Gastroenterologist (digestive), Pediatricians, Pediatric Specialist
10 years of experience
Video profile
Accepting new patients
Northwest Dallas
Children's Medical Center of Dallas
1935 Medical District Dr
Dallas, TX 75235
877-445-1234
Locations and availability (2)

Education ?

Medical School Score
Texas A&M University (2000)
  • Currently 1 of 4 apples

Awards & Distinctions ?

Awards  
National Inflammatory Bowel Disease Fellowship Award
NASPGHAN Travel Award (2008)
National Inflammatory Bowel Disease Fellowship Award (2006)
Best Pediatric Resident (2002)
Chief Resident (2003)
Appointments
University of Texas Southwestern Medical School at Dallas
Associations
American Board of Pediatrics

Affiliations ?

Dr. Patel is affiliated with 4 hospitals.

Hospital Affilations

Score

Rankings

  • UT Southwestern University Hospital - St. Paul
    5909 Harry Hines Blvd, Dallas, TX 75235
    • Currently 4 of 4 crosses
    Top 25%
  • Children's Medical Center of Dallas
    1935 Motor St, Dallas, TX 75235
    • Currently 4 of 4 crosses
    Top 25%
  • UT Southwestern University Hospital - Zale Lipshy
    5151 Harry Hines Blvd, Dallas, TX 75235
    • Currently 4 of 4 crosses
    Top 25%
  • UT Southwestern St. Paul Hospital
  • Publications & Research

    Dr. Patel has contributed to 106 publications.
    Title Leukocytes and the Natural History of Deep Vein Thrombosis: Current Concepts and Future Directions.
    Date April 2011
    Journal Arteriosclerosis, Thrombosis, and Vascular Biology
    Excerpt

    Observational studies have shown that inflammatory cells accumulate within the thrombus and surrounding vein wall during the natural history of venous thrombosis. More recent studies have begun to unravel the mechanisms that regulate this interaction and have confirmed that thrombosis and inflammation are intimately linked. This review outlines our current knowledge of the complex relationship between inflammatory cell activity and venous thrombosis and highlights new areas of research in this field. A better understanding of this relationship could lead to the development of novel therapeutic targets that inhibit thrombus formation or promote its resolution.

    Title Update in Pediatrics: Focus on Fat-soluble Vitamins.
    Date February 2011
    Journal Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition
    Excerpt

    This article provides an update on fat-soluble vitamins (A, D, E, and K) in the healthy pediatric population and in children with chronic disease states that commonly cause deficiencies, specifically cystic fibrosis and cholestatic liver disease. For each fat-soluble vitamin, the biological function, nutrition availability, absorption, deficiency, toxic states, and monitoring parameters are defined.

    Title Images in Clinical Medicine. Plasmacytoma of the Skull.
    Date December 2010
    Journal The New England Journal of Medicine
    Title Water Mediated Construction of Trisubstituted Pyrazoles/isoxazoles Library Using Ketene Dithioacetals.
    Date March 2010
    Journal Journal of Combinatorial Chemistry
    Excerpt

    A small molecule library of alkyl, sulfone, and carboxamide functionalized pyrazoles and isoxazoles has been developed via a rapid sequential condensation of various alpha-acylketene dithioacetals (1a-o) with hydrazine hydrate or hydroxylamine hydrochloride, followed by oxidation of sulfide to sulfone using water as the reaction medium. An efficient and safe oxidation of sulfides (4/5a-o) to the corresponding sulfones (6/7a-o) using sodium per borate system in aqueous medium is reported. The concise and two step synthesis of trisubstituted pyrazoles and isoxazoles was investigated under variety of reaction condition. The newly developed methodology has the advantage of excellent yield and chemical purity with short reaction time using water as a solvent.

    Title Left Ventricular Accessory Chamber: a Case Report and Review of the Literature.
    Date January 2010
    Journal Pediatric Cardiology
    Excerpt

    Congenital left ventricular out-pouching, consisting of left ventricular aneurysms, left ventricle diverticulae, and double-chambered left ventricle, is a rare cardiac malformation. Criteria to differentiate between left ventricular aneurysm and diverticulum are defined. Reports of left ventricular accessory chamber in the medical literature are rare. In this article, we present a case of left ventricular accessory chamber diagnosed during the late prenatal period. Review of the literature, imaging modalities used for differentiation of the nature of this lesion, and management plan are discussed.

    Title Picture Quiz. The Perils of a "foosh".
    Date January 2010
    Journal Bmj (clinical Research Ed.)
    Title Comparison of the Oxidative Folding of Lysozyme at a High Protein Concentration Using Aromatic Thiols Versus Glutathione.
    Date October 2009
    Journal Journal of Biotechnology
    Excerpt

    The production of proteins using recombinant DNA technology often requires the use of in vitro protein folding. In order to facilitate in vitro protein folding, a redox buffer is added to the protein folding mixture. The redox buffer is composed of a small molecule disulfide and/or a small molecule thiol. Recently, redox buffers containing aromatic thiols have been shown to be an improvement over traditional redox buffers such as glutathione. For in vitro protein folding to be relevant to protein production on a larger scale, high protein concentrations are required to avoid large volumes of folding buffer. Therefore, we investigated the in vitro folding of lysozyme at 1 mg/mL instead of the traditional 0.1 mg/mL. Aromatic thiols and aromatic disulfides were compared directly with glutathione and glutathione disulfide, the most commonly used redox buffer. Folding experiments at pH 7 using aromatic thiols increased the yield by 20-40% and the folding rate constants by as much as 11 times relative to glutathione. At pH 8, improvements in yields of up to 25% and up to a 7-fold increase in folding rate constants were demonstrated. The effect of aromatic disulfide concentration was also investigated.

    Title Infection Control Practices in Assisted Living Facilities: a Response to Hepatitis B Virus Infection Outbreaks.
    Date July 2009
    Journal Infection Control and Hospital Epidemiology : the Official Journal of the Society of Hospital Epidemiologists of America
    Excerpt

    The medical needs of the approximately 1 million persons residing in assisted living facilities (ALFs) continually become more demanding. Moreover, the number of ALF residents is expected to double by 2030. ALFs are not subject to federal oversight; state regulations that govern ALF infection control are variable. In 2005, two outbreaks of acute hepatitis B virus (HBV) infection in ALFs in Virginia were associated with sharing fingerstick devices used in blood glucose monitoring.

    Title Relative Effectiveness of a Blue Light-filtering Intraocular Lens for Photoentrainment of the Circadian Rhythm.
    Date May 2009
    Journal Journal of Cataract and Refractive Surgery
    Excerpt

    To compare the relative effectiveness of photoentrainment of the circadian rhythm by a blue light-filtering tinted intraocular lens (IOL) (AcrySof Natural SN60), an untinted UV-only filtering IOL (AcrySof SA60), and human lenses in 4 age groups.

    Title Disseminated Intravascular Coagulation After Endovascular Aneurysm Repair: Resolution After Aortic Banding.
    Date April 2009
    Journal Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
    Excerpt

    Disseminated intravascular coagulation (DIC) has been shown to affect 2% to 4% of patients with abdominal aortic aneurysms. In rare cases of DIC caused by aneurysms, operative repair has been curative. Endovascular aneurysm repair (EVAR) has been established as an effective treatment. We report a 73-year-old man in whom severe bleeding developed from groin incisions and cannulae sites immediately after EVAR. An intraoperative angiogram showed a type I endoleak, but the procedure had to be abandoned due to continued bleeding. Blood tests confirmed a diagnosis of disseminated intravascular coagulation that persisted chronically 3 months postoperatively. Attempts to repair the endoleak with stenting were unsuccessful, resulting in persistence of disseminated intravascular coagulation. This resolved after successful treatment of the endoleak with aortic banding.

    Title Regarding "strategies to Improve Spinal Cord Ischemia in Endovascular Thoracic Aortic Repair: Outcomes of a Prospective Cerebrospinal Fluid Drainage Protocol".
    Date April 2009
    Journal Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
    Title Evaluation of the Risk Assessment Matrix: a Mental Health Triage Tool.
    Date April 2009
    Journal Emergency Medicine Journal : Emj
    Excerpt

    The Risk Assessment Matrix (RAM) is a mental health triage tool designed to assist emergency department (ED) staff to make rapid and accurate assessment of a patient with a suspected or actual mental health problem, and to identify patients at immediate risk of self-harm. A study was conducted to evaluate the effectiveness of this triage tool.

    Title Downloadable Algorithm to Reduce Inappropriate Shocks Caused by Fractures of Implantable Cardioverter-defibrillator Leads.
    Date December 2008
    Journal Circulation
    Excerpt

    The primary method for monitoring implantable cardioverter-defibrillator lead integrity is periodic measurement of impedance. Sprint Fidelis leads are prone to pace-sense lead fractures, which commonly present as inappropriate shocks caused by oversensing.

    Title Ranbp2 and Cltc Are Involved in Alk Rearrangements in Inflammatory Myofibroblastic Tumors.
    Date June 2008
    Journal Cancer Genetics and Cytogenetics
    Excerpt

    Inflammatory myofibroblastic tumors (IMTs) are rare soft tissue tumors occurring primarily in children and young adults. ALK gene rearrangements have been identified in this neoplasm, with fusion of the ALK gene at 2p23 to a number of different partner genes. Metaphase cytogenetic analyses of these tumors have been relatively few, however, and may help to identify additional variant partners. We report on an IMT from a 2-year-old boy with a karyotype of 45,XY,der(2)inv(2)(p23q12)del(2)(p11.1p11.2),-22. FISH showed ALK-RANBP2 fusion in this tumor. The breakpoint was cloned and the fusion was confirmed, making this the third reported case of IMT with ALK-RANBP2 fusion. In addition, we identified the ALK fusion partner in a previously reported IMT with t(2;17)(p23;q23) as CLTC, a gene reported to be involved in four other IMTs, and showed that the breakpoint involved a novel ALK-CLTC fusion. FISH evaluation of nine other IMTs identified CLTC as the fusion partner in one additional case, but RANBP2 was not involved in the remaining eight IMTs, suggesting that the variant partners involved in ALK rearrangements in IMTs are diverse.

    Title Assessment of Applied Epidemiology Competencies Among the Virginia Department of Health Workforce.
    Date June 2008
    Journal Public Health Reports (washington, D.c. : 1974)
    Excerpt

    OBJECTIVES: Epidemiologists play critical roles in public health. However, until recently, no formal standards existed for epidemiology practice. In 2005, the Centers for Disease Control and Prevention and Council of State and Territorial Epidemiologists drafted Competencies for Applied Epidemiologists in Governmental Public Health Agencies (AECs) that provide a foundation for expectations and training programs for three tiers of practice. We characterized the Virginia Department of Health (VDH) epidemiology workforce and assessed its baseline applied epidemiology competency by using these competencies. METHODS: Epidemiologists representing multiple divisions developed an Internet survey based on the AECs. Staff who met the definition of an epidemiologist were requested to complete the survey. Within eight skill domains, specific competencies were listed. For each competency, frequency and confidence in performing and need for training were measured by using Likert scales. Differences among tier levels were assessed using analysis of variance. RESULTS: Eighty-eight people from 10 program areas responded and were included in the analysis. Median epidemiology experience was four years, with 52% having completed formal training. Respondents self-identified as Tier 1/entry-level (38%), Tier 2/mid-level (47%), or Tier 3/senior-level (15%) epidemiologists. Compared with lower tiers, Tier 3 epidemiologists more frequently performed financial or operational planning and management (p=0.023) and communication activities (p=0.018) and had higher confidence in assessment and analysis (p<0.001). Overall, training needs were highest for assessment/ analysis and basic public health sciences skills. CONCLUSIONS: VDH has a robust epidemiology workforce with varying levels of experience. Frequency and confidence in performing competencies varied by tier of practice. VDH plans to use these results and the AECs to target staff training activities.

