Visual outcomes and ocular morbidity of patients with uveitis referred to a tertiary center during first year of follow-up.

PURPOSE: To describe the visual outcomes and morbidity of newly referred uveitis patients. METHODS: Retrospective cohort study of 133 newly referred uveitis patients with active uveitis who required care in a tertiary center for at least 1 year. Main outcomes were best-corrected visual acuity (BCVA) at referral and 1 year after referral, duration of visual impairment, systemic medications used, as well as all complications and surgeries during the first year of follow-up. Generalized estimating equation models was used to assess prognosticators for poor BCVA. RESULTS: The mean age at onset of uveitis was 43 years. The proportion of patients with at least one eye with BCVA ≤0.3 decreased from 35% at referral to 26% (P=0.45) at 1-year follow-up. The mean duration of visual impairment in the first year after referral was 4 months per affected eye. At 1-year follow-up, bilateral visual impairment was observed in 4% but at least one ocular complication developed in 66% and 30% of patients required at least one intraocular surgery. Systemic immunosuppressive treatment was required in 35% of patients and the mean number of visits to ophthalmologist was 11 per year, while 8% of patients required hospital admission. Prognosticators for poor visual outcome included surgery undergone before referral (odds ratio (OR), 3; 95% CI, 1-11; P=0.047), visual impairment at referral (OR, 21; 95% CI, 8-54; P<0.001), and glaucoma before referral (OR, 7; 95% CI, 2-28; P=0.007). CONCLUSIONS: Patients with severe uveitis had a favorable BCVA 1 year after referral with only 4% of patients having bilateral visual impairment. This, in contrast to the prolonged duration of visual impairment during the first year of follow-up and the demanding care.

Diagnosis and treatment of tuberculous uveitis in a low endemic setting.

OBJECTIVE: To determine factors associated with the diagnosis of tuberculous uveitis and the response to anti-tuberculous treatment (ATT). METHODS: A retrospective case study was performed at the University Medical Centre Utrecht between October 2007 and December 2009. Patients with possible tuberculous uveitis (TBU) were selected from all patients with an unexplained uveitis. Demographics, ethnicity, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), tuberculin skin test (TST), QuantiFERON (QFT) test, and ocular findings were evaluated. An interdisciplinary panel discussed if there was a presumed TBU and decided to start treatment. When there was a decrease in intraocular cell count and/or improvement in visual acuity after ATT, the confirmation of presumed TBU was made. RESULTS: Of 585 patients with unexplained uveitis, 66 (11.3%) fulfilled the definition of possible TBU. Ten (15.4%) patients were regarded as having presumed TBU and received ATT. All of them had latent tuberculosis (LTB). The ocular situation improved in seven patients (70%). A history of TB contact, abnormalities on chest radiology, and extraocular manifestations of TB were associated with a good response to ATT in the case of presumed tuberculous uveitis. CONCLUSIONS: Tuberculous uveitis remains difficult to diagnose. No clearly correlating factors that predicted the response to ATT, including ocular parameters, could be identified.

Recession of the inferior rectus muscle in Graves' orbitopathy.

PURPOSE: To identify the predictive factors for overcorrection and depression impairment after recession of the inferior rectus muscle (IRM) in patients with Graves' orbitopathy. DESIGN: Retrospective cohort study, single institution. METHODS: The charts of 124 consecutive patients who underwent recession of the IRM were retrospectively examined, as well as all literature with regard to the subject until January 2008. Ductions measurements, computed tomography (CT) appearance, proptosis, NOSPECS-scores, duration of thyroid disease, duration of orbitopathy, previous treatment of Graves' thyroid disease and orbitopathy, extent of recession, age, gender, diabetes, smoking, and use of immunosuppressants were all evaluated for prognostic significance. RESULTS: Duration and severity of orbitopathy and impaired contralateral elevation were significant prognostic factors for overcorrection. Increase of volume of the ipsilateral superior rectus muscle was an independent risk factor for both overcorrection and limitation of depression. CONCLUSION: An increase in volume of the ipsilateral superior rectus muscle should be considered when determining the extent of recession of the IRM.

Precoagulation minimizes blood loss during standardized hepatic resection in an experimental model.

BACKGROUND: Precoagulation of liver tissue before transection is a novel concept in hepatic surgery. Comparative data with conventional techniques are lacking. This study tested the hypothesis that precoagulation results in reduced blood loss during hepatic transection. METHODS: Precoagulation was performed with two different devices, the TissueLink floating ball (group 1) and a dissecting sealer (group 2), and compared with ultrasonic dissection (group 3). For each technique 12 partial liver resections were performed in six pigs. Blood loss per dissection surface area was the main outcome parameter. RESULTS: The transected surface area was similar in all groups. Animals in groups 1 and 2 had significantly less blood loss than those in group 3 (3.6 and 1.3 versus 11.9 ml/cm2 respectively; P = 0.009 and P = 0.002). One pig in group 1 died as a result of wound dehiscence. In one animal in group 2 a gastric perforation was observed after death. In group 3 bile leakage occurred in two animals, and a large haematoma was observed on the transection surface in one animal after death. CONCLUSION: Precoagulation of liver tissue before transection is associated with less blood loss compared with ultrasonic dissection.

