Optical coherence tomography detection of characteristic retinal nerve fiber layer thinning in nasal hypoplasia of the optic disc.

PurposeTo determine the clinical usefulness of optical coherence tomography (OCT) for detecting thinning of the retinal nerve fiber layer (RNFL) in eyes with nasal hypoplasia of the optic discs (NHOD).Patients and methodsThe medical records of five patients (eight eyes) with NHOD were reviewed. The ratio of the disc-macula distance to the disc diameter (DM/DD) and the disc ovality ratio of the minimal to maximal DD were assessed using fundus photographs. The RNFL thicknesses of the temporal, superior, nasal, and inferior quadrants were evaluated using OCT quadrant maps.ResultsAll eight eyes had temporal visual field defects that respected the vertical meridians that needed to be differentiated from those related to chiasmal compression. The mean DM/DD ratio was 3.1 and the mean disc ovality ratio was 0.81. The mean RNFL thicknesses of the temporal, superior, nasal, and inferior quadrants were 90.3, 103.1, 34.8, and 112.8 microns, respectively.ConclusionSmall optic discs and tilted discs might be associated with NHOD. Measurement of the RNFL thickness around the optic disc using OCT scans clearly visualized the characteristic RNFL thinning of the nasal quadrants corresponding to the temporal sector visual field defects in eyes with NHOD. OCT confirmed the presence of NHOD and might differentiate eyes with NHOD from those with chiasmal compression.

Patching retinal breaks with Seprafilm for treating retinal detachments in humans: 9 years of follow-up.

PurposeTo describe the long-term surgical outcomes of four patients treated for retinal detachment using Seprafilm as a novel technique.MethodsRetinal breaks in four eyes were covered with Seprafilm using a transvitreal approach after cataract surgery, pars plana vitrectomy, fluid-air exchange, and laser photocoagulation. Neither long-standing gas nor silicone oil was used. The patients were not instructed to maintain a specific head positioning postoperatively.ResultsSuccessful retinal reattachment was achieved with a single surgery in all four eyes, and none developed proliferative vitreoretinopathy. The mean best-corrected visual acuity preoperatively and 9 years postoperatively were 20/97 and 20/33, respectively. The intraocular pressure increased several days postoperatively that lasted no longer than 2 weeks. Visual field defects either in the inferonasal or inferotemporal quadrant were detected postoperatively. The mean electroretinogram a- and b-wave amplitude ratios of the operated eyes to the fellow eyes were 0.68 and 0.64 preoperatively and 0.87 and 0.92 postoperatively, respectively. The mean corneal endothelial cell density was 2365 cells/mm2 preoperatively and 2592 cells/mm2 postoperatively.ConclusionCovering retinal breaks with Seprafilm may promote retinal reattachment without gas tamponade and postoperative head positioning. The visual outcomes 9 years postoperatively showed no apparent adverse effects of intraocular application of Seprafilm.

Patching retinal breaks with Seprafilm in experimental rhegmatogenous retinal detachment of rabbit eyes.

PURPOSE: To examine the short-term effect of Seprafilm for patching retinal breaks in experimental rhegmatogenous retinal detachment of rabbit eyes. METHODS: Experimental retinal detachment with a break was made and repaired by fluid-gas exchange during vitreous surgery in 10 rabbit eyes. In seven eyes, Seprafilm was applied to cover iatrogenic retinal breaks entirely (study group) and in other three eyes operations were finished without Seprafilm application (control group). Funduscopic examination was carried out in both groups and in study group optical coherence tomography (OCT) was performed to observe Seprafilm on the retinal break. Eyes of study group were enucleated on 7th and 14th postoperative day for histological evaluation. RESULTS: The funduscopic examination showed that the retina was reattached in all eyes of study group. Meanwhile all three eyes of control group resulted in proliferative vitreoretinopathy. OCT showed that Seprafilm adhered to the retina tightly. Funduscopic examination and OCT showed Seprafilm dissolved within 14 days. Histological examination revealed that Seprafilm adhered tightly to the retina and there was no inflammatory change at the Seprafilm application sites. CONCLUSIONS: In our small number of this study, Seprafilm was found to be beneficial to patch small and posteriorly located retinal breaks in vitreous surgery for rhegmatogenous retinal detachment.

