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Background and Aims: Despite the reported salutary benefits of a Mediterranean diet (MD) on a wide variety of health conditions, the specific microbial changes associated with an MD within the gastrointestinal (GI) tract are not well studied. Specifically, although population and survey-based studies have shown microbial changes, there are no published data on how an MD alters the gut flora in a controlled setting., Methods: We recruited 10 healthy subjects, each of whom gave a stool sample at baseline and then was provided with prepared meals of a "typical" American diet; after 2 weeks, a second stool sample was collected. All subjects were then provided with prepared meals based on the MD for another 2 weeks, followed by a final stool sample collection. Stool samples were batch analyzed with DNA extraction, and sequencing libraries were generated. Measures of bacterial diversity, species richness, and enterotypes were performed., Results: All ten subjects tolerated the diets well. Bacterial diversity increased with an MD, as measured by alpha diversity via the Simpson index. Furthermore, there were significant differences in 5 bacterial genera between the 2 diets., Conclusion: This small pilot study of controlled diets demonstrates that the MD can rapidly alter the gut microbiome in healthy subjects at the level of global microbial diversity and individual genera. These data confirm the findings of previous observational studies and establish the feasibility of conducting longer term studies on the impact of the MD on the flora of the GI tract and its relationship to digestive diseases., (The Author(s). Published by S. Karger AG, Basel.)

Background: Gene editing using CRISPR/Cas9 is a widely used tool for precise gene modification, modulating gene expression and introducing novel proteins, and its use has been reported in various filamentous fungi including the genus Fusarium. The aim of this study was to optimise gene editing efficiency using AMA1 replicator vectors for transient expression of CRISPR constituents in Fusarium venenatum (A3/5), used commercially in the production of mycoprotein (Quorn™)., Results: We present evidence of CRISPR/Cas9 mediated gene editing in Fusarium venenatum, by targeting the endogenous visible marker gene PKS12, which encodes a polyketide synthase responsible for the synthesis of the pigment aurofusarin. Constructs for expression of single guide RNAs (sgRNAs) were cloned into an AMA1 replicator vector incorporating a construct for constitutive expression of cas9 codon-optimised for Aspergillus niger or F. venenatum. Vectors were maintained under selection for transient expression of sgRNAs and cas9 in transformed protoplasts. 100% gene editing efficiency of protoplast-derived isolates was obtained using A. niger cas9 when sgRNA transcription was regulated by the F. venenatum 5SrRNA promoter. In comparison, expression of sgRNAs using a PgdpA-ribozyme construct was much less effective, generating mutant phenotypes in 0-40% of isolates. Viable isolates were not obtained from protoplasts transformed with an AMA1 vector expressing cas9 codon-optimised for F. venenatum., Conclusions: Using an AMA1 replicator vector for transient expression of A. niger cas9 and sgRNAs transcribed from the native 5SrRNA promoter, we demonstrate efficient gene editing of an endogenous marker gene in F. venenatum, resulting in knockout of gene function and a visible mutant phenotype in 100% of isolates. This establishes a platform for further development of CRISPR/Cas technology in F. venenatum for use as a research tool, for understanding the controls of secondary metabolism and hyphal development and validating prototypes of strains produced using traditional methods for strain improvement., (© 2021. The Author(s).)

