Activities of amikacin, roxithromycin, and azithromycin alone or in combination with tumor necrosis factor against Mycobacterium avium complex.

The effect of amikacin and two new macrolides (roxithromycin and azithromycin) used either alone or in combination with recombinant tumor necrosis factor (TNF) to inhibit or kill Mycobacterium avium complex in human macrophages was examined in vitro. Macrophage monolayers infected with M. avium complex (strain 101, serotype 1) were treated with antibiotics or TNF by using three different protocols: (i) antibiotics or TNF was added to the monolayers immediately after infection and washed out after 24 h, (ii) antibiotics or TNF was replenished daily for 4 dys, or (iii) infected macrophage monolayers were treated with antibiotics plus TNF for 4 consecutive days.

Evolution of high-dose cisplatin.

High-dose cisplatin therapy, defined as 200 mg/m2/course, is currently undergoing extensive clinical trials in a variety of solid tumors. The reduction of the incidence and severity of cisplatin-induced nephrotoxicity has led to clinical trials of higher doses of cisplatin. By maintaining nephrotoxicity to acceptable levels, dose response relationships have shown increased efficacy of cisplatin therapy.

Tumor necrosis factor, alone or in combination with IL-2, but not IFN-gamma, is associated with macrophage killing of Mycobacterium avium complex.

Organisms belonging to the Mycobacterium avium complex (MAC) are the most common bacterial pathogens in patients with AIDS but factors associated with the activation of cellular defense mechanisms against this atypical mycobacterium have not been defined. Peritoneal macrophages harvested from a chronic MAC infection in C57 black mice are able to kill approximately 86% of intracellular MAC in contrast to 0 to 20% killing by unstimulated human and mouse macrophages in vitro. The availability of human rTNF-alpha, rIFN-gamma, and rIL-2 permitted evaluation of the role of each of these lymphokines/monokines, alone or in combination, in activating macrophages in vitro to kill MAC.

A multidisciplinary approach to orbital neoplasm.

The patient with orbital and periorbital neoplasia requires careful assessment of the extent and biologic activity as well as histopathologic categorization. Treatment is optimal through a multidisciplinary approach involving the ophthalmic surgeon, plastic surgeon, neurosurgeon, head and neck surgeon, and oral surgeon.

Computer-designed prostheses for orbitocranial reconstruction.

Three-dimensional imaging is an adjunct to preoperative evaluation and surgical management in some patients with complex anatomic defects of various etiologies. Deformities defined by conventional computerized tomography can be viewed as accurate three-dimensional images calculated from the original scan. The images are viewed on a high-resolution video monitor and can be photographed for a permanent record.

Heterotopic prosthetic ventricles as a bridge to cardiac transplantation. A multicenter study in 29 patients.

Heterotopic prosthetic ventricles were used to support the circulation in 29 candidates for heart transplantation who were expected to die before procurement of a donor heart. Twenty-one of these patients (average age, 36 years) underwent successful transplantation after 8 hours to 31 days of circulatory support. The other eight patients died because their condition could not be stabilized for transplantation, despite restoration of blood flow.

In vivo evaluations of a new thromboresistant polyurethane for artificial heart blood pumps.

To reduce the risk of thromboembolic complications in prosthetic blood pumps, we have developed a new segmented polyurethane elastomer. This material is unique because its mechanical properties for long-term durability and surface properties for biocompatibility have been separated and developed in two distinct materials. Improved thromboresistance is then obtained by a 1% concentration of a new polymeric surface-modifying additive blended with the base polyurethane before fabrication of the blood pump.

Speech restoration post-pharyngolaryngoesophagectomy using tracheogastric fistula.

Restoration of voice and speech in patients with gastric pull-up presents a formidable challenge, and many of these patients are left at best with a poorly functional electrolaryngeal speech. To improve this condition, a tracheogastric puncture stented with a biflanged self-retaining Groningen voice button was accomplished, resulting in gastric mucosa vibrations during exhalatory phase. The biomechanical characteristics of gastric vibrations and tracheogastric puncture candidate selection criteria are discussed.

Aneurysmal bone cyst of the orbit.

Proptosis of the left eye had developed in a 42-year-old woman for 2 months' duration. Roentgenogram studies showed a mass in the roof of the left orbit and bone erosion. An excisional biopsy confirmed the presence of an aneurysmal bone cyst.

Torpedo monoclonal antibodies react with components of the human peripheral nervous system.

A panel of 141 monoclonal antibodies, generated to the Torpedo ray cholinergic nerve terminal preparation, were tested for binding to components of human nerve and muscle. Tested by immunofluorescence, 13 of the antibodies reacted with components of the human intercostal nerve, and 9 bound either muscle or blood vessels in a diversity of staining patterns. Results indicate that the antibodies identify a spectrum of different antigens.

Systemic toxicity of botulinum toxin by intramuscular injection in the monkey.

Botulinum toxin (Oculinum) was injected intramuscularly into eight monkeys. The LD50 dose is estimated to be approximately 39 U/kg body weight. The lowest dose that caused systemic toxicity, 33 U/kg, was close to the fatal dose range, 38-42 U/kg.

Some legal decisions significant for ophthalmology.

The court decisions included in this article reflect judicial attitudes towards medicolegal cases in most states. The courts have defined and amplified issues of informed consent, the physician's duty to warn patients and protect third parties, the limitations of the "Good Samaritan" statute, the responsibility of the physician to prepare insurance reports, and the denial of coverage by third party payers. Several cases regarding these issues are reviewed and their implications for ophthalmologists are discussed.

Phagocytosis and intracellular killing of Mycobacterium avium complex by human and murine macrophages.

1. Host defenses against Mycobacterium avium complex (MAC) are poorly defined. Peritoneal macrophages from black and beige mice, and cultured human macrophages were infected in vitro with MAC serotype 1 from an AIDS patient, in the presence or absence of normal or convalescent serum.

Phacoemulsification and implantation of posterior chamber intraocular lens in eyes with quiescent proliferative diabetic retinopathy.

A phacoemulsification procedure, combined with an "in-the-bag" lens implantation, was performed on ten eyes that once had proliferative diabetic retinopathy (PDR). The ten eyes were in eight patients who had a 20-plus year history of either type I or type II diabetes mellitus. All eyes had reached the "quiescent" state of diabetic retinopathy 2-13 years before the cataract surgery through either argon laser pan retinal photocoagulation and/or pars plana vitrectomy.

Role of digitalis in chronic congestive heart failure and sinus rhythm.

Whereas the use of digitalis in atrial fibrillation is universally accepted, its administration in patients in sinus rhythm for its inotropic properties has recently been questioned. The risk of digitalis administration is high and may be unavoidable because of the occurrence of changes in sensitivity to digitalis. Benefits of digitalis are poorly defined.

The technique of cranial bone grafts in the correction of posttraumatic orbital deformities.

The technique of split-thickness cranial bone graft for reconstructive orbital surgery, is reported in five patients who sustained extensive orbital trauma. This technique involves exposing the skull via a coronal scalp incision, after which the cranial bone is split in situ along the diploe. The outer table of the cranial bone is then used as a graft to correct orbital defects and other associated bony deformities.