bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterization of women with a history of recurrent vulvovaginal candidosis
Authors: Novikova Natalia , Mårdh Per‐Anders
Published: March 2003

Background.  To characterize history, signs, and symptoms in women with a history of recurrent vulvovaginal candidosis (RVVC) and who had consulted with symptoms generally associated with the condition.

Methods.  Eighty‐three women with a history consistent with RVVC were interviewed regarding 32 parameters and 10 signs found at the clinical examination were noted. Candida cultures were made from the introitus and the posterior vaginal fornix.

Results.  Only in a few of the 43 women with and the 40 without a positive yeast culture could any of the many etiological factors that have been associated with RVVC be traced. Only two factors differed between the groups, namely yogurt intake, which was reported by 28 (68%) and 38 (95%) women in these groups, respectively. Vaginal douching was performed by 10 (23%) women in the Candida‐positive group and by 17 (42%) women in the Candida‐negative group. Pruritis and burning occurred in 31 (72%) and 22 (51%) of culture‐positive patients, which was less frequent than in the culture‐negative group, i.e. reported by 19 (47%) and 9 (22%) patients, respectively (p= 0.022 and p= 0.007). Edema (p= 0.026) of the vulva as well as erythema (p= 0.019) and edema (p= 0.008) of the vaginal mucosa, caseous discharge (p= 0.016), were found more often in the Candida culture‐positive cases.

Conclusions.  History and results of clinical examination of patients with RVVC are not enough to distinguish those who are culture‐positive from those who are culture‐negative for Candida from the genital tract.
Twin pregnancy outcome and chorionicity
Authors: Baghdadi Sabah , Gee Harold , Whittle Martin J. , Khan Khalid S.
Published: March 2003

Acta Obstet Gynecol Scand 2003; 82: 18–21. © Acta Obstet Gynecol Scand 2003

Background.  Based on research of relatively poor quality, it is generally believed that dichorionic twins have lower perinatal mortality than monochorionic twins. We assessed the relationship between the pattern of perinatal loss in twin pregnancy and chorionicity.

Methods.  A cohort study of 238 consecutive sets of twin pregnancies registered in our antenatal service over a 2‐year period (1996–98) had chorionicity determined by ultrasound at 12–16 weeks' gestation. Follow up included scanning at 20 weeks' gestation for anomaly, and at 2–3‐weekly intervals from 24 weeks' gestation onwards for growth and well being. Hazard ratios were computed for comparing the risk of death according to chorionicity. The perinatal loss patterns were analyzed according to gestational age at demize and that at delivery using survival analysis.

Results.  Overall, 17/238 (7.1%) twin pregnancies suffered mortality: 14/190 (7.3%) amongst the dichorionic and 3/48 (6.2%) amongst the monochorionic twins. The hazard ratio for mortality was 0.89 (95% confidence interval 0.27–2.97, p = 0.85), considering gestational age at demize as the outcome. For gestational age at delivery as the outcome, the hazard ratio for mortality was 0.93 (95% confidence interval 0.27–3.15, p = 0.91). Survival analysis showed that amongst the dichorionic twins the hazard of death continued to rise throughout gestation. In contrast, the hazard of death for the monochorionic twins rose gradually to a maximum at 28 weeks' gestation and was then constant.

Conclusion.  Chorionicity did not affect the overall fetal loss rate amongst the twin pregnancies in our setting. There were differences in patterns of loss according to chorionicity, which require further investigation.
Relationship between polycystic ovaries, body mass index and insulin resistance
Authors: Cresswell Janet , Fraser Robert B. , Bruce Christine , Egger Peter , Phillips David , Barker David J. P.
Published: March 2003

Acta Obstet Gynecol Scand 2003; 82: 61–64. © Acta Obstet Gynecol Scand 2003

Background. To investigate insulin levels in lean and overweight women with and without polycystic ovaries. An observational, cross‐sectional study at The Northem General Hospital, Sheffield, UK.

Methods. Sixty‐eight women born at Jessop Hospital, Sheffield, between 1952 and 1953 were divided into four groups according to the status of their polycystic ovaries and body mass index: either > or ∼ 25. Therefore, this was an unselected sample, unlike previous studies that have recruited from endocrine clinics or similar. Subjects underwent pelvic ultrasonography to visualize their ovaries in order to diagnose or exclude polycystic ovaries. They all underwent a short insulin tolerance test.

Results. Women with a body mass index > 25 and with polycystic ovaries were the most insulin resistant. Women with a body mass index of ≤?25 and with normal ovaries were the most insulin sensitive. Women with a body mass index ≤?25 and polycystic ovaries were the more resistant than those with a body mass index > 25 and with normal ovaries.

Conclusion. Obesity increases insulin resistance, and the presence of polycystic ovaries increases insulin resistance. The presence of polycystic ovaries appears to have a stronger influence than obesity on insulin resistance. This is the first study to demonstrate these relationships using unselected volunteers.
Laser acupuncture and low‐calorie diet during visceral obesity therapy after menopause
Authors: Wozniak Piotr , Stachowiak Grzegorz , PiÊta‐DoliÑska Agnieszka , Oszukowski Przemyslaw
Published: March 2003

Acta Obstet Gynecol Scand 2003; 82: 69–73. © Acta Obstet Gynecol Scand 2003

Background.  To compare the efficiency of low‐calorie diet and low‐calorie diet applied together with laser acupuncture in the therapy of visceral obesity in postmenopausal women.

