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OBJECTIVE: To review a large number of equine overground endoscopy (OGE) examinations to determine the incidence of dynamic upper airway obstructions (DUAO); correlations were explored with laryngeal endoscopy findings at rest and abnormal exercising respiratory noise. METHODS: Retrospective analysis of horses presenting for OGE because of perceived poor performance and/or history of abnormal exercising respiratory noise between 2010 and 2014. Signalment, history and examination findings during resting laryngeal endoscopy and OGE were reviewed. RESULTS: Of the total examinations, 311 were reviewed. One or more DUAO were found in 249/311 horses. From 210 males (colts and geldings), 121 had arytenoid cartilage collapse (ACC) and 111 had vocal fold collapse (VFC). From 101 females, 25 had intermittent dorsal displacement of the soft palate (DDSP). Resting laryngeal function grade 4 was found in 121/311 of the study population and 92/210 of males. An association was found between horses with lower resting arytenoid abduction ability to dynamic ACC and higher resting arytenoid abduction ability with DDSP. Abnormal exercising respiratory noise was positively associated with the presence of DUAO. CONCLUSIONS: Multiple DUAO in association with abnormal exercising respiratory noise was a common finding in horses examined for poor performance. This study highlights the importance of OGE in accurately diagnosing the nature of DUAO associated with poor performance.

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Silicone abrasion particles are known to cause inflammatory changes following Swanson arthroplasty. Titanium grommets were introduced to protect the implants from wear and abrasion. Two cases with histological evidence of symptomatic titanium particulate tissue inflammation following Swanson joint replacement with grommets are presented.

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Nkx6-2 (former Gtx) is a murine-homeobox-containing gene localized distally on Chromosome (Chr) 7. Analysis of the expression pattern, together with DNA binding assays, suggests that this gene product might be important for differentiated oligodendrocyte function and in the regulation of myelin gene expression. We now report on the cloning and characterization of the human homolog (NKX6B). DNA sequence analysis of an 11-kb genomic fragment revealed that the complete human gene spans 1.2 kb and is composed of three exons. NKX6B is predicted to encode a polypeptide of 277 amino acids with 97% identity to mouse Nkx6-2. Northern blot experiments showed that NKX6B expression is tightly controlled in a tissue-specific fashion with the highest site of expression being the brain. Finally, using STS content mapping and RH analyis, we demonstrated that NKX6B maps to the 10q26, a region where frequent loss of heterozygosity has been observed in various malignant brain tumors. These results may implicate NKX6B as a candidate tumor suppressor gene for brain tumors, particularly for oligodendrogliomas.

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PURPOSE: To report the incidence, management, and prevention of patient reports of glare and streaks around a point source of light or a dark shadow in the temporal field of vision after acrylic intraocular lens (IOL) implantation. SETTING: A private practice. METHODS: Cases in which patients complained vigorously of dysphotopsia were catalogued prospectively during the implantation experience in 6668 consecutive eyes having surgery between January 1995 and June 1999. The techniques of topical-intracameral anesthesia, temporal clear corneal incisions, and phacoemulsification were used in all cases. Alternate IOL styles were selected for use from July 1999 to April 2000. RESULTS: Fourteen cases (0.2%) were identified. The complaints resolved in 1, were diminished in 1, and were tolerated without change in 7. Five eyes of 4 patients required IOL exchange with capsular bag placement of a poly(methyl methacrylate) (PMMA) or silicone lens for resolution of symptoms. Selecting alternate IOL styles reduced the incidence of dysphotopsia. CONCLUSIONS: Glare and streaks from a point source of light represent positive photic expressions of dysphotopsia, and temporal dark shadows represent similar negative photic expressions. Both appear to be associated with shiny square-edge optics made of high-refractive-index acrylic polymer. Intraocular lenses of PMMA and silicone with rounded edges, along with square-edge acrylic IOLs with nonreflective edges, appear less likely to cause clinically significant pseudophakic dysphotopsia.

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Accepting the evidence that evolution is largely finished and that sexual reproduction is incapable of supporting macroevolution, indicates that macroevolutionary changes were produced presexually through the cytological events associated with the first meiotic division. This reproductive mode is ideally suited to the production of new structural rearrangements of preexisting genetic information in instantaneous homozygous form. These new arrangements (position effects) produce new and discrete species. Thus, speciation results not from new genetic information, but rather from information already present (preformed). The several parallels that exist between epigenesis and preformation in both ontogeny (development) and phylogeny (evolution) are discussed. I propose that both of these phenomena have proceeded through the selective activation (derepression) of an enormous potential supply of information already present at the onset of each of these biological phenomena. Acceptance of these possibilities can serve to liberate us in our quest for the ultimate truth concerning these two closely related phenomena.