    Title Cutaneous Human Papillomavirus Infection, the Ever2 Gene and Incidence of Squamous Cell Carcinoma: a Case-control Study.
    Date April 2008
    Journal International Journal of Cancer. Journal International Du Cancer
    Excerpt

    The first evidence of an association between HPV and non-melanoma skin cancer comes from patients with epidermodysplasia verruciformis (EV). EV is a rare heritable disease characterized by cutaneous warts that display not only a high rate of progression to squamous cell carcinoma on sun-exposed sites, but also a strong predisposition to infection by beta-HPVs, for which HPV 5 and 8 predominate. Two EV genes (EVER1 and EVER2) have been identified, and we tested the hypothesis that variation in the EVER2 gene (rs7208422) is related to seropositivity to HPV (of the genus beta types) and risk of squamous cell carcinoma in a population-based case-control study of SCC (n = 239 cases and 432 controls). Among controls, variant genotype was associated with beta-HPV seropositvity (OR = 2.3, 95%CI = 1.2-4.3), specifically HPV5 or 8 seropositivity (OR = 2.4, 95%CI = 1.1-5.1) and seropositivity for multiple beta-HPV types (OR = 2.7, 95%CI = 1.1-6.6). Furthermore, variant genotype was also related to SCC risk [adjusted OR for homozygous variant versus homozygous wild type for the EVER2 polymorphism 1.7, 95% CI 1.1-2.7]. These data provide evidence for a role of genetic variation in the EVER2 gene in beta-HPV infection and risk of SCC, shedding light on the link between HPVs and skin cancers.

    Title Adverse Neurologic Effect of Methylene Blue Used During Parathyroidectomy.
    Date February 2008
    Journal Head & Neck
    Title Ultrasonography Underestimates the Volume of Normal Parenchyma in Benign Testicular Masses.
    Date November 2007
    Journal The Journal of Urology
    Excerpt

    PURPOSE: In children with testicular masses characteristic ultrasonographic features may occasionally allow the preoperative determination of a benign process and permit a testis sparing procedure to be performed. Often the amount of normal parenchyma surrounding the mass may be seemingly negligible, which may prompt some investigators to wonder what a testis sparing procedure might realistically spare. MATERIALS AND METHODS: We retrospectively reviewed 7 consecutive patients with intratesticular lesions who underwent surgical exploration. Several of these children seemingly had complete replacement of the testis with the pathological process with little to no discernible normal parenchyma. The surgical technique involved delivery of the testis and control of the vessels. The capsule was incised and the normal parenchyma was bluntly separated to the level of the tumor. The mass was then mobilized circumferentially and enucleated intact. The residual parenchyma was reapproximated, the capsule was closed and the testicle was replaced in the scrotum. All patients were followed postoperatively by physical examination and ultrasonography. RESULTS: The series consists of 7 children 10 to 188 months old (mean age 68). The final diagnosis was cystic teratoma in 4 cases, epidermoid tumor in 2 and a simple cyst in 1. Postoperative physical examinations revealed symmetrical testes. Postoperative ultrasonography demonstrated normal echo texture and testicular volumes. Furthermore, no tumor recurrence was detected. CONCLUSIONS: Classic ultrasonographic patterns of testicular masses may permit preoperative identification of a benign process, permitting a testis sparing procedure to be planned. However, ultrasonography underestimates the amount of normal residual parenchyma because this tissue is compressed against the capsule into a thin rim. The amount of normal residual parenchyma identified on preoperative ultrasound should not be used as a factor when deciding whether a testis sparing procedure might be appropriate.

    Title Gene-drug Interaction at the Glucocorticoid Receptor Increases Risk of Squamous Cell Skin Cancer.
    Date August 2007
    Journal The Journal of Investigative Dermatology
    Excerpt

    Non-melanoma skin cancers (NMSCs) are the most common malignancy among US Caucasians. Using a population-based study of NMSC we found that oral steroid use is associated with nearly 6-fold elevated risk of squamous cell carcinoma among individuals with a common genetic variant in the steroid receptor (NR3C1) gene. Given the large numbers of individuals on immunosuppressive drug therapy for inflammatory disease, these findings have important implications for NMSC screening and prevention.

    Title Elevated Pulse Wave Velocity Increases the Odds of Coronary Calcification in Overweight Postmenopausal Women.
    Date July 2007
    Journal American Journal of Hypertension : Journal of the American Society of Hypertension
    Excerpt

    BACKGROUND: Aortic stiffness, assessed using carotid-femoral pulse wave velocity (cfPWV), predicts all-cause and cardiovascular mortality. Brachial-ankle pulse wave velocity index (baPVI) is a newer measure of arterial stiffness obtained using an automated system. Our aim is to evaluate the association between both these measures of arterial stiffness and coronary calcification (CAC), in overweight/obese postmenopausal women, without apparent cardiovascular disease. METHODS: The CAC was assessed using electron beam tomography in 504 postmenopausal women, aged 52 to 62 years (88.2% white) with mean body mass index (BMI) 30.8 kg/m(2). The CAC scores were analyzed as CAC >0 and CAC >100 versus CAC = 0, or as ln (CAC + 1). RESULTS: The cfPWV was available in 476 women (mean [SD]: 900 (255) cm/sec) and baPVI was available in 441 women (mean [SD]: 1434 (231) cm/sec. Any CAC (CAC >0) was present in approximately 51% of the cohort. Both high cfPWV (RR = 1.5, 1.6, and 1.7 for quartiles 2, 3, and 4 v 1) and baPVI (RR = 2.9, 3.7. and 4.0 for quartiles 2, 3, and 4 v 1) were associated with the presence of calcification (CAC >0). The association was attenuated but remained significant only for baPVI after adjusting for age, systolic blood pressure, average waist circumference, BMI, fasting glucose, insulin, lipids, hormone replacement therapy, and smoking status. High odds of severe calcification (CAC >100) was seen with the highest quartile of the cfPWV (RR = 5.3) and baPVI (RR = 7.8), and these associations remained significant in multivariable analysis. CONCLUSIONS: Both cfPWV and baPVI are associated with presence and severity of coronary calcification in overweight postmenopausal women.

    Title Vesicoscopic Cross-trigonal Ureteral Reimplantation: a Minimally Invasive Option for Repair of Vesicoureteral Reflux.
    Date July 2007
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Cross-trigonal ureteral reimplantation is a commonly performed procedure for the correction of vesicoureteral reflux. Most previously described laparoscopic techniques have used an extravesical approach. A "vesicoscopic" technique is analogous to standard open cross-trigonal repair in principle, except that 3 ports with insufflation of the bladder are used to perform the ureteral reimplantation. MATERIALS AND METHODS: A retrospective review was performed of patients treated for primary vesicoureteral reflux with either vesicoscopic or open ureteral reimplantation. For patients with vesicoscopic reimplantation a 5 mm port is placed in the dome of the bladder and 2, 3 mm ports are placed laterally. The ureters are mobilized transvesically, cross-trigonal submucosal tunnels are made and the ureters are sutured in place with intracorporeal suturing. The bladder ports are closed and a urethral catheter is left indwelling for 36 hours. Among the open reimplantation group 38 patients underwent cross-trigonal ureteral reimplantation, 2 underwent extravesical ureteral reimplantation and 2 were excluded due to insufficient records. Followup imaging for both groups included ultrasonography at 1 month and voiding cystography at 3 months postoperatively. RESULTS: A total of 52 consecutive children underwent vesicoscopic ureteral reimplantation with 1 patient converted to open intravesical reimplantation, and 40 consecutive controls underwent open ureteral reimplantation. Postoperative vesicoureteral reflux resolution rates for the vesicoscopic and open groups were 91% (42 of 46 patients) and 97% (31 of 32 patients), respectively. Mean patient age and mean maximal grade of vesicoureteral reflux in the vesicoscopic and open groups were 5.7 and 4.0 years (p=0.001), and 2.8 and 3.2 (p=0.036), respectively. Mean operative times for vesicoscopic and open procedures were 199 and 92 minutes, respectively (p=0.001). While the average length of hospital stay of 2 days was similar between the groups (p=0.122), less oral and intravenous analgesia was needed postoperatively in the vesicoscopic group (p=0.001 and p=0.005, respectively). Complications of vesicoscopic ureteral reimplantation included urinary leakage in 1 child, bladder stones in 1 and bilateral ureteral obstruction in 1. There were no complications in the open group. CONCLUSIONS: There is an ever increasing trend toward minimally invasive surgery. Our preliminary results indicate that vesicoscopic ureteral reimplantation is an effective procedure with minimal morbidity. Although success rates for vesicoureteral reflux resolution were slightly lower in the vesicoscopic group in this study, the favorable results of other series and the improvement in postoperative discomfort observed here suggest that this technique may be a reasonable option in the management of vesicoureteral reflux. Further refinement of the technique and critical analysis of the long-term outcomes are needed to understand fully its place in the treatment of vesicoureteral reflux.

    Title Diaphragm Paralysis Definitively Diagnosed by Ultrasonography and Postural Dependence of Dynamic Lung Volumes After Seven Decades of Dysfunction.
    Date April 2007
    Journal Lung
    Excerpt

    Unilateral diaphragm paralysis is an important and often unrecognized cause of dyspnea. In patients with appropriate risk factors, such as prior head and neck surgery and presentation of positional dyspnea or dyspnea on submersion, unilateral diaphragmatic paralysis should be considered. We present our approach to the diagnosis of diaphragm paralysis and demonstrate the utility of upright/supine spirometry and M-mode ultrasonography in these patients' evaluation.

    Title Anesthesia and Electroconvulsive Therapy: a Retrospective Study Comparing Etomidate and Propofol.
    Date February 2007
    Journal The Journal of Ect
    Excerpt

    BACKGROUND: The choice of anesthetic can influence the efficacy of electroconvulsive therapy (ECT). In the UK, propofol is a popular induction agent for ECT, but is associated with higher stimulus charge, shorter seizures, and known to affect seizure threshold. Etomidate is an alternative induction agent but there are concerns over its adverse events and safety. OBJECTIVES: We examined the differences between propofol and etomidate in the real life situation of an ECT clinic by assessing their effect on (i) length of course of ECT (ie, number of treatments required to remission), (ii) adverse effects of each induction agent, (iii) the number of 'missed seizures,' and (iv) stimulus dose (charge in mC), which relates to seizure threshold. METHOD: Using a retrospective naturalistic study design, 94 patients were identified over a 36-month period in our ECT clinic, of which, 65 met the inclusion criteria. Of these, 36 had received etomidate and 29 had received propofol as induction agents throughout their course of ECT. RESULTS: Patients who received propofol had a significantly longer course of ECT, higher seizure thresholds, and increased amounts of electrical charge (mC) over their course. There were no significant differences in adverse events with either of the induction agents. CONCLUSIONS: When used for acute courses of ECT, propofol and etomidate are equally well tolerated as induction agents. Patients who received propofol had longer acute courses of ECT and, consequently, longer and costlier inpatient stays. Etomidate could be a better alternative induction agent in ECT.

