Bilateral lateral rectus resection for residual esotropia.

PURPOSE: Residual or recurrent esotropia is a common problem following bilateral medial rectus recessions for esotropia, and various surgical techniques have been advocated. We have favored bilateral lateral rectus resections. METHODS: We reviewed our results in 25 patients, aged 7 to 89 months (mean 27 months), with a follow-up of 7 to 95 months (mean 39 months) following the second surgery. Survival analysis was used, with success (survival) defined as alignment within 10 PD at last follow-up. RESULTS: Median survival was 84 months with an estimated mean survival of 55 months. There are 15 of 25 patients (60%) currently successful. There were 8 undercorrections and 2 overcorrections. Three patients, included among those not successful, required a third procedure. Survival was similar to previous reports of primary esotropia and consecutive exotropia. CONCLUSIONS: Our results suggest that bilateral lateral rectus resection is a reasonable surgical option in the treatment of residual esotropia following recessions of both medial recti.

The prevalence of uveitis in juvenile rheumatoid arthritis.

BACKGROUND: Because asymptomatic uveitis has been an important cause of visual loss in children with juvenile rheumatoid arthritis, periodic ophthalmologic screenings of such patients have been recommended. Recently, some authors have found a decreased prevalence of uveitis in children with juvenile rheumatoid arthritis. METHODS: We studied a total of 76 patients (63 girls and 13 boys, aged 1 to 16 years), referred to 3 pediatric ophthalmology practices between March 1976 and October 1999. Follow-up examinations were performed at intervals of 3 to 6 months according to current guidelines, during the following 6 months to 23 years (mean, 55 months). RESULTS: Uveitis developed in 10 children (13%). Of these 10 children, 2 were symptomatic (blurred vision, discomfort) and 7 were diagnosed with uveitis at the initial visit. Only 1 patient had asymptomatic uveitis after initial negative findings on screening examination. Final visual acuity for all the compliant children in the uveitis group was better than 20/30. DISCUSSION: The prevalence of uveitis in our study is similar to rates found by other recent authors. This decrease may reflect a tendency for systemic medications to prevent the development of ocular inflammation. We believe that screening guidelines should be reevaluated, especially for asymptomatic children with negative findings on initial examinations.

Developmental delay and poverty in the strabismus clinic.

BACKGROUND: Strabismus and poverty are more common among developmentally delayed children. Poverty is difficult to define, but qualification for Medicaid benefits has been used as an indicator in the past. METHODS: There was a retrospective review of 95 patients with strabismus younger than 7 years who were seen in the Department of Pediatric Ophthalmology at the Albany Medical Center for a 12-month period and were reviewed for the presence or absence of developmental delay. These patients were selected from 2 groups: one with Medicaid coverage and one without. RESULTS: Developmental delays were noted in 13 patients without Medicaid (27.0%) and in 26 patients with Medicaid (55.3%) (P = .0096). Patients with Medicaid were less likely to name Allen pictures by age 3 years (P = .0003). CONCLUSIONS: Poverty is more commonly associated with delays in patients with strabismus, and this should alert ophthalmologists who work with Medicaid patients to seek to identify the presence of developmental delay in managing the care of these patients.

Processing syntactic relations in language and music: an event-related potential study.

In order to test the language-specificity of a known neural correlate of syntactic processing [the P600 event-related brain potential (ERP) component], this study directly compared ERPs elicited by syntactic incongruities in language and music. Using principles of phrase structure for language and principles of harmony and key-relatedness for music, sequences were constructed in which an element was either congruous, moderately incongruous, or highly incongruous with the preceding structural context. A within-subjects design using 15 musically educated adults revealed that linguistic and musical structural incongruities elicited positivities that were statistically indistinguishable in a specified latency range. In contrast, a music-specific ERP component was observed that showed antero-temporal right-hemisphere lateralization. The results argue against the language-specificity of the P600 and suggest that language and music can be studied in parallel to address questions of neural specificity in cognitive processing.

Ultraviolet radiation-induced ubiquitination and proteasomal degradation of the large subunit of RNA polymerase II. Implications for transcription-coupled DNA repair.

