Subclinical audiological findings in carriers of recessive genes for deafness

The existence of subclinical signs in the hearing of carriers of recessive mutations for deafness has aroused much controversy in the literature. The present study comprised 30 carriers of recessive mutations for deafness, and a control group of 30 healthy volunteers, matched for gender and age. All participants underwent a series of hearing tests, including pure-tone audiometry, speech tests, Bekesy audiometry and notch noise tests. The main results were: hearing loss in high frequencies (3000 and 4000 Hz), an elevation of the acoustic reflex threshold, as well as an elevation of the identification of 2000 Hz pure tone in the presence of white noise and notch noise. A notch in the Bekesy audiogram was also identified in several carriers. An interaction was found between gender and the carrier trait in the hearing threshold at 4000 Hz, and in the ipsi- and contralateral acoustic reflex at 500 Hz and 1000 Hz. These subclinical signs may be complementary to DNA research in the investigation of genetic deafness of unknown origin.

Phenotypic analysis of lymphocytes and monocytes/macrophages in peripheral blood and bronchoalveolar lavage fluid from patients with pulmonary sarcoidosis

BACKGROUND

The granulomatous inflammation in sarcoidosis is driven by the interplay between T cells and macrophages. To gain a better understanding of this process the expression by these cells of cell surface activation markers, co-stimulatory molecules, and adhesion molecules was analysed.

METHODS

CD4+ and CD8+ T lymphocytes from peripheral blood (PBL) or bronchoalveolar lavage (BAL) fluid, as well as paired peripheral blood monocytes and alveolar macrophages from 27 patients with sarcoidosis were analysed by flow cytometry.

RESULTS

CD26, CD54, CD69, CD95, and gp240 were all overexpressed in T cells from BAL fluid compared with those from PBL in both the CD4+ and CD8+ subsets, while CD57 was overexpressed only in BAL CD4+ cells. In contrast, CD28 tended to be underexpressed in the BAL T cells. Monocyte/macrophage markers included CD11a, CD11b, CD11c, CD14, CD16, CD54, CD71, CD80 and CD86 and HLA class II. CD11a expression in alveolar macrophages (and peripheral blood monocytes) was increased in patients with active disease and correlated positively with the percentage of BAL lymphocytes. Expression of CD80 in macrophages correlated with the BAL CD4/CD8 ratio.

CONCLUSIONS

Our data indicate substantial activation of both CD4+ and CD8+ lung T cells in sarcoidosis. There were also increased numbers of BAL lymphocytes whose phenotypic characteristics have earlier been associated with clonally expanded, replicatively senescent cells of the Th1 type.

The lymphocytic alveolitis in sarcoidosis is associated with increased amounts of soluble and cell-bound adhesion molecules in bronchoalveolar lavage fluid and serum

OBJECTIVES

Pulmonary sarcoidosis is a chronic inflammatory disorder of unknown aetiology accompanied by a lymphocytic alveolitis. It is likely that a selective and temporal expression of adhesion molecules plays a crucial role in the recruitment of cells to the inflammatory site. We investigated the expression of adhesion molecules on alveolar T-lymphocytes and in bronchoalveolar lavage (BAL) fluid and serum to elucidate mechanisms behind the accumulation of cells in the lung in sarcoidosis.

DESIGN

In a cross-sectional study in patients with active and inactive sarcoidosis and in healthy volunteers, we examined, in serum and in BAL fluid, the soluble adhesion molecules, VCAM-1, ICAM-1, and P-, E- and L-selectin. In addition, the expressions of alpha4-beta1 (VLA-4) and alpha5-beta1 (VLA-5) integrins on alveolar T-lymphocytes were analysed.

SETTING

The subjects attended the outpatient clinic at the Division of Respiratory Medicine, Karolinska Hospital, Stockholm, Sweden.

SUBJECTS

Nineteen sarcoidosis patients, nine with clinically active disease, and 13 healthy volunteers were included in the study. The sarcoidosis diagnosis was based on a typical histological and/or clinical (symptoms, radiograph, lung function) picture.

