bluuebunny/crossref_metadata_2025 huggingface dataset:
Inflammatory lesions of the lung, submandibular gland, bile duct and prostate in a patient with IgG4‐associated multifocal systemic fibrosclerosis
Authors: HAMED Ghullam , TSUSHIMA Kenji , YASUO Masanori , KUBO Keishi , YAMAZAKI Seiichi , KAWA Shigeyuki , HAMANO Hideaki , YAMAMOTO Hiroshi
Published: May 2007

Abstract:  Multifocal systemic fibrosclerosis (MSF) is a multisystem disease, which often mimics malignancy. A 70‐year‐old asymptomatic man with lesions in the lung, prostate, submandibular glands and bile ducts appeared to have malignancy. Biopsy of a lung nodule showed IgG4‐positive plasma cell infiltration and the serum IgG4 was elevated. A diagnosis of MSF was made and the patient treated with oral prednisolone at 1 mg/kg/day. Sclerosing cholangitis, retroperitoneal fibrosis, Riedel’s thyroiditis, fibrotic pseudotumor of the orbit and fibrosis of the salivary glands have all been reported to be part of this disease. It is now necessary for MSF to be considered in patients with pulmonary lesions mimicking lung cancer.
Hydatid cyst presenting as an eosinophilic pleural effusion
Authors: AKTOĞU ÖZKAN Serir , ERER Onur F. , A YALÇIN Yavuz , YUNCU Gökhan , AYDOĞDU Zekiye
Published: May 2007

Abstract:  A 61‐year‐old woman presented with an eosinophilic pleural effusion, secondary to transdiaphragmatic intrapleural spread of an hepatic hydatid cyst. Right posterolateral thoracotomy and frenotomy revealed a loculated pleural effusion associated with a 10 × 8 cm hydatid cyst in the posterior segment of the liver. Hydatid disease should be included in the differential diagnosis of eosinophilic pleural effusions in endemic regions.
Radiological findings of alveolar hydatid disease of the lung caused by Echinococcus multilocularis
Authors: OHSAKI Yoshinobu , SASAKI Takaaki , SHIBUKAWA Kiyoko , TAKAHASHI Toru , OSANAI Shinobu
Published: May 2007

Abstract:  Alveolar hydatid disease is a highly malignant form of echinococcosis caused by the larvae of the cestode Echinococcus multilocularis. Alveolar hydatid disease always affects the liver and can metastasise to the lungs and brain. The case reports describe the radiological features of alveolar hydatid disease of the lung caused by E. multilocularis. Multiple nodules which varied in size and shape were seen on CXR, CT showed most nodules to be lobulated, well circumscribed and of varying shape. Multiple lobulated lesions located between two segments of the lung and of varying shape appear to be characteristic of pulmonary alveolar hydatid disease caused by E. multilocularis.
Evaluation of a new inflammatory molecule (triggering receptor expressed on myeloid cells‐1) in the diagnosis of pleural effusion
Authors: CHAN Ming‐Cheng , CHANG Kai‐Ming , CHAO Wen‐Cheng , LIN Liang‐Yi , KUO Benjamin Ing‐Tiau , HSU Jeng‐Yuan , WU Chieh‐Liang
Published: May 2007

Background and objective:  The triggering receptor expressed on myeloid cell‐1 (TREM‐1) is a newly discovered molecule that is associated with the inflammatory response to microorganisms. We investigated the role of surface and soluble TREM‐1 in differentiating different disease entities in pleural effusion formation.

Methods:  Sixty‐seven patients with pleural effusion due to transudate (14), malignancy (15), tuberculous pleuritis (16), para‐pneumonic effusion (10) and empyaema (12) were included in this study. Surface TREM‐1 was measured by flow cytometry and was expressed as mean fluorescence intensity and soluble TREM‐1 was measured by ELISA and expressed as pg/mL. Results are given as mean levels ± SEM.

Results:  Surface TREM‐1 was measured in 24 patients and the levels were highest in para‐pneumonic effusion (30.0 ± 8.4) and lowest in malignant pleural effusion (5.2 ± 1.1) and tuberculous pleuritis (5.2 ± 2.4). Soluble TREM‐1 was highest in effusions of infectious aetiology (para‐pneumonic effusion (979.4 ± 229.6) and empyaema (1712.6 ± 299.5)) and lowest in non‐infectious effusions (transudate (81.2 ± 4.5 pg/mL) and malignancy (111.3 ± 20.7). At a cut‐off value of 114 pg/mL, soluble TREM‐1 yielded a sensitivity of 87.5% and a specificity of 89.7% in differentiating non‐infectious effusion from tuberculous pleuritis. At a cut‐off value of 374 pg/mL, sTREM‐1 yielded a sensitivity of 93.8% and a specificity of 90.9 in differentiating tuberculous pleuritis from bacterial pleural effusion.

Conclusion:  Soluble and surface TREM‐1 are valuable markers in establishing the aetiology of pleural effusions.
Effect of a simple educational intervention on the hospital management of community‐acquired pneumonia
Authors: SERISIER David J. , BOWLER Simon D.
Published: May 2007

Background and objectives:  Both the speed of commencement and the appropriateness of i.v. antibiotic administration influence outcomes in patients hospitalized with community‐acquired pneumonia (CAP). While quality improvement projects have been linked to better CAP management and outcomes, there are limited data evaluating simple and achievable interventions.

Methods:  A simple educational programme targeting rapid and appropriate antibiotic administration for the inpatient treatment of CAP was evaluated using a retrospective chart review of all patients admitted through the emergency department with CAP during ‘pre‐intervention’ and ‘post‐intervention’ periods.

