Relation between duration and severity in bereavement-related depression.

OBJECTIVE: Prolonged duration is commonly used as an indicator that bereavement-related depression (BRD) is pathological. DSM-IV replaced the traditional 1-year pathology cut-point by a 2-month cut-point. Yet, little evidence exists regarding the validity of these cut-points in indicating increased BRD severity. This study evaluated the validity of the 2-month and 1-year cut-points in differentiating less severe from more severe BRDs in a nationally representative U.S. sample. METHOD: National Comorbidity Survey respondents with BRD's (n = 152) lasting 0-8, 9-52 and >52 weeks were evaluated for depression severity using six severity indicators. Cut-point validity was established by discontinuities in severity levels between durations below and above the cut-point. RESULTS: Bereavement-related depressions of >52-week duration were significantly higher than 9- to 52-week BRDs on four of six severity indicators and on a cumulative overall severity measure of mean number of severity indicators per person, whereas ≤8-week and 9- to 52-week durational categories differed on one severity indicator and not on overall severity. Additional analyses using durations 0-12, 13-26, 27-52 and >52 weeks suggested that alternative <52-week cut-points also lack validity. CONCLUSION: The traditional 1-year cut-point validly identifies increasing BRD severity; DSM's 2-month cut-point does not. Duration does not indicate increasing BRD severity before 1 year. Research using the 2-month cut-point may yield misleading results.

Streptococcal endophthalmitis from contaminated donor corneas after keratoplasty. Clinical and laboratory investigations.

We report three cases of Streptococcus viridans endophthalmitis following penetrating keratoplasty in which S viridans was cultured from the recipient eye, McCarey-Kaufman (M-K) media, and corneoscleral rims. As a laboratory correlation, we investigated the ability of S viridans to survive in M-K medium supplemented with gentamicin. After M-K medium was inoculated with S viridans, it was stored overnight at 4 degrees C, after which the temperature was raised to 23 degrees C. Periodic colony counts were performed for up to 24 hours after warming. No killing occurred in the cold. Ten hours passed before there was one log reduction in the bacterial colony count. Organisms could still be cultured at 24 hours. We conclude that gentamicin alone may be inadequate prophlyaxis against S viridans contamination of donor corneas.

Streptococcus sanguis survival in K-Sol. Comparison of gentamicin and the fluoroquinolone antibiotics.

Viridans streptococci are poorly covered by gentamicin sulfate in corneal storage medium. To evaluate possible antibiotic alternatives among the newer broad-spectrum fluoroquinolone antibiotics, we compared the survival of the viridans representative Streptococcus sanguis in K-Sol with gentamicin sulfate (100 mg/L), norfloxacin (250 mg/L), ciprofloxacin lactate (250 mg/L), ofloxacin (250 mg/L), or no antibiotic. At 23 degrees C, K-Sol with gentamicin produced a 2-log kill by 80 minutes. By comparison, only one of the others (norfloxacin) had achieved a 2-log kill by 4 hours. At 4 degrees C, all antibiotics differed little from the control, and none was superior to gentamicin.

Topical nonsteroidal agents and corneal wound healing.

The effects on corneal wound healing of two topical nonsteroidal anti-inflammatory agents, flurbiprofen sodium (0.03%) and diclofenac sodium (0.1%), and the topical corticosteroid, prednisolone sodium phosphate (1%), were evaluated in masked, controlled rabbit studies. Healing of epithelial scrape wounds was significantly retarded in all three treatment groups for the first 3 days after wounding. There was no difference in the epithelial healing rate between the two nonsteroidal or corticosteroid treatment groups. Clinical grading of epithelial quality, conjunctival hyperemia, keratitis, stromal edema, and corneal haze were similar in all groups. There was a significant early decrease in the iritis score in the diclofenac treatment group. The strength of 2-mm central penetrating corneal trephination wounds and the collagen content of these wounds were similar in all groups. Both the topical nonsteroidal anti-inflammatory agents and the corticosteroid used in the preparations and dosages investigated in this study decreased early epithelialization of scrape wounds but had no apparent effect on corneal stromal healing. No toxic effects of the various drugs were found.

