bluuebunny/crossref_metadata_2025 huggingface dataset:
Relation of estrogen receptor expression in endometrial cancer specimens to bone mineral density
Authors: DOUCHI TSUTOMU , TSUJI TAKAHIRO , TOKUHISA TAKUYA , FUJIE YUKA , KATANOZAKA MARI , YOSHINAGA MITSUHIRO , NAGATA YUKIHIRO
Published: March 2003

Background. To investigate the relation of estrogen and progesterone receptor (ER and PR) expression in endometrial cancer specimens to bone mineral density (BMD).

Materials and methods. Subjects were 48 postmenopausal women with endometrial cancer treated with hysterectomy. Baseline characteristics included age, years since menopause (YSM), height, weight, and body mass index (BMI). Lumbar spine BMD (L2–4), the ratio of trunk fat to leg fat mass (trunk‐leg fat ratio), body fat mass, and the percentage of body fat were measured by dual‐energy x‐ray absorptiometry (DEXA). ER and PR expression in endometrial cancer specimens were determined immunohistochemically.

Results. Of 48 women, 32 (66.7%) were ER/PR‐positive, nine (18.8%) were ER/PR‐negative, three (6.3%) were ER‐positive/PR‐negative, and four (8.3%) were ER‐negative/PR‐positive. Lumbar spine BMD and trunk‐leg fat ratio were significantly higher in women with ER‐positive than in those with ER‐negative (p<0.05), but other variables did not differ between the two groups. BMD and baseline‐ and anthropometric characteristics did not differ between the two groups divided by the presence or absence of PR expression.

Conclusions. ER expression in endometrial cancer specimens is associated with higher lumbar spine BMD.
Effects of leptin on basal and FSH stimulated steroidogenesis in human granulosa luteal cells
Authors: GREISEN SUSANNE , LEDET THOMAS , MØLLER NIELS , JØRGENSEN JENS OTTO LUNDE , CHRISTIANSEN JENS SANDAHL , PETERSEN KARSTEN , OVESEN PER
Published: March 2003

Background. Body weight influences fertility and studies in mice have indicated that leptin is one of the mediators of this effect. Leptin is believed to centrally stimulate the hypothalamic‐pituitary axis resulting in increased gonadotropin release. Moreover, leptin is present in follicular fluid and the receptor is expressed in the human ovary. The aim of this study was to evaluate the direct effect of leptin on cultured human granulosa cell steroidogenesis.

Methods. Granulosa cells were obtained in connection with IVF procedures, and then cultured in a serum‐free medium containing androstenedione (1 μM) for a total of 4 days. After 2 days of culture the medium was changed and the hormones under study were added. We tested the effect of leptin (1, 20, 100 ng/ml) on basal, FSH (10–100 ng/ml), and FSH (10–100 ng/ml)+IGF‐I (30 ng/ml) stimulated steroidogenesis.

Results. Leptin (20 ng/ml and 100 ng/ml) significantly reduced basal and FSH‐stimulated estradiol secretion (p<0.05). Basal and FSH (10 and 30 ng/ml) stimulated progesterone production was significantly inhibited by leptin 20 ng/ml, whereas leptin 100 ng/ml significantly reduced basal but not FSH stimulated progesterone production. Finally, steroidogenesis stimulated by IGF‐I alone and in combination with FSH was not influenced by leptin.

Conclusion. These results suggest that leptin acts directly to inhibit basal and FSH stimulated estradiol and progesterone production in cultured human granulosa cells. This raises the possibility that high circulating leptin levels as seen in obese women may compromise fertility through peripheral mechanisms.
Effectiveness of the conveen continence guard (a disposable vaginal device) in the treatment of complicated female stress incontinence
Authors: NILSSON CARL GUSTAF
Published: March 2003

Background. Treatment alternatives for women with stress urinary incontinence, complicated by prior unsuccessful surgery or concomitant diseases that prevent surgical intervention are limited. The aim of this study was to investigate the usefulness and effectiveness of a disposable vaginal device, the Conveen Continence Guard, in cases where surgery was not recommended for treatment of stress urinary incontinence.

Methods. Twenty‐eight women, with a urodynamically proven stress urinary incontinence, were offered the use of a vaginal device during a prospective three‐week treatment period. Objective and subjective prevention of urinary leakage was assessed by a 24‐h pad‐weighing test, by a visual analog scale and a quality of life questionnaire. At the end of the treatment period the women answered a questionnaire on the ease and comfort of use of the device.

Results. Of the nineteen women who completed the study, 89.5% were cured or improved according to subjective assessments, the respective figure being 84.2% according to objective assessment.

Conclusion. The Conveen Continence Guard seems to be a promising treatment alternative for women for whom other treatment methods have failed. The device was well tolerated by the women and was regarded easy to use.
Carcinoma of the cervical stump. The Radiumhemmet series 1959–1987. Treatment and prognosis
Authors: Hellström Ann‐Cathrin , Sigurjonson Thore , Pettersson Folke
Published: March 2003

Background. The purpose of this retrospective study is to evaluate the longterm prognosis for cervical stump cancer compared to matched controls with cancer in an intact uterus.

