Serial composition of human milk in preterm and term mothers.

Human milk samples were collected from 86 mothers induced in the study on days 3, 7, 14 and 28 of lactation. The mothers were divided into three groups on the basis of gestation viz. group 1: 37-41 weeks (n=41), group II: 33-36 (n=23) and group III: <33 weeks gestation (n=22). All the samples were analysed for the estimation of fat, lactose and protein. The results obtained from the investigations were statistically analysed. The analysis of the results revealed a lower amount of fat and lactose in preterm milk as compared to term milk (p<0.01). These were found to increase in amount with increasing postnatal age (p<0.05). The protein levels were observed to be significantly higher in preterm than term milk (p<0.01). These were observed to decrease significantly with increase in postnatal age (p<0.01).

Febrile status epilepticus as the first presentation of cortical developmental malformation: report of 2 cases.

Cortical developmental malformations are an important cause for epilepsy. The epileptic disorder usually begins with sporadic seizures, followed by gradually increasing seizure frequency and culminating in epilepsia partialis continua. We report the de-novo occurrence of focal status epilepticus accompanying hyperpyrexia in two male children, aged 18 months and 4 years. One child had prior neuro-developmental delay, while in the other, developmental milestones were normal. In both instances, there were no seizures prior to the presenting neurological illness. Cerebrospinal fluid examination was normal in both the cases. Magnetic resonance imaging revealed extensive pachygyria in one patient and focal cortical thickening in the other. Therefore, cortical developmental malformation may be suspected as an underlying aetiology in children presenting with de-novo status epilepticus and hyperpyrexia.

The Nidek MK-2000 microkeratome system.

PURPOSE: To assess flap thickness and the performance of the Nidek MK-2000 microkeratome during laser in situ keratomileusis (LASIK). METHODS: Three hundred seventy consecutive eyes of patients undergoing LASIK had the depth of flaps measured via subtractive pachymetry. All flaps were created using two different model numbers of the Nidek MK-2000 microkeratome. Both 130-microm and 160-microm depth plates were evaluated. Microkeratome-induced complications were also recorded. RESULTS: Buttonhole flaps and free flaps were not seen in this study. One short flap occurred and suction could not be obtained in two eyes. The mean flap thickness obtained using the 130-microm depth plate for model number 121 was 129 +/- 21.8 microm. The mean flap thickness obtained using the 160-microm depth plate for model number 121 was 150 +/- 29.6 microm. The mean flap thickness obtained using the 130-microm depth plate for model number 65 was 152 +/- 25 microm. The mean flap thickness obtained using the 160-microm depth plate for model number 65 was 173 +/- 26.9 microm. CONCLUSION: The Nidek MK-2000 microkeratome is safe and creates flaps of predictable thickness.

Dark-adapted Pupil Sizes in a Prospective Evaluation of Laser in situ Keratomileusis Patients.

PURPOSE: This study presents the results of scotopic pupil size measurement in a group of laser in situ keratomileusis (LASIK) patients and the implications this value has for night vision symptoms and treatment zones. METHODS: This was a prospective study measuring the dark-adapted pupil of 218 patients using a handheld pupillometer. RESULTS: The mean scotopic pupil size was 5.66 mm with a standard deviation of 1.04 mm. Pupils ranged in size from 3.00 mm to 9.00 mm. CONCLUSION: Results suggest that a number of patients may have seotopic pupil size well beyond the treatment zones commonly used or available in refractive laser systems. Treating with an ablation zone that is smaller than the mesopic pupil will often result in night vision disturbances. Next generation technology such as the Nidek EC-5000 excimer laser can incorporate larger treatment diameters in order to reduce the incidence of halos and glare at night. [J Refract Surg 2000; 16(suppl):S239-S241].

Familial occurrence of pseudoexfoliation in Canada.

