Diabetic macular edema and argon laser photocoagulation: a prospective randomized study

Loss of vision from diabetic retinopathy can result from complications of neovascular proliferation, or frequently, from macular edema secondary to background diabetic retinopathy. Although the benefits of photocoagulation for proliferative diabetic retinopathy have been clarified by the National Eye Institute's collaborative diabetic retinopathy study, those for background diabetic retinopathy with macular edema remain unclear. Several articles have described the visual benefits and reduction of edema following photocoagulation of eyes with background diabetic retinopathy and macular edema, but only Patz's study was prospectively designed utilizing a random assignment of laser treatment for one eye with the other eye remaining untreated. This article reports the two-year results of a similar prospective study in which one eye in each of 39 patients with symmetrical macular edema secondary to background diabetic retinopathy was randomly selected to receive argon laser photocoagulation, while the fellow eye remained untreated.     

Intraoperative balloon-catheter dilatation: University of Florida experience

Thirty-four patients with stable angina underwent coronary artery bypass surgery with supplemental intraoperative coronary artery balloon-catheter dilatation. Coronary dilatation was performed on 35 vessels at 50 sites. The balloon catheter could not be passed through one stenotic site. Intimal dissection occurred at two sites, as noted on early postoperative angiographic studies, with resolution on follow-up studies. There was one perioperative myocardial infarction, 100% early relief of angina, and one operative death. Of 25 distal arterial narrowings studied early by angiography (mean, 10 days), 15 (60%) were unchanged, two (8%) were worse, and eight (32%) were improved. Discrete narrowings improved more than diffuse narrowings; in 46% of the former there was an increase in luminal diameter, in comparison to only 17% of the latter. During a maximal 34-month follow-up period, two patients developed recurrent angina and one died of congestive heart failure. Of 13 distal coronary narrowings studied late (mean, 1 year), six (46%) were unchanged, three (23%) were worse, and four (31%) were improved. Postoperative serial catheterization (early and late) of 10 distal narrowings revealed that nine were unchanged and one was worse. Adjunctive intraoperative coronary balloon-catheter dilatation can be performed safely with acceptable clinical results. The procedure may also allow more complete revascularization of the myocardium.     

Institution of Physiological Pacing Utilizing Preexisting Hardware

Six patients with ventricular inhibited pacemakers, who experienced adverse effects from loss of atrial contribution to cardiac output and loss of atrioventricular synchrony, were successfully converted to atrial demand (3 patients) and atrioventricular sequential systems (3 patients). The preexisting ventricular pulse generator was used for atrial pacing in 3 patients, and the preexisting ventricular leads were employed for atrioventricular sequential pacing in 3 patients. The advantages and potential risks of utilizing preexisting hardware for conversion of ventricular pacing into physiological pacing are discussed.     

Fluorescein angiography in retrolental fibroplasia: experience from 1969-1977

Acute proliferative retrolental fibroplasia (RLF) has been studied in premature infants employing a Zeiss fundus camera and fluorescein angiography. A total of 164 angiograms have been performed on 122 infants. At the present time, angiography is reserved for studying infants with peculiar or puzzling fundus pictures. A dose of 0.1-0.4 cc of 10% sodium fluoresceinate is employed, depending on the age and the weight of the baby. Fluorescein clearly outlines the major arteriovenous shunt in the retina, which is the hallmark of acute RLF. The shunt fills with fluorescein and leaks it profusely. On regression, a fine brush border of capillaries is seen in the region where the shunt previously had been located. Study of the population susceptible to RLF reveals it to be the smallest sickest babies in the premature nursery.     

Method of Managing the Small Aortic Annulus during Valve Replacement

In a series of 130 patients undergoing aortic valve replacement, 20 had the ascending aorta enlarged with a Dacron patch. Eight of these required division of the annulus with extension of the incision inferiorly to the anterior leaflet of the mitral valve. The resulting separation of the annulus allowed a larger size valve to be inserted. Glutaraldehyde-fixed porcine heterografts were used in all patients having the annulus enlarged. No deaths occurred in those patients having annular enlargement, and the postoperative studies show no evidence of mitral valve dysfunction.