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Evaluation of adverse reactions of aponidine hydrochloride ophthalmic solution.

We prospectively evaluated the adverse reactions of apraclonidine in 20 normal volunteers by instilling a single drop of 1% apraclonidine in their right eyes. Examinations, including blood pressure, pulse rate, conjunctiva and cornea, intraocular pressure (IOP), pupil diameter, basal tear secretion and margin reflex distance of both upper and lower eyelids, were performed prior to entry and at 1, 3, 5 and 7 hours after instillation. The ocular hypotensive effects were statistically significant for apraclonidine-treated eyes throughout the study and also statistically significant for contralateral eyes from three hours after topical administration of 1% apraclonidine. Decreases in systolic blood pressure were statistically, but not clinically, significant. No significant changes in diastolic blood pressure, pulse rate and basal tear secretion were noted. Conjunctival blanching and mydriasis were commonly found. Upper lid retraction was frequently noted. While the elevations of the upper lid margin in most subjects were not more than 2 mm and did not cause noticeable change in appearance, one subject suffered from mechanical entropion and marked corneal abrasion 3 hours after instillation of the medication. This may well be a particularly notable finding in Asian people.

Adrenergic alpha-Agonists↗

Effects of three techniques of lung management on pulmonary function during cardiopulmonary bypass.

In this study, 30 patients undergoing elective myocardial revascularization were divided randomly in three groups (10 patients each) with different management of the lungs during CPB: Group 1, lungs deflated; Group 2, static inflation with PEEP = 5 cmH2O and FIO2 = 1.0; Group 3, static inflation with PEEP = 5 cmH2O and FIO2 = 0.21. Measurements (Qs/Qt, P(A-a)O2, PaO2, Cstat, Cdyn, PIP, AUTO-PEEP, Rrs,max, Rrs,min and DRrs) were performed after the induction of anesthesia (T0), 20 minutes (T1) and 2 hours (T2) after the end of CPB. Respiratory mechanics data were obtained only at T0 and T2 because the sternal retraction. The Group 1 presented a statistically significant increase in Qs/Qt, P(A-a)O2 and Peak Inspiratory Pressure (PIP); in this group we noticed also a decrease in PaO2 values, static compliance (Cstat) and dynamic compliance (Cdyn) values comparing basal versus T1 and T2 values. The Group 2 showed a statistically significant increase in Qs/Qt and P(A-a)O2 values; also in this group we observed a statistically significant decrease in PaO2 and Cdyn values comparing basal versus T1 and T2 values. The Group 3 presented a statistically significant decrease in PaO2 values (basal versus T1 and T2); this group also presented an increase in Qs/Qt values, in the immediate postbypass period (T1), and P(A-a)O2 values significantly increase comparing basal versus T1 and T2 values. In all the three groups the respiratory system resistance and AUTO-PEEP values were unchanged after the end of CPB. The comparison between the groups showed a significant minor impairment of gas exchange (PaO2 and P(A-a)O2), Qs/Qt and Cstat in the third group of patients. These results show that lungs inflation with air during CPB, effectively preserve respiratory system mechanics: this might be due to a preservation of bronchial perfusion simply due to the mechanic expansion of the lung otherwise compromized when the lungs are completely collapsed. However it is necessary to emphasize that CPB has negative effects on gas-exchange whatever technique of lung management is used.

Anesthesia, Inhalation↗

[Amiodarone induced retrobulbar neuritis. Clinical case].

We report a 66 years old male, with an ophtalmologic history of long sightedness, admitted to the hospital due to paroxysmal atrial fibrillation crises in the context of a coronary heart disease. He was treated with i.v. amiodarone, receiving a total dose of 6 g in 72 hours. After the third day of treatment, the patient noticed a correction of his long sightedness and 24 h later, he complained of hlurred vision and orbital frontal headache. Visual field examination revealed a concentric retraction of visual field and a centrocecal scotoma in both eyes. Amiodarone was withdrawn and dexametasone treatment was begun. Three days after amiodarone discontinuation, sight improved and visual field returned to normal. Although retrobulbar neuritis has been associated to various drugs, amiodarone has not been considered as a possible agent.

