Confocal scanning laser microscopy in patients with postoperative endophthalmitis.

PURPOSE: To investigate alterations of corneal layers in eyes treated for acute postoperative endophthalmitis. METHODS: In this retrospective, nonrandomized comparative study, eyes treated with 25 gauge pars plana vitrectomy (PPV) for acute post-cataract endophthalmitis (group A) were compared to eyes receiving uneventful cataract surgery (group B) and uneventful 25 gauge PPV for epiretinal membrane (group C). After a minimum follow-up of 8 months from last surgical procedure, laser scanning in vivo confocal microscopy (IVCM) was performed. RESULTS: Twelve eyes for each group were recruited. Comparing study eyes with control eyes of group B and C, no statistical difference was found in corneal epithelial cell density (p = n.s.), in density of nerve fibers (p = n.s.), mean grade of nerve reflectivity (p = n.s.), mean grade of nerve tortuosity (p = n.s.), mean grade of anterior keratocyte activation (p = n.s.), and corneal endothelium cell density (p = n.s.), whereas a statistically higher mean grade of posterior keratocyte activation was found in group A (p < 0.01). Epithelial and endothelial corneal morphologies were graded as regular in all groups. Langerhans cells and corneal dendritic-shaped hyper-reflective endothelial deposits were found in group A. Both findings were absent in group B and C, and the difference was statistically significant (p < 0.01). CONCLUSIONS: IVCM was a useful tool in the detection of microscopic chronic corneal abnormalities caused by postoperative endophthalmitis. These findings confirmed the presence of a subclinical chronic corneal inflammation localized to the posterior stroma that should be related to the infectious process. Future studies might clarify pathological processes in the acute phase of postoperative endophthalmitis.

Corneal confocal scanning laser microscopy in patients with dry eye disease treated with topical cyclosporine.

PurposeTo investigate the effect of cyclosporine on corneal ultrastructure and on major signs and symptoms of patients with dry eye disease.Patients and methodsIn this prospective cohort study, patients with dry eye disease were treated with a drop of cyclosporine 0.05% twice daily. Clinical evaluation was carried out at baseline and at months 1, 3, and 6. All patients completed the Ocular Surface Disease Index (OSDI) questionnaire, and tear film break-up time (BUT), fluorescein and lissamine green staining, and Schirmer test were carried out. In vivo confocal microscopy was also performed and epithelial cellular density, keratocyte activation, and subbasal plexus morphology were assessed.ResultsA total of 40 patients completed the study. After 6 months, OSDI, BUT, and fluorescein and lissamine green staining showed a clinically significant improvement. During the 6-month follow-up, density of intermediate epithelial cells increased from 1969.5±85.4 cell/mm2 to 4881.2±175.7 cell/mm2 (P<0.01); average grade of keratocyte activation decreased from 3.6±0.1 to 1.8±0.1 (P<0.001); average grade of number of subbasal nerves decreased from 5.3±0.2 to 2.6±0.2 (P<0.001); average grade of nerve reflectivity decreased from 3.8±0.1 to 2.1±0.2 (P<0.001); and average grade of nerve tortuosity decreased from 3.8± 0.1 to 2.2±0.2 (P<0.001).ConclusionCyclosporine was effective in controlling symptoms and signs of dry eye disease. In vivo confocal microscopy showed an increase in cell density of intermediate epithelium cells, a decrease in hyperreflective keratocytes, and a decrease in density, tortuosity, and reflectivity of nerve fibers.

Synthesis, chemical characterization, computational studies and biological activity of new DNA methyltransferases (DNMTs) specific inhibitor. Epigenetic regulation as a new and potential approach to cancer therapy.

