bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative clinical and physiological features of Maori, Pacific Islanders and Europeans with sleep related breathing disorders
Authors: BALDWIN DAVID R. , KOLBE JOHN , TROY KIRSTY , BELCHER JOHN , GIBBS HELEN , FRANKEL ANTHONY , EATON TAM , CHRISTMAS TIM , VEALE ANDREW
Published: February 2008

Abstract

Recent studies have suggested that there is a familial association of sleep apnoea syndrome and that this is not entirely explained by inheritance of known risk factors. Maori (M) and Pacific Islanders (PI) have many of the body habitus features associated with sleep apnoea and therefore might be expected to exhibit more severe disease than Europeans (E).

Objective:

To compare the clinical and physiological characteristics of the different ethnic groups and to determine if race was an independent predictor of severity of sleep apnoea.

Methodology:

A prospective evaluation of patients attending the Sleep Disordered Breathing Clinic which serves the whole of Auckland (population 1.1 million), New Zealand was conducted for the period July 1994 to August 1995. The evaluation included history including a 26 question questionnaire, Epworth sleepiness score, examination, and where indicated, full polysomnography.

Results:

A total of 233 patients (154 E, 48 M AND 33 PI), underwent full polysomnography. Forty‐one (85%) of the M and 31 (94%) of PI had obstructive or mixed sleep apnoea compared with only 74 (49%) of the E (P< 0.0001; x2). There were few racial differences in the responses to the sleep questionnaire. M and PI were shown to have much greater neck and waist circumference and body mass indices. Severity parameters (apnoea‐hypopnoea index, wake and minimum oxygen saturation, and apnoea duration) were greater for both M and PI compared with E (P< 0.001; Mann‐Whitney U‐test). Stepwise regression identified neck size, body mass index and age as independent predictors of severity.

Conclusion:

When other factors were controlled for, race was not an important independent predictor of severity of sleep apnoea.
Tuberculous empyema
Authors: BAI Kuan‐Jen , WU Ing‐Her , YU Ming‐Chih , CHIANG I‐Hsin , CHIANG Chen‐Yuan , LIN Tao‐Ping , LEE Yung‐Chie , LUH Kwen‐Tay
Published: February 2008

Abstract The clinical courses of 35 tuberculous empyema patients were investigated retrospectively from November 1990 through November 1995. Most patients had nonspecific symptoms and signs but with far‐advanced pulmonary parenchymal lesions in their chest roentgenographs. The effusions showed neutrophilic leukocytosis with a 60% positive culture rate for Mycobacterium tuberculosis. Multidrug resistant strains were found in 7 out of 18 cultures. All patients received chemotherapy and eight of them underwent additional surgical management. Twenty‐two (62.9%) patients had been treated successfully and one patient is still under treatment. The remaining 12 patients either died during treatment or defaulted; and four (11.4%) of them had died of tuberculosis. We conclude that the treatment outcome of tuberculous empyema is less satisfactory than that of pulmonary tuberculosis, however, modem multidrug chemotherapy with repeated drainage and opportune surgical interventions could be in prospect of successful treatment of tuberculous empyema.
Airway cough sensitivity to inhaled capsaicin and bronchial responsiveness to methacholine in asthmatic and bronchitic subjects
Authors: FUJIMURA Masaki , KAMIO Yumie , HASHIMOTO Takuma , MATSUDA Tamotsu
Published: February 2008

Abstract The objective of this study was to evaluate the effect of chronic airway inflammation on airway cough sensitivity and non‐specific bronchial responsiveness, and the relationship between them. The capsaicin cough threshold, defined as the lowest concentration of capsaicin causing five or more coughs, and non‐specific bronchial responsiveness, defined as the methacholine concentration causing a 20% fall in forced expiratory volume in 1 s (FEV1) (PC20‐FEV1)were measured in 18 asthmatic, 13 bronchitic (sinobronchial syndrome) and 28 healthy non‐atopic subjects. All subjects were non‐smoking men. The geometric mean values (μmol) of the cough threshold were 18.9 (GSEM 1.29), 8.69 (GSEM 1.29) and 27.6 (GSEM 1.31) in asthmatic, bronchitic and normal subjects, respectively. The value in bronchitic subjects was significantly lower (P“0.02) than that in normal subjects. The geometric mean value of PC20‐FEV1 in asthmatic subjects (0.48mg/ml (GSEM 1.38)) was significantly lower than that in bronchitic subjects (18.5mg/ml (GSEM 1.75)) (P“0.001). There was no correlation between cough threshold and PC20‐FEV1 values (correlation coefficient (r)= 0.155). These results indicate that cough sensitivity is potentiated by chronic airway inflammation in bronchitis but not in asthma, and suggest that cough sensitivity and bronchial responsiveness may be independently potentiated by different mechanisms resulting from chronic airway inflammation.
Sarcoidosis associated with multiple large pulmonary nodules
Authors: KUROGOUCHI Fumio , FUJIMORI Yoshifumi , OHARAZAWA Akiko , NAGASAKI Masaaki , MIYAZAWA Koichi , SANO Kenji , KUBO Keishi , KIYOSAWA Kendo
Published: February 2008

