Nearpoint phoria changes associated with the cessation of childhood myopia progression

BACKGROUND: A convergent (eso) shift in near phoria associated with the onset of myopia has been reported. METHODS: Data from two Midwestern United States optometry practices were used to assess whether the near phoria shifted back in the divergent (exo) direction after the cessation of childhood myopia progression. Data were collected for myopic children who had three or more examinations before the age of 15 years and at least one examination after the age of 17 years. RESULTS: Refractive error data were used to calculate an index of the age of cessation of childhood myopia progression. The phoria at the first examination after the cessation age was designated as the baseline and was normalized to zero. For all previous and subsequent examinations, the changes in phoria with respect to the baseline phoria were calculated. The phoria at the examination just after the cessation age was significantly more divergent than those at the first, third, and fourth examinations prior to the cessation age (1.1, 1.4, and 1.7 prism diopters, respectively). The third visit after the cessation age was 1.8 prism diopters more divergent than the first visit after the cessation age. Thus, these data showed an exo shift in near phoria after the cessation of childhood myopia progression.     

Relationship of accommodative response and nearpoint phoria in a sample of myopic children.

Esophoria has been associated with onset and progression of myopia in children. The induction of myopia by optical defocus shown by animal models suggests that a high lag of accommodation during near work may contribute to myopia in children. This paper examines the relationship of nearpoint phoria and accommodative response in a sample of children with myopia. Accommodative response was measured under binocular conditions with the Canon Autoref R-1 autorefractor with a 40 cm viewing distance. Phorias were measured with the von Graefe method using a 40 cm test distance. In the statistical analysis exophoria was scored as a negative number and esophoria was scored as a positive number. The coefficient of correlation of accommodative response with phoria was -0.32 (n = 73; p<0.01), thus showing an association of a more positive (more convergent) near phoria with lower accommodative response. The correlation coefficient increased to -0.39 when an exponential function was used. When only esophores were considered, the correlation coefficient was -0.59 (n = 44; p<0.001). Lower accommodative response (higher lag of accommodation) was associated with greater esophoria.     

The natural history of the double pylorus

A study of 11 patients with "double pylorus" revealed that a second channel between the gastric antrum and the duodenal bulb is the result of ulcer penetration. The fistula can be a sign of spontaneous recovery from ulcerative disease; the fistula occurred in conjunction with clinical improvement in the majority of the patients. The advantages of radiological vs. endoscopic diagnostic procedures are discussed.     

Symptomatic shoulder instability due to lesions of the glenoid labrum

Lesions of the glenoid labrum can be associated with and cause shoulder instability and symptomatology by (1) allowing the shoulder to dislocate recurrently (anatomical instability); (2) allowing the shoulder to subluxate (anatomical instability); and (3) allowing the shoulder to click, catch, and lock secondary to partially attached fragments becoming interposed between the articular surfaces (functional instability). The latter two clinical entities are usually associated with "lesser" labral damage and diagnosis can be difficult. Six illustrative cases are presented and salient diagnostic and therapeutic points are discussed. The glenohumeral axillary arthrotomogram is presented as a sensitive diagnostic test for detecting labral lesions.     

Munchausen syndrome by proxy--a cause of preterm delivery.

OBJECTIVE: To present the first case of Munchausen syndrome by proxy involving self-induced preterm delivery. CLINICAL FEATURES: A 27-year-old Caucasian woman induced antepartum haemorrhage and rupture of membranes with a knitting needle at 26 weeks' gestation, leading to delivery of the infant. This "prenatal child abuse" led to a prolonged intensive care stay, extensive treatment and subsequent bronchopulmonary dysplasia. As the child recovered from the effects of extreme prematurity, he became a victim of fabricated illness and recurrent smothering episodes. INTERVENTION AND OUTCOME: After the diagnosis of Munchausen syndrome by proxy was made, the child was removed from the mother and he has since enjoyed good health. CONCLUSION: Self-induction of antepartum haemorrhage can lead to preterm delivery and may be recognisable by certain clinical parameters. The victim of self-induced preterm delivery, if survival ensues, may be subject to further abuse.     

Phase II and pharmacokinetic study of ecteinascidin 743 in patients with progressive sarcomas of soft tissues refractory to chemotherapy.

PURPOSE: To assess the efficacy of the marine-derived alkaloid ecteinascidin 743 (ET-743) in patients with soft tissue sarcomas that progressed despite prior conventional chemotherapy and to characterize the pharmacokinetic profiles of ET-743 in this patient population. PATIENTS AND METHODS: Thirty-six previously treated soft tissue sarcoma patients from three institutions received ET-743 as a 24-hour continuous intravenous (IV) infusion at a dose of 1,500 microg/m(2) every 3 weeks. Pharmacokinetic studies were also performed. Patients were restaged every two cycles for response by objective criteria. RESULTS: Objective responses were observed in three patients, with one complete response and two partial responses, for an overall response rate of 8% (95% CI, 2% to 23%). Responses were durable for up to 20 months. Two minor responses (43% and 47% tumor reduction) were observed, for an overall clinical benefit rate of 14%. The predominant toxicities were neutropenia and self-limited transaminitis of grade 3 to 4 severity in 34% and 26% of patients, respectively. The estimated 1-year time to progression and overall survival rates were 9% (95% CI, 3% to 27%) and 53% (95% CI, 39% to 73%), respectively. The maximum observed plasma concentration and total plasma clearance of ET-743 (mean +/- standard deviation), 1.04 +/- 0.48 ng/mL and 35.6 +/- 16.2 L/h/m(2), respectively, were consistent with previously reported values from phase I studies of the drug given as a 24-hour IV infusion. CONCLUSION: ET-743 is a promising new option for the management of several histologic subtypes of sarcoma. Durable objective responses were obtained in a subset of sarcoma patients with disease progression despite prior chemotherapy. Additionally, the relatively high survival rate noted in this series of previously treated patients further justifies development of this agent.     