This work deals with the synthesis, the chemical characterization of dibutyltin(IV) complex of caffeic acid (Bu2Sn(IV)HCAF, caf1) and its cytotoxic action on tumor cells. The coordination environment at the tin center was investigated by FTIR, (119)Sn{(1)H} cross polarization magic angle spinning, electrospray ionization mass spectroscopy in the solid state and UV-vis, fluorescence and (1)H, (13)C and (119)Sn NMR spectroscopy in solution phases. Density functional theory study confirmed the proposed structures in solution phase and indicated the most probably stable conformation. The effects on viability of breast cancer MDA-MB231, colorectal cancer HCT116, hepatocellular carcinoma HepG2 and Chang liver cells, an immortalized non-tumor hepatic cell line, have been investigated. The effect of a variation in structure of caf1 was found to lead to a change in the respective antiproliferative properties: caf1 induces loss of viability in HCT116, MDA-MB-231, and HepG2; the complex shows only moderate effects in non-tumor Chang liver cells. caf1 exerts lower cytotoxic activity than Bu2SnCl2, suggesting that the binding with H3CAF modulates the marked cytotoxic activity exerted by Bu2SnCl2; caf1 displays a considerably more pronounced antitumoural effect towards cell lines than caffeic acid. It is known that caffeic acid can modulate DNA (cytosine-5)-methyltransferases 1 (DNMT1) mediated DNA methylation. In this paper we demonstrate that caf1 treatment was able to induce a time-dependent reduction of global DNA methylated status. This effect was also confirmed by a concomitant reduction DNMT1 expression level. The effect induced by caf1 was more evident not only with respect to untreated cells but also compared to H3CAF treated cells.

Improvement of renal function in epidermolysis bullosa patients after gluten free diet: two cases.

Epidermolysis bullosa (EB) is a rare inherited genetic disease characterized by an abnormal response of the skin and mucosa to mechanical trauma. Dystrophic EB (DEB) is very often associated with many extra cutaneous complications. Those complications involve either epithelial associated tissues or other organs. In particular, several renal complications have been described for DEB in the recessive form, such as amyloidosis, post-infection glomerulonephritis, upper and lower urinary tract obstruction and IgA-Nephropathy (IgAN). In the cases reported below we have two patients diagnosed with DEB that showed compromised renal function and proteinuria. The switch of the normal diet toward a gluten free diet resulted beneficial for both patients, since renal function was rescued and proteinuria cured. Moreover, a general health status improvement was recognised, given that nutritional condition was ameliorated and bone growing enhanced. Furthermore, in both patients the presence of autoantibodies anti-COL7 indicating an autoimmune form of the disease. Therefore, patients received low doses of betametasone useful to reduce inflammatory state and to control immune system function. In conclusion, our results prompt us to hypothesized that in these patients, due to the fragility of the intestinal mucosa, the absence in the diet of gluten may be beneficial.

Study of ethane level in exhaled breath in patients with age-related macular degeneration: preliminary study.

PURPOSE: A variety of factors have been implicated in the pathogenesis of age-related macular degeneration (ARMD), and oxidative stress plays an important role in the onset and progression of the disease. Breath ethane is now considered a specific and non-invasive test for determining and monitoring the trend of lipid peroxidation and free radical-induced damage in vivo. This test provides an index of the patients' overall oxidative stress level. We evaluated the breath ethane concentration in exhaled air in patients with advanced ARMD. METHODS: In this study, we enrolled 13 patients with advanced ARMD and a control group, and a breath analysis was carried out by gas chromatography. RESULTS: The mean ethane level in the ARMD patients was 0.82 ± 0.93 nmol/l (range: 0.01-2.7 nmol/l) and the mean ethane value in the control group was 0.12 ± 0.02 nmol/l (range: 0.08-0.16 nmol/l). The difference between the values of the 2 groups was statistically significant (p < 0.005). Receiver operating characteristic analysis showed an elevated area under the curve (0.831; 95% CI: 0.634-0.948), with a significance level of p < 0.0014 (area = 0.5). CONCLUSIONS: These preliminary results seem to indicate that breath ethane levels are higher in most patients with ARMD. The breath ethane test could thus be a useful method for evaluating the level of oxidative stress in patients with ARMD. To our knowledge, there are no data on this type of analysis applied to ARMD.

Endovascular treatment of pulmonary and cerebral arteriovenous malformations in patients affected by hereditary haemorrhagic teleangiectasia.

