Worsening of hepatic dysfunction as a consequence of repeated hydroxyethylstarch infusions

BACKGROUND/AIMS

Due to its apparent safety and low cost, hydroxyethylstarch (HES) is increasingly used as a volume expander. The aim of this retrospective study was to highlight the risk of hepatic dysfunction after iterative HES infusions.

METHODS

Between April 1996 and April 1998, nine patients were referred for worsening of their clinical condition after repeated HES infusions. Six patients had previous chronic liver disease, cirrhosis in four cases. All patients underwent a liver biopsy.

RESULTS

All post-HES liver biopsies showed diffuse microvacuolization of Kupffer cells, which was associated with focal hepatocyte vacuolization in seven cases. The vacuoles contained periodic acid Schiff positive material at their margins and were lysosomal by electron microscopy. The clinical symptoms of hepatic disease, although difficult to interpret in cirrhotic patients, worsened after HES infusions. Portal hypertension was noted in three non-cirrhotic patients. Serum alkaline phosphatase and gammaglutamyl transferase activities were increased when compared with previous values. Eight patients died, six of them within 1-4 weeks of hepatic failure or septic shock. In the only living patient, symptoms improved after HES withdrawal.

CONCLUSIONS

Repeated administration of HES could favour severe portal hypertension, liver failure and sepsis, particularly in the setting of chronic liver disease. The basis of these adverse effects is the lysosomal storage of HES in Kupffer cells and hepatocytes.

[Recurrence of finger tendon giant cell tumors after excision through a "shark teeth" approach. Report of 25 cases]

Local recurrences after excision of a giant cell tumor of the tendon sheath are classically related to incomplete excision. We have review a special group of circumferential tumors excised through a huge approach. Twenty-six circumferential tumors were excised between 1985 and 1998, through a special incision described by the senior author. It is composed of four triangular flaps drawn around the finger, one dorsal, one palmar (both proximally based) and two lateral (distally based). Six presented already with a recurrence of previous operations (mean 2.5 interventions). Some anatomical neighboring structure was "invaded" in all except one case. However the approach allows for a macroscopically satisfactory excision. Twenty-five patients were reviewed by an independent observator after a mean follow-up of six years. Six patients (24%) presented a recurrence after a mean postoperative delay of 17 months. Among them five have been already operated (83%) and five had multiple tumors. Satisfactory excision does not prevent recurrence and two types of distinct tumors exist. Recent immunohistological studies give support to this view and such examination is recommended.

Investigating sources of variability of monochromatic and transverse chromatic aberrations across eyes

Schematic eye models have typically been used to explain the average monochromatic and chromatic imaging properties of the eye. Both monochromatic aberrations and transverse chromatic aberration are known to vary widely across subjects. However, to our knowledge, the ability of schematic eye models to predict these individual variations has not been tested experimentally. We used a spatially resolved refractometer to measure the monochromatic aberrations and the optical transverse chromatic aberration (oTCA) in a group of 15 eyes. By recording the 1st and 4th Purkinje images for five directions of gaze, we also estimated the tilt, misalignment of ocular surfaces (front surface of the cornea and back surface of the lens) and off-axis position of the fovea (angle alpha), as well as pupil centration. We conclude that, contrary to expectations none of those factors are major contributors to the variability in monochromatic aberrations and oTCA in this group of eyes. Simulations show that corneal curvature and corneal conicity are also unlikely to account for the observed relation between monochromatic aberrations and oTCA. Our results suggest an important contribution of corneal irregularities to those aberrations.

The treatment of gastroesophageal reflux disease with proton-pump inhibitors and its implications on managed care--clinical overview of gastroesophageal reflux disease. Roundtable discussion

The importance of gastroesophageal reflux disease (GERD) to managed health care systems cannot be overestimated. It contributes significantly to the use of health care resources, including doctor's services, medication consumption, and diagnostic testing. A roundtable meeting of 13 managed care experts was convened January 23, 2001 in Dallas, to discuss the implications of GERD on the managed care system. The following proceedings are published in five sections. In the first part, Jeffrey Danzig, MD, a gastroenterologist, provides the clinical foundation for the discussion, based on the existing literature and his personal practice.

Uterine prolapse in 2 dromedary camels

Two cases of uterine prolapse in dromedary camels in a herd with concomitant cases of white muscle disease are described. Serum selenium and glutathione peroxidase in whole blood were investigated in both patients and showed statistical difference compared with a control group. Results suggest that selenium deficiency could promote uterine prolapse in dromedary camels.