Nosocomial outbreak of epidemic keratoconjunctivitis accompanying environmental contamination with adenoviruses.

An outbreak of acute keratoconjunctivitis involving 27 patients occurred in the Department of Ophthalmology, Kurume University Hospital. Adenoviral DNA was detected in four inpatients, one outpatient and one healthcare worker. Sequence-based typing of adenoviral DNA indicated serotype 3 from one inpatient, the rest being serotype 37. At a later stage of the outbreak adenoviral DNA types 37 and/or 3 were also detected from almost all environmental instruments and commonly used eye drops, despite thorough disinfection of the environment and enforcement of various infection control measures. The detection rate of adenoviral DNA in environmental swabs was 81%. A further second disinfection of the environment reduced the detection rate of adenoviral DNA to 38%. The outbreak ceased after closing the ophthalmology ward and outpatient consulting room, accompanied by enhanced cleaning of environmental instruments and the introduction of disposable eye drops for individual patients.

Aqueous humor levels of asymmetric dimethylarginine (ADMA) are positively associated with monocyte chemoattractant protein-1 (MCP-1) in patients with uveitis.

BACKGROUND/AIMS: The aim of the study was to evaluate whether aqueous humor levels of asymmetric dimethylarginine (ADMA) are associated with monocyte chemoattractant protein-1 (MCP-1). METHODS: Aqueous humor levels of ADMA and MCP-1 were measured by high-performance liquid chromatography (HPLC) and ELISA, respectively, in 31 uveitis samples and nine cataract control samples. RESULTS: Aqueous humor ADMA and MCP-1 levels were significantly higher in infectious or non-infectious uveitis patients than in controls (0.67+/-0.04 nmol/ml vs 0.55+/-0.03 nmol/ml vs 0.43+/-0. 04 nmol/ml (p<0.01) and 29.0+/-11.3 ng/ml vs 4.5+/-1.2 ng/ml vs 0.47+/-0.1 ng/ml (p<0.01), respectively). A positive correlation between ADMA and MCP-1 levels in aqueous humor was found in control and uveitis patients (r = 0.33, p<0.05). CONCLUSION: The results demonstrated that aqueous humor levels of ADMA were positively associated with MCP-1 in humans. Our present observations suggest that aqueous humor levels of ADMA may be a novel biomarker of inflammation in uveitis.

Aqueous humour levels of asymmetric dimethylarginine (ADMA) are correlated with pigment epithelium-derived factor (PEDF) in patients with uveitis.

The association between the aqueous humour levels of asymmetric dimethylarginine (ADMA) and pigment epithelium-derived factor (PEDF) was evaluated. Aqueous humour levels of ADMA and PEDF were measured by high-performance liquid chromatography and enzyme-linked immunosorbent assay, respectively, in 31 uveitis samples and nine cataract control samples. Aqueous humour ADMA and PEDF levels were significantly higher in infectious and non-infectious uveitis patients than in controls (0.67+/-0.04 nmol/ml and 0.55+/-0.03 nmol/ml versus 0.43+/-0.04 nmol/ml for ADMA; 8.22+/-1.45 microg/ml and 5.22+/-0.95 microg/ml versus 1.32+/-0.22 microg/ml for PEDF). A significant positive correlation between ADMA and PEDF levels in aqueous humour was found in control and uveitis patients. These results demonstrated that the aqueous humour level of ADMA is correlated with PEDF in humans and suggest that both ADMA and PEDF in aqueous humour may be elevated in response to inflammation in uveitis.

Urinary isoflavonoid excretion and soy consumption in three generations of Japanese women in Hawaii.

