Blood pressure variability and brain morphology in elderly women without cardiovascular disease.

OBJECTIVE: To examine the relationship between blood pressure (BP) variability (BPV), brain volumes, and cognitive functioning in postmenopausal women with few modifiable cardiovascular risk factors. METHODS: Study participants consisted of postmenopausal women enrolled in the Women's Health Initiative Memory MRI study (WHIMS-MRI) without cardiovascular disease, diabetes mellitus, hypertension, or current smoking at baseline (1996-1999). BP readings were taken at baseline and each annual follow-up visit. BPV was defined as the SD associated with a participant's mean BP across visits and the SD associated with the participant's regression line with BP regressed across visits. Brain MRI scans were performed between 2004 and 2006. Cognitive functioning was assessed at baseline and annually thereafter with the Modified Mini-Mental State Examination (3MSE) scoring until 2008. The final sample consisted of 558 women (mean age 69 years, median follow-up time [interquartile range] 8 [0.8] years). RESULTS: In adjusted models including mean systolic BP, women in the highest tertile of systolic BPV had lower hippocampal volumes and higher lesion volumes compared to women in the lowest tertile. No relationship between BPV and 3MSE scoring was detected. CONCLUSIONS: In postmenopausal women with few modifiable cardiovascular risk factors, greater visit-to-visit systolic BPV was associated with reductions in hippocampal volume and increases in lesion volumes at later life. These data add evidence to the emerging importance of BPV as a prognostic indicator even in the absence of documented cardiovascular risk factors.

Evaluation of an adult immunization composite measure in the Indian Health Service.

BACKGROUND: Government agencies, healthcare accreditation bodies and quality improvement organizations support the development of new quality measures. Composite quality measures use more than one measure to develop a broader assessment of healthcare system function. Currently, no composite measures for adult immunization coverage exist. Development of such measures could facilitate improvements in adult immunization coverage by focusing on measurement of receipt of all age-recommended vaccines. METHODS: We recruited five Indian Health Service (IHS) and Tribal health clinics to pilot an Adult Immunization Composite Measure (AICM). Data were collected monthly over seven months using a pre-programmed electronic health record (EHR) reporting tool (IHS sites); Tribal sites used third-party software or a programmable EHR reporting function. Data collected included: number of adults aged 19 years and over who were active users of the facility with at least two visits in the last three years; the cumulative number fully immunized per age-based recommendations for tetanus toxoid-containing vaccines, pertussis, zoster and pneumococcal vaccines; and the percent immunized for the AICM and for each individual vaccine. Coverage was calculated for three age groups: 19-59 years; 60-64 years; and 65 years and older. RESULTS: All sites reported aggregate immunization data monthly from patient EHR records. For all adults 19 years and older, AICM coverage ranged from 49% to 87% at the end of the report period. Two sites showed increases in AICM coverage ≥ 3%. Improvements in zoster vaccine coverage accounted for most of the increase observed. One site specifically focused on improving zoster coverage as a result of using the AICM. CONCLUSIONS: We demonstrated the feasibility of implementing a composite measure of adult immunization coverage. This is the first measure capable of monitoring immunization completeness, coverage improvement and overall adult vaccine program effectiveness for adults who receive all recommended, age-based vaccines.

Usefulness of the ratio of orbital fat to total orbit area in mild-to-moderate thyroid-associated ophthalmopathy.

OBJECTIVE: To identify a useful predictor of thyroid-associated ophthalmopathy (TAO) from orbital CT images; to evaluate the orbital fat and extraocular muscle area ratio as a CT-derived measure; and to investigate the correlations between this ratio and the clinical manifestations in mild-to-moderate TAO. METHODS: Between January 2012 and March 2013, 44 patients with TAO and 23 controls were studied prospectively. All of the patients underwent ophthalmic examinations, including clinical activity score, exophthalmometry, clinical photographs, alternate prism and cover test, duction and version test, Hess screen test, binocular single vision test, thyroid function tests and orbital CT. The cross-sectional areas of the four rectus muscles, superior oblique muscle, optic nerve and total orbit area were calculated in the coronal view 6 mm posterior from the posterior pole of globe. RESULTS: The cross-sectional area measured on orbital CT showed increased orbital fat in patients with TAO and an increased orbital fat to total orbit area ratio (fat/orbit) in TAO with retraction and proptosis. There were significant correlations between fat/orbit and margin reflex distance 1 (p = 0.022), margin reflex distance 2 (p = 0.013) and the exophthalmometric value (p = 0.007). CONCLUSION: The orbital fat to total orbit area ratio (fat/orbit) is a useful diagnostic index in mild-to-moderate TAO. ADVANCES IN KNOWLEDGE: The orbital CT offers a useful diagnostic index in TAO.

