Benefit of ablative versus palliative-only radiotherapy in combination with nivolumab in patients affected by metastatic kidney and lung cancer.

PURPOSE: Here, we present the results from a retrospective analysis, with the purpose of evaluating the safety and feasibility of nivolumab and radiotherapy (RT) concomitant association in metastatic kidney and lung cancer patients. MATERIALS AND METHODS: From August 2015 until September 2017, we retrospectively observed 20 patients with metastatic lung and renal cell carcinoma who had been initiated therapy with nivolumab and underwent concomitant RT. RT was administered either as an ablative therapy in the oligometastatic/oligoprogressive setting or as palliative-only treatment for symptomatic patients. Data on progression-free and overall survival (PFS and OS), treatment response and adverse events were collected and reported. Comparison between palliative-only and ablative treatments was performed. RESULTS: PFS and OS were 7 and 12.5 months in the entire population, respectively. Oligoprogressive patients treated with ablative intent, compared to patients undergoing RT with palliative-only intent, had statistically longer PFS (11.5 vs 5.2 months, HR 0.42, CI 0.18-0.98, p 0.03) and OS (17.9 vs 10.31 months, HR 0.41 CI 0.16-1.02, p 0.04). Considering only patients treated with ablative intent, 87.5% showed response to treatment, and complete response was reported in 37.5% of cases. Adverse G2-G3 related to combination treatment were reported as follows: 1 gastrointestinal (nausea), 4 breakthrough pain. CONCLUSIONS: Our data showed significant advantage for oligoprogressive patients treated with RT during nivolumab therapy. No safety alert emerged. These results underline the potential synergistic effects of RT and Immune therapy combination. Our analysis prompts further prospective studies exploring the benefit of integrated treatment strategies.

Fracionamento de carboidratos e proteínas de gramíneas tropicais cortadas em três idades / Carbohydrates and proteins fractions of tropical grasses cut at three ages

Avaliou-se o fracionamento dos carboidratos e das proteínas das gramíneas tropicais tifton 85 (Cynodon dactylon cv Tiffon 85), braquiária (Brachiaria brizantha cv Marandu) e tanzânia (Panicum maximum Jacq. cv Tanzânia), cortadas aos 28, 35 e 54 dias de idade. Determinaram-se os teores de matéria seca (MS), matéria orgânica (MO), proteína bruta (PB), extrato etéreo (EE), fibra em detergente neutro corrigida para cinzas e proteína (FDN CP), fibra em detergente ácido (FDA), lignina (LIG), nitrogênio insolúvel em detergente neutro (NIDN) e nitrogênio insolúvel em detergente ácido (NIDA). Para PB determinaram-se as frações A, B1+B2, B3 e C, e para os carboidratos as frações A+B1, B2 e C. Foi utilizado o delineamento inteiramente ao acaso, em arranjo em parcelas (gramíneas) subdivididas (idades de corte). Houve efeito significativo (P<0,05) da idade de corte sobre os teores de MS, FDN CP, NIDN e NIDA. Os teores de PB apresentaram declínio com o avanço da idade. O capim-marandu apresentou teores elevados para as frações A+B1 e B2 dos carboidratos (25,5 e 34,8 por cento dos carboidratos totais, respectivamente) e para as frações A e B1+B2 das proteínas (28,1 por cento aos 35 dias e 53,8 por cento da PB aos 28 dias, respectivamente).(AU)

The carbohydrates and proteins fractions of tropical grasses Tifton 85 (Cynodon dactylon cv Tifton 85), brachiaria (Brachiaria brizantha cv Marandu), and Tanzania (Panicum maximum Jacq. cv Tanzania) were evaluated at cut ages of 28, 35, and 54 days. Contents of dry matter (DM), organic matter (OM), crude protein (CP), ether extract (EE), fiber in neutral detergent corrected for ashes and protein (NDF CP), fiber in acid detergent (ADF), lignin (LIG), neutral detergent insoluble nitrogen (NDIN), and acid detergent insoluble nitrogen (ADIN) were determined. For CP, the A, B1+B2, B3, and C fractions were determined. For carbohydrates, the fractions A+B1, B2, and C were measured. A completely randomized split-plot design was used. Effect of cut age on DM, NDF CP, NDIN and ADIN was observed. The CP contents decreased with the progress of the age for the three grasses. The Marandu grass presented high percentage of the fractions A+B1 and B2 for the total carbohydrate (25.5 and 34.8 percent, respectively) and of the fractions A and B1+B2 for the proteins (28.1 percent CP at 35 days and 53.8 percent CP at 28 days, respectively).(AU)

