Retrospective analysis of a novel method of transscleral suture fixation for posterior-chamber intraocular lens implantation in the absence of capsular support

PURPOSE

To determine the safety and efficacy of an alternative method for transscleral fixation of a secondary posterior-chamber intraocular lens (pcIOL) during penetrating keratoplasty.

METHODS

Eighty-nine eyes that underwent secondary pcIOL implantation by using a modified transscleral suture-fixation technique during penetrating keratoplasty were retrospectively evaluated. The surgical technique used suture fixation to the surface of the sclera 5 mm posterior to the limbus, with the knot buried beneath Tenon's capsule and conjunctiva. Patient records were reviewed for postoperative complications, including suture erosion, pcIOL subluxation, vitreous hemorrhage, and retinal detachment. Mean follow-up was 24.4 months, with a range of 4-68 months.

RESULTS

All eyes had successful fixation of their pcIOL immediately after surgery. Three (3.3%) eyes had graft failure. Six (6.7%) of 89 eyes showed evidence of suture erosion or partial exposure. Postoperative suture breakage occurred in two (2.2%) eyes. Posterior-segment complications included retinal detachment in one (1.1%) eye, vitreous hemorrhage in one (1.1%) eye, and limited choroidal hemorrhage in two (2.2%) eyes. Median visual acuity at 1-year follow-up was 20/70 (range, 20/25 to light perception).

CONCLUSION

This transscleral fixation technique provides a straightforward alternative to previously described techniques. Suture erosion, IOL dislocation, and posterior-segment complications occurred at relatively low rates compared with other pcIOL implantation techniques.

Suppressors of an Arabidopsis thaliana phyB mutation identify genes that control light signaling and hypocotyl elongation

Ambient light controls the development and physiology of plants. The Arabidopsis thaliana photoreceptor phytochrome B (PHYB) regulates developmental light responses at both seedling and adult stages. To identify genes that mediate control of development by light, we screened for suppressors of the long hypocotyl phenotype caused by a phyB mutation. Genetic analyses show that the shy (short hypocotyl) mutations we have isolated fall in several loci. Phenotypes of the mutants suggest that some of the genes identified have functions in control of light responses. Other loci specifically affect cell elongation or expansion.

Bilateral monocular diplopia associated with lid position during near work

PURPOSE

To describe a common pattern of topographic changes and clinical signs of six patients presenting with a complaint of monocular diplopia after reading and to investigate the cause of this topographic disturbance.

METHODS

PATIENT POPULATION

Subject group of six patients with monocular diplopia complaints after reading and 20 patients without such complaints. Examinations performed before and after a reading period of 30 min: videokeratoscopic examination, red reflex examination, position of the lids in primary gaze and in reading position.

DATA ANALYSIS

inspection of keratoscopic rings, qualitative analysis of topography maps, comparison of SAI and SRI of control and subject groups before and after reading, comparison of lid position of control and subject group.

RESULTS

Half of the subject group and none of the control group developed subtle ring distortions of keratoscopic rings. SAI and SRI values increased significantly in the subject group compared with the control group (p = 0.02 and p < 0.001, respectively) corresponding to the development of a focal distortion in the entrance pupil of the videokeratoscopic image. Each subject developed a horizontal band on red reflex located at the superior, middle, or inferior aspect of the pupil after near work. Two controls developed faint bands in the red reflex outside the entrance pupil. The interpalpebral fissure in down gaze was narrower in the subject group compared with the control group (p = 0.001).

CONCLUSIONS

Some individuals may develop monocular diplopia after reading. We hypothesize that during near work these corneal topographic alterations occur primarily related to the position of the lids and tear film interaction with the corneal surface.

Baroreflex function in sedentary and endurance-trained elderly people

OBJECTIVE

to determine the differences associated with age and endurance exercise training on the baroreflex function of healthy subjects.

DESIGN

cross-sectional study.

SETTING

university research department.

PARTICIPANTS

26 (10 female) sedentary, healthy, normotensive elderly subjects (mean age 67 years, range 62-81), eight (two female) elderly endurance-trained athletes (66 years, 62-69) and eight (two female) young (30 years, 25-34) subjects.

