bluuebunny/crossref_metadata_2025 huggingface dataset:
Laparoscopic resection of gallbladder remnant: Case report
Authors: Lee Kit‐Fai , Lee Shin‐Cheung , Leong Heng‐Tat
Published: March 2003

Recurrent symptomatic cholelithiasis can arise from residual gallbladder after a previous incomplete cholecystectomy. Diagnosis relies on a high index of suspicion and appropriate investigations such as ultrasound, computed tomography scan, endoscopic retrograde cholangiopancreatography or magnetic resonance cholangiopancreatography (MRCP). A case of symptomatic gallbladder remnant with gallstone 3 years after a previous laparoscopic cholecystectomy, which was managed successfully with laparoscopic resection, is described. The predisposing factors and preventive measures for such a rare complication are discussed.

Chinese Abstract

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Adult interhemispheric subdural haematoma: A simple option for an uncommon problem
Authors: Datta Narendra Nath , Rehman Safi‐Ur , Chan Kwong‐Yau , Chan Kin‐Wai , Poon Christopher Yee‐Fat , Kwok John Ching‐Kwong
Published: March 2003

Two cases of interhemispheric subdural haematoma are presented. None of the patients had any neurological deficit on admission. They developed progressive neurological deficits within a day or two. Surgical treatment was by a large convexity craniectomy and a wide opening of the dura. The dura was left open in one case and primary duroplasty was done in the other. No deliberate attempt was made to remove the interhemispheric clot. Both patients made a quick and complete recovery by this simple procedure. Cranioplasty was carried out subsequently.

Chinese Abstract

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Diagnostic difficulties in the differentiation of pancreatic pseudocyst and cystic pancreatic neoplasm
Authors: Artioukh Dmitri Y. , Zeiderman Michael R.
Published: March 2003

Cystic tumours of the pancreas are rare and may be difficult to differentiate from pseudocysts, especially when the lesion is discovered after abdominal trauma. The case of a 48‐year‐old woman who developed a cystic lesion of the pancreas 4 months after blunt abdominal trauma is reported. Whilst the lesion had diagnostic features consistent with pseudocyst, the final diagnosis of benign mucinous cystadenoma was established only after radical resection 27 months later. The possible role of trauma in its aetiology is discussed.
Creation of a subcutaneous tunnel in antesternal oesophageal replacement with the aid of a rigid sigmoidoscope
Authors: Poon Chi‐Ming , Lee Danny Wai‐Hung , Chan Angus Chi‐Wai
Published: March 2003

A technique to create a subcutaneous tunnel in antesternal oesophageal replacement using a rigid sigmoidoscope is reported.
The cutaneomarginal eyelid graft
Authors: O’Donnell Brett A
Published: March 2003

Purpose: To assess the effectiveness of the cutaneomarginal graft.

Methods: The cutaneomarginal graft consists of eyelid margin tissue with anterior lamella skin. The tarsal plate is resected following harvesting of a wedge of eyelid tissue. The graft is used to repair eyelid defects following excision of neoplasms which spares the posterior lamella. The graft is principally used at the lateral most part of the lower eyelid following Mohs surgery. A case series of five patients are reviewed to assess the effectiveness of the technique.

Results: All patients achieved a satisfactory result following grafting and there were no donor site complications.

Conclusions: The cutaneomarginal graft is an effective means of repair, although with limited indications.
Confusing means with ends: A manager's reflections on experience in agricultural landscapes of Western Australia
Authors: Wallace Ken J.
Published: March 2003

Summary Since ‘landcare’ in its modern form began in Australia during the early 1980s, considerable resources have been focused on applying tools and processes, such as community empowerment, regionalization, integrated catchment management, and facilitation and coordination. While these are valuable tools to achieve goals, they are not themselves goals. Unfortunately, they have frequently become ends in themselves. This confusion of means and ends has hindered landcare achievements in Australia. Examples of this are provided, and then contrasted with management based on goals that emphasize realistic targets, highlight barriers to goal achievement, and facilitate the development of well‐targeted actions. The complexity of most natural resource management issues, the lack of technical solutions and the long timescales over which management must be applied have all contributed to the confusion of means and ends.
Adverse effects of topical antiglaucoma drugs on the ocular surface
Authors: Arıcı Mustafa Kemal , Arıcı Dilek Sema , Topalkara Ayşen , Güler Cenap
Published: March 2003

Purpose: This study was designed to determine the effect of long‐term antiglaucoma topical medication on the ocular surface; measuring basal Schirmer’s and tear break‐up time tests using conjunctival impression cytology.

Methods: The ocular surfaces of 30 control subjects (group 1), 24 primary open‐angle glaucoma patients treated with 0.5% betaxolol hydrochloride (group 2), 27 primary open‐angle glaucoma patients treated with 0.5% timolol maleate (group 3) and 26 primary open‐angle glaucoma patients treated with 0.5% betaxolol and 1% dipivefrin hydrochloride (group 4) were evaluated. Basal Schirmer’s and tear break‐up time tests were measured and ocular surface changes were determined by impression cytology. Impression cytology specimens of each group were graded and scored in the range 0–3 according to Nelson’s method.

Results: Patients in groups 2, 3 and 4 showed statistically significant fewer normal basal Schirmer’s tests (wettability) and tear break‐up time tests (P < 0.01). Also, the conjunctival impression cytology scores were significantly higher in groups 2, 3 and 4 than in group 1 (P < 0.01).

