bluuebunny/crossref_metadata_2025 huggingface dataset:
Unusual presentation of necrotizing fasciitis in a patient who had achieved long‐term remission after irradiation for testicular cancer
Authors: MIYAGAWA TOMOAKI , KAWAI KOJI , ONOZAWA MIZUKI , HATTORI KAZUNORI , SHIMAZUI TORU , AKAZA HIDEYUKI
Published: April 2005

Abstract  We report a case of a 60‐year‐old man with necrotizing fasciitis complicated by streptococcal toxic shock syndrome. The patient had received high‐dose chemotherapy and radiotherapy to the pelvis for relapsed seminoma 7 years previously. He had been in long‐term remission. He was admitted to the Tsukuba University Hospital, Tsukuba‐City, Ibaraki, Japan, with complaints of fever and localized erythema over the foreskin. The patient suffered from septic shock and multiple organ failure. Despite intensive care, he died 18 h after admission. Streptococcus pyogenes was isolated from both the wound and blood culture. To our knowledge, this is the first description of necrotizing fasciitis primarily affecting the penile skin.
Lectin‐reactive alpha‐fetoprotein as a marker for testicular tumor activity
Authors: KAWAI KOJI , KOJIMA TAKAHIRO , MIYANAGA NAOTO , HATTORI KAZUNORI , HINOTSU SHIRO , SHIMAZUI TORU , AKAZA HIDEYUKI
Published: April 2005

Abstract  Background:  Lens culinaris agglutin (LCA)‐affinity electrophoresis resolves serum α‐fetoprotein (AFP) into three isoforms, AFP‐L1, ‐L2 and ‐L3. The ratio of AFP‐L3 to total AFP (AFP‐L3%) is frequently high in hepatocellular carcinoma (HCC) patients, and thus, it is widely used for early diagnosis of HCC. In the present study, we used the subfraction profile of LCA‐binding AFP to diagnose and monitor testicular tumor activity.

Methods:  Serum samples were collected from 21 testicular tumor patients, and the LCA‐reactive fractions were determined by LCA‐affinity electrophoresis coupled with antibody‐affinity blotting. The histological diagnosis was non‐seminomatous germ cell tumor (NSGCT) in 15 patients and pure seminoma in six patients.

Results:  Serum AFP levels were abnormally elevated (>20 ng/mL) in 10 of 15 NSGCT patients. One NSGCT patient and two seminoma patients showed borderline AFP levels between 10 and 20 ng/mL. LCA‐reactive AFP was detected in all 11 NSGCT patients with serum AFP levels above 10 ng/mL, but not in the two seminoma patients with serum AFP levels above 10 ng/mL. In testicular tumor patients, the broad band of AFP‐L2 could not be completely separated from AFP‐L3. The mean ratio of AFP‐L3 plus AFP‐L2 (AFP‐L2 + 3%) was as high as 94% (range 80–99%) in these patients. Serial determinations of LCA‐reactive fractions were performed in eight of the 11 LCA‐reactive AFP‐positive patients. They included five patients who received chemotherapy, and three patients who underwent orchiectomy for stage I NSGCT. In three of eight patients, LCA‐reactive AFP was detected even after normalization of total AFP levels. All three patients relapsed, with elevation of serum AFP within several months.

Conclusion:  Determination of LCA‐reactive AFP might be a useful marker for testicular tumor activity in patients with lower AFP levels.
Presentation and therapy of myelolipoma
Authors: MEYER ANDREAS , BEHREND MATTHIAS
Published: April 2005

Abstract  Background:  Adrenal myelolipoma is a rare and benign, hormonally inactive tumor frequently discovered incidentally. Because of the increasing rate of detection of adrenal myelolipoma, use of the correct diagnostic examination and treatment, with respect to surgical excision or regular controls, is continually gaining importance. We report herein on the largest series of surgically treated patients with adrenal myelolipoma from a single institute.

Methods:  The clinical charts of 12 patients who underwent adrenal surgery for myelolipoma were reviewed. Follow up was carried out by means of re‐examination or by personal contact with the primary physician. It was possible to perform a re‐examination on eight of the 12 patients 6.9 years after the operation: one patient had died 5.2 years after surgery.

Results:  Diagnosis of adrenal myelolipoma was made incidentally in seven patients, and during examination for reasons of unspecific abdominal or flank pain in five patients. A transabdominal approach was taken in five patients, a subcostal approach was taken in three patients and a translumbal approach was taken in four patients. At the follow up, all formerly symptomatic patients were free of symptoms. No recurrence could be seen; however, in one patient a contralateral adrenal myelolipoma had developed.

Conclusions:  Symptomatic tumors, growing tumors or tumors larger than 10 cm should be excised surgically by means of an endoscopic or conventional approach, depending on the size. Surgical indication should not be liberalized by the introduction of more gentle operative techniques such as the translumbal or the endoscopic approach. A close follow up should be maintained in the case of patients free of symptoms, and for those with a definite diagnosis from imaging procedures.
Adenosquamous carcinoma of the prostate
Authors: EGILMEZ TULGA , BAL NEBIL , GUVEL SEZGIN , KILINC FERHAT , OZKARDES HAKAN
Published: April 2005

