bluuebunny/crossref_metadata_2025 huggingface dataset:
Ambulatory blood pressure as predictor of preeclampsia in diabetic pregnancies with respect to urinary albumin excretion rate and glycemic regulation
Authors: Lauszus Finn F. , Rasmussen Ole W. , Lousen Thea , Klebe Thomas M. , Klebe Joachim G.
Published: March 2003

Background. Twenty‐four‐hour ambulatory blood pressure was evaluated as a predictor of preeclampsia in women with insulin‐dependent diabetes mellitus with respect to urinary albumin excretion rate and glycemic regulation.

Methods. One hundred and fifty‐one women with insulin‐dependent diabetes mellitus were consecutively recruited from the outpatient maternity ward for 24 hour ambulatory blood pressure measurement with a portable monitor (SpaceLab 90207). Blood pressure was measured three times during pregnancy and once after delivery. Evaluation was performed with receiver‐operator‐characteristics curves in primiparous women. Stratified analysis and multiple regression was applied with respect to urinary albumin excretion rate, HbA1c, age, duration of diabetes mellitus, uric acid, and BMI.

Results. The incidence of preeclampsia was significantly associated with increasing urinary albumin excretion rate, primiparity, and ambulatory blood pressure. Ambulatory blood pressure was associated with HbA1c throughout pregnancy adjusted for urinary albumin excretion rate. The ambulatory blood pressure was higher from first trimester throughout pregnancy in women developing preeclampsia compared to women who did not have preeclampsia. The best sensitivity and specificity for predicting preeclampsia in primiparous women were at cut‐off values of systolic and diastolic day ambulatory blood pressure above 122 and 74 mmHg, respectively. The relative risk of preeclampsia was significantly higher when ambulatory blood pressure was above the cut‐off values and increased further with higher urinary albumin excretion rate.

Conclusions. The relationship between ambulatory blood pressure and preeclampsia is not confined to women with macroalbuminuria but is also present in women with normo‐ and microalbuminuria. Poor glycemic control and increased urinary albumin excretion rate is associated with preeclampsia when ambulatory blood pressure is above cut‐off values of 122/74 mmHg (systole/diastole). Ambulatory blood pressure is a reliable measurement for prediction of preeclampsia in primiparous women with insulin‐dependent diabetes mellitus.
The fetal origins hypothesis: placental insufficiency and inheritance versus maternal malnutrition in well‐nourished populations
Authors: Henriksen Tore , Clausen Torun
Published: March 2003

The ‘Fetal origins hypothesis’ states that individuals born small because of malnutrition are predisposed to adult diseases. Fetal malnutrition has two main causes, poor maternal nutrition and placental insufficiency. A distinction between these causes is important because it is likely that maternal nutrition has been sufficient in the majority of populations in which the fetal origins hypothesis has been tested. Thus, placental insufficiency is a more reasonable cause of reduced fetal growth in adequately nourished populations. Placental insufficiency is mainly due to inadequate vascular adaptation at the uteroplacental interface (‘poor placentation’). Among women with placental insufficiency syndromes such as pre‐eclampsia and ‘idiopathic’ intrauterine growth retardation, there is an increased prevalence of risk factors for cardiovascular diseases. Maternal cardiovascular risk factors may therefore increase the risk of adult diseases in the offspring both through direct inheritance and by interfering with uteroplacental vascular adaptation. The latter may result in placental insufficiency and fetal growth retardation that by itself could cause adult disease (as the Fetal origins hypothesis states). Alternatively, the association between low birth weight for gestational and adult disease could be an epiphenomenon, leaving inheritance as the main explanation for the fetal origins hypothesis, in adequately nourished populations.
Suspected big baby: a difficult clinical problem in obstetrics
Authors: Haram Kjell , Pirhonen Jouko , Bergsjø Per
Published: March 2003

Background. Large for gestational age fetuses, also called macrosomic fetuses, represent a continuing challenge in obstetrics.

Methods. We review various problems with large for gestational age fetuses. We have performed a literature search, mainly through the database PubMed (includes the Medline database). The clinical problem is discussed from the primary care provider's, the patient's and the obstetrician's point of view.

Results. Macrosomomia is arbitrarily defined as having a fetal weight of above the 90th percentile, a birth weight of above 4000 g or 4500 g, or a birth weight of over +2 standard deviation of the mean birth weight by gestational age. The diagnosis of macrosomia is difficult, both by palpation and symphysis fundus measurement; even with sophisticated sonographic measures. The combination of biparietal diameter, femur length and abdominal circumference appears to be no better than abdorminal circumference alone..

Interpretation. Based on the literature, labor should not be induced in nondiabetic pregnancies. The best policy is to await spontaneous birth or to induce labor after 42 weeks completion. A great number of cesarean sections have to be performed to avoid a single case of plexus brachialis paresis resulting from a difficult shoulder delivery. Cesarean section should not be considered in nondiabetic pregnancies unless the estimated fetal weight is above 5000 g. In pregnancies complicated by diabetes mellitus there are reasons for selective induction of labor if macrosomia is suspected and for cesarean section if the calculated birth weight is above 4000 g. Each department should have a strategy to handle such a situation because the problem with the difficult shoulder delivery cannot be completely avoided. Different procedures of managing difficult shoulder delivery are described.
Termination of third‐trimester pregnancy before term with gemeprost vaginal pessaries
Authors: Frambach Torsten , Müller Thomas , Blissing Silke , Sütterlin Marc , Dietl Johannes
Published: March 2003

Objective.  Determination of the efficacy and side‐effects of the synthetic prostaglandin analog gemeprost for termination of pregnancy in the third trimester.