RESULTS

In sarcoidosis patients, particularly in those with active disease, an increase of the expressions of beta1-integrins was accompanied by elevated concentrations in BAL fluid of soluble VCAM-1. In serum, the levels of E-selectin and ICAM-1 were significantly higher in patients with active disease than in those with inactive disease and controls.

CONCLUSIONS

The findings offer some mechanistic explanations as to how the cell-rich alveolitis in sarcoidosis occurs, and furthermore suggest additional markers, such as s-ICAM-1, for assessment of disease activity.

Effects of prenatal and postnatal methylmercury exposure from fish consumption on neurodevelopment: outcomes at 66 months of age in the Seychelles Child Development Study

CONTEXT

Human neurodevelopmental consequences of exposure to methyl-mercury (MeHg) from eating fish remain a question of public health concern.

OBJECTIVE

To study the association between MeHg exposure and the developmental outcomes of children in the Republic of Seychelles at 66 months of age.

DESIGN

A prospective longitudinal cohort study.

PARTICIPANTS

A total of 711 of 779 cohort mother-child pairs initially enrolled in the Seychelles Child Development Study in 1989.

SETTING

The Republic of Seychelles, an archipelago in the Indian Ocean where 85% of the population consumes ocean fish daily.

MAIN OUTCOME MEASURES

Prenatal and postnatal MeHg exposure and 6 age-appropriate neurodevelopmental tests: the McCarthy Scales of Children's Abilities, the Preschool Language Scale, the Woodcock-Johnson Applied Problems and Letter and Word Recognition Tests of Achievement, the Bender Gestalt test, and the Child Behavior Checklist.

RESULTS

The mean maternal hair total mercury level was 6.8 ppm and the mean child hair total mercury level at age 66 months was 6.5 ppm. No adverse outcomes at 66 months were associated with either prenatal or postnatal MeHg exposure.

CONCLUSION

In the population studied, consumption of a diet high in ocean fish appears to pose no threat to developmental outcomes through 66 months of age.

HLA-DR predicts the prognosis in Scandinavian patients with pulmonary sarcoidosis

Although most patients with sarcoidosis have a good prognosis, a significant proportion runs a more severe and prolonged disease course. There is no marker to distinguish these subpopulations of patients, however. To investigate the relationship between HLA haplotype and clinical course, 122 Scandinavian patients with sarcoidosis were genomically typed for HLA-DR, -DQA1 and -DQB1 alleles using PCR amplification with sequence-specific primers. Control subjects were 250 healthy Swedish volunteers. Patients were carefully clinically monitored for up to 10 yr. We found that HLA-DR17(3) was overrepresented among sarcoidosis patients (33%) compared with control subjects (17%, p < 0.001). Ninety-one patients were followed for more than 2 yr and classified into chronic or nonchronic patients, according to disease outcome. Among the 34 patients with a nonchronic form of sarcoidosis, 65% were DR17(3)-positive (p < 10(-5) versus control subjects). On the other hand, DR14(6) and DR15(2) were significantly associated with chronic disease. Even in patients with clinical manifestations that are normally associated with good prognosis, HLA typing enabled a subgrouping into two categories with significantly different clinical courses. Therefore, HLA class II typing is a valuable tool in predicting the outcome of the disease in Scandinavian sarcoidosis patients.