Conclusions: The conclusion was that it is possible that conjunctival surface and tear film function change after the long‐term use of antiglaucoma medication.
Secondary haemorrhage after dacryocystorhinostomy
Authors: Tsirbas Angelo , McNab Alan A
Published: March 2003

Objective: To describe the incidence, clinical features, possible risk factors and outcome of patients suffering secondary haemorrhage after dacryocystorhinostomy (DCR).

Methods: Records of all patients undergoing external DCR by one surgeon (AAM) over a 6‐year period were analysed retrospectively.

Results: After 293 DCR operations in 260 patients, 10 patients had a secondary haemorrhage (one after bilateral DCR), usually between days 4 and 10 post‐operatively (mean 6.8 days). Six of the 10 were hospitalized for 2–5 days (mean 2.8 days), all of whom had nasal packing, intravenous antibiotics and intravenous fluids; none required blood transfusion. Three patients had immune system defects, three had used non‐steroidal anti‐inflammatory drugs (NSAID) and four had no obvious risk factors. All 10 had a successful outcome following DCR (compared to an overall failure rate of 25/293 (8.5%): 16 anatomical and nine functional).

Conclusions: Secondary haemorrhage after DCR was found to occur after 3.8% of DCR. Risk factors include being immunocompromised and taking NSAID prior to surgery. The haemorrhage did not adversely affect surgical outcome.
Symptomatic intraocular inflammation in multiple sclerosis
Authors: Towler Hamish MA , Lightman Susan
Published: March 2003

Purpose: The aim of this study was to determine the type and outcome of uveitis in patients with multiple sclerosis.

Methods: A retrospective study of 16 patients attending the uveitis clinic who had a clinically definite diagnosis of multiple sclerosis and symptomatic intraocular inflammation. The type of uveitis and complications present as well as the outcome of therapeutic intervention, either medical or surgical, was determined.

Results: Chronic, bilateral anterior uveitis was present in six patients. Secondary cataracts requiring surgery occurred in 10 eyes, and trabeculectomy was done on five eyes for secondary glaucoma. Symptomatic vitritis (visual blurring and/or visually significant floaters) occurred in eight patients and was bilateral in four. Occlusive peripheral retinal vasculitis with subsequent areas of ischaemia and neovascularization requiring panretinal laser photocoagulation developed in eight eyes, five of which also required vitrectomy. Other posterior segment complications included macular oedema (four) and epiretinal membrane involving the macula (two). Five patients required systemic steroids for control of posterior uveitis. The median visual improvement following cataract surgery or vitrectomy was 3 Snellen lines to a median visual acuity of 6/18.

Conclusions: A wide range of clinical patterns of uveitis, which may be both symptomatic and sight‐threatening, occur in patients with multiple sclerosis. In addition, the complications of uveitis may cause significant visual morbidity, much of which is amenable to appropriate surgical intervention. It is important that these potentially remediable conditions are recognized and treated to ensure that patients with multiple sclerosis retain optimum visual function.
Cataract extraction in a major ophthalmic hospital: Day‐case or overnight stay?
Authors: Atalla Maged L , Wells Kristen K , Peucker Nicole , Yi Qing , McCarty Daniel J , Louis Damien , Taylor Hugh R
Published: March 2003

Purpose: Cataract surgery is increasing in Australia and represents a significant burden on limited health resources. This study examines the frequency and outcomes of cataract surgery for patients who were hospitalized overnight compared with those treated as day surgery cases.

Methods: Medical records of 671 consecutive admissions for cataract surgery at the Royal Victorian Eye and Ear Hospital were reviewed. Data analysed included demographic features, insurance status, length of hospitalization, ophthalmic conditions, medical conditions, social problems and planned surgical technique. Ophthalmic and anaesthetic complications, active ophthalmic and medical interventions were also studied.

Results: Of the 671 patient admissions for cataract during the study period, 226 (33.4%) were hospitalized overnight. Factors significantly associated with overnight hospitalization in univariate analyses include older age, female sex, country residence, Veterans’ Affairs insurance, monocular vision status, pre‐existing ischaemic heart disease, pre‐existing asthma/chronic obstructive lung disease, absence of carer, transportation problems, planned extra‐capsular cataract extraction technique, ophthalmic complications and active ophthalmic and/or medical interventions. After adjusting for possible confounding factors using backwards stepwise multivariate logistic regression models all except pre‐existing ischaemic heart disease and opthalmic complications were significantly associated with overnight admission for cataract surgery. In total, 14 cases (2.1%) needed active ophthalmic and/or medical interventions, 13 overnight cases and one day case.

Conclusions: These data suggest that many patients who are hospitalized overnight for cataract surgery could be safely treated as day cases. Such a shift in the pattern of care for cataract surgery could provide a significant potential for health care savings.
Projected number of Australians with visual impairment in 2000 and 2030
Authors: Foran Suriya , Wang Jie Jin , Rochtchina Elena , Mitchell Paul
Published: March 2003

This study aimed to project population‐based prevalence data associated with visual impairment, in order to estimate the number of affected older Australians (aged 50 or older) in the years 2000 and 2030. We used data from the Blue Mountains Eye Study (BMES) and Melbourne Visual Impairment Project (MVIP), together with Australian Bureau of Statistics population projections. Similar definitions for moderate (6 / 24–6 / 60 visual acuity) and severe (< 6 / 60 visual acuity) visual impairment were used. Combining age‐standardized data, we estimated that in the year 2000, 38 820 (0.73%) and 25 590 (0.48%) Australians aged 50 years or older will have moderate and severe visual impairment, respectively. By 2030, these rates will have more than doubled, to an estimated 85 910 (0.92%) and 57 930 (0.62%) Australians with moderate and severe visual impairment, respectively. Women aged 50 years or older will have a 1.8‐fold and four‐fold risk, respectively, of moderate and severe visual impairment compared to men. Visual impairment will affect an increasing proportion of older Australians. Newer approaches to therapy, rehabilitation and community support for persons with visual impairment will be needed to meet this challenge.
Effect of stimulus duration in flicker perimetry
Authors: Anderson Andrew J , Vingrys Algis J
Published: March 2003