Abstract Parenchymal manifestations of pulmonary sarcoidosis include a diffuse, symmetric, reticulonodular interstitial pattern, a fibrotic pattern, and an acinal pattern. Large pulmonary nodules in sarcoidosis are rare, and their frequency (>1 cm in diameter) has been estimated at 2–4%. We report a rare case of sarcoidosis associated with large bilateral pulmonary nodules. These nodules reached up to 7 cm in diameter, which is larger than any others reported previously. Furthermore, these nodular lesions developed within only 6 months of normal chest X‐ray results and were not found to accompany bilateral hilar lymph adenopathy, which is observed in the usual course of sarcoidosis. As described above, this case of pulmonary sarcoidosis was significant not only in terms of the large size of the nodules but also the unique chest X‐ray course.
Transcatheter embolization of pulmonary arteriovenous malformations in Rendu‐Osler‐Weber disease
Authors: SHIOYA Takanobu , SANO Masa‐Aki , KAGAYA Manabu , ITO Nobuaki , WATANABE Akiko , SATO Kazuhiro , ITO Takehumi , SASAKI Masahiro , HASHIMOTO Manabu , MIURA Mamoru
Published: February 2008

Abstract Interest in the treatment of the pulmonary arteriovenous malformations (PAVMs) that occur in approximately one‐third of patients with Rendu‐Osler‐Weber (ROW) disease (hereditary haemorrhagic teleangiectasia) has recently been renewed. PAVMs can now be occluded safely by the transvenous placement of detachable balloons or metal coils, thus avoiding the many potential complications of thoracotomy. This study analyses the treatment of eight PAVMs in four ROW patients by transcatheter embolization using detachable balloons or metal coils. After embolization, the mean right‐to‐left shunt fraction significantly decreased from 39.1 ± 5.1% to 11.9 ±1.1% (P< 0.05) and PaO2significantly increased from 53.3 ± 7.8 torr to 76.2 ±8.4 torr (P<0.05). No serious complications occurred. One detachable balloon was deflated, but no recanalization occurred. We conclude that transcatheter embolization is a safe and efficacious treatment for PAVMs associated with ROW disease. Long‐term studies are now needed to determine the risk of recanalization in this treatment.
A silicosis patient presenting with an enlarged supraclavicular lymph node
Authors: WaiWONG Tze , SunYU Tak , MingTAM Cheuk , RongWANG Xiao
Published: February 2008

Abstract A stone splitter was discovered to have an enlarged supraclavicular lymph node which showed nodules with bi‐refringent crystals on histological examination. He had worked in a dusty environment for more than 10 years with ineffective respiratory protection. He gave a history of occasional cough with blood‐stained sputum for 10 years for which no definite diagnosis was made. Silicosis (classified as type s/s with profusion 1/1) was confirmed after his chest radiographs were reviewed. The presentation was unusual and illustrated the importance of an occupational history in clinical practice.
How do symptoms have an impact on the prognosis of renal cell carcinoma?
Authors: Kawata Nozomu , Nagane Yusuke , Yamaguchi Kenya , Ichinose Taketo , Hirakata Hitoshi , Takahashi Satoru
Published: February 2008

Aim:  Symptomatic renal cell carcinoma (RCC) is well known to have a characteristic behavior. We therefore evaluated the impact of systemic symptoms on the prognosis of RCC.

Methods:  Patard's criteria were used to classify symptoms before operation into three groups defined as: S1 (incidental tumor), S2 (localized symptoms) and S3 (systemic symptoms). Selected clinicopathological factors including gender, maximum tumor diameter, clinical stage, hemoglobin, C‐reactive protein (CRP) and immunosuppressive acidic protein, nuclear grade and venous invasion were measured preoperatively in 252 patients. To determine impacts of them on the prognosis of RCC, we compared quantitative results using Cox multivariate analysis.

Results:  The cancer‐specific five‐year survival rates were 93.1%, 71.0%, and 20.2% for S1 (144 patients), S2 (80 patients) and S3 (28 patients), respectively (P < 0.0001). By the univariate analysis, S2 and S3 were significant prognostic factors (risk ratio 4.5, P = 0.0003, risk ratio 19.15, P < 0.0001, respectively). By the multivariate analysis limited to preoperative clinical characteristics, S3 and CRP were independent factors (risk ratio 7.05, P = 0.0006, risk ratio 3.53, P = 0.0052, respectively). When pathological factors as well as preoperative clinical features were included on multivariate analysis, S3 and CRP remained to be independent predictive factors (risk ratio 6.01, P = 0.0031, risk ratio 2.64, P = 0.0040, respectively). Among pathological factors, only nuclear grade was a significant prognostic factor (risk ratio 2.92, P = 0.013).

Conclusion:  The presence of systemic symptoms is an independent prognostic factor along with nuclear grade and CRP.
The potential role of prebiopsy magnetic resonance imaging combined with prostate‐specific antigen density in the detection of prostate cancer
Authors: Kubota Yasuaki , Kamei Shingo , Nakano Masahiro , Ehara Hidetoshi , Deguchi Takashi , Tanaka Osamu
Published: February 2008

Aim:  Two‐thirds of patients with a gray‐zone prostate‐specific antigen (PSA) level undergo unnecessary biopsy. Sensitivity is not yet sufficient to permit the use of modified PSA parameters or magnetic resonance (MR) imaging alone for prostate cancer screening. Thus, we evaluated the combination of MR imaging and PSA density (PSAD) for specificity and sensitivity.

Methods:  During the period April 2004 through March 2006, 185 patients with a PSA level of 4.0–10.0 ng/mL underwent MR imaging and transrectal ultrasonography‐guided 8‐core biopsy (systemic sextant biopsy of the peripheral zone plus two cores of transition zone). All MR images were interpreted prospectively by two radiologists. An image was considered positive for prostate cancer if any feature indicated a cancerous lesion. Receiver operating characteristic (ROC) curves were used to compare the usefulness of the PSA level, PSAD and PSA transitional zone density (PSATZ) for the detection of prostate cancer.

