bluuebunny/crossref_metadata_2025 huggingface dataset:
Induced posterior vitreous detachment by intravitreal sulfur hexafluoride (SF6) injection in patients with nonproliferative diabetic retinopathy
Authors: Ochoa‐Contreras Daniel , Delsol‐Coronado Lizett , Buitrago Mauricio E. , Velasco‐Barona Cecilio , Quiroz‐Mercado Hugo
Published: March 2003

Purpose: To induce posterior vitreous detachment (PVD) in patients with non‐proliferative diabetic retinopathy (NPDR) by injecting an intravitreal gas bubble of SF6 and to compare the evolution of the diabetic retinopathy between eyes with gas induced PVD and non‐injected eyes without PVD.

Methods: An intravitreal gas bubble of SF6 was injected via the pars plana in twelve eyes of twelve patients with NPDR and no previous PVD. Subsequent clinical, ultrasonographic and angiographic controls were performed to evaluate the development of PVD and progression of the disease.

Results: All gas‐injected eyes developed PVD. All eyes with induced PVD (treatment group) remained stable without progression of the retinopathy after 2 years of follow up. In the control group (contralateral eyes without PVD), two eyes (16.6%) progressed to proliferative diabetic retinopathy (PDR) (p=0.23); five (41.6%) showed progression to more severe stages of NPDR (p=0.01) and another 41.6% of such eyes remained stable.

Conclusions: Intravitreal SF6 injection induced PVD in all eyes of our study without undesirable side effects. Further studies are necessary to make conclusions regarding the correlation between the presence of induced PVD and the progression of diabetic retinopathy.
Direct silicone intubation using Nunchaku‐style tube (NST‐DSI) to treat lacrimal passage obstruction
Authors: Inatani Masaru , Yamauchi Tomofusa , Fukuchi Masaru , Denno Sachiko , Miki Masaki
Published: March 2003

Purpose: To confirm the usefulness of direct silicone intubation using a Nunchaku‐style tube (NST‐DSI) for the treatment of lacrimal passage obstruction.

Methods: Included in this retrospective study were 54 cases (45 patients) of adult‐onset lacrimal passage obstruction on which NST‐DSI was performed. The cases were subdivided into two groups: 29 cases of common canalicular obstruction (the canalicular obstruction group) and 25 cases of nasolacrimal duct obstruction (the duct obstruction group).

Results: At the final examination, irrigating fluid passed readily through the lacrimal passage in 39 (72.2%) of the 54 cases. Twenty‐two cases (75.9%) were successful in the canalicular obstruction group (29 cases) whereas 17 cases (68.0%) were successful in the duct obstruction group (25 cases).

Conclusion: NST‐DSI is an effective alternative to treat both common canalicular obstruction and nasolacrimal duct obstruction. We regard NST‐DSI as the first choice for the treatment of lacrimal passage obstruction.
The cost of cataract patients awaiting surgery
Authors: Stenevi Ulf , Lundström Mats , Thorburn William
Published: March 2003

Purpose: To describe the cost for society services caused by the patients awaiting surgery for one year in Gothenburg, 1997.

Methods: From a waiting list of 1458 patients awaiting cataract surgery 250 randomly selected patients were interviewed. The structured questions focused on community services, such as home help, subsidised travel by taxi, medical treatment at home, visual aids, hospital stay and medical consultation, caused by the cataract symptoms.

Results: The total cost for the community for the 1 458 patients awaiting surgery was an estimated SEK 5 200 000. Hospital stay and home help were the largest parts of this community expense.

Conclusion: The direct costs for society for one year caused by 1 458 patients awaiting cataract surgery with a mean waiting time of 9.8 months was approximately the same as operating 800 patients (eyes).
An Evaluation of Onset and Duration of Action of Patanol® (Olopatadine Hydrochloride Ophthalmic Solution 0.1%) Compared to Claritin® (Loratadine 10 mg) Tablets in Acute Allergic Conjunctivitis in the Conjunctival Allergen Challenge Model
Authors: Abelson Mark B. , Welch Donna L.
Published: March 2003

Purpose: To compare the clinical efficacy of Patanol® (olopatadine hydrochloride ophthalmic solution 0.1%) to Claritin® (loratadine 10 mg) tablets, in the conjunctival allergen challenge model.

Methods: This was a randomized, double‐masked, single center, contralateral controlled, antigen challenge model study. The concentration of allergen that elicited a positive response was determined at Visits 1 and 2 (itching ≥2 and redness ≥2 OU). At Visit 3, 29 subjects were randomized into two groups. Fifteen subjects received Claritin® tablet and Patanol® ophthalmic solution 0.1% in one eye and placebo in the contralateral eye. Fourteen subjects received placebo tablet and Patanol® in one eye and placebo in the contralateral eye. One hour after drug administration, subjects were challenged with the antigen that elicited a positive response. At 3, 7, and 10 minutes, itching was subjectively evaluated. At Visit 4, the same procedure was followed as in Visit 3, but antigen challenge occurred 8 hours after drug instillation.

Results: Results were analyzed by eye. Eyes treated with Patanol® (concomitant with placebo tablet) had significantly lower ocular itching scores when compared to eyes treated with placebo (concomitant with Claritin®) at 3, 7 and 10 minutes in the onset of action evaluation (p<0.05). Eyes treated with Patanol® (concomitant with placebo tablet) had significantly lower ocular itching scores at 7 minutes and there was a statistical trend (0.05<p<0.1) at 10 minutes in duration of action evaluation.

