[Resection of a metastatic left ventricular tumor with an aid of thoracoscopy].

A 61-year-old woman who complained of chest pain and cough was admitted to our hospital. She was diagnosed with multiple metastasis of breast or lung cancer, and a cardiac tumor was detected by echocardiography during chemotherapy. The tumor was located on the papillary muscle near the apex, had a smooth surface, and was well mobile. Emergency operation was performed because the tumor was considered to be a cause of cerebral infarction. Under cardiopulmonary bypass, resection of the tumor was performed by trans-mitral-valve approach. By using a thoracoscope, we could share information and obtain the details of the tumor during the operation. Resection using a trans-mitral-valve approach with an aid of thoracoscopy is considered useful.

Prediction of future scotoma on conventional automated static perimetry using frequency doubling technology perimetry.

AIM: To see if scotoma detected with frequency doubling technology (FDT) is confirmed by Humphrey field analyser (HFA) 3 years later. METHODS: Subjects were first examined with the screening C-20-1 program of FDT. The visual field was examined annually for 4 years using HFA program C30-2. The central 58 test points in HFA were assigned to one of the 17 clusters corresponding to FDT test points. Each cluster was represented as the lowest probability symbol of total deviation (TD) of the HFA test points included in the cluster. Clusters were graded normal, suspected scotoma, and scotoma depending on probability of TD-5% or more, 5%-1%, less than 1%, respectively. Relative risk (RR) of abnormality on FDT for future scotoma on HFA was estimated. RESULTS: 80 eyes of 42 patients were followed up for 4 years. While 4.0% of normal clusters of HFA with normal FDT results developed into scotoma cluster, 20.8% of normal clusters with abnormal FDT results developed into scotoma cluster with HFA at the third year. RR for future scotoma was 5.24 (95% CI, 2.75 to 10.0, p<0.05). CONCLUSION: An abnormal result in FDT shows a high risk of future scotoma on HFA after 3 years even if the original HFA perimetry showed normal results.

Comparison of iridial pigmentation between latanoprost and isopropyl unoprostone: a long term prospective comparative study.

AIM: To compare incidence of iridial pigmentation prospectively induced by long term treatment with latanoprost and isopropyl unoprostone (hereafter, unoprostone) in Japanese patients with glaucoma. METHODS: Patients with glaucoma treated with prostaglandin (PG) related ophthalmic solutions were sequentially enrolled. Patients treated for more than 30 months with PG related ophthalmic solutions were subjected to analysis. The entry criteria were no history of intraocular surgery, laser iridotomy, and/or laser trabeculoplasty within 12 months before and after the enrolment; and no history of uveitis; no changes in antiglaucoma drugs within 6 months before and after the enrolment. Photographs of the irides were taken under the same conditions and three glaucoma specialists evaluated the iridial pigmentation with masking of patient information. The correlation of iridial pigmentation with the background factors and the reduction of intraocular pressure (IOP) before and after the treatment were investigated. RESULTS: 48 eyes in 48 patients satisfied the enrolment criteria (25 eyes in the latanoprost group, 23 eyes in the unoprostone group). At the end of the follow up period, iridial pigmentation was present in 15 patients (60.0%) in the latanoprost group and seven patients (30.4%) in the unoprostone group. The correlation between development of iridial pigmentation and age, sex, concurrent use of other ophthalmic solutions, and IOP reduction was not significant. CONCLUSIONS: The incidence of iridial pigmentation induced by latanoprost or unoprostone is high in the case of long term treatment. Iridial pigmentation did not affect PG related ophthalmic solution induced IOP reduction.

Agreement between frequency doubling perimetry and static perimetry in eyes with high tension glaucoma and normal tension glaucoma.

