A four-year follow-up of hearing and development in children exposed in utero to vibro-acoustic stimulation. To obtain information of hearing and neuro-development in children exposed to vibro-acoustic stimulation in utero. Information collected from Swedish child care programmes. Department of Obstetrics and Gynaecology, Karolinska Institutet, Danderyd University Hospital, Sweden. Children of 460 mothers exposed to vibro-acoustic stimulation for the assessment of fetal well-being during high- and low-risk pregnancies during 1985-1987. Auditory test (20-25 dB at eight frequencies between 500 and 8000 Hz) and general neurological examination at four years of age. No hearing damage or neuro-developmental abnormalities that could be connected to the vibro-acoustic stimulation were found. Vibro-acoustic stimulation, as applied in clinical practice, did not endanger either neurological development or hearing in children exposed in utero.


The treatment of periocular basal cell carcinomas by radiotherapy. Experience in the treatment of periocular basal cell carcinoma is described. Excellent local control rates and minimal morbidity have been achieved in a series of 128 tumours occurring in 127 patients with a minimum 3 year follow-up.


Impression cytology of conjunctival melanosis and melanoma. Impression cytology using cellulose acetate paper has been used in various ocular surface disorders as a simple non-invasive diagnostic test. To assess its value in differentiating melanocytic tumours, 24 patients with a range of pigmented lesions of the conjunctiva were examined using this technique. Cytological and histological diagnoses were compared in 23 cases. In 73% of cases impression cytology predicted the histological diagnosis by detection of superficial atypical melanocytes and their proportion relative to benign epithelial cells. This pilot study shows impression cytology to be a useful diagnostic aid in the differentiation of pigmented tumours of the bulbar conjunctiva.


Retinopathy of prematurity in surfactant treated infants. Seventy six babies of less than 1500 g birth weight who had surfactant replacement therapy for severe respiratory distress syndrome were studied to assess the presence and stage of subsequent retinopathy of prematurity (ROP). A control group of 90 babies, matched for birth weight and gestational age, who did not have surfactant therapy were also studied. Threshold ROP or greater was found in 1.7% of the surfactant group and 7.8% of the controls. For the babies of less than 1000 g birth weight 4.0% of the surfactant babies and 16.3% of the controls reached threshold disease or greater. It is concluded that surfactant therapy is not associated with an increased incidence or severity of severe ROP in this preterm population.


PhXA34--a prostaglandin F2 alpha analogue. Effect on intraocular pressure in patients with ocular hypertension. PhXA34, a prostaglandin analogue, was given topically to 40 patients with untreated ocular hypertension in a double masked randomised study. One single dose of 0.3, 1, 3, 10 micrograms, or placebo (vehicle) was given to one eye of each patient. A dose related IOP reduction ranging from 11 to 35% was observed with a maximal effect with 3 and 10 micrograms PhXA34. No hyperaemia was seen except after 10 micrograms PhXA34, where a mild to moderate hyperaemia was seen from 8 hours with a duration of up to 24 hours. Mild foreign body sensation in the PhXA34-treated eye was noted by three patients. No cells or flare were seen.


Twin study on cup/disc ratio of the optic nerve head. Seventeen healthy twin pairs (10 monozygotic and seven dizygotic) from the Finnish Twin Cohort Study were examined to study the impact of heredity v environment in the determination of cup-to-disc area ratio. These twins were free from any known eye disease. The cup/disc ratio was determined using stereo photography and a computer assisted analysis technique. The zygosity of all twin pairs was confirmed with the DNA 'fingerprint' technique. The intrapair correlations were high among monozygotic pairs compared with those among dizygotic twin pairs. The difference of cup/disc area ratios between the right eyes of members of monozygotic twin pairs was statistically significantly smaller than that of dizygotic twin pairs (p < 0.001). The same was true for left eyes (p < 0.01). This result confirms a genetic determination in cup/disc area ratio in normal eyes.


Cystoid macular oedema following cataract extraction in patients with diabetes. The course of cystoid macular oedema (CMO) following extracapsular cataract extraction with posterior chamber intraocular lens implantation was prospectively studied in 44 eyes of 44 consecutive diabetic patients without preoperative CMO. In 50% of eyes CMO was observed 6 weeks after surgery and in 25% was still present at 1 year. The preoperative presence of diabetic retinopathy significantly affected the postoperative onset and persistence of CMO. CMO occurred postoperatively in only 32% of eyes without pre-existing diabetic retinopathy and in 81% of eyes with pre-existing diabetic retinopathy (p < 0.05). CMO persisted at 1 year after surgery in only 7% of eyes without pre-existing diabetic retinopathy and in 56% of eyes in which diabetic retinopathy persisted (p < 0.01). Angiographic CMO (that is, detectable only on fluorescein angiography) was more common than clinical CMO (detectable on ophthalmoscopic examination as well) in eyes with no pre-existing diabetic retinopathy, whereas clinical CMO was seen more often than angiographic CMO when diabetic retinopathy was present preoperatively (p < 0.01). The course and final visual outcome of angiographic CMO were more favourable than in clinical CMO. Final visual acuity of at least 6/12 was achieved in 86% of eyes with angiographic CMO and in only 33% of eyes with clinical CMO. On the basis of the above findings we believe that cataract extraction should not be recommended for eyes with pre-existing diabetic retinopathy until the vision has deteriorated to at least 6/30-6/60.


Ophthalmic pain following cataract surgery: a comparison between local and general anaesthesia. Ophthalmic pain following uncomplicated extracapsular cataract surgery was assessed postoperatively in 61 patients; 55% undergoing ophthalmic surgery had no pain or discomfort postoperatively, and 32% reported slight discomfort. Approximately 8% of patients reported mild pain and the remaining 5% experienced moderate to severe pain. Local anaesthesia was shown to be more comfortable postoperatively than general anaesthesia in the immediate postoperative period with both groups receiving similar amounts of postoperative analgesics.


The course of diabetic retinopathy following cataract surgery in eyes previously treated by laser photocoagulation. The course of diabetic retinopathy following extracapsular cataract extraction with posterior chamber lens implantation in eyes previously treated by laser photocoagulation for diabetic retinopathy was retrospectively studied in 33 eyes (33 patients). In 20 eyes (61%) there was no change in the retinal status postoperatively. In 13 (39%) there was postoperative progression of diabetic retinopathy compared with the fellow non-operated eye, in which progression occurred in nine eyes (27%). The severity of the preoperative status affected the incidence of progression. Four eyes (12%) developed complications of diabetic retinopathy--that is, rubeosis iridis and vitreous haemorrhage--which regressed after lasering. Cystoid macular oedema developed in 13 eyes (39%) and its incidence varied according to the postoperative course of diabetic retinopathy. The majority of the eyes showed a postoperative improvement in vision.


Strampelli's osteo-odonto-keratoprosthesis. Clinical and histological long-term features of three prostheses. The histological features are reported of osteo-odonto-acrylic laminae removed from three patients who for differing underlying causes received Strampelli's osteo-odonto-keratoprostheses (OOK) 20, 16, and 12 years previously. It appears that preservation of the alveolar-dental ligament plays a definitive role in the maintenance of the prosthesis. If this tissue undergoes necrosis as a consequence of an inflammatory disease the implanted material is eventually lost. However when no such event occurs the OOK is well preserved and well tolerated even 20 years after implantation.


The role of preservatives in the conjunctival toxicity of subconjunctival gentamicin injection. Subconjunctival gentamicin was identified as the cause of conjunctival chemosis and capillary closure in a recent study conducted in this department. The gentamicin preparation used in the study contained preservatives. The current prospective study was set up to investigate the role of preservatives in the conjunctival toxicity of subconjunctival gentamicin. Seventy five patients undergoing cataract surgery were enrolled in the study. They were split into three groups of 25 each. Group A patients were given a subconjunctival injection of a preservative-free aqueous solution of gentamicin at the end of the cataract procedure. Group B patients were given a subconjunctival injection of gentamicin containing sodium metabisulphite and disodium edetate as preservatives at the end of the cataract procedure. Group C was the control group where patients were not given any subconjunctival injection. The incidence of severity of conjunctival chemosis were observed in the three groups. The difference between groups A and B patients who received preservative-free gentamicin and gentamicin with preservatives respectively was significant (p < 0.02).


Cataract surgery in Fuchs' heterochromic iridocyclitis. Eighteen eyes in 17 patients with Fuchs' heterochromic iridocyclitis underwent cataract extraction with or without intraocular lens implantation (17 extracapsular and one intracapsular). Intraoperative complications included hyphaema, poor pupillary dilatations, and localised zonule dehiscence with vitreous loss. Only four eyes developed a marked anterior uveitus (two pseudophakic and two aphakic) which resolved within 2 weeks with topical steroids. Three eyes developed a rise in intraocular pressure (IOP) to more than 30 mm Hg on the first postoperative day. In all three eyes the IOP returned to normal off all therapy within 1 week. In one of three eyes preoperative glaucoma was made worse following surgery. Visual acuity testing revealed that 15 eyes (83.3%) achieved 6/12 vision or better. Lamellar macular hole, pre-existing macular scar, and pre-existing retinal detachment accounted for the poor visual result.


Low dose cyclosporin A versus pulsed cyclophosphamide in Behçet's syndrome: a single masked trial. A single masked trial of cyclosporin A 5 mg/kg/day versus monthly 1 g intravenous boluses of cyclophosphamide was conducted among 23 patients with Behçet's syndrome and active, potentially reversible uveitis. The trial was unmasked after a mean of 12 (SD 2) months for the cyclosporin A group (n = 12) and a mean of 10 (SD 3) months for the cyclophosphamide group (n = 11). During the initial 6 months the visual acuity significantly improved (p < 0.001) in the cyclosporin A group whereas this was not observed in the cyclophosphamide group. The subsequent follow-up of patients up to 24 months suggested that the initial improvement in visual acuity with cyclosporin A was not sustained. More extensive and especially long-term studies of cyclosporin A in the uveitis of Behçet's syndrome are warranted.


Lid melanoma and parkinsonism.

Lid melanoma and parkinsonism. This is a case report of a patient with parkinsonism on levodopa therapy who developed a lid margin melanoma. The possible association is discussed.


Capsular 'pits' in the human lens.

Capsular 'pits' in the human lens. The lens capsule is an atypical basement membrane surrounding the lens epithelial cells and lens fibres which make up the remainder of the human lens. A seemingly unreported morphological change visible in the lens capsule with the biomicroscope is described.


Bilateral macular coloboma and pigmented paravenous retinochoroidal atrophy. A patient had bilateral macular coloboma with aggregations of pigment clumps located perivascularly, predominantly paravenously, and in other parts of the retina. The Toxoplasma IgG antibody was negative. The diagnosis of bilateral macular coloboma with pigmented paravenous retinochoroidal atrophy was made and seemed to be a developmental abnormality in origin.