Conclusions: Patanol® therapy was significantly more efficacious than Claritin® in reducing ocular itching related to allergic conjunctivitis.
Transpupillary thermotherapy as an adjunct to ruthenium plaque radiotherapy for choroidal melanoma
Authors: Seregard Stefan , Landau Irène
Published: March 2003

ABSTRACT. Purpose: To review the Swedish experience using transpupillary thermotherapy (TTT) as an adjunct to ruthenium plaque radiotherapy for choroidal melanoma.

Methods: A retrospective chart review of 27 patients receiving TTT for juxtapapillary or juxtafoveal growth present at the time of diagnosis, or recurrent growth at the tumour margin, or significant exudation following ruthenium brachytherapy for choroidal melanoma.

Results: Follow‐up ranged from 6 to 29 months (median=20 months). Tumour growth regressed completely (n=8), regressed partially (n=11), remain unchanged (n=6) or progressed (n=2). Complications included focal lens opacity with or without associated posterior synechiae (n=3), retinal haemorrhage (n=2) and retinal vein occlusion (n=1). Seventeen patients (63%) maintained or improved visual acuity and 2 eyes were enucleated following combined treatment.

Conclusion: Many of the treated eyes would have been enucleated in the past, suggesting that TTT used in combination with ruthenium brachytherapy improves the short term globe salvage rate. Ocular side effects do occur but are usually not significant.
The effect of early steroid treatment after PRK on clinical and refractive outcomes
Authors: Vetrugno Michele , Maino Anna , Quaranta Grazia Maria , Cardia Luigi
Published: March 2003

ABSTRACT. Purpose: To evaluate the effects of steroid treatment administered in the first days after excimer laser keratectomy (PRK) on re‐epithelialization time, postoperative pain, haze and refractive outcome.

Methods: A randomised, double masked trial was carried out on two groups of patients (40 patients each), who underwent PRK. Group A (steroid group) received 0.1% fluorometholone acetate whereas group B (NSAID group) received 0.5% ketorolac tromethamine until re‐epithelialization was completed. Subsequently, all 80 patients received the same steroid treatment: 0.1% fluorometholone acetate for myopic corrections up to −5 D, or dexamethasone for myopic corrections exceeding –5 D. Both drugs were tapered off over approximately 3 months. Follow‐up examinations were planned at 1, 3, 6, 12 months after surgery.

Results: Re‐epithelialization was completed after three days, without any significant difference between groups. A higher hyperopic shift was shown in the steroid group and a more severe regression was reported in the NSAID group (p<0.001). Haze was significantly reduced in the steroid group (p=0.005), especially for myopic corrections over −5 D (p=0.015). Pain was significantly reduced in the NSAID group (p=0.002).

Conclusion: Steroid eyedrops administered in the first days after PRK did not affect re‐epithelialization time. Moreover, a modulation of the inflammatory response in this period appears to reduce haze and myopic regression in high myopic patients.
Epidemiology of endogenous uveitis in north‐eastern Italy. Analysis of 655 new cases
Authors: Mercanti Andrea , Parolini Barbara , Bonora Adriana , Lequaglie Quintino , Tomazzoli Laura
Published: March 2003

ABSTRACT. Purpose: To report the results of a retrospective analysis among endogenous uveitis patients in the north‐eastern area of Italy.

Methods: The authors reviewed a series of 655 new cases treated between October 1986 and December 1993. The incidence of endogenous uveitis was calculated based on a 100,000 patient population.

Results: The average incidence was 11.40/100,000. The majority of patients were between the ages of 20 and 70 years (74.43%). A probable diagnosis was determined in 55.57% of cases; anterior uveitis was diagnosed in 58.01% of cases, posterior uveitis in 26.11%, panuveitis in 12.98%, and intermediate uveitis in 2.9% of cases. The authors observed recurrences in 25.49% of cases. While the first cases are almost equally distributed in the various months, the recurrences seem to be significantly more frequent in the cold (from November to February; mean air temperature<8°) and transitional months (October and from March to May; mean air temperature from 8°C to 18°C) than in the warm months (from June to September; mean air temperature >18°C). Respectively p=0.003 and p=0.029.

Conclusion: The incidence in this series is lower than in other European and American studies. Despite the high rate of idiopathic cases in this study, the authors support that the presentation of single case experiences may allow improved multi‐centric analysis and a greater understanding of the epidemiology of uveitis.
Mucor endophthalmitis
Authors: Bhansali Anil , Sharma Ashok , Kashyap Ajit , Gupta Amod , Dash R. Jiban
Published: March 2003

ABSTRACT. Purpose: To report on a case of type 2 diabetes, with eyelid gangrene and endophthalmitis as a presenting manifestation of rhino‐orbito‐cerebral mucormycosis.

Results: CECT head showed proptosis, mucosal thickening in the ethmoid sinus and hypodense lesions in the frontal and occipital lobes. Vitreous tap showed right angle branched aseptate hyphae consistent with mucormycosis.

Conclusions: A diabetic patient presenting with sudden loss of vision, eyelid gangrene and endophthalmitis, involvement by an angio‐invasive fungus‐like mucormycosis is an important consideration.
Phacoemulsification and intraocular lens implantation in eyes with open‐angle glaucoma
Authors: Pohjalainen Tuula , Vesti Eija , Uusitalo Risto J. , Laatikainen Leila
Published: March 2003

ABSTRACT. Purpose: To study the effect of phacoemulsification and intraocular lens implantation (PHACO IOL) on intraocular pressure (IOP) and glaucoma medication in open‐angle glaucoma (OAG) eyes.

