Left ventricular remodelling and improvement in Freestyle stentless valve haemodynamics

OBJECTIVE

To assess how left ventricular (LV) hypertrophy, geometry and function change after stentless aortic valve replacement for aortic stenosis, and to elucidate the physiological mechanism of the improvement in stentless valve haemodynamics.

METHODS

81 patients with aortic stenosis (age 75 +/- 6 years, 47 male) underwent aortic valve replacement (plus CABG in 33 patients) with a Freestyle stentless porcine valve (mean size 23 +/- 2 mm). They were prospectively investigated by Doppler echocardiography at 2 weeks, 3-6, 12, and 24 months after operation. Two hundred and forty-six echocardiograms were obtained and analysed. Aortic valve performance was assessed from its effective orifice area (EOA), the transvalvular increase in mean flow velocity (delta mV), the deceleration time of aortic flow velocity, and mean pressure drop (mPG). LV hypertrophy was assessed from LV mass index; LV geometry, from the ratio of wall thickness to the radius (T/R ratio) and LV function, from stroke volume index (LVSVI) and myocardial stroke work (SW).

RESULTS

By 2 years after operation, LV mass index had fallen from 162 +/- 64 to 109 +/- 36, g/m2, and T/R ratio from 0.61 +/- 0.25 to 0.43 +/- 0.10. LVSVI increased from 29.4 +/- 10 to 42 +/- 17, ml/m2, and myocardial SW from 3.1 +/- 1.6 to 5.2 +/- 2.2, mJ/cm3 (all P < 0.001 by ANOVA), while LV outflow tract diameter remained unchanged. At the same time, stentless valve EOA increased from 1.59 +/- 0.75 to 2.2 +/- 0.72, cm2, and delta mV (from 82 +/- 31 to 49 +/- 24, cm/s) and mPG (from 9.7 +/- 5.0 to 5.2 +/- 3.7 mmHg) both fell significantly (all P < 0.001 by ANOVA): as the deceleration time of aortic flow velocity increased from 153.6 +/- 64.1 to 202.7 +/- 37.6 ms (P < 0.001 by ANOVA).

CONCLUSION

After stentless aortic valve replacement, LV mass index and wall thickness both fall towards normal, and myocardial stroke work increases. These ventricular remodelling processes are accompanied by a more physiological flow jet at valve cusp level, which permits a greater stroke volume to be ejected with a smaller transvavular velocity increase, so that effective orifice area increases.

Effects of incoordination on left ventricular force-velocity relation in aortic stenosis

OBJECTIVE

Tension development is often incoordinate in the hypertrophic left ventricle (LV). The present study aimed to elucidate the possible effects of incoordination on standard LV force-velocity relations in patients with aortic stenosis (AS).

DESIGN

Prospective study during aortic valve replacement with transoesophageal cross sectionally guided M mode echocardiogram, combined with high-fidelity LV pressure recorded by pressure transducer tip catheter, and thermodilution cardiac output.

SETTING

Tertiary cardiac referral centre.

PATIENTS

37 patients (mean (SD) age 63 (12)) years were studied before and 20 hours after aortic valve replacement.

MAIN OUTCOME MEASURES

LV function was assessed regionally by peak velocity of circumferential fibre shortening (peak Vcf), mean systolic wall stress, and peak myocardial power; and globally by LV stroke work index. LV coordination was quantified as cycle efficiency, derived from LV pressure-dimension loop (lower normal limit > or = 76%).

RESULTS

22 patients with a coordinate LV had significantly higher peak Vcf (1.85 (0.47) v 1.46 (0.64) s-1) peak myocardial power (20.8 (8.5) v 12.0 (6.1) mW.cm-3) and global stroke work index (440 (155) v 325 (150) mJ.m-2) than those of 15 patients with an incoordinate ventricle, all P < 0.05; though there was no significant difference in LV end diastolic dimension, mean systolic wall stress, LV mass index, or the incidence of coronary artery disease (P > 0.05, respectively). Furthermore, when contraction was coordinate, mean systolic circumferential wall stress correlated inversely with peak Vcf (r = - 0.71) and positively with peak myocardial power (r = 0.83), both P < 0.01. When contraction was incoordinate, these correlations did not apply; instead peak Vcf (r = 0.65) and peak myocardial power (r = 0.73) both correlated positively with cycle efficiency (P < 0.02 and 0.01, respectively). By 20 hours after surgery, values of cycle efficiency, peak Vcf, and myocardial power were indistinguishable in the previously coordinate and incoordinate groups.

