Pocket power.
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Computer Communication Networks↗
Biomedical subjects
M O'Keefe
Publications and source records attributed to M O'Keefe.
Cyclocreatine inhibits stimulated motility in tumor cells possessing creatine kinase.
Cyclocreatine (1-carboxymethyl-2-iminoimidazolidine), an analog of creatine and a substrate for creatine kinase (EC 2.7.3.2), inhibits the stimulated motility of tumor cells which possess creatine kinase. A2058-055 human melanoma cells, transfected with a creatine kinase gene, showed an 80-90% reduction in chemotactic response to type IV collagen when incubated overnight in the presence of 10 mM cyclocreatine (p < 0.0001 for n = 8 experiments). This inhibitory effect of cyclocreatine can be partially reversed by addition of creatine to the overnight cell treatment. Non-transfected cells, with very low levels of creatine kinase, were not significantly inhibited. Further experiments utilizing type IV collagen as attractant demonstrated that cyclocreatine inhibited the chemokinetic (91%) and the haptotactic (73%) responses and the in vitro invasion of A2058-055 cells through Matrigel-coated membranes (88%). In addition, motility stimulation of A2058-055 cells by either autotaxin or fibronectin was markedly inhibited by cyclocreatine. DU-145 prostatic tumor cells, which express endogenous creatine kinase, also have a reduced motility response to either autotaxin or epidermal growth factor induced motility in the presence of cyclocreatine.
Antineoplastic Agents↗
Assisted suicide. Bitter ends in Oregon?
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Drug Costs↗
Posttraumatic stress disorder among incarcerated battered women: a comparison of battered women who killed their abusers and those incarcerated for other offenses.
The present study examined differences in the amount and severity of spousal violence and posttraumatic stress symptoms between incarcerated battered women who killed/seriously assaulted their abusers and battered women incarcerated for other offenses. Additionally, several risk and buffering variables suggested by trauma research were tested to determine their ability to predict present posttraumatic stress disorder (PTSD) symptomatology. Findings revealed that battered women who killed/seriously assaulted their batterers experienced more frequent and severe spousal abuse than those in the comparison group. No significant group differences were found for present PTSD symptom levels. Predictors of present PTSD symptomatology included: childhood sexual abuse, childhood physical abuse, past PTSD symptomatology, length of time elapsed since living with partner and receiving counseling in prison. The implications of the findings are discussed.
Adult↗
Congenital ptosis: longterm results using stored fascia lata.
PURPOSE: Frontalis brow suspension, using stored donor fascia lata, allows early correction of severe congenital ptosis. We report longterm results of 18 patients, (29 ptotic eyelids). METHODS: Patient records were retrospectively reviewed. Lid position at the first and subsequent post-operative visits was recorded, as was the time when ptosis recurred. RESULTS: The mean follow-up period was 42.9 months (range 7 to 84 months). All patients achieved a Good initial result. Partial ptosis recurrence was noted in 7 patients (10 eyelids), within 18 months of surgery. One of these patients required reoperation. Lid position did not change after the first 18 months. No late failures were encountered. CONCLUSION: Longterm lid position is remarkably stable after early surgical correction of severe congenital ptosis using stored fascia lata.
Blepharoptosis↗
Ophthalmic abnormalities in homocystinuria: the value of screening.
PURPOSE: Homocystinuria, a genetic metabolic abnormality, eventually causes a variety of ocular and other pathologies if not treated. To evaluate the results of screening newborns for homocystinuria, we compared ophthalmic outcomes for two groups of homocystinuria patients who had been diagnosed either at birth or later than 6 weeks. METHODS AND RESULTS: Nineteen patients had been screened and diagnosed shortly after birth, with treatment instigated before 6 weeks of age (mean follow-up and age 10.8 years; median 11 years). Eight of 17 were myopic; 13 of 15 had good vision in both eyes; one had lens subluxation. The second group of 17 patients were diagnosed later than 6 weeks, often (12 patients) because of ocular problems (mean follow-up 8.3 years; mean age 19.4 years; median age 16 years). Visual function varied from 6/6 (4 patients) to less than 6/36 (4 patients); 3 eyes had no perception of light. Thirteen patients had lens subluxation or dislocation. CONCLUSION: Early diagnosis and treatment of homocystinuria is advantageous.
