Association between the levels of prostaglandin E2 in tears and severity of dry eye

AIM: To investigate the relationship between the levels of prostaglandin E2 (PGE2) in tears and dry eye disease severity based on both clinical symptoms and signs. METHODS: Tear samples were collected from 36 non-Sjögren syndrome dry eye patients (10 males and 26 females, mean age 50.11±11.17y). All participants completed the Ocular Surface Disease Index (OSDI) questionnaire and underwent a detailed ophthalmic examination including, tear film breakup time (TBUT), ocular surface fluorescein staining, Schirmer I test, and meibomian gland assessment. The level of PGE2 in tears was measured using enzyme-linked immunosorbent assay (ELISA). The independent associations between tear PGE2 levels and other variables including demographics, OSDI scores, TBUT, Schirmer scores, ocular surface staining scores, and stage of meibomian gland dysfunction (MGD) were evaluated using linear regression analysis. RESULTS: The mean PGE2 level in tears of dry eye patients was 537.85±234.02 pg/mL. The tear PGE2 levels significantly positively correlated with OSDI scores (R=0.608, P<0.001), however, they did not significantly associate with TBUT (R=0.153, P=0.373), Schirmer scores (R=-0.098, P=0.570), ocular surface staining scores (R=0.282, P=0.095), and stage of MGD (R=-0.107, P=0.535). Male sex was significantly negatively correlated with tear PGE2 levels. CONCLUSION: The levels of PGE2 in tears are positively correlated with dry eye symptoms. However, no significant association was found between tear PGE2 levels and the results of other common dry eye diagnostic tests.     

Renal infarction as a presentation of austrian syndrome: thromboembolic phenomenon of pneumococcal endocarditis

ABSTRACT:: A 52-year-old unvaccinated and splenectomized man presented with fever, altered sensorium, bilateral flank pain and chest discomfort accompanied with paroxysmal atrial fibrillation with a rapid ventricular response. An abdominal computed tomography scan was performed, which revealed a right renal infarct and splenosis. Transthoracic echocardiography was performed, which demonstrated an echodense structure on the mitral valve with mitral regurgitation and a vegetation on the aortic valve with aortic regurgitation. Subsequently, he was found to have pneumococcal infective endocarditis, pneumococcal pneumonia and bacterial meningitis, namely Austrian syndrome. He underwent an early aortic valve and mitral valve repair but still had a poor clinical outcome. Renal infarction has a mortality of approximately 13.2%, which is strongly influenced by the underlying diseases and infectious complications. Medical and surgical treatment initiated in a timely manner is often inadequate. The authors report the first case of Austrian syndrome presenting with renal infarction as a clue to an embolic event associated with infective endocarditis in this study.     

Discrepancy of left and right hip bone mineral density (BMD) in Thai women: diagnostic agreement and misclassification

Objective

To determine the diagnostic agreement and the degree of misclassification when using data from the left and right hips.

Methods

The cross-sectional study of 1,943 perimenopausal and postmenopausal Thai women, who had bone mineral density (BMD) measurements at the left (non-dominant) and right hips for the screening of low bone mass (LBM) or osteoporosis (OP) in the Department of Radiology, Faculty of Medicine, Chiang Mai University from September 2008 to August 2010 was performed. The kappa statistic was used to assess diagnostic agreement. The prevalence of LBM and OP and the percentage of misclassification were reported.

Results

There was a significant correlation between the left and right BMD values for the femoral neck (FN) (r ²?=?0.83; p?<?0.001) and the total hip (TH) (r ²?=?0.89; p?<?0.001). The diagnostic agreement of the FN and TH regions was significant in all study groups ranging from 0.69 to 0.76 (p?<?0.001). For the final diagnosis, which is based on the least T-score of the FN or TH regions, the diagnostic agreement was 0.73 for all women, 0.77 for perimenopausal women, 0.73 for postmenopausal women, 0.70 for postmenopausal women age less than 65?years and 0.71 for postmenopausal women age greater than or equal to 65?years. The percentage of misclassification for all women was 16.9?%, with 3.3?% being downgraded from normal to LBM and 3.4?% from LBM to OP.

Conclusion

Despite the fact that good diagnostic agreement was demonstrated in this study, a significant number of diagnostic discordance between left and right hips (16.9?%) was also observed. BMD measurements of both hips are recommended for diagnosing LBM and OP in clinical practice.     

