Design and performance of a large lumen glaucoma drainage device.

PurposeWe report the in vivo testing of a large-lumen glaucoma drainage (LL-GDD) device equipped with a flow regulator. The device's membrane can be non-invasively opened with laser in the postoperative period to adjust aqueous flow and intraocular pressure.MethodsThe initial LL-GDD prototypes were constructed using 22 G silicone angiocatheters cut down to size. A 10 nm PVDF membrane was then affixed to the end using cyanoacrylate. The LL-GDD was tested first in a model eye equipped with ports for infusion and pressure measurement and in New Zealand rabbits.ResultsNew Zealand white satin cross rabbits were used, two eyes receiving the LL-GDD and the two fellow eyes serving as the control group with no intervention performed. After the procedure, the IOP in the LL-GGD surgical group dropped an average of 5.5 mm Hg (P=0.001), which was maintained until the membrane laser procedure at week 5 resulting in an average IOP reduction of 1.8 mm Hg. At week 7, the average IOP in the surgical group was 11 mm Hg compared with 18 mm Hg in the control group (P<0.001). A second laser procedure was done to completely open the membrane face, which resulted in an immediate drop in the average IOP of the surgical group by another 2.7 mm Hg, which was maintained until the study termination at day 55.ConclusionsThe large-lumen glaucoma drainage device demonstrated an ability both to prevent immediate postoperative hypotony and to allow progressively lower IOP on demand in this proof-of-concept study.

Immunophenotyping in peripheral blood mononuclear cells, aqueous humour and vitreous in a Blau syndrome patient caused by a novel NOD2 mutation.

The genetic and immunophenotypic characteristics of a 3-year-old patient with Blau syndrome (BS), an early onset sarcoidosis caused by mutations in NOD2, were investigated. Molecular analysis of NOD2 gene was achieved by PCR and direct nucleotide sequencing. Immunophenotyping included cytometric analysis of memory-effector markers on T-cells, and cytokine in serum, aqueous humour and vitreous. A novel M513R mutation in NOD2 was demonstrated. Immunophenotyping revealed higher frequency of CCR4+ cells and CCR9+ cells on CD4+ cells; most CD8+ cells were CCR7- and CCR9+. IL6 and IL-8 were detected in a gradient manner: vitreous humour>aqueous humour>serum. The immunophenotype in this patient was characterized by a differential expression of chemokine receptors on T cells and by a particular ocular microenvironment enriched in IL-6 and IL-8. To our knowledge, this is the first study analysing the immunological features of BS at aqueous humour, vitreous and blood levels. Our results expand the knowledge of the genetic and immunopathological basis of BS.

Epidemiology of dermatomycoses of humans in central Poland. Part III. Tinea pedis.

The total number of dermatophytoses (7393) included 2025 (27.4%) tinea pedis cases. Etiological factors in descending order by contribution were: Trichophyton rubrum (41.7%), Trichophyton mentagrophytes var. granulosum (30.9%), T. mentagrophytes var. interdigitale (10.0%), Epidermophyton floccosum (7.4%), T. mentagrophytes var. quinckeanum (6.9%), Trichophyton tonsurans (2.3%), Trichophyton spec. (0.4%), Trichophyton terrestre (0.2%), Trichophyton violaceum (0.1%). In the years 1987-93 the incidence of tinea pedis substantially increased over 1994-96. Today tinea pedis is second by incidence among all clinical forms of dermatophyte infections of skin and skin appendages in the Lódz region.

Epidemiology of dermatomycoses of humans in Central Poland. Part II--Non-dermatophyte infections of nails and periungual walls.

This study presents the epidemiology of dermatomycoses and their etiological agents of people living in the Lódz region, Central Poland, over the years 1987-1996. The study comprised a total of 25,737 patients. Positive mycological results were obtained for 14,084 patients (54.7%). The total number of 14,295 of positive mycological results included 6902 (48.3%) isolations of non-dermatophyte fungi. Among these positive results, isolations from subjects with infections of nails and periungual walls amounted to 2034 (29.5%). Candida albicans (59.9%) and Aspergillus sp. (17.3%) were major etiological factors of those infections. The decade in question was marked by a steady growth in incidence of the infections studied, especially over the years 1994-1996.

Epidemiology of dermatomycoses of humans in central Poland. Part I--Superficial infections caused by yeasts and moulds.