OBJECTIVE: To explore soy intake and urinary isoflavonoid excretion within several generations of American-Japanese women based on the hypothesis that earlier generations excrete higher levels of urinary isoflavonoids, in particular the metabolite equol, than later generations. SUBJECTS: A convenience sample of 43 women from 19 families aged 18-78 years, all of whom reported at least 50% Japanese ancestry. INTERVENTIONS: Each woman collected overnight urine samples at baseline and after consuming one serving of soymilk, both samples were analyzed for the isoflavonoids daidzein, genistein and equol using liquid chromatography-mass spectrometry. RESULTS: Median isoflavone intakes during the last year were 7.2 mg/day for the first generation, 7.3 mg/day for the second generation and 6.3 mg/day for the third generation (P=0.36). At baseline, the median isoflavonoid excretion for the first generation was nonsignificantly higher than for later generations (190, 86 and 42 nmol/h; P=0.20) but after intervention, the median urinary isoflavonoid excretion was very similar for the three groups: 2465, 1895 and 2775 nmol/h (P=0.70). Following intervention, a nonsignificantly higher proportion of older than younger women (53 vs 32 and 33%; P=0.41) excreted the metabolite equol. The respective median equol excretion rates by generation following intervention were 39.5, 4.2 and 3.5 nmol/h (P=0.04). CONCLUSIONS: This small investigation among three generations of Japanese-Americans detected a higher equol production among older women after a soy challenge, but no difference in the excretion of total isoflavonoids after a standardized dose of soymilk was observed.

Ultrasound biomicroscopic analysis of posterior chamber intraocular lenses with transscleral sulcus suture.

OBJECTIVE: To investigate the postoperative problems of intraocular lenses (IOLs) with transscleral sulcus suture. DESIGN: Retrospective observational case series. PARTICIPANTS: Forty-one subjects (43 eyes) were included. INTERVENTION: All eyes had undergone transscleral sulcus suture of IOLs. Surgeries were all performed by surgeons in our clinic using the same technique. MAIN OUTCOME MEASURES: Ultrasound biomicroscopy of the suture sites, their surrounding structures, and central anterior chamber depth. Other parameters studied included visual acuity, aqueous flare, and routine ophthalmic examinations. RESULTS: Thirty-two of 86 haptics were sutured at the ciliary sulcus (CS) region and 29 at the ciliary process region, which was the space between CS and pars plicata, and 25 posterior to pars plicata. We designated the cases with at least one haptic located in the CS region as the anterior group, and the other cases as the posterior group. In the anterior group, anterior chamber depth was significantly more shallow than in the fellow eye in which IOLs were fixed in the bag (P = 0.049). There was a statistically greater incidence of IOL iris contact in the anterior group than in the posterior group (P = 0.00057). Pigment dispersion was seen in seven cases, all of which were classified as anterior group. Eyes in the posterior group had more aqueous flare than their fellow eyes (P = 0.014). Two cases, in which more than two lines of postoperative best-corrected visual acuity was lost because of macular degeneration after cystoid macular edema, showed marked elevation of aqueous flare in the sutured eyes compared with their fellow eyes. Forty-one of 86 haptics had vitreous incarceration. CONCLUSIONS: This technique has many limitations: the difficulty of suturing precisely at the ciliary sulcus, IOL iris contact, pigment dispersion, high aqueous flare, and vitreous incarceration. These induce two major postoperative complications: chronic inflammation and influence on the adjacent vitreous such as vitreous incarceration. The suturing technique and instruments need to be improved to diminish such complications.

Ultrasound biomicroscopy of the anterior segment after congenital cataract surgery.