CONCLUSIONS

In aortic stenosis, incoordination causes a fall in LV peak Vcf proportional to the increase in systolic wall stress, and thus modifies the standard LV force-velocity relation to mimic depressed contractility. However, incoordination and subsequent ventricular dysfunction were largely reversible once the aortic stenosis had been relieved.

Effects of valve substitute on changes in left ventricular function and hypertrophy after aortic valve replacement

BACKGROUND

Residual left ventricular hypertrophy adversely affects long-term outcome after aortic valve replacement. A stentless biological valve in the aortic position has been shown to offer a better hemodynamic profile than a stented one. However, it remains to be defined whether this difference is translated into inter-mediate-term effects on left ventricular structure and function.

METHODS

One hundred thirty-seven patients receiving single aortic valve replacement (52 with concomitant coronary artery bypass graft) were enrolled in this study. Ninety-eight were men, and the mean age was 68 years (range, 55 to 90 years). Of the 137 patients, 39 had an aortic homograft, 72 a Toronto stentless porcine valve, and 26 had a stented porcine or bileaflet mechanical valve, with mean valve size of 25 +/- 2.5 mm (mean +/- standard deviation). Left ventricular muscle mass and function were assessed by M-mode echocardiography performed before and 0.5, 6, 12, 24, and 36 months after operation, and recorded on paper for off-line digitizing. Peak valve prosthesis pressure gradients were quantified by continuous wave Doppler.

RESULTS

A total of 330 echocardiograms obtained during this study were adequate for computer digitizing. Clinical data, preoperative left ventricular function, and hypertrophy were similar between the three groups. Significant improvement in left ventricular function and major regression of left ventricular hypertrophy had occurred in the entire population by 6 months after operation. Multivariate analysis of variance showed that patients with previous aortic regurgitation had a larger left ventricular cavity size (p < 0.001) and greater mass index (p = 0.001) postoperatively than those with previous aortic stenosis. In addition, peak valvular gradient was lower (p < 0.001), mass index less (p < 0.001), and left ventricular function more normal both systolic, by a greater peak velocity of dimension shortening (p = 0.05) and wall thickening (p = 0.002), and diastolic, by a greater peak velocity of dimension lengthening (p = 0.046), with an aortic homograft or stentless porcine valve compared with a mechanical or stented biological valve. There was no significant difference in peak valve gradient, left ventricular mass index, or function between the aortic homograft and the stentless porcine valve. Age, sex, and concomitant coronary artery bypass graft, as well as aortic cross-clamp time, cardioplegia method, and valve size all proved to be insignificant determinants of postoperative left ventricular hypertrophy or function.

CONCLUSIONS

In the first 2 years after implantation, the superior hemodynamic performance of aortic homograft and stentless porcine valve appears to result in more extensive regression of ventricular hypertrophy and greater improvement of left ventricular function than occurs with a mechanical or stented biological valve. These findings encourage the use of a stentless biological valve in older patients requiring aortic valve replacement, and a larger scale long-term randomized study of stentless versus stented biological valve or mechanical valve seems warranted.

[An epidemiological study on influenza pandemic]

A cross-sectional epidemiological study on "the relationship between five variables [Fish, Pig, Duck, Chicken and Integrated Fish Farming (IFF)] and influenza pandemic" was carried out in 697 disease surveillance spots in the rural areas of Shandong & Henan provides. Results suggested that ducks might have played an important role in the ecology of influenza. Pigs did not seem to be a greater culprit in ecology of influenza but gave the inconsistent view with the hypothesis that IFF could lead to human influenza pandemic.

Early changes in regional and global left ventricular function after aortic valve replacement. Comparison of crystalloid, cold blood, and warm blood cardioplegias

BACKGROUND

The clinical effects of different cardioplegic methods on left ventricular (LV) function have not been fully elucidated, particularly in the setting of myocardial hypertrophy.