Mammography interval and breast cancer mortality in women over the age of 75.

The purpose of this study is to evaluate the relationship between mammography interval and breast cancer mortality among older women with breast cancer. The study population included 1,914 women diagnosed with invasive breast cancer at age 75 or later during their participation in the Women's health initiative, with an average follow-up of 4.4 years (3.1 SD). Cause of death was based on medical record review. Mammography interval was defined as the time between the last self-reported mammogram 7 or more months prior to diagnosis, and the date of diagnosis. Multivariable adjusted hazard ratios (HR) and 95 % confidence intervals (CIs) for breast cancer mortality and all-cause mortality were computed from Cox proportional hazards analyses. Prior mammograms were reported by 73.0 % of women from 7 months to ≤2 year of diagnosis (referent group), 19.4 % (>2 to <5 years), and 7.5 % (≥5 years or no prior mammogram). Women with the longest versus shortest intervals had more poorly differentiated (28.5 % vs. 22.7 %), advanced stage (25.7 % vs. 22.9 %), and estrogen receptor negative tumors (20.9 % vs. 13.1 %). Compared to the referent group, women with intervals of >2 to <5 years or ≥5 years had an increased risk of breast cancer mortality (HR 1.62, 95 % CI 1.03-2.54) and (HR 2.80, 95 % CI 1.57-5.00), respectively, p trend = 0.0002. There was no significant relationship between mammography interval and other causes of death. These results suggest a continued role for screening mammography among women 75 years of age and older.

Lack of positive effect of intravitreal bevacizumab in central serous chorioretinopathy: meta-analysis and review.

PURPOSE: To review and evaluate the effects of intravitreal bevacizumab injection (IVB) in centralserous chorioretinopathy (CSC) by meta-analysis. PATIENTS AND METHODS: Clinical controlled studies that evaluated the effect of IVB in CSC were identified through systematic searches of Embase, PubMed, and the Cochrane Central Register of Controlled Trials. Data on the best-corrected visual acuity (BCVA) in logMAR and central macular thickness (CMT) in µm at baseline and 6 months after IVB were extracted and compared with those treated by simple observation. RESULTS: Four clinical controlled studies were included in the meta-analysis. The IVB injection group achieved better BCVA at a follow-up of 6 months. However, the analysis showed that there were no significant differences of BCVA at 6 months after injection between IVB group and the observation group (-0.02 logMAR, 95% CI -0.14 to 0.11, P=0.80). The analysis of the reduction in CMT revealed that the difference between groups was not statistically significant (-8.37 µm, 95% CI -97.26 to 80.52, P=0.85). No report assessed severe complications or side effects of IVB in patients with CSC. CONCLUSIONS: Meta-analysis failed to verify the positive effect of IVB in CSC based on the epidemiological literature published to date.

A systematic mapping approach of 16q12.2/FTO and BMI in more than 20,000 African Americans narrows in on the underlying functional variation: results from the Population Architecture using Genomics and Epidemiology (PAGE) study.

Genetic variants in intron 1 of the fat mass- and obesity-associated (FTO) gene have been consistently associated with body mass index (BMI) in Europeans. However, follow-up studies in African Americans (AA) have shown no support for some of the most consistently BMI-associated FTO index single nucleotide polymorphisms (SNPs). This is most likely explained by different race-specific linkage disequilibrium (LD) patterns and lower correlation overall in AA, which provides the opportunity to fine-map this region and narrow in on the functional variant. To comprehensively explore the 16q12.2/FTO locus and to search for second independent signals in the broader region, we fine-mapped a 646-kb region, encompassing the large FTO gene and the flanking gene RPGRIP1L by investigating a total of 3,756 variants (1,529 genotyped and 2,227 imputed variants) in 20,488 AAs across five studies. We observed associations between BMI and variants in the known FTO intron 1 locus: the SNP with the most significant p-value, rs56137030 (8.3 × 10(-6)) had not been highlighted in previous studies. While rs56137030was correlated at r(2)>0.5 with 103 SNPs in Europeans (including the GWAS index SNPs), this number was reduced to 28 SNPs in AA. Among rs56137030 and the 28 correlated SNPs, six were located within candidate intronic regulatory elements, including rs1421085, for which we predicted allele-specific binding affinity for the transcription factor CUX1, which has recently been implicated in the regulation of FTO. We did not find strong evidence for a second independent signal in the broader region. In summary, this large fine-mapping study in AA has substantially reduced the number of common alleles that are likely to be functional candidates of the known FTO locus. Importantly our study demonstrated that comprehensive fine-mapping in AA provides a powerful approach to narrow in on the functional candidate(s) underlying the initial GWAS findings in European populations.