    Title Analysis of Patients with Good Uncorrected Distance and Near Vision After Monofocal Intraocular Lens Implantation.
    Date August 2006
    Journal Journal of Cataract and Refractive Surgery
    Excerpt

    PURPOSE: To analyze factors contributing to uncorrected visual acuity of at least 6/12 for distance and at least J4 for near (pseudoaccommodation) after monofocal intraocular lens (IOL) implantation. SETTING: Iladevi Cataract and IOL Research Center, Ahmedabad, India. METHODS: In a case-controlled study of 30 eyes (30 patients) that had phacoemulsification, those with pseudoaccommodation were assigned to cases and 30 eyes (30 patients) without pseudoaccommodation were designated as controls. Controls were matched by identical best corrected visual acuity, age, and postoperative duration. Subjective refraction was done with retinoscopy. Factors analyzed included corneal astigmatism, pupil size, axial IOL movement, amplitude of accommodation, axial length (AL), and age. Corneal astigmatism was noted on topography and interpreted as against the rule (ATR) (180 +/- 15 degrees), with the rule (WTR) (90 +/- 15 degrees), and oblique (OB) (45/135 +/- 30 degrees). Pupil size was noted on topographic display and AL and anterior chamber depth (ACD) on immersion A-scan. The axial IOL movement was calculated as the difference in ACD after instillation of cyclopentolate 1% (Cyclopent) and subsequently pilocarpine nitrate 2% (Carpinol) at separate visits, and amplitude of accommodation was measured with static and dynamic retinoscopy. Multivariate logistic regression and odds ratio with 95% confidence intervals were determined. RESULTS: Mean spherical equivalent was -0.45 +/- 0.63 diopter (D) in cases and -0.35 +/- 0.83 D (P = .61) in controls. Multivariate logistic regression in cases versus controls: corneal astigmatism (ATR versus WTR and OB collectively): 10.19 [1.8,57.44], P = .009; pupil size: 0.45 [0.07,2.71], P = .38; axial IOL movement: 1.39 [0.51,0.77], P = .514; amplitude of accommodation: 2.95 [0.93,9.3], P = .065; AL: 0.55 [0.29,1.02], P = .058; and age: 0.98 [0.5,1.95], P = .963. CONCLUSION: The study suggests a significant role of ATR corneal astigmatism in good uncorrected distance and near vision after monofocal IOL implantation.

    Title The Relationship Between Overactive Bladder and Sexual Activity in Women.
    Date August 2006
    Journal International Braz J Urol : Official Journal of the Brazilian Society of Urology
    Excerpt

    PURPOSE: We assessed the relationships between bladder symptoms, demographic, and medical history variables and sexual dysfunction in women with overactive bladder (OAB) disorder. MATERIALS AND METHODS: Seventy-eight women diagnosed with OAB completed self-administered questionnaires related to overall heath status, bladder function, and sexual function. Data were compiled for questionnaire responses, and multivariate logistic regression analyses were performed to determine predictors of sexual dysfunction. RESULTS: Bothersome bladder symptoms were reported by > or = 60% of the sample. Sixty-percent of the sample was sexually active in the past month. Difficulty with sexual arousal, orgasm, and sexual enjoyment were reported by about 25% of the women. Sexual partner status was the best predictor of sexual arousal, orgasm, and sexual enjoyment. Menopausal status emerged as an important predictor of arousal and sexual enjoyment. CONCLUSION: The majority of women with symptoms of OAB viewed these symptoms as bothersome. However, the extent of symptom bother did not predict aspects of female sexual dysfunction (FSD). Instead, menopausal and partner status emerged as the best predictors of FSD in our sample.

    Title Risk of Cancer As a Result of Community Exposure to Gasoline Vapors.
    Date February 2006
    Journal Archives of Environmental Health
    Excerpt

    The Tranguch Gasoline Spill leaked 50,000-900,000 gallons of gasoline from underground storage tanks, potentially exposing an area of Hazle Township and Hazleton, Pennsylvania, to chronic low levels of benzene since at least 1990. A retrospective cohort study of 663 individuals representing 275 households assessed whether affected residents were at increased risk for cancer from 1990-2000 compared with the Pennsylvania populace. Age-adjusted standard incidence ratios (SIRs) were calculated using Pennsylvania rates to determine expected numbers. The age-adjusted SIR for the gasoline-affected area was 4.40 (95% confidence interval: 1.09-10.24) for leukemia. These results suggest an association between living within the area affected by the Tranguch Gasoline Spill and increased risk for leukemia.

    Title Ethnic Variation in Hypertension Among Premenopausal and Perimenopausal Women: Study of Women's Health Across the Nation.
    Date December 2005
    Journal Hypertension
    Excerpt

    Data are sparse regarding hypertension prevalence, treatment, and control among some ethnic groups of American women. Furthermore, the effects of ethnicity on hypertension, independent of other factors that vary with ethnicity, are poorly understood. We examined the prevalence of hypertension (defined as systolic > or =140 or diastolic > or =90 mm Hg or receiving treatment), treatment, and control (to <140/<90 mm Hg) in a multiethnic study of premenopausal and perimenopausal women. Stepwise multivariable logistic regression was used to select covariates associated with hypertension. Among 3292 women, 46.9% were white, 28.3% were black, 8.7% were Hispanic, 7.6% were Chinese, and 8.5% were Japanese. Among these 5 ethnic groups, respectively, there was substantial variation in prevalence of normal blood pressure levels (<120/<80 mm Hg; 59.9%, 35.4%, 16.8%, 67.2%, and 63.7%) and hypertension (14.5%, 38.1%, 27.6%, 12.8%, and 11.0%). After multivariable adjustment, hypertension prevalence was 2 to 3x higher among black and Hispanic women but similar among Chinese and Japanese women compared with white women. Among hypertensive participants, prevalence of antihypertensive treatment was highest among blacks (58.9%) and whites (55.2%) and lowest among Chinese (34.4%). Prevalence of control to goal blood pressure levels was highest among whites (43.0%) and Japanese (38.7%) and markedly lower among Hispanic women (11.4%). Compared with whites, black and Hispanic women have significantly higher prevalence of hypertension independent of other factors, whereas Chinese and Japanese women have similar prevalence. Treatment and control rates vary considerably across ethnicities. Greater efforts must be made to improve hypertension awareness, treatment, and control in all middle-aged women, particularly those in ethnic minority groups.

    Title Treatment of Postpriapism Erectile Dysfunction by Closure of Persistent Distal Glans-cavernosum Fistulas 5 Years After Shunt Creation.
    Date December 2005
    Journal Urology
    Excerpt

    Erectile dysfunction is common after the formation of a glans-cavernosum shunt for intractable priapism. Often patients require placement of a penile prosthesis to restore sexual function. We report a case of restoration of full erections after reversal of a glans-cavernosum shunt in a 30-year-old man who had been treated for priapism 5 years previously. On the basis of our experience, it seems reasonable to attempt shunt reversal for correction of erectile dysfunction in selected patients who likely have a persistent vascular fistula.

    Title Weight Change is Associated with Change in Arterial Stiffness Among Healthy Young Adults.
    Date October 2005
    Journal Hypertension
    Excerpt

    Risk factors for arterial stiffness progression have not been well characterized. We examined the relationship between arterial stiffness progression and body weight and weight gain in a group of healthy young adults. Aortic pulse-wave velocity was assessed at 2 time points approximately 2 years apart in 152 white and black adults aged 20 to 40 years, and was standardized by the time between visits to obtain annualized pulse-wave velocity changes. Blacks had 15.5 cm/s per year larger annual pulse-wave velocity increases compared with whites (P=0.02), even after multivariable adjustment for weight and blood pressure changes. Larger annual pulse-wave velocity increases were also associated with larger baseline body weight (P=0.02), waist girth (P=0.003), and body mass index (P<0.001), and greater annual weight gain (P=0.02), after adjustment for baseline pulse-wave velocity. After multivariable adjustment that included blood pressure changes, larger baseline waist girth (P=0.009), baseline body mass index (P=0.001), body mass index increase (P=0.037), and weight gain (P=0.017) remained significantly associated with larger annual pulse-wave velocity progression. Weight change showed a direct relationship with pulse-wave velocity change; mean annual pulse-wave velocity changes were -29.9 cm/s per year (regression) for those with >or=4.5 kg annual weight loss and 18.2 cm/s per year (progression) for those with >or=4.5 kg annual weight gain. These data show strong associations between weight gain and arterial stiffness progression, as well as between weight loss and arterial stiffness regression. These data greatly underscore the vascular benefit of weight loss. Successful weight loss programs in young adults, particularly blacks, are needed.

    Title Paracrine Stimulation of Surfactant Secretion by Extracellular Atp in Response to Mechanical Deformation.
    Date September 2005
    Journal American Journal of Physiology. Lung Cellular and Molecular Physiology
    Excerpt

    We developed a heterologous system to study the effect of mechanical deformation on alveolar epithelial cells. First, isolated primary rat alveolar type II (ATII) cells were plated onto silastic substrata coated with fibronectin and maintained in culture under conditions where they become alveolar type I-like (ATI) cells. This was followed by a second set of ATII cells labeled with the nontransferable, vital fluorescent stain 5-chloromethylfluorescein diacetate to distinguish them from ATI cells. By morphometric analysis, equibiaxial deformation (stretch) of the silastic substratum induced comparable changes in cell surface area for both ATII and ATI cells. Surfactant lipid secretion was measured using cells metabolically labeled with [(3)H]choline. In response to 21% tonic stretch for 15 min, ATII cells seeded with ATI cells secreted nearly threefold more surfactant lipid compared with ATII cells seeded alone. ATI cells did not secrete lipid in response to stretch. The enhanced lipid secretion by ATII plus ATI cocultures was inhibited by treatment with apyrase and adenosine deaminase, suggesting that ATP release by ATI cells enhanced surfactant lipid secretion at 21% stretch. This was confirmed using a luciferase assay where, in response to 21% stretch, ATI cells released fourfold more ATP than ATII cells. Because ATI cells release significantly more ATP at a lower level of stretch than ATII cells, this supports the hypothesis that ATI cells are mechanosensors in the lung and that paracrine stimulation of ATII cells by extracellular ATP released from ATI cells plays a role in regulating surfactant secretion.

    Title Bronchial Epithelial Compression Regulates Epidermal Growth Factor Receptor Family Ligand Expression in an Autocrine Manner.
    Date June 2005
    Journal American Journal of Respiratory Cell and Molecular Biology
    Excerpt

    The epidermal growth factor receptor (EGFR), an important signaling pathway in airway biology, is stimulated by compressive stress applied to human airway epithelial cells. Although the EGFR ligand, heparin-binding epidermal growth factor-like growth factor (HB-EGF), is known to be released as a result of this stimulation, whether compressive stress enhances expression of other EGFR ligands, and the duration of mechanical compression required to initiate this response, is not known. Human airway epithelial cells were exposed to compressive stress, and expression of four EGFR ligands was examined by quantitative PCR. Cells were exposed to: (1) continuous compressive stress over 8 h, (2) compression with and without EGFR inhibitor (AG1478), or (3) time-limited compression (3.75, 7.5, 15, 30, and 60 min). Compressive stress produced a sustained upregulation of the EGFR ligands HB-EGF, epiregulin, and amphiregulin, but not transforming growth factor-alpha. Inhibition with AG1478 demonstrated that expression of HB-EGF, epiregulin, and amphiregulin is dependent on the signaling via the EGFR. Immunostaining for epiregulin protein demonstrated increased expression with compression and attenuation with EGFR inhibition. The response of all three EGFR ligands persisted long after the mechanical stimulus was removed. Taken together, these data suggest the possibility of a mechanically activated EGFR autocrine feedback loop involving selected EGFR ligands.

