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PubMed2005

[Clinical analysis and follow-up study of postural orthostatic tachycardia syndrome in 28 pediatric cases].

OBJECTIVE: Lightheadedness, dizziness, chest discomfort, headache, pallor, palpitation, blurred vision, fatigue, and syncope are main symptoms of postural orthostatic tachycardia syndrome (POTS), but they are also common problems in clinical pediatrics. Besides, most of POTS cases have normal findings in routine examinations on cardiac and central nervous system. Therefore, they are often unable to be correctly diagnosed and treated in time. Since head-up tilt test (HUT) was introduced to diagnose unexplained syncope in children, it was discovered that the most common pattern of unexplained syncope in children was vasovagal syncope. But in the course of the investigation, we and other groups identified a large subgroup of patients who had a less severe form of orthostatic intolerance characterized by postural tachycardia, lightheadedness, dizziness, and chest discomfort, etc. This disorder has become generally known as the POTS, which in children is not rare, but its report was not seen in China so far. The aim of this article is to recognise the clinical pictures of POTS in children and to explore its diagnostic criteria and therapeutic protocol. METHODS: All 28 pediatric patients of POTS who met the diagnostic criteria were selected to be the observation group. Age and sex distribution were observed, and the duration of symptoms, baseline heart rate and blood pressure were also recorded. The frequency of symptoms, the rate of misdiagnosis and the efficiency of therapeutic protocol were also analysed. RESULTS: Twenty-eight patients were diagnosed as POTS, occupying 31.8% of all unexplained syncope or lightheadedness in children. Eleven were males and 17 females. The ratio of male to female was 1:1.5. All the 28 cases were from 6 to 16 years old, 5 of which were < 10 years and 23 were from 10 to 16 years old, including 10. The duration of symptoms of POTS in children was from 1 month to 6 years. The average was about 13 months, and more than one half were in 6 months. The most common orthostatic symptoms were lightheadedness or dizziness, syncope, chest discomfort, pallor and blurred vision associated with nausea and/or vomiting. During HUT or standing, an increase in heart rate > 35 beats per minute within 10 minutes was the most common finding, and some were associated with > 120 beats per minute within 10 minutes after HUT or standing up. The average time of the occurrence of abnormal responses was about 5 minutes. Especially, we found only 36% of patients were diagnosed with standing up test. Most of them were diagnosed with HUT. POTS in children was misdiagnosed as epilepsy or myocarditis in 43% patients. Multiple treatment protocol including health education and supportive, physical and medical therapy were most helpful in children with POTS. CONCLUSION: POTS is commonly seen in school-aged girls. The common symptoms include dizziness, syncope and chest distress. HUT is an important tool in its diagnosis. A comprehensive therapeutic regimen is recommended in the treatment.

Adolescent↗
PubMed1992

Inter-observer variability in a computer-assisted optic nerve head assessment system.

A computer-assisted optic nerve head analysis system was used to measure parameters of the optic nerve head from one eye from each of 15 subjects. The subjects comprised three groups of five, being glaucomatous, ocular hypertensive, and normal. The 15 images produced were analysed in a randomized masked fashion by ten observers of varying levels of experience to test the inter-observer variability of the measurements. An analysis of variance demonstrated significant differences in the measurements made by the different observers. Fisher's F-test showed that all the parameters assessing the pallor area of the optic nerve head had significantly lower inter-image variance (reported previously) compared with inter-observer variance (at the 5% level). Variability in taking measurements of the pallor area of the optic nerve head is mainly due to observer variations rather than the image variations.

Glaucoma↗
PubMed2005

Knowledge and practices of traditional birth attendants in prenatal services in Lagos State, Nigeria.

