Hemodynamic responses of thiopental and propofol in different-aged patients during endotracheal intubation

BACKGROUND

Thiopental and propofol are 2 popularly used anesthetic induction agents that have different pharmacological and pharmacokinetic actions. It is not clear how the hemodynamic responses differ in different-aged patients using these 2 drugs for anesthetic induction. The aim of this study was to investigate the hemodynamic responses to propofol and thiopental of different-aged patients during endotracheal intubation.

METHODS

Sixty patients, 20 to 83 years old, were included in this study. Patients were randomly divided into 6 groups according to age and different inductive anesthetics. Non-invasive blood pressure (NIBP) monitoring was performed every minute before anesthesia, during anesthetic induction with 5 mg.kg-1 thiopental or 2 mg.kg-1 propofol intravenously, and after intubation.

RESULTS

Propofol induction produced a smaller mean arterial pressure increase immediately after intubation than did thiopental induction in adult and elderly groups (101.0 +/- 18.5 and 104.0 +/- 21.1 mmHg in the propofol groups vs. 138.3 +/- 17.1 and 138.9 +/- 16.1 mmHg in the thiopental groups at 1 minute after intubation, p < 0.001 and p = 0.001, respectively). Differences in heart rate between propofol and thiopental groups were found in young and adult groups (85.1 +/- 9.2 and 81.7 +/- 10.9 in the propofol groups vs. 94.5 +/- 9.9 and 95.0 +/- 14.0 beats per minute in the thiopental groups at 1 minute after intubation, p = 0.041 and p = 0.029, respectively).

CONCLUSION

Propofol induction produced more stable hemodynamics after intubation in adult and elderly patients than did thiopental induction. Therefore, it is safer to use propofol for induction and intubation in adult and elderly patients.

Hepatopulmonary syndrome in poorly compensated postnecrotic liver cirrhosis by hepatitis B virus in Korea

BACKGROUND

Hepatopulmonary syndrome (HPS) refers to the association of hypoxemia, intrapulmonary shunting and chronic liver disease. But there is no clear data about the prevalence of HPS in postnecrotic liver cirrhosis by hepatitis B virus (HBV), the most common cause of liver disease in Korea. The aim of this study was to investigate the prevalence of HPS in poorly compensated postnecrotic liver cirrhosis by HBV, and the correlation of the hepatopulmonary syndrome with clinical aspects of postnecrotic liver cirrhosis by HBV.

METHODS

Thirty-five patients underwent pulmonary function test, arterial blood gas analysis and contrast-enhanced echocardiography. All patients were diagnosed as HBV-induced Child class C liver cirrhosis and had no evidence of intrinsic cardiopulmonary disease.

RESULTS

Intrapulmonary shunt was detected in 6/35 (17.1%) by contrast-enhanced echocardiography. Two of six patients with intrahepatic shunts had significant hypoxemia (PaO2 < 70 mmHg) and four showed increased alveolar-arterial oxygen gradient over 20 mmHg. Only cyanosis could reliably distinguish between shunt positive and negative patients.

CONCLUSIONS

The prevalence of intrapulmonary shunt in poorly compensated postnecrotic liver cirrhosis by HBV was 17.1% and the frequency of hepatopulmonary syndrome was relatively low (5.7%). 'Subclinical' hepatopulmonary syndrome (echocardiographically positive intrapulmonary shunt but without profound hypoxemia) exists in 11.4% of cases with poorly compensated postnecrotic liver cirrhosis by HBV. Cyanosis is the only reliable clinical indicator of HPS of HBV-induced poorly compensated liver cirrhosis. Further studies are required to determine if the prevalence and clinical manifestations of HPS varies with etiology or with geographical and racial differences.

Ocular blood flow measurements and their importance in glaucoma and age-related macular degeneration

This survey of methods for assessing ocular hemodynamics in glaucoma and age-related macular degeneration is not complete, but it does cover those likely to be encountered in the literature. A fundamental problem in getting to grips with the ocular blood flow literature is the difficulty in comparing the results of similar studies employing different assessment techniques. As evident from the discussion above, each technique evaluates a portion of the ocular circulation in a distinct way. Some of the methods overlap with regard to the tissues that can be used for examination, while others are directed at entirely different parts of the ocular vasculature. Despite these difficulties, hemodynamic studies of glaucoma and AMD are likely to grow in importance. On the basis of accumulating epidemiological and clinical evidence, it is becoming apparent that intraocular pressure is not the sole etiological factor in glaucoma, and retinal pigment epithelium senescence is not the sole etiological factor in AMD. Circumstantial evidence of vascular involvement in glaucoma and AMD has now been bolstered by experimental evidence. If the current pace of refinement of newly established technologies for evaluating ocular blood flow is maintained, they will soon be ready for deployment in the clinic. The only problem is the availability of expensive instruments and trained personnel. The ultimate beneficiaries of work in this area will not be researchers, but patients.

Effect of brimonidine tartrate on ocular hemodynamics in healthy volunteers

While alpha2-adrenergic agonists, such as brimonidine tartrate, significantly reduce the intraocular pressure (IOP), the presence of vasoconstrictor postsynaptic alpha2 receptors on vascular smooth muscle raise the possibility that brimonidine could potentially compromise ocular blood flow. Consequently, the ocular hemodynamic effects of brimonidine were studied in normal subjects. Twelve healthy volunteers were included in this prospective, double-masked, placebo controlled, crossover-designed clinical trial. They received either brimonidine tartrate 0.2% or placebo b.i.d. for 2 weeks. Goldmann tonometry and color Doppler imaging (CDI) were performed at baseline, at 2 hr, 1 week, and 2 weeks after the treatment. Fundus angiography using a scanning laser ophthalmoscope was performed at baseline and 2 weeks after treatment to determine retinal arteriovenous passage time. Brimonidine lowered IOP at 2 hr, 1 week, and 2 weeks (p = 0.058, p = 0.031, and p = 0.022, respectively). Brimonidine did not affect the retrobulbar arterial velocities measured by CDI, nor retinal arteriovenous passage time. In conclusion, two-week treatment with brimonidine reduces IOP and does not reduce the bulk retinal or retrobulbar arterial perfusion in young healthy volunteers.

Distal anterior cerebral artery aneurysms: clinical features and surgical outcome

Aneurysms of the distal anterior cerebral artery (DACA) are rare and their surgical treatments present some unique difficulties from a technical standpoint. In this report, we presented our experiences of cases with DACA aneurysms, and analyzed the clinical features and prognostic factors affecting the final outcomes. Among 770 cases of intracranial aneurysms operated from 1990 to 1998, 19 cases of DACA aneurysms (2.5%) were studied retrospectively. The characteristic findings were female preponderance (M:F = 1:2.8), common multiple aneurysms (57.9%), and frequent intracerebral hemorrhage (ICH) on initial brain CT scan (42.1%). All patients were operated via interhemispheric approach. Intraoperative aneurysmal rupture was developed only in 3 cases (15.8%), and had no relationship with the final outcome Fifteen out of 19 patients (78.9%) showed favorable outcome with a mortality rate of 5.3%. The follow-up data suggest that the initial ICH on brain CT scan portend a poor prognosis.

New neuroretinal rim blood flow evaluation method combining Heidelberg retina flowmetry and tomography

AIM

Accurate Heidelberg retina flowmeter (HRF) measurements require correct manual setting of the HRF photodetector sensitivity. The neuroretinal rim produces a weak signal relative to the peripapillary retina. A newly developed HRF alignment and sensitivity protocol, capable of accurate rim measurement, was investigated.

METHODS

18 eyes of nine healthy volunteers were examined by HRF. Three images of each eye were taken using three different imaging methods. Method 1: a conventional image (optic nerve head centred image with photodetector sensitivity optimised for the strong signal from the peripapillary retina); method 2: the setting of method 1 with photodetector sensitivity optimised for the weak signal from the rim; and method 3: the setting of method 2 with the temporal rim margin tangent to the lateral image border to remove the overpowering signal from the temporal peripapillary retina. The neuroretinal rim was defined by the Heidelberg retina tomograph (HRT). Blood flow and reflectivity values (DC component) in the rim area were compared for the three methods using pointwise analysis. Coefficients of variation of repeated measurements in 12 subjects have been calculated for method 3.

