bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of fluconazole and liposome entrapped fluconazole for C. albicans induced experimental mycotic endophthalmitis in rabbit eyes
Authors: Gupta Suresh K. , Dhingra Narendra , Velpandian Thirumurthy , Jaiswal Jagdish
Published: March 2003

Purpose: To study the efficacy of intravitreally injected plain and liposome encapsulated fluconazole in the doses of 100 and 200 Ψg in Candidal endophthalmitis in rabbit eyes.

Method: Endophthalmitis was induced by injecting Candida albicans (1000 CFU/0.1 ml). Seventy two hours after inoculation, plain and liposome encapsulated fluconazole (REVs) were injected. At day 16 sterility was studied using vitreous culture.

Results: In the 100 & 200 Ψg plain fluconazole group, vitreous sterility was seen in 62.5% and 75%, respectively. In the liposome entrapped fluconazole a culture sterility of 25% and 50% for 100 Ψg and 200 Ψg, respectively, was seen.

Conclusion: Plain fluconazole in the dose of 100 and 200 Ψg was equally effective against Candidal endophthalmitis in rabbits, but a failure of 25–37.5% of the eyes to respond, discourages one from using fluconazole as a sole therapy. Liposome entrapped fluconazole was found to be inferior to plain fluconazole in this model.
Palpebral myiasis in a Danish traveler caused by the human bot‐fly (Dermatobia hominis)
Authors: Bangsgaard Regitze , Holst Bengt , Krogh Erik , Heegaard Steffen
Published: March 2003

Purpose: To demonstrate a case of palpebral myiasis caused by Dermatobia hominis in a Dane traveling in the Brazilian rain forest.

Methods: Surgical removal and histological examination.

Results: Within three weeks after returning from the Brazilian rain forest, the patient developed a localized swelling of the left upper eyelid and follicular conjunctivitis. A funnel containing a larva was found between the cilia. The larva was excised together with surrounding inflammatory tissue.

The clinical findings as well as zoological and pathological examinations indicated a case of palpebral myiasis caused by Dermatobia hominis.The larva was removed in its third stage four weeks from symptom debut.

Conclusions: Infestation with Dermatobia hominis should be suspected when itching and red swelling of the lid are present in patients who have been to Central and South America.
Epidemiological Study of 134 Subjects with Allergic Conjunctivitis
Authors: Belfort R. , Marbeck P. , Hsu C. C. , Freitas D.
Published: March 2003

ABSTRACT. At times it is difficult to distinguish among the subtypes of chronic allergic conjunctivitis. A prospective study with 134 patients was carried out. Patients were diagnosed with vernal keratoconjunctivitis (VKC), atopic keratoconjunctivitis (AKC) or perennial allergic conjunctivitis (PAC). Demographic information was also collected including, age at symptom onset, sex, history of non‐ocular allergy, and history of family allergy. Forty‐six percent were diagnosed with VKC, 40% with AKC, 8% with PAC, and 6% were not specifically diagnosed. This distribution information as well as the demographic information collected demonstrates that there are patterns within each subgroup of chronic ocular allergy sufferers. These findings will be helpful in the diagnosing and proper classification of ocular allergic conditions.
Allergic Conjunctivitis and Contact Lenses: Experience with Olopatadine Hydrochloride 0.1% Therapy
Authors: Brodsky M.
Published: March 2003

Objective: The efficacy of Patanol®, a topically applied anti‐allergic agent, was evaluated in a group of patients with allergic conjunctivitis due to contact lens wear (GROUP I) and a group comprised of seasonal allergic conjunctivitis patients, vernal conjunctivitis patients and atopic keratoconjunctivitis patients (GROUP II).

Methods: One drop of Patanol® was administered to each eye twice daily. Signs and symptoms were assessed 7, 14, and 28 days after initiation of drug therapy.

Results: Itching/burning, tearing, hyperemia and papillary reaction were reduced to scores of 0/1 (absent/mild) in 85%, 90%, 81% and 62%, respectively, of GROUP I patients at Day 28. The allergic conditions in GROUP II patients also improved with Patanol® treatment. Itching/burning, tearing, hyperemia and papillary reactions were absent/mild in 60%, 76%, 96% and 90%, respectively, of these patients at Day 28.

Conclusion: Patanol® treatment effectively and rapidly alleviated the signs and symptoms of allergic conjunctivitis due to contact lens wear as well as vernal conjunctivitis, atopic keratoconjunctivitis and the common seasonal allergic conjunctivitis. Patanol® allowed allergic patients to be more comfortable while permitting them to continue using contact lenses.
Latent proliferative sickle cell retinopathy in sickle cell trait
Authors: Mehta J. S. , Whittaker K. W. , Tsaloumas M. D.
Published: March 2003

ABSTRACT. Purpose: To describe a patient with sickle cell trait who developed latent proliferative sickle cell retinopathy after mild blunt trauma.

Method: Case Report. A 20‐year‐old man with unilateral Stage 3 sickle retinopathy associated with an ischaemic ridge presenting three years after the initial mild blunt ocular trauma.

Results: Fundus examination of the left eye showed an ischaemic ridge delineating avascular from vascular retina. Fluorescein angiography of the left eye showed an avascular peripheral retina and multiple sea fan neovascularization. Blood studies showed him to be Hb AS.

