Presurgical prediction of postsurgical visual acuity in patients with media opacities

Of the estimated 1 million patients each year in the United States who undergo surgery for media opacities, perhaps 5-10% fail to improve because of pre-existing, undiagnosed retinal and/or optic nerve disease. In this paper, the standard presurgical evaluation (case history, visual acuity, refraction, pupillary response testing, biomicroscopy, ophthalmoscopy, tonometry, visual fields and color vision) and the supplementary presurgical evaluation (entoptic phenomena appreciation, ophthalmic ultrasonography, fluorescein angiography, laser interferometry, potential acuity meter, visual evoked potential, electroretinography, contrast sensitivity and hyperacuity measurements) are reviewed.

Normative data and control studies of flash VEP's for comparison to a clinical population

The effects of aging, interocular comparisons, pupil dilation, iris pigmentation, and simulated cataracts on bright flash visual evoked potentials (VEP's) of normal observers were studied to assess the flash VEP as a potential predictor of postsurgical visual function in cataract patients. Seventy-six observers (from 20 to 80 years old) were tested for age differences in flash VEP's. Implicit time measures for transient responses increased significantly as a function of age, but neither transient nor steady-state response amplitudes were altered significantly. Moreover, no significant changes in VEP's occurred as a function of interocular comparisons, pupil dilation, or differences in iris pigmentation of normal observers. Simulation of cataracts with 14 observers did not affect implicit time measures, but did change response amplitudes significantly. Therefore, implicit time measures of cataract patients should be compared either to those of normal age-matched controls or, in the case of a unilateral problem, to the normal fellow eye. Delayed implicit time measures, after the appropriate comparison, suggest optic nerve/pathway dysfunction. However, comparisons of amplitude measures require compensation for opacity density.

Sexual behavior, contraceptive practice, and reproductive health among Liberian adolescents

This paper reports on a survey that was aimed at obtaining information for use in designing programs to reduce the incidence of adolescent pregnancy in Liberia. The sample of 1,488 never-married adolescents aged 14-21 was divided into subgroups based on age, sex, student status, and (for non-students) level of education. Although 57-93 percent of respondents claimed to have received information on reproductive health, only 2-21 percent could identify the monthly fertile period. Thirty to 49 percent of females ages 14-17 years have sexual relations at least once a month; over 80 percent of female non-students ages 18-21 years are sexually active. Highest levels of current contraceptive use were reported for 18-21-year-old female students (51 percent). Never-use of contraception among sexually active respondents was 97 percent for 14-17-year-old non-student females with a low educational level. Insufficient information about family planning methods and inaccessibility were the main reasons cited for non-use. Half of females ages 14-21 years who are currently attending school have been pregnant, as have 67 percent of those not in school. These results indicate a substantial unmet need on the part of Liberian adolescents with respect to reproductive health knowledge, information, and access to contraceptive methods.

Spondylolysis in Scheuermann's disease

Increased lumbar lordosis places increased stress on the pars interarticularis. Fatigue fractures of the pars can result in spondylolysis. There was a 50% incidence of asymptomatic spondylolysis in 18 patients who had Scheuermann's kyphosis and an increased lumbar lordosis. This significant increase further confirms the pathogenesis of spondylolysis. Patients with Scheuermann's disease with low-back pain should be evaluated with oblique radiographs of the lumbar spine to rule out spondylolysis.

Magnetic resonance planned thalamotomy followed by X-ray/CT-guided thalamotomy

Magnetic resonance imaging (MRI) is currently the optimal neuroradiologic technique for visualizing the anterior and posterior commissure for defining the AC-PC line. CT is the optimal technique for electrode and probe guidance during stereotactic thalamotomy. Various possibilities of transferring or overlying MRI and CT are outlined which in some future might result in more refined methods of CT-MRI guidance for stereotactic surgery.

Promoting self-directed hemodialysis: Measurement and cognitive-behavioral intervention

Approximately 98% of hemodialysis patients who are treated in hemodialysis units currently use staff-directed treatment. This may well be the most expensive and most dependent mode of hemodialysis treatment. If an effective strategy were developed to enhance degree of self-directed care, millions of public health dollars might be saved while patients reap potentially substantial psychological benefits. The present research took two steps in the direction of promoting increased self-directed treatment of hemodialysis. First, a reliable and easily used behavioral observation system was developed to define and measure degree of self-directed treatment of hemodialysis. Second, a five-step cognitive-behavioral strategy to improve degree of self-directed treatment was developed and tested preliminarily. The strategy includes an initial rationale, decisional counseling, behavioral contracting, self-monitoring, and staff support/problem solving. Four nurses used this approach with 4 elderly patients (mean age = 70.5 years). A multiple-baseline-across-subjects design revealed substantial and relatively rapid improvements in degree of self-directedness associated with the intervention for the 3 patients who remained healthy throughout the study. The discussion focuses on the implications of the results for future research.

