Risk factors for open-angle glaucoma: the Barbados Eye Study.
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Adult↗
Biomedical subjects
A Sommer
Publications and source records attributed to A Sommer.
Missense mutation in the paired domain of PAX3 causes craniofacial-deafness-hand syndrome.
Craniofacial-deafness-hand syndrome (MIM 122880) is inherited as an autosomal dominant mutation characterized by the absence or hypoplasia of the nasal bones, profound sensorineural deafness, a small and short nose with slitlike nares, hypertelorism, short palpebral fissures, and limited movement at the wrist and ulnar deviations of the fingers. In a family of three affected individuals with this syndrome, a mother and two children, a missense mutation (Asn47Lys) in the paired domain of PAX3 was initially detected by SSCP analysis. PCR amplification using an oligonucleotide with a terminal 3'-residue match for the C-to-G transversion in codon 47 showed the presence of this mutation in the DNA from all affected members. The DNA from unaffected members were refractory to PCR amplification with the mutation-specific oligonucleotide but did amplify a control primer pair in the same PCR reaction tube. A previously described missense mutation in this same codon (Asn47His) is associated with Waardenburg syndrome type 3 (Hoth et al., 1993). Substitution of a basic amino acid for asparagine at residue 47, conserved in all known murine Pax and human PAX genes, appears to have a more drastic effect on the phenotype than missense, frameshift and deletion mutations of PAX3 that cause Waardenburg syndrome type 1.
Amino Acid Sequence↗
[Spiral CT angiography in stenoses of the middle cerebral artery].
INTRODUCTION: Transcranial Doppler ultrasonography (TCD) and magnetic resonance angiography (MRA) are well-established techniques for ascertaining intracranial obstructive artery disease. The short examination time required for additional helical CT angiography (CTA) allows quick management of emergency patients already undergoing native CT. However, today the ability of CTA to detect stenoses of the middle cerebral artery (MCA) has not been proven. To analyse the value of CTA in the classification of atherosclerotic disease 23 MCA stenoses confirmed by TCD and MRA were investigated. METHODS: CTA was performed on a Hispeed advantage scanner (GE) using a bolus injection of 70 ml KM and 40 ml NaCl with a flow rate of 2.5 ml/s, a thickness of 1 mm, a pitch of 1.5 and a 1 mm increment. CTA was presented as maximum intensity projection (MIP) and as multi-projection volume reconstruction (MPVR). A three-step classification of stenosis was compared with the results of TCD and MRA. RESULTS: Good opacification of the MCA was achieved in M1 and M2 segments in all patients. Classification of stenosis by CTA agreed with MRA and TCD in 14 cases; 7 stenoses were assigned to a lower classification by CTA. Two low-grade stenoses could not be proven by CTA. Although MIP and MPVR yield the same result in stenosis classification MPVR showed a sharper image quality. In contrast to MRA, veins were highly opacified in CTA. Artery and vein were sometimes superimposed, which had to be avoided by changing the projection angle. CONCLUSION: Medium- and high-grade MCA stenoses can be demonstrated by CTA quickly and reliably. Compared to MRA and TCD, CTA provides lower grading of stenosis.
Blood Flow Velocity↗
Rate of progression in open-angle glaucoma estimated from cross-sectional prevalence of visual field damage.
PURPOSE: To estimate the rate of visual field loss in persons with open-angle glaucoma. METHODS: The visual field data obtained by Goldmann perimetry from 151 persons with open-angle glaucoma from the Baltimore Eye Survey were graded on a nine-level severity scale. Approximately one half of these persons had previously diagnosed glaucoma and were being treated. Using regression analysis, their scores were compared to other features, including age, vertical cup/disk ratio, treatment status, gender, race, and intraocular pressure. These data were used to estimate the average rate of progressive field loss and blindness in glaucoma. RESULTS: Among 112 black subjects, the severity of visual field damage was significantly associated with age (P < .02), history of glaucoma treatment (P < .04), and intraocular pressure (P < .0001). Using the relationship between age and damage, we estimated that the rate of deterioration of black glaucoma subjects was two grading levels per decade, which is consistent with previous reports. For 39 white subjects, the inclusion of age improved the model relationship between damage score and other variables. The best estimate of individual damage rate for whites was similar to that in blacks. However, the statistical association of age and damage in whites was less strong than in blacks, possibly because of fewer white subjects in the sample. CONCLUSIONS: While glaucoma is a frequent cause of visual disability, rate of progressive visual field loss is not sufficient to lead to bilateral blindness in the majority of those affected. Aggressiveness of glaucoma therapy should be related to the rate of visual field loss stressing confirmation of field progression.
