Exfoliative cytology for diagnosis of Helicobacter pylori]

From January 1988 through June 1996, 12 patients who had extrahepatic bile-duct cancer received preoperative radiotherapy at doses of 40.6 Gy to 58.4 Gy. At restaging, 1 patient was found to have liver metastases and the remaining 11 patients were taken to surgery. Nine patients underwent resection, and 8 of the 9 received intraoperative radiotherapy. Complications occurred in 4 patients, 3 of whom died postoperatively. The 2 patients who died of intraabdominal complications received both preoperative radiation doses of more than 55 Gy and intraoperative radiotherapy doses of 14 Gy or more. Histologic evidence of irradiation effects was present in all specimens. Irradiation effects on perineural invasion were observed in varying degrees. Two of the four patients who had marked irradiation effects on perineural invasion developed local recurrence, which was found at autopsy to have infiltrated the hepatic hilum without obstructing the hepatic ducts. One patient who had minimal irradiation effects on perineural invasion developed local recurrence with obstructing the hepatic ducts. Of the 2 patients who had positive margins, the patient with marked irradiation effects on perineural invasion survived 18 months, but the patient with slight irradiation effects on perineural invasion survived only 5 months. The high complication rate requires modification of this strategy. The propriety of combining preoperative radiotherapy with intraoperative radiotherapy as well as the radiation dose should be reinvestigated.     

Exfoliative dermatitis due to immunologically confirmed carbamazepine hypersensitivity

A 6-year-old Caucasian girl experienced a generalized erythematous skin rash during carbamazepine therapy. Over the next four days the eruption worsened into erythroderma with fever and generalized lymphadenopathy. Routine laboratory studies revealed increased serum levels of liver enzymes and eosinophilia. Immunologic reactivity to the anticonvulsant carbamazepine and its analogs was investigated both in vivo and in vitro by patch tests and lymphocyte proliferation assays, respectively.     

Modified phacoemulsification in situ

We describe a phacoemulsification technique for cataracts in eyes with anticipated weak zonular apparatus. After central sculpting, a crater 90% deep is made. A horizontal fracture is created with the phaco probe and chopper. The nucleus is chopped, dividing the inferior hemisection into 2 pie-shaped pieces, which are then emulsified. Without rotating the nucleus, a groove is made at the superior hemisection and a vertical fracture created with the chopper. The bevel of the phaco probe is then turned down to emulsify each quadrant separately. This technique is especially useful in eyes with weakened zonular apparatus such as those with hypermature cataract, uveitis, long-standing glaucoma, trauma, retinitis pigmentosa, and operated retinal detachments.     

Corneal opacification occurring after phacoemulsification and phacofragmentation

Four patients developed progressive corneal opacification five to eight months after ultrasonic cataract extraction. Transmission electron microscopy was performed in all patients. Scanning electron microscopy, performed in only one patient, showed radiating folds of Descemet's membrane with pits on its posterior surface as well as focal traumatic disruption probably caused by probe contact. Bullous keratopathy was present in one patient. Two other patients had folds of Descemet's membrane and a thin retrocorneal fibrous layer. All four tumor specimens showed secondary epithelial and stromal changes. The common denominator was the total or partial absence of endothelium or marked alterations of its remnants.     

Exfoliative toxin detection using reversed passive latex agglutination: clinical and epidemiologic applications

A rapid and simple method for detecting exfoliative toxin serotypes A and B from clinical isolates has been developed as a test kit (EXT-RPLA; Denka Seiken Co. Ltd., Niigata, Japan). This method is based on reversed passive latex agglutination. The detection limit of the EXT-RPLA observed for purified exfoliative toxin serotypes A and B was 1 ng/ml. We evaluated the clinical and epidemiologic uses of the EXT-RPLA. A total of 381 isolates of Staphylococcus aureus, 292 from various clinical specimens and 89 from the skin of dermatologic patients, were studied. The EXT-RPLA detected 19 exfoliative toxin producers, including 16 serotype A producers and 3 serotype B producers, but no double producers. The sensitivity and specificity of the EXT-RPLA were confirmed by the newborn mouse bioassay and a PCR assay for the structural genes for exfoliative toxin serotypes A and B (eta and etb, respectively). The overall positivity rate of exfoliative toxin producers was 5.0% (19 of 381), including 16 serotype A isolates and 3 serotype B isolates. Of the 89 isolates from the skin of dermatologic patients, 12 (13.5%) were positive for exfoliative toxin production. Only 2 (1.3%) of the 153 methicillin-resistant S. aureus isolates produced exfoliative toxin, while 17 (7.5%) of the 228 methicillin-sensitive isolates produced exfoliative toxin. The EXT-RPLA assay is a simple and reliable method for detecting exfoliative toxin, and we recommend its use for the rapid diagnosis of staphylococcal scalded skin syndrome. We also recommend its use for detection of this syndrome so that effective control measures can be taken against the spread of this syndrome.     

