bluuebunny/crossref_metadata_2025 huggingface dataset:
Tension free vaginal tape: a procedure for all ages
Authors: Allahdin Sabeena , McKinley Carolyn A. , Mahmood Tahir A.
Published: September 2004

Objective.  To assess the success and complications of the tension free vaginal tape (TVT) procedure in different age groups.

Patients and methods.  This prospective long‐term study of 179 consecutive cases of urodynamically confirmed urinary incontinence that had had the TVT procedure was conducted from March 1999 to December 2002 at a District General Hospital. To assess whether outcome was influenced by the patient's age, the patients were divided into three age groups: group A (30–49 years old), group B (50–69 years old) and group C (70–90 years old). Operative details and early and late complications were recorded, and patients were followed up with clinic visits at 6 weeks and 6 months and a quality of life questionnaire was completed at 1 year.

Results.  Of the 179 patients included in the study, 53 (29.6%) were in group A, 91 (50.8%) in group B and 35 (19.5%) in group C. The subjective cure rate for the patients was 84.9%, 81.3% and 85.3% in groups A, B and C, respectively. A significant improvement in symptoms was reported by 3.8%, 14.3% and 8.6% women, respectively. The failure rate was 11.3%, 4.4% and 5.7%, respectively. The intraoperative complication rate was 5.6%. The overall postoperative complication rate was 29.6%. A total of 86.2% of the patients were treated as day cases. Patients who had intraoperative complications or initial voiding difficulties (i.e. those patients requiring “in/out” catheterization before spontaneous voiding was established) were in hospital for 1–2 days.

Conclusions.  Our data showed better subjective cure rates and substantial improvement rates without any significant increase in intraoperative complications with increasing age. Postoperative complications of urgency and vaginal wall erosion were more common in the older aged patients but were easily resolved. Hospital stay and recovery period were short, making TVT a suitable procedure for all ages.
Reproducibility and validity of simple questions to identify urinary incontinence in elderly women
Authors: Rohr Gitte , Christensen Kaare , Ulstrup Kirsten , Kragstrup Jakob
Published: September 2004

Background.  Epidemiologic studies are dependent on simple and valid questions to assess the prevalence and type of urinary incontinence.

Objective.  To examine the reproducibility and validity of two standardized questions seeking to identify stress and urge incontinence among elderly women.

Methods.  A random sample of 421 women 75 years or older living in the center of Odense, Denmark, were invited to participate, and 223 (53%) accepted a first interview in their home. A sample of 154 women were selected for a second interview with the same questions [accepted by 144 (94%)]. The second visit also included a long open interview about incontinence and was followed by a prospective registration of leakages.

Results.  In the first interview 39% (95% confidence interval (CI) 34–47%) of the elderly women reported incontinence. The reliability of the questions was acceptable [kappa of 0.81 (95% CI 0.34–0.89)] with percent agreement of 90% (95% CI 84–95%) between first and second interviews for all incontinence (stress and/or urge). When the open interview was used as a “gold standard,” the questions showed acceptable validity: a sensitivity of 0.91 (95% CI 0.86–0.96) and a specificity of 0.86 (95% CI 0.80–0.92) for all incontinence.

Conclusion.  Standardized questions about incontinence give reproducible answers and produce information that is comparable to a long open interview.
The effect of home biofeedback training on stress incontinence
Authors: Aukee Pauliina , Immonen Paula , Laaksonen David E. , Laippala Pekka , Penttinen Jorma , Airaksinen Olavi
Published: September 2004

Background.  To compare the effectiveness of pelvic floor training (PFT) with the aid of a home biofeedback device to PFT alone for urodynamic stress urinary incontinence (SUI) in women after a 1‐year follow‐up.

Methods.  A randomized study comparing two conservative interventions was conducted in an outpatient clinic of a university hospital. Thirty‐five consecutive women were randomized to either the PFT with home biofeedback group or the PFT alone group. The intensive training period lasted 12 weeks. After 1 year, 33 women could be evaluated according to the protocol. At the 1‐year visit pelvic floor muscle activity was measured and the need for surgical intervention was evaluated. Logistic multivariate analysis was used to predict response to the PFT.

Results.  In the home biofeedback training group 11/16 (68.8%) avoided surgery vs. 10/19 (52.6%) in the PFT alone group. The difference was not statistically significant. In the nonoperated home biofeedback group the increase in pelvic floor muscle activity (p = 0.005 in supine, p = 0.005 in standing) and the decrease in leakage index (p = 0.05) was significant after 12 weeks and pelvic floor activity remained constant. By contrast, in the nonoperated PFT group the increase in pelvic floor muscle activity after 12 weeks predicted a good result for conservative treatment.

Conclusions.  This randomized controlled trial suggests that the home biofeedback method in PFT has a good success rate of 68.8%. The change achieved in leakage index after 12 weeks of training predicted an effective outcome for conservative treatment.
Genetic and environmental influences on urinary incontinence: a Danish population‐based twin study of middle‐aged and elderly women
Authors: Rohr Gitte , Kragstrup Jakob , Gaist David , Christensen Kaare
Published: September 2004

Background.  Familial clustering has been reported for urinary incontinence (stress and urge), but different etiologies for the two types of incontinence have been suggested.

Objective.  The aim of this study was to estimate the relative influence of genetic and environmental factors on stress, urge, and mixed incontinence among elderly and middle‐aged women.

