Tear Film and Ocular Surface Evaluation in Gestational Diabetes Mellitus.

BACKGROUND: Dry eye syndrome is one of the complaints of diabetic patients. The aim of the present study was to evaluate the tear functions in pregnant women with gestational diabetes mellitus (GDM) using tests: Schirmer, tear break-up time (TBUT), and tear film osmolarity (TFO) tests and the Ocular Surface Disease Index score (OSDI). METHODS: Pregnant women with GDM (Group 1, n=46) and healthy pregnant women (Group 2, n=36) were enrolled. Initially, all participants were asked to answer the OSDI and then they underwent a detailed ophthalmic examination including Schirmer, TBUT, and TFO tests. The individuals with ocular or systemic disorders that might affect the tear function tests and who were using topical medications were excluded. RESULTS: The results of Schirmer, TBUT, TFO tests and OSDI scores were 11.20±4.93 mm, 5.59±2.16 sec, 309.65±14.80 mOsm/L, and 9.59 ± 9.69 in Group 1, respectively, and 12.33±5.33 mm, 5.67±2.68 sec, 308.36±16.00 mOsm/L, and 10.62±8.66 in Group 2, respectively. There was no significant difference in any of the tear function tests and OSDI scores between the study groups (p>0.05). CONCLUSION: GDM seems to have no negative effects on tear function tests. This may be due to a lack of duration of hyperglycemia long enough to affect the tear function tests of pregnant women.

The effects of blood glucose regulation on tear function tests in diabetic patients.

PURPOSE: To investigate whether blood glucose regulation in patients with diabetes mellitus (DM) has an influence on the ocular surface disease index (OSDI) score and tear function tests such as tear film osmolarity (TFO), tear break-up time (TBUT) and Schirmer tests. METHODS: Fifty diabetic patients with a fasting blood glucose (FBG) level greater than 200mg/dL and HbA1c level greater than 10% were recruited for this prospective study. All of the patients underwent a detailed ophthalmic examination including OSDI questionnaire, TFO test, TBUT test and Schirmer test initially. All tests were repeated after obtaining regulation of patients' blood sugar (approximately 6 weeks later). RESULTS: The mean age of the diabetic patients in the study was 54.96±12.48 years. Initially, the mean FBG, postprandial blood glucose (PBG) and HbA1c levels were 301.40±79.11mg/dL, 431.06±74.47mg/dL and 12.31±1.67%, respectively. After blood glucose regulation; the levels of all parameters (153.78±59.32mg/dL, 252.32±88.34mg/dL and 9.67±1.60%, respectively) statistically significantly decreased (P<0.001). The mean levels of OSDI score, TFO measurement, TBUT test and Schirmer test were 28.38±16.46 points, 349.66±13.09 mOsm/L, 6.44±1.91s and 8.66±3.57mm initially, and 17.82±11.70 points, 314.14±12.80 mOsm/L, 6.62±2.03s and 9.02±3.68mm after blood glucose regulation, respectively. Although the improvements in TBUT and Schirmer test values were not statistically significant (P>0.05), statistically significant reduction was obtained in OSDI scores and TFO levels (P<0.001, for each). CONCLUSION: DM, which is a hyperosmolar disorder, appears to cause elevation in OSDI score and increase in TFO level, especially if blood glucose is poorly regulated.

Refractive errors and refractive development in premature infants.

PURPOSE: To examine refractive errors and refractive development in premature infants. METHODS: Premature infants in the retinopathy of prematurity (ROP) screening program were recruited and examined longitudinally between 28 and 58 weeks postmenstrual age. For performing cycloplegic retinoscopy, 1% tropicamide was administered, two drops with a 10-minute interval, in order to paralyze accommodation and to achieve cycloplegia. Birth weight, gestational age, gender and acute ROP disease were recorded. The relationship between spherical equivalent, astigmatism and postmenstrual age was evaluated. RESULTS: A total of 798 readings were obtained from 258 infants (131 females, 127 males) between 28 and 58 weeks postmenstrual age. The median number of examinations was 3 (minimum 1, maximum 7). In the comparisons of birth weight, gestational age, spherical equivalent and astigmatism between genders, there were no statistically significant differences (P>0.05). Gestational age (regression analysis, r(2)=0.30, P<0.01) and birth weight (regression analysis, r(2)=0.22, P<0.01) had a significant effect on refractive error development. Preterm babies with lower birth weight and those born more prematurely had lower spherical equivalent. The spherical equivalent of the eyes correlated significantly with the postmenstrual age of the infants (r=0.512, P<0.01). CONCLUSIONS: Infants with low gestational age and low birth weight also had low spherical equivalent. Moreover, spherical equivalent correlated with increasing postmenstrual age. However, astigmatism did not correlate with postmenstrual age and did not associate with gestational age or birth weight.

