Efficacy of combined ultrasound-guided hydrodilatation with hyaluronic acid and physical therapy in patients with adhesive capsulitis: A randomised controlled trial

OBJECTIVE

To evaluate the therapeutic effect of combining ultrasound-guided hydrodilatation with hyaluronic acid and physical therapy compared with physical therapy alone in patients with adhesive capsulitis.

DESIGN

A prospective, single-blinded, randomised controlled trial.

SETTING

Single medical centre.

PARTICIPANTS

Patients with adhesive capsulitis (N = 62) were divided into group A: ultrasound-guided hydrodilatation with hyaluronic acid + physical therapy (N = 31) and group B: physical therapy alone (N = 31).

INTERVENTIONS

Group A received three doses of ultrasound-guided hydrodilatation with hyaluronic acid-based injectates (20 mL in total). Both groups underwent structured physical therapy.

OUTCOME MEASURES

The primary outcome measure was Constant score, while secondary outcomes included Shoulder Pain and Disability Index score, numerical rating scale (at rest, night, and during motion), 36-item Short Form Health Survey, and range of motion of the shoulder. All measurements were collected at baseline, 6 weeks, and 12 weeks post-injection.

RESULTS

At week 12, the Constant scores were 68.29 ± 14.55 and 62.77 ± 14.44 for groups A and B, respectively. There was a greater reduction in the Constant score, Shoulder Pain and Disability Index, and numerical rating scale between the baseline and 6 weeks and between the baseline and 12 weeks in group A (Constant score: p < 0.05, Shoulder Pain and Disability Index: p < 0.01, and numerical rating scale: p < 0.05).

CONCLUSION

The combination of ultrasound-guided hydrodilatation with hyaluronic acid in conjunction with physical therapy provides additional benefits compared to physical therapy alone for the treatment of adhesive capsulitis at up to 12 weeks.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02708706.

Ultrasound Imaging and Guidance for Distal Peripheral Nerve Pathologies at the Wrist/Hand

Ultrasound has emerged as a highly valuable tool in imaging peripheral nerve lesions in the wrist region, particularly for common pathologies such as carpal tunnel and Guyon's canal syndromes. Extensive research has demonstrated nerve swelling proximal to the entrapment site, an unclear border, and flattening as features of nerve entrapments. However, there is a dearth of information regarding small or terminal nerves in the wrist and hand. This article aims to bridge this knowledge gap by providing a comprehensive overview concerning scanning techniques, pathology, and guided-injection methods for those nerve entrapments. The median nerve (main trunk, palmar cutaneous branch, and recurrent motor branch), ulnar nerve (main trunk, superficial branch, deep branch, palmar ulnar cutaneous branch, and dorsal ulnar cutaneous branch), superficial radial nerve, posterior interosseous nerve, palmar common/proper digital nerves, and dorsal common/proper digital nerves are elaborated in this review. A series of ultrasound images are used to illustrate these techniques in detail. Finally, sonographic findings complement electrodiagnostic studies, providing better insight into understanding the whole clinical scenario, while ultrasound-guided interventions are safe and effective for treating relevant nerve pathologies.

Blink synkinesis monitoring during microvascular decompression for hemifacial spasm

BACKGROUND

In the present study, we investigated whether blink synkinesis monitoring during microvascular decompression (MVD) is effective for predicting long-term outcomes in patients with hemifacial spasm (HFS).

METHODS

This retrospective study included 69 patients who had undergone MVD for HFS at a tertiary hospital. All patients underwent intraoperative monitoring of blink synkinesis, lateral spread responses (LSRs), and facial nerve motor-evoked potentials (FNMEPs). Baseline signals were compared to those obtained following decompression with Teflon, and postoperative outcomes were recorded.

RESULTS

A total of 65 patients were observed with complete relief of symptoms after 1 year after MVD, while 61 patients were observed with initial disappearance of blink synkinesis, 57 patients were observed with initial elimination of the LSR, and 45 patients with initial decreases in FNMEP amplitude (>50%). The highest sensitivity and accuracy values were observed for blink synkinesis. Chi-square tests comparing the sensitivity of the three methods revealed that FNMEP monitoring was associated with significantly lower sensitivity values than the remaining methods. Combined use of blink synkinesis and LSRs did not significantly increase sensitivity (61/65 vs 62/65) or accuracy (62/69 vs 63/69).

CONCLUSION

Our results demonstrate that blink synkinesis monitoring is safe during MVD for HFS. Furthermore, blink synkinesis was associated with the highest sensitivity and predictive values among the three methods evaluated. These findings suggest that blink synkinesis can be regarded as the first choice for intraoperative monitoring during MVD. Concurrent use of blink synkinesis and LSR monitoring may maximize the ability to predict patient prognosis and determine the extent of decompression.

Evaluation of acupuncture effect to chronic myofascial pain syndrome in the cervical and upper back regions by the concept of Meridians

Myofascial pain syndrome (MPS) in the cervical and upper back regions is a common medical problem. The involved muscles include trapezius, multifidi, splenius cervicis, levator scapulae, supraspinatus or infraspinatus. Acupuncture is a well-known method for relief of chronic pain. In this study, we evaluated the effect of acupuncture in MPS and its durability by using the concept of meridians. Twenty-nine patients with chronic MPS in the upper back and cervical regions received acupuncture 2 times per week for 3 weeks. According to the pathways of the meridians, we chose acupuncture points by the pain regions located in which parts of meridian passing (i.e. "Where the meridian passes, where to treat the disease."). We evaluated the intensity of pain by visual analog scales (VAS) and active range of motion (ROM) of neck before and after therapy. After receiving acupuncture for 3 weeks, VAS of pain fell significantly from 9.0+/-1.0 to 4.9+/-2.5 and active ROM of neck significantly increased from 35.8+/-10.2 degrees to 61.3+/-9.4 degrees (p<0.05). The onset of symptom relief was gradual and duration of symptom relief after a course of acupuncture was average 5.3+/-1.2 days. In conclusion, acupuncture is a somewhat effective method for pain relief of patients with chronic MPS in the cervical and upper back regions. However, the effect of acupuncture with the concept of meridians on MPS is insidious and the duration of the relief is not long enough.

