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PubMed1982

Evaluation of laser iridectomy in angle-closure glaucoma: provocative tests.

An argon laser iridectomy was performed on 18 eyes of 14 patients with closed-angle glaucoma. The intraocular pressure (IOP) was controlled in all but one eye within normal limits. Variable amounts of pigment were found on gonioscopy in all cases. The mydriasis test was positive in one eye (5.5%) after homatropine and in 5 eyes (28%) after tropicamide drops. 80% of the positive results occurred in lightly pigmented irides. The dark-prone position test was positive in 7 eyes (38%), 71% of the positive results occurring in heavily pigmented irides. Tomography was also performed; the possibility of trabecular damage is discussed.

Eye Color↗

PubMed1987

A comparison of cycloplegic and manifest refractions on the NR-1000F (an objective Auto Refractometer).

The manifest (dry) and cycloplegic refractions of 50 eyes of 25 patients aged 8 to 28 years were studied on the Nikon Auto Refractometer NR-1000F (AR) and compared with the results of clinical refraction (CR) under homatropine and the final clinical acceptance on postmydriatic testing. Only patients in the younger age groups with low to moderate refractive errors were included in this study; high myopes and hypermetropes and patients with aphakia and mixed astigmatism were excluded. The degree of agreement for spherical equivalents, sphere components, and cylinder components was analysed separately for both cycloplegic and manifest refractions on the AR and CR. The results showed that the fixation target in the NR-1000F induces significant instrument myopia during manifest refraction in the younger patients with lower refractive errors. We recommend that caution should be exercised in interpreting manifest refractions on the AR, especially in younger patients. A cycloplegic automatic refraction would be acceptably accurate.

Adolescent↗

PubMed2006

Hepatic angiomyolipoma with trace amounts of fat: a case report and literature review.

Hepatic angiomyolipoma (AML), a rare benign mesenchymal tumour, is characterised by the presence of mature adipose tissue, smooth-muscle cells and thick-walled blood vessels. Increasing attention to hepatic AMLs has led to the discovery that sufficient proportions of fat often allow for definite diagnoses preoperatively. However, the proportion of fatty tissue in these tumours is highly variable. One case of hepatic AML is reported, where the amount of fat was <1%. In this case, the viral hepatitis markers, including hepatitis B antigen and anti-hepatitis C virus antibody, were negative. The serum alpha-fetoprotein level was 3.4 ng/ml and in the normal range. Abdominal ultrasonography showed a hypoechoic mass measuring 5 cm in diameter and without an obvious capsule in the left lobe of the liver. A dynamic computed tomography scan showed a well-defined and slightly enhanced mass in the medial segment of the left lobe of the liver. Angiography showed that the mass was hypervascular in character. As hepatocellular carcinoma was highly suspected from these preoperative image studies, a left lobectomy was carried out. Microscopically, the amount of fat was too low to establish a diagnosis of hepatic AML. However, positive homatropine methylbromide 45 immunoreactivity of the smooth-muscle cells seemed to assist in arriving at the diagnosis.

Adipose Tissue↗

PubMed1977

Effect of atropine on vascular adrenergic neuroeffector transmission.

Atropine, homatropine, scopolamine, procaine, lidocaine and phentolamine inhibited the contractile response of rabbit isolated pulmonary artery elicited by electrical-field stimulation. Methylatropine had no effect. The inhibition induced by atropine (2 x 10(-6)-2 x 10(-4) M) had a rapid onset of action and then remained almost constant. The inhibition was slowly reversible. The potency of atropine as an inhibitor of responses to field stimulation was very much less than the potency of phentolamine. The inhibition was not antagonized by cocaine or (+)-amphetamine. Atropine (3 x 10(-5) and 3 x 10(-4) M) enhanced the electrical-field-stimulation-induced outflow of tritium from the pulmonary artery preloaded with 3H-(-)-noradrenaline. In contrast, atropine in a concentration-dependent manner either had no effect or slightly decreased the tyramine-induced outflow of tritium. Atropine reduced the contractile response of the pulmonary artery evoked by tyramine. Atropine (10(-4) and 3 x 10(-4) M) and phentolamine inhibited the arterial contractions elicited by exogenous (-)-noradrenaline in an apparently competitive manner. The contractions of rabbit isolated aorta elicited by (-)-noradrenaline, serotonin and histamine were inhibited by atropine (10(-5) and 10(-4) M). Atropine was very much less potent in antagonizing noradrenaline, histamine and serotonin than in antagonizing acetylcholine. tthe inhibotory potency of atropine, procaine and lidocaine on the accumulation of 3H-(-)-noradrenaline by rabbit aorta in vitro was much less than that of cocaine. The relationship between the aortic concentration of 3H-atropine and in vitro accumulation was almost linear. The accumulation was slightly higher at 37 degrees C than at 1 degree C. The results suggest that atropine blocks alpha-adrenoceptors, both presynaptically at the adrenergic neurone terminals and postsynaptically at the smooth muscle. In addition, atropine may possibly act in a nonspecific manner at postsynaptic sites.

