Subconjunctival mitomycin C as adjunctive therapy before pterygium excision

PURPOSE: To evaluate the safety and efficacy of subconjunctival mitomycin C as adjunctive therapy before pterygium surgery. DESIGN: Prospective noncomparative case series. PARTICIPANTS: Thirty-six eyes of 36 patients. INTERVENTION: Thirty-six eyes of 36 patients prospectively received 0.1 ml of 0.15 mg/ml mitomycin C subconjunctivally injected into the head of the pterygium 1 month before bare sclera surgical excision. MAIN OUTCOME MEASURE: Recurrence of pterygia. RESULTS: The pterygia resolved in 34 (94%) of 36 eyes, with a recurrence rate of 6% over a mean follow-up of 24.4 months. No wound-healing complication developed in any patient. CONCLUSIONS: Subconjunctival mitomycin C is an effective treatment before pterygium excision. Subconjunctival injection allows exact titration of mitomycin C delivery to the activated fibroblasts and minimizes epithelial toxicity.     

Decreased pigment epithelium-derived factor and increased vascular endothelial growth factor levels in pterygia

PURPOSE: Pterygia are histologically composed of proliferating fibrovascular tissue. This study compared expression levels of an angiogenic inhibitor, pigment epithelium-derived factor (PEDF), in pterygia with those in normal corneal and conjunctival tissues. METHODS: The normal human conjunctival and corneal tissues were obtained from surgery or from donor eyes without ocular diseases. Pterygia were excised by therapeutic surgery under a microscope. Pigment epithelium-derived factor and vascular endothelial growth factor (VEGF) were measured by Western blot analysis. Their cellular localizations were determined by immunohistochemistry. RESULTS: Intensive PEDF immunostaining was detected in all the normal corneal and conjunctival samples analyzed, predominantly in the epithelium and endothelium of the cornea and in the epithelium of the limbus and conjunctiva. Under the same immunostaining conditions, pterygial samples showed negative or faint PEDF staining. In contrast, the same pterygial samples all showed intensive VEGF staining, predominantly in the epithelium and in blood vessels. Western blot analysis confirmed that the average PEDF level in pterygia was drastically lower than those in normal corneal and conjunctival tissues, respectively. In contrast, the VEGF level in pterygia was significantly higher than in the normal tissues. CONCLUSION: Pterygia exhibit significantly lower PEDF but higher VEGF levels than those in normal corneas and conjunctivae. The decreased PEDF level in pterygia may play a role in the formation and progression of pterygia.     

Preincisional treatment to prevent pain after ambulatory hernia surgery

We designed this study as a randomized comparison of postoperative pain after inguinal hernia repair in patients treated with triple preincisional analgesic therapy versus standard care. Triple therapy consisted of a nonsteroidal antiinflammatory, a local anesthetic field block, and an N-methyl-D-aspartate inhibitor before incision. The treatment group (n = 17) received rofecoxib, 50 mg PO, a field block with 0.25% bupivacaine/0.5% lidocaine, and ketamine 0.2 mg/kg IV before incision; controls (n = 17) received a placebo PO before surgery. The anesthetic protocol was standardized. Postoperative pain was treated by fentanyl IV and oxycodone 5 mg/acetaminophen 325 mg PO as required for pain. Pain scores (0-10) and analgesic were recorded for the first 7 days after surgery. Pain scores were 47% lower in the treatment group before discharge (3.1 +/- 0.6 versus 5.9 +/- 0.6, P = 0.0026) (mean +/- SE) and 18% less in the first 24 h after discharge (5.6 +/- 0.4 versus 6.8 +/- 0.5, P = 0.05); oral analgesic use was 34% less in the treatment group (4.6 +/- 0.8 doses versus 7.1 +/- 0.7 doses, P = 0.02) in the first 24 h after surgery. We conclude that triple preincisional therapy diminishes pain and analgesic use after outpatient hernia repair, and encourage further evaluation of this technique. IMPLICATIONS: Outpatients undergoing inguinal hernia repair under general anesthesia report moderate-to-severe pain after surgery. Triple preincisional therapy that included rofecoxib, 50 mg PO, ketamine, 0.2 mg/kg IV, and local anesthetic field block reduced pain scores and analgesic use in the first 24 h after discharge.     

