Conjunctival wound closure by saline injection in sutureless, scleral tunnel incision phacoemulsification

PURPOSE: To compare two methods of conjunctival closure in phacoemulsification. SETTING: Frimley Park Hospital NHS Trust, Surrey, England. METHODS: This prospective, randomized study comprised 40 patients (40 eyes) who had phacoemulsification via superior axis scleral tunnels and implantation of a poly(methyl methacrylate) intraocular lens with a 5.5 mm optic diameter. In 24 eyes, the conjunctival wound was closed manually with a Moorfields forceps (Group A). In 16, 0.5 ml of balanced salt solution was injected subconjunctivally to reappose the conjunctival wound (Group B). Conjunctival reapposition was assessed by measuring the maximum radial distance of bare sclera preoperatively and during outpatient clinic visits at 1, 7, and 28 days postoperatively. RESULTS: Follow-up was obtained on 38 eyes. One day after surgery, total wound closure was achieved in 15 of 16 eyes in Group B; however, closure was still incomplete in 13 of 22 Group A eyes. At 7 days postoperatively, the size of the conjunctival wound remained significantly smaller in Group B eyes (P < .01). CONCLUSION: The saline injection produced a faster rate of conjunctival wound closure than standard manual reapposition.     

Increased urinary free cortisol: a potential intermediate phenotype of essential hypertension

We evaluated urinary cortisol excretion as a potential intermediate phenotype of essential hypertension in 153 white patients with essential hypertension and 18 normotensive white control subjects. Analyses were controlled for dietary sodium and gender to adjust for potential confounding effects of these variables on cortisol excretion. Urinary cortisol excretion measured on both high- and low-salt diets was significantly related to hypertension by repeated measures ANCOVA (P=.02). Additional determinants of urinary free cortisol included dietary sodium intake and gender; cortisol excretion was significantly higher in men (P=.0006) and during a high-sodium diet (P=.0001). Maximum likelihood analysis showed urinary cortisol to have a bimodal distribution on both 200-mmol (P<.01) and 10-mmol (P<.002) sodium diets in hypertensive subjects. On the low-salt diet, the mean urinary cortisol in normotensive subjects (108.7+/-44.7 nmol/d) was similar to the mean of hypertensive subjects in the low mode (127.2+/-43.0 nmol/d). The high mode comprised 31.2% of the hypertensive population and had a mean urinary cortisol of 224.3+/-93.8 nmol/d. Subjects with the highest urinary free cortisol showed the least sensitivity of blood pressure to dietary sodium loading (P<.05). These data suggest that there is an association between salt-resistant hypertension and high urine cortisol levels. This association may have a genetic basis.     

Sleep-disordered breathing in children with myelomeningocele

BACKGROUND: Although patients with myelomeningocele and the Chiari II malformation are known to have sleep apnea and respiratory control deficits, the prevalence, types, severities, and associations of sleep-disordered breathing (SDB) have not been adequately defined. METHODS: A cross-sectional study of our myelomeningocele clinic population was undertaken to correlate polysomnographic results with historical data and findings from magnetic resonance imaging of the Chiari malformation, pulmonary function results, and nocturnal pulse oximetry. RESULTS: A questionnaire survey of symptoms was available for 107 of 109 children (98% of the clinic population), and 83 patients agreed to undergo overnight polysomnography. Breathing during sleep was classified as normal in 31 cases (37%), mildly abnormal in 35 cases (42%), and moderately/severely abnormal in 17 cases (20%). Among the 17 patients with moderately/severely abnormal SDB, 12 patients had predominantly central apneas and 5 had predominantly obstructive apnea. Patients with a thoracic or thoracolumbar myelomeningocele, those who had previously had a posterior fossa decompression operation, those with more severe brain-stem malformations, and those with pulmonary function abnormalities were more likely to have moderately/severely abnormal SDB, relative risks (95% confidence intervals) 9.2 (2.9 to 29.3), 3.5 (1.3 to 8.9), 3.0 (0.9 to 10.5), and 11.6 (1.6 to 81.3), respectively. Failure of obstructive SDB to resolve after adenotonsillectomy in four patients suggested abnormal control of pharyngeal airway patency during sleep. Nocturnal pulse oximetry accurately predicted moderately/severely abnormal SDB with a sensitivity of 100% and a specificity of 67%. CONCLUSIONS: The pathogenesis of SDB in patients with myelomeningocele involves the functional level of the spinal lesions, congenital and acquired brainstem abnormalities, pulmonary function abnormalities, disorders of upper airway maintenance, and sleep state. Polysomnography and nocturnal pulse oximetry should be performed in high-risk patients to detect and classify SDB.     

A specific stimulator of granulocyte colony-stimulating factor accelerates recovery from cyclophosphamide-induced neutropenia in the mouse

We have identified a small molecular weight compound, SCH 14988, which specifically stimulates in vitro granulocyte-colony stimulating factor (G-CSF) production from activated human peripheral blood mononuclear cells and monocytes but not other cytokines or CSFs with hematoregulatory activity. In vivo administration of SCH 14988 to mice rendered neutropenic by cyclophosphamide treatment resulted in the accelerated recovery of the peripheral neutrophil compartment. This activity correlated with increased in vivo G-CSF levels and stimulation of marrow granulopoiesis, and was comparable to that of exogenously administered recombinant human G-CSF. No alterations to other leukocyte populations in peripheral blood, spleen, or the peritoneal cavity were observed. These findings suggest that SCH 14988 may be clinically useful to enhance neutrophil granulopoiesis, as well as to study the mechanisms involved in G-CSF gene regulation.     

Membrane and synaptic properties of mitral cells in slices of rat olfactory bulb

We are able to recognize very many different faces of individuals we know, apparently using a complex and ill-understood set of identifying features; it seems natural to assume that faces are perceived as spanning the equivalent of a high-dimensional vector space. I explore ways to probe the structure of perceptual face space without making a priori hypotheses about either the space itself or the mechanisms of perception and recognition, and using solely neuronal responses recorded in the monkey, and metrics derived from their mutual similarities. Within this approach, the dimensionality of face space remains an elusive concept, but the metric content and ultrametric content of the face sets used can be quantified and compared with those of other perceptual sets.     

Substituted 3-phenylpiperidines: new centrally acting dopamine autoreceptor antagonists

The (+)-and (-)-enantiomer of compounds 4 and 5 were synthesized and tested for central dopamine (DA) receptor stimulating activity, using biochemical and behavioral tests in rats. Based on the available data the (-)-enantiomers of 4 and 5 are characterized as centrally acting DA autoreceptor antagonists with oral activity. They display a similar pharmacological profile as the prototype DA autoreceptor antagonists (+)-1 and (+)-2 and show a certain preference for the D3 DA receptor antagonist binding site.     

Developmental and symptom specificity of hopelessness, cognitive errors, and attributional bias among clinic-referred youth

The present study examined the unique and interactive relationships between age and indices of psychopathology (i.e., anxiety, aggression, and depression), with three types of maladaptive cognitions: hopelessness, negative cognitive errors, and attributional bias. Some negative cognitions were not unique to depression and were associated with broader psychopathology. Developmental considerations also influenced some negative cognitions or qualified the association between negative cognitions and depression.