METHODS AND RESULTS

Sixty-four patients (mean age, 62 +/- 12 years; 41 men, 23 women) who were undergoing elective aortic valve replacement (stenosis, 49; regurgitation, 15; concomitant coronary artery bypass grafting, 22), with LV mass index 230 +/- 70 g/m2, were randomized to the following groups: antegrade crystalloid cardioplegia (CCP, 21 patients), antegrade/retrograde cold blood cardioplegia (CBP, 23 patients), or continuous retrograde warm (37 degrees C) blood cardioplegia (WBP, 20 patients). Mean aortic cross-clamp and cardiopulmonary bypass times were 100 +/- 20 and 126 +/- 24 minutes. Positive inotropic drug therapy was required postoperatively in 9 patients after CBP, 14 after CCP, and 18 after WBP. Perioperative LV function was assessed using transesophageal M-mode echocardiography, combined with high-fidelity LV pressure recording and thermodilution cardiac output, before bypass and 0.5, 1, 3, 6, 12, and 20 hours after cross-clamp removal. There was a similar fall in LV peak circumferential wall stress at constant LV end-diastolic dimension in each group after aortic valve replacement. The increase in contraction velocity was significant from 0.5 hour with CBP; however, no significant increase occurred until 12 hours with CCP and until 20 hours with WBP. The rate and extent of LV pressure fall and early diastolic filling rate both increased with CBP, and only in this group did ventricular coordination improve. LV stroke work index was maintained with CBP throughout the postoperative period with less inotropic support than with the other two methods.

CONCLUSIONS

In the hypertrophied LV, CBP offers the best preservation of myocardial physiological response and ventricular function with less inotropic support.

Perioperative assessment of aortic homograft, Toronto stentless valve, and stented valve in the aortic position

We investigated aortic valve hemodynamic performance and perioperative left ventricular function in 50 patients (mean [+/- SD] age, 64 +/- 9 years; 34 men, 16 women) undergoing elective aortic valve replacement, using an aortic homograft (n = 20), a Toronto stentless porcine valve (n = 20), or a stented bioprosthesis (n = 10), by transesophageal echocardiography combined with high-fidelity cavity pressure recordings and thermodilution cardiac output measurements. Thirty-nine patients had aortic stenosis; 11 had predominant regurgitation. Thirteen patients with concomitant coronary artery stenosis underwent grafting. Left ventricular mass index in all patients was 280 +/- 110 g/m2. The transvalvular pressure drop and energy consumption were significantly higher with stented than stentless valves (5 with aortic homograft and 11 with Toronto valve, with matched age and valve size; 20 +/- 12 versus 3 +/- 9 mm Hg; 21% +/- 13% versus 8% +/- 8%, both p < 0.01). However, there was no difference in these variables between the Toronto valve and the aortic homograft (3 +/- 12 versus 2 +/- 10 mm Hg; 5% +/- 14% versus 2% +/- 12%, both p > 0.05), although the Toronto valves (normalized to body surface area) were larger than the aortic homografts (14.4 +/- 1.9 versus 12.6 +/- 1.8 mm/m2, p < 0.01). There was no significant difference in left ventricular stroke volume index or stroke work index in the systemic circulation, either between stentless and stented valves or between aortic homografts and Toronto valves, although the cross-clamp time required to insert a stentless valve was 20 minutes longer than that for a stented valve.(ABSTRACT TRUNCATED AT 250 WORDS)

Anatomical definition of aortic root abscesses by transesophageal echocardiography: planning a surgical strategy using homograft valves

Infective endocarditis of the native or a prosthetic aortic valve may be complicated by abscess cavity development in the aortic root, and successful treatment depends upon early diagnosis, clear anatomical definition preoperatively, and maintaining sterility of the second implant. Homograft valves offer many advantages in this setting. Timing of surgery and the choice of the particular technique depends on accurate characterization of the anatomical details of the abscess. Five cases of paravalvular aortic root abscess in the setting of prosthetic valve endocarditis are described. In each case the diagnosis was made with transesophageal echocardiography, and the information was used in planning the operative procedure of homograft valve replacement. This strategy is proposed as optimal management of this potentially lethal condition.

Local therapy of corneal allograft rejection with cyclosporine

PURPOSE

We evaluated the therapeutic effect of 0.5% topical cyclosporine on human corneal allograft rejection.

METHODS

Sixteen patients (16 eyes) with corneal allograft rejection, refractory to the conventional treatments, were recruited and treated with 0.5% cyclosporine eyedrops in this study.

RESULTS

Of 16 eyes with corneal graft rejection after penetrating keratoplasty treated with 0.5% cyclosporine eyedrops, nine eyes were completely cured, six eyes improved markedly, and treatment was ineffective in one eye. A follow-up of 12 to 24 months (three eyes for 12 months, five eyes for 18 months, and eight eyes for 24 months) disclosed that rejection recurred in three of the nine cured eyes--two eyes after suspension of cyclosporine and one eye after removal of the sutures. The recurrence of rejection resolved by resumption of the cyclosporine eyedrops.

