Importance of platelet aggregation in patients with end-stage renal disease.

The exact etiology of the conflicting hemostatic disorder in the advanced stage of chronic renal disease, i.e. prothrombotic versus bleeding tendency, is not completely understood. Abnormal platelet function in patients with renal failure is not caused by high concentrations of urea, although the presence of fibrinogen fragments may prevent binding of normal fibrinogen and formation of platelet aggregates. Hemostatic abnormalities in end-stage kidney disease may be affected, to some extent, by the choice of renal replacement therapy. Patients on hemodialysis have an increased risk of thrombotic events, primarily due to the release of thromboxane A2 and adenosine diphosphate into the circulation, as well as platelet degranulation. Some activation of platelets occurs due to the exposure of blood to the roller pump segment, but microbubbles may also play a role. Renal transplantation is the treatment of choice for patients with end-stage renal disease. Immunosuppressive therapy is associated with an increased risk of thromboembolic complications. Additional research is required to identify the potential benefits of different immunosuppressive therapies in relation to platelet aggregation, keeping in mind the long- term need for immunosuppression in renal transplant patients.

Excimer laser correction of hyperopia, hyperopic and mixed astigmatism: past, present, and future.

The broad acceptance of "spot scanning" or "flying spot" excimer lasers in the last decade has enabled the domination of corneal ablative laser surgery over other refractive surgical procedures for the correction of hyperopia, hyperopic and mixed astigmatism. This review outlines the most important reasons why the ablative laser correction of hyperopia, hyperopic and mixed astigmatism for many years lagged behind that of myopia. Most of today's scanning laser systems, used in the LASIK and PRK procedures, can safely and effectively perform low, moderate and high hyperopic and hyperopic astigmatic corrections. The introduction of these laser platforms has also significantly improved the long term refractive stability of hyperopic treatments. In the future, further improvements in femtosecond and nanosecond technology, eye-tracker systems, and the development of new customized algorithms, such as the ray-tracing method, could additionally increase the upper limit for the safe and predictable corneal ablative laser correction ofhyperopia, hyperopic and mixed astigmatism.

[Prevention and treatment of intensive care unit delirium]. / Prevencija i terapija bolesnika s delirijem u jedinici intenzivnog lijecenja.

Delirium is a common problem in intensive care patients, frequently underdiagnosed and resulting in prolonged hospital stay and a high risk of morbidity and mortality. On the other hand, reversibility of the condition points to the importance of prevention, early diagnosis and immediate therapy. Management strategy is directed to nonpharmacological interventions as preventive measures and pharmacological treatment, which includes typical and atypical neuroleptics. Delirium management includes haloperidol as the first line medication, but also olanzapine and risperidone as atypical neuroleptics. Benzodiazepines are used in delirium caused by alcohol withdrawal.

Sunshine on holidays--eye risks.

Ultraviolet (UV) light is the most common cause of radiation injury to the eye which in acute exposure causes photokeratitis and photoconjunctivitis. After a whole day exposure to the sun on the Mediteranian coast patient presented with mixed conjunctival injection, chemosis, edematous corneal epithelium with superficially present fluoresceine positive small pinpoint defects. Epithelial bullous changes, circular stromal infiltration in the middle stromal perifery and reduction of corneal transparency were more pronounced on the left eye. After treatment moderate conjunctival injection remained together with circular stromal infiltration in the middle perifery, corneas were transparent, epithelialised and fluorescein negative. Anterior chambers and lenses were clear. One month after patient regained bilateral visual acuity of 1.0. To our kownledge, this case shows for the first time connection between acute ultraviolet radiation exposure and persistent circular stromal infiltration in the middle corneal perifery in humans.

Blue light filtering intraocular lenses in phacoemulsification cataract surgery.

Blue light can damage retina and cause age related macular degeneration. After cataract surgery and lens removal retina stays unprotected. Blue light filtering intraocular lenses (IOL) increase protection of the retina. In our prospective study we investigated clinical results after bilateral implantation of Acrysof Natural IOL to 30 patients (N = 60 eyes). In a control group (N = 60 eyes, 30 patients), standard acrysof IOL was implanted bilaterally. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA) and Nd YAG laser capsulotomy rate were measured and compared with control group. Subjective patient's satisfaction and subjective colour perception were also investigated. There was no significant difference in UCVA, BCVA and Nd YAG laser capsulotomy rate between the two groups. High patient's satisfaction was noticed (96.7% of patients would implant Acrysof Natural IOL again). Acrysof Natural IOL enables good visual acuity VA, low rate of Nd YAG laser capsulotomy and high patient's satisfaction without colour perception disturbances.

[Ten years of work of Lions Croatian Eye Bank]. / Deset godina rada Lions Hrvatske ocne banke.

Lions Croatian Eye Bank (LCEB) was founded in December 1995 under the leadership of Professor Nikica Gabric, to grow into the Reference Center for Corneal Transplantation of the Ministry of Health and Social Welfare of Republic of Croatia in 2001. The work of LCEB is coordinated according to the European and International Tissue Bank Association directives and laws (TBI). All donor tissues to be tested in the eye bank to ensure safe clinical usage. During the 1996-2006 period, 796 co have rneas were collected and 592 natio(74.37%) transplanted. Among patients that underwent corneal transplantation, only 26% were from local district, which reflects thenal character of LCEB. Currently there are 235 ients on the waiting list for corneal transplantation, 56 (23.8%) of them from Zagreb County and 179 (76.2%) from other parts of Croatia.

[Evaluation of vascular risk factors in primary open-angle glaucoma using doppler sonography]. / Procjena vaskularnog cimbenika rizika u primarnom glaukomu otvorenog kuta metodom obojene doplerske sonografije.

UNLABELLED: Primary open angle glaucoma (POAG) is a syndrome of progressive optic neuropathy characterized by optic nerve head excavation and visual field defects. Poor correlation between intraocular pressure (IOP) and progression of glaucoma disease puts vascular mechanism in the center of attention. By color Doppler sonography, quantification of blood flow changes in the vessels which supplying optic nerve head is possible. AIM: To examine the antiglaucomatous action of selective-blockers by color Doppler sonography. PATIENTS AND METHODS: Forty-four patients (88 eyes) were divided into two groups: group 1 treated with selective beta-blockers and group 2 treated with nonselective beta-blockers. Vascular indices (RI, PI) were measured in the central retinal artery and posterior ciliary arteries. RESULTS: Decreased blood flow and increased vascular indices were found in both groups, with a statistically significant difference between group 1 and group 2. Blood flow velocity was higher and vascular indices were lower in group 1 (Betoptic 0.5%) than in group 2 (Timolol 0.5%). CONCLUSIONS: beta-blockers, selective (betaxolol-calcium channel blockers) have more potent vasoactive and neuroprotective action. Color Doppler sonography is useful in the quantification of blood flow changes in the vessels in patients with POAG.