Results:  Of the 185 patients, 62 had prostate cancer. Sensitivity and specificity of the axial T2‐weighted MR imaging findings for cancer detection were 79.0% and 59.4%, respectively. The area under the ROC curve was 0.590 for the PSA level, 0.718 for PSAD and 0.695 for PSATZ. MR imaging findings and PSAD were shown by multivariate analysis to be statistically significant independent predictors of prostate cancer (P < 0.001). With a PSAD cut‐off value of 0.111, sensitivity was 96.8%, but specificity was 19.5%. Combining MR imaging findings with PSAD increased the specificity to 40% and retained 95% sensitivity.

Conclusion:  MR imaging findings combined with PSAD provide high sensitivity and improve the specificity for the early detection of prostate cancer.
Verapamil prevents the apoptotic and hemodynamic changes in response to unilateral ureteral obstruction
Authors: Topcu Sukru O , Celik Sukru , Erturhan Sakip , Erbagci Ahmet , Yagci Faruk , Ucak Ramazan
Published: February 2008

Introduction: Obstruction of the urinary tract has marked effects on renal blood flow, glomerular filtration rate (GFR), and tubular function. Moreover, ureteral obstruction results in an injury response that can progress to irreversible renal fibrosis and tubular atrophy by apoptosis.

Methods: We examined the effect of a calcium channel blocker (verapamil) on renal functions and the abundance of apoptotic (p53, Fas, proliferating cell nuclear antigen [PCNA]) markers 1 week after Unilateral Ureteral Obstruction (UUO).

Results: Immunohistochemistry studies revealed that UUO was markedly associated with up‐regulation in the expression of p53 (1550 ± 82vs100 ± 23%), Fas (657 ± 48vs100 ± 31%), and proliferating cell nuclear antigen (945 ± 70vs100 ± 17% of sham levels). Administration of verapamil normalized the up‐regulation of apoptotic markers p53 (724 ± 116vs1550 ± 82%); Fas (162 ± 38vs657 ± 48%) and PCNA (353 ± 54vs945 ± 70%). Furthermore, tubular diameter, as an important marker for detecting tubular atrophy was significantly decreased compared to those in UUO rabbits. The percent area of interstitial fibrosis in UUO kidneys was significantly greater than that in Verapamil‐treated kidneys. Importantly, Verapamil reduced the development of interstitial fibrosis in UUO rabbits. We measured the GFR and renal blood flow in UUO. Short‐term Verapamil challenge partially prevented the decrease in GFR (non‐treated UUO: 62 ± 14; Verapamil + UUO: 119 ± 7; Sham: 127 ± 23 μL·min−1·kg body wt−1,P < 0.05) and renal blood flow (non‐treated UUO: 1.1 ± 0.4; Verapamil + UUO: 5.0 ± 0.2; sham: 6.3 ± 0.2 mL·min−1·kg body wt−1,P < 0.05).

Conclusion: Verapamil significantly prevents impairment in renal function and also prevents the up‐regulation of p53, Fas, and PCNA during UUO, demonstrating a marked renoprotective effect of Verapamil treatment in conditions with urinary tract obstruction.
Results of treatment of renal calculi with lower‐pole fluoroscopically guided percutaneous nephrolithotomy
Authors: Nishizawa Koji , Yamada Hitoshi , Miyazaki Yu , Kobori Go , Higashi Yoshito
Published: February 2008

Objective:  To prospectively assess the clinical efficacy and safety of lower‐pole fluoroscopically guided percutaneous nephrolithotomy (PNL).

Methods:  A total of 90 renal units in 87 patients underwent lower‐pole fluoroscopically guided PNL for renal calculi. The average patient age was 56.0 years. Staghorn calculi were present in 41 renal units. There were 22 were upper pole, 54 middle pole, 76 lower pole, 70 pelvic and 18 ureteropelvic junction calculi. Patients without significant residual fragments greater than 3mm on postoperative day 2 were defined as primarily successful. Significant residual fragments were treated with shock wave lithotripsy (SWL) every other day from postoperative day 3.

Results:  Mean operative time was 129.5 min (SD, 49.0). Blood transfusion was required in four patients. Septic shock developed in three patients. Sixty‐three percent of the patients (57 of 90 procedures) were primarily successful after PNL: 83.7% of non‐staghorn patients (41 of 49 procedures) and 39.0% of staghorn patients (16 of 41 procedures). Of the 33 patients with significant residual fragments, 13 staghorn and six non‐staghorn patients had residual fragments in their middle calyces. Of the preoperative variables, staghorn calculus and calculus in the middle calyx were significant predictors of significant residual fragments after PNL. After adjunctive SWL, the overall success rate was 94.5%.

Conclusions:  Our study suggests that lower‐pole fluoroscopically guided PNL is a safe and effective therapy for patients with staghorn or non‐staghorn calculi. In patients with staghorn calculi or calculi in the middle calyx, adjunctive treatment is sometimes required to treat significant residual fragments.
Evaluation of the association of current cigarette smoking and outcome for patients with clear cell renal cell carcinoma
Authors: Parker Alexander , Lohse Christine , Cheville John , Leibovich Bradley , Igel Todd , Blute Michael
Published: February 2008

Objectives:  Cigarette smoking is a well known risk factor for the development of renal cell carcinoma (RCC); however, its association with tumor aggressiveness and patient outcome remains in question. Herein, we test the hypothesis that cigarette smoking is associated with a more aggressive phenotype and poorer outcome among patients with RCC.

