Innervation of the porcine ciliary muscle and outflow region

The porcine eye serves as a model to study various functions of the aqueous outflow system. To compare these data with the primate eye, a detailed investigation of the distribution of contractile properties and of the innervation of the outflow region was conducted in the porcine eye. In all quadrants of the anterior eye segment, elastic fibres connected the ciliary muscle (CM) with the well-developed scleral spur (ScS) and also partly with the corneoscleral trabecular meshwork (TM) and the loops of the collecting outflow channels. Immunohistochemistry with antibodies against smooth muscle alpha-actin revealed intense staining of the CM and some myofibroblasts in the ScS and outer TM. In addition to a few cholinergic and aminergic nerve fibres in the outflow region, numerous substance P- and calcitonin-gene related peptide-positive nerve fibres and nerve endings were found near the outflow loops of the porcine TM. Although the porcine CM serves rather as a tensor choroideae muscle than as a muscle for accommodation, the innervation and morphology of the collecting outflow channel loops and of the expanded TM between the ScS and the cornea showed close similarities to the primate eye.     

Femoral neck surgery using a local anaesthetic technique

Thirty cases of femoral sub-capital fractures, Garden grades 1-4, were reduced and internally fixed with crossed Garden screws using femoral nerve block. In addition, sedation and analgesia was provided by low dose ketamine and diazepam. No deaths or other complications occurred in these patients. In a similar group of patients who received spinal analgesia in the same unit under similar conditions there was one death and two cerebrovascular accidents.     

Gamma-glutamyl transpeptidase of bovine ciliary body: purification and properties.

Gamma-glutamyl transpeptidase activity in the bovine ciliary body is six to ten times higher than those in the iris, retina and pigment epithelium. The enzyme activity of the bovine lens is very low. When the ciliary body homogenate is fractionated, the activity is largely found in the microsomal fraction. After solubilization with 0·5% Emulphogene BC-720, the enzyme has been purified 32 times by fractionation with ammonium sulfate and ion exchange chromatography on epichlorohydrin triethanolamine cellulose. The apparent K_m of the ciliary body enzyme for l-γ-glutamyl-p-nitroanilide is determined to be 1·3 mm when glycylglycine is used as the γ-glutamyl acceptor. The activity is inhibited markedly by Ca²⁺ (150 mm), Mg²⁺ (150 mm), Na²⁺ (100 mm) and maleate (60 mm). Of the 23 amino acids tested, glycylglycine, l-glutamine and l-methionine are especially good acceptors. A comparison of the ciliary body enzyme with bovine kidney enzyme indicates that the two enzymes are similar in their solubility in ammonium sulfate, behavior on epichlorohydrin triethanolamine cellulose, activity toward different amino acid acceptors, pH optima, and apparent K_m values for γ-glutamyl-p-nitroanilide. However, they are different in the electrophoretic mobilities in polyacrylamide gel; the ciliary body enzyme migrates faster toward the anode than the kidney enzyme. After treatment of the enzymes with neuraminidase, however, they migrate in electrophoresis at essentially identical mobilities. It is therefore concluded that the difference in electrophoretic behavior between ciliary enzyme and kidney enzyme is attributed to different amounts of sialic acid present.     

Why is Intraocular Pressure Elevated in Chronic Simple Glaucoma?: Anatomical Considerations

Ultrastructural analysis of 400 trabeculectomy specimens of glaucomatous eye revealed three types of extracellular deposits within the cribriform layer of the trabecular meshwork. One of these derives from the sheath of the subendothelial elastic-like fibres. Tissue culture and ultrahistochemical studies led to the assumption that these deposits contain glycoproteins, probably secreted by the cribriform layer cells.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

Thermoablation of Liver Metastases: Efficacy of Temporary Celiac Plexus Block

Purpose To determine the efficacy of celiac plexus block during thermoablation of liver metastases.Methods Fifty-five consecutive patients underwent thermoablation therapy of liver tumors by laser-induced thermotherapy. Twenty-nine patients received a temporary celiac plexus block, 26 patients acted as control group. In both groups fentanyl and midazolam were administered intravenously upon request of the patient. The duration of the intervention, consumption of opiates, and individual pain sensations were documented.Results No complications resulting from the celiac plexus block were recorded. Celiac plexus block significantly reduced the amount of pain medication used during thermoablation therapy of liver tumors (with block, 2.45 μg fentanyl per kg body weight; without block, 3.58 μg fentanyl per kg body weight, p < 0.05; midazolam consumption was not reduced) in patients with metastases ≤5 mm from the liver capsule. For metastases farther away from the capsule no significant differences in opiate consumption were seen. Celiac plexus block reduced the time for thermoablation significantly (178 min versus 147 min, p < 0.05) no matter how far the metastases were from the liver capsule. Average time needed to set the block was 12 min (range 9–15 min); additional costs for the block were marginal. As expected (as pain medications were given according to individual patients’ needs) pain indices did not differ significantly between the two groups.Conclusion In patients with liver metastases ≤5 mm from the liver capsule, celiac plexus block reduces the amount of opiates necessary, simplifying patient monitoring. In addition celiac plexus block reduces intervention time, with positive effects on overall workflow for all patients.     

