Is optical coherence tomography an effective device for evaluation of tear film meniscus in patients with acne rosacea?

PURPOSE: To investigate the tear meniscus using Fourier-domain optical coherence tomography (FD-OCT) in patients with acne rosacea and to determine the relationship between tear film break-up tests (TBUT), Schirmer test and FD-OCT values and to compare them with that of healthy controls. METHODS: One hundred and four patients with acne rosacea and 104 body mass index age-sex-matched healthy subjects were enrolled in this prospective case-control study. Tear meniscus height (TMH), tear meniscus depth (TMD), and tear meniscus cross-sectional area (TMA) were measured using FD-OCT (RTVue-100); TBUT, Schirmer test and dry eye questionnaire (OSDI) were evaluated. Correlation was assessed using Spearman's correlation coefficient. RESULTS: Mean TMH, TMD, TMA, TBUT, and Schirmer test values of acne rosacea patients were significantly lower than and OSDI score significantly higher than those of controls. Tear mensicus values were significantly correlated with OSDI scores, TBUT, and Schirmer test results. The intraobserver intraclass correlation coefficient (ICC) for tear parameters ranged from 0.90 to 0.96 and interobserver ICC ranged from 0.92 to 0.94, which revealed high reproducibility for all measurements parameters both acne rosacea and control subjects. Accuracy of dry eye diagnosis by FD-OCT was 60.4% for TMH, 58.7% for TMD, and 64.8% for TMA. CONCLUSION: Tear meniscus measurement with FD-OCT could provide acceptable specificity and sensitivity in diagnosis of dry eye in acne rosacea patients.

Entomological Survey for Sand Fly Fauna in Imamoglu Province (Cutaneous Leishmaniasis Endemic Region) of Adana, Turkey.

Leishmaniasis, presenting in two clinical forms, cutaneous and visceral in Turkey, is widespread in most of the countries in the Mediterranean Basin. An average of 10 to 13% of cases are reported from Adana every year. This paper presents the results of an entomological survey in an endemic focus of cutaneous leishmaniasis in Imamoglu province of Adana in Turkey.We collected 654 sand fly specimen using 100 light traps in 20 nights in August 2013 and July 2014. Several keys and previous drawings were used in the identification of the species. In total, six Phlebotomus species were identified; Phlebotomus tobbi (50.3%), Phlebotomus papatasi (34%), Phlebotomus perfiliewi (2.9%), Phlebotomus sergenti (0.4%), Phlebotomus neglectus/syriacus (0.8%), and Sergentomyia spp. (11.5%). In addition, the female/male rate was found to be 0.84.Collected sand flies (44 pools of 1-10 individuals) were analyzed microscopically, and no promastigotes were found in the midgut specimens. Using a genus specific real time-polymerase chain reaction (PCR) assay for simultaneous detection of Old Word Leishmania. We detected only 3 of the 44 pools with Leishmania by genus-specific real-time PCR assay.P. tobbi was found to be dominant species in spite of the differences in sand fly fauna composition. To the best of our knowledge, this is the first study for sand fly fauna including 15 villages where endemic focus of cutaneous leishmaniasis in Imamoglu, Adana Province, Turkey.

Lupus in a patient with cystinosis: is it drug induced?

A 9-year-old girl with a diagnosis of cystinosis since 2 years of age, on cysteamine therapy, presented with complaints of serositis and arthritis, and laboratory tests revealed high antinuclear antibody titers with hypocomplementemia. Kidney biopsy was not consistent with lupus nephritis. With prednisolone treatment her complaints resolved and creatinine level decreased, but on follow-up, serological features of systemic lupus erythematosus (SLE) continued. Six years after cessation of prednisolone, lupus features were reactivated, with positive antihistone antibodies and ANCA. Coincidence of cystinosis and SLE is very rare, and to the best of our knowledge this is the fourth case reported in the literature. Physicians should be aware that cystinosis patients may have some autoimmune manifestations with features of true or drug-induced lupus. In the light of this case, pathophysiology and treatment are discussed.

Evaluation of choroidal thickness using enhanced depth imaging by spectral-domain optical coherence tomography in patients with pseudoexfoliation syndrome.

