bluuebunny/crossref_metadata_2025 huggingface dataset:
A novel immunoassay for the evaluation of rod outer segment digestion in cultured retinal pigment epithelial cells
Authors: Zhang Dan , Lai May C , Constable Ian J , Rakoczy Piroska E
Published: March 2003

In this work a novel enzyme‐linked immunoabsorbent assay quantifying residual rod outer segments in the medium of rod outer segment‐challenged retinal pigment epithelial cells is described. A retinal pigment epithelial cell line (D407) that produces low level of cathepsin D, and a primary human retinal pigment epithelial cell culture (HRPE51) that has normal cathepsin D levels, were challenged with bovine rod outer segments. At 3 days post‐challenge, the amount of undigested or residual bovine rod outer segments left in the culture medium was quantified by an enzyme‐linked immunoabsorbent assay. An antibody raised against bovine rod outer segments, which had been purified and labelled with nitroiodophenyl haptens, was used in the assay. The sensitivity of the immunoassay was less than 10 2 bovine rod outer segments per mL and the signal followed a linear curve, saturating around 10
6 bovine rod outer segments per mL. HRPE51 cells had no residual bovine rod outer segments present in the medium following a challenge with 10
4 bovine rod outer segments per mL. In the medium of D407 cells, residual bovine rod outer segment levels were higher at all bovine rod outer segment concentrations when compared to the residual bovine rod outer segment levels in HRPE51 cells, suggesting that D407 cells have a lower digestive capacity. These results demonstrated that the immunoassay for detecting bovine rod outer segments is a sensitive and reliable technique that can be used to quantify the amount of residual bovine rod outer segments, following bovine rod outer segment challenge of retinal pigment epithelial cells.
Neuroretinal rim measurement error using PC‐based stereo software
Authors: Eikelboom Robert H , Barry Chris J , Jitskaia Ludmila , Voon Angel Sp , Yogesan Kanagasingam
Published: March 2003

The neuroretinal rims of a set of glaucoma patients were measured using digitized stereo photographs, to determine the reproducibility of computerized stereo measurements of the neuroretinal rim. Each rim was measured five times at 18 locations, with measurement error (ME) defined as the mean of standard deviations of each set of measurements. The following ME were determined: (i) inter‐sessional variability (n = 27 right and 24 left eyes, at t1 and t2); (ii) inter‐assessor variability (n = 9, 2 assessors); and (iii) variability after colour adjustment algorithms were applied (n = 15). The results were as follows: (i) inter‐sessional variability was 3.41 ± 1.08 for t1 and 3.22 ± 0.84 for t2;; (ii) there was a significant difference between the two assessors, although the ME was still low; and (iii) there was no significant differences between the ME of unadjusted and adjusted images. With a measurement error of up to 11% of rim width, these results show that low‐ cost rim measurements can be made using PC‐based software.
Detection of vision impairment in people admitted to aged care assessment centres
Authors: Nottle H R , McCarty C A , Hassell J B , Keeffe J E
Published: March 2003

Vision is not routinely tested when the health of older people is assessed, and the aim of this study was to detect older people with vision impairment for referral to appropriate eye care services. People admitted for assessment and or rehabilitation in three aged care assessment centres had distance and near visual acuity assessed with a simplified vision test. A pinhole test was used when necessary. Referral criteria were distance visual acuity of less than 6 / 12; near vision of less than N8, and people with diabetes who had not attended a dilated fundus examination in the last 2 years. Visual acuity results were obtained in 93% of patients (685 / 735). Those unable to perform the vision test were very ill or had severe cognitive impairment. Forty‐three per cent of patients (266 / 646) had impaired vision and, of these, 70.6% (188 / 266) were referred to eye care specialists. Forty‐five per cent were referred to ophthalmologists, 36% to optometrists and 20% to low vision services. This significant proportion of patients with poor vision suggests that vision screening is warranted.
Current Australian practice in the prevention and management of corneal allograft rejection
Authors: Barker Nigel H , Henderson Timothy RM , Ross Carolyn A , Coster Douglas J , Williams Keryn A
Published: March 2003

Purpose: To determine current practices in the prevention and management of corneal allograft rejection in Australia.

Methods: A questionnaire was circulated to attendees at the 1998 Eye Bank Meeting in Adelaide. Twenty‐four responses were received and analysed.

Results: All respondents used topical corticosteroids for routine prophylaxis and to treat established rejection episodes. Prednisolone acetate was the most frequently prescribed topical corticosteroid. Systemic non‐steroidal immunosuppression was prescribed almost exclusively for high‐risk grafts. Seventy‐five per cent of surgeons used systemic antiviral agents for the treatment of graft rejection in patients with Herpes simplex keratitis.

