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Ten out of 31 cases of severe corticosteroid-resistant uveitis showed a good clinical response to systemic chlorambucil therapy. Cases of Behcet's syndrome, sympathetic ophthalmia, chronic cyclitis, and rheumatoid sclerouveitis seem to be in the most favorable categories to be considered for cytotoxic-immunosuppressive therapy.
PURPOSE: To evaluate the clinical effect and safety of evisceration with hydroxyapatite (HA) orbital implant. METHODS: A retrospective analysis of all eviscerations with HA implant performed between January 1998 and May 2000 in Zhongshan Ophthalmic Center was completed. Patient records were reviewed for demographic data, surgical indication, sphere size, clinical outcome, and complications. The average follow-up interval was 11.6 months (2-24 months). RESULTS: Primary evisceration with HA implantation was performed in total 78 cases. All patients underwent successful surgery without major complications. There was no case with those complications, including implant extrusion, exposure and implant dislocation, in the series examination. No patient has symphathetic ophthalmia during follow-up interval. CONCLUSION: In strict selected cases with surgical indication of evisceration, primary evisceration with HA implantation is a safe and effective method for treating patients with a blind, painful or atrophic eye.
In several ancient systems of medicine including Ayurveda, Greek, Roman, Siddha and Unani, Ocimum sanctum has vast number of therapeutic applications such as in cardiopathy, haemopathy, leucoderma, asthma, bronchitis, catarrhal fever, otalgia, hepatopathy, vomiting, lumbago, hiccups, ophthalmia, gastropathy, genitourinary disorders, ringworm, verminosis and skin diseases etc. The present review incorporates the description of O. sanctum plant, its chemical constituents, and various pharmacological activities.
Staphylococcus aureus is a bacterium which has shown variations, as to susceptibility, to antimicrobial agents. By the plate dilution method, response to 12 different antibiotics is studied in 609 strains isolated from children admitted, or who attended the outpatient clinic of the Hospital Infantil de México, between 1973 and 1974. Ninety per cent or over, of all strains, were sensitive to eight of the antibiotics. The most effective were: gentamicin, (99.8%), cephalothin and cloxacillin (99%). Lesser sensitivity was found to penicillin (28.7%), ampicillin (33.5%) and tetracycline (49%). In general, resistance was greater in cases of surgical wounds and abscesses, and lesser in respiratory infections (pharyngeal exudates and bronchoaspirations). All strains isolated from purulent ophthalmias showed resistance to penicillin and 91%, to ampicillin.
We report the seventh family of Fowler like syndrome (proliferative vasculopathy and hydrocephaly-hydrencephaly syndrome) and first case from Indian subcontinent. A 35 weeks extremely growth retarded male baby showed enlarged ventricles, thinned out cerebral cortex, diffuse intra-cerebral as well as peri-ventricular calcification, cerebral and corneal vasculopathy, unilateral micro-ophthalmia along with corneal opacity and depressed pulsatile anterior fontanel. This case was different from others concerning association with extreme oligohydramnios (in contrast to polyhydramnios), extreme growth restriction (in contrast to normal growth) and absence of gross muscle hypoplasia. No causative factors like TORCH infection, chromosomal abnormality or positive family history was noted in this case.
INTRODUCTION: Uveitis in children is rare: 3%-8% of all cases. It requires the same diagnostic and etiological processes as uveitis in adults, with additional difficulties at examination and a sometimes insidious progression. MATERIAL AND METHODS: Retrospective study of 20 cases of childhood uveitis from 1995 to 2000. All patients received an ophthalmologic examination and an etiological search, with specific and/or symptomatic treatment and follow-up lasting from 6 months to 5 years. RESULTS: The 20 children presenting uveitis were 4-16 years old, with etiologies as follows: 8 cases of Behçet's disease, 2 cases of Vogt-Koyanagi-Harada's disease, 1 case of sarcoidosis, 1 case of uveitis associated with coeliac disease, 1 case of toxoplasmosis, 1 case of sympathetic ophthalmia, 1 case of uveitis with streptococcal infection, 3 cases of ocular toxocarosis, and 2 cases with unknown etiology. Treatment based on the etiological findings was started in the cases of toxoplasmosis and uveitis from streptococcal infection. The others were treated with high- and then digressive-doses of corticosteroids. ANALYSIS: We have noted the high incidence of Behçet's disease in our series. Progression was marked by frequent recurrence for one case of Vogt-Koyanagi-Harada's syndrome and one case of toxoplasmosis. This study also revealed a few cases of complicated cataract. DISCUSSION: Clinical characteristics, diagnosis, and treatment of uveitis in children are discussed.
