"Falling down": a retroperitoneal catastropheC.

Hemoperitoneum due to ruptured retroperitoneal varices is an extremely rare condition and a poor prognostic sign with a catastrophic and life-threatening situation. Early recognition affords appropriate management and urgent surgical intervention in order to favor the survival rate. In this case report we accurately describe the complex clinical course of a 56-year old woman with retroperitoneal varices, who few months earlier had a chest trauma with multiple left lower rib fractures and 10 years earlier she underwent to ovarian hyperstimulation for an ovulation induction. She was taken to the emergency room for a fainting episode with signs of a clear hemodinamic shock without a present history of trauma. The intricacy of this case was mostly due to the choice of the correct management, where the damage control resuscitation turned out to have an important role.

[Early electroretinografic changes in elderly RA patients treated with hydroxychloroquine]. / Variazioni elettroretinografiche precoci nei pazienti anziani con artrite reumatoide trattata con idrossiclorochina.

OBJECTIVE: To evaluate the effectiveness of fundoscopy, electrooculography, electroretinogram and visually evoked potentials in early detection of hydroxychloroquine retinal toxicity in RA patients and to evaluate the influence of patients' age, drug dosage, concomitant therapy (prednisone and methotrexate) and serum creatinine levels in the development of this side effect. METHODS: From september to december 1999, we have enrolled 32 RA patients (13 males, 19 females) starting hydroxychloroquine treatment. The patients underwent regular ophthalmological examination (fundoscopy, electro-oculography, electroretinogram and visually evoked potentials) every 4 months. Disease activity was evaluated every two months by clinical and routine serological examination. RESULTS: No patients developed retinopathy during 1 year's follow-up; fundoscopy, electrooculography, and visually evoked potentials did not vary from the baseline. On the other hand, electroretinogram showed early alterations of scotopic and photopic response; moreover a significant statistical correlation between patients' age (more than 65 years) and b1 photopic wave increase (p < 0,05) was observed. No correlation was found between the development of electro-retinographic alterations and hydroxychloroquine dosage, concomitant therapy and serum creatinine levels CONCLUSION: Our data show the inefficacy of fundoscopy, electrooculography and visually evoked potentials in early detection of hydroxychloroquine retinopathy. On the other hand electroretinogram allows early detection of retinal alterations during hydroxychloroquine treatment, in patients older than 65 years.

Mydriatic effect of ocular decongestants studied by pupillography.

The mydriatic effect of three ocular decongestants, containing 0.1% tetrahydrozoline hydrochloride, 0.3% chlorpheniramine maleate, and 0.05% tetrahydrozoline hydrochloride in combination with 0.3% pheniramine maleate, respectively, was evaluated in 10 healthy volunteers. The study was carried out using a single dose of the tested drug, instilling 2 drops in one eye and 2 drops of a placebo in the other. The papillary diameters were measured by photographic pupillography under basal conditions and 15, 30, 45, 60, 90, and 120 min after each treatment. Near and distance visual acuity and tonometry were evaluated under basal conditions and 50 and 95 min after instillation of drugs. No statistical significant differences between the treated and the control pupil diameters were found after instillation of 0.1% tetrahydrozoline hydrochloride or 0.3% chlorpheniramine maleate. The combination of 0.05% tetrahydrozoline hydrochloride with 0.3% pheniramine maleate caused a significant mydriasis from 30 min up to 120 min (p < 0.01 and p < 0.0005) after instillation, more pronounced in light irides. No local and systemic effects and no effects on visual acuity and ocular pressure were detected. On the basis of our results, it is possible to conclude that the persistent mydriatric action of the two-drug combination is due to a synergism; the use of these eyedrops should be avoided in subjects with narrow-angle glaucoma, light irides, narrow iridocorneal angle, and low anterior chamber for the risk of ocular pressure increase.

Pupillographic evaluation of the mydriatic effect of ibopamine solution.

