Bilateral congenital corneal keloids and anterior segment mesenchymal dysgenesis in a case of Rubinstein-Taybi syndrome

PURPOSE

To report the unusual association of bilateral corneal keloids and anterior segment mesenchymal dysgenesis in a child with Rubinstein-Taybi syndrome.

METHODS

Case report of a 2-year-old boy.

RESULTS

Excision of the epicorneal mass in the right eye was followed by recurrence of the lesion. Multiple penetrating keratoplasties were unsuccessful in reconstructing the anterior segment because of recurrent corneal epithelial breakdown, suggesting limbal stem cell insufficiency. Histopathology and electron microscopy of the excised mass lesion showed features typical of a corneal keloid: thickened keratinized epithelium, absent Bowman's layer, and fibrovascular hyperplasia, with haphazard orientation of the collagen lamellae. Ultrasound biomicroscopy and intraoperative findings suggested a diagnosis of Peter anomaly, but genetic analysis did not show a PAX6 mutation.

CONCLUSION

The findings in our patient add to the spectrum of ocular changes described in Rubinstein-Taybi syndrome and confirm earlier reports of poor ocular prognosis in corneal keloids and Rubinstein-Taybi syndrome.

Screening and in vitro production of diplodiatoxin from the isolates of Stenocarpella maydis and its toxigenic effect on bacterial strains

Stenocarpella maydis from different maize growing regions in South Africa were collected and screened for the presence of diplodiatoxin. The presence of diplodiatoxin in these isolates was detected by thin layer chromatography and further confirmed by atomic pressure chemical ionization mass spectrometry. Samples containing diplodiatoxin showed a strong positive ion at m/z=307. MC34, MC35, MC43 and MC50 isolates of Potchefstroom region produced high amount of diplodiatoxin, whereas some of the isolates from Potchefstroom (D72, D74, D78, D79 and D80) and Cedara (CH3 and U3H) regions did not contain diplodiatoxin. Experiments were conducted to optimize in vitro production of diplodiatoxin using the isolate MC 43. A varied range of pH (3.0 to 5.0) and various culture media viz., PDB, CME, CLM and MSM were tested. Growth of mycelium and production of diplodiatoxin was maximum in PDB media at pH 4.5 and it was observed that diplodiatoxin was produced in detectable quantity in the cultures older than 6 weeks in this media. Further, diplodiatoxin was isolated and purified from 8-weeks-old cultures of MC43 isolate and confirmed by nuclear mass resolution. The standard and the compound purified showed similar NMR spectrum. Sixty-gram (fresh weight) mycelium yielded 19.52 mg of diplodiatoxin. Effect of diplodiatoxin on the growth of various bacterial strains in agar-gelled LB media was studied. They showed different range of tolerance to diplodiatoxin. The increasing order of tolerance to diplodiatoxin was Stenocarpella maydis < B. cereus < B. subtulus < P. fluorescense < E. coli. Further, the effect of different concentrations (4.88-49.70 microg/mL) of diplodiatoxin on the growth of S. aureus in LB liquid media was studied. Presence of diplodiatoxin in the media reduced cell growth as compared to the control thus, confirming anti-bacterial activity of diplodiatoxin.

The diagnostic value of seminal a-glucosidase enzyme index for sperm motility and fertilizing capacity

OBJECTIVE

To find out the diagnostic value of seminal a-glucosidase enzyme index in the ejaculated semen samples of proven-fertility and primary infertility patients, for the sperm motility and fertilizing capacity.

METHODS

The study which lasted approximately 2 years was carried out in the Andrology Department of the Arab Fertility Center, Jeddah, Kingdom of Saudi Arabia. Eighty-five healthy male patients (age 25-38 years) were admitted into the study. They were divided into 2 main groups as proven-fertility group and primary infertility group. Each group was again subdivided into 4 classes based on the sperm concentrations. The sperm motility assessment was carried out quantitatively by Semi automated Computer assisted Semen analysis using Autosperm analyzer. Simultaneously, a-glucosidase enzyme index was determined in all the semen samples.

