bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk of Introduction of Drug-Resistant Malaria in a Non-Endemic Country, Kuwait: A Real Threat?
Authors: Iqbal Jamshaid , Sher Ali , Hira P.R. , Al-Anezi Abdul Aziz
Published: April 2003

Objectives: This study investigates the prevalence of drug-resistant malaria infection in Kuwait in patients with malaria infection to the two most important and primary antimalarial drugs, chloroquine and mefloquine. Study Subjects and Methods: In vitro screening of malarial parasites to chloroquine and mefloquine was done during 1994–1996 in all those cases who presented with malaria-like symptoms and had a parasite density of ≥1,000 asexual pure Plasmodium falciparum parasites per microlitre of blood and had not taken any antimalarial drugs during the last 3 weeks. Results: During 1987–1997 the total number of malaria cases detected ranged between 650 and 1,350 each year. More than 75% of the cases had Plasmodium vivax infection. The majority of these cases (>98%) were detected in individuals coming from various malaria-endemic areas to reside or work in Kuwait. Of the 575 cases tested for drug resistance 42 isolates (7.3%) were resistant to chloroquine (MIC >8 pmol) and 6 isolates (1.04%) were resistant to mefloquine (MIC >64 pmol). The 50% inhibitory concentrations were 2.7 and 4.8 pmol for chloroquine and mefloquine, respectively. All the 6 isolates that were resistant to mefloquine were also resistant to chloroquine. Chloroquine resistance was seen in patients from various malaria-endemic countries. Conclusion: To date no indigenous case of malaria has been detected in Kuwait, however, recent environmental and demographic changes in and around the State of Kuwait may threaten the present status of zero endemicity. In this study we show that 7.3% of the malaria isolates tested were resistant to chloroquine and 1.04% isolates were resistant to mefloquine.
Serum Total Cholesterol, Apolipoprotein E {FC12}e4 Allele, and Alzheimer’s Disease
Authors: Notkola Irma-Leena , Sulkava Raimo , Pekkanen Juha , Erkinjuntti Timo , Ehnholm Christian , Kivinen Paula , Tuomilehto Jaakko , Nissinen Aulikki
Published: April 2003

The σ4 allele of the apolipoprotein E (apoE) is associated with Alzheimer’s disease (AD) and also with elevated serum total cholesterol and low-density lipoprotein levels. However, the interrelationships between apoE genotype, plasma cholesterol levels and AD risk have been studied very little. We examined the possible role of serum total cholesterol in the pathogenesis of AD in a population-based sample of 444 men, aged 70–89 years, who were survivors of the Finnish cohorts of the Seven Countries Study. Previous high serum cholesterol level (mean level ≥6.5 mmol/l) was a significant predictor of the prevalence of AD (odds ratio = 3.1; 95% confidence interval = 1.2, 8.5) after controlling for age and the presence of apoE σ4 allele. In men who subsequently developed AD the cholesterol level decreased before the clinical manifestations of AD. We conclude that high serum total cholesterol may be an independent risk factor for AD and some of the effect of the apoE σ4 allele on risk of AD might be mediated through high serum cholesterol.
Differentiation of Acute Cortical and Subcortical Ischemic Stroke by Risk Factors and Clinical Examination Findings
Authors: Dulli Douglas , D’Alessio Donn J. , Palta Mari , Levine Ross L. , Schutta Henry S.
Published: April 2003

Background: Differentiation between acute cortical and subcortical ischemic stroke may be problematic when cortical stroke presents without obvious cortical deficits such as aphasia, neglect or hemianopia. This study explores stroke risk factors and clinical variables that may assist in this differentiation. Methods: Records of consecutive patients with acute ischemic stroke, examined within 72 h of symptom onset, were reviewed. Stroke type was verified by clinical course and follow-up imaging. Stroke risk factors and acute examination findings were compared by odds ratios and positive predictive values for cortical and subcortical stroke. Results: For 355 patients studied, 237 had cortical stroke and 118 had subcortical stroke. Odds ratios for cortical stroke were highest for atrial fibrillation by EKG (OR = 4.77, CI = 2.08–10.94), recent hospitalization (OR = 4.51, CI = 2.39–8.53) and nonalert mental status (OR = 4.50, CI = 2.29–8.87). Possible cardioembolic condition, ischemic heart disease and peripheral vascular disease were also significant, but hypertension, age and diabetes mellitus were not significantly different for the stroke subtypes. Cortical deficits were absent in 19.4% of cortical stroke patients on initial examination. Predictive models were generated based on the presence or absence of cortical deficits and the interaction of significant risk factors with degree of motor deficit. Conclusions: There are clinical features that, in addition to initial examination, may help differentiate cortical from subcortical ischemic stroke. These features may be relevant to both diagnostic and therapeutic approaches to acute stroke.
Progressive Multifocal Leukoencephalopathy in the United States, 1979–1994: Increased Mortality Associated with HIV Infection
Authors: Holman Robert C. , Török Thomas J. , Belay Ermias D. , Janssen Robert S. , Schonberger Lawrence B.
Published: April 2003

