Dark adaptation and visual pigment regeneration in human cones.

Foveal threshold elevation and red-green cone pigment regeneration have been studied in the dark after a wide range of bleaches in normal man with a view to probing the limits of the application of the Dowling-Rushton relation: i.e., the direct proportionality between log threshold elevation and fraction of unregenerated pigment. Cone pigment regeneration (and threshold recovery) is much faster after short bleaches than expected from the kinetics of a simple monomolecular reaction. Recovery is faster after a fixed (short) duration bleach the weaker it is. Except for the first 30 s after relatively weak bleaches and the entire recovery after a very brief (<0.001 s) saturating bright flash which bleaches a little more than 50%, the results are accurately fit by the Dowling-Rushton relation over the entire range tested with only one arbitrary constant (the proportionality factor). Theory predicts too low threshold in comparison with what is obtained, for both of these exceptions

The blue arcs of the retina.

Around a dim light viewed in a dark room can be seen faint blue-gray arcs which occupy that part of the visual field corresponding to the retina where the arcuate nerve fiber bundle passes from macular ganglion cell bodies to the optic nerve. These blue arcs of the retina are an entoptic phenomenon in which action potentials of the arcuate nerve fiber bundle presumably excite adjacent neurons. The experiments here described show that the light stimulus initially evoking the blue arcs excites cones and not rods as has been generally believed until now. Another commonly held idea is that the blue arcs are produced by bioluminescence or fluorescence associated with the action potentials in the arcuate nerve fiber bundle. The experiments described here disprove this hypothesis.

The luminosity curve of the protanomalous fovea.

Threshold spectral sensitivities (in the dark, or against bright colored backgrounds) are identical in the red-green range for both protanopes (dichromats) and protanomalous trichromatic color defectives. The latter, however, must have an additional photolabile cone pigment in the red-green range, and its presence is revealed by heterochromatic brightness matching through the spectrum (i.e. luminosity curves). The absorption spectrum of the anomalous cone pigment can be inferred from the protanomalous and protanopic luminosity curve, given reasonable assumptions as to how the different cone mechanisms pool their responses. Depending upon these assumptions, the pigment inferred is either (a) dilute solution of the normal red pigment (assumed density 1.0 for the deuteranope) or (b) similar in its absorption spectrum to the normal green pigment but shifted slightly toward the long wave end of the spectrum. Experimental attempts to choose between these alternatives have so far proved equivocal though (b) seems more likely on the basis of indirect evidence.

The luminosity curve of the deuteranomalous fovea.

Analogous to protans, the two types of deutan color-defectives-the dichromats (deuteranopes) and the anomalous trichromats (deuteranomalous)-do not differ in spectral sensitivity in the red-green range at threshold (either in the dark or against bright colored backgrounds). However, luminosity curves obtained by heterochromatic brightness matching show the latter to be slightly more sensitive in the blue-green, and slightly less so in the red, than the former. Experiment proves that these differences are due (at least in part) to contributions of cones containing the deuteranomalous anomalous pigment which are missing from the deuteranope's eye. The absorption spectrum of the anomalous pigment can be inferred with assumptions (analogous to those already made with protanomalous trichromats) about how the different cone mechanisms pool their responses to yield luminosity. Two alternatives thus revealed are (a) the normal red pigment in dilute solution or (b) a spectrum very similar to that of the normal red pigment but shifted slightly toward the short wave end of the spectrum. Since the spectrum inferred by (a) has the same lambda(max) as the normal red pigment, (a) predicts that deuteranomalous observers will require a negative red primary when matching monochromatic lights of wavelengths near the lambda(max). This is not observed.

Elevated risk of anaphylactoid reaction from radiographic contrast media is associated with both beta-blocker exposure and cardiovascular disorders.

