bluuebunny/crossref_metadata_2025 huggingface dataset:
Bilateral coronoid hyperplasia in two brothers.
Authors: Colquhoun A , Cathro I , Kumara R , Ferguson M M , Doyle T C A
Published: September 2002

Coronoid hyperplasia is a rare condition of unknown aetiology that can occur in both unilateral and bilateral forms. Without radiographic investigation the diagnosis is often missed. Researchers have postulated a familial form of inheritance. This study reports the occurrence of coronoid hyperplasia in two brothers. The parents were unaffected and there are no other siblings. The diagnosis was confirmed with the aid of panoramic radiographs and axial computed tomographic scans with para-sagittal reconstructions which demonstrated enlargement of the coronoid processes and in one case impingement against the zygomatic bone. One brother was successfully treated with a unilateral intra-oral coronoidectomy whilst the other was unsuccessfully treated with a bilateral intra-oral coronoidectomy.
Inflammatory orbital pseudotumor with infratemporal fossa extension mimicking temporomandibular joint dysfunction.
Authors: Lee J Y , Kim K D , Hwang E H , Park H S , Park C S
Published: September 2002

Inflammatory orbital pseudotumor is a benign space-occupying lesion of unknown origin that involves all or part of the fatty tissue within the orbit. Occasionally the disease may extend into the middle cranial, the pterygopalatine, and the infratemporal fossa through the various foramina of the orbit, although extension into the infratemporal fossa is very rare. We present a case which extends into the infratemporal fossa through the inferior orbital fissure, resulting in presenting symptoms mimicking temporomandibular joint dysfunction.
Malignant melanoma of mandibular gingiva; the usefulness of fat-saturated MRI.
Authors: Hayashi T , Ito J , Katsura K , Honma K , Shingaki S , Ikarashi T , Saku T
Published: September 2002

Case report of a histologically validated malignant melanoma affecting the mandibular molar gingiva in a 31-year-old woman. Tumour was evaluated by magnetic resonance (MR) imaging at 1.5-T, spin-echo 3 mm slice thickness with T1-weighted and fat-saturated T1-weighted images. The fat-saturated T1-weighted images demonstrated the lesion more clearly than conventional T1-weighted images.
The views of primary health care professionals about the management of breast problems in clinical practice
Authors:   The BRIDGE Study Group
Published: August 2002

Rationale, aims and objectives To identify primary health care professionals’ views about patients presenting with breast problems, and their approaches to clinical management. Methods Qualitative study using practice‐based semi‐structured group discussions with primary health care professionals. All practices were involved in a study evaluating the effect of the national breast symptom management guidelines on clinical practice. Discussion groups were conducted in the practices; 15 of the 34 study practices were audio‐taped. Groups comprised the partners and practice nurses at each practice. All members of each group were well known to one another. There was good attendance by all doctors, with 75% of male partners and 90% of female partners present at the meetings. Of the practice nurses, 51% attended. In all, 86 professionals attended the meetings. Results A number of themes arose consistently from the discussions. Participants were concerned about the possible consequences of errors in diagnosis and about difficulties concerning the ‘management of uncertainty’. Doctors were influenced especially by adverse past experiences. Other difficult situations included referral decisions and the management of risk factors in isolation from clinical presentation. Outside influences on presentation and management, such as the media, were also noted. Conclusions The management of breast disease is perceived as a complex issue by health professionals. The patient and doctor contextual factors described must be taken into account in discussions about what constitutes appropriate clinical management and in the development and implementation of clinical guidelines to improve management.
Responses of primary health care professionals to UK national guidelines on the management and referral of women with breast conditions
Authors:   The BRIDGE Study Group
Published: August 2002

Rationale, aims and objectives To explore the responses of primary health care professionals to guidelines in general, and to the UK national guidelines on the management and referral of women with breast conditions in particular. Methods Qualitative study using practice‐based, semistructured group discussions with primary health care professionals. All practices were involved in a study evaluating the effect of the national breast symptom management guidelines on clinical practice. Discussion groups were conducted in the practice; fifteen of the 34 study practices were audio‐taped. Groups comprised the available partners and practice nurses at each practice. All members of each group were well known to one another. There was good attendance by all doctors, with 75% of male partners and 90% of female partners present at the meetings. Of the practice nurses 51% attended. In all, 86 professionals attended the meetings. Results A number of areas for comment arose consistently in each discussion. Guidelines in general were welcomed, although there was more support for evidence‐based than consensus‐based guidelines. The breast lump guideline was also welcomed, participants commenting that it was concordant with current practice. The breast pain guideline was more contentious, participants reflecting that it recommended more primary care management than was usual, and fell outside the experience and confidence of doctors or the expectations of patients. Participants felt it did not incorporate psychosocial factors into recommended management, despite this being an important part of primary care management. Conclusions There are concerns about consensus guidelines and doubts about the applicability of the breast pain guideline in this complex management area. The failure of these guidelines to address patient anxiety may limit their implementation.
Primary renal candidiasis: Fungal mycetomas in the kidney
Authors: Morris Burzin S , Chudgar Priya D , Manejwala Owais
Published: August 2002