MEASUREMENTS

baroreflex sensitivity was quantified by the alpha-index, at high frequency (HF, 0.15-0.35 Hz) and mid frequency (MF, 0.05-0.15 Hz), derived from spectral and cross-spectral analysis of spontaneous fluctuations in heart rate and blood pressure.

RESULTS

resting heart rate was significantly lower in endurance-trained athletes than sedentary elderly people (58 +/- 12 versus 68 +/- 11 min(-1), P < 0.05) but not different to that in healthy young subjects (63 +/- 9 min[-1]). alpha(HF) in sedentary elderly subjects (8.1 +/- 4.2 ms.mm Hg[-1]) was lower than both endurance-trained elderly athletes (14.8 +/- 4.8 ms.mm Hg(-1), P < 0.05) and healthy young subjects (28.3 +/- 21.8 ms.mm Hg(-1), P < 0.05) and was not significantly different between endurance-trained elderly athletes and healthy young subjects (P = 0.10). alpha(MF) in healthy young subjects (15.4 +/- 8.8 ms.mm Hg[-1]) was greater than in sedentary elderly subjects (6.5 +/- 3.2 ms.mm Hg(-1), P < 0.01) and endurance-trained elderly athletes (6.9 +/- 2.0 ms.mmHg(-1), P < 0.01), while there was no significant difference between the two elderly groups (P = 0.66).

CONCLUSIONS

both components of the baroreflex measured by the alpha-index show a decrease with age. Elderly endurance-trained athletes have less reduction in the high, but not mid, frequency component of the alpha-index compared with sedentary elderly subjects. Some of the age-related changes in baroreflex sensitivity may be related to physical fitness and activity levels.

Effects of aerobic exercise training and yoga on the baroreflex in healthy elderly persons

It is unclear whether the age-associated reduction in baroreflex sensitivity is modifiable by exercise training. The effects of aerobic exercise training and yoga, a non-aerobic control intervention, on the baroreflex of elderly persons was determined. Baroreflex sensitivity was quantified by the alpha-index, at high frequency (HF; 0.15-0.35 Hz, reflecting parasympathetic activity) and mid-frequency (MF; 0.05-0.15 Hz, reflecting sympathetic activity as well), derived from spectral and cross-spectral analysis of spontaneous fluctuations in heart rate and blood pressure. Twenty-six (10 women) sedentary, healthy, normotensive elderly (mean 68 years, range 62-81 years) subjects were studied. Fourteen (4 women) of the sedentary elderly subjects completed 6 weeks of aerobic training, while the other 12 (6 women) subjects completed 6 weeks of yoga. Heart rate decreased following yoga (69 +/- 8 vs. 61 +/- 7 min-1, P < 0.05) but not aerobic training (66 +/- 8 vs. 63 +/- 9 min-1, P = 0.29). VO2 max increased by 11% following yoga (P < 0.01) and by 24% following aerobic training (P < 0.01). No significant change in alpha MF (6.5 +/- 3.5 vs. 6.2 +/- 3.0 ms mmHg-1, P = 0.69) or alpha HF (8.5 +/- 4.7 vs. 8.9 +/- 3.5 ms mmHg-1, P = 0.65) occurred after aerobic training. Following yoga, alpha HF (8.0 +/- 3.6 vs. 11.5 +/- 5.2 ms mmHg-1, P < 0.01) but not alpha MF (6.5 +/- 3.0 vs. 7.6 +/- 2.8 ms mmHg-1, P = 0.29) increased. Short-duration aerobic training does not modify the alpha-index at alpha MF or alpha HF in healthy normotensive elderly subjects. alpha HF but not alpha MF increased following yoga, suggesting that these parameters are measuring distinct aspects of the baroreflex that are separately modifiable.

Mitochondrial function in muscle from elderly athletes

The extent to which mitochondria are involved in the aging process is controversial; much of the reported decline in mitochondrial oxidations in human skeletal muscle may be due to disease and inactivity rather than age. To study true aging, mitochondrial respiratory chain function was studied in 9 young and 12 elderly athletes. No significant deterioration with age was observed. If mitochondria are involved in aging, it must be through a more subtle mechanism than a global decline in respiratory chain activity.

