Predictors of glaucoma in patients with uveitis and scleritis.

BACKGROUND: To examine risk factors for development of glaucoma in a large cohort of subjects with uveitis and scleritis. METHODS: Retrospective review of subjects diagnosed with uveitis or scleritis between 2006 and 2019 at Auckland District Health Board. Subjects were excluded if they had glaucoma due to another cause. Main outcome measure was development of glaucoma. Data for local steroid use was not available. RESULTS: 3462 eyes of 2414 subjects were included in the study. Mean follow-up was 5.7 years (total follow-up time 19,897 eye years). Median age was 44.3 years and 1189 (49.3%) were female. Glaucoma developed in 222 eyes (6.3%) during the follow-up. Five-year cumulative risk of glaucoma was 6.2% (CI 5.0-7.5%) for anterior uveitis, 5.4% (CI 3.2-9.0%) for intermediate uveitis, 1.6% (CI 0.4-6.7%) for posterior uveitis, 8.7% (CI 6.5-11.7%) for panuveitis, and 3.2% (CI 1.0-9.5%) for scleritis. Five-year cumulative risk of glaucoma was lowest in HLA-B27 uveitis at 0.9% (CI 0.4-2.1%) and highest in viral uveitis 15.1% (CI 10.1-22.3%), sarcoidosis 9.9% (CI 6.1-15.9%) and tuberculosis 9.7% (CI 5.4-17.0%). On multivariate analysis, risk factors for development of glaucoma were older age at presentation, higher presenting intraocular pressure, chronic inflammation, and cystoid macular oedema. CONCLUSIONS: Glaucoma is a common complication of uveitis and scleritis and was more frequent in older subjects, high presenting IOP, chronic inflammation and those with cystoid macular oedema. Local steroid therapy contributes to this, but is not quantifiable in this study. Targeted screening is required to avoid irreversible progression of glaucomatous optic neuropathy.

Plug-and-play adaptive optics for commercial laser scanning fluorescence microscopes based on an adaptive lens.

In this Letter, we present a solution for simple implementation of adaptive optics in any existing laser scanning fluorescence microscope. Adaptive optics are implemented by the introduction of a multiactuator adaptive lens between the microscope body and the objective lens. Correction is performed with a sensorless method by optimizing the quality of the images presented on screen by the microscope software. We present the results acquired on both a commercial linear excitation confocal microscope and a custom-made multiphoton excitation microscope.

Is the therapeutic index better with gemcitabine-based chemoradiation than with 5-fluorouracil-based chemoradiation in locally advanced pancreatic cancer?

PURPOSE: To retrospectively compare the toxicity and efficacy of concurrent gemcitabine-based chemoradiation with that of concurrent 5-fluorouracil (5-FU)-based chemoradiation in patients with unresectable pancreatic cancer. PATIENTS AND METHODS: Between September 1996 and May 2000, 114 patients with localized unresectable adenocarcinoma of the pancreas were treated with concurrent chemoradiation. Locally advanced unresectable disease was defined as low-density tumor in contact with the superior mesenteric artery (SMA) or celiac artery, or occlusion of the superior mesenteric-portal venous confluence. Fifty-three patients were selected to receive gemcitabine in 7 weekly cycles (250-500 mg/m(2)) with concurrent radiotherapy (median dose 30 Gy, range 30-33 Gy in 10-11 fractions). The remaining 61 patients received continuous-infusion 5-FU (200-300 mg/m(2)) with concurrent radiotherapy (30 Gy in 10 fractions). Radiotherapy was delivered to the primary tumor and regional lymphatics. Patients receiving gemcitabine and those receiving 5-FU had a similar mean Karnofsky performance status (KPS, 89% vs. 86%), distribution of tumor grade (43% vs. 33% poorly differentiated), and percent weight loss (all p = NS). However, patients treated with gemcitabine had a significantly larger median maximum cross-sectional tumor area (TA, 8.8 cm(2) vs. 5.7 cm(2), p = 0.046) and were significantly younger (median age 60 vs. 68 years, p <0.001). Severe acute toxicity (ST) was defined as toxicity requiring a hospital stay of more than 5 days, mucosal ulceration with bleeding, more than 3 dose deletions of gemcitabine or discontinuation of 5-FU, or toxicity resulting in surgical intervention or death. Kaplan-Meier analysis was used to calculate the actuarial rate of local progression on imaging (LP), the rate of distant metastasis (DM), and the overall survival (OS) rate. The imaging was reviewed in resected patients. RESULTS: Patients receiving gemcitabine developed significantly more ST during treatment (23% vs. 2%, p < 0.0001) than did those receiving 5-FU. Patients treated with gemcitabine had a similar 10-month LP rate (62% vs. 61%), 10-month DM rate (55% vs. 47%), 1-year OS rate (42% vs. 28%), and median OS duration (11 months vs. 9 months) to patients treated with 5 FU (all p = NS). Five patients who received gemcitabine and 1 patient who received 5-FU underwent margin-negative pancreaticoduodenectomy after chemoradiation. Three patients had a short segment (10 cm(2) (p = 0.03) and poor differentiation (p = 0.07) were associated with a worse survival duration; however, other factors, such as KPS and weight loss >10% and age did not influence OS. CONCLUSION: Despite the selection of healthier patients to receive gemcitabine, there was a significantly higher severe toxicity rate than with 5-FU. The median and 1-year survivals were not significantly different with the use of concurrent gemcitabine; however, the tumors treated were significantly larger. Additionally, a small number of patients with minimal arterial involvement whose disease met our radiographic definition of unresectable disease had margin-negative resections after treatment with gemcitabine-based chemoradiation. These possible benefits and the high rate of severe toxicity define a very narrow therapeutic index for concurrent gemcitabine-based chemoradiation given by this schedule of administration.