Evidence for magnesium sulfate as a tocolytic agent

The objective of our study is to quantitatively examine the available evidence regarding the efficacy and side effects of magnesium sulfate for acute tocolysis (from randomized trials) compared with placebo and beta-agonist agents. Randomized trials comparing magnesium sulfate with placebo or beta-agonists for tocolysis were identified with a MEDLINE-based search and was supplemented by a search of obstetrical textbooks and bibliographies. Trials underwent quality evaluation and data abstraction by two independent, blinded investigators. Outcomes evaluated included delivery delay of various durations as well as the frequency of major and minor side effects. Summary odds ratios and 95 percent confidence intervals for dichotomous outcomes were calculated using a random effects model. Interstudy heterogeneity for these outcomes was assessed with a Q statistic. We identified 12 randomized controlled trials of magnesium sulfate for acute tocolysis. Four studies were excluded because of either lack of comparison of magnesium sulfate to either placebo or beta-agonists or lack of reporting clinical outcomes of interest. The eight remaining randomized trials comparing magnesium sulfate with placebo or beta-agonists were included in this analysis. There was no significant difference between MgSO4 and placebo for any of the measured outcomes for delay in delivery. Comparing magnesium sulfate to ritodrine or beta-agonists did not demonstrate any differences between the agents in achieving clinically significant tocolysis. There was a significant difference between MgSO4 and beta-agonists in the frequency of medication discontinuation because of side effects, but not in the frequency of major adverse drug events. There are few data comparing magnesium sulfate with a placebo for acute tocolysis. Magnesium sulfate seems to be comparable to ritodrine and beta-agonists, although the available data are not sufficient for a rational choice between these agents.

The risk of cancer associated with specific mutations of BRCA1 and BRCA2 among Ashkenazi Jews

BACKGROUND

Carriers of germ-line mutations in BRCA1 and BRCA2 from families at high risk for cancer have been estimated to have an 85 percent risk of breast cancer. Since the combined frequency of BRCA1 and BRCA2 mutations exceeds 2 percent among Ashkenazi Jews, we were able to estimate the risk of cancer in a large group of Jewish men and women from the Washington, D.C., area.

METHODS

We collected blood samples from 5318 Jewish subjects who had filled out epidemiologic questionnaires. Carriers of the 185delAG and 5382insC mutations in BRCA1 and the 6174delT mutation in BRCA2 were identified with assays based on the polymerase chain reaction. We estimated the risks of breast and other cancers by comparing the cancer histories of relatives of carriers of the mutations and noncarriers.

RESULTS

One hundred twenty carriers of a BRCA1 or BRCA2 mutation were identified. By the age of 70, the estimated risk of breast cancer among carriers was 56 percent (95 percent confidence interval, 40 to 73 percent); of ovarian cancer, 16 percent (95 percent confidence interval, 6 to 28 percent); and of prostate cancer, 16 percent (95 percent confidence interval, 4 to 30 percent). There were no significant differences in the risk of breast cancer between carriers of BRCA1 mutations and carriers of BRCA2 mutations, and the incidence of colon cancer among the relatives of carriers was not elevated.

CONCLUSIONS

Over 2 percent of Ashkenazi Jews carry mutations in BRCA1 or BRCA2 that confer increased risks of breast, ovarian, and prostate cancer. The risks of breast cancer may be overestimated, but they fall well below previous estimates based on subjects from high-risk families.

Lung and blood T-cell receptor repertoire in extrinsic allergic alveolitis

Patients with extrinsic allergic alveolitis (EAA) have accumulations of T-lymphocytes in their lungs. CD8+ lung T-cells, in particular, have been implicated in the pathogenesis of EAA. The objective of the present study was to analyse the T-cell receptor (TCR) V alpha and V beta gene usage of CD4+ and CD8+ lung and peripheral blood lymphocytes (PBLs) before and after treatment. Twelve patients with clinical signs of extrinsic allergic alveolitis were studied at disease onset, and nine of the 12 were also studied after treatment and clinical recovery. Lung cells, obtained by bronchoalveolar lavage (BAL), and paired PBL samples were analysed by flow cytometry using a panel of anti-TCR V monoclonal antibodies. The changes in TCR V gene usage were most pronounced in BAL CD8+ cells, as compared to the BAL CD4+, PBL CD8+ and PBL CD4+ subsets. At disease onset, 10 of the 12 patients had lung restricted expansions of CD8+ T-cells using a particular V alpha or V beta gene segment, and 8 of the 12 patients had CD8+ T-cell expansions in PBL. For the patients in whom a follow-up was possible, a majority of the expansions in the lungs were normalized, whereas most of the expansions in PBL remained. An over-representation of human leucocyte antigen (HLA)-DR2 (15) was detected, particularly among patients with farmer's lung. An increased selected T-cell receptor V gene usage may follow specific interactions between T-cells and antigens. In extrinsic allergic alveolitis, we determined that such expansions occur most frequently in the lung CD8+ T-cells. Since most expansions of lung CD8+ T-cells normalized with clinical improvement, these are further implicated in the pathogenesis of extrinsic allergic alveolitis.