Adult↗
A prospective trial of self-expanding metal stents in the palliation of malignant esophageal obstruction after failure of primary curative therapy.
BACKGROUND: Self-expanding metal stents have been shown to be safe and effective for the primary palliation of patients with inoperable malignant esophageal obstruction. We sought to determine their safety and efficacy in patients who fail curative therapy. METHODS: Seventeen patients with esophageal carcinoma who had recurrent dysphagia after radiation, surgery, or chemoradiation therapy for esophageal carcinoma were studied. All patients had recurrent dysphagia, and an uncovered metal stent was inserted for palliation. Patients were followed-up at 4-week intervals until death. Palliation was measured by a dysphagia score and the Karnofsky index. RESULTS: Seventeen patients with recurrent dysphagia after primary treatment with surgery (n = 4), radiation (n = 11), and chemoradiation (n = 2) received uncovered Wallstents for palliation of dysphagia. The dysphagia score improved by at least 1 point in all patients. Thirteen of 17 patients had a 2 point improvement in the dysphagia score. The Karnofsky index improved significantly (from 58 +/- 3 to 66 +/- 3, p = 0.0002). Fourteen of the 17 patients had patent stents until death. Three of 12 patients (25%) died of stent-related complications (bleeding in 1, septic complications in 2 patients). CONCLUSIONS: Patients with recurrence of esophageal carcinoma after surgery can be successfully treated with metal stents, but patients who have received radiation therapy with curative intent may be at greater risk for complications because of radiation-induced tumor necrosis and vascular changes in the esophageal wall. Larger prospective studies are necessary to clarify this issue.
Aged↗
Human tissue responses to metal stents implanted in vivo for the palliation of malignant stenoses.
BACKGROUND: We sought to determine the histologic effects of metal stent placement on tumor tissue and on normal tissue proximal and distal to the tumor in patients with expandable metal stents implanted in vivo. METHODS: Twelve patients with 10 to 16 mm uncovered Wallstents were studied, 5 with esophageal stents, 4 with biliary stents and 3 with antral-duodenal stents. Stent duration ranged from 18 days to 15 months. Eleven autopsy specimens and one surgical specimen were examined. The organs with the stent in place were removed, and histologic specimens were obtained using a special saw-microtome that cuts through the tissue and the material of the stent. RESULTS: In all organs examined, the stent was incorporated into the material of the tumor to a varying degree. In the normal areas above and below the stenosis, the stent was incorporated into the wall of the organ and was covered by a collagenous reactive layer on the luminal aspect. The collagenous reaction was limited and did not cause exuberant growth or obstruction in any of the cases. CONCLUSIONS: The struts of uncovered Wallstents of 10 to 16 mm in diameter migrate into the submucus space above and below the tumor, probably by pressure necrosis, and become incorporated into the wall of the organ.
Aged↗
Impact of neonatal vitamin A supplementation on infant morbidity and mortality.
OBJECTIVE: To determine whether vitamin A supplementation at birth could reduce infant morbidity and mortality. STUDY DESIGN: We conducted a placebo-controlled trial among 2067 Indonesian neonates who received either 52 micromol (50,000 IU) orally administered vitamin A or placebo on the first day of life. Infants were followed up at 1 year to determine the impact of this intervention on infant mortality. A subgroup (n = 470) was also examined at 4 and 6 months of age to examine the impact on morbidity. RESULTS: Vital status was confirmed in 89% of infants in both groups at 1 year. There were 19 deaths in the control group and 7 in the vitamin A group (relative risk = 0.36; 95% confidence interval = 0.16, 0.87). The impact was stronger among boys, infants of normal compared with low birth weight, and those of greater ponderal index. Among infants examined at 4 months of age, the 1-week period prevalence of common morbidities was similar for vitamin A and control infants. However, during this same 4-month period, 73% and 51% more control infants were brought for medical treatment for cough (p = 0.008) and fever (p = 0.063), respectively. CONCLUSIONS: Neonatal vitamin A supplementation may reduce the infant mortality rate and the prevalence of severe respiratory infection among young infants.
