bluuebunny/crossref_metadata_2025 huggingface dataset:
Amniotic fluid erythropoietin concentrations differentiate between acute and chronic causes of fetal death
Authors: Teramo Kari A. , Schwartz Robert , Clemons Gisela K. , Widness John A.
Published: March 2003

Background.  Increased fetal plasma erythropoietin concentration is an indicator of chronic fetal hypoxia. Amniotic fluid erythropoietin levels correlate highly significantly with fetal erythropoietin levels before labor. We studied AF erythropoietin levels after fetal death in order to determine whether this could differentiate between stillbirths from acute or chronic causes.

Methods. Amniotic fluid was obtained after fetal death for erythropoietin measurement following fetal death in 21 pregnancies. Two of the pregnancies had twins, of which one infant was born alive. All 22 stillborn fetuses had an autopsy. None had malformations. Without prior knowledge of the results of the erythropoietin analyzes, the causes of fetal death were divided into acute, chronic or unknown groups.

Results. Eight pregnancies had an acute cause of fetal death (e.g. cord complication or placental abruption), eight pregnancies had a chronic cause (intrauterine growth restriction or erythroblastosis) and in five pregnancies the cause of fetal death could not be determined. In all eight pregnancies with an acute cause of fetal death, AF erythropoietin levels were normal (< 20 mU/mL). In contrast, six of the eight pregnancies with a chronic cause had AF erythropoietin levels above normal (range from 49.9 mU/mL to 391 mU/mL). In the five pregnancies with an unknown cause of fetal death, AF erythropoietin levels were normal in three and elevated in two.

Conclusions. Elevated AF erythropoietin levels, identified after fetal death, suggest that the fetus died from a chronic hypoxic event, whereas normal AF erythropoietin levels suggest that the fetus died from an acute event.
Preoperative serum SCC, CA125, and CA19‐9 levels and lymph node status in squamous cell carcinoma of the uterine cervix
Authors: Takeda Mahito , Sakuragi Noriaki , Okamoto Kazuhira , Todo Yukiharu , Minobe Shin‐Ichiro , Nomura Eiji , Negishi Hiroaki , Oikawa Mamoru , Yamamoto Ritsu , Fujimoto Seiichiro
Published: March 2003

Background.  We wanted to investigate the clinical usefulness of determining the pretreatment levels of multiple serum tumor markers in predicting lymph node status and the prognosis for patients with cervical carcinoma.

Methods.  The preoperative serum levels of squamous cell carcinoma antigen (SCC), cancer antigens CA125 and CA19‐9 were assayed simultaneously in 103 patients with stages IB to IIB cervical SCC undergoing radical hysterectomy. The cut‐off values of SCC, CA125, and CA19‐9 in this study were 1.5 ng/ml, 35 U/ml, and 37 U/ml, respectively. The relation between preoperative tumor marker levels and histopathologic prognostic factors including lymph node metastasis and patient survival was studied.

Results.  Preoperative serum SCC, CA125, and CA19‐9 levels were significantly related to the FIGO stage. In addition, serum SCC and CA125 levels were significantly related to tumor diameter, depth of cervical stromal invasion, lymph‐vascular space invasion, and lymph node metastasis. We subsequently created a double‐tumor‐marker (DTM) index, which incorporated the number of positive markers of SCC and CA125. The DTM index was strongly related to the number of positive pelvic lymph nodes (p = 0.0002) and to the site of positive nodes (none vs. pelvic only vs. common iliac/paraaortic) (p = 0.0005). Probability of lymph node metastasis according to the DTM index = 0, 1, and 2 was 6/48 (12.5%), 14/45 (31.1%), and 8/10 (80.0%), respectively. The rate of common iliac/paraaortic node metastasis according to the DTM index = 0, 1, and 2 was 1/48 (2.1%), 2/45 (4.4%), and 3/10 (30.0%), respectively. By logistic regression analysis, it was shown that the DTM index and tumor diameter were independently related to lymph node metastasis. Using multivariate Cox regression analysis including singly determined serum SCC and CA125 levels, clinical stage (IB/IIA vs. IIB), tumor diameter (≤ 2 vs. 2–4 vs. > 4 cm), parametrial invasion, lymph node metastasis, and the DTM index, the DTM index was found to be the most important prognostic factor (p = 0.0005). However, when the sites of positive nodes were included in the multivariate analysis, only the sites of positive nodes (p = 0.0008) and parametrial invasion (p = 0.041) showed independent prognostic significance.

Conclusion.  Combination assay of pretreatment serum SCC and CA125 levels seems to be useful in estimating lymph node status and the prognosis for patients with cervical SCC in a preoperative setting.
Longitudinal umbilical vein blood flow changes in normal and growth‐retarded fetuses
Authors: Di Naro Edoardo , Raio Luigi , Ghezzi Fabio , Franchi Massimo , Romano Francesco , Addario Vincenzo D'
Published: March 2003

Objective.  To explore whether the umbilical vein blood flow of growth‐retarded fetuses with normal Doppler parameters changes over time differently to that of normally grown fetuses.

Methods.  Fifteen consecutive women whose fetus was diagnosed to be growth restricted were compared with 30 women whose fetus was normally grown. Two ultrasonographic evaluations were conducted at 2‐weekly intervals (± 2 days) in all cases. At each sonographic evaluation, umbilical vein blood flow parameters were obtained by digital color Doppler velocity profile integration. To allow comparisons among fetuses, the umbilical vein blood flow per minute was normalized for abdominal circumference.

