[Complications after implantation of anterior chamber lenses. An analysis of 4,100 explanted intraocular lenses]

In this study we analyzed the incidence and types of complications seen after cataract surgery and implantation of anterior chamber intraocular lenses (AS-IOLs). This report is based on a review of 4104 explanted AC-IOLs that were submitted to the Center for IOL Research over the past 10 years. The results from pathological examinations were correlated with clinical information. Of the 4104 IOLs, 50% were closed-loop designs (n = 2095/4104), and 22% were open-loop lenses (919/4104). The IOLs most frequently explanted were the closed loop designs Leiske (n = 847) and Stableflex (n = 808). The most important reason for explantation was corneal pathology. Closed-loop IOLs had a much higher complication rate than open-loop lenses. Flexible open-loop AC-IOLs showed the highest explantation rate during the first postoperative year due to surgical problems. The complication rate of closed-loop AC-IOLs increased with implant duration and were responsible for 80% of the corneal pathology. Flexible open-loop AC-IOLs can be an alternative for secondary or exchange implantation. Furthermore, they could also be a viable alternative for cataract surgery in developing countries in order to help catch up with the overwhelming backlog of cases that exist there.

The role of gallium-67-citrate in the detection of phenytoin-induced pneumonitis

A patient with a history of cardiac transplant presented with a fever of undetermined etiology. The patient had been on multiple medications, including phenytoin, which can occasionally cause allergic or hypersensitivity pneumonitis. A chest x-ray and CT scan of the chest revealed no active disease. A 67Ga study was obtained after intravenous administration of 377.4 MBq (10.2 mCi) of 67Ga-citrate. The images showed diffuse intense lung uptake bilaterally. Bronchoscopic biopsy revealed hypersensitivity pneumonitis. Phenytoin was withdrawn and corticosteroid was started in therapeutic doses. A follow-up gallium study obtained 25 days after the baseline demonstrated marked improvement in the lungs with concurrent clinical recovery. This case illustrates the usefulness of 67Ga in the detection of drug-induced pneumonitis and in the follow-up of response to therapy.

Communication strategies used by an expert nurse

Individualization of care, or tailoring of care, involves taking into account the client's individuality, and allowing that individuality to determine interpersonal approaches and health-illness management actions (Cox, 1982). Cox's definition of tailoring was empirically supported in a study of three naturally occurring clinical encounters (Brown, 1992). The present analysis was conducted using the research methods of discourse analysis to further understand how the expert nurse in Brown's study used speech actions to enact tailoring. The nurse provided clients with explicit opportunities to introduce their issues, elicited descriptions of their daily lives, expressed personal regard for them, yet also assessed their clinical states. This discourse profile is unlike others reported in the literature and may be considered exemplary.

Indium-111-labeled anti-EGFr-425 scintigraphy in the detection of malignant gliomas

BACKGROUND

The monoclonal antibody anti-epidermal growth factor receptor (EGFr) antibody-425, against the epidermal growth factor receptor, has the potential to bind specifically to gliomas and not normal brain tissue. A prospective study was conducted (1986-1988) to evaluate the use of Indium-111 (111In)-labeled anti-EGFr-425 in the localization of gliomas before radioimmunotherapy with Iodine-125 (125I)-labeled anti-EGFr-425.

METHODS

Twenty-eight patients with intracranial neoplasms were injected intravenously with an average dose of 2.2 mCi 111In-labeled anti-EGFr-425. Planar and single-photon emission computed tomography scans were performed after 48 and 72 hours. Control studies also were performed in two cases with 111In-labeled Co 17-1A (an antibody to colorectal cancer) and in one case with unlabeled 111In chloride.

RESULTS

The immunoscintigraphic findings were generally in good agreement with computerized tomographic findings. The definitive diagnosis was established by biopsy findings: 23 gliomas (1 Grade I, 5 Grade II, 6 Grade III, and 11 Grade IV), 1 meningioma, and 4 metastatic lesions. The localization of gliomas with 111In-labeled anti-EGF-425 had a sensitivity of 0.96, a specificity of 0.60 and an accuracy of 0.90.

