Hand, Foot, and Mouth Disease in Children: Clinical Characteristics of an Outbreak in Novi Sad, Serbia.

Hand, foot, and mouth disease (HFMD) is a relatively common mild viral infection that usually affects young children, mainly occurring during the late spring, early summer, and fall months. It is most commonly caused by members of the human enterovirus (HEV) genus. Recently, HFMD has received renewed attention because of evidence that this disease could have clinical, epidemiological, and etiological characteristics different from those initially associated with it. HFMD may be associated with neurologic or cardiopulmonary complications and can, rarely, lead to death. Our study was a retrospective analysis on 83 children (<18 years of age) who were clinically diagnosed with HFMD at the Department of Dermatology of the Institute for Child and Youth Health Care of Vojvodina, in a single, tertiary-care university hospital in Novi Sad, Vojvodina province, Serbia, for the time period from January 2016 to December 2017. During the study period, HFMD was diagnosed in 83 children. Our results suggest that the outbreak of HFMD occurred in younger children (average age 3.10 years), who seem to be the most susceptible age group for HFMD infection. Taking into account that the diagnosis of HFMD is usually clinical, we believe that it is important for health professionals to be well-informed about the clinical features and the course of the disease. Good personal hygiene and the implementation of a surveillance system can help stop the spread of the disease and prevent outbreaks.

Multifocal Infantile Hemangioma - Presentation of 4 Cases and Review of the Selected Literature.

BACKGROUND: Multifocal infantile hemangiomas (IHs) are focal cutaneous lesions affecting more than 1 anatomic site. The multifocal distribution pattern is the rarest form of IH manifestation, accounting for only 3-4% of all affected infants. This type of cutaneous IHs may be a marker for extracutaneous disease, with the liver being the most frequently affected organ. METHODS: We investigated the clinical and epidemiological characteristics of a small case series of infants with multifocal IHs presenting with different clinical patterns, all diagnosed and treated in a regional tertiary-care pediatric clinic. RESULTS: Four infants with multifocal IHs were included in the analysis. There were 3 girls and 1 boy. Three out of 4 infants were prematurely born (2 of them very preterm), while only 1 was full-term. Clinical patterns in all cases were quite different, but more than 20 cutaneous IHs were present in each of the patients. Two infants had multifocal liver hemangioma, but without complications. In 3 out of 4 patients, systemic propranolol therapy was introduced, with excellent response in two cases (both with liver involvement). CONCLUSION: With the increase in the number of cutaneous IHs, the probability of internal organ involvement, most often the liver, also increases. Evaluation for extracutaneous lesions is indicated in infants with 5 or more cutaneous IHs. Treatment of infants with multifocal IHs should be individualized and consider all relevant risk factors, including prematurity.

Infantile Hemangiomas with Minimal or Arrested Growth - Do They Occur More Often in Premature Infants Than It Seemed?

Infantile hemangiomas with minimal or arrested growth (IH-MAGs) are a subtype of infantile hemangiomas (IHs), characterized by absent or minimal (equal or less than 25% of the total IH surface area) proliferation. They are less conspicuous than classical IHs, but can also be complicated by ulceration or can be misdiagnosed as capillary malformations. The literature on IH-MAGs is scarce, but with increasing interest in the literature. We investigated the clinical and epidemiological characteristics of IH-MAGs in a retrospective series of cases found in a regional tertiary-care pediatric clinic during a 7-year period. Eleven infants with 14 IH-MAGs were included in the analysis. There were 7 girls and 4 boys. Unlike the majority of other authors, we have found 7 premature and 4 full-term infants in our case series. Most of the IH-MAGs were classified as focal (78.57%), were present at birth (72.72%), and were located on the lower body, below the waist line (71.42%). In almost all infants, erythematous background as well as vasoconstricted patches and/or halos were present, while fine or coarse telangiectasias were observed mainly in full-term infants. A subtle proliferative component was observed in only one case on follow-ups. There were no ulcerations. The therapy - topical and oral beta-blocker - was introduced in two cases of IH-MAGs in the face region. Clinical characteristics of IH-MAGs in our case series were similar to those found in other studies on this subject. However, we found a significantly higher percentage of premature infants with IH-MAGs than in any available reference.