Aged↗

Lymphoma of the breast.

The mammograms of 25 women and six men (33 breasts) with lymphoreticular disease of the breast were reviewed. Three patients had HD, 21 NHL (one bilateral), three had leukemic involvement of the breast, and four had plasmacytoma (one bilateral). All patients had identifiable and localized abnormalities in their breasts, many of which were well-defined masses ranging in diameter from 2 to 9 cm. From this series it would seem that lymphomatous involvement of the breast has a noticeable predilection to form relatively circumscribed masses on the mammogram. However, they lacked tumor calcifications or secondary changes such as the surrounding distortion or localized skin retraction often associated with primary breast carcinomas. This nonspecific appearance usually compromises the proper diagnosis in a primary clinical presentation of a lymphomatous breast mass without associated axillary lymphadenopathy or known lymphomatous disease of the breast.

Adult↗

New retraction technique to allow better visualization of Calot's triangle during laparoscopic cholecystectomy.

BACKGROUND: Bile duct injuries during laparoscopic cholecystectomy (LC) are thought to occur because surgeons tend to confuse the common bile duct (CBD) with the cystic duct. Among reasons for this misidentification, the difference in the way the operating field is exposed in LC compared to open cholecystectomy should be noticed. Using Dr. Reddick's technique, which is commonly practiced, the upward and the lateral traction of the gallbladder results in a narrower Calot's triangle and angulation of the CBD. These anatomical distortions are thought to contribute to ductal injuries during LC. METHODS: We propose a new method to expose Calot's triangle during LC. The principle of this technique is to expose the hepatic hilus by retracting the caudal surfaces of the quadrate and lateral lobes of the liver using an atraumatic curved instrument. RESULTS: The advantages of this technique are that one gains wide exposure of the hepatic hilus, leaves Calot's triangle undistorted, and avoids tenting the CBD. CONCLUSIONS: This new technique may make LC safer and decrease the number of bile duct injuries associated with the misidentification of the anatomy.

Cholecystectomy, Laparoscopic↗

Colonial modern skeletal change in the U.S.A.

Eighty-two people dating from 1975 to 1879 compared with 182 modern middle-class White and Black skeletons test the myths of radical changes produced by improved diet, less disease, and nineteenth century immigration. Longevity increases and health and growth improvement is clearest in reduced juvenile deaths (census data) and deepening of true pelvis. Stature increase is minimal (though seventeenth century Londoners and modern West Africans are shorter than Colonial to Modern Americans); teeth deteriorate and for cultural reasons fractures increase. Clavicles and forearms elongate. From Old to New World Colonial samples there is a noticeable skull change (and a greater Old World to Modern contrast) but White Colonial to Modern shows strong continuity surprisingly, the key changes being increasing head height, and retraction of face with increasing nose projection, and longer mastoids, resulting from selection and mixture. Blacks change more, possibly from Indian and White mixture. Variabilities are above average. Change is much less than expected, and apparently involves heterosis and selection as well as the obvious health advance and mixtures.

Adolescent↗

H wave and spinal root potentials in neuromonitoring of S1 root function during evacuation of herniated disc: preliminary results.

