Review of the endometrial effects of estrogens and progestins.

Several controversial areas have been reviewed. It would seem from the evidence at hand that progression from endometrial hyperplasia to endometrial carcinoma does occur in a significant percentage of women and that endometrial hyperplasia, particularly adenomatous hyperplasia and atypical hyperplasia, must be regarded as premalignant changes. Gambrell believes that all stages of hyperplasia should be regarded as premalignant. Previous and retrospective studies provide evidence implicating estrogens in the causation of both endometrial hyperplasia and endometrial carcinoma. Although some of these studies may have design flaws, the amount of data is substantial. Prospective studies have demonstrated an increased risk of hyperplasia in women treated with estrogens. An increased risk of endometrial carcinoma in estrogen users compared with nonusers has been suggested even more recently. Reviewed as a whole, the cumulative evidence provided by these studies clearly supports this association, and it would appear the only issue left to resolve may be the magnitude of the association. Cyclic administration of estrogens may decrease the risk of development of endometrial carcinoma. It would seem, however, that such administration does not totally eliminate risk under any circumstances, and in fact, a dose-related relationship appears to persist. It seems well established that progestogens do decrease the risk of both endometrial hyperplasia and endometrial carcinoma associated with the administration of estrogen to peri- and postmenopausal women. Such reduction in risk is significant and lower relative risks in estrogen/progestogen treated women have been reported compared to untreated women. This reduction in risk has been reported in a variety of studies. Whitehead and co-workers have provided a clear biochemical mechanism for progestogen protection of the endometrium in the antagonism of estrogen at the endometrial cellular level. The evidence at hand in the literature would suggest that progestogens should be administered for at least 10 days per cycle. In summary, there is good evidence that the addition of a progestin to estrogen therapy prescribed for the symptoms of menopause provides protection from endometrial hyperplasia and related carcinoma. The protection conferred is greater than that afforded by cyclical estrogen-alone therapy, and allows for continuous therapy, hereby providing greater symptomatic relief. There is little evidence for adverse effects caused by the added progestins, but further studies of women on combined therapy will undoubtedly be warranted.


Host defenses and bacterial resistance.

The amount of knowledge and understanding about the human immune system has expanded rapidly in the past several decades. The ability of the physician to care for pregnant women, specifically those with infectious diseases, can be enhanced through a basic understanding of host defenses and the normal alterations of these defenses encountered during pregnancy. A general understanding of bacterial resistance to antimicrobial agents will also aid the practitioner in selecting the appropriate setting and agent when prescribing these drugs.


The penicillins.

The penicillins have played a major role in the treatment of many obstetric and gynecologic infections. The advent of the newer broad-spectrum penicillins has allowed their use as single-agent therapy for certain infections. Although toxicity is extremely low, disadvantages of their use include superinfection and induction of resistance. The cost of therapy is comparable with other antibiotics with similar coverage.


Limited-spectrum (first-generation) cephalosporins.

Except in the treatment of pyelonephritis, the first-generation cephalosporins are rarely the first line drug of choice for any suspected infection in obstetrics. Other antibiotics have a narrower spectrum of antimicrobial coverage and are cheaper. Unless culture dictates the use of cephalosporins for main-line therapy, the use of first-generation cephalosporins should be limited to the treatment of pyelonephritis in pregnancy and for prophylaxis at the time of surgery.


Extended-spectrum (second- and third-generation) cephalosporins.

The extended-spectrum cephalosporins provide better activity against gram-negative bacilli and anaerobes than first-generation agents. Cefoxitin and cefotetan (second-generation) and ceftriaxone (third-generation) have excellent activity against B. fragilis and are useful in the treatment of postoperative infections and pelvic inflammatory disease. The extended-spectrum cephalosporins are as efficacious as first-generation agents for prophylaxis of cesarean section and hysterectomy. The first-generation drugs, such as cefazolin, are considerably less expensive than these newer compounds, however, making first-generation agents the drugs of choice when used for prophylaxis. The majority of the third-generation agents should be reserved for the treatment of meningitis and resistant nosocomial infections.


Imipenem-cilastatin.

Imipenem-cilastatin, with its broad spectrum of activity and relative safety, offers an excellent alternative for the treatment of many obstetric and gynecologic infections. In addition, the possibilities for intramuscular administration give clinicians additional treatment options. Because of the relatively high cost of imipenem-cilastatin, it should not be considered "first-line" therapy for most obstetric and gynecologic infections at present. Misuse and overuse of imipenem-cilastatin will result in the further development of resistant organisms, as has already been seen with many other antibiotics, and continued monitoring of susceptibility patterns is necessary.


Clindamycin.

Clindamycin has been extensively used in the therapy of obstetric and gynecologic infections for over 20 years. This antibiotic is well known for it activity against anaerobic bacteria, particularly beta-lactamase-producing strains of the Bacteroides species. Clinicians should also recognize its very good activity against aerobic gram-positive cocci, such as the group B streptococci, but be aware of its absence of activity against aerobic gram-negative rods, such as E. coli. In combination with an aminoglycoside, clindamycin has become the standard by which other antimicrobials have been judged in the treatment of pelvic infections. A dose of 900 mg administered intravenously every 8 hours is recommended when treating the serious infections discussed. Although concern about the potential side effect of pseudomembranous colitis is valid, in practice, this is an uncommon problem that responds well to the discontinuation of clindamycin and to the treatment of the C. difficile-induced condition with vancomycin or metronidazole.


Metronidazole.

Metronidazole has proven to be a useful and inexpensive antibiotic for the treatment of T. vaginalis and bacterial vaginosis. Few alternatives exist for these two specific indications, and metronidazole will continue to play a primary role in therapy. Oral metronidazole continues to be a very inexpensive alternative to oral vancomycin for the treatment of C. difficile-induced pseudomembranous colitis. For the treatment of moderate to severe mixed aerobic/anaerobic pelvic infections, metronidazole should be considered secondarily in patients who have failed other multiple- or single-drug regimens or in patients who are infected. with anaerobic organisms resistant to other commonly used agents including clindamycin, cefoxitin, cefotetan, or ampicillin/sulbactam. Metronidazole is not a first line drug of choice for antibiotic prophylaxis in obstetric and gynecologic patients.


The aminoglycosides.

The three most commonly used aminoglycosides in obstetrics and gynecology are gentamicin, tobramycin, and amikacin. These drugs bind to subunits of the ribosome and inhibit bacterial protein synthesis. They are primarily active against aerobic gram-negative bacilli. Their principal adverse effects are nephrotoxicity, ototoxicity, and neuromuscular blockage. They may be administered intramuscularly or intravenously and usually are used in combination with other drugs for treatment of disorders such as pyelonephritis, chorioamnionitis, puerperal endometritis, and pelvic inflammatory disease.


Aztreonam.

Aztreonam is a synthetic monobactam antibiotic that has excellent activity against aerobic gram-negative bacilli. It can be used as a single agent for the treatment of upper urinary tract infections caused by organisms resistant to the cephalosporins and ampicillin. It also can be administered in combination with a drug such as clindamycin for treatment of pelvic inflammatory disease or postoperative pelvic infections.


The quinolone antibiotics.

The fluorinated quinolones are synthetic derivatives of nalidixic acid. They are well absorbed when administered orally and have an extended duration of action. They are of primary value in treating gonorrhea and complicated urinary tract infections in nonpregnant women.


Erythromycin.

Even with the continuing emergence of new antibiotics, erythromycin continues to be used extensively in obstetrics and gynecology. It is inexpensive, with a long history of usage and proven safety. When oral erythromycin preparations are given in the correct dose and with proper timing in relation to meals, no individual preparation offers a significant therapeutic advantage. Its uses include the treatment of respiratory tract infections, chlamydial and other genital tract infections in pregnancy, puerperal mastitis, and acute conjunctivitis of the newborn.


The tetracyclines.

The tetracyclines are inexpensive drugs that are of primary value in treating nonpregnant women who have acute urethral syndrome or endocervicitis due to Chlamydia trachomatis. They are contraindicated in pregnancy because they are injurious to fetal teeth and bone.


Antiviral agents.

Antiviral agents are less numerous and often more toxic than antibacterial agents. Acyclovir is commonly used for suppression and treatment of recurrent genital herpes simplex virus and may be indicated for pregnant women with disseminated herpes. Zidovudine is indicated for pregnant women with human immunodeficiency virus infection who have low CD4 lymphocyte counts. Ganciclovir, vidarabine, ribavirin, amantadine, didanosine, and foscarnet are rarely indicated in gynecology and are not recommended for use in pregnancy.


Topical antifungal agents.

Current knowledge of fungal cell architecture and biochemistry allows limited understanding of the mode of action of presently available topical antifungal agents. Nystatin, first introduced in the 1950s for treatment of vulvovaginal candidiasis, has been surpassed by the imidazoles and triazoles as the first choice of treatment for vulvovaginal candidiasis. The lack of clear superiority of any one azole agent or dosing regimen leads some authors to recommend a short course of therapy (1-3 days) for acute uncomplicated candidal vaginitis using factors including anatomic distribution of inflammation and patient preference (such as previous hypersensitivity or allergic reaction to the agent, the cost of the agent, and the preferred vehicle for administration of the agent) to choose the specific antifungal agent (see Table 1). Recurrent cases or treatment during pregnancy may require longer therapy (6-14 days), again using an agent chosen because of these factors. Although theoretic risks may exist, actual harm to the fetus or pregnancy has not been demonstrated with the use of the topical azoles during any trimester of pregnancy. The development of antimycotic resistance need not be considered in infrequent and occasional episodes of candidal vaginitis, and it is rarely a cause of treatment failure even in chronic or recurrent cases.


Evaluation and management of orofacial sensory nerve injuries.

Sensory disturbances can occur as a result of a number of dental procedures, maxillofacial injuries and pathology. The dentist is expected to inform patients of the likelihood of nerve injury prior to conducting invasive procedures. If a patient develops a sensory deficit after treatment, the practitioner should be aware of objective means of assessment of the deficit and techniques available for management. Our understanding of nerve injury, regeneration and treatment has markedly progressed in recent years. This paper provides current information on the prevention and management of neurosensory disturbances likely to be encountered in dental practice.


Asian Americans: an increasing reality in the population and the dental profession.

