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Unilateral somatic and intracranial hypoplasia.

We report on clinical and MR findings in a woman with a peculiar disease. She was studied from childhood to adulthood. She showed several anomalies affecting structures of ectodermal and mesodermal origin. Specific defects included right cerebral and cerebellar hypoplasia, right cerebral cortical polymicrogyria, agenesis of the corpus callosum, right micro-ophthalmia and cataract, right breast hypoplasia, right upper and lower extremity hypoplasia, bilateral acral alterations affecting especially the middle phalanges, left hemifacial hypoplasia (probably secondary to the severe contralateral cerebral hemisphere lesion), mental retardation and partial epilepsy. MR disclosed right cerebral and cerebellar hypoplasia, right cerebral cortical polymicrogyria, agenesis of corpus callosum and right micro-ophthalmia. She did not exhibit either orbital cysts or cutaneous abnormalities. The complex symptomatology of unknown origin presented by this patient suggests a new developmental malformation consisting in hypoplasia of a complete hemibody.

Abnormalities, Multiple↗

Gunshot wounds of the orbit.

Isolated gunshot wounds of the orbital contents are relatively rare, and therefore their management deserves updating in terms of current practices. Two cases of isolated gunshot wounds to the orbital contents are presented, and the diagnosis, management, and prognosis are reviewed. In general, in the absence of light perception, enucleation within a planned timetable is the treatment of choice to prevent sympathetic ophthalmia from destroying sight in the uninjured eye. If light perception is present, every attempt should be made to preserve the injured eye. Enucleation of a blind injured eye is the treatment of choice because it is a more complete eradication of the potential for sympathetic ophthalmia. In selected cases, evisceration can be successfully substituted.

Adult↗

Ceftriaxone treatment of penicillinase-producing Neisseria gonorrhoeae infections in children.

The incidence of penicillinase-producing Neisseria gonorrhoeae (PPNG) among adults with gonorrhea in Brooklyn now exceeds 24%. Because children usually acquire their infection from adults, it follows that we have had a concomitant rise in PPNG among sexually abused children. The Centers for Disease Control now recommends ceftriaxone for the first line treatment of gonorrhea but there are no data as to its use in children for this indication. From May, 1987, through March, 1989, 33 children, 4 days to 10 years of age, were admitted to Kings County Hospital for 34 episodes of gonorrhea. Nine (26.5%) were caused by PPNG. Twenty-three were female; 10 were male. There were 17 isolates from the vagina, 3 from the urethra, 9 from the pharynx, 9 from the rectum and 6 from the eye. Eight children (all girls) had infections at greater than or equal to 1 site; 2 were infected at 3 sites. Twenty-eight children were sexually abused and 5 were neonates with ophthalmia (1 PPNG). All isolates were susceptible to ceftriaxone by disc diffusion testing. Agar dilution was performed for 18 isolates; minimal inhibitory concentrations to ceftriaxone were less than or equal to 0.06 mg/liter. The 5 PPNG isolates tested had minimal inhibitory concentrations to penicillin of 2 to 16 mg/liter and 3 isolates were resistant to tetracycline with minimal inhibitory concentrations of 32 mg/liter. Twenty-eight children were treated with a single dose of ceftriaxone, including the 5 neonates with ophthalmia; the dose was 125 mg if less than 45 kg or 250 mg if greater than 45 kg.(ABSTRACT TRUNCATED AT 250 WORDS)

Ceftriaxone↗

Outbreak of erythromycin-resistant staphylococcal conjunctivitis in a newborn nursery.

We investigated an outbreak of erythromycin-resistant Staphylococcus aureus conjunctivitis in a hospital newborn nursery that used erythromycin eye ointment to prevent ophthalmia neonatorum. Cases occurred in 2 clusters; 20 (14%) of 146 infants in the nursery developed conjunctivitis from July through October, 1987; and 5 (7%) of 69 infants in the nursery developed conjunctivitis during April and May, 1988. A case-control study of the first cluster demonstrated that culture-confirmed cases were more likely than controls to have received prophylactic erythromycin eye ointment or their initial bath from one nurse (odds ratio, 9.0; P = 0.01) or to have been delivered by one physician (odds ratio, 12.7; P = 0.03). The nurse was the only staff person to have a nasopharyngeal culture which yielded erythromycin-resistant S. aureus. Control measures, instituted in October, 1987, included using silver nitrate drops instead of erythromycin eye ointment for prophylaxis; however, in January, 1988, the hospital resumed use of erythromycin eye ointment. No additional cases were identified until mid-April, 1988, when the second cluster of cases occurred. At that time the hospital reinstituted the use of silver nitrate and no additional cases were identified. This investigation illustrates the potential for conjunctival infection with an antimicrobial-resistant pathogen when antimicrobials are used to prevent ophthalmia neonatorum.

