Postoperative complications after simultaneous vitrectomy and cataract surgery.

OBJECTIVE: We reviewed postoperative complications after simultaneous vitrectomy, phacoemulsification, aspiration, and acryl lens insertion. PATIENTS AND METHODS: Combined surgery was performed in 316 eyes of 279 patients between 1995 and 1997. Postoperative observation was continued in all of them for more than 6 months. The diagnoses that led to vitrectomy included diabetic retinopathy in 155 eyes, rhegmatogenous retinal detachment in 64 eyes, macular hole in 43 eyes, and other diseases in 93 eyes. The rate of postoperative complications that needed any reoperation was investigated. RESULTS: Reoperations were needed for intravitreal hemorrhage in 23 eyes (7.3%), retinal detachment in 15 eyes (4.7%), rubeotic glaucoma in 6 eyes (1.9%), and other conditions in 4 eyes (1.3%). Among them, reoperations were performed on 13 eyes (4.1%) twice and more. A removal of an intraocular lens was needed in 16 eyes (5.1%) for treatment of vitreoretinal disease. In patients with diabetic retinopathy, reoperations were needed for intravitreal hemorrhage in 21 eyes (13.5%), rubeotic glaucoma in 6 eyes (3.9%), other diseases in 4 eyes (2.6%), and a removal of an intraocular lens was needed in 10 eyes (6.5%) at a higher rate than the other disease. CONCLUSION: This combined surgery is considered advantageous for removing peripheral vitreous, while preventing these complications is important for preserving visual function.

Normal tension glaucoma and primary open angle glaucoma associated with increased platelet aggregation.

On purpose of the present study was to evaluate platelet aggregation and fibrinolytic systems in patients with normal tension glaucoma (NTG) or primary open angle glaucoma (POAG). For platelet aggregation, we photoelectrophotometrically investigated adenosine diphosphate (ADP) or collagen-induced platelet aggregation in consecutively selected patients with glaucoma (22 patients with NTG and 13 patients with POAG) and 42 glaucoma free control subjects with normal ocular findings. The aggregation patterns of the patients' platelets reacted abnormally to ADP 1 microM or collagen 0.5 microg/ml as evidenced by secondary aggregation were compared with those of control subjects. For blood coagulative and fibrinolytic systems, we measured prothrombin time, activated partial thromboplastin time, fibrinogen, thrombin-antithrombin III complex (TAT), alpha2 plasmin inhibitor-plasmin complex. Seventeen of 22 patients (77%) with NTG and 5 of 13 patients (38%) with POAG showed abnormal secondary aggregation. A significant difference was observed between the two groups. No control subjects showed abnormal secondary aggregation. In the fibrinolytic test, all the parameters examined showed within normal ranges, although the log10(TAT) value was higher in NTG than in POAG. Results of the present study suggested that increased platelet aggregation as defined by ADP or collagen induced abnormal secondary aggregation in vitro is frequently associated with glaucoma patients and this tendency is more apparent in NTG than that in POAG.

Differential expression of mRNAs for sialyltransferase isoenzymes induced in the hippocampus of mouse following kindled seizures.

Sialic acids play important roles in various biological functions. In the brain, evidence suggests that sialylation of glycoproteins and glycolipids affects neural plasticity. While the 18 sialyltransferase isoenzymes (STs) identified to date synthesize individual sialyl-oligosaccharide structures, they each exhibit activity toward more than one substrate and can overlap in their specificity. Therefore, the distribution of STs is a secondary factor in the study of specific sialylation. Here, seven STs; ST3Gal I-IV, ST8Sia IV, ST6Gal I and ST6GalNAc II, the expressions of which were identified in the adult hippocampus by RT-PCR, showed diverse localization patterns in the hippocampus on in situ hybridization, suggesting that the individual cells expressed relevant STS: Furthermore, to assay activity-related changes in ST expression, we used amygdaloid-kindling among models of neural plasticity. Differential expression of the STs participating in the kindling, notably, up-regulation of ST3Gal IV and ST6GalNAc II mRNAs, and down-regulation of ST3Gal I and ST8Sia IV mRNAs, were observed in the hippocampus following kindled seizures. These results indicate that ST expressions are regulated by physiological activity and may play a role in neural plasticity.