Patients.  Retrospective record study of 40 women who had undergone third trimester termination of pregnancy before term by serial administration of gemeprost because of intrauterine fetal death or hopeless fetal prognosis. Patients with multiple pregnancy, a Bishop score > 5, contractions or contraindications to prostaglandins were excluded.

Methods. Gemeprost vaginal pessaries (1‐mg) were given at 6‐hourly intervals until labor intervened. The main parameter studied was the induction‐delivery interval, the length of time between administration of the first dose and delivery. Statistical analysis was performed with the chi‐square and the Mann–Whitney U‐test.

Results. The median induction‐delivery interval was 14.4 h (range 3–48 h). Delivery occurred within 12 h in 17 women (42.5%), within 24 h in 27 women (67.5%) and within 36 h in 37 women (92.5%). An average of 2.6 doses were given per patient. Multigravidae had a significantly shorter induction‐delivery interval than primigravidae (p < 0.01). A total of 87.5% women required analgesia. Side‐effects were infrequent.

Conclusions. The administration of gemeprost vaginal pessaries represents an efficient method with few side‐effects for the induction of labor in the third trimester, provided patients are chosen carefully and monitored closely.
Ovarian tumor cell detection in peripheral blood progenitor cells harvests by RT‐PCR
Authors: Kurata Hitoshi , Takakuwa Koich , Tsuneki Ikunosuke , Aoki Yoichi , Tanaka Kenichi
Published: March 2003

Background.  To evaluate the frequency of tumor cell contamination in autologous peripheral‐blood progenitor cells from patients with ovarian cancer, and to determine the impact of infusing such cells on relapses after high‐dose chemotherapy.

Methods.  Seventy‐three samples of peripheral‐blood progenitor cells from 24 ovarian cancer patients were studied for contaminated tumor cells by cytokeratin 7 and cytokeratin 20 reverse transcriptase polymerase chain reaction.

Results.  Tumor cell contamination in peripheral‐blood progenitor cells was detected in 11 of 24 patients (46%) and, among these, in four of 11 patients who received transplantations of peripheral‐blood progenitor cells. There was no trend towards longer relapse‐free survival in patients infused with cytokeratin‐negative peripheral‐blood progenitor cells as compared with positive ones. Interestingly, two of four patients who received transplantations of peripheral‐blood progenitor cells containing tumor cells were free from progression at 20 and 41 months after transplantation.

Conclusion.  Tumor cell contamination of peripheral‐blood progenitor cells was frequently noted by transcriptase polymerase chain reaction in patients with ovarian cancer. The biological and clinical significance of this finding remains to be elucidated.
Reproductive hormones: ageing and the perimenopause
Authors: Robertson David M. , Burger Henry G.
Published: March 2003

This review explores the pituitary‐ovarian hormones involved with ageing and the onset of menopause. The serum patterns of pituitary‐ovarian hormones throughout the menstrual cycle alter as menopause approaches. The increase in follicular phase FSH prior to menopause is attributed to an early decline in the ovarian hormone, inhibin B, which negatively regulates follicle‐stimulating hormone (FSH) secretion. Serum inhibin B is believed to reflect the age‐related decrease in ovarian follicle reserve, which is the primary source of serum inhibin B. The later rise in serum luteinizing hormone (LH) during the menopause transition is due to a cessation of ovarian follicle development. Hormonal patterns during the luteal phase of the menstrual cycle also show changes with age but these changes are poorly understood.
Induction to delivery time interval in patients with and without preeclampsia: a retrospective analysis
Authors: Griffiths Anthony N. , Hikary Nadia , Sizer Andrew R.
Published: March 2003

Background.  Anecdotally, it is suggested that patients with preeclampsia have a shorter induction to delivery interval than patients without preeclampsia, despite there being no good objective evidence.

Methods.  A retrospective analysis of 136 primiparous, singleton, cephalic, nonassisted vaginal deliveries between January 1997 and January 2000. Sixty‐eight women had induction of labor for preeclampsia and 68 women without preeclampsia had induction of labor for other reasons. The two groups were already case‐matched for maternal and gestational age. The following details were recorded from the case notes: maternal age, gestation at delivery, initial Bishop score, total dose of prostaglandin administered, induction to delivery interval, duration of second‐stage labor, birthweight, and the percentage of Apgar scores < 7 at 5 min. Statistical analysis was carried out with a Mann–Whitney U‐test, with the aid of SPSS version 9, Microsoft Windows

Results.  The women with preeclampsia had a statistically significant longer induction to delivery interval than those without preeclampsia. The mean induction to delivery interval of women with and without preeclampsia was 1049.5 min and 762.5 min, respectively (p < 0.001)

Conclusion.  Women with preeclampsia had a longer induction to delivery interval than patients without preeclampsia. This fact must be considered when deciding upon the mode of delivery in preeclamptic patients.
Cytologic screening and human papilloma virus test in women undergoing artificial fertilization
Authors: Lundqvist Monalill , Westin Cecilia , Lundkvist ÖRjan , Simberg Niklas , Strand Anders , Andersson Sonja , Wilander Erik
Published: March 2003

Background.  Infertile women in Sweden are offered in vitro fertilization (IVF) within the frame of the social security system. The present investigation was undertaken to evaluate the prevalence of genital human papilloma virus (HPV) infection in relation to the results of cytologic screening and to the infertility in these women.