To examine trends in progressive multifocal leukoencephalopathy (PML) mortality in the United States, we analyzed PML death rates and deaths for 1979 through 1994, using US multiple cause-of-death data. During the 16-year study period 3,894 PML deaths were reported. The age-adjusted death rate increased more than 20-fold, from less than 0.2 per million persons before 1984 to 3.3 per million persons in 1994. The increase was attributable to infection with human immunodeficiency virus (HIV) which was recorded on 2,267 (89.0%) of 2.546 death records from 1991 through 1994. PML age-adjusted death rates increased abruptly for all males beginning in 1984 and for black females in 1990. Only a small increase was observed for white females. In 1994, PML was reported in 2.1% of white males who died with HIV-associated disease compared with 1.2% of white females and 1.0% of black males and females who died of similar causes. The epidemic of PML deaths is increasing in parallel with the AIDS epidemic. The increase in HIV-associated PML deaths, first noted among males, has also become apparent among females and probably reflects the increasing importance of drug use and heterosexual transmission of HIV. The reason for the higher prevalence of PML among white males with HIV infection is unknown.
Spectrum of Disease in Vascular Cognitive Impairment
Authors: Rockwood Kenneth , Howard Kellee , MacKnight Chris , Darvesh Sultan
Published: April 2003

The recognition that cognitive impairment of vascular origin is not limited to multi-infarct dementia has led to the development of several sets of new criteria for vascular dementia (VaD). We set out to define the spectrum of disease in patients presenting with vascular cognitive impairment (VCI). Of 412 patients consecutively seen at a memory clinic, 80 had VCI. These patients had vascular cognitive impairment not dementia (n = 19), VaD (n = 48), and mixed Alzheimer’s disease-VaD (n = 13). Radiographic patterns were: white matter changes only (40%); multiple infarcts (30%); single strategic stroke (14%), and no identified lesion (16%). Of note, 19 (24%) of these patients meet none of the currently published criteria for VaD. To better understand and treat ischaemic causes of cognitive impairment, the concept of VaD should be expanded to include patients who do not meet traditional dementia criteria.
Executive Cognitive Impairment: A Novel Perspective on Dementia
Authors: Royall Donald R.
Published: April 2003

In 1994 the American Psychiatric Association added impairment of executive control functions (ECF) to its list of cognitive domains that should be considered in the assessment of dementia. This recommendation has not been widely implemented. None the less, there is growing evidence that ECF impairment is common, strongly associated with disability and functional decline, and not well detected by traditional dementia screening tests. This article reviews the implications of ECF for the epidemiology of dementia. The total number of dementia cases may be much greater than previously thought and we are likely to be selectively missing cases with reversible causes of ECF impairment.
Hypothalamic-Pituitary-Adrenal Axis Suppression and Inhaled Corticosteroid Therapy
Authors: Chrousos George P. , Harris Alan G.
Published: April 2003

The safety of long-term inhaled corticosteroid therapy at commonly prescribed doses is an issue of growing concern to physicians and international regulatory bodies. This is so because long-term use of these drugs has become the mainstay of chronic asthma management and their introduction now is widely recommended in official treatment guidelines at the ‘mild persistent’ stage of asthma, where regular daily therapy is first begun. In addition to more frequent use of inhaled corticosteroids, there is a further trend to use higher doses of existing inhaler therapies and to use the newer and more potent compounds that have recently become available. At the same time as these developments have been taking place, there has not been a concurrent move to a more rigorous examination of the safety profile of these inhaled corticosteroid treatments – especially to assess their effects on the hypothalamic-pituitary-adrenal (HPA) axis. Most safety data with respect to HPA axis effects have been derived from testing methods that are limited in their ability to detect HPA system impairment and, more seriously, that can give the impression of functional integrity in the HPA axis when there may be moderate (or even greater) impairment. In this first part of a two-part review of the HPA axis effects of inhaled corticosteroids and of how these effects should be assessed, we examine the currently used and the currently available testing methodologies and also review the present state of knowledge concerning the structure and function of the HPA axis and the effects of its suppression. It is clear that there are state-of-the-art tests to assess in a discriminating manner the safety profile of inhaled corticosteroids. These tests have been insufficiently employed, including during the drug development process, yet they are readily available, relatively inexpensive and can detect adrenal suppression before the appearance of clinical effects. In part 2 of this review we examine what can be learned about the effects of inhaled corticosteroid therapy on the HPA axis from the limited amount of reliable published information from clinical and pharmacological studies describing their use and safety.
Testosterone Suppresses the Response of the Hypothalamic-Pituitary-Adrenal Axis to Interleukin-6
Authors: Papadopoulos Anastasios D. , Wardlaw Sharon L.
Published: April 2003