Coronary sinus occlusion enhances coronary collateral flow and reduces subendocardial ischemia.

On the hypothesis that coronary sinus occlusion (CSO) may reduce myocardial ischemia, we examined the effects of CSO on coronary collateral blood flow and on the distribution of regional myocardial blood flow (RMBF) in dogs. Thirty-eight anesthetized dogs underwent occlusion of the left anterior descending coronary artery with or without CSO and intact vasomotor tone. We measured RMBF and intramyocardial pressure (IMP) in the subendocardium (Endo) and subepicardium (Epi) separately. With intact vasomotor tone, CSO during ischemia significantly increased RMBF in the ischemic region (IR), particularly in Endo from 0.17 +/- 0.03 to 0.33 +/- 0.05 ml x min(-1) x g(-1) (P < 0.05), and increased the Endo/Epi from 0.59 +/- 0.10 to 1.15 +/- 0.15 (P < 0.01). These effects of CSO were partially abolished by adenosine. However, the Endo/Epi was still increased from 0.90 +/- 0.13 to 2.09 +/- 0.30 (P < 0.01). The changes in RMBF in IR were significantly correlated with the peak CS pressure during CSO. The Endo/Epi of IMP in IR was significantly decreased during CSO. In conclusion, CSO potentially enhances coronary collateral flow, and preserves the ischemic myocardium, especially in Endo.

[Epidemiologic study of diabetic retinopathy in nine hospitals in the Aomori area].

PURPOSE: To examine the prevalence of diabetic retinopathy and the relationship between diabetic retinopathy and systemic risk factors. METHODS: A cross sectional study of diabetic retinopathy was conducted on 1,826 eyes of 913 randomly selected patients with type 2 diabetes in 9 central hospitals in Aomori Prefecture and the surrounding district. Retinopathy levels and maculopathy were assessed by binocular funduscopy, fundus photography and, if necessary, by fluorescein angiography. Multiple logistic regression analysis was performed to determine independent effects of systemic risk factors on diabetic retinopathy. RESULTS: The prevalence of background retinopathy was 31%, of preproliferative retinopathy 5%, and of proliferative retinopathy 5% in all patients. However, in 3 hospitals in which the patients were routinely examined by fluorescein angiography, background retinopathy was found to be present in 60%, preproliferative retinopathy in 5%, and prolifertive retinopathy in 7%. Maculopathy was found in 8% of diabetic patients and the prevalence was 11% in the eyes with background retinopathy, 40% with preproliferative retinopathy, and 50% with proliferative retinopathy. Multiple logistic regression analysis showed that retinopathy was significantly associated with duration of diabetes, methods of diabetic control, hypertension, nephropathy, and neuropathy. CONCLUSION: The detection rate of background diabetic retinopathy by fluorescein angiography was twice as sensitive as that by binocular funduscopy and fundus photography. The prevalence of maculopathy increases with the progression of retinopathy. Several systemic risk factors have significant association with diabetic retinopathy and maculopathy.

Radiation therapy for small choroidal neovascularization in age-related macular degeneration.

PURPOSE: To evaluate the effects of radiation therapy on age-related macular degeneration with subfoveal or juxtafoveal choroidal neovascularization < or =1 disc area. METHODS: Fourteen patients (14 eyes) received a total radiation dose of 10-20 Gy in 5-10 fractions. The mean follow-up time was 22 months. Ten patients (10 eyes) in a control group were followed up for an average of 16 months without treatment. RESULTS: At a 12-month posttreatment examination, funduscopic and angiographic findings showed improvement in 7 eyes (50%), no change in 1 eye (7%), and deterioration in 6 eyes (43%) among the treated patients. The same findings demonstrated improvement in 1 eye (10%), no change in 2 eyes (20%), and deterioration in 7 eyes (70%) among the control patients. This difference was determined to be statistically significant between the two groups by the Mann-Whitney U-test. Visual acuity had improved in 4 eyes (29%), was unchanged in 6 eyes (43%), and had declined in 4 eyes (29%), among the treated patients. Among the control patients, visual acuity had improved in none of the eyes (0%), was unchanged in 6 eyes (60%), and had declined in 4 eyes (40%). The difference in visual acuity between the two groups was not statistically significant. CONCLUSIONS: Radiation therapy inhibited small choroidal neovascularization, as seen by funduscopy and angiography, but its effectiveness in improving visual prognosis was not always evident.