The mydriatic effects of ibopamine solution at the concentrations of 0.25%, 0.50%, 1% and tropicamide solution at the concentration of 1% were evaluated in 22 clinically healthy volunteers. The study was conducted at single dose, instilling 1 drop of each concentration of ibopamine and of tropicamide in one eye and 1 drop of placebo in the other. The pupillary diameter was measured by photographic pupillography immediately before and at 10, 20, 30, 45, 60, 90, 120, 180, 240 min after each instillation. Immediately before and 45 min after each instillation, visual acuity was also measured for both near and distant objects. The ibopamine solution exerted a dose-related mydriatic effect in both magnitude and duration. The mean maximum pupillary diameters were 5.5, 8.0, 9.1 mm with ibopamine at 0.25%, 0.50%, 1% and 8.6 mm with tropicamide. The mean times to reach the maximum pupillary diameter were 60, 54, and 50 min with the three concentrations of ibopamine, and 47 min with tropicamide. The duration of the mydriatic effect was less than 4 h with ibopamine and very much more with tropicamide. No effect on accommodation was found with ibopamine, while a cycloplegic effect was constantly noted with tropicamide. On the basis of the results obtained, it is concluded that ibopamine is to be preferred when mydriasis is required with good absolute values and brief duration (examinations of the fundus, examinations with Goldmann's lens, etc.), without cycloplegia.

Electroretinographic and visual-evoked potential abnormalities in patients with beta-thalassemia major.

Various ocular abnormalities have been reported in patients with thalassemia, and have been, for the most part, attributed to the toxic effects of high-dose desferrioxamine (DFO). We have performed an electroretinographic and visual-evoked potential (VEP) study in 31 thalassemic patients who had never received high doses of DFO. The abnormalities found were very similar to those reported in early siderosis bulbi and included a b1-wave of significantly higher amplitude at 1 min and at the alpha point. VEPs showed a N1-P1 amplitude significantly greater than in controls. These findings, which were more marked in older patients, point to an important causative role of iron in their genesis.

Electroretinographic and visual evoked potential abnormalities in myotonic dystrophy.

Pattern visual evoked potentials (VEPs) and electroretinograms (ERGs) were recorded in 20 patients with myotonic dystrophy. Thirteen out of 20 cases presented both VEP and ERG abnormalities, 3 only ERG alterations, 2 only abnormal VEPs. A significant inverse correlation between P100 latencies and b1 wave amplitude was observed, while N1-P100 and b1 wave amplitude exhibited a parallel change. These data suggest that retinal abnormalities may have a role in inducing subclinical visual pathway alterations in myotonic dystrophy.

Comparative kinetics of phenobarbital after administration of the acid and the propylhexedrine salt (barbexaclone).

The kinetics of phenobarbital (PB) was compared after oral administration of equivalent doses of the drug as the acid or the propylhexedrine salt (barbexaclone) to 7 normal volunteers. The absorption and elimination parameters were very similar. It was concluded that propylhexedrine did not affect the serum kinetics of PB given as barbexaclone.

Pharmacokinetic and pharmacodynamic studies following the intravenous and oral administration of the antiparkinsonian drug biperiden to normal subjects.

The pharmacokinetics and pharmacodynamics (changes in pupil size and salivary flow) of biperiden following a single oral and intravenous dose were investigated in six normal subjects. After the injection plasma concentrations declined biphasically, with half-times of 1.5 h for the rapid phase and 24 h for the terminal phase. Clearance and apparent volume of distribution were high (12 ml X min-1 X kg-1 and 24 l X kg-1 respectively). Absorption was rapid but the systemic availability was incomplete (33%), probably due to first-pass metabolism. Central nervous system (CNS) adverse effects and changes in pupil size were observed after both routes of administration while salivary flow was affected only by the injection.

Effects of lead on the visual system of occupationally exposed subjects.

A quantitative measurement of visual field in mesopic adaptation was performed for 35 workers occupationally exposed to lead and 35 referents matched for age, smoking, and alcohol consumption. The mean level (+/- SD) of lead in blood was 47 +/- 16 microgram/100 ml (2.25 +/- 0.77 mumol/l) [range 21-82 microgram/100 ml (1.01-3.94 mumol/l)]. In 10 exposed subjects a central scotoma was found that was not evidenced in any of the referents. A highly significant decrease in visual sensitivity was observed for the exposed subjects a central scotoma was found that was not evidenced in any of the referents. A highly significant decrease in visual sensitivity was observed for the exposed subjects. The results point to damage of central and peripheral optic nerve fibers. In the most severe cases, central vision is preferentially affected, and therefore the results are suggestive of subclinical optic neuropathy.

Diagnostic value of objective campimetry.

The results obtained in ten normal subjects with a new method of pupillocampimetry are described and compared with those obtained with routine campimetry. Once the relationship between the two methods was established, ten subjects suffering from pregeniculate or postgeniculate lesions of the optic pathways were examined by pupillocampimetry. This study shows the value of this new method, particularly for the differential diagnosis of pre- or postgeniculate lesions.