Abstract  Adenosquamous carcinoma of the prostate is an unusual histological variant of prostate cancer. The histogenesis of this tumor remains uncertain. The stimulus for the development of the squamous metaplastic cells had been thought to be related to hormone and/or radiation therapy. This report presents a case of adenosquamous carcinoma of the prostate with abscence of previous hormone or radiation therapy. The case showed negative prostate‐specific antigen and high molecular weight cytokeratin staining of the adenocarcinoma component, and negative prostate‐specific antigen and positive high molecular weight cytokeratin staining of the squamous cell carcinoma component. The adenocarcinoma component stained intraluminally with periodic acid schiff. The staining features and the distinct localizations of the components with intermingling, but no transition, are against the collision‐type tumor theory and support the theory that the adenocarcinoma and squamous components arise de novo from pluripotent stem cells. The patient had a rapid downhill clinical course and died 3 weeks after the diagnosis was made.
Prognostic significance of vascular invasion in patients with bladder cancer who underwent radical cystectomy
Authors: HARADA KEN‐ICHI , SAKAI IORI , HARA ISAO , ETO HIROSHI , MIYAKE HIDEAKI
Published: April 2005

Abstract  Background:  The objective of this study was to determine whether vascular invasion (i.e. lymphatic and blood vessel invasion) could be a useful prognostic predictor in patients with locally invasive transitional cell carcinoma (TCC) of the bladder who underwent radical cystectomy.

Methods:  This series included 114 consecutive patients undergoing radical cystectomy for primary TCC of the bladder between November 1989 and July 2003. Several clinicopathological characteristics of these patients were analyzed, focusing on the association between vascular invasion and disease recurrence after radical cystectomy.

Results:  Lymphatic and blood vessel invasions were detected in 55 (48.2%) and 33 (29.8%) specimens, respectively. Lymphatic invasion was significantly associated with pathological stage, tumor grade, lymph node metastasis, blood vessel invasion and disease recurrence, whereas blood vessel invasion was significantly related to pathological stage, lymph node metastasis, lymphatic invasion and disease recurrence. Recurrence‐free survival in patients with lymphatic invasion was significantly lower than that in those without lymphatic invasion, and a similar significant difference in recurrence‐free survival was observed between patients with and without blood vessel invasion. However, multivariate analysis using the Cox proportional hazards model showed that only pathological stage and lymph node metastasis could be used as independent predictors for disease recurrence after radical cystectomy.

Conclusions:  Despite a significant association between several prognostic parameters, vascular invasion was not an independent predictor of disease recurrence; therefore, if there are other conventional parameters available, there might not be any additional advantage to considering the presence of vascular invasion when predicting the prognosis of patients undergoing radical cystectomy for TCC of the bladder.
Study of a rat model for calcium oxalate crystal formation without severe renal damage in selected conditions
Authors: YAMAGUCHI SATOSHI , WIESSNER JOHN H , HASEGAWA ANDREW T , HUNG LINDA Y , MANDEL GRETCHEN S , MANDEL NEIL S
Published: April 2005

Abstract  Background:  Although nephrotoxic in high doses, ethylene glycol (EG) has been used with ammonium chloride (NH4Cl) or vitamin D3 to study calcium oxalate stone formation in rat models. In the present study we used EG alone or with NH4Cl to study hyperoxaluria, crystaluria, and crystal attachment to renal epithelial cells in rats with minimal renal damage.

Methods:  Six‐week‐old male Sprague–Dawley (SD) rats were given food and special drinking water. In experiment 1 the drinking water contained 1.0% NH4Cl plus four different concentrations of EG (0.8%, 0.4%, 0.2%, 0.1%). In experiment 2 the drinking water contained EG alone (0.8%, 0.4%, 0.2%, 0.1%). Urine was collected for 24 h before the rats were sacrificed. In experiment 1 the rats were sacrificed 5–13 days after starting the special water. In experiment 2 the rats were sacrificed 7–21 days after starting the special water. Bladder urine was also obtained. Blood and urine were tested for calcium, phosphorus, and creatinine. In addition, urine was tested for pH, oxalate and N‐acetyl‐β‐D glucosaminidase (NAG). Kidney sections were stained with hematoxylin‐eosin, von Kossa and Pizzolato stain. Crystal morphology was determined using polarizing microscopy, and composition was determined using high‐resolution X‐ray powder diffraction.

Results:  Experiment 1: Aggravation of renal function, an increase in urinary oxalate and NAG excretion, and crystals observed in the kidneys all correlated with EG concentration and length of drinking time. In bladder urine, calcium oxalate monohydrate (COM) crystals exceeded calcium oxalate dihydrate (COD) crystals. Experiment 2: Renal function remained unchanged. Oxalate excretion increased and NAG increased slightly. Crystals occurred only in the papillary tip region. Crystals in bladder urine were mostly COD.

Conclusion:  In the current rat model, calcium oxalate crystaluria could be induced without severe renal damage in selected cases. Either and/or both COM and COD might form and interact with kidney epithelium. We propose different experimental conditions to study the various phases of calcium oxalate stone formation in young male SD rats.
Use of atresic vagina as a urethra to repair iatrogenic incontinence, secondary to a complete longitudinal urethral incision
Authors: ALBAYRAK SELAMI , GÖKTAS CEMAL , CANGÜVEN ÖNDER
Published: April 2005

Abstract  Vaginal atresia is a rare congenital anomaly. Patients with this pathology commonly present with amenorrhea, or an inability to have sexual intercourse. A dorsal urethral wall incision was performed in a woman who complained of difficulty with coitus. Her gynecologist intended to expand the vagina, thinking the diagnosis was a vaginal septum. We report a repair technique for total urinary incontinence following a longitudinal complete urethral incision, which also involved the bladder neck. The vaginal reconstruction consisted of an ileal segment, whereas the urinary incontinence was corrected using a rectus fascial sling. To our knowledge, this is the first case of this kind reported in the literature.
The relationship of magnesium intake to serum and urinary calcium and magnesium levels in Trinidadian stone formers
Authors: ANATOL TREVOR I , PEREIRA LEXLEY PINTO , MATTHEW JASON , SAWH LALL
Published: April 2005

Abstract  Background:  The present study was undertaken to investigate the relationship between the dietary intake of magnesium and the serum and urinary levels of calcium and magnesium in a group of Trinidadian stone formers.

