Cholecystokinin stimulates heat shock protein 27 phosphorylation in rat pancreas both in vivo and in vitro

BACKGROUND & AIMS

Mammalian heat shock protein 27 (hsp27) is believed to function under normal physiological conditions and during cellular stress. Recent studies indicate a role for hsp27 in regulating actin-cytoskeletal dynamics. In the present study, secretagogue-regulated phosphorylation of hsp27 in rat exocrine pancreas was investigated both in vivo and in isolated acinar cells.

METHODS

Western analysis after two-dimensional electrophoresis was used to measure the phosphorylation of hsp27 after treatment of rats or acinar cells with secretagogues. Cholecystokinin-stimulated mitogen-activated protein kinase-activated protein (MAPKAP) kinase 2 activity was measured after immunoprecipitation of the kinase.

RESULTS

hsp27 exists as three isoforms in acini: one nonphosphorylated (pI 6.2) and two phosphorylated (pIs 5.9 and 5.7) forms. Infusion of rats with a secretory or supermaximal dose of cerulein produced an acidic shift in hsp27, indicating an increase in its phosphorylation; the higher dose, known to cause pancreatitis, had a twofold greater effect. In isolated acini, increases in hsp27 phosphorylation were evident at 10 pmol/L and maximal at 1 nmol/L cholecystokinin. The hsp27-specific kinase MAPKAP kinase 2 was activated 2.4-fold with 1 nmol/L cholecystokinin treatment.

CONCLUSIONS

hsp27 phosphorylation was stimulated by low and high concentrations of cholecystokinin, both in vivo and in vitro. Phosphorylation was potentially mediated via the MAPKAP kinase 2 intracellular signaling pathway.

Anaesthetic management of patients undergoing surgery for tachyarrhythmias. Initial experience with 16 patients

Sixteen patients suffering from various cardiac arrhythmias were treated surgically. Intraoperative computerised electrophysiologic mapping was used in 14. Thirteen patients were suffering from Wolff-Parkinson-White syndrome. They underwent surgical division or cryoablation of accessory pathways. Two patients who had rheumatic mitral stenosis with left atrial clot underwent "Maze III" procedure with open mitral commissurotomy and clot removal. One patient with paroxysmal refractory ventricular tachycardia and a left ventricular aneurysm had an aneurysmectomy with subendocardial resection of the arrhythmic focus. All antiarrhythmic medications were discontinued preoperatively. Morphine was the principal anaesthetic agent, supplemented with halothane. Muscle relaxation was provided with pancuronium bromide. The various problems encountered included hypotension and arrhythmia during placement of epicardial band array for mapping (4 patients), ventricular tachycardia during internal jugular vein cannulation (1 patient) and continuance of delta wave after cryoablation in 2 patients. Halothane may have interfered with electrophysiologic mapping and accurate localization of accessory pathway leading to persistence of delta wave. The choice of anaesthetic agents should be guided by the electrophysiologic effects and potential influence of these agents on the accessory pathways.

Bilateral intraabdominal ganglioneuroblastoma in an adult

Ganglioneuroblastoma is an unusual tumour in an adult. We present a case of bilateral intraabdominal ganglioneuroblastoma in an adult patient. The two tumours had different morphological features and origins. The appearances on ultrasound, CT and MRI are discussed. To the best of our knowledge, this is the first case of bilateral ganglioneuroblastoma reported in an adult patient with ultrasound, CT and MRI findings.

Single lead DDD system: a comparative evaluation of unipolar, bipolar, and overlapping biphasic stimulation and the effects of right atrial floating electrode location on atrial pacing and sensing thresholds