AIMS: To investigate the agreement in results between frequency doubling technology (FDT) and the conventional automated static perimeter in eyes with normal tension glaucoma (NTG) and high tension glaucoma (HTG). METHODS: 72 eyes of 36 patients, who had two or more experiences with the Humphrey field analyser (HFA) program C30-2, were examined with the screening C-20-1 program of FDT. The result of FDT at each of the 17 stimulus points was graded as one of four categories. 58 out of 76 test points of HFA were assigned to one of the 17 clusters corresponding to FDT test points. Each cluster was represented as the lowest (scotoma of HFA) or the highest (threshold of HFA) probability symbol of total deviation (TD) of the HFA test points included in the cluster. The agreement between scotoma/threshold of HFA and FDT results was evaluated for NTG and HTG. RESULTS: In a total of 65 eyes, the Spearman coefficients between the FDT and HFA (threshold/scotoma of HFA) were 0.599 and 0.515 (p<0.0001), respectively. In the HFA mean deviation matched 20 HTG eyes and 20 NTG eyes, the number of points with abnormal FDT results were 102 and 62 in eyes with HTG and NTG, respectively. The eyes with HTG had more abnormal FDT results than NTG eyes (p=0.0014, Mann-Whitney U test). The kappa coefficient between FDT and threshold of HFA in eyes with HTG and NTG was 0.288 and 0.520, respectively, and the agreement between FDT and scotoma of HFA was 0.480 and 0.439, respectively. CONCLUSIONS: The best agreement of the results of FDT and HFA was observed in eyes with NTG using threshold of HFA. The eyes with HTG showed lower agreement with more abnormal points in FDT results, which suggests enough sensitivity of FDT in eyes with NTG, and higher sensitivity of FDT in eyes with HTG.

Staged carotid stenting and carotid endarterectomy for bilateral internal carotid artery stenosis. Preliminary experience.

SUMMARY: The purpose of this study was to evaluate the efficacy and safety of staged carotid stenting (CS) and carotid endarterectomy (CEA) for bilateral internal carotid artery stenosis. With this strategy, initial carotid stenting was performed for the high grade carotid stenosis to reduce the risk of subsequent CEA. Eight patients were treated with staged CS and CEA; CS for asymptomatic side followed by CEA for symptomatic side. Sufficient revascularization was obtained in all procedures but one CS procedure. Two minor stroke caused by distal embolism occurred during the perioperative period of CS. Postprocedural persistent hypotension was observed in one CS procedure. The mean interval between CS and CEA was 19.8 days. In conclusion, although our strategy has some advantages such as avoidance of bilateral cranial nerve palsy and shorter admission period over staged CEA, relatively high complication rate was noted at the first CS without any stroke morbidity post CEA. Our preliminary result showed that further reduction of periprocedural complication rate at the initial stenting is mandatory for this approach justified.

Iridial pigmentation induced by latanoprost ophthalmic solution in Japanese glaucoma patients.

PURPOSE: To investigate the incidence of iridial pigmentation induced by latanoprost ophthalmic solution in Japanese glaucoma patients by a prospective and observer-masked study. PATIENTS AND METHODS: Sixty-nine eyes of 69 glaucoma patients were included. Patients who had undergone intraocular surgery, laser trabeculoplasty, and laser iridotomy within 12 months before enrollment, and patients with history of uveitis and any changes in antiglaucoma drugs within 6 months before enrollment were excluded. Iridial photographs were taken by one examiner under the same conditions at 1, 3, and 6 months after the initiation of latanoprost treatment. Three glaucoma specialists, masked of patient information, independently assessed the iridial pigmentation. Cases with iridial pigmentation diagnosed by three specialists were categorized as showing a definite increase in iridial pigmentation. RESULTS: A definite increase in iridial pigmentation occurred in 3.5%, 9.7%, and 35.0% of eyes within 1, 3, and 6 months of treatment, respectively. Age, gender, or concomitantly used eyedrops did not significantly influence the incidence of iridial pigmentation within 6 months of instillation. A reduction of intraocular pressure by latanoprost did not differ significantly between patients with and without iridial pigmentation. CONCLUSION: The incidence of iridial pigmentation by latanoprost ophthalmic solution in Japanese patients was higher than previously reported values in pigmented races.

