ABSTRACT
Objetivo: Determinar si el tratamiento inicial de inyección intravítrea de triamcinolona (TA) asociada a la fotocoagulación con láser en rejilla (FLR) es más efectivo que el tratamiento láser aislado en el edema macular diabético (EMD) quístico.MétodosEstudio clínico prospectivo no aleatorizado. Catorce ojos (14 pacientes) con diagnóstico de EMD quístico fueron tratados con FLR, según el protocolo del Estudio de Tratamiento Precoz de la Retinopatía Diabética (ETDRS), asociando una inyección de 4 mg de TA. Se seleccionó de forma retrospectiva un grupo control (16 ojos [16 pacientes]) tratado únicamente con FLR. Las principales medidas a analizar fueron los cambios en la agudeza visual (AV) y en el grosor del edema macular medido por tomografía de coherencia óptica (OCT).ResultadosEn el grupo tratado, la media de seguimiento fue de 14,9 meses (rango 12 a 19). La AV en tres ojos (21,4%) se incrementó > 2 líneas ETDRS, en cinco ojos (35,7%) permaneció sin cambios y en 6 ojos (42,8%) disminuyó > 2 líneas ETDRS. El grosor macular central disminuyó de media 106,2 μm (30,2%). No hubo diferencias estadísticamente significativas con el grupo control, en los cambios de la AV ni en la disminución del espesor macular (p = 0,2). En 4 ojos (28,5%) hubo incremento patológico de la presión intraocular.ConclusionesAunque todos nuestros pacientes mejoraron anatómicamente el EMD quístico en relación con los parámetros de OCT y angiografía fluoresceínica, el 42,8% perdieron dos o más líneas de AV con el tratamiento asociado de inyección intravítrea de TA y FLR. Añadir la inyección intravítrea de TA a la FLR no resultó efectiva a los 12 meses de seguimiento para el manejo del EMD quístico (AU)
Background: To determine if primary intravitreal injection of triamcinolone acetonide (TA)plus grid laser photocoagulation (GLP) is effective in treating cystoid diabetic macular edema(DME).Methods: Prospective comparative non-randomized clinical trial. Fourteen eyes (14 patients) diagnosed with cystoid DME were treated with GLP according to the Early Treatment Diabetic Retinopathy Study (ETDRS) guidelines, plus an intravitreal injection of 4 mg of TA. A matched control group (16 eyes [16 patients]) treated with GLP was selected retrospectively from ou rmedical records. Best-corrected visual acuity (BCVA), and quantitative change in optical coherence tomography (OCT) macular thickness were assessed. Results: Mean follow up was 14.9 months (12 to 19 months). In 3 (21.4%) eyes BCVA increased> 2 ETDRS lines, in 5 (35.7%) eyes BCVA remained the same, and BCVA decreased >2 ETDRS lines in 6 (42.8%) eyes. Central macular thickness, as measured by OCT, decreased a meanof 106.2 m (30.2%). The difference with the control group was not statistically significant (P=0.2). Four (28.5%) eyes developed an increased in intraocular pressure in our study group.Conclusions: Although all of our patients showed an improvement of cystoid DME by means of OCT and fluorescein angiography, 42.8% (6 eyes) lost 2 or more lines in BCVA with primary intravitreal injection of TA plus GLP. Primary intravitreal injection of TA plus GLP may not be effective for cystoid DME at 12-months (AU)
Subject(s)
Humans , Triamcinolone/therapeutic use , Macular Edema/drug therapy , Diabetic Retinopathy/drug therapy , Intravitreal Injections , Light Coagulation , Prospective StudiesABSTRACT
BACKGROUND: To determine if primary intravitreal injection of triamcinolone acetonide (TA) plus grid laser photocoagulation (GLP) is effective in treating cystoid diabetic macular edema (DME). METHODS: Prospective comparative non-randomized clinical trial. Fourteen eyes (14 patients) diagnosed with cystoid DME were treated with GLP according to the Early Treatment Diabetic Retinopathy Study (ETDRS) guidelines, plus an intravitreal injection of 4 mg of TA. A matched control group (16 eyes [16 patients]) treated with GLP was selected retrospectively from our medical records. Best-corrected visual acuity (BCVA), and quantitative change in optical coherence tomography (OCT) macular thickness were assessed. RESULTS: Mean follow up was 14.9 months (12 to 19 months). In 3 (21.4%) eyes BCVA increased > 2 ETDRS lines, in 5 (35.7%) eyes BCVA remained the same, and BCVA decreased >2 ETDRS lines in 6 (42.8%) eyes. Central macular thickness, as measured by OCT, decreased a mean of 106.2 µm (30.2%). The difference with the control group was not statistically significant (P = .2). Four (28.5%) eyes developed an increased in intraocular pressure in our study group. CONCLUSIONS: Although all of our patients showed an improvement of cystoid DME by means of OCT and fluorescein angiography, 42.8% (6 eyes) lost 2 or more lines in BCVA with primary intravitreal injection of TA plus GLP. Primary intravitreal injection of TA plus GLP may not be effective for cystoid DME at 12-months.
