Is the phakic eye normal in monocular pediatric aphakia?

This retrospective review of 97 pediatric patients who underwent monocular surgery for congenital or developmental cataracts studied the incidence of abnormalities in the contralateral phakic eye. Fifty-nine percent of patients had a normal phakic eye. However, 40 patients showed at least one abnormality in the phakic eye: reduced vision (21%), nystagmus (19%), cataract (15%), iris heterochromia (9%), myopia (6%), microphthalmos (6%), pupillary miosis (2%), congenital glaucoma (2%), optic nerve abnormality (2%), aniridia (1%), and corneal opacity (1%). Not all abnormalities were detected at the time of diagnosis of the contralateral cataract. The more significant findings of reduced vision and nystagmus in the phakic eye were usually detected postoperatively, often several months after the optimum time for treatment of pediatric cataracts. We suggest that monocular cataract surgery not be delayed. This will allow the best vision to be obtained for the aphakic eye, as the "sound eye" may not always be normal in monocular pediatric aphakia.     

Pregnancy outcome in patients with repeat visits to the labor observation area near term

Patients whose pregnancies are near term and who repeatedly visit the labor observation area but are found not to be in labor and have no clear diagnosis for their complaints remain a source of concern for the obstetrician. In order to determine whether this is a population with special perinatal risks, such cases were reviewed over a 4-month period at Charity Hospital in New Orleans. Seventy-one patients were identified who had repeatedly visited the labor observation area near term. Compared with those in the general obstetrics population, these patients had a significantly increased risk of cesarean section for "failure to progress." Repeat visitors to the labor observation area should be viewed as having a high risk for later abnormalities of active labor. Careful management of labor abnormalities in such patients could theoretically lower their need for cesarean section.     

Beyond dirty linen: linen use management as an innovative asset

Because linen is an item used by virtually every inpatient in the hospital, hospital administrators will find that if they provide laundry managers an appropriate data base, they can motivate them to a larger role of linen use managers.     

Prenatal diagnosis for paediatricians

In Ontario, approximately 140,000 women deliver newborn infants each year. Of these women, 60,000 to 70,000 have multiple marker screening, 10,000 undergo amniocentesis or chorion villus sampling and virtually all have at least one prenatal ultrasound. Multiple marker screening is not used in every province and territory; however, amniocentesis and prenatal ultrasound are used throughout Canada. Most paediatric patients will have been exposed to some form of prenatal diagnosis. If an abnormality is found prenatally, parents may have concerns to discuss with the paediatrician after the child is born. Likewise, if a child with a problem is born following a normal pregnancy, the parents will want to know why the problem was missed prenatally. Paediatricians should be aware of prenatal tests that have been performed to understand better their patients and their families.     

Uptake of individual fatty acids into adipose tissue in relation to their presence in the diet

BACKGROUND: The fatty acid composition of adipose tissue triacylglycerol reflects, but is not identical to, the fatty acid composition of the habitual diet. OBJECTIVE: We investigated whether the fatty acid composition of adipose tissue is explained by differences between fatty acids in early storage in adipose tissue after a meal. DESIGN: Nine healthy men ate a meal containing several fatty acids. Blood samples were taken for 6 h after the meal from an arterialized hand vein and a vein draining the anterior abdominal subcutaneous adipose tissue. RESULTS: Net storage of fatty acids in adipose tissue occurred between 1 and 4 h after the meal. In relation to the amount fed, storage of fatty acids differed (P < 0. 01) between classes (n-3 polyunsaturated < saturated < n-6 polyunsaturated < monounsaturated); oleic acid was stored in the greatest amounts. These differences agreed closely with published data, except for n-3 polyunsaturated fatty acids. The only individual metabolic step at which significant differences between fatty acids was shown was incorporation of fatty acids into chylomicron triacylglycerol. Differences between fatty acids in rate of extraction from chylomicron triacylglycerol and net uptake into adipose tissue in the postprandial period were significant (P < 0. 01), but not when expressed in relation to proportions in chylomicron triacylglycerol. CONCLUSIONS: The characteristic fatty acid pattern of adipose tissue may predominantly reflect the early metabolic handling of different fatty acids. Adipose tissue uptake of n-3 polyunsaturated fatty acids is slow in relation to that of other fatty acids.     

