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Biomedical subjects

E M Graham

Publications and source records attributed to E M Graham.

107 records · Page 6Linked to original sources
PubMed1987

Cyclosporin A in the treatment of severe Behçet's uveitis.

Twelve patients with active Behçet's uveitis with marked deterioration of visual acuity in at least one eye were treated with cyclosporin A (CyA). An initial improvement in the severity of ocular inflammation and systemic features occurred in all cases and persisted until the dose was reduced or the drug withdrawn when a rapid recurrence of symptoms was noted. The visual acuity also initially improved in ten patients and this was maintained in seven cases until the dose of CyA was reduced. At this time, acuity was unchanged in two patients and was worse in three others-two of the latter as a result of vitreous haemorrhage in the absence of active inflammation. Seven of the 12 patients had therapy stopped because of complications; severe malaise and nausea (three cases), decreased renal function (three cases), and blindness (one case). Cyclosporin A is of value in the control of Behçet's uveitis but toxicity limits its use and the benefits only last while the patient is on this therapy.

Adult↗
PubMed1987

Neovascularisation associated with posterior uveitis.

Twenty-six patients (39 eyes) with retinal neovascularisation associated with ocular inflammation were identified from the retinal vasculitis clinic at St Thomas's Hospital. Eight patients had sarcoidosis, seven patients Behçet's disease, and 11 had idiopathic retinal vasculitis. Twenty-three patients had required systemic therapy to control the inflammation and 11 patients received laser photocoagulation. Fluorescein angiography showed significant capillary closure in 15 eyes and diffuse microvascular leakage in the remaining 24 eyes. All patients had posterior vitreous detachment. The visual prognosis was good despite vitreous haemorrhage being the presenting feature in 22 eyes, and the new vessels resolved in 70% of cases. However, laser treatment was followed by a significant increase in cystoid macular oedema (p less than 0.01). This retrospective study suggests that medical therapy is the first line of treatment in this group of patients. Photocoagulation should be performed when the eye is quiet and should be reserved for patients with recurrent vitreous haemorrhages and significant capillary closure.

Adolescent↗
PubMed1987

Experimental posterior uveitis. I: A clinical, angiographic, and pathological study.

The clinical, angiographic, and histopathological features of experimental posterior uveitis in the black hooded Lister rat are described. This mild form of experimental allergic uveoretinitis (EAU) is induced by sensitisation with retinal S antigen in Freund's complete adjuvant, and the inflammation produced is confined to the posterior segment of the eye. This allows for the first time precise photographic and angiographic documentation of the evolution of clinical signs, because there is minimal clouding of the vitreous by inflammatory cells. Clinically the disease is characterised by the appearance of disc oedema and periphlebitis, followed by focal infiltrates in the deep retinal layers, with eventual atrophy of the pigment epithelium. Histologically, retinal vasculitis is associated with focal mononuclear cell infiltration and necrosis of the photoreceptor layers. This model closely resembles the clinical features of idiopathic retinal vasculitis seen in man.

Animals↗
PubMed1986

Optic neuropathy in sarcoidosis.

Five patients with isolated optic neuropathy and sarcoidosis are discussed. The spectrum of clinical disease was variable but two groups could be identified: patients with chronic progressive visual loss which was associated with thickening of the optic nerve and was refractory to steroid treatment, and patients with acute or subacute optic neuropathy in which the visual loss responded rapidly to steroids. In the latter group steroid dependence developed in all three of the patients. In none did the clinical picture resemble that of the optic neuritis associated with multiple sclerosis.

Acute Disease↗
PubMed1986

Differential diagnosis of ocular sarcoidosis.

The ocular manifestations of sarcoidosis are diverse and include dry eyes due to lacrimal gland involvement, uveitis and optic nerve disease. The differential diagnosis varies in each situation, but the ocular signs are generally typical and a full clinical and ophthalmological examination will reveal the correct diagnosis.