    Title Automatic Identification of Clinical Lead Dysfunctions.
    Date June 2005
    Journal Pacing and Clinical Electrophysiology : Pace
    Excerpt

    Implantable cardioverter defibrillators (ICD) lead dysfunctions can cause inappropriate shocks. Current ICDs store lead diagnostics and detected episodes. This stored information with intracardiac electrograms (EGM) and sensed RR interval patterns may characterize the ICD lead performance. The aim of this analysis was to determine the sensitivity and positive predictive value (PPV) of an automatic lead dysfunction identification algorithm. This algorithm uses RR and EGM data to distinguish noncardiac oversensing (OS), for example, due to conductor fracture, and cardiac OS, for example, T-wave OS, from detected episodes. The algorithm also uses lead diagnostics: sensing integrity counter trends (e.g., RR intervals <140 ms), nonsustained tachyarrhythmias episodes with a mean RR <200 ms and impedance trends to identify lead fractures. The PPV was determined using the stored memory from 1,756 ICD patients enrolled in a 13-center long-term lead study with an average follow-up of 18.3 patient-months. Sensitivity was determined in 35 patients who presented with OS or lead fracture-related adverse events confirmed by stored ICD diagnostics. The algorithm sensitivity was 97.1% (34/35). There were 43 additional patients identified by the algorithm without an adverse event. Stored ICD diagnostics confirmed lead dysfunctions in 32 of 43 patients corresponding with an 85.7% PPV (66/77). ICD memory diagnostics and episodes with intracardiac EGM may be used to identify ICD lead dysfunctions with high sensitivity and PPV. This algorithm may be implemented in postprocessing ICD environments (e.g., remote server, programmer) to rapidly identify lead dysfunction prior its clinical manifestation.

    Title Cardiovascular Risk Factors Associated with Enlarged Diameter of the Abdominal Aortic and Iliac Arteries in Healthy Women.
    Date May 2005
    Journal Atherosclerosis
    Excerpt

    The abdominal aorta is known to be more susceptible to arterial dilation than to occlusion primarily due to the effects of vascular aging. Few studies have considered the effects of cardiovascular risk factors on arterial diameter, particularly within a population of healthy women at mid-life. This study seeks to examine associations between cardiovascular risk factors and abdominal aortic and iliac adventitial diameter. Abdominal aortic ultrasound was performed in 260 post-menopausal women aged 53.9+/-2.5 years at time of scan as a component of the Healthy Women Study. Risk factors were evaluated at premenopause and post-menopausal clinic visits closest in date to the abdominal ultrasound scan. Post-menopausal weight and change of weight from pre- to post-menopause were among the strongest correlates of larger adventitial diameter after controlling for age, systolic blood pressure, and body size using height. Other post-menopausal risk factors significantly correlated with both abdominal aortic and iliac diameter were BMI, waist circumference, HDL, and insulin (p<0.05). These data suggest that weight is a key risk factor in the promotion of vascular aging as indexed by enlarged arterial diameter. Women at mid-life should continue to be targeted for weight interventions to reduce their risk for more serious cardiovascular complications.

    Title Light Normalizing Intraocular Lenses.
    Date March 2005
    Journal International Ophthalmology Clinics
    Title An Algorithm to Predict Implantable Cardioverter-defibrillator Lead Failure.
    Date January 2005
    Journal Journal of the American College of Cardiology
    Excerpt

    OBJECTIVES: The goal of this analysis was to test an algorithm that identifies implantable cardioverter-defibrillator (ICD) lead problems before clinical failure and/or inappropriate therapy. BACKGROUND: The ICD lead failures typically present as inappropriate shock therapy. Identifying lead failures before their clinical presentation may prevent patient discomfort, improve device longevity, and avoid device-induced proarrhythmia. METHODS: We tested an algorithm that uses two measures of oversensing and one measure of abnormal impedance to detect a lead failure. The oversensing measures consisted of a counter for RR intervals <140 ms and nonsustained ventricular tachycardia episodes with mean RR interval <200 ms. The impedance measure tracked lead impedances every day and each week. Abnormal impedance was defined as a decrease in impedances or an outlier value compared with baseline. Lead failures were identified when both oversensing measures were met or abnormal impedance and one oversensing measure occurred. The stored data from 696 patients with an ICD were analyzed to determine the sensitivity and specificity of the algorithm to detect lead failures. RESULTS: Twenty-nine patients demonstrated clinical lead failures with an average of 6 +/- 9 inappropriate shocks per patient. The two oversensing measures used in the algorithm predicted 72% (21 of 29) of the lead failures. Fulfilling at least two of the three impedance and oversensing measures, the sensitivity of our algorithm was 83% (24 of 29) with a 100% (667 of 667) specificity. CONCLUSION: Oversensing combined with abnormal impedance trends may be used to identify ICD lead failures with high sensitivity and very high specificity.

    Title Developmental Regulation of Claudin Localization by Fetal Alveolar Epithelial Cells.
    Date January 2005
    Journal American Journal of Physiology. Lung Cellular and Molecular Physiology
    Excerpt

    Tight junction proteins in the claudin family regulate epithelial barrier function. We examined claudin expression by human fetal lung (HFL) alveolar epithelial cells cultured in medium containing dexamethasone, 8-bromo-cAMP, and isobutylmethylxanthanine (DCI), which promotes alveolar epithelial cell differentiation to a type II phenotype. At the protein level, HFL cells expressed claudin-1, claudin-3, claudin-4, claudin-5, claudin-7, and claudin-18, where levels of expression varied with culture conditions. DCI-treated differentiated HFL cells cultured on permeable supports formed tight transepithelial barriers, with transepithelial resistance (TER) >1,700 ohm/cm(2). In contrast, HFL cells cultured in control medium without DCI did not form tight barriers (TER <250 ohm/cm(2)). Consistent with this difference in barrier function, claudins expressed by HFL cells cultured in DCI medium were tightly localized to the plasma membrane; however, claudins expressed by HFL cells cultured in control medium accumulated in an intracellular compartment and showed discontinuities in claudin plasma membrane localization. In contrast to claudins, localization of other tight junction proteins, zonula occludens (ZO)-1, ZO-2, and occludin, was not sensitive to HFL cell phenotype. Intracellular claudins expressed by undifferentiated HFL cells were localized to a compartment containing early endosome antigen-1, and treatment of HFL cells with the endocytosis inhibitor monodansylcadaverine increased barrier function. This suggests that during differentiation to a type II cell phenotype, fetal alveolar epithelial cells use differential claudin expression and localization to the plasma membrane to help regulate tight junction permeability.

    Title Cool (trpm8) and Hot (trpv1) Receptors in the Bladder and Male Genital Tract.
    Date September 2004
    Journal The Journal of Urology
    Excerpt

    PURPOSE: Overactive bladder symptoms due to various etiologies have been successfully treated with capsaicin by desensitization of the temperature sensitive vanilloid receptor TRPV1. Recently another temperature sensitive receptor, TRPM8, activated by menthol and cool temperatures (8C to 28C) was described that may be the proposed cool receptor, at least in part mediating the bladder response in the diagnostic ice water test. We defined the sites of mRNA and protein expression of TRPM8 and TRPV1 in the rat and human genitourinary tract. MATERIALS AND METHODS: Prostate, testis, penis, bladder and dorsal root ganglion tissue was obtained from rats. Prostate, testicle, seminiferous tubules, corpus cavernosum, glans, overlying glans skin, scrotal skin and bladder were obtained from human patients. Reverse transcription-polymerase chain reaction was done using species specific primers for TRPM8 and TRPV1. Immunofluorescence staining for TRPM8 was performed in rat tissues as well as in cultured human urothelial cells. RESULTS: TRPM8 and TRPV1 mRNA were detected in all rat tissues. Human samples demonstrated TRPM8 mRNA in prostate, testicle, seminiferous tubules, scrotal skin and bladder. No TRPM8 mRNA was identified in human corpus cavernosum, glans or overlying glans skin. Separation of layers in human bladder demonstrated mRNA for TRPM8 only in the urothelium and not in the detrusor. Immunofluorescence location of TRPM8 was found in rat prostate, DRG and bladder, and in human urothelial cells in culture. TRPV1 mRNA was detected in all human genitourinary tract tissues. CONCLUSIONS: These results demonstrate that mRNA and protein for TRPM8 exist in multiple genitourinary organs in the rat and human, and it may be considered a possible new target, as is TRPV1, for the pharmacological treatment of detrusor overactivity or other urological disorders.

    Title Folie a Deux in Bipolar Affective Disorder: a Case Report.
    Date July 2004
    Journal Bipolar Disorders
    Excerpt

    BACKGROUND: The syndrome of folie a deux is uncommon and often described in the context of schizophrenia. We report a case of induced delusional disorder associated with bipolar affective disorder (BAD). CASE REPORT: We present a case of monozygotic twins in their late 60s with an unusually close relation with one another and relative isolation from other people. Both twins have been diagnosed as suffering from BAD and relapsed into mania with psychotic symptoms. During their hospital stay they exhibited features consistent with folie a deux. Separation caused disappearance of the phenomenon whilst the affective disorder persisted. CONCLUSION: This case highlights the unusual and rare phenomenon of folie a deux occurring in the context of BAD. It also suggests current difficulty in defining folie a deux as an entity according to current diagnostic criteria.

    Title Oral Manifestations Associated with Hiv Infection: Evaluation, Assessment, and Significance.
    Date April 2004
    Journal General Dentistry
    Excerpt

    During the course of HIV disease, oral lesions frequently are the initial manifestation of underlying immune deterioration. Typically, these lesions are readily accessible and lend themselves to being examined. Therefore, it is important to perform oral examinations routinely both in dental and medical settings. The recognition and treatment of these early signs of immune suppression may have a significant impact on the survival and the quality of life of HIV-infected patients. This article briefly discusses the HIV epidemic and common intraoral manifestations associated with HIV disease progression.

    Title Increased Risk for Developmental Delay in Saethre-chotzen Syndrome is Associated with Twist Deletions: an Improved Strategy for Twist Mutation Screening.
    Date March 2004
    Journal Human Genetics
    Excerpt

    The majority of patients with Saethre-Chotzen syndrome have mutations in the TWIST gene, which codes for a basic helix-loop-helix transcription factor. Of the genetic alterations identified in TWIST, nonsense mutations, frameshifts secondary to small deletions or insertions, and large deletions implicate haploinsufficiency as the pathogenic mechanism. We identified three novel intragenic mutations and six deletions in our patients by using a new strategy to screen for TWIST mutations. We used polymerase chain reaction (PCR) amplification with subsequent sequencing to identify point mutations and small insertions or deletions in the coding region, and real-time PCR-based gene dosage analysis to identify large deletions encompassing the gene, with confirmation by microsatellite and fluorescence in situ hybridization (FISH) analyses. The size of the deletions can also be analyzed by using the gene dosage assay with "PCR walking" across the critical region. In 55 patients with features of Saethre-Chotzen syndrome, 11% were detected to have deletions by real-time gene dosage analysis. Two patients had a translocation or inversion at least 260 kb 3' of the gene, suggesting they had position-effect mutations. Of the 37 patients with classic features of Saethre-Chotzen syndrome, the overall detection rate for TWIST mutations was 68%. The risk for developmental delay in patients with deletions involving the TWIST gene is approximately 90% or eight times more common than in patients with intragenic mutations.