Corneal endothelial damage associated with phacoemulsification

Ergonovine maleate (EM) is a powerful stimulant of human tubal motility. It has been therefore thought that EM could interfere with normal ovum transport and serve as a contraceptive. The tube activating effects of EM and methyl EM were evaluated in 14 women and results confirmed that both are powerful stimulants of the human Fallopian tube. EM immediately post coitus significantly reduces the conception rate.     

Unusual presentation of phacoanaphylaxis following phacoemulsification

A case of phacoanaphylaxis following phacoemulsification is presented. The unusual features of the disease included the markedly delayed onset and the clinical appearance of the hypopyon. Emphasis is placed on the cytologic examination of anterior chamber aspirate in such cases.     

Triple procedure with phacoemulsification prior to grafting

OBJECTIVE: To evaluate the value of transesophageal color Doppler echocardiography in the diagnosis of intrathoracic masses. METHODS: Twenty patients with intrathoracic masses were examined by transesophageal echocardiography (TEE), including 12 patients with central lung masses and 8 with mediastinal masses. The neoplasms were explored by two-dimensional realtime ultrasonography, Doppler color flow imaging (DCFI) and pulsed Doppler (PD). The results were compared with computed tomography (CT), operative and pathological examination findings. RESULTS: We were able to identify the size, structure (solid or cystic), anatomic relationship, metastatic lymph nodes and venous carcinoembolus of the masses. Furthermore, the hemodynamic data in the vasculature inside the masses were detected. CONCLUSIONS: As a new method, TEE with Doppler technique is not only valuable in differentiating malignant and benign neoplasms but also useful for preoperative evaluation of the mass resectability in patients with intrathoracic neoplasms.     

Viscoelastic adherence to corneal endothelium following phacoemulsification

OBJECTIVE: The study examined the prevalence and correlates of criminal victimization and the relationship between victimization and client outcomes for homeless clients with mental illness. METHODS: Subjects were clients in community treatment programs participating in the Access to Community Care and Effective Services and Supports (ACCESS) program of the Center for Mental Health Services. Data were obtained through interviews conducted at program entry and at three and 12 months after entry with ACCESS clients in 18 sites during the first year of program operation (N = 1,839). Self-reports of victimization during the past two months as well as data on sociodemographic, health, and social adjustment indicators were obtained at each time point. Multiple regression was used to determine both the correlates of victimization among this population and the effect of recent victimization on client outcomes three and 12 months after program entry. RESULTS: Forty-four percent of the clients were the victims of at least one crime during the two months before entering the program. Women were significantly more likely than men to have been victimized. Multivariate analysis showed that the more severe the client's psychotic symptoms, alcohol abuse, and criminal history, the more likely he or she was to have been victimized. Recent victimization had a significant impact on client outcomes in terms of increased homelessness and decreased quality of life. Victimization shortly before program entry was also the single most important predictor of victimization at both follow-up points. CONCLUSIONS: These findings suggest the critical need for service providers who work with homeless people with serious mental illness to assess the extent to which they have been victims of crime and to address issues of victimization and safety along with psychiatric and social adjustment problems.     

Simplified anesthesia technique for scleral tunnel phacoemulsification

A simplified anesthesia technique for sutureless scleral tunnel, small incision, one-port phacoemulsification is described. Step 1: Mild intravenous sedation is achieved with 1 mg of midazolam and 10 mg of propofol. Step 2: A tetracaine- or preservative-free-lidocaine-soaked Weck cell sponge is applied to the superior bulbar conjunctiva and the superior episcleral tissue for localized anesthesia. Step 3: Preservative-free lidocaine 1%, 0.75 cc, is injected into the anterior chamber for intraocular anesthesia. This technique can be used in the presence of all types of cataracts, requires about 10 seconds to complete, and can be used with all phacoemulsification techniques. Results of the technique in a study population are reported.     

Vitrectomy for retained lens fragments after phacoemulsification

PURPOSE: Posterior lens fragments after phacoemulsification can be a serious complication of cataract surgery. This study is designed to evaluate the clinical features of eyes after pars plana vitrectomy has been performed to remove posteriorly dislocated lens fragments after phacoemulsification. METHODS: The authors performed a retrospective chart review of 126 consecutive eyes of 126 patients with dislocated lens fragments after phacoemulsification, managed with pars plana vitrectomy at Associated Retinal Consultants of Michigan. These eyes were operated on from January 1986 through January 1996. RESULTS: The relation of the intervals between cataract surgery and vitrectomy to various postoperative clinical parameters was studied. Clinical features at presentation included elevated intraocular pressure (IOP over 25 mmHg) in 52.4% of the eyes, uveitis in 69.6%, and corneal edema in 50.8%. Initial visual acuity was 20/400 or worse in 73.8% of the eyes. The mean preoperative visual acuity was 20/278 (median, 20/400), whereas the mean final visual acuity was 20/40 (median, 20/50) after a mean follow-up of 18.9 months. Retinal detachments were found in 20 eyes: 7 before vitrectomy and 13 during or after it. After surgery, 44% of eyes achieved a final visual acuity of 20/40 or better and 90% were 20/400 or better. The distribution of best-corrected final visual acuities among the eyes showed statistically significant differences based on the type of intraocular lens (IOL) used, with posterior chamber IOL greater than anterior chamber IOL, and anterior chamber IOL greater than aphakia. Reasons for a poor visual outcome included persistent corneal edema (four eyes), retinal detachment (two eyes), central retinal vein occlusion (two eyes), age-related macular degeneration (two eyes) glaucoma (one year), and endophthalmitis (one eye). CONCLUSIONS: There were no statistically significant differences between early (< 7 days) and delayed (8 days or more) vitrectomy when increased IOP, corneal edema, choroidal effusions, cystoid macular edema, and visual acuity were analyzed. The use of vitrectomy to remove posteriorly dislocated lens fragments has been shown to be an effective treatment method that significantly reduces the inflammatory response and hastens visual recovery.     

