Augmented Medial Rectus Recession with Non-Absorbable Suture Loops is Effective in the Treatment of Convergence Excess Esotropia.

AIM: To evaluate the surgical outcomes of augmented medial rectus recession with non-absorbable 5.0 white braided polyester suture (Alcon Laboratories, Forth Worth, Texas, USA) loops in patients diagnosed with convergence excess esotropia. Methods: Clinical records of 21 patients with convergence excess esotropia who have been operated with symmetric medial rectus recessions augmented with non-absorbable suture loops were reviewed. Initial scleral bite was planned according to the distance deviation. Non-absorbable sutures tied leaving a loose loop which was 1 mm for a near-distance disparity of 10 PD, 1.5 mm for 15PD, and 2 mm for 20 PD. Postoperative changes in near-distance disparity were evaluated. RESULTS: The mean preoperative near-distance disparity of 17,21 ± 1,68 standard mean of error (SE) prism diopters (PD) decreased to 3,15 ± 0,88 PD SE at 12 month postoperatively. Near-distance disparity of 10 PD or less was achieved in all patients after surgery at the sixth month, 1 patient showed 12 PD of disparity at the first-year control. No overcorrection has been noted. CONCLUSION: Bilateral medial rectus muscle recession procedure augmented with polyester suture loops effectively decreases the disparity between near and distance deviations in patients with convergence excess esotropia. Because of our good results and an easy, noninvasive approach without any additional complications, we recommend this technique to treat convergence excess esotropia.

Epicardial adipose tissue thickness in patients with chronic obstructive pulmonary disease having right ventricular systolic dysfunction.

OBJECTIVE: The aim of the present study was to evaluate epicardial fat thickness (EFT) in patients with chronic obstructive pulmonary disease (COPD) having right ventricular systolic dysfunction (RVSD). PATIENTS AND METHODS: This study was comprised of 98 patients with COPD and 40 healthy controls. All the study participants underwent 2-dimensional, pulsed and tissue-doppler transthoracic echocardiographic examination for the measurements of EFT and parameters of right and left ventricular functions. Patients with COPD were divided into mild and severe RVSD groups according to right ventricular fractional area changes (RVFACs). RESULTS: Age, gender, prevalence of diabetes mellitus, hypertension, body-mass-index (BMI) and dyslipidemia were similar between COPD patients and controls, as were between mild, and severe RVSD groups. Prevalence of smoking were higher in COPD patients than in controls. Right ventricular end-diastolic diameter, myocardial performance index and peak pulmonary systolic pressure were found to be higher in COPD patients, while tricuspid annular plane systolic, excursion, isovolumic accelerating time, EFT and EFT/BMI were found to be lower in COPD patients. COPD patients with severe RVSD had thinner EFT and lower EFT/BMI values than those with mild RVSD (4.10 ± 0.77 vs 5.48 ± 1.28 mm, p < 0.001, respectively). CONCLUSIONS: The present study shows that the EFT decreases in patients with COPD and it is also associated with the degree of RVSD. Therefore, evaluating EFT in patient with COPD may provide information about the severity of the disease.

Link between aortic valve sclerosis and myocardial no-reflow in ST-segment elevation myocardial infarction.

OBJECTIVE: The"no-reflow" phenomenon is associated with a worse prognosis at follow-up for patients with acute ST-segment elevation myocardial infarction (STEMI). Predicting and preventing no-reflow is therefore a crucial step in improving the prognosis of STEMI patients. The purpose of this study was to investigate the association between aortic valve sclerosis (AVS) and myocardial no-reflow in patients with STEMI. PATIENTS AND METHODS: Patients with a first-time diagnosis of STEMI were enrolled consecutively. No-reflow was defined as a final TIMI 3 flow with a myocardial blush of grade < 2, temporary epicardial coronary no-reflow, and distal coronary occlusion. AVS was defined by echocardiography as thickening and calcification of the normal trileaflet aortic valve without obstruction to the left ventricular outflow. RESULTS: No-reflow developed in 41 patients. In univariate analysis, age, male gender, smoking, culprit lesion Syntax score (SX score), and hypertension were significantly associated with no-reflow. Multivariate binary logistic regression analyses demonstrated age [95 % confidence interval (CI), 1.024-1.096; p=0.001), AVS (95 % CI, 1.002-1.100; p=0.039], culprit lesion SX score (95 % CI, 1.08-1.021 p=0.008), and symptom-to-balloon time (95 % CI, 1.020-1.097; p=0.002) as independent determinants of myocardial no-reflow. CONCLUSION: AVS was significantly and independently associated with myocardial no-reflow in STEMI patients.

Decline of compound muscle action potentials and statistical MUNEs during Wallerian degeneration.

AIM OF THE STUDY: In two previous studies, we found that the compound muscle action potential (CMAP) amplitude loss was significantly higher than the loss of estimated motor unit numbers in the course of Wallerian degeneration (WD). In order to overcome some drawbacks of the method previously used, we performed a similar CMAP vs MUNE comparison by using the statistical motor unit number estimation (MUNE) method. PATIENTS AND METHODS: Initial electrophysiological studies on 6 patients were performed between 22 and 98 hours after the injuries; it was possible to make repeated examinations, four times in 1 nerve, twice in 1 nerve and three times in 4 nerves, before the eventual complete disappearance of the CMAPs. RESULTS: The transected/intact (T/I) side CMAP ratios declined steeply as WD evolved. They were significantly lower than the relatively stable MUNE ratios 48 hours after the injury. CONCLUSION: This study, performed with the use of statistical MUNE, strengthens our previous observation by the incremental method that might have some relevance to the pathophysiology of early WD. CMAP amplitude loss that is more than expected from the amount of axonal degeneration may indicate a considerable amount of inactive muscle fibers in the motor units innervated by the nerve fibers, which are undergoing degeneration but still retain their excitability. Although technical sources of error cannot be totally excluded, our findings could more likely be explained by the failing of neuromuscular synapses in an asynchronous order before complete unresponsiveness of the motor unit ensues.