Blood pressure changes after intravitreal bevacizumab in patients grouped by ocular pathology.

PURPOSE: We evaluated the effects of intravitreal injection of bevacizumab (Avastin; Novartis, Basel, Switzerland) on blood pressure (BP) in the context of ocular vascular pathology. METHODS: This study retrospectively examined 135 consecutive patients treated with intravitreal injections of 1.25 mg bevacizumab for retinal vascular disease; there were 61 cases of diabetic retinopathy, 30 of retinal vein occlusion, 35 of choroidal neo-vascularization (CNV), and 9 of other retinal vascular diseases. BP was measured before injection and at 30 min, 1 day, 1 week, 3 weeks, and thereafter monthly over a 6-month period. RESULTS: In the CNV group, 30-min post-injection systolic values were significantly higher than baseline, and systolic and diastolic values after 1 day, 1 week, and 3 weeks were significantly lower than before injection. No other pressure measurement differed significantly from baseline values in the other groups. DISCUSSION: Intravitreal bevacizumab injection is safe in terms of its effect on BP, regardless of ocular pathology.

Comparison of the topographic ablation zone after photorefractive keratectomy for myopia using two different excimer lasers.

PURPOSE: To compare the topographic features of eyes treated with photorefractive keratectomy (PRK) for myopia using two different excimer lasers. METHODS: A total of 65 eyes in 39 patients treated with PRK (6.0-mm optical zone) using Technolas 217C and VISX S4 excimer lasers were evaluated retrospectively to determine the size of the topographic ablation zone. RESULTS: The zones ablated using the VISX S4 had shorter diameters in both axes (-0.89+/-0.73, -1.59+/-0.49 mm; both P=0.00), whereas those ablated using the Technolas 217C had a longer diameter in the major axis (0.96+/-0.63 mm; P=0.00) and a shorter diameter in the minor axis (-0.39+/-0.59 mm; P=0.00). The theoretical ablated zone was a circle with a diameter of 6.0 mm. The Technolas 217C group tended to have oval cuts in comparison with the VISX S4 group, and the difference between the programmed (6.0 mm) and topographic diameters was significant in both groups. CONCLUSIONS: There was a difference between the programmed and postoperative topographic diameters of the ablation zone. The postoperative ablation zone differed in shape and size according to the type of excimer laser.

The effects of Donepezil on traumatic brain injury acute rehabilitation outcomes.

PRIMARY OBJECTIVE: To evaluate the effects of administering Donepezil during inpatient rehabilitation for individuals with TBI. RESEARCH DESIGN: Retrospective, age and injury severity matched, mixed between-within subjects analysis. METHODS AND PROCEDURES: Thirty-six patients with moderate-to-severe TBI admitted to acute rehabilitation within 90 days of injury. Main outcome measures included FIM cognitive total scores and rehabilitation lengths of stay. INTERVENTION: Initiation of Donepezil administration beginning at 5 mg daily. Dose titration and continuation based on perceived clinical response. MAIN OUTCOMES AND RESULTS: No differences in cognitive improvement were observed between the Donepezil treatment group and the matched control group. Sub-set analyses suggested that administration of Donepezil early in the rehabilitation stay was significantly related to higher rates of cognitive improvement. CONCLUSIONS: Preliminary evidence suggests that Donepezil administration early in the rehabilitation stay may have advantageous treatment effects. A prospective, randomized, placebo-controlled clinical trial with standard timing, dosage and treatment duration is recommended to further evaluate treatment efficacy.

Moderate renal impairment and risk of dementia among older adults: the Cardiovascular Health Cognition Study.

