Temperature and rainfall are related to fertility rate after spring artificial insemination in small ruminants.

A total number of 1092 artificial inseminations (AIs) performed from March to May were documented over four consecutive years on 10 Payoya goat farms (36° N) and 19,392 AIs on 102 Rasa Aragonesa sheep farms (41° N) over 10 years. Mean, maximum, and minimum ambient temperatures, mean relative humidity, mean solar radiation, and total rainfall on each insemination day were recorded. Overall, fertility rates were 58 % in goats and 45 % in sheep. The fertility rates of the highest and lowest deciles of each of the meteorological variables indicated that temperature and rainfall had a significant effect on fertility in goats. Specifically, inseminations that were performed when mean (68 %), maximum (68 %), and minimum (66 %) temperatures were in the highest decile, and rainfall was in the lowest decile (59 %), had a significantly (P < 0.0001) higher proportion of does that became pregnant than did the ewes in the lowest decile (56, 54, 58, and 49 %, respectively). In sheep, the fertility rates of the highest decile of mean (62 %), maximum (62 %), and minimum (52 %) temperature, RH (52 %), THI (53 %), and rainfall (45 %) were significantly higher (P < 0.0001) than were the fertility rates among ewes in the lowest decile (46, 45, 45, 45, 46, and 43 %, respectively). In conclusion, weather was related to fertility in small ruminants after AI in spring. It remains to be determined whether scheduling the dates of insemination based on forecasted temperatures can improve the success of AI in goats and sheep.

[Role of Bacterial Adhesin RAPA1 in Formation of Efficient Symbiosis of Rhizobium leguminosarum with Bean Plants].

Bacterial adhesins, the proteins responsible for attachment of plant growth-promoting rhizobacteria to plant roots, are involved in formation of stable associative symbioses. In the present work enhanced expression of the rapA1 adhesin gene in Rhizobium leguminosarum PVu5 was shown to improve the efficiency of nodulation on bean roots inoculated with the modified strain. The rapA1 gene was cloned into the pJN105Turbo plasmid, this construct was used for transformation of R. leguminosarum PVu5, bean plants were inoculated by this transgenic strain, and efficiency of root nodule formation was determined. In the plants treated with rapA1-transgenic rhizobia, the number of root nodules was on average two times higher than in the plants inoculated with the original strain. Aggregation of R. leguminosarum was achieved when the rapA1 gene expression was enhanced either in rhizobia or in the co-cultured modified strain E. coli pJN105TurboRapA1.

First Report of 'Candidatus Phytoplasma pyri' Causing Peach Yellow Leaf Roll (PYLR) in Spain.

