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Biomedical subjects

C V Reddy

Publications and source records attributed to C V Reddy.

At least 19 recordsLinked to original sources

Microholes of the macula.

OBJECTIVE: To describe the clinical syndrome of microholes of the macula. PATIENTS: Fourteen patients with acute symptoms caused by full-thickness microholes of the macula. RESULTS: Patients with macular microholes had the acute onset of central scotoma with mild to moderate visual acuity loss. Examination revealed a detachment of the vitreous over the fovea, often with an operculum or a total posterior vitreous detachment, and a sharply demarcated, 50- to 133-micrometer round hole in the center of the macula. On follow-up, all patients had a stable or improved scotoma and visual acuity. CONCLUSIONS: Macular microholes appear to be caused by an acute detachment of the vitreous from the fovea and can be distinguished from Gass stage 2 idiopathic macular holes.

Acute Disease

Visual prognosis of multifocal choroiditis, punctate inner choroidopathy, and the diffuse subretinal fibrosis syndrome.

PURPOSE: To characterize the visual prognosis of patients with multifocal choroiditis and panuveitis (MCP), punctate inner choroidopathy (PIC), and the diffuse subretinal fibrosis (DSF) syndrome. METHODS: Forty-one patients with MCP, 16 with PIC, and 5 with DSF syndrome were evaluated. The mean follow-up was approximately 39 months for patients with MCP, 51 months for patients with PIC, and 59 months for patients with DSF syndrome. Complete ophthalmic examinations were performed, and photofiles were reviewed. RESULTS: The final average visual acuity for patients with MCP was 20/50. Forty-five of the 68 involved eyes (66%) had 20/40 visual acuity or better. Choroidal neovascularization (CNV) developed within choroiditis lesions in 22 (19 patients) of 68 eyes, causing visual acuity poorer than 20/50 in 14 eyes. The final average visual acuity in patients with PIC was 20/39; 23 (77%) of the 30 involved eyes had visual acuity of 20/40 or better. Six of the seven eyes with 20/50 or poorer vision had CNV. Six other eyes had CNV within the macula that regressed spontaneously with good resultant vision. Seven of the ten involved eyes with DSF syndrome had 20/200 or poorer vision. Poor vision was due to fibrosis and atrophy within the macula. CONCLUSION: Most patients with MCP and PIC retained visual acuity of 20/40 or better. In nearly one third of patients with MCP and PIC, CNV developed. Severe visual loss in these diseases was usually due to subfoveal CNV. Patients with DSF syndrome had a poor prognosis due to fibrosis and atrophy involving the macula.

Adrenal Cortex Hormones

Enlarged blind spots in chorioretinal inflammatory disorders.

PURPOSE: This study was undertaken to better characterize patients with multifocal choroiditis and panuveitis (MCP), punctate inner choroidopathy (PIC), multiple evanescent white dot syndrome (MEWDS), and diffuse subretinal fibrosis syndrome. The specific aim was to determine whether these disorders were different entities or part of a spectrum of diseases with similar features. METHODS: Seventy-nine patients were included in this study. Most of the patients have been followed up prospectively since July 1980 with some found retrospectively. RESULTS: Forty-one patients had MCP, 16 had PIC, 6 had diffuse subretinal fibrosis syndrome, and 16 had MEWDS. Patients with MCP had visual loss and visual field defects caused directly by visible lesions or recurrent inflammation around old lesions. In particular, clustering of lesions around the optic nerve and nasal periphery was seen in patients with MCP and appeared to be related to visual field loss. Patients with PIC also had enlarged blind spot and other field defects explained by fundus lesions. Patients with PIC and MCP did not have recurrent lesions on extended follow-up. Patients with diffuse subretinal fibrosis syndrome represented a subset of patients characterized with lesions in the posterior pole, sever scarring, and visual loss. Patients with MEWDS had the least inflammation with symmetrically distributed lesions. Minimal permanent chorioretinal scarring was seen in patients with MEWDS. Visual field defects improved in most patients with MEWDS and PIC, whereas most patients with MCP and diffuse subretinal fibrosis syndrome did not improve. CONCLUSIONS: Although enlarged blind spots are a feature of all four disorders, other clinical, angiographic, and electroretinographic evidence suggest that these are different entities.

Adolescent

Clinical science review: current aspects of thrombolytic therapy in women with acute myocardial infarction.