Methods:  We examined data on 2242 patients treated with radical nephrectomy or nephron‐sparing surgery for unilateral, sporadic, clear cell RCC at Mayo Clinic Rochester between 1970 and 2002. Associations of self‐reported smoking status with death from RCC were assessed using Cox proportional hazards regression models summarized with hazard ratios (HR) and 95% confidence intervals (CI).

Results:  While former cigarette smoking was not associated with an increased risk of RCC death, current cigarette smokers were 31% more likely to die from RCC compared with non‐smokers on a hazard ratio scale (HR 1.31; 95% CI 1.09–1.58; P = 0.004). Interestingly, current smokers were more likely to present with advanced disease (i.e. later TNM stage) compared with both former and never smokers. After adjustment for TNM stage group and tumor grade, there was no longer a statistically significant increase in the risk of death from RCC for current cigarette smokers (HR 0.99; 95% CI 0.82–1.19; P = 0.875).

Conclusions:  Patients who report current smoking at time of surgery are at increased risk of RCC death; however, this association is attenuated after adjustment for standard pathological indices and is therefore of little prognostic value. Nevertheless, the association of current smoking with more advanced disease at presentation (e.g. metastatic spread) warrants further investigation.
Laparoscopic adrenalectomy for malignant tumors
Authors: Eto Masatoshi , Hamaguchi Masumitsu , Harano Masahiko , Yokomizo Akira , Tatsugami Katsunori , Naito Seiji
Published: February 2008

Objectives:  The treatment of malignant adrenal tumors using laparoscopic surgery remains controversial. We thus compared the perioperative outcome of the laparoscopic adrenalectomy for the treatment of malignant tumors with the outcome for benign tumors. We also evaluated the oncological outcome of the laparoscopic adrenalectomy for a malignancy.

Methods:  Since 1999 a total of nine laparoscopic adrenalectomies for a malignancy have been performed in nine patients. The median adrenal tumor size was 3 cm. The laparoscopic approach was transperitoneal in all cases. Seven patients had no evidence of a systemic metastatic disease, whereas two patients with a metastatic renal cell carcinoma had systemic metastatic disease at the time of the operation.

Results:  The median operation time was 165 min and the estimated blood loss was 75 mL in the laparoscopic adrenalectomy for a malignancy. There was no significant difference between laparoscopic adrenalectomy for malignant and benign tumors. Regarding the oncological outcome, seven of the nine patients, including the two palliative cases, treated with a laparoscopic adrenalectomy for a malignancy were alive at a median follow‐up of 20 months. One patient died of other causes.

Conclusions:  Our results clearly indicate that a laparoscopic adrenalectomy for the treatment of a metastatic adrenal malignancy can be performed with an acceptable outcome as a minimally invasive method in carefully selected patients.
What do people with glaucoma know about their condition? A comparative cross‐sectional incidence and prevalence survey
Authors: Danesh‐Meyer Helen V , Deva Narme C , Slight Carol , Tan Yu Wee , Tarr Ken , Carroll Stuart C , Gamble Greg
Published: February 2008

Abstract

Purpose:  To assess and compare glaucoma knowledge between patients with established glaucoma, newly diagnosed glaucoma and the general population.

Methods:  208 glaucoma patients, 100 newly diagnosed glaucoma patients from three clinical centres and 100 controls from non‐ophthalmology outpatient clinics, were recruited and completed a validated self‐administered true/false questionnaire assessing glaucoma knowledge. Demographic data were also recorded. Glaucoma knowledge score, out of a maximum of 22, and odds ratios (OR) with 95% confidence intervals (CI) of survey characteristics associated with falling in the lowest quartile of the overall knowledge score was evaluated for each study group.

Results:  Established glaucoma patients had (median 17, interquartile range 15–19) marginally but significantly (P < 0.05) greater glaucoma knowledge scores than new patients (median 16, interquartile range 13–18). Both of these groups scored significantly better than the control population (median 13, interquartile range 10–14, P < 0.05). Significant misconceptions regarding glaucoma include: 80% of all participants thought that topical medications could not have systemic side‐effects, 48% of established glaucoma patients believed symptoms would warn them of disease progression. One‐third of new patients considered blindness to be a common outcome of having glaucoma. For established patients, factors associated (P < 0.05) with a lesser likelihood of scoring in the lowest quartile of the total score included having family (OR 0.33, 95% CI 0.11–0.98) or friends (OR 0.28, 95% CI 0.06–0.97) with glaucoma, being referred by an optometrist compared with general practitioner (OR 0.21, 95% CI 0.08–0.57), speaking English at home (OR 0.13, 95% CI 0.04–0.49) and being seen in the private health‐care sector (OR 0.13, 95% CI 0.04–0.42).

Conclusion:  Patients with established glaucoma have only slightly greater knowledge than newly diagnosed patients, with both patient groups harbouring significant misconceptions regarding glaucoma. Educational programmes and material should be tailored to address these misconceptions.
The effect of photodynamic therapy on retrobulbar blood flow parameters
Authors: Türkçüoǧlu Peykan , Deniz Nurettin , Koç Mustafa , Kurt Julide , Çeliker Ülkü
Published: February 2008

Abstract

Purpose:  To investigate the effect of photodynamic therapy (PDT) on retrobulbar blood flow parameters.

Methods:  Twenty‐four patients with choroidal neovascular membrane of at least four MPS disc area in one eye due to age‐related macular degeneration scheduled for PDT were recruited. Peak systolic and end diastolic velocity of ophthalmic, central retinal and posterior ciliary artery of both eyes were measured with colour Doppler imaging and resistivity index were computed before, at the first and fourth weeks following PDT.

