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Biomedical subjects

A Cusumano

Publications and source records attributed to A Cusumano.

At least 19 recordsLinked to original sources
PubMed2000

Role of T lymphocytes in renal disease in HIV-transgenic mice.

The pathogenesis of human immunodeficiency virus (HIV)-associated focal segmental glomerulosclerosis (FSGS) has remained obscure. It has been proposed that renal parenchymal cells may be infected with HIV-1. If such infection occurs, the target cells would be expected to express viral proteins and thus could be targets for cytotoxic T lymphocytes. We previously described mice transgenic for a gag-pol-deleted HIV-1 genome that developed FSGS. In the present study, we tested the requirement for functional T cells in the evolution of renal disease in this model. We bred the HIV-transgenic mice (T26) with athymic nude mice to produce athymic T26 mice. We confirmed by flow cytometry of peripheral blood, thymus, lymph node, and spleen that the athymic T26 mice lacked mature T cells. The athymic T26 mice developed renal disease characterized by FSGS, tubular atrophy and dilatation, and interstitial infiltrate that was qualitatively identical to that seen in the parental T26 mice. Quantitative assessment of the athymic T26 mouse kidneys showed that glomerulosclerosis, tubular injury, and interstitial infiltrate were less severe compared with the parental T26 mouse kidneys. Although T26 mouse kidneys had a mixed cellular infiltrate composed of CD4 cells, CD8 cells, and macrophages, interstitial infiltrates within the athymic T26 mouse kidneys included macrophages but lacked both CD4 and CD8 cells. The renal expression of the HIV transgene was 1. 7-fold greater in T26 mice compared with athymic T26 mice. We conclude that mature T cells are not absolutely required for the development of HIV-associated nephropathy in transgenic mice but that, in their absence, renal disease is significantly milder. These data suggest that T-cell-mediated cytotoxicity directed against renal cells expressing virally encoded proteins is not an essential feature of renal pathogenesis in this model.

Animals↗
PubMed1998

Three-dimensional ultrasound imaging. Clinical applications.

OBJECTIVE: The aim of this report is to describe the technology of three-dimensional (3-D) ultrasonic imaging and its impact on improved diagnosis and monitoring of ocular disease. DESIGN: The authors reviewed techniques for acquiring and displaying 3-D ultrasound data of the eye. PARTICIPANTS: The authors applied these techniques to representative individual cases, including a choroidal hemorrhage, a ciliary body melanoma, a ciliary body detachment, a displaced posterior chamber intraocular lens, and topographic analysis of a normal cornea. INTERVENTION: A computer-controlled motion system was used to perform very high-frequency (VHF) (50-MHz) and conventional (10-MHz) digital 3-D ultrasound data collection. The scanning system allowed digitization of ultrasound data from a series of parallel planes. The 3-D data could be manipulated interactively to obtain two-dimensional images in any plane through the scan volume. The 3-D images were constructed by volume rendering and could be positioned for viewing from a variety of perspectives. The 3-D ultrasound parameter images representing acoustic scatterer properties were generated by spectrum analysis of digitized echo data. Color maps representing the contour and thickness of the epithelium and stroma of the central corneal were generated by digital signal processing of 3-D echo data. RESULTS: Quantitative volume measurement and biometric techniques enhanced the diagnostic and treatment planning information content in 3-D ultrasound images. The location and extent of hemorrhage and clots within the suprachoroidal space were shown with solid modeling. Volume changes in ciliary body melanoma over time were documented and 3-D ultrasound parameter image changes associated with radiation therapy observed. In ciliary body detachment, the extent of the detachment was shown. Solid modeling of a posterior chamber intraocular lens showed misplacement of the haptic in relation to the lens capsule remnants. Keratopachymetric maps showed the range and variance of thickness and local radius of curvature measurements in the cornea. CONCLUSIONS: Quantitative volume measurement and biometric tools combined with segmentation of 3-D ultrasound images improve diagnostic and treatment planning informational content of 3-D ultrasound images through improved localization of tissue structures.

Choroid Hemorrhage↗
PubMed1997

[Liver histology in chronic hemodialysis patients infected with hepatitis C virus].

