Lower nasal distribution of cortical cataract: the Blue Mountains Eye Study

Previous reports have indicated that cortical cataract commences in the lower nasal lens, possibly due to sunlight exposure because of the shallow brow temporally. The present study aimed to assess the lens sector distribution of cortical cataract in a population. The Blue Mountains Eye Study assessed 3654 residents aged 49–97years; 3270 phakic subjects had retroillumination lens photographs graded using the Wisconsin method, which divides the lens into eight radial sectors with a grid overlay. Graders estimated percentage of cortical opacity in each sector. The lower nasal area consistently had the greatest opacity, a pattern present at each age and similar in both sexes, despite the 20% greater cortical cataract in women. The mean area of lens cortex involved by opacities in the lower nasal hemisphere was four fold greater than in the upper temporal hemisphere at each age. The lower nasal distribution was highly symmetrical when both eyes were affected. When > 20% of the lower nasal lens quadrant had cortical opacity, 88% of bilaterally affected subjects had cortical cataract in the same quadrant of the fellow eye. The lower nasal distribution may indicate a role for sunlight in the aetiology of cortical cataract, which could be considered when examining other cortical cataract risk factors, such as diabetes, vascular disease and hormonal factors in women.     

Low-level echogenicity in intraventricular hemorrhage versus ventriculitis

Serial cranial sonograms of 55 neonates with large perinatal intraventricular/intraparenchymal hemorrhages and moderate-to-severe posthemorrhagic hydrocephalus were reviewed. In all 55 patients, the ventricles were initially enlarged and filled with anechoic cerebrospinal fluid, which contained discrete hyperechoic fragments of hematoma. Between 7 and 25 days after the initial hemorrhagic episode, however, diffuse, low-level echogenicity appeared in the ventricles of 34 patients. The low-level echogenicity was transient and persisted for 7-59 days (average, 18 days). In 32 patients, low-level echogenicity was a benign finding associated with prior intraventricular hemorrhage. In two patients, the low-level echogenicity was associated with ventriculitis. Low-level echogenicity appeared, increased, then cleared, but reappeared with the onset of ventriculitis in these two patients. Thickening of the ependyma and abnormal periventricular echogenicity, signs of inflammation, were also present. Although low-level echogenicity may commonly be a benign finding, the possibility of ventriculitis should not be ignored.     

Traditional and complementary medicine (T/CM) in the treatment of erection difficulties – experience from the Asian Men's Attitudes To Life Events and Sexuality (MALES) study

BackgroundLittle is known about the practice, perceptions and experience of using traditional and complementary medicine (T/CM) for erection difficulties among Asian men.MethodsA total of 10,934 Asian men living in China (n = 2,055), Japan (n = 877), Korea (n = 2,000), Malaysia (n = 3,000) or Taiwan (n = 2,002) were recruited via random digit dialing, street interception and face-to-face interview in the Asian Men's Attitudes To Life Events and Sexuality (MALES) Phase I study. The Phase II study was comprised of a total of 1,286 men who experienced erection difficulties and who lived in China (n = 255), Japan (n = 228), Korea (n = 225), Malaysia (n = 380) or Taiwan (n = 228).ResultsUse of T/CM for erection difficulties (9.1%) was relatively low compared to conventional medicine (83.5%). Among those that seek help and treatment from T/CM, the majority were respondents from Malaysia, followed by respondents from China, whereas respondents from Japan and Korea ranked lowest. Use of a combination of alternative and conventional therapy was prevalent. Erection difficulty was amongst the highest in terms of preference of treatment seeking using traditional approaches after back pain, arthritis and gout. Overall outcome was expressed as ‘Partly satisfied’ with T/CM treatment for erection difficulties. The main reason that T/CM outweighs conventional medicine was because it was perceived that T/CM had fewer side effects than conventional medicine (56.1%). Users of T/CM were mostly middle-aged, married, employed, and perceived their health status and the severity of their erection dysfunction as moderate.ConclusionsThe findings help to identify the differences in practices and beliefs about T/CM among Asian countries and provide useful information to conventional practitioners about the alternative help- and treatment-seeking behaviors for erectile difficulties.     