Methods: 38 open‐angle glaucoma (OAG) eyes with cataract underwent phacoemulsification and intraocular lens implantation (PHACO IOL) performed by one surgeon (RJU). None of the patients had prior intraocular surgery. Surgery was performed by scleral incision on 37% and by clear corneal incision on 63%. Patients were re‐examined on the first postoperative day, after one week, 4 months, and in 29 cases 1–3.7 (mean 2.8) years after the operation.

Results: The mean preoperative IOP was 18.4±3.3 mmHg with a mean of 1.7 glaucoma medications. On the first postoperative day, the mean IOP rose to 28.2±12.5 mmHg. IOP ≥30 mmHg occurred in 39.5% of the eyes. After one week, IOP had returned to the preoperative level. After 4 months, IOP had further decreased to 16.1±3.8 mmHg (p=0.0027). After a mean follow‐up of 1–3.7 (mean 2.8) years, the average postoperative IOP was 15.1±2.9 mmHg, being significantly (p=0.001) lower than the preoperative IOP with 86% of the patients having a mean of 1.6 drugs on average. The type of incision (scleral vs. corneal) did not affect the postoperative IOP level. Using the criteria of Bigger and Becker (1971) the long‐term IOP control after PHACO‐IOL surgery was improved or unchanged in 86% and worse in 14% of the preoperatively well‐controlled OAG eyes.

Conclusions: In OAG eyes PHACO IOL is associated with a significant decrease in IOP with less medication up to 1–3.7 (mean 2.8) years.
Cellular proliferation and leukocyte infiltration in the rabbit cornea after photorefractive keratectomy
Authors: Gan Lisha , Hamberg‐Nyström Hélene , Fagerholm Per , Van Setten Gysbert
Published: March 2003

Purpose: To map the proliferative activity of corneal cells during wound healing

following photorefractive keratectomy (PRK) and to compare two markers for proliferation.

Methods: PRK, 5‐ mm in diameter with a ‐6 D setting, was performed in one eye of 28 New Zealand White Rabbits. The rabbits were sacrificed at time points between 12 hours and three months after surgery. The treated and fellow corneas were fixed in 10% formaldehyde, paraffin embedded, and immunohistochemically stained for proliferate cell nuclear antigen (PCNA) and at one time point, 1 week, also for Ki‐67.

Results: Following initial sliding of the epithelial cells, the proliferative activity in the wound area starts in the leading edge (24 hours) and is spread towards the periphery. The proliferative activity peaks after one week and subsides during the following two weeks. Early (24 hours) proliferative activity is also seen in the limbal epithelium which peaks after three days. The keratocytes express PCNA in the peripheral stroma 48 hours after injury. They then also migrate to repopulate the stroma under the wound area. The expression period lasts 1 week and subsides the following week. Leukocytes are found in the wound as early as 12 hours after injury. The cells disappear around the time of epithelial wound closure, i.e. after 3 days. The two proliferative markers PCNA and KI 67 show a similar distribution after surgery.

Conclusion: Epithelial proliferative activity starts earlier after injury, and is preceded by leukocyte presence in the wound. The PCNA expression starts later in the keratocytes but lasts somewhat longer (3 weeks). PCNA expression appears more efficient than Ki‐67 to show proliferative activity of slow cycling cells in the cornea
Strabismus surgery: Fibrin glue versus vicryl for conjunctival closure
Authors: Dadeya Subhash , Ms Kamlesh
Published: March 2003

Purpose: The aim of present study was to compare the results of conjunctival closure by fibrin glue with vicryl in strabismus surgery.

Methods: 19 patients undergoing bilateral symmetrical strabismus surgery were included in this study. Conjunctival incisions were closed with 6–0 vicryl in the right eye and fibrin glue in the left eye.

Results: On first post‐operative day 15 out of 19 eyes (78.9%) had well apposed conjunctiva, 3 out of 19 eyes (15.79%) had 1 mm retraction and one out of 19 eyes (5.26%) had 2 mm retraction, which needed suturing, in cases in which fibrin glue was applied. Increased discomfort and excessive watering was noted during the early postoperative period in 8 out of 19 eyes (42.1%), in eyes in which the conjunctiva was closed with 6–0 vicryl, as compared to none in the fibrin glued eyes (p=0.005). However, the difference disappeared after 21 days.

Conclusion: Fibrin glue can be used as an alternative to suturing for conjunctival closure following strabismus surgery.
Anterior chamber depth estimation by Scheimpflug photography
Authors: Holmén Jörgen B. , Ekesten Björn , Lundgren Björn
Published: March 2003

Purpose: To obtain a model suitable for evaluation of the anterior chamber depth (ACD) maintaining capacity of viscoelastic substances – a critical parameter in cataract surgery.

Methods: ACD was estimated using an anterior segment analysis system (EAS‐1000, Nidek Co Ltd, Japan). Variation was studied as an effect of batch number and eye within batch, storage, globe fixation, globe position, and repeated analyses of Scheimpflug images.

Results: Considerable variation in ACD was found between eyes, batches, and as a result of prolonged storage (biological factors). Different IOPs before surgery caused significant alterations in ACD after overfilling with a viscoelastic substance. No significant differences were found when the globe position was altered or when the ACD was re‐estimated repeatedly from the same photograph.

Conclusion: Differences due to biological factors are more important than methodological errors caused by the Scheimpflug instrument. To reduce these variations when viscoelastics are evaluated, all measurements should be calculated as % of ACD before surgery and the anterior chamber should be overfilled with a viscoelastic solution.
Neoplasia versus hyperplasia of the retinal pigment epithelium
Authors: Heegaard Steffen , Larsen Jens Nicolai Brink , Fledelius Hans Callø , Prause Jan Ulrik
Published: March 2003

Purpose: To present the clinical and histopathological characteristics of two different tumor‐like lesions of the retinal pigment epithelium (RPE).

