Obesity as a risk factor for malignant melanoma and non-melanoma skin cancer.

The dramatic increases in incidence of both obesity and many cancers including skin cancer emphasize the need to better understand the pathophysiology of both conditions and their connections. Melanoma is considered the fastest growing cancer and rates of non-melanoma skin cancer have also increased over the last decade. The molecular mechanisms underlying the association between obesity and skin cancer are not clearly understood but emerging evidence points to changes in the tumor microenvironment including aberrant cell signaling and genomic instability in the chronic inflammatory state many obese individuals experience. This article reviews the literature linking obesity to melanoma and non-melanoma skin cancer.

Using mobile clinics to deliver HIV testing and other basic health services in rural Malawi.

CONTEXT: The majority of Malawians are impoverished and primarily dependant on subsistence farming, with 85% of the population living in a rural area. The country is highly affected by HIV and under-resourced rural health centers struggle to meet the government's goal of expanding HIV testing, antiretroviral treatment, and other basic services. ISSUE: This report describes the work of two four-wheel drive mobile clinics launched in 2008 to fill an identified service gap in the remote areas of Mulanje District, Malawi. The program was developed by an international non-governmental organization, Global AIDS Interfaith Alliance (GAIA), and the Mulanje District Health Office, with funding from the Elizabeth Taylor HIV/AIDS Foundation. The clinics provide: (1) rapid HIV testing and treatment referral; (2) diagnosis and treatment of malaria; (3) sputum collection for TB screening; (4) diagnosis and treatment of sexually transmitted and opportunistic infections; and (5) pre-natal care. The clinic vehicles provide medical supplies and personnel (a clinical officer, nurse, and nurse aide) to set up clinics in community buildings such as churches or schools. LESSONS LEARNED: In such a project, the implementation process and schedule can be affected by medication, supply chain and infrastructural issues, as well as governmental and non-governmental requirements. Timelines should be sufficiently flexible to accommodate unexpected delays. Once established, service scheduling should be flexible and responsive; for instance, malaria treatment rather than HIV testing was most urgently needed in the season when these services were launched. Assessing the impact of healthcare delivery in Malawi is challenging. Although mobile clinic and the government Health Management Information System (HMIS) data were matched, inconsistent variables and gaps in data made direct comparisons difficult. Data collection was compromised by the competing demand of high patient volume; however, rather than reducing the burden on existing health centers, the data suggest that the mobile clinics provided services for people who otherwise may not have attended a health center. The GAIA mobile clinics were integrated into a catchment area through a community participation model, allowing point-of-care primary health services to be provided to thousands of people in remote rural villagers. Strong relationships have been forged with local community leaders and with Malawi Ministry of Health officers as the foundation for long-term sustainable engagement and eventual integration of services into Health Ministry programs.

Unhealthy behaviours for self-management of HIV-related peripheral neuropathy.

The prevalence of peripheral neuropathy is frequent in HIV disease and is often associated with antiretroviral therapy. Unhealthy behaviours, particularly substance-use behaviours, are utilized by many HIV-positive individuals to manage neuropathic symptoms. As part of a larger study on self-care for symptoms in HIV disease, this study analyzed the prevalence and characteristics of unhealthy behaviours to self-manage peripheral neuropathy in HIV disease. Sociodemographic and disease-related correlates and unhealthy behaviours were examined in a convenience sample of 1,217 respondents who were recruited from data collection sites in several US cities, Puerto Rico, Colombia, and Taiwan. Results of the study indicated that respondents with peripheral neuropathy (n=450) identified a variety of unhealthy self-care behaviours including injection drug use, oral drug use, smoking cigarettes and alcohol ingestion. Specific unhealthy behaviours that participants reported to alleviate peripheral neuropathy included use of marijuana (n=67), smoking cigarettes (n=139), drinking alcohol (n=81) and street drugs (n=30). A subset of those individuals (n=160), who identified high levels of neuropathy (greater than five on a scale of 1-10), indicated significantly higher use of amphetamines and injection drug use in addition to alcohol use and cigarette smoking. For participants from Norway, substance use (using alcohol: 56%) was one of the most frequent self-management strategies. Implications for clinical practice include assessment and education of persons with HIV for self-care management of the complex symptom of peripheral neuropathy.

Perception of cabin air quality in airline crew related to air humidification, on intercontinental flights.

