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Biomedical subjects

T A Ciulla

Publications and source records attributed to T A Ciulla.

At least 55 records · Page 3Linked to original sources
PubMed1997

Acute progressive multifocal Best's disease in a 61-year-old man.

PURPOSE: To report acute progressive multifocal Best's disease in patients in their seventh decade. METHOD: We report one such case. RESULTS: We examined a 61-year-old man with strikingly symmetric, 1-disk diameter serous retinal detachments involving each fovea. Fluorescein angiography was unremarkable, with no dye leakage. Electrophysiologic testing confirmed the diagnosis. Visual acuity decreased, and within 1 month, the size and number of lesions rapidly increased. Three months later, the lesions quickly evolved to the classic vitelliform stage. CONCLUSION: This well-documented case expands the spectrum of findings in multifocal Best's disease.

Acute Disease↗
PubMed1997

Talc embolism: a static retinopathy.

PURPOSE: To document the static nature of crystalline deposits in talc retinopathy. METHOD: Case report. RESULTS: A 38-year-old woman with a remote history of intravenous drug abuse showed the incidental finding of fine, irregularly shaped refractile deposits in the retinal microvasculature. At 2-year follow-up, fundus findings were identical to the initial manifestation with respect to the distribution and position of crystalline deposits in each fundus. CONCLUSION: This case documents the static nature of crystalline deposits in talc retinopathy.

Adult↗
PubMed1997

Blebitis, early endophthalmitis, and late endophthalmitis after glaucoma-filtering surgery.

PURPOSE: The differentiating characteristics in blebitis and early and late endophthalmitis after glaucoma filtration surgery are reviewed. METHODS: All admission records and operative reports, as well as available office notes, on patients with blebitis or bleb-associated endophthalmitis admitted to a large referral eye center from 1985 to 1995 were reviewed retrospectively. RESULTS: Ten cases of blebitis and 33 cases of bleb-associated endophthalmitis were identified. One patient with blebitis progressed to culture-positive endophthalmitis. Of the 33 cases of bleb-associated endophthalmitis, there were 6 cases of early endophthalmitis (before postoperative week 6) and 27 cases of late endophthalmitis. In early endophthalmitis, Staphylococcus epidermidis was isolated on vitreous culture in 4 (67%) of 6 cases, whereas in late endophthalmitis, this organism was isolated in only 1 (4%) of 27 cases. In the 27 late cases, Streptococcus species and gram-negative organisms comprised 48% of isolates; of 33 cases of endophthalmitis, 15 (45%) demonstrated no growth on vitreous culture. Patients with endophthalmitis fared more poorly than those with blebitis in terms of visual outcome. CONCLUSIONS: Because blebitis may be prodromal to endophthalmitis, aggressive antimicrobial therapy, perhaps with oral quinolones, is warranted. In addition, patients with blebitis should be observed closely to identify extension into the vitreous cavity so that intravitreous antibiotics can be administered in a timely fashion. Finally, clinicians should not extrapolate the results of the Endophthalmitis Vitrectomy Study to the postfiltration surgery endophthalmitis given the differing pathogenesis and unique spectrum of organisms.

Adult↗
PubMed1997

Vascular endothelial growth factor-induced retinal permeability is mediated by protein kinase C in vivo and suppressed by an orally effective beta-isoform-selective inhibitor.

Increased vascular permeability and excessive neovascularization are the hallmarks of endothelial dysfunction, which can lead to diabetic macular edema and proliferative diabetic retinopathy in the eye. Vascular endothelial growth factor (VEGF) is an important mediator of ocular neovascularization and a known vasopermeability factor in nonocular tissues. In these studies, we demonstrate that intravitreal injection of VEGF rapidly activates protein kinase C (PKC) in the retina at concentrations observed clinically, inducing membrane translocation of PKC isoforms alpha, betaII, and delta and >threefold increases in retinal vasopermeability in vivo. The effect of VEGF on retinal vascular permeability appears to be mediated predominantly by the beta-isoform of PKC with >95% inhibition of VEGF-induced permeability by intravitreal or oral administration of a PKC beta-isoform-selective inhibitor that did not inhibit histamine-mediated effects. These studies represent the first direct demonstration that VEGF can increase intraocular vascular permeability through activation of PKC in vivo and suggest that oral pharmacological therapies involving PKC beta-isoform-selective inhibitors may prove efficacious for the treatment of VEGF-associated ocular disorders such as diabetic retinopathy.

