Nutritional status in anorexia nervosa: clinical chemistry, vitamins, iron and zinc

Routine clinical chemical variables and parameters of the vitamin, iron and zinc status were measured in 20 female patients with anorexia nervosa (AN) and in 10 lean and 10 normal weight, healthy, female control subjects. Patients with AN had higher activities of L-gamma-glutamyl transferase (gamma-GT) and glutamate pyruvate transaminase (SGPT) and a higher concentration of prealbumin in serum and lower leucocyte and lymphocyte counts in blood. For the other routine clinical chemical parameters no significant differences between the groups were observed. AN patients had higher serum vitamin B12 and retinol levels. No significant differences were found for the status parameters of thiamin, vitamin B6, vitamin C, folate, vitamin E and vitamin D. Contradictory results were obtained for the riboflavin status: AN patients had a lower level of flavin adenine dinucleotide (FAD) in blood and a lower stimulation ratio of the glutathione reductase activity in erythrocytes (alpha-EGR). Patients with AN had higher serum ferritin concentration and lower total iron binding capacity (TIBC). However, haemoglobin (Hb), haematocrit (Ht) and iron saturation were not significantly different. No significant difference was found in the concentration of zinc in plasma. In spite of the poor intake of nutrients and energy, the results obtained did not indicate an inadequate status of vitamins, iron and zinc in patients with AN.     

Clinical application of epiderm growth factor in patients with most severe eye burns

20 eyes of 11 patients suffering from most severe eye burns of grade 4 or worse were treated in addition to various other drugs with epiderm growth factor (EGF) or placebo in a double-blind test. Among 10 eyes treated with EGF, 6 achieved complete regeneration of the corneal epithelium, and 1 additional case, of the conjunctival epithelium. Among the eyes receiving placebo, only 3 out of 10 healed; all of them were also treated with fibronectin. Although in these very difficult cases EGF could not be investigated as a single therapy, and various other undefined factors may have been effective, in the extended course of the disease the period of EGF treatment was marked by a significant better regeneration of the epithelium.     

Severe herpetic keratitis. I: Prevalence of visual impairment in a clinic population.

We report a prevalence study of the best visual acuity in the affected eye of 100 selected patients with herpetic keratitis seen during a two-year period. Sixty-two patients retained an acuity of 6/9 or better without requiring penetrating keratoplasty (PK). The prevalence of reduced visual acuity severe enough to warrant PK was 33%. Patients requiring PK for whom full clinical records were available suffered a mean of 6.8 episodes of keratitis. In this group of patients the vision of 18 fell from 6/6 to 6/60 over a mean period of 8.5 years. Once visual acuity was permanently reduced to 6/12, 78% of patients proceeded to lose vision to 6/60. Unilateral visual impairment occurs in at least a third of patients with severe herpetic keratitis. Once vision falls permanently to 6/12, the long-term prognosis for vision appears to be poor.     

Ocular hypotensive effects of monoamine oxidase-A inhibitors in rabbit

The effects of monoamine oxidase-A (MAO-A) inhibitors with epinephrine on intraocular pressure in the pigmented rabbit were studied. MAO-A inhibitors were used topically with or without various concentrations of epinephrine. For the measurement of intraocular pressure, applanation pneumatonography was used and tissue MAO activities were determined by radiometric assay. After topical administration with clorgyline, MAO-A activities in the bulbar conjunctiva and the iris-ciliary body were remarkably inhibited, whereas MAO-B inhibition was minimal. Maximal reduction of intraocular pressure with 0.05% epinephrine was 3.2 mmHg. Single administration of clorgyline, amiflamine, moclobemide or CGP 11305-A caused decreases in the intraocular pressure of 2.0, 2.5, 1.8 and 2.4 mmHg, respectively. In the coadministration experiments with epinephrine, the ocular hypotensive effects of epinephrine were potentiated with clorgyline, amiflamine, moclobemide and CGP 11305-A (6.6, 4.8, 5.6 and 5.8 mmHg). On the contrary, they were not influenced by the MAO-B inhibitor deprenyl. These results indicated that MAO-A inhibitors potentiated the ocular hypotensive effects of epinephrine, and that the coadministration of a reversible MAO-A inhibitor with epinephrine might be useful for patients with glaucoma.     