We investigated the relationship between stimulus duration and flicker thresholds when flickering stimuli were presented on luminance pedestals. Mean‐modulated flicker thresholds remained constant with changes in stimulus duration. However, flicker presented on a luminance pedestal gave masking at short durations, decaying exponentially to stable thresholds with time. These stable thresholds were elevated when compared with the mean‐modulated condition. The lowest threshold in a stimulus onset asynchrony function predicted the threshold obtained from a luminance‐pedestal flicker stimulus of the same duration. This suggests that luminance‐pedestal flicker thresholds are determined by the most detectable cycle in a multiple cycle stimulus. We find that the 800 ms stimulus duration used in the Medmont™ M600 perimeter (Medmont, Camberwell, Australia) is suitable to determine stable flicker thresholds.
Streaming and bouncing: observations on motion defined objects
Authors: Burns Nicholas R , Zanker Johannes M
Published: March 2003

When two identical objects move in opposite directions on the same path and at the same speed, they can appear, after crossing over, to continue in their original directions (streaming), or to reverse direction (bouncing). In order to be able to manipulate visibility by adding noise, we used objects defined by contrast, flicker, or motion, and thereby extended previous findings on luminance‐defined objects. Two identical rectangles (1.1 × 1.4°) composed of random dot patterns moved toward each other at a speed of 3.5°/s. In experiment 1 we used backgrounds of a grey field, static random dots, or dynamic noise, and examined the effect of introducing a pause in motion and a visual distractor. In experiment 2 we introduced visual noise at four levels. For all three types of motion display, we found an increase in the proportion of the bouncing percept when either a pause in motion or an attentional distractor was introduced. Experiment 2 showed that neither of these effects depends on the visibility of the moving objects. An increase in the bouncing percept, due to a pause in motion or the distraction of attention, can be observed for all types of object definition, and is not affected by decreasing the visibility of the motion‐defined objects. This finding suggests that the role of attention in determining the perception of bouncing does not lie in the modulation of object visibility.
Functional implications of vision impairment
Authors: Weih LeAnn , McCarty Catherine A , Taylor Hugh R
Published: March 2003

This study investigated the functional implications of vision impairment. A total of 508 participants in the Visual Impairment Project completed the VF‐14 questionnaire, vision‐related functional tasks, an interview, and the ophthalmic examination. Participants with less than 6 / 12 presenting acuity were more likely to report a moderate to high degree of difficulty performing VF‐14 items (odds ratios from 6 to 44). They were also more likely to be unable to recognize a 10 cent coin (OR; 7.0, 95% CL; 2.6, 19.3) or correctly read a telephone number (OR; 10.1, 95% CI; 5.6, 18.1). As demonstrated by the VF‐14 and the functional tasks administered in this study, visual impairment affects the ability of people to conduct a variety of common daily tasks.
Topical anaesthesia for phacoemulsification surgery
Authors: Lindley‐Jones MFH
Published: March 2003

Aim: To assess the discomfort experienced by patients undergoing phacoemulsification under topical anaesthesia.

Methods: Thirty patients had a collagen contact lens, soaked in 4% lignocaine, placed on the cornea 23–89 min preoperatively. Immediately preoperatively, additional ophthetic drops were inserted. The patients underwent phacoemulsification surgery with the insertion of a foldable intraocular lens. This group was compared with 30 age‐ and sex‐matched controls who underwent phacoemulsification and the insertion of a non‐foldable lens under peribulbar anaesthesia. (8 mL of an 80 : 20 mix of 0.5% bupivacaine, 4% lignocaine and hyaluronidase). The pain perceived by patients was assessed on a verbal analogue scale (0–10) at administration of anaesthesia, perioperatively and 3–6 h postoperatively.

Results: Topical anaesthesia was less painful than peribulbar anaesthetic at administration (difference in mean pain score 1.2, P < 0.05, Wilcoxon paired signed rank test). Patients experienced more pain during the operation under topical anaesthesia (difference in means 0.63, P < 0.05). There was no difference between the groups postoperatively.

Conclusion: Topical anaesthesia does not carry the risk of injection into, or injury of, the many delicate structures of the orbit. Because it provides acceptable levels of anaesthesia for phacoemulsification, it could be used more frequently.
Eyelid retractor surgery as an adjunct to cicatricial ectropion repair
Authors: O'Donnell Brett A
Published: March 2003

Purpose: To evaluate the effectiveness of eyelid retractor repair in cicatricial ectropion of the lower eyelid.

Methods: The study design was a prospective case series. One hundred and twenty eight eyelids were operated on in 100 consecutive patients with cicatricial ectropion. All patients underwent lower eyelid retractor repair via a conjunctival approach combined with skin replacement to the anterior lamella with or without a horizontal lid tightening procedure. When only medial ectropion was present, a medial‐based transpositional skin flap was used to repair the anterior lamella (26 eyelids). The remaining eyelids with ectropion involving all or most of the eyelid underwent upper‐to‐lower eyelid lateral‐based transpositional skin flap repair (92 eyelids), or full thickness free skin grafting (10 eyelids). Horizontal lid tightening was performed by lateral canthoplasty in 123 eyelids.

