The effect of simulated cataract on the glaucomatous visual field

PURPOSE: The current study is designed to determine the effect of light scattering (simulated cataract) on glaucomatous visual fields. METHODS: Twelve patients with relative scotomas caused by glaucoma underwent the 30-2 threshold test with the Humphrey Visual Field Analyzer twice: once with and once without having a light-diffusing piece of ground glass in front of the eye, which, in previous experiments, has been shown to decrease perimetric threshold by 4.4 decibels (dB) in normal eyes. As controls, 12 patients underwent the same examination with and without a piece of clear glass in front of the eye. In each pair of fields, five points were analyzed within the relative scotoma and compared with five points in a normal area of the opposite hemifield. RESULTS: The diffusing ground glass produced a mean decrease of perimetric threshold of 5.7 dB (standard deviation [SD] = 3.3 dB) within the area of relative scotoma compared with 6.1 dB (SD = 2.4 dB) within the normal area and 4.4 dB (SD = 2.25 dB) at the fovea. The differences between means were not statistically significant. In addition, the diffusing glass did not affect the corrected pattern SD (CPSD) index (6.5 dB with the diffuser and 6.5 dB without). CONCLUSION: Light scattering depresses the glaucomatous visual field diffusely. Relative glaucomatous scotomas and normal areas are depressed equally, expressed as change in decibel of sensitivity. Therefore, in following patients with cataracts and glaucoma, depression of threshold sensitivity in glaucomatous areas out of proportion to normal areas should not be attributed to the light-scattering effect of the cataract, but rather to possible worsening of glaucomatous damage.     

A double-masked, randomized 1-year study comparing dorzolamide (Trusopt), timolol, and betaxolol. International Dorzolamide Study Group

OBJECTIVE: To investigate the safety profile and efficacy of 2.0% dorzolamide hydrochloride, when administered three times daily for up to 1 year, compared with that of 0.5% timolol maleate and 0.5% betaxolol hydrochloride, each administered twice daily. In addition, the effect of adding dorzolamide to the regimen of patients with inadequate ocular hypotensive efficacy while they were receiving one of the two beta-adrenoceptor antagonists and the effect of adding timolol to the regimen of patients receiving dorzolamide were also evaluated. DESIGN: A double-masked, randomized, parallel comparison. SETTING: Multinational study at 34 international sites. PATIENTS: Five hundred twenty-three patients with open-angle glaucoma or ocular hypertension, 17 to 85 years of age. Patients currently using ocular hypotensive medications were required to undergo a washout. INTERVENTION: Two percent dorzolamide three times a day, 0.5% timolol (Timoptic, Merck, Whitehouse Station, NJ) twice daily, and 0.5% betaxolol solution (Betoptic, Alcon, Fort Worth, Tex) twice daily. RESULTS: At 1 year, the mean percent reduction in intraocular pressure at peak of 2% dorzolamide, 0.5% timolol, and 0.5% betaxolol was approximately 23%, 25%, and 21%, respectively. At afternoon trough, the mean percent reduction in intraocular pressure was 17%, 20%, and 15% for dorzolamide, timolol, and betaxolol, respectively. CONCLUSIONS: The ocular hypotensive efficacy of 2.0% dorzolamide, given three times a day, is comparable with that of 0.5% betaxolol, given twice daily, for up to 1 year. In addition, long-term use of dorzolamide was not associated with clinically meaningful electrolyte disturbances or systemic side effects commonly observed with the use of oral carbonic anhydrase inhibitors.     

The effect of surface coating of femoral prostheses implanted without cement: a 2- to 4-year follow-up study

The complement system covalently attaches C3d to microbial antigens which binds to CR2 on B lymphocytes, leading to a markedly enhanced adaptive immune response to that antigen. The enhancement is mediated by the cross-linking of the CR2-CD19 complex to mIg which augments the activation of several intracellular signalling pathways. Two additional receptors of the B lymphocyte, FcgammaRIIB and CD22, have opposing effects when cross-linked to mIg, the former suppressing signalling by recruiting the inositol phosphatase, SHIP, and the latter by activating the phosphotyrosine phosphatase, SHP-1. Two principles emerge from these studies: innate immunity guides the adaptive immune response, and activation of the B lymphocyte is determined by co-receptors which evaluate the biological characteristics of antigen.     