Objectives: Endotoxin and the inflammatory cytokines interleukin (IL)-1 and IL-6 are potent activators of the hypothalamic-pituitary-adrenal (HPA) axis. Previous studies in the rodent and in the primate have shown that the responses of the HPA axis to endotoxin and to IL-1 were enhanced by gonadectomy and attenuated by testosterone or estradiol replacement. The mechanisms underlying these observations are unclear, but there is evidence that gonadal steroids have direct inhibitory effects on IL-6 synthesis and release. Since endotoxin and IL-1 both stimulate IL-6, the question arises as to whether the sex-steroid-induced suppression of the HPA response to endotoxin and IL-1 results solely from decreased IL-6 release, or whether other mediators are involved. Methods: We have therefore examined the ACTH and corticosterone responses to IL-6 in intact and castrated male rats with and without testosterone replacement. Animals were castrated 2 weeks prior to study; testosterone was replaced by subcutaneous Silastic capsules. Four days prior to study, an indwelling right atrial catheter was implanted. Blood samples for ACTH and corticosterone radioimmunoassays were collected through the catheter 0, 20, 40, 60, 120 and 180 min after intravenous injection of recombinant human IL-6 (500 ng). Results: IL-6 stimulated ACTH and corticosterone release in all groups, with peak stimulation occurring within the first hour. The release of both ACTH and corticosterone was significantly attenuated in the intact (n = 9) and testosterone-replaced (n = 5) animals compared to the castrated animals without replacement (n = 7). Peak ACTH levels were 340 ± 58 and 133 ± 41 pg/ml in the intact and testosterone-replaced animals versus 678 ± 170 pg/ml in the castrated animals (p < 0.02). Peak corticosterone levels were 29 ± 4.7 and 30 ± 4.2 µg/dl in the intact and testosterone-replaced animals versus 47 ± 5.8 µg/dl in the castrated animals (p < 0.05). Conclusions: We conclude that testosterone attenuates the response of the HPA axis to IL-6 in the rat. This would indicate that other mechanisms, in addition to the inhibition of IL-6 release, are responsible for restraining the HPA response to inflammatory stimuli in the presence of gonadal steroids.
Blood Interleukin-6 and Tumor Necrosis Factor-α Elevation after Intracerebroventricular Injection of Escherichia coli Endotoxin in the Rat Is Determined by Two Opposing Factors: Peripheral Induction by LPS Transferred from Brain to Blood and Inhibition of Peripheral Response by a Brain-Mediated Mechanism
Authors: Chen Guanjie , McCuskey Robert S. , Reichlin Seymour
Published: April 2003

Following intracerebroventricular injection of LPS in rats, IL-6 and TNF-α appear in peripheral blood. To determine whether these changes are mediated by passage of the injected LPS from the brain to the blood, the time course of appearance in blood of bioactive LPS after intracerebroventricular injection was compared with the time course of appearance of IL-6 and of TNF-α in blood. Bioactive LPS was detected 30 min after intracerebroventricular injection, the first time interval tested. TNF-α appeared in peripheral blood at 30 min, IL-6 at 60 min and both cytokines as well as LPS achieved highest levels at 120 min. To determine pharmacokinetics of LPS transfer from brain to blood more precisely, radioiodinated LPS was injected intracerebroventricularly. 125I-LPS was detected in blood as early as 5 min after intracerebroventricular injection, reached peak levels at about 2 h, and was transferred from brain to blood at a rate corresponding to bulk flow (% of brain content per min was 1.40 ± 0.58 and 1.00 ± 0.21% in series 1 and 2, respectively). 70.0% of total injected LPS had entered blood by 4 h. However, when administered intravenously (by a programmed pump) at the same rate that it enters the blood after intracerebroventricular injection LPS induced a much greater cytokine response than when given intracerebroventricularly. This paradoxical response was shown in further studies to be due to the simultaneous central inhibitory effect of LPS; coinjection of intracerebroventricular LPS markedly reduced the peripheral cytokine response to intravenous LPS infusion.
Single-Blind, Placebo Phase-in Trial of Two Escalating Doses of Selegiline in the Chronic Fatigue Syndrome
Authors: Natelson Benjamin H. , Cheu Joseph , Hill Nancy , Bergen Michael , Korn Leo , Denny Thomas , Dahl Kristina
Published: April 2003

Aim: To perform a clinical trial of selegiline in 25 patients with chronic fatigue syndrome (CFS) where patients were told they would receive placebo or active agent at different times during the 6-week trial. We chose selegiline, a specific monoamine oxidase (MAO) B receptor inhibitor, because a prior trial of low-dose phenelzine, a nonspecific MAO inhibitor, showed a small but significant therapeutic effect. Methods: Questionnaires comprised of 19 tests of mood, fatigue, functional status and symptom severity were collected at the start and end of the trial as well as 2 weeks after its start. The trial was done in three 2-week blocks: in the first, 2 placebo pills were given per day; in the next, one 5-mg tablet of agent and one placebo were given per day, and in the last, a 5-mg tablet of agent was given twice a day. The plan was to compare the changes in the 19 tests during the placebo phase to those found in the active treatment phase in 19 patients completing the trial. Findings: Significant improvement in 3 variables – tension/anxiety, vigor and sexual relations – was found. A significant pattern of improvement compared to worsening was found for the 19 self-report vehicles during active treatment as compared with placebo treatment. Evidence for an antidepressant effect of the drug was not found. Conclusions: Selegiline has a small but significant therapeutic effect in CFS which appears independent of an antidepressant effect.
Diurnal Variation of Adrenocortical Activity in Chronic Fatigue Syndrome
Authors: MacHale S.M. , Cavanagh J.T.O. , Bennie J. , Carroll S. , Goodwin G.M. , Lawrie S.M.
Published: April 2003

Baseline morning and evening serum cortisol and ACTH concentrations, and diurnal changes in hormone levels, were measured in 30 patients with chronic fatigue syndrome (CFS) but without concurrent depressive disorder and a control group of 15 weight-, age- and sex-matched healthy volunteers. Morning cortisol levels were non-significantly lower in CFS patients, while evening levels were non-significantly higher. ACTH concentrations were non-significantly higher in both the morning and evening. The diurnal change in cortisol levels was significantly less in CFS than in controls (p < 0.05). In CFS subjects, evening levels of cortisol correlated significantly with measures of general health and physical functioning, while diurnal change in cortisol was positively correlated with measures of functional improvement over the past year and current social functioning. These results suggest that there is a relationship between adrenocortical function and disability in CFS, but do not reveal the causal connection.
Pituitary-Adrenal and Parasympathetic Function in Chronic Schizophrenic Patients with Postoperative Ileus or Hypotension
Authors: Kudoh Akira , Ishihara Hironori , Matsuki Akitomo
Published: April 2003

