Search PubMed⌕ Search

Biomedical subjects

R Belfort

Publications and source records attributed to R Belfort.

At least 37 records · Page 2Linked to original sources
PubMed1999

Intraocular inflammatory reactions without focal necrotizing retinochoroiditis in patients with acquired systemic toxoplasmosis.

PURPOSE: To describe the occurrence of intraocular inflammatory reactions as the sole ophthalmic manifestation of acquired systemic toxoplasmosis. METHODS: Review of medical records for 10 patients with uveitis and evidence of recent Toxoplasma gondii infection. RESULTS: Patient ages ranged from 3 to 51 years. Ocular symptoms were present in each of eight adult patients. Inflammation was unilateral in nine patients; it manifested as vitreous humor cells and haze (10 patients), anterior chamber cells (seven patients), and retinal vasculitis (seven patients). No patient had necrotizing retinochoroiditis upon initial examination. Inflammation resolved in each of nine patients who had follow-up examinations. Foci of retinitis or inactive retinochoroidal scars were seen in four of these nine patients during follow-up examinations, at intervals of 2.0 weeks to 2.5 years after initial examination. CONCLUSIONS: Retinal vasculitis and associated inflammatory reactions may be the only ophthalmic disorder during the early stages of a newly acquired T. gondii infection. Later development of retinitis or scars consistent with toxoplasmic retinochoroiditis in the same eyes suggests that the initial, isolated inflammation may be caused by the presence of parasites in retinal tissue. These cases may have implications for understanding the original source of retinal infection in patients who have recurrent toxoplasmic retinochoroiditis and for treatment of newly acquired T gondii infection.

Adolescent↗
PubMed1998

Antihelminthic drugs in diffuse unilateral subacute neuroretinitis.

PURPOSE: To evaluate the efficacy of ivermectin and thiabendazole in confirmed cases of diffuse unilateral subacute neuroretinitis. METHODS: Two patients with diffuse unilateral subacute neuroretinitis were treated with anthelminthic drugs. The first patient was treated with ivermectin and the second, with thiabendazole. RESULTS: The worms were still mobile after treatment with ivermectin or thiabendazole. With the application of photocoagulation, the organisms were destroyed, and the patients' vision improved. CONCLUSION: In these two patients, ivermectin and thiabendazole were not effective in treating confirmed diffuse unilateral subacute neuroretinitis.

Acute Disease↗
PubMed1998

Hyphema after peribulbar anesthesia for cataract surgery in Fuchs' heterochromic iridocyclitis.

PURPOSE: To describe an unusual ocular sign in one patient with Fuchs' heterochromic iridocyclitis at cataract surgery. METHODS: We describe a patient with Fuchs' heterochromic iridocyclitis and cataract who developed a 1 mm hyphema observed two minutes after peribulbar anesthesia for cataract surgery. RESULTS: The patient was found to have an equivalent of the Amsler-Verrey sign. It appeared after peribulbar anesthesia and before any instrument touched the globe. It did not interfere with surgery and disappeared completely by day 2. CONCLUSION: The appearance of a hyphema after peribulbar anesthesia in Fuchs' heterochromic iridocyclitis is an unusual sign that may have the same pathophysiology as the Amsler-Verrey sign.

Adult↗
PubMed1998

Alterations in blood-aqueous barrier after corneal refractive surgery.

