A prospective, randomised, multicenter trial for surgical treatment of central retinal vein occlusion: results of the Radial Optic Neurotomy for Central Vein Occlusion (ROVO) study group.

BACKGROUND: To compare the surgical outcomes and evaluate the effectiveness of two treatments for central retinal vein occlusion (CRVO), radial optic neurotomy (RON) and intravitreal triamcinolone (IVT), in comparison to natural history. METHODS: A prospective, placebo-controlled, randomised and multi-center study. Patients with CRVO were treated in three groups - with either RON, a single intravitreal injection of 4 mg triamcinolone acetonide, or a placebo treatment. The main outcome measures were change of VA (visual acuity) and proportion of eyes with a significant improvement (defined as > 3 lines logMAR scale) of VA from baseline to month 12. RESULTS: Ninety patients were included. Due to insufficient data, seven were excluded. Forty-seven percent (n = 18) of patients treated with RON showed an increase in VA, in comparison to 10 % (n = 2) of placebo-treated patients, and 20 % (n = 5) of patients treated with IVT. Significantly more patients showed an improvement in VA following RON than in the placebo group (p = 0.009). Significantly more patients showed an improvement in VA following RON than in the IVT group (p = 0.034). No significant difference was found when directly comparing improvement in VA following IVT and placebo (p = 0.667) treatment.Significantly (p = 0.007) more patients in the placebo group (35 %, n = 7) showed a deterioration (defined as > 3 lines LogMAR scale) in VA than patients in the RON group (8 %, n = 3). CONCLUSION: Our study showed that following treatment with RON, patients with CRVO display a significantly better long-term VA than untreated patients and patients treated with a single dose of IVT.

Performance evaluation of the Sysmex XE-5000 hematology analyzer for white blood cell analysis in cerebrospinal fluid.

CONTEXT: The newest generation hematology analyzer, Sysmex XE-5000 (Sysmex Corporation, Kobe, Japan) is equipped with an improved body fluid analysis mode. OBJECTIVE: To evaluate the applicability of the XE-5000 analyzer to white blood cell (WBC) analysis in cerebrospinal fluid (CSF). DESIGN: A total of 425 routinely collected, consecutive CSF samples were included in the study. For a comparison of total WBC counts, the results of routine chamber counts were grouped into categories of 0 to 5 (n  =  330), >5 to 10 (n  =  36), >10 to 50 (n  =  39), >50 to 200 (n  =  15), and >200 (n  =  5) WBC/µL. Microscopic differential counts were performed using cytospins from 276 samples. Results were grouped according to the percent content of polymorphonuclear (PMN) cells, 0% to 25% (n  =  263), >25% to 50% (n  =  7), >50% to 75% (n  =  3), and >75% to 100% (n  =  3) of WBC. Corresponding results of XE-5000 analysis were matched to these particular count categories. RESULTS: For total WBC counts, the proportions of samples correctly classified by the XE-5000 from the percentage groups described above were 88%, 47%, 72%, 93%, and 100%, respectively. After the two lowest count categories were combined into one range of 0 to 10 WBC/µL, matches increased to 95%. For PMN counts in the 0% to 25% group, 37% of samples were misclassified by the XE-5000. Conversely, for samples with microscopic PMN counts of more than 25%, there was a trend toward underestimation by the XE-5000. Mismatches were most pronounced in samples with fewer than 10 WBC/µL. CONCLUSIONS: The Sysmex XE-5000 hematology analyzer yields valid total CSF cell counts and may be considered an acceptable alternative to the traditional chamber method, even for samples with low WBC counts. However, it cannot be recommended as a suitable alternative for manual differential cytologic workup.

Reproducibility of segmentation error correction in age-related macular degeneration: Stratus versus Cirrus OCT.

