain GABAergic inhibitory neurons of the cerebral cortex. Here we report that expression of PARV in the developing neocortex of rats and mice occurs with a sequence which does not follow the usual 'inside-out' gradient of cortical development. Thus, PARV-immunoreactive neurons appear first in layer V and only thereafter in the remaining cortical layers. An adult-like pattern of immunoreactivity is reached simultaneously in layers II-III and VIb. These observations indicate that the mechanisms regulating the functional maturation of PARV-containing inhibitory neurons are different from those that generally govern developmental processes in the cortex.


Inhibition of nitric oxide synthesis does not reduce infarct volume in a rat model of focal cerebral ischaemia. The effect of the nitric oxide (NO) synthesis inhibitor Ng-nitro-L-arginine methylester (L-NAME) on ischaemic brain damage was determined in a rat model of focal cerebral ischaemia. Ischaemia was induced by permanent occlusion of the left middle cerebral artery (MCA) and infarction assessed 4 h post-occlusion by quantitative histopathology. L-NAME (30 mg/kg s.c.), administered 30 min pre- and 30 min post-MCA occlusion, did not significantly alter the volume of ischaemic damage in the cerebral hemisphere, neocortex or caudate nucleus compared with saline controls. This result provides no support for the view that NO generation is a key component in the post-ischaemic cascade leading to acute neuronal death.


Central 6-hydroxydopamine lesions decrease mineralocorticoid, but not glucocorticoid receptor gene expression in the rat hippocampus. The role of hippocampal noradrenergic inputs in the modulation of corticosteroid receptor expression has been investigated. Adult male rats were given central 6-hydroxydopamine (6-OHDA) and the expression of hippocampal mineralocorticoid (MR) and glucocorticoid (GR) receptor mRNA was examined after two weeks by in situ hybridization histochemistry. Expression of MR mRNA was significantly decreased in all subregions of the hippocampus except CA2, but 6-OHDA lesions had no effect on GR mRNA expression. These data reveal differential regulation of the two receptor types by noradrenergic inputs.


Evidence for sex steroid receptors in feline brainstem. Specific binding sites for estrogens, androgens, and progestins were found in cytosol from perfused cat brainstem with the use of a steroid binding assay. These sites resemble 'classical' steroid receptors in ligand specificity as well as in sedimentation properties (sedimentation constant 8-10S on sucrose density gradient). The presence of estrogen receptor in brainstem extracts was also confirmed by an enzyme immunoassay employing monoclonal antibodies directed against human estrogen receptor. This finding may be relevant to known influences of sex steroids on respiration.


Absence of a daily neuronal rhythm in the suprachiasmatic nuclei of acircadian Djungarian hamsters. The suprachiasmatic nuclei (SCN) in mammals generate and maintain a variety of daily rhythms. In nocturnally active rodents, SCN electrical activity is high during the subjective day (that time of locomotor inactivity) and low during the subjective night. The present experiment examines the relationship between SCN neuronal activity and the expression of overt circadian behavior in the Djungarian hamster (Phodopus sungorus). Wheel-running locomotor activity was measured in 2 groups of hamsters housed in constant dark (DD). Twelve hamsters, selected from ongoing experiments in our laboratory, showed no overt circadian rhythm in locomotor activity. A second group of 9 control animals exhibited rhythmic wheel-running activity in DD. In contrast to control animals, in vitro SCN electrical activity in brain slices prepared from acircadian hamsters showed no circadian variation. These data indicate that in acircadian animals SCN electrical activity properly reflects behavioral patterns.


The stability of human eye orientation during visual fixation. Using the magnetic search coil technique, gaze stability in the horizontal, vertical and torsional planes was measured binocularly in human subjects during visual fixation. Horizontal and vertical eye rotations exhibited a mixture of slow drifts and resetting microsaccades yielding an average standard deviation of 0.11 and 0.10 deg, respectively. In contrast, torsional rotations showed unsystematic smooth drifts with fewer saccades yielding an average standard deviation of 0.18 deg. The lower precision of gaze control in the torsional plane may reflect (i) a discrepancy between the encoding of retinal images in two dimensions but of ocular motor control signals in three dimensions, and (ii) the visual consequences of ocular drifts in the torsional plane, which differ from those in the horizontal and vertical planes.


Thermal sensitivity and effect of temperature acclimation on ocular serotonin N-acetyltransferase activity in Rana perezi. The thermal sensitivity and the response to thermal acclimation of the serotonin N-acetyltransferase (NAT) activity in frog ocular tissue were studied. The ocular NAT shows a positive thermal modulation for both cosubstrates (tryptamine and acetyl-CoA). The higher NAT activity in the cold-acclimated group (4 degrees C) with respect to the warm-acclimated one (24 degrees C) implies a partial thermal compensation of the enzyme. The present results suggest that frog ocular NAT response to temperature entails a modulation of thermal sensitivity of the enzyme rather than changes in enzyme concentration.


Modifications of ependymal cells membranes by galactocerebrosides in cell culture. In this paper we have demonstrated that treatment of ependymal cells in culture by galactocerebrosides induced a decrease in plasma membrane fluidity and an increase of EGF binding sites. We have shown in a previous work that galactocerebroside in vitro and in vivo caused an important morphological change in ependymal cells that grew into an astrocytic shape after a five day treatment. We discuss the hypothesis that the first event in morphological effect could be a modification of plasma membrane followed by important changes in molecules distribution.


Effects of thiorphan, bestatin and a novel metallopeptidase inhibitor JMV 390-1 on the recovery of neurotensin and neuromedin N released from mouse hypothalamus. The effects of the endopeptidase 24.11 ('enkephalinase') inhibitor thiorphan, the aminopeptidase inhibitor bestatin and a novel metallopeptidase inhibitor JMV 390-1 on the K(+)-evoked release of immunoreactive neurotensin and neuromedin N (iNT and iNN) from mouse hypothalamic slices were examined. (JMV 390-1 inhibits several metallopeptidases including endopeptidases 24.11, 24.15 and 24.16, and aminopeptidase N equipotently with Ki values around 50 nM.) Thiorphan increased the recovery of released iNT nearly 2-fold and had no effect on iNN. Bestatin produced a 4-fold increase in iNN recovery and was inactive on iNT. Finally, iNT and iNN recoveries were increased up to 4- and 5-fold, respectively, by JMV 390-1. These results show that in the mouse hypothalamus endopeptidase 24.11 participates with other metalloendopeptidases to the degradation of endogenously released NT while endogenously released NN is principally degraded by aminopeptidase(s).