Methods:  A group of 102 confirmed stone formers presenting to urological clinics were interviewed using a questionnaire designed to obtain a semi‐quantitative estimate of their oral magnesium intake. Patients were invited to give blood samples for serum calcium and magnesium levels and to provide 24‐h urine specimens for the measurement of urinary levels of these minerals, as well as total urinary volumes. A group of 102 controls was subjected to a similar interview and blood and urinary testing. Chi‐square tests and Student's t‐tests were used to examine group demographic differences. The Mann–Whitney test investigated differences in biochemical indices. Binary logistic regression was used to identify predictors of stone formation.

Results:  Blood samples were obtained from 60 patients and 98 controls. Urine samples were returned by 34 patients and 97 controls. Only 10 stones were retrieved from patients. Patients had a significantly lower magnesium intake, but higher median serum and urinary calcium levels, and higher serum calcium to magnesium ratios than controls. Independent variables capable of predicting stone formation included total magnesium intake and serum and urinary calcium levels.

Conclusions:  Increased serum and urinary calcium levels, calcium to magnesium ratios, and a low magnesium intake were predictive of stone formation in this Trinidadian population.
Intussusception of the bladder neck does not promote early restoration to urinary continence after non‐nerve‐sparing radical retropubic prostatectomy
Authors: SAKAI IORI , HARADA KEN‐ICHI , HARA ISAO , ETO HIROSHI , MIYAKE HIDEAKI
Published: April 2005

Abstract  Background:  The objectives of the present study were to investigate whether buttressing sutures, which prevent the bladder neck from pulling open as the bladder fills, can promote earlier recovery from urinary incontinence after radical retropubic prostatectomy (RRP) and to identify possible risk factors associated with urinary incontinence after RRP.

Methods:  The present study included 72 patients who underwent non‐nerve‐sparing RRP without neoadjuvant therapy between January and December 2003. Among these 72 patients, intussusception of the bladder neck was performed in 24 who consented to this procedure. In the present series, continence was defined as the absence of any need to use sanitary pads or diapers. Continence was evaluated by a patient interview 1, 3 and 6 months after RRP.

Results:  There were no significant differences in clinicopathological characteristics between patients with and without intussusception of the bladder neck. The percentage of continent patients 1, 3 and 6 months after RRP was 34.7%, 63.9% and 95.8%, respectively, and there were no significant differences in continence between the two groups at any time point. Among several factors examined, only bladder neck preservation was an independent predictor of recovery from urinary incontinence 1 and 3 months after RRP.

Conclusions:  These findings suggest that it would be important to preserve the bladder neck for early return to continence after non‐nerve‐sparing RRP; however, intussusception of the bladder neck may not offer significant improvement in earlier return of urinary control.
Sebaceous gland carcinoma of the eyelid presenting as a conjunctival papilloma
Authors: Khong Jwu Jin , Leibovitch Igal , Selva Dinesh , Dodd Thomas , Muecke James
Published: April 2005

An unusual presentation of sebaceous carcinoma of the eyelid is described in a 96‐year‐old man who presented with a large papillomatous palpebral conjunctival lesion in the left upper eyelid. The patient underwent a shave excision of the lesion, followed by a full thickness excision with paraffin section margin control. Histopathology revealed a sebaceous gland carcinoma with no evidence of pagetoid spread. Although rare, sebaceous gland carcinoma should be considered in the differential diagnosis of a conjunctival papilloma.
Periorbital ecchymosis as a sign of perforating injury of the globe
Authors: Ghazi‐Nouri Seyed M , Vote Brendan J , Sullivan Paul M
Published: April 2005

The distinction between penetrating eye injury with retained intraocular foreign body and perforating globe injuries is not always easy clinically. The case is presented of a 25‐year‐old man who sustained a perforating eye injury that was through a clear self‐sealing corneal entry site and had no conjunctival or periorbital injury. He had periorbital ecchymosis on presentation suggesting that the globe had been perforated with resulting retro‐orbital blood tracking to the periorbital region. This sign would not be expected had the foreign body remained intraocular. The management options of these cases are discussed.
Clinical Case Notes
Authors: Wakely Laura A , Small Keith M , Long Helen M , Maslin Keith F , Wells Anthony P
Published: April 2005

The case is presented of a highly aggressive congenital epithelial cyst of the anterior chamber. The patient underwent four primary procedures to remove the cyst and its three recurrences, and one procedure for secondary glaucoma. The primary cyst and first recurrence occurred in the anterior chamber, whereas the second and third recurrences occurred in the pars plana region. Attempts at optical correction of the eye were weighed against complications arising from further procedures, and a conservative approach favouring preservation of the eye became the management strategy in this case.
The eye and sleep
Authors: McNab Alan A
Published: April 2005

Background: Sleep‐associated disorders of the eye are increasingly recognized. Disordered sleep has also been found in some blind patients.

Methods: Review of the current state of knowledge of sleep‐related eye disorders and blindness‐related sleep disorders.