Phytochrome B affects responsiveness to gibberellins in Arabidopsis

Plant responses to red and far-red light are mediated by a family of photoreceptors called phytochromes. Arabidopsis thaliana seedlings lacking one of the phytochromes, phyB, have elongated hypocotyls and other tissues, suggesting that they may have an alteration in hormone physiology. We have studied the possibility that phyB mutations affect seedling gibberellin (GA) perception and metabolism by testing the responsiveness of wild-type and phyB seedlings to exogenous GAs. The phyB mutant elongates more than the wild type in response to the same exogenous concentrations of GA3 or GA4, showing that the mutation causes an increase in responsiveness to GAs. Among GAs that we were able to detect, we found no significant difference in endogenous levels between wild-type and phyB mutant seedlings. However, GA4 levels were below our limit of detectability, and the concentration of that active GA could have varied between wild-type and phyB mutant seedlings. These results suggest that, although GAs are required for hypocotyl cell elongation, phyB does not act primarily by changing total seedling GA levels but rather by decreasing seedling responsiveness to GAs.

Longitudinal effects of change in body mass on measurements of ventilatory capacity

BACKGROUND

In several longitudinal studies changes in body mass and in forced expiratory volume in one second (FEV1) have been found to be negatively correlated. This paper tests the hypothesis that failure to allow for the association can lead to error in the interpretation of longitudinal measurements of ventilatory capacity.

METHODS

Male shipyard workers (n = 1005) were assessed on two occasions with an average interval between measurements of 6.9 years. A respiratory symptoms questionnaire, detailed anthropometric measurements, and dynamic spirometric tests were undertaken. Multiple regression analysis was used to identify variables which contributed to the changes in lung function.

RESULTS

After allowing for age and growth in stature, a change in body mass of 1 kg was, on average, associated with a mean (SE) converse change in FEV1 of 17.6 (2.0) ml, and in forced vital capacity (FVC) of 21.1 (2.5) ml. Neglect of changes in body mass (which in this context reflected changes in body fat) led to underestimation of the longitudinal decline in FEV1 with age and failure to detect significant improvements in FEV1, both in smokers following discontinuation of smoking and in shipyard welders and caulker/burners as a consequence of leaving their employment. The estimated peak ages and associated peak levels of the indices were found to differ, depending on whether or not they were expressed at constant body mass.

CONCLUSIONS

Neglect of changes in body mass can lead to erroneous conclusions being drawn from longitudinal measurements of FEV1.

Transfer factor (diffusing capacity) standardized for alveolar volume: validation, reference values and applications of a new linear model to replace KCO (TL/VA)

Transfer factor (TL) varies with alveolar volume (VA), but not in the manner implied by the carbon monoxide transfer coefficient (KCO (TL/VA)). This paper considers two other simple models (one linear and one exponential) which might standardize TL for VA, and asks the questions: 1) Is either model valid? 2) What are appropriate reference values? and 3) Will the model be useful? The relationship of TL to VA within subjects at different depths of inspiration, and between subjects having lungs of different sizes, were measured and compared. The subjects were asymptomatic, nonsmoking, Caucasian adults, including 31 males assessed in the laboratory and 503 male and female participants in population studies. The linear partial regression coefficients of TL on VA (L corrected for body temperature, atmospheric pressure and water saturation (BTPS)) standardized for height (H) in metres, were similar within- and between-subjects; the coefficients applied over a wide range of values for VA. This was not the case for the exponential model. The resulting reference equations in SI units for males and females were: TL = 11.52 H + 2.72 VA.H-2 - 0.051 Age -12.35. RSD 1.17; and TL = 4.87 H + 2.29 VA.H-2 - 0.019 Age -3.03. RSD 0.92, respectively. The residual standard deviations (RSD) about the new relationships were less than in other series. The new linear model could account for much of the variation between different published reference values for TL; it could be useful clinically, in circumstances when VA deviates from the norm. The model does not explain differences in TL associated with gender. Inclusion of VA.H-2 as a covariate in the reference equation for transfer factor, in addition to age and height, improves the accuracy of prediction of normal transfer factor compared with current reference values; its use suggests that some of the differences between published values is due to the volume term. The equations can be used clinically, and eliminate the need for carbon monoxide transfer coefficient.