INTRODUCTION: The accuracy of retinal thickness measurement in age-related macular degeneration by optical coherence tomography (OCT) is affected by threshold algorithm line errors. The reproducibility of error correction in Stratus and Cirrus OCT should be examined. METHODS: OCT examinations of a consecutive series of 104 patients with neovascular age-related macular degeneration included in another study were reviewed. 72 eyes exhibited failures in Stratus OCT and 32 eyes in Cirrus OCT and were included in this new study. Algorithm line failures of Stratus OCT (retinal thickness program) and Cirrus OCT (Macular Cube 512×128 program) were corrected independently twice by two ophthalmologists and two residents, respectively, using the Stratus and Cirrus OCT built-in software. Reproducibility was assessed by the interclass correlation coefficient (ICC). RESULTS: The corrected values of central retinal thickness were significantly lower than the automated measured values in Stratus OCT for all examiners (p<0.001), while in Cirrus OCT the differences were not significant (p=0.06-0.09). For Stratus OCT, the ICC for central retinal thickness was 0.991 and 0.997 for the experienced ophthalmologists and 0.89 and 0.97 for the residents. For Cirrus OCT, the ICC was 1.0 and 1.0 for the experienced ophthalmologists and 0.99 and 0.95 for the residents. CONCLUSION: The reproducibility of threshold algorithm line failure correction was good overall in Stratus and Cirrus OCT and can therefore be recommended to improve retinal thickness measurement, particularly when experienced examiners perform the corrections.

Lower serum total testosterone is associated with lymph node metastases in a radical prostatectomy cohort study.

BACKGROUND: Data on testosterone levels of patients with prostate cancer of different grade and stage are inconsistent. We retrospectively investigated serum total testosterone of a radical prostatectomy cohort to further shed light on this problem. PATIENTS AND METHODS: The preoperative level of serum total testosterone of 217 patients (mean age: 65±5.8 years) undergoing radical prostatectomy between 1989 and 2002 was analyzed for possible associations with Gleason score (≤6 vs. <7 vs. 8-10) and tumor stage (pT2 vs. pT3 vs. N+) with adjustment for age, diabetes and obesity. Patients exhibiting prostate-specific antigen (PSA) levels of >10 ng/ml and biopsy Gleason scores of ≥7 were submitted to standard lymphadenectomy. RESULTS: The multivariate model revealed a significant effect of body mass index (BMI) (p=0.0003) and diabetes (p=0.002) on testosterone levels. Significantly lower testosterone levels were recorded in patients with nodal metastases (p<0.0001) compared to patients with non metastatic disease. No significant associations between testosterone, Gleason score and stage were found in patients with non- metastatic disease. CONCLUSION: Testosterone levels prior to radical prostatectomy were lower in patients with nodal involvement.

Predictors of short-term success in smoking cessation in relation to attendance at a smoking cessation program.

INTRODUCTION: The identification of individual characteristics that predict success in smoking cessation is necessary to improve the effectiveness of smoking cessation efforts. The aim of this study was to identify the factors that predict success in smoking cessation in people who attended 2, 3, 4, or 5 sessions of a smoking cessation program. METHODS: The participants comprised 2,471 people who attended at least 2 consultations during a 5-week smoking cessation program. Success in smoking cessation was defined as self-reported abstinence and having an exhaled carbon monoxide level ≤10 parts per million at the final consultation. Baseline characteristics were compared using univariate analysis of variance and the chi-square test. A stepwise multivariate logistic regression model was used to analyze the effect of baseline characteristics and the slopes of the withdrawal symptoms on the success in smoking cessation. RESULTS: Participating in a higher number of sessions gradually increased the chance of smoking cessation from 12.1% to 61.2% (p < .0001). Logistic regression analysis revealed that the independent predictors of success in smoking cessation were being male; low nicotine dependence; smoking few cigarettes per day at baseline; having no history of depression; having low values for craving for cigarettes, irritability, frustration, anger, or nocturnal awakening at baseline; decreased craving for cigarettes and restlessness with time; and use of nicotine replacement therapy (NRT). People who attended more sessions tended to be older. CONCLUSIONS: Attending more sessions of a smoking cessation program, NRT, and coping with withdrawal and psychosocial symptoms increases the chance of short-term success in smoking cessation.

Quality and reproducibility of retinal thickness measurements in two spectral-domain optical coherence tomography machines.