Administration, Topical↗

Biological activities of partially purified elastase produced by Flavobacterium meningosepticum.

Injection of viable cells of Flavobacterium meningosepticum at doses of 10(6) colony-forming units/eye caused ophthalmia in rabbits' corneas. Elastase, free of protease activity, was partially purified from broth cultures of F. meningosepticum ATCC12535 and TMS516. The optimum pH of the elastase activity was about 8.0. The activity was suppressed by Ni, Zn, Co, EDTA, and o-phenanthroline, and accelerated by Cu and Fe. The minimum dose of the elastase causing ophthalmia in the eyes of rabbits was 5 micrograms/eye (0.065 elastase units). The minimum lethal dose of the elastase for suckling mice by intracerebral injection was 0.4 micrograms (0.0052 elastase units)/suckling mouse, and its minimum lethal dose for adult mice by intraperitoneal injection was 740 micrograms/mouse (9.52 elastase units).

Animals↗

Traumatic eye injuries due to large unusual foreign bodies: a Singapore case series.

PURPOSE: Traumatic eye injuries due to large foreign bodies (FB) are rare. The visual prognosis is often poor in these cases because of severe ocular damage. Staged surgical procedures with eventual enucleation or evisceration are often indicated. METHODS: Case series. RESULTS: The authors describe two patients with eye injury due to large FB with visual acuity of no light perception at presentation. Both had initial repair of the ocular injuries and removal of the FB. One patient with an intraocular FB eventually underwent enucleation; the other, with intraorbital FB, had evisceration as a secondary procedure. Orbital implantations were done in both. Neither of the patients had developed sympathetic ophthalmia at the last review. CONCLUSIONS: The visual outcome of eye injuries due to large FB is poor. Both enucleation and evisceration can be performed with low risk of sympathetic ophthalmia. Prevention remains the best approach to such devastating injuries.

Adult↗

Electron microscopic studies on retinochoroidal atrophy in the human eye.

Nine eyeballs were enucleated from nine patients with excessive myopia, secondary retinochoroidal atrophy, absolute glaucoma, uveal malignant melanoma, Behçet's disease and sympathetic ophthalmia. The retina and choroid were studied with light and electron microscopes. The results were: In excessive myopia, marked blockade of choriocapillaries was accompanied by progressive retinal degeneration. In secondary retinochoroidal atrophy induced by retrobulbar fibrosis, the choriocapillaries were partially blocked and the retina had markedly degenerated. In Behçet's disease, exudative inflammation was recognized in the choroid extending to the retina and causing retinal detachment, though the choriocapillaries remained morphologically normal. In sympathetic ophthalmia, both the choriocapillaries and the retina remained normal, though marked inflammation was recognized in the outer layer of the choroid. In absolute glaucoma, the fine structures of the choriocapillary were well preserved in spite of bulbar hypertonia. In uveal malignant melanoma, the ultra structure of the choriocapillary near the tumor was well preserved. The choriocapillaries were normal even when the retina had degenerated. Retinal degeneration was recognized when changes such as blockage, disappearance, dilatation and increased permeability were found in the choriocapillaries. Damage to the choriocapillaries might play an important role in inducing and developing retinochoroidal atrophy.

Adult↗

A hospital based study on the prevalence of conjunctivitis due to Chlamydia trachomatis.