Methods.  The study population consisted of 74 postmenopausal females with visceral obesity who were divided into two groups according to an employed 6‐month slimming procedure. In the first group (n = 36) a low‐calorie diet was applied, while women in the second group (n = 38) were on the same kind of diet, having additionally one cycle of laser acupuncture procedure at the same time. At baseline and at the end of the study, body weight, body mass index and waist‐to‐hip ratio were determined in all women.

Results.  After 6 trial months both groups exhibited a statistically significant drop in body weight, body mass index and waist‐to‐hip ratio. The mean reduction of body weight, body mass index and waist‐to‐hip ratio was significantly higher in the second group of women (laser acupuncture plus low‐calorie diet).

Conclusions.  (1) Our results testify that the combination of a low‐calorie diet and laser acupuncture is characterized by a higher efficacy than a low‐calorie diet alone in lowering body weight, body mass index and waist‐to‐hip‐ratio. (2) Laser acupuncture is an additional useful healing method in the therapy of visceral postmenopausal obesity.
A comparison between one‐ and two‐field 60° fundus photography when screening for diabetic retinopathy
Authors: Von Wendt Gunvor , Rönnholm Petri , Heikkilä Kauko , Summanen Paula
Published: March 2003

Purpose: To compare the severity level of diabetic retinopathy obtained when assessed from two versus only one 60° photographic field using colour transparencies and red‐free, black‐and‐white photographs. To compare the areal coverage of these two photographic strategies to that of seven‐field 30° photography.

Methods: Two ophthalmologists graded photographs of 74 eyes of 74 type I and II diabetes patients. Inter‐method agreement was expressed in percentages and using kappa statistics and scatter‐diagrams. The comparison of the approximate photographic areal coverage was done from diagrams using planimetry.

Results: The severity level of retinopathy when judged from two photographic fields was more severe in 13.5% (Grader 1) and in 16.2% (Grader 2) from colour transparencies and in 13.5% (Grader 1) and in 14.9% (Grader 2) from red‐free black‐and‐white prints, as compared to assessments from only one field. Kappa values (0.84–0.86) for inter‐method agreement for five pooled retinopathy levels revealed good agreement. Neither grader missed retinopathy requiring clinical assessment or treatment (levels ≥47) when minimal retinopathy (levels 14–20) was detected using only one 60° colour slide or red‐free photograph. A second optic disc‐centred field provided valuable additional information when more severe retinopathy lesions (levels ≥30) were detected in the macula‐centred field. One macula‐centred 60° photograph covered 60% and two 60° photographs 80% of the area covered by seven‐field 30° photography. Two‐field 60° photography covers areas left outside seven‐field 30° photography.

Conclusion: We propose the use of one macula‐centred 60° photograph when screening for the first lesions of diabetic retinopathy. After they have been found two‐field 60° photography is recommended.
Spotting of disc haemorrhages on fundus pictures; on Kodachrome slides and on digitally enhanced images
Authors: Holm O. , Krakau C. E. T.
Published: March 2003

Purpose: To find out whether digital processing can facilitate interpretation of fundus photographs.

Methods: Digitised fundus pictures were manipulated and enhanced by a process called histogram equalisation. Essentially, the gamma values for red (R), green (G), and blue (B) were separately modified. The principle is explained and exemplified.

Material and Results: Small disc haemorrhages, which may normally be hard to detect, became more visible after histogram equalisation, which is demonstrated in test series.

Conclusion: Digital histogram equalisation offers a new way of looking at fundus pictures, which, alone or combined with other capabilities of digital processing, has great potential for diagnosis, as well as for follow up studies. The possibility to decide the true nature of suspect spots after applying the enhancement procedure is likewise of great value.
Prolonged persistence on the ocular surface of fortified gentamicin ointment as compared to fortified gentamicin eye drops
Authors: Lomholt Jeanet Andersen , Møller Jens Kjølseth , Ehlers Niels
Published: March 2003

Purpose: A comparative study on the elimination of gentamicin from the ocular surface and the concentration of gentamicin in the anterior chamber following application of either an ointment or eye drops containing equal concentrations (1.5%) of gentamicin.

Methods: A disc‐diffusion test was used to determine the concentration of gentamicin in fornix inferior of 10 persons. The anterior chamber concentration of gentamicin was determined in 5 cataract patients by the TDX analyzer, Abbot Laboratories, Il., USA.

Results: Ten minutes following application, the concentration of gentamicin was significantly higher in the eyes receiving ointment (310.6 mg/L) compared to drops (45 mg/L) (p<0.01).

Furthermore, gentamicin could be detected 40 minutes after application in the eyes receiving ointment compared to 10 minutes in the eyes receiving drops. The anterior chamber concentration of gentamicin after application of either drops or ointment was lower than 0.6 mg/L and thus below detection limit.

Conclusions: The persistance of gentamicin ointment was significantly longer on the ocular surface as compared to gentamicin eye drops. Gentamycin ointment may thus provide a means to reduce the high application frequency presently in use with eye drops to treat bacterial keratitis and thereby reduce patient inconvenience, especially during nighttime.
Short‐term effect of latanoprost and timolol eye drops on tear fluid and the ocular surface in patients with primary open‐angle glaucoma and ocular hypertension
Authors: Thygesen J. , Aaen K. , Theodorsen F. , Kessing S. V. , Prause J. U.
Published: March 2003

Purpose: To investigate and compare the short term effects of topical latanoprost and timolol on the tear fluid and ocular surface condition in patients with bilateral primary open angle glaucoma or ocular hypertension.

Methods: Thirty‐seven patients were included in this randomized, double‐masked, parallel group study. Patients received either latanoprost 0.005% (n=18) or timolol 0.5% (n=19) instilled once daily in the morning for a treatment period of 27 days. Routine ophthalmic examinations, including intraocular pressure measurement, as well as tests to evaluate tear fluid and the ocular surface were performed.

