Photochemical Crosslinking of Tarsal Collagen as a Treatment for Eyelid Laxity: Evaluation in Ex Vivo Human Tissue.

PURPOSE: Experimental investigation in human eyelids to confirm that exposing excised tarsal plates to ultraviolet-A radiation can induce a stiffening effect through the riboflavin-photosensitized crosslinking of tarsal collagen. METHODS: Thirteen tarsal plates excised from nonfrozen human cadavers were irradiated with ultraviolet-A rays (365 nm wavelength) at an irradiance of 75 mW/cm2 for 3 minutes, equivalent to a radiation fluence of 13.5 J/cm2, in the presence of a riboflavin derivative as a photosensitizer. The tensile stress (strength) and Young's modulus (stiffness) of both nonirradiated and irradiated specimens were measured with the BioTester 5000 in the uniaxial mode at a strain of 10% and analyzed statistically. Individual specimens excised from 2 cadavers were also examined by routine histopathologic protocols to assess the effect of radiation on the Meibomian glands and collagen organization. RESULTS: The irradiation enhanced both stiffness and strength of the human tarsal specimens, the difference between the test samples and controls being statistically significant (p < 0.0002 for n = 13). Histology indicated no damage to tarsal connective tissue or to Meibomian glands, and revealed a more compact packing of the collagen network located around the glands, which may be beneficial. The existence of collagen compaction was also supported by the reduction of samples' thickness after irradiation (p = 0.0645). CONCLUSIONS: The irradiation of tarsal tissue with ultraviolet-A light of tarsus appears to be a safe and effective method for reducing eyelid laxity in human patients.

Incidence and Antifungal Susceptibility of Candida Albicans Infections.

INTRODUCTION: Candida albicans is the most common inhabitant of the skin, mouth, vagina and gastro intestinal tract of human beings. One of the major reasons for the increase in Candida infection is the development of its resistant strains due to drugs used in the treatment of candidiasis. MATERIALS AND METHODS We studied 4027 samples collected from patients in various wards of the Emergency County Hospital Craiova, Romania between 2014-2015. The specimens were: pharyngeal exsudates, sputum, tracheal secretions, skin secretions, stools, ear secretions, urine, vaginal secretions. All the specimens were transported to the microbiology laboratory and cultured within 3 to 4 h of collection. Among the 4027 samples, 652 showed culture characteristics similar to Candida albicans.The samples were inoculated under sterile conditions using Sabouraud culture media, a medium designed to inhibit bacterial growth and allow the development of fungi. Antifungal Susceptibility Testing was performed by disc diffusion according to CLSI 2014 guidelines using: clotrimazole, ketoconazole, miconazole, econazole, amphotericine B, fluorocytozine, nistatin. RESULTS AND DISCUSSION In our study group the urocultures and dermatological products have a high infection rate, between 100% to 70%, in contrast, we find evidence of secretion ear (3.13%) and the throat swab (9.33%). Various resistant levels were detected against antifungal drugs but, complete resistance to 5 - Fluorocitozina (100%), and the organisms showed highly sensitive to Cotrimazol si Ketoconazol (100%). In the case of Miconazol 256 (39, 26%), Econazol, 215 (32,98%), Amphotericinei B, 230(35,28%). Nystatin 329 (50,46%). CONCLUSIONSElucidating these mechanisms may provide new foundations for antifungal chemotherapy and can present an exciting challenge for the future investigations. Candida albicans infections are present and diverse clinical pathology.

Fluoroscopy-based navigation system in spine surgery.

The variability in width, height, and spatial orientation of a spinal pedicle makes pedicle screw insertion a delicate operation. The aim of the current paper is to describe a computer-assisted surgical navigation system based on fluoroscopic X-ray image calibration and three-dimensional optical localizers in order to reduce radiation exposure while increasing accuracy and reliability of the surgical procedure for pedicle screw insertion. Instrumentation using transpedicular screw fixation was performed: in a first group, a conventional surgical procedure was carried out with 26 patients (138 screws); in a second group, a navigated surgical procedure (virtual fluoroscopy) was performed with 26 patients (140 screws). Evaluation of screw placement in every case was done by using plain X-rays and post-operative computer tomography scan. A 5 per cent cortex penetration (7 of 140 pedicle screws) occurred for the computer-assisted group. A 13 per cent penetration (18 of 138 pedicle screws) occurred for the non computer-assisted group. The radiation running time for each vertebra level (two screws) reached 3.5 s on average in the computer-assisted group and 11.5 s on average in the non computer-assisted group. The operative time for two screws on the same vertebra level reaches 10 min on average in the non computer-assisted group and 11.9 min on average in the computer-assisted group. The fluoroscopy-based (two-dimensional) navigation system for pedicle screw insertion is a safe and reliable procedure for surgery in the lower thoracic and lumbar spine.