CONCLUSION

Immunoscintigraphy with 111-In labeled anti-EGFr-425 can be useful in the management of malignant gliomas, especially before radioimmunotherapy with 125I-labeled anti-EGFr-425.

Embryonic expression of the single Tribolium engrailed homolog

We have cloned and sequenced the single Tribolium homolog of the Drosophila engrailed gene. The predicted protein contains a homeobox and several domains conserved among all engrailed genes identified to date. In addition it contains several features specific to the invected homologs of Bombyx and Drosophila, indicating that these features most likely were present in the ancestral gene in the common ancestor of holometobolous insects. We used the cross-reacting monoclonal antibody, 4D9, to follow the expression of the Engrailed protein during segmentation in Tribolium embryos. As in other insects, Engrailed accumulates in the nuclei of cells along the posterior margin of each segment. The first Engrailed stripe appears as the embryonic rudiment condenses. Then as the rudiment elongates into a germ band, Engrailed stripes appear in an anterior to posterior progression, just prior to morphological evidence of the formation of each segment. As in Drosophila (a long germ insect), expression of engrailed in Tribolium (classified as a short germ insect) is preceded by the expression of several homologous segmentation genes, suggesting that similar genetic regulatory mechanisms are shared by diverse developmental types.

Postconcussional disorder: time to acknowledge a common source of neurobehavioral morbidity

Closed head injuries are common, affecting approximately 2 million people annually in the United States. The majority of these are "mild" in the sense of not being associated with prolonged unconsciousness, intracranial bleeding, skull fracture, or protracted periods of confusion. Yet a proportion of such "mild" injuries are accompanied by persisting cognitive, vegetative, and affective-behavioral sequelae, some of which affect day-to-day life. We argue that there is sufficient research to indicate that postconcussional symptoms occur and that they tend to have a predictable configuration. It is necessary to recognize the existence of "Postconcussional Disorder" in our nosology in order to provide more prompt diagnosis and management and to facilitate scholarly communication and research regarding this important neurobehavioral disorder.

Paradoxical changes in iodine-131 scintigraphic findings in advanced follicular thyroid cancer

We present the findings on iodine-131 (131I) scintigraphy, thallium-201 (201Tl) scintigraphy and quantitative thyroglobulin (QTG) estimation in two patients with follicular carcinoma of the thyroid with extensive metastases. The lesions were initially seen on 131I scintigraphs, but were not subsequently visualized with scanning doses of 131I (5 mCi), while retaining their ability to produce increasing amounts of thyroglobulin and take up 201Tl. Implications in choosing the appropriate diagnostic tests in the management of differentiated thyroid cancer are discussed.

Ixr1, a yeast protein that binds to platinated DNA and confers sensitivity to cisplatin

Structure-specific recognition proteins (SSRPs) bind to DNA containing intrastrand cross-links formed by the anticancer drug cisplatin. A yeast gene encoding an SSRP, designated IXR1, was cloned and sequenced. The Ixr1 protein, a member of the high mobility group-box protein family, bound specifically to DNA modified with cisplatin but not inactive platinum compounds. A yeast strain with an inactivated IXR1 gene was half as sensitive to cisplatin and accumulated one-third as many platinum-DNA lesions after treatment with cisplatin as the parental strain. These findings suggest that SSRPs play a role in mediating the cytotoxicity of cisplatin.

Structure and function of the homeotic gene complex (HOM-C) in the beetle, Tribolium castaneum

The powerful combination of genetic, developmental and molecular approaches possible with the fruit fly, Drosophila melanogaster, has led to a profound understanding of the genetic control of early developmental events. However, Drosophila is a highly specialized long germ insect, and the mechanisms controlling its early development may not be typical of insects or Arthropods in general. The beetle, Tribolium castaneum, offers a similar opportunity to integrate high resolution genetic analysis with the developmental/molecular approaches currently used in other organisms. Early results document significant differences between insect orders in the functions of genes responsible for establishing developmental commitments.