Results.  The absolute vein blood flow was lower in growth‐retarded than in normally grown fetuses (209 ml/min ± 73 vs. 313 ml/min ± 72, p < 0.01). The median (range) umbilical vein blood flow normalized for abdominal circumference was significantly lower in growth‐retarded than in normally grown fetuses at the first [0.70 (0.32; 1.15) vs. 1.11 (0.65; 2.07), p < 0.05] and at the second [0.71(0.30; 1.09) vs. 1.14 (0.69; 2.05), p < 0.05] sonographic evaluation. The difference in umbilical vein blood flow normalized for abdominal circumference between the second and the first examination was significantly lower in growth‐retarded than in appropriate for gestational age fetuses [−0.005 (− 0.08; 0.06) vs. 0.02 (− 0.08; 0.1), p < 0.05].

Conclusion.  This study demonstrates that umbilical vein blood flow normalized for biometric parameters is lower in growth‐retarded fetuses than in healthy fetuses even in the absence of umbilical artery Doppler abnormalities.
Intermittent progestin administration as part of hormone replacement therapy: long‐term comparison between estradiol 1 mg combined with intermittent norgestimate and estradiol2 mg combined with constant norethisterone acetate
Authors: Ylikorkala Olavi , Wahlström Torsten , Caubel Patrick , Lane Rosanne
Published: March 2003

Background. To decrease exposure to progestin during hormone replacement therapy (HRT), a novel oral regimen consisting of constant 17β‐estradiol (E2) daily plus intermittent norgestimate (NGM) has been developed.

Methods. A multicenter study compared the safety and efficacy of E2 1 mg daily plus intermittent NGM 90 µg (3 days off, 3 days on) (n = 150) vs. a continuous oral dose of E2 2 mg plus norethisterone acetate (NETA) 1 mg (n = 172) daily, for a period of 2 years. Endometrial biopsies were performed at 1 and 2 years. Subjects recorded the occurrence of vasomotor symptoms, uterine bleeding, and adverse events on diary cards.

Results. At 2 years' follow‐up, no subject had developed endometrial hyperplasia or cancer. Endometrial atrophy was seen in 75% of subjects using the intermittent NGM regimen and in 78% of women using the constant NETA regimen. Both groups maintained a 96% reduction in vasomotor symptoms up to 2 years. The rates of bleeding and/or spotting showed no difference between the groups, and at 2 years' follow‐up, 73% of women in the intermittent NGM group and 83% of subjects in the constant NETA group were amenorrheic. There was a lower incidence of progestin‐associated side‐effects, such as abdominal discomfort, edema, painful bleeding episodes, and breast symptoms, with the intermittent progestin regimen vs. the constant progestin regimen. Intermittent NGM use was associated with an elevation in HDL‐ and HDL2‐cholesterol, whereas constant NETA reduced these lipoproteins.

Conclusions. The intermittent administration of a progestin, such as NGM, provides a new, well‐tolerated regimen to achieve endometrial safety, an adequate rate of amenorrhea, and effective reduction of vasomotor symptoms in postmenopausal women.
Cytokine concentrations in the amniotic fluid during parturition at term: correlation to lower uterine segment values and to labor
Authors: Kemp Birgit , Winkler Matthias , Maas Anja , Maul Holger , Ruck Peter , Reineke Thorsten , Rath Werner
Published: March 2003

Background.  In previous studies a significant increase in interleukin (IL)‐6 and IL‐8 concentrations in the lower uterine segment parallel to cervical dilatation at term could be found, however only a weak correlation to duration of labor was detected. This study compares amniotic fluid concentrations of interleukin (IL)‐6 and IL‐8 with those in the lower uterine segment, and the duration of labor.

Methods.  Amniotic fluid and lower uterine segment specimens were obtained from 29 patients during cesarean section at term. The patients were divided into groups according to cervical dilatation (< 2 cm, 2–3.9  cm, 4–6 cm, > 6 cm) and to labor (0 h, > 0–12 h, > 12 h). Interleukin‐6 and IL‐8 concentrations were determined by enzyme immunoassay.

Results.  Amniotic fluid IL‐6 already increased at 2–3.9 cm (p = 0.02), while the steepest increase in IL‐8 was observed at > 6 cm (p = 0.003). No correlation with lower uterine segment values was observed for either of the cytokines. However, the amniotic fluid IL‐6 concentration correlated with labor (p = 0.0008).

Conclusion.  The increase in the concentration of IL‐6 in the amniotic fluid earlier than its increase in the lower uterine segment supports the hypothesis that IL‐6 plays a crucial role for the promotion of labor in the first place, and afterwards for the biochemical degradation processes in the lower uterine segment. The fact that the greatest increase in IL‐8 concentration occurs only at > 6 cm indicates that this chemotactic cytokine has only minor significance in the initiation of parturition by its concentration in the amniotic fluid.
Bacterial vaginosis in early pregnancy may predispose for preterm birth and postpartum endometritis
Authors: Jacobsson Bo , Pernevi Peter , Chidekel Lene , Jörgen Platz‐Christensen Jens
Published: March 2003

Background.  Bacterial vaginosis (BV) has been reported to be associated with spontaneous preterm delivery and infectious morbidity after birth in non‐Swedish populations. Our intention was to investigate the situation in a Swedish population.