Endometrial cancer: asymptomatic endometrial findings. Characteristics of postmenopausal endometrial cancer.

Endometrial cancer affects patients at every age, however it occurs more frequently in menopause (> 50) and in postmenopause (> 70). The most frequent symptoms are bleeding and vaginal discharge. When hematometra or pyometra is present the patient may feel pain. In some cases endometrial adenocarcinoma is asymptomatic and the diagnosis is casually made during ultrasound examination or by histological examination of a uterus surgically removed for other indications. In these cases the most frequent findings are polyps and abnormally increased thickness of the endometrial mucosa. In postmenopause polyps and abnormal endometrial thickness are usually limited to a small area and surrounded by atrophic mucosa. Higher incidence rates of endometrial cancer were correlated with polyps and an increased number of serous type tumors were identified in the > 65-year age group. Endometrial carcinoma may be estrogen correlated or non-estrogen associated. Patients in postmenopause are often affected by non-estrogen correlated endometrial carcinoma. According to Kurman and other authors the first type of endometrial adenocarcinoma (estrogen correlated) is characterized by low-grade malignancy. On the contrary, non-estrogen correlated neoplasia is more aggressive. In our case series including 102 women aged > 70 years with endometrial carcinoma we found that survival was correlated with stage and grading - early stages were the most frequent and the grade increased with stage. In fact all the patients with relapses had grade 2 or 3 adenocarcinomas. Thirty-one patients > 70 years (30.69%) had a non-endometrioid type of cancer.

Accuracy of office hysteroscopy in the diagnosis of endometrial hyperplasia.

In the last decade the advantages of office hysteroscopy performed without cervical dilatation and/or anaesthesia were fully demonstrated. Many authors consider office hysteroscopy the gold standard diagnostic method in the diagnosis of intrauterine pathology, with high accuracy and compliance. The best sensitivity and specificity are reached in the diagnosis of focal lesions as submucous myomas and polyps but controversy still persists regarding hysteroscopic accuracy in the definition of endometrial hyperplasia. The aim of this prospective study was to evaluate the efficacy of outpatient hysteroscopy in the diagnosis of endometrial hyperplasia and to compare hysteroscopic findings with histology. From April 2000 to May 2002, 145 diagnostic office hysteroscopies were performed at the Euganea Medica clinic. Sensitivity in the detection of endometrial hyperplasia was 89.36%, specificity 91.96%, positive predictive value (PPV) 82.36% while negative predictive value (NPV) reached 95.37%. Uniformity of histology associated with outpatient mini-invasivity and high compliance favour office hysteroscopy and represent important elements in its diffusion as a first level diagnostic method even in the diagnosis of hyperplasia.

Detecting early glaucoma by assessment of retinal nerve fiber layer thickness and visual function.

PURPOSE: To compare the abilities of scanning laser polarimetry (SLP), optical coherence tomography (OCT), short-wavelength automated perimetry (SWAP), and frequency-doubling technology (FDT) perimetry to discriminate between healthy eyes and those with early glaucoma, classified based on standard automated perimetry (SAP) and optic disc appearance. To determine the agreement among instruments for classifying eyes as glaucomatous. METHODS: One eye of each of 94 subjects was included. Healthy eyes (n = 38) had both normal-appearing optic discs and normal SAP results. Glaucoma by SAP (n = 42) required a repeatable abnormal result (glaucoma hemifield test [GHT] or corrected pattern standard deviation [CPSD] outside normal limits). Glaucoma by disc appearance (n = 51) was based on masked stereoscopic photograph evaluation. Receiver operating characteristic (ROC) curve areas, sensitivities, and specificities were calculated for each instrument separately for each diagnosis. RESULTS: The largest area under the ROC curve was found for OCT inferior quadrant thickness (0.91 for diagnosis based on SAP, 0.89 for diagnosis based on disc appearance), followed by the FDT number of total deviation plot points of < or =5% (0.88 and 0.87, respectively), SLP linear discriminant function (0.79 and 0.81, respectively), and SWAP PSD (0.78 and 0.76, respectively). For diagnosis based on SAP, the ROC curve area was significantly larger for OCT than for SLP and SWAP. For diagnosis based on disc appearance, the ROC curve area was significantly larger for OCT than for SWAP. For both diagnostic criteria, at specificities of > or =90% and > or =70%, the most sensitive OCT parameter was more sensitive than the most sensitive SWAP and SLP parameters. For diagnosis based on SAP, the most sensitive FDT parameter was more sensitive than the most sensitive SLP parameter at specificities of > or =90% and > or =70% and was more sensitive than the most sensitive SWAP parameter at specificity of > or =70%. For diagnosis based on disc appearance at specificity of > or =90%, the most sensitive FDT parameter was more sensitive than the most sensitive SWAP and SLP parameters. At specificity > or = 90%, agreement among instruments for classifying eyes as glaucomatous was poor. CONCLUSIONS: In general, areas under the ROC curve were largest (although not always significantly so) for OCT parameters, followed by FDT, SLP, and SWAP, regardless of the definition of glaucoma used. The most sensitive OCT and FDT parameters tended to be more sensitive than the most sensitive SWAP and SLP parameters at the specificities investigated, regardless of diagnostic criteria.

