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A 62-year-old woman was referred with poor vision following manual small incision cataract surgery. On presentation, the uncorrected distance visual acuity in the involved eye was 3/60, whereas slit-lamp examination revealed a central corneal edema with the peripheral cornea relatively clear. Direct focal examination with a narrow slit upper border and lower margin of detached rolled up Descemet’s membrane (DM) could be visualized. We performed a novel surgical approach, “double-bubble pneumo-descemetopexy.” The surgical procedure included unrolling of DM with “small air bubble” and descemetopexy with “big bubble.” No postoperative complications were observed, and best corrected distance visual acuity improved to 6/9 at 6 weeks. The patient had a clear cornea and maintained BCVA 6/9 during 18 months at follow-up. Double-bubble pneumo-descemetopexy, a more controlled technique, provides a satisfactory anatomical and visual outcome in DMD without the need for endothelial keratoplasty (Descemet’s stripping endothelial keratoplasty or DMEK) or penetrating keratoplasty.
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ABSTRACT: The aim of this study is to determine serum amyloid-A (SAA) concentration in the cases of pneumonia, pneumoenteritis, and enteritis which are frequently encountered in calves in veterinary medicine. Although a great deal of experimental studies has been conducted in this field, studies on naturally infected calves are quite few. Eighty calves at the age of 0-6 months were used in the study and the calves were divided into four groups. Due to the clinical examination, the calves diagnosed with pneumonia (Group P; n=20), with pneumoenteritis (Group PE; n=20) and with enteritis (Group E; n=20) formed the disease group as the healthy ones formed the control (Group C; n=20) group. After the body temperatures of all calves were taken, blood samples were obtained from Jugular vein for haematological and biochemical measurements. As haematological, white blood cell (WBC), red blood cell (RBC), hemoglobin (Hb) and hematocrit (Hct) measurements were performed in Veterinary Hematology Analyzer. Serum amyloid-A (SAA), interleukin 1 (IL-1β), interleukin 6 (IL-6), tumor necrosis factor-α (TNF-α) concentration measurements were carried out with ELISA reader by using commercial kits. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin (ALB), total bilirubin (T. Bil), total protein (TP), gamma glutamyltransferase (GGT), blood urea nitrogen (BUN) concentration measurements were conducted in autoanalyzer by using commercial kits. In all disease groups (P, PE, and E) body temperature, haematologic parameters (WBC, RBC, Hb and Hct), serum biochemical parameters (AST, ALT, ALB, T. Bil, TP, GGT and BUN), SAA concentration and serum concentrations of cytokines (IL-1β, IL-6 and TNF-α) were determined to be higher in comparison to the control group (P<0.005). According to these findings, routine measurement of serum SAA concentration in veterinary medicine is considered to be beneficial in determining the severity of the disease, in selecting the proper treatment, in monitoring the applied treatment, and detecting subclinical diseases. In the light of these findings we acknowledge that routine measurements of serum SAA concentration from the moment the calves are diagnosed with pneumonia, enteritis and pneumoenteritis in veterinary medicine until the actual cause is determined (bacteria, virus, parasites, etc.) would avail the clinician to, identify the severity of the disease, select the appropriate treatment and monitor the effectiveness of the treatment.
RESUMO: O objetivo deste estudo é determinar amilóide A (SAA) da concentração sérica nos casos de pneumonia, pneumoenterites e enterite, que são frequentemente encontrados em bezerros em medicina veterinária. Apesar de uma grande quantidade de estudos experimentais terem sido realizados neste campo, os estudos sobre animais com infecção natural são muito poucos. 80 vitelos com a idade de 0-6 meses de idade foram utilizados no estudo e os animais foram divididos em quatro grupos. Devido ao exame clínico, os bezerros diagnosticados com pneumonia (Grupo P; n=20), com pneumoenterites (Grupo PE; n=20) e com enterite (Grupo E; n=20) formaram o grupo de doença, como as saudáveis, formando o grupo controle (Grupo C; n=20). Após as temperaturas corporais de todos os bezerros, foram tomadas amostras de sangue que foram obtidas de veia jugular para medições hematológicas e bioquímicas. Como hematológica, glóbulos brancos (WBC), glóbulos vermelhos (RBC), hemoglobina (Hb) e hematócrito (HCT) foram realizados em Hematologia Veterinária Analyzer. O soro amilóide-A (SAA), a interleucina 1 (IL-1β), interleucina 6 (IL-6), fator de necrose tumoral (TNF-α) medidas de concentração foram efectuadas com um leitor de ELISA, utilizando kits comerciais. Aspartato aminotransferase (AST), alanina aminotransferase (ALT), albumina (ALB), bilirrubina total (T. Bil), proteína total (TP), gama glutamiltransferase (GGT), ureia (BUN) às medições das concentrações foram realizadas em auto-analisador por utilizandos kits comerciais. Em todos os grupos de doenças (P, PE, e E), a temperatura corporal, parâmetros hematológicos (WBC, RBC, Hb e Hct), parâmetros bioquímicos de soro (AST, ALT, ALB, T. Bil, TP, GGT e BUN), a concentração SAA e as concentrações séricas de citocinas (IL-1β, IL-6 e TNF-α) foram determinadas a ser mais elevadas em comparação com o grupo controle (P<0,005). De acordo com estas descobertas, a medição rotineira da concentração de soro SAA em medicina veterinária é considerada benéfica para determinar a gravidade da doença, na selecção de um tratamento adequado, no seguimento do tratamento aplicado e para a detecção de doenças subclínicas. À luz desses resultados, reconhecemos que as medições de rotina da concentração SAA soro do momento em que os bezerros são diagnosticadas com pneumonia, enterite e pneumoenterites em medicina veterinária, até que a causa real seja determinada (bactérias, vírus, parasitas, etc.), seria aproveitar o clínico, a fim de identificar a gravidade da doença, além de seleccionar o tratamento adequado e monitorar a eficácia do tratamento.
