Mediastinal pancreatic pseudocyst with recurrent pleural effusion. Demonstration by endoscopic retrograde cholangiopancreatogram and subsequent computed tomography scan

Mediastinal pseudocysts of internal pancreatic fistulas are rare as a cause of bilateral pleural effusions even in relapsing pancreatitis. We describe a 38-year-old man with recurrent bilateral pleural effusion as a complication of a pancreatic pseudocyst. Extension of a pancreatic pseudocyst into the posterior mediastinum was clearly identified by endoscopic retrograde cholangiopancreatogram and subsequent computed tomography scan of the abdomen and chest, and the complication was successfully treated by surgical management. We stress the importance of definite assessment of the communication of pancreatic pseudocyst with mediastinum in patients with pancreatitis who develop recurrent pleural effusions.

Intraocular pressure-dependent dynamic changes of optic disc cupping in adult glaucoma patients

The authors performed a study of intraocular pressure-dependent changes in optic disc cupping in 17 adults with chronic open-angle glaucoma. Analyses with the Rodenstock Optic Nerve Head Analyzer were performed at baseline low intraocular pressure during therapy, after elevation of intraocular pressure (from therapeutic failure or noncompliance), and after reduction of intraocular pressure with successful therapy. Optic disc cupping increased significantly upon short-term increase of intraocular pressure from baseline of 20.4 +/- 2.5 mmHg to 31.1 +/- 5.9 mmHg. Optic disc cupping reverted to baseline after persistent intraocular pressure reduction to 19.3 +/- 4.8 mmHg. These data demonstrate intraocular pressure-dependent dynamic changes of optic disc cupping in patients with demonstrable glaucomatous optic nerve damage. They underscore the detrimental effect of elevated intraocular pressure and the beneficial effect of intraocular pressure reduction on optic disc cup changes.

Transcriptional regulation of p90 with sequence homology to Escherichia coli glycerol-3-phosphate acyltransferase

We have previously isolated cDNA clones for several mRNAs that are dramatically increased in livers of fasted mice refed a high carbohydrate diet. We report here the sequence and regulation of one such mRNA; the 6.8-kilobase mRNA has an open reading frame of 2481 nucleotides, and the coded protein contains 827 amino acid residues (Mr of 90,000) with a 30% identity and an additional 42% similarity in an approximately 300-amino acid stretch to Escherichia coli glycerol-3-phosphate acyltransferase. The p90 mRNA is highly expressed in liver and in adipose tissue. When previously fasted mice were refed a high carbohydrate, fat-free diet, the liver mRNA level for p90 was increased about 20-fold at 8 h. Administration of dibutyryl cAMP at the time of refeeding prevented the increase in the p90 mRNA by 70%. In addition, there was no increase in the p90 mRNA level when previously starved streptozotocin-diabetic mice were refed. In diabetic animals, the p90 mRNA level increased by 2-fold 1 h after insulin injection and reached a maximum of 19-fold after 6 h. The increase in transcription rate of the p90 gene preceded that of steady state mRNA level caused by fasting/refeeding, and cAMP abolished the increase in transcription. Transcription of the p90 gene was not detectable in either fasted or refed streptozotocin-diabetic mice, but increased 4-fold 30 min after insulin administration and further increased up to 8-fold at 2 h. On-going protein synthesis was necessary for this increase.

PERG and spectral sensitivity in ocular hypertensive and chronic open-angle glaucoma patients

Pattern electroretrinography (PERG) was performed in 33 patients with chronic open-angle glaucoma (COAG), 18 ocular hypertensive (OH) patients, and 24 normal subjects. COAG patients exhibited significantly lower PERG amplitudes than did normal subjects (P8rps = 0.025; P16rps less than 0.0001). The OH patients fell into two distinct groups: those with normal PERG scores and those with lower than normal scores. OH patients with PERG scores significantly lower than control values demonstrated significantly larger cup-to-disc ratios (P = 0.002) and higher initial intraocular pressures (IOPs) than did OH patients with normal PERG scores (P = 0.021). In the 11 OH patients in whom spectral sensitivity measurement was available, statistically significant correlations were found between the blue-cone sensitivity loss and the PERG amplitude (r8rps = 0.772, P8rps = 0.0053 and r16rps = 0.699, P16rps = 0.0167, respectively. Our results demonstrate reduced PERG amplitude in high-risk OH patients and further illustrate the correlation between PERG amplitude and blue-cone spectral sensitivity in OH subjects. Confirmation of the roles of PERG and spectral sensitivity in the detection of early glaucoma requires longitudinal study.