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PURPOSE: To compare the efficiencies of the operative procedures, the changes in postoperative corneal endothelial cell density (ECD), and incision performance after cataract surgery using 2 different phacoemulsification tips. SETTING: Wolfe Clinic, Marshalltown, Iowa, USA. METHODS: A randomized prospective study of 119 consecutive cases was conducted. All patients were adults having phacoemulsification using a modified in situ fracture technique. All cases were done by 1 surgeon using the Alcon Legacy 20000 phacoemulsification machine with normal vacuum cassettes and tubing. One of 2 45 degree phacoemulsification tips was used: the 1.1 mm TurboSonics (n = 65) or the 0.9 mm MicroTip (n = 54). Measurements at the time of surgery included metered phacoemulsification time and mean phacoemulsification power. Corneal keratometry and ECD by contact specular microscopy were determined preoperatively and 10 weeks postoperatively. RESULTS: The mean metered phacoemulsification time was statistically significantly different between the 2 groups: 1.1 mm TurboSonics = 1.25 minutes; 0.9 mm MicroTip = 1.66 minutes. The mean ultrasound power was also significantly different: 1.1 mm TurboSonics = 52.98%; 0.9 MicroTip = 49.07%. Loss of corneal ECD was not significantly different: 1.1 mm TurboSonic = 3.68%; 0.9 mm MicroTip = 5.79%. Mean diopters of induced incisional keratometric flattering was similar: 1.1 mm TurboSonics, 0.32 diopters (D) +/- 0.61 (SD); 0.9 mm MicroTip, 0.25 +/- 0.49 D. There were no cases of anterior radial capsule tear, posterior capsule tear, vitreous loss, iris aspiration, suture closure, or incision leak. CONCLUSIONS: Although a longer mean metered phacoemulsification time was required with the 0.9 mm MicroTip, corneal endothelial cell loss and incisional keratometric performance were not different from those of cases in which the larger 1.1 mm TurboSonics tip was used. Both tips can be used effectively and safely for phacoemulsification of the human cataract.

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PURPOSE: To compare the efficiencies of the operative procedures and the reductions in postoperative corneal endothelial cell density (ECD) after cataract surgery using 2 different phacoemulsification tips and their associated cassettes and tubing. SETTING: Wolfe Clinic, Marshalltown, Iowa, USA. METHODS: A randomized prospective study of 100 consecutive cases was conducted. All patients were adults having phacoemulsification using a hybrid in situ fracture technique. All cases were performed by 1 surgeon using the Alcon Legacy 20000 phacoemulsification machine. One of 2 45 degree phacoemulsification tips and associated cassettes and tubing were used: the 1.1 mm TurboSonics with normal tubing (n = 47) or the 0.9 mm Aspiration Bypass System (ABS) tip with high-vacuum cassettes and tubing (n = 53). Measurements at the time of surgery included metered phacoemulsification time, percentage power used, total time spent in the phacoemulsification process, and milliliters of balanced salt solution (BSS) used. Corneal ECD was determined preoperatively and 10 weeks postoperatively. An independent statistician performed 2-sample t tests or Wilcoxon rank sum tests on the data. RESULTS: There were no cases of anterior radial capsule tear, posterior capsule tear, vitreous loss, iris aspiration, incision leak, or suture closure. There was no correlation between amount of corneal ECD loss and any operative variable measured. Similar measurements for the 1.1 mm TurboSonics and the 0.9 mm ABS included, respectively, ECD loss 7.34% and 8.22%; metered phacoemulsification time 1.29 and 1.22 minutes; total time of the phacoemulsification process 113 and 105 seconds. There were statistically significant differences between the 1.1 mm TurboSonics tip and 0.9 mm ABS tip performance in mean power percentage overall (52% versus 48%) and overall BSS volume used (85 versus 76 mL). CONCLUSIONS: The 0.9 mm ABS phacoemulsification tip used with the high-vacuum cassette and tubing provided the physical advantages of tip-size reduction while requiring similar ultrasonic power and BSS volumes as the 1.1 mm TurboSonics tip with standard cassette and tubing. Together, they provide a wider available dynamic range in which to integrate ultrasonic power, higher vacuum, and higher aspiration flow rates to improve the efficiency and ease of use than the standard 1.1 mm TurboSonics cataract operation.

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This paper describes the modification of the symbolic representation of Cleft Lip and Palate anomalies described by Friedman et al. These modifications were made in order to facilitate the computerisation of clinical records and database integration, and to improve the compliance and accuracy of cleft data collection.