PURPOSE: To evaluate the structure of the anterior segment after congenital cataract surgery with ultrasound biomicroscopy. METHODS: Ultrasound biomicroscopy was performed on 28 eyes of 15 patients after congenital cataract surgery (age range, 8-27 years; mean, 13.1 +/- 1.1 years), of which 26 eyes had pars plana lensectomy and two eyes had phacoemulsification and aspiration, and on 21 eyes of 11 phakic control subjects who were healthy (age range, 6-17 years; mean, 11.5 +/- 1.1 years). The angle-opening distance at 500 microm was measured on a line perpendicular to the trabecular meshwork 500 microm from the scleral spur, and the trabecular-iris angle was measured. RESULTS: Angle-opening distance at 500 microm in the congenital cataract group ranged from 174 to 920 microm (mean, 424 +/- 28 microm), and in the control group it ranged from 260 to 1,119 microm (mean, 643 +/- 57 microm), a difference that was significantly different (P =.0004, Student t test). The trabecular-iris angle in the congenital cataract group ranged from 30.4 to 66.9 degrees (mean, 41.9 +/- 1.6 degrees) and in the control group ranged from 32.1 to 69.8 degrees (mean, 44.9 +/- 2.5 degrees), a difference that was not significantly different (P =.28, Student t test). This means that there is a tendency for high insertion of the iris in the congenital cataract group, and intraocular pressure was elevated after surgery (including glaucoma and ocular hypertension) in 10 (47.6%) of 21 eyes with high insertion. The pars plicata after congenital cataract surgery was significantly flatter than that of control subjects (P =.0057, Student t test). CONCLUSIONS: Ultrasound biomicroscopy is a useful method for evaluating the anterior segment of eyes with congenital cataract, and complications after cataract surgery can be caused by disorganization of the anterior segment. Patients with abnormalities of the anterior segment should be followed up closely for the development of glaucoma.

Mental nerve neuropathy as a result of primary herpes simplex virus infection in the oral cavity. A case report.

We describe a 25-year-old woman who had mental nerve neuropathy. The symptom was attributed to herpes simplex virus infection, which appeared as herpetic gingivostomatitis 4 days after the extraction of the lower third molar. This case suggests that herpes simplex virus can infect the inferior alveolar nerve through an extraction wound and can induce mental nerve neuropathy.

Long-term results of out-of-the-bag intraocular lens implantation.

PURPOSE: To evaluate long-term results of out-of-the-bag intraocular lens (IOL) implantation. SETTING: Department of Ophthalmology, Tenri Yorozu Hospital, Nara, Japan. METHODS: This study comprised 22 patients, 13 women and 9 men, who had cataract surgery by phacoemulsification and out-of-the-bag IOL implantation because of a posterior lens capsule rupture. Sixteen patients had in-the-bag IOL implantation in the fellow eye, and these eyes were used as a control group. The IOL's position was determined by ultrasound biomicroscopy (UBM). Anterior chamber flare counts were measured by a laser flare meter. The corneal endothelium was observed by specular microscopy. RESULTS: Mean follow-up after cataract surgery was 35 months +/- 22 (SD). The UBM revealed that in the 19 eyes with sulcus-to-sulcus IOL fixation, the optics touched the iris. In 3 eyes, 1 haptic was fixated at the sulcus and the other at the ciliary body. In 2 of these eyes, the optics did not touch the iris. Anterior chamber flare counts in eyes with sulcus-to-sulcus IOL fixation were significantly higher than in eyes with in-the-bag or sulcus-to-ciliary-body fixation (P < .05). There were no statistical differences in corneal endothelial cell counts based on haptic placement. CONCLUSION: Rubbing between the IOL optic and iris seems to contribute to the high flare counts in eyes with a sulcus-to-sulcus IOL fixation. A larger haptic angle may be needed to prevent contact between the iris and IOL optic in such cases.

Selective high dose gamma-globulin treatment in Kawasaki disease: assessment of clinical aspects and cost effectiveness.

BACKGROUND: High-dose intravenous gamma-globulin (IVGG) plus aspirin (ASA) treatment is effective in preventing coronary artery complications in acute Kawasaki disease (KD). However, gamma-globulin is very expensive, especially in Japan. Furthermore the indication for IVGG treatment and the optimal dose of gamma-globulin remain controversial. OBJECTIVES: To examine these two issues, we used Harada's scoring system to investigate whether a single 2 g/kg dose therapy has any advantage over the 5 day 400 mg/kg per day therapy. METHODS: We studied 203 patients with KD who had no coronary artery complications on admission. Of these, 145 patients scored 4 or more on Harada score within the first 9 days of illness and were treated with IVGG treatment. Using a random number table, 72 patients were selected to receive a single 2 g/kg dose (2 g group), while the remaining 73 patients were treated with 400 mg/kg per day for 5 consecutive days (400 mg group). Those who had a Harada score of three or less received no IVGG (non-IVGG group) treatment (58 patients). RESULTS: The incidence rate of coronary artery complications in the 2 g group was significantly lower than in the 400 mg group. The duration of high fever, positive duration of C-reactive protein and the number of hospital days in the 2 g group were each significantly shorter than in the 400 mg group. The total medical expense in the 2 g group was significantly lower than in the 400 mg group. There were no coronary artery complications in the non-IVGG group. CONCLUSIONS: It was found to be clinically more effective and more cost effective to select a patient by Harada's scoring system and, where a score of four or more was obtained, to administer a single 2 g/kg intravenous dose of gamma-globulin for acute KD.

