Noninvasive assessment of corneal sensitivity in young and elderly diabetic and nondiabetic subjects

PURPOSE: To investigate the effect of age and diabetes on corneal sensitivity using the noncontact corneal aesthesiometer (NCCA). METHODS: One hundred sixteen nondiabetic subjects and 111 diabetic subjects (33 type I and 78 type II) were recruited and divided into three age groups: Young (or=60 years). The exclusion criteria included patients with severe retinopathy requiring treatment, a history of invasive ocular surgery, or a history of conditions known to affect corneal sensitivity. The corneal cooling sensation threshold, for the right eye of each subject, was assessed with a double-staircase method-of-limits technique with the NCCA. This instrument uses a controlled pulse of air to produce a small, localized reduction in the surface temperature of the eye, which is detected by the nerves in the corneal epithelium. RESULTS: Analysis of the scatterplot of each subject's central cooling sensation threshold revealed a gradual loss of sensitivity with increasing age (nondiabetic, r(2) = 0.349; diabetic, r(2) = 0.131). Within the nondiabetic group, inter-age-group comparisons found significant differences between the central corneal cooling sensation thresholds for the three age groups (t-test, P < 0.01). Within the diabetic group, a significant difference was found between the Middle and Older categories only (t-test, P < 0.05). In summary, the Young group was more sensitive than the Middle group, which was more sensitive than the Older group. Within both type I and type II diabetic subjects, there was neither a significant relationship between duration of the disease and corneal sensitivity (t-test, P > 0.05) nor a gender-based difference (t-test, P > 0.05). CONCLUSIONS: There is a gradual reduction in corneal sensitivity with increasing age in both nondiabetic subjects and diabetic subjects, along with an increasing variation in the measured threshold. There is no relationship between corneal sensitivity and the time since diagnosis of diabetes for a thermally cooling stimulus, suggesting that the A partial differential and C fibers of the corneal innervation are affected differently by abnormal glucose metabolism in the diabetic cornea.     

The cultural and social meanings of childbearing for Chinese and Scottish women in Scotland

OBJECTIVE: to analyse the meanings that women gave to their childbearing experiences in order to provide some useful insights as to how their experiences might be improved. SETTING: maternity units in Scotland. DESIGN: four semi-structured interviews with each of ten Chinese and ten Scottish women in their own language; and unstructured interviews with 45 health workers, women's relatives and their friends. FINDINGS: having children was meaningful to Scottish and Chinese women in Scotland in different ways which were related to their social positions, beliefs and practices involved and the change in social status on the birth of a child. Different meanings demanded different coping strategies in healthy childbearing. Scottish women took greater interest in their sense of control over their childbearing. Some Chinese women were experiencing more extensive cultural conflicts and changes as they tried to identify with the new culture, while the others were experiencing gradual changes over a period of time consciously or unconsciously. Both Chinese and Scottish women in the study were in a struggle between autonomy and control over their childbearing--between the mind and the body. CONCLUSION: childbearing is socially shaped and culturally specific. Maternity services need to consider ways in which cultural sensitive care can be provided to women in a multi-ethnic modern society.     

Rice-body formation in atypical mycobacterial tenosynovitis and bursitis: findings on sonography and MR imaging

OBJECTIVE: This article describes rice bodies found in patients with atypical mycobacterial tenosynovitis and bursitis, emphasizing the sonographic and MR imaging appearances of these small bodies. CONCLUSION: Rice bodies occur in patients with atypical mycobacterial tenosynovitis and bursitis. When small, rice bodies are better visualized on MR imaging than on sonography, allowing the radiologist to consider appropriate diagnoses.     

cGMP-dependent and not cAMP-dependent kinase is required for adenosine-induced dilation of intracerebral arterioles

Adenosine (ADO) is a potent cerebral vasodilator and has been proposed as a metabolic regulator of cerebral blood flow. However, the signal transduction pathway by which ADO causes vasodilation in cerebral microvessels is currently unknown. The current study was designed to investigate the role of cyclic nucleotides and cyclic nucleotide-dependent protein kinases in ADO-induced dilation of resistance-sized rat cerebral arterioles that develop spontaneous tone. Arterioles were cannulated and perfused intraluminally at constant flow (2 microl/min) and pressure (60 mm Hg). ADO (29.7 +/- 2.0%; 1 microM), CGS-21680 (16 +/- 4%, 1 microM), 8-bromo-cyclic guanosine monophosphate (8 Br-cGMP; 29.9 +/- 3.9%; 100 microM), sodium nitroprusside (SNP; 30.6 +/- 3.3%, 1 microM), cyclic guanine monophosphate-dependent protein kinase activator (Sp-8-pCPT-cGMPS, 25.9 +/- 4.2%; 10 microM), forskolin (30.5 +/- 5.9%; 0.1 microM), and pH 6.8 all produced large dilations. The selective cGMP-dependent protein kinase inhibitor, Rp-8-pCPT-cGMPS (10 microM), had no effect on resting diameter or reactivity to acidic pH, but significantly ( < 0.05) attenuated arteriolar dilations to ADO (59%, n = 8), CGS-21680 (60%, n = 4), SNP (62%, n = 3), 8 Br-cGMP (88%, n = 3), and Sp-8-pCPT-cGMPS (98%, n = 3). H8, the less-selective cyclic nucleotide-dependent protein kinase inhibitor, had similar effects as Rp-8-pCPT-cGMPS. Additionally, the inhibitor of the soluble guanylate cyclase, 1H-[1,24]oxadiazolo-[4,3-a]quinoxalin-1-one (ODQ), blocked the response to SNP (70% inhibition) and significantly inhibited the ADO response (43% inhibition). In contrast, inhibition of the cyclic ADO monophosphate (cAMP)-dependent protein kinase Rp-8-CPT-cAMPS had no effect on the ADO, SNP, or pH responses, but significantly blocked forskolin-induced vasodilation (53%). It is concluded that ADO-induced vasodilation in cerebral microvessels, at least in part, involves cGMP and cGMP-dependent protein kinase, but not cAMP or cAMP-dependent kinase. Our data therefore provides a new insight into mechanisms by which ADO invokes vasodilation in cerebral microvascular arterioles.     

