Retinal nerve fibre layer measurements are reduced in patients with obstructive sleep apnoea syndrome.

PURPOSE: To determine the retinal nerve fibre layer (RNFL) thickness in patients with obstructive sleep apnoea syndrome (OSAS) in order to investigate the possibility of detecting early signs of glaucoma in this population. METHODS: A total of 66 consecutive patients admitted for polysomnographic evaluation of suspected OSAS. Patients underwent an overnight sleep study in an effort to diagnose and determine the severity of OSAS. Patients who had the disease were classified as having mild and severe OSAS, while patients who did not have the disease were classified as controls. All patients received physical, neurological, and ophthalmological evaluation including visual acuity, slit-lamp examination, Goldmann applanation tonometry, gonioscopy with a three mirror contact lens, and fundus examination. After these examinations, patients with glaucoma and patients who had ophthalmological and/or systemic disease known to affect RNFL thickness were excluded from the study. The RNFL thickness was assessed with a scanning laser polarimeter (Nerve Fiber Analyzer GDx, Laser Diagnostic Technologies Inc., San Diego, CA, USA). RESULTS: A total of 34 patients with obstructive sleep apnoea (19 mild, 15 severe) and 20 age-matched controls were included in the study. The thickness of RNFL was reduced in patients with OSAS compared to controls. The decrease in RNFL was found to be correlated with the severity of sleep apnoea (r=0.78, P=0.01). CONCLUSIONS: The sleep apnoea syndrome is correlated with a proportional decrease in the RNFL. Decreased ocular perfusion related to hypoxia and vasospasm associated with OSAS may cause RNFL thinning, which may precede clinically detectable glaucoma.

Localized benign pleural mesothelioma: a case report.

Primary neoplasms of the pleura are rare tumors and the majority are generally mesotheliomas. Mesotheliomas are either localized and mostly benign, or diffuse and uniformly malignant neoplasms. Localised benign pulmonary mesothelioma (solitary fibrous tumor of the pleura) are originally thought to be a variant of diffuse pleural mesothelioma because they consists of a spindle cell stroma associated with branching tubular structures lined by cuboidal cells. Our case which is reported below shows the clinical spectrum of the more common benign variant. Clinical differential diagnosis of benign and malign mesotheliomas is not clear. Complete surgical resection is the preferred treatment for both types and usually curative with the benign mesothelioma. The localised pleural variant is benign in most cases, and it is even less common, constituting only 10% of all mesotheliomas [1]. The importance of localised benign mesothelioma is that it is almost impossible to differentiate from a malignant neoplasm preoperatively and it may occasionally recur, sometimes with a malignant change.

Common variable immunodeficiency in an adult with recurrent pneumonia.

Primary immunodeficiency syndromes are rarely diagnosed among adults. Common variable immunodeficiency (CVID) is a congenital immunological disorder characterized by defective antibody production. In this report, we describe a 35-year-old male suffering from a common variable immunodeficiency, referred to us because of a lobar pneumonia. He had a history of recurrent pulmonary infections, which was present months before presentation, suggesting hypogammaglobulinemia. We found a severe hypogammaglobulinemia, which confirmed the diagnosis of CVID. His immunoglobulin profiles upon admission before infusion of immunoglobulin (normal ranges) were: IgG < 1.41 (8-17) g/l, IgA 0.25 (0.85-4.9) g/l, IgM 0.182 (0.5-3.7) g/l, and IgE < 2 (< 120) IU/ml. His HLA profiles were HLA A2 A26, B18 B38, Cw7, DR11 and DQ7 DQ9. He was treated with intravenous immunoglobulin. After this regimen, his IgG was maintained at > 6.0 g/L. On follow up, he has been free of opportunistic infections. In conclusion, CVID should be considered in the differential diagnosis of recurrent pneumonia in adults.

Prevalence of byssinosis and respiratory symptoms among cotton mill workers.

