bluuebunny/crossref_metadata_2025 huggingface dataset:
A practical protocol to assess impacts of unplanned disturbance: a case study in Tuggerah Lakes Estuary, NSW
Authors: Underwood A. J. , Chapman M. G. , Roberts D. E.
Published: March 2003

Summary Environmental managers are often confronted with unplanned or accidental disturbances that may lead to environmental impacts. Procedures for detecting or measuring the size of such impacts are complicated because of the lack of data available before the disturbance and because of the intrinsic variability of most natural measures. Here, a protocol for detecting impacts is illustrated for single‐measure variables (numbers of individual species) and multivariate measures (relative abundances of invertebrates in assemblages). The present paper describes a case concerning drainage of acidified water into an estuary due to construction of a drainage channel in an area of wetland for which there had been no prior investigations (i.e. no ‘before’ data). The spatial extent of any impact was also unknowable. Sampling was, therefore, designed to allow for impacts of only a few tens of metres (using control sites 50 m from the mouth of the channel) and impacts covering much larger areas (500 m and 1 km from the mouth of the channel). Invertebrates in the mud around the channel and in control sites were sampled in replicated cores and the amount of seagrass in each core was weighed. Average abundances of invertebrate animals and weights of seagrass were compared, as was variation among samples in potentially impacted and control sites (using univariate analyses of variance). Sets of species were compared using multivariate methods to test the hypothesis that there was an impact at one of the scales examined. In fact, there was no evidence for any sort of impact on the fauna or seagrasses; the disturbance was a short‐term pulse without any obvious or sustained ecological response. One consequence of the study was that the local council was able to demonstrate no impact requiring remediation and no penalties were imposed for the unapproved construction of the channel. The implications of this type of study after an environmental disturbance are discussed. The present study identifies the need for clear definition of relevant hypotheses, coupled with rigorous planning of sampling and analyses, so that reliable answers are available to regulators and managers.
Using soil and litter arthropods to assess the state of rainforest restoration
Authors: Nakamura Akihiro , Proctor Heather , Catterall Carla P.
Published: March 2003

Summary The present study investigated recolonization patterns of selected soil and litter arthropods following replanting of pasture with rainforest species in the Mary River catchment of eastern subtropical Australia. While extensive research has been conducted in rehabilitated mined sites in Australian dry sclerophyll forests, very little attention has been paid to rainforest restoration on previously pastoral land. We examined the utility of soil and litter arthropod groups for monitoring the progress of restoration, and the relationship between arthropod assemblage patterns and environmental factors potentially under the control of those doing the replanting. Leaf litter was extracted from 20 sites: five remnant rainforest, five pasture, and 10 sites that had been revegetated (from 1 to 12 years previously) with a diversity of indigenous species. Ants (identified to genus), centipedes, millipedes, isopods, amphipods and mites were enumerated and their assemblages described with multi‐ and univariate methods. Ant genera alone proved unable to distinguish pasture from rainforest, and mites (identified only to oribatid or non‐oribatid) proved of limited use because these two groups were present in all samples in extremely high numbers that overwhelmed the contributions of other arthropod groups. However, a coarse taxonomic approach using five arthropod groups (ants, centipedes, millipedes, isopods, amphipods) clearly discriminated between pasture and rainforest, and also arranged the revegetated sites between these two extremes. Simple frequency scores based on the presence/absence of these arthropod groups in each of three replicate subplots were sufficient to achieve this separation of site types. Habitats created by close planting of trees and mulching may accelerate invertebrate colonization and, thus, promote the rapid establishment of processes and functions characteristic of developing rainforests.
Retinal neurodegeneration: early pathology in diabetes
Authors: Lieth Erich , Gardner Thomas W , Barber Alistair J , Antonetti David A
Published: March 2003

Normal vision depends on the normal function of retinal neurons, so vision loss in diabetes must ultimately be explained in terms of altered neuronal function. However, to date relatively little attention has been paid to the impact of diabetes on the neural retina. Instead, the focus of most research has been primarily on retinal vascular changes, with the assumption that they cause altered neuronal function and consequently vision loss. An increasing body of evidence suggests that alterations in neuronal function and viability may contribute to the pathogenic mechanisms of diabetic retinopathy beginning shortly after the onset of diabetes. This view arises from neurophysiological, psychometric, histopathological and biochemical observations in humans and experimental animals. The collective evidence from past and recent studies supports the hypothesis that neurodegeneration, together with functional changes in the vasculature, is an important component of diabetic retinopathy. The authors invite other investigators to include the neural retina as a component of their studies so that the pathogenesis of diabetic retinopathy can be understood more clearly.
Hypovitaminosis A in metropolitan Adelaide
Authors: Qureshi Salmaan H , Selva‐Nayagam Dinesh N , Crompton John L
Published: March 2003

Hypovitaminosis A is a well‐recognized condition in many developing countries. However, in the developed world the diagnosis is frequently missed or delayed because of its rarity. A 67‐year‐old man from metropolitan Adelaide presented to us with gradual but severe bilateral visual loss. He had marked punctate epithelial keratopathy in both eyes. Hypovitaminosis was suspected because of his bizarre dietary habit, and this was confirmed by a combination of impression cytology of the ocular surface and biochemical testing of his venous blood. His vision responded dramatically to vitamin A supplementation. Hypovitaminosis A should be suspected in severe cases of ‘dry‐eye’, especially in those patients with unusual dietary habit or malabsorption.
Management of diabetic retinopathy by Australian ophthalmologists
Authors: McCarty Cathy A , McKay Rob , Keeffe Jill E ,   the Working Group on Evaluation of the NHMRC Retinopathy Guideline Distribution
Published: March 2003

Objective: To describe current management practices of diabetic retinopathy used by Australian ophthalmologists.