Asian Americans are one of the fastest growing minorities in the United States. The use of services by this diverse population can and is affected by a host of demographic, cultural and language factors. But little to no data on the oral conditions of this minority group are available.


Temporal arteritis mimics TMJ/myofascial pain syndrome.

Dental pathology is definitely the most common cause of orofacial pain. Dentists astutely diagnose and treat the various pathologic dental conditions. The restoration of the masticatory system is usually achieved in a proficient, straightforward and predictable manner. Certain patients' orofacial pains do not have a dental etiology and are refractory to treatment. The protean manifestations of temporal arteritis may present with major pain complaints mimicking dental pathology. A case report of such a patient is presented.


Skeletal variations of the seventh cervical vertebrae in the mouse with special reference to the foramina transversaria and the accessory foramina.

The formation of foramina transversaria in the seventh cervical vertebra of CBA and C57BL mice and their offspring is found to behave as if it is determined by a single semi-dominant gene. The accessory foramina of Weber (1950) are investigated in the same material. These foramina are classified into two types and their heredity is evaluated.


A transmission electron microscopic study of macromelanosomes in sporadic dysplastic naevi.

Melanosomes in sporadic dysplastic nevi were examined by transmission electron microscope. In particular the structure of macromelansomes was observed. Macromelanosomes were present in both nevus cells and keratinocytes. They were round and consisted of a core structure and a cortex structure. The core was composed of electron-dense amorphous material and electron-lucent microvesicles. The cortex contained grains of different sizes and electron densities. Occasionally small melanosomes were observed in the cortex. Electron-lucent microvesicles were also present in small spherical and ellipsoid melanosomes. Melanosome complexes observed in nevus cells contained degrading melanosomes with electronlucent microvesicles, dispersed microvesicles and grains. Melanosome complexes with structures resembling those found in macromelanosomes were also present. The result of the investigation suggests that melanosome complexes found in nevus cells might become macromelanosomes through autophagy.


Should we or shouldn't we treat condensing osteitis with root canal therapy?

The intent of this article is to review with the dental clinician the literature concerning a lesion labeled condensing osteitis. A radiographic and histologic picture is presented along with etiology and diagnosis. A conclusion is drawn from the available literature to treat these lesions with endodontic therapy.


Fine structure of developed human tongue muscle.

The purpose of this study was to clarify the relationship myofibrils, mitochondoria and other cytoplasmic organella in the developed lingual muscle (vertical, transverse, and longitudinal) by using various microscopic levels: light, scanning electron, and transmission electron. The tongue muscles were examined in seventeen autopsy specimens: eight, 12-32 weeks gestation and ten adults (five male, five female; 54-93 years). The muscle fiber rapidly developed. A large number of mitochondoria and glycogen granules increased and the size of myofibrils in the middle stage also increased, ranging from 24 to 28 weeks gestations. The developed myofibrils were differentiated, the VL and TL at first are developed before the LL developed. These results suggest that the lingual intrinsic muscle have differences in properties during development.


Stereo architecture of the lamina propria in the mouse laryngopharynx in scanning electron microscopy.

In the ventral wall of the mouse laryngopharynx, a fairly large number of the epithelial papillae containing taste bud (provisionally denominated the pharyngeal papillae) were observed. The NaOH cellmaceration method was applied in order to demonstrate the stereo architecture of the connective tissue papillae (CTP) of the pharyngeal papillae. The CTP appeared as a cylindrical wall surrounding a round depression, and consisted of a delicate meshwork of collagen fibrils. It is suggested that the CTP constitute the skeletal framework of the pharyngeal papillae and that the round depression corresponds to the site of taste bud. Furthermore, the collagen fibrillar architecture in the extrapapillary region appeared to be arranged to meet specific functional needs. That is, in the rostral end of the laryngopharynx, the collagen fibrils ran solitarily to form a coarse meshwork and seemed to allow the epithelium a certain degree of freedom of motion in swallowing. On the other hand, in the caudal part the fibrils concentrated into the thick bundles of the fibers running side by side along the long axis of the laryngopharynx and, therefore, appeared to play an important role in resisting the excessive stretching force.


Is there a shortage of dental hygienists?

Dental hygiene faculty from the Ohio State University, working under a grant from the Ohio Dental Association, surveyed licensed dentists and dental hygienists in Ohio in order to determine work-related concerns and possible solutions to perceived shortages of hygienists. There were 585 respondents from those selected through stratified systematic sampling based on state dental district for a 69% rate of dentist return and a 73% rate of hygienist return. The joint surveys assessed attitudes and documented experiences in several categories: practice background, opinion about hygiene employment shortage, compensation, aspects of hygiene satisfaction, reasons for ever terminating hygiene practice and future conditions persuading a return to hygiene practice. This article, the first in a series, presents findings from the survey of dentists relative to a perceived shortage of clinical dental hygienists. Forty-eight percent of dentist respondents believe that there is a shortage, while 52% are either not sure or believe there is no shortage. Those sensing a shortage have either tried to find a hygienist and could not believe there is a smaller pool to choose from, or have heard that colleagues have been unable to find a hygienist. Solutions to the shortage focus on better recruitment of qualified students, encouraging reentry of non-practicing hygienists, and promoting retention of hygienists in existing practices. Less frequently, dentists suggest starting new hygiene programs or training hygienists by preceptorship.


Scanning electron microscopic study on the lingual papillae in the Manchurian chipmunk, Tamias sibiricus asiaticus.

The superfacial structures of the tongues in the Manchurian Chipmunk, Tamias sibiricus asiaticus, were observed by scanning electron microscope. The tongues were long, tapering, narrow and thick with a long apical free portion and a small lingual prominence in the posterior half. In this animal, three circumvallate papillae were present in an inverted triangle, a minority of conical papillae on the pharyngeal part and parallel large conical papillae on the lateral border. The fungiform papillae were scanty on the dorsal surface. These characters suggested this animal was more primitive than the others in rodents.


Insertions of the lumbrical and interosseous muscles in the human foot.

The lumbrical and interosseous muscles in twenty-five feet of Japanese adult cadavers were dissected. The lumbrical muscles mainly continued into the dorsal aponeuroses or the terminal tendons of the extensor digitorum longus muscle, though they occasionally issued some accessory and slender tendons inserting into the bases of the proximal phalanges. Rarely, the lumbrical muscle showed an atavistic anomaly. In this anomaly, the lumbrical muscle was divided into two tails which continued into the bases of the proximal phalanges of the contiguous toes. The plantar and dorsal interosseous muscles were mainly attached to the bases of the proximal phalanges. Frequently, the plantar and dorsal interosseous muscles issued some accessory and small tendons continuing into the dorsal aponeuroses. This fact suggests that the plantar and dorsal interosseous muscles in the foot, like the palmar and dorsal interosseous muscles in the hand, are composite muscles derived from the flexor brevis, contrahens and other muscles.


Anatomical study of the accessory mental foramen and the distribution of its nerve.

We examined the range of the accessory mental foramen [AMF] and its accessory mental nerve in three Japanese cadavers. The diameters of the AMF were relatively small: 0.74 mm, 0.80 mm and 0.89 mm. The distances between the mental foramen and AMF were: 0.67 mm, 2.1 mm and 5.74 mm. The distribution of the accessory mental nerve was different in the three cases. These nerves communicated with the branches of the facial and buccal nerves.


A supernumerary muscle between the adductors brevis and minimus in humans.

In order to elucidate the nerve supply of a supernumerary muscle observed between the adductors brevis and minimus in humans and to investigate its true nature and mechanism of formation, 100 body halves from 50 adult Japanese cadavers were subjected to gross anatomical examination. A supernumerary muscle was noted in 33 (33.0%) out of the 100 thighs. In each of these thighs, it arose from the upper part of the inferior ramus of the pubis and ran obliquely downwards and laterally. It was inserted into the anterior surface of the insertion aponeurosis of the adductor minimus (17/33 thighs, 51.5%), the upper part of the pectineal line (9/33 thighs, 27.3%), or the posterior side of the base of the lesser trochanter (7/33 thighs, 21.2%). It was supplied, from its posterior aspect, by a filament from the twig originating from the posterior branch of the obturator nerve and being distributed to the superficial fasciculus of the obturator externus (18/33 thighs, 54.5%) or by a twig directly originating from the posterior branch (15/33 thighs, 45.5%). The obturator nerve received fibers from L1234 (4/33 thighs), L234 (25/33 thighs), L2345 (2/33 thighs) or L34 (2/33 thighs) and, moreover, its posterior branch ran through (25/33 thighs, 75.8%) or over (8/33 thighs, 24.3%) the obturator externus to emerge into the thigh. Based on the topographical-anatomical relationships of this muscle to its nerve supply, it seems probable that it is formed by separation from the superficial layer of the obturator externus and changes into an independent structure during the process of ontogeny. Furthermore, from a statistical standpoint, the segmental composition or course of the obturator nerve is not related to either the formation or incidence of this muscle.


Morphological study of parafollicular cells and the parathyroid gland in the house shrew (Suncus murinus).

A morphological study of parafollicular cells in the thyroid gland and parathyroid gland of the house shrew (Suncus murinus) was made. The results indicated that (1) there were two pairs of parathyroid glands which were located in the upper part of the house shrew thyroid gland, (2) the volumes of the house shrew parathyroid glands ranged from 0.014 to 0.079 mm3, (3) the number of parafollicular cells along the follicles was largest in the upper part of the thyroid lobe, while no parafollicular cells were present in the isthmus, and (4) there were about 20 parafollicular cells per 100 follicular cells and 1.519 parafollicular cells per follicle. The number of parafollicular cells per 100 follicular cells was thus about 5 times larger than that in rats and the number of parafollicular cells per follicle about 2.5 times larger than that in rats.


Development of collagen fibers and vasculature of the fetal TMJ.