Conclusions: In our patient the proliferative changes were the result of his initial mild trauma associated with an increase in the intraocular pressure. The latent development of the sea‐fan neovascularization associated with an ischaemic ridge is unusual. Advice about potential complications to patients with Hb AS after ocular trauma is advocated.
Metabolic abnormalities in patients with primary open‐angle glaucoma
Authors: Elisaf Moses , Kitsos George , Bairaktari Eleni , Kalaitzidis Rigas , Kalogeropoulos Christos , Psilas Kostas
Published: March 2003

ABSTRACT. Purpose: Although there are few data on the underlying mechanisms of primary open‐angle glaucoma (POAG), it has been suggested that metabolic diseases may play a role in the evolution of the disease. We carried out the present study to investigate the involvement of metabolic disturbances in POAG pathogenesis.

Material/methods:

Serum metabolic parameters were evaluated in 49 POAG patients without a known history of diabetes mellitus and 72 age and sex matched individuals without glaucoma (control group).

Results: Among the metabolic parameters examined, only fasting serum glucose and uric acid levels were found significantly higher in patients with glaucoma compared to the control population (117±17 mg/dl vs 105±11 mg/dl, p=0.05 and 6.2±1.9 mg/dl vs 5±1.2 mg/dl, p=0.006, respectively). Additionally, a considerably greater proportion of patients had disturbances of the carbohydrate metabolism and hyperuricemia.

Conclusion: We conclude that disturbances of carbohydrate and uric acid metabolism could play a role in glaucoma damage and pathogenesis.
Demonstration of increasing standard pH value of lacrimal fluid with increase of flow rate
Authors: Janszky I. , Vámosi P. , Országh I. , Berta A.
Published: March 2003

ABSTRACT. Purpose: To test the hypothesis that pH value of human tears is affected by flow rate.

Methods: After stimulation with a drop of 70% alcohol into the ipsilateral nasal cavity tears from the left eyes of 30 healthy volunteers were collected with glass capillaries while flow rate of tear secretion was registered. The pCO2, actual and standard pH were determined in the collected samples with the Astrup method. Standard pH is defined as the pH of the sample that has been equilibrated at 37 °C with a gas mixture having pCO2=40 mmHg.

Results: The flow rate correlated positively and significantly with both the standard pH value (r=0.503, p<0.01) and the pCO2 (r=0.517, p<0.01) while there was no correlation between the actual pH and the flow rate.

Conclusion: Loss of CO2 from the sample is a cause of serious uncertainty in tear pH determination. A positive flow rate‐pH relationship was found for human tears when the uncertainty was removed by determination of the standard pH.
Clinical features and a follow‐up study in a family with X‐linked progressive cone‐rod dystrophy
Authors: Mäntyjärvi Maija , Nurmenniemi Piia , Partanen Juhani , Myöhänen Terttu , Peippo Maarit , Alitalo Tiina
Published: March 2003

ABSTRACT. Purpose: To study a large family with X‐linked progressive cone‐rod dystrophy.

Methods: There were 128 members in the family. Of these, 45 had an ophthalmological examination and 3 gave their permission to use the results of their recent ophthalmological examination. In addition to the usual eye examination, visual fields, colour vision, dark adaptation and electroretinogram (ERG) were examined.

Results: Ten affected men aged 6 to 81 years were found in the family. The visual acuities varied from counting fingers (cf) 10 cm to 0.5 in the right eye (RE) and from cf 30 cm to 0.4 in the left eye (LE). The refraction was myopic in all affected members, varying from −1.5 to −24.0 D (RE) and from −2.0 to −20.25 D (LE). In visual functions, central scotomas and concentric constriction in the visual fields, red or red‐green defects in colour vision, abnormal cone and rod dark adaptation and affected cone response in ERG were found. The 6 obligate carriers were aged 17 to 77 years. Their visual acuities varied from 0.05 (strabismic amblyopia) to 1.25(RE) and from 0.7 to 1.25 (LE), and refraction from ±0 to +6.0 D (RE) and from −0.5 to +5.0 D (LE). Their visual fields and colour vision were normal. The non‐affected men were aged 13 to 55 years, their visual acuity was normal in both eyes, and refraction varied from −5.0 to +1.5 D (RE) and from −5.5 to +1.75 (LE). The result of the eye examination was normal except in colour vision: two men were congenitally deuteranomalous. The women who were not obligate carriers were aged 10 to 77 years, their visual acuity was from 0.3 to 1.6 in both eyes, and refraction from −5.5 to +4.75 (RE) and from −5.25 to +4.0 (LE). Two women had one amblyopic eye. Otherwise the eye examination was normal.

Conclusions: The clinical diagnosis of X‐linked cone dystrophy 1 (COD1) is based on progressive loss of visual acuity, moderate or high myopia, red colour vision defect and affected cone response or cone and rod response in ERG. The future identification of the COD1 gene will confirm the diagnosis of the disease and help in genetic counseling of the family.
Thyroid‐associated orbitopathy developed during hormone replacement therapy
Authors: Øgard Christina Gerlach , Øgard Carsten , Almdal Thomas Peter
Published: March 2003

ABSTRACT. Thyroid‐associated orbitopathy (TAO) developed in relation to estrogen combined with progesterone therapy has not been reported previously. We report a case of a 56‐year‐old postmenopausal woman who during estrogen/progesterone treatment developed signs and symptoms of orbitopathy. The patient had no previous history of autoimmune‐ or thyroid disorders. The initial eye symptoms disappeared after withdrawal of hormone replacement therapy. Five years later estrogen/progesterone treatment was re‐instituted. The patient had relapse of orbitopathy. The hormones were discontinued and the eye symptoms disappeared again. This suggests that estrogen and/or progesterone could be of some pathogenetic importance in the induction of orbitopathy
Presumed sertraline maculopathy
Authors: Şener Emin Cumhur , Kıratlı Hayyam
Published: March 2003

ABSTRACT. Purpose: To report a unique case of a woman who developed simultaneous bilateral maculopathy presumed to result from intake of sertraline hydrochloride, a serotonin reuptake inhibitor.