Effect of celiprolol on cardiac hypertrophy in hypertension.

The present study was undertaken to clarify whether celiprolol and atenolol, beta1-selective beta blockers with and without intrinsic sympathomimetic activity (ISA), respectively, might improve ischemic damage in the isolated perfused hearts of spontaneously hypertensive rats (SHR), and whether long-term treatment with celiprolol may reduce left ventricular hypertrophy (LVH) in patients with essential hypertension. Atenolol (50 mg/kg/day) or celiprolol (300 mg/kg/day) for 7 weeks significantly reduced the blood pressure in SHR to the same degree, and both drugs decreased the heart rate, but the magnitude of the fall in heart rate was significantly higher with atenolol treatment than with celiprolol treatment. Both treatments significantly reduced the ratio of LV weight to body weight in SHR and significantly improved the coronary reserve in SHR to the same extent. Both treatments significantly improved the extent of recovery of the pressure-rate product and the extent of percent recovery of the coronary flow after reperfusion following 30 min of ischemia in SHR. Celiprolol treatment in patients with essential hypertension for 12 months significantly decreased interventricular septal thickness (IVST)+LV posterior wall thickness (PWT) and LV mass index (LVMI), but there was no significant correlation between IVST+PWT or LVMI and blood pressure before and after treatment. IVST+PWT and LVMI were significantly decreased after 3 months of treatment and these LVH indices were significantly smaller after 6 and 12 months of treatment than after 3 months of treatment. In conclusion, both celiprolol and atenolol treatment reduced LVH and improved the ischemic damage in SHR. In essential hypertensive patients with LVH, celiprolol treatment effectively reduced blood pressure and achieved LVH regression.

Postoperative refractive error after simultaneous vitrectomy and cataract surgery.

PURPOSE: To evaluate the effect of vitrectomy on postoperative refraction after simultaneous vitrectomy and cataract surgery. METHODS: We compared the spread between predicted and actual refractions in 206 eyes after a simultaneous vitrectomy, phacoemulsification, aspiration and acrylic lens insertion (combined surgery group), and in 67 eyes after cataract surgery only (cataract surgery group) as control. A vitrectomy was performed for diabetic retinopathy in 127 eyes, macular hole in 32 eyes, rhegmatogenous retinal detachment in 16 eyes, branch retinal vein occlusion in 15 eyes, and other conditions in 26 eyes. In the combined surgery group, 79 eyes had a gas tamponade after insertion of the intraocular lens. RESULTS: The spread between predicted and actual refractions was - 0.05 +/- 1.18 diopters (average +/- SD) in the combined surgery group and +0.55 +/- 1.32 D in the cataract surgery group. The actual refractive errors in the combined surgery group were found to shift toward myopia when compared with the controls. Among the combined surgery group, 127 eyes without a gas tamponade showed a postoperative refractive error of +0.14 +/- 1.11 D, while 79 eyes with a gas tamponade demonstrated an error of -0.36 +/- 1.22 D. CONCLUSIONS: Use of a gas tamponade in the combined surgery group increased the myopic change and was thought to have pressed the intraocular lens forward.