Results: Incomplete eyelid closure during sleep (lagophthalmos) may be physiological but in some patients can cause significant symptoms. Nocturnal lagophthalmos may be a limiting factor in the surgical repair of some eyelid and orbital disorders. Normal eyelid closure has also been linked to the development of a number of ocular surface disorders. Sleep disorders are common, and obstructive sleep apnoea (OSA) the commonest. OSA is associated with a number of serious systemic diseases and also several eye disorders including floppy eyelid syndrome, optic neuropathy, glaucoma, anterior ischaemic optic neuropathy and papilloedema secondary to raised intracranial pressure. Treatment of OSA may help floppy eyelid syndrome, halt progression of associated glaucoma, and reduce intracranial pressure in patients with associated papilloedema. The diagnosis of OSA can only be made with formal sleep studies, but asking a small number of appropriate questions will help screen those patients who should be referred for sleep studies. Some blind patients have disordered sleep patterns due to disruption of the retinal input into the hypothalamic‐pineal melatonin secreting apparatus. This can be alleviated by oral administration of melatonin.

Conclusions: Ophthalmologists should be aware of sleep‐associated eye disorders and refer appropriate patients for formal sleep studies. Sleep abnormalities in blind patients should be enquired about and patients offered assessment and treatment by a sleep physician.
Simple formula for determining the location of the equator
Authors: Kim Seunghyun , Suh Youngwoo , Cho Yoonae A
Published: April 2005

The determination of the position of the equator is very important during strabismus surgery for safe maximum recession. The purpose of this study is to present a simple formula for estimating the location of the equator (E = axial length·π/4 – corneal diameter/2). A previous formula (E = 2πr[β/360]), although well presented, proved relatively complex to understand and apply to the clinical situation. There was no significant difference between the values calculated by the new formula and the previous formula when the horizontal corneal diameter was between 10.0 and 11.5 mm (P = 0.23, r = 0.998). In this range, the mean difference between the values calculated by the two formulae was only 0.1 ± 0.08 mm (range 0–0.35 mm). Another advantage of the new formula is that the actual measured values of corneal diameter and axial length can be used. It is hoped that this simple formula can be used as an alternative for determining the location of the equator.
Prevalence of cicatricial trachoma in an indigenous population of Central Australia: the Central Australian Trachomatous Trichiasis Study (CATTS)
Authors: Landers John , Kleinschmidt Andrew , Wu Johnny , Burt Benjamin , Ewald Dan , Henderson Tim
Published: April 2005

Background: Trachoma is one of the leading causes of blindness worldwide, resulting from conjunctival scarring, upper lid entropion and trichiasis, leading to corneal scarring and opacification. This study was designed to investigate the current prevalence of cicatricial trachoma in an indigenous population within Central Australia and help determine whether trachoma remains a public health issue.

Methods: Participants aged 40 and over were recruited from patients attending one of 16 remote ophthalmology clinics held at indigenous communities in Central Australia within the Northern Territory. Once informed consent had been obtained, each patient underwent examination for evidence of trachomatous scarring, trachomatous trichiasis and corneal opacities. Results were collated and compared with previous prevalence surveys.

Results: Among the sample (n = 181), there were 97 patients (54%; 95% CI 46.7–61.3) with trachomatous scarring, 15 patients (8%; 95% CI 2.8–13.2) with trichiasis and 5 patients (3%; 95% CI 0.5–5.5) with corneal opacities.

Conclusion: This study suggests that, although the prevalence of the cicatricial and blinding consequences of trachoma may be decreasing in patients aged 40 years or greater, when compared with the current prevalence in other areas of Australia, trachoma still remains a public health issue in Central Australia.
Management of sight‐threatening optic nerve sheath meningioma with fractionated stereotactic radiotherapy
Authors: Richards Josephine C , Roden Dermot , Harper Christopher S
Published: April 2005

Background: Previous management of optic nerve sheath meningioma included conservative observation, surgery, radiosurgery and conventional radiotherapy. All carried significant risk, either of visual loss or damage to adjacent structures. Fractionated stereotactic radiotherapy appears to have few side‐effects and may preserve or improve vision. To date only three groups have published their experience with this modality.

Methods: A retrospective review of patients with optic nerve sheath meningioma treated with stereotactic radiotherapy in an academic complex was conducted. Patients with greater than 18 months follow up and no previous related surgery were eligible for inclusion. Patients received an average of 43.5 Gy to the tumour in 26 fractions. Case records from the treating institutions as well as those of the referring ophthalmologist were analysed. The limited literature on the subject was reviewed in order to draw conclusions relevant to contemporary patient management.

Results: Four patients had undergone follow up for over 18 months. Prior to treatment all had exhibited progressive loss of visual function. In all cases visual function remained stable or improved at the last assessment. Side‐effects included radiologically detected cerebral changes in one patient and transient hair loss in one patient.

Conclusions: This treatment modality represents a promising refinement of previous treatment options. It may be offered to patients who demonstrate progressive loss of visual function caused by optic nerve sheath meningioma. It offers significant advantages over other currently available therapeutic options but its use should be tempered by the knowledge that long‐term side‐effects are yet to be determined.
Assessing the accuracy of Orbscan II post‐LASIK: apparent keratectasia is paradoxically associated with anterior chamber depth reduction in successful procedures
Authors: Cairns Gerard , Ormonde Susan E , Gray Trevor , Hadden O Bruce , Morris Tony , Ring Peter , McGhee Charles NJ
Published: April 2005

Purpose: To establish a relationship between the forward protrusion of the cornea (keratectasia), following successful LASIK, and anterior chamber depth.