Background: Gene editing using CRISPR/Cas9 is a simple and powerful tool for elucidating genetic controls and for crop improvement and its use has been reported in a growing number of important food crops, including recently Fragaria . In order to inform application of the technology in Fragaria, w e targeted the visible endogenous marker gene PDS (phytoene desaturase) in diploid Fragaria vesca ssp. vesca 'Hawaii 4' and octoploid F.  ×  ananassa 'Calypso'., Results: Agrobacterium -mediated transformation of leaf and petiole explants was used for efficient stable integration of constructs expressing plant codon-optimised Cas9 and single guide sequences under control of the Arabidopsis U6 - 26 consensus promoter and terminator or Fragaria vesca U6III regulatory sequences. More than 80% ('Hawaii 4') and 50% ('Calypso') putative transgenic shoot lines (multiple shoots derived from a single callus) exhibited mutant phenotypes. Of mutant shoot lines selected for molecular analysis, approximately 75% ('Hawaii 4') and 55% ('Calypso') included albino regenerants with bi-allelic target sequence variants. Our results indicate the PDS gene is functionally diploid in 'Calypso'., Conclusion: We demonstrate that CRISPR/Cas9 may be used to generate biallelic mutants at high frequency within the genomes of diploid and octoploid strawberry. The methodology, observations and comprehensive data set presented will facilitate routine application of this technology in Fragaria to single and multiple gene copy targets where mutant phenotypes cannot be identified visually., Competing Interests: All the authors declare that they have no competing interests.

The cultivated strawberry, Fragaria × ananassa   ( Fragaria spp.) is the most economically important global soft fruit. Phytophthora cactorum , a water-borne oomycete causes economic losses in strawberry production globally. A bi-parental cross of octoploid cultivated strawberry segregating for resistance to P . cactorum , the causative agent of crown rot disease, was screened using artificial inoculation. Multiple putative resistance quantitative trait loci (QTL) were identified and mapped. Three major effect QTL ( FaRPc6C , FaRPc6D and FaRPc7D ) explained 37% of the variation observed. There were no epistatic interactions detected between the three major QTLs. Testing a subset of the mapping population progeny against a range of P. cactorum isolates revealed no significant interaction ( p  = 0.0593). However, some lines showed higher susceptibility than predicted, indicating that additional undetected factors may affect the expression of some quantitative resistance loci. Using historic crown rot disease score data from strawberry accessions, a preliminary genome-wide association study (GWAS) of 114 individuals revealed an additional locus associated with resistance to P . cactorum . Mining of the Fragaria vesca Hawaii 4 v1.1 genome revealed candidate resistance genes in the QTL regions., Competing Interests: The authors declare that they have no conflict of interest.

The availability of short stature apple scions that required minimal applications of chemical growth retardants and could be used with a range of rootstocks would be of considerable benefit to fruit growers. We have suppressed the expression of a gene encoding the gibberellin (GA) biosynthetic enzyme GA 20-oxidase to reduce the levels of bioactive GAs in a scion variety, resulting in significant reductions in stem height. Application of GA3 reversed the effect. The scion remained dwarfed after grafting on to normally invigorating rootstocks, whilst control plants of the same cultivar displayed the expected vigour when grafted on to these rootstocks. This approach could be applicable to any perennial crop variety, allowing dwarf trees to be obtained on any available rootstock or on their own roots without the need for chemical growth retardant application. In effect, seedlings that are well suited to local conditions (drought, salinity) could be employed as tree rootstocks, as could existing rootstocks valued for characters other than vigour control, such as pest and disease resistance.

Clinicians' reaction to isolating Candida organisms in urine culture (> or = 10(4) CFU ml-1) was assessed in a retrospective review of 133 consecutive in-patients (> or = 15 years-of-age) over a 5 month period. The average age was 68.8 years and male/female ratio was 0.36 (35/98). Most (78.2%) patients had an indwelling catheter, and many (35.3%) were in the intensive care unit (ICU). In response to culture-result, clinicians initiated antifungal therapy in 80 instances (60.2%). Treatment was often based on a single culture without documenting the infection (n = 53/80, 66.3%) in the absence of risk for invasive disease. Removing the indwelling-catheter was never attempted and antibiotics were rarely discontinued or modified (1.3%). Fluconazole was most frequently utilized (n = 42, 52.5%), followed by amphotericin-B bladder-irrigation (n = 26, 32.5%), and combined fluconazole/amphotericin-B bladder-irrigation (n = 12, 15%). Therapy was more frequently initiated in ICU-cases (76.6 versus 55.6%; P = 0.023) and less often in non-catheterized individuals (40.7 versus 69%; P = 0.012) and patients with 10(4) CFU ml-1 (25.9 versus 72.7%; P < 0.0001). These findings show that clinicians nowadays do not follow current guidelines for the management of candiduria. Efforts to increase clinicians' awareness of these guidelines, which are intended to confirm the diagnosis and stratify treatment according to patient risk factors, appear to be necessary.