Methods: Full clinical ocular examination, color vision testing, automated static perimetry, electroretinography, electrooculography and fundus fluorescein angiography were performed. Living members of her family were also examined.

Results: The patient had normal electroretinography and electrooculography results. Automated static perimetry showed generalized reduction of sensitivity and central scotomas. Macular lesions resolved 6 months after discontinuation of sertraline, however, during twenty months of follow‐up her visual acuity and abnormalities in other psychophysical tests did not improve.

Conclusion: Patients started on sertraline should be informed of the potential risk of developing maculopathy, and they should be examined regularly to detect possible early alterations.
Optic neuritis and multiple sclerosis
Authors: Söderström Mats
Published: March 2003

ABSTRACT. Purpose: Review of the association between optic neuritis (ON) and multiple sclerosis (MS).

Results: MS often presents as acute unilateral ON. While it is clear that many patients with ON suffer from a generalized disease of the central nervous system that will go on to clinically definite MS (CDMS), it is also clear that others do not. With more and more well‐informed patients and the emerging pharmacotheraphy for MS, the distinction between those patients with ON who have MS and those who do not, has become more important than ever before. Recently, a large randomized clinical trial on patients with ON or other clinically isolated syndromes suggestive of MS and evidence of prior subclinical demyelination on magnetic resonance imaging of the brain, found that treatment with recombinant interferon‐beta‐1a is beneficial by reducing the development of CDMS.

Conclusion: Ophthalmologists should refer their patients with acute ON to a neurologist for MS‐directed investigations and decisions regarding early institution of disease modifying therapy.
Quantitative assessment of retinal thickness in diabetic patients with and without clinically significant macular edema using optical coherence tomography
Authors: Yang Chang‐Sue , Cheng Ching‐Yu , Lee Fenq‐Lih , Hsu Wen‐Ming , Liu Jorn‐Hon
Published: March 2003

ABSTRACT. Purpose: To assess patients with diabetic macular edema quantitatively using optical coherence tomography (OCT).

Methods: OCT was performed in 14 eyes with diabetic retinopathy and ophthalmoscopic evidence of clinically significant macular edema (CSME) and in 19 diabetic eyes without CSME. Retinal thickness was computed from the tomograms at fovea and other 36 locations throughout the macula.

Results: The mean±standard deviation foveal thickness was 255.6±138.9 μm in eyes with CSME, and 174.6±38.2 μm in eyes without CSME (p=0.051). Within 2000 μm of the center of the macula, eyes with CSME had significantly thicker retina in the inferior quadrant than those without CSME (p<0.01). The foveal thickness was correlated with logMAR visual acuity (γ=0.68, p<0.01). OCT identified sponge‐like retinal swelling and/or cystoid macular edema in 11 (58%) eyes without CSME, and in 12 (86%) eyes with CSME.

Conclusions: Criteria of CSME seem to be insufficient in really identifying macular edema. OCT may be more sensitive than a clinical examination in assessing diabetic macular edema and is a quantitative tool for documenting changes in macular thickening.
Immunohistological study of infiltrated cells and cytokines in murine herpetic keratitis
Authors: Inoue Tomoyuki , Inoue Yoshitsugu , Kosaki Ryo , Inoue Yumiko , Nishida Kohji , Shimomura Yoshikazu , Tano Yasuo , Hayashi Kozaburo
Published: March 2003

Purpose: To identify localization and kinetics of infiltrated cells and cytokines in murine herpetic keratitis.

Methods: HSV‐1 was inoculated onto the scarified BALB/c corneas. At given times post infection (PI), eyes were removed and studied immunohistochemically using monoclonal antibodies against several infiltrated cells and cytokines.

Results: Neutrophils and NK cells infiltrated as early as 1 day PI reaching a maximum number at 2 day PI in initial stage. γδ TCR positive cells were observed in the corneal stroma from 1 day PI to 8 day PI. IL‐2 and IFN‐γ were positive in the cell‐infiltrated areas of the epithelial and stromal lesions, whereas IL‐4 was negative throughout the experiment.

Conclusion: Our results indicated that cytokine profile upon herpes infection on the cornea is Th1 dominant. Together with neutrophils in the early phase of infection, γδ positive T cells may play an additional role in protecting the cornea against incoming pathogens.
The regional distribution of diabetic retinopathy lesions may reflect risk factors for progression of the disease
Authors: Bek Toke , Helgesen Andreas
Published: March 2003

Background: Diabetic retinopathy is graded by semi‐quantitative assessment of the morphological lesions as seen on fundus photographs. This grading method mainly considers the type and number of retinopathy lesions, implying that the diagnostic value of the regional distribution of retinopathy lesions is largely unknown.

Design and methods: Case control design. The study group consisted of fifteen diabetic patients successively examined in a screening clinic, with retinopathy lesions predominantly around the larger vascular arcades. The control group consisted of fifteen patients pairwise matched with the patients in the study group regarding sex, age, diabetes type, and diabetes duration. The two groups were compared with respect to the distribution of individual retinal lesions (microaneurysms/dot haemorrhages, blot haemorrhages, cotton wool spots, and hard exudates) around the larger vascular arcades and in the macular area, hypertensive vascular abnormalities (crossing phenomena, arteriolar narrowing, arteriolar light reflex), metabolic regulation, and blood pressure.

