Search

Objective To determine the results of photodynamic therapy (PDT) in highly myopic eyes with choroidal neovascularization (CNV). Design Open-label, consecutive, interventional case series. Methods Forty-eight eyes of 46 consecutive Japanese patients with a myopic CNV were studied. The eyes were treated with PDT and were followed up from 1 to 4 years. The best-corrected visual acuities (BCVAs) at the baseline and after the PDT were compared. Multivariate regression analyses were used to determine the factors that were significantly associated with the BCVA at 3 or 4 years. Results The mean follow-up period was 3.2 years. Sixty-nine percent of the patients obtained angiographic closure by a single PDT treatment, and the average number of PDT treatments was 1.4. Chorioretinal atrophy developed in 61% of the eyes at 3 years and in 70% of the eyes at 4 years. The BCVA did not change significantly after the PDT. Multivariate regression analyses showed that the BCVA at 3 years was significantly correlated with the baseline BCVA and area of chorioretinal atrophy. Analyses of the 20 patients at 4 years or more showed that in 5 of 7 (71.4%) patients with juxtafoveal CNV, chorioretinal atrophy did not develop and that all had BCVA of 0.5 or better. However, in 12 of the 13 patients with a subfoveal CNV, chorioretinal atrophy developed at 4 years, and 10 of these patients had BCVA of 0.1 or worse. Conclusions In highly myopic patients, 69% obtained angiographic closure by a single PDT treatment, and recurrence was rare. These findings indicate that PDT is still a good option for treating CNVs in highly myopic patients.

Objective To investigate the long-term progression pattern of myopic maculopathy and to determine the visual prognosis of each progression stage. Design Retrospective, observational case series. Participants The medical records of 806 eyes of 429 consecutive patients with high myopia (refractive error more than −8.00 diopters [D] or axial length ≥26.5 mm) who were followed for 5–32 years were reviewed. Methods Participants had complete ophthalmological examinations including best-corrected visual acuity, axial length measurements, fluorescein angiography, and color fundus photography, at least once a year. The presence and type of posterior staphyloma was determined by binocular stereoscopic ophthalmoscopy. The types of myopic maculopathy included tessellated fundus, lacquer cracks, diffuse chorioretinal atrophy, patchy chorioretinal atrophy, choroidal neovascularization (CNV), and macular atrophy. None of the patients had received any type of treatment for the maculopathy. Main Outcome Measures The longitudinal long-term progression pattern and the visual prognosis of each type of fundus lesion. Results During the mean follow-up of 12.7 years, 327 of the 806 highly myopic eyes (40.6%) showed a progression of the myopic maculopathy. The most commonly observed patterns were from tessellated fundus to the development of diffuse atrophy and lacquer cracks, an increase in the width and progression to patchy atrophy in eyes with lacquer cracks, an enlargement of the diffuse atrophy, and the development of patchy atrophy in eyes with diffuse atrophy, and an enlargement and fusion of patches of atrophic areas in eyes with patchy atrophy. Eyes with tessellated fundus, lacquer cracks, diffuse atrophy and patchy atrophy at the initial examination progressed to the development of CNV. Eyes with CNV developed macular atrophy. The fusion of patchy atrophy, the development of CNV, and macular atrophy all led to significant visual decreases. A posterior staphyloma was observed more frequently in eyes that showed progression from tessellated fundus, diffuse atrophy, and patchy atrophy than those without a progression. Conclusions These findings indicate that myopic maculopathy tends to progress in approximately 40% of highly myopic eyes, and the pattern of progression affects the visual prognosis. Preventive therapy targeting posterior staphyloma should be considered to prevent the visual impairment caused by the progression of myopic maculopathy. Financial Disclosures The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Purpose To determine the characteristics of a macular retinoschisis using noninvasive retromode imaging by a new, commercial confocal scanning laser ophthalmoscope (F10; Nidek, Aichi, Japan) and to compare the findings with those obtained by conventional optical coherence tomography (OCT). Design Open-label, consecutive, interventional case series. Methods Sixty-six consecutive highly myopic eyes were examined by multiple scans of the posterior fundus within the retinal vascular arcade using the Cirrus OCT (Carl Zeiss Meditec, Oberkochen, Germany). The retinas also were examined with the F10. Results OCT examinations showed that 22 (33.3%) of the 66 eyes had a macular retinoschisis. Retromode imaging by F10 showed a characteristic fingerprint pattern at the corresponding area of the macular retinoschisis in all 22 eyes. The fingerprint pattern consisted of radiating retinal striae centered on the fovea and many light dots and lines that ran in parallel to the striae or formed a whorled pattern surrounded the radiating striae. Two patients had both inner and outer retinoschisis, and the border between them was outlined as a change in the course of the linear reflex by the retromode imaging. Also, an inner lamellar hole was found in 2 patients and was observed as a circular defect of the deep retinal reflex by the retromode imaging. In contrast, the 44 eyes that did not have a macular retinoschisis by OCT showed no abnormal findings by F10. Conclusions Retromode imaging by F10 shows characteristic alteration of the retina that corresponds to the site of the macular retinoschisis.