Context and process of informed consent for pharmacologic strategies in labor pain care

The care of women experiencing labor pain often challenges midwives to provide ethical informed consent for the pharmacologic strategies common in most of America's childbearing environments. A systematic approach to this clinical dilemma begins with a conceptual understanding of the origins of labor pain stimuli, factors affecting their central nervous system processing, and the differentiation of the concepts of pain, suffering, and comfort. These concepts can be integrated into a labor pain care, rather than pain management, model for clinical practice. Because most midwives provide care for laboring women in acute care hospitals, the midwife must also understand how the standards of the Joint Commission on Accreditation of Healthcare Organizations influence the behavior of other professionals in the health care environment for laboring women and the process of informed consent. A systematic approach to informed consent for pharmacologic strategies for labor pain care strategies should begin during pregnancy and includes full, unbiased disclosure of the nature, benefits, risks, side effects, and efficacy of all methods that are available in the chosen birth setting.     

Atypical sinusitis in adults must lead to looking for cystic fibrosis and primary ciliary dyskinesia

HYPOTHESES/OBJECTIVES:: In adults, purulent pansinusitis or nasal polyposis starting early in life or that is permanently infected or associated either with chronic bronchial infection, infertility, or situs inversus are uncommon. In these atypical cases of chronic sinusitis (ACS), a primary dysfunction of the mucociliary clearance can be suspected. Adult patients with ACS were therefore investigated to detect primary ciliary dyskinesia (PCD) or cystic fibrosis (CF). STUDY DESIGN: Open, prospective study. PATIENTS AND METHODS: Forty-two patients with ACS were investigated with ciliary beat frequency and ultrastructure analysis in nasal cells and cystic fibrosis transmembrane conductance regulator (CFTR) gene mutation analysis in blood leukocytes. RESULTS: The diagnosis of PCD was confirmed in seven (17%) patients. At least one CFTR gene mutation was detected in 16 (38%) patients. The diagnosis of CF was suggested in three (7%) compound heterozygous patients. Another 13 (31%) patients were heterozygous for a CFTR gene mutation or a complex allele. Comparison of clinical features of ACS showed that only a family history of chronic sinusitis (P <.01) or chronic bronchitis (P <.02) and the presence of diffuse bronchiectasis (P <.0001) or serous otitis media (P <.0001) were significantly more frequent in PCD patients than in patients carrying CFTR gene mutations or those without PCD or CFTR gene mutations. CONCLUSIONS: ACS should be considered a remarkable entity in which congenital abnormalities of epithelial cells are frequently detected (55% of patients). The higher frequency of mutations in ACS patients compared with the general population suggests that heterozygoty for CFTR gene mutation could be a sinusitis-causing status.     

Prospective echocardiographic evaluation of atrioventricular conduction in fetuses with maternal Sjögren's antibodies

OBJECTIVE: Fetal complete atrioventricular block (AVB) occurs in 2-5% of Sj?gren's antibodies (SSA/SSB)-positive pregnancies with substantial morbidity and mortality. We evaluated the incidence of 1 degrees and 2 degrees AVB by measuring Doppler-derived mechanical PR intervals. STUDY DESIGN: We compared mechanical PR intervals of fetuses of SSA/SSB positive mothers referred to a single cardiology center between 1997 and 2003 with control fetuses and fetuses with 1 degrees or 2 degrees AVB confirmed by magnetocardiography or postnatal electrocardiogram. RESULTS: One hundred thirty-nine fetal echocardiograms performed on 59 SSA/SSB-positive pregnant women at 24.3 +/- 5.0 weeks gestation were compared with 150 controls. Mechanical PR intervals of the study group (120.5 +/- 9.8 milliseconds) and controls (120.6 +/- 8.7 milliseconds) were the same but differed significantly from fetuses with 1 degrees and 2 degrees AVB (191.5 +/- 29.6 msec). CONCLUSION: The incidence of 1 degrees and degrees 2 fetal AVB in SSA/SSB-positive pregnancies is low and can be identified by abnormal mechanical PR interval.