Vitrectomy in uveitis patients.

PURPOSE: To evaluate the causes and success rates of pars plana vitrectomy (PPV) in uveitis patients. METHODS: Retrospective study of the charts of 26 uveitis patients (28 eyes) who underwent PPV between the years 2008 and 2011. We examined surgical indications and success rates, based on visual outcomes, complications and diagnosis in case of vitreous biopsy. RESULTS: (1) Therapeutic PPV (TV) was performed in 36% of the eyes, (2) TV combined with epiretinal membrane (ERM) peeling in 21% and (3) diagnostic PPV (DiV) was performed in 64% of the eyes. Eight eyes (28,6%) underwent a combined cataract and vitreous surgery. Visual acuity (VA) improved in 16 eyes (57%), with a mean improvement of -0,9 log of the minimum angle of resolution (logMAR), although the effect was transient in 7% of the cases. VA remained stable in 11 eyes (39%) and decreased in 1 (4%). Post-operative complications were cystic macular oedema (CMO) in 3 eyes (11%), cataract in 5 eyes (18%) and retinal detachment in 2 eyes (7%). Diagnostic tests were performed in 18 eyes with a success rate of 55%. CONCLUSIONS: In our series of patients with uveitis, a good andstable improvement of VA was found when PPV was performed with ERM peeling while the effect on VA was more transient in the other cases. A good success rate of diagnosis was also found in DiV. However, considering the possible severe complications, diagnostic vitrectomy should be limited to selected cases.

Direct current control of three magnon scattering processes in spin-valve nanocontacts.

We have investigated the generation of spin waves in the free layer of an extended spin-valve structure with a nanoscaled point contact driven by both microwave and direct electric current using Brillouin light scattering microscopy. Simultaneously with the directly excited spin waves, strong nonlinear effects are observed, namely, the generation of eigenmodes with integer multiple frequencies (2f, 3f, 4f) and modes with noninteger factors (0.5f, 1.5f) with respect to the excitation frequency f. The origin of these nonlinear modes is traced back to three-magnon-scattering processes. The direct current influence on the generation of the fundamental mode at frequency f is related to the spin-transfer torque, while the efficiency of three-magnon-scattering processes is controlled by the Oersted field as an additional effect of the direct current.

VERTOS II: percutaneous vertebroplasty versus conservative therapy in patients with painful osteoporotic vertebral compression fractures; rationale, objectives and design of a multicenter randomized controlled trial.

BACKGROUND: The standard care in patients with a painful osteoporotic vertebral compression fracture (VCF) is conservative therapy. Percutaneous vertebroplasty (PV), a minimally invasive technique, is gaining popularity as a new treatment option. Many prospective and retrospective studies have reported on the effectiveness and safety of PV, but no large randomized controlled trial (RCT) has been published. OBJECTIVE: To estimate cost-effectiveness of PV compared to conservative therapy in terms of: pain reduction, quality of life, complications, secondary fractures and mortality. MATERIALS AND METHODS: The VERTOS II study is designed as a prospective, multicenter RCT. Patients with a painful VCF with bone edema on MR imaging, local back pain for 6 weeks or less, osteopenia and aged 50 years or older, after obtaining informed consent are included and randomized for PV or conservative therapy. In total 200 patients will be enrolled. Follow-up is at regular intervals during a 1-year period with standard questionnaires, addressing: clinical symptoms, pain medication, Visual Analogue Scale (VAS) score, quality of life and cost-effectiveness. Secondary fractures, necessary additional therapies and complications are recorded. CONCLUSION: The VERTOS II study is the first methodologically sound RCT designed to assess the cost-effectiveness of PV compared to conservative therapy in patients with an acute osteoporotic VCF. TRIAL REGISTRATION: http://www.clinicaltrials.gov, NCT00232466.

Reduced forearm bone mineral content and biochemical evidence of increased bone turnover in women with euthyroid goitre treated with thyroid hormone.

We used single-photon absorptiometry to assess forearm bone mineral content (BMC/BW) (arbitrary units normalized for bone width) at a proximal site (PBMC/BW) and at a more distal site (DBMC/BW) in 60 women treated with 25-50 micrograms T3 or 50-100 micrograms T4 for euthyroid goitre, in 13 untreated goitre patients, and in 2 controls matched for age and menopausal state for each goitre patient. BMC/BW was not significantly different between untreated goitre patients and controls. In 36 premenopausal patients, treated for 5.8 +/- 5.4 years (mean +/- SD) a slight decrease in PBMC/BW of about 5% compared to controls to controls was observed (PBMC/BW 1.42 +/- 0.19 vs 1.49 +/- 0.13, P less than 0.05). In 24 postmenopausal patients, treated for 10.0 +/- 5.8 year, a 20% deficit in BMC/BW compared to controls was found (DBMC/BW 0.80 +/- 0.18 vs 1.06 +/- 0.20, P less than 0.001 and PBMC/BW 1.14 +/- 0.20 vs 1.42 +/- 0.19, P less than 0.001). Biochemical indices of bone metabolism in 43 pre and post-menopausal patients and 43 controls showed in the patients a higher serum alkaline phosphatase activity (AP) (P less than 0.01 and P less than 0.05 and serum osteocalcin (NS and P less than 0.05). AP was negatively correlated with TSH levels and, in postmenopausal patients, with DBMC/BW and PBMC/BW. Our results suggest that treatment of euthyroid women with moderate doses of thyroid hormone increases bone turnover with clear adverse effects on bone mineral status in postmenopausal patients.