A questionnaire-based study was conducted on 189 Traditional Birth Attendants (TBAs) on their knowledge and practices in prenatal services. Only 86 (45.5%) of them associated cessation of menstrual period with pregnancy while others use mystic power 46 (24.3%), early morning sickness, pallor of conjunctiva and reaction to herbs 56 (29.6%) to detect pregnancy. Fundal height n=76 (40.2%), palpation n=82 (43.4%), special soaps and soups n=52 (27.5%) and special devices n=8 (4.2%) are used to determine stages of pregnancy. Foetal health status is determined by regular foetal movements n=95 (50.3%), mystic power n=15 (8%), soap n=2 (1.1%), special concoction 9 (4.8%), health status of mother n=67 (35.4%) and foetal heart beat n=24 (12.7%). Ninety seven (51.3%) of them used herbal treatment, 77 (40.7%) used incantations, 189 (100%) used special soaps as their main methods of delivery, while only 18 (9.5%) of respondents refer difficult cases to hospitals. Instruments used for separating cord were blade 123 (65.1%) and scissors 40 (21.1%). Symptoms recognized by the TBAs as signs of complications in pregnancy were dizziness, swollen feet, pallor, tiredness, absent foetal movement, loss of appetite, heaviness, pain in back/stomach/side, weight loss, vomiting, bleeding, fever/malaria, head ache, bad dream, premature or delayed labour. Although some of them recognized some danger signs in pregnancy and labour, only very few would refer difficult cases for emergency obstetric interventions. Clear protocols for management and referral, which are necessary for improved maternal survival, should be provided through regular training of the TBAs.

Clinical Competence↗
PubMedDate not supplied

[Silicone occlusive sheeting vs silicone cushion for the treatment of hypertrophic and keloid scars. A prospective-randomized study].

BACKGROUND: Silicone gel and silicone occlusive sheeting are widely used at present for the treatment of hypertrophic and keloid scars. In recent studies the possibility was raised that static electricity generated by friction activated silicone sheeting could be the reason for this effect, and that it can, with time, cause involution of hypertrophic and keloid scars. Objective of this study was to test this hypothesis and to observe weather a continuous and also an increased negatively charged static electric field will shorten the treatment period. A silicone cushion was developed with the purpose of increasing a negative static-electric charge to accelerate the regression process. METHODS: From November 2001 to June 2002 we studied in a prospective randomized study, 72 patients with hypertrophic an keloid scars. The trial extended over a 8-month period. 37 patients underwent silicone occlusive sheeting, the remaining 35 patients underwent silicone cushion (Clinicel). RESULTS: Treatment with the silicone cushions yielded 74,2% cessation of itching and burning followed by pallor and flattening of the scar, some markedly so, over a few weeks to 5 months period. Additional 25,7% had their scars resolved in up to 8 months of treatment. Four patients (11,4%) who add recalcitrant scars with little response to the use of the silicone cushion were given intralesional corticosteroid injections, in addiction to the use of the cushion, resulting in a fairly rayed resolution of these scars over a period of 2 months. Treatment with the silicone occlusive sheeting yielded 52,3% itching and burning cessation followed by pallor and flattening of the scar, some markedly so, over a few weeks to 5 months period. Additional 22,1% had their scars resolved in up to 8 months of treatment. In conclusion by comparing the results of this trial using silicone cushions for the treatment of hypertrophic and keloid scars with those obtained using silicone gel or occlusive sheeting, a much faster response was demonstrated.

Cicatrix, Hypertrophic↗
PubMed1992

[A clinicopathological study of two respirator-aided long-survival cases of amyotrophic lateral sclerosis].

We reported two respirator-aided 10-year-survival male patients with sporadic amyotrophic lateral sclerosis (ALS). Their ages at onset were 54 and 52, clinical features common in both cases, the durations to tracheotomy 32 months and 27 months respectively, and the durations for respiratory support over 8 years in both cases. There were normal external ocular movement, normal pelvic sphincter function, normal sensory system and no bed sores throughout 10 years of illness. The brain weighted 1,295 g in case 1 and 1,430 g in case 2, being normal macroscopically. The spinal cord was slightly wasted with atrophic anterior roots. The histopathological study demonstrated the typical pattern of ALS in spite of the prolonged survival with artificial respiration. Neuronal loss and gliosis of the motor nuclei in the spinal cord and brainstem were more striking than those of the natural course. Neither hypertrophic astrocyte, central chromatolysis nor neuronophagia was observed. This finding suggested inactive condition of the degeneration. The pattern of white matter degeneration in the cord indicated some pallor of anterior and lateral columns, severe pallor of pyramidal tracts and intact posterior column and spinocerebellar tracts. The giant pyramidal cells in the precentral gyrus were lost in both cases. Pyramidal degeneration was traceable up to the cerebral peduncles in the case 2 and undetectable in that portion in the case 1. On the other hand, the extraocular muscle nuclei, the Onuf's nuclei, the dorsal motor nucleus of the vagus nerve, intermediolateral and Clarke's nuclei were relatively preserved, though no cell count was done in Clarke's nuclei and Onuf's nuclei.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Prognostic indicators in haemolytic uraemic syndrome.