Restriction endonuclease fragment length variations (RFLV) were detected in mice with DNA probes for myelin basic protein (Mbp), glucocorticoid receptor-1 (Grl-1), and Friend MuLV integration site-2 (Fim-2). RFLV of the Mbp gene were found in SacI restriction patterns, RFLV of the Grl-1 gene were found in EcoRV patterns, and RFLV of the Fim-2 were found in BglII patterns. A three-point backcross was carried out by the backcross mating (C57BL/KsJ-spm/spm x MOL-MIT)F1 males x C57BL/KsJ-spm/spm; spm is an autosomal recessive gene causing sphingomyelinosis. From the results, spm, Grl-1, Fim-2, and Mbp loci were mapped on chromosome 18, and the following order of genes is proposed, with distances between genes in parentheses: centromere--spm--(7.8 cM)--Grl-1--(7.8 cM)--Fim-2--(39.1 cM)--Mbp--telomere. All laboratory strains and two European subspecies (Mus mus domesticus and M. m. brevirostris) carry the Grl-1a, Fim-2a, and Mbpa alleles. In contrast, another wild subspecies from Europe (M. m. musculus) and some Asian subspecies (M. m. molossinus, Chinese mice of wild origin, and M. m. yamashinai) carry the Grl-1b, Fim-2b, and Mbpb alleles. Only castaneus strains carry the intermediate combination of the Grl-1b, Fim-2a, and Mbpb alleles.

Purpose To determine the morphologic features (grade and type) of posterior staphylomas and to analyze the relationship between the morphologic features and the incidence of myopic macular lesions. Design Observational case series. Methods Two hundred and nine eyes of 108 consecutive patients with high myopia were studied. The grade of staphylomas was determined from B-scan ultrasonographic images across the optic disk. The type of staphyloma was determined by binocular funduscopy and was classified according to the criteria of Curtin. The participants were divided into two groups: younger than 50 years and 50 years and older. The long-term morphologic progression of staphylomas was analyzed in nine patients who were followed up for more than 20 years. Results Ninety percent of 209 eyes had a staphyloma. The prevalence of staphylomas and more advanced grades of staphylomas (> grade 2) were significantly higher in the older than in the younger patients. The higher grades of staphylomas were associated with more severe myopic retinal degeneration. Type II staphyloma was the most prominent overall; however, in older subjects, the incidence of type II was decreased significantly, and that of type IX was increased significantly. The eyes with type IX staphyloma tended to have more severe myopic retinal degeneration than eyes with type II staphylomas. The long-term follow-up study demonstrated a progression from type II to type IX with increasing age. Conclusions These results suggest that the morphologic features of staphylomas worsens as the patient ages. The progression from type II to type IX probably increases the mechanical tension on the macular area of highly myopic eyes, which then leads to myopic fundus lesions.

