Age dependence of ocular biometric measurements under cycloplegia with tropicamide and cyclopentolate

Background : Cyclopentolate continues to be the cycloplegic of choice for refracting young children, although many studies of ocular biometry promote the use of tropicamide. Methods : To clarify the role of drug type in biometric measurements, cycloplegia was induced in two disparate age groups using cyclopentolate and tropicamide on two separate occasions. Refraction, phakometry and A-scan ultrasonography measurements were made on two groups of Tibetan children resident in Nepal. Results : Cyclopentolate produced significantly more cycloplegia in the younger group, which was supported by phakometry measurements. However, in clinical terms, the difference between the measurements was not significant. Conclusion : We conclude that although cyclopentolate is more effective than tropicamide in relaxing accommodation in young children, the use of a local anaesthetic prior to instillation of tropicamide produces refractive data virtually equivalent to that of cyclopentolate, regardless of the age group measured. However, biometric measurements may be susceptible to greater error when near fixation targets are used during phakometry procedures.     

Bone mineral status in children with phenylketonuria under treatment

Bone mineral status was assessed in 48 children with phenylketonuria (PKU) (20 M, 28 F, aged 2.5-17 y). Bone density was measured in the distal third of the right forearm using single photon absorptiometry and was expressed as ±SD with respect to age- and gender-matched controls. Serum calcium (Ca), magnesium (Mg), phosphorus (P), alkaline phosphatase (ALP), parathyroid hormone and 25-hydroxyvitamin D were measured in morning samples. The ratios of urinary Ca/creatinine (UCa/ UCr), UP/UCr, UMg/UCr and hydroxyproline (OH-Pr)/UCr were calculated in urine samples collected over a period of 3h. Patients' data were compared with those of 50 controls (22M, 28F, aged 3-15y). The data showed severe osteopenia (below -2 SD) in 22/48 patients. Bone loss was more prominent in patients over 8y old. Bone density correlated significantly with age ( r =– 0:56, p < 0.001) and with Phe ( r =– 0:49, p < 0.007) but did not correlate with the other biochemical indices studied. Comparing PKU children with controls, significantly higher serum calcium and magnesium ( p = 0:04, p < 0.001, respectively), lower ALP ( p = 0:01), higher UCa/UCr ratio ( p < 0.001), lower UP/UCr ( p < 0.001) and lower UOH-Pr/UCr ( p < 0.001) were found. Dietary compliance was poor in patients over the age of 8y, as only 3/22 of ≤ 8y had mean serum phenylalanine >10mgdl⁻¹, in contrast to 21/26 in the older group. It is clear from the data that osteopenia is commonly found in PKU patients from early life. The biochemical data indicate a metabolic state of low bone turnover in PKU patients. In conclusion, a better, more restricted diet may correct osteopenia.     

Cyclic oscillation of blood neutrophils in a patient with multiple myeloma

A patient with multiple myeloma developed periodic blood neutropenia (periodicity of 15-25 days) after 3 yr of intermittent treatment with cytotoxic agents. Peaks of serum colony-stimulating activity (CSA) level coincided with valleys of blood neutrophils. Fraction of marrow neutrophils in the multiplicative pool was high during blood neutrophil valleys and low during neutrophil peaks. In contrast, the maturation storage pool exhibited the reverse pattern. An increased fraction of marrow neutrophilic cells in the multiplicative pool was in active proliferation during a blood neutrophil valley and a decreased fraction during a blood neutrophil peak. These findings suggest that the marrow granulopoiesis was regulated through CSA. The defect causing the periodicity was probably related to the reduced number of neutrophils in the marrow maturation storage pool, which in turn may be related to a reduced and/or defective granulocytic stem cell pool size consequent to the long-term administration of cytotoxic drugs and/or infiltration of the marrow by myeloma cells.     

A noncomputerized count-based technique for the determination of resting left ventricular ejection fraction

A noncomputerized, count-based technique for the determination of left ventricular ejection fraction (LVEF), which does not use geometric assumptions of left ventricular shape, was developed. The noncomputerized technique and computerized multigated ventriculography using both fixed and variable region-of-interest (ROI) methods were performed on 16 patients. The LVEFs obtained with the noncomputerized technique correlated well with both the fixed ROI computerized technique (r = .87) and the variable ROI computerized technique (r = .86). It is concluded that when a computer is not available, the noncomputerized technique is a valid alternative for the determination of LVEF in resting patients in stable sinus rhythm.     

Photoprovocation in the Patients with an EBV Associated Hydroa Vacciniforme‐Like Eruption

Skin conditions in individuals with undifferentiated connective tissue disease (UCTD) are poorly classified and characterised. We reviewed 892 consecutive cases of individuals who had a workup for UCTD. ATAbs were positive in 526(59%). The ATAb(+) and ATAb(−) groups had similar antinuclear antibody (ANA) positivity (32% versus 28% respectively), average age (59 versus 58), and female‐male ratio (8:1 versus 6:1). ATAb positivity was significantly associated with a dermatitis, manifested as erythematous macules/patches or papules on legs, shoulders or upper backs, in 9%(47/526) individuals versus 2%(7/366) in ATAb(−) individuals (Pearson's chi‐square = 18.7, p < 0.0001). Sixteen individuals with dermatitis had biopsies, 14 ATAb(+) and 2 ATAb(−). Routine hematoxylin‐eosin and colloidal iron‐stained sections were examined. Eleven biopsies (79%) from ATAb(+) individuals (5 ANA‐negative, 5 with thyroid disease) and one from ATAb(−) ANA(−) individuals showed interface/lichenoid dermatitis with mild basal keratinocyte vaculopathy, variable dermal mucin deposition, and perivascular mononuclear inflammatory cell infiltrates in the upper dermis. The interface dermatitis was not significantly associated with ANA positivity or thyroid disease. In summary, we report an ATAb‐associated interface dermatitis in UCTD patients which may represent a new subset of autoimmune disease, and suggest that ATAb tests may be a useful marker for UCTD.     

T2 effect of hemoglobin concentration: assessment with in vitro MR spectroscopy

T2 values were measured at 0.23 and 4.7 T for deoxygenated blood samples (43%-73% O2 saturation) with hematocrits of 18%-100%. An increase in the hematocrit produced a marked reduction in T2 at both field strengths. Cell lysis did not abolish the T2 effect at either field strength. The authors conclude that the increase in hemoglobin concentration caused by formation of a retracted clot is a cause of the hypointense appearance of acute hemorrhage compared with brain on T2-weighted clinical magnetic resonance images. This is particularly important on low-field-strength systems, which are not sensitive to the T2 shortening effects of paramagnetic intracellular deoxyhemoglobin.