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Biomedical subjects

A Sommer

Publications and source records attributed to A Sommer.

At least 253 records · Page 14Linked to original sources
PubMed1990

Assessment of vitamin A status by a disk applicator for conjunctival impression cytology.

Conjunctival impression cytology was performed on 236 Indonesian preschool children, half of whom had mild xerophthalmia and half of whom were age-matched controls. We devised an applicator that applies a paper disk of fixed area to the conjunctiva with even pressure. The disk applicator was used to collect impression cytology specimens from the temporal bulbar conjunctiva of one eye while the original strip technique was used on the other eye. Mean (+/- SD) serum retinol values for children with normal and abnormal discs were 22.0 +/- 8.6 micrograms/dL and 18.0 +/- 7.2 micrograms/dL P less than .0001). Mean serum values for normal and abnormal strips were 21.7 +/- 8.6 micrograms/dL and 19.0 +/- 7.7 micrograms/dL (P less than .03). Specimens obtained with the new disk applicator corresponded more closely with serum vitamin A levels and therefore vitamin A status than those obtained with the traditional strip technique.

Child↗
PubMed1990

Xerophthalmia, keratomalacia and nutritional blindness.

Vitamin A deficiency remains a major cause of pediatric ocular morbidity. Over five million children develop xerophthalmia annually, a quarter million or more becoming blind. It is also a major pathway for measles-associated blindness, particularly in Africa. Treatment is practical and inexpensive, based upon the oral administration of 200,000 IU vitamin A on two successive days, at a cost of 10 cents U.S. Given the potential rapidity of corneal necrosis (keratomalacia) and the relative inaccessibility of health services to those at greatest risk, prevention is probably more important than treatment. Oral administration of high dose supplements (2000,000 IU every 3 to 6 months), vitamin A fortification of commonly consumed items, or best of all, increased dietary intake of natural sources of vitamin A will reduce the number of needlessly blind young children. Given recent evidence that vitamin A deficiency greatly increases overall mortality, even among children without evidence of xerophthalmia, the same prophylactic regimen may improve child survival by 35% or more.

Blindness↗
PubMed1990

Developing specialty-wide standards of practice: the experience of ophthalmology.

In 1986, the American Academy of Ophthalmology (AAO) developed national guidelines for the diagnosis and treatment of major eye disease. A core committee of 10 AAO members detailed the framework and goals for the guidelines and wrote a series of broad criteria outlining the ophthalmologist's moral and ethical responsibilities. Several panels of AAO-physician experts were formed to develop guidelines for specific conditions. The panels were formed according to subspecialty and were assigned well-defined issues, such as the diagnosis and management of chronic, adult-onset open-angle glaucoma. Process and structure standards were developed first; outcome standards are scheduled for future development. The first five sets of practice guidelines have been approved by the AAO's Governing Council. These include standards for the comprehensive eye exam, as well as four disease-specific guidelines--open-angle glaucoma, glaucoma suspect, diabetic eye disease, and cataract.

Clinical Protocols↗
PubMed1990

Screening for glaucomatous visual field loss. The effect of patient reliability.

Eighty-eight glaucoma patients and 252 normal subjects underwent C-30-2 testing on the Humphrey Field Analyzer. The effect of fixation losses, high false-positive and false-negative response rates on visual field test results was assessed using the mirror image method of detecting asymmetry across the horizontal meridian, and the Humphrey STATPAC pattern standard deviation (PSD) and mean deviation (MD). Glaucoma patients with poor fixation (greater than or equal to 20%) had less depressed fields and fewer localized defects than those with good fixation. Fixation loss did not affect measures of localized defects or generalized depression among normal subjects. High false-positive rates (greater than or equal to 10%) were associated with less-depressed visual fields among glaucoma patients and normal subjects. Visual fields were depressed by an average of 9 dB for glaucoma patients and 7 dB for normal subjects with high false-negative rates (greater than or equal to 33%), when compared with those with low false-negative rates. Apparent localized defects were observed among normal subjects with high false-negative rates. Most of these defects were located in the superior nasal and adjacent arcuate area.

Fixation, Ocular↗
PubMed1990

Detecting and treating retinopathy in patients with type I diabetes mellitus. A health policy model.

Diabetic retinopathy is the major cause of new cases of blindness among working-age Americans. The authors analyzed the medical and economic implications of alternative screening strategies for detecting retinopathy in a diabetic population. The approaches compared included dilated fundus examination at 6-, 12-, and 24-month intervals with and without fundus photography. Potential savings from screening and treatment are based on amounts paid by the federal government for blindness-related disability. Screening for and treating retinopathy in patients with type I diabetes mellitus was cost-effective using all screening strategies. Between 71,474 and 85,315 person years of sight and 76,886 and 94,705 person years of reading vision can be saved for each annual cohort of patients with type I diabetes mellitus when proper laser photocoagulation is administered. This results in a cost savings of $62.1 to $108.6 million. Annual examination of all diabetic patients and semi-annual examination of those with retinopathy was more effective than annual examination with fundus photography. This screening strategy is consistent with the Preferred Practice Pattern for Diabetic Retinopathy of the American Academy of Ophthalmology.

Adolescent↗
PubMed1990

Tolerance of preschoolers to two dosage strengths of vitamin A preparation.

