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Retinopathy of prematurity is a disease affecting the blood vessels of the retina in premature infants that may result in scarring, retinal detachment, and loss of vision. An association between this condition and the exposure of premature infants to supplemental oxygen has been postulated, but the relation between retinopathy of prematurity and blood oxygen levels has not been defined. The purpose of this study of a cohort of preterm infants was to correlate the incidence and severity of retinopathy of prematurity with the duration of exposure to different ranges of oxygen tension as measured by transcutaneous monitoring (tcPO2).One hundred one premature infants (birth weight, 500 to 1300 g) requiring supplemental oxygen had continuous monitoring of tcPO2. The number of hours during which the tcPO2 was 80 mm Hg or higher was tabulated for each infant during the first four weeks of life.There was a significant association between the amount of time that the tcPO2 was greater than or equal to 80 mm Hg and the incidence and severity of retinopathy of prematurity. The odds ratio for each 12-hour period in which the tcPO2 was greater than or equal to 80 mm Hg was 1.9 (95 percent confidence interval, 1.2 to 3.0) after adjustment for the following factors: birth weight less than or equal to 1300 g (odds ratio, 2.3 [95 percent confidence interval, 1.6 to 3.4]), five-minute Apgar score of 7 or less (odds ratio, 7.2 [95 percent confidence interval, 2.5 to 21]), and exposure to inspired oxygen at a concentration greater than or equal to 0.4 (odds ratio, 1.0 [95 percent confidence interval, 0.97 to 1.05]). The association was stronger for tcPO2 values of greater than or equal to 80 mm Hg occurring from the second through the fourth week of life; during this period, the adjusted odds ratio for a 12-hour period of such exposure was 3.1 (95 percent confidence interval, 1.6 to 6.1).This study supports an association between the incidence and severity of retinopathy of prematurity and the duration of exposure to arterial oxygen levels of 80 mm Hg or higher, measured transcutaneously.

• In order to test the hypothesis that glaucomatous and nonglaucomatous optic disc cupping can be distinguished ophthalmoscopically, three ophthalmologists experienced in assessing optic dics were asked to view fundus stereophotographs as "unknowns." Of 29 eyes with nonglaucomatous optic atrophy, 13 (44%) were misdiagnosed as showing glaucoma by at least one observer. Of four optic disc features specifically analyzed, neuroretinal rim pallor proved to be 94% specific for nonglaucomatous atrophy, while focal or diffuse obliteration of the neuroretinal rim was 87% specific for glaucoma. These two signs are the most useful in making the distinction. Thinning of the rim was more common in glaucoma than in nonglaucomatous atrophy, but was only 47% specific for glaucoma. Laminar dots were present in both types of excavation.

SummaryIn the present study the relative influence of several variables, other than distal renal tubular hydrogen ion secretion, on urinary pCO2, was evaluated. Thirteen studies were conducted in 12 healthy volunteers aged 21-51 years who Received 2 mequiv/kg body weight of NaHCO3 orally. When urine pH exceeded 7.4, urinary pCO2, and arterial blood pCO2, were measured. The maximal difference between urine and arterial blood pCO2 was 47 ± 2 (SE) mm Hg. In order to obtain data extending over a wide range of urine flow rates, pH, and bicarbonate and phosphorus levels, seven subjects subsequently ingested 20 ml/kg body weight of water. Bivariate Pearson analysis (pre- and post-water-loading data pooled) showed a positive correlation between UpCO2 and the following variables: UpH (r = 0.77), Uhco3 (r = 0.88), UHCO3V (r = 0.45), and Up (r = 0.53) (P < 0.001 for all). A negative correlation was obtained between UpCO2 and V (r = −0.69, P < 0.001). Multiple regression analysis suggested that UHCO3 and Up were the ...

To determine whether the use of continuous transcutaneous oxygen monitoring (tcPO2) could reduce the incidence of retinopathy of prematurity (ROP) in pre-term infants receiving oxygen therapy, a randomized, prospective trial of constant monitoring using the transcutaneous oxygen monitor versus intermittent monitoring of oxygen was performed on a population of premature infants at very high risk for the development of ROP. Two hundred ninety-six infants were randomly assigned to either a constantly monitored (CM) or standard care (SC) group. CM infants had tcPO2 monitored continuously as long as they required supplemental oxygen, whereas SC infants had tcPO2 monitored only during the more acute state of their illness. Management of both groups was otherwise identical. One hundred one of 148 infants in the CM group and 113 of 148 in the SC group survived. The overall incidence of ROP was 51% in the CM group and 59% in the SC group (no significant difference). In infants over 1000 g birthweight, as the weight increased there was increasing risk of developing ROP in the SC group. The odds ratio for the ROPsc:ROPcm reached 7.6 in infants between 1200 and 1300 g in infants with Apgar scores greater than or equal to 8 at 5 minutes. The incidence of cicatricial ROP was similar in both groups: four in the CM and five in the SC group.