Iatrogenic Anetoderma of Prematurity: A Series of 5 Clinical Cases and Literature Review.

Iatrogenic anetoderma of prematurity (IAOP) represents a benign iatrogenic dermatosis characterized by focal, well-demarcated areas of atrophic skin in preterm infants. We present the cases of 5 infants diagnosed with IAOP during a 3-year period in a tertiary-care university hospital. Skin atrophy patches were absent at birth in all presented infants, and there was no family history of anetoderma. All of the infants were born with very low gestation and birth weight, with a clinical course that was complicated with several serious prematurity-related complications with consequent long periods of unstable vital functions and the need for continuous monitoring. Skin defects consistent with IAOP were located on the previous ECG electrode sites. IAOP changes in all the infants were in the form of oval patches of skin atrophy in the middle chest region, with an additional few small, round patches bellow the nipple on both sides in one girl. Diagnosis of IAOP was based on characteristic clinical findings. IAOP is rare, benign, but permanent skin injury in the most immature of infants, with a potential for considerable aesthetic and psychological burden. Due to the constant increase in survival of very and extremely preterm infants, more often without major developmental consequences, milder complications like IAOP will become more and more important.

Effects of an eight-week exercise program on parameters of the lipid profile of female students.

BACKGROUND: Increased lipid levels are one of the major risk factors for the development of cardiovascular diseases. The aim of the current study was to evaluate the effect of short-term (8 weeks) aerobic exercise of moderate to vigorous intensity on lipid profile in young healthy females. METHODS: 27 female students (mean age 20.5 ± 1 year) completed 8 weeks of aerobic training that included two exercise sessions of continuous aerobic activity of moderate intensity (running 35-60 min) and one exercise session with interval training of vigorous intensity. Intervention aerobic capacity and lipid profile were examined before and after the exercise. RESULTS: Exercise intervention has caused a decrease of low density lipoprotein levels per 9.8% (from 2.52 ± 0.47 to 2.27 ± 0.53 mmol/L; p < 0.001) and significant improvement of high density lipoprotein (HDL) levels per 22.7% (from 1.29 ± 0.24 to 1.59 ± 0.24 mmol/L; p < 0.001), total cholesterol/HDL ratio per 17.2 % and aerobic capacity (VO2max) per 3.8 % (43.9 ± 3.7 to 45.56 ± 3.63 mLO2/kg/min). CONCLUSIONS: The results support the hypothesis that a short-term aerobic exercise intervention of moderate to vigorous intensity may have significant effects on blood lipid profile in young healthy females.

Major risk factors for chronic venous disease development in women: is childbirth among them?

Many studies have reported that Chronic venous disease (CVD) occurs more in females than males, due to pregnancy. The study was conducted over the period 2014-2015 at the Dermatovenereological clinic, Novi Sad, Serbia. We performed a cross-sectional study of 554 women. According to Clinical-Etiology-Anatomy-Pathophysiology (CEAP) staging, the sample was divided into three groups: Mild CVD (classes 1-3 by CEAP) - n = 72; Severe CVD (classes 4-6 by CEAP) - n = 122 and a Control (no CVD) - n = 360 patients. The age range of participants was 18 to 93 years (average 54.92 years). Most important CVD risk factors were examined in detail. Out of 554 examinees, 22.03% had severe CVD, and 12.99% had mild CVD. Bivariate analyses showed a significantly higher proportion of women who had deliveries in the severe CVD and mild CVD groups, compared with the control group. Other significantly related factors were older age, family history of varicose veins, standing job position and hypertension. After performing multiple logistic regression analysis, older age, standing job position and family history of varicose veins remained significant, while childbirth lost its significance. Our results suggest that childbirths are not associated with the occurrence of CVD.

Discriminant analysis of cardiovascular and respiratory variables for classification of road cyclists by specialty.