CONCLUSIONS

This study demonstrated that treatment of corneal graft rejection with 0.5% topical cyclosporine yielded good results in eyes with satisfactory preoperative corneal transplantation beds and beneficial effects in eyes with poor preoperative corneal transplantation beds.

Unidentified retained left atrial myxoma: intra-operative detection by trans-oesophageal echocardiography

A 73-year-old woman underwent surgery for removal of a large left atrial myxoma diagnosed by transthoracic echocardiogram. At operation a large tumour was removed, and the left atrium and atrial septum closed. Trans-oesophageal echocardiography prior to weaning from cardiopulmonary bypass revealed that a smaller tumour, which had not been detected by visual inspection or palpation, remained within the left atrium. This was removed through the atrial septum, and the operation completed uneventfully. The patient made a full recovery.

Doppler reconstruction of left ventricular pressure from functional mitral regurgitation: potential importance of varying orifice geometry

OBJECTIVE

To assess the left ventricular pressure pulse, in particular its time course, reconstructed from the continuous wave Doppler signal of functional mitral regurgitation using the simplified Bernoulli equation.

DESIGN

Prospective study with simultaneously recorded high fidelity left ventricular pressure and continuous wave Doppler traces of functional mitral regurgitation, along with indirect left atrial pressure, electrocardiograms, and phonocardiograms.

SETTING

Tertiary referral cardiac centre.

PATIENTS

9 patients (age 60 (17) years) were studied immediately before or 1-20 h after routine cardiac surgery.

RESULTS

104 cardiac cycles were analysed. There were no consistent differences between directly measured and reconstructed pressures in the time intervals from Q to + dP/dt (mean (SD) 125 (35) v 130 (35) ms and from Q to -dP/dt (389 (30) v 387 (28) ms or from Q to maximum pressure (267 (40) v 270 (40) ms, all P = NS). The time from Q to the onset of pressure rise (67 (30) v 64 (30) ms, P < 0.01) and the duration of total left ventricular systole (404 (50) v 408 (50) ms, P < 0.01) measured by the two methods were effectively identical, though the small difference was consistent enough to be statistically significant. The calculated peak pressure drop between the left ventricle and the left atrium (45-100 mm Hg) significantly underestimated left ventricular pressure (72-150 mm Hg; 70 (11) v 105 (15) mm Hg, P < 0.01) even if mean left atrial pressure (14 (4.0) mm Hg) was taken into account. Compared with those directly derived from left ventricular pressure, values of pressure measured at + dP/dt (26 (6.5) v 53 (10) mm Hg, P < 0.01) and -dP/dt (30 (8.0) v 60 (10) mm Hg, P < 0.01), and those of the rates of increase (675 (155) v 815 (155) mm Hg/s, P < 0.01) and fall (610 (145) v 845 (175) mm Hg, P < 0.01) were all significantly underestimated by Doppler. The underestimation in peak rates of pressure change could not entirely be explained by a scaling effect of absolute pressure. To investigate interrelations between the two methods throughout the cardiac cycle, reconstructed left ventricular pressure was plotted against the direct record. The plots confirmed that the reconstructed pressure was always less than directly measured pressure, the relative degree of underestimation falling as the pressure rose. This was not the effect of acceleration but probably reflects changing geometry of the regurgitant orifice.

CONCLUSION

The continuous wave Doppler trace of functional mitral regurgitation is suitable for studying the timing of overall mechanical events and normalised rates of change of pressure in the left ventricle. Estimates of atrioventricular pressure drop by this method and particularly its absolute rates of change seem to be less reliable.

Early changes in left ventricular function after aortic valve replacement for isolated aortic stenosis