Magnetic resonance imaging in partial complex epilepsy

The yield of magnetic resonance (MR) imaging was investigated in 30 patients with partial complex epilepsy, and the results were compared with those of computed tomography (CT). Magnetic resonance imaging and CT disclosed focal cerebral abnormalities in 13 (43%) and eight (26%) patients, respectively. Two additional focal temporal lesions were identified by double-dose CT scanning, increasing the yield of CT to 33%. Magnetic resonance images were abnormal in all patients with focally abnormal CT scans, and in four patients (50%) they defined the extent of the temporolimbic lesions better than did the CT scans. Two of these patients had gliomas. In addition, MR images were focally abnormal in 85% of the patients in whom scalp electroencephalograms showed focal ictal discharges. These data indicate that MR imaging is more informative than CT in partial complex epilepsy.

Pictures in sentences: understanding without words

To understand a sentence, the meanings of the words in the sentence must be retrieved and combined. Are these meanings represented within the language system (the lexical hypothesis) or are they represented in a general conceptual system that is not restricted to language (the conceptual hypothesis)? To evaluate these hypotheses, sentences were presented in which a pictured object replaced a word (rebus sentences). Previous research has shown that isolated pictures and words are processed equally rapidly in conceptual tasks, but that pictures are markedly slower than words in tasks requiring lexical access. The lexical hypothesis would therefore lead one to expect that rebus sentences will be relatively difficult, whereas the conceptual hypothesis would predict that rebus sentences would be rather easy. Sentences were shown using rapid serial visual presentation (RSVP) at a rate of 10 or 12 words per second. With one set of materials (Experiments 1 and 2), readers took longer to judge the plausibility of rebus sentences than all-word sentences, although the accuracy of judgment and of recall were similar for the two formats. With two new sets of materials (Experiments 3 and 5), rebus and all-word sentences were virtually equivalent except in one circumstance: when a picture replaced the noun in a familiar phrase such as seedless grapes. In contrast, when the task required overt naming of the rebus picture in a sentence context, latency to name the picture was markedly longer than to name the corresponding word, and the appropriateness of the sentence context affected picture naming but not word naming (Experiment 4). The results fail to support theories that place word meanings in a specialized lexical entry. Instead, the results suggest that the lexical representation of a noun or familiar noun phrase provides a pointer to a nonlinguistic conceptual system, and it is in that system that the meaning of a sentence is constructed.

Visual evoked potential (VEP) delays in central serous choroidopathy

The authors examined a series of ten consecutive patients with unilateral, idiopathic central serous choroidopathy. Visual acuities ranged from 20/20 to 20/70 during the active stage. VEPs were recorded to square sizes of 14, 28, and 56 min of arc. Overall, 90% of the patients had statistically significant VEP delays from the affected eye, while only 30% had statistically significant reductions in amplitude during the active stage. Six of the ten patients were reevaluated after the condition fully resolved. In all six, the VEP latency returned to normal. Although the mechanism of these VEP delays is not clear, their presence has been well documented. Therefore, a VEP delay in isolation of other tests should not be used in the differential diagnosis of macular vs optic nerve disease. One should specifically rule out macular disease in any patient with a delayed VEP before presuming the presence of a visual pathway dysfunction.

Pictures in sentences: Understanding without words

To understand a sentence, the meanings of the words in the sentence must be retrieved and combined. Are these meanings represented within the language system (the lexical hypothesis) or are they represented in a general conceptual system that is not restricted to language (the conceptual hypothesis)? To evaluate these hypotheses, sentences were presented in which a pictured object replaced a word (rebus sentences). Previous research has shown that isolated pictures and words are processed equally rapidly in conceptual tasks, but that pictures are markedly slower than words in tasks requiring lexical access. The lexical hypothesis would therefore lead one to expect that rebus sentences will be relatively difficult, whereas the conceptual hypothesis would predict that rebus sentences would be rather easy. Sentences were shown using rapid serial visual presentation (RSVP) at a rate of 10 or 12 words per second. With one set of materials (Experiments 1 and 2), readers took longer to judge the plausibility of rebus sentences than all-word sentences, although the accuracy of judgment and of recall were similar for the two formats. With two new sets of materials (Experiments 3 and 5), rebus and all-word sentences were virtually equivalent except in one circumstance: when a picture replaced the noun in a familiar phrase such as seedless grapes. In contrast, when the task required overt naming of the rebus picture in a sentence context, latency to name the picture was markedly longer than to name the corresponding word, and the appropriateness of the sentence context affected picture naming but not word naming (Experiment 4). The results fail to support theories that place word meanings in a specialized lexical entry. Instead, the results suggest that the lexical representation of a noun or familiar noun phrase provides a pointer to a nonlinguistic conceptual system, and it is in that system that the meaning of a sentence is constructed.

