Effect of smoking on skin elastic fibers: a morphometric and immunohistochemical analysis

Tobacco smoking is one of the major health problems in the world. This study was conducted to investigate the morphological changes of the dermal elastic tissue of sun-protected skin induced by smoking. Punch biopsies were obtained from the nonexposed skin of 15 smokers and 15 nonsmokers to evaluate the dermal elastic fibers using morphometric analysis and immunohistochemical techniques. Elastic fibers of the reticular dermis were more numerous, thickened and fragmented in smokers than in nonsmokers. Correlations between the cumulative tobacco dose and the morphology of the elastic fibers were highly significant. Immunohistochemical analysis for alpha-1-antitrypsin showed negative cytoplasmic staining for all samples of both smokers and nonsmokers. This study indicates that smoking is one of the risk factors that lead to an increase in elastic fibers of the reticular dermis. This increase is due to elastic tissue degradation rather than by new synthesis, as in solar elastosis. Furthermore, smoking has multiplicative effects on facial ageing and could share, at least in part, a pathophysiological pathway

Phacoemulsification in cases of pseudoexfoliation using in situ nuclear disassembly without nuclear rotation

The purpose was to assess the safety and frequency of intraoperative complications of phacoemulsification using an in situ nuclear disassembly technique in pseudoexfoliation [PEX] cases. The work was done in Rustaq Hospital, Rustaq, Sultanate of Oman. This prospective, interventional, noncomparative study included 103 cases of cataract with pseudoexfoliation that underwent phacoemulsification with in situ nuclear disassembly using Alcon Infinity machine with Ozil handpeice and Kelman-style 45[degree sign] phacoemulsification tip. Of the 103 cases, 55 males [53.4%] and 48 [46.6%] females, one case developed posterior capsular rupture, and four cases developed zonular dehiscence that was partial in three cases and >180[degree sign] in one case only. The best corrected visual acuity [BCVA] 4 weeks postoperatively using logMAR notation was as follows: 66 cases [65.1%] had BCVA of 0.30 or better [logMAR notation], and 37 cases [35.9%] had BCVA of 0.48 or less. Safe and efficient phacoemulsification without nuclear rotation could be achieved in cases pseudoexfoliation in which zonular weakness is a concern by utilizing the versatility of Kelman style phaco tip to do lateral sweep sculpting and in situ cracking techniques. It prevents zonular stress by avoiding manipulation or rotation of the nucleus in cases

impact of intraoperative transoesophageal echocardiography on decision-making during cardiac surgery

Real time intraoperative transoesophageal echocardiograpgy [TOE] has an expanding role in peri-operative management and surgical decision making. Studies of the effect of transoesophageal echocardiography [TOE] on intraoperative decision making commonly emphasise major changes in operative plans. We examined more subtle effects using a novel scale, recording influences on management as follows: Level 1: TOE had no effect on management, confirmed and quantified known pathology. Level 2: TOE altered hemodynamic and/or anesthetic management. Level 3: TOE evaluated the adequacy of surgical intervention/or repair. Level 4: TOE led to an alteration in the surgical plan. We compared the impact of TOE as an aid to intra-operative management in coronary artery bypass cases with other types of cardiac surgery. Retrospective, observational study in a single centre, university-affiliated hospital included 319 patients undergoing cardiac surgery and suitable for TOE. TOE was performed in each patient before and after the institution of cardiopulmonary by-pass. Normal and abnormal echocardiographic findings as well as immediate outcomes of the surgical procedure were recorded using a standard database form. Instances where TOE lead to alteration in operative management were documented. The findings were also compared with those documented on preoperative echocardiography. In 141 CABG patients TOE had a level 1 impact in 73%, level 2 impact in 11.6%, levels 3 and 4 in 7% and 7.8% respectively. In 178 non CABG patients these values were 2%, 1.6%, [p < 0.05], 72.4% [p < 0.05] and 23.6% [p < 0.05] respectively. The impact of TOE in CABG procedures, while significantly less than that in non-CABG surgical procedures, remains substantial

Evaluation of a blood conservation strategy in the intensive care unit: a prospective, randomised study