Results: After one drop of medication, tear secretion was significantly reduced by timolol, but not by latanoprost. At the end of the study the break‐up time (BUT) was significantly decreased in the timolol group but not in the latanoprost group. The BUT still remained in the normal range in both groups, although it is important to note that timolol was administered at half the clinical dose. Both latanoprost and timolol tended to increase Rose‐Bengal staining of the cornea and conjunctiva after one month of treatment but no statistically significant difference was found between the groups. Corneal sensitivity was within the normal range for all patients during the study.

Conclusion: Regarding ocular surface effects, no clinically important differences between latanoprost and timolol were observed as all the effects remained in the normal range.
Comparison of endothelial cell density estimated by contact and non‐contact specular microscopy
Authors: Isager Peter , Hjortdal Jesper Ø. , Guo Suping , Ehlers Niels
Published: March 2003

Purpose: To compare a contact and a non‐contact specular microscope in the determination of endothelial cell density.

Subjects and methods: One hundred and twenty‐one eyes from 70 patients who had undergone various degrees of photorefractive keratectomy for myopia were included. The endothelium was imaged by contact (Konan Clinical Specular Microscope) and non‐contact (Topcon SP‐1000) specular microscopy and the endothelial cell density estimated.

Results: The average endothelial cell density achieved by the contact specular microscope was 3011±298 cells/mm
2 (mean±SD, n=121) and by the non‐contact specular microscope 3015±265 cells/mm
2 (n=121). The difference in endothelial cell density between the contact and the non‐contact specular microscope (contact minus non‐contact) was −4±175 cells/mm2 (t=0.26, 2p>0.05 in a paired t‐test). The sampling error on the estimated endothelial cell density was 76 cells/mm2 for the contact specular microscope and 74 cells/mm2 for the non‐contact specular microscope.

Conclusion: The average endothelial cell density and the precision of the measuring technique were similar for the contact and the non‐contact specular microscope. Furthermore, the endothelial cell densities estimated by the two instruments at various values of anterior central corneal refractive power and central corneal thickness were similar. The two instruments can be used interchangeably.
Vogt‐Koyanagi‐Harada syndrome in a pregnant patient treated with high‐dose systemic corticosteroids
Authors: Doi Motoaki , Matsubara Hisashi , Uji Yukitaka
Published: March 2003

Purpose: Vogt‐Koyanagi‐Harada (VKH) syndrome is usually treated with high‐dose systemic corticosteroids. However, in a pregnant patient with VKH syndrome, the effects of high‐dose corticosteroids on the fetus are controversial. We discuss treating VKH syndrome during pregnancy, systemic corticosteroids, and abnormalities in the delivered infant.

Methods: Case report and literature review.

Results: A 26‐year‐old Japanese woman in the 16th week of gestation was diagnosed with VKH syndrome and treated with high‐dose systemic prednisolone after the 18th week of gestation. Although the patient's ocular findings gradually improved, a low‐birth‐weight infant was delivered with epibulbar dermoid, lipodermoids, and preauricular appendages. Although low birth weight might result from systemic prednisolone administration, the anomalies of the infant may have been inherited rather than caused by VKH syndrome and high‐dose systemic corticosteroid administration.

Conclusion: In this case and previously reported cases, VKH syndrome and systemic corticosteroids administered during pregnancy may not precipitate abortion and congenital malformation.
Malignant changes in a giant orbital keratoacanthoma developing over 25 years
Authors: Alyahya Ghassan A. , Heegaard Steffen , Prause Jan Ulrik
Published: March 2003

Purpose: To report a patient with a history over 25 years of a slowly growing, large, invasive crateriform tumour filling the anterior part of the orbit.

Methods: A 61‐year‐old male presented with a large tumour of the left orbit. Exenteration was performed with subsequent histological analysis of the excised mass.

Results: The main tumour showed the characteristic features of a keratoacanthoma. However, the posterior aspect of the tumour disclosed the morphology of a squamous cell carcinoma. Six months later, the patient presented with metastases to lymph nodes, lung and mediastinal tissue. A leukemoid reaction was diagnosed by fine needle biopsy.

Conclusion: The giant variety of keratoacanthoma may fail to regress and can transform into a squamous cell carcinoma. In our patient, the development of a chronic lymphoid leukemia raises the possibility that it may be the underlying cause for the transformation of the posterior part of the keratoacanthoma into a frank squamous cell carcinoma.
Retinopathy of prematurity, a decrease in frequency and severity. Trends over 16 years in a Danish county
Authors: Fledelius Hans C. , Dahl Helena
Published: March 2003

Purpose: To analyse the trends over 16 years (1982–97) in a Danish county regarding the clinical appearance of retinopathy of prematurity (ROP).

Methods: The data for birth years 1993–97 regarding the regular ophthalmic surveillance for ROP in the region have been analysed. With gestational age (GA) 32 weeks and/or a birthweight (BW) 1750 g as attempted screening limits a total of 177 premature infants were surveyed. Comparison was made with studies of a similar set‐up from the preceding four 3‐year periods comprising a total of 814 subjects.

Results: The number of survivors regarded at a higher risk of developing ROP (GA and BW both <32 weeks/1750 g, n=478) showed an even increase over the five investigation periods. The ROP frequency, however, fell from a level of 39% to 10%, there were fewer with severe sequels to ROP, and the children surveyed ‘above limits’ eventually avoided ROP.

