DIAGNOSTICS AND TREATMENT OF PERFORATED PYLORODUODENUM ULCERS IN WOMEN.

The results of treatment of 75 women with perforated ulcers have been studied. There were prevailed women of middle and elderly age groups among patients who underwent surgery. A wound closure of perforated opening and abdominal sanation were performed by laparoscopic means in 30,7% of patients and using midline laparotomy in 29,3% cases. There were carried out the laparoscopic sanation of the abdominal cavity and the wound closure of perforated ulcer from mini-access using the set of mini-assistant in 10,7% patients. Radical operations were applied in 16% cases. The early postoperative complications took place in 8,1% of the patients, the rate of lethality was 4,0%. The long-term results were evaluated and considered as good in 55,5% women, satisfactory ­ in 30,1% and unsatisfactory ­ in 14,2% cases.

Effects of 5-(3,3-dimethyl-1-triazeno)imidazole-4-carboxamide, 1-(2-chloroethyl)-3-(4-methylcyclohexyl)-1-nitrosourea, and L-phenylalanine mustard on B16, Cloudman S91, and Harding-Passey mouse melanomas.

The effects of 5-(3,3-Dimethyl-1-triazeno)imidazole-4-carboxamide (DTIC), 1-(2-chloroethyl)-3-(4-methylcyclohexyl)-1-nitrosourea (MeCCNU), and L-phenylalanine mustard (L-PAM) have been compared by using three i.p. transplanted mouse melanomas: the B16 melanoma in C57BL/6 mice; the Harding-Passey (HP) malanoma in BALB/c X DBA/2F1 (hereafter called CD2F1) mice; and the Cloudman S91 melanoma in DBA/2 mice. HP melanoma responds well to all three drugs. S91 responds only to L-PAM and MeCCNU. DTIC may accelerate death in mice bearing this tumor. B16 responds well to L-PAM and moderately well to MeCCNU and to multiple injections of DTIC. The best response to DTIC and MeCCNU is given by HP, while the best response to L-PAM is given by S91. Tumor cell-doubling times were found to be 1.5 days for B16, 2 DAYS FOR HP, and 3 days for S91. HP would seem to be the most responsive malanmoma with respect to the 3 agents studied. This may be due to an interaction between the chemotherapeutic agents and the host immune response, since the HP tumor arose in a noninbred mouse and is thus nonsyngeneic with the CD2F1 host. All three tumors appear to be interesting biological models for studying drug combinations and combined therapeutic modalities against melanoma.

Complement activation by nylon- and polypropylene-looped prosthetic intraocular lenses.

Uncomplicated placement of an intraocular lens at the time of routine cataract extraction is associated with a greater inflammatory response than simple lens extraction. We have shown that certain components of prosthetic intraocular lenses are capable of activating the complement system in human serum in such a fashion as to generate peptides capable of mediating acute inflammatory reactions. Normal human serum was incubated with intraocular lenses in vitro and then examined for cleavage products of C3 and C5 and for C5-derived chemotactic activity for human polymorphonuclear leukocytes. Polymethylmethacrylate lenses with nylon and polypropylene loops were found to be capable of causing cleavage of C3 (detected by crossed immunoelectrophoresis) and C5 (detected by single-dimension radioimmunoelectrophoresis) as well as generation of C5-derived chemotactic activity in human serum. Serum incubated with polymethylmethacrylate lenses without loop supports exhibited no such activity. Results of our studies indicate that certain nylon- and polypropylene-looped intraocular lenses are not "inert" biologically and may elicit acute inflammatory reactions.

Chemical effects of alkali on polymethylmethacrylate intraocular lenses.

Polymethylmethacrylate intraocular lenses were left in 10% NaOH or 10% KOH for various periods of time. Contact angles were unaltered and electron spectroscopy for chemical analysis was unchanged. This concentration of alkali does not appear to chemically change the lens surface during the study period.

A new model to assess staphylococcal adhesion to intraocular lenses under in vitro flow conditions.

Adhesion of staphylococcal cells to intraocular lenses coated with heparin was studied under in vitro flow conditions (280 microl min(-1)) at 37 degrees C. The intraocular lenses were incubated with human cerebrospinal fluid for 1 h or with cerebrospinal fluid including 0.50% plasma for 12 h, prior to bacterial challenge. Two strains of Staphylococcus epidermidis selected for this study, were isolated from biomaterial-associated infections. Bacterial adhesion was quantitated by bioluminescence and visualized by fluorescence microscopy of acridine orange stained bacteria. Surface coating with heparin significantly decreased bacterial adhesion of both strains after incubation with cerebrospinal fluid including 0.50% plasma for 12 h (p = 0.0209). However, no difference in bacterial adhesion was obtained between intraocular lenses with and without heparin, after incubation with cerebrospinal fluid for 1 h (p = 0.327). Microscopy showed that more bacteria were present on intraocular lenses without heparin than on intraocular lenses with heparin. The results show that preincubation with a proteinaceous fluid influences subsequent bacterial adhesion to the polymer surface. The results suggest that IOLs with heparin coating may be less prone to bacterial adhesion under perfusion conditions after surface conditioning in human CSF with 0.50% plasma and a preincubation period of 12 h. Heparin coating might be a valuable tool to decrease implant-associated bacterial endophthalmitis.

