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The majority of men treated for localized prostate cancer are cured of their disease. As a result, it is important to discuss long-term quality of life (QoL) expectations when counseling patients regarding treatment options. The varying QoL outcomes for radical prostatectomy, external beam radiotherapy, brachytherapy, and cryotherapy will be reviewed.

First published July 12, 2001; 10.1152/ajprenal.00355.2001.— A decrease in blood pH may be due to either a reduction in bicarbonate concentration ([HCO3−]; metabolic acidosis) or to an increase in Pco2(respiratory acidosis). In mammals, metabolic, but not respiratory, acidosis increases urine calcium excretion without altering intestinal calcium absorption, indicating that the additional urinary calcium is derived from bone. In cultured bone, chronic metabolic, but not respiratory, acidosis increases net calcium efflux (JCa), decreases osteoblastic collagen synthesis, and increases osteoclastic bone resorption. Metabolic acidosis increases bone PGE2production, which is correlated with JCa, and inhibition of PGE2production inhibits this acid-inducedJCa. Given the marked differences in the osseous response to metabolic and respiratory acidosis, we hypothesized that incubation of neonatal mouse calvariae in medium simulating respiratory acidosis would not increase medium PGE2levels, as observed during metabolic acidosis. To test this hypothesis, we determined medium PGE2levels and JCafrom calvariae incubated at pH ∼7.1 to model either metabolic (Met; [HCO3−] ∼11 mM) or respiratory (Resp; Pco2∼83 Torr) acidosis, or at pH ∼7.5 as a control (Ntl). We found that after 24–48 and 48–51 h in culture, periods when cell-mediated JCapredominates, medium PGE2levels andJCawere increased with Met, but not Resp, compared with Ntl, and there was a direct correlation between medium PGE2levels and JCa. Thus metabolic, but not respiratory, acidosis induces the release of bone PGE2, which mediates JCafrom bone.

Metabolic acidosis induces bone calcium efflux initially by physicochemical dissolution and subsequently by cell-mediated mechanisms involving inhibition of osteoblasts and stimulation of osteoclasts. In rat kidney, acidosis increases endogenous prostaglandin synthesis, and in bone, prostaglandins are important mediators of resorption. To test the hypothesis that acid-induced bone resorption is mediated by prostaglandins, we cultured neonatal mouse calvariae in neutral or physiologically acidic medium with or without 0.56 μM indomethacin to inhibit prostaglandin synthesis. We measured net calcium efflux and medium PGE2levels. Compared with neutral pH medium, acid medium led to an increase in net calcium flux and PGE2levels after both 48 h and 51 h, a time at which acid-induced net calcium flux is predominantly cell mediated. Indomethacin inhibited the acid-induced increase in both net calcium flux and PGE2. Net calcium flux was correlated directly with medium PGE2(r= 0.879,n= 29, P< 0.001). Exogenous PGE2, at a level similar to that found after acid incubation, induced net calcium flux in bones cultured in neutral medium. Acid medium also stimulated an increase in PGE2levels in isolated bone cells (principally osteoblasts), which was again inhibited by indomethacin. Thus acid-induced stimulation of cell-mediated bone resorption appears to be mediated by endogenous osteoblastic PGE2synthesis.

In the choice of grafts and flaps for lid repair epidermic grafts may be employed. The technic of cutting such grafts and the after care of them is discussed. Details of operations for ectropion and Symblepharon with restoration of the cul-de-sac are particularly considered. Read before the American Academy of Ophthalmology and Oto-Laryngology, September 24, 1926.

In 1929 I prepared a report for the International Congress of Ophthalmology on the method of under-graduate and postgraduate teaching in Great Britain and her dominions and in North and South America. The report as it pertains to the undergraduate teaching in this country need not concern us here. There is one point in the postgraduate teaching in this country, however, that may be of interest. Questionnaires were sent to all the class A colleges, requesting a statement concerning the facilities for postgraduate instruction in ophthalmology, and replies were received from forty. Of these, seven were reported as offering a systematic postgraduate course in ophthalmology. It is quite impossible to state definitely the number of institutions in which postgraduate training is given for the reason that, in the classification, some reports include only those giving announced courses, while others include those giving instruction to the resident staff. The latter, it

