Sharp-edged intraocular lens design as a cause of permanent glare.

PURPOSE: To evaluate patients who had implantation of an acrylic intraocular lens (IOL) and reported edge glare that did not lessen with time. SETTING: Hawthorn Eye Clinic, Kew, Victoria, Australia. METHOD: This retrospective study comprised patients who had uneventful phacoemulsification and then reported glare that did not abate after 12 months. RESULTS: Five patients (7 of 322 eyes; 2.2%) who received an AcrySof MA30BA IOL with a 5.5 mm optic and 1 patient (1 of 221 eyes; 0.5%) who received an AcrySof MA60BM IOL with a 6.0 mm optic reported permanent edge glare. Extensive retinal and neurological evaluations in 2 patients showed no deficits in 1 and an abnormal photopic red electroretinogram in the other. Pilocarpine 1% was used in 3 patients and gave no relief of symptoms. Two patients (3 eyes) had IOL explantation with complete resolution of glare symptoms. There was no statistical significance between the 2 types of IOLs. CONCLUSION: Sharp-edged IOL designs can cause permanent intractable glare.

Carotid artery ectasia coexistent with primary open angle glaucoma.

A 60-year-old smoker presented with high intraocular pressure in the right eye with a right afferent pupil defect and visual field suggestive of primary open angle glaucoma in the right eye only, when an examination 2 years earlier had revealed no hint of ocular pathology. Radiological investigations demonstrated prominent ectasia of the internal carotid arteries extending into the proximal middle cerebral arteries. The changes in the carotids extended throughout the cavernous sinus regions, encroached on the under surface of the optic chiasm and were closely related to the internal aspects of both optic canals. In primary open angle glaucoma management, neural imaging is not normally recommended; however, neural imaging investigations should be considered if the presentation is not typical of a chronic bilateral optic neuropathy

An evaluation of the safety and efficacy of botulinum toxin type A (BOTOX) when used to produce a protective ptosis.

PURPOSE: To evaluate the safety and efficacy of botulinum toxin type A (BOTOX, Allergan) when used to produce a protective ptosis in patients where a surgical tarsorrhaphy would otherwise be required. METHODS: A total of 21 patients entered into the study. Doses of 2.5 and 5.0 units of BOTOX were injected into the levator palpebrae superioris muscle through the eyelid. The patients were followed daily where practical until a ptosis developed and then monitored 1-2 weekly until the ptosis was resolved. Injections were repeated, if necessary until the underlying condition had healed. RESULTS: Ptosis took an average +/- SE of 4.0 +/- 0.5 days to develop (range 2-8 days). Duration of ptosis was an average +/- SE of 46.0 +/- 12.1 days (range 1-206 days). The effective dosage was 5 units of BOTOX in 0.1 mL. In 16 patients, the ptosis produced by BOTOX was sufficient to allow the underlying disease to heal and a surgical tarsorrhaphy was avoided. One patient required a surgical tarsorrhaphy and three patients required other surgical intervention to correct the underlying condition. One patient was lost to follow up. Diplopia was seen in five patients but resolved in all cases. CONCLUSIONS: BOTOX was a suitable alternative to a surgical tarsorrhaphy.

Atrial fibrillation following cardiac surgery.

Atrial arrhythmias are the most common complication of cardiac surgeries, occurring in 30% of patients undergoing coronary revascularization and 60% of patients having valvular surgeries. The most frequently occurring atrial arrhythmia, atrial fibrillation (AF), not only causes uncomfortable palpitations, but has also been shown to increase postoperative hospital length of stay and morbidity, including hemodynamic compromise and stroke. Both the frequency and the potential consequences of AF make prevention and early intervention important aspects in the postoperative care of cardiac surgery patients.

Implementing neuromuscular blockade monitoring in a surgical intensive care unit.

Long-term infusions of neuromuscular blocking agents are being used with increasing frequency in critical care areas to paralyze patients for optimal ventilatory support or to reduce patient energy demands. Prolonged weakness with no sensory disturbance has been reported in some patients. The complex nature of the critically ill patient makes the pharmacokinetics of neuromuscular blocking agents unpredictable. Monitoring neuromuscular blockade with a peripheral nerve stimulator and administering the appropriate dose may minimize the complications of its use. The CNS can be the change agent to assist the nursing staff in incorporating recent technological innovations and research findings in nursing clinical practice. The rational model of change serves as a guide when little resistance is anticipated or when change is perceived as rational.

High-dose steroid therapy offers improvement in spinal cord injuries.

A spinal-cord injury can alter every aspect of a victim's life. Despite continued improvements in mortality associated with a spinal-cord injury, until recently little progress had been made in improving neurologic function. This paper reviews the development of steroid therapy for spinal cord injuries, the mechanisms of action, and the nursing care associated with its use.

A scanning electron microscope study of porcine corneal endothelium stored in chondroitin sulphate.