Effects of timolol and betaxolol on choroidal blood flow in the rabbit

Endothelium-dependent hyperpolarization of vascular smooth muscle cells (VSMCs) plays a crucial role in regulating vascular tone, especially in resistance vessels. It has been proposed that metabolites of arachidonic acid (AA), formed by cytochrome P-450 monooxygenase (P450), are endothelium-derived hyperpolarizing factors (EDHFs). These metabolites have been reported to mediate dilation to endogenous vasoactive compounds, such as bradykinin and acetylcholine. However, it is not known whether these metabolites of AA contribute to dilation of human resistance vessels. This is important since it has been proposed that EDHF serves as a compensatory mechanism to maintain dilation in disease states. Therefore, we studied the effect of AA on vessel diameter and VSMC membrane potential in isolated human coronary microvessels. Arterioles (81+/-5 microm, n=70) were dissected from right atrial appendages at the time of cardiac surgery and cannulated at a distending pressure of 60 mm Hg and zero flow. Changes in internal diameter were recorded with videomicroscopy. Some vessels were impaled with glass microelectrodes to measure membrane potential of VSMCs while internal diameters were simultaneously recorded. After constriction (47+/-2%) with endothelin-1, AA (10(-10)to 10(-5)mol/L) induced substantial dilation of human coronary microvessels, which was abolished by removal of the endothelium. Treatment with 17-octadecynoic acid (17-ODYA, 10(-5) mol/L; a P450 inhibitor) attenuated maximal dilation to AA (49+/-9% versus 91+/-4% [control]; P<0.05 versus control), whereas indomethacin (INDO, 10(-5) mol/L; a cyclooxygenase inhibitor) and N omega-nitro-L-arginine methyl ester (L-NAME, 10(-4) mol/L; a NO synthase inhibitor) were without effect. Both 17-ODYA and miconazole (10(-5) mol/L, a chemically distinct P450 inhibitor) further reduced the dilation to AA in the presence of INDO. The presence of 40 mmol/L KCl or charybdotoxin (10(-8) mol/L, a blocker of large-conductance Ca2+-activated K+ channels) impaired dilation to AA (19+/-9% [KCI] versus 76+/-5% [control] and 47+/-6% [charybdotoxin] versus 91+/-3% [control]; P<0.05 for both). After depolarization with endothelin-1 (-26+/-1 mV from -48+/-3 mV [before endothelin]), AA (10(-5)mol/L) in the presence of INDO and L-NAME induced hyperpolarization of VSMCs (-57+/-5 mV). In the presence of 17-ODYA together with INDO and L-NAME, endothelin produced similar depolarization (-26+/-2 mV from - 48+/- 3 mV), but hyperpolarization to AA was reduced (-33+/-2 mV; P<0.05 versus absence of 17-ODYA). AA metabolites formed primarily by P450 produce potent endothelium-dependent dilation of human coronary arterioles via opening of Ca2+-activated K+ channels and hyperpolarization of VSMCs. These findings support an important role for P450 metabolites in the regulation of human coronary arteriolar tone.     

A double-masked, randomized, 1-year study comparing the corneal effects of dorzolamide, timolol, and betaxolol. Dorzolamide Corneal Effects Study Group

OBJECTIVE: To compare the long-term effects of dorzolamide hydrochloride (Trusopt, Merck and Co Inc, White-house Station, NJ), timolol maleate, and betaxolol hydrochloride on corneal endothelial cell density and corneal thickness. METHODS: This 1-year multicenter study was conducted in 298 patients with ocular hypertension or open-angle glaucoma who had a baseline central corneal endothelial cell density greater than 1500 cells/mm2 and central corneal thickness less than 0.68 mm in each eye. Patients were randomized to 0.5% betaxolol twice daily, 0.5% timolol twice daily, or 2.0% dorzolamide 3 times daily. Specular microscopy and ultrasonic pachymetry of the central cornea was performed at baseline and 6 and 12 months following institution of therapy. Endothelial cell densities were determined by a single masked observer. RESULTS: The mean percent changes from baseline for both outcome measures were similar in all 3 treatment groups at both 6 and 12 months. After 1 year of treatment, the mean percent loss in endothelial cell density from baseline was 3.6%, 4.5%, and 4.2% for the dorzolamide, timolol, and betaxolol groups, respectively. The mean percent change from baseline for corneal thickness was 0.47%, -0.25%, and 0.39% for the dorzolamide, timolol, and betaxolol groups, respectively. CONCLUSIONS: Dorzolamide is equivalent to timolol and betaxolol in terms of the change in central endothelial cell density and thickness after 1 year of therapy. All 3 treatments exhibit good long-term corneal tolerability in patients with normal corneas at baseline.     

The tinnitus intensive therapy habituation program: A 2-year follow-up pilot study on subjective tinnitus.

