Sclerosing canaliculitis after 5-fluorouracil breast cancer chemotherapy.

Background: 5-Fluorouracil is a pyrimidine analogue that inhibits DNA synthesis and is commonly used in the treatment of carcinomas of the breast, gastrointestinal tract and genitourinary tract. Excessive tearing that resolves on cessation of treatment is commonly described as a side effect of the drug. Permanent stenosis of the punctum and canaliculus is extremely rare, with only 12 cases reported in the world literature.

Corticotropin releasing factor receptor 1-deficient mice display decreased anxiety, impaired stress response, and aberrant neuroendocrine development.

Corticotropin releasing factor (CRF) is a major integrator of adaptive responses to stress. Two biochemically and pharmacologically distinct CRF receptor subtypes (CRFR1 and CRFR2) have been described. We have generated mice null for the CRFR1 gene to elucidate the specific developmental and physiological roles of CRF receptor mediated pathways.

Fast eye movement initiation of ocular torsion in mesodiencephalic lesions.

Three patients with episodic ocular torsion and skew deviation due to mesodiencephalic lesions were studied by using binocular three-dimensional scleral search coils. The conjugate ocular torsion (upper pole of each eye rotating toward the side of the brainstem lesion) was initiated by a torsional fast eye movement. During prolonged episodes, torsional nystagmus was also present.

Dissociated effects of botulinum toxin chemodenervation on ocular deviation and saccade dynamics in chronic lateral rectus palsy.

Aim: Changes in saccade velocity/amplitude characteristics (main sequence) and attenuation of distance esotropia in response to botulinum toxin (BTX-A) chemodenervation of the antagonist medial rectus were studied in a group of nine patients with chronic lateral rectus palsy.

Methods: Serial measurements of ocular deviation and infrared oculograms of saccadic eye movements to targets at 5 degrees-20 degrees of lateral gaze were made before injection and at 2, 4, 8, 16, and 20 weeks after injection.

Results: At 2 weeks after injection, the ocular deviation changed by a mean of 34.

The management of lymph node tuberculosis notified in England and Wales in 1993.

We have compared the management of 219 cases of lymph node tuberculosis reported to the 1993 national notification survey with the recommended standards of treatment. The diagnosis was supported by positive histology and bacteriology in 81 cases (37%), positive histology in 70 (32%), positive bacteriology in 26 (12%), and on only clinical grounds in 40 (18%). Most patients (88%) were under the care of thoracic physicians.

The management of pulmonary tuberculosis notified in England and Wales in 1993.

We have compared the management of 925 cases of pulmonary tuberculosis reported to the 1993 national tuberculosis notification survey with the recommended standards of treatment. Forty-eight per cent of patients were white, 36% came from the Indian subcontinent (ISC) and 15% were of other ethnic origin. Most patients (86%) were under the care of thoracic physicians.

Ocular ultrasound in Alagille syndrome: a new sign.

Background: Alagille syndrome (AS) is one of six forms of familial intrahepatic cholestasis, all of which present with neonatal jaundice and paucity of intrahepatic bile ducts. Differentiation of these individual syndromes is crucial as their treatments and prognoses vary. It is the ophthalmic features, posterior embryotoxon on particular, that distinguish AS.

Tissue-specific binding of radiolabeled activin A by activin receptors and follistatin in postimplantation rat and mouse embryos.

Activin affects the growth and differentiation of many cultured cell types, including rat anterior pituitary cells and gonadal and neuronal cell lines. Endogenous activins regulate mesoderm induction, body axis formation, and organogenisis in the developing embryo. The messenger RNAs encoding inhibin/activin subunits, follistatin (an activin-binding protein), and activin type II receptors (ActRII and IIB) are expressed in various cell types and tissues of the embryonic rat and mouse.

Phage typing and drug resistance of Shigella sonnei isolated in England and Wales.

Phage typing of Shigella sonnei has been used to examine isolates from the 1991-2 sonnei dysentery outbreak in England and Wales and compare them with strains isolated during and following a widespread foodborne outbreak in 1994 which was associated with consumption of imported lettuce. The distribution of phage types was different in the three periods studied with PT 3 predominating during 1991-2, PT 2 during the 'lettuce' outbreak in the summer months and PT 6 during the subsequent months. PT 6 was frequently associated with travel outside the UK.

Retinopathy in haemoglobin C trait.

Retinopathy associated with sickle-C and sickle cell disease is well described. Sickle trait and haemoglobin C trait are generally considered benign conditions, with infrequent systemic manifestations. Rare cases of retinopathy in sickle trait, in the presence of contributory factors, exist and we recently reported three such patients.

A randomized study of the influence of perfusion technique and pH management strategy in 316 patients undergoing coronary artery bypass surgery. II. Neurologic and cognitive outcomes.

Unlabelled: This double-blind, randomized comparison of pulsatile or nonpulsatile perfusion and alpha-stat or pH-stat management during cardiopulmonary bypass was designed to assess postoperative central nervous system outcomes.

Methods: Neurologic and cognitive testing was conducted before the operation and 7 days and 2 months after the operation in 316 patients having coronary artery bypass and in a reference cohort of 40 patients having major vascular and thoracic operations.