BACKGROUND: Different variables determine the performance of cyclists, which brings up the question how these parameters may help in their classification by specialty. The aim of the study was to determine differences in cardiorespiratory parameters of male cyclists according to their specialty: flat riders (N.=21), hill riders (N.=35), or sprinters (N.=20) and obtain the multivariate model for further cyclists classification by specialties, based on selected variables. METHODS: Seventeen variables were measured at submaximal and maximum load on the cycle ergometer Cosmed E 400HK (Cosmed, Rome, Italy) (initial 100 W with 25-W increase, 90-100 rpm). Multivariate discriminant analysis was used to determine which variables group cyclists within their specialty, and to predict which variables can direct cyclists to a particular specialty. RESULTS: Among nine variables that statistically contribute to the discriminant power of the model, achieved power on the anaerobic threshold and the produced CO2 had the biggest impact. The obtained discriminatory model correctly classified 91.43% of flat riders, 85.71% of hill riders, while sprinters were classified completely correct (100%), i.e. 92.10% of examinees were correctly classified, which point out the strength of the discriminatory model. CONCLUSIONS: Respiratory indicators mostly contribute to the discriminant power of the model, which may significantly contribute to training practice and laboratory tests in future.

Clinical Efficacy of Combination Therapy with Podophyllotoxin and Liquid Nitrogen Cryotherapy in the Treatment of Genital Warts in Men.

High prevalence, peculiar etiopathogenesis, and ineffective therapies have contributed to the fact that genital warts are one of the most challenging issues in modern medicine. This prospective study was aimed at determining the clinical efficacy of combination therapy with 0.5% podophyllotoxin solution and liquid nitrogen cryotherapy in the local treatment of genital warts in men. One hundred and ten consecutive male patients with genital warts were randomly assigned to two groups. The control group consisted of two subgroups: 30 patients treated with podophyllotoxin and 30 patients treated with cryotherapy. The experimental group included 50 patients treated with combination therapy. The therapy continued until complete regression, but not longer than six weeks. Analysis of the average increase in the number of cleared warts compared to week zero found a significant clinical improvement in the group treated with a combination therapy in relation to the group treated with podophyllotoxin at the end of each of the six weeks and in comparison with the group treated with cryotherapy at the end of each of the first three weeks. After discontinuation of therapy, a significantly lower recurrence rate and appearance of new condylomas was observed at the end of the third month in the group treated with a combination therapy compared with each group treated with monotherapy, and at the end of the sixth month compared with patients treated with cryotherapy. The combination of podophyllotoxin and cryotherapy showed a significantly higher efficacy in the treatment of genital warts in comparison with monotherapy with podophyllotoxin after 6 weeks of treatment (P<0.001), with considerably lower recurrence and appearance of new warts compared with cryotherapy during the 6 months after therapy (P<0.005).

Frequency of Peripheral Arterial Disease in Patients With Chronic Venous Insufficiency.

BACKGROUND: It is estimated that about 15% (10% - 30% in most of the studies) of the total adult population has some aspects of the Chronic Venous Insufficiency (CVI). Frequency of the Peripheral Arterial Disease (PAD) in the adult population is 3% - 4%. Studies dealing with etiopathogenesis of leg ulcers show that between 10% and 18% of all ulcers are of mixed, arterial-venous origin. OBJECTIVES: The purpose of this study was to find out if there is a higher frequency of PAD among CVI patients in comparison with the control group, as well as to discover some common risk factors for CVI and PAD. PATIENTS AND METHODS: This cross-sectional descriptive study was conducted at the dermatovenereological clinic, clinical center of Vojvodina, Serbia. A total of 162 examinees were included. All patients were examined for the existence of CVI and staged according to CEAP (Clinical, etiology, anatomy and patophysiology) classification. In this way, 3 groups were formed: Patients with the mild forms of CVI (stage 1 - 4 by CEAP classification), 57 patients; patients with the severe forms of CVI (stage 5 and 6 by CEAP classification), 55 patients; control group (no CVI), 50 patients. Also, the Ankle Brachial Pressure Index (ABPI) was assessed in all subjects, and its value of ≤ 0.9 was set as criteria for diagnosis of PAD. The same sample was divided according to the presence of PAD into two groups. The most important risk factors for CVI and PAD were identified for each patient through complete examination, medical record and appropriate questionnaire. RESULTS: Our results showed that the risk factors for CVI were high Body Mass Index (BMI), hypertension, predominantly standing position during work and positive family history for CVI. In the same sample it was found that 28 (17.28%) patients had PAD. Relevant risk factors for PAD in the present study were: high BMI, hypertension, diabetes and a positive family history for PAD. Comparison of frequency of PAD among patients with severe forms of CVI and control group showed that this difference was statistically significant (P = 0.0275; OR 3.375; 95% CI 1.125 - 10.12). After multivariate analyses, adjusted odds ratio OR was still statistically significant. CONCLUSIONS: The peripheral arterial disease is more frequent in patients with the severe form of CVI, than in patients without CVI. Concomitant risk factors for CVI and PAD were high BMI and hypertension. In each patient with severe CVI it is necessary to determine the ABPI, in order to exclude the presence of PAD.