Conclusion: There was a wide variation amongst surgeons in the choice of therapy for routine prophylactic immunosuppression as well as for the treatment of established corneal allograft rejection.
Traumatic intramuscular orbital haemorrhage
Authors: Gock Germaine , Francis Ian C , Mulligan Susan
Published: March 2003

Retrobulbar haemorrhage is an uncommon but well‐ documented complication of retrobulbar anaesthetic blocks in ocular surgery. Peribulbar anaesthesia has been advocated to be equally effective but safer. The incidence of retrobulbar haemorrhage with peribulbar blocks is very low. We report a case in which a peribulbar anaesthetic for cataract surgery resulted in sight‐threatening retrobulbar haemorrhage within the medial rectus muscle and required an anterior orbitotomy and direct decompression of the muscle. The surgery was successful. This case illustrates a potentially serious complication of peribulbar anaesthesia, with the successful outcome achieved by rapid definitive diagnosis and intervention.
Isolated amyloidosis of anterior uvea and trabecular meshwork
Authors: Mansour Ahmad M , Hidayat Ahmed A , Gorevic Peter D
Published: March 2003

Amyloid deposition in the iris is rare, scanty and associated with systemic disease. We present a case of isolated localized heavy amyloid infiltration of the iris and describe a new hillock‐pattern feature visualized using scanning electron microscopy.
Ockham’s glaucoma
Authors: Whiting Mark An , Walland Mark J
Published: March 2003

The combination of characteristic optic nerve head cupping, arcuate visual field loss and ocular hypertension would usually be thought sufficient to diagnose glaucoma. Only in the absence of elevated intraocular pressure, when normal tension glaucoma may be suspected, would intracranial imaging normally be performed to exclude occult pathology. A case is presented which illustrates the continuing need for vigilance, and an open mind, years after an apparently straightforward diagnosis has been made.
Intraocular pressure before and after cataract surgery in participants of the Melbourne Visual Impairment Project
Authors: Dimitrov Peter N , Mukesh Bickol N , Taylor Hugh R , McCarty Catherine A
Published: March 2003

The purpose of this study was to investigate the effect of cataract surgery on intraocular pressure (IOP) in a cluster‐stratified random sample of the population of Victoria, Australia. A total of 3271 participants aged 40 years or older were examined at baseline for the Visual Impairment Project. The baseline study (1992–1994) was followed by a 5‐year incidence study. The IOP data were compared between participants who had cataract surgery between the two stages of the study and participants with and without cataract at follow up. The IOP was also compared before and after cataract extraction in glaucoma participants. An eligible 89 non‐glaucoma and 24 glaucoma participants had cataract surgery between the two time points. The analyses showed that IOP increases with age in non‐operated eyes in both glaucoma and non‐glaucoma groups. However, IOP decreased significantly after cataract surgery in eyes with glaucoma but did not change significantly in non‐glaucoma participants.
Neuro‐ophthalmological sequelae of horse‐related accidents
Authors: Fleming P Richard I , Crompton John L , Simpson Donald A
Published: March 2003

Purpose: The aim of this study was to highlight the neuro‐ophthalmological dangers associated with horse riding, and working around horses, and the importance of wearing adequate headgear to protect the rider from neuro‐ ophthalmic injuries. It raises the questions of whether the current laws regarding helmet use are satisfactory, and whether helmets currently used are of an adequate standard.

Methods: The records over a 20‐year period of one neuro‐ophthalmologist in Adelaide were reviewed producing 22 patients with neuro‐ophthalmological sequelae of head injuries as a result of horse‐related accidents.

Results: There were 22 patients (16 female, six male), one of whom was involved in three separate accidents. Of these, seven were professional riders and 15 amateur. In 20 of the 24 accidents, patients were either thrown or fell from the horse. Helmets were worn in 15 of the accidents. All the patients had closed head injuries of varying severity. The most common neuro‐ophthalmological complication found was a fourth‐nerve palsy in 11 patients. Five patients had a significant loss of vision and two of these were severe enough to warrant a blind pension.

Conclusions: Horse riding and working around horses constitute an occupation or recreation with inherent dangers. Previous studies have shown that wearing of protective headgear reduces the risk and severity of head injuries, and helmet use should be vigorously promoted. The current laws and practices regarding helmet use are not uniform and seem to be inadequate. The current standard for equestrian safety helmets (AS/NZS 3838:1998) embodies improvements on earlier helmet standards and certainly increases the rider’s chances of surviving a severe impact. Nevertheless, serious brain injuries have occurred in wearers of approved helmets, and further research is desirable to ensure the optimum degree of protection compatible with rider acceptance.
Relationship between age and intraocular pressure: the Blue Mountains Eye Study
Authors: Rochtchina Elena , Mitchell Paul , Wang Jie Jin
Published: March 2003

This study aimed to assess the influence of age on intraocular pressure (IOP) in a general population. The Blue Mountains Eye Study assessed 3654 residents aged 49+ years during 1992−1994. Intraocular pressure was measured using Goldmann applanation tonometry. Subjects with glaucoma, those currently on glaucoma medications and those with a history of cataract surgery were excluded. The IOP was reliably measured in 3260 subjects. Mean IOP was 16.0 mmHg with no significant difference found between men and women (P < 0.89).
In univariate analyses, age was positively associated with IOP (P < 0.05).
Systolic blood pressure (SBP) was strongly positively associated
with IOP (P < 0.001). After adjusting
for SBP, there was a trend for IOP to decrease with increasing age
(P < 0.051). After further adjusting
for other potential confounders (diabetes, glaucoma family history
and myopia), age was no longer significantly associated with intraocular
pressure (P < 0.29). In summary, no evidence was found of an independent age affect on IOP.
High heritability of myopia does not preclude rapid changes in prevalence
Authors: Rose Kathryn A , Morgan Ian G , Smith Wayne , Mitchell Paul
Published: March 2003

The aetiology of myopia is complex, but the major form of myopia results from an interplay between genetic factors and environmental influences. Although there are clear patterns of family inheritance and high heritability values in studies from all over the world, environmental factors are increasingly important in determining myopic outcomes in East Asia, and perhaps elsewhere. This is not paradoxical, as high heritability does not preclude strong environmental influences. The lower heritability values obtained from parent−offspring correlations in populations of East Asian origin where there are marked differences in the environmental exposures (education and urbanization) of parents and children, and where there has been a major shift in the population distribution of myopia, are consistent with this view. Despite the impact of environmental pressures in East Asia, there is evidence that parental myopia influences the position of their offspring within that new population distribution.
Phacoemulsification in filtered chronic angle closure glaucoma eyes
Authors: Khokhar Sudarshan , Sindhu Narottama , Pangtey Mayank S
Published: March 2003

Purpose: To report the results of phacoemulsification in eyes with chronic angle closure glaucoma having a functional filtering bleb.

