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Biomedical subjects

R J Simmons

Publications and source records attributed to R J Simmons.

At least 73 records · Page 4Linked to original sources

Observations of child psychiatry in China.

Child and adolescent psychiatry in the People's Republic of China is discussed following a brief visit and literature review. The Chinese practice of psychiatry is the same for adults and children, and primarily involves the treatment of severely disturbed patients in psychiatric hospitals. There is also a trend toward movement into the community and the schools as a result of the Chinese focus on Attention Deficit Disorders. Antisocial and delinquent behaviours, developmental problems, relationship and family problems, and reactions to illness and hospitalization are not handled by psychiatrists but by others in the local communities. These problems are managed, however, and with the shortage of child psychiatrists the arrangement may be appropriate.

Adolescent↗

Acute glaucoma following Nd: YAG laser membranotomy.

A 65-year-old aphake with a functioning filtration bleb underwent neodymium:YAG laser membranotomy. Shortly thereafter, he acutely developed pain, nausea, and visual blur with an intraocular pressure of 42 mm Hg. The mechanism of the acute glaucoma is believed to be occlusion of the fistula by herniated vitreous.

Acute Disease↗

Argon laser trabeculoplasty in the presurgical glaucoma patient.

The trabecular meshwork in 334 eyes of 260 patients with medically uncontrolled primary and secondary open-angle glaucoma was treated with the argon laser. The average intraocular pressure reduction obtained was 7.1 mm Hg. Tonographic data showed significant increase in the facility of outflow. Glaucoma surgical intervention was avoided in 87.5% of phakic eyes and in 62.1% of aphakic eyes. Laser trabeculoplasty was found to be effective in primary open-angle glaucoma, pseudoexfoliation glaucoma, pigmentary glaucoma, angle recession glaucoma, glaucoma secondary to uveitis, and in eyes with failed glaucoma surgical procedures. The length of follow-up in this series ranged from one week to 21 months, with an average of five months. The major complication noted was a rise in intraocular pressure following treatment. In one eye, a small central island of vision was lost due to this intraocular pressure elevation. Treating one-half of the angle in each of two treatment sessions separated by a few weeks reduces the degree of this pressure elevation. The glaucoma status of 3% eyes was made worse after treatment with trabeculoplasty.

Adolescent↗

Neovascular glaucoma in systemic occlusive vascular disease.

A 58-year-old woman was seen with a red inflamed right eye with rubeosis iridis and neovascular glaucoma with closure of the angle. There was no evidence of the diabetes and no evidence of occlusion of the central retinal vein. Physical examination was normal except for an absent carotid pulse on the right side, a carotid bruit on the left side, and absence of the pulse in all extremities. Further evaluation revealed severe arteriosclerosis involving many major branches of the aorta, including both carotid arteries. This patient had neovascular glaucoma as the only presenting sign of severely arteriosclerotic stenosis of both carotid arteries. This case demonstrates the need for emphasis on this rare but occult life-threatening cause of neovascular glaucoma. Ophthalmologists should be alert to the possible presence of carotid occlusive disease as a causative factor when cases of neovascular glaucoma are encountered.

Aorta, Abdominal↗

Progressive low-tension glaucoma: treatment to stop glaucomatous cupping and field loss when these progress despite normal intraocular pressure.

Our thesis, inspired by the experience and teaching of Paul A. Chandler, is that after the optic discs have developed cupping and atrophy from elevated intraocular pressure they tend to become abnormally vulnerable and, in some cases, may continue to deteriorate even if the intraocular pressure is brought to the teens. At this stage they behave the same as in eyes with so-called low-tension glaucoma, which have developed progressive cupping and atrophy with pressures always in the teens. In either case, we find that the progression of cupping and field loss can be stopped by reducing the intraocular pressure to lower levels, preferably to 10 mm Hg or less. We have found that such low pressures are most reliably attained by surgery, using a special technique we call the shell tamponade filtration procedure, which involves the use of a glaucoma shell in conjunction with standard (full-thickness sclerostomy) filtration operations and certain specific operative and perioperative maneuvers. We present nine case reports illustrating our thesis. Glaucomatous cupping and loss of visual field were progressing relentlessly at normal pressures in each case. This progressive deterioration was shown to be arrested by reduction of the pressure to less than 12 mm Hg in 13 eyes.

Aged↗

Nanophthalmos: a perspective on identification and therapy.

