Crack eye syndrome.

BACKGROUND: Cocaine is an alkaloid prepared from the leaves of the Erythroxylon coca plant. It is widely recognized as one of the most dangerous illicit drugs in use today. The U.S. Substance Abuse and Mental Health Services Administration estimates that 23.5 million Americans have used cocaine at some time in their life. Corneal defects from crack cocaine were first described in 1989 and later named crack eye syndrome in 1993. CASE REPORT: A 40-year-old man reported to the eye clinic reporting vigorous eye rubbing after repeated exposure to and use of crack cocaine. A corneal infiltrate with an overlying epithelial defect developed and the man was treated with ciprofloxacin, homatropine, and diclofenac. This case presents background information concerning the systemic and ocular manifestations of cocaine, as well as the clinical presentations of crack eye syndrome, with recommendations on treatment. CONCLUSIONS: A thorough social history should be elicited when patients who have unilateral or bilateral corneal defects of unknown origin are examined, or when treating persons with no other known risk factors for corneal disruption. Prompt recognition and treatment are the main factors in successful management of crack eye syndrome.

Biomechanical evaluation of cervical spine stabilization methods using a porcine model.

STUDY DESIGN: The biomechanical stability of three different methods of cervical spine stabilization was evaluated in a porcine model. Specimens were tested in flexion, extension, and axial rotation. OBJECTIVES: Our goal was to determine if posterior lateral mass plating after anterior reconstruction provided more stability compared with unicortical or bicortical anterior plate fixation after a simulated corpectomy. SUMMARY OF BACKGROUND DATA: Previous implant biomechanical evaluations use ligamentous and intervertebral disc disruption models under constrained and nonrepetitive loading. This study examines implant performance using a corpectomy model loaded for multiple cycles, allowing for unconstrained motion. METHODS: Twenty-one porcine cervical spines were destabilized with a one-level cervical corpectomy and reconstructed with an anterior methacrylate graft. Each construct was stabilized with either an AO Morscher plate system with unicortical, self-locking screws; a Caspar plate with biocortical screws; or two posterior lateral mass plates. Testing with cyclic loads was performed on an MTS machine in flexion, extension, and axial rotation. RESULTS: There was no statistical difference between the two anterior forms of fixation in flexion, extension, or axial rotation. Posterior lateral mass plating was significantly more stable than either anterior construct. Screw loosening was seen more frequently with bicortical Caspar plating. CONCLUSIONS: After a single-level cervical corpectomy and idealized grafting, all three surgical constructs provided stability equal to or greater than the intact condition in flexion, extension, and axial rotation. In unstable cervical spine injury patterns involving anterior disruption, this study supports the use of anterior grafting combined with posterior lateral mass plating to achieve maximum stability.

A contact-coupled finite element analysis of the radiocarpal joint.

A plane-strain finite element contact model of the radiocarpal joint has been developed to investigate the mechanical relationship between initial intra-articular fracture of the distal radius, subsequent imprecise reduction of articular incongruency, and final onset of osteoarthrosis. The model includes the radius, two carpal bones (the lunate and the scaphoid), and the articulations and ligamentous connections between the bones. The model has been validated through comparisons with previous experimental and computational models of the wrist. The relationship between malreduced intra-articular fracture of the distal radius and the subsequent onset of posttraumatic radiocarpal osteoarthrosis is clinically important but poorly understood. The broad objective of the current research is the development of a well-verified computational model of the radiocarpal joint, which in concert with previously developed experimental models, will be capable of providing guidance toward rigorously grounded improvements in distal radius intra-articular fracture management techniques. This model represents a first step toward this objective as well as a new level of computational simulation of wrist mechanics.

Effects of intraperitoneal L-leucine, L-isoleucine, L-valine, and L-arginine on milk fat depression in early lactation cows.

