Long-term results of vitrectomy for removal of submacular hard exudates in patients with diabetic maculopathy

PURPOSE: To investigate long-term results of vitrectomy for the removal of submacular hard exudates in patients with diabetic maculopathy. METHODS: Thirteen eyes of 10 patients with diabetic maculopathy underwent vitrectomy to remove submacular hard exudates from December 1993 to March 1999. The mean preoperative logMAR visual acuity +/- SD was 1.54 +/- 0.43. Preoperatively, the exudates ranged from 0.5 to 3 disk diameters (average, 1.25 disk diameters). Exudates were removed using subretinal forceps through a minimal paramacular retinotomy after vitrectomy. In all cases, 20% SF6 gas tamponade was added. The mean postoperative observation period was 43.2 months. RESULTS: Visual acuity was improved in 7 eyes (54%) 1 year after surgery; however, visual acuity over longer periods was improved in only 5 eyes (38%) as compared with the preoperative findings. The mean final visual acuity +/- SD was 1.62 +/- 0.59, which did not show statistically significant improvement over that in the control group. Although submacular hard exudates and macular edema disappeared during the postoperative period, atrophic or degenerative changes occurred in many cases. CONCLUSION: Visual improvement could not be obtained for a long period after removing submacular hard exudates in most of the patients, suggesting that diabetic maculopathy should be treated before massive exudate deposits appear in the macula.     

Patellar dislocation in Kabuki syndrome

We describe four individuals (two females and two males) with Kabuki syndrome and recurrent dislocation of the patella. The age of diagnosis of patellar dislocation ranged from 11 to 23 years. One individual underwent excision of the free fragment and transfer of the tibial tuberosity with good outcome. Two required patellar brace for instability. Characteristics of individuals with the syndrome at a high risk of patellar dislocation include female, adolescence or young adulthood, joint laxity, and obesity.     

Epidemic nosocomial keratoconjunctivitis caused by adenovirus type 4

PURPOSE: To evaluate the clinical features of nosocomial epidemic keratoconjunctivitis(EKC) occurring in the ophthalmology ward of Sapporo Medical University Hospital and to devise preventive measures for it. MATERIALS AND METHODS: We studied the symptoms and clinical course of 2 patients who had EKC and 16 patients who had EKC caused by nosocomial infections in our hospital. We attempted to detect adenovirus antigen and viral DNA from conjunctival swabs and also to isolate the virus. RESULTS: The clinical symptoms of EKC were conjunctival hyperemia in 18 patients(100%), conjunctival follicles in 11 patients (61.1%), discharge in 8 patients(44.4%), superficial punctate keratopathy in 7 patients(38.9%), swelling of the eyelids in 3 patients(16.7%), and fever in 3 patients(16.7%). 72% were positive for Adeno-check. Adenovirus type 4 was isolated from the conjunctival swabs. We considered that the route of hospital infection was infection from the doctor's hands, from eye drops, and from contact lenses. We disclosed that nosocomical EKC had occurred in our hospital. The hospital infection was eliminated by closing the ophthalmology ward and sterilizing instruments and washing hands. CONCLUSIONS: The delay of proper measures increased the risk of nosocomical infection. We recognized the importance of careful observation of patients and immediate preventive efforts in nosocomical infection.     

Retinal changes in magnesium-deficient rats

The purpose of the present study is to investigate the retina in magnesium (Mg) deficiency and elucidate the local functions of trace elements. After delivery, mother Wistar Kyoto rats were fed a low Mg diet containing 0.1 mg Mg per 100 g diet with all other nutrients and distilled and deionized water. Infant rats were suckled by their mother rats for 21 days and then fed the same Mg-deficient diet. Control mother rats were fed commercial rat pellets containing 24 mg Mg per 100 g diet and all other nutrients. The retinas were examined by electron microscopy and secondary ion mass spectrometry (SIMS) microscopy at 6 weeks of age. In the Mg-deficient rats serum Mg levels were significantly lower and calcium (Ca) levels higher than in the control rats. The retinas of Mg-deficient rats showed multifocal necrosis in the pigment epithelial cells; photoreceptor cell outer segments were deformed near the necrotic cells, and some pigment epithelial cells contained many lamellar bodies. Many photoreceptor cell nuclei showed pyknotic (apoptosis-like) changes. SIMS images showed lower Mg concentration throughout the retina of the Mg-deficient rats, and the ratio of Ca to Mg concentration was significantly higher than in the control rats. Mg deficiency induces multifocal necrosis in the retinal pigment epithelial cells and pyknotic (apoptosis-like) changes in the photoreceptor cell nuclei. The changes in Mg-deficient retinas may be due to an imbalance in the distribution of Mg and Ca trace elements.     