Methods.  This is a population‐based classical twin study of 1168 female twin pairs [548 monozygotic (MZ) and 620 dizygotic (DZ)] from a middle‐aged (46–68 years) and an old (70–94 years) cohort identified in the Danish Twin Registry. Urinary incontinence was assessed with the help of two validated questions identifying stress and urge incontinence in interviews.

Results.   For urge incontinence, the tetrachoric correlation was significantly higher for MZ twins, compared to that for DZ twin pairs in both middle‐aged [0.51 (95% CI: 0.26–0.71) versus −0.22 (95% CI: −0.59–0.18)] and elderly [0.50 (95% CI: 0.27–0.68) versus 0.28 (95% CI: 0.02–0.42)], indicating genetic effects. The heritability of urge incontinence was 42% (95% CI: 16–63%) among middle‐aged women and 49% (95% CI: 29–65%) among the elderly. Moreover, mixed incontinence had a substantial genetic component. The role of genetic factors was less clear in stress incontinence.

Conclusions.  Genetic factors play a substantial role in the development of urge and mixed incontinence, whereas the role of genetic factors in stress incontinence is less prominent.
Preclinical Comparison of Ebastine and Other Second Generation H1‐Antihistamines
Authors: Yakuo Ikuhisa , Yabuuchi Masafumi , Ito Tsugutaka
Published: September 2004

Abstract: The present study was performed to compare the properties of ebastine – the long duration of antiallergic effect and less penetration to the CNS – with those of other H1‐antihistamines. Passive cutaneous anaphylactic reaction was induced and the dye leakage from the skin measured after oral administration of the various H1‐antihistamines in guinea pigs. The H1‐antihistamines examined inhibited passive cutaneous anaphylactic reactions, with ED50 values of 1.55–5.77 mg/kg administered orally. Evaluation at doses close to the ED50 values determined that the rank order of the various H1‐antihistamines for the duration of antiallergic effects, calculated from the AUC, was as follows: ebastine>cetirizine≥oxatomide=loratadine=epinastine. The inhibition of [3H]‐mepyramine binding to the cortical membrane was examined ex vivo after oral administration of the drugs in rats. Ketotifen as a positive control of sedative antihistamine, oxatomide, cetirizine, ebastine and epinastine dose‐dependently inhibited the [3H]‐mepyramine binding to rat cortical membranes. However, ebastine and epinastine did not show 50% [3H]‐mepyramine binding inhibition even at 100 mg/kg orally. In conclusion, ebastine was shown to be a potent and long‐lasting H1‐antihistamine with less effect to the CNS. Consequently, in conjunction the two experimental models used in this study – passive cutaneous anaphylactic reaction in guinea pigs and ex vivo[3H]‐mepyramine binding to rat cortical membrane – may be important to estimate the duration of antiallergic effects of drugs and to detect their sedative effects, which are important indicators in the development of new antiallergic drugs.
The inadequate smear: does it matter?
Authors: Bhaumik J. , Morris P. G. , Beer H. R. , Fielder H. , Coles E. C. , Leeson S.
Published: September 2004

The objective of this study was to quantify the incidence of underlying cervical intraepithelial neoplasia (CIN) among women referred for colposcopy with three consecutive inadequate smears. The design was a retrospective cohort study analysing data from a regional colposcopy database at Cervical Screening Wales. Women who were referred to all the colposcopy clinics in Wales with three consecutive inadequate smears, the third inadequate smear being taken between 1 April 2001 and 31 March 2002 constituted the study population. The results of the fourth smear taken at the colposcopy clinic after three consecutive inadequate smears, the worst biopsy results from any of the subsequent colposcopies and the relationship between the result of the fourth smear taken at colposcopy clinic and any histology result were the main outcome measures. The accuracy of the colposcopic opinion was also examined. Of the 433 women identified as having been referred because of three consecutive inadequate smears, 302 were linked to either a subsequent smear and/or a biopsy result. An adequate smear result was available for 85% of these women when the smear was taken in the colposcopy clinic; 77% were reported as negative and 8% were abnormal. Of the 347 women seen in the colposcopy clinic, high‐grade CIN was seen in 3% and low‐grade lesion in 8%. The sensitivity and specificity of the fourth inadequate smear test in predicting underlying CIN were 15% and 84% respectively, with a positive predictive value of 8%. The sensitivity and specificity of colposcopy in predicting histological CIN among patients with three inadequate smears was 70% and 49%, respectively, and the positive predictive value was 44%. This study raises the question as to whether three consecutive inadequate smears should be considered as an indication for colposcopy, or merely for a further smear to be taken in circumstances where there is a greater likelihood getting an adequate result.
Molecular diagnostic cytopathology: definitions, scope and clinical utility
Authors: Salto‐Tellez M. , Koay E. S. C.
Published: September 2004

Molecular diagnosis is the application of molecular biology techniques and knowledge of the molecular mechanisms of disease to diagnosis, prognostication and treatment of diseases. Although it is not widely used in routine molecular cytological practice, some examples are presented here of the application of molecular techniques to the routine cytopathological diagnosis of solid tumours and lymphoreticular malignancies. The term ‘molecular diagnostic cytopathology’ is proposed to define the application of molecular diagnosis to cytopathology, and the challenges of the introduction of molecular diagnosis into routine diagnostic histopathology and cytopathology are discussed. Finally, the importance of a combined morphological, immunophenotypic and molecular approach to maintain the diagnostic pathologist at the heart of the clinical decision‐making process is emphasized.
Evidence for magma mixing in the Mariana arc system
Authors: MEEN JAMES K. , STERN ROBERT J. , BLOOMER SHERMAN H.
Published: September 2004