Conclusions: Using the ROP profile as a yardstick for the quality of the neonatal service given to the most immature newborns over the period 1982–97, the risk limits regarding GA and BW have gone down. More and more of the heavier preterm babies now escape ROP. A significant decrease in frequency of ROP in the more immature groups has been observed, and fewer cases have progressed to visual impairment.
Choroideremia associated with subretinal neovascular membrane
Authors: Endo Keiko , Yuzawa Mitsuko , Ohba Norio
Published: March 2003

Purpose: To report two Japanese patients with choroideremia, one male and one heterozygous female, who developed subretinal neovascular membrane and/or subretinal fibrosis in the intermediate stage of the disease, and, in addition, to describe marked clinical manifestation in a heterozygous carrier female.

Method: Two patients were examined by slip‐lamp biomicroscopy, ophthalmoscopy and other ophthalmoloscopic examinations.

Results: Two cases showed moderately advanced ophthalmoscopic and functional abnormalitities compatible with choroideremia, and in addition, subretinal lesion in the fovea and/or midperiphery.

Conclusion: The intermediate stage of choroideremia may occasionally be complicated with choroidal neovascular membrane in the fovea, the midperiphery, or both, which resolves spontaneously and results in subretinal fibrous scarring. The occurrence of this complication in the fovea leads to episodic central visual loss, while midperipheral lesion may remain unrecognized.
Ocular findings in Fryns syndrome
Authors: Cursiefen Claus , Schlötzer‐Schrehardt Ursula , Holbach Leonard M. , Vieth Michael , Kuchelmeister Klaus , Stolte Manfred
Published: March 2003

Purpose: To demonstrate the ocular histopathologic findings in Fryns syndrome, a multiple congenital anomaly syndrome, with characteristic features including Dandy‐Walker malformation, cleft palate, diaphragmatic hernia, lung hypoplasia, distal limb anomalies and polyhydramnios. The prevalence is about 0.7 per 10,000 births. Reported ocular features include microphthalmus, “cloudy cornea”, irregularities of Bowman's layer, thickened posterior lens capsule and retinal dysplasia.

Methods: Case report. The ocular histopathologic and ultrastructural findings in a male fetus with Fryns syndrome who died immediately after his birth at 26th week of gestation are shown.

Results: An abnormal Descemet's membrane was found in addition to “cloudy corneae”. Electron microscopy demonstrated absence of the banded collagen fibrils in Descemet's membrane, indicating corneal endothelial dysfunction. Otherwise, the eye was morphologically normal for its age; none of the other reported ocular features of Fryns syndrome were found.

Conclusion: Corneal endothelial dysfunction might cause abnormal composition of anterior Descemet's membrane and could contribute to the “cloudy cornea” known to occur in Fryns syndrome.
Safety and Efficacy Comparison of Emedastine 0.05% Ophthalmic Solution Compared to Levocabastine 0.05% Ophthalmic Suspension in Pediatric Subjects with Allergic Conjunctivitis
Authors: Secchi A. , Ciprandi G. , Leonardi A. , Deschenes J. , Abelson M. B. ,   the Emadine Study Group
Published: March 2003

Purpose: To determine the efficacy and tolerance of emedastine 0.05% ophthalmic solution compared to levocabastine 0.05% ophthalmic suspension in pediatric subjects.

Methods and Materials: In a randomized, double‐masked, parallel controlled study, emedastine 0.05% ophthalmic solution BID was compared to levocabastine 0.05% ophthalmic suspension BID, for control of the signs and symptoms of allergic conjunctivitis in pediatric subjects ages 3–16. Subjects who met all inclusion and exclusion criteria received masked study medication with instructions to instill drops twice daily, in the morning and evening. A diary was completed by the parents four times daily for the first two and last two weeks of the study. Treatment lasted 42 days. Drug efficacy was assessed at the initial administration in the office at Day 0 and after 3, 7, 14, 30 and 42 days.

Results: Overall results showed both drugs have an effect and that emedastine was significantly superior (p<0.05) to levocabastine for the relief of chemosis on Days 14, 30 and 42; of itching on follow‐up Days 30 and 42 (p<0.05); of redness on Days 30 and 42; for eyelid swelling on Days 14 and 30; and for physician's impression score on Days 7, 14, 30 and 42.

Conclusion: These results confirm previous preclinical and clinical data on the potent and long acting efficacy of this promising new ophthalmic anti‐allergic drug, emedastine in pediatric subjects.
Ocular Allergies: Association with Immune Dermatitis
Authors: Calonge Margarita
Published: March 2003

Purpose: To describe the type of skin involvement that patients with ocular allergies are prone to suffer due to the atopic association of the condition.

Methods: Review of the published literature and retrospective data from our patient series.

Results: Patients with ocular allergies may have skin affected with one or several combinations of the following dermatologic problems: contact dermatitis, urticaria/angioedema, and atopic dermatitis, with secondary infections as a possible consequence of this later disorder. Other rare skin disorders have been occasionally reported in association with ocular atopy.

Conclusion: Patients with ocular allergies may have a spectrum of ‘allergic’ skin problems, the most severe of which is atopic dermatitis. Ocular surface involvement in atopic dermatitis should be diagnosed as atopic keratoconjunctivitis, a sight‐threatening disorder, until proven otherwise.
Angiolymphoid hyperplasia with eosinophilia should not be confused with Kimura’s disease
Authors: Seregard Stefan
Published: March 2003

ABSTRACT. Purpose: To emphasize the differences between angiolymphoid hyperplasia with eosinophilia (ALHE) and Kimura’s disease (KD), two entities often confused in the ophthalmic literature.