Methods.  In this cohort study, 924 patients were enrolled consecutively. A Papanicolaou (Pap) smear, which included a posterior fornix sample, was obtained at the first visit (median: 12 weeks and 1 day) at the two antenatal care units in central Göteborg 1990–91. Clue cells in the Pap smear were considered to be consistent with BV. The principal outcome variables were spontaneous preterm birth (< 37 weeks) and postpartum endometritis. A relative risk (RR) was calculated with a 95% confidence interval.

Results.  The prevalence of BV was 15.6%. An association was seen between BV in early pregnancy and postpartum endometritis [RR 3.26 (1.38–7.71)]. A non‐significant association was found between BV and spontaneous preterm birth [RR 2.10 (0.90–4.94)]. A multiple logistic regression analysis was performed adjusting for primi‐/multiparity and antibiotics during pregnancy and the odds ratio was 2.16 (0.87–3.64).

Conclusions.  The prevalence of BV was 15.6% in this Swedish pregnant population. The risk for postpartum endometritis was tripled among women with BV in early pregnancy. The risk for spontaneous preterm birth among women with BV was doubled but non‐significant, although the samples were obtained early in pregnancy.
Lacrimal canalicular stenosis associated with systemic 5‐fluorouracil therapy
Authors: Prasad Somdutt , Kamath Girish G. , Phillips Russell P.
Published: March 2003

Purpose: Ocular side effects of systemic 5‐fluorouracil therapy include excessive lacrimation which often resolves on cessation of therapy. Permanent stenosis of lacrimal puncta and canaliculi is rare. This report highlights this uncommon complication of 5‐fluorouracil therapy.

Methods: Report of two cases and review of literature.

Results: Severe stenosis of puncta and canaliculi may be associated with prolonged systemic 5‐fluorouracil therapy.

Conclusion: It is important for both the oncologist and ophthalmologist to be aware of the potential ocular toxicity of 5‐fluorouracil. Surgical management to relieve the epiphora is often challenging, and early intervention may be beneficial.
Bilateral necrotizing scleritis and blindness in the myelodysplastic syndrome presumably due to relapsing polychondritis
Authors: Loeffler Karin U. , McLean Ian W.
Published: March 2003

Purpose: The purpose of this study was to report a case of bilateral blindness, bilateral necrotizing scleritis, and bilateral deafness in a patient with myelodysplastic syndrome (MDS). In such a patient, the possibility of relapsing polychondritis (RPC) associated with MDS must be considered.

Case Report/Methods: A 66‐year‐old patient suffered from myelodysplastic syndrome (MDS). Shortly before his death, he became bilaterally blind and deaf. A biopsy was taken from the conjunctiva and the bone marrow, and both eyes were obtained after death for further investigation. Findings of the clinical and laboratory work‐up for the patient's hematologic disorder as well as an examination of the eyes by light microscopy and immunohistochemistry are presented.

Results: Ocular sections showed a diffuse necrotizing scleritis with moderate uveitis and no identifiable infectious agent. Neither was there any evidence of a leukemic infiltration. – The deafness had been due to inner ear failure, and the patient died of a cardiac failure.

Conclusions: Non‐infectious scleritis associated with inner ear deafness is a strong indication of relapsing polychondritis (RPC). Furthermore, RPC can be associated with MDS. Thus, in addition to leukemic infiltration and infection involving ocular structures, ophthalmologists and otolargyngologists should be aware of the association between MDS and RPC and the potential complications.
Hyperhomocysteinemia and the MTHFR C677T mutation in central retinal vein occlusion
Authors: Larsson J. , Hultberg B. , Hillarp A.
Published: March 2003

Background: Hyperhomocysteinemia is a factor that predisposes to thrombosis, and the C677T mutation in methylene‐tetrahydrofolate reductase (MTHFR) is known to give increased plasma homocysteine. We wanted to investigate if these factors were overrepresented in a group of patients with central retinal vein occlusion.

Methods: 116 patients with a history of central retinal vein occlusion were examined for the presence of hyperhomocysteinemia and the MTHFR C677T mutation.

Results: Compared to the control groups, there was no significant increase, neither in plasma homocysteine nor in the frequency of the MTHFR C677T mutation in the patients. Even when we looked selectively at the young patients, age less than 50 years, no difference could be detected.

Conclusion: It seems that neither hyperhomocysteinemia nor the MTHFR C677T mutation is an important risk factor for the aetiology of central retinal vein occlusion.
Iris indocyanine green angiography in pseudoexfoliation syndrome and capsular glaucoma
Authors: Parodi Maurizio Battaglia , Bondel Elvio , Saviano Sandro , Ravalico Giuseppe
Published: March 2003

Purpose: The iris vasculature shows typical changes in pseudoexfoliation syndrome (PXS) revealed by iris fluorescein angiography (IFA), such as hypoperfusion, microneovascularisation, and anastomotic vessels. Iris indocyanine green angiography (IICGA) can visualize more precisely details of the iris vascular pattern, especially as regards hypoperfusion and capillary dilatations.

The aim of the present study is to describe the angiographic features of PXS on IFA and IICGA, comparing eyes affected with those not affected by capsular glaucoma.

Methods: In a prospective study 42 consecutive patients affected by PXS underwent a complete ophthalmologic examination including IFA and IICGA. Thirty‐two eyes were affected by capsular glaucoma. IICGA was performed using IMAGEnet System H1024.

