Child abuse and neglect: a diagnostic guide for the optometrist

Since approximately 40% of all physically abused children have ocular complications, it is increasingly important for optometrists to be prepared for an encounter with a child patient who has been abused. This review of the literature was undertaken to develop a diagnostic guide for the optometrist in face of a growing incidence of child abuse. It describes different types of abuse and their physical, emotional and behavioral manifestations. A special emphasis has been placed on head trauma and associated ocular signs. A list of state child protective services agencies, and how to contact them, is included.

Stability over time in the distribution of population forecast errors

A number of studies in recent years have investigated empirical approaches to the production of confidence intervals for population projections. The critical assumption underlying these approaches is that the distribution of forecast errors remains stable over time. In this article, we evaluate this assumption by making population projections for states for a number of time periods during the 20th century, comparing these projections with census enumerations to determine forecast errors, and analyzing the stability of the resulting error distributions over time. These data are then used to construct and test empirical confidence limits. We find that in this sample the distribution of absolute percentage errors remained relatively stable over time and data on past forecast errors provided very useful predictions of future forecast errors.

The release of PGF2 alpha and PGE2 from separated cells of human endometrium and decidua

The capacity of separated glandular and stromal cells from endometrium and first trimester decidua to release prostaglandins (PGs) was studied over 48 hours in culture. Glandular preparations released more PGs than stromal preparations in all tissues. Stromal release of PGs did not alter throughout the cycle or in early pregnancy but the capacity of glandular preparations to release PGs varied considerably. Proliferative glands released most PGF2 alpha and PGE2 followed by secretory glands and decidua. Histamine (10(-5)) stimulated PG release from endometrial and decidual glands but the response of proliferative glands was greatest. Actinomycin D stimulated release of PGF2 alpha and PGE2 from glandular cells of secretory endometrium and decidua. These results suggest that in vitro release of PGs is suppressed after ovulation and is in part due to inhibition of PG release by a protein or proteins synthesized in the glandular fraction of secretory endometrium or decidua.

The fibrogenic response of adult rat lung to continuous propranolol treatment

Fibrogenesis is a common pulmonary response to injury, which is usually preceded by other severe reactions, including inflammation, fluid exudation, and alveolar epithelial damage and proliferation. The purpose of this study was to examine the morphologic effects on the distal lung of a continuous propranolol treatment. Adult male rats were treated, via a subcutaneous osmotic pump, with a continuous (approximately 0.5 mg/hour) dose of propranolol HCl, a potent wide range beta-adrenergic blocking agent, in saline, or saline alone. The animals were killed after one week or three weeks. Electron microscopy of the lungs of the propranolol-treated animals revealed a dramatic increase in the prominence of interstitial cells and fibers of the alveolar septa, along with focal thickening of endothelial cells and some morphologic changes in type II alveolar epithelial cells. In some animals an analysis of total protein content, as well as 3H-proline incorporation into total protein and collagen was undertaken. The results of this study indicated a significant increase in total protein content and proline incorporation into collagen in the lungs of animals treated for seven days with continuous propranolol. There was no evidence of stimulated blood cells, macrophages, edema or severe epithelial damage. This study provides morphologic evidence that continuous treatment with moderate levels of propranolol results in a fibrogenic response in the peripheral lung, in the absence of typical hallmarks of severe pulmonary damage.

Effect of platelet-activating factor on the release of PGF-2 alpha and PGE-2 by separated cells of human endometrium

Synthetic platelet-activating factor (PAF-acether, 1-0-alkyl-2-acetyl-sn-glycero-3-phosphocholine) caused a dose-dependent increase in the synthesis of prostaglandin (PG) E-2 by an enriched glandular, but not stromal, fraction of human endometrium removed in the secretory phase of the menstrual cycle. PAF-acether did not alter the synthesis of PGF-2 alpha by this fraction and consequently there was a significant reduction in the ratio of the amounts of PGF-2 alpha/PGE-2 released by the cells into the culture medium. The preimplantation human embryo secretes PAF, and these findings may have relevance to the local maternal recognition of pregnancy.