Eight Holstein cows were assigned following calving to two groups, balanced for parity, using a continuous completely randomized block design. Cows were fed a diet with 13.5% CP and 22.4% ADF from 35 to 55 DIM and then 13.8% CP and 15% ADF from 56 to 92 DIM. Alfalfa grass hay was the forage source, and concentrate mixtures contained primarily corn and soybean meal. Cows were given daily intraperitoneal infusions of a solution of L-Leu (46.1 g, 84.2 mM), L-Ile (31.4 g, 57.3 mM), L-Val (38.3 g, 78.2 mM), and L-Arg (25.0 g, 34.4 mM) or physiological saline following the a.m. milking from 42 through 84 DIM. Infusion of AA significantly increased plasma concentrations of Leu, Ile, Val, and Arg. Effects of AA infusion occurred during the low fiber period. Cows receiving AA maintained daily milk fat yield, increased p.m. milk fat yield, decreased less in p.m. milk fat percentage, and increased daily and p.m. yields of C16 fatty acids in milk. During the posttreatment period, cows previously receiving AA declined in daily milk fat yield, milk fat percentage, and total daily C4 to C16 milk fatty acid yield. Results suggest that the infused AA may have increased de novo synthesis of C16 milk fatty acids.

An optometric quality assurance program.

BACKGROUND: To be accredited by the Joint Commission on Accreditation of Health Care Organizations (JCAHO), a health care facility must have an ongoing quality assurance program. METHODS: In accordance with JCAHO Guidelines the Optometry Section at the Cleveland Veterans Administration Medical Center developed such a program as part of the Medical Center's hospital-wide ongoing quality assurance plan. RESULTS: The methodology used to develop a quality assurance program is outlined. A discussion of how specific clinical indicators are used to monitor performance and/or patient outcomes is presented. CONCLUSIONS: After the quality assurance monitoring period is completed the data is analyzed; if the outcome is unacceptable action must be taken to improve care. This dynamic process involves patient outcomes and enhances overall care.

Effect of total and rumen undegradable protein on the performance of cows fed low fiber diets.

Twelve multiparous and 18 primiparous Holstein cows were fed a 17.3% CP, 21.0% ADF diet during wk 2 through 6 postpartum. Cows then were assigned from wk 7 through 14 to one of three low fiber (10.7% ADF) dietary treatments containing either 14.4 or 18.7% CP, the latter with or without a soybean meal enhanced with rumen undegradable protein. Treatments had no effect on milk yield or composition in multiparous cows, although milk fat percentage was not depressed in multiparous cows receiving the low fiber diets. The soybean meal diet enhanced with rumen undegradable protein increased yields of milk, 4% FCM, fat, protein, and DMI compared with the 14.4% CP diet in primiparous cows; it also increased yields of 4% FCM and fat versus the 18.7% CP, untreated diet in primiparous cows. Blood urea N concentrations were greater for high CP diets than for the low CP diet in both parity groups. Rumen acetate: propionate ratios were higher for both high CP diets than for the low CP diet in multiparous cows. Soybean meal enhanced with rumen undegradable protein improved yields of milk and its components in primiparous cows fed low fiber diets, even when high protein diets were fed.

Influence of dietary protein and supplemental niacin on lactational performance of cows fed normal and low fiber diets.

Forty-seven cows (24 primiparous) were assigned to one of four normal (20.5%) ADF diets for wk 2 to 5 postpartum. Dietary treatments in a 2 x 2 factorial design were diets of 13.8 versus 18.8% CP and 0 versus 12 g/d of niacin per cow. During wk 6 to 13 postpartum, cows were fed low (11.8%) ADF diets while maintaining CP and niacin treatments. Low CP diets contained solvent-extracted soybean meal; rumen soybean meal with enhanced undegradable protein was used in high CP diets. High CP diets increased milk protein percentage in multiparous cows and yields of milk, 4% FCM, fat, protein, and SNF in primiparous cows during the normal fiber period. High dietary CP also increased yields of 4% FCM, fat, protein, and SNF in primiparous cows fed normal fiber diets. When switched to low fiber diets, primiparous cows fed high CP diets decreased more in 4% FCM and fat yields than those fed low CP. Primiparous cows fed niacin decreased more in 4% FCM than controls. High dietary CP increased DMI in primiparous cows fed normal fiber diets, but those fed low CP diets increased more in DMI when switched to low fiber diets. Supplemental niacin appeared to interact with dietary CP in multiparous cows, increasing blood glucose and decreasing blood beta-hydroxybutyrate and NEFA concentrations with the high CP, normal fiber diet. Increased dietary CP improved yields of milk and milk components in primiparous cows.

Histological evaluation of ovine mammary tissue xenografted into cyclosporine-treated mice.