Methods: Case report of a subcutaneous mass in the periocular region of a 45‐year old woman and a MEDLINE review of the ophthalmic and non‐ophthalmic literature on ALHE and KD.

Results: The clinical and histopathological findings of the present case were consistent with ALHE, but not with KD. A survey of the current ophthalmic literature indicates that these two designations are still often used synonymously, despite that non‐ophthalmic papers now separate ALHE from KD.

Conclusion: The clinical and histopathological features of ALHE are most often distinctly different from KD and these entities should be clearly separated in the ophthalmic literature.
Anthrax as the cause of preseptal cellulitis and cicatricial ectropion
Authors: Soysal Hülya Gökmen , Kıratlı Hayyam , Recep Ömer Faruk
Published: March 2003

ABSTRACT. A 54‐year‐old female farmer with anthrax infection of the eyelids is presented. She was initially managed with high dose intravenous penicillin G treatment. Following complete healing of the eyelid lesions, significant cicatricial ectropion resulted. Her right lower eyelid ectropion was corrected by surgical reconstruction using full thickness skin graft after a period of 6 months during which the cicatrization process stabilized. Satisfactory cosmetic and functional improvement was achieved. Anthrax of the eyelid must be considered in the differential diagnosis of preseptal or orbital cellulitis and any reconstructive procedure should be attempted only after the cessation of the healing process.
A murine cell culture model for post‐trabeculectomy anfibrotic treatment: Induction of apoptosis by Cyclosporin
Authors: Cristofanilli M. , Pescosolido N. , Risuleo G. , Scarsella G.
Published: March 2003

ABSTRACT. Purpose: Experimental trials aimed at the research of selective antifibrotic agents are under development for the alternative treatment of glaucoma patients who are usually considered high‐risk post‐surgical individuals after trabeculectomy. Authors present here an in vitro model system for the treatment of post‐trabeculectomy patients. The study is aimed at the evaluation of different drugs in a mouse fibroblast model.

Methods: The antifibrotic activity of Cyclosporin A, Interferon 2α, 5‐Fluorouracyl was investigated on 3T6 cells in culture. Cell viability and proliferation was assessed after drug treatment. Molecular analysis of DNA degradation was evaluated by means of radioactive labeling and gel electrophoresis.

Results: The three drugs were shown to affect cell proliferation and viability in a differential fashion. However, only Cyclosporin A was able to control cell proliferation, inducing apoptosis. This phenomenon was reduced by supplementation of trolox, a compound known to inhibit programmed cell death. These results strongly suggest that this model system might be useful as a test of pharmacological functionality.

Conclusion: A rapid and efficient model system is described for the assessment of cell viability and proliferation after treatment with agents of potential pharmacological use. Cyclosporin A induces a significant apoptosis. This is important for the negative control of fibrotic degeneration in post‐trabeculectomy that is required for successful surgery in glaucoma patients. Therefore, Cyclosporin A might become a clinically interesting drug for the antifibrotic treatment of post‐trabeculectomy.
Cyclodextrins in eye drop formulations: enhanced topical delivery of corticosteroids to the eye
Authors: Loftsson Thorsteinn , Stefánsson Einar
Published: March 2003

Cyclodextrins are cylindrical oligosaccharides with a lipophilic central cavity and hydrophilic outer surface. They can form water‐soluble complexes with lipophilic drugs, which ‘hide’ in the cavity. Cyclodextrins can be used to form aqueous eye drop solutions with lipophilic drugs, such as steroids and some carbonic anhydrase inhibitors. The cyclodextrins increase the water solubility of the drug, enhance drug absorption into the eye, improve aqueous stability and reduce local irritation.

Cyclodextrins are useful excipients in eye drop formulations of various drugs, including steroids of any kind, carbonic anhydrase inhibitors, pilocarpine, cyclosporins, etc. Their use in ophthalmology has already begun and is likely to expand the selection of drugs available as eye drops.

In this paper we review the properties of cyclodextrins and their application in eye drop formulations, of which their use in the formulation of dexamethasone eye drops is an example. Cyclodextrins have been used to formulate eye drops containing corticosteroids, such as dexamethasone, with levels of concentration and ocular absorption which, according to human and animal studies, are many times those seen with presently available formulations. Cyclodextrin‐based dexamethasone eye drops are well tolerated in the eye and seem to provide a higher degree of bioavailability and clinical efficiency than the steroid eye drop formulations presently available. Such formulations offer the possibility of once per day application of corticosteroid eye drops after eye surgery, and more intensive topical steroid treatment in severe inflammation.

While cyclodextrins have been known for more than a century, their use in ophthalmology is just starting. Cyclodextrins are useful excipients in eye drop formulations for a variety of lipophilic drugs. They will facilitate eye drop formulations for drugs that otherwise might not be available for topical use, while improving absorption and stability and decreasing local irritation.
Outcome of vitrectomy in patients with Terson syndrome
Authors: Ritland Jan Ståle , Syrdalen Per , Eide Nils , Vatne Harald O. , Øvergaard Ralf
Published: March 2003

Purpose:  To report findings and evaluate the results of vitrectomy in 22 eyes with Terson syndrome.

Methods:  We reviewed retrospectively the records of patients who underwent pars plana vitrectomy as a result of vitreous haemorrhage. Twelve cases concerned unilateral vitrectomy and five concerned bilateral vitrectomy. The time interval between intracranial haemorrhage and vitrectomy was 1–10 months (mean 5.9 months).

