Central Macular Thickness in Diabetic Macular Edema.

CONTEXT: Retinal microvascular dysfunction differs in macular edema lesions in the two eyes of the same patient with diabetic retinopathy. OBJECTIVE: To evaluate the relationship between central macular thickness (CMT) and metabolic/systemic factors including anthropometric and laboratory findings, in patients with regressed diabetic retinopathy and a history of pars plana vitrectomy (PPV) combined with internal limiting membrane peeling in one eye. SUBJECTS AND METHODS: Forty-two eyes with PPV and the same patients' fellow 42 eyes (without PPV) included this study. Fasting blood samples of these 42 diabetics were collected to study adiponectin levels and other routine parameters. RESULTS: The average hemoglobinA1c value was 7.3±1.3%. CMT of the vitrectomized eyes were significantly correlated with atherogenic index of plasma, total cholesterol, low density lipoprotein cholesterol and uric acid (UA). On the other hand, CMT of the nonvitrectomized fellow eyes significantly correlated with glucose levels and diabetes duration. Adiponectin, adiponectin/body mass index, adiponectin/fibrinogen were found significantly higher in the subgroup with CMT≥300µm in the vitrectomized eyes (P<0.05). UA levels were higher in the subgroup with CMT≥300µm in the fellow (nonvitrectomized) eyes (P<0.05). CONCLUSIONS: Although there was no relationship between CMT and hemoglobinA1c values, CMT seemed to be affected by atherogenicity, prooxidant chemical alterations in the course of inflammation, so determination of adiponectin and UA levels may be suggested before surgery to predict the atherosclerotic damage and the postoperative CMT value. Vitrectomy performed at the proper time may be helpful in metabolic remodeling process of the retinal tissue along with life style changes, well control of diabetes, and intraocular treatments.

[Lagophthalmos and ectropion of the upper eyelids in congenital ichthyosis]. / Lagophthalmus mit Oberlidektropium bei kongenitaler Ichthyosis.

This report concerns the case of a 10-year-old female patient with congenital ichthyosis who developed bilateral ectropion of the upper eyelids resulting in massive ocular surface alterations due to lagophthalmos. A complex surgical approach with partial excision, tarsal strip refixation and a free skin graft led to normalization of the eyelid positioning and healing of the ocular surface.

[Treatment of trichiasis and distichiasis with a biopsy punch -- an effective and practical method for eyelash follicle excision]. / Behandlung der Trichiasis und Distichiasis mit Biopsiestanzen - eine effektive und praxisnahe Methode zur Wimpernbalgexzision.

Localised distichiasis and trichiasis with resulting keratopathy leads to considerable impairment for the patient. We present a new technique which enables the surgeon to excise the lash with its follicle to prevent regrowth in a single movement. The procedure does not need any preparation, leaving the lid with minimal concomitant trauma which prevents recurrence of trichiasis. The excision is done with a dermatological biopsy punch (Kai Europe GmbH, Solingen, Germany). The punch is placed on the appropriate place perpendicular to the lid margin where the punch is driven 3-4 mm parallel to the lash. Histopathological diagnosis should be obtained not only to prove the principle of this technique: the entire biopsy material should be handed over to the pathologist as distichiasis and trichiasis can be the first sign of lid tumours. The presented technique of hair follicle excision with a biopsy punch is extremely effective. Success can be proven by the results of histological work-up of the biopsy material.

Circulating levels of adiponectin, orexin-A, ghrelin and the antioxidant paraoxonase-1 in metabolic syndrome.

AIM: Metabolic syndrome (MS) is a disorder consisting of various abnormalities such as dyslipidemia, obesity, hypertension and hyperglycemia. Over the past two decades, the prevalence of MS has greatly increased, and it has become a global health problem. We measured and compared plasma concentrations of adiponectin, orexin-A, ghrelin and the antioxidant paraoxonase-1 (PON1) between patients with metabolic syndrome (MS) and healthy controls. METHODS: A total of 87 patients (46 women, 41 men) with MS and 40 healthy controls (21 women, 19 men) with a BMI less than 25 kg/m2 were enrolled in the study. The plasma concentrations of the adiponectin, orexin-A, ghrelin and PON1 were measured by ELISA. RESULTS: Plasma concentrations of Orexin-A were significantly higher in patients with MS than controls (P<0.001). However, plasma concentrations of adiponectin, ghrelin and PON1 were significantly lower in patients with MS compared to controls (P<0.001, P<0.001 and P<0.001, respectively). CONCLUSION: Our data confirmed the previous findings that plasma concentrations of orexin-A is higher than controls, however plasma concentrations of PON1, ghrelin and adiponectin are lower compared to controls.

Long term non-invasive ventilation in the community for patients with musculoskeletal disorders: 46 year experience and review.