RESULTS

The neuroretinal rim area measured by method 1 had a significantly lower brightness compared with method 2 and 3 (p=0.0002 and p=0.0002, respectively). Method 2 provided proper sensitivity for the weak signals of the rim area based on rim tissue DC values; however, this sensitivity setting was too high for the strong signal from the peripapillary retina. Method 3 avoided the strong peripapillary signal with the proper signal from the rim and provided significantly higher flow values of the rim area at 75 and 90 percentile pixels (p=0.0065 and p=0.0038 respectively) compared with method 2. Interobserver repeatability ranged from 16.85% to 21.96% for the different parameters.

CONCLUSIONS

Method 3 provides an accurate and reproducible flow measurement of the neuroretinal rim area through proper sensitivity for the weak rim signal, alignment, and removal of the strong temporal signal from the image. This new method is recommended to improve accuracy of blood flow measurement in the neuroretinal rim.

Intraocular pressure and photorefractive keratectomy: a comparison of three different tonometers

PURPOSE

To evaluate the intraocular pressure (IOP) with three different instruments, Goldmann applanation tonometer (GAT), noncontact tonometer, and Tono-Pen after photorefractive keratectomy (PRK) for myopia.

METHODS

A prospective case series study to evaluate preoperative and postoperative IOP measurements of 149 eyes at 12 months. We performed GAT, noncontact tonometry, Tono-Pen central, and Tono-Pen temporal periphery measurements. We also performed measurements of the central corneal thickness (CCT) by ultrasonic pachymetry and keratometry. Pre-operative IOP reading served as control for all studies.

RESULTS

After PRK, IOP reading was significantly reduced in the treated eyes when compared with the control measurements (11.87+/-1.73 vs. 13.37+/-1.52 mm Hg, p<0.0001 with GAT; 12.07+/-1.6 vs. 13.51+/-1.59 mm Hg, p<0.0001 with noncontact tonometer; 12.18+/-1.6 vs. 13.48+/-1.55 mm Hg, p<0.0001 with Tono-Pen central; 13.48+/-1.65 vs. 13.71+/-1.56 Hg, p<0.0104 with Tono-Pen temporal periphery). There was also a significant correlation between IOP reading changes measured by GAT, noncontact tonometer, Tono-Pen central, and change of CCT and between reduction of IOP reading and keratometry (r2>0.39, p<0.0001 for each). The correlation between IOP reading change by Tono-Pen temporal periphery and CCT was also significant but r2 value was only 0.034. Tono-Pen temporal periphery postoperative IOP measurements had the best correlation with preoperative GAT IOP (r2 = 0.57, p<0.0001).

CONCLUSIONS

PRK reduced IOP reading as measured by GAT, noncontact tonometer, and Tono-Pen central; less so when measured by Tono-Pen temporal periphery. Early detection of glaucoma and IOP follow-up in glaucoma patients may be done best by peripheral Tono-Pen measurements over the nonablated cornea.

Presacral epidermoid cyst: imaging findings with histopathologic correlation

BACKGROUND

The aim of this study was to determine the imaging characteristics of presacral epidermoid cysts and correlate the imaging findings with the histopathologic findings.

METHODS

We retrospectively reviewed sonographic, computed tomographic, and magnetic resonance examinations in four consecutive patients with a pathologically proven presacral epidermoid cyst. Imaging findings of the presacral epidermoid cyst were correlated with the histopathologic findings.

RESULTS

In all four patients, sonography showed a presacral mass with a heterogeneous low echogenicity, and computed tomography showed a discrete well-defined hypodense presacral mass with a thin wall. In the three patients who underwent magnetic resonance imaging, the mass showed a heterogeneous low signal intensity on the T1-weighted image and a high signal intensity with multiple small foci of low signal intensity in the nondependent portion of the mass on the T2-weighted image. These imaging findings correlated well with the pathologic results. Aggregates of keratinous material contributed to these imaging findings.

CONCLUSION

In the diagnosis of the presacral epidermoid cyst, sonographic and magnetic resonance imaging findings may be helpful.

Bronchoscopic, radiologic and pulmonary function evaluation of endobronchial tuberculosis

OBJECTIVE

Endobronchial tuberculosis (EBTB) causes problems in both making a diagnosis and following up the endobronchial lesion, because the lesion is not evident in simple chest radiograph. Frequently, the diagnosis and follow up of EBTB lesion during treatment mainly depend on bronchoscopy. Chest computed tomography (CT) and pulmonary function test (PFT) have also been used in evaluating EBTB and differentiating it from the other diseases. Primary purpose of the present study was to observe the change of EBTB lesion during treatment and determine the optimal time and the indication of follow-up bronchoscopy. We also evaluate the usefulness of chest CT and PFT in EBTB.

METHODOLOGY

Eighty-one biopsy-proven EBTB patients were enrolled from 1992 to 1997. Endobronchial tuberculosis was classified into seven subtypes: actively caseating, fibrostenotic, oedematous-hyperaemic, tumorous, ulcerative, granular, and non-specific bronchitic type according to bronchoscopic features by Chung's Classification. The change of bronchoscopic findings during treatment in each subtype of EBTB was evaluated prospectively. Follow-up bronchoscopy was done each month until there was no subsequent change in endobronchiat lesion, and every 3 months thereafter, and at the end of treatment. Chest CT and PFT were performed in 26 and 68 patients respectively, at initial bronchoscopy.

RESULTS

Twenty-two of the 34 cases of actively caseating EBTB changed into the fibrostenotic type, and the other 12 healed without sequelae. Seven of the 11 cases of oedematous-hyperaemic EBTB changed into the fibrostenotic type, and the other four healed. Nine of the 11 cases of granular EBTB, six cases of non-specific bronchitic EBTB, and two cases of ulcerative EBTB resolved completely. However, the other two cases of granular EBTB changed into the fibrostenotic type. Seven cases of fibrostenotic EBTB did not improve despite antituberculosis chemotherapy. These various changes in bronchoscopic findings occurred within 3 months of treatment. In 10 cases of tumorous EBTB, seven progressed to the fibrostenotic type. In addition, new lesions appeared in two cases, and the size of the initial lesions increased in another two cases, even at 6 months after treatment. On chest CT findings of 26 EBTB patients, the length of bronchial involvement was measured from 10 to 55 mm. Bronchial stricture was noticed in 25 cases and the range of narrowing was from total occlusion to near normal, and there was wide variation in bronchial stricture even within same subtype of EBTB. The dominant feature of PFT in EBTB at the diagnosis was restrictive pattern.

CONCLUSION

The therapeutic outcome of each subtype of EBTB can be predicted by follow-up bronchoscopy during the initial 3 months, with the exception of the tumorous type. In tumorous EBTB, the evolution of the lesions during treatment is very complicated, and bronchial stenosis may develop at a later time. Chest CT was useful in measuring the length of involved bronchus and degree of stricture in EBTB. PFT may be useful in differential diagnosis and follow up of EBTB.

Regional differences in optic disc and retinal circulation

PURPOSE

To determine regional differences in the circulation of the optic disc, the peripapillary choroid and the retinal vessels using the techniques of computerized image analysis and fluorescein angiography.

METHODS

Ten young normal subjects were studied. Fluorescein angiography was performed with a scanning laser ophthalmoscope. The rate of filling of fluorescein or slope was measured in the four quadrants of the optic disc, the peripapillary choroid and the major retinal arteries and veins. A total of 125 points was measured from each image of the fluorescein angiograms for a total of 20 to 30 images. Retinal vessel width was measured using computerized image analysis.

RESULTS

Comparison of the rates of filling of fluorescein or slopes showed significant differences from zero among the four quadrants of the optic disc (p= 0.01 to <0.02), of the peripapillary choroid (p=0.01 to <0.05) and among the major retinal arteries (p=0.01 to <0.02) and retinal veins (p=0.02 to <0.05). No significant differences were noted between the quadrants for retinal arterial width with the retinal veins only showing a significant difference between the inferior nasal and inferior temporal vein (p=0.02 to <0.05).

CONCLUSION

Evaluation of the circulation of the optic disc, retina, and peripapillary choroid should take into account regional differences among these structures.

Chronic subdural hematoma: evaluation of the clinical significance of postoperative drainage volume

OBJECT

A wide variation in postoperative drainage volumes is observed during treatment of chronic subdural hematoma (CSDH) with twist-drill or burr-hole craniostomy and closed-system drainage. In this study the authors investigate the causes of the variation, the clinical significance thereof, and its influence on treatment outcome.