Methods: One hundred and fifteen eyes of 59 patients who had undergone Zyoptix LASIK and 39 eyes of 21 patients who had undergone PlanoScan LASIK at the Eye Institute, Centre for Refractive Surgery, Remuera, Auckland, New Zealand, were included in the study. The results of Orbscan II acquisitions, taken before and 8.3 weeks ± 4.0 (mean ± standard deviation) following the procedure, were analysed to determine the amount of forward protrusion of the central 2 mm diameter of the posterior surface. The apparent keratectasia was then related to the Orbscan II anterior chamber depth (ACD) measurement in a linear mixed model analysis that included ‘right or left eye’, ‘sex’, ‘type of LASIK procedure’, ‘change in pachymetry’, ‘postoperative pachymetry’, ‘change in anterior corneal curvature’, ‘postoperative anterior corneal curvature’, ‘planned ablation depth’ and ‘time until follow‐up’ as factors and covariates.

Results: The mean ± SD amount of keratectasia determined by Orbscan II was 22.8 ± 26.8 µm for the Zyoptix group and 16.9 ± 24.6 µm for the PlanoScan group. The reduction in depth of the anterior chamber was 14.7 ± 79.3 µm for the Zyoptix group and 18.2 ± 68.8 µm for the PlanoScan group. The mixed model analysis demonstrated strong relationships with postoperative pachymetry and change in anterior corneal curvature (P < 0.001 and P < 0.001, respectively). Furthermore, the statistical model showed a marked significant difference in the Orbscan II assessment of keratectasia and change in ACD (P < 0.001).

Conclusion: Using the Orbscan II device, the forward protrusion of the posterior corneal surface appears to coincide with a paradoxical reduction in depth of the anterior chamber. Although the keratectasia found in this study is accompanied by thin postoperative corneas and larger central pachymetry change, the contradictory decrease in anterior chamber depth creates uncertainty of measurement, and of ectasia as a mechanism of regression.
History of retinal surgery in New Zealand
Authors: Polkinghorne Philip J , Brochner Olga H
Published: April 2005

The history of retinal surgery in New Zealand is relatively short but covers a period of transition from caustic cautery to laser retinopexy, from scleral shortening to 25 gauge vitrectomy. The practitioners of this craft include some of the notable figures in medicine in New Zealand, and in their own way each contributed to the welfare of those patients with surgical retinal disease.
Stretch‐activated channels: a mini‐review. Are stretch‐activated channels an ocular barometer?
Authors: Kalapesi Freny B , Tan James CH , Coroneo Minas T
Published: April 2005

All cells are subject to physical forces by virtue of their position in a dynamically changing environment. This review outlines the various putative ‘mechanosensors’, or sensors of pressure cells possess, and discusses in particular the role stretch‐activated membrane channels play in pressure recognition and transduction. The widespread occurrence of these channels is discussed and these ‘mechanosensors’ are related to pressure‐related diseases, in particular, glaucoma.
Intraocular pressure measurement in patients with previous LASIK surgery using pressure phosphene tonometer
Authors: Cheng Arthur CK , Leung Dexter YL , Cheung Eva YY , Fan Dorothy SP , Law Ricky WK , Lam Dennis SC
Published: April 2005

Purpose: To compare intraocular pressure (IOP) assessment in post‐LASIK patients using non‐contact tonometry, pressure phosphene tonometry and applanation tonometry.

Methods: Sixty‐two consecutive LASIK patients were analysed preoperatively and postoperatively with non‐contact, pressure phosphene and applanation tonometry. Comparisons among these values were assessed with paired sample Student t‐test, Pearson's correlation test and Bland–Altman plotting.

Results: There was no significant difference for preoperative IOP measurement between non‐contact, pressure phosphene and applanation tonometry. The mean ±SD difference between the preoperative non‐contact tonometry and postoperative pressure phosphene tonometry IOP measurements was 0.80 ± 2.77 mmHg (P < 0.01). Postoperative applanation tonometry significantly underestimated IOP measurement by 5.45 ± 2.96 mmHg (P < 0.001) and postoperative non‐contact tonometry significantly underestimated IOP measurement by 9.96 ± 2.25 mmHg (P < 0.001).

Conclusion: Pressure phosphene tonometry may provide an alternative method for the assessment of IOP in post‐LASIK patients.
Use of PCR to diagnose Toxoplasma gondii chorioretinitis in eyes with severe vitritis
Authors: Okhravi Narciss , Jones Colin D , Carroll Nora , Adamson Peter , Luthert Philip , Lightman Susan
Published: April 2005

Two cases are reported of intraocular inflammation in which severe vitritis hampered the fundal view, making an accurate clinical diagnosis impossible, and vitreous analysis using conventional techniques was unhelpful. PCR for Toxoplasma gondii was positive in both cases and provided the only way of confirming the diagnosis. Other ocular samples also underwent PCR for Toxoplasma DNA and the specificity of this approach is demonstrated.
Clinical Case Notes
Authors: Yang David S , Hilford David J , Conrad Diana
Published: April 2005

Meningococcal C conjugate vaccines have proved to be safe and highly efficient in preventing group C meningococcal disease. Very few serious side‐effects have been reported. The case is reported of a 14 year‐old boy who developed acute posterior multifocal placoid pigment epitheliopathy 3 days after receiving the vaccine. No other cause of uveitis was detected from history or from investigations. The patient was treated with topical and systemic corticosteroids and his visual acuity improved to near normal in both eyes at 4 months. Meningococcal immunization may have precipitated acute posterior multifocal placoid pigment epitheliopathy in this adolescent.
Clinical Case Notes
Authors: Clement Colin I , Myers Phillip , Tan Kimberley P
Published: April 2005

