Polypoidal choroidal vasculopathy, diagnosis and management.

Polypoidal Choroidal Vasculopathy (PCV) was first identified in 1985. Initially considered to be rare, PCV is currently frequently diagnosed in patients of African and Asian descent. In Caucasians, PCV counts for 10% of cases of AMD, and for up to 85% of patients with hemorrhagic or exudative retinal pigment epithelial detachment. Although the clinical presentation can be suggestive, extensive investigation with the indispensable indocyanine green angiography, is required for confirmation of PCV. Treatment has to be considered in active disease threatening the macula. Photodynamic therapy with Verteporfin is required for closure of PCV complexes. Anti-VEGF treatment reduces associated macular edema.

Intravitreal bevacizumab for myopic choroidal neovascularization: 1-year and 2-year results.

METHODS: A retrospective interventional case series of 29 patients with mCNV was conducted. Charts were reviewed of all patients who received IVB for active mCNV and who had a follow-up of at least 12 months after the first injection. Patients were divided into three groups based on length of followup: patients in Group 1 had a follow-up of > or =12 months, in Group 2 of > or =18 months and in Group 3 of > or =24 months. Changes in visual acuity (VA) and CMT were analyzed, as were safety considerations such as intraocular inflammation and endophthalmitis. RESULTS: Twenty women and nine men with a mean age of 62.2 years (range 31-85) were included. No peri- or post-injection ocular or systemic side effects were noted in either group. Mean logMAR best-corrected visual acuity (BCVA) at baseline for all patients (n=29) was 0.71. Mean visual acuity for all 29 patients had improved significantly at 3 months (p = 0.0035) and one year (p = 0.0042) after baseline. Although visual acuity gains were maintained at 18 and 24 months, these were not statistically significant (p = 0.11 and p = 0.19, respectively). The mean CMT decreased significantly at one year after baseline. CONCLUSION: This study confirms that administration of intravitreal bevacizumab is a safe and effective treatment modality for mCNV. Statistically significant visual improvement can be obtained.

Conjunctival effects of a selective nasal pollen provocation.

BACKGROUND: Several clinical and experimental observations suggest that allergen deposition in the nose may partially be responsible for the induction of conjunctival symptoms in allergic rhinitis. The aims of this study were to evaluate the induction of conjunctival symptoms by selective nasal allergen provocation and to assess the feasibility of the different tools for evaluation of conjunctival allergic inflammation. METHODS: Grass pollen allergic subjects with rhinoconjunctivitis symptoms during the pollen season (n = 12) underwent a nasal sham and grass pollen provocation extra-seasonally. Nasal and conjunctival symptoms were scored using the Visual Analogue Scale (VAS) system at baseline, 15 min, 1 h and 24 h after provocation. In addition to Peak Nasal Inspiratory flow (PNIF) measurements, conjunctival inflammation and vascular congestion were evaluated and histamine and substance P levels in tear fluid were measured. RESULTS: Selective nasal grass pollen provocation induced ocular pruritus, lacrimation and conjunctival vascular congestion. PNIF values correlated inversely with lacrimation (r = -0.71, P < 0.001) and ocular pruritus (r = -0.41, P < 0.05). Four out of 11 patients showed a conjunctival eosinophilic inflammation and levels of histamine (r = 0.73, P < 0.05) and substance P (r = 0.67, P = 0.05) in tear fluid correlated with conjunctival symptoms. CONCLUSION: Selective nasal grass pollen provocation induced conjunctival inflammation, ocular pruritus and lacrimation, which correlated with histamine and substance P levels in tear fluid and inversely with the PNIF values. These data show a naso-ocular interaction in allergic rhinitis and offer objective tools for evaluation of conjunctival inflammation in allergic rhinoconjunctivitis.

Intravitreal bevacizumab for myopic choroidal neovascularization: short-term and 1-year results.

PURPOSE: To report three-month and one-year safety and efficacy results of intravitreal bevacizumab injection (IVB) for active choroidal neovascularization associated with pathological myopia (mCNV). METHODS: This retrospective interventional case series of 23 patients (23 eyes) was conducted at the medical retina center in the Leuven University Hospital Department of Ophthalmology, a referral center for macular diseases in Belgium. Charts were reviewed of all patients who received 1.25 mg IVB for active mCNV. If patients had two treated eyes, the eye with the longest follow-up was selected as the study eye. Injections were repeated as needed based on a decrease in visual acuity, an increase in central macular thickness (CMT) of >100 micromm on optical coherence tomography (OCT), the recurrence of macular edema on OCT and/or leakage on fluorescein angiography (FA). For statistical analysis, patients were divided into two groups based on length of follow up: patients in Group 1 had a follow-up of > or =12 months, while those in Group 2 had <12 months of followup. Changes in visual acuity (VA), as measured by the Early Treatment of Diabetic Retinopathy Study (ETDRS) protocol, and CMT were analyzed, as were safety considerations such as intraocular inflammation and endophthalmitis. RESULTS: Twenty-three eyes of 23 patients with ages ranging from 20 to 84 years (mean 57.7 years) were included. Mean best-corrected visual acuity (BCVA) at baseline for all patients (n=23) was 45 letters (Snellen equivalent: 20/120; 8 lines). At 3 months after initial treatment, the mean BCVA improved significantly (P < 0.05) to 58 letters (20/60(2); 10.5 lines). Eight patients had > or =12 months of follow-up (Group 1); 15 patients had > or =3 months of follow-up (Group 2). The mean BCVA for Group 1 improved significantly (P < 0.05) from 45 letters (20/120; 8 lines) to 60 letters (20/60; 11 lines), having received an average of 2.75 injections (range: 1-5) during this period and an average of one injection thereafter (mean follow-up after 12 months: 8 months). The mean BCVA for Group 2 improved significantly (P < 0.05) from 47 letters (20/120(2+); 8 lines) to 61 letters (20/60(1+); 11 lines), having received an average of 1.3 injections. CMT for all patients decreased from a mean of 266 mm at baseline to 201 mm at 1 month, 181 micromm at 3 months and 192 at 12 months (Group 1). Greater patient age was correlated with the need for more frequent injections. The oldest half of Group 1 (mean age 68.5 years) required an average of 3.75 injections, while the youngest half (mean age 39.5 years) required only 1.75. In Group 2, an inverse correlation between age and time between injections was observed. A total of 42 injections were administered. No peri- or postinjection ocular or systemic side effects were noted in either group. CONCLUSION: Short-term and twelve-month results indicate that IVB is a safe and effective method to improve visual, reduce CMT and inhibit progression of mCNV.