METHODS

A total of 175 cases were investigated between January 1991 and December 1997. Of these, 145 patients had surgery for CSDH, of whom 30 had bilateral lesions. The cases of CSDH were divided into five subtypes (low-density, isodense, high-density, mixed-density, and layering types) on the basis of the brain computerized tomography (CT) findings. Burr-hole craniostomies with closed-system drainage were performed in all patients and the drainage was maintained for 5 days, during which daily amounts of fluid were measured. The mean drainage volume over 5 days was 320 ml, with the largest volume (413 ml) seen in the low-density type and the smallest (151 ml) in the mixed-density type of CSDH. There were recurrences in six patients (seven instances, 4%). The mixed-density type had the highest recurrence rate (8.6%), whereas there was no recurrence for the low-density type. There were no recurrences in 81 patients in whom the total drainage volumes for 5 days were more than 200 ml, but there were recurrences in six (seven instances) of 94 patients in whom the total drainage volume was less than 200 ml.

CONCLUSIONS

The postoperative drainage volumes varied greatly because of differences in the outer membrane permeability of CSDH, and such variation seems to be related to the findings on the CT scans obtained preoperatively. Patients with CSDH in whom there is less postoperative drainage than expected should be carefully observed, with special attention paid to the possibility of recurrence.

Effect of mitomycin-C on posterior capsule opacification in rabbit eyes

PURPOSE

To determine whether mitomycin-C can inhibit posterior capsule opacification (PCO) without causing ocular toxicity.

SETTING

Yonsei Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.

METHODS

Mitomycin-C dissolved in sodium hyaluronate (0.2 cc of 0.2 mg/mL) was injected into the empty capsular bag for 3 minutes after endocapsular phacoemulsification in rabbit eyes. Three months after surgery, the obstruction rate of visible light caused by PCO was measured using an optical power meter.

RESULTS

The mean obstruction rate of visible light was 81.0% +/- 8.3% (SD) in the control group in which sodium hyaluronate without mitomycin-C was used, 30.5% +/- 10.1% in the group in which mitomycin-C was dissolved in sodium hyaluronate, and 71.9% +/- 6.8% in the group in which mitomycin-C was dissolved in a balanced salt solution. Statistically significant differences were found among all 3 groups.

CONCLUSIONS

Our results suggest that the application of mitomycin-C dissolved in sodium hyaluronate effectively reduces PCO in rabbit eyes.

Characteristics of lung cancer in Korea, 1997

The high proportion of smokers and the incidence of advanced, unresectable lung cancer in Korea were examined to aid the development of a national anti-smoking program and the early detection of lung cancer. Koreans are a single racial group with a high smoking rate among men and a contrastingly low smoking rate among women. This report documents a retrospective investigation conducted by The Korean Academy of Tuberculosis and Respiratory Disease into the characteristics of all lung cancers diagnosed between 1 January 1997 and 31 December 1997 in Korea. Among the 3794 patients included in this study, 76.8% were smokers and, in particular, 89.8% of the males were smokers. Squamous cell carcinoma was the most frequent type of lung cancer encountered (44.7%), followed by adenocarcinoma (27.9%). The smoking rate in the case of adenocarcinoma was significantly lower than that found in both squamous cell carcinoma and small cell cancer. The most common symptom was a cough. Only 7.2% of patients were asymptomatic. Bronchoscopic biopsy has a primary role in the diagnosis of squamous cell carcinoma and small cell cancer, but percutaneous needle biopsy has a more important role in the case of adenocarcinoma. Two-thirds of the nonsmall cell lung cancer patients were detected in the unresectable advanced stages (IIIB and IV). In contrast to other countries, squamous cell carcinoma is still the most frequent type of lung cancer in Korea. The high proportion of smokers and the incidence of advanced, unresectable lung cancer at diagnosis have urged development of a national anti-smoking program to promote the cessation of smoking and the early detection of lung cancer.

F wave monitoring during surgery for adult tethered cord syndrome--a case report

We would like to report our first attempt in intraoperative study of F wave response electromyography (EMG) to monitor the spinal motor function during a spinal surgery for excision of a giant lumbosacral lipoma.

Ocular haemodynamics in glaucoma associated with high myopia

The ocular blood flow of a group of high myopic and glaucomatous eyes has been investigated by means of the Color Doppler Imaging (CDI) technique, comparing the results with those of some very myopic eyes without glaucoma, some non-myopic glaucomatous eyes and with a control group. The Ophthalmic Artery (OA), the Short Posterior Ciliary Arteries (SPCAs) and the Central Retinal Artery (CRA) were considered. For every vessel, peak systolic velocity (SV), end-diastolic velocity (DV) and the Pourcelot Resistivity Index were studied. The statistical analysis was performed by means of t-test according to Bonferroni procedure for multiple comparisons. The authors registered in the group of eyes with glaucoma associated with very severe myopia some abnormalities of the OA blood flow systolic velocity which might be interpreted as a vascular risk factor for the pathogenesis of the glaucomatous optic neuropathy; these abnormalities are more severe in glaucoma patients with high myopia than in an age-matched group of glaucoma patients without myopia.

Design and synthesis of alpha,beta-unsaturated carbonyl compounds as potential ACE inhibitors

The alpha,beta-unsaturated amide that is incorporated into the basic structural frame of a simple substrate molecule of angiotensin converting enzyme was found to serve as a Michael acceptor for the catalytic carboxylate of Glu-127, inhibiting the enzyme irreversibly.

Determination of enantiomeric metabolites of l-deprenyl, d-methamphetamine, and racemic methamphetamine in urine by capillary electrophoresis: comparison of deprenyl use and methamphetamine use

The enantiomeric analysis of urine collected from rats administered l-deprenyl, d-methamphetamine (MA), or dl-MA and from healthy male volunteers who ingested l-deprenyl by capillary electrophoresis (CE) using carboxy methylated-beta-cyclodextrin (CMCD) as a chiral selector was investigated to compare the metabolic pattern of l-deprenyl with the metabolism of d- or dl-MA. Urine from illegal drug abusers was also analyzed for the comparison of therapeutic drug (l-deprenyl) use with illicit drug (d-MA) use. MA enantiomers (l-, d-), amphetamine (AM) enantiomers (l-, d-), l-deprenyl, and desmethylselegiline (DMS) enantiomers (l-, d-) were simultaneously separated and detected with clear resolution. L-deprenyl and its metabolites, l-MA, l-AM, and l-DMS, were detected in rat urine sample collected up to 24 h after oral administration of l-deprenyl (10 mg/kg), and the urinary l-AM/l-MA ratio was 2.45 +/- 0.55. This AM/MA ratio was significantly higher than the ratios obtained from rats administered with d-MA (5 mg/kg) and dl-MA (10 mg/kg). The d-AM/d-MA ratio was 0.98 +/- 0.25 for the d-MA treatment, and the d-AM/d-MA and l-AM/l-MA ratios were 0.72 +/- 0.24 and 0.71 +/- 0.21, respectively, for the dl-MA treatment. Analysis of human urine revealed that, unlike in rat urine, the MA content was much greater than the AM content, resulting in the AM/MA ratios being far lower in cases of healthy adult men treated with l-deprenyl (10 mg) and MA abusers. The AM/MA ratio from l-deprenyl users (0.33 +/- 0.03) was significantly higher than the ratio from MA abusers (0.20 +/- 0.12). Results indicate that although metabolic patterns of the drugs in rat and humans may be different, the AM/MA ratio from l-deprenyl use is significantly higher than the ratio from MA use in both rat and human urine. This ratio, however, cannot give conclusive proof of deprenyl or MA use in humans. The simultaneous chiral separation for all the metabolites of l-deprenyl and MA by CE analysis used in this study could provide rapid and simple discrimination between therapeutic drug use and illegal drug abuse.

The effective concentration and exposure time of mitomycin-C for the inhibition of lens epithelial cell proliferation in rabbit eyes

The proliferation of residual lens epithelial cells following cataract surgery is assumed to be a major cause of posterior capsular opacification. To assess the efficacy of mitomycin-C in preventing posterior capsular opacification, we determined the effective concentration and exposure time of mitomycin-C in inhibiting rabbit lens epithelial cell proliferation. The fourth-passaged rabbit lens epithelial cells were maintained for one day and then exposed to mitomycin-C for 1, 2, 3, and 5 minutes, respectively. There were 9 different plating concentrations of mitomycin-C with two-fold serial dilution. The maintenance of the phenotypic properties of lens epithelial cells was confirmed by continuous transcription of lambda-crystalline mRNA determined by reverse transcription-polymerase chain reaction and the polymorphism of the restriction fragment. Cell proliferation was assayed with 3H-thymidine incorporation into DNA. The fourth-passaged cells maintained the expression of lambda-crystalline mRNA, suggesting that they are phenotypically authentic lens epithelial cells. The effective concentrations and exposure time of mitomycin-C were 0.1 mg/ml for 1 minute and 2 minutes, and 0.025 mg/ml for 2 minutes. By these results, we postulated that mitomycin-C at relatively short incubation times could be clinically used for prevention of posterior capsular opacification after cataract surgery.