[Stenting for proximal subclavian and brachiocephalic artery occlusion--preliminary results].

The authors report the initial results, between January 1998 and February 2001, of stenting utilizing the brachial approach in seven patients for total occlusions at the following locations: two right subclavian, one brachiocephalic, and five left subclavian arteries. All lesions were associated with subclavian steal syndrome. Indications for the treatment included ischemic symptoms in the affected arm (seven patients), and vertebrobasilar insufficiency (five patients). A total of eight stents were implanted in six occluded arteries, resulting in a 75% procedural success rate. Procedural complications encountered were two subintimal dissections by a 0.035-inch guide wire during recanalization, and one stent dislodgement with migration. There was no stroke, presumably because of the previously reported preventive effect of delayed reversal of a stealing vertebral artery. Follow-up over a mean duration of 11 months revealed no sign or symptom of recurrence in cases with initial technical success. The results of the current study, with a literature survey, indicated that percutaneous transluminal angioplasty with primary stent deployment in an occluded prevertebral segment of the subclavian or the brachiocephalic artery should be considered as an available choice for treatment. Further points, such as some remaining technical and clinical problems, will require more experience and consideration.

Cystoid macular edema associated with topical latanoprost in glaucomatous eyes with a normally functioning blood-ocular barrier.

PURPOSE: To study prospectively using optical coherence tomography (OCT) whether topical latanoprost induces retinal disorders, such as cystoid macular edema, in patients with glaucoma and a normally functioning blood-ocular barrier. METHODS: Sixty-eight eyes of 38 patients with glaucoma and no history of intraocular surgery, uveitis, or laser trabeculoplasty were studied. Before initiation of latanoprost treatment and after 1, 3, and 6 months of treatment, OCT images were taken, and the following tests were performed: visual acuity examination, fundus ophthalmoscopy, intraocular pressure measurement, and fundus color photography. To evaluate retinal thickness in the fovea accurately. OCT scanning was repeated six times, and the smallest value was used as the retinal thickness in the fovea. RESULTS: Latanoprost ophthalmic solution did not influence retinal thickness in the fovea at any investigated time points compared with the time before instillation, and no changes were observed in visual acuity, ophthalmoscopic findings, and fundus photographs. The intraocular pressure was reduced significantly at all investigated time points compared with the time before instillation. CONCLUSIONS: It is unlikely that topical latanoprost induces retinal disorders, such as cystoid macular edema, in glaucomatous eyes with a normally functioning blood-ocular barrier.

[Stenting for the occlusive carotid and subclavian arteries in Takayasu arteritis].

The authors report the initial results of stenting in four patients of Takayasu arteritis for 11 occlusive carotid and subclavian arteries between January 1999 and December 2000. The lesions included stenoses of two right subclavian, three right common carotid, two left common carotid, and two left subclavian arteries, and total occlusion of two subclavian arteries. A total of 14 stents were implanted in 10 arterial lesions, resulting in a 91% procedural success rate. One failure was due to inability to cross the total occlusion of the subclavian artery. Procedural complications and problems were pain during balloon angioplasty in three patients, vaso-vagal reflex in two, carotid artery perforation associated with transient horseness in one, and stent migration in one. There was no permanent morbidity. Follow-up over a mean duration of 12 months revealed one symptomatic recurrence of left subclavian stenosis, followed by a successful re-dilatation. The results of the current study indicated that primary stenting is an excellent therapeutic option for the occlusive carotid and subclavian arteries in Takayasu arteritis. A long-term follow-up is required to determine the response or behavior of stented segments of the affected arteries.

Restenosis after stent placement for ostial stenosis of vertebral artery.