Results: The patients in the study group had significantly more microaneurysms and haemorrhages around the larger vascular arcades than had the control group, but there was no difference between the vascular changes in the two groups. The study group had significantly higher blood pressure than had the control group, whereas there was no significant difference in metabolic regulation between the two groups.

Conclusions: The findings suggest the existence of a hypertensive‐like retinopathy in diabetic patients with lesions mainly around the larger vascular arcades, but with no increase in hypertensive vascular changes. This pattern is not identified with current semi‐quantitative grading methods. Further improvement of clinical decisions made from fundus photographs of diabetic retinopathy requires the development of computerised methods for quantitative assessment of retinal lesions.
Octyl 2‐cyanoacrylate tissue adhesive in experimental scleral buckling
Authors: Ricci Benedetto , Ricci Francesco
Published: March 2003

Purpose: In this experimental study, a sutureless scleral buckling was performed by using a tissue adhesive glue to fixate a silicone band to the sclera. In fact, one of the major risks of traditional scleral buckling is accidental perforation of the bulb, which is more frequent when the sclera is extremely thin as it is in newborns or in eyes with high myopia or scleromalacia.

Methods: An encircling band of silicone, which is generally anchored to the sclera itself, was sutured in 36 rabbit eyes to three small silastic patches that had been glued to the sclera, at the level of the equator, using octyl 2‐cyanoacrylate tissue adhesive. In this manner the anchoring sutures passed through silicone and silicone. The band was tightened to produce buckling of the sclera and its ends were glued together using the same adhesive.

Results: Examination of the eyes from 15 days to 6 months after surgery revealed that the buckle was stable, with no signs of slippage, in 33 eyes. In the remaining 3 (one examined after 15 days, 2 examined after 45 days), one of the three support patches had become detached but there was still no evidence of slippage.

Conclusions: The stability of the buckle up to six months after surgery suggests that this new adhesive might be used for sutureless surgery in certain types of retinal detachment, such as that associated with stage 4 ROP in which the encircling band has to be removed after several months.
Classification of the spectrum of Coats’ disease as subtypes of idiopathic retinal telangiectasis with exudation
Authors: Cahill M. , O'Keefe M. , Acheson R. , Mulvihill A. , Wallace D. , Mooney D.
Published: March 2003

Purpose: An increasing variety of eponymous terms have been used to describe atypical cases of Coats’ disease. A group of typical cases of Coats’ disease and other cases of differing severity were classified as one of four subtypes of idiopathic retinal telangiectasis with exudation and compared with regard to clinical outcome.

Methods: In a retrospective clinical review patients with typical and atypical Coats’ disease were classified as severe, focal, juxtafoveal or associated (with another disease) forms of idiopathic retinal telangiectasis with exudation.

Results: 53 eyes in 50 patients were examined of which 62% (n=31) were male. 12 eyes were classified as severe (group 1), 22 focal (group 2), 12 juxtafoveal (group 3) and 7 associated (group 4). The mean age at diagnosis was lowest in group 1 eyes (6.8 years). The best visual acuity at presentation was 6/60 in group 1 whereas high proportions of eyes in the other groups had initial visual acuities of 6/24 or better. In group 1 only one eye was treated, the majority of eyes were blind or had been enucleated whereas 34 (79%) of eyes in the other groups were suitable for treatment and 29 eyes (67%) retained pre‐treatment visual acuity or better at last follow‐up.

Conclusions: Idiopathic retinal telangiectasis with exudation is a spectrum of disease, which is synonymous with Coats’ disease. In this retrospective study eyes with severe idiopathic retinal telangiectasis with exudation corresponding to typical Coats’ disease, have poorer vision at presentation, are less suitable for treatment and have worse outcomes than eyes with other subtypes. The spectrum of disease severity seen in idiopathic retinal telangiectasis with exudation may be due to second somatic mutations in genes with an existing germline mutation (the two hit theory) and a mosaic phenotype.
Visual functions and adverse ocular effects in patients with amiodarone medication
Authors: Ikäheimo Kirsi , Kettunen Raimo , Mäntyjärvi Maija
Published: March 2003

Purpose: To study visual functions and ocular adverse effects of long‐term amiodarone medication.

Methods: We performed an eye examination of 22 patients with long‐term amiodarone medication. In addition to corrected visual acuity, colour vision was studied with the Standard Pseudoisochromatic Plates part 2 and Farnsworth‐Munself 100 hue test. Contrast sensitivity was examined with the Pelli‐Robson chart. Visual fields were tested by Goldmann and Friedmann perimetry.

Results: Two patients with otherwise healthy eyes had abnormal blue colour vision test results. Otherwise colour vision, contrast sensitivity, and visual field test results were within normal range or could be explained by eye diseases such as cataract. Corneal drug deposits were found in 100% of the examined eyes. Slight anterior subcapsular lens opacities were found in 22.2%. Dry eyes were diagnosed in 9.1%. The eye fundi did not reveal any abnormalities that could be thought of as caused by amiodarone.

