Congenital retinal macrovessels: a "low visual acuity" case report with a 14-year follow-up.

We report a rare case of congenital retinal macrovessel with decreased visual acuity, with a 14-year follow-up. Both the clinical findings and the visual acuity remained unchanged throughout the follow-up period.

Autosomal recessive familial exudative vitreoretinopathy: evidence for genetic heterogeneity.

Two unrelated families with familial exudative vitreoretinopathy (FEVR) show apparent autosomal recessive inheritance rather than the previously reported autosomal dominant or X-linked recessive mode of inheritance. Compared with the other modes of inheritance, the inherited clinical features here include earlier onset (at birth) and a more severe progressive course.

[The application of a new diagnostic protocol for stroke in the young]. / Applicazione di un nuovo protocollo diagnostico dell'ictus giovanile.

Cerebral infarction before the age of 45 years accounts for 4-6% of all strokes. The etiology remains unexplained in a significant proportion of patients even after extensive investigations. The reported risk factors of this age group are cardiopathies, hypertension, smoking, hypercholesterolemia, reduction of anticoagulant proteins, hypercoagulable states, antiphospholipid antibodies primary syndrome, antiphospholipid antibodies secondary syndrome, some hemoglobinopathies, hyperviscosity syndromes, vasculitis, collagen vascular diseases, fibromuscular dysplasia, arterial dissections, migraine, myopathy encephalopathy lactic acidosis stroke like episodes, homocystinuria, familial amyloid angiopathy, microangiopathy with retinopathy encephalopathy and deafness, systemic lupus erythematosus, use of cocaine, traumas or manipulations of neck, AIDS. From 1/1/94 to 04/30/95 we observed 19 patients with cerebral infarctions and 9 patients with transitory ischemic attacks in young people. The aim of our study was to apply a diagnostic protocol by sequential tests of first level and second level. According to this protocol we found that the more common risk factors were ischemic cardiopathy, hypertension, smoking and hypercholesterolemia. Moreover we observed other independent risk factors, although less frequent, like the antiphospholipid antibodies, neurolupus, AIDS, deficit of protein S.

[Evaluation of the coagulation and fibrinolysis system in 54 patients with type 2 diabetes mellitus: correlations with lipid metabolism and blood glucose control]. / Valutazione del sistema coagulativo e fibrinolitico in 54 pazienti con diabete mellito tipo 2; correlazioni con il metabolismo lipidico e il controllo glicometabolico.

Diabetic patients have increased morbidity and mortality attributable to myocardial infarction, cerebrovascular disease and peripheral vascular disease, due to a high incidence of premature atherosclerosis. Abnormalities of hemostasis have been reported in many studies on diabetes over almost thirty years, but unfortunately the results have often appeared contradictory. The hemostatic alterations could lead to increased risk of vascular disease in diabetic patients. We have studied some coagulation factors (Fibrinogen, Factor II, Factor VII) and coagulation inhibitors (Protein C, Protein S), and plasminogen in fifty-four type 2 diabetic patients. The possible relationship between coagulation factors and coagulation inhibitors and parameters for glyco-metabolic control (glycosylated hemoglobin, fructosamine) and disturbed lipid metabolism (cholesterol, triglycerides) have ben analyzed. Our results show increase of fibrinogen, correlated with the metabolic control of the disease, positive correlation between plasminogen, factor II, protein S and hypertriglycerides, decreased levels of protein C correlated neither with metabolic control of disease neither with disturbed lipid metabolism.

[Prevalence of patients with HIV infection in an emergency department]. / Prevalenza di pazienti con infezione da HIV in un dipartimento di emergenza.

The activity at an ED, primarily aiming at providing rational and qualified support to critically ill patients, is forced to manage very different nosographic entities, including infectious, often contagious, pathologies. In this context the diffusion of HIV infection poses a number of problems concerning both the kind of patients presenting to the ED and the professional risk of health-care workers. In the first four months of 1992 the incidence of patients with recognized or presumed HIV infection at the "Pronto Soccorso Medico" was of 1.78% of 2327 patients admitted. This study aims to contribute to the epidemiologic definition of the risk of HIV infection due to occupational exposure, stressing the peculiar conditions of urgency-emergency often characterizing the activity within the ED.

Treatment of retinal detachment in Marfan syndrome.

