Therapy for ocular toxoplasmosis.

We conducted a prospective multicenter study of the efficacy of current therapeutic strategies for ocular toxoplasmosis in 149 patients. Treatment consisted of the following three triple-drug combinations: group 1, pyrimethamine, sulfadiazine, and corticosteroids; group 2, clindamycin, sulfadiazine, and corticosteroids; and group 3, trimethoprim, sulfamethoxazole and corticosteroids. Patients with peripheral retinal lesions were not treated systemically. No difference in the duration of inflammatory activity was observed between treated and untreated patients (P = .5). The most important factor predicting the duration of inflammatory activity was the size of the retinal lesion itself, independent of the treatment (P < .001). We found a reduction in size of the retinal inflammatory lesion for 49% of the pyrimethamine-treated patients (17 of 35) compared to 20% of the untreated patients (eight of 41) (P < .01). However, the most frequent occurrence of side effects was also associated with pyrimethamine medication (26%, nine of 35). The mean recurrence rate after three years of follow-up was 49% for all patients (60 of 122 patients), with no differences between treated and untreated patients (P = .6).

Cyclosporin in the treatment of severe chronic idiopathic uveitis.

In a randomised double-masked study of 27 patients with a severe chronic idiopathic uveitis we evaluated the efficacy, safety, and tolerability of cyclosporin. All received prednisone in a low dose (0.3 mg/kg/day). In 14 patients this was combined with cyclosporin in a single daily dose of 10 mg/kg/day, while 13 patients received a placebo. The dosages were tapered off in accordance with a protocol, and we compared the number of months of successful therapy before the uveitis relapsed. The efficacy results, as expressed in a Kaplan-Meier curve, were in favour of cyclosporin. Owing to the small sample size, however, this difference did not reach statistical significance. The immunosuppressive effect of cyclosporin was not permanent, and in all but one patient the intraocular inflammation relapsed on reduction of dosage. Rather small cumulative doses of cyclosporin proved to be nephrotoxic, but subjective tolerability for cyclosporin was good.

Seasonal variation in respiratory syncytial virus chest infection in the tropics.

Respiratory syncytial virus (RSV) is the most important cause of lower respiratory tract infection (LRTI) in young children. We determined if there was a seasonal variation in Malaysia in the incidence of RSV infection in young children admitted with LRTI, and possible associations of RSV infection with local meteorological parameters. A total of 5,691 children, aged less than 24 months and hospitalized with LRTI (i.e., bronchiolitis and pneumonia) between 1982-1997, were included in this study. Nasopharyngeal samples were collected and examined for RSV by immunofluorescence, viral culture, or both. Seasonal variations were determined by analyzing the monthly RSV-positive isolation rate via time series analysis. Possible correlations with local meteorological parameters were also evaluated.RSV was isolated in 1,047 (18.4%) children. Seasonal variations in RSV infection rate were evident and peaked during the months of November, December, and January (test statistics [T] = 53.7, P < 0.001). This seasonal variation was evident for both bronchiolitis and pneumonia categories (T = 42.8 and 56.9, respectively, P < 0.001). The rate of RSV infection appeared to correlate with the monthly number of rain days (r = 0.26, P < 0.01), and inversely with the monthly mean temperature (r = -0.38, P < 0.001). In the tropics, seasonal variations in the incidence of RSV infection are evident, with an annual peak in November, December, and January. This information provides a guide for healthcare provisions and implementation of RSV prevention.

Efficient image gradient based vehicle localization.

This paper reports novel algorithms for the efficient localization and recognition of traffic in traffic scenes. The algorithms eliminate the need for explicit symbolic feature extraction and matching. The pose and class of an object is determined by a form of voting and one-dimensional (1-D) correlations based directly on image gradient data, which can be computed "on the fly." The algorithms are therefore very well suited to real-time implementation. The algorithms make use of two a priori sources of knowledge about the scene and the objects expected: (1) the ground-plane constraint and (2) the fact that the overall shape of road vehicles is strongly rectilinear. Additional efficiency is derived from making the weak perspective assumption. These assumptions are valid in the road traffic application domain. The algorithms are demonstrated and tested using routine outdoor traffic images. Success with a variety of vehicles in several traffic scenes demonstrates the efficiency and robustness of context-based image understanding in road traffic scene analysis. The limitations of the algorithms are also addressed in the paper.

