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Renowned French painter Edgar Degas suffered of progressive light sensitivity and blurred central vision in both eyes, which affected his life and art in many ways. A first cousin from his mother's side, Estelle Musson of New Orleans also lost vision in a similar fashion at a comparable age. We postulated that Edgar and Estelle shared the same retinal pathology that possibly developed in a hereditary fashion, and we were interested whether any of their living family descendants might carry ABCA4 mutations to test the possibility that Edgar Degas may have had Stargardt disease. Edgar was never married and had no children, but Estelle had five children, four of whom from her marriage to Edgar's younger brother, and there are several descendants still living in New Orleans area. Genetic testing on five of Estelle's great grandchildren (Edgar's great grandnieces) were performed searching for ABCA4 mutations. We could not document any disease-causing variations in the ABCA4 gene in any of the descendants and therefore concluded that Edgar Degas most likely did not have Stargardt disease. Estelle and Edgar may have shared a different hereditary disease or have had two different retinal dystrophies or had another eye disease, including the unlikely possibility of inflammatory disease. [ABSTRACT FROM AUTHOR]

Objectives: To examine trends in acquired immunodeficiency syndrome (AIDS) risk behavior and human immunodeficiency virus (HIV) seroprevalence among injecting drug users (IDUs) in New York City from 1984 through 1992.Design and Setting: Comparisons were made between two surveys of IDUs at the same hospital-based New York City drug abuse detoxification program: 141 IDUs in 1984 and 974 IDUs in 1990 through 1992. National Death Registry, New York City Health Department, and drug treatment program records were also used.Participants: Persons attending detoxification program randomly selected for participation. Eligibility was based on injection within previous 2 months; 99% acceptance rates were obtained. Participants in the 1984 and 1990 through 1992 surveys were 66% and 79% men, 21% and 19% white, 33% and 34% African American, and 45% and 46% Latin American, respectively.Interventions: Community-based AIDS prevention programs, including underground syringe exchanges.Main Outcome Measures: Acquired immunodeficiency syndrome risk behaviors; HIV serostatus; CD4+ cell counts; death rates among 1984 subjects; and injection and intranasal routes of drug administration.Results: The HIV seroprevalence remained stable at slightly more than 50%. Mean CD4+ cell counts declined from 0.716 x 10(9)/L (716/microL) to 0.575 x 10(9)/L (P < .009). Annual death rate among 1984 subjects was 3%, with a significantly higher rate among HIV-seropositive subjects (relative risk, 2.57; 95% exact binomial confidence interval, 1.12 to 6.61). Large-scale declines were observed in AIDS risk behaviors, eg, use of potentially contaminated syringes declined from 51% to 7% of injections (P < .001). Recent additional risk reduction was associated with use of the underground syringe exchanges. Intranasal heroin use was the primary route of drug administration for 46% of heroin admissions to New York City drug treatment programs.Conclusions: The HIV seroprevalence has remained stable among this population of New York City IDUs for almost a decade. Continuation of current trends should lead to further reduction in HIV transmission, although reversal of the trend to intranasal use could lead to substantially increased transmission. [ABSTRACT FROM AUTHOR]

Open reduction and internal fixation of a distal radius fracture can leave a volar plate in close proximity or touching the tendons of the wrist. This cadaveric study examines the how volar plate position changes contact pressure and force against the flexor pollicis longus (FPL) tendon in multiple wrist extension positions. This study suggests that moving the plate from an ideal position (distal edge at the watershed line) to a malposition (5 mm distal to the watershed line) significantly increased the force by 72.7% and contact pressure by 33.5% on the FPL. Multiple clinical case reports have described rupture of the flexor tendons associated with distally positioned plates or protruding screw heads, creating prominent or sharp edges. This study illustrates that in order to minimize contact pressure on the flexor tendons, plating distal to the watershed line should be avoided when possible. [ABSTRACT FROM PUBLISHER]