Results: As detailed in part I of this study, mortality in patients having coronary bypass was 2.

A randomized study of the influence of perfusion technique and pH management strategy in 316 patients undergoing coronary artery bypass surgery. I. Mortality and cardiovascular morbidity.

Unlabelled: The impact of perfusion technique and mode of pH management during cardiopulmonary bypass has not been well characterized with respect to postoperative cardiovascular outcome.

Methods: This double-blind, randomized study comparing outcomes after alpha-stat or pH-stat management and pulsatile or nonpulsatile perfusion during moderate hypothermic cardiopulmonary bypass was undertaken in 316 patients undergoing coronary artery bypass operations.

Results: Cardiovascular morbidity and mortality were not affected by pH management, and the incidence of stroke (2.

A comparison of partial and full mouth scoring of plaque and gingivitis in oral hygiene studies.

The clinical testing necessary to demonstrate the safety and efficacy of new toothbrushes is complex and expensive. Any modification of methodology that could reduce complexity and cost without compromising quality would benefit both investigators and the public. Results from an 8-week toothbrush study were assessed for the use of partial as compared to full-mouth evaluations.

Sickle retinopathy in patients with sickle trait.

Sickle trait is traditionally considered a benign condition by ophthalmologists. Three cases of sickle retinopathy in subjects with sickle trait are reported. In all cases the onset of retinopathy was related to other contributing factors: in one case a traumatic hyphaema and raised intraocular pressure, in two others diabetes mellitus.

Change in pH of plaque and 10% carbamide peroxide solution during nightguard vital bleaching treatment.

The purpose of this study was to evaluate in vivo changes in the pH of plaque and of a 10% carbamide peroxide solution occurring within the bleaching guard during a 2-hour nightguard vital bleaching procedure. Baseline pH values for plaque and the carbamide peroxide solution were established. A small hole was placed in the anterior interproximal region of the guard to allow placement of the pH electrode.

Antipodal alpha-N-(methyl through decyl)-N-normetazocines (5,9 alpha-dimethyl-2'-hydroxy-6,7-benzomorphans): in vitro and in vivo properties.

The enantiomeric (-)- and (+)-N-(methyl through decyl) normetazocines (5,9 alpha-dimethyl-2'-hydroxy-6,7-benzomorphans) were synthesized and their in vitro and in vivo activities determined. Increasingly bulky enantiomeric N-alkyl homologs were prepared until their interaction with the sigma 1 receptor decreased and their insolubility became a hindrance to their evaluation in vivo and/or in vitro. The (-)-methyl, -pentyl, -hexyl, and -heptyl homologs were essentially as potent as, or more potent than, morphine in the tail-flick, phenylquinone, and hot-plate assays for antinociceptive activity; the (-)-propyl homolog had narcotic antagonist activity between that of nalorphine and naloxone in the tail-flick vs morphine assay, and it also displayed antagonist properties in the single-dose suppression assay in the rhesus monkey.

Salivary pH changes during 10% carbamide peroxide bleaching.

The purpose of this study was to evaluate the effect on salivary pH of a 10% carbamide peroxide solution when used with a custom-fitted guard for bleaching teeth. Baseline pH values were established for unstimulated saliva and on saliva produced while wearing an empty guard. After insertion of a guard half filled with Proxigel, salivary pH measurements were made at 5-minute intervals until the values returned to baseline levels.

Evaluating spatter and aerosol contamination during dental procedures.

A pilot study evaluated the distribution of spatter and aerosols generated by high-speed instrumentation. In the first phase, fluorescent dye was added to the handpiece water supply. In the second, blood agar culture plates were placed in the operatory.

The effect of surgery on the AC/A ratio.

The accommodative convergence/accommodation (AC/A) ratio is used clinically as a diagnostic tool in the assessment of convergence excess and near esotropia and the differentiation of true and simulated divergence excess. An abnormally high AC/A ratio has been implicated in the aetiology of some forms of strabismus but the evidence for alteration in the ratio following surgery is inconclusive. In a prospective study of 38 patients the effect of routine squint surgery was investigated in concomitant strabismus.

Churg-Strauss vasculitis presenting with severe visual loss due to bilateral sequential optic neuropathy.

A 44-year-old man with severe visual loss due to an acute bilateral sequential optic neuropathy is described, where the associated pulmonary disease and peripheral eosinophilia led to a diagnosis of Churg-Strauss syndrome (allergic angiitis). The mechanism of the optic neuropathy was most probably acute ischaemia of the anterior optic nerve due to direct involvement of the short posterior ciliary arteries by inflammatory disease of the vessel wall.

Macular ischaemia in posterior uveitis.

The commonest cause of visual morbidity in patients with posterior uveitis is cystoid macular oedema, which usually responds to immunosuppressive treatment. However, a small group of patients do not have a satisfactory visual outcome despite apparently adequate therapy. In a retrospective study of 345 angiograms of 135 patients with active non-occlusive retinal vasculitis 12 patients were identified by independent masked review as showing macular ischaemia on their fluorescein angiograms.