Visual evoked potentials in macular disease

Although a delayed visual evoked potential is considered to be the hallmark of optic nerve disease, relatively little has been published about VEP delays in macular disease. In this study, 20 patients with either acquired unilateral maculopathy or bilateral maculopathy in which one eye was more affected than the other were evaluated. VEP amplitudes and peak latencies were compared between eyes when recordable. Nine patients (45%) exhibited significant interocular delays in the affected or more affected eye while only four patients (20%) exhibited significant interocular attenuations in amplitude. In the nine patients exhibiting delays, three patients had a visual acuity of 20/30 or better in the affected eye or more affected eye. In the patients exhibiting amplitude attenuations, no patient had a visual acuity better than 20/50 in the affected or more affected eye. Although the mechanism of VEP delays in maculopathy is not clear, a VEP delay, in isolation of other tests, should not be used in the differential diagnosis of macular vs optic nerve disease. The clinician should specifically rule out macular disease in any patient with a delayed VEP before presuming the presence of a visual pathway dysfunction.

Endocrine abnormalities in a patient with partial trisomy 4q

Partial trisomy of the long arm of chromosome 4, usually resulting from a familial segregation of a balanced translocation, has been described in a number of patients. This report describes the genetic and endocrine findings in a 16 year old 46,XY,12q+ mentally retarded male. The banding pattern of the extra chromatin material from this de novo unbalanced translocation shows that the distal segment of the long arm of chromosome 4 is involved. Comparison of the clinical features in this patient with cases of partial trisomy 4q previously reported support the cytogenetic evidence for this translocation involving the distal portion of 4q. Endocrine data suggested an end-organ resistance, characterised by extreme hyperinsulinaemia, primary hypothyroidism, and hypergonadotrophic hypogonadism associated with no signs of autoimmunity. To our knowledge, no endocrine evaluation has been previously reported in patients with partial trisomy 4q.

Radiation induced carcinoma of the middle ear

Radiation induced carcinoma of the middle ear is rare. Only four cases have been reported; an additional case is now described. The treatment approach for radiation induced carcinoma of the middle ear has not yet been established. Radiation therapy for advanced cases is discussed as an alternative to surgical treatment. Previous reported cases are reviewed.

Septo-optic dysplasia and median cleft face syndrome in a patient with isolated growth hormone deficiency and hyperprolactinemia

A pituitary evaluation was carried out in a 12-year-old girl who had early puberty, short stature, optic nerve hypoplasia, and agenesis of the corpus callosum. Her growth hormone (GH) response to insulin-induced hypoglycemia and arginine infusion was blunted. Basal and stimulated levels of prolactin were elevated. The association of GH deficiency and hyperprolactinemia suggests a disruption of the dopaminergic modulation of these hormones. The facial features seen in our patient, such as hypertelorism, V-shaped frontal hairline, and cleft nose and upper lip, are enough to justify the diagnosis of median cleft face (MCF) syndrome. However, the optic nerve hypoplasia and the GH deficiency are characteristics of septo-optic dysplasia, and, to our knowledge, they have never been described in patients with MCF syndrome. Our case fulfills the diagnostic criteria of both, representing a link between both ends of this spectrum.

Growth enhancement of prolactin-sensitive mammary tumor by periaqueductal gray stimulation

The weight of prolactin-insensitive and prolactin-sensitive tumors implanted in female rats was measured upon their sacrifice. The group that received periaqueductal gray (PAG) stimulation subsequent to prolactin-sensitive tumor implantation had statistically higher incidence of enhanced tumor growth than non-PAG stimulated control group (P less than .001). There was no statistically significant difference seen in the tumor growth in rats implanted with prolactin insensitive tumor, whether or not they had PAG stimulation. These results suggest that enhanced tumor growth with PAG stimulation may be related to prolactin release, previously reported to occur with beta-endorphin and opiate administration.