Animals↗
PubMed1996

Postvitrectomy positioning complicated by ulnar nerve palsy.

PURPOSE: Ulnar nerve palsy is an unusual complication of postvitrectomy positioning. METHOD: We report two such cases. RESULTS: Both patients developed ulnar nerve palsy after maintaining a face-down position for 2 to 4 weeks after vitrectomy with intraocular perfluoro-octane. The neuropathy resolved in one patient after he was instructed to avoid prolonged pressure on his flexed elbows, whereas the other patient ultimately required surgical decompression of the nerve at the elbow. CONCLUSION: Ulnar nerve palsy can result from postvitrectomy positioning associated with prolonged direct pressure on the ulnar nerve or compression of the ulnar nerve via flexion of the elbow.

Adult↗
PubMed1996

Severe penetrating eye trauma caused by fish pick accidents.

PURPOSE AND METHODS: The authors describe three cases in which commercial fishermen presented with penetrating ocular injuries from fish picks, which are hand-held, fish-sorting tools with relatively blunt tips designed to partially penetrate fish and expedite handling. Ocular injuries from this tool have not been reported previously. RESULTS: Presenting visual acuity was light perception in two cases and hand motions in one case. Corneal laceration and vitreous hemorrhage were seen in all cases. Initial ultrasound showed no retinal detachment, and all patients underwent primary repair of the corneal laceration. However, within the first 2 months, follow-up ultrasound was suggestive of retinal detachment in all cases, and pars plana vitrectomy was performed. One patient who was found to have a retinal hole but no retinal detachment did well, with a visual acuity of 20/80. Two patients with retinal detachment did poorly, one with a dense epiretinal membrane and the other with a chronic irreparable retinal detachment and extensive subretinal fibrosis. CONCLUSIONS: These injuries differ from fish hook injuries because the instrument is much larger and is blunt in nature, imparting significant energy into the eye. Consequently, patients with these injuries have a much less favorable outcome.

Adult↗
PubMed1996

Intravitreal toxicity of dental adhesives in the rabbit.

PURPOSE: The authors tested the intravitreal toxicity of four commonly employed dental adhesives to determine their suitability as retinal adhesives. METHODS: Two glass ionomers, a polycarboxylate, and a composite resin (Ketac-Bond Radiopaque Poly Maleic Acid [ESPE, Oberbay, Germany], Vitrebond Light Cure Glass Ionomer [3M, St. Paul, MN], Carbchem Zinc Polycarboxylate Cement [PSP Dental Company, Kent, United Kingdom], and Kerr Porcelite Dual Cure [Kerr, Romulus, MI]) were reconstituted according to the manufacturer's recommendations, and 0.1 mliter was injected separately into the vitreous cavity of New Zealand white rabbits. Serial slit-lamp and funduscopic evaluations were performed up to 3 months after injection. Selected eyes were studied angiographically and histopathologically. RESULTS: Intravitreal administration of the glass ionomers Ketac-bond or Vitrebond lead to intense vitritis within the first weeks. Necrotic retinal detachments ultimately developed in these eyes, along with those administered the polycarboxylate cement Carbchem. Eyes injected with the composite resin Porcelite Dual Cure showed no ophthalmoscopic evidence of vitreous or retinal toxicity and no angiographic evidence of vascular toxicity. Histopathology of the eyes with this intravitreal composite resin cement revealed mild disorganization of photoreceptor nuclei and outer segments. CONCLUSIONS: Among the agents studied, the dual-cure composite resin cement Porcelite showed the least ocular toxicity. Further studies to evaluate its intraocular toxicity and efficacy as a retinal adhesive are warranted.

Animals↗
PubMed1995

Retinal artery occlusion in rabbit eyes using human atheroma.