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Objective:To explore the neutrophil CD64 and sTREM-1 in elderly patients with community-acquired pneumonia ( CAP) in the diagnosis of clinical value. Methods: 76 elderly CAP hospitalized patients were divided into severe pneumonia group (n=23) (live in 15 cases,8 deaths)and ordinary pneumonia group(n=53) according to severity;45 patients in the control group compared with healthy older persons. Peripheral blood neutrophil CD64 was measured by automatic flow cytometry,sTREM-1 levels was measured by double-antibody sandwich enzyme-linked immunosorbent assay. The receiver operating characteristic curve ( ROC curve) was used to check diagnostic value of the detection. Results: Median concentrations of CD64 and sTREM-1 in the severe pneumonia group,general pneumonia group and control group were 37. 49,18. 82 and 10. 63 MFI,and 75. 39,65. 31 and 43. 96 pg/ml, respective-ly. Although there was significant differences among the three groups ( P<0. 05 ); CD64 and sTREM-1 in Severe pneumonia survival group reduced to a normal level as his condition improved gradually,death group continued to rise as the disease,and peaked at the time of death;the area under the ROC curve of CD64,sTREM-1were respectively 0. 876,0. 843,which was 0. 917 by combination of CD64 and sTREM-1. Conclusion: Both CD64 and sTREM-1 are good markers in the diagnosis value of CAP, the dynamic changes of two may reflect the condition and prognosis of CAP.
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Objective To investigate the effects of different ventilation modes on PaCO 2 and PaO 2 during laparoscopic surgery in the Trendelenburg position.Methods Forty cases of laparoscopic resection of rectal cancer were randomly divided into group A (n =20)and group B (n =20).Under general anesthesia,all the cases were in volume-controlled ventilation mode (VCV,tidal volume=10 ml/kg)before pneumoperitoneum.After ventilating in VCV mode for 20 minutes with a lower tidal volume (8 ml/kg),group A was converted to PCV mode for 20 minutes and then back to the VCV mode for 20 minutes again.Next we switched to PCV combined with PEEP (5 cm H 2 O)mode (PCV+PEEP)for 20 minutes.In group B,we only alternated PCV with PCV combined with PEEP.Arte-rial blood-gas analysis was obtained at each time when ventilating mode changed.Results In both group A and B,PaO 2 in VCV mode was less than that in PCV mode and PCV+PEEP mode (P <0.05),PaO 2 in PCV mode was also less than that in mode PCV+PEEP mode (P <0.05).PaCO 2 in PCV and PCV combined with PEEP mode was less than that in VCV mode (P <0.05 ),and there was no difference of PaCO 2 in PCV mode and PCV+PEEP mode.The pH value in VCV mode was less than that in PCV mode and PCV+PEEP mode (P < 0.05).There was no difference in pH value between PCV mode and PCV+PEEP mode.Conclusion PCV combined PEEP mode is beneficial ei-ther in increasing or decreasing of PaCO 2 during laparoscopic surgery in the Trendelenburg position comparing with single VCV mode or PCV mode.
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Nosocomial infection is one of the most common morbidity among hospitalized patients. While study dealing with epidemiologic pattern of those in living patients are numerous, studies focusing on patients who died of them are few. In this prevalence study, we found that patients having fatal nosocomial infections presented some distinguishable features. From May 1982 to December 1983, 109 out of 300 cases had fatal nosocomial infections (36.3%). There was a total of 168 episodes of infection in these patients (1.5 episodes per patient). The ages ranged from 13-91 years and both sexes were equally affected. Septicemia was the most common infection related directly to death (a causal relationship). Pneumonia was commonly contributing to death while urinary tract infection was the most common infection not related to death. Most patients had either rapidly fatal or ultimately fatal underlying diseases. The infections disease episodes in both types of underlying diseases were not significantly different. There was a bimodal age group distribution of those who died of infections (30 and 60 years). The peak survival was rather short (mode of 20.0 days) and the fatal infection occurred early in the hospitalized course (mode of 5.0 days). These data suggested that the prevalence of fatal nosocomial infection was high severe infection occurred early and types of infection may be a predictor of fatal outcome,. Any intervention focusing on prevention of severe infection, such as septicemia and pneumonia, should be encouraging.