Conclusion: The slight blue colour vision defect found in two patients with otherwise healthy eyes might represent an early sign of the optic nerve impairment which is a rare complication of amiodarone medication. The number of corneal and lens changes as well as dry eyes were found at levels previously described.
Optical coherence tomography of choroidal neovascularization in high myopia
Authors: Baba Takayuki , Ohno‐Matsui Kyoko , Yoshida Takeshi , Yasuzumi Kenjiro , Futagami Soh , Tokoro Takashi , Mochizuki Manabu
Published: March 2003

Aim:  To investigate morphologic changes in the eye with choroidal neovascularization (CNV) in high myopia using optical coherence tomography (OCT).

Methods:  Optical coherence tomography was performed in 35 patients (42 eyes) with myopic CNV. Myopic CNV was divided into active, scar, or atrophic stages based on funduscopic and fluorescein angiographic findings. The characteristics of OCT findings in each stage were identified.

Results:  In the active stage (11 eyes), OCT clearly displayed a neovascular membrane as a highly reflective dome‐like elevation above the retinal pigment epithelium (RPE). No apparent subretinal fluid accumulation around the CNV was identified. In the scar stage (12 eyes), only the surface of the CNV showed high reflectivity, which was markedly attenuated below the surface. In the atrophic stage (19 eyes), the CNV had become totally flat and chorioretinal atrophy around the regressed CNV showed high reflectivity.

Conclusions:  Optical coherence tomography demonstrated characteristic features at each stage of myopic CNV. Optical coherence tomography appears to be useful in evaluating the stage and activity of myopic CNV.
Usher syndrome clinical types I and II: Could ocular symptoms and signs differentiate between the two types?
Authors: Tsilou Ekaterini T. , Rubin Benjamin I. , Caruso Rafael C. , Reed George F. , Pikus Anita , Hejtmancik James F. , Iwata Fumino , Redman Joy B. , Kaiser‐Kupfer Muriel I.
Published: March 2003

Purpose:  Usher syndrome types I and II are clinical syndromes with substantial genetic and clinical heterogeneity. We undertook the current study in order to identify ocular symptoms and signs that could differentiate between the two types.

Methods:  Sixty‐seven patients with Usher syndrome were evaluated. Based on audiologic and vestibular findings, patients were classified as either Usher type I or II. The severity of the ocular signs and symptoms present in each type were compared.

Results:  Visual acuity, visual field area, electroretinographic amplitude, incidence of cataract and macular lesions were not significantly different between Usher types I and II. However, the ages when night blindness was perceived and retinitis pigmentosa was diagnosed differed significantly between the two types.

Conclusions:  There seems to be some overlap between types I and II of Usher syndrome in regard to the ophthalmologic findings. However, night blindness appears earlier in Usher type I (although the difference in age of appearance appears to be less dramatic than previously assumed). Molecular elucidation of Usher syndrome may serve as a key to understanding these differences and, perhaps, provide a better tool for use in clinical diagnosis, prognosis and genetic counseling.
Optical coherence tomography in choroidal neovascular membrane associated with Best's vitelliform dystrophy
Authors: Andrade R. E. , Farah M. E. , Cardillo J. A. , Höfling‐Lima A. L. , Uno F. , Costa R. A.
Published: March 2003

A 29‐year‐old black male with Best's dystrophy presented an elevated choroidal neovascular membrane in the right eye that was diagnosed and followed with fluorescein‐indocyanine green angiography and optical coherence tomography. The subretinal neovascularization was successfully treated with argon laser photocoagulation. One month later, the visual acuity improved and an optical coherence tomography confirmed regression of the serous macular detachment. The final clinical picture remained stable for 12 months of follow‐up.
Cardiovascular effects of timolol maleate, brimonidine or brimonidine/timolol maleate in concomitant therapy
Authors: Stewart William C. , Stewart Jeanette A. , Jackson Angi L.
Published: March 2003

Purpose:  To examine the influence on maximal exercise performance in young healthy volunteers of timolol 0.5%, brimonidine 0.2% or placebo versus brimonidine 0.2% and timolol 0.5% used concomitantly.

Methods:  The subjects in this prospective, double‐masked, crossover comparison were dosed 15 min prior to treadmill testing. A period of 1 week was allowed between tests.

Results:  The 20 subjects who completed the trials (average age 24.5 ± 7.4) had a mean maximum exercise heart rate of 196 ± 12 bpm for placebo, 182 ± 13 bpm for timolol, 187 ± 10 bpm for brimonidine, and 186 ± 11 bpm for timolol/brimonidine concomitant therapy (p < 0.005). During recovery, the placebo group demonstrated a statistically higher systolic blood pressure (min 6) and pulse (mins 2 and 4) (p < 0.01). In addition, subjects treated with timolol/brimonidine demonstrated more premature contractions (atrial or ventricular) overall during exercise and recovery (p = 0.01). The brimonidine and concomitant treatment groups showed the greatest number of adverse events per subject, the most common of which were dizziness and fatigue (p = 0.031).

Conclusion:  This study suggests that both timolol and brimonidine, used alone and concomitantly, cause cardiovascular effects consistent with their pharmacology.
Photodynamic therapy for circumscribed choroidal haemangioma
Authors: Landau Irène M. E. , Steen Björn , Seregard Stefan
Published: March 2003

Purpose:  To assess the efficacy of photodynamic therapy (PDT) as a new treatment for circumscribed choroidal haemangioma (CCH).

Methods:  Eight patients with CCH were treated with PDT using a protocol similar to that used in the standard treatment of neovascular age‐related macular degeneration.

Results:  Visual acuity improved in six of eight eyes, remained unchanged in one eye and deteriorated in one eye after 3–15 months (median 7 months) follow‐up. Pre‐treatment metamorphopsia disappeared in all but two cases. The thickness of the CCH measured with standardized echography showed marked regression within 1 month after PDT. In six eyes there was no remaining protrusion after PDT and one lesion was barely detectable. One patient experienced a transient choroidal effusion and perifoveal haemorrhage.