Methods. From 1959 to 1987, 145 patients were treated for an infiltrating carcinoma of the cervical stump at Radiumhemmet representing 2.2% of all cervical cancers. Three control cases to each case were selected from the cohort of cervical carcinoma cases – matched to year of treatment, stage, histology and age (plus, minus 2 years). Actuarial survival was calculated for cases and controls. Survival differences were analyzed with the Kaplan‐Meier technique. The age distribution for cases ranged between 36 and 84 years with a mean age of 60.6 years. The mean age for the control series is 9 years of age (range 35–86 years). Among the cases 87.6% were squamous cell carcinoma and 12.4% were adenocarcinomas. Treatment of carcinoma of the uterine stump at Radiumhemmet followed the same modality as was practised for ordinary cervical cancer cases i.e. two brachyradium applications with 3 weeks interval followed by external irradiation. The dose of irradiation from the intracavitary application given to the stump cancers was lower than that given to comparable cases of the common cervical cases.

Results. No evidence was found of poorer longterm prognosis for radiologically treated squamous cell carcinoma of the uterine stump compared to that of the ordinary cervical carcinomas. Stump cancers of the adenocarcinoma type had a worse prognosis than adenocarcinomas in an intact uterus (p<0.07) and also compared with stump cancers of the squamous epithelial type (p=0.05). The complication rate was higher for the stump cancer cases compared with that for cervical cancers in intact uterus. The mean time interval from subtotal hysterectomy to the stump cancer diagnosis was 17.6 years with a range from 1 to 46 years.

Conclusions. Recent discussions argue for a better sexual function after subtotal hysterectomy. Our study gave no convincing argument in terms of poorer prognosis for radiologically treated carcinoma of the uterine stump compared to that of the total cervical cancer series. It is thus necessary to weigh the possible gains with subtotal hysterectomy against the relatively low risk to fall victim of a stump cancer. Complications following surgery, as well as possible physiologic and sexual functions of the cervix, should be taken into account.
Child births in a modified midwife managed unit: Selection and transfer according to intended place of delivery
Authors: Holt Jan , Vold Ingar Nikolai , Backe Bjørn , Johansen May Vollnes , Øian Pål
Published: March 2003

Background. As small obstetrical departments may not be able to give second‐level perinatal care, the delivery unit at Lofoten hospital was for the years 1997–98 reorganized to a modified midwife managed unit. Women at low obstetrical risk were delivered at this unit and women at high risk were referred to the central hospital. We assessed the effectiveness of the risk selection.

Material and methods. The study was a prospective, pragmatic, population‐based trial. Desired outcome was defined as a non‐operative delivery at 35–42 weeks gestational age giving an infant not needing resuscitation. Intermediate outcomes: Operative deliveries, infants transferred to neonatal intensive care unit and infants diverging from normal. The intended place of delivery was ultimately decided at admittance to the midwife managed unit.

Results. Of the 628 women in study 435 (69.3%) gave birth at the midwife managed unit, 152 (24.2%) were selected to be delivered at the central hospital and 41 (6.5%) were transferred to the central hospital after admittance to the midwife managed unit. Desired outcome was recorded in 94% of the deliveries at the midwife managed unit as compared to 50.3% at the central hospital. Women who intended to be delivered at the midwife managed unit, needed fewer operative deliveries and relatively few infants were transferred to the neonatal intensive care unit or diverged from normal.

Conclusions. As nearly 70% of the births occurred at the midwife managed unit and 94% of these deliveries had a desired outcome, this indicates an effective selection process. This model might be an alternative to centralization of births in sparsely population areas.
Symptoms across pregnancy in relation to psychosocial and biomedical factors
Authors: Rodriguez Alina , Bohlin Gunilla , Lindmark Gunilla
Published: March 2003

Background.There is current interest in symptoms during pregnancy, but yet little is known about their prevalence and how often they are experienced across pregnancy. The reasons why some women experience more symptoms or experience them more often than others has received limited research attention.

Objective.To document the prevalence and frequency of 27 pregnancy symptoms and to systematically investigate, cross‐sectionally and prospectively, the effect of psychosocial factors on the prevalence and frequency of these symptoms, while controlling for biomedical factors.

Methods.Four hundred and seventy‐six nulliparous Scandinavian women who attended routine prenatal care in Uppsala county, Sweden, were studied six times during pregnancy (gestational weeks 10, 12, 20, 28, 32, and 36).

Results.The prevalence of symptoms was high, but only a smaller portion of these symptoms were experienced frequently. Psychological stress particularly contributed to the prevalence and frequency of concurrent symptoms and predicted symptoms up to 16 weeks later, independent of medical risk, smoking, and weight gain.

Conclusions.Prevalence rates may be inflated, because many symptoms were experienced only ‘occasionally’ during each of the 4‐week periods we sampled. By examining how frequently symptoms were experienced, we gained an indication of which symptoms are more likely to be bothersome or intrude upon daily activities. Psychosocial variables accounted for individual differences in symptom reports after taking biomedical factors into account. Attention to psychosocial variables in future studies will aid in our understanding of the etiology of pregnancy symptoms.
Peritoneal fluid concentrations of interleukin‐4 in relation to the presence of endometriosis, its stage and the phase of the menstrual cycle
Authors: Gazvani M. Rafet , Bates Michelle D. , Vince Gillian S. , Christmas Stephen E. , Lewis‐Jones D. Iwan , Kingsland Charles R.
Published: March 2003

Background. Interleukin‐4 (IL‐4) is a cytokine with both stimulatory and inhibitory effects on the inflammatory system such as macrophage inhibition and T‐cell activation. It is known to regulate several monocyte functions, including inhibition of the synthesis of cytokines such as IL‐1, IL‐6 and TNF‐α as well as potentiating IL‐8.

