David A. Lee

THE HONORING OF ACCOUNTS

An experiment within a questionnaire was designed to isolate factors that would predict the honoring of accounts. Subjects acted as bystanders and read short vignettes describing an interaction containing an offense by one actor, a demand for an account by the other, and an account by the former. The context and offense, the type of account, and the status relationship between demander and accounter were systematically varied. After reading each vignette, subjects rated the offense, the demand, the account, and the accounter on several dimensions. Factors found to affect the prediction of honoring behavior were: the moral worth of the offender, his penitence, his superior status relative to the demander, and the offensiveness of the violation. Honorability was predicted by moral worth, the offenders personal control over the offense, and the appropriateness of the demand. Differences in the prediction of honoring behavior and honorability were discussed.

A Clinicopathologic Study of Primary Adenoid Cystic Carcinoma of the Lacrimal Gland

A retrospective study of 26 patients with the diagnosis of primary adenoid cystic carcinoma of the lacrimal gland was performed with use of randomly selected tissue from each tumor. An attempt was made to determine any associations among clinical presentation, survival, and tumor histologic patterns. We found that lower tumor grades were associated with a predominantly Swiss-cheese (cribriform) pattern. Both lower tumor grade and Swiss-cheese pattern were associated with longer survival. The basaloid (solid) pattern or bone invasion was not associated with a shorter survival. Between men and women, there were no differences in clinical presentation, histologic patterns, or survival. Survival was not affected by surgical or radiation therapy.

Effect of clonidine on aqueous humor flow in normal human eyes

A randomized, double-blind, placebo-controlled study of the effect of topical 0.125% clonidine, a relatively specific alpha 2-adrenergic agonist, on the rate of aqueous humor flow in the eyes of 24 normal human subjects was performed with fluorophotometry. The effect of clonidine on intraocular pressure, anterior chamber volume, pupil size, pulse, and blood pressure was also studied. Clonidine-treated eyes had a 2 mmHg decrease in intraocular pressure which was statistically significant. Fellow placebo-treated eyes had a smaller but significant decrease in pressure. However, between clonidine and fellow placebo-treated eyes, no significant difference was found in intraocular pressure. Aqueous humor flow was 21% lower in clonidine-treated eyes as compared to fellow placebo-treated eyes, 1.9 microliter min-1 as compared to 2.4 microliters min-1. No significant difference was found in anterior chamber volume, blood-aqueous barrier diffusion constant, and apparent resistance between clonidine and fellow placebo-treated eyes. Clonidine produced a significant miosis of 0.4 mm in treated eyes and miosis of 0.2 mm in fellow eyes. Topical 0.125% clonidine significantly decreased systolic blood pressure by 3 mmHg, but did not affect diastolic blood pressure or pulse.

The clinical diagnosis of Reiter's syndrome. Ophthalmic and nonophthalmic aspects.

The histories of 113 patients with Reiters syndrome were reviewed to obtain information regarding the sequence of the clinical signs and symptoms, laboratory findings, and progression of disease. Rheumatologic manifestations occurred in 98% of the patients, genitourinary manifestations in 74%, ophthalmic manifestations in 58%, and mucocutaneous manifestations in 42%. Four major criteria and six categories of minor criteria for the diagnosis of Reiters syndrome, based on the frequency and specificity of the various manifestations of the disease, are proposed. The ophthalmic and nonophthalmic features are important to appreciate because the ophthalmologist is frequently at the pivotal point in suggesting or supporting the diagnosis.

Effect of phenylephrine on aqueous humor flow

The effect of topical 2.5% phenylephrine hydrochloride, an alpha adrenergic agonist, on the rate of aqueous humor flow was studied in the eyes of 22 normal human subjects. The drug and a placebo were administered by random assignment from coded containers with the fellow eye serving as the control. Intraocular pressure, anterior chamber volume, corneal thickness and the rate of clearance of topically applied fluorescein from the anterior chamber were measured. Four of the 22 subjects underwent a study of the effect of phenylephrine on the permeability to fluorescein of the blood-aqueous barrier. No statistically significant effect of the drug was found on the rate of aqueous humor flow, intraocular pressure, anterior chamber volume, corneal thickness or permeability of the blood-aqueous barrier.

Bilateral medial rectus muscle recession and lateral rectus muscle resection in the treatment of congenital esotropia.

In a retrospective study of 36 patients with congenital esotropia treated surgically by bilateral medial rectus muscle recession and lateral rectus muscle resection, we found that 22 patients (61%) had not required further surgery and that 14 patients (39%) had required further corrective surgery. Seven of these 14 patients had overcorrections and seven had undercorrections. Patients who required a second operation were significantly younger (mean age, 12 months) than those who did not (mean age, 23 months). The most common second surgical procedure was bilateral tenotomy or disinsertion of the inferior oblique muscle. Bilateral medial rectus muscle recession and lateral rectus muscle resection is useful in severe (50 prism diopters or more) congenital esotropia. The surgical success rate may be improved with bilateral inferior oblique muscle disinsertions or tenotomies in patients with inferior oblique muscle overaction. Accurate preoperative examinations in patients old enough to cooperate may help avoid overcorrection and undercorrection.

Surgical Treatment of Lateral Rectus Muscle Paralysis

We conducted a retrospective study of 55 cases to investigate the effectiveness of three different surgical procedures (medial rectus muscle recession and lateral rectus muscle resection in 16 cases, the Hummelsheim procedure in 27 cases, and the Jensen procedure in 12 cases) in the treatment of lateral rectus muscle paralysis. All three procedures were equally effective. Shorter duration of lateral rectus muscle paralysis, greater preoperative lateral version, less contracture of the medial rectus muscle, and a traumatic origin for the sixth cranial nerve damage had a significant effect (P less than .05) on the final results of surgery.