Fungal infections of the urinary tract have a predilection for drainage structures rather than for the renal parenchyma. Of the causal factors, diabetes mellitus, immunosupressed states, AIDS and prematurity are those most commonly encountered. The case of a young, diabetic man whose chief clinical presentation was dysuria is described. On further examination he was found to harbour fungal balls in the right kidney. Radiological manifestations of acute pyelonephritis were also present. Although primary renal candidiasis is often commensurate with systemic fungaemia, he displayed none of the clinical features of disseminate infection and, hence, was treated conservatively with oral antifungal agents. Fortuitously, spontaneous passage of fungal particulate matter in urine was later reported.
Ultrafast MRI of the fetus
Authors: Glastonbury Christine M , Kennedy Anne M
Published: August 2002

During the last decade there has been increasing interest in MRI for the evaluation of ultrasound‐detected fetal abnormalities. Motion artefacts previously precluded detailed imaging, but this is now possible using single‐shot rapid acquisition sequences. These ultrafast techniques with subsecond images capture ‘snap‐shot’ views of the fetus. By virtue of the infinitely long relaxation time (TR) these images are heavily T2‐weighted so that fluid around and within the fetus delineates the anatomy.

Currently, fetal MRI has shown to be most beneficial in the investigation of cerebral abnormalities suspected from sonography, and in the detection of subtle associated anomalies. It clearly has a role in the evaluation of complex somatic abnormalities, and is helpful in the evaluation of fetuses prior to surgery.

We present a pictorial review of our experience with single‐shot fast spin‐echo (SSFSE) imaging, demonstrating normal anatomy of the fetal brain and body. In addition we present cerebral and somatic abnormalities to illustrate cases where we have found fetal MRI to be a useful adjunct to sonography.
MRI appearances of the sphenoid sinus at the late follow‐up of trans‐sphenoidal surgery for pituitary macroadenoma
Authors: Connor SEJ , Deasy NP
Published: August 2002

We aimed to demonstrate the appearances of the sphenoid sinus on MRI performed later than 2 years post‐ transsphenoidal surgery (TSS). We retrospectively reviewed 47 patients in whom follow‐up MRI scans had been performed at least 2 years post‐TSS. We specifically reviewed the clinical and imaging of those patients in whom the sphenoid sinus was filled with signal abnormality or masses were present arising from the sinus roof and classified them as tumour or indeterminate abnormalities on imaging criteria. We documented other clinicoradiological details. Twelve of 47 patients demonstrated sphenoid sinus filling or sinus roof masses and in six of 12 patients it was possible to classify them as tumourous using imaging and clinical criteria. The indeterminate and non‐tumourous sphenoid sinus abnormalities most frequently had a T1‐weighted signal similar to subsellar tumour and displayed rim enhancement and thus could not be reliably distinguished from tumourous abnormality on the basis of signal or enhancement characteristics. The presence of a well‐defined surgical defect in the sella floor was associated with resolution of abnormality on MRI follow‐up. We concluded MRI findings of sphenoid sinus filling or sinus roof masses are present in approximately 26% of scans performed longer than 2 years post‐TSS. Half of these are of indeterminate origin and follow‐up is required to discriminate tumour from non‐ tumour with certainty. A well‐defined surgical defect in the sella floor is, however, suggestive of a non‐tumourous abnormality.
Renal parenchymal malakoplakia: An unusual cause of unilateral, diffuse renal enlargement
Authors: McKeen SK , Tie MLH
Published: August 2002

Renal parenchymal malakoplakia is usually described as a multi‐ or unifocal process. We report an unusual case presenting with unilateral diffuse renal enlargement consistent with an early stage in the evolution of this disease.
False negative biliary scintigraphy in gangrenous cholecystitis
Authors: Grant Robyn L , Tie Mark LH
Published: August 2002

Gangrenous cholecystitis is a serious complication of acute cholecystitis and is associated with increased morbidity and mortality rates. We report a case in which the diagnosis was suggested by ultrasound, but cholecystectomy delayed due to atypical clinical presentation and a false negative radionuclide biliary scan.
CT and MRI appearances of methotrexate leucoencephalopathy
Authors: Wilks Michael J , Tie Mark LH , Pozza Christopher H
Published: August 2002

Methotrexate is a well recognised cause of diffuse symmetrical leucoencephalopathy. The widespread use of the drug in chemotherapeutic regimes necessitates awareness of this complication. A case report and a brief literature review is presented.
Spinal angiolipoma: Report of three cases and review of MRI features
Authors: Garg Ajay , Gupta Vipul , Gaikwad Shailesh , Deol P , Mishra Nalin Kant , Sharma Mehar Chand , Vaish Sandeep
Published: August 2002

We report three cases of spinal angiolipoma, two intramedullary and one epidural, and review their MRI features. Diagnoses were established preoperatively in all cases. Specific MRI features including the importance of postgadolinium fat‐saturated T1‐weighted images and presence of vascular flow‐voids are discussed with histopathological correlation. A characteristic morphological appearance of intramedullary angiolipoma has been suggested.
Peritoneal mesothelioma: CT and MRI findings
Authors: Puvaneswary M , Chen S , Proietto T
Published: August 2002

Two patients with histologically proven diagnosis of peritoneal mesothelioma are presented. Both patients had CT scans of the abdomen. The second patient was also examined with MRI.
Gadolinium‐enhanced computed tomographic aortography
Authors: Chryssidis S , Davies RP , Tie MLH
Published: August 2002