Epiretinal membranous tissue in retinal detachment due to macular holes in highly myopic eyes

Objective: To determine the frequency of occurrence of epiretinal membranous tissue in retinal detachment due to macular hole and to evaluate the efficacy of vitreous surgery including removal of the membrane.Design: Noncomparative case series.Participants: Eighteen highly myopic eyes with retinal detachment due to macular holes. Results: Epiretinal membranous tissue was removed from 7 eyes (39%) and retinal reattachment was obtained in 14 eyes (78%) after the initial vitreous surgery. Of 4 eyes that required reoperation, 2 eyes achieved reattachment after a long term of internal tamponade. Histological examination of an epiretinal membrane from one case revealed that it was composed of glial cells, connective tissue, and fragments of inner limiting membrane. An intraoperative use of autologous serum as a tissue adhesive for macular holes had no effect on surgical success.Conclusion: The first therapeutic choice for this disease should be vitreous surgery with removal of the epiretinal membrane when practical, though the membrane cannot always be identified in every case.

Effect of inhaled nitric oxide on cardiovascular response to catecholamine in heart failure.

We examined the dose responses to continuous infusion of isoproterenol (ISO) and norepinephrine (NE) in normal (control) and procainamide-induced heart failure dogs with or without inhalation of 70 ppm nitric oxide (NO). Inhaled NO affected neither left ventricular (LV) function nor hemodynamics at baseline in both control and heart failure dogs. There were no significant differences in the responses to ISO and NE with or without inhaled NO in the control. The responses of LV dP/dt to ISO and NE were significantly enhanced in heart failure; however, they were not affected by inhaled NO. In contrast, LV pressure and dimension at end diastole were significantly increased, and pulmonary vascular resistance (PVR) was significantly decreased by inhaled NO during infusion of both ISO and NE in heart failure. In conclusion, the positive inotropic response to cathecholamine is not affected by inhaled NO even in heart failure. Inhaled NO decreases PVR, but potentially increases LV preload in the presence of additional stress of cathecholamine in heart failure.

[Epiretinal membranous tissue in retinal detachment due to macular holes in highly myopic eyes].

OBJECTIVE: To determine the frequency of occurrence of epiretinal membranous tissue in retinal detachment due to macular hole and to evaluate the efficacy of vitreous surgery including removal of the membrane. DESIGN: Noncomparative case series. PARTICIPANTS: Eighteen highly myopic eyes with retinal detachment due to macular holes. RESULTS: Epiretinal membranous tissue was removed from 7 eyes (39%) and retinal reattachment was obtained in 14 eyes (78%) after the initial vitreous surgery. Of 4 eyes that required reoperation, 2 eyes achieved reattachment after a long term of internal tamponade. Histological examination of an epiretinal membrane from one case revealed that it was composed of glial cells, connective tissue, and fragments of inner limiting membrane. An intraoperative use of autologous serum as a tissue adhesive for macular holes had no effect on surgical success. CONCLUSION: The first therapeutic choice for this disease should be vitreous surgery with removal of the epiretinal membrane when practical, though the membrane can not always be identified in every case.

[Radiation therapy for small choroidal neovascularization in age-related macular degeneration].

OBJECTIVE: To evaluate radiation therapy for age-related macular degeneration with subfoveal or juxtafoveal choroidal neovascularization smaller than or equal to 1 disc area. DESIGN: Nonrandomized comparative clinical trial. PARTICIPANTS: Fourteen eyes received a total radiation dose of 10-20 Gy in 5-10 fractions. The mean follow-up time was 22 months. Ten eyes in a control group were followed for an average of 16 months without any treatment. RESULTS: At a 12-month follow-up examination, funduscopic and angiographic findings had improved in 7 eyes (50%), were unchanged in 1 eye (7%) and, had deteriorated in 6 eyes (43%) among the treated patients. The same findings had improved in 1 eye (10%), were unchanged in 2 eyes (20%), and had deteriorated in 7 eyes (70%) among the control patients. There was a statistically significant difference by Mann-Whitney U test between the two groups. Visual acuity had improved in 4 eyes (29%), was unchanged in 6 eyes (43%), and had declined in 4 eyes (29%) among the treated patients. Among the control patients visual acuity had improved in none of the eyes (0%), was unchanged in 6 eyes (60%), and had declined in 4 eyes (40%). The difference between the two groups was not statistically significant. Of the 7 cases whose fundus had improved by 12 months, 4 cases maintained a favorable status through the following 2 years. CONCLUSION: Radiation therapy had an inhibitory effect on small choroidal neovascularization when viewed by funduscopy and angiography, but, the efficacy for visual prognosis was not always identified.