A double-blind, randomized, controlled parallel group study evaluating the efficacy and safety of acemetacin for the management of osteoarthritis

The aim of the present study was to compare the efficacy and tolerability of a new form of nonsteroidal antiinflammatory drug (NSAID), acematacin (Acemet), with indomethacin, in patients suffering from osteoarthritis (OA). Patients diagnosed with OA were included in a double-blind, randomized, controlled parallel group study A total of 42 patients were randomized to either acemetacin 60 mg t.i.d. or indomethacin 25 mg t.i.d. for 28 days. At an outpatient clinic, each patient was followed up regularly for efficacy, compliance and possible adverse events. Both drugs produced a statistically significant improvement for primary efficacy variables: change of pain score during motion and restriction of body movement. Values for overall tolerability and incidence of gastrointestinal side effects were significantly lower for acemetacin than for indomethacin. We therefore suggest that acemetacin, by demonstrating significant tolerability and safety advantages, is as effective as indomethacin for the treatment of OA.

Giant tear retinal detachment after laser in situ keratomileusis--a case report

A 42-year-old woman with a refractive error of -10.00S - 2.00C x 105 degrees in the right eye underwent laser in situ keratomileusis (LASIK) at our hospital. LASIK was performed using the Schwind excimer laser (Keratom Multiscan, Schwind, Kleinostheim, Germany) and Moria LSK--One manual microkeratome with a 130 microns ablation plate. The uncorrected visual acuity improved postoperatively, and the patient was very satisfied. However, nine months later, she complained of sudden loss of visual acuity in the right eye. Indirect ophthalmoscopy revealed a giant retinal tear extending from 10:00 to 2:00 o'clock position with retinal detachment and vitreous hemorrhage. We performed scleral buckling procedure (with silicone band encircling), vitrectomy, and fluid-gas exchange with air/SF6 mixture. The retina attached postoperatively and remained so during 3-month follow-up period, but cellophane maculopathy was noted.

Klebsiella pneumoniae orbital cellulitis

We present a case of orbital cellulitis due to Klebsiellapneumoniae infection. The computed tomography revealed cellulitis over the right cheek with abscess formation in the right eyelid and ipsilateral chronic obstructive sinusitis. Incision and drainage of orbital abscess and functional endoscopic sinus surgery were performed sequentially. Klebsiella pneumoniae was confirmed via culture from these two lesions. The patient achieved complete remission without sequalae after surgical intervention and systemic antibiotics. We describe a successfully treated case of Klebsiella pneumoniae orbital cellulitis, which has never been reported before.

Monoclonal anti-double stranded DNA antibody is a leucocyte-binding protein to up-regulate interleukin-8 gene expression and elicit apoptosis of normal human polymorphonuclear neutrophils

OBJECTIVES

To determine whether anti-double stranded DNA (anti-dsDNA) autoantibody could bind and affect the functions of normal human polymorphonuclear neutrophils (PMN).

METHODS

Normal human PMN were incubated with different concentrations of a monoclonal mouse anti-dsDNA antibody (12B3) or mouse isotype-matched IgG2a. The binding of anti-dsDNA and PMN was measured by flow cytometry and interleukin-8 (IL-8) gene expression in PMN was detected by enzyme-linked immunosorbent assay (ELISA) and reverse transcription-polymerase chain reaction (RT-PCR). PMN apoptosis was justified by morphological changes. The cognate antigen(s) of anti-dsDNA on the PMN surface was identified by membrane biotinylation, immunoprecipitation and Western blot.

RESULTS

The binding of PMN with anti-dsDNA was much higher than with non-specific mouse IgG2a (70.8 vs 2.0%). Anti-dsDNA at concentrations higher than 12.5 ng/ml significantly enhanced the production and mRNA expression of IL-8 by PMN. However, anti-dsDNA facilitated PMN apoptosis after 3 h incubation. Western blot analysis of biotinylated PMN cell lysates demonstrated that a 50-52 kDa membrane molecule is the cognate antigen of anti-dsDNA.

CONCLUSIONS

Anti-dsDNA autoantibody up-regulates IL-8 gene expression and elicits activation-induced cell death (AICD) of human PMN via binding to a 50-52 kDa membrane-expressed molecule.

Color vision after laser in situ keratomileusis

PURPOSE

To evaluate the effect of laser in situ keratomileusis (LASIK) on color vision.

SETTING

Department of Ophthalmology, China Medical College Hospital, Taichung, Taiwan.

METHOD

This prospective study comprised consecutive patients having LASIK. Patients were eligible for inclusion if they had a best corrected visual acuity of 20/20 or better and a normal color vision test preoperatively and an uncorrected near visual acuity of 20/40 or better postoperatively. Color vision was tested using the Farnsworth-Munsell 100-hue test (FM 100 test) preoperatively and 1 day, 1 week, and 1 month postoperatively.

RESULTS

Twenty-nine eyes of 15 patients having LASIK were enrolled in the study. The mean patient age was 29.2 years +/- 2.9 (SD). The mean preoperative spherical equivalent refractive error was -5.6 +/- 1.8 diopters, and the mean preoperative error score of the FM 100 test was 3.79 +/- 1.55. After surgery, no significant change in the error score was observed at 1 day (4.30 +/- 1.07, P =.1039, paired t test), 1 week (3.72 +/- 1.25, P =.8125, paired t test), or 1 month (3.97 +/- 1.29, P =.6149, paired t test).

CONCLUSION

Laser in situ keratomileusis did not affect color vision evaluated by the FM 100 test.