Previous animal models of central retinal artery occlusion using glass or latex embolic material may not simulate human disease. We have developed a rabbit model using human atherosclerotic material, which may be useful in developing embolus specific treatments, including thrombolysis or laser photodisruption. Fresh human atherosclerotic plaque was harvested from atherosclerotic human aorta by mechanical removal and suspension in normal saline. The suspension was agitated vigorously to produce small particles, which were separated into various sizes by filtration through mesh filters with specific pore sizes. The common carotid artery of the anesthetized rabbit was isolated by neck dissection and cannulated using a modified Seldinger technique. Suspensions of human atherosclerotic plaque were injected into the common carotid artery via this cannula. All animals were examined by slit lamp and fluorescein angiography before and after retinal artery occlusion. This model reliably produced retinal artery occlusion using human atherosclerotic plaque. Plaque particles less than 105 microns reliably produced branch retinal artery occlusion, while larger plaque particles less than 149 microns reliably produced central retinal artery occlusion. Sublingual nitroglycerin, at 0.1 mg/kg, intravenous verapamil, from 0.2 mg/kg to 2 mg/kg, and intracarotid urokinase given acutely in standard doses failed to cause reperfusion. This model will be very useful in the study and treatment of retinal vascular disorders as it may more closely simulate human disease over previous models using artificial embolic materials. Embolic specific treatment stategies, such as thrombolysis and laser photodisruption, may be further developed with this model.

Animals↗
PubMed1994

Primary parathyroid hyperplasia associated with thyroid hemiagenesis and agenesis of the isthmus.

BACKGROUND: Congenital thyroid anomalies can be caused by abnormal descent or agenesis of part of the thyroid gland. Agenesis of the thyroid gland may involve one or both lobes of the gland, with or without isthmus, and is very rare. Congenital thyroid anomalies have been reported to be associated with thyroid diseases (hyperthyroidism, adenomatous goiter, and cancer) but not with parathyroid diseases. METHODS: Case reports of two patients describe the methods used. RESULTS: We report two patients with hyperparathyroidism and congenital thyroid anomalies. One patient had a left thyroid lobe hemiagenesis and the other patient had agenesis of the thyroid isthmus. Both patients had primary hyperparathyroidism caused by parathyroid hyperplasia and were treated by subtotal parathyroidectomy. The parathyroid glands and recurrent laryngeal nerves were in their usual positions despite the abnormal development of the thyroid glands. CONCLUSIONS: When thyroid hemiagenesis or isthmus agenesis is found in patients undergoing parathyroidectomy for hyperparathyroidism, parathyroid hyperplasia should be suspected. If parathyroid hyperplasia is present, subtotal parathyroidectomy and bilateral thymectomy are recommended. The parathyroid glands and the recurrent laryngeal nerves can be found in their usual locations.

Adult↗
PubMed1991

Seronegative myasthenia gravis: a plasma factor inhibiting agonist-induced acetylcholine receptor function copurifies with IgM.

Anti-acetylcholine receptor antibodies cannot be detected by standard radioimmunoassay in 10 to 15% of patients with generalized myasthenia gravis (seronegative myasthenia gravis). We investigated the effect of seronegative myasthenia gravis plasma on 22Na+ flux through acetylcholine receptors and voltage-gated sodium channels in the human rhabdomyosarcoma cell line, TE671. Fourteen of 19 seronegative MG plasmas inhibited acetylcholine receptor 22Na+ flux; none inhibited voltage-gated sodium channel flux. The inhibitory activity was found in the IgG-depleted fraction, and copurified with IgM after gel-filtration chromatography. Inhibitory activity was absent from the plasma of 8 healthy control subjects and of 6 patients with the Lambert-Eaton myasthenic syndrome, but was present in the IgG-depleted plasma fraction of 4 of 6 seropositive patients with myasthenia gravis and all 5 patients with demyelinating polyneuropathy. We conclude that a low-affinity serum factor, probably an IgM antibody, found in a high proportion in patients with seronegative and those with seropositive myasthenia gravis may contribute to the muscle weakness in myasthenia gravis, but its role in these and other neuroimmunological disorders requires further investigation.

Autoantibodies↗
PubMed1989

A susceptibility locus for multiple sclerosis is linked to the T cell receptor beta chain complex.

Inheritance of T cell receptor beta chain (TCR beta) genes was analyzed in families of 40 sibling pairs concordant for the relapsing-remitting form of multiple sclerosis (MS). TCR beta haplotypes were determined by segregation analysis of polymorphic markers within the TCR beta complex. The mean proportion of TCR beta haplotypes identical by descent (IBD) inherited by MS sibling pairs was significantly increased compared with expected values (means test, p less than 0.004), whereas the distribution of haplotype sharing was random when MS patients were compared with their unaffected siblings. Furthermore, one allelic form of a TCR beta variable region gene segment was overrepresented on MS chromosomes compared with those parental chromosomes not transmitted to MS offspring both in the MS sibling pair families and in a second group of families containing only one individual affected with MS. These results demonstrate that a gene within the TCR beta complex or a closely linked locus influences susceptibility to MS.

DNA Probes↗