Conclusion:  Photodynamic therapy is a promising new treatment for CCH as it restores visual function in most cases without causing apparent ocular or systemic side‐effects.
A case of central visual loss in a child due to macular cavernous haemangioma of the retina
Authors: Naftchi Soheila , La Cour Morten
Published: March 2003

Purpose:  To report a case of retinal cavernous haemangioma localized to the fovea.

Methods:  Clinical examination, fluorescein angiographic study and magnetic resonance imaging are reported.

Results:  A 9‐year‐old girl presented with acute loss of vision in the right eye. Ophthalmoscopy showed intraretinal bleeding in the macula, while fluorescein angiography showed a lesion typical of a small cavernous retinal haemangioma, localized in the central macula. Family history was negative.

Conclusion:  Central cavernous retinal haemangioma is a rare cause of central visual loss and should be distinguished from other retinal vascular abnormalities with more profound systemic implications for the patient.
Species‐barrier‐independent prion replication in apparently resistant species
Authors: Hill Andrew F. , Collinge John
Published: March 2003

Prion diseases of humans and animals are associated with the accumulation of an abnormal isoform (PrPSc) of the host‐encoded prion protein (PrPC). Transmission of these diseases between mammalian species is usually limited by a ‘species barrier’, which can be mediated by differences in primary sequence of the prion protein between donor and host species. Studies on species barriers usually rely on the development of clinical disease in inoculated animals as an assessment of susceptibility in a particular host. Recent studies by a number of groups have demonstrated that the absence of clinical symptoms does not necessarily exclude transmission of prion disease across a species barrier. Such results indicate that subclinical or carrier states exist in these diseases, which has public health implications regarding human exposure to BSE prions and iatrogenic transmission from apparently healthy humans. Here the issue of subclinical prion diseases is reviewed and implications are discussed.
Histologic changes in thyroid nodules after percutaneous ethanol injection in patients subsequently operated on due to new focal thyroid lesions
Authors: Pomorski Lech , Bartos Magdalena
Published: March 2003

This paper reports macro‐ and microscopic changes in hyperfunctioning thyroid nodules (HTN), initially diagnosed as solitary, in patients treated with percutaneous ethanol injection (PEI). In 78 patients, benign solitary HTN were diagnosed by clinical and hormonal examination. High resolution ultrasonography confirmed the solitary nodule. The results of fine needle aspiration biopsy (FNAB), performed twice, ruled out malignancy of the nodule. The patients were referred for PEI treatment. At 1‐year follow‐up, newly formed thyroid nodules, whose volumes increased, were detected in five patients (6.4%) with HTN, initially diagnosed as solitary. Therefore, these patients were operated on. Subtotal thyroidectomy was performed. At the intraoperative macroscopic evaluation, a hard fibrous solid mass was found in place of three nodules (n1, n2, n3) following PEI treatment. The middle area of the cut surface of PEI‐treated nodules (n4 and n5) in the other two patients was firm and haemorrhagic, surrounded by a fibrous mass. Histolopathologic examination of n1, n2 and n3 revealed fibrosis and hyalinosis. Examination of n4 and n5 showed haemorrhagic necrosis in the middle of the nodules surrounded by fibrous tissue.
Gastric inverted hyperplastic polyp. Report of four cases and relation to gastritis cystica profunda
Authors: YAMASHITA MICHIKO , HIROKAWA MITSUYOSHI , NAKASONO MASAHIKO , KIYOKU HIROSHI , SANO NOBUYA , FUJII MASAHIKO , KOYAMA TAKASHI , YOSHIDA SADAHIRO , SANO TOSHIAKI
Published: March 2003

Gastric inverted hyperplastic polyp (IHP) is a rare type of gastric polyp, and is characterized by downward growth of the hyperplastic mucosal components into the submucosa. To the best of our knowledge, 16 gastric IHP cases have been described in the English literature, but the pathogenesis has not been established. We report the clinical and pathological findings of four gastric IHP cases. The lesions were mainly composed of hyperplastic foveolar‐type glands with focal cystic dilatation. Pyloric type glands, endocrine cells, acinic cell metaplasia, and smooth muscle bundles were also seen as components of the polyp. Two cases (cases 1 and 4) coexisted with multifocal gastritis cystica profunda (GCP) and gastric adenocarcinoma. Case 4 furthermore exhibited an intermediate form between IHP and GCP. We suggest that IHP may be GCP associated with exaggeratedly hyperplastic and metaplastic changes. In case 4, the coexisting gastric carcinoma was mainly located in the submucosa, whilst the mucosal component was minimal. Five out of twenty reported gastric IHP cases, including our cases, coexisted with gastric adenocarcinoma. These facts would lead us to further investigate the relation between gastric IHP and carcinoma.
The role of bacteriolysis in the pathophysiology of inflammation, infection and post‐infectious sequelae
Authors: GINSBURG ISAAC
Published: March 2003