Methods: Two cases of tumor‐like lesions of the RPE were identified in the files of the Eye Pathology Institute. The clinical characteristics and the light‐ and electron microscopical morphology of the lesions were compared and the diagnoses were re‐evaluated applying modern immunostainings.

Results: Clinically, both adenoma and tumor‐like hyperplasia of the RPE may present with prominent retinal feeder arterioles. The lesions are hypofluorescent in the filling phases and have multiple hyperfluorescent zones in the late phase in fluorescein angiography. They show high internal reflectivity by A‐scan and appear as solid tumors by B‐scan ultrasonography. Histologically, the two presented lesions of the RPE are different. The first is an adenoma of the vacuolated subtype. The other lesion is a hyperplasia of the RPE disclosing a tubular morphology. The pathologically active cells in both cases were positive for the reaction with antibodies against: cytokeratin, NSE, vimentin, S‐100, HMB‐45, desmin and SMA. However, only the adenoma was sporadic melan‐A positive.

Conclusion: Adenomas and tumor‐like hyperplastic lesions of the RPE are very rare lesions. They share many morphological and immunohistological characteristics. Of the presented cases only the RPE adenoma is sporadic melan‐A positive.
A clinicopathological study of venous loops and reduplications in diabetic retinopathy
Authors: Bek Toke
Published: March 2003

Purpose:  To study possible causes of the gradual venous occlusion that precedes the formation of venous loops and reduplications in diabetic retinopathy using histopathological techniques.

Methods: Casts of the retinal vascular system from six eyes of five diabetic patients were used to identify venous loops and reduplications. Subsequently the lesions were studied by immunohistochemistry using antibodies against cellular and non‐cellular components previously shown to be disturbed in the diabetic retina.

Results: In all eyes the venous abnormalities identified on the casts were accompanied by abnormal wall partitions dividing the venous lumen. These partitions consisted of a double layer of flat cells displaying immunoreactivity to von Willebrand factor and actin (endothelial cells), but not to glial fibrillary acid protein or S‐100 protein (glial cells), CD3, CD20, CD68, or neutrophil elastase (leucocytes). Neutrophile granulocytes adhering to the walls of larger retinal venules were unrelated to the venous partition and to capillary occlusion in the adjacent retinal areas.

Conclusions: Venous loops and reduplications are associated with partitions of the larger retinal venules consisting of a double layer of endothelial cells anchored to a thin basement membrane. An elucidation of the factors distinguishing this endothelial cell proliferation from preretinal new vessel formation may be important for understanding the pathophysiology of proliferative diabetic retinopathy.
Age‐related maculopathy: pathogenetic features and new treatment modalities
Authors: Algvere Peep V. , Seregard Stefan
Published: March 2003

A considerable amount of new information on putative pathogenetic mechanisms in age‐related maculopathy and degeneration has emerged in recent years. This comprises experimental studies on retinal pigment epithelium (RPE) and rod photoreceptor ageing, lipofuscin accumulation, the roles of oxidative stress and free radical formation, as well as antioxidants and other defensive mechanisms operating against environmental factors and ageing.

The current application of photodynamic therapy (PDT) using verteporfin marks a new era in the treatment of subfoveal classical choroidal neovascularization. Several new treatment modalities, such as transpupillary thermotherapy (TTT) and anti‐vascular endothelial growth factor (VEGF) agents for inhibition of neovascularization, have emerged and are undergoing multicentre clinical trials. A period of dynamic development in this field has commenced.
Refractive change during hyperbaric oxygen therapy. A clinical trial including ultrasound oculometry
Authors: Fledelius Hans C. , Jansen Erik C. , Thorn Jens
Published: March 2003

Purpose:  To record changes in refraction and refractive parameters associated with a standard hyperbaric oxygen treatment protocol consisting of a 95 min session at > 95% oxygen at 2.5 atmospheres (ATA) given daily Monday to Friday, to a total of 30 sessions.

Patients and methods:  Seventeen of the 26 patients included were able to attend for ophthalmic assessment at time zero (to) and after 20 treatments (t20). Thirteen patients also had a post‐treatment follow‐up. Most patients were being treated for osteoradionecrosis after radiotherapy of ENT cancers, and drop‐outs for the eye exam were common. Refraction was determined subjectively and by refractometry, before and after tropicamide 1% eyedrops. Refractive parameters were assessed by keratometry and by A‐scan axial ultrasound measurement.

Results: Results are given for the 17 patients with to and t20 assessments. The induced refractive change ranged from 0 to 1.5 D. When observed, refractive changes were myopic in nature. The shift averaged 0.58 D according to the refractometer and 0.49 D as subjectively assessed, with corresponding median change values being 0.62 and 0.39 D. The differences between 0 D and these values, although small, were statistically highly significant.

Conclusions: The refractive changes associated with hyperbaric oxygen therapy were smaller than the literature had led us to expect. No significant change in axial eye length measurements was found, and keratometry readings reflected only minimal change, although this was statistically significant on a 0.05 level. Therefore it is most likely that lens changes, whether in internal refractive indices or curvatures, accounted for the transitory shift towards more myopic/less hyperopic values.
Long‐term outcome of trabeculectomy in terms of intraocular pressure
Authors: Ehrnrooth Pia , Lehto Ilkka , Puska Päivi , Laatikainen Leila
Published: March 2003

Purpose:  To evaluate the outcome, long‐term results and contributing prognostic factors of trabeculectomy in terms of intraocular pressure (IOP) and to compare the results in primary open‐angle glaucoma (POAG) and exfoliation glaucoma (EG).

