Peripheral keratitis associated with erythema elevatum diutinum

PURPOSE: To describe a case of peripheral keratitis associated with erythema elevatum diutinum (EED), an unusual immune-complex-mediated cutaneous vasculitis. DESIGN: Observational case report. METHODS: A 25-year-old man who was diagnosed 15 months previously with erythema elevatum diutinum presented with an inflammatory peripheral keratitis of the left eye. RESULTS: Serologic investigations for systemic disorders associated with vasculitic peripheral ulcerative keratitis were unremarkable. As the sclerokeratitis was thought to represent an ocular extension of the patient's cutaneous vasculitis, dapsone therapy was initiated and resulted in a rapid response of both the cutaneous and the ocular inflammation. CONCLUSIONS: Erythema elevatum diutinum should be included in the differential diagnosis of vasculitic peripheral keratitis.     

A dual optic accommodating foldable intraocular lens

AIM: To design an accommodating intraocular lens with extended accommodative range that can be adapted to current standard phacoemulsification and endocapsular implantation technique. METHOD: Ray tracing analysis and lens design; cadaver eye implantation. RESULTS: Ray tracing analysis indicated that axial movement of an exaggerated converging anterior optic linked by spring loaded haptics to a compensatory static diverging posterior optic produced greater change in conjugation power of the eye compared to axial movement of a single optic lens. A dual optic one piece foldable silicone lens was constructed and implanted via a 4 mm corneal incision into the capsular bag of two cadaver eyes. CONCLUSION: A dual optic intraocular lens design can increase the optical effect of a given displacement and suggests improvements for accommodating intraocular lenses.     

Multisampling suprathreshold perimetry: a comparison with conventional suprathreshold and full-threshold strategies by computer simulation

PURPOSE: To compare a multisampling suprathreshold strategy with conventional suprathreshold and full-threshold strategies in detecting localized visual field defects and in quantifying the area of loss. METHODS: Probability theory was applied to examine various suprathreshold pass criteria (i.e., the number of stimuli that have to be seen for a test location to be classified as normal). A suprathreshold strategy that requires three seen or three missed stimuli per test location (multisampling suprathreshold) was selected for further investigation. Simulation was used to determine how the multisampling suprathreshold, conventional suprathreshold, and full-threshold strategies detect localized field loss. To determine the systematic error and variability in estimates of loss area, artificial fields were generated with clustered defects (0-25 field locations with 8- and 16-dB loss) and, for each condition, the number of test locations classified as defective (suprathreshold strategies) and with pattern deviation probability less than 5% (full-threshold strategy), was derived from 1000 simulated test results. RESULTS: The full-threshold and multisampling suprathreshold strategies had similar sensitivity to field loss. Both detected defects earlier than the conventional suprathreshold strategy. The pattern deviation probability analyses of full-threshold results underestimated the area of field loss. The conventional suprathreshold perimetry also underestimated the defect area. With multisampling suprathreshold perimetry, the estimates of defect area were less variable and exhibited lower systematic error. CONCLUSIONS: Multisampling suprathreshold paradigms may be a powerful alternative to other strategies of visual field testing. Clinical trials are needed to verify these findings.     

Effect of epidural blockade on indicators of splanchnic perfusion and gut function in critically ill patients with peritonitis: a randomised comparison of epidural bupivacaine with systemic morphine

OBJECTIVES: (a) To measure gastric tonometry values in critically ill patients with peritonitis and to assess the impact of epidural analgesia on these values. (b) To assess the impact of epidural analgesia on gastro-intestinal motility by abdominal ultrasound and paracetamol absorption. (c) To observe any change in clinical outcome that may result from the use of epidural analgesia in such patients. DESIGN: A double-blinded, prospective, randomised and controlled study of general intensive therapy unit (ITU) patients. PATIENTS: Twenty-one patients admitted with peritonitis and adynamic small bowel following abdominal surgery were randomly allocated to receive either intravenous morphine or epidural bupivacaine for analgesia. MEASUREMENTS AND RESULTS: Gastric intramucosal pH (pHig) and the mucosal:arterial PCO2 gradient (Pg-PaCO2) were measured at admission and after 24 h of analgesia. Analysis of mean changes in tonometry values showed a rise in Pg-PaCO2 and a fall in pHig in the morphine group and a significant difference between groups in the Pg-PaCO2 trends (p = 0.024). Significant improvements in the ultrasound appearance of the small bowel were observed in the epidural group (p = 0.0037, Mann-Whitney U test of median changes in a locally developed scoring system). There were no significant differences between the groups in any of the variables derived from the paracetamol absorption test (n = 10); both groups showed persistently delayed gastric outflow throughout the study period. CONCLUSIONS: Epidural analgesia resulted in improvements in gastric mucosal perfusion and the ultrasound appearance of the small bowel, indicating potential clinical benefit in a group of patients in whom epidural catheterisation is traditionally contraindicated.     

ABCB1 (MDR 1) polymorphisms and progression-free survival among women with ovarian cancer following paclitaxel/carboplatin chemotherapy

PURPOSE: The human ABCB1 gene encodes P-glycoprotein, which transports a broad range of anticancer drugs, including paclitaxel. Although the functional consequences of ABCB1 polymorphisms have been the subject of numerous studies, few have assessed the association with clinical outcome. EXPERIMENTAL DESIGN: We assessed the association between the 2677G>T/A, 3435C>T, and 1236C>T ABCB1 polymorphisms and progression-free and overall survival in 309 patients from the Australian Ovarian Cancer Study treated with paclitaxel/carboplatin and subsequently tested significant observations in an independent validation set. RESULTS: Women who carried the minor T/A alleles at the 2677G>T/A polymorphism were significantly less likely to relapse following treatment compared with homozygote GG carriers (P(Log-rank)=0.001) in the Australian Ovarian Cancer Study cohort. Subgroup analyses showed that this effect was limited to cases with residual disease 1 cm (P(Log-rank)=0.3). This effect was not confirmed in an independent validation set of carboplatin/paclitaxel-treated patients (n=278) using a higher residual disease cut point (T/A polymorphism on progression-free survival in ovarian cancer patients who are treated with a taxane/carboplatin, which is dependent on the extent of residual disease, with a better prognosis for patients with the 2677T/A allele and minimal residual disease.