Baerveldt drainage implants in eyes with a preexisting scleral buckle.

OBJECTIVE: To describe the surgical insertion of a Baerveldt drainage implant and postoperative visual acuity and intraocular pressure (IOP) outcomes in patients with a preexisting scleral buckle. METHODS: Medical records of all patients with a preexisting scleral buckle who underwent insertion of a Baerveldt drainage implant at Bascom Palmer Eye Institute, Miami, Fla, from January 1, 1994, through December 31, 1998, were reviewed. Outcome measures included visual acuity and IOP at 1 year. RESULTS: At 1 year postoperatively, 14 (88%) of 16 patients had stable or improved visual acuity. Preoperatively, mean IOP was 30.9 mm Hg and the mean number of antiglaucoma medications was 3.4; at 1 year postoperatively, mean IOP was 12.0 mm Hg and the mean number of antiglaucoma medications was 0.8 (P<.001). Nine patients (56%) achieved an IOP of greater than 5 and no greater than 21 mm Hg without medication, and an additional 7 (44%) achieved this level of IOP control with medication. No patient required further surgery for uncontrolled IOP during the follow-up interval, which ranged from 19. 1 to 45.5 months. CONCLUSION: Baerveldt drainage device insertion behind or over a preexisting encircling band is often successful in managing refractory glaucoma in patients who have undergone previous scleral buckling procedures. Arch Ophthalmol. 2000;118:1509-1513

Biochemical characterization of some species of Trypansoma (Schizotrypanum) from bats (Microchiroptera).

Trypanosoma (Schizotryanum) species isolated from bats (Microchirotera) in Europe and Latin America were examined by determining the buoyant densities of their nuclear and kinetoplastic deoxyribonucleic acid (DNA) and the electrophoretic patterns of six isoenzymes. By these criteria they were separated into three distinct groups -- two from Europe (T. dionisii and T. vespertilionis) and one from America. T. dionisii was also separable by its morphology in vitro. Geographical location and DNA buoyant densities suggested that the American stocks were more closely related to T. cruzi than to the European species, though they differed from it marginally in kinetoplastic DNA density and in being noninfective to mice. Similar stocks studied by other workers have been shown to differ from T. cruzi also in reduced infectivity to, and lack of natural association with, Triatominae, and in antigenic composition. It is therefore proposed that trypanosomes of the subgenus Schizotryanum occuring naturally in Microchiroptera and differing from T. cruzi sensu stricto as outlined above should be treated as a distinct subspecies, T. cruzi marinkellei ssp. nov. T. cruzi sensu stricto thus becomes the nominate subspecies T. cruzi cruze Chagas 1909.

Transpupillary thermotherapy for small choroidal melanoma.

PURPOSE: To report the treatment of small choroidal melanoma with transpupillary thermotherapy. METHODS: We examined a nonrandomized and uncontrolled series of 14 eyes of 14 patients who were followed up with serial ophthalmoscopy, ultrasonography, and photography. Transpupillary thermotherapy was performed upon documented evidence of tumor growth. RESULTS: After transpupillary thermotherapy, mean follow-up +/- SD was 16 +/- 6.41 months (range, 7 to 28 months) with 10 eyes followed up for at least 1 year. The mean preoperative tumor height was 1.79 +/- 0.59 mm (range, 0.78 to 2.60 mm). Six months after treatment, the mean height was 0.54 mm +/- 0.57 mm (range, 0.00 to 1.16 mm). In 10 eyes, the treated lesion flattened entirely with a mean interval between treatment and flattening of 8.7 months (range, 3 to 21 months). Three patients required retreatment for lack of regression or recurrent growth. The average time to retreatment was 11 months (range, 5 to 15 months). No eye was retreated more than once. There were three amelanotic lesions, all treated in a single session without recurrence. Complications consisted of retinal hemorrhage, retinal vascular occlusion, retinal traction, exudative serous neurosensory detachment, vitreitis, and postoperative pain. The sole treatment failure occurred in an eye treated with a juxtapapillary tumor, with recurrence developing from a previously flattened lesion. This eye was enucleated 10 months after the single initial treatment. At the time of writing, there had been no tumor-related death. CONCLUSIONS: Transpupillary thermotherapy may represent a viable treatment alternative for both pigmented and amelanotic small choroidal melanoma. Diligent follow-up is axiomatic because retreatment may be necessary. Recurrent tumors may develop from flat lesions. Juxtapapillary tumors may be at higher risk for recurrence. Definitive statements regarding the role of transpupillary thermotherapy in the management of small choroidal melanoma await 5-year and 10-year morbidity and mortality data.

Epibulbar allergic granulomatous nodules in a human immunodeficiency virus-positive patient.

