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Biomedical subjects

J Schiffman

Publications and source records attributed to J Schiffman.

At least 37 records · Page 2Linked to original sources
PubMed1997

Visual acuity outcomes among patients with appositional suprachoroidal hemorrhage.

OBJECTIVE: The purpose of the study is to investigate visual acuity outcomes among patients with appositional suprachoroidal hemorrhage and to identify clinical features associated with visual prognosis. DESIGN: The study design was a retrospective chart review. PARTICIPANTS: All patients whose ocular echographic examination results showed appositional suprachoroidal hemorrhage at the Bascom Palmer Eye Institute between January 1, 1987, and December 31, 1996 were included. Fifty-one patients were identified. INTERVENTION: Demographic and clinical data were abstracted from patients' medical records. MAIN OUTCOME MEASURES: Visual acuity at 3, 6, and 12 months posthemorrhage and clinical features associated with visual prognosis were defined. RESULTS: At final follow-up fifteen (29.4%) patients achieved either their prehemorrhage visual acuity (n = 7) or a visual acuity of 20/200 or better (n = 8), but 14 (27.5%) patients had no light perception. Predictors of a poor visual outcome include vitreous incarceration in the wound/bleb (P = 0.014), concurrent or delayed retinal detachment (P = 0.003), and afferent pupillary defect on presentation (P = 0.002). Poorer visual acuity on presentation (r = 0.37, P = 0.008) and longer duration of central retinal apposition (r = 0.51, P < 0.001) also were significantly associated with poor final visual acuity. Patients in whom the suprachoroidal hemorrhage maintained an appositional configuration for more than 14 days were more likely to have worse final visual acuities than were patients with appositional choroidals for fewer than 14 days (P = 0.006). The association between duration of apposition and final visual acuity was significant, both among patients whose suprachoroidal hemorrhages were observed (n = 26, r = 0.60, P = 0.001) and among patients who underwent secondary surgical intervention (n = 23, r = 0.66, P = 0.001). Patients with postoperative suprachoroidal hemorrhages achieved better final visual acuities than did patients in whom suprachoroidal hemorrhages developed intraoperatively or after trauma (P = 0.038). CONCLUSIONS: Appositional suprachoroidal hemorrhage is a serious ocular complication with a guarded visual prognosis. A variety of clinical features, including vitreous incarceration in the wound/bleb, concurrent or delayed retinal detachment, afferent pupillary defect, presenting visual acuity, and duration of central retinal apposition, may help predict visual outcome.

Adult↗
PubMed1997

Retinal changes associated with tamoxifen treatment for breast cancer.

PURPOSE: This study was undertaken to estimate the incidence of retinal changes and determine the prevalence of ocular toxicity associated with tamoxifen treatment in a breast cancer population. METHODS: The study was based on a population cross-sectional survey, including 290 patients taking tamoxifen from 6 months to 12 years; 274 patients were analysed. The main outcome measures were the incidence of retinal changes and visual impairment. RESULTS: The incidence of retinal changes was 0.9% (3 of 274 patients). All 3 patients were asymptomatic. The length of tamoxifen treatment ranged from 39 months to 120 months in the affected patients, with cumulative tamoxifen doses ranging from 23.7 g to 73 g. CONCLUSIONS: Retinopathy in patients receiving low doses of tamoxifen is rare and, in our study, did not result in changes in visual acuity. We found no retinopathy in patients receiving tamoxifen within the first 3 years of treatment or in patients receiving a total tamoxifen dosage of less than 23.7 g. Although retinopathy can occur in a tamoxifen-treated population, its low incidence and an associated good prognosis for vision does not merit special screening for this problem.

Aged↗
PubMed1997

The significance of white-centered retinal hemorrhages in the shaken baby syndrome.

Retinal hemorrhages in healthy children with or without a history of associated trauma are a strong indicator of child abuse. This report describes six cases of battered infants who presented with white-centered retinal hemorrhages. We discuss potential mechanisms for the presence of white-centered retinal hemorrhages in battered children.

Battered Child Syndrome↗
PubMed1997

In vitro efficacy of carboplatin and hyperthermia in a murine retinoblastoma cell line.