Methylmethacrylate monomer in intraocular lenses of polymethylmethacrylate. Cellular toxicity.

Tissue cultures of secondary rabbit kidney cells were grown in maintenance medium containing varying concentrations of methylmethacrylate monomer from 5% to 0.05%. No pathologic changes were observed in those tissue cultures containing 0.1% or less monomer as compared to controls. Data from previous studies on the rate of elution of monomer from polymethylmethacrylate and from published studies of aqueous humor dynamics indicate that the monomer level in intraocular lenses will be less than the concentration toxic to living cells in tissue culture.

A model for steroid effects in herpes keratitis.

Dextran-Blue 2000 was used as a marker to determine the effect of steroids on large molecule transfer through the cornea. In superficially scarified corneas topically applied steroids greatly enhanced the transfer of this chromophore through the cornea in the in vivo state, but had little effect in vitro. This implies that the steroid effect is an active process. Since herpes simplex virus is approximately the same molecular weight and configuration as the chromophore used, this study explains one aspect of how steroids may be detrimental when used in the presence of this virus.

Longterm timolol therapy.

Of 145 patients registered for an investigation of timolol, 27 patients were dropped for unrelated reasons. Among the remaining 118 patients (212 eyes), a significant reduction in intraocular pressure resulted from twice-a-day topical instillation of 0.25 or 0.5% timolol to ocular hypertensives, primary open-angle glaucoma or aphakic glaucoma patients. Outflow facility improved only slightly, but remained improved throughout the course of this study. A significant reduction in aqueous secretion, however, was the predominant cause of intraocular pressure reduction. Timolol alone controlled intraocular pressure in 87% of ocular hypertensives, in 68% of patients with chronic open-angle glaucoma and in 68% of patients with angle-unobstructed aphakic glaucomas. The addition of epinephrine brought the intraocular pressure to less than 22 mm Hg in 85% of the total group of patients.

Stereoscopic acuity measurement in aphakia.

We performed a variety of tests to assess binocular function on monocular aphakic patients wearing contact lenses, monocular pseudophakic patients, bilateral spectacle-wearing aphakic patients, bilateral aphakic contact lens wearers, and bilateral pseudophakic patients. Stereoscopic acuity levels at distance and near when visual acuity was at least 6/12 (20/40) provided the most useful data. Pseudophakic patients and contact lens wearers performed equally well and outperformed spectacle wearers. Implant patients did not have superior stereoscopic acuity.

Sodium hydroxide sterilzation of intraocular lenses.

Intraocular lenses of polymethylmethacrylate contaminated with various inocula of bacteria, spores, and fungi were sterilized by modifications of the Ridley method using sodium hydroxide. Positive cultures were obtained from iris-supported lenses contaminated with concentrations of approximately 1 x 10(6) organisms per milliliter after one hour in 10% NaOH. No positive cultures were obtained when lenses remained in 10% NaOH for three hours, a time corresponding to a 1 x 10(-6) probability of surviving organism. The NaOH method, when appropriately used, is an effective sterilization process for intraocular lenses.

The effects of timolol on cataract extraction and intraocular pressure.

We studied the effect of timolol on post-operative intraocular pressures (IOPs) in a control and experimental group of 30 eyes, each in patients who had uncomplicated intracapsular cataract extractions, most with iris clip lenses. Closure of the eye in each case was with three 6-0 silk sutures preplaced in a morticed incision. Six control eyes had IOP increases of 6 mm Hg or more within 24 hours of surgery. One patient treated with timolol had an IOP increase of 6 mm Hg or more. The differences in IOP between the control and experimental groups were statistically significant at the .01 level. The pressure lowering ability of timolol appears to be prophylactic as well as therapeutic. It is well suited for pseudophakic eyes as pressure reduction is not associated with pupillary alterations.

Argon laser photocoagulation of the posterior segment in pseudophakia.

A series of in vitro, in vivo, and clinical studies was performed to explore the safety and efficacy of argon laser and xenon arc photocoagulation in pseudophakia. The polymethylmethacrylate intracameral lens (Fyodorov) proved resistant to photothermal decomposition and allowed transmission of therapeutically effective energy levels to the retina. The argon laser delivered through a slit lamp and contact lens optical system appears to be the preferred method for posterior segment photocoagulation in pseudophakia. On the basis of five-day tissue culture studies and clinical experience of two years, the intracameral lens does not appear to be a toxic or transmission barrier to careful argon laser photocoagulation.

Surgical repair of leaking blebs.

To repair a ruptured filtering bleb, we used the conjunctiva alone, or combined with its undissected Tenon's fascia, to cover the sclerostomy site. We used mattress sutures to thread the new flap into a vertical corneal groove anterior to the sclerostomy, creating a firm, nonretracting but still sufficiently "porous" cover that maintained filtration and resisted infection and perforation. Seven of eight cases of ruptured filtering blebs have been successfully repaired in this manner with the maintenance of adequate filtration.

