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PubMed2005

Clinical characteristics of inflammatory bowel disease in Thailand: a 16 years review.

OBJECTIVE: Inflammatory bowel disease is an uncommon gastrointestinal problem in Asia. Recently, there have been many reports from Japan and India demonstrating a higher incidence of this disease entity in this region. To date, there has been only one report from Thailand regarding clinical manifestation of ulcerative colitis. However, information regarding Crohn 's disease has never been demonstrated. MATERIAL AND METHOD: The authors retrospectively reviewed clinical data on both ulcerative colitis (UC) and Crohn's disease (CD) during a 16 year period from the medical records of King Chulalongkorn Memorial Hospital, one of the main referral centers in Thailand. RESULTS: There were 55 patients diagnosed as inflammatory bowel disease. Of these, 45 were diagnosed as UC and the rest were CD. Mean age of UC and CD patients was 32 and 40.5 years respectively. The authors did not find any significant relationship between smoking and colonic cancer in these patients. The main presentations of UC patients were mucous bloody diarrhea and watery diarrhea whereas watery diarrhea, fever and weight loss were the main presentations of patients with CD. There were fistulas in 2 CD patients. In addition, oral ulcer and panuveitis were diagnosed in 2 different CD patients. One UC patient had PSC (primary sclerosing cholangitis) and another had pyoderma gangrenosum. The majority of UCpresented as pancolitis (46.7%) while ileocolic involvement was more common in CD (60%). CONCLUSION: In Thailand, UC is more common than CD whereas disease involvement is more localized to ileocolic region in CD than UC. Similar to Western countries, both UC and CD are presented at relatively young age.

Adult↗
PubMed1991

[Humoral immune response to retinal S-antigen in patients with uveitis].

Experimental autoimmune uveoretinitis (EAU) is a predominantly T-cell-mediated autoimmune inflammatory disease of the retina and uveal tract of the eye. Retinal S-antigen, a protein found in retinal photoreceptor cells, is a potent agent for the induction of EAU in susceptible species and strains. Elevated titers of antibody to S-antigen have been reported in patients with different forms of uveitis. Serum samples from 166 patients and 87 healthy blood donors were tested by immunoblotting against human retinal abstract for IgG, IgM and IgA antibodies to S-antigen. Compared to the controls the patient sera showed a higher incidence of S-specific antibodies (17.5% vs 9.2%). No specific correlation between the presence of any type of uveitis and anti-S antibodies has been found (anterior uveitis 15.1%, posterior 19.6%, panuveitis 18.9%). There was a higher incidence especially with IgG antibodies during active disease (19.7% vs 9.2% in controls). The results suggest that since EAU is T-cell mediated, antibodies in humans may be most important as indicators of autoimmunity rather than mediators of the inflammation. As these anti-S antibodies might be induced by disruption and nonspecific inflammation of the retina and uvea alone, an important and difficult question in patients is whether or not these secondary autoimmune response can contribute to the induction of uveitis.

Animals↗
PubMed1976

Canine herpes-induced retinal dysplasia and associated ocular anomalies.

Thirty-eight newborn Beagle puppies from eight litters of a specific pathogen-free colony maintained in isolation were inoculated with canine herpesvirus. Pups were killed between one and 30 days after inoculation. Histopathologic studies were carried out on the eyes and other tissues in conjunction with fluorescent antibody and viral isolation studies. Evidence of ocular inflammation manifested by panuveitis with the presence of intranuclear inclusion bodies was usually seen by the fourth day after infection. Eyes with severe inflammation showed peripheral anterior synechiae, cataract, and keratitis. The presence of the virus was confirmed by viral isolation from ocular tissues and fluorescent antibody studies. Developmental anomalies included retinal dysplasia with fold and tube formation of the neural retina, retardation of retinal maturation, and areas of necrosis and reorganization were seen. The retinal pigment epithelium showed initially patchy depigmentation and vacuolization and, subsequently, folding hypertrophy and duplication as well as areas of widespread atrophy and patchy loss. In some animals ectopic retina was found within cystic spaces of the optic nerve. These experiments confirm the ability of canine herpes infection in neonatal pups to produce severe ocular inflammation with subsequent retinal dysplasia and associated ocular anomalies.