Results:  During a mean follow‐up of 23.3 months (range 1–69 months) visual acuity (VA) improved in 21 of 22 eyes. Preoperative VA was ≤ 0.1 in 20 of 22 eyes, while postoperative VA was ≥ 0.5 in 16 of 21 eyes. Poor visual outcomes were mainly caused by retinal detachments (seven eyes, in which three were caused by proliferative vitreoretinopathy), epiretinal membranes (seven eyes) and optic atrophy (one eye). Our study concurs with recent reports suggesting early vitrectomy in bilateral cases and in cases where ultrasonography shows epiretinal membrane or proliferative retinopathy formation.
Accidental mydriasis from exposure to Angel's trumpet (Datura suaveolens)
Authors: Havelius Ulf , Åsman Peter
Published: March 2003

Purpose:  To report clinical findings after accidental instillation into the eye of sap from Angel's trumpet (Datura suaveolens).

Methods:  We report findings on seven patients who developed sudden onset of unilateral mydriasis. At least three of them also had ipsilateral cycloplegia and one developed transient tachycardia.

Results:  The symptoms evolved after ocular exposure to sap from Angel's trumpet, a plant containing natural alkaloids with parasympatholytic properties. Six patients were initially unaware of the cause of their symptoms. In these cases, patient history revealed recent contact with Angel's trumpet.

Conclusion:  Accidental ocular instillation of sap from Angel's trumpet should be noted as a cause of sudden onset of mydriasis in otherwise unaffected patients and also of general symptoms like tachycardia.
A comparison of the effects on intraocular pressure of latanoprost 0.005% and the fixed combination of dorzolamide 2% and timolol 0.5% in patients with open‐angle glaucoma
Authors: Honrubia F. M. , Larsson L. I. , Spiegel D. ,   the European Latanoprost Study Group
Published: March 2003

Purpose:  To compare the effects on intraocular pressure (IOP) of latanoprost 0.005% and the fixed combination of dorzolamide 2% and timolol 0.5%.

Methods:  Overall, 226 patients whose IOP was insufficiently controlled by timolol alone were randomized to receive either latanoprost once daily or the fixed combination of dorzolamide plus timolol twice daily. Intraocular pressure was measured at 10 : 00 am and 5 : 00 pm at baseline and after 3 months of treatment.

Results:  Mean IOP was reduced from baseline in both groups (p < 0.001), with a mean ± SEM reduction of − 4.3 ± 0.3 mmHg (19%) for the latanoprost treatment group and − 4.0 ± 0.3 mmHg (17%) for the dorzolamide plus timolol treatment group. The two therapies were similarly effective in lowering IOP levels (mean difference in reduction: − 0.4 ± 0.4; 95% confidence interval: − 1.1, 0.4).

Conclusions:  Monotherapy with latanoprost once daily was as effective in reducing mean IOP as the fixed combination of dorzolamide plus timolol twice daily in patients with IOP insufficiently controlled by timolol alone.
Modified Class II open sandwich restorations: evaluation of interfacial adaptation and influence of different restorative techniques
Authors: Andersson‐Wenckert Ingrid E. , Van Dijken Jan W. V. , Hörstedt Per
Published: March 2003

The sandwich technique with resin‐modified glass ionomer cement (RMGIC) has been proposed to relieve the contraction stresses of direct resin composite (RC) restorations. The aim of this study was to evaluate the interfacial adaptation to enamel and dentin of modified Class II open RMGIC/RC sandwich restorations and the influence of different light curing techniques and matrix bands. Forty box‐shaped Class II fillings were placed in vivo in premolars scheduled for extraction after one month. In groups I and II, a metal matrix was used; RC was inserted with horizontal (group I) and diagonal (group II) increments and cured with indirect/direct light. Group III was performed as group II, but a transparent matrix was used. Group IV was as group II, but with a separating liner between RMGIC and RC. Group V was a closed sandwich restoration. Interfacial quality was studied using SEM replica technique. Gap‐free interfacial adaptation to enamel was observed for RMGIC in 70%, for RC in 70% and to dentin for RMGIC in 81%, for RC in 56%. No significant differences were seen between the experimental groups. At the cervical margins, RMGIC showed significantly better adaptation to enamel than RC, 74% and 42%, respectively. In conclusion, the investigated restorations showed a high percentage of gap‐free interfacial adaptation in vivo. Interfacial adaptation to dentin and to cervical enamel was significantly better for RMGIC than for RC.
Outer membrane vesicles from Neisseria meningitidis
Authors: Mirlashari Mohammad Reza , Høiby Ernst Arne , Holst Johan , Lyberg Torstein
Published: March 2003

Flow cytometry was used to study the expression of leukocyte adhesion molecules CD11a, CD11b, CD11c, CD14, and CD62L (L‐selectin) and production of reactive oxygen species (ROS) in an ex vivo human whole‐blood system stimulated with lipopolysaccharide‐containing outer membrane vesicles (LPS‐OMV) from N. meningitidis. Results demonstrated a dose‐dependent increase in surface expression of CD11a, CD11b, CD11c and CD14 in granulocytes and monocytes (maximal at 30–120 min) upon OMV‐LPS challenge, whereas CD62L expression was heavily downregulated (maximal at 30–120 min). The OMV‐associated LPS was almost as potent (on a weight basis) as purified LPS from E. coli in inducing adhesion molecule modulation but the response was delayed. Upon stimulation with OMV‐LPS or E. coli‐LPS, the production of intracellular ROS increased in both granulocytes and monocytes when dihydroethidium (DHE, mainly reflecting superoxide anion) was used as a probe, whereas peroxynitrite production monitored with dihydrorhodamine 123 (DHR) was not significantly changed. The OMV‐mediated modulation of leukocyte adhesion molecule expression and increased ROS production may certainly lead to increased entrapment of leukocytes in the microcirculation and contribute to untoward inflammatory reactions as seen in systemic meningococcal disease.
Reduced expression of both Bax and Bcl‐2 is independently associated with lymph node metastasis in human breast carcinomas
Authors: Bukholm Ida R. K. , Bukholm Geir , Nesland Jahn M.
Published: March 2003