Patients on amiodarone have an increased incidence of optic neuro­pathy. The unusual case is reported of a 67‐year‐old man who developed bilateral optic neuropathy 4 weeks after commencing amiodarone and then had unilateral recurrence of segmental disc swelling despite cessation. The case highlights amiodarone‐induced optic neuropathy as a different clinical entity to anterior ischaemic optic neuropathy. It is characterized by insidious onset, bilateral disease and protracted disc swelling progressing to optic atrophy. Patients that experience any visual disturbance while taking amio­darone should seek urgent ophthalmic review.
Clinical implications of Nε‐(carboxymethyl)lysine, advanced glycation end product, in children and adolescents with type 1 diabetes
Authors: Hwang J. S. , Shin C. H. , Yang S. W.
Published: April 2005

Aim:  The aim of this study was to investigate the relationship between serum levels of the glycoxylation product Nε‐(carboxymethyl)lysine (CML) and development of chronic diabetic complications and degree of diabetic control in children and adolescents with type 1 diabetes.

Methods:  The serum levels of CML were measured in 87 patients with uncomplicated type 1 diabetes mellitus (12.7 ± 4.6 years of age) and in seven patients with background retinopathy, microalbuminuria or neuropathy (18.2 ± 5.2 years of age) and compared with those in 64 normal control subjects (12.6 ± 5.2 years of age). The mean durations of diabetes in uncomplicated and complicated patients were 5.0 ± 3.4 years (0.1–14 years), and 8.6 ± 5.0  years (3.1–18 years), respectively. The serum levels of CML were measured by enzyme‐linked immunosorbent assay using a monoclonal anti‐CML antibody (6D12).

Results:  The serum levels of CML were significantly higher in the patient group than those in the control group; 0.85 ± 0.37 (0.37–1.93) U/ml vs. 0.56 ± 0.23 (0.15–1.05) U/ml (p < 0.001) and significantly higher in the patient group with chronic complications than those in patient group without chronic complications; 1.06 ± 0.39 (0.72–1.78) U/ml vs. 0.83 ± 0.36 (0.37–1.93) U/ml (p < 0.05). Weak, but statistically significant relationship between CML levels and haemoglobin A1c levels at the measurement of CML was observed (r = 0.29, p < 0.05).

Conclusions:  Our data are suggesting that higher serum levels of CML are involved in the development of chronic diabetic complications, and serum levels of CML reflect the degree of diabetic control for a long duration in type 1 diabetic children and adolescents.
Metabolic risk factors in formerly obese women – effects of a pronounced weight loss by gastric band operation compared with weight loss by diet alone
Authors: Ritt M. , Piza H. , Rhomberg M. , Aigner F. , Lechleitner M.
Published: April 2005

Aim:  The aim of the present study was to evaluate differences in the metabolic risk profile in formerly obese women, in whom a significant weight loss was obtained by Swedish adjustable gastric band (SAGB) operation or by diet alone.

Methods:  A total of 40 patients (24 after SAGB and 16 after diet) participated in the study. Clinical data, including body mass index (BMI), waist‐to‐hip ratio, body fat content and blood pressure values, as well as laboratory results [fasting glucose, insulin, homeostasis model assessment (HOMA) index, leptin, lipid values and markers of subclinical inflammation] were evaluated before a planned abdominoplastic operation.

Results:  Patients in the SABG group had lost a significantly greater amount of weight (52.7 ± 10.0 kg) compared with the diet group (20.0 ± 11.5 kg; p < 0.001), and the percent excess weight loss was 69.1 ± 11.4 in the SAGB group and 54.5 ± 17.7 (p < 0.040) in the diet group. Before the abdominoplastic operation neither the mean BMI nor the percentage of fat mass revealed a significant difference between the groups. Fasting insulin (6.1 ± 3.0 µU/ml) and the HOMA index (1.4 ± 0.7) as a measure of insulin resistance were significantly lower in the SAGB than in the diet group (fasting insulin: 8.2 ± 3.8 µU/ml; p < 0.048; HOMA index: 2.0 ± 1.0; p < 0.031). Swedish adjustable gastric band patients showed significantly lower plasma leptin levels (9.4 ± 10.8 ng/ml) than the dietary‐treated patients (13.9 ± 9.6 ng/ml; p < 0.014), while tumour necrosis factor‐alpha serum levels were increased in the SAGB group (17.6 ± 7.3 pg/ml) compared with the diet group (11.9 ± 0.49 pg/l; p < 0.048).

Conclusions:  The extensive weight loss in formerly obese women after SAGB operation was paralleled by a favourable metabolic profile indicating a higher degree of insulin sensitivity than in women after a successful, but less pronounced weight loss by diet alone.
Lipoic acid prevents collagen abnormalities in tail tendon of high‐fructose‐fed rats
Authors: Thirunavukkarasu V. , Nandhini A. T. A. , Anuradha C. V.
Published: April 2005

Background:  Non‐enzymatic glycation of proteins, leading to chemical modification and cross‐linking are of importance in the pathology of diabetic complications. We studied the effect of α‐lipoic acid (LA) on the glycation and cross‐linking of collagen from tail tendon of high‐fructose‐fed rats.

Methods:  The rats were divided into four groups of six each. Two groups of rats were fed with a high‐fructose diet (60/100 g diet) and administered with either LA (35 mg/kg body weight, intraperitoneally) (FRU + LA) or saline (FRU) for 45 days. The other two groups were fed control diet containing starch (60/100 g diet) and administered with either saline (CON) or LA (CON + LA). The rats were maintained for 45 days and then sacrificed. Collagen was isolated from tail tendon and the extent of glycation, fluorescence, aldehyde and peroxidation levels were measured. The tail tendons were separated, and shrinkage temperature was also measured. Acid‐soluble collagen was extracted from tail tendon and subjected to sodium dodecyl sulphate polyacrylamide gel electrophoresis.