Material and methods.  Two hundred and fourteen women, mean age 32 years (range 20–40), admitted to the Center for Reproduction at Uppsala University Hospital for investigation of infertility and IVF were studied. Human papilloma virus tests were performed by a sensitive polymerase chain reaction‐based technique in cervical smears obtained at a medical examination or during oocyte retrieval. Cytologic screening results were obtained from medical records or at the time of investigation. The infertile women were compared with 197 healthy female controls.

Results.  Infertility resulted from female factors in 47% and male factors in 29% of the cases, and remained unexplained in 24%. Seven percent of the infertile women were HPV‐positive compared with 9.1% of the controls. Only genital and oncogenic HPV types were identified. Human papilloma virus type 16 was most prevalent, and examination of the HPV 16 E6 gene showed that this prototype predominated over variants. No correlation was found between HPV infection and cause of infertility. Abnormal cytology was observed in 2.3% of the infertile women and 4.1% of the controls.

Conclusions.  Human papilloma virus infections might appear somewhat less frequently in infertile women admitted for IVF than in a control population. In both groups HPV infection was more common than cytologic abnormalities, possibly indicating that present HPV tests are more sensitive in detecting HPV infections than cytologic screening.
Cost‐analyzes based on a prospective, randomized study comparing laparoscopic colposuspension with a tension‐free vaginal tape procedure
Authors: Persson Jan , Teleman Pia , Etén‐Bergquist Christina , Wølner‐Hanssen Pål
Published: March 2003

Background.  The aim of this study was to compare laparoscopic colposuspension with tension‐free vaginal tape (TVT) in terms of costs to the county.

Methods.  In a prospective, randomized study, we approached 270 consecutive women presenting for evaluation of stress urinary incontinence symptoms at one university hospital. Preoperatively, and at 1‐year follow‐up, the women underwent urodynamic evaluation, an ultra‐short pad‐test and completed a lower urinary tract symptoms questionnaire. We randomized 79 consenting, eligible women to either procedure; a 1‐year follow‐up examination was performed on 68/71 (96%) women that were available. The procedures were performed as described previously. Main outcome measures were all relevant costs for goods and services associated with the procedures.

Results.  The baseline characteristics of the two groups were similar. The TVT procedure was performed significantly faster than the laparoscopic colposuspension, i.e. 44.9 ± 14.2 min compared with 60.5 ± 13.4 min (p < 0.0001). Even so, procedural costs were significantly lower for laparoscopic colposuspension than for TVT (€ 1273.4 compared with € 1342.8 p < 0.001). At the 1‐year follow‐up visit, three women operated on with TVT and one operated on with laparoscopic colposuspension required re‐operation for continuous stress urinary incontinence. One women operated on with TVT had her sling cut for bladder‐emptying problems. Total costs, including re‐operations were € 1462.6 for a TVT procedure and€ 1314.5 for a laparoscopic colposuspension.

Conclusion.  In our hands, the laparoscopic colposuspension was less expensive to the county than the TVT procedure.
An update on the controversies of tocolytic therapy for the prevention of preterm birth
Authors: Ingemarsson Ingemar , Lamont Ronald F.
Published: March 2003

Acta Obstet Gynecol Scand 2003; 82: 1–9. © Acta Obstet Gynecol Scand 2003

Preterm birth is the major cause of perinatal mortality and morbidity in the developed world. Where there are no contraindications to their use, tocolytics can improve neonatal survival rates by approximately 3% per day between 23 and 27 weeks gestation with a concomitant reduction in morbidity. The ultimate aim of tocolytic therapy is to prolong pregnancy until growth and maturation is complete, but even short‐term delay may enable the administration of antepartum glucocorticoids to reduce hyaline membrane disease or to arrange transfer to a center with neonatal intensive care facilities. Both of these have been shown to reduce neonatal mortality and morbidity. Until recently, none of the currently used tocolytics, whether licensed or unlicensed, were developed specifically for the inhibition of preterm labor and consequently, they exhibit various potentially serious side‐effects. As a result of the recent licensing of the oxytocin antagonist, atosiban, developed for the treatment of preterm labor and due to its high utero‐specificity, obstetricians have experienced an advance in their options for the management of spontaneous preterm labor.
Elevated maternal mid‐trimester chorionic gonadotropin ≥4 MoM is associated with fetal cerebral blood flow redistribution
Authors: Hershkovitz Reli , Erez Offer , Sheiner Eyal , Landau Daniella , Mankuta David , Mazor Moshe
Published: March 2003

Acta Obstet Gynecol Scand 2003; 82: 22–27. © Acta Obstet Gynecol Scand 2003

Background. Elevated mid‐trimester human chorionic gonadotropin (hCG) is associated with adverse maternal and perinatal outcome. The aims of the study were to evaluate the association between elevated hCG, fetal pathological arterial waveforms and maternal and perinatal complications.

Methods. Pulsatility indices (PI) of middle cerebral artery (MCA) and umbilical artery (UA) were determined prospectively in 121 consecutive patients with abnormal maternal serum hCG (> 2.5 MoM). Each patient had four US scans during pregnancy. Patients with known structural or chromosomal anomalies were excluded.

Results. Of 121 women with hCG > 2.5 MoM, 36/121(29.6%) had hCG between 2.5 and 3.0 MoM, 35/121(28.9%) had hCG between 3.0 and 3.5 MoM, 21/121(17.3%) had hCG of 3.5–4.0 MoM, 17/121(14.1%) had hCG levels between 4.0 and 4.5 MoM, and 12/121(9.9%) had hCG > 4.5 MoM. Middle cerebral artery PI was significantly lower in women with hCG > 4.0 MoM between 28 and 36 weeks' gestation, but not between 18 and 27 weeks' gestation. No differences of MCA PI were found when the cut‐off point of hCG was 3.5. Women with hCG levels > 4.0 MoM had a significantly higher rate of preterm deliveries, cesarean sections, higher rate of Apgar scores < 7 and a significantly lower mean birth weight in comparison with women with hCG < 4.0 MoM. The prevalence of PIH and preeclampsia and perinatal death were found to be higher among patients with hCG levels > 4.0 MoM, although not significantly. No differences were found at hCG levels less than 4.0 MoM.