A comparative study of betaxolol and dorzolamide effect on ocular circulation in normal-tension glaucoma patients

OBJECTIVE

To determine whether dosages of a selective beta-blocking agent (betaxolol) and a topical carbonic anhydrase inhibitor (dorzolamide), sufficient to significantly lower intraocular pressure (IOP), have similar or disparate impact on the retinal and retrobulbar circulation.

DESIGN

Counterbalanced crossover, with open-label use of medications.

PARTICIPANTS

Nine persons with normal-tension glaucoma (NTG).

INTERVENTION

After a 3-week drug washout, NTG patients were studied after 1 month of treatment with either dorzolamide or betaxolol, with determinations of IOP and retinal and retrobulbar hemodynamics.

MAIN OUTCOME MEASURES

At baseline and after treatment with each drug, retinal arteriovenous passage time was determined by scanning laser ophthalmoscopy after fluorescein dye injection, and flow velocities in the central retinal and ophthalmic arteries were measured with color Doppler ultrasonography imaging.

RESULTS

Betaxolol and dorzolamide each lowered IOP significantly, with these changes apparent and maximal after 2 weeks (each P < 0.05). In contrast, dorzolamide (but not betaxolol) accelerated arteriovenous passage of fluorescein dye in the inferior temporal quadrant of the retina (P < 0.05). Neither drug affected arteriovenous passage in the superotemporal retina or any aspect of central retinal or ophthalmic artery flow velocity after either 2 or 4 weeks.

CONCLUSIONS

Although both dorzolamide and betaxolol are effective ocular hypotensive agents and their topical instillation leaves retrobulbar hemodynamics unaltered, dorzolamide alone accelerates inferotemporal retinal dye transit.

Bronchoscopic assessment of the evolution of endobronchial tuberculosis

BACKGROUND

We previously classified forms of endobronchial tuberculosis (EBTB) into seven subtypes by bronchoscopic finding: actively caseating, edematous-hyperemic, fibrostenotic, tumorous, granular, ulcerative, and nonspecific bronchitic.

STUDY OBJECTIVE

To evaluate the value of this classification in predicting the therapeutic outcome of EBTB.

DESIGN

A prospective study with serial bronchoscopy performed from the diagnosis of EBTB to the completion of antituberculosis chemotherapy.

PARTICIPANTS

Eighty-one patients with biopsy-proven EBTB.

INTERVENTIONS

Fiberoptic bronchoscopy was done every month until there was no subsequent change in the endobronchial lesions, every 3 months thereafter, and at the end of treatment.

RESULTS

Twenty-two of the 34 cases of actively caseating EBTB changed into the fibrostenotic type, and the other 12 healed without sequelae. Seven of the 11 cases of edematous-hyperemic EBTB changed into the fibrostenotic type, and the other 4 healed. Nine of the 11 cases of granular EBTB, 6 cases of nonspecific bronchitic EBTB, and 2 cases of ulcerative EBTB resolved completely. However, the other two cases of granular EBTB changed into the fibrostenotic type. Seven cases of fibrostenotic EBTB did not improve despite antituberculosis chemotherapy. These various changes in bronchoscopic findings occurred within 3 months of treatment. In 10 cases of tumorous EBTB, 7 progressed to the fibrostenotic type. In addition, new lesions appeared in two cases, and the size of the initial lesions increased in another two cases, even at 6 months after treatment.

CONCLUSIONS

The therapeutic outcome of each subtype of EBTB can be predicted by follow-up bronchoscopy during the initial 3 months of treatment, with the exception of the tumorous type. In tumorous EBTB, close and long-term follow-up is advisable because the evolution of the lesions during treatment is very complicated and bronchial stenosis may develop at a later time.

A new classification of male pattern baldness and a clinical study of the anterior hairline

Male pattern baldness is the most common type of baldness occurring after the age of puberty. Various surgical techniques for hair reconstruction have been introduced. Since the Norwood classification method is too detailed and complicated to be used for various surgical operations, there is a strong need for a simpler classification. Selection of the shape and height of the frontal and temporal hairlines is important in hair restoration surgery. But due to lack of standard measures, there have been difficulties in performing surgical operations for male pattern baldness. We therefore studied the prevalence of male pattern baldness in 1731 Korean men according to age and types, based on the new classification method, between September 1995 and February 1996. At the same time, we also measured the average heights of the frontal and temporal hairlines and identified the morphology and the incidence of various types of anterior hairlines in 108 normal male adults. There are six types of male pattern baldness according to the new classification method. One peculiar type could not be classified by the Norwood classification method. The six types are designated types M, C, O, U, MO, and CO. In the morphological classification of the anterior hairline, the linear type was most common (70.37%). The heights of the frontal and temporal hairlines were 6.53 cm for the median line, 5.9 cm (left side) and 5.95 cm (right side) for the paramedian line, 8.49 cm (left and right side) for the temporal recession line, and 6.61 cm (left side) and 6.62 cm (right side) for the temporal hairline. The authors present the research outcomes as baselines that can be used for hair restoration surgery and further study of male pattern baldness.

Comprehensive assessment of retinal, choroidal and retrobulbar haemodynamics during blood gas perturbation

BACKGROUND

A study was performed to evaluate the effect of isoxic hypercapnia on ocular haemodynamics using colour Doppler imaging (CDI), scanning laser Doppler flowmetry (SLDF) and ocular blood flow (OBF) tonography.

METHODS

Measurements were taken for one eye of each of 14 healthy subjects (mean age 27 +/- 6 years) during breathing of room air and then during isoxic hypercapnia (breathing CO2 and room air). Using CDI, blood flow velocities and resistance indices were determined for the ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary arteries (SPCAs). Using SLDF a 10 x 10 pixel frame was used to measure blood flow, volume and velocity in each quadrant of the peripapillary retina. Pulsatile ocular blood flow (POBF) was measured using the OBF tonograph.

RESULTS

Using CDI, peak systolic and end diastolic velocities increased and resistance index decreased significantly in the SPCAs during hypercapnia. Using SLDF, blood flow, volume and velocity increased significantly during hypercapnia in the superior temporal quadrant of the peripapillary retina. No significant difference was observed between baseline and hypercapnia for POBF.

CONCLUSIONS

Isoxic hypercapnia resulted in an increase in peripapillary retinal and SPCA blood flow parameters as determined by SLDF and CDI respectively. This implies the presence of autoregulatory activity in these vasculatures. These findings may be of significance in the pathogenesis of ocular disease such as glaucoma where autoregulation is thought to be compromised.

Instrumented facet fusion for the degenerative lumbar disorders

A new, simple, minimally morbid procedure used to treat degenerative lumbar spinal disorders is described. The authors based their treatment on the McBride technique of facet fusion, which was modified and supplemented with pedicle screw fixation. The first 32 consecutive patients with degenerative spondylolisthesis and failed back surgery syndrome were treated, and followed for more than a year. Surgically, 26 patients had a single level fusion, and 6 patients had a two level fusion. Postoperative radiographs and computed tomography (CT) scans were evaluated to determine the fusion status. There were no specific complications related with the facet fusion. Thirty of 32 (93.8%) had solid fusions according to the computed tomographic criteria. Two patients showed a questionable union on CT scan but motion was less than 5 degrees on dynamic films. While 96.2% (25/26) of patients with a single level procedure had solid fusion, rate of union in the patients with two level procedures was 83.3% (5/6). This preliminary study of 32 patients shows that instrumented facet fusion appears to be a safe and effective procedure for lumbar spine fusions, demonstrating a high fusion rate with rarely serious complications.