In vivo distribution studies of radioactively labelled platinum complexes; cis-dichlorodiammine platinum(II), cis-trans-dichlorodihydroxy-bis-(isopropylamine) platinum(IV), cis-dichloro-bis-cyclopropylamine platinum(II), and cis-diammine 1,1-cyclobutanedicarboxylate platinum(II) in patients with malignant disease, using a gamma camera.

The in vivo distribution in man of the four platinum derivatives cis-dichlorodiammine platinum(II) (DDP), cis-trans-dichlorodihydroxy-bis-(isopropylamine) platinum (IV) (CHIP), cis-dichloro-bis-cyclopropylamine platinum(II) (CP), and cis-diammine 1, 1-cyclobutanedicarboxylate platinum(II) (CBDCA) has been observed. The availability of these compounds labelled with the radioactive isotope of platinum, platinum-191, has made serial in vivo imaging of their distribution possible. Injection of 17-35 MBq (5-28 mg) of the labelled compound IV was followed by imaging, using a gamma camera, with particular reference to the kidneys, liver, and tumour site. Hepatic and renal clearances were observed in all nine patients, but no unequivocal evidence of tumour uptake was found. The left kidney uptake was estimated at times up to 7 days after injection. Mathematical analysis of some of the uptake curves failed to show any significant difference between the clearance times observed. However, the two patients who received CBDCA did show a higher initial renal uptake, falling within the 1st day to levels comparable with those of the other compounds, and the three patients who received DDP showed consistently liver uptake.

Persistent corneal edema in aphakic eyes from daily-wear and extended-wear contact lenses.

Corneal edema developed in seven aphakic eyes of six patients (three men and three women ranging in age from 60 to 88 years) who used daily- or extended-wear hydrophilic and silicone contact lenses. This edema, which developed suddenly, persisted despite discontinuation of contact lens wear and treatment with topical corticosteroids. The onset of the edema occurred in two patterns. In three eyes, edema occurred soon (30 minutes to 30 days) after the contact lens was first worn and persisted during follow-up periods averaging 15 months. In the other four eyes, the edema developed late, after 20 to 66 months. In three of these eyes, edema resolved after follow-up periods averaging seven months. In the fourth eye, it was still present after 18 months. Of the affected eyes in which peripheral endothelial cell densities could be measured, all but one had fewer than 800 cells/mm2. Central cell densities in the five uninvolved fellow eyes averaged 1,964 cells/mm2. Marked polymegathism and cornea guttata were present in all affected and fellow eyes. We believe this condition is a complication of aphakic contact lens wear, distinct from contact-lens-intolerance syndrome and aphakic bullous keratopathy.

Classification and treatment of local septic complications in acute pancreatitis.

BACKGROUND: An international symposium on acute pancreatitis recently developed a clinical classification system for severe acute pancreatitis that classifies all local septic complications into three groups: infected necrosis (IN), sterile necrosis (SN), and pancreatic abscess (PA). Despite the appeal of having three distinct, well-defined labels for this complex process, the clinical utility of this schema has yet to be determined. The purpose of this study was to investigate the prognostic and therapeutic utility of applying this clinical classification system to a large group of surgical patients with local septic complication from acute pancreatitis. PATIENTS AND METHODS: We reviewed the cases of 62 patients with complicated pancreatitis, classifying them into IN (n = 20), SN (n = 14), or PA (n = 28) groups. Ranson's score, APACHE II score, and computed tomography grading were calculated within the first 48 hours of admission. Information on patient demographics, etiology of pancreatitis, operative procedures, timing of intervention, bacteriology, blood loss, intensive care unit days, ventilator days, and morbidity and mortality were also accrued and analyzed. RESULTS: Despite similar demographics and etiology of pancreatitis, patients with necrosis, both IN and SN, were more critically ill than were patients with PA (APACHE II score > 15, 21% versus 0%, respectively), required earlier operative intervention (mean 14 days versus 29 days, P = 0.02), required necrosectomy with drainage (65% versus 4%, P < 0.001) rather than simple drainage (3% versus 86%, P < 0.001), more reoperations (2.3 versus 1.1, P < 0.05), and had a significantly higher mortality rate (35% versus 4%, P < 0.05). In addition, patients with IN required significantly more hospital days, ventilator days, and blood transfusions than either patients with SN or PA (P < 0.05). CONCLUSIONS: We conclude that this classification system allows for the stratification of patients into three distinct groups--infected necrosis, sterile necrosis, and pancreatic abscess--and has both therapeutic and prognostic usefulness.