SUMMARY: The purpose of this study was to evaluate our initial procedural success rate and angiographical outcome of stent placement for vertebral artery (VA) stenosis at the intermediate followup period (11.3 +/- 7.3 months). Stent placement was successfully performed in 20 procedures (19 patients), resulting in a marked reduction of stenosis from 78.7 +/- 12.6 % before to 8.7% +/- 10.6 after stenting. Follow-up angiography, performed after an interval of 11.3 +/- 7.3 months, revealed restenosis greater than 50% in a total of 6 procedures (40%) out of 15. Although PTA with stent placement for stenosis affecting VA origin provided excellent initial success, restenosis occurred at a significant rate even during the intermediate follow-up period.

[Influence of cataract on scanning laser polarimetry].

PURPOSE: To evaluate the influence of cataract on scanning laser polarimetry. METHODS: Nerve fiber layer thickness (NFLT) around the optic nerve head was measured before and after surgery in 43 eyes of 43 patients with cataract. Phacoemulsification-aspiration and intraocular lens implantation was performed in all eyes. RESULTS: The mean NFLT increased 13.41% (p < 0.0001) postoperatively. Positive correlation(rs = 0.56, p = 0.001) was observed between NFLT measurements and cataract degree, using Lens Opacities Classification System III. Significant positive correlation(rs = 0.493, p = 0.004) was observed between NFLT measurements and posterior subcapsular cataract degree. CONCLUSION: Scanning laser polarimetry may underestimate NFLT in individuals with dense cataract.

Effect of decreased retinal illumination on frequency doubling technology.

PURPOSE: To investigate the effect of changes in retinal illumination on Frequency Doubling Technology (FDT). METHODS: Five eyes, of 5 adults who were free from identifiable ocular pathology, were examined using the Snellen chart and the Pelli-Robson chart, conventional automated perimetry, and the full threshold N-30 program of FDT. Each test was performed with and without a 0.9, 1.5, or 2.4 log unit neutral-density (ND) filter placed before the eye. Furthermore, the influence of pupil diameter on FDT test results was compared after treatment with pilocarpine or cyclopentolate with the influence of ND filters. RESULTS: All tests showed a decrease in sensitivity with decreasing retinal illumination. Frequency Doubling Technology showed an especially pronounced and significant decrease in sensitivity. The maximum mean threshold difference in FDT results with ND filter was 31.2 dB while that with the Humphrey Field Analyzer and the Pelli-Robson chart were 13.3 dB and 0.66 log contrast, respectively. The mydriatic state of the pupil increased the sensitivity of FDT and the miotic state decreased it to about the same extent as the the 0.9 ND filter. CONCLUSION: The change in retinal illumination has more impact on FDT than on spatial contrast tests and conventional automated perimetry. It is important to take this into account in evaluating FDT results.

Effects of artefacts on scanning laser polarimetry of retinal nerve fibre layer thickness measurement.

AIMS: To investigate the effects of artefacts on scanning laser polarimetry of the retinal nerve fibre layer. METHODS: Six eyes of six normal volunteers and an artificial nerve fibre layer were examined using the nerve fibre analyser II. The retinal nerve fibre layer thickness (RNFLT) was measured in each of four 90 degree quadrants, superior (S), temporal (T), inferior (I), and nasal (N), at 1.5 disc diameters from the disc margin. Study 1: Measurement in normal eyes. The amount of maximum error in RNFLT measurements was investigated as follows: (1) the intensity setting of the laser beam was changed to be as weak as possible or to be as strong as possible; (2) the intentional offsets of the laser beam axis in relation to the pupil were made in four directions; (3) the eye was rotated by shifting the head 45 or 90 degrees; (4) the right eye was measured by moving it to the left eye position on the head rest. Study 2: Measurements on an artificial nerve fibre layer. The birefringence measurements were confirmed with a plastic disc, which has a radial arrangement of birefringence. The plastic disc with black paper was fixed at the right eye position or the left eye position on the head rest. The retardation of the laser beam by the plastic disc on the black paper was measured. The retardation of the plastic disc was checked by an automatic birefringence evaluation system (ABR-10A, Uniopt Co, Ltd, Shizuoka). RESULTS: Study 1: The effects of the rotated eye and the measurement of the opposite eye position were significant. The eyes rotated 90 degrees showed quite a different pattern in which the thicker and thinner locations of the RNFLT are switched. The nasal RNFLT of the baseline and the 90 degree rotated eye are 41.9 (SD 6.0) microm and 122.5 (11.2) microm, respectively (p<0.0001, Scheffe multiple comparison test). Study 2: The uniform retardation of the plastic disc was observed with the ABR-10A. The NFA detects the retardation of the plastic disc which the retardation map showed as a double humped pattern. CONCLUSIONS: Study 2 indicated that the amount of corneal compensation was not small. The cause of significant influences by the rotated eyes and right eyes measurement in left eye position were thought to be incorrect corneal compensation. To increase the diagnostic ability of SLP, an improved compensation of the cornea is thought to be important.