Results: IFA can easily detect the microneovascularisation, whereas IICGA allows a better recognition of iris hypoperfusion and anastomotic vessels, and it can reveal iris pigment epithelium defects. While the degree of hypoperfusion was similar in the two subgroups, eyes affected by capsular glaucoma more frequently showed signs of both microneovascularisation (marked stromal tufts and marked plexi), and of anastomotic vessels (peripheral loop, lesser circle and oblique vessels), with statistically significant difference. A clear correlation between hypoperfusion, microneovascularisation, and anastomotic vessels as regards site and extent was not noticed.

Conclusions: A different angiographic pattern can be detected in PXS eyes with capsular glaucoma in comparison with eyes without it. Further studies are needed to correlate angiographic features revealed by IFA and IICGA, with clinical features.
Markers of thrombophilia in retinal vein thrombosis
Authors: Hansen Lene , Kristensen Hanne Lene , Bek Toke , Ingerslev Jørgen
Published: March 2003

Purpose: To study the prevalence of risk factors for systemic thromboembolism in patients with retinal vein thrombosis (RVT).

Methods: Fifty‐four patients younger than 70 years, diagnosed with a retinal vein thrombosis at the Department of Ophthalmology, Århus University Hospital, were examined for the presence of venous thrombosis risk factors.

Results: 23 patients had a central RVT, 26 had a branch RVT, and 4 had a macular RVT. Nineteen (35.2%) of the patients displayed increased levels of plasma homocysteine, one patient (1.9%) the Factor V Leiden mutation, and one patient (1.9%) displayed an antiphospholipid antibody. All other tests for thrombophilia rendered normal. In 15 of the patients with hyperhomocysteinemia, folic acid substitution returned plasma homocysteine to a normal value in 12 cases.

Conclusion: A surprisingly high prevalence of hyperhomocysteinemia was detected in this cohort of RVT patients, clearly superseding the prevalence of around 17% found in patients suffering venous thromboembolism in other vascular compartments. Our finding points to the likelihood that hyperhomocysteinemia may be a significant risk factor for retinal vein thrombosis.
Functional and structural measurements in a multifactorial glaucoma risk model
Authors: Polo Vicente , Abecia Emilio , Pablo Luis E. , Pinilla Isabel , Larrosa Jose M. , Honrubia Francisco M.
Published: March 2003

ABSTRACT. Purpose: To evaluate the relationship between a multifactorial probability risk model of developing glaucomatous visual field defects and the assessment of the retinal nerve fiber layer (RNFL) and short‐wavelength automated perimetry (SWAP) in glaucoma suspects.

Methods: 157 eyes of 157 glaucoma suspects were included in the study. The risk of developing glaucomatous defects was assessed by applying a multifactorial model that included intraocular pressure, vertical cup‐to‐disk ratio, age and family history. Photographs of the RNFL and SWAP were performed.

Results: The SWAP was abnormal in 54 cases (34.3%); 21% of abnormal perimetries were obtained in the low‐risk group, 37% in the moderate risk group and 56% in the high risk group. The nerve fiber layer evaluation in the different risk stages showed a pattern similar to the results obtained with SWAP. Multiple regression analyses, performed with the four variables included in the model with SWAP and RNFL evaluation, showed the relationship between the risk factors and the presence of glaucomatous damage – evaluated by RNFL and SWAP (p<0001).

Conclusions: The probability model showed a good correlation between the risk scale and the RNFL and SWAP assessment.
Normative measurements of Korean orbital structures revealed by computerized tomography
Authors: Lee Jong Soo , Lim Dae Won , Lee Sang Hyup , Oum Boo Sup , Kim Hak Jin , Lee Hak Jong
Published: March 2003

ABSTRACT. Purpose: The purposes of this study were to establish criteria for the diameters of normal extraocular muscles, the width of the optic nerve, and the globe position as revealed by CT, and to investigate the effects of age and sex on these parameters in the Korean population.

Subjects and Methods: Diameters of extraocular muscles (medial, lateral, superior complex, and inferior rectus), distance from the interzygomatic line to the posterior margin of the globe, width of the optic nerve‐sheath complex, and length of the interzygomatic line were calculated for 214 patients on axial and direct coronal CT images, and the effects of age and sex were analyzed.

Results: Normal range for the diameters as given by mean±2SDs of extraocular muscles were medial rectus, 2.2–5.4 mm; lateral rectus, 2.1–4.9 mm; inferior rectus, 2.5–5.7 mm; and superior complex group, 2.6–6.4 mm. The mean optic nerve‐sheath complex was 4.1 mm and the values ranged from 2.9 mm to 5.3 mm. The mean length of the interzygomatic line was 103.8 mm. The normal posterior position of the globe as here designed was 11.2 mm behind the interzygomatic line (range, 6.4–15.3 mm). All parameters under study were a little larger in males than females. Statistically, however, there was no significant difference between males’ and females’ results, nor between the various age groups (p>0.05).