Hereditary Haemorrhagic Teleangiectasia (HHT) is a vascular disorder of angiogenesis transmitted in an autosomal dominant pattern, characterised by heterogeneity in clinical manifestations. One of the most important organ involved is lung, including pulmonary arteriovenous malformations (PAVM). PAVM occur in 20 to 30% of the HHT population and recently are considered a marker of disease. PAVM are direct artery-to-vein connections with low pressure and without an interveining capillary bed. PAVM are classified as simple (supplied by one feeding artery) or complex (receiving blood supply from two or more feeding artery). According to the international reports, treatment it's recommendable for all PAVM with feeding vessels 3mm or larger, in order to reduce the risk of cerebral ischaemia and neurologic manifestations frequently attributed to paradoxical embolisation. Transcatheter embolotherapy of PAVM is a form of treatment based on occlusion of the feeding artery to a PAVM by using platinum coils or detachable balloons. The technique of coil embolisation involves the exact localisation of PAVM by pulmonary angiography followed by superselective percutaneous caheterisation of feeding artery obtained by using a dedicated 7F guiding catheter, which coaxially allocates a 5F hydrophilic catheter advanced in order to perform both superselective angiography of feeding artery and embolisation itself. Inside the 5F catheter the platinum coils are advanced using a .035'' guide-wire and released until an optimal occlusion of feeding artery is achieved. At the end of the procedure angiographic control is performed in order to verify the occlusion of feeding artery. The use of platinum coils is preferable over detachable balloons when feeding artery are greater than 7 mm in diameter and have irregular anatomical configuration. On the other hand, the principal advantage of using detachable balloons is that the balloon itself can be deflated and repositioned if necessary. Transcatheter embolotherapy is technically safe and clinically effective and may represent the primary choice of treatment in HHT patients. On the other hand the most common complications of this treatment (pleurisy and air embolism) can be prevented by using some tips during the embolisation procedure like "anchor technique," "scaffold technique" and "balloon assisted technique." Cerebral arteriovenous malformations (CAVM) are present in 10-20% of patients with HHT and multiple in 50% of cases. Cortical surface is the most frequent localisation. Angiography is needed to diagnose all CAVM and to clarify the angioarchitecture of the lesion. In HHT CAVM are usually either micro-AVM, with a nidus not bigger than 1 cm, or small AVM, with a nidus between 1 and 3 cm. Quite frequently there are lesions characterised by arteriovenous fistulas. In the three patterns of CAVM usually found in HHT, small AVM are the most risky for bleeding although the risk is lower than that associated with sporadic ones. It is estimated from 0.38 to 0.69% per year in spite of the general incidence of bleeding in sporadic CAVM that ranges from 2 to 4% per year. In HHT patients, at present, the precise indications and timing of treatment are not established. Trend is to treat small AVM and AVF and to follow-up micro-AVM with MRI and angiography. As for sporadic CAVM, treatment of small AVM is usually referred to stereotactic radiosurgery. Endovascular embolisation is proposable if the lesion is easily reachable by microcatheterism and the position of the microcatheter is safe. Glue is used for embolisation and the technique is briefly discussed.

Surgical and anesthesiological procedures and patients outcome in a major teaching hospital, in a major non-teaching hospital and in a minor hospital.

AIM: This study was carried out to evaluate the outcome of patients in different hospitals with the aim to plan future structural and management changes. METHODS: All the anaesthesiological and surgical procedures were observed for a 2 weeks period in a major teaching hospital (A), in a major nonteaching hospital (B) and in a minor nonteaching hospital (C) in all the patients requiring anaesthesia. The main and the co-existing diseases and the surgical and anaesthesiological treatments they received were evaluated to determine the outcome. The ASA class, the duration of the procedure, the length of staying in hospital, the transfusions of blood or derivatives, the adverse events for each patient were also observed. RESULTS: The results showed that the patients admitted to the teaching hospital were classified in higher ASA risk classes and had surgery of longer duration, with a higher ratio of major surgery. The outcome was satisfactory in all the 3 hospitals, with a 2 days length of stay respectively in 30% (A and B) and 50% (C) of the patients. The rate of mortality was low: only 3 patients in hospital A and no patient in B and C died in a period of 2 days following surgery. Hospitals B and C showed a large use of modern techniques such as autologous blood transfusion and central and peripheral anaesthetic blocks, with a better cost-benefit ratio than the major teaching hospital. CONCLUSIONS: This study showed good results, but it should be repeated in a few years in order to evaluate any change and possible improvement in the management and outcome of the patients.