'Candidatus Phytoplasma prunorum,' which causes European stone fruit yellows (ESFY), is the prevalent phytoplasma affecting Prunus spp. in Europe. It is closely related to 'Ca. P. pyri,' which causes pear decline (PD) in pear trees. Both phytoplasma belong to the ribosomal group 16Sr-X and are naturally transmitted by different species of Cacopsylla spp. (4). In North America, 'Ca. P. pyri' is responsible for peach yellow leaf roll (PYLR), transmitted by Cacopsylla pyricola from pear to peach trees (1). In Spain, 'Ca. P. prunorum' is widespread on Prunus spp., but its occurrence on Prunus persicae is very low and 'Ca. P. pyri' is present in every pear orchard (3). During 2012, a previously unreported syndrome including early reddening, leaf curling, decline, abnormal fruits, and in some cases chlorosis and death of peach trees was reported on peach in Lleida, northern Spain. Symptoms were different to ESFY and PYLR, in that flowering disorders such as ESFY or yellows were not apparent, and reddening and decline were the most common symptoms. The disease was present in a wide range of varieties and rootstocks, suggesting insect transmission in an area where C. pruni, vector of 'Ca. P. prunorum,' was not previously reported, but C. pyri was abundant in pear orchards. Shoot samples from 20 symptomatic peach trees were collected in seven orchards within a 2 km2 area with an estimated incidence of 40%, which was higher in the borders. DNA was extracted from 1 g of leaf midribs and phloem tissue and amplified with ribosomal universal primers P1/P7 followed by nested PCR with R16F2n/R16R2 and specific primers fO1/rO1 that target the 16Sr-X group (3). The final PCR products were digested with RsaI enzyme. Amplifications with non-ribosomal specific primers, Imp ESFY, Imp PD A and Imp PD B that amplify sequences of gene Imp, that encode a phytoplasma membrane protein, were also carried out (2). Tissue samples with ESFY and PD and peach seedlings were used as positive and negative controls, respectively. Amplified PCR products were sequenced and compared to sequences deposited in GenBank. Phytoplasmas were detected in 18 of the 20 samples analyzed. No phytoplasmas were detected in negative peach controls. All digestions of fO1/rO1 PCR products from peach samples showed a PD profile, while no ESFY profile was detected. All samples were positive with specific primers Imp PD A and B. None of the peach samples were positive with the specific Imp-ESFY primers. Sequencing of R16 and Imp PDA and B amplicons revealed the presence of a stable isolate. The sequences were submitted to the European nucleotide archive (ENA) with the accession nos. HG737345 and HG737344. Based on the 16S rDNA sequence, this strain is 100% homologous to the reference strain PD1 (GenBank Accession No. AJ542543) and 99.55% homologous to strain PD 33 Lib (GenBank FN600725) based on the Imp gene sequence. This is the first report of PD phytoplasma in peach trees in Spain, and the first report in Europe of PD phytoplasma causing economically important outbreaks in peach orchards, following a pattern that could be similar to PYLR in North America. This strain is genetically closer to some European or Middle Eastern PDs than to North American PYLR. References: (1) C. L. Blomquist et al. Plant Dis. 86:759, 2002. (2) J. L. Danet et al. Microbiology 157:438, 2011. (3) M. Garcia-Chapa et al. J. Phytopathol. 151:584, 2003. (4) E. Seemüller et al. Int. J. Syst. Evol. Microbiol. 54:1217, 2004.

Heterogeneity Between Ducts of the Same Nuclear Grade Involved by Duct Carcinoma In Situ (DCIS) of the Breast.

PURPOSE: Nuclear grade of breast DCIS is considered during patient management decision-making although it may have only a modest prognostic association with therapeutic outcome. We hypothesized that visual inspection may miss substantive differences in nuclei classified as having the same nuclear grade. To test this hypothesis, we measured subvisual nuclear features by quantitative image cytometry for nuclei with the same grade, and tested for statistical differences in these features. EXPERIMENTAL DESIGN AND STATISTICAL ANALYSIS: Thirty-nine nuclear digital image features of about 100 nuclei were measured in digital images of H&E stained slides of 81 breast biopsy specimens. One field with at least 5 ducts was evaluated for each patient. We compared features of nuclei with the same grade in multiple ducts of the same patient with ANOVA (or Welch test), and compared features of nuclei with the same grade in two ducts of different patients using 2-sided t-tests (P ≤ 0.05). Also, we compared image features for nuclei in patients with single grade to those with the same grade in patients with multiple grades using t-tests. RESULTS: Statistically significant differences were detected in nuclear features between ducts with the same nuclear grade, both in different ducts of the same patient, and between ducts in different patients with DCIS of more than one grade. CONCLUSION: Nuclei in ducts visually described as having the same nuclear grade had significantly different subvisual digital image features. These subvisual differences may be considered additional manifestations of heterogeneity over and above differences that can be observed microscopically. This heterogeneity may explain the inconsistency of nuclear grading as a prognostic factor.

Effects of melatonin implants during non-breeding season on sperm motility and reproductive parameters in Rasa Aragonesa rams.