Method. In an attempt to clarify the association between IL‐4 and endometriosis, we measured the concentration of IL‐4 in the peritoneal fluid of 52 women; 24 with endometriosis and 28 with no endometriosis, controlling for the phase of the cycle and the stage of disease.

Results. There was no difference in the concentrations of IL‐4 between women with (n=28) and without endometriosis (n=24). No difference was found between the IL‐4 concentrations in women with different stages of endometriosis. Levels of IL‐4 did not show a difference according to the phase of the cycle in either group.

Conclusion. Our results indicate no association between peritoneal fluid levels of IL‐4 and endometriosis and hence suggest that IL‐4 is not involved in the pathogenesis of endometriosis.
Psychological distress before and after prenatal invasive karyotyping
Authors: Cederholm Maria , Sjödén Per‐Olow , Axelsson Ove
Published: March 2003

Background. The aim was to evaluate the psychological and physical impact on women submitting to early amniocentesis or chorionic villus sampling and their preferences concerning fetal invasive procedures in a forthcoming pregnancy.

Method. Fifty‐one women undergoing early amniocentesis or chorionic villus sampling at 10–13 weeks gestation participated. The women completed questionnaires including the Hospital Anxiety and Depression Scale on three occasions: before, immediately after, and one week after the invasive procedure.

Results. The women were more concerned about a spontaneous abortion and waiting for the result than about a possible unreliable result. A majority of the women did not worry about the risk of fetal injury induced by the procedure. More women in the chorionic villus sampling group found the invasive procedure to be physically straining. Two‐thirds of the women experienced no or minor psychological strain but one‐third experienced major strain. Approximately 20% were classified as doubtful cases and cases of clinical anxiety. Nearly all women would choose to have an invasive procedure of the same kind in a forthcoming pregnancy.

Conclusions. The psychological and physical impact on women undergoing invasive procedures for fetal karyotyping does not constitute a major clinical problem. However, a certain number of women report distress and anxiety which should be attended to by professionals involved in fetal invasive procedures. These women may benefit from more support.
Anal sphincter damage after vaginal delivery: functional outcome and risk factors for fecal incontinence
Authors: De Leeuw Jan Willem , Vierhout Mark E. , Struijk Piet C. , Hop Wim C. J. , Wallenburg Henk C. S.
Published: March 2003

Objective. To assess the role of anal sphincter damage following delivery in the development of anorectal complaints and urinary incontinence, and to identify obstetric factors associated with subsequent fecal incontinence.

Methods. The retrospective cohort study with matched controls used a postal questionnaire and analysis of delivery and operation records from all women who underwent primary repair of a third or fourth degree perineal rupture in our hospital between 1971 and 1991, and their controls, matched for date and parity. Frequencies of complaints were compared using the Mantel‐Haenszel common odds ratio [OR] for matched‐control studies. Obstetric risk factors for fecal incontinence were assessed with multivariate logistic regression analysis.

Results. In the period studied, 171 women underwent a primary repair. One hundred and forty‐seven of which returned the questionnaire (86%), compared with 131 of the controls (73%). Analysis was performed on 125 matched pairs with a median follow‐up of 14 years. Fecal incontinence was reported by 39 patients and 16 controls (OR: 3.09; 95% confidence interval: 1.57–6.10). Urinary incontinence was reported by 65 cases and 52 controls (OR:1.46; 95% CI: 0.91–2.37). Among women with anal sphincter damage, the extent of anal sphincter damage was an independent risk factor for fecal incontinence. (OR: 2.54; 95% CI: 1.45–4.45). Subsequent vaginal delivery was not associated with the development of fecal incontinence (OR: 2.32; 95% CI: 0.85–6.33). In primiparous women mediolateral episiotomy protected for fecal incontinence after anal sphincter damage (OR: 0.17; 95% CI: 0.05–0.60).

Conclusions. Anal sphincter damage following delivery is significantly associated with subsequent anorectal complaints, but not with urinary incontinence. The extent of sphincter damage is an independent risk factor for the development of fecal incontinence. Mediolateral episiotomy protects for fecal incontinence in primiparous women.
Diagnostic evaluation of intrauterine fetal deaths in Stockholm 1998–99
Authors: Karin Petersson , Katarina Bremme , Roger Bottinga , Alexandra Hofsjö , Ingela Hulthén‐Varli , Marius Kublickas , Margareta Norman , Nikos Papadogiannakis , Kjell Wånggren , Kerstin Wolff
Published: March 2003

Background. To evaluate the diagnostic methods and to elucidate the etiology of intrauterine fetal death.

Material and methods. A prospective study was conducted on all intrauterine fetal deaths occurring in Stockholm County in 1998–99. During a 24‐month period, 188 cases of intrauterine fetal death with gestational ages of ≥ 22 weeks were investigated in accordance with structured test protocol. All information from antenatal and delivery records as well as all test results were entered in to an Internet‐based database for continuous evaluation.

Results. A presumptive explanation to the stillbirth was established in 91% of the cases. The most common factors associated with intrauterine fetal death could be identified as infections (24%), placental insufficiency/intrauterine growth restriction (22%), placental abruption (19%), intercurrent maternal conditions (12%), congenital malformations (10%), and umbilical cord complications (9%).