Subject(s)
Diabetic Retinopathy/therapy , Laser Coagulation , Macular Edema/therapy , Triamcinolone Acetonide/therapeutic use , Aged , Combined Modality Therapy , Diabetic Retinopathy/drug therapy , Diabetic Retinopathy/surgery , Humans , Intravitreal Injections , Laser Coagulation/adverse effects , Macular Edema/drug therapy , Macular Edema/surgery , Middle Aged , Ocular Hypertension/chemically induced , Pilot Projects , Prospective Studies , Treatment Outcome , Triamcinolone Acetonide/administration & dosage , Triamcinolone Acetonide/adverse effects , Visual AcuityABSTRACT
AIMS: To study the effects of intravitreal bevacizumab (Avastin) on retinal neovascularization (RN) in patients with proliferative diabetic retinopathy (PDR). METHODS: Retrospective study of patients with RN due to PDR who were treated with at least one intravitreal injection of 1.25 or 2.5 mg of bevacizumab. Patients underwent ETDRS best-corrected visual acuity (BCVA) testing, ophthalmoscopic examination, optical coherence tomography (OCT), and fluorescein angiography (FA) at baseline and follow-up visits. RESULTS: Forty-four eyes of 33 patients with PDR and a mean age of 57.2-years (range: 23-82 years) participated in the study. Thirty-three eyes (75%) had previous panretinal photocoagulation (PRP). Twenty-seven eyes (61.4%) showed total regression of RN on fundus examination with absence of fluorescein leakage, 15 eyes (34.1%) demonstrated partial regression of RN on fundus examination and FA. Follow-up had a mean of 28.4 weeks (range from 24 to 40 weeks). BCVA and OCT demonstrated improvement (P<0.0001). Three eyes without previous PRP ('naive' eyes) and with vitreous haemorrhage have avoided vitreo-retinal surgery. One eye (2.2%) had PDR progression to tractional retinal detachment requiring vitrectomy, and one eye (2.2%) had vitreous haemorrhage with increased intraocular pressure (ghost cell glaucoma). No systemic adverse events were observed. CONCLUSIONS: Intravitreal bevacizumab resulted in marked regression of RN in patients with PDR and previous PRP, and rapid resolution of vitreous haemorrhage in three naive eyes. Six-months results of intravitreal bevacizumab at doses of 1.25 or 2.5 mg in patients with PDR do not reveal any safety concerns.
Subject(s)
Angiogenesis Inhibitors/administration & dosage , Antibodies, Monoclonal/administration & dosage , Diabetic Retinopathy/drug therapy , Retinal Neovascularization/drug therapy , Adult , Aged , Aged, 80 and over , Antibodies, Monoclonal, Humanized , Bevacizumab , Female , Fluorescein Angiography , Humans , Injections, Intralesional , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
OBJECTIVE: To report 10 instances of decompression retinopathy (DCR) developing after intraocular surgery. METHODS: This was a case series of 9 patients (10 eyes). Decompression retinopathy occurred after trabeculectomy (4 eyes), phacomulsification (3 eyes), Ahmed valve placement (1 eye), silicone oil removal (1 eye) and vitrectomy (1 eye). Fundus evaluation and fluorescein angiography were performed in all instances. RESULTS: Superficial, subhyaloidal, and deep retinal hemorrhages were noted in the posterior pole and peripheral retina; some of these had a white center. Nine (90%) of 10 eyes had a previous diagnosis of glaucoma, 6 having primary open-angle glaucoma, 2 neovascular glaucoma and 1 secondary glaucoma associated with intravitreal silicone oil. The patient without glaucoma had a history of cataract surgery and a vitrectomy to close a macular hole. The mean preoperative intraocular pressure (IOP) was 36.6 mm Hg (range: 15 to 58 mm Hg) despite maximal medical therapy in those patients with glaucoma. Fluorescein angiography demonstrated hypofluorescence throughout the study associated with superficial, and deep retinal hemorrhages. On the first post-operative day, visual acuity (VA) decreased more than 2 ETDRS lines in all cases. A pars plana vitrectomy (PPV) was performed in 5 eyes. All patients improved more than 2 ETDRS lines at a mean of 9 months after DCR. CONCLUSIONS: A gradual decrease of IOP pre-operatively and intra-operatively is recommended in order to avoid this complication. Early vitrectomy represents a useful treatment in many cases. A previous history of glaucoma seems to be an important risk factor for the development of DCR.