Metacarpal synostosis: a simple classification and a new treatment technique

The current classification of metacarpal synostosis is based on the extent of the synostosis. The authors propose a new classification that takes into account the shape of the metacarpal bones, the curvature of the epiphysis, and the discrepancy in length between the two bones. This classification provides better guidelines for the correction of all components of the deformity. The classification is based on the authors' observations of and experience with 36 cases of metacarpal synostosis; 13 of the deformities were surgically corrected. The I-shaped deformity, whether with distinct (type d) or fused (type f) metacarpophalangeal joints, does not require surgical correction. The U-shaped deformity has parallel epiphysis and does not require surgery unless the two metacarpals are asymmetrical in length (type a) or tightly fused (type t); in these cases, simple lengthening or widening of the space with a bone graft is sufficient. Y-shaped synostosis should be separated whether the branches are symmetrical or asymmetrical, the latter having one branch shorter than the other. Because the epiphyses are already divergent, simple separation does not effectively correct Y-shaped synostosis. The authors propose an osteotomy to isolate a trapezoidal segment of bone from the bifurcation. The isolated bone segment is then reversed in the proximal-distal direction to provide a "plateau" upon which the two distal metacarpals can be realigned. Two cases of Ys (symmetrical) synostosis were successfully treated with this technique; one case of Ya (asymmetrical) synostosis also required distraction lengthening of the shorter metacarpal to achieve an excellent result. One of the most difficult types of metacarpal synostosis to treat is k-shaped synostosis, observed only between the fourth and fifth metacarpals; in this type, the head of the short fifth metacarpal abuts the metaphysis of the fourth. Osteotomy and distraction lengthening provide predictable results for correction of this deformity. The authors suggest that k-shaped synostosis might represent a late evolution of untreated Ua synostosis.

tert-Butyl hydroperoxide-induced lipid signaling in hepatocytes: involvement of glutathione and free radicals

tert-Butyl hydroperoxide (TBHP) mobilizes arachidonic acid (AA) from membrane phospholipids in rat hepatocytes under cytotoxic conditions, thus leading to an increase in intracellular AA, which precedes cell death. In the present work, the involvement of lipid peroxidation, thiol status, and reactive oxygen species (ROS) in the intracellular AA accumulation induced by 0.5 mM TBHP was studied in rat hepatocytes. Cells treated with TBHP maintained viability and energy status at 10 min. However, TBHP depleted GSH, as well as inducing lipid peroxidation and ROS formation, detected by dichlorofluorescein (DCF) fluorescence. TBHP also significantly increased (32.5%) the intracellular [14C]-AA from [14C]-AA-labelled hepatocytes. The phospholipase A(2) (PLA(2)) inhibitor, mepacrine, completely inhibited the [14C]-AA response. The addition of antioxidants to the cell suspensions affected the TBHP-induced lipid response differently. The [14C]-AA accumulation correlated directly with ROS and negatively with endogenous GSH. No correlation between [14C]-AA and lipid peroxidation was found. Promethazine prevented lipid peroxidation and did not affect the [14C]-AA increase. We conclude that TBHP stimulates the release of [14C]-AA from membrane phospholipids through a PLA(2)-mediated mechanism. Endogenous GSH and ROS play a major role in this effect, while lipid peroxidation-related events are unlikely to be involved. Results suggest that specific ROS generated in iron-dependent reactions, different from lipid peroxyl radicals, are involved in PLA(2) activation, this process being important in TBHP-induced hepatocyte injury.

Ab initio vibrational calculations on ara-T molecule: application to analysis of IR and Raman spectra

The FTIR and FT-Raman spectra are reported for the arabinonucleoside ara-T (1-beta-D-arabinofuranosylthymine), which shows antiviral activity. The accurate knowledge of the vibrational modes is a prerequisite for the elucidation of drug-nucleotide and drug-enzyme interactions. The FTIR and FT-Raman spectra of ara-T were recorded from 4000 to 30 cm(-1). A tetradeuterated derivative (deuteration at N3, and hydroxyl groups O'2, O'3, and O'5) was synthesized and the observed isotopic shifts in its spectra were used for the vibrational analysis of ara-T. The theoretical frequencies and the potential energy distribution (PED) of the vibrational modes of ara-T were calculated using the ab initio Hartree-Fock/3-21G method. An assignment of the vibrational spectra of ara-T is proposed considering the scaled PED and the observed band shifts under deuteration. The scaled ab initio frequencies were in reasonable agreement with the experimental data.

[Progressive bone lengthening of the hand in congenital malformations. 41 cases]

PURPOSE OF THE STUDY

We retrospectively reviewed the experience of two Hand Units with progressive bone distraction lengthening, collecting 41 cases of hand skeleton lengthening for congenital malformations.

MATERIAL AND METHODS

The Ilizarov callostasis method was used in 31 cases and in 10 cases bone union was reestablished at a second stage with an iliac graft (2 cases), vascularized metacarpal bone graft (one case), and vascularized (one case) or nonvascularized (3 cases) toe epiphysis. In the last three cases of index lengthening, the distal part was translocated to the tip of the third, deepening at the same stage the first web. The most frequently treated malformation was symbrachydactyly (22 cases).