Conclusions. In pregnancies with mid‐trimester hCG > 4.0 MoM, redistribution of cerebral blood flow is expressed after 28 weeks' gestation. These pregnancies have higher rates of maternal and neonatal complications as compared to pregnancies with lower hCG levels.
Leiomyosarcoma of the uterus: a clinicopathologic study of 21 cases
Authors: Hsieh Chin‐Hsiung , Lin Hao , Huang Chao‐Cheng , Huang Eng‐Yen , Chang Shiuh‐Young , ChangChien Chan‐Chao
Published: March 2003

Acta Obstet Gynecol Scand 2003; 82: 74–81. © Acta Obstet Gynecol Scand 2003

Background. The purpose of the present study was to identify the prognostic factors of and to determine the most appropriate mode of treatment for uterine leiomyosarcoma.

Methods. We reviewed the hospital records, including surgical notes and pathologic reports, of 21 patients with uterine leiomyosarcoma treated at Chang Gung Memorial Hospital, Kaohsiung, Taiwan, between 1987 and 1997. Univariate analysis was performed using the log‐rank test. Cox regression was used to identify independent prognostic factors.

Results. The mean follow‐up time was 30 months, and the 5‐year disease‐free survival rate was 55%. Evaluating the correlation between clinicopathologic parameters and survival, early stage (p = 0.0002), tumor cells without necrosis (p = 0.0026), low‐grade tumor (p = 0.015), absence of vascular space involvement (p = 0.006), and tumor without atypia (p = 0.016) were associated with good prognosis. However, in a multivariate analysis using the Cox model, only advanced stage (p = 0.032) and tumor necrosis (p = 0.032) were found to be independent poor prognostic factors. The 5‐year disease‐free survival was only 21% in patients with the presence of any one or both of these two factors. Five of 11 patients in this group had received aggressive adjuvant therapy after surgery, and none of them survived more than 19 months.

Conclusions. We found that patients with advanced stage or presence of tumor necrosis had an extremely poor prognosis. Adjuvant therapy seemed to play a limited role, and provided no survival benefit. Treatment for these patients should be palliative until effective therapeutic modalities prove otherwise.
Choroidal Langerhans' cell histiocytosis
Authors: Kim In Taek , Lee Sang Min
Published: March 2003

Purpose: To report a patient with choroidal Langerhans' cell histiocytosis.

Methods: A solitary tumor was found in the left eye of a 49‐year‐old male who had no definite history of systemic disorders, but had observed visual disturbances for a period of 1 month. Ultrasonography, fluorescein angiography, and indocyanine green angiography were performed and the eyeball was enucleated. We prepared the specimen for microscopic examinations.

Results: Fluorescein angiographic findings of the lesion were mottled hyperfluorescence in the arteriovenous phase and strong hyperfluorescence in the late phase. Hypofluorescence in both early and late phases showed on indocyanine green angiogram. The lesion of choroid was widely infiltrated by histiocytes, though no extraocular invasion was found. Immunohistochemical studies including S‐100 and CD 68 staining revealed characteristic features of Langerhans' cell histiocytosis. Electron microscopic examination of the histiocytes showed histiocytosis X body (Birbeck granule) in the cytoplasm and indented nucleus.

Conclusion: We consider that this is a case of choroidal Langerhans' cell histiocytosis with no evidence of systemic lesions.
Cyclosporine treatment of RPE allografts in the rabbit subretinal space
Authors: Crafoord Sven , Algvere Peep V. , Kopp Eva Dafgård , Seregard Stefan
Published: March 2003

Purpose: To determine the effects of systemic cyclosporine A (CsA) on the survival of retinal pigment epithelial (RPE) allografts in the subretinal space in an animal model using atraumatic transplantation surgery.

Methods: Following pars plana vitrectomy, an RPE cell suspension from brown rabbits was injected with a glass micropipette into the subretinal space of 39 albino rabbits. For immunosuppression, 22 rabbits were given an injection of CsA, 20 mg daily intramuscularly, 17 rabbits with RPE grafts were controls. The grafts were monitored by biomicroscopy, color fundus photography, and fluorescein angiography. Rabbits were sacrificed at 1, 3 and 6 months, respectively, and the eyes processed for light and electron microscopy including immunohistochemistry.

Results: After three months, the transplanted RPE cells, in both the CsA group and the controls, formed a monolayer in the subretinal space. Although a few macrophages were encountered, there was no massive cellular infiltration and the photoreceptor layer was well preserved. After six months, however, there was a disruption of grafted RPE cells in both groups, characterized by dispersion of melanin pigment in the subretinal space, and invasion of macrophages with focal photoreceptor damage but no infiltration of lymphocytes in the retina or choroid. No significant differences between the CsA treated and the control eyes were discernible.

Conclusion: Although the subretinal space has been considered an immunologically privileged site, we found that the survival of RPE allografts was limited. CsA did not prevent RPE allograft destruction in the subretinal space. The transplant seems to be disrupted either by immunological mechanisms that are not inhibited by CsA, or by nonimmunologic events.
Simultaneous, bilateral rhegmatogenous retinal detachment
Authors: Krohn Jørgen , Seland Johan H.
Published: March 2003

Purpose: To examine the incidence, the preoperative findings and the surgical outcome of patients presenting with simultaneous, bilateral retinal detachment.