Risk factors in endophthalmitis leading to evisceration or enucleation

BACKGROUND AND OBJECTIVE

This study aimed to evaluate the risk factors associated with evisceration or enucleation in endophthalmitis cases.

PATIENTS AND METHODS

A retrospective analysis was conducted of all cases of endophthalmitis in a single unit over a 10-year period. The cases were divided into two groups. The group 1 consisted of patients with endophthalmitis who underwent evisceration or enucleation. The group 2 included patients with endophthalmitis who recovered with intravitreal injection or vitrectomy.

RESULTS

During the 10-year study period, 86 patients with endophthalmitis were admitted for treatment. Evisceration or enucleation was undergone by 20 patients (23.2%) (Group 1); Group 2 consisted of 66 patients. Older age (P = 0.03), no light perception at presentation (P < 0.0001), endophthalmitis associated with corneal ulcer (P < 0.0001), and endogenous endophthalmitis (P = 0.048) were statistically significant factors associated with the need for evisceration or enucleation.

Microdialysis of salicylic acid from viscous emulsion samples prior to high-performance liquid chromatographic determination

A micro-dialysis method was developed to isolate aqueous salicylic acid from viscous emulsion samples prior to HPLC determination. The optimal conditions for obtaining dialysis efficiency of salicylic acid as well as chromatographic conditions were investigated. Experimental results indicated that the dialysis achieved at pH 2.0 (0.025 M phosphate solution), 0.5 M NaCl addition, and 50-microl/min flow-rate of perfusion stream offered an optimal result. The proposed method provided a simple procedure for isolating salicylic acid from viscous emulsion samples. Application was illustrated by the analysis of salicylic acid in cosmetic products.

Induction of apoptosis by esculetin in human leukemia cells

Esculetin, a coumarin compound, has been shown to exhibit antioxidant and anti-inflammatory effects. In the present study, esculetin was found to inhibit the survival of human promyelocytic leukemia HL-60 cells in a concentration-dependent and time-dependent manner. HL-60 cells underwent internucleosomal DNA fragmentation and morphological changes characteristic of apoptosis after a 24-h treatment with esculetin (100 microM). Flow cytometric analysis showed that the hypodiploid nuclei of HL-60 cells were increased to 40.93% after a 36-h treatment with esculetin (100 microM). Further investigation showed that esculetin induced the release of cytochrome c from mitochondria into cytosol in a time-dependent and concentration-dependent manner. Moreover, esculetin application reduced Bcl-2 protein expression to 58% after 9 h as compared with that time at 0. Cysteine protease 32 kDa proenzyme (CPP32), a caspase 3, was activated and its substrate, poly (adenosine diphosphate-ribose) polymerase, was cleaved after a 24-h treatment of HL-60 cells with esculetin. These data suggest that esculetin induces apoptosis in human leukemia cells by increasing cytosolic translocation of cytochrome c and activation of CPP32.

Polyclonal anticardiolipin antibodies purified from sera of patients with active systemic lupus erythematosus induce apoptosis of the cultured glomerular mesangial cells

OBJECTIVE

To test the effect of anticardiolipin antibodies (aCL) on cultured glomerular mesangial cells with regard to their expression of apoptosis-related genes.

METHODS

aCL purified from active lupus sera by cardiolipin micelles were incubated with cultured rodent mesangial cells (RMC). Morphological changes of the RMC were observed. The genomic DNA was extracted for the detection of apoptosis. The total cell RNA was extracted for detection of Fas, c-myc, p53, and bcl-2 transcripts by reverse transcription-polymerase chain reaction.

RESULTS

aCL (100 GPL-U/0.1 mg protein/ml) bound to RMC more prominent than human IgG (100 microg/ml). The antibodies suppressed RMC proliferation in a dose-dependent manner. The RMC were undergoing apoptosis as evidenced by morphologic changes, fluoresceinannexin V staining and appearance of nucleosome-sized DNA fragments. RMC spontaneously express p53 and c-myc but not Fas or bcl-2. aCL (100 GPL-U/ml) enhanced the expression of Fas but not other apoptosis-related genes and suppressed the intracellular tyrosine phosphorylation.

CONCLUSIONS

Binding of aCL can induce apoptosis of the RMC. The aCL may be implicated in the pathogenesis of lupus nephritis.

Effect of laser-assisted in situ keratomileusis on the retinal nerve fiber layer

PURPOSE

To assess the effects of laser-assisted in situ keratomileusis (LASIK) on the retinal nerve fiber layer (RNFL).

METHOD

In a prospective study, the RNFL thickness of 35 eyes of 20 consecutive patients was measured before and 1 month after LASIK by scanning laser polarimetry.

RESULTS

The postoperative integrals and averages of RNFL thickness were statistically significantly lower than preoperative values, except in the temporal quadrant.

CONCLUSION

LASIK has a significant effect on RNFL thickness determined by scanning laser polarimetry. Further studies are needed to determine whether the corneal compensation algorithms are affected by the keratome flap, whether the decreased averages and integrals of the RNFL thickness are reversible, and how to protect the RNFL.