Using 12 human fetuses, histological development and changes in connective fiber structure and fine vascular patterns have been investigated in various fetal gestational stages by light and scanning electron microscopy. The main arterial supply of the articular disc was from the bilaminar region and pterygoideus lateralis muscle. The vascular network on the disc surface was related with fluid secretion. When the bilaminar region was compressed, it caused ischemia and fibrosis as the main pathological changes in TMJ derangement. A decrease in fluid from blood vessels might occur in TMJ degeneration. Collagen fibers in the disc passed mainly anteroposteriorly. In the anterior and posterior bands, muscular tendon fibers came from the pterygoideus lateralis muscle and superior stratum of the bilaminar region. In the posterior band three-dimensional structures of collagen fibers suitable for load bearing were observed. The compass network and process on the disc showed the normal structure that is formed gradually and has functions including dispersion, pressure bearing, friction-proofing and storage of the synovial fluid. Attachments of the disc were suitable for disc function. Large elastic fibers in the posterolateral part of the superior stratum of the bilaminar region may be antagonistic to the upper head of the pterygoideus lateralis muscle fibers passing medioanteriorly, indicating that this antagonism is available for disc function.


Arterial supply of the masseter muscle in the lion (Panthera leo).

There are few reports on the vascular system of the lion or Panthera leo except for that on the facial artery investigated by Lin and Takemura (1990). Morphological analysis of the masseter muscle of the lion according to the muscle-tendon theory has been performed only by Takemura et al. (1991). The present authors attempted to elucidate the blood supply of the masseter, using 3 lion heads injected with acryl plastic into the carotid system by the plastic vascular injection method. This description is based on examination of the detailed laminar formation of the masseter. The findings are discussed in comparison with those of the felid family in carnivorae. Masseteric branches of the superficial temporal, buccal and facial arteries were distributed to the primary sublayer of the superficial layer, those of the above arteries and the masseteric artery to its secondary sublayer, the intermediate layer and the anterior and posterior portions of the deep layer, and those of the superficial temporal and masseteric arteries to the primary sublayer of the posterior portion of the deep layer. The maxillomandibularis muscle was supplied by the buccal and masseteric arteries and the zygomaticomandibularis by the superficial temporal and posterior auricular arteries as well. No gross differences between the lion and cat were observed in arterial supply of the masseter proper and improper, although the superficial temporal artery was distributed only to the superficial and intermediate layers in the cat but to all the deep layers in the lion.


Case of an abductor pollicis longus muscle: variation or differentiation?

A variation of the abductor pollicis longus muscle in a 65 year old cadaver was encountered during routine dissection in our department. The muscle was found to split into two bellies and give off two tendons, one of which inserted to the abductor pollicis brevis, opponens pollicis and flexor pollicis brevis muscles. The other tendon inserted to the first metacarpal bone which is considered a normal insertion site for the abductor pollicis longus muscle.


A variation of a coeliac trunk.

The coeliac trunk is a wide branch of the abdominal aorta which arises from just below the aortic hiatus. It is about 1.25 cm. long (5). In our cadaver the length of the coeliac trunk was observed to be 4.5 cm. Additionally the inferior phrenic arteries which normally arise from the abdominal aorta were derived from the coeliac artery.


Age estimation from second metacarpals in children.

On the basis of cross-sectional data of 630 boys and 611 girls aged 0 to 19 years investigated during 1959-60, the present study attempts to estimate age from skeletal maturity and measurements (length, width and cortical thickness) of an isolated second metacarpal. A combination of the maturity score with the bone length gives a better estimate of age than either one of the bone measurements or a combination of them. However, the maturity score alone does not necessarily provide a better estimate of age than the bone length. In skeletal remains of immature children, the epiphysis is not usually available to estimate age. Age could be estimated by means of multiple linear equations from the diaphyseal length and width of the second metacarpal with a standard error of 1.26 years in immature children aged 6 to 17 years, regardless of sex. Although, this method certainly seems to be useful for age estimation of a population, it is not necessarily applicable to individuals. In addition, the equation obtained from the variables in this series is not universally applicable to other populations or to Japanese of earlier eras, with the same degree of certainty.


Microvascular architecture of the lingual papillae in the Japanese monkey (Macaca fuscata fuscata).

The microvascular architecture of all kinds of lingual papillae in the Japanese monkey was investigated on plastic corrosion casts and epithelium-separated specimens under a scanning electron microscope. Three kinds of the filiform papillae were observed; the circularly-arranged papillae with a small papilla in the center on the lingual apex, a simple large conical papilla with a bilateral pair of spines on the lingual body and the aggregated filiform papillae on the top of an epithelial projection on the lingual radix. Five to eight capillary loops were arranged in a circle of the above filiform papillae on the lingual apex. Arterioles ascended in the filiform center on the lingual body to form an intrapapillary network in the shape of a large cone, from which capillary loops were observed only on the top surface of the papilla. Capillary loops arising from the subepithelial capillary network in the epithelial projection were distributed to each filiform papilla on the lingual radix. Globular fungiform papilla on the lingual apex were supplied by capillary loops radiating from the intrapapillary capillary network. Cylindrical fungiform papillae on the lingual body were supplied by capillary loops only on the top surface of each fungiform papilla without any loop formation on the lateral surface. Four vallate papillae, a medial and lateral pair, were supplied by arterioles ascending in the papillary center to form an intrapapillary capillary network, from which capillary loops were sent off on the top surface of the papilla and formed a network in the lateral surface. Each foliate papilla was supplied by an arteriole passing through each papillary center along the long axis and 5 or 6 capillary loops from the arteriole on the frontal section. Every lingual papilla was supplied by a characteristic microvascular pattern, which correlated closely with the location of the papillae and areas reflecting the regional role of the tongue movement, especially in the filiform and fungiform papillae.


Outcome of treatment for bilateral congenital cataracts.

The outcome of treatment for bilateral congenital cataracts was studied retrospectively in a group of 51 patients. Two major categories of lens opacities were identified. In the first category, the opacities were extensive and visual impairment was evident early in the first year. These cataracts often occurred in eyes with small corneal diameters and poorly dilating pupils. Postoperative strabismus was nearly universal; nystagmus developed in over 50%; and late onset open-angle glaucoma developed in 8 of the 29 patients studied. Early surgery did not seem to abort the development of nystagmus in this group of patients. In the second category, the lens opacities were partial, often lamellar in configuration, and visual impairment was less severe. Surgery was usually performed after 3 years of age, with good visual results if the opacities were symmetrical and there was no nystagmus. No deprivation amblyopia developed in this group, even when surgery was delayed into the second decade. Strabismus developed postoperatively in about a third, but so far, no delayed open-angle glaucoma has been identified.


Peribulbar anesthesia for primary vitreoretinal surgery.

We prospectively studied the efficacy of peribulbar anesthesia in 76 consecutive patients who underwent vitreoretinal surgery. The mean duration of anesthesia was 124.74 +/- 50.17 minutes, and the mean duration of akinesia, 151.5 +/- 54.45 minutes. Adequate anesthesia and akinesia, independent of the duration of surgery, was obtained in 26 of 33 (78.8%) patients who underwent vitrectomy; 9 of 32 (28.1%) who underwent scleral buckling; and 2 of 11 (18.2%) who underwent vitrectomy combined with scleral buckling. In all, topical and systemic supplementation of drugs for inadequate anesthesia or akinesia allowed 32 of the 33 (97%) vitrectomies, 30 of the 32 (94%) scleral buckling procedures, and all 11 of the combined surgeries to be completed as planned. Three (4%) patients vomited, moved, or were restless, resulting in an operative complication or postponement of surgery. Fifty-eight (76%) said they would desire similar anesthesia if subsequent surgery was needed in the same or fellow eye. We conclude that peribulbar anesthesia should be considered primarily for patients requiring vitreous surgery alone, and as an alternative for patients requiring scleral buckling or combined surgery for whom general anesthesia is contraindicated.


Intraoperative application of 5-fluorouracil during trabeculectomy.

We report the preliminary results of the first 20 consecutive cases in which the antimetabolite 5-fluorouracil (5-FU) was applied directly beneath the conjunctival flap during trabeculectomy in high-risk patients. Seventeen were considered early successes, with 3-month postoperative intraocular pressures less than 21 mmHg, representing at least a 20% decrease from preoperative values. Successful blebs were pale, with conjunctival microcysts and without significant vascularization over the trabeculectomy site, similar to the appearance of blebs in eyes administered postoperative subconjunctival injections of 5-FU. There were no cases of corneal epithelial defects, and no eyes had lost more than one line of preoperative vision at the time of last follow up. Although the longer term efficacy of this method is unknown, these results suggest that it may represent a safe and effective alternative for administering 5-FU.


Measurement of progressive disc change in glaucoma.

We describe a videographic procedure for detecting minute changes in disc topography of glaucomatous eyes that involves measuring the displacement of selected circumlinear vessels. The problem of recognizing the difference between parallactic errors and true changes in topography is emphasized.


The early cell kinetic response during healing of corneal epithelial wounds.

The labeling index and the mitotic rate were measured at 4-hour intervals during the first 24 hours after a central abrasion had been made in the corneal epithelium of six groups of four rats each. The proliferative response was noted in the conjunctival, the limbal, and the corneal epithelium. After 24 hours, the density of epithelial cells was equal throughout the corneal epithelium, but there was only half the normal number of cells. Physiological mechanisms seem strongly to regulate the total number of cells per square unit throughout the healing corneal epithelium, but the nature of these mechanisms is unknown.


Posterior relaxing retinotomies: analysis of anatomic and visual results.

Fifteen eyes with complicated retinal detachments--11 with proliferative vitreoretinopathy (C3 D3), 2 with posterior segment trauma, and 2 with inflammatory retinopathy--were treated with vitrectomy, membrane peeling, and large posterior retinotomy. All posterior relaxing retinotomies were circumferential, including temporal quadrants in all cases. With a minimum follow up of 6 months, 12 eyes (80%) were attached posterior to the retinotomy. Reproliferation resulted in redetachment in 3 eyes (20%). Visual acuity improved in 53%, remained unchanged in 20%, and decreased in 27%. Of the 11 eyes that achieved stable or improved visual acuity, 5 (45%) achieved 20/400 to 20/25 vision, 5 achieved counts fingers perception, and 1 patient remained stable at hand motion perception. Of all the eyes undergoing surgery, hypotony (intraocular pressure < 5 mm Hg) occurred in 6 eyes (40%); 3 of these were among the 12 eyes with attached retinas.


The use of fibrin glue in mucous membrane grafting of the fornix.

We report using a fibrin-glue tissue adhesive in place of sutures to place a full-thickness mucosal graft into a defect created in a scarred fornix of an ophthalmic socket. This technique minimizes tissue trauma and aids hemostasis and healing.