Discriminating between normal and glaucomatous eyes using the Heidelberg Retina Tomograph, GDx Nerve Fiber Analyzer, and Optical Coherence Tomograph.

OBJECTIVE: To compare the ability of 3 instruments, the Heidelberg Retina Tomograph (HRT), the GDx Nerve Fiber Analyzer (GDx), and the Optical Coherence Tomograph (OCT), to discriminate between healthy eyes and eyes with early to moderate glaucomatous visual field loss. SUBJECTS AND METHODS: Forty-one patients with early to moderate glaucomatous visual field loss and 50 healthy subjects were included in the study. The HRT, GDx, and OCT imaging and visual field testing were completed on 1 eye from each subject within a 6-month interval. Statistical differences in sensitivity at fixed specificities of 85%, 90%, and 95% were evaluated. In addition, areas under the receiver operating characteristic (ROC) curve were compared. RESULTS: No significant differences were found between the area under the ROC curve and the best parameter from each instrument: OCT thickness at the 5-o'clock inferior temporal position (mean +/- SE, 0.87 +/- 0.04), HRT mean height contour in the nasal inferior region (mean +/- SE, 0.86 +/- 0.04), and GDx linear discriminant function (mean +/- SE, 0.84 +/- 0.04). Twelve HRT, 2 GDx, and 9 OCT parameters had an area under the ROC curve of at least 0.81. At a fixed specificity of 90%, significant differences were found between the sensitivity of OCT thickness at the 5-o'clock inferior temporal position (71%) and parameters with sensitivities less than 52%. Qualitative assessment of stereophotographs resulted in a sensitivity of 80%. CONCLUSION: Although the area under the ROC curves was similar among the best parameters from each instrument, qualitative assessment of stereophotographs and measurements from the OCT and HRT generally had higher sensitivities than measurements from the GDx.

Congenital or torsion-induced absence of Fallopian tubes. Two case reports.

Unilateral absence of a uterine tube is an extremely rare finding, for which there are two possible etiopathogenic causes: in some cases it is due to haemorrhage filling of the cavity and its reabsorption as a result of asymptomatic torsion of the uterine tube during adult life, in pediatric age or even during intrauterine life; alternatively, the absence may be congenital, associated with developmental alterations of the mesonephric and paramesonephric ducts. The article presents two cases of fallopian tube absence: a congenital monolateral absence and a tubal torsion during pregnancy. The symptomatology of the torsion of the fallopian tube in pregnancy can be milder than in the classic description with peritoneal reaction and severe clinical alteration. The main risk factors for tubal torsion are: adhesions and inflammatory processes, ovarian cysts, usually of dermoid type, menstrual period, pregnancy, abnormal long mesosalpinx and/or mesovarium, pelvic congestion induced by constipation and disturbed venous blood flow from the adnexa. A congenital defect of the mesonephric duct is followed by a homolateral defect of the paramesonephric duct. The resulting anomaly is characterized by the absence of the uterine tube, uterus-tube angle, kidney and ureter. Partial or total unilateral defects of a paramesonephric duct are more common than aplasia of both ducts. Some authors have suggested that an inadequate blood supply during the descent into the pelvis of the caudal part of the paramesonephric duct might feasibly lead to incomplete tube development.

