ASSESSMENT OF CLINICAL AND IMAGISTIC STRUCTURAL PROGRESSION IN GLAUCOMA.

Glaucoma is a progressive optic neuropathy, characterized by loss of retinal ganglion cells and retinal nerve fiber layer as well as visual field loss. Therefore, in glaucoma, the correlation between structure and function is important, since it can be useful for tracking glaucomatous changes and for following the progression of the disease.

[Structure-function correlation in early diagnosis of glaucoma progression]. / Corelatii structura-functie în diagnosticul precoce al progresiei glaucomatoase.

PURPOSE: The study investigates the correlations between structure and function in early detection of glaucoma progression. MATERIALS AND METHOD: A prospective study was carried on 204 patients diagnosed with POAG and a follow-up period of 4 years. All the patients underwent complex ophthalmological examination, C/D ratio, Disk Damage Likelyhood Scale (DDLS), automated perimetry and Heidelberg retina tomography RESULTS: The relations between structure and function were investigated for all patients, but also according to clinical stage of glaucomatous damage. Structural progression was more frequently associated with perimetric progression for patients with moderate advanced glaucoma. For patients with preperimetric glaucoma and early glaucoma, the progression was present more often for structural test (19,04% and 29,3%), while perimetric progression was less frequent objectivated and weak correlated with structural progression (16,66%). For the 15 cases diagosed with both structural and functional progression, the locations of the structural lesion and functional defect were better correlated in cases involving the poles of the optic disc. CONCLUSIONS: Structure-function relation depends on clinical stage of glaucoma and the location of the glaucomatous defects. In early stages, structural investigations can detect progression before perimetry, while in advanced stages, the functional tests are more useful for early detection of progression.

[Primary antiphospholipid syndrome]. / Sindromul antifosfolipidic primar.

Antiphospholipid syndrome (APS) is a disorder characterised by recurrent arterial or venous thrombosis and/or pregnancy losses, in the presence of persistently elevated levels of anticardiolipin antibodies and/or evidence of circulating lupus anticoagulant (these abnormalities are detected by blood tests). Primary APS occurs when there is no evidence of associated diseases. APS in the presence of an underlying disease, usually systemic lupus erythematosus, is called secondary APS.

Five batches representative of Ontario-grown American ginseng root produce comparable reductions of postprandial glycemia in healthy individuals.

Evidence indicates that the glycemia-lowering effect of American ginseng root may be batch dependent. We therefore evaluated the effect of 5 root batches, representative of Ontario-grown American ginseng, on postprandial glucose and insulin indices. Twelve healthy subjects (5 male, 7 female), mean +/- SE age 26.5 +/- 2 years, body mass index 23.96 +/- 3.41 kg/m2, fasting blood glucose 4.77 +/- 0.04 mmol/L, were assigned to consume 9 g of American ginseng from 5 farms (A-E), administered in randomized sequence on 5 separate visits, and a water-control during the 6th and last visit. Treatments were consumed 40 min before a 2-hour 75-gram oral glucose tolerance test. Plasma glucose and insulin were measured at baseline, before, and during the test. Compared with control, batches A and C reduced glucose incremental area under the curve (IAUC) by 35.2% (156 vs. 240 mmol.min/L) and 32.6% (162 vs. 240 mmol.min/L), respectively. Batches A, C, and E reduced incremental peak glucose by 1.3, 1.2, and 1.1 mmol/L, respectively. Batch C reduced the insulin IAUC by 27.7% (15.8 vs. 21.8 nmol.min/L). Effects on glucose and insulin parameters were not different across ginseng treatments. The mean of the 5 ginseng treatments reduced peak postprandial glucose by 1.0 mmol/L, glucose IAUC by 27.7% (173 vs. 240 mmol.min/L), and insulin IAUC by 23.8% (16.6 vs. 21.8 nmol.min/L) relative to control. (All results statistically significant at p < 0.05.) American ginseng decreased postprandial glycemia and insulinemia; however, 40% of the batches did not reduce glycemia with the anticipated magnitude, irrespective of their saponin composition.

When a placebo is not a 'placebo': a placebo effect on postprandial glycaemia.

