Glaucoma prevalence in the Nordic countries. Estimates based on glaucoma drug consumption

Glaucoma prevalences in the 5 Nordic countries are estimated on basis of a) wholesale of glaucoma medicaments (Denmark, Iceland, Norway, and Sweden) and b) registered glaucoma patients receiving free medication (Finland). Prevalences are compared nationally and internationally. The estimated glaucoma prevalence is highest in Norway (2.19% related to the population greater than 40 years), lowest in Denmark (0.76% in the same age group). The prevalence in Iceland, Finland, and Sweden are 2.0, 1.94, and 1.55%, respectively. We suggest that the relatively large differences in glaucoma prevalence between the countries may be explained by geographical differences in occurrence of capsular glaucoma. The sources of error concerning prevalence estimates based on glaucoma drug consumption are discussed. Pre-supposing a balance numerically between undetected glaucoma cases and patients receiving glaucoma medication without really having glaucoma, the glaucoma drug sales statistics may be taken as fair indicators of glaucoma prevalence.

Degree of myopia in relation to intelligence and educational level

Intelligence test scores and educational levels were compared for 5943 myopic and 9891 non-myopic 18-year-old men being drafted for military service in Denmark. The former were grouped by degree of myopia, in the range -0.25 diopters (D) to -7.75 D, according to the power of correcting lenses required. Myopes of all degrees had significantly higher test scores and educational levels than non-myopes. However, the relation of these two variables to degree of myopia was not linear; for both variables there were no significant differences among myopia groups in the range -2.0 to -7.75 D. Whereas factors associated with intelligence and education seem to be important in triggering the onset of myopia, they seem to be much less important in determining the degree to which myopia progresses.

[Concordance for myopia and discordance for optic disk cupping in a pair of monozygotic twins]

Of a pair of monozygotic twins who are both myopic, only twin B has an optic nerve pit in her left eye. At the age of 19 her visual acuity was reduced due to macular edema. Three years later, krypton laser coagulation treatment produced an appreciable improvement. Although both twins are myopic, the anisomyopia observed illustrates the influence of environment on ocular refraction.

Membranous nephropathy in a bone marrow transplant recipient

A bone marrow transplant recipient is described who had development of nephrotic syndrome in association with chronic graft-versus-host disease (GVHD) and on cyclosporine (CsA) treatment withdrawal. Renal biopsy revealed a membranous glomerulonephritis (MG). The possible relationship between this autoimmune disorder, the immunological features of GVHD in experimental animals, and the influence of CsA is discussed.

Intraocular lens calculation. An evaluation of Binkhorst and SRK estimates in 100 consecutive cataract extractions with 3M type 78 anterior chamber lens implantation

Intraocular lens power prediction and final astigmatism were evaluated in 100 consecutive cataract patients (age 57-92 years, mainly with intracapsular extraction) 4-13 months after insertion of a 3M type 78 anterior chamber lens. The analysis was based on refractive recordings from the referring ophthalmologists who took care of post-operative controls. Ninety-two patients were accepted for the study. A Sonometrics DBR 400 ultrasound equipment and a Haag-Streit keratometer had been used for measuring eye length and corneal power, the Binkhorst programme and SRK formula for selecting IOL power, resulting in an IOL range of +12 to +23 D. Mainly, low myopia was intended. Nearly 50% fell within 0.5 D from predicted value; 90% were within +/- 1.5 D, by both calculating methods. SRK predictions appeared unaffected by eye size, while axial length (x) significantly influenced Binkhorst prediction (y): y = 8.08-0.35x (r = -0.40), the deviation being most marked in very short eyes. For eyes of midsize the two methods did not differ. Regarding astigmatism, 3 patients ended with values above 3D. In 83% it was less than 2D. Eighty per cent obtained a visual acuity of 0.5 or better. All things considered we feel that the calculation procedure should be standard when performing cataract surgery with IOL implantation.