Surgical landmarks in trabecular surgery.

Clinical and histologic studies in 40 eyes of 35 patients with chronic open-angle glaucoma or chronic angle-closure glaucoma operated by various types of "trabeculectomies" were assessed to evaluate whether success was correlated with the surgical approach or with the presence of trabecular tissue in the pathologic specimen. It was clearly demonstrated that it is not necessary to localize or enter Schlemm's canal in order to perform successful trabeculectomies; it is not necessary to operate posterior to the scleral spur; and it is not necessary to excise either Schlemm's canal or trabecular tissue to achieve success. In essence, trabeculectomies primarily function as fistulizing operations carried out under scleral flaps substituting a scleral-conjunctival barrier to aqueous flow rather than the conjunctival barrier alone provided by standard glaucoma operations. This greater obstruction explains the absence of shallow chambers, the reduced incidence of polycystic bleb formation and, perhaps, an avoidance of long-term complications that often result from these two factors.

Tissue culture methods for testing the toxicity of ocular plastic materials.

A screening method using tissue culture techniques determined inertness of ocular alloplastics. Secondary rabbit kidney cells revealed the presence of toxic constituents by absence of growth or cytopathic changes, or both. The optical portions of the lenses studied were nontoxic, whereas the polyamide loops of one lens were toxic. A keratoprosthesis that had been in situ in a patient for two years was highly toxic in culture. A neutralized agar overlay technique was not sufficiently sensitive to screen anterior chamber implants. The tissue culture technique, in combination with chemical, optical, and animal experimentation, may be helpful in determining which implant systems are most suitable for in vivo use.

Detection, removal, and effect of unpolymerized methylmethacrylate in intraocular lenses.

Gas-liquid chromatography, infrared spectroscopy, or Raman spectroscopy were used to determine the level of monomer in intraocular lenses and in the preforms used in each step of the manufacturing process. Heating, lathing, molding, and grinding caused an increase in monomer content, presumably the result of depolymerization. The tendency of methylmethacrylate to volatilize, repolymerize, or dissolve precludes high monomer contents from persisting in intraocular lenses. Vacuum ovens or water baths significantly reduced the monomer content to levels of 0.5% or less. Lenses with a monomer content higher than that found in currently available commercial lenses had no effect on rabbit kidney cell cultures. Lens fragments with a similarly elevated monomer content were indistinguishable from lenses with a low monomer content in rabbit eyes. According to these data, monomer does not appear to be a toxic agent in currently available intraocular lenses.

Retinal detachment in pseudophakia.

In a series of cataract patients excluding myopic individuals, under age 60 years, and cases in which vitreous loss occurred, retinal detachment was no less frequent after intracapsular cataract extraction and Sputnik iris supported lenses than in controls. Both groups were followed up for a minimum of two years. The detachments predominantly occurred from retinal breaks in areas of the retina that looked normal preoperatively.

Cataract extraction in glaucoma.

Cyclodialysis lens extraction or cyclodialysis canalicular trabeculectomy lens extraction in one eye and cataract extraction in the fellow eye were performed in 24 glaucoma patients. The combined procedure follow-up was from five to 12 years in the first group, two to four years in the second group, and from three to ten years in the control group. The 50% success rate of cyclodialysis lens extraction can be enhanced with no significant increase in surgical morbidity or postoperative complications by performing a cyclodialysis canalicular trabeculectomy where the disinsertion of the scleral spur is carried out under direct visualization.

Time analysis of corneal endothelial cell density after cataract extraction.

Serial endothelial photographs were taken preoperatively and postoperatively in 200 eyes; 111 eyes contained a Rayner iris clip lens, 54 eyes contained a Fyodorov Sputnik lens, and 35 eyes had no lens. Central endothelial cell density was changed in all instances, with counts in implanted eyes declining 25 to 30%, and in nonimplanted eyes 10 to 15%. In both instances, the decline essentially ceased at about three months. The cause of the greater decline in implanted eyes appeared to be mechanical and subsequent cell loss after the 90-day period was virtually equal for the two groups. Methods that may be used to alter the difference in cell density occurring with implantation are best analyzed by using the 90-day period data for comparison.

Levobunolol vs timolol for open-angle glaucoma and ocular hypertension.

A group of 162 patients with chronic open-angle glaucoma or ocular hypertension were treated twice daily for up to 15 months with one of the following topical ophthalmic solutions: 0.5% levobunolol, 1% levobunolol, or 0.5% timolol. Overall mean reductions in intraocular pressure were 8 mm Hg for patients receiving 0.5% levobunolol or timolol and 8.2 mm Hg for patients receiving 1% levobunolol. There were no significant differences between levobunolol and timolol in mean reductions in intraocular pressure, percent of patients with adequately controlled intraocular pressure, or life-table estimates of the probability of successful treatment.