Surgery in the prism adaptation study: accuracy and dose response. Prism Adaptation Study Research Group.

Three hundred twenty-two patients underwent strabismus surgery for acquired esotropia according to a rigid protocol in the Prism Adaptation Study (PAS). This report describes the PAS surgical technique and the methods used to evaluate and assure adherence to the surgical protocol. We present analyses of the discrepancies between the amount of recession surgery planned by the surgeon and the amount of recession estimated by the masked graders from documentary photographs. In 74% of patients, the total discrepancy (combined from both medial rectus operations) was 1 mm or less. There was a distinct trend for masked graders to estimate larger recession amounts than were dictated by the protocol and claimed to be done by the surgeon. In 24% of patients, the masked graders estimated that the recession was more than 1 mm greater than that claimed by the surgeon, while in 2%, the graders estimated that the surgery was more than 1 mm less than planned. Of the 74 patients for whom the graders' estimated total recession was more than 1 mm greater than the amount planned by the surgeon, 88% were successful. Of the six patients for whom the graders' estimated total recession was more than 1 mm less than the amount planned by the surgeon, five (83%) were successful. We propose new surgical tables for patients with acquired esotropia. Enhanced amounts of recession appear to be necessary to decrease the rate of undercorrection for each group of patients.     

苄基四氢巴马汀对表达于非洲爪蟾卵母细胞及中华大蟾蜍卵母细胞的延迟整流钾电流的抑制作用

苄基四氢巴马汀对表达于非洲爪蟾卵母细胞及中华大蟾蜍卵母细胞的延迟整流钾电流的抑制作用童秋生，夏国瑾，姚伟星，江明性，白小川，包永德（同济医科大学基础医学院药理学教研室，武汉４３００３０；中国科学院上海生理学研究所，上海２０００３１）苄基四氢巴马汀（ｂ...     

苄基四氢巴马汀对α和β等受体的影响

苄基四氢巴马汀(BTHP)使苯福林对大鼠肛尾肌和兔主动脉条作用的累积量效曲线平行右移,最大反应不压低,pA₂值分别为5.86和5.8,但对甲氧明和B-HT920升高DP作用的量效曲线无明显影响。BTHP可使异丙肾上腺素和组胺正性频率作用的量效曲线非平行右移,最大反应压低。BTHP还能明显缩短大鼠再灌流所致心律失常的持续时间。结果提示,BTHP对α₁受体的阻断及对β和H₂受体的非竞争性拮抗作用可能与该药抗心律失常作用有部分关系但并非其主要机理。     

Optic neuropathy from the use of intracranial muslin

Following repair of an anterior communicating artery aneurysm with McFadden clips and muslin, a 32-year-old woman developed a steroid-responsive optic neuropathy. When she was explored, a sterile abscess with surrounding fibrotic tissue involving the muslin was found adjacent to the right optic nerve. The patient's vision improved following removal of the abscess.     

Retinal nerve fiber layer thickness in amblyopic eyes

PURPOSE: To compare the peripapillary retinal nerve fiber layer (RNFL) thickness of sound and amblyopic eyes. DESIGN: Prospective observational case series. METHODS: Setting: Institutional. Study population: Patients with unilateral strabismic, anisometropic, or combined amblyopia. Observation: Fast RNFL analysis with ocular coherence tomography (OCT) of sound and amblyopic eyes. Measure: Mean RNFL thickness. RESULTS: For the 17 patients (mean age 10.7 years) in whom both eyes were imaged, the mean thickness of the sound eye was 109.2 microm (median 112.7) and of the amblyopic eye was 104.2 microm (median 105.0), and the average difference (sound eye less amblyopic eye) was 5.0 microm (median 3.0) (95% confidence interval -2.3, 12.2, P = .17). The sound eye was 10 microm or more thicker than the amblyopic eye in four patients; the amblyopic eye was 10 microm or more thicker than the sound eye in one patient; and the difference was within 10 microm in 12 patients. Test-retest data were obtained for 23 pairs of sound eyes and 21 pairs of amblyopic eyes, with 75% of the test-retest pairs within 7%. CONCLUSIONS: We found a small, but not clinically significant, difference in nerve fiber layer (NFL) thickness between amblyopic and sound eyes. Reliability was excellent, with most eyes testing within 7% of the first test.     

