Sir, Unusual ultrasound biomicroscopy appearance after non-penetrating trabecular surgery with SK gel implant Case report We report a case of an unusual ultrasound biomicroscopy (UBM) appearance in a POAG patient at 15 months after receiving non-penetrating trabecular surgery (NPTS). A 37-year-old male received NPTS of the right eye for POAG in a local hospital 15 months ago. After the operation, the IOP was controlled under 15 mmHg. At 14 months, he experienced severe pain in the right eye and blurred vision. Upon examination, the IOP was 50 mmHg, the cornea had oedema, and the pupil was slightly displaced superiorly. After treatment with 20% mannitol, the IOP was controlled and corneal transparency recovered. The gonioscopy examination showed that the iris root adhered to the remanent membrane of NPTS areas. Therefore, a laser iridectomy was performed and 0.005% latanoprost was administered daily, reducing the IOP to 20 mmHg. The patient then arrived at our hospital for further treatment. Our examination results were as follows: IOP 19.5 mmHg, the bleb of right eye was pale and had a thin wall with darkening of the subconjunctival area, and the pupil decentered. The gonioscopy result showed that the iris root had adhered to the surgical area. The UBM picture is shown in Figure 1. Comment Based on the case history and examination results, we believe that after NPTS, the sudden break of the residual membrane at the operation area resulted in the pressure difference between the upper and lower surface of iris. Figure 1 Unusual UBM appearance of bleb and iris after NPTS.
Guidelines from the Centers for Disease Control and Prevention, Atlanta, Ga, recommend that all pregnant women be offered human immunodeficiency virus (HIV) testing to ensure that they have the opportunity to use currently available therapeutic interventions to reduce the risk infecting their offspring with HIV. These recommendations have resulted in an increased number of low-risk women being tested and a significant rise in the percentage of false-positive results from HIV antibody screening tests and ambiguous (indeterminate) findings from confirmatory tests. Women receiving such results are generally in emotional turmoil yet must make treatment choices if they prove to be infected. This article provides guidelines to help general medical practitioners to understand the nature of HIV testing, to assess a woman's infection status when initial tests are ambiguous, and to determine when treatment is appropriate.
The release of serotype III group B streptococcal polysaccharides into the supernatant fluid was examined under a variety of physiological conditions. Release of both high-and low-molecular-weight type III antigens was fairly constant throughout exponential growth, but increased markedly upon entering the stationary phase of growth. Increased glucose and decreased phosphate concentrations both caused a large increase in release of antigens. Inhibition of protein synthesis in exponentially growing cells by chloramphenicol (10 pg/ml) caused a condition of unbalanced growth in which antigen release was increased greatly over control values. Strain variability in antigen release was also observed. Strains which are known to be high neuraminidase producers released elevated levels of both low-and high-molecular-weight type Ill antigens. Non-neuraminidase-producing strains released considerably less high-molecular-weight antigen, but similar levels of the low-molecular-weight antigen compared with the high neuraminidase producers. Strain D136C, a type III non-neuraminidase producer, released negligible quantities of the high-molecular-weight antigen in the supernatant fluid. These results indicate that both the physiological environment and the type III strain are important in determining the quantity of type-specific antigen released into the culture fluid.
The type-specific antigens (TSA) of group B streptococcus (GBS) represent the primary virulence factors for these organisms, yet little is known about their relationship to the cell surface of GBS. Crude cell walls of serotype III GBS strain 110 were purified by extraction with sodium dodecyl sulfate, LiCl, and urea, which removed essentially all of the protein associated with the cell wall as determined by amino acid analysis. Only those amino acids found in peptidoglycan were present, which included alanine, lysine, and glutamate (3.5:1:1 molar ratio). In contrast, these procedures resulted in the release of only 4.6% of the wall-associated TSA, indicating that protein was not the primary means by which TSA was bound to the cell surface. Mutanolysin (20 pug/ml) treatment of purified cell walls resulted in the release of 95% of the wall-associated TSA. The covalent association of TSA, the group B polysaccharide, and the peptidoglycan was demonstrated by the presence of N-acetylmuramic acid, rhamnose, alanine, glutamate, and lysine in mutanolysin-extracted TSA material purified by DEAE-Sephacel anion exchange and Sepharose 4B gel chromatography. Chemical analysis of purified cell walls revealed that group B antigen and peptidoglycan comprised 37.4 and 36.5%, respectively, whereas TSA accounted for 22.1 to 24.5% of the weight of the purified walls. Of the total 283.5 mg of TSA produced per 10-liter culture of GBS strain 110, 8.4% was released into the supernatant fluid. The remainder (249 mg) comprised the cell wall antigen. As described above, 4.6% of the cell wall antigen was extractable by nonenzymatic methods, which represented 3.8% of the total TSA, whereas 87.8% of the total TSA produced appeared to be covalently attached to the cell wall.
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