Corneal endothelial involvement in pseudoexfoliation syndrome

Information on corneal manifestation in pseudoexfoliation syndrome is restricted to specular microscopic studies. We investigated morphologic changes of the posterior cornea of two corneal buttons with Fuchs' endothelial dystrophy obtained at penetrating keratoplasty and of one enucleated glaucomatous eye from three patients with ocular pseudoexfoliation syndrome. By transmission electron microscopy, large clumps of typical pseudoexfoliation material were found adhering to the corneal endothelium and masses of pseudoexfoliation material were incorporated into the posterior Descemet's membrane. In the affected areas, the endothelial layer appeared irregular and discontinuous, with loosely adherent, degenerating cells producing pseudoexfoliation fibers and fibroblastic cells spreading to cover denuded Descemet's membrane. The present findings indicate that the pseudoexfoliation material is initially formed by degenerative endothelial cells and that it becomes subsequently buried by overgrowing cells. The corneal endothelial involvement may potentiate complications of cataract surgery and open angle glaucoma in patients with pseudoexfoliation syndrome.     

Serious infections due to Pseudomonas aeruginosa

Infections due to Ps. aeruginosa are a problem in the tropics as in other parts of the world. Over a four year period, 15 patients attending University College Hospital, Ibadan, were proved to have septicaemia due to this organism and 13 patients died rapidly as a direct result of the infection. The two patients who survived the acute episode had received immediate treatment with at least one antibiotic active against Ps. aeruginosa: a third patient, who received immediate appropriate antibiotic therapy, was already suffering from aplastic anaemia and died rapidly despite treatment. The remaining patients received inappropriate antibiotic therapy because pseudomonas infection was not suspected at the time the diagnosis of septicaemia was made. Patients most at risk appear to be the very young and those with pre-existing malignant or other conditions affecting the defence mechanisms of the body: it is suggested that routine initial management of such patients should include a blood culture, followed by immediate treatment with an antibiotic combination that includes at least one agent likely to be active against Ps. aeruginosa. The development of medical services can lead to the introduction of ophthalmic or other operations on tissues that are highly susceptible to infection before facilities are provided for the maintenance of a pathogen-free environment. Following an outbreak of eye infection after cataract extractions, carried out in an old and unsatisfactory theatre, wide-spread room contamination was demonstrated with the same strains of Ps. aeruginosa that had been responsible for the clinical infections. Chemical disinfection of the theatre floor failed to eliminate the organisms, although other experiments suggested that the drying effect of air-conditioning would be successful in this respect. The wisdom of introducing such operations before the provision of adequate facilities is seriously questioned.     

Studies on long chain cis- and trans-acyl-CoA esters and Acyl-CoA dehydrogenase from rat heart mitochondria

A quantitative counterimmunoelectrophoresis technique has been applied to evaluation of RNA antibodies in serum and unconcentrated CSF. Serum anti-RNA antibodies have been found at high dilutions in some patients with infectious diseases, subacute panencephalitis and multiple sclerosis. RNA antibodies in CSF are significantly linked to oligoclonal aspect, i.e. to a synthesis of IgG inside the CNS.     

Instrumentation problems for physicians

The physician has, for whatever reasons, diminished his or her level of involvement on the team dedicated to developing, refining, and evaluating medical technology. As a result, the challenge confronting the physician and the technology development team today is to orchestrate a team structure that will ensure the greatest input and commitment from physicians and other professionals during current and future technology development. The charges of cost escalation and dehumanization in our system of health care delivery will also be discussed, as will the lack of, or confusion about, access to data concerning cost of a given instrument, and fuzzy semantics and perspectives on technology and instrumentation. The author suggests answers to, or means to ameliorate, the problems.     

