Bacterial endophthalmitis after closed vitrectomy

Four cases of bacterial endophthalmitis occurred after more than 2,800 closed vitrectomies. Despite vigorous antibiotic therapy, all four eyes were lost. The poor outcome seems to result from difficulties in diagnosing this condition in its early stages. Important clinical indications, such as orbital pain, corneal edema and infiltrate, excessive intraocular inflammatory reaction, hypopyon, and diminished fundus reflex, are often masked by the usual postoperative course. According to our study, the incidence of endophthalmitis after closed vitreous surgery is 0.14%. Three of the four patients with endophthalmitis were diabetic. Our clinical findings are compared with those in the four other cases reported in the literature.

Septic choroidal effusion after scleral buckling operation

We treated a case of suppurative choroidal effusion occurring after a scleral buckling procedure in a diabetic patient. Staphylococcus epidermidis was isolated from culture of the suprachoroidal fluid, but cultures of the vitreous fluid and anterior chamber aspirate yielded no growth. There was no associated infection of the scleral implant material and no formation of scleral abscess. Despite intensive systemic, periocular, and topical therapy with antibiotics and corticosteroids, vision could not be salvaged. We suspect the route of infection was through the scleral perforation site for drainage of subretinal fluid.

Comparison of plasma levels of canrenone and metabolites after base hydrolysis in young and elderly subjects following single and multiple doses of spironolactone

Plasma levels of canrenone and 'total metabolites' after base hydrolysis were compared in young and elderly subjects following single and multiple doses of spironolactone. After the initial dose on Day 1, plasma levels of canrenone and 'total metabolites' were higher in the young than in the elderly group, and significant differences were found between the two age groups in the AUC for both canrenone and 'total metabolites'. However, these differences between the two age groups diminished after multiple dosing on Day 8, and the steady state pre-dose plasma levels of canrenone and 'total metabolites' were significantly higher in the elderly subjects. The accumulation ratios of canrenone and 'total metabolites' were significantly higher in the elderly than in the young subjects. Both canrenone and canrenoic acid were extensively bound to plasma protein, but no differences were found between the two age groups in protein binding. Observed differences in plasma levels after single and multiple dosing between young and old subjects may be consequences of many factors such as a proportionate shift in metabolism with age; impaired oral absorption of the parent compound; and/or altered volume of distribution of the drug.

Pharmacokinetics of canrenone and metabolites after base hydrolysis following single and multiple dose oral administration of spironolactone

The pharmacokinetics of canrenone and 'total metabolites' after base hydrolysis was studied in eight young volunteers following single and multiple dose oral administration of spironolactone. The plasma levels of canrenone and 'total metabolites' were fitted to a two-compartment open model with a first-order absorption process. From our eight normal subjects studied, the harmonic mean of the distributive half-life (t1/2 alpha) of canrenone was found to be 1.66 h, and the harmonic mean of the terminal elimination half-life (t1/2 beta) to be 22.6 h. Harmonic means of the distributive and elimination half-lives of 'total metabolites' after base hydrolysis were 2.48 h and 28.8 h respectively. The accumulation ratio of canrenone was 2.53, whereas that of 'total metabolites' was 1.89. Despite the fact that spironolactone has been shown to induce hepatic metabolism of other drugs, no evidence of autoinduction was noted in the present study, as plasma levels of canrenone and 'total metabolites' were found to obey a linear two-compartment model with reproducible absorption and disposition after single and multiple doses.

Determination of nitrazepam and temazepam in plasma by high-performance liquid chromatography

A rapid and simple high-performance liquid chromatographic analysis of nitrazepam in plasma with temazepam as an internal standard is described here. Alternatively, this assay method can also be used to determine temazepam plasma concentrations with nitrazepam as the internal standard. Chloroform was used as an organic solvent for the extraction process. The percentage recoveries of nitrazepam and temazepam were 79% and 85%, respectively. The coefficient of variation of the within-day precision of the assay procedure at a concentration equal to 50 ng/ml of nitrazepam was 2.4% (n = 5), and that for day-to-day precision at the same concentration was 4.7% (n = 5). Calibration curves for nitrazepam and temazepam were linear over their therapeutic ranges. Pharmacokinetic parameters obtained with this method after a single oral dose of 5 mg of nitrazepam in five normal subjects were comparable to results obtained in previous studies.

