The influence of surface configuration on the retention of posts designed for use with a cast-on technique

OBJECTIVES

The combination of an individually cast core and a prefabricated metal post is one of the many techniques to restore endodontically treated teeth. The surface characteristics of commercially available posts vary considerably and likely influence retention. In this study, the surface configuration of 11 castable prefabricated post systems and their retention at the post-cement interface were investigated.

METHOD AND MATERIALS

Scanning electron microscopic photos were made to assess surfaces of the posts. Etchant residues or applied surface layers were also analyzed with an electron beam microprobe. For the retention measurements, 6 posts from each system were cemented in artificial root canals with a zinc phosphate cement. Retention was measured on a universal testing machine.

RESULTS

Analysis of variance and the Ryan-Einot-Gabriel-Welsch F test revealed significant differences in retention between posts; these differences were related to the microstructure of the surfaces of the posts. In general, the coarser the surfaces, the better the retention. Gold plating of the etched surface for one manufacturer resulted in less retention compared to posts of the same type and size that were not plated.

CONCLUSION

The surface configuration of a post could be an important factor when selecting a prefabricated post system.

Caries prevention with chlorhexidine-thymol varnish in high risk schoolchildren

In a prospective, randomised and blinded cohort study, the acceptance and effectiveness of a 3-monthly chlorhexidine-thymol varnish application was assessed in 8- to 10-yr-old children (n=29) with high caries incidence after brushing with a 1.23% fluoride gel. The children of the control group (n=25) brushed with a fluoride gel only. The standardised interview showed good acceptance of the varnish applications in spite of the bitter taste. Caries incidence in one year was 1.2 DMFS (SD 1.5, median 1; 95% confidence interval 0-1) for the test group and 2.1 DMFS (SD 2.3, median 2; 95% confidence interval 0-3) for the control group. Due to a slightly lower reduction in caries incidence (42.3%) than in other studies and a higher standard deviation than in unselected study groups, the power of the present study was not high enough to prove this difference in caries incidence to be statistically significant in the Mann-Whitney test (P=0.11). This was also found for the difference of 0.4 initial lesions. The distribution patterns of caries incidence for tooth groups (70% in the first permanent molar) and surfaces (58% on occlusal surfaces) did not differ between the test and the control group. The reductions of caries incidence which have been found in highly caries active children of the present study should be evaluated further with a larger study sample.

Rotation of Listing's plane with convergence: independence from eye position

PURPOSE

To determine whether asymmetrical vergence results in a rotation of Listing's plane independent of vergence-associated changes of eye position in the orbit.

METHODS

Six normal subjects were required to fixate on a 3x3 array (40 degrees on a side) of light-emitting diodes arranged on a flat screen 124 cm from the subject. Disparity-induced vergence was elicited with a horizontal Fresnel prism (30 cm/m, approximately 17 degrees) placed in front of one eye. In four subjects accommodative vergence (10 degrees to 15 degrees) was produced by placing a minus spherical lens in front of one eye while the other eye was covered. Eye position was measured binocularly using three-axis search coils. Control data were collected without prisms during monocular and binocular viewing. For all data a planar regression was used to fit torsional eye position as a function of horizontal and vertical position to calculate the horizontal and vertical primary positions that define the orientation of Listing's plane.

RESULTS

In the prism experiment, the horizontal primary position of the eye not wearing the prism rotated temporally by 3.9 degrees +/-1.7 degrees compared with the both eyes viewing control condition. The rotation of the prism eye was in a similar range (3.4 degrees +/-2.0 degrees). With accommodation, the horizontal primary position of the viewing eye rotated temporally by 4.4 degrees +/-1.4 degrees compared with the monocular viewing control. In both the accommodation and the prism paradigms there was usually a rotation of vertical primary position downward.

CONCLUSIONS

Vergence-induced changes in Listing's plane can be independent of changes in orbital position associated with vergence. This finding supports a role for changes in central innervation in the elaboration of Listing's law.

[Motor and sensory responses in fusion of vertical disparities in different convergence places]

To study motor and sensory responses in vertical fusion at different angles of horizontal vergence in normal humans.