Methods:  This study involved retrospective evaluation of 138 consecutive patients (138 eyes) with either POAG or EG. All patients had undergone primary trabeculectomy performed by the same surgeon between November 1994 and August 1996. Only one eye per patient was included. Operations performed with the use of antimetabolites were excluded. All patients were aged over 40 years and were white. Follow‐up for all subjects lasted at least 2 years. Successful control of IOP was defined as achieving IOP ≤ 21 mmHg without medication (complete success) or with a single topical medication (qualified success). Success rates were determined using the Kaplan‐Meier survival curve, and risk factors were analysed with proportional hazards regression.

Results:  According to the Kaplan‐Meier survival curve, success rates (complete or qualified) were 82% at 1 year, 70% at 2 years, 64% at 3 years and 52% at 4 years. A total of 63% were complete successes at 1 year, 54% at 2 years, 45% at 3 years and 40% at 4 years. Complete success rates were significantly better in the POAG group than in the EG group. Proportional hazards regression analysis showed that the presence of EG and early postoperative IOP > 30 mmHg decreased the possibility of complete success, while a cataract operation performed during follow‐up improved it.

Conclusion:  The IOP‐reducing effect of trabeculectomy decreases gradually. After 4 years, 52% of operated eyes had IOP ≤ 21 mmHg with or without a single topical medication. Diagnosis of EG implied a worse long‐term outcome for trabeculectomy in terms of IOP.
Radius and asphericity of the posterior corneal surface determined by corrected Scheimpflug photography
Authors: Dubbelman Michiel , Weeber Henk A. , Van Der Heijde Rob G. L. , Völker‐Dieben Hennie J.
Published: March 2003

Purpose:  To obtain the shape of the posterior corneal surface in a healthy population, using Scheimpflug photography corrected for distortion due to the geometry of the Scheimpflug imaging system and the refraction of the anterior corneal surface.

Methods:  The posterior corneas of 83 subjects, ranging in age from 16 to 62 years, were measured in the vertical meridian using corrected Scheimpflug photography. The aspherical shape of the anterior Corneal surface was also determined in conjunction with the correction of Scheimpflug images.

Results:  The average radius of the anterior corneal surface was 7.87 ± 0.27 mm (SD), while the average radius of the posterior corneal surface was 6.40 ± 0.28 mm (SD). The ratio between the posterior and the anterior radius of curvature was 0.81 ± 0.02. The asphericity of the anterior and the posterior corneal surfaces was 0.82 ± 0.18 and 0.62 ± 0.27, respectively. The asphericity of the posterior corneal surface decreased significantly with age. The posterior/anterior asphericity ratio is also dependent on age and was 0.98 ± 0.17 at 16 years of age and 0.53 ± 0.30 at 62 years of age.

Conclusion:  Corrected Scheimpflug photography is an appropriate technique for measuring the radius and asphericity of the posterior corneal surface. The asphericity of the posterior corneal surface changes with age.
Ocular perfusion abnormalities in diabetes
Authors: Ciulla Thomas A. , Harris Alon , Latkany Paul , Piper Heidi C. , Arend Oliver , Garzozi Hana , Martin Bruce
Published: March 2003

Purpose:  To review the role of ocular perfusion in the pathophysiology of diabetic retinopathy, one of the leading causes of irreversible blindness in the industrialized world.

Methods:  We carried out a Medline search of the literature published in English or with English abstracts from 1966 to 2000 using various combinations of relevant key words.

Results:  Hyperglycaemia leads to a wide variety of vascular abnormalities at the microvascular and macrovascular levels, including abnormal autoregulation.

Conclusion:  Three major aspects of ocular perfusion in diabetic retinopathy require additional investigation. Firstly, the precise mechanisms that link elevated glucose to dysfunction of retinal vascular cells need to be identified. Secondly, those factors that lead to both capillary dropout and to angiogenesis, twin processes that are linked to tissue hypoxia and lead to excess perfusion, increased risk of extravascular leakage and frank haemorrhage, must be carefully delineated. Finally, once specific knowledge of disease fundamentals has been amassed, tests of therapies to reverse or prevent these pathological processes can move forward.
Prion diseases: Epidemiology in man
Authors: Pedersen Nils Strandberg , Smith Else
Published: March 2003

Prion disease in man was first described as Creutzfeldt‐Jacob disease (CJD) in the 1920s. CJD may have three different origins: sporadic, familial, due to mutations in the prion gene, or infectious, due to iatrogenic exposure to infectious brain material. As an example of the latter, kuru, in Papua New Guinea, was a variant of CJD transmitted by cannibalism. Between 1957 and 1982 more than 2500 died of kuru. Sporadic CJD is the most common form of CJD and occurs with an incidence of around one per million in most parts of the world. Familial CJD accounts for approximately 10% of all European cases of CJD, and is associated with inherited mutations of the prion protein gene, caused by one of the 24 single amino acid substitutions or insertions of octapeptide repeats. CJD caused by infections involves either iatrogenic cases of CJD, resulting from exposure to infectious brain, pituitary or ocular tissue, or from ingestion of infected food items. As of today, a few hundred iatrogenic cases of CJD have been diagnosed worldwide, the majority due to transmission by cadaveric pituitary HCG. So far, 111 cases of vCJD have been diagnosed caused by BSE‐contaminated food. The size of the epidemic is still unclear and worst‐case scenarios indicate that we may expect many thousands of cases in the future.
Infection control: Preventing iatrogenic transmission of spongiform encephalopathy in Danish hospitals
Authors: Jepsen Ole B.
Published: March 2003