OBJECTIVE: This study aims to review the clinical presentations of Haemolytic Uraemic Syndrome (HUS) and to compare the poor prognostic indicators with mortality. METHODS AND MATERIALS: Prospective study carried out in Renal Dialysis ward of Dhaka Shishu Hospital, Bangladesh from September 2001 November 2003 for a period of 26 months. All children admitted to renal dialysis ward with oliguria or anuria with pallor was included in this study. HUS was confirmed after laboratory investigations showing features of hemolytic anaemia, thrombocytopenia and renal insufficiency. Various clinical presentations were reviewed. Then bad prognostic factors were compared with mortality. RESULTS: There were total 25 cases of HUS in 26 months.17 (68%) were males and 8(32%) females.21 (84%) children were < 5 years. Only 4(16%) were > 5 years. Before onset of HUS 40% children had bloody diarrhoea, 36% had acute watery diarrhoea and 24% had others symptoms. The other presentations noted were fever 88%, respiratory distress and convulsion 52% and oliguria 40%, anuria 60%, reluctant to feed 40% and cough 28%. The main physical findings noted were irritability 40%, pallor 100%, dehydration 28%, puffy face with oedema 32%, high blood pressure 16%, hepatomegaly 28%, jaundice, sclerema and petechial rashes 8%, lethargic 16%, acidotic breathing 48% and rectal prolapse 12%. 44% children died after HUS and 56% recovered from the illness. Mortality was 66% when duration of illness before onset of HUS was > 14 days. With duration of anuria < 3 days there was no mortality but it was 91% and 100% with anuria > 3 to 8 days and >8 days respectively. Mortality was 78% when age was < 18 months and it was 75% when age was > 5 years. Diarrhoea associated HUS had 27% and non diarrhoea associated HUS had 85% mortality. Mortality was 77% and 100% respectively when HUS was associated with convulsion and hypertension. WBC > 30,000 had mortality 100% and decreased platelet count < 30,000 had mortality 80%. With creatinine level > 700 micromol/L mortality was 80% and with Serum potassium level 5.6 to 7.5 mmol/L mortality was 67%. CONCLUSION: HUS comprised of varieties of presentations. Diarrhoea was the commonest preceding illness before onset of HUS. The bad prognostic indicators carrying high mortality was duration of illness before onset of HUS >14 days, anuria > 3 days, age < 18 months and >5 years, Non diarrhoea associated HUS, HUS associated with convulsion and hypertension, WBC > 30,000/cumm, platelets < 30,000/cumm, creatinine level > 700 micromol/L and serum potassium level 5.6 to 7.5 mmol/L. Since bad prognostic factors may progress rapidly to mortality, consultation with paediatrician and transfer to a tertiary care centre should be done when HUS is diagnosed so that it can be managed appropriately in time.

Child, Preschool↗
PubMed2005

Clinical features, etiology and short term outcomes of interstitial pneumonitis in HIV/AIDS patients.