METHODS

The study included 12 normal subjects. A cross (+) extending 3.4 degrees x3.2 degrees was presented dichoptically. Vertical disparity was introduced by changing the vertical position of the cross in front of one eye. The disparity was incremented by 0.08 degrees every 8 s. Distance viewing was tested with 1 degrees of convergence demand, near vision with 6-15 degrees convergence demand. Eye movements were recorded using three-axis search coils.

RESULTS

Vertical fusion capability was larger at near vision than at distance in 9 of 12 subjects. For the entire group, total vertical fusion capability (motor plus sensory response) differed between distance (mean 1.68 degrees ) and near (mean 2.39 degrees ). The motor component differed significantly between distance (mean 1.42 degrees ) and near (mean 2.13 degrees ). No difference in the sensory component was seen between distance (mean 0.26 degrees ) and near (mean 0.27 degrees ).

CONCLUSIONS

Vertical fusion capability increases with convergence. This increase is mainly due to an increase of the motor response.

Immune-mediated retinopathy in a patient with stiff-man syndrome

BACKGROUND

Stiff-man syndrome is a rare neurological disorder characterised by rigidity and violent spasms of the body musculature. In the majority of patients, presence of antibodies against glutamic acid decarboxylase (GAD), the enzyme synthesizing gamma-aminobutyric acid (GABA), suggests an autoimmune attack against GABA-ergic inhibitory neurons. We report a 32-year-old patient with stiff-man syndrome and anti-GAD antibodies who developed subacute progressive loss of vision in the right eye, and in the left eye 18 months thereafter.

METHODS

Ophthalmological work-up included electro-retinogram (ERG), visual evoked potentials (VEP) and fluorescein angiography. Antiretinal antibodies were investigated using an indirect immunofluorescence technique on frozen sections of macaque retina with patients serum and FITC-conjugated goat antihuman immunoglobulin. Staining with monoclonal anti-GAD65 antibodies and with serum from three healthy normals served as controls.

RESULTS

Visual acuity of both eyes decreased to 0.16 within a span of 6 weeks. Perimetry revealed a central scotoma in the visual field of both eyes. VEP and flash ERG were progressively disturbed on the right eye. On the left eye, initially only pattern ERG and photopic responses were abnormal. Follow-up recordings revealed widespread pathology of photopic single and flicker responses. Immunofluorescence revealed strong reactivity of the inner plexiform layer and to a lesser extent staining of the outer plexiform layer at dilutions of 1:1000 with patients serum. The same retinal staining pattern was obtained with monoclonal anti-GAD65 antibodies.

CONCLUSIONS

These findings suggest autoimmune retinopathy, mediated by anti-GAD65 autoantibodies as the underlying cause of visual loss.

Comparison of measurements obtained with hand files or the Canal Leader attached to electronic apex locators: an in vitro study

AIM

The aim of the present in-vitro study was to combine directly the Canal Leader handpiece (SET, Olching, Germany) with the electronic apex locators ROOT ZX (Morita, Kyoto, Japan) and JUSTY (Yoshida, Tokyo, Japan) to find out whether the working length values thus obtained were identical to those resulting from the combination of the same electronic devices with hand files.

METHODOLOGY

A total of 50 natural extracted teeth with single canals and mature apices were used. A radiograph was used as a control and the distance from the radiographic apex to the tip of the file was measured and compared with the results of the electronic length determination.

RESULTS

For both electronic devices the differences amongst the distribution of the measurements were not statistically significant under the specified conditions (P > 0.05), indicating that the measurements with hand files and with the Canal Leader were identical for the majority of the cases.

CONCLUSIONS

Under the conditions of this study the working length of canals obtained with electronically assisted hand files were similar to those obtained with the electronically assisted mechanical handpiece Canal Leader.

Effect of horizontal vergence on the motor and sensory components of vertical fusion

PURPOSE

To compare motor and sensory capabilities for fusion of vertical disparities at different angles of horizontal vergence in healthy humans.

METHODS

Eye movements were recorded from both eyes of 12 healthy subjects using three-axis search coils. The stimulus was a cross (+) (3.4 x 3.2 degrees , vertically and horizontally, respectively) presented to each eye with a stereoscopic display. Vertical disparities were introduced by adjusting the vertical position of the cross in front of one eye. The disparity was increased in small increments (0.08 degrees ) every 8 seconds. Viewing was defined as "near" if there was a horizontal disparity that elicited 6 degrees to 15 degrees convergence, depending on the subject's capability for horizontal fusion; viewing was defined as "far" at 1 degrees convergence. Maximum motor (measured), sensory (stimulus minus motor), and total (motor plus sensory) vertical fusion were compared.

