Prevalence of HLA B7 in MS with symptomatic uveitis.
Explore the source record for details and available documents.
Child↗
Biomedical subjects
E M Graham
Publications and source records attributed to E M Graham.
Late onset Leber's optic neuropathy: a case confused with ischaemic optic neuropathy.
A case is reported of a 63-year-old man with progressive central visual loss in one eye followed 11 months later by involvement of the fellow eye. A diagnosis of chronic ischaemic optic neuropathy was considered. However, despite a negative family history, the absence of electrocardiographic abnormalities, and minimal fundus changes a diagnosis of Leber's optic neuropathy was made on the basis of magnetic resonance imaging findings and the mitochondrial DNA mutation at base pair 11778.
DNA, Mitochondrial↗
Intermediate uveitis and sarcoidosis.
Explore the source record for details and available documents.
Adult↗
Anti-endothelial cell antibodies in retinal vasculitis.
Auto-antibodies to endothelial cells are found in a variety of vasculitic disorders including two diseases associated with retinal vasculitis: Behcet's disease and multiple sclerosis. In this study we have examined the prevalence of anti-endothelial cell antibodies [AECA] in 15 patients with retinal vasculitis [RV] associated with Behcet's disease, multiple sclerosis or sarcoidosis and 20 patients with idiopathic retinal vasculitis. 47% of patients with RV associated with systemic disease and 35% of patients with idiopathic RV had AECA, compared to 1% of 70 normal controls. The mean levels of AECA were similar in both groups of patients, and comparable to levels found in other systemic vasculitides.
Adult↗
Erythromycin.
Even with the continuing emergence of new antibiotics, erythromycin continues to be used extensively in obstetrics and gynecology. It is inexpensive, with a long history of usage and proven safety. When oral erythromycin preparations are given in the correct dose and with proper timing in relation to meals, no individual preparation offers a significant therapeutic advantage. Its uses include the treatment of respiratory tract infections, chlamydial and other genital tract infections in pregnancy, puerperal mastitis, and acute conjunctivitis of the newborn.
Conjunctivitis, Inclusion↗
Intraabdominal sound levels during vibroacoustic stimulation.
Vibroacoustic stimulation is widely used in the United States as a test for fetal well-being, yet little information is available on the adequacy of the electronic artificial larynx that is commonly used as the stimulator. To determine whether the intraabdominal sound pressure level was dependent on the static force applied to the electronic artificial larynx, we measured the sound pressure level at a position 20 cm from the surface of the anterior abdominal wall in nonpregnant ewes. The electronic artificial larynx was pressed against the surface with three levels of static force: mild, moderate, and strong. Between mild and strong static forces there was a trend toward a reduction in sound pressure level at the fundamental frequency (85 Hz) and the overtones (170 to 1600 Hz) (p less than 0.08). To further examine the relationship between the static force of sound source against the abdomen and the intraabdominal sound pressure level, sine wave oscillations between 20 Hz and 4.0 kHz were produced with an industrial shaker. With a constant dynamic force (0.16 N) applied to the shaker across frequencies, the sound pressure level was greatest at lower frequencies (100 to 110 dB) and less at higher frequencies, above 1.0 kHz (60 to 80 dB). Consistent with the electronic artificial larynx experiments, strong application of the shaker resulted in greater transmission of sound than did mild application (p less than 0.02).
Abdomen↗
Systemic associations of retinal vasculitis.
Explore the source record for details and available documents.
Behcet Syndrome↗
Cocaine alters behavioral states in fetal sheep.