Objectives: To explore the effects of a new tinnitus treatment program (tinnitus intensive therapy [TIT]) based on auditory perception principles and neural habituation. Methods: A follow-up study with measurement of treatment effects every third month over a 2-year period in which the cases were their own controls. Participants: There were 25 participants with a mean age 50.1 years (SD = 16.1); 10 women (52.7 years; SD = 16.8) and 15 men (48.3 years; SD = 15.9). The participants were recruited from clinical population admitted to a polyclinic tinnitus treatment program in western Germany. Results: There was a significant reduction of tinnitus in the follow-up period. Mean baseline tinnitus scores (Tinnitus Fragebogen; Goebel & Hiller, 1998) at the start of the treatment were 50.9 (SD = 14.5) and the final scores were 14.2 (SD = 5.9). In total, the clinical improvement over the follow-up period was 72.1%. Conclusion: The TIT program showed a significant clinical treatment effect and should be tested further in a multicenter treatment project. The findings support the Jastreboff habituation model of tinnitus, but social cognitive factors should also be taken into account. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Japanese career progress study: A 7-year follow-up.

A longitudinal study of managerial progress, begun by the present 1st author and colleagues (1978, 1980) in 1972 in a Japanese department store chain, monitored the professional and dyadic development of a cohort group of 80 newly recruited male college graduates (mean age 23.6 yrs) over their 1st 3 yrs with the company. Seven waves of data were collected from Ss, their immediate superiors, and company records. After 7 yrs with the company, Ss were promoted to their 1st management positions. The present study examined the preemployment selection test results and measured quality of vertical dyadic exchanges between S and his immediate superior over the 1st 3 yrs and the interaction of these 2 factors in predicting the speed of promotion, annual salary, and size of bonus after 7 yrs. Results show that the 1st 3 yrs were critically important to Ss; the combined effect of exchange and ability produced significant contributions to all 3 career outcomes assessed. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Suicide attempts in a cohort of drug abusers: a 5-year follow-up study

A group of 125 drug abusers admitted consecutively for detoxification and short-term rehabilitation were followed up 5 years after discharge. They were asked about possible suicide attempts in a semi-structured face-to-face interview. Nearly half of the group (45%) reported having attempted suicide at some point in their life. The most common reasons given were the loss of a person whom they loved, and feelings of loneliness. Only three respondents reported using their drug of choice in the attempt(s). The suicide attempters were more often found to have been in child psychiatric treatment earlier, and to have experienced loss of significant others in childhood, than those who did not report attempting suicide. At follow-up the suicide attempters indicated that they experienced more depressive moods and more severe psychological problems than those who had never made a suicide attempt. The importance of assessing the risk of suicide attempts among drug addicts in order to be able to take measures to prevent future suicidal behaviour is emphasized.     

Motor recovery after stroke depends on intact sustained attention: A 2-year follow-up study.

The functional recovery of 47 right-brain-damaged stroke patients was studied over a 2-year period. The researchers hypothesized that sustained attention capacity should predict the degree of motor and functional recovery over this period because of a proposed privileged role of sustained attention in learning-based recovery of function. As predicted, significant correlations were found between sustained attention capacity at 2 months and functional status (including the Barthel Index) at 2 years. This relationship was shown to exist independently of 2-month functional status. Furthermore, compared with a left-brain-damaged group of cerebrovascular accident (CVA) patients, the right-brain CVA group did not recover functional ability as well over the 2-year period. This increasing difference in functional status over a 2-year period was mirrored by an emerging difference in sustained attention capacity, in favor of the left-brain CVA group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Borderline disorder in Turkey: a 2- to 4-year follow-up

1. Conventional and germ-free rats were fed a fibre-free elemental diet with or without the addition of fermentable dietary fibres. We have previously reported that fibre was associated with greatly increased epithelial cell proliferation, but only in the conventional group, implying that it is the breakdown of fibre by the colonic microflora that is the main determinant of mucosal proliferation in the hind gut. The relationship of these changes to various plasma hormones implicated in intestinal growth control are described in this paper. 2. The most dramatic finding was that plasma levels of enteroglucagon and peptide YY were greatly increased in the germ-free groups. The response of these rats to fibre differed in that fibre decreased levels of enteroglucagon and peptide YY in the germ-free animals, but increased them in the conventional rats. Gastrin and insulin levels were significantly lowered in the fibre-supplemented groups, but were not affected by the microflora. 3. These results corroborate our previous findings that the effects of fibre and its fermentation are dynamically complex, and demonstrate that, like proliferation, direct effects and indirect fermentation-derived effects on plasma hormones also coexist.     

