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Purpose: To determine the safety and efficacy of autogenous palmaris longus tendon as a sling material in frontalis suspension surgery for ptosis correction in children., Methods: In a prospective study, the authors evaluated 15 frontalis sling suspension surgeries using palmaris longus tendon in 14 consecutive children with congenital ptosis. The method of harvesting the palmaris longus tendon is described in detail., Results: The mean age of the patients was 4.7 years (range, 2 to 7 years). At a mean follow-up of 30 months (range, 20 to 40 months), all ptotic eyelids were successfully corrected with good final lid position. No recurrence of ptosis was encountered. In one eye, knot slippage of the sling was related to upper eyelid trauma, which was readily repaired. Otherwise, no exposure keratitis, wound infection, eyelid contour abnormality, or ptosis overcorrection occurred. There were no complications associated with the palmaris longus tendon donor site., Conclusion: Frontalis suspension with autogenous palmaris longus tendon appears to be an effective treatment for congenital ptosis with poor levator function in children. Its use as an alternative material to fascia lata for sling surgery in children can be considered.

Objective: The purpose of the study is to investigate the rate and degree of ocular-hypertensive response to topical steroids in Chinese children., Design: The study design was an institutional, randomized, clinical trial., Participants: A total of 19 consecutive patients were studied., Intervention: Topical steroids were administered to Chinese children younger than 10 years of age who underwent bilateral strabismus surgery. One eye was randomized to receive topical 0.1% dexamethasone (DMS), whereas the fellow eye received 0.1% fluorometholone (FML) six times per day for up to 4 weeks. Intraocular pressure (IOP) was measured on the day before operation and at postoperative days 1, 3, 6, 10, 13, and 27, then every 2 weeks thereafter until the IOP fell to preoperative levels. Topical steroids would be stopped if IOP was 30.00 mmHg or greater., Main Outcome Measures: Peak IOP and maximal change of IOP from baseline were measured and categorized into low, intermediate, and high levels. Time to peak IOP also was studied., Results: A total of 16 patients were included. The peak IOP for DMS-treated eyes was 30.66 +/- 8.35 mmHg (range, 13.00-48.00 mmHg), whereas that in FML-treated eyes was significantly lower at 20.66 +/- 6.03 mmHg (range, 11.30-36.30 mmHg) (P = 0.001). The maximal change in IOP ranged from -2.60 to +31.00 mmHg in DMS-treated eyes (mean, 15.48 +/- 8.71 mmHg), almost double that of FML-treated eyes (range, +1.00 to +17.00 mmHg; mean, 5.83 +/- 4.96 mmHg) (P = 0.001). When the ocular-hypertensive responses of both DMS and FML groups were categorized into three levels of severity, significant differences were found between the two treatment groups (P = 0.001). In the DMS group, nine patients (56.25%) were high responders and six patients (37.5%) were intermediate responders. In the FML group, only one patient (6.25%) was a high responder., Conclusions: The ocular-hypertensive response to topical DMS in children occurs more frequently, more severely, and more rapidly than that reported in adults. A total of 56% of the studied children, all younger than 10 years of age, were high responders to topical DMS. Of these, 89% attained their peak IOP within 8 days. Its use in children should best be avoided if possible. It would be desirable to monitor the IOP when it is being used. Conversely, FML produced a much less ocular-hypertensive effect and therefore poses an acceptable risk of clinically significant pressure elevation.