Renal impairment is associated with an increased risk of carotid atherosclerosis and stroke, determinants of cognitive dysfunction and dementia. The purpose of this study was to determine whether moderate renal impairment is associated with incident dementia among community-dwelling older adults. Participants in the Cardiovascular Health Cognition Study without prevalent dementia (n = 3349) were included in the analysis. Incident dementia was confirmed through neurologic testing. Renal function at baseline was estimated by the inverse of serum creatinine (1/SCr); moderate renal impairment was defined as SCr > or = 1.3 mg/dl for women and > or = 1.5 mg/dl for men. Cox regression models were used to estimate the association of renal impairment with incident dementia. Because SCr is also a function of muscle mass, the authors determined whether the relationship between SCr and dementia was particularly strong among individuals without severe co-morbidity at baseline, as reflected by self-reported general health status. There were 477 incident dementia cases over a median 6 yr follow-up. After adjustment for potential confounders, moderate renal insufficiency was associated with a 37% increased risk of dementia (95% CI = 1.06 to 1.78). Similarly, a 0.5-unit decrement in 1/SCr (equivalent to an increase in SCr from 1.0 to 2.0 mg/dl) was associated with a 26% increased risk (95% CI = 1.02 to 1.60). These associations were present only among the 84% of older adults who reported good-excellent health. Among those in good-excellent health, higher SCr was associated with vascular-type dementia but not Alzheimer-type dementia. Moderate renal impairment, reflected by a higher SCr, is associated with an excess risk of incident dementia among individuals in good-excellent health. Strategies to prevent or delay the onset of dementia in patients with moderate renal impairment are needed.

A morphological study of drill holes applied with mitomycin-C in hydroxyapatite orbital implants.

For maximum motility of the prosthesis, the hydroxyapatite orbital implant should be drilled and coupled to the prosthesis via a motility peg. However, problems of peg extrusion have been reported to occur in 25-30% of cases. In this animal study, serial histopathological changes within the drill hole after hydroxyapatite implantation were observed and the effect of mitomycin-C (MMC) was evaluated as a new method of hole maintenance. A hole was drilled into each hydroxyapatite implant 20 weeks after enucleation and different concentrations of MMC solution were applied. The morphological changes of the holes were evaluated with proliferating cell nuclear antigen. In the control group (non-MMC-treated), all the motility pegs were extruded showing occluded holes. In the groups treated with 0.5 and 1.0 mg/ ml MMC, all the motility pegs were maintained in position with the holes at ample depth and width. However, toxicity, such as conjunctival ulcer and implant exposure around the hole, was observed in the 1.0 mg/ml MMC group. A 0.5 mg/ml MMC application for 5 min to the drill hole effectively reduced the risk of peg extrusion in this albino rabbit model.

Vastus medialis obliquus and vastus lateralis activity in open and closed kinetic chain exercises in patients with patellofemoral pain syndrome: an electromyographic study.

OBJECTIVES: To evaluate the electromyographic activities of vastus medialis obliquus (VMO) and vastus lateralis (VL) muscles in open and closed kinetic chain exercises in subjects with patellofemoral pain syndrome (PFPS). DESIGN: Case-controlled study. SETTING: Rehabilitation science center in a tertiary medical center. PARTICIPANTS: Ten patients with bilateral knee pain diagnosed with PFPS and 10 healthy volunteers. INTERVENTIONS: Subjects performed open kinetic chain exercise on an isokinetic dynamometer and closed kinetic chain exercise by squat-to-stand and stand-to-squat tasks. Surface electromyography was done for the VMO and VL muscles. MAIN OUTCOME MEASURES: VMO/VL ratios were calculated after normalization of muscle activities. RESULTS: The VMO/VL ratios of PFPS subjects were significantly lower than were those of unimpaired subjects during knee isokinetic closed kinetic chain exercises (p = .047). However, there was no statistical difference in VMO/VL ratio between subjects with and without PFPS during closed kinetic chain exercises (p = .623). Maximum VMO/VL ratio was obtained at 60 degrees knee flexion in closed kinetic chain exercise. CONCLUSION: In closed kinetic chain exercises, more selective VMO activation can be obtained at 60 degrees knee flexion. Maximal VMO/VL ratio was observed at this knee flexion angle, and muscle contraction intensity was also greatest.

Acquired pendular nystagmus with voluntary inhibition.

This report documents a case of voluntary inhibition of acquired pendular nystagmus after head trauma. A 30-year-old male developed oscillopsia and decreased visual acuity, as well as findings of acquired pendular nystagmus with voluntary inhibition after head trauma. The EOG finding was horizontal 18-20 Hz bilateral symmetrical pendular nystagmus in all directions of gaze at near and distant fixation. Nystagmus did not change with 14 Prism Diopter base-out prisms on both eyes, but it was possible to abolish it intentionally. Baclofen and Clonazepam had no effect in improving the patient's symptoms and EOG finding.