Conclusion: Our CT results may help clinical ophthalmologists to accurately assess enlargement of the extraocular muscles and the optic nerve as well as aiding in the evaluation of exophthalmos.
Simultaneous management of blood flow and IOP in glaucoma
Authors: Harris Alon , Jonescu‐Cuypers Christian , Martin Bruce , Kagemann Larry , Zalish Miriam , Garzozi Hannah J.
Published: March 2003

ABSTRACT. Factors other than intraocular pressure (IOP) elevation must be involved in initiation and progression of glaucoma. An additional element in disease causation may be ischemia in the retina and optic nerve head. Ischemic damage to neurons in the CNS is similar mechanistically and histopathologically to changes seen in glaucoma. Further, glaucoma patients with normal IOP show clear evidence for cerebral and ocular ischemia. Aging and atherosclerosis reduce the ability of the eye to autoregulate blood flow when ocular perfusion pressure changes: the dependence of blood flow on perfusion pressure links ischemia to IOP. Consequently, neuroprotective treatments for glaucoma should be designed to both reduce IOP and improve ocular nutrient delivery.
Ocular and orbital cysticercosis
Authors: Pushker Neelam , Bajaj Mandeep S. , Chandra Mahesh , Neena
Published: March 2003

ABSTRACT. Purpose: To study the demographic factors, clinical diagnosis, results of investigation, modalities of treatment and their outcome in ocular and extraocular cysticercosis.

Method: A total of 20 patients were recruited for the study. Ultrasonography and computed tomography were done for all the patients. Serial ultrasound was obtained in patients receiving medical treatment. Therapy was individualized according to the location of the cyst.

Results: The commonest clinical presentation was proptosis (9 of 20) with restriction of ocular movements, followed by subconjunctival cyst, subretinal cyst, papilloedema, atypical optic neuritis, lid nodule and intraretinal cyst. Ultrasonography was comparable with computed tomographic scan for detection of scolex. Two of the twenty patients had associated cysts in the brain parenchyma. Medical or surgical therapy as indicated, had a satisfactory outcome.

Conclusion: Cysticerci can lodge themselves in any part of the ocular and extra ocular tissue. Associated brain parenchyma involvement is quite rare. The clinical presentation, treatment and outcome mainly depends on the location of the cyst.
The development of myopia in Hong Kong children
Authors: Goldschmidt Ernst , Lam Carly S. Y. , Opper Sylvia
Published: March 2003

ABSTRACT. Purpose: The purpose of this two and one‐half year follow‐up study is to evaluate the relationship between early academic activities and the development of myopia.

Methods: 128 children randomly selected from 51 pre‐schools completed an education and vision assessment study. At the end of the period, the children were 8.5 years old. Data were collected on developmental performance in the areas of cognition, language, social, academic and motor skills. The prevalence of myopia, mean refraction and change of refraction over this period were described in terms of the gender, geographical areas, type of pre‐schools and type of primary schools.

Results: The prevalence of myopia shifted towards a higher proportion of myopia in all the above categories. The mean refraction at the initial visit was 0.5 D and became about −0.50 D at the follow‐up visit. There was no difference in the changes of refraction in relation to the type of pre‐school or primary school. The change of refraction was also not related to the educational scores. However, there was a statistically significant difference in the academic scores, in particular the reading scores, between the activity and conventional primary schools. There was also gender difference in language scores between the girls and the boys of the activity schools. There was no difference in all scores between the myopes and non‐myopes.

Conclusion: The present study did not demonstrate a relationship between early academic activities and development of myopia. However, the higher reading scores and the slightly faster progression rate in the conventional schools may indicate an influence of the curriculum on the refractive development. A longer follow‐up study may elucidate a clearer trend.
Risk factors for corneal graft failure and rejection in penetrating keratoplasty
Authors: Inoue Kenji , Amano Shiro , Oshika Tetsuro , Tsuru Tadahiko
Published: March 2003

ABSTRACT. Purpose: To evaluate risk factors for graft failure and allograft rejection after penetrating keratoplasty (PK).

Methods: We retrospectively studied clinical results of PKs in terms of graft survival and rejection‐free graft survival rates. PKs were done on 271 eyes between 1987 and 1997. Clinical results were analyzed by Kaplan‐Meier’s life table method and the log‐rank test. Relative risks and adjusted survival probabilities for each value of the factor were compared with the risk for a specified reference value.

Results: The overall rates of graft survival and rejection‐free graft survival in 10 years after PK were 79.3% and 77.9%, respectively. Higher relative risk of graft failure was associated with corneal vascularization (relative risk for within one quadrant=1.67, two quadrants=2.37, three or more quadrants=3.39), regraft (relative risk for one failed previously graft=2.08, two or more failed previously graft=2.65), aphakia (relative risk=2.17) or pseudophakia (relative risk=3.02), presence of anterior synechia (relative risk=2.91), presence of posterior synechia (relative risk=2.56), long (more than 85 minutes) operation time (relative risk=2.20), and older (more than 50 years) recipient age (relative risk=2.38). Higher relative risk of rejection was associated with corneal vascularization (relative risk for within one quadrant=2.35, two quadrants=2.03, three or more quadrants=2.63), long (more than 85 minutes) operation time (relative risk=1.47), and younger (less than 60 years) donor age (relative risk=2.10). There was no association between graft failure or allograft rejection and graft size or suture technique, respectively.

Conclusion: The risk factors for graft failure after PK were corneal vascularization, regraft, aphakia or pseudophakia, presence of anterior synechia, presence of posterior synechia, long operation time, and older recipient age. The risk factors after PK for allograft rejection were corneal vascularization, long operation time, and younger donor age.
Contact lens induced keratitis associated with contact lens wear
Authors: Dejaco‐Ruhswurm Irene , Scholz Ursula , Hanselmayer Georg , Skorpik Christian
Published: March 2003

Purpose: To evaluate clinical characteristics, risk factors, management and outcome of contact lens induced keratitis (CLIK) associated with contact lens wear.