PURPOSE: To evaluate the accuracy and reproducibility of retinal thickness measurements in exudative age-related macular degeneration (AMD) by the Spectralis (Heidelberg Engineering, Heidelberg, Germany) and the Cirrus (Carl Zeiss Meditec, Dublin, CA) optical coherence tomography (OCT) systems. METHODS: Eyes with exudative age-related macular degeneration were randomly assigned to one of eight groups, each different in the sequence of examiner and OCT system. The 512 × 128 cube program of the Cirrus and the 30° × 25° volume scan containing 32 lines of the Spectralis were performed twice. The correlation between the examinations was expressed by the interclass correlation coefficient (ICC). RESULTS: Enrolled in the study were 112 patients and 112 eyes (mean age, 76.5 ± 7.9 years; range 51-89), with 14 patients in each group. The mean error scores per line were 0.53 and 0.52 in the Cirrus, significantly (P < 0.001) lower than in the Spectralis (0.83 and 0.98). For automatic central retinal thickness (CRT), the ICC for Cirrus (all examinations calculated) was 0.61 for groups 1 to 4 (the same examiner) and 0.65 for groups 5 to 8 (two different examiners); for Spectralis (13.4% not calculated) the ICC was 0.93 for groups 1 to 4 and 0.86 for groups 5 to 8. After error correction, the Cirrus ICC improved to 1.0 and 0.99 and the Spectralis ICC to 1.0 in both groups. CONCLUSIONS: Considerable differences were found between the two systems, both of which incorporate the spectral-domain technology. Different positioning of segmentation lines, control of localization, density of included scan lines, and number of available maps explain the differences in segmentation quality and reproducibility. Manual correction of segmentation and centralization improves the reproducibility.

Conversion of Stratus optical coherence tomography (OCT) retinal thickness to Cirrus OCT values in age-related macular degeneration.

AIM: Spectral domain optical coherence tomography (SD OCT) is of increasing importance and is gradually replacing time domain OCT (TD OCT). Our aim was to determine a formula to convert Stratus OCT (TD OCT) to Cirrus OCT (SD OCT) retinal thickness. METHODS: Central retinal thickness (CRT) and retinal volume (RV) were obtained by the macular thickness program of Stratus OCT and the cube 512 × 128 program of Cirrus OCT in patients with exudative age-related macular degeneration (AMD). Algorithm line failures were corrected. A linear model with Stratus OCT CRT as fixed factor and Cirrus OCT CRT as dependent variable was applied to calculate the conversion formula. RESULTS: OCT examinations of 104 eyes of 104 patients were reviewed and corrected when necessary. Stratus and Cirrus OCT CRT were significantly correlated (p<0.0001). For CRT the formula Cirrus CRT=58.63+0.94 × Stratus CRT was calculated. The correlation was significantly influenced by the height of the CRT values (p<0.0001), but not by whether correction was necessary. For RV the formula Cirrus OCT RV=3.098+0.98 × Stratus OCT RV was calculated. CONCLUSION: Stratus OCT and Cirrus OCT use a different posterior reference line within the hyper-reflective band of the outer retina. Therefore a conversion formula is necessary to compare Stratus and Cirrus OCT CRT values, and this has been determined in our study.

Light chain-induced acute renal failure can be reversed by bortezomib-doxorubicin-dexamethasone in multiple myeloma: results of a phase II study.

PURPOSE: To assess the efficacy of bortezomib-doxorubicin-dexamethasone (BDD) therapy in patients with multiple myeloma with light chain-induced acute renal failure. PATIENTS AND METHODS: Sixty-eight patients with light chain-induced acute renal failure and glomerular filtration rate (GFR) less than 50 mL/min received bortezomib (1.0 mg/m(2) on days 1, 4, 8, and 11), doxorubicin (9 mg/m(2) on days 1 and 4), and dexamethasone (40 mg on days 1, 4, 8, and 11); if well tolerated after two cycles, bortezomib could be increased to 1.3 mg/m(2) and doxorubicin administered on days 1, 4, 8, and 11. RESULTS: By intent-to-treat analysis a myeloma response was obtained in 72% of 18 previously and 50 not previously treated patients (complete response [CR]/near CR [nCR], 38%; very good partial response [VGPR], 15%; partial response [PR], 13%; minor response [MR], 6%). Renal response was achieved in 62% of patients (renal CR, 31%; renal PR, 7%; renal MR, 24%). Median GFR increased from 20.5 to 48.4 mL/min. GFR improvement correlated with tumor response; the greatest increase to 59.6 mL/min was seen in the group of patients with CR/nCR/VGPR. Median progression-free survival was 12.1 months. One- and 2-year survival rates were 72% and 58%, respectively. Survival did not differ between patients with and without renal response but was inferior in previously treated patients (P < .001). In multivariate analysis, baseline GFR and tumor response correlated with renal response, and pretreatment status, lactate dehydrogenase, and myeloma response correlated with survival. The most common grade 3 or 4 toxicities were infection (19.1%), thrombocytopenia (14.7%), neutropenia (14.7%), fatigue/weakness (10.3%), and polyneuropathy (8.8%). CONCLUSION: BDD induced a high rate of myeloma and renal responses, and treatment was well tolerated.

