Botulinum A toxin treatment of a deviated orbital implant.

We report a case of progressive deviation of an implant that resulted in conjunctival thinning and an inadequately fit prosthesis. Such a case may have been treated with conjunctival grafting or replacement of the implant with an hydroxyapatite sphere. In this case, injection of botulinum A toxin (Botox) into the contracted medial rectus muscle contributed to the successful refitting of a new and stable prosthesis and improvement of the conjunctival integrity. Possible explanations of the progressive shift in the position of the implant and its postinjection stability are discussed.

Effect of varying drop size on the efficacy and safety of a topical beta blocker.

We studied the effects on efficacy and safety of varying the drop size of a topical solution of levobunolol 0.5%. In a double-masked, crossover acute study, we administered a single drop of either 35 microL of vehicle, or 20, 35, or 50 microL of levobunolol one hour before the subjects began a ten-minute treadmill challenge electrocardiogram. After exercise the mean heart rate was 111 beats per minute (bpm) in the vehicle group and 102 to 103 bpm in the three levobunolol groups, which were significantly different from the control group but not from each other. In a randomized double-masked, parallel, chronic study, 117 patients with elevated intraocular pressure (IOP) instilled one of the three drop sizes of levobunolol twice daily for three months. Mean decreases in IOP ranged from 5.1 to 6.0 mmHg in the three groups, not significantly different from each other in mean IOP, heart rate, or blood pressure. We conclude that drop size in the range tested had no clinically significant effect on either efficacy or safety of a beta blocker such as levobunolol.

Expanded binocular peripheral visual fields following surgery for esotropia.

We measured the horizontal extent of the binocular peripheral field of vision in ten adult esotropes using Goldmann perimetry before and after strabismus surgery. In every case there was expansion of the field by an amount approximately commensurate with the change in angle of strabismic deviation. This occurred regardless of the presence of amblyopia or recovery of binocular fusion. Subjective improvement in peripheral vision was appreciated by a number of patients. Visual field expansion should be recognized as a significant indication for correction of esotropia.

Enzyme-linked immunosorbent assay for detection of antibodies against Streptococcus pneumoniae capsular polysaccharides.

The development of an assay to measure the human immune response to pneumococcal capsular polysaccharides is described.

Evaluation of commercial latex agglutination reagents for grouping streptococci.

A total of 155 strains of beta-hemolytic streptococci were serologically grouped by conventional techniques (Lancefield extraction and capillary precipitin testing) and by latex agglutination (LA). Agreement between conventional and LA techniques was 97% when the instructions of the manufacturer for the LA technique were followed. Agreement of 99% was obtained when modified autoclave extracts were used as antigens in the LA procedure. A total of 82 strains of non-beta-hemolytic streptococci were also tested by conventional, prescribed LA, and modified autoclave procedures. The agreement between conventional techniques and both LA procedures was 76%. However, when serological cross-reactions in the conventional grouping procedures were considered as errors, the accuracy of identification of both LA procedures was 88% among the non-beta-hemolytic strains. Of 13 strains of Streptococcus bovis, 10 did not react with the LA group D reagent but were serogroup D by conventional techniques. More S. bovis strains were grouped by the LA technique when extracts of 20 ml of broth cultures were used as antigens; however, cross-reactions were observed with non-group D strains when this technique was applied to them.

Presumptive identification of group A, B, and D streptococci on agar plate media.

Several presumptive tests were evaluated for their effectiveness in differentiating streptococci. When the tests were combined into a battery and the resulting reactions were interpreted as patterns, the overall presumptive identification rate was at least 97%. We used the hemolytic reaction, susceptibility to bacitracin and sulfamethoxazole plus trimethoprim (1.25 micrograms plus 23.75 micrograms), and standard CAMP reactions on sheep blood Trypticase soy agar, and bile-esculin and 6.5% NaCl agar tolerance tests with incubation in candle extinction jars. Subsequently, 98.9% of the group A; 95.3% of the group B; 100% of the beta-hemolytic non-group A, B, or D; 92.3% of group D enterococcal; 100% of the group D non-enterococcal; and 92.8% of the viridans streptococci were presumptively identified. We then used the hemolytic reactions, susceptibility of bacitracin and sulfamethoxazole-plus-trimethoprim disks, CAMP disk reactions on sheep blood Trypticase soy agar and bile-esculin and 6.5% NaCl agar tolerance tests with incubation in normal atmosphere. Subsequently, 98.1% of the group A; 98.6% of the group B; 99.2% of the beta hemolytic non-group A, B, or D; 97.5% of the group D entercoccal; 97.6% of the group D non-entercoccal; and 92.4% of the viridans strains were presumptively identified.

Presumptive identification of group A, B, and D streptococci.

A battery of five tests was used for presumptive identification of the pathogenic streptococci. The non-serological methods included determination of hemolysis for all strains, bacitracin susceptibility for group A streptococci, hippurate hydrolysis by group B streptococci, and bile-esculin reaction for group D streptococci. Enterococcal group D streptococci were differentiated from non-enterococcal group D streptococci by 6.5% NaCl tolerance. Two other categories of streptococci resulted: beta-hemolytic streptococci non-groups A, B, or D; and alpha- or nonhemolytic streptococci, not enterococci, not further identified (viridans streptococci). The tests were used as a battery and not as single entities. In this manner more than 99% of the group A, 99% of the group B, 81% of the beta-hemolytic streptococci non-group A, B, or D, 99% of the group D enterococci, 97% of the group D non-enterococci, and 94% of the viridans streptococci were correctly identified.

Distribution by serological type of group B streptococci isolated from a variety of clinical material over a five-year period (with special reference to neonatal sepsis and meningitis).

A total of 898 group B streptococci isolated from a wide variety of human clinical sources from July 1967 through June 1972 were typed by the Lancefield precipitin test. Only 11% of the strains were nontypable. Twenty-six percent of the group B strains were from respiratory sources, 22% were from cerebrospinal fluid (CSF) and blood, 13% were from the female genital tract, 12% were urine specimens, and the remaining 27% were from other varied sources. The clinical conditions reported for patients from whom these organisms were isolated included neonatal meningitis and sepsis, pharyngitis, urinary tract and female genital tract infections, and various skin and wound infections. Seventy percent of the CSF and blood cultures from patients with meningitis or sepsis, or both, were type III, whereas the overall percentage of this type was 32%. All but three CSF isolates were from patients under 2 years of age; the distribution of CSF isolates appeared to be the same for both sexes. In contrast, group B streptococci were isolated more frequently from the blood of males than from the blood of females. There were twice as many blood cultures from patients under 2 years of age than from those that were older.