Metastatic endophthalmitis caused by Clostridium perfringens. A case of metastatic endophthalmitis due to Clostridium perfringens originating from the biliary tract is reported. The grave visual prognosis and the importance of early detection and treatment of the primary source of infection are emphasised.


Does aspirin affect the rate of cataract formation? Cross-sectional results during a randomised double-blind placebo controlled trial to prevent serious vascular events. UK-TIA Study Group. A total of 2435 patients with transient ischaemic attack or minor ischaemic stroke were entered into the UK-TIA aspirin trial and randomised to treatment with aspirin 1200 mg/day, aspirin 300 mg/day, or placebo. At a single point in time during the trial patients were examined ophthalmoscopically for evidence of cataracts. The length of time that each patient had been participating in the trial at the time of ophthalmic examination varied from 1 to 5 years. The prevalence of cataracts was similar in patients allocated aspirin and patients allocated placebo irrespective of the length of time that they had been in the trial. These findings suggest that aspirin taken in a dose of 300 to 1200 mg daily for a few years does not prevent cataracts.


Do patients like day case cataract surgery? One hundred and fifty consecutive questionnaires following day case cataract surgery showed that 87% of the patients would choose day surgery again. The questionnaires were directed at the patients' attitudes to day surgery for their cataracts. There was overwhelming acceptance of the travelling and inconvenience involved.


The dark perimetric stimulus.

The dark perimetric stimulus. We determined the disappearance eccentricities of dark and bright stimuli of equal size in the inferonasal central visual field using the oculokinetic perimetry technique at different levels of surrounding illumination. The results suggest that a dark stimulus on a bright background has a smaller 'isoptre' than an equally bright stimulus on a dark background, and that variation of ambient illumination and consequent alteration of background luminance have less effect on the visibility of a dark stimulus than a bright one.


Red eyes in renal failure.

Red eyes in renal failure. Of 57 patients with chronic renal failure who all had deposition of calcium salts in the conjunctival and corneal tissue two developed a brief episode of painful irritation and redness of the conjunctiva and subconjunctiva. This hyperaemia was adjacent to erosions of the corneal epithelium of the eye as a consequence of exfoliation of calcium concretions from the superficial corneal epithelium. Eight patients showed inflammatory reactions of the conjunctivae that were clinically identical to inflamed pingueculae. Three patients showed an inflammatory reaction of the eye that was characterised by a waxy red, more or less diffuse, episcleral and conjunctival hyperaemia extending beyond the palpebral fissure. The average value of the serum calcium concentration in these patients was particularly high and statistically significantly higher than in patients with calcification but without inflammatory signs and also higher than in patients who showed pingueculitis. We propose to reserve the term 'red eye of renal failure' for the latter group of patients.


Ulcerative blepharitis in atopic patients--is Candida species the causative agent? A total of 50 patients suffering both from atopic skin disease and different clinical forms of blepharitis have been included in this study. Microbiological investigations (for bacteria and fungi) of the lid margins were performed in all cases. In 21 (42%) of the patients an ulcerative blepharitis which heavily involved the follicles of the lashes was diagnosed. The remaining 29 cases presented with blepharitis of the squamous type. The cultures revealed that 19 of the 21 patients with ulcerative blepharitis were found to grow Candida species, whereas fungi could not be detected in any of the other cases of blepharitis. The frequencies of concomitant bacterial organisms found in the cultures were similar in both groups. As atopic patients are known to exhibit a defect in their cell-mediated immunity and possibly also a defective IgA antibody response it is a widely accepted assumption that these immunological changes are contributing factors to the development of a localised inflammation of the lids which is initiated by a variety of micro-organisms. We postulate that when Candida species happen to coincide with severe inflammation in atopic patients a blepharitis of the ulcerative type will develop or deteriorate thereby implying that these microorganisms may play an important role in the development or deterioration of this severe chronic inflammation. It is therefore advisable to perform repeated scrapings and cultures in every case of recalcitrant blepharitis.


Retinal blood flow alterations associated with scleral buckling and encircling procedures. The bidirectional laser Doppler technique and monochromatic photography were used to measure the absolute blood flow rate in the major temporal retinal arteries in seven patients following unilateral scleral buckling and encircling procedures, and in two patients before and after removal of scleral buckling elements. In the seven patients who had undergone uncomplicated scleral buckling procedures the arterial flow rates were on average 50% lower (p = 0.01) in the surgically treated eyes than in the contralateral eyes. Removal of scleral buckling elements in two patients produced increases of 73% and 44% in arterial blood flow rates.


Onset of retinopathy of prematurity as related to postnatal and postconceptional age. The hypothesis that both perinatal events and stage of retinal development are important factors in determining the age at onset of retinopathy of prematurity (ROP) was tested by comparing gestational age at birth with postnatal and postconceptional age when ROP (using ICROP) was first seen. The study population consisted of 207 infants (111 placebo (P) treated, 96 vitamin E (E) treated) who developed ROP among a group of 914 premature infants (460 P, 454 E) enrolled in a randomised clinical trial of the effect of prophylactic use of vitamin E at pharmacological serum levels on incidence and severity of retinopathy. The mean postnatal age at onset of retinopathy was delayed in E treated infants compared with P treated infants by 1.4 weeks (t = 4.004, p < 0.0001). For both P and E treated infants postnatal age at onset of ROP (which reflects the state of retinal development at which birth insults occur) and postconceptional age at onset of ROP which defines state of maturity) were correlated with gestational age at birth. This suggests that both the event of premature birth and the extent of retinal development are important in determining when ROP will first be observed.


Cryotherapy for retinopathy of prematurity--a prospective study. Cryotherapy has been shown to reduce the unfavourable outcome in retinopathy of prematurity with stage 3 threshold disease by 50%. In a prospective study cryotherapy had a favourable outcome in 13 of 24 eyes with stage 3 threshold disease. The visual outcome, refraction, and complications of cryotherapy are discussed.


Corneal diameter in premature infants.

Corneal diameter in premature infants. The size of the cornea is important in the diagnosis of primary infantile glaucoma. Reference values regarding eyes of premature infants are scarce. Such data are of special importance in areas such as the Middle East where infantile glaucoma is common and often evident already at birth. The authors have measured the horizontal corneal diameter of the eyes of 127 premature Saudi infants with a gestational age between 23 and 36 weeks and a birth weight ranging from 540 g to 4720 g. The corneal diameter ranged from 7.75 mm to 10 mm. The smallest diameter (7.75 mm) was found in an infant with a gestational age of 23 weeks and having a birth weight of 520 g. The largest diameter (10 mm) belonged to two infants with a gestational age of 34 and 35 weeks and a birth weight of 2250 g and 2240 g respectively. Corneal diameter was positively correlated (p < 0.001) with gestational age and birth weight. Graphs depicting the regression line of corneal diameter on gestational age and of corneal diameter on birth weight together with the 95% confidence limits for individual values are provided for reference.


Pigmented epithelial tumours of the conjunctiva. Two out of 60 conjunctival epithelial tumours reviewed between 1973 and 1989 were found to be pigmented. One tumour was a pigmented papilloma and the other a pigmented squamous cell carcinoma. The melanin pigment was found in epithelial tumour cells as well as in macrophages, dendritic melanocytes, and Langerhans cells. The distinction between the latter two types of cells was possible in one of the tumours only. Both tumours were found in dark-skinned white patients without any evidence of conjunctival acquired melanosis.


Spontaneous subconjunctival haemorrhage--a sign of hypertension? The relationship between the condition of spontaneous subconjunctival haemorrhage (SCH) and hypertension was investigated. Seventy eight patients with SCH and 78 controls with unrelated ophthalmic conditions were compared. Blood pressure (BP) was significantly higher at presentation in the group with SCH at 149 (SD 27)/89 (SD 15) versus 142 (SD 25)/81 (SD 12). The proportion of hypertensives by WHO criteria (systolic blood pressure > 160 and/or diastolic blood pressure >95) was 46% on presentation compared with 23% of the control group. The morphology of the lesion did not influence the association with hypertension although there was a suggestion that the group with raised haemorrhages had a tendency to higher systolic blood pressure. It is recommended that all patients with SCH have their BP checked; this will result in the diagnosis of a significant number of new hypertensives.


Optimal postoperative refraction for good unaided near and distance vision with monofocal intraocular lenses. Forty five eyes with up to 2 dioptres of myopic astigmatism and up to 1 dioptre sphere either plus or minus following cataract extraction and implantation of a monofocal intraocular lens were examined to assess their unaided visual acuities. Forty three percent were able to see 6/12 and N8, and 60% were able to see 6/12 and N10. Subjects with between 1 and 2 dioptres of myopic astigmatism and virtually no sphere were able to see 6/12 and N10 in 82% of cases. This study confirms the benefits to both distance and near vision of myopic astigmatism as an alternative to multifocal intraocular lenses.


Calculation of the power of anterior chamber implants. Ninety seven eyes with anterior chamber implants and a best corrected visual acuity of at least 6/12 were studied, firstly, to compare the predictive accuracies of the commonly used formulas for intraocular lens (IOL) power calculation and, secondly, to determine the effect of optimising the 'A' constant on the predictive accuracies of the empirical Sanders-Retzlaff-Kraff (SRK) formulas. The accuracies of the empirical formulas (SRK and SRK II) were generally similar to those of the theoretical formulas (Binkhorst II and Colenbrander-Hoffer). However the original SRK formula was more accurate than the two theoretical formulas in long eyes and in all eyes overall. Optimisation of the 'A' constants did not improve the predictive accuracy of the empirical SRK formulas.


Bilateral optic nerve sheath meningiomas in a patient with neurofibromatosis type 2. A 34-year-old woman who presented with hearing loss and tinnitus was found to have reduced vision bilaterally. Computed tomography scan revealed bilateral acoustic neuromas and bilateral optic nerve sheath meningiomas. The presence of bilateral acoustic neuromas fulfils the criteria for the diagnosis of central neurofibromatosis (neurofibromatosis type 2). Although this is the first report of bilateral optic nerve sheath meningioma in neurofibromatosis type 2, meningiomas are commoner in this dominantly inherited disorder, than in its absence and both forms of central nervous system tumour may be caused by loss of tumour suppressor genes on chromosome 22.


Malignant melanoma of the optic nerve head in a case of oculodermal melanocytosis. Malignant melanoma of the uveal tract, orbit, and brain have been reported to occur in patients with oculodermal melanocytosis. A 60-year-old Caucasian man with oculodermal melanocytosis developed a malignant melanoma of the optic nerve head in the left eye. This case is the first reported example of a malignant melanoma developing in the optic nerve associated with oculodermal melanocytosis. After presentation the patient refused surgery for 19 months and the progression of the tumour necessitated an exenteration of the orbit.