The influence of air humidification in aircraft, on perception of cabin air quality among airline crew (N = 71) was investigated. In-flight investigations were performed in the forward part and in the aft part on eight intercontinental flights with one Boeing 767 individually, equipped with an evaporation humidifier combined with a dehumidifying unit, to reduce accumulation of condensed water in the wall construction. Four flights had the air humidification active when going out, and turned off on the return flight. The four others had the inverse humidification sequence. The sequences were randomized, and double blind. Air humidification increased relative air humidity (RH) by 10% in forward part, and by 3% in aft part of the cabin and in the cockpit. When the humidification device was active, the cabin air was perceived as being less dry (P = 0.008), and fresher (P = 0.002). The mean concentration of viable bacteria (77-108 cfu/m(3)), viable molds (74-84 cfu/m(3)), and respirable particles (1-8 microg/m3) was low, both during humidified and non-humidified flights. On flights with air humidification, there were less particles in the forward part of the aircraft (P = 0.01). In conclusion, RH can be slightly increased by using ceramic evaporation humidifier, without any measurable increase of microorganisms in cabin air. The cabin air quality was perceived as being better with air humidification. PRACTICAL IMPLICATION: Relative air humidity is low (10-20%) during intercontinental flights, and can be increased by using ceramic evaporation humidifier, without any measurable increase of microorganism in cabin air. Air humidification could increase the sensation of better cabin air quality.

Symptom management and self-care for peripheral neuropathy in HIV/AIDS.

Peripheral neuropathy is the most common neurological complication in HIV and is often associated with antiretroviral therapy. As part of a larger study on self-care for symptoms in HIV disease, this study analyzed the prevalence and characteristics of peripheral neuropathy in HIV disease, sociodemographic and disease-related correlates and self-care strategies. A convenience sample of 1,217 respondents was recruited from data collection sites in several US cities, Puerto Rico, Colombia and Taiwan. Results of the study indicated that respondents with peripheral neuropathy (n=450) identified 20 self-care behaviors including complementary therapies, use of medications, exercise and rest and/or elevation of extremities. Ratings of frequency and effectiveness were also included. An activities checklist summarized into five categories of self-care behaviors including activities/thoughts, exercise, medications, complementary therapies and substance was used to determine self-care behaviors. Taking a hot bath was the most frequent strategy used by those with peripheral neuropathy (n=292) and received the highest overall rating of effectiveness of any self-management strategies included in this study at 8.1 (scale 1-10). Other self-care strategies to manage this symptom included: staying off the feet (n=258), rubbing the feet with cream (n=177), elevating the feet (n=236), walking (n=262), prescribed anti-epileptic agent (n=80), prescribed analgesics (n=84), over-the-counter medications (n=123), vitamin B (n=122), calcium supplements (n=72), magnesium (n=48), massage (n=156), acupuncture (n=43), reflexology (n=23) and meditation (n=80). Several behaviors that are often deemed unhealthy were included among the strategies reported to alleviate peripheral neuropathy including use of marijuana (n=67), cigarette smoking (n=139), drinking alcohol (n=81) and street drugs (n=30).

Health and perception of cabin air quality among Swedish commercial airline crew.