Potentiation of spontaneous synaptic activity in rat mossy cells. Recent studies have demonstrated the vulnerability of dentate mossy cells to seizure-induced damage. One source of potentially damaging synaptic input are spontaneously active granule cell terminals ('mossy terminals'.) We sought to test whether there were activity-dependent changes in the spontaneous excitatory input to mossy cells. Using the in vitro slice preparation, we examined the frequency and amplitude of spontaneous excitatory postsynaptic potentials (EPSPs) after intracellular current injection designed to mimic the extreme depolarization these neurons receive during repetitive afferent stimulation. In 4 of 7 neurons, depolarization with trains of current pulses resulted in a significant and persistent increase in frequency of spontaneous synaptic depolarizations (to an average of 178% of the initial baseline rate). In 3 of these affected neurons, an increased frequency of large amplitude, fast-rising EPSPs accounted for the majority of this change. Injection of hyperpolarizing current pulses failed to alter spontaneous activity in 3 other mossy cells. These results suggest spontaneous synaptic input to mossy cells in plastic and can be potentiated by depolarization of a single postsynaptic mossy cell. The ability of mossy cells to potentiate their excitatory input may be relevant to their vulnerability to excitotoxic injury during repetitive afferent stimulation.


Delayed increase of extracellular arginine, the nitric oxide precursor, following electrical white matter stimulation in rat cerebellar slices. Amino acid levels were measured in perfusates from biplanar slices of rat cerebellum installed in a Krebs-filled three-compartment chamber. The two lateral compartments housed the white matter and a section containing parallel fibres respectively. The central compartment housed cortical structures, including the Purkinje cell and granule cell bodies. This arrangement allows selective electrical stimulation of the parallel fibre or mossy fibre pathways, recording of the evoked responses to such stimulation and collection of the perfusion medium passing through the central chamber for amino acid analysis using high-pressure liquid chromatography (HPLC). Both, 2-Hz and 5-Hz stimulation of white matter caused a delayed increase in arginine levels in the perfusate. Since L-arginine is the physiological precursor of nitric oxide, a neuronal messenger in the brain, the data suggest that physiological stimuli can result in the release of this precursor, possibly to supply the nitric oxide synthase.


Polyamine-sensitive binding of [125I]ifenprodil in washed, frozen-thawed synaptic membranes: evidence for high affinity binding requiring an open NMDA channel. Binding of [125I]-labelled ifenprodil, a non-competitive N-methyl-D-aspartate (NMDA) antagonist acting at the polyamine domain, was studied in washed, frozen-thawed synaptic membranes. Under these conditions where the NMDA channel is essentially in a closed channel state and in the presence of GBR 12909, [125I]ifenprodil binding was rapid, reversible, stereospecific, saturable and to a single population of sites (Kd 76 microM, Bmax 140 nmol/mg protein). Binding was inhibited by spermine, spermidine and ifenprodil congeners. These characteristics differed from those found in fresh membranes (open channel state), with ifenprodil congeners being less potent and potencies of polyamines being unchanged. These data suggest independent, but interacting sites for polyamines and ifenprodil congeners, the latter sensitive to endogenous modulators, labelled by [125I]ifenprodil and probably not NMDA-linked. High affinity binding of ifenprodil congeners seems likely to require an open ('activated') NMDA channel.


Localization of dopamine D2 receptor mRNA with non-radioactive in situ hybridization histochemistry. A digoxigenin-labeled antisense 42-mer oligonucleotide was used for the localization of the dopamine D2 receptor mRNA in the rat brain. The digoxigenin label was identified with alkaline phosphatase conjugated sheep-anti-digoxigenin. In good analogy with the known terminal fields of the dopaminergic system, various nuclei throughout the brain were labeled. Positive in situ hybridization signals were also found in dopamine cell groups of the substantia nigra and ventral tegmental area and in regions where a dopaminergic innervation is controversial, like the cerebellar cortex and the hippocampus. The non-radioactive in situ hybridization procedure described, shows the localization of the dopamine D2 receptor mRNA with a very high contrast and an optimal histological resolution.


Bilateral destruction of neocortical and perirhinal projection targets of the acoustic thalamus does not disrupt auditory fear conditioning. The present study examined whether complete bilateral destruction of auditory cortex would interfere with auditory fear conditioning in rats. Complete destruction of auditory cortex required lesions of temporal neocortical and perirhinal periallocortical areas. Fear conditioning was assessed by measuring freezing and arterial pressure responses elicited by an acoustic stimulus after pairing with footshock. Animals with complete bilateral lesions of auditory cortex showed conditioned arterial pressure and freezing responses comparable to those of unoperated controls. In contrast, bilateral destruction of the acoustic thalamus interfered with the conditioning of both responses. These results demonstrate that the auditory cortex is not required for the conditioning of fear responses to simple acoustic stimuli and add to the growing body of evidence that fear conditioning can be mediated by subcortical (amygdaloid) projections of the acoustic thalamus.


Origin of luteinizing hormone-releasing hormone (LHRH) neurons in the chick embryo: effect of the olfactory placode ablation. A unilateral olfactory placodectomy resulted in the absence of luteinizing hormone-releasing hormone-immunoreactive (LHRH-ir) cells in the olfactory-forebrain axis of the operated side, whereas the development of the LHRH neuronal system was not disturbed on the unoperated side. In the embryos in which a fragment of the medial olfactory epithelium was spared the damage, a small number of LHRH-ir cells were detected in the nasal region of the operated side, where the lack of the central projection of the olfactory nerve caused stagnation of LHRH-ir cells, no ir-cells being found in the brain area. These results suggest that LHRH neurons originate in the olfactory placode and then migrate into the forebrain along the olfactory nerve.


Cholinergic fiber loss occurs in the absence of synaptophysin depletion in Alzheimer's disease primary visual cortex. The significance of cholinergic degeneration in Alzheimer's disease (AD) depends, in part, on whether it is an early event, possibly integral to the progression of the disease, or a late event, occurring only as a secondary effect of cortical degeneration. We have been studying the primary visual cortex in AD cases, on the assumption that the disease process may be retarded in this relatively-spared area, thus providing a 'window' on early AD. In this work, we have quantified acetylcholinesterase fiber density and the density of an immunohistochemical reaction for synaptophysin as measures of cholinergic and total synaptic loss, respectively, in the primary visual cortex of AD and control cases. Cholinergic fibers were depleted to 15% of control values, while synaptophysin density was not significantly altered. Cholinergic degeneration thus appears to occur in the absence of generalized synaptic loss in this area.


Evidence for increased calcium influx across the choroid plexus following brief ischemia of gerbil brain. Following 5 min ischemia of gerbil brain, unidirectional transfer of calcium from plasma to cerebrospinal fluid was measured quantitatively with 45CaCl2 at 4 days postischemic recirculation. 45Ca influx across the choroid plexus increased significantly from 0.0101 +/- 0.001 min-1 measured in sham-operated animals (n = 15) to 0.0294 +/- 0.002 min-1 determined in ischemic animals (n = 21; P less than 0.05). Histological examination of choroid plexus was carried out in Cresyl violet-stained sections from gerbils subjected to 5 min ischemia followed by 4 days (n = 6) and 7 days (n = 7) postischemic recirculation. Increased calcium transfer to cerebrospinal fluid was associated with cell damage of choroid plexus observed at 4 days postischemia. Endothelial choroid plexus injury was still detectable at 7 days after the ischemic insult suggesting a long-lasting pathomorphological process. Postischemic alterations in choroid plexus functions apparently expose brain tissue to much higher calcium influx into cerebrospinal fluid which, in turn, may contribute to calcium-related cell damage of the central nervous system.