Radiographic contrast agents using gadolinium have a better safety profile and photoelectric effect than iodinated contrast, allowing use where iodinated contrast is contraindicated. A case of gadolinium‐enhanced computed tomographic aortography (CTA) for suspected thoracic dissection is reported. Aortic enhancement was sufficient for confident exclusion of an intimal flap. The findings were later confirmed by MRI. Vascular enhancement diminished below the diaphragm and tissue enhancement was minimal. Gadolinium diethylenetriamine penta‐acetic acid (Gd‐DTPA) may be used for CTA of the thoracic aorta, where the use of iodinated contrast is contraindicated. Multi‐slice CT may expand the role of gadolinium enhancement in the future.
Beginning angiography: A step‐by‐step guide
Authors: Heng Robert C , Bell Kevin W
Published: August 2002

Procedures in radiology are still very much learnt as an apprenticeship. While there is no substitute for hands‐on practice and the one‐to‐one teaching of an experienced consultant, it has been our experience that learning is significantly facilitated by the availability of simple, easy‐to‐follow, relevant notes for pre‐reading, especially in the difficult and potentially hazardous area of angiography. However, we have had surprising difficulty in finding an introductory text that is suitable for the teaching of angiography to new, never‐seen‐it‐before trainees. We have therefore developed a short, simple, illustrated manual within our department for introducing angiography to first‐year registrars, which we present in this article. We hope trainees will find it of use for providing an overview of the principles and the basic techniques involved prior to beginning formal training in this challenging and rewarding specialty.
Relevance of VacA and mucosal pathological changes in Chinese patients with upper gastrointestinal diseases before and after Helicobacter pylori eradication
Authors: CHEN Xiao Yu , VAN DER HULST Rene , VAN DER ENDE Arie , PAN Zhi Jun , XIAO Shu Dong , TYTGAT Guido NJ , TEN KATE Fiebo JW
Published: August 2002

OBJECTIVE:  To investigate the influence of VacA activity on gastric mucosa prior to and after Helicobacter pylori eradication in Chinese patients with peptic ulcers and chronic gastritis.

METHODS:  Seventy‐four dyspeptic patients with H. pylori infection were enrolled. The status of H. pylori infection was evaluated by culture and histo­pathology before and 4−6 weeks after H. pylori eradication therapy. Histological specimens were examined and graded semiquantitatively according to the updated Sydney classification.

RESULTS:  Helicobacter pylori with VacA was found in 59 of 74 patients (80%), and its prevalence in patients with peptic ulcers and chronic gastritis was similar. Helicobacter pylori eradication rates in patients with VacA+ and VacA− strains were similar. Before eradication, the degrees of acute or chronic inflammation, epithelial damage, atrophy, intestinal metaplasia (IM) and the number of lymphoid follicles were similar in patients with VacA+ and VacA−H. pylori. Four to 6 weeks after the eradication of H. pylori infection, the degrees of acute and chronic inflammation, and epithelial damage in the antrum decreased significantly, particularly in patients with VacA+H. pylori (P < 0.0001). The number of lymphoid follicles in the antrum also decreased more in patients with VacA+H. pylori than in those with VacA−H. pylori (P= 0.051). However, there was no difference in the extent of atrophy and IM between these two groups.

CONCLUSIONS:  There is no specific correlation between VacA+/VacA−H. pylori strains and mucosal clinicopathological features in Chinese patients with upper gastrointestinal diseases before and after eradication therapy. Successful eradication of H. pylori infection does not improve atrophic and IM lesions of the gastric mucosa.
HLA‐DR genotypes in Chinese patients with ulcerative colitis
Authors: PENG Zhong Sheng , HU Pin Jin , GUO Yun Wei , CHEN Min Hu , CUI Yi , LIU Si Cun
Published: August 2002

OBJECTIVE:  To study HLA‐DR genotypes and to analyze the relationship between HLA‐DR genotypes, antineutrophil cytoplasmic antibodies (ANCA) and clinical classification of ulcerative colitis (UC) in Chinese patients.

METHODS:  Eighty UC patients and 123 healthy subjects were enrolled in the study. Serum ANCA was detected by using indirect immunofluorescence and HLA‐DR was genotyped by using the polymerase chain reaction with sequence‐specific primers (PCR‐SSCP).

RESULTS:  The positive rate of ANCA in UC patients was 55%, but 0.0% in the controls. The HLA‐DR2 and DR15 positive rates in the UC patients were 58.8 and 40%, respectively, which were significantly greater than 30.1 and 17.9% in the controls (P < 0.05). In the UC patients, the DR15‐positive rate was significantly higher, but the DR16‐positive rate was significantly lower in the ANCA‐positive group than in the ANCA‐negative group (52.3 vs 25.0%; 9.1 vs 30.6%, P < 0.05). The HLA‐DR2 and DR15‐positive rates in chronic persistent UC patients were significantly greater than those in the incipient or chronic recrudescent type of UC (84.2 vs 50.0 or 51.4%; 63.2 vs 29.2 or 35.1%, P < 0.05).