Single lead DDD pacing using unipolar or bipolar stimulation is limited by high atrial threshold. Overlapping biphasic (OLBI) waveform stimulation via atrial floating ring electrodes may preferentially enhance atrial pacing and avoid diaphragmatic pacing. Single lead DDD pacing with OLBI atrial pacing was studied in 12 patients (6 men and 6 women; mean age 74 +/- 7 years) with complete heart block. At implantation, atrial bipolar rings (area 27 mm2, separation 10 mm) were positioned at radiological defined high, mid, and low right atrial (RA) levels, and P wave amplitude and atrial and diaphragmatic pacing thresholds were determined in each position using unipolar, bipolar, and OLBI stimulation in random order. Although statistically insignificant, both the maximum and minimum sensed P wave amplitudes tended to be lower in the low RA position. Independent of the stimulation modes, minimum atrial pacing threshold occurred in the mid-RA. At mid-RA, the atrial pacing threshold was significantly lower with OLBI pacing compared with either unipolar or bipolar mode (3.9 +/- 2.2 V vs 6.7 +/- 3.5 V and 6.9 +/- 3.5 V, P < 0.05). Although the diaphragmatic thresholds were similar, OLBI pacing modes in the mid-RA and final location significantly improved the safety margin for avoidance of diaphragmatic pacing compared with unipolar mode. There was no correlation between atrial pacing and sensing threshold. At predischarge testing, all but one patient who developed atrial fibrillation had satisfactory atrial capture and a stable atrial pacing threshold (day 0: 2.6 +/- 1.1V vs day 2:3.2 +/- 1.3V, P = NS). However, diaphragmatic pacing occurred in four of 11 (36%) patients, especially in the upright position (sitting and standing). Our preliminary clinical results suggest that OLBI pacing via atrial floating ring electrodes can reduce the atrial pacing threshold. To optimize atrial pacing and sensing, the bipolar electrodes should be located at the mid-RA level first, although the high RA is an alternative. Despite significant improvements in the safety margin for diaphragmatic pacing with OLBI pacing, diaphragmatic stimulation remains a clinical problem.

Alterations in macrophage G proteins are associated with endotoxin tolerance

Previous studies have suggested that endotoxin tolerance induces macrophage desensitization to endotoxin through altered guanine nucleotide regulatory (G) protein function. In the present study the binding characteristics of the nonhydrolyzable GTP analogue GTP gamma [35S] to macrophage membranes from endotoxin tolerant and control rats were determined. Membranes were prepared from peritoneal macrophages harvested from rats 72 h after two sequential daily doses of vehicle or Salmonella enteritidis endotoxin (100 micrograms/kg on day 1 and 500 micrograms/kg on day 2). GTP gamma [35S] bound to a single class of sites that were saturable and displaceable in control and endotoxin tolerant macrophage membranes. The maximum specific binding of GTP gamma [35S] was significantly (P < 0.01) decreased in membranes from tolerant rats compared to control (Bmax = 39 +/- 7 pmol/mg protein in control vs. 11 +/- 2 pmol/mg protein in endotoxin tolerant; n = 5). There were no significant differences in the Kd values. To determine whether the reduced GTP gamma S binding was due to decreases in G proteins, macrophage membrane G protein content was determined by western blotting with specific antisera to Gi1,2 alpha, Gi3 alpha, Gs alpha, and the beta subunit of G. Scanning densitometric analysis demonstrated differential decreases in tolerant macrophage membrane G proteins. Gi3 alpha was reduced the most to 48 +/- 8% of controls (n = 3), and this reduction was significant compared to those of other G proteins. Gi1,2 alpha and G beta were reduced to 73 +/- 5% (n = 3) and 65 +/- 4% (n = 3) of control values, respectively. Gs alpha(L) and Gs alpha(H) were reduced to 61 +/- 5% (n = 3) and 68 +/- 3% (n = 3) of control, respectively. These results demonstrate that endotoxin tolerant macrophages exhibit decreased membrane GTP binding capacity and differential reductions in the content of specific G proteins. The cellular mechanisms leading to such alterations in G proteins and their functional significance in the acquisition of endotoxin tolerance merit further investigation.

Tissue-arterial PCO2 difference is a better marker of ischemia than intramural pH (pHi) or arterial pH-pHi difference

Gastric intramucosal pH (pHi) is often calculated by the Henderson-Hasselbalch equation, using arterial plasma [HCO3-]ap and PCO2 measured in saline obtained from a silastic balloon tonometer after equilibration in the lumen of the stomach. A pHi value less than approximately 7.3 pH units is often taken as evidence of intestinal ischemia. An alternative measure is tissue PCO2 (PtCO2)-PaCO2 difference [P(t-a)CO2]. The idea is that PtCO2 will increase slightly relative to PaCO2 as O2 supply decreases, and then increase strikingly when flow decreases to a critical value, because of liberation of CO2 from tissue Hco3- by anaerobically generated strong acid. A third method is arterial plasma pH (pHap)-pHi difference [pH(ap-i)]. We used mathematical simulations to test the hypotheses that calculated pHi is independent of arterial acid-base status; and pH(ap-i) provides the same information as does P(t-a) CO2. Using the Van Slyke version of the arterial whole blood [standard base excess] ([SBE]aWB) equation, it was found that a change in [SBE]aWB at constant PaCO2 and constant PtCO2 produces a change in calculated pHi (P = 0), such that the relation between changing [SBE]aWB and changing pHi is predictable by a single polyomial equation (R2 = .999). pH(ap-i) avoids this confounding influence of [SBE]aWB. However, it was further shown that pH(ap-i) can be associated with a wide range of P(t-a)CO2, depending on the magnitude of pH(ap-i), and on the PaCO2 at which P(t-a)CO2 is measured. We conclude that P(t-a)CO2 is a more reliable index of gastric oxygenation than is pHi alone or pH(ap-i).

