Biomedical subjects
Publications and source records attributed to H Cohn.
Approaches to treatment of the flat bleb after filtering surgery depends on the IOP, bleb appearance and absence or presence of a leak, anterior chamber depth, and the time since surgery. Treatment modalities include simple watching and waiting, reinstituting medical therapy, digital massage, laser suture lysis, YAG goniopuncture, or reoperation.
A two-phase surgical approach may be chosen with the glaucoma intervention done first when there is advanced glaucomatous involvement and only moderate lens opacity; and cataract surgery is the first priority when there has been substantial vision loss due to the lens with a moderate case of glaucoma stabilized medically. In the case of closed-angle glaucoma, it may be preferable to operate on the lens alone rather than perform filtration or combined surgery. Our personal experience with 31 patients undergoing phacotrabeculectomy at two sites without adjunctive antimetabolites has shown that this technique is effective in controlling intraocular pressure in glaucoma patients (mean decrease in pressure, 29%), with few complications.
KamLAND has measured the flux of nu;(e)'s from distant nuclear reactors. We find fewer nu;(e) events than expected from standard assumptions about nu;(e) propagation at the 99.95% C.L. In a 162 ton.yr exposure the ratio of the observed inverse beta-decay events to the expected number without nu;(e) disappearance is 0.611+/-0.085(stat)+/-0.041(syst) for nu;(e) energies >3.4 MeV. In the context of two-flavor neutrino oscillations with CPT invariance, all solutions to the solar neutrino problem except for the "large mixing angle" region are excluded.
A human cancer vaccine composed of autologous tumor cells modified with the hapten dinitrofluorobenzene (DNP) induces cell-mediated immunity to the tumor cells and the development of inflammatory responses within metastatic sites. In this study we determined whether DNP vaccine could induce regression of established metastases. Ninety-seven patients (83 evaluable) with surgically incurable metastatic melanoma were treated with DNP vaccine preceded by low-dose cyclophosphamide. Tumor regression was assessed by standard criteria. The development of cell-mediated immunity to melanoma-associated antigens was measured by delayed-type hypersensitivity (DTH) testing before and after DNP vaccine treatment. Survival analysis was performed by the Kaplan-Meier method. There were 11 antitumor responses: 2 complete, 4 partial and 5 mixed. Both complete responses and 2 of the 4 partial responses occurred in patients with lung metastases. Response durations were as follows: partial responses-5, 6, 8 and 47+ months; and complete responses-12 and 29 months. Tumor regression required at least 4 months to become evident and in 2 cases maximum regression was not observed until 1 year after beginning treatment. Patients who exhibited tumor regression survived longer than those who did not (median survival times: responders, 21.4 months; non-responders, 8.7 months; p = 0.010). DTH to DNP-modified and unmodified autologous melanoma cells was induced in 87% and 42% of patients, respectively. The DTH response to unmodified cells was significantly associated with prolonged survival. Autologous DNP-modified melanoma vaccine can induce clinically meaningful regression of metastases and small lung metastases appear to be unusually sensitive. The development of DTH to unmodified, autologous tumor cells may be an important indicator of the vaccine's efficacy.
PURPOSE: To investigate the different treatment strategies in France and the direct costs for patients with newly diagnosed primary open-angle glaucoma or ocular hypertension who have started treatment with beta-blockers, and to estimate the total direct cost for two years of treat. MATERIAL: and methods: We analyzed 225 medical charts retrospective in eleven academically and office-based centers in France over the first two years after diagnosis. Standard costs for each resource in current medical practice were determined from the French Social Security perspective. RESULTS: The vast majority of patients (90%) had a diagnosis of primary, open-angle glaucoma or ocular hypertension in both eyes. In 60% of the patients we found a moderate or severe defect in their visual field or optic nerve. Intraocular pressure before treatment was 23.9+4.7mmHg and 17.5+4.2mmHg after two years of treatment. Over the first two years, 25% of visits led to a change in therapy (medical or surgical), involving 64% of the patients. Two-thirds of the changes occurred during the first year of treatment and in around 80% of cases for low intraocular pressure at check-up. Laser surgery or surgical intervention was performed in 25% of the patients. Total direct costs for two years were 5698F.F. The intraocular pressure before treatment was positively correlated (p<0.01) with treatment costs, while the initial intraocular pressure-lowering effects of treatment were negatively correlated with two-year costs. CONCLUSION: After two years of treatment, the mean intraocular pressure decreased from 24 to 17.5mmHg. The higher the basal intraocular pressures is, the more intensive the treatment and the higher the costs. The more efficient the treatment to decrease baseline intraocular pressure is, the earlier the costs will be reduced.
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PURPOSE: Glaucoma is an optic neuropathy in which optic nerve changes are important in diagnosis and progression, because the visual field may remain normal even while the optic nerve is undergoing significant damage. Accurate methods to objectively document the appearance of the optic nerve are necessary. In order for an optic disc imaging system to be clinically useful for detecting change, its reproducibility must be established. METHODS: We measured the reproducibility of duplicate measurements in 59 eyes of 31 consecutive patients, grouped into glaucoma subjects (n = 29) and eyes with glaucoma (n = 30), with the 3.10 OIS Glaucoma-Scope. In order to simulate two visits on one day, sets of three optic disc images were obtained first, followed by a repeat set, and the best disc images of each (chosen by the computer) were compared. RESULTS: The coefficients of variation of duplicate measurements for glaucoma suspects and patients with glaucoma were respectively: vertical cup/disc (c/d) ratio, 6.3% and 3.47%; horizontal c/d ratio, 4.61% and 2.97%; c/d area, 3.29% and 1.37%; cup area, 1.82% and 1.72%; mean position (MP) disc, 13.3% and 10.42%; MP total, 10.1% and 13.2%. For three eyes the examination was not possible (opacification of posterior capsule, miosis). CONCLUSION: These results suggest that the 3.10 version of the OIS Glaucoma-Scope allows reproducible measurements in living eyes.