PURPOSE: To determine the cell-killing activity of varying doses of carboplatin, graded hyperthermia, and the combination of carboplatin and hyperthermia in the treatment of a transgenic murine retinoblastoma cell line. METHODS: Replicate cell wells (more than six wells per dose point) from an established transgenic murine retinoblastoma cell line (Rb-6) were exposed to a single application of hyperthermia for 15, 30, 60, and 120 minutes at temperatures of 37 degrees C (control), 40 degrees C, and 43 degrees C. Carboplatin dose response treatment was studied at doses of 2000, 1000, 500, 400, 300, 200, 100, and 50 ng per well. Combined treatment studies used these carboplatin dosages with each of the graded hyperthermia exposure temperatures at each exposure time. At 24 hours, all wells were pulsed with 3H-thymidine for 24 hours, washed three times, harvested, and counted. Raw counts (3H-thymidine) were fitted to a linear regression model to calculate the lethal dose for 50% (LD50) of cells. RESULTS: The LD50 for carboplatin exposure at 37 degrees C occurred at 542 ng. The LD50 for hyperthermia at 40 degrees C occurred at 90 minutes and at 43 degrees C it occurred at 62 minutes. Combined hyperthermia and carboplatin exposure yielded a synergistic interaction with an LD50 of 327 ng at 43 degrees C for 30 minutes. Determination of a thermal enhancement ratio yielded an enhancement range of 1.1 to 25.8. CONCLUSIONS: The synergistic cytocidal interaction of heat and carboplatin in a transgenic murine retinoblastoma cell line has been established in this study. The increased thermal enhancement ratio documents the potential utility of combined treatment applications in reducing treatment levels of single-modality therapy, potentially allowing for a decrease in treatment-related morbidity.

Animals↗
PubMed1995

Postischemic intestinal motility in rat is inversely correlated to length of ischemia. An in vivo animal model.

An inverse correlation between postischemic gastrointestinal motility and the length of intestinal ischemia was found in an animal model. Intestinal ischemia was caused without concurrent laparotomy and for a predetermined time period (ischemia time) by pulling on an external nylon thread that was threaded through a double-lumen catheter. This catheter was passed into the abdominal cavity to encircle the superior mesenteric artery. Gastrointestinal motility was determined by the introduction of a color-marked meal into the animal's stomach and the measurement of the proportionate length of the small bowel filled with it (transit index). This simple and reliable animal model can also be used for the evaluation of techniques and pharmacological manipulations aimed at modulation of the effects of intestinal ischemia on intestinal motility and its consequences.

Animals↗
PubMed1995

Endophthalmitis after penetrating trauma. Risk factors and visual acuity outcomes.

PURPOSE: To identify clinical characteristics that were associated with an increased incidence of endophthalmitis in eyes with penetrating ocular trauma. METHODS: In part 1, a retrospective analysis was performed on 258 consecutive patients with penetrating ocular trauma presenting to the Bascom Palmer Eye Institute between October 1987 and January 1991. In part 2 of the study, 28 consecutive patients with culture-proven endophthalmitis were identified from the Clinical Microbiology Registry from April 1987 through September 1987 and February 1991 through August 1993. Clinical variables were evaluated in each part for association with an increased risk of endophthalmitis. RESULTS: In part 1 of the study, endophthalmitis developed in 13 (5%) of the 258 patients. Endophthalmitis did not occur in eyes that had blunt injury. In those eyes with a lacerating injury, there was an increased relative risk of infection in eyes with disruption of the crystalline lens. This risk factor was found statistically significant by univariate and multivariate analysis. In part 2 of the study, lens disruption was present in 24 (86%) of 28 patients with culture-proven endophthalmitis. Of the 41 patients with infection from part I and part II, 22 (54%) achieved visual acuity of 20/ 400 or greater. Endophthalmitis caused by coagulase-negative staphylococci had the best visual outcome, with 7 (64%) of 11 patients obtaining visual acuity of 20/ 400 or greater. CONCLUSION: Lens disruption in eyes with penetrating trauma is a significant risk factor for the development of endophthalmitis. The prognosis for useful vision in eyes with posttraumatic endophthalmitis is best when infection is caused by less virulent organisms.

Anti-Bacterial Agents↗
PubMed1994

Epidural anesthesia accelerates the recovery of postischemic bowel motility in the rat.