Emergencies in hereditary haemorrhagic telangiectasia.

BACKGROUND: Hereditary haemorrhagic telangiectasia (HHT) is a systemic autosomal dominant vascular disease. Although the clinical picture is that of a chronic disabling disease, vascular malformations can suddenly lead to life-threatening conditions. AIM: To assess the frequency and type of emergency acute complications in HHT. DESIGN: Retrospective case-note review. METHODS: From August 2000 to December 2004, our specialized HHT centre saw 139 patients (74 males, 65 females, mean age 45.5 years, range 14-77) with a definite diagnosis of HHT. We reviewed their clinical files and recorded all visits for acute complications (massive nosebleeds, haematemesis, melaena, haematochezia, haemothorax, haemoptysis, TIA/ischaemic stroke, haemorrhagic stroke, brain abscess). RESULTS: Fifty patients (35.9%) had at least one acute complication. There were a total of 93 visits potentially involving the emergency department. Most commonly, patients sought urgent medical attention for nosebleeds and gastrointestinal bleeding (63.4%), but there were also disorders of the brain, lung, heart and liver. DISCUSSION: Acute complications of HHT are not uncommon and can be severe and wide-ranging. Physicians should be aware of HHT and its major complications, as a prompt diagnosis is essential to direct patients to the most appropriate therapies, and to suggest screening for visceral involvement in their relatives.

Mitochondrial dysfunction associated with cardiac ischemia/reperfusion can be attenuated by oxygen tension control. Role of oxygen-free radicals and cardiolipin.

Reactive oxygen species (ROS) are considered an important factor in ischemia/reperfusion injury to cardiac myocites. Mitochondrial respiration is an important source of ROS generation and hence a potential contributor to cardiac reperfusion injury. Appropriate treatment strategy could be particularly useful to limit this ROS generation and associated mitochondrial dysfunction. In the present study, we examined the effect of lowering the oxygen tension, at the onset of the reperfusion, on various parameters of mitochondrial bioenergetics in rat heart tissue. After isolation of mitochondria from control, ischemic, normoxic and hypoxic reperfused rat heart, various bioenergetic parameters were evaluated such as rates of mitochondrial oxygen consumption, complex I and complex III activity, H2O2 production and in addition, the degree of lipid peroxidation, cardiolipin content and cardiolipin oxidation. We found that normoxic reperfusion significantly altered all these mitochondrial parameters, while hypoxic reperfusion had a protective effect attenuating these alterations. This effect appears to be due, at least in part, to a reduction of mitochondrial ROS generation with subsequent preservation of cardiolipin integrity, protection of mitochondrial function and improvement of post-ischemic hemodynamic function of the heart.

Airways humidification during mechanical ventilation. Effects on tracheobronchial ciliated cells morphology.

AIM: Airways humidification during mechanical ventilation (MV) can be performed by means of heat and moisture exchangers (HME). Good performance of selected hygroscopic HME was shown in terms of tracheal temperature and humidity control and low tube obstruction rates. However, few data are available on their effects on tracheobronchial ciliated cells. The purpose of this study was to evaluate the effects of 2 different HME on ciliated cell during MV. METHODS: Twenty consecutive patients undergoing elective surgery lasting <4 h were randomly assigned to be treated with Rusch (Group 1) or Mediflux (Group 2) hygroscopic HME. The morphology of tracheobronchial ciliated cells was evaluated from cytologic smears of endotracheal aspirate. Smears were prepared by using the thin-prep processor, stained using the Papanicolau method and examined in triplicate: recognizable respiratory cells were graded on a six-point scale, according to the normal appearance of cilia, cytoplasm and nucleus. RESULTS: In Group 1, 178.3+37 cells were retrieved from aspirates and , 155.6+58 in Group 2 (NS). The score was 739+241 in Group 1 and 617+329 in Group 2 (NS). Cilia and end plate were undamaged in 80+17% and 81+20% cells respectively in Group 1 and in 56+23% and 62+22% cells respectively in Group 2 (P<0.01 and <0.05). CONCLUSIONS: During MV epithelial tracheobronchial cells can be affected by the humidification device used. Our findings suggest that the 2 HME tested in the present study have a different impact on ciliated cells structure.