Volcanoes of the Mariana arc system produce magmas that belong to several liquid lines of descent and that originated from several different primary magmas. Despite differences in parental magmas, phenocryst assemblages are very similar throughout the arc. The different liquid lines of descent are attributed to differences in degree of silica saturation of the primary liquids and in the processes of magmatic evolution (fractional crystallization vs magma mixing). Pseudoternary projections of volcanic rocks from several arc volcanoes are used to show differences between different magmatic suites. In most of the arc, parental liquids were Ol‐ and Hy‐normative basalts that crystallized olivine, augite, and plagioclase (± iron‐titanium oxide) and then plagioclase and two pyroxenes, apparently at low pressure. Eruptive rocks follow subparallel liquid lines of descent on element–element diagrams and on pseudoternary projections. Magmas at North Hiyoshi are Ne‐normative and have a liquid line of descent along the thermal divide due to precipitation of olivine, augite, and plagioclase. Derived liquids are large ion lithophile element (LILE)‐rich. Magmas at other Hiyoshi seamounts included an alkaline component but had more complex evolution. Those at Central Hiyoshi formed by a process dominated by mixing alkaline and subalkaline magmas, whereas those at other Hiyoshi seamounts evolved by combined magma mixing and fractional crystallization. Influence of the alkaline component wanes as one goes south from North Hiyoshi. Alkaline and subalkaline magmas were also mixed to produce magmas erupted at the Kasuga seamounts that are behind the arc front. The alkaline magmas at both Hiyoshi and Kasuga seamounts had different sources from those of the subalkaline magmas at those sites as indicated by trace element ratios and by Nd.
Fukutoku‐oka‐no‐ba Volcano: A new perspective on the Alkalic Volcano Province in the Izu–Bonin – Mariana arc
Authors: SUN CHIH‐HSIEN , STERN ROBERT J. , YOSHIDA TAKEYOSHI , KIMURA JUN‐ICHI
Published: September 2004

Pumice samples from Fukutoku‐oka‐no‐ba in the Izu–Bonin – Mariana (IBM) arc were analysed for 40 trace elements and Sr, Nd, and Pb isotopic compositions. These samples are shoshonites (59.4–61.8 wt% SiO2), characterized by high contents of K2O (3.74–4.64 wt%), Ba (1274–1540 p.p.m.), Rb (91–105 p.p.m.), and light rare earth elements. The characteristics of alkali‐element enrichment are similar to those of other parts of the Alkalic Volcano Province (AVP) in the northern Mariana and southernmost Volcano arcs. Sr (87Sr/86Sr = 0.7036–0.7038) and Pb isotopic compositions (206Pb/204Pb = 19.08–19.11, 207Pb/204Pb = 15.62–15.63, 208Pb/204Pb = 38.85–38.91) of Fukutoku‐oka‐no‐ba pumice are relatively radiogenic, whereas Nd is unradiogenic (143Nd/144Nd = 0.51283–0.51286). Fukutoku‐oka‐no‐ba is isotopically distinct from Iwo Jima and is similar to the Hiyoshi Volcanic Complex, suggesting that Fukutoku‐oka‐no‐ba might have a magma source similar to that of the Hiyoshi volcanic complex. Plots of Pb and Nd isotopes for AVP lavas trend toward the fields of ocean island basalt (OIB) source and pelagic sediments, which are possible sources of AVP enrichments.
Tropical Forest Fragments Enhance Pollinator Activity in Nearby Coffee Crops
Authors: RICKETTS TAYLOR H.
Published: September 2004

Abstract: Crop pollination by wild bees is an ecosystem service of enormous value, but it is under increasing threat from agricultural intensification. As with many ecosystem services, the mechanisms, scales, and species through which crop pollination is provided are too poorly understood to inform land‐use decisions. I investigated the role of tropical forest remnants as sources of pollinators to surrounding coffee crops in Costa Rica. In 2001 and 2002 I observed bee activity and pollen deposition rates at coffee flowers along distance gradients from two fragments and one narrow riparian strip of forest. Eleven eusocial species were the most common visitors: 10 species of native meliponines and the introduced honeybee,Apis mellifera(hereafterApis). Bee richness, overall visitation rate, and pollen deposition rate were all significantly higher in sites within approximately 100 m of forest fragments than in sites farther away (maximum distance of 1.6 km).Apisvisitation rates were constant across the distance gradient, however, andApisaccounted for >90% of all floral visits in distant sites. The gradient from the riparian strip showed a similar drop in bee species richness with distance, but visitation rates were uniformly low along the gradient. Throughout the study area,Apisabundances declined sharply from 2001 to 2002, reducing visitation rates by over 50% in distant sites (whereApiswas almost the only pollinator). In near sites, however, overall visitation rates dropped only 9% because native species almost entirely compensated for theApisdecline. Forest fragments (more so than the riparian strip) thus provided nearby coffee with a diversity of bees that increased both the amount and stability of pollination services by reducing dependence on a single introduced pollinator. Exploring the economic links between forest preservation and coffee cultivation may help align the goals of conservation and agriculture within many regions of global conservation priority.
Roads and Landscape Pattern in Northern Wisconsin Based on a Comparison of Four Road Data Sources
Authors: HAWBAKER TODD J. , RADELOFF VOLKER C.
Published: September 2004