RESULTS

Mean lengthening was 2.3 cm (0.9 to 3.5) with a mean treatment duration of 3.8 months (1.5 - 8.2). The "lengthening index" was 0.59. There was a significant difference between phalanx and metacarpal lengthening, but the amount of lengthening or treatment duration were not affected by technique (Ilizarov vs bone grafting) or age. The complication rate was 32%. There were two complete failures, one extensor tendon tear, 3 pin tract infections (one requiring interruption of the lengthening), 2 cases of relevant pain, 2 delayed unions, 2 angulations and 1 callus fracture, 1 metacarpophalangeal dislocation and 1 joint stiffness.

DISCUSSION

Despite advances in micorsurgical toe transfer, there are still indications for bone lengthening in congenital malformations. The apparent simplicity of the technique can mask a certain number of complications, emphasizing the need for surgical experience. Progressive bone lengthening in congenital deformity has the advantage of preserving sensitivity and avoiding bone resorption. Callostasis does not increase the duration of treatment compared to bone graft.

17beta-estradiol affects in vivo the low density lipoprotein composition, particle size, and oxidizability

The aim of this study was to explore the possible modifications induced by 17beta-estradiol (E(2)) in vivo on low-density lipoprotein (LDL) lipid composition, particle size, and oxidizability. For this purpose, women were recruited from an in vitro fertilization program, ranging their plasma E(2) levels from less than 12 pg/ml to more than 2000 pg/ml at the end of the treatment. The LDL lipid constituents were analyzed by thin layer chromatography and image analysis, and the LDL diameter was calculated from the lipid data. The results showed that high plasma E(2) levels were associated with smaller LDL particles, with lower amounts of free and esterified cholesterol and an increased relative content of alpha-tocopherol. The hormonal treatment produced a remodelation of the LDL acyl composition, rendering a lipoprotein enriched in saturated fatty acids, with a poorer polyunsaturated fatty acid content. These alterations in the physicochemical properties of LDL paralleled changes in the susceptibility of LDL to in vitro oxidation induced by both Cu(2+) and the peroxyl radical generator, 2,2'-azobis (2-amidinopropane), these changes being mainly reflected in a reduced maximum oxidation rate. The in vivo changes in the physicochemical properties of LDL induced by E(2) could explain some of the antiatherogenic actions of estrogens.

Acquired haemophilia in the elderly is a severe disease: report of five new cases

Acquired haemophilia is a rare but life-threatening bleeding disease that can be observed in males or females at various ages. In the present study, we report on five cases of acquired factor (F) VIII inhibitors diagnosed in the elderly population over a period of 5 years between 1995 and 1999 in our hospital. The median age of the patients at the time of diagnosis was 76.2 years (66-92 years). In all cases, the diagnosis was suggested by mild to severe bleeding with no previous bleeding history. While the absence of associated conditions is frequently reported especially among the elderly, in our series an underlying disease was found in four out of the five cases: kidney tumour (two cases) and autoimmune disease (two cases). The bleeding was controlled in four patients using porcine FVIII (two cases) or recombinant FVIIa (two cases). The inhibitors were completely resolved in two patients (kidney tumour, GoodPasture syndrome) by treatment of the underlying disease. However, three patients died as direct or indirect consequence of having an inhibitor. Our series confirms and extends previous data reporting the complexity and severity of this disorder. Because bleeding is often severe, a prompt and correct diagnosis is required to provide adequate therapeutic options that take the advanced age of the patients into account.

[Pollicization, remains of the past or current operation]

Pollicization is a long time honored operation but more recent introduction of microsurgical techniques allowing toe to thumb transfers has changed the indications in trauma and congenital malformations. We reviewed two series of patients to assess the long-term result in both traumatized and malformed hands. Twenty-seven pollicized mutilated fingers were reviewed with a mean follow up of 9.5 years; the longest follow up published in the literature. Despite the age quite advanced of the population and multidigital amputations (more than two fingers were amputated in 16 cases), 21 patients had a good or fair result on a global score including mobility, sensibility, daily use, cortical integration, cold intolerance or pain and appearance. In congenital malformations, hypoplasia or aplasia of the thumb in presence of long fingers remains one of the best indication of pollicization. Out of 35 operated children, 27 were reviewed with a sufficient follow up (mean 6 years) to assess the result. Sensibility and growth were excellent (3 cases need some secondary shortening) mobility was close to normal in 61% of cases but the main concern was the strength which reached only 42% of the standard.