Results: Relief of cicatricial ectropion symptoms was reported in 90% of patients overall. A normal punctum position was achieved in 70% of eyelids, overall, and was highest (88%) with a medial‐based transpositional skin flap.

Conclusions: Eyelid retractor repair combined with skin replacement and horizontal lid shortening is an effective procedure for cicatricial ectropion.
Sino‐orbital fistula: two case reports
Authors: McNab Alan A
Published: March 2003

A fistula between the paranasal sinuses and the orbit as a late complication of orbital fractures is rare and may present with intermittent symptoms due to air passing into the orbit. A case note review of two patients with sino‐orbital fistula is presented. Two patients, 23‐ and 30‐year‐old males, presented with intermittent symptoms of globe displacement, diplopia or discomfort months after repair of an orbital floor fracture with a synthetic orbital floor implant. The symptoms occurred after nose blowing. They were both cured by removal of the implant and partial removal of the tissue surrounding the implant. A sino‐orbital fistula may complicate the otherwise routine repair of an orbital floor fracture, but may be cured by removal of the implant and part of the surrounding pseudocapsule.
Central serous retinopathy complicating systemic lupus erythematosus: a case series
Authors: Khng CGYW , Yap EY , Au‐Eong KG , Lim TH , Leong KH
Published: March 2003

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder with widespread manifestations including the eye. Central serous retinopathy (CSR) has been associated as a complicating event in SLE, although it is uncommon. We present a case series of four female Chinese SLE patients who developed CSR during the course of their systemic disease. All four presented clinically with typical CSR. Angiographic findings did not show evidence of choroidal ischaemia or delayed choroidal filling. Resolution of the serous retinal detachment occurred in all four patients. Recovery of vision was seen in three patients. The clinical outcome was similar to that occurring in the usual male population. Central serous retinopathy as a manifestation of SLE may be caused by various factors. These include SLE‐associated choroidopathy, systemic hypertension, renal disease, retinal pigment epithelial dysfunction and glucocorticoid therapy.
The macular hole: report of an Australian surgical series and meta‐analysis of the literature
Authors: Kang H K , Chang Andrew A , Beaumont Paul E
Published: March 2003

Purpose: To report an Australian series of macular hole surgery by pars plana vitrectomy and fluid‐gas exchange, and to identify factors influencing the outcome of the surgery through meta‐analysis of the literature.

Methods: Fifty‐six consecutive cases of macular hole were treated by pars plana vitrectomy, fluid‐gas exchange and face‐down positioning for at least 7 days, and prospectively followed for 3–12 months. Thirty‐six reports of macular hole surgery were reviewed. A meta‐analysis on the pre‐ and postoperative parameters was performed on 389 cases, in which case‐specific data‐points were available.

Results: In the current series, anatomical closure was achieved in all (100%) of 16 stage 2, and in 35 (87.5%) of 40 stage 3 or 4 macular holes. At least 2 logMAR lines of improvement in visual acuity were seen in 10 (62.5%) stage 2 and 20 (50.0%) stage 3 or 4 holes. Postoperative visual acuity was 6/12 or better in 10 (62.5%) stage 2 and 17 (42.5%) stage 3 or 4 holes. In both the current series and the meta‐analysis, favourable surgical outcomes were associated with stage 2 macular holes, better preoperative visual acuity, and shorter preoperative duration. Adjuvant use was associated with a higher rate of anatomical closure but there was no clear benefit in terms of postoperative visual acuity.

Conclusion: Our experience and the results of the meta‐analysis suggest that macular hole surgery should be offered as early as possible once full‐thickness neuroretinal defect occurs.
Iodine‐125 episcleral plaque therapy in uveal melanoma
Authors: Sia Serena , Harper Chris , McAllister Ian , Perry Adrian
Published: March 2003

Purpose: To assess the efficacy of iodine‐125 (I‐125) episcleral plaque therapy in the management of uveal melanoma with regard to local control, survival, globe preservation and visual outcome.

Methods: Between January 1985 and January 1997, 50 patients with the diagnosis of uveal melanoma were treated with I‐125 episcleral plaques. The mean initial tumour height was 5.5 mm (range, 2.0–9.5 mm) and basal diameter 9.5 mm (range, 4.0–14.5 mm). I‐125 seeds with a mean activity of 1259.1 MBq were used. The mean apical dose was 80.5 Gy (range, 68.0–95.0 Gy). Scleral dose ranged from 225.0 to 940.0 Gy. Pretreatment visual acuity was 6/60 or better in 43 patients.

Results: One patient was lost to follow up and excluded from analysis. The remaining 49 patients had a mean follow up of 39.5 months. There were seven local failures, with a mean duration to tumour progression of 16.7 months. All seven patients were successfully managed with enucleation. Five other enucleations were performed for treatment‐ related complications. At the time of analysis, 10 patients have died, five of metastatic melanoma. Of the patients with preserved globes, corrected visual acuity was 6/60 or better in 31 patients.