Abstract:  Roads are important components of landscapes; they fragment habitat, facilitate invasive species spread, alter hydrology, and influence patterns of land use. Previous research on the ecological impacts of roads may have underestimated their effect because currently available sources of road data do not include the full road network. We compared differences in road density and landscape pattern among U.S. Census Bureau TIGER line files, U.S. Geological Survey 1:100,000‐scale digital line graphs, and U.S. Geological Survey 1:24,000‐scale digital raster graphics in northern Wisconsin to road data derived from 1:40,000‐scale digital orthophotos. Road density measured from digital orthophotos (2.82 km/km2) was significantly greater than that of digital raster graphics (1.62 km/km2) and more than double that of digital line graphs (1.21 km/km2) and TIGER (1.27 km/km2) data. The increased road densities in raster graphics and orthophoto data were mainly due to the addition of minor roads. When all roads were used to define patch boundaries, landscape metrics produced with orthophoto data showed significantly greater levels of fragmentation than those based on line or raster graphics. For example, maximum patch size was 1074 ha and total edge was 109 km for line graphs, compared with 686 ha and 211 km for orthophoto data. Roads are missing in commonly used data, primarily because mapping standards systematically exclude minor roads. These standards are not ecologically based and may result in false assumptions about the ecological effects of roads. We recommend that future studies take special consideration of the completeness of road data and consider whether all ecologically relevant roads are included.
Landscape Context Moderates Edge Effects: Nesting Success of Wood Thrushes in Central New York
Authors: DRISCOLL MELANIE J. L. , DONOVAN THERESE M.
Published: September 2004

Abstract: Despite two decades of research into the effects of habitat fragmentation and edges on nesting birds, critical information about how edges affect the success of natural nests of Neotropical migratory songbirds breeding in heterogeneous landscapes is still missing. We studied abundance and nesting success in Wood Thrushes (Hylocichla mustelina) breeding across a heterogeneous landscape in central New York from 1998 to 2000 to test the hypothesis that edge effects on nesting passerines are stronger in fragmented than contiguous landscapes. We monitored nests to estimate nesting success in edge and interior habitats in both fragmented and contiguously forested landscapes. In contiguous landscapes, daily survival rate did not differ between edge nests (0.963) and interior nests (0.968) (χ2= 0.19,p= 0.66). In contrast, in fragmented landscapes, daily survival estimates were higher in interior (0.971) than edge (0.953) nests (χ2= 3.1,p= 0.08). Our study supports the hypothesis that landscape composition moderates edge effects on actual nests of birds but does not determine the mechanisms causing these patterns.
Reliability of Absolute and Relative Predictions of Population Persistence Based on Time Series
Authors: LOTTS KELLY C. , WAITE THOMAS A. , VUCETICH JOHN A.
Published: September 2004

Abstract:  Conventional population viability analysis (PVA) is often impractical because data are scarce for many threatened species. For this reason, simple count‐based models are being advocated. The simplest of these models requires nothing more than a time series of abundance estimates, from which variance and autocorrelation in growth rate are estimated and predictions of population persistence are generated. What remains unclear, however, is how many years of data are needed to generate reliable estimates of these parameters and hence reliable predictions of persistence. By analyzing published and simulated time series, we show that several decades of data are needed. Predictions based on short time series were very unreliable mainly because limited data yielded biased, unreliable estimates of variance in growth rate, especially when growth rate was strongly autocorrelated. More optimistically, our results suggest that count‐based PVA is sometimes useful for relative risk assessment (i.e., for ranking populations by extinction risk), even when time series are only a decade long. However, some conditions consistently lead to backward rankings. We explored the limited conditions under which simple count‐based PVA may be useful for relative risk assessment.
Slow Growth and Lack of Recovery in Overfished Holothurians on the Great Barrier Reef: Evidence from DNA Fingerprints and Repeated Large‐Scale Surveys
Authors: UTHICKE S. , WELCH D. , BENZIE J.A.H.
Published: September 2004

Abstract:  Commercially fished holothurians have important functions in nutrient recycling, which increases the benthic productivity of coral reef ecosystems. Thus, removal of these animals through fishing may reduce the overall productivity of affected coral reefs. To investigate the potential for recovery of overfished holothurian ( Holothuria nobilis) stocks on the Great Barrier Reef (GBR), we (1) conducted field surveys on 23 reefs after fishery closure, (2) modeled total virgin biomass and compared it with the total amount fished, and (3) estimated individual growth rates with a DNA fingerprinting technique. Two years after fishery closure, no recovery of H. nobilis stocks on reefs previously open to fishing was observed. Densities on reefs protected from fishing since the onset of the fishery in the mid 1980s remained about four times higher than on fished reefs. Based on density estimates and geographic information system data on the habitat area of each reef, we calculated that the virgin biomass (in the main fished area between 12° and 19°S) was about 5500 t and is now about 2500 t. The reduction is on the same order of magnitude as the total amount fished until 1999 (approximately 2500 t). The DNA analysis of repeated samples on three locations indicated high recapture rates of fingerprinted and released individuals of H. nobilis. Fitting growth curves with Francis's growth function indicated that medium‐sized individuals (1 kg) grew 35–533 g /year, whereas large animals (2.5 kg) consistently shrank. Small animals (<500 g) were rarely observed. In combination, these data indicate that production of H. nobilis stocks is very low, presumably with low mortality, low recruitment, and slow individual growth rates. Consistent with anecdotal evidence, recovery of H. nobilis stocks on the GBR may take several decades, and we suggest a highly conservative management plan to protect both the stocks and the ecosystem.
Effects of Coastal Lighting on Foraging Behaviorof Beach Mice
Authors: BIRD BRITTANY L. , BRANCH LYN C. , MILLER DEBORAH L.
Published: September 2004