[Percutaneous needle aponeurotomy. Complications and results]

Recently French rheumatologists have repopularized fasciotomy using a percutaneous needle technique. This blind approach has been claimed to be plagued by numerous complications. We reviewed the charts of 211 patients treated consecutively on 261 hands and 311 fingers to assess the rate of postoperative complications. The first 100 patients were evaluated with a mean follow up of 3.2 years to assess the rate of recurrences and extension of the disease. In the whole group the mean age was 65 years and delay between onset and treatment was six years. Rupture of the cords were performed only in the palm in 165 cases, in the palm and finger in 111 and purely at digital level in 35. Complications were scarce without infection or tendon injury but one digital nerve was found injured during the second procedure. Postoperative gain was prominent at metacarpophalangeal joint level (79% versus 65% at interphalangeal level). Reoperation rate was 24%. In the group controlled at 3.2 years follow up, recurrence rate was 58% and disease "activity" 69%. Fifty nine hands need further surgery. The ideal indication for this simple and reliable technique is an elderly patient with a bowing cord and a predominant MP contracture.

Ocular aberrations before and after myopic corneal refractive surgery: LASIK-induced changes measured with laser ray tracing

PURPOSE

To determine objectively the changes in the ocular aberrations (3rd order and above) induced by myopic LASIK refractive surgery and its impact on image quality.

METHODS

The ocular aberrations of 22 normal myopic eyes (preoperative refraction ranged from -13 to -2 D) were measured before (2.9 +/- 4.3 weeks) and after (7.7 +/- 3.2 weeks) LASIK refractive surgery using a laser ray tracing technique. A set of laser pencils is sequentially delivered onto the eye through different pupil locations. For each ray, the corresponding retinal image is collected on a CCD camera. The displacement of the image centroid with respect to a reference provides direct information of the ocular aberrations. Root-mean-square (RMS) wavefront error was taken as image quality metric.

RESULTS

RMS wavefront error increased significantly in all eyes but two after surgery. On average, LASIK induced a significant (P = 0.0003) 1.9-fold increase in the RMS error for a 6.5-mm pupil. The main contribution was due to the increase (fourfold, P < 0.0001) of spherical aberration. The increase in the RMS for a 3-mm pupil (1.7-fold) was also significant (P = 0.02). The modulation transfer (computed for 6.5-mm pupil) decreased on average by a factor of 2 for middle-high spatial frequencies.

CONCLUSIONS

(1) Laser ray tracing is a well-suited, robust, and reliable technique for the evaluation of the change of ocular aberrations with refractive surgery. (2) Refractive surgery induces important amounts of 3rd and higher order aberrations. The largest increase occurs for spherical aberration. Decentration of the ablation pattern seems to generate 3rd order aberrations. (3) This result is important for the design of customized ablation algorithms, which should cancel existing preoperative aberrations while avoiding the generation of new aberrations.

Comparing laser ray tracing, the spatially resolved refractometer, and the Hartmann-Shack sensor to measure the ocular wave aberration

PURPOSE

To compare quantitatively three techniques to measure the optical aberrations of the human eye: laser ray tracing (LRT), the Hartmann-Shack wavefront sensor (H-S), and the spatially resolved refractometer (SRR). LRT and H-S are objective imaging techniques, whereas SRR is psychophysical.

METHODS

Wave aberrations were measured in two normal subjects with all three techniques implemented in two different laboratories.

RESULTS

We compared the experimental variability of the results obtained with each technique with the overall variability across the three methods. For the two subjects measured (RMS wavefront error 0.5 microm and 0.9 microm, respectively), we found a close agreement; the average standard deviation of the Zernike coefficients within a given method was 0.07 microm, whereas the average global standard deviation across techniques was 0.09 microm, which is only slightly higher.

CONCLUSIONS

There is a close match between the Zernike coefficients obtained by LRT, H-S, and SRR. Thus, all three techniques provide similar information concerning wave aberration when applied to normal human eyes. However, the methods are operationally different, and each has advantages and disadvantages depending on the particular application.

Toe transfer in congenital hand malformations

Fifty-eight patients with congenital hand abnormalities underwent 65 toe-to-hand transfers. Symbrachydactyly (51 cases) was the most frequent indication. Forty-seven second toe-to-hand transfers were performed in 44 patients. The mean follow-up time was 5.2 years. Two failures occurred in cases in which only one artery was anastomosed; no failures were noted when more than one artery fed the transfer. Two patients with a single second-toe transfer presented with lateral instability of the transferred metatarsophalangeal joint. The mean active range of motion was 38 degrees, with a mean extension lag of 25 degrees. The mean two-point discrimination was 5 mm. Forty-one patients used the transferred toe well, when performing activities of daily living and playing games. Toe-to-hand transfer, prior to the establishment of the grip pattern, facilitates integration of the transfer.

Microsurgical reconstruction of the hypoplastic thumb, type IIIB

If a classically hypoplastic thumb, type IIIA, presenting with a first carpometacarpal joint, is amenable to reconstruction, a type IIIB case without the basal joint, is classically treated by pollicization. The authors concur with this opinion, but found two circumstances in which reconstruction is an option in a type IIIB thumb, either when an adolescent asks for improvement of an unstable but utilized thumb, or when a parent definitely refuses pollicization. In such cases, a free, vascularized metatarsophalangeal joint is the first step of the reconstruction, followed by classic non-microsurgical steps. The authors reviewed five cases, with a mean follow-up of 7.8 years. Hypoplasia of the reconstructed thumb, and a limited pinch, allow this option only with restricted indications.