From anxiety to action: facilitating faculty development during curriculum change. Nurse educators, both as individuals and as faculty collectively, have recognized the need for change. But as anyone with a basic knowledge of change theory knows, change is usually accompanied by varying degrees of resistance.


A new age ISM: beyond a toxic apple.

A new age ISM: beyond a toxic apple. Munhall argues for a synthesis and respect for various educational pedagogues, acknowledging the core values and beliefs about education that reflect our infinite variety. The article abandons the myth of the handsome prince and is the second of a trilogy on apples.


The legacy of New Jersey physician book collectors. This article offers a brief history of the development of New Jersey's major history of medicine collection, and an overview of selected resources currently available to researchers. Old and rare medical books now are available to a new generation of physicians and scholars.


Medical book collecting: a retrospect and a forecast. Medical book collecting and historical research are complementary pursuits. The author summarizes the contributions of bibliophiles who used their collections as a source of inspiration for historical studies and addresses the challenges confronting medical book collectors.


Heirs of Osler: medical bibliophiles in America. An heir is one who appears to acquire a trait from a predecessor or carries on his tradition. The author presents details about the great bibliophiles who received their stimulus from William Osler, his associates, or his writings. William Osler influenced the formation of private libraries in the United States.


CLIA-88 final rule: Part 3.

CLIA-88 final rule: Part 3. Physicians performing laboratory tests must have a registration certificate as of September 1, 1992. To continue testing without this certificate could lead to large fines and possible prosecution. This article covers quality assurance, quality control, and maintenance of instruments.


Case report: malignant mesenchymoma of the mediastinum. Malignant mesenchymoma is a malignant tumor arising in the soft tissues of the body. It is a rapidly growing tumor prone to recurrences and occasional metastasis. It occurs at all ages and locations but has a preference for the extremities and the retroperitoneum.


Profiles in medicine: tribute to Oscar Auerbach, MD. He is prepared to lecture on lung pathology. Instead, Dr. Oscar Auerbach discusses the role of the physician in society and what tremendous contributions each student has the potential to make. This speech re-energizes second-year medical students every year.


Challenges for teachers of women's health. Until recently, nursing literature had not addressed feminist issues and nurse educators have had little experience in programs of women's studies. The author discusses some implications for nurse educators as they relate to the new scholarship of women and a new consciousness of women's health. Factors contributing to the need for particular ways of teaching when dealing with women as students and with women's health experiences as subject matter are addressed. Using specific examples from her experience in teaching an open enrollment course in women's health, the author describes the use of some feminist pedagogical approaches and the students' response to them.


Public schools as a clinical setting for RN students. The challenge to select meaningful clinical sites for RN students is a problem for educators. The significance of the public schools as an initial clinical site, the contribution of RNs to school health programs, student responses, and adaptations to the school setting are presented. Outcomes of the experience will interest nurse educators attempting to provide a professional education for RN to BSN students and provide a service to the community.


Clinical case studies: a strategy for teaching leadership and management. In the realities of clinical practice, BSN students are expected to demonstrate both clinical and managerial skills. Presenting leadership and management content through the use of complex patient situations in a clinical case study approach can assist in preparing them. This approach demonstrates to students that leadership and management is an integral part of professional practice.


Faculty support for gay and lesbian nursing students. Gay and lesbian nursing students seem to be invisible. Because the color of their skin does not reveal their minority status, the decision whether to "come out of the closet" is a choice that must be remade-renegotiated-every day of the students' lives. Nursing faculty can play a pivotal role in supporting these students by their attitudes and activism.


Students attend nurses association convention for college credit. The author describes a college course that facilitates student attendance at the Iowa Nurses' Association (INA) convention and promotes observation of nurse leaders as they consider nursing and political issues. Using the guidelines in this article, nursing faculty can develop a similar course in their institutions and generate student interest in the activities of the state professional associations.


Reciprocal learning among students in the clinical area. Reciprocal learning is a cooperative, collegial method in which there is mutuality of student to student or student to faculty interaction, assistance, and benefits. This teaching method is congruent with curriculum revolution concepts. The authors describe reciprocal learning and provide an example of its application in the clinical area. Guidelines for implementation of the strategy are presented.


The teacher crisis in nursing education--revisited. The nationwide shortage of teachers is severely and negatively impacting nursing. Many qualified applicants are being rejected by nursing schools, yet the quality of programs is jeopardized when faculty are hired with limited teaching experience and little, if any, formal education as teachers. The author reviews the development and status of graduate nursing education for teachers, documents strong arguments for increasing the number of graduate programs to prepare more teachers of nursing, and raises important questions about teacher education.


Three games for classroom instruction.

Three games for classroom instruction. This article outlines three games appropriate for the education of student nurses. "Categories" is a question-answer type of bowl game. Team players earn points by correctly answering questions in selected areas of nursing content. "A Piece of the Pie" is a variation of a popular board game. Players fill in game "pies" which represent selected areas of nursing content by correctly answering questions. "Outburst" is a game consisting of two teams who accumulate a score by shouting out, in turn, items that they believe would be included under a topic heading.


The nature of scientific truth.

The nature of scientific truth. The purpose of this article is to share with the readers the authors' views on the need for a philosophical foundation in nursing scholarship. The philosophical premises of realism, idealism, and empiricism are discussed. In addition, the research methods most appropriately used with each philosophical stance are identified and discussed. The authors strongly suggest that nursing epistemology will not advance along the lines of good science until all nursing theorists, thinkers, and philosophers identify their underpinning philosophical positions prior to the discovery of theory, through research and other scientific endeavors. A nursing science fiction account of discovery and theory is used to illustrate the points made within the article.


Concepts from eastern philosophy and Rogers' Science of Unitary Human Beings. A brief outline of Buddhist thought is presented. Four concepts from early Indian philosophy which contributed to the development of the middle way consequence (Madhyamika Prasangika) school of Tibetan Buddhist philosophy are discussed. These are: action (karma), direct perception, emptiness, and dependent arising. An overview of Martha Rogers' science of unitary human beings is given, followed by a discussion of the concepts of energy field and integrality within her worldview. Buddhist concepts of action, direct valid perception, and emptiness are considered in relation to Rogers' notion of energy field; the concept of dependent arising is compared to Rogers' principle of integrality. It is proposed that Rogers' worldview includes areas of similarity with concepts used in Tibetan Buddhist philosophy.


The meaning of being an elder in Nepal.

