Reliability and validity of the function in sitting test in nonambulatory individuals with multiple sclerosis.

Poor seated balance negatively impacts the performance of activities of daily living in nonambulatory individuals with multiple sclerosis (MS) and is frequently a target of rehabilitation interventions. However, there is a lack of clinical measures of seated balance in nonambulatory individuals with MS, thus limiting evaluation of rehabilitation treatments. The aim of this investigation is to determine the reliability and concurrent validity of the Function in Sitting Test (FIST) as a measure of sitting balance in nonambulatory individuals with MS. Twenty nonambulatory individuals with MS [mean age±SD=56.8±10.9 years, women n=15 (75%), mean MS duration±SD=17.8±9.2 years, mean wheelchair usage duration±SD=5.9±4.7 years] underwent a FIST and posturography assessment. The FIST is a 14-item clinical functional assessment of sitting balance validated in adults with acute stroke. The seated posturography assessment involved participants sitting on a force platform without support for 30 s. On the basis of the center of pressure trajectory obtained from the force platform software, two force platform outcomes were quantified: sway area (mm) of the center of pressure and virtual time to contact to the functional boundary (seconds). Internal consistency reliability was assessed using Cronbach's coefficient-α. The test-retest reliability was evaluated using the intraclass correlation coefficient (ICC). Concurrent validity of the FIST was assessed by Spearman's rank correlation analysis. Cronbach's-α as an index of internal consistency of the FIST was 0.91. The test-retest reliability was found to be excellent (ICC=0.92). The FIST was significantly correlated with virtual time to contact to the functional boundary (ρ=0.487, P=0.02), but not with sway area (ρ=-0.267, P=0.25). The observations provide evidence that the FIST is a reliable and valid tool to assess seated postural control in nonambulatory individuals with MS.

Combined timolol and pilocarpine vs pilocarpine alone and timolol alone in the treatment of glaucoma.

We compared the effects of pilocarpine 4% alone, timolol 0.5% alone, and a combination of timolol 0.5% and pilocarpine 4% in the treatment of glaucoma. We treated 43 patients with glaucoma using each drug and then with the combination of drugs for four weeks each. Only patients with a morning intraocular pressure of at least 24 mm Hg without treatment were included. The patients were examined, after one and four weeks of treatment with pilocarpine, timolol, or combined timolol 0.5% and pilocarpine 4%, before the morning dose and at two and five hours after it. At the end of the study, the mean reduction in intraocular pressure from baseline was 9.2 +/- 5.1 mm Hg (28.5% +/- 12.7%) with combined timolol 0.5% and pilocarpine 4%, 5.6 +/- 3.6 mm Hg (17.6% +/- 9.7%) with pilocarpine, and 7.5 +/- 5.0 mm Hg (21.2% +/- 12.6%) with timolol. Intraocular pressure was consistently lower with the combination treatment than with timolol or pilocarpine alone. We believe that this combined solution of timolol-pilocarpine is a valuable contribution to the treatment of open-angle glaucoma.

[Excimer laser photorefractive keratectomy for myopia].

We have used excimer laser during the past year to correct refractive errors (myopia and hypermetropia) and to remove superficial corneal scars. 714 eyes underwent excimer laser photorefractive keratectomy for correction of myopia and 81% of the patients achieved uncorrected visual acuity of 6/12 or better without glasses. 17 patients underwent a second treatment to correct residual myopia and all of them had uncorrected visual acuity of 6/12 or better 6 months later. The results show that excimer laser photorefractive keratectomy is a safe and efficient procedure to correct myopia. The possibility of various postoperative complications appearing over the long term suggests cautious optimism.

The pitfall of dacryostenosis.

We examined a 65-year-old woman with complaints of epiphora, which was diagnosed as due to dacryostenosis. After she had undergone dacryocystorhinostomy for this presumed condition, we discovered a large mass protruding through the incision. A biopsy showed anaplastic carcinoma, and a CT scan revealed that the right-side sinuses were filled with tumor. We conclude that the possibility of paranasal sinus tumors should at least be considered before initiating treatment for complaints of epiphora in elderly patients.