Changes in the interpupillary distance with age and its effect on the near fusion free position

PURPOSE

The effect of the rate of the interpupillary distance (IPD) change with age on the near fusion free position was investigated in the present study.

METHODS

Three hundred and fifty-two children aged from 2 to 16 years of age were tested. Interpupillary distance was estimated with a modified Viktorin's method and the near fusion free position was measured with a modified Maddox Wing.

RESULTS

The results reveal a significant difference in IPD growth rate between females and males and between children aged below and above 5 years. Most children below 5 years of age were orthophoric, but heterophoria became more common above 5 years of age.

CONCLUSION

The present study suggests that the oculomotor control system for convergence can compensate for age changes in IPD.

Airway reactivity in welders: a controlled prospective cohort study

In a 3-year survey, respiratory symptoms, spirometry, and methacholine reactivity were measured annually in welders (n = 51) and non-welder controls subjects (n = 54) to determine whether welding-related symptoms are associated with accelerated decline in lung function or changes in airway reactivity. In the cross-workshift study, maximal midexpiratory flow rate declined reversibly during a welding day, whereas 1-second forced expiratory volume and forced-vital capacity were unchanged. In the longitudinal study, the welders had significantly more reversible work-related symptoms of cough, phlegm, wheeze, and chest tightness than the non-welder shipyard control subjects. In this group of actively working welders, across-workshift changes in midflow and reversible symptoms were related to the welding occupation, but evidence for chronic irreversible effects on spirometry or airway reactivity was not seen over the 3 years of observation. The short period of observation was not optimal for detecting a chronic effect on lung function. Work practices and engineering controls may be successfully preventing irreversible respiratory effects, but not mild reversible effects, in this group of welders.

Early postoperative angiographic assessment of radial grafts used for coronary artery bypass grafting

Despite a revival of interest in using the radial artery as an alternative conduit for myocardial revascularization, little angiographic documentation of early postoperative results has been presented, particularly in North America. Accordingly, 60 of 150 patients who underwent coronary artery bypass with radial arteries from November 1993 to July 1995 have had postoperative cardiac catheterization at our institution. The patency rate of the radial artery grafts was 95.7% (90 of 94 grafts patent) with an average internal diameter of 2.51 mm. Four radial artery grafts showed diffuse narrowing. The patency rate of the internal thoracic artery grafts was 100% with an average internal diameter of 2.25 mm. Three of 62 grafts demonstrated diffuse narrowing. Two of 24 (7.7%) saphenous vein grafts were occluded; the average internal diameter was 3.23 mm. The internal thoracic artery, the radial artery, and saphenous vein grafts were, respectively, 7.5%, 19.5%, and 53.3% larger than the anastomosed native coronary arteries. Graft-dependent flow was found in 81.1% of the radial artery grafts.

CONCLUSION

The results of this study demonstrate that the short-term patency rate of radial artery grafts is excellent.

Incidence of vocal fold paralysis in infants undergoing ligation of patent ductus arteriosus

BACKGROUND

Left-sided, iatrogenic vocal fold paralysis (IVFP) secondary to recurrent laryngeal nerve injury is a potential complication of ligation of patent ductus arteriosus (PDA). This study investigates specific risk factors associated with IVFP.

METHODS

A retrospective chart review was performed for all infants 12 months of age or younger who underwent operative PDA closure at the University of Iowa from January 1, 1991, to January 1, 1994.

RESULTS

Six cases of IVFP were diagnosed in 68 infants who underwent PDA ligation using clips (52.9%), suture ligatures (41.2%) or both (5.9%). Compared with infants without postoperative IVFP, infants with IVFP were smaller at birth (0.9 versus 2.3 kg; p < 0.001) and more premature (gestational age, 26.3 versus 33.8 weeks; p < 0.001), and were smaller (1.1 versus 3.4 kg; p < 0.001) and younger (31.9 versus 88.4 days; p < 0.001) at operation. Weight gain from birth to operation was significant only in infants without postoperative IVFP (p < 0.05). Although the overall incidence of IVFP in all infants undergoing PDA closure was 8.8%, five of the six cases (83.3%) of IVFP occurred in extremely low birth weight infants, ie, those weighing 1 kg or less at birth. Among the cohort of extremely low birth weight babies undergoing operation, the incidence of IVFP was 22.7%. Iatrogenic vocal fold paralysis was associated only with the use of surgical clips; however, because clips were used in 90.9% of the premature infants requiring PDA ligation, it was not possible to establish whether suture ligature is a safer technique.

