Optic disk neovascularization in a patient with cytomegalovirus retinitis associated with renal transplantation

PURPOSE

To report the development of optic nerve head neovascularization during the recovery phase of cytomegalovirus (CMV) retinitis in a renal allograft recipient.

CASE REPORT

A 46-year-old male renal allograft recipient developed CMV retinitis seven months after transplantation. At the time of the diagnosis, the patient was being immunosuppressed with prednisone, cyclosporine, and azathioprine, and was treated with repeated intravitreal and intravenous ganciclovir. Six weeks after the initiation of therapy, optic disk neovascularization developed. This was confirmed by fluorescein angiography, which showed no areas of retinal capillary nonperfusion. At this stage, active retinal lesions were partially resolved. Apart from intraocular inflammation, no other cause of neovascularization was detected. Over the following six months, optic disk neovascularization regressed spontaneously without causing vitreous hemorrhage or visual loss. There was no recurrence of CMV retinitis during follow-up.

CONCLUSION

Optic disk neovascularization may develop in the healing phase of CMV retinitis in renal transplant recipients.

Evaluation by exercise testing of children with mild and moderate valvular aortic stenosis

BACKGROUND

The aim of the present paper was to determine the factors related to sudden death in aortic stenosis.

METHODS

The factors related to sudden death were investigated in 40 asymptomatic children with mild and moderate aortic stenosis by treadmill testing.

RESULTS

The QT interval of aortic stenosis cases were significantly longer than those of healthy children with increasing heart rates during exercise.

CONCLUSIONS

A longer QT interval of aortic stenosis cases compared to normal children during exercise is the first sign of myocardial ischemia and leads to fatal ventricular arrhythmias and sudden death. For this reason we recommend that exercise testing should be performed frequently in aortic stenosis patients and that close follow up is necessary for patients with long QT segments that can be a marker for severe arrhythmias.

Role of the vitreous in age-related macular degeneration

PURPOSE

To investigate the relationship between posterior vitreous detachment (PVD) and age-related macular degeneration (AMD).

METHODS

The condition of the vitreous was examined by slit-lamp funduscopy and ultrasonography in 93 eyes of 50 patients with AMD (exudative or dry) and 100 eyes of 50 controls.

RESULTS

There was complete PVD in 31 of the 93 eyes (33.3%) of 50 patients with AMD and the posterior vitreous was attached in 62 of these eyes (66.6%). In the control group, in 50 eyes (50%) of 50 subjects there was posterior vitreous detachment. The prevalence of PVD in eyes with macular degeneration was significantly lower (P < .05). There was no statistically significant difference between the exudative and the nonexudative groups in respect to PVD.

CONCLUSIONS

PVD may have a protective role against the development of AMD. Chronic vitreomacular traction and/or continuous exposure to free radicals and cytokines may possibly be one of the causes of AMD in eyes with attached vitreous.

Disulfonic stilbene prevents selenite-induced cataract in rat pup lens

It is known that the subcutaneous injection of a single dose of sodium selenite into suckling rats results in the development of large nuclear opacities. The intracellular transport of selenite in various cells, except lens cells, occurs via the Cl/HCO3 exchanger. The aim of the present study is to investigate the possible role of the anion-exchange inhibitor, disulfonic stilbene (SITS), in the selenite-induced catarogenesis in the rat pups. Wistar albino rats (8-10 d old) were separated into three groups: one control and two experimental. The first experimental group was injected subcutaneously with a single dose of 30 nmol sodium selenite/g body weight. The second experimental group was injected with a single dose of 10 nmol SITS/g body weight 15 min before the same dose selenite injection. The control group did not have any injections. The stage of cataract development was examined on d 7 postinjection with slit-lamp photographs. In SITS pretreated group, all eyes remained transparent (considered as stage 0), whereas in the selenite-injected group, the animals did have different stage of nuclear cataract; 8 animals have stage 5, 10 animals have stage 4, and 4 animals have stage 3. A pretreatment of SITS completely prevented cataract formation of the selenite-induced cataract model in rat pups.

Retinal tears associated with panuveitis and Behçet's disease

To report retinal tears formation in 3 eyes of 2 patients with active panuveitis and Behçet's disease. We describe 2 patients that were diagnosed and treated for Behçet's disease with active panuveitis. Retinal tears developed while the inflammation was active. The patients were treated with topical, oral steroids, and cyclosporine therapy for bilateral panuveitis. One patient presented with a retinal tear located at the periphery of the active retinal lesion. The other had multiple tears associated with active retinal lesions in both eyes. Argon laser photocoagulation was performed in both patients as soon as the tears were detected. Ocular inflammation was controlled with this therapy, and only a few mild flare-ups occurred. The patients have been followed up for 8 and 16 months, respectively. During this period no new retinal tears have developed. Although retinal tear formation is rarely associated with Behçet's panuveitis, the clinician should be aware of this as a possible complication. When structural changes are present in the vitreous, detailed ophthalmoscopy is indicated to assess for retinal tears. If a tear is detected in a patient with panuveitis and Behçet's disease, laser photocoagulation therapy should be performed immediately to prevent retinal detachment.

