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Biomedical subjects

G A Shun-Shin

Publications and source records attributed to G A Shun-Shin.

At least 19 recordsLinked to original sources

Glutathione adducts, not carbamylated lysines, are the major modification of lens alpha-crystallins from renal failure patients.

alpha-Crystallins from the water-soluble and the water-insoluble, guanidine-soluble portions of lenses from four renal failure patients and two normal donors of similar age were isolated and enzymatically digested into peptides. Molecular weights of the peptides, determined by fast atom bombardment mass spectrometry, indicated modifications specifically associated with renal failure. The only modifications observed in the alpha-crystallins from renal failure patients, but not in the normal old lenses, were glutathione adducts to Cys 131 and Cys 142. These adducts were present in the lenses of all four renal failure patients, but not in the two normal old lenses. The four lenses from the renal failure patients were searched for evidence of carbamylation at lysyl or cysteinyl residues: carbamylation was not detected. Because the same mass spectrometric methods had previously demonstrated sufficient sensitivity and specificity to detect as little as 5% modification in the examination of in vitro carbamylated bovine lenses, these results indicated that carbamylation is not a major modification of the lens alpha-crystallins of renal failure patients.

Aged

Central corneal light scatter in long-term diabetics.

Changes in corneal thickness have been correlated with severity of diabetic retinopathy. Measuring light scatter at the central cornea may reflect the changes in corneal thickness and hence the retinopathy. This study compared the peak central corneal light scatter between 22 insulin-dependent diabetic patients with disease of at least 10 years' duration and 29 controls. No significant difference was found in the light-scattering properties of the central cornea between the two groups. This technique does not offer an alternative method of screening for diabetic retinopathy.

Cornea

Heterogeneity in ultrastructure and elemental composition of perinuclear lens retrodots.

PURPOSE: To unravel the cataractogenic process(es) leading to the birefringent lenticular bodies known as perinuclear retrodots. METHODS: Ten human lenses containing biomicroscopically verified perinuclear retrodots were systematically screened and analyzed using scanning electron microscopy and energy dispersive x-ray microanalysis to verify their ultrastructure and elemental composition. RESULTS: Three types of retrodots were distinguished, different in size, ultrastructure, and origin. Two of them contained calcium phosphate, the third probably contained calcium oxalate. All three types were separated from surrounding normal fibers and the crystalline inclusions were sequestered within membrane-lined bodies. CONCLUSIONS: Because of these observations and data found in the literature it is postulated that elevated free calcium is the initiating factor in the formation of retrodots, trapped by either oxalate or phosphate and sequestered in the retrodots. It is suggested that the oxalate is derived from ascorbate because of impaired protection against oxidative stress in the older lens. Phosphoric acid is believed to be released by calcium-induced hydrolysis of membrane phospholipids.

Calcium Oxalate

Keratometry using the Goldmann tonometer.

Keratometry using the Goldmann tonometer is a reliable and readily available guide to corneal astigmatism following cataract surgery. In regular corneal astigmatism the Goldmann tonometer rings are distorted into skewed ellipses. The axis of the cylinder can be measured by rotating the tonometer head until an undistorted ellipse is obtained. The power is then assessed by comparison with standard ellipses. The difference in the intracular pressure readings (mmHg) in the two principal meridians was also a good guide to the presence of astigmatism. Goldmann keratometry was performed by a single masked observer in 71 patients 8 weeks after routine extracapsular cataract surgery. This was compared with Javal-Schiotz Keratometry performed by an independent observer. In 83% of patients the axis was measured to within 20 degrees. The 95% confidence interval for the power was +/- 2.90 DC; and 87% of patients would have sutures removed appropriately.

Astigmatism

Functional endoscopic transnasal dacryocystorhinostomy.

Endoscopic nasal surgical techniques are revolutionising the management of nasal and sinus disorders. Historically the surgical approach to the nasolacrimal sac and duct has been indirect by an external approach because of poor visualisation intranasally. The nasolacrimal apparatus is, however, intimately related to the lateral nasal wall and may readily be approached using an endoscopic technique which minimises functional interference with the physiological action of the lacrimal pump. This paper describes a technique of endoscopic intranasal dacryocystorhinostomy which has success rates comparable to those obtained by the more conventional external approach.