The tolerance to two alternative large-dosage strengths of vitamin A preparation was determined in a double-blind study involving 2471 children in two municipalities in the Philippines. Each child, aged 1-6 y, not suffering from active xerophthalmia or from nausea and/or vomiting, headache, diarrhea, and fever, was randomly given 1 mL of a syrupy suspension later identified to contain 0, 60, or 30 mg vitamin A. Clinical evaluation of subjects was done by physicians 24 h and 1 wk after dosing. Nausea and/or vomiting and headache were twice as common among children given 60 mg than those given 30 mg. Severe vomiting (1.2%) was confined to those given 60 mg. Almost all experienced their symptoms within 24 h after dosing; symptoms lasted for no more than 12-24 h. The incidence of diarrhea and fever for vitamin A recipients was not significantly different from that of those receiving placebo.

Aging↗
PubMed1990

[Anesthesiologic complications in risk patients during and following upper and lower abdominal interventions].

It was the aim of this study to determine intraoperative and postoperative complications following lower abdominal or upper abdominal surgical interventions both quantitatively and qualitatively using the risk classification of the Mannheim risk check list. The types of surgical interventions in the upper and lower abdomen can be considered as comparable in respect of influence exercised on the homeostasis. The case records of 386 patients were evaluated retrospectively who had been operated on at the biliary tract, stomach (upper abdomen) or sigma, rectum or ileocaecum (lower abdomen). Preceding diseases were noted and recorded, and so were intraoperative and postoperative complications up to the 4th postoperative week. Statistical testing was effected by means of the chi-square test with alpha = 0.05. In accordance with the determined risk classifications, the incidence of preceding diseases increased for both the types of surgery (cardiovascular diseases and pulmonary diseases being the preliminary diseases recorded in this context). If intraoperative and postoperative complications are broken down, there is a dominance of bronchopulmonary complications after upper abdominal surgery postoperatively, and an equal distribution of overall intraoperative complications. The data prove that in assessing the risk according to the Mannheim risk check list, laparotomies of the upper abdomen are underestimated, so that this type of surgery should rank higher in risk check list than large-scale laparotomies at the sigma and rectum. Over and above this, the enhanced pulmonary risk of upper abdominal surgery continuous to be a proven fact.

Aged↗
PubMed1990

Vision screening in a primary care setting. A missed opportunity?

To determine the effectiveness of vision screening in a primary care setting, we administered a questionnaire and a vision test to 458 patients from a general medical clinic. Subjects were referred for complete ophthalmologic evaluation if they failed the vision test or met other "high-risk" criteria based on information contained in the questionnaire. Patient-initiated requests for eye examinations were also honored. A total of 169 patients were scheduled for eye examinations, and 148 actually underwent ophthalmologic evaluation. One hundred one of those examined were referred on the basis of the study criteria. "Serious eye disease" (cataract, glaucoma, diabetic retinopathy, or age-related macular degeneration) was diagnosed in 96 (95%) of these patients. Prompt surgical intervention was recommended in 27 (27%), and medical treatment was begun in 21 (21%). Of those with serious eye disease, 59% met the criteria by failing the vision test, while 69% met the high-risk criteria determined by the questionnaire. Of the 148 subjects who received ophthalmologic evaluations, 47 requested them. Serious eye disease was diagnosed in 23 (50%) of the 47 patients. None of these individuals required immediate surgery, and medical treatment for glaucoma was begun in eight (17%). These data suggest that screening for serious eye disease in a primary care setting is an efficient mechanism to use for the identification of patients with undetected ocular disorders that require follow-up or treatment.

Aged↗
PubMed1990

Changing indications for cataract surgery: 1974 to 1988.

To examine changes in indications for cataract surgery which have contributed to the increasing rate of cataract extractions, we compared preoperative characteristics of 265 patients who had undergone surgery in 1988 with a similar number who had undergone surgery by the same four ophthalmologists in 1974 and 1982. Between 1974 and 1988 the number of extractions performed annually by two high-referral hospital-based surgeons rose by 68%. Over 90% of these procedures in 1974 were intracapsular extractions; in 1988, 90% were extracapsular extractions with intraocular lenses. In 1988, preoperative visual acuity was better in both the study eyes and the fellow eyes, the proportion of those with acuities better than 20/60 having risen from 10% to 21%, and from 49% to 67%, respectively. The proportion of patients waiting more than 2 years for surgery on the second eye doubled between 1974 and 1988. These changes, already evident by 1982 for the hospital-based surgeons, became characteristic of the community-based surgeons' practices as well between 1982 and 1988.

Adult↗
PubMed1989

An amino-terminally extended and post-translationally modified form of a 25kD basic fibroblast growth factor.

Basic fibroblast growth factor (bFGF) is a heparin-binding angiogenic polypeptide mitogen. bFGF proteins characteristically have a molecular weight of 18,000 which is consistent with the predicted primary translation product of 155 amino acids from the cDNA. More recently, higher molecular weight forms of bFGF have been identified but their structural relationship to the commonly known 18kD bFGFs has not been established. We now show that a 25kD bFGF purified from guinea pig brain tissue is an N-terminally extended and post-translationally modified form of the growth factor. Although the exact nature of the post-translational modifications has not been determined, circumstantial evidence suggests that they may be methylated arginines.

Amino Acid Sequence↗