We have shown previously that UV radiation and other DNA-damaging agents induce the ubiquitination of a portion of the RNA polymerase II large subunit (Pol II LS). In the present study UV irradiation of repair-competent fibroblasts induced a transient reduction of the Pol II LS level; new protein synthesis restored Pol II LS to the base-line level within 16-24 h. In repair-deficient xeroderma pigmentosum cells, UV radiation-induced ubiquitination of Pol II LS was followed by a sustained reduction of Pol II LS level. In both normal and xeroderma pigmentosum cells, the ubiquitinated Pol II LS had a hyperphosphorylated COOH-terminal domain (CTD), which is characteristic of elongating Pol II. The portion of Pol II LS whose steady-state level diminished most quickly had a relatively hypophosphorylated CTD. The ubiquitinated residues did not map to the CTD. Importantly, UV-induced reduction of Pol II LS level in repair-competent or -deficient cells was inhibited by the proteasome inhibitors lactacystin or MG132. These data demonstrate that UV-induced ubiquitination of Pol II LS is followed by its degradation in the proteasome. These results suggest, contrary to a current model of transcription-coupled DNA repair, that elongating Pol II complexes which arrest at intragenic DNA lesions may be aborted rather than resuming elongation after repair takes place.

Corneal edema after pediatric cataract surgery.

INTRODUCTION: We have encountered idiopathic corneal edema in four patients (five eyes) after pediatric lensectomy. This problem has not been previously described in the pediatric ophthalmology literature. METHODS: Clinical and operative records were reviewed. The children, who ranged in age from 15 months to 6 years, underwent apparently uncomplicated limbal lensectomy without lens implantation. After surgery, all received subconjunctival hydrocortisone (12.5 mg) and 2 to 4 drops daily of topical prednisolone acetate. The corneal edema developed between 2 and 14 days after surgery. RESULTS: The condition cleared in all patients during a 5- to 14-day course of intensive topical steroids. No sequelae have been apparent. Final visual acuities are 20/30 or better in the three children (four eyes) old enough for recognition acuity testing. The fifth eye has excellent central fixation. CONCLUSIONS: We suspect that the corneal decompensation was a manifestation of sterile inflammation. Two of the children had a history of iritis. Difficulty measuring cellular response at the slit-lamp examination and instilling eyedrops at home may have contributed to the complication. Postoperative corneal decompensation can be responsive to topical steroids, which we now prescribe more intensively even in apparently quiet eyes.

Validating the integrity of one-way check valves for the delivery of contrast solution to multiple patients.

The infusion of contrast solution into multiple patients from a single infusion bag is desired in clinics concerned with the high cost of the solution. Using one-way check valves in the infusion line is a protection method to reduce the risk of blood-borne cross-contamination. The suitability of this method is assessed through testing of the operating characteristics of the valves and infusion system and the high back pressure testing of the valves. The results indicate that the use of back-flow valves can ensure the prevention of flow from the patient to the injector. Results also indicate that the use of sprung valves, those which require a significant forward pressure to open them, are more appropriate for this application.

International pharmaceutical spending controls: France, Germany, Sweden, and the United Kingdom.

France, Germany, Sweden, and the United Kingdom each use different types of policies for controlling prescription drug spending. Until recent years, these policies have relied heavily on regulating prices charged by drug manufacturers, with different systems providing varying degrees of pricing freedom. While these policies appear to have brought some degree of price restraint, they have not prevented continued growth in prescription drug spending. As a result, each country is supplementing its policies with measures aimed at physicians and consumers and targeted at reducing a perceived over-utilization of pharmaceutical products.

The prevalence of gallstone disease in very old institutionalized persons.

We present the results of a study that was undertaken at a large geriatric nursing home to assess the prevalence of gallstone disease in very old institutionalized persons. One hundred seventeen residents underwent ultrasound examination of the gallbladder. Two thirds of 82 women and half of 35 men had gallstone disease. When stratified for age, 80% of women and men over the age of 90 years were positive for the disease. In summary, the prevalence of gallstone disease in our very old nursing home population was found to be unexpectedly high.

Tetrahydroaminoacridine-lecithin combination treatment in patients with intermediate-stage Alzheimer's disease. Results of a Canadian double-blind, crossover, multicenter study.