Epidural analgesia for labour and delivery. Current evidence.

Currently, evidence-based medicine indicates that epidural analgesia (EA) labor is not associated with cesarean and instrumental delivery for dystocia. This evidence was obtained from clinical investigations of variability in clinical labor management. An optimized balance between anesthesiological and obstetric practice is vitally important for securing spontaneous delivery. The total dose of local anesthetic for EA may be associated with operative delivery when there is a lack of obstetric care standardization and co-interventions reducing unintended EA effects. Furthermore, combining local anesthetic low dose and opioid low dose may produce a new balance with obstetric management. Physiological and pharmacological knowledge together with recent clinical findings suggest that combined opioid-local anesthetic low dose EA causes minimal negative effects on labor progress and is effective and safe in terms of maternal and neonatal outcome. Internal communication between obstetricians and anesthesiologists is essential for optimizing EA labor management. Processes of health care quality management, such as medical audit and peer review, should be routinely practiced to reach this goal.

Organometallic complexes with biological molecules. XVIII. Alkyltin(IV) cephalexinate complexes: synthesis, solid state and solution phase investigations.

Dialkyltin(IV) and trialkyltin(IV) complexes of the deacetoxycephalo-sporin-antibiotic cephalexin [7-(d-2-amino-2-phenylacetamido)-3-methyl-3-cephem-4-carboxylic acid] (Hceph) have been synthesized and investigated both in solid and solution phase. Analytical and thermogravimetric data supported the general formula Alk(2)SnOHceph(.)H(2)O and Alk(3)Snceph(.)H(2)O (Alk=Me, n-Bu), while structural information has been gained by FT-IR, (119)Sn Mössbauer and (1)H, (13)C, (119)Sn NMR data. In particular, IR results suggested polymeric structures both for Alk(2)SnOHceph(.)H(2)O and Alk(3)Snceph(.)H(2)O. Moreover, cephalexin appears to behave as monoanionic tridentate ligand coordinating the tin(IV) atom through ester-type carboxylate, as well as through beta-lactam carbonyl oxygen atoms and the amino nitrogen donor atoms in Alk(2)SnOHceph(.)H(2)O complexes. On the basis of (119)Sn Mössbauer spectroscopy it could be inferred that tin(IV) was hexacoordinated in such complexes in the solid state, showing skew trapezoidal configuration. As far as Alk(3)Sn(IV)ceph(.)H(2)O derivatives are concerned, cephalexin coordinated the Alk(3)Sn moiety through the carboxylate acting as a bridging bidentate monoanionic group. Again, (119)Sn Mössbauer spectroscopy led us to propose a trigonal configuration around the tin(IV) atom, with R(3)Sn equatorial disposition and bridging carboxylate oxygen atoms in the axial positions. The nature of the complexes in solution state was investigated by using (1)H, (13)C and (119)Sn NMR spectroscopy. Finally, the cytotoxic activity of organotin(IV) cephalexinate derivatives has been tested using two different chromosome-staining techniques Giemsa and CMA(3), towards spermatocyte chromosomes of the mussel Brachidontes pharaonis (Mollusca: Bivalvia). Colchicinized-like mitoses (c-mitoses) on slides obtained from animals exposed to organotin(IV) cephalexinate compounds, demonstrated the high mitotic spindle-inhibiting potentiality of these chemicals. Moreover, structural damages such as "chromosome achromatic lesions", "chromosome breakages" and "chromosome fragments" have been identified through a comparative analysis of spermatocyte chromosomes from untreated specimens (negative controls) and specimens treated with the organotin(IV) complexes.