CONCLUSIONS:  In Chinese UC patients, the positive rates of HLA‐DR2 and ANCA were significantly higher compared with healthy controls. The increase in the DR2‐positive rate was associated with the increase in the DR15‐positive rate in ANCA‐positive UC patients, and was associated with the increase in the DR16 gene positive rate in ANCA‐negative UC patients. In general, HLA‐DR genotypes are related to the clinical classification of ulcerative colitis.
Overexpression of peroxisome proliferator‐activated receptor γ and retinoid X receptor α in gastric carcinomatous tissue
Authors: YAO Li Ping , WU Kai Chun , WU Han Ping , SONG Bao Hua , QIAO Tai Dong , FAN Dai Ming
Published: August 2002

OBJECTIVE:  To investigate the expression of peroxisome proliferator‐activated receptor γ (PPAR‐γ) and retinoid X receptor α (RXR‐α) in chronic gastritis, gastric mucosal dysplasia and gastric carcinoma and to identify any correlations between PPAR‐γ and RXR‐α expression in this progression sequence.

METHODS:  Immunohistochemical methods (avidin− biotin−peroxidase complex) were used to examine the expression of PPAR‐γ and RXR‐α in 53 patients with gastric carcinoma, 18 with gastric mucosal dysplasia and 30 with chronic atrophic gastritis. Thirty‐one patients with chronic non‐atrophic gastritis acted as controls.

RESULTS:  The positive rates of PPAR‐γ and RXR‐α in gastric carcinoma were 41.5 and 54.7%, 27.8 and 38.9% in gastric mucosal dysplasia, 10.0 and 20.0% in chronic atrophic gastritis, and 6.5 and 16.1% in chronic non‐atrophic gastritis, respectively. The expression of PPAR‐γ and RXR‐α increased during the progression from chronic non‐atrophic gastritis to chronic atrophic gastritis, then to gastric carcinoma. Compared with chronic gastritis, the expression of PPAR‐γ and RXR‐α in gastric mucosal dysplasia and gastric carcinoma was significantly increased (P < 0.05, P < 0.01). In gastric carcinoma, the expression of PPAR‐γ and RXR‐α was not associated with tumor cell differentiation or metastasis in the lymph nodes (P > 0.05). There was a positive correlation between the expression of PPAR‐γ and RXR‐α in gastric carcinoma (r= 0.54, P < 0.01).

CONCLUSIONS:  Overexpression of PPAR‐γ and RXR‐α protein is apparent in human gastric cancer. This might be an early event in carcinogenesis, and both PPAR‐γ and RXR‐α may play independent and/or synergistic roles in the progression of gastric carcinoma.
Combined lamivudine and famciclovir therapy for patients with chronic hepatitis B
Authors: XU Ke Cheng , LI Shao Bai , WENG Shao Ji , LEI Chun , YE Ping
Published: August 2002

OBJECTIVE:  No single antiviral drug is able to eradicate hepatitis B virus (HBV) infection. It has been shown in vitro that lamivudine and panciclovir (the active metabolite of famciclovir) act synergistically to inhibit HBV replication. To study the therapeutic efficacy of combined lamivudine and famciclovir therapy in patients with chronic hepatitis B.

METHODS:  Twenty‐one patients with chronic hepatitis B, who had been given lamivudine monotherapy for more than 6 months without improve­ment, had increased serum alanine aminotransferase (ALT) and HBV‐DNA levels, and were positive for hepatitis B surface antigen (HBsAg); 17 were positive for HBeAg. The diagnosis was verified by histology in 12 HBeAg‐positive cases. All patients were given combined therapy with lami­vudine (100 mg q.d.) and famciclovir (500 mg t.i.d.) orally for 4 months, and then with lamivudine alone for 5−10 months.

RESULTS:  Serum HBV‐DNA levels were initially 1 × 108.19 ± 1.18 copies/mL,
then decreased to 1 × 105.25 ± 1.18 copies/mL
at the end of the combined treatment and 1 × 105.25 ± 1.82 copies/mL
in the follow‐up period (P < 0.01).
Serum ALT decreased from 225 ± 110 U/L before
the trial to 79 ± 50 U/L
at the end of the combined treatment and 81 ± 48 U/L
in the follow‐up period (P < 0.01).
In 17 HBeAg‐positive patients, eight (47.1%) had HBeAg/anti‐hepatitis
B e antigen (HBeAg) seroconversion with a significant decrease of HBV‐DNA
(<1 × 104 copies/mL)
and normal ALT (P < 0.01). Of
four HBeAg‐negative patients, three had decreased levels of HBV‐DNA,
to below 1 × 104 copies/mL,
which was associated with a significant decrease in ALT. Two patients
had recurrent flare‐ups in the follow‐up period, but both HBV‐DNA
and ALT were lower than the pretreatment levels. In 10 patients who
underwent a second liver biopsy, improvements in inflammatory activity
and fibrosis were seen in eight (80%) and four (40%)
cases, respectively (P < 0.05).

CONCLUSIONS:  The combination treatment of lamivudine and famciclovir has synergistic or additive anti‐HBV effects, and may be an alternative therapy for patients with active chronic hepatitis B.
Esophageal motility in patients with sliding hiatal hernia and reflux esophagitis
Authors: YE Ping , LI Zhao Shen , XU Guo Ming , LU Ren Hua , ZOU Duo Wu , YIN Ning
Published: August 2002

OBJECTIVE:  To study the radiographic and esophageal motility changes that are characteristic of patients with both sliding hiatus hernia (HH) and reflux esophagitis.