Lung and blood T-cell receptor repertoire in extrinsic allergic alveolitis

Patients with extrinsic allergic alveolitis (EAA) have accumulations of T-lymphocytes in their lungs. CD8+ lung T-cells, in particular, have been implicated in the pathogenesis of EAA. The objective of the present study was to analyse the T-cell receptor (TCR) V alpha and V beta gene usage of CD4+ and CD8+ lung and peripheral blood lymphocytes (PBLs) before and after treatment. Twelve patients with clinical signs of extrinsic allergic alveolitis were studied at disease onset, and nine of the 12 were also studied after treatment and clinical recovery. Lung cells, obtained by bronchoalveolar lavage (BAL), and paired PBL samples were analysed by flow cytometry using a panel of anti-TCR V monoclonal antibodies. The changes in TCR V gene usage were most pronounced in BAL CD8+ cells, as compared to the BAL CD4+, PBL CD8+ and PBL CD4+ subsets. At disease onset, 10 of the 12 patients had lung restricted expansions of CD8+ T-cells using a particular V alpha or V beta gene segment, and 8 of the 12 patients had CD8+ T-cell expansions in PBL. For the patients in whom a follow-up was possible, a majority of the expansions in the lungs were normalized, whereas most of the expansions in PBL remained. An over-representation of human leucocyte antigen (HLA)-DR2 (15) was detected, particularly among patients with farmer's lung. An increased selected T-cell receptor V gene usage may follow specific interactions between T-cells and antigens. In extrinsic allergic alveolitis, we determined that such expansions occur most frequently in the lung CD8+ T-cells. Since most expansions of lung CD8+ T-cells normalized with clinical improvement, these are further implicated in the pathogenesis of extrinsic allergic alveolitis.

Racial differences in survival from gynecologic cancer

OBJECTIVE

To determine whether survival from gynecologic cancer is different between African-American and white patients at an inner-city hospital with both a large clinic and a private service.

METHODS

We studied 538 patients (89 African American, 449 white) diagnosed with cervical, uterine, or ovarian cancer at a single institution from January 1, 1989 through December 31, 1993. Information was obtained on age, stage, site of disease, histology, and type of health insurance (public or commercial). Insurance coverage was used as a proxy for socioeconomic status. Overall survival was estimated by the method of Kaplan and Meier and compared by the log-rank test. Cox proportional hazard modeling was used to evaluate the effects of multiple factors on survival.

RESULTS

African-American patients were significantly older and were more likely to have cervical cancer and public insurance than white patients. Overall survival was worse for African-American patients than for white patients (P < .05). However, stage for stage, there was no significant difference in survival between the groups. There was also no difference when patients were grouped by insurance status. African Americans had a significantly worse survival for cervical cancer than whites, and African-American patients older than 65 years had a worse survival than whites of similar age. On multivariate analysis, only stage and insurance coverage were significant predictors of survival.

CONCLUSIONS

African-American patients with gynecologic cancer at our institution have worse overall survival than white patients. The survival difference seems to be due predominantly to differences in socioeconomic status and stage at diagnosis.

Behavioral consequences of in utero exposure to mercury vapor: alterations in lever-press durations and learning in squirrel monkeys