Conclusions. A relevant test protocol in cases of intrauterine fetal death reduces the number of unexplained cases to a minimum. An Internet‐based register on test results of fetal deaths may enable a continuous evaluation of the diagnostic tools and etiologic factors in an ever‐changing panorama. The results from the present study can serve as a base for a case‐control study in Sweden.
The value of routine estradiol monitoring in assisted conception cycles
Authors: Thomas Kevin , Searle Tom , Quinn Alison , Wood Simon , Lewis‐Jones Iwan , Kingsland Charles
Published: March 2003

Background. Traditional monitoring of an in vitro fertilization (IVF) treatment cycle includes regular estradiol levels and ultrasound scans in an attempt to reduce the risk of ovarian hyperstimulation syndrome (OHSS). The need for estradiol monitoring remains controversial.

Methods. We reviewed 538 consecutive cycles of IVF that were carried out in our unit to ascertain whether routine estradiol monitoring was of help in preventing OHSS and could be used to predict treatment outcome. Two hundred and sixty‐eight patients had their ovarian response monitored with ultrasound (USS) and estradiol levels on the day of hCG administration. The following 270 had USS monitoring but only had an estradiol level checked if they were deemed to be at high risk of OHSS (> 20 follicles on USS or symptomatic).

Results. Pregnancy rates per treatment cycle and per embryo transfer were similar in the two groups (all p > 0.05). There were two patients in each group requiring admission to hospital for OHSS.

Conclusions. Estradiol levels did not correlate with IVF outcome. In summary therefore estradiol levels are a poor predictor of treatment success and done routinely do not reduce the incidence of OHSS. It is only necessary to measure the estradiol level in those patients at risk of OHSS on USS monitoring.
An evaluation of midwives' counseling of pregnant women in fear of childbirth
Authors: Ryding Elsa Lena , Persson Asa , Onell Cecilia , Kvist Linda
Published: March 2003

Acta Obstet Gynecol Scand 2003; 82: 10–17. © Acta Obstet Gynecol Scand 2003

Background.  The aim of this clinical evaluation was to study birth experience, post‐traumatic stress symptoms, and satisfaction with care in new mothers who had consulted specially trained midwives because of a fear of childbirth during pregnancy.

Methods.  Sixty‐two women were eligible for the study, of whom 53 (85%) participated at 1–14 months postpartum. For comparison, a group of 53 women were matched for parity and mode of delivery. All 106 women completed two self‐rating scales, the Wijma Delivery Experience Questionnaire (W‐DEQ) and the Impact of Event Scale (IES), and answered several open questions about their opinion of the antenatal preparation given.

Results.  Those women who had been treated for fear of childbirth reported a rather more frightening experience of delivery, and more frequent symptoms of post‐traumatic stress related to delivery than did the women in the comparison group. Nevertheless, satisfaction with care was manifest in the study group.

Conclusions.  Women who seek help for fear of childbirth are a vulnerable group. Because the counseling received by the women in this study did not accord them the same positive experience of childbirth as the average parturient at the unit, more effective forms of treatment may be necessary. However, as most of the women were very satisfied with their care and with the outcome, one may assume that the care given had improved their situation to some degree.
Comparability of three‐dimensional optic disc imaging with different techniques
Authors: Gundersen Kjell Gunnar , Heijl Anders , Bengtsson Bo
Published: March 2003

Purpose: We wanted to compare optic nerve head topography measurements and discrimination between normal and glaucomatous eyes with two entirely different three‐dimensional optic disc imaging techniques, confocal scanning laser tomography (Heidelberg Retina Tomograph, Heidelberg Engineering) and raster tomography (Glaucoma‐Scope, Ophthalmic Imaging Systems).

Methods: Both eyes of 225 normal subjects and 229 eyes of 166 patients with glaucoma at different stages were imaged with the Heidelberg Retina Tomograph and the Glaucoma‐Scope. Optics discs were analysed in 15° sectors around the circumference. Depth measurements were calibrated on objects with known dimensions.

Results: We observed no significant differences in absolute measurements of maximum cup depth and cup area between the two instruments. We observed small differences in absolute measurements of disc anti rim area between the two instruments. Discrimination between normal and glaucomatous eyes was close to identical for the two instruments. Both instruments had the same ability to distinguish glaucomatous regional alterations of optic nerve head topography from normal disc configuration.

Conclusion: Both instruments while using entirely different principles for three‐dimensional optic disc imaging gave very similar results. This correspondence of results implies that the same optic disc parameters can be analysed, and the results interpreted similarly for both methods, and probably with other three‐dimensional imaging instruments. It may also indicate that results of studies with one of the instruments have general validity.
Corneal epithelial changes due to adenovirus type 8 infection
Authors: Tabery Helena M.
Published: March 2003

Purpose: To investigate corneal epithelial changes in human adenovirus type 8 (Ad8) infection, and compare them with herpes simplex virus type 1 (HSV1) changes.

Material and method: 12 patients with Ad8 infection: in 10 verified by tissue culture, in 2 clinically. The corneae were photographed by non‐contact photomicrography.

Results: Within the first days the epithelium showed multiple elevations measuring about 20–30 μm in diameter, and from about day 5 large numbers of scattered subsurficial abnormal cells. At the end of the first week larger (about 150–200 μm in diameter) epithelial foci started to appear. No focal ulcerative changes were observed.

Conclusions: The subsequent stages of Ad8 cytopathic effect are difficult to discern. The primary virus target seems to be the deeper epithelial layers. The damaged cells are probably successively transported toward the surface and desquamated. The etiology of larger focal changes is unclear. The presence (HSV1) or absence (Ad8) of ulcerative changes differentiates these two infections.
Atrial septal defect with interatrial aneurysm and Axenfeld‐Rieger syndrome
Authors: Bekir Necdet A. , Güngör Kıvanç
Published: March 2003

Purpose: The aim of this presentation is to report a rare association between interatrial aneurysm and Axenfeld‐Rieger syndrome.