The Danish infection control guidelines dealing with transmissible spongiform encephalopathy (TSE) recognise that preventive measures to avoid iatrogenic transmission must be taken, though the risk for patients in Danish hospitals can be characterised as minimal. A minimal risk situation cannot meanwhile be maintained unless hospitals and other healthcare institutions are prepared and have effective and well‐functioning decontamination procedures in place suited for the purpose. The guidelines recommend that staff both in the operating theatre and in the Central Sterile Supply Department (CSSD) must be able to apply the procedures needed for safe handling and decontamination of used instruments. These include cleaning and effective sterilisation, as well as quarantine procedures and ways to discard and incinerate certain used instruments. The guidelines also address occupational safety, and single‐use instruments are recommended where these are available and can be safely used. Effective procedures for decontamination of instruments and other medical devices are identified as the key to prevention of iatrogenic spread of TSE. Hospitals are advised to have their sterilisers and other equipment professionally checked in order to make sure that specific procedures for safe handling and decontamination of used surgical instruments and other medical equipment are available in case of suspected or confirmed TSE.
Generation of EBV‐specific CTLs suitable for adoptive immunotherapy of EBV‐associated lymphoproliferative disease following allogeneic transplantation
Authors: Hoffmann Thomas , Russell Charlotte , Vindeløv Lars
Published: March 2003

Lymphoproliferative disease induced by EBV (EBV‐LPD) is a complication of allogeneic transplantation caused by T‐cell immunodeficiency. EBV‐LPD responds poorly to conventional treatment modalities. Recently, adoptive transfer of EBV‐specific, HLA‐class I‐restricted CTL lines was shown to be effective both as prophylaxis and as treatment of EBV‐LPD. The CTL lines are produced by in vitro selection of EBV‐specific memory T cells contained in MNC of EBV‐seropositive individuals by repeated stimulation with irradiated EBV‐transformed cells. The non‐EBV‐reactive and potentially alloreactive cells remain unactivated. Twenty‐one CTL lines were initiated. All were successfully generated and shown to be HLA‐restricted and EBV‐specific as well as CD8/CD4 and CD45RO positive T cells. The majority of the CTL lines were generated from BMT donors, but two CTL lines were obtained from solid organ transplant recipients receiving immunosuppression. Evidence of probable in vivo efficacy is presented. Development of efficient adoptive T‐cell strategies for EBV‐positive malignancies could serve as a model for treatment of other viral or malignant disorders.
The effects of enoxaparin on the reparative processes in experimental osteonecrosis of the femoral head of the rat
Authors: Norman Doron , Miller Yoav , Sabo Edmund , Misselevich Ines , Peskin Bezalel , Zinman Chaim , Levin Daniel , Reis Daniel N. , Boss Jochanan H.
Published: March 2003

The blood supply of one femoral head of 6‐month‐old rats was severed by incising the periosteum of the neck and cutting the ligamentum teres. The rats were killed on the 30th postoperative day and the femoral bones were obtained for semiquantification of the reparative processes in the necrotic heads. Fourteen rats were treated with enoxaparin and 14 untreated animals served as controls. Statistically, the amounts of necrotic bone in the epiphysis were less, the extent of remodeling of the femoral heads was milder, and the articular cartilage degeneration was slighter in the enoxaparin‐treated than untreated rats. There was no significant difference in the quantities of newly formed bone in femoral heads of treated and untreated rats. These findings are in agreement with the known effects of unfractionated and low‐molecular‐weight heparins which enhance osteoclastic bone resorption and angiogenesis and decrease osteoblastic bone formation. The former activities, operative in minimizing the structural distortion of the femoral head, oppose the crucial event in the pathogenesis of post‐osteonecrotic osteoarthritis.
Investigation of Candida dubliniensis in Candida spp.‐positive hemocultures
Authors: Dolapci Istar , Tekeli Alper , Gocmen J. Sedef , Aysev Derya , Guriz Haluk
Published: March 2003

Candida dubliniensis
is one of the
Candida
species which was first recognized in 1995. The yeast was misidentified because of its phenotypic similarities with
Candida albicans.
In this study, blood samples of patients from various departments at Ankara University Medical Faculty between January 1996 and September 2000 were investigated for distribution of
Candida
spp. and presence of
C. dubliniensis.
Ninety‐eight culture positive fungi were included in the study. Phenotypic tests for identification of
C. dubliniensis
and tests for differentiation of the yeast from
C. albicans
, such as colony morphology on Staib agar, growth at 42 °C and 45 °C, β‐glucosidase activity and carbohydrate assimilation, were carried out. Sixty‐four of the isolates produced germ tubes and chlamydospores, and none of them had the phenotypic characteristics of
C. dubliniensis. Further large‐scale studies of specific patient groups are necessary to reveal the etiologic importance of this yeast.
Ectopic hamartomatous thymoma: a case report with immunohistochemical and ultrastructural studies
Authors: Fukunaga MASAHARU
Published: March 2003

