Variation of radiation sensitivity of Friend erythroleukemia cells cultured in the presence of the differentiation inducer DMSO.

Differentiation of Friend erythroleukemia cells (FELC) was induced with 1.5% dimethyl sulfoxide (DMSO) in the culture medium. Cell growth, erythroid differentiation, and radiosensitivity of the proliferative capacity of the cells were measured and compared to a noninduced control culture of identical age. Induced cells first appeared on Day 2 after DMSO addition, and increased to a maximum of 80 to 90% of the cell population on Day 5, whereas in the control culture, induction was less than 2% of the cells. Radiosensitivity of the cells in the induced culture, relative to that of cells in the control culture, showed an age-dependent variation. On Days 1 and 2 after DMSO addition, the cells in the induced culture were more radiosensitive than those in the control culture. At later times this relationship was reversed, and between Days 3 and 5 the clonable cells in the induced culture were less radiosensitive than those in the control culture. These results suggest that the metabolic events associated with commitment of FELC to differentiate affect their ability to cope with the radiation-induced lesions underlying the loss of division capacity.

Necrotizing enterocolitis and volvulus in the premature neonate.

Premature infants presenting to the neonatal intensive care unit at the Hospital for Sick Children with a surgical abdomen over a 5-year period were studied retrospectively to determine the factors leading to the diagnosis of malrotation with volvulus and necrotizing enterocolitis (NEC). Fifteen preterm infants (less than 37 weeks) were diagnosed as having volvulus, and 54 had surgically treated NEC. Those with NEC were more likely to be systematically ill with grossly bloody stools, abdominal tenderness, and thrombocytopenia (P less than .005). Bilious vomiting and bilious gastric residuals were the only hallmarks of volvulus (P less than .005). Although the radiographic findings of thickened bowel walls and intramural air were significantly related to NEC, the accuracy and interobserver reliability in diagnosing these features was variable as was the ability to distinguish NEC from volvulus or normal on plain abdominal radiographs. Volvulus is an important cause of surgical abdomen in the preterm infant and can be misdiagnosed as NEC. An unusual course or the presence of bilious vomiting in any patient thought to have NEC should alert the clinician to the possibility of this diagnosis.

Factors predisposing to postoperative intraocular inflammation.

This prospective study of 123 patients undergoing cataract extraction determined the preoperative and surgical factors predisposing to an exaggerated postoperative inflammatory response. It is important to identify the patients at increased risk of complications requiring additional prophylaxis or more intensive postoperative care, particularly when selecting patients for day case surgery. Previous intraocular inflammation or surgery was the factor most strongly associated with marked inflammation on the first postoperative day (p < 0.01, compared to uncomplicated patients). As a result, patients stayed in hospital an average of one day longer (p < 0.001) and required significantly more steroid drops (p < 0.001). Other factors of significance, but reducing importance were: difficult surgery, non-caucasian race and brown irides. Amongst uncomplicated patients, the difficulty of surgery was most significantly related to a high inflammation score (p < 0.01). Non-caucasian patients stayed in hospital significantly longer than their caucasian counterparts (p < 0.05), and required more steroid drops (p < 0.001). Of caucasian patients, those with brown irides were inpatients for significantly longer than those with blue or hazel (p < 0.05). No other factors studied significantly altered postoperative inflammation: neither the presence of diabetes, nor the technique of cataract extraction.

Floppy eyelid syndrome and mental retardation.

OBJECTIVE: To report four subjects with a combination of floppy eyelid syndrome, mental retardation, and increased mechanical stimulus to the affected side. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: The authors retrospectively reviewed the charts of four mentally retarded subjects with floppy eyelid syndrome. INTERVENTION: Surgical tightening of three upper lids and one lower lid was performed in three subjects. MAIN OUTCOME MEASURE: Relief of symptoms. RESULTS: The affected eyelids were treated surgically; in case 1 by anterior lamellar repositioning and lateral and medial canthal tightening, in case 2 by horizontal upper lid shortening, and in case 3 by horizontal lid shortening of both upper and lower lids. There was marked relief from symptoms in all three cases. In case 4, surgery was deferred at parental request. CONCLUSIONS: These cases support the role of mechanical factors in the pathogenesis of floppy eyelid syndrome. Subjects with mental retardation may cooperate poorly with examination, and we believe that there should be a careful search for floppy eyelid syndrome in the presence of chronic conjunctivitis or unexplained epitheliopathy.

A randomized controlled trial of intracameral lidocaine during phacoemulsification under topical anesthesia.

OBJECTIVE: To test the hypothesis that adjunctive intracameral 1% lidocaine reduces intraoperative pain during phacoemulsification using topical anesthesia. DESIGN: Prospective, double-masked, randomized, controlled trial. PARTICIPANTS: A total of 200 patients undergoing routine phacoemulsification under topical 1% tetracaine were studied. INTERVENTION: Randomization to 0.5 ml intracameral, unpreserved, epinephrine-free 1% lidocaine or placebo was conducted. MAIN OUTCOME MEASURE: Intraoperative pain was quantified by the patients using a 0-10 visual analog pain scale. RESULTS: Intraoperative pain scores (+/- standard deviation) for the lidocaine and control groups were 1.29 +/-1.24 and 1.44 +/- 1.33, respectively (P > 0.35). CONCLUSIONS: In a rigorously double-masked, prospective, randomized, controlled trial there was no significant reduction in intraoperative pain when intracameral 1% lidocaine was used during phacoemulsification under topical anesthesia.

Clinicopathological report Periocular tumour of the follicular infundibulum.