Imbalance between pro‐apoptotic and anti‐apoptotic proteins, causing altered apoptosis, may lead to tumour development and tumour progression, and reduced response to adjuvant therapy. In this study, we evaluated the expression patterns of Bcl‐2, Bcl‐xL, and Bax protein in 126 primary invasive breast carcinomas, and the association with other clinicopathological parameters. We used immunohistochemical methods to evaluate protein expression. Reduced expression of both Bax and Bcl‐2 was associated with lymphnode metastases in univariate analyses (one‐way ANOVA) as well as in multivariate analysis (binary logistic regression) (Bcl‐2 p=0.003 univariate, p=0.01 multivariate, Bax p=0.05 univariate, p=0.03 multivariate). Bcl‐2 overexpression showed an inverse association with cyclin A (p=0.05), while expression of Bcl‐xL showed an association only with cyclin D3 (p=0.04). Bcl‐xL expression also showed a highly significant association with oestrogen receptor status (p=0.009). Bcl‐2 and Bcl‐xL showed an association with different D‐type cyclins, indicating different pathways of pathogenesis. Expression of Bcl‐2 was associated with better patient survival in univariate analysis (Kaplan meyer p=0.04), but lost its prognostic value in multivariate analysis (Cox regression p=0.2).
Isolation of exfoliated colonocytes from human stool as a new technique for colonic cytology
Authors: Bandaletova Tatiana , Bailey Nina , Bingham Sheila A. , Loktionov Alexandre
Published: March 2003

Cell exfoliation in the gut is an important cell renewal mechanism. To approach its investigation we applied a novel immunomagnetic technique for isolation of exfoliated cells from human stool. Exfoliated colonocytes were isolated from 168 stool samples. The cells were assessed microscopically using conventional stains and immunohistochemistry. The technique allowed us to obtain well‐preserved colonocytes displaying characteristic features of well‐differentiated colonic epithelium and positive immunostaining for cytokeratin 5/8. No mucin‐producing cells were found. Exfoliated cells did not produce inducible nitric oxide synthase, albeit cultured colon carcinoma cells HT‐29 analysed in parallel showed strong immunostaining. Analysis of exfoliated cell numbers in consecutive stool samples from the same subjects revealed considerable interindividual variation. Overall exfoliated colonocyte numbers were relatively low, isolation being unaffected by addition during the procedure of excessive amounts of HT‐29 cells. Apoptosis was extremely rare among exfoliated colonocytes. Well‐preserved exfoliated colonocytes can be consistently isolated from human faeces using a simple procedure. Our findings suggest that the actual process of cell exfoliation in the human colon may be much less intense than is generally accepted. Exfoliated cell isolation from human stool constitutes a convenient non‐invasive approach that can be used for diagnostic and research purposes.
Lymphoepithelioma‐like carcinoma of the breast
Authors: Peştereli Hadice Elif , Erdoğan Okan , Kaya Resmiye , Karaveli F. Şeyda
Published: March 2003

Lymphoepithelioma‐like carcinoma (LELC) of the breast is a rare, newly recognized subtype of breast carcinoma. Distinction from medullary carcinoma is important because of the difference in biologic behavior of these two neoplasms and LELC of the breast is regarded as an unusual form of lobular carcinoma. We present the case of a 56‐year‐old female with a breast mass measuring 2 cm in diameter, which was diagnosed as invasive lobular carcinoma with LELC pattern. This is the ninth case reported in the English literature and to the best of our knowledge the first one with lymph node metastasis.
Mumps: immune status of adults and epidemiology as a necessary background for choice of vaccination strategy in Jordan
Authors: Batayneh NAJI , Bdour SALWA
Published: March 2003

The prevalence of antibodies against mumps in 333 students at Jordan University was assessed using the ELISA technique. Most of the students (93.7%) were seropositive for mumps. About 50% of unvaccinated students and students vaccinated using the optional single‐dose MMR vaccine had mumps. The incidence rate of mumps in different age groups and sexes, the geographic distribution and the seasonality of mumps infection prior to the adoption of compulsory MMR vaccination were investigated during the period from 1988 to 2000. Mumps occurred in all age groups in both sexes and the incidence rate was higher in children aged 5–14 years than in adults. There was a higher frequency in winter and spring with epidemic peaks in 1988, 1993 and 2000. Southern Jordan had the highest incidence rate due to low vaccination coverage by the private clinics. The data support the introduction of compulsory MMR vaccination in Jordan for all susceptible individuals. Evaluation of the effectiveness of the compulsory single‐dose vaccine and, based on the outcome, a second dose of this vaccine is also recommended in order to achieve and maintain a high level of immunization.
Esthesioneuroblastoma: A Danish clinicopathological study of 40 consecutive cases
Authors: Ingeholm Peter , Theilgaard Sune A. , Buchwald Christian , Hansen Hanne Sand , Francis Dorthe
Published: March 2003

