Anterior ischemic optic neuropathy: Classification of field defects by Octopus™ automated static perimetry

Visual fields of patients with anterior ischemic optic neuropathy (AION) were classified according to quantitative criteria, using the Octopus perimeter. Although a significant altitudinal pattern of field loss was found in 55% of perimetric examinations, the "spared" hemifields routinely showed some loss of sensitivity. This finding, along with the diffuse loss of sensitivity in a high percentage of visual fields, indicates more extensive involvement of the circulation of the anterior optic nerve head than has previously been suggested. Furthermore, patients with diabetes mellitus alone were found to have a statistically separable pattern of visual field loss. The pathophysiologic implications of the visual fields in AION and their relationship to the clinical findings were investigated.     

“Reducing body”-like inclusions in skeletal muscle in childhood-onset acid maltase deficiency

Summary Unusual inclusions with some of the features of reducing bodies were encountered in the skeletal muscle biopsy of a 2.5-year-old boy with childhoodonset acid maltase deficiency. The biopsy revealed a vacuolar myopathy with lysosomal storage of glycogen and eosinophilic refractile inclusions in myofibers, which appeared dark blue with the menadione-nitroblue tetrazolium reaction. The significance of the association of inclusions with reducing properties in the setting of acid maltase deficiency is discussed.     

Current concepts in inguinal hernia in infants and children

Trends are changing in the management of infants and children with indirect inguinal hernias. Advances in neonatal intensive care have resulted in the survival of many small premature infants who have a high incidence of inguinal hernia. The rate of incarceration, strangulation, and gonadal infarction in these babies is twice that of the general pediatric age group. Respiratory immaturity, apnea, bradycardia, and associated neonatal conditions require special management at the time of hernia repair, usually performed just before discharge from the neonatal intensive care unit. New information concerning volume loss and depletion of germ cells beginning at 6 months of age in boys with undescended testes has stimulated the performance of orchiopexy when the patient is 1 year of age. More than 90% of boys with cryptorchid testes at the age of 1 year have an associated hernia that requires concomitant repair at the time of orchiopexy. The use of the peritoneal cavity for fluid absorptive purposes in hydrocephalus treated by venticuloperitoneal shunts or of peritoneal dialysis for renal failure and metabolic diseases such as hyperammonemia and lactic acidosis causes increased intraabdominal pressure and results in the appearance of a previously unrecognized hernia. Recognition of these and other conditions associated with a high incidence of hernial occurrence should allow early diagnosis and treatment before the development of complications. Most elective repairs of hernias are safely performed in the outpatient setting; however, some infants and children with concurrent illnesses are best managed in a morning admissions program, in which hospital admission occurs postoperatively.

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Resumen Este artículo se refiere a las tendencias en el manejo de lactantes y niños con hernias inguinales indirectas. Los avances logrados en el cuidado intensivo neonatal han resultado en la supervivencia de muchos pequeños prematuros, quienes exhiben una elevada incidencia de hernia inguinal. La tasa de incarceración, estrangulación, e infarto gonadal en estos pacientes es dos veces la de la población pediátrica general. La inmadurez respiratoria, apnea, bradicardia, y otras condiciones neonatales asociadas requieren un manejo especial con ocasión de la reparación herniaria, la cual generalmente se realiza inmediatamente antes de la salida de la unidad de cuidado intensivo neonatal. Nuevos conocimientos sobre pérdida de volumen y depleción de las células germinales, lo cual comienza a los 6 meses de edad en niños con testículos no descendidos, ha estimulado la realización de orquidopexia cuando el paciente llegue a la edad de un ano. Más del 90% de los niños con testículos criptorquídicos a la edad de un año tienen una hernia asociada que requiere reparación concomitante con la orquidopexia. El uso de la cavidad peritoneal para efectos de absorción de fluidos en el caso de hidrocéfalos tratados con la implantación de sistemas valvulares ventriculoperitoneales, o de diálisis peritoneal para falla renal y enfermedades metabólicas tales como hiperamonemia o acidosis láctica, causa un aumento en la presión intraabdominal y resulta en la aparición de una hernia previamente inaparente. La identificación de estas y otras condiciones asociadas con una elevada incidencia de hernia debe hacer posible el diagnóstico y tratamiento tempranos, antes de que se presenten complicaciones. La mayoría de las reparaciones herniarias pueden ser realizadas en forma adecuada como procedimientos ambulatorios. Sin embargo, algunos infantes y niños con enfermedades concurrentes pueden ser mejor manejados en un programa de admisión matinal, en el cual la hospitalización se produce en el postoperatorio.

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Résumé Le traitement des hernies inguinales obliques externes chez le bébé et l'enfant évolue. Les progrès accomplis dans les soins intensifs des nouveau-nés ont permis la survie d'un plus grand nombre d'enfants prématurés qui présentent une fréquence plus importante de hernies inguinales. Le taux d'engouement, d'étranglement, et d'ischémie gonadale chez cette population est deux fois celui de la population pédiatrique générale. Le développement respiratoire inachevé, l'apnée, la bradycardie, et d'autres conditions néonatales associées sont autant de facteurs qui nécessitent le travail d'une équipe spécialisée au moment du traitement de la hernie qui se situe juste avant la sortie de l'unité de soins intensifs. Certaines études ayant montré une perte de volume et une déplétion de cellules germinales à partir de l'âge de 6 mois chez le garçon avec une ectopie testiculaire, on préconise une orchidopexie tôt, à l'âge d'un an. Plus de 90% de ces enfants présentent une hernie associée qui doit être réparée en même temps. L'utilisation de la cavité péritonéale pour dériver l'hydrocéphalie par shunt ventriculopéritonéal ou pour dialyse péritonéale en cas d'insuffisance rénale ou autres maladies métaboliques comme l'hyperammonémie et l'acidose lactique sont des causes d'hyperpression intra-abdominale avec augmentation du nombre de cas de hernies jusqu'alors méconnues. Une meilleure connaissance de ces conditions propices à augmenter le nombre de hernies symptomatiques devrait permettre d'en faire le diagnostic plus tôt et de les traiter avant l'apparition des complications. La plupart des hernies non compliquées sont traitées sans hospitalisation. Cependant, quelques bébés et enfants ayant d'autres maladies concomitantes sont mieux traités avec un programme d'hospitalisation de jour, c'est-à-dire que l'enfant est hospitalisé pendant 24 heures après son opération.