Conclusions: Good local tumour control and survival can be achieved with episcleral plaque therapy. Globe preservation with useful vision was possible in the majority of cases. Our findings are in keeping with other reported series.
Orbital involvement in cherubism
Authors: Carroll Andrew L , Sullivan Timothy J
Published: March 2003

Cherubism is a rare, inherited condition characterized by fibro‐osseous lesions of the maxilla and mandible. It has recently been localized to chromosome 4p16.3. The fullness of the lower half of the face and retraction of the lower lids gives the characteristic ‘eyes raised to heaven’ cherubic appearance. A case report of a 7‐year‐old girl with extensive orbital involvement of cherubism is presented. The patient underwent multidisciplinary surgery for the bony lesions, which extended from the maxillary antrum into adjacent structures, including extensive extraperiosteal orbital involvement. Cherubism may have orbital manifestations including lower lid retraction, proptosis, diplopia, globe displacement and visual loss due to optic atrophy. Ophthalmologists should be aware of the syndrome, its ophthalmic features and overall management.
Dacryocystorhinostomy for epiphora in the presence of a patent lacrimal system
Authors: O’Donnell Brett , Shah Rajiv
Published: March 2003

Purpose: To evaluate the success rate of dacryocystorhinostomy (DCR) for epiphora in patients with a clinically patent lacrimal drainage system.

Methods: A series of 51 patients, 12 men and 39 women, who underwent DCR surgery for epiphora with a clinically patent lacrimal drainage system in the background of normal eyelid examination, were evaluated. All patients underwent fluorescein dye disappearance testing and Jones 1 and 2 testing with dacryocystograms in borderline cases. A standard DCR was performed with bicanalicular silicone tubing inserted in all cases. The average time for the removal of the silicone tubes was 9.6 weeks.

Results: In 48 cases (94%) there was improvement in symptoms with minimal or no significant epiphora postoperatively.

Conclusions: Epiphora with a patent lacrimal drainage system obstruction can be successfully treated by DCR based on fluorescein dye disappearance tests and Jones 1 and 2 tests, with dacryocystography in borderline cases.
Serotype and adhesion of Pseudomonas aeruginosa isolated from contact lens wearers
Authors: Thuruthyil Sophy J , Zhu Hua , Willcox Mark DP
Published: March 2003

The purpose of the present study was to correlate the serotypes of Pseudomonas aeruginosa to the bacterial adhesion to contact lenses and human corneal epithelial cells. Twenty‐three strains isolated from contact lens wearers were used for the study. The bacterial serotypes were examined with a P. aeruginosa antisera kit. The attachment of bacteria on contact lenses or human corneal epithelial cells was determined by counting the number of adhered bacteria after incubation of the bacteria with contact lenses or corneal epithelial cells. The 23 ocular isolates belonged to seven serotypes. Strains of serotypes I, G and E were the three dominant serogroups and were more adhesive to contact lenses compared with other groups of the bacteria. The bacterial serotypes and the clinical sequelae were not strongly related. These results indicate that the surface characteristics of bacterial serotypes are related to the bacterial adhesion to the surface, but the pathogenesis of the bacteria may result from multiple factors.
Ocular complications of paediatric patients with nephrotic syndrome
Authors: Ng Joan SK , Wong William , Law Ricky WK , Hui Joannie , Wong Esther N , Lam Dennis SC
Published: March 2003

Purpose: To investigate ocular complications arising from nephrotic syndrome and/or its treatments in children.

Methods: A cross‐sectional study was conducted in a teaching hospital. A total of 31 paediatric patients with nephrotic syndrome were studied. Comprehensive ophthalmic assessments on best‐corrected visual acuity, intraocular pressure, slit‐lamp and fundus examination were taken. Information regarding histological diagnosis of nephrotic syndrome and its treatment regimen in each patient was reviewed and analysed.

Results: Bilateral posterior subcapsular cataracts were detected in three of 29 patients (10.3%) who received steroid therapy. Two had normal vision while one had visual acuity reduced to 6/15 in both eyes. The age of onset of the nephrotic syndrome in these three patients was 2 years, which was significantly younger than those without cataract (5.4 ± 3.2 years, P < 0.001). Three patients (9.7%) had isolated asymptomatic fundal findings of tortuous and dilated retinal vessels. Hypertensive retinopathy was found in one patient (3.2%). No steroid‐induced glaucoma, uveitis, ocular infection, or other eye complications related to the use of steroids or other immunosuppressive agents were noted.

Conclusions: Children who have nephrotic syndrome often require prolonged, intermittent high dose of systemic corticosteroid therapy. Paediatricians should be aware of the potential risk of developing steroid‐related complications, especially posterior subcapsular cataract. It appears to have a higher risk when steroid therapy is used in very young patients. Early detection would help to prevent amblyopia development, particularly in the group of immature eyes.
Imaging posterior polymorphous corneal dystrophy by in vivo confocal microscopy
Authors: Grupcheva Christina N , Chew Gerald SM , Edwards Matthew , Craig Jennifer P , McGhee Charles NJ
Published: March 2003

To identify features of posterior polymorphous dystrophy (PPMD) by in vivo confocal microscopy, the corneas of a female patient with PPMD were examined using slit‐lamp biomicroscopy and slit‐scanning in vivo confocal microscopy. Characteristic endothelial vesicular and band lesions were seen clinically and easily identified using in vivo confocal microscopy. However, endothelial pleomorphism, an increased density and reflectance of posterior stromal keratocytes, and prominence of corneal nerves were also delineated. In vivo confocal microscopy enhances clinicopathological diagnosis and follow up of corneal dystrophies with subtle clinical presentations, such as PPMD.
Effects of post‐mortem delay and storage duration on the expression of GFAP in normal human adult retinae
Authors: Wu Kathy HC , Penfold Philip L , Billson Francis A
Published: March 2003