Purpose: We assessed the value of determining strain relatedness in differentiating persistent from recurrent candiduria., Materials and Methods: Prospective monitoring of patients with candiduria (10(4) or greater colony forming units per ml.) during a 5-month period. All patients with persistent or recurrent infection after documented clearance were selected. Pair isolates were typed using restriction endonuclease analysis of genomic deoxyribonucleic acid with SfiI. Isolates were considered related if all deoxyribonucleic acid bands matched., Results: We encountered 22 and 5 patients with persistent and recurrent infection, respectively. The isolates were recovered 1 to 140 days apart (21.56 +/- 28.97). Most patients were women (85.2%) with a mean age of 66.41 +/- 18.11 years. Risk factors included antibiotics (100%), indwelling catheter (88.9%) and diabetes mellitus (40.7%). Of 15 individuals who received antifungal therapy candiduria persisted in 10 and resolved but recurred within 4 to 26 days (13.00 +/- 9.08) after treatment in 5. Candida albicans accounted for 34 of 58 isolates (58.6%), and it was mixed with other species in 4 cultures. Paired strains were genetically identical in 26 of 27 patients. Strain persistence was documented in 21 of 22 cases with persistent infection and in all 5 patients with recurrent disease., Conclusions: These findings show that strain persistence is exceedingly frequent in candiduria. These results imply that determining strain relatedness of Candida urinary isolates may not be reliable in differentiating persistent from recurrent infection.

The significance of isolating Candida species from intravascular catheters was examined retrospectively. Our findings demonstrate that these organisms are encountered among patients with proven invasive candidiasis or as an isolated finding. Febrile patients with yeasts in two or more additional sites may be at risk for invasive cadidiasis and may benefit from treatment.

The frequency of strain relatedness was determined among randomly selected patients with coagulase-negative staphylococcal infections as determined in multiple blood cultures by plasmid typing, determination of species, and antibiotyping. Strain relatedness was demonstrated in 21 of 47 episodes of bacteremia (44.7%) among 34 patients, with a similar percentage among patients with two or one positive blood culture in 24 h (14 of 30 [46.7%] versus 7 of 17 [41.2%], respectively). Same-strain bacteremia was more frequent in cases of infection among patients with a corresponding fever (15 of 21 [71.4%]), among patients infected with organisms from an identifiable source (7 of 9 [77.8%]) and with non-Staphylococcus epidermidis species (9 of 11 [81.8%]), and among patients with nosocomially acquired infections (18 of 36 [50%]). Comparing episodes with or without strain relatedness, no difference was noted in the time to growth (2.1 +/- 1.4 versus 1.9 +/- 0.9 days, respectively), in bacterial growth in two culture bottles (5 of 14 [35.7%] versus 8 of 24 [33.3%], respectively), and in the presence of additional negative blood cultures (9 of 21 [42.9%] versus 11 of 26 [42.3%], respectively). The antibiotypes of all related strains and 7 of 44 (15.9%) unrelated pairs were identical. These findings demonstrate that coagulase-negative staphylococci from multiple blood cultures are frequently unrelated, suggesting a high prevalence of contamination. In the absence of precise measures for demonstrating strain relatedness, the combination of a clinical assessment with antibiotype determination appears to be a suitable alternative.

An outbreak of gastroenteritis at a large teaching hospital affected at least 52 workers. Investigation implicated a tuna salad, and the circumstances suggested Clostridium perfringens as the etiologic agent. The risk of such outbreaks may be reduced by cooling of ingredients prior to mixing and refrigeration in small steel containers.