不同切口超声乳化白内障吸除术临床应用研究

目的:探讨透明角膜缘隧道切口和角膜隧道切口超声乳化白内障吸除术治疗老年性白内障的临床效果.方法:将行白内障超声乳化吸除人工晶体植入术的患者80例96眼,随机分为观察组40例(49眼)和对照组各40例(47炎),观察组采用透明角膜缘隧道切口,对照组采用角膜隧道切口,比较两组患者术后裸眼视力、角膜散光和手术并发症发生情况.结果:观察组患者术后裸眼视力、角膜散光值均优于对照组,差异存在统计学意义(P＜0.05);两组患者并发症发生率相似,无统计学差异(P＞0.05).结论:采用透明角膜隧道切口超声乳化白内障吸除术治疗老年性白内障,有利于术后视力恢复,降低角膜散光程度,值得临床推广应用.     

The effect of phacoemulsification on aqueous outflow facility

OBJECTIVE: Although control of intraocular pressure (IOP) after cataract extraction may be of critical importance, little is known regarding changes in facility of outflow in the early postoperative period. The effect of phacoemulsification and conjunctival peritomy size on the coefficient of aqueous outflow facility (C) and IOP was studied. DESIGN: Participants were assigned randomly to one of two treatment groups. PARTICIPANTS: Seventy-four patients with cataract and without evidence of glaucoma were studied. INTERVENTION: Patients were randomized to receive either single- or two-quadrant conjunctival peritomy and phacoemulsification. MAIN OUTCOME MEASURES: Tonometry and tonography were assessed before surgery and at 1 day, 1 week, 6 weeks, and 1 year after surgery by a masked observer. RESULTS: Fifty patients with a mean of 11.4 months' (range, 10-13 months) follow-up were analyzed. Patients with reduced preoperative facility of outflow (as defined by C < or = 0.28 microliter/min/mmHg) showed a significant improvement from a mean preoperative value of 0.24 +/- 0.04 microliter/min/mmHg to 0.41 +/- 0.22 microliter/min/mmHg at 1 year (P = 0.002, N = 19). Among all patients, there was no significant change between mean preoperative C and last follow-up (0.39 +/- 0.23 vs. 0.46 +/- 0.38 microliter/min/mmHg, not significant [ns], N = 50). Furthermore, there was no significant change between mean preoperative and final IOP (23.7 +/- 4.1 vs. 23.3 +/- 3.9 mmHg, ns, N = 50). There was a significant elevation of mean IOP on postoperative day 1 to 27 +/- 6.2 mmHg (P = 0.001, N = 50). Patients with IOP elevations greater than 8 mmHg on postoperative day 1 had significantly elevated IOP at 1 year compared to preoperative values (P = 0.02, N = 12). There were no significant differences detected regarding C or IOP between single- or two-quadrant peritomy groups. CONCLUSIONS: Outflow facility improves after phacoemulsification in patients with a reduced preoperative coefficient of aqueous outflow. Postoperative day 1 IOP is significantly elevated after phacoemulsification. Conjunctival peritomy size does not appear to play a role in aqueous outflow facility or IOP after surgery.     

Prospective, randomized trial of Microvisc and Healon in routine phacoemulsification

PURPOSE: To compare the safety and efficacy of the new sodium hyaluronate viscoelastic, Microvisc, with those of Healon in routine phacoemulsification. SETTING: York Finch Eye Associates and York Finch General Hospital, Toronto, Ontario, Canada. METHODS: An unmasked, prospective, randomized clinical trial of 100 eyes in 100 patients having routine phacoemulsification and intraocular lens implantation was conducted to compare the safety and efficacy of Microvisc with those of Healon. Visual acuity, corneal thickness, and intraocular pressure were assessed preoperatively and at 6 hours, 1 and 5 days, and 1 and 6 months postoperatively. RESULTS: There were no statistically significant differences between the two treatment groups at any follow-up CONCLUSION: Based on the parameters assessed, both viscoelastic products were safe and provided comparable outcomes.