PURPOSE: To investigate the choroidal thickness using optical coherence tomography in the eyes of patients with unilateral and bilateral pseudoexfoliation syndrome and to compare them with healthy controls. METHODS: We studied four groups: (1) affected eyes from 30 patients with unilateral PEX syndrome affecting the right eye of 17 patients and the left eye of 13 patients; (2) clinically unaffected eyes of 30 patients with unilateral PEX syndrome; (3) the eyes of 30 patients with bilateral PEX syndrome; and (4) the eyes of 30 normal healthy subjects. Choroidal thickness was evaluated using high-speed, high-resolution enhanced depth imaging by spectral-domain optical coherence tomography. Optical coherence tomography features were compared in all groups using the statistical package SPSS v 15.0. RESULTS: The mean subfoveal choroidal thicknesses were 237.35±58.01 µm in group 1; 330.75±47.84 µm in group 2; 206.3±86.75 µm in group 3; and 311.8±51.42 µm in group 4. Significant differences in the mean subfoveal choroidal thickness were found between groups 1 and 2 (P<0.001), groups 1 and 4 (P=0.004), groups 2 and 3 (P<0.001), and groups 3 and 4 (P<0.001). CONCLUSION: In this study, it was observed that clinically affected eyes of patients with PEX syndrome have significantly thinner choroids compared with the clinically unaffected eyes of patients with unilateral PEX syndrome and eyes of healthy controls.

Evaluation of choroidal thickness using spectral-domain optical coherence tomography in migraine patients during acute migraine attacks: a comparative study.

PURPOSE: The purpose of this study was to assess choroidal thickness in migraine patients during acute migraine attacks and compare them with healthy controls, using spectral domain optical coherence tomography (OCT). PATIENTS AND METHODS: In this prospective case-control study, choroidal thicknesses of 46 migraine patients during acute migraine attacks and 46 age- and sex-matched healthy subjects were measured using a high-speed, high-resolution frequency domain-OCT device. All patients underwent a complete ophthalmic examination before the measurements. OCT measurements were taken at the same time of day (0900 hours), in order to minimize the effects of diurnal variation. RESULTS: There was a statistically significant difference in mean choroidal thickness between the migraine patients during acute migraine attacks (356.3±21.46 µm) and the controls (302.3±18.34 µm; P=0.000). There were significant differences at all measurement points (P<0.001 for all). CONCLUSION: The increased choroidal thickness of the migraine patients during acute migraine attacks might be related to the vascular pathology of the disease. Further studies are needed to evaluate the etiopathologic relationship between choroidal thickness and acute migraine attack.

High estradiol levels and depth of anaesthesia.

Estradiol is a steroid-structured hormone that has a periodic rhythm in the menstrual cycle. We aimed to evaluate the interference of high estradiol levels and the depth of anaesthesia. The study was performed on 44 females undergoing gynaelocologic surgery. Blood samples were performed for estradiol level before the procedures. BIS scores were recorded at 5-min intervals after induction and during the operation. Cases were assigned to three groups: Group 1 (n: 17) estradiol levels at or under 100 microg/dl, Group 2 (n: 14) levels were between 100 and 200 microg/dl and Group 3 (n: 13) levels were above 200 microg/dl. Estradiol levels were found to be 59.94 +/- 23.59 microg/dl in Group 1, 138.60 +/- 23.49 microg/dl in Group 2 and 239.30 +/- 41.08 microg/dl in Group 3. Significant differences were found between initial control and 10 and 80 min BIS levels. Anaesthetic consumption showed a decreased tendency in high estradiol cases. We concluded that an advanced clinical series should be performed to fully define the relationship between estradiol levels and anaesthesia depth.

Optical coherence tomography evaluation of macular edema after intravitreal triamcinolone acetonide in patients with parafoveal telangiectasis.

PURPOSE: Parafoveal telangiectasis (PT) is a developmental or acquired microvascular abnormality of the macula. Leakage of the abnormal parafoveal capillaries leads to macular edema with subsequent decrease in visual acuity. Intravitreal triamcinolone acetonide is recently widely used in the management of intraocular proliferative, edematous, and neovascular diseases. METHODS: This report presents the evaluation of three cases with PT in whom intravitreal triamcinolone acetonide (IVTA) injection was performed. Fundus fluorescein angiography (FA) and optical coherence tomography (OCT) were used in follow-up of the patients. RESULTS: Following pars plana intravitreal injection of 4 mg of triamcinolone acetonide, the patients had angiographic improvement of the macular edema and minimal decrease in retinal thickness on OCT, accompanied by improvement in visual acuity and subjective visual assessment. CONCLUSIONS: The results of the present study on parafoveal capillary telangiectasis suggest that the intravitreal injection of triamcinolone acetonide may be a therapeutic option to increase visual acuity and decrease vascular leakage on FA. Following IVTA procedure, follow-up of these patients with both OCT and FA is important for correct clinical evaluation. Future studies on this method seem to be warranted.

Resuscitation with modified gelatin causes higher bacterial translocation in experimental sublethal hemorrhagic shock.