PURPOSE: To report an unusual epibulbar inflammatory process in a patient with human immunodeficiency virus (HIV). METHODS: Case report. A 32-year-old man developed fleshy epibulbar nodules on his right conjunctiva and cornea after being treated for conjunctivitis. A biopsy of the lesions was done, and the specimen was processed for histopathologic examination. RESULTS: The biopsy specimen contained inflammatory cells, including an eosinophilic abscess. The diagnosis was allergic granulomatous nodules. CONCLUSION: This case illustrates the occurrence of epibulbar allergic granulomatous nodules in an HIV-positive patient.

Isoenzyme changes during the life cycle of Trypanosoma cruzi.

The isoenzyme profiles, for 14 enzymes, of amastigotes, trypomastigotes and epimastigotes were compared in various cloned and uncloned T. cruzi stocks belonging to different zymodemes. A culture method with a human diploid cell line was developed and produced either pure amastigotes or trypomastigotes in high yields. Trypomastigotes were also isolated from rat blood and from liquid culture. Epimastigotes were harvested from various acellular media and from the overlay of cell monolayers. The isoenzyme patterns of each life-cycle stage showed consistent differences in the number, position and intensity of the electrophoretic bands for certain enzymes. With the single exception of one peptidase, the variable patterns were stage-specific regardless of whether the organisms were harvested from animals or from various cultures at different temperatures.

Enzyme electrophoresis in characterizing the causative organism of Gambian trypanosomiasis.

Trypanosoma (Trypanozoon) brucei includes three morphologically identical subspecies which are poorly defined by clinical behaviour; T. b. brucei does not infect man, whereas T. b. rhodesiense causes an acute, and T. b gambiense a chronic, disease. Thirty-three isolates of the complex, each of which had previously been identified on clinical or other criteria, were compared by the electrophoretic patterns of two trypanosomal enzymes, alanine aminotransferase (ALAT) and aspartate aminotransferase (ASAT). One particular ALAT pattern clearly segregated a group of human pathogens of which all except one were labelled T. b. gambiense. The exception was labelled T. b. rhodesiense, and in addition three putative T. b. gambiense isolates did not have this pattern; it is suggested that only one presents a serious anomaly. The T. b. gambiense group could also be subdivided by three ASAT patterns which coincided with known groupings based on serological criteria.

The sheep as a potential reservoir of human trypanosomiasis in the Republic of the Congo.

The identical electrophoretic isoenzyme patterns of a human-plasma-resistant Trypanozoon stock from a sheep and of two other stocks from trypanosomiasis patients in the Congo Republic indicated that the sheep stock was probably infective to man. These, and one further human stock from the Congo, closely resembled stocks isolated from man in Liberia and Ivory Coast.

Isolation of Trypanosoma brucei gambiense from northern Uganda: evaluation of the kit for in vitro isolation (KIVI) in an epidemic focus.

867 individuals from 3 sites near the town of Adjumani in the East Moyo region of north-west Uganda were investigated clinically and serologically for evidence of current trypanosome infections. Blood samples were taken from 94 persons with a positive card agglutination test for trypanosomiasis (CATT) and clinical suspects and inoculated into the kit for in vitro isolation of Trypanosoma brucei gambiense (KIVI). Amongst this group, 30 parasitaemic individuals were identified by microhaematocrit centrifugation and the quantitative buffy coat technique (QBC). Only 80% of these isolates, and one isolate from an aparasitaemic individual, grew in culture. The success or failure of cultures from parasitaemic patients was unrelated to the size of the trypanosome inoculum. The implications of these results and possible reasons for the failure of KIVI are discussed.

A comparison of parasitological methods for the diagnosis of gambian trypanosomiasis in an area of low endemicity in Côte d'Ivoire.

The card agglutination test for trypanosomiasis (CATT) was used to examine 8974 inhabitants in 14 village areas south-west of Daloa, Côte d'Ivoire; 114 (1.3%) were CATTT or +/-, and were further examined by one or more of 6 methods for the direct detection of trypanosomes: lymphatic gland puncture, stained thick blood film (TBF), haematocrit centrifugation technique (HCT), mini-anion exchange column (MAEC), quantitative buffy coat method (QBC), and kit for in vitro isolation of trypanosomes (KIVI). Trypanosomes were seen by at least one method in 16 (14.0%) of the CATT+ group. Blood from 356 of the 8860 CATT- group was inoculated into KIVI; trypanosomes grew from the blood of 1 person. Eleven of the 17 patients with detectable trypanosomes were screened by all 6 methods: 6 were HCT+; 7 were gland+; 10 were MAEC+; 10 were KIVI+; 11 were both TBF+ and QBC+. One CATT+ patient was KIVI+ but otherwise negative, although TBF was not done. The overall prevalence of trypanosomes was 0.2% rising to 0.8% in one village area. The results support previous evidence that a reappraisal of procedures is required in the customary system of surveillance for gambian sleeping sickness.

The identification by isoenzyme patterns of two distinct strain-groups of Trypanosoma cruzi, circulating independently in a rural area of Brazil.