Beheading the pterygium.

I describe a safe, easily learned, accessible, and inexpensive method for excision of the pterygium head using the tip of a 23-gauge needle as a cutting tool. The incision is controlled precisely, and excision of unaffected tissue, particularly at the limbus, is minimized by using point cutting edge techniques and by varying tissue tension to control tissue sectility ("cuttability").


Comparison between B-scan ultrasound and MRI in the detection of diabetic vitreous hemorrhage.

The efficacy of proton magnetic resonance imaging (MRI) was evaluated and compared with that of B-scan ultrasound in the detection and differentiation of diabetic vitreous hemorrhage. Although conventional spin-echo MRI could not locate vitreous hemorrhages, gradient-recalled-echo (GRE) MRI readily did so. The aberrant signals appeared to originate from the interfacing between hemorrhages and the vitreous, and possibly also from the paramagnetic effect of the ferrous ion. The information provided by boundary/susceptibility detection, unique to the GRE sequence, is useful in delineating the extent of vitreous hemorrhage and hemolysis. However, for the diagnosis and follow up of diabetic vitreous hemorrhages, MRI appears no more informative than B-scan ultrasonography.


Combined cataract-glaucoma surgery using the THC:YAG (holmium) laser ab interno without gonioscopy.

We describe a simple method of combined cataract-glaucoma surgery, involving use of the THC:YAG (holmium) laser ab interno, without gonioscopy, in which the initial cataract incision remains small and the glaucoma filtering procedure can be completed relatively quickly, with minimal surgical manipulation of the conjunctiva. In a series of 15 eyes (13 patients) with visually significant cataracts and medically uncontrolled glaucoma, followed for an average of 14 weeks (range, 1 to 26 weeks), 13 of the 15 eyes had decreased IOP. Visual acuity was improved in 9 eyes, remained the same in 4 eyes (with age-related macular degeneration), and was worse in 2 eyes (with opacification of the posterior capsule sufficient to account for the decrease in acuity).


Small-incision manual extracapsular cataract extraction using selective hydrodissection.

Hydrodissection is a technique in which balanced salt solution is injected through a cannula into various layers of a cataractous lens to separate the lens lamella in a nonspecific location. Selective hydrodissection allows separation of the lens lamella at different desired anatomical layers. The technique allows the smallest possible nucleus, ie, the hard-core nucleus, to be hydroexpressed as a separate entity, requiring, correspondingly, a relatively small capsulorhexis and limbal incision. Then, in a second maneuver, the epinucleus, which engulfs the hardcore nucleus to form the adult nucleus, also can be aspirated or hydroexpressed as a whole. Selective hydrodissection permits scleral incision and stitchless surgery in planned extracapsular cataract extraction and also may serve as an intermediate step for surgeons who wish to convert to or learn phacoemulsification techniques.


Filtering seton implant for glaucoma: initial animal trial.

A newly developed silicone filtering seton device was implanted in each of five eyes of four rhesus monkeys after they had undergone extensive argon-laser trabeculoplasty to raise their intraocular pressure (IOP). One animal (one implant eye) was killed at 6 weeks. The other three animals (four implant eyes) were observed for 17 to 24 months following implantation surgery. Mild to moderate postoperative inflammation subsided during the first postoperative week. The eyes remained quiet throughout the remainder of follow up. The postoperative IOPs varied between 18% and 70% of the IOPs at the time of implant surgery. In the three monkeys that had unilateral surgery, the IOP at the final follow-up measurement was equal to or lower than the IOP in the unoperated fellow eye. In the monkey that had bilateral surgery, both of the final IOPs were lower than the preoperative ones.


Healon Yellow as a surgical tool in maneuvering intraocular tissues.

Tinted sodium hyaluronate (Healon Yellow) was used during posterior segment surgery mainly for the dissection of epiretinal membranes in cases of proliferative diabetic retinopathy and macular pucker. The yellow color facilitated injecting the viscoelastic substance under the membranes and simplified its removal at the end of surgery.


Subconjunctival gentamicin induction of extraocular toxic muscle myopathy.

Subconjunctival injection of commercially available gentamicin, delivered in one of several protocols, caused an acute toxic reaction myopathy of the extraocular muscles. The response began as a small focal infiltrate of polymorphonuclear leukocytes, and as the lesion progressed it assumed a mononuclear cell predominance accompanied by muscle fiber degeneration. The injection of individual components of the commercial preparation (gentamicin, methylparaben, ethylenediaminetetraacetic acid (EDTA) and sodium bisulfite), each at the same concentration as in the parent solution, gave no response except for gentamicin alone. Gentamicin caused acute toxic myopathy when injected away from the muscles and when given as an isotonic solution in saline compared to the hypotonic commercial solution. Solutions at acidic pH not containing gentamicin did not initiate myopathy. Several factors that have been inferred as participating in the toxic response to gentamicin have been eliminated. Gentamicin alone is responsible for the induction of the extraocular muscle myopathy.


Ibudilast may improve retinal circulation in patients with diabetes mellitus.

Ibudilast selectively vasodilates cerebral vessels without reducing blood pressure. We investigated the effect of the drug on retinal circulation in 8 patients with diabetes mellitus, using the video-densitometric image analysis of fluorescein angiography. We compared the build up time, the time constant of washout rate and the mean circulation time (MCT) before and after oral therapy with ibudilast. After 2 weeks of daily administration (30 mg), MCT was shortened significantly (4.2 +/- 2.8 vs. 3.0 +/- 1.6 s, p = 0.0215). Since retinal circulation in patients with diabetes mellitus was improved by ibudilast, the drug may be useful to treat disorders such as diabetic retinopathy.


Retinal pigment epithelial cells secrete urokinase-type plasminogen activator and its inhibitor PAI-1.

Secretion of plasminogen activators and their inhibitors was examined in cultures of human retinal pigment epithelial (RPE) cells. The methods employed were zymography and reverse zymography, solid-phase immunocapture assay, metabolic labeling followed by immunoprecipitation, and immunofluorescence. The results showed that these cells produce urokinase-type plasminogen activator (u-PA) and a plasminogen activator inhibitor (PAI) which is immunologically and biochemically similar to PAI-1. Tissue-type plasminogen activator activity (t-PA) was not detected, but we detected small amounts of t-PA in an inactive complex with inhibitor in RPE cell-conditioned media. We conclude that RPE cells have the potential to utilize u-PA-catalyzed plasminogen activation which is subject to regulation by PAI-1. These results may have a bearing on the pathogenesis of proliferative retinal diseases.


X-ray induced DNA strand break induction and rejoining in cultured bovine lens epithelial cells.

DNA strand break induction and rejoining in cultured bovine lens epithelial cells were measured by the alkaline unwinding technique followed by hydroxyapatite chromatography. DNA damage is described in terms of dose effect curves for unwinding immediately after irradiation (0 min) and for unwinding after a recovery period (30 min). The dose effect curves obtained are purely exponential with D0 values of 29.3 Gy (0 min) and 138 Gy (30 min), respectively. Rejoining data are given in terms of rejoining enhancement curves with half-times for overall rejoining being in the range from 4 to 10 min, independent of the dose. Kinetics of strand breaks are also presented in terms of decay curves, which are best described by the sum of three exponential components. The half-times of these components have been determined as tau(I) approximately 2 min, tau(II) approximately 15 min and tau(III) approximately 500 min. These components of damage decay curves are discussed in relation to cell killing.


Distribution of glucose and lactate in the interphotoreceptor matrix.

The photoreceptor cells of the retina derive their nourishment from the choroidal blood supply behind the retina. If the extracellular interphotoreceptor matrix (IPM) mediates this retinal nutrition, then gradients in concentrations of nutrients such as glucose and waste products such as lactic acid would be expected across the IPM, from the neural retina to the retinal pigment epithelium (RPE); this hypothesis is examined here. Gentle methods were employed to prepare IPM from the retinal surface (IPM-R) and apical RPE surface (IPM-P) of bovine eyes, and contamination from adjacent tissues was very low. The actual intrinsic volumes of the IPM-R (180 microliters) and IPM-P (87 microliters) compartments were estimated from dilution of trypan blue dye added to the wash buffer used for sample preparation; these measurements were required for calculation of concentrations. In the IPM-R samples glucose was virtually undetectable and the lactate concentration was very high (13 mM). Near the RPE surface (IPM-P) both compounds were present at levels (glucose 0.9 mM, lactate 3.8 mM) more comparable to those in blood serum. Similar results were obtained with fresh rabbit eyes. This difference in distribution (nutrient more concentrated near RPE, waste product near retina) indicates gradients consistent with the utilization of the IPM as a pathway for outer-retinal nutrition.


Laser trabeculostimulation in open-angle glaucoma: a new trial. Part I.

We describe herein a new trial to stimulate trabecular meshwork tissue and thereby increase outflow facility. The efficacy of our laser trabeculostimulation (LTS) was compared with that of conventional laser trabeculoplasty (LTP), since LTP causes shrinkage and cicatrization of the meshwork tissue, thus limiting the reduction of postoperative intraocular pressure (IOP). The mean preoperative IOP of 40 eyes was 24.9 +/- 6.8 mm Hg (mean +/- SD). LTS was applied with a 50-microns spot, a power setting of 50 mW and an exposure time of 1 s. With LTS, the IOP decreased but then increased afterward. Results indicate that low power (50 mW) is effective if used for a longer duration. Our LTS can be applied repeatedly and used in addition to conventional LTP. Although our LTS was less effective than LTP, the trial may lead to the development of another useful treatment modality.


Bilateral metastatic sclerochoroidal calcification in a patient with hyperparathyroidism.

We present the case of a 39-year-old man with bilateral sclerochoroidal calcification with primary hyperparathyroidism. Both the calcium and parathyroid hormone levels were elevated. Funduscopic examination revealed slightly elevated, multiple yellow lesions in both eyes. Fluorescein angiography showed filling defects of the choroid. Ultrasonography showed elevated, highly reflective lesions, and a computed tomography scan of the globe disclosed sclerochoroidal lesions with high density. We discuss the mechanism of sclerochoroidal calcification.


Argon laser photocoagulation for the treatment of diabetic macular oedema. Comparative study of efficacy between focal extramacular treatment and focal macular perifoveolar treatment.