[Predicted versus actual postoperative refractive error after simultaneous vitrectomy and cataract surgery].

PURPOSE: We compared the spread between predicted and postoperative actual refractive errors after simultaneous vitrectomy, phacoemulsification, aspiration, and acryl lens insertion and after cataract surgery alone. METHODS: Cataract surgery and vitrectomy (combined surgery group) were performed in 185 eyes, and cataract surgery only (cataract surgery group) in 63 eyes. Vitrectomy was needed for diabetic retinopathy in 104 eyes, macular hole in 26 eyes, rhegmatogenous retinal detachment in 25 eyes, and other conditions in 30 eyes. RESULTS: The spread between predicted and actual refractive errors were +0.19 +/- 1.24 D (mean +/- standard deviation) in the combined surgery group and +0.91 +/- 1.40 D in the cataract surgery group. Gas tamponade in the combined surgery group increased the myopic change more than anything else. CONCLUSION: Actual refractive errors in the combined surgery group were found to shift to myopia more than in the cataract surgery group. Gas tamponade was considered to press the intraocular lens forward in the combined surgery group.

A case of cardiac sarcoidosis: significance of ventricular tachycardia originating from the septum.

A 65-year-old woman was admitted for assessment of recurrent tachycardia. Cross-sectional echocardiography showed that the anterobasal portion of the ventricular septum was thin and dyskinetic. An electrophysiologic study revealed ventricular tachycardia, during which marked fragmented potentials could be obtained from the anterior septal aspect of the right ventricle. The site of earliest activation was in the vicinity of the His bundle. A diagnosis of cardiac sarcoidosis was made by based on endomyocardial biopsy combined with the clinical manifestations. Ventricular tachycardia originating from the anterior septum may be an indicator of underlying cardiac sarcoidosis.

Three cases of primary lung cancer undetected by an annual checkup.

An annual check by chest roentgenogram is very important for the early detection of lung cancer. We present three cases of primary lung cancer which were not detected by the double check system or previous examination. The three patients visited our hospital for evaluation of an ill-defined opacity in the upper lobe of the lung. In the three cases, no abnormality had been reported in the previous year's annual chest X-ray, and we concurred in the decisions. The correct diagnoses of the three cases were well or poorly differentiated adenocarcinoma, and were still amenable for surgical therapy. A poorly defined tumor in this region is very difficult to detect because of superimposed opacities of other anatomical structures. When a questionable shadow in this region is found but without the typical radiological features of lung cancer, it is important to search for indirect indications of adenocarcinoma. These may include fibrotic changes and absence of inflammation. In our cases, the increased number of normal-size bronchi penetrating the ill-defined tumor, seem to have diagnostic significance.

[Low-dose radiation, therapy for choroidal neovascularization in age-related macular degeneration].

The efficacy of low-dose radiation was evaluated in the treatment of eyes with subfoveal or juxtafoveal choroidal neovascularization in age-related macular degeneration. Ten eyes of ten patients received a total dose of 14 Gy of 10 MV X-rays in seven fractions and the mean follow-up time was 12 months (range 9 approximately 18 months). Thirteen control eyes of thirteen patients were followed for an average of 18 months (range 12 approximately 24 months). Visual acuity was improved in 2 eyes (20%), unchanged in 3 eyes (30%), and deteriorated in 5 eyes (50%) of treated patients, and it was improved in no eyes (0%), unchanged in 5 eyes (32%), and deteriorated in 8 eyes (50%) of the control patients at their last follow-up examinations. Funduscopic and angiographic findings were improved in 3 eyes (30%), unchanged in 2 eyes (20%), and deteriorated in 5 eyes (50%) of treated patients, and they were improved in no eyes (0%), unchanged in 5 eyes (32%), and deteriorated in 8 eyes (50%) of the control patients. These results suggested that low-dose radiation is beneficial for the management of subfoveal or juxtafoveal choroidal neovascularization in age-related macular degeneration.