Setting: Two‐page self‐administered questionnaire mailed to 622 ophthalmologists listed with the Royal Australian College of Ophthalmologists.

Methods: The survey included questions about practice details such as size and location; specialty; current practice with regard to management of patients with diabetes; confidence in screening for diabetic retinopathy; and a number of patient scenarios related to screening, follow‐up and treatment of diabetic retinopathy.

Results: Of the 577 eligible ophthalmologists, 475 (82%) completed the questionnaire. They had been practicing ophthalmology between 1 and 50 years (median 16 years) and 89 (19%) indicated that they had a subspecialty interest either in vitreo‐retinal surgery or in medical retina. For 145 (30.5%) of the ophthalmologists, at least one of their practices was located in a country area. The estimated percentage of patients with diabetes ranged from 0.1 to 60% (mean = 9.9%). Retinal specialists perform between 0 and 750 macular focal photocoagulation procedures per year (mean = 94) compared with a range of 0–350 for non‐retinal specialists (mean = 10.3) (t = 6.1, P < 0.001). The ophthalmologists were presented with a hypothetical patient with cataract requiring surgery and clinically significant macular oedema that would be difficult to treat (but not impossible) because of the cataract. Seventy‐seven ophthalmologists (16%) said they would delay the macular laser therapy until after the cataract surgery had been performed. In multivariate logistic regression models, non‐retinal specialists were 4.44 times as likely to perform the cataract surgery first (95%CL = 1.57, 12.6) and ophthalmologists who had been in practice more than 15 years were 2.50 times as likely to perform cataract surgery first (95%CL = 1.47, 4.26). There were other examples of practice that differed from the National Health and Medical Research Council (NHMRC) guidelines in patient scenarios. The majority of ophthalmologists (60%) expressed a moderate or strong need to learn more about the management of diabetic retinopathy.

Discussion: The variability in the management of diabetic retinopathy by Australian ophthalmologists and the desire of ophthalmologists to learn more about diabetic retinopathy provide evidence to support the need for the NHMRC Guidelines for Diabetic Retinopathy. These data will be used to evaluate changes in practice as a result of the implementation of the guidelines.
Operated and unoperated cataract in Australia
Authors: McCarty Catherine A , Nanjan Mukesh B , Taylor Hugh R
Published: March 2003

Purpose: To quantify the prevalence of cataract, the outcomes of cataract surgery and the factors related to unoperated cataract in Australia.

Methods: Participants were recruited from the Visual Impairment Project: a cluster, stratified sample of more than 5000 Victorians aged 40 years and over. At examination sites interviews, clinical examinations and lens photography were performed. Cataract was defined in participants who had: had previous cataract surgery, cortical cataract greater than 4/16, nuclear greater than Wilmer standard 2, or posterior subcapsular greater than 1 mm
2.

Results: The participant group comprised 3271 Melbourne residents, 403 Melbourne nursing home residents and 1473 rural residents. The weighted rate of any cataract in Victoria was 21.5%. The overall weighted rate of prior cataract surgery was 3.79%. Two hundred and forty‐nine eyes had had prior cataract surgery. Of these 249 procedures, 49 (20%) were aphakic, 6 (2.4%) had anterior chamber intraocular lenses and 194 (78%) had posterior chamber intraocular lenses. Two hundred and eleven of these operated eyes (85%) had best‐corrected visual acuity of 6/12 or better, the legal requirement for a driver’s license. Twenty‐seven (11%) had visual acuity of less than 6/18 (moderate vision impairment). Complications of cataract surgery caused reduced vision in four of the 27 eyes (15%), or 1.9% of operated eyes. Three of these four eyes had undergone intracapsular cataract extraction and the fourth eye had an opaque posterior capsule. No one had bilateral vision impairment as a result of cataract surgery. Surprisingly, no particular demographic factors (such as age, gender, rural residence, occupation, employment status, health insurance status, ethnicity) were related to the presence of unoperated cataract.

Conclusions: Although the overall prevalence of cataract is quite high, no particular subgroup is systematically under‐serviced in terms of cataract surgery. Overall, the results of cataract surgery are very good, with the majority of eyes achieving driving vision following cataract extraction.
Modulation of tear film protein secretion with phosphodiesterase inhibitors
Authors: Evans Victoria , Willcox Mark D P , Millar Thomas J
Published: March 2003

A double‐blind randomized clinical study was conducted to determine whether nicardipine hydrochloride was a useful treatment for dry eye. We examined its effect on the tear film, ocular surface and ocular comfort. Nicardipine hydrochloride, 3‐isobutyl‐1‐methylxanthine and pilocarpine hydrochloride were dissolved in an artificial tear vehicle and applied topically to one eye of 12 subjects on separate days. Ocular physiology, ocular comfort and tear volume were assessed. The trial was repeated with nicardipine in an aqueous gel vehicle. Tears were collected and assessed for protein concentration and protein profile, using electrophoresis and mass spectrometry. Nicardipine induced conjunctival redness and symptoms of dryness and irritation. There was no change in total tear protein concentration or volume. An increase in a 68 kDa protein was observed, this was probably due to conjunctival vessel dilation and leakage of albumin. The adverse symptomatology and increased conjunctival redness experienced with nicardipine make it an undesirable treatment for dry eye.
Survey of dry eye symptoms in Australian pilots
Authors: McCarty Daniel J , McCarty Catherine A
Published: March 2003