Results:  Following PDT, the mean peak systolic velocity of posterior ciliary artery increased significantly to a value of 31.90 ± 13.44 at the first (P = 0001), then returned to an insignificant value of 29.95 ± 13.03 at the fourth week (P = 0.360), when compared with pre‐PDT mean measurement (30.16 ± 13.15). Resistivity index of posterior ciliary artery also increased significantly to a value of 0.740 ± 0.77 at the first (P = 0.046), then returned to an insignificant value of 0.666 ± 0.14 at the fourth week (P = 0.407), when compared with pre‐PDT mean measurement (0.709 ± 0.90). All the other measured data (peak systolic velocity, end diastolic velocity, resistivity index of ophthalmic and central retinal artery; end diastolic velocity of posterior ciliary artery of the treated eyes; all colour Doppler imaging measurements of untreated eyes) did not show any significant change at the first and fourth week following PDT, when compared with the pre‐PDT values.

Conclusion:  The peak systolic velocity and resistivity index of the posterior ciliary artery appear to increase in the first week and return to their baseline values at the fourth week following PDT.
Eye care in Timor‐Leste: a population‐based study of utilization and barriers
Authors: Palagyi Anna , Ramke Jacqueline , Du Toit Renee , Brian Garry
Published: February 2008

Abstract

Background:  To determine utilization of Western‐style conventional health services for eye problems in Timor‐Leste, and barriers to seeking that care.

Methods:  An interview‐based questionnaire was administered as part of a population‐based cross‐sectional survey of 50 clusters (urban and rural) of 30 people aged ≥40 years.

Results:  Of 1470 people enumerated, 1414 were examined (96.2%). A total of 1293 (91.4%) reported at least one previous or present eye problem, mostly (88.6%) blurred/poor vision, for near and/or distance. Men (OR 1.6, 95% CI 1.1–2.3), literates (OR 2.1, 95% CI 1.4–3.5), urban dwellers (OR 4.1, 95% CI 2.6–6.4) and those in paid employment compared with being a farmer (OR 3.0, 95% CI 1.5–5.9) were more likely to have reported a problem. A total of 858 (66.4%) sought Western‐style care for its remedy. Non‐utilization was associated with being illiterate (OR 3.7, 95% CI 2.9–4.8), a rural dweller (OR 3.8, 95% CI 3.0–4.9), unemployed (OR 1.6, 95% CI 1.1–2.2) or a farmer (OR 5.2, 95% CI 3.5–7.6) compared with being in paid employment, having moderately impaired compared with non‐impaired near vision (OR 1.4, 95% CI 1.1–1.8), and red/itchy/painful eyes compared with blurred vision (OR 2.3, 95% CI 1.6–3.2), but not age, gender or poor distance vision. Lack of awareness of service availability was the most frequent reason for not seeking treatment (32.9%), especially for rural respondents. Attitudinal reasons were also prevalent (32.5%), with social (11.8%), economic (11.5%) and service‐related (9.0%) issues less so.

Conclusions:  If eye health is to improve in Timor‐Leste, there must be better appreciation of it, and increased availability, accessibilty and awareness of services.
Treatment of recurrent corneal erosion syndrome using the combination of oral doxycycline and topical corticosteroid
Authors: Wang Louis , Tsang Hughie , Coroneo Minas
Published: February 2008

Abstract

Recurrent corneal erosion syndrome is a debilitating condition for which there are many treatment options with varying rates of success. One treatment of interest in recent years is the combination of oral doxycycline and topical corticosteroids, both of which have been shown to inhibit key metalloproteinases important to disease pathogenesis. To assess the efficacy of this treatment, we conducted a retrospective single‐observer case series involving all patients with recurrent corneal erosion syndrome who were treated at a community‐based clinic with oral doxycycline and topical corticosteroid between January 2000 and July 2007. Twenty‐one patients were identified. All received oral doxycycline 50 mg twice daily and topical fluoromethalone 0.1% three times daily for at least 4 weeks. At 8 weeks post commencement of treatment, 15/21 patients (71%) were symptom free. All but one of these patients reported an improvement in symptoms. Of those patients not lost to follow up, 15/18 patients (83%) and 11/15 patients (73%) denied any symptoms suggestive of relapse at 6 and 12 months, respectively. Among the patients in remission was one who had responded poorly to other treatments including ocular lubricants, epithelial debridement, serum eyedrops, anterior stromal puncture, and phototherapeutic keratectomy. Treatment of recurrent corneal erosion syndrome with the combination of oral doxycycline and topical corticosteroid is effective. It may help patients with recurrent corneal erosion syndrome who have failed other forms of treatment. This non‐invasive treatment modality should also be considered as the first treatment option when conservative management with ocular lubricants fails.
Mutation screening of TGFBI in two Iranian Avellino corneal dystrophy pedigrees
Authors: Alavi Afagh , Elahi Elahe , Rahmati‐Kamel Mohsen , Karimian Farid , Rezaei‐Kanavi Mojgan
Published: February 2008

Abstract

Purpose:  Genetic analysis and phenotypic features of Avellino corneal dystrophy patients from Japan and some European countries have been published. We report for the first time the genetic analysis and phenotypic features of two Avellino corneal dystrophy pedigrees from the Middle East.

Methods:  Slit‐lamp biomicroscope photographs of cornea were obtained, and corneal tissue sections were stained with masson‐trichrome and Congo red. DNA was isolated from peripheral blood leucocytes and exons 4 and 12 of TGFBI were screened for mutations by direct sequencing.

