Combined intravitreal bevacizumab with phacoemulsification in visually significant cataract and visually significant exudative maculopathy

We investigated the visual outcome of combined phacoemulsification with intravitreal bevacizumab, in eyes with dense cataract and visually significant exudative maculopathy. Prospective longitudinal pilot study of consecutive patients treated by two surgeons in 2006, using intravitreal bevacizumab at the end of phacoemulsification. The historical control group consisted of consecutive subjects with exudative maculopathy and dense cataract treated by the same surgeons with the help of phacoemulsification without intravitreal bevacizumab prior to 2006. Thirty-one treated patients had the mean [SD] logMar best corrected visual acuity improving from - 1.48 [0.50] preoperatively to - 0.67 [0.38] in the first postoperative week [p< 0.001], to - 0.64 [0.40] in the first postoperative month [p< 0.001], and to - 0.62 [0.42] [p< 0.001] on the last follow-up [mean 4.2 months, range 1 - 9 months]. Fourteen control patients had the mean [SD] log Mar best corrected visual acuity improving from - 1.78 [0.79] preoperatively, to - 0.91 [0.53] in the first postoperative week [p< 0.001], to - 0.86 [0.45] in the first postoperative month [p< 0.001], and to - 0.90 [0.47] [p< 0.001] on the last follow- up [mean 19.6 months, range 1 - 49 months]. Initial visual acuities, final visual acuities, and percentage of visual improvement at one month were all not significantly better in the intervention compared to the control group at one month. In the study group, the fovea was flattened at the one-month follow-up, by 90-diopter slit lamp examination and / or Optical coherence tomography. The combination of intravitreal bevacizumab and phacoemulsification is beneficial for maximal visual rehabilitation in the first postoperative month

Effect of preoperative hydration on postoperative nausea and vomiting

Postoperative nausea and vomiting [PONV] remains one of the most common postoperative complications, causing discomfort, patient dissatisfaction, delayed discharge and increased costs. Our aim: Was to determine whether preoperative IV rehydration with a balanced salt solution would decrease the incidence of PONV in patients at increased risk for these symptoms. Sixty female patients [physical status ASA class I and II] presenting for laparoscopic cholecystectomy were included in the study and were instructed to fast from the previous midnight. Patients were randomly assigned to either a control group [group 1] or a high infusion group [group 2] according to the volume of fluid infused preoperatively. Patients of control group [group 1] didn't receive pre-operative fluid bolus, whereas patients of the high infusion group [group 2] received pre-operative fluid bolus of Ringer's solution in a volume of 1.5 mL kg[-1] h[-1] of fasting time. This volume was completely administered in group 2 before induction of anesthesia, over approximately 30 min, in the preoperative holding area. The incidence of PONV, was assessed by a blinded investigator during the stay in post anesthesia care unite [PACU], and at 6, 12 and after 24 hrs postoperatively. Post-operative adverse effects [thirst, pain and drowsiness], and the need for supplemental antiemetic and analgesic therapy were also recorded during stay in PACU and for 24 hrs. The incidence of PONV and the need for anti-emetics were significantly reduced in the high volume infusion group at all time intervals. The high volume infusion group also had decreased postoperative thirst, drowsiness, and pain scores and required less supplemental analgesia. Preoperative hydration effectively reduces the incidence of PONV, antiemetic and analgesic requirements in patients with increased risk of PONV

Percutanous ablative therapy for HCC: a comparison of three modalities

This study was performed on 78 patients having liver cirrhosis with 91 focal hepatic lesions detected by ultrasound and proved histopathologically to be HCC [biopsy and/or fine needle aspiration cytology; FNAC]. They were 70 males and 8 females their ages ranged between 37 and 75 years old. Patients were classified into three groups, Group A was formed of 32 patients with 37 focal lesions where they received RFA. Group B encountered 25 patients with 26 focal lesions and they received PAI Group C included 21 patients with 28 focal lesions were treated by PEI. Complete ablation was assessed by re-biopsy and/or FNAC, triphasic CT and AFP serum level. As regards the outcome of therapy in group A, complete ablation was achieved in 14/18 [78%] for lesions

Diabetic sensorimotor neuropathy: electrophysiological, Histopathological and Immunohistochemical study

To determine the role of IgM and IgG deposition in the neuronal tissue in the pathogenesis of diabetic sensorimotor neuropathy. This study was carried out on 30 diabetic patients. They were divided into three groups, group I comprised 10 insulin dependent diabetic patients with peripheral neuropathy, group II 10 non-insulin dependent diabetic patients with peripheral neuropathy and group III 10 diabetic patients without peripheral neuropathy as a control group. All patients were subjected to clinical examination, laboratory investigations [urine analysis for proteinuria, fasting and postprandial blood glucose levels], neurophysiological studies including EMG and motor nerve conduction studies of median and common peroneal nerves and sensory conduction studies of median and sural nerves. Sural nerve biopsies were taken and subjected to histopathological examination under transmission electron microscope and immunohistochemical examination for detection of IgG and IgM deposition. Motor and sensory nerve conduction velocities were diminished in all patients of, group I and II. There were significant correlations between motor nerve conduction velocities with age, duration of diabetes and neuropathy. As regards histopathological examination, there were endoneurial capillary closure, segmental demyelination and axonal degeneration in addition to vascular changes in the form of thickening of the basement membrane, medial thickening and endothelial proliferation. There were immunoglobulin M and G deposition in the sural nerve biopsies at two identical sites perineurial and endoneurial. In, group III, electrophysiological studies were abnormal in only one patient and histopathological studies revealed no important detectable abnormalities, also immunohistochemical examinations showed no significant immunoglobulins [Igs] deposition. The deposition of immunoglobulins in the peripheral nerves of diabetic patients with peripheral neuropathy might be related to primary and specific activation of immune system effectors against unknown neuronal antigens or may be secondary to destruction of the blood nerve barrier, possibly by hyperglycemia. Neural deposition of Igs should be considered as an additional evidence for a role for the humeral immune mechanisms in the pathogenesis of diabetic sensorimotor neuropathy

Cardiac involvement in primary sjogren's syndrome patients detected with echocardiography

To determine a pattern of cardiac involvement in primary Sjogren's syndrome patients and to evaluate these cardiac abnormalities in asymptomatic patients. The study was carried out on 20 primary Sjogren's syndrome patients [PSS] as well as 10 healthy controls matched in age and sex. None of the patients had evidence of cardiac symptoms. All subjects had complete history, clinical examination, laboratory tests [Rh F, ANA and anti Ro and anti La], chest X-ray, ECG and echocardiography. Cardiac abnormalities were detected in 7 [35%] primary Sjogren's syndrome patients out of 20 [PSS] patients examined with echocardiography. Seven [35%] presented with left ventricle diastolic dysfunction and 6 [30%] presented with pulmonary hypertension but only [15%] showed left ventricle hypertrophy, there were 2 patients with mitral regurge and only 1 patient with mitral stenosis and prolapse and also, 1 [5%] presented with aortic regurge and 1 [5%] patient by tricuspid regurge. There was significant difference between PSS patients and control subjects as regards to diastolic functions [E peak, A peak, E/A and DFT] and there was no correlation between the occurrence of these silent cardiac abnormalities and the clinical and laboratory findings. Cardiac involvement is common in PSS but clinically with silent manifestations. Thus, echocardiography should be done for all patients with PSS to detect any cardiac abnormalities