In 1996, a questionnaire was distributed to 4000 Australian commercial pilots for the quantification of symptoms of dry eye. The 1246 respondents ranged in age from 18–71 years (mean age 40.4 years), and 98.2% were men. Symptoms of dry eye during flight were reported by 901 (72.3%, 95% CI = 69.7–74.8) while only 67 (5.4%, 95% CI = 4.2–6.8) reported dry eye independent of flight. In univariate analyses, the following factors were associated with dry eye in flight: age, use of distance glasses, smoking, average weekly number of flight hours, type of aircraft usually flown, and normal cruising altitude. In a multiple logistic regression model, only the class of aeroplane (large jets vs propeller‐driven planes) (OR = 1.75, 95% CI = 1.34–2.28) and estimated number of flight hours per week (OR = 1.58, 95% CI = 1.34–1.86) were related to dry eye symptoms. In conclusion, self‐reported symptoms of dry eye are common in Australian pilots and are associated with aeroplane class and flying time.
Projected number of Australians with glaucoma in 2000 and 2030
Authors: Rochtchina Elena , Mitchell Paul
Published: March 2003

Accurate Australian glaucoma prevalence has been provided by two population‐based studies: the Blue Mountains Eye Study (BMES) and the Melbourne Visual Impairment Project (MVIP). Both studies defined glaucoma as the presence of matching optic disc cupping with rim thinning and glaucomatous field defects demonstrated on automated perimetry. Combining ‘definite’ and ‘probable’ rates, the glaucoma prevalence in persons aged 50 and over, age‐standardized for the 2000 projected Australian population, was 2.70% (BMES) and 3.13% (MVIP), including rates for ‘definite’ glaucoma of 2.12% (BMES) and 2.50% (MVIP). The number of Australians aged 50 and over in the year 2000 with glaucoma could be estimated as from 144 000 persons (BMES) to 167 000 persons (MVIP). Assuming similar age‐specific rates, the number of Australians aged 50 and over in the year 2030 with glaucoma could be estimated as from 307 000 persons (BMES) to 337 000 persons (MVIP). Ocular hypertension (OH) was defined as present in subjects without glaucoma with intraocular pressure (IOP) of more than 21 mmHg, including treated subjects with ‘normal’ examination IOP. The age‐standardized OH prevalence was 5.15% (BMES), which projects to 275 000 Australians with OH in 2000, increasing to 513 000 in 2030.
An innovation in developing world cataract surgery: sutureless extracapsular cataract extraction with intraocular lens implantation
Authors: Ruit S , Paudyal G , Gurung R , Tabin G , Moran D , Brian G
Published: March 2003

Purpose: The benefits of sutureless cataract surgery have not been available to the majority of developing world patients. This report describes a surgical technique developed to gain the benefits of self‐sealing sutureless techniques, without the need for costly, complex instrumentation, expensive consumables, or difficult nucleus fragmentation manoeuvres in the anterior chamber.

Method: A detailed description of a sutureless technique that uses only standard manual extracapsular cataract extraction instrumentation is presented. The clinical records of 362 consecutive completed sutureless surgeries were reviewed, and preliminary indicative data of visual outcome for those having follow up between postoperative weeks 3 and 8 are also presented.

Results: Hospital and eye camp experience confirms this operation offers speed, routinely 5 min or less with mature cataracts, reduced cost because no suture, viscoelastic or anterior chamber maintainer is needed, wound security and stability, and rapid effective visual rehabilitation. Uncorrected distance visual acuity during the third to eighth postoperative week was available for 266 of the 362 patients (73%): 10, 145, 101, and 10 had acuities of better than 6/9, 6/9–6/18, 6/24–6/60, and worse than 6/60, respectively. Ninety‐seven, 165, 12, and two of the 276 (76%) patients with recorded corrected distance acuity were in the same groups. Comparing postoperative with preoperative corneal astigmatism for each patient with postoperative information available (208), without regard to axis, the amplitude of astigmatism worsened by a mean of 0.94 dioptres (± 0.17, 95% confidence; ± 1.23 standard deviation; 7.5D maximum worsening; 2.5D maximum improvement). No attempt has been made to analyse complication type or frequency in this preliminary report.

Conclusion: The authors believe this sutureless cataract extraction technique to be an innovation with widespread application in the developing world. Further and more exhaustive critical appraisal is warranted.
Diode laser cyclophotocoagulation: longer term follow up of a standardized treatment protocol
Authors: Walland Mark J
Published: March 2003

Background: Diode laser cyclophotocoagulation (cyclodiode) is gaining acceptance as a therapy for refractory or end‐stage glaucoma. The aim of the study was to establish whether a reproducible dose–effect relationship exists following a single standardized cyclodiode treatment to lower intraocular pressure (IOP).

Methods: This paper reports results from a longer‐term follow up of a trial involving the study of 30 patients with uncontrolled IOP and advanced glaucoma who were treated with a single episode of either a half or a full standardized dose of laser depending on clinical risk of phthisis and monitored for IOP control, visual acuity, postoperative inflammation and phthisis.