Hysteroscopic follow-up in tamoxifen treatment for breast cancer.

In the postmenopausal women endocrinotherapy proves to be as useful as the cytotoxic treatment in breast cancer therapy, regarding the percentage and duration of response, both in prophylactic and palliative therapy, with the advantage of milder side-effects and a better quality of life. This study was carried out in order to evaluate the Tamoxifen weak estrogenic activity, which could appear during long-term therapies, determining endometrial morphological modifications. Twenty-one postmenopausal women suffering from breast cancer underwent hysteroscopy with target biopsy or curettage at the same time with mastectomy and afterwards during additional Tamoxifen treatment at 12 and 24 months. Our results confirm that this simple, outpatient endoscopic investigation should be provided as a routine in the follow-up of oncologic patients during hormonotherapy.

Risk factors for breast cancer. Case-control study results.

The great importance of knowing the risk factors for breast pathology in order to reveal the risk categories is well known. In many geographical areas breast cancer is the most common female neoplasm. Recent Italian statistics point out that every year 83 women out of 100,000 develop breast cancer and that its incidence is increasing. Every year in Italy 10,000 women die of breast cancer. In our retrospective study 146 women suffering from breast cancer, treated in our Institute from 1970 to 1993, were enrolled. We excluded 4 patients, surgically treated in another Institute and 35 who presented a second or a third gynaecological cancer. We considered age, menarche, parity and menopausal age in all patients in order to evaluate the association of these risk factors with breast cancer development. The average age when neoplasm was first diagnosed was 53.07 years (between 30-84 years), with a 9.4% incidence in patients under 35 years old. In 41.1% of the cases, menarche was present under 12 years and in only 14.1% after 14 years, therefore confirming the reduction of mammary cancer risk in women with late menarche. Twenty one point five per cent of the patients were nulliparous. In our case series no protective factor seemed to be related with 1 or 2 pregnancies (43.9%). The menopausal average age was 50.2, with an average fertile life period of 37.1 years. Our study also considered the location of the primary neoplasia (60.7% in the upper-outer quadrant), the tumor size (3.08 cm average diameter) and the histological type (81.3% ductal form).(ABSTRACT TRUNCATED AT 250 WORDS)

Short-term results of combined radioimmunotherapy in inoperable lung cancer.

Fifty-three inoperable lung cancer patients were treated with radiotherapy combined with immunostimulation with BCG. A good response was obtained in 30 patients (56%); the results were not significantly different than those obtained with a control group of 50 lung cancer patients matched by age, sex and stage of the disease (24 out of 50 equals 46%). These short-term results were compared with the immunologic "status" of patients evaluated before treatment by the parameters monitoring in vivo and in vitro delayed type hypersensitivity. The good response to therapy was documented in a higher percentage of patients with positive skin tests to recall and standard antigens and with normal values of lymphocyte transformation with PHA and Rosette E-forming cells, in comparison with patients with low levels of immunocompetence. An impairment of the cell-mediated immune response was found after combined therapy, presumably due to radiotherapy. BCG was not able to restore the patient's immunocompetence, no effect on host's immune reactivity was demonstrated. As regards humoral immunity, the patients with low levels of IgG before treatment (12/14) showed a good response.

Affinity and specificity of penicillin-antibody interaction determined by an enzyme (E. coli beta-galactosidase) immunoassay.

An enzyme immunoassay (EIA) for a penicillin derivative is described with a sensitivity at least at the nanogram level. The label, E. coli beta-galactosidase is a macromolecule of 540 000 daltons: the size of the enzyme and the ease of linking penicilloyl residues to it make it an interesting model to study the effect of the degree of haptenic substitution (DS) in the tracer on the parameters of EIA. Our results show that the affinity of the binding reaction between antibody and tracer is proportional to the DS but the sensitivity of inhibition is not affected, at least not between 1 and 10 penicilloyl residues per GZ molecule. The theoretical consequences and practical applications of multivalent tracers in EIA are discussed.

Carbohydrate metabolism in PHA stimulated human peripheral blood lymphocytes.

Human peripheral blood lymphocytes (PBL) stimulated in vitro by phytohemoagglutinin (PHA) manifest augmented glycolysis and oxidation of glucose-1-14C, indicating an increased utilization of the pentose pathway. Lactic acid production, as index of increased glycolysis, follows the same kinetic of thymidine incorporation and can be easily quantitated by an enzymatic assay.