Exposure to mercury vapor in utero results in the accumulation of mercury in the cerebellum, hippocampus, and other regions of the nervous system associated with motor function and learning, but little is known about the functional consequences of prenatal exposure. The offspring of pregnant squirrel monkeys exposed to 0.5 or 1.0 mg/m3 of mercury vapor during the last 2/3 or more of gestation were studied. Median maternal blood levels ranged from 0.025 to 0.18 microgram/g and exposures were estimated to range from 20 to 62 micrograms/day, with cumulative doses of 1304 to 4305 micrograms. Unexposed monkeys born at about the same time served as controls. The monkeys' lever pressing was maintained under various Concurrent Random-Interval Random-Interval schedules of reinforcement. Time allocation on each lever was examined during behavioral transitions and in steady state. No difference in sensitivity to reinforcer ratios was identified in steady state, but there was much more variability in the steady-state performance of exposed monkeys, as indicated by the standard deviation of the regression, than in controls. Logistic regression was used to examine the transition to new schedule parameters. Exposed monkeys were found to produce smaller or slower transitions than controls. The magnitude and stability of lever-press durations for controls and exposed monkeys were indistinguishable early in the experiment, but at the end the exposed monkeys had longer lever-press durations and the session-to-session variability was much greater. One monkey's exposure began during the third week of gestation (earlier than any of the others) and the behavior of this monkey was so erratic that some of the analyses could not be accomplished. Long-term effects of prenatal mercury vapor exposure included instability in lever-press durations and steady-state performance under concurrent schedules of reinforcement as well as aberrant transitions. The levels used were close to those reported in occupational settings under conditions of poor hygiene, but were at least 10- to 50-fold greater than those more commonly reported.

Sarcoidosis and regional enteritis in two patients

Both sarcoidosis and Crohn's disease (regional enteritis) are characterized by granuloma formation and they also have an unknown etiology. Only a few subjects with co-existing sarcoidosis and Crohn's disease have been reported in the literature. We report two cases who suffered from both disorders. In the two subjects Crohn's disease began first and the symptoms of sarcoidosis came later; four and sixteen years, respectively.

In utero lead exposure in squirrel monkeys: motor effects seen with schedule-controlled behavior

Timed-pregnant squirrel monkeys were exposed orally to lead during the last 1/2 to 2/3 of gestation such that maternal lead levels ranged from 21 to 70 micrograms/dl in blood. Offspring of these lead-exposed monkeys were compared to gender-matched, untreated controls (blood-lead levels from 4 to 9 micrograms/dl), born at about the same time. When the monkeys were 3 to 7 years old they were trained to pull a T-shaped bar against 1 kg spring through a displacement of 1 cm. This performance was examined during acquisition of different fixed-ratio (1, 5, and 20) and fixed-interval (120", 300", and 600") schedules of reinforcement and during steady state under the fixed-ratio 5 and fixed-interval 600". Monkeys exposed prenatally to lead showed an increased number of responses failing to meet the requirement of pulling against 1 kg spring through a 1 cm displacement when behavior was maintained by a fixed-ratio schedule, which engenders a vigorous, high-rate pattern of responding. This increased number of incomplete responses first appeared in the acquisition of a fixed-ratio 5 and fixed-ratio 20 schedules of reinforcement, remained after the fixed-ratio 5 schedule was allowed to reach steady state, and did not appear under the fixed-interval schedule. Neither body weight not response rate were affected by lead, but it was necessary to control for these variables using multiple regression to isolate lead's effect. The appearance of incomplete responses while the monkeys pulled vigorously against a 1 kg spring suggests that lead exposure during gestation produced subtle motor impairments years after exposure has ended. Deficits in the acquisition of behavior (learning) under Concurrent Random Interval schedules of reinforcement have also been reported with these monkeys. Together, these reports reveal prolonged deficits in learning and motor function resulting from in utero exposure to lead at maternal blood lead levels (21-70 micrograms/dl) that could result from exposure to ambient air in heavily polluted urban environments or in occupational settings meeting current World Health Organization standards.

Pathological changes in the Brown Norway rat cerebellum after mercury vapour exposure

Our previous studies have demonstrated that mercury vapour exposure of Brown Norway rats induced an autoimmune response with development of glomerulonephritis and resulted in mercury deposition in the central nervous system, particularly in the neurons. The aim of this study was to investigate the effect on the central nervous system. A loss of Purkinje cells accompanied by Bergmann glial cell proliferation was found at a brain mercury level of 0.71 micrograms/g and became even more pronounced as the exposure dose increased. At a brain mercury level of 5.0 micrograms/g, a heavy gliosis was present in the brain stem, particularly around the pontine nuclei. In comparison with our previous study, the pathological changes in the brain appeared at the same mercury exposure dose as the glomerulonephritis. However, the location of pathological changes at the mercury level of 0.71 micrograms/g was not completely in accordance with the mercury distribution in the brain, which might be due to the sequence of mercury deposition, its amount or the vulnerability of the various cells classes.