PURPOSE: To assess alterations in the blood-aqueous barrier after radial keratotomy (RK), photorefractive keratectomy (PRK), laser in situ keratomileusis (LASIK), and phototherapeutic keratectomy (PTK). METHODS: Aqueous flare was evaluated using the Kowa FM 500 laser flare meter in a total of 87 eyes from 82 patients who underwent refractive surgery. Measurements were obtained preoperatively in 51 eyes of 51 patients who underwent RK or PRK and again at the end of surgery, and at 1 day and 1 week postoperatively. These patients had been randomized (double masked) to receive topical 0.1% dexamethasone, polymyxin B (6,000 U/ml), and 0.5% neomycin 4 times a day for 1 week after surgery, or polymyxin B (6,000 U/ml) and 0.5% neomycin for 1 week. Aqueous flare measurements were also obtained before surgery in 36 eyes (31 patients) that underwent LASIK and again at 1 day and 1 and 2 weeks postoperatively. All patients in this group received topical 0.1% dexamethasone, polymyxin B (6,000 U/ml), and 0.5% Neomycin 4 times a day for 15 days after surgery. RESULTS: Uneventful RK induced a significant increase in flare immediately after surgery, although this did return to baseline 1 day after surgery (Friedman test). Measurements at 7 days after surgery were similar in steroid-treated and untreated groups. Limbal bleeding, which occurred in 23% (12/51) eyes, did not induce significantly increased flare as compared to uneventful RK. Microperforations, which occurred in 18% (9/51) eyes, did induce significant alterations in the blood-aqueous barrier that persisted for >1 day, but measurements returned to preoperative levels by day 7. PRK and LASIK induced substantially increased flare in some eyes. Phototherapeutic keratectomy, in particular, induced an elevation in flare measurements that did not return to normal levels even by 15 days after surgery (Friedman test). CONCLUSIONS: Using mean results of laser flare meter evaluation, uneventful RK appears to induce short-lasting elevations in aqueous flare in both steroid-treated and untreated patients. Microperforation induced prominent alterations in flare measurements, although limbal bleeding did not. Both PRK and LASIK did appear to increase flare measurements in some eyes, while PTK induced significant elevations in aqueous flare in the majority of eyes.

Adolescent↗
PubMed1997

HIV-antibody detection in vitreous humor and serum by enzyme immunosorbent assay and particle agglutination test.

PURPOSE: To compare enzyme immunosorbent assay (EIA) and the particle agglutination (PA) test for the detection of antibodies to the human immunodeficiency virus (HIV) in cadaveric vitreous humor and serum. METHODS: Seventeen cadavers presenting pathologic signs of acquired immunodeficiency syndrome (AIDS) at autopsy and 33 without AIDS signs were evaluated. Consistency (k) and significance (p) between the diagnostic tests were established. RESULTS: The right and left eyes of each of 48 bilaterally tested cadavers presented identical diagnostic results in all laboratory tests. All tests were positive for antibodies in the AIDS cadavers except for two EIA-negative vitreous results. Three autopsy-negative cadavers showed by both EIA and PA testing positive results in serum and negative in vitreous. Two of them showed a serum-positive Western blot. CONCLUSION: Serum EIA anti-HIV antibody detection test is the current gold standard for evaluating corneal donor material. Neither the PA test nor EIA should be used for vitreous testing because of their low sensitivity.

Adult↗
PubMed1996

Squamous cell carcinoma of the conjunctiva in a patient with the acquired immunodeficiency syndrome.

PURPOSE: To alert ophthalmologists to the possibility of human immunodeficiency virus (HIV) infection in individuals with conjunctival squamous cell carcinoma. METHODS: We treated a 24-year-old patient with the acquired immunodeficiency syndrome who developed a limbal mass. The mass was excised and examined by routine histologic and immunohistochemical methods. RESULTS: The histopathologic examination disclosed infiltrating squamous cell carcinoma with features of spindle cell carcinoma. Frequent abnormal mitotic figures were present in this neoplasia. CONCLUSIONS: Squamous cell carcinoma with histologic features of aggressive behavior in a young individual should alert physicians to the possibility of HIV infection. Such patients may require frequent follow-up examination, even after complete excision of the tumor.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Presumed ocular and central nervous system tuberculosis in a patient with the acquired immunodeficiency syndrome.

PURPOSE: To elucidate a case of tuberculous choroiditis in a patient with the acquired immunodeficiency syndrome (AIDS). METHODS: We treated a 35-year-old woman who had AIDS with neurologic involvement caused by Mycobacterium tuberculosis. She developed a yellow-white chorioretinal infiltrate with indistinct borders and mild vitreitis in the right eye, probably caused by this pathogen. RESULTS: The patient's visual acuity improved in the right eye with healing of the ocular lesion and her neurologic condition improved after specific therapy with isoniazid, rifampin, and ethambutol. CONCLUSION: Tuberculosis must be considered in the differential diagnosis of posterior uveitis and choroiditis in AIDS patients.