Background Tretinoin is considered the benchmark prescription topical therapy for improving fine facial wrinkles, but skin tolerance issues can affect patient compliance. In contrast, cosmetic antiwrinkle products are well tolerated but are generally presumed to be less efficacious than tretinoin. Objectives To compare the efficacy of a cosmetic moisturizer regimen vs. a prescription regimen with 0·02% tretinoin for improving the appearance of facial wrinkles. Methods An 8-week, randomized, parallel-group study was conducted in 196 women with moderate to moderately severe periorbital wrinkles. Following 2 weeks washout, subjects on the cosmetic regimen ( n = 99) used a sun protection factor (SPF) 30 moisturizing lotion containing 5% niacinamide, peptides and antioxidants, a moisturizing cream containing niacinamide and peptides, and a targeted wrinkle product containing niacinamide, peptides and 0·3% retinyl propionate. Subjects on the prescription regimen ( n = 97) used 0·02% tretinoin plus moisturizing SPF 30 sunscreen. Subject cohorts ( n = 25) continued treatment for an additional 16 weeks. Changes in facial wrinkling were assessed by both expert grading and image analysis of digital images of subjects’ faces and by self-assessment questionnaire. Product tolerance was assessed via clinical erythema and dryness grading, subject self-assessment, and determinations of skin barrier integrity (transepidermal water loss) and stratum corneum protein changes. Results The cosmetic regimen significantly improved wrinkle appearance after 8 weeks relative to tretinoin, with comparable benefits after 24 weeks. The cosmetic regimen was significantly better tolerated than tretinoin through 8 weeks by all measures. Conclusions An appropriately designed cosmetic regimen can improve facial wrinkle appearance comparably with the benchmark prescription treatment, with improved tolerability. [ABSTRACT FROM AUTHOR]

Objectives included (1) to develop methods for identifying injection drug users with accelerating injection habits so they might be referred to counseling and treatment and (2) to investigate behavioral correlates of accelerating injection habits, including syringe-exchange program utilization. Data on drug use, enrollment in methadone maintenance, and demographic variables were obtained from 328 subjects who were seronegative for human immunodeficiency virus (HIV) who attended anywhere from 4 to 11 quarterly study visits for interview, HIV pretest counseling and risk reduction counseling, and blood donation for HIV antibody testing. Subjects were recalled 2 weeks after each study visit to receive their results and post-test counseling. We characterized subjects according to their patterns of drug injection as accelerating, decelerating, or stable, using intraindividual regression analyses and categorization rules, and by syringe-exchange use as consistent users, sporadic users, or nonusers. The present subjects included 52% with decelerating, 29% with stable, and 19% with accelerating rates of drug injection. There were 128 subjects (39%) who were categorized as consistent users of syringe-exchange programs, 84 (25%) were categorized as sporadic users, and 116 (35%) were categorized as nonusers. All syringe-exchange groups showed significantly decelerating drug injection. Rates of decline were significantly less, however, among consistent syringe-exchange users than sporadic or nonusers of syringe exchanges. Categorical analysis also showed significant differences among groups, with 30% of consistent syringe-exchange program users having accelerating rates of drug injection compared to 9% of nonusers and 17% of sporadic users. That consistent syringe-exchange users included a larger proportion of individuals whose drug habits were accelerating than did sporadic users or nonusers of syringe exchanges suggests a need for improved identification and counseling of such subjects by syringe-exchange program staff. The present statistical approaches may be of value in targeting such efforts. The ability of a syringe-exchange program to attract a disproportionate share of drug users with accelerating rates of drug injection underscores the importance of these programs to HIV prevention efforts. [ABSTRACT FROM AUTHOR]

