Ambulatory transcutaneous carbon dioxide monitoring for children with neuromuscular disease.

OBJECTIVE: Early screening and diagnosis of nocturnal hypoventilation can slow progression to diurnal hypercapnia and mortality in children with neuromuscular disease (NMD). However, gold standard, laboratory-based polysomnography (PSG) testing is a limited resource. Therefore, we evaluated the diagnostic accuracy of ambulatory transcutaneous carbon dioxide (tcCO2) monitoring used in the home compared to PSG in children with NMD. METHODS: Prospective, cross-sectional study in children 0-18 years old with a confirmed diagnosis of NMD and a clinically indicated need for PSG. Ambulatory tcCO2 was assessed by a respiratory therapist in participant's homes. Demographics, and PSG (including tcCO2). RESULTS: We enrolled 39 children with NMD; 3 had unusable ambulatory tcCO2 data because of failure of drift correction on the machine (n = 2) or an air bubble (n = 1). The remaining 36 patients aged 11 months to 16 years (median (IQR) 12.5 years (6.0-15.8)) had ambulatory tcCO2 and outpatient level 1 PSG data. Ambulatory tcCO2 monitoring had a sensitivity of 20.0% (95% confidence interval [CI] 0.5-71.6%) and a specificity of 93.5% (95% CI 78.6-99.2%). Almost all children and/or parents (34/36, 94%) preferred ambulatory monitoring over in-hospital PSG. CONCLUSIONS: Ambulatory transcutaneous carbon dioxide monitoring was not sufficiently accurate as a clinical tool for the diagnosis of nocturnal hypoventilation our cohort of children with neuromuscular disease despite being preferred over PSG by both children and parents.

Clinical Aspects of Pterygium in the Presence of Cataract.

Two of the most common UV-induced eye affections are pterygium and cataract. They are both defined as progressive diseases that impair patients' vision and share some common elements in their evolution process. The purpose of this study was to determine whether the presence of cataract influences the clinical signs and symptoms of patients with pterygium. Therefore, we have analyzed 84 patients with pterygium, among which 23 also presented cataract, as an overall study lot, as well as divided by age decades. We have determined that almost all patients with both pterygium and cataract declared extensive UV exposure in antecedents and have also reported a blurred vision. We found no correlation between the presence of cataract and the size of pterygium lesions, or symptoms like foreign body sensation, tearing or symblepharon.

Comparative study of diseases of the stomatognathic system and specific parameters of osteoporosis.

UNLABELLED: What are the specific parameters of dental health that present with modifications in osteoporosis (OP)? Both OP and a decreased bone mass can affect dental health. A low mineral density may lead to the loss of dentures because the jaw is exposed to the effects of periodontitis and without strong sustainability the teeth may lose their stability. INTRODUCTION: We compared the values of the periodontal index (IP) with a T score for women presenting with OP at menopause and those without OP. We found that there is a relation between OP and the loss of bone mass at the oral-facial level. METHODS: The study included 87 patients, aged between 35 and 75 years. We correlated gums and IP with the T score for the two groups. RESULTS: We found a significant difference between the values of the IP index for the group with OP in comparison with the control group. Thus a correlation between OP and IP was confirmed. CONCLUSIONS: IP was statistically significantly higher in women at menopause with OP than those without OP. Gum retraction was significantly higher in women at menopause with OP than in the control group. There was thus a real correlation between bone mineral density (BMD) and IP, while between BMD and dental mobility we found no correlation.

Prevalence of the c.35delG and p.W24X mutations in the GJB2 gene in patients with nonsyndromic hearing loss from North-West Romania.