The porcine cornea was used as a model for the study of the effects of corneal storage in 2.5% chondroitin sulphate at 3, 5, 8, and 10 days. The corneal endothelium was studied by scanning electron microscopy and image analysis was used to measure cell area, density, and the percentage of cell disruption and loss. Corneal endothelial cells from freshly slaughtered 5- to 6-month-old pigs had a mean posterior surface area of 134 +/- 30 microns2 and a density of 6,300 +/- 640 cells/mm2. In storage conditions, there was a decrease in cell area to 102 +/- 18 microns2 at 5 days and 88 +/- 23 microns2 at 10 days of storage, with a cell density of 7,110 cells/mm2 at 5 days and 6,500 cells/mm2 at 10 days. There was a disruption rate of 12% at 5 days and 26% at 10 days of storage. The effect on the endothelium after suspension in storage medium was compared with laying the corneas endothelium uppermost. An increased disruption rate was found in the suspended corneas. The effect of the time interval between enucleation and preparation on percentage cellular disruption was linear.

A comparison of changes in plasma thyrotropin beta- and alpha-subunits, and mouse thyrotropic tumor thyrotropin beta- and alpha-subunit mRNA concentrations after in vivo dexamethasone or T3 administration.

Dexamethasone, like T3, inhibits the production of TSH. T3 inhibits TSH synthesis by reducing transcription of the genes encoding TSH-beta and alpha-subunits. Little information is available concerning the effects of dexamethasone on the individual subunits, or the combined effects of dexamethasone with T3. In a preliminary study, hypothyroid mice bearing the thyrotropic tumor TtT 97 were treated with 25, 250, or 500 micrograms dexamethasone ip daily for ten days. Plasma levels of TSH and its subunits were unchanged after 25 micrograms of dexamethasone and maximally suppressed after 250 micrograms. Plasma TSH was reduced to 51% (P less than .02), free TSH-beta to 54% (P less than .01), and alpha-subunit to 62% (P less than .001) of control values. In two similar experiments hypothyroid mice bearing TtT 97 were treated with dexamethasone (250 micrograms), T3 (0.5 or 1 microgram), or both dexamethasone with T3 for 10 days. Total alpha-subunit and TSH-beta were calculated by adding 1/2 TSH + free subunit concentrations. In the experiment using 1 microgram of T3, total plasma alpha-subunit was reduced by dexamethasone to 72%, by T3 to 45% (P less than .02), and by combined treatment to 23% (P less than .01) of control values. In the experiment using 0.5 microgram of T3, total plasma alpha-subunit was reduced by dexamethasone to 66% (P less than .05), by T3 to 67% (P less than .05), and by combined treatment to 46% (P less than .02) of control values.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute thyroid hormone withdrawal rapidly increases the thyrotropin beta and alpha-subunit messenger ribonucleic acids in mouse thyrotropic tumors.

We have abruptly discontinued T3 administration to hypothyroid mice bearing thyrotropic tumors and measured increases in tumor steady state TSH subunit mRNA levels with time. Hypothyroid mice bearing the thyrotropic tumor TtT97 were injected daily with T3 (10 micrograms/100 g BW, ip, daily) for 10 days. Groups of mice (n = 3) were killed on the day of the last T3 injection (day 0) and 1, 2, 3, or 5 days after stopping T3 treatment. Plasma T3 concentrations fell to subnormal values between days 1 and 2 after stopping T3 treatment. Plasma TSH and total TSH subunit concentrations were 3% of untreated hypothyroid control concentrations on day 0, and rose 4-fold between days 1 and 2 and 20-fold by day 5 (P less than 0.01). Plasma total alpha-subunit concentrations were 28% of untreated hypothyroid control concentrations on day 0, rose to 158% of baseline values by day 2, and rose 3-fold by day 5 (P less than 0.001). Tumor TSH beta and alpha-subunit mRNA levels were 5% and 52% (P less than 0.01) of hypothyroid control levels on day 0. TSH beta mRNA levels rose nearly 9-fold between days 1 and 2 (P less than 0.01). alpha-Subunit mRNA levels rose to 135% of initial values by day 2 and to 144% of initial values by day 3 (P less than 0.05). Changes in tumor TSH subunit mRNA levels paralleled changes in plasma subunit glycoprotein concentrations. Increases in tumor subunit mRNA levels after abruptly stopping T3 treatment occurred rapidly, predominantly between 24-48 h after stopping T3, and TSH beta mRNA was considerably more responsive than alpha-subunit mRNA.

Altitude quotient - IQ Discrepancy as an index of personality disorganization among drug offenders.

Twenty-five inmates of the Petersburg Federal Reformatory Drug Abuse Program, Petersburg, Virginia were selected as Ss in this study. Intercorrelations among AQ-IQ discrepancies, MMPI scales and behavioral adjustment ratings were computed. The results suggested that the AQ-IQ discrepancy is of questionable efficacy as an index of personality disorganization.