Anemia is a common problem in the ICU population. Most patients are anemic at admission, their hemoglobin concentrations declining further thereafter. The aim of the present study was to evaluate the effect of a combination strategy, involving closed arterial blood gas sampling and the use of pediatric vials for phlebotomy [Group A], on the sampling-induced blood loss and the rate of decline in hemoglobin in adult ICU patients. Combination [Group A] was compared to the current standard technique of arterial line sampling and adult vial phlebotomy [Group B] in a prospective, randomised, ethically-approved trial for the first 72 hours of their ICU stay. Peri-operative, oncology, coagulopathic and uremic patients were excluded. All other ICU patients with arterial cannulae and predicted to stay beyond 3 days, were enrolled. 39 patients entered the study, 20 in Group A, and 19 in Group B. Data collection was complete for all. There was a statistically significant difference in sampling-induced blood loss between the groups over the first 72 hours of treatment [mean +/- standard deviation: 15.16 +/- 5.3 ml Group A vs 45.11 +/- 14 ml Group B, p < 0.001]. There was a smaller decline in mean hemoglobin level, which was not statistically significant [0.79 +/- 0.6 g/dL vs 1.30 +/- 1.13, p = 0.09]. Overall, this strategy reduced measurable blood losses from phlebotomy. In larger trials it might also preserve hemoglobin levels

Efficacy and safety of selective laser trabeculoplasty as a primary procedure for controlling intraocular pressure in primary open angle glaucoma and ocular hypertensive patients

Assessment of the potential efficacy and safety of selective laser trabeculoplasty [SLT] as a primary therapeutic modality for lowering the intraocular pressure [IOP] in high tension open angle glaucoma [OAG] and ocular hypertensive patients [OHT]. Twenty five patients [35 eyes] were enrolled in this prospective interventional longitudinal clinical study, undertaken during the period January 2005 to October 2006. All the laser procedures were done in the Oyoon Eye Center in Cairo, Egypt. Informed consent was taken from the patients after explanation of the procedure. Eighteen patients [25 eyes] had mild to moderate high tension open angle glaucoma, and there were 7 ocular hypertensive patients [10 eyes]. Participants underwent selective laser trabeculoplasty [SLT] 180 degrees and followed up over a period of 12 months to assess the intraocular pressure lowering effect after SLT. Possible complications of the procedure were reported. The intraocular pressure [mean +/- standard deviation [StDev]] decreased from baseline pre-operative value of 26.78 +/- 3.13 mm Hg to 19.34 +/- 1.89 mm Hg 12 months after SLT [p <0.001]. The average reduction in intraocular pressure [IOP] was 7.44 mm Hg [95% confidence interval 6.45 - 8.41 mm Hg]. By the end of the follow up period [12 months], 62.9% of cases [22 eyes] showed IOP decrease by > /= 30% from the baseline value, and 77.1% of cases [27 eyes]showed IOP decrease by > /= 25% of baseline IOP. Selective laser trabeculoplasty is an effective IOP lowering modality. It can be used as a primary treatment for open angle glaucoma and ocular hypertensive patients. If the minimal side effects reported are considered, it can be concluded that SLT has a potential safety to be used as primary alternative treatment for open angle glaucoma and ocular hypertensive patients

Laparoscopic supracervical hysterectomy compared with total abdominal hysterectomy

To assess if laparoscopic supracervical hysterectomy [LSH] had any advantage over traditional total abdominal hysterectomy [TAH] carried out for benign conditions. This prospective case control study was carried out between June 2005 and October 2006 in the Obstetrics and Gynecology Department of Zagazig University Hospitals, Zagazig, Egypt. Twenty-eight women operated upon by LSH were compared to 56 women who had undergone TAH. Variables compared were patient's age, weight, preoperative diagnosis, number of previous laparotomies, operative time, intra/post-operative complications, blood loss, uterine weight, hospital stay, need for analgesia, and resumption of normal activity. Patient's demographics were similar in both groups. The operative time was longer in the LSH group [93.7 +/- 5.7 versus 69.0 +/- 6.8 min, p=0.001]. Other operative and post-operative parameters were similar except that LSH patients showed shorter hospital stay [1.7 +/- 0.5 versus 4.0 +/- 0.7 days], time to resume normal activity [20.8 +/- 2.6 versus 50.0 +/- 7.9 days] and lower dose of post-operative analgesia [141.7 +/- 62.4 versus 282.0 +/- 87.4mg diclofenac], [p=0.001]. Laparoscopic supra cervical hysterectomy is a safe procedure and should be considered, if hysterectomy will be carried out for a benign condition with healthy cervix. A further larger study is needed to confirm these findings