Methods: A prospective and non‐comparative study was undertaken in 60 consecutive eyes of 44 patients having a functional filtering bleb for chronic angle closure glaucoma and undergoing cataract surgery. Only those cases who had intraocular pressure ≤ 21 mmHg over the preceding 6 months without any medical therapy following trabeculectomy were included in the study. All patients underwent phaco­emulsification through a superior clear corneal, three‐stepped, 1.5 mm long tunnelled incision and in‐the‐bag intraocular lens implantation. Surgical difficulties, complications, postoperative intraocular pressure and best‐corrected visual acuity were studied and analysed over a follow up of 6 months.

Results: Complications seen during the surgery were iris trauma in 11 eyes (18.33%), thermal corneal burn in four (6.6%), corneal oedema in seven (11.66%), vitreous loss in one (1.6%), breach in rhexis in two (3.3%), fibrinoid reaction in one (1.6%) and early increase in intraocular pressure in one (1.6%). Postoperatively, visual acuity improved in all cases. None of the patients had poor vision that could be attributed to the surgical procedures. Difference in intra‐ocular pressure (preoperative 15.37 ± 2.59 mmHg) at all occasions during follow up was found to be statistically insignificant (P > 0.05 using paired t‐test). The central anterior chamber depth was statistically significant (P = 0.002) when preoperative (1.90 ± 1.27 mm) was compared to postoperative at 6 months (2.11 ± 1.27 mm).

Conclusion: Phacoemulsification in eyes with a functional filtering bleb for chronic angle closure glaucoma is challenging. However, with slight modifications in technique, it can be accomplished without compromising the functioning of the bleb.
Microstructural analysis of Salzmann's nodular degeneration by in vivo confocal microscopy
Authors: Ku Judy YF , Grupcheva Christina N , McGhee Charles NJ
Published: March 2003

A 44‐year‐old man with symptoms of ocular irritation and corneal changes characteristic of Salzmann's nodular degeneration in the left eye was examined using in vivo confocal microscopy. In vivo confocal microscopy highlighted an irregularly shaped basal epithelium with foci of prominent nuclei, and disrupted anterior stromal architecture with increased reflectivity of extracellular matrix within the nodules. These observations were consistent with prior histopathological descriptions of Salzmann's nodular degeneration. In vivo confocal microscopy enhances the clinicopathological assessment of degenerative corneal diseases, such as Salzmann's nodular degeneration, without the need for biopsy.
Orbital dirofilariasis
Authors: Stringfellow Gavin J , Francis Ian C , Coroneo Minas T , Walker John
Published: March 2003

Dirofilariasis is a parasitic disease of domestic and wild animals that occasionally may present as zoonotic infection in humans. The microfilariae are accidentally transmitted to humans by Culex and Aedes mosquitoes. Ophthalmic infections with Dirofilaria are well documented all over the world, including America, Europe and Australia. The infection may be periorbital, subconjunctival or intraocular. In this report a case is described of orbital dirofilariasis that presented as ptosis and lid swelling. Australian ophthalmologists should consider dirofilariasis as part of the differential diagnosis of orbital swelling and inflammation.
Indocyanine green angiographic interpretation of reticular dystrophy of the retinal pigment epithelium complicated by choroidal neovascularization
Authors: Zeldovich Alina , Beaumont Paul , Chang Andrew , Kang Kwon
Published: March 2003

A 37‐year‐old woman presented with flashes in her left eye and bilateral visual distortion. Fundal examination revealed a reticular ‘fishnet’ pattern of retinal pigmentation in both eyes consistent with reticular dystrophy of the retinal pigment epithelium. In the left eye there was a small haemorrhage and a shallow serous macular detachment. Fluorescein angio­graphy demonstrated subfoveal choroidal neovascularization. Indocyanine green angiography (ICG) revealed more extensive involvement than fluorescein angiography, with small areas of intense hyperfluorescence amongst reticular areas of hypofluorescence. These changes, as interpreted in light of the known histopathological localization of ICG, are consistent with varying stages of dysfunction of the retinal pigment epithelium in this disease.
Outcome and number of cataract surgeries in India: policy issues for blindness control
Authors: Dandona Lalit , Dandona Rakhi , Anand Raj , Srinivas Marmamula , Rajashekar Varda
Published: March 2003

Purpose: To assess what impact attention to quality of cataract surgery and postoperative follow up can have on cataract blindness in India, and to estimate the number of surgeries needed to eliminate cataract blindness in India.

Methods: In a population‐based sample of 5268 persons in two rural areas in the state of Andhra Pradesh, India, data on the visual outcome of cataract surgery were obtained on 129 eyes of 106 persons operated previously. These were compared with the visual outcome of cataract surgery performed during 1999 in 2394 eyes of 2213 persons at two new rural eye centres set up in these areas that pay particular attention to the quality of eye care. Blindness in an eye was defined as presenting distance visual acuity less than 6/60, and in a person as this acuity level in the better eye. These data were extrapolated to India.