BACKGROUND: A case-control study, with both retrospective and concurrent subject selection, was performed (1) to determine whether greater risk for anaphylactoid reaction from contrast media associated with beta-blocker exposure reflects presence, or is independent of underlying cardiovascular disorder; and (2) to characterize further the risk of anaphylactoid reaction from contrast media in patients with cardiovascular disorders and patients with asthma. METHODS: Adverse reactions from intravenous contrast media were recorded in accordance with quality assurance guidelines. Anaphylactoid reactions were classified as mild to moderate (urticaria/angioedema), severe (stridor, bronchospasm, or hypotension), or major and life-threatening (hypotension with or without the need for subsequent hospitalization). Medical records from reactors were compared with those from matched (gender, age, date, and type of contrast study) controls who received conventional contrast media without adverse reaction. RESULTS: Of 34,371 intravenous contrast media procedures performed, 122 anaphylactoid reactions were recorded. The risk of anaphylactoid reaction was significantly associated with asthma (odds ratio [OR], 8.74; 95% confidence interval [CI], 2.36 to 32.35; P = .0012). The risk of bronchospasm was associated with beta-blocker exposure (OR, 3.73; 95% CI, 1.18 to 11.75; P = .025) and with asthma (OR, 16.39; 95% CI, 4.30 to 62.46; P = .0001). The risk of major and life-threatening reaction was associated with the presence of cardiovascular disorder (OR, 7.71; 95% CI, 1.04 to 57.23; P = .046). Among patients with severe reactions, the risk of hospitalization was elevated by the presence of cardiovascular disorder (P = .001), exposure to beta-blockers (OR, 7.67; 95% CI, 1.79 to 32.85; P = .029), or asthma (OR, 20.7; 95% CI, 1.21 to 355.55; P = .065). Although beta-blocker exposure and the presence of cardiovascular disorder were highly associated (chi 2 = 49, P < .001), a greater risk of bronchospasm with severe reaction was observed in nonasthmatic patients with cardiovascular disorders receiving beta-blockers (OR, 15.75; P = .023). Among reactors with asthma, receiving beta-blockers, or with a cardiovascular disorder, 60.8% (31/51) experienced severe anaphylactoid reactions, compared with 35.2% (25/71) of patients without these risk factors (OR, 3.62; P = .005). CONCLUSIONS: beta-Blocker exposure and cardiovascular disorder are both statistically significant risk factors for severe anaphylactoid reaction from contrast media. Thus, patients receiving beta-adrenergic blockers and patients with asthma, on the basis of greater risk for bronchospasm, and patients with cardiovascular disorders, on the basis of elevated risk of major and life-threatening reaction, are appropriate target populations for risk reduction measures before receiving intravenous infusion of contrast media.

Visual pigment kinetics in abnormalities of the uvea-retinal epithelium interface in man.

In four patients with abnormalities of the interface between photoreceptors and their vascular supply, bleached visual pigments regenerated abnormally slowly, with double exponential time courses, although the time constant of the first exponential was abnormally fast. During therapy in one patient the slower exponential returned to normal early after treatment, whereas the fast component persisted even after clinically complete recovery. The results could be explained by the following hypothesis. In normal eyes, two pigment-regeneration routes exist, the more rapid (which depends on a short-lived intermediate) playing no role after a long full bleach. Uvea abnormalities cause slower regeneration in the normal main route and slower breakdown of the normally short-lived intermediate.

Can computed tomography of the chest stage lung cancer? Yes and no.