We studied the efficacy and safety of oral tetrahydroaminoacridine (THA) combined with lecithin in 52 patients with Alzheimer's disease. The maximal tolerated dose of THA (up to 100 mg per day) was determined during an eight-week titration period, after which the tolerated dose of THA or placebo was given during two sequential randomized periods of treatment lasting eight weeks each. Highly purified lecithin (4.7 g per day) was administered during all phases of the study. Efficacy was expressed in terms of scores on the Mini-Mental State (MMS) test, the modified MMS test, the Hierarchic Dementia Scale, the Rapid Disability Rating Scale-II, and the behavioral scale of Reisberg et al. Safety was assessed by careful clinical monitoring as well as serial measurements of liver aminotransferases. Forty-six patients completed the titration period, and 39 completed the double-blind period, during which only the MMS score showed a small but significant increase (P less than 0.05) after four weeks of treatment with THA. Autonomic side effects of THA were common but mild. Reversible elevations of serum aspartate and alanine aminotransferase levels to three or more times the upper limit of normal occurred in 17 percent of patients; most of the patients affected were women. A liver biopsy performed in one patient showed resolving focal liver-cell necrosis. These studies fail to demonstrate a significant clinical benefit of THA given orally in a maximal dose of 100 mg per day over a period of eight weeks in combination with lecithin.

Calcium channel blockers for tardive dyskinesia in geriatric psychiatric patients.

Nifedipine treatment resulted in variable improvement in tardive dyskinesia in eight geriatric psychiatric patients. Patients with affective disorders and hypertension demonstrated improvement in other areas as well.

Relationships between human blood groups, bacterial pathogens, and urinary tract infections.

Blood groups of 137 patients with acute pyelonephritis and chronic upper tract infection, cystitis, and asymptomatic bacteriuria were compared with those of a normal uninfected control population. In addition, the identified uropathogens were categorized according to the patient's blood group. There was a significant association between the diagnosis of chronic upper tract infection and blood group B as compared with controls (p = less than 0.05, chi 2). Analysis of the bacterial isolates showed that more patients with blood group B had infections with Pseudomonas sp., Klebsiella pneumoniae, and Proteus sp. than was expected; and fewer patients with blood group A had infections with Pseudomonas than predicted (p = less than 0.05, chi 2). There was an increased number of patients in blood group AB with infections caused by Escherichia coli and Klebsiella pneumoniae. These results suggest that an individual's blood group may be a significant factor in the host-response to bacterial invasion and influence the development of infection with certain gram-negative bacilli.

Opportunistic infections in homosexual men.

In summary, we have described a homosexual patient who died of Kaposi's sarcoma and overwhelming disseminated opportunistic infections. Review of the literature attests to the severe alterations of immune surveillance inherent in the homosexual population as a whole and the need for vigorous clinical investigation when warranted.

Antibody to kidney antigen in the urine of patients with urinary tract infections.

One hundred six urine specimens from 26 patients with acute and chronic pyelonephritis and cystitis were tested by radioimmunoassay to determine (1) whether antibody to normal human kidney antigen was present and (2) whether the presence or absence of this antibody correlated quantitatively with antibody to the patient's own infecting organism. Of the 106 urine specimens tested, 55 (52%) contained elevated antibody to human kidney antigen. For 80 (75%) of 106 urine specimens there was a correlation between the results of quantitative assays for antibody levels to kidney antigen and to the bacterial antigen. Indirect fluorescent antibody studies of thin sections of normal human kidneys and a patient's urine containing elevated levels of antibody to kidney antigen and to bacterial antigen demonstrated diffuse renal localization. Results indicate the occurrence of antibody to kidney antigen, particularly in urine specimens from patients with chronic pyelonephritis and from urine specimens containing elevated levels of antibody to bacterial antigen.

Transient alteration of theophylline half-life: possible association with Herpes simplex infection.

Transient alteration of theophylline half-life resulting in theophylline neurotoxicity is reported in a nine-year-old child. The alteration in theophylline elimination half-life was associated with Herpes simplex gingivostomatitis. This association has not previously been demonstrated. The report is contrasted with a study of theophylline clearance variability in children.