Inhibitory effect of esculetin on oxidative damage induced by t-butyl hydroperoxide in rat liver

Increasing evidence regarding free radical-generating agents and inflammatory processes suggests that accumulation of reactive oxygen species can cause hepatotoxicity. A short-chain analog of lipid hydroperoxide, t-butyl hydroperoxide (t-BHP), can be metabolized to free radical intermediates by cytochrome P-450 in hepatocytes, which in turn can initiate lipid peroxidation, affect cell integrity and result in cell injury. In this study, we used t-BHP to induce hepatotoxicity in vitro and in vivo and determined the antioxidative bioactivity of esculetin, a coumarin compound. Our investigations showed that pretreatment with esculetin (5-20 microg/ml) significantly decreased the leakage of lactate dehydrogenase (LDH) and alanine transaminase (ALT), and also decreased the formation of malondialdehyde (MDA) in primary cultured rat hepatocytes induced by a 30-min treatment with t-BHP. An in vivo study in rats showed that pretreatment with esculetin (i.p.) at concentrations of 0.5 and 5 mg/kg for 5 days before a single i.p. dose of t-BHP (0.1 mmol/kg) significantly lowered the serum levels of the hepatic enzyme markers (ALT and AST) and reduced oxidative stress in the liver. Histopathological evaluation of the rat livers revealed that esculetin reduced the incidence of liver lesions induced by t-BHP, including hepatocyte swelling, leukocyte infiltration, and necrosis. Based on the results described above, we speculate that esculetin may play a chemopreventive role via reducing oxidative stress in living systems.

Total morphine stability in urine specimens stored under various conditions

The stability of total morphine in urine stored under various conditions was studied using control and experimental specimens. Samples in the control group were prepared using drug-free urine spiked with morphine at three concentration levels (300, 1000, and 2500 ng/mL), each with the pH adjusted to 5.5, 6.5, and 7.5. Samples in the experimental group came from 20 alleged heroin addicts (provided by Taipei Municipal Psychiatric Hospital). Samples in both groups were divided into two categories--one with and one without the precipitate (formed at 0 degrees C) removed. Samples in each of these two categories were further divided into two sub-groups--one with and one without sodium azide (0.05%) added. Total morphine contents in these samples were first determined by gas chromatography-mass spectrometry prior to storage and at 6, 12, 18, and 24 months following storage at -20, 4, 25, and 35 degrees C. Effects of sample treatment (azide addition and precipitate removal), pH, and storage temperature and length were evaluated by examining the percentage of total morphine remaining at the four time intervals following the initial determination. Major findings were as follows: (1) total morphine decomposition was minimal when stored for 12 months at -20 degrees C, which is a common current practice; (2) samples with lower initial sample pH had slower total morphine decomposition rates; and (3) azide addition appeared to have no detectable effect, whereas precipitate removal appeared to marginally reduce the decomposition rate, especially for samples with lower pH.

Increased excretions of beta2-microglobulin, IL-6, and IL-8 and decreased excretion of Tamm-Horsfall glycoprotein in urine of patients with active lupus nephritis

Tubulointerstitial nephritis is a less frequently recognized but important complication of systemic lupus erythematosus. We have investigated the cytokine beta2-microglobulin (beta2M) and Tamm-Horsfall glycoprotein (THG) excretions in the urine of systemic lupus erythematosus patients to identify indices for evaluation of tubulointerstitial inflammation in lupus nephritis (LN). Daily urine was collected from 15 patients with active LN, from 12 patients with inactive LN, and from 17 normal subjects. The amounts of soluble interleukin (IL) 2 receptor, IL-6, IL-8, beta2M, and THG in urine were measured. Beta2M and THG were regarded as indicators of proximal and distal renal tubule function, respectively. The urinary excretions of IL-6 and IL-8 were significantly higher in patients with active LN than in those with inactive LN and in normal individuals. The excretion of soluble IL-2 receptor in all three groups of subjects was not significantly different. On the other hand, the excretion of beta2M in patients with LN was significantly higher than that in normal individuals. The excretion of beta2M in patients with active or inactive LN was not significantly different. The THG excretion was lower in patients with active LN and tubulointerstitial inflammation as compared with patients with inactive LN or normal individuals. Six patients underwent pulse cyclophosphamide therapy during the course of experiments. Five of them showed a decrease in IL-8 and IL-6 excretions in urine after the treatment. The excretions of beta2M and THG in urine, in addition to IL-6 and IL-8, can reflect the renal inflammatory activity in patients with lupus tubulointerstitial nephritis as well as in those having lupus glomerulonephritis.

Evidence against genetic anticipation in familial colorectal cancer

Anecdotal reports of hereditary colorectal cancer suggest that genetic anticipation (earlier appearance in successive generations) occurs, but ascertainment bias and cohort effects confound this interpretation. Using approaches that correct for such biases, we examined the age at diagnosis of colorectal cancer from family history questionnaires completed by subjects in the Johns Hopkins Hereditary Colorectal Cancer Registry; 475 parent-offspring pairs in 308 pedigrees were studied. We observed the expected cohort effect among offspring, in that the mean ages at diagnosis of those born before 1921, between 1921 and 1930, and after 1930 were 63 +/- 13 (SD), 57 +/- 10, and 42 +/- 10 years, respectively, while their parents' mean ages were 65 +/- 14, 66 +/- 14, and 58 +/- 15 years, respectively. In the cohort born before 1921, in which observation periods for both parents and offspring were comparable, there was no difference in age at diagnosis by pairwise comparison or life table analysis (P = 0.15 and 0.23, respectively; r = 0.32). Subgroup analysis of 67 pairs from 38 families that met the International Collaborative Group (ICG) criteria for hereditary nonpolyposis colorectal cancer (HNPCC) and of 14 pairs from 7 families with known germline mutations of DNA mismatch repair genes also showed no significant differences (mean age at diagnosis: 56 +/- 14 years for parents and 57 +/- 16 years for offspring from ICG families, and 45 +/- 10 years for parents and 44 +/- 12 years for offspring in families with known mutations). We also found no evidence for effect of parental gender on age at diagnosis in offspring of either gender, nor a secular trend toward younger onset colorectal cancer in this sample. In conclusion, there is no evidence for genetic anticipation or genomic imprinting of age at diagnosis in this sample of colorectal cancer families. Apparent anticipation appears to reflect a birth cohort bias of ascertainment.

Natural history of central islands after laser in situ keratomileusis

PURPOSE

To assess the incidence and natural history of central islands following laser in situ keratomileusis (LASIK) and evaluate the association of central island characteristics with visual acuity.