Results: In the population‐based sample, of the 129 operated eyes, 51 (39.5%) were blind after surgery, which included 41 (31.8%) from cataract surgery‐related causes. Of the 106 persons in the population sample who had had cataract surgery in one or both eyes, 26 (24.5%) were still blind. In contrast, for the cataract surgery at the two rural eye centres paying attention to quality, 3.1% of the eyes and 1.8% of the persons were blind soon after surgery, but these figures could increase 2.6 times over the lifetime of these persons. The 3.5 million cataract surgeries in India in 2000 are estimated to result in 0.32 million persons having blindness averted over their lifetime. To eliminate cataract blindness in India, an estimated 9 million good‐quality cataract surgeries are needed every year during 2001−2005, increasing to over 14 million surgeries needed every year during 2016−2020 on persons most likely to go blind from cataract.

Conclusions: The number of persons in whom blindness is being averted due to cataract surgery in India is currently a very small fraction of the number blind from cataract. If adequate attention is given to the quality of eye care, for the current number of cataract surgeries in India it should be possible to increase by threefold the number in whom blindness can be averted with cataract surgery. In addition to improving quality, the annual number of cataract surgeries has to be at least threefold the current number during 2006−2010 if cataract blindness in India is to be eliminated.
A Case of Purulent Pancreatic Ductitis Successfully Treated by Endoscopic Stenting
Authors: Aoki Shigeru , Okayama Yasutaka , Hayashi Katsuki , Imai Hideto , Okamoto Tetsu , Kobayashi Shinya , Shiraki Shigehiro , Gotoh Kazuo , Sano Hitoshi , Ohara Hirotaka , Nomura Tomoyuki , Joh Takashi , Yokoyama Yoshifumi , Itoh Makoto
Published: March 2003

A 50‐year‐old male received conservative medical treatment for acute exacerbation of chronic pancreatitis. High fever, abdominal pain, as well as enhancement of inflammatory response and pancreatic enzymes in serum, persisted after treatment for 1 month. Purulent pancreatic fluid was drained by endoscopically placing an 8F plastic stent in the main pancreatic duct, resulting in marked improvement of clinical symptoms. This case appears to provide useful information in considering indications for pancreatic stents.
Reversible protruded lesion regarded as idiopathic appendiceal intussusception
Authors: Honmyo Ubehiko , Shimada Shinya , Yamamoto Shin‐ichi , Oshima Shigeki , Maeda Masaomi , Yoshinaka Ichiro , Mizumoto Seiichi , Murakami Akitoshi , Misumi Atsunobu
Published: March 2003

A patient with a reversible protruded lesion regarded as idiopathic appendiceal intussusception was investigated in this study. The patient was a 78‐year‐old male, who consulted our department as a result of positive occult blood in his stool sample. There was no associated pain, nausea, vomiting, fever, chill or anorexia. He had no prior surgical history. Total colonoscopy detected a sigmoidal polyp and a protruded lesion in the caecum. The protruded lesion (about 12 mm in diameter) covered with normal mucosa was diagnosed as a benign submucosal tumor at that time. The periodic follow‐up colonoscopy showed an orifice on top of the protuberance. Further detailed observation revealed that the lesion reduced by itself, and resulted in showing a normal orifice of the appendix; however, afterwards it protruded again. These observations led to the diagnosis of the lesion as type B of Atkinson's classification in appendiceal intussusception. To our knowledge, approximately 200 cases of appendiceal intussusception have been documented in scientific reports worldwide. In Japan, only 10 cases of idiopathic appendiceal intussusception have been described. This case is considered to be important for presenting the initial stage of the complete intussusception of the appendix.
Hemodynamic evaluation of rectal varices by endoscopic color Doppler ultrasonography
Authors: Sato Takahiro , Yamazaki Katsu , Toyota Jouji , Karino Yoshiyasu , Ohmura Takumi , Suga Toshihiro
Published: March 2003

Background: Rectal varices are an infrequent but potentially serious cause of hematochezia. In this paper, the hemodynamics of rectal varices using endoscopic color Doppler ultrasonography (ECDUS) are evaluated.

Method: This study consisted of six rectal variceal patients who had F2 type of the rectum, and four of the six had a positive red color sign. We monitored the color flow images of rectal varices.

Results: Color flow images of rectal varices were obtained in all six patients. Color flow images of inflow and outflow vessels of rectal varices were obtained in all six patients. We performed endoscopic injection sclerotherapy (EIS) on three of the six patients. After EIS, ECDUS revealed the disappearance of the variceal blood flow in one case, and the decrease of blood flow in two cases.

Conclusion: The technique of ECDUS is a useful modality for detecting rectal varices on color flow images and for evaluating the therapeutic effects of EIS.
Efficacy of Argon Plasma Coagulation for Bleeding Gastroduodenal Ulcers
Authors: Asakura Yasushi , Imai Yukinori , Arai Shin , Kinoshita Manabu , Kakinuma Toru , Kakoi Kotaro , Rai Fumie , Eguchi Yuichiro , Fujiwara Kenji , Ota Shinichi
Published: March 2003

Background:  Argon plasma coagulation (APC) can achieve an effective coagulation of large areas with a relatively shallow but well‐controlled and uniform coagulation depth. There are only a few reports of APC therapy applied to bleeding peptic ulcers, especially ulcers with exposed vessels.