Factors associated with postoperative pulmonary complications in patients with severe chronic obstructive pulmonary disease.

The purpose of this study was to determine the incidence of different postoperative pulmonary complications (PPCs) and their associated risk factors in patients with severe chronic obstructive pulmonary disease (COPD) (forced expiratory volume in 1 s [FEV1] < or = 1.2 L and FEV1/forced vital capacity (FVC) < 75%) undergoing noncardiothoracic operations. Thirty-nine of 105 patients (37%) had one or more PPCs (death, pneumonia, prolonged intubation, refractory bronchospasm, or prolonged intensive care unit (ICU) stay). Thirty-eight of 39 patients (97%) with a PPC had an anesthetic duration > 2 h. Our study patients had a 47% 2-yr mortality rate. We determined specific risk factors for each PPC by analyzing potential preoperative and intraoperative risk factors. Pulmonary factors alone do not predict the likelihood of PPCs in severe COPD patients. Multiple logistic regression identified composite scoring systems, such as the ASA physical status, as the best preoperative predictors of PPCs, probably because they include both pulmonary and nonpulmonary factors. During the intraoperative period, avoiding general anesthesia with tracheal intubation may decrease the risk of postoperative bronchospasm. Shortening the duration of surgery and anesthesia may decrease the risk of prolonged ICU stay.

Frames of reference for allocating attention to space: evidence from the neglect syndrome.

With respect to what frames of reference, or spatial coordinate systems, is attention allocated to locations in space? We posed this question about the spatial attention system that has been damaged in neglect patients, distinguishing among three possible types of spatial reference frame: viewer-centered, according to which locations are coded with respect to the viewer, environment-centered, according to which locations or coded with respect to the environment, and object-centered, according to which locations are coded with respect to an object. The three candidate frames of reference were decoupled from one another by rotating either the viewer or the stimulus object. Visual search performance suggested that the neglected hemifield was defined with respect to both viewer-centered and environment-centered frames of reference, but not with respect to an object-centered frame of reference. The role of objects in the allocation of attention to space, and the relation between our findings and the "two cortical visual systems" hypothesis, are discussed.

Thoracic bioimpedance and Doppler cardiac output measurement: learning curve and interobserver reproducibility.

Nine previously untrained health professionals learned to measure cardiac output (Qt) by suprasternal continuous-wave Doppler ultrasound (QtDopp) and by thoracic bioimpedance (Qtbi). Each received standardized written, videotaped, and individual instruction. First the novice, then the reference examiner, measured QtDopp or Qtbi in triplicate in an adult male subject. The reference examiner was blind to the novice measurements and the novice was not informed of the reference measurements. Each novice repeatedly measured QtDopp or Qtbi in different subjects until the mean novice QtDopp or Qtbi was within 10% of the corresponding mean reference measurement in three of four consecutive subjects. The novice observers required an average of 12.9 +/- 3.5 trials to learn to measure QtDopp, and an average of 8.4 +/- 4.5 trials to learn to measure Qtbi. The likelihood of novice agreement with the reference improved with experience. The same degree of intraobserver variability as reported for Qt measured by thermodilution (coefficient of variance less than or equal to 10%) was achieved with Qtbi in 150 (99%) of 152 triplicate measurements and QtDopp in 216 (97%) of 222 triplicate measurements. More importantly, interobserver agreement (within 10%) was achieved with both Qtbi and QtDopp. Reproducible noninvasive Qt measurement will allow these techniques to be used to monitor trend changes in Qt.

A comparison of radial, brachial, and aortic pressures after cardiopulmonary bypass.

Previous investigations have identified falsely low radial artery pressures after cardiopulmonary bypass (CPB). The present study investigates the relationship among radial, brachial, and aortic arterial pressures in 33 cardiac surgical patients following CPB. Two minutes after separation from CPB, clinically important (greater than or equal to 10 mmHg) underestimation of systolic aortic pressures occurred in 17 of 33 (52%) radial artery catheters, while occurring in seven of 33 (21%) brachial artery catheters. Radial artery mean pressure underestimated aortic mean pressure by greater than or equal to 5 mmHg in 21 of 33 (61%) patients two minutes after CPB, while an equivalent aortic-to-brachial artery mean arterial pressure difference occurred in nine of 33 (27%) patients. The incidence of aortic-to-radial mean arterial pressure differences greater than or equal to 5 mmHg decreased to 40% (four of ten patients) by ten minutes after CPB, although interpretation is complicated by decreased availability of aortic pressure measurements. Multivariate analysis failed to identify factors predisposed to central-to-peripheral pressure gradients. Radial and brachial arterial pressures were compared both before and after CPB in all 33 patients. Brachial artery systolic and mean pressures were higher than corresponding radial artery measurements two minutes after CPB (P less than 0.05), followed by gradual resumption of a normal brachial-to-radial pressure relationship over 60 minutes. Either vasospasm in the brachial and radial arteries or profound arteriolar vasodilation in the upper extremity might cause the observed central-to-peripheral arterial pressure differences. The progressive central-to-peripheral decrease in mean arterial pressure favors the latter mechanism.(ABSTRACT TRUNCATED AT 250 WORDS)

