[Effectivity of an occlusion-supporting PC-based visual training programme by horizontal drifting sinus gratings in children with amblyopia]. / Webbasierte Stimulationstherapie bei Kindern mit unbehandelter Amblyopie.

BACKGROUND: The studies of Kämpf et al. suggested an efficiency of a computer-based stimulation therapy by drifting sinus gratings in patients with anisometropic and/or strabismic amblyopia but provided no clear evidence. This is the first trial with amblyopic patients without previous treatment at the beginning of amblyopia therapy. METHODS: A prospective, randomised, single-blinded, placebo-controlled study of n = 15 patients with anisometropic and/or strabismic amblyopia without previous treatment was performed. Age of the patients was between 4 and 10 years, mean 6.3 years (± 2.0), all after full correction of refraction errors and refractive adaptation. Stimulation therapy was performed 5 times a week over 4 weeks, respectively 2 × 20 min, a drifting sinus grating of constant spatial and temporal frequency was combined with computer games (n = 8). Control group had only computer games with a neutral background (n = 7). In both groups patching was only done in stimulation times. RESULTS: Stimulation and control group did not differ due to age, gender, and cause of amblyopie, baseline visual acuity, and time of wearing glasses. There was no significant difference in the development of visual acuity over the stimulation period between stimulation and control groups. CONCLUSIONS: Stimulation therapy with drifting sinus gratings did not improve the development of visual acuity in the first phase of amblyopia treatment combined with minimal occlusion therapy. Accordingly, the stimulation therapy is not adequate to replace sufficient occlusion therapy. Whether this therapy could support patching therapy and improve acuity development in later therapy phases cannot be assumed from this trial.

Body mass index and injury risk among US children 9-15 years old in motor vehicle crashes.

OBJECTIVE: To determine the relationship between body mass index (BMI) and injury risk among US children in motor vehicle crashes. DESIGN: Cross-sectional study using data from the Partners for Child Passenger Safety study, a child-focused crash surveillance system. PARTICIPANTS: A probability sample of children, 9-15 years of age, involved in crashes in parent-operated vehicles between 1 December 2000 and 31 December 2006. MAIN OUTCOME MEASURE: The odds ratio of Abbreviated Injury Severity (AIS) 2+ injuries (overall and body region specific) by BMI category: underweight, normal, overweight, and obese. RESULTS: The study sample included 3232 children in 2873 vehicles, representing a population estimate of 54 616 children in 49 037 vehicles. Approximately 15% (n = 502) sustained an AIS 2+ injury to any body region; 34% of the children were overweight or obese. There was no overall increase in injury risk by BMI; however, body region differences were found. In multivariate logistic regression, compared with normal weight children, the odds of sustaining an AIS 2+ injury to the extremities for overweight and obese children was 2.64 (95% CI 1.64 to 4.77) and 2.54 (95% CI 1.15 to 5.59), respectively. CONCLUSIONS: Although overweight and obese children are not at increased overall risk of injury, they are at increased risk of injury to the lower and upper extremities. This increased risk may be due to a combination of physiology, biomechanical forces, and vehicle design.

[Severe Aspergillus endophthalmitis occurring after liver transplantation in an 8-month-old baby]. / Aspergillus-Endophthalmitis nach Lebertransplantation bei einem Säugling.

Immunosuppressed patients and transplant patients bear an increased risk for invasive aspergillosis and Aspergillus endophthalmitis. An 8-month-old boy developed severe unilateral panuveitis after liver transplantation. Bronchopulmonary infiltrates were present, but a pulmonary Aspergillus infection was not confirmed. An enucleation was performed in order to prevent a life-threatening disseminated Aspergillus infection.

[Best's disease with normal EOG. Case report of familial macular dystrophy]. / Morbus Best mit normalem EOG. Fallvorstellung einer familiären Makuladystrophie.

Best's disease is an autosomal dominant disorder with incomplete penetrance and variable expression. A typical characteristic of Best's disease is a pathological EOG. We describe four members of a family with bilateral, subfoveal vitelliform lesions. The EOG was normal in all cases. Genetic analysis of the oldest son indicated a heterozygotic mutation Ala234Val in the VMD2 gene, so-called bestrophin gene, which is associated with Best's disease. Molecular genetic analysis also found Best's disease with a normal EOG. A normal EOG cannot exclude Best's disease. The family members should receive genetic consultation and if wished analysis of the VMD2 gene.

Three-in-one parenteral nutrition: a safe and economical method of nutritional support for infants.

