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Objective: To investigate the incidence of allergic and respiratory diseases through age 3 years in children fed docosahexaenoic acid (DHA)- and arachidonic acid (ARA)-supplemented formula during infancy., Study Design: Children who completed randomized, double-blind studies of DHA/ARA-supplemented (0.32%-0.36%/0.64%-0.72% of total fatty acids, respectively) versus nonsupplemented (control) formulas, fed during the first year of life, were eligible. Blinded study nurses reviewed medical charts for upper respiratory infection (URI), wheezing, asthma, bronchiolitis, bronchitis, allergic rhinitis, allergic conjunctivitis, otitis media, sinusitis, atopic dermatitis (AD), and urticaria., Results: From the 2 original cohorts, 89/179 children participated; 38/89 were fed DHA/ARA formula. The DHA/ARA group had significantly lower odds for developing URI (odds ratio [OR], 0.22; 95% confidence interval [CI], 0.08-0.58), wheezing/asthma (OR, 0.32; 95% CI, 0.11-0.97), wheezing/asthma/AD (OR, 0.25; 95% CI, 0.09-0.67), or any allergy (OR, 0.28; 95% CI, 0.10-0.72). The control group had significantly shorter time to first diagnosis of URI (P = .006), wheezing/asthma (P = .03), or any allergy (P = .006)., Conclusions: DHA/ARA supplementation was associated with delayed onset and reduced incidence of URIs and common allergic diseases up to 3 years of age., (Copyright 2010 Mosby, Inc. All rights reserved.)

Objective: To examine the relationship between mild traumatic brain injury (mTBI), psychiatric conditions, pain medications, and injury severity on cognitive functioning in service members admitted to a burn unit. We hypothesize that psychiatric co-morbidity and pain medications will have a stronger relationship with cognitive dysfunction than mTBI diagnosis in this population., Method: Retrospective review of clinical evaluations (n=194) completed between September 2005 - October 2007 on service members with burn injuries secondary to explosive munitions. Evaluations were completed during the acute stage of recovery (mean=7.87 weeks). mTBI diagnosis (n=50) was made through a clinical interview using ACRM criteria. Exclusion criteria included duration of posttraumatic amnesia > 24 hours (n=10); and inability to complete neurocognitive measures due to severe bimanual burns and/or amputations (n=17). Cognitive functioning was evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)., Results: Subjects who sustained mTBI demonstrated significantly greater difficulty on the RBANS visuospatial and attention/processing speed indices. A hierarchical linear regression, using mTBI diagnosis, psychiatric diagnosis, time since injury, presence of pain medications, and measures of trauma severity as predictive factors, found that mTBI diagnosis had a significant, but small unique effect on cognitive functioning. Contrary to our hypothesis, psychiatric co-morbidity was not shown to have a significant effect on this population of acutely injured service members., Conclusions: While the relationship between severe TBI and cognitive functioning is well established, the relationship between mTBI and its effects on cognitive and behavioral abilities is less clear. The current study demonstrates that mTBI and analgesic medications have a small effect neurocognitive functioning in this population. Continued examination of this relationship is warranted.

The laser interferometer can effectively bypass the optics of the eye and measure retinal function in patients with immature cataracts. However, it is not known how much laser interferometric measurements are impaired by cataract density. In this study we compared objective lens opacity using the IntraOptics opacity lensmeter with contrast sensitivity (CS) measured by a Randwal He-Ne laser interferometer. Comparison of lens opacity with CS in the cataract population revealed an inverse linear relationship between objective lens opacity and retinal contrast sensitivity. Separation by cataract type showed correlation coefficients as high as -0.91 for nuclear sclerotic predominant cataracts and as low as no significant correlation for posterior subcapsular predominant cataracts. Comparisons of before and after implantation surgery contrast sensitivities (as measured by the laser interferometer) with preoperative lens opacities (as measured by the IntraOptics opacity lensmeter) quantified the extent to which laser interferometric measurements underestimated potential retinal function. We found that for all cataracts, other than posterior subcapsular predominant cataracts, potential contrast sensitivity (in decibels) was underestimated by about 0.2 to 0.3 times the opacity measured by this technique.

Preoperative contrast sensitivity functions (CSFs) were determined for 15 cataract patients using laser-generated patterns that effectively bypassed the optical components of the eye. These functions were compared with postoperative CSFs determined using traditional methods by transmission through the optics of the eye. Accurate prediction of postoperative contrast sensitivity occurred in 91% of the cases (ten of 11) for patients with preoperative visual acuity of 20/200 or better and in 67% of all the cases (ten of 15). Prediction failures occurred when the laser interferometer was not able to penetrate the cataract or when postoperative complications occurred. These results suggest that preoperative measurement of laser interferometric CSF is a useful predictor of postoperative CSF for patients with mild to moderate cataracts that can be bypassed by the laser and with better than 20/200 preoperative visual acuity. The problem of assessment when lens opacity is advanced is addressed in Part II.

Superior oblique muscle palsy is a frequently encountered acquired muscle deficit accounting for vertical and torsional diplopia. There were two cases of residual isolated superior oblique palsy following anterior ethmoidal artery ligation for epistaxis, a finding not previously reported. The mechanism is suggested to be due either to direct trochlear damage by separation from the periosteum or to localized hematoma formation beneath the periosteum with resultant fibrosis and displacement of the trochlea from its normal apposition to the frontal bone.

A 62-year-old man was noted on routine examination to have a dark lesion in the peripheral fundus of the right eye and a corresponding dark scleral mass. The lesion was initially suspected to be a choroidal melanoma with extrascleral extension. The patient denied having ocular trauma. Orbital x-rays and ultrasonography, however, demonstrated the lesion to be an occult transcleral metallic foreign body. An occult foreign body should be considered in the differential diagnosis of a small choroidal or ciliary body melanoma with extrascleral extension.

Recombinant human epidermal growth factor (EGF) was assessed for its capacity to stimulate proliferation of human corneal endothelial cells in vitro in organ culture with 87 human corneas. The EGF in defined serum-free (S-F) media was able to stimulate endothelial cell mitosis (t test P less than 0.01) in matched transected human corneas after a four-day incubation period as judged by histologic studies. Clearly defined endothelial mitotic figures were seen in all stages of cell division throughout the endothelial cell layer. The implication of increasing corneal endothelial cell numbers in donor corneas before transplantation using a human growth factor, potentially available in pure form in unlimited quantities, is discussed.

Phthiriasis palpebrarum is an uncommon cause of blepharitis and conjunctivitis and may easily be overlooked. A high index of suspicion and careful examination of the patient's lid margins and eyelashes will lead to the proper diagnosis. Treatment is best accomplished by careful removal of the lice and nits (louse eggs) from the patient's lashes. Local application of a pediculocide such as yellow mercuric oxide N.F. 1% ophthalmic ointment applied twice daily for one week or 0.25% physostigmine (Eserine) ointment applied twice daily for a minimum of ten days, to the lid margins should be considered when the total removal of Phthirus pubis and nits is not possible mechanically. Body hair should be examined for infestation with lice and treated with gamma benzene hexachloride shampoo. This medication should be used with caution in infants, children and pregnant women. Family members, sexual contacts, and close companions should be examined and treated appropriately; clothing, linen and personal items should be disinfected with heat of 50 degrees C for 30 minutes.