RESULTS

In 9 (75%) of 12 subjects the maximum total vertical fusion was more in near than in far viewing. The three who did not show this effect had relatively weak horizontal fusion. For the entire group, the motor component differed significantly between far (mean, 1.42 degrees ) and near (mean, 2.13 degrees). Total vertical fusion capability (motor plus sensory) also differed significantly between far (mean, 1.68 degrees ) and near (mean, 2.39 degrees ). For the sensory component there was no difference between between far (mean, 0.268 degrees ) and near (mean, 0.270 degrees ). As vertical disparity increased in a single trial, however, there was a small gradual increase of the contribution of the sensory component to vertical fusion.

CONCLUSIONS

Vertical fusion capability usually increases with convergence. This increase is caused primarily by an increase in the motor component. There is a gradual but small increase in the sensory component as target disparity slowly increases.

Posterior fixation suture and convergence excess esotropia

The present study investigates the results of Cuppers' 'Fadenoperation' in patients with non-accommodative convergence excess esotropia. Particular attention is given to postoperative eye alignment at distance fixation. Group 1 (n=96) included patients with a 'normal' convergence excess. The manifest near angles (mean ET 16.73 degrees +/- 6.33 degrees, range 4 degrees -33 degrees ) were roughly twice the size of the distance angles (mean ET 6.50 degrees +/- 3.62 degrees, range 0 degrees -14 degrees ). These patients were treated with a bilateral fadenoperation of the medial recti without additional eye muscle surgery. Three months after surgery, the mean postoperative angles were XT 0.5 degrees +/- 3.3 degrees (range XT 11 degrees -ET 5 degrees ) for distance fixation, and ET 2.7 degrees +/- 3.6 degrees (range XT 5 degrees -ET 14 degrees ) for near fixation, respectively. Postoperative convergent angles at near fixation >ET 10 degrees were present in two patients (1.9%). Group 2 (n=21) included patients with a mean preoperative distance angle of ET 9.2 degrees +/- 3.7 degrees (range 6 degrees -16 degrees ) and a mean preoperative near angle of ET 23.4 degrees +/- 3.1 degrees (range 16 degrees -31 degrees ). These patients were operated on with a bilateral fadenoperation of the medial recti and a simultaneous recession of one or both medial rectus muscles. Mean postoperative angles were XT 0.5 degrees +/- 4.6 degrees (range XT 12 degrees -ET 7 degrees ) for distance fixation and ET 1.4 degrees +/- 4.5 degrees (range XT 8 degrees -ET 13 degrees ) for near fixation, respectively. In this group, 2 patients (10.6%) had a postoperative exotropia >XT 5 degrees at distance fixation, and two patients had residual esotropia>ET 10 degrees at near fixation. Group 3 (n=17) included patients with a pronounced non-accommodative convergence excess. Near angle values (mean of 17.8 degrees +/- 5.3 degrees, range ET 7 degrees -26 degrees ) were several times higher than the distance angle values (mean ET 1.9 degrees +/- 4.2 degrees, range XT 3 degrees -ET 6 degrees ). These patients were treated with a bilateral fadenoperation of the medial recti and a simultaneous resection of one or both medial rectus muscles. Mean postoperative angles were ET 0.2 degrees +/- 4.7 degrees (range XT 8 degrees -ET 6 degrees ) for distance fixation and 5.3 degrees +/- 6.1 degrees (range XT 3 degrees -ET 12 degrees ) for near fixation, respectively. One patient had a postoperative distance angle >XT 5 degrees, whereas two patients displayed postoperative convergent angles >ET 5 degrees at near fixation.

Familial congenital horizontal gaze paralysis and kyphoscoliosis

Congenital horizontal gaze paralysis is a rare disorder which may be associated with severe scoliosis of early onset. We present the clinical findings of two sisters with this syndrome. The additional finding of a unique pericentric inversion of chromosome 12 is considered to be incidental. Every child with congenital horizontal gaze paralysis should be evaluated for a possibly associated scoliosis. If present, a diagnosis of this presumably autosomal recessive syndrome can be made with appropriate treatment and genetic counseling.