Efficacy of a standard human anthrax vaccine against Bacillus anthracis spore challenge in guinea-pigs

The efficacy of an anthrax vaccine licensed for human use, MDPH-PA, was tested in guinea-pigs intramuscularly challenged with 10, 100 or 1000 LD50 of spores from two virulent strains of Bacillus anthracis, Vollum 1B and Ames. As demonstrated in other investigations, immunization with MDPH-PA provided better protection against challenge with the Vollum 1B strain than with the Ames strain, although vaccine efficacy against the Ames strain was better than previously reported. Enzyme-linked immunosorbent assay of serum antibody titres to B. anthracis protective antigen showed that there was no significant correlation between survival and antibody titres.     

A multidiscipline approach in low vision rehabilitation

The first low vision clinic was instituted at the Industrial Home for the Blind in 1953 in response to a growing demand that more effective use be made of the residual vision in blind persons. The technology was there. Eye practitioners certainly knew enough about vision problems to offer many of these people an opportunity to enter a new life. The problem was: how to put that knowledge to work through a sound service delivery system. By its twentieth anniversary in 1973 the clinic had seen almost 5,000 patients for low vision evaluation and had built a service which consistently provided substantial and useful improvement in vision through the use of optical aids to a majority of its patients. The low vision optometric staff works as an integral part of a rehabilitation team. That team consists of a number of professionals, including ophthalmologists, social workers, teachers, and a variety of rehabilitation instructors. All members work simultaneously to create a total program of rehabilitation for thepartially sighted. We feel this teamwork approach is of basic importance to effective rehabilitation.     

What's the latest? Cultural age deadlines for family transitions

Several questions about the degree to which cultural schedules exist for the timing of life transitions, as well as the nature of these schedules, remain unexplored. In this article, we examine age timetables for central family transitions. Do individuals perceive age deadlines for these transitions, and by what ages do they think that men or women should have experienced them? How much consensus exists about these deadlines? Why are they considered important, and what consequences are perceived for men or women who miss them? A key theoretical question with which we are concerned is whether contemporary thinking about these deadlines can be considered "normative." A random sample of 319 adults from the Chicago metropolitan area were interviewed about eleven separate life-course transitions, six of which were from the family sphere. By and large, the majority of respondents perceived deadlines for most of the family transitions discussed. While the deadlines cited were quite variable in range, they were also concentrated within a narrow band of ages. The dimensions underlying individuals' thinking about deadlines were centered primarily on the development of self and personality, or were linked to concerns about the sequencing of roles and experiences over lifetime. However, late timing was generally thought to be acceptable, accompanied by little social tension, and without consequences for the individual's life or the lives of other persons to whom one is intimately connected. While a rough, "normal biography" of family life existed in the minds of our respondents, the deadlines attached to that biography were flexible guidelines for the course of family life, not rigid, normative principles. These findings are discussed in light of recent debates about life-course theory and research.     

Pattern and antibiotic susceptibility of bacteria in pyogenic meningitis in a children's emergency room population in Maiduguri, Nigeria, 1988-1992

From January 1988 to November 1992, 107 (3.5%) of 3074 postneonatal children admitted to the Children's Emergency Room, University of Maiduguri Teaching Hospital, Nigeria, had sporadic pyogenic meningitis; 66 (61.7%) were aged < or = 12 months. Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae together were responsible for 77.3% (58) of 75 culture-proven cases, 13.4% (10) had Enterobacteriaceae, 5.3% (4) had Staphylococcus aureus and 4% (3) untyped alpha-haemolytic streptococci. Fifty percent of 62 bacteria were resistant to ampicillin, 47.2% of 36 to penicillin and 10.7% of 56 to chloramphenicol; none of 21 bacteria was simultaneously resistant to all three antibiotics. Up until 1992, we have encountered treatment failure with a regimen containing chloramphenicol in only 2 of 53 patients; the 2 patients had coliform meningitis. Non-meningococcal bacteria are an important cause of sporadic pyogenic meningitis in sub-Saharan Nigeria and chloramphenicol is the most appropriate initial drug of choice at the present time for the management of sporadic meningitis.