Methods: The study comprised all consecutive patients presenting with contact lens related presumed microbial keratitis during a 12‐month period at our department. Detailed demographic data, type of contact lens, duration of lens wear, wearing schedule and lens hygiene were derived from a self‐administered questionnaire. Severity of ulcer, corneal scrapings, treatment and final outcome were evaluated.

Results: 27 patients with CLIK, some of which may have been sterile peripheral infiltrates, due to contact lens wear were detected. In the majority of the cases patients had used disposable soft contact lenses (89%) and most of them had a daily wearing schedule (78%). 51.8% patients cleaned their lenses regularly. 6 (22%) applied no disinfection since their lenses were disposable on removal. In 3 of our cases with CLIK, penetrating keratoplasty had to be performed.

Conclusion: Disposable contact lenses seem to have been a predisposing factor for contact lens induced keratitis also when used on a daily wear schedule. Insufficient contact lens care products and/or manufacturing characteristics may be responsible for CLIK, which is also observed in otherwise compliant contact lens users. In 3 of our patients with CLIK keratoplasty became necessary, indicating that contact lens induced keratitis may result in severe corneal complications.
The Swedish national survey of surgical excision for submacular choroidal neovascularization (CNV)
Authors: Berglin Lennart , Algvere Peep , Olivestedt Göran , Crafoord Sven , Stenkula Staffan , Hansson Lars‐Jörgen , Tomic Zoran , Kvanta Anders , Seregard Stefan
Published: March 2003

Purpose: To compare the visual outcome after surgical removal of subfoveal choroidal neovascularization (CNV) in patients younger and older than 50 years of age.

Methods: Patient records from all Swedish centers performing submacular CNV surgery were reviewed and 90 patients treated between 1992–1999 with a follow‐up of 6 months or more were included. The results obtained in 49 patients aged 51–89 years (median=72 years) with neovascular disease caused by age‐related macular degeneration (AMD) were compared with the outcome of 41 patients aged 6–49 years (median=36 years) with CNV secondary to non‐AMD causes. The main outcome measure was the improvement or deterioration in visual acuity (standardized in logMAR units) at 6 months following surgery. Secondary endpoints were recurrent CNV and surgical complications.

Results: The level of preoperative visual acuity was not significantly different between younger patients with CNV associated with non‐AMD and older patients with visual loss due to AMD (p=0.069). However, visual acuity at 6 months after surgery was better (p=0.0042) in younger patients (median improvement=0.19 logMAR) than in older patients (median improvement=0.0 log MAR). Marked visual improvement (>1 log MAR unit) was seen in 29% of non‐AMD patients <50 years compared to 0% in the AMD group >50 years.

Conclusion: Surgical removal of submacular CNV does not appear to improve visual acuity in patients > 50 years of age. However, it may be beneficial for younger patients where a substantial improvement of visual acuity is seen in a subset of these patients. Further studies are required to assess the long‐term outcome.
Spontaneous remodelling of retinal veins accidentally severed during vitreous surgery
Authors: Koizumi Kan , Yasuhara Toru , Yamasaki Toshihide , Kinoshita Shigeru
Published: March 2003

Background:  To report the spontaneous remodelling of retinal veins inadvertently severed during vitreous surgery.

Methods:  Four diabetic patients who underwent vitrectomy during which retinal veins were damaged were followed for at least 6 months. Haemorrhages from severed veins were controlled by raising intraocular pressure and by endodiathermy of the distal ends of the veins. This was followed by fluid/gas exchange.

Results:  Remodelling of venous channels in the damaged areas was observed in all eyes. In three of the four eyes we found evidence of collateral veins. In the other eye we noted the connection of two ends of an interrupted vein. No signs of retinal vein occlusion (e.g. superficial retinal haemorrhages and retinal oedema) were observed.

Conclusion:  These findings suggest that a spontaneous remodelling mechanism to repair damaged venous channels may exist in retina.
An evolutionary analysis of the aetiology and pathogenesis of juvenile‐onset myopia
Authors: Cordain Loren , Eaton S. Boyd , Brand Miller Jennie , Lindeberg Staffan , Jensen Clark
Published: March 2003

The available evidence suggests that both genes and environment play a crucial role in the development of juvenile‐onset myopia. When the human visual system is examined from an evolutionary perspective, it becomes apparent that humans, living in the original environmental niche for which our species is genetically adapted (as hunter‐gatherers), are either slightly hypermetropic or emmetropic and rarely develop myopia. Myopia occurs when novel environmental conditions associated with modern civilization are introduced into the hunter‐gatherer lifestyle. The excessive near work of reading is most frequently cited as the main environmental stressor underlying the development of myopia. In this review we point out how a previously unrecognized diet‐related malady (chronic hyperinsulinaemia) may play a key role in the pathogenesis of juvenile‐onset myopia because of its interaction with hormonal regulation of vitreal chamber growth.
Dorzolamide and ocular blood flow in previously untreated glaucoma patients: a controlled double‐masked study
Authors: Bergstrand Ingar C. , Heijl Anders , Harris Alon
Published: March 2003

Purpose:  The aim of this study was to investigate the haemodynamic effects of topical dorzolamide treatment in eyes with newly detected and previously untreated glaucoma.

Methods:  Forty‐seven patients with open angle glaucoma were consecutively randomized to dorzolamide versus placebo TID during a 6‐week double‐masked treatment trial. Ocular blood flow was investigated at baseline and on therapy using colour Doppler imaging of the retrobulbar vessels and scanning laser ophthalmoscope fluorescein angiograms of the retinal circulation.