Birth Weight↗
The cause-specific prevalence of visual impairment in an urban population. The Baltimore Eye Survey.
BACKGROUND: Whereas population-based data on the causes of bilateral blindness have been reported, little information is available on the distribution of causes of central vision loss less severe than the criteria used to define legal blindness. This visual impairment is responsible for a high proportion of eye care service use and results in important reductions in functional status. METHODS: Data from the Baltimore Eye Survey were used to estimate the cause-specific prevalence of visual impairment (best-corrected visual acuity worse than 20/40 but better than 20/200) among black and white residents of east Baltimore who were 40 years of age or older. Eligible subjects underwent a screening examination at a neighborhood location and, for those whose best-corrected visual acuity was less than 20/30, a definitive ophthalmologic examination at the Wilmer Eye Institute. RESULTS: The prevalence of visual impairment was 2.7% in whites and 3.3% in blacks; the age-adjusted relative prevalence (B/W) was 1.75 (P = 0.01). The leading causes of visual impaired eyes were cataract (35.8%), age-related macular degeneration (14.2%), diabetic retinopathy (6.6%), glaucoma (4.7%), and other retinal disorders (7.3%). Cataract, diabetic retinopathy, and glaucoma were more common as a cause of visual impairment among blacks, whereas macular degeneration was more frequent among whites. More than 50% of all subjects had the potential for improvement in vision with appropriate surgical intervention. CONCLUSION: Visual impairment is a prevalent condition among inner city adults 40 years of age or older. The distribution of causes suggests that improvements in the visual health of the population could be achieved with more effective delivery of efficacious ophthalmologic care.
Adult↗
Detection of incident field loss using the glaucoma hemifield test.
PURPOSE: To examine different definitions of incident visual field loss among patients with elevated intraocular pressure and varying numbers of abnormal glaucoma hemifield test results over an average of 6 years of follow-up. METHODS: A cohort of patients with annual C-30-2 Humphrey visual fields were followed for a minimum of 5 years. Three different definitions of field loss were compared: 1, 2, or 3 consecutive annual abnormal glaucoma hemifield test results. RESULTS: Of 253 subjects, 506 eyes were followed for 5 to 9 years. If incident field loss was defined as one or more normal fields followed by one abnormal glaucoma hemifield test result, the incidence of field loss was 63.6 per 1000 person-years of follow-up. For two or three consecutive abnormal glaucoma hemifield test results, the rates were 27.6 and 19.2 per 1000 person-years of follow-up, respectively. Among patients with field loss in one eye at the start of the study, the incidence of field loss in the fellow eye using 1, 2, or 3 consecutive abnormal fields as the definition of incident field loss was 60.9, 55.5, and 25.5 per 1000 person-years of follow-up, respectively. Three years after incident field loss, 31.9% (1 abnormal test result), 76.5% (2 abnormal test results), and 88.5% (3 abnormal test results) of eyes with incident field loss had an abnormal hemifield test result. For eyes with one, two, and three consecutive abnormal glaucoma hemifield test results at the start of the study, 59.2%, 83.6%, and 89.1%, respectively, had an abnormal field 3 years later. CONCLUSIONS: One abnormal glaucoma hemifield test result is not a consistent criterion for defining incident field loss. The use of two or three consecutive abnormal fields to define incident field loss makes it more likely that subsequent test results will be abnormal.
Adult↗
Doyne Lecture. Glaucoma: facts and fancies.
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Adult↗
[The value of colloid scintigraphy and erythrocyte scintigraphy in detecting acute or intermittent gastrointestinal hemorrhages].