Electron microscopic studies on the formation of renal juxtaglomerular cell granules in the vitally stained mouse kidney.

Mouse renal juxtaglomerular cells (JGC) were vitally stained with neutral red, and then fixed with glutaraldehyde to study by electron microscopy. Ultrastructural observation showed a large number of characteristic low electron dense juxtaglomerular granules (JGG) or low dense granules (LDG) in the cytoplasm of JGC. Many LDG contained a flocculent material with a dense core, which was as dense as the contents of JGG. Two kinds of LDG were observed. One of LDG was surrounded by single membrane and partial membrane, and another was surrounded by double membranes. Some LDG did not contain electron dense flocculent material. LDG were surrounded by rough endoplasmic reticulum (r-ER). Alteration of Golgi apparatus and r-ER was observed in JGC. Golgi complex did not associate with JGG and LDG.

Genetic linkage analyses of Romano-Ward syndrome (RWS) in 13 Japanese families.

Romano-Ward syndrome (RWS) is an autosomal dominant disorder characterized by prolongation of the electrocardiographic QT interval, with clinical manifestations that include recurrent syncope and sudden death from ventricular arrhythmias. Presymptomatic diagnosis is difficult because of the variability in these signs among carriers, but it is important for clinical management to prevent sudden cardiac death. To find an LQT (long QT) locus in Japanese patients and to identify DNA markers useful for presymptomatic diagnosis, linkage analyses were undertaken in 13 Japanese families with RWS patients by means of two DNA markers located on 11p15.5. One of these marker loci, HRAS, was previously reported to be tightly linked to the LQT locus in another ethnic group. Our analyses of homogeneity suggest evidence for genetic heterogeneity of RWS within the Japanese population.

[A case of myelodysplastic syndrome with pericarditis due to atypical Mycobacterium].

A 28-year-old woman with high fever and cough was admitted because of an abnormal shadow on the chest X-ray film. Mycobacterium kansasii was detected by sputum culture. The complete blood cell count disclosed pancytopenia and the myelogram showed slight hypoplasia and abnormality of the cell morphology. We diagnosed her disease as atypical mycobacteriosis and myelodysplastic syndrome. We began medical therapy with antituberculous drugs against Mycobacterium kansassi, and the sputum culture became negative. She was discharged after 4 months, but cardiothoracic ratio (CTR) increased gradually and pericardial effusion was detected by echocardiogram during follow-up. She was admitted again. We did not perform exploratory puncture, because the pericardial effusion did not increase for 6 months after admission and she had no complaints. We continued the antituberculous drugs, and CTR and the pericardial effusion decreased during follow-up. We considered the diagnosis in this case to be pericarditis due to Mycobacterium kansasii.

A case report of isolated levocardia without intracardiac anomalies associated with sick sinus syndrome.

A 42-year-old female with cardiomegaly showed bradycardia without syncope. Clinical data showed that she had an isolated levocardia with interruption of the inferior vena cava. Isolated levocardia was defined as a normally placed heart associated with situs ambiguus of other viscera. She did not have intracardiac anomalies. Isolated levocardia without intracardiac anomalies, as in this case, has only been reported in 13 other cases. Isolated levocardia is often accompanied by severe complex intracardiac anomalies and, therefore, most of the patients have a short life span. Situs ambiguus, especially left isomerism, is frequently associated with deteriorated sinus node function, and an interruption of the inferior vena cava may also be an indication of this phenomenon. Therefore, the patient's sinus node function was examined using an electrophysiological study and a 24-hour ambulatory electrocardiogram. Sick sinus syndrome was finally confirmed.