An epidemiological study of androgenic alopecia in 3114 Korean patients.

BACKGROUND: Androgenetic alopecia (AGA) is the most common type of hair loss, and is characterized by the transformation of terminal scalp hair into vellus hair. The epidemiology of AGA is not fully understood. A strong genetic basis has long been identified, although little is known of its nongenetic causes. AIM: To evaluate the association of AGA with a number of environmental factors, including smoking, drinking and sleeping habit. METHODS: In total, 3114 Korean individuals with AGA who attended any one of 17 dermatology clinics in 6 cities in South Korea between March 2011 and February 2012 were enrolled in the study. Epidemiologic a data were collected using a standard questionnaire. RESULTS: No association was seen between eating or sleeping habits and severity of hair loss. However, drinking and smoking were associated with the severity of AGA in male patients. We also found that patients of both genders with a family history had more advanced types of hair loss, and the age of onset of AGA in male patients with a family history was earlier than that in male patients without a family history. CONCLUSIONS: Although the evidence for an environmental influence on AGA remains very weak, we did find an association between hair loss severity and certain environmental factors, such as smoking and drinking. Family history with more severe hair loss and an earlier age of onset.

A review of pedestrian fatalities in Singapore from 1990 to 1994.

The authors reviewed 369 consecutive pedestrian fatalities, which occurred from 1990 to 1994. This represented 28.5% (range 23.3 to 37.2; 95% CI 26% to 31%) of all road accident autopsies during that time. The mean and median ages of this population were 51 (95% CI 48.63 to 53.37) and 54 years, respectively. There were 160 (43.3%) who were in the economically productive ages of 20 to 59 years. Of the 369 victims, 224 (60.7%) were males and 145 (39.3%) females, there being a preponderance of males across all age groups. Most of these accidents occurred during the hours of daylight and in conditions of good weather and visibility. It was estimated that pedestrian behaviour contributed, in part, to at least three-quarters of these fatalities. The majority of these pedestrians died from multiple injuries (181; 49.1%) and closed head injury (146; 39.6%). The vast majority of subjects (357; 96.7%) had injury severity scores (ISS) > or = 16. A total of 100 subjects (27.1%) died at the sites of the accidents. Of these, 99 had ISS > or = 16, with 31 having had ISS = 75 (maximum score). Similarly, all 55 deaths that occurred in the A & E departments were associated with ISS > or = 16, with 6 having ISS = 75. This would imply that most of the deaths that had occurred on site and at A & E departments were not unexpected. Interestingly, no pedestrian aged < or = 12 years had an ISS < or = 16, suggesting that they may be more vulnerable to serious or life-threatening injury than adults. There were 46 (12%) victims who had detectable levels of ethanol in their blood samples, of whom, 10 had ISS = 75. However, the difference between the latter proportion and that of the rest of the pedestrian population who had no alcohol detected in their blood samples (31/323), was only marginally significant (95% CI 0.002 to 0.245). There was a high prevalence of pre-existing and intercurrent diseases, such as ischaemic heart disease (58.8%), hypertensive heart disease (30.4%), chronic obstructive airways disease (47.4%), bronchopneumonia (18.2%) and evidence of systemic hypertension (40.7%). It is submitted that the existence of these underlying conditions should be anticipated, or suspected, in the management of injured pedestrians, particularly the elderly, as they may influence the outcome of their critical care.

Early vitrectomy and endolaser photocoagulation in patients with type I diabetes with severe vitreous hemorrhage.

