Postoperative endophthalmitis resulting from prosthesis contamination in a monocular patient

Monocular patients who wear an ocular prosthesis may harbor pathogenic conjunctival flora both in the socket and in the contralateral eye. They may therefore be at increased risk of developing endophthalmitis after intraocular procedures. We studied a monocular, prosthesis-wearing, 86-year-old man who underwent cataract extraction, subtotal transpupillary vitrectomy, and intraocular lens insertion. Fulminant endophthalmitis ensued postoperatively, and despite complete vitrectomy and administration of intraocular antibiotics, the eye lost light perception. Intravitreal as well as conjunctival cultures bilaterally grew Proteus mirabilis. The patient disclosed that he cleaned the prosthesis frequently because of discharge. We considered an association between this bacterial colonization and the risk of developing postoperative endophthalmitis and suggest prophylactic measures for treatment of monocular patients undergoing intraocular procedures.

An in vitro method using vascular smooth muscle cells to study the effect of compounds on cell proliferation and intracellular lipid accumulation

Primary cultures of vascular smooth muscle cells (SMC) were incubated with hyperlipidemic rabbit serum (HLRS) to produce intracellular lipid accumulation. Cultures were exposed to different concentrations of the test compounds and their effects upon cell proliferation and intracellular lipid accumulation were measured. The in vitro results obtained with different Ca2+ antagonists, a HMG-CoA reductase inhibitor and other hypolipidemic substances showed a strong correlation with the in vivo activities of these compounds, suggesting that cultured SMC may be a useful initial in vitro model to detect new chemical entities active upon atherosclerosis related parameters.

Intraocular tissue plasminogen activator concentrations after subconjunctival delivery

BACKGROUND

Topical application of recombinant tissue plasminogen activator (tPA) results in detectable intraocular tPA levels. The authors sought to determine whether subconjunctival delivery of recombinant tPA results in enhanced intraocular drug levels.

METHODS

One week after first performing a gas vitrectomy in each eye, the authors injected 0.4 ml of a tPA solution (1 or 10 mg/ml) subconjunctivally in one eye of 16 rabbits and 0.4 ml of sterile water in the fellow control eye. Vitreous taps were performed to obtain vitreous samples for measuring tPA concentrations. An anterior chamber paracentesis was then done for each concentration at 15, 30, and 60 minutes. Aqueous and vitreous tPA concentrations were determined using a two-site enzyme-linked immunosorbent assay (ELISA).

RESULTS

Vitreous tPA levels were higher than aqueous levels in the treated eyes. Vitreous levels averaged 7 +/- 7 ng/ml for the 1-mg/ml group (n = 7/7) and 202 +/- 230 ng/ml for the 10-mg/ml group (n = 7/8). Aqueous levels were positive in 8 of 16 samples. The authors conclude that subconjunctival delivery of tPA results in both vitreous and aqueous tPA levels.

Combined trabeculectomy, cataract extraction, and foldable lens implantation

The efficacy of foldable silicone intraocular lenses in combined glaucoma/cataract surgery was retrospectively analyzed in 19 consecutive operations. Preoperatively all patients were receiving medical treatment for glaucoma; 21% had intraocular pressures above 21 mm Hg despite the medical therapy. Postoperatively, reduction of intraocular pressure to 21 mm Hg or less was achieved in 84% of eyes, with 58% requiring no antiglaucoma medications. Mean improvement of Snellen visual acuity was 4.9 lines; 84% of eyes achieved a final acuity of 20/40 or better. Median follow-up was 59 weeks (range 25 to 88 weeks). Thirteen eyes (68%) had a filtration bleb present when last examined. These preliminary results suggest that foldable silicone IOLs are an effective alternative to poly(methyl methacrylate) lenses in combined glaucoma/cataract surgery.