Adolescent↗
Medical student education in paediatrics and child health: where are we going?
In most undergraduate medical curricula, learning is becoming less content based and the emphasis is changing to problem based learning, continuing self directed learning, and the use of a wide range of learning resources. Particular needs in paediatrics and child health are an increasing emphasis on learning in ambulatory care and community based health facilities, and on assessment processes which are formative and reflect the learning objectives appropriately. A wide range of resources is needed for learning at a time when teaching hospital and health system facilities face significant financial restraints.
Ambulatory Care↗
Longer-term visual outcome of eyes with retinopathy of prematurity treated with cryotherapy or diode laser.
AIMS: Visual outcome of 66 eyes in 37 patients who had undergone treatment with either cryotherapy or diode laser for threshold retinopathy of prematurity was assessed. METHODS: 17 patients, representing 30 eyes treated with cryotherapy, were examined at between 56 and 98 months corrected age (median 68 months). 20 patients representing 36 eyes treated with diode laser, were examined at between 30 and 66 months corrected age (median 51 months). Structural outcome was categorised as: optimal--flat posterior pole; suboptimal--macular ectopia, optic nerve hypoplasia, retinal fold involving the macula, and retinal detachment involving the macula. RESULTS: Optimal structural outcome was, in the absence of amblyopia, associated with optimal visual acuity (of 6/12 or better) in all cases, with most eyes achieving a visual acuity of 6/9 or 6/6. Suboptimal structural outcome was invariably associated with suboptimal visual acuity. Amblyopia was present in eight out of 20 cryotherapy treated eyes and in five out of 26 laser treated eyes with an optimal structural outcome. Refractive errors were significantly less in laser treated eyes as was the incidence of anisometropic amblyopia. CONCLUSION: Eyes treated with either cryotherapy or diode laser for threshold retinopathy of prematurity with optimal structural outcome are associated with development of optimal visual acuity--that is, 6/12 or better. Treatment with either cryotherapy or laser does not in itself reduce the visual potential of these eyes.
Amblyopia↗
Causes of blindness in the adult population of the Republic of Ireland.
BACKGROUND/AIM: Blindness in the developed countries affects 3.5 million people. This study was conducted on the causes of blindness in the Republic of Ireland based on the register of the National Council for the Blind of Ireland. The aim was to determine the prevalence of potentially avoidable blindness and to identify its causes. METHOD: Criteria for registration as blind are in Ireland: best corrected visual acuity of 6/60 (0.1) or less in the better eye or a visual field restricted to 20 degrees or less. Data on 5002 adults 16 years an older registered as blind were analysed. The causes of blindness are classified in 17 diagnostic categories. RESULTS: The leading causes of blindness are macular degeneration and glaucoma, each accounting for 16% (812 and 795). Cataract accounted for 11% (561), a third of these had an associated cause of blindness and one tenth had a cognitive deficit. Diabetic retinopathy ranked as the 11th cause of blindness and accounted for 3% (147). More than half of the patients were 65 years and older. CONCLUSION: 25% of blindness was potentially avoidable. The treatable causes were glaucoma and diabetic retinopathy in the working population and glaucoma and cataract over 65 years of age. Glaucoma is the most important, which raises the question of a screening programme. The prevalence of blindness of 3% due to diabetic retinopathy is lower than in most other series.
Adolescent↗
Using systematic reviews in clinical education.
