Sequestration and late activation of lenticular Candida abscess in premature infants.
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Abscess↗
Biomedical subjects
Mark W Johnson
Publications and source records attributed to Mark W Johnson.
Clostridium sordellii endophthalmitis after suture removal from a corneal transplant.
PURPOSE: To report a case of endophthalmitis caused by Clostridium sordellii. METHODS: A 33-year-old man sustained a penetrating injury of the right eye that resulted in several ocular surgical procedures including pars plana vitrectomy, scleral buckling, scleral-sutured posterior chamber intraocular lens, and penetrating keratoplasty. More than 4 years after the penetrating injury he presented for examination with pain, photophobia, redness, decreased vision, and floaters in the right eye. Vitreous culture grew Clostridium sordellii. RESULTS: Following intravitreal injection of antibiotics, the patient's vision improved from 3/200 to 20/80 (baseline visual acuity) within 2 days. All signs of inflammation resolved without recurrence. CONCLUSIONS: Clostridium sordellii endophthalmitis may have a more benign course than the fulminant endophthalmitis typically seen with other Clostridium species.
Adult↗
Terminal ileitis secondary to Mycobacterium gordonae in a renal transplant.
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Adult↗
Clinicopathologic study after submacular removal of choroidal neovascular membranes treated with verteporfin ocular photodynamic therapy.
PURPOSE: To report the clinicopathologic findings after submacular removal of choroidal neovascular membranes (CNV) treated with verteporfin ocular photodynamic therapy. DESIGN: Interventional case series. METHODS: Retrospective review of eight eyes of eight patients who underwent submacular surgery for CNV after having previously received verteporfin ocular photodynamic therapy for presumed ocular histoplasmosis (one patient), age-related macular degeneration ([AMD] three patients) pathologic myopia (two patients), punctate inner choroiditis (one patient), and idiopathic CNV (one patient). All cases had undergone ocular photodynamic therapy with verteporfin using standard protocols. Six of eight patients suffered a submacular hemorrhage after ocular photodynamic therapy, and two of eight patients refused further ocular photodynamic therapy. All patients subsequently had submacular surgery with removal of the CNV. One membrane was routinely processed, sectioned, and stained with hematoxylin and eosin. Five membranes were stained with toluidine blue for light microscopic examination. Semithin (1.0 microm) sections were cut and stained with uranyl acetate-lead citrate for transmission electron microscopy. RESULTS: Choroidal neovascular membranes were removed at 3 days (presumed ocular histoplasmosis), 29 days (punctate inner choroiditis), 63 days (AMD, pathologic myopia), 66 days (AMD), 107 days (pathologic myopia), 116 days (AMD), and 152 days (idiopathic) after verteporfin ocular photodynamic therapy. Histopathologic and ultrastructural examination showed areas of vascular occlusion at 3 days that were not seen at later time points. All specimens had patent CNV. There were signs of vascular damage with extravasated erythrocytes and fibrin, pigment clumping in cells, and inflammatory cells in all but the 3-day specimen. CONCLUSIONS: This case series presents data only from patients who refused repeat treatment with ocular photodynamic therapy or who developed submacular hemorrhage after initial photodynamic therapy. Histopathologic evaluation of CNV 3 days after verteporfin ocular photodynamic therapy showed partial vascular occlusion that was not present in later specimens. These later specimens demonstrated evidence of vascular damage. Verteporfin ocular photodynamic therapy does not appear to lead to permanent and complete occlusion of the CNV. Thus, treatments that lead to permanent closure of CNV without damage to the retinal pigment epithelium and sensory retina are still needed.
Adult↗
Personalized follow-up increases return rate at urban eye disease screening clinics for African Americans with diabetes: results of a randomized trial.