Early postpartum hysterectomy: incidence and risk factors.

OBJECTIVE: To determine the incidence and risk factors of early postpartum hysterectomy at the University Hospital in Vienna. DESIGN: Retrospective case-control study. SETTING: General Hospital Vienna, a tertiary referral center. POPULATION: All 15,858 women who gave birth between 1st January 2003 and 31st December 2008. METHODS: Analysis of all cases of early postpartum hysterectomy using data from the clinical documentation system. MAIN OUTCOME MEASURE: Postpartum hysterectomy done during or within 24 hours of birth. RESULTS: The incidence of early postpartum hysterectomy was 1.39/1,000. Abnormally adherent placenta was the most common cause for hysterectomy followed by uterine atony and uterine rupture. There were no maternal deaths. Abnormal placentation, increased blood loss and lower gestational age were significant risk factors in women undergoing hysterectomy. The newborns of these women had a lower birthweight, significantly lower Apgar scores at 1 and 5 minutes and were more often transferred to the neonatal intensive care unit (NICU). An additional analysis in a sample of women with uterine atony identified age as risk factor for hysterectomy. CONCLUSION: Abnormal placentation, increased blood loss, low gestational age and maternal age are risk factors for early postpartum hysterectomy.

Repeatability and reproducibility of retinal thickness measurements by optical coherence tomography in age-related macular degeneration.

PURPOSE: To evaluate the repeatability and reproducibility of retinal thickness measurements in exudative age-related macular degeneration (AMD) using Stratus optical coherence tomography (OCT) (Carl Zeiss Meditec, Inc., Dublin, CA). DESIGN: Prospective, observational case series. PARTICIPANTS: A total of 200 eyes of 200 subjects with exudative AMD. METHODS: Macular thickness and fast macular thickness programs of Stratus OCT were performed twice by the same examiners or 2 different examiners. The sequence of examiners was randomized 1:1:1:1. The variability of 1-mm subfield central retinal thickness (CRT), center point thickness (CPT), and retinal volume (RV) was calculated. MAIN OUTCOME MEASURES: Interobserver and intraobserver variability of retinal thickness measurements. RESULTS: Ninety-nine patients/eyes were enrolled in study arm 1 (repeated by the same examiner), and 101 patients/eyes were enrolled in study arm 2 (repeated by different examiners). Values of CPT, CRT, and RV were well correlated (interclass correlation coefficient, 0.71-0.93) in both study arms, revealing better results for the macular thickness program than for the fast macular thickness program. Threshold algorithm line failures were significantly correlated to the absolute differences of 2 repeated measurements for CPT, CRT, and RV but not with manually corrected maximum retinal thickness (MRT). Maximum retinal thickness was significantly influenced by the examiner performing the measurement. Age, lesion composition, examiner performing OCT examination, and sequence of examination had no significant influence. CONCLUSIONS: The repeatability and reproducibility of retinal thickness measurements were high, presenting better results for CRT and RV versus CPT, and for the macular thickness program versus the fast macular thickness program. The reliability of retinal thickness measurement was most frequently affected by algorithm line failures and fixation problems. A possible solution may be manually corrected measurement, such as MRT.

The effects of early environmental conditions on the reproductive and somatic development of juvenile guinea pigs (Cavia aperea f. porcellus).

Little is known about the effects of the early environment on the development of non-seasonally reproducing species like the domestic guinea pig (Cavia aperea f. porcellus). Although guinea pigs reproduce throughout the year, there is evidence for environmental sensitivity of their reproductive physiology. To investigate the sensitivity of juvenile body weight and puberty to differences in the prenatal and early postnatal environment, subjects were exposed to either of two experimental conditions mimicking seasonal variation: a long photoperiod with 25 degrees C ambient temperature ("LD/25 degrees C"), or a short photoperiod with 15 degrees C ("SD/15 degrees C"). Mean body weight of F1-males from LD/25 degrees C-conditions was higher than that of SD/15 degrees C-males during the whole pubertal period, although the difference was significant only during the early growth phase. Testosterone concentrations also differed significantly between the two treatment groups, pointing to an earlier pubertal onset in LD/25 degrees C- than SD/15 degrees C-males. In F1-females, treatment effects on body weight or age at first estrus were absent. This indicates that the somatic and reproductive development is more sensitive to early photoperiod and temperature conditions in male than female guinea pigs, and that other environmental factors may also play a crucial role for reproductive maturation in this species.