The effect of melatonin implants administered during non-breeding season in Rasa Aragonesa rams on sperm motility parameters and other reproductive traits was assessed. In a first experiment, two Rasa Aragonesa rams were implanted (with melatonin group M), remaining other two males as control group (C). Semen of each group was collected from 1 May to 23 June, twice or three times a week, and motility parameters were assessed using a computer-assisted sperm analysis system. Melatonin increased the percentage of progressive motile spermatozoa, particularly during 46-75 days after melatonin implantation (p < 0.01). In experiment 2, M and C in vitro fertilization ability had been determined by zona-pellucida binding assays, using spermatozoa from experiment 1, obtained 60-70 days after melatonin was implanted. A significantly higher number of spermatozoa attached per oocyte was observed in frozen-thawed immature ovine oocytes incubated with sperm from M animals than in those incubated with sperm from the C group (p < 0.01). Finally, a field assay (experiment 3) was performed. In this case, five Rasa Aragonesa rams were implanted with melatonin and three remained as control group. Sperm doses from those animals were used for artificial insemination of 2608 Rasa Aragonesa ewes from 39 different farms at non-breeding season. Fertility, litter size and fecundity were studied. Semen from melatonin implanted rams seemed to increase both fertility and fecundity in ewes inseminated with spermatozoa obtained 46-60 days after implantation (p < 0.1). Thus, melatonin treatment in rams during non-breeding season modifies sperm motility parameters and seems to improve the fertilization parameters obtained.

Ductal carcinoma in situ of the breast (DCIS) with heterogeneity of nuclear grade: prognostic effects of quantitative nuclear assessment.

BACKGROUND: Previously, 50% of patients with breast ductal carcinoma in situ (DCIS) had more than one nuclear grade, and neither worst nor predominant nuclear grade was significantly associated with development of invasive carcinoma. Here, we used image analysis in addition to histologic evaluation to determine if quantification of nuclear features could provide additional prognostic information and hence impact prognostic assessments. METHODS: Nuclear image features were extracted from about 200 nuclei of each of 80 patients with DCIS who underwent lumpectomy alone, and received no adjuvant systemic therapy. Nuclear images were obtained from 20 representative nuclei per duct, from each of a group of 5 ducts, in two separate fields, for 10 ducts. Reproducibility of image analysis features was determined, as was the ability of features to discriminate between nuclear grades. Patient information was available about clinical factors (age and method of DCIS detection), pathologic factors (DCIS size, nuclear grade, margin size, and amount of parenchymal involvement), and 39 image features (morphology, densitometry, and texture). The prognostic effects of these factors and features on the development of invasive breast cancer were examined with Cox step-wise multivariate regression. RESULTS: Duplicate measurements were similar for 89.7% to 97.4% of assessed image features. For the pooled assessment with approximately 200 nuclei per patient, a discriminant function with one densitometric and two texture features was significantly (p < 0.001) associated with nuclear grading, and provided 78.8% correct jackknifed classification of a patient's nuclear grade. In multivariate assessments, image analysis nuclear features had significant prognostic associations (p

Triple-negative breast cancer: clinical features and patterns of recurrence.

PURPOSE: To compare the clinical features, natural history, and outcomes for women with "triple-negative" breast cancer with women with other types of breast cancer. EXPERIMENTAL DESIGN: We studied a cohort of 1,601 patients with breast cancer, diagnosed between January 1987 and December 1997 at Women's College Hospital in Toronto. Triple-negative breast cancers were defined as those that were estrogen receptor negative, progesterone receptor negative, and HER2neu negative. The prognostic significance of triple-negative breast cancer was explored. RESULTS: The median follow-up time of the 1,601 women was 8.1 years. One hundred and eighty of 1,601 patients (11.2%) had triple-negative breast cancer. Compared with other women with breast cancer, those with triple-negative breast cancer had an increased likelihood of distant recurrence (hazard ratio, 2.6; 95% confidence interval, 2.0-3.5; P < 0.0001) and death (hazard ratio, 3.2; 95% confidence interval, 2.3-4.5; P < 0.001) within 5 years of diagnosis but not thereafter. The pattern of recurrence was also qualitatively different; among the triple-negative group, the risk of distant recurrence peaked at approximately 3 years and declined rapidly thereafter. Among the "other" group, the recurrence risk seemed to be constant over the period of follow-up. CONCLUSIONS: Triple-negative breast cancers have a more aggressive clinical course than other forms of breast cancer, but the adverse effect is transient.