Importance of ethnic base standard references for the diagnosis of osteoporosis in Thai women

Many studies demonstrated the importance of using ethnic-specific normal database in the diagnosis of osteoporosis (OP). Aims of this study were to assess diagnostic agreement, prevalence of OP, and diagnostic misclassification between Caucasian, Japanese, and Thai normal databases. The cross-sectional study of 3181 Thai women who had bone mineral density (BMD) measurement between January 2008 and December 2010 was performed. BMDs at lumbar spine (LS), femoral neck (FN), and total hip (TH) were derived to T-score by using Caucasian, Japanese, and Thai standard references. Kappa statistic was used to assess diagnostic agreement and misclassification. Diagnostic agreements between Caucasian and Thai reference databases were 0.39 for LS and 0.90 for FN. No statistical agreement was found in TH region (0.01, p value=0.264). Applying the Japanese reference, diagnostic agreements were 0.71 for LS, 0.76 for FN, and 0.94 for TH regions. Prevalence of OP in postmenopausal women was 64.1%, 37.7%, and 41.4% using Caucasian, Japanese, and Thai standard references. Percentage of misclassification was varied by menopausal status and reference database from 11.2% to 48.7%. When applying Japanese databases instead of Caucasian normal databases, overall diagnostic misclassification decreased from 35.1% to 16.1%. Choice of reference database has a significant effect on the diagnosis of low bone mass and OP. Japanese reference database has better diagnostic agreement with previously studied Thai reference database in 1999 than Caucasian reference database.     

Results of chimney modification technique in ureterointestinal anastomosis of Hautmann ileal neobladder in bladder cancer

BACKGROUND: To evaluate the surgical technique and functional outcome of a new application of the chimney modification to the popular Hautmann ileal neobladder. This modification used 3-5 cm chimney tubularized ileal segment for the bilateral ureterointestinal anastomosis. METHODS: Between December 2000 and July 2004, 15 patients (14 men, 1 woman) with invasive bladder cancer underwent radical cystectomy and Hautmann neobladder with chimney modification at Siriraj Hospital, Bangkok. Mean age was 61.7 years (range, 43-72 years). Perioperative morbidity, early and late urinary diversion-related complications, other surgical complications, follow-up results of ureterointestinal anastomosis, renal function and metabolic disorders were evaluated. Patients were interviewed about their continence, voiding function and potency. RESULTS: At a mean follow-up of 29.5 months, two patients had died of cancer progression. Of the 15 patients, nine (60%) had 10 early complications. Eight complications were related to the neobladder and two were not. Three (20%) patients had three late complications. Two complications were neobladder-related and one was not. There was no perioperative mortality. There was no ureteroileal anastomosis stricture in this series. Neobladder-ureteral reflux was demonstrated in eight of 22 ureteral units in 11 patients in whom cystography was performed. All patients had normal upper urinary tract without evidence of urinary obstruction. All 14 men (93% of study sample) had spontaneous urination, normal renal function and no metabolic acidosis. Good and satisfactory continence in the day and night were 93% and 73%, respectively. All male patients experienced impotence postoperatively. Only one sought treatment and was successfully treated with sildenafil. The one woman in this study required intermittent catheterization to empty the neobladder completely. She also had renal insufficiency with serum creatinine of 2.2 mg/dL and hyperchloraemic metabolic acidosis. CONCLUSION: New chimney modification in Hautmann ileal neobladder is simple and safe. Complications are acceptable. Follow-up results of renal and voiding functions are satisfactory. This operation can maintain good quality of life for patients with bladder cancer undergoing radical cystectomy.     

Both EMLA and Placebo Cream Reduced Pain during Extracorporeal Piezoelectric Shock Wave Lithotripsy with the Piezolith 2300

Background: The objectives were to determine whether a eutectic mixture of local anesthetic (EMLA) or placebo cream reduces pain during extracorporeal piezoelectric shock wave lithotripsy (EPSWL), and to determine which of the components of the application (i.e., the occlusive dressing, the cream, or the local anesthetic) contributes to analgesia.