Fracionamento de carboidratos e proteínas de gramíneas tropicais cortadas em três idades / Carbohydrates and proteins fractions of tropical grasses cut at three ages

Avaliou-se o fracionamento dos carboidratos e das proteínas das gramíneas tropicais tifton 85 (Cynodon dactylon cv Tiffon 85), braquiária (Brachiaria brizantha cv Marandu) e tanzânia (Panicum maximum Jacq. cv Tanzânia), cortadas aos 28, 35 e 54 dias de idade. Determinaram-se os teores de matéria seca (MS), matéria orgânica (MO), proteína bruta (PB), extrato etéreo (EE), fibra em detergente neutro corrigida para cinzas e proteína (FDN CP), fibra em detergente ácido (FDA), lignina (LIG), nitrogênio insolúvel em detergente neutro (NIDN) e nitrogênio insolúvel em detergente ácido (NIDA). Para PB determinaram-se as frações A, B1+B2, B3 e C, e para os carboidratos as frações A+B1, B2 e C. Foi utilizado o delineamento inteiramente ao acaso, em arranjo em parcelas (gramíneas) subdivididas (idades de corte). Houve efeito significativo (P<0,05) da idade de corte sobre os teores de MS, FDN CP, NIDN e NIDA. Os teores de PB apresentaram declínio com o avanço da idade. O capim-marandu apresentou teores elevados para as frações A+B1 e B2 dos carboidratos (25,5 e 34,8 por cento dos carboidratos totais, respectivamente) e para as frações A e B1+B2 das proteínas (28,1 por cento aos 35 dias e 53,8 por cento da PB aos 28 dias, respectivamente).

The carbohydrates and proteins fractions of tropical grasses Tifton 85 (Cynodon dactylon cv Tifton 85), brachiaria (Brachiaria brizantha cv Marandu), and Tanzania (Panicum maximum Jacq. cv Tanzania) were evaluated at cut ages of 28, 35, and 54 days. Contents of dry matter (DM), organic matter (OM), crude protein (CP), ether extract (EE), fiber in neutral detergent corrected for ashes and protein (NDF CP), fiber in acid detergent (ADF), lignin (LIG), neutral detergent insoluble nitrogen (NDIN), and acid detergent insoluble nitrogen (ADIN) were determined. For CP, the A, B1+B2, B3, and C fractions were determined. For carbohydrates, the fractions A+B1, B2, and C were measured. A completely randomized split-plot design was used. Effect of cut age on DM, NDF CP, NDIN and ADIN was observed. The CP contents decreased with the progress of the age for the three grasses. The Marandu grass presented high percentage of the fractions A+B1 and B2 for the total carbohydrate (25.5 and 34.8 percent, respectively) and of the fractions A and B1+B2 for the proteins (28.1 percent CP at 35 days and 53.8 percent CP at 28 days, respectively).

Bagaço de mandioca (Manihot esculenta, Crantz) na dieta de vacas leiteiras: consumo de nutrientes / Cassava bagasse (Manihot esculenta, Crantz) in the diet of lactating cows: intake of nutrients

Avaliou-se o efeito da inclusão de diferentes níveis (0, 5, 10 e 15 por cento) de bagaço de mandioca à dieta de 12 vacas mestiças leiteiras Holandês x Zebu (composição racial com variação de » a ¾ de sangue H x Z) com 478,5kg de peso corporal médio e com 100 a 150 dias de lactação, distribuídas em três Quadrados Latinos 4 x 4. Foi avaliado o consumo de matéria seca (MS), matéria orgânica (MO), proteína bruta (PB), extrato etéreo (EE), fibra em detergente neutro (FDN), fibra em detergente ácido (FDA), carboidratos totais (CHT), carboidratos não-fibrosos (CNF) e nutrientes digestíveis totais (NDT). Forneceu-se silagem de capim-elefante como fonte de volumoso. As relações volumoso:concentrado utilizadas foram de 65,19:34,81; 61,59:38,41; 59,08:40,92 e 54,76:45,24. Formularam-se as dietas isoprotéicas e isoenergéticas. Houve aumento linear do consumo de MS, MO, PB, CHT, CNF e NDT, efeito quadrático do consumo de EE e redução do consumo de FDA com o aumento do BM, enquanto o consumo de FDN não diferiu entre os tratamentos.O bagaço de mandioca pode ser utilizado até o nível de 15 por cento de inclusão na dieta total de vacas mestiças leiteiras sem trazer transtornos fisiológicos ou nutricionais aos animais.(AU)