RESULTS

The results were tabulated as per the standard sperm motility grades of the World Health Organisation, under the classified sperm concentrations of the study. The progressive motility grades were compared with the enzyme index of a-glucosidase in both the groups. The total progressive motility was found higher in the high-density (classes I and II) than the low-density (classes III and IV) semen samples. The enzyme index readings of the various classes of sperm concentrations were significant (p<0.05) and showed a stepwise fall from 89% +/-9% to 52%+/-3% in the proven fertility group. Although, a similar trend has been observed (48%+/-5% to 20%+/-2%) in the primary infertility group, the enzyme index class II sperm concentration (44%+/-6%) was not found significant with class 1 (48%+/-5%) sperm concentration, but the significance was achieved with the other 2 classes. The readings of enzyme index between the groups were found highly significant (p, 0.001).

CONCLUSION

The enzyme index of a-glucosidase estimations in semen samples may indicate a positive correlation with progressive motility and fertilizing capacity of spermatozoa and may serve as diagnostic value in individuals showing normal levels of sperm concentration and serum androgen.

Capsulorhexis phimosis in retinitis pigmentosa despite capsular tension ring implantation

A 56-year-old man with retinitis pigmentosa presented with dense nuclear sclerosis and scattered zonular loss with laxity confirmed by ultrasound biomicroscopy. He had extracapsular cataract extraction with a 6.0 mm continuous curvilinear capsulorhexis and implantation of a capsular tension ring (CTR) and a single-piece poly(methyl methacrylate) (PMMA) intraocular lens (IOL) in the capsular bag in his left eye. Severe anterior capsule fibrosis and contracture of the capsulorhexis opening with nasal decentration of the IOL were noted 4 months after surgery. A neodymium:YAG (Nd:YAG) laser anterior capsulotomy was performed to prevent further zonular stress and IOL decentration. The centripetal forces of capsular fibrosis after cataract surgery may exceed the centrifugal resistance of the standard CTR and PMMA IOL in patients with retinitis pigmentosa. Such patients must be carefully monitored postoperatively. An Nd:YAG laser anterior capsulotomy is a safe and effective option to manage anterior capsule fibrosis.

Interface fluid after laser in situ keratomileusis

We report a case in which raised intraocular pressure (IOP) was associated with interface fluid after uneventful bilateral laser in situ keratomileusis (LASIK). The patient presented with diffuse lamellar keratitis in both eyes 3 weeks postoperatively that was treated aggressively with topical corticosteroids. A steroid-induced rise in IOP resulted in interface fluid accumulation and microcystic edema. Measurements with the Goldmann tonometer revealed an IOP of 3.0 mm Hg in both eyes. However, Schiotz tonometry recorded a pressure of 54.7 mm Hg in both eyes. Reduction in the dosage of topical corticosteroid and medical treatment of the raised IOP resulted in resolution of the microcystic edema and interface fluid accumulation. This case highlights the inaccuracies of IOP measurement after LASIK and the resulting complications.

Bilateral penetrating keratoplasty--indications, results and review of literature

PURPOSE

To analyze the indications, functional results, and rates of graft rejection and failure after bilateral penetrating keratoplasty (PK) in a major eye care hospital and research center in India.

METHODS

Retrospective review of the case records of 38 patients who underwent bilateral PK and had at least 6 months follow-up after corneal transplantation in the second eye.

RESULTS

The mean age of the 38 patients (20 M, 18 F) was 35 +/- 25 years (range, 0.5 to 79 years). Mean follow-up was 49 +/- 23 months (range, 13.4 to 116.4 months) after surgery in the first eye and 31 +/- 22 months (range, 6.6 to 103.6 months) after surgery in the second eye. The average time interval between surgery in the first and second eye was 18 +/- 10 months (range, 0 to 38 months). The commonest indications for surgery were corneal dystrophies (50%), aphakic bullous keratopathy (21%), and keratoconus (11%). Postoperatively, secondary glaucoma occurred in 2 first and 3 second eyes. Best-corrected visual acuity at last follow-up was > 6/12 in 34% of first eyes and 50% of second eyes, and was < 6/60 in 26% and 18% of first and second eyes respectively. Allograft rejection occurred in 4 of the first eyes and 3 of the second eyes. The two-year graft survival rate in first eyes was 70% and in second eyes was 83%. Worse outcomes were noted in grafts performed for secondary endothelial failure. Earlier graft failure occurred in first eyes (54 +/- 5 months) compared to second eyes (79 +/- 10 months) (Logrank Test p = 0.2311).

CONCLUSIONS

Bilateral penetrating keratoplasty has reasonable success in selected patients. Corneal transplantation in the second eye does not seem to increase the risk of graft rejection in either eye.