Results:  None of the flow parameters, retrobulbar or retinal, changed significantly on therapy when the results were analysed with the Bonferroni method. Analysis with non‐simultaneous tests also failed to reveal any significant changes either in retrobulbar flow velocities in the central retinal artery, ophthalmic artery or in the short posterior ciliary arteries, or in the retinal parameters (arm‐retina time, arteriovenous passage time, mean dye velocity or macular capillary velocity), while capillary velocities at the optic disc decreased significantly in the dorzolamide group (P = 0.03). Intraocular pressure reduction was significantly more pronounced in the dorzolamide group (P = 0.002), with − 4.8 ± 2.9 mmHg (P < 0.0001) versus−1.8 ± 3.0 mmHg in the placebo group (P = 0.006).

Conclusions:  The present study indicated no measurable vascular effects from topical dorzolamide treatment in previously untreated glaucoma eyes.
Treatment of acute neonatal bacterial conjunctivitis: a comparison of fucidic acid to chloramphenicol eye drops
Authors: Normann Erik Kreyberg , Bakken Odd , Peltola Juha , Andréasson Bengt , Buhl Susanne , Sigg Peter , Nielsen Klaus
Published: March 2003

Purpose: To compare the clinical and bacteriological effects of fucidic acid (Fucithalmic®: 1.0%) and chloramphenicol (Minims®: 0.5%) eye drops in neonates with a clinical diagnosis of acute conjunctivitis of suspected bacterial origin.

Methods: A total of 456 n ewborns with gestational age > 32 weeks with acute conjunctivitis of suspected bacterial origin acquired within the first 28 days of life were included in the study. They were randomly assigned to a 7‐day treatment with eye drops using either fucidic acid (1.0%) (Fucithalmic®) applied twice per day, or chloramphenicol (0.5%) (Minims® Chloramphenicol) applied six times per day. The subjects were followed up with two visits (on days 1 and 8) and by telephone 2 weeks after the end of treatment.

Results:  Eighty‐nine per cent of the neonates treated with Fucithalmic® were cured, compared to 87.9% of those treated with Minims® Chloramphenicol (n.s). The drug was used as instructed in 90.7% of patients treated with Fucithalmic® and in 78.0% of those treated with Minims® Chloramphenicol (P < 0.001).

Conclusion:  Treating neonatal conjunctivitis with fucidic acid is easier than with chloramphenicol and is equally effective.
Retinal dysfunction and anterior segment deposits in a patient treated with rifabutin
Authors: Ponjavic V. , Gränse L. , Bengtsson Stigmar E. , Andréasson S.
Published: March 2003

Purpose:  To describe the clinical and electrophysiological findings in a young boy with decreased vision possibly due to retinal damage by rifabutin.

Methods:  An 8‐year‐old boy with osteomyelitis was referred due to visual disturbance. During a period of 4 years, the boy was examined six times with electroretinography. Ophthalmological examination included testing of visual acuity, slit‐lamp inspection, fundus inspection, fundus photography and kinetic perimetry. Two electrophysiological methods were performed for objective evaluation of retinal function, namely full‐field electroretinography and multifocal electroretinography.

Results:  We found a slightly reduced visual acuity, a slowly increasing amount of yellow‐white deposits on the posterior surface of the cornea and on the anterior part of the lens, a normal fundus appearance, and normal visual fields. However, the electroretinogram was abnormal on several occasions during therapy with rifabutin, but returned to normal 3 months after withdrawal of the medication. The multifocal electroretinogram returned to normal after the full‐field electroretinogram had done so. The anterior chamber deposits still remain.

Conclusion:  Long‐term treatment with rifabutin may have a reversible and previously undescribed side‐effect on retinal function. The drug may also accumulate irreversibly on the posterior surface of the cornea and on the anterior surface of the lens. We suggest that objective evaluation of retinal function with electrophysiological methods should be performed in patients with visual disturbance during treatment with rifabutin.
Secretion from submucosal salivary glands of the ferret in response to a cholinesterase inhibitor applied onto the oral mucosa
Authors: Ekström Jörgen , Helander Herbert F.
Published: March 2003

Parasympathomimetics or cholinesterase inhibitors taken orally may relieve dry‐mouth symptoms, but this route of administration is often associated with adverse systemic reactions. In the present study, an animal model was worked out aimed at stimulating the submucosal glands and avoiding systemic effects. In the anesthetized ferret, saliva from the parotid, sublingual and submandibular glands was prevented from reaching the mouth. Vehicle or physostigmine was applied topically for 10 min on the buccal and labial mucosa on one side, while the other side served as a control. Fluid from each side was collected every 5 min Mean basal secretion was 0.17 mg 5 min−1. The response to physostigmine 0.1% did not exceed that of the vehicle. At higher concentrations the responses lasted 80–120 min. Peak secretion was nine (0.25% physostigmine), 13 (0.5% physostigmine) and 40 (1% physostigmine) times higher than baseline. At 1% physostigmine, the secretion from the control side was elevated, and a small flow from the duct‐cannulated parotid gland occurred, indicating systemic effects. Arterial blood pressure was well maintained. Additional observations on the duct‐cannulated zygomatic gland showed that secretion from this gland increased already within the 10‐min period of application of physostigmine to the overlying mucosa. The distance between the mucosa and the zygomatic gland was only about 1 mm. Physostigmine‐induced secretion was abolished by atropine. Local gland stimulation may be an attractive alternative for the treatment of dry mouth.
Quantitative analysis of substance P, neurokinin A and calcitonin gene‐related peptide in gingival crevicular fluid associated with painful human teeth
Authors: Awawdeh Lama A. , Lundy Fionnuala T. , Linden Gerard J. , Shaw Chris , Kennedy John G. , Lamey Philip‐John
Published: March 2003