Animals↗
PubMed1991

[Antibody titer to Toxoplasma gondii in uveitis of toxoplasmosis and other origin].

The diagnostic value of toxoplasma serology in ocular toxoplasmosis is a controversial issue. Some authors feel that a positive titer indicates nothing more than that the patient had been exposed to Toxoplasma gondii at some stage. Even if in most cases the diagnosis is based on the morphological findings on the fundus, it might sometimes be useful to have an additional serologic evaluation. In a retrospective study we compared the level of antitoxoplasmosis antibodies (measured in a complement fixation test and an immunofluorescence test) in 75 patients with clinically proven ocular toxoplasmosis and 146 patients with uveitis of other origin. In our results we showed that the incidence of positive titers and antibody levels are significantly higher in patient with ocular toxoplasmosis than in other uveitis patient (chi 2-test, Mann-Whitney Willcoxon test, p = 0.05). There was no significant difference between antibody levels in patients with anterior uveitis, posterior uveitis or panuveitis of nontoxoplasmotic origin. No correlation between the antibody levels and amount of retinochorioidal fundus lesions could be found. Based on our results, we conclude that in cases where fundus findings are compatible with ocular toxoplasmosis and a complement fixation or immunefluorescence test is positive, specific antitoxoplasmotic therapy should be started.

Animals↗
PubMed1991

[Endogenous posterior uveitis and toxoplasma infection: a case-control study].

The present study was first carried out to evaluate the effects of toxoplasma infections on endogenous posterior uveitis in Tian in city. In this report, 118 cases of endogenous posterior uveitis and 236 clinical and health controls were studied by 1:2 pair match case-control method. The clinical controls were OPD patients without uveitis and the health controls were normal persons. The prevalence rate of toxoplasma infection in three groups were 31.4%, 11.9% and 9.3% respectively. The differences of three groups was higher significant. The odds ratio (OR) of toxoplasma infection in posterior uveitis was 3.72 (2.17-6.39). The difference of the two controlled groups was not significant. The odds ratio of toxoplasma infection in central exudative retinochoroiditis and panuveitis were 4.78 and 3.33. The toxoplasma infection was not significantly related to the optic retinitis. The results suggest that toxoplasma infection as a suspect agent of endogenous posterior uveitis.

Case-Control Studies↗
PubMedDate not supplied

[Diagnosis of toxocariasis in uveitis in children].

Seventeen children aged 2 to 13, suffering from uveitis of unknown etiology, were screened for chronic infections, toxocariasis included. Antibodies to Toxocara canis were detected in the blood of two children with negative results of tests for toxoplasmosis, tuberculosis, herpetic and cytomegaloviral infections. One of these two suffered from panuveitis, the other from granulomatous chorioretinitis. Both the clinical forms are characteristic of ocular toxocariasis.

Adolescent↗
PubMed1991

[Uveitis: an etiological study of 200 cases following a protocol].

BACKGROUND: To evaluate the usefulness of a systematic study of patients with uveitis and to assess the associated systemic diseases. METHODS: 200 patients seen in an outpatient clinic for the evaluation of uveitis between 1981 and 1988 were included in the study. Patients with eye disease associated with drug abuse or human immunodeficiency virus were excluded. The study protocol included an initial clinical and ophthalmological evaluation followed by selected specific investigations. RESULTS: Anatomical localization: anterior uveitis 122 (61%), posterior 41 (20.5%), panuveitis 30 (15%) and intermediate 7 (3.5%). ETIOLOGY: 74 cases (37%) were secondary, 101 (50.5%) were idiopathic, and 25 (12.5%) were specific syndromes of uveitis of unknown cause. Toxoplasmosis was the most common cause of infective uveitis, and ankylosing spondylitis was the most common noninfective cause. Diagnostic process: group 1, diagnosed by the ophthalmological investigation (25 cases); group 2, diagnosed on the basis of the accompanying clinical features and/or specific investigations (66 cases); and group 3, diagnosed by wider detection methods (8 cases). CONCLUSIONS: There was a remarkably high rate uveitis without etiological diagnosis. The evaluation of patients with uveitis requires a careful evaluation of ocular and systemic features, followed by selected specific investigation. The indiscriminate use of diagnostic tests is not warranted.