METHODS:  Thirty patients were diagnosed with HH by using gastroscopy. These patients were divided into two groups according to the severity of their esophagitis: group HH1 (grades A and B, n= 18); group HH2 (grades C and D, n= 12). Sliding HH was confirmed by barium meal examination. Radiographic techniques were used to test for spasms and strictures, the coarseness of the mucosa, and to study the types of reflux and clearance. Esophageal pH (24‐h), lower esophageal sphincter pressure and the frequency and amplitude of esophageal peristalsis during reflux were also studied.

RESULTS:  Radiography revealed that the mucosa was coarse in all cases. Eighty percent of patients had sucking reflux and 36.7% had passive clearance. The percentages of total, supine and upright acid exposure times were greater in patients with HH than those in the controls (P < 0.01), but the difference between the HH1 and HH2 groups was not significant. Lower esophageal sphincter resting pressure was less in the HH group than that in the control group (P < 0.05). However, there were no differences in the length of the sphincter among groups. During episodes of acid reflux, the frequency and amplitude of peristalsis, and the percentage of normal primary esophageal peristalsis were all lower in HH patients than in the controls, and the duration of peristalsis was increased relative to that of the controls (P < 0.05).

CONCLUSIONS:  Sucking reflux and passive clearance are very important in HH. Esophageal acid exposure time does not correlate with the severity of esophagitis. Lowered lower esophageal sphincter resting pressure, decreased frequency and amplitude, and increased duration of esophageal peristalsis during the episode of reflux may play an important role in the pathogenesis of sliding HH.
Developing a general practice library: a collaborative project between a GP and librarian
Authors: Pearson David , Rossall Hannah
Published: August 2002

The authors report on a self‐completed questionnaire study from a North Yorkshire based general practice regarding the information needs of its clinicians. The work was carried out with a particular focus on the practice library, and the findings identified that a new approach to maintaining and developing the library was needed. The literature regarding the information needs of primary care clinicians and the role of practice libraries is considered, and compared to those of the clinicians at the practice. Discussion follows on how a collaborative project was set up between the practice and a librarian based at the local NHS Trust library in order to improve the existing practice library. Difficulties encountered and issues unique to the project are explored, including training implications presented by the implementation of electronic resources. Marketing activities implemented are discussed, how the library will operate in its new capacity, and how ongoing support and maintenance of the library will be carried out. It is concluded that although scepticism still exists regarding librarian involvement in practice libraries, collaboration between clinicians and librarians is an effective approach to the successful development and maintenance of a practice library, and recommendations are therefore made for similar collaborative work.
The influences of stimulus wavelength and eccentricity on short‐wavelength pathway isolation in automated perimetry
Authors: Cubbidge R. P. , Wild J. M.
Published: August 2002

The aim of the study was to determine whether the suggested stimulus and background parameters employed in commercially available short‐wavelength sensitive perimetry (SWAP) are clinically appropriate. Threshold versus intensity curves were measured using a modified Humphrey Field Analyser. The reduction in background luminance was achieved using aperture stops in order to avoid changes in the chromaticity of the background. Short‐wavelength thresholds were determined for 440, 450 and 460 nm stimuli and were corrected for pre‐receptoral absorption. Short‐wavelength sensitive pathway isolation was approximately 1.5 log units and decreased with increases in eccentricity and in stimulus wavelength. It would seem that the use of a 450 nm narrowband stimulus filter would offer a compromise between both the physiological requirements and the physical properties of the stimulus. Such an approach would reduce some of the inherent between‐subject normal variability associated with SWAP.
Changes in the static accommodation response with age
Authors: Kalsi M. , Heron G. , Charman W.N.
Published: August 2002

A transverse study of the monocular, steady‐state accommodation response/stimulus curves for 49 normal subjects with ages between 17 and 49 years shows that the slope of the curve reduces only slowly with age up to about 40 years and then declines rapidly as complete presbyopia is approached. Such behaviour appears to result from the accommodation system changing its characteristics with age to make optimal use of the available objective amplitude of accommodation and the depth‐of‐focus of the eye.
Sighting dominance, handedness, and visual acuity preference: three mutually exclusive modalities?
Authors: Pointer Jonathan S.
Published: August 2002

It is tempting, even perhaps for the clinician, to assume prima facie that an individual's handedness is indicative of other lateral asymmetries, including ocular (sighting) dominance and preferred monocular acuity. An analysis of new data relating to these three modalities, as collated from counter‐balanced groups of normally sighted male and female children and adults examined in optometric practice, confirms the general fallacy of this assumption and considers why it is such a persistent misconception. The degree of association between the three modalities in right‐preferent individuals is revealed as statistically no greater than chance. On the basis of this study, estimates of right‐sided hand, eye and/or acuity congruency are derived for the information of the clinician in the prescribing environment of the consulting room.
How large is the optic disc? Systematic errors in fundus cameras and topographers
Authors: Meyer Tina , Howland Howard C.
Published: August 2002

Purpose: To determine whether or not there are systematic differences in the areas of optic discs as measured by different machines using different measurement algorithms and whether racial or gender differences exist in optic disc area measurements.

Methods: We examined the results of twenty‐three published studies on the size of normal optic discs of various patient populations. Studies differed in the type of instrument and method used to measure optic disc area, and the number, age, race and gender of subjects examined. Noticing that different machines exhibited statistically significant systematic differences in optic disc sizes of comparable populations, we computed a “normalization” factor for each machine based on these mean differences. Applying this normalization factor to the results, we then re‐examined the differences between racial and gender groups.