[Basic and clinical studies on tazobactam/piperacillin in pediatric field].

A drug susceptibility test of the combination drug TAZ/PIPC, which consists of a newly developed beta-lactamase inhibitor, tazobactam (TAZ), and one of penicillin antibiotics, piperacillin (PIPC), with combination ratio of 1:4 in potency, was conducted with stock strains and clinical isolates. The clinical efficacy and safety of its injection was also evaluated in children with a variety of infectious diseases. The results were as follows: 1. In susceptibility test, 114 strains from 4 species of stock strains were treated with 8 drugs, that is, TAZ/PIPC, PIPC, penicillin G (PCG), ampicillin (ABPC), cefotiam (CTM), cefotaxime (CTX), ceftazidime (CAZ), and sulbactam/cefoperazone (SBT/CPZ). Of three clinically isolated species from patients, Staphylococcus aureus (S. aureus) was treated with TAZ/PIPC, PIPC, methicillin (DMPPC), CTM, CTX, and SBT/CPZ, and the others were treated with the same drugs except for DMPPC. The MICs were measured for these bacterial strains inoculated at the concentration of 10(6) CFU/ml. The MIC90 values of TAZ/PIPC against 45 strains of Streptococcus pyogenes (S. pyogenes), one of the stock cultures of Gram-positive cocci, were 0.05 microgram/ml and similar to those of PIPC, CTM, CAZ, and SBT/CPZ. The MICs of TAZ/PIPC for 28 strains of Streptococcus agalactiae (S. agalactiae) were 0.39 microgram/ml and similar to those of PIPC, CTM, CAZ, and SBT/CPZ. As for Gram-negative bacilli, the MIC90 of TAZ/PIPC against 10 strains of Bordetella pertussis (B. pertussis) were 0.10 microgram/ml and similar to those of PIPC. The MIC90 of TAZ/PIPC against 31 strains of Haemophilus influenzae (H. influenzae) were 0.05 microgram/ml and similar to those of PIPC, CTX, and SBT/CPZ. Regarding Gram-positive cocci isolated from patients received this combination drug, the MIC90 of TAZ/PIPC against 2 strains of S. aureus, a non beta-lactamase producing strain and a low-beta-lactamase producing strain, were 0.78 microgram/ml and 3.1 micrograms/ml, respectively; the former value was similar to those of PIPC, DMPPC, CTM, and CTX, and the latter was similar to those of PIPC, DMPPC, CTX, and SBT/CPZ. Of 4 strains of Streptococcus pneumoniae, 2 strains were inhibited at 0.05 microgram/ml, and the others at 1.56 micrograms/ml; both values were similar to those of PIPC, SBT/CPZ. As for Gram-negative bacilli, 6 of 7 strains of H. influenzae did not produce beta-lactamase and 1 strain was a high producer. The MICs of TAZ/PIPC against beta-lactamase nonproducing strains were < or = 0.025 microgram/ml in 5 strains and 0.39 microgram/ml in 1 strain, and the values were similar to those of PIPC and SBT/CPZ. While the MIC of TAZ/PIPC against the high beta-lactamase producing strain was 0.78 microgram/ml; similar to that of SBT/CPZ and smaller than that of PIPC. 2. The results of clinical effects on 7 diseases in 33 cases were as follows: TAZ/PIPC was clinically judged "excellent" in 17 (51.5%); good in 14 (42.4%); fair in 2 (6.1%). No case with no response was seen in this study, and the total efficacy rate of "excellent" and "good" was 93.9%. 3. Bacteriological effects were evaluated in 17 strains of 4 species, and all of them were eradicated. 4. Adverse reactions were judged in 35, which consisted of 33 in which the clinical effects were evaluated and 2 dropped from this study. Of these cases, diarrhea was observed in 4 (11.4%). 5. Laboratory tests revealed an increase in platelets in 1 of 32 cases (3.1%), and eosinophilia in 2 of 29 cases (6.9%). Biochemical profile showed an increase in GPT alone and abnormal increases in both GOT and GPT in 1 each out of 21 cases.