This work presents the epidemiology of dermatomycoses and their etiological agents of people living in the Lódz region, Central Poland, over the years 1987-1996. The analysis involved subjects referred by physicians to three major mycological laboratories in Lódz (covering the entire mycological diagnostics of the Lódz region). The study comprised a total of 25,737 persons aged 1-82. Positive results of mycological examinations were obtained for 14,084 (54.7%) patients. The total number of 14,295 positive mycological results included 6902 (48.3%) isolations of non-dermatophyte fungi. The non-dermatophytes included: Candida-like (69.8%), moulds (26.9%) and lipophilic yeasts (3.3%). The distribution of non-dermatophytes was characterized by dependence on sociodemographic features such as subjects' age, place of residence, education and occupation. Candida-like fungi are etiological factors of superficial infections of all clinical types whereas moulds were found to cause infections of finger and toe nails and periungual walls.

Laser prostatectomy. Long-term follow-up of 303 patients.

OBJECTIVE: This retrospective study was undertaken to evaluate results and complications in 303 patients with symptomatic bladder outlet obstruction due to benign prostatic hyperplasia (BPH) who underwent laser prostatectomy focusing on the long-term follow-up, 57 patients had a follow-up of more than 3 years. MATERIALS AND METHODS: A total of 303 patients were treated with the neodymium:YAG laser system for 1993 to 1997, of whom 57 patients were followed up for at least 3 years. All of the patients have been evaluated after 3 months, 6 months and 2 years. 57 patients were evaluated after 3 years. Pre- and postoperative American Urological Association (AUA) symptom score, uroflowmetry (UF), and immediate and long-term complications were assessed. RESULTS: The mean AUA symptom scores of 303 patients decreased over the 24 months follow-up from 16.9 to 7.6. In 57 patients after 36 months the mean AUA symptom score was 7.1. The mean maximal UF increased over the 24 months from 9 to 14.1 cm3/s in 303 patients. In 57 patients at 3 years the mean UF was 13. 9 cm3/s. The overall complications of 303 patients included two perforations of the bladder wall and two perforations of the prostatic capsule. Six (1.9%) patients had postoperative febrile UTI and 28 (9.2%) patients had acute urinary retention after catheter removal. Early bleeding occurred in 3 (0.9%) patients, late bleeding in 8 (2.4%), 4 (1.2%) had urethral stricture, and 1 had stricture of the bladder neck. The overall reoperation rate for symptomatic residual tissue was 1.9% (6 patients). CONCLUSION: Neodymium:YAG laser ablation of prostate represents an efficacious surgical intervention for symptomatic bladder outlet obstruction due to BPH with minimal associated morbidity.

Epidemiology of dermatomycoses of humans in central Poland. Part IV. Onychomycosis due to dermatophytes.

The total number of dermatophytoses (7393) included 1567 (21.2%) cases of onychomycosis. Etiological factors in descending order were: Trichophyton rubrum (58.8%), Trichophyton mentagrophytes var. granulosum (26.2%), T. mentagrophytes var. quinckeanum, T. mentagrophytes var. interdigitale (5.1%), Trichophyton tonsurans (4.1%), Trichophyton violaceum (1.5%), Trichophyton spec. (1.1%). An increase in the incidence was noted between 1994 and 1996. At present, onychomycosis is third by incidence among all clinical forms of dermatophyte infections of skin and skin appendages in the Lódz region.

Epidemiology of dermatomycoses of humans in central Poland. Part V. Tinea corporis.

The total number of dermatophytoses (7393) included 2204 (29.8%) cases of tinea glabrosa. Etiological factors in descending order were: Microsporum canis (23.5%), Trichophyton mentagrophytes var. granulosum (21.6%), Trichophyton rubrum (17.8%), Trichophyton tonsurans (10.4%), Epidermophyton floccosum (7.7%), T. mentagrophytes var. quinckeanum (6.0%), Microsporum gypseum (5.3%), Trichophyton violaceum (3.7%), T. mentagrophytes var. interdigitale (2.3%), Microsporum equinum (0.7%), Trichophyton verrucosum (0.4%), Trichophyton spec. (0.4%), Microsporum cookei (0.14%). At present tinea glabrosa is dominant among all clinical forms of dermatophyte infections of skin and skin appendages in the Lódz region.

[Own clinical observations of toxocara infections]. / Infekcje Toxocara w swietle materialów wlasnych.

Toxocarosis clinical forms wers diagnosed according to Kraus et. al. (1995). There were three forms: 1) asymptomatic - marked by hypereosynophilia and ELISA positive serologic reaction, 2) minor - with cutaneous, pulmomary and pseudorheumatic lesions, 3) major - with hepatosplenomegaly and multifocal inflammatory lesions of organ of sight. Over the years of 1994-1997 in Infectious, Parasitic and Tropical Diseases clinic of the Voivodship Specialist Hospital of Lódz we found and treated 137 Toxocara canis cases. Among them 63 (46:0%) asymptomatic, 57 (42.6%) minor and 17 (12.4%) major forms were diagnosed. The disease was detected in 80 (58.4%) adults and 57 (41.6%) children. Seventy six patients lived in towns and 61 in country. Minor form patients had the symptoms as follows: skin allergy, large joints lesions, augmentation in lymph nodes. Radiology examinations revealed pulmonary lesions. Using ultrasonography there was found hepatosplenomegaly and changes echogenity in patients with major form. Biochemical tests showed elevation in hepatic enzymes activity. Lesions of organ of sight were multifocal and usually included uveitis, retinitis, inflammation of anterior chamber and inflammation of vitreous body.