     

Lung surfactant gelation induced by epithelial cells exposed to air pollution or oxidative stress

Lung surfactant lowers surface tension and adjusts interfacial rheology to facilitate breathing. A novel instrument, the interfacial stress rheometer (ISR), uses an oscillating magnetic needle to measure the shear viscosity and elasticity of a surfactant monolayer at the air-water interface. The ISR reveals that calf lung surfactant, Infasurf, exhibits remarkable fluidity, even when exposed to air pollution residual oil fly ash (ROFA), hydrogen peroxide (H2O2), or conditioned media from resting A549 alveolar epithelial cells (AEC). However, when Infasurf is exposed to a subphase of the soluble fraction of ROFA- or H2O2-treated AEC conditioned media, there is a prominent increase in surfactant elasticity and viscosity, representing two-dimensional gelation. Surfactant gelation is decreased when ROFA-AEC are pretreated with inhibitors of cellular reactive oxygen species (ROS), or with a mitochondrial anion channel inhibitor, as well as when A549-rho0 cells that lack mitochondrial DNA and functional electron transport are investigated. These results implicate both mitochondrial and nonmitochondrial ROS generation in ROFA-AEC-induced surfactant gelation. A549 cells treated with H2O2 demonstrate a dose-dependent increase in lung surfactant gelation. The ISR is a unique and sensitive instrument to characterize surfactant gelation induced by oxidatively stressed AEC.     

New rat model of Pneumocystis carinii infection.

Rats free of latent Pneumocystis carinii organisms were immunosuppressed with adrenal corticosteroids and transtracheally injected with P. carinii. These animals subsequently developed P. carinii pneumonia. Infection was accomplished by using organisms from infected rat lung or from culture. Diffuse infection was produced with no significant differences in the numbers of organisms found in various lobes of the lungs. Infections progressed over time so that by 6 weeks postinoculation all animals were heavily infected. Infection by transtracheal injection has three advantages over current models. First, transtracheal injection provides a reliable model which is not dependent on naturally occurring latent Pneumocystis infection. Second, transtracheal injection allows the perpetuation of specific Pneumocystis strains. Third, transtracheal injection is a more rapid and economical means of producing severe Pneumocystis pneumonia.     

Serial Testing of Postural Control After Acute Lateral Ankle Sprain

OBJECTIVE: To identify subjects' changes in postural control during single-leg stance in the 4 weeks after acute lateral ankle sprain. DESIGN AND SETTING: We used a 2 x 2 x 3 (side-by-plane-by-session) within-subjects design with repeated measures on all 3 factors. All tests were performed in a university laboratory. SUBJECTS: Seventeen young adults (9 men, 8 women; age, 21.8 +/- 5.9 years; mass, 74.9 +/- 10.5 kg; height, 176.9 +/- 7.1 cm) who had sustained unilateral acute mild or moderate lateral ankle sprains. MEASUREMENTS: Measures of center-of-pressure excursion length, root mean square velocity of center-of-pressure excursions (VEL), and range of center-of-pressure excursions (RANGE) were calculated separately in the frontal and sagittal planes during 5-second trials of static single-leg stance. RESULTS: We noted significant side-by-plane-by-session interactions for magnitude of center-of-pressure excursions in a given trial (PSL) (P =.004), VEL (P =.011), and RANGE (P =.009). Both PSL and VEL in the frontal plane were greater in the injured limbs compared with the uninjured limbs on day 1 and during week 2 but not during week 4, whereas sagittal-plane differences existed during all 3 testing sessions. Injured-limb, frontal-plane RANGE scores were greater than uninjured values at day 1 but not during weeks 2 or 4. No significant differences in sagittal-plane RANGE scores were seen. CONCLUSIONS: Postural control was significantly impaired in the injured limbs at day 1 and during week 2 after lateral ankle sprain but not during week 4. Consistent improvement in postural control measures on both injured and uninjured limbs was seen throughout the 4 weeks after ankle sprain.     

Neural substrates of coping behavior in the rat: possible importance of mesocorticolimbic dopamine system

This study measured expression of Fos protein, an indicator of neural activation, in 116 brain regions of rats that were able to control a stressor (i.e., avoid and/or escape an electric shock), and compared the changes with those observed in yoked rats that received the same shocks but without having control over them. The authors' interest was to find brain regions where elevated activity occurs in conjunction with control. Activity in these brain regions might be responsible for the consequences of having control, such as reduction of stress responses. Eleven brain regions were found in which rats with control showed significantly more Fos expression than was seen in yoked rats that did not have control. Six of these brain regions were part of the mesocorticolimbic dopamine system. These results point to the mesocorticolimbic dopamine system as being importantly involved in the mediation and/or the consequences of coping behavior.