Keratoconus detected by videokeratography in candidates for photorefractive keratectomy

BACKGROUND

Patients with corneal shape abnormalities should be identified prior to photorefractive keratectomy (PRK). We used videokeratography screening to detect subclinical corneal abnormalities, including keratoconus, which might have been missed by conventional clinical evaluation.

METHODS

One hundred forty-six apparently normal myopic eyes (-1.00 to -7.00 diopters [D] with less than 1.50 D of cylinder) of 91 consecutive patients who were candidates for PRK were screened by videokeratography.

RESULTS

In 6 of 91 patients (7 of 146 eyes), unsuspected corneal shape abnormalities were detected by videokeratography. Two patients had definite keratoconus and three were classified as keratoconus suspects by inferior corneal steepening (Rabinowitz I-S index ranging from 1.62 to 6.20 D). One patient had early pellucid marginal degeneration.

CONCLUSIONS

Keratoconus suspects and contact lens-induced changes resembling keratoconus are present in the "normal" myopic population that presents for refractive surgery. Videokeratographic screening is the only effective means of identifying these and other corneal shape abnormalities.

Efficacy of oral beta-agonist maintenance therapy in preterm labor: a meta-analysis

OBJECTIVE

To analyze the available data on the efficacy of oral beta-agonist maintenance therapy in delaying delivery and in decreasing the incidence of preterm birth and its complications.

DATA SOURCES

A computer search of English-language abstracts using MEDLINE (medical subject heading terms: labor, premature and beta-adrenergic receptor agonist, therapeutic use) was supplemented with a review of the bibliographies of obstetric texts to identify randomized trials of oral beta-agonist maintenance therapy.

METHODS OF STUDY SELECTION

Six trials were identified, of which four met our inclusion criteria for the meta-analysis.

DATA EXTRACTION AND SYNTHESIS

Trials to be included in this meta-analysis underwent trial quality evaluation and data abstraction independently by two blinded investigators. An estimate of the odds ratio (OR) and risk difference was calculated for the dichotomous outcomes using both a random effects model and a fixed effects model. Continuous outcomes were pooled using a simple weighted average of the within-study difference in means. The pooled OR for preventing preterm delivery was 1.09 (95% confidence interval [CI] 0.60-1.99) and the OR for preventing recurrent preterm labor was 1.05 (95% CI 0.53-2.05). The pooled difference in the mean interval to delivery was -0.22 days (95% CI -2.5 to +1.99).

CONCLUSIONS

The available data do not support a role for beta-agonist maintenance therapy after resolution of an acute episode of preterm labor in reducing the incidence of preterm delivery, increasing the interval to delivery, or reducing the incidence of recurrent preterm labor.

Prolonged behavioral effects of in utero exposure to lead or methyl mercury: reduced sensitivity to changes in reinforcement contingencies during behavioral transitions and in steady state

Postnatal exposure to lead or methyl mercury results in mental retardation, learning deficits, and other neurobehavioral effects in humans, and adverse consequences of prenatal exposure have been clearly documented with methyl mercury. To examine the developmental neurotoxicity of these metals, especially lead, concurrent schedules of food reinforcement were used to identify learning deficits in squirrel monkeys exposed during gestation to either methyl mercury or lead. Pregnant squirrel monkeys were administered methyl mercury (0.7 to 0.9 ppm in maternal blood) or lead (21 to 79 micrograms/dl in maternal blood) during the last half to two-thirds of gestation. At about 5-6 years of age, offspring were trained to lever press under concurrent schedules of reinforcement in which separate random interval reinforcement schedules operated independently on two levers. Reinforcement densities were varied such that 20 to 90% of the reinforcers were programmed to derive from the left lever (i.e., one lever was "richer" than the other). At steady state, the behavior of the controls was sensitive to reinforcement density and showed little lever bias, but the behavior of monkeys exposed to more than 40 micrograms/dl of lead and to methyl mercury was less sensitive to reinforcement rates and heavily biased. When relative reinforcement density on a lever changed, the unexposed animals' response rates gradually shifted to the newly rich lever. The behavior of monkeys exposed to methyl mercury or more than 40 micrograms/dl of lead changed slowly, not at all, or in the wrong direction. Steady-state behavior of monkeys exposed to less than 40 micrograms/dl resembled controls, but acquisition progressed more slowly and required 2-4 times as many reinforcers to complete. These effects suggest a behavioral mechanism--insensitivity to changing reinforcement contingencies--by which learning deficits and behavioral changes associated with these metals might be related to toxicant exposure. Since maternal blood levels corresponded to those that could be experienced in occupational settings, the present data raise the possibility of fetal hazards associated with maternal lead exposures at levels tolerated in humans in occupational settings.