The meaning of being an elder in Nepal. The purpose of this qualitative descriptive research study was to explore the meaning of being an elder in Nepal. The nurse researcher, accompanied by an interpreter, travelled to six villages east and west of Kathmandu Valley to speak with 25 individuals about their experiences in later life. Questions structured within Parse's theoretical perspective guided discussions to uncover older persons' views of aging, their relationships with others, and the changes and hopes of daily life. Findings revealed that the meaning of being an elder in Nepal is "cherishing necessities for survival intermingles with the rapture of celebration with important others, as diminishing familiar patterns expand moments of respite, while regard from others affirms self, and changing customs create comfort-discomfort as what-was unfolds into new possibles." Findings were congruent with Parse's theoretical concepts of valuing, enabling-limiting, and transforming. This study supported Parse's theory as a valuable guide for human inquiry and expanded the body of nursing knowledge on aging. Specific guidelines for practice and research are proposed.


Nursing theory: the 21st century.

Nursing theory: the 21st century. On September 21, 1990, at the University of California, Los Angeles, Neuropsychiatric Institute and Hospital, six nurse theorists participated in a panel discussion on theory development for the 21st century. The theorists included Dorothy Johnson, Betty Neuman, Dorothea E. Orem, Rosemarie Rizzo Parse, Martha E. Rogers and Callista Roy. The panel provided the participants the opportunity to speculate on the course for future development of nursing knowledge. Three questions were posed to the panel relating to the development of their models, the direction nursing theory will take in the 21st century, and current research emerging from the extant theories. The panel also addressed questions from the audience.


Elements of transcultural and translinguistic research: a personal experience. Prior to undertaking the exploration of phenomena in a research study with people from different cultures, certain elements must be addressed in order to bridge cultural and linguistic differences. In this article, the authors explore some of these elements, with specific reference to personal experiences in a research study done in Italy, the results of which will not be presented here. Elements discussed include: transcultural/translinguistic literature review, protection of human subjects, translinguistics, maintaining necessary and appropriate contact with persons at the research site, presentation of research to participants, structuring interviews, and post-session amenities.


The TMPDS personality: fact or fiction? An overview. It is widely accepted that abnormal personality traits and psychological stress are important factors in the etiology and maintenance of the temporomandibular pain and dysfunction syndrome (TMPDS). However, this assumption is based largely on clinical lore rather than research evidence. Continued belief in the stress theory has onerous implications. Such conclusions will lead not only to problems of patient care, but may also forge an unstable foundation for future research. Three theories have been advanced that support a relationship between personality and TMPDS. They are the psychosomatic, coping and psychophysiological theories. But evidence in support of all three theories is currently lacking. It has not been shown that TMPDS cases are characterized by a specific premorbid personality or an exaggerated vulnerability to psychological stress.


[The "major" proteins of the human myocardium in ontogeny]. Two-dimensional electrophoresis according to O'Farrell was used for studying changes in the content of major proteins of human myocardium at various stages of pre- and postnatal development. On the basis of the protein pattern specific of certain stages of myocardium differentiation the degree of development of the human cardiac muscle can be determined. The most pronounced changes in myocardium protein spectra are characteristic of the first half of pregnancy.


[The assessment of the level of genetic damages accumulated with age and induced in liver cells by the micronucleus production]. Latent genetic disturbances in aging liver cells can be registered during interphase by the appearance of micronuclei resulting from certain chromosomal aberrations. Micronuclei were also detected in postmitotic hepatocytes of mouse liver regenerating after partial resection of CCl4 poisoning. In 1.5- and 2-month-old mice, the proportion of micronuclei-containing cells was on average 0.59 and 0.89%, respectively. At the age of 4 and 7 months, the proportion of aberrant cells in hepatocyte population, including cells containing multiple micronuclei, increased to 5.93 and 11.7%, respectively. In order to evaluate parameters used to characterize "spontaneous" aging, experiments were performed in which genetic disturbances were induced by x-irradiation or treatment with dipin, an alkylating agent (individually or in combination); the effect was determined one and two months after the treatment. The yield of micronuclei under the conditions of a mild treatment (irradiation at a dose of 0.7 and 1.4 Gr or dipin at a dose of 30 mg/kg body weight) was similar to that observed during aging. The possible reasons for the increased (as compared to the published data) rate of genetic disturbances in arbitrary intact animals are discussed.


A corneal topography algorithm that produces continuous curvature. A new method is developed for calculating corneal curvature based on the reflected image of a series of concentric rings (keratoscopy). Previous methods had the drawback that the calculated corneal power was discontinuous in that it changed abruptly at each ring. The present method fits the corneal curvature with a cubic polynomial and produces a continuous estimate of the local power of the cornea. The cubic function also provides a better fit to the corneal curvature than previous methods that used a circle to provide the local fit. The full computer program for the algorithm is presented. Four different definitions of the local dioptric power are discussed.


Testing hypotheses on dioptric power.

Testing hypotheses on dioptric power. Transformation of dioptric power from the conventional clinical representation as sphere, cylinder, and axis to the vectorial representation known as the vector h makes it possible to apply formal multivariate statistical methods to dioptric power. Methods are described for testing hypotheses on mean dioptric power and on variance-covariance of dioptric power for one and more than one population. A number of numerical examples are presented. Attention is drawn to the underlying assumption of multivariate normality, to other limitations of the methods, and to pitfalls in the use of the methods. Three-dimensional scatter plots, shown by means of stereo-pair drawings, are useful for detecting departures from normality.


[The gametotoxic effect of antenatal exposure to thiotepa in mice]. ThioTEPA was injected intraperitoneally into female 101/H and CBA mice on day 12 of pregnancy at a dose of 2.5 mg/kg body weight. As a result, the number of prospermatogonia in 19-day-old male fetuses decreased to 78.8% in 101/H mice and to 63.7% in CBA mice. The gametotoxic effect on the male offspring (F1) in 101/H mice treated with thioTEPH included the significant decrease in the number of spermatogonia A, spermatocytes I at preleptotene and pachytene, as well as of spermatids at the stage 7 of development. Interstrain differences are described in the intensity of spermatogenesis in the mature intact animals and in regeneration capacity of gonads after prenatal thioTEPA administration.


[The development of diploid parthenogenetic mouse embryos of the inbred C57BL and CBA strains]. We studied preimplantation development in vitro and postimplantation development in vivo of diploid parthenogenetic mouse embryos of C57BL/6 and CBA strains, as well as of (CBA x C57BL/6)F1 hybrids. Development to blastocyst stage of diploid eggs obtained from C57BL/6, CBA, and hybrid mice was observed in 90, 15, and 73% cases, respectively. After implantation, C57BL/6 embryos did not develop to somite stages, while CBA and hybrid embryos reached various stages of somite formation in 45 and 30% cases, respectively. Cultivation of embryos beginning from one-cell stage in the medium containing 2% newborn calf serum increased the yield of blastocysts from 15 to 59% in CBA embryos and from 73 to 90% in hybrids; However, such effect was not observed with C57BL/6 embryos. The latest stages of development observed in CBA and hybrid diploid parthenogenetic embryos were 33-35 somites and 25-30 somites, respectively. Imprinting patterns in chromosomes of CBA and C57BL/6 gametes are discussed.