First Report of Phytoplasmas Associated with the Degeneration Syndrome of Artichoke in Catalonia (Spain).

Spain is the second largest producer of artichoke (Cynara scolymus L.) in the world with 230,000 tons produced annually. The region of Catalonia, located in northeast Spain, has 3,500 ha dedicated to this crop. Low yield and degeneration anomalies are widespread problems in the Mediterranean area. The degeneration syndrome results in curled leaves and late development of capitulum. The association of this syndrome with different viruses such as Artichoke degeneration virus (ADV), Artichoke latent virus (ALV), Broad bean wilt virus (BBWV), Cucumber mosaic virus (CMV), and many others was not conclusive. Other studies indicated that this phenomenon could be related to a regression of the cultivar toward the species of origin, the wild cardoon (C. cardunculus L. var. sylvestris). The distribution of degenerated plants in the principal artichoke-growing areas of Catalonia together with the presence of plants with normal and degenerated tissues in the same plant suggested the presence of phytoplasmas. Samples from 30 symptomatic and 30 asymptomatic plants of cv. Blanca de Tudela were collected in February of 2006 from different areas of Catalonia and analyzed by PCR amplification of phytoplasma DNA. DNA for PCR analyses was prepared from leaf petioles and midribs according to the Ahrens and Seemüller procedure (1). Nested-PCR was carried out with rRNA primer pairs P1/P7 and fU5/rU3 (2,3). Alternatively, nested-PCR, with primers Tuf 1 f/r in the first step and Tuf AY f/r in the second, amplifying a DNA fragment of the elongation gene Tu of the phytoplasmas belonging to Aster yellows and stolbur groups was conducted (4). Results showed a high correlation between presence of symptoms and phytoplasma detection. Phytoplasmas were detected in 100% of the symptomatic plants (30 of 30) and only in one of the asymptomatic plants. The restriction fragment length profiles of Tuf AY amplicons with HpaII showed two different patterns, the most important belonging to the aster yellows (16SrI) group phytoplasma and the other to the stolbur (16SrXII) group phytoplasma. To our knowledge, this is the first time that phytoplasmas have been detected in artichoke and associated with degeneration of this crop. References: (1) U. Ahrens and E. Seemüller. Phytopathology 82:828, 1992. (2) S. Deng and C. Hiruki. J. Microbiol. Methods 14:53, 1991. (3) K. H. Lorenz et al. Phytopathology 85:771, 1995. (4) B. Schneider et al. Microbiology 143:3381, 1997.

Biological significance of occult micrometastases in histologically negative axillary lymph nodes in breast cancer patients using the recent American Joint Committee on Cancer breast cancer staging system.

The biological significance of occult metastases in axillary lymph nodes of breast cancer patients is controversial. The purpose of the study was to determine the prognostic significance of occult micrometastases using the current American Joint Committee on Cancer (AJCC) staging system in a cohort of women with node-negative breast cancer, of whom 5% received adjuvant systemic therapy and who all had long-term follow-up. We studied a cohort of 214 consecutive histologically node-negative breast cancer patients with a median follow-up of 8 years. Blocks of the axillary lymph nodes were assessed for occult micrometastases by examination of an additional hematoxylin-eosin-stained slide and by immunohistochemical staining using an antibody to low molecular weight keratin. Occult metastases were classified according to the sixth edition of the AJCC cancer staging manual. We examined the prognostic effects of occult micrometastases and other clinicopathologic features on recurrence outside the breast with disease-free interval (DFI) and survival from breast cancer with disease-specific survival (DSS). Cytokeratin-positive tumor cells were identified in the lymph nodes in 29 of 214 cases (14%). Two cases had isolated tumor cells and no cluster larger than 0.2 mm [pN0(i+)], whereas 27 of 214 (13%) had micrometastases (larger than 0.2 mm and

The role of reexcision for positive margins in optimizing local disease control after breast-conserving surgery for cancer.