OBJECTIVE: In Central and South-Eastern European countries, the most frequent mutation types responsible for congenital nonsyndromic sensorineural hearing loss (NSHL) are c.35delG and p.W24X (15-55.8% and 2.5-4.3%, respectively). The aim of the study was to determine for the first time in Romania the prevalence of c.35delG and p.W24X mutations in patients with NSHL. MATERIAL: 75 unrelated children with NSHL from Transylvania (North-West Romania). METHODS: a. Audiological examination (otoscopy, tympanogram, acoustic otoemission and tonal audiogram or auditory evoked potentials); b. detection of the c.35delG (semi-nested-PCR, RFLP and ARMS-PCR analysis) and p.W24X (ARMS-PCR analysis) mutations. RESULTS: Audiological examination allowed the diagnosis of hearing loss of various degrees: moderate in 8 patients (10.7%), severe in 14 cases (18.7%), profound in 53 patients (70.6%). The number of reported mutation cases as against the number of alleles indicates a 33.3% frequency rate for c.35delG mutation and respectively 5.3% for p.W24X mutation. All 22 patients with 35delG/c.35delG genotype (19 patients), c.35delG/p.W24X genotype (2 patients) or p.W24X/p.W24X genotype (1 patient) presented profound/severe hearing loss. CONCLUSION: Our study confirms that the frequency rate of the two mutations analyzed in patients with NSHL from North-West Romania is comparable to that seen in other Central and South-Eastern European countries. The homozygote or compound heterozygote states represent a major risk factor for profound or severe deafness. Audiological screening in newborns and genetic testing in confirmed congenital hypoacusis cases are compulsory for early therapeutic intervention (hearing prosthesis or cochlear implant) and genetic counselling.

[Subconjunctival nodule with Dirofilaria repens]. / Nodul subconjunctival cu Dirofilaria repens.

Dirofilaria repens infection, a zoonotic illness, is rarely seen in humans; it is more frequently met over the endemic areas of the Southern Europe and Sri Lanka. The authors report a case of dirofilaria conjunctivae in a 27 year old woman from Craiova; such infections are hardly to be found in our country. Our patient presented a mobile, bulbar, subconjunctival tumoral formation which was surgically removed; immature Dirofilaria repens was revealed into it. Case particularity was that the patient had not visited any of the endemic areas. Environmental changes with global warming can lead to some new unspecific diseases in our country.

[Mydriasis--areflexia syndrome in eye with posterior chamber intraocular lens]. / Sindromul midriaza--areflexie la ochi cu pseudofak de camera posterioara.

PURPOSE: To describe a rare complication of classical EEC technique with posterior chamber IOL implantation in the sulcus. PATIENTS AND METHODS: This is a retrospective study of 296 eyes which underwent EEC and CP implantation. None was operated with phacoemulsification. The posterior chamber IOL originated from 4 renowned manufacturers. RESULTS: In 25 eyes, at 2 to 7 month after surgery, we noticed a mydriasis with pupillary areflexia, though the majority (20 eyes) presented a miotic pupil in the days following surgery. CONCLUSION: The authors discuss possible causes of such a delayed complication: direct trauma of the iris, difficult haptic introduction in the sulcus, toxic material on the i., o.l. More probably the interaction of more than a cause is necessary for this delayed complication.

[Evolution of ocular infection in diabetes mellitus patients]. / Evolutia infectiilor oculare la bolnavii cu diabet zaharat.

PAPER AIM: The paper presents the infectious complications at patients with diabetes mellitus, and the evolution of these complications with the type of diabetes and the treatment with orale hypoglycemic agents or insulin. MATERIAL AND METHOD: The survey was fulfilled in the Clinic of Ophthalmology of Craiova and in the Metabolic Diseases clinic, during a period of 10 years. RESULTS: We surveyed 497 hospitalized patients, and we noticed different infectious complications: kerato-endothelitis in 9 cases, herpetic keratitis in 11 cases, anterior uveitis in 16 cases, corneal ulcus in 24 cases, total uveitis in 6 cases. In 17% of the cases, the patients were not previously aware about the diabetes affection. CONCLUSIONS: The very severe infectious complications of the eye in diabetes, determine the doubling of the ocular and general treatment, for normalisation of the blood glucose and a good evolution of the diabetes.