Molecular batteries: ferrocenylsilylation of dendrons, dendritic cores, and dendrimers: new convergent and divergent routes to ferrocenyl dendrimers with stable redox activity

The ferrocenylsilylation of the phenol triallyl dendron 2, of the phenol nonaallyl dendron 4, and of the 9-, 27-, 81-, and 243-allyl dendrimers 7-10 (monitored by the disappearance of the signals of the olefinic protons in 1H NMR spectra) has been achieved using ferrocenyldimethylsilane 1 and Karstedt's catalyst in diethyl ether at 40 degrees C, yielding the corresponding ferrocenyl dendrons and dendrimers. An alternative convergent synthesis of the nonaferrocenyl dendron 5 was carried out by reaction of the triferrocenyl dendron 2 with a protected triododendron followed by deprotection. Reaction of the nonaferrocenyl dendron 5 with hexakis(bromomethyl)benzene gave the 54-ferrocenyl dendron 6. All the ferrocenyl dendron and dendrimers produce a chemically and electrochemically reversible ferrocenyl oxidation wave at seemingly the same potential. Stable platinum electrodes modified with the high ferrocenyl dendrimers were fabricated. The soluble orange-red ferrocenyl dendrimers can also be oxidized in CH2Cl2 by [NO][PF6] to the insoluble deep blue polyferrocenium dendrimers. For instance, the 243-ferrocenium dendrimer has been characterized by its Mossbauer spectrum, which is of the same type as that of ferrocenium itself. The ferrocenium dendrimers can be reduced without any decomposition back to the ferrocenyl dendrimer, indicating that these multielectronic redoxstable dendrimers behave as molecular batteries.

[Value of a new first web space reconstruction in congenital hand deformities. A study of 54 patients]

INTRODUCTION

Only a few studies are available in the literature on the specific problem of the congenital contracture or absence of the first web in hand deformities, and first web reconstruction.

MATERIAL AND METHODS

Sixty-seven first web plasties in 54 patients were retrospectively analyzed: they included 44 cases of classical plasties, i.e., Z-plasty (21 cases); dorsal flap plasty of the index (19 cases), thumb (1 case), or the hand (10 cases), and 16 cases of' pseudo-kite flap.

RESULTS

The results were difficult to assess, as the syndromes were dissimilar and the deformities were not comparable (e.g., Apert syndrome versus Poland syndrome). However, it was found that the 'pseudo-kite' technique which was applicable to certain cases resulted in a web extension of 3.2 cm without any deepening.

DISCUSSION

No method of classical assessment can be used to comprehensively evaluate the results of first web reconstruction due to the wide variability in clinical characteristics, the lack of patient cooperation in this young age group, the possible MPJ articular thumb instability, and growth factors. Although 4-flap Z-plasty is an adequate technique for non-severe first web deformities, the 'pseudo-kite' flap approach is useful in more severe cases. In 13 cases, a peroperative measurement before and following plasty was made, and a significant increase (205%) in planimetric and stereotactic gain compared to pre-plasty findings was noted.

CONCLUSION

It does not seem logical to have a particular preference for a certain approach when considering first web reconstruction in congenital malformations. Each technique has its advantages and disadvantages, depending on patient age, the type of malformation, the state of the thumb, the extent of the first web deformity and the possible presence of scar tissue.

[Classification and treatment of symbrachydactyly. A series of 117 cases]

In the present study, a modification has been proposed of the Blauth and Gekeler classification, aimed at a more accurate definition of appropriate surgical treatment. An analysis was made of a series of 120 cases of symbrachydactyly (117 patients); however, surgery was only performed in 86 cases (51 toe transfers in 49 patients; mean age at surgery 12 months). Type I included the separation of short and sometimes stiff fingers; type II, the 'pseudo-cleft', could be subdivided into three groups. Type IIA included those hands with more than two long and frequently hypoplastic digits, regarding which a decision had to be made between removal of rudimentary fingers or their stabilization. In type IIB, hand function was good and surgery was rarely needed. Type III (monodactylous) could also be subdivided into two categories, i.e., normal thumb in type IIIA and hypoplasia in IIIB. Finally, in type IVA, toe transfer surgery was performed on condition that wrist mobility was sufficient to compensate for the insufficient mobility of the artificial thumb on the anterior aspect of the radius. In all cases, a weak but useful pincer movement was obtained, with poor cosmetic results. In the case of toe transfers, surgery was advocated before the age of one year; and although mobility was disappointing (35 degrees active motion), good growth and excellent discrimination (5 mm on average) was observed. Symbrachydactyly is a fairly frequent congenital malformation; its diverse clinical features require a precise classification to better determine adequate treatment management.