Visual field global indices in patients with reversal of glaucomatous cupping after intraocular pressure reduction

The authors investigated visual field changes in 28 eyes of 28 adult patients with early-to-moderate chronic open-angle glaucoma (COAG) in whom reversal of glaucomatous disc cupping was documented by computerized image analysis (Rodenstock Optic Nerve Head Analyzer) after intraocular pressure (IOP) reduction from 29.3 (+/- 5.9) to 19.4 (+/- 4.3) mmHg over 34.8 (+/- 24.8) weeks. Humphrey Statpac global indices (mean deviation and pattern standard deviation) improved in direct proportion to the magnitude of IOP reduction even after controlling for the possible influences of learning effect, short-term fluctuation, reliability, duration of IOP reduction, age, and pupil size. The mean visual field global indices (mean deviation and pattern standard deviation) improved in patients with IOP reduction of 40% or greater, in statistically significant contrast to no improvement of mean global indices with IOP reduction less than 35%. The beneficial effect of IOP reduction is apparent in COAG patients with topographical evidence of reversal of cupping.

Additive effect of 1% apraclonidine hydrochloride to nonselective beta-blockers

The short-term additive effect and side effects of adding 1% apraclonidine hydrochloride to nonselective beta-blockers were investigated in 21 patients with ocular hypertension or early primary open-angle glaucoma. After a unilateral single dose application of topical 1% apraclonidine hydrochloride, intraocular pressure (IOP), heart rate, and interpalpebral distance were measured. The mean IOP of treated eyes showed a decline from a baseline of 20.0 +/- 3.0 mmHg to 18.1 +/- 3.2 mmHg at 1 hour (P less than 0.005), 16.5 +/- 2.6 mmHg at 2 hours (P less than 0.001), 15.2 +/- 2.5 mmHg at 3 hours (P less than 0.001), 18.5 +/- 3.0 mmHg at 12 hours (P = 0.02), and 19.2 +/- 2.9 mmHg at 24 hours (P = 0.2). No statistically significant change in the heart rate was seen. The interpalpebral distance of the treated eyes showed a significant increase (P less than 0.05) at all time intervals except 24 hours (P = 0.17). The authors conclude that 1% apraclonidine hydrochloride provides an additive pressure-lowering effect to nonselective beta-blockers for at least 12 hours after a single application, and shows promise as a useful adjunctive agent for short-term use in glaucoma therapy.

Intraocular pressure-dependent retinal vascular change in adult chronic open-angle glaucoma patients

Intraocular pressure (IOP)-dependent retinal vascular changes were investigated in 33 eyes of 33 adult chronic open-angle glaucoma (COAG) patients by measuring major retinal vascular calibers at the optic disc border before and after mean (+/- standard deviation) IOP reduction from 35.3 (+/- 7.2) to 16.5 (+/- 4.7) mmHg for 11.2 (+/- 13.5) weeks. Both mean arterial and venous calibers were significantly reduced (P less than 0.0001 for each), from 87.8 (+/- 14.2) and 128.3 (+/- 20.8) microns at high IOP to 82.0 (+/- 13.8) and 121.4 (+/- 18.5) microns at low IOP. Arterial and venous caliber decreases correlated positively with magnitude of IOP reduction (r = 0.503, P less than 0.01 and r = 0.555, P less than 0.001, respectively). While the IOP-dependent retinal arterial caliber change was highly significant in patients 55 years of age or younger (r = 0.636, P less than 0.01) and in the overall study group, it was not significant in patients older than 55 years (r = 0.205, P greater than 0.1). Age seems to be more influential than magnitude of IOP reduction in patients older than 55. Thus, diminished IOP-dependent retinal arterial caliber change in the elderly may be one factor contributing to the higher incidence and prevalence of glaucoma in this population.

Visual field defects in diabetic patients with primary open-angle glaucoma

We reviewed the automated visual field tests of 110 nondiabetic and 87 diabetic patients with primary open-angle glaucoma randomly selected from a large glaucoma practice to investigate a possible qualitative difference in the pattern of visual field defects between nondiabetic and diabetic patients with primary open-angle glaucoma. A single reviewer analyzed, in masked fashion, the visual field tests of each patient and decided whether or not visual field defects were present mainly in the inferior half of the visual field. Of the 110 nondiabetic patients, 40 (36.4%) had visual field defects located mainly in the inferior half of the visual field in one or both eyes, whereas 56 of the 87 (64.4%) diabetic patients had such defects. This difference was statistically significant (P = .0001). We believe that a vascular factor, such as that attributable to diabetes mellitus, may influence glaucomatous optic nerve damage, thus causing a difference in the pattern of visual field loss in patients with primary open-angle glaucoma.