Subarachnoid anaesthesia in caesarean delivery: effects on alertness.

AIM: Subjects in spinal anaesthesia have been reported to show a decrease in the level of alertness, even when they have not received any sedative drugs. THE AIM: of this study is to verify, in caesarean delivery if the bupivacaine subarachnoid anaesthesia, with or without intrathecal fentanyl dose, produces a sedative effect, to define the entity and to identify the mechanism that most likely causes it. METHODS: The clinical investigation is divided into Part I (non-randomized trial) and Part II (randomized trial) and is set in the University hospital's delivery-unit. Part I: 45 pregnant women were recruited and enrolled in 3 groups: women having natural delivery (n=15), women receiving caesarean delivery with subarachnoid anaesthesia (n=15) and with general anaesthesia (n=15). Self-rating depression scale (SDS), self-rating anxiety scale (SAS), state anxiety inventory (SAI) and trait anxiety inventory (TAI) psychometric tests were patient-completed for pre-delivery anxiety evaluation. Part II: 23 pregnant women undergoing caesarean delivery were single-blind randomized to receive subarachnoid anaesthesia with single 12.75 mg 0.5% hyperbaric bupivacaine (n=10) or with 12.75 microg 0.5% hyperbaric bupivacaine and 15 mg fentanyl (n=13). Bispectral index (BIS), observer's assessment of alertness/sedation (OAA/S) scale, self-sedation visual analogic scale (VAS) and mean arterial pressure (MAP) were perioperatively monitored. RESULTS: Part I: it was found, using SAI, a higher level of state anxiety in the pregnant women undergoing caesarean delivery than those having natural delivery (p<0.05). Part II: pregnant women receiving subarachnoid anaesthesia for caesarean delivery had a decrease of the level of alertness from 10 to 70 min after the execution of lumbar puncture (p<0.05), with a sedative peak from 35 to 45 min (p<0.01), as measured by OAA/S scale and self-sedation VAS but not by BIS. Women who received bupivacaine-fentanyl spinal anaesthesia had a more consistent sedative effect from 35 to 70 min (p<0.05). CONCLUSIONS: Pregnant women undergoing caesarean delivery had a more elevated level of state anxiety, assessed by SAI, as seen in Part I. Subarachnoid anaesthesia in caesarean delivery is associated with a reduction of alertness level. A double mechanism might cause a clinically valuable sedative effect, observed by OAA/S scale and self-sedation VAS: decrease of the afferent spinal inputs and an anxiolytic psychophysiologic effect, induced by good outcome of the birth and mother-baby contact. Intrathecal bupivacaine-fentanyl dose produces a larger alertness decrease than single bupivacaine, because the anaesthetic block density increases. BIS was not a sensitive measure to detect the light sedation occurring in Part II of this study.

Organometallic complexes with biological molecules. XVII. Triorganotin(IV) complexes with amoxicillin and ampicillin.