A case of ectopic hamartomatous thymoma (EHT) arising in the supraclavicular region of a 52‐year‐old male is presented. The well‐defined tumor measuring 1.7 × 1.5 × 0.7 cm consisted of three components: spindle cell (70%), epithelial (25%), and adipose (5%). The spindle cell component was characterized by sheet‐like, haphazard and short fascicular arrangements of bland spindle cells. Neither mitotic figures nor cellular pleomorphism were found. Admixed with, and adjacent to, the spindle cell areas was an obviously epithelial component of variable appearance, ranging from glandular spaces lined by mainly cuboidal clear cells, irregularly anastomosing cords, and strands of epithelial cells to irregular solid nests of squamous epithelium with dark and clear cytoplasm. Myoepithelial cells were also observed. Immunohistochemically, the spindle cells were strongly and diffusely positive for cytokeratins and some of them were positive for BRST2, alpha‐smooth muscle actin, and CD 10. The tumor was negative for S‐100 protein, glial fibrillary acidic protein, and CD34. Ultrastructurally, tonofilaments and desmosomes were observed in the spindle cells. The findings indicate an epithelial origin. The patient was well without recurrence or metastasis 8 months after excision. Pathologists and clinicians should be aware of the existence of ectopic hamartomatous thymoma in the supraclavicular or suprasternal region and should differentiate it from a high‐grade sarcoma, such as biphasic synovial sarcoma or glandular malignant peripheral nerve sheath tumor.
VEGF concentrations in tumour arteries and veins from patients with rectal cancer
Authors: Werther Kim , Bülow Steffen , Hesselfeldt Peter , Jespersen Nils Frode Kragh , Svendsen Mads Nordahl , Nielsen Hans jørgen
Published: March 2003

This pilot study investigated the hypothesis that the tumour itself is the source of the elevated vascular endothelial growth factor (VEGF) concentrations which are often observed in peripheral blood from patients with rectal cancer. Twenty‐four consecutive patients with primary rectal cancer were included. Blood samples were drawn preoperatively from peripheral veins (I) and intraoperatively from peripheral veins (II), tumour arteries (III), and tumour veins (IV). In the four compartments, VEGF concentrations were measured in serum, EDTA plasma, and supernatants from lysed whole blood. Additionally, automated complete white cell and platelet counts were performed. In serum and EDTA plasma, no significant differences in VEGF concentrations were observed (p=0.1 and p=0.5), respectively) between tumour arteries and tumour veins. However, in supernatants from lysed blood, VEGF concentrations were significantly (p=0.03) lower in venous blood than in arterial blood. Unexpectedly, a 16% reduction (p<0.0001) in the number of neutrophils was observed during transit of the arterial blood through the rectal tumours, while none of the other types of leukocytes or platelets was significantly reduced in numbers during the same passage. These findings indicate that the tumour itself is not the only source of elevated VEGF concentrations in peripheral blood from patients with rectal cancer. A consistent finding was that a large number of neutrophils disappeared from the blood during passage through the rectal tumour. However, the significance and fate of the migrating neutrophils cells are unknown and should be investigated further.
Neuroendocrine differentiation in carcinoma of the breast
Authors: Bofin A. M. , Qvigstad G. , Waldum C. , Waldum H. L.
Published: March 2003

The aim of the study was to determine if, by means of tyramide signal amplification (TSA), the presence of chromogranin A (CgA)‐positive tumour cells could be demonstrated in breast cancer cases found to be negative by conventional immunohistochemical staining. Sections from 44 cases of breast cancer (28 infiltrating ductal carcinomas, 2 lobular carcinomas, 4 ductal carcinomas in situ (DCIS), 7 lobular carcinomas in situ (LCIS), and 3 mucinous carcinomas) were stained for CgA by conventional immunohistochemical methods and by immunohistochemistry with TSA. The sections were also histologically graded and their oestrogen receptor (ER), progesterone receptor (PgR) and HER‐2 oncogene status was recorded. Five of the tumours showed CgA‐positive staining with the polyclonal antibody 430 with conventional methods. Thirty cases showed CgA‐immunoreactive tumour cells after immunohistochemical staining with the polyclonal antibody 430 with TSA. However, eight of these also showed faint staining with the negative control antibody X0936 with TSA. One case showed immunopositivity for CgA using a monoclonal antibody without tyramide amplification and only a further two cases were positive when TSA was applied. The presence of CgA appears to be associated with a lower histological grade and may be more often found in oestrogen receptor‐positive tumours.
Clonal clustering and colonization factors among thermolabile and porcine thermostable enterotoxin‐producing Escherichia coli
Authors: Valvatne Håvard , Steinsland Hans , Sommerfelt Halvor
Published: March 2003

A considerable proportion of enterotoxigenic Escherichia coli (ETEC) do not possess identifiable colonization factors (CFs). Genetic fingerprint analyses based on repetitive sequence‐based polymerase chain reaction (rep‐PCR) showed that 9 of 10 such CF‐negative isolates which produced the thermolabile and the porcine thermostabile enterotoxin could be divided into three clusters. Following transformation with a plasmid harbouring the gene encoding CfaR, a positive regulator for several ETEC adhesins, three of the six strains in the first cluster expressed coli surface antigen 20 (CS20). No CFs were identified on the two transformed strains in the second cluster while the transformants of the two strains in the last cluster expressed CS12, the N‐terminal amino acid sequence of which was deciphered. The study illustrates the potential of using genetic fingerprinting to group ETEC into clusters of strains with genes encoding different CFs and confirms the ability of CfaR to induce the expression of several different CFs.
The influence of CD4 and CXCR4 on maedi‐visna virus‐induced syncytium formation
Authors: HOVDEN ARNT‐OVE , SOMMERFELT MAJA A.
Published: March 2003