Tests of forecast accuracy and bias for county population projections

"This article deals with the forecast accuracy and bias of population projections for 2,971 counties in the United States. It uses three different projection techniques and data from 1950, 1960, 1970, and 1980 to make two sets of 10-year projections and one set of 20-year projections. These projections are compared with census counts to determine forecast errors. The size, direction, and distribution of forecast errors are analyzed by size of place, rate of growth, and length of projection horizon. A number of consistent patterns are noted, and an extension of the empirical results to the production of confidence intervals for population projections is considered." A comment by Paul M. Beaumont and Andrew M. Isserman is included (pp. 1,004-9) together with a rejoinder by the author (pp. 1,009-12). This is a revised version of a paper presented at the 1986 Annual Meeting of the Population Association of America (see Population Index, Vol. 52, No. 3, Fall 1986, p. 456).

The effect of estradiol-17 beta and actinomycin D on the release of PGF and PGE from separated cells of human endometrium

Estradiol-17 beta selectively stimulated the release of PGF from separated glandular but not stromal cells of human secretory endometrium (p less than 0.025) but had no effect on PGF release from either type of cells obtained from proliferative endometrium. PGE release was not affected by estradiol-17 beta. Actinomycin D did not antagonise the effect of estradiol-17 beta on PGF release from secretory, glandular cells. Basal release of PGF from these cells was stimulated by actinomycin D alone (100 ng/ml) (p less than 0.025) and PGE release stimulated in the presence of estradiol-17 beta. Actinomycin D had no effect on PGF or PGE release from proliferative endometrium. These findings suggest that estradiol-17 beta stimulates PGF release by a mechanism that does not affect PGE release and which is not dependent on the synthesis of new protein. The basal release of PGF and PGE by glandular cells of secretory endometrium in vitro is regulated by protein/proteins which reduce PG release.

Progesterone and antiprogestins, a comparison of their effect on prostaglandin production by human secretory phase endometrium and decidua

The mechanism by which progesterone inhibits PG production is not clear. In systems using isolated human endometrial fragments, progesterone has been shown to inhibit PG production markedly. We have used such a system to test the action of two antiprogesterone steroids RU486 (Roussell-Uclaf) and ZK98734 (Schering) on isolated human endometrial and decidual tissue, with and without added progesterone. Progesterone (200 nM) reduced PGF2 alpha production by the secretory phase endometrium from 10.9 ng/mg tissue/24 hr to 1.9 ng/mg/24hr on the third day of culture (p less than .01) and this effect was antagonised by the addition of either 200 nM RU486 or 200 nM ZK98734 (6.3 and 7.2 ng/mg/24 hr respectively). The antiprogestins on their own showed a slight inhibitory effect on day 3 and RU486 treatment resulted in a significant (p less than .05) decrease in PG production from control. PGE and the main 13,14-dihydro-15-keto metabolites of E and F were also significantly decreased by progesterone and restored by the antiprogestins. The PG production by decidua increased on days 2 and 3 in response to progesterone + antiprogestins but this was not significant. This data shows that the inhibition of PG production shown by progesterone, acting on secretory phase endometrium cultured as tissue fragments, is reversible by the receptor blocking antiprogestins.

The effect of the antiprogestins RU 486 and ZK 98734 on the synthesis and metabolism of prostaglandins F2 alpha and E2 in separated cells from early human decidua