UNLABELLED: Health symptoms and perception of cabin air quality (CAQ) among commercial cabin crew were studied as a function of personal risk factors, occupation, and work on intercontinental flights with exposure to environmental tobacco smoke (ETS). A standardized questionnaire (MM 040 NA) was mailed in February to March 1997 to all Stockholm airline crew on duty in a Scandinavian airline (n=1857), and to office workers from the same airline (n=218). During this time, smoking was allowed only on intercontinental flights. The participation rate was 81% (n=1513) by the airline crew, and 77% (n=168) by the office group. Statistical analysis was performed by multiple logistic regression analysis, controlling for age, gender, atopy, current smoking habits, and occupation. The most common symptoms among airline crew were: fatigue (21%), nasal symptoms (15%), eye irritation (11%), dry or flushed facial skin (12%), and dry/itchy skin on hands (12%). The most common complaint about CAQ was dry air (53%). Airline crew had more nasal, throat, and hand skin symptoms, than office workers did. Airline crew with a history of atopy had more nasal, throat, and dermal face and hand symptoms than other crew members did. Older airline crew members had more complaints of difficulty concentrating, but fewer complaints of dermal symptoms on the face and hands than younger crew members did. Female crew members reported more headaches than male crew members reported. Smoking was not associated with frequency of symptoms. Pilots had fewer complaints of most symptoms than other crew had. Airline crew that had been on an intercontinental flight in the week before the survey had more complaints of fatigue, heavy-headedness, and difficulty concentrating. Complaints of stuffy air and dry air were more common among airline crew than among office workers from the same airline. Female crew had more complaints of stuffy and dry air than male crew had. Older cabin crew had fewer complaints of dry air than younger crew had, and cabin crew with atopy had more complaints of dry air than other crew had. Current smokers had fewer complaints of stuffy air than non-smokers had. Airline crew that had been on a flight on which smoking was allowed in the week before the survey, had more complaints of stuffy air, dry air and passive smoking, than crew that had not been on such a flight in the preceding week had. PRACTICAL IMPLICATIONS: Complaints on cabin air quality and health symptoms were common among commercial airline crew, and related to age, gender, atopy and type of work onboard. The hygienic measurements showed that the relative air humidity is very low on intercontinental flights, and particle levels are high on flights with passive smoking. This illustrates the need to improve the cabin air quality in commercial airlines. Such improvements could include better control of cabin temperature, air humidification, efficient air filtration with high efficiency particulate air filter (HEPA) filtration on all types of aircraft and sufficient air exchange rate in order to fulfil current ventilation standards.

PCR-generated linear DNA fragments utilized as a hantavirus DNA vaccine.

The field of DNA vaccines has grown rapidly, and since most such vaccines involve the inoculation of large circular DNA molecules previously propagated in bacteria, several inconveniences (e.g. the presence of antibiotic resistance genes, impurities from bacterial cultures or inefficient uptake of the large and bulky plasmid DNA molecules to the nucleus) are debated. In this study, we have explored the possibility of using smaller and more flexible PCR-generated linear DNA fragments instead. Phosphorothioate (PTO)-modified primers were used successfully to protect the PCR-generated DNA fragments from exonuclease degradation, and by using a nuclear localization signal-peptide to target the linear DNA to the nucleus the immune response against the encoded antigen was further improved. This approach was tested in cell culture using a sensitive reporter system and in vivo with DNA encoding the amino-terminus of the Puumala hantavirus nucleocapsid protein. Our results indicate that linear DNA fragments have a great potential as a genetic vaccine and phosphorothioate modification in combination with a nuclear localization signal peptide increase the stability and targets the linear DNA molecules to the nucleus resulting in an improved biological response examined both in vitro and in vivo.

Ocular, nasal, dermal and general symptoms among commercial airline crews.

OBJECTIVE: To study symptoms among a commercial cabin crew, in relation to personal risk factors, perceived psychosocial work environment, occupation, and work on intercontinental flights, with exposure to environmental tobacco smoke (ETS). METHODS: A standardized questionnaire (MM 040 NA) was mailed in February-March 1997 to all Stockholm aircrew on duty in a Scandinavian flight company ( n=1,857), and office workers from the same company ( n=218). During this time, smoking was allowed only on intercontinental flights. The participation rate was 81% ( n=1,513) of the aircrew, and 77% ( n=168) of the office group. Statistical analysis was performed by multiple logistic regression analysis, keeping age, gender, atopy, current smoking, occupation, and perceived psychosocial work conditions simultaneously in the model. RESULTS: The most common symptoms among the aircrew were fatigue (21%), nasal symptoms (15%), ocular symptoms (11%), dry or flushed facial skin (12%), and dermal hand symptoms (12%). The aircrew had more nasal (odds ratio (OR) = 3.12), throat (OR=5.75), and dermal symptoms on the face (OR=2.03), and hands (OR=3.68), than the office workers. The aircrew with a history of atopy had an increase of most symptoms (OR=1.5-3.8), but age, gender, or smoking was not associated with symptoms. Perceived stress due to excess of work was associated with fatigue (OR=7.33), feeling heavy-headed (OR=9.52), headache (OR=5.10), and facial dermal symptoms (OR=3.75), while those crew with better work control and work satisfaction had less fatigue. For most symptoms, there were no differences between different categories onboard, but pilots had fewer ocular (OR=0.28) nasal (OR=0.52), and dermal hand symptoms (OR=0.39). Airline crew that had been on an intercontinental flight the previous week had more complaints of fatigue (OR=1.87), heavy-headedness (OR=1.89), and difficulties concentrating (OR=3.22). CONCLUSION: There was an association between symptoms and work stress, lack of influence on working conditions, atopy, and work on intercontinental flights where smoking was allowed. In view of the increase of civil aviation, the working conditions for aircrews need further attention.