A prospective study was conducted at Bamrasnaradura Hospital, Nonthaburi Province, Thailand from November 11, 2002 to January 5, 2003. A total of 59 HIV/AIDS patients with interstitial infiltrates on chest radiographs were included in the study. The objectives of this study were to describe the clinical manifestations and determine the etiologies of interstitial pneumonitis, assess the short-term outcomes and determine the accuracy of the clinical diagnosis of the etiologies of interstitial pneumonitis in HIV/AIDS patients at Bamrasnaradura Hospital, Nonthaburi, Thailand. Tuberculosis was the most common diagnosis (44%), followed by Pneumocystis carinii pneumonia (25.4%), bacterial pneumonia (20.3%) and fungal pneumonia (10.2%). In tuberculosis, compared to other diagnoses, a mild cough (p = 0.031), pallor (p = 0.021), lymphadenopathy (p < 0.001), absence of skin lesions (p = 0.003), higher mean body temperature (p = 0.004) and an absence of dyspnoea on exertion (p = 0.042) were significant findings. On multivariate analysis, however, only an absence of skin lesions (p = 0.023) remained a statistically significant predictor of TB. In Pneumocystis carinii pneumonia compared to other diagnoses, dyspnea on exertion (p = 0.014), non-purulent sputum production (p = 0.047), a higher mean respiratory rate (p < 0.001), absence of lymphadenopathy (p < 0.001) and lack of purulent sputum (p = 0.030) were significant factors. By multivariate analysis, only an absence of lymphadenopathy were shown to be independently and statistically significantly associated (p = 0.040). In bacterial pneumonia, compared to other diagnoses, production of purulent sputum (p = 0.014), hemoptysis (p = 0.006), pallor (p = 0), skin lesions (p = 0.002) and a severe cough (p = 0.020) were significantly associated factors. On multivariate analysis, none of these factors were statistically significant. In fungal pneumonia, compared to other diagnoses, headache and papulonecrotic skin lesions were common findings, but no factor had a significant association. After four weeks, 59.3% of the patients were alive, 13.6% died and 27.1% were lost to follow-up. Among the alive patients 88.6% had clinically improved. On multivariate analysis, no factor was shown to be a statistically significant predictor of death. The cumulative survival after 28 days was highest among PCP patients, followed by bacterial pneumonia, tuberculosis and fungal pneumonia, but this difference was not statistically significant (p = 0.0453).

AIDS-Related Opportunistic Infections↗
PubMed1991

Visual outcomes of pituitary adenoma surgery. St. Vincent's Hospital 1968-1987.

Pituitary tumors are a significant cause of visual morbidity. The medical records of 45 patients with histologically verified pituitary adenoma and visual defects (fields and/or acuity) were reviewed. The patients' ages ranged from 19 to 80 years with a mean of 52.4 years. Ophthalmologists referred 76% of the patients for neurosurgical opinion. Bitemporal field defects were present in 89%. Twenty-three patients underwent transfrontal craniotomy prior to 1984, and the remaining twenty-two subsequently had transsphenoidal microsurgery. Of those eyes with abnormal visual acuity preoperatively, 74% had improvement noted postoperatively (p less than 0.001). Of those eyes with preoperatively abnormal visual fields, 68% improved (p less than 0.001). For transsphenoidal surgery the rate of improvement for fields was 81%. Preoperative visual acuity, visual field score, and patient age, were not predictive of postoperative acuity. Optic disc pallor was associated with poorer postoperative fields and acuity compared to eyes without preoperative pallor. Transsphenoidal surgery is effective treatment for visual compromise due to pituitary adenoma, and the need for early diagnosis is emphasized.

Adenoma↗
PubMed1991

Parental reports of apnea and bradycardia: temporal characteristics and accuracy.

A prospective examination was made of the temporal course of parental observations in response to a monitor alarm of apnea (apnea setting of 20 seconds) or bradycardia (bradycardia setting of 80 beats per minute). Data were obtained from 155 subsequent sudden infant death syndrome siblings followed up at home, during the first 20 weeks of life, on an apnea/bradycardia monitor with an attached event recorder. In addition, parental reports were compared to an objective recording of the pattern of cardiorespiratory activity surrounding each monitor alarm. Only those parental observations were considered which reported the infant to be asleep with no apparent equipment malfunction following an apnea alarm (with or without pallor, cyanosis, or the provision of external stimulation) or a low heart rate alarm associated with pallor, cyanosis, or stimulation. Observations were analyzed within each of five age periods (less than 29, 29 through 56, 57 through 84, 85 through 112, 113 through 140 days). The percentage of infants reported to have prolonged apnea, prolonged apnea with stimulation, or bradycardia with stimulation was found to decrease with age. An examination of the linked event recordings failed to document an episode of apnea as long as 15 seconds for any of the reported episodes of apnea. Furthermore, bradycardia as long as 5 seconds in duration could be documented in only 3 of 422 reported episodes of bradycardia. These results indicate the potential for considerable error when total reliance is placed on parental observations and point to the necessity for objective event recordings when using home monitors in the clinical management of at-risk infants.