All consecutive patients with positive blood culture for Candida species over a 6-year period were evaluated to define recent epidemiologic characteristics of candidemia, and to assess the prevalence of late complications. We encountered 106 cases; medical records were available for 99 of them. The rate of candidemia was increasing until 1990, after which it declined. C. albicans was the most common species, but in the last 2 years, C. tropicalis and C. parapsilosis were emerging. Overall mortality rate was 54.5% without significant variation during the study period. Antifungal therapy was withheld in 24/99 cases (24.2%). Decision to withhold treatment was taken in 19/59 cases (32.2%) before the availability of fluconazole in 1990, compared with 5/40 cases (12.5%) afterward (p < 0.05). Follow-up was possible in 35 instances for an average period of 17.1 months (range: 1-48 months); 7 of these individuals, all with transient candidemia, were untreated. None of the survivors developed late complications. These findings demonstrate that candidemia appears to be declining since 1990, with a noticeable decrease in the prevalence of C. albicans but an increase in that of C. tropicalis and C. parapsilosis, that fewer patients are left untreated since fluconazole became available, and that the risk of late complications among the survivors is low.

Objectives: To define the clinical characteristics of acyclovir neurotoxicity and to outline how to distinguish it from viral encephalitis., Design: Case series of acyclovir neurotoxicity., Setting: All cases reported in Index Medicus or in bibliographic reviews of acyclovir neurotoxicity plus two representative studies of Varicella zoster and Herpes simplex virus encephalitis., Subjects: Thirty-five patients who developed neuropsychiatric symptoms during acyclovir therapy., Interventions: Analysis of the patients' demographics, risk factors, acyclovir dosages and duration, clinical and laboratory findings and outcome., Main Outcome Measures: All clinical and laboratory findings that were statistically significantly different from viral encephalitis., Results: The median age was 53.3 years. The most common predisposing factors were the use of other potentially neurotoxic medications (17 cases) and acute or chronic renal failure (15 cases). Acyclovir levels were frequently found above the therapeutic range. The characteristic manifestations were confusion (15 cases), hallucination or delirium (9 cases), agitation (8 cases) and lethargy (10 cases). Few patients had associated tremors (11 cases). Fever, headache, seizures and focal neurologic findings were distinctly rare. Cerebrospinal fluid and computed tomography were normal except in patients with other central nervous system disorders. Symptoms appeared within 2 days of therapy in the majority and resolved completely within several days of discontinuing acyclovir., Conclusions: Acyclovir neurotoxicity is a self-limiting, dose-dependent phenomenon which is more common in the elderly, in patients with renal failure or in association with other neurotoxic medications. It is distinguished from viral encephalitis by its sudden onset, absence of fever or headache, lack of focal neurologic findings and normal cerebrospinal fluid.

A case of group B streptococcal meningitis in an adult is presented with a review of 42 other cases reported in the English literature since 1940. Their median age was 58 years (72.5% were older than 45 years). Male/female ratio was 0.9:1, with male predominance in patients older than 60 years (76.5%). Predisposing illnesses were common but 13.9% of cases reported had no identifiable risk factor. Encephalopathy and bacteremia were frequent (81.3% and 94.4% respectively) and many patients (30%) had other foci of infection. Gram stain of cerebrospinal fluid was positive in 75% of cases. Mortality was 18.4% and 9.7% of survivors had bilateral hearing loss. Thus, this review illustrates that group B streptococcal meningitis in adults is a rare disease which occurs among high risk individuals. It is characterized by frequent encephalopathy, prevalence of other foci of infection and bacteremia with an outcome similar to other types of purulent meningitides.