Calcium antagonists can be classified using in vitro toxicity and potency indices

The toxicity of eleven calcium antagonists from different chemical families was determined in rat hepatocyte primary cultures. The calcium antagonist potency of the same compounds was also determined in isolated rabbit aortic rings contracted with high K+. The hepatocytotoxicity of the calcium antagonists was not directly linked to blockade of voltage-operated calcium channels, since there was no correlation between the rank order of hepatotoxicity and that for calcium antagonist potency. The toxicity and calcium antagonist potency of each calcium antagonist examined were used to calculate an in vitro therapeutic index value for each compound. It was observed that therapeutic indices fell into three distinct groups and we therefore propose that the in vitro therapeutic index can be used to subclassify the calcium antagonist group of drugs. The proposed classification corresponds very closely with one already suggested by Spedding on pharmacological grounds. In conclusion, the in vitro therapeutic index may provide a useful tool in the characterization and subclassification of novel calcium antagonist compounds.

Subconjunctival injection of purified blood mononuclear cells into alkali-injured rabbit eyes

Monocytes transform into tissue macrophages that scavenge necrotic debris from wounds but also release substances stimulatory to fibroblasts. In an effort to encourage the healing process, monocytes, purified from rabbit blood, were injected subconjunctivally 1 or 2 days and 6 or 7 days after alkali injury to the rabbit eye. The injected monocytes failed to alter the course of the alkali-injured eyes. Specifically, the incidence of corneal ulceration in the experimental group was not statistically different from that of the control group. A byproduct of this study was a presentation of the technique to purify platelet-free mononuclear leukocytes from rabbit peripheral blood.

Comparison of in vivo acute lethal potency and in vitro cytotoxicity of 48 chemicals

The cytotoxicity of 48 compounds included in the MEIC (Multicenter Evaluation of In Vitro Cytotoxicity) list was determined in cultures of rat hepatocytes, McCoy, and MDBK cells. The average minimum concentration of each compound inducing cytotoxicity was measured in each cell type. The cytotoxicity values were then compared with published oral LD50 values for rats and mice. The logarithmic transformation of in vivo toxic doses and the corresponding in vitro cytotoxic concentrations showed a statistically significant correlation between the in vitro and in vivo values. The results show that an accurate in vivo LD50 dose could be predicted from in vitro data for at least 75% of the selected compounds. It is hoped that this finding will not only stimulate others to pursue in vitro technique but will eventually lead to elimination of the in vivo LD50 test.

Infective endocarditis due to Streptococcus sanguis I occurring on a normal mitral valve

We report a 64 year old lady in whom infective endocarditis of the mitral valve occurred with no previous underlying heart disease. Streptococcus sanguis I was isolated on blood culture and 2-D echo cardiography showed a vegetation on the anterior mitral leaflet. The viridans group of streptococci are classically associated with subacute endocarditis occurring on structurally abnormal valves, but involvement of a normal valve by these organisms is rare.

Nephropathy in noninsulin-dependent diabetes mellitus: comparative study with normoproteinuric and microproteinuric subjects

The role of specific risk factors in the development of diabetic nephropathy was examined among noninsulin-dependent diabetic subjects attending the Diabetes Clinic of Christian Medical College Hospital, Vellore during 1986-87. Seventy-three subjects with normal protein excretion (less than 150 mg/24 hr) were compared with 66 microproteinuric (150-500 mg/24 hr) and 61 macroproteinuric subjects (greater than 500 mg/24 hr). The risk factors included family history of diabetes, tobacco use, dietary habits and metabolic control; the latter was assessed from an average of 5 clinic blood sugar determinations done annually per patient. Patients who had developed proteinuria were characterized as mostly men, with increased tobacco consumption and early onset of proteinuria in relation to duration of diabetes. The mean blood sugar value was significantly high in both the proteinuric groups compared to the group with no proteinuria (p less than 0.01). There was a striking increase in the prevalence of ischemic heart disease, hypertension and retinopathy in the macroproteinuric group compared to the other two groups (p less than 0.01). It is concluded that the risk of developing nephropathy was significantly higher in men, in smokers and in those with poor metabolic control (mean postprandial blood sugar more than 200 mg/dL). Furthermore, it was clearly evident from our study that the diabetic subjects with nephropathy had a higher incidence of hypertension, retinopathy, hyperlipidemia and ischemic heart diseases.

