Herpes simplex virus type 1 (HSV-1)--induced retinitis following herpes simplex encephalitis: indications for brain-to-eye transmission of HSV-1

Herpes simplex encephalitis is a severe neurological disease with high mortality and morbidity rates. Reactivated herpes simplex virus type 1 (HSV-1) can cause relapses and might even spread to the retina, where it can induce a potentially blinding eye disease, known as acute retinal necrosis. In the present study, the HSV-1 strains in the brain and eye of 2 patients with acute retinal necrosis following an episode of herpes simplex encephalitis were genotyped. The HSV-1 strains in both the brain and eye were identical in each patient, but they differed interindividually. The data suggest brain-to-eye transmission of HSV-1 in these patients.     

Ileal endogenous nitrogen recovery is increased and its amino acid pattern is altered in pigs fed quebracho extract

Ileal endogenous nitrogen recovery (ENR) in pigs (9 +/- 0.6 kg body weight) was estimated simultaneously using the (15)N-isotope dilution technique ((15)N-IDT) and the peptide alimentation ultrafiltration (UF) method. Diets were cornstarch, enzyme-hydrolyzed casein with no (control) or high (4%) content of quebracho extract (Schinopsis spp.) rich in condensed tannins. The amino acid (AA) pattern of the ENR was also determined. The ENR of pigs fed the quebracho diet was higher (P = 0.0001) than that of pigs fed the control diet [6.00 vs. 1.95 g/kg dry matter intake (DMI) for the (15)N-IDT and 5.18 vs. 1.49 g/kg DMI for the UF method, respectively]. With the (15)N-IDT, ENR values were 0.44-0.79 g/kg DMI (24%) higher (control P = 0.0032, quebracho P = 0.0002) than for the UF method. Apparent nitrogen digestibility depended on diet (69.0% quebracho vs. 86.0% control, P = 0.0001). Real nitrogen digestibility (RD-N) determined by the UF method was higher (P = 0.0001) for the control than for the quebracho diet (91.4 vs. 88.2%). Corresponding values for the (15)N-IDT did not differ (P = 0.0569) between diets (92.8 vs. 91.4%). The (15)N-IDT gave higher values for RD-N of both diets (control P = 0.0030, quebracho P = 0.0002) compared with the UF method. Endogenous AA recoveries (g/kg DMI) were increased 300% (P = 0.0001) and the AA-pattern of ENR was changed (P from 0.0001 to 0.7530 for different AA) by the quebracho diet. A constant AA-pattern of ENR cannot be assumed. Despite limitations of both techniques, the (15)N-IDT and the UF method gave similar results with respect to ENR.     

Birdshot chorioretinopathy: long-term manifestations and visual prognosis

PURPOSE: To ascertain the clinical features and long-term visual prognosis of birdshot chorioretinopathy (BCR), and to identify patients at risk of visual loss. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Fifty-five consecutive patients with HLA-A29-positive BCR who were identified in ophthalmology departments of the University Medical Center of Utrecht and The Eye Hospital Rotterdam, of whom 37 were observed for at least 5 years. INTERVENTION: A review of the medical and photographic and/or angiographic records of 55 patients with HLA-A29-positive BCR. MAIN OUTCOME MEASURES: Numerous variables were compared, including age and gender distribution, onset and course of BCR, ocular manifestations, therapeutic strategies and their outcomes, complications, systemic diseases, visual acuity (VA), and features associated with poor visual outcome. RESULTS: Loss of VA was gradual; the number of affected eyes with VA less than 20/200 increased from 9 of 108 (8%) at onset to 22 of 73 (30%) at 5 years and 19 of 49 (39%) at 10 years of follow-up. The cause of compromised VA was predominantly macular edema and macular atrophy (42 of 55 [76% of cases]). We found strong associations between the VA at onset and visual outcome after 5 and 10 years (P = 0.005 and P = 0.006, respectively). Mean VA at the 5-year follow-up was significantly lower if macular leakage was observed on angiography (P<0.001). No differences in annual loss of VA were observed between patients treated by standard therapeutic modalities and untreated patients. CONCLUSION: The visual prognosis of BCR in a spectrum of uveitis is poor, and the recommended therapeutic regimens have had no effect on long-term visual prognosis. New treatment strategies are needed for this blinding disorder.     

Juvenile fibrous hamartoma of the pharynx.

A case of juvenile fibrous hamartoma of the pharynx in a three-year-old boy is described. It is a rare tumour, mostly occurring in the subcutaneous tissues in the infant. A pharyngeal localisation has not been described before. Complete local excision appeared sufficient for cure.     

Adhesion molecules in iris biopsy specimens from patients with uveitis

BACKGROUND/AIMS—Earlier studies on intraocular tissue have demonstrated that T lymphocytes play a major role in the pathogenesis of uveitis. Adhesion molecules are immunoregulatory molecules for the interaction between T lymphocytes and vascular endothelium and they play an important role in the recruitment of specific T lymphocytes from the circulation into inflamed tissue. In uveitis an increased expression of some of these adhesion molecules may be expected.
METHODS—The presence of adhesion molecules was investigated in iris biopsy specimens from 11 patients with uveitis and eight controls (patients with primary open angle glaucoma) immunohistochemically with a panel of monoclonal antibodies: LECAM (CD 62L), ICAM-1 (CD 54), LFA-1 (CD 11a/18), VCAM-1 (CD 106), VLA-4 (CD 49d), and HECA-452, a marker for high endothelial venules.
RESULTS—Positive staining for ICAM-1, LFA-1 and VCAM-1 was found in the iris in a significantly higher number of uveitis patients than in controls. The remaining adhesion molecules were also found in a higher number of uveitis patients than in controls, but this difference did not reach statistical significance.
CONCLUSION—An increased expression of adhesion molecules was found in the iris of patients with uveitis, indicating an immunoregulatory function for adhesion molecules in the pathogenesis of uveitis.

Keywords: adhesion molecules; uveitis; iris     

Clinical analysis of Fuchs' heterochromic cyclitis

Fuchs' heterochromic cyclitis (FHC) is an important diagnosis to make. Not only for the patient, because incorrect diagnosis may lead to unnecessary therapy and the failure to detect secondary glaucoma, but also for the comparison of studies on the etiology of FHC, which is still unknown. No clinical criteria for establishing the diagnosis of FHC have been internationally accepted yet. By means of clinical analyses of FHC patients in different parts of the world, predominant clinical features may be distinguished and combined to form (internationally accepted) diagnostic criteria. We report a clinical analysis of 51 FHC patients in the Netherlands. Acute symptoms (severe redness, pain or photophobia) were never (100%) encountered. Characteristic keratic precipitates (88%) and/or minimal aqueous cells and flare (60%) and/or vitreous opacities (84%) were major signs, indicating a chronic inflammatory activity, in which no synechiae (100%) were present. Heterochromia (82%) was not a constant sign, but iris stromal atrophy, which causes the heterochromia, was always present (100%). Cataract was present in 82% as a result of the chronic iridocyclitis. Secondary glaucoma was present in 22%. Based on the predominant clinical findings obtained from this analysis of FHC patients, and on data in the literature, we propose clinical diagnostic criteria for FHC. Future studies, also including other uveitis groups, are necessary to confirm these diagnostic criteria.Abbreviations FHC Fuchs' heterochromic cyclitis