Postweaning nutritional programming of ovarian development in beef heifers.

Peripubertal caloric restriction increases primordial follicle numbers at breeding, which may improve reproductive potential. Our hypothesis was that feed restriction was changing primordial follicle number through stimulation of follicle formation via leptin, roundabout axon guidance receptor, homolog 4 (), or or through inhibition of follicle activation via anti-Müllerian hormone (). Heifers ( = 30) were fed a ration consisting of 30% alfalfa hay, 69.8% corn silage, and 0.2% salt as DM. Heifers received the control diet for 42 d before an initial 6 heifers were ovariectomized at 8 mo of age. The remaining 24 heifers were divided into 2 treatment groups. Controls were offered 97.9 g DM/kg BW over the entire feeding period. Stair-step heifers received 67.4 g DM/kg BW for 84 d. Following the 84-d restriction, heifers were stepped up to receive 118.9 g DM/kg BW over a 15-d period and were held at this feeding level 68 d. At the end of the feed restriction (11 mo of age), ovaries were collected from 6 heifers per treatment, and at the end of the refeeding period (13 mo of age), ovaries were collected from 6 heifers per treatment. Plasma leptin concentrations were greater in control heifers than in stair-step heifers at 11 mo of age ( < 0.0001). In histological sections, stair-step heifers had more primordial follicles ( = 0.03) than control heifers at 13 mo of age. There was no difference in secondary or antral follicle numbers between dietary treatment groups or ages. Relative abundance of mRNA in ovarian cortex of control heifers was greater at 13 mo than at 11 mo or before feed restriction (8 mo; = 0.01). Relative abundance of mRNA in stair-step heifers at 13 mo was greater than before feed restriction ( = 0.02) and at 11 mo did not differ from 8 or 13 mo ( = 0.70). Relative abundance of mRNA in the ovarian cortex followed a similar pattern, being greater in stair-step heifers at 11 mo compared with control heifers ( = 0.001). At 13 mo, mRNA did not differ between treatments ( = 0.30). Abundance of mRNA in the ovarian cortex did not change due to dietary treatment or age ( > 0.10). In conclusion, developing heifers on a stair-step compensatory growth scheme resulted in larger ovarian reserve before the onset of breeding, which may have beneficial effects on increasing reproductive lifespan.

A case of bilateral cryptophthalmia and euryblepharon with two-stage reconstruction.

PURPOSE: A two-stage reconstruction of cryptophthalmia and euryblepharon occurring in the same patient is described. METHODS: Case report. RESULTS: The 7-month-old patient underwent forniceal reconstruction and upper eyelid reformation in a two-stage procedure that used the excess lower eyelid tissue present in euryblepharon to augment the cryptophthalmia-related upper eyelid deficiency. CONCLUSIONS: To reconstruct the eyelids of this patient with both cryptophthalmia and euryblepharon, we were able to use the manifestations of one disorder to address the deficiencies of the other.

Venous valve station changes in "primary" and postthrombotic reflux: an analysis of 149 cases.

The purpose of this study was to analyze valve station changes noted during venous valve reconstruction and the associated outcome. One hundred and forty-nine valve reconstructions were available for analysis at the time of surgical exploration; the venous valve was graded according to valve station changes (VS grades) from zero through six. Ascending venography was analyzed by a similar grading system and the two methods were compared. The results of this analysis showed that valve station wall changes are frequently present in patients with deep venous reflux and pose technical challenges during valve reconstruction; the outcome, however, appears unaffected. Grade 0 to 1 valve station changes are predominantly due to "primary" reflux, with an occasional instance of postthrombotic etiology. Grade 2 or 3 valve station changes are roughly evenly divided between phlebosclerosis of primary reflux and postthrombotic etiologies. The mechanism of onset of reflux with preservation of valve cusps in the latter group of postthrombotic cases is probably different from currently accepted theories of evolution of postthrombotic changes. Postthrombotic valve damage is variable, and the valve station anatomy may be sufficiently preserved in some patients to allow direct valve repair.

Orbital development after enucleation in early childhood.

PURPOSE: To identify growth retardation in the orbits of children who have undergone enucleation and orbital implantation. METHODS: Children who underwent unilateral enucleation for retinoblastoma were examined. Any patient who had received external beam radiation or chemotherapy was excluded. Follow-up time was 5.5 to 10 years (mean, 8.33 years). Several linear measurements were made on the enucleated orbit and the fellow orbit. These measurements were compared using the paired Student t test and multivariate analysis of variance. RESULTS: There was no statistically significant difference in any of the measured orbital dimensions between the enucleated and fellow orbits. CONCLUSIONS: Enucleation in children, when combined with a large orbital implant, does not cause orbital growth retardation.