Parietal lobe mechanisms of spatial attention: modality-specific or supramodal?

Is the spatial attention system divided into separate, modality-specific subsystems, or is there a supramodal spatial attention system? More specifically, does the role of the parietal lobe in spatial attention involve modality-specific or supramodal mechanisms? We addressed this question using a variant of Posner's spatial cuing task. Parietal-lesioned patients performed a simple reaction time task to lateralized visual target stimuli, preceded on each trial by either non-predictive lateralized visual cue stimuli or non-predictive lateralized auditory cue stimuli. With both types of cues, we found disproportionate slowness in responding to invalidly cued contralesional targets, indicative of an impairment in disengaging attention from the ipsilesional to the contralesional side of space. The finding of an attentional disengagement impairment for visual targets with auditory cues implies that the parietal lobe's attentional mechanism operates on a representation of space in which both visual and auditory stimuli are represented, in other words, a supramodal representation of space.

Effect of butoconazole nitrate cream and wax insert on the barrier property of contraceptive devices.

A new method was developed to assess the quality of the barrier property of several types of commonly used contraceptive devices (diaphragm, cervical cap, and condom). Our data showed that butoconazole nitrate cream and wax inserts did not affect the barrier property of the contraceptive devices when the products were placed in contact with the devices for up to 72 hours at 37 degrees C.

PIP: A new method was developed to assess the effects of imidazole-based antifungal products on the barrier property of contraceptive devices. 2 brands of diaphragm, 1 brand of condom, and 1 brand of cervical cap currently available in the UK were tested with this method. Disks cut from each device were attached to the sawed-off ends of 10 ml syringes and dipped in a beaker containing either butoconazole nitrate cream or a molten wax insert. The devices were placed in an oven set to simulate physiological temperature and then checked for barrier damage at 24, 48, and 72 hours. The results with both products were excellent in terms of their lack of effect on barrier properties of contraceptives. No leakage was observed in any of the devices placed in contact with the butoconazole cream. With the wax insert, the Ortho diaphragm and the Prentif cervical cap showed no signs of leakage; however, 1 of the 4 Durex condoms tested and 2 of the 4 Durex diaphragms leaked at 48 hours. In all these cases, the leakage was regarded as an artificial phenomenon rather than a barrier failure. Repeat testing revealed no leakage with these products when care was taken to keep the molten insert away from the contraceptive's seam. Scanning electron microscopy failed to reveal any deterioration or damage in any of the sampled products.

Stability constants for complex formation between alpha-cyclodextrin and some amines.

Complex formation of alpha-cyclodextrin with 15 amines (including seven 4-substituted anilines) was studied by the potentiometric method, supplemented by direct UV spectrophotometry and a competitive indicator spectrophotometric method. The data were analyzed in terms of 1:1 and 1:2 complexes (amine-cyclodextrin ratios) and the stability constants K11a, K12a, K11b, and K12b were evaluated; the subscripts indicate the stoichiometry and conjugate acid-base form. For all amines K11b was greater than K11a and K12a was 0. On the basis of the relationship of complex stability to amine structure, it was concluded that the primary binding site in anilines is the 4-substituent.

Potentiometric study of molecular complexes of weak acids and bases applied to complexes of alpha-cyclodextrin with para-substituted benzoic acids.

The theory of the potentiometric methods of studying complexes of ionizable substrates was developed, nd graphical techniques are described for obtaining stability constant estimations from the data. The method described is for a system in which the conjugate acid and base forms of the substrate (S), are capable of forming 1:1 (SL) and 1:2 (SL2) complexes with the ligand (L). It was applied to complexes of alpha-cyclodextrin (cyclohexaamylose) with 10 para-substituted benzoic acid derivatives. Letting K11a and K12a be stability constants for the conjugate acid forms of the substrates, and K11b, K12b for the conjugate base forms, it was found that K12b is zero for all substrates, K12a is zero for seven of the substrates, and K11a greater than K11b in every case. Hammett plots yielded p11a and p11b values of -0.31 and 0.77, respectively, which was interpreted to mean that K11a mainly represents binding at the carboxylic acid site, and K11b describes binding at the site of the para-substituent. This model of the complexing suggests that K12a represents binding at the para-substituent, and therefore K12a should vary roughly with substituent as K11b does; this trend was observed.