The medical records of 20 infants under 1 year of age who received parenteral nutrition (PN) for a minimum of 1 week were reviewed. Patients were divided into two groups based on the method of PN administration. One group received PN by the traditional two-plus-one method where lipid emulsion is given separately from the dextrose-amino acid mixture. The second group received PN by the three-in-one method where lipid emulsion is admixed with the dextrose and amino acids. There were no statistically significant differences between the two groups in the amount of calories, lipid, dextrose, protein, calcium, and phosphorus received per kg of body weight. Average daily weight gain was not statistically different, and no obvious trends were noted in serum biochemical parameters between the two groups. Average total PN days for the groups (13 +/- 7 days for the two-plus-one group vs 39 +/- 35 days for the three-in-one group) were significantly different (p less than 0.05). A cost comparison of the two methods of PN administration indicated that the two-plus-one method costs our hospital $11.78 more per day than the three-in-one solution. We conclude that the three-in-one method of PN administration is safe, efficacious, and cost effective for infants under 1 year of age.

Algorithms for Bayesian background-subtracted Fourier darkfield imaging.

Formal consideration of prior information on the Fourier amplitude of background contrast in an image, using the same Bayesian principles of statistical inference which underlie thermodynamics, allows one to subtract background without favoring only selected parts of frequency space. Without the bias in frequency space which causes periodicity bleeding and mars literal interpretation of Fourier-filtered images, the shape transform of aperiodic objects can be left intact. Algorithms for Bayesian background subtraction from one- and two-dimensional images are presented which further consider, in ad hoc fashion, one's uncertainty about background amplitude. The results help explain the reported success of Fourier truncation, and indicate that Bayesian background-subtracted images can minimize root-mean-square image error, as well as periodicity bleeding, in comparison to Fourier-filtered and Fourier-truncated alternatives.

Heterogeneous Dolichos biflorus lectin binding to a subset of rat alveolar macrophages in normal and fibrotic lung tissue.

The distribution of Dolichos biflorus lectin in the rat lung and during fibrosis after irradiation was investigated by lectin histochemical and electron microscopical techniques and double immunofluorescence labelling with the monoclonal antibodies RM-1 and ED-1. The results indicate a selective reaction of Dolichos biflorus lectin with a subpopulation of alveolar macrophages. No binding of the lectin was detectable in ED-1-positive macrophages but strong staining occurred in a part of the RM-1-positive cell population. In fibrotic lung specimens an increased number of Dolichos biflorus lectin-positive macrophages was found in which focally ED-1 reactive and RM-1 negative cells appeared. The finding of changing lectin binding pattern in a radiation-induced lung model emphasizes the suitability of the Dolichos biflorus lectin as a marker of macrophage activation or functional specialization.

Interventions to prevent softball related injuries: a review of the literature.

OBJECTIVES: To examine the published evidence on interventions to prevent softball related injuries among adults, and to encourage more epidemiologic research as a foundation for future softball injury prevention efforts. METHODS: The authors reviewed literature identified from six electronic databases for studies on softball related injuries. The search was limited to studies written in the English language, published between 1970 and 2002, and involving adult populations. Research was excluded that evaluated baseball ("hard ball") related injuries or was aimed at injury treatment. Identified studies were categorized by study design. Intervention/prevention papers were evaluated further and described in detail. RESULTS: The search strategy identified 39 studies specifically related to softball. Most studies were case reports/case series (n=13) or descriptive studies (n=11); only four were analytic or intervention/prevention studies. Studies collected data in a variety of ways, often without denominator data to permit calculation of injury rates. Studies also did not differentiate between slow or fast pitch softball activities and most did not mention the type of softball that was used. CONCLUSIONS: Surprisingly few studies exist on interventions to reduce injuries during softball, one of the most popular recreational sports in the US. Of the existing literature, much attention has been on sliding related injuries, which comprise only a segment of softball injuries. Basic epidemiologic studies describing the nature, severity, and risk factors for softball injuries in a variety of populations are needed, followed by additional intervention evaluation studies aimed at modifiable risk factors.

[Applanation tonometry in "normal" patients and patients after LASIK]. / Applanationstonometrie bei Normalpatienten und Patienten nach LASIK.