Influence of cage density and prior dietary phosphorus level on phosphorus requirement of commercial leghorns

Two studies were conducted to determine whether cage density and prior dietary nonphytate P (NPP) level affect hens' P requirements. In Experiment 1, hens were housed at three cage densities (300, 400, and 600 cm2 or 46.5, 62.0, and 93.0 inches2/hen) and fed four levels of NPP (0.15, 0.25, 0.35, and 0.40%) for 6 wk to determine the effect of cage density on the P requirement. Egg production (EP), feed consumption (FC), egg weight (EW), and egg specific gravity (ESG) were measured to evaluate performance. Cage density influenced EP within Week 1 (P < 0.01), and during Weeks 5 and 6, there was a cage density x NPP-level interaction (P < 0.05). At 300 cm2, EP was more severely affected by 0.15 and 0.25% NPP than at 400 and 600 cm2. A linear decrease (P < 0.001) in FC was observed because of decreased NPP. Hens at 300 cm2 consumed 4 g less feed/hen per d than hens at 400 cm2. A linear decrease in EW was observed as the NPP level decreased (P < 0.01) from 0.25 to 0.15%, and there was no effect of cage density. Experiment 2 was conducted to determine the effect of prior dietary P levels on time required to create a P deficiency. Hens fed 0.4% NPP were divided into two groups and fed 0.25 and 0.4% NPP for 4 wk. At the end of 4 wk, hens fed 0.25% NPP were further divided into three groups and were fed diets containing 0.09, 0.25, and 0.30% NPP for an additional 6 wk. Hens fed 0.4% NPP were divided into three groups and fed diets containing 0.09, 0.4, and 0.45% NPP. Reduction of NPP from 0.4 and 0.25% to 0.09% reduced EP by 8.5 and 6.8%, respectively, within 3 wk. Prior NPP levels had no influence on time required to create a P deficiency in terms of EP. Reduction of NPP from 0.4 and 0.25% to 0.09% reduced (P < 0.05) FC. A decline in FC occurred 2 wk earlier in hens previously fed 0.4% than those fed 0.25% NPP. This result indicates that hens fed 0.4% NPP became P deficient more quickly than hens fed 0.25%. We concluded that cage density and prior NPP level affect the hen P requirements or time required to create a P deficiency.

Single microassay for matrix degrading enzymes

Matrix degrading enzymes are implicated in several disease processes such as abdominal aortic aneurysms and emphysema, however, monitoring proteolytic activity in a single assay is not well-established. Numerous assays have been developed to measure matrix degrading enzymes, which use artificial substrates or substrates derived from natural substrate protein. We have recently developed an assay for elastolytic activity based on the detection of primary amines, using trinitrobenzene sulfonic acid (TNBSA), following the digestion of succinylated elastin. The assay is also versatile enough to allow the detection of other proteases through the use of succinylated substrate specific for given protease. In order to improve the sensitivity and versatility of the assay we have refined the buffer conditions (PBS pH 7.2/1 mM CaCl2) to provide a 60 % increase in sensitivity to elastolytic activity and also formulated a substrate mixture containing succinylated elastin, collagen and gelatin. The combination of a substrate mixture and an optimum buffer will allow a spectrum of enzymes to be detected in a single reaction, providing a more complete picture of total proteolytic activity in a biological sample. This assay may also provide a tool to use proteolytic activity as a marker to monitor pathologic conditions involving matrix turn-over.

Developing customer databases

There is a growing consensus among pharmaceutical companies that more product and customer-specific approaches to marketing and selling a new drug can result in substantial increases in sales. Marketers and researchers taking a proactive micro-marketing approach to identifying, profiling, and communicating with target customers are likely to facilitate such approaches and outcomes. This article provides a working framework for creating customer databases that can be effectively mined to achieve a variety of such marketing and sales force objectives.

Observations on the breeding habitat of Aedes species in the steel township, Rourkela

Prompted by report of large number of dengue fever cases in township of Rourkela steel plant, entomological surveys were carried out to know the distribution and extent of Aedes breeding in and around the dengue fever affected areas. Out of 2062 water containers searched, 819 were positive for Aedes larvae. The house index (HI), container index (CI) and Breteau index (BI) were 53.4, 39.7 and 118.5 respectively. 27.9% of the houses had single breeding habitats. The breateau index of single storeyed houses and double storeyed buildings was 149.8 and 54.6 respectively, showing that the single storeyed houses have more potential for Aedes breeding. The breeding preference ratio (BPR) was highest for plastic containers. Three species of Aedes were found breeding in different habitats and Aedes aegypti was found breeding in coolers, cement tanks, tyres and miscellaneous containers with a prevalence rate of 13.2%. The role of entomological surveillance and health education has been highlighted for the control of disease through community participation.