PRIMARY MENINGOCOCCAL CONJUNCTIVITIS IN CHILDREN

SUMMARY Four cases of primary meningococcal conjunctivitis in children are reported. This represents an incidence of 2% of patients presenting with conjunctivitis to a paediatric A&E department. All were initially treated with topical chloramphenicol, followed by systemic rifampicin once the diagnosis had been established. No ocular or systemic complications developed, nor recolonisation of the conjunctiva or colonisation of the nasopharynx at follow-up (1–2 years).     

Simultaneous confirmation and differentiation of human T-lymphotropic virus types I and II infection by modified western blot containing recombinant envelope glycoproteins

A modified Western blot (WB) that includes both shared (r21e) and unique recombinant envelope proteins from human T-lymphotropic virus (HTLV) type I (rgp46I) and type II (rgp46II) was compared to conventional HTLV serologic tests in 379 United States blood donors and individuals residing in diverse geographic regions, and the specimens were categorized as positive (n = 158), indeterminate (n = 158), or negative (n = 63) for HTLV infection. Of the 158 HTLV-I/II-positive specimens (66 requiring radioimmunoprecipitation assay [RIPA] for confirmation), 156 reacted concordantly with r21e, gag, and either rgp46I or rgp46II, thus eliminating the need for RIPA in all but two specimens and yielding a test sensitivity of 98.7 percent. Of the 158 indeterminate and 63 negative specimens, none reacted with r21e and rgp46I or rgp46II, yielding a test specificity of 100 percent. Furthermore, analysis of an additional 184 consecutive specimens from a retrovirology reference laboratory demonstrated that the modified WB correctly identified 27 of 28 HTLV-I specimens and all 13 HTLV-II specimens, with a test sensitivity of 97.6 percent. None of specimens that were indeterminate or nonreactive in conventional WB and/or RIPA and none of the screening enzyme immunoassay-negative specimens reacted with r21e and either rgp46I or rgp46II, for a test specificity of 100 percent. Thus, the modified WB appears to be highly sensitive and specific for simultaneous detection and discrimination of HTLV-I from HTLV-II and has the advantage of being a one-step assay that is easily performed in all types of laboratory settings and allows rapid, reliable, and standardized testing for HTLV-I/II infection.     

USE OF SOLVENTS TO DISPERSE EAR WAX

SUMMARY In this test a course of 4 drops twice a day for 5 days of ear wax solvents, a cerumenolytic, sodium bicarbonate, or sterile water significantly increased the clearance of wax from ears by natural expulsion and eliminated the requirement for ear syringing in 50% of cases.     

Creutzfeldt--Jakob Disease in Recipients of Human Growth Hormone in the United Kingdom: A Clinical and Radiographic Study

In the past 3 years there have been five further cases, in additionto one case reported in 1985, of Creutzfeldt-Jakob disease inrecipients of human growth hormone in the United Kingdom. Theclinical findings of two of these cases are described, demonstratinga typical presentation with a predominantly cerebellar syndromeat onset which is not commonly a presenting feature of sporadicCreutzfeldt-Jakob disease. In one case a ^99mTc hexamethylpropylenaminesingle photon emission tomographic scan showed marked impairmentof tracer uptake in the basal ganglia and cerebral cortex ata time when the clinical picture was predominantly cerebellar.This technique may be useful in early diagnosis. In the othercase post mortem examination of the brain showed prominent amyloiddeposition in the cerebellum, which has not been described previouslyin pituitary-hormone related Creutzfeldt-Jakob disease. Thepreviously published cases of growth hormone-related Creutzfeldt-Jakobdisease are reviewed and reasons for the particular clinicalpattern seen are discussed.