Results:  The probands of the pedigrees had phenotypic features consistent with diagnosis of Avellino corneal dystrophy. They were homozygous for the same R124H mutation in TGFBI as previously reported in Avellino patients from Japan and European countries. Heterozygous carriers of the mutation were identified in the pedigree and shown to have symptoms of disease milder than those of the probands.

Conclusion:  The finding of R124H in the Middle Eastern (Iranian) population supports the proposal that perhaps only substitution of histidine for arginine at position 124 of tumour growth factor beta induced protein results in the Avellino corneal dystrophy phenotype. As both probands were originally diagnosed with granular corneal dystrophy, and as heterozygous carriers of R124H were unaware of their disease status prior to genetic analysis, the importance of genetic analysis is emphasized.
Retrocapsular lens matter in uneventful phacoemulsification: does it really exist?
Authors: Liu David TL , Lee Vincent YW , Li Chi‐Lai , Choi Paul CL , Lam Philip TH , Lam Dennis SC
Published: February 2008

Abstract

Purpose:  To have the first cytopathological evaluation of any lens matter fragments within retrocapsular anterior vitreous in those patients undergone uneventful phacoemulsification in Prince of Wales Hospital, Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong.

Methods:  Thirty patients with cataracts and various vitreoretinal conditions that required combined surgery were recruited. After the uneventful clear corneal phacoemulsification, three sclerotomies including infusion port were created with cautions against any inadvertent leakage of vitreal content. The anterior vitreous at retrocapsular space was harvested by a special ‘round‐the‐clock’ dry vitrectomy into a special specimen reservoir hub and syringe. The aspirate was immediately fixed in 50% ethanol and together with a masked positive control sent for cytocentrifugation processing. The microscope slides of the anterior vitreal content and control were stained with haematoxylin and eosin and papanicolaou. Positive controls were collected from the effluent fluid of the phaco cassettes right after the phacoemulsification. The samples were masked and examined by an experienced pathologist for any cytopathological evidence of lens matter.

Results:  Out of 30 patients, three suspicious cases of retrocapsular lens fragment were noted by retroillumination on the operating table. However, all the anterior vitreous specimens were negative for lens matter whereas all the controls were positive after cytopathological verification.

Conclusions:  This is the first cytopathological study objectively indicating low likelihood of the postulation that retrocapsular lens matter occurred after uneventful phacoemulsification.
Combined cataract surgery and vitrectomy for vitreous haemorrhage secondary to age‐related macular degeneration
Authors: Roufail Edward , Polkinghorne Philip J
Published: February 2008

Abstract

Purpose:  To report on the functional outcome of surgery on patients with concurrent cataract and breakthrough vitreous haemorrhage from age‐related macular degeneration (ARMD).

Methods:  Retrospective case series.

Results:  Five eyes were included in the study. The post operative follow‐up interval ranged from 9 to 12 months. Preoperative visual acuity ranged from hand motion to perception of light. Two surgeries were complicated by iatrogenic breaks, and a further surgery was required to re‐attach the retina in one of these eyes. Only one of the five eyes experienced an improvement in visual functioning.

Conclusion:  In this series, the outcome of surgery for combined cataract and breakthrough vitreous haemorrhage, secondary to ARMD was poor. The functional outcome of surgery for combined cataract and vitreous haemorrhage secondary to ARMD in this series was poor.
Does observer bias contribute to variations in the rate of retinopathy of prematurity between centres?
Authors: Darlow Brian A , Elder Mark J , Horwood L John , Donoghue Deborah A , Henderson‐Smart David J ,   on behalf of the Australian and New Zealand Neonatal Network
Published: February 2008

Abstract

Purpose:  We aimed to indirectly assess the contribution from observer bias to between centre variability in the incidence of acute retinopathy of prematurity (ROP).

Methods:  The Australian and New Zealand Neonatal Network (ANZNN) collected data on the highest stage of acute ROP in either eye in 2286 infants born at less than 29 weeks in 1998–1999 and cared for in one of 25 neonatal intensive care units (NICUs). Chi‐squared analysis was used to detect differences in the proportion of stages of ROP for each neonatal intensive care unit. These proportions were compared with those reported in two large studies of treatment for ROP.

Results:  The incidence of acute ROP in the ANZNN cohort was 42% and the ratio of stage 1:2:3 ROP was 1.5:1.9:1. There was considerable variation in both the incidence of acute ROP and the proportions with stage 1:2:3 ROP between centres. A chi‐squared test determined that the assignment of stages 1, 2 and 3/4 ROP was not independent of centre (χ248 = 165.2; P < 0.0001). Treatment of stage 3 ROP varied between 15% and 120%, indicating some eyes were treated at less than stage 3.

Conclusion:  The data are highly suggestive of observer bias contributing to the observed between centre variation in the incidence of acute ROP. In neonatal intervention studies where acute ROP is an outcome it would seem important to have an accreditation process for examining ophthalmologists, and there are similar arguments for neonatal networks which collect these data.
Cyclosporin effectively inhibits posterior capsule opacification after phacoemulsification in rabbits: a preliminary study
Authors: Totan Yüksel , Yağcı Ramazan , Erdurmuş Mesut , Bayrak Reyhan , Hepşen İbrahim Feyzi
Published: February 2008

Abstract

Purpose:  To evaluate whether cyclosporin A prevents or reduce posterior capsule opacification after phacoemulsification surgery in rabbit eyes.