Methods: We present a 20‐year‐old girl with Axenfeld‐Rieger syndrome, in whom the diagnosis was confirmed by the facial dysmorphic appearance, slit‐lamp examination, applanation tonometer, gonioscopy, and cardiovascular examination.

Results: The patient had prominent Schwalbe's line in all quadrants, iris atrophy, and secondary glaucoma in both eyes. The echocardiogram revealed an atrial septal defect with interatrial aneurysm.

Conclusion: This is the first case report of coexisting Axenfeld‐Rieger syndrome and interatrial aneurysm. We would like to stress that aneurysm can be a potential occult source of cerebral embolism.
Retinopathy of prematurity in a Copenhagen high‐risk sample 1997–98
Authors: Fledelius H. C. , Kjer Birgit , Rosenberg Thomas
Published: March 2003

Purpose: From two recent materials to describe the present clinical status regarding retinopathy of prematurity in Denmark, and to outline trends over time.

Methods: A) Results of regular ophthalmic surveillance of 201 clinically selected (higher risk of ROP than average) pre‐term infants of birth year 1997–98 taken care of in the two greater Copenhagen tertiary neonatal units, in an intended prospective design. Gestational age range was 24–32 weeks at delivery; birth weights 490–2200 g. Median values 28 weeks and 1090 g. B) A brief account of the latest ROP‐associated registrations of visual impairment in Danish children aged 0–17 years (n=138).

Results: A) ROP was observed in 31.3% (n=201). Retinal cryotherapy was given to eleven ‘own’ cases and to two from elsewhere (n=13, gestational age at delivery 25–31 weeks). Five had cryotherapy twice. Four of the 13 were later registered for visual impairment. B) Comparing the first and the latest third of the registrations, visual impairment has dropped in frequency and severity over the period from 1981 till now.

Conclusions: Compared to previous data the present clinical profile of ROP in Denmark indicates a relatively lower overall frequency of ROP and a decrease in eventual severe visual impairment. Undoubtedly, the continued refinement of neonatal care has been of relevance, but the definite decline in visual impairment further reflects a more complete ophthalmic surveillance, on a national basis. The advanced cases are generally detected in time and retinal ablation therapy offered.
Macular hole surgery without routine membrane excision or use of adjuvants
Authors: Byhr Eva , Lindblom Bertil
Published: March 2003

Purpose: To present results of macular hole surgery without adjunctive treatment or routine membrane dissection, but with a long duration tamponade.

Methods: Fifty‐one consecutive eyes underwent surgery with vitrectomy. Membrane peeling was performed only when traction was obvious. Pure perfluoropropane gas was injected as a tamponade followed by prone positioning for two weeks. All eyes were examined with scanning laser ophthalmoscopy (SLO) before and after surgery.

Results: The macular hole was closed successfully in 48 eyes (94%) after one procedure. Visual acuity improved to 0.50 or more in 18 eyes (35%). Improvement of two or more lines was achieved in 35 eyes (69%). Two eyes developed retinal detachments and two eyes showed post‐operative visual field defects previously reported after macular hole surgery.

Conclusion: In this series the results and complication rates compare favourably with other reports of macular hole surgery. However, in contrast to many previous studies, membrane peeling was not done. The extent and long duration of the gas tamponade was thought to be important for the surgical success.
Pars plana vitrectomy for regression of choroidal neovascularization with age‐related macular degeneration
Authors: Ikeda Tsunehiko , Sawa Hiroshi , Koizumi Kan , Yasuhara Toru , Yamasaki Toshihide
Published: March 2003

Objective: In age‐related macular degeneration, the posterior vitreous surface often remains attached to a higher degree than expected for the patient's age, suggesting the involvement of the posterior vitreous membrane in the pathophysiology of choroidal neovascularization. Thus, we performed simple pars plana vitrectomy and artificial posterior vitreous detachment in order to induce regression of choroidal neovascularization.

Methods: Vitrectomy was performed in 12 eyes of 11 patients with age‐related macular degeneration in whom the posterior vitreous surface remained attached, and in whom there was evidence of highly active choroidal neovascularization. The posterior vitreous membrane was artificially detached during surgery, but photocoagulation and/or a subretinal procedure for choroidal neovascularization was not performed. Patients underwent fluorescein and indocyanine green angiography both pre‐ and postoperatively to assess the status of choroidal neovascularization.

Results: Six months after surgery, 6 of the 12 eyes showed regression of choroidal neovascularization, and in 2 eyes it had disappeared completely. Subretinal exudative changes in 8 eyes had improved. Visual acuity testing showed improved vision in 4 eyes, unchanged vision in 4 eyes, and worsening of vision in 4 eyes. The final best corrected visual acuity was 10/20 or better in one eye, 10/20 to 20/200 in 7 eyes, and 20/200 or worse in 4 eyes.

Conclusion: The results of the present study suggest the involvement of the posterior vitreous membrane in the pathophysiology of age‐related macular degeneration. Furthermore, the minimally invasive pars plana vitrectomy may represent a new treatment for age‐related macular degeneration.
Diffuse retinal hemorrhages (ocular decompression syndrome) after trabeculectomy with mitomycin C for neovascular glaucoma
Authors: Danias John , Rosenbaum Jacob , Podos Steven M.
Published: March 2003

Purpose: To describe a case of ocular decompression syndrome in a patient after trabeculectomy with mitomycin C for neovascular glaucoma.