Pars plana lensectomy and vitrectomy were done to treat six eyes with retinal detachment and dislocated lenses in five consecutive patients with Marfan syndrome. In five eyes, the retinas were reattached (follow-up range, 18 months to 4 years). In one eye, the retina redetached ten months after primary surgery and was repaired successfully with pneumatic retinopexy (follow-up, 3 years).

Long-term effects of befunolol on the corneal endothelium and the consensual ophthalmotonic reaction.

In a double-blind study, 30 patients with ocular hypertension were randomly assigned to receive one drop of 0.5% befunolol or placebo (the drug vehicle) in each eye twice daily for 120 days. The befunolol used contained no preservatives. Before and after treatment the number and shape of the endothelial cells of the five corneal sectors were evaluated. After 120 days of twice-daily application of befunolol or placebo, no changes in the shape or density of the corneal cells were found in any patient. No differences in the patients receiving befunolol or placebo were noted. The consensual ophthalmotonic reaction was studied in 15 of the patients before and after befunolol administration. A significant decrease in intraocular pressure was noted at 30 minutes and at 1, 2, 3, 4, 5, and 6 hours after befunolol. Intraocular pressure also decreased significantly at 1 to 4 hours after placebo, and then returned to pretreatment levels at 6 hours.

Ocular alterations induced by hyperproteinic diet in growing rats.

According to literature reports about experimental damages in several organs with high metabolic rate induced by a rich animal protein diet, authors studied in rats, which had been exposed to hyperproteinic diet (casein 40%, lactalbumin 20%) since fetal life, the eyeball and external ocular muscle modifications. Histologic studies at different times have shown that in 60 day old rats a vacuolar degeneration was present in both rod and cone layer and outer nuclear layer of the retina. In 80 day old rats, together with a complete degeneration of the whole retina, external ocular muscles appeared severely fragmentated showing lipid degeneration areas along their bundles.

Treatment of retinal detachments due to macular holes.

Seven cases of retinal detachment due to macular holes in myopic eyes with posterior vitreous detachment were treated by exchanging liquid vitreous with an intravitreal gas bubble (40% SF6 + 60% air in one case, SF6 alone in six cases). All patients were positioned face down until the bubble absorbed. No cryotherapy, diathermy, or photocoagulation was used to create a chorioretinal adhesion. the retina reattached in six cases, with follow-up periods ranging from 6 to 24 months. One case failed because the patient was unable to maintain a prone position.

Ultrastructure of the levator muscle of the eyelid in ptosis due to third nerve palsy.

This paper deals with the histopathology of the levator muscle of the upper eyelid obtained in three cases of ptosis due to 3rd nerve palsy. Light- and electron-microscopy show muscle fibers decreased in number and altered, showing vacuolation, mitochondrial degeneration, large glycogen amounts, disorientation of myofibrils and Z-line changes. The findings are discussed and compared to the data reported by others.

[Classification of chronic hepatitis]. / In tema di classificazioni delle epatiti croniche.

After an examination of the classifications of chronic hepatitis put forward between 1968 and the present a critical review of the subject is presented. On the basis of personal experience and in the light of recent developments, another classification is proposed which together with morphological criteria, haematochemical evaluation and particularly, statistically processed immunological data would permit adequate monitoring of possible therapeutic treatments.

[Changes in blood sugar and blood insulin chronic liver diseases]. / Modificazioni glicemiche ed insulinemiche nelle epatopatie croniche.

Glycaemic and insulinaemic alterations in chronic hepatopathies have been investigated by means of endovenous glucose load curves. Calculation of the mathematical increment on the curves confirmed the presence of variations in glycaemia and insulinaemia. A critical evaluation of altered glucose tolerance compared to hyperinsulinism was also made.

[Multiple bilateral pigmented epithelium detachments or atypical vitelliform degeneration? (author's transl)]. / Soulèvements multiples et bilatéraux de l'épithélium pigmentaire ou atypique dégénérescence vitelliforme?

A case of bilateral multiple pigment epithelium detachments in a 36 year old man is reported. The value of E.R.G., E.O.G. and fluorescein angiography in the differential diagnosis between multiple serous detachments of the pigment epithelium and multiple vitelliform degeneration is stressed.

[Juvenilis macular degeneration in a family affected by cystinuria]. / Dégénérescence maculaire juvénile chez une famille atteinte de cystinurie.

This paper deals with a family affected by cystinuria associated with eye signs of juvenilis macular degeneration.