Progress in measurement of ocular blood flow and relevance to our understanding of glaucoma and age-related macular degeneration

New technologies have facilitated the study of the ocular circulation. These modalities and analysis techniques facilitate very precise and comprehensive study of retinal, choroidal, and retrobulbar circulations. These techniques include: 1. Vessel caliber assessment; 2. Scanning laser ophthalmoscopic fluorescein angiography and indocyanine green angiography to image and evaluate the retinal circulation and choroidal circulation respectively; 3. Laser Doppler flowmetry and confocal scanning laser Doppler flowmetry to measure blood flow in the optic nerve head and retinal capillary beds; 4. Ocular pulse measurement; and 5. color Doppler imaging to measure blood flow velocities in the central retinal artery, the ciliary arteries and the ophthalmic artery. These technique have greatly enhanced the ability to quantify ocular perfusion defects in many disorders, including glaucoma and age-related macular degeneration, two of the most prevalent causes of blindness in the industrialized world. Recently it has become clear, in animal models of glaucoma, that retinal ganglion cells die via apoptosis. The factors that initiate apoptosis in these cells remain obscure, but ischemia may play a central role. Patients with either primary open-angle glaucoma or normal-tension glaucoma experience various ocular blood flow deficits. With regard to age-related macular degeneration, the etiology remains unknown although some theories include primary retinal pigment epithelial senescence, genetic defects such as those found in the ABCR gene which is also defective in Stargardt's disease and ocular perfusion abnormalities. As the choriocapillaris supplies the metabolic needs of the retinal pigment epithelium and the outer retina, perfusion defect in the choriocapillaris could account for some of the physiologic and pathologic changes in AMD. Vascular defects have been identified in both nonexudative and exudative AMD patients using new technologies. This paper is a comprehensive update describing modalities available for the measurement of all new ocular blood flow in human and the clinical use.

Regional differences in retinal vascular reactivity

PURPOSE

Although glaucomatous visual field defects are more common in the superior field than in the inferior field, microaneurysms are more frequent in the superior than in the inferior retina in diabetic retinopathy. The authors hypothesized that differences in vascular hemodynamics in the two areas might contribute to these phenomena.

METHODS

The blood flow response to hyperoxia and hypercapnia was evaluated in peripapillary retinal tissue superior and inferior to the optic nerve head using confocal scanning laser Doppler flowmetry. In 14 young, healthy persons, blood flow was measured while breathing room air and during isocapnic hyperoxia (100% O2 breathing) and isoxic hypercapnia (PCO2 increased 15% above baseline). Histograms were generated from pixel-by-pixel analysis of retinal portions of superior and inferior temporal quadrants of the entire image.

RESULTS

Baseline blood flow in the inferior temporal quadrant was significantly greater than in the superior temporal quadrant (P < 0.05). However, the inferior region failed to increase in perfusion during hypercapnia and experienced significant mean blood flow reduction; flow reduction in the pixels at the 25th, 50th, 75th, and 90th percentile of flow; and an increased percentage of pixels without measurable flow, during hyperoxia (each P < 0.05). In contrast, in the superior temporal region, hyperoxia failed to reduce blood volume, velocity, or flow, whereas hypercapnia significantly increased mean flow; increased flow in the pixels at the 25th, 50th, 75th, and 90th percentile of flow; and reduced the percentage of pixels without measurable flow (each P < 0.05).

CONCLUSIONS

The inferior temporal quadrant of the peripapillary retina is, in comparison with the superior temporas region, less responsive to vasodilation and more responsive to vasoconstriction. These differences could contribute to different susceptibility to visual field defect or vascular dysfunction in the superior and inferior retina.

Diurnal variation in plasma norepinephrine in patients with heart failure

Diurnal variation in plasma norepinephrine (PNE) levels is well documented in healthy individuals but not in patients with heart failure. Therefore, we attempted to determine variations in PNE levels over 24 hours, measured hourly, in six patients with an ejection fraction below 40% and a history of heart failure of longer than 3 months. Three controls without a history of heart failure also were evaluated. Both patients and controls had diurnal variations in PNE, with highest levels occurring during the day and lowest at night. When data in patients were evaluated by 6-hour time intervals the mean value for 6:00 A.M.-12:00 noon was approximately twice as high as 12:00 midnight-6:00 A.M. (689+/-329 vs 338+/-166 pg/ml, p<0.05, respectively). Patients also had significant peak to trough variation in PNE levels compared with controls (959+/-396 vs 386+/-84 pg/ml, p<0.02, respectively). These results suggest that significant intrapatient variations in PNE occur over 24 hours in patients with heart failure. These variations may have to be accounted for when evaluating and treating patients with heart failure.

Color Doppler imaging discloses reduced ocular blood flow velocities in nonexudative age-related macular degeneration

PURPOSE

To study ocular perfusion defects in age-related macular degeneration.

METHODS

Twenty-five subjects with nonexudative age-related macular degeneration were compared with 25 age-matched control subjects in studies of flow velocities in several retrobulbar vessels. Color Doppler imaging, which was performed by an examiner who was masked to the subjects' assignment to the control or age-related macular degeneration group, measured peak systolic and end diastolic velocity in the ophthalmic, central retinal, and nasal and temporal posterior ciliary arteries of one eye. A resistive index was calculated from the peak systolic and end diastolic velocity.

RESULTS

Subjects with nonexudative age-related macular degeneration showed a consistent trend toward lower peak systolic and end-diastolic velocities in the posterior ciliary arteries. For example, in the nasal posterior ciliary artery, the mean end diastolic velocity measured 1.45 +/- 0.34 cm per sec in the age-related macular degeneration group compared with 1.96 +/- 0.66 cm per sec in the control group, yielding a 26% decrease in the age-related macular degeneration group, which represented the largest difference and was highly statistically significant (P = .0012). The resistive index was not significantly altered in the nasal or temporal posterior ciliary artery. Subjects with nonexudative age-related macular degeneration did not differ from control subjects in peak systolic velocity, end diastolic velocity, or resistive index in the ophthalmic artery. In the central retinal artery, the end diastolic velocity was lower (1.37 +/- 1.95 cm per sec vs 1.95 +/- 0.66 cm per sec), whereas the resistive index was higher (0.83 +/- 0.05 vs 0.76 +/- 0.06 cm per sec), in the age-related macular degeneration group; these results were highly statistically significant (P = .0007 and P < .0001, respectively).

CONCLUSIONS

Retrobulbar vascular changes in nonexudative age-related macular degeneration subjects include reduced flow velocities in the nasal and temporal posterior ciliary arteries. The reduced peak systolic velocity, combined with the reduced end diastolic velocity at a constant resistive index, seen in nonexudative age-related macular degeneration, is consistent with reduced bulk flow in these vessels, suggesting that choroidal perfusion is abnormal in this form of age-related macular degeneration. The changes in the central retinal artery suggest there may be a more generalized perfusion abnormality beyond the choroid in patients with age-related macular degeneration or that the central retinal artery exhibits a secondary autoregulatory response to a primary change elsewhere.

Glaucoma patients demonstrate faulty autoregulation of ocular blood flow during posture change

BACKGROUND/AIMS

Autoregulation of blood flow during posture change is important to ensure consistent organ circulation. The purpose of this study was to compare the change in retrobulbar ocular blood flow in glaucoma patients with normal subjects during supine and upright posture.

METHODS

20 open angle glaucoma patients and 20 normal subjects, similar in age and sex distribution, were evaluated. Blood pressure, intraocular pressure, and retrobulbar blood velocity were tested after 30 minutes of sitting and again after 30 minutes of lying. Retrobulbar haemodynamic measures of peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI) were obtained in the ophthalmic and central retinal arteries using colour Doppler imaging (CDI).

RESULTS

When changing from the upright to supine posture, normal subjects demonstrated a significant increase in OA EDV (p = 0.016) and significant decrease in OA RI (p = 0.0006) and CRA RI (p = 0.016). Glaucoma patients demonstrated similar changes in OA measures of EDV (p = 0.02) and RI (p = 0.04), but no change in CRA measures.

CONCLUSION

Glaucoma patients exhibit faulty autoregulation of central retinal artery blood flow during posture change.

mRNA expression of netrin-1, an axon guidance protein in chick and rat embryos

The guidance of axons to their targets in developing neurons is believed to be mediated by diffusible chemotropic factors secreted by target cells. In vertebrates, commissural axons pioneer a circumferential pathway to the floor plate at the ventral midline of the embryonic spinal cord. Floor plate cells secrete a diffusible factor called 'netrin', that promotes the outgrowth of axons in the embryonic chick brain. The cloning of cDNAs encoding netrin showed that it is homologous to UNC-6, a laminin-related protein which is required for the circumferential migration of cells and axons in Caenorhabditis elegans. The differential expression of the netrin-1 gene was examined by slot blot analysis in various chick embryonic tissues, especially in the embryonic brain at various developmental stages. The netrin-1 transcript was most strongly expressed in the brain at the early developmental stages of E3 to E7 that corresponds to the time of emergence and full generation of commissural axons in the chick brain. In order to study whether netrin-1 can act as a global cue to guide all circumferentially migrating axons in the CNS, the localization of netrin-1 mRNA expression in the rat embryos was examined by in situ hybridization. Netrin-1 mRNA was detected in the neuroepithelial cells of the ventral midline along the entire rostrocaudal axis of the E18 rat embryo. These results suggest that netrin-1 functions as a global guidance cue for ventrally directed circumferential migrations toward the midline at all axial levels where the floor plate is found.