Methods:  The aim of this study is to evaluate the usefulness of APC as a means of achieving endoscopic hemostasis for bleeding gastroduodenal ulcers. Thirty‐nine patients having these ulcers were treated with APC.

Results:  The success rates for initial hemostasis and complete hemostasis with APC are 87% and 97.4%, respectively. These results are almost equal to those of injection therapy and hemoclip. Six cases that re‐bled after other hemostatic procedures obtained complete hemostasis finally with APC. In one ineffective case of APC, complete endoscopic hemostasis was achieved with hemoclip.

Conclusion:  Argon plasma coagulation therapy is an effective therapeutic alternative in endoscopic hemostasis for bleeding peptic ulcers.
Anorectal manometric abnormalities and effect of cisapride in patients with chronic idiopathic constipation
Authors: Duowu Zou , Guoming Xu , Zhaoshen Li , Ning Yin
Published: March 2003

OBJECTIVES: To investigate abnormalities in anorectal motility, changes in rectal visceral perception of balloon distention and the effect of cisapride on patients with chronic idiopathic constipation (CIC).

METHODS: Anorectal manometry was carried out in 30 CIC patients using the Synectics Visceral Stimulator combined with PcPolygraf before and after treatment with cisapride (10 mg three times daily for 4 weeks). Twenty age‐matched controls were also studied before cisapride therapy.

RESULTS: Patients with CIC had lower anorectal sphincter squeeze pressures (P < 0.05), larger minimum relaxation volumes necessary to elicit the anorectal inhibitory reflux (P < 0.05), higher rectal defecation volume thresholds and higher rectal maximum tolerable volume thresholds (P < 0.01) compared with the controls. All of the abnormalities significantly improved and defecation frequency greatly increased after 4 weeks of cisapride therapy (P < 0.01). Cisapride was effective in 46.67% of patients with CIC.

CONCLUSIONS: Patients with CIC have abnormalities of both anorectal motility and rectal visceral perception of balloon distention. Cisapride can improve these abnormalities and is effective in approximately one‐half of CIC cases.
Effect of release‐controlled nifedipine on portal hemodynamics in cirrhotic patients
Authors: Chengyong Qin , Dongxing Liu , Juren Zhu , Lina Fu , Zhaohai Wan , Guoquan Zhang , Tao Jia
Published: March 2003

OBJECTIVE: To evaluate the therapeutic effect of release‐controlled nifedipine on portal hypertension.

METHODS: Thirty‐two cirrhotic patients were enrolled to investigate, by using duplex Doppler ultrasonography, differences in portal hemodynamics before and after treatment with release‐controlled nifedipine (30 mg once per day).

RESULTS: After taking nifedipine, the diameter, blood velocity and blood flow of the portal vein decreased, but only the change in velocity was statistically significant. After treatment, the congestion index increased, and the blood velocity and blood flow of the splenic vein significantly decreased. The resistance and pulsatile indices of the right hepatic and splenic arteries also decreased markedly. The total hepatic blood flow was elevated slightly and there were no significant changes in mean arterial pressure and heart rate.

CONCLUSIONS: The resistance and pulsatile indices of the hepatic and splenic arteries are representative indices of portal resistance. Release‐controlled nifedipine may decrease portal pressure by the following mechanisms: (i) decrease of systemic blood pressure triggers the sympathetic reflex, leading to splanchnic artery constriction and portal blood flow reduction; (ii) dilatation of the portal vein and sinusoids leads to decrease portal resistance; and (iii) dilatation of the collateral veins. Nifedipine has no significant effect on systemic circulation in normotensive cirrhotic patients, therefore it has good prospects as a drug for clinical use in portal hypertension.
Preliminary assessment of miniprobe sonography in the diagnosis of gastric varices and evaluation of treatment with Histoacryl
Authors: Qi Zhu , Yunlin Wu , Jiayu Xu
Published: March 2003

OBJECTIVE: In comparison with conventional endoscopy, the clinical value of miniprobe sonography (MPS) was assessed both in the diagnosis of gastric varices (GV) and in the evaluation of its treatment with the tissue adhesive agent Histoacryl.

METHODS: Twelve patients with liver cirrhosis and portal hypertension caused by hepatitis B in nine cases and hepatitis C in three cases were examined by MPS to verify the presence of gastric fundic varices before and after endoscopic treatment with Histoacryl. Curative efficacy of Histoacryl treatment was defined by the finding of variceal lumen obliteration characteristics in the ultrasonic image.

RESULTS: Gastric fundic varices were detected in 10 patients by using MPS, however, only seven cases were detected by using conventional macroscopic examination. For gastric fundic varices, the diagnostic accuracies of standard endoscopy and MPS were 75% (9/12) and 100% (12/12), respectively. Furthermore, MPS was able to produce a practical ultrasonic image of complete or incomplete variceal vessel lumen obliteration for use in the assessment of the efficacy of endoscopic treatment with Histoacryl.