Nanophthalmos is a rare and blinding disease. Diagnostic features include a small eye, small cornea, shallow anterior chamber, narrow angle, high lens/eye volume ratio, and uveal effusion. Intraocular surgery has a high rate of disastrous complications and blindness. The 32 eyes (16 patients) presented are in three categories based on angle closure and intraocular pressure levels. Treatment methods included medication, laser iridotomy and gonioplasty, peripheral iridectomy, filtration surgery, and cataract extraction. Glaucoma medication was effective, although miotics sometimes increased pupillary block. Laser iridotomy was successful in 83% of six eyes; laser gonioplasty in 91.6% of 12 eyes. Peripheral iridectomy succeeded in two of seven eyes, and filtering operations provided tension control in two of five eyes. Thirteen of 15 eyes undergoing filtration surgery suffered severe postoperative visual loss. Cataract extraction improved vision in only three of six eyes. The authors' experience confirms that surgery in nanophthalmic eyes has an extremely high complication rate with disastrous results. Medication and laser therapy are the procedures of choice for angle-closure glaucoma in nanophthalmos.

Adult↗

Studies on a human melanoma cell line: effect of cell crowding and nutrient depletion on the biophysical and kinetic characteristics of the cells.

In an investigation of the changes that occur in cultured neoplastic cells as they outgrow their supply of nutrient, MM96 human melanoma cells were found to diminish in size and to proliferate more slowly. These changes were accompanied by a moderate increase in the proportion of cells with a G1-like DNA content. When replated under favorable conditions, many of these cells gradually resumed active proliferation. Continuing adverse culture conditions led to a continued fall in cell size, loss of reproductive viability, and finally to rapid cell death. Simultaneous buoyant-density and velocity-sedimentation-fractionation experiments showed that cells from exponential cultures were moderately dense and rapidly sedimenting, cells from postexponential cultures were less dense and much more slowly sedimenting, and dye-excluding cells from reproductively nonviable, late postexponential cultures were of widely variable though generally high density, and were moderately rapidly sedimenting. Although neither fractionation method resulted in significant enrichment of clonogenic cells, depletion was seen at both extremes of both types of profile. Cells fractionated by velocity were sorted according to DNA content and hence location in the cell cycle. The relationship between sedimentation rate and cell-cycle location was reflected in the continuous thymidine labeling patterns of the separated cells. Study of these patterns suggested that cycle durations lengthened as crowding increased and nutrient became depleted, and shortened upon reseeding at low density into fresh medium.

Cell Line↗

Biophysical and morphological correlates of kinetic change and death in a starved human melanoma cell line.

An investigation was made of the sequential biophysical and morphological changes that occur as cultured human melanoma cells (MM96) outgrow their supply of nutrient. Simultaneous buoyant-density and velocity-sedimentation fractionation experiments were used to characterize cells from 3 kinetically differing types of culture. Cells from exponential cultures were large, moderately dense and rapidly sedimenting; cells from post-exponential cultures were of intermediate size, less dense and much more slowly sedimenting; and dye-excluding cells from reproductively non-viable late post-exponential cultures were small, of widely variable though generally high density and sedimented moderately rapidly. Although reproductive viability was high in cells from both exponential and post-exponential cultures, depletion of clonogenic cells was seen at the extremes of the distribution profiles of cells fractionated by either method. This was particularly evident at the low-density extreme of the buoyant-density profiles where cells retained viability despite their loss of proliferative potential. As cells became post-exponential, nuclear size diminished in parallel with cell size, the number of microvilli declined, mitochondria condensed, cytoplasm vacuolated, the frequency of osmiophilic vacuolar inclusions rose, chromatin clumped and nucleoli became prominent. Progression to a reproductively non-viable late post-exponential state resulted in a continued parallel fall in nuclear size, increased cytoplasmic blebbing, further mitochondrial condensation, an increased proportion of cytoplasmic vacuoles containing osmiophilic material, the major part of which was melanin, and further clumping and margination of chromatin. Cells progressed rapidly from this newly described pre-apoptotic state to death by apoptosis, a process characterized by the budding and division of cells into a number of ultrastructurally well-preserved membrane-bound fragments.

Biophysical Phenomena↗

Tritiated-thymidine-induced increased DNA content and irreversible differentiation in a human melanoma cell line.

When cultured in the presence of 2.0 microCi/ml (methyl-3H)thymidine (3H-TdR) the growth rate of 6 human melanoma lines and 1 subline progressively slowed then stopped, a change that was accompanied by loss of reproductive viability as assessed by colony formation in agar, but unaccompanied by a comparable inhibition of thymidine incorporation. In all cases increases in cell size, nuclear size and DNA content were observed. In 1 cell line only, MM96, these changes were accompanied by a profound increase in morphological differentiation. Despite this MM96 did not show increased differentiation in response to 2 x 10(-7) M alpha melanocyte stimulating-hormone (alpha MSH), which in fact stimulated growth, or in response to 10(-3) M N6,O2'-dibutyryl adenosine 3':5'-monophosphate (db-cAMP), 10(-3) M theophylline or 5 x 10(-4)M guanosine-5'-triphosphate (GTP), all of which retarded growth. With none of the cell lines was differentiation increased in response to 10(-3)M db-cAMP although in each case growth was retarded. These results reinforce the importance of colony assays vs DNA synthesis studies in assessing reproductive viability and show that supra-reproductively lethal levels of 3H-TdR can by-pass defects in the differentiation pathway of at least one, but not all, human melanoma cell lines.