BACKGROUND: Intestinal ischemia is associated with derangement of gastrointestinal motility. Uncontrolled clinical observations that bupivacaine injected into the epidural space causes faster recovery of bowel motility after various abdominal operations led us to assess the hypothesis that epidural anesthesia can hasten the recovery of gastrointestinal motility in the immediate postischemic period. METHODS: Gut motility studies were performed in rats in which epidural anesthesia and intestinal ischemia could be initiated without the need to provoke surgical trauma. Epidural lidocaine was compared to epidural saline in their effect on intestinal motility after a 30-min period of bowel ischemia. RESULTS: Total ischemia to the small bowel resulted in pronounced postischemic adynamic ileus as evidenced by only 0.7% of the total length of the small bowel filled with a marker meal at the end of the study period (transit index) compared with 84.4% in the control group. Lidocaine epidural anesthesia caused significantly more rapid resolution of the adynamic ileus (60.3% of the bowel filled with the marker meal vs. 30.9% in the controls in which saline was injected). CONCLUSIONS: Epidural lidocaine compared to epidural saline hastens the recovery of gastrointestinal motility in rats after a 30-min period of bowel ischemia. This effect may be elicited by attenuation of sympathetic efferent inhibitory pathways or by vasodilatation caused by the sympathetic block. These results suggest that lidocaine epidural block not only alleviates pain in situations of ischemic injury to the bowel but may also hasten the recovery from postischemic paralytic ileus.

Anesthesia, Epidural↗
PubMed1993

Association of herpes zoster ophthalmicus with acquired immunodeficiency syndrome and acute retinal necrosis.

We conducted a review to investigate the prevalence of human immunodeficiency virus (HIV), or acquired immunodeficiency syndrome (AIDS), in patients with herpes zoster ophthalmicus, as well as the incidence of acute retinal necrosis after herpes zoster ophthalmicus. All charts of patients seen at our institution between 1987 and 1992 with a primary diagnosis of herpes zoster ophthalmicus were reviewed. Of 112 patients with herpes zoster ophthalmicus, 29 (26%) had HIV or AIDS. All these patients were younger than 50 years at the time of diagnosis. Five of 29 (17%) immunocompromised patients had acute retinal necrosis after herpes zoster ophthalmicus. No acute retinal necrosis was identified in the nonimmunocompromised patients after herpes zoster ophthalmicus. We recommend that all patients younger than 50 years who have herpes zoster ophthalmicus at initial examination be tested for HIV. Additionally, HIV-infected patients should be monitored closely after herpes zoster ophthalmicus for development of acute retinal necrosis. Long-term oral prophylactic as well as initial high-dose intravenous acyclovir may be appropriate in HIV-infected individuals with herpes zoster.

AIDS-Related Opportunistic Infections↗
PubMed1993

Fluorescein angiography in the diagnosis of giant cell arteritis.

Clinical data and fundus fluorescein angiograms were analyzed from 35 patients with acute (onset less than four weeks) anterior ischemic optic neuropathy. Nineteen of the 35 patients (54%) had nonarteritic disease, and 16 patients (46%) had giant cell arteritis confirmed by biopsy. Patients with arteritis had higher erythrocyte sedimentation rates, larger cup/disk ratios, and delayed fluorescein dye appearance and choroidal filling times. Three additional patients with cranial arteritis confirmed by biopsy, but without visual loss, had angiographic characteristics similar to patients with arteritic ischemic neuropathy. We consider fluorescein angiography a valuable diagnostic adjunct in identifying patients with giant cell arteritis.

Adrenal Cortex Hormones↗
PubMed1992

A cohort study of transcutaneous oxygen tension and the incidence and severity of retinopathy of prematurity.