Predicting who will use a hearing aid

Elderly patients receiving a hearing aid have usually experienced a hearing disability for many years. Simple methods of screening the pre-retirement age group for hearing impairment are described. Screening is feasible and effective.

Clinical profile of Indian non-insulin-dependent diabetics with nephropathy and renal failure

We studied the clinical profile of 296 non-insulin-dependent diabetic (NIDDM) patients with nephropathy and renal failure. Male preponderance was striking in this group and the age of onset of diabetes was between 30 and 50 years in 75%. Retinopathy was present in 86% with proliferative changes in 20% and coronary artery disease was evident in 40% of the patients. The incidence of retinopathy and coronary artery disease was significantly higher in this group than in a group of non-insulin-dependent diabetics without nephropathy (86% vs. 18.5%; 40% vs. 30% respectively, P less than 0.01). It is our observation that patients with NIDDM developing nephropathy and renal failure have had an early onset of disease and are significantly more often male. There is also a greater incidence of elevated blood pressure, coronary artery disease and retinopathy in this group.

Field evaluation of polycarbonate versus conventional safety glasses

Of all the causes of eye injury, gunshot has recently been cited as resulting in the highest rate of blindness and the lowest rate of visual recovery. Many of these cases are hunting accidents in which safety glasses could have prevented or lessened ocular damage. To evaluate the effectiveness of various types of safety glasses, we fired a Remington automatic shotgun at mannequin heads fitted with one of four types of safety lenses. From a distance of 10 yards, only polycarbonate lenses provided even partial protection. At 30 yards, polycarbonate and heat-treated lenses provided the best protection, whereas chemically treated and CR39 lenses provided significantly less protection. We recommend that hunters using shotguns in areas of poor visibility wear widely available polycarbonate safety glasses as well as "hunter's orange" to minimize their risk of devastating ocular gunshot injury.

Ocular lawnmower injuries

In the 10-year period from 1977 to 1987, lawnmowers have been responsible for approximately 70,000 injuries annually with an estimated 5% (3300) involving the eyes. Hyphema, angle recession, and traumatic retinopathy are especially common forms of lawnmower ocular trauma. A series of 14 cases of lawnmower-induced eye injuries is presented along with demographics of the patient population involved. An analysis of various types of lawnmowers currently in use are also included, and preventive measures are suggested.

Chronic valproic acid and coantiepileptic drug therapy and incidence of increases in serum liver enzymes

Results are described on the association of increased serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) activities with valproic acid (VPA) and coantiepileptic drug therapy in a group (n = 126) of randomly selected chronically medicated out-patients. The highest incidence (SGOT, 28.3%; SGPT, 26.1%) of elevations occurred in patients comedicated with VPA-phenobarbital (PB)-phenytoin (PHT) combinations, followed by those in the VPA-PB group (SGOT, 19.5%; SGPT, 7.3%). No SGPT elevations were detected in any patients (n = 40) on chronic VPA monotherapy, while SGOT was marginally elevated in 20% of the cases. Considering the total sample (n = 126), SGOT activities were found to be linearly and directly correlated with VPA plasma concentration (n = 126, r = 0.228, p less than 0.01), PB concentration (n = 86, r = 0.352, p less than 0.01), PHT concentration (n = 45, r = 0.336, p less than 0.01), sum of VPA-PB concentrations (n = 86, r = 0.440, p less than 0.001), and sum of VPA-PB-PHT concentrations (n = 45, r = 0.481, p less than 0.001). The corresponding correlations for SGPT activities were similar, except that no correlation was observed in the case of VPA monotherapy. Student's t tests for equality of means showed that the subgroup with abnormal enzyme activities had a significantly higher mean plasma concentration for PB, PHT, sum of VPA-PB, and sum of VPA-PB-PHT when compared with normal enzyme subgroup patients.(ABSTRACT TRUNCATED AT 250 WORDS)