Cystoid macular edema after pediatric intraocular lens implantation: fluorescein angioscopy results and literature review

PURPOSE

To evaluate the occurrence of cystoid macular edema (CME) after lens extraction, anterior vitrectomy, and intraocular lens implantation (IOL) in children using angioscopy after administration of oral fluorescein.

SETTING

Centers in Tamil Nadu, India, and Hong Kong, China.

METHODS

This study comprised 18 children (28 eyes) who had cataract extraction, posterior capsulorhexis, anterior vitrectomy, and in-the-bag IOL implantation. The presence of CME was evaluated 1 week and 4 to 6 weeks after surgery using fluorescein angioscopy.

RESULTS

Anterior chamber fibrin occurred in 4 eyes (14.3%). Fluorescein angioscopy was performed 1 week after surgery in all eyes and after 1 month in 25 eyes (89.3%). No eye demonstrated the presence of CME on fluorescein angioscopy.

CONCLUSIONS

Cystoid macular edema did not occur in the early period after pediatric cataract surgery using current surgical techniques. Longer follow-up is required to ascertain the incidence of CME in the late postoperative period.

Management of atypical epicapsular star

An 18-year-old woman had brown pigment deposits on the central anterior capsule of the lens associated with poor visual acuity and significant anisometropia. Surgical removal of the deposits, phacoemulsification, and intraocular lens implantation resulted in visual improvement. Epicapsular stars are formed by the confluence of multiple fine pigmentary deposits. Although they cause amblyopia, this does not appear to be dense. Surgical removal of these central deposits may improve vision, even if the patient presents as an adult.

Marketing decision support systems for strategy building

Brand teams charged with the commercialization of pharmaceutical products in the pipeline operate in an uncertain environment. Market, customer and competitive interrelationships undergo changes, often in ways that are unpredictable with conventional research practices. This article describes a framework whereby such uncertainty can be managed more effectively in the context of ongoing business needs.

Significance of pathologic patterns of pelvic lymph node metastases in endometrial cancer

OBJECTIVE

The aim of this study was to correlate the pathologic characteristics of pelvic lymph node metastases with survival, recurrence, and patterns of recurrence in endometrial cancer.

METHODS

Sixty patients with epithelial endometrial cancer and pelvic node metastasis were managed surgically between 1984 and 1993 at the Mayo Clinic. The mean number of nodes harvested was 16.7 and the mean number of nodes positive was 3.0. Mean follow-up was 45.5 months. The pathologic patterns of lymph node metastases were characterized.

RESULTS

Outcome was related to pathologic patterns of pelvic node metastasis. Both diameter of lymph node metastasis (P < 0.01) and capsular integrity (P < or = 0.01) influenced 5-year disease-related survival and 5-year progression-free survival. The percentage of biopsied pelvic lymph nodes harboring metastatic disease and the proportion of the involved lymph nodes occupied by tumor significantly influenced death rates and recurrence rates (P < 0.05). The immune response and the absolute number of positive pelvic nodes did not impact recurrence or survival. The above characteristics of pelvic node metastasis correlated also with patterns of recurrence. Regression analysis indicated that capsular integrity (RR = 2.97; P = 0.005) and proportion of positive pelvic nodes biopsied (RR = 3.84; P = 0.01) were significant predictors of recurrence, whereas diameter of metastasis (RR = 3.68; P = 0.02) and proportion of positive pelvic nodes biopsied (RR = 4.04; P = 0.02) were most predictive of survival.

CONCLUSIONS

The pathologic patterns of pelvic node metastasis appear to be significantly related to survival, recurrence, and patterns of recurrence.

Olecranon stress fracture in a weight lifter: a case report

Stress fractures have been reported in the upper limb of sportspeople involved in upper limb dominated events. Olecranon stress fractures have been cited in baseball pitchers, javelin throwers, and gymnasts. The unusual case of a stress fracture of the olecranon in a young weight lifter is reported here. The minimally displaced stress fracture was treated with tension band and two Kirschner wires. The fracture healed in four months and the patient returned to light sports activity after six months.

