NEOVASCULAR SECONDARY GLAUCOMA, ETIOLOGY AND PATHOGENESIS.

RATIONALE: Neovascular secondary glaucoma is a condition characterized by increased intraocular pressure due to the neovascularization occurring at the iridocorneal angle and iris, the most common complication of end-stage ischemic retina. The early diagnosis and treatment of this disease are important, because the functional prognosis is reserved. OBJECTIVE: Knowing and understanding the etiology and pathogenesis of neovascular secondary glaucoma. METHODS AND RESULTS: Review of the angiogenesis theory to understand the etiology and pathogenesis of neovascular secondary glaucoma. VEGF is the most studied proangiogenic factor involved in the neovascular glaucoma pathogenesis. The 9 isoforms contain consensus signal sequences for extracellular secretion, all of them binding to a specific receptor subtype and stimulating tissue specific angiogenesis. VEGF and VEGF-m RNA levels are significantly increased in the ischemic retina. Diabetes mellitus (with diabetic retinopathy), central retinal vein thrombosis and repeated retinal detachments are diseases that cause neovascular glaucoma through ischemia. DISCUSSION: Correct evaluation of the iris neovascularization followed by a proper treatment is the most important in a case of secondary neovascular glaucoma. Repeated gonioscopy is indicated in cases with high risk of developing neovascular glaucoma. Close monitoring of a patient with high thromboembolic risk: valvular heart disease, open-heart surgery, other angioplasties.

Refractory secondary glaucoma-clinical case.

RATIONALE AND OBJECTIVE: The major objective of treatment in glaucomatous disease is the decrease of intraocular pressure while maintaining the patient's vision and quality of life. Despite therapeutic possibilities, some cases of glaucoma remain refractory to treatment with the maintenance of elevated intraocular pressure and further progression of the disease.Artificial drainage systems, Ahmed valve, is a treatment alternative for refractory glaucoma when medical therapy, laser or conventional surgery have shown no results. METHODS AND RESULTS: We present the case of a patient presenting with refractive to medical treatment secondary glaucoma, following cataract surgery and vitrectomy for retinal detachment. DISCUSSIONS: One of the complications of vitreoretinal surgery is secondary glaucoma. Some of the patients with this type of glaucoma are unresponsive to conventional medical therapy. In such situations, a DPS implantation is needed such as an Ahmed valve in our case. There are situations in which classical surgery-trabeculectomy--has no theoretical chance of success (in cases of neovascular glaucoma, secondary glaucoma, and inflammatory glaucoma post vitreoretinal surgery), [5,6]. Even though ASD are only used for refractory glaucoma, in this type of glaucoma, ADS can be used successfully as first line surgery.

Cortisol and immune measures in boars exposed to three-day administration of exogenous adrenocorticotropic hormone.

The aim of the study was to evaluate the effect of adrenal stimulation by adrenocorticotropic hormone (ACTH) on blood cortisol concentration and on circulating total and differential leukocyte counts during and in the 16 days after ACTH administration. Swedish Landrace boars aged approximately 6-7 months were used. ACTH-treated animals (n = 7) were given ACTH intravenously at 10 microg/kg body mass for 3 days. A control group of animals (n = 7) received 1 ml of sterile 0.9% saline intramuscularly. ACTH induced a highly significant increase (p>0.0001) in serum cortisol in treated boars. On the day after the last ACTH dose, the cortisol concentration was significantly higher, but the level of significance was lower than during ACTH administration (p>0.05). During ACTH treatment, a significant increase was recorded in total leukocyte count and neutrophil percentage (p>0.05 to p>0.0001), along with the increase in blood cortisol concentration, whereas percentage lymphocyte count showed a significant decrease. Lymphopenia disappeared upon cessation of treatment, but neutropenia developed in the week after treatment. On all three days of ACTH challenge, the neutrophil-to-lymphocyte ratio was significantly increased. An increase in eosinophil percentage was recorded on treatment days 1 and 2, whereas ACTH treatment had no effect on basophil percentage. In conclusion, three-day administration of ACTH to young boars during restraint caused effects similar to acute stress situations, as suggested by disappearance of the effects on immune function after the last drug dosage.

Distribution of airborne bacteria in swine housing facilities and their immediate environment.

This paper describes a bacteriological analysis of air samples taken from swine housing facilities and the immediate environment. The air volume of the samples was pre-programmed by a standard air sampler (MAS-100, Merck) and was directly impacted onto the bacteriologic agar surface (Petri dishes, standard diameter of 90 mm). The bacterial contamination in forty-eight samples was 2.59 x 10(5) CFU/m3 (ranging from 8.46 x 10(4) to 5.30 x 10(5) CFU/m3). Potentially pathogenic bacterial agents predominated in all samples (100%), while primarily pathogenic bacteria were isolated in a minor proportion of samples (33%-66%). Airborne bacterial contamination in samples (N = 16) obtained from emptied facilities ranged from 1.8 x 10(3) CFU/m3 (that is, after coarse mechanical washing) to 0.8 x 10(2) CFU/m3 (upon completion of disinfection). Control measurements at different locations and distance from the farm (N = 32) pointed to the presence of non-pathogenic airborne bacteria, ranging from 1.55 x 10(2) to 3.70 x 10(2) CFU/m3. The results of this preliminary study showed that the emission of potentially pathogenic bacteria from animal housing facilities to the immediate farm environment via aerosol was very low.