The effect of colloidal solutions on bacterial translocation was studied. Sublethal hemorrhagic shock was established by blood withdrawal until the mean arterial pressure fell to 40 mmHg within 15 min on 36 adult Wistar Albino rats. Resuscitation was performed using four different solutions with the same amount of blood. Group I (n = 9) 0.9% NaCl, Group II (n = 9) 10% dextran 40, Group III (n = 9) 6% hydroxyethyl starch, Group IV (n = 9) 4% modified fluid gelatin. Before resuscitation and after anesthesia blood samples were drawn to analyze pH, PCO2, PO2, SaO2, HCO3 and ABE values. Twenty-four hours after anesthesia laparotomy was performed to obtain tissue samples of the liver, spleen and mesenteric lymph nodes. Samples were cultured on EMB and blood agar media. Results were analyzed with the one-way ANOVA and Post-hoc test (Tukey's HSD). The translocated bacteria were mainly Eschericia coli and three grew in Group I, two in Group II, three in Group III and six in Group IV. Although there was a trend in difference in bacterial translocation rates among groups, statistical analyses revealed no difference among groups (p < 0.05). It can be concluded that resuscitation with modified gelatin causes higher bacterial translocation in an experimental sublethal hemorrhagic shock model.

Phyllodes tumor of the breast: case series of 40 patients.

Cystosarcoma phyllodes is a rare, uncommon fibroepithelial tumor of the breast. We analyzed the clinical situation in relation to the histopathologic findings. Forty types of surgery, recurrences, histopathologic diagnosis and follow-up of patients were studied retrospectively. Histopathologic examination results were evaluated by logistic regression analysis. Surgery was performed on all patients as the initial treatment. At the first examination 38 cases were evaluated as benign and the remaining two as malignant. Recurrent tumors were seen in nine (22.5%) cases during follow-up with a mean recurrence time of 30.1 months. Five of the recurrent cases were evaluated as malign. The total number of malignant cases reached seven (17.5%). In statistical analysis evidence of tumor necrosis, stromal atypism, stromal cellularity, number of mitoses and stromal overgrowth were found to be significantly correlated with malignancy (p < 0.05). Recurrences were also significantly correlated with stromal cellularity, stromal overgrowth, necrosis and malignancy (p < 0.05). Cystosarcoma phyllodes recur with a high incidence and may transform to malignant disease. The patients should be followed strictly in order to detect recurrence earlier.

The efficacy of intravenous versus epidural tramadol with patient-controlled analgesia (PCA) in gynecologic cancer pain.

We attempted to compare the analgesic effects of tramadol infusion intravenously and epidurally administered through a patient-controlled analgesia (PCA) method for postoperative analgesia following gynaecological cancer surgery. Forty patients undergoing elective cancer surgery, included in the American Society of Anesthesiologists (ASA) class II and III, were randomly placed into two groups. The patients in the intravenous (IVA) group were administered a 20 mg bolus of tramadol intravenously and the patients in the epideral analgesia (EA) group epidurally five minutes before induction. The PCA equipment was programmed to deliver 20 mg of tramadol as a bolus dose, with a lock-out time of 15 minutes, at a 10 mg/hour infusion rate in both groups. A visual analogue scale (VAS) and patient satisfaction as well as haemodynamic and respiratory parameters were determined at given times postoperatively. Total tramadol consumption at 24 hours and side-effects were recorded. There was no difference between groups based on haemodynamic and respiratory parameters whereas there was a significant difference based on tramadol consumption, VAS and side-effects of tramadol and patient satisfaction between groups. VAS values of patients, 6.85 +/- 1.34 and 3.00 +/- 1.58, respectively, for the IVA group (group 1) and the EA group (group 2) were found to be significantly different. Postoperative patient satisfaction was higher was in group 2 than in group 1 (3.45 and 2.7, respectively). In conclusion, epidural administration of tramadol through the PCA method following gynecologic cancer surgery was found to be a more effective analgesia in lower doses when compared to the intravenous administration.

The effect of lidocaine/prilocaine cream on an experimental wound healing model.

The effects of lidocaine/prilocaine cream on wound healing were evaluated in this study. An incisional wound model on abdominal wall was performed on mice. A full thickness skin incision 2 cm in length was performed then it was sutured primarily with 4/0 polypropylene. In group I (n = 10) only suturing was done (control group), in group II (n = 10) lidocaine cream was applied after suturing on wound site and it was repeated for 6 days (twice in a day), in group III (n = 10) lidocaine/prilocaine cream was applied topically after suturing and repeated 6 days (twice in a day). At day 7, incisions were excised for evaluating tensile strength and 5-hydroxyproline (5-HP) values. Tensile strength values were lowest in control group and highest in lidocaine/prilocaine treatment group. 5-HP values were also expressed the same results. Both tensile strength and 5-HP values increased significantly in treatment groups in regard to the control (p < 0.05). It was concluded that lidocaine/prilocaine cream as topical anaesthetic agent had no adverse effect in an incisional wound model, furthermore it may have some beneficial effects on wound healing which remains to be evaluated and it can be used safely in day-to-day emergency practices.