SETTING

Department of Ophthalmology, China Medical College Hospital, Taichung, Taiwan.

METHODS

A consecutive series of 406 eyes of 212 patients who had LASIK was retrospectively evaluated. Uncorrected visual acuity (UCVA) was measured and corneal topography performed preoperatively and 1 week and 1, 3, 6, and 9 months postoperatively. Best spectacle-corrected visual acuity (BSCVA) was evaluated preoperatively and 1, 3, and 6 months postoperatively.

RESULTS

The topographic images obtained at 1 week demonstrated central islands in 23 eyes of 20 patients (5.7%). No new cases of central island formation were identified after 1 week. Of the 23 eyes with central islands, the 6 month post-LASIK maps were available in 20 eyes of 18 patients. There was a significant difference in the size and power of the central islands between 1 week and 6 months. However, the power and size decreased slowly. Within 6 months, only 5 of 20 central islands (25.0%) had resolved. Eight eyes were undercorrected, and 1 eye lost 2 lines of BSCVA. Central islands larger than 1.8 mm or 3.0 diopters (D) were significantly correlated with lower UCVA.

CONCLUSION

Most central islands that occur with LASIK persist more than 6 months. Large central islands (>/=1.8 mm or >/=3.0 D) are risk factors for lower UCVA. Preventive measures are necessary.

Reiter's syndrome caused by Streptococcus viridans in a patient with HLA-B27 antigen

A 26-year-old male patient with mitral valve prolapse and HLA-B27 antigen received endodontic treatment for dental caries. Two weeks later fever, dysuria, diarrhea, sterile inflammatory arthritis of lower limbs, enthesitis, dactylitis, conjunctivitis, and uveitis consecutively developed. Blood culture performed at the time of active arthritis yielded Streptococcus viridans. He did not have any history of psoriasis, acute infectious diarrhea, chronic inflammatory bowel diseases, or sexually transmitted diseases. Laboratory studies also excluded the possibility of infections by human immunodeficiency virus, hepatitis B or C virus, chlamydia, and streptococci from the upper airway. This report indicates that Streptococcus viridans can be the triggering microorganisms of Reiter's syndrome in some circumstances.

Pediatric endogenous endophthalmitis

Pediatric endogenous endophthalmitis is a rare disease that can cause serious ophthalmic damage. We describe two cases of pediatric endogenous endophthalmitis. The first occurred in an 8-month-old boy and the second in a 7-day-old girl. These two patients had developed pneumonia due to Pseudomonas aeruginosa infection prior to the onset of ocular symptoms. The interval between the onset of pneumonia and ocular symptoms was 1 week, but endophthalmitis was diagnosed 9 days after the onset of ocular symptoms in the first case and 3 days after the onset of ocular symptoms in the second case. The ocular manifestations included eyelid swelling, purulent discharge, redness, corneal edema, hypopyon, and poor red reflex. Despite treatment with aggressive antimicrobial therapy, both patients became totally blind with eyeball atrophy.

Ablation centration after active eye-tracker-assisted photorefractive keratectomy and laser in situ keratomileusis

PURPOSE

To evaluate the ablation centration after active eye-tracker-assisted photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) and to investigate the effect of surgery, patient, and surgeon on the centration.

SETTING

Department of Ophthalmology, China Medical College Hospital, Taichung, Taiwan, Republic of China.

METHODS

This retrospective study comprised 177 eyes of 101 patients: 16 eyes had PRK and 161, LASIK. All laser treatments were performed with the aid of an eye tracker. The amount of decentration was analyzed by corneal topography. The factors influencing centration were divided into surgery related (PRK/LASIK), patient related (low/high myopia and effect of learning), and surgeon related (learning curve).

RESULTS

The mean decentration was 0.33 mm in PRK eyes and 0.35 mm in LASIK eyes. For the surgery-related factor, there was no significant difference between the PRK and LASIK eyes. For the patient-related factors, centration was better in the second eye (effect of learning) and decentration was more severe in eyes with high myopia (low/high myopia). For the surgeon-related factor, there was no significant difference between eyes that had the first 50 LASIK procedures and those that had the last 50 procedures.

CONCLUSIONS

An eye tracker, which makes the laser beam follow the eye's movements, helps to avoid severe decentration. This study showed, however, that an active eye-tracking system alone cannot ensure good centration. Patient cooperation and fixation are important.

Inhibitory effect of 12-O-tetradecanoylphorbol-13-acetate-caused tumor promotion in benzo[a]pyrene-initiated CD-1 mouse skin by baicalein

The effects of topical application of baicalein on 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced promotion of skin tumors, hyperplasia, ornithine decarboxylase activity, and inflammation were evaluated in female CD-1 mice. Topical application of baicalein (0.08, 0.16, or 0.2 mumol) with TPA (5 nmol) twice weekly for 24 weeks to mice previously initiated with benzo[a]pyrene inhibited the number of TPA-induced tumors per mouse significantly. Preapplication of the same amount of baicalein also afforded significant protection against TPA-induced hyperplasia in the ear skin. Topical application of baicalein inhibited tumor promoter-caused induction of epidermal ornithine decarboxylase activity by TPA (5 nmol). The topical application of baicalein (0.008, 0.016, or 0.02 mumol) inhibited TPA-induced edema of mouse ears by 88%, 96%, or 97%, respectively. Pretreatment of mouse skin with various amounts of baicalein caused inhibition of H2O2 and myeloperoxidase formation by TPA. These results indicate that baicalein can be a potential cancer-chemopreventive agent against tumor promotion.

Transscleral fixation of foldable intraocular lens after pars plana lensectomy in eyes with a subluxated lens

Two patients had a subluxated crystalline lens: one with Marfan's syndrome and the other with traumatic cataract. A pars plana lensectomy with transscleral fixation of a foldable silicone intraocular lens rather than a conventional poly(methyl methacrylate) lens was performed. Excellent, rapid visual rehabilitation was obtained using this small incision technique.