Pancreatic islet cells antibodies in diabetic patients submitted to pancreas transplantation

Several pieces of evidence suggest an autoimmune etiology of diabetes mellitus type 1. To trace patients who are susceptible to the disease, we utilized islet cells antibodies (ICAs). The aim of this study was to evaluate the presence of ICAs among diabetic patients undergoing simultaneous transplantation of the pancreas and kidney (SPK). Twenty-six diabetic patients received an SPK, 12 of whom were included in this analysis. The indirect immunofluorescence method was utilized for quantitation of ICAs. The types of ICAs were no different following transplantation of the pancreas. The serum levels of pre-existent ICAS in diabetic patients undergoing SPK with immunosuppression were not reduced, and they did not interfere with the function of the implanted pancreas over a period of 60 days.     

Ocular Disposition of the Hemiglutarate Ester Prodrug of ∆9-Tetrahydrocannabinol from Various Ophthalmic Formulations

Purpose

The overall goal of this project is to enhance ocular delivery of ?⁹-Tetrahydrocannabinol (THC) through the topical route.

Methods

Solubility, stability and in vitro transcorneal permeability of the relatively hydrophilic hemiglutarate ester derivative, THC-HG, was studied in the presence of surfactants. The solutions were characterized with respect to micelle size, zeta potential and solution viscosity. In vivo studies were carried out in New Zealand albino rabbits. A previously reported promising THC-HG ion-pair formulation was also studied in vivo.

Results

Aqueous solubility and stability and in vitro transcorneal permeability of THC-HG was enhanced significantly in the presence of surfactants. THC levels in the ocular tissues (except cornea) were found to be below detection limits from mineral oil, surfactant or emulsion based formulations containing THC. In contrast, micellar and ion pair based THC-HG formulations produced significantly higher total THC concentrations in the anterior ocular chamber.

Conclusion

In this study, although delivery of THC to the anterior chamber ocular tissues could be significantly increased through the prodrug and formulation approaches tested, further studies are needed to increase penetration to the back-of-the eye.     

Chemical stability and bioadhesive properties of an ester prodrug of Delta 9-tetrahydrocannabinol in poly(ethylene oxide) matrices: effect of formulation additives

The objective of the present research was to stabilize a novel hemiglutarate ester prodrug of Delta(9)-tetrahydrocannabinol (THC), in polyethylene oxide (PEO) polymeric matrices produced by hot-melt fabrication, for systemic delivery of THC through the oral transmucosal route. For this purpose, the influence of pH modifiers and antioxidants employed as stabilizing agents in these matrices was investigated. Based on the stability studies, two final formulations were made, and the stability of the active was assessed in these systems. In addition, the bioadhesive properties of PEO matrices were studied as a function of bioadhesive polymer type and concentration, contact time, drug loading and wetting time. Of all of the polymers investigated, bioadhesion was highest with Carbopol((R)) 971p. Bioadhesion increased with bioadhesive polymer concentration and wetting time to a certain level beyond which there was no further contribution. Both the contact time and drug loading influenced the bioadhesion. Severe degradation of the prodrug was observed during storage, even at room temperature (75% at the end of 3 months). Incorporation of the stabilizing agents in the PEO matrices reduced the degradation of the prodrug considerably. Citric acid was the most effective of all of the pH modifiers studied. Among the various antioxidants utilized, degradation was observed least in presence of BHT and ascorbic acid. Only 7.6% and 8.2% of prodrug degraded in these matrices, respectively, as compared to the PEO-only matrices (59.4%) at the end of 3 months at 25 degrees C/60% RH. The prodrug was very stable in both of the final formulations at the end of the 3 months at 40 degrees C/75% RH.