Social skills training for primary school children: a 1-year follow-up study

OBJECTIVE: To evaluate the effectiveness of the Rochester Social Problem Solving Program to reduce emotional and behavioural problems amongst primary school children. METHODOLOGY: Children in years 3 and 4 at primary school were assessed prior to receiving the program, immediately after the program and 1 year after the program. At each assessment, the functioning of the children who received the program was compared to the functioning of children enrolled in years 3 and 4 at a comparable school who did not receive the program. RESULTS: The program improved the ability of children to cope with potentially difficult social situations. However, the program did not reduce the prevalence of teacher-reported or mother-reported childhood emotional and behavioural problems. CONCLUSIONS: School-based social skills programs may be more effective in reducing childhood emotional and behavioural problems if they include components which focus specifically on childhood behaviour problems as well as components focusing on social skills and peer relationships.     

Nerve fiber layer defects with normal visual fields. Do normal optic disc and normal visual field indicate absence of glaucomatous abnormality?

PURPOSE: When the optic disc has normal appearance with no abnormalities in routine automated perimetry, the subject is not considered to have glaucoma. The purpose of this study is to show how such patients may have localized retinal nerve fiber layer defects with corresponding functional abnormality. METHODS: The authors selected eight eyes of eight patients who had a localized retinal nerve fiber layer defect extending within a few degrees from fovea but in whom the optic disc appearance and Humphrey 30-2 visual fields were normal. Of the eight patients, three had positive family history of glaucoma, two had suspected retinal nerve fiber layer abnormality in routine eye examination, two had increased intraocular pressure (IOP), and one had advanced low-tension glaucoma in one eye with a normal fellow eye. The authors examined the central 10 degrees visual field with 1 degree resolution using Humphrey perimeter and the Ring and Centring programs of the high-pass resolution perimeter. RESULTS: A central field defect corresponding to retinal nerve fiber layer defect was found in six of eight patients: in both 10 degrees Humphrey field and Centring programs (2 eyes), in Humphrey only (2 eyes), and in Centring only (2 eyes). CONCLUSION: The results indicate that retinal nerve fiber layer photographs are helpful in diagnosing glaucoma because early glaucomatous abnormalities cannot be excluded without nerve fiber layer photography. Currently available routine perimetric examination programs do not always detect very early functional damage.     

Cardiovascular outcome in white-coat versus sustained mild hypertension: a 10-year follow-up study

BACKGROUND: The aim of this study was to compare the risk conferred by white-coat versus sustained mild hypertension for the development of cardiovascular disease. METHODS AND RESULTS: Patients (n=479) who underwent 24-hour intra-arterial ambulatory blood pressure monitoring on the basis of a persistently elevated clinic systolic blood pressure of 140 to 180 mm Hg were followed up for the development of subsequent cardiovascular events during a 9.1+/-4. 2-year period. White-coat hypertension, defined as a clinic systolic blood pressure of 140 to 180 mm Hg associated with a 24-hour ambulatory systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg, was present in 126 patients, and the remainder had sustained mild hypertension. A subgroup of patients without complications underwent follow-up echocardiography and carotid ultrasound. White-coat hypertensives were younger (44+/-12 versus 52+/-10 years, respectively; P<0.001) and had a significantly lower incidence of cardiovascular events (1.32 versus 2.56 events per 100 patient-years, respectively; P<0.001) than sustained hypertensives. Multivariate analysis revealed age (P=0.002), sex (P=0.007), race (P=0.001), smoking (P=0.005), and the presence of white-coat hypertension (hazard ratio, 0.29; 95% CI, 0.09 to 0.90; P=0.04) to be independent predictors of subsequent cardiovascular events. Subgroup analysis in patients without complications revealed a lower incidence of left ventricular hypertrophy and lesser degrees of carotid hypertrophy in the white-coat group. CONCLUSIONS: These findings indicate a relatively benign outcome in white-coat hypertension compared with sustained mild hypertension.     

Memory self-efficacy predicts memory performance: Results from a 6-year follow-up study.

