Paediatric laser DCR

PURPOSE: Endoscopic laser dacrocystorhinostomy is an alternative procedure to external approach DCR in children. We report our results with 5 patients (6 eyes) with congenital nasolacrimal duct obstruction. Methods: Six endonasal DCR's were carried out using the KTP laser in patients with congenital nasolacrimal duct obstruction resistant to probing and intubation. RESULTS: The follow-up ranged from 3-8 months. All patients experienced a recurrence of their symptoms postoperatively. CONCLUSION: Endoscopic laser assisted DCR is not a successful procedure in children.     

Prophylaxis of postoperative deep vein thrombosis and pulmonary embolism

Routine prophylaxis of deep vein thrombosis and pulmonary embolism is justified by the importance of these complications as sources of major morbidity and mortality in otherwise healthy patients more than 40 years old undergoing extensive elective operations. As no one prophylactic technique is ideal, the continuing controversy is over the choice of technique for each patient. Appropriate selection of a prophylactic technique requires a careful preoperative assessment based upon the relative risk of thromboembolism due to associated disease, the risk of bleeding complications secondary to an underlying bleeding diathesis, the possibility of major morbidity from unexpected postoperative bleeding determined by the anatomic site of surgical procedure and the risk of thromboembolism imposed by the surgical procedure itself (57). For patients at high risk, warfarin remains the prophylactic agent of choice. To date, the available data on combinations of mechanical and chemical techniques are incomplete and contradictory, but future studies may identify synergistic combinations. In patients at high risk who also greatly risk having bleeding complications, vena caval interruption should be considered. In patients undergoing operation at moderate risk, low dose heparin, dextran and external pneumatic compression devices are beneficial. In patients undergoing elective hip and knee operation at moderate risk, aspirin appears especially safe and effective. When major morbidity may result from anticoagulation in patients at moderate risk for deep vein thrombosis and pulmonary embolism, external pneumatic compression devices, gradient elastic stockings or elevation of the leg should be used. Further carefully controlled clinical trials are needed to identify even better options for prophylaxis.     

Translation of Pr55(gag) augments packaging of human immunodeficiency virus type 1 RNA in a cis-acting manner

The full-length RNA of human immunodeficiency virus type 1 (HIV-1) serves both as a messenger (mRNA) to direct the translation of Pr55(gag) proteins and as genomic or viral particle RNA (vpRNA) to be packaged into virions. In this study, we have assessed a putative cis-acting effect of Pr55(gag) translation on HIV-1 RNA packaging. To pursue this subject, we have measured the relative competence of two distinct types of HIV-1 RNA for being packaged by virus particles under conditions in which only one of them is permissive for production of Pr55(gag). Not surprisingly, wild-type BH10 RNA was packaged at far higher efficiency than that associated with mutant viral RNA that was deleted of RNA packaging signals and incapable of Pr55(gag) production. However, when production of Pr55(gag) was eliminated from the wild-type BH10 viral RNA by insertion of stop codons either in matrix (MA) or in capsid (CA) sequences, regardless of retention of wild-type RNA packaging signals, these Pr55(gag)-deficient viral RNAs were packaged at low levels similar to those observed with viral RNA species that lack RNA packaging signals and are capable of Pr55(gag) generation. Moreover, loss of Pr55(gag) production did not affect stability of the relevant viral RNA; this observation rules out the possibility that lowered packaging efficiency associated with Pr55(gag)-deficient HIV-1 RNA is a result of reduced RNA stability. Taken together, our data demonstrate that cis translation of Pr55(gag) is needed for efficient packaging of HIV-1 RNA.     

Quality of life in referred patients presenting to a specialty clinic for osteopathic manipulative treatment

Previous research has found that patients of osteopathic physicians tend to report poorer general health perceptions than persons in the general population or than patients of allopathic physicians. Quality of life and level of healthcare satisfaction in patients referred to a specialty clinic for osteopathic manipulative treatment (OMT) at a college of osteopathic medicine were measured in 1997. Data from the Medical Outcomes Study 36-Item Short Form (SF-36) were used to compute standardized scores in the following eight health scales: physical functioning, role limitations because of physical problems, bodily pain, general health perceptions, vitality, social functioning, role limitations because of emotional problems, and mental health. There were 185 patients who returned the survey (mean response rate, 90%), including 22 new and 163 established patients. Patients reported poorer health than the general population on all eight scales (P < .001). Patients frequently reported poorer quality of life than referents with hypertension, congestive heart failure, type 2 diabetes mellitus, recent acute myocardial infarction, or clinical depression. More than 97% of established patients were satisfied or very satisfied with the healthcare received at the clinic. This study suggests that referred patients presenting to osteopathic physicians for OMT may have poorer quality of life than is generally recognized when relying only on traditional diagnostic approaches. Early detection and treatment of musculoskeletal conditions may be important factors in preventing chronicity and its impact on quality of life.     