Results:  There were 108 pre‐intervention patients (56 women, median age 63 years) and 88 post‐intervention patients (43 women, median age 61 years) included in the evaluation. Comparison of indicators of care in the post‐intervention period with those in the pre‐intervention period showed there were significant changes in: median time to antibiotic administration (2.5 h vs 3.5 h, 95% CI: 0–1.25, P = 0.01); subjects not prescribed macrolide antibiotics (2.3% vs 10.2%, 95% CI for OR 1.02–46.19, P = 0.04); hospital length of stay (3.5 vs 6 days, 95% CI: 1–3, P < 0.001) and mortality (0% vs 6.5%, 95% CI for OR 1.13 to infinity, P = 0.02).

Conclusion:  A simple, inexpensive educational intervention was associated with significant improvements in the hospital management of CAP. The widespread introduction of similar programmes has the potential to effect substantial improvements in management, and possibly patient outcomes, and requires prospective confirmation in a larger, randomized sample.
Clinical characteristics of tuberculosis in patients with liver cirrhosis
Authors: CHO Young‐Jae , LEE Sang Min , YOO Chul‐Gyu , KIM Young Whan , HAN Sung Koo , SHIM Young‐Soo , YIM Jae‐Joon
Published: May 2007

Background and objectives:  Patients with liver cirrhosis are likely to be susceptible to tuberculosis (TB) because of immune system dysfunction. The aim of this study was to elucidate the clinical characteristics and treatment responses in TB patients with cirrhosis.

Methods:  Cases were patients with TB detected during their follow up for liver cirrhosis over a 4‐year period. Controls were randomly selected patients with TB but no liver disease, matched to cases by age and gender in a 3:1 ratio.

Results:  Thirty‐six cases and 108 controls were enrolled. Extrapulmonary TB was more common in cases than controls (31% vs 12%, P = 0.02). Clinical and radiographic manifestations and response to treatment did not differ between the two groups. The frequency of hepatotoxicity was higher in the cases than in the controls who were treated with a regimen containing rifampicin and isoniazid, although the difference was not statistically significant (27% vs 10%, P = 0.079).

Conclusions:  TB patients with liver cirrhosis show extrapulmonary involvement more frequently. Patients with pulmonary TB and cirrhosis usually respond well to anti‐TB treatment although appear to present more frequently with treatment‐related hepatotoxicity.
Arm span as an independent predictor of pulmonary function parameters: validation and reference values
Authors: GOLSHAN Mohammad , CRAPO Robert O. , AMRA Babak , JENSEN Robert L. , GOLSHAN Roozbeh
Published: May 2007

Background and objectives:  To determine if arm span can be used as a measure of body length in developing prediction equations for lung function and to compare these equations with height‐derived equations.

Methods:  Standing height and arm span were measured for all study subjects. Spirometry measurements included FVC, FEV1, FEV1/FVC ratio, PEFR, FEF25, FEF50, FEF75 and FEF25−75. These data were used to develop prediction equations using multiple regression analysis based on age, gender and arm span. An independent group (225 subjects) was used to evaluate the accuracy of the equations. Predicted values for each parameter were calculated separately for arm span and height and compared with the measured values.

Results:  Study subjects comprised 1865 healthy non‐smoking Persian volunteers. Arm span‐based equations accurately predicted all of the spirometric parameters. The standard errors of the estimate for prediction equations based on arm span were slightly smaller than those based on standing height. Average predicted values based on height predicted from arm span did not consistently agree with the measured values.

Conclusions:  Predicting pulmonary parameters using equations based on arm span is as reliable as using equations based on standing height and are more accurate for patients in whom height cannot be measured reliably.
Pulmonary function testing in New Zealand: The use and importance of reference ranges
Authors: MARSH Suzanne , ALDINGTON Sarah , WILLIAMS Mathew V. , WEATHERALL Mark , ROBIONY‐ROGERS David , JONES David , BEASLEY Richard
Published: May 2007

Background and objectives:  The diagnosis, assessment and management of a wide range of respiratory diseases rely on accurate interpretation of lung function tests through the use of reference equations to generate predicted values. This paper ascertains the suitability of reference equations currently used in New Zealand through comparison with newly derived equations from the Wellington Respiratory Survey, and discusses the relevance of the findings to the Asia Pacific region.

Methods:  A survey of lung function testing facilities determined the reference equations in common usage. Pulmonary function test results from healthy, lifelong non‐smoking subjects (n = 180) were expressed as percentage predicted values, with comparisons made between the currently used and Wellington Respiratory Survey reference equations. Differences in disease severity classification in subjects with COPD (n = 46) and asthma (n = 61) were determined, using the different reference equations.

Results:  Currently used equations significantly underpredict measured values for FEV1, PEF, TLC and RV by up to 20%. Severity classification of COPD and asthma based on per cent predicted FEV1 was substantially altered by the choice of reference equation.

Conclusion:  Many reference equations in current usage in New Zealand are no longer suitable for use. The applicability of reference equations used in other populations and countries within the Asia Pacific region requires further investigation. We recommend that up‐to‐date reference equations are derived and implemented if those currently used are shown to be unsatisfactory.
Gender‐associated differences in dyspnoea and health‐related quality of life in patients with chronic obstructive pulmonary disease
Authors: KATSURA Hideki , YAMADA Kouichi , WAKABAYASHI Ritsuko , KIDA Kozui
Published: May 2007

Background and objectives:  Recent studies have reported several gender‐associated differences among patients with COPD, but gender‐associated differences in health‐related quality of life (HRQoL) in patients with COPD have not yet been clarified. This study evaluated gender differences in dyspnoea and HRQoL in patients with COPD.