[Therapeutic trials of aclarubicin in previously treated acute leukemias and hematosarcomas]

In a phase I-II trial, 38 patients with acute myeloid leukemia (AML) were given single drug induction therapy with aclarubicin (ACM) according to two dosing schedules: treatment 1: 10 to 30 mg/m2/d to a maximum total dose of 300 mg/m2 or until development of unacceptable toxicity: treatment 2: 15 mg/m2/d in ten-day courses separated by ten-day intervals. Response rates were 15% with treatment 1 and 44% with treatment 2 (overall response rate 34%). Complete remission (CR) was achieved in 6 patients who had previously failed to respond to adriamycin (ADM). Toxicity was more frequent and more severe in those patients given more than 150 mg/m2 ACM per course. The main side effects were oropharyngeal mucositis and diarrhea. Three patients exhibited T wave inversion and one had an episode of auricular flutter. In a separate trial in 16 patients with AML we used cyclic chemotherapy combining ACM (20 mg/m2/d) and ARA-C (200 mg/m2/d) for seven consecutive days. Complete remission rate was 50%. Severe ventricular rhythm disorders were seen in two patients. In a phase I-II study, 19 patients with acute lymphoid leukemia (ALL) and 8 patients with non-Hodgkin lymphoma (NHL) were given ACM alone according to the regimen designated treatment 1 described above. Response rates were 11% (2/19) in ALL and 25% (2/8) in NHL. A review of the literature is presented in the discussion of the original trials reported herein.

Treatment of advanced colorectal and gastric adenocarcinomas with 5-fluorouracil and high-dose folinic acid

We report the results of an expanded trial of 5-fluorouracil (5-FU) combined with high-dose folinic acid for treatment of patients with advanced colorectal or advanced gastric adenocarcinoma. In each treatment course, the patients received both 5-FU (340 to 400 mg/m2/d by intravenous (IV) infusion for a period of 15 minutes) and folinic acid (200 mg/m2/d by IV bolus) for 5 consecutive days, with a 21-day interval between courses. Eighty-six patients with colorectal carcinoma were evaluated. The combined complete and partial response rates were 39% for 54 patients who did not receive prior chemotherapy and 22% for 32 patients who had previously received chemotherapy. Four patients who were previously resistant to 5-FU attained objective responses. The median time to disease progression for the 28 responders was 10 months. The median survival time of responders was 19.5 months, and the probability of their being alive at 2 years was 40%. Of 27 patients with gastric adenocarcinoma, 13 (48%) responded to therapy. Their median time to disease progression was 5.5 months. The median survival time of responders was 11 months, and their probability of being alive at 15 months was 30%. Toxicity was within acceptable limits. Toxic effects included stomatitis, diarrhea, conjunctivitis, skin rash, and mild myeloid hypoplasia. In a separate study, plasma concentrations of L-folates greater than 10(-5) mol/L were achieved after a rapid single IV injection of 200 mg/m2 of folinic acid. Comparisons of our results with those reported in previous studies on 5-FU administered as a single agent suggest that, in advanced colorectal and gastric adenocarcinoma, folinic acid administered in high doses enhances the effectiveness of 5-FU administered concomitantly. Furthermore, some colorectal tumors that were previously resistant to 5-FU become sensitive to this drug. The survival of the patients who responded to therapy was markedly improved over that observed in reported series of untreated patients with advanced colorectal and gastric adenocarcinomas.

Visual acuity in Danish school children

The medical records of 8769 school children attending the 2nd-5th grades in the Municipality of Odense have been scrutinized with regard to visual acuity. 1216 children were subject to examination, of these 1034 were found to have reduced vision due to anomalies of refraction other causes. Bilateral reduction in vision of less than or equal to 6/18 was observed in 8 children corresponding to 0.09%. Unilateral reduction in sight of less than or equal to 6/12 (employed here as the definition of amblyopia) was seen in 1.07% of the children. This applied to 1.39% of the boys and 0.73% of the girls; the difference is statistically significant. The lower frequency of amblyopia as compared to earlier investigations is probably a consequence of better vision screening during preschool age.