Alice in Wonderland syndrome as an initial manifestation of Epstein-Barr virus infection. We present a patient with serologically confirmed Epstein-Barr virus (EBV) infection who had illusions of size, shape, and colour of objects but none of the typical symptoms and signs peculiar to infectious mononucleosis (IM) except sore throat which developed 2 weeks after the initial visual disturbances. The bizarre feelings about the images of body and objects are called the 'Alice in Wonderland syndrome' due to the similarity with Alice's dreams. The same symptomatology including visual metamorphosia is defined in patients with migraine, epilepsy, intoxication due to hallucinogenic drugs, schizophrenia, hyperpyrexia, and cerebral lesions. Alice in Wonderland syndrome has also been reported in the course of IM.


Inhibition of intraocular fibrin formation with annexin V. Annexin V is a member of the calcium- and phospholipid-binding proteins, known to have an antithrombotic effect. For the first time, we have tested its ability to prevent intraocular postoperative fibrin formation in a standardised rabbit model and compared its effect with that of heparin. Annexin V, 20 micrograms and 60 micrograms, injected in the anterior chamber post-operatively, significantly reduced the area of the fibrin clot and its time to clearing. Annexin V appeared to be as efficient as heparin. It probably acts by preventing phospholipids from playing their role in the coagulation cascade which leads to fibrin formation. Furthermore, annexin V has an anti-inflammatory effect by protecting phospholipids from phospholipase A2 activity. Therefore, annexin V might be considered as a new therapeutic agent acting both on fibrin formation and inflammatory processes.


Continued breakdown of the blood aqueous barrier following cataract surgery. Following routine extracapsular cataract and posterior chamber implant surgery, recovery of the blood aqueous barrier (BAB) was quantified by sequential anterior chamber fluorophotometry. This was correlated with surgical details and postoperative findings to ascertain those factors which were related to excessive damage of the BAB immediately after surgery and to failure to recover a normal BAB by 3 months postoperatively. A cohort of 84 patients was followed. In the early postoperative period excessive levels of damage to the BAB were related to iris damage (p < 0.01) and diabetes mellitus (p < 0.01). By 3 months, 79% of the eyes had recovered normal BABs and 21% (18 eyes) had persisting excessive fluorescence which correlated with an abnormal pupil shape (p < 0.02) and the development of posterior synechiae (p < 0.001).


Immunoimaging of choroidal melanoma: assessment of its diagnostic accuracy and limitations in 101 cases. Immunoscintigraphy (IS) was performed on 101 patients with space occupying intraocular lesions including choroidal melanomas (85), choroidal naevi (11), non-melanoma metastases (three), and other melanoma simulating lesions (two). Scintigraphic images with conventional and emission computer tomography techniques were obtained after the intravenous injection of 99mTc-labelled F(ab')2 fragments of monoclonal antibody (MoAb) 225.28S directed against the high molecular weight-melanoma associated antigen (HMW-MAA). Immunohistochemistry was performed on sections of four out of 10 melanoma-containing eyes to confirm MoAb binding. IS demonstrated positive scans in 66 out of 85 choroidal melanomas, offering a sensitivity of 78%. Sensitivity was dependent on the lesion size. True negative results were obtained in 15 out of 16 non-melanoma lesions (specificity 94%). False positive antibody accumulation was found in one patient with a post-traumatic subretinal haemorrhage. Immunohistochemistry demonstrated positive MoAb 225.28S binding in all melanoma sections. In summary IS offered substantial sensitivity and specificity in the differentiation of intraocular lesions, particularly choroidal melanomas, naevi, and metastases. In combination with other diagnostic procedures such as ultrasound echography and fluorescein angiography IS proved to be a valuable method in the diagnosis of choroidal melanoma.


Detection of colour vision abnormalities in uncomplicated type 1 diabetic patients with angiographically normal retinas. Colour vision function was assessed in 38 non-complicated type 1 diabetic patients in whom fluorescein angiography was normal, and was compared with that in 36 age-matched, non-diabetic controls. All of the patients were healthy and none were taking medication except insulin. The eye examination, which was normal in every patient, included the Ishihara and City University tests, measurement of Snellen acuity, slit-lamp examination, tonometry, and fundal photography as well as fluorescein angiography. Colour discrimination ability was measured with the Farnsworth-Munsell 100-hue test. Mean (SE) 100-hue test error score for the diabetic group was 86.8 (8.1) compared with 28.2 (3.3) for controls, p<<0.001. There was no relation between colour vision abnormalities and diabetes duration (r = 0, p>0.05), blood glucose at the time the colour tests were performed (r = 0.4, p > 0.05), most recent glycated haemoglobin result (r = 0.3, p>0.05), or the mean of all previous glycated haemoglobin results (r = 0, p>0.05). It is concluded that colour discrimination may be abnormal in uncomplicated type 1 diabetic patients before the onset of retinopathy, and that colour discrimination losses in diabetes may not be of vascular aetiology.


Abnormal dark adaptation kinetics in autosomal dominant sector retinitis pigmentosa due to rod opsin mutation. The time course of dark adaptation was measured in 10 subjects from three families with autosomal dominant sector retinitis pigmentosa (RP) due to mutations in the first exon of the rod opsin gene. In each subject cone adaptation and the early part of the recovery of rod sensitivity followed the normal time course, but the later phase of rod adaptation was markedly prolonged. The recovery of rod sensitivity is much slower than that reported in any other outer retinal dystrophy. Using a model based upon primate data of rod outer segment length and turnover, we have calculated that the delayed phase of the recovery of rod sensitivity in the RP patients tested following strong light adaptation could be due in part to formation of new disc membrane with its normal concentration of rhodopsin rather than in situ regeneration of photopigment.


Confocal imaging of the fundus using a scanning laser ophthalmoscope. A confocal scanning laser ophthalmoscope (cSLO) was used to examine the effects of confocal optics on the image of the human fundus in vivo. Patients from a retinal clinic and a glaucoma clinic were examined using the cSLO in the confocal mode. A degree of optical sectioning could be achieved, and the results agree with a best axial resolution of 300 microns measured in a model eye. The main advantage of using a confocal system was found to be the improved contrast of the images. This improved the resolution of structures such as the lamina cribrosa and optic disc drusen which are seen in low contrast in conventional images. The improved contrast of the confocal images is partly achieved by excluding light which has been scattered within the plane of focus. Structures which multiply scatter light will become less visible with confocal optics and hard exudates were found to be an example of such a structure. The cSLO and the fundus camera are seen as complementary instruments rather than as alternatives for imaging the fundus. It is envisaged that confocal imaging will enable details of the fundus to be revealed which are at present not seen in conventional images.


The effects of subconjunctival betamethasone on the blood aqueous barrier following cataract surgery: a double-blind randomised prospective study. The aim of this double-blind randomised prospective study was to assess the effect of subconjunctival Betnesol (betamethasone sodium phosphate 0.1%) on the recovery of the blood aqueous barrier (BAB) following cataract surgery in uncomplicated eyes. Twenty patients [10 male, mean age 71.4 (SD 12.7) years] admitted for routine cataract surgery were randomised into two groups. All patients recruited into the study were free of other ocular disease and were not taking any anti-inflammatory medication. Group A received a subconjunctival injection of cefuroxime (125 mg) alone while group B received a subconjunctival injection of both cefuroxime and Betnesol. All surgery was performed by a single surgeon using a standardised surgical technique and all patients received the same postoperative medication. The Kowa laser flare cell meter was used to measure aqueous flare and cells preoperatively and on the first, second, and seventh postoperative day, and at 1 and 3 months following surgery. The code was broken only after all patients had been followed-up for 3 months postoperatively. There was no significant difference between the two groups in aqueous flare and cells at any of the postoperative visits. In this study we were unable to demonstrate any beneficial effect of subconjunctival betamethasone on damage to and recovery of the BAB following cataract surgery in the uncomplicated eye.


Long-term survival of endothelium following transplantation of corneas stored by organ culture. This study reports corneal graft survival, endothelial cell changes, and visual outcome in 20 patients who received some of the first corneas stored by organ culture in the Corneal Transplant Service Eye Bank in Bristol. Mean donor age was 48 years (SD 15, n = 20) and corneas were stored for an average of 21 days (SD 7, n = 20). Preoperative endothelial cell density was 2334 cells/mm2 (SD 235, n = 18) and this fell by 8% (SD 12) to 2158 cells/mm2 (SD 372) within the first 2 months following transplantation. In 13 patients, endothelial cell density thereafter declined exponentially with a half-life of 41 months (SD 17, n = 12; one patient excluded as an outlier). Corneas that suffered rejection episodes showed the highest rates of loss of endothelial cells. Endothelial cell loss 4 years after transplantation was 46% (SD 16, n = 12), which was similar to the postoperative decline in cell density reported for corneas stored for far shorter periods in McCarey-Kaufman medium at 4 degrees C.


Assessment of central visual function after successful retinal detachment surgery by pattern visual evoked cortical potentials. The pattern of visual recovery after successful surgery by pattern visual evoked cortical potentials (VECP), visual acuity, colour vision, and critical fusion frequency was investigated in 14 eyes with retinal detachment involving the macula. The temporal tuning characteristics in the evoked potentials were measured as based on the P100 amplitude and the frequency necessary for evoking 0 mu V amplitude, which was defined as an objective critical fusion frequency by extrapolating the curve. Significant improvement in visual acuity and colour vision was observed within 2 months postoperatively. A significantly increased P100 peak latency became shorter as the postoperative days increased. In general, a good correlation was noted between the P100 peak latency and subjectively measured visual acuity, colour vision, and critical fusion frequency. The objective critical fusion frequency measured by VECP recovered gradually during the 6 months after surgery. Functional recovery was not related to the length of time the macula was detached before surgery.


Fibronectin synthesis in subretinal membranes of proliferative vitreoretinopathy. In situ hybridisation and immunohistochemical studies were conducted on six surgically excised subretinal membranes of proliferative vitreoretinopathy to investigate whether displacement of retinal pigment epithelial and glial cells to subretinal membranes was associated with fibronectin production by the subretinal membrane cells. Fibronectin messenger RNA (mRNA) and fibronectin immunoreactivity were observed in some cells in all of the subretinal membranes studied and up to 30% of the cells in individual specimens showed intense labelling for fibronectin mRNA. The results support the concept that the cells in subretinal membranes produce fibronectin. Locally produced fibronectin may play a role in subretinal membrane cohesion, and displacement of retinal pigment epithelial and glial cells from their normal location may induce the cells to manufacture fibronectin. Fibronectin production may be more prominent in migrating subretinal cells.