Pattern of publication of ophthalmic abstracts in peer-reviewed journals

Presentation of research work at scientific meetings and professional societies is an important first step toward effective scientific communication of research results. To determine the current publication patterns of abstracts, a computerized MEDLINE literature search was performed on 175 randomly selected ophthalmic clinical and basic science abstracts published in conjunction with two ophthalmic national meetings. This search revealed that 105 abstracts (60%) led to full-length articles in peer-reviewed journals within 50 to 56 months of the meeting date. A median interval of 13 months occurred from date of abstract publication to acceptance of the corresponding article. Most articles appeared within 3 years of abstract presentation. Sixty-four percent (48 of 75) of the posters and free papers presented at the annual meeting of the American Academy of Ophthalmology in November 1984 led to full-length articles, as did 57% (57 of 100) of the abstracts presented at the annual meeting of the Association for Research in Vision and Ophthalmology in May 1985. These findings emphasize the preliminary nature of abstracts. The fact that nearly 60% of abstracts are published reflects favorably on the review process of both meetings.

Computerized optic disc analysis with adjunct stereoscopic viewing of disc photographs

We have investigated the potential usefulness of stereoscopic viewing of optic disc photographs in marking the disc margin in computerized analysis with the Rodenstock Analyzer in 48 eyes of 26 patients with ocular hypertension or primary open-angle glaucoma. Marking of the disc margin without Method 1) and with the aid of stereoscopic viewing of disc photographs (Method 2) three consecutive times by one observer at the same sitting, and three subsequent topographic analyses of each method were done on each 48 eyes. The mean intraphotographic variabilities of such optic disc parameters as rim area, and cup volume with Method 2 were significantly less than those with Method 1 overall and in 16 eyes (33%) with poor video images having an ill-defined disc margin (p less than 0.05 for each), but not in 32 eyes (67%) with clear video images having a well-defined disc margin. Furthermore, the mean paired differences of rim area, disc area and cup volume between the two methods (Method 1 minus Method 2) were also statistically significant overall and in eyes with poor video images (p less than 0.05 for each).

Oncocytic glomus tumor of the trachea

An oncocytic variant of glomus tumor of the trachea occurred in a 47-year-old woman. She experienced intermittent cough and hemoptysis for about three years. Bronchoscopy and chest CT scan showed a small reddish polypoid tumor on the lower end of the trachea. Bronchoscopic biopsy was carefully done and was diagnosed as oncocytoma. A wedge resection of the tumor was done. Tumor cells were characterized by strongly eosinophilic granular cytoplasm on light microscopy and by numerous closely packed round or ovoid mitochondria with prominent tubular cristae on electron microscopy. They were arranged in a sheet around small vessels, as a result of which the biopsy diagnosis of oncocytoma was changed to oncocytic glomus tumor. To our knowledge, this is the first report of an oncocytic glomus tumor arising from the trachea.

Prevalence of Paragonimus westermani in some Ulchin school children

In order to estimate the prevalence of Paragonimus westermani among the school children in Ulchin county, Kyungpook Province, five primary schools were selected for sampling. The children were first examined using an intradermal test with Paragonimus antigen, Lot No. 890417, and then examined for Paragonimus eggs from sputa and stools collected from the intradermal-positive cases. In a total of 382 children examined, 53 cases or 13.9 percent revealed positive reactions for Paragonimus westermani. The sex specific rate of infection was a little higher in boys than in girls. The age specific rate of Paragonimus westermani infections varied from age to age. Paragonimus westermani was most prevalent in the 8-year-old group in both sexes and showed about the same proportion among boys and girls of each age group. A comparison of the reliability for the detection of Paragonimus eggs from intradermal positive cases in this study showed that the sputum test was more sensitive than the stool test. Summarizing the results, this study indicates that the prevalence for Paragonimus westermani is still high and the endemic foci of the fluke exists in Ulchin county, Kyungpook Province, Korea.

Enhancing filtration in the early postoperative trabeculectomy refractory to digital massage

Digital massage often can be used to lower intraocular pressure (IOP) after trabeculectomy or trabeculectomy combined with extracapsular cataract extraction and intraocular lens implantation. However, occasionally filtration, and thus IOP reduction, is refractory to massage. We present a pressure-lowering technique in which focal pressure is applied adjacent to the trabeculectomy flap firmly enough to indent the sclera and induce bleb formation.