[Response of bone metastases to medical treatment: definition of evaluation criteria and classification trials]. / Réponse des métastases osseuses aux thérapeutiques médicales: définition des critères d'évaluation et essai de classification.

Bone metastases are very frequent. Some are sensitive to the action of anticancer drugs. However, there is as yet an unsolved methodological problem in the evaluation of response to these drugs. The uniquely radiological UICC criteria are quite insufficient, in as much as they appear with a long delay and sometimes give erroneous results. In this work we give a brief review of biological and clinical knowledge about bone metastases, and we attempt to give an array of the possible evaluation criteria and their respective value. We propose as a working hypothesis a classification of responses taking into account the criteria: the urinary hydroxyproline to urinary creatinine ratio, the serum dosage of bone isoenzyme of alkaline phosphatase and propeptide of type III procollagen (P III NP), and as an essential element, an analysis of all available imaging techniques. A visual study of bone scintillation scans must precede that of radiographs and, when possible, it must be associated to computerized scintillation scanning. When metastasis are located to the pelvis, the vertebral column, or the sternum, a CT scan or better, a nuclear magnetic resonance study (IRM), is indispensable in order to have a direct measure of the tumor extension to soft tissues. Furthermore, in the case of isolated metastases, one of these imaging techniques allows a diagnostic biopsy. Finally an analysis of response at the bone level will always be associated with a measure of their duration and an evaluation of metastases to other sites.

Endotoxin levels in rural Thai and urban Singaporean homes.

BACKGROUND: Exposure to dust endotoxin and allergens in early childhood may influence the development of allergic diseases. AIMS: This study aimed to evaluate dust endotoxin and dust mite allergens in urban Singapore and rural Thai homes of young children and study potential environmental influences. METHODS: Mattress dust endotoxin and Der p 1, Der f 1, group 2 (Der f 2 and Der p 2) and Blo t 5 allergen levels were quantified in 101 infant mattress dust samples, 51 from urban Singapore and 50 from rural Thailand. Comprehensive questionnaires on the home environment and cleaning practices were completed. RESULTS: Endotoxin levels in rural Thailand were significantly higher than in urban Singapore (geometric mean 26,334.12 +/- 4.60 and 18,377.85 +/- 2.52 endotoxin units/g, respectively; p = 0.032). In contrast, higher levels of Der f 1 (p = 0.02), group 2 (p < 0.01) and Blo t 5 (p < 0.01) allergens were found in Singapore homes compared with rural Thai homes. Multiple logistic regression analysis showed that the use of detergents (p = 0.001) and disinfectants (p = 0.024) to clean floors and mattress protectors (p = 0.021) were independently associated with lower endotoxin levels. CONCLUSION: Endotoxin levels are higher in rural compared with urban homes in South East Asia. The reverse was true for dust mite allergen levels. Certain identifiable home environmental conditions and practices accounted for the differences in endotoxin levels.

Distinct pattern of commensal gut microbiota in toddlers with eczema.

BACKGROUND: Recent studies have demonstrated differences in the composition of gut microbiota in infants with and without allergic diseases, particularly eczema. METHODS: A case-control study involving 21 toddlers (age 3.0 +/- 0.5 years) with and 28 age-matched toddlers without eczema was conducted. Four groups of aerobic gut microbiota were identified and quantitated in stool samples grown on selective media. Three groups of anaerobes were enumerated by fluorescent in situ hybridization followed by quantitative flow cytometry. We also performed molecular typing of lactic-acid-producing bacteria (LAB) and enterococcal isolates to facilitate detailed analysis at species level by bacterial 16S rDNA sequencing. RESULTS: Toddlers with eczema harbored significantly lower counts of Bifidobacterium [(median 0.14 (25th and 75th percentile: 0.04 and 0.47) vs. 0.71% (0.16, 1.79) of cells acquired, p = 0.003)] and Clostridium [(0.28 (0.09, 0.78) vs. 0.83% (0.35, 1.82) of cells acquired, p = 0.012)] but significantly higher counts of total LAB [7.3 (6.1, 8.5) vs. 5.7 (4.4, 7.3) log CFU/g, p = 0.006] in particular enterococci [6.3 (4.8, 7.4) vs. 5.0 (3.4, 6.4) log CFU/g, p = 0.018]. There was no significant correlation between eczema severity score and bifidobacterial counts. CONCLUSION: The results further confirm previous reports that the gut microecosystem differs between children with and without eczema and extend them beyond infancy.