Prenatal exclusion of Norrie's disease.

Prenatal exclusion of Norrie's disease. We report on the use of DNA marker probes and linkage analysis to exclude Norrie's disease in the male fetus of a high risk carrier. There are no clinical markers in females carrying the Norrie's disease gene; thus DNA linkage analysis is an essential technique in the management of families 'at-risk' for this severe ophthalmic disease. The principles of DNA linkage are discussed.


Congenital nystagmus: rebound phenomenon following removal of contact lenses. Symptoms resulting from congenital nystagmus can be significantly reduced by wearing corneal contact lenses. A 90 minute therapeutic trial with contact lenses was performed on a 20-year-old affected patient and produced a beneficial effect. Upon removal of the lenses however the patient showed a transient rebound phenomenon with oscillopsia lasting about 20 minutes. This phenomenon, although it might be expected in theory, has apparently not previously been observed either because it is rare or because in most patients it is not clinically apparent. The purpose of this report is not to discourage treating patients with congenital nystagmus by means of contact lenses, but rather to draw attention to the occasional occurrence of such a rebound phenomenon and to discuss its theoretical significance.


Behçet's disease: activated T lymphocytes in retinal perivasculitis. A 38-year-old man who died from systemic Behçet's disease had previously suffered from severe, recurrent bilateral retinal vasculitis, and anterior uveitis for 10 years. Immunopathological examination of the eyes postmortem revealed marked hyaline thickening of the retinal and optic nerve vessels. The vessels had an intramural and perivascular infiltrate of T lymphocytes which stained positively for CD4 and IL2 receptor surface markers. Small numbers of cells in the optic nerve head, retinal vascular endothelium, and retinal pigment epithelium were HLA DR positive.


Sudden blindness in a child: presenting symptom of a sphenoid sinus mucocele. A 10-year-old girl with no nasal or respiratory symptoms developed a headache lasting a few hours. The next day she became totally blind in the right eye and over 5 days vision in the left eye deteriorated to bare light perception. The diagnosis of a sphenoid sinus mucocele was made radiologically and drainage via an endonasal sphenoidectomy produced 12 ml of brownish fluid. Endoscopic biopsy of the wall confirmed the diagnosis of a mucocele. Steroid treatment was given postoperatively, but vision recovered to 6/12 in the left eye only. The importance of urgent clinical diagnosis and treatment is stressed.


Actinomycosis of the orbit.

Actinomycosis of the orbit. Actinomycosis is a very rare cause of orbital abscess usually attributable to direct spread from adjacent structures. A case of actinomycosis of the orbit is presented, which was treated as orbital pseudotumour for 3 months before progression of signs and symptoms, despite high dose steroids, led to the diagnosis being reconsidered.


Phakomatous choristoma of the orbit: a case report. We report the case of a 3-month-old infant with a rare phakomatous choristoma of the orbit. This lesion is believed to be a congenital neoplasm of lenticular anlage. The clinical, radiological, and histopathological findings are presented.


Broken intraocular lens during cataract surgery. A case of planned routine extracapsular cataract extraction is described where surgery was complicated peroperatively by fracture of the posterior chamber lens implant. The technique of lens implantation is discussed.


Current concepts in pediatric burn care: general management of severe burns. Severe burns and scalds are still frequent. If the burn victim is a child, it should ideally be taken care of in a pediatric burn center, where both the burn and child-related needs are specifically met. The goals of burn care are to preserve life, to preserve function, to limit physical and psychological sequelae and to provide social reintegration. The system of burn care essentially consists of adequate initial resuscitation followed by early surgery aimed at rapid and definitive wound closure. Vigorous nutritional support as well as early rehabilitation and continuous psychosocial care are of paramount importance. The paper summarizes the essentials of pediatric burn care (burn surgery excluded).


Current concepts in pediatric burn care: surgery of severe burns. Optimal surgical therapy of severe burns in children has been controversial for a long time. A review of the current literature shows that prompt surgical excision of necrotic tissue and immediate autografting have become the standard in most burn centers. The authors present a concept based on prompt excision of third degree burns and discuss the problems of intermediate cover arising in massive burns.


Current concepts in pediatric burn care: management of burn wounds with cultured epidermal autografts. Our experience with CEA is based on 21 patients operated on from 1986 to 1991. The areas covered with CEA measured 500 cm2 to 3160 cm2. At one setting no more than 40 sheets of 40 cm2 CEA have been transplanted. The take of CEA is over 75% when applied to dermis. The same holds true when covering "deepithelialised" skin homografts on immunosuppressed patients. Scar formation has not been a problem, and the overall results have been good.


Current concepts in pediatric burn care: the biology of cultured epithelial autografts: an eight-year study in pediatric burn patients. An 8-year histopathological study of skin regeneration and wound healing in 22 pediatric patients treated with cultured epithelial autografts (CEA) grafted to full-thickness burn wounds excised to muscle fascia is reported. Biopsies of CEA have been analyzed by light microscopic, immunohistochemical, morphometric, electron microscopic and ultrastructural immunolabelling techniques and compared to controls of meshed split-thickness autograft (MSTA) interstices at comparable times postgrafting. At transplantation, CEA are undifferentiated and lack both granular and cornified cell layers. By 6 days postgrafting, CEA differentiate all normal epidermal strata but lack rete ridges. De novo formation of a confluent basal lamina and mature hemidesmosomes is complete by about 3 weeks. Anchoring fibrils appear sparse and immature (as in MSTA controls) compared to normal skin until about 6-12 months. CEA develop rete ridges and a neodermis with normal stromal and vascular organization at about 6-12 months, whereas MSTA interstice controls do not. At 4-5 years, elastin expression is also observed in the CEA neodermis, completing the dermal regeneration process. Normal epidermal differentiation is maintained long-term. These long-term results indicate that CEA regenerate a stable normal epidermis and are capable of inducing dermal regeneration from wound bed connective tissue.


Critical reflections on the use of human cultured keratinocytes in children with burns. The authors report on their experience in the use of cultured keratinocytes in severely burned children, observed in the Surgical Emergency and Pediatric Surgery Department at the Gaslini Institute of Genova. Seventeen cases are described, divided into three groups: patients treated exclusively by autografts; patients treated both by auto- and allografts; patients treated exclusively by allografts. Indications to the various techniques are reported, and the advantages and disadvantages of cultured skin are discussed. Some of the most likely causes of failure are pointed out, with an update review of the literature.


Acute respiratory distress due to malignant schwannoma. A case report. A 13-year-old boy with acute respiratory distress due to a malignant schwannoma located in the neck, is reported. This case suggested that malignant schwannoma in the neck can lead to airway obstruction.


Air trapping from torsion of a congenital cyst of the lung. Report on a case of congenital cyst of the lung which was attached to the pleura of the right upper lobe and because of torsion of its pedicle produced air trapping and mediastinal shift. Etiology, diagnosis and surgical indications are reviewed from the literature. No similar case has been previously reported.


Tracheal rupture in a newborn during a complicated delivery. Diagnosis and surgical repair. Rupture of the trachea is an exceptional obstetrical lesion. The infant reported in this paper, at 1 hour of age, developed respiratory distress with pneumomediastinum, bilateral pneumothorax and subcutaneous emphysema. This resulted from the fact that the trachea had ruptured, within 1 cm of the carina, during the difficult delivery. When the child was 23 days old, operation proved necessary because extubation was not feasible. The stenotic portion of the trachea was resected and continuity restored by end-to-end anastomosis. The tracheal lumen at the site of the anastomosis proved normal by bronchoscopic examination 4 months after the operation. There is only one similar case in the literature. The etiology of this rupture is discussed.


Esophageal stricture as a complication in Henoch-Schönlein purpura. We report on a three-year-old boy with Henoch-Schönlein purpura developing an esophageal stenosis during severe clinical course of this disease. There are to date no reports on the development of such a complication. The possible pathogenesis in relation to stricture formation of ileum and ureter in Henoch-Schönlein's purpura is discussed.


Intussusception and duodenal stenosis: an infrequent but expected association. Two boys with intussusception, intestinal malrotation and duodenal stenosis are reported. Because intussusception is associated with malrotation, which is in turn associated with duodenal stenosis, this combination of abnormalities may be expected in up to 3% of children with intussusception.


Lactic acidosis from thiamine deficiency during parenteral nutrition in a two-year-old boy. This is a case report of a two-year-old boy who was operated electively for a blind-loop syndrome of the proximal jejunum. Because of the appearance of chylous ascites, parenteral nutrition was carried out postoperatively. The boy developed a severe uncompensated acidosis and paralytic ileus. Relaparotomy on suspicion of ischemic bowel did not explain the cause of the acidosis and ileus. Postoperatively, the child's condition worsened, requiring intensive care. The drastically elevated lactate levels corroborated the eventually suspected diagnosis of a vitamin B1 deficiency syndrome. The administration of thiamine within two hours produced correction of the acidosis without further bicarbonate therapy. In 24 hours circulation was stabilized. Two months post-operatively the boy had completely recovered from the sequelae of his shock event.


Endorectal pull-through operation for diffuse cavernous hemangiomatosis of the sigmoid colon, rectum and anus. A 6-year-old girl with diffuse cavernous hemangiomatosis of the sigmoid colon, rectum and anus underwent endorectal pull-through operation for sphincter-saving resection. Rectal mucosa was resected from 4 cm above peritoneal reflection to anal skin margin and the normal sigmoid colon was pulled down through the rectal muscular cuff. Ligation of the superior rectal and left internal iliac arteries at operation achieved satisfactory control of bleeding. Postoperative manometric studies showed almost normal sphincter tone and good response to rectal stimuli by balloon inflation. The endorectal pull-through (Soave-Denda procedure) is a common procedure for Hirschsprung's disease and the best procedure for the sphincter-saving treatment of diffuse cavernous hemangiomatosis of the colon and rectum.


Facial balance in cleft lip and palate. I. Normal development and cleft palate. A full understanding of balanced facial growth, based on a complete knowledge of the anatomy and physiology of the region, is essential if cleft lip and palate is to be treated successfully. The cleft abnormality is the cause of underdevelopment and subsequent loss of function. Cleft surgery must aim to restore normal anatomy and physiology with emphasis on muscle reconstruction of the lip and soft palate if normal facial development is to be achieved.


Facial balance in cleft lip and palate. II. Cleft lip and palate and secondary deformities. The cleft abnormality is the cause of underdevelopment and subsequent loss of function. Primary cleft surgery and surgery to correct the secondary deformities of previous non-functional repair should aim to restore normal anatomy and physiology, with an emphasis on muscle reconstruction of the lip and soft palate if normal facial development is to be encouraged.