Adolescent

Analysis of retro-illumination photographs for use in longitudinal studies of cataract.

Retro-illumination photography has potential for the monitoring of cortical and posterior subcapsular cataract formation. Variations in the individual illumination results have limited accurate quantification of opacities within such images. We present a new image analysis technique which minimises the effect of uneven and varying retro-illumination. The new technique has been tested for variation between photographers and over a short time period. We believe it is of value in lens assessment in combination with a semi-quantitative grading system.

Cataract

Is cortical spoke cataract due to lens fibre breaks? The relationship between fibre folds, fibre breaks, waterclefts and spoke cataract.

Fibre folds, previously called lamellar separation of the lens, have been found by electron microscopy to be associated with fibre breaks, which are seen in vivo as the circular shades of Obazawa. This led to the present study to determine the relationship between fibre folds, fibre breaks, waterclefts and spoke cataract. All lenses with fibre folds were found to have circular shades. A few instances of circular shades without fibre folds were found, suggesting that the fibre break may be the primary pathology. It was found that circular shades occurred in association with spoke cataract only when fibre folds were also present. Thus there is no essential causal relationship between fibre breaks and spoke cataract. The occurrence of waterclefts was unrelated to the presence of the other features. The lower nasal quadrant of the lens was the most common site for the four features. The depth of spoke cataracts was found to be unrelated to the age of the patient, which makes it unlikely that accommodational stress at the time of onset of presbyopia is causative.

Age of Onset

Dissociated eye movements in craniosynostosis: a hypothesis revived.

A characteristic pattern of dissociated eye movements was observed in a large proportion of our patients with a variety of craniosynostosis syndromes. These anomalies simulate overaction of the inferior oblique and underaction of the superior oblique muscles which, however, cannot fully explain the abnormalities. In a number of cases, excyclorotation of the muscle cone was observed, with the upper pole of the eye tilted away from the midline. It is postulated that such excyclorotation of the eyes will lead to dissociated eye movements which can be explained on physiological grounds according to Hering's law. This paper presents a review of our patients and evidence to support this hypothesis.

Adolescent

Technical note: computed tomographic dacryocystography.

The technique of computed tomographic dacryocystography is described. It was developed in response to the pre-operative imaging requirements for transnasal endoscopic dacryocystorhinostomy, a new minimally invasive operation performed as a primary procedure to relieve epiphora. However, it is also helpful in the assessment of patients after failed conventional external dacryocystorhinostomy when the information provided will help to determine the subsequent surgical approach. In addition the technique will assist surgical planning in cases of epiphora associated with sinus surgery, facial trauma and maxillofacial tumours by determining the site and extent of pathology.

Dacryocystorhinostomy

Morphologic characteristics and chemical composition of Christmas tree cataract.

PURPOSE: Christmas tree cataract consists of highly refractile multicolored "needles" crisscrossing the lens fibers of the deep cortex. The fact that the colors vary according to the angle of the incident light, and that in retroillumination only a dim outline of the cataract is seen, would suggest that Christmas tree cataract is a diffractive phenomenon. This study was performed to unravel the ultrastructure and chemical composition of the Christmas tree needles. METHODS: Eight lenses from donor eyes and four extracapsularly extracted lenses with Christmas tree cataract were investigated by scanning and transmission electron microscopy. The chemical composition was studied with energy-dispersive x-ray microanalysis and Raman microspectroscopy. RESULTS: Scanning electron microscope examination showed that the needles are smooth, rectangular, plate-like elements bordered by membranes and amorphous material and running crisscross through the lens. In the specimens for transmission electron microscopic examination, the needles proved to be largely dissolved, but the remains showed regular spacings of approximately 5 nm. Material identical in spacing and electron density was found in neighboring cells bound to a reticular membranous network originating from the fiber-limiting membranes. Energy-dispersive x-ray and Raman microanalysis showed that the needles have a high sulfur content and pronounced S-S, CS-SC, and C-S vibrations. The cytoplasm adjacent to the needles and reticular meshwork had an elevated Ca++ content. CONCLUSIONS: It is concluded that cystine is the most likely candidate for the Christmas tree needles and that the needles probably are formed as the result of an age-related aberrant breakdown of crystallins induced by elevated Ca++ levels.