Methods: A retrospective analysis of the medical records of patients undergoing surgery for rhegmatogenous retinal detachment between 1990 and 1998.

Results: During this period a total of 827 operations for rhegmatogenous retinal detachment were done in 791 consecutive patients. Eighteen patients (2.3%) had simultaneous, bilateral retinal detachment, giving an annual incidence of 0.35 patients per 100 000 population. They all presented with unilateral symptoms. Compared with the group of unilateral or consecutive, bilateral retinal detachments, patients suffering from simultaneous, bilateral retinal detachments were significantly younger, with a mean age of 40.3 years. Thirteen patients had multiple, round retinal holes associated with lattice degeneration. Sixteen patients were myopic, ranging from −3 to −9.25 diopters. The retina was reattached in 35 (97%) of the 36 eyes operated on during the study period.

Conclusion: Simultaneous, bilateral retinal detachment is usually found in relatively young, myopic patients with round, atrophic retinal holes, presenting with unilateral visual symptoms.
Stability of graft refractive power after penetrating keratoplasty
Authors: Isager Peter , Hjortdal Jesper Ø. , Ehlers Niels
Published: March 2003

Purpose: Patients needing penetrating keratoplasty (PK) and cataract extraction with intraocular lens (IOL) implantation may be handled with a single triple procedure or a two‐stage procedure with initial keratoplasty and cataract surgery in a later session. The latter approach is considered more safe by some surgeons and allows adjustment of the IOL power to the power of the actual corneal graft. The purpose of this study was to estimate the optimal timing of cataract surgery with IOL implantation by studying the refractive stability of 8 mm penetrating keratoplasty grafts.

Methods: Penetrating keratoplasty (8.0 mm graft and recipient bed) was performed in 28 eyes of 28 patients. Corneal topography (TMS‐1) was studied at 1, 2, 3, 6, and 12 months after surgery and after suture removal (30 months). The central spherical equivalent graft power was computed from the topographical data (rings 2 through 4).

Results: On average, the spherical equivalent graft power was stable from one month after surgery up to suture removal (range: 41.9 to 42.7 diopters). After suture removal the graft steepened slightly (0.7 diopters). Corneal refractive power of single grafts fluctuated considerably over time. The standard deviation on time‐dependent changes in graft power was from 3 months efter PK smaller than the standard deviation on the graft powers at 12 months.

Conclusion: The average central spherical equivalent power of an 8.0 mm donor graft in an 8.0 mm recipient bed was stable from one month after penetrating keratoplasty until suture removal. A two‐stage procedure with cataract surgery performed 3 months after PK can, compared to the triple procedure, reduce postoperative ametropia at 12 months if graft topography is taken into consideration at the time of cataract surgery. We recommend that cataract surgery with IOL implantation takes place from 3 months after penetrating keratoplasty.
Hemostatic effects of SF6 after diabetic vitrectomy for vitreous hemorrhage
Authors: Koutsandrea CH. N. , Apostolopoulos M. N. , Chatzoulis D. Z. , Parikakis E. A. , Theodossiadis G. P.
Published: March 2003

ABSTRACT. Purpose: To investigate the hemostatic effects of SF6 gas in preventing postoperative vitreous hemorrhage in diabetic vitrectomy.

Methods: A prospective, randomized study of 33 diabetic eyes with vitreous hemorrhage, treated by vitrectomy. In 17 of our cases SF6 20% was injected into the eye at the end of the operation, while in 16 cases BSS remained in the vitreous cavity.

Results: The incidence of vitreous hemorrhage recurrence was 17.6% for the SF6 group and 12.5% for the BSS group (statistically not significant). Progression of lens opacities was observed in 23.5% of the SF6 group, and in 18.8% of the BSS group (statistically not significant, with a higher incidence in the SF6 group).

Conclusions: SF6 gas did not show hemostatic effects in the cases studied. Furthermore, it may have contributed to cataract progression. Therefore we suggest that the use of SF6 is not recommended as a treatment modality in preventing new vitreous hemorrhage after diabetic vitrectomy.
Results of a neurosurgical two‐wall orbital decompression in the treatment of severe thyroid associated ophthalmopathy
Authors: Linnet J. , Hegedüs L. , Bjerre P.
Published: March 2003

ABSTRACT. Purpose: Follow‐up of patients with severe thyroid associated ophthalmopathy treated with a transcranial two‐wall orbital decompression and reconstruction.

Methods: A two‐wall transcranial orbital decompression was performed in 30 such patients (50 eyes). The patients were evaluated one month postoperatively, and long‐term evaluation (median 14 months, range 2–54 months) was carried out. The main outcome measures were visual acuity, proptosis measured by Hertel ophthalmometry, soft tissue involvement, and restriction of eye motility.

Result:

Visual acuity improved rapidly in 28 of 32 affected eyes with normalization in 19 eyes (p<0.001). Worsening was not seen. Median proptosis was reduced by 4.0 mm, range 0–10.0 (p<0.001). Double vision was present in 24 patients before operation 14 of whom achieved binocular vision (p<0.001). Three patients had unchanged complaints and the double vision worsened in one patient. Seventeen of 20 patients on preoperative corticosteroid treatment discontinued this medication in relation to surgery. Complications included one case of perioperative minor stroke and two cases of facial nerve frontal branch palsy.

