Hematuria induced by urethral catheterization

The amount of traumatic hematuria induced by urethral catheterization was studied by comparing the pre- and post-catheterization urinalyses of 93 patients presenting to the emergency department with abdominal complaints of an acute nature. Thirty-nine male patients ranging in age from 4 to 91 years and 51 female patients ranging in age from 1 to 70 years were studied. Catheterizations were performed by nurses (54%), resident house-staff (38%), and nurse practitioners (8%). Overall, hematuria was induced in 16 of 93 patients (17.2%) and, when present, never exceeded 3 RBC/hpf.

Optic disk cupping and pallor measurements of patients with a disk hemorrhage

We evaluated whether the rate of occurrence of glaucomatous disk damage in eyes with an optic disk hemorrhage differed from the rate of occurrence in control eyes. We compared 24 patients with a disk hemorrhage to 24 control patients, who had been matched for diagnosis, disk appearance, and visual fields. Cup volume and cup-to-disk area ratio of the optic disk were measured using the stereophotogrammetric technique, and area of pallor was measured using computerized image analysis. We found that diabetes increased the probability that a patient would have a disk hemorrhage, and that a hemorrhage was associated with progression of glaucomatous disk changes in half of the cases during the mean 3.1-year follow-up period. However, the mean rate of glaucomatous disk damage in patients with a hemorrhage was not different from matched control patients. A disk hemorrhage is a sign of later disk damage, but it does not alter the rate of glaucomatous disk progression.

Nerve fiber layer photography. A comparative study

Observation of the retinal nerve fiber layer with red-free light is an important means of evaluating optic nerve integrity. Many investigators have attempted to increase the usefulness of the technique by improving photographic procedures. Most reports comparing various parameters neither indicate the method of comparison nor give quantitative measure of the improvement gained with different films, filters, cameras, or processing procedures. We have compared in a masked fashion the parameters most recently recommended in the literature. Twelve trained observers compared 12 masked pairs of nerve fiber layer photos taken from the same eye in the same manner on two cameras and preferred those taken with a Canon CF-60Z camera 69% of the time and those taken with a Zeiss FF-111 17% of the time (this difference was statistically significant, P less than 0.01). Fourteen observers compared 14 pairs of photographs and judged Panatomic-X film to be superior to Plus-X film 51% of the time and both films to be of the same quality 25% of the time (this difference was also significant P less than 0.05). Fifteen observers compared 12 pairs and preferred the Standard SE-40 blue filter 2:1 over the green Spectrotech 540 filter. This difference was not statistically significant, and the preference was found to be dependent on fundus pigmentation and clarity of the media. The blue filter gave better contrast for the nerve fiber layer in patients with lightly pigmented fundi, and use of the green filter resulted in less light scatter in patients with ocular media opacities.

Level of indoor allergens in dust from homes of allergic and non-allergic individuals

In a number of studies performed on different locations throughout the world and in homes inhabited both by healthy individuals as well as by patients allergic to the specific allergen, the content of the major allergens from the house dust mite (Der p I, m I and f I), cat (Fel d I) and dog (Ag 3, 13) was measured. The comparison between homes of allergics and non-allergics revealed a tendency to high levels of cat allergens in homes of non-allergics. The content of the mite allergens showed large variations both with respect to the total amount of mites and the species of the mites.

Desensitization to topical epinephrine in the rabbit eye: attenuation by dexamethasone

Desensitization of ocular adrenergic receptors was examined in vivo in albino rabbit eyes. Repeated topical administration of 2.0% l-epinephrine bitartrate (equivalent to 1.1% free base) to the rabbit eye resulted in the loss of ocular hypotensive response on the second day of daily or twice-daily treatment. Concurrent topical administration of dexamethasone phosphate (0.1%) prolonged the pressure-lowering effect of 2.0% l-epinephrine for up to 5 days. Loss of pressure-lowering response was accompanied by 100% inhibition of ciliary process beta-adrenergic-sensitive adenylate cyclase activity following 6 days of topical administration of l-epinephrine; inhibition of c-AMP synthesis was attenuated by dexamethasone (27% decrease in activity after 6 days of treatment). The data suggest that modulation of epinephrine-induced desensitization by corticosteroids in the rabbit eye is associated with stabilization of beta-adrenergic-sensitive adenylate cyclase activity.

Increased diameter of the anterior ciliary artery with increased intraocular pressure

We analyzed the relationship between the hemodynamics of the anterior ciliary artery and intraocular pressure (IOP) by measuring the pressure of the artery with a modified pressure chamber method and the diameter of the artery on color photographs taken with a photo slit lamp (Zeiss). Of 38 subjects, nine were normal, and 29 were ocular hypertensive. We found a significant positive correlation between diameter of the anterior ciliary artery and IOP and a significant negative correlation between pressures of the anterior ciliary artery and IOP. The increase in IOP may influence the circulation of the anterior uvea, resulting in a decrease in anterior ciliary arterial pressure and an increase in diameter of the anterior ciliary artery. Our results support the concept that the blood flow in the anterior ciliary artery is from the inside of the eye to the outside.