Intrauterine cocaine exposure causes subtle neurologic abnormalities in human newborn infants; however, the mechanism for these abnormalities is not known. To investigate whether cocaine alters fetal behavioral state, the electrocortical, electro-ocular and neck muscle electrical activity was monitored in 7 chronically instrumented fetal sheep before and during both saline and cocaine HCl infusions directly to the fetus. Saline infusion to the fetus had no effect on the percentage of time spent in rapid eye movement sleep compared to no infusion (37.5 +/- 11.6% vs 46.3 +/- 4.6%, mean +/- SD, P greater than 0.1). Cocaine infusion directly to the fetus had no effect on fetal arterial pO2, but did increase mean arterial pressure from 53.6 +/- 15 mmHg to 61.0 +/- 21 mmHg (P less than 0.01). In addition, during cocaine infusion, the percentage of time spent in rapid eye movement sleep dropped to 3.9 +/- 5.1% (P less than 0.0001) and the average duration of rapid eye movement epochs decreased from 10.1 +/- 3.0 min precocaine infusion to 1.9 +/- 2.6 min during cocaine infusion (P less than 0.02). The influence of cocaine was noted in a frequency analysis of the electrocorticogram. The amplitude of the energy centered at 1 Hz during cocaine infusion (73.8 +/- 4.0 dB) was greater than the amplitude during rapid eye movement sleep (65.5 +/- 4.7 dB) and less than the amplitude during non-rapid eye movement periods (79.9 +/- 4.5 dB) (P = 0.01). Cocaine appears to alter fetal behavioral state directly and this may play a role in the abnormal behavior in newborn infants exposed to cocaine in utero.
Animals↗
Bilateral visual loss with eosinophilic infiltration in the bone marrow and the retina.
A young patient is described who presented with sudden visual loss in the left eye quickly followed by proliferative retinopathy with retinal detachment and thrombotic glaucoma. He developed similar initial symptoms in the right eye but has now made a complete recovery in that eye on systemic steroids, oral acyclovir, cyclosporin A and colchicine. Pathological examination of the left eye revealed inflammation in the ciliary body, retina and choroid with prominent eosinophils. The nature of the initial insult and the possible role of the eosinophils are discussed.
Adult↗
The investigation of patients with retinal vascular occlusion.
The investigation of patients with retinal artery occlusion, retinal vein occlusion and cotton wool spots is discussed. The majority are due to either emboli or atheroma and occur in elderly patients. A full clinical history and examination remain the essential part of the investigation but the ophthalmologist must select patients in whom further investigation is warranted. The recent recognition of the importance of antiphospholipid antibodies and natural anticoagulant deficiency states in the pathogenesis of thrombosis has identified a group of young people in whom specific therapy may be indicated.
Humans↗
Intraocular tuberculosis.
Twelve patients with a diagnosis of intraocular tuberculosis are described. Nine patients presented with florid ischaemic retinal vasculitis and a marked tendency to neovascularisation. Two patients developed choroidal tubercles; iris nodules were observed in association with anterior uveitis in the remaining patient. The methods of diagnosis, management and possible mechanisms of pathogenesis of these different clinical presentations are discussed.
Adult↗
A point prevalence study of 150 patients with idiopathic retinal vasculitis: 1. Diagnostic value of ophthalmological features.
This paper describes the ophthalmological features of 150 patients with idiopathic retinal vasculitis, 67 of whom had isolated retinal vasculitis (RV) and 83 had RV associated with systemic inflammatory disease (RV + SID). The diagnosis of retinal vasculitis was made by ophthalmoscopy and fluorescein angiography, and patients with any identifiable cause (infection, ischaemia, or malignancy) were excluded from the study. Patients with isolated RV tended to have peripheral vascular sheathing, macular oedema, and diffuse capillary leakage. Those with RV accompanying Behçet's disease often had branch vein retinal occlusions and retinal infiltrates together with macular oedema and diffuse capillary leakage; the retinal infiltrates were pathognomonic for Behçet's disease. In sarcoidosis the retina typically showed features of periphlebitis associated with focal vascular leakage. Patients with uveomeningitis, multiple sclerosis, arthritis, or systemic vasculitis showed diffuse retinal capillary leakage associated with a mixture of the other features. Poor visual function was particularly associated with macular oedema and branch vein retinal occlusion, while the retina appeared to 'withstand' the impact of vascular sheathing, periphlebitis, or neovascularisation alone. Within the limitations of a point prevalence study it was concluded that different patterns of retinal vasculitis occur in different systemic inflammatory diseases, and that in isolated retinal vasculitis there is a particular association between peripheral vascular sheathing, macular oedema, and diffuse capillary leakage. In Part 2 we describe the results of examining the sera of these patients for the presence of antiretinal antibodies and circulating immune complexes.