Histopathologic correlation of the three-layered intravascular ultrasound appearance of normal adult human muscular arteries

The purpose of this study was to correlate intravascular ultrasound images from normal peripheral muscular arteries with the microscopic arterial components by using surgical microdissection techniques. There has been uncertainty about the precise anatomic constituents that are represented by the intravascular ultrasound three-layer image in human peripheral arteries. Forty of 66 grossly normal human femoropopliteal arterial segments obtained at autopsy were found to have a three-layered appearance and were subjected to selective surgical microdissection of intima, media, or adventitia. After microdissection, arteries were imaged with a 30 MHz intravascular ultrasound system; two observers blindly reviewed video tapes to assess for the presence or absence of a one-, two-, or three-layered arterial appearance. Removal of internal elastic lamina and/or intima results in a weak but evident inner ultrasound acoustic interface as a result of the media, which is normally echo-lucent. Removal of the adventitia and/or external elastic lamina results in a weak outer ultrasound acoustic interface. Isolated removal of the media does not alter the three-layered ultrasound image. In normal adult human femoropopliteal arteries the inner bright acoustic reflection (layer) is derived from the interface of blood with the intima and internal elastic lamina and the second bright interface (third layer) is from the external elastic lamina and adventitia. The mid-echo-lucent zone is the result of the media. However, any portion of the arterial wall, including muscular media, can act as an acoustic interface.

A two-year experience with excimer laser photorefractive keratectomy for myopia

PURPOSE

This report summarizes the authors' 2-year experience with excimer laser photorefractive keratectomy (PRK) on 160 eyes of 128 patients.

METHODS

All eyes were treated with an excimer laser: fluence, 160 mJ/cm2; frequency, 5 Hz; ablation zone diameter, 5.0 to 5.5 mm; and depth per pulse, 0.21 to 0.27 microns. A suction fixation ring was used in all eyes either with nitrogen flow (79 eyes) or without nitrogen flow (81 eyes) across the cornea. Follow-up ranged from 1 month (152 eyes) to 24 months (12 eyes).

RESULTS

At 3 months, 82% (139) of eyes achieved an uncorrected visual acuity of 20/40 or better; 83% were corrected to within +/- 1 diopter (D) of intended correction and 30% lost one line of best-corrected visual acuity. At 6 months, 88% (124) of eyes achieved an uncorrected visual acuity of 20/40 or better; 84% were corrected to within +/- 1 D of intended correction and 15% lost one line of best-corrected visual acuity. At 12 months, 91% (71) of eyes achieved an uncorrected visual acuity of 20/40 or better; 84% were corrected to within +/- 1 D of intended correction and 17% lost one line of best-corrected visual acuity. At 24 months, 100% (12) of eyes achieved an uncorrected visual acuity of 20/40 or better; 91.6% were within +/- 1 D of intended correction and 0% lost one line of best-corrected visual acuity.

CONCLUSIONS

In eyes with a follow-up of 6 to 24 months, 77% to 100% achieved an uncorrected visual acuity of 20/40 or better and 84% to 92% were corrected to within +/- 1 D of the intended correction. The authors conclude that excimer laser PRK appears to be a safe procedure capable of correcting the eyes of patients with low to moderate myopia with approximately the same degree of accuracy as radial keratotomy.

