Retinal dialysis and detachment in a child after airbag deployment.

A variety of airbag-associated ocular injuries have been reported in children sitting in the front passenger seat during automobile collisions. These injuries range from corneal abrasions to traumatic hyphema with secondary glaucoma and cataract. We report the case of a 5-year-old boy who experienced retinal dialysis and detachment associated with airbag deployment. The patient recovered 20/20 visual acuity after cryopexy and placement of a radial sponge.

Cervical intervertebral disc injury during simulated frontal impact.

Cervical disc injury due to frontal impact has been observed in both clinical and biomechanical investigations; however, there is a lack of data that elucidate the mechanisms of disc injury during these collisions. The goals of the current study were to determine the peak dynamic disc annular tissue strain and disc shear strain during simulated frontal impact of the whole human cervical spine model with muscle force replication at 4 g, 6 g, 8 g and 10 g horizontal accelerations of the T1 vertebra. These data were compared with those obtained during physiological loading, and with previously reported rear impact data. Peak disc shear strain and peak annular tissue strain during frontal impact exceeded (p<0.05) corresponding physiological limits at the C2-C3 intervertebral level, beginning at 4 g and 6 g, respectively. These subsequently spread throughout the entire cervical spine at 10 g, with the exception of C4-C5. The C5-C6 intervertebral level was at high risk for injury during both frontal and rear impacts, while during frontal impact, in addition to C5-C6, subfailure injuries were likely at superior intervertebral levels, including C2-C3. The disc injuries occurred at lower impact accelerations during rear impact as compared with frontal impact. The subfailure injuries of the cervical intervertebral disc that occur during frontal impact may lead to the chronic symptoms reported by patients, such as head and neck pain.

Near confluent laser photocoagulation for the treatment of threshold retinopathy of prematurity.

OBJECTIVE: To evaluate the effect of a near confluent pattern of indirect laser photocoagulation in reducing the rate of progression and re-treatment of threshold retinopathy of prematurity. METHODS: This study examined a noncomparative interventional case series. We performed a retrospective review of the medical records of patients who underwent peripheral laser ablation by 1 surgeon for threshold retinopathy of prematurity from 1997 to 2002. A total of 58 eyes from 31 patients were treated, and 44 eyes of 23 patients were included in the study. Ten eyes of 5 infants had zone 1 disease, and 34 eyes of 18 infants had zone 2 disease. Laser spots were placed in a near confluent pattern in the peripheral avascular retina between the ridge of extraretinal proliferation and the ora serrata. The mean +/- SD number of laser spots was 2534 +/- 455 for zone 1 (range, 2100-3378) and 1850 +/- 487 for zone 2 (range, 1030-2689). RESULTS: In 7 eyes of 4 infants with zone 1 disease, the retinopathy regressed and did not require any further treatment. Three eyes of 2 infants, however, progressed after laser treatment and required vitrectomy surgery. Progression was defined as the development of stage 4 or 5 disease. None of the patients with zone 2 disease had progression of retinopathy, and none of them needed more than 1 treatment. Patients tolerated the procedure well, and there were no complications at the time of the procedure or at follow-up visits. CONCLUSIONS: A near confluent pattern of laser photocoagulation may reduce the rate of progression of threshold retinopathy of prematurity in zone 2 (0%). The near confluent pattern of treatment may also reduce the re-treatment rate of the disease (0%). Larger studies are needed to confirm our findings.

Anterior segment complications related to vitreous substitutes.

Vitrectomy is the most common surgical technique performed in eyes with vitreoretinal disease. The development and widespread use of vitreous substitutes has revolutionized vitreoretinal surgery and improved anatomic and visual results. The three most common types of vitreous substitutes available in North America include silicone oil, intraocular gas, and perfluorocarbon liquid. Each of these agents has unique properties, allowing completely different roles of the agents in vitreoretinal surgery. The physical properties, clinical indications, and potential complications of these agents are described.

Ocular manifestations of injection drug use.

Injection drug use can result in a variety of severe ocular conditions. Hematogenous dissemination of various fungi and bacteria may produce endophthalmitis with resultant severe visual loss. Retinal arterial occlusive disease may result from talc and other particulate emboli. Most commonly, life-threatening systemic diseases such as endocarditis and HIV infection secondarily affect the eye. Because many of these conditions may result in blindness if untreated, accurate diagnosis and prompt initiation of therapy are essential.

[Neurohumoral mechanisms in pathophysiology of chronic heart failure]. / Mechanizmy neurohumoralne w patofizjologii przewleklej niewydolnosci serca.