Amphetamine↗

PubMed1988

Effects of mydriatic agents on neutrophil migration.

We have investigated the effects of various mydriatic agents on the locomotion of polymorphonuclear leukocytes in vitro. Human as well as rat neutrophils showed a dose-dependent increase of migration into micropore filters when tested against cyclopentolate hydrochloride at a dose range between 16 and 63 micrograms/ml. At higher doses (250 micrograms/ml), a complete inhibition of neutrophil migration was observed. A commercially available cyclopentolate hydrochloride preparation showed identical effects. Little or no changes in neutrophil locomotion were seen with atropine, homatropine, scopolamine or tropicamide when tested at the same concentration range. Since addition of cyclopentolate to either the lower or upper compartment of the multiwell chemotaxis chamber gave virtually the same results, it is assumed that the drug most likely induces a chemokinetic neutrophil response. However, an additional chemotactic effect cannot be excluded. These in vitro observations may help to explain an accidental observation in a patient with severe anterior uveitis who showed a massive, localized leukocyte accumulation on the corneal endothelium after contact with a cyclopentolate-soaked cotton pledget.

Animals↗

PubMed2002

Scavenging of photogenerated oxidative species by antimuscarinic drugs: atropine and derivatives.

The quenching ability of photogenerated oxidative species by some antimuscarinic drugs generically named atropines (e.g. atropine [I] eucatropine [II], homatropine [III] and scopolamine [IV]) have been investigated employing stationary photolysis, polarographic detection of dissolved oxygen, stationary and time-resolved fluorescence spectroscopy, and laser flash photolysis. Using Rose Bengal as a dye sensitiser for singlet molecular oxygen, O(2)((1)Delta(g)), generation, compounds I-IV behave as moderate chemical plus physical quenchers of the oxidative species. Correlation between kinetic and electrochemical data indicates that the process is possibly driven by a charge-transfer interaction. The situation is somewhat more complicated employing the natural pigment riboflavin (Rf) as a sensitiser. Compounds I and II complex Rf ground state, diminishing the quenching ability towards singlet and triplet excited state of the pigment. On the other hand, compounds III and IV effectively quench Rf excited states, protecting the pigment against photodegradation. Under anaerobic conditions, semireduced Rf (Rf(.-)) is formed through quenching of excited triplet Rf. Nevertheless, although Rf(.-) is a well-known generator of the reactive species superoxide radical anion by reductive quenching in the presence of oxygen, the process of O(2)((1)Delta(g)) production prevails over superoxide radical generation, due to the relatively low rate constants for the quenching of triplet Rf by the atropines (in the order of 10(7) M(-1)s(-1) for compounds III and IV) in comparison to the rate constant for the quenching by ground state oxygen, approximately two orders of magnitude higher, yielding O(2)((1)Delta(g)). Compound I is the most promising O(2)((1)Delta(g)) physical scavenger, provided that it exhibits the higher value for the overall quenching rate constant and only 11% of the quenching process leads to its own chemical damage.

Atropine↗

PubMed1993

[Partition behavior of tropane alkaloids between organic solvents and water].