Biomicroscopic and histopathologic observations after corneal laser photocoagulation in a rabbit model of corneal neovascularization.

Corneal neovascularization complicates many anterior segment diseases. Corneal laser photocoagulation using yellow light (577 nm) has been shown to reduce corneal neovascularization. No histopathologic studies of the effects of this treatment on the eye have been reported, however. Target (cornea) and nontarget (iris, lens, retina, and choroid) ocular tissue were studied 1, 24, and 48 h and 5 days after yellow dye corneal laser photocoagulation in a rabbit model of corneal neovascularization. Biomicroscopic examination of the corneas revealed intracorneal hemorrhage in five of 24 (21%) eyes of nonpigmented rabbits. Faint lenticular opacities were observed in two eyes of pigmented rabbits 24 h after laser treatment. Histopathologic examination revealed increased cellularity (neutrophils) (p < 0.005) in the cornea, increasing from 1 h after treatment, peaking 24 h later, and persisting past 5 days. Distortion of the corneal lamellae by red blood cells occurred in eyes in which intracorneal hemorrhage developed. These results indicate that corneal laser photocoagulation using yellow light is a relatively safe procedure for reducing corneal neovascularization.

Management of corneal complications in xeroderma pigmentosum.

Xeroderma pigmentosum is an uncommon, recessively inherited disorder characterized by hypersensitivity to ultraviolet (UV) radiation, with defective repair of DNA damage caused by short-wavelength radiation. Patients with this disease experience progressive and precancerous changes in sun-exposed areas of the skin and mucous membranes. Some patients develop progressive neurologic degeneration. Eye involvement includes lid, conjunctiva, and corneal disorders. We report clinical, histopathologic findings, and complex management strategies used for a 33-year-old woman with xeroderma pigmentosum and recurrent corneal ulcerations that required corneal transplantation, topical cyclosporin, perilimbic conjunctival resection followed by topical mitomycin C, and corneal dye-laser photocoagulation of neovascularization in the left eye.

Survival of Streptococcus viridans in gentamicin-supplemented McCarey-Kaufman medium.

Our experience with three cases of Streptococcus viridans endophthalmitis, following penetrating keratoplasty, prompted us to investigate the ability of gentamicin-supplemented McCarey-Kaufman (M-K) medium to kill S. viridans contaminants. After inoculation of 20 cc of gentamicin-supplemented M-K with S. viridans, the M-K was exposed to temperature conditions similar to those that would be encountered by a donor cornea during storage (4 degrees C) and preoperative warming prior to keratoplasty (23 degrees C). Colony counts were performed at regular intervals. After 1 h of warming, no reduction in the initial inoculum had occurred. This is in contrast to results from similar experiments with Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa in which more than 1 log unit of killing occurred after 1 h. While previously reported clinical experience has demonstrated an overall low incidence of postkeratoplasty endophthalmitis using gentamicin-supplemented M-K, our own recent clinical and laboratory data suggest that additional or alternate antibiotic coverage for S. viridans may be prudent.

Corneal laser photocoagulation for treatment of neovascularization. Efficacy of 577 nm yellow dye laser.