Subject(s)
Intraocular Pressure , Ophthalmologic Surgical Procedures/adverse effects , Retinal Diseases/etiology , Adult , Aged , Aged, 80 and over , Female , Humans , MaleABSTRACT
INTRODUCTION: Up to 5% of the population suffers from neuropathic pain (NP). A bibliographical search in several databases revealed that, to date, there are no protocols to guide physicians who are not specialists in pain that enable them to treat NP and thus improve patients' quality of life. AIMS: The aim of this study is to provide Spanish-speaking physicians who are not specialists in pain with a set of guidelines for the treatment of NP. A bibliographical search was performed in order to base the results and conclusions on the evidence-based medicine methodology. DEVELOPMENT: First, we review the most effective clinical and paraclinical methods for diagnosing NP, and the LANSS pain scale is reported as the most appropriate method of clinically evaluating NP. The anatomical paths and the physiology of pain are then described and we review the molecular variables involved. Finally, we point out the current therapeutic options and propose an algorithm for the treatment of NP. CONCLUSIONS: There is no specific set of guidelines for the treatment of NP. At the present time, the keystone of NP treatment consists in the use of antidepressant and anticonvulsive drugs. There is a need for further clinical trials to prove the effectiveness of using combined medication.
Subject(s)
Nervous System Diseases , Pain , Decision Trees , Humans , Nervous System Diseases/diagnosis , Nervous System Diseases/drug therapy , Nervous System Diseases/etiology , Nervous System Diseases/physiopathology , Pain/diagnosis , Pain/drug therapy , Pain/etiology , Pain/physiopathology , Practice Guidelines as TopicABSTRACT
AIMS: The aim of this study is to develop a set of guidelines for the clinical management of neuropathic pain (NP), a disorder suffered by up to 5% of the population, specifically for use by the Spanish-speaking community, in order to improve the quality of medical care and to standardise the treatments offered in medical centres. DEVELOPMENT: The paper describes the methodology used to search for guidelines concerning the clinical management of NP in databases, written communications and other resources, and the results of this search are presented. The research group is split into three groups: anatomical-physiological, diagnosis and therapeutic approach, each of which defines the nature of the papers that used to design the protocol.
Subject(s)
Pain Management , Practice Guidelines as Topic , Adult , Databases, Bibliographic , Humans , Medical Informatics/standards , Practice Guidelines as Topic/standards , Quality Assurance, Health CareABSTRACT
A DNA-binding domain (DBD) was identified on simian virus 40 (SV40) major capsid protein Vp1, and the domain's function in the SV40 life cycle was examined. The DBD was mapped by assaying various recombinant Vp1 proteins for DNA binding in vitro. The carboxy-terminal 58-residue truncated Vp1DeltaC58 pentamer bound DNA with a K(d) of 1.8 x 10(-9) M in terms of the protein pentamer, while full-length Vp1 and carboxy-terminal-17-truncated Vp1DeltaC17 had comparable apparent K(d)s of 5.3 x 10(-9) to 7.3 x 10(-9) M in terms of the protein monomers. Previously identified on Vp1 was a nuclear localization signal (NLS) consisting of two N-terminal basic clusters, NLS1 (4-KRK-6) and NLS2 (15-KKPK-18). Vp1DeltaC58 pentamers harboring multiple-point mutations in NLS1 (NLSm1), NLS2 (NLSm2), or both basic clusters (NLSm1. 2) had progressively decreased DNA-binding activity, down to 0.7% of the Vp1DeltaC58 level for NLSm1. 2 Vp1. These data, along with those of N-terminally truncated proteins, placed the DBD in overlap with the bipartite NLS. The role of the Vp1 DBD during infection was investigated by taking advantage of NLS phenotypic complementation (N. Ishii, A. Nakanishi, M. Yamada, M. H. Macalalad, and H. Kasamatsu, J. Virol. 68:8209-8216, 1994), in which an NLS-defective Vp1 could localize to the nucleus in the presence of wild-type minor capsid proteins Vp2 and Vp3. This approach made it possible to dissect the role of the bifunctional Vp1 NLS-DBD in virion assembly in the nucleus. Mutants of the viable nonoverlapping SV40 (NO-SV40) DNA NLSm1, NLSm2, and NLSm1. 2 replicated normally following transfection into host cells and produced capsid proteins at normal levels. All mutant Vp1s were able to interact with Vp3 in vitro. The mutants NLSm1 and NLSm1. 2 were nonviable, and the mutant Vp1s unexpectedly failed to localize to the nucleus though Vp2 and Vp3 did, suggesting that the mutated NLS1 acted as a dominant signal for the cytoplasmic localization of Vp1. Mutant NLSm2, for which the mutant Vp1's nuclear localization defect was complemented by Vp2 and Vp3, displayed a 5,000-fold reduced viability. Analysis of NLSm2 DNA-transfected cell lysate revealed a 10-fold reduction in the level of DNase I-protected viral DNA, and yet virion-like particles were found among the DNase I-resistant material. Collective results support a role for Vp1 NLS2-DBD2 in the assembly of virion particles. The results also suggest that this determinant can function in the infection of new cells.