PURPOSE: In a retrospective analysis the diagnostic value of two scintigraphic methods was compared with each other. METHOD: 104 patients with acute or intermittent gastrointestinal haemorrhage were examined with 121 scintigraphic studies. We compared scintigraphic results with surgical findings, endoscopic results or final clinical diagnosis. We used two scintigraphic methods, colloid scintigraphy and in vivo/vitro red blood cell scintigraphy. RESULTS: Our scintigraphic findings reached a sensitivity of 72% and a specificity of 100%. We calculated a sensitivity of 68% for colloid scintigraphy and a sensitivity of 79% for red blood cell scintigraphy. The correct localisation of bleeding was successful in 52 (98%) cases. CONCLUSIONS: Our results demonstrate that red blood cell scintigraphy is the method of choice in detecting intermittent gastrointestinal hemorrhage. We believe that with new preparation kits for in vivo labelling red blood cell scintigraphy will become seriously competitive for the colloid scintigraphic method.
Acute Disease↗
Cure of gastric ulcer disease after cure of Helicobacter pylori infection--German Gastric Ulcer Study.
BACKGROUND: Helicobacter pylori infection is associated with gastric ulcer disease in about 75% of cases. OBJECTIVE: The aim of this study was to determine whether H. pylori eradication reduces gastric ulcer relapse rates. DESIGN: The study was randomized, controlled, multicentric and investigator blinded, and was conducted at three university hospitals, two teaching hospitals, and by six practising gastroenterologists. METHODS: During a period of 1 year 152 patients with gastric ulcers were randomly assigned to one of two treatment regimens: omeprazole 20 mg daily in the morning for 8 weeks (74 patients), or bismuth subsalicylate 600 mg three times daily for 8 weeks combined with 500 mg amoxicillin twice daily and 1000 mg tinidazole twice daily for the first 10 days (triple therapy) (78 patients). Follow-up examinations were performed 6, 12 and 18 months after treatment and whenever ulcer symptoms occurred. RESULTS: Of the 152 randomized patients five were excluded because of gastric cancer, 10 missed follow-up examinations and seven receiving triple therapy terminated treatment because of side effects. Of the remaining 130 patients, five of 69 (7.2%) in the omeprazole and six of 61 (9.8%) in the triple group were H. pylori negative. After 8 weeks' therapy, the gastric ulcer was healed in 85.9% (omeprazole) and in 81.8% triple) in H. pylori-positive patients, and in 80% (omeprazole) and 16.7% (triple) in H. pylori-negatives. H. pylori was eradicated in 8.1% of the patients who received omeprazole monotherapy and in 78.2% receiving triple therapy, and in 8.1% and 69.4% in an intention-to-treat analysis. The subsequent relapse rates during a follow-up period of 12 months were 50% in the omeprazole group and 4% in the triple group. Gastric ulcer relapse was observed in 49% of patients who were H. pylori positive and in 2% who were H. pylori negative after treatment. CONCLUSION: The data show that the presence of H. pylori is an important predictor of gastric ulcer relapse and that eradication of H. pylori may heal gastric ulcer disease.
Adult↗
Glaucoma risk factors observed in the Baltimore Eye Survey.
The Baltimore Eye Survey identified race, intraocular pressure, systemic hypertension, perfusion pressure, family history, and quite possibly the structure and organization of the optic nerve head as potential etiologically significant risk factors in the development of glaucomatous optic nerve damage. These findings have been confirmed by subsequent, sometimes equally rigorous population-based studies in other communities and countries. The Baltimore Eye Survey failed to demonstrate a role for diabetes but revealed that estimates of the significance of diabetes, like that of family history, are subject to considerable selection bias.
Age Factors↗
Public health aspects of ophthalmic disease: introduction.
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Blindness↗
Severity of Helicobacter pylori gastritis predicts duodenal ulcer recurrence.
BACKGROUND: Helicobacter pylori gastritis is suggested to be the underlying condition leading to duodenal ulcer disease. The aim of the study was to investigate the relationship between chronic active H. pylori gastritis and the risk of duodenal ulcer (DU) recurrence. METHODS: One hundred and eighty-eight patients were followed up with regard to the evolution of their H. pylori gastritis after they had received antibacterial or acid-suppressing treatment for their DU. Four weeks, 1 year, and 2 years after treatment and in the case of DU recurrence several morphologic indicators of gastritis were studied histologically in the antrum and corpus. RESULTS: In patients who were cured of H. pylori infection a significant and long-lasting regression of all gastritis variables were observed. patients with persistent H. pylori infection after antibacterial treatment showed only a temporary regression of all gastritis variables. In the overall group of patients who received acid-suppressive therapy there was no change in gastritis. However, in the subgroup of patients who received omeprazole monotherapy, no change in the antrum but a statistically significant increase of gastritis in the corpus was observed. The grade of antral gastritis at the end of treatment was significantly and positively correlated with the risk of DU recurrence and was independent of the kind of pretreatment (18.5% recurrences in grade-2 versus 86% in grade-4 gastritis). CONCLUSIONS: The data show that the grade of gastritis is an important risk factor for duodenal ulcer recurrence. Cure of H. pylori infection is associated with healing of chronic H. pylori-associated gastritis. These data lend considerable support to the hypothesis that H. pylori gastritis is the most important factor among those leading to duodenal ulcer disease.