Simultaneous kindling of the bilateral hippocampi: an advanced model for epilepsy research.

PURPOSE: To examine whether simultaneous kindling of bilateral hippocampi [bilateral kindling (BK)] could accelerate the achievement of seizures by the breakdown of kindling antagonism or decelerate the achievement of seizures by its enhancement. METHODS: The hippocampi of 17 adult rabbits were simultaneously kindled bilaterally according to Goddard's method. RESULTS: All animals developed stage 5 convulsions after a mean of 28 stimulations. Six animals showed spontaneous seizure discharges. Afterdischarge duration increased abruptly during the early period of kindling, but thereafter it gradually progressed. Chronological analyses of interictal discharges (IIDs) demonstrated that simple as well as complex types of IIDs increased their frequencies during BK. CONCLUSIONS: Compared with unilaterally kindled animals, the BK procedure significantly increased the percentage of animals that successfully kindled (100% vs. 59%; p < 0.01), whereas it significantly decelerated the kindling progression (28 days vs. 19 days; p < 0.02). We conclude that the BK procedure represents potentiation of both excitatory and inhibitory mechanisms. Although the reason why such an antagonistic relationship between them breaks down is still unknown, the BK provides an advanced animal model to study the pathogenic mechanisms of kindling and to screen anticonvulsants.

The influence of age, gender, refractive error, and optic disc size on the optic disc configuration in Japanese normal eyes.

PURPOSE: To investigate the influence of age, gender, refractive error, and optic disc size on optic disc configuration in Japanese normal eyes. METHODS: Ninety-two eyes from 92 visually normal Japanese subjects (mean refractive error+/-SD: -1.26+/-2.25 D, range -8 D to +3 D) were examined using a confocal scanning laser tomograph, TopSS. The following disc parameters were investigated: disc size, total or quadrant C/D area ratio and neuroretinal rim area, half-depth area, volume below, and average cup depth. RESULTS: The disc diameter ( mean+/-SD: 1.84+/-0.16 mm) and disc size showed highly significant correlations with the C/D ratio (p<0.001) and the neuroretinal rim area (p<0.001). No other correlation was observed. CONCLUSION: These results indicate that the optic disc diameter and disc size have higher correlations with the optic disc configuration than age, gender, and refractive error in Japanese. These results are similar to those data reported for eyes of Caucasians or Afro Americans, and should be considered when optic discs are evaluated.

A new parameter for assessing the thickness of the retinal nerve fiber layer for glaucoma diagnosis.