Coronary endothelial dysfunction after Kawasaki disease: evaluation by intracoronary injection of acetylcholine.

OBJECTIVES: This study sought to assess the endothelial function of long-term coronary artery lesions in patients with Kawasaki disease (KD). BACKGROUND: The vascular function of the coronary arteries in children with long-term KD remains uncertain. We report our findings of the vascular response of the coronary arteries to intracoronary injection of acetylcholine (ACh) in patients with KD. METHODS: A total of 35 patients (25 patients with KD and 10 control subjects) were examined using coronary angiography. Individual arteries were divided into four groups according to the type of the coronary artery lesion: group 1 consisted of 25 sites with regressed aneurysms. These aneurysms had developed in the acute stage but had subsequently regressed and demonstrated normal findings on the follow-up coronary angiogram. Group 2 consisted of 24 sites with persistent aneurysms. Group 3 involved 60 angiographically normal sites in the same patients as those in group 1 or 2. Group 4 consisted of 30 sites in control subjects who had congenital heart disease with normal coronary arteries. During coronary angiography we infused 15 microg of ACh chloride into the coronary artery. The lumen diameters were measured using a cine videodensitometric analyzer to study the distensibility of the coronary artery wall. RESULTS: The mean (+/-SD) change in diameter was an increase of 11.71+/-12.34% in group 3 (coronary arteries without lesions in patients with KD) and 12.21+/-9.71% in the control group, demonstrating marked vasodilation in both groups. In contrast, the changes in the regressed aneurysms of group 1 and in the persistent aneurysms of group 2 were -2.65+/-12.12% and -0.08+/-6.51%, respectively, demonstrating no change or mild vasoconstriction. The change in groups 1 and 2 was significantly less than that in group 3 or in the control group. Group 3 showed no significant difference from the control group. CONCLUSIONS: These findings suggest that long-term coronary artery lesions, even after aneurysm regression, may have impaired endothelial function. A long-term follow-up study for those patients is essential.

[Effect of nipradilol on aqueous flow in glaucoma patients treated with timolol].

The effect of nipradilol solution (KT-210) on aqueous flow was evaluated using fluorophotometry in 10 patients (6 primary open-angle glaucoma and 4 ocular hypertension) treated with timolol for more than one month. A single dose of 0.5% timolol was instilled into both eyes at 8 AM, and 0.25% KT-210 or placebo was instilled into both right and left eye at 11 AM; the treated eye was chosen randomly. Aqueous flow was measured every hour from 9 AM to 3 PM. There was no significant difference in pretreatment aqueous flow between the two eyes; 1.98 +/- 0.53 microliters/min in the KT-210 treated eyes, and 1.98 +/- 0.76 microliters/min in the placebo treated eyes. The flow measured 1 to 4 hours after KT-210 instillation was 1.66 +/- 0.69 microliters/min, 2.23 +/- 1.02 microliters/min, 2.20 +/- 0.67 microliters/min, and 1.68 +/- 0.64 microliters/min, respectively. This flow did not differ significantly from the flow in the placebo treated eyes (1.83 +/- 0.86 microliters/min, 1.79 +/- 0.69 microliters/min, 2.26 +/- 0.58 microliters/min, and 1.84 +/- 0.32 microliters/min).

The vascular function of the long-term coronary artery after Kawasaki disease--evaluation by intracoronary injection of acetylcholine.