The effect of different inclusion levels (0, 5, 10, and 15 percent) of cassava bagasse to the diet of 12 Holstein x Zebu crossbred dairy cows (breed composition varying from » to ¾ H x Z blood), averaging 478.5kg body weight and 100 to 150 days in milk was evaluated. Cows were distributed in three 4 x 4 latin squares. The intake of dry matter (DM), organic matter (OM), crude protein (CP), ether extract (EE), neutral detergent fiber (NDF), acid detergent fiber (ADF), total carbohydrates (TC), non fiber carbohydrates (NFC), and total digestible nutrients (TDN) were evaluated. Elephant grass silage was provided as roughage source. The roughage:concentrate ratios were 65.19:34.81; 61.59:38.41; 59.08:40.92; and 54.76:45.24. Isonitogen and isoenergetic diets were formulated. There was a linear increase in DM, OM, CP, TC, NFC, and TDN intakes, quadratic effect of EE intake, and a reduction of ADF intake with the increase of the BM; while no diference among treatments was observed for NDF intake. The cassava bagasse can be used until 15 percent inclusion level in the total diet of crossbred dairy cows without physiological or nutritional damage.(AU)

Bagaço de mandioca (Manihot esculenta, Crantz) na dieta de vacas leiteiras: consumo de nutrientes / Cassava bagasse (Manihot esculenta, Crantz) in the diet of lactating cows: intake of nutrients

Avaliou-se o efeito da inclusão de diferentes níveis (0, 5, 10 e 15 por cento) de bagaço de mandioca à dieta de 12 vacas mestiças leiteiras Holandês x Zebu (composição racial com variação de » a ¾ de sangue H x Z) com 478,5kg de peso corporal médio e com 100 a 150 dias de lactação, distribuídas em três Quadrados Latinos 4 x 4. Foi avaliado o consumo de matéria seca (MS), matéria orgânica (MO), proteína bruta (PB), extrato etéreo (EE), fibra em detergente neutro (FDN), fibra em detergente ácido (FDA), carboidratos totais (CHT), carboidratos não-fibrosos (CNF) e nutrientes digestíveis totais (NDT). Forneceu-se silagem de capim-elefante como fonte de volumoso. As relações volumoso:concentrado utilizadas foram de 65,19:34,81; 61,59:38,41; 59,08:40,92 e 54,76:45,24. Formularam-se as dietas isoprotéicas e isoenergéticas. Houve aumento linear do consumo de MS, MO, PB, CHT, CNF e NDT, efeito quadrático do consumo de EE e redução do consumo de FDA com o aumento do BM, enquanto o consumo de FDN não diferiu entre os tratamentos.O bagaço de mandioca pode ser utilizado até o nível de 15 por cento de inclusão na dieta total de vacas mestiças leiteiras sem trazer transtornos fisiológicos ou nutricionais aos animais.

The effect of different inclusion levels (0, 5, 10, and 15 percent) of cassava bagasse to the diet of 12 Holstein x Zebu crossbred dairy cows (breed composition varying from » to ¾ H x Z blood), averaging 478.5kg body weight and 100 to 150 days in milk was evaluated. Cows were distributed in three 4 x 4 latin squares. The intake of dry matter (DM), organic matter (OM), crude protein (CP), ether extract (EE), neutral detergent fiber (NDF), acid detergent fiber (ADF), total carbohydrates (TC), non fiber carbohydrates (NFC), and total digestible nutrients (TDN) were evaluated. Elephant grass silage was provided as roughage source. The roughage:concentrate ratios were 65.19:34.81; 61.59:38.41; 59.08:40.92; and 54.76:45.24. Isonitogen and isoenergetic diets were formulated. There was a linear increase in DM, OM, CP, TC, NFC, and TDN intakes, quadratic effect of EE intake, and a reduction of ADF intake with the increase of the BM; while no diference among treatments was observed for NDF intake. The cassava bagasse can be used until 15 percent inclusion level in the total diet of crossbred dairy cows without physiological or nutritional damage.