Optimum Drop Height for Maximizing Power Output in Drop Jump: The Effect of Maximal Muscle Strength.

The main purpose of this study was to explore the cause-and-effect relation of maximal muscle strength (MSmax) on the optimum drop height (DHopt) that maximizes power output in drop jump. In total, 30 physically active male students participated in this study, whereas the 16 subjects were selected according to their resistance strength training background (i.e., level of MSmax) and allocated into 2 equal subgroups: strong (n = 8) and weak (n = 8). The main testing session consisted of drop jumps performed from 8 different drop heights (i.e., from 0.12 to 0.82 m). The individual DHopt was determined based on the maximal value power output across applied ranges of drop heights. The tested relationships between DHopt and MSmax were moderate (r = 0.39-0.50, p ≤ 0.05). In addition, the stronger individuals, on average, showed maximal values of power output on the higher drop height compared with the weaker individuals (0.62 vs. 0.32 m). Finally, significant differences in the individual DHopt between groups were detected (p < 0.01). The present findings suggest that drop height should be adjusted based on a subject's neuromuscular capacity to produce MSmax. Hence, from the perspective of strength and conditioning practitioners, MSmax should be considered as an important factor that could affect the DHopt, and therefore should be used for its adjustment in terms of optimizing athlete's testing, training, or rehabilitation intervention.

Effects of Rusanda Spa balneotherapy combined with calcipotriol on plaque psoriasis.

BACKGROUND/AIM: Treatment of psoriasis is very complex and there are no still universal, nor unique treatment modalities. Apart from conventional treatment, which includes topical calcipotriol (vitamin D3 analogue), balneotherapy is drawing increased attention worldwide. Being part of climatotherapy, balneotherapy is defined as the use of natural environmental factors in the treatment of health conditions, whereas in the treatment of psoriasis it means the use of mineral baths and peloids. The aim of this study was to examine the therapeutic efficacy of mineral waters and peloids of the Rusanda Spa on plaque psoriasis in patients also treated with calcipotriol. METHODS: The study included 60 patients divided into two groups. The first group included patients treated with mineral waters, peloids and calcipotriol in the Rusanda Spa, while the second one included those treated only with calcipotriol. The study took 21 days, and each patient was followed up for at least one month after ending the treatment. The treatment efficacy was measured by psoriasis area severity index (PASI) scores on the days 0, 7, 14 and 21 during the treatment and 30 after the end of the therapy. RESULTS: After a 3-week treatment in the Rusanda Spa, the first group showed a decrease in PASI score by 59.45%, whereas in the group of outpatients treated by calcipotriol it was 39.34%. On the day 30 following the treatment, the first group presented with the PASI score reduction of 58.44%, and the second group of 34.78%. The therapeutic efficacy of mineral waters and peloids combined with calcipotriol showed to be significantly higher in regard to monotherapy with calcipotriol (p < 0.05). In regard to clinical symptoms, the best results were obtained in the reduction of desquamation (p < 0.001). CONCLUSION: The results of our study show that in the treatment of plaque-type psoriasis, topical calcipotriol combined with Spa Rusanda balineotherapy is more effective than topical calcipotriol alone. Randomized controlled trials are needed to confirm the effects of balneotherapy as monotherapy in treatment of this type of psoriasis.

Leg stiffness adjustment during hopping at different intensities and frequencies.