[Efficacy of ophthalmic suspension of Brinzolamide (Azopt) in the primary or combined therapy for patients with hypertensive glaucomas]. / Eficacitatea suspensiei de Brinzolamida (Azopt) în terapia primara sau combinata la pacientii cu glaucom hipertensiv.

UNLABELLED: The primary objective of this prospective study was to evaluate the efficacy of lowering intraocular pressure, safety and tolerability of Brinzolamide 1% ophthalmic suspension as primary or adjunctive therapy in hypertensive glaucomas. MATERIAL AND METHOD: Brinzolamide 1% was administrated in monotherapy or in combination for 26 patients suffering from hypertensive glaucomas. The patients were divided in two groups: group I--included 10 patients (20 eyes) with primary open-angle glaucoma in which suspension Brinzolamide was administrated in monotherapy, and, group II--(16 patients with 30 eyes) with diverse forms of hypertensive glaucomas, that the Brinzolamide was administrated in adjunctive therapy, after the failure of another forms of medication, especially, beta-blockers. Intraocular pressure was assessed at 8, 10 AM, and 6 PM in first day, then daily at 8 AM, 7 days, and finally, weekly, at 8 AM all the period. Dilated fundoscopy, automated perimetry, visual acuity, were performed in addition to hematology, blood chemistry, urinalysis testing and ocular events. RESULTS: The intraocular pressure-lowering observed on treatment was as follows: 3.5 mmHg to 4.8 mmHg (13.5% to 18.2%) in patients which Brinzolamide 1% dosed two times a day, and, 4.2 to 5.2 mmHg (17.8 to 20.9%) after administration Brinzolamide three times a day. The association of Brinzolamide with another therapy induces in an additive ocular hypotensive effect, which was stable in the whole period of the study. The ocular and general tolerance was significantly improved for another hypotensive drugs and another carbonic anhydrase inhibitors topically active. This fact allows a long treatment period.

[Clinical and epidemiological aspects in ocular tuberculosis]. / Tuberculoza oculara--aspecte clinice si epidemiologice.

150 new cases of ocular tuberculosis, representing 1% of total tuberculose cases, was diagnosticated during the last 10 years, in both Ophthalmological and Pneumophtisiological Clinics of Craiova. Ocular tuberculosis is the local manifestation of a general latent tuberculosis; the uveal diseases represent 46% of cases of ocular tuberculosis. 51 of 150 cases of ocular tuberculosis was corioretinal forms, which evaluated uni or bilateral, with one and multiple focares; in only one case we constated a coroidian tuberculom form.

[Color Doppler ultrasonography of the orbit in the treatment and evolution of the open angle glaucoma with normalized pressure]. / Aportul echografiei Doppler color orbitar în tratamentul si evolutia glaucomului cu unghi deschis cu tensiune normalizata.

UNLABELLED: The purpose of the paper consists to evaluate the vascular component that it takes part to ethiopatogenie of certain forms of primary open angle glaucomas, as well as to suggest a specific treatment. MATERIAL AND METHOD: 14 patients (28 eyes) with primary open angle glaucomas with average of 64 years were investigated by Color Doppler Imaging. All patients present deteriorations papilo-perimetric or/and visual acuity, in spite of normalized pressure by medical or surgical treatment. RESULTS: The calculus of the velocimetric indices allowed us to measure the vascular resistance index that is increased at 6 patients in ophthalmic circulation, 4 patients in central retinal artery and 2 patients in whole shaft carotid-ophthalmic. We are found a correlation between papilo-perimetric deteriorations and the value of the vascular resistance index, too. Giving vasodilatative drugs that grow the ocular blood flow by improving the microcirculation at the level of the optic nerve's head, such as calcium channel blockers, could benefit effects for this type of patients. CONCLUSIONS: Orbitar Color Doppler Imaging allows to evaluate the vascular lesions that have a negative influence in the evolution of primary open angle glaucomas, and, therefore, suggesting a specific treatment.