Glial fibrillary acidic protein (GFAP) is an established marker of retinal glia and has been shown to be modulated by several cytokines and retinal pathology. The influence of a number of factors, including post‐mortem delay, storage duration and retinal pathology, on the distribution and morphology of macroglia and GFAP antigenicity was examined in human retina. The effects of these parameters on GFAP expression were estimated using immunohistochemistry, confocal microscopy and image analysis. Changes in expression of anti­genicity were analysed in human retinal cryosections at three levels: constitutive, aberrant and total. The results indicated that short‐term and long‐term storage duration had no significant effect on GFAP immunoreactivity at all three levels of expression (P > 0.2).
However, a significant increase in GFAP immunoreactivity and distribution
at all three levels of expression was associated with prolonged
post‐mortem delay (> 30 h) (P < 0.05). This study highlights the importance of rigorous matching of post‐mortem delay between control specimens in histological studies of human retinae. The study further demonstrates the utility of Eye Bank retinae fixed and stored in 2% paraformaldehyde, provided that appropriate controls are applied.
Photographic documentation of spontaneous extrusion of a subconjunctival cysticercus cyst
Authors: Raina Usha Kaul , Jain Shailley , Arora Ritu , Mehta Dinesh Kumar , Sharma Vivek
Published: March 2003

Spontaneous extrusion of a subconjunctival cysticercus cyst is a rare occurrence. The case reported is of a 20‐year‐old man who presented with a subconjunctival cysticercus cyst that was suspected to be undergoing spontaneous extrusion. The eye was photographed as the parasite extruded through the conjunctival opening with undulating movements over 3−4 min.
Optic disc swelling in an adolescent with insulin dependent diabetes mellitus
Authors: Fraser‐Bell Samantha , Capon Malcolm
Published: March 2003

A 14‐year‐old Ukrainian girl with uncontrolled insulin dependent diabetes developed bilateral optic disc swelling when diabetic treatment was instituted. There was no retinal ischaemia. The disc swelling resolved completely over 8 months without specific ocular therapy. Disc swelling in juvenile diabetics must be differentiated from disc neovascularization. These patients may develop retinal ischaemia and neovascularization after the disc changes resolve.
Citation analysis and journal impact factors in ophthalmology and vision science journals
Authors: Sims Joanne L , McGhee Charles NJ
Published: March 2003

Citation analysis has evolved over the last 50 years as one parameter for assessing the quality of research published in scientific, technology and social science journals. This is based on the assumption that influential research is widely cited by other scientists and clinicians. With the advent of the Internet, Journal Citation Reports from the Institute for Scientific Information (ISI‐JCR) have become widely available to individuals and institutions. In an increasingly competitive research environ­ment, aspects of citation analysis have been suggested as simple proxy, objective measures to evaluate the research quality of a journal, published articles, research institutions and even individual researchers. This review article provides an overview of citation analysis, including definitions, uses of these reports, and related controversies and potential abuses. As it has become the most commonly used indicator, there is a particular focus on the use of the Journal Impact Factor (JIF). This is a widely quoted measure indicating the frequency with which the average article published in a journal of interest will be quoted within a specified time frame that therefore allows approximate comparisons of journals within a particular field of interest. Given the relative paucity of information in this area, emphasis is placed on citation analysis within ophthalmology, in particular in regard to the 43 ophthal­mology, vision science and optometry journals that are listed in the ISI‐JCR 2001 reports.
MAGNIFYING RATIO and RESOLUTION OF ELECTRONIC ENDOSCOPES
Authors: Yabe Hisao
Published: March 2003

Olympus has been continuing to improve the resolution of its endoscope with each generation developed, and recently it commercialized highly practical magnifying endoscopes such as GIF‐Q24 0Z and CF‐Q240Z. However, the magnifying ratio and resolution of an endoscope are not defined officially by academic conferences. In addition, there is no united definition agreed among endoscope manufacturers. This document aims to explain the definitions of magnifying ratio, maximum magnifying ratio, resolution, and maximum resolution of electronic endoscopes, based on the definitions used by Olympus.
ENDOSCOPIC SPHINCTEROTOMY: MY METHOD
Authors: Hirata Nobuto
Published: March 2003

In order to perform safe and accurate endoscopic sphincterotomies, it is necessary to master the basic techniques of front face of the papilla and deep cannulation into the bile duct. To perform these techniques an appropriate dose of sedatives is indispensable. Once deep cannulation is achieved, the guidewire should be applied to maintain an access route to the bile duct. There are about 90 types of sphincterotome currently available, which causes difficulty in selecting the proper instrument, although there are fewer guidewire style sphincterotome. At incision, care must be taken not to over energize so as to avoid complications.
STANDARDIZATION OF ENDOSCOPIC ULTRASONOGRAPHY PROCEDURES FOR THE PANCREAS USING RADIAL and CONVEX methods
Authors: Hirooka Yoshiki , Goto Hidemi , Itoh Akihiro , Hashimoto Senju , Hayakawa Tetsuo
Published: March 2003

We describe the standard endoscopic ultrasonography (EUS) procedure of the pancreas used in our institute. Both radial scanning and convex (or linear) scanning methods have valid uses, so these two methods will coexist in the future. Physicians learning EUS need to master both types. It is important to standardize both types of EUS procedure. Generally, physicians persist in the method mastered first and don’t make use of the other method. In order to plan the standardization of EUS procedures, it may be reasonable to standardize the procedures of both type EUS simultaneously, comparing radial scan mode and linear (convex) scan mode. Here we demonstrate our standard procedures for both EUS modes, mainly emphasizing the visualization maneuver of the pancreas.
THE ASSESSMENT OF THE BILIOPANCRATIC ACCESSORIES INVESTIGATION OF THE ENDOSCOPIC FORUM JAPAN
Authors: Maguchi Hiroyuki
Published: March 2003