Liver biopsies were analyzed in 21 patients with chronic renal failure (CRF) who tested positive for Hepatitis C Virus (HCV), using Elisa II and/ or PCR. The study included 14 men and 7 women, the average age being 41 years old (range: 20-65). The average span of time under dialysis was 64 months (range: 12-192). Hbs ag. was positive in six patients. Patients underwent biopsy for showing persistent rise of transaminase for more than 6 months. The modified Knodell Index was used to grade hepatic lesions. All biopsies showed chronic hepatitis, of which 2 were associated with cirrhosis. Eight patients were infected with mild chronic hepatitis, ten were infected with moderate chronic hepatitis, and only three patients had a severe lesion. Fibrosis was mild in 13 cases, moderate in 6, and 2 had cirrhosis. Chronic Hepatitis C characteristic lesions analysis showed lymphoid nodules in 6 cases (29%), ductal epithelium lesions in 7 (33%), and steatosis in 7 (33%). Chronic HCV infection in our patients seems to have histologic characteristics similar to those reported in HCV positive non CRF patients.

Adult↗
PubMed1996

[Nutritional status of patients on chronic hemodialysis].

The objective was to determine the nutritional status (NS) in a population undergoing chronic hemodialysis (CHD), and correlate it with dialysis dose and morbimortality. A total of 55 patients, 27 men and 28 women, aged 47 +/- 15 and with a history of CHD of 54.6 +/- 47.6 months were evaluated. NS was classified into: adequate, mild malnutrition, moderate malnutrition and severe malnutrition. A score based on usual laboratory data (total iron-binding capacity [TIBC], albumin and cholesterol), clinical evaluation and anthropometric measurements (body mass index [BMI], mid brachial circumference, tricipital fold [TF], mid brachial muscle circumference [MBMC]), was used. In addition, a 7-days' intake auto-registration plan was conducted, and protein catabolic rate (PCR) was determined. Calorie intake was of 27 +/- 13 kcal/kg/day and protein intake was of 1.2 +/- 0.5 g/kg/day. No correlation was found between the latter and PCR. 49.1% of patients had moderate to severe malnutrition, only 9 patients had an adequate NS. However anthropometric measurements showed that TF, MBMC and BMI were normal in 54.5%, 45%, and 72.7% of patients, respectively. No correlation was found between NS and age onset of CHD, sex, creatinine, dialysis dose (Kt/V x = 1.24 +/- 0.12), PCR and morbidity. A longer history of dialysis was associated with a worse NS (p < 0.01). In addition, NS significantly correlated with albumin (p < 0.01) and mortality (p < 0.05). The estimated death risk was 9.45 times higher in patients with moderate and severe malnutrition.

Energy Intake↗
PubMed1995

Intraocular lens removal from eyes with chronic low-grade endophthalmitis.

Intraocular lenses (IOLs) were removed from 11 eyes with chronic low-grade endophthalmitis after cataract extraction to restore useful vision and prevent recurrence. One anterior chamber lens, one iris-supported lens, and nine posterior chamber lenses were removed. In the eyes with posterior chamber lenses, the posterior capsule was intact; total (n = 7) or partial (n = 2) capsulectomy was performed in these eyes. Aqueous humor specimens obtained at surgery were positive for bacteria in five eyes, but scanning electron microscopy showed bacteria on all removed IOLs and capsular bags. Final best corrected visual acuity was 20/40 or better in seven eyes. Reduced visual acuity, between 20/50 and 20/400 in three eyes and counting fingers in one eye, was related to retinal detachment (n = 2) and age-related macular degeneration (n = 2). Transient hyphema was seen in one eye. With a mean follow-up of 21 months (range 10 to 31 months), no recurrence of inflammation was observed. The results show that negative cultures do not preclude a bacterial cause for infection and that primary IOL removal with partial or total capsulectomy provides a surgical approach to the treatment of chronic low-grade endophthalmitis not responsive to medical therapy.

Aged↗
PubMed1995

[Complex anterior chamber dysgenesis with bilateral corneal ectasia].

BACKGROUND: Sclerocornea is a congenital, uni- or bilateral, non-progressive, non-inflammatory malformation characterized by histological changes of the cornea resembling scleral tissue. CASE REPORT: We report the case of a 2-month-old child with bilateral dysplasia of the anterior segment including: 1. extreme corneal ectasia; 2. vascularized, opacified microcornea; 3. presence of rudimental limbus; 4. anterior scleral dysplasia. The axial length measured by means of ultrasonography (A-scan) was about 24 mm in both eyes. A penetrating keratoplasty was first performed in the right eye and one week later in the left eye. Intraoperatively an advanced iris atrophy with extensive anterior synechiae, as well as a localized anterior subcapsular cataract were seen bilaterally. A pale optic disk with a maximally enlarged optic cup could be seen only in the left eye. CONCLUSION: Although the histologic examination was compatible with the diagnosis of sclerocornea, the presence of atypical clinical findings previously unreported does not allow a definite classification of the case reported herein.