Quantitative evaluation of the effects of a bicarbonate and glucose-free balanced salt solution on rabbit corneal endothelium in vitro. Whole corneas from 2- to 2.5-kg albino rabbits were perfused in vitro at 35 to 36 degrees C with a commercial balanced salt solution (BSS) that lacks bicarbonate and glucose. The corneas swelled at an average rate of 45 +/- 11 microns/h. Evaluation of the corneal endothelium by scanning electron microscopy revealed no obvious cytotoxic effect beyond the occasional small area affected by air bubble damage. Morphometric analysis of the central corneal endothelium revealed no significant differences between the endothelial mosaic of perfused corneas, when compared to freshly fixed corneas, in terms of percentage 6-sided cells (pleomorphism) and variance in cell areas (polymegethism). In this example, therefore, a corneal swelling induced by a bicarbonate and glucose-free BSS does not appear to be due to either obvious endothelial cytotoxic effects or significant morphological alteration of the endothelial mosaic.


[The distribution and relation to the cytoskeleton of specific prosomal proteins in the oogenesis of the clawed toad]. Using immunoblotting and immunofluorescent microscopy, we showed the presence in Xenopus laevis oocytes of two prosomal proteins (27 and 31-33 kDa) and studied their distribution during oogenesis. In the ooplasm, both proteins are detected in prosomal clusters of various size. During previtellogenesis, prosomal proteins are diffusely distributed in the nucleoplasm and form evenly distributed clusters in the cytoplasm. During oocyte growth, prosomal proteins disappear from the nucleus and form animal-vegetal and cortical gradients in the cytoplasm. In the course of oocyte maturation prosomal clusters become smaller. After artificial activation of the egg, the dorso-ventral gradient of distribution of prosomal proteins is observed. Double immunohistochemical labeling revealed morphological association between prosomal clusters and fibril-like structures of the oocyte containing actin and myosin. The latter are then replaced by diffusely distributed actin and myosin. Thus, correlation is observed between localization of the acto-myosin complex of the oocyte and that of prosomal proteins.


[The testosterone level in the testes of silver foxes during prenatal development]. The level of testosterone in serum and testes of the silver fox fetuses on days 31, 35, 40, 45, and 50 of gestation was determined using radioimmunoassay. In testes, testosterone was first detected at day 31; then its level gradually increased. Serum testosterone was detected only at day 40. Subsequent increase in its concentration was insignificant. Human chorionic gonadotropin stimulated testicular testosterone production in vitro beginning from day 40. We suggest that in the silver fox, testes are capable of responding to gonadotropins already by the day 40 of prenatal development but the formation of pituitary-gonadal axis proceeds until the end of embryogenesis.


Interest of presbyopes in contact lens correction and their success with monovision. The presbyopic population is seen as a large potential source of contact lens wearers. The aims of this study were: (1) to estimate the percentage of presbyopes interested in contact lenses, (2) to ascertain the success of interested presbyopes with monovision correction, and (3) to determine the percentage willing to continue wearing monovision lenses after 1 month's trial. Seven practitioners in Sydney surveyed consecutive presbyopes attending their practices about their interest in contact lenses. Of the 1133 presbyopes surveyed, 314 (28%) were interested in trying monovision lenses. A total of 72 patients were subsequently fitted with monovision in high water content hydrogel form. After 1 month, 46 of these patients (64%) were still wearing the lenses, and 39 (54%) expressed willingness to continue with monovision correction. The major reasons for discontinuation from lens wear during the 1-month trial were inadequate vision and difficulty in lens handling.


[The formation of oval-cell ducts during hepatic carcinogenesis in mice. Its relationship to the pre-existing canals of Hering]. It has been shown that a population of the oval cells is formed in mouse liver during the dipin-induced carcinogenesis (Radaeva, Factor, 1990b). This paper deals with the origin of the oval cells and their proliferation potential depending on localization in the liver lobule. Series of semithin liver sections were studied under the light microscope and detected labeled cells analyzed under electron microscope on serial ultrathin sections. We found that proliferation of cells of terminal bile ductules (Hering [correction of Gering] canals) takes place at the early stages of liver carcinogenesis. These cells and first labeled oval cells had similar size and morphology and jointly formed the ducts. Oval cell population was heterogeneous in terms of proliferative potential. Proportion of proliferating cells (38-45%) in the oval cells of Hering [correction of Gering] canals and small ducts surrounding portal tracts remained similar throughout the period of formation of the oval cell population. In the oval cells infiltrating the parenchyma, the proportion of proliferating cells appeared to depend on the intensity of the oval cell response: it attained the maximum (62%) on intermediate stage and decreased to the minimum (22%) at the peak of the reaction. These data suggest that Hering [correction of Gering] canals probably give origin to the ducts formed by oval cells.


Crystalline lens power in myopia.

Crystalline lens power in myopia. Growth of the eye shows a coordinated pattern whereby the reduction in refractive power of the cornea and crystalline lens tends to reduce the myopia that would otherwise result from the normal increase in axial length. There is some controversy as to whether the reduction in crystalline lens power is influenced by the refractive state of the eye, i.e., an active role in the emmetropization process, or is simply related to the changing lens dimension occurring with growth. We measured ocular dimensions and determined the crystalline lens powers in 19 myopes and 19 emmetropic subjects matched for age, gender, and ethnic origin. No significant difference was found in corneal radius of curvature for the two groups, but there was a significant difference (p < 0.05) in crystalline lens power of 2.30 D. These results suggest that greater compensation for axial elongation of the eye was afforded by the decrease in crystalline lens power than by corneal flattening.


Anisometropic amblyopia: is the patient ever too old to treat? Amblyopia is an example of abnormal visual development that is clinically defined as a reduction of best corrected Snellen acuity to less than 6/9 (20/30) in one eye or a two-line difference between the two eyes, with no visible signs of eye disease. We describe a sequential management program for anisometropic amblyopia that consists of four steps: (1) the full refractive correction, (2) added lenses or prism when needed to improve alignment of the visual axes, (3) 2 to 5 h/day of direct occlusion, and (4) active vision therapy to develop monocular acuity and improve binocular visual function. We examined records of 19 patients over 6 years of age who had been treated using this sequential management philosophy. After 15.2 (+/- 7.7) weeks of treatment the Amblyopia Success Index (ASI) documented an average improvement in visual acuity of 92.1% +/- 8.1 with a range from a low of 75% by a 49-year-old patient to a maximum of 100% achieved by 42.1% of the patients (8 of 19). Patients who had completed therapy 1 or more years ago (N = 4) maintained their acuity improvement. From these results we conclude that following a sequential management plan for treatment of anisometropic amblyopia can yield substantial long-lasting improvement in visual acuity and binocular function for patients of any age.