AIDS-Related Opportunistic Infections↗
PubMed1996

Herpes zoster peripheral ulcerative keratitis in patients with the acquired immunodeficiency syndrome.

The purpose of this study was to describe the clinical characteristics and course of peripheral ulcerative keratitis (PUK) secondary to herpes varicella-zoster virus in patients with the acquired immunodeficiency syndrome (AIDS). Three AIDS patients with ocular herpes zoster infection (mean age at onset, 33.0 years; range, 30-42) developed PUK. The three patients had skin involvement, and two of them had bilateral keratouveitis. All were treated with high-dose oral acyclovir (4 g/day) with or without topical antiviral therapy. Two of the patients responded well to oral acyclovir, but one of them stopped the treatment, and bilateral progressive outer retinal necrosis and lethal encephalitis developed. The third patient had a recurrent episode of inflammation with PUK, extensive stromal scarring, and deep neovascularization. AIDS patients with herpes varicella-zoster virus infection may have severe and protracted corneal manifestations, including PUK. The correct diagnosis and aggressive early long-term systemic antiviral treatment must be instituted to control inflammation, ulcer progression, and complications.

Acquired Immunodeficiency Syndrome↗
PubMed1994

The progressive outer retinal necrosis syndrome. A variant of necrotizing herpetic retinopathy in patients with AIDS.

BACKGROUND: The progressive outer retinal necrosis syndrome is a recently recognized variant of necrotizing herpetic retinopathy. This report characterizes more fully its clinical features and course. METHODS: Using standardized clinical criteria, patients with progressive outer retinal necrosis syndrome from four institutions were identified. Patient records were reviewed retrospectively for the following data: medical and demographic characteristics, presenting symptoms, physical findings, course, responses to treatment, and outcomes. RESULTS: Thirty-eight patients (65 involved eyes) were studied. All had acquired immune deficiency syndrome. A known history of cutaneous zoster was documented in 22 (67%) of 33 patients. Median CD4 lymphocyte count was 21/mm3 (range, 0-130/mm3). Median follow-up was 12 weeks. The most common presenting symptom was unilateral decreased vision (35 of 65 eyes, 54%); median visual acuity at presentation was 20/30 (range, 20/20 to no light perception [NLP]). Anterior chamber and vitreous inflammatory reactions were absent or minimal in all patients. Typical retinal lesions were multifocal, deep opacities scattered throughout the periphery, although macular lesions also were present in 21 eyes (32%) at diagnosis. Lesions progressed rapidly to confluence. Initial intravenous antiviral therapy appeared to reduce disease activity in 17 (53%) of 32 eyes, but treatment did not alter final visual outcome. Visual acuity was NLP in 42 (67%) of 63 eyes within 4 weeks after diagnosis. Retinal detachment occurred in 43 (70%) of 61 eyes, including 13 (93%) of 14 eyes that received prophylactic laser retinopexy. CONCLUSION: The progressive outer retinal necrosis syndrome is characterized by features that distinguish it from cytomegalovirus retinopathy, acute retinal necrosis syndrome, and other necrotizing herpetic retinopathies. Visual prognosis is poor with current therapies.

AIDS-Related Opportunistic Infections↗
PubMed1993

Differentiation of Toxoplasma gondii from closely related coccidia by riboprint analysis and a surface antigen gene polymerase chain reaction.