Saphenectomy in the presence of chronic venous obstruction.

BACKGROUND: The results of saphenectomy in patients with morphologic and functional obstruction were compared with those in patients without obstruction. Excision of secondary saphenous varices associated with deep venous obstruction has long been considered contraindicated for fear of compromising its collateral contribution. Recent advances in accurate functional assessment of venous obstruction make it possible to test this concept. METHODS: Saphenectomy was carried out in 51 limbs without morphologic or functional obstruction and 64 limbs with varying grades of venous obstruction. Significant deep venous obstruction on ascending venography was present in the latter group. Functional assessment of obstruction was based on the arm/foot venous pressure differential technique, outflow fraction measurements, and outflow resistance calculations. Valve reconstruction was carried out in conjunction with saphenectomy in 81% of cases. RESULTS: Saphenectomy was clinically well tolerated in both groups, and there was no difference in outcome as measured by objective tests for obstruction; improvement in reflux and calf venous pump function was largely similar. Among seven limbs with severe preoperative venous obstruction (grade III or IV), five (70%) had significantly improved obstructive grading, presumably as a result of elimination of reflux flow. CONCLUSIONS: The traditional admonition against removal of secondary varices should be reexamined. Saphenectomy may be indicated in postthrombotic syndrome with mixed obstruction/reflux. The procedure is clinically well tolerated and without malsequelae. Improvement in reflux parameters without significant worsening of objective measures of obstruction is documented in this group.

Axial transformation of the profunda femoris vein.

PURPOSE: To highlight a special subset of cases of venous stasis in which the profunda femoris vein enlarges to a variable extent (axial transformation) to compensate for severe postthrombotic changes in the accompanying superficial femoral vein. METHODS: Among 500 consecutively treated patients with severe venous stasis, 57 patients had axial transformation of the profunda femoris vein. Venous obstruction and reflux were assessed by means of arm-foot pressure differential, ambulatory venous pressure measurement, air plethysmography, and duplex examination. Ascending and descending venograms also were obtained. A variety of valve reconstruction techniques were useful in correcting reflux in the enlarged profunda femoris vein and the companion postthrombotic superficial femoral vein. RESULTS: In 55% of patients the profunda femoris vein was larger than normal and provided partial outflow from the leg through a profunda-popliteal connection, but the superficial femoral vein was still the dominant outflow tract (grades I and II). In 36% of patients the profunda femoris was the dominant outflow tract from the leg, and in another 9% it was the sole axial outflow tract (grades III and IV). The skin changes of advanced venous stasis were present among 92% of patients and frank ulceration among 88%. Antireflux operations on the profunda femoris vein and companion superficial femoral vein, including ligation and division in some instances, were well tolerated. Despite a postthrombotic cause, obstruction did not worsen after surgical treatment, and reflux improved according to most laboratory measurements. Complete ulcer healing was obtained with the surgical techniques described. The actuarial recurrence-free survival rates were 90% 1 year and 66% 5 years after treatment. CONCLUSION: Axial transformation of the profunda femoris vein is present in a subset of instances in which severe postthrombotic changes are present in the companion superficial femoral vein. Profunda femoris reflux is invariably present in these instances because of compensatory dilatation and enlargement of this vessel. Simultaneous valve repair of the axially transformed profunda femoris vein and companion superficial femoral vein to abolish reflux yields excellent long-term results and healing of stasis ulceration.

Reassembly of corneal epithelial adhesion structures after excimer laser keratectomy in humans.

OBJECTIVE: To determine the pattern of long-term reformation of the adhesion structures after excimer laser phototherapeutic keratectomy. METHODS: Four corneal buttons were removed at penetrating keratoplasty 6 to 15 months after initial excimer laser phototherapeutic keratectomy. Morphometric analysis of electron micrographs of the wound bed was performed to determine the extent and pattern of reformation of hemidesmosomes, anchoring fibrils, and basal laminae. RESULTS: Eight percent of the basal epithelial cells had underlying normal anchoring fibrils at 6 months, compared with 35% at 15 months. The percentage of basal cell membrane occupied by hemidesmosomes remained fairly constant (35.2% to 37.7%). With the exception of a localized area of multilamination seen at 9 months, the cross-sectional area of basal lamina per 100 microns of basal cell membrane increased with the duration of wound healing (18.0 microns 2 at 6 months, 24.4 microns 2 at 15 months) but remained below normal levels (32 microns 2). CONCLUSIONS: These data suggest that after human excimer keratectomy, the anchoring fibrils and basal lamina do not completely normalize even after 15 months.