Janet Cassady

A cohort study of transcutaneous oxygen tension and the incidence and severity of retinopathy of prematurity.

Abstract Background. 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). Methods. 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. Results. There was a significant association between the amount of time that the tcPO2 w...

Retinopathy of prematurity. Diagnosis, severity, and natural history.

This article presents data gathered in a prospective clinical trial of constant monitoring of oxygen therapy on the diagnosis, severity (as coded by a severity index [SI]) and natural history of retinopathy of prematurity (ROP) in 214 surviving infants with birthweights less than or equal to 1300 g. ROP developed in 119 (55.6%) infants and, of these, cicatricial ROP developed in nine (7.6%). The disease was diagnosed at 8-9 weeks on the average in infants with birthweights less than 900 g and 4-5 weeks in infants 900 to 1300 g. Those infants in whom the disease regressed, ROP lasted approximately 15 weeks. The severity of the disease, as defined by the SI, was strongly correlated with the birthweight of the infant and weakly correlated with the total duration of oxygen therapy.

Current Trends in Amblyopia Therapy

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 authors personal experience in the treatment of amblyopia at the Bascom Palmer Eey Institute from 1966 through 1976 is presented with the factors that influenced the outcome of this therapy.

Intraocular Lenses, Axial Length, and Retinal Detachment

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).

Retinopathy of Prematurity: A Randomized, Prospective Trial of Transcutaneous Oxygen Monitoring

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.

Fluorescein Angiography in Retrolental Fibroplasia: Experience from 1969 - 1977

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 fluoresceinate 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.

Reduction of pesticide residues in human adipose tissue with diphenylhydantoin

Abstract 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.

Adipose tissue fatty acid composition of adolescents in a U.S.-Greece cross-cultural study of coronary heart disease risk factors

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.

Comparison of anileridine and meperidine as obstetric analgesia: A double blind study of 471 patients

Abstract 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 patients 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.

Transcutaneous Oxygen Monitoring and Retinopathy of Prematurity

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 less than or equal to 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 greater than or equal to 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 greater than 1000 grams, but not in the smaller infants in whom this complication occurs more frequently and is more severe.