Abstract:  Introduction of artificial light into wildlife habitat represents a rapidly expanding form of human encroachment, particularly in coastal systems. Light pollution alters the behavior of sea turtles during nesting; therefore, long‐wavelength lights—low‐pressure sodium vapor and bug lights—that minimize impacts on turtles are required for beach lighting in Florida (U.S.A.). We investigated the effects of these two kinds of lights on the foraging behavior of Santa Rosa beach mice ( Peromyscus polionotus leucocephalus). We compared patch use and giving‐up densities of mice for experimental food patches established along a gradient of artificial light in the field. Mice exploited fewer food patches near both types of artificial light than in areas with little light and harvested fewer seeds within patches near bug lights. Our results show that artificial light affects the behavior of terrestrial species in coastal areas and that light pollution deserves greater consideration in conservation planning.
Effects of Alternative Cotton Agriculture on Avian and Arthropod Populations
Authors: CEDERBAUM SANDRA B. , CARROLL JOHN P. , COOPER ROBERT J.
Published: September 2004

Abstract: Among the major agricultural crops in the southeastern United States, cotton (Gossypium hirsutumL.) generally provides the least suitable habitat for most early successional songbirds. Newer cropping approaches, such as use of conservation tillage and stripcover cropping, offer hope for improving the ecological value of cotton fields. We examined the effects of clover stripcover cropping with conservation tillage versus conventionally grown cotton with either conventional or conservation tillage on avian and arthropod species composition and field use in east‐central Georgia. Stripcover fields had higher bird densities and biomass and higher relative abundance of arthropods than both conservation tillage and conventional fields. During migration and breeding periods, total bird densities on stripcover fields were 2–6 times and 7–20 times greater than on conservation and conventional fields, respectively. Abundance and biomass for epigeal arthropods were also greatest on stripcover fields during much of the breeding season. Although the clover treatment attracted the highest avian and arthropod densities, conservation fields still provided more wildlife and agronomic benefits than conventional management. Our findings suggest that both conservation tillage and stripcropping systems will improve conditions for birds in cotton, with stripcropped fields providing superior habitat. The reduction of inputs possible with the clover system could allow farmers to lower costs associated with conventional cotton production by $282–317/ha. This reduction of input, coupled with similar or possibly increased yield over conventional systems makes stripcover cropping not only a good choice for reducing negative impacts on wildlife and surrounding ecosystems, but also an economically desirable one.
First case of post‐conception Verteporfin exposure: pregnancy and neonatal outcome
Authors: De Santis Marco , Carducci Brigida , De Santis Lidia , Lucchese Angela , Straface Gianluca
Published: September 2004

Purpose:  To assess pregnancy and neonatal outcomes in a woman accidentally exposed to Verteporfin photodynamic therapy in the third week of pregnancy.

Methods:  Post‐conception counselling and prospective follow‐up by telephone interview at Telefono Rosso (Teratology Information Service) were carried out. The baby was examined at birth and at 26 months.

Results:  The outcome of the pregnancy was normal and a healthy female child with a normal birthweight was born. The baby's follow‐up was normal at 26 months.

Conclusions:  This is the first reported case of a childbearing woman being accidentally exposed to Verteporfin during pregnancy. No fetal or neonatal adverse effects were documented.
Optical coherence tomography in a case of Bietti's crystalline dystrophy
Authors: Meyer Carsten H. , Rodrigues Eduardo B. , Mennel Stefan , Schmidt Jörg C.
Published: September 2004

Purpose:  To demonstrate the cross‐sectional morphology in crystalline retinopathy.

Methods:  A 24‐year‐old woman with Bietti's crystalline dystrophy (BCD) and bilaterally decreased vision and nyctalopia was examined by optical coherence tomography (OCT).

Results:  Fundus examination demonstrated numerous reflective, yellow‐white crystalline deposits scattered throughout the posterior pole and midperipheral retina. Optical coherence tomography disclosed an abnormally level of high reflectivity in red to orange colours throughout the entire neuroretina, retinal pigment epithelium (RPE) and choroid. The RPE–choriocapillaris complex was thickened and hyper‐reflective, corresponding with dense crystalline deposits.

Conclusion:  The observed uncommon hyper‐reflectivity in BCD relates to the deposition of numerous infiltrates. In vivo investigations by OCT confirmed histological studies that a crystalline retinopathy corresponds with numerous infiltrates in the retina, RPE and choroid. The RPE and choroid have intensive hyper‐reflection and may be the primary location of the disease.
Refractive change after transscleral fixation of posterior chamber intraocular lenses in the absence of capsular support
Authors: Mimura Tatsuya , Amano Shiro , Sugiura Takeshi , Funatsu Hideharu , Yamagami Satoru , Araie Makoto , Eguchi Shuichiro
Published: September 2004

Purpose:  To report the refractive change that occurred over 12 years after secondary transscleral fixation of posterior chamber intraocular lenses (PC IOLs).