The authors treated corneal neovascularization in 25 eyes of 23 patients with corneal laser photocoagulation using 577 nm yellow light. Four groups of patients were treated: patients with corneal neovascularization and active graft rejection (group 1); patients with neovascularization before penetrating keratoplasty (PK) (group 2); lipid keratopathy patients with opacification and/or focal edema threatening the visual axis (group 3); and patients with extensive corneal neovascularization, who were not candidates for PK (group 4). Area of neovascularization and clinical outcome were monitored. After corneal laser photocoagulation, there was a statistically significant reduction in the neovascularized area in group 1 from 32% of corneal area to 10%, and in group 3 from 46% to 27%. All five patients in group 1 had resolution of their graft rejection. In group 3, there was a reduction in the area of corneal opacification from 59% of corneal area to 52%. This difference was not statistically significant. Seven of nine patients in group 3 had stabilization or improvement in their vision over a mean of 9.3 months follow-up. There was no significant change in neovascularized area in groups 2 and 4. In group 2, no rejection reactions occurred over a mean of 5.6 months follow-up after PK. In group 4, corneal laser photocoagulation was disappointing.

The vicissitudes of measurement: a confirmatory factor analysis of the Emotional Autonomy Scale.

This study examined the factor structure of the Emotional Autonomy Scale (EAS) as proposed by Steinberg and Silverberg. Participants were from three independent samples of adolescents in grades 6 (n = 1,842), 8 (n = 1,769), and 10 (n = 1,232), with each sample consisting of three ethnic groups: African American, European American, and Mexican American. None of the confirmatory factor analyses for these samples supported the factor structure proposed by Steinberg and Silverberg. From the three models tested, the EAS is best described by the four originally proposed factors, combined with two method factors, one consisting of the positively worded scale items and one consisting of the negatively worded scale items. Results show that the EAS exhibits poor construct validity and behaves quite differently for the different grade and ethnic groups. The strong impact of method variance on the factor structure is discussed. Although various alternative solutions to the psychometric problems in the EAS are proposed, the most credible solution may be to reexamine the conceptual foundations of emotional autonomy and develop better measures of those concepts for adolescents.

Corneal argon laser photocoagulation for neovascularization in penetrating keratoplasty.

Corneal argon laser photocoagulation (CALP) was used in 13 patients to treat deep stromal vascular ingrowth. Eight patients had undergone successful penetrating keratoplasty but had developed deep stromal vessels into the graft associated with signs of graft rejection, which did not improve with steroid treatment alone (group 1). After CALP, there was marked regression of the neovascularization with reversal of graft rejection in all eyes. Three additional patients with vascularized corneas, referred for penetrating keratoplasty, underwent CALP preoperatively with obliteration of the vessels (group 2). Two of these patients have since undergone keratoplasty and, in both, the grafts have remained avascular and clear over a 21-month follow-up. Two other patients with corneal injury and progressive corneal opacification and vascularization have also been treated with CALP (group 3). CALP may be a useful adjunct in the treatment of corneal neovascularization. Further clinical studies are needed to define its exact role.

Depletion of O6-alkylguanine-DNA alkyltransferase correlates with potentiation of temozolomide and CCNU toxicity in human tumour cells.

Temozolomide (8-carbamoyl-3-methylimidazo[5,1-d]-1,2,3,5-tetrazin-4-(3H)-one) has shown promising activity in Phase I trials against some brain (glioma) and skin (melanoma, mycosis fungoides) cancers. Temozolomide and lomustine (CCNU) showed parallel toxicity in seven human tumour cell lines and this generally correlated (correlation coefficients 0.87 and 0.92 respectively) with the level of expression of the DNA repair protein O6-alkylguanine-DNA alkyltransferase (ATase, EC 2.1.1.63). Pretreating cells with the ATase inhibitor, O6-benzylguanine (BG), potentiated cytotoxicity to a similar degree with both drugs, but did not sensitise a cell line (ZR-75-1) expressing very low levels of this protein. When BG pretreatment was combined with repeat doses of temozolomide a dramatic potentiation (300 fold) was seen in MAWI cells, which express high levels of ATase, but not in a cell line (U373) expressing lower levels of ATase. [14C]-labelled temozolomide uptake was similar in sensitive and resistant lines. Human ATase-cDNA transfected xeroderma pigmentosum (XP) fibroblasts were more resistant than XP control cells to temozolomide and the related chloroethylating agent mitozolomide and although BG completely suppressed ATase activity in these cells, resistance was still greater than in control cells.