Pathogenic mechanisms of chronic systolic heart failure are constantly of great interest. In recent years the neurohumoral theory of heart failure has gained attraction. According to this theory, neurohumoral mechanisms play the main role in the pathogenesis of heart failure, especially in its progression. These mechanisms can be divided into 2 categories: vasoconstrictive, mitogenic and antinatriuretic on the one hand and vasodilative, antimitogenic and natriuretic on the other one. The former consists of sympathetic nervous system, renin-angiotensin-aldosterone system, vasopressin, endothelin, cytokines. The latter comprises natriuretic peptides, prostaglandins and nitric oxide. Undoubtedly unfavourable roles of sympathetic system and renin-angiotensin-aldosteron have been shown in the progression of heart failure. Data are being also gathered confirming harmful effects of endothelin and cytokines and possibly of neuropeptide Y and vasopressine. Extensive data exist that demonstrate beneficial influence of natriuretic peptide on heart failure. The roles of nitric oxide as well as recently discovered adrenomedullin and medullipin are far from clear.

Inhibition of gastric secretion relieves diarrhea and postprandial urgency associated with irritable bowel syndrome or functional diarrhea.

Five patients with gastroesophageal reflux disease (GERD), who also had chronic functional diarrhea and postprandial urgency, unexpectedly noted rapid relief of their diarrhea and urgency when they took lansoprazole for their heartburn. To determine if this surprising result was not fortuitous, all 20 patients seen during the next six months for chronic diarrhea and postprandial urgency due to irritable bowel syndrome (IBS) or functional diarrhea were treated with inhibitors of gastric secretion: 14 with proton-pump inhibitors and 6 with H2 blockers. All patients had rapid, marked improvement. Usually within three days, their symptoms abated and they usually had one to three formed stools per day. Relief continued during the one to six months they were followed on therapy. Five patients stopped therapy, had recurrent diarrhea, and rapid relief upon resuming therapy. Thus, inhibition of gastric secretion effectively controls the diarrhea and postprandial urgency associated with IBS or functional diarrhea, probably by diminishing the gastrocolic or gastroenteric reflex.

Age-dependent retinoic acid regulation of gene expression distinguishes the cervical, thoracic, lumbar, and sacral spinal cord regions during development.

We evaluated whether differences in the availability of retinoic acid (RA) establish distinct patterns of RA-dependent gene expression in the embryonic mouse thoracic/sacral versus cervical/lumbar spinal cord regions. Exogenous RA elicits ectopic expression of an RA-activated transgene and the RA receptor beta in the dorsal thoracic and sacral cord in mice at embryonic day (E) 12.5, but not E14.5. This age-dependent regulation is cell autonomous and is not accompanied by changes in expression patterns of several retinoid receptors, binding proteins, or the SMRT nuclear corepressor. Instead, this change apparently reflects the loss of endogenous RA in the dorsal thoracic and sacral cord between E12.5 and E14.5. Thus, chronic exposure to exogenous RA between E11.5 and E13.5 restores ectopic RA-mediated gene expression. These observations suggest that the local availability of RA establishes absolute differences in gene expression that distinguish the thoracic and sacral cord from the cervical and lumbar cord during midgestation.

Nutrition, biochemistry, and tinnitus.

Biochemical mechanisms are a significant factor in neurootological problems. Investigation of biochemical causes of neurootological problems, such as tinnitus, are warranted and can be cost-effective. Dietary, nutritional, chemical, hormonal, immunological, and stress factors are involved directly in neurootological problems and must be evaluated and considered in designing the treatment regimen for patients complaining of tinnitus.

T cells specific for a polymorphic segment of CD45 induce graft-versus-host disease with predominant pulmonary vasculitis.

To study the character of graft-vs-host disease (GVHD) induced by T cells specific for hemopoietic cells, T cells specific for a polymorphic segment of CD45 were transferred into CD45 congenic mice. C57BL/6 mice that express the CD45b allele were immunized with a 13 mer peptide representing the polymorphic segment (p257-268) of CD45a protein. Conversely, C57BL/6 mice congenic for CD45a were immunized with the CD45b peptide. CD4+ T cells specific for allelic CD45 peptides were elicited. Importantly, T cells specific for CD45 peptides proliferated specifically and vigorously in response to spleen cells expressing the appropriate polymorphic CD45 protein. T cells specific for CD45 induced a substantial graft-vs-host response (GVHR) with predominant early pulmonary vasculitis and later more widespread interstitial mononuclear cell infiltration and alveolitis. No GVHR was induced in bone marrow chimeras expressing only donor hemopoietic cells. Thus, donor T cell recognition of host hemopoietic cells is sufficient to elicit GVHR, but the classical skin, liver, and gut manifestations of GVHD were not observed. The CD45-specific T cells used secreted Th1 cytokines, but without detectable soluble IL-2. Studies using CD45-specific T cells with different effector functions might allow further dissection of donor cell requirements for GVHD syndromes.

The infectious etiology of peptic ulcer disease. Diagnosis and implications for therapy.