Tumour of the follicular infundibulum (TFI) is an uncommon, benign lesion of the skin adnexae. Four cases are reported of periocular TFI. In all cases a clinical diagnosis of basal cell carcinoma was made before surgery; however, histopatholog ca examination revealed TFI. This is an epithelial tumour showing differentiation along the lines of the follicular infundibulum. Characteristic features are a shelf-like proliferat on of pale epithelia cells in the upper dermis, attachment to the epidermis and the upper portions of the pilosebaceous units, a dense border of elastic fibres, and palisading of the peripheral cell layer of the tumour plate. This benign tumour has not, to the authors' knowledge, been reported in the ophthalmic literature. It has a non-specific appearance and may be clinically misdiagnosed as naevus sebaceous, xanthoma, seborrhoeic keratosis, or basal cell carcinoma.

Subconjunctival betamethasone is of benefit after cataract surgery.

Following cataract extraction, the intraocular inflammatory response is particularly marked in some patients, who then require more intensive post-operative care. This prospective randomised double-masked controlled trial of 246 patients undergoing cataract extraction assessed the efficacy and safety of a prophylactic subconjunctival injection of betamethasone (Betnesol, Glaxo) in improving the post-operative course. Betamethasone injected subconjunctivally at the end of cataract extraction significantly reduces anterior segment inflammation (p < 0.05) on the first post-operative day. It also reduces the need for additional steroid treatment and in-patient stay (p < 0.05). The benefits are most marked in those patients prone to a greater inflammatory response: especially those with previous intraocular inflammation (p < 0.01), but also those with racial pigmentation or difficult surgery. There was no evidence of adverse effects following betamethasone; in particular there was no endophthalmitis or steroid-induced elevation of intraocular pressure. We therefore conclude that subconjunctival injection of betamethasone is a practical, safe and effective means of improving the quality and efficiency of patient care.

Reliability of the peabody developmental gross motor scale in children with cerebral palsy.

The test/retest, intrarater, and interrater reliability of the Peabody Development Gross Motor Scale (PDGMS) was assessed in 12 children with mild or moderate cerebral palsy. A baseline test was administered, scored, and videotaped by one rater and rescored from the videotape by a second independent rater. In order to minimize the effect of developmental maturation, test/retest correlation coefficients of the tests were performed two weeks apart. The intraclass correlation coefficients ranged from 0.82 to 0.98. For interrater reliability, testing following the same protocol was repeated at 2 weeks, 3 and 6 months. Interrater correlation coefficients (r) ranged from 0.89 to 0.98. Interrater correlation coefficients (ICC) from scoring and later rescoring ten videotapes with the closest and furthest interrater agreement ranged from 0.88 to 0.99. The balance and locomotor skill categories were most responsive for assessing gross motor function in this population. These data support the use of the PDGMS as an assessment tool for children with cerebral palsy and the reliability of videotaping assessments.

Early somatosensory evoked potentials in preterm infants: their prognostic utility.

We hypothesized that somatosensory evoked potentials (SEPs) recorded early in the course of a preterm infant life would be predictive of long-term neurodevelopmental outcome. We recorded unilateral, median nerve SEPs in 88 preterm infants twice in the first 3 weeks of life (SEP1 and SEP2). We found both SEP1 and SEP2 to be significantly associated with the presence of periventricular leukomalacia on head ultrasound (p = 0.04 and p = 0.02 for SEP1 and SEP2, respectively). Both SEP1 and SEP2 were predictive of later cerebral palsy (CP) (p = 0.03 and p = 0.003, respectively). False-positive results were frequent (13 of 17 for SEP1 and 20 of 28 for SEP2). A normal SEP, even when there was periventricular echogenicity on head ultrasound, was associated with a normal outcome in all but 1 instance. SEP1 and SEP2 were less accurate than head ultrasound findings of periventricular leukomalacia in the prediction of later CP (73, 69 and 93%, respectively). SEPs done in the first 3 weeks of life may provide additional prognostic information, particularly when the test is normal. Abnormal SEPs in this period must be interpreted cautiously.

Neuromuscular approach to the motor deficits of cerebral palsy: a pilot study.

Six children with mild cerebral palsy (CP) entered a study of overnight low-intensity transcutaneous electrical stimulation (ES) to the leg muscles. After 6 months, statistically significant improvement was noted on the Peabody Developmental Motor Scales scores in gross motor, locomotor, and receipt/propulsion skills. When ES was withdrawn for 6 months, there was uniform loss in scores. Reinstitution of ES resulted in further significant improvements in total gross motor, balance, locomotor, and receipt/propulsion skills. In selected cases, overnight ES may be a useful addition to standard rehabilitation services.

Fatal combined defects in mitochondrial multienzyme complexes in two siblings.

A female child suffering from intrauterine growth retardation was born by caesarean section at 32 weeks. In the immediate newborn period there was a metabolic acidosis but this resolved. Hypotonia, muscular weakness and poor respiratory effort were evident and the child died at 6 days of age. A previous male sibling had died at 3 months of age after similar symptoms with seizures and a dysmyelination disorder. Post-mortem examination of both children showed damage to the basal ganglia. Defects in the activities of the pyruvate dehydrogenase complex, cytochrome oxidase and succinate cytochrome c reductase were found in cultured skin fibroblasts. Similar defects were found in isolated muscle mitochondria but not in isolated liver mitochondria from the patient. Immunoblotting for cytochrome oxidase showed that the multienzyme complex was not assembled in muscle and skin fibroblast mitochondria, but was assembled in liver mitochondria. Similar results were obtained in cultured skin fibroblast mitochondria for complex I of the mitochondrial respiratory chain. This is the first occasion that multiple defects have been demonstrated both in tissue and in culture skin fibroblasts in mitochondrial respiratory chain complexes.