Vibrational analysis and spectra of orotic acid

The IR and Raman spectra of polycrystalline anhydrous orotic acid and its N1, N3, and O12 trideuterated isotopomer are recorded in the 4000-40 cm(-1) spectral interval as part of a series of vibrational analyses of nucleosides, nucleotides, and related compounds carried out in our laboratory. The frequencies of the fundamental transitions and the potential energy distributions of the 39 normal modes of orotic acid and its isotopomer are calculated by an ab initio density functional theory Becke3P86/6-311G** treatment. Assignments of the vibrational modes are proposed that consider the results of these calculations and the observed spectra. The results of the ab initio treatment are related to crystallographic and spectral data, and they are compared with previous assignments for similar molecules.

Cholesterol biosynthesis in normocholesterolemic patients after cholesterol removal by plasmapheresis

Plasmapheresis and low-density lipoprotein (LDL)-apheresis are recognized procedures for the treatment of hyperlipidemia resistant to diet and lipid-lowering drugs and provide information on cholesterol synthesis in hypercholesterolemic patients. However, cholesterol synthesis after acute cholesterol removal from plasma has never been investigated in normocholesterolemic patients. In this study, cholesterol synthesis was evaluated in three normocholesterolemic patients by determination of plasma lathosterol, lathosterol-to-cholesterol ratio, and plasma mevalonic acid. In a short-term kinetic study, samples were collected before and after plasmapheresis and every 6 hours during 24 hours. In the second part of the study, cholesterol synthesis was evaluated daily for 3 days. In normocholesterolemic patients, cholesterol returns to basal levels in 3 days. However, cholesterol removal did not result in a significant increase in lathosterol-to-cholesterol ratio or in plasma mevalonic acid, despite a slight increase in lathosterol. In contrast, when repeated plasma exchanges induced a dramatic hypocholesterolemia (< 1 mmol/liter), an acute but transient stimulation of cholesterol synthesis was observed (lathosterol/cholesterol ratio and MVA, respectively, increase from 8.2 to 22.3 and from 28 nmol/liter to 98 nmol/liter). This study shows that cholesterol synthesis is not stimulated by plasmapheresis in normocholesterolemic patients but is enhanced in dramatic hypocholesterolemic patients (< 1 mmol/liter).

Laser Ray Tracing versus Hartmann-Shack sensor for measuring optical aberrations in the human eye

A comparison and validation study of Laser Ray Tracing (LRT) and Hartmann-Shack wave-front-sensor (to be referred to as H-S) methods was carried out on both artificial and human eyes. The aim of this work was double. First, we wanted to verify experimentally the equivalence of single- and double-pass measurements for both H-S and LRT. This interest is due to the impossibility of making single-pass measurements in human eyes. In addition, we wanted to validate the LRT technique by comparing it with the H-S wave-front sensor, currently used in many physiological optics laboratories. Comparison of the different methods and configurations carried out in the artificial eye yielded basically the same results in all cases, which means a reciprocal validation of both LRT and H-S, in either single- or double-pass configurations. Other aspects, such as robustness against speckle noise or the influence of the size of the entrance (H-S) or exit (LRT) pupil were studied as well. As a global reference, the point-spread function (PSF) of the artificial eye was recorded directly on a CCD camera and compared with simulated PSF's computed from the experimental aberration data. We also applied these two methods to real eyes (double pass), finding again a close match between the resulting aberration coefficients and also between the standard errors for two normal subjects. However, for one myopic eye with an especially low optical quality (RMS wave-front error >2 microm) and asymmetric aberrations, the array of spots recorded with the H-S sensor was highly distorted and too difficult to analyze.

Antioxidant activities of estrogens against aqueous and lipophilic radicals; differences between phenol and catechol estrogens

Natural estrogens have much greater radical-scavenging antioxidant activity than has previously been demonstrated, with activities up to 2.5 times those of vitamin C and vitamin E. The biological significance of this finding remains to be elucidated. In this work the antioxidant activity of a range of estrogens (phenolic, catecholic and stilbene-derived) has been studied. The activity of these substances as hydrogen-donating scavengers of free radicals in an aqueous solution has been determined by monitoring their relative abilities to quench the chromogenic radical cation 2,2'-azinobis-(3-ethylbenzothiazoline-6-sulphonic acid) (ABTS*+). The results show that the order of reactivity in scavenging this radical in the aqueous phase is dependent on the precise estrogenic structure, with phenolic estrogens being more potent antioxidants than catecholestrogens or diethylstilbestrol. The ability of the same estrogens to scavenge lipid phase radicals has also been assessed, determined by the ex vivo enhancement of the resistance of low-density lipoprotein (LDL) to oxidation; the order of efficacy is different from that in the aqueous phase, with the phenolic estrogens estriol, estrone and 17beta-estradiol being less potent than 2-hydroxyestradiol, 4-hydroxyestradiol, or diethylstilbestrol. In this lipid-based system, phenolic estrogens were found to be unable to regenerate alpha-tocopherol from LDL subjected to oxidative stress, while at the same time 2- and 4-hydroxyestradiol significantly delayed alpha-tocopherol loss. These results indicate that the various estrogens are good scavengers of free radicals generated in both the aqueous and the lipophilic phases. The antioxidant activity of an estrogen depends not only on the hydrophilic or lipophilic nature of the scavenged radical, but also on the phenol and catechol structures of the estrogen compound.