BACKGROUND & OBJECTIVES: Very few studies have been done in India to determine the prevalence of Chlamydia trachomatis causing conjunctivitis using polymerase chain reaction (PCR) methods. Hence the prevalence of primary conjunctivitis due to C. trachomatis among individuals attending ophthalmic hospitals in Chennai was determined and compared with our earlier results. METHODS: A total of 328 conjunctival swabs from 255 (both eyes 73 and one eye 182) patients were investigated by fluorescent antibody test (FAT) on direct smears, culture and PCRs for cryptic plasmid and major outer membrane protein (MOMPI) gene of C. trachomatis. An infant with ophthalmia neonatorum was also included. RESULTS: Among these 328 specimens processed, 16 (4.9%) from 12 (4.7%) patients were positive by cryptic plasmid PCR. Among these, 3 from 2 patients were positive by FAT (direct smear), culture and PCR for MOMP 1 gene. Both eyes of the infant with ophthalmia neonatorum were positive by all the methods. The sensitivity of FAT and culture (18.8%) was lower compared to PCR. INTERPRETATION & CONCLUSION: A significant decrease in the prevalence of adult chlamydial conjunctivitis has occurred in the 10-year period among patients reporting to the ophthalmic hospitals in Chennai. PCR using cryptic plasmid primers was found to be the most sensitive method to detect C. trachomatis in patients with conjunctivitis.

Chlamydia Infections↗

[Cyclosporin A in therapy of chronic uveitis].

48 patients with chronic severe uveitis of pressumed noninfectious origin resistent to corticosteroids have been treated with Cyclosporin A. All patients had an initial loading dose of 5 mg/kg/day followed by a dose reduction according to ocular inflammatory activity and tolerability and according the guidelines by BenEzra, Nussenblatt and Timonen. Most of the patients received additional corticosteroids in a low dose. 35 out of these 48 patients (13 suffering from intermediate uveitis, 11 from retinal vasculitis, 5 panuveitis, 4 "pressumed histoplasmosis" and 2 sympathetic ophthalmia) were treated for 1 year and observed after withdrawing of Sandimmun for at least 6 months. The majority of these patients have manifested a positive therapeutic response to Cyclosporine, in particular patients suffering from vasculitis, panuveitis and sympathetic ophthalmia. All 35 patients were treated before for a long time with steroids without success, 19 out of these 35 in addition with cytotoxic agents. The immunosuppressive effect of Cyclosporine was not permanent, frequently the inflammation relapsed on reduction of dosage or withdrawing of the drug. Guidelines for combined regimen (Cyclosporine and corticosteroids and vitrectomy) were given. Although a large variety of side effects were reported the compliance was good.

Administration, Oral↗

The traumatized eye.

Injuries to the eye, both contusional and perforating, have a considerable visual morbidity not the least of which is a cosmetically unacceptable eye. Meticulous primary surgical repair and judicious secondary reconstruction of the eye may not only preserve visual functions but substantially improve the patient's appearance. Most cosmetic problems follow perforating eye injuries and include corneal leucomata, iris and pupillary abnormalities, cataract, phthisis bulbi and enucleation. Oculo-motor abnormalities, particularly divergent squint, are common where substantial loss of vision has occurred in one or both eyes. In the series reported 215 eyes were enucleated secondary to ocular trauma over a 10 year period (2,162 injured eyes), the vast majority following perforating injury. The risk of sympathetic ophthalmia was the reason for enucleation in 50.7 per cent of cases although sympathetic ophthalmia was identified in only two instances. Cosmetic defects secondary to contusional injuries are uncommon and mostly due to iris abnormalities and cataract.

Adult↗

Sympathetic uveitis after trauma and vitrectomy.

A case is describes in which the earliest clinical manifestations of sympathetic uveitis that occurred after trauma and pars plana vitrectomy were confined primarily to the retina, retinal pigment epithelium, and choroid posteriorly, and resembled focal lesions of acute posterior multifocal placoid pigment epitheliopathy. Similar focal lesions were noted on gross examination of the enucleated inciting eye. Histopathological examination revealed that these lesions were caused by focal choroidal granulomas and overlying Dalen-Fuchs nodules. Sympathetic ophthalmia was also noted in four other patients in whom the condition developed after trauma and vitrectomy.

Adult↗

From suspicion to action: the chemical conjunctivitis and silver nitrate connexion example in Brazilian hospitals.

