Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 7 de 7
Filter
1.
J Med Case Rep ; 12(1): 11, 2018 Jan 17.
Article in English | MEDLINE | ID: mdl-29338755

ABSTRACT

BACKGROUND: The incidence of anterior ischemic optic neuropathy after coronary artery bypass graft procedures ranges from 1.3 to 0.25%. The mechanisms of anterior ischemic optic neuropathy after cardiovascular procedures remain undefined but many systemic and related-to-surgery risk factors could underlie anterior ischemic optic neuropathy. In this case, we report a rare presentation of a bilateral anterior ischemic optic neuropathy after coronary artery bypass graft and speculate on the preoperative hyperhomocysteinemia as an independent risk factor for anterior ischemic optic neuropathy. CASE PRESENTATION: A 56-year-old white man, a tobacco smoker with type 2 diabetes and coronary artery disease, underwent a conventional coronary artery bypass graft with extracorporeal circulation. In spite of ongoing anti-aggregation, antithrombotic, and vasodilator therapy, 10 days after the surgery he complained of severe bilateral visual loss. Funduscopy and fluorescein angiography revealed a bilateral anterior ischemic optic neuropathy. Analysis of preoperative laboratory tests revealed hyperhomocysteinemia. CONCLUSION: Hyperhomocysteinemia could increase the risk of ocular vascular damage and bilateral ocular involvement in patients who have undergone conventional coronary artery bypass graft.


Subject(s)
Coronary Artery Bypass/adverse effects , Hyperhomocysteinemia/complications , Optic Neuropathy, Ischemic/etiology , Eye/blood supply , Fluorescein Angiography , Fundus Oculi , Humans , Hyperhomocysteinemia/diagnosis , Male , Middle Aged , Optic Neuropathy, Ischemic/diagnosis , Postoperative Complications , Risk Factors , Vision Disorders/etiology
2.
J Ophthalmol ; 2017: 3161680, 2017.
Article in English | MEDLINE | ID: mdl-28163929

ABSTRACT

Purpose. Ocular trauma with retained foreign body is an important cause of visual impairment in working-age population. Clinical status impacts on the timing and planning of surgery. In the last year small gauge vitrectomy has become safer and more efficient, extending the range of pathologies successfully treated. Aims. To evaluate the safety and outcomes in patients with open eye injury with retained foreign body that underwent early 25-gauge vitrectomy. Methods. In this retrospective, noncomparative, interventional case series, we performed 25-gauge vitrectomy on 10 patients affected by open globe injuries with retained foreign body, over 3 years. We analyzed age, wound site, foreign body characteristics, ocular lesions correlated, relative afferent pupillary defect, visual acuity, and intraocular pressure. Follow-up evaluations were performed at 1, 3, and 6 months. According to the clinical status we performed other procedures to manage ocular correlated lesions. Results. The median age of patients was 37 years. The foreign body median size was 3.5 mm (size range, 1 to 10 mm). 25-gauge vitrectomy was performed within 12 hours of trauma. Foreign body removal occurred via a clear corneal or scleral tunnel incision or linear pars plana scleral access. Visual acuity improved in all patients. Endophthalmitis was never reported. Only two cases reported postoperative ocular hypertension resolved within the follow-up. Retinal detachment recurred in one case only. Conclusions. 25-gauge vitrectomy could be considered as early approach to manage open globe injuries with a retained posterior segment foreign body in selected cases with good outcomes and low complication rate.