Culture forms of 17 Trypanosoma cruzi stocks, primarily isolated from a rural area of endemic Chagas disease at São Felipe, Bahia, Brazil, were compared by the electrophoretic patterns of six enzymes: aspartate aminotransferase, alanine aminotransferase, glucose-6-phosphate dehydrogenase, malate dehydrogenase (decarb-oxylating) (NADP+), glucosephosphate isomerase and phosphoglucomutase. Two markedly distinct combinations of isoenzyme patterns were seen, justifying the arrangement of the 17 stocks into two strain-groups, each of which was enzymically homogeneous. One combination was characteristic of the 11 domestic stocks of T. cruzi derived from both human infections and domiciliated animals; the second was characteristic of the six sylvatic stocks derived from opossums and a sylvatic triatomine species. The enzyme patterns were independent of the original host and the type of culture medium used. Distinction of the two strain-groups accords with epidemiological evidence that the domestic and sylvatic transmission cycles in São Felipe do not overlap. It is suggested that the diverse enzyme characters of the two strain-groups circulating in São Felipe reflect diverse origins; the domestic form of T. cruzi probably invaded the area from the south of Brazil with the domestic triatomine vector, Panstrongylus megistus.

Direct isolation in vitro of Trypanosoma brucei from man and other animals, and its potential value for the diagnosis of gambian trypanosomiasis.

A recently described simple kit for isolating African trypanosomes in vitro (KIVI) was tested further with blood samples from man and other animals in Côte d'Ivoire and République du Congo. A high rate of success was achieved, with positive cultures being found 5-36 d after inoculation. The method was also of value in diagnosis. Parasitaemia was initially detected by the haematocrit method; in addition, the mini-anion exchange column was used for human blood and lymph fluid from patients with swollen glands was examined. The card agglutination test (CATT) was applied to the human blood samples. In Côte d'Ivoire, all 5 parasitaemic patients, who were also positive by CATT, yielded positive KIVI cultures. Of 15 animals, 2 parasitaemic and 10 apparently aparasitaemic individuals gave positive cultures. In the Congo, none of the 22 animals was parasitaemic and none gave a positive culture. Of 647 human subjects initially screened, 61, mostly with a positive CATT, were examined by KIVI; 20 gave positive cultures. Seven of these cultures originated from patients in whom no trypanosome had been seen in blood or lymph fluid, although blood from 2 parasitaemic patients failed to yield positive KIVI cultures. Some patients with CATT-negative whole blood and/or serum were positive by KIVI.

Epidemiological aspects of three Trypanosoma cruzi zymodemes in Bahia State, Brazil.

Culture forms of 104 stocks of Trypanosoma cruzi isolated in different regions of the State of Bahia were compared by electrophoresis of six enzymes. The three distinct combinations of isoenzyme patterns seen were designated ZI, Z2 and Z3. In an area of endemic Chagas's disease in eastern Bahia, T. cruzi Z1 was associated with sylvatic mammals and sylvatic triatomines, whereas T. cruzi Z2 was associated with a separate domestic cycleof transmission. T. cruzi Z1 was also found in sylvatic triatomines from other parts of the State. In contrast, in an area of the São Francisco Valley region of western Bahia, both T. cruzi Z1 and Z2 were isolated from man, domestic animals, and peridomestic rats. T. cruzi Z3 was isolated from an armadillo and from Panstrongylus geniculatus, a triatomine commonly found in armadillo burrows. Both T. cruzi Z1 and Z2 appeared to be pathogenic in man: T. cruzi Z1 was isolated from patients with acute Chagas's disease and from a single patient with chronic cardiac manifestations. T. cruzi Z2 was isolated from some asymptomatic individuals but was also associated with acute disease and chronic cardiac and digestive syndromes.

The persistence of genetic homogeneity among Trypanosoma brucei rhodesiense isolates from patients in north-west Tanzania.

Trypanosomes isolated during 1991 from nine patients with Rhodesian sleeping sickness in north-west Tanzania were genetically characterized by electrophoresis of ten enzymes. Eight isolates were allocated to a known zymodeme (Z306); another had an enzyme profile (Z379) not previously encountered. An example of Z306 has been previously isolated in 1971, nearby in a part of Rwanda adjacent to the border with Tanzania; in addition, a closely related isolate, in Z307, was collected in 1959 from a patient in north-west Tanzania. The new zymodeme (Z379) was 94% similar to Z306, and both had a close similarity of 89% to Z307. All these isolates belonged to the zambezi strain group of related zymodemes, and evidence is presented that other examples of the group have been collected from man in Tanzania since 1959. Such apparent long term genetic stability is similar to circumstances further south in an endemic area of Zambia, where 12 examples of Z306 and two of Z307 were acquired over a period of 12 years from patients. The similar genetic homogeneity among trypanosomes in endemic parts of both Tanzania and Zambia contrasted markedly with the heterogeneity described to the north of Tanzania in that different strain groups circulate in epidemic areas of Kenya and Uganda.