Onset of oscillopsia after visual maturation in patients with congenital nystagmus

PURPOSE: To describe the clinical and oculographic characteristics of a cohort of five patients with congenital nystagmus (CN) and late-onset oscillopsia caused by a coincidental decline in other visual and/or ocular motor functions. DESIGN: Retrospective, observational, case series. PARTICIPANTS: Five visually mature patients with CN and recent-onset oscillopsia were evaluated clinically and with motility recordings. INTERVENTION: Eye movement analysis was performed off-line by computer analysis of digitized data. Nystagmus was analyzed for null-zone characteristics, waveforms, frequency, amplitudes, and slow-phase drift velocity during foveation. Surgical and medical treatment of associated ocular conditions in four of five patients. MAIN OUTCOME MEASURES: Presence of symptomatic oscillopsia and average time during foveation periods of slow-phase drift velocity less than 10 degrees /second. RESULTS: One of the five patients had associated rod-cone dystrophy, and another had recurrence of childhood head posturing with return of an eccentric null zone. The remaining three patients had decompensated strabismus associated with their oscillopsia. All five patients complained of oscillopsia in primary position that was relieved in the four who received treatment. Treatment included prismatic correction in one patient and surgery in three. Recordings in primary position after treatment showed increased duration during foveation periods of slow-phase drift velocity less than 10 degrees /second and an overall decreased intensity (amplitude/frequency) of the nystagmus. CONCLUSIONS: Symptomatic oscillopsia in patients with CN is unusual. This visually disturbing symptom can be precipitated by new or changing associated visual sensory conditions (e.g., decompensating strabismus, retinal degeneration). If the associated conditions can be treated, then accompanying oscillopsia may be relieved.     

Transtibial and tibial inlay double-bundle posterior cruciate ligament reconstruction: Surgical technique using a bifid bone-patellar tendon-bone allograft

The treatment of posterior cruciate ligament injuries is difficult and controversial. Reconstructive technique and graft design are 2 of the unsolved issues in posterior cruciate ligament reconstruction. We present a technique using a bifid bone-patellar tendon-bone allograft for reconstruction of the posterior cruciate ligament. This graft more closely mimics normal anatomy and may be used in both transtibial and tibial inlay reconstructions.     

The Death of Work

We have long worshiped work. But work, in the traditional sense, is now dead. The death of work, as a meaningful activity for men, poses a health problem. Men run a risk when their needs are not met. Without work, men are in need of money, meaning, and identity. Their lives are no longer structured in time. The meaning of the relationship between man and work is found in the work experience of each individual. Man must create his own meaning in a responsible and fully human way. This calls for a new work ethic based on self-awareness and responsibility, in our day, money works, not man. Money has become the meaning of work and time. Man must return to the true meaning of the work experience through purposeful living. Our new mission, our new work, is to become fully responsible men, concerned for all of life.     

Cyclic adenosine monophosphate and human gastric acid secretion

This report concerns gastric juice, plasma, and urinary levels of adenosine 3, 5-monophosphate (cAMP) in 27 subjects undergoing routine gastric analysis under maximum stimulation with betazole or pentagastrin. Cyclic AMP was measured by sensitive and specific radioimmunoassay. No increase in concentration of cAMP was noted in gastric juice, plasma, or urine following either betazole or pentagastrin stimulation. Betazolestimulated human gastric acid secretion was associated with an increased cAMP output into the gastric juice (P<0.05). There was no change in cAMP output following pentagastrin stimulation. The peak acid output produced by pentagastrin and betazole was similar. The lack of increase in cAMP concentration lends support to the concept that cyclic AMP is not a primary mediator in the stimulation of gastric acid secretion by betazole or pentagastrin in the human. The physiologic significance of the increase in cAMP output following betazole stimulation remains unresolved.Supported by Bureau of Medicine and Surgery Clinical Investigation Program Project No. 2-06-322.     

Squamous cell carcinoma of the rectum

Summary A case of squamous cell carcinoma of the rectum is reported. This case is of interest because of its unusual histologic type and because it was discovered at a stage in which its pathogenesis could be readily determined. The views expressed are those of the authors and do not necessarily reflect those of the Navy Department or the Naval Service as a whole.     

The adverse effect of chocolate on lower esophageal sphincter pressure

Decreased lower esophageal sphincter (LES) pressure after ingestion of chocolate has been previously noted. We have further evaluated the effect of chocolate on the known ability of gastric alkalinization or bethanechol to increase LES tone. 9 normal subjects were studied using an infused open-tip recording system. Pressure was monitored for a 15-min basal period, and for 60 min after ingestion of 120 ml of chocolate syrup either alone or with the concurrent administration of commercial antacid, oral bethanechol, or subcutaneous bethanechol. After chocolate ingestion, mean basal LES pressure of 14.6±1.1 (±SEM) mm Hg decreased significantly (P<0.01) to 7.9±1.3 mm Hg. An identical LES response occurred when antacid was given with the chocolate dose. Oral bethanechol (25 mg) and chocolate together resulted in lesser decreases in LES pressure. Subcutaneous bethanechol (5 mg) and chocolate produced significant increases (P<0.05) in sphincter pressure, although of lesser magnitude than reported with bethanechol alone. These results indicate that the adverse effect of chocolate on the LES is not reversed by gastric alkalinization and suggest that bethanechol in sufficient dose may overcome chocolate-induced decreases in LES pressure.This work was supported by the Department of the Navy Clinical Investigation Program Grant #5-05-530R.     

Stromal Progenitor Cells Present Within Liposuction and Reduction Abdominoplasty Fat for Autologous Transfer to Aged Skin

BACKGROUND: Autologous fat is used for direct transfer to locally replace fat, as well as for use intradermally in the treatment of rhytids in aged skin. OBJECTIVE: To determine if the components of the autologous fat could be separated to produce a better agent for the treatment of rhytids. METHODS: Liposuction material from four patients and fat from abdominoplasty from five patients was processed by homogenization and centrifugation to separate mature lipocytes from other stromal cell populations in its associated extracellular matrix, and then to separate this from the blood and cellular debris. The cellular layer was evaluated histologically and with the immunohistochemical antibodies for CD34, SM-actin, S-100 protein, MIB-1, Bcl-2, and factor XIIIa. RESULTS: The cellular layer showed spindle cells, some small vascular structures, a small amount of mature fat, and extracellular matrix. CD34 showed diffuse staining of most spindle and endothelial cells in all sections, factor XIIIa showed only focal staining of spindle and dendritic cells, and Bcl-2 showed light to moderate staining in scattered cells within the cellular component. S-100 protein, SM-actin, and MIB-1 were negative. CONCLUSION: Processed liposuction and abdominoplasty processed fat may be ideal for the treatment of wrinkles in aged skin because it contains progenitor stromal cells that are known to be present within the fat and which may be concentrated by processing methods.     

From Donor to Patient: Another Safety Factor

A standardized technical procedure effectively utilizes the inherent value of imprinted numbers on integral donor tubing of a plastic blood container. For crossmatching technics particularly, the described method facilitates the handling of the specific portion of the tubing segment imprinted with numbers. Small pieces of the plastic tubing, cut after draining the segment blood sample, bear the manufacturer's serial digits. These "tabs" of plastic are retained by a simple method for final comparison with the numbers on tubing still attached to the plastic bag. Photographs show details of the procedure, which has proved safe and practical in four years of usage. The resulting consistency and reliability of such donor blood sample confirmation minimize the inevitable problems of human error.