Bagaço de mandioca na ensilagem do capim-elefante: qualidade das silagens e digestibilidade dos nutrientes / Cassava bagasse in elephant grass ensilage: quality of the silage and digestibility of the nutrients

Utilizaram-se 16 novilhas ¾ Holandês-Zebu com idade média de 15 meses e peso médio inicial de 144kg, para avaliar o efeito da adição de diferentes níveis (5; 10; 15 e 20 por cento) de bagaço de mandioca na ensilagem do capim-elefante (Pennisetum purpureum, Schum) sobre a qualidade e a digestibilidade dos nutrientes da dieta. Os tratamentos consistiram de quatro dietas contendo, como volumoso, silagem de capim-elefante com quatro diferentes níveis de bagaço de mandioca, mais concentrado balanceado, com quatro repetições por tratamento. Avaliou-se a qualidade das silagens, os consumos de nutrientes das dietas e as digestibilidades dos nutrientes das silagens e das dietas totais. O bagaço de mandioca elevou o teor de matéria seca (MS) da silagem, preservando-a com o pH que variou de 3,85 a 4,07 e a relação N-NH3/NT de 6,2 a 7,85. Os consumos médios diários de MS e proteína bruta (PB) não diferiram entre os tratamentos (P>0,05). Os consumos médios de fibra em detergente neutro (FDN) e fibra em detergente ácido (FDA) apresentaram comportamento linear decrescente (P<0,05) com o aumento dos níveis de bagaço de mandioca. Não foi detectada diferença entre os tratamentos (P>0,05) na digestibilidade da MS (DMS), da FDN (DFDN) e da FDA (DFDA) das silagens. Os nutrientes digestíveis totais (NDT) das silagens foram semelhantes em todos os tratamentos. A digestibilidade da PB (DPB), do extrato etéreo (DEE) e dos carboidratos não-fibrosos (DCNF) das silagens decresceu linearmente (P<0,05) com o aumento do nível do bagaço de mandioca nas silagens. Constatou-se que não houve diferença (P>0,05) na DMS, DPB, DFDN, DFDA, DEE, DCNF e NDT entre as dietas experimentais. O nível de adição de 5 por cento de bagaço de mandioca à silagem de capim-elefante é satisfatório para sua preservação, propiciando boa digestibilidade.(AU)

Sixteen ¾ Holstein-Zebu heifers aging 15 month-old averaging 144kg were used to evaluate the effect of the additions of different levels of cassava bagasse (5; 10; 15 and 20 percent) to elephant grass (Pennisetum purpureum, Schum) ensilage on the diet quality and nutrients digestibility. The treatments consisted of four diets containing, as roughage, elephant grass silage with four different levels of cassava bagasse plus balanced concentrate, with four repetitions per treatment. Silages quality, diet nutrients intake and nutrients digestibility of the silages and total diets were evaluated. Cassava bagasse increased the dry matter (DM) content, of the silages preserving them with a pH varying from 3.85 to 4.07 and N-NH3/NT ratio from 6.2 to 7.85. Daily dry matter and crude protein (CP) mean intakes did not differ among the treatments (P>0.05). Neutral detergent fiber (NDF) and acid detergent fiber (ADF) mean intakes showed a decreasing linear behavior (P<0.05) with the increase of cassava bagasse levels. There was no detected difference among the treatments (P>0.05) for DM (DMD), NDF (NDFD) and ADF digestibility (ADFD). The total digestible nutrients (TDN) of the silages were similar in all the treatments. The CP (CPD), ether extract (EED) and non-fiber carbohydrates digestibility (NFCD) of the silages decreased linearly (P<0.05) with the increase of cassava bagasse levels. There was no difference (P>0.05) in DMD, CPD, NDFD, ADFD, EED, NFCD and TDN among the experimental diets. The 5 percent cassava bagasse addition to its elephant grass silage was satisfactory to preservation resulting in good digestibility of the elephant grass silage.(AU)

Bagaço de mandioca na ensilagem do capim-elefante: qualidade das silagens e digestibilidade dos nutrientes / Cassava bagasse in elephant grass ensilage: quality of the silage and digestibility of the nutrients