BACKGROUND: Until now it was thought that morphological parameters of the eye such as corneal thickness, corneal curvature and axial length do not affect tonometry results. However, the aim of this study was to find out whether there actually is an influence of these parameters on applanation tonometry. PATIENTS AND METHOD: In this prospective study we examined 125 eyes of 125 normal patients with a corneal thickness of 568.8 +/- 43.79 microm, a corneal curvature of 7.72 +/- 0.27 mm and an axial length of 23.62 +/- 2.05 mm. Before performing a phacoemulsification, the anterior chamber was temporarily punctured. With a closed system the intraocular pressure (IOP) was manometrically set at 20, 35 and 50 mmHg using an H (2)O column. The IOP was then measured with a Perkins tonometer. With these patients we compared 102 eyes that had undergone LASIK due to a myopia of 6.3 +/- 2.17 D. Before and 6 months after surgery, IOD, k-values and central corneal thickness of these patients were measured. RESULTS: At all set pressure levels there was a highly significant correlation of measured IOP and corneal thickness. At all set pressure levels the measured IOP significantly depended on corneal thickness (r(2) = 0.78 - 0.83). After LASIK, IOP was reduced from 16.5 +/- 2.1 to 12.9 +/- 1.9 mmHg. There was a significant correlation between IOP and corneal curvature as well as corneal thickness (r(2) = 0.631; P < 0.001). The biomechanical characteristics of the cornea are changed so that the measured IOP has to be corrected by an additional 0.75 mmHg. CONCLUSION: Since corneal thickness does affect Goldmann applanation tonometry we recommend to use the "Dresden Correction Table" (Tab. ) to achieve the real IOP. Pressure measurements after LASIK are inaccurate because of a change in corneal biomechanics, corneal thickness and curvature and they should be corrected as follows: IOP (real) = IOP (measured) + (540 - CCT)/71 + (43 - K-value)/2.7 + 0.75 mmHg.

Intestinal absorption of 1,25-dihydroxyvitamin D3 in the rat.

Intestinal absorption of 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] from in vivo jejunal sacs was studied in rats with thoracic duct and bile duct cannulas. In 6 h 86.5% of the administered 1,25(OH)2D3 was absorbed, but only 7.3% was recovered in thoracic duct lymph. Appearance in plasma of [3H]-1,25(OH)2D3 after intrajejunal administration was identical in rats with and without diverting lymph cannulas, indicating that the 1,25(OH)2D3 is absorbed almost entirely via portal blood. When 1,25(OH)2D3 was instilled into the jejunum in a fat suspension without bile salts rather than a mixed micellar solution, less was recovered in lymph, but total intestinal absorption was unchanged. High-pressure liquid chromatography of a lymph extract demonstrated that 1,25(OH)2D3 was present only as the unchanged secosteroid. In lymph, only 4.1% of the 1,25(OH)2D3 was in the chylomicrons, with the remainder bound to the plasma protein fraction of lymph. Treatment of rats with cycloheximide to block chylomicron synthesis did not decrease absorption of 1,25(OH)2D3. These results indicate that intestinal absorption of 1,25(OH)2D3 is effective and not very dependent on luminal bile salts. Almost all 1,25(OH)2D3 is released from the intestine directly into portal blood and does not require packaging in chylomicrons for transport into intestine lymph.

Comparison of vitamin D and 25-hydroxyvitamin D absorption in the rat.

We have studied the intestinal absorption of physiological amounts of vitamin D and 25-hydroxyvitamin D [25(OH)D3] in vivo from jejunal sacs in rats with thoracic and bile duct cannulas. Under all test conditions, absorption of 25(OH)D was greater than absorption of vitamin D. The majority of absorbed vitamin D and 25(OH)D was transported from the intestine in portal blood rather than lymph. When the luminal fluid contained 2.5 mM oleic acid and monoolein, the presence of taurocholate did not affect total intestinal absorption of vitamin D or 25(OH)D but increased recovery of vitamin in lymph. When luminal fat content was increased to 10 mM oleic acid and monoolein, total absorption of both vitamin D and 25(OH)D was enhanced by taurocholate. No significant metabolism of vitamin D or 25(OH)D occurred during absorption and transport in lymph. Fifty-three percent of lymph vitamin D was found in the chylomicron fraction, compared with only 13% of 25(OH)D. Inhibition of chylomicron synthesis by cycloheximide decreased vitamin D absorption by 46% but diminished 25(OH)D absorption by only 30%. These differences in behavior of vitamin D and 25(OH)D during absorption may explain the superior absorption of 25(OH)D in patients with malabsorption.

Does furosemide alter the hemodynamic response to rapid intravascular transfusion of the anemic fetal lamb?