[The centriolar cycle in polykaryons formed in the fusion of heterophasic cells]. In this work we studied the centriolar cycle in fused cells containing heterophasic nuclei. Embryonic pig kidney cells were double-labeled with 3H- and 14C-thymidine and fused using a PEG-DMSO-serum method (Manandkhar et al., 1991). Fused cells containing nuclei at various cell cycle periods were selected after embedding in epon on the basis of isotope marking. Ultrastructure of centrioles was studied in serial ultrathin sections of selected cells. Centrioles of cells fused at different interphase periods showed a tendency to become synchronized in a manner similar to that of the nuclei. The G1-cell partners suppressed replication of S-centrioles or induced disorientation of centrioles of G2-diplosomes. In G1-S fused dikaryons, procentriole formation in G1-centrioles was not observed. This indicates the absence in the S-cell partner of an excess of a factor which could induce replication of the G1-centriole. However, G2-cell partner stimulated procentriole formation in G1- or unreplicated early S-centrioles. Asynchronous replication of G1-, S- and G2- centrioles was observed in some G1-S, G1-G2 and S-G2 fused cells. Heterophasic cellular environment containing mixed cell cycle factors appears to be responsible for the opposite effects on the structure of centrioles. In oocytes or early embryonic cells, due to the presence of a large amount of centriolar precursor material, centriolar replication cycle can proceed independently of the synthetic activity controlled by the nucleus.(ABSTRACT TRUNCATED AT 250 WORDS)


Reliability of the tear break-up time technique of assessing tear stability and the locations of the tear break-up in Hong Kong Chinese. The measurement of tear break-up time (TBUT) in assessing stability of the tear film is somewhat controversial, even though the technique is widely used. We examined reliability of the technique within and among examiners and conclude that measurements of TBUT can be made reliably; full-beam observation of the cornea is preferable to scanning the cornea with a narrow slit in making the measurements. There may be differences in TBUT measurements made in the same subjects among examiners, but these differences are smaller with more experienced practitioners. In the Hong Kong Chinese (HK-Chinese), tear break-up appears to be more likely to first occur in the inferior periphery of the cornea. In this population mean TBUT is about 7.20 s; assuming a Gaussian distribution of TBUT values, 2.1 s should be adopted as the lower limit for normal TBUT in HK-Chinese.


Epidemiological evidence that access to routine optometric care benefits nursing home residents. Public perception is that nursing home residents receive less than adequate health care. To confirm or refute this view we provided routine optometric services to 47 residents in a nursing home who had ready access to primary medical care. Average refractive error, intraocular pressure, visual acuity, and the prevalence of ocular disease were analyzed. Despite the fact that routine primary medical care was provided in-house and ophthalmologic care was provided on a consultation basis, our study revealed a need for further medical intervention. Seven percent of the patients received a legend prescription for drugs for ocular conditions, whereas 11% received an over-the-counter preparation. Although 11% were already under ophthalmological care, we requested consults from ophthalmology for another 11%. An additional patient was referred to an internist. This study shows that even in nursing homes where residents have access to in-house medical management, routine vision care provided by optometrists can disclose undetected medical problems and improve the quality of life.


Light-induced amaurosis associated with carotid occlusive disease. A 74-year-old man with the isolated complaint of uniocular transient visual loss after exposure to bright light was found to have severe ipsilateral, atherosclerotic carotid occlusive disease. Signs of ocular ischemia that were present included slightly reduced visual acuity, mild afferent pupillary defect, lowered intraocular pressure, increased photostress recovery time, and reduced opthalmodynamometry values on the affected side. After a subclavian to internal carotid artery bypass procedure, the patient's symptoms resolved completely and his ocular signs returned to normal. This patient's initial symptom, referred to as light-induced amaurosis (LIA), is an unfamiliar manifestation of the ocular ischemic syndrome. We discuss the condition and summarize the literature.


Literature review of hepatitis B: should eye care practitioners receive a hepatitis B vaccine? The incidence of Hepatitis B infection has been steadily increasing over the last 5 years. The current literature has established that eye care practitioners are in the high risk category for contracting and transmitting this serious viral infection. Hepatitis B Virus (HBV) is present in all bodily fluids including tears and is considered to be more easily transmitted with a higher degree of infectiousness than Human Immunodeficiency Virus (HIV). Fortunately, unlike Acquired Immune Deficiency Syndrome (AIDS), hepatitis can be prevented with a vaccine. Recent improvements in the hepatitis vaccine have made it safer and more effective. As optometrists expand their scope of practice, it becomes essential to increase the knowledge base and awareness of this clinical entity so informed decisions can be made regarding vaccination by eye care practitioners, teaching faculty, and students.


Estimation of dioptric power from measurements that may include measurements of dioptric power. A general routine exists for estimating dioptric power from any number of measurements of sagitta, lens thickness, meridional curvature or power, and prismatic effect. This paper shows how the routine is modified when among the measurements there are measurements of dioptric power itself.


National outcomes of cataract extraction. Increased risk of retinal complications associated with Nd:YAG laser capsulotomy. The Cataract Patient Outcomes Research Team. The authors studied 57,103 randomly selected Medicare beneficiaries who underwent extracapsular cataract extraction in 1986 or 1987 to determine the possible association between performance of neodymium (Nd):YAG laser capsulotomy and the risk of subsequent retinal break or detachment. Cases of cataract surgery were identified from Medicare claims submitted in 1986 and 1987 and were followed through the end of 1988. Episodes of cataract surgery, posterior capsulotomy, and retinal complications were ascertained based on procedure and diagnosis codes listed in physician bills and hospital discharge records. Lifetable and Cox's proportional hazards models were used to analyze the risk of retinal detachment or break in patients undergoing and not undergoing capsulotomy during the period of observation. Of the 57,103 persons identified as having undergone extracapsular cataract extraction in 1986 or 1987, 13,709 subsequently underwent Nd:YAG laser capsulotomy between 1986 and 1988. A total of 337 persons had aphakic or pseudophakic retinal detachments between 1986 and 1988 and an additional 194 underwent repair of a retinal break. Proportional hazards modeling shows a 3.9-fold increase in the risk of retinal break or detachment among those who underwent capsulotomy (95% confidence interval: 2.89 to 5.25). Younger patient age, male sex, and white race also were associated with increased risk of retinal complications after extracapsular cataract extraction. The authors conclude that there is a statistically significant increase in the risk of retinal detachment or break in those patients who undergo capsulotomy after cataract extraction. Therefore, capsulotomy should be deferred until the patient's impairment caused by capsular opacification warrants the increased risk of retinal complications associated with performance of capsulotomy.


Prevalence of glaucoma. The Beaver Dam Eye Study. The purpose of this study is to determine the prevalence of glaucoma in the population participating in the Beaver Dam Eye Study (n = 4926). All subjects were examined according to standard protocols, which included applanation tonometry, examination of the anterior chamber, perimetry, grading of fundus photographs of the optic disc, and a medical history interview. Visual field, cup-to-disc ratio, and intraocular pressure (IOP) criteria were used to define the presence of open-angle glaucoma. Definite open-angle glaucoma was defined by the presence of any two or all three of the following: abnormal visual field, large or asymmetric cup-to-disc ratio, high IOP. The overall prevalence of definite open-angle glaucoma was 2.1%. The prevalence increased with age from 0.9% in people 43 to 54 years of age to 4.7% in people 75 years of age or older. There was no significant effect of sex after adjusting for age. Of the 104 cases of definite open-angle glaucoma, 33 had IOPs less than 22 mmHg in the involved eye. Hemorrhage on the optic disc was found in 46 people; 2 of these had glaucoma. Narrow-angle glaucoma was rare, with two definite cases in the population. The prevalence of open-angle glaucoma in Beaver Dam is similar to that in other white populations. Findings from this study re-emphasize the notion that estimates of glaucoma prevalence should be based on assessing multiple risk indicators.