To determine the accuracy of computed tomography (CT) of the chest in the staging of lung cancer, we studied 418 patients with primary pulmonary carcinoma between 1979 and 1986. Each had a preoperative scan performed before detailed operative staging. Each CT scan was analyzed for components of the current TNM staging system. Computed tomography sensitivity and specificity for mediastinal lymph node metastasis were 84.4% and 84.1%, with corresponding positive and negative predictive accuracies of 68.7% and 92.9%, respectively. When TNM stages were derived from CT scans, only 190 of 418 (45.4%) completely agreed with operative staging. An additional 53 of 418 (12.7%) predicted the correct stage, although components of the TNM system were incorrect. In 94 of 418 scans (22.5%) CT overestimated the stage, whereas in 81 (19.4%) CT downgraded the stage. Computed tomography suggested metastatic lesions in liver, lung, adrenal gland, bone, or abdominal lymph nodes in 40 of 373 scans (10.7%); only five of 40 (12.5%) had documented metastasis. In summary, CT of the chest cannot accurately stage primary lung carcinoma according to the TNM classification. Because the negative predictive accuracy for mediastinal lymph node metastasis remains high (92.9%), invasive staging can be deferred for definitive thoracotomy when no lymphadenopathy is evident on CT. The high negative predictive accuracy for scans of the chest and upper abdomen makes CT a useful tool for exclusion of metastatic disease.

A note on the action spectrum of human rod vision.

A template representing the spectral distribution of the absorption coefficients of human rhodopsin was fitted to each of 59 individual action spectra of human rod vision (from one of three populations) by an optimization routine. Curve-fitting parameters included peak wavenumber, optical density at this wavenumber and (for those from the population neither aphakic nor constrained to ages where the standard lens transmissivity curve is supposed valid), density of the latter at the wavenumber of peak lens absorption. The average peak wavenumber of each population differed significantly from that of the other two. Either the standard curve of lens absorption (even with peak lens density as a curve-fitting parameter) is inappropriate for correcting the normal spectrum or the rhodopsins in the retinas of these populations do not all have identical wave-numbers of peak absorbance.

In search of the elusive long-wave fundamental.

Action spectra for threshold detection of flicker (30 Hz) were obtained on 11 deuteranopes under carefully controlled adaptation conditions. Individual differences were large, so that each one of the long-wave fundamentals proposed by different theorists finds reasonable justification in the spectrum measured on at least one deuteranope. Some deuteranopes' spectra are not described by any one of these "fundamentals". To a first approximation at least, trichromats' spectra show the property of linear additivity. One such trichromat's spectrum agreed well with that of a deuteranope with whom he shares a common erythrolabe, and appears to be uninfluenced by his chlorolabe-filled cones.

Do deviations from radiance-invariance of metameric matches contradict the three pigment theory of foveal trichromacy?

According to the pigment theory of matching, metameric matches result from the equation of the rates of photoisomerizations for each of the three classes of cone pigments excited by the two matched fields. If true, matches are radiance-invariant and additive. Tests of the theory in this paper show small but ubiquitous failures in radiance-invariance due to systematic rather than random errors in matching. A choice between two possible explanations for these systematic errors favors the view that in subjects who deliberately or intuitively search for the middle of the matching range, the errors are due to an asymmetry in the Weber fraction for color (Trezona) at low (but not high) levels of retinal illuminance.

The change in color matches with retinal angle of incidence of the colorimeter beams.

Differences between W.D.W. chromaticities of monochromatic lights obtained with all colorimeter beams incident on the retina "off-axis" and those found for lights striking the retina normally have been studied throughout the visible spectrum on 4 normal trichromats. The results are inconsistent with: (i) the assumption in Weale's theories of the Stiles-Crawford hue shift that the sets of absorption spectra of the visual pigments catching normally and obliquely incident photons are identical, and (ii) "self-screening" explanations for the change in color with angle of incidence on the retina. The color matching functions of a protanomalous trichromat are inconsistent with the hypothesis that the absorption spectra of the visual pigments catching normally incident photons in his retina are those catching obliquely incident photons in the normal retina.

"Self-screening" of rhodopsin in rod outer segments.