3.
Am J Gastroenterol ; 100(1): 207-19, 2005 Jan.
Article in English | MEDLINE | ID: mdl-15654802

ABSTRACT

OBJECTIVE: To perform meta-analyses of studies on outcome of bleeding ulcers of different proton-pump inhibitors (PPIs) regimens, after stratification of patients by endoscopic stigmata, and analysis of studies with and without endotherapy. METHODS: A total of 35 randomized trials comparing PPIs to placebo and/or H2-receptor antagonists (H2RAs) in 4,843 patients with high-risk endoscopic stigmata were retrieved. Outcomes were rebleeding, surgery, and mortality. RESULTS: Monotherapy with oral or bolus PPIs was superior to placebo and H2RAs in reducing rebleeding in both bleeders and nonbleeders at index endoscopy; the need for surgery was reduced only when compared to H2RAs. In nonbleeders, PPI monotherapy was as effective as a combination of endotherapy with H2RAs. A combination of endotherapy with PPIs was superior to monotherapy in reducing bleeding and surgery, and superior to endotherapy alone in minimizing rebleeding, but not surgery; the benefit was lost when confronted to endotherapy plus H2RAs, whether PPIs were given as infusion or bolus. By pooling data from studies comparing high doses of PPIs as continuous infusion versus regular doses as intermittent bolus, rebleeding, surgery, and mortality were not significantly different. CONCLUSIONS: Combination of endotherapy with either PPIs or H2RAs is indicated for nonbleeding ulcers at endoscopy with the intent to reduce rebleeding and surgery. Its value may extend to bleeding lesions, but current data are scanty. The benefit appears to be independent from route and doses of PPIs, as oral, bolus, or infusional methods are all effective.


Subject(s)
Anti-Ulcer Agents/therapeutic use , Hemostasis, Endoscopic , Peptic Ulcer Hemorrhage/therapy , Proton Pump Inhibitors , Combined Modality Therapy , Histamine H2 Antagonists/therapeutic use , Humans , Treatment Outcome
4.
Dig Dis Sci ; 43(1): 51-5, 1998 Jan.
Article in English | MEDLINE | ID: mdl-9508535

ABSTRACT

Controversial data exist in the literature about the presence and clinical relevance of hepatic arterial-venous shunting. An interesting opportunity for reconsidering the problem has been provided by the use, in the study of liver function, of D-sorbitol, a substance whose first-pass hepatic extraction is very high in normal subjects, while being directly related to circulatory alterations in liver cirrhosis. Because of this property, the systemic bioavailability of D-sorbitol during hepatic arterial infusion can be assumed to reflect arterial-venous shunting. Thirteen biopsy-proven cirrhotic patients (ages 35-66 years), who required diagnostic arterial catheterization, entered the study. Patients were studied on two subsequent days, in which a sterile pyrogen-free solution (1.5%) of D-sorbitol was administered by direct low-rate infusion (15 mg/min for 20 min) into the hepatic artery and the systemic circulation, respectively. Urine samples were spontaneously collected for 8-hr periods before and during/after each infusion. The hepatic arterial bioavailability of D-sorbitol was calculated as the ratio between the net cumulative urinary outputs of D-sorbitol after infusions into the hepatic artery and the systemic vein. Observed values confirm the existence and the large variability (0-88.7%) of hepatic arterial-venous shunting in cirrhotic patients.


Subject(s)
Liver Circulation/physiology , Liver Cirrhosis/physiopathology , Adult , Aged , Biological Availability , Female , Hepatic Artery , Humans , Male , Middle Aged , Sorbitol/metabolism
5.
Dig Dis Sci ; 36(9): 1189-96, 1991 Sep.
Article in English | MEDLINE | ID: mdl-1893803

ABSTRACT

A diagnostic protocol was studied, designed to evaluate the main parameters of liver circulation in man. A water solution of D-sorbitol (S) and indocyanine green (ICG) was infused intravenously in six controls and nine cirrhotics. Steady-state renal and hepatic S clearances as well as hepatic ICG clearance were calculated. In controls the values (mean +/- SD) of the independent measurements of S and ICG hepatic clearance were 978 +/- 107 and 519 +/- 142 ml/min, respectively, while in cirrhotic patients they were 554 +/- 238 and 231 +/- 90 ml/min. Owing to the kinetic properties of S, its hepatic clearance may be regarded as a measure of functional liver plasma flow (FLPF). The total liver plasma flow (TLPF) values (mean +/- SD), calculated according to Fick's principle, were 1091 +/- 157 ml/min (S method) and 1033 +/- 153 ml/min (ICG method) in controls, and 1251 +/- 554 and 1284 +/- 677 ml/min in cirrhotics. In controls, FLPF was found to be very close to TLPF. In cirrhotic patients the difference between TLPF and FLPF (ranging from 169 to 2093 ml/min when measured by S method) was considered as an approximate estimate of intrahepatic shunting. The procedure is safe and simple and may add a new dimension to the investigation of hepatic circulation.