AIM: To determine the changes in the tibial H reflex and spinal nerve root potentials (SRPs) of the S1 root during posterior discectomy and the effects of surgical manipulation. METHODS: Tibial H reflex responses (M and H waves) were intermittently recorded from the soleus muscle by surface electrodes during different stages of surgery in 5 patients with S1 radiculopathy. All patients had Achilles reflex preserved bilateraly and no paresis on manual strength testing preoperatively. SRPs were additionally obtained by direct epidural recordings from the surgically exposed S1 root in 2 of them. RESULTS: The variations in the amplitude of H wave were minor and reversible upon the cessation of surgical manipulation of the root, but the H reflex was not lost either temporarily or permanently in any of the patients. Prolongation of H wave latency by up to 18% at the end of surgery in comparison with preoperative value was noticed in 4 patients. However, there was increased degree of desynchronization of the SRP in some phases of the spinal root manipulation, such as root mobilization before the disc incision and retraction during the disc evacuation. H waves and SRPs were continuously present during the surgery. Ankle jerks were preserved postoperatively in all 5 patients. CONCLUSION: Unremarkable variations in H wave latency may be followed by increased SRP desynchronization. Monitoring of the epidurally recorded SRPs seems to be more sensitive to surgical manipulations of the spinal nerve root than the tibial H reflex recordings from the soleus muscle.

Adult↗

Hepatitis induced by Kava (Piper methysticum rhizoma).

BACKGROUND/AIMS: Botanical drugs are widely used and often contain highly active compounds. Kava root (Piper methysticum rhizoma), used frequently in Europe as a remedy against anxiety, contains kavapyrones with sedative effects. Seven case reports suggested the development of hepatitis after the intake of Kava. METHODS: We analyzed 29 novel cases of hepatitis along with Kava ingestion which occurred between 1990 and 2002 in addition to the seven already published case reports using a clinical diagnostic scale established for adverse hepatic drug reactions. RESULTS: Hepatic necrosis or cholestatic hepatitis were noticed with both alcoholic and acetonic Kava extracts. The majority of the 29 patients and the additional seven published reports were women (27 females, nine males). Both the cumulative dose and the latency to when the hepatotoxic reaction emerged were highly variable. Nine patients developed fulminant liver failure, of which eight patients underwent liver transplantation. Three patients died, two following unsuccessful liver transplantation and one without. In all other patients, a complete recovery was noticed after the withdrawal of Kava. Pathophysiologically, both immunoallergic and idiosyncratic factors may be responsible. CONCLUSIONS: The present report emphasizes the potentially severe hepatotoxicity of Kava which has recently led to the retraction of Kava-containing drugs by the pharmacovigilance authorities in Germany.

Acute Disease↗

Altered Golgi apparatus in hydrostatically loaded articular cartilage chondrocytes.

OBJECTIVES: Articular cartilage proteoglycan content is controlled by joint loading. This study aimed to elucidate the role of hydrostatic pressure in this regulation. METHODS: Primary cultures of chondrocytes from bovine articular cartilage, grown on coverslips, were subjected to 5, 15, or 30 MPa hydrostatic pressure, applied continuously or cyclically at 0.125 or 0.05 Hz. The Golgi apparatus was visualised either by a fluorochrome coupled wheat germ agglutinin or by transmission electron microscopy. Proteoglycan synthesis was studied by the incorporation of sulphur-35 labelled sulphate. RESULTS: After 30 MPa continuous hydrostatic pressure, the Golgi apparatus was observed in a compact form with a concomitant decrease in proteoglycan synthesis. The normal stacked appearance of the Golgi apparatus was no more visible in the electron microscopy preparation of the pressurised chondrocytes. This effect was reversible and was also noticed after 15 MPa continuous load, though to a minor extent. Cyclic pressures (5-30 MPa) caused no apparent change in the Golgi apparatus. The shape of some cells changed to a more retracted form after 30 MPa continuous pressure. Nocodazole, which causes disassembly of the microtubules, blocked the compacting influence of pressurisation on the Golgi apparatus, and reduced proteoglycan synthesis to about half of the control level. CONCLUSIONS: The packing of the Golgi apparatus is dependent on microtubules and may contribute to the inhibition of proteoglycan synthesis observed in articular cartilage subjected to high hydrostatic pressure.

Animals↗

Touch, awareness of touch, and compliance with a request.

In certain situations it has been shown that touch has a positive effect on the compliance with a request expressed by a stranger. However, the difference between the effect of touch on request compliance between people who had noticed and those who had not noticed this contact has never been taken into account. In this experiment a female confederate asked 227 women to answer a questionnaire. When asking for their collaboration the forearm was or was not touched for a brief period of 1 to 2 seconds. Analysis showed that touch was associated with significantly higher compliance to the request but no difference was found between subjects who had noticed the tactual contact and subjects who had not noticed.