Cabin air quality: indoor pollutants and climate during intercontinental flights with and without tobacco smoking.

The aim was to determine cabin air quality and in-flight exposure for cabin attendants of specific pollutants during intercontinental flights. Measurements of air humidity, temperature, carbon dioxide (CO2), respirable particles, ozone (O3), nitrogen dioxide (NO2) and formaldehyde were performed during 26 intercontinental flights with Boeing 767-300 with and without tobacco smoking onboard. The mean temperature in cabin was 22.2 degrees C (range 17.4-26.8 degrees C), and mean relative air humidity was 6% (range 1-27%). The CO2 concentration during cruises was below the recommended limit of 1000 ppm during 96% of measured time. Mean indoor concentration of NO2 and O3, were 14.1 and 19.2 micrograms/m3, with maximum values of 37 and 66 micrograms/m3, respectively. The concentration of formaldehyde was below the detection limit (< 5 micrograms/m3), in most samples (77%), and the maximum value was 15 micrograms/m3. The mean concentration of respirable particles in the rear part of the aircraft (AFT galley area) was much higher (49 micrograms/m3) during smoking as compared with non-smoking conditions (3 micrograms/m3) (P < 0.001), with maximum values of 253 and 7 micrograms/m3. In conclusion, air humidity is very low on intercontinental flights, and the large variation of temperature shows a need for better temperature control. Tobacco smoking onboard leads to a significant pollution of respirable particles, particularly in the rear part of the cabin. The result supports the view that despite the high air exchange rate and efficient air filtration, smoking in commercial aircraft leads to a significant pollution and should be prohibited.

Experimental exposure to propylene glycol mist in aviation emergency training: acute ocular and respiratory effects.

OBJECTIVES: Propylene glycol (PG) (1-2 propanediol; CAS No 57-55-6) is a low toxicity compound widely used as a food additive, in pharmaceutical preparations, in cosmetics, and in the workplace-for example, water based paints, de-icing fluids, and cooling liquids. Exposure to PG mist may occur from smoke generators in discotheques, theatres, and aviation emergency training. Propylene glycol may cause contact allergy, but there is sparse information on health effects from occupational exposure to PG. METHODS: Non-asthmatic volunteers (n=27) were exposed in an aircraft simulator to PG mist over 1 minute, during realistic training conditions. Geometric mean concentration of PG was 309 mg/m3 (range 176-851 mg/m3), with the highest concentrations in the afternoon. The medical investigation was performed both before and after the exposure (within 15 minutes). It included an estimate of tear film stability break up time, nasal patency by acoustic rhinometry, dynamic spirometry, and a doctor's administered questionnaire on symptoms. RESULTS: After exposure to PG mist for 1 minute tear film stability decreased, ocular and throat symptoms increased, forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) was slightly reduced, and self rated severity of dyspnoea was slightly increased. No effect was found for nasal patency, vital capacity (VC), FVC, nasal symptoms, dermal symptoms, smell of solvent, or any systemic symptoms. Those exposed to the higher concentrations in the afternoon had a more pronounced increase of throat symptoms, and a more pronounced decrease of tear film stability. In four subjects who reported development of irritative cough during exposure to PG, FEV1 was decreased by 5%, but FEV1 was unchanged among those who did not develop a cough. Those who developed a cough also had an increased perception of mild dyspnoea. CONCLUSION: Short exposure to PG mist from artificial smoke generators may cause acute ocular and upper airway irritation in non-asthmatic subjects. A few may also react with cough and slight airway obstruction.

Cabin environment and perception of cabin air quality among commercial aircrew.