CONCLUSIONS

This study demonstrates that the single major risk factor for IVFP after ligation of PDA is birth weight less than 1 kg.

Chondroid syringoma of the head and neck: clinical management and literature review

This report describes the case of a chondroid syringoma occurring in the nasofacial groove of a 60-year-old woman. This benign, mixed epithelial tumor is infrequently seen by the otolaryngologist-head and neck surgeon, and therefore may not be included in the differential diagnosis of a nodular lesion on the skin of the head and neck. However, the most frequent site of occurrence for these relatively rare cutaneous lesions is the head and neck region. Histologically, these tumors are quite similar to pleomorphic adenomas of salivary gland origin, and optimal surgical management similarly requires removal of a cuff of normal tissue, rather than a simple shelling out of the lesion. The clinical presentation, pathology and recommended management of this rare tumor are discussed.

Gender-associated differences in emergency department pain management

STUDY OBJECTIVE

To determine whether patient or provider gender is associated with the number, type, and strength of medications received by emergency department patients with headache, neck pain, or back pain.

DESIGN

Prospective cohort study.

SETTING

Stanford University Hospital ED PARTICIPANTS: Patients 18 years and older who arrived at the ED with a chief complaint of headache, neck pain, or back pain between February 1, 1993, and September 30, 1993. Provider participants included medical students, interns, residents, nurse practitioners, and attending physicians.

RESULTS

ED administration of analgesic versus no analgesic, strength of analgesic administered, and administration of multiple medications. The study group consisted of 190 patients, 110 of them female. The patients were evaluated by 84 providers, 60 of them male. According to the providers surveyed, female patients described more pain than did male patients (P < .01) and were perceived by providers to experience more pain (P = .03). Female patients received more medications (P < .01) and were less likely to receive no medication (P = .01). Female patients also received more potent analgesics (P = .03). Linear and logistic regression analysis showed that patient perception of pain was the strongest predictor of the number and strength of medications given; patient gender was not a predictor.

CONCLUSION

Female patients with headache, neck pain, or back pain describe more pain and are perceived by providers to have more pain than male patients in the ED. Female patients also receive more medications and stronger analgesics. In this study, severity of patient pain rather than gender stereotyping appeared to correlate most with pain-management practices.

Linkage of a gene for dominant non-syndromic deafness to chromosome 19

Inherited hearing impairment can occur either in the presence of other clinical features (syndromic hearing loss, SHL) or in isolation (non-syndromic hearing loss, NSHL). The latter is more common and is highly heterogeneous. To date, six NSHL loci have been mapped. We report the identification of a seventh locus (DFNA4) on chromosome 19q13 and suggest DM kinase as a possible candidate gene.

Identifying true lidocaine allergy

Allergies to local anesthetics are rare. More often, the allergic response is caused by a metabolite, preservative or unrelated substance. At times, an apparent allergic reaction can be brought on by anxiety. An idiopathic reaction to lidocaine is described, and allergy testing is discussed.

The effect of Isoptin SR on blood pressure, heart function and hypertrophy of left ventricle of hypertensive patients

Isoptin SR was used in 65 essential hypertensive patients. 240mg Isoptin SR (German Knoll Pharmaceutical company) per day was used in group A (35 cases) for 6 weeks, and in group B (30 cases) for 24 weeks, BP in group A and B decreased obviously in the first and second week after treatment. Marked effective rate and total effective rate were 65.7% and 74.3% respectively in group A, and 70.0% and 83.3% in group B. There were no significant changes of HR in group A before and after treatment while there was a decrease of HR in group B (P < 0.001). Left atrium (LA) decreased after 6 weeks in group A with an obvious increase of E/A ratio. There was significant decrease in LA, increase in E/A ratio, regression of IVS, LVPW and LVMI, but no changes in SV, CO, LVEF after 24 weeks of treatment of Isoptin SR in group B. E/A ratio was very sensitive and occurred earliest both in group A and group B. Side effects such as headache, dizziness, constipation, insomnia, peripheral oedema, sinus bradycardia occurred mainly in the first week of treatment. These symptoms disappeared gradually in the course of continued administration of Isoptin SR.

