Pharmacologic elevation of blood inorganic phosphate in hypoxemic patients with COPD.

We have shown that in patients with COPD, myocardial efficiency during exercise is enhanced following acute elevations of plasma phosphate (Pi). A decrease in Hb-O2 affinity (increase in P50) was not responsible for the improvement. We postulated that the physiologic benefit was due to the acute reversal of a subclinical myocardial Pi depletion.

A randomized clinical trial of feeder vessel photocoagulation of sickle cell retinopathy. A long-term follow-up.

Long-term follow-up of patients enrolled in a randomized prospective trial of feeder vessel photocoagulation for proliferative sickle retinopathy has been completed. Of the 44 patients enrolled in Chicago, nearly a decade follow-up has been achieved on 29 patients (45 eyes). There were 20 control untreated eyes and 25 argon laser-treated eyes.

Aminocaproic acid versus prednisone for the treatment of traumatic hyphema. A randomized clinical trial.

One hundred twelve patients who sustained hyphema after blunt trauma were enrolled in a double-blind randomized clinical trial to determine the relative efficacies of aminocaproic acid (Amicar) and systemic prednisone for reducing the rate of secondary hemorrhage. Fifty-six patients received an oral dosage of 50 mg/kg of aminocaproic acid every 4 hours for 5 days, up to a maximum of 30 g daily, and 56 patients received an oral dosage of 40 mg of prednisone daily (adjusted for weight) in two divided doses. Placebo pills and liquids were given to each patient to mask the treatment schedules.

A randomized clinical trial of scatter photocoagulation of proliferative sickle cell retinopathy.

A randomized prospective clinical trial of argon laser scatter photocoagulation therapy for proliferative sickle cell retinopathy was performed on 116 patients (174 eyes) in Kingston, Jamaica. Ninety-nine eyes were treated with scatter photocoagulation and 75 eyes served as controls. The average length of follow-up was 42 months for the control eyes and 47 months for the treated eyes.

Bilateral congenital ocular cysts.

This report presents an unusual case of bilateral congenital ocular cysts. These are in the spectrum of congenital cystic eye and microphthalmos with cysts. Diagnostic evaluation, including orbital B-scan ultrasonography, computed tomography and magnetic resonance imaging is described.

Oxygen affinity of hemoglobin and peripheral nerve degeneration in experimental diabetes.

Peripheral neuropathy remains a major complication of diabetes. Numerous etiological theories of metabolic and/or vascular disturbances have been suggested including decreased endoneurial oxygen tension with presumed tissue hypoxia. Increases in the affinity of hemoglobin for oxygen (Hb-O2 affinity) may also produce tissue hypoxia and such Hb-O2 affinity changes have been implicated in the pathogenesis of diabetic microangiopathy.

Intraocular tissue plasminogen activator in a rabbit model of traumatic hyphema.

Tissue plasminogen activator was used to evaluate the clearance of traumatic hyphema in a rabbit model. A neodymium-YAG laser was used to disrupt iris vessels, creating a traumatic hyphema. Tissue plasminogen activator (1800 IU/0.

An update on techniques of photocoagulation treatment of proliferative sickle cell retinopathy.

Proliferative sickle cell retinopathy (PSR) can lead to visual loss from vitreous haemorrhage and traction or rhegmatogenous retinal detachment. We review two techniques of photocoagulation for PSR, feeder vessel photocoagulation and scatter photocoagulation. A prospective randomised trial of feeder vessel photocoagulation for PSR demonstrated that the incidence of vitreous haemorrhage and visual loss was diminished in eyes which were treated.

Femorofemoral bypass: a profile of graft failure.

We have reviewed our experience with 71 patients who had a femorofemoral bypass for unilateral iliac artery occlusion or stenosis. We analyzed morbidity, mortality, initial relief of symptoms, early patency, and long-term primary and secondary patency; and we attempted to identify the cause of graft failure. The overall hospital mortality after operative repair was 4%.

Conjugal temporal arteritis.

We report the simultaneous occurrence of biopsy-proven temporal arteritis in husband and wife. Serologic and viral studies were negative, including viral culture of the wife's temporal artery. The concurrent incidence of giant cell arteritis in a married couple would suggest a common exogenous exposure.

Atrial natriuretic peptide and the renin-aldosterone axis during exercise in man.

Under non-exercise conditions, atrial natriuretic peptide (ANP) elevation suppresses plasma renin activity (PRA) and aldosterone (PA). A similar effect of ANP on PRA-PA during exercise has been suggested but not demonstrated. We measured ANP, PRA, PA, plasma potassium (K+), and changes in plasma volume (PV) and blood volume (BV) at rest and during incremental cycle ergometer exercise to exhaustion in ten healthy males.