OBJECTIVE: Our objective was to study the perception of cabin air quality (CAQ) and cabin environment (CE) among commercial cabin crew, and to measure different aspects of CAQ on intercontinental flights. METHODS: A standardized questionnaire was mailed in February-March 1997 to all Stockholm-based aircrew on duty in a Scandinavian flight company (n = 1,857), and office workers from the same company (n = 218). The answers were compared with an external reference group for the questionnaire (MM 040 NA). During this time, smoking was allowed on intercontinental flights, but not on other shorter flights. Smoking was prohibited on all flights after 1 September 1997. The participation rate was 81% (n = 1,513) in the aircrew, and 77% (n = 168) in the office group. Air humidity, temperature, carbon dioxide (CO2) and respirable dust were measured during intercontinental flights, during both smoking and nonsmoking conditions. Statistical analysis was performed by multiple logistic regression analysis, keeping age, gender, smoking, current smoking, occupation, and perceived psychosocial work environment simultanously in the model. RESULTS: Air humidity was very low (mean 5%) during intercontinental flights. In most cases (97%) the CO2 concentration was below 1,000 ppm. The average concentration of respirable particles was 67 microg x m during smoking conditions, and 4 microg x m(-3) during non-smoking conditions. Complaints of draftiness, too high temperature, varying temperature, stuffy air, dry air, static electricity, noise, inadequate illumination, and dust were more common among aircrew as compared with office workers from the same company. Female crew had more complaints on too low temperature, dry air, and dust. Current smokers had less complaints on stuffy air and environmental tobacco smoke (ETS). Younger subjects and those with atopy (childhood eczema, allergy to tree or grass pollen, or furry animals) reported more complaints. Reports on work stress and lack of influence on working conditions were strongly related to perception of a poor cabin environment. Flight deck crew had more complaints about inadequate illumination and dust, but less complaints about other aspects of the cabin environment, as compared with flight attendants. Aircrew who had been on a flight the previous week, where smoking was allowed, had more complaints on dry air and ETS. CONCLUSION: Complaints about work environment seems to be more common among aircrew than office workers, particularly draft, stuffy air, dry air, static electricity, noise, inadequate illumination and dust. We could identify personal factors of importance, and certain conditions that could be improved, to achieve a better perception of the cabin environment. Important factors were work stress, lack of influence on the working conditions, and environmental tobacco smoke on some longer flights. The hygienic measurements in the cabin, performed only on intercontinental smoking flights, showed that air humidity is very low onboard, and tobacco-smoking onboard leads to significant pollution from respirable dust.

Changes in the ocular and nasal signs and symptoms of aircrews in relation to the ban on smoking on intercontinental flights.

OBJECTIVES: This study determined the influence of exposure to environmental tobacco smoke (ETS) in aircraft on measured and perceived cabin air quality (CAQ), symptoms, tear-film stability, nasal patency, and biomarkers in nasal lavage fluid. METHODS: Commercial aircrews underwent a standardized examination, including acoustic rhinometry, nasal lavage, and measurement of tear-film break-up time. Eosinophilic cationic protein, myeloperoxidase, lysozyme, and albumin were analyzed in the nasal lavage fluid. Inflight investigations [participation rate 98% (N=39)] were performed on board 4 flights, 2 in each direction between Scandinavia and Japan. Scandinavian crew on 6 flights from Scandinavia to Japan participated in postflight measurements after landing [participation rate 85% (N=41)]. Half the flights permitted smoking on board, and the other half, 0.5 months later, did not. Hygienic measurements showed low relative air humidity on board (2-10%) and a carbon dioxide concentration of <1000 ppm during 99.6% of the cruising time. RESULTS: The smoking ban caused a drastic reduction of respirable particles, from a mean of 66 (SD 56) microg/m3 to 3 (SD 0.8) microg/m3. The perceived CAQ was improved, and there were fewer symptoms, particularly ocular symptoms, headache and tiredness. Tear-film stability increased, and nasal patency was altered. CONCLUSIONS: Despite a high air exchange rate and spatial separation between smokers and nonsmokers, smoking in commercial aircraft may cause significant air pollution, as indicated by a large increase in respirable particles. This ETS exposure is associated with an increase in ocular and general symptoms, decreased tear-film stability, and alterations of nasal patency.

Urinary cotinine concentration in flight attendants, in relation to exposure to environmental tobacco smoke during intercontinental flights.