Analysis of prophylactic laser coagulation of retinal defects and degenerations performed in patients of the Free University of Amsterdam during the period from 1982 to July 1986.

In order to evaluate the prophylactic effect on retinal detachment a retrospective analysis was made of the prophylactic laser coagulations for retinal defects and degenerations performed on patients of the Free University of Amsterdam during the period from 1982 to July 1986. The main conclusion is that in a total of 273 treated eyes only two developed a spontaneous retinal detachment after coagulation. This is an incidence of 0.7%, which compares favourably with untreated groups. The treatment criteria were: 1. symptomatic defects; 2. defects and degenerations in fellow eyes; 3. asymptotic defects in aphakia, myopia greater than 5 D, single eyes and a positive family history. The most frequent complication was vitreous haemorrhage due to rupture of a patent vessel bridging the detached lip of a horseshoe tear, but vision was restored to normal in all but one case after the haemorrhage cleared.

Prevention of IOP-rise following Nd-YAG laser capsulotomy with pre-operative timolol eye-drops and 1 tablet acetazolamide 250 mg systematically.

Short-term observation following Nd-YAG laser capsulotomy indicates that serious elevation of intra-ocular pressure may occur, unrelated to the amount of energy used. In this study the IOP in 3 groups of 10 pseudophakic patients undergoing Nd-YAG laser posterior capsulotomy was measured before capsulotomy and 2 and 4 hours afterwards, using the fellow-eye as control. The first group received no medication, the second received timolol 1/2% eyedrops preoperatively, the third group a combination of timolol 1/2% and 1 tablet of acetazolamide 250 mg systemically. Pretreatment with timolol 0.5% minimizes IOP-rise but does not give complete protection. The combination of timolol 0.5% with 1 tablet of acetazolamide 250 mg proves to be a safe procedure for the prevention of IOP-rise after YAG laser capsulotomy. To prevent other complications it is advisable to make a small capsulotomy of 2-3 mm diameter using as little energy as possible. Also a defocussing system in the laser is a great advantage. Indomethacin drops during a period of 6 weeks after Nd-YAG laser capsulotomy should prevent cystoid macular edema.

Timolol and intra-ocular pressure elevation following neodymium: YAG laser surgery.

The intra-ocular pressure in 76 patients, undergoing Neodymium: YAG laser surgery was measured just before treatment, and one and two hours afterwards. The fellow eye served as a control. Serious elevation of the intra-ocular pressure was demonstrated, especially in capsulotomy in the aphakic eye, to a lesser extent in pseudophakic eyes. Intra-ocular pressure elevation of more than 20 mm was seen in iridectomies. Timolol 1/2% eyedrops given before Neodymium: YAG laser treatment minimized the elevation of the intra-ocular pressure. Prolonged follow-up of the intra-ocular pressure is recommended.

The Joubert syndrome associated with bilateral chorioretinal coloboma.

A case of the Joubert Syndrome is reported. This syndrome, of which 11 cases have hitherto been described, is characterized by aplasia of the cerebellar vermis in addition to episodic hyperpnoea, abnormal eye movements, rhythmic protrusion of the tongue, ataxia, and mental retardation. The diagnosis was made by the clinical symptoms, computerized axial tomography of the brain, and lumbar pneumencephalography. Bilateral typical colobomata of retina and choroid were an additional anomaly, described for the first time in association with the Joubert Syndrome. The possible relationship between the ocular and cerebral anomalies is discussed.

Long-term follow-up of laser trabeculoplasty.