Ventricular performance following valve replacement for chronic mitral regurgitation: importance of chordal preservation.

OBJECTIVE: To assess immediate and late changes in left ventricular performance after mitral valve replacement (MVR) for mitral regurgitation with or without preservation of chordae tendineae. EXPERIMENTAL DESIGN: a prospective, one year follow-up, study. SETTING: university cardiosurgical hospital. PATIENTS: Fourteen patients with symptomatic chronic mitral regurgitation were divided into Group A (n = 7), which underwent MVR with chordal preservation, and Group B (n = 7) which underwent MVR with chordal transection. METHODS: Transesophageal echocardiography, obtained simultaneously with radial artery and pulmonary capillary wedge pressures over a range of loading conditions, was used to estimate left ventricular elastance (Eps), calculated as the slope of peak systolic pressure/end-systolic volume relation, and preload recruitable stroke work (PRSW). Measurements were taken intraoperatively before and after cardiopulmonary bypass, 6 hours later and 10 days later. Transthoracic echocardiography follow-up data were obtained after 3 months and one year. RESULTS: Eps significantly decreased immediately after MVR (p = 0.018), with no difference among 2 groups. Eps gradually increased to preoperative levels 10 days after surgery. PRSW also significantly decreased after MVR (p = 0.01). The decrease was significantly larger in Group B (p = 0.038). During follow-up, Group A showed a significantly better ejection fraction (p = 0.008), and a smaller end-systolic volume index (p = 0.01) and left ventricular mass index (p = 0.04), than Group B. CONCLUSIONS: These data support the hypothesis that chordal preservation during MVR has beneficial effects on left ventricular performance.

Chordal preservation improves postoperative ventricular performance following valve replacement for chronic mitral regurgitation.

Worsening of left ventricular performance had been recognized after mitral valve replacement for mitral regurgitation. The effects of chordal preservation on ventricular performance after mitral valve replacement have been assessed. Twelve patients with mitral regurgitation were allocated to group A (undergoing mitral valve replacement with chordal preservation), or to group B (undergoing mitral valve replacement with chordal excision). Transoesophageal echocardiography was recorded simultaneously with radial artery and pulmonary capillary wedge pressures. Load was varied by withdrawal of blood from a venous line of cardiopulmonary bypass and/or nitroglycerine bolus. Ventricular performance was assessed by the slope of peak systolic pressure-end-systolic volume relation (Eps), and by the slope of the left ventricular stroke work-end-diastolic volume relationship. Eps significantly decreased immediately after mitral valve replacement (P < 0.02), with no difference among two groups. Eps gradually increased to preoperative levels 10 days after surgery. Pre-load recruitable stroke work also significantly decreased after mitral valve replacement (P = 0.01). The decrease was significantly larger in group B (P < 0.04). These data support the hypothesis that chordal preservation during mitral valve replacement has beneficial effects on left ventricular performance.

[Perioperative myocardial failure and mechanical cardiac support --a five year experience]. / Perioperaciona slabost srca i mehanicka potpora radu srca--petogodnisnje iskustvo.

Inability to wean a patient from the cardiopulmonary bypass after open heart procedure is reality of the clinical practice. The only realistic chance for these patients is some form of mechanical circulatory support. Over the period from November 1988 to November 1993, in 17 patients the roller-pump mechanical assist device was inserted, i.e. 0.47% of 3589 patients were operated on during this period. Thirteen patients required mechanical circulatory support immediately after surgical procedure due to inability to wean them from cardiopulmonary bypass. In three patients the roller-pump was inserted preoperatively (percutaneous insertion), and in one patient mechanical circulatory support was started six hours after the procedure for sudden cardiac deterioration. Partial and temporary "bypass" of the damaged left ventricular function is achieved by insertion of inflow cannula into the left atrium, and outflow cannula into the ascending aorta. Depending on the inflow cannula size and volume load, we were able to achieve blood flow of 3.5 to 5 liters/minute. Using this system we were able to improve the left ventricular function in eight patients (47%), and five patients were discharged from hospital (29.4%). The roller-pump mechanical circulatory support proved to be efficient, reliable, easy to monitor and operate. Overall results are comparable to the published data as well as to other types of more versatile and costly devices for mechanical circulatory support.

[Continuous and pulsed Doppler in the examination of arterial circulation in the extremities]. / Kontinuirani i pulsni Doppler u ispitivanju arterijske cirkulacije ekstremiteta.

The authors present their experience in the investigation of arterial circulation by continuous and pulsed Doppler. The results obtained by Doppler's method were correlated with other noninvesive methods and arteriography. Arteriographic findings were scored by Bollinger method. A statistically significant difference of the flow and systolic pressure values was found between angiographically normal subjects and those with single and multiple lesions. The authors conclude that ankle flow and systolic index measurements, obtained by Doppler technique, are influenced by the degree, extensiveness and localisation of arteriosclerotic lesions on the lower limb arteries. The method was successfully applied in the control of the effects of medicamentous and surgical therapy.