Users' subjective evaluation of electronic vision enhancement systems

The aims of this study were (1) to elicit the users' responses to four electronic head-mounted devices (Jordy, Flipperport, Maxport and NuVision) and (2) to correlate users' opinion with performance. Ten patients with early onset macular disease (EOMD) and 10 with age-related macular disease (AMD) used these electronic vision enhancement systems (EVESs) for a variety of visual tasks. A questionnaire designed in-house and a modified VF-14 were used to evaluate the responses. Following initial experience of the devices in the laboratory, every patient took home two of the four devices for 1 week each. Responses were re-evaluated after this period of home loan. No single EVES stood out as the strong preference for all aspects evaluated. In the laboratory-based appraisal, Flipperport typically received the best overall ratings and highest score for image quality and ability to magnify, but after home loan there was no significant difference between devices. Comfort of device, although important, was not predictive of rating once magnification had been taken into account. For actual performance, a threshold effect was seen whereby ratings increased as reading speed improved up to 60 words per minute. Newly diagnosed patients responded most positively to EVESs, but otherwise users' opinion could not be predicted by age, gender, diagnosis or previous CCTV experience. User feedback is essential in our quest to understand the benefits and shortcoming of EVESs. Such information should help guide both prescribing and future development of low vision devices.     

Cervical Cancer with Paraaortic Metastases: Significance of Residual Paraaortic Disease after Surgical Staging

Cervical carcinoma frequently metastasizes to the paraaortic region, necessitating extended field radiotherapy to effect a cure. As imaging modalities are unreliable in identifying all cases of paraaortic nodal metastases (PAN), surgical staging is often utilized prior to radiotherapy. This study was aimed at identifying factors predictive of survival in women with cervical carcinoma and paraaortic metastases. In particular, survival based on extent of paraaortic disease was examined. The study group consisted of 43 women (stages IB–IVB) identified between 1982 and 1993 who were treated with extended field radiation for cervical carcinoma with histologically confirmed paraaortic metastases. The estimated 5-year survival for the study population was 24% with a median survival of 18 months. Pelvic tumor size had a significant impact on survival with the median survival being 34 months if the primary lesion was <6 cm compared to 14 months if ≥6 cm (P= 0.01). Eight of the 26 (31%) women without residual PAN disease after surgical staging remain alive and disease free (mean follow-up, 74 months). In contrast, only 1 of the 17 (6%) women with gross residual PAN is alive 71 months after treatment (P= 0.05). However, a comparison of Kaplan–Meier survival curves did not show a statistically significant advantage to the surgical excision of grossly involved PAN (P= 0.98). Although long-term survival among women with grossly involved, unresected paraaortic metastases is uncommon, further study is necessary to elucidate the role of surgical excision of bulky aortic disease in women with cervical cancer.     

Dermoid tumours occurring at the site of previous meningocele repair

Two cases of dermoid tumours following meningocele repair have been reported because of the rarity of the condition and paucity of literature. It should be stressed that a dermoid tumour should be considered in the differential diagnosis of neurological deterioration in patients with a repaired meningocele.     

Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach: a prospective randomized controlled trial

Background  

Minimal access approaches to inguinal hernia repair have added to the ongoing debate over the “best groin hernia repair.” The present prospective randomized controlled trial was done to compare the totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques of laparoscopic inguinal hernia repair.     

Feasibility of measles vaccine: Experience with live attenuated virus vaccine in and around Sevagram

301 susceptible children between 9 months to 59 months of age from villages around Sevagram were immunised against measles with the live attenuated Schwartz strain. Ouster approach was adopted. 95 percent coverage was achieved. Follow up for next 15 days by village health worker revealed mild reactions to measles vaccine in 70(23.25%) Upper respiratory cattarh with or without fever was the commonest finding. Measle like rash was a rare finding (only two children). Acute allergic edema of the vaccinated limb within 12 hof vaccination and rapid response to antihistaminics was an interesting observation in one child. By and large, duration of postvaccinal illness confined to 3–4 days. Thus, considering 95 percent coverage with the single dose vaccine and mild nature of reactions, it is felt that measles vaccine can easily be accepted in rural India.     

Imaging of normal and pathologic joint synovium using nonlinear optical microscopy as a potential diagnostic tool

An estimated 1.3 million people in the United States suffer from rheumatoid arthritis (RA). RA causes profound changes in the synovial membrane of joints, and without early diagnosis and intervention, progresses to permanent alterations in joint structure and function. The purpose of this study is to determine if nonlinear optical microscopy (NLOM) can utilize the natural intrinsic fluorescence properties of tissue to generate images that would allow visualization of the structural and cellular composition of fresh, unfixed normal and pathologic synovial tissue. NLOM is performed on rabbit knee joint synovial samples using 730- and 800-nm excitation wavelengths. Less than 30 mW of excitation power delivered with a 40×, 0.8-NA water immersion objective is sufficient for the visualization of synovial structures to a maximum depth of 70 μm without tissue damage. NLOM imaging of normal and pathologic synovial tissue reveals the cellular structure, synoviocytes, adipocytes, collagen, vascular structures, and differential characteristics of inflammatory infiltrates without requiring tissue processing or staining. Further study to evaluate the ability of NLOM to assess the characteristics of pathologic synovial tissue and its potential role for the management of disease is warranted.     

Outcomes of extremely low birth weight infants in the NICU after initiation of a two-team care model

Neonatal nurse practitioners (NNP) have an increasing and continuous presence in most neonatal intensive care units (NICUs); a presence which has at times been perceived as at odds with the training and development of pediatric residents and neonatal fellows. This is a single-center cohort study of infants born at ≤1000 g and ≤28 weeks of gestation cared for by either a team consisting of residents and a fellow (R/F) or consisting of NNPs (NP). Groups were compared by Student's t-test or chi-square, and associations estimated by logistic regression. There were no differences in primary outcomes between the teams except for a lower incidence of severe retinopathy of prematurity (ROP) in babies on the R/F team compared to the NNP team. In this first post-duty hours cohort, clinical outcomes between the teams were similar. These data suggest that either model can be safely utilized within a level 3 NICU.