Results: Diffuse retinal hemorrhages developed in the posterior pole of a patient with neovascular glaucoma after he underwent trabeculectomy with mitomycin C. The hemorrhages persisted for less than 9 months.

Conclusions: Acute decompression of the eye in patients with high intraocular pressure can lead to the development of posterior pole hemorrhages. The course of this rare syndrome is relatively benign.
Long‐term observations of a patient with choroidal melanoma following fractionated stereotactic radiotherapy: A case report
Authors: Tokuuye Koichi , Sumi Minako , Kagami Yoshikazu , Murayama Shigeyuki , Ikeda Hiroshi , Kaneko Akihiro , Akine Yasuyuki
Published: March 2003

ABSTRACT. A 60‐year‐old man with choroidal melanoma was treated with fractionated stereotactic radiotherapy and followed for 6 years. During this period, the tumor has not changed in size, and the patient has experienced only a slight decrease in visual acuity. In this case, stereotactic radiotherapy appears to have been safe and effective and may also be a cost‐effective alternative to particle or plaque therapy.
Myopia profile in Copenhagen medical students 1996–98. Refractive stability over a century is suggested
Authors: Fledelius Hans C.
Published: March 2003

Purpose: To assess the myopia prevalence and profile in today's Danish medical students and to compare the pattern with previous and contemporary investigations.

Methods: As part of the tutoring in ophthalmology 1996–98 Copenhagen medical students of five successive terms (in their 10th semester, n=294) were interviewed and spot‐checked about their refraction. Myopia from −0.5 D was recorded and myopia onset age stated.

Results: The age range was 22–41 years, median age 26. Myopia ranging from −0.5 to −8 D was encountered in 147 students (50% of all; females 53.9%, males 45%). In seven the myopia was unilateral. Median values for myopia degree and onset age were −2.5 D and 16 years in female myopes (n=89) which differed significantly from the male values (n=58) of −1.5 D and 18 years. Including the age of 18 as lower cut‐off for adult‐onset myopia 44.9% of the myopes belonged to this category.

Conclusions: The results are in close agreement with recent Norwegian student investigations, and there is no obvious trend of a worsening of the academic myopia issue in our part of the world. This is in marked contrast to student myopia profiles as reported in Taiwan, Singapore, and Hong Kong where myopia is booming, by number and degree.
Visually impaired Swedish children. The 1980 cohort study; aspects on mortality
Authors: Blohmé Jonas , Tornqvist Kristina
Published: March 2003

Purpose: Assessment of the burden of mortality in a cohort of visually impaired children in a geographically defined area.

Methods: A 19‐year follow‐up of medical records and death certificates.

Results and conclusions: Of the initial 128 patients, born 1962–76, 17 (13%) had died, giving a highly significant increase in mortality compared to the equivalent age‐specific Swedish population (p‐value <0.000001). All deceased had additional impairments. Respiratory causes of death were found in 12/17 cases. The primary ophthalmological diagnosis was cerebral visual impairment in 8 cases, optic atrophy in 6 cases, one each of congenital cataract, microphthalmus and chorioretinitis. A more pronounced level of visual impairment gave an increased risk of mortality. A significantly higher mortality rate among multiply impaired was seen in the combined group with ‘childhood blindness’ (visual acuity <0.05) and `visual impairment, undetermined or unknown' opposed to the group with ‘low vision’ (visual acuity 0.05–<0.3) (p=0.047).
Latanoprost‐induced increase of tyrosinase transcription in iridial melanocytes
Authors: Stjernschantz Johan , Ocklind Anette , Wentzel Parri , Lake Staffan , Hu Dan‐Ning
Published: March 2003

Purpose: Latanoprost, the active principle of XalatanR eye drops, has been shown to cause increased iridial pigmentation as a side‐effect in some patients. The purpose of the present study was to investigate whether latanoprost affects tyrosinase, the rate limiting enzyme in melanogenesis, at the gene transcription level in the iridial melanocytes.

Methods: Four cynomolgus monkeys were treated unilaterally with 3 or 11 μg latanoprost once daily for 10 days. The contralateral eye received the vehicle only. Tyrosinase mRNA was visualized by in situ hybridization using radiolabelled riboprobes. The transcription of tyrosinase was also studied in vitro using cultivated human iridial melanocytes. Tyrosinase RNA was quantified by Northern blotting.

Results: In the monkeys transcription of tyrosinase was found to be increased in iridial melanocytes of the treated eyes compared to the control eyes. Increased transcription of tyrosinase was in addition found in the iridial pigment epithelium and in melanocytes of the anterior choroid. Latanoprost was also found to increase the transcription of tyrosinase in melanocytes isolated from at least one human eye.

Conclusions: Although the tyrosinase enzyme has to undergo complex post‐translational modification to become biologically active, which we have not studied, it appears that latanoprost treatment may increase the transcription of the tyrosinase gene in some individuals, consistent with increased melanogenesis in the iridial melanocytes leading to darker eye colour.
Morphology of epithelial keratitis in herpes zoster ophthalmicus
Authors: Tabery Helena M.
Published: March 2003

Purpose: To investigate the in vivo morphology of epithelial changes in acute herpes zoster keratitis.

Methods: 10 patients with acute disease. In 7, systemic acyclovir treatment was started at presentation, in 2 24 hours before, 1 was not treated. The corneae were examined with the slit lamp, followed intermittently for 3–30 days, and photographed at intervals ranging between 1 to 7 days.