Development of dried liposomes containing beta-galactosidase for the digestion of lactose in milk

The hydrolyzed-lactose milk for lactase-deficient subjects has a sweeter taste than whole milk, and some subjects dislike its taste. In order to cope with this shortcoming, we examined whether beta-galactosidase, which hydrolyzes lactose, added to the whole milk in the form of dried liposomes, would be able to digest lactose in milk following the lysis of liposomes in the presence of bile salts. Dried liposomes containing beta-galactosidase were prepared in the presence of trehalose by the dehydration-rehydration vesicle method to overcome the instability of the conventional liposome suspension. The stability of liposomal membranes was evaluated by measuring the activity of entrapped beta-galactosidase under various storage conditions. By treating liposomes with trehalose, which was found to prevent the fusion of liposomes and the leakage of entrapped drug, the entrapping efficiency increased up to fourfold. Over 95% of dried liposomes which had been stored at 17 degrees C for 60 days were reconstituted to liposomes upon rehydration process. From the stability study, dried liposomes were found to retain 87% of beta-galactosidase activity at 17 degrees C after 60 days and to be more stable than the multilamellar vesicle suspension prepared without trehalose. The lysis study showed that dried liposomes were hardly lyzed in the simulated gastric fluid with pepsin, but lyzed immediately more than 90% in 0.01 M deoxycholic acid. Lactose hydrolysis in the presence of deoxycholic acid after the addition of dried liposome-entrapped beta-galactosidase to whole milk was proportional to the quantity of entrapped beta-galactosidase and the amount of dried liposomes added. These results demonstrate that beta-galactosidase entrapped in liposome is stable and reconstituted mostly upon rehydration, and can digest lactose in milk after the efficient lysis of liposomes in the presence of bile salts. This study implies that beta-galactosidase entrapped in liposome may be applied to whole milk for lactase-deficient subjects.

Dorzolamide, visual function and ocular hemodynamics in normal-tension glaucoma

The purpose of this study was to determine how a topical carbonic anhydrase inhibitor, dorzolamide, alters visual function and ocular blood flow in persons with normal-tension glaucoma. Eighteen normal tension glaucoma patients, after washout of other ocular medications, were treated for four weeks with 2% dorzolamide, three times daily. A control group of eleven other normal-tension glaucoma patients received placebo eye drops. Patients were studied before treatment, and after two and four weeks of treatment. Each study included assessment of central visual function (contrast sensitivity), intraocular pressure (IOP), and several aspects of ocular hemodynamics, including measures of retinal arteriovenous passage time, retinal arterial and venous diameters, and flow velocities in the ophthalmic, central retinal, and posterior ciliary arteries. Dorzolamide significantly reduced IOP at two and four weeks (each p<0.01), and at the same time increased contrast sensitivity at both three and six cycles per degree (each p<0.05). Neither of these variables changed significantly in the control group. Dorzolamide also accelerated retinal arteriovenous passage time of fluorescein dye, at constant retinal arterial and venous diameters (p<0.05), but failed to change flow velocities in any retrobulbar vessel. The ability of dorzolamide to improve contrast sensitivity in persons with normal-tension glaucoma may be related to either IOP reduction or altered ocular perfusion.

Ginkgo biloba extract increases ocular blood flow velocity

We evaluated a possible therapeutic effect of Ginkgo biloba extract (GBE) on glaucoma patients that may benefit from improvements in ocular blood flow. A Phase I cross-over trial of GBE with placebo control in 11 healthy volunteers (8 women, 3 men: Age; 34 +/- 3 years, mean +/- SE) was performed. Patients were treated with either GBE 40 mg or placebo three times daily orally, for 2 days. Color Doppler imaging (Siemens Quantum 2000) was used to measure ocular blood flow before and after treatment. There was a two week washout period between GBE and placebo treatment. Ginkgo biloba extract significantly increased end diastolic velocity (EDV) in the ophthalmic artery (OA) (baseline vs GBE-treatment; 6.5 +/- 0.5 vs 7.7 +/- 0.5 cm/sec, 23% change, p=0.023), with no change seen in placebo (baseline vs GBE-treatment; 7.2 +/- 0.6 vs 7.1 +/- 0.5 cm/sec, 3% change, p=0.892). No side effects related to GBE were found. Ginkgo biloba extract did not alter arterial blood pressure, heart rate, or IOP. Ginkgo biloba extract significantly increased EDV in the OA and deserves further investigation in ocular blood flow and neuroprotection for possible application to the treatment of glaucomatous optic neuropathy as well as other ischemic ocular diseases.

Efficacy of apraclonidine 1% versus pilocarpine 4% for prophylaxis of intraocular pressure spike after argon laser trabeculoplasty

OBJECTIVE

The authors compared the efficacy of apraclonidine 1% versus pilocarpine 4% prophylaxis of post-argon laser trabeculoplasty (ALT) intraocular pressure (IOP) spike.

DESIGN

Prospective randomized clinical trial.

PARTICIPANTS

Two hundred twenty-eight eyes of 228 patients with primary open-angle glaucoma undergoing ALT were studied.

INTERVENTION

Patients were given 1 drop of either apraclonidine 1% (n = 114) or pilocarpine 4% (n = 114) 15 minutes before ALT.

MAIN OUTCOME MEASURES

Peri-ALT IOPs and incidences of post-ALT IOP spikes at 5 minutes, 1 hour, and 24 hours were compared between the two groups.

RESULTS

The two groups were similar in age, race, and medical dependency. Post-ALT mean IOPs at 5 minutes, 1 hour, and 24 hours were significantly lower than pre-ALT mean IOPs in both apraclonidine (P < 0.001) and pilocarpine (P < 0.001) groups. Incidences of IOP spikes greater than 1, 3, and 5 mmHg at 1 hour post-ALT were 21.1%, 14.9%, and 8.8% for the apraclonidine group and 12.3%, 5.3%, and 4.4% for the pilocarpine group (P = 0.076, 0.015, and 0.18 chi-square test). In the apraclonidine prophylaxis group, patients on long-term apraclonidine showed significantly higher incidence of post-ALT IOP spike than the patients without such long-term apraclonidine use (35.7%, 15 of 42 eyes, vs. 12.5%, 9 of 72 eyes; P = 0.003). In addition, peri-ALT pilocarpine prophylaxis tended to be less effective in patients undergoing long-term pilocarpine therapy but without statistical significance (17.4%, 8 of 46 eyes, vs. 9.4%, 6 of 64 eyes; P = 0.17).

CONCLUSION

Peri-ALT pilocarpine 4% was at least as effective as, if not more effective than, apraclonidine 1% in post-ALT IOP spike prophylaxis. Peri-ALT apraclonidine prophylaxis was not effective in patients on long-term apraclonidine, and peri-ALT pilocarpine prophylaxis tended to be less effective in patients undergoing long-term pilocarpine therapy. Pilocarpine 4% can be considered as a first-choice drug for post-ALT IOP spike prophylaxis, especially in patients under treatment with apraclonidine.

Vascular aspects in the pathophysiology of glaucomatous optic neuropathy

Glaucoma remains a major eye illness with unknown etiology. Although elevated intraocular pressure is clearly a major risk factor, vascular deficits may contribute to initiation and progression of glaucoma. When intraocular pressure is acutely elevated in healthy individuals, the resistance index (derived from the peak systolic and end-diastolic velocities and an indirect index of vascular resistance distal to the site of measurement) in the central retinal and posterior ciliary arteries increases progressively. This result implies that mechanical and vascular factors may be coupled in such a way that perfusion of the retina and optic nerve head may be influenced by changes in the intraocular pressure. Further, at night, when ophthalmic artery flow velocities fall as arterial blood pressure falls in glaucoma patients, the risk of disease progression may be increased. The constancy of these same flow velocities in age-matched healthy individuals points to a possible vascular autoregulatory defect in glaucoma. In addition, in normal-tension glaucoma, vasodilation (CO2 inhalation) normalizes retrobulbar arterial flow velocities, hinting that some vascular deficits in glaucoma may be reversible. Finally, Ca2+ channel blockade improves contrast sensitivity in patients with normal-tension glaucoma, who also show increased retrobulbar vessel flow velocities, a result suggesting that visual function loss may be linked to ocular ischemia. Emerging evidence points to a role of ischemia in the pathogenesis of glaucoma, suggesting that treatments designed to improve ocular blood flow may benefit glaucoma patients.