We carried out the first questionnaire survey about pancreas and biliary endoscopy Japan. The questionnaire was distributed to 19 institutions during the period 4 months and we gathered information from 1193 respondents. The endoscopic approaches to bile duct‐related regions accounted for 81% of all procedures. Therapy accounted for 74% of these. The examination and therapy procedures both achieved a success rate of over 80% The standard type of cannula was the first choice in 52% of endoscopic retrograde pancreatography (ERP) and 45% of endoscopic retrograde cholangiography (ERC). The short taper type (30%) is the second choice in ERP, and the short taper type (26%) and long taper (22%) are the second choice in ERC. EST is currently used in 71% of bile duct stone endoscopies in Japan, where EPBD was thought to be relatively prevalent. Various types (over 30) of sphincterotomes are used and the overall frequencies of guidewire usage are 65%.
Visualization of human gastric ancer with a novel indrared furescent labeling marker of anti‐carcinoembryonic antigen in vitro
Authors: Ito Susumu , Muguruma Naoki , Hayashi Sigehito , Taoka Sotoko , Bando Terumi , Kusaka Yosihiro , Yano Mitsuyasu , Ichikawa Souichi , Hiasa Aya , Omoya Tosihiro , Honda Hirohito , Shimizu Ichiro , Ii Kunio , Nakamura Kazunari , Takesako Kazuhiro , Goto Yosiaki , Shibamura Seiichi
Published: March 2003

Background: An indocyanine green (ICG) derivative (ICG N‐hydroxy sulfo succinimide ester (ICG‐sulfo‐OSu)) as an antibody labeling substance suitable for vital immunohistochemical staining, and an appropriate fluorescence imaging system for ICG‐sulfo‐OSu using infrared (IR) rays has been developed. The aim of this study is to demonstrate the antibody labeling substance at the cancerous tissue using this imaging system.

Methods: ICG‐sulfo‐OSu‐labeled mouse antihuman carcinoembryonic antigen (CEA) monoclonal antibody and the imaging system for an IR fluorescent microscope were employed in this experiment. According to the standardized procedure, paraffin sections of 10 cases of gastric cancer were stained with anti‐CEA antibody by the avidin‐biotinylated peroxidase complex (ABC) method. Three cases of gastric cancer that stained positive were used for the IR imaging analysis.

Results: The incubation of the gastric cancer specimens with ICG‐sulfo‐OSu‐anti‐CEA antibody‐complex resulted in positive staining in the lesion spots. Infrared fluorescence was observed in a well‐matched coincidence of oxidized 3,3′‐diamino‐benzidine tetrahydro‐chloride (DAB)‐positive sites. No chemical luminescence was confirmed in the rest of the neoplastic areas with ICG‐sulfo‐OSu complex.

Conclusion: Specific antibodies with ICG‐sulfo‐OSu have a significant ability to label the cancer cells and reflect sufficient amounts of the fluorescence by IR rays. Therefore, ICG‐sulfo‐OSu is very useful for IR fluorescent endoscopic detection of microcancers by using the immunohistochemical staining method.
Endoscopic ultrasonography and endoscopic retrograde pancreatography in the diagnosis of chronic pancreatitis
Authors: Songür Yildiran , Oğuz Dilek , Gürkaynak Gönül , Demirci Fikret , Şahin Burhan
Published: March 2003

Background: The diagnosis of chronic pancreatitis (CP) in the early stages is often problematic. Endoscopic retrograde pancreatography (ERP), secretin test and computed tomography are not sensitive enough to detect the early stages of CP. The aim of this study was to investigate the features of CP in endoscopic ultrasonography (EUS) in patients with unexplained abdominal pain and/or suspected CP.

Methods: Thirty‐four consecutive patients in whom CP was suspected after reviewing their history, abdominal ultrasonography and upper gastrointestinal endoscopy findings underwent EUS. Endoscopic ultrasonography was performed by an author who was aware of the history but blinded to the ERP results. Nineteen patients underwent ERP. Endoscopic ultrasonography was used to evaluate parenchymal changes (echogenic foci, echo pattern, prominent interlobular septa, lobularity, cyst and cavities) and ductal changes (dilatation, echogenicity of duct wall, irregularity, side branch ectasia, tortuousity).

Results: Nine patients were found to be normal with regard to EUS examination. Abnormal studies for EUS were 25, while for ERP they were 17. The agreement between ERP and EUS was 100% in the 14 patients with moderate and severe disease. The diagnosis of early or mild CP was established with EUS in 11 patients. Endoscopic retrograde pancreatography, which was performed in five of the patient groups with mild disease, was normal in two patients and showed mild changes in three patients.

Conclusions: Endoscopic ultrasonography may contribute to establishing the diagnosis and severity of CP found by ERP. Prospective randomized studies and long‐term follow up of patients are needed in order to determine the role of EUS in the diagnosis of early CP.
Effect of endoscopic treatment of gastric antral vascular extasia associated with chronic liver disease
Authors: Satomi Eriko , Kaneko Akira , Nishimura Yoshiya , Michida Tomoki , Komori Masato , Iyoda Kenya , Sugiyasu Yasunori , Yuki Nobukazu , Yamamoto Keiji , Kurosawa Kazuhei , Kato Michio , Ikeda Masahiro
Published: March 2003

Background: Gastric antral vascular ectasia (GAVE), as a cause of upper gastrointestinal bleeding, has been treated surgically, endoscopically and pharmacologically for the past 20 years.