[Comparison of addition of theophylline to inhaled steroid with doubling of the dose of inhaled steroid in asthma]

The anti-asthmatic effect of theophylline may supplement those of inhaled steroids in asthma. The aim of the present trial was to study how the addition of theophylline compares to doubling the dose of inhaled steroid in asthmatics who remain symptomatic on beclomethasone dipropionate (BDP) 400 micrograms/day. The trial was designed as a randomized, double-blind, parallel-group study in several European countries. 69 patients were treated for 6 weeks with theophylline plus BDP 400 micrograms/day, compared to 64 patients treated with BDP 800 micrograms/day. The mean +/- SD serum theophylline concentration was 10.1 +/- 4.2 mg/l. Lung function measurements were made throughout the study and patients kept daily records of peak expiratory flow rate (PEF), symptoms and salbutamol usage. Forced expiratory volume in one second and PEF at week 6 were significantly increased by both treatments (p < 0.01). PEF variability was reduced by about 30% in both groups. There were significant improvements in asthma symptoms and rescue medication use (p < 0.001). There were no significant differences between the treatment groups. The study demonstrated clinical equivalence of theophylline plus beclomethasone dipropionate 400 micrograms/day and beclomethasone dipropionate 800 micrograms/day in patients whose asthma is not controlled on beclomethasone dipropionate 400 micrograms/d. The results support the use of theophylline as steroid-sparing agent. The combination of low-dose inhaled steroid plus theophylline is a suitable treatment for moderate asthma.

Active apical secretory efflux of the HIV protease inhibitors saquinavir and ritonavir in Caco-2 cell monolayers

PURPOSE

To investigate in vitro the mechanisms involved in the gastro-intestinal absorption of the HIV protease inhibitor, saquinavir mesylate (Invirase), whose oral bioavailability is low, variable, and significantly increased by co-administration with ritonavir, also an HIV protease inhibitor but with higher oral bioavailability.

METHODS

Confluent epithelial layers of human Caco-2 cells mimicking the intestinal barrier.

RESULTS

Both saquinavir and ritonavir showed polarized transport through Caco-2 cell monolayers in the basolateral to apical direction (secretory pathway), exceeding apical to basolateral transport (absorptive pathway) by factors of 50-70 and 15-25, respectively. Active efflux was temperature dependent, saturable and inhibited by verapamil and cyclosporin A. Saquinavir and ritonavir decreased each other's secretory permeability and hence elevated their net transport by the absorptive pathway.

CONCLUSIONS

Saquinavir and ritonavir are both substrates for an efflux mechanism in the gut, most likely P-glycoprotein, which acts as a counter-transporter for both drugs. Together with sensitivity to gutwall metabolism by cytochrome P-450 3A, this may partially account for the low and variable oral bioavailability of saquinavir in clinical studies and for its increased bioavailability after co-administration with ritonavir.

Comparison of addition of theophylline to inhaled steroid with doubling of the dose of inhaled steroid in asthma

The anti-asthmatic effects of theophylline may supplement those of inhaled steroids in asthma. The aim of the present trial was to study how the addition of theophylline compares to doubling the dose of inhaled steroid in asthmatics who remain symptomatic on beclomethasone dipropionate (BDP) 400 microg x day(-1). The trial was designed as a randomized, double-blind, parallel-group study in several European countries. Sixty nine patients were treated for 6 weeks with theophylline plus BDP 400 microg x day(-1), compared to 64 patients treated with BDP 800 micro x day(-1). The mean+/-SD serum theophylline concentration was 10.1+/-4.2 mg x L(-1). Lung function measurements were made throughout the study and patients kept daily records of peak expiratory flow (PEF), symptoms and salbutamol usage. Forced expiratory volume in one second and PEF at week 6 were significantly increased by both treatments (p<0.01). PEF variability was reduced by about 30% in both groups. There were significant improvements in asthma symptoms and rescue medication use (p<0.001). There were no significant differences between the treatment groups. The study demonstrated clinical equivalence of theophylline plus beclomethasone dipropionate 400 microg x day(-1) and beclomethasone dipropionate 800 microg x day(-1) in patients whose asthma is not controlled on beclomethasone dipropionate 400 microg x day(-1). The results support the use of theophylline as a steroid-sparing agent. The combination of low-dose inhaled steroid plus theophylline is a suitable treatment for moderate asthma.