Results:
By comparing the results of mean optic disc areas of different racial groups made with different machines, and normalizing results according to those of the Zeiss fundus camera, we found the normalization factors for the following machines to be, Zeiss fundus camera: 1 (by definition), Rodenstock Optic Disc Analyzer (RODA): 1.51, Topcon fundus camera: 1.04, Heidelberg Retina Tomograph (HRT): 1.15 and TopSS scanning laser ophthalmoscope: 1.29. That is, to bring the results of area measurements made with a RODA machine in line with those made with a Zeiss fundus camera, one should multiply the former by the factor 1.51. Using the normalized results, we confirmed the findings of previous authors that the optic disc areas of black subjects were statistically significantly larger than those of white subjects(
n
‐weighted mean effect=0.556±0.142 S.E.,
n
=5). Further, the meta‐analysis of various racial populations from five studies shows that males have significantly larger discs than females (
n
‐weighted mean effect=0.151±.055 S.E.,
n =9).

Conclusion: Different machines and techniques give different results when populations of similar racial composition are measured. We recommend applying the above normalizing factors when comparing studies that employ different instruments.
Analysis of discrimination threshold on the tritan axis
Authors: García J. A. , Yebra A. , Hita E. , Romero J.
Published: August 2002

Discrimination thresholds on the tritan axis were obtained for an extensive group of 66 stimuli: in some of the stimuli,S‐cone trolands were held constant by keeping the product of theS‐cone excitation level and the luminance unchanged, while in others only the luminance was changed to establish variousS‐cone troland values. These thresholds depended clearly on theS‐cone value of the stimuli, while they remained almost constant against the retinal illumination. Thus, we noted that the excitation of theL−2M channel had practically no influence over the discrimination threshold on the tritan axis, although this independence of ΔS fromL−2M was not so obvious when theS value was high. With our data, we performed different fits, and found that the fit including the termsS,(L−2M) and(L+M) adapted better to our results.
Fatigue reduces tonic accommodation
Authors: Hasebe Satoshi , Graf Erich W. , Schor Clifton M.
Published: August 2002

Ocular accommodation adopts a mean baseline response level of approximately 1.0 D in the absence of blur feedback (open‐loop state). This baseline or tonic accommodation (TA) can be elevated following a sustained monocular accommodative response to a dioptric stimulus (lens adaptation) that exceeds the baseline open‐loop level of TA. The accommodative response to the lens persists in the open‐loop state (accommodative hysteresis), and eventually decays to a stable end‐point. Interestingly, if the baseline TA is high, the monocularly adapted accommodative state can decay to an end‐point that is below the initial pre‐adapted baseline level of the TA (counter‐adaptive response) (McBrien, N.A. and Millodot, M., (1988). Differences in adaptation of TA with refractive state. Invest. Ophthalmol. Vis. Sci., 29, 460–469).

We have investigated the possible contribution of accommodation fatigue to the counter‐adaptive change in baseline TA following sustained accommodation. Two fatigue procedures were used while viewing a target at 66 or 33 cm. In a monocular condition, accommodation was stimulated for 3 min with lens values alternating from −1.5 to +1.5 D at a rate of 0.25 Hz. In the binocular condition, convergence was stimulated with alternating prism values from 9 prism diopters (PD) base‐out to 9 PD base‐in. Both monocular and binocular tasks resulted in a significant reduction of TA.

These results suggest that previously reported reductions of baseline TA following sustained monocular accommodation or binocular convergence could have resulted from fatigue of the accommodative system. Accommodative fatigue could be responsible for the lower values of TA observed in counter‐adaptive responses to sustained accommodative or convergence effort.
Description of a method for neutralising the Stiles–Crawford effect
Authors: Scott Dion H. , Atchison David A. , Pejski Peter A.
Published: August 2002

The influence of the Stiles–Crawford effect on visual performance can be investigated by filters based on the apodisation model of the Stiles–Crawford effect. We describe the development of practical filters to achieve neutralisation. We present some results of the Stiles–Crawford function showing that the filters work well for expected errors in aligning filters in front of the eye.
Randomised controlled trial of an integrated versus an optometric low vision rehabilitation service for patients with age‐related macular degeneration: study design and methodology
Authors: Russell Wanda , Harper Robert , Reeves Barnaby , Waterman Heather , Henson David , McLeod David
Published: August 2002

A number of studies have measured the outcomes of low vision care but these have usually been longitudinal case series, thus constituting very low quality of evidence for effectiveness. To date, there have been no randomised controlled trials (RCTs) which have evaluated the effectiveness and cost effectiveness of different models of care in low vision. The size of the low vision population and the paucity of systematic evaluation have created a pressing need for evidence about cost‐effectiveness in order to inform service developments for low vision rehabilitation. This paper describes the study design and methodology of a three‐arm RCT currently under way in Manchester. The baseline population recruited is also described. A traditional hospital‐based optometric service is being compared with an integrated service (comprising the addition of community‐based rehabilitation officer input) and with more generic community input (which is non‐integrated and is not vision specific). A wide range of outcome measures are being assessed at recruitment and 12 months post‐intervention, including low vision specific and generic quality of life measures, patterns of low vision aid use, and task performance. The rationale for the trial is discussed and the main study outcomes are described.
Clinical evaluation of the Shin‐Nippon SRW‐5000 autorefractor in children
Authors: Chat Sandy W. S. , Edwards Marion H.
Published: August 2002