Effect of timolol versus pilocarpine on visual field progression in patients with primary open-angle glaucoma. Relatively few studies have been conducted linking decreasing intraocular pressure (IOP) to preservation of visual field. This investigation was conducted to determine if this link could be made and to compare the long-term effect of two ocular hypotensive agents on preservation of visual field. In an observer-masked study, 189 patients with primary open-angle glaucoma received either timolol or pilocarpine by random allocation. The dose of antiglaucoma agent was increased from 0.25% to 0.5% twice daily for timolol or from 2% to 4% four times daily for pilocarpine if the initial IOP response was inadequate. After an on-treatment baseline, visual fields were followed every 4 months for 2 years using the Octopus program 32. Compared with timolol, significantly more patients receiving pilocarpine discontinued use because of inadequate IOP control (P < or = 0.01). By comparing the mean visual field scores, it can be seen that the pilocarpine group had a significantly worse score at all timepoints from month 4 to month 24. The pilocarpine group also had a greater mean number of test loci with decreased sensitivity of 5 or more decibels (dB) at all timepoints. The mean within-patient regression slope for timolol was 0.01 dB/month and for pilocarpine was -0.06 dB/month (P < 0.01). The study has shown that over a 2-year period, patients treated with pilocarpine 2% or 4% four times daily experienced a significantly greater visual field deterioration than that seen in patients receiving either 0.25% or 0.5% timolol twice daily. Although these data do not support a link between lowering of IOP and visual field preservation, treatment with timolol was associated with significantly less visual field loss than treatment with pilocarpine.


Which is better? One or two? A randomized clinical trial of single-plate versus double-plate Molteno implantation for glaucomas in aphakia and pseudophakia. Previous studies have suggested that primary double-plate Molteno implantation may be beneficial. Therefore, the authors performed a randomized clinical trial to evaluate the relative effectiveness and safety of single- versus double-plate Molteno implantation. From March 1988 to February 1990, 132 patients who underwent Molteno implantation for medically uncontrollable non-neovascular glaucomas in aphakia or pseudophakia were randomly assigned to receive either single- or double-plate implants. The 1- and 2-year life-table success rates (success [survival] defined as 6 mmHg < or = final intraocular pressure [IOP] < or = 21 mmHg without additional glaucoma surgery or devastating complication) were 55% and 46% with single-plate implantation and 86% and 71% with double-plate implantation, respectively. The final postoperative visual acuities were within one line of the preoperative visual acuities or had improved in 73% and 80% of patients, respectively. Choroidal hemorrhages and/or effusions, corneal decompensation, flat anterior chambers, and phthisis bulbi were more common in the patients who had undergone double-plate Molteno implantation; however, transient elevations of IOP during the first few postoperative months were more common in the patients who had undergone single-plate Molteno implantation. Double-plate Molteno implantation more frequently affords IOP control than single-plate Molteno implantation; however, double plates are associated with greater risks of choroidal hemorrhages and/or effusions, corneal decompensation, flat anterior chambers, and phthisis bulbi.


Incidence and management of glaucoma after intravitreal silicone oil injection for complicated retinal detachments. Intravitreal silicone oil injection used for managing complicated retinal detachments can be associated with elevated intraocular pressure (IOP). This study was undertaken to determine the incidence of glaucoma in patients who underwent silicone oil injection, as well as to evaluate the effectiveness of medical and surgical therapy in patients in whom glaucoma developed. The postoperative courses of 50 eyes of 47 consecutive patients who underwent pars plana vitrectomy and silicone oil injection for the management of complicated retinal detachments were reviewed retrospectively. The outcomes of patients who underwent silicone oil removal and/or glaucoma surgery also were evaluated. The mean overall postoperative IOP before any glaucoma surgery was 16.7 +/- 9.3 mmHg (range, 0 to 45 mmHg), with a mean follow-up of 16.6 +/- 12.1 months (range, 2 to 51 months). Twenty-four (48%) eyes had postoperative IOPs of at least 25 mmHg and IOP elevations of at least 10 mmHg above the preoperative levels. Twenty-one (42%) eyes underwent complete removal of silicone oil and/or glaucoma surgery to effect IOP control. The IOPs were controlled to 21 mmHg or less (but > 5 mmHg) in 8 of 14 eyes that underwent removal of silicone oil alone, in 3 of 5 eyes that underwent Molteno implantation, and in 1 eye that underwent Nd:YAG transscleral cyclophotocoagulation, but not in 1 eye that underwent a modified Schocket procedure (mean follow-up, 13.5 +/- 11.0 months; range, 0.2 to 33 months). Intraocular pressure elevation is a common occurrence after intravitreal silicone oil injection. The underlying mechanism may often be multifactorial in nature. Patients in whom uncontrolled IOP develops may benefit from aggressive medical and/or surgical treatment with silicone oil removal, glaucoma implants, or cyclodestructive procedures.


Diabetes, hyperglycemia, and age-related maculopathy. The Beaver Dam Eye Study. The purpose of this study is to examine the association among hyperglycemia, diabetes status, and age-related maculopathy in a population-based study of people between the ages of 43 and 86 years who lived in Beaver Dam, Wisconsin between 1988 and 1990. Age-related maculopathy was determined from stereoscopic fundus photographs. In the nondiabetic group (n = 4291), no relationship was found between glycosylated hemoglobin and any signs of age-related maculopathy. Diabetes status was not associated with early age-related maculopathy. People 75 years of age or older with diabetes (n = 85) had a higher frequency of exudative macular degeneration (9.4%) than those without (4.7%) but had similar frequencies of pure geographic atrophy (3.8% for those with diabetes and 3.4% for those without diabetes). The relative risk of exudative macular degeneration in men with diabetes who were 75 years of age or older compared with those who did not have diabetes was 10.2 (95% confidence interval [CI]: 2.4, 43.7); for females it was 1.1 (95% CI: 0.4, 3.0). These data suggest that diabetes is not related to early age-related maculopathy or geographic atrophy. The relationship of exudative macular degeneration to diabetes in older men, but not women, may be a result of chance. Further longitudinal study of this observation is needed.