OBJECTIVE: To evaluate the effectiveness of using personalized follow-up, as compared to reminder letters, in increasing return rates at urban eye disease screening clinics for African Americans with diabetes, and to identify factors predictive of the patient's likelihood of returning for annual follow-up exams. RESEARCH DESIGN AND METHODS: All patients attending free community-based retinopathy screening clinics who were advised to return in one year for another diabetes eye evaluation (DEE) were randomized to standard or personalized follow-up interventions. Patients in the standard follow-up group received reminder letters a month before it was time to return for their next annual DEE. Patients in the intensive personalized intervention also received the letters, but those patients who did not call for an appointment within 10 days received a phone call from project staff, encouraging them to return for a DEE. RESULTS: One hundred thirty-two African Americans with diabetes were randomized to one of the 2 treatments. The return rate for the intensive, personalized follow-up group was 66%, significantly (P=.001) higher than the 35% return rate for the standard follow-up group. CONCLUSION: This study demonstrated the efficacy of personal contact by telephone in improving return rates for annual DEEs in this population of patients. This finding is consistent with one of the key design principles of the project, which was to establish credible personal relationships with community leaders and patients as a means to maximize the utilization of the eye screening clinics.
Adult↗
For the patient. Eye screening can prevent eye disease. Personalized follow-up increases return rate at urban eye disease screening clinics for African Americans with diabetes: results of a randomized trial.
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Black or African American↗
Incidence of donor renal fibromuscular dysplasia: does it justify routine angiography?
BACKGROUND: The use of digital subtraction angiography (DSA) versus helical CT angiography (CTA) or MR angiography (MRA) for live renal donor evaluation is still controversial. Although CTA and MRA can detect some proximal moderate to severe arterial changes caused by fibromuscular dysplasia (FMD), mild and distal moderate FMD are not detected well without angiography. METHODS: This is a retrospective chart review of all potential, normotensive live renal donors at our center from July 1995 to June 2001. One hundred fifty-nine patients completed the donor evaluation process and underwent DSA. RESULTS: Seven cases of FMD, an incidence of 4.4%, were discovered. These patients were eliminated from donation. The distribution of renal vessels for our 159 patients was single arteries bilaterally, 64.8%; single left with multiple right, 16.4%; double left with single right, 9.4%; and multiple bilateral arteries, 9.4%. Three of the seven FMD patients had bilateral disease. Two of the seven (28.6%) FMD patients have subsequently required antihypertensive medications, with one requiring angioplasty of a progressive FMD stenotic lesion. CONCLUSIONS: We are concerned that CTA or MRA may overlook mild cases of DSA-detectable FMD. All seven FMD patients had single left renal arteries and would have undergone left donor nephrectomy. This would have resulted in their remaining right native kidneys having mild to moderate FMD in six of seven patients and in four donor kidneys having mild to moderate FMD. The need for antihypertensive medications in two of these seven potential donors within 4 years of their evaluation supports previous literature reports.
Adult↗
Laparoscopic incisional hernia repair in liver transplant and other immunosuppressed patients.
We report the early results of laparoscopic incisional hernia repair in a small group of immunosuppressed patients and compare these results with a cohort of patients with open repair. We describe a modification used to secure the cephalad portion of the Gore-Tex mesh in high epigastric incisional hernias often encountered after liver transplantation. Data were gathered retrospectively for all incisional hernia repairs by our group from March 1996 to January 2001. Twelve of 13 attempted patients had successful completion of their laparoscopic hernia repairs with no reported recurrences to date. Two of these procedures were performed for recurrent hernias. We completed nine of nine attempted laparoscopic hernia repairs in liver transplant patients with epigastric incisional hernias. We repaired two of three attempted lower midline incisional hernias in renal disease patients. One of these patients was soon able to reuse his peritoneal dialysis catheter. A total of 15 patients, 12 with liver transplants, underwent open repair of their incisional hernias. These patients had seven recurrences and/or serious mesh infections with five patients electing repeated operations. In our initial series, laparoscopic mesh repair of incisional hernias is practical and safe in the abdominal organ transplant population with a low incidence of early recurrence and serious infections.