Methods: We analyzed the clinical effect of endoscopic treatment for 12 cases of GAVE diagnosed at Osaka National Hospital between January 1993 and October 1998.

Results: Eight of the 12 cases were treated endoscopically due to marked anemia and histories of gastrointestinal bleeding. All had chronic liver disease (CLD). Mean age was 69 years on diagnosis. Male to female ratio was 1 : 1. Gastric antral vascular ectasia was a cause of 3.9% of bleeding associated with CLD. The modes of endoscopic treatment of the eight cases were laser photocoagulation (1), electrocautery (3), and heater probe thermocoagulation (4). The initial treatment required an average of 5.1 sessions over a period of 43 days. Initial hemostasis was successful in all cases. Treatments for recurrent bleeding were necessary in six cases within 9.2 months, and endoscopic coagulation was again effective in two cases. Corticosteroids were effective in two of three cases resistant to endoscopic therapy. Mean follow‐up period after initial treatment was 2.8 years. The mean total number of therapeutic endoscopy sessions was 9.6.

Conclusion: Endoscopic treatments and/or corticosteroids have yielded sufficient results in the hemorrhage of GAVE. Factors affecting the recurrence of GAVE need to be analyzed in CLD patients.
RETROSPECTIVE STUDY OF ENDOSCOPIC FINDINGS: 250 CASES OF GASTRIC CANCER
Authors: Hosokawa Osamu , Kaizaki Yasuharu , Nakaya Takakiyo , Hinoshita Tetsuya , Watanabe Kunishige , Douden Kenji , Hayashi Hiroyuki
Published: March 2003

Background: The accuracy of endoscopy for detecting gastric cancer is high but failures may occur if the cancer is not visualized or recognized with gastroscopy. The aim of this study was to understand the reasons why gastroscopy may not detect gastric cancer.

Methods: Patients with gastric cancer (n = 4053) diagnosed between 1979 and 1996 were studied by linking gastroscopic examinations (n = 111 094). Endoscopic records were reviewed in 250 patients who were diagnosed with gastric cancer but had not been diagnosed as such on the examination within the previous 3 years.

Results: In 33 patients (13.2%) gastric cancer was detected at the advanced stage. The percentage of advanced cancer was significantly higher on the cardia and the gastric body than it was on the angulus and the antrum. In 107 patients (42.8%) no lesion was identified after reviewing endoscopic records. In 102 patients (40.8%) marked lesions were present but had not been diagnosed as such. In 41 patients (16.4%) gastric cancer may have been overlooked but due to a lack of photographic documentation in the specific areas, these findings were not confirmed. The percentage of the indeterminate examinations was significantly higher in lesions on the remnant stomach and the cardia than in other areas.

Conclusion: In order to reduce the proportion of the advanced gastric cancer to under 20%, repeated endoscopic examinations were recommended within 2 years even if any suspicious lesions could not be detected by the initial examination.
IMPORTANCE OF THE FISTULA TRACT ANGLE IN FISTULA TRACT DISRUPTION IN PERCUTANEOUS ENDOSCOPIC GASTROSTOMY
Authors: Yokose Yoshihiko , Nishikawa Toru , Sugimoto Yasushi , Takahashi Seiichi , Sakurai Ritsuro
Published: March 2003

Background: The fistula tract angle formed by percutaneous endoscopic gastrostomy (PEG) was examined. Also, the previous literature on fistula tract disruption is reviewed and the possible influence of the fistula tract angle on fistula tract disruption by non‐endoscopic catheter change is discussed.

Methods: A total of 15 patients aged 24–80 years were examined.The fistula tract angle was measured as the angle of elevation between the tangent line at the orifice of the PEG stoma and the longitudinal axis of the catheter.

Results: Values of the angle ranged from 56 to 90° (mean 77.6°), with four cases (27%) having angles below 70°.With one case of pan‐peritonitis after catheter insertion at 90°, laparotomy revealed that the angle of the fistula tract was low at 62° and that the catheter had broken through the tract just below the abdominal wall.

Conclusion: This study suggests that the fistula tract angle might be a potential risk factor for fistula tract disruption by non‐endoscopic catheter change.
Pneumatosis Cystoides Intestinalis Following Steriod Pulse Therapy in a Patient with Polyarteritis Nodosa
Authors: Kohsaki Takuhiro , Nishimori Isao , Taniuchi Keisuke , Miyaji Eiki , Okamoto Nobuto , Morita Masanori , Onishi Saburo , Kohsaki Shino , Fujiwara Yoshimasa , Yoshida Shoji
Published: March 2003

We present a case of a 67‐year‐old female with polyarteritis nodosa, complicated by pneumatosis cystoides intestinalis. The definite diagnosis of polyarteritis nodosa was obtained by histological findings on a biopsy specimen from her sural nerve. Following steroid pulse therapy, she developed gastrointestinal symptoms such as nausea, abdominal fullness and watery diarrhea. Abdominal X‐ray and computed tomography showed an abundance of gas contrast within the large intestinal wall. Colonoscopy revealed submucosal tumor‐like multiple elevated lesions from the sigmoid to transverse colon. These findings indicated pneumatosis cystoides intestinalis and the patient was accordingly treated with a high concentration of oxygen via a nasal catheter. One week later, her symptoms and the gas in the bowel wall completely disappeared. Pneumatosis cystoides intestinalis may be one of the complications of steroid pulse therapy.