PURPOSE: To determine if adjunctive endolaser photocoagulation has further improved the outcome of early vitrectomy for severe vitreous hemorrhage in young patients with type I insulin-dependent diabetes. METHOD: The authors reviewed clinical records and fundus photographs of all primary diabetic vitrectomies performed at the Yale Eye Center between July 1986 and June 1993. Only young patients with type I diabetes who underwent vitrectomy within 6 months of vitreous hemorrhage were included. RESULTS: Of 197 vitrectomies for diabetic retinopathy, 12 eyes of ten patients met the Diabetic Retinopathy Vitrectomy Study Group criteria. Patients ranged in age from 24 to 29 years (mean, 27.3 years) and had 11 to 21 years (mean, 17.2 years) of history of diabetes. Preoperative visual acuity was 5/200 in seven eyes, 2/200 in three eyes, hand motions in one eye, and light perception in one eye. The duration of vitreous hemorrhage was approximately 1 month in two eyes, 1 to 3 months in five eyes, and 3 to 6 months in five eyes. Neovascularization was documented in 12/12 eyes. Preoperatively, all patients had received panretinal photocoagulation with 1937 to 5328 burns (mean, 4126). Postoperative follow-up ranged from 12 to 38 months (mean, 24.6 months). Best-corrected postoperative visual acuity was 20/40 or better in 7 eyes (58.33%) and 20/70 or better in 11 eyes (91.66%). Neovascularization involuted in 11/12 eyes and remained so till the last follow-up. CONCLUSION: Patients with type I diabetes with severe vitreous hemorrhage benefit from early endolaser photocoagulation combined with current vitrectomy techniques. The authors' findings are consistent with those of the Diabetic Retinopathy Vitrectomy Study Group, and patients can expect both improved visual acuity and anatomic success.

A quantitative and qualitative assessment of the Solitaire Bifocal Contact Lens.

We performed qualitative and quantitative assessments of contact lens performance at 1 and 6 months among 23 patients enrolled in the Solitaire Bifocal Contact Lens Study. Overall satisfaction and comfort at 6 months was rated good to excellent in 83% and 84% of patients, respectively. Daytime acuity at distance and near were rated very good to excellent in 75% and 83% of subjects. Quantitative measurements of distance and near acuities at 1 month revealed 83% and 88% of subjects, respectively, seeing better than or equal to 20/25 or J1. At 6 months there was a moderate decrease in the measured distance acuity. A disparity in glare disability was noted, with 53% of subjects indicating significant glare problems but only 21% of glare tested patients having acuities worse than 20/40. Attrition from the study was highest in the first month and was more common among first-time contact lens users. Overall, this segmented bifocal contact lens is well-tolerated and provides good distance and near vision for presbyopic patients.

Clinical evaluation of the anterior constant focus (ACF) annular bifocal contact lens.

We evaluated the distance and near vision of 33 presbyopic patients who wore the Anterior Constant Focus (ACF) rigid gas permeable (RGP) bifocal lens. Twenty-seven patients (82%) wore the lenses for one year; the six patients who quit the study complained of unacceptable vision (four patients) and discomfort (two patients). Twenty-five patients (76%) obtained 20/25 or better distance vision, and 28 patients (85%) obtained J2 or better near vision. Contrast sensitivity was within normal limits in 24 of 33 (73%) patients. We feel the ACF lens provides good bifocal vision in a non-translating RGP design.

Current status of malaria in Malaysia.

The Malaria Eradication Program was started in 1967 in Peninsular Malaysia. Since then and up to 1980, there was a reduction in the number of reported malaria cases from 160,385 in 1966 to 9,110 cases for Peninsular Malaysia. Although the concept of eradication has changed to one of control in the 1980, the anti-malaria activities have remained the same. However, additional supplementary activities such as the use of impregnated bednets, and the Primary Health Care approach, have been introduced in malarious and malaria-prone areas. Focal spraying activity is instituted in localities with outbreaks in both malaria-prone and non-malarious areas. Passive case detection has been maintained in all operational areas. In 1990, 50,500 cases of malaria were reported of which 69.7% (35,190) were from Sabah, 27.8% (14,066) from Peninsular Malaysia and 2.5% (1,244) from Sarawak. Until June 1991 a total of 18,306 cases were reported for the country. Plasmodium falciparum continues to be the predominant species, contributing to 69.6% of the parasites involved. The case fatality rate for 1990 was 0.09%. There were 43 deaths all of which were attributed to cerebral malaria. The problems faced in the prevention and control of malaria include problems associated with the opening of land for agriculture, mobility of the aborigines of Peninsular Malaysia (Orang Asli) and inaccessibility of malaria problem areas. There is need to ensure prompt investigation and complete treatment of cases especially in malarious areas. The promotion of community participation in control activities should be intensified. Primary Health Care should be continued and intensified in the malarious areas.(ABSTRACT TRUNCATED AT 250 WORDS)

Removal of viscoelastic materials after experimental cataract surgery in vitro.