AIM: In an attempt to use the quantitative optic disc measurements of the Glaucoma-Scope (OIS Sacramento, CA, USA) to distinguish glaucomatous from normal optic discs, a new variable was investigated, the mean disc corrected for the disc size by dividing by the disc area: MP/D. METHODS: Glaucoma-Scope disc evaluation was performed on 81 eyes of 51 patients split into the following groups based on Humphrey 24-2 visual field and clinical criteria of glaucoma: chronic glaucoma n = 27 (including only early, n = 17, and low tension glaucoma, n = 10), ocular hypertension n = 24, pseudoglaucomatous large discs, n = 12, and normal eyes, n = 18. Classic optic disc variables (the vertical and horizontal c/d ratios, and the c/d area) were compared with the new MP/D index calculating receiver operating characteristic curves. RESULTS: The MP/D ratio was able to identify the glaucomatous eyes more easily than other ratios. Areas under the curves were: 0.91 (MP/D); 0.87 (c/d area); 0.85 (c/d vertical); and 0.80 (c/d horizontal). The MP/D index was also correlated with the mean deviation (r = 0.466; p = 0.001). CONCLUSION: MP/D may prove useful in detecting glaucomatous optic nerve damage and could be an interesting screening tool for primary open angle glaucoma.
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PURPOSE: The aim of the study was to compare 2 combinations of eye drops containing 2% carteolol and 2% pilocarpine: LCM 1010: ready to use eye drops CBS 341A: eye drops to be reconstituted (freeze-dried powder + solvent). METHODS: Ninety-seven patients with primary open angle glaucoma or simple ocular hypertension were included in a randomized, double-blind multicentric study comparing 2 parallel groups of treatment. Intra-ocular pressure was greater than 21 mmHg with beta-blocker alone. One instillation of 2% carteolol-2% pilocarpine combination was given twice a day for one month. Before and after this treatment, intra-ocular pressure was measured at 9 am (12 hours after evening instillation) and at 11 am (2 hours after morning instillation). RESULTS: Both treatments reduced intra-ocular pressure by a comparable amount and there was no significant difference between groups at either measure: at 9 am: 2.11 +/- 2.39 mmHg (mean +/- SD) for LCM 1010 1.79 +/- 1.73 mmHg for CBS 341 A p = 0.25 at 11 am: 3.75 +/- 3.83 mmHg for LCM 1010 3.40 +/- 1.69 mmHg for CBS 341 A p = 0.42. Both eye drops were generally well tolerated. CONCLUSION: Efficacy and safety of ready to use eye drops 2% carteolol-2% pilocarpine combination proved to be comparable to that of eye drops to be reconstituted in the treatment of ocular hypertension poorly controlled by beta-blocker eye drops alone.
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Results of routine perimetric testing of the left and right hemifields in normal subjects have been assumed to be symmetric although asymmetry due to hemispheric dominance has been established for other psychophysical tests. These asymmetries have sometimes been related to sex. With the advent of computerised static perimetry, subtle differences between the left and the right hemifields might be found that were not obvious before. This study investigated differences in retinal sensitivity between the hemifields and the role of sex and eye dominance. Forty three unequivocally right handed and right eye dominant normal adult volunteers, 24 females and 19 males, underwent Humphrey 24-2 testing, half beginning with the left eye, the other half with the right eye. The Peridata program was used to calculate decibel totals per hemifield. Four subjects were excluded because of poor cooperation or test artefacts. In females, the total of the left hemifield was significantly less than the right (p < 0.01) by a mean 18.2 (SD 24) dB equivalent to a difference of 0.34 dB per tested point. No significant difference in hemifields was found for males, between the sexes for both eyes combined, or between the two eyes for either sex. It was concluded that asymmetries in retinal sensitivity with respect to the vertical axis may be physiological and found in females, but not in males.
Trabeculectomy is the most commonly performed filtering procedure in the surgical treatment of open angle glaucoma. One may oversimplify and state that a trabeculectomy is indicated in a case of uncontrolled IOP on maximum tolerated medical therapy in the presence of significant optic disk and/or visual field changes. However, before one actually proposes a trabeculectomy one must consider for a given patient: How does one define IOP control? What are the chances of success of the surgery? What are the operative risks? What are the risks of not operating for the case under consideration? And more generally: What are the arguments of earlier surgery? Where does Argon Laser Trabeculoplasty fit into the therapeutic regimen? The questions are examined with the specific goal of making a rational decision for the patient at hand.
Intranasal midazolam was tested in pediatric patients undergoing ophthalmological examination. 15 children aged 3.5 months to 10 years received 0.35-0.5 mg.kg-1 intranasal midazolam in association with a corneal anesthesia. The onset of sedation was rapid and permitted adequate ocular examination in all cases. In 8 of 15 cases where surgery followed immediately, the induction of inhalational anesthesia was easier. No local or general adverse reaction was noted. This non-invasive method of anesthesia may be compared to the intrarectal administration of midazolam, but the rapid onset of sedation and a cleaner route seem more suitable in surgical environment.
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