[Inflammatory ocular diseases associated with oro-dental pathology]. / Afectiuni inflamatorii oculare asociate patologiei buco-dentare.

PAPER AIM: It is presented the correlation between the uveitis and the focal dental disease with infection, irritation or allergic pathogenicity. MATERIAL AND METHOD: This study was performed on a set of 54 patients with uveitis and dental diseases patients hospitalized in the Clinic of Ophthalmology of Craiova, during 1998-1999. This correlation was observed in 38-40% of uveitis. There were also mentioned some dental damages associated with uveitis: radicular focal infections, periodontitis under prosthetic works, fights cavities, inclusions dental chronic maxillary osteitis. RESULTS: The correlation uveitis-dental diseases was noticed in 1.2-1.8% of the hospitalized patients, comparing with 3-5% in literature (including the ocular adnexa diseases). CONCLUSIONS: This study shows the reality of the correlations between uveitis and dental diseases. It was relieved the importance of correlation ophthalmologist-stomatologist.

[Chorioretinal lesions in deaf mutes]. / Leziuni corioretiniene la surdomuti.

The paper reports a study of 216 patients of special deaf-mute schools from Craiova. The exam of them showed us the presence of retinal degenerative lesions in 17 cases (7.8%). There was not a parallelism between deafness' degree and retinal lesions expanse. In point of clinical aspect, the retinal degenerative lesions were Sjögreen retinal lesions in 6 cases, colloidal Amalric-Bessou retinal lesions in 6 cases. In 2 cases lesions had a pseudoinflammatory aspect and another 2 cases were peripheral lesions like "salt and pepper's". Only one case had pigmentary osteoblastic mobilization. Deafness was associated with oligophrenia in 15 cases, with discreet manifestations of eredoataxia Friedreich in 5 cases, with epilepsy in 2 cases and with nanism in another 2 cases. It is necessary a complex oto-neuro-ophthalmological exploration of patients with deaf-muteness.

[The incidence of ocular complications in 10,000 diabetes mellitus patients hospitalized at Dolj County Clinical Hospital]. / Incidenta complicatiilor oculare la 10.000 de pacienti cu diabet zaharat dispensarizati la Spitalul Clinic Judetean Dolj.

The paper surveys the statistical results of retrospective analysis for observation sheets of patients having mellitus diabetes, type I and II, hospitalized during the last 10 years at the Ophthalmological Clinic in Craiova. The accent was made on the ocular complications related to the type of mellitus diabetes, the age of its debut, the evolution length, the treatment made, glycemia compensation, which make this affection to be the first cause of cecity at adult age.

[Periodontal regeneration with enamel derivate proteins (Emdogain)--clinical evaluation]. / Régénération parodontale a dérivés de la matrice proteique de l'email (Emdogain)--évaluation clinique.

UNLABELLED: The study was undertaken in order to evaluate the effect of Emdogain as an adjuvant in periodontal surgery in promoting bone level gain, compared to bone levels after surgery. METHOD: The study was realised on 6 patients. who had pair test sites and control sites. Two interproximal sites were selected in each patient at a distance from each other, in the same maxilla, with infra-osseous defects with depth > or = 4 mm and width > or = 2 mm. The patients were followed on a long term period, initially and after 8 and 16 months. RESULTS: The average values of the clinical attachment level were evaluated both in the test sites and in the control group at 8 months and 16 months, The radiographic osseous level continued to recede at the group treated with Emdogain, and in the control group it remained at its initial level. The radiographic gain was ascertained after 16 months. CONCLUSION: This study proves that the topic use of Emdogain as an adjuvant, during periodontal defects surgery, on radicular surfaces, determines a gain in the clinical attachment and an osseous gain observed on X-rays.

[Comparison on the effects of metronidazole in subgingival application in the treatment of adult periodontitis]. / Studiul comparativ al efectului metronidazolului în aplicatii subgingivale în tratamentul parodontitei adultului.