Methods:  Twenty rabbits underwent cataract surgery in their right eyes were randomized into two groups. In group 1, 0.1 mL cyclosporin A (0.5 mg/mL) was given into the capsular bag after phacoemulsification and 0.1 mL cyclosporin A (0.5 mg/mL) was injected subconjunctivally once every 3 days for 1 week. Group 2 served as a control group. The development of posterior capsule opacification was assessed weekly, its density was graded clinically, and the proliferation of lens epithelial cells was evaluated histologically.

Results:  On clinical assessment, cyclosporin A was significantly effective in preventing posterior capsule opacification compared with controls (P = 0.0045). On histological analysis, there was significantly reduced proliferative activity on posterior capsules in the treatment group, in contrast to multilayer lens epithelial cells proliferation in the control group.

Conclusion:  The preliminary results indicate that cyclosporin A is effective in suppressing posterior capsule opacification in rabbits, yet requires further investigation.
In vivo confocal microscopy in a patient with conjunctival lymphoma
Authors: Pichierri Patrizia , Martone Gianluca , Loffredo Antonio , Traversi Claudio , Polito Ennio
Published: February 2008

Abstract

A case of primary conjunctival mucosa‐associated lymphoid tissue lymphoma studied by in vivo corneal confocal microscopy (IVCM) is described for the first time. Examination of the lower mediobulbar and forniceal conjunctiva of the left eye of a 37‐year‐old female patient showed a typical salmon‐pink patch. IVCM examination of the conjunctival lesion showed irregular, polygonal, conjunctival bulbar epithelial cells with blurred edges and without visible nucleus. Many small, roundish, hyper‐reflective cells were also seen. These cells were arranged diffusely or in nests in cyst‐like hypo‐reflective spaces. A few highly reflective cells were also visible among deep stromal collagen fibres. The IVCM picture recalled the histological profile of low‐grade mucosa‐associated lymphoid tissue lymphoma, characterized by sheets of neoplastic cells around reactive follicles. IVCM enabled non‐invasive evaluation of the eye surface at high magnification and with good contrast, and could be useful for early differential diagnosis of conjunctival lesions.
Anterior chamber depth and primary angle‐closure glaucoma: an evolutionary perspective
Authors: Casson Robert J
Published: February 2008

Abstract

Anterior chamber depth is an inheritable trait which is affected by age, gender and race. Over 30 years ago, Alsbirk proposed that the shallow anterior chamber, which was typical of the Greenlandic Inuit, and which brings the iris in proximity to the cornea, may have evolved as a thermoregulatory adaptation to resist corneal freezing. Here, this hypothesis is revisited. Recent population genetic data which provide evidence for migration patterns of early humans are discussed and the notions of natural selection and ocular adaptation to cold climates are considered. Problems with the hypothesis are examined, but the idea that the shallow anterior chamber has a thermoregulatory role appears sound and suggests that shallow anterior chambers may have evolved inHomo sapiensliving in north‐east Asia during the last Ice Age.
Citation analysis of the most influential authors and ophthalmology journals in the field of cataract and corneal refractive surgery 2000–2004
Authors: Fan Jennifer C , McGhee Charles NJ
Published: February 2008

Abstract

Purpose:  To identify the most published authors on the topics of ‘cataract’ and ‘LASIK’, the journals in which they publish, and the citation patterns of the most‐cited articles by these authors over a 5‐year publication period.

Methods:  Science Citation Index Expanded (SCI) was used to identify the 30 most‐published authors in ‘cataract’ and ‘laser in situ keratomileusis’ (LASIK) (2000–2004 inclusive). SCI was subsequently used to analyse the recorded articles for each author in terms of source journal, the most commonly cited articles and citation source.

Results:  Of the 30 most‐published authors in the fields of cataract and LASIK, the USA was the most well‐represented source country, accounting for 33%; 20% were from Australia, and 17% from Austria. Germany and Japan each contributed 7%. Eighty per cent of the publications produced by these 30 authors (2000–2004) were in 10 journals, of which the Journal of Cataract and Refractive Surgery (JCRS) published more than one‐third. Of the three most‐cited articles for each author, the greatest number were published in JCRS (35.6%). The citation count of the articles had a weak correlation to the journal impact factor of the source journal; however, the self‐citation rate of these articles did not.

Conclusions:  The USA and Australia together were the source of more than half of the most‐published authors on cataract and LASIK and the majority of articles published by the 30 most prolific authors were published in only 10 journals. The impact factors of the publication journals preferred by these authors are influenced by the article citation counts, not vice versa.
Patient‐focused outcomes following detection in a hospital‐based screening programme for C282Y haemochromatosis
Authors: McCullen M. A. , Fletcher L. M. , Dimeski G. , Pink A. , Powell L. W. , Crawford D. H. G. , Hickman P. E.
Published: February 2008

Background:  Haemochromatosis is a common genetic disease in populations of a northern European origin. However, there is uncertainty as to whether it is a condition that should be screened for.

Aims:  To determine the proportion of persons, in a public hospital setting, who were homozygous for the C282Y mutation for hereditary haemochromatosis and the proportion of these persons who would benefit from therapeutic phlebotomy.

Methods:  All persons who had blood submitted for pathology testing, had total iron‐binding capacity and iron measured and transferrin saturation calculated, and where this result exceeded 40%, genotyping for the C282Y mutation was carried out.

Results:  Of 18 779 patients screened, 887 (5.4%) were found to have transferrin saturation greater than 40%. Thirty‐five of these were homozygous for the C282Y mutation. Fourteen were previously known to be affected and six of these were non‐compliant with venesection. Venesection was commenced in 5 of the 21 newly diagnosed subjects.

