Floppy iris syndrome with oral imipramine: A case series.

Intraoperative floppy iris syndrome (IFIS) has commonly been seen with long-term use of α1-adrenoceptor blocking agents. We observed IFIS in three patients during phacoemulsification due to oral imipramine therapy. The three patients took imipramine for 25 years, 10 months and 1 year, respectively. However, only the first patient was on oral therapy at the time of surgery, while the other two patients had stopped 4 months and 2 months prior to undergoing phacoemulsification. The first and third patients developed complete IFIS features, while the second had only partial IFIS characteristics. Phacoemulsification could be completed in all three patients without any complication. None of these patients had history of taking any of the α1-adrenoceptor blocking agents. This is the first anecdotal report of IFIS with the oral use of imipramine and hence further evidences are required to ascertain the association of oral imipramine therapy and IFIS. However, ophthalmologists undertaking phacoemulsification on patients on imipramine therapy should be alert for the occurrence of IFIS.

La insulinoterapia intensificada más antineuríticos es superior a antineurítico puro en neuropatía diabética dolorosa / Intensified insulin therapy plus antineuritic medication is more effective than antineuritics alone in painful diabetic neuropathy

Background: The basis of the treatment of painful diabetic neuropathy is the use of drugs that block the transmission of pain (antineuritics) and a good metabolic control of underlying disease. Aim: To describe the outcomes of 17 type-2 diabetics with painful neuropathy, treated between 1988 and 2005 with symptomatic therapy plus intensified insulin. Material and methods: Review of medical records of 17 type-2 diabetic patients, aged 63±11 years and a duration of diabetes of 15±8 years. All patients received intensified insulin therapy with 0.35 units/kg of NPH insulin (2/3 before breakfast and 1/3 evening meal), plus capillary glucose measurements and regular insulin (with sliding-scale centered in ~0.1 units/kg) before the 3 main meals. All patients were also treated with gabapentin, nortriptyline or clomipramine. Pain was assessed using a visual analog score of 10 points. Results: After 1 year, glycosilated hemoglobin decreased from 10.0±1.4 percent to 7.7±1.2 percent (p~=0.003). Pain decreased from 10 to 5.1±3.3 at one month, 2.3±3.2 at six months, and 3.1±3.6 at 1 year (p <0.01). There was a direct statistical correlation between the reduction of HbA1C and pain decline (r =0.736; p =0.037). Pain scores were lower than those reported elsewhere for Pregabalin (n =76; p =0.05), Lamotrigine (n =27; p <0.0005), Topiramate (n =208; p <0.005), and Gabapentin (n =84; p <0.025). The lack of difference to Sodium Valproate (n =21; p =0.07) had borderline significance. Conclusions: The addition of intensified insulin therapy to the symptomatic treatment of painful neuropathy in type-2 diabetics, significantly enhanced the reduction of pain. The lowering of glycosilated hemoglobin was a significant predictor of success in pain reduction.

The impact of heterogeneity on the diagnosis and treatment of interstitial cystitis / O impacto da heterogeneidade no diagnóstico e tratamento da cistite intersticial

A cistite intersticial (CI) é uma doença cuja etiologia permanece desconhecida. A CI é um dos estados mais incômodos na prática urológica. Geralmente afeta mulheres, que apresenta sintomas de dor ao encherem a bexiga e freqüência urinária. A CI é uma síndrome heterogênea e é, freqüentemente, dividida em dois subtipos. Comparada à CI clássica, a do tipo näo-ulcerativa difere por apresentar aspectos sintomáticos, endoscópicos e histológicos diferentes, além da resposta aos vários tipos de tratamento. Esta revisäo é uma introduçäo à síndrome da CI, no que diz respeito a características clínicas e critérios de diagnóstico. Uma variedade de modalidades de tratamento têm sido sugeridas ao longo dos anos, e säo aqui revisadas e avaliadas, entre as quais estäo a hidrodistençäo da bexiga, a terapia de instilaçäo intravesical, a medicaçäo oral e a estimulaçäo elétrica transcutânea do nervo, a ressecçäo transuretral do tecido doente da bexiga, a cistectomia supratrigonal seguida de enterocistoplastia e derivaçäo urinário.