The partition behavior of tropane alkaloids (TrA) between organic solvent and water was studied under various conditions. The apparent partition coefficient, log P', increases with pH with a slope of +1 in the acidic to neutral pH range, then tends to approach to a constant value in the alkaline region. Thus the partition of TrA to the organic phase is based on the neutral form of TrA. From the pH dependency of the partition and pH titration of TrA, the intrinsic partition coefficients log P0 and pKa values for each TrA were estimated. Values of pKa and log P0 for scopolamine were smaller than those for atropine or homatropine. It was considered that the presence of the epoxide ring in scopolamine molecule reduces the log P0 and pKa because of its polar and electro-inductive effect. It was also expected from the results of pH-dependent partition behavior that in the low pH region some portion of TrA cations is transferred to the organic phase by forming an ion-pair complex with an anion, in the aqueous phase. The log P' of TrA was measured in the presence of various kinds of anions (halides and alkyl sulfonates, C5-C8) at about pH 2, where almost all TrA are present as a protonated form. The relations between the log P' and the logarithmic concentration of anions is linear at low concentrations of anions as expected from the ion-pair partition equation.(ABSTRACT TRUNCATED AT 250 WORDS)

Alkaloids↗

PubMed1998

[Epidemiology of drug use during the first three months of life in a urban area of southern Brazil].

INTRODUCTION: The few studies on the use of medicines in children point to excessive use, and in these studies, physicians are those mainly responsible for the prescription of medicines. In order to get to know the patterns of consumption medicines better, a study was made in children in their first three months of life, according to social biological, food pattern and use of health services of variables. METHOD: The patterns of the use of medicines during the first three months of life in 655 urban children born in Pelotas, Brazil, in 1993, were described. Information on the use of medicines was collected during a two-week period in the first and third month of life. RESULTS: The use of medicines was reported by 65% of mothers at the 1st and 69% at the 3rd month of life. Seventeen per cent of children consumed three or more different medicines during those periods. Fixed combinations of three or more components-which was taken as an indicator of the poor of medicines quality-were consumed by 14% of the children at the 1st and 19% at the 3rd months of life. At the latter age, 20% of children had used a given medicine for one month or more. At the first month follow-up, Benzalkonium Chloride + Normal Saline Solution (nasal drops), Nystatin Mixture and Dimethicone + Homotropine were the most frequently used medicines. At the third month they were, Aspirin, Benzalkonium Chloride + Normal Saline Solution and Dimethicone + Homatropine. The main reasons for taking medicines were cramps at the first month and colds at the third. At the first month follow-up, children with three or more siblings used 64% less medicines than the older ones. Children who were not breast-fed at the end of the first month showed a 75% greater risk of use of medicines. Similar results were observed at the third month follow-up. Some of the medicines used were not recommendable for children. CONCLUSION: Since early age children are submitted to an intense use of medicines for almost every conceivable reason, with the risk of potential side-effects and the possible lead to medicine or other drugs addiction.

Age Factors↗

PubMedDate not supplied

Measurements of the air conditioning capacity of the nose during normal and pathological conditions and pharmacological influence.

A simple method is introduced for measuring the air conditioning capacity of the nose. A flow of 8 1/min dry air is introduced by a catheter into the nasopharynx, while 5 1/min is sucked out from the investigated nasal cavity through a psychrometer. The additional 3 1/min passes down into the pharynx, thus reducing the intermingling with expiratory air. By using CO2 as a tracer, this error was found to be maximally 15% and often about 1%. The three different enthalpy factors: increase in enthalpy of dry air, vaporization, and increase in enthalpy of water vapour, were calculated separately and the vaporization was found to be the dominant factor. The calculated total supply of humidity showed that the method presented causes at least a slight stress on the humidifying capacity. Pharmacological studies have shown that subcutaneously injected atropine decreased the total enthalpy and that of water vapour, while nasal administration of oximetazoline also decreased the total enthalpy. Nasal administration of homatropine or pilocarpine had no effect on the air conditioning. In comparison with normal subjects, those with vasomotor rhinitis had an increased enthalpy of the air, while the same enthalpy factor was reduced in cases with atrophic rhinitis. Laryngectomized patients had no significant difference in the air conditioning capacity of the nose in relation to normal subjects, while patients operated with partial maxillectomy had a considerable reduction in vaporization and total enthalpy.

Atropine↗

PubMed1974

A nonfatal case of intentional scopolamine poisoning.