Spoke-wheel pattern in renal oncocytoma seen on double-phase helical CT

Renal oncocytomas are benign, solid tumours of the kidney. An angiographic spoke-wheel pattern is known to be associated with oncocytomas, although it is not pathognomonic. On review of the literature, we found two reports of sonographic spoke-wheel appearance in oncocytomas. These were sufficiently characteristic to enable a confident preoperative diagnosis of oncocytoma. We present a case of a surgically proven oncocytoma with a distinct helical CT appearance, -commensurate with the angiographic and sonographic spoke-wheel appearance from which the diagnosis was suspected preoperatively.     

Prevalence and risk factors of iodine deficiency among schoolchildren

The aim of this study was to demonstrate the prevalence of iodine deficiency among schoolchildren and the risk factors influencing it. One thousand five hundred and seventy-three schoolchildren were chosen from 14 schools in seven different regions in Istanbul. After all data relating to sociodemographic factors and the use of iodized salt were recorded, iodine contents of urine samples were determined by the Sandell Kolthoff reaction. Chi-squared and multiple regression analysis were used for the investigation of the correlation between iodine deficiency and risk factors. The prevalence of goitre (> or = 2 grade) was 1.9 per cent. The median urine iodine level was in the normal range (10.5 microg/dl). In 46.2 per cent of the students the urine iodine levels were below 10 microg/dl and 13.9 per cent of the students had urine iodine levels below 5 microg/dl. The prevalence of iodine deficiency was significantly higher in younger (< or = 10 years) children, in children with less educated mothers and fathers, and with poorer and more crowded families (p < 0.01, p < 0.01 and p < 0.01, p < 0.001, respectively). The rate of iodine deficiency was significantly higher in females than in males and also higher in children who lived on the European side of Istanbul than on the Anatolian side of Istanbul (p < 0.0001, p < 0.0001, respectively). The rate of use of iodized salt was 44.4 per cent and the iodine deficiency rate was not affected by the use of iodized salt (p > 0.05). Although the median urine iodine level was in the normal range, in 46.2 per cent of the students urine iodine levels were low (< 10 microg/dl). As there seems to be no effect from the use of iodized salt in iodine deficiency, the use of a more stable potassium iodate for the fortification of salt may be required.     

Association of Lewis blood group phenotype with preterm premature rupture of membranes

OBJECTIVE: To evaluate the distribution of Lewis blood group phenotype and secretor status among women with preterm premature rupture of membranes. METHODS: ABO and Lewis blood group phenotypes were determined in 20 consecutive women with preterm premature rupture of membranes. The control group was composed of 48 women from our database without known history of preterm delivery. RESULTS: Of the 20 patients with preterm premature rupture of membranes six had blood type A (30%), nine type B (45%), two type AB (10%), three type O (15%), three Le(a(-)b(+)) (15%), one Le(a(+)b(-)) (5%), and 17 had Le(a(-)b(-)) (80%). Of the 48 controls, 18 had blood type A (37.5%), 10 type B (20.9%), two type AB (4.1%), 18 type O (37.5%), 37 Le(a(-)b(+)) (77.1%), six Le(a(+)b(-)) (12.5%), and five had Le(a(-)b(-)) (10.4%). The difference in the proportions of the A, B, AB, and O phenotypes between the groups was not statistically significant. The distribution of ABO and Lewis phenotype in the control group was similar to that in the general population. The proportion of combined recessive and nonsecretor phenotypes Le(a(+/-)b(-)) between patients with preterm premature rupture of membranes (17 of 20, 85%) and controls (11 of 48, 22.9%) was statistically significant (P <.001). CONCLUSIONS: Women with the Le(a(-)b(+)) phenotype who do secrete Le(b) antigen may have a protective effect against preterm premature rupture of membranes.