CONCLUSIONS: Miniprobe sonography was found to be significantly superior to conventional macroscopic diagnosis in both the detection of fundic varices and the evaluation of the efficacy of endoscopic therapy. Moreover, MPS could play an important role in follow up and in evaluation of the need for further treatment. Therefore, MPS appears to be a safe and very useful clinical technique in evaluating patients with portal hypertension with respect to the detection of fundic varices and may help in selecting patients for appropriate therapy.
Beneficial effects of growth hormone on bacterial translocation during the course of acute necrotizing pancreatitis in rats
Authors: Xingpeng Wang , Bingxian Wang , Jianxin Wu , Guoliang Wang
Published: March 2003

OBJECTIVE: Because bacterial translocation from the gut is one of the important sources of bacterial infection in acute necrotizing pancreatitis (ANP), and growth hormone (GH) has the ability to promote intestinal epithelial proliferation, we investigated the effects of GH on bacterial translocation in a rat ANP model.

METHODS: Acute necrotizing pancreatitis was induced in rats via injection of 5% sodium taurocholate into the biliopancreatic duct. The rats with ANP were treated with either human recombinant GH or a placebo. Laparotomized animals without ANP induction (sham operation) served as controls. Twenty‐four hours after the operation, blood was drawn for bacterial culture and determinations of amylase, lipase and endotoxin. Peritoneal fluid and specimens of mesenteric lymph nodes (MLN), liver, pancreas and spleen were taken for bacterial culture by standard techniques. Intestinal mucosal permeability was assessed by measuring the movement of [125I]‐labeled albumin from blood to the intestinal lumen. Insulin‐like growth factor‐1 (IGF‐1) mRNA was detected in the liver and ileum by reverse transcription–polymerase chain reaction (RT‐PCR). Morphological changes in the pancreas and ileum were also analyzed.

RESULTS: Administration of GH significantly decreased the activity of serum amylase and lipase, decreased the plasma endotoxin level and reduced the incidence of bacterial translocation. Moreover, the survival rate of ANP rats was improved. The severity of inflammation in the pancreas and ileum was reduced by GH treatment. Ileal mucosal thickness, villus height and crypt depth in GH‐treated rats were obviously increased as compared with those of ANP rats. The intestinal permeability was markedly decreased in the GH group as compared with the ANP group. GH treatment resulted in upregulation of IGF‐1 mRNA expression in ileum, but not in liver.

CONCLUSIONS: These results suggest that exogenous GH has beneficial effects in maintaining the integrity of the intestinal mucosal barrier and reducing the incidence of bacterial translocation in rats with ANP. One of the mechanisms might be the upregulation of IGF‐1 mRNA in the intestine by GH.
Screening of gastric cancer cell sublines using the adhesion method
Authors: Chen Xiangrong , Ren Weiping , Dong Jufang , Xiao Shudong , Sloane Bonnie F.
Published: March 2003

OBJECTIVE: To screen subpopulations of gastric cancer cell lines with different malignant phenotypes.

METHODS: Two subpopulations from the human gastric cancer cell line MKN‐45 were separated by using the laminin adhesion method. One subpopulation was less invasive and non‐metastatic, whereas the other was more invasive and metastatic. The relative invasiveness and migratory capacities of the two subgroups were observed by using the Boyden chamber and by inoculating the cells into nude mice.

RESULTS: The two subgroups, the laminin‐adherent cells (Lm+) and the laminin non‐adherent cells (Lm–), were separated. During in vitro experiments, the Lm+ cells were more invasive and their migratory ability was greater relative to the Lm– cells. The rates of tumor formation after subcutaneous inoculation in nude mice and of lung tumor foci formation after tail vein inoculation were higher in Lm+ cells than those in Lm– cells. In vivo, Lm+ cells were found to have higher metastatic potential and to be more invasive.

CONCLUSIONS: In vitro, the adhesion method is a simple and time‐saving way to screen a particular phenotypic cell subpopulation with a high success rate. There are discrepancies in invasiveness and migratory ability between in vitro Lm+ and Lm– cells, which suggests that these properties of gastric cancer cells are closely related to their adhesiveness to the basement membrane and extracellular matrix.
Effect of vitamin E and selenium on the tissue inhibitor of metalloproteinase‐1 mRNA expression in hepatic stellate cells
Authors: Li Xuanhai , Wang Yuqin , Cheng Wufeng , Wang Danyi , Li Feng
Published: March 2003

OBJECTIVE: To investigate the effects of vitamin E and different doses of selenium on the expression of the tissue inhibitor of metalloproteinase‐1 (TIMP‐1) mRNA in the hepatic stellate cells (HSC) of CCl4‐induced hepato‐fibrotic rats. The mechanism of these therapeutic actions is investigated at a molecular level.

METHODS: Hepatic fibroses were induced by intraperitoneal injection of 40% CCl4 in olive oil and treated by dietary supplementation with vitamin E and different doses of selenium. Liver tissue sections were stained with routine hematoxylin and eosin staining and Masson trichrome staining for collagen. With β‐actin as an internal control, the reverse transcriptase–polymerase chain reaction (RT‐PCR) method was applied to quantify the change of TIMP‐1 mRNA in HSC.

RESULTS: The expression level of TIMP‐1 mRNA in HSC was significantly downregulated and collagenous fiber proliferation in the liver was also significantly reduced in the groups of rats treated with vitamin E (250 mg/kg) and low dosages of selenium (0.2 mg/kg). However, the expression of TIMP‐1 mRNA was upregulated, but not significantly, in the group treated with high dosages of selenium (1.0 mg/kg).