Comparison of the effects of two viscoelastic agents, Healon and Viscoat, on postoperative intraocular pressure after penetrating keratoplasty.

Sixty-two patients undergoing penetrating keratoplasty were randomized to receive Healon (1% sodium hyaluronate) or Viscoat (3% sodium hyaluronate and 4% chondroitin sulfate) as a means of maintaining the anterior chamber during surgery. Neither viscoelastic agent was irrigated from the eye at the end of the procedure. Intraocular pressures (IOPs) were measured at 4, 10, 24, and 72 hours postoperatively.

Effects of topical glaucoma drugs on fistulized rabbit conjunctiva.

Conjunctival fibroblastic proliferation with contracting scar formation has been implicated as a possible cause of glaucoma filtering surgery failure. The effects of glaucoma medications on bulbar conjunctiva were evaluated in both eyes of 20 pigmented rabbits, with 5 rabbits per group each receiving singular topically applied daily doses of either 0.5% timolol, 1% epinephrine, 4% pilocarpine, or artificial tears in a masked fashion for 4 months.

Duplication of the uterus with a noncommunicating functioning uterine horn.

Incomplete duplication of the uterus with a functioning noncommunicating uterine horn is a rare developmental anomaly of the paramesonephric ducts. Although usually described in association with obstetric catastrophes, it has been reported recently in young women with gynecologic complaints. We describe a nulliparous patient with dysmenorrhea that had increased since menarche and a large pelvic mass.

Retinal arterial macroaneurysms: risk factors and natural history.

A case control study was conducted to identify the systemic and ocular risk factors for retinal arterial macroaneurysms. Forty-three patients with 52 photographically confirmed macroaneurysms were located. Forty-three age-matched, race-matched concurrent control patients were also identified.

Effect of positive and negative pressure breathing on sodium and water excretion.

Positive and negative pressure breathing purportedly alter renal sodium and water excretion by modifying hemodynamics and/or hormonal regulators of sodium and water homeostasis. To test this hypothesis we monitored hemodynamic and hormonal responses in seven normal men to (1) continuous positive pressure breathing (19 +/- 1 mm Hg for 30 minutes) after water loading (urine volume = 15 +/- 1 ml/min); and (2) continuous negative pressure breathing (11 +/- 1 mm Hg for 30 minutes) after maintenance water ingestion (urine volume = 4 +/- 1 ml/min), in random order. Each study was repeated on a control day without pressure breathing.

Macular degeneration. A devastating but treatable disease.

To provide optimum care for patients who have age-related macular degeneration, primary care physicians need to be aware of symptoms such as acute loss of vision and distorted vision. Immediate referral to an ophthalmologist is necessary so that diagnosis can be confirmed and laser treatment can begin if indicated. Patients are at risk for recurrence and should use an Amsler grid daily to detect further visual changes.

Is chromosome 10 a primary chromosomal abnormality in endometrial adenocarcinoma?

Seven cases of endometrial adenocarcinoma (EC) are reported. Two of these cases exhibited diploid chromosome ranges and showed simple rearrangements involving a chromosomal abnormality of chromosome 10. In four cases, the chromosome number ranged between 50 and 70; rearrangements were more complex, with many abnormalities such as homogeneously stained regions, minutes, dicentrics, and ring chromosomes.

The unexpected guest: problem of iris reposition.

A 31-year-old male presented with a corneal laceration and iris prolapse in the left eye. The surgical repair was complicated by epithelial ingrowth on the lens capsule. The appropriate management of both the initial trauma and subsequent complication is discussed.

Oxygen delivery and cardiac output during exercise following oral phosphate-glucose.

Phosphate has been proposed as an ergogenic aid since it may enhance O2 delivery and cardiac work efficiency by increasing plasma phosphate (P Pi), red blood cell phosphate (RBC Pi), 2,3-diphosphoglycerate (DPG), RBC adenosine triphosphate (ATP), and P50. In 10 normal, fasting males we measured cardiac output (Q) by CO2 rebreathing, heart rate (HR), O2 deficit (O2DEF), and O2 consumption (VO2) during cycle ergometer exercise (60% of peak VO2). Stroke volume (SV) and arteriovenous O2 difference (A-VO2) were calculated.

Assessment of intraocular pressure in vitrectomized gas-containing eyes. A clinical and manometric comparison of the Tono-Pen to the pneumotonometer.

Elevation of intraocular pressure (IOP) in gas-containing eyes occurs not infrequently, and applanation tonometry in eyes with epithelial irregularities is not accurate. The pneumotonometer and TonoPen (Oculab, La Jolla, Calif) are alternative tonometers for use in these eyes, yet the accuracy of determining IOP with the Tono-Pen has not been determined manometrically. We performed a clinical and manometric study comparing the Tono-Pen with the pneumotonometer in gasfilled vitrectomized eyes.