Conclusion: The transcranial two‐wall decompression is a simple, an efficient and a low‐risk procedure for treatment of patients with severe thyroid associated ophthalmopathy.
Maculopathy and visual acuity in newly diagnosed type 2 diabetic patients and non‐diabetic subjects: A 10‐year follow‐up study
Authors: Voutilainen‐Kaunisto Raija , Teräsvirta Markku , Uusitupa Matti , Niskanen Leo
Published: March 2003

ABSTRACT. Purpose: The long‐term evolution of diabetic maculopathy and visual acuity and their risk factors in patients with newly diagnosed Type 2 diabetes and in control subjects.

Methods: A 10‐year prospective study consisting of a representative group of 133 (70 men, 63 women) newly diagnosed Type 2 diabetic patients diagnosed at health centers between 1979 and 1981 and 144 (62 men, 82 women) non‐diabetic control subjects recruited from the population register. The frequency of maculopathy was determined by grading of 45 ° fundus photographs and fluorescein angiograms. The subjects were studied at baseline and after 5 and 10 years.

Results: The frequency of maculopathy in Type 2 diabetic patients was low at the time of diagnosis but increased sharply after 5 years of the disease and at the 10‐year examination 21% of diabetic patients had signs of maculopathy. By the 10‐year follow‐up the visual acuity declined more markedly in the diabetic patients than in the control subjects. Poor glycaemic control was the most important predictive factor for the development of maculopathy as well as deterioration of visual acuity.

Conclusions: In newly diagnosed patients with Type 2 diabetes one‐fifth had developed maculopathy which deteriorated their visual acuity. Poor glycaemic control was the most important predictor of maculopathy.
Age‐related utilisation of cataract surgery in Sweden during 1992–1999. A retrospective study of cataract surgery rate in one‐year age groups based on the Swedish National Cataract Register
Authors: Lundström Mats , Stenevi Ulf , Thorburn William
Published: March 2003

ABSTRACT. Purpose: To study the utilisation and increase of first eye cataract surgery in one‐year age groups between 60 and 90 years of age during 1992–1999.

Methods: Data was extracted from the National Swedish Cataract Register (NCR) that covers about 93.2% of all cataract extractions performed in Sweden during 1992–1999. The total number of living persons in each one‐year age group was collected from the Year Book of Statistics in Sweden (1993–2000).

Results: The number of cataract extractions in Sweden increased by 54.8% from 1992 to 1999. The rates of first eye cataract surgery in one‐year age groups between 60 and 90 years of age were different for females and males and this difference did not change during a 37% increase of the surgery volume from 1992 to 1999. The rate of first eye cataract surgery increased significantly both for females (+29.4%) and males (+27.2%) during 1992 to 1999 in Sweden.

Conclusion: The rate of first eye cataract surgery increased significantly from 1992 to 1999 but the gender difference in age‐related utilisation of surgery remained unchanged. The increase in rate was about the same in all age groups.
Macular star associated with posterior hyaloid detachment
Authors: Akura Junsuke , Ikeda Tomohiro , Sato Keiko , Ikeda Naohiro
Published: March 2003

ABSTRACT. Purpose: To report a patient with a Leber’s idiopathic stellate neuroretinitis‐like lesion that was caused by vitreous traction accompanying a posterior hyaloid detachment.

Methods: We present a 49‐year‐old woman who showed segmental optic disc edema, peripapillary retinal detachment, and a macular star.

Results: An incomplete posterior hyaloid detachment was present, and the posterior hyaloid membrane was attached to the nasal margin of the optic disc. Fluorescein angiography revealed a bent retinal artery on the upper margin of the optic disc, and leakage of fluorescein was observed from this area.

Conclusion: Vascular damage to the optic disc due to vitreous traction should also be considered as a mechanism for the ophthalmoscopic appearance of the fundus when lesions suggestive of Leber’s idiopathic stellate neuroretinitis are present in an adult.
Acute posterior multifocal placoid pigment epitheliopathy and ulcerative colitis: a possible association
Authors: Di Crecchio Lorenzo , Parodi Maurizio Battaglia , Saviano Sandro , Ravalico Giuseppe
Published: March 2003

ABSTRACT. Purpose: To report a case of Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE) in the course of Ulcerative Colitis (UC).

Methods: A complete ophthalmologic evaluation, including fluorescein and indocyanine green angiography, was performed.

Results: A patient with exacerbation of UC was referred to our department for sudden visual loss in RE. Ophthalmoscopy disclosed multifocal yellow‐white placoid lesions typical of APMPPE in RE. There were no lesions in the fellow eye. On fluorescein angiography (FA), the active lesions showed early hypofluorescence, followed by late staining. Indocyanine green angiography (ICGA) revealed early and late hypofluorescence corresponding to the lesions observed clinically, and late anular staining surrounding a hypofluorescent lesion at the posterior pole. On LE ICGA revealed lesions not detected with ophthalmoscopy and FA. After corticosteroid therapy the lesions healed.

Conclusion: Ulcerative Colitis may be responsible for the onset of AMPPPE by an immunological mechanism of delayed type hypersensitivity reaction.
The prevalence and causes of bilateral and unilateral blindness in an elderly urban Danish population. The Copenhagen City Eye Study
Authors: Buch Helena , Vinding Troels , La Cour Morten , Nielsen Niels Vesti
Published: March 2003

Purpose: To study the prevalence and causes of bilateral and unilateral blindness in an elderly urban Danish population.