Results:  Fructose administration caused accumulation of collagen in tail tendon. Glycation, collagen‐linked fluorescence, aldehyde and peroxide contents were elevated. The gel pattern of acid‐soluble collagen from the fructose‐fed rat showed elevated β‐component. These changes were alleviated by the simultaneous administration of LA.

Conclusion:  Administration of LA has a positive influence on tail tendon collagen glycation and other variables in high‐fructose‐fed rats.
The effect of diets high in protein or carbohydrate on inflammatory markers in overweight subjects
Authors: Due A. , Toubro S. , Stender S. , Skov A. R. , Astrup A.
Published: April 2005

Aim:  Increased levels of inflammatory markers have been associated with weight gain and cardiovascular disease. The aim of the present study was to investigate the effect of diets high in either carbohydrate or protein on the inflammatory markers C‐reactive protein (CRP), haptoglobin and transferrin in plasma after weight loss.

Methods:  Fifty overweight subjects [age: 18–56 years, body mass index (BMI): 27–34] were randomly assigned to an ad libitum, fat‐reduced diet (30% of energy, E%), either high in protein and low in carbohydrate (25 E and 45 E% respectively) or high in carbohydrate and low in protein (58 E and 12 E% respectively), during 6 months of strictly controlled dietary intervention with dietary counselling.

Results:  An average reduction of 25% in CRP and an average increase of 20% in haptoglobin and transferrin were seen in both groups, however, these changes were not significant. In cross‐sectional analyses after the intervention CRP was associated with fat mass (r = 0.323, p = 0.03), and the changes in CRP were associated with various indices of body fatness (Δbody weight r = 0.346, p = 0.02). Changes in body fatness were positively associated with Δtransferrin (r = 0.344, p = 0.02) and nearly significantly associated with Δhaptoglobin (r = 0.271, p = 0.07) after 6 months. Multiple regression analysis showed no associations between dietary protein and carbohydrate content and serum CRP, haptoglobin or transferrin concentrations, and this remained unaltered after adjustment for weight change.

Conclusion:  Dietary carbohydrate/protein ratio has no effect on inflammatory markers, but the study confirmed that body fatness is positively associated with levels of serum CRP.
Effects of sibutramine on abdominal fat mass, insulin resistance and blood pressure in obese hypertensive patients
Authors: Faria A. N. , Ribeiro Filho F. F. , Kohlmann N. E. , Gouvea Ferreira S. R. , Zanella M. T.
Published: April 2005

Objective:  The objective of this study is to assess the effects of sibutramine on body weight, body fat distribution, insulin resistance, plasma leptin, lipid profile and blood pressure profiles in hypertensive obese patients.

Methods:  Eighty‐six central obese hypertensive patients (BMI = 39 ± 5 kg/m2, 84% of women, 48 ± 8.5 years old) were placed on a hypocaloric diet and placebo therapy for 4 weeks. They were then randomized to receive sibutramine (10 mg) or placebo for 24 weeks. Both, before therapy and at the end of the study, the waist and hip circumferences were measured and the waist/hip ratio (WHR) was calculated; abdominal ultrasonography was performed in order to estimate the amount of subcutaneous fat (SF) and visceral fat (VF), and the visceral/subcutaneous ratio. Beyond HOMA‐r, another insulin resistance index (IRIp) was calculated by means of the formula: peak of blood glucose after oral glucose load × plasma insulin level/104. Fasting plasma leptin and lipid levels were also determined.

Results:  Sibutramine induced greater weight reduction than placebo (6.7 vs. 2.5%, p < 0.001). Reductions in WHR (0.97 ± 0.08 vs. 0.94 ± 0.07, p < 0.01), IRIp (0.11 ± 0.07 vs. 0.09 ± 0.06 mmol μ/l2) and VF (6.4 ± 2.4–6.0 ± 2.4 cm, p < 0.01) were observed only with sibutramine. Plasma leptin decreased with placebo (24 ± 15 vs. 18 ± 10 UI/l, p < 0.01), but not with sibutramine (18.8 ± 8.4 vs. 18.2 ± 13.2 UI/l). No clinically significant change in lipid profile was observed in both groups. Moreover, office and 24‐h blood pressure values did not change during placebo or sibutramine therapy, whereas a significant increase in office heart rate, from 78.3 ± 7.3–82 ± 7.9 b.p.m., p = 0.02, was observed with sibutramine.

Conclusions:  Sibutramine therapy induced greater body weight loss than placebo in hypertensive obese patients. This was associated with WHR reduction, decreases in VF and insulin resistance. The maintenance of leptin levels during sibutramine therapy may be important to avoid weight recovery, although this finding must be confirmed by other prospective studies.
Oxytocin receptors and cholesterol: interaction and regulation
Authors: Gimpl Gerald , Burger Katja , Politowskat Ewa , Ciarkowski Jerzy , Fahrenholz Falk
Published: April 2005