Methods:  A total of 21 patients who underwent transscleral fixation of PC IOLs were studied. We were able to follow 15 eyes of 15 patients for more than 12 years. We evaluated refractive change in each patient for 12 years after the operation.

Results:  The spherical refractive equivalent was − 0.95 ± 2.21 D immediately after the operation, − 1.16 ± 2.28 D after 2 years and − 1.37 ± 1.94 D after 12 years.

Conclusion:  There were few changes in the spherical refractive equivalent up to 12 years after the operation.
Ascorbic acid reversibly inhibits proliferation of retinal pigment epithelial cells
Authors: Heckelen A. , Hermel M. , Kondring B. , Schrage N. F.
Published: September 2004

Purpose:  Proliferation control in adult retinal pigment epithelial (ARPE) cells is an essential factor in the clinical management of proliferative vitreoretinopathy (PVR). Factors which inhibit PVR and which are without toxic potential are therefore of interest in controlling proliferation. The aim of the present study was to gain insight into a possible function of high intraocular ascorbic acid levels as a physiological modulator of proliferation.

Methods:  Adult retinal pigment epithelial cells were incubated in vitro with increasing concentrations of ascorbic acid (0.5–4 mmol, pH 7.4). Cell proliferation was assayed by the bromide‐deoxy‐uridine (BrdU) assay. The culture medium (CM) containing ascorbic acid was replaced with normal CM and the recovery of proliferation was measured after 24 hours. In order to be able to distinguish between proliferation inhibition, apoptosis, necrosis and recovery of proliferation, we performed TUNEL assays and fluorescence analysis cell‐counter (FAC) analysis.

Results:  Ascorbic acid significantly inhibits ARPE cell proliferation if it is present in concentrations above 2 mmol. Proliferation resumed in all ARPE cell cultures after pre‐incubation with ascorbic acid, indicating that direct toxicity of ascorbic acid is a negligible factor. The time‐point and extent of recovery in proliferation was dependent on the initial ascorbic acid concentration. Fluorescence‐labelled cell counts on apoptosis markers (FAC) data showed some induction of apoptosis and necrosis after incubation with 4 mmol ascorbic acid.

Conclusions:  Ascorbic acid has a dose‐dependent influence on the proliferation of vital ARPE cells. This possibly reflects the role of ascorbic acid at a physiological level within the vitreous cavity in preventing proliferative vitreoretinopathy (PVR). These findings may stimulate the development of new strategies in the clinical treatment of PVR.
An unusual pathogen causing microbial keratitis
Authors: Saeed M. Usman , Jafree Afsar Jalil , DeCock Romain , Nash James
Published: September 2004

Introduction:  We report a rare case of Mycobacterium fortuitum affecting the corneal graft of a patient 6 years post‐graft, possibly associated with contact lens use.

Conclusions:  This case shows the need for careful microbiological techniques when dealing with patients presenting with microbial keratitis. It must be kept in mind that unusual and slow growing organisms may also be responsible for corneal ulceration. If a slow growing organism is suspected, a microbiological diagnosis may not be forthcoming for weeks. Misidentification of the responsible pathogen may further complicate management for the clinicians. Cases such as these, which may not respond to medical therapy as expected, may prove a difficult therapeutic challenge to physicians.
Functional and anatomic results of macular hole surgery complicated by massive indocyanine green subretinal migration
Authors: Brazitikos Periklis D. , Androudi Sofia , Tsinopoulos Ioannis , Papadopoulos Nick Th. , Balidis Miltiadis , Georgiadis Nikolaos
Published: September 2004

Purpose:  To report the functional and anatomic results of macular hole (MH) surgery complicated by massive subretinal migration of indocyanine green (ICG) dye.

Design:  Interventional case report.

Methods:  We performed standard pars plana vitrectomy surgery for a stage 3, senile idiopathic MH. After posterior vitreous detachment and vitreous removal, we instilled 2 ml of ICG (0.5%, 270 mOsm); the surgery was complicated by diffuse subretinal migration of the ICG dye but peeling of the internal limiting membrane (ILM) was performed (despite the obvious difficulties from the low contrast between the green‐stained ILM overlying a green‐stained subretinal space) and the rest of the procedure was completed with a final injection of 16% C3F8.

Results:  Post‐surgical optical coherence tomography confirmed the anatomic closure of the MH. Digital photography with the excitation and barrier filters for ICG showed a striking autofluorescence along the inferior vascular arcade, which remained intense 7 months after surgery. Despite the massive subretinal migration of ICG, visual acuity (VA) improved to 20/30.

Conclusions:  This is the first report of VA recovery despite massive subretinal migration of ICG dye during MH surgery. Subretinal migration of ICG dye may be a potential complication during MH surgery; this should alert the surgeon to limit its use, despite the possible absence of clinically apparent toxic effects.
Neurosarcoidosis mimicking Sjögren's syndrome
Authors: Tuisku Ilpo S. J. , Konttinen Yrjö T. , Soinila Seppo , Karma Anni , Tervo Timo M. T.
Published: September 2004

Purpose:  To describe a patient with a long disease history who was finally diagnosed with neurosarcoidosis and to discuss the reasons behind the delayed diagnosis.