Adolescent↗
PubMed1991

Sympathetic ophthalmia associated with anterior chamber intraocular lens implantation.

We describe a rare case of sympathetic ophthalmia associated with intracapsular cataract extraction and anterior-chamber intraocular lens implantation. This occurred three months after an immediate postoperative complication of pupillary block, flat anterior chamber, and wound dehiscence with one of the lens haptics dissecting into the subconjunctival space. Both eyes developed granulomatous panuveitis, which partially responded to medical treatment. Removal of the anterior-chamber intraocular lens and pars plana vitrectomy resulted in control of the uveitis with significant visual improvement. A pathologic examination of material from the anterior chamber and vitreous showed lymphocytes, histiocytes, and pigment cells contributing to the diagnosis of sympathetic ophthalmia. To the best of our knowledge, this is the first report of an intraocular lens implicated as a cause of sympathetic ophthalmia.

Aged↗
PubMed1990

[Alternatives to steroid therapy in chronic uveitis].

In a search for alternative therapeutic methods other than corticosteroids and cytostatics, the effect of a dialyzable leukocyte extract (DLE), the antimetabolite 5-fluorouracil and the immunosuppressive agent cyclosporin A in corticosteroid-resistant idiopathic uveitis was studied. When DLE was administered to 26 patients who had uveitis forms with exogenous triggering (e.g., infection), as well as forms with an autoimmune background, there was a reduction in the number and duration of recurrences and a statistically proven prolongation of the inflammation-free intervals. This was particularly true in anterior and posterior uveitis and to a lesser extent in the intermediate form. No side effects were observed. 5-Fluorouracil, injected subconjunctivally, is indicated in intermediate uveitis with marked vitreous infiltration and beginning proliferation. Corneal erosion occurs relatively often. During treatment with cyclosporin A (low dose, 5 mg/kg of body weight per day), 14 of 17 patients (9 with intermediate uveitis, 6 with retinal vasculitis, 1 with sympathetic ophthalmia, 1 with panuveitis) showed improved results; in 2 cases the findings remained stationary and only 1 case had low-grade deterioration. If one takes into consideration the fact that in this patient any therapy would have failed, the results are convincing. This is particularly true of retinal vasculitis. There is no effect in cases of central hemorrhagic chorioretinopathy. So far, there have been no serious side effects.

Adrenal Cortex Hormones↗
PubMed1990

[Clinical features of uveitis in childhood during the past 20 years].

One hundred and fifty five cases (237 eyes) of children with uveitis were clinically observed in the past 20 years. There was no fluctuation in the number of patients during the period. Concerning the age as the first visit, the smallest group was under 4 years of age and the numbers of patients increased at ages 14 and 15. Chief complaints usually corresponded to the age of the cases. Cases with anterior uveitis accounted for 25% of all cases, intermediate uveitis 12%, posterior uveitis 45% and panuveitis consisted of 17% of all cases, respectively. In the course of treatment, improvement of visual acuity was not statistically significant; the visual prognosis of cases affected under age 7 years was relatively poor. At the time of final observation, the visual acuity of cases, who had first visited during the past 10 years, were better than those who presented during the previous decade. Uveitis had healed or improved in 68% of cases treated in our clinic. As complications, band-shaped keratopathy was seen in 8% of the patients, cataract in 22% and glaucoma in 5%, respectively. Thirty two per cent of the cases received systemic steroid therapy and the average duration was 3.8 months. Fifty two operations were performed in 30 cases (19%), 37 eyes (16%); 16 were cataract operations and 24 were operations for glaucoma.

Adolescent↗
PubMed1989

Uveitis in childhood--Part III. Posterior.

Toxoplasma, nematodes, and cytomegalovirus are the most common causes of uveitis in children involving the posterior pole. Discussion of treatment and management is detailed. Rubella retinitis and subacute sclerosing panencephalitis are specific entities which are limited in their initial presentation in children. Panuveitis including sympathetic ophthalmia, Vogt-Koyanagi-Harada, and Behçet's syndromes, while relatively rare in their occurrence, demand early treatment intervention. Specific antimicrobial therapy and adrenocorticosteroids as well as therapeutic suggestions are also included. This is the last part of a three-part series of articles.

Humans↗
PubMed1989

Cyclosporine in Behçet's disease resistant to conventional therapy.