Methods:  Study participants were 156 patients with COPD (men 117, women 39); men were individually matched to women by age and FEV1% predicted to give a ratio of 3:1 (male : female). Study participants were evaluated for dyspnoea and completed HRQoL questionnaires. An oxygen cost diagram (OCD) was used to assess the degree of dyspnoea and Morale Scale was used to assess subjective well‐being. St. George’s Respiratory Questionnaire (SGRQ) and SF‐36 were used for HRQoL evaluation. The findings in the male and female groups were compared.

Results:  The OCD and Morale Scale showed significantly lower values for female patients with COPD. Disease‐specific HRQoL assessed by SGRQ was significantly worse, except for symptoms, in female patients with COPD. Generic HRQoL assessed by SF‐36 was also significantly worse, except for general health and social functioning. Stepwise multiple regression showed OCD, Morale Scale and 6‐min walking distance to be significantly associated with total SGRQ score in the male group, and Morale Scale and 6‐min walking distance were significant associations in the female group.

Conclusions:  Gender differences exist in dyspnoea and HRQoL in patients with COPD. These need to be considered when designing treatment strategies for COPD patients.
Effects of high‐intensity exercise training in a pulmonary rehabilitation programme for patients with chronic obstructive pulmonary disease
Authors: HSIEH Meng‐Jer , LAN Chou‐Chin , CHEN Ning‐Hung , HUANG Chung‐Chi , WU Yao‐Kuang , CHO Hsio‐Ying , TSAI Ying‐Huang
Published: May 2007

Background and objectives:  The benefits of pulmonary rehabilitation for patients with COPD depend on the intensity of training. Traditional pulmonary rehabilitation programmes (PRPs) do not consistently achieve high‐intensity training and have variable training effects. This study examined the effects of high‐intensity exercise training on cardiac and pulmonary function in COPD patients.

Methods:  Patients with COPD participated in a 6‐week, cardiopulmonary exercise test‐based PRP. Spirometry, 6‐min walking distance and cardiopulmonary exercise test were used to evaluate cardiopulmonary function, respiratory muscle strength and endurance at rest, during exercise and before and after the programme. Patients were encouraged to complete high‐intensity exercise with a targeted training intensity of at least 75% maximum oxygen uptake (V̇O2).

Results:  Thirty‐four COPD patients were enrolled into the study; 16 completed the high‐intensity training, 18 did not. At the end of the 12‐session PRP, submaximal exercise capacity (6‐min walking distance, 461.8 ± 77.2–502.7 ± 66.9 m, P < 0.001) improved in both the patients who completed high‐intensity training and those who did not. Only the patients who completed high‐intensity training had significant improvements in FVC (2.47 ± 0.70–2.70 ± 0.62 L, P = 0.024) at rest, maximal exercise capacity (peak V̇O2, 1001.6 ± 286.4–1116.1 ± 320.4 mL/min, P = 0.020) and work efficiency (7.3 ± 1.4–8.4 ± 1.8 mL/min/watt, P = 0.026). There was no statistically significant difference between the two groups in the change in the physiological parameters before and after exercise.

Conclusions:  Exercise training in a PRP improved submaximal exercise capacity. Only patients who completed high‐intensity exercise training showed improvements in maximal exercise capacity, FVC and work efficiency.
Pulmonary nocardiosis: Risk factors and outcomes
Authors: MARTÍNEZ TOMÁS Raquel , MENÉNDEZ VILLANUEVA Rosario , REYES CALZADA Soledad , SANTOS DURANTEZ Maruja , VALLÉS TARAZONA José Manuel , MODESTO ALAPONT Manuel , GOBERNADO SERRANO Miguel
Published: May 2007

Background and objectives:  Pulmonary nocardiosis (PN) is an infrequent but severe infection caused by Nocardia spp., which can behave either as opportunistic or primary pathogens. The present study identifies the risk factors for PN, clinical symptoms and radiographic features and the factors that affect its prognosis.

Methods:  An observational study of all the patients diagnosed with PN over a 13‐year period at the authors’ institution.

Results:  Thirty‐one adult patients were identified with PN, 11 of whom had disseminated nocardiosis. The predisposing conditions were COPD (23%), transplantation (29%), HIV infection (19%), alcoholism (6.5%) and treatment with steroids (64.5%). Respiratory tract sampling using non‐invasive techniques had a diagnostic yield of 77%, while specimens from invasive methods had a yield of 47%. Mean time to diagnosis was 42 days. Dissemination to the central nervous system was related to alcoholism. The mortality rates were 41% for PN and 64% for disseminated nocardiosis; when Nocardia disseminated to the central nervous system, the mortality was 100%.