Utilizaram-se 16 novilhas ¾ Holandês-Zebu com idade média de 15 meses e peso médio inicial de 144kg, para avaliar o efeito da adição de diferentes níveis (5; 10; 15 e 20 por cento) de bagaço de mandioca na ensilagem do capim-elefante (Pennisetum purpureum, Schum) sobre a qualidade e a digestibilidade dos nutrientes da dieta. Os tratamentos consistiram de quatro dietas contendo, como volumoso, silagem de capim-elefante com quatro diferentes níveis de bagaço de mandioca, mais concentrado balanceado, com quatro repetições por tratamento. Avaliou-se a qualidade das silagens, os consumos de nutrientes das dietas e as digestibilidades dos nutrientes das silagens e das dietas totais. O bagaço de mandioca elevou o teor de matéria seca (MS) da silagem, preservando-a com o pH que variou de 3,85 a 4,07 e a relação N-NH3/NT de 6,2 a 7,85. Os consumos médios diários de MS e proteína bruta (PB) não diferiram entre os tratamentos (P>0,05). Os consumos médios de fibra em detergente neutro (FDN) e fibra em detergente ácido (FDA) apresentaram comportamento linear decrescente (P<0,05) com o aumento dos níveis de bagaço de mandioca. Não foi detectada diferença entre os tratamentos (P>0,05) na digestibilidade da MS (DMS), da FDN (DFDN) e da FDA (DFDA) das silagens. Os nutrientes digestíveis totais (NDT) das silagens foram semelhantes em todos os tratamentos. A digestibilidade da PB (DPB), do extrato etéreo (DEE) e dos carboidratos não-fibrosos (DCNF) das silagens decresceu linearmente (P<0,05) com o aumento do nível do bagaço de mandioca nas silagens. Constatou-se que não houve diferença (P>0,05) na DMS, DPB, DFDN, DFDA, DEE, DCNF e NDT entre as dietas experimentais. O nível de adição de 5 por cento de bagaço de mandioca à silagem de capim-elefante é satisfatório para sua preservação, propiciando boa digestibilidade.

Sixteen ¾ Holstein-Zebu heifers aging 15 month-old averaging 144kg were used to evaluate the effect of the additions of different levels of cassava bagasse (5; 10; 15 and 20 percent) to elephant grass (Pennisetum purpureum, Schum) ensilage on the diet quality and nutrients digestibility. The treatments consisted of four diets containing, as roughage, elephant grass silage with four different levels of cassava bagasse plus balanced concentrate, with four repetitions per treatment. Silages quality, diet nutrients intake and nutrients digestibility of the silages and total diets were evaluated. Cassava bagasse increased the dry matter (DM) content, of the silages preserving them with a pH varying from 3.85 to 4.07 and N-NH3/NT ratio from 6.2 to 7.85. Daily dry matter and crude protein (CP) mean intakes did not differ among the treatments (P>0.05). Neutral detergent fiber (NDF) and acid detergent fiber (ADF) mean intakes showed a decreasing linear behavior (P<0.05) with the increase of cassava bagasse levels. There was no detected difference among the treatments (P>0.05) for DM (DMD), NDF (NDFD) and ADF digestibility (ADFD). The total digestible nutrients (TDN) of the silages were similar in all the treatments. The CP (CPD), ether extract (EED) and non-fiber carbohydrates digestibility (NFCD) of the silages decreased linearly (P<0.05) with the increase of cassava bagasse levels. There was no difference (P>0.05) in DMD, CPD, NDFD, ADFD, EED, NFCD and TDN among the experimental diets. The 5 percent cassava bagasse addition to its elephant grass silage was satisfactory to preservation resulting in good digestibility of the elephant grass silage.