In this paper a comparative study of efficacy between focal extramacular and focal macular perifoveolar argon laser photocoagulation for the treatment of diabetic macular oedema is presented. The follow-up period was 12 months and was based on fluorescein angiograms. After focal extramacular treatment, diabetic macular oedema was resorbed in 54.6% of the cases, remained unchanged in 28.4% and deteriorated in 17.0%. After focal macular perifoveolar treatment resorption of diabetic macular oedema was achieved in 73.7% of the cases, remained unchanged in 17.1% and deteriorated in 9.2%. Focal macular perifoveolar treatment gives statistically significantly better clinical results than focal extramacular treatment (p < 0.05).


[Semiconducting lasers for the treatment of vascular retinopathy].

Clinical photocoagulation was performed successfully in 18 eyes with retinal vascular disease. In all cases semiconductor laser was used emitting wave lengths from 780 to 840 nm. Energy for visible coagulation edema was 400 up to 1,200 mW, time between 0.2 and 1 s. In 3 cases using endolaser, acute retinal traction during light exposition was seen; retinal hemorrhages occurred in no patient. Four patients complained of moderate to marked pain compared to argon laser treatment. In all cases visible marked retinal scars of therapeutical range were observed.


Monozygotic twin brothers with age-related macular degeneration.

We report the simultaneous development of exudative macular degeneration in monozygotic twin brothers. This report supports the hypothesis that genetic factors may be implicated in the pathogenesis of age-related macular degeneration.


Extraocular muscles in congenital strabismus: muscle fiber and nerve ending ultrastructure according to different regions.

The ultrastructure of the extraocular muscles of patients affected by congenital strabismus is not completely known, and the structures responsible of the pathogenesis of this condition are still to be determined. Specimens obtained from patients suffering from congenital strabismus were studied and compared with specimens obtained from patients enucleated for various pathologies and not affected by any disorder in the oculomotor system. The scleral myotendinous junction, where the occurrence of an altered proprioceptive innervation was already reported, was examined, and findings obtained were compared with those observed in the muscle body (venter), where motor innervation is prominent and usually described as normal. Only a small number of damaged muscle fibers was found everywhere. The damage consisted in alterations of both contractile structures and mitochondria and resulted in severer lesions in the scleral myotendinous junction rather than in the muscle body. The normal muscle fibers were innervated by motor nerve endings with normal features and by few altered proprioceptors. The less damaged muscle fibers were innervated by normal motor nerve endings and severely damaged proprioceptors. The most severely damaged muscle fibers did not receive any type of innervation. These data seem to imply that the most important functional alteration in strabismus regards the scleral myotendinous junction. It is the authors' opinion that these findings might have a clinical importance in choosing the treatment to be pursued in patients with a squint.


Orbital involvement in Waldenström's macroglobulinemia: ultrasound, computed tomography and magnetic resonance findings.

A case of orbital involvement in Waldenström's macroglobulinemia is presented. Orbital echography, computed tomography (CT) and magnetic resonance imaging (MRI) were performed and revealed a retrobulbar mass of the right orbit. Ultrasonography suggested a lymphoid orbital tumor. A CT scan was nonspecific, but helpful in exactly locating the tumor and excluding bony lesions. Signal intensity patterns of MRI were characterized by a low intensity on T1- and T2-weighted images. A marked enhancement of the tumor was evident after intravenous injection of a paramagnetic contrast agent (gadolinium-DTPA). Although the definite diagnosis could only be established by means of an ultrasound-guided fine-needle aspiration biopsy, MRI in connection with the history of our patient strongly suggested a diagnosis of orbital lymphoma in Waldenström's disease.


Waardenburg syndrome in Japanese patients. Case reports and literature review.

A 3-year-old girl (case 1) had a blue iris and albinotic fundus in the right eye and bilateral deafness. Her 6-month-old sister (case 2) had hypopigmented irides and fundi in both eyes and bilateral deafness. We found that the ratios of interinner canthal distance to interpupillary distance were less than 0.65 in normal Japanese controls. In our patients, these ratios were within the normal range, indicating the absence of dystopia canthorum. After reviewing the recent Japanese literature, we found that the hypopigmented iris and deafness seen in our patients are common in Japanese patients with Waardenburg syndrome.


Human lens transparence in high-myopic subjects.

The possibility of a relation between high myopia and lens opacity was studied. For this research, the Lens Opacity Meter 701 was used. The lens opacity values measured in 91 high-myopic eyes were compared with those measured in a control group of 106 emmetropic eyes. This comparison showed that myopic had always higher lens opacity values than emmetropic ones, and this result was statistically significant after the age of 20.


Efficacy and stability of amblyopia therapy.

To determine the efficacy and stability of therapy, we reviewed the charts of 64 amblyopes with strabismus and/or anisometropia who had been treated by direct occlusion. For patients aged 7 years or less (N = 39), 90% (35/39) showed some acuity gain, with 69% (27/39) achieving at least a doubling of acuity (0.3 log units). Fifty-four percent obtained 20/40 (6/12) or better after an average treatment period of 3.8 months. Some reduction in visual acuity (VA) subsequently occurred for 75% (24/32) of those patients followed. For patients aged 8 years or more (N = 26), 77% (20/26) showed some acuity gain with 31% (8/26) improving at least 0.3 log units. Twenty-seven percent (7/26) obtained 20/40 (6/12) or better after an average treatment period of 4.2 months, although no patients older than 10 years (N = 13) achieved 20/40 (6/12). Loss of some of the acuity gain subsequently occurred for 67% (12/18) of those followed. These findings indicate that VA can be improved by patching therapy in most patients older than 7 years, but the acuity improvement is somewhat less than in younger patients. At least 67% of all amblyopes followed for 1 year lost some of the acuity gain after cessation of therapy, regardless of the age when treated. As a reduction of the acuity gain is likely to occur within the first year after cessation of therapy, it is recommended that amblyopic patients of all ages be followed at regular intervals.


Short-term, low-contrast visual acuity reduction associated with in vivo contact lens drying.

Hydrogel contact lens surfaces partially desiccate during extended interblink intervals, producing a microscopically rough and irregular surface that scatters light. Such light scattering could reduce retinal image contrast, elevating thresholds for target perception. To test this idea, we measured low (7%)-contrast visual acuity of subjects who wore: (1) hydrogel contact lenses, (2) rigid gas permeable (RGP) lenses, and (3) no contact lenses when the subjects blinked normally and when they suppressed blinking. Acuity thresholds were determined using computer-generated acuity stimuli and a staircase psychophysical procedure. Cessation of blinking resulted in small reductions in low-contrast acuity for subjects wearing RGP lenses (mean loss: 0.1 line) or no lenses (mean loss: 0.3 lines). Subjects wearing hydrogel lenses, however, generally exhibited substantial reduction of acuity (mean loss: 4.1 lines) when blinking was suppressed.


Role of visual acuity, stereoacuity, and ocular dominance in monovision patient success.

Monovision (MV) contact lens correction of presbyopia induces substantial reductions in stereoacuity and small reductions in binocular visual acuity (VA). This study examined those effects in a group of successful and a group of unsuccessful MV patients. Compared to performance with a full binocular correction, the unsuccessful group demonstrated significant losses in both functions. These reductions were smaller in the successful group and of marginal statistical significance only for stereoacuity. Laterality of sighting dominance and laterality of distance/near correction had minimal effect on the results.


Set shot shooting performance and visual acuity in basketball.

Common sense suggests that decreasing visual acuity will have a negative effect on basketball shooting performance. To test the hypothesis that basketball shooting performance monotonically decreases with decreasing acuity, 19 subjects attempted 25 set shots from a fixed location at each of 5 different acuity levels: 6/6 or better and vision blurred (by optical defocus) to visual acuities of 6/12, 6/24, 6/48, and 6/75. Our results revealed a small but statistically nonsignificant decrease in shooting performance between the 6/6+ and 6/12 conditions. For visual acuities between 6/12 and 6/75, the number of baskets made remained constant. We conclude that decreases in visual acuity over the range of 6/6+ to 6/75 resulting from defocus do not significantly reduce set shot shooting performance.


To use or not to use the refractive correction along with hand-held magnifiers.

Equivalent viewing power (EVP), field of view, and working distance (WD) were calculated for 4 different magnifier equivalent powers, four magnifier-to-eye distances, and for uncorrected spherical ametropias varying from +20.00 to -20.00 D in 0.25 D steps. Results show that the various viewing conditions which arise (depending on whether or not the refractive correction is worn) can differ considerably. The uncorrected unaccommodating myope has a greater EVP than the equivalent power of the magnifier if he chooses a magnifier-to-eye distance shorter than the focal length of the magnifier. In this situation, field of view is also enhanced. The uncorrected unaccommodating hyperope using a magnifier-to-eye distance longer than the focal length of the magnifier achieves a stronger EVP than the equivalent power of the magnifier. However, field of view is then reduced. For the uncorrected unaccommodating spherical ametrope, the use of a magnifier-to-eye distance corresponding to the focal length of the magnifier seems to be a good compromise between EVP, field of view, and working distance.


Re-evaluation of the four prism diopter base-out test.

The four prism diopter base-out (4 delta BO) test is often recommended for use as an objective assessment of binocular visual function in patients with suspected microstrabismus or central suppression; however, many aspects of the test are unknown. In this series of investigations we evaluated: (1) inter-observer agreement between 2 examiners, using 15 subjects; (2) types of eye movements made and prevalence of the various response types demonstrated in 212 children and 116 adults with normal binocular vision, and 10 children and 4 adults with abnormal binocular vision; and (3) repeatability of test results for 22 subjects evaluated on two separate occasions. In addition, using an SRI Eye-tracker, we documented the eye movements made while testing 2 subjects with small angle strabismus and 4 subjects with normal binocular vision. We found the following results: (1) inter-observer agreement is high; (2) both children and adults exhibit many atypical responses, whether or not they have normal binocular vision; (3) diplopia awareness does not differentiate between subjects with normal and abnormal binocular vision; and (4) 4 delta BO test results are not repeatable. Due to frequent atypical and variable responses in subjects with or without normal binocular vision, we suggest the examiner use caution when making a diagnosis based solely on the 4 delta BO test.


