Clinically suspected primary acquired nasolacrimal duct obstruction: clinicopathologic review of 150 patients.

Purpose: The incidence of lacrimal sac pathology in patients with clinically suspected primary acquired nasolacrimal duct obstruction is unknown. This is an important issue when considering the potential risk of either conservative nonsurgical management or laser dacryocystorhinostomy, neither of which permits direct visualization and biopsy of the lacrimal outflow apparatus.

Methods: A total of 162 lacrimal sac biopsy specimens were obtained in 150 consecutive patients undergoing external or endonasal dacryocystorhinostomy for clinical primary acquired nasolacrimal duct obstruction from January 1992 to October 1994.

The anatomy of the common canaliculus.

Background: The functional valve between the common canaliculus and the lacrimal sac has traditionally been attributed to the valve of Rosenmüller, although this anatomical structure has never been rigorously documented.

Objective: To define the anatomy of the canaliculus-sac junction.

Methods: Twelve rigid plastic casts of the lacrimal outflow systems were obtained in human cadaver specimens using a well-known biologic casting material (partially polkymerized monomer to which a catalyst and promoter were added).

The anatomy of Whitnall ligament.

Background: The current understanding of the anatomy of Whitnall ligament does not explain its functional role in eyelid movement. This anatomic study was designed to determine the exact relation of Whitnall ligament to the levator muscle and aponeurosis.

Methods: The anatomy of the eyelid was examined by surgical dissection of 20 eyelids undergoing Müllerectomy via a conjunctival approach, anatomic dissection of 20 fresh cadaver orbits, and histologic correlation in four fresh specimens.

Photoemission Study of CO Adsorption on Gd.

Angle-resolved UV photoemission spectroscopy has been used to investigate the interaction of CO with Gd films, grown on W(110). The results suggest the CO absorbs dissociatively, initially forming Gd(2)O(3), with subsequent catalytic oxidation of CO to form carbonate.

Gd/W(110) interface formation studied by w 4f surface core-level spectroscopy.

W 4f core-level spectra of Gd films on W(110) show components which can be identified as being due to bulk and interface W. The results suggest that the W/Gd interface is abrupt, i.e.

Utilization of Photoemission Cross-Section Effects for Monitoring Thin-Film Growth in UHV.

Given the tunability of synchrotron radiation, photoemission spectroscopy can be used to monitor the growth modes of thin films in UHV. Cross-section effects such as Cooper minima and resonant photoemission can be exploited to maximize the adsorbate signal and minimize that from the substrate. Under favourable circumstances growth can be monitored in real time at coverages of <1%.

Efficacy of unanesthetized spiral computed tomography scanning in initial evaluation of childhood leukocoria.

Purpose: To evaluate the use of spiral/helical computed tomography (CT) in the preoperative evaluation of pediatric leukocoria.

Methods: A total of 34 patient charts and imaging studies were reviewed from a consecutive series of children referred with the diagnosis of presumed retinoblastoma. Of these patients, 31 had a confirmed diagnosis of retinoblastoma.

Recent advances in pediatric HIV.

Pediatric human immunodeficiency virus (HIV) infection is a disease of mother-to-infant transmission. The World Health Organization estimates there will be ten million HIV-infected children by the end of this century. It is now thought that both intrauterine and intrapartum transmission of HIV occurs.

The specificity of anti-HCV supplementary assays.

A total of 920 samples from blood donors screened as anti-HCV negative by two third-generation screening assays (Ortho Diagnostics v3.0 and Murex Diagnostics VK48) were tested by two supplementary anti-HCV assays, RIBA III (Ortho Diagnostics) and Western blot (Murex Diagnostics VK68). Six (0.

The effect of fluorescein volume on lacrimal outflow transit time.

The Jones primary dye test is a commonly used test of lacrimal outflow. Some clinicians, however, find it of limited practical significance because of variable outcome and relatively low sensitivity in documenting normal lacrimal excretory function. We hypothesized that an important variable affecting the transit time may be the volume of fluorescein used in the primary dye test.

Thyroid ophthalmopathy.