Adult↗
Tacrolimus dosing requirements and concentrations in adult living donor liver transplant recipients.
Living donor liver transplantation in adult recipients is becoming increasingly common. The liver metabolizes most drugs, including immunosuppressive agents. Right-lobe grafts used in adult living donor liver transplantation consist of only 50% to 60% of the total liver. The purpose of this study is to determine whether there is a difference between tacrolimus doses and concentrations in patients who received a partial liver transplant from a living donor (LRD) versus those who received a whole-liver transplant from a cadaveric donor (CAD). Thirteen LRD recipients and 13 CAD recipients who underwent transplantation between April 1998 and July 2000 were included in this analysis. A CAD control group matched for age, sex, and race was used for comparison. Tacrolimus doses and concentrations were analyzed weekly for the first 4 weeks, then monthly for 6 months posttransplantation. There was no difference in acute rejection rates, renal and liver function test results, or number of potentially interacting medications administered between groups. LRD recipients required significantly lower doses of tacrolimus compared with CAD recipients at 2 weeks (0.058 v 0.110 mg/kg/d; P <.01), 3 weeks (0.068 v 0.123 mg/kg/d; P <.02), 4 weeks (0.086 v 0.141 mg/kg/d; P <.02), 2 months (0.097 v 0.141 mg/kg/d; P <.03), and 3 months (0.099 v 0.138 mg/kg/d; P <.03). Tacrolimus 12-hour trough concentrations were similar between groups at all times except for 2 weeks posttransplantation, when LRD recipients' concentrations were significantly greater than those of CAD recipients (12.4 v 9.5 ng/mL; P <.03). In addition, in the first month posttransplantation, LRD recipients were more likely to have greater concentrations of tacrolimus (>15 ng/mL; 22.1% v 9.2%; P <.01). In conclusion, LRD recipients have significantly decreased tacrolimus dosing requirements compared with CAD recipients during the first 3 months posttransplantation despite having similar tacrolimus concentrations.
Adult↗
Delayed neuropsychologic dysfunction after liver transplantation for acute liver failure: a matched, case-controlled study.
Although several studies have identified posttransplant neurologic sequelae in patients with acute liver failure (ALF), the effects of these sequelae on neuropsychologic functioning after transplant is unknown. This study compared neuropsychologic functioning of ALF patients with chronic liver disease patients after liver transplantation. After liver transplantation, seven ALF patients were compared with a matched control group of patients who had been transplanted for chronic liver disease. The patients were matched by gender, age (within 5 years), and time since transplantation (within 2 years). Patients completed a 2-hour battery of tests, which included measures of attention, memory, motor performance, abstract conceptualization, and visuospatial perception. There were no significant differences between the groups on measures of socioeconomic status or education. Significant differences were found on three separate tests: WAIS-III Vocabulary, WAIS-III Similarities, and WMS-III Paired Associate Learning II. Although these tests measure distinct functions (vocabulary knowledge, abstract conceptualization, and delayed verbal recall), they may be influenced by broader verbal functions, such as verbal fluency, conceptualization, and the ability to articulate ideas. When patients were asked what functions had noticeably deteriorated since transplantation, nearly all complained of memory difficulties, and there was no difference between groups. However, more ALF than chronic liver disease (CLD) patients complained of concentration difficulties. The results of this study suggest that ALF patients may experience more neuropsychologic dysfunction after transplant. Further studies are required to expand on these initial observations with the potential to improve patient care and referral to appropriate rehabilitative services.
Acute Disease↗
Metastatic leiomyosarcoma mimicking polycystic liver disease.
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Cysts↗
Relation of sleep state to hypoxemic episodes in ventilated extremely-low-birth-weight infants.