One of the most important factors associated with local recurrence after lumpectomy in breast cancer patients is the status of the surgical margin. Standard surgical practice is to obtain clear margins even if this requires a second surgical procedure. It is assumed that reexcision to achieve clear margins when positive margins are present at initial excision is as effective as complete tumor removal at a single procedure; however, the efficacy of reexcision in this context has not been well studied. A retrospective search of the Henrietta Banting Breast Centre database from 1987 to 1997 identified 1430 patients who underwent lumpectomy for invasive breast cancer: 1225 patients (group A) had negative margins at the initial surgery and 152 patients (group B) underwent one or more reexcisions to achieve negative margins. Fifty-three patients had positive margins at final surgery, but no reexcision was done (group C). Logistic regression was used to identify factors that were predictive of a positive margin; predictors of local recurrence in women whose tumors were completely resected were determined using Cox's proportional hazards model. Patients in groups A, B, and C differed with respect to mean age at diagnosis (58 years, 51 versus, and 56 years, respectively, p < 0.0001), mean tumor size (19 mm, 16 mm, and 26 mm, respectively, p < 0.0001), node positivity (30%, 22%, and 41%, respectively, p = 0.004), and the presence of a ductal carcinoma in situ (DCIS) component (60%, 64%, and 79%, respectively, p = 0.007). The mean follow-up period was similar for the three groups (8 years, 8 years, and 9 years, respectively, p = 0.17). Young age was the only variable predictive of positive margins. Among patients undergoing complete tumor excision, there was a suggestion of a higher 10 year local recurrence rate in reexcision group B, but the difference did not reach statistical significance (11.6% versus 16.6%, p = 0.11). Cox's multivariate regression analyses identified older age, smaller tumor size, receiving radiation therapy, and tamoxifen use as significantly decreasing the rate of local recurrence in patients with negative margins at initial surgery or after reexcision. Our data confirm the results of previous studies indicating that young age is an independent predictor of positive margins after lumpectomy for invasive breast cancer. The only independent predictor of local recurrence in our study cohort was large tumor size. There was a trend toward a higher local recurrence rate if more than one procedure was required to secure clear margins, although this effect was not independent of other factors. Reexcision to clear involved margins is an important surgical intervention for both younger and older women.

Ascertaining prognosis for breast cancer in node-negative patients with innovative survival analysis.

Clinical decisions to administer adjuvant systemic therapy to women with early breast cancer require knowledge about baseline prognosis, which is only assessable in the absence of such adjuvant treatment, which most patients currently do receive. The Cox model is the standard tool for assessing the effect of prognostic factors; however, there may be substantive differences in the estimated prognosis obtained by the Cox model rather than a log-normal model. For more than 50 years, clinical breast cancer data for cohorts of patients have supported the choice of a log-normal model. The prognostic impact of model type is examined here for a cohort of breast cancer patients, only 7% of whom received adjuvant systemic therapy. We quantitated prognosis utilizing Kaplan-Meier, Cox, and log-normal survival analyses for 415 consecutive T1-T3, M0, histologically node-negative patients who were operated on for primary breast cancer at Women's College Hospital between 1977 and 1986. Recurrence outside the breast for disease-free interval (DFI) and breast cancer death for disease-specific survival (DSS) were the events of interest. The patient follow-up for these investigations was 96% complete: a median 8 years for those surviving. Factors used in these investigations were age, weight, tumor size, histology, tumor grade, nuclear grade, lymphovascular invasion, estrogen receptor (ER), progesterone receptor (PR), combined ER/PR receptor, overexpression of neu oncoprotein, DNA ploidy, S-phase, and adjuvant therapy. In our study we found evidence against the Cox assumption of proportional hazards, which is not an assumption for the log-normal approach. We identified patients with greater than 96% and others with less than 40% DSS at 10 years. The difference in prognosis determined by using the Cox versus the log-normal model ranged for DFI from 1.2% to 8.1%, and for DSS from 0.4% to 6.2%; interestingly, the difference was more substantial for patients with a high risk of recurrence or death from breast cancer. Estimated prognoses may differ substantially by survival analysis model type, by amounts that might affect patient management, and we think that the log-normal model has a major advantage over the Cox model for survival analysis.