A report of ten cases of intra-ocular sarcoma in children is made from the records of the ophthalmic clinic of the University of Michigan. The pathologic material was examined in the department of pathology under the direction of Dr. A. S. Warthin, to whom we are indebted for the final diagnosis made in each of the cases submitted.In the ten cases, fourteen eyes were affected clinically and eleven were made available for pathologic study. In four cases (6, 7, 8 and 9), both eyes were involved. In case 9, the second eye was enucleated after death and the pathologic findings are included in this report. In eight cases the history showed no evidence of an hereditary tendency. In two cases (8 and 9) the history was unknown, although the patients were sisters, each having both eyes affected. In six cases the orbit was subjected to roentgen-ray therapy after exenteration

This is the report of a comparative study of results obtained in 1,421 cataract operations performed in the author's private practice and the ophthalmic clinic of the University of Michigan. Presented to the Section on Ophthalmology of the American Medical Association, June, 1921. Published here by courtesy of the Journal of the A. M. A.

These are reviewed under the heads; amblyopia, paralysis of extrinsic muscles, changes in refraction, xanthelasma, iritis, cataract, retinitis, neuritis and retinal lipemia. A case of glaucoma is reported, illustrating the need of blood examination for sugar. Lecture before the Section of Instruction, American Academy of Ophthalmology and Oto-Laryngology, Montreal meeting, 1924.

The majority of systematic writers on hysteria assert that the most common ocular stigma of this neurosis is a concentrically contracted field of vision. From time to time, however, suggestions have been made intimating the possibility of error in this statement. As my experience seems rather to agree with the minority, I determined to tabulate a relatively small number of cases, the records of which were complete, and present conclusions from this series alone. The results here obtained, however, agree with the findings in a much larger number of cases, the records of which are too incomplete for publication.Whether the lesion in hysteria be central or peripheral, whether due to anesthesia of the retina, or entirely a matter of suggestion, is not to be considered in this paper.The cases are all from the neurological or ophthalmological clinic in the University of Michigan. Dr.

In general, there are three principal theories advanced to account for the causation of choked disk: the inflammatory, the toxic or chemical and the mechanical. In addition to these theories, it has been suggested that various combinations of the factors involved in them may be regarded as the possible cause of the swelling of the disk in cases of increased intracranial pressure.The mechanical theory of the causation of choked disk depends on increased intracranial pressure, increased intravaginal pressure, disturbance of the return blood flow and obstruction of lymph flow through the intravaginal to the subarachnoid spaces. Whether or not the increased intracranial pressure must be associated with increase in the amount of cerebrospinal fluid is still in dispute.The original theory of von Graefe that the increase of intracranial pressure caused by a tumor led to compression of the cavernous sinus, and that this gave rise to an engorgement

With comparative review of the literature as to the various details, two cases of retinal lipemia are reported, in which the relationship of acidosis to the occurrence, disappearance, and recurrence of the phenomenon in the retinal vessels was carefully traced. No disease except diabetes uncomplicated by treatment produces lipemia of sufficient degree to be recognized ophthalmoscopically. Diabetics probably do not show retinal lipemia unless they are in acidosis. Approximately, retinal lipemia occurs when blood fats rise above 3.5 percent, and disappears when the blood fats fall below 2.5 percent. From the department of ophthalmology, University of Michigan.

By ophthalmia nodosa is understood an affection of the eye caused by the entrance into the tissues of the eyeball of the hair of certain varieties of caterpillar. It was first described by Pagenstecher1 in 1883 as "caterpillar-hair ophthalmia," later by Wagenmann2 as "pseudotuberculosis," and by Saemisch as "ophthalmia nodosa." It shows a tendency to form tubercle-like structure, often showing nodules appearing singly or in crops, progressing mostly with exacerbation and remissions. The patient does not always give a history of caterpillar contact, the diagnosis being made with the aid of the microscope.We are indebted for studies on this subject to Baas,3 Wagenmann,2 Hillemann,4 Kruger,5 Lawford,6 Stargardt,7 de Schweinitz and Shumway,8 Teutschlaender9 and others, and for an analysis of the literature to Ginsberg,10 Greeff,11 and Parsons.12The disease is most common among those who work in

After observing the results obtained by Colonel Elliot in treating glaucoma by his corneoscleral trephining operation, it seemed possible that scleral trephining might be utilized in the treatment of detachment of the retina.May 19, 1913, the first operation was performed, and since that time fifteen operations have been made on eleven patients, all of which are included in this report.Two operations were performed in Case 7, also in Case 8, and three in Case 9. In Cases 1 and 2, the sclera was trephined over the site of the detachment without incising the choroid and retina. In all the other cases, in addition to trephining the sclera, an incision with a cataract knife was made in the choroid or the choroid and retina, and the subretinal fluid, and, in most instances, a few drops of vitreous, were allowed to escape. TECHNIC The operation may be described in detail