BACKGROUND: Retinopathy of prematurity is a disease affecting the blood vessels of the retina in premature infants that may result in scarring, retinal detachment, and loss of vision. An association between this condition and the exposure of premature infants to supplemental oxygen has been postulated, but the relation between retinopathy of prematurity and blood oxygen levels has not been defined. The purpose of this study of a cohort of preterm infants was to correlate the incidence and severity of retinopathy of prematurity with the duration of exposure to different ranges of oxygen tension as measured by transcutaneous monitoring (tcPO2). METHODS: One hundred one premature infants (birth weight, 500 to 1300 g) requiring supplemental oxygen had continuous monitoring of tcPO2. The number of hours during which the tcPO2 was 80 mm Hg or higher was tabulated for each infant during the first four weeks of life. RESULTS: There was a significant association between the amount of time that the tcPO2 was greater than or equal to 80 mm Hg and the incidence and severity of retinopathy of prematurity. The odds ratio for each 12-hour period in which the tcPO2 was greater than or equal to 80 mm Hg was 1.9 (95 percent confidence interval, 1.2 to 3.0) after adjustment for the following factors: birth weight less than or equal to 1300 g (odds ratio, 2.3 [95 percent confidence interval, 1.6 to 3.4]), five-minute Apgar score of 7 or less (odds ratio, 7.2 [95 percent confidence interval, 2.5 to 21]), and exposure to inspired oxygen at a concentration greater than or equal to 0.4 (odds ratio, 1.0 [95 percent confidence interval, 0.97 to 1.05]). The association was stronger for tcPO2 values of greater than or equal to 80 mm Hg occurring from the second through the fourth week of life; during this period, the adjusted odds ratio for a 12-hour period of such exposure was 3.1 (95 percent confidence interval, 1.6 to 6.1). CONCLUSIONS: This study supports an association between the incidence and severity of retinopathy of prematurity and the duration of exposure to arterial oxygen levels of 80 mm Hg or higher, measured transcutaneously.

Apgar Score↗
PubMed1991

Radiation-induced optic neuropathy: a magnetic resonance imaging study.

Optic neuropathy induced by radiation is an infrequent cause of delayed visual loss that may at times be difficult to differentiate from compression of the visual pathways by recurrent neoplasm. The authors describe six patients with this disorder who experienced loss of vision 6 to 36 months after neurological surgery and radiation therapy. Of the six patients in the series, two had a pituitary adenoma and one each had a metastatic melanoma, multiple myeloma, craniopharyngioma, and lymphoepithelioma. Visual acuity in the affected eyes ranged from 20/25 to no light perception. Magnetic resonance (MR) imaging showed sellar and parasellar recurrence of both pituitary adenomas, but the intrinsic lesions of the optic nerves and optic chiasm induced by radiation were enhanced after gadolinium-diethylenetriaminepenta-acetic acid (DTPA) administration and were clearly distinguishable from the suprasellar compression of tumor. Repeated MR imaging showed spontaneous resolution of gadolinium-DTPA enhancement of the optic nerve in a patient who was initially suspected of harboring recurrence of a metastatic malignant melanoma as the cause of visual loss. The authors found the presumptive diagnosis of radiation-induced optic neuropathy facilitated by MR imaging with gadolinium-DTPA. This neuro-imaging procedure may help avert exploratory surgery in some patients with recurrent neoplasm in whom the etiology of visual loss is uncertain.

Aged↗
PubMed1987

Transcutaneous oxygen monitoring and retinopathy of prematurity.

This study was performed to determine whether the use of continuous tcPO2 monitoring could reduce the incidence of ROP in preterm infants receiving oxygen therapy. Two hundred and ninety-six infants with birth weights less than or equal to 1300 grams were randomly assigned to a continuous monitoring (CM) or a standard care (SC) group. CM infants had tcPO2 monitored continuously as long as they required supplemental oxygen while SC infants had tcPO2 monitored only during the more acute state of their illness. Management of both groups was otherwise identical. One hundred and one of 148 infants in the CM and 113 of 148 patients in the SC groups survived. Mean birth weights and gestational age were similar in both groups. Duration of mechanical ventilation and oxygen therapy was also similar. The overall incidence of ROP was 51% in the CM and 59% in the SC group. As birth weight for infants greater than or equal to 1000 grams increased a higher risk for developing ROP was noted in the SC group. Four infants in the CM and 5 in the SC group developed cicatricial ROP. These results suggest that continuous tcPO2 monitoring may reduce the incidence of ROP in infants with birth weights greater than 1000 grams, but not in the smaller infants in whom this complication occurs more frequently and is more severe.

Birth Weight↗
PubMed1987

Retinopathy of prematurity. A randomized, prospective trial of transcutaneous oxygen monitoring.