Objectives: To evaluate the effects of a brief educational program on beliefs, knowledge, and behaviors related to skin cancer control among internal medicine housestaff and attending physicians., Design: Randomised controlled trial., Setting: Urban academic general medicine practice., Participants: Internal medicine housestaff and attending physicians with continuity clinics at the practice site., Intervention: Two 1-hour educational seminars on skin cancer control conducted jointly by a general internist and a dermatologist., Measurements and Main Results: Self-reported attitudes and beliefs about skin cancer control, ability to identify and make treatment decisions on 18 skin lesions, and knowledge of skin cancer risk factors were measured by a questionnaire before and after the teaching intervention. Exit surveys of patients at moderate to high risk of skin cancer were conducted 1 month before and 1 month after the intervention to measure physician skin cancer control practices reported by patients. Eighty-two physicians completed baseline questionnaires and were enrolled in the study, 46 in the intervention group and 36 in the control group. Twenty-five physicians attended both sessions, 11 attended one, and 10 attended neither. Postintervention, the percentage of physicians feeling adequately trained increased from 35% to 47% in the control group (p = .34) and from 37% to 57% in the intervention group (p = .06). Intervention physicians had an absolute mean improvement in their risk factor identification score of 6.7%, while control physicians' mean score was unchanged (p = .06). Intervention and control physicians had similar increases in their postintervention lesion identification and management scores. Postintervention, the mean proportion of patients per physician stating they were advised to watch their moles increased more among intervention physicians than control physicians (absolute difference of 19% vs -8%, p = .04). Other changes in behavior were not significant., Conclusions: Although we observed a few modest intervention effects, overall this brief skin cancer education intervention did not significantly affect primary care physicians' skin cancer control attitudes, beliefs, knowledge, or behaviors. A more intensive intervention with greater participation may be necessary to show a stronger impact on attitudes and knowledge about skin cancer control among primary care physicians.

Ten consecutive cases of severe unilateral congenital ptosis were surgically corrected before 1 year of age (range 3-11 months) in an attempt to achieve early functional and cosmetic improvement. In all cases, a frontalis suspension using Mersilene mesh was performed. With a mean follow-up of 40.3 months (range 33-54 months), all patients achieved normal or near normal eyelid position and all had their chin-up head posture resolved. One patient developed a mild exposure keratitis that was treated successfully with topical antibiotics and lubricants. Our findings suggest that the Mersilene mesh sling has good potential for ptosis management in infants who are too young for fascial harvesting. However, a larger series with a longer follow-up period is required before the eventual safety and efficacy of the Mersilene mesh sling can be properly ascertained.

Cystic schwannoma of the orbit is unreported in the world literature. A 54-year-old Caucasian man presented to our clinic with a 5 year history of progressive right-sided proptosis and diplopia. A large paramedian cystic mass displacing the right globe downwards and laterally was demonstrated. From the clinical and radiological features, the presumptive diagnosis of right frontal sinus mucocoele was made. However, the excisional biopsy of the lesion revealed the rare diagnosis of cystic schwannoma, arising from a branch of the first division of the trigeminal nerve. Post-operatively, the patient had a smooth recovery with visual acuity of 20/20 in each eye; full binocular single vision was also re-established. The differential diagnoses of cystic orbital mass, and the radiological and histological findings of the lesion, are described and discussed.

Three serum markers, TPS, CA 15.3 and CEA, were used to monitor the response to treatment of 20 patients with metastatic breast cancer. At the time of the first evidence of metastases or at the time of progression of known metastatic disease, 84% of TPS values were above the reference limit, as compared to 74% for CA 15.3 and 84% for CEA. If the treatment instituted was effective, 60% of TPS values showed an early (within 2 or 3 weeks after commencement or change of therapy) reduction in level against only 27% of CA 15.3 and 27% of CEA levels. This suggests that TPS provides a more sensitive and earlier predictor of therapeutic response. In patients with clinical evidence of further progression of disease while on therapy, 86% of TPS values showed persistent elevation or increase, as compared to 71% of CA 15.3 levels and only 36% of CEA levels. It was also noted in these patients that TPS values rose earlier than either CA 15.3 or CEA. This indicates that TPS is a more reliable predictor of response to treatment than the other two markers. In addition, we found that, at the time of presentation, in women who had visceral metastases (liver, lung, or brain alone or in combination), 87% of TPS values were raised, as compared to 80% of CA 15.3 and 73% of CEA values. In women who had bone and soft tissue metastases at presentation, 75% of TPS values were elevated, against 50% of CA 15.3 and 75% of CEA values.(ABSTRACT TRUNCATED AT 250 WORDS)

A series of delta 17 unsaturated cycloalkyl and cycloalkenyl analogues of enisoprost was synthesized to investigate the effects of omega chain unsaturation on gastric antisecretory activity and diarrheogenic side effects. Of these, the 17E, 18-cyclopentenyl analogue 5d displayed potent gastric antisecretory activity in dogs but very weak diarrheogenic properties in rats and is the most selective prostaglandin compound discovered in these laboratories. Structurally, 5d contains both a conjugated diene and tertiary allylic alcohol in the omega chain, and these chemical features impart some interesting oxidative and acid-catalyzed epimerization and allylic rearrangement reactivities, respectively.