Scopolamine, a drug not usually found in poisoning, was found to be the cause of toxicity in three persons. This paper stresses the need to confirm any unusual iodoplatinate spots that may occur in emergency drug screening. Gastric lavages appear to be the most useful source for recovering belladonna compounds as no scopolamine was found in the urine, either at admission or the day after. Atropine and scopolamine are easily separated from each other by TLC and GLC but homatropine separates poorly from atropine.

Chromatography, Thin Layer↗

PubMed1999

Crack eye syndrome.

BACKGROUND: Cocaine is an alkaloid prepared from the leaves of the Erythroxylon coca plant. It is widely recognized as one of the most dangerous illicit drugs in use today. The U.S. Substance Abuse and Mental Health Services Administration estimates that 23.5 million Americans have used cocaine at some time in their life. Corneal defects from crack cocaine were first described in 1989 and later named crack eye syndrome in 1993. CASE REPORT: A 40-year-old man reported to the eye clinic reporting vigorous eye rubbing after repeated exposure to and use of crack cocaine. A corneal infiltrate with an overlying epithelial defect developed and the man was treated with ciprofloxacin, homatropine, and diclofenac. This case presents background information concerning the systemic and ocular manifestations of cocaine, as well as the clinical presentations of crack eye syndrome, with recommendations on treatment. CONCLUSIONS: A thorough social history should be elicited when patients who have unilateral or bilateral corneal defects of unknown origin are examined, or when treating persons with no other known risk factors for corneal disruption. Prompt recognition and treatment are the main factors in successful management of crack eye syndrome.

Adult↗

PubMedDate not supplied

[Effect of pilocarpine and cycloplegic substances on ophthalmic tone in healthy eyes and ones with glaucoma].

The study was carried out on the eyes of patients (aged 20-75 eyes) without glaucoma and with primary open-angle glaucoma (POAG). A single instillation of 1 or 2% pilocarpin hydrochloride did not lead to a decrease of intraocular pressure (IOP) in the eyes without glaucoma. IOP fluctuations after pilocarpin instillations were accidental and as a rule were observed both in the treated and control eyes. Instillations of the same pilocarpin solutions significantly decreased IOP in the eyes with OAG in the majority of cases (in 76% in our study), which is apparently due to removal or decrease of the canalicular block. The results of relieving tonometric pilocarpin test should be taken account of in early diagnosis of glaucoma, but the diagnostic parameters of the test should be determined more precisely. After instillation of short-acting cycloplegic drugs (1% homatropin and 0.5% tropicamide) IOP did not change either in normal or POAG eyes. These drugs are recommended for dilatation of the pupil for ophthalmoscopy in patients with anterior chamber open angle glaucoma.

Adult↗

PubMedDate not supplied

[Encapsulated filtering blebs--incidence and methods of treatment].