In presenting the subject which I have chosen for your consideration today, I shall depart somewhat from the traditions of the section, and invite your attention to a purely medical topic.Some years ago in an effort to collect a large number of tonometric readings in order to determine the average normal tension of the eyeball, I had the tension taken of the eyes of all the patients in the hospital and outpatient department, whenever possible. Among this number were six cases of brain tumor. Some time later when compiling the histories of the brain tumor cases, I observed that when the amount of the choked disk was the same in the two eyes, the tension was equal or nearly so, and when the swelling was greater in one eye than in the other, the tension was different in the two eyes, being least in the one showing the greater

Seventeen cases previously reported in the literature are reviewed and two new cases added. As regards the obscure etiology it has been suggested on the one hand that the uveal tract is first affected, changes in the other pigmented structures being due to anaphylaxis from the disseminated uveal pigment; and on the other hand that all the changes are due to a common source of infection. Read before the Chicago Ophthalmological and the Chicago Otolaryngological Societies at a joint meeting with the American Academy of Ophthalmology and Otolaryngology, October 21, 1930.

The possibility of involvement of the orbit or its contents in diseases of the nose and accessory sinuses has been so well established from an anatomic point of view as to need no further proof. It is only necessary to study the investigations of Onodi, Birch-Hirschfeld and Loeb to be convinced of this fact. When considered from a clinical point of view, however, the frequency of the association is less constant than the anatomic investigations might lead one to suppose. While in many cases the causal connection is obvious, there are others in which a relation is difficult or indeed impossible to establish.Diseases are excited in the eye through the nose by direct communication, in the orbit through the anatomic relations of the accessory sinuses, through nervous reflex action, and as a result of general toxemia. It is not always easy from subjective symptoms alone to determine whether the

The first description of postoperative psychoses dates back to the sixteenth century when Para called attention to the occurrence of mental symptoms after operations. In 1819 Depuytren described a "delirium nervosum" which occurred in the first three days after an operation, and in 1842 psychoses after eye operations were reported by Sherzog. Sichel1 in 1863 described a peculiar delirium which he had observed seven or eight times in the wake of cataract operations. All the patients were over 60 years old. He attributed it to sealing the lids and thought the mental effect similar to homesickness. Arlt2 wrote in 1874:The second eye isncovered before the fourth day only when the patient becomes restless because of darkness. In old patients, much run down, timid and nervous, mental disturbances may occur during the first few days after the operation.I have been unable to find a classification from the standpoint of the psychiatrist. Evidently no single form of mental disturbance is characteristic of postoperative delirium. Hurd3 would limit the cases to those clearly the

I wish to express to the officers and fellows of the College of Physicians of Philadelphia my appreciation of the honor they have conferred on me by extending an invitation to deliver the second de Schweinitz lecture. I have chosen to present a second review of the published records of severe cases of uveitis with associated alopecia, poliosis, vitiligo and deafness.In 1931 I reported 2 cases of uveitis with associated alopecia, poliosis, vitiligo and deafness and reviewed the records of 17 other cases found in the literature, basing my conclusions on the total of 19 cases.1 Since that time 10 additional cases have been reported. Five of these were reported from Cuba, 2 by Yanes and Ferrer2 and 3 by Avalos,3 1 was reported from China, by Luo,4 and 1 from South America, by Weskamp,5 and 3 were reported from the United States, 2

This report of 450 cases of extraction of senile cataract is offered as a study of the comparative results obtained by the use of the combined, simple and intracapsular methods of operation and is in no way a brief for any one procedure. Each method of operation was used in 150 cases. The cases in which the combined method was used were all from private records; those in which the simple method was used were from private and clinical records, and those in which the intracapsular method was used were all from clinical records. The clinical records were from the ophthalmological department of the University of Michigan.The cases selected for the simple operation were presumably uncomplicated; the corneas were large, the pupils were dilatable and the patients were well behaved. The cases selected for the intracapsular operation (performed according to the Knapp-Török method) were presumably uncomplicated ; the