Interleukin-13 increases prostaglandin E2 (PGE2) production by normal human polymorphonuclear neutrophils by enhancing cyclooxygenase 2 (COX-2) gene expression

OBJECTIVE

To investigate whether interleukin-13 (IL-13) can affect arachidonic acid metabolism and phagocytic activity of normal human polymorphonuclear neutrophils (PMN).

METHODS

Normal human PMN (1 x 10(6) cells/ml) were incubated with different concentrations of IL-13 (0.1-10 ng/ml) for a variety of times (30-120 min). Phagocytosis and intracellular cyclooxygenase-2 (COX-2) were detected by flow cytometry. The expression of COX-1 and COX-2 mRNA was detected by RT-PCR. The concentration of PGE2 in the PMN cultured supernatants was determined by EIA.

RESULTS

We found that IL-13 at an optimal concentration of 1 ng/ml significantly enhanced COX-2 gene expression and PGE2 production (121.57 +/- 22.17 pg/ml in IL-13 stimulation vs. 73.16 +/- 11.72 pg/ml in controls) by PMN. In addition, IL-13 stimulated PMN phagocytosis via increased complement receptor type 1 (CR1) and type 3 (CR3), but not IgG Fcgamma receptor type 3 (FcgammaRIII). The cytoplasmic neutral esterase activity of PMN was also enhanced by IL-13 stimulation for 24 h.

CONCLUSIONS

These results suggest that IL-13 can stimulate PMN and modulates the inflammatory reactions via the cyclooxygenase pathway.

The effect of human polyclonal anti-dsDNA autoantibodies on apoptotic gene expression in cultured rat glomerular mesangial cells

In our previous studies, we found that polyclonal anti-double-stranded DNA antibodies (anti-dsDNA) purified from sera of patients with active systemic lupus erythematosus (SLE) were cytotoxic to cultured rat glomerular mesangial cells (RMC) through an apoptotic mechanism. In order to determine whether these nephritogenic antibodies affect the expression of apoptosis-related genes in the tissues, the expression of Fas, p53, c-myc, and bcl-2 genes in the kidneys and livers of 12-week-old normal BALB/c and autoimmune MRL-lpr/lpr mice was detected by a reverse transcription-assisted polymerase chain reaction (RT-PCR). We found the mRNA of the four genes were expressed in the tissues of the normal mice. In contrast, decreased expression of the four genes in the kidney and absent expression of bcl-2 in the liver of the lpr mice were noted. Interestingly, RMC only expressed p53 and c-myc, but not Fas or bcl-2, in culture. The purified polyclonal anti-dsDNA dose-responsively (50-200 IU/ml) suppressed the 3H-thymidine incorporation of RMC after incubation for 48 h. However, the incubation of 100 IU/ml of anti-dsDNA with RMC for 4 h did not affect the expression of these apoptotic genes. The results suggest that anti-dsDNA induce RMC apoptosis via an unidentified mechanism different from Fas, c-myc or p53 pathway.

Pure red cell aplasia in a man with RA

A 65 year-old man with long-standing rheumatoid arthritis (RA) developed pure red cell aplasia (PRCA), which was apparently not caused by drugs or viral infections. The condition responded favorably to danazol in combination with sulfasalazine. This was probably the 2nd case of RA with PRCA in a male patient.

Successful treatment of recurrent corneal intraepithelial neoplasia with topical mitomycin C

PURPOSE

To evaluate the clinical efficacy of topical mitomycin C (MMC) 0.04% in the treatment of recurrent corneal intraepithelial neoplasia.

METHODS

A 71-year-old man presented with a limbal tumor that had extended onto the inferior temporal quadrant of the left cornea. Superficial lamellar sclerokeratectomy was performed to remove the tumor, which was histopathologically demonstrated to be a corneal intraepithelial neoplasia. Fifteen months after the surgical excision, the tumor recurred at the previous keratectomy site. The patient was treated topically with 0.04% MMC four times daily for 2 weeks, during which time he only had a mild degree of conjunctival hyperemia and ocular pain.

RESULTS

The tumor resolved completely after 2 weeks of treatment and did not recur during the 10-month follow-up.

CONCLUSION

Topical MMC may be an effective alternative treatment for recurrent corneal intraepithelial neoplasia and deserves further evaluation.

The expression of genes modulating programmed cell death in normal human polymorphonuclear neutrophils

Normal human polymorphonuclear neutrophils (PMN) have a short life and die in progression via apoptosis. In order to understand the molecular basis of PMN apoptosis, the expression of apoptosis-related (Fas, Fas-ligand, p53, and c-myc) and survival-related (bcl-2) genes was detected by flow cytometry, Western blot and reverse transcription-assisted polymerase chain reaction (RT-PCR). We found that Fas and Fas-ligand (FasL) were expressed on the surface of most of the cells. However, the disappearance of FasL was much faster than Fas after 24 h incubation. p53 and bcl-2 were also expressed in the cytoplasm of most of the cells. In contrast, the expression of c-myc was negligible in PMN. The addition of monoclonal anti-human Fas antibody (25 micrograms/ml) to PMN suspension enhanced whereas anti-FasL antibody (25 micrograms/ml) suppressed PMN apoptosis in 48 h incubation. These results suggest that the activation of Fas pathway induced by Fas-FasL interaction among PMNs is one of the mechanisms for spontaneous PMN apoptosis. Lack of proto-oncoprotein c-myc expression in PMN is responsible for their non-proliferative property and may aggravate the spontaneous apoptosis of the cells.