Results: A lowering of IOP at the final follow up was achieved in 83% of patients, with a mean follow‐up time of 21 months. For patients receiving a full standardized laser dose, preoperative IOP was 49.4 ± 11.2 mmHg (mean ± SD) and postoperative IOP was 28.5 ± 20.0 mmHg (42% reduction); 45% of patients achieved IOP < 22 mmHg and 68% gained an IOP reduction > 30%. For the half treatment cases, the preoperative IOP was 29.4 ± 4.3 mmHg (mean ± SD) and the postoperative IOP was 18.3 ± 10.0 mmHg (38% reduction); 63% of patients achieved IOP < 22 mmHg and 50% gained an IOP reduction of > 30%. Of 22 sighted eyes, nine (41%) recorded no change in vision; and nine (41%) lost and four (18%) gained vision. Hypotony was seen in 4/22 (18%) of full standardized laser dose cases.

Conclusion: Longer follow‐up times confirm that diode laser cyclophotocoagulation is a convenient and useful therapy in the control of IOP in end‐stage glaucoma. Response of IOP to the laser therapy is highly variable, particularly in the neovascular glaucoma group, and it does not appear to be possible to predict an IOP outcome for an individual eye. Circumferential treatments in neovascular eyes should be avoided. Prospects for long‐term vision retention in end‐stage eyes are poor, perhaps due to progression of the underlying disease.
Contrast sensitivity following focal laser photocoagulation in clinically significant macular oedema due to diabetic retinopathy
Authors: Talwar Dinesh , Sharma Namrata , Pai Anant , Azad Raj Vardhan , Kohli Anupama , Virdi Prem S
Published: March 2003

Purpose: To evaluate the influence of focal laser photocoagulation on contrast sensitivity in diabetic patients with clinically significant macular oedema (CSMO).

Methods: A prospective non‐comparative interventional study was performed on a group of patients with CSMO at Dr Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, a tertiary eye care centre. Thirteen diabetic patients (14 eyes) with CSMO and no history of prior photocoagulation were recruited for this study. Direct focal photocoagulation of all leaking microaneurysms was performed using an argon green laser (514 nm). A contact lens was used as a slit lamp delivery system. Evaluation of the best corrected Snellen visual acuity, contrast sensitivity, slit lamp biomicroscopy, macular status on direct ophthalmoscopy and fluorescein angiography was carried out 1 month and 3 months after laser photocoagulation.

Results: Following direct focal laser photocoagulation, focal CSMO resolved completely in all but one eye, 4–8 weeks later, as seen on slit lamp biomicroscopy and/or fluorescein angiography. Post‐treatment, visual acuity remained stationary in eight eyes, improved by one line in three eyes, by two lines in two eyes and by three lines in one eye. The mean ± SD pretreatment and post‐treatment decimal visual acuities were 0.49 ± 0.30 and 0.59 ± 0.28, respectively. The mean ± SD pre‐laser contrast sensitivity score was 121.3 ± 83.6, which increased significantly to a mean ± SD of 151.6 ± 80.5 following direct focal photocoagulation.

Conclusion: Focal argon laser photocoagulation in CSMO in diabetics helps in improving the contrast sensitivity and stabilizes the visual acuity. The changes in contrast sensitivity and visual acuity are independent of each other.
Transforming growth factor‐β1 induces α‐smooth muscle actin expression and fibronectin synthesis in cultured human retinal pigment epithelial cells
Authors: Stocks Shelli Z , Taylor Steve M , Shiels Ian A
Published: March 2003

Background: Proliferative vitreoretinopathy is a serious complication of retinal detachment, yet its pathogenesis is not fully understood. Retinal pigment epithelial cells and glial cells are found in the fibrous membranes in proliferative vitreoretinopathy. Many cytokines are involved in the pathology. Transforming growth factor (TGF)‐β1, a cytokine found in serum, has been shown to be an important factor regulating the synthesis of fibrous extracellular matrix in proliferative vitreoretinopathy.

Methods: Cultured human retinal pigment epithelial cells were used in the experiments. The effects of TGF‐β1 on phenotype and function in retinal pigment epithelial cells were recorded as changes in the expression of α‐smooth muscle actin and fibronectin synthesis using immunohistochemistry and enzyme‐linked immunosorbent assay, respectively.

Results: TGF‐β1 induced the expression of α‐smooth muscle actin (P < 0.0001, n = 3), and significantly increased the synthesis of fibronectin by cultured human retinal pigment epithelial cells (P < 0.01, n = 4).

Conclusions: Elevated levels of TGF‐β1 in proliferative vitreoretinopathy may contribute to phenotype changes in retinal pigment epithelial cells leading to matrix deposition and contraction. Since the elevated levels of TGF‐β1 may emanate from a number of diverse sources in proliferative vitreoretinopathy, developing an antagonist to TGF‐β1 may offer an approach to the treatment of proliferative vitreoretinopathy.
The increasing prevalence of myopia: implications for Australia
Authors: Rose Kathryn , Smith Wayne , Morgan Ian , Mitchell Paul
Published: March 2003