Adolescent↗

Management of Duane retraction syndrome.

BACKGROUND: Duane retraction syndrome is the most common cause of congenital aberrant ocular innervation. We report referral practices, clinical characteristics and complications, prevalence of congenital and familial anomalies, and management outcomes from a clinic-based series. METHODS: Retrospective clinic-based study of 65 patients with Duane retraction syndrome seen between January 1994 and March 2004. RESULTS: The majority of patients were girls with type I Duane retraction syndrome associated with esotropia in primary gaze. Twenty percent of cases were complicated by absent binocular stereoacuity and 16.9% had amblyopia. Family history of any ocular disorder was reported in 38.5% of cases, while an associated congenital abnormality was found in 46% of patients. There was a significant delay between the age when ocular abnormalities were first noticed and the age when patients presented at our tertiary referral center (P < .001). Twenty-two percent of patients underwent surgical correction at a mean age of 6 years. Most procedures were unilateral or bilateral medial or lateral rectus recessions. Postoperative ocular alignment < or = 15 prism diopters (PD) was achieved in 86% of cases, with 50% of cases having < or = 5 PD. CONCLUSIONS: Amblyopia and absent binocular stereo vision affected one in five patients with Duane retraction syndrome. There was significant delay between identification of an abnormality and presentation at the eye clinic.

Amblyopia↗

High hydrostatic pressure effects in vivo: changes in cell morphology, microtubule assembly, and actin organization.

We present the first study of the changes in the assembly and organization of actin filaments and microtubules that occur in epithelial cells subjected to the hydrostatic pressures of the deep sea. Interphase BSC-1 epithelial cells were pressurized at physiological temperature and fixed while under pressure. Changes in cell morphology and cytoskeletal organization were followed over a range of pressures from 1 to 610 atm. At atmospheric pressure, cells were flat and well attached. Exposure of cells to pressures of 290 atm or greater caused cell rounding and retraction from the substrate. This response became more pronounced with increased pressure, but the degree of response varied within the cell population in the pressure range of 290-400 atm. Microtubule assembly was not noticeably affected by pressures up to 290 atm, but by 320 atm, few microtubules remained. Most actin stress fibers completely disappeared by 290 atm. High pressure did not simply induce the overall depolymerization of actin filaments for, concurrent with cell rounding, the number of visible microvilli present on the cell surface increased dramatically. These effects of high pressure were reversible. Cells re-established their typical morphology, microtubule arrays appeared normal, and stress fibers reformed after approximately 1 hour at atmospheric pressure. High pressure may disrupt the normal assembly of microtubules and actin filaments by affecting the cellular regulatory mechanisms that control cytological changes during the transition from interphase into mitosis.

Actins↗

External (subciliary) vs internal (transconjunctival) involutional entropion repair.

PURPOSE: To compare surgical outcomes of internal (transconjunctival) vs external (subciliary) involutional entropion repair. DESIGN: Retrospective, consecutive case series. METHODS: Electronic medical record review of all patients who underwent involutional entropion repair at the Jules Stein Eye Institute over a 4-year period was performed. MAIN OUTCOME MEASURES: Anatomic and functional success, recurrence rate, and complications. RESULTS: Forty-nine eyes (39 patients) were operated. Twenty-nine eyes underwent subciliary incision repair; 20 eyes underwent transconjunctival repair, both with lower lid retractors reinsertion. Good correlation was found between two masked observers in grading surgical outcome (on a scale of 1 to 4) (r = .76, P < .001). Forty-two cases (84%) achieved good surgical repair and improvement in symptoms. Recurrence was noticed in 4 eyes (8.2%). Recurrence was higher with the internal approach (15% vs 3% with subciliary incision), but this was not statistically significant (P = .14). Complications included: three cases (8.2%) with mild eyelid retraction that were treated conservatively, three cases with postoperative ectropion (all in the external approach, two of which lateral canthal resuspension was not performed), and two cases (4.1%, one case in each group) with pyogenic granuloma. CONCLUSIONS: Surgical correction of involutional entropion by reinsertion of lower eyelid retractors has similar outcome with internal (transconjunctival) and external (subcilliary) approaches. Although not statistically significant, internal repair may result in a higher recurrence rate, whereas external repair may show more postoperative ectropion, most probably attributable to scarring of the anterior lamella. Lateral canthal resuspension, when needed, may reduce the rate of postoperative ectropion.