Influence of body fat on the onset of vecuronium induced neuromuscular blockade

The onset time of vecuronium, a muscle relaxant, was measured after a bolus intravenous injection of 0.15 mg kg(-1) of vecuronium into 40 surgical patients aged 59-64 years. The onset time was then compared between male and female patients and the relationship between onset time and body fat (% of body weight) was analyzed. Arterial plasma concentrations of vecuronium were measured at 75, 195, and 375 sec after administration of vecuronium to 8 patients. The female patients (n = 23) showed a shorter onset time and more body fat than the male patients (n = 17). The onset time significantly decreased with increasing body fat in both groups. When only females with body fat of less than 30% (n = 10) were compared with the male group (all male patients had body fat of less than 30%), the body fat, onset time, and regression lines between the onset time and the body fat did not differ significantly. Except in the patient with the highest body fat, plasma concentrations at 195 and 375 sec significantly increased with increasing body fat. We concluded that the higher body fat in females is largely responsible for the faster onset of vecuronium action in females. A smaller distribution volume of vecuronium may also be one of the reasons for the faster onset of vecuronium in females.     

Replacement of the Canine Inferior Vena Cava with a Seeded Graft

The patency and microscopic findings of gelatin-coated Dacron grafts seeded with endothelial cells and implanted into the inferior vena cava of dogs was evaluated. A total of 25 mongrel dogs were divided into four experimental groups according to whether or not an antiplatelet agent was administered and a seeded or nonseeded graft was implanted. In the groups not given antiplatelet therapy that were implanted with a nonseeded graft, occlusion of the graft occurred soon after surgery. In contrast, in the majority of animals implanted with a seeded graft and given antiplatelet therapy, graft patency was evident for up to 4 weeks postoperatively. In the latter animals, scanning electron microscopy 4 weeks after surgery showed the formation of confluent endothelial-like cells within 5 mm from the anastomosis, as well as insular endothelial-like cells in the central part of the graft. The simple centrifugal seeding method enables endothelial-like cells to adhere to grafts, suggesting that it may be useful in venous replacement. Received: October 18, 1999 / Accepted: November 20, 2000     

Biological activities of natural resources around us are now in the limelight

There are various kind of natural resources around us, and they must contain a lot of unknown bioactive substances. Some may be structurally very strange for us, and some are very familiar. But their biological activity was not unfortunately investigated in detail. Accordingly, exploring new types of pharmaceutical resources may give lead compounds of the drugs in the future. Among those natural resources, I examined squid ink and scallop soup. From squid ink, an antitumor glycoconjugate was obtained. Its polysaccharide moieties, illexin A, illexin B and illexin C, were isolated, and the spectral data and chemical transformation of their acid hydrolysate revealed to bear a unique branched repeating unit, [-3GlcA beta 1-4(GalNAc alpha 1-3)Fuc alpha 1-]n. Moreover, scallop soup gave antitumor glycogen by the action of protease. The fine structure of glycogen was investigated by the sequential enzyme digestion method using beta-amylase and pullulanase, while the unit chain was analyzed by high performance anion exchange chromatography. The results showed that the antitumor active glycogen was highly branched with shorter chain than glycogens without antitumor activity.     

Successful pregnancy outcome in a patient with HbE/beta (0)-thalassemia

Successful pregnancy outcome is described in a patient with hemoglobin E/beta(0)-thalassemia which is expressed as thalassemia major. A 21 year-old Laotian female complicated by severe anemia became pregnant. The diagnosis of hemoglobin E/beta (0)-thalassemia was made by hemoglobin analysis. The fetal weight estimated by abdominal echogram decreased during pregnancy. She received blood transfusions, in order to improve intrauterine growth retardation. Hemoglobin concentration was maintained at the level greater than 9 g/dl. Fetal growth was improved by the treatment. A normal full-term male infant was born by a caesarean section, and splenectomy was performed at the same time.