Sequence and structural implications of a bovine corneal keratan sulfate proteoglycan core protein. Protein 37B represents bovine lumican and proteins 37A and 25 are unique

Amino acid sequence from tryptic peptides of three different bovine corneal keratan sulfate proteoglycan (KSPG) core proteins (designated 37A, 37B, and 25) showed similarities to the sequence of a chicken KSPG core protein lumican. Bovine lumican cDNA was isolated from a bovine corneal expression library by screening with chicken lumican cDNA. The bovine cDNA codes for a 342-amino acid protein, M(r) 38,712, containing amino acid sequences identified in the 37B KSPG core protein. The bovine lumican is 68% identical to chicken lumican, with an 83% identity excluding the N-terminal 40 amino acids. Location of 6 cysteine and 4 consensus N-glycosylation sites in the bovine sequence were identical to those in chicken lumican. Bovine lumican had about 50% identity to bovine fibromodulin and 20% identity to bovine decorin and biglycan. About two-thirds of the lumican protein consists of a series of 10 amino acid leucine-rich repeats that occur in regions of calculated high beta-hydrophobic moment, suggesting that the leucine-rich repeats contribute to beta-sheet formation in these proteins. Sequences obtained from 37A and 25 core proteins were absent in bovine lumican, thus predicting a unique primary structure and separate mRNA for each of the three bovine KSPG core proteins.

The role of iodine-131 and thallium-201 imaging and serum thyroglobulin in the management of differentiated thyroid carcinoma

BACKGROUND

A prospective study was conducted to evaluate the use of iodine-131 sodium scintigraphy, thallium-201 chloride scintigraphy, and quantitative serum thyroglobulin estimation in the detection of differentiated thyroid carcinoma after thyroidectomy and iodine-131 sodium ablative therapy.

METHODS

Thirty-one patients with a median age of 45.6 years (range, 20-73 years) were included in the study. After optimal endogenous thyroid-stimulating hormone stimulation (> 50 mU/ml), 53 pairs of iodine-131 and thallium-201 scans were performed. Concomitant serum thyroglobulin levels were available for 32 pairs of scans. The presence or absence of thyroid cancer was established by clinical, radiologic, and/or biopsy findings.

RESULTS

The concordance between iodine-131 and thallium-201 scan findings in the presence of disease (25 scan sets) was 36%. The concordance in the absence of disease (28 scan sets) was 82%. Iodine-131 scanning was found to be significantly better (P < 0.05) than thallium-201 scanning, in terms of sensitivity (0.8 versus 0.6), specificity (0.96 versus 0.82), accuracy (0.89 versus 0.72), and the predictive value of a positive test (0.95 versus 0.75). The measurement of serum thyroglobulin had a low sensitivity (0.3) in the study but had a specificity of 1.0.

CONCLUSION

It was concluded that iodine-131 sodium scintigraphy is superior to thallium-201 scintigraphy and serum thyroglobulin estimation for the detection of residual or metastatic differentiated thyroid carcinoma. However, the use of combined modalities provides a higher diagnostic yield. Thallium-201 scintigraphy was especially useful in cases in which iodine-131 scintigraphy was negative and quantitative thyroglobulin levels were elevated.

The Tribolium homeotic gene Abdominal is homologous to abdominal-A of the Drosophila bithorax complex

The Abdominal gene is a member of the single homeotic complex of the beetle, Tribolium castaneum. An integrated developmental genetic and molecular analysis shows that Abdominal is homologous to the abdominal-A gene of the bithorax complex of Drosophila. abdominal-A mutant embryos display strong homeotic transformations of the anterior abdomen (parasegments 7–9) to PS6, whereas developmental commitments in the posterior abdomen depend primarily on Abdominal-B. In beetle embryos lacking Abdominal function, parasegments throughout the abdomen are transformed to PS6. This observation demonstrates the general functional significance of parasegmental expression among insects and shows that the control of determinative decisions in the posterior abdomen by homeotic selector genes has undergone considerable evolutionary modification.

Abnormal intracerebral thallium localization in a bacterial brain abscess

A 56-yr-old man with a prior history of renal cell carcinoma had moderately intense abnormal localization of 201Tl-chloride in a solitary brain lesion which was discovered to be a bacterial abscess. The organisms isolated by culture included Actinomycosis odontolyticus, Peptostreptococcus and Hemophilus aphrophilus. Because of the clinical presentation, MRI characteristics and thallium scintigraphic findings, the lesion had been felt to represent either a primary or a metastatic neoplasm. This case illustrates the need for caution in the interpretation of thallium brain scintigram.

