Secondary implantation

Aphakia is a disabling condition. It must be corrected by spectacles, contact lenses, refractive keratoplasty, or insertion of a pseudophakos. In those patients who do not tolerate a contact lens or cataract spectacles, refractive keratoplasty or secondary implantation of an IOL should be considered. Keratophakia and hyperopic keratomileusis have not yet evolved to the point at which refractive keratoplasty can be considered a practical answer to aphakia. This leaves a significant population of aphakic patients who can be visually rehabilitated only be secondary implantation of an IOL. Despite the risks and hazards associated with any intraocular surgery, the benefits derived from successful correction of aphakia with secondary implantation fully justify this procedure. Secondary implantation is a proved, successful modality for the corretion of aphakia. The number of patients requiring secondary implantation is not great, but in patients in whom secondary implantation is indicated, both the patient and the physician will find the results most rewarding.     

Effects of sorbinil on glomerular structure and function in long-term-diabetic rats

We investigated the role of the aldose reductase pathway in the pathogenesis of the nephropathy of rats with sever (non-insulin-treated) streptozocin-induced diabetes of 6 mo duration. The initial experiment included four groups of rats: diabetic and control animals on a 20% protein diet, which were untreated or treated with sorbinil (an aldose reductase inhibitor). Food intake was increased by diabetes but was uninfluenced by sorbinil, whereas urinary urea nitrogen excretion was increased and body weight was decreased by both variables. Glomerular basement membrane (GBM) width was increased by diabetes and decreased by sorbinil. No other structural changes were noted. We speculated that sorbinil could have slowed the abnormal rate of GBM thickening in diabetic rats and the normal increase in GBM width in control rats by inducing a mild catabolic state. The second experiment also involved four groups of rats: diabetic and control animals on a 50% protein diet, which were untreated or treated with sorbinil. In these studies, diabetes was again associated with reduced body weight, but sorbinil had no influence on urinary urea nitrogen. Urinary albumin excretion, which was increased by diabetes, was not affected by sorbinil. GBM width was increased by diabetes, but in contrast to animals on 20% protein diets, the animals on 50% protein diets and treated with sorbinil did not have reduced GBM widths. Mesangial volume fraction was greater in diabetic animals than in controls, and sorbinil largely prevented mesangial expansion in them. Surprisingly, the control animals on the 50% protein diet and given sorbinil had increased mesangial volume fraction compared with control rats on the same diet not given the drug.(ABSTRACT TRUNCATED AT 250 WORDS)     

Behavioral treatment of child abuse. A developmental perspective

This article reviews cognitive and behavioral treatment strategies that have been employed with parents who physically abuse their children. Using a developmental framework, a broadened view of abuse is presented that emphasizes targets for intervention that not only reduce aversive parental behavior but also increase behaviors that lead to more optimal child outcome. Interventions with maltreaters are then described, focusing on three periods of childhood--infancy, middle childhood, and adolescence. An argument is made for there being different goal parental behaviors during each of these periods, as well as unique child-based demands that act as obstacles to parents' successfully meeting these goals. Where behavioral treatments with abusive parents do not yet exist, treatments with similar parent populations are described. The article concludes with a discussion of the treatment issues facing the field in the future.     

Surgical treatment of echinococcal cyst of the heart. Report of two cases and review of the world literature.

The case histories of two children with echinococcal cysts of the left ventricular myocardium are reported. Both patients underwent successful enucleation of the cysts, after initial local treatment with 0.5 percent silver nitrate solution. A previous review of the world literature on the surgical treatment of echinococcal cyst of the heart, published in 1971, is brought up to date by the addition of 60 new cases to the 118 cases then described. Instillation of 0.5 percent silver nitrate solution into the cyst cavity is now a routine procedure in our institution to sterilize the cyst and to kill the scolices. This substance is preferable to formalin and hypertonic sodium chloride solution, because it acts rapidly and is nontoxic and nonabsorbable. The two children in this report are the first in whom silver nitrate solution was used to sterilize the myocardial cysts.     

Altered plasma levels of nerve growth factor and transforming growth factor-beta2 in type-1 diabetes mellitus

Nerve growth factor (NGF) and transforming growth factor-beta2 (TGF-beta2) are cytokines which have known immunological effects. An elevated level of NGF has been reported in certain autoimmune diseases, whereas TGF-beta2 is an immunosuppressor which is known to play a role in regulating cell proliferation. A role of this cytokine has been proposed in the pathogenesis of type-1 diabetes mellitus (IDDM), but no clinical studies have yet measured its serum level in this disease. In this study we measured the levels of NGF and TGF-beta2 in the sera of patients with IDDM (n = 26) and values were compared to those of age-matched normal subjects (n = 27) and also to patients with type-2 diabetes mellitus (NIDDM) (n = 26) with similar HbA1c levels and an equal duration of diabetes. Serum NGF levels were significantly elevated in IDDM patients compared to those of age-matched controls (p <.001) and NIDDM controls (p <.01). TGF-beta2 levels were lower in IDDM patients when compared with the healthy control (p <.001) and the NIDDM control (p <.05). There was no correlation between the levels of NGF and TGF-beta2. The duration of diabetes and the level of HbA1c did not affect the NGF and TGF-beta2 levels in the IDDM patients. We conclude that an increase in NGF and a suppression in TGF-beta2 levels are present in patients with type-1 diabetes mellitus and that both cytokines may play independent roles in the pathogenesis of this disease.     

Corneal topography, ultrasound biomicroscopy, and scatterometry

This paper presents a review of corneal topography, including history, literature, physics and technology, data analysis, and recent advances in the field. Clinical applications are also discussed and include contact lens fitting, diagnosis of keratoconus, and refractive surgery.