Acute Disease↗
PubMed1985

Cerebral and retinal vascular changes in systemic lupus erythematosus.

A 16-year-old white boy with acute systemic lupus erythematosus (SLE) who presented with chorea and florid retinopathy died in renal failure three months after diagnosis. Pathological studies revealed two types of lesion in both the cerebral and ocular vessels. Some meningeal and choroidal vessels showed a typical vasculitis with fibrinoid necrosis, whereas other meningeal and retinal vessels were occluded by amorphous hyaline material in the absence of vasculitis.

Adolescent↗
PubMed1985

Cyclosporin A in the treatment of posterior uveitis.

Cyclosporin A was used in nine patients with severe refractory posterior uveitis. Four patients had Behcet's disease, one had sarcoidosis, one had HLA B27 related arthritis and uveitis and three had idiopathic retinal vasculitis. The drug had beneficial ocular effects in all patients in the early stages of treatment with an improvement in the visual acuity and reduction in the severity of inflammation. The relapse rate and need for additional steroids were reduced in all patients. However, renal function deteriorated in seven patients to such an extent that the dose of Cyclosporin A had to be reduced with consequent relapse of uveitis.

Adult↗
PubMed1984

Graves' disease presenting with bilateral acute painful proptosis, ptosis, ophthalmoplegia, and visual loss.

Two middle-aged women presented with bilateral acute painful proptosis, ptosis, ophthalmoplegia, and visual loss. In both an initial diagnosis of orbital cellulitis was made, but they did not respond to systemic antibiotics. Orbital computerised tomographic (CT) scans were thus done within 36 h of admission and they showed grossly enlarged extraocular muscles in each case suggestive of dysthyroid eye disease. Clinical examination was otherwise normal. When high doses of systemic steroids were substituted for the antibiotics the physical signs resolved rapidly, accompanied by a dramatic reduction in the size of extraocular muscles on CT scanning. One patient subsequently became clinically hypothyroid, while the other showed clinical and biochemical evidence of thyroid overactivity. These case-reports suggest that patients with bilateral acute painful proptosis should have an early CT scan to exclude atypical dysthyroid disease. Delay in giving systemic steroids may allow the development of unnecessary visual loss due to optic nerve damage.

Acute Disease↗
PubMed1983

Treatment of chlorpropamide overdose with diazoxide.

A patient who took a chlorpropamide overdose was treated for several hours with concentrated glucose solutions, with little success in maintaining adequate serum glucose concentrations. Intravenous diazoxide administration was begun with the hope of decreasing pancreatic insulin release. After diazoxide was begun, glucose requirements decreased dramatically, and serum glucose was supranormal for most of the period of diazoxide administration. The case was complicated by the fact that the patient had taken three agents that can cause hypoglycemia--chlorpropamide, alcohol, and aspirin. Drug interactions potentiating the hypoglycemic effect of the chlorpropamide were also possible. Glucose infusion is the mainstay of therapy for a sulfonylurea overdose. However, glucose acts as a further stimulus of insulin release from a sulfonylurea-primed pancreas. Administration of concentrated glucose solutions is technically difficult because of damage to veins. Metabolic consequences of high rates of glucose infusion to hyperinsulinemic patients include hypokalemia and hypophosphatemia. Diazoxide appeared to decrease the glucose requirement in this patient, as it did in three other reported cases. Diazoxide is approved for certain hypoglycemic, hyperinsulinemic conditions. Sulfonylurea overdose represents a hypoglycemic, hyperinsulinemic condition; diazoxide appears to be an effective treatment.

Adolescent↗
PubMed1981

Ocular changes in limited forms of Wegener's granulomatosis.

Eight patients who had limited forms of Wegener's granulomatosis are described, with details of their pathology. Ocular pathological data were available for 2 of them. The condition carries a serious ocular risk; useful vision was lost in 6 out of 16 eyes (37%). An indolent but slowly progressive marginal keratitis and scleritis was a prominent feature in 4 patients and was helpful in suggesting the diagnosis. Limited froms of Wegener's granulomatosis carry a better prognosis and response to treatment than the classical disease.