Joint distribution of sphere, cylinder, and axis.

A mathematical expression for the joint probability density function of sphere, cylinder, and axis is presented for the first time. It holds under certain circumstances. A relation is derived which may be useful in obtaining the joint probability function when that expression does not hold. The joint probability density function is of fundamental importance in all quantitative studies of dioptric power in the form sphere, cylinder, and axis. Some of its properties are described. It represents a hypersurface in a four-dimensional space with a maximum, a saddle point, and variety of ridges.


Eye position and head size in the Chinese population: a comparison of the Chinese from Hong Kong with the Chinese from Guangdong Province.

Measurements obtained in this study include facial and head dimensions. From our findings, it would appear that the Chinese population in Hong Kong have not become different in the two or three generations that separate them from those living in Guangdong province of China.


Chromatic aberration and optical power of a diffractive bifocal contact lens.

Although diffractive contact lenses have been well documented in theory, no definitive experimental data have been reported which confirm that the near image is in fact created by diffraction rather than by refraction. We have tested the diffraction hypothesis for one type of diffractive contact lens (the Hydron Echelon bifocal) experimentally by measuring its longitudinal chromatic aberration in isolation and when worn on the eye. The basis of this test is that, according to theory, diffractive lenses should have chromatic aberration which is opposite in sign to that measured for the eye. Objective measurements of chromatic aberration were made with a focimeter when the lens was in a wet cell. Subjective measurements were made with a Badal optometer when the lens was worn on the eye. Four control experiments were conducted to provide baseline measurements of the eye's chromatic aberration, against which we compared the results obtained for the diffractive contact lens. The data were also compared with conventional measurements of refractive error obtained by standard subjective techniques and by an automated infrared refractor. Our results showed that the longitudinal chromatic aberration of the diffraction image of the Echelon bifocal lens was about one-half that obtained under the four control conditions: for the naked eye, for the nondiffraction image of the Echelon lens, or for either image of a refractive bifocal contact lens (CIBA Bisoft). These results are consistent with the theoretical prediction that the negative chromatic aberration of a diffractive contact lens should partially cancel the positive chromatic aberration of the human eye.(ABSTRACT TRUNCATED AT 250 WORDS)


Equivalent oxygen percentage as a function of hydration in hydrogel lenses: an in vivo study.

Although many investigations have examined the parameters of hydrogel lens hydration loss, the in vivo effect (in humans) on lens oxygen behavior has not been characterized previously. Human subjects wore 2 different lenses (a thin, 38% water polymacon lens and a thin, 55% water bufilcon lens) for 5-min periods under either fully hydrated (i.e., with saline regularly applied to the lens) or partially hydrated (i.e., with "normal" wear of 1 blink every 5 s) conditions. An equivalent oxygen percentage (EOP) technique and a gravimetric method were used to determine lens oxygen behavior and hydration, respectively. The hydration results demonstrate that significant lens dehydration occurs during the partially hydrated (normal blink rate) condition compared to the in situ, fully hydrated situation. A corresponding, statistically significant diminution in oxygen equivalency was also observed.


Ocular manifestations of chronic fatigue and immune dysfunction syndrome.

Chronic fatigue and immune dysfunction syndrome (CFIDS) is a disease presenting with systemic, sensory, cognitive, and psychological manifestations. Ocular symptomatology is reported in the visual, functional, perceptual, and pathological aspects of the visual system. The purpose of the research was to evaluate ocular symptoms in patients with CFIDS. One hundred and ninety CFIDS patients [155 females, 35 males; mean age of 41 years (range 15 to 72)] and 198 healthy controls [133 females, 65 males; mean age of 42 years (range 8 to 89)] were surveyed via written questionnaire. Evaluation of data showed statistical significance at levels ranging from 0.0001 to 0.007 for all but one symptom surveyed. It appears that the ocular symptoms of CFIDS are genuine. Further research is needed to determine the etiology and appropriate treatment of this disease.


Optometry research. Part 2: Grants received.

Part 1 showed that the dominant provider of ophthalmic research funding (85%) was the National Eye Institute (NEI) and that on the average optometry faculty members had received about 3% of that funding over the years. Part 2 shows how this 3% of NEI funding has been distributed among the 16 U.S. schools in existence during the period studied and why 3% is a rational result under current conditions.


Effect of storage time with different lens care systems on in-office hydrogel trial lens disinfection efficacy: a multi-center study.

A combined prospective and retrospective study was conducted to evaluate the efficacy of in-office disinfection methods for hydrogel trial contact lenses. Two hundred and twenty-one trial contact lenses, disinfected by four different disinfection methods, were collected from seven Study Centers and cultured for microbial contamination after various storage periods. Negative and positive control lenses were included as an additional Center in this double-masked study. There was a significant difference in the incidence of microbial contamination among the Centers for all storage times (chi 2 p < 0.001). Contamination of trial lenses in Centers using thermal disinfection with preserved saline (SoftWear Saline) was negative and thermal disinfection with nonpreserved saline (LensPlus Saline) was 8.7%. Lens contamination in Centers using chemical disinfection was 13.6% with ReNu and 40.7% with OptiFree. The degree of contamination ranged from 90 colony forming units (CFU)/ml to over 10 million CFU/ml. Among the microorganisms isolated after the different disinfection methods were Alcaligenes xylosoxidans, Serratia marcescens, Moraxella phenylpyruvica, Enterobacter agglomerans, Pseudomonas stutzeri, and various gram-positive organisms. This study suggests that practitioners should redisinfect all inventory trial lenses at least once a month to minimize the risk of patient infection.


True and apparent oxygen permeabilities of contact lenses.

We studied the passage of oxygen through some commercially available contact lenses. Oxygen diffusion coefficients were determined by the time-lag method and a 201T Redher permeometer was used to measure the oxygen permeability and transmissibility by the polarographic method. The measurements were carried out at room temperature with 0.09% sodium chloride physiologic solution. The following types of lenses were tested: (1) 12 lenses of cellulose acetate butyrate (CAB) of a mean thickness of 0.194 mm (observed Dk approximately 6.3 barrers) (1 barrier is equivalent to 10(-11) cm3 of O2 (STP).cm2/cm3.s.mm Hg). (2) 13 lenses of a cross-linked polyhydroxyethyl methacrylate (2-HEMA), manufactured by Lenticon and Bausch & Lomb, with 40 and 38.6% water content, respectively. The mean thicknesses were 0.160 and 0.148 mm, respectively (observed Dk approximately 12 to 13.5 barrers). (3) Finally 10 lenses of a copolymer of 2 HEMA with N-2-vinylpyrrolidone (2-HEMA/VP), manufactured by Bausch & Lomb under the name Hydrocurve II, with 55% water content and a mean thickness of 0.138 mm (observed Dk approximately 24.5 barrers). For a given lens thickness, the transmissibility and permeability of lenses whose main material is 2-HEMA are found to be equivalent. This fact suggests the use of such material as a standard in the study of diffusion processes in contact lenses of low oxygen permeability (Dk approximately 12 to 13.5 barrers). We studied the boundary layer effects and found significant discrepancies between true and apparent oxygen permeabilities. The apparent transmissibility decreased with increasing lens thickness, this effect being more apparent for lenses with low water content. Oxygen permeability is found to be exponentially dependent on water content rather than on the chemical composition of the hydrogel.


Influence of power changes in single cut rigid contact lenses on tear pump efficiency.

Differences between corneal oxygen uptake rates measured after 5 min of static (without blinking) and 5 min of dynamic (with blinking once every 5 s) non-gas permeable (polymethyl methacrylate) contact lens wear, referenced to the oxygen uptake rates of the normal open eye, were used as indications of tear pump efficiencies associated with each of seven contact lens back vertex powers (-9.00 to +9.00 D, in 3.00 D steps). Measurements were made in vivo on six human corneas showing with-the-rule (0.25 to 0.87 D) toricity. Lens overall diameter was 8.8 mm, optic zone diameter was 7.4 mm, and base curve radius was fitted "on K." Lens center thickness was 0.14 mm for all minus-powered lenses, and 0.19, 0.26, 0.34, and 0.41 mm for the plano, +3.00, +6.00, and +9.00 D lenses, respectively, maintaining an edge thickness of 0.11 mm. Under both static and dynamic wearing conditions, no significant differences were found among the corneal oxygen uptake rates associated with the various contact lens back vertex powers; however, the difference between the static and dynamic condition data, an indication of tear pump efficiency, was greatest for the -3.00 D lens. The difference values associated with the +9.00 and +6.00 D lenses were significantly lower than those associated with the minus power lenses.


Shape of the myopic eye as seen with high-resolution magnetic resonance imaging.

We have obtained multislice magnetic resonance (MR) images of the eye and calculated ocular dimensions along the three cardinal axes: antero-posterior (A-P), equatorial, and vertical. We found no difference in the shape of hyperopic (average refractive error: +3.72 D) and emmetropic eyes, both of which had an equatorial diameter longer than the A-P and vertical diameters. Myopic eyes (average refractive error: -6.54 D) were larger than hyperopic eyes, and most had the same spheroelliptical shape as that of the emmetropic and hyperopic eyes. The results suggest that during myopic progression an overall enlargement or a radial volume expansion has occurred.


An innovative solution to continuing misuse of red light on automobiles.

A novel approach [referred to as the RLMS (Red Light Means Stop) approach] to automotive rear lighting has recently been suggested as a means to enhance perceptibility of the rear lights. In the RLMS approach, only red colored light is displayed during braking, and only amber colored light is displayed at other times. Color per se then provides, for most drivers, an immediately perceptible visual stimulus by which brake lights are distinguished from tail lights. In earlier testing, simultaneous display of nonred tail lights and red brake lights confronted test subjects with antagonistic visual stimuli, thereby compromising, and underutilizing, the value of color. It is suggested that the potential safety value of the RLMS approach is significant, and that comprehensive testing should be conducted in a timely manner.


Evaluation of intraocular pressure in a pediatric population.

The purpose of this study was to examine the intraocular pressure (IOP) in a pediatric population without general anesthesia, and compare it to the IOP in a normal adult population. Little information is available on the normal IOP in a pediatric population. IOP was measured in a sample of 212 eyes (111 patients) using the Keeler Pulsair Hand Held Non-Contact Tonometer to determine the range of IOP in this population. Patients ranged in age from 7 months to 5 years, 10 months. The mean IOP of each eye was based on three readings. These IOP values were grouped by the chronological age of the children. The results support the conclusion that infant/toddler patients have lower mean IOP than adults and that as age increases, IOP increases.