The effects of retrograde cardioplegia technique on myocardial perfusion and energy metabolism: a magnetic resonance imaging and localized phosphorus 31 spectroscopy study in isolated pig hearts

OBJECTIVE: The present work was designed to study the myocardial perfusion and energy metabolism during retrograde cardioplegia performed with different methods, including deep coronary sinus cardioplegia, coronary sinus orifice cardioplegia, and right atrial cardioplegia. METHODS: Isolated pig hearts were subjected to antegrade cardioplegia, right atrial cardioplegia, deep coronary sinus cardioplegia, and coronary sinus orifice cardioplegia in a random order. Cardioplegic distribution was assessed by T1-weighted magnetic resonance imaging in 1 group of hearts (n = 8). The flow dynamics of cardioplegia were assessed by T2*-weighted imaging in a second group of hearts (n = 8). RESULTS: T1-weighted images revealed an apparent perfusion defect in the posterior wall of the left ventricle, the posterior portion of the interventricular septum, and the right ventricular free wall during deep coronary sinus cardioplegia. The perfusion defect observed in the first 2 regions with deep coronary sinus cardioplegia resolved with coronary sinus orifice cardioplegia. Right atrial cardioplegia provided the most homogeneous perfusion to all regions of the myocardium relative to the other 2 retrograde cardioplegia modalities. T2*-weighted images showed that the 3 retrograde cardioplegia modalities provided similar cardioplegic flow velocities. Localized phosphorus 31 spectroscopy showed that the levels of adenosine triphosphate and phosphocreatine were significantly lower in the posterior wall (adenosine triphosphate, 42.86% +/- 5.91% of its initial value; phosphocreatine, 11.43% +/- 11.3%) than the anterior wall (adenosine triphosphate, 89.19% +/- 8.83%; phosphocreatine, 59.54% +/- 12.58%) of the left ventricle during 70 minutes of normothermic deep coronary sinus cardioplegia. CONCLUSIONS: Deep coronary sinus cardioplegia results in myocardial ischemia in the posterior wall of the left ventricle and the posterior portion of the interventricular septum, as well as in the right ventricular free wall. Coronary sinus orifice cardioplegia improves cardioplegic distribution in these regions. Relative to deep coronary sinus cardioplegia and coronary sinus orifice cardioplegia, right atrial cardioplegia provides the most homogeneous perfusion.     

The developmental appearance of a major basilar papilla-specific protein in the chick

The sensory epithelium of the chick cochlea, the basilar papilla, contains a major protein of approximately 23,000 daltons. This protein was as abundant as actin in the papilla, yet could not be found in significant quantities in any other cochlear tissue. The protein appeared at a time in development when other studies have shown that the chick embryo develops peripheral auditory competence. These observations suggest a role for this protein in cochlear function.     

A systematic scoping review of measures of participation in disability and rehabilitation research: A preliminary report of findings

Purpose/objectiveThe concept of participation is emerging as a gold-standard of outcome measurement in disability and rehabilitation. We aimed to assess the status of methods to measure this new concept.Method/designWe conducted a scoping review and a content analysis to assess the literature on participation.ResultsWe identified 586 articles addressing participation. Seventy-two articles passed all exclusion criteria. Twenty-four articles cited the International Classification of Function as their conceptual foundation. Most studies included individuals with a broad range of impairments (cross disability). Most instruments relied on self-report in a cross-sectional design. We noted three levels of measurement (static, interactional, and dynamic). Few studies reported collecting data on the environment along with participation. Subjective aspects of participation emerged as an important consideration but few articles reported measuring it.ConclusionsThe concept of participation represents more than a “shift from negative to more positive language.” It represents a transformational concept that requires new, dynamic measures collected in context.