Desempenho de novilhas leiteiras alimentadas com silagem de capim-elefante com adição de diferentes níveis de bagaço de mandioca / Performance of dairy heifers fed on elephantgrass silage added with different levels of cassava bagasse

Avaliou-se o efeito da adição de diferentes níveis (5; 10; 15 e 20 por cento) de bagaço de mandioca na ensilagem do capim-elefante (Pennisetum purpureum, Schum) sobre o desempenho de novilhas leiteiras. Utilizaram-se 16 novilhas ¾ Holandês × Zebu, com idade média de 15 meses e peso vivo inicial de 144kg, com quatro repetições por tratamento. O experimento constou de 14 dias de adaptação, quando as novilhas receberam apenas silagem, e 56 dias de período experimental. Realizaram-se pesagens e tomadas as medidas da altura de cernelha e da circunferência torácica, após jejum de 16 horas, no início do experimento e no 28º e 56º dias. Os consumos médios diários de matéria seca (MS) e proteína bruta não diferiram entre tratamentos (P>0,05). Os consumos médios de fibra em detergente neutro e fibra em detergente ácido apresentaram comportamento linear decrescente (P<0,05). O desempenho foi verificado por meio das médias do peso vivo inicial, do peso vivo final, do ganho de peso médio diário, do aumento de perímetro torácico, do aumento de altura de cernelha e da conversão alimentar da MS. Não se observou influência dos tratamentos (P>0,05) sobre as características estudadas. (AU)

The effect of cassava bagasse addition levels (5, 10, 15 and 20%) to elephantgrass silage on dairy heifers performance was evaluated. Sixteen ¾ Holstein x Zebu heifers with 15 months of age and 144kg of initial body weight were used in a completely randomized block design with four replicates and four treatments. The experiment was carried out for 56 days after and adaptation period of 14 days in which the heifers were fed the respective treatment diets. Weight, withers height and thoracic circumference were recorded often 16 hours fasting at the beginning of the experiment and at days 28 and 56. No differences between treatments were observed for day mother (DM) and crude protein daily intake. The neutral detergent fiber and acid detergent fiber showed a linear reduction behavior. No treatment effects were observed for final body weight, daily weight gain, thoracic perimeter, withers height and DM feed efficiency.(AU)

Desempenho de novilhas leiteiras alimentadas com silagem de capim-elefante com adição de diferentes níveis de bagaço de mandioca / Performance of dairy heifers fed on elephantgrass silage added with different levels of cassava bagasse

Avaliou-se o efeito da adição de diferentes níveis (5; 10; 15 e 20 por cento) de bagaço de mandioca na ensilagem do capim-elefante (Pennisetum purpureum, Schum) sobre o desempenho de novilhas leiteiras. Utilizaram-se 16 novilhas ¾ Holandês × Zebu, com idade média de 15 meses e peso vivo inicial de 144kg, com quatro repetições por tratamento. O experimento constou de 14 dias de adaptação, quando as novilhas receberam apenas silagem, e 56 dias de período experimental. Realizaram-se pesagens e tomadas as medidas da altura de cernelha e da circunferência torácica, após jejum de 16 horas, no início do experimento e no 28° e 56° dias. Os consumos médios diários de matéria seca (MS) e proteína bruta não diferiram entre tratamentos (P>0,05). Os consumos médios de fibra em detergente neutro e fibra em detergente ácido apresentaram comportamento linear decrescente (P<0,05). O desempenho foi verificado por meio das médias do peso vivo inicial, do peso vivo final, do ganho de peso médio diário, do aumento de perímetro torácico, do aumento de altura de cernelha e da conversão alimentar da MS. Não se observou influência dos tratamentos (P>0,05) sobre as características estudadas.

Visual field defects in children with congenital glaucoma.

PURPOSE: To determine visual field defects in a cohort of children with congenital glaucoma. METHODS: Monocular visual fields were measured in 24 meridians for targets V4e, I4e, I2e, and I1e, using a Goldmann perimeter in a group of 13 children between the ages of 4 and 14 years with congenital glaucoma and 10 age-matched healthy children. Localized visual field defects (eg, paracentral scotoma, nasal step, and arcuate scotoma) were determined by abnormal findings or shape of the eye in at least one of each of the targets presented. RESULTS: Visual field extent for target 12e was significantly constricted for unilateral and bilateral cases of congenital glaucoma when compared with control eyes. A post-hoc procedure (Tukey Test) showed significant differences between unilateral cases and normal control eyes, and between bilateral cases (best outcome eye) and normal control eyes. Stimuli V4e and 14e results were comparable for patients and normals. Stimulus I1e showed significantly different total extent visual field for bilateral and normal controls. Specific visual field defects were found only in bilateral cases. Paracentral scotoma was found in 1 of 12 eyes with bilateral congenital glaucoma. Nasal steps were found in 6 of 12 eyes with bilateral congenital glaucoma. Arcuate scotoma were found in 4 of 12 eyes with bilateral congenital glaucoma. CONCLUSION: Localized visual fields were found in 37.5% of eyes with congenital glaucoma. Early treatment for congenital glaucoma provided better visual field outcome.