We studied the relationship between parasympathetic, sympathetic and pituitary-adrenal functions in chronic schizophrenic patients with complications such as postoperative paralytic ileus and hypotension during anaesthesia. Plasma epinephrine, norepinephrine (NE), adrenocorticotropin (ACTH), cortisol and the coefficient of variation (CV) of the R-R intervals on the electrocardiogram (ECG) as parasympathetic parameter were measured in schizophrenic and control patients. The CV value of the R-R interval on the ECG before the start of anaesthesia was significantly decreased to 2.3 ± 0.2 in the schizophrenic patients as compared with 3.5 ± 0.3 of the control patients. The CV value of the R-R interval on the ECG in schizophrenic patients with postoperative paralytic ileus was more diminished to 1.6 ± 0.2. The CV values in schizophrenic patients with and without hypotension during anaesthesia were similar and we could not find any significant difference. Chronic schizophrenic patients developed a decrease in NE, ACTH and cortisol responses to surgical stress, while there were no significant differences in these hormonal changes between those patients with and without paralytic ileus and hypotension during anaesthesia. In conclusion, the CV value of the ECG R-R interval may be correlated inversely with the expectancy of postoperative ileus in chronic schizophrenic patients. Their suppressed pituitary-adrenal function and sympathetic system may be indirectly associated with the paralytic ileus and hypotension.
Associations between Plasma Glucose and DSM-III-R Cluster B Personality Traits in Psychiatric Outpatients
Authors: Svanborg Pär , Mattila-Evenden Marja , Gustavsson Petter J. , Uvnäs-Moberg Kerstin , Åsberg Marie
Published: April 2003

Associations between personality traits, measured with the Karolinska Scales of Personality, the Impulsiveness subscale from the Impulsiveness, Venturesomeness and Empathy (IVE) Inventory, and with self-assessed personality traits and disorders (SCID-II Screen Questionnaire), and plasma insulin, glucagon and glucose, respectively, were explored in a sample of 101 psychiatric outpatients of both sexes. No relationships between the peptide hormones and personality measures were found. However, fasting glucose values, which were all essentially within the normal biological variation, were significantly related to several personality measures. For males, a low blood glucose was associated with low stable general level of functioning, with high IVE Impulsiveness, and with self-assessed histrionic and narcissistic traits. High number of self-assessed personality traits for all cluster B personality disorders was strongly associated with high IVE Impulsiveness. The results of the present study support the generalizability of earlier findings from alcoholic impulsive offenders: in males, low blood glucose is associated with an extrovert and impulsive, acting-out behavior that includes the breaking of societal norms and rules. In contrast, for females a positive relationship between fasting glucose and self-assessed histrionic personality traits was found. Because no association between global level of functioning and glucose was found in women, these personality traits may not necessarily be maladaptive, as was the case for males.
Effect of Posture and Isoproterenol on Beat-to-Beat Heart Rate and QT Variability
Authors: Yeragani Vikram K. , Pohl Robert , Jampala V.C. , Balon Richard , Kay Jerald , Igel Gina
Published: April 2003

Rationale: Recent literature emphasizes the utility of QT variability to study ventricular electrophysiologic function. In this investigation, we sought to test the hypothesis that beat-to-beat fluctuations in QT intervals are mediated by sympathetic activity in normal subjects using postural challenge and isoproterenol infusions. Subjects and Methods: We obtained ECG in the supine and standing postures during spontaneous breathing, at 12, 15 and 20 per minute controlled breathing (n = 19), and before and after infusions of isoproterenol, a β-adrenergic agent, in the supine posture during spontaneous breathing (n = 11) using lead II configuration in healthy human adult subjects. Heart rate (HR) and QT time series data were analyzed by spectral analysis of 256 s of real-time data. Beat-to-beat QT intervals were measured by automated analysis of ECG. A QT variability index (QTvi) was calculated for each subject as the logarithm of the ratio of normalized QT variance to normalized HR variance. We also calculated fractal dimensions of QT time series during spontaneous breathing. Results: QTvi was significantly higher in the standing than in the supine posture (–1.93 ± 0.27 vs. –1.47 ± 0.41; p = 0.0001), and also during isoproterenol infusions in the supine posture (–1.83 ± 0.39 vs. –1.27 ± 0.43; p = 0.0001). Fractal dimensions of QT time series were also significantly higher during standing (p = 0.00001) and isoproterenol infusions (p = 0.0002). Respiratory rate or tidal volume did not account for the increased QT variability seen in the standing posture. Conclusions: A change from the supine to the standing posture as well as infusion of isoproterenol significantly increased the absolute as well as normalized QT variability, which appears to be due to an increase in sympathetic activity associated with these conditions.
Retinal Degeneration in Hereditary Ceruloplasmin Deficiency
Authors: Yamaguchi Katsuhiro , Takahashi Shigeki , Kawanami Toru , Kato Takeo , Sasaki Hideo
Published: April 2003

A 56-year-old Japanese man was diagnosed as having hereditary ceruloplasmin deficiency. His ceruloplasmin concentration was below the lower limit of detection. Serum copper and iron concentrations were below normal, but the ferritin concentration was highly elevated. An ophthalmoscopic examination showed retinal degeneration with yellowish discoloration of the fundus in both eyes. Fluorescein angiography demonstrated a dark choroid in the posterior pole. Geographic areas of window defects were seen in the midperipheral fundus. The retinal degeneration in this patient was thought to be caused by the cellular iron deposition that occurred as a result of ceruloplasmin deficiency.
Management of Moderate to Advanced Coats’ Disease
Authors: Kıratlı Hayyam , Eldem Bora
Published: April 2003