Traditional educational methods change clinical practice only with considerable effort and difficulty. In particular, the teaching of critical appraisal in the setting of journal clubs does not increase the amount of medical research read by trainees. Experiential learning theory, corroborated by the success of problem-based learning, encourages us to link learning to the numerous medical questions that physicians generate while providing patient care. Systematic reviews can link these questions with the results of research that would otherwise be difficult to locate, read, and appraise. Systematic reviews are a uniquely powerful mechanism for teaching, and they offer teachers a new opportunity to model rational and effective use of information. Systematic reviews should be made available at clinical sites for use during "teachable moments." Resistance to the use of systematic reviews can be reduced by using existing journal clubs to teach about the strengths and limitations of these reviews. The point that systematic reviews are meant to assist, not replace, clinical decision making deserves emphasis in such teaching.
Education, Medical↗
Medulloepithelioma of the optic nerve head.
Medulloepithelioma of the optic nerve is a rare developmental tumor. We describe a 2-year-old boy with profound loss of vision associated with a visible tumor of the optic nerve head in his left eye. A clinically diagnosed retinoblastoma necessitated left eye enucleation. The histopathological diagnosis was malignant medulloepithelioma that was incompletely resected. Further tumor resection was required, and the patient received adjunctive chemotherapy and radiotherapy. Four years after treatment, the patient has neither clinical nor radiological evidence of tumor.
Chemotherapy, Adjuvant↗
Radiofrequency diathermy capsulorhexis of the anterior and posterior capsules in pediatric cataract surgery: preliminary results.
PURPOSE: To assess the effectiveness of radiofrequency diathermy capsulorhexis in preventing opacification of the posterior capsule in pediatric cataract extraction. SETTING: The Children's Hospital, Dublin, Ireland. METHODS: Radiofrequency diathermy capsulorhexis to the anterior capsule followed by injection of sodium hyaluronate behind the posterior capsule and primary posterior capsule diathermy capsulorhexis were performed in 14 eyes of 7 children requiring cataract surgery. RESULTS: Six patients had bilateral congenital and 1 patient bilateral developmental cataracts. Ten eyes (5 patients) received heparin-surface-modified intraocular lenses, and 4 eyes (2 patients) were left aphakic. There were no intraoperative complications, and only mild anterior segment inflammation was noted postoperatively. CONCLUSION: With follow-up from 7 to 16 months (mean 12.1 months), our results showed no epithelial regrowth or opacification of the posterior capsule following diathermy capsulorhexis.
Cataract↗
Topographical analysis of ablation centration after excimer laser photorefractive keratectomy and laser in situ keratomileusis for high myopia.
PURPOSE: To evaluate the ablation centration after photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) for high myopia and to assess the association between decentration and best corrected visual acuity (BCVA), glare, monocular diplopia, and halo phenomenon. SETTING: Mater Private Hospital, Dublin, Ireland. METHODS: Corneal topography was used to analyze centration in two groups of patients with myopia of more than 6.0 diopters: 18 had PRK and 18, LASIK. A standardized questionnaire assessed the preoperative and postoperative prevalence of glare, monocular diplopia, and halo phenomenon. RESULTS: "Significant" ablation decentration (0.5 mm) in the LASIK group (1.33 mm) was almost twice that in the PRK group (0.75 mm). Glare increased from 27% preoperatively to 42% in the PRK group; monocular diplopia increased in the LASIK group. Halo phenomenon decreased after both procedures. CONCLUSION: Laser in situ keratomileusis represents a step forward in the surgical correction of high myopia, but the accuracy of the corneal ablation location must be improved. Suction ring fixation of the globe or real time tracking systems may help improve centration.
Adult↗
Adolescents' exposure to community and school violence: prevalence and behavioral correlates.