Novel triorganotin(IV) complexes of two beta-lactamic antibiotics, 6-[D-(-)-beta-amino-p-hydroxyphenyl-acetamido]penicillin (=amoxicillin) and 6-[D-(-)-alpha-aminobenzyl]penicillin (=ampicillin), have been synthesized and investigated both in solid and solution states. The complexes corresponded to the general formula R(3)Sn(IV)antib*H(2)O (R=Me, n-Bu, Ph; antib=amox=amoxicillinate or amp=ampicillinate). Structural investigations about configuration in the solid state have been carried out by interpreting experimental IR and 119Sn Mössbauer data. In particular, IR results suggested polymeric structures both for R(3)Sn(IV)amox.H(2)O and R(3)Sn(IV)amp*H(2)O. Moreover, both antibiotics appear to behave as monoanionic bidentate ligands coordinating the tin(IV) atom through ester-type carboxylate, as well as through the beta-lactamic carbonyl. Evidence that in none of these compounds water molecules were involved in coordination, was provided by thermogravimetric investigations. On the basis of 119Sn Mössbauer spectroscopy it can be inferred that tin(IV) was pentacoordinate in all of the complexes in the solid state, showing an equatorial R(3)Sn(IV) trigonal bipyramidal (tbp) configuration. The nature of the complexes in solution state was investigated by using 1H and 13C nuclear magnetic resonance (NMR) spectroscopy, while an 119Sn spectrum was obtained for n-Bu(3)Sn(IV)amp*H(2)O. Although 1H- and 13C-NMR measurements suggested that in dimethyl sulfoxide (DMSO)-d(6) solution the polymeric structure collapsed, due to a solvolysis process of the beta-lactamic carbonyl bonding to the organometallic moiety, the complexes have been shown to maintain the same trigonal bipyramidal configuration at tin(IV) atom by the coordination of a DMSO molecule. Cytotoxic activity of these novel semisynthetic antibiotic derivatives has been tested towards spermatocyte chromosomes of the mussel Brachidontes pharaonis (Mollusca: Bivalvia) using two different chromosome-staining techniques such as Giemsa and CMA(3). The occurrence of typical colchicinized-like (c-like) mitoses on slides obtained from animals exposed to organotin compounds, directly confirmed the high mitotic spindle-inhibiting potency of these chemicals. In addition, by comparative analysis of spermatocyte chromosomes from untreated specimens (negative controls) and specimens treated with the triorganotin(IV) complexes, structural damages such as 'achromatic lesions' and 'chromosome breakages' have been identified.

Macular thickness measured by optical coherence tomography (OCT) in diabetic patients.

PURPOSE: 1) To compare macular thickness (MT) by optical coherence tomography (OCT) in diabetics and controls; 2) to assess the relationship between MT and stage of diabetic retinopathy (DR) and macular edema (ME); 3) to quantify MT changes after laser treatment for ME. METHODS: One-hundred and thirty-seven patients with diabetes mellitus (216 eyes) were admitted to the study and examined by stereo-color fundus photos, retinal fluorangiography and OCT. DR was classified as: 1) no DR (46 eyes: 21.3%); 2) background DR (66 eyes: 30.6%); 3) pre-proliferative DR (50 eyes: 23.1%); 4) proliferative DR (54 eyes: 25%). The study group was then divided into three ME groups: 1) no edema (65 eyes: 30.1%); 2) not clinically significant ME (no CSME) (45 eyes: 20.8%); 3) clinically significant macular edema (CSME) (106 eyes: 49.1%). Three-month follow-up tomograms were taken to evaluate eyes laser-treated only for ME. The control group consisted of 50 eyes of 50 non-diabetic, age- and sex-matched subjects. RESULTS: MT was 369.3 +/- 163.2 microm in diabetics and 161.9 +/- 12.9 microm in controls (p < 0.001). In the four DR groups it was: 1) 211.0 +/- 37.6 microm; 2) 370.8 +/- 159.6 microm; 3) 419.1 +/- 138.2 microm; 4) 456.1 +/- 162.0 microm (p<0.001). In the three ME groups, MT was: 1)227.8 +/- 53.4 microm; 2) 321.8 +/- 124.2 microm; 3) 476.2 +/-146.6 microm (p < 0.001). In the 52 eyes treated with laser photocoagulation of the posterior pole only and with a follow-up > 3 months, MT before and after treatment was 468.2 +/- 83. 17 microm and 372.1 +/- 120.63 microm. CONCLUSIONS: MT was greater in diabetics than controls and tended to increase with DR and ME severity. OCT is a sensitive technique for detecting early diabetic macular abnormalities and quantifying their reduction after laser treatment.

Hypoxic reperfusion limits functional impairment following cardioplegic arrest in isolated rat heart.