Microspectrophotometry (MSP) shows rhodopsin highly concentrated (about 3.0 mmol/l) in rod outer segments (ROS). Calculation of the in vivo absorption spectrum of human rhodopsin from such data reveals a striking failure to agree with the action spectrum of human rod vision. Agreement is good between the spectral distribution of absorption coefficients and the action spectrum, but the "concentration-broadening" (or "self-screening") introduced by the high end on absorbance at this concentration results in a misfit among the largest in the 93 years comparisons of this kind have been made! To deal with this anomaly, it has been suggested that "concentration-broadening" is inappropriate for rhodopsin in rod vision. This proposal was tested by comparing rod action spectra of 15-day-old and adult rats, since the lengths of ROS increase by a factor of about two in maturation. Three lines of evidence are inconsistent with it. Although the conundrum remains unexplained, it cannot be dismissed by supposing "self-screening" inappropriate for night vision.

Case report: CT of a duodenal paraganglioma.

Paraganglioma is a neoplasm of neuroectodermal origin that occurs rarely in the bowel. This case report illustrates the previously undescribed CT appearance of a duodenal paraganglioma. An intensely enhancing mass in the region of the pancreatic head was found. The intense enhancement ruled out adenocarcinoma and focal pancreatitis. An islet cell tumor of the pancreas was the major differential diagnostic consideration.

TMJ biocompatible orthodontic treatment.

The papers summarized here indicate that TMJ dysfunction remains a complicated problem, requiring a multidisciplinary team approach. Psychological stress is an important factor in diagnosis. New concepts of joint function must be considered. The functional anatomy of the TMJ from an arthroscopic perspective should be studied. New treatment methods, such as the polycentric hinge joint articulator, should be considered. And finally, orthodontic diagnosis and treatment conventions need to be modified, from obtaining a complete history, clinical examination, arriving at a diagnosis and obtaining informed consent for treatment that may include psychological counseling, splint therapy, simultaneous fixed orthodontics and splint therapy and possible TMJ arthroscopic surgery for nearly all orthodontic patients.

Analysis of panoramic cephalometrics using s skeletal cephalostat.

A panoramic head positioning device, the S.C., was tested for magnification production of radiographs and for repositioning. Ten skeletal Class I dentulous skulls with uniform metal markers were examined. The purpose was to see if a skeletal analysis could be obtained from panoramic radiographs. Basal skeletal magnification varied anatomically both vertically and horizontally, but the magnification percentages and their ranges, for the most part, were calculable. The few exceptions were believed due to lack of proper alignment of the S.C. and the General Electric Panelipse. Proper alignment could also correct the right to left asymmetrical magnification differences. Means and standard errors from 290 skeletal measurements were calculated and could serve as standards for skeletal analysis using panoramic cephalometrics.

Clinical radiography in the orthodontic practice.

One practitioner's approach to minimizing patient exposure in diagnostic x-ray procedures in an individual orthodontic practice.

Rapid palatal expansion in adults with and without surgery.

A cemented palatal expansion appliance with a bite plane is used successfully in adults up to 43 years of age, augmented with lateral maxillary osteotomy in the older ages range.

TMJ diagnosis and treatment in a multidisciplinary environment--a follow-up study.

New modalities--TMJ direct parasagittal CT and MRI scans and arthroscopic visualization and surgery--along with psychological and other health professional support, are changing the approach to clinical orthodontic practice. This report presents an update on clinical experience over a period of time, with emphasis on orthodontics, psychology, and arthroscopic surgery.

Corrected parasagittal direct CT imaging of the temporomandibular joint. With arthroscopic correlation.

Direct CT studies of the temporomandibular joints, using axial, coronal, and condylar axis corrections for parasagittal views perpendicular to the long axis of the condyle head to provide detailed CT examination of the bony structures and associated soft tissues. Images of selected patients are correlated with arthroscopic evaluation and treatment, yielding a unique perspective for evaluation of the imaging method and the joint itself. Based on these findings, a hypothetical mechanism of TMJ derangement is proposed.

Direct parasagittal computed tomography and arthroscopic surgery of the temporomandibular joint.

An overview of an interdisciplinary approach to TMJ problems, with preliminary findings on the application of CT scanning and arthroscopic surgery in cases that do not respond to conservative therapy.