To determine whether the choroidal vasculature is altered in highly myopic eyes with or without posterior staphyloma using indocyanine green angiography. In addition, to analyze long-term changes of the choroidal vasculature in patients who were observed for at least 5 years with indocyanine green angiography.Consecutive, retrospective, observational case series.Three hundred twenty-one eyes of 195 patients with high myopia.Indocyanine green angiograms were analyzed, and the effect of posterior staphyloma on the choroidal vasculature was studied. Changes in the indocyanine green-determined choroidal vasculature detected after at least 5 years were analyzed in 57 eyes of 36 patients.Indocyanine green angiography assessment of the choroidal vasculature.A choroidal flush was detected in all of the control eyes but only 52 (16.2%) of the 321 highly myopic eyes. A displacement of the entry site of the posterior ciliary arteries into the choroid was observed in 76.6% of the eyes with posterior staphyloma and in 25.3% of the eyes without (P0.001). There were fewer large choroidal veins in the posterior fundus, and in some cases, there was marked variation in the diameter of neighboring large choroidal veins in the highly myopic patients. Of 57 eyes that were followed for5 years, 9 (15.8%) showed changes in the choroidal vascular structure in the later indocyanine green angiograms. Four of 9 eyes showed dilation or enlargement of posterior routes of choroidal venous outflow, 5 showed narrowing of the large choroidal veins, and 2 had a loss of the large choroidal veins (overlapped). One patient developed choroidal neovascularization after loss of the large choroidal veins.These findings indicate that the choroidal vasculature can be significantly altered in highly myopic eyes, and this is more prevalent in eyes with posterior staphyloma. Whether these alterations are related to the development of chorioretinal lesions in highly myopic eyes is now being investigated.

Objective To evaluate the prevalence and clinical features of a newly recognized peripapillary lesion specific to high myopia, peripapillary detachment in pathologic myopia (PDPM), in a large series of patients with high myopia. Methods Three hundred twenty-four patients (632 eyes) with high myopia were enrolled in this study. We examined the prevalence, range, fluorescein and indocyanine green angiographic findings, and optical coherence tomography findings of PDPM for these patients. Visual field testing (Goldmann kinetic perimetry and the Humphrey 30-2 program) was also performed in the patients with PDPM. Results Peripapillary detachment in pathologic myopia was identified in 31 of 632 highly myopic eyes (4.9%). The optical coherence tomographic scan across the PDPM lesion revealed a localized detachment of retinal pigment epithelium adjacent to the optic nerve. Although PDPM was always situated adjacent to the inferior edge of the optic disc, in some patients it surrounded almost the entire optic disc. There was a steep excavation of the inferior myopic conus adjacent to the PDPM, and the inferotemporal retinal vein was markedly bent at the transition from the PDPM to the excavated myopic conus. Glaucomatous visual field defects were frequently detected in eyes with PDPM (71.0%). Conclusions The findings of this study indicate that PDPM is not uncommon among highly myopic eyes. Although its pathogenesis and pathologic significance require further classification, PDPM might be another indicator of visual field defects in high myopia.

An electronic musical instrument has a waveform memory and a tone generator. The waveform memory has a plurality of storage areas, each of which is capable of storing a fixed bit-width data. In the case where the bit-width of the waveform data corresponding to a musical tone waveform is different from the bit-width of the data which can be stored in each storage area, the whole waveform data corresponding to the musical tone waveform are stored in the waveform memory so as not to allow the generation of empty areas which store no data. The waveform data may be divided if necessary and the divided parts of the waveform data are stored in some storage areas of the waveform memory. The tone generator reads out the data corresponding to a desired musical tone which is to be generated and which are stored in the waveform memory, and determines the waveform data from the read out data based on the bit-width of the waveform data of the desired musical tone, and generates the musical tone based on the determined waveform data.

A novel enzyme for producing difructose anhydride IV (di-D-fructofuranose 2,6' : 6,2' dianhydride) from levan of Bacillus mesentericus was prepared from a culture of Arthrobacter ureafaciens, and the conditions and method to determine the enzymatic activity were determined. Levan of Bacillus subtilis also yielded the difructose dianhydride, but inulin, inulobiose, sucrose, levanbiose, and levantriose did not produce it on enzymic reaction under similar test conditions.