Three cases of pyogenic sacroiliitis are described, and the English literature from 1878 to 1990 reviewed, for a total of 166 cases. In 1 patient the source of infection was identified at the site of an intravenous line; 1 patient had 2 risk factors for developing the disease (pregnancy and intravenous drug use); and a third patient had no source of infection and no associated risk factors. The diagnosis of pyogenic sacroiliitis was made in each patient by history, physical examination, and positive skeletal scintigraphy or computed tomography of the sacroiliac joint. The infectious agent causing septic arthritis was identified by fine-needle aspiration of the sacroiliac joint under fluoroscopic guidance. Two of the 3 patients also had an open biopsy of the sacroiliac joint--one to confirm the organism causing septic arthritis, and the other for surgical drainage of the infected sacroiliac joint. Cultures from all 3 patients grew organisms uncommon for this disease, and all were treated for 6 weeks with intravenous antibiotics. In all patients pain diminished after treatment. Pyogenic sacroiliitis is a relatively rare condition (1-2 cases reported/year) that may be clinically difficult to diagnose unless the clinician is familiar with the disease. A prompt diagnosis can prevent significant morbidity and reduce serious complication. Major predisposing factors include intravenous drug use, trauma, or an identifiable focus of infection elsewhere, but 44% of patients have no predisposing or associated factors identified. Most patients present with an acute febrile illness with pain in the buttocks and pain on movement that stresses the affected sacroiliac joint. There is no specific blood test which points to the diagnosis of pyogenic sacroiliitis, although the erythrocyte sedimentation rate may be greater than 100 mm/hr. The diagnostic procedure of choice is bone scan with attention to the early perfusion phase, which usually localizes the affected sacroiliac joint. Unilateral involvement is the rule. In patients whose blood cultures fail to reveal a causative organism, fluoroscopic guided fine-needle aspiration of the sacroiliac joint under general anesthesia may help to identify the organism. If all cultures are negative, open biopsy of the sacroiliac joint may be required. Open biopsy should also be done if sequestration or an abscess is formed, or if the patient fails to respond to antibiotic therapy.(ABSTRACT TRUNCATED AT 400 WORDS)

Following the M1 air crash on 8 January 1989, 39 casualties were taken to the Queen's Medical Centre, Nottingham. A team of 31 radiographers and four radiologists used all five X-ray rooms adjacent to the Accident and Emergency Department. Patients with head and spinal injuries were further assessed in the CT suite by four radiographers and a neuroradiologist. The volume of work in the first few hours and in the subsequent days is described. All radiological examinations have been reviewed and the injuries, including those missed at initial assessment, are discussed. The role of the radiologists was to issue immediate reports, manage examinations so as to minimize any delay and assess the need for further specialized investigation. Important problems were identified, specifically: the call-out system; patient deterioration and lack of resuscitation equipment; patient flow; documentation; radiology equipment; and missed injuries. These problems are discussed and recommendations are made for X-ray Departments in dealing with disasters.

Potentially useful and valuable donor-eye tissue is lost because physicians decide erroneously that certain deceased people are not suitable donors. The Indiana Lions Eye Bank Inc. needs and will receive with gratitude any and all donated eyes. Donated ocular tissue can be used for research or teaching, if not for actual transplantation. All deceased people should be regarded as suitable eye donors, except when the cause of death or other factors might pose risks for enucleators themselves.

Diffuse idiopathic skeletal hyperostosis (DISH) is now recognized with increasing frequency in the elderly population. Whilst usually a relatively asymptomatic process, serious neurological sequelae have been reported. A previously unreported complication, severe focal thoracic canal stenosis, is presented. Attention is drawn to the need for full assessment of the whole spine by CT myelography in patients presenting with evidence of myelopathy.

An acute, febrile, self-limited disease process occurred in an otherwise healthy young adult that satisfies accepted criteria for the diagnosis of Kawasaki disease. Unusual features of this case include the patient's age and the documentation of notable, acute noncalculous distention of the gallbladder, a recognized complication of the condition. Evidence of cystic-duct obstruction during the acute phase of distention and subsequent establishment of patency during the convalescent stage is provided with the use of serial ultrasonographic and radioisotopic studies. Discussion of the possible mechanisms for acute hydrops of the gallbladder in Kawasaki disease is included and the need to consider this diagnosis in young adults with the appropriate clinical manifestations is underscored.