Asthenopia induced by computer-generated fusional vergence targets.

A questionnaire was used to evaluate asthenopia in 30 normal subjects (Ss). Then, each S experienced 3 min of continuous alternating convergent and divergent fusional vergence or a control condition which was identical to the experimental condition, but without any vergence demand, i.e., version. The stimulus was a computer-generated flat fusion red-blue anaglyph picture of a horse. The order of vergence and version conditions were randomized. Asthenopia measures and maximal fusional vergence ranges measures were repeated immediately after each condition. Results indicated a significantly higher rating of asthenopia after induced vergence than version. There were no differences in maximal fusional vergence ranges or recovery values after the two conditions. Correlations between pretreatment asthenopia scores and asthenopia scores after either induced vergence or version were also not significant. Post hoc analyses of Ss grouped as having either high or low asthenopia, according to baseline ratings, revealed no significant differences in vergence or version conditions. Alternative hypotheses for these results are presented.


Traumatic avulsion of the optic nerve.

Avulsion of the optic nerve is an infrequent traumatic event which results in a permanent and usually devastating loss of vision. We present two cases which highlight the salient features of partial and complete optic nerve avulsion. The clinical findings, including the results of B-scan ultrasonography, fluorescein angiography, and computed tomography (CT) are discussed. In addition, the past two decades of literature pertaining to optic nerve avulsion are reviewed and summarized.


Optometry research. Part 1: Funding sources.

Part 1 of this report presents an overview of U.S. ophthalmic research in general and of optometry research in particular and identifies the National Eye Institute (NEI) as the dominant funder of both types of research. Part 2 examines how NEI funding has been distributed among the U.S. schools and colleges of optometry in the past, whereas Part 3 examines the production of published research from the schools and colleges and the Department of Veterans Affairs Optometry Service. Information is presented to indicate that the schools of optometry account for about 3% of all NEI funding and produce about 3% of all published ophthalmic research. Published optometry research results mainly from the activities of four schools and the VA Optometry Service, which has rapidly become the leading source of articles published in The Journal of the American Optometric Association and presenter of continuing education at the Academy's annual Ellerbrock Lectures. This study suggests optometry needs to husband its relatively small research base and, in the author's opinion, concentrate on the support of clinical trials and research directly relevant to primary eye care rather than basic biologic or physiologic research.


Factors influencing hand/eye synchronicity in the computer age.

In using a computer, the relation of vision to hand/finger actuated keyboard usage in performing fine motor-coordinated functions is influenced by the physical location, size, and collective placement of the keys. Traditional nonprehensile flat/rectangular keyboard applications usually require a high and nearly constant level of visual attention. Biometrically shaped keyboards would allow for prehensile hand-posturing, thus affording better tactile familiarity with the keys, requiring less intense and less constant level of visual attention to the task, and providing a greater measure of freedom from having to visualize the key(s). Workpace and related physiological changes, aging, onset of monocularization (intermittent lapsing of binocularity for near vision) that accompanies presbyopia, tool colors, and background contrast are factors affecting constancy of visual attention to task performance. Capitas extension, excessive excyclotorsion, and repetitive strain injuries (such as carpal tunnel syndrome) are common and debilitating concomitants to computer usage. These problems can be remedied by improved keyboard design. The salutary role of mnemonics in minimizing visual dependency is discussed.


Scanning electron microscopy of the mucosal surface of the forestomachs and abomasa of grey, white and black Karakul lambs.

Homozygous grey and white Karakul lambs suffer from a lethal genetic factor causing death after weaning. Previous studies revealed large milk-filled rumens in the grey and white lambs which was attributed to a significant decrease in the number of myenteric ganglia and neurons in the rumen wall. This study was undertaken to determine the effect of milk on the epithelial lining of the forestomachs of affected grey and white lambs. In the forestomachs of the black lambs the polygonal epithelial cells were tightly packed, seemed to overlie one another and cytoplasmic projections occurred on the cell surfaces. In the grey and white lambs the epithelium had an eroded appearance due to sloughing of the surface cells and the cytoplasmic projections were lower and had a weathered appearance compared to the black lambs. No obvious differences could be detected in the abomasa of grey, white and black lambs. It is concluded that the milk in the forestomachs of the grey and white lambs is responsible for the epithelial changes.


Parasites of South African wildlife. XIII. Helminths of grey rhebuck, Pelea capreolus, and of bontebok, Damaliscus dorcas dorcas, in the Bontebok National Park.

A total of 25 grey rhebuck, Pelea capreolus, and 16 bontebok, Damaliscus dorcas dorcas, were shot for parasite recovery at bi-monthly intervals in the Bontebok National Park, south-western Cape Province, from February 1983 to December 1983 and February 1983 to February 1984, respectively. The grey rhebuck and the bontebok each harboured 9 nematode species and the latter animals 1 cestode species. Ostertagia hamata was most abundant and most prevalent in the grey rhebuck and Longistrongylus curvispiculum and Nematodirus spathiger in the bontebok. Longistrongylus schrenki is recorded for the first time in grey rhebuck, and Trichostrongylus falculatus and Moniezia expansa in bontebok. The total nematode burdens of the bontebok were considerably larger than those of the grey rhebuck. No clear pattern of seasonal abundance for the helminths of either host species was evident.


Subsampling of large light trap catches of Culicoides (Diptera: Ceratopogonidae).

Analyses of 2 light trap catches comprising 6,041 and 1,598 Culicoides showed that the reliability of subsampling such catches increased with subsample size, while the subsampling error decreased with an increase in the number of individuals per species present in a subsample. Subsamples comprising approximately 500 Culicoides are deemed sufficient for comparing population densities between sites and sampling occasions and also give an acceptable indication of relative species abundance at a site. It is recommended that species for which the mean number of specimens in subsamples originating from 3 catches at a site is less than 7, should not be included in biometric analyses aimed at comparisons of population densities. For all other species a test level of 1% rather than 5% should be used for such comparisons. When species ratios obtained from subsampled catches are employed as indicators of abundance, the chi-squared test should be utilized at a 1% level if the ratios originate from 3 catches at a site and at a 0.1% level if only one catch per site is made. Due to poor representativeness of small catches, it is suggested that species for which fewer than 7 individuals are present in a single subsample, be excluded from chi-squared tests. A 5-point procedure for subsampling a large light trap collection of Culicoides is given.


Evaluation of the efficacy of d-penicillamine and trientine as copper chelators using an in vitro technique involving ovine red blood cells.

An in vitro technique for haemolysing ovine red blood cells with copper sulphate was standardized to induce c 50% haemolysis with 0.5 mM CuSO4 after incubation for 14 h at 38 degrees C. This technique was then applied to test the efficacy of trientine and d-penicillamine in preventing haemolysis. Trientine concentrations of 0.5; 1.0 and 1.5 mM were found to be the most effective (P < 0.05) in reducing copper-induced haemolysis. One and 1.5 mM concentrations of d-penicillamine were also effective (P < 0.05), but in this experiment a 0.5 mM concentration failed to protect the erythrocytes.


A survey of small stock tick control practices in the eastern Cape Province of South Africa.

Current small stock tick control practices and producer attitudes towards tick control in the eastern Cape Province of South Africa are discussed. These were ascertained from returns to a questionnaire survey to which 31.2% of farmers polled, responded. In general, producers did not favour an intensive tick control policy for small stock. Angora, mutton and wool farmers had a definite preference for synthetic pyrethroid acaricides, the majority treating either less than 6 times p.a. or between 11-15 times p.a. Most producers changed acaricides because of price. All small stock producers favoured plunge dip application of acaricides while the majority of wool sheep and Angora producers utilized footbath application as a second preference. Mutton producers favoured pour-on and hand spray application as a second choice. Producers who used plunge dip application techniques experienced the highest percentage of confirmed acaricide resistance which is in accordance with application preference. The general incidence of confirmed acaricide resistance, however, was of a low order but highest amongst mutton farmers. An average cost for acaricide treatment of R1.65 per small stock unit p.a. was calculated from data gained in this survey. Only a small number of producers used the available heartwater vaccine. Small stock mortalities experienced by producers per production unit indicated higher mortalities at high acaricidal treatment frequencies. Farmers allowing a small number of ticks to infest their sheep experienced fewer mortalities due to heartwater than those than kept their sheep free of ticks. Angora goat farmers experienced the same, but with higher mortalities, probably due to the apparently high susceptibility of Angora goats to heartwater.


A survey of cattle tick control practices in the eastern Cape Province of South Africa.

Current cattle tick control practices and producer attitudes towards tick control in the eastern Cape Province of South Africa are discussed. These were ascertained from answers to a questionnaire survey to which 31.2% of farmers responded. In general, producers favoured intensive tick control. Beef and dairy farmers had a definite preference for synthetic pyrethroid acaricides, the majority followed a 25 times p.a. treatment frequency and most changed acaricides because of price. Beef producers favoured pour-on application of acaricides while the majority of dairy producers utilized plunge dipping. Producers who used hand spray techniques experienced the highest percentage of confirmed acaricide resistance. A costs of R11.27 for acaricide treatment per bovine per annum was calculated from data gained in this survey. A cost index of 2,496 was calculated by relating acaricide cost to the prevailing price of beef in the region. Only a small number of producers used heartwater, babesiosis and anaplasmosis vaccines. Relative tick borne disease mortality ratios indicated higher heartwater mortalities at high acaricide treatment frequencies. These results are discussed in relation to the tick control regimes practised.


The transovarial transmission of Babesia trautmanni by Rhipicephalus simus to domestic pigs.

Rhipicephalus simus was, for the first time, experimentally proven to be a transovarial vector of Babesia trautmanni of domestic pigs. The nymphal and adult progeny of experimentally infected female ticks transmitted the infection to 2 susceptible splenectomized pigs. Features of the infection included a prepatent period of 6-8 days post-tick infestation, a febrile reaction for 3 days and a maximum parasitaemia score of 15 (more than 6 parasites per 300 red blood cells). Other clinical signs in both pigs were mild inappetence and listlessness. Both pigs recovered without any antibabesial therapy.