The immunogenetic mechanisms of various ocular diseases were investigated utilizing recently developed molecular biological and molecular genetic techniques. It was revealed that HLA-B 51 was closely associated with Behçet's disease. Investigation of genetic polymorphism of TNF-beta (tumor necrosis factor-beta) showed that 95% of Behçet's disease patients had the 10.5 kbp Nco I fragment. It was therefore concluded that the gene of susceptibility to Behçet's disease is located between HLA-B and TNF-beta loci on the short arm of chromosome 6. Similar studies of HLA-DNA typing in Harada's disease frequently seen in Japan showed that frequencies of HLA-DRB1 * 0405, HLA-DQA1 * 0301 and HLA-DQB1 * 0401 were significantly increased in patients compared with normal controls. These data suggested that those who have serine at position 57 of HLA-DR, glutamic acid at position 70 and aspertic acid at position 71 of HLA-DQ respond to certain unknown agents significantly more than those without them, thus leading to the development of Harada's disease. The same HLA association was observed between Harada's disease and sympathetic ophthalmia, and the immunogenetic mechanism was thought to be similar in both diseases. Recent immunogenetic and molecular genetic investigations on various ocular diseases have shed new light not only on the genetic individual susceptibility and biased racial differences, but also on the diagnosis of the ocular diseases, reclassification of disease entities according to HLA associations, and judgement of disease prognosis. Further progress of molecular medicine may make it possible to treat various intractable ocular diseases by gene therapy in the near future.
Chlamydia trachomatis is currently the most common sexually transmitted disease in the United States. The prevalence in pregnant women ranges between 2% and 47%. It is well known that C trachomatis can be transmitted from the genital tract of an infected mother to her newborn infant, causing conjunctivitis or pneumonia or both, along with their longstanding complications. A review of the literature failed to show, however, conclusive evidence of transmission of infection to the newborn infant when the infant was born by cesarean section with intact amniotic membranes. We present a case of a young black woman with a history of chlamydia cervicitis during pregnancy whose infant was delivered by cesarean section because of failure to progress. She gave birth to a healthy term infant who developed ophthalmia neonatorum on the 3rd day of life. Examinations of conjunctival scrapings with direct fluorescent staining (chlamydia MicroTrak) performed on the 1st and 3rd day of life were positive. The initial test was performed because of the maternal history. The infant was mildly symptomatic at the time the study was repeated for confirmation. Our findings strongly suggest the possibility of either transmembrane or transplacental route of infection in the pathogenesis of neonatal chlamydia infection. Further study is needed to confirm this possibility.
To obtain information on potential developmental toxicity, hydroquinone (HQ) was administered to pregnant New Zealand White rabbits (18 mated per dose group) in aqueous solution (0, 25, 75, or 150 mg HQ/kg/day) by gavage on Gestation Days (GD) 6 to 18. Caesarean sections were performed on GD 30. Doses of 75 and 150 mg/kg/day adversely affected feed consumption and/or body weights of dams during the treatment period. At these doses, however, treatment-related effects were not evident from physical observations, liver and kidney weights, premature delivery incidence, and caesarean sectioning data. The NOEL for maternal toxicity was 25 mg/kg/day. In the 150 mg/kg/day dose group, total incidences of external, visceral, and skeletal findings for fetuses did not differ statistically from controls. Slight, statistically insignificant, increases were found, however, in the incidences of ocular and minor skeletal malformations (micro-ophthalmia, vertebral/rib defects, angulated hyoid arch) on both a per fetus and a per litter basis. Under the conditions of this study, HQ at 150 mg/kg/day produced minimal developmental alterations in the presence of maternal toxicity. The NOEL for developmental toxicity was 75 mg/kg/day.
These recommendations specify appropriate treatment, including dosage of antibiotics for uncomplicated gonococcal infections in adults, infections with penicillinase-producing Neisseria gonorrhoeae, acute salpingitis, acute epididymitis, disseminated gonococcal infections, and gonococcal infections in pediatric patients (including neonatal infections). Special attention is given to important diagnostic considerations, relation of gonococcal infections to concomitant venereal infections, treatment of sexual partners, follow-up, treatment failures, treatments not recommended, allergic problems in treatment, needs for hospitalization, and prevention of gonococcal ophthalmia. Attention is called to the importance of using no less than the recommended dosages of antibiotics.