Sixteen patients (16 eyes) with Coats’ disease who had either total bullous exudative retinal detachment or macular involvement and/or at least two quadrants of exudative retinal detachment were followed for a mean period of 60.6 months. Three patients with no light perception received no treatment. Ten eyes received cryotherapy on one or more occasions and two had laser photocoagulation. One eye underwent subretinal fluid drainage, intraocular infusion and cryotherapy. In those patients who could be tested, all the treated eyes retained their initial visual acuities. All 16 eyes had an acceptable cosmesis and none progressed to painful neovascular glaucoma or phthisis bulbi. Patients with late onset disease had a more benign course.
Acute Comitant Esotropia in a Boy with Head Trauma and Convulsions Receiving Carbamazepine
Authors: Fukuo Yoshifumi , Abe Tomohiro , Hayasaka Seiji
Published: April 2003

We examined an 11-year-old boy who complained of acute onset of diplopia. The patient had head trauma and postsurgical convulsions and had been treated with carbamazepine. Diplopia developed after the dose of carbamazepine was increased to 700 mg/day. On examination, comitant esotropia and lateral gaze nystagmus were found. These disorders disappeared after carbamazepine was decreased to 400 mg/day. We believe that acute comitant esotropia and lateral gaze nystagmus may have been precipitated by head trauma and carbamazepine in our patient.
Radiographic Features of an Aneurysmal Bone Cyst of the Orbit
Authors: Hino Nozomi , Ohtsuka Kenji , Hashimoto Masato , Sakata Motomichi
Published: April 2003

Aneurysmal bone cyst is an unusual benign solitary lesion of bone occurring rarely in the orbit. In this report, we present computed tomography and magnetic resonance images of an orbital aneurysmal bone cyst involving the frontal bone in a 16-month-old boy. The aneurysmal bone cyst exhibited bone destruction, new bone formation of the orbital roof and fluid-fluid levels in the lesion following hemorrhage. These radiographic features may be useful for diagnosing orbital aneurysmal bone cysts.
Choroidal Coloboma in Two Members of a Family
Authors: Eida Hiroko , Ohira Akihiro , Amemiya Tsugio
Published: April 2003

A family with choroidal coloboma is reported. A 43-year-old Japanese woman with choroidal coloboma including the optic disk and extending to the inferior half of the fundus in both eyes had horizontal nystagmus, microcornea and mild cortical cataract in both eyes. Her 40-year-old younger sister had choroidal colobomas in both eyes and also a horizontal nystagmus, microcornea in both eyes and a mature cataract in the left eye. They had no systemic abnormalities. Their parents and 2 younger sisters showed neither ocular nor systemic abnormalities. Choroidal coloboma with iris coloboma has been reported frequently, but familial choroidal coloboma without involvement of the iris and with no systemic abnormalities is rare.
Downward Gaze Palsy Caused by Bilateral Lesions of the Rostral Mesencephalon
Authors: Ohashi Tsutomu , Nakano Takafumi , Harada Takayuki , Yoshida Kazuhiko , Fukushima Kikuro , Matsuda Hidehiko
Published: April 2003

A 55-year-old man with diabetes mellitus developed diplopia and experienced difficulty in moving his eyes in the vertical plane, especially downward. Horizontal movement of each eye was normal with exotropia. Magnetic resonance imaging revealed small and high signals on both sides of the midbrain near the interstitial nucleus of Cajal (INC). Based upon the recent experimental evidence, we speculate that bilateral lesions involving the INC may have caused downward gaze palsy in our patient.
An Image Analysis Study of Cataract Development after Trabeculectomy with Mitomycin C
Authors: Daugeliene Lina , Yamamoto Tetsuya , Sawada Akira , Kitazawa Yoshiaki
Published: April 2003

We prospectively measured quantitative changes in the crystalline lens after trabeculectomy with mitomycin C. Twenty-four eyes in 24 trabeculectomy cases were consecutively enrolled in the study. The enrollment criteria consisted of: phakic eye, no history of intraocular surgeries and no corneal opacification. The transparency of the lens was measured and analyzed by EAS-1000 preoperatively, then 1 and 3 months postoperatively. Changes occurred primarily in the anterior part of the lens, especially in the anterior subcapsular region. The multivariate regression analysis demonstrated an association of cataract development with age, myopic refraction, difference in preoperativce and postoperative IOP and systemic hypertension.
Intraocular Pressure Changes after Phacoemulsification and Foldable Silicone Lens Implantation Using Healon GV®
Authors: Mastropasqua Leonardo , Carpineto Paolo , Ciancaglini Marco , Falconio Gennaro
Published: April 2003