Infantile infection and diabetes insipidus in children with optic nerve hypoplasia.

BACKGROUND: Bilateral optic nerve hypoplasia (BONH) is often associated with other central nervous system midline abnormalities (septo-optic dysplasia). Hormonal dysfunction, caused by anterior (cortisol) and posterior (ADH) pituitary involvement, can be sudden, severe, and life threatening. METHODS: Case series. Three cases of septo-optic dysplasia (SOD) presenting as infantile infection with associated diabetes insipidus are reported. The diagnosis of SOD was suspected only after ophthalmological evaluation; further evaluation led to the diagnosis of panhypopituitarism. CONCLUSIONS: A high index of suspicion is required to diagnose SOD in children when the disorder presents with infantile infection and hypernatraemia. Early warning signs of neonatal jaundice and hypoglycaemia should prompt ophthalmological evaluation.

Assessing 24-hour blood glucose patterns in diabetic paitents treated by peritoneal dialysis.

The minute-to-minute effect on blood glucose levels of high-dextrose peritoneal dialysate is not known. We arranged for 7 patients with diabetes, treated by peritoneal dialysis (PD), to wear a continuous glucose monitoring system (CGMS: Medtronic MiniMed, Northridge, CA, U.S.A.). A sensor was inserted subcutaneously into the skin of the patient's abdomen or back to measure glucose in the interstitial fluid. Readings were recorded every 5 minutes for up to 72 hours. The portion of the day during which the patient's blood glucose levels were greater than 180 mg/dL (calculated as a percentage of time) was recorded. Most of the patients participating in the study had elevated levels of glycohemoglobin and hemoglobin A1c, and, for a large percentage of the day, showed blood glucose tracings well above the recommended standards of control. Representative CGMS tracings from patients with type 1 and type 2 diabetes are shown.

Educating women about breast cancer. An intervention for women with a family history of breast cancer.

OBJECTIVE: To evaluate an "information aid" for women with a family history of breast cancer. DESIGN: Before-after descriptive study. SETTING: Family practices in Ontario. PARTICIPANTS: Of 405 randomly selected Ontario physician members of the College of Family Physician's of Canada's National Research System, 97 agreed to participate and to recruit three consecutive female patients with any family history of breast cancer. INTERVENTIONS: Patients completed a baseline questionnaire and, after reviewing the information aid, a satisfaction questionnaire. Four weeks later, they completed a third questionnaire. MAIN OUTCOME MEASURES: Patient satisfaction, knowledge, worries related to breast cancer, risk perception, and attitudes toward screening. RESULTS: Of 203 patients recruited, 160 (79%) completed all three questionnaires. The information aid was rated excellent or very good by 91% of the women; 99% would recommend it to other women. Knowledge improved significantly; worry about breast cancer did not increase. CONCLUSION: The information aid is a useful resource for women and primary care physicians and could facilitate appropriate risk assessment and management of women with a family history of breast cancer.

First Report of Stolbur Phytoplasma in Avocado in Spain.