Malnutrition and growth failure in cyanotic and acyanotic congenital heart disease with and without pulmonary hypertension

AIM

To investigate the effect of several types of congenital heart disease (CHD) on nutrition and growth.

PATIENTS AND METHODS

The prevalence of malnutrition and growth failure was investigated in 89 patients with CHD aged 1-45 months. They were grouped according to cardiac diagnosis: group aP (n = 26), acyanotic patients with pulmonary hypertension; group ap (n = 5), acyanotic patients without pulmonary hypertension; group cp (n = 42), cyanotic patients without pulmonary hypertension; and group cP (n = 16), cyanotic patients with pulmonary hypertension. Information on socioeconomic level, parental education status, birth weight and nutrition history, number of siblings, and the timing, quality, and quantity of nutrients ingested during weaning period and at the time of the examination were obtained through interviews with parents.

RESULTS

There was no significant difference between groups in terms of parental education status, socioeconomic level, duration of breast feeding, and number of siblings (p > 0.05). Group cP patients ingested fewer nutrients for their age compared to other groups. 37 of the 89 patients were below the 5th centile for both weight and length, and 58 of 89 patients were below the 5th centile for weight. Mild or borderline malnutrition was more common in group aP patients. Most group cp patients were in normal nutritional state, and stunting was more common than wasting. Both moderate to severe malnutrition and failure to thrive were more common in group cP patients.

CONCLUSION

Patients with CHD are prone to malnutrition and growth failure. Pulmonary hypertension appears to be the most important factor, and cyanotic patients with pulmonary hypertension are the ones most severely affected. This study shows the additive effects of hypoxia and pulmonary hypertension on nutrition and growth of children with CHD.

Helicobacter pylori antibodies in hemodialysis patients and renal transplant recipients

In this cross-sectional, controlled study, Helicobacter pylori (H. pylori) infection, a probable factor in the development of gastrointestinal problems, was investigated in dialysis patients and renal transplant recipients. Forty-seven dialysis patients (22 male, 25 female, mean age of 36.6 +/- 15 yr (range 18-83 yr)), 57 renal transplant recipients (39 male, 18 female, mean age of 36.8 +/- 10 yr (range 19-60 yr)) and 55 healthy individuals (34 male, 21 female, mean age of 33.4 +/- 9.6 yr (range 21-58 yr)) were included and no significant difference was found in the study groups. The mean time spent on dialysis in the hemodialysis group was 32.5 +/- 27.7 months (range 1-100 months). H. pylori antibodies were detected in 22 of 57 (38.6%) patients in the transplantation group, 31 of 47 (65.9%) patients in the dialysis group and 39 of 55 (72.5%) in the control group. No correlation was found between H. pylori infection and age, sex, primary disease, frequency of dialysis, duration and type of transplantation and the immunosuppressive therapy. However, patients with H. pylori antibodies spent a shorter time on dialysis compared to patients without the antibodies (26.6 +/- 23.5 vs 44.1 +/- 32.1 months, p = 0.038). The frequency of H. pylori infection in the transplantation group was significantly lower than the control and dialysis groups (p < 0.01). This finding may be explained on the basis of decreased humoral antibody response to H. pylori infection, secondary to immunosuppressive therapy rather than decreased incidence of infection in the transplantation group. Finally, we concluded that the value of the serological test for diagnosis of H. pylori infection should be interpreted cautiously in these patient groups.

Central diabetes insipitus in a patient with congenital toxoplasmosis

A 33-day-old male infant who developed central diabetes insipitus as a complication of congenital toxoplasmosis is presented. He had polyuria and hypernatremia on admission and responded to Intranasal desmopressin acetate with the normalization of above mentioned findings. Computed tomographic (CT) scan of the brain showed obstructive hydrocephaly with periventricular and right basal ganglion calcification. CT scan of the pituitary gland, thyroid function tests, and serum cortisol levels were all normal. This is the first report of isolated diabetes insipitus with congenital toxoplasmosis in literature and central diabetes insipitus should be remembered if polyuria and hypernatremia develops in a patient with congenital toxoplasmosis.

The effect of selenium and vitamin E on microvascular permeability of rat organs

The effects of dietary sodium selenite and vitamin E on the microvascular permeability of rat organs such as heart, brain, kidney, liver and eye were investigated by using the Evans blue leakage method. Combined deficiency of selenium and vitamin E caused an increase in the permeability of the heart and eye with respect to their controls while it had no considerable effect on the permeability of other organs. On the other hand, toxic levels of selenium (4.2 mg/kg) in diet decreased the permeabilities in kidney, liver, and eye whereas this parameter of brain increased in the same animal group. These results suggested that low or high sodium selenite and vitamin E contents in diet could alter the microvascular permeability of different organs in different manners. It might be important to give reasonable explanations for the pathophysiology of some diseases that are characterized with organ damage and/or disfunction originated from selenium deficiency or toxicity.