The vascular function of the coronary arteries in children after Kawasaki disease (KD) as yet remains uncertain. Here we report our findings of the vascular response of the coronary arteries after intracoronary injection of acetylcholine in patients after KD. A total of 29 patients, 19 after KD and 10 as control, were examined using coronary angiography (CAG). These were divided into 4 groups according to the type of the coronary artery lesions: Group 1 consisted of those with regressed aneurysms and involved 29 sites. These aneurysms had developed in the acute stage and had subsequently regressed and demonstrated normal findings in follow-up CAG. Group 2 consisted of those with persistent aneurysms involved 30 sites. Group 3 involved 52 angiographically normal sites in patients after KD. And Group 4 consisted of control patients and involved 70 sites. These patients had congenital heart disease with normal coronary arteries. During CAG we infused 15 micrograms acetylcholine chloride into the right or left coronary artery. The luminal diameters were measured using a cine-videodensitometric analyser to study the distensibility of the coronary artery wall. The change in the diameter was an increase of 13.71% +/- 15.09% (mean +/- SD) in the normal KD Group 3, and 12.21% +/- 13.83% in the control Group 4, demonstrating marked vasodilatation. In contrast, the change in the regressed aneurysms Group 1, and in the persistent aneurysms Group 2, was -2.65% +/- 16.65%, and -0.08% +/- 6.51%, respectively, demonstrating no change or mild vasoconstriction. The change in Group 1, and in Group 2, was less than in normal Group 3 or control Group 4. The normal Group 3 showed no significant difference from control Group 4. These findings suggested that the coronary artery with regressed aneurysms, or with persistent aneurysms after KD has impaired vascular function and is therefore at risk for developing to atherosclerosis in the long-term.

Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients.

BACKGROUND: The long-term consequences of the cardiovascular sequelae in Kawasaki disease remain uncertain. METHODS AND RESULTS: We identified 594 consecutive children with acute Kawasaki disease between 1973 and 1983, and this cohort was followed up for 10 to 21 years (mean, 13.6 years). In all patients, we evaluated coronary lesions by coronary angiography just after the acute stage. One hundred and forty-six patients (24.6%) were diagnosed as having coronary aneurysms. A second angiogram was performed 1 to 2 years later in all 146 patients who previously had coronary aneurysms, which demonstrated that 72 (49.3%) of these 146 had regression in the coronary aneurysm. A third angiogram was performed for 62 patients, a fourth for 29, and a fifth for 17. By 10 to 21 years after the onset of the illness, stenosis in the coronary aneurysm had developed in 28 patients. Myocardial infarction occurred in 11 patients, 5 of whom died. In the 26 patients with giant coronary aneurysms, stenotic lesions developed in 12, and no regression occurred. The 448 patients with normal findings at the first angiogram subsequently never developed any abnormal cardiac findings. Systemic artery aneurysms developed in 13 patients (2.2%), and valvular heart disease appeared in 7 (1.2%). CONCLUSIONS: The incidence of coronary aneurysm in acute Kawasaki disease was 25%, 55% of which showed regression. During follow-up, ischemic heart disease developed in 4.7% and myocardial infarction in 1.9%. Death occurred in 0.8%.

[Production and metabolism of prostaglandin D2 by cultured chick retinal pigment epithelial cells].

The production and metabolism of prostaglandin (PG) D2 in cultured chick retinal pigment epithelial (RPE) cells were studied. The production of PGD2 was evaluated using thin layer chromatography (TLC) after labeling the RPE cells with 1-14Carachidonic acid (AA) and radioimmunoassay (RIA). The metabolism was evaluated by measuring the activity of 15-hydroxyprostaglandin dehydrogenase. The conversion of AA to PGD2 was detected by TLC, and this conversion was inhibited with indomethacin (10(-5)M). In a steady state, 198 +/- 50 pg/6 x 10(5) cells/2 hours of PGD2 was detected by RIA. The amount of PGD2 was greater than that of both PGE2 and PGF2 alpha. The nicotinamide adenine dinucleotide phosphate (NADP)-linked 15-hydroxyprostaglandin dehydrogenase activity was detected in the 10,000 g supernatant of the RPE cells. These results demonstrated that cultured chick RPE cells produce and metabolize PGD2.