PURPOSE: The purpose of this research was to study adolescents' perceptions of violence in their communities and schools and examine the relationship between these reports and their emotional and behavioral functioning, controlling for the effects of family violence and other sociodemographic variables. METHODS: Respondents included 935 urban and suburban high school students who completed the Youth Self-Report (YSR) as well as measures assessing their perceptions of community, school, and family violence. RESULTS: This sample of high school students was exposed to high levels of violence in their communities and schools. Over 45% of the students reported witnessing severe forms of violence such as a shooting or stabbing in their communities or schools during the year prior to the study. Hierarchic regression analyses revealed that for males, exposure to community and school violence was a significant predictor of aggressive acting-out behaviors, even when controlling for the effects of family violence and other sociodemographic variables. For girls, only exposure to school violence was a significant predictor of aggression. The results for internalizing scores (depression, withdrawal) were less impressive, particularly for males. CONCLUSIONS: The high levels of violence exposure of adolescents in their communities and schools and the associated increase in behavior problems suggest the need for developing school and community intervention programs to treat violence and its impact.
Adolescent↗
Sulphur hexafluoride in the treatment of flat anterior chamber following trabeculectomy.
The efficacy and side effects of sulphur hexafluoride (SF6) in the reformation of the flat anterior chamber (AC) after standard trabeculectomies were studied. Ten patients with lenticulocorneal touch following trabeculectomy were enrolled. All had water-tight conjunctival wounds with overflowing fistulas. In 5, one to four surgical attempts to reform the AC were unsuccessful. Two to seven days after trabeculectomy, the AC was reformed by a single injection of SF6/air mixture (20-40%). Gas was injected through the limbus at 3 or 9 o'clock. The AC remained deep after absorption of the gas in 2-7 days. All patients had stromal oedema in the first 4 days. This resolved and specular microscopy did not show any abnormality. After a mean follow-up of 2.5 years, all had normal intraocular pressure, 3 with one topical antiglaucoma treatment. Three patients developed cataracts before and 3 after reformation of the AC. The latter 3 were not anterior capsular cataracts as induced by gases. SF6/air mixture (20-40%) is inert and kind to the cornea and, as it is absorbed in less than 7 days, it exerts minimal damage to the crystalline lens. It is effective in the reformation of flat ACs.
Aged↗
Cloverleaf skull anomaly with extreme orbitostenosis.
A neonate presented with cloverleaf skull anomaly and severe proptosis requiring urgent cranioplasty to attain eyelid closure. Despite this, she experienced exposure keratitis and corneal perforations. A ventriculoperitoneal shunt was performed subsequently to relieve hydrocephalus, but respiratory problems eventually led to her death at 6 months. This case highlights the complexity of the problems encountered in the cloverleaf skull anomaly, and a brief review discussing its management is included. Despite improvements in treatment of this condition, the overall prognosis remains poor.
Acrocephalosyndactylia↗
Bilateral clinical anophthalmos.
We report on the risk factors, associations and outcome of 5 children with bilateral clinical anophthalmos. Our study showed no gestational, environmental or hereditary association but confirmed strong association with multiple systemic abnormalities.
Abnormalities, Multiple↗
Atropine penalisation versus occlusion as the primary treatment for amblyopia.
AIMS/BACKGROUND: Pharmacological penalisation of non-amblyopic eyes is an infrequently used alternative to occlusion for treating amblyopia. The authors compared the efficacy of atropine penalisation and that of occlusion as a primary treatment for amblyopia. METHODS: Thirty six newly diagnosed patients with amblyopia were allocated to two groups for treatment. Eighteen patients in each group were treated either with atropine penalisation (group A) or occlusion therapy (group P). RESULTS: There was a statistically significant improvement in visual acuity in both groups treated. In group A improvement of the geometric mean visual acuity of the amblyopic eye was from 6/50 to 6/11 (p < 0.001). In group P improvement of the geometric mean visual acuity was from 6/60 to 6/19 (p < 0.001). In group A non-compliance with treatment was only 6% (2/18). Non-compliance in group P was 45% (8/18) at some stages of the treatment. Neither group produced an incidence of occlusion amblyopia. CONCLUSIONS: In this study atropine penalisation has been shown to be as effective as occlusion therapy in the treatment of amblyopia. Patient acceptance of atropine penalisation was superior to that for occlusion therapy as was shown by the compliance rate. Atropine treatment was also advantageous in that compliance could be readily checked by inspection.
Amblyopia↗