Inhibition of posterior capsule opacification with an immunotoxin specific for lens epithelial cells: 24 month clinical results

PURPOSE: To assess the safety and effectiveness of an immunotoxin, MDX-RA, designed to inhibit posterior capsule opacification (PCO). SETTING: Eleven private practices in the United States. METHODS: This study comprised 63 eyes of 63 patients having extracapsular cataract extraction by phacoemulsification; these patients were enrolled in a Phase I/II clinical investigation of the immunotoxin MDX-RA. At the close of surgery, 21 patients were treated with placebo, 23 patients with 50 units of the immunotoxin, and 19 patients with 175 units of the immunotoxin as an aqueous solution. The patients were monitored for 24 months after primary cataract surgery using external eye and slitlamp examinations, visual acuity assessment, ophthalmoscopy, pachymetry, tonometry, endothelial cell counts, and lens capsule photography. Posterior capsule opacification, recorded on lens capsule photographs, was graded independently by a committee of 3 cataract surgeons. The incidence of neodymium:YAG (Nd:YAG) capsulotomy was projected from the opacification results. RESULTS: The immunotoxin, at the 50 unit dose, was well tolerated and effective in inhibiting PCO. At the 175 unit dose, there was a trend toward increased postoperative inflammation that was transient with no residua. From 6 to 24 months postoperatively, the 50 unit dose significantly inhibited PCO compared with the placebo (P < .05). This significant reduction in PCO translated into a significantly lower projected need for Nd:YAG capsulotomy in the 50 unit than the placebo group (P < .004). About 60% in the placebo group and 4% in the 50 unit group were projected to need an Nd:YAG capsulotomy by 3 years postoperatively. CONCLUSION: The immunotoxin was well tolerated and was effective in reducing PCO for up to 24 months after cataract surgery. Although these preliminary results are encouraging, a larger study is underway to determine whether the reduction in PCO by the immunotoxin decreases the need for Nd:YAG capsulotomy.     

On the dynamic covariation between interpersonal behavior and affect: prediction from neuroticism, extraversion, and agreeableness

It was posited that the traits of Neuroticism, Extraversion, and Agreeableness are predictors of dynamic intraindividual processes involving interpersonal behavior and affect. Hypotheses derived from the behavioral concordance model that individuals with high scores on a trait would experience more positively valenced affect when engaging in behavior concordant with that trait than individuals with low scores on the trait were tested. Participants completed a questionnaire measure of the traits and reported on behavior and affect during interpersonal interactions using event-contingent sampling forms approximately 6 times a day for 20 days. Trait scores were related to indexes of the association between each dimension of interpersonal behavior and affect calculated for each individual. Previous findings concerning the trait of Agreeableness were replicated, and results strongly supported the behavioral concordance model for the trait of Neuroticism. Thus, at least some traits can provide information about intraindividual processes that vary over time.     

The laryngeal mask airway: a new standard for airway evaluation in thoracic surgery

BACKGROUND: Thoracic surgeons typically perform fiberoptic bronchoscopy (FOB) before thoracotomy, usually on the day of the operation after intubation with a single-lumen endotracheal tube (ETT) and before insertion of a double-lumen ETT. This routine requires two laryngoscopies and two intubations. The laryngeal mask airway (LMA) is an airway device developed in England and approved by the Food and Drug Administration in 1991 for clinical use in the United States. It requires neither mask ventilation nor laryngoscopy and allows FOB visualization of the epiglottis, larynx, and entire trachea. We assessed the LMA as an alternative to a single-lumen ETT for FOB before thoracotomy. METHODS: Through prospective assessment, 50 patients underwent FOB after insertion of an LMA before thoracotomy. Pulse rate, blood pressure, ease of insertion of the LMA, quality of FOB, and complications of LMA insertion were assessed. RESULTS: During LMA insertion, blood pressure and pulse rate increased less than 5% from baseline in all patients. The LMA was inserted successfully in all patients within 10 seconds. No complications occurred as a result of LMA insertion. CONCLUSIONS: Insertion of the LMA causes minimal hemodynamic response. From the time of induction of general anesthesia, insertion of the LMA is quick, simple, and safe and eliminates the need for endotracheal intubation with a single-lumen ETT before double-lumen tube insertion. The LMA, in contrast to the ETT, allows a complete survey of the larynx and trachea. The LMA is autoclavable, reusable, and cost effective. Therefore, in patients who require FOB immediately before thoracotomy, LMA use should be the standard for airway evaluation.     

Utilizing increased response effort to reduce chronic hand mouthing

The effects of increased response effort on levels of hand mouthing, leisure engagement, and adaptive elbow flexion were investigated with 2 individuals who had been diagnosed with profound disabilities. Arm restraints designed to alter the amount of physical effort necessary to engage in hand mouthing were used. Results indicated that the treatment strategy reduced levels of hand mouthing but produced only small to moderate reductions in levels of leisure engagement and adaptive elbow flexion. At follow-up, the effects of increased response effort on hand mouthing and leisure engagement were maintained for both participants; however, the restraints were associated with substantial reductions in adaptive elbow flexion for 1 participant.     

A reappraisal of the hormonal regulation of larval fat body histolysis in female Drosophila melanogaster

The histolysis of larval fat body cells in adult female Drosophila melanogaster was examined in wild type and mutant animals. The fat body cells of wild type (Canton-S), apterous56f homozygotes, apterous78jts homozygotes and heterozygotes, apterous4/+, ecdysoneless1 homozygotes and heterozygotes all underwent histolysis normally during the 72 h following adult eclosion. Only in the case of ap4/ap4 adults did the cells fail to histolyze normally. The fat body cells of both diapausing and non-diapausing wild type females underwent histolysis at the same rate. Attempts to demonstrate histolysis in vitro were unsuccessful, even in the presence of juvenile hormones (JHs), larval ring glands, or adult ovaries. In all strains other than the ap4 homozygotes, a significant proportion of larval fat body cells were dead at any time while the ap4/ap4 animals, almost all cells remained viable. It is postulated that fat body cell lysis following eclosion is not a JH-mediated event, but is elicited by an as yet unidentified factor(s), possibly originating in the ovary.     

Glaucoma drainage implants in pediatric patients

To assess the use of drainage implants in pediatric patients with glaucoma refractory to conventional medical and surgical therapy, we retrospectively reviewed 20 consecutive eyes in children 10 years of age or younger treated with 16 Molteno (three of which were removed and replaced with second Molteno shunts) and seven Baerveldt implants. The age of the patients ranged from 1 month to 10 years (mean, 3 years). The patients had undergone a mean of two previous failed glaucoma procedures (range, one to six). The mean intraocular pressure (IOP) prior to drainage tube implantation was 37 +/- 4 mm Hg, compared with a mean of 18 +/- 6 mm Hg following surgery, with average postoperative follow up of 25 months (range, 8 to 41 months). The overall success, defined as IOP < or = 21 mm Hg without further surgical therapy, was 80%. Postoperative glaucoma medications were required in 75% of patients. There were 23 complications, one of which resulted in decreased visual acuity. These findings demonstrate that drainage tube implants can be effective in lowering IOP in uncontrolled pediatric glaucomas. Patients often require postoperative glaucoma medications and close monitoring for complications.