Subject(s)
Hepatic Veins/physiopathology , Liver Circulation/physiology , Liver Cirrhosis, Alcoholic/physiopathology , Portal Vein/physiopathology , Sorbitol , Adult , Blood Flow Velocity/physiology , Catheterization, Peripheral , Clinical Protocols , Female , Humans , Indocyanine Green , Infusions, Intravenous , Liver Function Tests , Male , Middle Aged
6.
Ric Clin Lab ; 18(4): 305-11, 1988.
Article in English | MEDLINE | ID: mdl-3247561

ABSTRACT

The hepatic clearance of D-sorbitol was proven to be a reliable parameter for evaluating the functional liver plasma flow. Twenty-five normal subjects and 50 cirrhotic patients were studied in order to assess if the measure of the plasma disappearance rate of sorbitol can be used as a simpler procedure to evaluate changes in liver perfusion and to predict modifications of drug bioavailability due to circulatory events. The plasma disappearance rate was calculated between 10 and 20 min after intravenous administration of a 2-g dose because in this time interval plasma levels were in the optimum range for the chemical assay, and the plasma concentration/time curve fitted a decreasing exponential function. Plasma disappearance rate values were found to correlate significantly (r = 0.666, p less than 0.001) with sorbitol hepatic clearance, as calculated after the 2-h test. The test had a good day-to-day reproducibility both in normal subjects and cirrhotic patients. In 5 patients submitted to surgical side-to-side portacaval shunt, decreases of plasma disappearance rate and sorbitol hepatic clearance showed no significant difference. Mean values (+/- SD) of D-sorbitol plasma disappearance rate were 0.048 +/- 0.014 min-1 in cirrhotic patients, and 0.081 +/- 0.014 min-1 in normal subjects (p less than 0.001).


Subject(s)
Liver Circulation , Liver Cirrhosis/blood , Sorbitol/blood , Blood Flow Velocity , Humans , Kinetics , Liver Cirrhosis/surgery , Portacaval Shunt, Surgical
7.
Allergol Immunopathol (Madr) ; 8(5): 429-38, 1980.
Article in English | MEDLINE | ID: mdl-7468394

ABSTRACT

The authors would first like to stress the increasing frequency of bronchial asthma during or after influenza. To find an explanation for this occurrence they observed tissue reactions following an injection of viral material. In their experiments, they injected into the skin of guinea pigs, strains of the Hong Kong, Texas and USSR influenza viruses using current vaccines, sacrificing groups of animals 2, 6, 24, 48 hours and 7 days after the injection. The histological study revealed the following picture of reaction to influenza viruses. Two hours after the injection: marked and diffuse infiltration of eosinophils in the connective tissue of the skin. After 6 hours: the infiltration shows a predominance of neutrophils. After 24 hours: the neutrophil infiltration is predominant and diffuse. There is evidence of considerable degranulation of eosinophils. The cutaneous histiocytes undergo fibrocytic and marcophagic proliferation. After 28 hours, the same picture. After 7 days there is sever degeneration with a peripheral fibroblastic reaction. The most important finding of this experiment is the early marked infiltration of eosinophils which follows the injection of the influenza viruses. The eosinophil infiltration appears to be related to the release of histamine caused by influenza viruses. The histological examination did not reveal the presence of immune allergic-type cells at any time. Therefore, the onset of asthmatic attacks would appear to be more related to the histamine-releasing action of the influenza viruses rather than to their sensitizing activity. Naturally, the latter may occur in human pathologies.


Subject(s)
Eosinophilia/etiology , Orthomyxoviridae Infections/complications , Skin Diseases/etiology , Animals , Asthma/etiology , Disease Models, Animal , Eosinophilia/pathology , Guinea Pigs , Orthomyxoviridae , Rabbits , Skin Diseases/microbiology , Skin Diseases/pathology
SELECTION OF CITATIONS
SEARCH DETAIL
...