In a review of 192 gastric resections, histological changes believed to represent dysplasia of nonmetaplastic gastric epithelium were observed. This paper presents a proposal for their classification. The main feature of this dysplasia is replacement of the differentiated cells lining the glands by undifferentiated cells with varying degrees of cytological abnormalities and cellular pleomorphism, but with absence of architectural glandular derangement. The classification is justified by cytokinetic and histologic observations in experimental gastric carcinogenesis and early human gastric carcinoma. The severity of the changes is graded, first, by the extent of involvement of the gland (crypt) as measured from the proliferative zone (PZ), and, second, by the degree of cytological abnormality. It utilizes a modification of the terminology of Riddell et al. (45) for dysplasia in inflammatory bowel disease wherein the term “dysplasia” denotes intraepithelial neoplasia. The changes are classified into (a) negative for dysplasia, (b) atypical, i.e., indefinite for dysplasia, and (c) positive for dysplasia. Changes negative for dysplasia are considered regenerative and consist of enlargement and vesicular transformation of the nucleus in the cells of the PZ and adjacent part of the crypt. Atypical changes consist of equivocal lesions difficult to classify as definitely regenerative or definitely dysplastic, and are hence called indefinite for dysplasia. They consist of loss of cytoplasmic differentiation of the cells lining the glands (i.e., mucus production and parietal and chief cell differentiation) with increased nuclear-cyto-plasmic ratio and moderate cytological atypicality. Based on the extent of gland involvement, the group with atypical mucosa is subdivided into two categories—atypical, probably negative for dysplasia (AtN) and atypical, probably positive for dysplasia (AtP). Mucosa exhibiting unequivocal cytological features of neoplasia with cellular and nuclear pleomorphism is classified as positive for dysplasia (D). This is subdivided into low-grade and high-grade dysplasia, the latter representing carcinoma in situ. Glandular architecture remains undisturbed in all stages and the cells remain cuboidal, without transformation into intestinal-type cells. This type of dysplasia was found in a significantly higher number of diffuse-type carcinomas than in intestinal-type carcinomas. The previously well-recognized adenomatous or metaplastic dysplasia was significantly more prevalent in intestinal-type carcinoma than in diffuse-type. We believe that this non-metaplastic dysplasia represents a second pathway in the genesis of gastric carcinoma, possibly the diffuse type, and would thus serve as an additional indicator of individuals at risk for gastric cancer. Our findings suggest that the PZ is the site of origin of this dysplasia.

Anileridine, a relative newcomer to the field of obstetric analgesia, was compared with meperidine in a double blind study involving four treatment groups. These treatment groups were as nearly alike in size and make-up as it is possible to obtain with a random sampling of patients. Four hundred seventy-one women were given a primary injection of either 75 mg. meperidine (Group 1), 30 mg. anileridine (Group 2), 75 mg. meperidine with 5 mg. perphenazine (Group 3), or 30 mg. anileridine with 5 mg. perphenazine (Group 4). All four of the treatment groups received 0.4 mg. of atropine sulfate and 0.5 mg. levallorphan tartrate. The state of anxiety of each woman was noted on admission and an evaluation of combined sedative-analgesic effect was made following the primary injection of medication. The patient's behavior in the postmedication period was noted, and the infants were rated by Apgar scores at 1 and 5 minutes after delivery. The analgesics produced almost exactly comparable effects, with 30 mg. anileridine apparently being equivalent to 75 mg. meperidine. When a phenothiazine derivative was added to either analgesic, an increase in the optimum response was obtained among the apprehensive patients but not in the calm patient. This increase was not statistically significant. Apgar ratings were essentially the same in all four treatment groups and indicated that anileridine, in equivalent dosage, had no more depressant effect on the fetus than meperidine whether or not these drugs were combined with the phenothiazine derivative. No significant side effects were noted following the use of either analgesic agent.

Blood pressure levels obtained on two occasions, one year apart, were evaluated among 212 children. An overall correlation of .65 was obtained for systolic pressure and .43 for diastolic pressure. The results suggest that adult levels of correlation are not reached in childhood and that screening programs must consider the relative lability of children's measurements in establishing referral criteria.