Effect of botulinum toxin A chemodenervation in sensory strabismus.

PURPOSE: To study the effect of botulinum toxin type A chemodenervation in sensory strabismus. METHODS: Twelve patients with sensory strabismus were treated with an injection of botulinum toxin type A (Botox; Allergan, Irvine, Calif). Botulinum toxin type A was diluted with 0.9% sodium chloride without preservative at a dose that ranged from 1.25-5 U. A Teflon-coated needle electrode was inserted into the medial rectus muscle in cases of esotropia and into the lateral rectus muscle in cases of exotropia. Four patients were treated with > or =2 injections of botulinum toxin type A. Changes in the angle of strabismus and related complications were followed for >6 months postinjection. RESULTS: The mean deviation before injection was 33.8 prism diopters (delta) and the mean corrective effect on the deviation was 72.8% after injection in patients with sensory strabismus. The final deviation in 9 patients was <10 delta. Complications were hypertropia in 3 (25%) patients and conjunctival hemorrhage in 1 (8.3%) patient. CONCLUSION: Botulinum toxin type A is likely to prevent muscle contracture and affect muscle and neuronal tissues. This study on the effects of sensory strabismus with botulinum toxin type A injection suggests it has the potential to replace surgery or be used as an adjuvant therapy.

Acinic cell carcinoma of the lacrimal gland with intracranial extension: a case report.

PURPOSE: To describe a patient with acinic cell carcinoma of the lacrimal gland presenting with atypical manifestations including erosion of the orbital roof and intracranial extension. We compare his clinical manifestations with two previously reported cases. METHODS: Case report. RESULTS: A 51-year-old man presented with a firm, tender, palpable mass in the superior temporal portion of his right orbit. CT scan demonstrated a large homogeneously enhancing mass displacing the globe inferiorly and eroding the roof of the orbit. MRI of the orbit showed intracranial extension of tumor. Biopsy revealed an acinic cell carcinoma of the lacrimal gland. CONCLUSIONS: Acinic cell carcinoma is a rare neoplasm occurring primarily in the major and minor salivary glands.

[Not Available]. / Shifting von Fusarienarten und ihren Toxinen in österreichischem Getreide.

Based on representative analyses of Austrian cereals, a distinct shift in the spectrum of Fusarium toxins and Fusarium species has been observed since the middle of the eighties.Although in the case of maizeF subglutinans - apart fromF graminearum - proved to be the most frequent and constant contaminant over the entire range of test series, there has been a shift in the spectrum of species which is not to be explained simply by seasonal variations or by the varying degree of occurrence of the European corn borer, which in Austria is considered to be the main vector for infections involving fusaria of the Liseola section. Compared to the results from earlier vegetation periods, the nineties brought a significant increase in the number of infections withF proliferatum, a fumonisin-producer. In all likelihood, this shift in the spectrum of species is due to the changed climatic conditions now prevailing in Austria - milder and more humid winters vs. drier and warmer summers - which favour the progress ofF proliferatum.The principal toxin-forming fungus on cereals in Austria isF graminearum. On maize, its respective populations are exclusively those which produce 15-acetyl-DON as a precursor to DON (deoxynivalenol). Whilst in the 1980s,F graminearum isolates from wheat yielded both 15-acetyl-DON and 3-acetyl-DON types, only 15-acetyl-DON populations could be detected in the last few years. One possible explanation for this phenomenon is the continual intensification of maize-wheat crop rotations. In the light of the above observations, the frequently used argument whereby EuropeanF graminearum isolates produce mainly 3-acetyl-DON and American strains prevalently 15-acetyl-DON will have to be reviewed.

Social motility in Myxococcus xanthus requires FrzS, a protein with an extensive coiled-coil domain.