Acute myocardial infarction (AMI) remains the greatest threat to health in our society and is the most common cause of death in the United States and in many other Western industrialized countries. Recent data demonstrate that mortality from MI is continuing to decline. In these days of more aggressive management of acute MI (AMI) there has been a resurgence of interest in advances in thrombolytic therapy. However, observational studies of patients with AMI have shown that women sustaining an AMI have a worse prognosis than men. AMI is the number-one killer of women in the United States; approximately 247,000 of more than 520,000 deaths due to AMI that occur each year are among women, and almost one-third of the women are younger than forty-five years old. While there have been great advances in thrombolytic therapy, these advances have benefited men to a more significant degree than they have benefited women. The purpose of this paper is to critically review the efficacy of thrombolytic therapy in women with AMI with consideration of some of the key components of its effectiveness: mortality, bleeding risk, infarct-artery patency, ventricular function, and cardiac arrhythmia.

Adult

Increased interleukin-1 activity in the injured vitamin A-deficient cornea.

Injury to a vitamin A-deficient cornea leads to severe acute inflammation often culminating in ulceration. We report on possible regulatory mechanisms involved in the pathogenesis of corneal inflammation in vitamin A deficiency. Thymocyte comitogenic assay and interleukin (IL)-6 induction in corneal fibroblasts have shown that thermally injured and mechanically abraded vitamin A-deficient rat corneas produce much higher levels of an IL-1-like factor as compared with uninjured or injured, normal control corneas. This was confirmed by antibody capture enzyme immunoassay, which detected high levels of IL-1 alpha and IL-1 beta in injured vitamin A-deficient corneas. To our knowledge this is the first report describing the induction of IL-1 in the vitamin A-deficient cornea by thermal and mechanical injuries. When mechanically injured corneas were screened for chemotactic activity, they were found to contain significantly higher levels of a chemoattractant as compared with similarly injured, normal control corneas. Chemotactic activity [expressed as a percentage of a known chemotactic tripeptide, formyl-methionyl-leucyl-phenylalanine (fMLP), found in medium harvested from vitamin A-deficient corneas] averaged 58.8 +/- 8.9% (SEM) as compared with 12.6 +/- 5.4% in medium conditioned by normal corneas. Checkerboard analysis confirmed that the activity in vitamin A-deficient cornea conditioned medium was chemotactic and not chemokinetic. These results demonstrate a correlation between IL-1 levels and severity of inflammation in the injured vitamin A-deficient rat cornea.

Animals

Radionuclide simultaneous dual-isotope stress myocardial perfusion study using the "three window technique".

Several methods are available for performing radionuclide stress myocardial perfusion studies. All of these methods require two separate acquisition and processing iterations, which is time-consuming and inconvenient for the patient. The authors introduce a new method using the "three window technique" that they developed to perform simultaneous dual-isotope imaging for stress myocardial perfusion studies. In addition to Tl-201 and Tc-99m windows centered at 70 KeV and 140 KeV, respectively, a third window centered at 105 KeV, representing scattered radioactivity from Tc-99m, is established. By subtracting the radioactivity in the third window from the radioactivity in the Tl-201 window, "crosstalk" interference is significantly reduced. The simultaneous dual-isotope imaging method acquires and processes resting and stress myocardial perfusion images simultaneously. It halves imaging time and doubles patient throughput, improves scheduling flexibility, and reduces patient waiting time and discomfort.

Heart

Effect of vitamin A deficiency on the adhesion of rat corneal epithelium and the basement membrane complex.

PURPOSE: To understand the underlying mechanisms responsible for the easy removal and sloughing of corneal epithelium in vitamin A deficiency. METHODS: An animal model of vitamin A deficiency, the vitamin A-deficient rat (A-rat), transmission electron microscopy, computer-assisted morphometric analysis and indirect immunofluorescence were used to study the adhesion of rat corneal epithelium to its basement membrane with emphasis on structure and molecular composition of the anchoring structures such as the hemidesmosome and bullous pemphigoid antigen. RESULTS: Transmission electron microscopy resolved numerous microseparations of the basal epithelial cell membrane from the basement membrane with intervening segmental basement membrane duplications and electron dense deposits. Morphometric analysis disclosed a statistically significant reduction in the frequency and size of hemidesmosomes. Four weeks after supplementing the diet with retinyl acetate (700 micrograms/week), significant reversal of these same structural abnormalities could be detected. Immunofluorescence staining for bullous pemphigoid antigen, a component of the adhesion complex, showed intense staining of the basal epithelial cytoplasm but weak and discontinuous staining of the basement membrane. Weak staining for laminin was also evident in A- corneas. In contrast, normal corneas displayed no cytoplasmic staining for bullous pemphigoid antigen and intense staining of the basement membrane for bullous pemphigoid antigen and laminin. CONCLUSIONS: The authors propose that structural abnormalities of the epithelial basement membrane complex are responsible for the observed loose epithelial adhesion and sloughing, as well as other known abnormalities of healing in the vitamin A-deficient rat cornea.