CD4 is the principal binding site for human and simian immunodeficiency virus (HIV/SIV) receptor interactions and the α chemokine receptor CXCR4 has been implicated as a primordial lentivirus receptor. This study sought to determine the relevance of CD4 and CXCR4 in virus‐receptor interactions for the prototype lentivirus, maedi‐visna virus (MVV) of sheep. Neither CD4 nor α/β chemokine receptors represent principal receptors for MVV since human osteosarcoma cells devoid of these molecules were susceptible to productive infection. Interestingly, the presence of either CD4 and/or CXCR4 on indicator cells dramatically enhanced MVV‐induced cell fusion (syncytium formation) for three independent virus strains. Syncytium formation results from virus‐receptor interactions and can be inhibited by receptor ligands. However, neither SDF‐1α that binds CXCR4 nor recombinant gp120 (rgp120) that binds CD4 could specifically inhibit the observed enhancement of MVV‐induced cell fusion under conditions that significantly reduced HIV‐1‐induced cell fusion. Our observations suggest that CD4 and CXCR4 may represent optional auxiliary components of an MVV receptor (or receptor complex) that facilitate MVV‐mediated membrane fusion events, a feature important for virus entry. This potential accessory role for CXCR4 in MVV receptor interactions may reflect the distant relationship between the ovine (MVV) and the human/feline lentiviruses (HIV/FIV).
Topical application of benzalkonium chloride to the stomach serosa increases gastric emptying time, acid secretion, serum gastrin and size of the mucosa
Authors: ZUCOLOTO S. , ROMANELLO L. M. F. , GARCIA S. B. , SOBREIRA L. F. R. , BARBOSA A. J. A. , TRONCON L. E. A.
Published: March 2003

Aim: In the present study we evaluated the effects of gastric myenteric denervation using benzalkonium chloride (BAC) on the time for gastric emptying, as well as gastric secretion, and mucosal epithelial cell size and population in rats. Methods and Results: Wistar rats were treated with topical serosal application of BAC to the stomach. Control animals received saline. Ninety days after surgery, gastric emptying time, gastric acid secretion and serum gastrin levels were studied. Next, the animals were sacrificed and the stomachs were removed, fixed in formalin and histologically processed for histomorphometry of the height, area and volume of the glandular portion, and volume and population of mucous, chief, parietal, G‐ and labelled cells. BAC animals showed a significant delay in gastric emptying and an increase in gastric acid secretion and serum gastrin levels. These animals also presented a significant reduction of myenteric neuron number, hypertrophy of parietal and chief cells, hyperplasia of G cells and an increase in the gastric mucosa area. Conclusion: The absence of the myenteric plexus seems to protect the stomach from the hyperplastic effects of hypergastrinemia. Gastric food stasis may act as a factor triggering morphological and functional alterations of the gastric epithelium. Although gastric food stasis is a common finding in medical practice, its physiopathological consequences are poorly understood and have not been frequently discussed in the literature.
Endemic nosocomial infections and misuse of antibiotics in a maternity hospital in Saudi Arabia
Authors: Bilal Naser Eldin , Gedebou Messele , Al‐Ghamdi Saleh
Published: March 2003

Patients admitted during a 6‐month period to a maternity hospital in Saudi Arabia were studied for nosocomial infections and misuse of antibiotics. Patient history and diagnosis on admission and subsequent clinical and laboratory data were analysed. Infection developing from 72 h after admission was considered nosocomial. Therapeutic and prophylactic data as recorded on the patients' charts were assessed for possible misuse of antibiotics. Of 3439 patients, 136 (4.0%) developed nosocomial infection: 2.0%, 8.9% and 37.7% in obstetric, gynaecologic and nursery patients, respectively. Infections among adults were mostly found in the urinary (44.4%) and lower genital (33.3%) tracts. Among newborns, over 70% of cases were eye and ear (29.8%), skin (26.2%) and blood (19.0%) infections. Gram‐negative bacteria caused 65.7% of the infections. Over 90% of the bacterial isolates were multidrug‐resistant. About 24% of patients received single or multiple antibiotics; 57.2% were misused. The minimal hospital cost estimate for both nosocomial infections and misused antibiotics was US $318,705. The findings of this study, the first of its type in this region, should prompt improved infection control measures as well as educational and antibiotic restriction interventions.
Protease activities in peri‐implant sulcus fluid from patients with permucosal osseointegrated dental implants. Correlation with clinical parameters
Authors: Eley B. M. , Cox S. W. , Watson R. M.
Published: March 2003

The 15 patients included in this study each had 2‐6 permucosal Branemark osseointegrated implants that had functioned successfully for 18 months or more. They were given a full oral examination which included measurements of probing depth and gingival, bleeding and plaque indices around the implants. Marginal bone reduction during the functional life of the implants was estimated from radiographs. At a separate visit, peri‐implant sulcus fluid (PISF) was collected on filter paper strips from the deepest probing site of each implant. PISF volumes were measured and the samples eluted into buffer. Protease activities in the eluates were determined by fluorimetric assay with peptidyl derivatives of 7‐amino‐4‐trifluoromethyl coumarin. Enzyme levels followed the order: cathepsin B/L > elastase > dipeptidyl peptidase IV > trypsin‐like activity. Total enzyme activities and concentrations both correlated positively with all clinical parameters in linear regression analysis. This was true on both a patient level using mean patient values and a site level using pooled patient data. Nearly all of the site level correlations were statistically significant, though coefficients were generally higher for total enzyme activities than concentrations. Elastase‐like activity gave the best overall correlations of the different proteases measured. Amongst the clinical parameters, correlations were generally best with gingival index and bone reduction. Total enzyme activities had good diagnostic specificity and sensitivity as predictors of clinical parameters and the figures were especially high for elastase‐like activity as a marker of bone reduction. PISF proteases may thus be of value in monitoring tissue responses to osseointegrated implants.