Variable tinted spectacle lenses: a comparison of aesthetics and visual preference.

PURPOSE: To determine the correlation between the aesthetics of lens tints preferred for cosmesis and lens tints preferred for viewing. METHODS: Thirty-five subjects (mean age: 25; 49% male, 51% female) with no significant ocular pathology participated in the study. Median visual acuity was 20/20. Color vision testing was performed on each subject using Ishihara plates, and those with abnormal scores were excluded from the study. Subjects were shown nine pre-selected tinted lenses (50% transmittance) of variable wavelengths. These lenses were mounted on two separate color backgrounds, one white and the other approximating their skin tone. Subjects were asked to choose from each background which tinted lens they would most prefer to wear and which lens they would least prefer to wear. The subjects were then shown a series of eight pictures (four nature photographs and four paintings) with different dominant wavelengths. Subjects were asked to grade the aesthetic effect of a clear lens and each of the nine tinted lenses on the appearance of the pictures. Chromaticity coordinates were calculated for each lens and picture. RESULTS: The blue lens was the most frequently chosen preferred lens to wear, followed by green, purple, and gray. The least preferred lenses were yellow, brown, and pink. For viewing the nature photographs, the clear lens was preferred over any of the tinted lenses. For viewing the paintings, the purple lens was most preferred. The yellow lens was least preferred for both photographs and paintings. CONCLUSIONS: Younger individuals with no significant ocular pathology preferred viewing both nature photographs and paintings through tinted lenses that did not, or only slightly, altered the chromaticity of the image. Whereas a clear lens was favored over the tinted lenses for viewing the photographs, some tinted lenses (purple and pink) were preferred for viewing paintings. There was no correlation between the most favored lens tint chosen based purely on cosmesis and the most favored lens tint based on viewing preference. However, the least preferred lens tint for cosmesis and viewing was yellow.

Acquired lower eyelid epiblepharon.

PURPOSE: Although congenital epiblepharon is a relatively common condition, particularly in Asians, acquired lower eyelid epiblepharon is rare. METHOD: We examined an 8-year-old boy who developed unilateral lower eyelid epiblepharon after a subciliary incisional approach for repair of a zygomatico-orbital fracture. RESULTS: The patient demonstrated an overriding fold of right lower eyelid skin and loss of the lower eyelid crease. At the time of surgical repair, disruption and scarring of the lower eyelid retractors, suborbicularis fascia, and orbital septum were noted. The epiblepharon was successfully corrected by plication of the retractors and skin to the tarsus. CONCLUSION: Disruption of the anterior subcutaneous fibers of the lower eyelid retractors (that is, capsulopalpebral fascia) contributes to epiblepharon.

Microbiology of chronic sinusitis in children.

To better understand the factors involved in chronic sinusitis in childhood, we cultured the sinuses, middle meatus, and nasopharynx in 39 children requiring surgical intervention. Sixty-nine percent of these patients had other medical problems, including asthma (49%) and immunologic compromise (18%). We cultured coagulase-negative staphylococcus in 18 patients, Streptococcus viridans in 14 patients, normal flora in 10 patients, Staphylococcus aureus in nine patients, group D streptococcus in five patients, Corynebacterium in five patients, Haemophilus influenzae in three patients, Neisseria in three patients, and Streptococcus pneumoniae, group A streptococcus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella oxytoca, Propionibacterium acnes, Actinomyces, and an anaerobic gram-negative bacillus in one patient each. Cultures yielded no growth in nine patients. A strong association between cultures of the middle meatus obtained ipsilaterally and cultures of the maxillary (83%) and ethmoid sinuses (80%) occurred. A poor correlation was found between cultures of the nasopharynx and maxillary (45%) and ethmoid sinuses (49%). All seven patients who had both maxillary and ethmoid sinus cultures showed the same organisms in both sinuses. Only 41% of organisms were found on both sides when procedures were performed bilaterally. Cultures of the middle meatus appear to be sensitive and specific for organisms within sinuses. The presence of predominantly nonvirulent organisms in low titers suggests that additional factors other than bacterial overgrowth contribute to the pathogenesis of chronic sinusitis in children.

Iodine-125 seed implantation as an adjunct to surgery in advanced recurrent squamous cell cancer of the head and neck.

Survival for extensive recurrent squamous cell carcinomas of the head and neck remains poor, with the major cause of death being local recurrence. Surgical implantation of iodine-125 interstitial seeds allows tumoricidal doses of radiation to be delivered to residual tumor while minimizing radiation doses to the surrounding tissues. From 1978 to 1988, 39 implantations were performed on 35 patients for extensive recurrent squamous cell carcinoma of the head and neck. The decision for implantation was based on positive margins or close to resection margins from frozen sections after salvage resection. The determinate 5-year disease-free survival was 41%, with both the overall and no evidence of disease 5-year survivals being 29%. Significant complications occurred in 36% of all cases. This figure increased to 56% when flap reconstruction was required. Possible reasons for this seemingly high complication rate are discussed. Considering the advanced nature of these recurrent carcinomas, surgical resection with iodine-125 seed implantation appears to be an effective method of managing disease that might otherwise be judged unresectable and treated for palliation only.

Intraoperative I-125 seed implantation for extensive recurrent head and neck carcinomas.