Conclusion:  Specific risk factors were found in 94% of patients, with the most common being corticosteroid treatment and immunosuppressive therapy. The time to reach diagnosis and to prescribe specific treatment was considerable and mandatory assessment for nocardia in high‐risk patients is required. The mortality rate of PN is high and early diagnosis and treatment are needed. Medications other than co‐trimoxazole may be required.
Non‐small cell lung cancer: Adjuvant and neo‐adjuvant chemotherapy
Authors: BRAHMER Julie R. , ETTINGER David S.
Published: May 2007

Abstract:  Of all cancers, non‐small cell lung cancer is one of the most commonly diagnosed and is the deadliest. With a dismissal survival rate even in the early stages of disease, investigations of adjuvant and neo‐adjuvant therapy have not had much impact until the 21st century. Starting in 2004, several randomized trials have shown significant improvements in survival treating patients with stage II and III disease. Adjuvant chemotherapy remains controversial in patients with stage I disease, in which most trials have not demonstrated a survival advantage. Investigators are studying molecular and genetic factors, which may predict who might benefit most from adjuvant therapy. While adjuvant therapy is now standard, neo‐adjuvant therapy either with chemotherapy alone or with concurrent chemotherapy and radiation has shown promise, but has yet to become a clear standard of care. Data are presented to support the standard use of adjuvant therapy in patients with stage II and III disease, as well as data supporting the use of neo‐adjuvant therapy in selected patients with non‐small cell lung cancer.
Lung cancer: New surgical approaches
Authors: SHERWOOD J. Timothy , BROCK Malcolm V.
Published: May 2007

Abstract:  Over the past two decades, many surgical specialties have seen a dramatic shift from large, open operations with wide incisions towards more‐minimal incisions and less‐invasive procedures. Surgical techniques for lung cancer are no exception, and today, video‐assisted thoracic surgical lobectomies are being performed with increasing frequency in large‐volume thoracic practices. Despite these new surgical techniques, however, the most substantial innovations that have changed surgical outcomes occurred away from the operative theatre. In lung cancer, in particular, the last 20 years have witnessed the clinical debut of more sophisticated, more elegant and more accurate imaging modalities for improved screening, diagnostic and staging, such as the spiral CT scan, PET scan, PET/CT and the endobronchial ultrasound machine. This technology has been complimented by more targeted chemotherapeutic regimens, novel methods of administering more accurate and more concentrated doses of radiation therapy, and innovative local excisional methods, such as the Cyberknife and radiofrequency ablation. The result has been that surgical excision, although remaining the most effective local therapeutic modality in early‐stage lung cancer, is no longer the ‘lone ranger’ treatment, but rather is part of a complex mosaic of multimodality therapy. As scientific advances continue to be translated into the clinic, this trend will inexorably continue with the advent of a molecular staging system using molecular markers and tumour profiling, which ultimately could enhance our ability to predict tumour chemosensitivity. In this brave new world, however, complete surgical resection of the lung cancer will continue to be critical.
Differences in practice and personal profiles between male and female ophthalmologists
Authors: Danesh‐Meyer Helen V , Deva Narme C , Ku Judy YF , Carroll Stuart C , Tan Yu Wee , Gamble Greg
Published: May 2007

Abstract

Purpose:  To assess practice profiles and attitudes towards career and family among ophthalmologists in Australia and New Zealand, with an emphasis on identifying gender differences.

Methods:  A 43‐part confidential survey addressing professional and personal issues was sent to all female ophthalmologists and to randomly selected age‐matched male ophthalmologists, registered with the Royal Australian and New Zealand College of Ophthalmologists in 2005.

Results:  A total of 254 (75%) of the surveys were returned, with no significant difference in response rate between genders. Differences in practice profiles were identified: females preferentially practise in the city (89.6% vs. 76.1%, P < 0.001), work fewer hours (70% of males working 40 hours per week, compared with 41% of females, P < 0.0001) and work part time (57.5% vs. 13.6%, P < 0.0001). Female ophthalmologists earn less (average income being NZ/Aus$37 913 [95% confidence interval 25 600–50 226] less, P < 0.0001); the difference remained significant (P < 0.0001) even when adjusted for hours worked. Up to 93.3% of male ophthalmologists are married or in a stable relationship, compared with 75.6% of females (P = 0.0003), and males are more likely to have children (P = 0.0007). There was no significant difference in overall career satisfaction between male and female ophthalmologists; however, females expressed greater frustration with managing professional and family commitments, and unequal career advancement opportunities.

Conclusion:  Significant differences exist in practice profiles and personal circumstances between male and female ophthalmologists. Females appear to balance work and personal responsibilities by working fewer hours, and for lower income. Despite this, they are less likely to be in a stable relationship, or to have children. However, there is no difference between the two groups in overall career satisfaction.
Outcomes of combined penetrating keratoplasty and cataract extraction compared with penetrating keratoplasty alone
Authors: Green Matthew , Chow Andrew , Apel Andrew
Published: May 2007

Abstract

Purpose:  To compare the rejection rates, graft failure rates, mean visual, keratometric and refractive outcomes of combined penetrating keratoplasty and cataract extraction with penetrating keratoplasty alone.

Methods:  A retrospective study of all patients who had combined keratoplasty and cataract extraction/intraocular lens insertion (49 eyes; mean age 65.3 years; mean follow up 17 months) compared with all patients who had keratoplasty only (58 eyes; mean age 64.0 years; mean follow up 14 months).

Results:  One hundred and seven eyes in 99 patients had keratoplasty in the period and were included in the study. The most common indication for keratoplasty in patients who had triple procedures was Fuchs' endothelial dystrophy (24.5%). During the study seven (6.5%) grafts failed and four (3.7%) had allogenic rejection without failure during this period. There was no statistical difference between the graft survival rates of the two study groups. The mean postoperative logMAR visual acuity (VA) was 0.42 and postoperative VA of 6/12 or better was seen in 71% of patients. Mean postoperative corneal curvature was 44.6 dioptres (D), mean corneal astigmatism was −4.0 D and was ≥5 D in 38%. Mean double‐angle Cartesian coordinates for corneal astigmatism were x−0.87 D and y−0.29 D. Mean best sphere of postoperative refractions was −0.61 D and mean absolute refractive error was 2.2 D. There was no statistically significant difference in VA, keratometric or refractive outcome measures between the two study groups.

