Delayed Conjunctival Closure in Adjustable Strabismus Surgery

Adjustable suture strabismus surgery has proved to be a significant aid in handling difficult strabismus cases, and various methods of conjunctival closure have been discussed. A new method of conjunctival closure, enabling direct visualization and manipulation of the muscle with minimal tissue drag during adjustment, is described. The conjunctiva can be fully closed over the knot after adjustment, providing increased patient comfort and a better cosmetic result.     

Argon laser trabeculoplasty in progressive low-tension glaucoma

Twenty-two phakic eyes with progressive low-tension glaucoma had a 360-degree argon laser trabeculoplasty (ALT). Seven of these eyes had diurnal curves performed pre- and two months postlaser treatment to measure the effect of ALT on diurnal pressure variation. Sixteen of the 22 eyes (73%) were clinical successes with a 4.9 mm Hg decrease at 12 months in the successful group. However there was a decreasing pressure lowering effect with time with a mean follow-up of 21.6 months. The diurnal curve data showed a 6.2 mm Hg decrease between the mean pressure pretreatment and two months postlaser treatment. The mean peak pressure posttreatment was 13.29 mm Hg, a 6.17 mm Hg decrease from the prelaser mean peak pressure. The finding of 24-hour pressure control and a reduction in the mean peak pressure confirms the usefulness of ALT in progressive low-tension glaucoma and we recommend that it be utilized as the step in between maximally tolerated medical therapy and filtering surgery.     

The comparative distribution of [Lys-Asn]-neurotensin8–13-like immunoreactivity in chicken and rat tissues

The presence of [Lys⁸-Asn⁹]-neurotensin_8–13-like immunoreactivity was studied by radioimmunoassay in chicken and rat tissues. In the chicken, [Lys⁸-Asn⁹]-neurotensin_8–13-like immunoreactivity showed a wide distribution throughout the central nervous system and the gastrointestinal tract, and the immunoreactive material co-eluted with the synthetic peptide on reverse-phase high performance liquid chromatography. In the rat, [Lys⁸-Asn⁹]-neurotensin_8–13-like immunoreactivity was widely distributed when 0.1 M HCl was used as the extraction procedure. However, the immunoreactive material did not co-elute with the synthetic peptide on reverse-phase high performance liquid chromatography; moreover, the addition of the aspartic proteinase inhibitor pepstatin to the extraction medium resulted in a large reduction in the levels of [Lys⁸-Asn⁹]-neurotensin_8–13-like immunoreactivity and no immunoreactive material could be detected when the tissues were extracted using acetone/HCl. The present results therefore indicate that [Lys⁸-Asn⁹]-neurotensin_8–13-like immunoreactivity is not present in rat tissues. That which was detected resulted from an extraction artefact.     

Biochemical effects of L-deprenyl in atypical depressives

To examine the biochemical effects of 10-30 mg/day L-deprenyl, measurement of 24-hr urinary output of phenylethylamine (PEA), 3-methoxy 4-hydroxy phenylethyleneglycol (MHPG), and L-deprenyl's amphetamine metabolites were carried out before and during the treatment of atypical depressives. Platelet monoamine oxidase (MAO) activity was also assessed. With L-deprenyl 10-30 mg/day, the expected MAO B inhibition occurred, as indicated by significant increase in urinary PEA excretion and virtual disappearance of platelet MAO activity. Twenty-five to 33% of the daily dose of L-deprenyl was recovered as urinary methamphetamine or amphetamine. Excretion of MHPG was significantly decreased with L-deprenyl 10-20 mg/day. Overall, the results suggest that L-deprenyl's antidepressant effects are mediated by some mechanism other than, or in addition to, MAO B inhibition.     

Patterns of diagnostic testing in the academic setting: The influence of medical attendings' subspeciality training

Internists with subspecialty training (subspecialists) constitute the majority of the medical faculty members and the test-ordering behavior of these subspecialists influences how house officers and students solve clinical problems. To assess whether test-ordering patterns are influenced by the ward attendings' subspecialty status, we identified the number of gastrointestinal endoscopic procedures, bone marrow procedures and exercise stress tests that were ordered on 9608 patients admitted to a medical service during a 3 year period. The patient management was supervised by attendings, 8 of whom were generalists and 37 of whom were subspecialists. House officers supervised by generalists ordered 23% fewer gastrointestinal procedures, 47% fewer bone marrow procedures, 43% fewer exercise stress tests and 29% fewer total procedures than house staff supervised by subspecialists (P—not significant, P < 0.001, P < 0.05 and P < 0.01, respectively). House officers perceive a difference between the test-ordering patterns of subspecialists and generalists. They attribute this difference to post-residency training and believe that the use of more tests indicates a greater compulsion toward an exhaustive evaluation.     

The immunologic basis of autoimmunization.

Autoimmunization is today so readily accepted as established fact that it is easy to forget its turbulent history. There was a time when a few stubborn physicians had to insist against informed opinion that autoimmune diseases really existed. The answer they received was, “… I'll never believe there is such a thing as an autoantibody.”¹ Now the tables are turned. Today immunochemists are presenting schemes that require the formation of autoantibodies during the normal immune response. ² Between these two extremes there is an evolution of thought that began with horror autotoxicus, ³ continued with the demonstration of experimental autoimmunization in laboratory animals, ⁴ entered the clinic with the realization that certain forms of hemolytic anemia were due to autoantibodies, ⁵ crystallized as a biologic problem with the advent of immunologic tolerance, ⁶ advanced into the rarefied theory of forbidden clones, ⁷ progressed immeasurably when spontaneous autoimmunity was found in the mouse, ⁸ and reached its present state of complexity with the discoveries of immunoglobulin receptors on lymphocytes, ⁹idiotypes, ¹⁰ and suppressor cells. ¹¹ Perhaps the most important advance was the realization, spontaneously arrived at by almost the entire immunologic community, that the production of autoantibodies can be understood only in the context of the general rules of antibody formation.     

Vaginal administration of ethinylestradiol: effects on ovulation and hepatic transcortin synthesis

Ethinylestradiol (EE) was given vaginally to circumvent the intestinal metabolism and initial liver passage which follow oral intake. This route of administration was chosen in an effort to enhance the antiovulatory potency of EE, while decreasing adverse hepatic reactions. Vaginal tablets containing 20-30 micrograms of EE were taken daily by 7 ovulating volunteers from day 5 to day 25 of the menstrual cycle. The regimen resulted in serum EE levels of 62 +/- 27 pg/ml (mean +/- S.D.) 8-10 hours after insertion. Ovulation was inhibited in 5 women (monophasic basal body temperature curves, serum progesterone levels of 0.9 +/- 1.1 ng/ml during the second half of the treatment cycle). The cortisol-binding capacity of transcortin was significantly elevated in all subjects (52.3 +/- 6.4 micrograms/100 ml; controls 25.7 +/- 2.2 micrograms/100 ml). These findings indicate that intravaginal EE is twice as potent as oral EE in regard to inhibition of ovulation as well as stimulation of the hepatic transcortin synthesis. Vaginal administration apparently increases the bioavailability of EE; it does not facilitate a selective reduction of estrogenic effects upon the liver.