Since its introduction to southern Spain in the late 1970s, avocado (Persea americana Mill.) has become an alternative irrigation crop to more traditional and less productive dry land crops such as olive, almond, and grapevine. Avocado orchards in this region currently cover an area of 7,500 ha, producing 58,000 tons of fruit in 2000, with 42,000 tons exported annually to the European Union. In summer 1999, symptoms similar to those caused by phytoplasmas were observed in a plot of avocado cv. Hass. Symptoms of leaf roll, leaf veinal chlorosis with the leaves becoming small and abnormally red, and dwarfing were irregularly distributed on affected trees. Host species of phytoplasmas, such as Lavandula officinalis and Thymus officinalis, are found (1) in orchards surrounded by Mediterranean forests. Leaves from eight symptomatic plants taken from affected plots and leaves from two symptomless plants taken from a healthy plot were collected in May, July, and October 2000, and analyzed for phytoplasma infection by polymerase chain reaction (PCR) assays. DNA for PCR was prepared from leaf petioles, midribs, or trunk phloem by phytoplasma-enrichment fraction according to Daire et al. (2). The stolbur phytoplasma was detected in trees by PCR using stolbur-specific nonribosomal primer pair stol 4 f/r (3) or by nested PCR with 16S rDNA primers pairs P1/P7 and fU5/rU3. Phytoplasmas were detected only in samples collected in July. Phytoplasmas were detected by universal primers in all symptomatic samples analyzed in July, whereas stolbur-specific primers gave positive results in only 75% of the symptomatic samples. Restriction fragment length polymorphism (RFLP) analysis with enzymes AluI and Tru9I confirmed the phytoplasma belonged to the stolbur group. To our knowledge, this is the first description of a phytoplasma disease of avocado trees in Spain. Stolbur is the most important vector-borne disease caused by phytoplasma in several crops. In Spain, it has been identified in various crops and weeds such as grapevine, pear, tomato, carrot, pepper, chicory, and strawberry, and appears to be ubiquitous in herbaceous plant host in several families. Rigorous control of stolbur in avocado should be implemented as soon as possible to avoid further disease development and subsequent economic damage to this industry. References: (1) A. Batlle et al. Eur. J. Plant Pathol. 106:811, 2000. (2) X. Daire et al. Ann. Appl. Biol. 121:95, 1992. (3) X. Daire et al. Eur. J. Plant Pathol. 103:507, 1997.

Posterior repositioning of glaucoma implants for anterior segment complications.

OBJECTIVE: To assess the efficacy of repositioning Baerveldt aqueous implant tubes from the anterior chamber into the vitreous cavity in the management of anterior chamber tube-related complications. DESIGN: Noncomparative case series. PARTICIPANTS: Nine eyes of eight consecutive subjects with anterior segment problems (corneal decompensation with a shallow anterior chamber or recurrent tube erosion unresponsive to conventional revision). INTERVENTION: Baerveldt implant tubes were repositioned from the anterior chamber into the vitreous cavity after pars plana vitrectomy. MAIN OUTCOME MEASURES: Preservation of visual acuity, maintenance of intraocular pressure (IOP) control, and resolution of the anterior segment problem. RESULTS: Nine eyes of eight subjects were collaboratively managed by the operating glaucoma and vitreoretinal surgeons and followed postoperatively for an average time of 17 months (range, 2-42 months). Visual acuity remained stable or improved in seven of the nine eyes. IOP remained controlled in all eyes, with an average IOP of 14.3 +/- 3.0 standard deviation mmHg (range, 10-18 mmHg). Progression of the anterior segment problem, which dictated the revision, was halted in three of five eyes with corneal decompensation and shallow anterior chambers and in all eyes with recurrent tube erosion. Postoperative complications included one successfully repaired retinal detachment occurring 9 months postoperatively. CONCLUSIONS: Repositioning of an anterior chamber Baerveldt shunt tube into the vitreous cavity is a viable option for resolving recalcitrant tube-related anterior segment complications.

Pathologic Characteristics of Breast Cancer that Predict for Local Recurrence After Lumpectomy Alone.