Conclusions:  The proportion of detected subjects who commenced venesection was significant. Results suggest that clinical penetrance is higher in Australia than other countries and that even in the environment of a large tertiary teaching hospital, phenotypic screening identifies cases of hereditary haemochromatosis, which are likely to benefit from treatment.
Risk factors for symptomatic hypocalcaemia complicating treatment with zoledronic acid
Authors: Chennuru S. , Koduri J. , Baumann M. A.
Published: February 2008

Background:  The bisphosphonate zoledronic acid is commonly prescribed to prevent skeletal complications in patients with multiple myeloma or metastatic cancer. Although symptomatic hypocalcaemia is a potential risk of treatment, it has been thought to be uncommon.

Aims:  After seeing several episodes of symptomatic hypocalcaemia following zoledronic acid administration, we undertook a review to determine the incidence of this complication in our population and to attempt to identify risk factors.

Methods:  We reviewed the records of all patients receiving zoledronic acid in two teaching hospitals over a 2‐year period. Findings collected included the indication for treatment, whether dosing was adjusted for creatinine clearance, coadministered medications, serum chemistries and clinical course.

Results:  Of 120 patients who received a total of 546 zoledronic acid infusions, hypocalcaemia developed related to 55 infusions (10%) in 42 patients (35%). Symptomatic hypocalcaemia requiring i.v. supplementation occurred in 10 patients (8%), in spite of appropriate dose adjustment for creatinine clearance and despite prophylactic administration of oral calcium and vitamin D. More patients who became hypocalcaemic developed impairment of creatinine clearance during zoledronic acid treatment than in the group that remained normocalcaemic. Hypomagnesaemia was found in all patients who developed hypocalcaemia who had serum magnesium measured.

Conclusions:  Hypocalcaemia was common in our patient group following zoledronic acid treatment. Because of the prolonged elimination half‐life of this agent (146 h), renal impairment occurring during a number of days after administration may increase risk. Hypomagnesaemia may further increase risk by blunting compensatory increase in parathyroid hormone secretion.
Outcome of patients with myelodysplastic syndromes – experience from a single institution in South Australia
Authors: Hui C‐H , Horvath N. , Lewis I. , To L.‐B. , Szabo F.
Published: February 2008

Aims:  To study disease characteristics of adult patients with myelodysplastic syndromes (MDS) in South Australia and to analyse their outcome and survival.

Methods:  One hundred and eight adult patients with confirmed MDS from marrow biopsies in the 76‐month period before April 2006 were retrospectively included in an MDS database.

Results:  The median age at diagnosis of this cohort was 70 years, with skewing of refractory anaemia with excess blasts and refractory cytopenia with multilineage dysplasia in the younger patients. Clonal cytogenetic abnormalities were present in 42% of patients. Median survival was 48 months, and secondary transformation to acute myeloid leukaemia was seen in 27%. Survival, according to the World Health Organization subtypes in ascending order, was refractory anaemia with excess blasts, refractory anaemia, refractory anaemia with ringed sideroblast, refractory cytopenia with multilineage dysplasia and del(5q). The International Prognostic Scoring System score stratified MDS patients into different risk groups and effectively discriminated significantly different survivals, ranging from a median 4 months for high‐risk patients to 72 months for low‐risk patients.

Conclusion:  An MDS database provides useful information regarding the disease characteristics and survival of MDS patients in South Australia and confirms the prognostic usefulness of the International Prognostic Scoring System. The future prospective collection of results will be invaluable in evaluating the effect of novel therapies on patient prognosis.
Job variation in Australian advanced training in neurology
Authors: Lueck C. J. , Morris J. , Pepper E.
Published: February 2008

Background:  Like training posts in other medical specialties, many of the 38 Australian core training posts in neurology have been criticized over a variety of issues relating to the quality of training provided. These issues include excessive hours of work (often related to understaffing), high inpatient workload and inadequate exposure to outpatients and/or specialist procedures. To examine these issues, we conducted an audit of Australian advanced training posts in neurology to obtain baseline data.

Methods:  Two questionnaires were sent out, one to each head of department and another to the advanced trainees currently in post, requesting information about each of the training posts. The posts were compared with each other on an individual basis and by grouping them into three geographically related groups.

Results:  There was complete ascertainment and a wide variation in most of the measures examined, including inpatient and ward consult numbers, staffing levels, general neurological and specialist outpatient clinic exposure and overtime requirements. Exposure to neurophysiology clinics and training in electroencephalogram was more uniform.

Conclusion:  Core advanced training jobs in neurology vary considerably across Australia, largely for historical reasons. This situation is suboptimal for many reasons. Training jobs ideally need to be modified to take into account the changing needs of trainees rather than just the service requirements of the various departments, but there are many resource issues involved in achieving this.
Who will replace me? A renal physician’s lament
Authors: Agar J. W. M.
Published: February 2008

The nephrology workforce is in trouble. Like other consultative‐heavy specialties dealing with the chronically ill, it is increasingly difficult to attract and retain trainees. The reasons are multifactorial but include perceptions of a high workload, poor remuneration and, for regional or remote services, isolation. The rate at which new nephrologists are being added to the workforce is insufficient to replace the projected retirements by 2010 and do not allow for any increase in numbers of patients with chronic kidney disease (CKD). However, both CKD incidence and prevalence are inexorably rising, and the patients within this category bear increasingly complex comorbidities. Who will replace the retirees? Sadly, perhaps the answer is no one – an answer which places this challenging specialty under real and imminent threat.