The authors studied the intraocular pressure (IOP) changes after phacoemulsification with two different kinds of foldable silicone lens implantation using Healon GV® as viscoelastic substance. One hundred patients undergoing cataract surgery were enrolled in this study. Inclusion criteria were: absence of ocular hypertension or glaucoma. Patients were randomly assigned to plate haptic (Silens PH®, Domilens® Chiron Vision, Lyon, France) or three-piece (CeeOn™& ;920, Pharmacia spa, Milano, Italia) silicone intraocular lens (IOL) implantation. Following phacoemulsification and cortical aspiration, the capsular bag was reinflated with Healon GV. After foldable silicone IOL insertion residual Healon GV was removed from the anterior chamber. IOP was measured preoperatively and at 6, 24 h and 1 week postoperatively. Six hours postoperatively IOP was higher in the Silens PH group than in the CeeOn group (20.85±5.42 vs. 18.88±2.95 mm Hg, p = 0.026). The difference was confirmed after 24 h (21.02±5.18 vs. 17.34±3.18 mm Hg, p < 0.01). Despite the medical treatment (acetazolamide 250 mg orally every 6 h), at the 24-hour control 2 eyes with plate haptic silicone lens showed IOP values higher than 30 mm Hg. Slitlamp examination showed in both eyes a shallowing of the anterior chamber together with the evidence of capsular bag hyperdistension and capsular block resulting from the occlusion of the circular anterior capsule opening by the plate haptic IOL. Residual Healon GV removal from the anterior chamber was performed. At 1-week control both eyes showed normalization of IOP. The use of a plate haptic silicone lens may be associated with a more consistent retention of Healon GV in the eye with trapping in the capsular bag. Retained viscoelastic may cause either trabecular meshwork blockage by viscoelastic substance or postoperative capsular bag hyperdistension, anteroplacement of the IOL optic and capsular block from occlusion of the circular anterior opening by the IOL optic.
Idiopathic Sclerosing Inflammation of the Upper Eyelid
Authors: Nagaki Yasunori , Hayasaka Seiji , Honma Masanori
Published: April 2003

Idiopathic sclerosing inflammation has commonly been found in the diffuse orbital tissues. We report the inflammation of the right upper eyelid in a 65-year-old man. Computed tomography and magnetic resonance imaging showed a diffuse mass localized only in the right upper eyelid. Histologic study of the excised specimen revealed dense collagenous tissue with sparse infiltration of mixed inflammatory cells. Immunohistochemical study showed that the inflammatory cells were largely composed of T cells (UCHL-1), histiocytes (PG-M1) and scattered plasma cells (immunoglobulins). No L26-positive B cells were found. We believe that idiopathic sclerosing inflammation of the upper eyelid, as demonstrated in our patient, may be rare.
Ultrastructural Localization of Gelsolin in Lattice Corneal Dystrophy Type I
Authors: Longanesi Lora , Cavallini Gian Maria , Iammarino Antonello , Vaccina Fabiana , Guerra Roberto , De Pol Anto
Published: April 2003

In the light of recent studies into lattice corneal dystrophies, with particular reference to gelsolin immunoreactivity, the authors set out to determine the ultrastructural localization of gelsolin molecules in lattice corneal dystrophy type I. Immunoelectron microscopy with a monoclonal antibody against the COOH-terminal of the native gelsolin molecule (clone GS-2C4) was used to compare antigelsolin reactivity in normal and dystrophic corneas. A gelsolin-like protein was observed at the level of the rough endoplasmic reticulum in both epithelial and endothelial cells, together with mild positive staining in stromal keratocytes of normal corneas; increased keratocytic immunoreactivity with positive staining within and/or around corneal amyloid deposits was revealed in dystrophic corneas. Observed intra- and extracellular immunoreactivity suggests that amyloid deposition may induce gelsolin synthesis; this actin-related protein could be involved in the rearrangement of corneal stroma in lattice corneal dystrophy.
Critical Perimetry – Functioning Methods
Authors: Graef Michael , Wassill Heiko
Published: April 2003

Visual field defects without any organic correlate require critical control to avoid inadequate management of psychogenic defects. Which methods are promising to detect psychogenic visual field defects? Twenty ophthalmologically trained volunteers motivated to pretend a concentric visual field loss were tested by manual perimetry with centripetal and centrifugal movement of the stimulus, by evoking saccadic eye movements towards a stimulus outside the subjectively claimed visual field and by observation of the volunteers’ strategy searching a stimulus beyond the subjectively claimed borders. Malingering could be proven in 16 persons. The most favourable procedure is to evoke eye movements towards a peripheral stimulus. These movements yield information about the visual field outside the subjectively stated limits.
Histopathological and Cell Biological Analyses of the Formation Mechanism of Anterior Polar Cataract
Authors: Majima Kiyoyuki , Majima Yoshinao
Published: April 2003

Anterior polar cataract, defined as an opacification limited to the anterior polar region of the crystalline lens, results in a significant decline of vision even though the area of opacification is generally small. Having performed histopathological and cell biological studies in an attempt to identify the formation mechanism of anterior polar cataract, we found that lens epithelial cells (LECs) in contact with the opacified region were arranged in a monolayer and contained vacuoles. Furthermore, compared to LECs obtained from cortical and nuclear cataractous lenses and cultured for the study, these LECs revealed a significantly diminished proliferation, suggesting that their physiological activity had been reduced. On the other hand, LECs existing within the opacified region were multi-layered, and there were structureless deposits including remnants of organelles among the cells. Based on these findings, we have concluded that the formation mechanism of anterior polar cataract is as follows: LECs contacting the opacified region initially undergo significant mitosis; rather than migrating towards the equator, these proliferating cells accumulate and form a multilayer in the anterior polar region. Since multi-layered cells are surrounded by the anterior lens capsule and the lens cortex, there is a limit as to how many layers the cells can continue to form; when this limit is reached, these cells next undergo endocytosis and exocytosis. Because the physiological activity has been reduced as a result of having undergone significant proliferation, the cells contacting the opacified area are no longer able to force the proliferating cells towards the anterior polar region; hence multi-layering of the cells and the entire cellular movement are terminated at this point and result in cells with vacuoles and diminished physiological activity. While further studies are required to confirm our hypothesis, we believe this is the first study to suggest a possible mechanism of formation of anterior polar cataract.
Relationship between Blood Flow Velocities in Retrobulbar Vessels and Laser Doppler Flowmetry at the Optic Disk in Glaucoma Patients
Authors: Bohdanecka Zuzana , Orgül Selim , Meyer AnjaB. , Prünte Christian , Flammer Josef
Published: April 2003