Antibodies reactive with HIV-1 antigens in systemic lupus erythematosus

Antibodies reactive with retroviral gag proteins have been detected in patients with systemic lupus erythematosus (SLE). We investigated the immune responses against human immunodeficiency virus (HIV) 1 antigens in the sera of 44 Turkish patients with SLE. Serum samples were tested by using two different commercial enzyme immunoassay (EIA) kits and by Western blotting. EIA studies revealed positive results in 12 patients (27%) for HIV-1 antigens by one of the kits that coated with purified viral antigens. Immunoblot analysis showed antibodies mainly to retroviral gag proteins in 23 patients (52%). The most frequent reactivity was against the p18 gag protein (n = 9). Although antibodies reactive particularly with p24 antigen were described in the previous reports, antibodies to p24 were found in only two patients. These findings might reflect a serologic diversity in different ethnic groups and also suggest the involvement of different triggers in the etiopathogenesis of SLE.

Effect of acute and chronic inhaled furosemide on bronchial hyperresponsiveness in mild asthma

We determined whether chronic administration of furosemide aerosol would be beneficial for the treatment of asthma. First, we showed that furosemide aerosol delivered from a metered-dose inhaler (10 and 20 mg) significantly protected against sodium metabisulfite (MBS) challenge by 0.6 and 1.3 doubling dilutions respectively in 12 volunteers with mild asthma. In a double-blind cross-over study, we examined the effect of furosemide aerosol from a twice more efficient metered-dose inhaler (10 mg four times per day) inhaled over 4 wk versus placebo in 12 other asthmatic subjects. There was no significant effect of furosemide on bronchial responsiveness to methacholine or MBS. Treatment with furosemide over 1 mo did not improve bronchial hyperresponsiveness in subjects with mild asthma.

A preliminary study on IL4 levels in extrinsic atopic asthmatic children

Interleukin 4, (IL4) known as a lymphokine secreted by type II helper T-cells, is thought to regulate IgG and IgE secretions. Therefore, elevated IL4 levels are expected in atopic allergic disease and parasitoses. The purpose of this study was to determine IL 4 levels in allergic asthmatic children. In 50 extrinsic atopic children (19 females, 31 males, mean age 8 +/- 4), IgE and IL 4 were found to be 469 +/- 296 U/L and 0.318 +/- 0.09 ng/ml, respectively. In seven control cases, IgE and IL4 levels were 62 +/- 25 and 0.106 +/- 0.017, respectively. Comparison of the two groups disclosed statistically significant differences in IL4 and IgE levels, suggesting the ability of IL4 to augment IgE production.

Importance of serum anticardiolipin antibody levels in coronary heart disease

During the past 10 years it has been shown that some patients with antibodies to phospholipids develop recurrent venous and arterial thromboses, repeated fetal loss, and thrombocytopenia. The aim of this study is to determine the importance of levels of serum anticardiolipin antibodies (ACA) in patients with coronary heart disease (CHD). The study population consisted of 76 CHD patients (Group 1) and 22 healthy subjects (Group 2). Group 1 comprised three subgroups: (1a) 32 patients with acute myocardial infarction (MI), (1b) 22 patients with chronic CHD and a history of MI, and (1c) 22 patients with CHD but without previous MI. Immunoglobulin G anticardiolipin antibodies (IgG ACA) and immunoglobulin M anticardiolipin antibodies (IgM ACA) were detected by ELISA. High IgG ACA levels were found in 36 patients (47%) in Group 1, but no high levels were found in the control group. IgM ACA levels showed no significant difference between the two groups. The ACA (IgG and IgM) levels showed no correlation with age, gender, risk factor profiles, platelet counts, coronary artery lesions, left ventricular function, and morbidity and mortality rates during the follow-up period of 22 months. As a result, measurement of ACA in CHD patients is unlikely to yield information that is diagnostically or prognostically important. The importance of serum anticardiolipin antibody levels in the natural history and prognosis of CHD is still undetermined and remains to be clarified.

Modulation by endothelium of the vascular effects of angiotensin II

Modulation by vascular endothelium of the effects of AII was studied in the isolated rabbit aortic and superior mesenteric artery strips. The contractile effect of AII was enhanced in rubbed aortic strips. Similar enhancement was obtained in hydroquinone pretreated unrubbed strips. The relaxing effect of acetylcholine in AII--induced precontracted aortic strips was abolished after rubbing and hydroquinone pretreatment. However, no significant changes were observed in the contractile response to AII on aspirin and nicotine pretreated strips. In the isolated mesenteric artery strips AII produced a biphasic responses. The contractile effect of AII was enhanced in rubbed strips. Similar potentiation was also obtained in hydroquinone, aspirin and nicotine pretreated unrubbed strips. The relaxation phase of AII response was completely abolished in rubbed strips but partially inhibited in hydroquinone, aspirin and nicotine pretreated unrubbed strips. From these results it was concluded that EDRF is the main endothelial humoral factor which modulates the effect of AII in the rabbit aorta while both EDRF and PGI2 are involved for the modulation of the effects of octapeptide in the mesenteric artery.