Apnea↗
PubMed1989

[Incidence of oral manifestations in children with acute leukemia].

Fifty children with oral manifestations of acute leukemia, ranging in age from 1 to 14 years, have been studied with reference to age, sex, location and clinical presentation of the oral lesions. Seventy six percent of the patients had the disease during the first decade of their life, 22% as acute myelocytic leukemia and 54% as acute lymphocytic leukemia. In the current study, acute leukemia exhibited a high predilection for males (70%) and mucosal pallor was the most common presenting oral symptoms (39.6%). Erythema, ulceration and swelling of the lip, tongue, palate and gingiva were also frequent symptoms. Extra oral involvement occurred in 60% of the cases as facial pallor and 11% as lymph node enlargement.

Child↗
PubMed1989

Timolol treatment prevents or delays glaucomatous visual field loss in individuals with ocular hypertension: a five-year, randomized, double-masked, clinical trial.

A 5-year, randomized, double-masked, clinical trial was conducted to determine whether treatment with topical timolol maleate was effective in preventing or delaying the onset of glaucomatous visual field loss in subjects with ocular hypertension. Sixty-five individuals considered to be at moderate risk for developing open-angle glaucoma were recruited for the study. In each patient, one eye was chosen randomly to receive timolol twice-daily while the fellow eye received diluent (placebo). Timolol administration reduced IOP from baseline in the treated eyes over the course of the study by a mean +/- SD of 4.9 +/- 3.4 mm Hg. Timolol administration also produced a mean +/- SD contralateral reduction of IOP from baseline in the untreated fellow eyes of 2.9 +/- 3.1 mm Hg. The mean +/- SD difference in IOP between the treated and untreated eyes during the study was 2.3 +/- 2.6 mm Hg. Over the course of the study reproducible visual field loss developed in 4 timolol treated eyes and 10 placebo treated eyes (P = .039, McNemar test). Clinical progressive optic disc cupping was noted in four treated and eight untreated eyes (P = .11, McNemar test). In the 42 subjects who completed a minimum 4-year follow-up, baseline and final optic disc photographs were analyzed using a computer image analysis system to determine changes in the area of disc pallor. The mean +/- SD increase in optic disc pallor was 0.86% +/- 2.4% in the timolol treated eyes and 1.80% +/- 3.6% in the placebo treated eyes. This difference was statistically significant (P = .04, paired t-test). This study provides evidence that medical treatment prevents or delays the onset of glaucomatous visual field loss and optic disc damage in individuals with ocular hypertension. The magnitude of the protective effect of timolol was partially obscured by the contralateral reduction of IOP in the placebo treated fellow eyes.

Adult↗
PubMedDate not supplied

The importance of cerebral lesions of vascular origin in the morphopathologic picture of old age dementia.

Our study refers to the complex neuropathologic examination of 70 demented patients (40 males and 30 females) above 60 years of age. Proportion of different types of cerebral damage with vascular pathogeny showed that 78% of the vascular dementia cases had as morphological background various aspects of multi-infarct dementia; softenings of variable size and lacunae, associated or not with myelinic rarefactions and pallor specific to subcortical arteriosclerotic encephalopathy; the remaining cases pointed to single anoxic lesion and/or subcortical encephalopathy. Perfect clinico-morphological diagnostic concordance has not always been reached in our sample--as in literature cases--often due to the dementia subtypes overlapping, and to the fact that the same clinical syndrome may show in different cerebral lesions. Likewise, no correlation has been found between lesion type, site or size and clinical picture or dementia course, which was also reported by other authors. On a morphopathogenic basis, we support the view that necrotic lesions of ischemic origin--multi-infarct and lacunar dementias--should be distinguished from myelinic rarefactions and pallor in the white matter, whose pathogeny is still controversial. Due attention is paid to the importance of the venous factor in the development of subcortical encephalopathy.