A case of retained metallic arrowhead in orbit and sphenoidal sinus through an unusual route is reported. The eyeball was removed because of a possible risk of sympathetic ophthalmia.
The paper presents current knowledge about the clinical course, diagnostic and treatment of chlamydial infections in the neonatal period. In the neonatal period, infections caused by Chlamydia trachomatis are in the majority of maternal origin. Chlamydia mother to child transmission occurs during vaginal birth. It can also occur but rarely, during caesarean section after premature rupture of membranes. Chlamydia trachomatis infection of the genitourinary system in pregnancy increases the danger of intrauterine growth restriction and foetal death. It rises the perinatal morbidity of foetuses and newborns and increases the risk of premature deliveries. Chlamydia trachomatis infection in newborns manifests as conjunctivitis and ophthalmia and less commonly as pharyngitis and otitis media. Erythromycin is applied in prophylaxis and treatment of Chlamydia infections.
Limited vision seems to have been Johann Sebastian Bach's (1685-1750) only physical problem. Myopia seems the most likely cause and he probably developed cataracts later in life. In addition to the cataracts, his worsening vision may have been due in part to some other eye problem. In 1750 Bach's vision became so poor that he had his eyes operated on by the travelling English eye surgeon John Taylor. Most likely the first operation was Taylor's standard couching procedure. About one week after the first operation, Bach was operated on again because of the reappearance of the cataract. Many painful and/or vision-reducing complications could have been induced by these intraocular operations: uveitis or endophthalmitis, secondary glaucoma, haemorrhage, retinal detachment, and even sympathetic ophthalmia. After the second operation Bach was blind. He died less than four months later.
The exact cause and nature of various ocular diseases are still unknown. In accordance with the progress of modern medical science, technology for research investigations has greatly developed and a variety of new results have recently been produced. However, they were mostly about exogenous factors such as bacteria or parasites. On the other hand, molecular biology has markedly progressed in the second half of the 20th century and has been applied to medical science. As for the exogenous factors, molecular techniques have been introduced to the diagnosis of infectious diseases, and their diagnosis has become much easier and much more exact than before. Similarly, in the field of immunogenetics, molecular genetics has greatly developed, and disease susceptibility or disease resistance has been investigated at the DNA or molecular level. Regarding the exogenous disease mechanisms, most infectious diseases occur when the microorganisms are transmitted to some individuals. In this case, endogenous factors play almost no or very little role. Adenovirus keratoconjunctivitis is one example. Human adenovirus (HAdV) is a DNA virus. Although HAdVs are classified into 51 different serotypes, only 7 of them such as HAdV-3, -4, -7, -8, -11, -19, and -37 usually develop acute keratoconjunctivitis. The genome of HAdV develops constant mutation, and new genome types often cause epidemics of nosocomial infections. Recent studies showed that most of the keratoconjunctivitis cases are caused by HAdV-37 in Japan. With regard to the endogenous disease mechanisms, only 30 years have passed since the recent molecular genetic studies on disease susceptibility started. Before that, genetic disease mechanisms were studied only in hereditary diseases such as color vision defects, which follow the modes of Mendelian inheritance. Therefore, the presence of disease susceptibility was not clearly understood in the so-called nonhereditary diseases. However, after our initial findings of the close association between Behçet's disease and HL-A 5 (later HLA-B 5 or HLA-B 51) in 1973, there were many reports on the presence of genetic predisposition to certain non-hereditary diseases. One example is Vogt-Koyanagi-Harada's (VKH) disease which has a close association with HLA-DRB 1*0405 in Japanese patients, as also was the case with sympathetic ophthalmia. These studies indicate that Behçet's disease may be called "a disease of the Yayoi people" and Vogt-Koyanagi-Harada's disease as "a disease of the Jomon people" when analyze the associated genetic factors. On the other hand, the human genome project has been successfully completed and it is now possible for us to investigate any genetic factor associated with certain diseases either on 22 pairs of autosomal chromosomes or on one pair of sex chromosomes. Our collaborative team has adopted the microsatellite methods utilizing the pooled DNA PCR method, and started investigation of any genetic association with ocular diseases, in addition to the HLA system on the short arm of autosomal chromosome 6. In the first screening of 100 DNA samples of Behçet's disease patients, for example, 9 % of microsatellite markers on the autosomal chromosomes 1, 6, 17, and 19 showed significant positive association. The same studies are now in progress by our collaborative team on inflammatory diseases such as sarcoidosis, and on noninflammatory conditions like hypertension or high myopia. These results suggest that exogenous environmental factors such as infections which may trigger the occurrence of the disease or conditions, and endogenous genetic factors which may predispose someone to contracting a disease, are both significantly associated with various ocular diseases, and construct intricate disease mechanisms. Therefore, in future studies of diagnosis, treatment, and prevention of various ocular diseases, both exogenous factors and endogenous factors have to be carefully analyzed and investigated.
