Treatment of refractory diffuse diabetic macular edema with lntravitreal bevacizumab

To analyze the short term visual acuity and anatomic response after a single dose of off-label intravitreal injection of bevacizumab in diffuse diabetic macular edema [DME] not responding to conventional laser photocoagulation. Prospective analysis of consecutive case series of 45 eyes of 38 patients with refractory diffuse DME who had one intravitreal injection of 1 .25 mg of bevacizumab [Avastin] and followed up for 3 months. All patients passed at least six months since their last laser treatment before inclusion in the study. Patients underwent best corrected visual acuity determination, intraocular pressure measurement, stereoscopic biomicroscopy of the macula and measurement of the retinal thickness by optical coherence tomography [OCT] at base line and follow up visits. At 1 month post-injection, visual acuity improved by 1 line in 7 eyes, unchanged from the pre-injection levels in 24 eyes and deteriorated in 14 eyes. At 3 months post injection, visual acuity improved in 1 8 eyes, it remained unchanged in 13 eyes and deteriorated in 14 eyes. The mean logMAR visual acuities were 0.60 [SD +/- 0.34], 0.64 [SD +/- 0.31] and 0.61 [SD +/- 0.32] at pre-injection, at 1 month post-injection and at 3 months post-injection respectively; but this mean decrease in vision was statistically not significant [P value=0.099]. The foveal thickness on optical coherence tomography had decreased in 27 eyes and it increased in 1 8 eyes at 1 month post-injection. At 3 months following injection, foveal thickness was reduced in 34 eyes, but was increased in 11 eyes. The mean foveal thicknesses were 444.95 micro [SD +/- 1 27.36], 394.95 micro [SD +/- 138.03] and 378.32 micro [SD +/- 112.01] at pre-injection, 1 month post-injection and 3 months post-injection respectively. This decrease in the foveal thickness was statistically significant [P value<0.001]. Intravitreal bevacizumab is effective in patients with diffuse DME which is refractory to treatment with conventional macular laser photocoagulation

Current concepts in intravitreal drug therapy for diabetic retinopathy

Diabetic retinopathy [DR] is a major cause of preventable blindness in the developed countries. Despite the advances in understanding and management of DR, it remains a challenging condition to manage. The standard of care for patients with DR include strict metabolic control of hyperglycemia, blood pressure control, normalization of serum lipids, prompt retinal laser photocoagulation and vitrectomy. For patients who respond poorly and who progressively lose vision in spite of the standard of care, intravitreal administration of steroids or/and anti-vascular endothelial growth factor [anti-VEGF] drugs appear to be a promising second-line of therapy. This review discusses the current concepts and the role of these novel therapeutic approaches in the management of DR

Study of aerobic granulocyte functional activity in the presence of a radiosensitizer [metronidazole]

The in vitro effects of metronidazole on the production of reactive oxygen species by polymorphonuclear [PMN] cells were studied by means of nitroblue tetrazolium and luminol-dependent chemiluminescence. At therapeutic doses of metronidazole [4.98-24.86 microg/mL] significant inhibition of the production of reactive oxygen species was noted in both methods. The inhibitory effect was in a dose-dependent pattern. The data suggest a scavenging mechanism of metronidazole on reactive oxygen species generated by PMN

Intravitreal injection of triamcinolone acetonide for the treatment of refractory diabetic macular edema

A prospective descriptive / non-comparative pilot study was used to evaluate the efficacy of intravitreal injection of triamcinolone acetonide [TA] for the treatment of patients with refractory diabetic macular edema that had not responded to laser treatment. Forty eyes of 35 patients with visual acuity [VA]

Inhibition of luminol-dependent chemiluminescence of human granulocytes by low doses of inorganic mercury

HgCl2, added in vitro to human granulocytes in whole blood, caused a marked inhibitory effect on the luminol-dependent chemiluminescence induced by BaS04 crystals in suspension of these cells. The effect was both dose- and time-dependent when BaS04 was used to stimulate the oxidative burst in granulocytes. Incubation with the highest concentration of HgCl2 used [10 mmol/L], however, did not cause disruption of the membranes of granulocytes. The effect of HgCl2 on the granulocytes was irreversible following washing of the HgCl2-treated cells with phosphate buffered saline. HgCl2 did not affect chemiluminescence produced when luminol was excited by oxidative hydrogen peroxide in a cell-free medium. These results suggest that some of the toxicity of HgCl2 may be greater than mediated by an action on the phagocytic immune system

comparative study of hemoglobin estimated by the traditional [WHO] technique and chemiluminescence method [research note]

The addition of hemoglobin [Hb] caused an inhibitory effect on the luminol-dependent chemiluminesence [CL] induced by the excitation of luminol by the oxidative metabolic, hydrogen peroxide, In a cell free medium. The CL was detected with an ultra-high sensitive photon counting system designed and built in the department of physiology. The Inhibitory effect produced by various Hb levels was dose dependent, reproducible and linear with an r=0.997. Hb concentration curves constructed by CL and standard Cyanmethaemoglobin [HiCN] methods were parallel. A comparison between the inhibited CL [area under the curves], and the optical density [HiCN method] produced by same Hb levels was linear with an r=0.990. There was no significant difference [0.1 > P < 0.5] between Rb level measured by CL and HICN method in healthy adults samples. A point of importance, turbidity due to high leukocytes count [250 x 109 CIL] has no significant effect on Hb levels measured by CL and the modified HICN methods. These results suggest that, CL method may provide an additional reliable method for Hb estimation

Kala-Azar in Iraq: treatment of relapsing cases by splenectomy

Kala-azar is an endemic disease in Iraq, caused by the parasite Leishmania donovani, It was found to be of mediterranean varient which affects children only. The patients are usually responding to the treatment with triantimony sodium gluconate. In some of the treated cases the disease relapses within few months of therapy and a second course of therapy is needed. In this paper we report two cases of relapsing kala-azar despite repeated medical treatment, managed successfully by splenectomy

Hydatid cysts of the spleen

A retrospective study of 23 patients with splenic hydatid cyst was carried out. The most frequent presenting symptoms in uncomplicated cysts were abdominal mass and gastrointestinal symptoms. Features of acute abdomen or toxaemia were encountered in complicated cysts due to rupture or suppuration. In this series, the disease was confined to the spleen in 43.48 per cent, coexisting in the liver in a similar figure and in the liver and lung in 14.04 per cent. Different diagnostic methods have been discussed. Pancytopenia is recorded in two cases. Surgical treatment varied: Splenectomy in favourable circumstances, Evacuation with primary closure of the cyst when fixity of the organ existed or evacuation with external drainage in infected cysts. Coexisting hepatic cysts were managed in one operative session. Staged surgery was carried out in multiple infestations

Anorectal melanoma

Three cases of anorectal melanomata have been reported. The tumour thickness in millimeter and the degree of infiltration as a guide for better evaluation is emphasized. The survival rates by different surgical methods are discussed. Primary melanoma of the anorectal region is rare. It is a highly malignant tumour and behaves in a more aggressive way than elsewhere in the body. During 25 years of active general surgical practice only 3 cases of primary melanomata have been encountered among a large series of malignancies of the anorectum by the authors

Intraperitoneal rupture of hydatid disease

Hydatid disease is still endemic in many parts of the world. The liver is affected more than other organs in the body. It is characterized by its latency. The disease is a slowly growing cyst that may remain dormant for a long period of time before it gives rise to symptoms. The symptoms sometimes arise when complications supervene. Rupture is the commonest complication. The cyst may rupture into the biliary system, into the peritoneal cavity, into the thorax or into an adjacent viscus. Intraperitoneal rupture has been discussed