Gliding motility in the developmental bacterium Myxococcus xanthus involves two genetically distinct motility systems, designated adventurous (A) and social (S). Directed motility responses, which facilitate both vegetative swarming and developmental aggregation, additionally require the 'frizzy' (Frz) signal transduction pathway. In this study, we have analysed a new gene (frzS), which is positioned upstream of the frzA-F operon. Insertion mutations in frzS caused both vegetative spreading and developmental defects, including 'frizzy' aggregates in the FB strain background. The 'frizzy' phenotype was previously considered to result only from defective directed motility responses. However, deletion of the frzS gene in an A-S+ motility background demonstrated that FrzS is a new component of the S-motility system, as the A-frzS double mutant was non-spreading (A-S-). Compared with known S-motility mutants, the frzS mutants appear similar to pilT mutants, in that both produce type IV pili, extracellular fibrils and lipopolysaccharide (LPS) O-antigen, and both agglutinate rapidly in a cohesion assay. The FrzS protein has an unusual domain composition for a bacterial protein. The N-terminal domain shows similarity to the receiver domains of the two-component response regulator proteins. The C-terminal domain is composed of up to 38 heptad repeats (a b c d e f g)38, in which residues at positions a and d are predominantly hydrophobic, whereas residues at positions e and g are predominantly charged. This periodic disposition of specific residues suggests that the domain forms a long coiled-coil structure, similar to those found in the alpha-fibrous proteins, such as myosin. Overexpression of this domain in Escherichia coli resulted in the formation of an unusual striated protein lattice that filled the cells. We speculate on the role that this novel protein could play in gliding motility.

Test-retest reliability of combined sensory index: implications for diagnosing carpal tunnel syndrome.

When compared to single nerve conduction tests, the combined sensory index (CSI) has been shown previously to have superior sensitivity and specificity for diagnosing carpal tunnel syndrome. The CSI is the sum of (1) median-ulnar ring finger antidromic latency difference at 14 cm (ring-diff); (2) median-radial thumb antidromic latency difference at 10 cm (thumb-diff); and (3) median-ulnar midpalmar orthodromic latency difference at 8 cm (palm-diff). To evaluate the reliability of single nerve conduction tests (ring-diff, thumb-diff, and palm-diff) vs. a combined summary variable (CSI), we conducted a prospective study during which the same investigator performed test and retest sessions on one hand of 32 subjects. Results showed that the CSI had the highest test-retest reliability (Spearman rho = 0.95), when compared with ring-diff, thumb-diff, and palm-diff (Spearman rho = 0.67, 0.75, and 0.74, respectively). Therefore, we propose the use of the CSI as not only an accurate but also a reliable method for diagnosing carpal tunnel syndrome.

Osseous metaplasia with functioning bone marrow in hydroxyapatite orbital implants.

BACKGROUND: Bone formation within the hydroxyapatite implant has been reported in explanted spheres in humans. Bone-specific differentiation was observed to occur earlier in the pores of spherical hydroxyapatite implants enhanced with osteogenin within the rabbit socket. We observed previously unreported bone marrow formation in a coralline hydroxyapatite implant placed into the rabbit orbit after evisceration. METHODS: One eye of each of 10 New Zealand white rabbits weighing between 2 and 3 kg was eviscerated and implanted with hydroxyapatite spheres. The explanted hydroxyapatite spheres 20 weeks after surgery were examined under the microscope. RESULTS: Histopathologic examination of the excised implants showed the presence of trabeculae of mature bone with fatty marrow and hematopoietic elements. Scattered throughout the fatty tissue were bone marrow elements consisting of precursors of the granulocytic and erythroid series and also megakaryocytes. CONCLUSION: The osseous metaplasia with functioning bone marrow was incidentally observed in the coralline hydroxyapatite implant without the addition of any osteogenesis-inducing agents.

Modified Kestenbaum surgery for correction of abnormal head posture in infantile nystagmus: outcome in 63 patients with graded augmentaton.

PURPOSE: To analyze the surgical effect of modified Kestenbaum surgery and show how to determine the amount of appropriate augmentation for correction of abnormal head posture in infantile nystagmus. METHODS: We reviewed the records of 63 patients with infantile nystagmus who required surgery for a significant face turn and who were followed for at least five months after surgery. Group 1, consisting of 29 patients, received Parks' modification of the standard Kestenbaum procedure (the 5-6-7-8 mm procedure); Group 2, 32 patients, received a 20% augmentation of the original Parks recommendation; and Group 3, 2 patients, received a 30% augmentation of the original Parks procedure. Pre-and postoperative measurements with electro-oculography (EOG) using Nicolet Compact Four/CA 2000 were made. RESULTS: The average preoperative face turn in the 63 patients with horizontal nystagmus was 31.9 degrees with an average postoperative face turn of 5.2 degrees. The average net change in face turn was 26.7 degrees. The average duration of time from surgery to final examination was thirteen months. Fifty-six out of 63 patients (89%) achieved a straight head position or a residual face turn of 10 degrees or less. CONCLUSION: A Parks' modified Kestenbaum procedure, with appropriate graded augmentation up to 30% is effective for the correction of abnormal head posture in infantile nystagmus without the need for larger augmentations.