Argon laser pretreatment in Nd: YAG iridotomy

Argon laser pretreatment prior to Nd:YAG laser iridotomy may decrease the incidence of operative hemorrhage. In a prospective, randomized clinical trial involving 12 patients (24 eyes), one eye was randomly assigned treatment with the Nd:YAG laser alone, while the other eye was pretreated with argon laser photocoagulation immediately prior to Nd:YAG laser. Eight of the 12 eyes (67%) treated with Nd:YAG laser alone had operative hemorrhages; only 2 of the 12 (17%) pretreated eyes did. Thus, argon laser pretreatment significantly reduced the incidence of hemorrhage during Nd:YAG iridotomy (P = .012).     

The Effects of Depressed Affect on Functional Disability Among Rural Older Adults

This study investigates functional disability among some of the nation's most vulnerable older adults: rural Medicaid recipients. Data were provided by 221 older adults (mean age = 75.9 years; 82% women) who were receiving community-based long-term care services through Medicaid. Participants self-reported functional ability involving the completion of six basic activities of daily living (BADLs), three cognitive instrumental activities of daily living (IADLS), and four physical IADLs. Self-reports of depressed affect and the number of physical health conditions were also obtained. Path analysis was used to examine all of the associations among age, gender, number of chronic health conditions, depressed affect and functional disability. The tested model was significant [chi2 (DF = 3, n = 221) = 5.052, p = 0.168; TLI = 0.945; CFI = 0.992; RMSEA = 0.056] and explained 45.1% of the variance in BADL disability. Depressed affect significantly predicted disability in cognitive IADLs and physical IADLs, which predicted disability in BADLs. Age and gender had indirect effects on BADL, through their association with cognitive IADLs and physical IADLs. The number of chronic health conditions exerted both indirect and direct effects on BADL disability. Results are discussed within the context of the growing literature that suggests the importance of psychological variables as predictors of functional disability. Moreover, we discuss whether community-based long-term care is appropriate for older adults with high levels of functional disability.     

Brain tumors in children. I. Advances in diagnosis

This article emphasizes the contributions that new diagnostic techniques have made toward the management of children with brain tumors. The development of computerized tomographic (CT) scanning has revolutionized both the diagnosis and management of patients with brain tumors and has obviated the previously inevitable delays in diagnosis. The development of magnetic resonance imaging (MRI) has certainly facilitated diagnosis of brain tumors in certain locations with the brain, but it remains unproven in other locations. It is clear that at least some of the early promise of MRI scanning has not been realized. Neither CT nor MRI are able to provide functional detail within the brain, nor are they able to differentiate tumor from peritumoral edema to better delineate the tumor margins. It is hoped that the currently experimental techniques of Positron Emission Tomography (PET) scanning and contrast-enhanced MRI scanning will provide such information in the near future. Neurophysiologic methods of assessing brain tumors merit greater consideration than has been afforded to date. Sensory evoked-potential monitoring provides information about nervous system function. This information is useful both in diagnosis and in monitoring of brain tumors, since the functional information can be localized to discrete regions within the brain. The value of cerebrospinal fluid (CSF) evaluation, both for cytology and tumor markers, cannot be overstated. A significant proportion of childhood brain tumors tend to seed throughout the neuraxis by the CSF pathways. Thus, evaluation of CSF cytology prior to surgical perturbation of the primary tumor should be undertaken whenever safely feasible, in order to avoid the dilemma of postoperative positive CSF cytology and its questionable significance.     

Hodgkin disease: contributions of chest CT in the initial staging evaluation

Chest radiographs and chest computed tomography (CT) scans were compared in 203 patients with newly diagnosed Hodgkin disease. The incidence of positive findings was tabulated from six intrathoracic lymph node groups, lung parenchyma, pericardium, pleura, and chest wall. The discordant cases were assessed to determine impact on clinical management. The CT scans provided additional evidence of disease involvement, ranging from 0% to 15% at each of the designated anatomic sites. Treatment was altered in 9.4% of all patients (19 of 203), including 13.8% (nine of 65) of those undergoing radiation therapy alone and 8.2% (ten of 122) of those undergoing combined-modality treatment. We conclude that routine chest CT examinations are valuable in the clinical management of those patients for whom radiation therapy is planned.