Clinical profile and immunological status of cytomegalovirus retinitis in organ transplant recipients

PURPOSE: Cytomegalovirus retinitis (CMV) is the most common ocular opportunistic infection in transplant recipients. This retrospective study attempts to report the differences in occurrence of cytomegalovirus retinetis in transplant recipients from those reported in patients with acquired immunodeficiency syndrome (AIDS). METHODS: 25 eyes of 15 transplant recipients (14 renal and one cardiac) with cytomegalovirus retinitis were retrospectively reviewed. Immunological profile included CD4+ and CD8+ T lymphocyte counts, CD4+/CD8+ cell ratio (5 cases) and serology for the viral antibodies (8 cases). RESULTS: A predominantly bilateral presentation (60%) was noted. Active cytomegalovirus retinitis (72%) in zone 2 (92%) of the inferotemporal quadrant (68%) was noted. The average cell counts were within normal limits (mean CD4 cell count-711/microliter), unlike in late stages of AIDS with cytomegalovirus retinitis (CD4 count < 50/microliter). Serology revealed an IgM positivity of 53%. Retinal detachment (52%) was the most common complication occurring after an average of 5.4 months. CONCLUSION: CMV retinitis in organ transplant recipients appears to differ from that in AIDS patients. CMV retinitis presents early and has different immunological profile, probably owing to differences in pathogenesis.     

Cytopathology of explanted intraocular lenses and the clinical correlation

PURPOSE: To study the cytopathological features of explanted intraocular lenses (IOLs) and correlate the features with their clinical presentation. SETTING: Ocular Pathology Department, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India. METHODS: The study comprised 61 explanted IOLs (48 posterior chamber IOLs and 13 anterior chamber IOLs) removed for the following reasons: pseudophakic bullous keratopathy (36), recalcitrant uveitis (7), retinal detachment (10), endophthalmitis (5), uveitis (7), IOL subluxation (2), and painful blind eye (1). The IOLs were stained with hematoxylin and eosin using a simple cytological technique. The cytopathological features were studied and correlated with the clinical presentations. RESULTS: The mean time of IOL explantation was 10.1 months after surgery. Twenty-one IOLs had granulomatous and nongranulomatous inflammations and 4, nongranulomatous inflammations. One IOL had fungal filaments on the surface. CONCLUSIONS: Intraocular lenses can produce both granulomatous and nongranulomatous inflammation. Granulomatous inflammation was the most common in this series. The surface of IOLs explanted because of intraocular infection may show infective agents.     

Association of LAR-like receptor protein tyrosine phosphatases with an enabled homolog in Hirudo medicinalis

Receptor protein tyrosine phosphatases (RPTPs) are thought to play important functions in pathfinding and target recognition by growing neuronal processes. The leech RPTPs HmLAR1 and HmLAR2 are expressed selectively by central neurons, Comb cells, and peripheral muscle tissues in the Hirudo medicinalis embryo. To explore the functions of HmLARs, we have sought to determine their physiological substrates. We report here the cloning and embryonic expression of Lena, the leech homolog of Enabled, a cytosolic protein implicated in actin-based cell motility. Lena is expressed in embryonic central neurons and in the Comb cell. We present experimental evidences indicating that Lena associates selectively with the intracellular domain of HmLAR1 and HmLAR2. Additionally, RNA interference (RNAi) of HmLAR1 in intact leech embryos leads to the hyperphosphorylation of Lena. We propose, therefore, that Lena is an in vivo substrate of HmLAR1 in neurons and perhaps of HmLAR2 in the Comb cells.     

A Bayesian analysis of bivariate ordinal data: Wisconsin epidemiologic study of diabetic retinopathy revisited

In many biomedical experiments one may often encounter bivariate data which are component-wise ordinal. The data set of the ophthalmologic experiment of the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) is an example of such data. Several authors considered the analysis of such data from different viewpoints. The present work reviews the existing literature based on the WESDR data and on the basis of some latent variables provide the technique for analysing such data more easily in a Bayesian framework. Computation supports the methodology to a great extent. A comparison between our approach and the likelihood based approach considered by Kim has also been made.     

Impairment of stimulation by estrogen of insulin-activated nitric oxide synthase in human breast cancer

Nitric oxide (NO) is reported to have several important effects in the control of neoplasm. We have reported before the presence of an insulin-activated constitutive form of membrane-bound nitric oxide synthase (IANOS) in various cells. Since the insulin-induced NO synthesis by IANOS could have important consequences on the pathophysiology of neoplastic cells, the role of estrogen on the activity of IANOS in malignant and nonmalignant breast tissue as well as in erythrocytes in breast cancer patients was determined. It was found that the IANOS activity of nonmalignant breast tissue was maximally stimulated by 4-fold over the basal activity in the presence of physiologic amounts of estrogen (8-32 nM). The enzymic activity was, however, inhibited by estrogen both below and above this range when compared to appropriate controls. In contrast, both the basal IANOS activity and the stimulatory effect of estrogen was markedly impaired in malignant breast tissue and in erythrocytes in these patients. It was also noted that tamoxifen, a widely used nonsteroidal compound in breast cancer, mimicked estrogen both in the stimulation and in the inhibition of IANOS activity in both of the tissues. These results indicated the probable existence of a novel pathway for estrogen effect independent of nuclear receptor for the stimulation of IANOS activity that might have important consequences in breast cancer and suggested that some of the beneficial effects of tamoxifen could be related to its estrogen-mimicking effect on IANOS independent of hormone-responsive elements sequence in the DNA.     

Poor outcome and quality of life in female patients undergoing secondary surgery for recurrent peptic ulcer disease

Secondary peptic ulcer surgery is uncommon given the success of a wide variety of medical therapies, plus the good outcome expected after primary peptic ulcer surgery. Early reports of secondary peptic ulcer surgery in the 1950s and 1960s suggested good long-term outcome in most patients; however, recent data suggest that patients operated in the Helicobacter pylori era have a worse outcome. We have attempted to quantify the poor outcome in these patients and measure the effect of sex, a previously unrecognized risk factor for poor outcome after peptic ulcer surgery. We reviewed the outcomes of 35 patients who underwent secondary peptic ulcer surgery for symptoms of persistent or recurrent peptic ulcer symptoms or complications of the condition. These patients were compared to a "control" group of patients to determine long-term quality of life as measured by the SF-36 and Visick scores (average follow-up 60 months). Visick and SF-36 scores were obtained through telephone interviews. The two groups of patients were age matched to eliminate age as a variable in the SF-36 results. There were more females than males in the secondary peptic ulcer surgery group (4.5/1 female-to-male ratio). Although perioperative mortality was zero for both groups, patients undergoing secondary peptic ulcer surgery had a high number of complications (57% of patients had complications). Patients undergoing secondary peptic ulcer surgery scored lower in seven of the eight subclasses of the SF-36 questionnaire compared to their age-matched cohorts. In contrast, average Visick scores showed slight improvement for three out of four symptoms reported. Immediate postoperative complications were not related to long-term quality of life issues. Secondary peptic ulcer surgery is more prevalent in females than in males. Although secondary peptic ulcer surgery is partially effective in alleviating symptoms, quality of life is poor. Presented at the Forty-Second Annual Meeting of The Society for Surgery of the Alimentary Tract, Atlanta, Georgia, May 20–23, 2001 (poster presentation).