Understanding leg and joint stiffness adjustment during maximum hopping may provide important information for developing more effective training methods. It has been reported that ankle stiffness has major influence on stable spring-mass dynamics during submaximal hopping, and that knee stiffness is a major determinant for hopping performance during maximal hopping task. Furthermore, there are no reports on how the height of the previous hop could affect overall stiffness modulation of the subsequent maximum one. The purpose of the present study was to determine whether and how the jump height of the previous hop affects leg and joint stiffness for subsequent maximum hop. Ten participants completed trials in which they repeatedly hopped as high as possible (MX task) and trials in which they were instructed to perform several maximum hops with 3 preferred (optimal) height hops between each of them (P3MX task). Both hopping tasks were performed at 2.2 Hz hopping frequency and at the participant's preferred (freely chosen) frequency as well. By comparing results of those hopping tasks, we found that ankle stiffness at 2.2 Hz ( p = 0.041) and knee stiffness at preferred frequency ( p = 0.045) was significantly greater for MX versus P3MX tasks. Leg stiffness for 2.2 Hz hopping is greater than for the preferred frequency. Ankle stiffness is greater for 2.2 Hz than for preferred frequencies; opposite stands for knee stiffness. The results of this study suggest that preparatory hop height can be considered as an important factor for modulation of maximum hop.

Drug-related pityriasis rubra pilaris with acantholysis.

INTRODUCTION: Acantholysis is rarely reported histological feature of Pityriasis rubra pilaris (PRP), recently recognized as having diagnostic specificity for differentiating PRP from psoriasis. CASE REPORT: Adult male patient one week after the introduction of simvastatin had experienced pruritic erythemo-squamous eruption on head and upper trunk that in a month progressed to erythrodermia, with islands of sparing. Histological picture combined pemphigus-like acantholysis with alternating hyper- and parakeratosis, follicular plugs and dermal inflammation, and confirmed the clinical diagnosis of classic adult type 1 PRP. Acitretin therapy resulted in a resolution of skin disease. Patch test with simvastatin was negative, scratch test was positive, and it was estimated that potential risk of oral challenge with simvastatin outweighed actual need for it. Drug triggering PRP episode is the most likely explanation for temporal relation between the start of simvastatin treatment and skin eruption. CONCLUSION: In management of rare inflammatory skin disease, such as PRP, we have to carefully observe and evaluate not only diagnostic features but possible external influences on its course also.

Epidemiological and clinical features of erythema infectiosum in children in Novi Sad from 2000 to 2009.

BACKGROUND/AIM: Erythema infectiosum (EI) is a common childhood illness, caused by human parvovirus B19. It occurs sporadically or in epidemics and is characterized by mild constitutional symptoms and a blotchy or maculopapular lacy rash on the cheeks (slapped-cheek) spreading primarily to the extremities and trunk. The aim of our study was to analyse the epidemiological and clinical characteristics of erythema infectiosum in children. METHODS: This study included 88 children observed in the Department of Dermatology of the Institute for Child and Youth Health Care of Vojvodina, in Novi Sad, during the period January 2000-December 2009. We compared the data about the clinical characteristics during and after the outbreak of EI observed from December 2001 to September 2002. The data were retrieved from the hospital database. RESULTS: During the study period, EI was detected in 88 children (44 females and 44 males), 0.213% of the total number of 41,345 children observed in the Department of Dermatology. An outbreak of erythema infectiosum was observed from December 2001 to September 2002, with the peak frequency in April and May 2002 and 39 diagnosed cases, and stable number of cases from 2005 to 2009 (a total of 49 diagnosed cases). The average age of infected children was 7.59 +/- 3.339. Eleven (12.5%) children were referred from primary care pediatricians with the diagnosis of urticaria or rash of allergic origin. The most constant clinical sign was reticular exanthema on the limbs, present in 100% of the cases, followed by 89.77% of cheek erythema. Pruritus was present in 9.09% of the children, mild constitutional symptoms in 5.68% and palpable lymph glands in 3.41% of the children. In all the cases the course of the disease was without complications. CONCLUSION: The results of this study confirm the presence of EI (the fifth disease) in our area with a mild course in the majority of patients. Since the diagnosis of EI is usually based on clinical findings, continuing medical education of primary health care pediatricians is essential for reducing the number of misdiagnosed cases.