During the past decade, peptic ulcer disease has become recognized as multifactorial in etiology, with a major component thought to be infection of the gastric mucosa with a spiral-shaped bacterium known as Helicobacter pylori. This organism has been found to cause most cases of chronic gastritis and is clearly pathogenic in most cases of duodenal and gastric ulceration. Biologic characteristics, epidemiology, and methods of detection (invasive and noninvasive) of H. pylori are discussed from a clinical perspective. Finally, eradication of H. pylori infection is difficult because of bacterial resistance and patient noncompliance.

Pancreatitis. Evaluation and treatment.

Acute and chronic pancreatitis present challenging problems for the physician. In acute pancreatitis, initial efforts should be directed toward supporting the patient hemodynamically. Recognition and early treatment of complications such as shock, renal failure, respiratory failure, hypocalcemia, abscess, hemorrhage, or unremitting symptoms caused by an impacted stone in the common bile duct are necessary. The cause of the pancreatitis must be identified, possibly for acute therapy, but certainly to prevent recurrences and progression of disease. In chronic pancreatitis, insufficiencies of pancreatic function must be identified and consequent malabsorption and diabetes treated appropriately. The major challenge is the relief of chronic pain. It is hoped that this can be accomplished medically, but in carefully selected cases, specific types of surgery may be required.

Peptide-based, but not whole protein, vaccines elicit immunity to HER-2/neu, oncogenic self-protein.

HER-2/neu, an overexpressed oncogenic protein, has been proposed as a human cancer vaccine target. HER-2/neu is a "self" protein, however, and methods of vaccine strategies that would be effective in immunizing patients to a "self" tumor Ag have not been established. Many of the tumor Ags defined in humans are nonmutated self proteins, e.g., MAGE, and overcoming tolerance may be key in the generation of effective anti-tumor immunity. One theory states that tolerance to self proteins is directed only to dominant epitopes of proteins and not to every portion of the protein. Accordingly, tolerance can be circumvented by immunization to peptide fragments, but not whole protein. The studies outlined here demonstrate rat neu-specific immunity could be elicited in rats by vaccination with immunogenic rat neu peptides, but not by immunization with the intact protein. A rat model was used since rat neu protein is 89% homologous to human HER-2/neu protein and has a similar tissue distribution and level of expression. Rats were immunized with groups of peptides derived from the amino acid sequence of the intracellular domain or extracellular domain of rat neu protein and both groups developed CD4+ T cell immunity and Ab immunity to rat neu peptides and protein. Animals immunized in a similar fashion with intact purified rat neu protein did not develop Ab or T cell immunity to rat neu. Furthermore, rats that developed neu-specific immunity showed no histopathologic evidence of autoimmunity directed against organs expressing basal levels of rat neu protein. These studies suggest an immunization strategy that might be effective in human cancer vaccines targeting self tumor Ag.

Variation in civil commitment processes across jurisdictions: an approach for monitoring and managing change in mental health systems.

This article demonstrates how unique local factors affect implementation of commitment statutes and, consequently, the extent to which implementation supports fundamental treatment philosophies. Four local variations in the implementation of Ohio's commitment statute are examined with a methodology designed to describe commitment processes. Qualitative case studies highlight factors that appear to contribute to variability across these sites. The authors contend that this information can be used as a system management tool at the state and local levels to (1) suggest needed changes in local service systems, (2) identify specific options/interventions for effecting change in desired directions and (3) assess the extent to which changes affect commitment processes in predictable ways that are consistent with philosophical principles.

The effects of short-term lansoprazole therapy on Helicobacter pylori infection and antral gastritis in duodenal ulcer patients.

BACKGROUND/AIMS: Lansoprazole is a new potent proton pump inhibitor that exhibits activity against Helicobacter pylori in vitro. This study endeavored to determine the effects of 4 wk of lansoprazole therapy upon H. pylori infection and antral gastritis in duodenal ulcer patients and to determine the relationship of the gastritis with Helicobacter infection and with ulcer activity. METHODS: Satisfactory antral biopsies were obtained from 119 duodenal ulcer patients before and after 4 wk of therapy with lansoprazole, ranitidine, or placebo. Sections were scored blindly for degree of active and chronic inflammation and extent of H. pylori infection. RESULTS: Four weeks of lansoprazole (30 mg daily) or ranitidine (300 mg daily) therapy produced a significant decrease in H. pylori infection. The reduction of H. pylori infection, but not ulcer healing per se, correlated with the decrease in active and chronic antral inflammation. Reduction of H. pylori infection, however, did not improve the good ulcer-healing rates already achieved at 4 wk by potent acid inhibition. CONCLUSIONS: Lansoprazole exhibits activity against H. pylori in vivo. Short-term improvement in antral gastritis is affected by reduction of H. pylori infection but not by ulcer healing.