Aged

The relationship between central nuclear scatter and perinuclear retrodots in the human crystalline lens.

Retrodots are common perinuclear features of age-related cataract. Clinical observation suggested that retrodots were associated with increased nuclear scatter. To test this hypothesis, retrospective data were analysed from 78 non-diabetic subjects (118 eyes), of at least 50 years of age, who had neither subscapsular nor axial spoke opacities. Retrodots were graded using the Oxford Clinical Cataract Classification and Grading system and central nuclear scatter was assessed by image analysis of Scheimpflug photographic negatives. Regression analysis in groups was performed according to the "intra-class correlation model" either considering retrodots as a graded feature (grades 0-5) or as a dichotomous variable (present or absent). After adjusting for age (treated as a co-variate), a highly significant association (P < 10(-6) was found between retrodots and increased nuclear scatter in each analysis. It is suggested that the co-existence of these two cataract types may reflect a common cataractogenic mechanism, possibly oxidative stress.

Aged

Prevention of cranial reossification after surgical craniectomy.

An experimental study in rats was designed to see whether the pericranium, used as a graft over the dura, can prevent or delay osseous reunion after craniectomy. A 10 x 3-mm section of the frontal and parietal bones, including the coronal suture line, was resected in 15 rats. Pericranium was then used as a free graft on one-half of the defect to cover the dura and separate it from the cut edges of the craniectomy. The other side acted as a control. All animals were killed 2 months after operation, the skull was removed, and any remaining bony defect on either side of the midline was revealed. The area of residual defect in 13 specimens was determined by statistical image analysis using the Oxford Modular Cataract Image Analysis System (Oxford, England) and Wilcoxon's rank sum test and showed a highly significant difference between the treated and the untreated sides (p = 0.002).

Animals

Capsular 'pits' in the human lens.

The lens capsule is an atypical basement membrane surrounding the lens epithelial cells and lens fibres which make up the remainder of the human lens. A seemingly unreported morphological change visible in the lens capsule with the biomicroscope is described.

Coronary Disease

The acuityscope: a resolution test target projection ophthalmoscope.

The Acuityscope projects an image of a three bar resolution test target onto the patient's retina, where it is viewed and read by an observer. The test target consists of a series of three bar targets varying in size on a logarithmic scale. Individual targets are identified in the projected image by Bailey-Lovie log visual acuity equivalents. The projected image includes only those target sizes which are useful for estimating visual acuity. The Acuityscope is used for assessing the quality of retinal image formation, and is thus able to differentiate between poor visual acuity due to image degradation, (e.g. cataract or corneal disease) and poor visual acuity due to image handling defects (e.g. retinal or optic nerve disease). The use of the instrument is relevant to both clinical situations (e.g. pre-operative assessment of opacification of optical media) and experimental situations (e.g. clinical trials).

Equipment Design

Growth spurt in a lens with a posterior subcapsular cataract.

Over a period of 5 years, the lenses of a patient with a unilateral posterior subcapsular cataract were documented using Scheimpflug slit-image photography. For the first time ever, a growth spurt was observed of the cataractous lens. It is postulated that this could be a reflection of either a mitotic spurt of the lens epithelium or a failure of compaction of the deeper lens fibres.

Adult

Comparative human cellular radiosensitivity: III. Gamma-radiation survival of cultured skin fibroblasts and resting T-lymphocytes from the peripheral blood of the same individual.

Skin and blood samples were obtained from 34 donors, for whom there was no indication of abnormal radiosensitivity. From these, in 33 cases both fibroblast and T-lymphocyte cultures were obtained and in 26 cases at least three fibroblast and at least two G0 (resting) T-lymphocyte survival assays were possible. Within this set of results, differences in radiosensitivity between donors were significant for fibroblasts but not T-lymphocytes, although the range of radiosensitivity was similar for the two cell types (D 0.90-1.68 Gy for fibroblasts; 1.26-2.15 Gy for T-lymphocytes). Furthermore, there was little evidence for a correlation in radiosensitivity between the two cell types. These results suggest limitations in the predictive value of conventional measurement of cell survival.

Cell Survival