Contact lenses for laser applications

Contact lenses for anterior and posterior segment laser applications are described. Commercially available lenses are classified according to design, application, manufacturer and cost.

Tractional detachment of the macula following branch retinal vein occlusion

In two patients, a detachment of the macula occurred following a branch retinal vein occlusion. Vitreoretinal relationships were investigated and documented by biomicroscopic photography. Both eyes showed partial posterior vitreous detachment with dense adhesions to a preretinal membrane at the macula. Vitreous contraction and traction appeared to be responsible for the detachment.

Schwangerschaftsprotein 1 (SP1) in serum and cerebrospinal fluid of patients with gestational trophoblastic disease

The beta subunit of human chorionic gonadotrophin (beta-hCG) and Schwangerschaftsprotein 1 (SP1) were measured by radioimmunoassay in the serum and cerebrospinal fluid (CSF) of 46 postmolar and postpartum patients who developed gestational trophoblastic disease. There was a significant correlation between beta-hCG and SP1 serum levels. The mean serum SP1 level in high-risk patients was significantly higher than that in low-risk patients. There was a significant correlation between serum and CSF beta-hCG levels. The ratio of serum to CSF beta-hCG levels was low in the three patients with clinical evidence of intracranial metastasis. SP1 was present in the CSF of only one of these three patients, but it could be detected in the CSF of another four patients without clinical evidence of metastases in the central nervous system. The two low-risk patients with SP1 present in the CSF showed poor response to intramuscular methotrexate.

Pre-operative cervical dilatation in termination of first trimester pregnancies using 16, 16-dimethyl-trans-delta 2 PGE1 methyl ester vaginal pessaries

The effect of a prostaglandin E1 analogue on the cervix prior to termination of first trimester pregnancy was studied in a double-blind placebo-controlled trial with 70 primigravid and 125 multigravid patients in the Hong Kong University Gynaecological Unit. One mg of 16, 16-dimethyl-trans-delta 2-prostaglandin E1 methyl ester (ONO 802) in the form of vaginal pessary was inserted 3 hours before vacuum aspiration. The cervical dilatation in patients receiving ONO 802 pessaries was significantly greater than that in patients who received no treatment or placebo pessaries but the difference in dilatation between patients who received no treatment or placebo was not significant. The blood loss during operation in patients receiving ONO 802 pessaries was also significantly less than that in patients receiving placebo pessaries. The side effects due to ONO 802 pessaries were mild and infrequent.

Bacterial endophthalmitis after retinal surgery

Two cases of postoperative endophthalmitis caused by Staphylococcus epidermidis occurring in 10,000 routine scleral buckling operations are reported. Intraocular access of bacteria is suspected through scleral perforations used for release of subretinal fluid and for air injection. In case 1, despite vigorous treatments with vitrectomy, corticosteroids, and antibiotics, visual acuity decreased to light perception. In case 2, with intensive therapy, visual acuity of 6/12 (20/40) was retained. The visual outcome seems to depend on the rapidity of diagnosis and the promptness of aggressive therapy before irreparable structural damage occurs.

Fulminating panophthalmitis due to exogenous infection with Bacillus cereus: report of 4 cases

Bacillus cereus is a seldom recognised but important cause of panophthalmitis. Although most reported cases have been the result of endogenous infection, we have recently seen 4 cases that followed ocular trauma. In each instance a fulminating panophthalmitis developed, accompanied by fever and leucocytosis. Despite prompt therapy all eyes were rapidly lost. In view of the selective antibiotic sensitivities of this organism and the fulminating course of the disease, conventional approaches to therapy, including standard prophylactic antibiotic regimens, are unlikely to be successful in such cases. Analysis of our cases suggest that ocular infection with B. cereus has certain features that may allow a provisional diagnosis to be made before isolation of the organism. Early recognition and prompt institution of effective therapy may lead to salvage of these eyes in the feature.

Erectile impotence associated with transurethral prostatectomy

A prospective study was done on the erectile function of 35 randomly-selected patients undergoing transurethral prostatectomy for benign prostatic hypertrophy. A preoperative sexual history was obtained, and the erectile function of each patient was recorded using a nocturnal penile tumescence monitor. Four to six weeks postoperatively, a repeat sexual history was taken and the erectile function was reassessed. In 12 of the 35 patients we noted a discordance between the erectile potency they reported in their sexual histories and the objective testing. There was no significant difference between the preoperative and postoperative nocturnal penile tumescence recordings for any given patient.