BACKGROUND: While the prevalence of byssinosis is decreasing in industrialized countries and persists at high levels in developing countries, this prevalence is remaining constant in Turkey. OBJECTIVE: In order to determine the effects of past cotton dust exposure on the respiratory tract, a total of 223 persons working in a cotton mill were included in this study. METHODS: A questionnaire was used to inquire about respiratory symptoms. Participants underwent several spirometric measurements, which were performed on the 1st, 3rd and 5th day of the working week. Cotton dust measurements were performed in different divisions of the factory. RESULTS: The most common respiratory symptom was chest tightness (20.3%). The prevalence of byssinosis was 14.2% in cotton-processing workers. Among these cases, 28.6% had symptoms on the 1st day of the week, and 71.4% had symptoms on all days of the week. An acute effect was seen in 53.6% of the workers with byssinosis. Mean respirable dust levels were between 0.095 and 0.413 mg/m(3). CONCLUSIONS: In spite of technological improvements, respirable dust concentrations are still above the permissible limits, and thus the risk of byssinosis remains. Workers in the cotton industry where obsolete technology is used and standardized protection measures are not applied should be followed for byssinosis.

Ultrafast computed tomography techniques in cardiac disease.

Ultrafast computed tomography (UFCT) with scan times in milliseconds has matured as an important diagnostic instrument since it was first introduced. Dynamic scanning can be performed virtually anywhere and the short scan times give cross-sectional images free of artifacts. These factors allow one to obtain CT studies in many different heart disorders, even in the postoperative period while the patient is on cardiopulmonary assist devices. The evaluation of coronary artery bypass graft patency remains an important use of the modality.

Pseudoaneurysm and arteriovenous fistula after femoral artery catheterization: association with low femoral punctures.

We determined the location of arterial injury in 11 patients who had pseudoaneurysms with (six cases) or without (five cases) arteriovenous fistula as a complication of cardiac catheterization. Medical records and arteriograms were examined retrospectively. Ten of the 11 pseudoaneurysms identified were located below the level of the femoral head. Five of six patients with arteriovenous fistula had simultaneous catheterization of both the femoral artery and the femoral vein. Although we did not determine the location of arterial puncture used in uncomplicated angiograms during the 5-year study period, our experience in 11 patients with pseudoaneurysms with or without arteriovenous fistula suggests that there is an association between a puncture site below the level of the femoral head and arterial injury. In addition, arteriovenous fistulas appear to be associated with simultaneous catheterization of the femoral artery and adjacent femoral vein.

Clinical experience with rapid acquisition cardiovascular CT imaging (cine CT) in the adult patient.

In this overview of cine-CT technology and its clinical application, the authors discuss the unique features of the imaging unit and describe the scanning programs and projections available for cardiac studies. Application of the unit to physiologic studies (e.g., cardiac output and ejection fractions) are illustrated, and examples of the value of the unit for the diagnosis of septal defects, aortic dissection, valvular regurgitation, prosthetic value malfunction and coronary artery bypass graft occlusion are presented.

Cardiovascular computed tomography (cine CT) of abnormal left ventricular wall motion due to epicardial pacing electrodes.

A patient with an abnormal cardiac silhouette on chest X-ray was studied by fast cardiovascular computed tomography (cine CT). The location of epicardial pacing electrodes and their relationship to myocardial wall motion abnormalities were examined. This eliminated the need for cardiac catheterization.

The functional and anatomic evaluation of the cardiovascular system with rapid-acquisition computed tomography (cine CT).

Cine CT combines the advantages of digital cross-sectional imaging with those of angiography. It provides vivid portrayal of complex anatomic relationships as well as important functional data not easily obtainable elsewhere, including quantitation of myocardial wall thickening and regional myocardial blood flow. The blood flow in major vessels following coronary artery bypass graft surgery and cardiac output have been quantified with accuracy. The future of cine CT will depend ultimately on controlled studies comparing this technique with other modalities, including echocardiography, magnetic resonance imaging, radionuclide angiocardiography, and contrast-enhanced catheter angiography.