    Title Can Higher Doses of Oxybutynin Improve Efficacy in Neurogenic Bladder?
    Date February 2004
    Journal The Journal of Urology
    Excerpt

    PURPOSE: We evaluated the efficacy and tolerability of higher dose oxybutynin chloride in patients with neurogenic bladder and multiple sclerosis, spinal cord injury or Parkinson's disease. MATERIALS AND METHODS: The study design was a prospective, 12-week dose titration trial of controlled release oxybutynin (OXY-XL). A 7-day washout period was used before initiation of the starting dose of 10 mg OXY-XL. Doses of OXY-XL were increased by 5 mg at weekly intervals to a maximum dose of 30 mg per day guided by patient perception of efficacy versus side effect. Voiding diaries were completed at baseline, and weeks 6 and 12. Post-void residuals were recorded. Criteria for study admission included post-void residual less than 200 ml. RESULTS: Of the 39 patients enrolled in the study 22 had multiple sclerosis, 10 had spinal cord injury and 7 had Parkinson's disease. There were 29 women (74%) and 10 men (26%). Within 1 week a decrease in the number of voids per day was seen in greater than 50% of the subjects. At the end of the study statistically significant decreases in the number of voids in 24 hours, episodes of nocturia and incontinence episodes were observed. Residual urine remained unchanged from 33.9 +/- 7.6 ml at baseline to 51.3 +/- 10.4 ml after 12 weeks at the final dose (p = 0.17). No patient experienced serious adverse events and none dropped out during the course of the 12-week study. At the end of the study 20.5% of subjects remained on 30 mg, 15.4% on 25 mg, 23.1% on 20 mg, 15.4% on 15 mg and 25.6% on 10 mg OXY-XL. CONCLUSIONS: Aggressive dosing of OXY-XL is safe and effective in patients with neurogenic bladder. Compared with nonneurogenic overactive bladder, higher doses of OXY-XL (15 mg daily or greater) were requested by 74.4% of the patients in our study. The onset of clinical efficacy can occur within 1 week, and doses up to 30 mg are well tolerated and effective in this population.

    Title Effects of Mutations in the Highly Conserved Dry Motif on Binding Affinity, Expression, and G-protein Recruitment of the Human Angiotensin Ii Type-2 Receptor.
    Date June 2003
    Journal Brain Research. Molecular Brain Research
    Excerpt

    The signaling pathways for the seven transmembrane G-protein coupled angiotensin II receptors (AT(1) and AT(2)) are just beginning to be understood. While these receptors play an important role in the development and differentiation of many tissues, including the cardiovascular and central nervous systems, information about amino acid motifs involved in angiotensin II-mediated signaling is only available for the AT(1) receptor subtype. In the present study, we mutated the conserved DRY(141-143) motif in the AT(2) receptor, which is thought to be involved in G-protein recruitment. Expression of wild type and mutant receptors in CHO-K1 cell plasma membranes was confirmed using radioligand binding analyses. Our findings indicate a significant change in the binding affinities (kD) and capacities (B(max)) of the mutant receptors relative to wild type. Alanine substitutions of D(141) and DRY(141-143) resulted in a significant decrease of binding affinity for both Sar(1)Ile(8)-angiotensin II (SarIle-Ang II) (mixed agonist/antagonist) and angiotensin II (agonist). The binding affinities following alanine substitutions of R(142) and Y(143) were not significantly different from wild type receptor. Interestingly, the R(142)-A and Y(143)-A mutants revealed a significant decrease in binding levels from wild type with SarIle-Ang II, but not angiotensin II. The effect of GTPgammaS on angiotensin II binding affinity between wild type and mutant receptors was similarly significant. The D(141)-A, Y(143)-A, and DRY(141-143)-AAA mutant receptors showed a marked decrease in GTPgammaS-induced angiotensin II affinity shift. The R(142)-A GTPgammaS binding affinity shift was not different from the wild type receptor. Our results support the hypothesis that the DRY motif plays a significant role in the binding affinity, structural stability and G-protein recruiting of the AT(2) receptor.

    Title What's New: Proton Pump Inhibitors and Pediatrics.
    Date March 2003
    Journal Pediatrics in Review / American Academy of Pediatrics
    Title Metastatic Cancer Presenting As Tmd--again. A Case Report.
    Date January 2002
    Journal Journal of the New Jersey Dental Association
    Title Cataract Surgery After Retinal Surgery.
    Date August 2001
    Journal Current Opinion in Ophthalmology
    Excerpt

    Many patients require surgery for cataract after retinal surgery. When evaluating patients preoperatively, the surgeon should pay careful attention to the assessment of visual function and potential acuity, and to the slit lamp examination of the lens, posterior capsule, anterior cortical vitreous, and zonules. The surgeon's technique must account for increased nuclear sclerosis, intraoperative miosis, a characteristically longer axial length, and fluctuations in anterior chamber depth from movement of the iris-lens diaphragm. Posterior capsule plaques are not unusual. Posterior capsule opacification is the most frequent late complication. Visual outcomes are usually good except when limited by pre-existing macular pathology. Vision-threatening complications of cataract surgery are unusual.

    Title Bilateral Lateral Rectus Recession for Consecutive Exotropia.
    Date December 2000
    Journal Journal of Aapos : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus
    Excerpt

    INTRODUCTION: Treatment of consecutive exotropia after bilateral medial rectus recessions has been rarely studied. Though several series have reported results of medial rectus advancement, none has described results of lateral rectus recessions. METHODS: We reviewed our results in 31 patients who underwent bilateral lateral rectus recessions for consecutive exotropia after bilateral medial rectus recessions. Mean follow-up was 30 months (range, 1-140 months) after the exotropia repair. RESULTS: At last follow-up, 20 of 31 patients (65%) had deviations of less than or equal to 10 PD. Limitation of adduction was not apparent. DISCUSSION: Cooper's dictum states that lateral rectus recession should be performed instead of medial rectus advancement. Our results suggest that this approach is generally successful. The outcome after exotropia repair in consecutive deviations is comparable to that after repair of primary exotropia.

    Title Cytogenetics and Cancer.
    Date March 2000
    Journal Current Opinion in Oncology
    Excerpt

    Techniques based on fluorescence in situ hybridization (FISH) have bridged the gap between molecular genetics and conventional cytogenetics. Since its introduction in the late 1980s, advanced FISH-based methods have greatly enhanced the cytogenetic analysis of hematopoietic and solid tumors and are rapidly gaining ground in clinical cytogenetic diagnostics. As interest in FISH technologies has grown, it has inspired an era of new FISH-based technologies such as multiplex FISH, spectral karyotyping, and comparative genomic hybridization. In this review, the focus is on the impact of these technologies in the field of cancer genetics.

    Title Evaluation of an Unused 1952 Ridley Intraocular Lens.
    Date December 1999
    Journal Journal of Cataract and Refractive Surgery
    Excerpt

    PURPOSE: To evaluate an unused 1952 historic Ridley intraocular lens (IOL) brought to Bombay, India, in 1952 from an Oxford Ophthalmologic Conference in England and given to 1 of the authors during his residency. SETTING: Alcon Laboratories, Fort Worth, Texas, USA. METHODS: The Ridley IOL was evaluated at Alcon Laboratories, Inc., using the established procedures of its Intraocular R&D Laboratories. Various optical and physical aspects of the Ridley lens were evaluated including (1) dimensions, (2) weight, (3) power, (4) resolution efficiency and modulation transfer function (MTF), (5) surface sphericity by interferometry, (6) ultraviolet (UV)-visible transmission characteristic, (7) attenuated total reflectance (ATR)-Fourier transform infrared reflectance spectrum, and (8) cosmetics by visual inspection using light microscopy. RESULTS: This 8.5 mm diameter, 2.4 mm thick, 23 diopter biconvex IOL weighed 108 mg. The ATR spectrum, UV-visible transmission, and refractive index confirmed its poly-(methyl methacrylate) material. The 0.56 MTF value at 100 line pairs/mm, per the International Standards Organization--IOL Optics Standard, and 93% resolution efficiency in water, per the American National Standard Institute IOL Optics Standard, revealed the IOL's excellent optics. This was confirmed by 0.278 wave root mean square surface figure as measured by Zygo interferometer using a 633 nm wavelength. Visual inspection revealed rough edges with sharp corners and some surface scratches. Early clinical experience with Ridley IOLs in Bombay, India, is briefly given. CONCLUSION: The Ridley IOL had excellent optical quality, meeting the requirements of current IOL optics standards. The selection of its dimensions was guided by the human crystalline lens, and the Ridley IOL was half as bulky. Although its clinical results were mixed, successful cases inspired subsequent improvements, leading to modern, highly satisfactory IOLs. This IOL represented a revolutionary innovation in ophthalmology.

    Title Overexpression of Ems1/cortactin in Nih3t3 Fibroblasts Causes Increased Cell Motility and Invasion in Vitro.
    Date August 1998
    Journal Oncogene
    Excerpt

    Cortactin, a p80/85 protein first identified as a src kinase substrate, is thought to be involved in the signaling pathway of mitogenic receptors and adhesion molecules mediating cytoskeletal reorganization. The cortactin gene, EMS1, maps to chromosome 11q13, a region amplified in head and neck squamous cell carcinomas (HNSCC) and breast cancer, which display lymph node metastasis and an unfavorable clinical outcome. To further address the role of cortactin in the malignant phenotype of cells, we stably overexpressed cortactin in NIH3T3 fibroblasts and evaluated the effects of elevated cortactin on cellular proliferation, motility and invasiveness. Cortactin overexpressing cells did not display any striking morphological changes, nor any significant differences in cell proliferation or saturation density as compared to control NIH3T3 cells. Furthermore, the cortactin overexpressing cells were anchorage dependent for growth. Interestingly, cortactin overexpressing cells were more motile and invasive in modified Boyden chamber assays. These results suggest that overexpression of cortactin may play a role in tumor progression by influencing tumor cell migration and invasion.

    Title Determining the Imaging Quality of Intraocular Lenses.
    Date July 1998
    Journal Journal of Cataract and Refractive Surgery
    Excerpt

    PURPOSE: To validate the proposed optical requirements of a draft international standard for intraocular lenses (IOLs). SETTING: Eight optical testing laboratories in the United States, Germany, Japan, and The Netherlands. METHODS: The testing laboratories performed modulation transfer function (MTF) tests on various IOLs using a model eye and visual resolution tests in air. Each laboratory performed duplicate measurements on a set of 43 lenses that was circulated among the testing laboratories. RESULTS: The interlaboratory tests showed that the MTF measurements using a model eye had better repeatability and reproducibility than the more common industry practice of resolution testing in air with parallel light and the United States Air Force three-bar target. However, the two methods correlated well. The commonly applied criterion that an IOL resolve in air at least 60% of the Rayleigh cutoff spatial frequency corresponded to a minimum requirement of 0.43 MTF units at 100 mm-1 in a model eye. CONCLUSIONS: Either criterion may be applied in accordance with a proposed international standard for IOLs. The model eye method can be applied over a broader range of dioptric powers and is relevant for materials that interact with aqueous. Both tests appear to have a greater ability to detect unwanted surface aberrations than resolution testing of IOLs in a water cell using parallel light, a method described in the current American National Standards Institute standard.

    Title In Vitro Adherence of Pseudomonas Aeruginosa to Four Intraocular Lenses.
    Date March 1998
    Journal Journal of Cataract and Refractive Surgery
    Excerpt

    PURPOSE: To compare the relative degrees of adherence of a clinical strain of Pseudomonas aeruginosa to the optic material of four intraocular lenses (IOLs). SETTING: Center for Applied and Environmental Microbiology, Georgia State University, Atlanta, Georgia, USA. METHODS: Intraocular lens optics made of poly(methyl methacrylate) (PMMA), AcrySof-acrylic, and silicone were included in this study. The IOLs were incubated in a minimal medium with cells of P. aeruginosa for 2 hours and 18 hours. Cells in the 2 hour experiment were prelabeled with 3H-leucine; those in the 18 hour experiments were postlabeled. After rinsing the IOLs to remove loosely adherent cells, we determined the number of cells adhered to coded lenses from calibration curves of disintegrations per minute versus cells per square millimeter. Additional lenses were incubated with P. aeruginosa and examined with scanning electron microscopy. RESULTS: The adherence of P. aeruginosa in order of increasing magnitude was AcrySof-acrylic < PMMA < silicone 1 < silicone 2. The differences between all groups were statistically significant. The scanning electron microscopy observations were in general agreement with the radiolabel studies. CONCLUSIONS: The AcrySof-acrylic IOL was less susceptible to primary adherence and 18 hour biofilm formation by P. aeruginosa than the PMMA and silicone IOLs, indicating that this material reduced pseudomonad adherence and the risk of endophthalmitis following cataract surgery.

