No description available.

No description available.

Typescript. / Thesis (Ph. D.)--University of Hawaii at Manoa, 1978. / Bibliography: leaves 170-172. / Microfiche. / xi, 172 leaves ill

Microbial keratitis is the most serious, and only potentially blinding complication of contact lens wear. To further understand and reduce the risk of this disease, incidence rates and risk factors have been estimated in numerous studies. Since these studies were conducted, new lens types have been introduced designed to reduce the risk of infection. It was hypothesised that the issues of contact lens related hypoxia and poor lens hygiene could be addressed by the introduction of silicone hydrogel and daily disposable lenses respectively. This thesis describes the incidence of and risk factors for contact lens related microbial keratitis in Australia and New Zealand. The incidence of infection was determined by capturing all cases of contact lens related presumed microbial keratitis in a 12-month surveillance study, and by estimating the number of lens wearers using a population-based phone survey. Characteristics of the cases and controls were compared to estimate risk factors. In Australia, rates of infection with daily and overnight wear of hydrogel lenses were similar to previously published reports (1.9 [95%CI]:1.8-2.0] and 19.5 [95%CI:14.6-29.5] per 10,000 wearers respectively). Compared to the incidence of infection with hydrogel lenses, silicone hydrogel lenses had a higher rate in daily wear (11.9 [95%CI: 10.0-14.6]), and a similar rate in extended wear (19.5 [95%CI:14.6-29.5]). Daily disposable lenses had a similar rate of infection to daily wear of hydrogel lenses (2.0 [95%CI:1.7-2.4]), but appeared to reduce the incidence of severe or vision loss keratitis (0.5 [95%CI: 0.5-0.6] and 0.0 [95%CI: 0.0-0.0] respectively). Conducting the study in New Zealand confirmed the increase in incidence for overnight use of lenses, irrespective of lens type. Comparison of the incidence rates in New Zealand and Australia show that the rates in the two countries are comparable, bar an unexplained lower rate of infection for extended wear of soft hydrogel lenses in New Zealand. Risk factors for infection were overnight use of lenses, from occasional overnight to extended wear use, poor lens case hygiene, smoking, high socio-economic status and less than 6 months experience in current lens type. Amongst daily wearers, Internet or mail order purchasing of lenses was also associated with a higher risk of infection. This study is unique in terms of the study design and sample size, and the wide scope of risk factors considered. The determination of these incidence rates of infection and identification of risk factors is of extreme value to lens wearers and lens care practitioners around the world, particularly as the strongest and most prevalent risk factors are modifiable.

No description available.

Microbial keratitis is the most serious, and only potentially blinding complication of contact lens wear. To further understand and reduce the risk of this disease, incidence rates and risk factors have been estimated in numerous studies. Since these studies were conducted, new lens types have been introduced designed to reduce the risk of infection. It was hypothesised that the issues of contact lens related hypoxia and poor lens hygiene could be addressed by the introduction of silicone hydrogel and daily disposable lenses respectively. This thesis describes the incidence of and risk factors for contact lens related microbial keratitis in Australia and New Zealand. The incidence of infection was determined by capturing all cases of contact lens related presumed microbial keratitis in a 12-month surveillance study, and by estimating the number of lens wearers using a population-based phone survey. Characteristics of the cases and controls were compared to estimate risk factors. In Australia, rates of infection with daily and overnight wear of hydrogel lenses were similar to previously published reports (1.9 [95%CI]:1.8-2.0] and 19.5 [95%CI:14.6-29.5] per 10,000 wearers respectively). Compared to the incidence of infection with hydrogel lenses, silicone hydrogel lenses had a higher rate in daily wear (11.9 [95%CI: 10.0-14.6]), and a similar rate in extended wear (19.5 [95%CI:14.6-29.5]). Daily disposable lenses had a similar rate of infection to daily wear of hydrogel lenses (2.0 [95%CI:1.7-2.4]), but appeared to reduce the incidence of severe or vision loss keratitis (0.5 [95%CI: 0.5-0.6] and 0.0 [95%CI: 0.0-0.0] respectively). Conducting the study in New Zealand confirmed the increase in incidence for overnight use of lenses, irrespective of lens type. Comparison of the incidence rates in New Zealand and Australia show that the rates in the two countries are comparable, bar an unexplained lower rate of infection for extended wear of soft hydrogel lenses in New Zealand. Risk factors for infection were overnight use of lenses, from occasional overnight to extended wear use, poor lens case hygiene, smoking, high socio-economic status and less than 6 months experience in current lens type. Amongst daily wearers, Internet or mail order purchasing of lenses was also associated with a higher risk of infection. This study is unique in terms of the study design and sample size, and the wide scope of risk factors considered. The determination of these incidence rates of infection and identification of risk factors is of extreme value to lens wearers and lens care practitioners around the world, particularly as the strongest and most prevalent risk factors are modifiable.