To determine whether the use of continuous transcutaneous oxygen monitoring (tcPO2) could reduce the incidence of retinopathy of prematurity (ROP) in pre-term infants receiving oxygen therapy, a randomized, prospective trial of constant monitoring using the transcutaneous oxygen monitor versus intermittent monitoring of oxygen was performed on a population of premature infants at very high risk for the development of ROP. Two hundred ninety-six infants were randomly assigned to either a constantly monitored (CM) or standard care (SC) group. CM infants had tcPO2 monitored continuously as long as they required supplemental oxygen, whereas SC infants had tcPO2 monitored only during the more acute state of their illness. Management of both groups was otherwise identical. One hundred one of 148 infants in the CM group and 113 of 148 in the SC group survived. The overall incidence of ROP was 51% in the CM group and 59% in the SC group (no significant difference). In infants over 1000 g birthweight, as the weight increased there was increasing risk of developing ROP in the SC group. The odds ratio for the ROPsc:ROPcm reached 7.6 in infants between 1200 and 1300 g in infants with Apgar scores greater than or equal to 8 at 5 minutes. The incidence of cicatricial ROP was similar in both groups: four in the CM and five in the SC group.

Blood Gas Monitoring, Transcutaneous↗
PubMed1987

Influence of transcutaneous oxygen monitoring on the incidence of retinopathy of prematurity.

This study was performed to determine whether the use of continuous transcutaneous oxygen tension (tcPO2) monitoring could reduce the incidence of retinopathy of prematurity in preterm infants receiving oxygen therapy. A total of 296 infants with birth weights less than or equal to 1,300 g were randomly assigned to a continuous monitoring or a standard care group. Infants in the continuous monitoring group had tcPO2 monitored continuously as long as they required supplemental oxygen, and infants in the standard care group had tcPO2 monitored only during the more acute state of their illness. Management of both groups was otherwise identical. Of 148 infants in the continuous monitoring group, 101 survived; of the 148 patients in the standard care group, 113 survived. Mean birth weights and gestational ages were similar for both groups. Duration of mechanical ventilation and oxygen therapy was also similar. The overall incidence of retinopathy of prematurity was 51% in the continuous monitoring group and 59% in the standard care group. As birth weight for infants greater than or equal to 1,000 g increased, a higher risk of retinopathy of prematurity developing was noted in the standard care group. Cicatricial retinopathy of prematurity developed in four infants in the continuous monitoring group and five in the standard care group. These results suggest that continuous tcPO2 monitoring may reduce the incidence of retinopathy of prematurity in infants with birth weights greater than 1,000 g but not in the smaller infants in whom this complication occurs more frequently and is more severe.

Birth Weight↗
PubMed1987

Retinopathy of prematurity. Diagnosis, severity, and natural history.

This article presents data gathered in a prospective clinical trial of constant monitoring of oxygen therapy on the diagnosis, severity (as coded by a severity index [SI]) and natural history of retinopathy of prematurity (ROP) in 214 surviving infants with birthweights less than or equal to 1300 g. ROP developed in 119 (55.6%) infants and, of these, cicatricial ROP developed in nine (7.6%). The disease was diagnosed at 8-9 weeks on the average in infants with birthweights less than 900 g and 4-5 weeks in infants 900 to 1300 g. Those infants in whom the disease regressed, ROP lasted approximately 15 weeks. The severity of the disease, as defined by the SI, was strongly correlated with the birthweight of the infant and weakly correlated with the total duration of oxygen therapy.

Cicatrix↗
PubMed1985

Echographic and histologic tumor height measurements in uveal melanoma.

We studied the relation between echographic tumor elevation (measured by standardized A-scan echography) and histologic tumor thickness (measured from histologic slides with an ocular micrometer) in a series of 53 choroidal and ciliary body melanomas enucleated within one month of the most recent echographic measurement. Histologic height was less than echographic height for all sizes and locations studied, with a correlation coefficient of r = .926. The following equations for straight lines described the relationship: Echographic height = 1.964 + (1.042 X histologic height). Histologic height = -0.660 + (0.823 X echographic height). Thus, current thickness criteria for small (less than 3 mm), medium (3 to 5 mm), and large (more than 5 mm) melanomas, based on histologic measurements, may be translated to the following echographic terms: small, less than 5.2 mm; medium, 5.2 to 7.2 mm; and large, more than 7.2 mm. The source of this difference is a variable degree of tumor shrinkage induced by fixation and histologic preparation.

Choroid↗