UNLABELLED: Control of subgingival plaque is the key of the treatment of periodontal diseases. The use of subgingival sustained-release antibiotic therapy is advocated for the beneficial effect on anaerobic flora. A single-blind clinical trial was carried out in 13 patients with adult periodontitis to compare the effects of subgingival application of metronidazole dental gel with those of subgingival scaling. METHOD AND MATERIALS: A split mouth design was used so that each patient received all treatments simultaneously. Randomly selected quadrants were treated with applications of 25% metronidazole gel, subgingival scaling, or a combination of scaling and gel application. The remaining quadrant in each patient was left untreated as a control. RESULTS: All three treatments were effective in significantly reducing bleeding on probing over the 14 weeks observation period. No statistically significant differences were found between scaling alone and combined treatment. Scaling and combined treatment were better than metronidazole. Metronidazole produced transient effects, best noted during the first 4 weeks after treatment. No additive effect of metronidazole was noted in the combined treatment. At week 14, only combined treatment sites and scaled showed statistically greater probing depths reduction than control sites. CONCLUSION: For the treatment of mild to moderate adult periodontitis, subgingival scaling alone is as effective as the combination of scaling and antibiotic therapy.

[Genetic predisposition in glaucoma]. / Predispozitia genetica în glaucom.

The comparative study of the genetic factors implication in low-tension and high-tension glaucoma showed the presence of glaucoma familial cases in both form. In 3 cases of low-tension glaucoma the presence of other familial cases of high-tension glaucoma was revealed. The existence of hereditary cases of high-tension glaucoma in families with low-tension glaucoma suggests the existence of some common factors, responsible for producing both affections. On the other hand, the systematic research of the existent glaucomatous deficits at the patients with glaucoma familial cases deserves greater attention.

[Progressive dystrophy of the cones]. / Distrofia progresiva a conurilor.

The 31-year-old female patient preserved photophobia, learning tiredness, pigmentary remaniations in the macular region to both eyes. With emphasis on the right eye. The photopic visual field shows a paracentral scotoma, 4 degrees inferior at the right eye, without the modification of the peripheric isopters. The darkness adaptation curve is monophasic, with reduction and delay of the alpha angulation. The chromatic sensation exam shows protanomaly. Angiographically, isolated macular lesions with the pigmentary epithelium atrophy and the persistency of the fluorescein in late venous time are confirmed. A genetic deficit of the membrane receptors, at the level of the pigmentary epithelium cells, might explain the selective dystrophia of the cone cells. The different renewal process of cones, compared to the stick cells, stays at the origin of selectively separated pathological processes.

[Variations in intraocular pressure in normal-pressure glaucoma and in hypertensive open-angle glaucoma]. / Studiul variatiilor tensiunii intraoculare în glaucomul cu tensiune normala si glaucomul cu unghi deschis hipertensiv.

The comparative study of the intraocular pressure variations at patients with low-tension glaucoma and hypertensive open-angle glaucoma reveals some common modifications regarding the aspect of the nictemeral levels of intraocular tension (the maximal variation of the nictemeral curve, the time of maximal intraocular pressure, variability) and the aspect of the provocative testes. The nictemeral curves and the provocative testes are used at the patients suspects of low-tension glaucoma both for diagnose and to eliminate the incipient open-angle glaucoma with one tensional pick.

[Tuberculosis of the tarsal conjunctiva]. / Tuberculoza conjunctivei tarsale.

A woman sixty-five old presents one pronounced swelling of the eyelids at the both eyes with the appearance of the multiple chalasions. The patient at twenty-six years old presented pulmonary tuberculosis, in the present stabilized. The morphopathology exam by a fragment of tarsus and conjunctiva shows an lymphocyt inflammatory infiltration with the presence of the epithelial cells and caseation areas. At level of conjunctiva it constats the presence of tuberculum follicles that are present too at the level of Meibomius canals of excretions. The disease is considered like an allergical reaction at endotoxin of Koch bacillus, secondary by some old tubercular lesions.