Heterogeneity assessment in individual CaCO3-CaSO4 particles using ultrathin window electron probe X-ray microanalysis.

In our previous studies, it has been demonstrated that both the excitation interactions between electrons and the atoms of the matrix and the matrix and geometric effects of electron-induced X-ray signals can be described by Monte Carlo simulation for low-Z elements, such as carbon, nitrogen, and oxygen, in individual atmospheric microparticles. In addition, by the application of a quantification method, which employs Monte Carlo simulation combined with successive approximations, at least semi-quantitative specification of the chemical compositions could be done. This has enlarged the scope of electron probe X-ray microanalysis (EPMA) for the single particle analysis of atmospheric environmental aerosol particles. In this work, we demonstrate that the heterogeneity of individual particles, even of micrometer size, can be characterized by the application of EPMA. X-ray photons obtained with different primary electron beam energies carry information on the chemical compositions for different regions in the particles. Artificially generated heterogeneous CaCO3-CaSO4 individual particles were measured at different accelerating voltages, and it was found that the Monte Carlo calculation is a powerful technique to extract the information on the heterogeneity of the particles that is contained in the measured X-ray data. Our approach can even estimate the thickness of the surface CaSO4 species by the application of the Monte Carlo calculation. A preliminary result for carbon-coated glass particles is also presented. The complexity involved in the analysis of real world particles is briefly mentioned with a result for heterogeneous SiO2 particle.

Single-particle analysis of aerosols at Cheju Island, Korea, using low-Z electron probe X-ray microanalysis: a direct proof of nitrate formation from sea salts.

A recently developed electron probe X-ray microanalysis (EPMA), called low-Z EPMA, employing an ultrathin window energy-dispersive X-ray detector, was applied to characterize aerosol particles collected at two sampling sites, namely, Kosan and 1100 Hill of Cheju Island, Korea, on a summer day in 1999. Since low-Z EPMA can provide quantitative information on the chemical composition of aerosol particles, the collected aerosol particles were classified and analyzed based on their chemical species. Many different particle types were identified, such as marine-originated, carbonaceous, soil-derived, and anthropogenic particles. Marine-originated particles, such as NaNO3- and Na2SO4-containing particles, are very frequently encountered in the two samples. In this study, it was directly proven that the observed nitrate particles were from sea salts. In addition, two types of nitrate particles from sea salts were observed, with and without Mg. The sodium nitrate particles without Mg were believed to be collected as crystalline form, either with the sodium nitrate particles being fractionally recrystallized within evaporating seawater drops or with recrystallized sodium chloride particles having reacted with gaseous nitrogen species in the air to form the crystalline sodium nitrate particles. The other seemed to be collected as seawater drops, where the atmospheric reaction had occurred in the droplets, and thus sodium as well as magnesium nitrates were observed. Carbonaceous particles are the most abundant in the samples at both sites. From this study, it was found that about three-quarters of the carbonaceous particles in the samples were biogenic, which partially explains a previously reported observation of a large concentration of organic carbon particles as compared to elemental carbon. Various soil-derived particles were also observed. In addition to aluminosilicate- and iron oxide-containing particles, which are ubiquitous components in soil-derived particles, CaCO3-, Al2O3- and Cr-containing particles were also frequently encountered.

Location of Staphylococcus aureus within the experimentally infected bovine udder and the expression of capsular polysaccharide type 5 in situ.

The objective of this study was to locate Staphylococcus aureus in the bovine udder and to investigate the expression of capsular polysaccharide type 5 (CP5) in situ in both the early and chronic stages of experimental intramammary S. aureus infections. Bovine udder tissue was obtained in early and chronic stages of intramammary infection; i.e., 24 to 96 h and 122 d after experimental intramammary infection with S. aureus Newbould 305. The presence and location of S. aureus was investigated by Gram staining of tissue sections. The expression of CP5 by S. aureus in situ was investigated by immunochemical staining of tissue sections with specific antibodies against CP5. Both in the early and chronic stages of infection, S. aureus was located within the lumen of alveoli or lactiferous ducts, in association with the epithelium, and within phagocytic cells. The staphylococci were mainly observed in clusters and often in the presence of polymorphonuclear neutrophils. Expression of CP5 by S. aureus was observed both in the early and chronic stages of infection. In general, CP5-positive S. aureus were located in alveoli and in association with the mammary epithelium. In the chronic infection, CP5-positive S. aureus were also located deep in the interstitial tissue. These results indicate that--both in early and chronic stages of experimental S. aureus mastitis--colonization of the mammary epithelia and invasion into the interstitial tissue occurs and that CP5 is expressed by S. aureus Newbould 305 in situ. The invasion of S. aureus in the interstitial tissue and the expression of CP5 probably help the bacteria to withstand the host defense mechanisms.