Persistence of increased bone resorption and possible role of dehydroepiandrosterone as a bone metabolism determinant in osteoporotic women in late post-menopause.

Specific data on bone metabolism in the late post-menopause are relatively scarce. This study presents data on the biochemical, hormonal and bone mineral status of a selected group of 22 osteoporotic women with at least 1 vertebral fracture who had been post-menopausal for a minimum of 5 yr. Bone resorption parameters were elevated in over two-thirds of these patients. The serum levels of dehydroepiandrosterone and its sulphate were negatively correlated with age and years since menopause but positively correlated with bone mineral content, bone turnover parameters (urinary calcium/creatinine, osteocalcin), 1,25-dihydroxy-vitamin D levels and the 1,25-dihydroxy-vitamin D/25-hydroxy-vitamin D ratio. These findings indicate that careful evaluation of the bone turnover rate in the late post-menopause can still have an important bearing on therapeutic decisions. They also support the theory that adrenal androgens play a role in bone mineral metabolism in the late post-menopause.

The diagnostic significance of the antiperinuclear factor for rheumatoid arthritis.

Sensitivity and specificity of antiperinuclear factor (APF) determination were assessed in 127 patients with classical or definite rheumatoid arthritis (RA). The control population consisted of 262 patients with rheumatic complaints other than RA. Our results showed a sensitivity of 86.6%, a specificity of 96.2% and a Youden index of 82.8% for APF in RA. In 14.2% of the total population with RA the rheumatoid factor (RF) became negative in the course of the disease; all but one were found to be actually APF positive. Of the population with RA analyzed, 8.6% were consistently RF negative but APF positive. In view of its strong sensitivity and specificity for RA, APF determination is a valuable serological tool for the diagnosis of the disease. In APF positive, RF negative patients with RA the prognosis seems to be poor.

Disease manifestations of progressive systemic sclerosis: sensitivity and specificity.

The authors conducted a study of 47 patients with a diagnosis of systemic sclerosis in order to determine the sensitivity, specificity and Youden index and consequently the diagnostic value of the generally accepted criteria and of some other common disease features. The control population consisted of 324 patients with rheumatoid arthritis and 35 patients with systemic lupus erythematosus. In addition to proximal scleroderma, the presence of which was required for inclusion in this study, other disease features score a high to moderate Youden index: sclerodactyly, Raynaud's phenomenon, appearance of perioral grooves, cinematographic evidence of esophageal hypomotility, periarticular calcifications, widening of the periodontal membrane on teeth radiographs and specific histologic changes on fingertip biopsy. Finally, a good correlation was found with most of the ARA subcommittee criteria.

Pigmented villonodular synovitis of the hip--association with osteochondromatosis.

Pigmented villonodular synovitis, diffuse or nodular in nature, is most commonly seen in the knee but occasionally involves the hip. The authors reviewed the medical records of seven patients with a pathological diagnosis of unilateral pigmented villonodular synovitis of the hip. Characteristic findings were proliferation of the synovial lining cells and subsynovial invasion of fibroblast or polyhedral mesenchymal cells in a nodular pattern. Multiple initiating factors have been advanced to account for the occurrence of this monoarticular chronic arthritis, but the etiology and pathogenesis still remain obscure. On three occasions the authors found an association with free floating osteochondromas and well-delineated foci of metaplastic cartilage under the synovial lining cells. Two benign lesions may occur simultaneously and are possibly related entities involving the synovial membranes as a reaction to a common etiologic factor. Although the histopathology of pigmented villonodular synovitis of the hip and the knee is identical, localization in the former joint has its typical clinical, radiological, differential diagnostic and therapeutic aspects.

Diagnostic arthroscopy of the hip joint in pigmented villonodular synovitis.

A case of pigmented villonodular synovitis of the hip is presented. The delay between the onset of symptoms and the histopathologic confirmation of this condition generally accounts for the massive local bone invasion, frequently necessitating a total hip arthroplasty. Earlier diagnosis through arthroscopy and subsequent chemical synoviorthesis might reduce the need for more aggressive surgery and improve the prognosis of this rare condition.