Enriched preparations of glandular and stromal cells were obtained from early human decidua and incubated for 24 h in the presence of two progesterone antagonists, RU 486 (17 beta-hydroxy-11 beta-[4-dimethylaminophenyl]17 alpha-[1-propynyl]-estra-4,9-dien-3-one) and ZK 98734 (17 beta-hydroxy-11 beta-4[4-dimethylaminophenyl]17 alpha-[3-hydroxy-1-propynyl]estra-4,9-dien-3-one) to determine the effect of the antiprogestins on the release of prostaglandin F2 alpha (PGF2 alpha) and PGE2 and their subsequent conversion to 15-keto-13,14-dihydro-PGF2 alpha and 15-keto-13,14-dihydro-PGE2. In the presence of exogenous arachidonic acid (AA, 30 microM), both steroids stimulated PGF2 alpha release by glandular, but not stromal, cells (P less than 0.001) and inhibited the metabolism of PGF2 alpha by the glandular fraction (P less than 0.005 and P less than 0.001 respectively). In the absence of exogenous AA, RU 486 and ZK 98734 stimulated the release of PGF2 alpha from glandular, but not stromal, cells (P less than 0.001 and P less than 0.005, respectively). Neither steroid altered the release or metabolism of PGE2 when the cells were incubated with AA, but both RU 486 and ZK 98734 increased the release of PGE2 by glandular, but not stromal, cells when incubated without AA (P less than 0.005 and P less than 0.001, respectively). Both steroids inhibited the metabolism of PGE2 under these conditions (P less than 0.05). These results suggest that 1) antiprogestins stimulate the synthesis of PGs by glandular cells in early human decidua, but do not alter the synthesis of PGs by stromal cells; 2) this stimulation of PG synthesis involves an effect on cyclooxygenase activity and is not a consequence of increased availability of endogenous AA; 3) the metabolism of PGs by glandular cells is altered by RU 486 and ZK 98734; 4) as RU 486 has greater antiglucocorticoid activity than ZK 98734, these results suggest that both steroids act on decidua by antagonizing endogenous progesterone rather than glucocorticoid activity.

Cytoplasmic enzyme patterns in isolated hamster pulmonary alveolar type II cells

Three cytoplasmic enzyme patterns were studied in pulmonary alveolar type II cells isolated from normal adult hamster lung: lactate dehydrogenase (total and isoenzymes), peroxidase, and beta-N-acetylglucosaminidase. Enzyme patterns of freshly-isolated type II cells were found to be different from those of freshly-isolated pulmonary hamster fibroblasts. After both types of cells had been cultured for seven days, no difference in cytoplasmic enzyme patterns remained. Lactate dehydrogenase isoenzyme patterns for type II cells were different from those obtained from polymorphonuclear leukocytes and alveolar macrophages. These data may be useful in detecting sources of lung injury by assessment of enzyme patterns in bronchoalveolar lavage fluid.

Glucocorticoids do not share with progesterone the potent inhibitory action on prostaglandin synthesis in human proliferative phase endometrium

The action of progesterone and glucocorticoids on human proliferative phase endometrium has been investigated using isolated fragments of endometrium cultured for 2 to 3 days. The action of progesterone (200-500 nM) in this system is to reduce prostaglandin F (PGF) production by 93 to 96%. This inhibition is considerably greater than the inhibitions observed using collagenase dispersed stromal or glandular cells. The addition of arachidonic acid (5 micrograms/ml) increased the production of the control wells but did not overcome the inhibitory effect of progesterone. When endometrial fragments were cultured for 48 hr in the presence of progesterone and subsequently homogenized and incubated, there was no difference in PG production between the progesterone treated tissue and the controls. In a separate series of experiments the effect of progesterone (500nM) was compared with cortisol (500nM) and the synthetic glucocorticoid dexamethasone (100nM) this dose of progesterone gave a 96% reduction in PGF synthesis but neither cortisol nor dexamethasone inhibited PGF production.

LRH agonist buserelin as a post-partum contraceptive: lack of biological activity of buserelin in breast milk

To evaluate the possibility of using the LRH agonist buserelin as a contraceptive for lactating women we have investigated the passage of buserelin into breast milk and explored possible biological activity in the infant. Eleven mothers received 600 micrograms buserelin by nasal spray. Buserelin was measured by radioimmunoassay in the breast milk of these mothers, and values ranged from undetectable levels (less than 15 pg/ml) to 8800 pg/ml. The maximum amount of buserelin that an infant could ingest during an average feed would be 1-2 micrograms. In adult men ingestion of 600 micrograms buserelin dissolved in cows milk was without biological effect upon both serum and urinary levels of luteinizing hormone. There was no change in the levels of LH found in the urine of infants fed by women who had received 600 micrograms buserelin by nasal spray. We conclude that the small amount of buserelin passing into the breast milk of these volunteers was without biological activity when ingested by the infant.