To assess the immediate effects of aortic valve replacement (AVR) for valvular aortic stenosis (AS) on left ventricular (LV) systolic and diastolic function and global hemodynamics, 17 patients with AS underwent transesophageal echocardiography combined with high-fidelity LV pressure recording and thermodilution cardiac output measurements before cardiopulmonary bypass and 0.5, 6, 12, and 20 hours after AVR. Compared with results before bypass, LV systolic function had already changed 30 minutes after AVR, and remained constant thereafter: peak LV systolic wall stress decreased (from 210 +/- 60 to 130 +/- 40 g.cm-2), peak rate of dimension shortening increased (from 7.3 +/- 2.2 to 9.7 +/- 2.1 cm.s-1), both p < 0.01. Peak segmental external power thus remained constant (16.6 +/- 6.7 vs 17.7 +/- 7.6 mW.cm-3); p = NS. Changes in LV diastolic function and global hemodynamics were delayed. The peak rate of ventricular pressure decrease, normalized to developed end-systolic pressure, increased (from 15 +/- 3.2 to 19 +/- 5.2 s-1) by 6 hours. The minimal ventricular pressure of early diastole decreased (from 8.9 +/- 4.9 to 4.3 +/- 3.7 mm Hg), the peak rate of dimension lengthening of early diastole increased (from 6.0 +/- 3.0 to 8.8 +/- 2.0 cm.s-1), and LV stroke volume index increased (from 24 +/- 7 to 31 +/- 6 ml.m-2) by 12 hours, all p < 0.01. LV incoordination, defined as the dimension changes during isovolumic periods, had also improved significantly at 20 hours. Heart rate and LV enddiastolic dimension did not change.(ABSTRACT TRUNCATED AT 250 WORDS)

Lactulose--a potential drug for the treatment of inflammatory bowel disease

Lactulose is a drug mainly used as a laxative and for the treatment of porto-systemic encephalopathy. Following oral administration, intact lactulose reaches the colon, where it is split by bacteria, leading to a reduction in faecal pH and creating intestinal conditions beneficial to Lactobacillus acidophilus and inhibitory to coliform bacteria, bacteroides, Salmonella and Shigella. It was shown that lactulose therapy clears faecal salmonella and shigella species and reduces the prevalence of urinary-tract infection and respiratory tract infections. Oral administration of lactulose abolishes and prevents systemic endotoxemia of gut origin. Therefore lactulose may be used for treatment of inflammatory bowel disease as bacteria and bacterial endotoxin have an important role in the pathogenesis of this disease.

[An etiopathological study of Mooren's ulcer]

With the indirect immuno fluorescence technique (IFT), the authors examined sera from 16 patients with Mooren's ulcer for the presence of antibodies against normal rabbit and human corneal epithelial cells, and determined the percentages of peripheral T-lymphocyte subsets in the patients and 20 controls. The results indicated that (1) antibodies against rabbit corneal epithelial cells were positive in 75% of the patients, and antibodies against human corneal epithelial cells were positive in 37.5%, whereas both antibodies were negative in the controls, and (2) the percentage of OKT8+ in patients was significantly lower, and the OKT4+/OKT8+ ratio significantly higher than in the controls. The authors concluded that regulatory imbalance existed in the immune system of the patients, and Mooren's ulcer was an autoimmunologic eye disease.

Immunological analysis and treatment of Mooren's ulcer with cyclosporin A applied topically

Mooren's ulcer is a chronic, painful rodent nonpurulent corneal ulcer. In order to discern the possible role that immunological processes (antibody and cell-mediated) play in the development of a Mooren's ulcer, we evaluated sera from patients (n = 16) for the presence of circulating antibodies against normal rabbit and human corneal epithelium using an indirect immunofluorescent technique (IFT) and determined the T-lymphocyte subsets (CD4, CD8, CD11) in the peripheral blood. This condition was treated with an immunophilin, cyclosporin A (CsA) (0.5% solution), applied topically. Antibodies against rabbit corneal epithelium were detected in 12 of 16 patients (75%), while only six of 16 (37.5%) patients had antibodies against human corneal epithelium. The percentage of CD8 (suppressor T cells) T lymphocytes was significantly lower in patients with Mooren's ulcer than in the controls (p < 0.01). Mooren's ulcer was effectively treated with 0.5% CsA in 11 of 18 (61.1%) affected eyes (n = 14 patients), as determined by long-term (24-31 months) follow-up. We noted particularly that regulatory imbalance existed in the immune systems of the patients. We also think that the limbus and conjunctival lymphoid tissue adjacent to the limbus might play an important role in the pathogenesis of the disease. The detection of serum antibodies against corneal epithelium and determination of T-lymphocyte subsets in the peripheral blood may provide a referential basis for the clinical diagnosis of Mooren's ulcer. Effective treatment with 0.5% topical CsA is primarily through the depression of ocular immunoreactions, although systemic action is not completely ruled out.