Laparoscopic management of omental torsion secondary to an occult inguinal hernia

Torsion of the greater omentum is an uncommon surgical emergency. Most of the reported cases have been primary omental torsion with infarction, in which the underlying cause is largely unknown. Right-sided abdominal symptoms are the predominant complaint. Left-sided omental torsion is rather infrequent, and the preoperative diagnosis is extremely difficult. We report a case of omental torsion secondary to an occult left indirect inguinal hernia that was successfully diagnosed and managed laparoscopically.     

Ictal (99m)Tc ECD SPECT in paroxysmal kinesigenic choreoathetosis

Paroxysmal kinesigenic choreoathetosis is a rare neurologic disorder characterized by sudden attacks of brief involuntary dyskinetic movement that are precipitated by voluntary movement. A 14-year-old male who presented with frequent brief attacks of hemidystonia triggered by sudden movement is reported. Investigations, including video electroencephalogram and magnetic resonance imaging of brain, were normal. There was excellent and sustained response to carbamazepine. Ictal single-photon emission computed tomography using (99m)Tc ethyl cysteinate dimer revealed increased perfusion of the contralateral basal ganglia, which is associated with onset of choreoathetosis attacks. Our findings provide evidence that hyperactivity of the basal ganglia is associated with the dyskinetic attacks in paroxysmal kinesigenic choreoathetosis.     

Use of diagnostic laparoscopy and laparoscopic ultrasound in the management of upper gastrointestinal malignancy

Background: Despite various preoperative imaging methods, unnecessary laparotomy is still quite common in upper gastrointestinal surgery. There have been some studies demonstrating the use of diagnostic laparoscopy and laparoscopic ultrasound in the detection of small peritoneal seedling and vascular encasement of major vessels respectively, and these are the findings often inadequately assessed by preoperative imaging. Objective: This is a study to evaluate the use of diagnostic laparoscopy and selective laparoscopic ultrasound in the management of upper gastrointestinal malignancy. Method: A prospective study was carried out during the period from January 1996 to December 1997. Patients with upper gastrointestinal malignancy underwent diagnostic laparoscopy and selective laparoscopic ultrasound before resection. The role of laparoscopic staging was evaluated according to the number of patients who avoided unnecessary laparotomy. Results: There were 159 patients of mean age 62.8 years diagnosed with upper gastrointestinal tumours during the study period. These patients had various upper gastrointestinal malignancies: gastric carcinoma (89), oesophageal carcinoma (27), hepatobiliary malignancy (26), peri‐ampullary carcinoma (15) and small bowel tumour (2). Routine diagnostic laparoscopy and selective laparoscopic ultrasound were carried out for these patients unless there were contraindications such as a history of previous upper gastrointestinal surgery or the patient required palliative procedure irrespective of resectability. There were 106 diagnostic laparoscopies and 42 laparoscopic ultrasounds performed. Unnecessary operations were avoided in 32 patients (30%) due to either diffuse carcinomatosis or locally advanced tumour with encasement of major vessels. The role of laparoscopic staging in avoiding unnecessary surgery was particularly pronounced in peri‐ampullary carcinoma (46%) and hepatobiliary malignancy (38%). Conclusion: In summary, diagnostic laparoscopy and selective laparoscopic ultrasound are useful in avoiding unnecessary laparotomy particularly in hepatobiliary and peri‐ampullary malignancy.      

Vaginal misoprostol alone for medical abortion up to 9 weeks of gestation: efficacy and acceptability

Misoprostol and mifepristone have been shown to be effective for medical abortion up to 9 weeks of gestation. When used alone, the successful complete abortion rate dropped to approximately 60%. It has been demonstrated that by adding water to misoprostol, the success rate rose to 92%. This is the first randomized study to investigate the efficacy of misoprostol and water versus misoprostol alone for first trimester medical abortion in women at 相似文献   

The clinical applications of multifocal electroretinography: a systematic review

Multifocal electroretinography (mfERG) is an investigation that can simultaneously measure multiple electroretinographic responses at different retinal locations by cross-correlation techniques. mfERG therefore allows topographic mapping of retinal function in the central 40-50 degrees of the retina. The strength of mfERG lies in its ability to provide objective assessment of the central retinal function at different retinal areas within a short duration of time. Since the introduction of mfERG in 1992, mfERG has been applied in a large variety of clinical settings. This article reviews the clinical applications of mfERG based on the currently available evidence. mfERG has been found to be useful in the assessment of localized retinal dysfunction caused by various acquired or hereditary retinal disorders. The use of mfERG also enabled clinicians to objectively monitor the treatment outcomes as the changes in visual functions might not be reflected by subjective methods of assessment. By changing the stimulus, recording, and analysis parameters, investigation of specific retinal electrophysiological components can be performed topographically. Further developments and consolidations of these parameters will likely broaden the use of mfERG in the clinical setting.