Histological and pathological alterations of ovine mammary parenchyma xenografted into cyclosporine-treated mice were studied. Forty-two mature, virgin female mice were assigned randomly to one of four treatments: 1) control, 2) control + estrogen/progesterone, 3) cyclosporine, and 4) cyclosporine + estrogen/progesterone. All mice received two subcutaneous mammary tissue explants taken from an estrogen and progesterone-primed ewe. After 3, 7, 14, 21, and 35 d, mice were killed and tissue was removed for an evaluation of epithelial morphology on a scale from 1 (poor) to 5 (excellent). Leukocyte type and number were determined in subepithelial stroma. The mean epithelial score for tissue collected on d 7 and d 21 were higher (P less than .05) for cyclosporine treatments (3.0) than for controls (1.6). Scores also were greater (P less than .01) when cyclosporine was combined with estrogen and progesterone than when cyclosporine was the sole treatment (3.8 vs 2.3). Epithelial scores for tissue recovered from mice given cyclosporine and steroids up to 35 d were not different from those of explants fixed at zero time. However, scores were lower (P less than .05) for three of five time periods for explants recovered from mice given cyclosporine alone. Lymphocyte number was higher (P less than .07) in controls (66) than in mice given cyclosporine and steroids (13 per field). The correlation between lymphocyte number and epithelial score was -.55. These results indicate that ovine mammary tissue xenografted into mice treated with cyclosporine can maintain a normal histological structure for an extended period of time.

Effects of plane of nutrition, growth hormone and unsaturated fat on growth hormone, insulin and prolactin receptors in prepubertal lambs.

The influence of plane of nutrition, growth hormone (GH) treatment and dietary polyunsaturated fat on serum concentrations of GH and insulin (INS) and binding capacities of GH, INS and prolactin (PRL) in liver, mammary parenchyma and adipose tissue was assessed in prepubertal ewe lambs. Ten lambs were assigned to each of four treatment groups. Treatments included: (A) lambs with ad libitum access to a high-energy ration; (G) lambs fed as group A and treated with bovine GH (.08 mg/kg/d); (R) lambs with feed intake restricted to limit ADG to about 120 g; and (S) lambs with ad libitum access to a ration including formaldehyde-protected sunflower seed. Diets, all approximately isonitrogenous and isocaloric, were fed from about 7 to 22 wk of age. Weekly blood samples were collected during wk 6 to 14 of the trial. Averaged across sampling dates, mean serum concentrations of GH were elevated in G lambs (P less than .05) and INS concentrations differed in the order G greater than A greater than R = S (P less than .05). Crude membranes for binding assays were prepared from liver, mammary parenchyma and adipose tissue. Mean concentrations of GH receptors in liver and PRL receptors in mammary parenchyma were elevated in group S lambs (P less than .01). Dietary polyunsaturated fat increased the number of GH receptors in liver and PRL receptors in mammary parenchyma. Increased availability of receptors may mediate the stimulation of mammary growth observed in lambs fed polyunsaturated fat.

Effects of plane of nutrition, growth hormone and unsaturated fat on mammary growth in prepubertal lambs.

Effects of plane of nutrition, growth hormone treatment and dietary polyunsaturated fat on mammary development were assessed in prepubertal ewe lambs. Ten lambs (15.6 kg initial body weight) were assigned to each of four treatment groups. Treatments included: (A) lambs given ad libitum access to a high-energy ration; (G) fed as group A but injected s.c. daily with bovine growth hormone (.08 mg/kg BW); (R) feed intake restricted to achieve a growth rate of about 120 g/d; and (S) given ad libitum access to a ration including a formaldehyde-protected sunflower seed supplement. Diets were isonitrogenous and isocaloric and were fed from about 7 to 22 wk of age. At slaughter, the udder was removed and divided into halves. One udder half was trimmed and the parenchyma was dissected from surrounding stroma for compositional analyses. Final body weight and rate of gain averaged 41.2, 42.8, 27.3 and 46.0 kg, and 251, 267, 112 and 311 g/d for groups A, G, R and S, respectively. In the same treatment order, mammary parenchymal weight averaged 15.3, 20.3, 14.2 and 25.6 g. Parenchymal dry, fat-free tissue and DNA content were 1.7, 2.5, 1.3 g and 12.6, 24.1, 10.4 and 18.8 mg, respectively. Mammary parenchymal development was stimulated by polyunsaturated fat but was not affected by plane of nutrition. Supplemental dietary lipid may promote mammogenesis in ruminants.