Penetrating eye injury from a rigid infant pacifier.

BACKGROUND: The use of infant pacifiers (dummies) is common in Australasian communities and has been reported to be associated with various injuries, but to date ocular trauma has not been reported. CASE REPORT: A 14-month-old child sustained a penetrating eye injury from the infant pacifier that was in his mouth during a minor fall. Only a lid laceration was detected at the time. One week later he presented with mydriasis, heterochromia and a poor red reflex. Diagnosis of a penetrating eye injury was made by examination under anaesthesia, with B-scan ultrasonography demonstrating hypotony but no retinal detachment or intraocular foreign body. Funduscopy revealed a small inferior vitreous haemorrhage. Exploration of the globe adjacent to the lid wound showed a 6 mm laceration through the sclera plugged with prolapsed vitreous. CONCLUSION: Serious ocular injury may result after a minor fall with some designs of rigid infant pacifiers. Heterochromia and anisocoria noted by the mother heralded more serious ocular injury in this case. The delay in diagnosis of this injury emphasizes the importance of ocular examination to exclude eye trauma when injuries occur around the orbit.

Renin-containing Müller cells of the retina display endocrine features.

PURPOSE: An ocular renin-angiotensin system has been implicated in the proliferation of retinal blood vessels and blindness in diabetes mellitus. Its cellular basis has not been established. The objective was to identify sites of renin synthesis, secretion, and processing in eyes from humans, BALB/c mice, Sprague-Dawley rats, and a hypertensive transgenic rat model (mREN-2) that displays amplified extrarenal renin synthesis. METHODS: Paraffin sections of eyes were incubated with antisera to renin protein, prorenin, vimentin, and Müller cells. Enzyme kinetic renin assay was performed on extracts of whole eyes (excluding lens and vitreous) and comparisons made with adrenal glands and kidneys. For detection of renin mRNA, retinas were separately pooled from BALB/c and Swiss mice. RESULTS: In normal rodent and autopsy human eyes, labeling for renin, vimentin, and Müller cell protein was observed in the cytoplasm of all macroglial Müller cells, with renin labeling most obvious in endfeet closely apposed to retinal blood vessels. Prorenin labeling was not detected. Less intense renin labeling, again without prorenin, was seen in nonpigmented ciliary epithelium of rodents. In transgenic (mREN-2) rat eyes, renin and prorenin labeling of Müller cells and nonpigmented ciliary epithelium were intense. Prorenin was localized to the posterior region of Müller cells but only sparsely to endfeet in rodent retinas, and renin was present only in an active form in amounts one third that of one adrenal. Renin mRNA was readily detected. In human retina, renin was present in active and pro-forms, and the total amount was approximately one fiftieth that of adrenal. CONCLUSION: Renin is synthesized in the retina and is specifically localized to the macroglial Müller cells. Nonpigmented ciliary epithelium also contains renin. The presence of prorenin in the posterior part of the Müller cell, with active renin throughout but notably in endfeet in apposition to retinal capillaries, suggests directional processing of renin. These findings are consistent with earlier suggestions that retinal neovascularization may be associated with Müller cell dysfunction.

Cerebral-evoked response from stimulation of dorsal nerve in impotent men.

Cerebral-evoked responses from 128 uncategorized, impotent men were compared with responses from 17 healthy age-height matched controls, after stimulation of two penile sites, and one tibial nerve at the ankle. Our goal has been to establish a simple screening test to identify neurogenic impotence in patients with normal superficial sensation. High-frequency stimulation at 5.7 c/s and minimal repetitions (300) per trial, allowed thirty to forty minute sessions in alert subjects. With these methods, the amplitudes of cerebral responses at N2 were most informative. All volunteers had measurable amplitude while 11.9 percent of patients did not. An additional 4.5 percent of patients had amplitude suppression of 2 SD compared with the control mean, suggesting that as many as 16.4 percent of such patients may have neural damage. Prolonged latencies alone were rare and not included in this total. Ninety-two of these 128 patients had Doppler flow studies, and only 2 showed both Doppler and electrical abnormalities. This suggests that neurogenic problems may often be independent of vascular disease. This evoked-response screen of the entire genitocerebral neuraxis offers a safe method of identifying a portion of those patients with neurogenic impotence.

Office uroflowmetry using a maximum flow rate purge meter.

The use of a purge size rotameter for the determination of maximum urinary flow rates represents an inexpensive and non-invasive method to detect obstructive or neurogenic lower urinary tract abnormalities. We have used the device to identify successfully selected patients with such abnormalities.

Protein electrophoretic patterns of canine prostatic fluid. Effect of hormonal manipulation.

The effects of castration and estrogen administration on prostatic fluid proteins were compared in two groups of dogs. Prostatic fistulae were created in 10 animals and prostatic fluid secretions stimulated by electroejaculation. After a stabilization period, five animals were administered polyestradiol phosphate and the remaining five were castrated. After 3 months estrogen administration was discontinued and depo-testosterone was administered to the castrate animals. Fluids were collected at weekly intervals throughout the study and prostatic fluid proteins separated by sodium dodecyl sulfate polyacrylamide gel electrophoresis. No difference between animal receiving estrogen and castrated animals was noted and administration of testosterone to castrate animals reestablished a normal protein pattern.

Anatrophic nephrolithotomy in the solitary kidney.

A retrospective analysis was conducted on 30 patients who had undergone anatrophic nephrolithotomy for staghorn calculus disease in a solitary kidney. No statistically significant difference (p greater than 0.1) was found between the average preoperative and postoperative renal function values. Of 27 patients who were infected preoperatively 19 were rendered free of further urinary tract infection and 24 of 30 patients (80 per cent) had no further recurrence of renal calculi. Because of the predictable morbidity and mortality associated with the non-operative management of staghorn calculus disease these patients are managed best by the complete surgical removal of all calculi and intensive antimicrobial therapy.

Struvite staghorn calculi in crossed fused ectopia.

Two patients with a struvite staghorn calculus in crossed fused renal ectopia are described. The susceptibility of these patients to urinary tract infection is discussed as is the anomalous extrarenal arterial vasculature to the ectopic and non-ectopic kidneys. Both patients were treated successfully with anatrophic nephrolithotomy and each has remained free of recurrent calculous disease to date.

Intrarenal nephrolithotomy and reconstruction of the solitary kidney.

There were 30 patients with solitary kidneys containing staghorn claculi who have been subjected to nephrolithotomy with extensive plastic revision of strictured calices using local renal hypothermia. These patients have been followed for 8 months to 16 years and all have had a recent in-hospital evaluation of renal function and recurrent stone formation. No surgical mortality occurred (death within 3 months of operation). Seven patients have died postoperatively, only 1 of whom had associated progressive deterioration of renal function as a contributory cause of death. It is concluded that surgical removal of calculi from a solitary kidney is a relatively safe procedure that results in significant improvement in the patient's well being. The degree of improvement is of such a nature that it may be equated to "cure of the disease" in 63 per cent of the patients.