OBJECTIVE: To determine whether hypoxemic episodes in ventilated extremely-low-birth-weight infants correlate with specific behavioral states. STUDY DESIGN: Three-hour video-electroencephalography-polysomnography was performed on 13 ventilated extremely-low-birth-weight infants with mean postconceptional age of 28.3 weeks. The electroencephalogram was scored for discontinuity. Rapid eye movements, body, head, and limb movements were scored from synchronized video. Sleep states were defined from electroencephalography, rapid eye movements, and movement criteria. Nonparametric statistics were used to test for differences in the proportion of time hypoxemic (oxygen saturation </=85%) between behavioral states. RESULTS: The proportions of time hypoxemic were 0.6% during quiet sleep, 4.4% during active sleep, 10.7% during indeterminate sleep, and 16.7% during arousal. There was a significant overall difference between the states (P =.004) and a significant difference between active sleep and indeterminate sleep in a pairwise comparison (P =.001). CONCLUSIONS: Higher proportions of hypoxemia were found during indeterminate sleep and arousal compared with active sleep and quiet sleep. We speculate that motor activity during sleep disruption could prevent effective mechanical delivery of ventilator breaths and contribute to episodes of hypoxemia. Our results suggest that strategies promoting uninterrupted sleep cycling analogous to the intrauterine state could improve ventilatory stability.
Female↗
Improvements in the understanding and treatment of macular hole.
Recent innovations in macular imaging and surgery have provided important new information concerning the pathogenesis and treatment of idiopathic macular hole. New imaging data suggest that localized perifoveal vitreous detachment (an early stage of age-related posterior vitreous detachment) is the primary pathogenic event in idiopathic macular hole formation. Detachment of the posterior hyaloid from the pericentral retina exerts anterior traction on the foveola and localizes into the foveola the dynamic vitreous traction associated with ocular rotations. Optical coherence tomography has clarified the pathoanatomy of early macular hole stages, beginning with a foveal pseudocyst (stage 1A) and typically followed by disruption of the outer retina (stage 1B) before progressing to a full-thickness dehiscence (stage 2). The treatment of macular hole continues to evolve as modifications to the standard surgical procedure are proposed and evaluated. These innovations include the use of cytokine adjuvants, peeling of the internal limiting membrane, vital staining of the internal limiting membrane with indocyanine green dye, and variations in the length of postoperative face-down positioning.
Diagnostic Techniques, Ophthalmological↗
Conducting community-based, culturally specific, eye disease screening clinics for urban African Americans with diabetes.
The purpose of this study was to evaluate the need for, and efficacy of, community-based culturally specific eye disease screening clinics for urban African Americans with diabetes. The study employed a variety of culturally specific methods in the design and performance of 43 community-based eye disease screening clinics in southeastern Michigan. One thousand, thirty-seven subjects were recruited for the study. Of that number, 817 identified themselves as African Americans and are the focus of this report. Of the 817 African-American patients screened, 84 (10%) needed to be examined by an ophthalmologist immediately (< 30 days), and 180 (22%) needed to be examined soon (within 1 to 3 months), while 544 (67%) were advised to return for another exam a year later. The project demonstrated that it was possible to use culturally specific techniques to identify a significant number of urban African Americans with diabetes in need of eye screening and treatment. However, lack of health insurance proved to be the primary barrier to receiving needed treatment. Although the project was successful, it is not a solution to what is essentially a health systems problem, ie, inadequate access to appropriate diabetes care for a significant number of our population.
Black or African American↗
Combined intravitreal injection of triamcinolone acetonide and panretinal photocoagulation for concomitant diabetic macular edema and proliferative diabetic retinopathy.