A large series of patients with intraocular lens implants had an overall 0.98% incidence of retinal detachment (eight detachments in 819 eyes). Within this group, patients with axial lengths of more than 25 mm had a statistically significantly higher incidence of retinal detachment (P = .054).

A cohort of 166 twin pairs (67 monozygotic and 99 dizygotic) born at the Jackson Memorial Hospital/University of Miami Medical Center between July 1, 1976 and December 31, 1980, was followed from birth to one year of age in order to estimate the genetic variance of blood pressure during the first year of life. The sex-adjusted summary estimate of heritability for systolic blood pressure during all of infancy was 0.22 (p less than 0.001), but statistically significant genetic variance was not found for diastolic blood pressure. When using blood pressures from six to 12 months of age, adjusted for infant sex, heritability was estimated as 0.33 (p less than 0.001) for systolic blood pressure and 0.24 (p = 0.04) for diastolic blood pressure; adjustment for body weight reduced these estimates to 0.27 (p less than 0.001) and 0.17 (p = 0.13), respectively.

This study was performed to determine whether the use of continuous tcPO2 monitoring could reduce the incidence of ROP in preterm infants receiving oxygen therapy. Two hundred and ninety-six infants with birth weights ≤ 1300 grams were randomly assigned to a continuous monitoring (CM) or a standard care (SC) group. CM infants had tcPO2 monitored continuously as long as they required supplemental oxygen while SC infants had tcPO2 monitored only during the more acute state of their illness. Management of both groups was otherwise identical. One hundred and one of 148 infants in the CM and 113 of 148 patients in the SC groups survived. Mean birth weights and gestational age were similar in both groups. Duration of mechanical ventilation and oxygen therapy was also similar. The overall incidence of ROP was 51% in the CM and 59% in the SC group. As birth weight for infants ≥ 1000 grams increased a higher risk for developing ROP was noted in the SC group. Four infants in the CM and 5 in the SC group developed cicatricial ROP. These results suggest that continuous tcPO2 monitoring may reduce the incidence of ROP in infants with birth weights > 1000 grams, but not in the smaller infants in whom this complication occurs more frequently and is more severe.

• A follow-up study was performed to determine the general prognosis for health and life in 86 patients with retinal artery occlusion or ophthalmoscopically observed retinal cholesterol emboli, not subjected to surgery. Survivorship rates and incidence of subsequent cerebrovascular disease were calculated and compared to expected survivorship rate of an age- and sex-matched population. Results were as follows: the patient group with retinal stroke as a whole showed a statistically significant diminished survivorship rate from the third year onward; patients with retinal occlusions without visible emboli had a survivorship rate comparable to the matched control; but patients with visible emboli demonstrated a strikingly diminished survivorship rate. In the study group, the combined time-corrected annual stroke mortality was 1,695 per 100,000 (four to five times greater than expected), but the largest single cause of death was cardiovascular disease. ( Arch Ophthalmol 95:1185-1189, 1977)

This report reviews the literature on amblyopia therapy from 1970 through 1976. New techniques of screening for amblyopia have been developed during this period. Modification of therapy which includes the use of penalization, prisms, red filter, and home exercises has been reported in the current literature. A summary of the author's personal experience in the treatment of amblyopia at the Bascom Palmer Eye Institute from 1966 through 1976 is presented with the factors that influenced the outcome of this therapy.

Adipose tissue fatty acid composition was studied in 139 boys, a subgroup of 1521 subjects aged 8-16 participating in the United States (New York City)--Greece cross-cultural study of coronary heart disease risk factor development. Adipose tissue was obtained by an aspiration technique, followed by transmethylation of fatty acids and gas-liquid chromatographic analysis. Statistically significant differences were found among different cohorts in their adipose tissue content of saturated, monounsaturated and polyunsaturated fatty acids. All United States cohorts had significantly higher (p less than 0.0001) levels of saturated and polyunsaturated fatty acids and significantly lower (p less than 0.0001) monounsaturated fatty acids compared to the Greece cohorts. These relationships held for all three types of fatty acids whether the non-Greek cohort from New York City or the cohorts of adolescents of Greek descent who reside in New York City alone, were compared to the cohorts residing in Greece. The differences in the adipose tissue fatty acids between the cohorts may be an important expression of the biochemical milieu which contributes to the development of relatively low coronary heart disease rates in Greece compared to those in the United States.