Conclusion:  Over a short follow up, keratoplasty combined with cataract extraction/intraocular lens insertion showed a similar risk of graft failure or allogenic graft rejection when compared with keratoplasty alone and we recommend the triple procedure for quicker visual recovery and less operative procedures.
Factors influencing poor visual outcome in patients treated with photodynamic therapy for choroidal neovascularization secondary to age‐related macular degeneration
Authors: Manku Kiran K , Rotchford Alan , Whitaker John , Amoaku Winfried M
Published: May 2007

Abstract

Background:  This study evaluated patients with choroidal neovascular membranes secondary to age‐related macular degeneration for factors that may predict the visual outcome after photodynamic therapy.

Methods:  A retrospective review of 172 eyes of 172 consecutive patients who received photodynamic therapy for predominantly classic with and without occult, minimally classic and occult choroidal neovascular membranes secondary to macular degeneration in private practice from June 2000 to September 2004 was undertaken. All eyes had a baseline vision of 6/12 to 6/60. Classification of lesion composition, retreatment and follow up adhered to published photodynamic therapy guidelines. The primary outcomes measured were effects of patient age, baseline visual acuity, lesion composition and lesion size on final visual acuity and loss of less than 15 letters of logMAR at 12 months.

Results:  All eyes were followed up for 12 months. Baseline mean logMAR visual acuity was logMAR 0.64. Using multivariate logistic regression, loss of logMAR vision at 12 months was independently associated with increasing age (P = 0.004), better baseline vision (P = 0.009) and increasing lesion size (P = 0.035). However, there was no association with lesion composition (P = 0.16). At 12 months the loss of 15 letters or less was found in 101 (59.7%; 95% confidence interval: 51.0–66.2%) of all patients.

Conclusions:  This study found no statistically significant association between lesion composition defined on fluorescein angiography and loss of visual acuity compared with previous studies. Factors associated with an increased rate of loss of 15 letters were increasing age of the patient, increasing lesion size and better baseline logMAR vision.
Non‐penetrating glaucoma surgery augmented with mitomycin C or 5‐fluorouracil in eyes at high risk of failure of filtration surgery: long‐term results
Authors: Choudhary Anshoo , Wishart Peter K
Published: May 2007

Abstract

Purpose:  To investigate the long‐term efficacy and safety of non‐penetrating glaucoma surgery (NPGS) augmented with mitomycin C (MMC) or 5‐fluorouracil (5FU) in eyes at high risk of failure of glaucoma filtration surgery.

Methods:  Prospective study of all eyes, undergoing NPGS with 0.04% MMC (1 to 2 min topical or 0.04 mL subconjunctival injection into the superior fornix) or 5FU (25 mg/mL topically for 5 min). Complete success was an intraocular pressure (IOP) ≤ 21 mmHg on no medication and qualified success an IOP ≤ 21 mmHg with topical medication. An additional criterion for success was a ≥20% drop in IOP or a reduction of at least two medications.

Results:  Twenty‐three eyes of 22 patients with a mean follow up of 41.4 months were reviewed. Fifteen eyes had failed trabeculectomy and seven had uveitic glaucoma. Mean preoperative IOP reduced from 25.8 ± 7.8 to 15.4 ± 4.9 mmHg at final visit, a mean change of 41%. Median number of preoperative medications decreased from 3 to 0 postoperatively. Cumulative probability of success was 100% at 2 years, 94% at 3 years and 85% at 4 years. No patient developed any long‐term complications. Complete success was achieved in 11 eyes and qualified success in 10 eyes. Two eyes failed and required further surgery.

Conclusion:  NPGS augmented with small‐volume MMC/5FU provides good long‐term IOP control in eyes at high risk of failure with a lower incidence of complications compared with augmented trabeculectomy and eliminates the need for postoperative bleb or suture manipulation.
Nanophthalmos in a Melanesian population
Authors: Tay Tien , Smith James EH , Berman Yemima , Adès Lesley , Missotte Isabelle , Saglibène Hēlène , Martin Frank , Mitchell Paul , Taylor David
Published: May 2007

Abstract

Purpose:  To characterize the ophthalmic features and causes of visual loss in a cohort of Melanesians living in New Caledonia with nanophthalmos.

Methods:  In this observational study, axial length, visual acuity (VA), cycloplegic autorefraction were assessed and dilated fundus examination was performed. Visual impairment was defined as VA < 6/12 in the better eye, hypermetropia as >+1.0 dioptre (D), astigmatism as ≥1.0 D and anisometropia as ≥1.0 D difference between both eyes. Unilateral amblyopia was defined as at least a two‐line difference in VA between both eyes and bilateral amblyopia as VA < 6/12 in both eyes which was not adequately explained by refractive error and macular folds.

Results:  Seventeen community‐dwelling participants (aged 1.1–45.3 years) with short axial length (range from 16.1 to 21.6 mm) were identified. Of the 17 subjects, 14 were found to have crowded optic discs, three with papillomacular folds, three with a papillomacular band and three with macular radial folds. Further, all subjects demonstrated bilateral hypermetropia (range from +1.3 D to +15.1 D). A high proportion of subjects had astigmatism (12) and anisometropia (nine) in at least one eye. Visual impairment was found in nine subjects: five bilateral and four unilateral. Causes of visual impairment included amblyopia (seven), ametropia (seven) and macular folds (two). Amblyopia was attributed to several factors, including hypermetropia, anisometropia, astigmatism and esotropia.

