Pathophysiology and clinical aspects of epiretinal membrane - review.

The epiretinal membrane (ERM) is a pathological tissue formed at the vitreoretinal interface. The formation of this tissue is associated with numerous symptoms related to disturbances of vision. These types of lesions may arise idiopathically or be secondary to eye diseases, injuries and retinal surgeries. ERM tissue contains numerous cell types and numerous cytokines, which participate in its formation. The aim of this paper is to summarize information about the etiology, epidemiology, pathophysiology and treatment of ERM, with a brief description of the main cells that build the ERM - as well as the cytokines and molecules related to ERM pathogenesis - being provided in addition.

Efficacy and safety of pleurectomy and wedge resection versus simple pleurectomy in patients with primary spontaneous pneumothorax.

BACKGROUND: The treatment of primary spontaneous pneumothorax (PSP) remains controversial. Guidelines do not explicitly define surgical procedures. Different treatment modalities are observed in clinics of same profile. Treatment is controversial. The aim of the work was to compare the effectiveness of two methods-pleurectomy and pleurectomy combined with wedge resection in patients with PSP in terms of safety and efficiency. METHODS: Non-randomized observational study based on clinical analysis of 73 patients, M:F ratio 3:1, aged 18 to 45 years, the average age was 29 years, operated between January 2008 and December 2014 due to the occurrence of PSP. Pleurectomy was supplemented by wedge resection in patients diagnosed intraoperatively with ELC (emphsema-like changes) ≥ III stage (classification of PSP by Vanderschueren). Efficacy was defined as follows: complete lung expansion, drainage (days), air leak, frequency of PAL (persistent air leak >5 days), recurrences and re-operations. Safety was defined as follows: heamothorax, major bleeding (loss of Hg >2 g/dL), infections, deaths. The research project was approved by the Bioethical Commission of the Silesian Medical University in Katowice (KNW/022/kb1/3/14). RESULTS: Mean follow-up was 22 months. Efficacy: recurrences occurred less frequently in group treated with pleurectomy without wedge resection. No results were found in other parameters. Safety: No results were found in all parameters. CONCLUSIONS: Efficacy and safety of pleurectomy vs. pleurectomy + wedge resection is comparable.

What do we know about Tietze's syndrome?

Tietze's syndrome is a benign, self-limiting arthropathy, without purulent character. The disease most often involves articulations: sternocostal, sternoclavicular, or costochondral joints. The characteristic symptoms are tenderness, pain and edema involving one of the aforementioned joints on one side. Diagnosis of Tietze's syndrome is based on physical examination (increase of palpation tenderness in the affected joint), laboratory tests (increase of inflammatory parameters) and imaging studies (USG, MRI). Differential diagnosis of Tietze's syndrome is based on exclusion of costal cartilage inflammation, coronary syndrome and inflammatory changes in the lung and pleura. Most commonly the treatment is conservative, in resistant cases surgical.

Boerhaave Syndrome - over 290 years of surgical experiences. Can the disorder recur?

Spontaneous perforation of the esophagus (Boerhaave syndrome) is a rare disease that poses a serious surgical challenge. The analysis of literature concerning the Boerhaave syndrome reveled cases of recurrent spontaneous perforation of the esophagus. The incidental nature of this condition calls for more accurate assessment of all such cases. The authors made a detailed evaluation of the data obtained from eight reports of recurrent Boerhaave syndrome. The data is presented as a summary table comparing the clinical course and outcomes of patients with the primary Boerhaave syndrome as well as recurrent Boerhaave syndrome.

New aspects in the diagnosis and treatment of primary spontaneous pneumothorax.

This paper provides a recapitulation of the position of the British Thoracic Society and the American College of Chest Physicians based on a review of the literature concerning the current methods of diagnosing and treating primary spontaneous pneumothorax (PSP). The previously developed guidelines were re-evaluated in 2015 by a task force of the European Respiratory Society (ERS). They are intended to be used by surgeons as well as emergency and pulmonary ward physicians, and they apply largely to emergency procedures. In recent years, the effectiveness of minimally invasive methods (punctures, drainage) in combination with talc pleurodesis for the initial therapy of PSP has been recognized. The efficacy of thoracoscopy (VATS) for the treatment of this disease has been proven by the development of minimally invasive surgical techniques in thoracic surgery. This paper also discusses the efficacy of the surgical methods available.

Differences in serum oxidative status between glaucomatous and nonglaucomatous cataract patients.