Unbleachable rhodopsin with an 11-cis-locked eight-membered ring retinal: the visual transduction process

Visual transduction occurs through photorhodopsin, the primary photoproduct of rhodopsin, which relaxes to bathorhodopsin and a series of other intermediates until it reaches the metarhodopsin II stage, upon which the enzymatic cascade leading to vision is activated. Despite advances in areas related to visual transduction, the triggering process itself, a key problem in the chemistry of rhodopsin, has remained unsolved. In order to clarify the extent of involvement of the chromophoric excited state versus the 11-cis to trans isomerization, and as an extension of past studies with 11-cis-locked seven-membered ring rhodopsin (Rh7), 11-cis eight- and nine-membered ring retinal analogs, ret8 and ret9, respectively, have been synthesized. The bulkiness of the tetramethylene bridge in ret8 led to numerous unexpected obstacles in attempts to reconstitute a ret8-containing rhodopsin (Rh8) embedded in lipid bilayer membranes. These obstacles were solved by using methylated rhodopsin which gave MeRh8 containing 11-cis-ret8 as its chromophore. MeRh8 exhibited UV-vis and CD spectra very similar to those of native rhodopsin (Rh); furthermore, the quantum efficiency of photorhodopsin formation was comparable to that of Rh.(ABSTRACT TRUNCATED AT 250 WORDS)

Ketorolac-induced bronchospasm in an aspirin-intolerant patient

A patient, in her mid-twenties, presented with "severe polypoid sinusitis" for sphenoethmoidectomy under general anesthesia. Upon preoperative medical evaluation, it was discovered that she was "allergic" to aspirin and suffered from stress-induced asthma. Before induction of anesthesia, the patient was administered intravenous hydrocortisone and two puffs of her albuterol inhaler to prevent a possible bronchospasm due to stress of the surgery or irritation from the endotracheal tube or other stimuli. The patient was maintained throughout the case with an inhalation anesthetic for its bronchodilatory effect. The surgery proceeded unremarkably, and the patient was then administered ketorolac tromethamine for postoperative pain. After an awake extubation, the patient was transferred to the postanesthesia care unit (PACU) for further monitoring. After 15 min in the PACU, the patient claimed having difficulty breathing. She was then administered terbutaline to produce bronchodilation, but her condition did not improve. Shortly thereafter, aminophylline, midazolam, and methylprednisolone were also administered intravenously. Meanwhile, the patient had to be reintubated and placed on ventilator support with heavy sedation. At this point, it was discovered that ketorolac may have been the cause of this response. Although the patient's condition began to improve, the histamine H1- and H2-receptor blockers diphenhydramine and ranitidine were coadministered. When the patient's condition returned toward normal, she was extubated. The patient's breathing continued to improve. Thereafter, she was transferred to an overnight observation bed and later dismissed to return home. The patient was advised of the episode and warned against future intake of other nonsteroidal antiinflammatory drugs.

Photoisomerization mechanism of the rhodopsin chromophore: picosecond photolysis of pigment containing 11-cis-locked eight-membered ring retinal

The primary photochemical event in rhodopsin is an 11-cis to 11-trans photoisomerization of its retinylidene chromophore to form the primary intermediate photorhodopsin. Earlier picosecond studies have shown that no intermediate is formed when the retinal 11-ene is fixed through a bridging five-membered ring, whereas a photorhodopsin-like intermediate is formed when it is fixed through a flexible seven-membered ring. Results from a rhodopsin analog formed from a retinal with locked 11-ene structure through the more flexible eight-membered ring (Ret8) are described. Incubation of bovine opsin with Ret8 formed two pigments absorbing at 425 nm (P425) and 500 nm (P500). P425, however, is an artifact because it formed from thermally denatured opsin or other proteins and Ret8. Excitation of P500 with a picosecond green pulse led to formation of two intermediates corresponding to photo- and bathorhodopsins. These results demonstrate that an appearance of early intermediates is dependent on the flexibility of the 11-ene and that the photoisomerization of P500 proceeds by stepwise changes of chromophore-protein interaction, which in turn leads to a relaxation of the highly twisted all-trans-retinylidene chromophore in photorhodopsin.