The relationship between blood flow velocities in retrobulbar vessels and blood flow at the optic nerve in glaucoma patients was assessed in a prospective study. The Heidelberg retina flowmeter (HRF) was used to assess optic nerve head blood flow in 13 open-angle glaucoma patients. In the same patients, color Doppler imaging (CDI) measurements were obtained from the ophthalmic artery, the central retinal artery and the posterior ciliary arteries. Using data for one randomly selected eye per subject, correlations between HRF recordings and CDI measurements were evaluated by means of Spearman’s rank correlation factor. All three HRF parameters correlated with CDI measurements obtained from retrobulbar vessels. The most marked correlations were those of the HRF parameter ‘volume’ with the end-diastolic velocity in the ophthalmic artery and the medial posterior ciliary artery (R = 0.79, p = 0.0012 and R = 0.81, p = 0.0007, respectively), and the peak systolic velocity in the lateral posterior ciliary artery (R = 0.82, p = 0.0006). The present study suggests that glaucoma patients with altered blood flow in retrobulbar vessels are likely to show an alteration in optic nerve blood flow as measured with the HRF.
Ultrastructural Effects of Topical Beta-Adrenergic Antagonists and an Alpha-Adrenergic Agonist on the Rabbit Cornea
Authors: Polat Sait , Özdemir Nusret , Soylu Merih , Mete Ufuk , Ünlügenç Zuhal , Kaya Mehmet
Published: April 2003

In the present study the effects of β-adrenergic antagonist and α-adrenergic agonist drugs on rabbit corneas were evaluated in vivo by using transmission electron microscopy. Twenty-four New Zealand albino rabbits were divided into six groups according to the drug applied. The rabbits to which only balanced salt solution (BSS) or BSS and benzalkonium chloride (BAC) were applied were taken as the control groups. The other four groups consisted of the rabbits to which Timoptic 0.5%, Betagan 0.5%, Betoptic 0.5% and Iopidine 1% were applied, respectively. All of drugs were instilled topically twice daily for 6 weeks. In the BSS group, all layers of the cornea were ultrastructurally normal. In the BSS and BAC group slight epithelial and endothelial changes were found. However, in the other groups, loss of microvilli, increase in glycogen particles, nuclear indentation, widening of the intercellular spaces and cytoplasmic vacuolization in epithelium were observed. No significant abnormality was found in the basal lamina, stroma and Descemet’s membrane. Slight ultrastructural changes were noted in the endothelium such as vacuolization due to dilatation of the endoplasmic reticulum cisternae and focal cytoplasmic lytic areas. The results of this study indicate that various ultrastructural changes occur in groups treated with antiglaucomatous drug and that topical treatment with timolol and apraclonidine for 6 weeks is more toxic to the rabbit cornea than levobunolol and betaxolol.
Vogt-Koyanagi-Harada Syndrome in an 11-Year-Old Boy
Authors: Ikeda Nariko , Hayasaka Seiji , Kadoi Chiharu , Nagaki Yasunori
Published: April 2003

An 11-year-old boy complained of headache, slight fever and decreased visual acuity. Intracameral cells and serous retinal detachment were found in both eyes. Pleocytosis was seen in the cerebrospinal fluid. Bilateral uveitis diminished rapidly in response to corticosteroid treatment. Depigmentation of the fundi developed several months later. We believe that Vogt-Koyanagi-Harada syndrome in a child, as demonstrated in our patient, may be uncommon.
Ocular Changes in Mucopolysaccharidosis IV A (Morquio A Syndrome) and Long-Term Results of Perforating Keratoplasty
Authors: Käsmann-Kellner Barbara , Weindler Josef , Pfau Britta , Ruprecht KlausW.
Published: April 2003

Background: The mucopolysaccharidoses (MPS) are an inhomogeneous group of disorders of errors in the carbohydrate metabolism with severe ocular involvement (corneal opacification, retinal degeneration, optic atrophy). Patient Presentation: We report on a boy aged 12 years, with Morquio A (MPS IV A) syndrome. Ocular findings: progressive pseudoexophthalmus due to shallow orbits, increasing corneal stromal clouding, intermittent dissociated manifest nystagmus of the left eye, nyctalopia. Visual acuity OD cc = 0.16, OS cc = 0.05. Electrophysiology: changes suggesting a symptomatic tapetoretinal degeneration and optic atrophy. Treatment and Course of Disease: OS: perforating keratoplasty. Postoperative improvement of visual acuity to 0.25 for nearly a year, followed by progressive reopacification of the corneal graft. Both eyes: progressive signs of tapetoretinal degeneration and optic atrophy. Visual acuity now reduced to OD 0.05, OS 0.1. Conclusions: Success of a keratoplasty is limited by (1) reopacification of the cornea, (2) visual impairment due to (a) retinal degeneration and (b) optic atrophy. The indication for perforating keratoplasty has to be thought about very carefully in these multimorbid patients. In our patient, beside progressive visual impairment there is a progressive deafness which dominates his social and school life. Attending school is severely complicated by the double handicap. Perforating keratoplasty enabled the boy to attend a school for physically handicapped without a special low-vision care for another year. Progressive visual loss without further treatment options now renders optical and electronic low-vision aids necessary. Although the time of improved visual acuity lasted less than a year, we think patients with a life expectancy of less than 20 years should have every possible improvement of their situation – even if it does not last permanently. We therefore propose perforating keratoplasty in spite of insufficient long-term results.
Ocular Filariasis: Not Strictly Tropical
Authors: Rouhette H. , Marty P. , Zur C. , Bain O. , Fenollar S. , Gastaud P.
Published: April 2003