Musical hallucinations, acquired deafness, and depression

Musical hallucinations associated with acquired deafness are rarely reported in the psychiatric literature. In the few cases studied no evidence of psychiatric disturbance is noted. The authors describe two patients with musical hallucinations while in a state of nonpsychotic depression. One of these suffered from acquired deafness and no organic pathology was demonstrable in the other. Cessation of musical hallucinations occurred concomitantly in both patients with improvement of the affective state. Depression might have a contributory role in the occurrence of such hallucinations.

Computerized enhancement of retinal nerve fiber layer

We investigated a number of image processing techniques for enhancing the retinal nerve fiber layer (NFL) in fundus photographs taken with red-free light. Wedge-type defects within the NFL were enhanced best by contrast enhancement algorithms such as histogram modification and extremum sharpening. Narrow, slitlike NFL defects can be enhanced by directional enhancement techniques. Normal NFL features were enhanced best by high-pass filtering techniques such as homomorphic filtering and adaptive enhancement. The enhanced normal NFL may be useful in the analysis of diffuse NFL loss. All of these successful enhancements of normal and defective features indicate that enhancing fundus photographs with digital image processing techniques should facilitate early detection of optic nerve damage from glaucoma and other diseases.

Clinical and laboratory evaluation of cytomegalovirus-induced mononucleosis in previously healthy individuals. Report of 82 cases

The present report describes the clinical and laboratory profile of 82 previously healthy individuals who developed cytomegalovirus (CMV)-induced mononucleosis. Many of these patients posed initial diagnostic problems and were hospitalized with diagnoses such as fever of undetermined origin, active viral hepatitis, acute leukemia, probable systemic lupus erythematosus, autoimmune hemolytic anemia, and severe pancytopenia. These patients underwent a variety of diagnostic biopsies, including liver biopsies (6) and bone marrow aspirations (9). Four patients had exploratory laparotomies, 1 for a ruptured spleen, and another had a splenectomy following an erroneous initial diagnosis of agnogenic myeloid metaplasia. There was no apparent clinical response to a short course of steroid therapy in 3 of 5 cases and acyclovir in another. The vast majority of these patients demonstrated infectious mononucleosis-type reactive blood smears, negative heterophil antibody studies, mildly or moderately elevated aspartate aminotransferase activity, and evidence for subclinical hemolysis on serial specimens. The peak serum bilirubin levels were above 2.0 mg/dl in only 2 of 71 cases tested, both of the latter patients having significant hemolysis (hemoglobin values 8.6-9.3 g/dl). The CMV-IgM test had a high sensitivity for detection of CMV macroglobulins (positive in 81 of 82 cases). In contrast, complement-fixing antibodies to CMV showed diagnostic four-fold titer changes in only 39/82 cases (47.6%). Despite its great sensitivity, the CMV-IgM test is limited by a one-way crossreaction of acute Epstein-Barr virus (EBV)-IM sera and spurious positive reactions in some sera due to the presence of rheumatoid factors. Based on EBV-specific serologic studies, the 82 patients with CMV-IM could be divided into 4 groups: 3 patients without antibodies to EBV; 2) 69 patients with uncomplicated serologic data indicative of long-past EBV infections; (3) 6 patients with unusual antibody profiles, e.g., anti-D responses; and (4) 5 patients, including 1 originally susceptible to EBV, with apparent dual CMV/EBV infections. At the conclusion of our study, final diagnoses and initial hematologic data were correlated in 750 cases in which CMV macroglobulins were searched for. The vast majority of patients with active CMV infections initially demonstrated either markedly or moderately reactive peripheral blood smears. These data support our impression that diagnostic tests for CMV, as well as for EBV, are seldom indicated in symptomatic previously healthy patients whose blood smears during the acute phase (first several weeks) of their illnesses are either nonreactive or minimally reactive.

The effects of photoperiod and lid suture on eye growth in chickens

Three models of postnatal eye enlargement in leghorn chicks (surgical fusion of the eyelids, MES; exposure to continuous light, 24L; prolonged darkness, OL) were characterized on a morphologic and temporal basis, and a relationship between photoperiod and eye growth was described. While pronounced enlargement of the eye was evident in the OL and MES groups after 6 wk, a 15-wk experimental period was necessary to produce significant (P less than 0.05) eye enlargement under 24L. This enlargement was unaffected by pinealectomy and was characterized by increased equatorial diameter and decreased axial length. The macrophthalmos resulting from both MES and OL was characterized by increases in absolute and relative eye weights, axial length, and equatorial diameter. The MES eyes, however, showed a pronounced bulging of the cornea and increased anterior chamber depth and equatorial diameter, while those from the OL group had a flattened cornea and decreased anterior chamber depth. Finally, a relationship between photoperiod and eye growth was established and was best described by an inverse, continuous semilogarithmic function.