Anterior Chamber↗
PubMed1994

Galactose- binding sites in the acinar cells of the human accessory lacrimal gland.

This investigation for the first time has collected evidence of a specific glycoconjugate contribution of the acinar cells from accessory lacrimal glands to human tears. Amongst group III lectin binding glycoconjugates, monosaccharides seem to be more prominent than disaccharides. alpha (and less obvious beta) Galactose sugar moieties appear to be specifically important. A need for further differentiating investigations is outlined.

Acetylgalactosamine↗
PubMed1994

[Chronic low grade endophthalmitis. A growing indication for explantation of intraocular lenses].

The aim of this study was to evaluate the effect of progress made in cataract surgery regarding the indications and results of intraocular lens (IOL) removal. For this purpose, the charts of all patients who had undergone IOL explantation at our institution between January 1990 and December 1992 were reviewed. Indications were divided into six groups: (a) chronic low-grade endophthalmitis; (b) pseudophakic bullous keratopathy; (c) luxation; (d) traumatic expulsion; (e) high-degree aniseikonia; (f) acute endophthalmitis. Visual acuities were grouped according to a good (1.0 to 0.5), acceptable (0.4 to 0.05) and poor (less than 0.05) outcome. Fifty-two IOL were removed from 52 eyes of 52 patients during the period considered in this study. Sixteen were anterior chamber, 5 were iris-fixated, and 31 were posterior chamber lenses. The removal rates were 30.8% for chronic, low-grade endophthalmitis (n = 16), 28.8% for bullous keratopathy (n = 15), 28.8% for luxation (n = 15), 5.8% for traumatic expulsion (n = 3), 3.8% for high-degree aniseikonia (n = 2), and 1.9% for acute endophthalmitis (n = 1). After explantation vision equal to or better than 20/400 was achieved by the vast majority of patients in all groups with the exception of those with bullous keratopathy. The progress made in cataract surgery over the last decade has greatly influenced the rate of complications leading to IOL removal. Continuous monitoring of explanted IOLs is mandatory to evaluate further changes in surgical technique and lens design.

Adolescent↗
PubMed1993

Epithelial interface cysts after epikeratophakia.

BACKGROUND: Epithelial interface cysts have been occasionally observed after lamellar keratoplasty. The authors report the incidence, clinical significance, and management of this complication in epikeratophakia patients. METHODS: From August 1987 to January 1991, 108 consecutive patients undergoing epikeratophakia entered a prospective study aimed at evaluating both clinical results and changes in corneal physiologic parameters. After an average hospitalization of 6 days, all patients underwent complete ophthalmologic examinations at regular intervals after surgery. All postoperative complications, including the development of epithelial interface cysts, were recorded and photographed. RESULTS: Over a 3-year period, epithelial interface cysts were observed in 8 eyes, with an overall incidence of 7.4%. All cysts originated under the periphery of the epilens. In five patients, the cysts enlarged centripetally but eventually ceased to grow, causing no visual impairment. In two patients, after an initial increase in size the cysts slowly regressed and finally disappeared. In only one patient, a cyst migrated over the visual axis, thus necessitating surgical removal. The cyst did not recur during an observation time of 18 months after debridement, allowing full recovery of visual acuity. CONCLUSION: The incidence of epithelial interface cysts after epikeratophakia is relatively high. Because of their peripheral location and self-limited growth, the clinical significance of this complication is low. The possibility of spontaneous regression of the cysts supports a conservative approach, as long as the visual axis is not affected. Surgical removal is possible without compromising the epi-lens and is compatible with an excellent visual outcome.

Adult↗
PubMed1993

The architecture of human accessory lacrimal glands.

Human accessory lacrimal glands were examined both light and electron microscopically and their gross architecture was reconstructed from serial sections. Every accessory lacrimal gland nodule is an individual organ with its own connective tissue coat and excretory duct. Within the gland proper, the excretory duct ramifies to form intralobular ducts, which are connected to the secretory glandular epithelia. The secretory epithelia are composed of elongated tubules terminating in short end pieces with lumina of variable width. True acini are absent. Thus, the accessory lacrimal glands are tubular glands. The cells of tubules and end pieces contain large secretory granules suggestive of a regulated mechanism of secretion. The content of organelles and the amount of secretory material present in neighboring cells can show pronounced differences. Both end pieces and tubules and, to a lesser extent, the intralobular ducts are surrounded by myoepithelial cells. The interstitial connective tissue contains blood vessels, free cells, and fibroblasts. Axons of nonmyelinated nerve fibers are in close spatial contact to vascular endothelial cells, connective tissue cells, free cells, and glandular epithelial cells. A few axons with parasympathetic characteristics and, less frequently, with sympathetic characteristics were identified between the epithelial cells of both secretory epithelium and intralobular ducts.