Tamm-Horsfall glycoprotein (THG) is a binder for surface membrane proteins on blood cells and glomerular mesangial cells

A macromolecule with a molecular weight of 90-100 kDa was purified from normal human pregnancy urine. The molecule was proved to be the Tamm-Horsfall glycoprotein (THG) by Western blot analysis. The macromolecule contains carbohydrate as detected by an enzyme immunoassay. Functionally, the glycoprotein can adhere to and stimulate the thymidine incorporation of human mononuclear cells (MNC) in modest degree via its membranotropic property. In addition to MNC, the protein can also bind to the surface of human polymorphonuclear neutrophils (PMN), red blood cells (RBC) and rat glomerular mesangial cells (RMC). Western blot analysis of various cell lysates with/without proteinase K pretreatment before cell lysis revealed that a 60 kDa and a molecule larger that 94 kDa on the surface of PMN, a 60 kDa protein on MNC and a 32 kDa protein on RBC are the binding molecules for THG. In contrast, many proteins on the surface of RMC could be bound by THG. Immunoprecipitation of membranous iodinated MNC lysates also confirmed that the 60 kDa molecule on MNC is the binding protein for THG. A number of monosaccharide including N-acetylneuraminic acid, N-acetyl-galactosamine, N-acetyl-glucosamine and alpha-methyl-D-mannoside could not inhibit the mitogenic effect of THG on human mononuclear cells. These results suggest that THG is capable of reacting with surface membrane proteins on different cells, but not through the specific carbohydrate-containing lectin-like receptors on the cell surface.

The relationship of aging to endotoxin shock and to production of TNF-alpha

BACKGROUND

Aged people are considered prone to gram-negative bacteremia and septic shock. This relationship was tested in murine endotoxin shock.

METHODS

Balb/c mice of various ages (1.4-13.4 months) were intraperitoneally injected with lipopolysaccharide (LPS), and rates of survival were observed. The production of TNF-alpha in vivo induced by LPS was measured.

RESULTS

The survival rates were the smallest in the oldest and youngest groups. Production of TNF-alpha attained a maximum at 2 h after LPS injection and was smaller in the oldest group; it had a reciprocal relationship to survival rates in each group except the youngest group.

CONCLUSION

Old and young mice had smaller rates of survival and greater production of TNF-alpha following endotoxin shock induced by LPS.

The reactivity of sera from patients with systemic lupus erythematosus to seven different species of single and double stranded deoxyribonucleic acids

OBJECTIVE

Anti-DNA antibodies are frequently found in the serum of patients with systemic lupus erythematosus (SLE). To understand whether the avidity of SLE sera to different species of single-stranded (ss) and double-stranded (ds) DNA is different or not, the reactivity of active SLE sera to seven species of DNA from viral, bacterial, piscine, and mammalian sources was compared.

METHODS

Nineteen sera from patients with active SLE were studied for their reactivity to different ssDNA and dsDNA from Escherichia coli (EC), Micrococcus lysodeikticus (ML), Clostridium perfringens (CP), calf thymus (CT), salmon testis (ST), human placenta (HP) and lambda phage by ELISA. The dsDNA was purified by treating it with S1 nuclease and proteinase K, followed by Sephacryl S-300 gel filtration. The ssDNA was purified by absorption on a hydroxyapatite column after heat-cleavage of the dsDNA.

RESULTS

The reactivity of SLE sera to 7 species of dsDNA was not significantly different and they recognized a more widely shared epitope. In contrast, the reactivity of these sera to 7 species of ssDNA was erratic and the antigens could be grouped into high (CP and HP), medium (EC, ML, CT, and ST) and low (lambda-phage) antigenicities.

CONCLUSION

The anti-ssDNA and anti-dsDNA antibodies of SLE patients recognize more widely shared determinants on the DNA of seven different species. Lambda-phage DNA shows the poorest immunogenicity among them.

Osteochondroma in a patient with juvenile ankylosing spondylitis associated with idiopathic thrombocytopenic purpura and alpha thalassemia

An unusual combination of osteochondroma, ankylosing spondylitis, thalassemia alpha, and thrombocytopenia was found in a young man who had once been an amphetamine addict. The association of these settings might have been coincidental but it cannot be excluded that the preexisting inflammatory processes or tissue destruction in the latter 3 diseases might have rendered the patient prone to the development of osteochondroma.

Production of the third component of complement (C3) by peripheral polymorphonuclear neutrophils of the patients with rheumatoid arthritis

Normal human polymorphonuclear neutrophils (PMN) can spontaneously produce the third component of complement (C3) in in vitro culture as detected by ELISA. This C3-producing capacity of PMN can be augmented by TNF-alpha (20 ng/ml) and bacterial lipopolysaccharide (100 ng/ml), but not by IL-1 beta or IL-8. The C3 production by PMN was found to be temperature dependent and was suppressed by the addition of protein inhibitor. The C3 mRNA in PMN could be detected by reverse transcription assisted polymerase chain reaction (RT-PCR) after TNF-alpha or LPS stimulation for 6 hours. To further understand C3 production by peripheral blood PMN in rheumatoid arthritis (RA), spontaneous and TNF-alpha stimulated production of C3 by peripheral PMN were compared in 15 cases of active RA, 15 inactive RA and 15 normal individuals. We failed to find any significant difference among the three groups. We conclude that PMN plays a negligible role in C3 hypercomplementemia in patients with active RA.