To describe the time course of the early development genetic variance for blood pressure, a cohort of twins is being followed from birth to 1 year of age. The present interim report describes systolic and diastolic blood pressure measurements for 102 twin pairs (39 monozygotic (MZ) and 63 dizygotic (DZ) in the newborn period and at 1, 3 and 6 months of age. Mean values for both systolic and diastolic blood pressure were similar regardless of race, sex, zygosity, or chorionicity. Statistically significant genetic variance was detected for systolic blood pressure at 6 months of age but not for diastolic blood pressure at any data point. The data are consistent with the hypothesis that genetic factors that determine within-family similarities of blood pressure may be detected early in life, and support the need for further investigation of both genetic and environmental determinants of blood pressure in young populations.

• In order to assess the contribution of fundus examination to the differential diagnosis of acquired optic neuropathy, five ophthalmologists viewed 163 fundus stereophotographs of nine disease entities as "unknowns." Glaucoma, central retinal artery occlusion (CRAO), and ischemic optic neuropathy (ION) were diagnosed by at least one observer with an accuracy above 80%. The remaining conditions (optic neuritis; compressive, traumatic, and hereditary optic neuropathies) were correctly identified with less than 50% accuracy. Retinal arteriolar attenuation and sheathing were most helpful in differentiating CRAO and ION. Although pathologic disc cupping often identified glaucoma, it was also seen in 20% of eyes with optic atrophy not associated with glaucoma. Excavation was more profound in glaucoma than in nonglaucomatous optic atrophy, the latter demonstrating relatively greater neuroretinal rim pallor. In 6% of nonglaucomatous optic atrophy eyes, however, disc cupping was misdiagnosed as "glaucomatous." Only 11% of eyes with previously documented papillitis or ION left clues that allowed observers to identify preexisting disc swelling.

Acute proliferative retrolental fibroplasia (RLF) has been studied in premature infants employing a Zeiss fundus camera and fluorescein angiography. A total of 164 angiograms have been performed on 122 infants. At the present time, angiography is reserved for studying infants with peculiar or puzzling fundus pictures. A dose of 0.1–0.4 cc of 10% sodium tluoresceinate is employed, depending on the age and the weight of the baby. Fluorescein clearly outlines the major arteriovenous shunt in the retina, which is the hallmark of acute RLF. The shunt fills with fluorescein and leaks it profusely. On regression, a fine brush border of capillaries is seen in the region where the shunt previously had been located. Study of the population susceptible to RLF reveals it to be the smallest sickest babies in the premature nursery.

Daily oral doses of 300 mg diphenylhydantoin given to 14 prisoner volunteers for periods of up to 9 months resulted in a significant depletion of pesticide residues in the adipose tissues. At 9 months, DDT, DDE and dieldrin residues were depleted by 75, 61 and 73% of pretreatment levels, respectively. Apart from gingival hypertrophy in one subject and transient elevation of alkaline phosphatase in 95% of treated cases, no other adverse effect was noted. In nine placebo controls from the same prison, a natural decline in residues was also noted, though the observed changes were not significant over the period of study. Estimates of pesticide-residue depletion rates in adipose tissue revealed a significantly shorter half-life in the treated than in the control subjects. For DDT, DDE and dieldrin this half-life was 6·4, 7·2 and 4·4 months, respectively, after diphenylhydantoin treatment compared with 26, 18 and 12 months, respectively, in the placebo controls. Although deliberate lowering of residues in man for therapeutic purposes is not recommended, the implications and potential application of the procedure are emphasized.

In order to determine whether maintaining the PaO2 between 50-70 mmHg by continuous TcPO2 monitoring could reduce the incidence of ROP, 296 infants with birth weight ≤ 1300g requiring O2 therapy from the first week of life were randomly assigned to a continuous monitoring (CM) or a standard care group (SC). CM group infants had TcPO2 monitoring for as long as they required supplemental O2. SC group infants had TcPO2 monitoring only during the more acute stage of their disease after which their PaO2 was monitored by intermittent sampling. Management of both groups was otherwise identical. 101/148 infants in the CM and 113/148 in the SC group survived. A conclusive positive or negative ROP diagnosis was made after a minimum of two eye examinations in 87 CM and 102 SC surviving infants. Mean birth weight and gestational age were the same in both groups (CM, 1038g, 29.7 wk; SC 1034g, 29.7 wk). The proportions of infants with neonatal asphyxia, RDS, those receiving indomethacin and blood transfusions were also similar in both groups. The incidence of ROP was similar in both groups, 43/87 CM vs 61/102 SC. Only in infants ≥ 1000g was ROP less frequent in CM than in SC group (15/53 vs 30/62 p=.045). Grades III-V cicatricial RLF occurred in 1 CM and 3 SC infants. Continuous oxygen monitoring may reduce the incidence of ROP in infants ≥ 1000g BWT. Supported by NEI Grant #EY03513-01