[Iatrogenic anisocoria after using a scopolamine patch for PONV prophylaxis]. / Iatrogene Anisokorie nach Scopolaminpflaster zur PONV-Prophylaxe.

This is a case report of a 29-year-old female patient who developed unilateral mydriasis following the use of a scopolamine patch for the prevention of postoperative nausea and vomiting (PONV).Given a medical history showing multiple risk factors for PONV, a preauricular scopolamine patch was applied prior to the induction of anesthesia. General anesthesia was induced with 150 mg propofol and 25 µg sufentanil and maintained with total intravenous anesthesia, using propofol (5 mg/kg per h) and remifentanil (2-3 µg/kg per h).Following an uneventful surgery of 90min duration, the patient was extubated and transferred to the recovery room, where the patch was removed. During the orthopedic ward round the following day, the clinical examination revealed anisocoria of the left eye in the form of unilateral mydriasis. In order to determine the cause of this clinical presentation, further neurological and ophthalmological examinations and investigations were carried out. In addition, magnetic resonance imaging was conducted to rule out a central nervous cause. The results of the investigations were negative and no pathology was identified. In addition, the symptoms resolved within 24 h of onset without any therapeutic intervention. Therefore, a suspected diagnosis of a pharmacologically induced anisocoria from the scopolamine patch was made, whereby the substance accidentally reached the affected left eye.Previous studies showed that scopolamine patches may reduce early emetic symptoms. Case reports describing the occurrence of anisocoria following the application of scopolamine patches have been previously published. In all of these cases the patches were used to prevent PONV and each case was comprehensively investigated using various diagnostic and clinical tools. It should be noted, however, that a dysfunctional accommodation is listed as a common side effect of the drug, affecting more than 1 in 10 patients.Even though the efficacy of scopolamine patches for the prevention of PONV is proven, clinicians should be aware of the common ophthalmological side effect. Particularly with respect to various surgical disciplines, where anisocoria may indicate an underlying surgery-related complication, the application of scopolamine patches should be well- considered.

[Advanced periocular basal cell carcinoma-a therapeutic challenge]. / Das fortgeschrittene periokuläre Basalzellkarzinom ­ eine therapeutische Herausforderung.

BACKGROUND: Basal cell carcinomas are the most common periocular malignant tumor. In advanced periocular basal cell carcinoma, vismodegib is a new treatment option which might potentially avoid surgical eye removal. CASE REPORT: We treated a 76-year-old patient unwilling to consent to surgery with vismodegib for advanced periocular basal cell carcinoma on the left forehead that had already undergone several previous treatments. After initial partial remission, the tumor regrew under ongoing therapy, so that radical surgical excision including orbital exenteration was performed. Unfortunately, the patient died thereafter due to septic multi-organ failure. CONCLUSION: Basal cell carcinoma and its new treatment options are gaining importance for ophthalmology due to rising incidence and prevalence rates. Vismodegib is a new encouraging option. However, for advanced tumors, it must be resolved whether complete histological remission may be achieved to avoid surgical intervention, or whether the area of resection can be significantly reduced. Current multicenter studies investigate these aspects further (ClinicalTrails.gov identifier: NCT03035188).

Loss of caveolae, vascular dysfunction, and pulmonary defects in caveolin-1 gene-disrupted mice.

Caveolae are plasma membrane invaginations that may play an important role in numerous cellular processes including transport, signaling, and tumor suppression. By targeted disruption of caveolin-1, the main protein component of caveolae, we generated mice that lacked caveolae. The absence of this organelle impaired nitric oxide and calcium signaling in the cardiovascular system, causing aberrations in endothelium-dependent relaxation, contractility, and maintenance of myogenic tone. In addition, the lungs of knockout animals displayed thickening of alveolar septa caused by uncontrolled endothelial cell proliferation and fibrosis, resulting in severe physical limitations in caveolin-1-disrupted mice. Thus, caveolin-1 and caveolae play a fundamental role in organizing multiple signaling pathways in the cell.

beta(1)-Subunit of BK channels regulates arterial wall[Ca(2+)] and diameter in mouse cerebral arteries.