Aged↗
PubMedDate not supplied

[Experimental studies of the development of linear electric current marks].

UNLABELLED: By means of reconstructing electric current pathways electrophysical conditions were explored causing electrocution death in the bathtub, according to many authors quite often indicated by linear electric lesions. In our experimental settings we observed appearance of circumscribed linear marks of pallor similar to electric lesions in the region of postmortem lividity of corpses at the same level as bathtub water. None of typical histological indicators could be seen in skin samples. So no evidence was given for electric burns even under conditions of high density and extended duration of current. Similar linear marks and equivalent histological results were found when corpses were put into the bathtub filled with cold water without any experimental electric contact. CONCLUSIONS: Linear marks of pallor may occur at water level even without any electric contact to corpse or water neither bathtub. IMPLICATIONS: According to specific conditions mentioned above linear so called electric lesions at water level do not indicate electric current yet lethal electric damage.

Burns, Electric↗
PubMed1981

Aeromonas hydrophila infection in Xenopus laevis.

Aeromonas hydrophila caused severe disease in a group of Xenopus laevis within 3 weeks of receipt. The primary clinical signs were marked pallor of the skin, petechiation, lethargy, anorexia, and edema. The duration of the outbreak was approximately 45 days during which time 21 frogs became sick and 18 died, despite tetracycline therapy. Pale skin, subcutaneous edema and hemorrhages, ascites, and pale livers were seen at necropsy. Aeromonas hydrophila was isolated from skin, and the same organism was isolated in pure culture from skeletal muscle. Tetracycline treatment via stomach tube was effective if given early in the course of the disease. The outbreak was controlled by removing sick frogs, feeding twice per week, changing the water several hours after feeding, and maintaining the frogs where the ambient temperature was 22 degrees C or lower. The pallor of the skin and general malaise were produced experimentally by crowding normal frogs, changing the water infrequently, and increasing ambient temperatures. Mild disease was reproduced experimentally by subcutaneous injection of Aeromonas hydrophila into apparently healthy frogs.

Aeromonas↗
PubMed1994

Anaemia in children: Part I. Can simple observations by primary care provider help in diagnosis?

The commonest and reliable method of diagnosing anaemia is by determining haemoglobin levels, which is an invasive technique. This cross-sectional study aims to detect the validity of diagnosing anaemia by simple non-invasive clinical techniques. This study screened 951 children (6-60 months) residing in a squatter settlement of Karachi. Every child was first labelled anaemic or normal by a clinical scoring system and then his/her haemoglobin was tested by finger prick method on a Hemocue. Mean age was 31.1 +/- 15.3 months (n = 945) and median was 32 months. The prevalence of anaemia by Hemocue was 78% (Anaemia = Hb < 11 gms%) and by clinical examinations 68%. Conjunctivae alone had the highest sensitivity (74%) and nails alone highest specificity (96%). Nails alone had the highest positive predictive value and conjunctivae alone highest negative predictive value (43.2%). Combinations of conjunctivae with either nails, palm or tongue yielded the highest validity. The results indicate that in PHC settings with no laboratory facilities, anaemia can be detected by pallor of conjunctivae associated with pallor of either nails, palm or tongue.

Anemia, Iron-Deficiency↗
PubMed1994

[Follow-up of arteriosclerosis-induced anterior ischemic optic neuropathy].