BACKGROUND: Oxidative stress contributes to both intraocular pressure regulation and glaucomatous neuropathy. The systemic redox status (solitary determination) was examined in primary open-angle glaucoma (POAG) patients with cataract and nonglaucomatous cataract patients. Cataract-matched group comparisons appear more precise in the context of oxidative stress evaluation. The aim of this study was to establish if systemic oxidative status in POAG patients was elevated compared with the cataract only subjects. METHODS: The study included patients with primary open angle glaucoma (POAG group, n = 30) and controls (non POAG group, n = 25). Serum concentration of lipofuscine (LPS), malondialdehyde (MDA) and activity of total superoxide dismutase (SOD), and its mitochondrial (Mn-SOD) and cystolic (Cu,Zn-SOD) isoform were measured. Total oxidant state (TOS) and total antioxidant capacity (TAC) in blood were also evaluated. RESULTS: Significant increase of LPS (p = 0.0002) and MDA (p = 0.005) concentration was observed in glaucomatous patients as compared with controls. Total SOD activity was significantly lowered in the glaucoma group (p = 0.003); serum level of Mn-SOD was significantly lower in glaucoma patients (p = 0.048) however, Cu,Zn-SOD was not. Glaucoma patients presented elevated mean TOS (p = 0.016). Both groups presented with comparable TAC. CONCLUSION: Systemic redox balance of cataract patients was significantly altered in the course of glaucoma.

Malignant mesothelioma as a difficult interdisciplinary problem.

The authors of the present report review the etiology and clinical symptoms of malignant pleural mesothelioma (MPM) as well as diagnostic techniques (both radiological and biomarkers) used for its detection. Subsequently, they present methods of multimodal treatment (surgery, chemotherapy, and radiotherapy) recommended by the International Mesothelioma Interest Group (IMIG). Finally, they discuss complications and long-term results associated with these methods of MPM treatment.

Relationship between visual status and functional status and the risk of falls in women. The RAC-OST-POL study.

INTRODUCTION: Falls in elderly women producing fractures are a public health problem that could be largely preventable. The aim of this study was to determine the effect of visual impairment on functional status, falls and fractures in women. MATERIAL AND METHODS: We examined 623 women aged ≥ 55 years in order to assess the association between visual status and functional status and the risk of falls and fractures. Distance, near visual acuity, and depth perception were examined. Functional status was assessed using the Instrumental Activities of Daily Living (IADL) and Timed Up and Go (TUG) tests. The history of falls in the last 12 months and prior osteoporotic fractures were recorded. RESULTS: The mean age of participants was 66.01 ±7.76 years. Distance visual acuity was correlated (r = -0.13, p < 0.0001) with an increased number of falls. The most prognostic fall factor was IADL (Z = 3.19, p < 0.05), which showed a significant association with distance acuity (r = 0.27, p < 0.0001). The TUG test time significantly increased with diminishing visual acuity: 10.6 ±3.1 s for good, 12.8 ±6.1 s for moderate and 15.3 ±8.8 s for poor visual acuity (p < 0.0001, ANOVA 24.4). The IADL also differs significantly (p < 0.0001) in subgroups divided according to visual acuity (23.6 ±1.5, 22.6 ±2.9, 21.2 ±4.8 points, respectively). In multivariate logistic regression on probability of falls including IADL, TUG and visual acuity, IADL was found to be an independent prognostic factor (p = 0.025). The data revealed no association of refractive correction, depth perception, or near visual acuity with fall incidence or history of fractures. CONCLUSIONS: Visual acuity influences functional status and number of falls in women aged over 55 years.

Selected metabolic aspects of elastin and collagen fiber proteolysis in diseases of the respiratory system - the significance of α1 antitrypsin deficiency.

The process of elastin and collagen fiber destruction was presented based on the example of the changes taking place in the course of chronic obstructive pulmonary disease and primary spontaneous pneumothorax. In 1963, when analyzing patients with α1 antitrypsin deficiency, Dr Laurell and Dr Eriksson hypothesized that elastolysis plays a role in the pathogenesis of emphysema, which marked the beginning of studies aimed at analyzing this process. The present work concerns new scientific reports regarding the hypothesis. The most important risk factors include protease-antiprotease imbalance and α1 antitrypsin protein deficiency.

The role and importance of club cells (Clara cells) in the pathogenesis of some respiratory diseases.