Defective spontaneous and bacterial lipopolysaccharide-stimulated production of interleukin-1 receptor antagonist by polymorphonuclear neutrophils of patients with active systemic lupus erythematosus

Interleukin-1 receptor antagonist (IL-1ra) binds competitively to IL-1 receptors but does not transduce the signal which blocks the biological activities induced by IL-1. In this study, polymorphonuclear neutrophils (PMN) and mononuclear cells (MNC) from the patients with active systemic lupus erythematosus (SLE) (n = 11), inactive SLE (n = 13) and normal individuals (n = 13) were compared for the IL-1ra producing capacity of these cells. PMN and MNC at a concentration of 1 x 10(6) cells/ml were incubated with medium alone (spontaneous) or stimulated with lipopolysaccharide (LPS, 100 ng/ml) for 24 h. The IL-1ra concentration in the supernatants was quantified by ELISA method. Both spontaneous and LPS-stimulated production of IL-1ra by PMN, but not by MNC, of active SLE were significantly lower than that of inactive SLE or normal groups. Prednisolone (1 and 5 micrograms/ml) did not change the production of IL-1ra by normal PMN either spontaneously or LPS-stimulation in in vitro study. Moreover, the IL-1ra producing capacity of PMN in seven active SLE on admission and after intensive immunosuppressive treatment was measured. These results suggest that the defective IL-1ra production by SLE-PMN is relevant to disease activity and may be regarded as a new indicator of disease activity in patients with active SLE.

The elevation of plasma DNA in patients with systemic lupus erythematosus is attributable to increased DNA release and defective DNA binding of mononuclear cells

BACKGROUND

Although immunoprecipitable DNA has been found in a subgroup of patients with systemic lupus erythematosus (SLE) exhibiting systemic vasculitis and/or central nervous system involvement, the mechanism for elevated plasma DNA in these patients is poorly understood.

METHODS

The plasma DNA concentrations and reactivity of serum and lymphocytes to six species of double-stranded DNA from calf thymus, human placenta, Escherichia coli, Micrococcus lysodeikticus, Clostridium perfringens and poly (dG.dC). poly (dG.dC) were measured in twenty-seven patients with active SLE. To understand the mechanism of increased plasma DNA in SLE, the DNA binding and release of the mononuclear cells were examined.

RESULTS

Compared with the controls, the incidence of the presence of plasma DNA was markedly increased in SLE (59.3% in SLE vs. 7.4% in controls) as detected by counterimmunoelectrophoresis. Except for DNA from Clostridium perfringens, the reactivity of lupus sera to various DNA samples was significantly higher than that of the controls. The reactivity of lymphocytes to 6 species of DNA (as defined by 3H-thymidine incorporation of the cells) was also higher in SLE patients. In DNA binding and releasing experiments, patients with SLE were found to have decreased 3H-DNA binding activity (0.169 +/- 0.018 micrograms/2 x 10(6) cells in SLE vs. 0.283 +/- 0.02 micrograms/2 x 10(6) cells in controls, p = 0.001) but to have increased spontaneous release of DNA (1,465 +/- 412 cpm in SLE vs. 630 +/- 179 cpm in controls, p = 0.0173) in mononuclear cells.

CONCLUSIONS

The results suggest that some subsets of lymphocytes can be sensitized by different DNA samples in vivo to increase endogenous DNA release from mononuclear cells, which in addition to decreased DNA clearance as has been previously reported, may be responsible for the elevation of plasma DNA in patients with SLE.

Decreased spontaneous and lipopolysaccharide stimulated production of interleukin 8 by polymorphonuclear neutrophils of patients with active systemic lupus erythematosus

OBJECTIVE

Interleukin 8 (IL-8) acts as a potent chemotactic cytokine and also as an autocrine factor for polymorphonuclear neutrophils (PMN), thus amplifying the acute inflammatory reaction. We undertook to study the IL-8 producing capacity of PMN in patients with systemic lupus erythematosus (SLE).

METHODS

PMN from twelve patients with active SLE, from fifteen patients with inactive disease and from sixteen healthy individuals were incubated for 24 hours in medium alone, or in medium with lipopolysaccharide (LPS) or TNF-alpha. The IL-8 concentration in the culture supernatants was measured by an enzyme linked immunosorbent assay.

RESULTS

We found that the spontaneous and LPS-stimulated, but not TNF-alpha-stimulated, production of IL-8 by the PMN of active SLE patients were significantly lower than that of healthy individuals. The impaired IL-8 production by SLE-PMN was linked to disease activity but not to the administration of steroid, because incubation of normal PMN or inactive SLE-PMN with prednisolone (1 microgram/ml and 5 micrograms/ml) for 24 hours did not affect IL-8 production. In addition, IL-8 production increased in three active SLE patients after effective treatment with immunosuppressants but not in two cases of ineffective treatment, in the follow-up study.

CONCLUSION

These results suggest that decreased IL-8 production is one of the defects of PMN in patients with active SLE, which might predispose SLE patients to infection.

Allopurinol hypersensitivity syndrome

Allopurinol hypersensitivity syndrome (AHS) is an infrequent but life-threatening adverse reaction of allopurinol therapy. The records of 38 patients with the allopurinol hypersensitivity syndrome evaluated at the Veterans General Hospital-Taipei were reviewed. The clinical pictures included fever, rash, leukocytosis, eosinophilia, impaired renal function and hepatocellular injury. Nine patients died (24%) and the major cause of death was infection. The use of corticosteroids increased neither survival nor mortality rate. Twenty-six percent of patients were treated with allopurinol for asymptomatic hyperuricemia, which was not an established indication of the drug, should be avoided. The most important factor of mortality was toxic epidermal necrolysis (TEN) (p < 0.001 compared with other skin lesions). As there is no way to identify the risk group of patients or to make effective treatment for AHS, the only means of minimizing the incidence of AHS is to limit the allopurinol therapy to accepted indications and to adjust the dosage for the patient's renal function.

Conjunctival involvement of lymphomatoid granulomatosis

Lymphomatoid granulomatosis is an angiocentric and angiodestructive lympho-proliferative disorder involving multisystems but rarely conjunctiva. We present a 62-year-old Chinese female with lymphomatoid granulomatosis who had an ulcerative conjunctival nodule. Conjunctival biopsy revealed pathological findings important for diagnosis and indicating progression of disease severity. To our knowledge, this is the first report to demonstrate pathological findings characteristic of lymphomatoid granulomatosis with conjunctival involvement.