The literature dealing with the biochemical basis of bacteriolysis and its role in inflammation, infection and in post‐infectious sequelae is reviewed and discussed. Bacteriolysis is an event that may occur when normal microbial multiplication is altered due to an uncontrolled activation of a series of autolytic cell‐wall breaking enzymes (muramidases). While a low‐level bacteriolysis sometimes occurs physiologically, due to “mistakes” in cell separation, a pronounced cell wall breakdown may occur following bacteriolysis induced either by beta‐lactam antibiotics or by a large variety of bacteriolysis‐inducing cationic peptides. These include spermine, spermidine, bactericidal peptides defensins, bacterial permeability increasing peptides from neutrophils, cationic proteins from eosinophils, lysozyme, myeloperoxidase, lactoferrin, the highly cationic proteinases elastase and cathepsins, PLA2, and certain synthetic polyamino acids. The cationic agents probably function by deregulating lipoteichoic acid (LTA) in Gram‐positive bacteria and phospholipids in Gram‐negative bacteria, the presumed regulators of the autolytic enzyme systems (muramidases). When bacteriolysis occurs in vivo, cell‐wall‐ and ‐membrane‐associated lipopolysaccharide (LPS (endotoxin)), lipoteichoic acid (LTA) and peptidoglycan (PPG), are released. These highly phlogistic agents can act on macrophages, either individually or in synergy, to induce the generation and release of reactive oxygen and nitrogen species, cytotoxic cytokines, hydrolases, proteinases, and also to activate the coagulation and complement cascades. All these agents and processes are involved in the pathophysiology of septic shock and multiple organ failure resulting from severe microbial infections. Bacteriolysis induced in in vitro models, either by polycations or by beta‐lactams, could be effectively inhibited by sulfated polysaccharides, by D‐amino acids as well as by certain anti‐bacteriolytic antibiotics. However, within phagocytic cells in inflammatory sites, bacteriolysis tends to be strongly inhibited presumably due to the inactivation by oxidants and proteinases of the bacterial muramidases. This might results in a long persistence of non‐biodegradable cell‐wall components causing granulomatous inflammation. However, persistence of microbial cell walls in vivo may also boost innate immunity against infections and against tumor‐cell proliferation. Therapeutic strategies to cope with the deleterious effects of bacteriolysis in vivo include combinations of autolysin inhibitors with combinations of certain anti‐inflammatory agents. These might inhibit the synergistic tissue‐ and‐ organ‐damaging “cross talks” which lead to septic shock and to additional post‐infectious sequelae.
Trimethylamine content in vaginal secretion and its relation to bacterial vaginosis
Authors: WOLRATH HELEN , BORÉN HANS , HALLÉN ANDERS , FORSUM URBAN
Published: March 2003

The presence of a fishy odor emanating from women who present with a malodorous vaginal discharge is well known. The odor is due to bacterial reduction of trimethylamine oxide to trimethylamine (TMA) in vaginal secretion. The release of TMA from specimens of vaginal fluid following the addition of alkali is often used in making a clinical diagnosis of bacterial vaginosis (BV). We now report a sensitive gas chromatographic method for analysis and quantification of TMA in vaginal fluid in which weighed samples were used. In addition, a proper diagnosis of BV was obtained using Gram‐stained smears of the vaginal fluid according to the method of Nugent et al. (R. P. Nugent et al., J Clin Microbiol 1991;29:297–301). We also diagnosed BV according to Hallén et al. (A. Hallén et al. Genitourin Med 1987;63:386–9). TMA was present in all women with a Nugent score between 7 and 10 and in almost all women diagnosed with BV according to the method of Hallén et al. TMA was not found or was only found in very low concentrations in vaginal fluid from women with Nugent scores of 0 to 3. TMA was also found in four women with a negative sniff test. It seems that high levels of TMA in samples of vaginal fluid are typical for BV regardless of the scoring method used for diagnosis. However, low levels of TMA, <5 μg/g vaginal fluid, do not always correlate with BV.
Effect of intravenous immunoglobulins on in vitro immunoglobulin formation in patients with antibody immunodeficiency
Authors: Krátká Zuzana , Bártová Jiřina , Kryštůfková Olina , Benetková Klára , Mrklas Lubor , Fučíková Tereza
Published: March 2003

Seventeen patients with antibody immunodeficiency (9 subclass IgG immunodeficiencies, 8 common variable immunodeficiencies) and clinically unambiguous immunodeficiency symptomatology participated in the study with 14 healthy donors. The patients were given regular intravenous immunoglobulin (IVIG) infusions with Endobulin. Blood was collected before and 7 days after infusion of the usual IVIG dose. Mononuclear cells were isolated from peripheral blood (PBMC) of the patients by Ficoll‐Paque gradient centrifugation. In order to monitor the ability to inhibit or activate polyclonal production of immunoglobulins in vitro, we stimulated PBMC with pokeweed mitogen (PWM) and with a mixture of pokeweed mitogen + concanavalin A (PWM+ConA). We found that an immunomodulatory effect of IVIG persists in vitro even one week after infusion. Polyclonally stimulated IgA and IgM production was suppressed by IVIG infusion mainly in patients with IgG subclass deficiency. The positive stimulatory effect of IVIG infusion on IgG production was confirmed. The IgG production increased in vitro after infusion in both groups of patients and was significantly higher than in healthy donors. Co‐stimulation of PWM‐stimulated cells with ConA caused an inhibition of immunoglobulin release in normal healthy donors. The infusion supported the capability of ConA to inhibit IgG production in vitro in patients with IgG subclass deficiency, whereas an increase in IgG production with PWM+ConA stimulation after infusion was found in CVID patients. We assume that lymphocytes activated by ConA produce suppressive factors, which can be affected by the IVIG infusion and which can have both an immunostimulatory and an immunosuppressive effect.
Regeneration and enlargement of jaw bone using guided tissue regeneration
Authors: Buser D. , Brägger U. , Lang N. P. , Nyman S.
Published: March 2003