Conclusions:  In this sample of Melanesians with nanophthalmos, a spectrum of ophthalmic features that was consistent with intraocular crowding was found. Over half of the subjects were visually impaired, mostly due to amblyopia and ametropia. Further characterization of the underlying genetic cause of nanophthalmos in this cohort will be the focus of future studies.
Manifestation of Coats' disease by age in Taiwan
Authors: Lai Chien‐Hsiung , Kuo Hsi‐Kung , Wu Pei‐Chang , Kuo Ming‐Lun , Chen Yung‐Jen
Published: May 2007

Abstract

Background:  To compare the differences in clinical manifestation of Coats' disease between younger and older patients in the Far East.

Methods:  Coats' disease cases diagnosed at one Taiwanese hospital from July 1986 to June 2004 were retrospectively reviewed (n = 30; 32 eyes). Patients were stratified into groups according to the initial diagnosis of Coats' disease at the age of <20 years (Group Y) or ≥20 years (Group O). The clinical manifestations of Coats' disease in Group Y (19 eyes) and Group O (13 eyes) were compared.

Results:  A higher proportion of female patients was noted in Group O (P = 0.046). Diseases were generally limited geographically, with 14 eyes (73.7%) manifesting involvement greater than 6 clock hours in Group Y and four eyes (30.8%) in Group O. The involved area including retinal telangiectasia and exudates was smaller in Group O (P = 0.016). Patients without posterior pole involvement were associated with better visual outcome (adjusted odds ratio, 6.5; 95% confidence interval, 1.1–40.1, P = 0.044).

Conclusion:  Coats' disease manifestation was different between different age groups. Treatment is important to prevent disease progression. Visual prognosis is associated with posterior pole involvement.
Bilateral spontaneous idiopathic extraocular muscle haematoma
Authors: Dean Simon J , Ross Jonathan , Kemp Ewan
Published: May 2007

Abstract

The authors present a case of bilateral sequential extraocular muscle haematoma, for which no apparent cause has been identified despite extensive investigation, and which resolved without persisting morbidity. As far as the authors are aware, this is the first bilateral case to be reported.
Mozart and smallpox
Authors: Zegers Richard HC
Published: May 2007

Abstract

In 1767 at 11 years of age, composer Wolfgang Amadeus Mozart contracted smallpox, allegedly causing him temporary blindness. Although now eradicated, smallpox in those days had a high mortality rate, and the history of classical music would have been very different if Mozart had become permanently blind, or died, as a result of the disease.
Primary angle closure glaucoma: a developing world perspective
Authors: Thomas Ravi , Sekhar G Chandra , Parikh Rajul
Published: May 2007

Abstract

Primary angle closure glaucoma (PACG) is estimated to affect a significant proportion of the population worldwide. Of those affected, the majority reside in developing countries. In the developing world, more than 80% of the people afflicted with glaucoma are unaware that they have the disease, and visual impairment from PACG is more severe than from primary open‐angle glaucoma. Considering the paucity of resources and competing opportunity costs, it is imperative that the developing world extrapolates current literature and exiting data sensibly, and develops cost‐effective strategies for the detection and management of angle closure glaucoma. The number needed to treat (NNT) was used to extrapolate the trials for an individual patient. To extrapolate to the overall population (where applicable) the authors used the population attributable risk percentage (PAR%). For individual patient care, treatment of a primary angle closure suspect (PACS) has an NNT of 6 over 5 years to prevent one patient progressing to primary angle closure (PAC). The NNT for PAC to prevent PACG over 5 years is 5. The ‘effective’ PAR% for PACS is 56.4% and the ‘effective’ PAR% for PAC is 65%. This suggests both PACS and PAC are important health burdens but because of the absence of a good screening test and the opportunity costs involved, population‐based screening will probably be unfeasible in developing countries.
Optical coherence tomography evidence of rapid progression from vitreomacular traction to full thickness macular hole
Authors: Lee Mun‐Wai , Cheng Bobby Ching‐Li , Ang Chong‐Lye
Published: May 2007

Abstract

The authors present a case of a patient with idiopathic vitreomacular traction who subsequently developed a full thickness macular hole 3 weeks following the onset of metamorphopsia. Vitreomacular traction is a well described phenomenon and has been known to resolve spontaneously and in this patient the conservative approach was adopted initially. However, she progressed rapidly to a full thickness macular hole and therefore, the authors recommend close monitoring of such patients with a view to early vitrectomy to prevent progressive morbidity.
Corneal perforation and intraocular lens prolapse in Serratia marcescens endophthalmitis
Authors: Sharma Neil S , Ooi Ju‐Lee , Downie John A , Coroneo Minas T
Published: May 2007

Abstract

A 72‐year‐old lady was referred with bacterial endophthalmitis secondary to complicated left cataract extraction. The organism was identified as Serratia marcescens. Despite aggressive treatment the eye continued to deteriorate with corneal perforation and prolapse of the intraocular contents.
Late intraocular pressure rise following intravitreal triamcinolone injection
Authors: Williams Christopher PR , Konstantopoulos Aristides , Rowley Steven A , Luff Andrew J
Published: May 2007

Abstract

Most ophthalmologists are aware of the risk of elevated intraocular pressure developing 1 or 2 months after an intravitreal injection of triamcinolone. However, the two cases reported here demonstrate that such a rise can occur significantly later than this. All patients who have had intravitreal steroid injection should therefore have prolonged intraocular pressure monitoring.
Intravitreal voriconazole for the treatment of endogenous endophthalmitis caused by Scedosporium apiospermum
Authors: Chen Fred K , Chen Simon DM , Tay‐Kearney Mei‐Ling
Published: May 2007