AIMS: Placebo effects in clinical trials remain uncertain. To investigate a placebo effect on acute postprandial plasma glucose, we conducted a follow-up investigation on a previous study. METHODS: The effect of placebo (9 g encapsulated cornstarch +500 ml water, taken at -40 min) on the plasma glucose response to a 75-g oral glucose tolerance test (OGTT) was assessed in a previous study in 12 healthy subjects (gender, five male, seven female; age 27 +/- 6 years; body mass index 24 +/- 3.4 kg m(-2)). This was compared with the effect of a water control (500 ml water taken alone at -40 min) on the same outcome in the same subjects in a follow-up study. RESULTS: Cornstarch placebo decreased plasma glucose area under the curve during the 75-g OGTT by 28% [Delta (95% confidence interval) -63.3 min mmol(-1) l(-1) (-218.33, 91.66), P < 0.02] compared with the water control (P < 0.05). CONCLUSIONS: Postprandial plasma glucose outcomes may be vulnerable to placebo effects.

[Diagnostic criteria in acute neuromyelitis]. / Criteriile de diagnostic revizuite pentru neuromielita optica.

Neuromyelitis optica, also known as Devic disease, was identified in the 19th century, is one of the inflammatory idiopathic demyelinating diseases of the central nervous system, often mistaken for severe multiple sclerosis. In 1999 it had been proposed diagnostic criteria for neuromyelitis optica, but in 2006 these criteria were revised by Dean Wingerchuck. These criteria are 99% sensitive and 90% specific for differentiating neuromyelitis optica from multiple sclerosis that present with optic neuritis or a myelitis syndrome. In the following article we present clinical, spinal and cerebral MR imaging, serological and aspects of cerebrospinal fluid examination features of neuromyelitis optica and the revised criteria of neuromyelitis optica established in 2006. The recently identified serum antibody biomarker: neuromyelitis optica immunoglobulin G (NMO Ig G), which target aquaporin 4 water channel, distinguish neuromyelitis optica from multiple sclerosis, is one of the revised criteria of neuromyelitis optica.

[Laparoscopic assisted vaginal hysterectomy (LAVH). Overview on 25 case series]. / Histerectomia vaginala asistata laparoscopic (HVAL). Experienta preliminara pe 25 de cazuri.

The aim of the study is to evaluate the laparoscopically assisted vaginal hysterectomy (LAVH) in terms of indications, uterine size, surgical procedures and their safety, intraoperative complications and blood loss, operative time, concomitant surgical procedures and postoperative period of complications. A total of 25 patients underwent LAVH between 1998 and 1993, in our surgical unit. The mean age of our patients was 44.2 years (range 36-66). The most common indication was fibromyoma. The mean size of the removed uterus was 11.5 cm. The mean weight was about 242 g. The mean estimated blood loss was 155 ml and the mean operative time 150 min. Intraoperative complications included one case of bladder injury due to thick adhesions. Postoperative complications included 2 cases of cystitis, and 3 cases of ileus. The hospital stay was 2 to 7 days.

[Minimal invasive treatment of the adnexal surgical pathology]. / Tratamentul minim invaziv al afectiunilor chirurgicale ale anexelor.

Laparoscopic approach has become the "golden standard" in managing a wide range of adnexial sufferings. Most laparoscopic cases allow patients to recover quickly. Conventional ultrasonography appears to be useful in the preoperative selection for this surgery. Conventional pulsed Doppler and colour Doppler sonography proved their importance in the diagnosis of malignancy. The aim of the study is to evaluate the advantages and the limits of the minimal invasive approach in managing surgical adnexial sufferings. A retrospective study was carried on 75 operative laparoscopy cases performed between 1998-2002. Surgical procedures were performed mainly for ovarian cysts (69 cases, 92%), but there were also treated other types of adnexial pathology such as: hydrosalpinx (2), piosalpinx (1), tubal cysts (2), ectopic pregnancy (7), pelvic adherences (7) and one case of hydatid tubal cyst. Types of surgery performed were cystectomy (36), ooforectomy (11), salpingo-ooforectomy (10), fenestration (10), salpingectomy (6), lysis of adhesions (7). The mean operation time ranged between 50 and 80 minutes and the mean postoperative stay was of 3.65 days.