Behçet's disease sera containing antiendothelial cell antibodies promote adhesion of T lymphocytes to cultured human dermal microvascular endothelial cells

Antiendothelial cell antibodies (AECA) have been detected in the sera of patients of autoimmune diseases showing vasculitis. Using IgM-ELISA, we found AECA in 42 (56%) of 75 sera samples from patients with Behçet's disease in a previous study. All of the 15 AECA-positive sera of Behçet's disease patients had an increased expression of the intercellular cell adhesion molecule-1 (ICAM-1), 93.3% of the sera induced the vascular cell adhesion molecule-1 (VCAM-1), and 100% of the serum induced the E-selectin molecule on human dermal microvascular endothelial cells (HDMEC). After stimulation of HDMEC with AECA-positive sera of Behçet's disease patients, the expression of ICAM-1 and VCAM-1 on HDMEC increased significantly at 4 hours, reaching a peak at 16 hours. Expression of E-selectin was induced at 1 hour after stimulation with a peak at 4 hours and it decreased thereafter. Adherence of T lymphocytes to HDMEC increased significantly after stimulation with AECA-positive sera from Behçet's disease patients. Also, the adherence of T lymphocytes to HDMEC increased at 4 hours and returned to its normal level at 48 hours. These results show that AECA-positive sera of Behçet's disease patients are capable of activating HDMEC to promote the adherence of T lymphocytes to increase the expression of ICAM-1, VCAM-1, and E-selectin on the cell surfaces. The whole process may play an important role in the pathogenesis of vasculitis in Behçet's disease.

Disposition and metabolism of 2-(2''(1'',3''-dioxolan-2-yl)-2- methyl-4-(2'-oxopyrrolidin-1-Yl)-6-nitro-2h-1-benzopyran (SKP-450) in rats

The disposition and metabolism of the new antihypertensive agent 2-(2"(1", 3"-dioxolan-2-yl)-2-methyl-4-(2'-oxopyrrolidin-1-yl)-6-nitro -2H-1-benzopyran (SKP-450) were investigated in male rats after single oral and i.v. doses of 14C-labeled compound. After an oral 2.0 mg/kg dose, mean radiocarbon recovery was 98.2 +/- 2.3% with 31.1 +/- 7.3% in the feces and 67.1 +/- 14.3% in the urine. Biliary excretion of radioactivity for the first 24-h period was approximately 40%, suggesting that SKP-450 is cleared either by hepatobiliary excretion or by renal excretion. SKP-450 was well absorbed; bioavailability calculated on the basis of radioactivity was 68 to 97%. Tissue distribution of the radioactivity was widespread with high concentrations in the liver and kidney but low central nervous system penetration. Radio-HPLC analysis of bile and urine from rats indicated the extensive metabolism of SKP-450 into oxidative metabolites. Oxidative metabolism of the dioxolanyl ring resulted in an aldehyde intermediate, subsequently confirmed in vitro, which was further oxidized to the corresponding carboxylic acid (M1) or reduced to the corresponding alcohol (M3). No parent drug was detected in the urine or bile. Glucuronide conjugate of M3 was also detected in urine and bile, accounting for 5.8 +/- 2.1 and 8.9 +/- 3. 7% of the excreted radioactivity, respectively. Quantitative data obtained from plasma samples suggest that the majority of circulating radioactivity was associated with metabolites. Our results suggest that the long duration of pharmacological activity of SKP-450 (>10 h) is largely attributable to its metabolites.

Peripapillary retinal blood flow in normal tension glaucoma

AIMS

To determine if normal tension glaucoma (NTG) patients differ from age matched controls in blood flow to the peripapillary retina, as measured with confocal scanning laser Doppler flowmetry (cSLDF; "Heidelberg retinal flowmetry").

METHODS

12 NTG patients and 12 age matched controls were compared using (a) 10 x 10 pixel boxes (the instrument default sample size), taken from the nasal and temporal peripapillary retina, (b) the average from two of these boxes, and (c) every qualifying pixel within the peripapillary retina.

RESULTS

Patients and controls did not differ in blood flow measured using the default sample from a single 10 x 10 pixel box, placed in either the temporal or nasal peripapillary retina, or expressed as the average from these two boxes. However, in histograms using every pixel from the peripapillary retina, NTG patients displayed significantly higher percentages of minimal flow pixels (defined as less than one arbitrary unit of flow: 30% v 19%, p < 0.01), and significantly lower flow in the 25th, 50th, and 75th percentile flow pixel (each p < 0.05) than did age matched controls.

CONCLUSION

NTG is characterised by reduced blood flow in the peripapillary retina, a result suggesting that blood flow deficits accompany, and perhaps may contribute to, disease development in these patients.

Screening and selection of acid and bile resistant bifidobacteria

Human fecal samples were used as a source of Bifidobacterium strains which are resistant to both acid and bile. The procedure used for screening was as follows: enrichment of Bifidobacterium strains with Bifidobacterium-selective transgalacto-oligosaccharide-propionate (TP) medium followed by acid (pH 2.0) and bile salt stressing (1.5% bile salt (w/v)). Two selected Bifidobacterium strains, designated HJ 30 and SI 31, showed considerably higher rates of survival when incubated in 50 mM phosphate buffer solution adjusted to pH 2.0 or 3.0 or in 50 mM phosphate buffer (pH 7.0) containing 0.5 or 1.0% (w/v) bile salt. HJ 30 and SI 31 were the only strains to have significant growth in Man Rogosa Sharpe (MRS) medium at 0.15% bile salt. All strains tested had similar growth rates in the absence of bile or at an initial pH value of 5.0 or 7.0 as determined by optical density measurements. For SI 31 the number of viable cell counts remained high (6 x 10(7) cfu/ml) for up to 72 h when grown in the skim milk medium, whereas all other strains examined declined to below 10(5) cfu/ml. These results demonstrate that the screening procedures developed in this study are effective for the selection of acid and bile resistant Bifidobacterium strains.

Brightness alters Heidelberg retinal flowmeter measurements in an in vitro model

PURPOSE

The Heidelberg Retinal Flowmeter (HRF), a laser Doppler flowmetry device, has captured interest as a research and clinical tool for measurement of ocular blood flow. Concerns remain about the range and accuracy of the values that it reports.

METHODS

An in vitro blood-flow model was constructed to provide well-controlled laminar flow through a glass capillary for assessment by HRF. A change in material behind the glass capillary was used to simulate changing brightness conditions between eyes.

RESULTS

Velocities reported by the HRF correlated linearly to true velocities below 8.8 mm/sec. Beyond 8.8 mm/sec, HRF readings fluctuated randomly. True velocity and HRF reported velocities were highly correlated, with r = 0.967 (P < 0.001) from 0.0 mm/sec to 2.7 mm/sec mean velocity using a light background, and r = 0.900 (P < 0.001) from 2.7 mm/sec to 8.8 mm/sec using a darker background. However, a large change in the y-intercept occurred in the calibration curve with the background change.

CONCLUSIONS

The HRF may report velocities inaccurately because of varying brightness in the fundus. In the present experiment, a darker background produced an overreporting of velocities. An offset, possibly introduced by a noise correction routine, apparently contributed to the inaccuracies of the HRF measurements. Such offsets vary with local and global brightness. Therefore, HRF measurements may be error prone when comparing eyes. When used to track perfusion in a single eye over time, meaningful comparison may be possible if meticulous care is taken to align vessels and intensity controls to achieve a similar level of noise correction between measurements.

Effects of long-term hypotensive therapy with nonselective beta-blockers on ocular hemodynamics in primary open-angle glaucoma

PURPOSE

Vascular factors have been implicated in the progression of glaucoma, but the impact of long-term beta blocker therapy on ocular circulation remains largely undefined. The purpose of this study was to prospectively evaluate the level of retrobulbar blood flow in patients with primary open-angle glaucoma (POAG) before and during long-term treatment with a nonselective topical beta blocker, and to compare these measures with those in untreated control subjects.