PURPOSE: To present our results of intravitreal injection of triamcinolone acetonide (IVTA) combined with panretinal photocoagulation (PRP) for patients with concomitant clinically significant diabetic macular edema and proliferative diabetic retinopathy. METHODS: Charts of patients undergoing combined IVTA and PRP were reviewed. Outcome measures included visual acuity, presence of macular edema, and response of proliferative disease to laser photocoagulation. RESULTS: Four patients were included in this study. All patients maintained stable visual acuity during the treatment period. All patients had improvement in the amount of macular edema, despite the application of PRP, as well as complete regression of their proliferative disease. There were no short-term complications associated with IVTA or PRP. CONCLUSION: Combination treatment with IVTA and PRP may provide benefit in patients with diffuse diabetic macular edema who require urgent PRP for proliferative diabetic retinopathy by preventing exacerbation of macular edema.
Adult↗
Microbiologic studies of multiple-dose containers of triamcinolone acetonide and lidocaine hydrochloride.
PURPOSE: Reports of high endophthalmitis rates following intravitreal triamcinolone acetonide (TA) injection have raised concerns about safety. One possible risk factor is the use of multiple-dose containers. The purpose of this study was to determine whether there is a substantial risk of contamination of multiple-dose containers. METHODS: Microbiologic Challenge Study: Suspensions of a known quantity of several microorganisms were placed in samples of TA to determine whether the preservative, benzyl alcohol 0.99%, is rapidly bacteriocidal. Simulated Clinical Use Study: After ten days of simulated clinical use of multiple-dose containers of TA and lidocaine hydrochloride 4%, samples were cultured. Additionally, samples from lidocaine containers in actual clinical use were cultured. RESULTS: Microbiologic Challenge Study: Four of five challenge organisms demonstrated moderate growth, even after 24 hours of exposure to the benzyl alcohol preservative. Simulated Clinical Use Study: Simulated clinical use of multiple-dose containers of TA and lidocaine did not result in contamination, nor did actual clinical use of multiple-dose lidocaine containers. CONCLUSIONS: No culture-proven contamination of multiple-dose containers in simulated or actual clinical use was found. However, TA suspension is capable of harboring viable bacterial and fungal pathogens. The use of multiple-dose containers of triamcinolone for intravitreal injections is therefore discouraged.
Anesthetics, Local↗
Informal diabetes education: impact on self-management and blood glucose control.
PURPOSE: The purpose of this study was to determine if participation in screening clinics to detect and treat diabetes-related eye disease also led to informal patient learning that had an impact on self-management behavior and blood glucose control. METHODS: To evaluate the evidence for patient learning over time, the data of patients who returned as advised for 2 subsequent annual diabetes disease screenings were analyzed. Evaluation measures included medication use, self-management behavior, and hemoglobin A1c (A1C). RESULTS: During the 2-year study period, the use of insulin increased by 37% at the first exam, 43% at the second exam, and 42% at the third exam (P = .02). No significant changes were found in the use of oral medication. Glucose self-monitoring also increased by 61% at the first exam, 71% at the second exam, and 76% at the third exam (P < .01). Mean A1C values for returning participants declined by 9.2% at the first exam, 8.9% at the second exam, and 8.6% at the third exam (P = .03). CONCLUSIONS: The screening clinics had an educational impact associated with behavior change (improved self-management and glucose control) even though the clinics were not intended to produce such change. Therefore, caregivers should consider that patient learning can and should be part of every diabetes care encounter.
Black or African American↗
Delayed posttraumatic Propionibacterium acnes endophthalmitis in a child.
A 7-year-old boy presented with granulomatous anterior uveitis after an unrecognized penetrating injury in the same eye 2 months previously. The uveitis was unresponsive to topical corticosteroid therapy, lensectomy with anterior vitrectomy, and administration of intraocular and subconjunctival injections of vancomycin. Pars plana vitrectomy, capsulectomy, and injection of intravitreal vancomycin were eventually performed, leading to complete resolution of the intraocular inflammation. Culture and histopathologic examination of a capsular specimen confirmed sequestered Propionibacterium acnes infection. This case demonstrates that P. acnes may cause delayed endophthalmitis following penetrating trauma and may persist within capsular remnants in the aphakic eye.
Anti-Bacterial Agents↗