Objective. To demonstrate the safety and use of the transcaruncular approach as a surgical technique that provides rapid exposure of the medial orbital wall and apex through a small cosmetic conjunctival incision. Methods: The transcaruncular anterior orbitotomy incision is made through the conjunctiva, between the plica and caruncle, with dissection to a subperiorbital plane along the medial orbital wall. This technique was used in 49 patients (58 orbits) between July 1995 and December 2000. The patients' ages ranged from 5 to 89 years (mean, 50 y). Results: The transcaruncular anterior orbitotomy approach provided appropriate surgical exposure in all cases of orbital decompression for thyroid-related orbitopathy (in 33 orbits [26 patients]); for biopsy of medial orbital or orbital apex masses in 12 patients; and for drainage of an orbital abscess or marsupialization of a mucocele in 7 orbits (6 patients). Five patients (6 orbits) underwent a transcaruncular approach for release of medial rectus entrapment after fracture. The single complication was 1 patient who required a revision procedure for treatment of medial fornix scarring with resolution of diplopia. Conclusions: The transcaruncular approach provides a safe, rapid, and cosmetically pleasing surgical approach to the medial orbital wall and orbital apex. This technique can be used for a variety of indications.

Background. A new children's hospital provided the impetus to investigate radiation dose and image quality in a fluoroscope that was specially engineered for pediatric fluoroscopy. Radiation protection management recommends radiation exposures that are as low as reasonably achievable, while still maintaining diagnostic image quality.Objectives. To obtain comparative phantom imaging data on radiation exposure and image quality from a newly installed fluoroscope before and after optimization for pediatric imaging.Materials and methods. Images were acquired from various thickness phantoms, simulating differing patient sizes. The images were evaluated for visualization of high- and low-contrast objects and for radiation exposure. Effects due to use of the image intensifier anti-scatter grid were also investigated.Results. The optimization of the new fluoroscope for pediatric operation reduced radiation exposure by about 50 % (compared to the originally installed fluoroscope), with very little loss of image quality. Pulsed fluoroscopy was able to lower radiation dose to less than 10 % of continuous fluoroscopy, while still maintaining acceptable phantom image quality.Conclusion. Radiation exposure in pediatric fluoroscopy can be reduced to values well below the exposure settings that are typically found on unoptimized fluoroscopes. Pulsed fluoroscopy is considered a requisite for optimal pediatric fluoroscopy.

Background. Traditionally, pediatric radiologists have been advocates of fluoroscopy systems that provide diagnostic images at the lowest possible radiation dose to the pediatric patient. Manufacturers of fluoroscopic equipment vary as to their claims of “low radiation“ exposures.Objectives. To obtain comparative data on radiation exposure and image quality from four pediatric hospitals, across variants of fluoroscopic equipment (such as pulsed versus continuous fluoroscopy).Materials and methods. Images were acquired from phantoms that simulated the size of a 3-year-old child. Phantom results, both stationary and rotating dynamic, were evaluated for radiation exposure and for image resolution of high- and low-contrast objects.Results. Radiation exposure from the four fluoro units varied widely; the lowest-dose selectable fluoro mode produced exposures varying between 34 and 590 mrads/min among the four fluoro units, and the highest-dose selectable fluoro mode produced 540–2230 mrads/min. The lowest radiation exposures were produced by pulsed fluoro units, and the very lowest radiation exposure was produced by a fluoroscope that had been especially optimized for pediatric imaging. There was only a small variation in image quality among the hospitals for visualization of stationary objects. A wide variability was noted for detection of objects on the moving phantom.Conclusions. The variability in the number of detected objects was considerably smaller than the variability in radiation exposure. Pulsed fluoroscopy provides improved resolution for moving objects. Optimization of one hospital's fluoroscope especially for pediatric imaging produced the best ratio of image quality to radiation exposure.

What must be done to improve our knowledge of American county government? In this article, eleven scholars provide a collective assessment of the literature on county government as well as an overview of research on that topic since the turn of the century. They offer a county government research agency for the 1990s that focuses on: the relationship between structure and government performance; the role of leadership and professional management; service delivery, administrative responsiveness and equity; county responsiveness to changing environmental conditions; county governments as democratic institutions; and the role of counties in the American federal system.

Local Govermental Reform and Territorial Democracy: The Case of Florida Get access Robert D. Thomas, Robert D. Thomas University of Houston Search for other works by this author on: Oxford Academic Google Scholar Vincent L. Marando Vincent L. Marando University of Maryland Search for other works by this author on: Oxford Academic Google Scholar Publius: The Journal of Federalism, Volume 11, Issue 1, Winter 1981, Pages 49–64, https://doi.org/10.1093/oxfordjournals.pubjof.a037349 Published: 01 January 1981

ABSTRACTThis research deals with the manner in which the Arizona Legislature dealt with the issue of the Central Arizona Project. Due to the massive costs and impact, the Central Arizona Project was handled by the Legislature in a nonroutinized manner. There was no Legislative precedent for dealing with such a major public work project. Given the Legislature's annual program concerns and priorities, it is neither structurally nor psychologically geared to respond to the Central Arizona Project in terms of placing it within an agenda of priorities even for discussion.