    Title Accuracy in Determining Intraocular Lens Dioptric Power Assessed by Interlaboratory Tests.
    Date April 1997
    Journal Journal of Cataract and Refractive Surgery
    Excerpt

    PURPOSE: To describe a testing program conducted by a standards group as a guide for setting international tolerances for intraocular lens (IOL) dioptric power. SETTING: Multicenter study. METHODS: Seven biconvex, poly(methyl methacrylate) IOLs ranging in power from 10.00 through 30.00 diopter (D) were circulated among nine participating laboratories experienced in IOL optical measurements. Each laboratory performed repeated optical tests to determine dioptric power. These results were analyzed for repeatability and reproducibility in accordance with methods specified by the International Organization for Standardization. RESULTS: Intralaboratory repeatability was less than 0.5% of the dioptric power, and interlaboratory reproducibility, when following a normalized procedure for correction and conversion, was less than 1.0% of the dioptric power. CONCLUSION: Tolerance limits of +/0 0.30 D in the range 0 to 15.00 D, +/- 0.40 D for 15.50 to 25.00 D, and +/- 0.50 D for 25.50 to 30.00 D have been proposed as an international standard for IOLs. The contribution of IOL power error within the limits of the standard are estimated to contribute less than 1.0% to the total error in postoperative refractive prediction.

    Title Construction of an Ultrasound Biopsy Phantom.
    Date August 1996
    Journal Australasian Radiology
    Excerpt

    The technique for construction of an agar-based ultrasound biopsy phantom is described. Features include tissue equivalent reflectivity, long life and non-shadowing targets. The phantom is useful for learning the necessary co-ordination between needle and probe for ultrasound needle guidance. This skill should initially be practised in vitro, on a device such as this.

    Title Painless Diplopia Caused by Extraocular Muscle Sarcoid.
    Date August 1994
    Journal Archives of Ophthalmology
    Title Endogenous Fusarium Endophthalmitis in a Patient with Acute Lymphocytic Leukemia.
    Date April 1994
    Journal American Journal of Ophthalmology
    Excerpt

    Endogenous fungal endophalmitis is an uncommon complication of systemic mycosis. Only a few cases involving Fusarium have been reported, most with unfavorable visual outcomes. We examined a 31-year-old woman with acute lymphocytic leukemia who developed sudden visual loss in her right eye. A dense, white placoid infiltrate was present in the right macula extending into the vitreous. An iris nodule and hypopyon were present in the left eye. A vitreous aspirate of the right eye was positive for Fusarium species. The patient progressively lost vision despite amphotericin B and 5-fluorocytosine therapy. She died from bronchopneumonia, fungemia, and multisystem failure. Histopathologic study disclosed a panophthalmitis with Fusarium organisms invading all the ocular coats in the right eye. Leukemic infiltrates were present in the left iris, anterior chamber, and trabecular meshwork. The ocular destructiveness of Fusarium may be caused by marked mycotic vascular invasion and occlusion with consequent infarction and necrosis of ocular tissues.

    Title Water Properties of Hydrogel Contact Lens Materials: a Possible Predictive Model for Corneal Desiccation Staining.
    Date March 1994
    Journal Biomaterials
    Excerpt

    A set of properties of the water contained within hydrogel contact lens materials was determined with the aim of developing a model which would predict the propensity of a hydrogel contact lens material to induce corneal desiccation staining. We postulated that materials containing a larger proportion of water with the properties of bulk water would tend to induce corneal desiccation more readily than materials with the same overall water content but containing a larger proportion of water that interacts strongly with the polymer. The water structure [as measured by differential scanning calorimetry (DSC)] and the permeabilities of water and glucose were determined for a series of commercial hydrogel lenses. Both glucose permeability and DSC measurements are sensitive indicators of water structure and able to distinguish between various materials. To illustrate the potential of our model, the results of a short-term clinical study are presented. Lower levels of staining were noted for a material with a lower glucose permeability and a larger amount of water melting below 0 degrees C than for a control lens, even though both materials were similar in water content and water permeability. Further clinical studies are needed to validate this model.

    Title Eight Years Experience with Permalens Intracorneal Lenses in Nonhuman Primates.
    Date May 1992
    Journal Refractive & Corneal Surgery
    Excerpt

    BACKGROUND: For the past 8 years, three independent laboratories have been researching the biocompatibility and performance of Permalens intracorneal lens implants in the corneas of nonhuman primates. Both myopic and hyperopic corrections have been achieved. This article describes the evolution of the intracorneal lens design and manufacturing process. METHODS: During this time period, 63 surgeries were performed on various species of nonhuman primates. Follow-up examination extended between 30 months and 8.2 years. Objective measures of refractive performance, as well as biocompatibility were made using slit lamp, retinoscopy, autorefractor, specular microscope, etc. Additionally, histopathology was performed on many of the specimens, both acute and chronic. RESULTS: Surgically successful implants were achieved in between 60% and 100% of eyes in the various series of lens implants outlined in the article. Levels of contamination in the preparation of hydrogels were felt to be responsible for many of the surgical failures. The removal of silicone and other contaminants seems to have significantly improved the biocompatibility of these materials within the cornea. The major histopathological finding was that there appeared to be some epithelial thinning over the implants, but in general excellent biocompatibility was obtained over the 8-year period outlined in this paper. CONCLUSIONS: Although extensive studies of biocompatibility have been completed, the future of the performance of these materials remains to be proven in the human subject. Additionally, empirical relationships between lens implant power and refractive results will have to be determined in humans, prior to their general clinical usage.

    Title Initial Human Experience with Permalens Myopic Hydrogel Intracorneal Lens Implants.
    Date May 1992
    Journal Refractive & Corneal Surgery
    Excerpt

    BACKGROUND: Previous nonhuman primate experimentation has demonstrated the successful use of Permalens hydrogel intracorneal lens implants for the correction of hyperopic and myopic refractive errors. This article documents the first human experience with myopic Permalens hydrogel intracorneal lens implants. METHODS: In this article, we report an 18-month follow up on five patients implanted with minus power hydrogel intracorneal lenses. All surgery and follow-up examinations were performed in Bogota, Columbia. The mean preoperative spherical refraction was -14.00 +/- 5.00 diopters (range, -9.5 to -19.00 D). RESULTS: Corrections of up to 13.00 D were achieved. Corrections deviated from the predicted correction by a mean of -5.00 +/- 2.10 D (range, -2.80 to -8.00 D). No significant surgical or postoperative complications were noted. Visual recovery was rapid, usually achieving maximum acuity within 1 month. CONCLUSIONS: Successful myopic refractive changes were accomplished in all five human subjects. The major problem with the study to date has been a significant undercorrection of the preoperative refraction. We anticipate that further empirically derived relationships between hydrogel lens power and refractive change will allow a more accurate prediction of refractive result. Also, the ability to surgically interchange myopic hydrogel inlays should allow correction of any residual refractive errors.

    Title Lipid Adsorption Onto Hydrogel Contact Lens Materials. Advantages of Nile Red over Oil Red O in Visualization of Lipids.
    Date February 1992
    Journal Optometry and Vision Science : Official Publication of the American Academy of Optometry
    Excerpt

    An artificial tear solution containing the major types of proteins, glycoproteins, and lipids represented in human tears has been developed. The adsorption of lipids onto various hydrogel lens materials (polymacon, lidofilcon A, phemfilcon A, etafilcon A) was examined by exposing the lenses to our artificial tear solution for 18 h. The adsorbed lipids were detected using Nile red stain. The patterns of deposits obtained in vitro were similar to those obtained with human worn lenses. The Nile red stain appeared far more sensitive in detecting lipids adsorbed to hydrogel lenses than the oil red O stain. It was found that lipids adsorb to hydrogel materials quite readily either in a pure state or combined with mucin or other proteins. In view of this work more attention should be given to the role of lipids in the etiology of various contact lens wear complications.

    Title Post-endoscopy Arterial Oxygen Desaturation and Pulse Oximetry.
    Date August 1991
    Journal The American Journal of Gastroenterology
    Title Effect of Proteins on Water and Transport Properties of Various Hydrogel Contact Lens Materials.
    Date July 1991
    Journal Current Eye Research
    Excerpt

    The effect of adsorbed substances on the properties of the water in various hydrogel contact lens materials was examined by exposing contact lenses (Hydron Zero 4, B&L 70, DuraSoft 3, Vistamarc, and Acuvue) to an artificial tear solution for various periods up to 14 days. The only materials affected were the high-water/ionic lenses which adsorbed a large amount of protein, predominantly lysozyme. In the DuraSoft 3 lenses the equilibrium water content (EWC) dropped from 49% to 46% and the freezing water from 28% to 21%. Similar changes were seen with the Vistamarc lenses. After a 10-day exposure of the Acuvue lens to artificial tears, the EWC decreased from 53% to 47% and the amount of freezing water from 33% to 23%. The decrease in the permeability of water seen with these materials was consistent with the decrease of the freezing water, i.e., the water able to participate in diffusion. Since the content of freezing water determines the transport through hydrogels it can be expected that any lens characteristics that depend upon the amount of this portion of water would be affected by the presence of proteins inside the polymer matrix. We extrapolated that an absolute change of 10% in the amount of freezing water could lead to a decrease in oxygen permeability of as much as 7 Dk units. In view of this work more attention should be given to changes in the properties of lenses during wear, in particular, in the high-water/ionic lenses.

    Title Mesenteric Vascular Disease Associated with Hypergastrinemia and Positive Secretin Stimulation Study.
    Date May 1991
    Journal The American Journal of Gastroenterology
    Title Pancreatic Fracture Secondary to Child Abuse: the Role of Computed Tomography in Its Diagnosis.
    Date February 1991
    Journal Clinical Pediatrics
    Title Endoscopic Appearance and Significance of Functional Lymphangiectasia of the Duodenal Mucosa.
    Date November 1990
    Journal Gastrointestinal Endoscopy
    Excerpt

    Intestinal lymphangiectasia is found in a wide variety of pathologic conditions. Functional lymphangiectasia has not been well characterized. We report 20 patients followed for 9 to 55 months (mean 30 months) after incidental detection at endoscopy of lymphangiectasia. Our study indicates that functional lymphangiectasia is not pathologic and does not warrant repeat endoscopy in the absence of other clinical indications.

    Title Candida Cellulitis: a Complication of Percutaneous Endoscopic Gastrostomy.
    Date January 1990
    Journal Gastrointestinal Endoscopy
    Title Acute Type A Hepatitis Presenting with Hypotension, Bradycardia, and Sinus Arrest.
    Date October 1989
    Journal Journal of Medical Virology
    Excerpt

    The cardiovascular complications of viral hepatitis are not widely recognized. Profound hypotension and a variety of dysrhythmias, including sinus arrest, have been reported in association with viral hepatitis, but most of these cases were described before the advent of specific viral serologic markers. Furthermore, previous instances of cardiovascular complications occurred during the course of an established viral syndrome. We report the cases of two previously healthy women who presented with unexplained hypotension and bradycardia as the initial manifestations of acute icteric hepatitis A. This phenomenon appears to represent a variant clinical presentation of a common viral entity.

