Endoscopic approach for orbital apex lesions: case series and review of the literature.

OBJECTIVE: The transnasal endoscopic approach may provide better visualisation and a safer approach to the orbital apex. This study presents a case series of orbital apex lesions managed by this approach. METHOD: This study was an eight-year retrospective analysis of seven patients who were operated on for orbital apex lesions in two tertiary medical centres. RESULTS: Complete tumour removal was performed in three patients and partial removal was performed in four patients. Visual acuity improved in three patients, remained stable in one patient and decreased in the other two patients. The visual field improved in four patients and did not change in two patients. Complications included worse vision and visual fields in 28.6 per cent of patients and late enophthalmos (of -1.25 ± 4.6 mm) in 2 patients. CONCLUSION: The transnasal approach to orbital apex lesions in selected cases may provide a rational alternative to transorbital surgery. Complete tumour removal should be weighed against the risk of damage to the optic nerve.

The significance of hypertensive response to exercise as a predictor of hypertension and cardiovascular disease.

Several studies have shown that exaggerated blood pressure (BP) response to exercise can predict the development of hypertension and target organ damage, but others did not. The aim of this study was to evaluate the relationship between exaggerated BP response to exercise (ExBPR) and the development of hypertension or cardiovascular disease. We reviewed the charts of male subjects who, during the years 1991-1994, had a routine check up that included an exercise stress-test. For each subject, the following parameters were noted: age; body mass index (BMI); history of diabetes; cigarette smoking; family history of ischaemic heart disease and lipid profile. BP and heart rate at rest and during exercise were recorded as well. ExBPR was defined whenever peak exercise systolic BP or diastolic BP was over 200 mm Hg or 100 mm Hg respectively. We identified 73 males who exhibited ExBPR and matched them with a control group of 117 subjects with similar age who had a normal BP response. The mean age of the studied group was 42.6 years and the average follow-up was 5.7 years. Baseline characteristics were similar in both groups. During the follow-up we observed hypertension among 22% in those with ExBPR in contrast to 2.6% in the control group (P < 0.0001). In addition, more subjects of the ExBPR group required cardiovascular medications than of those in the control group (19.2% vs 4.3%, P = 0.0008). Thus, it seems that ExBPR predicts the development of hypertension and cardiovascular diseases. We therefore suggest that subjects with ExBPR should be followed more closely and be instructed for lifestyle modifications which may delay the development of such diseases.

Reproducibility of exaggerated blood pressure response to exercise in healthy patients.

BACKGROUND: An exaggerated blood pressure response (ExBPR) to exercise has been shown to be predictive of future hypertension and left ventricular hypertrophy. The aim of this study was to test the reproducibility over time of ExBPR and to better characterize patients who consistently respond in this manner. METHODS: During periodical health examination, patients underwent routine treadmill exercise testing. ExBPR was said to be present if systolic blood pressure and/or diastolic blood pressure at peak exercise exceeded 200 mm Hg and 100 mm Hg, respectively. Over the past 25 years, 117 healthy patients with ExBPR performed 2 to 7 consecutive treadmill exercise tests. According to subsequent ExBPR, these patients were divided into a concordant group-those who had at least two-thirds repetitions of the ExBPR-and a discordant group-those who had less than two-thirds repetitions. For comparison, we identified patients who did not have ExBPR (control group). RESULTS: Of the 117 patients who had ExBPR, only 18 (15.4%) were in the concordant group in subsequent tests. No clinical features were found to characterize patients in the concordant group. In the two study groups, the variability of blood pressure measurements during stress was significantly greater than in the control group. Also, systolic blood pressure measurements at rest and after 3 minutes of recovery were significantly lower in the control group. CONCLUSIONS: ExBPR to exercise is rarely reproducible, and there are no clinical findings characterizing those who consistently respond in this manner. Thus the prognostic importance of blood pressure response to exercise should be reconsidered.