An attempt was made by the International Congress of Ophthalmology in 1929 to gather information concerning the method of presenting the subject of ophthalmology to undergraduate and postgraduate students in all the countries of the world, and I was assigned the task of collecting the data from England and her dominions and from North and South America. With your permission I shall draw on some of the material collected for that report. In this country, letters were sent to the colleges and universities in "Class A" group as graded by the American Medical Association, requesting information on the number of hours devoted to the teaching of ophthalmology, together with the method of presenting the subject before the undergraduate students. Replies were received from forty colleges and universities. From these data the following facts were assembled: In six institutions ophthalmology is not taught as a special subject. In the

The subject of simple glaucoma is one about which so much has been written that it is with some temerity I even venture to make a suggestion concerning its management. I shall, however, begin by presenting the results obtained from the use of epinephrine and a proprietary epinephrine substitute (Link's Glaucosan) in a limited number of cases, and give the comparative results obtained following iridectomy and the trephine operation.CLASSIFICATION AFTER TREATMENTIf ophthalmologists were to make a post-treatment classification of patients assumed to have simple glaucoma, the following grouping might be possible :The type in whom spontaneous recovery occurs.The type in whom the condition will be arrested by general treatment and the use of miotics.The type in whom it will be arrested by proper surgical intervention.The type in whom the condition will progress in spite of all efforts.Type 1.—This type includes patients with

Choroideremia may be classified as a bilateral developmental abnormality in which the entire choroid, except a small area in the region of the macula, is absent. The central vision may be normal, but there is always a marked contraction of the visual fields, usually associated with night-blindness. The condition was first described in 1872 by Ludwig Mauthner.1 He disagreed with Leber, who thought that these cases could be classified in the retinitis pigmentosa group. While the pathology of these cases may not be definitely settled until more observations have been made, including a more thorough study of the histologic and functional characteristics of the condition, most observers believe that choroideremia is the result of a congenital defect and is not due to an inflammatory change.A report of a case is presented, together with an unpublished case, notes of which are furnished by Dr. de Schweinitz,

I. REPORT OF COLONEL ELLIOT'S CASES At the request of Chairman Todd, and with the consent of Colonel Elliot, I have the privilege of presenting to the members of the Section the results of the sclerocorneal trephining operations for the relief of glaucoma performed by Col. R. H. Elliot during his visit to the United States last fall.In preparing this report, circular letters were sent out to those for whom Colonel Elliot operated, and reports of cases were received from the surgeons named in Table 1, to whom I wish to express my sincere appreciation for their hearty cooperation.The classification of results in Table 4 is based on the effect the operation produced on the tension of the eyeball, the data concerning the acuity of vision before and after operation being too meager to justify conclusions.Of the twenty cases in which an iridectomy had been made, either at time

The case here reported and others referred to illustrate the importance and difficulties of the diagnosis of intraocular tumors. Read before the American Ophthalmological Society, June 1920.

This report of 300 cases of cataract extraction, from the Ophthalmologic Clinic of the University of Michigan, is offered primarily as a study of the comparative results obtained in three series of 100 consecutive cases in which operation was performed respectively by the combined, the simple and the Knapp-Torok methods of procedure. As a matter of record, there is included a table showing the incidence of the following complications: loss of vitreous, spontaneous hemorrhage, iris prolapse, infection, secondary glaucoma, average astigmatism and cataract delirium. Cases in which iridectomy had been performed previously, either as a preliminary to extraction or for the relief of glaucoma, are omitted from the series.The compilation of the visual results obtained after the cataract operation is usually made after one of two procedures has been followed. Either the percentage of the total number operated with a visual acuity of 6/12 or better is reported, or

Cases of neurofibromata (pseudo-neuromata, solitary neuromata) of the orbit are extremely rare, there being but two cases on record. Of these, one reported by Tersch1 involved the lachrymal branch, and one reported by Marchetti2 the infraorbital branch of the fifth nerve.The ophthalmic division of the fifth nerve has been involved in multiple neuromata, and Bietti3 has described amputation neuromata of the ciliary nerves after optic-ciliary-neurotomy. Houel4 has described small tumors of the third, fourth, nasal and frontal branches of the fifth nerve, found postmortem, which had never caused clinical symptoms.The extreme rarity of neurofibromata is shown by the following statement of Tersch: "A solitary neuroma is altogether a rare tumor and its location in the orbit appears at least a curiosity;" and of Marchetti, who, after eliminating the plexiform neuromata as described by Billroth and others, says: "The exposition of the case shows its