Adult↗
PubMedDate not supplied

A retrospective analysis of Erb's palsy cases and their relation to birth weight and trauma at delivery.

Brachial plexus injury is assumed to be associated with the traumatic delivery of a macrosomic fetus in the vast majority of cases. This study was undertaken to examine the relationship of brachial plexus injury to birth weight and trauma at delivery, to compare our incidence to the incidence in other populations, and to examine how the incidence of brachial plexus injury has changed in our institution over the last 30 years. A retrospective analysis of 14,358 births from January 1, 1987, to June 30, 1991, identified 15 cases of brachial plexus injury (all Erb's palsy, incidence 0.10%). Maternal and neonatal charts were reviewed. There were 14 cases of Erb's palsy out of 11,484 vaginal deliveries (0.12%) and one case of Erb's palsy out of 2,874 cesarean deliveries. There was birth trauma (i.e., shoulder dystocia) noted at the time of delivery in eight cases (53.3%). However, a surprising finding was that in the other seven cases (46.7%) there was no evidence of shoulder dystocia at delivery. In the group in which Erb's palsy occurred and trauma was noted at the time of delivery, the average birth weight was 4,265 +/-480 g (range 3,550-5,110 g), with seven out of eight (88%) being large for gestational age (LGA). In the group in which Erb's palsy occurred but no trauma was noted at the time of delivery, the average birth weight was 2,906 +/- 745 g (range 1,590-3,950 g), with one out of seven (14%) being LGA. The infants without recognizable trauma weighed significantly less (P = 0.0009). In the group with trauma noted at delivery one out of eight (13%) received pitocin, and in the group without trauma noted at delivery one out of seven (14%) received pitocin. There was no significant difference in 5 min Apgar scores < 7 (3/8 vs. 0/7), umbilical cord pH (7.27 +/- 0.07 vs. 7.24 +/- 0.10), or base excess (-3.1 +/- 1.6 vs. -5.3 +/- 3.3) between those with recognizable trauma and those without recognizable trauma. The incidence of brachial plexus injury in this institution from 1987 to 1991 was 0.10%, which was unchanged from the incidence of 0.12% from 1954 to 1959, even though the cesarean rate rose from 5% to 20% during this period. The appearance of Erb's palsy in the newborn may not be as closely linked to birth weight and recognizable birth trauma as has previously been thought. In this study half the cases of Erb's palsy occurred in normal-sized infants without trauma noted at delivery. The incidence of Erb's palsy in our population is similar to that of other reported studies and has remained unchanged over the past 30 years, even as our cesarean rate has risen from 5% to 20%.

Apgar Score↗
PubMedDate not supplied

Characterization of a very-high-affinity ouabain binding site in term fetal guinea pig brain Na+,K(+)-ATPase.