[Effect of a local nonsteroidal anti-inflammatory drug on postoperative irritation after squint surgeries. Prospective randomized double-blind study]

BACKGROUND

Topical application of a nonsteroidal antiphlogistic drug (NSAD) is often recommended to minimize postoperative lid and conjunctival edema. However, the effectiveness of such therapy remains controversial.

PATIENTS AND METHODS

The study presented included 100 patients aged 23.6 +/- 19.5 (5 to 77) years, who were randomly assigned to two treatment groups. Group 1 included 50 patients who underwent squint surgery, and who received Flurbiprofen ED twice a day from the first preoperative day to the third postoperative day. Group 2 served as a control group. These patients were treated with the same regimen using artificial tears. The extent of lid and conjunctival edema was assessed and scored from 1 to 4 on the fourth postoperative day.

RESULTS

Squint surgery was performed on 129 eyes of 100 patients. In 32 eyes (24.8%) one muscle was operated on. In 79 eyes (61.2%) 2 muscles and in 18 eyes (14%) three muscles were operated on. The average postoperative conjunctival edema score was 2.08 +/- 0.62 (Flurbiprofen group) and 2.04 +/- 0.67 (control group), respectively. The scoring values for lid edema were 1.90 +/- 0.54 and 1.82 +/- 0.43. The differences between the two groups were not statistically significant (P = 0.21 and 0.39; Mann-Whitney test). No influence of the patient's age on the development of lid and conjunctival edema could be detected (P > 0.08). However, the number of muscles that were operated on had a significant influence on both parameters (P = 0.01 and 0.028). Single muscle operations revealed the lowest scaling values (P < 0.02 and P < 0.04). No difference was found whether 2 or 3 muscles were operated on (P = 0.24 and 0.12).

CONCLUSIONS

No beneficial effect of topical application of NSAD on postoperative lid and conjunctival edema could be found in this controlled study.

[Carcinoma-associated retinopathy in breast carcinoma and carcinoid tumor]

BACKGROUND

Carcinoma-associated retinopathy (CAR) is a rare paraneoplastic syndrome characterized by diffuse retinal photoreceptor degeneration in the presence of an epithelial tumor. We report on three patients, who developed paraneoplastic retinopathy in the presence of breast carcinoma and a cervical carcinoid tumor.

MATERIALS AND METHODS

In addition to biomicroscopic, psychophysical, electrophysiological and angiographic examinations, serum samples were obtained for immunohistochemical staining of human retina.

RESULTS

Ring-shaped visual field defects with statokinetic dissociation and abnormal rod and cone responses were found. Immunohistochemical findings included reactions at the level of the inner segments of the photoreceptors, the outer nuclear layer and the outer plexiform layer in absence of anti-recoverin antibodies.

CONCLUSIONS

CAR should be considered in the differential diagnosis of visual loss in presence of tumors other than small-cell carcinoma of the lung. The presence of antiretinal antibodies is compatible with a tumor-induced immune response to epitopes shared by both the tumor and retinal tissue. Apparently, various retinal proteins may function as autoantigens.

Sebaceous-gland deposition of isotretinoin after topical application: an in vitro study using human facial skin

As yet, topically applied isotretinoin fails to show convincing clinical efficacy in the treatment of severe recalcitrant acne. Although the reason for this is not known, it is possible that topical application results in low, pharmacologically inactive isotretinoin concentrations in the sebaceous glands, the most likely site of isotretinoin action. It has been suggested that topically applied liposomes enhance the delivery of drugs into the sebaceous glands. Accordingly, we compared the isotretinoin concentration in sebaceous glands and other skin compartments following topical application of small unilamellar vesicles, multilamellar vesicles, preformed vesicles (Natipide II) or mixed micelles of lecithin and bile salt. We found that the concentration of isotretinoin measured in the sebaceous glands varied between 0.17 and 1.57 ng/mg tissue. The comparison between ethanolic gel and liposomal or micellar gel did not reveal any significant difference. However, application of the Natipide formulation resulted in significantly lower isotretinoin concentrations in the sebaceous glands when compared to the ethanolic gel. Autoradiography and fluorescence microscopy indicated that isotretinoin penetrated the sebaceous glands along the follicular route. In conclusion, our in vitro study showed that, following topical administration, substantial amounts of isotretinoin were delivered to the sebaceous glands via the follicular route, whereby the ethanolic gel was as efficient as a liposomal or a mixed micellar gel.

