The value of lacrimal scintillography in the assessment of patients with epiphora.

PurposeTo assess the influence of dacryoscintillography (DSG) on the treatment decision for patients with epiphora and clinically patent non-functioning lacrimal systems.MethodsA retrospective 3-year review. Inclusion: patients having DSG for epiphora with delayed tear clearance, lacrimal system patency on syringing, and no visible external cause for watering. On the basis of regurgitation during syringing, tear ducts were divided into freely patent (FP≤20%) or stenosed. The DSG results were examined for correlation with symptoms and clinical examination, the influence on decision to proceed to dacryocystorhinostomy (DCR), and the ability to predict the surgical outcome.ResultsA total of 242 eyes were examined. The clinical diagnosis was FP in 45.5%, nasolacrimal duct stenosis (NLDS) in 26.4%, and other in 3.3%. The DSG was normal in 30.9% of FP and 18.7% of NLDS eyes. Of the asymptomatic eyes, 46.7% had an abnormal DSG. DSG sensitivity was 73.6% and specificity 53.3%. There was no significant difference in DSG results in those with FP or NLDS.DCR was recommended in 39.1% of the symptomatic eyes with abnormal DSG. DCR surgery was considered inappropriate in all 46 eyes with normal DSG. DCR was successful in 76.5%, however, the DSG result did not affect the success of surgery.ConclusionDSG has severe limitations due to lack of correlation with symptoms and clinical examination, inability to separate lacrimal duct narrowing from lacrimal pump function, and inability to predict the results of surgery. DSG can at best provide limited guidance on whether to proceed to DCR surgery.

Comparison of antibody- and cell-mediated immune responses after intramuscular hepatitis C immunizations of BALB/c mice.

Current treatments for hepatitis C infection have limited efficacy, and there is no vaccine available. The goal of this study was to compare the immune response to several immunization combinations against hepatitis C virus (HCV). Six groups of mice were immunized at weeks 0, 4, and 8 with different combinations of a candidate HCV vaccine consisting of 100 microg recombinant HCV core/E1/E2 (rHCV) DNA plasmid and/or 25 microg rHCV polyprotein and 50 microL Montanide ISA- 51. Four weeks after the last injection, all groups of mice were sacrificed and blood samples and spleens were collected for measuring the levels of specific HCV antibodies (total IgG, IgG1, and IgG2a). Cell proliferation and intracellular interferon-gamma were also measured. Among the groups of immunized mice, only the mice immunized with rHCV DNA plasmid, rHCV polyprotein, and montanide (group D) and mice immunized with rHCV polyprotein and montanide (group F) demonstrated a significant increase in the total IgG titer after immunization. IgG1 was the predominant antibody detected in both groups D and F. No IgG2a was detected in any of the groups. Proliferation assays demonstrated that splenocytes from group D and group C (rHCV DNA primed/rHCV polyprotein boost) developed significant anti-HCV proliferative responses. The combination of an rHCV DNA plasmid, rHCV polyprotein, and montanide induced a high antibody titer with a predominance of IgG1 antibodies and recognized the major neutralization epitopes in HVR1. In contrast, group C did not show an increase in anti-HCV antibodies, but did show a proliferative response.

Cell wall-deficient bacteria as a cause of infections: a review of the clinical significance.

Cell wall-deficient bacteria (CWDB) are pleomorphic bacterial forms. These atypical organisms may occur naturally or they can be induced in the laboratory. Their presence has been known about for over a century, but a definite link to clinical disease outcomes has not been demonstrated. A number of case reports and laboratory studies suggest some disease associations, however. Considerable controversy surrounds the true relevance of CWDB to disease; there is a widespread belief that they may represent a response by the walled organism to adverse extracellular conditions like antibiotic pressure. This review looks at studies published between 1934 and 2003, which were identified by Dialog DataStar using the key words 'cell wall deficient bacteria and clinical significance and infections' and by further scanning the reference list at the end of the papers retrieved. We conclude that the evidence for the clinical significance of CWDB in disease is not compelling.

Epidemiological and clinical findings in viral hepatitis.

An HBsAg prevalence of 17.27% was found in 480 young adult viral hepatitis (VH) patients from semi-closed communities. The evolution of HBsAg positive VH had a seasonal aspect, resembling that of serologically negative forms. Analyzed according to the moment when the communities were set up, HBsAg-negative VH morbidity had a biphasic pattern, suggesting the occurrence of two distinct viral etiologies. The length of the stationary phase, the prevalence of protracted clinical forms, that high frequency of relapses and of the need for corticotherapy point to the increased severity of HBsAg positive VH.