A three dimensional analysis of soft and hard tissue changes following bimaxillary orthognathic surgery in skeletal III patients. The three dimensional changes in the bone and the ratio of soft tissue to bone movement were investigated in a group of 16 Skeletal III patients following orthognathic surgery. Computerised tomogram scans were taken for each patient pre-operatively and 1 year postoperatively. The scans were superimposed, radial measurements calculated, and the changes illustrated by two separate colour scales. There was no constant pattern of movement in the maxilla or mandible in these patients. However, following a Le Fort 1 osteotomy there was commonly a 1:1 ratio in the midline which increased to 1.25:1 at the alar bases and over the canine regions bilaterally. There was also a 1.25:1 ratio or greater over the chin and mentalis regions following mandibular set back.


The conservative management of osteoradionecrosis of the mandible with ultrasound therapy. A regimen of ultrasound with local debridement and metronidazole has proved to be an effective and practicable treatment for osteoradionecrosis, achieving healing in 10/21 (48%) cases without the need for surgery or sophisticated technology. Nine further patients were successfully treated by covering the preserved mandible with a local intra-oral flap. Only 2 patients required mandibular resection with reconstruction. An ultrasound programme of 1 watt/cm2, 3 mega Hz. pulsed 1:4, 15 min a day for 60 days would seem to be optimum. However, a range of dosage needs to be further explored for inducing neovascularity and neocellularity in the irradiated tissues.


Informed consent in oral and maxillofacial surgery: a study of its efficacy. This paper explains the legal principle of informed consent in surgery and presents the results of a study of the efficacy of verbal information as part of the informed consent process in oral and maxillofacial surgery, using third molar surgery as a model. The results showed that patients were most likely to recall being warned about pain and swelling and less likely to recall being warned about trismus, dysaesthesia of the lip and dysaesthesia of the tongue. The last two are complications with important medicolegal implications. It appeared to make no difference to their recall if they were given this information on a preadmission clinic or on admission. The implications of these findings are discussed.


Cosmetic extensile exposure of the facial skeleton. Professor A. K. Henry coined the term 'extensile exposure'. Three incisions are described to expose the facial skeleton. The incisions are placed to best cosmetic advantage and provide extensile exposure to fit many of the routine procedures undertaken by the oral and maxillofacial surgeon.


Professional qualifications of the membership of the British Association of Oral and Maxillofacial Surgeons. The medical and higher academic qualifications of the current membership of the British Association of Oral and Maxillofacial Surgeons were analyzed. Of the total membership, 69.3% possessed a postgraduate dental fellowship, 28.3% held a formal medical qualification and 16.5% held a higher academic degree. Half (45.9%) of the Fellows (Consultants), one-third (28.1%) of the Members and one-tenth (10.9%) of the Associate Members were medically qualified. Consultants in NHS positions and Members in higher training grades accounted for the majority of medically qualified individuals. Higher academic qualifications were held by one-fifth (20.8%) of Fellows, one-tenth (11.4%) of Members and one-fifth (17.7%) of Associate Members. Most of those possessing higher academic qualifications were consultants in University appointments, Members not in training and overseas Associate Members. A dental basis for the specialty was upheld by the finding that 99.7% of Fellows held a post-graduate dental fellowship. These results are discussed in relation to current recommendations for clinical and academic training in oral and maxillofacial surgery in the UK.


Jehovah's Witness: a management dilemma in severe maxillofacial trauma. The fundamentalist beliefs of a Jehovah's Witness can create major clinical and medicolegal problems when blood or blood products are needed to sustain life. The continuing expansion of Jehovah's Witnesses (1/4 million in UK; 4 million worldwide) means that encounters with the sect and surgeons in clinically critical situations are likely to increase. This paper describes such a case in which a 24-year-old male died from maxillofacial injuries because transfusion was denied. The special clinical and ethical management criteria are emphasized and the legal vulnerability of the clinician is discussed. It is no longer possible for clinicians in the UK to act independently in the management of such cases without risking censure or loss of indemnity from the employing health authority.


Cowden's disease: a rare but important manifestation of oral papillomatosis. A case of Cowden's disease is reported, and possible differential diagnosis for the oral lesions is suggested.


The prevalence of orthodontic treatment need. The prevalence of unmet orthodontic treatment need amongst 955 12-year-old Sheffield children has been assessed using the Index of Orthodontic Treatment Need [I.O.T.N.]. The Index was found to be quick and simple to use, and demonstrated very good levels of intra-examiner agreement.


Shear bond strength of ceramic brackets with chemical or mechanical retention. The study was undertaken to measure and compare the shear bond strengths of a ceramic bracket with chemical retention, a ceramic bracket with a new type of textured base providing mechanical retention, and a metal bracket with foil-mesh base. The tests were performed on 51 extracted human premolars which were randomly divided into three equally large groups (n = 17)--one group for each type of bracket. After debonding, the site of failure was noted and the enamel surface inspected with scanning electron microscopy. The ceramic bracket with chemical retention exhibited significantly higher bond strength than the corresponding bracket with textured base. In comparison with the metal bracket significantly higher bond strengths were recorded for both types of ceramic brackets. The ceramic bracket with mechanical retention and the metal bracket were comparable as regards the site of bond failure. In some cases the chemical bond provided very high values of bond strength. Enamel failure were recorded in three teeth which had been bonded with this type of ceramic bracket.


An investigation into the effect of a fluoride releasing adhesive on the prevalence of enamel surface changes associated with directly bonded orthodontic attachments. Despite careful patient selection, decalcification still remains a problem during fixed orthodontic treatment. The advantages of a method of delivering fluoride to the area of the tooth most at risk, which does not rely on patient compliance, makes a fluoride releasing bonding adhesive desirable. The aims of this study were to investigate the potential of a fluoride releasing bonding material for preventing decalcification and to monitor its efficacy at retaining orthodontic brackets. In order to carry out the first part of the study it was necessary to devise a reproducible and sensitive method of recording the extent and severity of any decalcification. A photographic technique which fulfils these criteria is described.


The performance of first molar orthodontic bands cemented with glass ionomer cement--a retrospective analysis. Various factors influencing the survival time of orthodontic bands cemented to first permanent molars with glass ionomer cement (KETAC-CEM, Espe) have been investigated. Data on 513 patients with 1424 first molar bands who completed orthodontic treatment between 1985 and 1989 inclusive were analysed. Performance of bands cemented to first permanent molars varied according to the operator, age of the patient and treatment mechanics, but not according to the sex of the patient or quadrant in which the band was fitted.


Bioprogressive brackets and pentamorphic arches. The use of high torque values with no tip in preadjusted incisor brackets in the Bioprogressive system, in conjunction with narrow anterior rectangular archwires may produce crown spacing, root crowding and upright central incisors. The solution to these problems would seem either to reduce the time spent in rectangular wires or to change to a bracket with reduced torque, together with appropriate second order compensations in the archwire or the bracket.


Storage of orthodontic study models in hospital units in the U.K. Orthodontic study models form an essential part of the dental records of patients undergoing diagnosis and treatment. In order to ascertain the problems encountered by hospital orthodontic units in the utilization and storage of study models, a questionnaire was circulated in February 1991 to members of the Consultant Orthodontists Group. All respondents took pretreatment study models, while 9 per cent took their final study models at some time other than the end of active treatment; 85.5 per cent of respondents stored their study models in their units, but most were beginning to experience difficulties in this regard. There was a wide range for storage times, and only 10 per cent of employing authorities had a stated policy on the storage of study models. There was a highly significant difference (P much less than 0.001) between the time that models are stored at present, and the desired storage times. Most respondents appeared to be rather uncertain about the precise medico-legal requirements concerning model storage. The implications for audit and medico-legal matters are discussed in the light of these findings.


Methods of debonding ceramic brackets.

Methods of debonding ceramic brackets. The problem of debonding ceramic brackets is still one which concerns the orthodontist. It is advisable to use the manufacturers recommended method of debonding each particular type of bracket. The risks of using such brackets need to be carefully assessed against the benefits. Risks can be minimized by carefully assessing the patient and the dentition, avoiding heavily restored teeth with pre-existing enamel cracks. It would seem wise to obtain an informed consent from the patient having out-lined the potential problems.


Lipoproteins enhance fibronectin binding to adherent cells. We have identified very low density (VLDL) and low density (LDL) lipoproteins as blood plasma components that enhance the binding and deposition of fibronectin into the extracellular matrices of cultured MG-63 osteosarcoma cells and human fibroblasts. The lipoproteins increased the binding and deposition of iodinated fibronectin by MG-63 cells threefold over control levels. LDL also increased the deposition of multimeric fibronectin into extracellular matrix as assessed by gel electrophoresis and fluorescence microscopy. High density lipoprotein (HDL) and the d > 1.21 g/ml nonlipoprotein fraction had less activity. Enhancement of binding of fibronectin was observed within 15 minutes, when binding was largely reversible. LDL also increased the binding of a fragment containing the 70-kd amino-terminal region of fibronectin that is primarily responsible for the reversible binding of fibronectin to cell layers. LDL had to be present simultaneously with radiolabeled fibronectin to exert an effect on fibronectin binding. LDL enhanced fibronectin binding equally well to normal skin fibroblasts and to familial hypercholesterolemic fibroblasts lacking the LDL receptor. Acetylation of LDL, performed to block its interaction with the LDL receptor, did not diminish the enhancement of fibronectin binding to MG-63 cells. These results indicate that LDL and VLDL interact with fibronectin to potentiate binding to monolayer cells through a pathway that does not involve the LDL receptor.