Intermittent esotropia associated with rippling muscle disease

PURPOSE

We report a rare myopathy known as rippling muscle disease, with the unique feature of extraocular muscle involvement, presenting as a variable esotropia.

METHODS

Chart review with a review of the literature.

RESULTS

Neurologic and neuro-ophthalmic examinations as well as electromyography and muscle biopsy confirm that this case closely resembles those described in the literature with the additional feature of a variable esotropia.

CONCLUSION

Rippling muscle disease may be associated with intermittent esotropia. The pathophysiology of this disorder is unknown, but the intermittent esotropia is likely related to "rippling" of the medial recti.

[Preferential projections for mapping and ablation of tachycardia of the right ventricle outflow. Anatomoradiological study]

PURPOSE

To select ideal radiologic projections for mapping and ablation of tachycardias of right ventricular outflow tract (RVOT).

METHODS

Ten hearts from human corpses were studied utilizing radiopaque material to identify the pulmonary valve and three distinct sites on this valve: septal anterior (A), septal posterior (P) and free-wall (L). Next, the hearts were filmed in the frontal plane and in oblique projections with 15 degrees increments to the right and to the left. The projections in which the sites were lateralized on the valve, eased radiologic interpretation and were considered ideal for mapping and ablation. Depending on the proximity of the sites to the lateral extremes of the pulmonary valve, the projections were considered ideal ( ), intermediary (++) and inadequate (+).

RESULTS

Projections [table: see text]

CONCLUSION

The A site of RVOT was best indicated in the 60 and 45 degrees left anterior oblique projections; the 0 degree postero anterior projection was best for mapping the P site; the L region was best explored in the 60 degrees right anterior oblique projection.

Pharmacological properties of 403U76, a new chemical class of 5-hydroxytryptamine- and noradrenaline-reuptake inhibitor

403U76 (5-chloro-[[2-[(dimethylamino)methyl]phenyl]thio]benzene- methanol hydrochloride) is a potent, competitive, inhibitor of 5-hydroxytryptamine (5-HT) and noradenaline reuptake into rat brain synaptosomes. Inhibition of 5-HT uptake in-vivo by 403U76 was demonstrated by potentiation of the behavioural effects of 5-hydroxytryptophan in rats and mice and blockade of p-induced depletion of 5-HT in rats. The firing of 5-HT-ergic dorsal raphe neurons in rats was decreased after intravenous administration of low doses of 403U76 as would be predicted for a 5-HT uptake inhibitor. 403U76 antagonized tetrabenazine-induced sedation, an effect associated with inhibitors of noradrenaline uptake, but not with inhibitors of 5-HT uptake. Thus 403U76 affects noradrenergic as well as 5-HT-ergic neurotransmission in-vivo. Potential anxiolytic activity was indicated by reductions in isolation-induced vocalizations in neonates after 403U76 treatment. Low intravenous doses of 403U76 were well tolerated and had no sustained cardiovascular effects. There were no deleterious behavioural side-effects at active doses. Effects observed on isolated tissues or transmitter receptors occurred only at very high concentrations and were pharmacologically unimportant. Thus 403U76 can be considered a potential antidepressant/anxiolytic agent that is a potent, selective inhibitor of 5-HT and noradrenaline reuptake.

The failed thoracocentesis

How often do we consider a differential diagnosis of diaphragmatic hernia in cases of failed thoracocentesis? How many of us remember that omental fat in the chest can behave in a fluid manner, layering along the chest wall, resulting in the misinterpretation of a decubitus view. A case is presented of a diaphragmatic hernia that was missed on conventional chest radiographs resulting in CT having to be performed. A high degree of suspicion is mandatory to reach the final diagnosis. Radiographs could be used more effectively and CT avoided.