Case Report:  A 58‐year‐old man with sick sinus syndrome and bradycardia, which was treated with a pacemaker, developed first right and then left facial palsy. Subsequently, multiple cranial nerve palsies developed and later spontaneously resolved. Neurosarcoidosis was suspected at that stage, but excluded because the patient had no typical sarcoid lung changes, his serum and cerebrospinal fluid angiotensin converting enzyme activity levels were normal and a computed tomography scan disclosed no central nervous system changes. During follow‐up, the patient developed extremely dry eyes and mouth, suggesting Sjögren's syndrome. Rheumatology consultation did not reveal any autoimmune or visceral features typical of Sjögren's syndrome and autoantibodies were negative. However, both labial salivary gland and conjunctival biopsies revealed non‐caseating granulomas, and neurosarcoidosis was diagnosed.

Conclusions:  Neurosarcoidosis is a relatively rare disease with a somewhat poor longterm prognosis in one‐third of cases, although the neurological manifestations often diminish or disappear in response to glucocorticoid treatment. Diagnosis is often a clinical challenge, especially in the absence of pulmonary changes or other features typical of sarcoidosis. The labial salivary gland and conjunctiva provide helpful biopsy sites for histopathological confirmation of the diagnosis.
Transpupillary thermotherapy for the treatment of subfoveal choroidal neovascularization associated with age‐related macular degeneration
Authors: Tranos P. , Singh M. , Peter N. M. , Dhir L. , Kon C. , Rassam S.
Published: September 2004

Objective:  To evaluate the efficacy of transpupillary thermotherapy (TTT) for the treatment of choroidal neovascularization (CNV) secondary to age‐related macular degeneration (AMD).

Design:  Prospective, non‐randomized, non‐masked, case‐selected series.

Methods:  All patients with subfoveal CNV due to AMD and initial visual acuity (VA) between 6/9 and 6/60 were offered the opportunity to undergo TTT. Recruited subjects were treated using a diode laser (810 nm) with a beam size of 1.2–3.0 mm and power settings of 460–1200 mW. Treatment was applied for 60 seconds in a subthreshold manner.

Main outcome measures:  Differences in VA and changes in the angiographic appearance of CNV.

Results:  Thirty‐one occult/predominantly occult and five classic/predominantly classic membranes were treated with TTT and were followed‐up for a mean of 6.0 ± 1.2 months. Following an average of 1.5 ± 0.7 (range 1–4) laser sessions, VA remained stable ( − 1 to + 1 Snellen line) in 24 (66.7%) eyes, improved by > 1 line in two (5.6%) eyes and decreased significantly (≥ 2 Snellen lines) in 10 (27.8%) eyes. Angiographically confirmed closure of CNV was detected in 22 (61.1%) patients. Membranes persisted in 11 (30.6%) eyes and recurred in three (8.3%) eyes. There was no association between reduction, elimination or persistence of angiographic leakage of CNV and change in VA after treatment (p = 0.347).

Conclusions:  Transpupillary thermotherapy may be effective at preserving vision and reducing CNV leakage in a number of patients with exudative AMD. Further studies are required to compare TTT with the natural course of subfoveal CNV and alternative treatment options.
Prognostic factors for survival after enucleation for choroidal and ciliary body melanomas
Authors: Isager Peter , Ehlers Niels , Overgaard Jens
Published: September 2004

Purpose:  To evaluate prognostic factors for the survival of patients treated by enucleation for choroidal and ciliary body melanomas.

Methods:  The study included 293 consecutive patients (147 men and 146 women) treated by enucleation for a choroidal or ciliary body melanoma during the period 1955–2000. The median age at treatment was 61 years (range 26–88 years). Clinical and histopathological findings, vital status at October 1st, 2002, and cause of death were registered. Prognostic factors for survival were evaluated by univariate and multivariate Cox proportional hazards analysis and by Kaplan–Meier survival analysis.

Results:  Follow‐up was complete. The median follow‐up time was 6.2 years (range 21 days to 43.4 years) and the median potential follow‐up time was 25.7 years (range 1.9–47.7 years). In multivariate Cox proportional hazards analysis an increased risk of melanoma‐related death was found for largest basal diameter (n = 264, p < 0.001, mortality rate ratio (RR) = 1.09 for continuous parameter in mm), anterior tumour margin at the iris/ciliary body versus choroid (p < 0.001, RR = 2.22), and non‐spindle cell type versus spindle cell (p = 0.047, RR = 1.45). An increased risk of death from all causes was found for men versus women (n = 266, p = 0.02, RR = 1.41), high age (p < 0.001, RR = 1.41 for continuous parameter in 10‐year age groups), largest basal diameter (p < 0.001, RR = 1.07), anterior tumour margin at the iris/ciliary body (p = 0.02, RR = 1.52), and non‐spindle cell type (p = 0.04, RR = 1.34).