Brunei Darussalam has a mixed population with entirely different cultures and religions. The overall incidence of Hepatitis B virus (HBV) infection is 6%. A racial analysis of the incidence of HBV infection in Brunei shows a significantly higher incidence in Chinese compared to the other races. This is consistent with the incidence in the neighbouring countries.

Sequestration of Plasmodium falciparum-infected erythrocytes is crucial to parasite survival as it prevents destruction in the liver and spleen. Knobs have been considered necessary but not sufficient for cytoadherence to vascular endothelial cells in vivo and to melanoma or umbilical vein endothelial cells in vitro. We describe here a knobless clone that cytoadheres strongly to C32 melanoma cells. This clone cannot express the knob-associated histidine-rich protein (KAHRP) due to the deletion of the KAHRP gene. Our results raise the possibility of an alternative mechanism for in vitro cytoadherence and suggest that the use of long term cultured isolates and melanoma cells as a model for cytoadherence in vivo may be misleading.

Epithelial surface antigen (ESA) is a glycoprotein with a distribution in vivo that is largely confined to human epithelial cells. Previous studies using a mouse monoclonal antibody (MH99) detecting ESA had shown that the antigen immunoprecipitated from most epithelial cancer cell lines has two chains (38,000 and 32,000 Da) when separated under reducing conditions and only one (38,000 Da) under nonreducing conditions. We now show that the 38-kDa band observed under nonreducing conditions consists of two species, one a 38-kDa single chain protein and the other a disulfide-linked dimer consisting of the 32-kDa chain bonded to a previously unrecognized 6-kDa chain. Pulse-chase studies have shown that ESA is synthesized as a 34-kDa protein which is glycosylated to a 38-kDa glycoprotein containing both high mannose and complex carbohydrate chains. With longer chase periods, a 32-kDa species also appears. Peptide mapping, together with the pulse-chase data, suggests that the 32- and 6-kDa species are formed from the 38-kDa protein, probably by limited proteolysis. Epithelial cell lines differ in their ratios of 38/32-kDa species, some cell lines having only the 38-kDa form. Incubation of radiolabeled extracts of cells having only the 38-kDa protein with unlabeled extracts of the other cell types resulted in progressive conversion of the 38-kDa species to the 32- and 6-kDa forms. Only cell lines expressing both forms of ESA are able to carry out this cleavage of the 38-kDa protein. This is a novel mechanism for generating cell-type related differences in cell surface glycoprotein expression. Finally, sequential immunoprecipitation experiments showed that the antigen detected by Ab MH99 is closely related or identical to that detected by Ab 17-1A, a previously described colon cancer antigen.

Three mouse monoclonal antibodies to distinct cell surface antigens were derived from immunizations with cells of Tera-1, a human teratocarcinoma cell line, and a membrane preparation of placental tissue. The distribution of the antigens on 165 cultured lines of various human tumors and normal cells was determined by mixed hemadsorption assays and on fresh tissues by immunofluorescence staining. K4 antigen is expressed on cell lines derived from teratocarcinomas but not on any other cultured cell tested. Normal adult colonic epithelium, some fetal tissues, and specimens of testicular teratocarcinoma were also K4 positive. K21 antigen was detected on teratocarcinoma cell lines and, at more than 100-fold lower levels, on cultures of normal and malignant kidney epithelium but not on other cultured cells. K21 expression in normal tissues is restricted to the epithelium of fetal intestine and bronchus. Other fetal tissues and all adult normal tissues tested lacked K21. A subset of teratocarcinoma specimens (5 of 8) was reactive with antibody K21. P12 antigen is represented on a wide range of cell lines and tissues, including a subset of teratocarcinomas. AbK4, AbK21, and AbP12 react with carbohydrate sequences present on high-molecular-weight glycoproteins. AbK21 and AbP12 recognize the lacto-N-tetraose and lacto-N-fucopentaose III (X-hapten) structures, respectively, whereas AbK4 reacts with a neuraminidase-sensitive determinant.