Tailoring nursing care to the individual client: empirical challenge of a theoretical concept

Tailoring of client-nurse interaction to the client's individuality is a central concept in Cox's Interaction Model of Client Health behavior, and represents a specification of the term individualization of care (Cox, 1982b). In this study, the empirical adequacy of Cox's definition of tailoring was challenged by comparing the content of naturally occurring encounters between an expert nurse and clients to content predicted by the definition. Analyses of the content of the encounters revealed that: client individuality was featured; client individuality and clinical assessment-management were considered in association with one another; and a majority of interventions were fitted to the individual client. The findings were interpreted as supportive of the empirical existence of tailoring as specified by Cox, and provided the bases for suggested refinements of the theoretical model.

The relationship between the stretching capability of the anterior capsule and zonules

The stretching capability of the zonules was studied in 40 human eyes obtained postmortem from 27 patients. A continuous circular capsulorhexis (CCC) (2.2-6.8 mm) was performed, and the lenses were removed by either phacoemulsification (26 eyes) or planned extracapsular cataract extraction (ECCE) (14 eyes). Maximal zonular stretch was calculated as the difference in distance between the ciliary processes and the zonular insertion at rest and after maximal stretch. This zonular stretch test showed that zonules can stretch to a mean distance of 3.82 mm before rupturing. Capsular elasticity was measured in 35 of the eyes by gradually opening a modified caliper until the capsular opening was torn. The ratio between the circumference at rupture and the circumference at rest was used as an index of capsular elasticity. Circumference of the intact capsulorhexis could be enlarged an additional 62% before a radial tear occurred. In most cases, no significant correlation was seen between the capsular and zonular capability to stretch. Maximal zonular stretch decreased significantly with age by approximately 0.5 mm for every 5 yr, whereas capsular elasticity did not show a significant correlation with age. Two eyes with pseudoexfoliation had relatively friable zonules but the capsular elasticity was within normal limits. Patient age is probably the best indicator of the stretching capability of the zonules.

Diagnostic significance of apparent abnormal bowel activity on Ga-67 scans in AIDS patients

Twenty-one Ga-67 studies on 19 AIDS patients were analyzed to investigate the relationship between clinically acute gastrointestinal disease and abnormal scintigraphic bowel activity. Whole body images were obtained at times ranging from 4 to 192 hours, with most exams imaged at 48 and 72 hours. Abnormal bowel activity was observed in eight of 21 exams. Patients experienced acute GI disease during seven studies. Gallium scan results and clinical presentation agreed in 14 cases; both were abnormal in four and normal in 10. However, four exams showed abnormal activity in asymptomatic patients, while three normal studies were obtained in patients with clinically evident GI disease. Sensitivity was 57% and specificity 71%. Positive predictive value was .50 and negative predictive value .77. All true-positive cases were associated with Mycobacterium avium intracellulare (MAI) infection. This study implies that gallium imaging is unreliable for diagnosing acute bowel disease in AIDS patients, but may suggest a particular pathogen (MAI) in the symptomatic individual.

A deficiency of the homeotic complex of the beetle Tribolium

In Drosophila, the establishment of regional commitments along most of the anterior/posterior axis of the developing embryo depends on two clusters of homeotic genes: the Antennapedia complex (ANT-C) and the bithorax complex (BX-C). The red flour beetle has a single complex (HOM-C) representing the homologues of the ANT-C and BX-C in juxtaposition. Beetles trans-heterozygous for two particular HOM-C mutations spontaneously generate a large deficiency, presumably by an exchange within the common region of two overlapping inversions. Genetic and molecular results indicate that this deficiency spans at least the interval between the Deformed and abdominal-A homologues. In deficiency homozygous embryos, all gnathal, thoracic and abdominal segments develop antennal appendages, suggesting that a gene(s) has been deleted that acts to distinguish trunk from head. There is no evidence that beetles have a homologue of the segmentation gene fushi tarazu of similar genomic location and function. On the basis of the genetic tractability, convenient genome size and organization of Tribolium, and its relatively long phylogenetic divergence from Drosophila (>300 million years), we have integrated developmental genetic and molecular analyses of the HOM-C. We isolated about 70 mutations in the complex representing at least six complementation groups. The homeotic phenotypes of adults and lethal embryos lead us to believe that these beetle genes are homologous with the Drosophila genes indicated in Fig. 1 (see text).