Methods: Data originated from a Danish epidemiologic cross‐sectional random sample population eye survey conducted during the years 1986–1988. The population consisted of 1,000 inhabitants aged 60 to 80 years in Copenhagen. The participants underwent an extensive ophthalmologic examination. A participation rate of 96.9% was achieved. Any blindness was defined as best‐corrected visual acuity (VA) worse than 0.05 (the WHO criteria) and VA of 0.1 or worse (the National criteria (NC) of blindness).

Results: The prevalence rates of bilateral and unilateral blindness were, respectively, 0.53% and 3.38% according to WHO, but 1.06% and 4.44% using NC. Bilateral blindness rose significantly with age (p=0.02). According to NC, age‐related macular degeneration (AMD) was the leading cause of bilateral blindness, accounting for 60% of all blind persons. Glaucoma, myopic macular degeneration, cataract and retinitis pigmentosa were jointly the second most common cause, each accounting for 10% of all bilaterally blind persons. Diabetic retinopathy was not a cause of bilateral blindness. Amblyopia was the most frequent, AMD the second most frequent, and diabetic retinopathy was among the third most common cause of unilateral blindness accounting for, respectively, 28.60%, 16.66% and 9.52% of all unilateral blindness.

Conclusions: Blindness was associated with increasing age. A calculation indicates that among Danes aged 60 to 80 years 7,736 are bilaterally blind and 35,503 suffer from unilateral blindness. This study highlights AMD as the most important cause.
Influence of laser irradiation on endogenous hyaluronan in rabbit iris and aqueous humor
Authors: Koralewska‐Makár Anna , Johnsson Cecilia , Bruun Anitha , Stenevi Ulf , Ehinger Berndt
Published: March 2003

Purpose: To monitor changes of endogenous hyaluronan in the iris tissue and aqueous humor after an isolated trauma to the iris by argon laser irradiation of the anterior surface of the iris.

Methods: Iris and aqueous hyaluronan concentrations in rabbit were measured with a radiometric assay at different time points after laser irradiation.

Results: Total hyaluronan content in iris tissue increased 3‐fold to a peak concentration of 71–72 μg/g at 1 and 2 days after laser treatment. Aqueous hyaluronan increased to a maximum of about 1.6 μg/ml at 2 h and 12 h after laser irradiation of the iris.

Conclusions: The iris tissue responds with increased hyluronan synthesis to an isolated iris argon laser irradiation and it seems to be the most important source of aqueous hyaluronan.
Electroretinogram contact lens electrode with tri‐color light‐emitting diode
Authors: Mizunoya Satoshi , Kuniyoshi Kazuki , Arai Mikki , Tahara Kyoji , Hirose Tatsuo
Published: March 2003

Purpose: This study was performed to evaluate a new electroretinogram (ERG) contact lens electrode containing four light‐emitting diodes (LEDs) that are used for both stimulus and background light.

Methods: The luminance of each LED could be changed independently and used as stimulus light. Red, blue, bright white, and flickering ERGs were recorded in 12 normal subjects and two patients with progressive cone dystrophy. The long‐duration light stimuli separated the on‐ and off‐responses of the ERG. This equipment is not according to the ISCEV standard.

Results: The tri‐color LED electrode contact lens can efficiently produce and record ERG responses. Off‐responses were recordable separately from on‐responses by lengthening the stimulus duration.

Conclusion: This combined stimulus‐electrode system is compact and portable. Combined with the portable amplifier and the recorder, the ERGs can be recorded easily in an operating room, at patients’ bedsides, and in remote locations away from clinics and hospitals.
Corneal grafting for keratoconus in mentally retarded patients
Authors: Haugen Olav H. , Høvding Gunnar , Eide Geir Egil , Bertelsen Torstein
Published: March 2003

Purpose:To compare the results of penetrating and non‐penetrating corneal grafting procedures in mentally retarded keratoconus patients.

Methods:In the years 1974–2000 41 mentally retarded patients with keratoconus (33 with Down syndrome) were operated with corneal grafting. Mean age at operation was 36.7±10.8 years. Three different surgical procedures were used (no randomization): penetrating keratoplasty (n=16), lamellar keratoplasty (n=5) and epikeratophakia (n=20). In a retrospective study, the non‐penetrating procedures (lamellar keratoplasty and epikeratophakia) were compared to the penetrating keratoplasties with regard to graft survival and frequency of serious complications. Mean follow‐up time of all grafting procedures was 80±58 months.

Results:All cases of serious complications (irreversible rejection, wound leakage or perforation) occurred in the penetrating keratoplasty group (p=0.0005). Older age at operation (p=0.011) adversely influenced the frequency of serious complications. Overall five‐year survival was 74.9%. Graft survival was not related to surgical procedure, but rather to age at operation (poorer survival in older age, p=0.012) and degree of retardation (poorer survival in patients with more severe retardation, p=0.051).

Conclusions:Because of the safety and low frequency of complications, epikeratophakia is recommended as the grafting procedure of choice in the majority of mentally retarded with keratoconus. In selected cases (good cooperation, age ≤40 years, and a good peripheral corneal thickness) penetrating keratoplasty may be performed, which, if uncomplicated, often will give better functional/optical results.
Optic disc biomorphometry with the Heidelberg Retina Tomograph at different reference levels
Authors: Vihanninjoki Kyösti , Burk Reinhard O.W. , Teesalu Pait , Tuulonen Anja , Airaksinen P Juhani
Published: March 2003

Purpose: The Heidelberg Retina Tomograph (HRT) is a confocal scanning laser tomograph that produces high resolution optical section images of the optic disc and central retina. Measurement accuracy and reproducibility is good. Several of the stereometric variables depend on the definition of a reference plane level. The purpose of the present study was to evaluate the four different reference levels in terms of their advantages and disadvantages in clinical work.