Cutis marmorata telangiectatica congenita in a preterm newborn - Case report and literature review.

BACKGROUND: Cutis marmorata telangiectatica congenita (CMTC) is a sporadic congenital skin vascular abnormality. Significant number of patients has other congenital anomalies. CASE REPORT: We report a case of a preterm male newborn with cutis marmorata pattern presented on the skin of the face, right side of front of the trunk, whole back, glutei and both legs. Besides, microretrognatia and asymmetric, bad-formed, low-set ears were notable. Ophthalmologic findings showed visual impairment and pale optic nerve papilla. Monitoring of child showed mental underdevelopment and motor retardation. CONCLUSION: CMTC is a rare finding with good prognosis of skin malformations, with an obligation of dermatologist and paediatrician to investigate other associated congenital anomalies.

Effects of nicotine on pulmonary surfactant proteins A and D in ovine lung epithelia.

Maternal smoking during pregnancy increases the incidence and severity of respiratory infections in neonates. Surfactant proteins A and D (SP-A and SP-D, respectively) are components of pulmonary innate immunity and have an important role in defense against inhaled pathogens. The purpose of this study was to determine if nicotine exposure during the third trimester of pregnancy alters the expression of SP-A and SP-D of fetal lung epithelia. Pregnant ewes were assigned to four groups; a nicotine-exposed full-term and pre-term group, and control full-term and pre-term group. Lung tissue was collected for Western blot and IHC analysis of SP-A level, Western blot analysis of SP-D level and qPCR analysis of SP-A and SP-D mRNA expression. Exposure to nicotine significantly decreased SP-A gene expression (P = 0.01) and SP-A protein level in pre-term lambs. This finding suggests that maternal nicotine exposure during the last trimester of pregnancy alters a key component of lung innate immunity in offspring.

Influence of different types of electromagnetic fields on skin reparatory processes in experimental animals.

Wound healing is a very complex process, some phases of which have only recently been explained. Magnetic and electromagnetic fields can modulate this process in a non-thermal way. The aim of this research was to compare the influence of constant and pulsed electromagnetic fields and low-level laser therapy (LLLT) on wound healing in experimental animals. The experiment was conducted on 120 laboratory rats divided into four groups of 30 animals each (constant electromagnetic field, pulsed electromagnetic field, LLLT and control group). It lasted for 21 days. Under the influence of the constant electromagnetic field the healing of the skin defect was accelerated in comparison with the control group. The difference was statistically significant in all the weeks of the experiment at the P < 0.01 level. Accelerated healing was also observed under the influence of the pulsed electromagnetic field (P < 0.05). In the group of animals exposed to LLLT, the healing of the skin defect was faster than in the control group. The statistical significance was at the P < 0.05 level. Different types of electromagnetic fields have a promoting effect on the wound healing process.

[Viral form of hemophagocytic syndrome with erythrodermal clinical picture--case report].

INTRODUCTION: Hemophagocytic syndrome is patophysiological entity with proliferation and over-activation of macrophages, with hemophagocytosis and production of proinflammatory cytokines. It arises as hereditary forms, or acquired, during viral, autoimmune or malignant diseases, and is usually a disorder with fulminant course and high incidence of lethal outcome. The precise mechanism is not resolved; it is a consequence of cytokine storm generated by over-activated T cells and macrophages, due to defects in T cellular cytototoxic function and inadequate down-regulation of immune response. CASE REPORT: A male patient, 26 years old, previously healthy, is presented. Generalized exfoliative dermatitis and lymphadenomegalia had lasted for half a year before admission to the hospital. Hemophagocytosis in lymph gland histology was diagnostic, with T cellular immunohistochemical profile CD3+, CD5-, CD8/-, CD43+/-, CD45RO+, bcl-2+, and numerous CD68+ histiocytes. Apart from elevated titer of Adenovirus serology, other laboratory findings and bone marrow histology were within normal limits. Two weeks of oral antibiotic and topical skin corticosteroid therapy were followed by a rapid improvement of clinical features. Residual skin lesions, linear petechia and flares of pale pink erythema used to recur for the next half a year. During the follow up, two years later there was no lymph gland enlargement, skin rash, or other signs. DISCUSSION: The diagnosis of virus-associated hemophagocytic syndrome with mild clinical course and seemingly spontaneous improvement was established, although it did not fulfill all proposed diagnostic criteria. It is possible that it increased the clinical awareness for these mild forms in immune-competent patients could account for the improved recognition of atypical cases with favorable outcome.