Specific diagnosis of exogenous bronchial asthma in children

Twenty-six children with exogenous asthma were studied by case history (CH), skin tests (ST), allergen-specific serum IgE (RAST), basophil histamine release (HR), and bronchial provocation tests (BPT). Nine standardized allergens were used from the following groups: house dust mite, animal dander, pollen, and mould fungi. For each allergen, the same batch was used throughout for all in vivo and in vitro studies, and the tests were carried out in a controlled, double-blinded manner, independent of each other. Different allergen concentrations were used and the results graded on a semi-quantitative scale. Approximately 120 comparable investigations, using in vivo and in vitro tests were carried out, followed by calculations of the sensitivity and specificity for each test alone, as well as for various combinations of tests, at various allergen-concentrations, and compared with the result of BPT, i.e. the true diagnosis. In this way the results could be used to directly compare the diagnostic value of each test, and combinations of tests. In general, a careful CH combined with ST gave the most reliable results. RAST was the most unreliable single analysis. When pollen or mite allergy was suspected, a combination of ST with either RAST or HR gave a further diagnostic reliability. HR as a single analysis did not seem to offer advantages over existing methods. None of the tests, or combinations of tests offered 100% sensitivity and specificity. By altering the concentration of allergen, the sensitivity, or specificity could be increased, but only at the expense of a decrease in the other. BPT is still necessary in many instances when a specific diagnosis is required.

Allergen-specific IgE antibodies against antigenic components in cow milk and milk substitutes

Crossed radioimmunoelectrophoresis (CRIE) was used to study the presence of serum IgE against antigenic components of cow milk in 21 selected milk-allergic patients. The amount of each IgE specificity was estimated by a scoring system. The milk-allergic children had mainly IgE against alpha-lactalbumin, beta-lactoglobulin, albumin and immunoglobulin, the four major proteins of bovine whey, as well as IgE against three casein components. A serum pool from 1000 normal adults had IgE against the same whey protein, but in smaller amounts, and no IgE against the casein components. Eight cow milk-based formulae, commonly used for infant feeding, and goat milk were studied by the same method. It was found that six of the milk substitutes did not differ significantly from cow milk in antibody binding, but the two hydrolysed casein products, Nutramigen and Pregestimil, consisted of such small molecules that the rabbit antisera could not precipitate the hydrolysed proteins in the gels on the CRIE plates. It was therefore not possible to study their IgE binding, if any, by this method.

Stereochronometry: quantitative measurement of optic disc cup changes

The authors have developed an objective, quantitative method for detecting optic disc cup changes that occur with time. Called stereochronometry, this new technique uses a stereoplotter to measure changes recorded in the combination of two single photographs taken of the same optic disc at different times. The reproducibility and sensitivity of stereochronometry were evaluated using a model eye. Stereochronometric measurements were significantly correlated with calibrated changes of depth and width of the cup of the model eye. Standard deviations for five measurements of cup changes without camera shift range from 2 microns to 18 microns, and errors (deviations of the mean of measurements from calibrated cup changes) ranged from -26 microns to +33 microns. Standard deviations and errors in the measurement of cup depth and width were significantly increased when the camera was shifted by 2.5 mm between photographs to simulate possible changes in photographic conditions.

Measurements of reversibility of optic disc cupping and pallor in ocular hypertension and glaucoma

Four cases are presented of young and elderly glaucoma patients who had both surgical and medical therapy and showed reversal of cupping and pallor of the optic disc. The cupping was measured by photogrammetry and the pallor by computerized image analysis from photographs of the optic disc. Two patients showed regression of visual field loss. The optic disc and visual field changes corresponded to the changes in ocular pressures, generally showing worsening with an increase in ocular pressure. With a decrease in ocular pressure there was regression of visual field loss and a decrease in cupping; pallor did not decrease consistently. The changes in cupping and pallor in some patients followed similar courses but in others behaved in an independent manner. It is proposed that these new sensitive and reproducible techniques for measuring changes in the optic disc may allow the detection of disc changes early in the disease, prior to visual field loss. If treatment is begun at this time, reversal of optic disc changes may occur.

The occurrence of indoor allergens in Saudi Arabia

Investigations on indoor airborne allergens in Saudi Arabia were performed by mold cultures and dust analyses by counter-current immunoelectrophoresis. Twenty fungal genera were isolated, with Aspergillus as the most often encountered. Most of the dust-bound fungi found are ubiquitous and common. Antibodies against Dermatophagoides pteronyssinus, cat- cow- and rat dander, and Cynodon dactylon pollen were used in the dust analyses. Animal antigens were found in five of the ten dust samples. House dust mites were extraordinarily rare. Pollen of Cynodon dactylon (Bermuda grass) was present in nearly all the samples, and in a concurrent clinical study this antigen was found to be the most common cause of perennial rhinitis.