An outbreak of Campylobacter jejuni gastroenteritis linked to meltwater contamination of a municipal well.

A large outbreak of Campylobacter jujuni gastroenteritis attributed to contamination of an unchlorinated municipal water system was investigated. Unlike most previous summer outbreaks, this one began in early spring and was attributed to meltwater entering one or more municipal wells. 241 suspected cases were documented, but retrospective information from local health care workers suggested a much larger outbreak. 45 laboratory-confirmed cases participated in a case-control study which showed a significant association between infection and amount of town water consumed. Stool specimens from 29 patients were studied with detailed serotyping by the method of Lior, with eight known serotypes and one previously unknown one identified. It is concluded that intensive surveillance of water quality during periods of spring runoff is essential, and that timely reporting of disease outbreak patterns in emergency department settings is necessary to protect the public's health.

Cancer incidence in an urban community: an historical cohort study.

This historical cohort study tested the hypothesis that residents of an industrialized urban community were at higher risk of cancer than residents of a comparable, but non-industrialized, community. The exposed (C1) and the unexposed (C2) cohorts resided in their respective neighbourhoods between 1952 and 1956. All incident cancers were identified through linkage with the Ontario Cancer Registry for 1964-1982. Cancer incidence rates in the two cohorts were 7.0 and 7.3 per 1,000 person-years, respectively. Relative risk estimates for all cancers, lung cancer and cancers associated with environmental exposure, were not significantly different from 1.0. Only colorectal cancers were significantly more frequent in the C1 than the C2 cohort, and these only in one sub-analysis. Overall, we conclude that if there was increased risk of cancer related to environmental pollution in the industrially exposed community, it was less than a two-fold increase.

Blood lead and associated risk factors in Ontario children.

The purpose of this study was to determine blood levels in Ontario children and to identify those risk factors associated with higher blood lead levels. A random sample of 1315 children aged 7 and younger from urban, suburban and rural Ontario was selected. Blood lead concentration was determined in finger prick blood samples by graphite furnace atomic absorption spectrophotometry. Measurements of lead in air, tap water, soil, and gasoline were also established. Traffic pattern were determined in each area. A questionnaire was administered to a random sample of 800 families of the children tested to assess the presence of other risk factors. Urban children had higher geometric mean blood lead levels (12.02, S.D. = 4.4 micrograms/dl) than suburban children (9.95, S.D. = 3.5 micrograms/dl), and they, in turn, had higher blood lead levels than rural children (8.91, S.D. = 3.9 micrograms/dl). Each of these differences is statistically significant (p less than 0.001). Fifty four (4.3%) of all children were at or above the alert level of 20 micrograms/dl. The proportion above the alert level did not differ significantly between urban, suburban and rural children. Blood lead levels were slightly higher for males than females and for pre-schoolers aged 3 and 4, compared to school age children aged 5 and 6. The blood lead levels of these children were significantly lower than that of children surveyed near a point source of industrial emissions. Multivariate statistical modelling resulted in a set of characteristics which best explained the differences in children's blood lead levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Smoking cessation with young women in public family planning clinics: the impact of physician messages and waiting room media.

This study evaluated the impact of a media program and a physician-delivered message in encouraging smoking cessation among young black women in public family planning clinics. Incorporated into the clinic visit, the 3- to 5-min physician message was intended to elicit a commitment from participants to take steps toward quitting, namely, to think about quitting, set a target date, enlist the help of family and friends, throw away matches and cigarettes, and to then quit "cold turkey." The media program consisted of specially designed posters in waiting rooms showing models of people in the process of quitting and a continuously run movie dealing with women and smoking. A total of 1,179 female smokers were recruited into the study when they came to three separate clinics in Baltimore, Maryland, to receive gynecological examinations and/or contraceptive services. Four separate interventions were tested: (I) a baseline questionnaire about smoking habits and related information; (II) baseline questionnaire plus media program; (III) baseline questionnaire plus physician message; and (IV) baseline questionnaire plus media program plus physician message. Conditions I and II were administered in Clinic A on alternating weeks, Condition III was administered in Clinic B, and Condition IV was administered in Clinic C. Follow-up was conducted at 3 and 12 months. Follow-up rates were 88.1% at 3 months, 79.9% at 12 months, and 84.1% for both 3 and 12 months. Among women receiving the physician message (Conditions III and IV), 9.9% reported not smoking at 12 months; the lowest selfreported cessation rate was 3.1% in Condition I. When verified through analyzing cotinine in saliva, quit rates were 0.09% in Condition I, 2.4% in Condition II, 3.7% in Condition III, and 2.1% in Condition IV. The fact that participants receiving the physician message quit smoking at a significantly greater rate than those who did not indicates the need for further study of the impact of physician-delivered smoking cessation messages and ways to increase their effectiveness.