BACKGROUND: During the 20th century, silver nitrate (SN) eye drops instillation to newborns had been the best prophylaxis against ophthalmia neonatorum (ON) caused by Neisseria gonorrheae, the most frequent cause of ocular infections leading to blindness. At present, this treatment has been questioned because there is a growing prevalence of other pathogens such as Chlamydia trachomatis, and SN is associated with chemical conjunctivitis (ChC). In addition, SN could present some conservation problems in tropical climates. Among other alternative drugs, 2.5% povidone-iodine has a proven efficacy, not only against Neisseria, but also against Chlamydia, has no conservation problems, has not been associated with ChC and is cheap. METHODS: The recently created Setor de Farmacovigilãncia (SF) of the São Paulo State in Brazil has created a pharmacovigilance network of 11 big public hospitals. During a periodical signal searching process, the SF found a cluster of 33 ChC reports from one of the network hospitals. RESULTS: The problem was discussed with the remaining participant hospitals and this signal was used as a way to strengthen the network. Thirteen months later, 622 ChC reports were received from six hospitals. DISCUSSION: Thus, this well-known side-effect in the literature was highlighted as a 'real' problem in Brazil, and some participant hospitals began a discussion period together with the delivery and newborn care professionals in order to switch SN by povidone-iodine. This is an example of both, how a simple pharmacovigilance exercise could improve the implication of health professionals with their own therapeutic problems and how a pharmacovigilance network could be strengthened.

Anti-Infective Agents, Local↗

Beta-lactams in sexually transmitted diseases: rationale for selection and dosing regimens.

A review is given of the selection and rational of optimal treatment regimens for patients with sexually transmitted pathogens, e.g. in cases of gonorrhea, chlamydial infections, chancroid, syphilis, pelvic inflammatory diseases and ophthalmia neonatorum. The scientific basis for the selection of a beta-lactam agent is discussed, including dose, MIC, the critical serum level and maintenance interval, and the duration of therapy. Except in the case of penicillinase-producing Neiserria gonorrhoeae, penicillin remained until recently the most effective agent available against many sexually transmitted diseases. However, ceftriaxone, a new third-generation cephalosporin, has been shown to have a long half-life (8 h) and excellent in vitro efficacy against Neiserria gonorrhoeae (including penicillinase-producing strains) and Haemophilis ducreyi. In view of its exceptional clinical efficacy against both gonorrhea and chancroid, clinical studies of its efficacy against other sexually transmitted diseases appear warranted.

Anti-Bacterial Agents↗

S-100 antigenic determinants in human retina.

Few or no S-100 determinants are detectable in normal human retina. However, the expression of this antigen was observed on the retinal Muller cells of eyes with sympathetic ophthalmia or uveitis. This finding, along with other experimental data, may be interpreted as indicating the retinal Muller cells may have an immunoactive role. Although the possibility of non-specific expression of the S-100 antigen during intraocular inflammation cannot be ruled out, it is postulated that, in the retina, Muller cells may have immunomodulating role similar to that of other S-100-positive/Ia-positive cells of certain lymphoid tissues.

Enzyme-Linked Immunosorbent Assay↗

[Intravitreal triamcinolone acetonide for the treatment of intraocular edematous and neovascular diseases].

BACKGROUND: Within the last 2 years, intravitreal application of triamcinolone acetonide has exponentially increased as a treatment option for various intraocular neovascular and edematous proliferative disorders. METHODS AND RESULTS: The best response to intravitreal triamcinolone acetonide injection in terms of gain in visual acuity was obtained for eyes with intraretinal edematous diseases such as diffuse diabetic macular edema, branch retinal vein occlusion, central retinal vein occlusion, and pseudophakic cystoid macular edema. Visual acuity increased and degree of intraocular inflammation decreased in eyes with various types of noninfectious uveitis including sympathetic ophthalmia. Intravitreal triamcinolone may be useful as angiostatic therapy in eyes with iris neovascularization and proliferative ischemic retinopathies. Possibly, intravitreal triamcinolone may be helpful for exudative age-related macular degeneration, alone or in combination with photodynamic therapy. In eyes with chronic, therapy-resistant, ocular hypotony, intravitreal triamcinolone can induce an increase in intraocular pressure and may stabilize the eye. The complications of intravitreal triamcinolone therapy, such as secondary ocular hypertension in about 40% of the eyes injected, cataractogenesis, postoperative infectious and noninfectious endophthalmitis, and pseudo-endophthalmitis will be covered in another article. Intravitreal triamcinolone injection can be combined with other intraocular surgeries including cataract surgery. Cataract surgery performed some months after the injection did not show a markedly elevated rate of complications. If vision increases after the intravitreal triamcinolone injection, the injection can be repeated. The duration of the effect of a single intravitreal injection of triamcinolone ranges between 2 and 9 months, probably depending on the dosage used. CONCLUSIONS: Intravitreal triamcinolone acetonide may offer a possibility for adjunctive treatment of intraocular oedematous and neovascular disorders. One has to take into account the side effects and the lack of long-term follow-up observations.