Redirected targeting of LDL to human monocyte Fc gamma receptors with bispecific antibodies. Recent studies indicate that low density lipoprotein (LDL)-immune complexes consisting of anti-LDL antibodies bound to LDL may contribute to macrophage foam cell development by uptake through immunoglobulin G (IgG) Fc receptors. As human mononuclear phagocytes possess three structurally and functionally distinct classes of IgG Fc receptors, we developed a system whereby the effects of LDL-immune complexes could be studied with respect to each type of IgG Fc receptor. Novel bispecific antibodies consisting of anti-Fc gamma receptor antibodies linked to anti-LDL antibodies were used to prepare bispecific LDL-immune complexes for targeting to specific Fc gamma receptors. In this report, the effects of bispecific LDL-immune complexes directed to Fc gamma receptor types I, II, and III were studied primarily with monocytes and were compared with the effects of similarly prepared bispecific complexes that targeted LDL to human leukocyte antigen (HLA) class I antigens. Each type of bispecific antibody was effective in targeting 125I-LDL to its respective site on the cell surface. Using fluorophore-labeled LDL and flow cytometry, bispecific complexes directed to Fc gamma receptor types I or II but not to HLA class I antigens caused a two- to sevenfold increase in cell-associated fluorescence relative to control cells treated with LDL in the absence of bispecific antibody. Uptake occurred in the presence of excess unlabeled LDL, acetylated LDL, and antioxidants. That the bispecific complexes triggered metabolic uptake was supported by studies of kinetics and temperature dependence. Using 125I-labeled complexes, metabolic degradation of LDL was demonstrated in association with each of the three types of Fc gamma receptors.(ABSTRACT TRUNCATED AT 250 WORDS)


Beta-VLDL-induced cholesterol ester deposition in macrophages may be regulated by neutral cholesterol esterase activity. We examined the role of enzyme activities involved in cholesterol ester metabolism in the accumulation of cholesterol ester in macrophages. When [3H]cholesterol linoleate-beta-very low density lipoproteins (beta-VLDLs) were incubated with rat resident peritoneal macrophages (RPMs), thioglycolate-elicited macrophages (TEMs), or alveolar macrophages (AMs), cholesterol ester accumulation was the greatest in TEMs and the least in AMs. The uptake of [3H]cholesterol linoleate-beta-VLDL into AMs was four times that into RPMs, and the uptake into TEMs was twice that into RPMs. The [3H]cholesterol released from [3H]cholesterol linoleate-beta-VLDL-loaded AMs was five times higher than from TEMs and RPMs, whereas those from RPMs and TEMs were almost the same. In studies using cell homogenates, the acid cholesterol esterase activity in AMs was 1.7 times that in TEMs and six times that in RPMs. The acyl-coenzyme A:cholesterol acyltransferase (ACAT) activities in AMs and TEMs were similar but were higher than that in RPMs. The neutral cholesterol esterase activity was seven times higher in AMs than in RPMs and TEMs. In the study using intact cells, the hydrolysis of loaded [3H]cholesterol linoleate-beta-VLDL in the presence of the ACAT inhibitor CL277,082 and the cholesterol [14C]oleate synthesis from [14C]oleate were enhanced in AMs about twofold compared with RPMs and TEMs. The reduction of de novo synthesized cholesterol [14C]oleate in the presence of CL277,082 was enhanced in AMs four times compared with TEMs or RPMs.(ABSTRACT TRUNCATED AT 250 WORDS)


Effect of marine lipids on cholesteryl ester transfer and lipoprotein composition in patients with hypercholesterolemia. While the effects of omega-3 (n-3) fatty acids present in marine lipids on plasma lipoprotein levels have been intensively studied, less is known about their impact on reverse cholesterol transport. For this reason, for a 3-month period we studied the effects of the administration of n-3 fatty acids (6 g/day) as a dietary supplement on cholesteryl ester transfer (CET), a key step in this process, and lipoprotein composition in 12 outpatients with genetically heterogeneous forms of hypercholesterolemia. Before treatment, CET in hypercholesterolemic patients, estimated as the mass of cholesteryl ester (CE) transferred from high density lipoprotein (HDL) to very low density lipoprotein (VLDL) plus low density lipoprotein (LDL), was markedly accelerated, peaking after only 1-2 hours of incubation of whole plasma; this response differed significantly (p < 0.001) from the initial delayed curvilinear response of control subjects. Consistent with the accelerated CET occurring in vivo, their triglyceride to esterified cholesterol core lipid ratio before treatment was reduced in the intact VLDL fraction and VLDL1 but not in VLDL2 or VLDL3 and was reciprocally increased in HDL. In addition, the free (unesterified) cholesterol to lecithin ratio of VLDL1 was abnormally increased. Recombination experiments performed with individual lipoprotein fractions revealed that accelerated CET was specifically associated with the VLDL1 subfraction and not LDL, HDL, and cholesteryl ester transfer protein (CETP), although pretreatment levels of CETP were significantly increased (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)


Reevaluation of regression of coronary arteriosclerotic lesions in repeat-spawning steelhead trout. At spawning, migratory salmonids have an extensive accumulation of coronary arteriosclerotic lesions. Nevertheless, when steelhead trout (Oncorhynchus mykiss) return to the ocean after spawning, an unusual phenomenon has been reported, namely, that these lesions have regressed naturally and almost completely (R.L. Van Citters and N.W. Watson, Science 1968; 159:105-107). In contrast to this earlier finding, we present data that show a high prevalence and severity of coronary lesions in 1) wild, repeat-spawning steelhead trout that were caught at high sea and 2) wild and cultured steelhead trout that had been held in sea pens for up to 1 year after maturation. Therefore, we refute the idea of natural lesion regression in steelhead trout. Coronary lesions in salmonids are characteristically lipid free despite the fact that there are high plasma levels of both total cholesterol and low density lipoproteins. This situation contrasts with the characteristic lipid deposition during lesion development in mammals. We therefore suggest that attention should be directed to explaining why coronary lesions accumulate despite very high dietary levels of omega-3 polyunsaturated fatty acids in the diets and tissues of these fish.


Familial combined hyperlipidemia and abnormal lipoprotein lipase. A previous study reported that heterozygotes for lipoprotein lipase (LPL) deficiency have reduced LPL, the lipoprotein pattern classified as familial combined hyperlipidemia (FCHL), elevated apolipoprotein (apo) B levels, and reduced high density lipoprotein (HDL) levels. These findings suggest that subjects with reduced LPL may form one subset of the FCHL population. The purpose of the present study is to determine whether a subset of patients with FCHL have reduced LPL. Three patient populations with FCHL were studied: 1) subjects with the diagnosis of FCHL (n = 9) established by previous family studies, 2) clinic patients with a tentative diagnosis of FCHL (n = 14), and 3) subjects undergoing angiography who had coronary artery disease (CAD) and a diagnosis of FCHL by family study (n = 33). Two of nine subjects with the established diagnosis of FCHL, five of the 14 FCHL clinic patients, and 13 of the 33 CAD subjects with FCHL had reduced LPL activity in the same range as do individuals who are obligate heterozygotes for LPL deficiency. Subjects with FCHL and reduced LPL had higher plasma triglyceride (p < 0.01) and lower HDL cholesterol (p < 0.025) levels than did the subjects with FCHL and normal LPL levels (327 +/- 201 versus 210 +/- 122 mg/dl [mean +/- SD] and 36 +/- 7 versus 44 +/- 13 mg/dl, respectively). Thus, in all three groups of patients with apparent FCHL, 20 of 56 subjects (36%) had reduced LPL, suggesting that one subset of the FCHL population may be identified by an abnormality in LPL activity that is associated with lipoprotein abnormalities.


Delayed clearance of postprandial chylomicrons and their remnants in the hypoalphalipoproteinemia and mild hypertriglyceridemia syndrome. Hypoalphalipoproteinemia (HPAL) with mild hypertriglyceridemia (HTG) is associated with increased coronary artery disease (CAD) risk. The aim of this study was to examine the metabolism of postprandial lipoproteins in HPAL/HTG subjects (n = 21). They had a fasting plasma high density lipoprotein (HDL) cholesterol level < 0.9 mmol/l, a triglycerides (TG) level of 2.0-7.1 mmol/l, and a normal low density lipoprotein (LDL) cholesterol level (< 3.7 mmol/l). They were either homozygous for apoprotein E3 (n = 13) or heterozygous for apoprotein E4 (n = 5) or E2 (n = 3). After ingestion of a vitamin A fat load, plasma and chylomicron (CM) retinyl palmitate (RP) response (areas under curves) was three times and non-CM RP response 2.5 times greater than in normolipidemic control subjects (n = 13). There was close correlation between fasting plasma TG level and postprandial RP response in HPAL/HTG subjects (plasma, r = 0.87; CM, r = 0.89; and non-CM, r = 0.84). In control subjects this correlation was present for plasma RP (r = 0.80) and CM RP (r = 0.61) but not for non-CM RP (r = 0.53). In contrast, postprandial RP response was not correlated with fasting plasma HDL cholesterol levels for both groups. There was also no correlation between fasting TG and fasting HDL cholesterol. Postheparin lipoprotein lipase and hepatic lipase activities were slightly higher in HPAL/HTG subjects. The pattern of postprandial change in HDL composition was similar to that in control subjects. These data indicate enhanced postprandial lipemia in the HPAL/HTG syndrome, and this may account for their increased CAD risk.(ABSTRACT TRUNCATED AT 250 WORDS)


Modulation of fibrinolytic response to venous occlusion in humans by a combination of low-dose aspirin and n-3 polyunsaturated fatty acids. Aspirin at high but not at low doses reduces the fibrinolytic response to venous occlusion. Inhibition of vascular prostacyclin synthesis could be involved in this effect. Fish oil supplementation may redirect prostanoid metabolism toward an overall "antithrombotic" condition but with controversial effects on prostacyclin formation. In this study we investigated the effect of low-dose aspirin together with n-3 polyunsaturated fatty acid (PUFA) supplementation on the fibrinolytic response to venous occlusion. Following a double-blind, randomized, crossover design, six healthy volunteers (three men and three women, 24-37 years old) were given for 29 days 5.3 g eicosapentaenoic and docosahexaenoic acids or a corresponding dose of n-6 PUFAs as control; aspirin (40 mg/day) was then added for an additional 14 days. A 2-month washout period was allowed before the crossover. Blood was collected before and after venous stasis on days 0, 29, and 43 of each test period. A combination of aspirin with n-3 PUFAs reduced the fibrinolytic response to venous occlusion in all subjects, the mean value of fibrinolytic activity after stasis being 240 +/- 40 mm2, a value significantly lower than at baseline (366 +/- 51 mm2, mean +/- SEM, p < 0.05). Similarly, the tissue-type plasminogen activator (t-PA) antigen level was lower in the aspirin + PUFA-treated group. Plasminogen activator inhibitor activity before stasis was enhanced by n-3 PUFA supplementation (from 7.5 +/- 2 to 14.8 +/- 3 IU/ml, p < 0.05), an effect not affected by aspirin.(ABSTRACT TRUNCATED AT 250 WORDS)


Effect of atherosclerosis on responses of the perfused rabbit carotid artery to human platelets. Vascular responses to intraluminal and abluminal activation of human platelets were examined in carotid arteries from normal and atherosclerotic rabbits. The carotid artery was perfused in vitro, platelets were activated with thrombin (0.1 unit/ml), and changes in diameter were measured. In vessels from normal animals, intraluminal activation of platelets produced dilatation of preconstricted arteries. The dilator response was attenuated by N omega-nitro-L-arginine (10(-5) M), an inhibitor of synthesis of endothelium-derived relaxing factor-nitric oxide (EDRF-NO), and augmented by LY53,857 (10(-5) M), a 5-HT2-serotonergic antagonist. Abluminal activation of platelets produced modest constriction in quiescent arteries, which was inhibited by LY53,857. Intraluminal but not abluminal ADP produced pronounced dilatation of preconstricted arteries. In vessels from atherosclerotic animals, endothelium-dependent dilatation to intraluminal activation of platelets and to ADP was impaired and dilator responses to sodium nitroprusside were normal. These experiments indicate that 1) intraluminal activation of human platelets produces endothelium-dependent dilatation in perfused carotid arteries, whereas abluminal activation of human platelets produces vasoconstriction, which is mediated primarily by serotonin, and 2) atherosclerosis markedly impairs vasodilator responses to activation of human platelets, probably because vasodilatation to ADP released from platelets is impaired.