Subject(s)
Capsid Proteins , Capsid/physiology , Simian virus 40/physiology , Virus Assembly , Animals , Mutation , Recombinant Proteins/geneticsABSTRACT
The population dynamics of Anopheles pseudopunctipennis larvae were studied in a foothill region near Tapachula, Mexico. Systematic surveillance of wet-season and dry-season habitats was conducted during 1990 and 1991. Sampling along transects of the Coatan River was employed to quantify habitat availability and population densities of larvae during the dry season. During the wet season, larvae were most abundant in temporary habitats, such as seepage springs, rain pools, and pools in stream and river margins. The temporary habitats disappeared during the dry season, which occurred concurrent with increasing densities of larvae in dry-season habitats within transects along the Coatan River. The great abundance of the dry-season riverine habitats, viz., small pools with filamentous algae, resulted in peak densities of host-seeking adult populations in villages associated with the river. During both seasons, there were significant associations between the presence and abundance of larvae and habitats containing filamentous algae, and secondarily with selected aquatic and semiaquatic plants. There was a significant correlation between mean numbers of larvae per habitat and mean numbers of breeding sites in the transects. Overall, An. pseudopunctipennis larvae were very abundant during the dry season and relatively uncommon during the wet season.
Subject(s)
Anopheles , Ecology , Seasons , Animals , Demography , Larva , MexicoABSTRACT
Studies of host selection patterns of Anopheles pseudopunctipennis were conducted in villages in foothills near Tapachula, Mexico. Based on 2 years of collections, 53.8 and 86.1% of all engorged females resting inside houses were found to contain human blood. Estimates of weighted and unweighted human blood indices, including data from outdoor resting collections, varied from 29.5 to 54.7%. Humans and dogs were the more common blood sources for all An. pseudopunctipennis mosquitoes, accounting for 96% of blood meals tested. Results of analyses of host preference through estimates of forage ratios (FRs) indicated that the large numbers of blood meals from humans and dogs were more reflective of host availability than host preference. An FR of less than 1 indicated that, in terms of host availability, proportionately fewer An. pseudopunctipennis females fed on humans than other large animal hosts. In contrast, FRs of 15-20 and 5-7 revealed strong selective biases for horses and pigs as sources of blood meals, respectively. The proportion of outdoor-resting, blood-engorged females containing human blood declined markedly after houses were sprayed with DDT. This response to house spraying is attributed to an excito-repellency effect of DDT.
Subject(s)
Anopheles/physiology , Animals , Dogs , Feeding Behavior , Female , Horses , Humans , Mexico , Mosquito Control , Population Dynamics , Seasons , SwineABSTRACT
Simple techniques of network thermodynamics are used to obtain the numerical solution of the Nernst-Planck and Poisson equation system. A network model for a particular physical situation, namely ionic transport through a thin membrane with simultaneous diffusion, convection and electric current, is proposed. Concentration and electric field profiles across the membrane, as well as diffusion potential, have been simulated using the electric circuit simulation program, SPICE. The method is quite general and extremely efficient, permitting treatments of multi-ion systems whatever the boundary and experimental conditions may be.
Subject(s)
Biological Transport , Membranes/metabolism , Models, Theoretical , Electric Conductivity , Ions , Mathematics , ThermodynamicsABSTRACT
Simple techniques of network thermodynamics are used to study the influence of concentration polarization on the determination of electrokinetic properties of physical and biological membrane systems. A network model of the polarization phenomenon resulting from discontinuities in transport numbers between the membrane and their adjacent solutions is proposed. The concentration profiles and potential drop across the membrane in plugs of monodisperse polystyrene particles and in giant algal cells have been simulated using the electrical circuit simulation program SPICE.
Subject(s)
Membranes/physiology , Models, Theoretical , Electrophysiology/instrumentation , Electrophysiology/methods , Kinetics , Mathematics , ThermodynamicsABSTRACT
Six cases of osteoid osteoma were studied histologically using the Gross technique. When the nidus is located centrally, it is reached by amyelinic fibers accompanying the vessel branches or as independent fibers. The pain is generally considered to reflect changes in vessel pressure and it could also be due to direct irritation of the nerve fibers included in or near the calcification focus.