Treatment of advanced colorectal and gastric adenocarcinomas with 5-fluorouracil combined with high-dose folinic acid. An update

Sixty-six patients with advanced colorectal adenocarcinoma and 24 with advanced gastric adenocarcinoma were treated; all had measurable tumors. The treatment was based on biochemical and cell culture studies which have demonstrated that an excess of intracellular reduced folates is necessary to provide optimal inhibition of thymidylate synthetase and to increase the cytotoxic effect of fluoropyrimidines. The treatment comprised 5-fluorouracil (5-FU) (370-400 mg/m2/day) and high dose folinic acid (200 mg/m2/day) given simultaneously for 5 consecutive days with a 21-day interval between courses. Of the 66 patients with colorectal carcinoma, 44 had not been previously treated with cytostatics and 22 were resistant to previous chemotherapy with 5-FU given either as a single agent or combined with other drugs. The response rates both complete (CR) and partial (PR) were 45% and 18% in the previously untreated and the previously treated patients, respectively. Time to disease progression in the 20 previously untreated patients ranged from 2 to 34.5+ months (median, 10.3 months) and that of the 4 patients previously resistant to 5-FU was 7, 10, 12 and 15 months, respectively. Median survival for the 24 responders was 20.4 months. Survival in responders was significantly superior to that observed in patients with progressive disease (P less than 10(-8)). Of the 24 patients with gastric adenocarcinoma, 23 had not been previously treated with cytostatics and one was resistant to a 5-FU containing regimen. The response rate (CR + PR) was 50% (12 patients). The single previously treated patient failed to respond. Time to disease progression in the 12 responders ranged from 2.1 to 28.9 months (median, 5.6 months).(ABSTRACT TRUNCATED AT 250 WORDS)

Phase I-II study of aclarubicin for treatment of acute myeloid leukemia

Aclarubicin (ACM) was administered as induction treatment to 40 patients with acute myeloid leukemia (AML) who were either refractory to initial induction chemotherapy or in relapse. Thirty-eight patients with AML, 2-80 years of age (mean +/- SE, 35.0 +/- 3.2), were evaluated during this study. Seventeen of these patients were given ACM after an unsuccessful attempt had been made to attain a complete remission (CR) with various regimens that included doxorubicin or daunorubicin; this group was considered resistant to these drugs. ACM was administered by rapid iv injection. Thirteen patients received a single course of ACM at a daily dose of 10-30 mg/m2 until a maximum total dose of 300 mg/m2 was reached or until unacceptable toxicity appeared. Of these patients, two (15%) attained a CR. The other 25 patients were given 10-day courses of ACM at a daily dose of 15 mg/m2 with 10-day intervals between courses; courses were repeated until the blast cells were cleared from peripheral blood and bone marrow or until progressive disease became evident. With this regimen, 11 patients (44%) attained a CR. The overall CR rate for the 38 patients was 34%. Total doses necessary to achieve a CR ranged from 150 to 600 mg/m2. A CR was attained by six patients who were previously resistant to a regimen containing moderate doses of doxorubicin. The incidence and severity of the toxic effects were related to the dose of ACM administered per course of therapy. The incidence of mucositis, diarrhea, vomiting, and infection in patients who received doses greater than 150 mg/m2/course was significantly higher than that observed in patients who received a dose of 150 mg/m2/course. In the latter patients, toxicity was within acceptable limits. Alopecia was not observed. Three patients had transient T-wave inversion, and reversible atrial flutter developed in one patient. Our results indicate that ACM is a major new drug for the treatment of AML.