Aged↗

Spectrum of disease due to Branhamella catarrhalis in children with particular reference to acute otitis media.

For many years Branhamella catarrhalis was regarded as a non-pathogenic inhabitant of the respiratory tract. This article outlines the spectrum of B. catarrhalis disease in childhood and the extent of the evidence for a pathogenic role of the organism. B. catarrhalis is a rare etiologic agent in septicemia, meningitis, and other systemic illness in both apparently normal and immunocompromised infants and children. It is an unusual cause of ophthalmia neonatorum, but can be confused with Neisseria gonorrhoeae. Whether or not B. catarrhalis is acquired from the birth canal in these cases has not been established. B. catarrhalis is most common as a respiratory tract pathogen in children, including pneumonia, bacterial tracheitis, sinusitis, and otitis media. Since it is difficult to rigorously document pathogenicity of any bacterium in bronchopulmonary infections in children, it is probable that the spectrum of B. catarrhalis disease is wider than that reported to date. The evidence for pathogenicity in acute otitis media is more extensive than for other infections. Otitis media due to B. catarrhalis is clinically similar to that due to other pathogens. B. catarrhalis can be isolated in pure culture from the middle ear exudate and persists if there is no antibacterial treatment. Gram-negative intracellular and extracellular diplococci can be seen on smears of the inflammatory exudate. There is preliminary evidence that there is an antibody response in B. catarrhalis otitis media. B. catarrhalis has emerged as an important and common pathogen in neonates, infants, and children.

Bacterial Infections↗

Clinical and histopathologic observations in severe Vogt-Koyanagi-Harada syndrome.

Vogt-Koyanagi (V-K) syndrome is a severe anterior uveitis associated with alopecia, vitiligo, poliosis, and dysacousia. Harada's disease (HD) is primarily a posterior uveitis accompanied by signs of meningeal irritation and abnormalities of the cerebrospinal fluid. The overlapping of clinical manifestations between the two justified considering them as part of a spectrum of one disease (V-K-H). In a clinicopathologic study of nine cases four patients (three with V-K syndrome and one with V-K-H syndrome) histopathologically displayed a granulomatous uveitis. Five patients (two with V-K syndrome and three with HD) showed a nongranulomatous uveitis. We emphasized this latter finding, since in the past the diagnosis of this syndrome has been discarded both clinically and histopathologically because of the absence of a granulomatous uveitis. We established the clinical and histopathologic differences between V-K-H and sympathetic ophthalmia. The designation "uveomeningoencephalitic syndrome" stresses the key features of V-K-H, namely the uveal involvement and signs of meningeal irritation (that is, headaches, personality changes, and cerebrospinal fluid alterations).

Adult↗

The sensitivity of Neisseria gonorrhoeae, Chlamydia trachomatis, and herpes simplex type II to disinfection with povidone-iodine.

Povidone-iodine is an effective broad-spectrum disinfectant with no reported toxicity to the cornea and conjunctiva when applied topically in single dose to the ocular surface. We challenged four strains of Neisseria gonorrhoeae, a clinical isolate of Chlamydia trachomatis, and one strain of herpes simplex virus type II with three different concentrations of povidone-iodine (5%, 1%, and 0.1%) for one minute. The challenge inoculum of Neisseria gonorrhoeae and herpes simplex virus type II were completely sterilized by all three solutions. The chlamydia titer was reduced by two log units at the 5% and 1% concentrations, but not the 0.1% concentration. Povidone-iodine may be of potential use in the prophylaxis of newborns against ophthalmia neonatorum.

Blood↗