BACKGROUND: A study was undertaken to assess the long term physiological and clinical outcome in 79 patients with musculoskeletal disorders (73 neuromuscular, six of the chest wall) who received non-invasive ventilation for chronic respiratory failure over a period of 46 years. METHODS: Vital capacity (VC) and carbon dioxide tension (PCO(2)) before and after initiation of ventilation, type and duration of ventilatory assistance, the need for tracheostomy, and mortality were retrospectively studied in 48 patients who were managed with mouth/nasal intermittent positive pressure ventilation (M/NIPPV) and 31 who received body ventilation. The two largest groups analysed were 45 patients with poliomyelitis and 15 with Duchenne's muscular dystrophy. Twenty five patients with poliomyelitis received body ventilation (for a mean of 290 months) and 20 were supported by M/NIPPV (mean 38 months). All 15 patients with Duchenne's muscular dystrophy were ventilated by NIPPV (mean 22 months). RESULTS: Fourteen patients with poliomyelitis on body ventilation (56%) but only one on M/NIPPV, and 10 of 15 patients (67%) with Duchenne's muscular dystrophy eventually received tracheostomies for ventilatory support. Five patients with other neuromuscular disorders required tracheostomies. Twenty of 29 tracheostomies (69%) were provided because of progressive disease and hypercarbia which could not be controlled by non-invasive ventilation; the remaining nine were placed because of bulbar dysfunction and aspiration related complications. Nine of 10 deaths occurred in patients on body ventilation (six with poliomyelitis), although the causes of death were varied and not necessarily related to respiratory complications. A proportionately greater number of patients on M/NIPPV (67%) reported positive outcomes (improved sense of wellbeing and independence) than did those on body ventilation (29%, p<0.01). However, other than tracheostomies and deaths, negative outcomes in the form of machine/interface discomfort and self-discontinuation of ventilation also occurred at a rate 2.3 times higher than in the group who received body ventilation. None of the six patients with chest wall disorders (all on M/NIPPV) required tracheostomy or died. Hospital admission rates increased nearly eightfold in patients receiving body ventilation (all poliomyelitis patients) compared with before ventilation (p<0.01) while in those supported by M/NIPPV they were reduced by 36%. CONCLUSIONS: Non-invasive ventilation (NIV) in the community over prolonged periods is a feasible although variably tolerated form of management in patients with neuromuscular disorders. While patients who received body ventilation were followed the longest (mean 24 years), the need for tracheostomy and deaths occurred more often in this group (most commonly in the poliomyelitis patients). Despite a number of discomforts associated with M/NIPPV, a larger proportion of patients experienced improved wellbeing, independence, and ability to perform daily activities.

Radon exhalation rates and gamma doses from ceramic tiles.

This study was carried out to assess the possible radiological hazard resulting from the use of zircon in glaze applied to tiles used in buildings. The 226Ra content of various stains and glazing compounds was measured using gamma spectroscopy and the 222Rn exhalation rates for these materials were measured using adsorption on activated charcoal. The radon exhalation rates were found to be close to or less than the minimum detectable values for the equipment used. This limit was much lower than the estimated exhalation rates, which were calculated assuming that the parameters controlling the emanation and diffusion of 222Rn in the materials studied were similar to those of soil. This implied that the 222Rn emanation coefficients and/or diffusion coefficients for most of the materials studied were very much lower than expected. Measurements on zircon powders showed that the 222Rn emanation coefficient for zircon was much lower than that for soil, indicating that only a small fraction of the 222Rn produced by the decay of 226Ra was able to escape from the zircon grains. The estimated increase in radon concentration in room air and the estimated external gamma radiation dose resulting from the use of zircon glaze are both much lower than the relevant action level and dose limit.

Angiotensin II does not contribute to rapid reflex control of arterial pressure.

Pharmacological blockade of the renin-angiotensin converting enzyme reportedly alters the heart rate (HR) power spectrum in conscious dogs, suggesting that these hormones contribute to the short-term regulation of arterial blood pressure. We tested this possibility using four independent procedures. First, HR power spectrum was determined in seven awake dogs before and after administration of enalaprilat (300 ng/kg), a converting-enzyme inhibitor. There were no significant changes in the average amplitude for the spectral peak between 0.003 and 0.1 Hz (i.e., the "low-frequency peak"). Second, the HR power spectrum was measured in 11 awake rabbits before and after treatment with deoxycorticosterone acetate (1 mg.kg-1.day-1) and salt (0.9% saline ad libitum) for 7 days to depress plasma renin levels. There were no significant changes in the amplitude of the HR power spectrum, although mean HR decreased from 206 +/- 3 to 184 +/- 4 beats/min after treatment. In the third experiment, another group of rabbits (n = 8) was tested after 2 wk on a low-salt diet to elevate plasma angiotensin levels and then after 2 wk on a normal salt diet. Once again there were no significant effects on the HR power spectrum. Finally, tranquilized dogs (n = 9) were subjected to sinusoidally varying lower body negative pressure at selected frequencies of 0.008-0.12 Hz. Tests were conducted in the control state and after administration of an angiotensin receptor antagonist (saralasin, 1 microgram.kg-1.min-1). Lower body negative pressure-induced fluctuations in arterial blood pressure were similar in both states. We find no evidence for the role of the renin-angiotensin system in the moment-to-moment regulation of arterial pressure and HR.