Myopia is often regarded as a minor priority in public health research, yet the public health costs of myopia are considerable, both due to the costs of optical correction and from the costs imposed by the morbidity resulting from myopia in terms of associated eye disease (glaucoma, posterior subcapsular cataract), and the visual impairment and blindness that can result from myopia due to myopic retinal degeneration and retinal detachment. There is clear evidence for a high and increasing prevalence of myopia in East Asia, apparently driven by increasing educational pressures and urbanization. Data from the USA, Europe and Australia are consistent with the data from Asia in terms of the role of these risk factors. However, the evidence for an increasing prevalence of myopia is more problematic, due to the lack of adequate longitudinal studies, and the confounding effects of age‐related hypermetropization. It is concluded that the prevalence of myopia is probably increasing in Australia, although the changes are of much lower magnitude than in East Asia. Longitudinal studies are, therefore, clearly required to quantify changes in the prevalence of myopia in Australia, for accurate assessment of the public health impacts and to assist with the development of preventive approaches.
Production of N‐acyl homoserine lactones by Gram‐negative bacteria isolated from contact lens wearers
Authors: Zhu Hua , Thuruthyil Sophy J , Willcox Mark DP
Published: March 2003

The purpose of this study was to investigate the production of N‐acyl‐homoserine lactone (AHL) signal molecules in ocular Gram‐negative bacteria. A total of 91 ocular strains isolated from contact lens adverse response patients and asymptomatic subjects were used in the study. These included Acinetobacter, Aeromonas hydrophila, Escherichia coli, Haemophilus influenzae, Klebsiella oxytoca, Pseudomonas aeruginosa, Serratia liquefaciens, Serratia marcescens, and Stenotrophomonas maltophilia. The biosensor strains Chromobacterium violaceum mutant CV026 and Agrobacterium tumefaciens A136 were used for detection of AHL signal molecules. The majority of A. hydrophila, P. aeruginosa, and S. liquefaciens strains produced more than one AHL molecule. Serratia marcescens strains were AHL positive only under detection of A136. The rest of the test species did not show any AHL production under the current detection system. These findings indicate that AHL‐ mediated quorum‐sensing systems are present in some of the ocular bacteria, and the different signal molecules may be involved with the quorum‐sensing pathway in the other bacterial species.
Posterior subtenon injection of corticosteroids using polytetrafluoroethylene (PTFE) intravenous cannula
Authors: Venkatesh Pradeep , Garg Satpal P , Verma Lalit , Lakshmaiah Nevratti C , Tewari Hem K
Published: March 2003

Injection of corticosteroids into the posterior subtenon space is a well established and highly effective modality in the treatment of intermediate uveitis. The conventional technique of posterior subtenon injection involves the use of a sharp tipped 26‐gauge, 5/8 inch needle that must be inserted up to its hub to obtain adequate placement of the drug into the posterior subtenon space. With this technique the risk of perforation of the globe, although minimal, remains a potential complication. Herein is described a new technique for injection of corticosteroids into the posterior subtenon space using an intravenous cannula made of polytetrafluoroethylene (PFTE) that allows safer delivery of the drug into the pos­terior subtenon space.
Endophthalmitis
Authors: Elder Mark J , Morlet Nigel
Published: March 2003

Australia and New Zealand continue to be at the forefront of endophthalmitis research. In this Clinical Controversy, an ophthalmologist from each country presents different approaches to the management of a 72‐year‐old patient with routine endophthalmitis following cataract surgery. Mark Elder concludes that this case needs aqueous and vitreous aspirates for culture and the initial treatment of choice is intracameral vancomycin and amikacin. The evidence for intravitreal steroids is equivocal. Systemic antibiotics are indicated if there is a possibility of a bacterial biofilm present on the intraocular lens. Nigel Morlet concludes that timely intervention with appropriate antibiotics delivered in the right concentration to the vitreous cavity is the crux of successful management of endophthalmitis. Aggressive treatment of the inflammatory response is also required to further reduce the damage to the intraocular structures. Both ophthalmologists agree that vit­rec­tomy is not necessarily the most appropriate treatment option.
Orbital abscess following uncomplicated phacoemulsification cataract surgery
Authors: Irvine Fiona , McNab Alan A
Published: March 2003

The case is presented of an 80‐year‐old woman who developed an orbital abscess after undergoing routine phaco­emulsification cataract surgery to her right eye. She was treated by drainage via an anterior orbitotomy and a sensitive Staphylococcus aureus was cultured. The presenting signs and symptoms resolved and final visual acuity was 6/9 in the right eye. One possible aetiology was the introduction of skin flora to orbital tissues during the peribulbar administration of local anaesthetic for the cataract surgery. Alternatively, secondary haemorrhage with secondary infection may have occurred.
Randomized clinical trial of the efficacy and safety of tropicamide and phenylephrine in preoperative mydriasis for phacoemulsification
Authors: Lam Philip TH , Poon Betty TM , Wu Wai‐Kwan , Chi Stanley CC , Lam Dennis SC
Published: March 2003

Purpose: To compare the mydriatic effect and safety between different concentrations of tropicamide and phenyle­phrine in preoperative mydriasis for phaco­emulsification.

Methods: Two hundred and seventeen consecutive eyes in the same number of Chinese patients undergoing phaco­emulsification under local or topical anaesthesia in a university‐based eye hospital were analyzed. Patients were randomized into two groups by cluster randomization, each group receiving a different preoperative mydriatic regimen. Regimen A consisted of tropicamide 1.0% with phenylephrine 2.5%, and Regimen B consisted of tropicamide 0.5% with phenylephrine 0.5%. The main outcome measures were horizontal pupillary diameter, systolic, diastolic and pulse pressure and pulse rate.

Results: The group who received Regimen A attained a mean horizontal pupillary diameter of 7.00 ± 1.06 mm. Their pupils were significantly larger than those receiving Regimen B (6.61 ± 1.03 mm, P = 0.007). No untoward cardiovascular effects were noted in either groups.