    Title Video Endoscopy in Percutaneous Endoscopic Gastrostomy Tube Placement.
    Date September 1989
    Journal Gastrointestinal Endoscopy
    Title Amebic Colitis Masquerading As Acute Inflammatory Bowel Disease: the Role of Serology in Its Diagnosis.
    Date September 1989
    Journal Journal of Clinical Gastroenterology
    Excerpt

    Amebic colitis needs to be considered in the differential diagnosis of infectious colitis or inflammatory bowel disease (IBD). Misdiagnosing amebic colitis as idiopathic inflammatory disease may be fatal. Although stool studies remain the initial approach to diagnosis, the incidence of false-negatives associated with this method is high. We report two cases of amebic colitis presenting as inflammatory bowel disease in which the diagnosis of amebic colitis was made by serology. Neither patient had any risk factors for acquiring amebiasis. Paired serology for amebic infections (2-4 weeks apart) should be performed in patients being evaluated for infectious colitis and inflammatory bowel disease.

    Title Campylobacter Pylori: "all That Glitters is Not Gold".
    Date July 1989
    Journal The American Journal of Gastroenterology
    Title Large-volume Paracentesis in Outpatients.
    Date February 1989
    Journal Annals of Internal Medicine
    Title At Least Two Mutant Alleles of Ornithine Delta-aminotransferase Cause Gyrate Atrophy of the Choroid and Retina in Finns.
    Date February 1989
    Journal Proceedings of the National Academy of Sciences of the United States of America
    Excerpt

    Gyrate atrophy of the choroid and retina (GA) is an inherited chorioretinal degeneration caused by deficiency of ornithine delta-aminotransferase (OAT; L-ornithine: 2-oxo-acid aminotransferase; EC 2.6.1.13). GA is one of the "Finnish genetic diseases," a group of several rare monogenic disorders that occur with increased frequency in the Finnish population. Using a combination of RNase A protection, genomic cloning, and polymerase chain reaction amplification of genomic DNA, we found one of two missense mutant OAT alleles to be present in each of 16 Finnish GA pedigrees. The first mutation R180T, in which arginine-180 is replaced by threonine, was present in homozygous form in patients from two pedigrees. The second mutation L402P, in which leucine-402 is replaced by proline, was present in homozygous form in patients from 14 pedigrees. Neither mutation was present in 19 Finnish controls. L402P was not present in 18 non-Finnish GA patients but R180T was found in an American GA patient. We constructed full-length mutant cDNAs by amplifying patient cDNA with the polymerase chain reaction and cloning a restriction fragment containing the mutation into an otherwise normal human OAT cDNA. These mutant cDNAs were then expressed in CHO-K1 cells, which lack endogenous OAT. Both R180T and L402P inactivate OAT. These results show molecular heterogeneity in GA alleles even in the Finnish population.

    Title Microscopy Motion Sickness.
    Date July 1988
    Journal The New England Journal of Medicine
    Title Optimum Anesthesia with Intrapleural Lidocaine During Chemical Pleurodesis with Tetracycline.
    Date April 1988
    Journal Chest
    Excerpt

    Chemical pleurodesis with tetracycline is frequently complicated by pleuritic chest pain. The most promising approach to control pain is to optimize the use of intrapleural lidocaine. While administering amounts of intrapleural lidocaine larger than commonly reported, we attempted to determine a safe and more effective dose, by using a subjective and objective assessment of pain, by measuring serum concentrations of lidocaine, and by observing patients for possible toxic effects of lidocaine. Chemical pleurodesis with tetracycline was performed on ten patients receiving an intrapleural dose of 200 mg of lidocaine (group 1) and on ten patients receiving a 250-mg dose (group 2). A significantly greater number of patients in group 2 were free of pain following pleurodesis (7/10 vs 1/10; p = 0.006). Of the 80 serum lidocaine levels obtained, only one value (6.1 micrograms/ml), in an asymptomatic patient in group 1, exceeded the therapeutic range (1.5 micrograms/ml to 5.5 micrograms/ml). One patient in group 2 experienced transient numbness of the right hand, a possible side effect of lidocaine. We conclude that to achieve optimum anesthesia during chemical pleurodesis with tetracycline, it is necessary to use doses of intrapleural lidocaine large than previously reported. Until the feasibility of a further escalation is demonstrated, 250 mg should be considered the standard dose.

    Title Keratoconus in a Rhesus Monkey.
    Date March 1988
    Journal Journal of Medical Primatology
    Excerpt

    A 15-year-old female rhesus monkey was observed to have bilaterally thinned and prominently curved corneas. Slit lamp observations, pachymetry, keratometry, and corneoscopy were consistent with a diagnosis of keratoconus, a relatively common corneal dystrophy in humans heretofore not described in a subhuman primate.

    Title Myopic Hydrogel Keratophakia. Improvements in Lens Design.
    Date December 1987
    Journal Cornea
    Excerpt

    In order for a refractive surgical procedure to be generally accepted, it must give a predictable result as well as generate a suitable optical surface. Previously, in a non-human primate model, we showed that hydrogel intracorneal lenses could flatten the cornea and thereby be used as a potential treatment for myopia. Over 20 D of central corneal flattening was observed in some cases. It was evident that the major corneal flattening occurred only in a very small area covered by the first corneascopic ring and that this area was irregular in that an elliptical reflection was generally obtained. We herein present the results of myopic hydrogel lens design modification. By enlarging the size of the lens and optical zone, the central corneal flattening became more regular as judged by corneascopic analysis. With the most recent lens designs, animals with high-minus implants showed circular corneascopic images with an average of 10.0 D of central flattening. This observation of corneal flattening was confirmed with autorefractor readings (average, -8.5 D) and keratometric readings (average, -9.0 D). These results are compared with earlier lens implants 5.5 mm in diameter where flattening was documented by reading the central corneascopic ring and could not be confirmed with either keratometric or autorefractor data. We feel these preliminary attempts at lens design modification have significantly enhanced the potential for future clinical application of this technique.

    Title Synthetic Keratophakia for the Correction of Aphakia.
    Date November 1987
    Journal Ophthalmology
    Excerpt

    Although the majority of aphakic patients will have intraocular lens implants (IOLs), there are several groups of patients for whom IOLs are not indicated. Synthetic keratophakia for the correction of aphakia has several inherent advantages over alternative forms of refractive surgery which use lathed corneal tissue. For example, the ability to produce a synthetic lens to precise specifications before surgery is a dramatic advantage over the use of lathed tissue lenses whose refractive properties cannot be determined until weeks or months after the lens is in place on the recipient cornea. Synthetic materials appear to behave in a predictable manner and are biocompatible. Both polysulfones and hydrogel materials can be used to correct aphakia in clinical situations where other modalities are less appropriate.

    Title Hemophilia A. Detection of Molecular Defects and of Carriers by Dna Analysis.
    Date October 1985
    Journal The New England Journal of Medicine
    Excerpt

    To understand the molecular basis of hemophilia A and to provide heterozygote detection and prenatal diagnosis by DNA analysis, we used cloned factor VIII:C DNA fragments to study 10 affected families. In four of these families, inhibitors of factor VIII:C had developed in affected persons. In one such family a deletion of approximately 80 kb within the factor VIII:C gene was identified. Carriers of the deletion were identified through detection of an abnormal DNA fragment located at the deletion end points. In another family a single nucleotide change in the coding region of the factor VIII:C gene produced a nonsense codon leading to premature termination of factor VIII:C synthesis. Carrier detection was performed in eight female members of this four-generation family. In a third family a small change in the size of a restriction-endonuclease fragment correlated with the presence of the mutant gene, and in the other seven families the molecular defect has not yet been identified. In addition, we used two common polymorphic sites in the factor VIII:C gene to differentiate the normal from the defective gene in four of six obligate female carriers from families with patients in whom inhibitors did not develop. Carrier detection was possible in other members of these families. These data suggest that DNA analysis of the factor VIII:C gene provides an accurate method of carrier detection and, potentially, of prenatal diagnosis in at least 50 per cent of the pedigrees affected by hemophilia A.

    Title Linkage Map on Chromosome 21q and the Association of a Dna Haplotype with a Propensity to Nondisjunction and Trisomy 21.
    Date August 1985
    Journal Annals of the New York Academy of Sciences
    Title Analysis of Dna Haplotypes Suggests a Genetic Predisposition to Trisomy 21 Associated with Dna Sequences on Chromosome 21.
    Date June 1985
    Journal Proceedings of the National Academy of Sciences of the United States of America
    Excerpt

    To test the hypothesis that there is a genetic predisposition to nondisjunction and trisomy 21 associated with DNA sequences on chromosome 21, we used DNA polymorphism haplotypes for chromosomes 21 to examine the distribution of different chromosomes 21 in Down syndrome and control families from the same ethnic group. The chromosomes 21 from 20 Greek families with a Down syndrome child and 27 control Greek families have been examined for DNA polymorphism haplotypes by using four common polymorphic sites adjacent to two closely linked single-copy DNA sequences (namely pW228C and pW236B), which map somewhere near the proximal long arm of chromosome 21. Three haplotypes, +, +---, and - with respective frequencies of 43/108, 24/108, and 23/108, account for the majority of chromosomes 21 in the control families. However, haplotype - was found to be much more commonly associated with chromosomes 21 that underwent nondisjunction in the Down syndrome families (frequency of 21/50; X2 for the two distributions is 9.550; P = 0.023; degrees of freedom, 3). The two populations (control and trisomic families) did not differ in the distribution of haplotypes for two DNA polymorphisms on chromosome 17. The data from this initial study suggest that the chromosome 21, which is marked in Greeks with haplotype - for the four above described polymorphic sites, is found more commonly in chromosomes that participate in nondisjunction than in controls. We propose an increased tendency for nondisjunction due to DNA sequences associated with a subset of chromosomes 21 bearing this haplotype.

    Title Assessment of Cervical Carotid Artery Disease. A Comparison Between the Doppler "echoflow" and Conventional Angiography.
    Date June 1985
    Journal The Medical Journal of Australia
    Excerpt

    Carotid artery disease is an important factor in the aetiology of stroke and cerebrovascular insufficiency. Angiography remains the definitive technique for the investigation of the carotid arteries, but the risk and expense involved has stimulated research into suitable non-invasive techniques. A comparison between a velocity-sensitive, colour-coded Doppler principle ultrasound flowmeter (Echoflow) and conventional angiography was conducted on 52 patients (101 arteries) investigated at Royal Perth Hospital over a 16-month period. An acceptable correlation was found in 78% of cases. Echoflow scanning proved to be particularly accurate in assessing normal arteries. Our results support the use of Echoflow as a first line of investigation, and in aiding the selection of cases requiring further study, although we caution against routine angiography in all patients with positive Echoflow scan results.