Thesis (doctoral)--Universität Mainz.

No description available.

No description available.

Abstract A population-based study to investigate the epidemiological, genetic and clinical features of neurofibromatoses (NF) in Northern Finland was carried out between 1989–1996. The area concerned was that served by Oulu University Hospital, with a total population of 733 037. A total of 197 patients with neurofibromatosis type 1 (NF1), five with neurofibromatosis type 2 (NF2) and eight with segmental neurofibromatosis (NF5) fulfilling the diagnostic criteria were identified among several hundred patients examined on account of a possible NF diagnosis. The 197 NF1 patients came from 119 families. 77 of these cases were sporadic, 117 familial, and three were mothers of children suffering from NF1 who were themselves diagnosed as having segmental NF. The male/female ratio was 0.93 (95 males and 105 females). The geographical distribution of the patients roughly corresponded to that of the general population in the area. The overall prevalence of NF1 was 23/100 000, with a peak prevalence of 34/100 000 in the age group 10 to 19 years. The overall birth incidence of NF1 was estimated to be 27/100 000, with the highest figure, 37/100 000, recorded in the six-year period 1990–1995. The mean age at the time of diagnosis was 20 ± 16 years in the whole population and 6 ± 4 years in the children born in the 1980's. A new mutation was suspected in 49% of the NF1 cases (96/197), and a mutation rate of 4.37 ± 0.72 × 10-5 was obtained for the period 1960–1995. The relative fitness of the NF1 patients was 0.48, being reduced more in the affected males (0.24) than in the females (0.72). The mean maternal and paternal ages of the sporadic patients were 30 ± 6 and 33 ± 6 years, respectively, which is significantly higher than in the general population. Two cases with a deletion of the NF1 gene were identified, one encompassing the loci from EVI-20 to INT-38 and the other the INT-27 locus, representing 3% of the 66 cases analysed. In seven familial cases the parental origin of the new mutation could be verified and linkage studies showed that the oldest affected individual in the family had inherited the mutation from the father in 6/7 cases. In one family seven members in three generations were affected with a rare spinal neurofibromatosis, and a linkage to the NF1 gene was shown. Of these seven patients, four are included among the 197 studied here while the other three lived outside the area. The diagnostic features of the 164 NF1 patients aged from three months to 73 years who were examined clinically included café au lait spots (CLS) in 96% of cases, freckles in 87%, neurofibromas in 69%, plexiform neurofibromas in 20%, Lisch nodules in 70%, optic glioma (asymptomatic) in 20% and pseudarthrosis in 3%. 56% of the cases had an affected first degree relative. A plexiform neurofibroma was diagnosed in 33 individuals and this became a malignant peripheral nerve sheath tumour(MPNST) during the seven years of monitoring in 15% of cases (5/33). Hyperintense T2 lesions in a MRI scan of the brain were found in 94% of the children under the age of six years who had had such a scan (n = 17) and in 84% of those under 16 years (n = 50). Symptoms related to NF1 which needed medical intervention, rehabilitation or follow-up were diagnosed in about 2/3 of the cases, and in 38% of cases such medical problems of this kind had been treated before NF1 was actually diagnosed. All these findings emphasise the need for a multidisciplinary approach to the follow-up of neurofibromatoses.