Chronic Disease↗
Uses and misuses of vitamin A.
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Americas↗
Evaluation of the effect of vitamin A-fortified margarine on the vitamin A status of preschool Filipino children.
OBJECTIVES: This study assessed the effects of consuming a highly hydrogenated, vitamin A (VA)-fortified margarine not requiring refrigeration on VA status of preschool children. DESIGN: A double-masked randomized community trial. SETTING: Six rural villages in Cavite, Southern Luzon, the Philippines. SUBJECTS: 296 and 285 children 3-6 y of age in the VA-fortified (experimental) and non-fortified (control) margarine groups, respectively. INTERVENTION: Each week for 6 months households were given 250 g of VA-fortified margarine [providing 28.8 micrograms retinol equivalents (RE) per g] or non-fortified (0 microgram RE) margarine of identical appearance for each enrolled child. Children's vitamin A status [serum retinol, xerophthalmia, and conjunctival impression cytology (CIC) status] and dietary intake were assessed at baseline and follow-up; margarine intake was monitored throughout the study. RESULTS: Daily margarine intake per child averaged 27 g in the experimental group (providing 776 micrograms RE) and 24 g (0 microgram RE) in the control group. After 6 months, mean serum retinol increased from 26.4 to 28.8 micrograms/dl in the experimental group but decreased from 26.6 to 25.1 micrograms/dl in controls (P < 0.001 at 6 months); the multiple-adjusted increment over controls was 2.4 micrograms/dl (P < 0.01). More importantly, the prevalence of low serum retinol (< 20 micrograms/dl) decreased from 25.7 to 10.1% in the experimental group but remained unchanged in controls (26.7 to 27.7%) (P < 0.01 at 6 months). At follow-up no experimental children had developed xerophthalmia but 1.4 and 1.8% of controls developed nightblindness and Bitot's spots, respectively. There were no differences in CIC between groups. CONCLUSION: Consumption of VA-fortified margarine significantly improved VA status of preschool Filipino children.
Child↗
Interobserver and intraobserver variability in the detection of glaucomatous progression of the optic disc.
PURPOSE: To evaluate the potential value of obtaining follow-up stereoscopic photographs on glaucoma suspects in identifying progressive optic nerve damage. METHODS: Nineteen sets of stereoscopic optic disc photographs, reflecting one eye from each of 19 patients at two time points, were selected from the records of subjects enrolled in the Glaucoma Screening Study. By consensus, three experts judged 13 of these eyes to have progressive glaucomatous optic nerve damage. Four other ophthalmologists who were masked to the expert panel evaluation then assessed glaucomatous progression in the same eyes. They were asked to evaluate glaucomatous progression in three ways: first, by drawing the optic nerve head appearance from initial stereoscopic photographs and later comparing their own drawings to follow-up stereoscopic photographs; second, by comparing serial stereoscopic photographs directly; and third, by comparing drawings of the optic nerve head made by another examiner to the follow-up photographs. RESULTS: Neither sensitivity nor specificity was consistently better for serial stereoscopic photographs than for drawings. Individual ophthalmologist agreement rates with the expert panel's determinations of progression were 23-62% when examiners compared their own drawings to follow-up photographs, 54-71% when examiners compared serial stereoscopic photographs, and 38-85% when comparing another ophthalmologist's drawings to follow-up photographs. CONCLUSION: Baseline stereoscopic photographs of the optic nerve head did not substantially improve recognition of progressive glaucomatous optic nerve damage when compared with the use of baseline drawings of the optic nerve head made from photographs in subjects who developed visual loss in the interim.
Disease Progression↗