Blood pressure disturbance in diabetes mellitus.

BACKGROUND: Arterial hypertension and, less often, postural hypotension are frequently associated with diabetes mellitus, and with diabetic complications and death. AIM: To review data on the relationship between hypertension and nephropathy in diabetes mellitus. METHODS: We reviewed data on both retinopathy and nephropathy in hypertensive diabetic patients. Data suggesting that vasopressin levels might affect blood pressure in upright patients with postural hypotension due to cardiocirculatory diabetic neuropathy were also examined. Antihypertensive treatment during different phases of diabetic nephropathy in insulin-dependent diabetes was reviewed. RESULTS: The data showed that hydrochlorothiazide and nitrendipine reduce urinary protein excretion in parallel with a reduction in blood pressure. However, the decreases in urinary protein excretion induced by captopril are not correlated with a reduction in blood pressure and may be related to decreases in intraglomerular pressure found in patients with mild renal failure taking furosemide. Domperidone, a peripherally acting dopaminergic antagonist is an additional therapeutic option for the treatment of diabetic postural hypotension.

Microalbuminuria, arterial blood pressure and retinopathy in insulin dependent diabetes

In order to evaluate the relationship between urinary albumin excretion, arterial blood pressure and diabetic retinopathy in insulin dependent diabetics we examined 55 patients without clinical proteinuria and whose disease had started before the age of 30. Each patient was asked to collect at least one overnight timed urine sample for albumin analysis by an ELISA method. Normoalbuminuria was defined as urinary albumin excretion (UAE) of < 20 mug/min (n = 32) and microalbuminuria as 21-200 mug/min (n = 23). Patients with microalbuminuria showed higher levels of blood pressure, serum creatinine and glicosylated haemoglobin as compared to normoalbuminuric patients. Significant correlation was observed between diastolic blood pressure and UAE (r = 0.52; p < O.001).Preproliferative and proliferative diabetic retinopathy was detected in 9 patients (l6.4 per cent). All of them had diabetes for more than 10 years, elevated UAE and diastolic blood pressure equal or higher than 85 mmHg. In our population of insulin dependent diabetics we found a high prevalence of microalbuminuria which is considered to be predictive of the latter development of diabetic nephropathy. Microalbuminuria is associated with elevated blood pressure and diabetic retinal lesions. We conclude that urinary albumin excretion should be monitored in patients with insulin dependent diabetes to detect those who should be considered at risk of developing nephropathy and retinopathy.

Pars plana and ora serrata anatomotopographic study of fetal eyes.

Morphology and topographic anatomical relations of pars plana, pars plicata and ora serrata were examined in 15 globes of fetuses, obtained from autopsy. The mean value of pars plana size was: nasal meridian = 1.15 +/- 0.32 mm; temporal meridian = 1.20 +/- 0.34 mm; superior meridian = 1.19 +/- 0.34 mm; inferior meridian = 1.15 +/- 0.34 mm. The mean value of the distance between the sclerocorneal limbus and the ora serrata was: nasal meridian = 3.22 +/- 0.30 mm; temporal meridian = 3.33 +/- 0.35 mm; superior meridian = 3.23 +/- 0.36 mm; and inferior meridian = 3.27 +/- 0.37 mm. A significant difference between the mean sizes of the pars plana in the superior meridian was found compared to the nasal and inferior meridian. The distances from Schwalbe's line to the ora serrata in the 4 meridians did not vary significantly. A positive, significant correlation between the antero-posterior diameter and the distances from the sclerocorneal limbus to the ora serrata was demonstrated in the 4 meridians.

Choroidal granuloma caused by 'Paracoccidioides brasiliensis'. A clinical and angiographic study.

A 48 year-old-female with a choroidal granuloma presented a systemic picture of paracoccidioidomycosis proven by rhinopharyngeal biopsy. The clinical picture, the differential diagnosis and the therapeutic test are discussed. This is the first time that the fluorescein angiography is described in such cases.