The purpose of this study was to define the hemodynamic response to rapid intravascular transfusion of the anemic fetal lamb and to determine whether furosemide alters that response. Sixteen experiments were performed in nine chronically instrumented gravid ewes between 0.8 and 0.9 of timed gestation. On day 1 of each experiment, each fetus was subjected to hemorrhage (40 ml/kg of estimated fetal weight) over 1 hour. On day 2, plasma was withdrawn from the stored fetal blood until the hematocrit was approximately 70%, and the packed red blood cells were returned to the fetus intravenously over 10 minutes. Each fetus received either furosemide (2 mg/kg) or control saline solution intravenously at time zero and again at 5 minutes. The order of experiments was randomly determined for each animal. Hemorrhage resulted in a similar decrease in fetal hematocrit in the two groups. The mean +/- SEM fetal hematocrit before hemorrhage was 38 +/- 3% in the furosemide group (n = 8) and 36 +/- 2% in the control group (n = 8). On day 2, the mean +/- SEM fetal hematocrit before transfusion was 28 +/- 2% in the furosemide group and 25 +/- 1% in the control group. There was no significant difference between groups in the fetal hemodynamic response to transfusion. At the end of the transfusion, the fetal central venous pressure had increased from 4.9 +/- 0.5 to 6.2 +/- 0.5 mm Hg in the furosemide group (p = 0.01) and from 3.9 +/- 0.2 to 5.8 +/- 0.3 mm Hg in the control group (p = 0.0001). Fetal mean arterial pressure increased from 42 +/- 1 to 50 +/- 1 mm Hg in the furosemide group (p = 0.0001) and from 40 +/- 1 to 46 +/- 1 mm Hg in the control group (p = 0.0007). Fetal heart rate decreased from 187 +/- 2 to 169 +/- 5 beats/min in the furosemide group (p = 0.004) and from 188 +/- 4 to 170 +/- 5 beats/min in the control group (p = 0.0008). Transfusion did not significantly change fetal pH in either group. At 120 minutes, the fetal PO2 had increased from 17 +/- 1 to 19 +/- 1 mm Hg in the furosemide group (p = 0.03) and from 19 +/- 1 to 21 +/- 2 mm Hg in the control group (p = 0.05). We conclude that rapid transfusion of the anemic fetal lamb resulted in modest increases in fetal central venous pressure and mean arterial pressure.(ABSTRACT TRUNCATED AT 400 WORDS)

Magnesium sulfate and promethazine do not interact to cause hypotension in gravid ewes.

The purpose of this study was to determine whether magnesium sulfate and promethazine interact to cause hypotension in gravid ewes. Fifteen experiments were performed in five chronically instrumented animals between 125 and 130 days of timed gestation (term = 145 days). In one group of experiments each animal received magnesium sulfate (4 gm intravenous bolus followed by 4 gm/hr intravenous infusion) then promethazine (50 mg intravenously). In a second group each animal received magnesium sulfate then saline solution as a control. In a third group each animal received saline solution then promethazine. Infusion of magnesium sulfate increased the mean (+/- SEM) serum magnesium concentration to 5.7 +/- 0.6 and 6.6 +/- 0.6 mg/dl in the magnesium sulfate-promethazine and magnesium sulfate-saline solution groups, respectively. Magnesium sulfate slightly decreased maternal mean arterial pressure (p less than 0.05) and increased cardiac output (p less than 0.05) in both the magnesium sulfate-promethazine and magnesium sulfate-saline solution groups. Otherwise there were no significant changes in maternal mean arterial pressure or cardiac output in any group. Promethazine increased maternal heart rate (p = 0.0001) in both the magnesium sulfate-promethazine and saline solution-promethazine groups. Magnesium sulfate increased uterine blood flow (p less than 0.01) in both the magnesium sulfate-promethazine and magnesium sulfate-saline solution groups, but promethazine blunted the increase in uterine blood flow associated with magnesium sulfate. Similarly, magnesium sulfate decreased uterine vascular resistance (p less than 0.01) in both the magnesium sulfate-promethazine and magnesium sulfate-saline solution groups, but promethazine eliminated the decrease in uterine vascular resistance associated with magnesium sulfate. Maternal and fetal arterial blood gas and acid-base values did not change in any group, except that there was a small, near-significant decrease (p = 0.06) in fetal pH 10 minutes after promethazine was given in the magnesium sulfate-promethazine group. We conclude that magnesium sulfate and promethazine did not interact to cause maternal hypotension in normovolemic gravid ewes. However, promethazine increased maternal heart rate and blunted the increase in uterine blood flow associated with magnesium sulfate.

Continuous epidural infusion of 0.0625% bupivacaine-0.0002% fentanyl during the second stage of labor.