本態性高血圧症患者につき,昇圧反応性と血圧,血漿レニン活性,循環動態および尿ナトリウム排泄量との相互関係をしらべ,さらにこれらに及ぼす安静の影響を検討した.高血圧症群は正常血圧群に比べ,昇圧剤に対する昇圧反応性が大きい傾向があり,とくにアンジオテンシン反応性は平均血圧値と有意の相関を示した.またアンジオテンシン,ノルエピネフリンおよび塩酸タイラミン反応性は,尿ナトリウム排泄量とも有意な相関関係を示した.腎疾患患者を含む全対象についての検討では,同様の傾向のほかに,アンジオテンシンおよびノルエピネフリン反応性が,血漿レニン活性と負の相関関係をもつことがみられた.本態性高血圧症患者16例中, 12例は入院後安静と軽度食塩制限(食塩摂取量1日8～10g)により血圧下降を示し,このさい全末梢血管抵抗の低下がみられた.この12例中7例においては,血圧下降とともにアンジオテンシン反応性は低下を示し,また血漿レニン活性の増大,尿ナトリウム排泄量および循環血漿量の減少,心拍数の増加傾向がみられた(A群). 12例中他の5例においては,アンジオテンシン反応性は不変か亢進を示し,ノルエピネフリン反応性の亢進,血漿レニン活性の低下,尿ナトリウム排泄量および循環血漿量の増加,心拍数の減少傾向がみられた(B群).これらの所見は, A群の患者ではナトリウムの過剰が,またB群の患者では交感神経機能の亢進が,高血圧の機序に関与していた可能性を推測させる.

The growth kinetics of a microorganism with high affinity for liquid hydrocarbon which has a low solubility in water was investigated for Candida intermedia IFO 0761 in our previous work. The microorganism contained a hydrocarbon pool in and/or on the cell. The transfer of water-soluble substrates to the cell was not the rate-limiting step in the growth of C. intermedia accompanied by clump formation with liquid hydrocarbon. The operating conditions necessary for the oxygen supply for the growth were adequate for the growth of C. intermedia on n-tetradecane. The saturation kinetics was valid for the specific growth rate of C. intermedia and specific concentration of hydrocarbon per unit cell mass; the specific growth rate was expressed by the following equation: (formula: see text).

Three kinds of freezing methods were tested with embryos of DNI strain. The survival rate after thawing was 47.5%, 66.7% and 77.8% in the 2-step method, modified slow freezing method and modified 2-step method, respectively. Then, the modified 2-step method was applied to the embryos from 7 strains and a pair of interstrain crosses. PMSG treatment at the beginning of diestrus following HCG treatment after 48 hrs resulted in much yield of 8-16-cell embryos in all strains. The average number for each strain was as follows: DNI; 18.9, DDN; 13.0, BS; 20.4, C57BL/6; 12.9, DBA/2; 17.5, CRN; 19.8, PAN; 13.7 and DNI x C57BL/6-Ay; 21.7. Development of frozen-thawed embryos in culture varied among strains. Proportion of embryos that developed to the morula or blastocyst stage was as follows: DNI; 64.6%, DDN; 71.9%, BS; 53.6%, C57BL/6; 57.3%, DBA/2; 65.0%, CRN; 52.5%, PAN; 17.4% and DNI x C57BL/6-Ay; 44.1%. These results indicate that the ability of embryos to survive freezing and thawing is influenced by their genetic background. Live young were produced from DNI, DDN, BS and DNI x C57BL/6-Ay embryos after transfer to recipients. Comparative assessment of the developmental ability of frozen-thawed embryos after transfer among strains should be performed in further study.