Synthesis and biological evaluation of some new amide moiety bearing quinoxaline derivatives as antimicrobial agents.

In this study, we aimed to synthesize some new quinoxaline derivatives bearing amide moiety and to evaluate their antimicrobial activity. A set of 16 novel compounds of N-[2,3-bis(4-methoxy/methylphenyl)quinoxalin-6-yl]-substituted benzamide derivatives were synthesized by reacting 2,3-bis(4-methoxyphenyl)-6-aminoquinoxaline or 2,3-bis(4-methylphenyl)-6-aminoquinoxaline with benzoyl chloride derivatives in tetrahydrofuran and investigated for their antimicrobial activity. The structures of the obtained final compounds were confirmed by spectral data (IR, (1)H-NMR, (13)C-NMR and MS). The antimicrobial activity of the compounds were determined by using the microbroth dilution method. Antimicrobial activity results revealed that synthesized compounds exhibited remarkable activity against Candida krusei (ATCC 6258) and Candida parapsilosis (ATCC 22019).

Microphthalmia in a case of Edward syndrome.

AIM: To present an infant of trisomy 18 (Edwards Syndrome) with unilateral microphthalmia. METHODS: A female infant who was born at 41 weeks of gestation had been diagnosed with Edwards Syndrome (ES). On ophthalmic examination, microphthalmia, microcornea, optic disc coloboma, and persistent hyaloid artery were determined in the left eye. In addition, abnormalities in the ears, hands, feet, and cardiovascular system were present. DISCUSSION: With this case report, we aimed to highlight the relationship between ocular disgenesis and chromosomal disorders and the importance of prenatal testing and genetic counseling for parents.

A new ocular trauma score in pediatric penetrating eye injuries.

PURPOSE: To assess the prognostic value of a new ocular trauma score (OTS) in pediatric penetrating injuries. METHODS: Children ≤ 15 years of age that presented to the emergency room with penetrating eye injuries between April 2007 and August 2008 were evaluated prospectively. All patients were reviewed on the basis of age, gender, time of injury and how it happened, time of admission, time of surgery, type of penetrating injury, initial and final visual acuity (VA), and concomitant eye pathology. Injuries were classified based on a new OTS, and we assessed the relationship with final VA and the new OTS. RESULTS: In total, 30 eyes in 29 patients (41.38% female, 58.62% male) with a mean age of 6.83 ± 4.00 years (range: 1-15 years) were included in the study. Initial VA, which was evaluated in 22 patients, was as follows: no light perception (NLP) in 2 (9.09%) patients, light perception (LP) to hand motion (HM) in 8 (36.36%) patients, counting fingers in 6 (27.27%) patients, 0.1-0.5 in 4 (18.18%) patients, and ≥ 0.6 in 2 (9.09%) patients. Final VA, which was evaluated in 27 patients, was as follows: NLP in 3 (11.11%) patients, LP to HM in 3 (11.11%) patients, counting fingers in 2 (7.41%) patients, 0.1-0.5 in 11 (40.74%) patients, and ≥ 0.6 in 8 (29.63%) patients. The relationship between initial VA and final VA was statistically significant (P < 0.001). CONCLUSIONS: The new OTS calculated at initial examination may be of prognostic value in children with penetrating eye injuries.

An approach to the detection of lesions in mammograms using fuzzy image processing.

An algorithm was developed in this study, using rule-based fuzzy logic, to enable masses that are hard to recognize or detect in mammograms to become more readily perceptible. Small lesions, such as microcalcifications and other masses that are hard to recognize, especially on film scan mammograms, were processed through segmentation. A total of 40 mammograms were used and they were classified by radiologists into three groups: those with microcalcifications (n=15), those with tumours (n=15), and those with no lesions (n=10). Five mammograms were taken as training data sets from each of the groups with microcalcifications and tumours. The algorithm was then applied to data not taken for training. The algorithm achieved a mean accuracy of 99% compared with the findings of the radiologists.

Skull metastasis of follicular thyroid carcinoma.

Metastasis of a follicular thyroid carcinoma (FTC) to the skull is very rare. We present a case of solitary lytic skull metastasis of a FTC in a 30-year-old woman. The patient presented with bulging on the left side of the head. Neuro-imaging techniques showed a lesion with an osteolytic component in the left frontal region. After a left frontal craniectomy the tumour was removed totally. The histopathological examination revealed a well-differentiated FTC metastasis and a complete total thyroidectomy was subsequently performed. The patient was given thyroid-stimulating hormone (TSH) suppression therapy followed by whole body iodine-131 (I131) internal radiation.

Intraradicular lumbar disc herniation: report of two cases and review of the literature.