The purpose of this study was to present the surgical procedures and the clinical results of guided tissue regeneration (GTR) treatment aimed at regenerating local jaw bone in situations where the anatomy of the ridge did not allow the placement of dental implants. 12 patients were selected for ridge enlargement or bony defect regeneration. A combined split‐ and full‐thickness flap was raised in areas designated for subsequent implant placement. Following perforation of the cortical bone to create a bleeding bone surface, a PTFE membrane was adjusted to the surgical site in such a way that a secluded space was created between the membrane and the subjacent bone surface in order to increase the width of the ridge or to regenerate bony defects present. Complete tension‐free closure of the soft tissue flap was emphasized. Following a healing period of 6 to 10 months, reopening procedures were performed and the gain of bone dimension was assessed. In 9 patients with 12 potential implant sites, a sufficient bone volume was obtained to allow subsequent implant placement. The gain of new bone formation varied between 1.5 and 5.5 mm. In 3 patients, acute infections developed which necessitated early removal of the membranes and no bone regeneration could be achieved. The results of the study indicate that the biological principle of GTR is highly predictable for ridge enlargement or defect regeneration under the prerequisite of a complication‐free healing.
Comparative evaluation of the oral tactile function bv means of teeth or implant‐supported prostheses
Authors: Jacobs R. , Van Steenberghe D.
Published: March 2003

To clarifv more of the tactile function of oral implants, both an interocclusal thickness detection and discrimination task were carried out in 4 different test conditions on 37 patients: t (tooth)/t, i (implant)/t. i/i and d (denture)/0 (overdenture supported by implants). For the interocclusal detection of steel foils. the 50percnt; detection threshold level (RL) in the 4 conditions was 20, 48, 64 and 108 pm, respectively. which indicates significant differences. The ability to discriminate interdental thickness differences was tested with a 0.2 and 1.0 mm standard. It was evaluated as the 75% discrimination level (DL). In the 0.2 mm discrimination task, corresponding DL‐values for the t/t, i/t, i/i and d/o condition were 25, 55, 66 and 134 μm, whereas the 1.0 mm standard gave values of 193. 293, 336 and 348 μm. respectively. All results differed significantly from each other (p<0.05) except for the i/i‐d/o comparison of the 1.0 mm discrimination task where the difference was negligible. The present findings indicate that the tactile sensibility of implants is reduced with regard to natural teeth. Remaining receptors of the peri‐implant tissues might play a compensatory role in the decreased exteroceptive I function.
Maxillary sinus augmentation using mandibular bone grafts and simultaneous installation of implants. A surgical technique
Authors: Hirsch J. M. , Ericsson I.
Published: March 2003

This paper presents a specific technique for maxillary sinus augmentation and simultaneous placement of implants in partially edentulous patients. In such patients. there is from time to time insufficient interarch distance for any type of onlay grafting. Healthy. non‐smoking patients without previous or present sinus pathology. where the radiological and clinicle examination revealed insufficient height and/or width of the remaining alveolar process in the posterior maxillary region, were selected. They were operated on using a mandibular bone graft obtained from the symphyseal region between the mental foramina and placed in the maxillary sinus. The recipient site was prepared by cutting in a rectangular shape the lateral sinus wall into the sinus lining. The bone wall was then separated towards the lateral nasal wall by rotating the inferior portion of the cut sinus wall medially. In the space thus created, the bone graft was placed. Fixtures were installed at the same session. The method described has proved to be uncomplicated to perform under local anesthesia and no major disadvantages for the patient or pre‐ or postoperative complications have so far been observed.
Clinical and microbiological findings on newly inserted hydroxyapatite‐coated and pure‐ titanium human dental implants
Authors: Rams T. E. , Roberts T. W. , Feik D. , MoIzan A. K. , Slots3 J.
Published: March 2003

The clinical and microbiologic features of 30 hydroxyapatite‐coated root‐form endosseous dental implants (Tri‐Stage) were compared to 10 similar pure titanium implants without hydroxyapatite coatings. In 7 of 9 partially edentulous patients studied, pure titanium fixtures were placed adjacent to hydroxyapatite‐coated implants. Implants in the maxilla were submerged beneath mucosal tissues after implant placement for a minimum of 6 months, and in the mandible for at least 4 months. All patients were prescribed short‐term beta‐lactam antibiotic therapy after fixture placement, and 8 of 9 used chlorhexidine mouthrinses after fixture exposure. Clinical and microbiological examination was carried out 7–10 months after fixed prosthetic loading of the implants. Clinical measurements included the gingival index, plaque index, bleeding on probing and peri‐implant probing depths determined with the Florida Probe system. Subgingival microbial samples were collected with paper points and transported in VMGA III. Specimens were examined by direct phase‐contrast microscopy and were plated onto nonselective and selective culture media for anaerobic and aerobic incubation. No significant mean clinical or microbiological differences were found between the implant types, although one hydroxyapatite‐coated implant exhibited deep probing depths, bleeding on probing and marked radiographic crestal bone loss. Streptococcus sanguis and Streptococcus mitis were the most predominant organisms recovered from clinically stable implants, whereas high proportions of Fusobacterium species and Peptostreptococcus prevotii were isolated from the ailing hydroxyapatite‐coated implant. One or more implants in 8 of the study subjects yielded enteric rods, pseudomonads, enterococci or staphylococci. The prognosis of implants with varying early microbiotas needs to be established in longitudinal studies.