Ocular side effects of isotretinoin therapy

Isotretinoin (Accutane Capsules) is a synthetic vitamin A compound used for treatment of recalcitrant cystic acne. It has numerous ocular toxic side effects which include anterior segment inflammation, dry eye syndrome, contact lens intolerance, altered refraction, photosensitivity, and reduced night vision. Eye care practitioners should be aware of these potential side effects and be prepared to communicate with the prescribing physician if side effects present.     

Cognitive-behavioral therapy for panic: an open study

This paper reports results of an open prospective study of 26 patients who met DSM-III criteria for panic disorder or agoraphobia with panic attacks. Cognitive-behavioral treatment alone produced clinically and statistically significant improvement in panic symptoms, including both full-blown and limited symptom episodes. In addition, the treatment produced improvement in associated symptoms of phobic avoidance and generalized anxiety. This work provides further preliminary indication of the usefulness of cognitive-behavioral strategies as an alternative to medication in symptom-oriented treatments.     

Programmed stimulation in the evaluation of life-threatening or potentially life-threatening ventricular arrhythmias

Conclusion In conclusion, programmed stimulation is an excellent and appropriate method to guide thrapy for life-threatening and potentially life-threatening arrhythmias that occur infrequently and with unpredictable timing.The sensitivity and specificity of programmed stimulation is excellent in patients whose clinical presentation is by sustained uniform ventricular tachycardia and cardiac arrest. In contrast, such parameters are substantially less in patients with nonsustained ventricular tachycardia and in those who present wit syncope. The predictive accuracy of therapy guided by programmed electrical stimulation in cohorts with cardiac artest and sustained uniform ventricular tachycardia cohorts is reasonably well established and appears to be very good. Although no large randomized controlled comparative study of noninvasive versus PES-guided therapy has yet been completed, preliminary evidence suggests that there is a decreased incidence of arrhythmia recurrence and sudden cardiac death when therapy is guided by PES. In the minority of patients with syncope in whom sustained uniform ventricular tachycardia is induced during PES, therapy may be effectively guided by this modality. PES appears to be of benefit in managing patients with coronary artery disease who present with nonsustained ventricular tachycardia and depressed ejection fraction thereby defining a high risk subset for a subsequent arrhythmic event. However, we have not found electrophysiologic testing postmyocardial infarction to be prognostically useful.Dr. Josephson is the Robinette Foundation Professor of Medicine (Cardiovascular Diseases)Supported in part by grants from the American Heart Association, Southeastern Pennsylvania Chapter, Philadelphia, PA; and National Heart, Lung, and Blood Institute, Bethesda, MD (HL28093, HL07346, HL24278).     

Pheochromocytoma and paraganglioma: comparison of MR imaging with CT and I-131 MIBG scintigraphy

To ascertain the magnetic resonance (MR) imaging characteristics of pheochromocytomas and paragangliomas and to compare MR with computed tomography (CT) and iodine-131 metaiodobenzylguanidine (I-131 MIBG), 19 patients (18 with pheochromocytomas, one with a paraganglioma) were studied. The 18 patients with pheochromocytomas had had positive findings with I-131 MIBG scintigraphy. Abdominal pheochromocytomas were generally hypointense compared with normal liver on T1-weighted MR images and extremely hyperintense on T2-weighted MR images. MR imaging was preferable to CT in the evaluation of primary pheochromocytomas due to superior tissue characterization, particularly in the patient with hypertension and borderline catecholamine levels. For patients with recurrent or metastatic disease, the data suggest that I-131 MIBG scintigraphy is the examination of choice.     

Monovision vs. aspheric bifocal contact lenses: a crossover study

Twenty selected presbyopic patients were fitted with both monovision correction and Hydrocurve bifocal contact lens correction in a crossover study. Eighty percent of the population preferred bifocal correction and 20% preferred monovision. The results suggest that bifocal contact lens correction should be explored prior to considering monovision correction.     

Spoilage of hydrogel contact lenses by lipid deposits. Tear-film potassium depression, fat, protein, and alcohol consumption

"Jelly-bump" deposits, which are composed mainly of lipids, on high water content, extended-wear hydrogel lenses, are a clinically significant problem of unknown etiology. The authors explored the effect of nutrition on the frequency of deposition of these jelly bumps. Forty-three patients were included in this masked case-control study from five contact lens practices in North America. Thirty patients were lipid-depositor cases and 13 were controls. Tear specimens were drawn and analyzed for potassium by atomic-absorption spectrophotometry. Detailed dietary histories were conducted and diet nutrient composition was computed. Patients with diminished tear-potassium concentrations have an increased risk of jelly-bump deposition. Elevated intake of protein, alcohol, and cholesterol also appeared to be correlated significantly with increased jelly-bump deposition. The authors found that diabetics and the use of diuretics, anticholinergics, sympathomimetics, were associated with tear-film potassium depletion and lipid deposit formation.