BACKGROUND: Reperfusion injury decreases both systolic contractility and diastolic compliance. Several studies indicate that the sustained decrease in diastolic compliance is mainly due to reactive oxygen intermediates (ROI) generation and calcium overload. METHODS: Male Wistar isolated rat hearts were divided into 2 groups (n=10 each), perfused according to Langendorff technique and exposed to 45 min of ischemia. Hearts belonging to the first group were reperfused with Krebs-Henseleit solution at 600 mmHg pO2; a 150 mmHg pO2 perfusate was utilized in the second group during the first minute and switched to 600 mmHg pO2 thereafter. Modifications in diastolic compliance and systolic contractility were assessed by changes in left ventricular end-diastolic (LVEDP) and developed pressure (LVDP), and first derivative of the pressure curve (dP/dt). RESULTS: Increase in LVEDP values, with respect to pre-ischemic data, were detected at 1, 5, 10, 20 min following reperfusion at 600 mmHg pO2, and were respectively: +40.17+/-18.61, +57.5+/-28.8, +59.8+/-30.5 and +63.2+/-34.1 mmHg. At 150 mmHg pO2 they were: +15.69+/-13.13, +22.4+/-14.1, +26.2+/-13.7 and +28.9+/-15.8, with a significant difference within the first 20 min (p<0.05). At high pO2 levels, LVDP decreased of 53.0+/-27.35, 60.5+/-22.6, 59.8+/-23.3 and 50.7+/-25.0 mmHg, versus 42.7+/-25.7, 38.0+/-29.5, 39.2+/-30.9 and 38.7+/-32.7 mmHg at lower pO2 (p=NS). The correspondent values of the dP/dt were 37.8+/-27.7, 30.1+/-17.2, 32.2+/-13.6 and 35.4+/-14.0% of pre-ischemic values at high pO2, versus 43.3+/-27.09, 51.9+/-25.1, 50.1+/-24.6 and 53.1+/-29.9% at lower pO2. Statistical significance was lower for LVDP and dP/dt than LVEDP. CONCLUSIONS: Diastolic functional impairment was partially reduced within the first 20 min following low pO2 reperfusion, but without any significant improvement of contractility.

Broad beam vs. flying spot excimer laser: refractive and videokeratographic outcomes of two different ablation profiles after photorefractive keratectomy.

PURPOSE: To assess the refractive outcomes and videokeratographic patterns in photorefractive keratectomy (PRK) of two last-generation excimer lasers: broad beam and flying spot lasers. METHODS: Forty eyes were treated for a mean myopic correction of -5.59+/-2.17 D with a Ladarvision excimer laser (Autonomous Technology Corp). We compared the refractive outcomes and the videokeratographic patterns with those of 40 eyes treated with the Summit Apex Plus laser (Summit Technology Inc) for a mean myopic correction of -5.60+/-2.24 D. RESULTS: During the 6-month follow-up, we found no significant difference in uncorrected and spectacle-corrected visual acuity, haze grade, regularity index, or decentration. The eyes treated by Ladarvision showed a lower refractive error at 1 month (P = .04), a lower incidence of central islands at 1 (P = .003) and 3 months (P = .04), a wider mean effective ablation area at 1 (P = .0004), 3 (P = .0000009), and 6 months (P = .0000000004), a less steep ablation edge at 1 (P = .0026), 3 (P = .015), and 6 months (P = .011). CONCLUSIONS: The small beam excimer laser provides better videokeratographic outcomes, which lead to quicker refractive stability and better visual performance.

Factitious HIV syndrome in young women.

Factitious HIV infection has been observed at our center in women presenting with a false history of HIV/AIDS. In a 2-year period, 4 women presented for HIV-related care, indicating they were HIV-seropositive, while repeated serologic testing revealed no evidence of HIV infection. In all cases, the women were either quite angry or appeared surprised when told that they did not have HIV infection. A common denominator in all 4 women was a history of prolonged sexual, physical, or emotional abuse. Three of the 4 had been to other physicians, changing doctors as soon as the absence of HIV infection was established. Appropriate psychiatric support is an important aspect in care of these women, although it may not be accepted. All presentations of HIV infection should be confirmed either by identifying hard-copy data of HIV test results or by retesting all patients before evaluation and treatment of presumed HIV-related illnesses.