Treatment of acute myeloid leukemia with a combination of intensive induction chemotherapy, early consolidation, splenectomy and long-term maintenance chemotherapy

The authors developed a therapeutic regimen in which 33 patients aged 11 to 61 years (mean +/- SE, 35.9 +/- 2.3 years) with acute myeloid leukemia (AML) were given intensive induction chemotherapy with Adriamycin (doxorubicin) (ADM), vincristine (VCR) and cytosine arabinoside (ARA-C). Twenty-nine of these patients (88%) attained a complete remission (CR) after 1, 2, or 3 courses and were then subjected to an early consolidation course of chemotherapy, identical to that for induction. After consolidation, all patients in CR received a long-term continuous maintenance therapy in which 6-mercaptopurine (6-MP) and methotrexate (MTX) were alternated, associated with periodic reinforcements with daunorubicin (DNR) and VCR. Twenty-five of the 29 patients who achieved a CR were splenectomized soon after the consolidation course. Histologic sections of the spleens, liver biopsy specimens, and lymph nodes, stained routinely and with the naphthol AS-D chloroacetate esterase (NCA) method, showed mature granulocytes and a few NCA positive mononuclear cells, but no proved leukemic infiltrates. For the 25 splenectomized patients, the probability of remaining in CR at 36 and 54 months was 75% and 66%, respectively; the probability of survival at 36 and 54 months was 85% and 75%, respectively. Age older than 40 years and evidence of extramedullary involvement at presentation appeared to carry a bad prognosis for disease-free survival.

Capillary haemangiomas of the eyelids and orbit. A review of 5 children

Five children, previously treated for capillary haemangiomas of the eyelid and orbit, have been examined concerning the functional and cosmetic results of the treatment. Different principles of treatment have been applied (surgical, X-irradiation and systemic corticosteroid). All the children developed amblyopia in varying degrees in the affected eye, dependent on the localization of the tumour and duration of eyelid occlusion. They also developed persisted corneal astigmatism. The results of refraction, oculometric measurement and CT-scan are compared and discussed. From the results of the follow-up examination and the literature on the subject, we have attempted to give guidelines for the treatment of children with eyelid and orbital capillary haemangiomas.

Fate of aclacinomycin-A and its metabolites effect on cell growth and macromolecular synthesis

The relationship between the structure and activity of aclacinomycin-A (ACM) metabolites was investigated in vitro in Friend leukaemia cells (FLC). The cytotoxic effect was related to the ease with which ACM and its metabolites accumulate in the nucleus. Cellular uptake and nuclear incorporation are influenced by the hexopyranoses linked to aklavinone (AKV) and by the two methyls linked to the L-rhodosamine amino groups. The effect of ACM and its metabolites on macromolecular synthesis depended on the drug concentrations and the exposure time. ACM was the most active in the inhibition of nucleic acid synthesis whereas it had no direct effect on protein synthesis even at high drug concentrations. When cells were treated for a short time with low drug concentrations (1 microM), RNA synthesis was inhibited to a greater extent than DNA synthesis. But when incubated for longer periods, inhibition of DNA synthesis increased further. RNA and DNA syntheses were both inhibited to about the same extent only when cells were exposed to the higher drug concentrations (10 microM). We conclude therefore that at low drug concentrations the effect on DNA synthesis is probably a consequence of RNA synthesis inhibition. The early DNA synthesis inhibition which occurs at higher drug concentrations may result from the direct action on the cellular genome.

[Treatment of acute myeloid leukemia with a protocol combining intensive induction chemotherapy, early consolidation treatment, splenectomy and long-term maintenance chemotherapy. Preliminary study]

Twenty-seven patients aged from 10 to 60 years (mean 34.4 +/- 13 years) in the first perceptible phase of acute myeloid leukemia were subjected to intensive induction chemotherapy consisting of adriamycin (ADM), vincristin (VCR) and cytosine arabinoside (ARA-C). Twenty-four patients (89%) attained complete remission (CR) after 1 to 3 cycles and were then given an early consolidation treatment with one of the previous cycles. This was followed by long-term continuous maintenance chemotherapy with 6-mercaptopurine (6-MP) and methotrexate (MTX) alternatively and 3-monthly reinforcement courses of donaurubicin (DNR) and VCR. Twenty of these 24 patients were splenectomized soon after the consolidation treatment. None of the spleens were enlarged, and histological sections of the spleens, liver biopsies and mesenteric lymph-nodes stained with routine dyes and by the naphthol AS-D chloroacetate esterase method revealed mature granulocytes but no demonstrable leukaemic cells. In the group of splenectomized patients, the probabilities of staying in complete remission at 27 and 44 months were 70 +/- 12.6% and 52 +/- 18.5% respectively, and the probabilities of remaining alive at 32 and 55 months were 79 +/- 11% and 57 +/- 19% respectively. Age over 40 and evidence of extramedullary infiltration at presentation appeared to leave little hope of disease-free survival. The rationale for the present therapeutic study is discussed.