OBJECTIVES: To measure and compare the urinary cotinine concentration (U-cotinine) in non-smoking cabin attendants (C/A) working with the Scandinavian Airlines System, before and after work on intercontinental flights with exposure to environmental tobacco smoke (ETS). METHODS: The study material consisted of 24 cabin attendants and one pilot, all volunteers and all without exposure to ETS in the home, working on 15 intercontinental flights. Information on age, gender and occupation was gathered, as well as possible sources of ETS exposure in other places, outside work and during previous flights, during a 3-day period prior to the investigation. Urine samples were taken before departure and after landing, on board, and were kept frozen (-20 degrees C) until analysis. Cotinine was analyzed by a previously developed gas chromatographic method, using mass spectrometry (MS) with selected-ion monitoring (SIM). The difference in U-cotinine before and after the flight was compared. Moreover, the change in U-cotinine during the flight was related to occupation (work in the forward or aft galley) and observed degree of smoking during each flight. RESULTS: The median U-cotinine was 3. 71 microg/g crea; 2.4 microg/l (unadjusted) (interquartile range 2. 08-8.67 microg/g crea) before departure, and 6.37 microg/g crea; 7.1 microg/l (interquartile range 3.98-19 microg/g crea) after landing, a significant difference (P < 0.003). C/A in the aft galley had a significantly higher concentration of U-cotinine after landing than subjects working in the front of the aircraft (P=0.01). In C/A working in the aft galley, the median increase of U-cotinine was 3. 67 microg/g crea; 3.2 microg/l (interquartile range 0.04-13.8 microg/g crea) during flight. In contrast, those seven subjects working in the forward part of the aircraft had no increase in U-cotinine during the flight (median increase 0.97 microg/g crea; 0. 5 microg/l interquartile range 0.27-2.65 microg/g crea). CONCLUSION: Tobacco smoking in commercial aircraft may cause significant exposure to environmental tobacco smoke among C/A working in the aft galley, despite high air exchange rates and spatial separation between smokers and non-smokers. This agrees with earlier studies, as well as measurements on the aircraft, showing a higher degree of ETS-related air pollution in the aft galley than in the forward galley. The average cotinine concentration in urine was similar to that in other groups with occupational exposure to ETS, e.g., restaurant staff, police interrogators and office workers. Since smoking in commercial aircraft may result in an involuntary exposure to ETS among non-smokers, it should be avoided.

Short-term effects of perinatal asphyxia studied with Fos-immunocytochemistry and in vivo microdialysis in the rat.

In the present study, the short-term consequences of various perinatal asphyctic periods were studied at the peripheral and CNS levels in the rat. Perinatal asphyxia was induced in rat pups delivered by caesarean section within the last day of gestation, by placing the uterus horns including the fetuses in a water bath at 37 degrees C for various periods of time (0-23 min). Following asphyxia, the uterus horns were opened. The pups were then removed and stimulated to breathe. Subcutaneous levels of pyruvate (Pyr), lactate (Lact), glutamate (Glu), and aspartate (Asp) were monitored with microdialysis 40 min after delivery. In parallel experiments, the pups were sacrificed 80 min after delivery. The brains were removed, fixed, cut, and processed for Fos immunocytochemistry. The number of Fos-immunoreactive (IR) cells in different brain structures was counted under light microscopy. Subcutaneous levels of Pyr, Lact, Glu, and Asp increased following perinatal asphyxia, as compared to caesarean-delivered pups or to spontaneously delivered controls. A maximum increase in Pyr levels (approximately threefold) was observed with 2-3 min of asphyxia, while Lact levels increased along with the length of asphyxia. A maximum increase in Glu and Asp levels (approximately threefold) was observed with 10-11 min of asphyxia. Fos-IR nuclei were predominantly found in the piriform cortex, and in the cortical amygdaloid complex. In some cases, mainly in pups exposed to asphyxia, Fos-positive cells were also seen in other tele-diencephalic structures.

Unintentional lens injury in glaucoma surgery.

In 1891, Priestly Smith wrote that in glaucoma surgery, "the lens is occasionally wounded, unsuspected by the operator," and described serious consequences. In 1953 Christensen and McLean found histologic evidence of perforation of the lens capsule in many eyes which had been enucleated after unsuccessful glaucoma surgery. Twelve additional enucleated eyes with lens perforations plus clinical consultations indicate that unintentional surgical injuries to the lens still are occurring during iridectomies, filtrations, and trabeculectomies and usually are unsuspected by the surgeon. This injury should be considered when a lens opacity becomes manifest within a few days or weeks after surgery. In addition to failure of the operation, the consequences vary from limited cataract formation to complete opacification and subluxation of the lens. The lens injury also may cause a severe phacogenic uveitis which requires early lens extraction to avoid extensive intraocular fibroplasia. Clinical features and histopathology are presented with illustrative cases. The prevention and management of unintentional lens injury are discussed.