[Analysis of the junctional rhythm characteristics in patients with nodal reentry tachycardia treated with slow pathway radiofrequency ablation]

PURPOSE

To study the quantitative and qualitative aspects of junctional rhythm (JR) during radiofrequency (RF) catheter ablation of slow pathway in atrioventricular nodal reentrant tachycardia.

METHODS

Twenty five patients, 5 males, ages ranging from 15 to 76 years, with recurrent atrioventricular nodal reentrant tachycardia, underwent to RF catheter ablation of slow pathway. During RF applications (40V, duration 60s) electrocardiographic was continuously recorded. The recordings were posteriorly used to study the presence and characteristics of JR (number of episodes, frequency and time of onset) at the effective and ineffective RF sessions. All variables were expressed as median and mean +/- SD. Univariate analysis of the effects of each variable on success or failure of ablation were performed using x2 test. A p value < 0.05 was considered significant.

RESULTS

One hundred forty nine RF sessions were performed, 25 effective and 124 ineffective (mean per patient 6, range 1 to 22). JR was present in 18 of 25 effective and 44 of 124 ineffective sessions (p < 0.05). Mean time of appearance was 12s, occurring later this time in 9 of 18 effective and in 10 of 44 ineffective sessions (p < 0.05). Mean number of episodes was 3, occurring higher number in 7 of 18 effective and in 4 of 44 ineffective sessions (p < 0.05). Median of frequency of JR was 100bpm; 11 of 18 effective and 15 of 44 ineffective sessions presented higher frequencies (p < 0.05).

CONCLUSION

JR during slow pathway ablation is a sensitive marker of ablation success. JR predictor of success has higher number of episodes, higher frequency and later time of appearance than that one of ineffective sessions.

Age-related distribution of neuropathologic changes in the cerebral cortex of patients with Down's syndrome. Quantitative regional analysis and comparison with Alzheimer's disease

OBJECTIVE

To investigate whether changes in the cerebral cortex exhibit similar distribution patterns in both disorders of Down's syndrome and Alzheimer's disease, we performed a comparative neuropathologic study of patients with these disorders to further clarify the possible relationships between these dementing conditions.

DESIGN

The regional and laminar distribution and density of neurofibrillary tangles and senile plaques were analyzed in the cerebral cortex of a series of 16 patients (aged 6 to 74 years) with Down's syndrome and in 10 elderly individuals with Alzheimer's disease.

RESULTS

Quantitative analyses revealed that the time course of neurofibrillary tangle formation in Down's syndrome displays regional patterns comparable with those observed in aging and Alzheimer's disease with layer II of the entorhinal cortex being affected first in Down's syndrome, followed by the hippocampus proper and neocortex. The oldest patients with Down's syndrome had neurofibrillary tangle densities sometimes higher than in patients with Alzheimer's disease. At variance with Alzheimer's disease, amyloid deposition was widespread in all of the cortical areas investigated and was observed much earlier than neurofibrillary tangle formation. Patients with Down's syndrome also frequently had higher senile plaque densities than patients with Alzheimer's disease.

CONCLUSIONS

These results indicate that the development of pathologic changes in patients with Down's syndrome does not parallel that observed in elderly individuals and patients with Alzheimer's disease in all respects. However, the comparable development patterns of neurofibrillary tangle formation suggest that detailed analysis of patients with Down's syndrome may be useful to further our knowledge of the mechanisms underlying the installation of the neuropathologic alterations leading to the demonstrated loss of select neuronal populations in Alzheimer's disease.

Multiple dust allergy in a semiurban environs

Multiple dust allergy in a study of 100 patients of nasobronchial hypersensitivity has been demonstrated by skin testing in Chandigarh and successfully desensitised over a 3-year period. The results are discussed and the multiple factors involved postulated.