The purpose of this study was to examine the relationship between memory self-efficacy (MSE) and a 6-year follow-up assessment of memory functioning in a sample of Dutch older adults. MSE was assessed by a Dutch abridged version of the Metamemory in Adulthood questionnaire (MIA; R. A. Dixon, D. F. Hultsch, & C. Hertzog, 1988; C. Hertzog, D. F. Hultsch, & R. A. Dixon, 1989; R. W. H. M. Ponds & J. Jolles, 1996). The total MSE score predicted memory performance at 6 years, as measured by the Visual Verbal Learning Task (VVLT; N. Brand & J. Jolles, 1985). A separate analysis of the different MSE subscales indicated that the MIA Change score was the most salient domain-specific MSE predictor of subsequent memory performance after 6 years. An extreme groups analysis of the MIA Change score revealed a pattern of performance for those who perceived that their memory was worsening, performing less well on the 3 trials of the VVLT when these were readministered at the 6-year follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of compulsive rituals with visual screening: a case study with long-term follow-up

The present study reports on the use of visual screening, a mildly aversive response suppression procedure, as a treatment for reducing compulsive behaviors in a four and one-half year-old developmentally disabled boy. Two distinct patterns of compulsive responding were observed: repetitive (stereotyped) shoe-related behaviors and a ritualistic shoe-related act. The effect of visual screening on repetitive shoe-related responses was initially evaluated in a laboratory setting under A-B-A-B-B1 experimental conditions and systematically extended to the classroom setting in multiple baseline fashion. Visual screening was also contingently applied as treatment for the shoe-related ritual, with the effects analyzed using a similar multiple baseline format across hospital residential unit and natural home settings. Results of the study indicated that visual screening was an effective treatment for suppressing both forms of the subject's compulsive responding and that it was an easily learned and administered procedure from both staff and parent perspectives. Follow-up data across 12 months were obtained and indicated that the effect of treatment was exceptionally durable.     

Endoscopic pancreaticobiliary procedures in patients with a Billroth II resection: a 10-year follow-up study

PURPOSE: To report uveitis associated with human immunodeficiency virus (HIV) infection and to suggest guidelines for treatment. METHODS: Six HIV-seropositive patients (10 eyes) with anterior or posterior uveitis or both were evaluated. After ineffective prolonged treatment with systemic and topical corticosteroids, specific systemic antiretroviral therapy with zidovudine was initiated in all patients. Aqueous humor was cultured in three eyes of three patients, and vitreous humor was cultured in one eye of one patient. RESULTS: In all 10 eyes of six patients, there was resolution of inflammation in 10 to 42 days after commencement of treatment with zidovudine (600 to 800 mg/day), despite no or minimal response to corticosteroids. Cultures of aqueous humor from three eyes of three patients and culture of vitreous humor from one eye of one patient were positive for HIV; no other organism was isolated. Systemic evaluation disclosed no other identifiable cause for the uveitis in any patient. CONCLUSIONS: Infection with HIV appears to be a cause of uveitis. A trial of zidovudine may be warranted in HIV-seropositive patients with uveitis that is poorly responsive to corticosteroid treatment when no other cause is identified. The efficacy of other retroviral agents was not determined.     

Isolated tear of the anterior cruciate ligament: 5-year follow-up study

During the period 1967 to 1971, 64 cadets at the United States Military Academy, West Point, New York, had surgical repair for isolated tear of the anterior cruciate ligament. In a 5-year follow-up study to determine the functional impairment, present disability, and reinjury to the knee, 32 of the 64 patients were located and evaluated by radiographic examination and either by interview or by questionnaire. Twenty-two were commissioned to full duty. 23 had attended ranger or airborne school, and 16 had been in combat. Impairment of ordinary activities was noted by 12 and impairment of athletic endeavors by 24; pain by 71%; swelling by 66%; stiffness by 71%; and instability by 94%. Seventeen of the 32 had had a significant reinjury after the repair of the anterior cruciate ligament. Clinically, we can diagnose the isolated tear of the anterior cruciate ligament by four essential ingredients--a pop at time of injury, inability to continue participation, gross swelling of knee, and maximal swelling within 12 hr. The mechanism of injury is usually deceleration and change of direction, not contact with another player. The follow-up study on this small series indicates that the patients have progressive deterioration of the knee.     

Financial problems and health complaints among farm couples: Results of a 10-year follow-up study.

Over a 10-year period, this survey study of 91 Dutch dairy farm couples investigated both causal and reversed causal relationships between couples' financial problems and husbands' and wives' mental and physical health complaints, as well as crossover effects of mental and physical health complaints between spouses. These relationships were tested simultaneously using structural equation modeling analyses. Results showed that financial problems were not predictive of health complaints for either spouse but that husbands' health complaints did predict both couples' financial problems and wives' health complaints 10 years later. These findings emphasize the importance of mental and physical health as resources for both the business and the family. For wives, these effects were not found, which may reflect the different positions of husbands and wives at the farm and, hence, the different ways they allocate their resources. (PsycINFO Database Record (c) 2010 APA, all rights reserved)