A randomized, double-blind, placebo-controlled study was performed to evaluate the analgesic efficacy and influence of continuing an epidural infusion of 0.0625% bupivacaine-0.0002% fentanyl during the second stage of labor in nulliparous women. When the cervix was fully dilated, coded study solution was substituted for the known bupivacaine-fentanyl solution. The study solution for 29 patients was 0.0625% bupivacaine-0.0002% fentanyl; 34 patients received saline placebo. The two groups had similar pain scores during the first stage of labor. During the second stage, pain scores were significantly higher in the saline-placebo group at each 30-min interval between 60 and 150 min after the diagnosis of full cervical dilation. Similarly, there was a significant difference between the two groups in global assessment of analgesia quality during the second stage, but the difference occurred in those patients with a second-stage duration of greater than or equal to 60 min. Among the women who delivered vaginally, eleven of 28 (39%) women in the bupivacaine-fentanyl group, versus five of 34 (15%) in the saline-placebo group, had surgical perineal anesthesia for vaginal delivery (P less than .05). Six of 28 (21%) women in the bupivacaine-fentanyl group, and five of 34 (15%) in the saline-placebo group, underwent instrumental vaginal delivery (P = NS). The median duration of the second stage of labor was 53 min (range = 5-283) in the bupivacaine-fentanyl group, and 63 min (range = 16-181) in the saline-placebo group (P = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Vision characteristics of individuals identified as Irlen Filter candidates.

Individuals with "scotopic sensitivity syndrome" have been reported to have visual symptoms including eye strain, headaches, blurred vision, double vision and words moving on the page. This study was designed to investigate Irlen's claims that these symptoms are unrelated to vision anomalies. She suggests that the use of Irlen tinted lenses/filters relieves these symptoms and results in improved reading performance. Thirty nine subjects (age 10-49) were recruited by advertising for a study of Irlen Filters/Lenses. Before the Irlen screening all subjects received an optometric examination. The results of this study demonstrate that 95 percent of the subjects identified as candidates for Irlen Filters did have significant and readily identifiable vision anomalies. Fifty seven percent of the subjects had received vision care within the past year, yet testing revealed that 90 percent of these subjects had significant vision problems that had not been corrected.

Does ritodrine worsen maternal hypotension during epidural anesthesia in gravid ewes?

The purpose of this study was to determine whether prior administration ritodrine worsens maternal hypotension during epidural anesthesia in gravid ewes. Twenty-four experiments were performed in nine chronically instrumented animals between 0.8 and 0.9 of timed gestation. The experimental sequence included the following: 1) at time-zero, intravenous (iv) administration of ritodrine, 0.004 mg.kg-1.min-1, or normal saline (NS) for 2 h; 2) at 120 min discontinuation of ritodrine, and administration of a 500 ml iv bolus of NS over 15 min; and 3) at 135 min epidural injection of 2% lidocaine or NS. There were three groups of experiments: 1) iv ritodrine-epidural lidocaine (n = 9); 2) iv NS-epidural lidocaine (n = 8); and 3) iv ritodrine-epidural NS (n =7). Epidural injection of lidocaine resulted in a median sensory level of T9 in both the ritodrine-lidocaine and NS-lidocaine groups. At 165 min (i.e., 30 min after the epidural injection of lidocaine), maternal mean arterial pressure was 19 +/- 3% below baseline (P = 0.0001) in the ritodrine-lidocaine group and 22 +/- 7% below baseline (P = 0.0001) in the NS-lidocaine group (NS between groups). At 120 min ritodrine had increased maternal cardiac output 45 +/- 6% above baseline (P = 0.0001) in the ritodrine-lidocaine group and 39 +/- 6% above baseline (P = 0.0001) in the ritodrine-NS group. Cardiac output remained above baseline (P less than 0.01) after epidural injection of lidocaine in the ritodrine-lidocaine group. In contrast, in the NS-lidocaine group cardiac output was 13 +/- 5% below baseline (P = 0.005) at 150 min. Fetal arterial pH did not change significantly in either the ritodrine-lidocaine or ritodrine-NS group.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunologic assessment of regional lymph node histology in relation to survival in head and neck carcinoma.

Histologic material from 84 cases of squamous cell carcinoma of head and neck regions was studied by double blind retrospective analysis. Sections of lymph nodes draining the tumors were examined microscopically to assess the morphologic pattern of response. Patients whose lymph nodes demonstrated active immunologic responses in the form of expanded inner cortices or increased numbers of germinal centers had 5-year survival rates significantly greater than those patients whose regional lymph nodes showed an unstimulated pattern. None of the patients whose lymph nodes showed the depleted pattern survived 5 years. These correlations were independent of the stage or grade of the tumor. Metastases occurred much more frequently in patients having regional nodes showing an unstimulated or depleted pattern than in those whose regional nodes showed evidence of immunologic activity. The data support the concept of a relationship between immunologic activity, progression of neoplasia, and survival. Morphologic assessment of immunologic activity in lymph nodes draining malignant tumors appear to be of significant value in the predicting survival.