Respiratory-ECG services department, Memorial Hospital of Union County, Ohio

At the 108-bed hospital in Marysville, Ohio, as at many similar rural medical facilities, the functional of the respiratory therapists extend beyond the traditional bounds of this discipline. They include noninvasive cardiodiagnostic testing, stress testing, Holter monitoring, and pulmonary function testing.

Simultaneous pattern-reversal electroretinograms and visual evoked potentials in diseases of the macula and optic nerve

Although it is well established that the flash electroretinogram (ERG) is preganglionic in origin, conflicting evidence exists concerning the main source of the pattern-reversal ERG(PERG). In this study, PERGs were recorded simultaneously with visual evoked potentials (PVEPs) in a group of patients and controls. In those patients with obvious macular disease, both the PERG and PVEP were reduced, whereas the standard flash ERG was normal. This result is consistent with either a preganglionic or ganglion cell origin of the PERG. In those patients with obvious optic nerve disease (n = 7), normal or near-normal PERGs were recordable even when PVEPs were completely absent. If the PERG reflects ganglion cell activity, one would anticipate both abnormal PVEPs and PERGs in these patients. These results suggest a preganglionic origin of the PERG in humans.

The differential diagnosis of retinal disease from optic nerve disease

Patients complaining of reduced acuity in the absence of a clearcut diagnosis present a challenge to the eye care practitioner. It is important to differentiate retinal disease from optic nerve disease as the etiology of the decrease in vision. This differentiation can have significant ramifications and must be determined for patient welfare and management. Several procedures may be used in making the differential diagnosis of macular or retinal from optic nerve disease. Some of these procedures are easy to perform and include Amsler grid, color vision testing, pupillary reflexes, light-brightness comparison, and macular dazzle. Other procedures require a greater degree of sophistication and include fluorescein angiography, the Visual Evoked Potential (VEP) and simultaneous VEPs and ERGs (Electroretinograms). The clinician should be aware of all of these procedures and how each may be useful in this differential diagnosis.

EDTA-mediated separation of cat tracheal lining epithelium

After specimens of cat trachea were incubated for 2 hr in 20 mM EDTA, the epithelium could easily be stripped from the mucosal surface with a dissecting needle. The epithelium was cleanly separated from its basal lamina, which remained fixed to the lamina propria. Epithelial cells were well preserved, junctional complexes were structurally intact, and there was no widening of intercellular spaces. The inferior epithelial surface was irregular, with numerous membrane-bound blebs arising from the constituent epithelial cells. Hemidesmosomes, which are found only on basal cells, were covered by a nap of fine filaments, the remnants of the filaments that normally traverse the lamina lucida. In many basal cells, cleaved hemidesmosomes were internalized, probably representing a stage in their lysosomal degradation. The basal lamina adhering to the lamina propria appeared in the transmission electron microscope as a sinuous linear density. In the scanning electron microscope, the basal lamina surface had an irregularly corrugated appearance. The basal lamina continued into the stomata of the submucosal gland ducts, which intersected the surface at an acute angle. Anchoring fibrils identical to those associated with stratified squamous epithelium were found in significant numbers on the connective tissue face of the basal lamina. Separation of tracheal tissues may provide a means whereby secretory activity and products of epithelium and submucosal glands can be individually assessed.

Computed tomography of abdominal fatty masses

Computed tomographic (CT) scans of 34 cases of abdominal fatty masses were reviewed retrospectively in order to establish criteria for distinguishing benign conditions from malignant tumors. By evaluating location, attenuation, internal consistency, and margination, it is possible not only to make this distinction but frequently to suggest a specific diagnosis. Abdominal fatty masses that are sharply marginated, homogeneous, and that show CT numbers less than or equal to the patient's normal fat can be considered benign. Malignancy should be suspected when an extrarenal abdominal fatty mass displays one or more of the following characteristics: inhomogeneity, infiltration or poor margination, CT numbers greater than the patient's normal fat, or contrast enhancement. Criteria for distinguishing between angiomyolipoma and liposarcoma are also discussed.

Comparison of a simplified whole blood and isolated lymphocyte stimulation technique

Whole blood and isolated lymphocyte stimulation in healthy men were compared utilizing PHA, ConA, and PWM. Dose response curves with each of the 3 mitogens were found to differ with the two techniques of lymphocytes stimulation. When incubation time was lengthened PWM responses increased markedly in both the whole blood and isolated lymphocyte assays. Increased incubation time had no effect on PHA cultures and increased the responses with ConA in the whole blood method. In each study, responses with 3H-thymidine were comparable to responses utilizing 125IUdR.