OBJECTIVES: We assessed recent (1992-1997) HIV incidence in the large HIV epidemic among injection drug users in New York City. METHODS: Data were compiled from 10 separate studies (N = 4979), including 6 cohort studies, 2 'repeat service user' studies, and 2 analyses of voluntary HIV testing and counseling services within drug treatment programs. RESULTS: In the 10 studies, 52 seroconversions were found in 6344 person-years at risk. The observed incidence rates among the 10 studies were all within a narrow range, from 0 per 100 person-years at risk to 2.96 per 100 person-years at risk. In 9 of the 10 studies, the observed incidence rate was less than 2 per 100 person-years at risk. The weighted average incidence rate was 0.7 per 100 person-years at risk. CONCLUSIONS: The recent incidence rate in New York City is quite low for a high-seroprevalence population of injection drug users. The very large HIV epidemic among injection drug users in New York City appears to have entered a 'declining phase,' characterized by low incidence and declining prevalence. The data suggest that very large high-seroprevalence HIV epidemics may be 'reversed.' [ABSTRACT FROM AUTHOR]

· Background: The clinical use of currently available carbonic anhydrase (CA) inhibitors is limited by systemic side-effects, thought to result from the inhibition of intracellular CA isoenzymes. This study investigates how benzolamide, a carbonic anhydrase inhibitor which does not readily penetrate cell membranes, modulates retinal pigment epithelium functions relative to acetazolamide, which diffuses into the cytosol. · Methods: Small retinal detachments were made in Dutch rabbits by injecting saline into the subretinal space. Detachment height was measured using a dual He-Ne beam YAG laser focusing system, and the fluid absorption rate was calculated before and after intravenous injections of saline, acetazolamide or benzolamide. Retinal adhesiveness was determined by peeling the retina from the RPE and measuring the amount of adherent pigment. · Results: The baseline fluid absorption rate of 0.04 μl/mm2/h was unchanged after injection of 0.9% NaCl or low-dose benzolamide (5 mg/kg). The absorption increased to about 0.14 μl/mm2/h after higher benzolamide doses (20–40 mg/kg) and to 0.13 μl/mm2/h after acetazolamide (20 mg/kg). Both acetazolamide and benzolamide significantly slowed the post-enucleation failure of retinal adhesiveness. · Conclusion: Since benzolamide had effects similar to acetazolamide, inhibition of membrane-bound CA appears to be sufficient to enhance subretinal fluid absorption and retinal adhesiveness. Membrane-specific CA inhibitors may therefore be of clinical value if they minimize side-effects from intracellular CA inhibition. [ABSTRACT FROM AUTHOR]

Since sexual transmission of HIV among and from drug injectors is a frequent source of infection, condom use by them is important for prevention. This paper focuses on predictors of condom use at last sex by drug injectors with 'activated motivation,' that is, by those who already are trying to use condoms to reduce HIV risk. Principal subjects are 1,240 drug injectors who report activated motivation to use condoms to prevent HIV and who had had sex within 6 months before the interview. Many used condoms at last sexual event with primary partners (65%) and with casual partners (80%). Condom use with primary partners increased over time, and was higher among those who knew they were HIV-positive or who talked about AIDS with sexual partners, but was lower among those who knew they were HIV-negative, who were Black, Hispanic, women, younger, or high school graduates, or who used crack with their partners at the sexual event. Condom use with casual partners was lower among women, older drug injectors, and those who were high on alcohol along with their partners, and tended to be more likely among those who know they are infected. Condom use with both primary and casual partners was greater with partners who did not themselves inject drugs. Programs should urge drug injectors who are trying to use condoms to avoid HIV transmission that having sex while using psychoactive substances may be a barrier to their doing so even if they want to use condoms and have done so in the past. Finally, research should be conducted to determine if persons with activated motivation should receive HIV prevention assistance that is different from that offered those who lack risk-reduction motivation or those who want to reduce their risk behaviors, but have been unable to implement the desired changes. [ABSTRACT FROM AUTHOR]