Aged↗

[A case report of condyloma acuminatum of urethral meatus in a boy].

A 4-year-old boy was referred for treatment of papillary tumor at the urethral meatus. He was well until December 1990, when his mother noticed a tumor at the urethral meatus. The tumor was resected elsewhere. However, a similar tumor was noted again at the urethral meatus in May, 1991. The patient was admitted on September 16, 1991. Retraction of the phimotic foreskin revealed a well-demarcated papillary mass, approximately 2 x 2 mm in diameter, at the urethral meatus. There were no tumors on foreskin or glans. Under general anesthesia endoscopy was performed to locate other tumors at the urethra and bladder. No tumors were found elsewhere. Then the meatal tumor was resected surgically. Pathology was condyloma acuminatum. There was no recurrence one year after surgery. We also reviewed 24 boys with condyloma acuminatum, including 13 boys with a solitary condyloma at the urethral meatus, reported in Japan.

Child, Preschool↗

Total lower lid reconstruction: technical details.

The main complications of this type of lower lid reconstruction are lash loss or malposition, entropion of the upper lid, upper lid retraction, undue laxity of the lower lid, and lid margin deformities. These can all be avioded by meticulous attention to surgical details and dressing techniques. I believe that this is the best and simplest method of providing a lid of acceptable function and appearance. The advantages of this type of operation are: (1) The new lower lid is constructed of lid tissue including the tarsus and conjunctiva from the upper lid. (2) The function and appearance of the new lower lid are acceptable with practically no tendency to late retraction. (3) The function and appearance of the upper lid need not be interfered with. (4) No external scars are produced except when a lash transplant is done. This transplant leaves a small, hardly noticeable scar in the lower part of the opposite brow. (5) The technique is relatively simple and well within the realm of any well-trained ophthalmic surgeon. The obvious disadvantages are the surgeon's inability to inspect the eye for two to four months and the inconvenience to the patient of having one eye closed for such a long period of time.

Alopecia↗

Transconjunctival Müller muscle recession with levator disinsertion for correction of eyelid retraction associated with thyroid-related orbitopathy.

PURPOSE: To evaluate the efficacy of transconjunctival Müller muscle recession and graded levator disinsertion for eyelid retraction in patients with thyroid-related orbitopathy (TRO). DESIGN: Retrospective consecutive case series. METHODS: Medical record review of 78 TRO patients (107 eyelids) who underwent surgery for upper eyelid retraction in a 5-year period was performed. Main outcome measures were anatomic and functional success, minimal reflex distance (MRD), lagophthalmos, eyelid asymmetry, and patient discomfort. RESULTS: One hundred seven eyelid retraction surgeries were performed on 78 TRO patients (63 women, mean age 49 years); mean follow-up time was 16.7 months. Upper eyelid position, lagophthalmos, exposure keratopathy, and patients' discomfort markedly improved after surgery (P < .001). Marginal reflex distance (MRD1) decreased an average of 2.6 mm from 6 mm pre-operatively to 3.4 mm post-operatively (P < .001); lagophthalmos decreased an average of 0.6 mm from 1.3 mm pre-operatively to 0.4 mm post-operatively (P = .006) Failure rate was 8.4%, most improved with a second surgery. Overcorrection was noticed in three cases (2.8%). Eyelid asymmetry improved from a mean of 1.0 mm pre-operatively to 0.4 mm post-operatively (P = .001); more than 80% of patients showed eyelid asymmetry of 1 mm or less. CONCLUSION: Transconjunctival Müller muscle and levator recession is safe and effective in correction of mild, moderate, or severe eyelid retraction in TRO patients. The failure rate is less than 10% and may be addressed by a second surgery.