Apo(a) isoforms predict risk for coronary heart disease. A study in six populations. Elevated concentrations of lipoprotein(a) (Lp[a]) in plasma are associated with premature coronary heart disease (CHD). Lp(a) levels are largely determined by alleles at the hypervariable apolipoprotein(a) (apo[a]) gene locus, but other genetic and environmental factors as well as diseases also affect plasma Lp(a) concentrations. It is therefore unclear whether Lp(a) is a primary genetic risk factor or whether Lp(a) levels are elevated secondary to disease in CHD patients. We have analyzed apo(a) phenotypes that represent a stable genetic trait in subjects with CHD and control subjects from different populations representing a variety of ethnic groups (Tyrol, Germany, Wales, Israel, Singapore Chinese, and Singapore Indian). Despite differences in sampling design and disease definition in this multipopulation case-control study, those apo(a) isoforms associated with high Lp(a) plasma concentrations (B, S1, and S2) were more frequent in the CHD patients in each ethnic group. These differences were significant in three of the studied populations and highly significant (p < 0.001) in the pooled (total) group. Lp(a) concentrations were also measured in all groups except Germans and were found to be consistently higher in cases than in control subjects in each ethnic group. For all but one population (Israeli) the differences were significant. The effects of the apo(a) size polymorphism on Lp(a) levels were similar in CHD patients and control subjects from different populations. The data demonstrate that alleles at the apo(a) locus determine the risk for CHD through their effects on Lp(a) concentrations across multiple populations with large differences in CHD frequency and risk factor profiles.


Quantification of atherosclerotic plaque composition in cholesterol-fed rabbits with 50-MHz acoustic microscopy. To determine whether high-frequency ultrasound could distinguish normal from pathological vascular structure and to elucidate the determinants of ultrasonic backscatter in different layers of normal and atherosclerotic arteries, high-resolution acoustic microscopy at 50 MHz was used to characterize aortic plaque in six New Zealand White rabbits fed a 2% cholesterol diet for 3.5 months. Four rabbits were fed a standard diet for 3.5 months to provide normal control data. Segments of aortas were excised, fixed in formalin, opened longitudinally, and mounted flat for insonification. For each specimen, backscattered radio frequency (rf) data were acquired from 30 to 100 independent sites separated by 500 microns. Portions of rf data were gated from discrete layers of the vessel wall for computation of integrated backscatter. Results of histological and immunocytochemical analyses of vessel wall thickness and composition were compared with those of ultrasonic analysis. Normal aortas manifested prominent but homogeneous backscatter (average integrated backscatter, -28.5 +/- 2.9 dB) throughout the vessel wall, with no clear distinction between intimal and medial layers. The atherosclerotic aortas manifested substantially reduced integrated backscatter from the thickened intima (-47.5 +/- 3.2 dB, p < 0.0001) but relatively normal integrated backscatter from the media (-31.2 +/- 1.6 dB; p = NS versus normal aortas). The thickness of the media for both normal and atherosclerotic rabbits was approximately 300 microns. Histological characteristics of atherosclerotic aortas confirmed the presence of substantial intimal thickening, with prominent foam cell and lipid infiltration abutting a more normal medial layer.(ABSTRACT TRUNCATED AT 250 WORDS)


True protein digestibility and amounts of endogenous protein measured with the 15N-dilution technique in piglets fed on peas (Pisum sativum) and common beans (Phaseolus vulgaris). The faecal and ileal true protein digestibilities of the raw pea (Pisum sativum) varieties finale and frijaune and the ileal true protein digestibility of steam-processed common beans (Phaseolus vulgaris) were measured in piglets using the 15N-dilution technique. The faecal true protein digestibility of both pea varieties was about 97. The ileal true protein digestibility was between 93 and 95, indicating that the pea protein is almost completely enzymically digested in the small intestine. The faecal apparent protein digestibility was 85 for both varieties while at the ileal level it was 79 and 74 respectively. The lower ileal apparent protein digestibility of peas can be attributed completely to the excretion of endogenous protein. The ileal apparent protein digestibility of toasted common beans was about zero (-4); the ileal true protein digestibility was about 66. This indicates that the protein of the common bean, although toasted, was highly resistant to enzymic digestion. It was calculated that per kg ingested bean protein, 340 g undigested bean protein and 700 g endogenous protein passed the terminal ileum. The results of the present study explain why in previous experiments a strongly reduced weight gain and even weight loss was observed in piglets fed on raw and toasted common beans.


Diet among oil-workers on off-shore oil installations in the Norwegian sector of the North Sea. Dietary studies based on 24 h recalls were carried out on four oil installations in the Norwegian sector of the North Sea. Two hundred and three persons were interviewed about what they had eaten the previous 24 h. Food purchased for the installations in the previous 5 months was recorded. Results based on 24 h recalls showed that average daily intake of energy was 12.2 MJ of which 17% came from protein, 44% from fat and 39% from carbohydrate, including 8% from sugar. Meat, vegetables, fresh fruits, seafood (shellfish), french fries, eggs, cream and ice-cream were important components of the diet, while bread, fish and cereals played a minor role. Average daily intake (mg) of nutrients were: calcium 1244, iron 15, vitamin A 1049 micrograms, vitamin D 4.1 micrograms, thiamin 1.6, riboflavin 2.2, nicotinic acid 22, ascorbic acid 143. Dietary fibre intake, estimated as unavailable carbohydrate, was on average 19 g, and the average daily intake of cholesterol was 755 mg. Intakes were compared with the Norwegian recommended dietary allowance. Most of the employees chose a diet which when eaten over a longer period of time may contribute to the development of coronary heart diseases (CHD) and thereby increase the morbidity and mortality from CHD in the oil industry.


Splanchnic fluxes of amino acids after duodenal infusion of carbohydrate solutions containing free amino acids or oligopeptides in the non-anaesthetized pig. Seven non-anaesthetized pigs (mean body-weight 64.6 kg) were used to study the intestinal absorption and hepatic metabolism of glucose and amino acids (AA) using carbohydrate solutions (maltose dextrin; 440 g/2 I), containing 110 g of either an enzymic milk-protein hydrolysate (PEP) with a large percentage of small peptides (about 50% with less than five AA residues) and very few free AA (8%) or a mixture of free AA (AAL) with an identical pattern, infused intraduodenally. Each pig was previously fitted under anaesthesia with electromagnetic flow probes around the portal vein and the hepatic artery, and with permanent catheters in the portal vein, carotid artery, one hepatic vein and the duodenum. Each solution was infused for 1 h after a fasting period (18 h) and each pig received both solutions at 8 d intervals. The observation period lasted 8 h. For most AA (his, lys, phe, thr, arg, tyr, pro) the absorption rate after infusion of PEP was significantly higher than after that of AAL during the 1st hour, but the differences quickly disappeared. After 8 h, the only differences concerned his and tyr (PEP > AAL) and met, glu and asp (AAL > PEP). There was a large uptake of blood AA by gut-wall cells, higher after AAL infusion than after PEP infusion, particularly for branched-chain AA (BCAA). The absorption of ammonia-nitrogen after both infusions was equivalent to two-thirds of urea-N passing from blood to intestinal tissues and lumen. Glucose absorbed within 8 h represented only 76% (PEP) or 69% (AAL) of the infused amounts. The cumulative hepatic total AA (TAA) uptake increased from 13 to 27% of the infused amounts between the 1st and the 8th hour after PEP infusion, and from 8 to 31% after AAL infusion. Most essential AA were largely taken up by the liver, with the exception of met (PEP) and thr and of BCAA, which were poorly retained for both solutions; there was a high uptake of ala and gly, and a release of asp, glu, and gln. Urea-N released by the liver within 8 h was equivalent to 23-25% absorbed amino-N and to around 1.5 times ammonia-N taken up by the liver within 8 h. Glucose was highly taken up by the liver during the first hours then released, the total uptake within 8 h representing about half the absorbed amount.(ABSTRACT TRUNCATED AT 400 WORDS)


Valine oxidation: the synthesis and evaluation of L-[3-3H]valine as a tracer in vivo. The suitability of L-[3-3H]valine for measuring valine oxidation was studied by comparing its oxidation rate with that of L-[1-14C]valine in rats and pigs. L-[3-3H]valine was synthesized by removal of the tritium on carbon-2 of L-[2,3-3H]valine by acetylation. The acetyl group was removed enzymatically using pig renal acylase 1 (EC 3.5.1.14) and the product was purified by ion-exchange and paper chromatography. For the first rat experiment L-[3-3H]valine was synthesized in our laboratory; for the subsequent experiments it was produced by Amersham International plc. In the first experiment in rats the two tracers were given by injection and 14CO2 was collected for 2 h. The oxidation of tritiated valine was significantly higher than that of L-[1-14C]valine. In a second experiment there was no difference. This was probably due to the higher purity of the labelled valine which, for the second experiment, was shown by nuclear magnetic resonance to contain only one tritium atom. In a study with pigs in which the two tracers were given by continuous infusion there was no significant difference between them in flux or oxidation. The results of this experiment were used to evaluate a model to estimate amino acid requirements. With pigs given a methionine-limiting diet a reduction in methionine intake, by reducing protein accretion, increased valine oxidation by the same proportion.