The Canon Autoref R‐1 is an ‘open‐field’ autorefractor which has been widely used for research purposes for the past 20 years, but is no longer manufactured. A new autorefractor, the Shin‐Nippon SRW‐5000, is now available, and if measures using this instrument are shown to be equally accurate and reliable, is likely to replace the R‐1. Here we report on the accuracy and reliability (repeatability and reproducibility) of refraction measures in a paediatric population (from 4 to 8 years of age). Subject numbers were 44 for cycloplegic measures and 53 for non‐cycloplegic measures. As would be expected, agreement with cycloplegic refraction and reliability were better when SRW‐5000 measures were taken using cycloplegia. Repeatability results from the SRW‐5000 autorefractor, both with and without cycloplegia were similar to those reported for the Canon R‐1.
Clinical evaluation of the Shin‐Nippon SRW‐5000 autorefractor in adults
Authors: Mallen E. A. H. , Wolffsohn J. S. , Gilmartin B. , Tsujimura S.
Published: August 2002

A clinical evaluation of the Shin‐Nippon SRW‐5000 (Japan), a newly released commercial autorefractor, was undertaken to assess its repeatability and validity compared to subjective refraction. Measurements of refractive error were performed on 200 eyes of 100 subjects (aged 24.4±8.0 years) subjectively (non‐cycloplegic) by one optometrist and objectively with the SRW‐5000 autorefractor by a second. Repeatability was assessed by examining the differences between the seven autorefractor readings taken from each eye and by re‐measuring the objective prescription of 50 eyes at a subsequent session. Although the SRW‐5000 read slightly more plus than subjective refraction (mean spherical equivalent +0.16±0.44 D), it was found to be highly valid (accurate) compared to subjective refraction and repeatable over the prescription range of +6.50 to −15.00 D examined. The Shin‐Nippon SRW‐5000 autorefractor is therefore a valuable complement to subjective refraction and as it offers the advantage of a binocular open field‐of‐view, has a great potential benefit for accommodation research studies.
Continuous recording of accommodation and pupil size using the Shin‐Nippon SRW‐5000 autorefractor
Authors: Wolffsohn J. S. , Gilmartin B. , Mallen E. A. H. , Tsujimura S.
Published: August 2002

A newly released commercial autorefractor, the Shin‐Nippon SRW‐5000 (Japan), has been found to be valid compared to subjective refraction and repeatable over a wide prescription range. Its binocular open field‐of‐view allows the accommodative state to be monitored while a natural environment is viewed. In conventional static mode, the device can take up to 45 readings in 1 min using digital image analysis of the reflected retinal image of a measurement ring. Continuous on‐line analysis of the ring provides high (up to 60 Hz) temporal resolution of the refractive state to an accuracy of <0.001 D. Pupil size can also be analysed to a resolution of <0.001 mm. The measurement of accommodation and pupil size was relatively unaffected by eccentricity of viewing up to ±10° and instrument focusing inaccuracies of ±5 mm. The resolution properties of the analysis are shown to be ideal for measurement of dynamic accommodation and pupil responses.
Behavioral and Pharmacologic Treatment of Transformed Migraine With Analgesic Overuse: Outcome at 3 Years
Authors: Grazzi Licia , Andrasik Frank , D'Amico Domenico , Leone Massimo , Usai Susanna , Kass Steven J. , Bussone Gennaro
Published: August 2002

Objective.—To determine whether combined treatment using medication and biofeedback would be more effective than drug treatment alone for treating transformed migraine complicated by analgesic overuse.

Background.—Headaches that are chronic, daily, and aggravated by medication overuse are particularly difficult to treat.

Methods.—Sixty‐one consecutive patients with transformed migraine and analgesic overuse were treated with inpatient pharmacologic therapy alone or with inpatient pharmacologic therapy combined with biofeedback‐assisted relaxation. All patients then were followed prospectively for 3 years.

Results.—Both treatment groups exhibited similar levels of improvement immediately following treatment and for 1 year thereafter. At year 3, participants receiving combined treatment showed greater sustained improvement on two of three outcome measures assessed (ie, fewer days of headache and reduced consumption of analgesic medication). In addition, a greater number of patients assigned to pharmacologic treatment alone relapsed (ie, resumed overuse of analgesics) compared to patients receiving combined treatment.

Conclusions.—These results suggest that a combination of pharmacologic and behavioral treatment is more effective than drug therapy alone in the long‐term management of transformed migraine with analgesic overuse. Confirmation of these findings, as well as extension to other forms of behavioral and cognitive‐behavioral treatment, is required.
Amitriptyline Versus Amitriptyline Combined With Fluoxetine in the Preventative Treatment of Transformed Migraine: A Double‐Blind Study
Authors: Krymchantowski Abouch Valenty , Silva Marcus Tulius , Barbosa Jackeline Soraya , Alves Luiz Anastácio
Published: August 2002

Background and Objectives.—Antidepressants are often used to treat chronic daily headache disorders such as transformed migraine, in part because of the high prevalence of associated mood disorder. We conducted this study to evaluate the efficacy and tolerability of combined treatment with amitriptyline and fluoxetine compared with amitriptyline alone for chronic daily headache due to transformed migraine.