Conclusion: Regimen A attained better preoperative mydriasis for phacoemulsification than Regimen B. Both regimens were safe with regard to their cardiovascular effects. The combination of tropicamide 1.0% and phenylephrine 2.5% is recommended as preoperative mydriatic for phacoemulsification in Chinese patients who have darkly pigmented irides.
Effects of intracameral lidocaine on ocular tissues
Authors: Atilla Huban , Tekeli Oya , Can Belgin , Karel Fatih , Saran Yüksel
Published: March 2003

Purpose: To investigate the ultrastructural changes in iris and corneal tissue induced by intracameral 1% lidocaine infusion applied during lens extraction in a rabbit model.

Methods: The study was conducted using New Zealand rabbits. Eight rabbits received 0.2 mL 1% lidocaine hydrochloride intracamerally and lens extraction was performed, keeping the posterior capsule intact. After lens extraction, cornea and iris tissue samples were obtained for electron microscopy. Eight eyes were included as a control group.

Results: Electron microscopy revealed morphological abnor­malities in both cornea and iris of the lidocaine injected eyes, different from the control group. Cytoplasmic vacuolization, phagosomes and residual bodies were observed in epithelial cells. Corneal fibroblasts contained fluid‐filled vacuoles, which could be due to the influx of water into the cells as a result of corneal endothelial damage. Mitochondrial swelling and residual bodies were also seen in the cytoplasm of fibroblasts. Blood vessels in the iris contained fluid material composed of fibrin and proteinaceous material and many vacuoles showed vascular endothelial injury.

Conclusion: Even a short period of exposure of intra­cameral lidocaine to the ocular tissues can induce histo‐logical changes that may result in functional defects.
MAGNIFYING COLONOSCOPIC FINDINGS BY ADAPTED INDEX OF HEMOGLOBIN ENHANCEMENT IMAGE PROCESSING SYSTEM IN ULCERATIVE COLITIS
Authors: Saitoh Yusuke , Fujiya Mikihiro , Watari Jiro , Kohgo Yutaka
Published: March 2003

In order to elucidate whether the adapted index of hemoglobin (IHb) enhancement image processing system is useful in the evaluation of ulcerative colitis, we retrospectively compared the conventional and adapted IHb processed images in a total of 109 images. These were composed of 49 conventional and 60 magnifying images in 26 patients with ulcerative colitis (UC). Using the adapted IHb enhancement image processing system, 15 of 26 cases (55 of 109 images) were judged as ‘informative’ and the others (11 of 26 cases; 54 of 109 images) were judged as ‘not informative’. On further analysis, almost all the images judged as ‘informative’ by adapted IHb enhancement enabled the easily detection of the enhanced capillary or transparencies of submucosal vessels with the combination use of magnifying colonoscopy. The major reason an image was judged as ‘not informative’ were too much halation, too much contrast and no differences between processed images and the original ones. Further prospective analysis will be required in the evaluation of adapted IHb color enhancement image processing system in the evaluation of UC.
COLOR ENHANCEMENT IN COLONOSCOPY MAY BE EFFECTIVE FOR DETECTION OF SUPERFICIAL TYPE COLORECTAL TUMORS
Authors: Shimizu Seiji
Published: March 2003

The possible roles of a newly developed color enhancement modality (Olympus Optical Co., Tokyo, Japan) in the diagnosis of superficial colorectal tumors are described based on my experience. Color enhancement was considered useful for recognizing the existence and extent of lesions without abrupt level difference. The effectiveness was remarkable for lesions that are slightly reddish by ordinary observation; however, it is also very useful for isochroous ones. The real significance of color enhancement is considered to be that it can facilitate the detection of superficial type tumors. A prospective study in a large series is necessary to elucidate whether this modality is truly useful for the detection of superficial type lesions.
A CASE OF GASTROINTESTINAL STROMAL TUMOR OF THE STOMACH WITH IMMUNOHISTOCHEMICAL CHARACTERISTICS OF GASTROINTESTINAL AUTONOMIC NERVE TUMOR
Authors: Shimada Shinya , Nakano Shogo , Inoue Kotaro , Tsuruta Junji , Iyama Ken‐Ichi , Ogawa Michio
Published: March 2003

The case of a 95‐year‐old Japanese female with a giant intramural tumor located in the upper third of the stomach is reported. A preoperative study using an endoscopic examination and gastrointestinal series revealed a large submucosal tumor with a deep concavity in the center of the surface accompanied by continuous bleeding. The tumor was removed by a minimal laparotomy instead of laparoscopic surgery because of its large size (8 × 7 × 6 cm). Its tissues were sampled, and examined by light microscopy, immunohistochemistry and electron microscopy. The tumor was vaguely encapsulated but had foci of partial infiltration of the capsule. It was comprised of spindle cells with severe nuclear pleomorphism. The mitotic count was four per 50 high‐power fields. The tumor was stained strongly positive for vimentin, CD 34 and c‐Kit, and weakly positive for neuron‐specific enolase; had fine granular cytoplasmic stainings for synaptophysin; and was negative for cytokeratins, smooth muscle actin and S‐100 protein. These immunohistochemical results strongly suggest that this tumor was a gastrointestinal autonomic nerve tumor (GANT); the ultrastructural findings, however, had no electron microscopic characteristics of the GANT.
CHANGES IN AUTONOMIC NERVOUS ACTIVITY DURING COLONOSCOPY USING SPECTRAL ANALYSIS OF HEART RATE VARIABILITY
Authors: Tezuka Kazuhiro , Nomura Masahiro , Saito Ken , Takeuchi Yoshikazu , Torisu Ryusuke , Yano Mitsuyasu , Nakaya Yutaka , Ito Susumu
Published: March 2003

Background: Cardiac events are known to occur during colonoscopic procedures. In order to clarify the changes in autonomic nervous activity during colonoscopy, the circulatory dynamics were examined by spectrum analysis and by observing 1/f fluctuations of heart rate.

