The influence of the cause of death and age on human corneal metabolism.

PURPOSE: Little is known about the metabolic status of human corneas before transplantation. The authors attempted to determine the influence of both cause of death and age on the corneal metabolism. METHODS: Adenosine-triphosphate (ATP), adenosine-diphosphate (ADP), glucose, and lactate were measured in the stroma and endothelium of 30 human corneas. The corneas were divided into four groups according to cause of death and four groups according to age. Corneas from donors with diabetes were excluded. RESULTS: Corneas from patients who died suddenly--because of cardiac infarction, for example--have good metabolic status even 24 hours after death. In corneas of patients with cancer or sepsis, the metabolism has run down. In comparison, corneas from patients with cancer are in better metabolic condition than those from donors with sepsis because they have adapted to catabolism. Corneas donated from patients with renal insufficiency show results somewhere in between. Statistical evaluation revealed significant differences in ATP concentrations for corneas from donors who died suddenly and from patients with renal insufficiency compared to corneas from patients with sepsis. It could be shown that glucose concentrations as a resource for metabolism increase with age. The best ATP-ADP ratios were found in the group of 40- to 59-year-old donors. Nevertheless, differences between the age groups were not statistically significant. CONCLUSION: From our results it can be concluded that the cause of death and systemic metabolism have an influence on corneal metabolism. Results concerning donor age reflect the well-known fact that donor age has no influence on the quality of keratoplasty material.

Traditional and new types of spondarthritis with special consideration of spondylodiscitis.

In rheumatology the so-called "seronegative spondarthritis" is a group of diseases characterized by the presence of HLA-B 27. This group includes the typical ankylosing spondylitis as well as atypical spondylopathies such as those occurring in psoriasis, Reiter's disease and chronic inflammatory enteropathies, which attack mainly the spine and secondarily the peripheral joints. In some severe cases, non-infectious, sterile spondylodiscitis was observed. These can lead to instability and fracture, followed by pseudarthrosis of the involved segment of the spine. In contrast to these traditional spondarthritides three new types are marked by the lack of HLA-B 27. 1) "Spondarthritis hyperostotica pustulo-psoriatica" (F. Schilling), a very rare variation of psoriatic spondylopathy, sometimes accompanied by spondylodiscitis. 2) Arthritis and spondarthritis in acne fulminans. 3) Destructive arthropathy and spondylopathy in long-term hemodialysis, occasionally occurring with spondylodiscitis, a very new type of spondarthritis. The amyloid B (beta-2-micro-globulin), discovered only four years ago, plays a dominant role in the pathogenetic chain of this disease. Details of the etiology of these very impressive diseases are presented. Destructive spondylodiscitis will no doubt be a challenge to neurosurgeons.

The leadership/management role: a differentiating factor for ADN/BSN programs?

The resurgence of the ADN/BSN issue relative to educational preparation and roles and the concomitant development of positions taken by the professional associations and National Commission on Nursing pointed to the need for study of current ADN/BSN curricula and utilization of graduates. Based upon a brief historical literature review and ADN/BSN competency statements, the leadership/management role was selected for study as a possible differentiating factor between these programs. Findings from a statewide study of ADN and BSN programs and a representative sample of nurse executives indicated that an education and service dilemma exists relative to this role. The majority of ADN program directors noted that a leadership/management component should be part of ADN curricula, whereas BSN program directors did not concur. Nurse executives utilized ADN graduates in leadership/management positions and stated that length of experience was an influencing factor in selection. Numerous other findings showed a discrepancy in beliefs and practices among educators and nurse executives. This survey demonstrates the need for curriculum changes and role clarification. The leadership/management role may be a viable area for consideration.

[Rare side effects of gold]. / Seltene Gold-Nebenwirkungen.

Rare side-effects of parenterally administered gold salts in rheumatoid arthritis are reported: metallic gold deposition in the teeth; reversible lymphadenopathies of the neck; IgA loss under gold treatment; gold-induced appearance of ANA and DNA-antibodies and gold deposition in the skin.

Spiritual well-being in older adults: Harmonious interconnectedness.

The current study was designed to identify indicators of spiritual well-being in persons 65 years of age and over, using a grounded theory approach through the constant comparative method of data analysis. The basic social process of harmonious interconnectedness was discovered. This process was the unifying force between categories and within each identified category. The study has implications for health care personnel in that it provides a basis for assessing spiritual well-being in patients.