Autoimmune glomerulonephritis induced by mercury vapour exposure in the Brown Norway rat

Subcutaneous injections of mercuric chloride induce an autoimmune glomerulonephritis with both granular and linear IgG deposits along the glomerular capillary wall and proteinuria. This disease is due to a T cell dependent polyclonal B cell activation responsible for production of antibodies against self (glomerular basement membrane, immunoglobulins, DNA, myeloperoxydase) and non self (sheep red blood cells, trinitrophenol (TNP)) components. Increase in serum IgE concentration is the hallmark of this disease. To determine if mercury vapours have pathogenic effects is an important problem of public health. The aim of this study was, first to compare the effects of mercury vapour exposure to those of mercury injections and, second, to compare the effects of high doses to those of low doses of mercury. Two exposure levels were studied corresponding to a mercury absorption of 13.1 mumol/week per kg body wt. and 1.7 mumol/week per kg body wt. during a 5-week period. It will be shown that, whereas the mercury concentration in the kidneys was similar in injected--and vapour exposed--rats, the mercury concentration in blood at the end of the exposure was about twice as high in the injected animals. Blood concentration of mercury was related to dose level but kidney content of mercury was similar in all groups, in spite of a dose difference by a factor of seven between low and high exposure. Mercury vapour and HgCl2 injections both trigger autoimmunity to the same extent and, in both cases the extent of autoimmune manifestations was dose-dependent.

HIV-infected health care professionals. Public opinion about testing, disclosing, and switching

BACKGROUND

We wanted to know what the public believes about the risks of human immunodeficiency virus (HIV) transmission in health care settings, and what opinions the public holds regarding HIV-infected health care professionals. We also wanted to uncover the correlates and predictors of those opinions.

METHODS

A telephone survey of a nationwide random probability sample of adults was conducted in summer 1991. Thirteen hundred fifty adults completed the survey. The response rate was approximately 63%. We assessed (1) public opinion about whether HIV-infected physicians, surgeons, and dentists should quit working, and (2) the public's self-reported intention to remain in the care of an HIV-infected professional or to switch to another provider.

RESULTS

Public concern about HIV transmission in health care settings has increased from 19% in 1988 to 38% in 1991. More of the public now believes that transmission from HIV-infected physicians is likely (up from 33% in 1988 to 46% in 1991). Yet, fewer respondents believe that HIV-infected physicians should not be allowed to work (45% vs 39%). Only 5% would deprive HIV-infected physicians of their livelihood as physicians. Fewer would switch from HIV-infected physicians now than in 1988 (56% vs 37%). Knowing someone with HIV infection was related to less concern and to less belief in likelihood of transmission as well as to increased support of HIV-infected health professionals' right to work.

CONCLUSIONS

Although the public is more concerned about HIV transmission in health care settings since 1988, fewer would not allow HIV-infected health care professionals to work now than in 1988. Personalizing the epidemic, by using personal physicians and people with acquired immunodeficiency syndrome as educators, might help continue the trend toward improved attitudes toward HIV-infected health care professionals.

Mercury distribution in the rat brain after mercury vapor exposure

Brown Norwegian rats were exposed to mercury vapor at a concentration of approximately 1 mg/m3 for 5 weeks 24 hr/day 7 days a week and 6 hr/day 3 days a week, respectively. The total mercury absorption was calculated to 264 and 35 micrograms per week and 100 g body weight. The mean blood mercury concentration was 0.25 +/- 0.03 and 0.09 +/- 0.01 microgram/g, and the total concentration in the brain was 5.03 +/- 0.73 and 0.71 +/- 0.10 microgram/g tissue, respectively. The mercury distribution in the brains was examined using a method based on chemographic principles. Mercury was found primarily in the neocortex, in the basal nuclei, and in the cerebellar Purkinje cells. This distribution pattern corresponded to the pattern of inorganic mercury described after exposure to methyl mercury. Distribution of mercury after administration of different mercury compounds is discussed.