CONCLUSIONS: The expression level of TIMP‐1 mRNA in HSC was significantly downregulated and collagenous fiber proliferation in the liver was significantly reduced in the groups of rats treated with vitamin E and appropriate dosages of selenium. This did not occur in groups with high dosages of selenium.
Establishment of a trinitrobenzene sulfonic acid‐induced rat colitis model
Authors: WANG Hao , OUYANG Qin , HU Ren Wei
Published: March 2003

OBJECTIVE: To set up a trinitrobenzene sulfonic acid (TNBS)‐induced colitis model in the rat and to assess its value in research studies of inflammatory bowel disease (IBD).

METHODS: A 0.85‐mL enema containing 30 mg TNBS dissolved in 50% ethanol was instilled into the rat colon to induce distal colitis. Control rats were instilled with 50% ethanol or TNBS/saline alone. Macroscopic histological changes of the colon and myeloperoxidase (MPO) activity of the mucosa were evaluated.

RESULTS: One week after the TNBS/ethanol enema, hyperemia, edema and ulceration of the colonic mucosa appeared with predominant infiltration of polymorphonuclear leukocytes in the distal colon. Four weeks after TNBS/ethanol enema, ulcers had healed macroscopically and lymphocytes and plasma cells became predominant. The tissue MPO activity increased on the first day after the TNBS/ethanol enema and this increase in MPO activity lasted for 3 weeks, but declined 4 weeks after the TNBS/ethanol enema. In contrast, macroscopic, histological changes and MPO activity returned to normal levels in control rats within the first week.

CONCLUSIONS: Trinitrobenzene sulfonic acid/ ethanol‐induced rat distal colitis is an ideal model of IBD and may serve as a tool for the investigation of the pathogenesis of and effects of pharmaceuticals on IBD.
Transcription of interleukin‐8 in gastric epithelial cells by Helicobacter pylori isolated from Chinese patients
Authors: LI Shu De , XU Guo Ming , LI Zhao Shen , JI Xu Huai , CRABTREE JE
Published: March 2003

OBJECTIVE:  To observe the effect of the vacA genotype and the cag pathogenicity island (cag PAI) of Helicobacter pylori isolated from Chinese patients on the transcription of interleukin‐8 (IL‐8) in gastric epithelial cells.

METHODS:  The vacA genotype and the existence of the cag PAI in strains of H. pylori were determined by gene sequencing and Southern blotting, respectively. L5F11 gastric epithelial cells carrying the IL‐8 report gene were cocultured with the bacteria; transcription of IL‐8 was indicated by luciferase activity and cytotoxin activity was detected by using a HeLa cell vacuolating assay.

RESULTS:  Strains with a complete cag PAI (n
= 15) were able to induce luciferase transcription to a greater extent than the wild‐type cag‐negative strain G50[(0.47 ± 0.09) × 106 c.p.m. vs (0.13 ± 0.02) × 106 c.p.m.; P < 0.01]. There was no difference in the luciferase activity induced by strains with partial cag (n
= 4) and by G50[(0.23 ± 0.08) × 106 c.p.m. vs (0.13 ± 0.02) × 106 c.p.m.; P > 0.05)]. No difference was found in the luciferase activity induced by the strains with vacA s1/m1 (n
= 5) and the strains with s1/m2 (n
= 14) [(0.29 ± 0.12) × 106 c..p.m. vs (0.53 ± 0.41) × 106 c.p.m.; P > 0.05] although the former had much higher vacuolating cytotoxin activity than the latter (P < 0.001).

CONCLUSION:  The transcription of IL‐8 in gastric epithelial cells induced by H. pylori isolated from Chinese patients is associated with the existence of cag PAI and not with the vacA genotype.
Inhibitory effects of aspirin and indometacin on the growth of Helicobacter pylori in vitro
Authors: WANG Wei Hong , HU Fu Lian , CY WONG Benjamin , BERG Douglas E , LAM Shiu‐Kum
Published: March 2003

OBJECTIVE:  The interactions between non‐steroidal anti‐inflammatory drugs and Helicobacter pylori have not been sufficiently documented to date. The aim of this study was to investigate the possible effects of aspirin and indometacin on the growth of H. pylori and to determine the effects of aspirin on the susceptibility of H. pylori to some antimicrobials.

METHODS:  Kinetic studies were performed by inoculating strains of H. pylori in brucella broth with different concentrations of aspirin and indometacin. Growth of bacteria in the broth was assessed spectrophotometrically and by viable colony counts after incubation for 24 and 48 h. Bacterial morphology was determined by Gram stain under light microscopy. The minimal inhibitory concentration (MIC) of aspirin and indometacin was determined by the standard agar dilution method. The MIC of amoxicillin, clarithromycin and metronidazole was measured in the presence and absence of aspirin by the E‐test method.

RESULTS:  Kinetic studies revealed that aspirin and indometacin inhibited the growth of H. pylori in a dose‐dependent manner. The bactericidal activity of these agents was expressed by cell lysis. Aspirin at 400 µg/mL produced an almost 2‐log decrease in the number of CFU/mL at 48 h. Similar inhibitory effects were obtained when 100 µg/mL indometacin was tested. The MIC at which 90% of H. pylori was inhibited was 512 µg/mL and 128 µg/mL for aspirin and indometacin, respectively. Increased susceptibility of H. pylori to amoxicillin, clarithromycin and metro­nidazole was found in the presence of aspirin.