Cholesterol affects the ligand binding function of the oxytocin receptor in a highly specific manner. While the structurally‐related cholecystokinin receptor shows a strong correlation between the membrane fluidity and its binding function, the oxytocin receptor behaves differently. A stringent and unique requirement of the affinity state of the oxytocin receptor for structural features of the sterol molecule has been found. The molecular requirements differ both from those postulated for sterol—phospholipid interactions and from those known to be necessary for the activity of other proteins. Employing a new detergent‐free subcellular fractionation protocol, a two‐fold enrichment of the oxytocin receptors (10–15% of total receptors) has been detected in the cholesterol‐rich, caveolin‐containing membrane domains of the plasma membrane. While most of the properties of the oxytocin receptors were indistinguishable in cholesterol‐poor versus cholesterol‐rich membrane compartments, high‐affinity oxytocin receptors localised in caveolin‐enriched low‐density membranes showed about a 3‐fold higher stability against thermal denaturation at 37°C compared with the oxytocin receptors localised in high‐density membranes. Moreover, addition of cholesterol to the cholesterol‐poor high‐density membranes fully protected the oxytocin receptors against thermal denaturation and partially rescued high‐affinity oxytocin binding. Although the membrane fluidity of the caveolin‐enriched domains was lower than that in the high‐density membranes, there was no correlation between the stability of oxytocin receptors and the fluidity level of the membrane domains. Finally, in a molecular modelling approach a putative cholesterol binding motif on the extracellular surface of the oxytocin receptor was found.
Signal pathways mediating oxytocin stimulation of prostaglandin synthesis in select target cells
Authors: Soloff Melvyn S. , Jeng Yow‐Jiun , Copland John A. , Strakova Zuzana , Hoare Sarasija
Published: April 2005

A major action of oxytocin is to stimulate prostaglandin production in reproductive tissues. The two major enzyme systems involved are cytosolic phospholipase A2 (cPLA2), which catalyses the formation of arachidonic acid from membrane glycerophospholipids, and prostaglandin endoperoxide‐H synthases‐1 and ‐2, which allow conversion of arachidonic acid to prostaglandins. During gestation, the concentrations of all three enzymes rise in the rabbit amnion. Agonists, including oxytocin, increase cPLA2 activity, in part, by elevating intracellular Ca2+ concentration, which causes cPLA2 to be translocated from the cytosol to intracellular membrane binding sites. Cytosolic PLA2 is then activated by a mitogen‐activated protein kinase (MAPK)‐dependent step. Our studies have elucidated signal pathways involved in oxytocin‐stimulated prostaglandin output in both rabbit amnion cells and Chinese hamster ovary cells stably transfected with the rat oxytocin receptor. The two cell types are alike with respect to oxytocin‐stimulated intracellular Ca2+ transients, mediation via Gq, and the specific MAPK that catalyses the phosphorylation of cPLA2. However, they differ with respect to the mechanisms of upregulation of key enzymes involved in prostaglandin E2 synthesis. These findings illustrate the tiers of complementary mechanisms involved in oxytocin stimulation of prostaglandin E2, and the extent of the diversity in the cellular signalling pathways involved.
Excitatory versus inhibitory modulation by ATP of neurohypophysial terminal activity in the rat
Authors: Lemos José R. , Wang Gang
Published: April 2005

Much is now known about the electrophysiological properties of the magnocellular neurones of the hypothalamus. Oxytocin neurones are characterized by an intermittent high frequency discharge during suckling that leads to the pulsatile release of oxytocin into the blood and to subsequent milk ejection. Vasopressin neurones are characterized by their asynchronous phasic activity (bursting) during maintained vasopressin release and the subsequent regulation of water balance. In both cases, it is the clustering of spikes, albeit with different time courses for each peptide, that facilitates hormone release. The mechanism underlying this differential facilitation is one of the major unanswered questions in neuroendocrinology. This paper considers recent evidence that indicates that ATP, co‐secreted with vasopressin and oxytocin, may play a key role in the regulation of stimulus—secretion coupling in the neurohypophysis. The activity of the type (II) Ca2+‐activated K+ (Kca) channel found in the nerve terminals was significantly increased in the presence of ATP on the cytoplasmic side of the channel. Extracellular ATP, in contrast, inhibited the type II Kca current in a dose‐dependent manner. Thus, intracellular and extracellular ATP exert opposite effects on the type II Kca channel of neurohypophysial terminals. Furthermore, ATP opens P2±2 channels to increase intracellular [Ca2+] in the nerve terminals and subsequent arginine vasopressin (AVP) release. In contrast, adenosine, acting via A1 receptors, specifically inhibits only the N‐type Ca2+ channel, thus decreasing neuropeptide release. These multiple, conflicting effects of ATP and its metabolite adenosine could explain the patterns of AVP release observed during physiological stimulation in vivo.
Intracellular calcium signalling in magnocellular neurones of the rat supraoptic nucleus: understanding the autoregulatory mechanisms
Authors: Dayanithi Govindan , Sabatier Nancy , Widmer Hélène
Published: April 2005

Oxytocin and vasopressin, released at the soma and dendrites of neurones, bind to specific autoreceptors and induce an increase in [Ca2+]1. In oxytocin cells, the increase results from a mobilisation of Ca2+from intracellular stores, whereas in vasopressin cells, it results mainly from an influx of Ca2+through voltage‐dependent channels. The response to vasopressin is coupled to phospholipase C and adenylyl‐cyclase pathways which are activated by V1(V1aand V1b)‐ and V2‐type receptors respectively. Measurements of [Ca2+]1in response to V1aand V2agonists and antagonists suggest the functional expression of these two types of receptors in vasopressin neurones. The intracellular mechanisms involved are similar to those observed for the action of the pituitary adenylyl‐cyclase‐activating peptide (PACAP). Isolated vasopressin neurones exhibit spontaneous [Ca2+]1oscillations and these are synchronised with phasic bursts of electrical activity. Vasopressin modulates these spontaneous [Ca2+]1oscillations in a manner that depends on the initial state of the neurone, and such varied effects of vasopressin may be related to those observed on the electrical activity of vasopressin neuronesin vivo.