Some determinants of postprandial lipaemia in Nigerian diabetic and non-diabetic subjects. The efficiency of clearance of plasma triacylglycerols (TAG) after fatty meals in non-diabetic Caucasian subjects is believed to determine the plasma level of high-density-lipoproteins-cholesterol (HDL-C). It is unknown if this observation holds in diabetic subjects and in other racial groups. In assessing the factors that determine TAG responses to acute fat loading in a tropical African population with a low prevalence of atherosclerotic disease, twenty (nine obese) non-insulin-dependent diabetic (NIDDM) patients with optimal glycaemic control and twelve (six obese) age-matched non-diabetic subjects were given meals containing 50 g fat (in butter) and 75 g carbohydrate (in white bread) over 15 min in the morning after a 12 h overnight fast. The fasting plasma levels of glucose, TAG, total cholesterol (total-C), HDL-C, low-density-lipoprotein-cholesterol, insulin and glycosylated haemoglobin (HBAlc) were estimated; glucose and TAG levels were also measured postprandially for 8 h at 2 h intervals. Postprandial lipaemia was consistently higher in the diabetic patients (about 50-100% more than values obtained in the non-diabetic subjects, even when corrected for differences in body mass) and correlated positively with age and postprandial glycaemia. This defect in TAG clearance was even worse (by about 50%) when glucose tolerance became further impaired after ten of the diabetic patients stopped oral hypoglycaemic treatment for 1 week and the fat-tolerance test was repeated. In the obese non-diabetic subjects, but not those of normal weight, there were significant negative relationships between the postprandial lipaemia and fasting plasma levels of HDL-C and HDL-C: total-C ratio, as reported in Caucasians. It is concluded that age and the ambient glucose concentration appear to be the important determinants of the efficiency of TAG clearance in diabetic subjects. This accords with clinical observations of increased atherogenic liability with increasing age and poorer glycaemic control. The determinants in non-diabetic subjects were less defined, indicating that postprandial lipaemia might be influenced by various factors (obesity as shown here) in different subsets of individuals.


The influence of a fish oil high in docosahexaenoic acid on plasma lipoprotein and vitamin E concentrations and haemostatic function in healthy male volunteers. Nine healthy male subjects consumed a daily fish oil supplement providing 2.1 g docosahexaenoic acid (22:6 n-3; DHA) and 0.8 g eicosapentaenoic acid (20:5 n-3; EPA) for 6 weeks. The proportion of EPA and DHA in plasma, erythrocytes, leucocytes and platelet phospholipids was increased by the supplement. Plasma concentration of triacylglycerol and very-low-density-lipoprotein-cholesterol were lowered and those of high-density-lipoprotein (HDL)- and HDL2-cholesterol and apoprotein B were increased. Platelet aggregation and thromboxane B2 production induced by collagen were partially inhibited. Both systolic and diastolic blood pressure fell during treatment and rose following withdrawal of the supplement. Statistically significant reductions in erythrocyte counts, packed cell volume and haemoglobin and increases in total leucocyte and monocyte counts occurred with the supplement. Plasma alpha-tocopherol concentrations fell below the normal range during the period of supplementation. It is suggested that future studies consider components other than EPA in fish oil. Further studies are needed to investigate the extent to which fish oil increases the requirement for antioxidant nutrients.


Adaptation of biliary response to dietary olive oil and sunflower-seed oil in dogs. The effects of adaptation to dietary fat of different degrees of unsaturation (olive oil and sunflower oil) on bile secretion were studied in dogs at rest and after food intake. The animals were prepared with a bidirectional biliary cannula and a duodenal cannula to provide bile return. The two experimental groups were fed on diets containing 150 g fat/kg in the form of either olive oil (O) or sunflower-seed oil (S). The flow-rate under resting conditions and the patterns of response to food were similar in both experimental groups, although postprandial hypersection were significantly greater in volume and more prolonged in group O. No appreciable differences in concentration and output of biliary cholesterol or phospholipids were noted between the two groups. In contrast, the concentration and output of bile acids differed significantly both at rest and after food: concentration and output of bile acids were greater at rest in group S. However, after food intake, these responses were increased only in group O. The results suggest that the type of dietary fat affects biliary response to food, probably through differences in the contribution of the gall bladder in the two experimental groups.


Effect of dietary fatty acid composition on inositol-, choline- and ethanolamine-phospholipids of mammary tissue and erythrocytes in the rat. The present study investigated the effect of feeding maize-oil, olive-oil and fish-oil diets, from weaning to adulthood, on rat mammary tissue and erythrocyte phospholipid fatty acid compositions. Effects of diet on the relative proportions of membrane phospholipids in the two tissues were also investigated. Mammary tissue phosphatidylinositol (PI) fatty acids were unaltered by diet, but differences in phosphatidylethanolamine (PE) and, to a lesser extent, phosphatidylcholine (PC) fractions were found between animals fed on different diets from weaning. Differences observed were those expected from the dietary fatty acids fed; n-6 fatty acids were found in greatest amounts in maize-oil-fed rats, n-9 in olive-oil-fed rats, and n-3 in fish-oil-fed rats. In erythrocytes the relative susceptibilities of the individual phospholipids to dietary modification were: PE > PC > PI, but enrichment with n-9 and n-3 fatty acids was not observed in olive-oil- and fish-oil-fed animals and in PC and PE significantly greater amounts of saturated fatty acids were found when animals fed on olive oil or fish oil were compared with maize-oil-fed animals. The polyunsaturated:saturated fatty acid ratios of PE and PC fractions were significantly lower in olive-oil- and fish-oil-fed animals. No differences in the relative proportions of phospholipid classes were found between the three dietary groups. It is suggested that differences in erythrocyte fatty acid composition may reflect dietary-induced changes in membrane cholesterol content and may form part of a homoeostatic response the aim of which is to maintain normal erythrocyte membrane fluidity. The resistance of mammary tissue PI fatty acids to dietary modification suggests that alteration of PI fatty acids is unlikely to underlie effects of dietary fat on mammary tumour incidence rates.


Nutritional implications of L-arabinose in pigs. The pentose sugar L-arabinose is one of the most abundant components released by complete hydrolysis of non-starch polysaccharides of feed ingredients of vegetable origin. Two studies were conducted to investigate the apparent ileal digestibility and urinary excretion of L-arabinose at dietary inclusion levels of 50 and 100 g/kg, and 25, 50, 75 and 100 g/kg respectively, in pigs. As a reference, D-glucose was included in the studies. Water intake, ileal flow of volatile fatty acids and ileal and faecal digestibilities of dietary nutrients in pigs fed on the different diets were also examined. Castrated pigs were prepared with a post-valvular T-caecum cannula to measure ileal digestibility. Faecal digestibility was measured in non-cannulated pigs. Apparent ileal digestibility of L-arabinose was found to be approximately 70%. The presence of L-arabinose in the diet increased ileal flow of volatile fatty acids and lactic acid, suggesting the occurrence of microbial degradation of L-arabinose in the pig small intestine. L-arabinose was partly excreted in the urine. The extent of this urinary excretion as a percentage of intake increased linearly (P < 0.01) as the dietary level increased. In pigs fed on the 25 g L-arabinose/kg diet, 10.9% of the L-arabinose consumed appeared in the urine. This level was increased to 14.7% when pigs were fed on a diet containing 100 g L-arabinose/kg diet. Faecal digestibility and retention of nitrogen decreased significantly in pigs fed on the L-arabinose diets.


Long-term effect of physical activity on energy balance and body composition. We studied the effect of an increase in physical activity on energy balance and body composition without interfering with energy intake (EI). Sixteen women and sixteen men, aged 28-41 years, body mass index 19.4-26.4 kg/m2, not participating in any sport before the start of the experiment, prepared to run a half-marathon competition after 44 weeks. Measurements of body composition, EI and energy expenditure (EE) were performed before (0 weeks), and 8, 20, and 40 weeks after the start of training. Body composition was measured with hydrodensitometry and isotope dilution, and EI with a 7 d dietary record. EE was measured overnight in a respiration chamber (sleeping metabolic rate (SMR)) and in a number of subjects over 2-week intervals with doubly-labelled water (average daily metabolic rate (ADMR)). ADMR showed an average increase of 30% in both sexes from the start of training onwards while SMR tended to decrease. EI showed a tendency to drop from week 20 to week 40 in the men and a tendency to increase from week 20 to week 40 in the women. Body mass (BM) did not change in both sexes until the observation at 40 weeks when the median value of the change in men was -1.0 kg (P < 0.01; Wilcoxon signed-rank) while the corresponding change of -0.9 kg in the women was not statistically significant. Body composition changes were most pronounced in men as well. Based on changes in BM, body volume and total body water, men lost 3.8 kg fat mass (FM) (P < 0.001; Wilcoxon signed-rank) and gained 1.6 kg protein mass (P < 0.01; Wilcoxon signed-rank) while the corresponding changes in women were 2.0 kg (P < 0.05; Wilcoxon signed-rank) and 1.2 kg (P < 0.05; Wilcoxon signed-rank). In men the loss of FM was positively correlated with the initial percentage body fat (Pearson r 0.92, P < 0.001). In conclusion, body fat can be reduced by physical activity although women tend to compensate for the increased EE with an increased EI, resulting in a smaller effect on BM and FM compared with men.


Chromium supplementation in impaired glucose tolerance of elderly: effects on blood glucose, plasma insulin, C-peptide and lipid levels. Altogether twenty-six elderly subjects (aged 65-74 years) with persistent impaired glucose tolerance (World Health Organization (1985) criteria) identified in a population-based study, were randomly treated either with chromium-rich yeast (160 micrograms Cr/d) or with placebo for 6 months. The 24 h urinary Cr increased from 0.13 (SE 0.03) to 0.40 (SE 0.06) micrograms/d in the Cr group (n 13) but no change was found in the placebo group (n 11) (0.13 (SE 0.02) v. 0.11 (SE 0.02) micrograms/d). No significant change was observed in the oral glucose tolerance test (glucose dose 75 g; 0, 1 and 2 h blood glucose respectively): 5.3 (SE 0.1), 9.3 (SE 0.3), 8.2 (SE 0.3) mmol/l v. 5.0 (SE 0.1), 8.5 (SE 0.4), 7.3(SE 0.5) mmol/l in the Cr group; 4.9 (SE 0.2), 9.2 (SE 0.6), 8.1 (SE 0.3) mmol/l v. 4.8 (SE 0.2), 8.5 (SE 0.5), 7.0 (SE 0.6) mmol/l in the placebo group (baseline v. 6 months). Glycosylated haemoglobin, plasma insulin, C-peptide and apolipoprotein A1 and B levels remained unchanged, and no improvement was seen in serum total cholesterol (6.2 (SE 0.3) v. 6.4 (SE 0.3) mmol/l for the Cr group, 6.2 (SE 0.4) v. 6.5 (SE 0.3) mmol/l for the placebo group), high-density-lipoprotein-cholesterol (1.1 (SE 0.1) v. 1.2 (SE 0.1) mmol/l for the Cr group, 1.0 (SE 0.1) v. 1.1 (SE 0.1) mmol/l for the placebo group) or triacylglycerols (2.5 (SE 0.4) v. 2.0 (SE 0.4) mmol/l for the Cr group, 2.4 (SE 0.2) v. 2.5 (SE 0.2) mmol/l for the placebo group). The present results indicate that Cr supplementation does not improve glucose tolerance or serum lipid levels in elderly subjects with stable impaired glucose tolerance.