Electron Transfer. 129. Copper Catalysis in the Thiol Reduction of Oxime-Bound Nickel(IV)(1)

Solutions of the Ni(IV) complex of the dianion of 2,6-diacetylpyridine dioxime (chelate II in text) are reduced very slowly by 2-aminoethanethiol at pH 2.3-3.0, but this reaction is catalyzed dramatically and specifically by dissolved copper, with Cu(I) the active reductant. When the [thiol]/[Ni(IV)] ratio exceeds 1.6, each Ni(IV) oxidizes two molecules of thiol, forming Ni(II) and R(2)S(2). At low concentrations of catalyst and reductant, reaction profiles are almost exponential, but at higher concentrations of either, curves become progressively more nearly linear. Reactions are sharply retarded by increases in acidity. Profiles for 14 runs, carried out with [H(+)] = 0.001-0.0040 M, [Ni(IV)] = (0.94-1.2) x 10(-)(5) M, [thiol] = (2.0-32) x 10(-)(4) M, and [Cu(2+)] = (2.5-80) x 10(-)(6)M, are consistent with a reaction sequence (eqs 2-10 in text) in which Cu(I) is generated in competing homolyses of the complexes Cu(II)(SRH) and Cu(II)(SRH)(2). Reduction of Ni(IV) appears then to proceed through a Ni(IV)Cu(I) adduct, which can undergo electron transfer (yielding Ni(III) and Cu(II)), either in a unimolecular fashion or, alternatively, as a result of attack by a second Cu(I) species. The Ni(IV)Cu(I) + Cu(I) process is reflected in approach to second-order dependences on [Cu(II)] and [thiol] (which generate Cu(I)) at high concentrations of these reagents. Reductions of the Ni(III) intermediate are taken to be much more rapid than those of Ni(IV). Kinetic trends in the present system stand in contrast to the more familiar catalytic patterns such as those seen when the same combination of thiol and catalyst is used to reduce superoxo complexes of cobalt(III). With the latter reactions, decay profiles for the oxidant tend to be exponential at high reagent concentrations but approach linearity at low.

Topical 5-fluorouracil in treating epithelial neoplasia of the conjunctiva and cornea

PURPOSES

To evaluate the efficacy of topical 5-fluorouracil (5-FU) in treating conjunctival and corneal epithelial neoplasia.

METHODS

Three patients underwent surgical excision of bulky disease followed by topical 1% 5-FU in artificial tear base for 2 to 3 weeks or until epithelial separation occurred. An additional three patients underwent treatment with topical 1% 5-FU alone.

RESULTS

Minimum follow-up was 6 months. In one patient with conjunctival in situ carcinoma and no detectable normal conjunctiva, who had normal findings on conjunctival histologic examination after application of topical 5-FU, a focus of invasive disease requiring orbital exenteration. One patient had a favorable response to 5-FU therapy but required a repeat excision for control of bulky disease. Four patients have remained disease-free for 10, 13, 18, and 30 months after topical 5-FU therapy.

CONCLUSION

With its potential selective toxicity on dysplastic epithelium, topical 5-FU shows promise as an adjunctive treatment for managing conjunctival and corneal epithelial neoplasia.

Lack of effect of inhaled morphine on exercise-induced breathlessness in chronic obstructive pulmonary disease

BACKGROUND

Inhaled nebulised morphine may reduce breathlessness in patients with lung disease, although the results of controlled trials are conflicting. A direct action of morphine on the lung has been postulated. This study aimed to investigate whether nebulised morphine reduced exercise-induced breathlessness in patients with chronic obstructive pulmonary disease (COPD) and to determine if this was a local pulmonary effect or occurred after systemic morphine absorption.

METHODS

A double blind, randomised, crossover study was performed in 12 men with COPD to compare the effects of nebulised morphine (10 and 25 mg), equivalent intravenous doses (1 and 2.5 mg), and placebo. Breathlessness (visual analogue scale), ventilation, gas exchange, and exercise endurance were measured during graded bicycle exercise.