CONCLUSIONS:  Aspirin and indometacin could significantly inhibit the growth of H. pylori when incubated in brucella broth in vitro. A subinhibitory concentration of aspirin enhanced the susceptibility of H. pylori to some antimicrobial agents.
Towards an Australian institute of trauma research: learning the lessons of history
Authors: Wigglesworth AM Eric C.
Published: March 2003

Although medical research in Australia in the 20th century has resulted in a reduction of approximately 95% in the death rate from the infectious and parasitic diseases, there has been no such beneficial outcome in road traffic accidents which, it is here suggested, were out of control from 1948 until 1970. In 1970 several concerned community groups (spearheaded by the Royal ­Australasian College of Surgeons) campaigned for the introduction of mandatory seat belt wearing. As a consequence of that initiative, and the virtual plethora of subsequent research activities, the road traffic accident rate has declined substantially in the last three decades. The death rate from drownings to toddlers (children under 5) was essentially unchanged until the 1970s when research into toddler pool deaths and the implementation of those research findings resulted in a downturn in toddler drownings in the last two decades. These two examples demonstrate the value of accident research and the implementation of research findings. By analogy with the contributions of the large medical research institutes, the creation of an Australian Institute of Trauma Research seems desirable and is here proposed.
Pyogenic liver abscess complicated by endogenous endophthalmitis
Authors: Tan Yu‐Meng , Chong Chee K. , Chow Pierce K. H.
Published: March 2003

Background:  Endogenous endophthalmitis is an inflammation of ocular tissues that can lead to deterioration of and loss of vision. Rarely, this can complicate the course of a patient with pyogenic liver abscess.

Methods:  Over an 18‐month period, 68 patients were treated for pyogenic liver abscesses. Three patients, all of whom were male and with diabetes, were diagnosed with a Klebsiella pneumoniae liver abscess complicated by endogenous endophthalmitis. Open surgical or percutaneous drainage of the liver abscess was undertaken and the symptomology and outcome of the endophthalmitis reviewed.

Results:  There was no mortality in our series. Two patients presented with simultaneous abdominal and ocular symptoms and one patient had ocular symptoms 3 days after surgical drainage of the liver abscess. Despite aggressive treatment, all patients had permanent deterioration of visual function with one patient becoming blind and requiring evisceration of the infected eye.

Conclusion:  Ocular symptoms in patients treated for pyogenic abscesses must be dealt with urgently with an ophthalmologic consultation. Increased awareness of this complication and a high index of suspicion are paramount for salvage of visual function.
Training general practitioners in flexible sigmoidoscopy to screen for colorectal cancer
Authors: Martin Jenepher A. , Crotty Brendan , Barbaro Dominic , Higlett Tracey , Zalcberg John
Published: March 2003

Background:  A screening programme to detect polyps or early carcinoma would significantly reduce the mortality and morbidity of colorectal cancer (CRC). The aims of the present study were to evaluate: (i) the feasibility of training general practitioners in flexible sigmoidoscopy (FS) for CRC screening; (ii) the acceptability of screening by faecal occult blood testing (FOBT) and FS in asymptomatic standard risk Australians aged over 50 years; and (iii) the yield of such screening.

Methods:  Subjects were recruited by general practitioner (GP) referral, newspaper advertisement or by a direct approach to retirement villages. Participants were mailed a FOBT kit and a prescreening questionnaire. Flexible sigmoidoscopy was performed by a GP supervised by an experienced endoscopist. Subjects then completed a second questionnaire. General practitioners were assessed after 50 unassisted procedures.

Results:  A total of 264 individuals contacted the study coordinator; 169 were screened. Screening was accepted well by the participants. Fifteen per cent of subjects had polyps and 4% had a positive FOBT. Training in FS was adversely affected by the availability of resources. Three GPs completed 50 unassisted procedures over a 15‐month period, but none were able to reliably assess the distal bowel.

Conclusions:  Although the three trainees and their supervisors did not consider that the GPs were adequately trained after 50 unassisted procedures, training was adversely affected by limited resources within the Victorian public hospital system. Screening by FOBT and FS was considered to be acceptable by the patients undergoing these procedures. Existing facilities are not adequate if GPs are to be trained in FS as part of a national CRC screening program.
Predicted impact on Victoria's ambulance services of a new major trauma system
Authors: Peeters Anna , Smith Karen , Cameron Peter , McNeil John
Published: March 2003

Background:   In 1999, a new major trauma system was proposed for the state of Victoria, Australia. The guidelines for the new system were aimed at delivering major trauma cases to definitive trauma care in the least time possible. The aim of the present study was to analyse the potential effect of this system on Victoria’s ambulance services.

Methods:  The present study modelled the workload of major trauma cases in Victoria’s ambulance service for one year pre‐ and post‐introduction of the guidelines. Cases were analysed regarding whether their first hospital destination would change under the proposed guidelines, and, subsequently, whether they would require interhospital transport to a higher level trauma service. The impact on the ambulance services was modelled as annual changes in distances travelled due to predicted changes in hospital destinations.

Results:  Analysis of the predicted changes indicated that, in general, Victoria"s metropolitan and rural road ambulance crews would not be greatly affected. However, some metropolitan road crews may have to travel extra distances for up to 110 cases per year. The major impact was on air retrieval crews, where the annual number of interhospital transfers is predicted to increase from approximately 150 to 330.

Conclusions:  The present study demonstrated that most of the impact of a new trauma system on Victoria"s ambulance services could be readily absorbed into the current workload. However, it also highlighted areas affected disproportionately within the ambulance services; in particular, air retrieval. Such studies are important to enable the effective implementation of new trauma systems.