Anatomic basis for disk displacement in temporomandibular joint (TMJ) dysfunction

This study was designed to investigate the site of lateral pterygoid muscle insertion into the temporomandibular joint (TMJ) disk, and the relationship between that attachment and the disk displacement. One hundred and ten TM joints from 78 cadavers were collected and sectioned in the sagittal plane. Sixty-two unilateral specimens were available and 16 additional specimens were selected randomly from the remaining cadavers in which both condyles were available. Thus statistical comparisons were not confounded by autocorrelation and were based on 78 independent specimens. The sites of muscle attachment in relation to the disk were identified histologically. Of the 78 joints 49 had anterior disk displacement. Of the 42 cases with insertion directly into the disk, 30 had anterior disk displacement. In contrast, only 19 of the 36 disks without direct muscle insertion were displaced. This finding indicated a statistically significant relationship between functional muscle attachment and disk displacement (chi 2 = 9.28, df = 1, p = 0.006). However, the superior head of the lateral pterygoid muscle (SLP) may not be the precipitating factor for anterior disk displacement even though it does coordinate disk movement on closure. Since other factors (e.g., trauma) can result in disk displacement, the SLP can maintain disk displacement only when it inserts directly into the disk. In cases of normal disk arrangement and condylar attachment, the muscle may not play a clinically significant role in disk displacement because disk attachment at the medial and lateral poles of the condyle allows the disk to move freely with the condyle.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of surfactin synthetase subunits in srfA mutants of Bacillus subtilis OKB105

The srfA operon of Bacillus subtilis functions in the biosynthesis of the lipopeptide antibiotic surfactin. On the basis of nucleotide sequence and genetic analysis, it is believed to encode three enzymes (E1A, E1B, and E2) that catalyze the incorporation of the surfactin substrate amino acids. Insertion, deletion, and amino acid substitution mutations of srfA were analyzed for subunit composition and activity as determined by assays of both amino acid-dependent ATP-PPi exchange and aminoacyl thioester formation. Insertion mutations in srfAA (encoding E1A, the subunit that incorporates Glu, Leu, and D-Leu) eliminated production and activity of all three enzymes. Deletions within srfAA and extending from srfAA to srfAB (encoding E1B, which incorporates Val, Asp, and D-Leu) abolished the activity and production of all three enzymes. Insertions between srfAA and srfAB and within srfAB eliminate the production and activity of E1B and E2. An insertion mutation in srfAC (encoding E2, which incorporates Leu) abolished the activity of E2 only. Mutations of the active serine in the putative 4'-phosphopantetheine-binding motif of the second and third domains of E1A eliminated thioester formation and severely reduced the ATP-PPi exchange activity of the two domains. However, the same mutation in the first domain of E1B had little effect on Val-dependent ATP-PPi exchange activity but abolished thioester formation. These results indicate that the coding assignments of the srfA genes are srfAA (E1A), srfAB (E1B), and srfAC (E2).

Risk factors for systemic hypersensitivity reactions after booster vaccinations with human diploid cell rabies vaccine: a nationwide prospective study

To determine the incidence of and risk factors for adverse reactions following the boosters, we conducted a nationwide prospective study of persons receiving pre-exposure booster vaccination with human diploid cell rabies vaccine (HDCV). Persons who had previously received three pre-exposure doses of HDCV and whose rabies neutralizing antibody titres were < or = 1:5 were enrolled in the study if they stated that they intended to receive a booster. Of the 98 persons enrolled in the study, 40 (41%) were in risk groups for whom boosters are not recommended. Three (3%) of 98 developed generalized urticaria or wheezing within 1 day of receiving boosters and three others (3%) developed urticaria 6 to 14 days after the booster. No differences were found between individuals with reactions (either type) and those with no adverse reaction according to age, gender, occupation, history of previous allergies, or time since or route of primary vaccination. Reactions were somewhat more common among persons who received primary vaccinations by the intramuscular route (i.m.) and booster vaccinations by the intradermal route (i.d.) (3/15, 20%) or primary vaccinations i.d. and booster vaccinations i.m. (2/10, 20%), and somewhat less common among persons who received both these vaccinations i.d. (1/52, 2%) or i.m. (0/7). The number of persons who develop allergic reactions may be minimized by administering vaccinations only when vaccination is strictly indicated. The influence of the route of primary and booster vaccinations on the development of reactions deserves further study.