The effect of deliberate omission of Trinordiol or Microgynon on the hypothalamo-pituitary-ovarian axis

The effect of deliberate omission of a phased formulation pill, Trinordiol (ethinyl estradiol 30 micrograms + levonorgestrel 50 micrograms: 6 tablets; ethinyl estradiol 40 micrograms + levonorgestrel 75 micrograms: 5 tablets; ethinyl estradiol 30 micrograms + levonorgestrel 125 micrograms: 10 tablets) or a low-dose, combined, oral contraceptive pill, Microgynon (ethinyl estradiol 30 micrograms + levonorgestrel 150 micrograms: 21 tablets) on the hypothalamo-pituitary-ovarian axis were studied. Thirty-six women were recruited to the study and divided equally between the two types of pill. Medication was begun on the 8th pill-free day of the cycle and continued for 7 days (Group 1), 14 days (Group 2) or 21 days (Group 3). Levels of FSH, LH, estradiol (E2) and progesterone (P) were measured in plasma on alternate days during the final week of pill therapy, and daily for the 7 days after stopping the pill. For the first 2 weeks of pill therapy, follicular activity, as judged by plasma levels of E2, was greater in women taking Trinordiol than in those taking Microgynon, but was similar in both groups by the third week of pill treatment. Five women taking Trinordiol (2 in Group 1 and 3 in Group 2) had plasma levels of E2 in excess of 500 pmol/l whilst taking the pills, and only 1 patient achieved this degree of follicular activity after stopping the tablets. One woman who had taken 7 days of Trinordiol (Group 1) showed a rise of plasma levels of P to 6.8 nmol/l, but luteinization did not occur in any of the remaining 35 women who took Trinordiol or Microgynon. These findings suggest that follicular activity is less completely suppressed by Trinordiol than Microgynon, at least in the first 2 weeks of pill therapy, but that normal ovulation is still a rare event in the week after cessation of either of these pills, even if only 7 days of medication have been taken.

A review and evaluation of the housing unit method of population estimation

"The housing unit (HU) method is used by public and private agencies throughout the United States to make local population estimates. This article describes many of the different types of data and techniques that can be used in applying the HU method, and it discusses the strengths and weaknesses of each. Empirical evidence from four different states is provided, comparing the accuracy of HU population estimates with the accuracy of other commonly used estimation techniques. Several conclusions are drawn regarding the usefulness of the HU method for local population estimation."

Accounting for migration in cohort-component projections of state and local populations

Migration is the most difficult component of state and local population growth to forecast accurately because it is more volatile than either births or deaths, and subject to much larger fluctuations within a short period of time. In addition, migration rates can be based on several different measures of migration and the base population. The choice of the appropriate base population has received little attention from demographic researchers, but can have a tremendous impact on population projections. In this article, I develop three different models for projecting migration, each using a different denominator for migration rates. Population projections for ten states are made, using identical data and cohort component techniques, except for the different formulations of migration rates. Differences among the three sets of projections are noted, and conclusions are drawn regarding their usefulness as forecasts of population growth.

Using Medicare data for short-run projections of the elderly population

As the elderly population of the United States grows in absolute number and as a proportion of total population, accurate projections of that population become increasingly important for sound policy decisions. Cohort component techniques are typically used for state and local projections of the elderly population, but are often outdated or even nonexistent for many local areas. This paper suggests an alternative approach, based on Medicare data and simple projection techniques. Projections for several base periods and projection horizons are made for all states and for counties in Florida and are compared with actual Medicare enrollment. On the basis of these comparisons it appears that Medicare data and simple projection techniques can produce very useful short-run projections of the elderly population for states and local areas.

Dysfunctional uterine bleeding

Dysfunctional uterine bleeding initially described abnormal bleeding unassociated with pregnancy, infection or tumour, and was assumed mainly to follow abnormal ovarian function. In conjunction with other menstrual disorders it is now recognized to be a problem predominantly of ovulatory cycles (Table 1). This article discusses the reasons behind this change of emphasis and medical approaches to the problem.