The report presents the cellular structure of the respiratory system as well as the history of club cells (Clara cells), their ultrastructure, and location in the airways and human organs. The authors discuss the biochemical structure of proteins secreted by these cells and their importance for the integrity and regeneration of the airway epithelium. Their role as progenitor cells for the airway epithelium and their involvement in the biotransformation of toxic xenobiotics introduced into the lungs during breathing is emphasized. This is followed by a discussion of the clinical aspects associated with club cells, demonstrating that tracking the serum concentration of club cell-secreted proteins is helpful in the diagnosis of a number of lung tissue diseases. Finally, suggestions are provided regarding the possible use of proteins secreted by club cells in the treatment of serious respiratory conditions.

Determination of Serum Ceruloplasmin Concentration in Patients with Primary Open Angle Glaucoma with Cataract and Patients with Cataract Only: A Pilot Study.

BACKGROUND The aim of this article was to describe the role of ceruloplasmin and to report preliminary results of ceruloplasmin concentrations in patients with primary open-angle glaucoma (POAG) with cataract and in patients with only cataract. Glaucoma, a neurodegenerative disease, is a heterogeneous group of conditions characterized by loss of retinal ganglion cells (RGC), their axons, progressive optic nerve damage, and visual field deterioration. MATERIAL AND METHODS The POAG group included 30 patients and the cataract group included 25 patients. RESULTS Ceruloplasmin plays an essential role in iron metabolism and inactivating free radicals. In the presented pilot study, serum ceruloplasmin level was lower in the POAG group in comparison to the group with only cataract. CONCLUSIONS In treating persistent inflammation in the course of glaucoma, antiglaucoma drugs may increase the permeability of the blood-ocular barrier, which may be connected with the lower concentration of serum ceruloplasmin in the glaucoma patients group.

Oxidative stress in the red blood cells of patients with primary open-angle glaucoma.

BACKGROUND: This study was designed to examine oxidative and antioxidative changes in the red blood cells (RBCs) of patients presenting with glaucomatous degeneration. METHODS: The experimental design was a case-control study of strictly selected patients who required antiglaucomatous surgery during primary open-angle glaucoma despite relatively regulated intraocular pressure (IOP) (POAG group, n = 30) and patients who underwent an operation for nonpathological cataracts (cataract group, n = 25). The activities of total superoxide dismutase (SOD), glutathione peroxidase (GPX), and catalase (CAT), as well as the concentration of malondialdehyde (MDA), were measured. Glaucomatous damage was estimated from a transient pattern electroretinogram. RESULTS: Significant increases in GPX (p = 0.026) and CAT (p = 0.000) activity were noted in the RBCs of POAG patients compared to those of cataract patients. Although SOD was elevated in patients with POAG, the differences compared to cataract controls were not significant (p = 0.079). MDA concentrations were significantly increased in the glaucoma group compared to the cataract controls. CONCLUSION: An oxidative disorder primarily represented by catalase upregulation was observed during the course of glaucoma.

Is it possible to standardize the treatment of primary spontaneous pneumothorax? Part 1: etiology, symptoms, diagnostics, minimally invasive treatment.

The authors of this report present the history of primary spontaneous pneumothorax (PSP) treatment, its etiology, clinical symptoms, and diagnostic methodology. Further, they discuss minimally invasive methods of treating PSP such as thoracentesis and chemical pleurodesis. They discuss the pros and cons of each method, emphasizing that, according to the international recommendations, they should be used as the first line of treatment for PSP.

Is it possible to standardize the treatment of primary spontaneous pneumothorax? Part 2: surgical methods of treatment.

The present report provides a detailed description of the surgical methods for primary spontaneous pneumothorax (PSP) treatment, from open surgery (thoracotomy) to minimally invasive procedures (video-assisted thoracoscopic surgery - VATS). It describes the methods of preventing pneumothorax recurrence, including partial or complete resection of the parietal pleura and chemical pleurodesis with VATS. The pros and cons of each method are presented. The paper also discusses new techniques for diagnosing pneumothorax, such as fluorescein-enhanced autofluorescence thoracoscopy (FEAT) and infrared thoracoscopy. Finally, the authors propose their own algorithm for the treatment of PSP.

A rare case of duodenal ulcer perforation accompanied by Boerhaave syndrome.

Esophageal perforation is the fastest progressing and the most life-threatening disruption of gastrointestinal tract continuity. It must be regarded as an emergency condition that requires early diagnosis as well as very aggressive and rapid implementation of treatment in order to avoid serious complications and death. Methods of treatment for spontaneous esophageal perforation continue to be a matter of controversy. However, all authors emphasize that ultimate success depends largely on the time taken to establish the diagnosis. The authors of this study describe a rare case of duodenal ulcer perforation accompanied by Boerhaave syndrome.