RESULTS

None of the treatments altered breathlessness, ventilation, or gas exchange at rest or at any time during exercise, and exercise endurance was unaffected. At peak exercise mean (95% CI) changes from placebo in ventilation were -0.8 (-0.57 to 1.1) l/min and -0.4 (-2.8 to 2.0) l/min for the highest intravenous and nebulised doses, respectively. For breathlessness equivalent values were +2 (-5 to 9) and +1 (-9 to 11) mm. The study was of sufficient power that it is unlikely that a clinically important effect was missed.

CONCLUSIONS

Nebulised morphine in these doses has no effect on exercise-induced breathlessness. These findings do not support the hypothesis that intrapulmonary opiates modulate the sensation of breathlessness in patients with COPD.

Effects of inhaled nebulized morphine on ventilation and breathlessness during exercise in healthy man

1. Nebulized inhaled morphine has been reported to increase exercise endurance in patients with chronic lung disease and to relieve dyspnoea in patients with malignant disease. Potential mechanisms include a central effect occurring after systemic drug absorption or a local action mediated by receptors in the lung. 2. The ventilatory effects of nebulized morphine (10 and 25 mg) were therefore compared with those of intravenous morphine (1.0 and 2.5 mg) and placebo in a double-blind study involving 12 young healthy males. Submaximal cycle ergometry with respiratory gas analysis was performed 15 min after drug administration and breathlessness assessed using a linear visual analogue scale. 3. Neither dose of inhaled morphine had statistically significant effects on spirometry, heart rate, ventilation, respiratory gases or breathlessness at any level of exercise. The slopes and intercepts of the lines relating ventilation to breathlessness were also unaffected. 4. Intravenous morphine 2.5 mg reduced breathlessness slightly at the highest equivalent workload [mean (least significant range) 33 mm (26-40 mm)] compared with placebo [41 mm (34-48 mm), P < 0.05] but had no other significant effects. 5. These results do not support the hypothesis that intrapulmonary opiate receptors modulate the sensation of breathlessness in healthy man. The possibility that inhaled morphine may affect breathlessness caused by other factors, such as disease, has not been excluded.

The birth control movement before Roe v. Wade

Beginning in the 1970s, historians and social scientists published a great deal on the birth-control movement in the United States, a subject that had been neglected. They were seeking perspective on the issues raised by profound changes in society that rendered problematic the gender system and family values of previous generations. It is no fluke that these scholars began to write the history of the effort to promote the separation of sex from procreation during the same decade that Congress removed contraception from the practices and information prohibited by the national obscenity laws (1971), and the Supreme Court ruled that married couples had a constitutionally protected right to practice contraception (1965), that the unmarried had a similar right of “privacy” (1972), and that pregnant women had the right to induced abortions performed by physicians during the first trimester of their pregnancies (1973). The Court's affirmation of a limited right to “abortion on demand” in Roev. Wadefollowed a decade of intense political struggle and judicial action at the state level, and Justice Harry A. Blackmun, who wrote the majority opinion, was self-consciously attempting to forge a consensus in areas of human behavior and public policy where conflicts were literally lethal and threatened the social order. In turn, much of the vitality of the scholarship on reproductive history that coincides with changes in the law sprang from the self-consciousness of women.

Mutational analyses of light-controlled seedling development in Arabidopsis

Arabidopsis mutants with decreased responses to light and mutants showing light responses in the dark have both been characterized. Some of the former mutants lack specific photoreceptors, such as the red/far-red light receptor phytochrome A, phytochrome B, or a putative blue light receptor, HY4. These have allowed the assessment of physiological functions of these photoreceptors. The mutants with light responses in the dark include some, such as det1 and cop1, that appear to identify light signal transduction components, and others, such as fus6, that may be less directly related to normal control of light responses. Double mutant studies suggest how the different gene products might interact.

Corneal tattooing to reduce glare in cases of traumatic iris loss

The traumatic loss of iris is often associated with symptoms of glare, which can be debilitating. This symptom may be benefitted by wearing a contact lens with a clear, central optical zone and opacification of the remainder. The patient who is contact lens-intolerant may be helped by tattooing of all of the cornea except the central visual axis. Four patients who had traumatic iris loss and who were treated by this technique reported reduced glare as well as improvement in the cosmetic appearance of the eye. Although corneal tattooing is an ancient procedure, it continues to be of benefit for selected patients.