Results: All but one patient had epithelial changes at presentation; all developed new ones. The smallest discernible entities were abnormal cells of about 10–15 μm in diameter, singular or grouped. Larger foci measured about 100–200 μm. 2 patients showed pseudodendrites at presentation, and further 3/9 observed ≥2 weeks developed them. Some lesions showed white surface plaques. No ulcerations were observed. Healing occurred ≤10–22 days after the onset of symptoms.

Conclusions: The study seemed to have followed the natural course of the disease.The rapidly changing morphology in the absence of ulcerative features indicated successive damage counteracted by reparative forces.
Optical coherence tomography (OCT) in acute macular neuroretinopathy
Authors: Feigl Beatrix , Haas Anton
Published: March 2003

Purpose: To evaluate the value of ocular coherence tomography (OCT) concerning diagnosis and pathogenesis of acute macular neuroretinopathy.

Methods: A 33‐year old woman complained of sudden onset of central scotomas in her right eye because of acute macular neuroretinopathy. We performed a direct ophthalmoscopy, a visual field testing, a fluorescein angiography (FA) a multifocal ERG (mf‐ERG) and an OCT.

Results: We found typical paracentral scotoma in visual field testing, a normal FA and mf‐ERG in her right eye. In OCT there was a band of higher reflectivity (115 μm) overlying an intact band corresponding to the retinal pigment epithelium (RPE)/ choriocapillaris complex. Retinal thickness was within the normal range.

Conclusion: OCT can be an additional valuable tool in acute macular neuroretinopathy as it is a disease with discrete pathology and often normal results in other diagnostic tests.
Cataract surgery and effectiveness 2. An index approach for the measurement of output and efficiency of cataract surgery at different surgery departments
Authors: Lundström Mats , Roos Pontus , Brege Klas Göran , Florén Ingrid , Stenevi Ulf , Thorburn William
Published: March 2003

ABSTRACT. Purpose: To describe a model for comparing the performance of cataract surgery among ophthalmology departments in terms of economic efficiency.

Methods: An index approach for the measurement of outcome of cataract surgery is modeled. The index approach uses information about activities and difficulties in daily life as well as visual acuity and age. The change in activities and difficulties after surgery is expressed by changes in distances, and an overall index score is calculated as ratios of values to distances. Values to distances are estimated as solutions to linear programming problems. Index scores are calculated for two groups of patients, those with an ocular co‐morbidity and those without. Economic efficiency is also estimated by use of an index approach. In the estimation of efficiency we use the calculated index scores of outcome of surgery as a measure of output of the ophthalmology department. Four different departments providing cataract surgery are compared.

Results: The studied departments showed differences to a great extent when traditional measures of cataract surgery outcomes were used. These differences changed when the outcomes were compared by use of index scores. When economic efficiency was calculated the difference between the departments was further reduced and only one department was considered inefficient according to the model.

Conclusion: An index approach was used to study outcomes of cataract surgery and economic efficiency in four departments. This approach takes into account the complexity of cost in relation to feasible outcome. The ranking between the departments described by traditional methods turned out differently using the model.
Gender and referral to cataract surgery in Sweden
Authors: Olofsson Per , Lundström Mats , Stenevi Ulf
Published: March 2003

ABSTRACT. Purpose: To investigate how cataract surgery was initiated and analyse possible gender difference in referral to surgery.

Methods: Consecutive patients scheduled for first eye cataract surgery at three Swedish community‐run eye departments were interviewed concerning how surgery was initiated.

Results: 649 patients were interviewed and 63.2% were female. The number of patients referred to surgery by an earlier contact with a health care provider was 271 (41.8%) and the remaining 378 (58.2%) patients had actively requested advice or help because of visual problems caused by cataract and without a prior regular contact. 44.7% of female patients were referred through a health care provider they visited for reasons other than cataract and the corresponding number for male patients was 36.8%. This gender difference is statistically significant at the 5% level.

Conclusion: A health care provider that patients visited for other problems than cataract referred female patients to cataract surgery to a significantly higher degree than male patients.
Scanning laser polarimetry versus frequency‐doubling perimetry and conventional threshold perimetry: Changes during a 12‐month follow‐up in preperimetric glaucoma. A pilot study
Authors: Holló Gábor , Szabó Antal , Vargha Péter
Published: March 2003

ABSTRACT. Purpose: To evaluate the possibility for detecting the progression in preperimetric primary open angle glaucoma (POAG) using scanning laser polarimetry (SLP), frequency‐doubling technology (FDT), and conventional automated perimetry (AP).

Patients and methods: 22 eyes of 11 preperimetric POAG patients were evaluated using SLP (Nerve Fiber Analyzer, GDx), AP (Humphrey 24–2 threshold test) and FDT (30 ° threshold test). All eyes had intraocular pressure (IOP) higher than 21 mmHg before treatment, but were consistently lower than 22 mm Hg with unchanged topical medication before and during the study. At the initial evaluation session optic nerve heads showed mild glaucomatous changes but the visual fields were normal (MD better than 2.0 dB, Glaucoma Hemifield Test: within normal limits or borderline). AP and FDT measurements were repeated 6 months later, and all three tests were repeated 12 months after the first investigation.