Cell Count↗

Simulated double Bjerrum's scotomas by retinal pigment epithelium and receptor degeneration.

A seemingly glaucomatous double Bjerrum's nerve fiber bundle defect was mimicked by pigment epithelium and receptor degeneration. The discrepancy between normal appearance of the disc and the abnormal visual field was a clue indicating need for further evaluation for retinal disease unrelated to glaucoma. Ophthalmologists should be aware of the possibility of this cause of double Bjerrum's or ring scotoma to avoid protracted workup for nonexistent neurologic disease or treatment of glaucoma.

Diagnosis, Differential↗

The role of gonio-photocoagulation in neovascularization of the anterior chamber angle.

Gonio-photocoagulation is a name applied to direct laser therapy to neovascular vessels in the anterior chamber angle in progressive anterior segment neovascularization. The technique is useful not in altering the stimulus to anterior segment neovascularization, but in immediately altering the product of the stimulus, the new vessels in the angle. The goal is to halt immediately progression toward angle closure and severe neovascular glaucoma. A recommended protocol is presented for incorporation of this technique into a prophylactic regimen for neovascular glaucoma in conjunction with retinal therapy to alter the stimulus.

Anterior Chamber↗

Angle-closure glaucoma in nanophthalmos.

Two patients had nanophthalmos with uveal effusion and angle-closure glaucoma. They were treated with a method based on the use of the laser, not only to perform iridotomy but to shrink the iris stroma, which appears to open the anterior chamber angle even without iridotomy. Additionally, we introduced three factors that may be diagnostic of nanophthalmos.

Choroid↗

Scanning electron microscopy of trabeculectomy specimens in open-angle glaucoma.

We examined trabeculectomy specimens obtained at the time of surgery for inadequately controlled open-angle glaucoma by scanning electron microscopy. Of the 50 specimens ten included a broad area of the trabecular meshwork. In these ten specimens the meshwork was obscured by material. We believe the degree of occlusion was significant in these specimens, which would lead to obstruction of aqueous outflow. No similar material was found in control specimens from persons of similar age.

Aged↗

Glaucoma associated with precipitates on the trabecular meshwork.

Precipitates on the trabecular meshwork may be the only sign of ocular inflammation. Fourteen patients who had glaucoma associated with precipitates on the trabecular meshwork and minimal or no other signs of ocular inflammation did not respond to usual antiglaucoma therapy. Treatment with topical steroids eliminated the precipitates and lowered the intraocular pressure. Careful gonioscopy is the key to accurate diagnosis.

Acetazolamide↗

A modified cyclodialysis spatula.

A cyclodialysis spatula specifically designed for glaucoma surgery is presented which facilitates the performance of the cyclodialysis procedure alone or in combination with cataract extraction and decreases the chance of inadvertent damage to the eye.

Glaucoma↗

Shell tamponade in filtering surgery for glaucoma.

The glaucoma shell tamponade technique in filtering surgery for glaucoma is a technique for (1) decreasing the incidence of flat anterior chamber and choroidal separation postoperatively, (2) promoting the development of a low diffuse filtration area, and (3) increasing the possibility of achieving very low resulting postoperative pressure. The glaucoma shell technique is applicable to all types of filtration procedures, including conventional filtering procedures utilizing no scleral flap and those utilizing a scleral flap, such as trabeculectomy. It can be used at surgery or can be applied in the postoperative period to deal with flat or shallow anterior chambers immediately at the time of onset. The shell tamponade technique can be utilized to aid in the management of some cases of leaking bleb in the early postoperative period or in the late postoperative period. The technique for operative and postoperative use of the glaucoma shell tamponade technique and its closely related pressure dressing is a demanding and exacting art. Because the technique increases the possibility of very low resulting tensions, its use should be considered especially for cases in which very low pressures are desired, such as some cases of extremely advanced cupping and field loss and low-tension glaucoma.

Anterior Chamber↗

The essential iris atrophies.

We studied 82 cases of essential iris atrophy. The findings support some traditional concepts of this complex spectrum of disorders, but conflict with others. Corneal abnormality appeared early and may be the primary disorder. A corneal endothelial disturbance was present in 55% of cases and corneal edema was present in 50%. Peripheral anterior synechiae occurred in all but one of the cases studied by gonioscopy. The pupil was distorted in 71% of the cases and was usually pulled in the direction of the most prominent synechia. The iris was stretched with stromal atrophy in 71%. Iris holes occurred in 33%. The degree of corneal and iris changes occurred as a spectrum of disorders. The prognosis for most patients with essential iris atrophy is slow progression with eventual involvement of vision because of corneal edema, secondary glaucoma, or both. Treatment of increased IOP was required in 77% of our cases, and 44% required surgical intervention.

Adolescent↗