Aims. To review all cases of esthesioneuroblastoma in Denmark from 1978 to 2000 with respect to staging, grading, histopathological and immunohistochemical evaluation, and prognostication. Methods and results. Possible cases of esthesioneuroblastoma were retrieved from Danish oncology departments. Patients were included on the basis of review of their files or pathology reports, and/or on the basis of histopathological and immunohistochemical examination. Forty‐nine possible cases were retrieved. Nine cases were excluded. Esthesioneuroblastoma is a malignant neuroendocrine tumour originating in the olfactory mucosa. It is a small blue cell neoplasm with a characteristic lobular architecture. It has a neuroendocrine immunophenotype and a sustentacular S‐100 staining pattern. The tumours were staged according to Kadish and graded according to Hyams. Kaplan‐Meier survival analysis was used to identify prognostic factors. Conclusion. The Kadish staging system was able to group the patients into prognostically relevant groups. Intracranial involvement and metastases at the time of diagnosis were found to be poor prognostic factors. Hyams grading system is difficult to work with and it was not possible to divide patients into prognostically relevant groups. Presence of necrosis, a diffuse growth pattern and a high proliferation index proved to be equally poor prognostic factors.
Molecular pathogenesis and prognostic factors in endometrial carcinoma
Authors: SALVESEN HELGA B. , AKSLEN LARS A.
Published: March 2003

Endometrial carcinoma is today among the most common gynecologic malignancies in industrialized countries. In order to improve the treatment and follow‐up of these patients, various prognostic factors have been extensively studied. Patient age, stage of disease, histologic type and histologic grade have been shown to influence survival significantly, and the prognostic impact of these traditional clinicopathologic variables is well established. In addition, parity, hormone receptor concentration in the tumor, DNA ploidy and morphometric nuclear grade have all been found to influence prognosis. Information about DNA ploidy has especially been used in the clinical situation to determine individualized treatment. The prognostic significance of markers for tumor cell proliferation, cell cycle regulation (p53, p21 and p16) and angiogenesis is discussed as well as the molecular basis of endometrial carcinoma. In conclusion, several prognostic markers have been identified. It is likely that the information derived from these tumor biomarkers will reduce the need for extensive surgical staging and adjuvant treatment in endometrial carcinoma.
Calibration of fusidic acid disk diffusion susceptibility testing of Staphylococcus aureus
Authors: OLSSON‐LILJEQUIST BARBRO , KÕLJALG SIIRI , KARLSSON INGA , KRONVALL GÖRAN
Published: March 2003

Single strain regression analysis, SRA, was used to calibrate disk diffusion fusidic acid susceptibility testing of Staphylococcus aureus in two laboratories using different standard methods but the same interpretative MIC limits. SRA equation constants were calculated using five different fusidic acid disk contents (1.5, 5, 15, 50, 150 μg). These disks were tested on five separate occasions against quality control strain S. aureus ATCC 29213. The National Committee for Clinical Laboratory Standards (NCCLS) method was employed in Tartu, Estonia (TE) and the Swedish Reference Group for Antibiotics (SRGA) method in Sweden at the Karolinska Hospital (KS). SRA constants obtained were used for calculating zone breakpoints corresponding to MIC breakpoints recommended by the SRGA (S ≤0.5 mg/L, R ≥1 mg/L). Zone diameter histograms from KS, performed with a 50 μg disk, and from TE, using a 10 μg disk, showed a clustering of wild type strains around 41 mm and 30 mm, respectively, reflecting differences in methodology. Zone breakpoints calculated from the equations were validated by comparison with the histograms. Breakpoints were also calculated for a suggested lower disk content in Sweden, 10 μg, and validated in tests of clinical isolates and by histogram analysis.
Levels of glycosaminoglycans in peri‐implant sulcus fluid as a means of monitoring bone response to endosseous dental implants
Authors: Beck C. B. , Embery G. , Langley M. S. , Waddington R. J.
Published: March 2003

The presence of certain glycosaminoglycans in peri‐implant sulcus fluid may be an effective means of monitoring changes in bone metabolic activity following initial loading of implant abutments. This study has investigated levels of chondroitin 4 sulphate and hyaluronan in peri‐implant sulcus fluid from titanium osseointegrated implants following initial abutment placement and exposure to masticatory stresses. Abutments were placed after a 3‐month osseointegration period post‐initial surgical placement of the interosseous stage. 10 edentulous patients, each with 5 mandibular implants were reviewed at 2, 4, 6 and 8 days after abutment placement. Clinical details were assessed and recorded and sulcus fluid collected in microcapillary tubes for a 5‐min period for each abutment. Levels of glycosaminoglycans were assessed using cellulose acetate electrophoresis and densitometric scanning of alcian blue stained strips against known glycosaminoglycan standards. Maximum levels of sulcus fluid (0.3–1.25 /5 min) were evident at 4 days with a decrease towards 8 days. Levels of sulphated glycosaminoglycans were also maximal at 2–4 days (range 0.03–0.126 μg/5 min) and decreased at 6‐8 days. Hyaluronan was detected within a similar range of values reaching maximal levels at 4 days and decreasing by 8 days. The results indicate that glycosaminoglycan levels of peri‐implant sulcus fluid is an effective means of measuring and maintaining changes in bone metabolism. The absence of proteodermatan sulphate precludes 1 soft tissues being a source of these markers.
Histomorphometric analyses of hydroxyapatite‐coated and uncoated titanium implants. The importance of the implant design
Authors: Gottlander Magnus , Albrektsson Tomas
Published: March 2003

Hydroxyapatite‐coated and uncoated titanium screws were inserted in the rabbit tibial metaphysis and evaluated by histomorphometry after 6 months of follow‐up. There was no difference in direct bone contact between the HA‐coated implants and the uncoated controls. The effect of HA‐coating on screw‐shaped implants seems to be uncertain, in contrast to unthreaded cylindrical designs, where there is more abundant documentation in favour of HA‐coated implants.