Etiopathological investigation of Mooren's ulcer

Using the indirect immunofluorescence test (IFT), the authors examined the sera of 16 patients with Mooren's ulcer for the presence of antibodies against normal rabbit and human corneal epithelial cells, and determined the percentages of T-lymphocyte subsets in the peripheral blood of the patients and controls. The results indicate that (1) serum antibodies against rabbit corneal epithelial cells were positive in 75% of the patients, serum antibodies against human corneal epithelial cells were positive in 37.5%, whereas in 20 normal controls the above serum antibody against both were negative; (2) the percentage of OKT8+ in patients was significantly lower and the OKT4+/OKT8+ ratio significantly higher than those in the controls (P < 0.01). The etiopathogenesis of Mooren's ulcer is discussed and the authors especially point out that regulatory imbalances exist in the patient's immune systems and Mooren's ulcer is an autoimmunological eye disease.

Impaired blood superoxide dismutase in the traumatic paraplegic patients

Blood superoxide dismutase (SOD) activity and blood copper, zinc-superoxide dismutase (Cu.Zn-SOD) content were measured by luminol chemiluminescence assay and by single radial immunodiffusion assay, respectively, in 50 patients with paraplegia due to traumatic injury to the spinal cord by the Tangshan Earthquake on July 28, 1976, compared with 20 age-matched healthy subjects. We found that blood SOD activity and blood Cu.Zn-SOD content in the paraplegic patients were significantly lower than those in healthy subjects (p < 0.01). In healthy subjects, blood Cu.Zn-SOD fully expressed the enzymatic activity, whereas only 77% of blood Cu.Zn-SOD in the paraplegic patients expressed the enzymatic activity, indicating that in the patients, part of blood Cu.Zn-SOD protein is in a state without function. Also the serum lipid peroxide level in the paraplegic patients was higher than that in healthy subjects (p < 0.05). These findings suggest decreased endogenous blood protection against oxygen derived free radicals in these paraplegic patients.

Treatment of severe Mooren's ulcer with cyclosporin A eyedrops

Sixteen patients (21 eyes) with severe, progressive Mooren's ulcer, unresponsive to medical or surgical therapy, were treated with 0.5% cyclosporin A (CsA) eyedrops. Only 18 eyes were included in this study. Fifteen eyes showed marked effects within the first 12 days. Eleven eyes completely healed, on the average, in 1.3 months without side-effects. Follow-up for 24-31 months showed no recurrence. The whole-blood level of CsA determined randomly by high-pressure liquid chromatography in 7 patients was 28.95 micrograms/L on the average. It is concluded that autoimmunological mechanism plays an important part in pathogenesis of Mooren's ulcer, and the efficacy of topical CsA is attributable to its effect of local depression of ocular immunopathological reactions.

[Treatment of severe Mooren's ulcer with cyclosporin A eyedrops]

16 patients (21 eyes) with severe progressive Mooren's ulcer unresponsive to medical or surgical therapy were treated with 0.5% cyclosporin A (CsA) eyedrops. 15 eyes showed remarkable amelioration within 12 days, and 11 eyes completely healed without side effects in an average 1.3 months. The total effective rate was 83.3%, with no recurrence in a follow-up of 12-19 months. Whole-blood levels of CsA were determined by high pressure liquid chromatography to average 28.95 ng/ml in 7 random patients. Autoimmunity was believed to be an important factor in the pathogenesis of Mooren's ulcer, and the efficacy of topical CsA was attributable to the local depression of ocular immunopathological reactions.

[A clinical investigation of rHuIFN alpha-1 in the treatment of herpes simplex virus keratitis]

A double blind clinical investigation on the treatment of 100 cases of HSV keratitis with rHuIFN alpha-1 and acyclovir instillations was carried out in 8 institutions in Beijing and elsewhere. Both eyedrops proved about equally effective with cure rates of 88.1% and 82.9% respectively. Until recently, 128 cumulative cases of various types of HSV keratitis treated with rHuIFN alpha-1 demonstrated a cure rate of 82.0%, indicating that topical rHuIFN alpha-1 was an effective nonspecific remedy for HSV keratitis.

[Treatment of experimental HSV keratitis with recombinant human interferon (rHuIFN): a clinical and scanning electron microscopic study]

Treatment of experimental HSV keratitis in rabbits with rHuIFN alpha-1 instillations was studied Clinical and scanning electron microscopic observations revealed that local application of rHuIFN alpha-1 protected the target cells against virus invasion and restrained development of HSV keratitis. The initial punctate lesions did not expand uniformly but linearly to form dendritic patterns due to varying sensitivity of cells to virus.