IgD levels in individuals infected with the human immunodeficiency viruses (HIV) were studied as a means of monitoring the character and timing of B cell activation in individuals with this infection. Significantly increased levels of IgD were characteristic of homosexual men who were HIV seropositive but asymptomatic or mildly symptomatic. The hyper IgD globulinaemia became progressively more pronounced in patients with increasingly severe infection and reached its most marked level in patients with AID Sreiated complex (ARC), In ARC patients, IgD levels were increased 8-8-fold above normal which was disproportionately greater than the 2 4-fold increase in IgG, the 1-8- fold increase in IgA and the 1-6-fold increase in IgM. IgD levels declined in AIDS patients (although remained elevated compared to controls). The data suggest that an unusual type of B cell activation is responsible for the unique pattern of hypergammaglobulinaemia seen in this disease and that the B cell activation occurs early in the pathogenesis of HIV infection, often before development of symptoms, and continues throughout the course of infection. [ABSTRACT FROM AUTHOR]

Thioridazine toxicity has been described as a 'progressive chorioretinopathy', but this designation can be misleading. During the first year after thioridazine exposure retinal pigmentation evolves from a granular to a patchy or nummular appearance. However, visual function and the electroretinogram typically improve during this period. Some cases may show chorioretinal atrophy and functional loss many years later, but there is little evidence for ongoing drug-related progression. Late atrophy may represent degeneration of cells that were injured subclinically at the time of initial drug exposure. Although thioridazine toxicity produces an evolving pigmentary disturbance, functional changes must be monitored independently of fundus appearance. [ABSTRACT FROM PUBLISHER]

Photoaversion, or light-induced interference with visual comfort and performance, has been a recognised but poorly documented symptom in retinitis pigmentosa (RP). We found that a majority of our RP patients complained of photoaversion even in the absence of significant cataract. RP patients had reduced contrast sensitivity relative to normal people, but the decrement in their visual performance as a result of glare or photostress was only slight. RP patients had raised short-term adaptation and increment threshold levels, but their rate of short-term or photopic adaptation was normal. Photoaversion in RP may result because a small interference with contrast sensitivity or adaptation can place patients in a range of functional disability, or it may derive from a combination of minor aberrations. [ABSTRACT FROM PUBLISHER]

A large group of individuals with retinal disease were tested prospectively for contrast sensitivity by means of Arden gratings. A subgroup of 19 were also tested with the Nicolet automated television system. Individuals with macular or peripheral dystrophy showed a general reduction in contrast sensitivity as visual acuity decreased. The loss of contrast sensitivity was more prominent for high spatial frequencies (6.4 cycles per degree) than for low ones (0.2 cycles per degree). Similar results were obtained for patients with achromatopsia and congenital stationary night blindness. Patients with functional complaints, but no organic basis for decreased acuity, showed greater scatter in their test scores. The Nicolet results showed somewhat smoother curves, but were no more specific in separating normality from abnormality. Contrast sensitivity testing was not specific for the retinal disease entities considered, but may be useful in recording a degree of retinal damage and a degree of functional visual disability. Contrast sensitivity appeared to be reduced whenever acuity was reduced, so that a distinction could be made between patients having a loss of contrast beyond the expectations for their level of acuity and those in whom a loss of contrast simply corroborates the reduction of acuity. [ABSTRACT FROM PUBLISHER]

Two elderly patients were noted to have unilateral central retinal arterial narrowing with cilioretinal arterial collaterals supplying the bulk of the flow to the inner retina. One patient had excellent acuity and normal pupillary reactions; the other had marked impairment of vision and an afferent pupillary defect. Both patients were asymptomatic. We suggest that these patients had gradual or partial central retinal arterial occlusion which allowed the development of a collateral arterial supply from the ciliary system. [ABSTRACT FROM PUBLISHER]

Serum copper, serum caeruloplasmin, and urinary copper excretion were measured in 38 American patients (and 15 family members) with recessive, dominant, and X-linked forms of retinitis pigmentosa. No abnormalities were found, in contrast to the findings of a recent study on Indian patients. Our data argue against a role for copper metabolism in ordinary retinitis pigmentosa. [ABSTRACT FROM PUBLISHER]

Visual pigment regeneration in the frog requires apposition between the retina and retinal pigment epithelium. However, regeneration occurs nearly as well with the retina upside down (i.e. with the inner limiting membrane facing the pigment epithelium) as right side up. [ABSTRACT FROM AUTHOR]