METHODS

Twelve control subjects and 12 patients with POAG were tested for intraocular pressure (IOP), heart rate, blood pressure, contrast sensitivity, visual field sensitivity, and retrobulbar flow velocity as measured by color Doppler imaging (CDI). Patients were evaluated after 4 weeks of drug washout and again after 3 and 6 months of treatment with a nonselective beta blocking agent. Control subjects were tested once.

RESULTS

At baseline, patients with POAG had significantly higher IOP than normal controls; CDI measures of the central retinal artery (CRA) and short posterior ciliary artery (SPCA) in the patients were significantly different from those in control subjects. In the patients, treatment resulted in a significant reduction in IOP and in CRA and SPCA resistance index.

CONCLUSION

Untreated patients with POAG have altered circulation in the CRA and SPCA compared with subjects of similar age and gender. These measures recover significantly during topical beta blocker therapy. The relationship of the pretreatment deficit and posttreatment recovery of CDI blood flow measures to the progression and therapeutic impediment of glaucomatous optic nerve deterioration remains to be determined.

Flavonoid constituents of Chorizanthe diffusa with potential cancer chemopreventive activity

An ethyl acetate-soluble extract of Chorizanthe diffusa was found to exhibit significant antioxidant activity, as judged by scavenging stable 1,1-diphenyl-2-picrylhydrazyl (DPPH) free radicals and inhibition of 12-O-tetradecanoylphorbol 13-acetate (TPA)-induced free radical formation with cultured HL-60 cells. Bioassay-directed fractionation of this extract using the DPPH antioxidant assay as a monitor led to the isolation of five structurally related flavonoids (1-5), including the novel compound 5,8,3',4',5'-pentahydroxy-3, 7-dimethoxyflavone (1). Isolates 1-5 demonstrated varying degrees of antioxidant or antimutagenic activity. Two of the compounds, 5,7,3', 4'-tetrahydroxy-3-methoxyflavone (2) and quercetin (4), were subsequently found to inhibit carcinogen-induced preneoplastic lesions in a mouse mammary organ culture model. Inhibitory activity of this type is known to correlate with cancer chemopreventive effects in full-term models of tumorigenesis.

The local addition of tenoxicam reduces the incidence of low back pain after lumbar epidural anesthesia

BACKGROUND

Postepidural backache is a common postoperative complaint after lumbar epidural anesthesia. Useful interventions to decrease the incidence of postepidural backache would be helpful.

METHODS

We performed a prospective, randomized, double-blind study to compare the effect of local addition of tenoxicam on the incidence of postepidural backache after nonobstetric surgery. One thousand unpremedicated ASA physical status I or II patients scheduled for hemorrhoidectomy were assigned randomly to tenoxicam or control groups. Patients in the control group received 25 ml lidocaine, 2%, with epinephrine 1:200,000 epidurally and 4 ml lidocaine, 1%, for local skin infiltration. Patients in the tenoxicam group received 25 ml lidocaine, 2%, with epinephrine 1:200,000 epidurally and 4 ml lidocaine, 1%, with tenoxicam (2 mg) 1:2,000 for local skin infiltration. Patients were interviewed at 24, 48, and 72 h postoperatively using a standard visual analog scale for evaluation of postepidural backache. A patient was considered to have postepidural backache when the postoperative visual analog scale score was higher than the preoperative score.

RESULTS

The incidence of postepidural backache in patients in the control group for the 3 days were 22.8%, 17.4%, and 9.2%, all of which were significantly more frequent than observed in the patients in the tenoxicam group (6.8%, 4.0%, and 1.2%, P < 0.01). There was a significant association between backache and multiple attempts at epidural needle insertion.

CONCLUSION

In summary, the local addition of tenoxicam reduced the incidence and severity of postepidural backache.

The genetics of vitiligo in Korean patients

BACKGROUND

Vitiligo is a common disorder whose exact cause is unknown, but genetic factors are thought to be involved. We analyzed 120 Korean proband families to clarify which genetic factors are involved in the pathogenesis of vitiligo in Korean patients.

METHODS

The genetics of vitiligo were analyzed in 120 Korean proband families out of 1030 vitiligo patients. Each family was analyzed through a proband afflicted with vitiligo.

RESULTS

In 51 (42.5%) of 120 proband families, at least one first-degree relative of the proband had vitiligo. The incidence of those affected among 1755 relatives (first-, second-, and third-degree) was found to be 8.0+/-0.6%. There was a statistically significant departure for segregation analysis which was inconsistent with inheritance as an autosomal or X-linked locus model. On the basis of our results, the inheritance pattern of vitiligo is more likely to tend toward the model of multifactorial inheritance. The threshold trait among first-degree relatives (7.2%) appeared to tend more toward the square root of the frequency in the general population (10%) than towards those of dominant (50%) or recessive (25%) models.

CONCLUSIONS

These results indicate that there are certain genetic factors involved in the etiology of vitiligo, and that vitiligo seems to have a polygenic nature.

Regulation of retinal and optic nerve blood flow

Blood flow to the retina and optic nerve remains constant over a range of elevated intraocular pressure or mean arterial pressure, independent of sympathetic activation (pressure autoregulation). In addition, increased metabolic activity in these tissues proportionally increases blood flow (metabolic autoregulation). At constant metabolic rate, altered arterial oxygen content reciprocally alters blood flow, leaving total oxygen delivery constant, while blood flow rises and falls with the arterial carbon dioxide tension. These responses are similar to those of the cerebral circulation. However, while aging, atherosclerosis, arterial hypotension, and individual variation may profoundly alter blood flow regulation and predispose to the development of illness, these factors remain largely unexplored.

Evidence of protein kinase C translocation by ischemic preconditioning in global ischemia model

We tested recent evidence that ischemic preconditioning (PC) involves in translocation of protein kinase C (PKC) from the cytosol to myocyte membrane. Isolated Langendorff-perfused rabbit hearts (n=96) were subjected to 60 or 45 min of ischemia (I) and 120 min of reperfusion (R) with or without PC (4 cycles of 5 min I and 5 min R; or single dose of 5 min I and 10 min R), respectively. Left ventricular function and infarct size (IS) were measured; myocardial cytosolic and membrane PKC activity were determined by 32P-gamma-ATP incorporation into PKC-specific peptide. PC enhanced improvement of functional recovery and reduced IS (26.9+/-1.4% versus 15.3+/-1.9%, p<0.01, in 60 min of I; 18.3+/-2.6% versus 8.6+/-2.5%, p<0.05, in 45 min of I); cytosolic PKC activity decreased 74% of total activity (p<0.05) both in 60 and 45 min of I; membrane PKC activity increased (1.7-fold of baseline, p<0.01, in 60 min of I; 1.8-fold, p<0.01, in 45 min of I; 1.5-fold, p<0.05, in 60 of min I and 120 min of R). From these results, it is concluded that translocation of PKC from the cytosol to myocyte membranes is an important mechanism responsible for PC effect.

Use of bacteriocinogenic lactic acid bacteria to inhibit spontaneous nisin-resistant mutants of Listeria monocytogenes Scott A

Nisin is a bacteriocin with a broad antibacterial spectrum including strains of Listeria monocytogenes. Populations of L. monocytogenes, however, frequently contain spontaneous nisin-resistant mutants. When a culture of L. monocytogenes Scott A was exposed to nisin concentrations between 10 and 500 IU ml-1, the initial decrease in viable numbers was followed by regrowth of survivors to nisin. Nisin-resistant mutants of L. monocytogenes Scott A were isolated after a single exposure to nisin at 100 IU ml-1 and were shown to be sensitive to the non-nisin bacteriocins, sakacin A and enterocin B, produced by Lactobacillus sake Lb 706 and Enterococcus faecium BFE 900, respectively. The regrowth of L. monocytogenes Scott A following the initial decrease due to exposure to nisin was prevented by nisin-resistant Lact. sake Lb 706-la and to a somewhat lesser extent, by Ent. faecium BFE 900-6a. Listerial cells surviving nisin action were thus inhibited by the bacteriocin-producing strains that might be used as starter or protective cultures in foods. Growth of a nisin-resistant mutant of L. monocytogenes Scott A (Li3) was also suppressed by the bacteriocinogenic cultures. Use of nisin in combination with a starter culture producing a non-nisin antilisterial bacteriocin may therefore prevent the emergence of nisin-resistant mutants of L. monocytogenes.