Medical and pharmacologic research of recent years has led to the development of many potent and efficacious topical ophthalmic medications. Unfortunately, many of these drugs are potentially toxic or allergenic, and their adverse effects have themselves become important external ocular diseases. This paper presents a classification of these adverse effects and provides a review of their etiology, pathogenesis, histopathology, diagnosis, and management. It is hoped that this information will be helpful to ophthalmologists in their efforts to anticipate, prevent, recognize, and treat drug-induced ocular problems and that it will serve to emphasize the importance of avoiding the ill-considered use of medications.

We report the rapid healing of several cases of marginal corneal ulceration of various aetiologies after the excision of a 4 to 7 mm strip of adjacent limbal conjunctiva. After conjunctivectomy the remaining conjunctiva was loosely recessed (without sutures). In one case with coexisting scleromalacia, we excised strips of adjacent bulbar conjunctiva with equally good results. Some of the cases had failed to respond to other modes of treatment including topical collagenase inhibitors. One case responded to peritomy and cryotherapy to the ulcer edges, but we have abandoned this treatment in favour of conjunctival excision. Limbal conjunctivectomy with recession is presumed to act by eliminating conjunctival sources of collagenase and proteoglycanase.

New knowledge of adverse external ocular reactions to topical ophthalmic medications was obtained by means of a computerized epidemiologic study, laboratory studies, and clinical observations. Listed below are the major findings and conclusions that represent facts or concepts that were previously unknown, uncertain, misunderstood, or forgotten: The incidence of clinically important drug reactions among all cases was at least 13.09% and may have been as high as 16.02%. Among treated patients it was at least 16.26% to 19.90%. Taken together, drug reactions were the second most common external disease diagnosis. The incidence of each kind of drug reaction was determined. Toxic papillary reactions accounted for 79.10% of drug cases and 10.35% of all cases. Toxic papillary keratoconjunctivitis was the third most common single diagnosis. The following epidemiologic factors were found to be related to the development or presence of drug reactions: number and variety of treating practitioners, number of practitioners consulted, number of practitioners consulted who treated, specific ophthalmologist consulted (8.24% of ophthalmologists referred 39.55% of all drug cases and showed a tendency habitually to overtreat), number and kinds of patients' symptomatic complaints, number of medications prescribed and used, number of days of treatment, particular drugs and preservatives used (but not their strengths or vehicles), underlying (primary) diagnoses, and inaccuracy of referring ophthalmologists' diagnoses. Patients with dry eyes were especially at risk for the development of toxic papillary reactions. Among all cases, the incidence of reactions to preservatives (mainly thimerosal) in contact lens solutions was 0.39% to 1.95%, depending on whether definite or probable cases, respectively, were considered. The incidence among the 54 patients who used daily-wear lenses (excluding extended-wear therapeutic and optical contacts) was 7.41% for definite reactions and 37.04% for probable ones. Factors relating to the development of papillary contact-lens reactions were daily wear, number of days of wear, and, especially, the preservatives to which the patients were exposed. Reactions occurred more often with soft lenses than with hard ones. Of patients with drug reactions, 5.22% had two different ones simultaneously. Coexisting reactions to pharmacologically active agents were also present in 15% of patients who reacted to preservatives in contact lens solutions. The ocular tissues that were affected by each kind of drug reaction were tabulated, and the relative degrees and sequences of involvement were discussed. The frequencies with which particular drugs, physical ag

Unlike keratoacanthomas occurring on the skin, those found on mucous membranes are decidedly rare. We present two cases of keratoacanthoma of the limbal area.