Conjunctiva↗

Skin harvesting on the scalp in children: utopia or reality.

UNLABELLED: Since 1990 we have used systematically the scalp as donor site for split skin graft in children. The aim of this retrospective and prospective study is to analyse the results, advantages, disadvantages, complications and problems of this method. MATERIAL AND METHODS: The series includes 43 children, age: 9 months to 15 years 6 months (mean age 5 years 9 months) who presented burns or other lesions. The surface to be grafted was 0.5% to 35% of the body surface (mean surface: 6.6% TBS). The follow-up was 25 to 1086 days (mean: 304 days). The donor site is prepared by marking of the hair-limit, shaving, disinfection and infiltration with normal saline under the galea of the surface to be harvested. Skin harvesting is done with an electrical dermatome. The donor site is covered with sponges soaked in adrenaline (1/500,000). RESULTS: 1 child required harvesting twice in 2 weeks, another one 3 times in 3 months. All the other children required only one procedure. 4 children needed a meshing of the graft. They required also harvesting from other donor sites. The surface to be grafted represented more than 15% TBS. 5 children with a surface to be grafted between 10 and 15% TBS could be covered in one session, without meshing, taking only the scalp. The healing of the scalp was complete after 7 to 14 days (mean: 9.5 days). There was no mortality in our series. We were not confronted with any infection. No hypertrophic scars or retractions were encountered. 3 children presented zones of alopecia, one had sequelae and needed two surgical procedures. The two other cases were minor cases and did not require further treatment. A certain sparseness of hair was noticed in a black girl, after the third harvesting. The blood losses were estimated as a total and have also to be attributed to the tangential excision of the burn area. CONCLUSION: Skin harvesting from the scalp in children can be recommended as first choice. The advantages, especially the rapid epithelialisation and the lack of visible scars, overcome the problems and the risks.

Adolescent↗

The rate of fibrinolysis is increased by free retraction of human gingival fibroblast populated fibrin lattices.

We previously demonstrated that human gingival fibroblasts (HGF), but not their dermal counterparts, when seeded in retracting fibrin lattices induced intense fibrinolysis that was observed at the earliest stages of contraction and led to complete matrix degradation by day 7 of culture. Our aim was to examine the influence of mechanical forces in such fibrinolytic processes. HGF were seeded in retracting (R) e.g. free floating or non retracting (NR) e.g. anchored fibrin lattices (FL). Cultures were analysed from day 1-12 by phase contrast microscopy and scanning electron microscopy (s.e.m.). Levels of fibrin degradation products (FDP) and tissue plasminogen activator (tPA) accumulating in culture media were quantified by ELISA. Urokinase (uPA) and gelatinase A (MMP2) were identified by zymographic techniques. At the s.e.m. level, vacuolization around some HGF was noticed at the earliest stages of culture for RFL and complete degradation of lattices occurred at day 7. Formation of lysed matrix cavity was far less intense in NRFL even after 12 days of culture. FDP amounts at day 4 of culture were equal to 79 +/- 14 and 8.5 +/- 0.6 micrograms/10(5) cells for RFL and NRFL, respectively; tPA levels were equal to 5.8 +/- 0.6 (RFL) and 2.1 +/- 0.3 ng/10(5) cells (NRFL) and differences were still evident at day 7. The kinetics of tPA production were identical in either retracting fibrin or collagen lattices. On the contrary, uPA and proMMP2 productions were similar in RFL and NRFL. Isometric forces, but not the matrix support, were responsible for accelerated tPA production and fibrinolysis in HGF populated lattices.

Biomechanical Phenomena↗