Comparison of Rosco Neo-Sensitabs with Oxoid paper disks in EUCAST disk diffusion antimicrobial susceptibility testing on Mueller-Hinton agar.

This study compared Neo-Sensitabs with Oxoid paper disks using the European Committee on Antimicrobial Susceptibility Testing (EUCAST) disk diffusion antimicrobial susceptibility test on Mueller-Hinton agar. The EUCAST-recommended quality control strains (Escherichia coli ATCC 25922, Pseudomonas aeruginosa ATCC 27853, Staphylococcus aureus ATCC 29213 and Enterococcus faecalis ATCC 29212) (Part I) and clinical isolates (Part II) were investigated. In Part I of the study, 27 combinations of antimicrobial agents were tested on four quality control strains repeatedly up to 60 times and zone diameters of tablets and disks were compared. In Part II of the study, 351 clinical isolates were included to cover a broad range of species, as well as resistance mechanisms. In Part I, four major deviations (>1 mm outside quality control ranges) were observed with Neo-Sensitabs. In one case with P. aeruginosa ATCC 27853 (meropenem), there was a corresponding major deviation (2 mm) with the Oxoid disk. The three remaining major deviations with Neo-Sensitabs were observed with meropenem (2 mm) in E. coli ATCC 25922 and with ciprofloxacin (2 mm) and gentamicin (3 mm) in P. aeruginosa ATCC 27853. For Oxoid disks, there were only minor deviations (=1 mm outside quality control ranges) in these three cases. In Part II, there were six discrepancies, susceptible versus resistant, in 3,533 comparisons between the two methods with the clinical isolates. The Rosco Neo-Sensitabs appear to be a possible alternative to Oxoid paper disks for EUCAST disk diffusion antimicrobial susceptibility testing on Mueller-Hinton agar.

Mean platelet volume on admission is associated with further left ventricular functions in primary PTCA patients.

AIM: In ST elevation myocardial infarction (STEMI) patients, mean platelet volume (MPV) is associated with infarct related artery patency both before and after reperfusion. In anterior STEMI patients successfully treated with primary percutaneous coronary intervention (PCI), the relationship between left ventricular (LV) function and MPV on admission is unknown. METHODS: 97 anterior STEMI patients successfully revascularizated with PCI between January 2010 and February 2011 are included. MPV on admission is recorded. All patients underwent transthoracic echocardiography within 3 days or before discharge. Patients were divided into two groups according to left ventricular ejection fraction (LVEF), as systolic dysfunction (LVEF < 50%, 1st group) and normal systolic functions (LVEF > 50%, 2nd group). The 1st group included 61 (47 males) patients and the 2nd group included 36 (35 males) patients. RESULTS: MPV was; 9.5+/-1.1 femtoliter (fL) in the 1st and 8.8+/-0.8 fL in the second group. The difference between the groups was significant (p = 0.001). There was a significant difference in the Troponin I levels and white blood cell (WBC) counts on admission between two groups (30+/-29 vs 12.2+/-15.1 ng/mL, p = 0.001 and 12.3+/-3.8 vs 10.6+/-3.4 counts ×109/L, p = 0.027, respectively). CONCLUSIONS: In anterior STEMI patients treated with percutaneous coronary intervention, increased MPV on admission is associated with impairment in left ventricular systolic function.

Parallel implementation of the accelerated BEM approach for EMSI of the human brain.

Boundary element method (BEM) is one of the numerical methods which is commonly used to solve the forward problem (FP) of electro-magnetic source imaging with realistic head geometries. Application of BEM generates large systems of linear equations with dense matrices. Generation and solution of these matrix equations are time and memory consuming. This study presents a relatively cheap and effective solution for parallel implementation of the BEM to reduce the processing times to clinically acceptable values. This is achieved using a parallel cluster of personal computers on a local area network. We used eight workstations and implemented a parallel version of the accelerated BEM approach that distributes the computation and the BEM matrix efficiently to the processors. The performance of the solver is evaluated in terms of the CPU operations and memory usage for different number of processors. Once the transfer matrix is computed, for a 12,294 node mesh, a single FP solution takes 676 ms on a single processor and 72 ms on eight processors. It was observed that workstation clusters are cost effective tools for solving the complex BEM models in a clinically acceptable time.

Phenytoin-induced parkinsonism.

This report presents a 30-year-old man who developed subacute phenytoin-induced cerebellar ataxia and parkinsonism that resolved after discontinuation of the phenytoin treatment. Phenytoin was started for seizure prophylaxis in another health institution where he was referred for bilateral intracerebral orbitofrontal haemorrhage due to a head trauma. To our knowledge, there has been only one other case report describing phenytoin-induced parkinsonism, which was also reversible. The issue of the development of parkinsonism due to the phenytoin toxicity in the case of bilateral orbitofrontal lesion is addressed.