Atypical adenomatous hyperplasia of the lung: a probable forerunner in the development of adenocarcinoma of the lung

An increasingly large body of work suggests that atypical adenomatous hyperplasia (AAH) of the lung may be a forerunner of pulmonary adenocarcinoma. Recognizing this fact, the World Health Organization now acknowledges the existence of AAH while noting difficulties that may be encountered in distinguishing AAH from the nonmucinous variant of bronchioloalveolar carcinoma. Regrettably, a universally acceptable definition of morphologic criteria for the diagnosis of AAH has not been achieved. This review of the literature examines the epidemiology, gross appearance, light microscopic findings, morphometry, immunohistochemistry, and molecular features of AAH and suggests a set of histopathologic features that may help the practicing pathologist identify this intriguing lesion. These features include the following: irregularly bordered focal proliferations of atypical cells spreading along the preexisting alveolar framework; prominent cuboidal to low columnar alveolar epithelial cells with variable degree of atypia but less than that seen in adenocarcinoma; increased cell size and nuclear-cytoplasmic ratio with hyperchromasia and prominent nucleoli, generally intact intercellular attachment of atypical cells with occasional empty-looking spaces between them without high cellularity and without tufting or papillary structures; and slight thickening of the alveolar walls on which the AAH cells have spread, with some fibrosis but without scar formation or significant chronic inflammation of the surrounding lung tissue. Several lines of evidence indicate that AAH is a lesion closely associated with adenocarcinoma of the lung, suggesting AAH may be involved in the early stage of a complex multistep carcinogenesis of pulmonary adenocarcinoma.

Effect of preoperative keratometry on refractive outcomes after laser in situ keratomileusis

PURPOSE

To evaluate the effect of preoperative keratometry on the refractive outcome after laser in situ keratomileusis (LASIK) for myopia.

SETTING

University Eye Clinic, Prince of Wales Hospital, Hong Kong, China.

METHODS

In this retrospective study, the records of patients who had LASIK for myopia greater than -6.0 diopters (D) using the Chiron Automated Corneal Shaper and the Schwind Keratome-F excimer laser were reviewed.

RESULTS

Laser in situ keratomileusis was performed in 167 eyes of 103 patients (mean age 34.7 years +/- 7.5 [SD]). Preoperative myopic spherical equivalent (SE) refraction was -9.0 +/- 2.0 D (range -6.0 to -13.9 D). Three months after surgery, SE refraction was -0.04 +/- 1.1 D (range +2.3 to -3.3 D); uncorrected visual acuity > or = 20/40 was present in 91.8% of 110 eyes in which emmetropia was the postoperative goal. Mean preoperative keratometry was 43.9 +/- 1.5 D (range 40.3 to 48.1 D). When eyes were stratified by the degree of preoperative myopia in 1.0 D steps, a trend toward greater undercorrection was noted in eyes with preoperative keratometry < 43.5 D than in those with steeper keratometry (> 44.5 D) in all myopia groups except the -7.0 to -7.9 D group. This difference was statistically significant in eyes with a preoperative SE of -10.0 to -10.9 D and -11.0 to -11.9 D.

CONCLUSIONS

Preoperative keratometry appeared to influence the refractive outcome after myopic LASIK. Eyes with flatter corneas tended to have greater undercorrection than eyes with similar myopia and steeper corneas. Validation of these findings in larger data sets using the methodology described may improve the predictability of current LASIK nomograms, particularly in eyes with high myopia.

Insect wing case: unusual foreign body

PURPOSE

To report five cases of insect wing case foreign body.

METHODS

Clinical presentation, investigations, management, and outcome of these cases are discussed.

RESULTS

Five patients, four males and one female, in the age group from 4 to 55 years presented with an insect wing case embedded in the cornea or peripheral limbus. All patients were relatively asymptomatic, and the foreign body was associated with vascularization and infiltration. Culture of the foreign body after removal showed Staphylococcus epidermidis in two cases and Corynebacterium species and Mycobacterium fortuitum in one case each. All patients responded to removal of the wing case foreign body and treatment with topical ciprofloxacin (0.3%).

CONCLUSION

Insect wing case is an unusual foreign body and produces minimal symptoms and may be associated with infective agents in some patients.