Encapsulation of the filtering bleb occurs as a complication of glaucoma filtering surgery in 8.3-28% of all eyes filtered, often between 2-4 weeks after surgery. It has a characteristic clinical appearance--highly elevated localized bleb, prominent surface vessels and patent sclerostomies on gonioscopy. This study retrospectively reviewed the results of 100 filtering operations, performed in the Prof. Dr. I. Stankovitsh Eye Department, focused on the incidence, possible risk factors and management of encapsulated filtering blebs. Trabeculectomy was done in all patients with limbus-based conjunctival flap, rectangular scleral flap 4 x 4 mm, and sclerostomy 2 x 2 mm. Two or three interrupted 10-0 nylon sutures were used to tether the flap, the conjunctiva with Tenon's capsule was closed with a running suture. All eyes received topical dexamethasone drops, mydriatics-homatropin or tropicamide and antibiotic ointment for three weeks. Possible risk factors were considered: sex, age, other eye or systemic disease, type of glaucoma, previous ocular procedure and antiglaucoma medical therapy, early postoperative complications, postoperative and final intraocular pressure (IOP). All eycs with encapsulated filtering bleb were given topical beta-blocker initially and carbonic anhydrase inhibitor, and if IOP continued to be uncontrolled incisional surgical management was performed. Success was defined as IOP maintained at less than 22 mmHg, with or without medication. An encapsulated filtering bleb developed in 9% of eyes. Previous argon laser trabeculoplasty was associated with an increased frequency of bleb encapsulation. The mean postoperative IOP was 11.30 +/- 1.90. Encapsulation of filtering bleb was developing at mean time of 19.9 +/- 3.0 after surgery. Six eyes returned to IOP below 21 (mean IOP was 20.17 +/- 0.90) within 4 weeks, and 4 of them continued on a topical beta-blocker. Four eyes required incisional surgery. A week after surgery mean IOP was 18 mmHg. Haemophthalmus occurred after one incision performed in a patient suffering from diabetes mellitus. Late scarring of the filtering bleb was developed in 2 eyes. Seven months and 2 years after filtration surgery mean IOP was 21.30 +/- 4.00 mmHg. The cause of bleb encapsulation is not known. Male patients, surgical glove powder, topical corticosteroids, previous argon laser trabeculoplasty and beta-blockers are some of potential risk factors for the development of encapsulated filtering bleb. This study suggests the association between development of encapsulated bleb and previous argon laser trabeculoplasty--40% in the eyes with encapsulation and 18% in the eyes without encapsulation. The optimal management of bleb encapsulation has not been defined. In this study topical antiglaucoma therapy achieved IOP control and cyst's remodeling in 60% of cases. Forty percent of all cysts required incisional surgical management. Encapsulation of the filtering bleb is not an uncommon complication of glaucoma filtration surgery. It is important to examine postoperative eyes frequently during the first 2 months to detect this complication. Fortunately, most eyes have their IOPs controlled with antiglaucoma therapy.

Adrenergic beta-Antagonists↗

PubMedDate not supplied

Preoperative topical flurbiprofen-Na+ in extracapsular lens extraction role in maintaining intraoperative pupillary dilatation.

Induction of intraoperative pupillary constriction, is predominantly a prostaglandin mediated process. The most potent antiprostaglandin NSAID, Flurbiprofen was used topically to study its efficacy against the above. In a prospective double blind clinical study, 50 brown eyes undergoing planned E.C.C.E., the pupils were dilated with 10% phenylephrine and 2% homatropine 1%/tropicamide. 25 eyes received 0.03% Flurbiprofen-Na+ eye drops 1/2 hourly starting two hours before surgery. The maintained intraoperative mydriasis in the two groups before anterior chamber entry (stage I) vs at the end of complete cortex wash (stage III) was: in control group (stage I) 8.46 +/- 0.48 mm vs (stage III) 3.56 +/- 0.43 mm (highly SS); in flurbiprofen group (stage I) 8.60 +/- 0.48 mm vs (stage III) 8.01 +/- 0.63 mm (NSS). The pupillary area available for surgical manipulation in the control group was significantly decreased from 56.18 mm2 in state I to 9.94 mm2 in stage III, while in flurbiprofen group it changed insignificantly from 58.05 mm2 in stage I to 50.24 mm2 in stage III. Postoperatively after cataract was observed in 44% eyes of control group as compared to only 8% of eyes of flurbiprofen group. Thus a maintained intraoperative mydriasis in flurbiprofen group led to better E.C.L.E. which is a mandatory prerequisite to preferred and better present day posterior chamber IOL implantation.

Adult↗

PubMedDate not supplied

[Neurotoxic effects induced by the topical administration of cycloplegics. A case report and review of the literature].

INTRODUCTION: We report a patient who developed an acute confusional state with hallucinations after exposure to cycloplejic eye drops, and review the current literature regarding neurotoxicity due to this type of eye drops. CASE REPORT: A 61 year-old man who developed in two occasions confusion, disorientation and vivid visual hallucinations following exposure to a cyclopejic eye drop containing atropine 2%, scopolamine 0.5% and phenylephrine 4%. We performed a literature search regarding neurological complications of cycloplegic eye drops using the PubMed Database and the services of the Virtual Library 'Agencia Lain Entralgo'. The clinical features of all reports in which the original document was obtained are analyzed and summarized. We have summarized the clinical features of 29 patients with neurotoxicity due to cyclopentolate, 19 to atropine, 18 to scopolamine, 7 to homatropine, and 2 to tropicamide. Our patient should be the fourth reported in Spain, being the offending drug in the four cases the same eye drop. The most commonly reported symptoms are visual hallucinations, behavioral disorders/acute psychosis, alterations of consciousness/confusion, restlessness/hyperactivity, ataxia and speech disorders. Many of the patients reported are children and elder. There have been reported some fatal cases, specially related with atropine. CONCLUSIONS: Neurotoxicity related with anticholinergic effects of cycloplegic agents is not infrequent, although it is not well known in our setting; and can cause death in some cases. Exposure to these drugs should be taken in account in the differential diagnosis of acute confusional syndromes.

