Botulinum toxin for the temporary treatment of involutional lower lid entropion: a clinical and morphological study.

PURPOSE: A prospective study was designed to evaluate the use of botulinum toxin as a temporary treatment in patients awaiting surgical repair for involutional entropion and to compare its use with lid taping. METHODS: Botulinum toxin was administered to 30 patients with involutional entropion (35 eyelids). These patients had all previously been using lid taping and lubricant ointment as a temporary measure whilst awaiting lid surgery. Patients' symptoms and signs were assessed before and after toxin injection. The date of entropion recurrence was recorded. Eyelid tissue from 8 patients treated with toxin and 3 control patients who had not been given toxin was obtained after surgical entropion repair and examined histologically to ensure the botulinum toxin had no potential detrimental effects on the results of surgery. RESULTS: The toxin was simple and quick to administer. Anatomical success was achieved in 33 of the 35 eyelids with significant improvements in symptoms and signs. The mean duration of action of the toxin was 12.5 weeks. Lower lid laxity was inversely correlated with duration of toxin action. There were no consistent changes in orbicularis oculi morphology after toxin injection. CONCLUSION: Botulinum toxin is a highly effective temporary treatment for involutional entropion with few complications and no adverse effects on the results of surgical entropion repair.

Practice variations by population: training significance.

OBJECTIVE: This study sought to examine variations in the frequency of procedures performed and patterns of care of sick infants and older children by general pediatricians in different sized communities. The results of the study will be considered in developing relevant educational experiences for postgraduate trainees. METHODOLOGY: Questionnaires were sent to 1412 Texas pediatricians requesting frequency information for 29 procedures and whether they provided various levels of care to sick infants and older children. Responses were tabulated by the size of the community in which each pediatrician practiced. RESULTS: Fifty-four percent of the questionnaires were returned. The proportion of pediatricians performing each procedure was significantly different for all but 8 of the 29 procedures between communities of less than 100,000 and more than 100,000 population. For all procedures with significant differences, the proportion of physicians performing the procedures was significantly greater for pediatricians practicing in communities of less than 100,000 population. No significant difference was found between the proportion of pediatricians providing newborn level II and III care; however, more than 65% of both groups provided level II care. Physicians in communities of less than 100,000 population were more likely to provide intermediate and intensive care beyond the newborn period. CONCLUSION: The general practice rotation in the community setting will not provide adequate training experiences for many of the procedures currently being performed by general pediatricians.

Acknowledgment and severity of stuttering as factors influencing nonstutterers' perceptions of stutterers.

The purpose of this study was to determine (a) if nonstutterers prefer to interact with mild and severe stutterers who acknowledge their stuttering and (b) if nonstutterers' perceptions of mild and severe stutterers' intelligence, personality, and appearance are altered as a function of stutterers' acknowledgment of their stuttering. Acknowledgment and nonacknowledgment videotapes of two mild and two severe male stutterers were made during interview situations. Eighty-four female subjects examined the interview tapes and were then instructed to answer questions and complete adjective scales. Findings indicate that significant numbers of female nonstutterers prefer to interact with severe stutterers who acknowledged their stuttering. Mild and severe stutterers who acknowledged their stuttering receive more favorable ratings on intelligence, personality, and appearance.

Superoxide reaction with nitroxides.

Stable, free radical nitroxides are commonly used ESR spectroscopy tools. However, it has recently been found that ESR observable signal from 5-membered ring spin-adducts or stable label nitroxides is lost or diminished by reaction with superoxide. A similar radical-radical annihilation was not found for six membered ring nitroxide radicals. To discern why six-membered ring nitroxides are not reduced under superoxide flux generated by hypoxanthine/xanthine oxidase, spectrophoptmetric (Cyt CIII) and chemiluminescence (lucigenin) and ESR assays were used to follow the reactions. Spectrophotometry and chemiluminescence clearly demonstrated that the six-membered piperidine-1-oxyl compounds (TEMPO, TEMPOL, and TEMPAMIN) rapidly react with superoxide: rate constants at pH 7.8 ranging from 7 x 10(4) to 1.2 x 10(5) M-1 s-1. The absence of detectable ESR signal loss results from facile re-oxidation of the corresponding hydroxylamine by superoxide. To fully corroborate the efficiency of the 6-membered nitroxide superoxide dismutase activity, they were shown to protect fully mammalian cells from oxidative damage resulting from exposure to the superoxide and hydrogen peroxide generating system hypoxanthine/xanthine oxidase. Since six-membered cyclic nitroxides react with superoxide about 2 orders of magnitude faster than the corresponding 5-membered ring nitroxides, they may ultimately be more useful as superoxide oxide dismutase mimetic agents.

Lupus-like nephritis heralding the definitive manifestation of systemic lupus erythematosus.

Four patients presented with the nephrotic syndrome. The histological appearances on renal biopsy were in three characteristic and in one suggestive of lupus nephritis. These patients did not initially have other clinical features of SLE, but three had a positive ANA and one a raised DNA titre. Remission occurred in two patients, in one spontaneously and in another following corticosteroid therapy, but two developed renal failure. During follow-up all developed elevated DNA binding levels and arthralgia or lymphopenia. The ARA classification criteria for lupus were only fulfilled at this late stage.