Conclusion:  The risk of melanoma‐related death after enucleation for a choroidal or ciliary body melanoma was high for tumours with large basal diameter, of non‐spindle cell type and anterior location. Additional risk factors for death from all causes were male sex and high age.
Optimality and Acceptance Criteria in Offshore Design
Authors: Ku¨bler Oliver , Faber Michael Havbro
Published: September 2004

The optimal design of offshore structures is formulated as a decision theoretical problem. The objective is to maximize the expected net present value of the life cycle benefit. The general optimization problem is simplified by taking into account the cost impacts of a possible reconstruction of the structure. The analytical solution to this problem has been derived for the case, where failure events follow a stationary Poisson process. The life cycle benefit is formulated in terms of the production profile, the design and construction costs, failure costs and reconstruction costs. In order to assess the effect of potential loss of lives, the costs of fatalities are included applying the concept of the Implied Costs of Averting a Fatality ICAF. The suggested approach to optimal design, which can be applied for any type of offshore structure, is exemplified considering the special case of steel structures. Here, it is standard to represent the ultimate structural capacity in terms of the Reserve Strength Ratio RSR. For the purpose of illustration, the relation between material usage and RSR, which is valid for monopod structures, is applied. Optimal RSR’s and corresponding annual failure rates are assessed for both manned and unmanned structures covering a wide range of different realistic ratios between the potential revenues and costs for construction, failure and reconstruction.
Risk-Based Inspection Planning for Mooring Chain
Authors: Mathisen Jan , Larsen Kjell
Published: September 2004

The use of risk-based inspection planning for offshore structural components is becoming quite familiar. This paper describes an application of this technique to mooring chain. In many cases, the technique is based on probabilistic modelling of fatigue crack growth in the structural components, and updating of the failure probability on the basis of inspections. The extension of this basis from a single component to very many components is necessary to tackle series systems, such as mooring chain, where a fatigue fracture can arise in any chain link. The theoretical basis for the analysis is described, including details of the model for stochastic dependency between the chain links. Results are shown that compare failure probabilities for a single chain link and a chain segment. The effects of various levels of inspection coverage are illustrated. An example of a cost optimal inspection plan is developed for mooring chain on an FPSO in the northern North Sea.
A Bayesian Model for the Probability Distribution of Fatigue Damage in Tubular Joints
Authors: Heredia-Zavoni Ernesto , Montes-Iturrizaga Roberto
Published: September 2004

A Bayesian framework is used for updating the probability distributions of the parameters of a fracture mechanics model and of crack size in tubular joints using information from inspection reports of fixed offshore structures. An error model, defined as the logarithmic difference between measured crack size during inspection and crack size predicted by the fracture mechanics model, is assumed to have a normal distribution with known mean and uncertain variance. The distribution of the error variance is modeled by a conjugate distribution for samples of normal variables with known mean and uncertain variance. Based on these assumptions, an analytical model is obtained using a Bayesian approach for the updated distributions of the parameters of the fracture mechanics model and of crack size based. The capabilities of the model are illustrated by means of examples using the Paris-Erdogan formulation for crack growth. The examples illustrate the effects of inspection times, measured crack size, and the distribution of stress ranges on the updated density functions of crack size, time varying reliability and expected cost of failure.
Efficiency Considerations for the Purely Tapered Interference Fit (TIF) Abutments Used in Dental Implants
Authors: Bozkaya Dinc¸er , Mu¨ftu¨ Sinan
Published: September 2004

A tapered interference fit provides a mechanically reliable retention mechanism for the implant-abutment interface in a dental implant. Understanding the mechanical properties of the tapered interface with or without a screw at the bottom has been the subject of a considerable amount of studies involving experiments and finite element (FE) analysis. In this paper, approximate closed-form formulas are developed to analyze the mechanics of a tapered interference fit. In particular, the insertion force, the efficiency, defined as the ratio of the pull-out force to insertion force, and the critical insertion depth, which causes the onset of plastic deformation, are analyzed. It is shown that the insertion force is a function of the taper angle, the contact length, the inner and outer radii of the implant, the static and the kinetic coefficients of friction, and the elastic modulii of the implant/abutment materials. The efficiency of the tapered interference fit, which is defined as the ratio of the pull-out force to insertion force, is found to be greater than one, for taper angles that are less than 6 deg when the friction coefficient is 0.3. A safe range of insertion forces has been shown to exist. The lower end of this range depends on the maximum pull-out force that may occur due to occlusion in the multiple tooth restorations and the efficiency of the system; and the upper end of this range depends on the plastic deformation of the abutment and the implant due to interference fit. It has been shown that using a small taper angle and a long contact length widens the safe range of insertion forces.
Quantitative Examination of a Perfusion Microscope for the Study of Osmotic Response of Cells
Authors: Takamatsu Hiroshi , Komori Yuichi , Zawlodzka Sylwia , Fujii Motoo
Published: September 2004

The perfusion microscope was developed for the study of the osmotic response of cells. In this microscope, the cells are immobilized in a transparent chamber mounted on the stage and exposed to a variety of milieus by perfusing the chamber with solutions of different concentrations. The concentration of the supplied solution is controlled using two variable-speed syringe pumps, which supply an isotonic solution and a hypertonic solution. Before using this system to characterize the osmotic response of cells, the change in the concentration of NaCl solution flowing through the chamber is examined quantitatively using a laser interferometer and an image processing technique. The NaCl concentration is increased from an isotonic condition to a hypertonic condition abruptly or gradually at a given constant rate, and decreased from a hypertonic condition to an isotonic condition. It is confirmed that the concentration is nearly uniform in the cross direction at the middle of the chamber, and the change in the NaCl concentration is reproducible. The average rate of increase or decrease in the measured concentration agrees fairly well with the given rate when the concentration is changed gradually at a constant rate. The rate of the abrupt change is also determined to be the highest limit achieved by the present method. As the first application of using the perfusion microscope for biological studies, the volume change of cells after exposure to a hypertonic solution is measured. Then, the hydraulic conductivity of the cell membrane is determined from the comparison of the volume change between the experiment and the theoretical estimation for the measured change in the NaCl concentration of the perfused solution.