Pars plana vitrectomy for intraocular inflammation-related cystoid macular edema unresponsive to corticosteroids. A preliminary study. To determine the role of pars plana vitrectomy in patients with intraocular inflammation-related cystoid macular edema that is unresponsive to corticosteroids. Eleven eyes of nine patients underwent a standard three-port pars plana vitrectomy. The primary indication was intraocular inflammation-related cystoid macular edema that was unresponsive to oral, sub-Tenon's, and topical corticosteroids. Preoperative follow-up ranged from 20 months to 144 months (average, 70 months). Postoperative follow-up ranged from 3 months to 108 months (average, 21 months). Seven eyes (64%) improved 4 or more lines of Snellen visual acuity within 4 weeks. Two eyes (18%) remained unchanged and 2 eyes (18%) worsened. Cystoid macular edema improved by clinical examination and fluorescein angiography in 9 eyes (82%) and by clinical examination alone in 2 eyes (18%). No intraoperative complications were noted. Postoperative complications consisted of cataract formation in 1 eye (9%), glaucoma in 2 eyes (18%), and epiretinal membrane formation in 1 eye (9%). Pars plana vitrectomy may have a role in the treatment of intraocular inflammation-related cystoid macular edema that fails to respond to corticosteroids. The subgroup of patients who benefit most remains to be identified.


Use of perfluoroperhydrophenanthrene in the management of suprachoroidal hemorrhages. Suprachoroidal hemorrhage may cause the expulsion of intraocular contents. Generally, cases of nonexpulsive suprachoroidal hemorrhage have a better outcome than their expulsive counterparts. Those cases with massive nonexpulsive suprachoroidal hemorrhage do better with treatment than without. Treatment modalities have included suprachoroidal hemorrhage drainage with or without intraocular volume reformation, and vitrectomy. The authors used the liquid perfluorocarbon perfluoroperhydrophenanthrene in the treatment of three patients with nonexpulsive suprachoroidal hemorrhage. The perfluorocarbon was injected into the vitreous cavity while the suprachoroidal blood was drained through anterior sclerotomies. With 5 months of follow-up, complete resolution of the suprachoroidal blood was noted in all patients. All three patients had attached retinas, and postoperative visual acuities were improved over preoperative visual acuities. Perfluoroperhydrophenanthrene and other perfluorocarbon liquids may be beneficial in the treatment of certain cases of nonexpulsive suprachoroidal hemorrhages.


Correlation between biochemical composition and fluorescein binding of deposits in Bruch's membrane. The fluorescence of drusen during fluorescein angiography is believed to have important prognostic and pathogenetic implications in age-related maculopathy. It is believed that deposits containing predominantly neutral lipids would be hydrophobic, resulting in hypofluorescence on fluorescein angiography, while the presence of polar phospholipids would be indicated clinically by hyperfluorescence because of its hydrophilic properties. To identify the potential determinants of fluorescence of drusen and Bruch's membrane, a series of macular specimens from human donors older than 60 years of age was examined. No clinical information was available concerning any previous eye disease. In vitro fluorescein binding was recorded microscopically, and the presence of fibronectin was sought by immunohistochemistry. The results were correlated with the proportions of phospholipids to neutral lipids identified by histochemical and biochemical studies. It was found that high content of neutral fats was associated with lack of both fluorescein binding and fibronectin, and, conversely, in those specimens with high proportions of phospholipids, fluorescein binding was strong and fibronectin was present. These observations support the central hypothesis concerning biophysical changes in Bruch's membrane with age and the potential importance of fluorescein angiography in the characterization of Bruch's membrane deposits.


Comparison of photocoagulation with the argon, krypton, and diode laser indirect ophthalmoscopes in rabbit eyes. The purpose of this study is to compare photocoagulation with the argon green, krypton red, and diode infrared laser indirect ophthalmoscopes in an experimental setting. Photocoagulation was performed with each of the laser indirect ophthalmoscopes in a grid pattern within one sector of the same eye of 14 Dutch-belted rabbits. Treatment was performed either with or without scleral depression. Measurements of the retinal burn diameters were performed after hemisecting the globes, and the burns were examined with light microscopy. Variation in burn intensity and diameter (10% to 28%) was common with all 3 laser indirect ophthalmoscopes. Five times more output energy was required to make equivalent burns with the diode laser indirect ophthalmoscope than with the argon or krypton laser indirect ophthalmoscopes. Choriovitreal hemorrhages only occurred during scleral depression. Histopathologically, the argon green laser indirect ophthalmoscope burns spared the choroid and inner sclera, while the intense krypton and diode burns had full-thickness choroidal involvement and even thermal injury to the inner sclera. Scleral depression reduced the mean energy required to create equivalent burns with all three laser indirect ophthalmoscopes. There was a 10% to 40% reduction in the mean retinal burn diameter with scleral depression (argon green, P < 0.0005; krypton red, P < 0.0005; and diode, P < 0.025). Photocoagulation with the argon green, krypton red, or diode infrared laser indirect ophthalmoscopes is a safe and effective method of retinal ablation. Decreasing the posterior nodal distance of the eye with scleral depression will produce a smaller spot on the retina with the laser indirect ophthalmoscope.


Avellino corneal dystrophy. Clinical manifestations and natural history. The pathologic features of a variant of granular corneal dystrophy has been described in which the presence of lattice changes in addition to characteristic granular lesions has been documented. The authors investigated the mode of inheritance, natural history, and clinical manifestations of this dystrophy. A family with this condition was investigated, and a pedigree was established. Family members underwent ophthalmic examination, and ophthalmic history was obtained. In addition, pathologic examination of corneal tissue from affected patients was performed. Similar to the four previously described cases, this family also traced its origins to Avellino, Italy. This autosomal dominant condition affected 27 of 92 family members, ranging in age from 5 to 77 years. Granular deposits were the earliest and most common manifestations. Lattice lesions were present in some patients with granular lesions. Older patients had anterior stromal haze between deposits, which impaired visual acuity. Recurrent granular deposits were noted in donor corneal tissue after penetrating keratoplasty for this condition. Pathologic examination of corneal tissue from affected patients confirmed the presence of hyaline material seen in granular dystrophy as well as fusiform deposits of amyloid, similar to those seen in lattice dystrophy type I. This study establishes the natural history and clinical manifestations of this condition.


Effects of povidone-iodine chemical preparation and saline irrigation on the perilimbal flora. To analyze the effects of 5% povidone-iodine preparation and saline irrigation on the species composition of perilimbal flora. Cultures were taken from the perilimbal conjunctiva in 100 eyes before preparation for ophthalmic surgery, after instillation of povidone-iodine solution, and after saline irrigation. Bacteria were isolated in 75% of eyes before preparation, in 28% after povidone-iodine instillation, and in 24% after saline irrigation. Fifty-one culture-positive eyes became negative with povidone-iodine, while only four culture-negative eyes became culture-positive (P < 0.001). The number of eyes yielding coagulase-negative staphylococci, Staphylococcus aureus, and Propionibacterium were significantly decreased after povidone-iodine instillation. Twenty-three culture-positive eyes became negative after saline irrigation, while 19 culture-negative eyes became culture-positive (P > 0.25). Povidone-iodine solution is effective in reducing bacterial recovery from the perilimbal conjunctiva, where most incisions for intraocular surgery occur. Saline irrigation after povidone-iodine preparation has no significant effect.