Shape changes produced in detergent extracted bovine retinal pigment epithelium when exposed to ATP. A comparison with fibroblasts and smooth muscle cells

The response of single detergent treated bovine retinal pigment epithelial cells in culture to ATP was measured with an image analyser. The most pronounced contraction was produced by 1.0 mM ATP with most change taking place in the first 10 min. At 1 h the area had decreased by about 33%, perimeter 22% and maximum length 25%. By way of comparison rabbit skin fibroblasts had a decreased area of approximately 40%, perimeter 25% and maximum length 22%. Bovine aortic smooth muscle cells on the other hand decreased in area by 55%, perimeter 40% and maximum length 36%. It is hoped that this assay may be used to evaluate drugs which could counteract contractile events in proliferative vitreoretinopathy.     

Nutrient intake in insulin-dependent diabetic patients with incipient nephropathy

The onset of diabetic nephropathy is characterized by subclinical elevation of urinary albumin excretion, so-called 'microalbuminuria' (M). Dietary assessments were carried out in 15 insulin-dependent diabetic patients with persistent M and an equal number with persistently normal albumin excretion. The groups were matched for sex, age, duration of diabetes, body mass index, insulin dose and glycosylated haemoglobin; there were no significant differences in systemic blood pressure, glomerular filtration rate, blood glucose and serum albumin concentrations between the groups; retinopathy was significantly more frequent in patients with M. Diabetics with persistent M were found to consume a significantly larger amount of fat (expressed as grams and percentage of total energy) and a significantly smaller percentage of total energy as carbohydrate than patients with normal albumin excretion; total dietary energy was larger in those with persistent M, but the difference was not significant. No significant differences were found in protein and fibre intakes between the groups. Our findings suggest that an excess in the dietary consumption of fat relative to carbohydrate might play an important role in the pathogenesis of early nephropathy in insulin-dependent diabetes mellitus. We emphasize the importance of careful attention to nutrient intake in the prevention and treatment of diabetic complications.     

Treatment versus no treatment in chronic open angle glaucoma

In a controlled randomized study 15 patients (20 eyes) with chronic open angle glaucoma and visual field defects were followed by greater than 1 year, 12 of them were followed for 3 years. Half of the group were untreated controls, the other half treated with pressure reducing medical therapy. At least 5 consecutive computerized visual fields were recorded (COMPETER) on each eye, and the linear regression coefficient was calculated. With the reservation for uncontrolled compliance no significant difference in the line of favourable effect of pressure reduction could be spotted, in spite of an average pressure reduction in the treated group of 4 mmHg. More important than this result, which is open to criticism for the smallness of the material, uncontrolled compliance etc, is the lesson that a randomized experiment with treated and non-treated glaucoma cases carried out in accordance with the Helsingfors convention is hardly feasible.     

The effect of YAG laser anterior capsulotomy on prostaglandin concentration in aqueous humor

The YAG (yttrium aluminum garnet) laser has been recommended for anterior capsulotomies. One major complication is elevated intraocular pressure. We report a study of the biochemical content of the aqueous humor after a YAG laser anterior capsulotomy. We analyzed 6-keto-prostaglandin F1 alpha, thromboxane B2 and protein concentrations in the aqueous humor of human eyes. The average values of protein, 6-keto-prostaglandin F1 alpha, and thromboxane B2 in the control eyes were 81.3 +/- 14.0 mg/dL, 17 +/- 30 pg/mL, and 10 +/- 10 pg/mL, respectively. These values were elevated to 182.4 +/- 81.3 mg/dL, 401 +/- 55 pg/mL, and 576 +/- 148 pg/mL, respectively, after YAG laser anterior capsulotomy. The samples with a moderate level of 6-keto-prostaglandin F1 alpha (less than 300 pg/mL) had negligible changes of thromboxane. The elevation of thromboxane was obvious only when prostaglandin levels rose above 300 pg/mL.     

Vitrectomy for idiopathic epiretinal membranes causing macular pucker.

We used vitreous surgery to remove idiopathic epiretinal membranes from the macular area in 70 consecutive cases. The abnormal tissue was successfully removed in each case. Vision improved postoperatively in 61 eyes (87%), remained unchanged in six eyes (9%), and worsened in three eyes (4%). However, at the time of final examination vision was improved in only 47 eyes (67%), primarily because of the occurrence or progression of nuclear sclerosis, which occurred in 38 of 60 phakic eyes (63%). Four preoperative factors were associated with final visual acuity of 20/60 or better: (1) initial vision of 20/100 or better, (2) shorter preoperative duration of blurred vision, (3) thin epiretinal membrane, and (4) absence of traction retinal detachment.