Abstract

Scedosporium apiospermum is an increasingly recognized cause of endogenous fungal endophthalmitis in immunocompromised patients. The authors describe two patients with endogenous S. apiospermum endophthalmitis treated with intravitreal and systemic voriconazole. Despite a prolonged course of systemic antifungal treatment, both patients subsequently required enucleation for intractable ocular pain due to secondary scleritis. Histological examination of the globes demonstrated the presence of fungal hyphae. Endogenous S. apiospermum endophthalmitis need to be considered in the differential diagnosis of necrotizing retinitis. Despite its efficacy in suppressing disseminated S. apiospermum infection, voriconazole may be ineffective in the treatment of endogenous S. apiospermum endophthalmitis especially if treatment is delayed.
Sight‐threatening orbital emphysema treated with needle decompression
Authors: Singh Mandeep , Phua Vanessa Mae , Sundar Gangadhara
Published: May 2007

Abstract

Orbital emphysema is rare in the absence of trauma, and is unlikely to result in visual loss. The authors describe a patient with no prior trauma who presented with decreased vision and increased intraocular pressure due to severe orbital emphysema after a sneeze. Computed tomography revealed subcutaneous emphysema of the lid and extraconal air in the orbit. Emergency needle decompression resulted in improvement in vision and intraocular pressure.
Binocular membranous cataract associated with binocular retinal detachment
Authors: Song Zong‐Ming , Fu Xiao‐Ying , Xue An‐Quan , Lu Fan , Wang Qin‐Mei , Qu Jia
Published: May 2007

Abstract

A 36‐year‐old man with a history of consanguineous marriage between his parents presented with bilateral membranous cataract that was complicated by bilateral rhegmatogenous retinal detachment (RRD). Biomicroscopy revealed an absence of the crystalline lens bilaterally, a single piece of integrated fibrotic membrane in the right eye, and a membrane with a central cleft at the level of the ciliary process in the left eye. A small amount of residual cortex was revealed in the peripheral part of the membranes bilaterally when the pupils were dilated. Funduscopic examination showed that the vitreous liquefied and retina detached bilaterally. The successful retinal reattachment by vitrectomy and the finding of a retinal tear proved that the RD was rhegmatogenous. This case investigates bilateral membranous cataract with bilateral RRD as a new syndrome, or whether RRD may be a new complication of membrane cataract.
Latanoprost‐related transient incontinence
Authors: Raja Vignesh , Sandanshiv Pravin , Asghar Muhammad , Moriarty Brendan
Published: May 2007

Abstract

Latanoprost has increasingly become the first choice in topical anti‐glaucoma therapy. Local adverse events like hypertrichosis and increased iris pigmentation are common whereas systemic adverse events have been rare and mild in intensity. The authors would like to report a case of transient urge incontinence after initiation of latanoprost therapy confirmed by challenge–rechallenge tests and speculate on the causal relationship.
Microbial cultures in open globe injuries in southern India
Authors: Gupta Arvind , Srinivasan Renuka , Kaliaperumal Subashini , Setia Sajita
Published: May 2007

Abstract

Purpose:  To determine the risk factors leading to positive intraocular culture in patients with open globe injury.

Methods:  A prospective interventional study involving 110 eyes of 110 patients of more than 15 years of age, presenting with open globe injury, was undertaken. Emergency repair of the injured globe was done. Prolapsed intraocular tissue or aqueous humour was sent for microbial work up before repair. In endophthalmitis cases intravitreal antibiotics were given according to the antimicrobial sensitivity. Chi‐square and logistic regression analysis were used to determine the risk factors.

Results:  Fifty‐six patients showed microbial contamination. Bacteria were cultured in 42 patients and fungi in 14 patients. Nineteen patients developed endophthalmitis, of which 18 patients showed microbial growth initially. In univariate analysis, initial visual acuity (<6/360, P = 0.002), presence of uveal tissue prolapse (P < 0.001), vitreous prolapse (P < 0.001) and length of laceration (>8 mm, P < 0.001) were significantly associated with positive microbial culture, however, in the multivariate stepwise logistic regression delay in surgical intervention (>72 h, P < 0.001), uveal tissue prolapse (P = 0.004) and corneosclearal laceration (>8 mm, P = 0.013) were associated with increased risk of positive microbial culture. Six patients had intraocular foreign body but were culture negative. Age, gender, site of injury and presence of cataract did not significantly affect the culture positivity.

Conclusions:  Microbial contamination is a risk factor for the development for endophthalmitis. Despite the high frequency of microbial contamination, it develops only in few cases. Systemic antibiotics, virulence of the organism and host factors play a role in the manifestation of endophthalmitis. Prophylaxis with intraocular antibiotics should be strongly considered in cases with poor vision at presentation, larger corneoscleral laceration, delayed surgical intervention and uveal tissue or vitreous prolapse.
Prevalence of plateau iris syndrome in young patients with recurrent angle closure
Authors: Stieger Roland , Kniestedt Christoph , Sutter Florian , Bachmann Lucas M , Stuermer Joerg
Published: May 2007

Abstract

Background:  To assess and describe the prevalence and clinical features associated with plateau iris syndrome (PIS) in young individuals with recurrent angle closure despite initial therapy.

Methods:  Chart review of 137 relatively young individuals (aged < 60 years) with symptoms of angle closure between 1995 and 2005. A follow‐up period of 36 months after initial presentation was retrospectively analysed. Seventy‐six patients with recurrent angle closure symptoms were clinically reviewed using gonioscopy and ultrasound biomicroscopy.

