Static and kinetic perimetry results of krypton red laser treatment for macular edema complicating branch vein occlusion.

Twenty patients with clinical and angiographic evidence of recent branch vein occlusion complicated by macular edema were assigned to receive krypton red laser treatment if their macular edema lasted more than three months. Visual acuity, static and kinetic perimetry, fundus photography, and fluorescein angiography were evaluated before treatment and at two-month intervals thereafter. Visual acuity improved by two lines one year after treatment in 65% of patients. Each of these patients had a complete perifoveal capillary arcade. Static perimetry results correlated well with visual acuity, and a significant threshold improvement was detected in these patients. Visual-acuity results and static and kinetic perimetry findings are presented. The rationale for selection of the krypton red wavelength (647 nm) is discussed.

Comparison of the efficacy of a two-day and a five-day schedule for infusing intravenous gamma globulin in the treatment of immune thrombocytopenic purpura in adults.

The standard schedule for treating immune thrombocytopenia purpura in adults with intravenous immunoglobulin G infusion (IVIG), 400 mg/kg per day for five days, was compared with a shorter schedule using 1,000 mg/kg per day for two days. Both schedules were found to be effective in correcting thrombocytopenia. Eleven of the 17 patients treated with the five-day regimen and nine of 10 patients treated with the two-day regimen had significant responses. Patients with an initial platelet count of less than 20,000 platelets/mm3 or with an estimated in vivo platelet survival in excess of 90 hours were less likely to have a response than were other patients. There were no serious side effects in either group, but thrombophlebitis was observed in some patients receiving the five-day regimen when a single intravenous catheter was used for more than three days. Headaches and, less commonly, low-grade fever were noted in some patients receiving the two-day regimen when infusions were given at flow rates in excess of 0.04 ml/kg/minute. Since the two-day regimen requires shorter hospitalization and corrects thrombocytopenia slightly faster than the five-day course, it may be particularly useful in correcting thrombocytopenia in hospitalized patients requiring splenectomy or other surgery.

Preferential transport of non-enzymatically glucosylated ferritin across the kidney glomerulus.

We have examined the significance of carbohydrate structure to the transglomerular passage of proteins. Carbohydrate-free (non-glycosylated) ferritin, prepared by Concanavalin-A-sepharose affinity chromatography, was perfused into rat kidneys, and was observed to be restricted from transglomerular transport and to accumulate within the lamina rara interna of the glomerular basement membrane. Visibility of the laminar structure of the glomerular basement membrane was enhanced following perfusion fixation containing tannic acid, permitting the observation of charge dense regions within the basement membrane. Non-enzymatically glucosylated ferritin was not restricted by the lamina rara interna and was observed to penetrate the lamina densa and lamina rara externa. Glucosylated ferritin was observed to be sequestered also by epithelial pinocytic vesicles and to be accumulated within multivesicular bodies. Quantitative measurements using fluorescently labelled ferritins indicated the preferential clearance of glucosylated ferritin from the plasma and preferential appearance of glucosylated ferritin in the urine. The differential transport of glucosylated ferritin was not due to the formation of a cationic protein, as isoelectric focusing established that glucosylation of ferritin results in a more anionic protein. These studies suggest that glucosylation of anionic proteins results in their increased transglomerular permeability. This increased protein permeability could contribute to the proteinuria observed in diabetic microangiopathy.

Bereavement counseling for gay individuals.

This article is intended to sensitize therapists to the particular concerns of the gay bereaved. Clinicians need to be aware of and accept homosexual and lesbian lifestyles as well as knowledgeable about grieving procedures before engaging in a therapeutic relationship with gay bereaved individuals. If the therapist has minimal information about either of these areas, the patient should be referred to another clinician who is more informed. The therapist and patient together should explore the possible mechanisms for a bereaved lesbian or gay man to cope with within his or her social environment. While it is now less of a problem than in the recent past, there is still little awareness of the specific problems homosexuals encounter and society has few structures to deal with them. Homosexual and lesbian couples who mourn their mates need to be seen and see themselves as worthy of support.

Survivors of prehospitalization sudden death. Characteristic clinical and angiographic features.

Cardiac catheterization and angiography were performed in 57 survivors of prehospitalization sudden cardiac death (PSD). Fifty-two had coronary artery disease. In most, the disease was severe, with almost universal involvement of the anterior descending artery. Associated left ventricular dysfunction was common. Although the majority of survivors had severe coronary artery disease, only 16 had an acute myocardial infarction associated with the PSD event and the extent of their coronary artery disease generally was less severe than those who died suddenly of an arrhythmia and no myocardial infarction. Cardiovascular symptoms of long duration prior to sudden death were not uncommon, although sudden death was the initial cardiac symptom in some. Others had crescendo angina as the initial symptom, and a few had a clinical history compatible with Prinzmetal's angina. Although severe coronary artery disease was the most common underlying abnormality, PSD may be an expression of multiple causes.