BACKGROUND: Genetic factors may play an important role in pseudoexfoliation syndrome. We describe the familial occurrence of pseudoexfoliation in Canadian families. METHODS: Probands with pseudoexfoliation were referred to a tertiary care glaucoma service in Ottawa because of a family history of pseudoexfoliation or glaucoma, or both. Probands and family members who agreed to participate underwent a systematic interview and eye examination. The pseudoexfoliation status was classified as affected, suspect or unknown based on preestablished criteria for the diagnosis of pseudoexfoliation and glaucoma. RESULTS: Thirty-four members of 10 families were assessed (18 affected, 2 suspect and 14 status unknown). Six families had two or more generations with pseudoexfoliation, and four families had one generation affected. There was a predominance of females among the affected subjects (17:1), and transmission in all cases appeared to be maternal. Eight of the families were of Irish/Scottish ancestry. Nine (50%) of the affected subjects had cardiovascular disease. Affected subjects tended to be older than suspects and those whose status was unknown (mean age 77, 67 and 55 years respectively). Seven subjects were affected unilaterally and 11 bilaterally. Affected subjects had moderate angle pigmentation in both eyes (mean +2.7, where 0 = no pigment and +4 = dense homogeneous pigment). The mean intraocular pressure in both eyes was higher for the affected subjects (23.1 [standard deviation (SD) 8.6] mm Hg) than for the suspects (16.8 [SD 6.1] mm Hg) and those of unknown status (16.8 [SD 2.9] mm Hg). An enlarged cup:disc ratio was seen in the affected subjects (mean 0.62). Eleven (61%) of the affected subjects had open angles on gonioscopy, and five had occludable angles and required peripheral iridectomy. Ten (56%) of the affected subjects were classified as having glaucoma, and 14 (78%) had evidence of cataract formation in at least one eye. INTERPRETATION: Pseudoexfoliation appears to be transmitted matrilineally, which raises the possibility of mitochondrial inheritance, X-linked inheritance or autosomal inheritance with genomic imprinting. A larger study of families with pseudoexfoliation is necessary to clarify the mode of transmission and to identify the gene(s) involved in the etiology of this disorder.

Selective laser trabeculoplasty v argon laser trabeculoplasty: a prospective randomised clinical trial.

AIMS: To compare the effectiveness of selective laser trabeculoplasty (SLT, a 532 nm Nd:YAG laser) with argon laser trabeculoplasty (ALT) in lowering the intraocular pressure (IOP) in patients with medically uncontrolled open angle glaucoma. METHODS: A prospective randomised clinical trial was designed. Patients were randomised to treatment with either SLT or ALT and were evaluated at 1 hour, 1 week, 1, 3, and 6 months post-laser. RESULTS: There were 18 eyes in each group. Baseline characteristics were similar in both groups. In the SLT group the mean IOP at baseline, 1, 3, and 6 months was 22.8 (SD 3.0), 20.1 (4.6), 19.3 (6.0), and 17.8 (4.8) mm Hg, respectively. In the ALT group, the mean IOP at baseline, 1, 3, and 6 months was 22.5 (3.6), 19.5 (4.7), 19.6 (5.6), and 17.7 (3.3) mm Hg, respectively. There was a greater anterior chamber reaction, 1 hour after SLT v ALT (p< 0.01). Patients with previous failed ALT had a better reduction in IOP with SLT than with repeat ALT (6.8 (2. 4) v 3.6 (1.8) mm Hg; p = 0.01). CONCLUSION: SLT appears to be equivalent to ALT in lowering IOP during the first 6 months after treatment. There is a slightly greater anterior chamber reaction 1 hour after SLT. Patients with previous failed ALT had a significantly greater drop in IOP when treated with SLT v ALT. These results need to be confirmed with a larger sample size.

Is pseudoexfoliation syndrome inherited? A review of genetic and nongenetic factors and a new observation.

Pseudoexfoliation (PEX) syndrome is the commonest identifiable cause of open-angle glaucoma worldwide. PEX is characterized clinically by small whitish deposits of fibrillar-granular material in the anterior segment of the eye. Despite its prevalence and potential for ophthalmic morbidity, surprisingly little is known about the etiology and pathogenesis of PEX. This article reviews the literature and presents evidence regarding genetic and nongenetic arguments for the etiology of pseudoexfoliation. Lines of evidence that support a genetic basis for PEX include transmission in two-generation families, twin studies, an increased risk of PEX in relatives of affected patients, and HLA studies. Nearly all pedigrees in the literature, and our own experience with PEX families in Iceland and Canada, suggest maternal transmission, raising the possibilities of mitochondrial inheritance, X-linked inheritance, and autosomal inheritance with genomic imprinting. A number of nongenetic factors have also been evaluated for their possible implication in the development of PEX. These include ultraviolet light, autoimmunity, slow virus infection, and trauma. It is possible that a combination of genetic and nongenetic factors may be involved in the etiology and pathogenesis of PEX, i.e. it may be a multifactorial disorder. Further studies with larger numbers of patients are needed to delineate more clearly the contribution of genetic (nuclear DNA, mitochondrial DNA or both) and nongenetic factors to the development of pseudoexfoliation syndrome and pseudoexfoliation glaucoma.

Parental attitudes towards epilepsy.

Parents of 352 children with history of epilepsy were interviewed by a pretested, open ended questionnaire to ascertain the nature of first aid care during an epileptic fit, complications arising out of this care, and parents' perceptions regarding causes of epilepsy. The commonest form of care provided was to force liquids by mouth (50.6%), followed by pressure over body to restrain convulsive movements (13.0%) or to put some object to force the teeth open (11.9%). The various causes of epilepsy according to the parents were: due to an evil spirit (26.7%0, heritable causes (13.9%), physical or mental weakness (6.6%) and brain damage (5.9%). The need of imparting knowledge and clear understanding about epilepsy among parents is emphasized.