Intraradicular lumbar disc herniation is very rare. The exact mechanism of the dural tear by a herniated disc is not known. Diagnosis of intraradicular lumbar disc herniation is difficult, so that it is rarely suspected preoperatively. This pathological entity may be a factor in the failure of lumbar disc surgery. We present the seventeenth and eighteenth cases of intraradicular lumbar disc herniation. We emphasise its importance and review the literature on intraradicular disc herniation.

Posttraumatic isolated infarction in the territory of Heubner's and lenticulostriate arteries: case report.

A 12 year old male had a secondarily generalized epileptic seizure and a subsequent right hemiparesis with fasciobrachial predominance after a closed head injury. His seizures responded to antiepileptic drug therapy immediately. Computerized tomographic scanning and magnetic resonance imaging showed an acute infarct of the head of the left caudate nucleus, indicating the isolated occlusion of the left recurrent artery of Heubner and lateral lenticulostriate arteries. Pathologies leading to vasculitis and embolism were also looked for, but no finding of associated systemic disease could be disclosed. We present this case since posttraumatic infarction in the territory of the deep perforators such as recurrent artery of Heubner and lateral lenticulostriate arteries are exceptionally rare conditions especially in this age group.

Intracranial penetrating injury associated with an intraoperative epidural haematoma caused by a spring-laden pin of a multipoise headrest.

Lack of an intermediary piece that should have been placed between the pin and spring resulted in skull penetration due to a rapid waste in the spring's compensatory capacity. Checking integrity of internal pieces should be performed regularly. Designing intermediary piece and spring as a single piece might increase safety.

Ossified thoracic spinal meningioma in childhood: a case report and review of the literature.

Spinal ossified meningiomas are extremely rare. This is a report of a study on a 15-year-old boy with thoracic spinal ossified meningioma. The meningioma was resected totally. Histopathological examination revealed a transitional meningioma (psammomatous+meningothelial). Immunohistochemically, Ki 67 antibody was applied but no positive staining was present. The surgical and pathological aspects of spinal ossified meningiomas were reviewed.

Giant thrombosed aneurysm of the vertebral artery in childhood: an extremely rare case.

In childhood, a significant proportion of giant aneurysms usually occur at the vertebrobasilary system. Nonetheless, giant totally thrombosed aneurysm which only involves the vertebral portion of the vertebrobasilary system is very rare. Up to this time, in childhood, a few giant aneurysm originating from vertebral artery have been reported, and to our knowledge only one case was reported to be totally thrombosed. The enlargement tendency of totally thrombosed aneurysms and management of these cases are still controversial. Thus, diagnosis and follow-up of cases where a radical approach could not be performed require a multi-modality radiologic approach. In this study, we reported a case of angiographically occult giant thrombosed vertebral artery aneurysm, which is extremely rare, and discussed the importance of CT and MRI in evaluation of these patients before surgical treatment.

Delayed traumatic intracerebral hematoma.

Although delayed traumatic intracerebral hematomas (DTICHs) have been frequently reported since 1970, the time interval from trauma to hemorrhage and diagnosis has not been well defined. Eight patients with DITCH were found among 1,320 head-injured patients admitted to the neurosurgical service through the emergency department from March 1989 to March 1990. The mean time interval between initial and follow-up CT scan was 22 h. The mean time interval between initial trauma and diagnosis of DITCH was 24 h. One patient was diagnosed incidentally by magnetic resonance imaging. Three patients underwent operation and five patients were managed conservatively. Three patients died, resulting in a case mortality rate of 37.5%. The time interval for DTICHs' development and pitfalls in its diagnosis were discussed.

Endobronchial tuberculosis simulating foreign body aspiration.

A case of sudden onset of severe respiratory distress is reported. Appropriate clinical and roentgenologic findings suggested foreign body aspiration. The foreign body was removed by fiberoptic rigid bronchoscope. Bronchoscopic, histopathologic, and microbiologic findings revealed that the foreign body was a granulomatous mass originating from endobronchial tuberculosis.

Diluted yogurt (ayran) versus water in dissolving oral rehydration salts.

Seventy-six children with gastroenteritis were treated with oral rehydration salts dissolved in ayran (diluted yogurt), and eighty patients were treated with oral rehydration salts dissolved in water. The patients whose ages ranged between three and twelve months accepted both solutions equally. However, the acceptance of the ayran-based solution was significantly greater than WHO's salt solution in the patients whose ages ranged between one and four years. It is proposed that ayran be used to dissolve oral rehydration salts in the treatment of diarrhea since it is more palatable and easily acceptable by children.

Monitoring cerebral blood flow during intracranial operations: an intravenous injection method.

A method of measuring cerebral blood flow during neurosurgery is described. It is an adaptation of the standard 133Xe intravenous injection method, with computation restricted to data collected over the first 3 min. In addition to a theoretical presentation of the method and an analysis of the effect of residual 133Xe activity when sequential runs are performed in close approximation, the technique is validated experimentally by comparison with intracarotid 133Xe injection in baboons.