Exudative pleural effusions in patients over forty years of age--an analysis of seventy-six patients

A prospective study of 76 consecutive patients over the age of 40 years, with exudative pleural effusion, was undertaken to determine the common causes of such a clinical condition. Malignant pleural effusions were the most common in this series, found in 49 patients (64.47%), all but one being metastatic from elsewhere. Forty were secondary to a carcinoma of the bronchus, 3 from carcinoma of the breast, 1 each from carcinoma of the ovary, oesophagus, and larynx; lymphoma accounted for the remaining 2. Infective causes accounted for 24 of the effusions (31.57%). Of the infections, tuberculosis was the most common, accounting for 17 of the 24. Other infective causes included bacterial empyemas in 4, ruptured amoebic liver abscess in 2, and actinomycosis in 1. Pancreatitis, pulmonary thromboembolism, and a post-cardiotomy syndrome were diagnosed in 1 patient each, while the diagnosis remained unknown in the remaining 5 patients. In 2 patients the diagnosis was made on autopsy.

The effect of bilateral gastric vagotomy and histamine stimulation on parietal cell activity in streptozotocin induced diabetic rat model

Disturbances in gastric secretions are commonly associated with diabetes mellitus and are usually attributed to autonomic neuropathy. Systematic documentation of the effects of experimental diabetes on parietal cell functions are not available. This study has been designed to evaluate the acid secretory status of the parietal cells in streptozotocin (STZ) induced rat model of diabetes mellitus by assessing the effect of bilateral gastric vagotomy and histamine administration on them. Results show that bilateral gastric vagotomy in the control rats as well as in experimental diabetes lowers the acid secreting capacity of the parietal cells. In the diabetic rats, however, vagotomy does not further decrease the gastric acid secretion. Histamine stimulation augments the acid secretory response in the controls but this rise is substantially prevented in the diabetic state. Histamine challenge following vagotomy in normal controls elicits a sharp rise in gastric acid secretion though not to the same extent as seen in rats with intact vagi. In the diabetic rats however, histamine fails to augment acid secretion after vagotomy. Diabetes is thus seen to severely impair the acid secretory response of the parietal cells and their responsiveness to histamine.

Sequential chemoimmunotherapy in the treatment of metastatic melanoma

PURPOSE

A phase II study that alternates the sequence of chemotherapy (carmustine [BCNU], cisplatin [CDDP], and dacarbazine [DTIC]) and biologic therapy (interleukin-2 [IL-2] and interferon alfa-2 alpha [alpha IFN]) was performed to establish a safe and efficacious way to sequence these forms of treatment for metastatic melanoma.

PATIENTS AND METHODS

Patients who had measurable metastatic melanoma, a Karnofsky performance status of greater than or equal to 70, and no clinically significant cardiac or pulmonary dysfunction were eligible for entry onto this trial. Responses to treatment were assessed after a treatment cycle by two tumor evaluations at least 4 weeks apart.

RESULTS

Forty-two consecutive patients with metastatic melanoma were treated with this sequential chemoimmunotherapy. Transient thrombocytopenia and neutropenia were observed frequently, but neither hemorrhage nor infection occurred in any of the patients. Of the 42 patients, 10 achieved a complete response (24%), 14 achieved a partial response (33%), two achieved a minor response (5%), eight had stable disease (19%), and eight (19%) had progressive disease. The median time to disease progression for all patients was 7 months. The median survival for all patients entered onto the trial was 11.5 months. A vitiligo-like depigmentation was induced in many patients by this treatment.

CONCLUSIONS

Cytotoxic chemotherapy can be administered safely immediately before or immediately after IL-2 and alpha IFN. Sequential chemoimmunotherapy administered as previously described yields a response rate of more than 55%. The overall survival curve suggests that a proportion of patients may achieve a long-term benefit from this treatment. Also, cutaneous depigmentation induced by this treatment suggests that immune modulation may contribute to the antimelanoma effect of this treatment.

Glaucoma after pediatric lensectomy/vitrectomy

Glaucoma after pediatric cataract surgery, once well recognized, now occurs only rarely after modern lensectomy/vitrectomy. The authors performed directed glaucoma evaluations of 34 eyes of 26 children. Based on intraocular pressures of 26 mmHg or greater, glaucoma was diagnosed in 8 (24%) eyes of 7 (27%) children. Glaucoma was found more commonly among children followed more than 60 months and was diagnosed up to 105 months after surgery. Typically, the glaucoma was open angle and asymptomatic. Four children had had previously normal pressures recorded. With longer follow-up, it is likely that more children will be diagnosed with glaucoma after lensectomy/vitrectomy procedures. The authors believe such patients should be followed as glaucoma suspects for the rest of their lives.