No serological evidence for the presence of swine vesicular disease virus in South Africa.

An indirect ELISA incorporating a protein A-peroxidase conjugate was developed for detecting antibodies to swine vesicular disease virus (SVDV) in pig sera. This test and a conventional virus neutralization test were found to be equally sensitive. A total of 2846 pig sera collected from various abattoirs in South Africa were tested using the indirect ELISA. No serological evidence of infection with SVDV in pigs in South Africa was found.


A comparative study of the thickness of the tunica muscularis in the forestomach and abomasum of grey, white and black Karakul lambs.

Homozygous grey Karakul lambs are born with a lethal genetic factor responsible for death and weaning age. When put on a high roughage diet under field conditions they develop distended, thin-walled rumens and sand impacted abomasa. Homozygous white Karakul lambs have a similar factor but survive for a longer period. Black Karakul lambs are not affected. The present study was undertaken to compare by image analysis the thickness of the tunica muscularis of the forestomach and abomasum of 24-hour old grey, white and black Karakul lambs. One square centimetre samples were taken from equivalent areas in each case of the rumen, reticulum, omasum and abomasum of 38 embalmed Karakul lambs. Haematoxylin and eosin stained histological sections of each sample were studied with a Vids 2 Image Analyzer and the thickness of the circular and longitudinal muscle layers was measured. An analysis of variance indicated a significant difference between the groups in the thickness of the tunica muscularis of the rumen, reticulum and abomasum; the grey group displaying the thinnest and the black group the thickest. The omasa were not affected. The study indicates a reduction in thickness of the tunica muscularis of the homozygous grey and white lambs when compared to normal black lambs.


Temporomandibular joint: surgically created disk displacement causes arthrosis in the rabbit.

To document a causal relationship between temporomandibular joint disk displacement and arthrosis, the disk was surgically displaced in one temporomandibular joint in each of three rabbits. The rabbits were sacrificed after 4 weeks and the mandibular condyles were studied radiographically and histologically. All three joints that underwent disk displacement had radiographic and histologic evidence of arthrosis, which included erosion of the bone, irregularity and fissure formation of the articular soft tissue cover, disruption of the subchondral layer of cartilage cells, and chondrocyte proliferation. No radiographic or histologic changes occurred in the joints that were untouched. The results suggest that surgically created disk displacement can cause arthrosis in the temporomandibular joint of the rabbit.


Cryosurgical treatment of hemangiomas of the lip.

Removal of hemangiomas presents difficult management problems. This article describes the treatment of hemangiomas of the lip by cryosurgery and, in particular, evaluates the effectiveness of freezing in nitrous oxide cryosurgery on these lesions. Four women and two men, ages 40 to 76 years and manifesting angiomatous lesions on the vermillion of the lower or upper lips, were treated. Each site was directly exposed to two consecutive freeze-thaw cycles of 40 seconds freezing time at -30 degrees C to -40 degrees C. No anesthesia was required. Healing was uneventful. Superficial necrotic tissue covered the lesion at 1 week and necrotic slough was separated after 2 to 4 weeks, leaving a fully epithelialized surface. In all cases, there was no scarring and no recurrence was noted during the 2.5 year follow-up.


Temporomandibular joint disk displacement without reduction. Treatment with flat occlusal splint versus no treatment.

A flat occlusal splint has been extensively used in the treatment of patients with temporomandibular joint disk displacement without reduction, but no studies with untreated controls have assessed its effect. We randomly assigned 51 patients with temporomandibular joint pain and arthrographically verified disk displacement without reduction to be treated with a flat occlusal splint or to serve as untreated control subjects in a 12-month clinical trial. Pain symptoms disappeared in about one third of the patients in each group. Another third of the patients in the control group improved. Sixteen percent of the patients in the control group and 40% of the patients treated with a flat occlusal splint were worse at the end than at the beginning of the study. Joint pain and muscle tenderness decreased more frequently in the nontreatment controls than in the treatment group. A statistically significant benefit of a flat occlusal splint over nontreatment control subjects could not be identified in this study of patients with painful disk displacement without reduction. The use of a flat occlusal splint in this patient group should therefore be reconsidered.


The morbidity associated with fifty maxillary fractures treated by closed reduction.

Fifty patients with maxillary fractures treated by closed reduction over an 85 month period at a Level I trauma center were reviewed. Thirty patients (60%) experienced forty-one midfacial complications. The most frequent problems were infraorbital nerve paresthesia (12), enophthalmus (5), septal deviation (3), and altered vision (3). No relationship could be established between complications and age, sex, cause of injury, or the method of suspension used. Most complications were related to concomitant injury or the concurrent management of fractures of other facial bones. Only eight problems (16%) were directly attributed to the closed reduction of maxillary fractures. Patients treated by closed reduction and maxillomandibular fixation without suspension experienced no surgical complications.


Maxillary osteomyelitis and spontaneous tooth exfoliation after herpes zoster.

Reports of spontaneous tooth exfoliation and osteonecrosis trigeminal herpes zoster are extremely rare and have been sporadic. This article reports a pertinent case of a 50-year-old man who exhibited prodromal odontalgia before the appearance of vesicular mucocutaneous lesions, together with severe destruction of the maxillary bone and exfoliation of multiple teeth. This patient was successfully treated using a unique closed nasal-vestibular drainage system for the ultimate control of maxillary bone viability. A review and analysis of the clinical aspects and the pathogenesis of herpes zoster and bone necrosis are discussed.


Traumatically induced peripheral osteoma. Report of a case.

Osteomas of the jaws are well-defined lesions that can present as an isolated finding or as part of a syndrome (e.g., Gardner's syndrome). The etiology of peripheral osteomas is somewhat controversial. Trauma has been implicated by several authors, and osteoma is presented here as a rather striking lesion with well-defined traumatic origins.


Effects of total body irradiation on salivary gland function and caries-associated oral microflora in bone marrow transplant patients.

Forty-one cancer patients who received chemoradiotherapy conditioning with bone marrow transplantation were examined for changes in salivary gland function and caries-associated oral microflora. Salivary flow rates (stimulated and unstimulated) and Streptococcus mutans levels decreased after pretransplant cytoreductive therapy and posttransplant prophylactic antibiotic therapy. Normal levels returned with time after the patients left the protected environment. Lactobacillus counts were not affected. Chronic graft-versus-host disease did not significantly influence saliva production. Results indicate that irradiation is probably the major factor responsible for the transient xerostomia.


Blood pressure response to routine restorative dental treatment with and without local anesthesia. Continuous noninvasive blood pressure registration with a finger manometer.

A continuous noninvasive blood pressure registration with the Finapres finger manometer was carried out during routine dental treatment, with and without local anesthesia. Forty patients (21 male), 21 to 64 years of age, were studied. Blood pressure was recorded continuously from 10 minutes before dental treatment to 10 minutes after treatment was completed. No local anesthetic was used in 25 patients. In 15 patients (seven men) local anesthetic was used. All patients showed a considerable blood pressure variation. During treatment a significant mean blood pressure increase was registered in the patients treated without local anesthesia. In the patients treated with local anesthesia no significant mean blood pressure changes during dental treatment could be established. However, during the actual administration of the local anesthetic solution a transient blood pressure increase was found, followed by a decrease shortly after removal of the needle from the mouth. After treatment of both groups of patients, a mean blood pressure decrease was established.


Efficacy of chlorhexidine and nystatin rinses in prevention of oral complications in leukemia and bone marrow transplantation.

The goal of reducing oral complications during chemotherapy and bone marrow transplantation has received attention at several centers. The current randomized study of 86 adults with leukemia treated with chemotherapy or bone marrow transplantation assessed the potential role of chlorhexidine, nystatin, and saline solution rinses to reduce the findings of oral mucositis, gingivitis, and oral infection. The results of this study did not show a reduction in mucositis with the use of these rinses. However, potential bacterial and fungal pathogens were identified less frequently in the patients using chlorhexidine rinse.


Plasma cell gingivitis. Report of two cases.

Plasma cell gingivitis is a disorder first described in the 1960s and was believed to be caused by an allergic reaction to flavored chewing gum and toothpaste. The lesion was believed to have been largely eliminated by removing the allergens from the products. We report two additional cases, not related to a known allergen. One patient was allergy tested thoroughly and given a strict elimination diet without resolution. Immunofluorescence study suggests a reactive rather than a neoplastic process.


Immediate biopsy versus a therapeutic trial in the diagnosis and treatment of vesiculobullous/vesiculoerosive oral lesions. Opposing viewpoints presented.

There are at least two treatment strategies in the diagnosis and treatment of oral vesiculobullous/vesiculoerosive disease. The relative merits of immediate biopsy and initial therapeutic trial regimens are debated.


Lichenoid lesions of oral mucosa. Diagnostic criteria and their importance in the alleged relationship to oral cancer.

Lichen planus and other lichenoid disorders of oral mucosa occur commonly, and yet they are poorly understood. Further, the question of the premalignant potential of oral lichen planus remains deeply mired in controversy. The object of this article is to delineate these problems, clarify the issues, and present evidence to support the position that true lichen planus of oral mucosa is not only less common than generally appreciated but also has no inherent predisposition to become malignant. Rationale and data from the literature are offered in support of this position.


Cinnamon-induced stomatitis venenata, Clinical and characteristic histopathologic features.

Fourteen new cases of cinnamon-induced stomatitis are reported. Ten of these fourteen cases were first detected on the basis of histopathologic changes, which included hyperkeratosis, chronic lichenoid mucositis with plasmacytic infiltration, and marked chronic perivasculitis. Six cases of false-positive histopathologic findings are presented for comparison. It is recommended that when the histopathologic features described are recognized, cinnamon stomatitis should be considered.


Survey of tissue diagnostic services in U.S. dental schools - 1990.

Tissue diagnostic services in U.S. dental schools were surveyed to determine activities during 1990. Results were compared with those of similar surveys conducted in 1953, 1958, 1969, 1975, 1980, and 1985. The information gathered from this survey reveals a progressive growth and development of tissue diagnostic services. This is seen not only in the increased numbers of biopsy accessions, which increased by 37% since the last survey, but is also reflected in the diversity of services now offered by oral pathologists.