Thyroid ophthalmopathy, idiopathic orbital inflammation, and orbital infection can occasionally demonstrate overlapping clinical features. It is essential to distinguish between these processes because appropriate treatments are distinct in each case. In the past year, the pathophysiology of thyroid ophthalmopathy has been the topic of many reports.

Interlocking Crawford triangles in frontalis suspension.

In Crawford's pattern of frontalis suspension, two bands are passed, one nasally and the other temporally, forming two base-down triangles with their apexes attached at the brow incisions. Over time, opposing vector forces in the center of the eyelid can cause "cheese-wiring" of the bands with resultant shortening of the inferior bases of both triangles and loosening of the suspensory loops. We modified the standard pattern by interlocking the bands centrally in the lid.

Effect of a topical anesthetic cream (EMLA) in reducing pain caused by infiltration of local anesthetic in eyelid surgery.

EMLA (eutectic mixture of local anesthetics) cream is a topical formulation of a mixture of lidocaine and prilocaine. It has been used to achieve local analgesia after application under an occlusive dressing. We carried out a double-blind randomized controlled clinical trial to assess the effect of 5% EMLA (25 mg/mL of lidocaine and of prilocaine) in reducing the pain caused by infiltration of local anesthetic in eyelid surgery.

Geriatric rehabilitation: nursing challenge of the '90s.

This article describes the stages, problems, nursing approaches, and challenges involved in geriatric rehabilitation practice. The article is based largely on patient experiences and outcomes observed at Capital Region Geriatric Rehabilitation Center (Cohoes, NY), a unique new model geriatric rehabilitation facility. The nursing rewards of working in the field and some common myths of aging are emphasized.

Orbital decompression for Graves' disease: exposure through a modified blepharoplasty incision.

A "transorbital" three-wall decompression through a modified blepharoplasty incision was used to treat 19 orbits for either cosmetic disfigurement or optic neuropathy. In the 14 orbits with disfigurement, surgical retroplacement averaged 5.2 mm; vision improved to 20/40 or better in four of five eyes with optic neuropathy.

Diabetes in prison: can good diabetic care be achieved?

Objective: To investigate the clinical characteristics and metabolic control of diabetic patients given structured diabetic care in prison.

Design: Survey of diabetic men serving prison sentences during a 22 month period in a large British prison.

Setting: HM Prison, Walton, Liverpool.

What do psychiatric emergency patients really want and how do they feel about what they get?

Psychiatric emergency patients range along a continuum from persons who present to the service with specific requests for help, to individuals who are brought to the service in handcuffs against their will for reasons they do not understand. In addition, studies suggest that psychiatric emergency patients' wishes and expectations often fall outside the traditional framework of psychiatric assessment, are not straightforward or concrete or are not accurately perceived by the clinicians who see them. How these factors impact on patient satisfaction with the treatment they have received is not well-understood, because the manner in which specific patient variables and treatments might relate to patient satisfaction among the psychiatric emergency service population has not been systematically studied.

Relationship of endomysial antibodies to jejunal mucosal pathology: specificity towards both symptomatic and asymptomatic celiacs.

Serum immunoglobulin A class antibodies reactive to the endomysial lining of the smooth muscle bundles of the gastrointestinal tract have recently been reported to be specific and sensitive indicators of celiac disease (CD). A total of 203 subjects were examined for serum endomysial antibodies (EmA) and in 103 small bowel biopsies were obtained. EmA were detected in 43 cases including 26 CD patients evaluated during the gluten challenge phase of diagnosis by European Society for Pediatric Gastroenterology and Nutrition criteria, 11 of 53 symptomatic patients, and 6 asymptomatic family members.

Antigliadin antibodies detected by enzyme-linked immunosorbent assay as a marker of childhood celiac disease.

Using an enzyme-linked immunosorbent assay (ELISA) assay, we studied the sera of 17 patients with celiac disease and 114 control subjects for the levels of IgG and IgA antigliadin antibodies. As a group, the patients with celiac disease had significantly higher levels of antigliadin antibodies of both IgG and IgA classes (p less than or equal to 0.001).