[Dermatophyte infections in persons returning from the tropics]. / Infekcje dermatofitowe u osób powracajacych z tropiku.

Over the years 1996-1997 mycological examination were performed in 367 persons with cutaneous lesions, returning from the tropics. Fungal infection was diagnosed in 141 patients. Twenty nine (42.65%) of the cases were of single-focal, 32 (47.06%) of bifocal and 7 (10.29%) of multifocal nature. One hundred forty one isolates included 50 (35.6%) moulds 23 (16.3%) yeast - like fangi and 68 (48.1%) dermatophytes. Genus classification of the dermatophytes was as follows: Microsporum - 16 (23.5%), Epidermophyton - 15 (22.1%), Trichophyton - 37 (54.4%). Over the years 1996-1997 the following dermatophyte species were isolated: M. audouini, M. ferrugineum, M. canis, T. rubrum, T. mentagrophytes var. granulosum, T. tonsurans, T. violaceum, E. floccosum. Microsporum genus was isolated from persons returning from East, West and Central Africa, and from South Europe, Trichophyton genus was isolated from persons returning from Asia and South America.

Fungal flora in human skin and skin appendages infections in the region of Lódz, Poland.

In the years 1987-95, 3550 patients with mycotic skin infections were divided into two groups: a group of 2282 (64.3%) subjects with dermatophytosis and a group of 1268 (35.7%) subjects with other fungal infections. Among dermatophytes the most common infectious agent was Trichophyton mentagrophytes (33%), followed by T. rubrum (30%) and Microsporum canis (11%). A total of 17% of all infections were caused by Candida sp.

[Quantitative analysis of testicular varicocele by scintigraphy].

Testicular varcocele is the most common factor affecting male fertility. The determental effects of the varicocele on semen quality and fertility are codonsidered to be related to its severity. The aim of this study was to establish a quantitative radioisotopic method for the diagnosis and evaluation of testicular varicocele. 31 men attending our infertility clinic underwent scintigraphy with a gamma camera scanner (Apex 415) equipped with a pinhole low energy collimator (zoom factor 2). The evaluation was performed in the supine position and the collimator at 8.5 cm above the testicular area. The patients' red blood cells were labeled in-vivo by injection of SN-pyrophosphate before i.v. administration of To-99. An image of the scrotal area was obtained and the computer processing consisted of a drawing of the region of interest over the area of the varicocele, with background subtraction. The following indices were calculated: testes total count, varicocele area (in pixels) and average count per pixel (ACPP). The patients also underwent high resolution duplex sonography (HRDS) using a Multigon duplex scanner with a 7.5 Mhz transducer. Spermatic vein diameter, and reflux when present, were determined. HRDS was performed to compare and to validate the results obtained by scintigraphy. In men without varicocele mean ACPP was 2.80, in those with mild varicocele 3.76, in those with moderate varicocele 5.40 and in those with severe varicocele 7.48. A significant positive correlation was found between ACPP values and severity of the varicocele, as determined either by the diameter of the spermatic veins or by reflux of blood in the veins. We conclude that the ACPP index obtained by this new technique enables objective diagnosis and quantitative grading of testicular varicocele.

Endoscopic correction of vesicoureteral reflux: our experience with 115 ureters.

Endoscopic subureteral injection of polytetrafluoroethylene was performed in 115 ureters to correct vesicoureteral reflux. We treated primary reflux in 84 single ureters, 16 duplex ureters and 4 megaureters (grade V), and secondary reflux in 11 ureters associated with neurogenic bladder, uncapped ureteroceles and failed ureteroneocystostomy. Followup evaluation consisted of a voiding cystourethrogram, which was done in the operating room immediately after the endoscopic procedure, ultrasound 1 month postoperatively, and a diethylenetriaminepentaacetic acid renal isotope scan and repeat voiding cystourethrogram 6 months after injection. Grades II to IV primary reflux involving single as well as duplex ureters resolved in 94% and 82%, respectively, of the cases after 1 injection and in 98% and 93% of the cases after 2 or more injections. The severely and chronically dilated ureters did not respond to the treatment.