Using a single test to measure human contrast sensitivity from early childhood to maturity

Despite the emerging scientific and clinical importance of measuring human contrast sensitivity (CS), developmental data are sparse, especially those obtained with a single methodology. We used a new, time-efficient, psychophysical card procedure to evaluate binocular CS in groups of 20 4- to 9-yr-olds and 10 adults. Combined with data from infants and toddlers obtained previously with the same method, our results show that CS is adult-like by 9 years of age. However, the pattern of development is asymmetrical across spatial frequency (SF): Sensitivity at high SF (which is very poor near birth) shows dramatic improvement over the first three years, but sensitivity at low SF shows much more gradual development, a result which may be explained by differences in the maturation of the underlying neural SF channels. Also notable is that the method shows clinical potential due to its relative speed, ease of use, and consistent results across such a broad age range.     

Vogt-Koyanagi-Harada disease

Vogt-Koyanagi-Harada disease is a chronic, granulomatous systemic autoimmune disease with manifestations in the ocular, central nervous, auditory, and integumentary systems. The target of attack seems to be antigens associated with melanocytes. Patients are usually of Asian, Middle Eastern, Asian Indian, Native American, or Hispanic ethnicity, and complain of neurologic symptoms quickly followed by decreased vision caused by a choroiditis, frequently with exudative retinal detachments. Corticosteroids are the mainstay of therapy, but other immunosuppressive therapy may be required. Complications, including cataract, glaucoma, choroidal neovascular membrane formation, and subretinal fibrosis, may limit final visual acuity.     

Dynorphin modulates ocular hydrodynamics and releases atrial natriuretic peptide via activation of kappa-Opioid receptors

The present study was designed to investigate the effect of the kappa opioid receptor (KOR) agonist, dynorphin A (Dyn), on aqueous humor dynamics (intraocular pressure (IOP), aqueous humor flow rate (AFR)), pupil diameter (PD) and atrial natriuretic peptide (ANP) levels in the aqueous humor of the rabbit. Topical and unilateral application of Dyn caused dose-related, bilateral reductions in IOP and AFR. An intermediate dose of Dyn (33 microg) caused bilateral mydriasis whereas a higher dose (100 microg) caused unilateral miosis. The Dyn-induced reduction in IOP and aqueous flow rate as well as the mydriasis were antagonized by nor-binaltorphimine (nor-BNI), a relatively selective KOR antagonist. In addition to the effects on IOP, PD and AFR, Dyn caused dose-related increases in aqueous ANP levels that was attenuated by nor-BNI. The present study indicates that Dyn reduces IOP, in part, by reducing AFR. Moreover, the increase in ANP levels could be involved in the Dyn-induced reductions in IOP and AFR. Based upon the inhibitory effects of nor-BNI, these Dyn-induced events are due, in part, to the activation of KORs in the ciliary processes of the eye.     

Ontogenetic quinpirole treatments produce spatial memory deficits and enhance skilled reaching in adult rats

There is a paucity of data on neurochemical abnormalities and associated effects on cognition and motor performance in rats ontogenetically treated with quinpirole, a rodent model of dopaminergic hyperfunction. The objective of the current study was to analyze the cognitive and motor effects produced by ontogenetic administration of quinpirole, a dopamine D(2)/D(3) receptor agonist. Past research from this laboratory has shown that ontogenetic quinpirole treatment sensitizes D(2) receptors and produces a variety of characteristic stereotypic behaviors in adult rats. In the current study, rats received quinpirole HCl (1 mg/kg/day) or saline from postnatal day (PD) 1 to PD 11 and went otherwise untreated until adulthood (PD 60). In Experiment 1, cognitive performance was assessed on the standard and matching-to-place versions of the Morris water task (MWT). In Experiment 2, skilled motor performance was assessed on the Whishaw reaching task and locomotor activity was also analyzed. We found that ontogenetically quinpirole-treated rats displayed a deficit on the probe trial given at the end of training of the standard version of the MWT but that there were no significant differences from control on the matching-to-place task. Additionally, rats treated in ontogeny with quinpirole showed significant enhancement in reaching accuracy on the Whishaw reaching task as well as increased locomotor activity relative to saline controls. These findings demonstrate that ontogenetic quinpirole treatments produce cognitive deficits, enhanced skilled reaching and hyperlocomotion. The behavioral changes produced by ontogenetic quinpirole treatment are consistent with dopaminergic hyperfunction, and possible mechanisms are discussed.