Animals

Internal mammary artery angiography should be a routine component of diagnostic coronary angiography.

Left internal mammary artery (LIMA) angiography was performed with diagnostic coronary angiography in 130 cases for which the coronary findings made use of the LIMA as a bypass graft a consideration. In 98% of the cases the approach to LIMA angiography was femoral with a 5F LIMA catheter first directed into the proximal subclavian and then advanced over a guidewire placed into the distal subclavian well beyond the origin of the LIMA. After withdrawing the wire the catheter was brought proximally to selectively cannulate and visualize the LIMA with nonionic contrast media. The only complication was a single transient occipital visual field loss. LIMA caliber too narrow to permit use as a graft was found twice, LIMA occlusion unrelated to prior surgery was found once, and LIMA occlusion related to prior surgery was found twice. Subclavian and/or vertebral stenosis was present five times. Large proximal branches of the LIMA best identified prior to surgery were present 12 times. Based on this experience, LIMA angiography 1) can be performed safely with a high degree of success, 2) demonstrates significant findings in 15% of cases, and 3) should therefore be performed whenever coronary angiographic findings make it appropriate to consider LIMA to coronary artery bypass grafting.

Adult

Effect of fibronectin on corneal epithelial wound healing in the vitamin A-deficient rat.

The authors investigated the in vitro and in vivo effects of fibronectin (Fn) on the migration of corneal epithelium of vitamin A-deficient (A-) and pair-fed control (A+) rats. Groups treated with 50 micrograms/ml Fn showed accelerated healing of epithelium in vitro (P less than 0.05) compared with control groups of A- and A+ rats. However, when 100 micrograms/ml Fn eye drops were administered 14 times over 20 hr, they had no significant effect on A+ rats in vivo, but increased the healing in A- rats (P less than 0.05). In this model, Fn promoted the healing of corneal epithelium under A- conditions where decreased endogenous Fn is seen, whereas A+ corneas in vivo, which have sufficient Fn over the wound surface, did not benefit from topical Fn administration.

Administration, Topical

Complete heart block complicating retrograde left heart catheterization.

Three cases of complete heart block complicating retrograde left heart catheterization are presented. In two of the three cases, electrophysiologic study documented block below the AV (atrial ventricular) node. In the third recurrent complete heart block was fatal. It appears that complete heart block complicating retrograde left sided cardiac catheterization is not simply a pericatheterization event; rather, it appears that there is high risk of recurrent complete heart block and that electrophysiologic study is mandatory.

Aged

Dynamics of corneal epithelial healing after an alkali burn. A statistical analysis.

A precise definition of epithelial healing kinetics following chemical injury is necessary to aid the investigation of control mechanisms, potential therapeutic intervention and ophthalmic drug toxicity. Wound healing was studied photographically at frequent intervals in rabbits following 1N or 4N alkali burns. Planar wound areas were determined by computerized planimetry and transformed mathematically to curved surface data. The decrease in equivalent wound radius with time was computer-modelled using two linear and three nonlinear regressions. A periodic function was also investigated. Serial photographs showed that intermittent attrition of small areas of the migrating wound edge was a common confounding variable. Although excellent coefficients of determination were found for all models, the addition of nonlinear factors gave a small advantage. A mean lag phase of 3.96 and 6.52 hr occurred after 1N and 4N alkali burns, respectively; wound edge attrition was notably prevalent in early healing. Epithelial healing in the rabbit had a fundamental linear component, with mean epithelial migration rates of 76 and 80 microns/hr after 1N and 4N alkali burns, respectively, and which continued to closure. A quadratic nonlinear component was also suggested. No significant circadian component was detected.

Alkalies

Bilateral coronary thrombosis in the absence of inducible coronary spasm, thrombocytosis, coagulation abnormalities, or angiographic evidence of coronary artery disease: previously undescribed method of myocardial infarction.

A 32-year-old man presented with symptoms and electrocardiographic changes consistent with acute anterolateral myocardial infarction. Selective coronary angiography revealed thromboses in the infarct related artery as well as in the right coronary artery. This case is unique because bilateral in-situ coronary thrombosis producing acute myocardial infarction was documented in the absence of previously proposed mechanisms.

Adult