Adolescent↗
A point prevalence study of 150 patients with idiopathic retinal vasculitis: 2. Clinical relevance of antiretinal autoimmunity and circulating immune complexes.
This study describes the occurrence of antiretinal antibodies and circulating immune complexes in the sera of a large series of patients with idiopathic retinal vasculitis whose ophthalmological and clinical features are presented in Part 1. Antiretinal antibodies were measured by indirect immunofluorescence and passive haemagglutination, and circulating immune complexes were measured by polyethylene glycol precipitation and Clq binding. The occurrence of antiretinal antibodies and that of circulating immune complexes were analysed in relation to each other, to severity of retinal disease, to the type of associated systemic inflammatory disease, and to the presence of individual features of retinal inflammation. In patients with retinal vasculitis together with systemic inflammatory disease circulating immune complexes were usually accompanied by antiretinal antibodies. However, those patients with antiretinal antibodies in the absence of circulating immune complexes tended to have more severe retinal vasculitis, a feature particularly evident in Behçet's disease (p = 0.028). In patients with isolated retinal vasculitis, severity of disease was associated with antiretinal antibody (p = 0.013), as well as with the occurrence of both antiretinal antibody and circulating immune complexes together (p = 0.010). In the series as a whole there was a tendency for individual features of retinal vasculitis to be associated with antiretinal antibodies unaccompanied by circulating immune complexes; especially in macular oedema (p = 0.028). In isolated retinal vasculitis there was also an additive effect of antiretinal antibodies and circulating immune complexes in relation to disease severity; in contrast, in patients with systemic inflammatory disease, the coexistence of antiretinal antibodies and concluded that both antiretinal autoimmunity and circulating immune complexes may act as immunopathogenetic factors in idiopathic retinal vasculitis but that, in certain patients, circulating immune complex formation seems to protect against the more severe forms of autoimmune retinal inflammatory disease.
Antigen-Antibody Complex↗
Ocular inflammatory changes in established multiple sclerosis.
Fifty consecutive patients with clinically definite multiple sclerosis were studied to assess the prevalence of concomitant uveitis. Asymptomatic ocular inflammatory changes were found in nine patients (18%) and appeared to show a positive correlation with severe and progressive disease. Conversely uveitis was uncommon in the presence of established optic atrophy which suggests a negative influence on its pathogenesis. In the absence of optic atrophy inflammatory changes in the eye may be a valuable index of disease activity.
Adolescent↗
Ptosis and supranuclear downgaze paralysis.
A patient developed the unusual combination of a supranuclear downward gaze paralysis and bilateral ptosis. It was caused by a single midbrain glioma. Other ocular motor functions were intact. The neuropathologic examination showed a tumor growing mainly around the third ventricle and the aqueduct. The findings agree with recent experimental evidence that a network of neural elements involved in eyelid control lies in the supraoculomotor area immediately dorsal to the oculomotor nucleus.
Aged↗
Precipitation of experimental autoallergic uveoretinitis by cyclosporin A withdrawal: an experimental model of uveitis relapse.