Cyclosporine (cyclosporine A) at 7 to 16 mg/kg/day was administered for eight to 18 months to four patients with Behçet's disease with bilateral panuveitis resistant to the combination of prednisone, colchicine, and chlorambucil. Visual acuity was maintained or improved in all eyes. Color vision also improved significantly. A dramatic and significant decrease of the chronic vitreous haze occurred within the first two weeks of therapy and persisted until the end of the study. Retinal inflammation, including hemorrhages, exudates, edema, and fluorangiographic abnormalities, decreased progressively in all eyes. The severity of the anterior and posterior acute attacks also decreased significantly. This study suggests that cyclosporine is beneficial for the treatment of refractory and severe Behçet's disease, but its side effects require careful follow-up.

Adult↗
PubMed1988

Topically applied cyclosporin for modulation of induced immunogenic uveitis in rabbits.

The experimental model of immunogenic uveitis induced by intraocular injection of human serum albumin in rabbits was inhibited by the topical application of cyclosporin A. The acute nonspecific inflammatory response that immediately follows intravitreous injection was not affected. However, the severe panuveitis that develops during the second week was markedly reduced. The safety and efficacy of topically applied cyclosporin A in this model of uveitis suggests that topical administration of this antigen-nonspecific immunosuppressor may be an effective route of therapy for certain immune-mediated forms of uveitis.

Administration, Topical↗
PubMed1988

Visceral leishmaniasis in an English foxhound from an Ohio research colony.

Visceral leishmaniasis was diagnosed in a 5-year-old English Foxhound born and housed in an Ohio research colony. Physical examination revealed pyrexia, hematochezia, panuveitis, splenomegaly, and lymphadenopathy. Hematologic and serum biochemical abnormalities consisted of anemia, thrombocytopenia, hypoalbuminemia, hyperglobulinemia, azotemia, and proteinuria. Postmortem examination revealed widely disseminated (spleen, bone marrow, lymph node, liver, kidney, lungs) Leishmania amastigotes within macrophages.

Animals↗
PubMed1988

[Luetic uveitis in a patient with AIDS. Case report].

We report on a 33-year-old male Turkish patient with primarily nonsuspect sexual behavior who presented with panuveitis unresponsive to therapy. HIV infection and secondary syphilis was diagnosed. The uveitis was the only manifestation of syphilis. Because of isosporiasis, an HIV infection of CDC class IV C1 was diagnosed. This is the second published case of acquired syphilitic uveitis in a patient with HIV infection. The diagnosis was delayed by a prozone phenomenon. Treatment with high doses of penicillin i.v. for 14 days led to complete recovery. Because the HIV infection may obscure the diagnosis of syphilis, this constellation will assume increasing importance with the growing number of HIV-infected patients.

AIDS Serodiagnosis↗
PubMed1987

[Reversible pancytopenia and cardiac murmur].

In this clinical-pathological conference the case of a patient with aplastic anemia is presented who recovered after treatment with prednisone and antilymphocyte serum. The patient's clinical course was however complicated by persistent fever and panuveitis. This was followed by acute mitral insufficiency and left ventricular failure, leading to the patient's death.

Acute Disease↗
PubMed1986

Genetic heterogeneity in uveitis.

Eighty-nine unrelated patients with ocular inflammation (uveitis) were investigated for the HLA class I and class II genetic markers, We subdivided our patients according to: 1. the anatomical location of the lesion; 2. the temporal course of the disease; 3. the aetiology. We eliminated from our sample of patients the individuals with other systemic diseases. We could not find an association with B27, as previously described, but we did note statistically significant differences between the class II antigen distribution in the different anatomical subgroups. HLA-DR3 seems a marker of the intermediate form of uveitis (p, uncorrected 0.03); the absence of DR1 in the patient group with posterior uveitis may be a protecting factor (p. uncorrected less than 0.01); the presence of DR4 in all cases of panuveitis is statistically significant (p, uncorrected = 0.0006).

Adolescent↗
PubMed1987

Sympathetic ophthalmia.

Sympathetic ophthalmia is a bilateral diffuse granulomatous panuveitis occurring after accidental or surgical penetrating injury to one eye. Onset of sympathetic ophthalmia may occur as early as 5 days or as late as 42 years following the injury.

Eye↗