Breast conservation surgery (BCS) plus irradiation has been shown to be equivalent to mastectomy in controlling ipsilateral breast cancer recurrence. The purpose of this study is to evaluate the factors that determine the rate of local recurrence in a group of patients treated with partial mastectomy without postoperative radiation, adjuvant hormonal therapy, or chemotherapy. We also assess the role of standard pathologic features, specifically lymphovascular invasion (LVI) in identifying high- and low-risk subsets of patients. We have a cohort of 293 patients treated with partial mastectomy followed prospectively for a median of 8 years. Data collected included patient's age, tumor size, tumor morphology, tumor grade, the extent of ductal carcinoma in situ (DCIS), the presence of LVI, lymph node status, and hormone receptors. Statistical analyses carried out were Kaplan-Meier plots with Wilcoxon (Peto-Prentice) test statistics for univariate analysis and Cox stepwise regression for multivariate analysis; the end point was local recurrence. The relapse rate in this cohort was 26%. In univariate analysis the significant factors associated with prolonged disease-free survival included older age, negative nodes, positive estrogen receptor (ER) status, and absence of LVI. Small tumor size was significant only in the univariate analysis. In the multivariate analysis, absence of comedocarcinoma entered the model in addition to the other variables. If the variables are stratified, a group of 66 patients with 6% local recurrence rate was identified. These were node-negative women >/=50 years of age with no LVI, no comedo DCIS, and ER-positive tumors. This study clearly indicates the important role of pathologic parameters in assessing the risk of recurrence.

Outcome of surgical management of superior oblique palsy: a study of 123 cases.

PURPOSE: To determine the outcome of the surgical management of superior oblique palsy at our institution. SUBJECTS AND METHODS: Retrospective review of 123 patients who underwent surgical correction of superior oblique paresis at Bascom Palmer Eye Institute from 1976 to 1996. Subject-Patients: 67% were male and 33% female. The mean age at surgery was 30.5 years (range, 2-78 years). Etiologies of the pareses were trauma (34%), congenital (33%), and acquired/non-traumatic (33%). The mean angle of preoperative vertical deviation in primary gaze was 14.0 delta (range, 0-45 delta). SURGERY: 109/123 (89%) patients underwent single muscle surgery. Of these 109, 57 had single oblique muscle surgery: a superior oblique tuck in 34/57 (60%); an inferior oblique weakening procedure in 22/57 (38%); and a Harada-Ito procedure in 1/57 (2%). The other 14 patients (11%) had bilateral surgery. RESULTS: The final postoperative vertical deviation in primary gaze was < or =3 PD in 60% of patients and < or =7 PD in 80%. The mean change in primary position vertical deviation postoperatively was 10.4 PD for distance and 13.0 PD for near. An "excellent" outcome (final vertical deviation &le3 PD in primary and reading gazes) was achieved most frequently in those patients with congenital pareses and isolated oblique muscle surgery. COMPLICATIONS: Clinically significant Brown's Syndrome occurred in 43/72 (60%) of those cases who had undergone a superior oblique tuck. The incidence of Brown's Syndrome was unrelated to tuck size. Reoperation was three times more likely to be necessary in traumatic cases than in congenital cases (35.0% vs 11.9%, p=0.02). CONCLUSIONS: Based on these results we recommend oblique muscle surgery as the initial procedure to correct superior oblique palsy when appropriate.

Poor stereopsis can support size constancy in albinism.

PURPOSE: The size of a retinal image is inversely related to the distance to the object that generates the image. Normal subjects therefore exhibit size constancy, in which the perceived size of an image is scaled according to its perceived distance. Albinos usually have such poor binocular vision that they perform very poorly on clinical tests for stereopsis. To investigate the functional consequences of this poor stereopsis, we investigated whether stereopsis in these subjects could support size constancy. METHODS: The stereothresholds of 10 albinos and 12 normal control subjects were measured. The presence of absence of size constancy was investigated by having subjects equate the subjective size of stereoscopically presented images whose image disparity indicated that they were at different distances. RESULTS: Laboratory results indicated that eight albinos (including five whose clinical tests indicated a lack of stereopsis) had measurable stereopsis of several thousand are seconds or better. Of these, four also exhibited size constancy. CONCLUSIONS: Albinos who do not demonstrate stereopsis on clinical tests can have stereoscopic perception that commonly used clinical tests do not detect. Moreover, some of these patients even use this poor stereopsis in judging the size of stereoscopically presented images.