This study set out to determine whether withdrawal of cyclosporin A (CyA) in Lewis rats sensitized to retinal S antigen would precipitate experimental autoallergic uveoretinitis (EAU), and whether challenge of such animals with S antigen or an unrelated stimulus would accelerate EAU onset after drug withdrawal. Rats were sensitized with 50 micrograms S antigen in Freund's complete adjuvant (FCA) and EAU onset was suppressed by 18 days of treatment with CyA at doses ranging from 3 to 10 mg/kg daily. Without challenge, seven out of 11 animals developed EAU with a median onset of 78 days. This was reduced to 68 days in rats challenged on day 32 with FCA alone, to 48 days with 10 micrograms S antigen in FCA, and to 41 days with 50 micrograms S antigen in FCA. The incidence, onset and severity of anterior uveitis and extent of photoreceptor destruction were related to both CyA dose and nature of challenge. The extent of photoreceptor destruction ran parallel with severity of anterior uveitis; and delayed-type hypersensitivity reactivity on day 43 was related to both severity of anterior uveitis (P less than 0.001) and photoreceptor damage (P less than 0.002). At the highest dose, CyA also delayed the appearance of antibody to S antigen; however, subsequent antibody levels were unrelated to EAU severity or to nature of challenge. The results indicate that CyA-induced suppression of the immunological response to S antigen can recover spontaneously after drug withdrawal, that challenge with either S antigen or FCA alone can accelerate the subsequent onset of EAU, and that these phenomena may provide a basis for investigating mechanisms underlying relapse of human uveoretinitis.
Animals↗
Differential effect of Bordetella pertussis on experimental posterior uveitis in the black-hooded Lister rat.
The effect of an additional adjuvant, Bordetella pertussis, on the clinical and histopathologic features of experimental autoimmune uveitis in black-hooded Lister rats was investigated. Disease was induced by a single footpad injection of purified retinal S-antigen in Freund's complete adjuvant. In those animals that did not receive B Pertussis the clinical features were those of a retinal vasculitis with disc edema, periphlebitis, and deep retinal infiltrates. In contrast, animals that received B pertussis developed lesions in the pigment epithelium and choroid. Histopathologic studies disclosed focal photoreceptor necrosis associated with mononuclear cell infiltration in both groups of animals. However, in the group that did not receive B pertussis the disease was predominantly a retinitis associated with perivascular infiltration of retinal vessels, whereas in the group that did receive B pertussis the main feature was a focal choroiditis, with superficial retinal lesions being rarely observed. Retinal photoreceptors were the target tissue in both groups of rats, but the route by which they were damaged was altered from predominantly retinal to choroidal by the addition of Bordetella pertussis as an adjuvant. This change may be ascribed to the ability of B pertussis toxin to sensitize vascular endothelium to local mast cell products, these cells being plentiful around choroidal vessels but absent in the retinal circulation.
Adjuvants, Immunologic↗
Retinal vasculitis.
Evidence is now accumulating on both clinical and experimental grounds that the retina is an a priori source of inflammatory activity. Reactive inflammation in the retina may produce many of the clinical signs previously ascribed to uveal inflammation. Autoimmune mechanisms are probably responsible for the majority of cases of retinal vasculitis. Autoimmune retinal vasculitis occurs without other classical signs of inflammatory response in any other parts of the body. When associated systemic manifestations occur they may reflect different underlying immunopathogenic abnormalities. Thus in diseases with predominantly arterial involvement (e.g. systemic lupus erythematosus, polyarteritis nodosa) the retinal arteries bear the brunt of this disease. In Behçet's disease the systemic involvement is usually venous and ocular involvement produces diffuse capillary and venous inflammation with areas of retinal necrosis and major vascular occlusion. The retinal appearances differ from sarcoidosis in which a granulomatous response produces characteristic periphlebitis. Finally, autoimmune retinal vasculitis produces diffuse capillary and venous damage, without any systemic signs. In the next decade the search will be for the identification of the specific antigens initiating these disparate retinal features. Retinal S antigen is a potent antigen, but rhodopsin, interphotoreceptor binding protein, and transducin all need further experimental investigation. Precise documentation will herald the dawn of new therapeutic measures based on a sound immunological fabric.
Adult↗