Patients and Methods.—Thirty‐nine patients, 26 women and 13 men, aged 20 to 69 years (mean, 36.4; SD, 2.5) who fulfilled criteria for transformed migraine proposed by Silberstein et al were studied prospectively. Amitriptyline was dosed as follows: 8 mg/day for 6 days, 8 mg twice a day for 6 days, 20 mg/day for 6 days, and 20 mg twice a day for 45 days. In the group receiving combination therapy, fluoxetine was dosed and administered identically. The initial and end of the study (9 weeks) headache indices (frequency × intensity) were compared between groups.

Results.—Twenty‐seven patients completed the study, 13 in the amitriptyline‐alone group (group 1) and 14 in the combination‐therapy group (group 2). The most frequent adverse event in both groups was dry mouth, and there was no significant difference in the occurrence of this or other adverse events between the two groups. Initial headache indices were similar for groups 1 and 2. The mean difference between the initial and final headache index for group 1 was 513.5 (P<.0005) and 893 (P<.0017) for group 2. The difference between the final headache index for the two groups was not significant (P>.207).

Conclusions.—We were unable to demonstrate any significant benefit from amitriptyline plus fluoxetine over amitriptyline alone in the treatment of chronic daily headache/transformed migraine. Because of the small number of subjects involved and the short duration of our study, a type II error cannot be excluded.
Olanzapine in the Treatment of Refractory Migraine and Chronic Daily Headache
Authors: Silberstein Stephen D. , Peres Mario F.P. , Hopkins Mary M. , Shechter Aaron L. , Young William B. , Rozen Todd D.
Published: August 2002

Background.—Olanzapine, a thienobenzodiazepine, is a new “atypical” antipsychotic drug. Olanzapine's pharmacologic properties suggest it would be effective for headaches, and its propensity for inducing acute extrapyramidal reactions or tardive dyskinesia is relatively low. We thus decided to assess the value of olanzapine in the treatment of chronic refractory headache.

Methods.—We reviewed the records of 50 patients with refractory headache who were treated with olanzapine for at least 3 months. All previously had failed treatment with at least four preventative medications. The daily dose of olanzapine varied from 2.5 to 35 mg; most patients (n = 19) received 5 mg or 10 mg (n = 17) a day.

Results.—Treatment resulted in a statistically significant decrease in headache days relative to baseline, from 27.5 ± 4.9 before treatment to 21.1±10.7 after treatment (P < .001, Studentttest). The difference in headache severity (0 to 10 scale) before treatment (8.7±1.6) and after treatment (2.2 ± 2.1) was also statistically significant (P < .001).

Conclusion.—Olanzapine may be effective for patients with refractory headache, including those who have failed a number of other prophylactic agents. Olanzapine should receive particular consideration for patients with refractory headache who have mania, bipolar disorder, or psychotic depression or whose headaches previously responded to other neuroleptic medications.
Intravenous Valproate Sodium in the Treatment of Daily Headache
Authors: Schwartz Tamara H. , Karpitskiy Vladimir V. , Sohn Richard S.
Published: August 2002

Background.—Treatment of chronic daily headache/transformed migraine is challenging, especially when it is complicated by overuse of analgesics, triptans, or both. One common approach involves the use of repetitive intravenous dihydroergotamine. We investigated the use of intravenous valproate sodium in the treatment of chronic daily headache/transformed migraine in patients who had contraindications to the use of or had failed treatment with dihydroergotamine.

Methods.—We administered intravenous valproate sodium (Depacon) to patients with chronic daily headache/transformed migraine (loading dose 15 mg/kg, followed by 5 mg/kg every 8 hours). All analgesics and triptans were discontinued prior to treatment with divalproex sodium, and preventative medications for migraine were begun or continued. All patients received instruction in behavioral modification and the proper use of analgesics and triptans.

Results.—Improvement in headache was reported by 80% of the patients treated, and valproate sodium was tolerated well by most.

Conclusion.—Intravenous valproate sodium may be of assistance in the initial management of patients with chronic daily headache/transformed migraine and analgesic/triptan overuse, especially when dihydroergotamine is ineffective or contraindicated.
Chronic Daily Headache: A Scientist's Perspective
Authors: Srikiatkhachorn Anan
Published: August 2002

Certain features of chronic daily headache, namely, increased headache frequency, expansion of headache area, and cutaneous allodynia, may imply sensitization of central nociceptive neurons in the trigeminal pathway. Repetitive activation of the trigeminal nerve can lead to a biologic and functional change in trigeminal nucleus caudalis neurons, characterized by a decrease in nociceptive threshold and receptive field expansion. Suppression of the endogenous pain control system can facilitate the process of central sensitization. Evidence of such suppression in patients with chronic daily headache includes decreased platelet serotonin, up‐regulation of 5‐HT2A receptors, increased platelet nitric oxide production, and increased levels of substance P and nerve growth factor in the cerebrospinal fluid. Results from a number of animal experiments have indicated that chronic analgesic exposure leads to changes in serotonin content and density of 5‐HT2A receptors in the central nervous system. This plasticity of the serotonin‐dependent pain control system may accelerate the process of sensitization; a biologic outcome that is expressed clinically by the development of chronic daily headache associated with analgesic overuse.