Human chorionic gonadotrophin and pregnancy-specific beta-1 glycoprotein (SP-1) in ectopic pregnancy

Human chorionic gonadotrophin (hCG) was estimated by radioreceptor assay (RRA), and beta hCG and pregnancy-specific beta 1 glycoprotein(SP-1) by radioimmunoassay (RIA) in 48 consecutive patients undergoing laparoscopy for suspected ectopic pregnancy. Twenty patients subsequently proven to have ectopic pregnancy had positive results for RIA-beta hCG, but RRA-hCG and SP-1 were negative in 3. Twenty-one nonpregnant patients had negative results for RRA-hCG and RIA-beta hCG, but one had a positive result with SP-1. Seven patients with intrauterine pregnancy had positive results in all 3 assays.

The problem of bacillus species infection with special emphasis on the virulence of Bacillus cereus

Although Bacillus cereus is an uncommon ocular pathogen, infection with it usually results in loss of the eye. Although previous reports have emphasized endogenous infection, our recent experience indicates the importance of B cereus infection following trauma. Management is hampered by ineffectiveness of current empirical antibiotic regimens. This microorganism is resistant to both the penicillins and the cephalosporins. Although B cereus is susceptible to gentamicin, our studies indicate that gentamicin by itself is inadequate to eradicate the infection. B cereus, however, is susceptible to clindamycin and combined therapy with gentamicin and clindamycin appears to offer the best approach. Early diagnosis is the key to successful treatment. We believe the clinical circumstances likely to lead to B cereus infection, as well as the manifestations of the disease itself, are sufficiently distinctive to alert the ophthalmologist to the possibility of this infection. Prompt recognition of the infection should allow institution of appropriate therapy before permanent structural changes occur.

Internuclear ophthalmoplegia in Fabry's disease

A 16-year-old boy with Fabry's disease had sudden onset of diplopia unassociated with any other neurologic symptoms. A right internuclear ophthalmoplegia characterized by optokinetic phenomena and ocular dysmetria was demonstrated. The diplopia resolved spontaneously in six weeks. This is the first reported case of internuclear ophthalmoplegia occurring with Fabry's disease and represents one of the youngest patients to have unilateral internuclear ophthalmoplegia presumably caused by vascular occlusive disease.

Caesarean section and placental transfer of alcuronium

The placental transfer of alcuronium was studied in twelve patients undergoing elective or emergency caesarean section. Umbilical cord vein and maternal plasma was analysed for alcuronium at dose-delivery time intervals ranging from 5 to 10.5 minutes. The mean umbilical vein concentration of the relaxant was 0.41 +/- 0.18 (SD) microgram/ml, and the mean foetal/maternal concentration ratio was 0.26 +/- 0.11. A positive correlation between foetal and maternal concentrations of alcuronium was demonstrated. Although alcuronium appears to cross the placenta rapidly and in reasonably high concentration, no apparent adverse effects on the neonates was evident as judged by measurement of Apgar scores.

Candida endophthalmitis and infection of costal cartilages

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Humoral and cell-mediated immune responses to epidermal growth factor in the rabbit

Epidermal growth factor (EGF), which has been shown to stimulate epidermal proliferation and keratinization and to induce regeneration of rabbit corneal epithelium, was studied for its immunogenic potential in rabbits. Mouse-derived EGF was administered topically, subconjunctivally, intrastromally, and systemically. Systemic immunization was done both with and without complete Freund's adjuvant (CFA). EGF-stimulated cultures of lymphocytes from peripheral blood, spleen, and lymph nodes of all immunized animals were tested for cell-mediated immunity (CMI) to EGF. All experimental animals demonstrated CMI as determined by either classic positive delayed skin tests or by in vitro production of migration inhibitory factors, regardless of the route of sensitization. Only animals immunized systemically with EGF and CFA produced high-titered specific anti-EGF antibody, and only this group showed ocular reactions after subsequent topical challenge of EGF. These results suggest that antibody to EGF is the major cause for ocular inflammatory reactions observed subsequent to topical EGF challenge of a sensitized animal.