Performance of persons with juvenile-onset amputation in driving motor vehicles

OBJECTIVE

To study the driving of motor vehicles by persons with juvenile-onset amputation and to compare the percentage of drivers among them with that found in the general population.

DESIGN

A follow-up study of subjects who were younger than 18 years of age at amputation and who underwent one-sided amputation, covering the period 1976 to 1996.

SETTING

The Prosthesis Service of the Asturias Central Hospital, Spain.

SUBJECTS

A total of 236 juvenile amputee patients.

RESULTS

The percentage of women with amputations who drive is lower than that of their male counterparts (p<.05). The percentage of drivers with upper limb amputations is greater than that of drivers with amputation of the lower limb (p<.05). Motor vehicle adaptations were used more frequently by people with upper limb amputations (p<.05). The ability to drive was not affected by the etiology or the side of amputation, or by the use of a prosthesis. The level of amputation affected driving ability in cases of amputation of the lower limb, but not in those of amputation of the upper limb.

CONCLUSION

The percentage of persons with juvenile-onset amputation who drive (47.4%) is similar to that found in the general population (40.8%), and the use of a prosthesis does not have any influence on the capacity to drive a car--89.2% of drivers and 93.5% of nondrivers used a prosthesis.

Phase plates for wave-aberration compensation in the human eye

We present a method for manufacturing phase plates to compensate for the wave aberration in the human eye. The wave aberration of the eye is measured in vivo by a new laser ray-tracing method and then compensated for by a phase plate placed in front of the eye. This plate is made from a gray-level single-mask photosculpture in photoresist. Two experiments were carried out, first with an artificial eye and then with a human eye: 80% compensation for the wave aberration was achieved in both cases.

A new approach to the study of ocular chromatic aberrations

We measured the ocular wavefront aberration at six different visible wavelengths (between 450 and 650 nm) in three subjects, using a spatially resolved refractometer. In this technique, the angular deviation of light rays entering the pupil at different locations is measured with respect to a target viewed through a centered pupil. Fits of the data at each wavelength to Zernike polynomials were used to estimate the change of defocus with wavelength (longitudinal chromatic aberration, LCA) and the wavelength-dependence of the ocular aberrations. Measured LCA was in good agreement with the literature. In most cases the wavefront aberration increased slightly with wavelength. The angular deviations from the reference stimulus measured using a magenta filter allowed us to estimate the achromatic axis and both optical and perceived transverse chromatic aberration (TCA), (including the effect of aberrations and Stiles-Crawford effect). The amount of TCA varied markedly across subjects, and between eyes of the same subject. Finally, we used the results from these experiments to compute the image quality of the eye in polychromatic light.

Incidence of factor IX inhibitor development in severe haemophilia B patients treated with only one brand of high purity plasma derived factor IX concentrate

Fifteen previously untreated patients (Pups) with severe haemophilia B (factor IX activity < or = 2 U/dl) only treated with one brand of plasma-derived high purity factor IX concentrate (FIX LFB) were studied. Age at first injection varied from 1 to 137 months and follow-up since this first injection from 21 to 86 months (median: 35). Cumulative exposure days (CED) were from 4 to over 100 (median: 26). Among these 15 Pups only one developed an inhibitor. Mutation analysis performed in all patients showed total gene deletion in the patient with inhibitor, partial gene deletion in another one, and missense mutations in 9 families. Mutation was not found in one patient. Actually, according to the data already published, only two patients were at high risk for inhibitor development in our population. Our study, although rather small, confirms the previously reported low incidence of inhibitors in haemophilia B. Large studies on incidence of FIX inhibitors are indeed difficult to perform, due to both the overall small number of severe haemophilia B patients and the low incidence of FIX inhibitors. Consequently, the impact of bias, such as prevalence of different types of gene defects in a given population, is major. Therefore, any study, dealing with incidence of FIX inhibitors in severe haemophilia B should report, for each patient, the type of gene defect.

Comedolytic effect of topical retinaldehyde in the rhino mouse model

BACKGROUND

Retinaldehyde is a key molecule in the metabolism of vitamin A by keratinocytes. In order to evaluate its range of topical activity in acne, its comedolytic effect was compared to that of retinoic acid in the same vehicle, in the rhino mouse model.

METHODS

The animals were treated on the back daily for 5 consecutive days per week for 3 weeks. At the end of this period, histological slides were analyzed in order to quantify the features of comedones and epidermal thickness.