PURPOSE: To investigate a new method for assessing the thickness of the retinal nerve fiber layer thickness (NFLT) for glaucoma diagnosis, using scanning laser polarimetry. MATERIAL AND METHODS: Thirty eyes of thirty patients with ocular hypertension or glaucoma were examined using a scanning laser polarimeter. NFL T was measured in each of four 90-degree quadrants; superior (S), temporal (T), inferior (I) and nasal (N) along 1.5-disc diameters concentric from the disc margin. The new parameters S-N (meaning the thickness of the superior nerve fiber layer over the nasal one) etc. were compared with the conventional parameters (S, S/N, etc.). The correlations between these parameters and the mean threshold of the associated visual field test points were included in the comparison. RESULTS: The total thickness (sum of S, I, N and T), N and T did not correlate to the visual field, but S and I did. The new parameters were well correlated to the visual field, S-N giving the best correlation coefficient (rs = O. 782, p < O.0001), and sensitivity and specificity (the area under the receiver operating characteristic curves was 0.91). CONCLUSIONS: The nasal NFLT was the smallest part of individual variation and glaucomatous damage. The new parameters, based on the nasal NFLT, were good evaluators of the changes in glaucoma.

Cross-linking of plasmalemmal cholesterol in lymphocytes induces capping, membrane shedding, and endocytosis through coated pits.

By use of a nicked and biotinylated perfringolysin O (BCtheta), which binds to cholesterol specifically, we studied consequences of cross-linking cholesterol in lymphocytes. When bound with BCtheta and then with labeled avidin or streptavidin, capping occurred in most cells within 30 min at 37 degrees C. It was inhibited by cytochalasin D or NaN3, but not by nocodazole. When BCtheta-cholesterol was capped, Thy-1 and transferrin receptor, a GPI-anchored protein and a transmembrane protein, respectively, remained evenly distributed. By fluorescence and electron microscopy, a cluster of small vesicles bound with BCtheta were observed in the cap. They were then shed in the medium or internalized through coated pits. The result indicates that cross-linking of cholesterol in lymphocytes induces capping, but does not affect distribution of membrane proteins, and that the capped cholesterol molecules are either shed as vesicles or endocytosed.

A new allele, DNASE1*6, of human deoxyribonuclease I polymorphism encodes an Arg to Cys substitution responsible for its instability.

A new allele, DNASE1*6, of human deoxyribonuclease I (DNase I) has been discovered by isoelectric focusing: its gene product has the most cathodic pI of the six electrophoretic variants. Results of DNA sequencing, mismatched PCR-restriction fragment length polymorphism, and transient transfection of the variant construct showed that the mutant was caused by a C-T transition at nucleotide position 1826, resulting in an Arg to Cys substitution at amino acid position 185 of the mature enzyme. The variant isoenzyme, expressed in COS-7 cells, was more labile than the other types. Instability and an increase in the pI value of the variant suggest that a structural alteration, perhaps due to aberrant formation of a disulfide bond, could occur in the enzyme.

Assessment of potential macular function using a color saturation discrimination test in eyes with cataract.

PURPOSE: To study the efficacy of a color saturation discrimination test (CSDT) in assessing potential macular function in eyes with cataract. SETTING: Yamanashi Medical University and Nirasaki City Hospital, Yamanashi, Japan. METHODS: In this prospective study of 200 consecutive eyes with cataract, the thresholds of color saturation discrimination on 6 hues were measured with the CSDT. The CSDT program was run on a personal computer and cathode-ray tube color monitor. The preoperative CSDT scores and postoperative visual acuities were compared. In addition, preoperative laser interferometry (LI) and postoperative CSDT were performed on selected patients and the results compared with their preoperative CSDT results. RESULTS: Patients who had a CSDT score of 11 or more had a significantly lower postoperative visual acuity (P < .0001). The prevalence of neuroretinal abnormality postoperatively increased with the preoperative CSDT score. The CSDT score was not correlated with preoperative visual acuity (P = 1409). Cataract severity had little influence on the CSDT score. The preoperative results of the CSDT and Ll were correlated with the postoperative acuity, with the correlation coefficient being stronger with the CSDT (r = -0.338 and 0.276 for CSDT and Ll, respectively). CONCLUSION: The CSDT was effective in evaluating neuroretinal pathology and predicting postoperative acuity.