Methods: The study group consisted of 39 subjects who underwent total colonoscopy (the TC group) and 46 subjects who underwent sigmoid colonoscopy (the SC group). Autonomic nervous function was assessed by analyzing the spectral analysis and 1/f fluctuation of the heart rate.

Results: In the TC group, high‐frequency spectral power (HF power; 0.15–0.40 Hz), which reflects parasympathetic activity, was decreased during the early stages of the examination compared with that before endoscopy, and it significantly decreased during the late stages of the examination. There were no significant changes in the SC group. However, low‐frequency power (LF power; 0.04–0.15 Hz) and the LF/HF ratio both increased during the examination in both groups, suggesting increased sympathetic tone. The 1/f fluctuations were analyzed as the averaged regression lines and as that which related the log amplitude to the log frequency of spectra. The slopes of the regression line of 1/f fluctuations in the TC and SC groups had a tendency to approach zero during the colonoscopic procedure.

Conclusion: These results indicate that the endoscopic procedure is stressful for patients. Total colonoscopy may more readily cause changes in the circulatory dynamics than does sigmoid colonoscopy. Increased blood pressure, arrhythmia and ST depression were also observed. These findings suggest that changes in autonomic nervous activity during colonoscopic procedure may cause cardiac accidents such as the appearance of fatal arrhythmia and acute myocardial infarction.
RECENT PROGRESS IN ENDOSCOPY‐BASED DIAGNOSIS OF HELICOBACTER PYLORI INFECTION
Authors: Sato Tadashi , Fujino Masayuki A , Kitahara Fumiaki , Abdullah Murdani
Published: March 2003

Numerous invasive and non‐invasive tests are available in the detection of Helicobacter pylori. Endoscopy‐based tests that include rapid urease test, histological examination and culture are important generally in the assessment of H. pylori status before eradication therapy. Recently, several new endoscopy‐based diagnostic methods have been developed aiming at rapid and accurate detection of the organisms. It would be possible to diagnose H. pylori infection in treated patients by using these new highly sensitive tests. Although the diagnosis of H. pylori infection itself is possible by using non‐invasive diagnostic tests, endoscopy‐based tests provide not only the diagnosis of the organisms, but also the exclusive information such as treatment indications and the susceptibility for the antimicrobial drugs. Recently, new triple therapy including clarithromycin has been widely performed in Japan. Along with an increase in the prevalence of the antibiotic‐resistant strains, culture may become a more important diagnostic method in the future. The inappropriate application of the tests may increase the potential risk of the misdiagnosis and the treatment failures. The diagnostic method should be selected by taking into account the circumstances in which a diagnosis is to be performed.
Diagnosis of multiple submucosal cysts of the stomach by endoscopic ultrasonography
Authors: Ohtsuka Hiroyuki , Ikeda Masahiro , Morozumi Atsuro , Kitahara Fumiaki , Kubo Katuhiro , Sato Tadashi , Nakamura Toshiya , Kojima Yuichiro , Abdullah Murdani , Fujino Masayuki A
Published: March 2003

Background:

The association of multiple submucosal cysts (MSC) of the stomach with gastric carcinoma has attracted clinical and pathological attention. The aim of the present study was to evaluate the diagnostic ability of endoscopic ultrasonography (EUS) for MSC and to investigate the relationship between MSC and gastric carcinoma.

Methods:

Six hundred and one patients with variable gastric diseases were examined by EUS. We used two ultrasound endoscopes (GF‐UM2 or GF‐UM3; Olympus, Tokyo, Japan) with either a 7.5 or 12 MHz probe and examined MSC using the water repletion method. Stomachs resected for gastric carcinoma were examined histologically.

Results:

Endoscopic ultrasonography was able to identify submucosal cysts as echo‐free round masses in the submucosal layer when the cysts were larger than 2 mm in diameter. Of 601 patients with variable gastric diseases, 16 (2.7%) were diagnosed with MSC. Twelve of these cases were accompanied with gastric carcinoma and MSC was histologically confirmed in 11 cases after surgical resection. The frequency of MSC detected by EUS was 4.7% (10/215) of early gastric carcinomas, 1.1% (2/185) of advanced gastric carcinomas and 2.1% (4/195) of other gastric diseases without gastric carcinoma. Six cases were a postoperative recurrence of gastric carcinoma. Only 25% (4/16) of MSC gave rise to endoscopic findings of submucosal tumor(s). Most MSC were distributed in the gastric body and the cysts were located beneath or adjacent to the carcinoma in approximately half the MSC cases accompanied by gastric carcinoma.

Conclusions:

Endoscopic ultrasonography provides information in the clinical diagnosis of MSC with regard to the existence and distribution of the cysts and the locational relationship between MSC and gastric carcinoma.
Endoscopic evaluation of reconstruction after proximal gastrectomy for cancer: Gastric tube versus jejunal interposition
Authors: Kakisako Kenji , Tamura Yoichi , Katsuta Takeshi , Kai Tetsuji , Tanimura Hideyuki , Kaketani Kazutoshi , Adachi Yosuke , Kitano Seigo
Published: March 2003

Background:

Since 1997, we have introduced proximal gastrectomy and gastric tube reconstruction for patients with small or superficial cancer of the gastric cardia. The aim of the present study was to present our experience with proximal gastrectomy in these patients and to assess the usefulness of this technique.