[Treatment of rectocolic and gastric adenocarcinomas with 5-fluorouracil associated with high doses of folinic acid. Results of an experimental study]

We report the results of a therapeutic trial in patients with rectocolic and gastric metastatic adenocarcinomas. This trial is based on experimental evidence that an excess of reduced intracellular folic acid increases the cytotoxicity of fluoropyrimidines. The treatment consists of 5-fluorouracile (5-FU) (370 to 400 mg/m2/24 h) and folinic acid in high doses (200 mg/m2: 24 h) given simultaneously for 5 consecutive days; the interval between courses is 21 days. Thirty patients with measurable rectocolic adenocarcinomas were evaluated. They were divided into two groups: 16 patients had had no previous chemotherapy and 14 had not responded to chemotherapy with 5-FU alone or associated with other cytostatic drugs. Response rates were 56% in the first group and 21% in the second. Five patients with measurable gastric adenocarcinomas were also evaluated; none had received previous chemotherapy. A partial response was recorded in three of these patients. Toxicity of the therapeutic regimen was acceptable. Stomatitis was the most common toxic side-effect. In patients with severe adverse side-effects recurrence was efficiently prevented by decreasing the daily dose of 5-FU to 30 mg/m2 during subsequent courses. We conclude that in the tumors studied folinic acid in high doses can improve the antitumoral effect of 5-FU and induce a response to this agent in some rectocolic tumors which were previously resistant.

Presenile cataract. A follow-up investigation with special reference to occupational aspects

A retrospective investigation was carried out of 100 patients below the age of 60 years operated for presenile cataract. The material has been divided into three occupational groups, depending on the visual requirements. The complaints prior to and after operation have been related to the patient ability to retain their employment. Of 78 patients who were still employed, only 45 were able to return to their former occupation after the first cataract extraction. The final result was that 62 patients could continue their former work, 12 changed their occupation due to aphakia problems, while four had to retire. The vision in the fellow eye, the type of work and the optical appliances have been found to be of primary importance. It is concluded that operation for unilateral cataract is inadvisable, if the vision of the fellow eye is good and contact lenses cannot be used, that the time between operations for bilateral cataract should be as short as possible, and that the use of contact lenses is essential.

Social and medical aspects of unilateral traumatic aphakia

Twenty-one males between 16 and 50 years of age were admitted during a five year period and treated for a corneal perforation and traumatic cataract. One did not attend the follow-up examination. Five patients were not offered contact lens owing either to their occupation or to bad visual acuity. Twelve patients were offered contact lens, but only four patients made permanent use of them and have good binocular function. Three patients were given an intraocular lens, two of these with good results. Many of the patients had considerable problems at work, and there appears to be a certain amount of relationship between the length of the sick leave and their later employment. Half of the patients had to change their occupation either totally or partly. Social security and social problems are discussed.

The karaite community of Iraq in Israel: a genetic study

Ninety-eight of 136 (72%) individuals at least 6 years of age from a small isolate of the Karaite community, known to have lived in Iraq since the tenth century, were examined. In Iraq this group maintained a highly inbred existence but married Karaites from Egypt after their immigration to Israel in 1951. Observations of several unique gene frequencies for blood group and isoenzyme markers, not described among other Jewish groups, are explicable by isolation and genetic drift in a very small community.

Postgraduate medical education: organization and aims. Denmark

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