Results: IOP, AP and FDT measurements showed no statistically significant changes during the 12‐month follow up period. In contrast to this, a tendency for a glaucomatous type decrease was seen with SLP in the retinal nerve fibre layer (RNFL) thickness parameters (mean superior and inferior sector thickness values, ellipse average thickness and maximal modulation). The mean decrease of RNFL thickness in the superior and inferior sectors was 2.77 μm and 2.48 μm, respectively. Using the two‐way nested ANOVA, which considers the relation between the right and left eyes of the subjects, the decrease was statistically significant (p=0.021) for the inferior sector RNFL thickness.

Conclusion: The results suggest that scanning laser polarimetry is a useful technique to detect and measure glaucomatous progression in early glaucoma. Scanning laser polarimetry of the RNFL may help to detect and quantify early progression even if worsening is not seen with perimetry and FDT tests.
Visual screening of Swedish children: An ophthalmological evaluation
Authors: Kvarnström Gun , Jakobsson Peter , Lennerstrand Gunnar
Published: March 2003

ABSTRACT. Purpose: This study describes the various ophthalmological conditions detected in the Swedish visual screening program for children.

Methods: The study was longitudinal and retrospective. All children (3126) born in 1982 in three Swedish municipalities have been followed from birth to ten years of age. Visual acuity was examined at the ages of 4, 5.5, 7 and 10 years. Before the age of 4, a gross examination of the eyes was performed.

Results: The prevalence of ametropia in the population was 7.7%, the prevalence of strabismus 3.1%, and the prevalence of organic lesions 0.6%. Seven children (0.2%) were visually handicapped (visual acuity ≤0.3 in the better eye). Refractive errors and microtropias were mainly detected at the age of 4, when the first visual acuity test was performed, while manifest strabismus was in many cases detected before this age. With this screening and subsequent diagnosis and treatment, the prevalence of deep amblyopia (visual acuity ≤0.3) has been reduced from 2% to 0.2%. With treatment, 47% of the amblyopic children achieved a visual acuity better than 0.7.

Conclusion: Visual screening is effective in detecting visual and ocular disorders. Most conditions are discovered before the age of 6. Compared to an unscreened population, the prevalence of amblyopia is greatly reduced.
A new technique for rigid gas permeable contact lens fitting following penetrating keratoplasty
Authors: Eggink Fred A. G. J. , Nuijts Rudy M. M. A.
Published: March 2003

ABSTRACT. Purpose: To evaluate a new, rigid gas permeable contact lens fitting technique following penetrating keratoplasty.

Methods: For the correction of postoperative anisometropia or astigmatism, a rigid gas permeable, tetra‐curve contact lens with an overall diameter of 12.0 mm and a back optic zone diameter of 8.5 mm was fitted in 36 eyes of 33 patients, 7 months after penetrating keratoplasty. The contact lens back optic zone radius was selected using the videokeratography values over the elevated edges of the transplant wound (with the sutures in place). Graft clarity, visual outcome, and corneal topography were evaluated up to 3 years after surgery at intervals of 6 months.

Results: Throughout the follow‐up period (range 6–36, mean 19.3±sd 11.8 months), all grafts remained clear. Mean contact lens daily wearing time averaged 13.6 (±sd 4.7) hours. Mean best‐corrected visual acuity improved from +0.36 (±sd 0.18) LogMAR with spectacles to +0.11 (±sd 0.11) LogMAR with contact lenses (p<0.0001). One patient was excluded from the study due to a lack of motivation and one had an adverse reaction to the stitches.

Conclusions: To improve the visual performance following penetrating keratoplasty, the described fitting technique, guided by videokeratography, eased selection of the back optic zone radius of the initial trial lens. The large diameter contact lenses with a tetra‐curve design were well tolerated in all patients for more than 13 hours daily.
The exfoliation syndrome in cognitive impairment of cerebrovascular or Alzheimer’s type
Authors: Linnér Erik , Popovic Vladislav , Gottfries Carl‐Gerhard , Jonsson Michael , Sjögren Magnus , Wallin Anders
Published: March 2003

ABSTRACT. The prevalence of exfoliation syndrome was studied in 39 patients suffering from dementia and cognitive impairment; a positive finding of exfoliation was detected in 11/39 of these patients. A comparison with an age‐matched population survey showed that the prevalence of ocular exfoliation and the relative risk were significantly elevated. These results suggested that lesions related to the exfoliative process might be located also in the brain of patients suffering from dementia and cognitive impairment.
The therapeutic effects of retinal laser treatment and vitrectomy. A theory based on oxygen and vascular physiology
Authors: Stefánsson Einar
Published: March 2003

ABSTRACT.The physiologic mechanism of photocoagulation can been seen in the following steps. The physical light energy is absorbed in the melanin of the retinal pigment epithelium. The adjacent photoreceptors are destroyed and are replaced by a glial scar and the oxygen consumption of the outer retina is reduced. Oxygen that normally diffuses from the choriocapillaris into the retina can now diffuse through the laser scars in the photoreceptor layer without being consumed in the mitochondria of the photoreceptors. This oxygen flux reaches the inner retina to relieve inner retinal hypoxia and raise the oxygen tension. As a result, the retinal arteries constrict and the bloodflow decreases. Hypoxia relief reduces production of growth factors such as VEGF and neovascularization is reduced or stopped. Vasoconstriction increases arteriolar resistance, decreases hydrostatic pressure in capillaries and venules and reduces edema formation according to Starling’s law.

Vitrectomy also improves retinal oxygenation by allowing oxygen and other nutrients to be transported in water currents in the vitreous cavity from well oxygenated to ischemic areas of the retina. Vitrectomy and retinal photocoagulation both improve retinal oxygenation and both reduce diabetic macular edema and retinal neovascularization.