Serous choroidal detachment is characterized by exudative detachment of the retina and choroid following leakage of fluid from the choriocapillaris into suprachoroidal space. This accumulation of fluid has been known to be a complication of various intraocular surgeries (cataract, glaucoma and retinal detachment surgery), where hypotony is combined with postoperative inflammation. Among other non surgical conditions associated with uveal effusion are idiopathic (uveal effusion syndrome, microphthalmia) and inflammatory diseases (scleritis, sympathic ophthalmia, pars planitis, Harada's disease). Idiopathic serous detachment of choroids is caused by scleral abnormalities associated with hypoplasia or partial absence of the vortex venous system. The most cases of postoperative choroidal detachment resolve spontaneously. Resolution is usually associated with rapid normalization of the intraocular pressure and reduction of intraocular inflammation. The natural course of idiopathic condition is variable but tends to be prolonged with remissions and exacerbations. Surgical management involving vortex vein decompression and/or sclerotomy is the most effective treatment in this patients.
Chlamydia trachomatis infection most commonly affects the urogenital tract. In men, the infection usually is symptomatic, with dysuria and a discharge from the penis. Untreated chlamydial infection in men can spread to the epididymis. Most women with chlamydial infection have minimal or no symptoms, but some develop pelvic inflammatory disease. Chlamydial infection in newborns can cause ophthalmia neonatorum. Chlamydial pneumonia can occur at one to three months of age, manifesting as a protracted onset of staccato cough, usually without wheezing or fever. Treatment options for uncomplicated urogenital infections include a single 1-g dose of azithromycin orally, or doxycycline at a dosage of 100 mg orally twice per day for seven days. The recommended treatment during pregnancy is erythromycin base or amoxicillin. The Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force recommend screening for chlamydial infection in women at increased risk of infection and in all women younger than 25 years.
The most common site of Neisseria gonorrhoeae infection is the urogenital tract. Men with this infection may experience dysuria with penile discharge, and women may have mild vaginal mucopurulent discharge, severe pelvic pain, or no symptoms. Other N. gonorrhoeae infections include anorectal, conjunctival, pharyngeal, and ovarian/uterine. Infections that occur in the neonatal period may cause ophthalmia neonatorum. If left untreated, N. gonorrhoeae infections can disseminate to other areas of the body, which commonly causes synovium and skin infections. Disseminated gonococcal infection presents as a few skin lesions that are limited to the extremities. These legions start as papules and progress into bullae, petechiae, and necrotic lesions. The most commonly infected joints include wrists, ankles, and the joints of the hands and feet. Urogenital N. gonorrhoeae infections can be diagnosed using culture or nonculture (e.g., the nucleic acid amplification test) techniques. When multiple sites are potentially infected, culture is the only approved diagnostic test. Treatments for uncomplicated urogenital, anorectal, or pharyngeal gonococcal infections include cephalosporins and fluoroquinolones. Fluoroquinolones should not be used in patients who live in or may have contracted gonorrhea in Asia, the Pacific islands, or California, or in men who have sex with men. Gonorrhea infection should prompt physicians to test for other sexually transmitted diseases, including human immunodeficiency virus.
A study of all the passages connected to lippitudo and ophthalmia--Latin compilers used these two terms to refer to one and the same eye disease--shows that while Celsus claims to be a follower of Hippocrates, he does not mention some of the explanations which appear in his main sources. He both clarifies and completes the prescriptions of the 'Father of Medicine'. It can therefore be said that the De Medicina is a descendant of the Hippocratic Corpus in the same way as La Fontaine's Fables are a descendant of Aesop's.