    Title Type I and Type Ii Mechanisms in the Photosensitized Lysis of Phosphatidylcholine Liposomes by Hematoporphyrin.
    Date December 1982
    Journal Photochemistry and Photobiology
    Title Symptomatic Medial Nephroptosis--an Ultrasonic Diagnosis.
    Date June 1982
    Journal The British Journal of Radiology
    Title Echopattern of the Enlarged Spleen on Ultrasonography.
    Date October 1981
    Journal Australasian Radiology
    Title Ultrasonic Evaluation of Obstructive Jaundice.
    Date October 1981
    Journal Australasian Radiology
    Title Ultrasonic Demonstration of Renal Artery Thrombosis.
    Date July 1981
    Journal The British Journal of Radiology
    Title Simple Waterbath Technique for Grey Scale Ocular Echography Using Commerical Contact Scanners.
    Date March 1980
    Journal Australasian Radiology
    Title The Diagnosis and Treatment of Lymphocoeles Associated with Renal Transplantation. A Report of 6 Cases and a Review of the Literature.
    Date October 1979
    Journal British Journal of Urology
    Excerpt

    Six patients have developed a lymphocoele after renal transplantation, an incidence of 4%. A lymphocoele should be suspected in a patient who develops a rising creatinine with a pelvic mass or pressure effects on the pelvic veins 1 or more months after operation. The diagnosis is confirmed by intravenous urography, venography and ultrasonography: the use of the latter as a diagnostic measure is recommended. Treatment is by marsupialisation into the peritoneum or external drainage with breakdown of all loculi. Aspiration is unsatisfactory.

    Title Simple Waterbath Technique for Thyroid Echography Using Commercially Available Contact Scanner.
    Date May 1979
    Journal Australasian Radiology
    Title Aortic Compliance. Studies on Its Relationship to Aortic Constituents in Man.
    Date January 1973
    Journal Archives of Pathology
    Title Coronary Blood Flow Responses to Intraaortic Balloon Pumping in Dogs Treated with Cardioactive Drugs.
    Date January 1973
    Journal Jaami; Journal of the Association for the Advancement of Medical Instrumentation
    Title Response to Single-segment Intraaortic Balloon Pumping As Related to Aortic Compliance.
    Date July 1972
    Journal The Annals of Thoracic Surgery
    Title Experimental Studies to Design Safe External Pediatric Paddles for a Dc Defibrillator.
    Date June 1972
    Journal Ieee Transactions on Bio-medical Engineering
    Title Comparative Fractionation of Dna from Ascites Tumour and Normal Cells on Hydroxyapatite Column.
    Date April 1969
    Journal Experientia
    Title Induction of Leukemia in Dba (-mti) Mice by Nucleic Acid. Dalton's Lymphoma in Ascites Form.
    Date February 1969
    Journal Indian Journal of Cancer
    Title Increment and Decrement Visual Thresholds.
    Date June 1968
    Journal Journal of the Optical Society of America
    Title Spatial Resolution by the Human Visual System. The Effect of Mean Retinal Illuminance.
    Date May 1967
    Journal Journal of the Optical Society of America
    Title Exposure Profiles and Human Papillomavirus Infection in Skin Cancer: an Analysis of 25 Genus Beta-types in a Population-based Study.
    Date
    Journal The Journal of Investigative Dermatology
    Excerpt

    An increasing number of studies report that genus beta human papillomaviruses (HPVs) are associated with skin cancer, with suggestions of specificity for squamous cell carcinoma (SCC) of the skin. We have conducted a systematic examination of HPV DNA in tumors from immunocompetent hosts, including SCC and basal cell carcinoma (BCC), using a highly sensitive methodology and population-based samples to test the hypothesis that a differential prevalence of beta-HPVs exists between SCC (n=101) and BCC (n=101) tumors. When testing for all known beta-HPV types, we found no significant difference in HPV prevalence between the two histologies. However, SCC lesions were significantly more likely to be infected with HPV genus beta-species 1 (includes types 5 and 8), than BCC samples (P=0.01); this difference was not observed for any other species. A histologic difference was also observed for those HPV types previously reported to be important in skin cancer (P=0.003). SCC samples showed a higher rate of infectivity (that is, were positive for multiple types) than BCC tumors (P=0.02). These data highlight the potential importance of various genus beta-HPV types, in particular genus beta-species 1 in SCC, and support the hypothesis of a behavioral difference of the virus within the two major histological skin cancers.

    Title A Subset of Cranial Fasciitis is Associated with Dysregulation of the Wnt/beta-catenin Pathway.
    Date
    Journal Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc
    Excerpt

    Cranial fasciitis, an unusual fibroproliferative lesion that occurs in the scalp of infants, is considered a posttraumatic reactive process similar to nodular fasciitis. Its pathobiology has not been investigated. Over the last 15 years, we diagnosed cranial fasciitis in six children; in one case, the lesion recurred after 4 years. This lesion and two others showed aberrant, diffuse nuclear reactivity for beta-catenin. One of the lesions with aberrant nuclear beta-catenin occurred in a child with a history of familial adenomatous polyposis (FAP) and a germline frameshift adenomatous polyposis coli (APC) mutation, c.878delG. The other APC allele in this tumor showed an acquired nonsense mutation, c.4132C --> T. Both these mutations lead to translation of a truncated APC protein. The other two cases of cranial fasciitis with aberrant nuclear beta-catenin occurred sporadically. One of these showed a point mutation, c.122C --> T, in exon 3 of CTNNB1. This mutation causes replacement of threonine with isoleucine at codon 41, leading to loss of a phosphorylation site in the beta-catenin protein. The third case with nuclear beta-catenin staining was the single one that showed recurrence. This tumor did not show mutations in exon 3 of CTNNB1 or in exons 8/9/16 of APC. The results of this small study indicate a dysregulation of the Wnt/beta-catenin pathway in a subset of cranial fasciitis, suggesting that this subset is pathobiologically related to desmoid fibromatoses rather than to nodular fasciitis. Occasional cases of cranial fasciitis may be associated with FAP and serve as an early indicator of this disease, information that would be important in the early diagnosis of FAP in patients without a family history of polyposis.Modern Pathology advance online publication, 27 June 2008; doi:10.1038/modpathol.2008.112.

    Title Cellulase Kinetics As a Function of Cellulose Pretreatment.
    Date
    Journal Metabolic Engineering
    Excerpt

    Microcrystalline cellulose (Avicel) was subjected to three different pretreatments (acid, alkaline, and organosolv) before exposure to a mixture of cellulases (Celluclast). Addition of beta-glucosidase, to avoid the well-known inhibition of cellulase by cellobiose, markedly accelerated cellulose hydrolysis up to a ratio of activity units (beta-glucosidase/cellulase) of 20. All pretreatment protocols of Avicel were found to slightly increase its degree of crystallinity in comparison with the untreated control. Adsorption of both cellulase and beta-glucosidase on cellulose is significant and also strongly depends on the wall material of the reactor. The conversion-time behavior of all four states of Avicel was found to be very similar. Jamming of adjacent cellulase enzymes when adsorbed on microcrystalline cellulose surface is evident at higher concentrations of enzyme, beyond 400U/L cellulase/8kU/L beta-glucosidase. Jamming explains the observed and well-known dramatically slowing rate of cellulose hydrolysis at high degrees of conversion. In contrast to the enzyme concentration, neither the method of pretreatment nor the presence or absence of presumed fractal kinetics has an effect on the calculated jamming parameter for cellulose hydrolysis.

    Title Central Pontine Myelinolysis As a Complication of Refeeding Syndrome in a Patient with Anorexia Nervosa.
    Date
    Journal The Journal of Neuropsychiatry and Clinical Neurosciences
    Title Potency Trends of Δ9-thc and Other Cannabinoids in Confiscated Cannabis Preparations from 1993 to 2008.
    Date
    Journal Journal of Forensic Sciences
    Excerpt

    The University of Mississippi has a contract with the National Institute on Drug Abuse (NIDA) to carry out a variety of research activities dealing with cannabis, including the Potency Monitoring (PM) program, which provides analytical potency data on cannabis preparations confiscated in the United States. This report provides data on 46,211 samples seized and analyzed by gas chromatography-flame ionization detection (GC-FID) during 1993-2008. The data showed an upward trend in the mean Δ(9)-tetrahydrocannabinol (Δ(9)-THC) content of all confiscated cannabis preparations, which increased from 3.4% in 1993 to 8.8% in 2008. Hashish potencies did not increase consistently during this period; however, the mean yearly potency varied from 2.5-9.2% (1993-2003) to 12.0-29.3% (2004-2008). Hash oil potencies also varied considerably during this period (16.8 ± 16.3%). The increase in cannabis preparation potency is mainly due to the increase in the potency of nondomestic versus domestic samples.

    Title Improvecarenow: The Development of a Pediatric Inflammatory Bowel Disease Improvement Network.
    Date
    Journal Inflammatory Bowel Diseases
    Excerpt

    There is significant variation in diagnostic testing and treatment for inflammatory bowel disease. Quality improvement science methods can help address unwarranted variations in care and outcomes.

    Title Short Pediatric Crohn's Disease Activity Index for Quality Improvement and Observational Research.
    Date
    Journal Inflammatory Bowel Diseases
    Excerpt

    Practical and objective instruments to assess pediatric Crohn's disease (CD) activity are required for observational research and quality improvement. The objectives were: 1) to determine the feasibility of completing the Pediatric Crohn's Disease Activity Index (PCDAI) and the Abbreviated PCDAI (APCDAI); and 2) to create a Short PCDAI by retaining and reweighting the most practical and informative components.

    Title Vesicovaginal Fistula: An Unusual Complication of Laparoscopic Assisted Nephroureterectomy.
    Date
    Journal Journal of Minimal Access Surgery
    Excerpt

    We report a case of vesicovaginal fistula in 71-year-old lady who had previously undergone a lapascopic assisted nephroureterectomy for transitional cell carcinoma in her right ureter and kidney. The surgery was uncomplicated with no post-operative problems and was discharged on day on seven. She later presented five weeks following the initial operation with signs and symptoms suggestive of a vesicovaginal fistula, which was confirmed on cystogram and flexible cystosopy. She proceeded to have an abdominal (O'Connor's) repair of the fistula together with cystodiathermy for a few superficial bladder recurrences. The area of the fistula (within the bladder) was noted to be tumour free. She had an uneventful post-operative recovery and was discharged from hospital on day 11. At six month follow-up, there was another superficial recurrence in the bladder that was resected, with no sign of fistula.

    Title Prevalence and Epidemiology of Overweight and Obesity in Children with Inflammatory Bowel Disease.
    Date
    Journal Inflammatory Bowel Diseases
    Excerpt

    BACKGROUND:: Obesity is a significant public health threat to children in the United States. The aims were to: 1) Determine the prevalence of obesity in a multicenter cohort of children with inflammatory bowel disease (IBD); 2) Evaluate whether overweight and obese status is associated with patient demographics or disease characteristics. METHODS:: We used data from the ImproveCareNow Collaborative for pediatric IBD, a multicenter registry of children with IBD, collected between April 2007 and December 2009. Children ages 2-18 years were classified into body mass index (BMI) percentiles. Bivariate analyses and multivariate logistic regression were used to compare demographic and disease characteristics by overweight (BMI >85%) and obese (BMI >95%) status. RESULTS:: The population consisted of 1598 children with IBD. The prevalence of overweight/obese status in pediatric IBD is 23.6%, (20.0% for Crohn's disease [CD] and 30.1% for ulcerative colitis [UC] and indeterminate colitis [IC]). African American race (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.10-2.48) and Medicaid insurance (OR 1.67, 95% CI 1.19-2.34) were positively associated with overweight/obese status. Prior IBD-related surgery (OR 1.73, 95% CI 1.07-2.82) was also associated with overweight and obese status in children with CD. Other disease characteristics were not associated with overweight and obesity in children with IBD. CONCLUSIONS:: Approximately one in five children with CD and one in three with UC are overweight or obese. Rates of obesity in UC are comparable to the general population. Obese IBD patients may have a more severe disease course, as indicated by increased need for surgery. Sociodemographic risk factors for obesity in the IBD population are similar to those in the general population. (Inflamm Bowel Dis 2010;).


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