Mice with a disrupted beta(1) (BK beta(1))-subunit of the large-conductance Ca(2+)-activated K(+) (BK) channel gene develop systemic hypertension and cardiac hypertrophy, which is likely caused by uncoupling of Ca(2+) sparks to BK channels in arterial smooth muscle cells. However, little is known about the physiological levels of global intracellular Ca(2+) concentration ([Ca(2+)](i)) and its regulation by Ca(2+) sparks and BK channel subunits. We utilized a BK beta(1) knockout C57BL/6 mouse model and studied the effects of inhibitors of ryanodine receptor and BK channels on the global [Ca(2+)](i) and diameter of small cerebral arteries pressurized to 60 mmHg. Ryanodine (10 microM) or iberiotoxin (100 nM) increased [Ca(2+)](i) by approximately 75 nM and constricted +/+ BK beta(1) wild-type arteries (pressurized to 60 mmHg) with myogenic tone by approximately 10 microm. In contrast, ryanodine (10 microM) or iberiotoxin (100 nM) had no significant effect on [Ca(2+)](i) and diameter of -/- BK beta(1)-pressurized (60 mmHg) arteries. These results are consistent with the idea that Ca(2+) sparks in arterial smooth muscle cells limit myogenic tone through activation of BK channels. The activation of BK channels by Ca(2+) sparks reduces the voltage-dependent Ca(2+) influx and [Ca(2+)](i) through tonic hyperpolarization. Deletion of BK beta(1) disrupts this negative feedback mechanism, leading to increased arterial tone through an increase in global [Ca(2+)](i).

The learning advantages of an external focus of attention in golf.

This study examined whether the learning advantages of an external focus of attention relative to an internal focus, as demonstrated by Wulf, Höss, and Prinz (1998), would also be found for a sport skill under field-like conditions. Participants (9 women, 13 men; age range: 21-29 years) without experience in golf were required to practice pitch shots. The practice phase consisted of 80 practice trials. One group was instructed to focus on the arm swing (internal focus), whereas another group was instructed to focus on the club swing (external focus). One day after practice, a retention test of 30 trials without instructions was performed. The external-focus condition was more effective for performance during both practice and retention.

[Identification of enteropathogenic strains of E. coli (EPEC) by application of the latex. II. A trial of applying the test in diagnostic examinations]. / Identyfikacja enteropatogennych szczepów E. coli (EPEC) przy zastosowaniu testu lateksowego. II. Próba wykorzystania testu w badaniach diagnostycznych.

The study was aimed at evaluation of diagnostic usefulness, prepared by own method, of a set of latex reagents for identification of enteropathogenic strains of E. coli (EPEC). EPEC strains in feces of 334 children with diarrhoea were searched by application at the same time of two methods: used routinely to this time slide agglutination test with commercial OK sera for enteropathogenic serotypes of E. coli and by a latex test with application of warmed culture of investigated strain in peptone water and polystyrene latex coated with immune globulins for O antigens of EPEC serotypes. By application of both methods EPEC strains were found in 50 (15.04%) children, by a latex test in 94 (28.1%) and by agglutination with OK sera in 67 (20.1%) of tested patients. Conformity of results obtained by both tests amounted to 82%. The latex test was found more useful for identification of EPEC strains because of simplicity of performance, higher sensitiveness and better repeatability of results, when compared with agglutination test with live E. coli and OK sera.

[A strain of Aeromonas veronii isolated from a patient suspected of cholera]. / Szczep Aeromonas veronii izolowany od chorego z podejrzeniem cholery.

Investigations were carried on a strain isolated from patient hospitalized in Poland. The patient returned from Odessa, a region with cholera epidemic. The strain was suspected to be Vibrio cholerae, but it did not agglutinate in V. cholerae 01 serum. The aim of this study was establishment of taxonomical classification of this strain, in order to demonstrate whether it is a representative of the non-cholera vibrio group (not agglutinating) or another representative of the family Vibrionaceae. The strain was resistant to bile salts in TCBS medium and demonstrated several properties from a borderline of two Vibrio and Aeromonas species. Its properties were similar to the group of recently described pathogenic vibrio, but it did not require higher concentrations of NaCl in the medium and was resistant to the vibriostatic factor 0/129. These properties were considered as decisive in differentiation of Vibrio and Aeromonas. The strain was finally classified as Aeromonas veronii. It is a first case in Poland of isolation of A. veronii from the feces of patient with cholera-like symptoms. As newly described pathogenic species of genus Vibrio and Aeromonas were not isolated in Poland, we present schemes which may serve for beginning of this type of diagnostic investigations.