Methods: A randomized, double blind, crossover study (part 1) was performed in 12 patients who were scheduled for EPSWL procedures on an ambulatory basis who received the first treatment without any intervention and who had verbal pain scores of 70 or more (on a 0-to-100 scale). For the next two treatments at 2-week intervals, patients were randomly assigned to receive either 10 g EMLA or 10 g placebo cream and then crossed over to receive the other. The cream and occlusive dressing were left in place and immersed in water throughout the procedure. Verbal numeric pain score was assessed at 5 min after receiving the maximal tolerable intensity of shock wave and at the end of the procedure. The study continued (part 2) in 202 ambulatory patients; 125 men and 77 women, American Society of Anesthesiologists physical status I and II, subjected to EPSWL were randomly allocated into five groups who received (1) nothing on the skin (control), (2) plastic occlusive dressing, (3) placebo cream and plastic occlusive dressing, (4) EMLA cream and plastic occlusive dressing, (5) EMLA cream and plastic occlusive dressing for 60 min to achieve cutaneous anesthesia, which was removed before EPSWL. Pain score was evaluated 10 min into the procedure and at the end of the procedure.

Result: Both parts of the study showed that patients who received either EMLA or placebo cream with dressing throughout the procedure experienced less pain and tolerated higher energy levels compared with the control. Patients who received only pre-EPSWL cutaneous anesthesia of EMLA and who received only the occlusive dressing did not have a reduction in pain score.     

Mail follow-up of chronic diseases in northeast Thailand

The use of mailed questionnaires to follow patients with chronic diseases was investigated in 650 patients from 16 provinces of northeastern Thailand who sought care at the University Hospital. The overall response rate to the first mail follow-up was 73.2%. If all three mail follow-ups were considered, up to 86.6% of all patients responded. The demographic variables appeared to be similar between the respondents and the non-respondents. Cancer and deterioration of disease status had an adverse effect on the response rate. Utilization of peripheral health centres to supplement mail follow-up in these sub-populations was suggested. Almost 78% of 650 patients were followed and interviewed to assess the validity of mailed response. The percentages of respondents and non-respondents who were followed were almost identical. Of the 504 patients followed, 92% were located. The successful location was over 98% for the respondents and only 54% for non-respondents. The agreement of some parameter such as death and survival time after discharge was very high between mail and intensive follow-up data. Less distinctive events had lower agreement rates. Some precautionary notes were voiced and the possibility of extension of mail follow-up in collection of information and supervision of health care was suggested.     

Laparoscopic live-donor nephrectomy: a comparison with the open technique and how to reach quality standards: a single-center experience in Thailand

ObjectiveWe report our experience with laparoscopic donor nephrectomy (LDN) compared with open donor nephrectomy (ODN). Prognostic factors associated with adverse outcomes in LDN were identified.MethodsFrom January 2000 to December 2009, 243 consecutive live-donor nephrectomies were performed, including 129 LDNs and 114 ODNs. We compared patient demographics, perioperative outcomes, and recipient graft function in each group. Prognostic factors for adverse outcomes in LDN were investigated using uni- and multivariate analyses.ResultsPatient demographics, except mean donor age (P = .032), were similar between groups. Mean operative time (219 vs 163 minutes; P < .001) and warm ischemia time (WIT; 3.1 vs 1.7 minutes; P < .001) were significantly longer in LDN. Conversely, mean analgesic requirement (9.2 vs 14.7 mg morphine; P < .001) and postoperative hospital stay (6.5 vs 7.1 days; P = .003) were significantly lower with LDN. Mean estimated blood loss (EBL) was slightly lower in LDN (P = .15). There were 7 conversions from LDN to ODN. Complication rates were similar between the groups (P = .38). Delayed graft function (10.9% vs 1.7%; P = .016) and mean serum creatinine level at 1 month (1.47 vs 1.3 mg/dL; P = .04) were higher for LDN. However, 5-year allograft survival was not inferior among LDN (90% vs 85%; P = .42). Mean operative time (268 to 175 minutes; P < .001), EBL (316 to 66 mL; P < .001), and complication incidence (8 to 0 cases; P < .002) gradually decreased from the initial 43 cases to the last 43 cases of LDNs. Among surgeons who had performed-30 LDNs, the mean operative time and WIT were 197 mL and 2.8 minutes, respectively.ConclusionsBased on our evidence, LDN was a feasible and safe surgical option for live-donor nephrectomy, even in a small volume center. Better results can be achieved after a learning curve of experience for both the surgeon and the institution.