Congenital hepatoblastoma and Beckwith-Wiedemann syndrome: a case study including DNA ploidy profiles of tumor and adrenal cytomegaly

A case of fatal congenital hepatoblastoma is described in which the autopsy provided the first evidence of Beckwith-Wiedemann syndrome. Aneuploid quantitative DNA patterns were found by image analysis of the tumor and the cytomegalic adrenal gland.

Striatal A2 receptor regulates apomorphine-induced turning in rats with unilateral dopamine denervation

The effect of the purine agonist N-ethylcarboxamido-adenosine (NECA) on apomorphine-induced rotation was investigated in rats with unilateral 6-hydroxydopamine lesions of the nigrostriatal pathway. Intrastriatal administration of NECA on the denervated side caused a dose-dependent inhibition of contralateral rotation. This inhibition was prevented by prior intrastriatal injection of theophylline. The adenosine A1 receptor antagonist 8-cyclopentyltheophylline was ineffective at concentrations which block this receptor, but effective in preventing the action of NECA at concentrations which block the adenosine A2 receptor. In the absence of apomorphine, NECA had no effect on behaviour. It is concluded that A2 receptor activation counteracts apomorphine effects in the striatum. Since the A2 receptor may be localized to striatal cholinergic neurones, the possible role of these neurones in purine-induced behaviours is discussed.

A cDNA encoding human ribosomal protein S24

We describe the isolation and nucleotide sequence of a cDNA encoding the human 40S ribosomal subunit protein (r-protein) S24 (Mr 15,425). Human S24 is virtually identical to the r-protein encoded by a cloned Xenopus laevis cDNA previously identified as S19 [Amaldi et al., Gene 17 (1982) 311-316].

Both A1 and A2a purine receptors regulate striatal acetylcholine release

The receptors responsible for the adenosine-mediated control of acetylcholine release from immunoaffinity-purified rat striatal cholinergic nerve terminals have been characterized. The relative affinities of three analogues for the inhibitory receptor were (R)-phenylisopropyladenosine greater than cyclohexyladenosine greater than N-ethylcarboxamidoadenosine (NECA), with binding being dependent of the presence of Mg2+ and inhibited by 5'-guanylylimidodiphosphate [Gpp(NH)p] and adenosine receptor antagonists. Adenosine A1 receptor agonists inhibited forskolin-stimulated cholinergic adenylate cyclase activity, with an IC50 of 0.5 nM for (R)-phenylisopropyladenosine and 500 nM for (S)-phenylisopropyladenosine. A1 agonists inhibited acetylcholine release at concentrations approximately 10% of those required to inhibit the cholinergic adenylate cyclase. High concentrations (1 microM) of adenosine A1 agonists were less effective in inhibiting both adenylate cyclase and acetylcholine release, due to the presence of a lower affinity stimulatory A2 receptor. Blockade of the A1 receptor with 8-cyclopentyl-1,3-dipropylxanthine revealed a half-maximal stimulation by NECA of the adenylate cyclase at 10 nM, and of acetylcholine release at approximately 100 nM. NECA-stimulated adenylate cyclase activity copurified with choline acetyltransferase in the preparation of the cholinergic nerve terminals, suggesting that the striatal A2 receptor is localized to cholinergic neurones. The possible role of feedback inhibitory and stimulatory receptors on cholinergic nerve terminals is discussed.

Preparation and study of human eyes obtained postmortem with the Miyake posterior photographic technique

A modification of the original Miyake technique of posterior photography of human eyes obtained postmortem is presented. A detailed description of globe preparation and equipment is described. Use of modern technology including a high magnification microscope system and video camera permits dynamic or realtime observations of tissue effects of various surgical procedures such as the cataract operation. This technique provides both a research and educational tool that can be used by ophthalmologists to improve the quality of surgery. Most important, it is an instructional tool that should reduce the "learning curve" that is inherent when modifying one's surgical technique.