Recovery of canine retina and optic nerve function after acute elevation of intraocular pressure: implications for canine glaucoma treatment.

PURPOSE: To characterize the timing and extent of functional recovery in healthy canine eyes exposed to acute elevation of intraocular pressure (IOP). METHODS: Acute elevation of IOP was induced in 14 healthy Beagles by elevating IOP above the levels of systolic blood pressure for 60 min (average elevation was between 100 and 160 mmHg). Menace, dazzle and pupillary light reflexes (PLR) were tested at 1, 7, 14 and 28 days post elevation. Optical coherence tomography was used to evaluate retinal thickness preoperatively and at 15 and 30 days post elevation. RESULTS: One day post elevation all animals were blind in the operated eye (no positive menace), 5/14 had positive PLR and 10/14 had positive dazzle response. Seven days post elevation 4/14 animals had positive menace response and all animals (14/14) had positive dazzle and PLR responses. Fourteen and 28 days post elevation all animals had positive menace, PLR and dazzle responses. Optical coherence tomography analysis revealed significant thinning of the inferior retina (pre elevation: 156.3 +/- 4.8 microm; 15 days post elevation: 125 +/- 10.4 microm; 30 days post elevation 123 +/- 11.9 microm; P < 0.01, anova). The superior retina, however, did not show any detectable decrease in thickness compared to control eyes (pre elevation: 193.8 +/- 2.6 microm; 15 days post elevation: 176.9 +/- 8.5 microm; 30 days post elevation 176.9 +/- 7 microm; P = 0.057, anova). CONCLUSIONS: Detailed functional and morphologic analysis revealed precise information about retinal damage after acute elevation of IOP. Canine retina has the capacity to recover at least some visual function even at 14 days after acute elevation of the IOP. More aggressive medical and surgical treatment of canine glaucomatous patients may be indicated despite complete loss of visual function, PLR and dazzle responses in early days after development of an acute glaucomatous attack.

Evaluation of retinal status using chromatic pupil light reflex activity in healthy and diseased canine eyes.

PURPOSE: To differentiate rod-cone-mediated pupil light reflexes (PLRs) from intrinsic melanopsin-mediated pupil light reflexes by comparing pupil responses with red and blue light stimuli of differing intensities in normal dog eyes and in those with sudden acquired retinal degeneration syndrome (SARDS) exhibiting a nonrecordable electroretinogram. METHODS: The PLR was evaluated in 14 healthy dogs using a computerized pupillometry system and in five dogs with SARDS. Contraction amplitude, velocity, and implicit time of the PLR were studied as a function of peak wavelength (480 nm vs. 630 nm) and light intensity (-0.29 to 5.3 log units) to determine characteristics of the rod-cone versus predominantly melanopsin-mediated PLR activity. RESULTS: The PLR in healthy, mildly sedated dogs could be elicited at low light intensities (-0.29 log units; 0.51 cd/m(2)). Canine SARDS patients displayed a complete absence of vision, electroretinographic amplitude, and PLR at low light intensity. However, in SARDS dogs, a pupil light reflex could be elicited with wavelengths corresponding to the melanopsin spectral sensitivity (blue light - peak at 480 nm) and at relatively high intensity (4.3 log units or higher), whereas red light (630 nm peak wavelength) was ineffective in eliciting any detectable PLR response even at light intensities of 6 log units (1,000,000 cd/m(2)). CONCLUSIONS: The PLR in healthy canine eyes can be elicited at very low light intensities using red and blue wavelengths of light, but in dogs with blindness caused by SARDS, the pupil reacts only to high-intensity blue wavelength light, implying loss of the rod-cone-mediated PLR and most likely the presence of intrinsic, melanopsin-mediated, retinal ganglion cell-mediated PLR.