The tachyzoite of the human pathogen Toxoplasma gondii is morphologically indistinguishable from the proliferative stages of some other zoonotic coccidia, including Sarcocystis. To determine the identity of such coccidia obtained from human tissues and other sources, we compared riboprints (through restriction enzyme analysis of the polymerase chain reaction [PCR]-amplified small subunit rRNA gene) of the following protozoa: the RH and ts-4 strains of T. gondii, lines OH3 and S11, which are two recently isolated T. gondii-like parasites from Brazil, Neospora caninum, Sarcocystis species, and the malarial parasite Plasmodium berghei. In addition, the protozoan genomes were examined by PCR for homologs of surface antigen genes of T. gondii, and by Southern hybridization to the heterologous rRNA gene probe pSM 389. Strains OH3, S11, ts-4, and RH shared identical riboprints, and OH3, S11, and ts-4 have p22 and p30 surface antigen gene structures similar to RH. In contrast, riboprints for N. caninum and T. gondii differ with respect to Dde 1 sites, and moreover, their genomes vary significantly from one another at both the p22 and p30 gene loci. The riboprints of Sarcocystis and P. berghei differ markedly from T. gondii and N. caninum and from each other. Bam HI pSM 389 restriction fragment length polymorphisms differentiate ts-4 from RH, OH3, and S11. Our results confirm that OH3 and S11 are indeed T. gondii, but that N. caninum and T. gondii are likely to be separate species, thereby resolving previous uncertainties concerning the identity of these parasites. Together, the variation in riboprints and surface antigen gene structure reflects the phylogenetic diversity among these coccidia, and in addition, confirms the value of riboprinting in the identification of apicomplexan parasites such as T. gondii.

Animals↗
PubMed1992

Retinal toxicity in human immunodeficiency virus-infected children treated with 2',3'-dideoxyinosine.

To assess the safety and antiretroviral activity of 2',3'-dideoxyinosine, we enrolled 43 children with symptomatic (Centers for Disease Control class P-2) human immunodeficiency virus infection in a Phase I-II study and monitored them prospectively for the development of ocular complications secondary to HIV infection or drug toxicity. Follow-up ranged from 12 to 103 weeks with a median follow-up of 71 weeks. Three of 43 children (7.0%) developed peripheral atrophy of the retinal pigment epithelium during treatment with 2',3'-dideoxyinosine. The two children with the most severe retinal atrophy were enrolled in the study at the highest dosage studied (540 mg/m2/day). In contrast to findings in children, no retinal atrophy in HIV-infected adults treated with 2',3'-dideoxyinosine has been evident to date.

Atrophy↗
PubMed1992

Intravenous administration of recombinant human macrophage colony-stimulating factor to patients with metastatic cancer: a phase I study.

PURPOSE: Recombinant human macrophage colony-stimulating factor (M-CSF) has been shown to stimulate specifically macrophage lineage differentiation in vitro and to induce cells capable of antitumor activity alone or in combination with an antibody. The administration of M-CSF to mice has demonstrated antitumor therapeutic effects in vivo. Therefore, a phase I trial of M-CSF administration to patients with metastatic cancer was undertaken. PATIENTS AND METHODS: M-CSF was given by intermittent intravenous bolus infusion every 8 hours for 7 days; the treatment cycle was repeated once after a week of rest. Cohorts of three patients underwent dose escalation from 10 to 100,000 micrograms/m2/d; 23 patients received 27 courses of M-CSF administration. All patients had metastatic solid tumors refractory to conventional therapy, including renal cell carcinoma (RCC) (nine), melanoma (seven), and colorectal carcinoma (seven). RESULTS: Treatment-related toxicity was minimal; five patients developed transient signs of ocular or periorbital inflammation, with iridocyclitis as the most severe manifestation. At the highest doses, platelet counts decreased with therapy (but remained > 100,000/mm3) and the absolute monocyte count increased during the course of therapy. Only at 30,000 and 100,000 micrograms/m2/d was treatment limited because of toxicity (iritis and malaise). Pharmacokinetic studies demonstrated up to a 1,000-fold increase in circulating serum M-CSF after bolus infusion; half-life varied from 1 to 6 hours. Complete regression of mediastinal adenopathy and multiple pulmonary metastases were observed in one patient with RCC. CONCLUSION: Recombinant M-CSF can be administered safely to patients with metastatic cancer at doses that demonstrate biologic activity.

Adult↗