Blepharoptosis↗
PubMed1992

Push-through intubation: effective palliation in 409 patients with cancer of the esophagus and cardia.

Between 1980 and 1989, 355 patients with cancer of the esophagus and 54 with cancer of the cardia underwent push-through intubation because of advanced tumor stage or medical contraindications to tumor resection. In 36 other patients (8.1%), the attempt at transtumoral intubation failed. The hospital mortality rate after intubation was 3.4%. The following complications were observed: hemorrhage in 2.0% of the patients, esophageal perforation in 4.9%, tube dislodgment in 12.7%, and tube obstruction in 4.4%. Early resumption of semisolid oral feeding was possible in 80% of the discharged patients. The actuarial 1-year survival rate was 7.7% and the median survival, 3.9 months. In conclusion, push-through intubation represents a valid therapeutic choice, which is indicated mainly for patients with a long, infiltrating, and circumferential stricture of the thoracic esophagus or cardia that is inoperable and for patients with an esophagorespiratory or esophagomediastinal fistula.

Adenocarcinoma↗
PubMed1991

Early and long-term results of pneumatic dilation in the treatment of oesophageal achalasia.

Between 1967 and 1989, 60 patients underwent pneumatic dilation of the cardia at our institution. Of these, 33 had not undergone any previous treatment (group 1), whereas 27 presented with recurrent dysphagia after a failure of surgical treatment (group 2). In this series there was no procedure-related mortality and a perforation occurred only in 1 patient who was treated conservatively. The mean follow-up was similar in both groups (44 and 49 months, respectively). The results of pneumatic dilation were either excellent or good in 61% of group 1 patients, and in 76% of group 2 patients. Reflux oesophagitis requiring medical therapy occurred in 1 group 2 patient. We conclude that pneumatic dilation is a safe and relatively effective procedure in patients with achalasia. Patients with a failed Heller myotomy seem to respond better than patients without previous surgery. However, the risk of gastro-oesophageal reflux after pneumatic dilation should not be underestimated.

Catheterization↗
PubMed1991

Is chronic intraocular inflammation after lens implantation of bacterial origin?

In an effort to better understand the cause of chronic intraocular inflammation after intraocular lens (IOL) implantation, both scanning and transmission electron microscopy were used to compare 1 anterior chamber, 1 iris-fixated, and 3 posterior chamber IOLs removed for this condition between 2 and 16 months after implantation with 8 IOLs explanted for other reasons (decentration in 4 cases, bullous keratopathy in 4 cases). Colonization with non-slime-producing, as well as slime-producing bacteria (1 case) in the presence of a thin membranous structure of cellular origin (multinucleated giant cells and macrophage-like cells) was demonstrated on all of the 5 IOLs explanted from inflamed eyes. Neither bacteria nor membranous structures could be identified on the IOLs removed because of dislocation or from eyes with bullous keratopathy. These observations indicate that bacterial colonization and the consequent host response may be characteristic features of many otherwise unexplained cases of intraocular inflammation after IOL implantation.

Aged↗
PubMed1991

Mycotic infection of the capsular bag in postoperative endophthalmitis.

A case of mycotic infection after uncomplicated extracapsular cataract extraction with implantation of a posterior chamber modified C-loop intraocular lens (IOL) is reported. Severe postoperative intraocular inflammation, diagnosed by aqueous cultures as secondary to Staphylococcus aureus endophthalmitis, did not respond to antibiotic therapy. Despite IOL and capsular bag removal and further antibiotic treatment, the inflammation persisted and phthisis followed. Retrospective electron microscopic examination of the explanted material demonstrated the presence of abundant fungal elements in the capsular bag and spores on the IOL surface. Vitreous taps performed at the time of explantation were negative for bacteria and fungi, confirming the localized nature of the mycotic infection. To our knowledge this report represents the first observation of a mycotic infection confined to the capsular bag after cataract surgery with implantation of a posterior chamber IOL.

Aged↗