Methods:
Sixty‐seven randomly chosen eyes belonging to 67 subjects were included in this study. Forty of the eyes were healthy and 27 had glaucoma. The HRT with software versions 1.09 and 1.11 was used to acquire and evaluate topographic measurements of the optic disc. Image analysis was performed at four different reference levels: 320 µm fixed offset reference level (REFd) (version 1.09), an individually determined reference level (REFi), a papillo‐macular reference level (REFm) and a flexible reference level (REFf) (version 1.11). ANOVA was used to determine differences in the topographic parameters between the reference levels.

Results: In terms of the healthy eyes, all the variables using different reference levels give rather similar results. However, with advanced glaucoma the measurement values provided with REFd are clearly different to those of the other reference levels. The measurement values using REFm and REFf provide fairly similar results in all clinical groups. REFf indicates the lowest point in the segment between 350° and 356° along the contour line and thus provides the most stable and clinically useful reference level at present.

Conclusion: At present, the flexible reference level REFf gives the most reliable and adequate HRT measurement values, both in normal and in glaucomatous eyes.
On the origin of intrinsic matrix of acellular extrinsic fiber cementum: Studies on growing cementum pearls of normal and bisphosphonate‐affected guinea pig molars
Authors: Jayawardena Chantha K. , Takahashi Nobuyuki , Watanabae Eiko , Takano Yoshiro
Published: March 2003

Cementum pearls (CPs) belong to a type of acellular extrinsic fiber cementum (AEFC) that form on the maturing enamel of guinea pig molars. This study aimed to elucidate the forming process of intrinsic matrix of AEFC using the CPs of normal and bisphosphonate‐affected guinea pig molars as experimental models. A group of guinea pigs were subjected to continuous administration of 1‐hydroxyethylidene‐1,1‐bisphosphonate (HEBP) for 2 wk to inhibit mineralization of growing CPs. Fenestration of the enamel organ and migration of periodontal cells on to the exposed surface of maturing enamel appeared to be unaffected by HEBP, whereas de novo formation as well as growth of pre‐existing CPs did not proceed under the same conditions. Immunoreactions for osteopontin were located exclusively on the mineralized matrix of preformed CPs, implying the absence of additional deposition or accumulation of putative intrinsic cementum matrix on the affected CPs, where the propagation of mineral phase had been arrested. In both normal and HEBP‐treated groups, distinct enzymatic reactions for alkaline phosphatase appeared on the cells of the periodontal ligament associated closely with the sites of CP formation, and along the mineralization front of CPs. These observations suggest that the mineralization process per se plays a central role in the deposition of AEFC matrix and that alkaline phosphatase of periodontal cells penetrating through the enamel organ to the maturing enamel surface plays a key role in the mineralization process of CPs.
Detection of orientation‐specific anti‐gp120 antibodies by a new N‐glycanase protection assay
Authors: Gram G. J. , Bolmstedt A. , Schønning K. , Biller M. , Hansen J.‐E. S. , Olofsson S.
Published: March 2003

Several functions have been assigned to the extensive glycosylation of HIV‐1 envelope glycoprotein gp120, especially immune escape mechanisms, but the intramolecular interactions between gp120 and its carbohydrate complement are not well understood. To analyse this phenomenon we established a new microwell deglycosylation assay for determining N‐linked glycan accessibility after binding of gp120‐specific agents. Orientation‐specific exposition of gp120 in ELISA microplates was achieved by catching with either anti‐C5 antibody D7324 or anti‐V3 antibody NEA‐9205. We found that soluble CD4 inhibited the deglycosylation of gp120 only when gp120 was caught by D7324 and not by NEA9205. In contrast, antibodies from HIV‐infected individuals inhibited the deglycosylation best when gp120 was caught by NEA9205. These results demonstrated that both the CD4‐binding site and the epitopes recognised by antibodies from HIV‐infected individuals have N‐glycans in the close vicinity. However, the difference in gp120 orientation indicates that antibodies in HIV‐infected individuals, at least partly, bind to epitopes different from the CD4‐binding site.

Finally, we determined the structural class of the glycan of one V1 glycosylation site of prototype HIV‐1 LAI gp120, which remained unsolved from previous studies, and found that it belonged to the complex type of glycans.
Platelet‐activating factor and lyso‐PAF possess direct antimicrobial properties in vitro
Authors: Steel H. C. , Cockeran R. , Anderson R.
Published: March 2003

The effects of platelet‐activating factor (PAF) and lyso‐platelet‐activating factor (L‐PAF) at concentrations of 0.25–20 μg/ml on potassium transport and growth of gram‐positive and gram‐negative bacteria have been investigated in vitro and compared with those of lysophosphatidylcholine (LPC). Potassium transport was determined using 86Rb+ as tracer, while growth was measured according to the extent of uptake of radiolabeled amino acids. All of the test phospholipids caused dose‐related inhibition of 86Rb+‐uptake and growth of gram‐positive bacteria, the order of potency being PAF>LPC>L‐PAF. Gram‐negative bacteria, on the other hand, were less sensitive to the inhibitory effects of the phospholipids on K+ transport and growth. Some, but not all, of the gram‐positive and gram‐negative bacteria were able to degrade LPC, but not PAF or L‐PAF, demonstrating that enzymatic degradation of phospholipids does not explain the differential sensitivity to these agents. The bioactive phospholipids LPC, PAF and L‐PAF may represent an oxygen‐independent antimicrobial host defense system operative primarily against gram‐positive bacteria.