Hyperthermia induces heat shock protein expression and protection against cerulein-induced pancreatitis in rats

BACKGROUND & AIMS

Heat shock proteins (HSPs) are part of the cellular stress response machinery. HSPs are expressed in the pancreas, but their protective potential has not been thoroughly investigated. The aim of this study was to characterize the pancreatic heat shock response both in vitro and in vivo and to study whether this response has protective effects.

METHODS

For in vitro experiments, rat pancreatic acini were exposed to heat and protein expression was analyzed through 35S-methionine labeling or Western blots. In vivo, cerulein pancreatitis was induced after whole body hyperthermia (42 degrees C).

RESULTS

After thermal stress (42 degrees C), acini increasingly expressed five proteins of 92, 72, 59, 58, and 30 kilodaltons, with HSP. 70 the most strongly induced 72-kilodalton protein. In vivo, increased expression of four isoforms of pancreatic HSP-70 was found. Isoform-specific antibodies identified the inducible and constitutively expressed (HSC-70) isoform of HSP-70. HSP-60 was also weakly induced after hyperthermia. Concomitantly, cerulein-induced pancreatic organ damage was greatly reduced after whole-body hyperthermia. The time course and strength of HSP induction correlated well with the time course and degree of protection against cerulein-induced pancreatitis.

CONCLUSIONS

A causal relation between hyperthermia-induced HSP expression and organ protection seems possible.

[Familial congenital horizontal gaze paralysis]

Familial congenital horizontal gaze paralysis is a rare disorder supposedly transmitted in an autosomal recessive fashion. Typically, all horizontal, conjugate eye movements are absent. Most patients are orthotropic with regular binocular function. The complete lack of horizontal eye movements is compensated for by turning the head in the desired direction. Another compensating mechanism is the use of convergent eye movements, when horizontal gaze is attempted. Eye movements in the vertical plane are only mildly affected. The majority of patients suffer from a scoliosis that manifests itself in early infancy and usually requires operative treatment. Maldevelopment of neurons of the abducens nuclei and the caudal longitudinal fascicle is said to be the cause. The possible outcome of the disease and the importance of a prompt diagnosis are discussed.

The diagnostic value of optic disc evaluation in acute elevated intracranial pressure

PURPOSE

Ophthalmologists often are asked to evaluate the optic disc for evidence of acute increased intracranial pressure (ICP). The authors studied the incidence of papilledema in a population of patients with a documented acute increase in ICP.

METHODS

Included in this study were 37 patients with acute elevated ICP due to a spontaneous hemorrhage or craniocerebral trauma. In all patients, the ICP was monitored continuously. Fundus examination was performed twice daily on at least 7 consecutive days.

RESULTS

According to the level and duration of the ICP, the patients were divided into three groups. Group 1 included 13 patients who had a slightly elevated ICP (range, 20-30 mmHg) on at least 3 consecutive days. In this group, 3 of 13 patients demonstrated venous congestion on the fifth or sixth day. No swelling of the optic disc was seen in this group. Group 2 included seven patients with an elevated ICP, with values ranging from 30 to 70 mmHg lasting for at least 3 consecutive days. In this group, one patient had a blurred disc margin on the sixth day. Group 3 included 17 patients with shortlasting ICP values, ranging from 30 to 60 mmHg for less than 72 hour. Neither papilledema nor abnormalities of fundus vessels were seen in this group.

CONCLUSION

Papilledema in acute elevation of ICP is an uncommon event. Its absence does not preclude the presence of ICP elevation.

[Acquired vertical diplopia in macular dystrophy as a model for obligate fixation disparity]

In patients with obligate fixation disparity central objects may be perceived as double when peripheral fusion is achieved. The diplopia cannot be resolved with prisms because the fusional power of the periphery is stronger than the central power. A different cortical integration of the peripheral and central parts of the retina is thought to be the underlying cause. We report on the clinical findings in a 45-year-old man with macular dystrophy who complained of binocular vertical diplopia of up to 1 degree. Investigation with the phase-difference haploscope revealed inhomogeneous retinal correspondence in the vertical plane, with a displacement of the visual field center relative to the periphery by 0.6 degrees. We suggest that paracentral scarring had caused displacement of receptors such that the center and the periphery could not be fused simultaneously. The case represents a model for a retinal origin of fixation disparity.