The Influence of α-Lipoic Acid and Garlic Administration on Biomarkers of Oxidative Stress and Inflammation in Rabbits Exposed to Oxidized Nutrition Oils.

We hypothesized that addition of substances with antioxidant activity could decrease the concentrations of biomarkers of oxidative stress and inflammatory process, thus inhibiting nonalcoholic steatohepatitis development. We investigated the influence of α-lipoic acid (ALA) and garlic administration on the development of adverse changes in rabbit liver and serum under oxidative stress conditions induced with HFD from oxidized oils. We determined 8-hydroxy-2'-deoxyguanosine (8 OHdG) and malondialdehyde (MDA) in liver homogenates, total oxidant status (TOS), lipid peroxides (LOO) and tumor necrosis factor alpha (TNFα) in blood serum, and TNFα and IL-1α genes expression in liver. The results indicate that the intake of dietary ALA and garlic was significantly associated with decreases of 8 OHdG and MDA levels in rabbits' liver tissue as well as TOS and LOO levels in rabbits' serum. Similarly, TNFα and IL-1α gene expressions were suppressed due to ALA and garlic supplementation. The histopathological analysis confirmed that HFD results in liver disorder leading to steatosis. This adverse effect of HFD was ameliorated by the supplementation of ALA and garlic. The obtained results indicate a beneficial effect of ALA and garlic administration by reducing the oxidative stress intensity and the levels of some proinflammatory cytokines in rabbits fed HFD.

Inducible and endothelial nitric synthetase expression and nitrotyrosine accumulation in iris vasculature of patients with primary open-angle glaucoma: a pilot study.

BACKGROUND: The "double-faced" effect of nitric oxide (NO) is thought to play an important role in triggering and progression of glaucoma. MATERIAL/METHODS: Iris samples were obtained during iridectomy in 35 patients (mean age of 65.4±5.3 years) with diagnosed primary open-angle glaucoma (POAG). The controls were collected postmortem from 10 donors with a mean age of 62.2±1.9 years. Visual field defects were evaluated by perimetry. The Hodapp-Parrish-Anderson classification was used to divide patients into 3 visual field defect groups. The intraocular pressure was measured 3 times before surgery using applanation tonometry. The phenotype activity of nitric oxide synthase (NOS) isoenzymes (endothelial--eNOS and inducible--iNOS) and expression of nitrotyrosine in iris vasculature was assessed. RESULTS: Significant differences were found between glaucoma patients and the controls in eNOS and iNOS activity (Mann-Whitney test, U=35.5, Z=-2.037, p=0.04 and U=21, Z=2.69, p=0.007, respectively). In addition, the results showed an upregulation of nitrotyrosine in the capillary endothelial cells in the study group, which was associated with the duration of diagnosed glaucoma (R-Spearman of 0.33, p=0.0047) and visual field mean defect MD (R-Spearman of 0.29, p=0.019). Moreover, the activity of nitrotyrosine was significantly correlated with iNOS immunoreactivity (R-Spearman of 0.5, p=0.0001). However, the iNOS activity significantly varied among Hodapp-Parrish-Anderson groups (p=0.03). CONCLUSIONS: Our observations confirmed the association between glaucomatous disturbances and upregulation of iNOS, together with increased nitrotyrosine storage.

Combination of bevacizumab and bromfenac therapy in age-related macular degeneration: a pilot study.

BACKGROUND: According to recent studies, the newest strategy for the treatment of exudative age-related macular degeneration is to combine anti-VEGF agents with non-steroid anti-inflammatory drugs (NSAIDs) such as nepafenac and bromfenac to decrease the frequency of intravitreal injections. Since most research has focused on ranibizumab, the aim of this study is to evaluate whether an alternative drug such as bevacizumab could lead to similar outcomes. MATERIAL AND METHODS: The study was conducted on a group of 26 patients who were administered intravitreal bevacizumab and topical bromfenac (study group) and 26 patients with single bevacizumab therapy (control group). Cases that were not qualified for ranibizumab therapy were included in the study group. RESULTS: The study revealed that the visual acuity and parameters observed in OCT improved more in the study group than in the control group. However, the correlations between the above factors and the frequency of intravitreal injections were statistically significant only in visual acuity. CONCLUSIONS: We recommend the combined therapy of bevacizumab and bromfenac as an alternative and beneficial method of treatment in patients with exudative AMD who do not qualify for ranibizumab therapy. This combined therapy might efficiently reduce the number of intravitreal injections of bevacizumab.