Over 24 months (January 1972-December 1973) 48 intravenous heroin users were admitted to Detroit General Hospital with 50 episodes of bacterial endocarditis (B.E.). Staphylococcus aureus (25 cases), enterococci (13 cases), and Pseudomonas aeruginosa (5 cases) were the usual pathogens, accounting for 86 per cent of these illnesses. Occasional episodes were due to other streptococci or diphtheroids which were susceptible to penicillin G. Staphylococcal and pseudomonas endocarditis usually involved the tricuspid valve, while enterococci affected aortic or mitral valves. Pre-existing valvular heart disease was not the sole determinant of the site of infection.

We report four patients who had glaucoma in association with the Maroteaux-Lamy syndrome. Two of these patients had acute angle-closure glaucoma, one had chronic angle-closure glaucoma, and one was treated for open-angle glaucoma; however, the angle structures could not be seen by gonioscopy. Standard peripheral iridectomy was inadequate for treatment of this angle-closure glaucoma because of the considerably increased thickness of the peripheral cornea that occurs in these patients. Our findings suggest that glaucoma may be more common in the Maroteaux-Lamy syndrome than has been realized and that the initial mechanism is secondary acute or chronic angle closure not related to pupillary block.

Serologic responses, physical findings, and survival were studied in 51 cases of proved (14 patients) or presumptive (37 patients) herpes simplex encephalitis occurring in North America between 1965 and 1972. On the basis of a statistical analysis of 16 serological parameters tested in both groups, presumptive cases are likely similar to definitive cases. Using this assumption, the following tentatives conclusions are possible. Complement-fixing antibodies may be more sensitive measures of rises in anti-herpes simplex virus antibodies than are conventional or complement-requiring neutralizing or passive hemagglutinating antibodies. Mortality in herpes simplex virus encephalitis may vary from 0 to 80% and may be predictable depending upon the occurrence of seizures, paralysis and coma. Coma seems to dictate the dour prognosis. When 51 cases of herpes simplex virus encephalitis reported in the literature by others between 1944 and 1972 were analyzed by this method, a comparably varied mortality was obtained. It did not appear that treatment with idoxuridine increased the likelihood of survival.

The ocular reactions to caterpillar hairs are diverse in nature and location, ranging from a toxic reaction to the external foreign bodies, keratoconjunctivitis or the formation of conjunctival nodules, to intense iritis, vitritis or papillitis. Four cases are presented in this paper to illustrate the various degrees of ocular involvement. Included are clinical photographs of intravitreal and subretinal hairs. A classification of these reactions is suggested to facilitate the choice of treatment.

Presumed accidental corneal exposure to Hibiclens (chlorhexidine 4% and detergent) in two patients resulted in severe and permanent corneal opacification. We investigated the corneal toxicity of Hibiclens by gross, biomicroscopic, and histopathologic studies of rabbit eyes exposed to Hibiclens for varying time intervals ranging from five to 15 minutes. Severe, irreversible, and progressive corneal damage resulted in all eyes studied.

Traumatic hyphema is a potentially serious problem, but the overall prognosis is good unless associated injuries are severe. Medical treatment is of little value for hyphema itslef but is useful for complications. Surgical treatment is hazardous and should be resorted to only in select circumstances. Severly of injury is more important than is treatment in determining the outcome. Practitioners should not feel obliged to use ritualistic therapy that they consider to be of uncertain value.

Oxisuran, a selective inhibitor of cellular immunity, delayed the rejection of bovine corneal xenografts when it was administered intraperitoneally to rabbits. The drug produced no significnat effect on the production of humoral antibody in response to injected sheep erythrocytes.

Carbenicillin disodium was temporally associated with eight episodes of a mild reversible anicteric hepatitis characterized by nausea, vomiting, and a tender, somewhat enlarged liver. Serum glutamic and oxaloacetic transaminase as well as alkaline phosphatase levels rose, but serum bilirubin values remained normal. There usually were no signs of concomitant allergy to penicillin, and other penicillins could be given subsequently without ill effects. Biopsy specimens of the liver showed spotty liver cell necrosis with no cholestasis.