Administration, Topical↗

PubMedDate not supplied

[Drug therapy of progressive myopia].

To stabilize weak and medium-severity progressive myopia, instillations of cycloplegics (homatropin or tropicamid) and of hypotensive agents (clofelin or thymolol) were administered into the conjunctival cavity once a day (at bedtime). The course of treatment lasted 30 days and was repeated every 2-3 months. Complete stabilization of myopia was achieved in 65-58% of cases, as evidenced by a follow-up of 3 years, on an average. Incomplete stabilization of the condition was observed in 35-42% of patients, the annual progress gradient being above 0.15 diopters. Simultaneously an accumulation of the relative accommodation reserves was observed, by 38.3% on an average, and a resolution of asthenopia. In a reference group of 50 subjects (100 eyes) spontaneous stabilization took place in 27% of cases, the relative accommodation reserve being unchanged.

Adolescent↗

PubMed1989

Pupil responsiveness in diabetes mellitus.

The authors compared pupil responsiveness to light, convergence, and the effects of topical cocaine 4%, epinephrine 1%, phenylephrine 1%, homatropine 10%, and pilocarpine 1% in a group of 62 diabetics with a sex- and age-matched group of normal subjects. The duration of disease, metabolic control, and type of diabetes mellitus, the presence and severity of diabetic retinopathy, and evidence of systemic vegetative neuropathy were considered. It was found that sympathetic denervation was related significantly to the duration of disease and to the development of systemic autonomic neuropathy. There were also signs of iris myopathy in the pupil alterations of long-standing diabetics, explaining the poor pupil responsiveness to mydriatics occasionally found in these patients. Pupillary autonomic diabetic neuropathy should be considered an early and major sign of the development of systemic vegetative diabetic disease.

Adolescent↗

PubMed1989

Characterization of the discriminative stimulus effects of physostigmine in the rat.

Rats were trained to discriminate physostigmine (0.1 mg/kg s.c.) from saline in a two-choice, discrete-trial avoidance paradigm. Stimulus generalization curves for physostigmine were steep; complete generalization with physostigmine occurred only at the 0.1 mg/kg training dose. The muscarinic cholinergic agonists oxotremorine, pilocarpine and arecoline were evaluated for physostigmine-like discriminative effects. Oxotremorine generalized with physostigmine at a dose of 0.1 mg/kg in four of six rats tested; partial generalization was engendered by this dose in the remaining two animals. Complete generalization with physostigmine was produced in only one of six rats treated with pilocarpine. However, pilocarpine (3.0-10 mg/kg) did engender some physostigmine-appropriate responding in all rats tested. Arecoline (1.0 mg/kg) produced primarily saline-appropriate responding in all animals tested. Neostigmine, eseroline and nicotine were tested for physostigmine-like discriminative effects in order to assess the specificity of the physostigmine cue. Eseroline (1.0 mg/kg), an opioid-like derivative of physostigmine, and neostigmine (0.1 mg/kg) engendered saline-appropriate responding. Similarly, nicotine failed to generalize with physostigmine at doses up to 1.0 mg/kg. The discriminative stimulus effects of physostigmine were sensitive to antagonism by atropine. Complete blockade of the stimulus effects of the training dose of physostigmine was produced by 1.0 to 3.0 mg/kg of atropine. In contrast, a 10-fold higher dose of the quaternary antagonist homatropine methylbromide was necessary to block the discriminative effects of physostigmine. The discriminative effects of physostigmine were not blocked or were only partially blocked by mecamylamine at doses up to 10 mg/kg. The results of these experiments suggest that the discriminative stimulus effects of physostigmine are selective and probably centrally mediated.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