Body fluid volumes, cardiac output, PRA and pressor responses to angiotensin II (AT) and norepinephrine (NE) were compared between untreated patients with essential hypertension aged younger than 35 (EH-I) and those aged older than 36 years (EH-II). Men blood volume, total body water and extracellular volume were not significantly different between the patients with essential hypertension and normotensive subjects. There were no difinite differences in each volume between the EH-I and EH-II patients either. However, the distribution of blood volume was significantly larger in the essential hypertensive patients than in the normotensive subjects, suggesting that the changes in blood volume might not be homogenous in essential hypertension. In addition, blood volume was noted to have a significant inverse correlation with PRA. Cardiac output at rest was slightly but not significantly less in the EH-I and EH-II groups than in the normotensive group. A decline in blood pressure following 'bed-rest' was accompanied by a decrease in total peripheral resistance index (TPRI). Thus, elevated peripheral vascular resistance seems to be responsible for the mild to moderate hypertension even in the younger patients. PRA and its increases in response to standing or furosemide were normal in the EH-I patients, while they were markedly suppressed in the EH-II patients as compared to the age-matched normotensive subjects. In addition, PRA had a significant inverse correlation with the blood pressure and the scores of the severity of hypertension in the patients with essential hypertension. Thus, it seems likely that low renin in essential hypertension is secondary to long-lasting hypertension. Pressor response to AT significantly correlated with mean blood pressure and that to NE did so with 24 hours' urinary sodium excretion in essential hypertensive patients. The influence of aging on the pressor responses were obscure: the relationships of the pressore responses to blood pressure or to urinary sodium excretion were not different between the EH-I and EH-II groups. The examinations were repeated in 16 patients with essential hypertension (16 to 48 year-old) in 11 to 30 days after the initial study. Twelve of the 16 patients had declines in blood pressure and TPRI at the second study. In 7 of the patients whose blood pressure declined following 'bed-rest', there were significant decreases in pressor response to AT and in blood volume and a significant increase in PRA (group A). The other 5 patients showed a significant decrease in PRA and an enhanced pressor response to NE (group B). The blood volume in the group A was significantly larger than that in the group B at the initial study. It is suggested that the cause of essential hypertension is not homogeneous in that the increased vascular resistance may have been attributed to sodium excess in some patients and to an increased sympathetic activity in others. Some additional factors remain to be taken into account to clarify the complicated aspects of essential hypertension.

Clinical pictures of aortitis syndrome are remarkably manifold. Depending on the site of lesions, many signs and symptoms can grow such as Takayasu's ocular change, pulseless disease, atypical coarctation of the aorta, renovascular hypertension and aortic regurgitation, with several combination in a case. Moreover, occurrence of dilative and aneurysmal changes of the aorta and its main branches in aortitis syndrome has recently been recognized. Two cases of aneurysms in the main branches of the aorta are presented with review of literature. The authors regard them as one of various important manifestations of aortitis syndrome, especially from prognostic and therapeutic standpoints.

In 21 hospitalized patients with benign essential hypertension, pressor responses to angiotensin were significantly correlated with levels of mean blood pressure, and pressor responses to each of angiotensin, norepinephrine and tyramine were correlated significantly with urinary sodium excretion. Sixteen of the 21 patients were studied twice with an averaged interval of 21 days without changes in daily salt intake during the hospitalization. Twelve of the 16 patients exhibited a decline in blood pressure at the second study, and the blood pressure reduction was due to a decrease in total peripheral resistance. At the same time, in 7 of the 12 patients (group A), there were a significant decrease in response to angiotensin, a marked increase in plasma renin activity and insignificant decreases in urinary sodium excretion and plasma volume. The other 5 patients (group B) showed a decrease in plasma renin activity, an enhanced response to norepinephrine, insignificant increases in urinary sodium excretion and plasma volume, and invariable or rather increased responses to angiotensin, when blood pressure was declined at the time of the second study. It is suggested that the hypertension in the group A may have been related to sodium excess, while that in the group B may have been associated with an increased sympathetic activity.

症例は血族結婚下にある35才姉(症例1)と29才妹(症例2)で,症例1は意識消失発作を主徴とし,症例2は無症状であった.検査で低Ca,高P血症が認められたが,血清PTH-C末端, N末端は正常範囲で,症例1はEllsworth-Howard試験で正常反応を示した.頭部CTでは2症例とも脳内に広範な石灰化像を認めた.本例は偽性特発性副甲状腺機能低下症のきわめてまれな家族内発症例と考えられた.