Effects of the steroidal aromatase inhibitor exemestane and the nonsteroidal aromatase inhibitor letrozole on bone and lipid metabolism in ovariectomized rats.

PURPOSE: Exemestane (EXE) and letrozole (LET) are third-generation aromatase inhibitors currently prescribed for postmenopausal hormone-dependent breast cancer. The impact on end organs of estrogen depletion in menopausal women is of significant clinical importance. We studied the effects of EXE, its principal metabolite, 17-hydroexemestane (17-H-EXE), and LET on bone and lipid metabolism in ovariectomized (OVX) rats. EXPERIMENTAL DESIGN: OVX rats were treated by weekly intramuscular injection for 16 weeks with 20, 50, and 100 mg/kg EXE, 20 mg/kg 17-H-EXE, and daily oral gavage of 1 mg/kg LET. At the end of the treatment period, bone mineral density (BMD), the bone resorption marker serum pyridinoline, the bone formation marker serum osteocalcin, bone mechanical properties, histomorphometry, and serum lipid concentrations were determined. RESULTS: Lumbar vertebral and femoral BMD, bending strength of the femur, compressive strength of the fifth lumbar vertebra, and trabecular bone volume were significantly higher in OVX animals given EXE and 17-H-EXE than in OVX controls. EXE and 17-H-EXE significantly reduced an ovariectomy-induced increase in serum pyridinoline and serum osteocalcin. EXE and 17-H-EXE given to OVX rats caused significant reductions of serum cholesterol and low-density lipoprotein cholesterol. In contrast, OVX rats treated with LET had BMD, bone biomarkers, mechanical failure properties, and lipid levels similar to those of OVX controls. CONCLUSIONS: EXE and 17-H-EXE significantly prevent bone loss, enhance bone mechanical strength, and lower serum cholesterol and low-density lipoprotein levels in OVX rats. These protective effects on end-organ function are not seen with the nonsteroidal inhibitor LET.     

Adult height in patients with childhood onset atopic dermatitis

Cross sectional studies have reported impaired growth in children with atopic dermatitis. If this growth impairment is irreversible, it would be expected to adversely influence final height attainment. The standing heights and other anthropometric parameters were assessed in 35 adults with onset of atopic dermatitis before 5 years of age and a control group of 35 adults with adult onset contact dermatitis or psoriasis. There was no significant difference in the standing height SD score, mid-parental height SD score, sitting height SD score, subischial leg length SD score, nor body mass index between the atopic dermatitis and control groups. The standing height SD score was not significantly different among: (a) patients with atopic dermatitis affecting less than 50% of their body surface area and those with greater than 50% affected; (b) patients using the four different potency topical corticosteroids; and (c) patients with atopic dermatitis without asthma and those with coexisting asthma. It is concluded that short stature is not a feature of our group of adult patients with onset of atopic dermatitis before 5 years of age, continuing into adulthood, and severe enough to require specialist care. This suggests that if growth impairment occurs in childhood, it is likely to be temporary and reversible.     

Satisfaction of forensic psychiatric patients with remote telepsychiatric evaluation

The level of satisfaction with telepsychiatry evaluations was determined in a sample of 43 forensic psychiatric patient inmates in a large urban jail. A forensic psychiatrist interviewed 20 patients in person, the other 23 remotely via interactive video. Demographic characteristics, physical health status, and psychiatric symptom severity on the Global Severity Index of the Brief Symptom Inventory were comparable in the two groups. Patient satisfaction with the evaluations was moderately high for patients in both groups, with no significant differences between them.     

Targeting the mevalonate pathway inhibits the function of the epidermal growth factor receptor.

PURPOSE: The epidermal growth factor receptor (EGFR) is a key regulator of growth, differentiation, and survival of epithelial cancers. In a small subset of tumors, the presence of activating mutations within the ATP binding site confers increased susceptibility to gefitinib, a potent tyrosine kinase inhibitor of EGFR. Agents that can inhibit EGFR function through different mechanisms may enhance gefitinib activity in patients lacking these mutations. Mevalonate metabolites play significant roles in the function of the EGFR; therefore, mevalonate pathway inhibitors may potentiate EGFR-targeted therapies. EXPERIMENTAL DESIGN: In this study, we evaluated the effect of lovastatin on EGFR function and on gefitinib activity. Effects on EGFR function were analyzed by Western blot analysis using phosphospecific antibodies to EGFR, AKT, and extracellular signal-regulated kinase. Cytotoxic effects of lovastatin and/or gefitinib were evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and flow cytometry. RESULTS: Lovastatin treatment inhibited EGF-induced EGFR autophosphorylation by 24 hours that was reversed by the coadministration of mevalonate. Combining lovastatin and gefitinib treatments showed enhanced inhibition of AKT activation by EGF in SCC9 cells. The combination of 10 mumol/L lovastatin and 10 mumol/L gefitinib treatments showed cooperative cytotoxicity in all 8 squamous cell carcinomas, 4 of 4 non-small cell lung carcinoma and 4 of 4 colon carcinoma cell lines tested. Isobologram and flow cytometric analyses of three representative cell lines with wild-type EGFR ATP binding sites confirmed that this combination was synergistic inducing a potent apoptotic response. CONCLUSIONS: Taken together, these results show that targeting the mevalonate pathway can inhibit EGFR function. They also suggest the potential utility of combining these clinically relevant therapeutic approaches.