In 22 patients with acute arteriosclerotic anterior ischemic optic neuropathy (AION), examinations were conducted before the start of therapy and between 1 and 3 years later. In the acute stage of the disease the patients were treated with hemodilution for 10 days. The visual acuity improved from 0.2 to 0.4 (median). Compared with the visual acuity before therapy, at the follow-up 1-3 years later visual acuity had improved by 3 lines or more in 11 patients, remained stationary in 9 patients (+/- 1 line), and worsened in 2 patients by 3 lines or more. The visual fields (Goldmann) improved in 8 patients, did not change in 10 patients and worsened in 4 patients. After 1-3 years, 14 patients (64%) showed a sectorial pallor and 8 patients (36%) a diffuse pallor of the optic disc. Videofluorescein angiography revealed hypofluorescent discs in all patients. No difference in arm-retina time (ART) was found between the acute phase (13.0 +/- 3.3 s) and the examination 1-3 years later (13.1 +/- 2.2 s). ART was within normal limits in all patients. The arteriovenous passage time (AVP) dropped significantly, from 2.36 (+/- 0.81) s in the acute phase to 1.91 (+/- 0.56) s 1-3 years later. However, the AVP still did not fall to normal levels (1.45 +/- 0.40 s). Slowed retinal hemodynamics (AVP) with normal ART at the same time suggests a disturbance in microcirculation still present 1-3 years after the acute phase of AION. The rheological parameters (hematocrit, plasma viscosity, erythrocyte aggregation index) did not show any change between examinations.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1996

Effects of CD11b/18 monoclonal antibody on rats with permanent middle cerebral artery occlusion.

The progression of a lesion from ischemic injury to infarct, after the permanent occlusion of a middle cerebral artery, may be influenced by the influx of leukocytes into the ischemic territory. We aimed to evaluate the effectiveness of treating rats that had permanent middle cerebral artery occlusion with a single dose of an anti-CD11b/18 monoclonal antibody injected 1 hour after the arterial occlusion. To mimic the clinical situation of patients with ischemic strokes who may be treated within 1 hour of the ischemic event, the artery remained occluded. Forty-one adult Wistar rats had permanent middle cerebral artery occlusion, and one was subjected to a sham operation. One hour later, 22 rats received CD11b/18 monoclonal antibody and an additional 20 were injected either with a nonspecific antibody (n = 10) or a buffer solution (n = 10). Experiments were terminated at intervals ranging 12 to 96 hours after the arterial occlusion. Endpoints included neurological testing, daily evaluation of body weight, counts of white blood cells in the peripheral blood, measurement of the area of pallor in the ischemic hemisphere, counts of necrotic neurons, and counts of leukocytes sequestered in the ischemic hemisphere. In experiments terminated 12 hours after the arterial occlusion (n = 4), there were fewer necrotic neurons in the group treated with the CD11b/18 monoclonal antibody compared with the two controls (P < .05), but this difference was not reflected in the neurological scores. Numbers of necrotic neurons in experiments terminated > 12 hours later were not different among the three subgroups. White blood cell counts in peripheral blood were lower in animals with arterial occlusion injected with the monoclonal antibody CD11b/18 (P < .05); numbers of leukocytes sequestered in the ischemic hemisphere were not different in the three groups. Neither changes in body weight nor in the volume of the area of pallor were significantly different among the three groups.

Animals↗
PubMed1995

[Traction vitreoretinal opticopathy in proliferative diabetic vitreoretinopathy].

UNLABELLED: In patients with proliferative diabetic vitreoretinopathy the authors noticed tractive vitreoretinal distortion of the optic disk to the nasal side. As a result of this distortion a reduction in visual acuity, pallor of the optic disk, and changes in the visual evoked potentials were registered. The disease in called "tractive vitreoretinal opticopathy." METHOD: We examined 15 diabetics with vitreoretinal traction and temporal pallor of the optic disk, as well as a reduction in visual acuity. Six patients were observed retrospectively and 9 patients prospectively before and after vitrectomy. Pre- and postoperative examinations included visual acuity, visual field, fluorescence angiography, and the conduction of visual evoked potentials (VEP). RESULTS: Within a postoperative follow-up of 2-8 months (mean 6.5 months) a return of optical vitality combined with an increase in visual acuity could be seen in 14 of 15 patients. In addition, some of the patients showed an improvement in the amplitudes and a reduction in the latency of the VEP. CONCLUSIONS: The authors assume that the axoplasmatic flow in the optic nerve fibers is reduced according to vitreoretinal traction. Furthermore, the traction may cause elongation of the capillaries, resulting in reduced perfusion of the optic disk. For these reasons early vitrectomy in patients with tractive vitreoretinal opticopathy is recommended.

Adult↗