In a retrospective study 274 eyes of 207 patients with glaucoma were followed, after they had undergone laser trabeculoplasty (LTP). We evaluated the success of the laser treatment and followed the course of the intraocular pressure (IOP) during 5 1/2 years after treatment. Three diagnosis-groups were formed. Group I consisted of primary open angle glaucoma (n = 208), secondary glaucoma (n = 8) and pigmentary glaucoma (n = 3). Group II (n = 29) consisted of low tension glaucoma. Group III (n = 26) had the diagnosis narrow angle glaucoma. Success was defined as follows: a reduction in IOP, no progressive visual field loss, no visual acuity loss due to glaucoma, no filtering surgery and no repeat LTP. Follow-up was continued until the moment of failure. In the case of success the minimum follow-up was 6 months. The mean decrease in IOP after LTP stabilized in all three groups. During a follow-up of 5 1/2 years the IOP lowering effect did not diminish in successful eyes. To compute the rate of success we used the Kaplan-Meier method. The low tension glaucoma group had a success rate of 82% after 4 years. The probability of success in group I was 53% after 5 1/2 years and in group III 51% after 4 1/2 years. These success rates did not differ significantly. Resuming, this study shows that LTP has postponed the need for surgical intervention at least up to 5 1/2 years.

Intraocular non-Hodgkin's lymphoma treated with systemic and intrathecal chemotherapy and radiotherapy. A case report and review of the literature.

A case of therapy-resistant bilateral intermediate uveitis is presented. Vitreous biopsy and lumbar puncture resulted in the diagnosis of high-grade malignant non-Hodgkin's lymphoma (NHL). Because chemotherapy and radiotherapy continue to yield better results in the treatment of NHL and a cure can be reached in a large group of patients with high-grade malignant NHL, early diagnosis is very important. We therefore recommend early vitreous biopsy in persistent, bilateral, granulomatous intermediate uveitis, especially in older patients. Our patient achieved a complete remission (follow-up period at the time of writing, 18 months after the beginning of polychemotherapy and radiotherapy). The chemotherapy modalities are briefly discussed.

The prevalence of asthma and allergies in Singapore; data from two ISAAC surveys seven years apart.

BACKGROUND AND AIMS: Over the past few decades, the prevalence of asthma has been increasing in the industrialised world. Despite the suggestion of a similar increase in Singapore, the 12 month prevalence of wheeze among schoolchildren in 1994 was 2.5-fold less than that reported in western populations. It was hypothesised that with increasing affluence in Singapore, the asthma prevalence would further increase and approach Western figures. A second ISAAC survey was carried out seven years later to evaluate this hypothesis. METHODS: The cross-sectional data from two ISAAC questionnaire based surveys conducted in 1994 (n = 6238) and in 2001 (n = 9363) on two groups of schoolchildren aged 6-7 and 12-15 years were compared. The instruments used were identical and the procedures standardised in both surveys. RESULTS: Comparing data from both studies, the change in the prevalence of current wheeze occurred in opposing directions in both age groups--decreasing in the 6-7 year age group (16.6% to 10.2%) but increasing to a small extent in the 12-15 year age group (9.9% to 11.9%). The 12 month prevalence of rhinitis did not change; there was an increase in the current eczema symptoms in both age groups. CONCLUSION: The prevalence of current wheeze, a surrogate measure of asthma prevalence, has decreased significantly in the 6-7 year age group. Eczema was the only allergic disease that showed a modest increase in prevalence in both age groups.

Prevention of IOP-rise following Nd-YAG laser capsulotomy with topical timolol and indomethacin.

Short term observation following Nd-YAG laser capsulotomy indicates that serious elevation of intra-ocular pressure may occur, unrelated to the amount of incident energy used. In this study we evaluated the effect of pre-treatment with anti-prostaglandin eyedrops on the rise in IOP. The IOP in forty pseudophakic patients, undergoing Nd-YAG laser posterior capsulotomy, was measured before capsulotomy and 2 and 4 hours afterwards. The fellow-eye was used as a control. Thirty minutes pre-operatively the patients were given one of the four following combinations of eyedrops: 1 drop timolol 0.5% and 1 drop placebo, 1 drop indomethacin 1% and 1 drop placebo, 1 drop timolol 0.5% and 1 drop indomethacin 1%, 1 drop placebo and 1 drop placebo. Statistical analysis of the results showed that indomethacin alone has little influence on the IOP-rise, whereas timolol has. When indomethacin is added to timolol there is no significant enhancement.