From 1978 to 1988, 41 patients with extensive recurrent carcinomas of the head and neck were treated with surgical resection plus intraoperative iodine-125 seed implantation. Surgery was performed to resect the tumors and to expose the tumor beds for implantation. I-125 seeds were implanted intraoperatively, with a spacing of 0.75-1 cm between adjacent seeds, either into the soft tissue in the tumor bed or onto small patches of gelatin sponges to cover the bone, nerve, or blood vessel involved with disease. Reconstructive flaps were used in 18 patients. The average I-125 dose delivered by the implanted seeds was 8,263 cGy. The determinate 5-year actuarial survival rate for the entire group was 40%. The 5-year local disease control rate was 44%. Major complications were transient wound infection (32%), flap necrosis (24%), fistula formation (10%), and carotid blowout (5%). These results indicate that surgical resection plus I-125 seed implantation provides a potentially curative treatment for patients with extensive recurrent head and neck carcinomas that would be considered traditionally unresectable and that would be treated only with palliative therapy.

Phenol as an adjuvant anesthetic for tympanostomy tube insertion.

The use of inhalational anesthesia for insertion of tympanostomy tubes in children provides no postoperative pain relief. Our retrospective analysis of children following tympanostomy tube insertion previously had shown significant postoperative elevations of blood pressure and heart rate in over 70% of cases. These changes, along with behavioral findings and complaints of discomfort, are suggestive of pain. Phenol has been used in adults for local anesthesia during tympanostomy tube insertion. This study determined prospectively whether pain occurred postoperatively and whether phenol placed on the tympanic membrane just prior to myringotomy would reduce postoperative pain in children, as measured by behavioral and physiologic parameters. Results of a double-blind, randomized trial in 46 children showed that both the phenol-treated and the control groups demonstrated significant elevations in pain scores postoperatively (P = 0.0001), which then slowly diminished to baseline by 45 min to one hour. The phenol group had consistently higher pain scores than the non-phenol group (P less than 0.001). Possible reasons for these findings are discussed.

Hyperthermia effects on the growth of a laryngeal squamous cell carcinoma cell line treated with recombinant human interferons alpha and gamma.

Clinical therapy with either interferon alpha or interferon gamma is associated with a febrile response. However, the effects of hyperthermia on the response to these interferons have not been elucidated fully. In this study, a cell line derived from a laryngeal squamous cell carcinoma (JHU-011-SCC-L-P) was grown in the presence of recombinant human interferon alpha (rHuIFN alpha) or recombinant human interferon gamma (rHuIFN gamma) and incubated at either 37 degrees or 39 degrees C, and cell growth rates were measured. Cells incubated with rHuIFN alpha demonstrated no difference in growth rates from control cells. Cells treated with rHuIFN gamma showed significant inhibition of growth at both temperatures, and the ratio of decreased growth at 39 degrees C was significantly greater than for the rHuIFN alpha and control groups. This hyperthermic effect did not depend on the continued exposure to rHuIFN gamma, and the effect appeared to depend on the duration of hyperthermia instead of the time sequence of hyperthermic exposure. Moreover, initial treatment at 39 degrees C for 24 hours was ineffective in producing the hyperthermic response produced with continuous hyperthermic exposure. These findings would indicate that the effect of rHuIFN gamma on this laryngeal squamous cell carcinoma cell line is enhanced significantly at 39 degrees C compared with 37 degrees C. There appears to be no similar hyperthermia-augmented antiproliferative effect of rHuIFN alpha-treated cells.

Computer imaging for instruction in facial plastic surgery in a residency program.

Aesthetic analysis of the face has advanced from a purely subjective opinion to complicated formulas based on measuring various combinations of angles, distances, and ratios. These concepts of facial harmony and surgical alterations have been difficult to teach in a residency program, especially regarding preoperative evaluation and a clear idea of the desired surgical results. The authors have utilized a computer imaging system to facilitate the preoperative facial analysis and to project what the postoperative surgical result should achieve based on these measurements. The use of this system has helped enhance the communication between resident and attending surgeon as well as educate the resident in important facial relationships. A degree of experimental freedom in alteration of facial features is provided. The methods of facial analysis and the advantages of computer imaging in a residency program are discussed.

Oral manifestations of the congenital insensitivity-to-pain syndrome.

The congenital insensitivity-to-pain syndrome is a sensory syndrome in which pain is impaired. It has been variably classified under a variety of terms, on occasion leading to some confusion. The condition is present at birth. The patient is usually, but not always, normal with respect to intelligence, development, and psychological adjustments. Other sensory perceptions are normal. Traumatic lesions as a result of self-mutilative acts are not uncommon, especially at an early age. The condition may not be apparent clinically until the time of initial tooth eruption. As the primary teeth erupt, the patient acquires the necessary apparatus for self-infliction of wounds to oral structures, skin, and fingernails. A case of congenital indifference to pain is presented, with clinical documentation of tooth-related problems occurring over a 2-year period and of the steps taken to correct or minimize the traumatic effects of chewing.

Recruitment of ethnic and socio-economically disadvantaged students into dentistry.

A program designed to attract and graduate underrepresented minorities and disadvantaged students in dentistry is reported. The program consisted of three phases: career orientation, recruitment, and academic enrichment/retention. In the six years of this program's existence, the number of minority students enrolled increased from 1 to 28, including 12 who were graduated by June 1979. Only two were lost because of academic difficulties. An analysis of grades and tutorial needs showed that students experienced the most difficulty with first-year basic science courses. Recommendations are presented for program improvement.