Injection of perfluoropropane gas to prevent hypotony in eyes undergoing tube implant surgery

Hypotony after fistulizing surgery is common, and most cases resolve without complications. Occasionally, a flat anterior chamber in phakic or pseudophakic eyes may lead to corneal decompensation or cataract formation. In aphakic eyes that have undergone previous vitreous surgery, flat anterior chambers will not develop, but large choroidal detachments and delayed suprachoroidal hemorrhage may occur while the eye is soft. To maintain intraocular pressure (IOP) in the early postoperative period, the authors used a technique to seal the drainage tube with a Vicryl tie, combined with injection of sodium hyaluronate, sulfur hexafluoride (SF6), or perfluoropropane (C3F8), perioperatively in 28 eyes undergoing glaucoma tube implant surgery. Eight eyes were treated with injection of sodium hyaluronate, 8 with SF6, and 12 eyes with C3F8. Hypotony was significantly less frequent in eyes treated with C3F8 compared with sodium hyaluronate (P less than 0.05). Mean IOP was significantly higher for eyes treated with C3F8 injection compared with sodium hyaluronate for the first 4 days after surgery (P less than 0.05).     

Interactions of iron deficiency and exercise training relative to tissue norepinephrine turnover, triiodothyronine production and metabolic rate in rats

The interactions of iron deficiency and exercise training relative to resting metabolic rate (RMR), tissue norepinephrine (NE) turnover and triiodothyronine (T3) production were examined in male Sprague-Dawley rats. Animals were assigned to iron-deficient (ID) or control (CN) diets and to sedentary (SD) or treadmill-exercise (EX) groups for 6 or 12 wk. Iron-deficient animals (hemoglobin 7.2 +/- 0.2 g 100 mL-1) had a 17% higher RMR and had slower growth rates than CN animals. Exercise training affected growth but not RMR in iron deficiency. Oxygen consumption (Vo2) following pharmacologic injection of norepinephrine was similar in both iron-deficient and exercised groups despite a 35% lower maximal exercise Vo2 in trained iron-deficient rats. NE turnover was lower in heart (55%) and liver (80%) of iron-deficient animals relative to controls. Trained iron-deficient animals had lower NE turnover in interscapular brown adipose tissue (IBAT) than sedentary iron-deficient animals; however, training did not alter NE turnover in control animals. In vitro liver and IBAT T3 production was similar in all groups except for lower activities (40%) in 6-wk iron-deficient, exercised animals. The significant effect of exercise on the growth attenuation of iron-deficient, exercised animals is thus not explained by increased IBAT metabolic activity or a generalized sympathetic nervous system activation. Decreased T3 production during periods of rapid growth and lean body mass development, however, may be important in exercised, iron-deficient animals.     

CNS-active substances: synthesis of epoxybenzoxocines

The 2-(2-Bromophenyl)-acetaldehyde acetals 8 are treated with n-BuLi and the aldehydes 7 and 11 to form the hydroxyacetales 9 and 12, respectively. 9 is cyclized under acidic conditions to the epoxybenzoxocine 2; analogously 12 yields the epoxydibenzoxocine 14.     

A comparison of the Brooker-Wills and Russell-Taylor nails for treatment of patients who have fractures of the femoral shaft

Seventy-three fractures of the femoral shaft (seventy patients) were randomized to treatment with interlocked nailing with either the Brooker-Wills femoral nail (thirty-nine fractures) or the Russell-Taylor femoral nail (thirty-four fractures). Sixty-one patients (sixty-four fractures) were prospectively followed from admission until healing of the fracture. Specific attention was paid to recording operative details, including technical difficulties associated with insertion of the nails. Technical difficulties were encountered in insertion of the proximal screw, distal screw, and nail, and in deployment of the fins. Insertion of the Russell-Taylor nail was associated with less technical difficulty, operative time, and estimated loss of blood. The two nails differ in their biomechanical properties, methods of fixation, and instrumentation. These differences did not affect the clinical outcome; the fractures in both groups of patients healed with excellent functional results.     

Laparoscopic repair/peritoneal toilet of perforated duodenal ulcer

Summary Laparoscopic techniques have been refined to the point where exposure, haemostasis and tissue approximation by suture approach those obtained at open access surgery. We report a patient with acute perforation of an ulcer in the first part of the duodenum who was successfully treated by laparoscopic oversewing and omental patching. The clinical indications for contemplating use of laparoscopic surgery for acute ulcer perforation, techniques employed and the areas for potential improvement of instruments, needles and sutures are discussed.     

Toxic shock syndrome after inguinal hernia repair. Report of a case with patient survival

A 40-year-old man developed fulminant multisystem failure several days after elective repair of an inguinal hernia. Toxic shock syndrome (TSS) was diagnosed. There was, however, no evidence of wound infection at the time of multisystem failure. Only later in his hospital course did the wound drain. Staphylococcus aureus was cultured from the wound and was the presumed etiologic agent in the patient's life-threatening illness. The patient recovered fully with supportive care, antibiotics, and surgical debridement of the inguinal hernia site. This case is discussed in the context of existing literature on the toxic shock syndrome. The site of infection is typically nonsuppurative, but the systemic manifestations are typically life threatening. The responsible organism is commonly believed to be a strain of S. aureus that expresses a toxin (TSS toxin-1) that effects multisystem failure, but which also diminishes the local inflammatory response and explains the benign appearance of the wound. Although this is a rare clinical entity, elective surgical procedures complicated by fatal TSS have been reported. Surgeons should understand this disease and the management necessary to avert mortality.     