A 65-year-old man consulted for a discomfort in the right eye that had suddenly appeared the evening before. The examination revealed a white worm localized under the temporal bulbar conjunctiva. After extraction, the parasitological characteristics identified the worm as Dirofilaria repens (Nochtiella subgenus). This is a parasite of canids and felids, usually nonpathogenic to humans, but which can be transmitted through mosquito bites, especially around the Mediterranean basin. The simple extraction of the worm, encysted under the skin or under the conjunctiva, cures the patient.
Confocal Microscopy in Posterior Polymorphous Corneal Dystrophy
Authors: Chiou Auguste G.-Y. , Kaufman Stephen C. , Beuerman Roger W. , Maitchouk Dmitri , Kaufman Herbert E.
Published: April 2003

Purpose: To report the distinguishing characteristics of posterior polymorphous corneal dystrophy (PPMD) using confocal microscopy. Material and Methods: Two consecutive patients with PPMD were prospectively examined using a white-light tandem scanning confocal microscope with a 24×/0.60 contact objective. Results: At the level of Descement’s membrane, roundish hyporeflective images were found in 1 patient. In the other patient, hyporeflective bands were detected. In both patients, patchy hyperreflective areas were identified. Conclusion: Confocal microscopy may allow diagnosis of PPMD by demonstrating the alterations in Descement’s membrane. This technique is especially valuable in cases of endothelial decompensation, where slit-lamp and specular microscopy may fail to demonstrate changes in Descement’s membrane.
Optic Nerve Blindness due to Paranasal Sinus Disease
Authors: Fujimoto Naoya , Adachi-Usami Emiko , Saito Eiko , Nagata Hiroshi
Published: April 2003

Patients with total blindness caused by paranasal sinus disease have rarely been reported. We retrospectively studied the prognosis of patients who had optic nerve blindness due to paranasal sinus disease. During the past 10 years, we identified 17 patients with optic nerve disease and posterior paranasal sinus disease. Seven of the 17 patients with optic nerve disease and paranasal sinus disease had no light perception. Five of these 7 patients with paranasal sinus disease had a final visual acuity of 20/200 or better. Two patients showed dramatic visual improvement after endonasal surgery. Because immediate surgery to correct paranasal sinus disease is required in affected patients, computed tomography should be done at the patient’s first visit.
Changes in the Epidemiology of Ruptured Globe Eye Injuries due to Societal Changes
Authors: Pump-Schmidt Cordula , Behrens-Baumann Wolfgang
Published: April 2003

We studied 208 records of patients, who had undergone primary repair of a ruptured globe. A comparison of the periods 1987–1989 and 1993–1995 suggests epidemiological changes as a result of broad changes in occupational and social conditions after the German reunification in 1989. The rate of ruptured globe injuries caused by occupational accidents decreased from 38.8% in the first period to 31.4% in the second. We found an increase in comparable eye injuries as a consequence of leisure activities. Within the years from 1993 to 1995, in occupational accidents, we found a significant decrease in eye injuries in industry while accidents in small companies (e.g. garages, builders and constructors) increased significantly compared to 1987–1989.
Regulation of Trabecular Meshwork Contractility
Authors: Stumpff Friederike , Wiederholt Michael
Published: April 2003

Ample evidence supports the theory that trabecular meshwork possesses smooth-muscle-like properties. Trabecular meshwork cells express a large number of transporters, channels and receptors, many of which are known to regulate smooth-muscle contractility. It has been shown that trabecular meshwork can be induced to contract and relax in response to pharmacological agents. In the model of the bovine eye, confirmed in some cases by experiments on primates, agents that contract trabecular meshwork reduce outflow. On the cellular level, this is coupled with depolarization and a rise in intracellular calcium. Relaxation of trabecular meshwork, on the other hand, appears to be coupled to a stimulation of the maxi-K channel, inducing hyperpolarization and a closure of L-type calcium channels. No significant differences between cells from a human and a bovine source emerged, either in classical measurements of membrane voltage, in measurements of intracellular calcium or patch-clamp experiments. Thus, pharmacological agents that relax trabecular meshwork seem promising candidates for further research – the ultimate goal being an improvement of glaucoma therapy in humans.
Oxidative Stress and Age-Related Cataract
Authors: Ottonello Simone , Foroni Chiara , Carta Arturo , Petrucco Stefania , Maraini Giovanni
Published: April 2003

The authors review the available evidence supporting the possible role of oxidative stress in cataract formation from an epidemiological and a clinical point of view. They discuss in more detail what is presently known about the molecular mechanisms of response of the mammalian lens to an oxidative insult and report unpublished data on gene modulation upon oxidative stress in a bovine lens model. Main research endeavors that seem to be a most promising source of new insights into the problem of age-related cataract formation are briefly discussed.