RESULTS

Topical treatment with a retinaldehyde (0.05% w/w) and a retinoic acid formulation (0. 025% w/w) induced comedolysis and increased the epidermal thickness with the same intensity.

CONCLUSION

These data indicate that retinaldehyde exerts a significant comedolytic activity.

Off-axis aberrations of a wide-angle schematic eye model

A schematic eye model based on anatomical data, which had been previously designed to reproduce image quality on axis, has been transformed into a wide-angle model by simply adding a spherical image surface that plays the role of the retina. This model captures the main features of the wide-angle optical design of the human eye with minimum complexity: four conic optical surfaces plus a spherical image surface. Seidel aberrations (spherical aberration, coma, astigmatism, field curvature, and distortion), longitudinal and transverse chromatic aberrations, and overall monochromatic spot diagrams have been computed for this eye model and for field angles ranging from 0 degree to 60 degrees by both finite and third-order ray tracing. The modulation transfer function for each field angle has been computed as well. In each case our results have been compared with average experimental data found in the literature, showing a reasonably good agreement. The agreement between the model and experimental data is better off axis, mainly at moderate (10 degrees-40 degrees) field angles, than on axis. The model has been applied to simulate a variety of experimental methods in which image aberrations are estimated from measurements taken in the object space. Our results suggest that for some types of aberration, these methods may yield biased estimates.

Laser ray-tracing method for optical testing

We have developed a novel laser ray-tracing method to measure aberrations in optical systems. It consists of delivering narrow laser pencils (by a laser scanner), recording the spots that are formed on the image plane (with a CCD camera), and computing the position of each centroid. This approach could be considered an experimental (approximate) implementation of standard numerical ray tracing. Several tests and experiments, including a direct comparison with a Hartmann-Shack wave-front sensor, provided highly satisfactory results that confirmed the validity of the method and revealed potential advantages.

Homeopathic effect on heart rate variability

We record ECGs from healthy human subjects during 24-h long intervals, using ambulatory equipment. We calculate from the data various parameters, searching for those that change in a clear and systematic way under a homeopathic stimulus, (Strophantus hispidus 30c). The energy fraction at high frequencies in the power spectrum of heart rate variability fulfills this condition, and we are able to interpret our results in a way consistent with the information on this medicine in the homeopathic Materia Medica.

The depth-of-field of the human eye from objective and subjective measurements

The depth-of-field (DOF) measured through psychophysical methods seems to depend on the target's characteristics. We use objective and subjective methods to determine the DOF of the eye for different pupil diameters and wavelengths in three subjects. Variation of image quality with focus is evaluated with a double-pass technique. Objective DOF is defined as the dioptric range for which the image quality does not change appreciably, based on optical criteria. Subjective DOF is based on the accuracy of focusing a point source. Additional DOFs are obtained by simulation from experimental wavefront aberration data from the same subjects. Objective and subjective measurements of DOF are only slightly affected by pupil size, wavelength and spectral composition. Comparison of DOF from double-pass and wavefront aberration data allows us to evaluate the role of ocular aberrations and Stiles-Crawford effect.

Vibrational study of a nucleoside analogue with antiviral activity, 5-chloro-2'-deoxyuridine, CDU

The experimental FTIR and FT-Raman spectra of 5-chloro-2'-deoxyuridine have been assigned on the basis of normal coordinate analyses, in the light of observed and calculated wavenumbers and isotopic shifts. The results indicate that virtually all normal modes of IDU involve some degree of vibrational coupling between the chlorouracil base and the deoxyribose moiety.

Monochromatic aberrations and point-spread functions of the human eye across the visual field

The monochromatic aberrations of the human eye along the temporal meridian are studied by a novel laser ray-tracing method. It consists of delivering a narrow laser pencil into the eye through a given point on the pupil and recording the aerial image of the retinal spot with a CCD camera. The relative displacement of this image is proportional to the geometrical aberration of the ray (laser pencil) at the retina. We scanned the pupils of four observers in steps of 1 mm (effective diameter, 6.7 mm) and for five field angles (0 degree, 5 degrees, 10 degrees, 20 degrees, and 40 degrees). In addition, the aerial image for each chief ray is a low-pass-filtered version of the retinal point-spread function corresponding to a fully dilated pupil. The resulting spot diagrams, displaying the distribution of ray aberrations, are highly correlated with these point-spread functions. We have estimated the wave-front error by fitting Zernike polynomials (up to the fifth order). Despite the large variation found among observers, the overall rms wave-front error is relatively homogeneous. At the fovea, the average rms value was 1.49 microns when the second-order terms (defocus and astigmatism) were considered; this was reduced to 0.45 micron when the second-order terms were ignored. The rms values increase slowly, in a roughly linear fashion with eccentricity, such that at 40 degrees they are approximately double. These results are consistent with previous findings on the off-axis optical quality of the eye.