The one significant complication of viscoelastic materials is that they may cause postoperative intraocular pressure rise. We investigated the rate and ease of removal of various viscoelastics using the Miyake video technique. Five viscoelastics were investigated: sodium hyaluronate (Healon), Healon GV, chondroitin sulfatesodium hyaluronate (Viscoat), hydroxypropylmethylcellulose (Occucoat), and polyacrylamide (Orcolon). The viscoelastics were dyed with fluorescein and, after filling the capsular bag with a viscoelastic material, a posterior chamber intraocular lens (IOL) was implanted. The viscoelastic was then aspirated using an automated irrigation/aspiration device. Healon and Healon GV were completely removed within 20 to 25 seconds. Viscoat adhered to the lens capsule and to the posterior surface of the IOL and cooplete removal required approximately 3.5 minutes. Most Occucoat and Orcolon was aspirated within one minute; however, removal was completed only after three minutes. Removal of Healon and Healon GV was faster and more complete than removal of the other viscoelastics. Whether a small amount of viscoelastic left in the eye or trapped behind the IOL optic has any clinical significance has to be studied.

The elastic properties of the lens capsule in capsulorhexis.

We investigated the ability of the anterior lens capsule to stretch and allow removal of lens substance and intraocular lens implantation through a continuous circular capsulorhexis. Capsulorhexis of various sizes (2.5 to 7.5 mm) were performed in 50 eyes obtained post mortem from 31 patients. The nucleus and cortex were removed by either phacoemulsification (35 eyes) or manual extracapsular cataract extraction (15 eyes). The opening of the capsule was then gradually enlarged, using a modified caliper with two pins attached to its tips, until the margins were torn. The capsule was torn when the circumference at the time of rupture was 1.6 times larger than the circumference of the original circular capsulectomy or 5.0 times larger than the diameter of the capsulectomy. Manual extraction of a lens nucleus with profile circumference (sagittal or anteroposterior) of 18.0 to 22.0 mm can be performed through a 5.5-mm opening and a 6.0- to 7.0-mm optic intraocular lens (profile circumference of 13.0 to 17.0 mm) can be implanted through a 4.5-mm capsulectomy.

An analysis of flexible anterior chamber lenses with special reference to the normalized rate of lens explantation.

A survey of 1204 closed-loop anterior chamber intraocular lenses (AC-IOLs) and 310 open-loop AC-IOLs accessioned between November 1982 and January 1990 was conducted at the Center for Intraocular Lens Research. An analysis of complication rates was done after normalization of data with respect to market share totals. The results establish that an unacceptable complication rate is associated with the closed-loop design when compared with either the tripod or quadripod lens styles. Furthermore, the closed-loop designs, while comprising an estimated 45% of the total number of AC-IOLs estimated to be implanted in the United States (n = 674,000), were responsible for 80% of the AC-IOLs explanted after complications and accessioned at the authors' center. A rethinking of the extreme condemnation of all anterior chamber IOLs that has surfaced in recent years is warranted. This is particularly true with respect to indications for use of sutured posterior chamber (PC) IOLs as well as with regard to possible use of open-loop AC-IOLs in less-industrialized nations.

Preparation and study of human eyes obtained postmortem with the Miyake posterior photographic technique.

A modification of the original Miyake technique of posterior photography of human eyes obtained postmortem is presented. A detailed description of globe preparation and equipment is described. Use of modern technology including a high magnification microscope system and video camera permits dynamic or realtime observations of tissue effects of various surgical procedures such as the cataract operation. This technique provides both a research and educational tool that can be used by ophthalmologists to improve the quality of surgery. Most important, it is an instructional tool that should reduce the "learning curve" that is inherent when modifying one's surgical technique.

Protection of gastric mucosa by sucralfate from aspirin-induced erosions.

The protective effect of sucralfate against aspirin caused damage to the gastric mucosa was studied in healthy male volunteers (age range 18 to 44 years) with no history of gastrointestinal disease. Each was randomly assigned to placebo or sucralfate. As determined by endoscopic studies, 8 of 12 subjects on sucralfate experienced complete protection; 3 were partially protected. The question was raised whether sucralfate might have inhibited the absorption of aspirin from the gastrointestinal tract, but measurement of salicylate levels showed no statistically significant difference between salicylate levels achieved after sucralfate and after placebo.