Results:  Based on chart analysis, 30 of 137 individuals were diagnosed with PIS (22%). After clinical review, 34 additional patients suffered from PIS as the underlying cause for persistent angle closure symptoms. The prevalence of PIS in our patient population with recurrent angle closure symptoms in spite of initial iridotomy or iridectomy was 54%.

Conclusion:  Among angle closure in young individuals, PIS is not uncommon. The causative mechanism of PIS in young individuals is peripheral iris block, rather than pupillary block which is more often prevalent in older patients. For proper diagnosis and therapy, ultrasound biomicroscopy and gonioscopy should be performed on every young individual with angle closure symptoms.
Clinical outcomes of keratitis
Authors: Green Matthew D , Apel Andrew JG , Naduvilath Thomas , Stapleton Fiona J
Published: May 2007

Abstract

Objection:  To analyse the patient, clinical and microbiological variables associated with poor outcomes from keratitis in patients presenting to a major public hospital in Australia.

Methods:  A retrospective audit of the records of all patients who had a corneal scraping in 5 years at Princess Alexandra Hospital (Brisbane, Australia) was carried out. The outcome of a patient's episode of keratitis was classified as poor if they had final visual acuity of 6/60 or worse; had vision loss during treatment; or a complication of keratitis; or needed surgical intervention.

Results:  A final outcome was established in 207 cases during the 5‐year period. Final vision of 6/12 or better was found in 48% (100) of cases while a poor outcome was seen in 28% (58). Linear regression showed poor outcomes were directly associated with age (P < 0.001) and disease severity (P < 0.001). Univariate analysis indicated that poor outcomes were more likely in patients who had had prior ocular surgery (P = 0.005) or ocular surface disease (P = 0.01) and were also associated with presenting visual acuity of worse than 6/60 (P < 0.001) and isolation of Streptococcus pneumoniae (P = 0.002). While patients with traumatic keratitis, contact lens‐related keratitis or negative corneal cultures (P = 0.009) were more likely to have good outcomes. Multivariate analysis showed that the relative risk of a patient having a poor outcome was 4.3× (CI 2.0–9.5) if they had severe keratitis, 4.1× (CI 1.8–9.5) if they had keratitis related to ocular surface disease and 3.8× (CI 1.8–8.3) if they were over 50 years old.

Conclusions:  An outcome of poor vision, vision loss during treatment, surgical intervention or complication of keratitis is more likely in patients with severe keratitis, keratitis related to prior ocular surface disease or older age.
Microbial keratitis following corneal transplantation
Authors: Das Sujata , Constantinou Marios , Ong Terrence , Taylor Hugh R
Published: May 2007

Abstract

Purpose:  To determine the predisposing risk factors and analyse the clinical and microbiological profiles of microbial keratitis following corneal transplantation.

Methods:  A retrospective analysis was done of hospital records of all patients who presented with microbial keratitis in the corneal graft between July 2000 and June 2005 at the Corneal Unit of Royal Victorian Eye and Ear Hospital, Melbourne, Australia.

Results:  Eighty‐one episodes of infection were identified in 62 patients over a 5‐year period. Thirteen patients had multiple episodes of infection. The mean age of the patients was 70 ± 16 years (range: 22–92 years). The median time interval between the graft and infection was 17 months (range: 6 days to 385 months). Twenty‐two (35%) episodes of primary infection were related to sutures. The associated predisposing risk factors were failed graft (40%), dry eye (18%), Herpes simplex keratitis (8%), and ocular surface disease (8%). Forty‐seven (76%) cases were culture positive for bacteria. Ten cases were positive for Herpes simplex virus (HSV) during presentation.

Conclusion:  Failed graft is a long‐term risk factor for graft infection in addition to ocular surface disease and H. simplex keratitis. All the predisposing risk factors increase the risk of recurrent graft infection.
A rapidly advancing mediastinal mass – overcoming tracheobronchial obstruction
Authors: FROST IAN , ROSS‐RUSSELL ROB , BASS SAM , BURKE AMOS
Published: May 2007

We report the case of a 7‐year‐old boy who presented with rapidly advancing airway obstruction secondary to mediastinal T‐cell nonHodgkins lymphoma. His brisk deterioration required transfer to the pediatric intensive care unit and intubation of the trachea. Unforeseen unilateral bronchial involvement led to gas trapping and critical pulmonary hyperinflation. Endobronchial advancement of the tracheal tube beyond the bronchial obstruction relieved pulmonary hyperinflation but subsequent one lung ventilation was poorly tolerated. We report the manufacture of a proximal ‘Murphy’s eye’ which allowed ventilation of the contralateral lung to proceed. To the best of our knowledge this is the first time that this technique has been described in a pediatric patient.
Anesthesia management in a child with PHACE syndrome and agenesis of bilateral internal carotid arteries
Authors: JAVAULT AURÉLIA , METTON OLIVIER , RAISKY OLIVIER , BOMPARD DOMINIQUE , HACHEMI MOHAMED , GAMONDES DELPHINE , NINET JEAN , NEIDECKER JEAN , LEHOT JEAN‐JACQUES , CANNESSON MAXIME
Published: May 2007

This is the first case report of successful anesthesia management in a high‐risk neurological procedure in a patient with PHACE syndrome. PHACE syndrome is rare but an important clinical entity. Anesthesiologists should be aware of the neurological, otolaryngogical, and vascular risk associated with this syndrome.