Plasma gonadotrophin and ovarian steroid concentrations in women with menstrual cycles with a short luteal phase

Daily plasma concentrations of FSH, LH, oestradiol-17 beta and progesterone were compared for 12 cycles with a short luteal phase and 19 cycles with a luteal phase of normal length (i.e. cycles in which the luteal phase lasted 12 or more days). FSH and LH concentrations were suppressed in short luteal-phase cycles in the early follicular phase and the length of the follicular phase was prolonged (median duration, 14.5 days, range 13-21 days: compared with 12 days, range 9-17, in control cycles; P less than 0.025). Preovulatory oestradiol-17 beta values and the mid-cycle concentrations of FSH and LH were similar in both groups. Plasma progesterone values in the luteal phase were similar in both groups over the 2nd to 5th days inclusive after the midcycle LH peak but declined in the short luteal phases thereafter. In short luteal-phase cycles, menstruation occurred in the presence of higher levels of oestradiol-17 beta and progesterone than in cycles of normal length and the rise of gonadotrophin in the late luteal phase of the cycle was delayed. These findings suggest that in cycles with a short luteal phase there is a lack of synchrony between the ovarian and menstrual events.

Surface glycoproteins as markers of the cellular status of B chronic lymphocytic leukaemia lymphocytes

The phenotype of B CLL cells is investigated with respect to their surface glycoproteins. These glycoproteins are identified by vectorial tritiation followed by 1 and 2 dimensional gel electrophoresis, and by lectin and MoAb binding using immunoprecipitation and flow cytometry. The profiles of the CLL cells are compared with those of normal B cells, prepared from tonsils, and T cells from peripheral blood. The CLL cells show many similarities with T cells, particularly the expression of glycoproteins which bind the MoAbs gpL 115, F10-44-2 and EZB 52, and a complex set of binding sites for Helix pomatia lectin. The significance of these observations in terms of the cellular origins of the leukaemic lymphocytes is discussed.

Influence of pulmonary endothelial cells on fetal lung development

Culture medium conditioned by pulmonary endothelial cells stimulated proliferation of cultured fetal lung cells, as measured by increases in cell numbers, incorporation of tritiated thymidine into DNA, and incorporation of labeled choline into membrane phospholipids. Medium conditioned by several other cell culture preparations of fetal lung did not elicit these effects. The growth-promoting activity was found to be concentrated in fractions of 42,000 and 89,000 molecular weight (mol wt). In addition to promoting cell growth, medium conditioned by pulmonary endothelial cells also appeared to stimulate the incorporation of labeled choline into surfactant-associated phosphatidylcholine. These results suggest that pulmonary endothelial cells may produce factors that stimulate the growth and perhaps also the differentiation of fetal lung cells in culture.

Abnormalities in the expression of the leucocyte-common antigen in chronic lymphocytic leukaemia

The surface glycoproteins of lymphocytes isolated from patients suffering from B cell chronic lymphocytic leukaemia (B-CLL) have been studied by radioactive labelling with impermeable probes and with MoAb. Several features not found in normal B cells have been observed. The abnormalities found in the expression of polypeptides of the leucocyte common (L-C) antigen, identified by appropriate MoAb, have been examined in detail. It has been shown by both biochemical analysis and MoAb binding that this group of polypeptides can, within a panel of B-CLL patients, range from a typical B cell pattern to the pattern resembling that normally found in T cells. The T lymphocyte profile is correlated with a poor prognosis (MVA C rating) and in the one patient where a change in the glycoprotein profile towards that of the T cell was observed, the change coincided with a clinical deterioration. The biological significance of the molecular diversity is discussed.

The short luteal phase and infertility

The distribution of the length of the luteal phase was investigated in 187 women with regular, apparently ovulatory menstrual cycles of whom 95 had unexplained infertility and the other 92 comprised a group of healthy volunteer subjects. If the short luteal phase is associated with infertility it might be expected to occur more frequently in women with unexplained infertility. A short luteal phase (defined as a luteal phase lasting less than or equal to 11 days) was found in 9% of the infertile group and in 8% of the normal group showing that these cycles do not occur more frequently in women with infertility.