Methods:

We studied 12 patients who underwent proximal gastrectomy for cancer of the gastric cardia at the Koga Hospital. The mode of anastomosis was gastric tube reconstruction (n = 8) or jejunal interposition (n = 4). Clinical and endoscopic findings were evaluated with special reference to the reflux esophagitis.

Results:

Operation time for gastric tube reconstruction was significantly shorter than that for jejunal interposition (234 vs 359 min, respectively; P < 0.01). Although one patient with jejunal interposition experienced dysphagia and vomiting, no patient with gastric tube reconstruction had such symptoms. Endoscopy showed that one symptomatic patient with jejunal interposition and one asymptomatic patient with gastric tube reconstruction had esophagitis. The remaining patients were free from esophagitis on endoscopy and all patients were alive without recurrence.

Conclusion:

In patients with proximal gastrectomy, surgical and endoscopic results were satisfactory after gastric tube reconstruction. Because the procedure is simple and safe, this technique is the treatment of choice for early proximal gastric cancer.
Diagnostic usefulness of laparoscopic fine‐needle aspiration for intraductal papillary tumor of the pancreas
Authors: Akagi Tomonori , Sasaki Atsushi , Bandoh Toshio , Matsumoto Toshifumi , Aramaki Masanori , Kawano Katsunori , Kitano Seigo
Published: March 2003

A 67‐year‐old man who was followed up for 20 years for a diagnosis of chronic pancreatitis developed a unilocular cystic lesion in the pancreatic body and a gallstone. The cystic lesion (3.0 cm in diameter) was considered to be a pseudocyst with suspicion of a mucinous cystic tumor. Laparoscopic ultrasonography and fine‐needle aspiration (FNA) were performed following laparoscopic cholecystectomy. Under laparoscopic observation, the pinhole puncture was immediately closed. Analysis of the fluid revealed clusters of epithelial cells with mild atypia, remarkably elevated tumor markers (carcinoembryonic antigen and CA19‐9) and a K‐ras oncogene mutation. Distal pancreatectomy was performed 3 months after laparoscopic FNA and the pancreatic mass was diagnosed as an intraductal papillary tumor. The patient’s postoperative course was uneventful and he continues to do well without signs of recurrence. Laparoscopic FNA appears useful and safe for the diagnosis of cystic masses in the pancreas.
Primary gastric lymphoma with arterial bleeding
Authors: YABUKI KIYOTAKA , MAEKAWA TAKEO , SATOH KOICHI , TAMASAKI YOSHIHISA , MAEKAWA HIROSHI , KUDO KEIZO , KAWA IKUKYO , WADA RYO , MATSUMOTO MICHIO
Published: March 2003

We experienced a case of primary gastric lymphoma with arterial bleeding. The case was an 88‐year‐old‐man who was admitted to our hospital with hematemesis. Gastroduodenal endoscopy revealed a gastric ulcerating tumor with arterial bleeding in the posterior wall of the angular gastric region, and a distal subtotal gastrectomy with lymph node dissection was performed. The resected tumor measured 7.0 × 3.0 cm in size with a blood vessel visible in the bottom of the ulcer. Pathologic examination confirmed a diagnosis of B‐cell malignant lymphoma of the diffuse large cell type. Metastasis was detected in nos 3 and 5 lymph nodes. According to the Ann Arbor and Naquvi classifications, the lymphoma was stage IIE and II, respectively. One year and 10 months after the operation, a computed tomography scan revealed a few swollen lymph nodes around the abdominal aorta. Recurrence of lymphoma was confirmed and chemotherapy comprising cyclophosphamide, doxorubin, vincristine and predonisolone was given at half the ordinary adult dose.
Strongly acidic electrolyzed water: valuable disinfectant of endoscopes
Authors: SAKURAI YUKIHIRO , OGOSHI KAZUEI , OKUBO TAKASHI , KAKU MITUO , KOBAYASHI INTETSU
Published: March 2003

Background: Glutaraldehyde (GA) is currently considered to be the best disinfectant for endoscope disinfection. However, GA poses high risks for medical staff involved in the process and also to the environment. Strongly acidic electrolyzed water (SAEW) has been recently re‐evaluated for its potent bactericidal effect and environmental safety.

Methods: Through the aspiration channel of the scopes, upper GI endoscopes and colonoscopes were experimentally contaminated with Pseudomonas aeruginosa, Mycobacterium
avium and hepatitis B surface antigen positive blood. Four disinfection methods were tested: manual washing only, soaking in 3% GA for 5 and 10 min, and a 10‐s soak in SAEW with 50 or 100 mL of aspiration.

Results: Direct plating culture was positive for Pseudomononas contamination after
manual washing only (1/5) and after a 5‐min soak in 3% GA. Complete disinfection,
confirmed by enrichment culture and polymerase chain reaction (PCR) of Pseudomonas
and hepatitis B surface antigen positive blood on the contaminated upper GI endoscope
was obtained after a 10‐min soak in GA and after using SAEW (0/5). Mycobacterum
avium are rather resistant against SAEW as determined by broth culture and PCR (1/5).

Conclusion: Strongly acidic electrolyzed water is a valuable disinfectant for endoscopes.