OBJECTIVE: To characterize the very-high-affinity ouabain binding site in fetal brain and determine its sensitivity to hypoxia. METHODS: Studies were performed on six normoxic and six hypoxic guinea pig fetuses at term and in six adult guinea pigs. Fetuses were delivered after the pregnant female had been exposed to 21% or 7% oxygen for 1 hour. Brain cell membranes were prepared and ouabain binding studies were performed. Ouabain binding was determined in the presence and absence of erythrosin B, a known inhibitor of high-affinity ouabain binding sites. RESULTS: Normoxic term fetal brain membrane had a Bmax (receptor number) of 84.2 +/- 13.6 pmol/mg protein, which decreased to 5.9 +/- 3.8 pmol/mg protein (93.0% decrease, P < .001) in the presence of erythrosin B. Normoxic fetal brain had a dissociation constant (Kd) (receptor affinity) of 24.6 +/- 4.5 nmol/L, which was unchanged in the presence of erythrosin B (Kd = 20.7 +/- 15.4 nmol/L, P = nonsignificant [NS]). Hypoxic term fetal brain had a Bmax of 74.7 +/- 8.3 pmol/mg protein, which decreased to 7.1 +/- 3.9 pmol/mg protein (90.5% decrease, P < .001) in the presence of erythrosin B. Hypoxic fetal brain had a Kd of 22.9 +/- 1.9 nmol/L, which was unchanged in the presence of erythrosin B (Kd = 24.5 +/- 9.9 nmol/L, P = NS). The adult control guinea pig brain had a Bmax of 104.1 +/- 13.3 pmol/mg protein, which decreased to 44.9 +/- 10.5 pmol/mg protein (P < .001) in the presence of erythrosin B, and a Kd of 214.3 +/- 31.3 nmol/L, which remained unchanged in the presence of erythrosin B (Kd was 165.4 +/- 36.0 nmol/L, P = NS). CONCLUSION: Fetal brain has a unique very-high-affinity ouabain binding site that is absent in adult brain and is sensitive to erythrosin B and resistant to hypoxia. We speculate that the presence of a Na+,K(+)-ATPase molecule with a very-high-affinity site may be advantageous to the fetal brain during early maturation as well as during hypoxia or ischemia.

Animals↗
PubMedDate not supplied

Ladies with Leber's hereditary optic neuropathy: an atypical disease.

PURPOSE: Leber's Hereditary Optic Neuropathy (LHON) is considered to be a disease predominantly affecting young males. The risk of women becoming symptomatic if they are carriers of a primary mutation is 1/5 of that in males. The disease however appears to behave differently in women in some instances. We describe three cases of ladies with LHON and discuss the importance of making the diagnosis. CASE REPORTS: A 28-year-old female presented with blurring of vision in her left eye with bilateral small hyperemic discs and telangiectatic vessels adjacent to them. DNA analysis confirmed the 11778 mutation and the second eye remains unaffected 10 years later. The second case was 49 years old and presented with bilateral visual loss developing over 3 months. She had no family history of visual loss but had a past history of Wolf Parkinson White syndrome and 3460 mutation was confirmed. The last case was diagnosed with multiple sclerosis at age 24 and went on to develop visual loss with poor recovery. DNA analysis demonstrated the 11778 mutation and confirmed LHON. CONCLUSIONS: All three cases, although not unique, posed considerable diagnostic difficulties over a long period of time. The authors have highlighted important associations of the disease and stress the importance of making the diagnosis in women. They are at increased risk of having affected children, unlike the affected males, especially if they are affected themselves and may wish to seek further genetic advice.

Adult↗
PubMedDate not supplied

Acute retinal necrosis presenting as central retinal artery occlusion with cilioretinal sparing.

PURPOSE: To report a case of acute retinal necrosis presenting as central retinal artery occlusion with cilioretinal sparing. METHODS: Single interventional case report. The findings of the ophthalmic examination, MRI, blood parameters, biopsy results and clinical course are reported. RESULTS: A forty two year old gentleman reporting sudden loss of sight, ophthalmic examination revealing uveitis, central retinal artery occlusion with cilioretinal sparing and peripheral necrotizing retinitis. CONCLUSIONS: Central retinal artery occlusion can be an early feature of acute retinal necrosis (ARN).

Adult↗
PubMedDate not supplied

Retinal infections.

Retinal infections may occur as part of a multisystem disease or as a distinct clinical entity. Early recognition of such infections and prompt treatment may prevent permanent visual loss, and can provide important diagnostic information.

Eye Infections↗
PubMedDate not supplied

The eye in systemic disease.

All systemic diseases can affect the eye. This article discusses the clinical changes in the eye within traditional disease categories. Emphasis is placed on the most common disorders, those in which specific eye findings assist in diagnosis and those where involvement of the eye requires urgent referral to an ophthalmologist.

Adult↗