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PURPOSE: To determine whether the use of the Alcon 20,000 Legacy phacoemulsification unit requires less phacoemulsification time and causes fewer intraoperative complications than the Alcon 10,000 Master unit. SETTING: Private practices in Kansas City, Missouri, and Marshalltown, Iowa, USA. METHODS: This prospective study comprised 400 consecutive cases of phacoemulsification with intraocular lens (IOL) implantation performed using the Alcon 20,000 Legacy unit by a high-volume phacoemulsification surgeon (n = 200) and a moderate-volume surgeon (n = 200). Data included age, phacoemulsification time, and surgical complications. The control study was a retrospective review of the same data from the previous 200 cases done by each surgeon with the Alcon 10,000 Master unit. RESULTS: In the combined series of 400 cases done with the 10,000 Master unit, mean age was 72.7 years and mean phacoemulsification (i.e., ultrasound) time, 1.97 minutes. There were 2 cases (0.50%) of vitreous loss and 3 cases (0.75%) of posterior capsule tear without vitreous loss. The total complication rate for both surgeons was 1.25% with the 10,000 Master. In the combined series of 400 cases done with the 20,000 Legacy unit, mean age was 72.5 years and mean phacoemulsification time, 1.50 minutes. There were no cases of vitreous loss and 1 case (0.25%) of posterior capsule tear without vitreous loss. The total complication rate for both surgeons was 0.25% with the 20,000 Legacy. The difference in complication rates between the two machines was not significant. Phacoemulsification time with the 20,000 Legacy unit was significantly less than with the 10,000 Master unit for both surgeons (P < or = .001 and .05, respectively). CONCLUSION: The Alcon series 20,000 Legacy unit proved to be a safe, reliable, and highly effective instrument for modern cataract extraction and IOL implantation that required significantly less phacoemulsification time than the 10,000 Master unit.

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Ovoid intraocular lenses (IOLs) accounted for approximately 35% of the lenses implanted in 1991. Despite their popularity among surgeons, patient observations and complaints suggest that ovoid lenses are associated with undesired optical images postoperatively. A pilot clinical study was carried out to test that hypothesis. A multicentered investigation of 289 cases with well-centered IOLs determined that 45% of 168 patients with ovoid lenses observed unwanted optical phenomena at some time after surgery, whereas 17% of 121 patients with round IOLs had similar complaints. Based upon the preliminary clinical study a laboratory investigation was designed to assess optical performance differences between ovoid and round IOLs. One testing system used scatterometry and a second, ray tracing analysis. Both methods determined that the truncated, thickened edge of ovoid lenses was associated with significant light scattering, possibly accounting for the extraneous light images observed by some patients. The results of the clinical and laboratory investigations suggest that undesired optical images produced by ovoid IOLs are due to lens shape rather than to the reduced dimension of the optic.

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Capsule contraction syndrome is an exaggerated reduction in anterior capsulectomy and capsular bag diameter after extracapsular cataract surgery. While rarely seen with can-opener-style capsulectomies with anterior radial capsular tears, it is relatively frequent with capsulorhexis. It is particularly common in patients with pseudoexfoliation and in eyes with a history of moderately severe uveitis. Its effects, which include extreme reduction in the capsulectomy opening, malposition of the opening, reduction in equatorial capsular diameter, and displacement of the IOL, seem more exaggerated in small capsulorhexis openings and in the older patient. Neodymium: YAG laser radial anterior relaxing capsulotomies done within three weeks of cataract surgery reduce the sphincter effect of the contraction and lessen the chronic zonular-traction-related complications of the condition, which may include spontaneous IOL dislocation and retinal detachment.

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Two cases of limited (nonexpulsive) acute intraoperative suprachoroidal hemorrhage (AISH) were identified in a consecutive series of 3,096 cataract surgeries accomplished by capsular bag phacoemulsification--an incidence of 0.06%. This is lower than that reported by me in 1986 when I was using iris plane phacoemulsification (0.81%). I believe the reduction is the result of decreased anatomical distortion from reducing the number and amplitude of intraocular pressure swings experienced by the globe during surgery. The pressure swings result from technique-mandated oscillations in infusion and aspiration dynamics, which are greater in number and amplitude in the iris plane technique.

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No significant complications including retrobulbar orbital hemorrhage after retrobulbar anesthetic block were identified in a retrospective review of 3,415 consecutive cataract surgical cases blocked and performed by one surgeon. The technique for retrobulbar injections using a disposable retrobulbar needle is described in detail. All injections were deliberately retrobulbar, directed toward the inferior temporal muscle cone, and were given immediately prior to cataract surgery by the surgeon.

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