The aim of this study was to investigate the presence of substance P (SP), neurokinin A (NKA) and calcitonin gene‐related peptide (CGRP) in the gingival crevicular fluid of teeth diagnosed with pain of pulpal origin compared with clinically healthy teeth, and to detect any changes in the levels of these neuropeptides in gingival crevicular fluid after removal of the pulp from the painful teeth. Gingival crevicular fluid was collected at baseline from one interproximal site at a painful and a non‐painful contralateral tooth from 54 adult patients. Sampling was repeated after 1 wk in a subset of 21 subjects. Samples were analysed for SP, NKA, and CGRP using radioimmunoassay. The mean levels of SP and NKA were significantly higher in gingival crevicular fluid from painful teeth compared with non‐painful teeth. The level of SP in the GCF of painful teeth fell significantly 1 wk after pulpectomy. In contralateral teeth, there were no significant differences in the levels of SP and NKA after 1 wk. It is concluded that SP and NKA are present in significantly greater amounts in the GCF of painful teeth compared with healthy teeth.
Mast cells and angiogenesis
Authors: Norrby Klas
Published: March 2003

Angiogenesis is tightly regulated by pro‐ and anti‐angiogenic factors. Secreting mast cells are able to induce and enhance angiogenesis via multiple in part interacting pathways. They include mast cell‐derived (i) potent pro‐angiogenic factors such as VEGF, bFGF, TGF‐beta, TNF‐alpha and IL‐8, (ii) proteinases and heparin, that release heparin‐binding pro‐angiogenic factors lodged on cell surfaces and in the extracellular matrix (ECM), (iii) histamine, VEGF, and certain lipid‐derived mediators that induce microvascular hyperpermeability having pro‐angiogenic effects, (iv) chemotactic recruitment of monocytes/macrophages and lymphocytes that are able to contribute with angiogenesis‐modulating molecules, (v) activation of platelets that release pro‐angiogenic factors, (vi) activation of neighboring stationary non‐mast cells, which secrete pro‐angiogenic factors, ECM‐degrading proteinases and stem cell factor which attracts, mitogenically stimulates and activates mast cells, (vii) auto‐ and paracrine stimulation of mast cells by stem cell factor, (viii) recruitment of mast cells by pro‐angiogenic factors such as VEGF, bFGF and TGF‐beta. As a result of ECM‐degradation and changes in the microenvironment following initial mast cell secretion, the mast cell populations may change significantly in number, phenotype and function. In tumor models, mast cells have been shown to play a decisive role in inducing the angiogenic switch which precedes malignant transformation. There is, moreover, strong evidence that mast cells significantly influence angiogenesis and thus growth and progression in human cancers.
T‐cell‐rich B‐cell lymphoma – diagnostic and therapeutic aspects
Authors: Axdorph Ulla , Porwit‐Macdonald Anna , Sjøberg Jan , Grimfors Gunnar , Bjørkholm Magnus
Published: March 2003

Background.
Morphologically, T‐cell‐rich B‐cell lymphoma (TCRB‐NHL) may be indistinguishable from Hodgkin's disease (HD). Immunophenotyping may be helpful in the separation of these entities. TCRB‐NHL is occasionally misdiagnosed and treated as HD. However, information is limited regarding clinical characteristics and outcome of this patient population. Furthermore, knowledge concerning any association with Epstein‐Barr virus (EBV) in TCRB‐NHL, as well as the immunophenotype of reactive T‐cells and the expression of T‐cell intracellular antigen‐1 (TIA‐1), granzyme B (GrB) and the CD3‐ζ‐chain is limited.
Patients and methods.
We have re‐evaluated 251 tumour biopsies from patients aged ≥15 years with HD diagnosed 1985–1994. Reclassification from HD to TCRB‐NHL was done in 12 cases (5%). Six TCRB‐NHL patients initially diagnosed and treated as B‐NHL were also included. All TCRB‐NHL biopsies were analysed for latent membrane protein 1 (LMP‐1), CD4, CD8, CD56, CD57, TIA‐1, GrB and CD3‐ζ‐chain.
Results.
Twelve cases of TCRB‐NHL were initially subclassified as HD (lymphocyte predominance 5, nodular sclerosis 3, and mixed cellularity 4). Of these 12 TCRB‐NHL patients, 6 were given radiotherapy alone, 5 MOPP/ABVD or similar combination chemotherapy, and one patient combined modality treatment. Male sex (p<0.05) and inguinal involvement (p<0.001) were significantly more frequent when TCRB‐NHL patients receiving HD treatment (n=12) were compared with the remaining patients with confirmed (conf) HD, while no significant differences were seen with regard to stage, bone marrow infiltration, splenomegaly or cause‐specific survival. Similar results were achieved when all TCRB‐NHL patients (n=18) were compared to conf HD patients. Lymphoma cells in three samples stained positively for LMP‐1. A decreased expression of CD3‐ζ‐chain was seen in 9/14 tumour biopsies.
Conclusion. Immunohistochemistry makes it possible to identify cases of TCRB‐NHL that are morphologically difficult to distinguish from HD. The outcome of TCRB‐NHL patients treated as having HD was comparable with that of the remaining HD population.