Juvenile progressive scoliosis and congenital horizontal gaze palsy

Eleven articles reporting 39 patients with the combination of progressive scoliosis and familial congenital gaze palsy have now been published. This disorder appears to be caused by a malfunction of the normal equilibrial control mechanism related to the brainstem or the central nervous system. The scoliosis progresses when the children begin to walk. Even when they are treated with physiotherapy or brace, they often require early operation. We consider that progressive juvenile or infant scoliosis associated with familiar congenital horizontal gaze palsy constitutes a clinical entity. We report two sisters with congenital gaze palsy, in one of whom scoliosis of at least 70 degrees (Cobb) developed, and review and analyze all cases published until now.

When should isolated liver transplantation be performed in primary hyperoxaluria type 1? Follow-up report of two children

The value of isolated liver transplantation in primary hyperoxaluria type 1 (PH1) and its timing are controversial. Two children with PH1 were followed up for 6 years after liver transplantation. A boy aged 5 years with a glomerular filtration rate (GFR) of 65 ml/min/1.73 m2 at the time of transplantation subsequently showed regression of calcium deposits in the kidneys, but GFR slightly declined, probably related to cyclosporin A toxicity. A girl with a severe neonatal form of PH1 received a liver at the age of 2 years when GFR had already declined to about 15 ml/min/1.73 m2 and extrarenal manifestations (bones, eyes) were present. In spite of these and further complications post-transplantation GFR stabilized. Growth failure was efficiently treated by growth hormone. Plasma and urinary oxalate concentrations, however, remained increased. It is suggested that in PH1 liver transplantation should be considered only if GFR is not rapidly declining and stays above 30 ml/min/1.73 m2. For an individual decision the different risks of liver transplantation and of combined kidney-liver transplantation as well as the possible benefits from previous conservative treatment must be considered.

Cycloduction as a possible side-effect of vertical transposition of horizontal eye muscles in A- and V-pattern

In general an A-or V-symptom is an additional sign of an oblique muscle dysfunction and is treated by surgery of oblique muscles. The vertical transposition of horizontal rectus muscles is a suitable treatment only in those cases with no coexistent vertical deviation. The mechanical particularities of this vertical displacement are summarized. Possible side effects of this surgical method, including cyclotropia are reported.

Effects of synthetic cyclic AMP analogs on amylase exocytosis from rat pancreatic acini

Diastereomers of adenosine 3',5'-phosphorothioate activate cAMP-dependent protein kinases (cAMP-PK) in vitro. We found that these compounds are highly selective tools to monitor cAMP-dependent PKA activation and its effect on amylase exocytosis from pancreatic acini. In permeabilized rat acinar cells, (Sp)-cAMPS dose-dependently stimulated amylase secretion, while (Rp)-cAMPS inhibited (Sp)-cAMPS-induced amylase release. In intact rat acini, 8-Br-(Rp)-cAMPS reduced the secretory responses to secretin, vasoactive intestinal polypeptide (VIP), 8-Br-cAMP, and 8-Br-(Sp)-cAMPS, but not to cerulein. Another derivative, dibutyryl-(Rp)-cAMPS, induced a small inhibitory effect against 8-Br-(Sp)-cAMPS and VIP, which was overlapped by an unspecific stimulatory effect on amylase exocytosis induced by the degradation product butyrate. Furthermore, (Sp)-5,6-dichloro-1-beta-D-ribofuranosylbenzimidazole-3',5'- monophosphorothioate ((Sp)-5,6-DCl-cBIMPS), a specific cAMP-PK activator, induced a maximal induction of cAMP-PK activity, but its stimulation of amylase secretion was less than that by secretin. (Sp)-5,6-DCl-cBIMPS regulated the phosphorylation of several proteins, which were also affected by secretin. However, secretin had additional effects. Its action was most likely mediated by a dual effect on the cAMP and the calcium pathway. Our results indicate that the cAMP-dependent pathway is involved in amylase exocytosis from rat pancreatic acini.