Rate of flow of aqueous humor determined from measurements of aqueous flare

Measurement of light scattered in the anterior chamber can provide important clinical information about the eye. In this study, a scanning ocular spectrofluorophotometer was used to measure scattering in the anterior chamber. Pathologic scattering (flare) was induced by argon laser photocoagulation of the iris in pigmented rabbits. The spectrally corrected intensity of the flare in inflamed eyes decreased as the inverse 2.2 power of the wavelength of the illuminating beam. The strongest signal with this instrument was measured at 470 nm. Diurnal variation of normal and spontaneous scatter from the aqueous humor was measured in nine pigmented rabbits entrained to a 12-hr light/12-hr dark cycle and in eight human subjects. A technique is described for determining the rate of flow of aqueous humor from scattered light when the transfer rate of scattering substance into the anterior chamber is constant. This technique was used to study changes in flow over the diurnal cycle. The rate of flow in human subjects during sleep was 60% of the rate during waking hours. In rabbits, the rate was lowest (44% of maximum) during the 6 hr after the lights were turned on, and were greatest just before the lights were turned on. These findings confirm previous studies of the circadian rhythm of aqueous humor flow in rabbits and humans.     

Cytostatic and immunosuppressive treatment of ocular Beh?et syndrome

Ocular symptoms of Beh?et's syndrome in 16 patients and the results of cytostatic and immunosuppressive therapy with cyclosporin A (6 patients), chlorambucil (6 patients), and a combination of cyclophosphamide and procarbacin (4 patients) are described. The clinical course and therapeutic outcome were compared to the patients' visual acuity and the duration of the disease prior to institution of cytostatic therapy. Average follow-up was 4.6 years, maximum 9 years. The principal ocular symptom in all patients was hemorrhagic, occlusive periphlebitis. Other symptoms, in descending order of frequency, were chorioretinitis, iridocyclitis, complicated cataract, secondary glaucoma and exudative retinal detachment. The patients in whom cytostatic therapy was instituted no later than 6 months after onset of the disease showed an improvement in or stabilization of visual acuity, as well as a clear reduction in signs of intraocular inflammation and frequency of recurrence. No improvement in visual acuity or ocular symptoms was achieved in cases where the disease was very advanced, despite cytostatic-immunosuppressive therapy. The results support early institution of immunosuppressive therapy in cases with Beh?et's syndrome where severe, irreversible damage has not yet occurred and in which vision is threatened in both eyes. However, due consideration must be given to the potential risks of immunosuppressive therapy, in particular the risk of a malignant tumor.     

D-[3H]galactose incorporation into glycogen in retinal cone cells

Previous studies have shown that bovine retinas incubated with [3H]galactose incorporated it, unmodified, into large molecules. Light and electron microscope autoradiography showed a significant proportion of the label to be in cone inner segments, and pulse-chase studies showed it was subsequently transported to the synaptic pedicles. In this report, evidence is presented to show that the galactose-labelled macromolecules are resistant to hydrolysis by proteolytic enzymes, testicular hyaluronidase, chondroitinase ABC, beta-glucosidase and beta-glucuronidase, but are readily degraded by alpha-amylase and beta-galactosidase, and to a lesser extent by beta-amylase. Treatment with alpha-amylase also leads to specific removal of radioactivity from cone inner segments and pedicles, as judged by light-microscopic autoradiography. These studies appear to indicate that the cone-specific galactose label is in glycogen or glycogen-like molecules.     

Four years' experience with a clinical intervention program: cost avoidance and impact of a clinical coordinator

Four years of data are reported on the drug cost avoidance and the net cost savings associated with a clinical pharmacy intervention program. In 1986 the pharmacy department at a 324-bed nonprofit community medical center began a clinical intervention program by adding one full-time equivalent for providing clinical services. A new clinical pharmacist position was created in 1988. A reorganization in 1989 resulted in further increases in staffing, including the creation of a clinical coordinator position to oversee the intervention program, and in administrative time. Staff pharmacists self-report a broad range of interventions on a clinical documentation form. During the period 1986-1989, monthly data on the number of types of interventions recommended, the percentage of recommendations accepted by the medical staff, and drug cost avoidance were tabulated. Cost avoidance was calculated by subtracting the cost of therapy ordered by the physician from the cost of therapy initiated as a result of the intervention. Net drug cost savings were calculated by subtracting from cost avoidance the cost of pharmacist time required for performing the interventions. The average number of interventions per month ranged from 170 in 1986 to 292 in 1990. During an 18-month period before the clinical coordinator was added, average monthly cost avoidance and net savings were $4932 and $3739, respectively. Average monthly cost avoidance increased to $6244 and savings to $4644 in a 12-month period after the clinical coordinator was added. A four-year study of a clinical intervention program showed that the dollar value and impact outlasted the initial success expected for such programs.