Neuroprotective effect of topically applied brimonidine tartrate 0.2% in endothelin-1-induced optic nerve ischaemia model

BACKGROUND: To investigate the neuroprotective effects of topically applied brimonidine tartrate 0.2% (BMD), an alpha(2)-receptor agonist, on the retinal ganglion cell (RGC) layer and inner nuclear layer (INL) of rabbit retina in endothelin-1 (ET-1)-induced optic nerve (ON) ischaemia model. METHODS: Osmotic minipumps were surgically implanted into one eye of 16 New Zealand Albino rabbits to deliver ET-1 at the constant rate of 0.5 microL/h for 2 weeks. Eyes were divided into four groups. ET-1 was given with (Group 3) and without topical BMD therapy (Group 1). Groups 2 and 4 were taken as controls. Rabbits were sacrificed at day 14. Morphological alterations, total cell number and proportion of cells undergoing apoptosis in INL and RGC layer were assessed by histopathological analysis to determine the survival of the cells of the INL and RGC layer. RESULTS: Endothelin-1 led to severe reduction of cells in both the RGC layer and INL in Group 1 (P < 0.05). In Group 3, the total cell number and the proportion of cells undergoing apoptosis in the RGC layer were comparable with the control group (Group 4), whereas the former was found to be higher and the latter was found to be lower than those recorded for Group 1. However, the total cell number in the INL was found to be lower in Group 3 compared with that of Group 4, despite topical BMD therapy (P < 0.05). CONCLUSIONS: Topically applied BMD seems to be neuroprotective and antiapoptotic in the ET-1-induced ON ischaemia model, especially for RGCs. BMD might be used as an adjuvant agent for its neuroprotective effects in hypoxic-ischaemic conditions such as diabetic retinopathy, normotensive glaucoma and other retinal vascular occlusive conditions which require further investigations.     

Nerve fiber layer assessment with scanning laser polarimetry in glaucoma patients and glaucoma suspects.

PURPOSE: To investigate whether scanning laser polarimeter can differentiate glaucoma and suspected glaucoma patients from normals. METHODS: Polarimetric measurements were obtained using the nerve fiber analyzer (NFA)-I from 80 eyes of patients with glaucoma with mostly moderate glaucomatous optic nerve damage (37 eyes with primary open angle glaucoma, 21 with normal tension glaucoma, 17 with pseudoexfoliative glaucoma, 3 with angle closure glaucoma, and 2 with juvenile glaucoma), 53 eyes of patients suspected of glaucoma based on disc appearance, and from age-matched healthy volunteers as control groups. Ratios (superior/nasal, inferior/nasal, superior/inferior) were used for assessing nerve fiber layer (NFL) thickness. Student's t-test and linear regression analysis were used for statistical analysis. RESULTS: Both the glaucoma patients and glaucoma suspects had significantly lower NFL ratios (mean S/N 2.34 +/- 0.47, I/N 2.46 +/- 0.52, S/I 0.94 +/- 0.18) than the control groups (respectively 2.88 +/- 0.48, 2.88 +/- 0.48, 1.00 +/- 0.13) (p<0.05). There was an ample overlap between the patient groups and the normals. The superior and inferior NFL ratios in glaucoma patients gradually decreased as the mean defect in visual field increased (linear regression analysis, p<0.05). CONCLUSIONS: The NFL of glaucomatous eyes and eyes suspected of glaucoma based on disc appearance was significantly less thick than normals. NFA-I detects pathological abnormalities in some patients with glaucomatous optic nerve damage and normal visual fields as measured by conventional achromatic computerized perimetry. NFA-I, however, is unable to distinguish these patients from normals, at least using these parameters, because of the considerable overlap.     

Transfusion-associated graft-versus-host disease: risk due to homozygous HLA haplotypes

BACKGROUND: Transfusion-associated graft-versus-host disease (TA-GVHD) may occur in transfusions of blood from HLA-homozygous persons to HLA- heterozygous persons who share a haplotype. STUDY DESIGN AND METHODS: Two mathematical models were developed to calculate the upper and lower limit of the associated risks in various populations using a combination of serology- and DNA sequence-based HLA haplotype frequencies. RESULTS: For nondirected transfusion, the range of the estimated risk in United States whites is 1 of 17,700 to 39,000 (1/6,900-48,500 in Germans; 1/1,600-7,900 in Japanese). The risk in directed donation between parents and children is increased at least 21- fold for US whites, 18-fold for Germans, and 11-fold for Japanese. CONCLUSION: For nondirected transfusions, the estimates of TA-GVHD risk derived in this model are lower than estimates of previously published models, are in better agreement with the clinical experience, and explain in part the observed discrepancy between TA-GVHD incidence in the United States and that in Japan. Most notably for US whites, the relative increase in risk in directed transfusion is larger than previously thought.     

Chondrosarcoma of the temporal bone in an infant: case report and review of the literature.

Cranial chondrosarcomas are rare. The majority of cases arise from the base of the skull and are most common in adult life. In this report, an infant with a chondrosarcoma of the temporal bone is discussed. We are not aware of a previously reported case of chondrosarcoma of the temporal bone in this age group.     

AIDS trends in Europe: decrease in the west,increase in the east

In 1996, 24 920 AIDS cases were reported in the WHO European Region, bringing the cumulative total to 185 808 cases including 6969 (4%) paediatric cases (<13 years). For the first time since the start of the epidemic, the annual number of cases reported d     

Pulmonary angiography with iopamidol: patient comfort, image quality, and hemodynamics

The choice of a contrast agent for pulmonary angiography has important implications for patient comfort, image quality, and perhaps the safety of the procedure, particularly for "high-risk" patients. In a prospective study the nonionic, low-osmolality agent iopamidol eliminated the problem of image degradation due to coughing, and patients showed excellent tolerance for it. However, pressure measurements obtained within 3-5 minutes of injection of iopamidol and diatrizoate sodium meglumine 76% showed no significant difference in the hemodynamic effects of the two contrast agents, either for normotensive or for pulmonary hypertensive patients. Contrary to a common presumption, pulmonary hypertension by itself did not appear to increase the risk of pulmonary angiography. The theoretic presumption of greater hemodynamic stability with low-osmolality contrast agents was not clinically evident in this trial with iopamidol. At present, enhanced patient comfort and improved image quality remain the only confirmed bases for choosing this contrast agent for pulmonary angiography.     

Modified simple prostatectomy: an approach to address large volume BPH and associated prostate cancers

Journal of Robotic Surgery - Simple prostatectomy is an option for management of patients with enlarged prostates and obstructive symptoms. However, the guidelines still do not state a...     

The ongoing dilemma in pelvic lymph node dissection during radical prostatectomy: who should decide and in which patients?

Journal of Robotic Surgery - Pelvic lymph node dissection (pLND) is considered the most reliable method for the detection of lymph node metastases in prostate cancer. Current clinical guidelines...     

Can we predict who will need lymphocele drainage following robot assisted laparoscopic prostatectomy (RALP)?

Journal of Robotic Surgery - Pelvic lymph node dissection (PLND) can cause lymphoceles. Lymphocele formation following PLND can reach up to 60% and are symptomatic in 0.4 to 16% of patients. The...     

Patterns of disease in patients at a tertiary referral centre requiring reoperative parathyroidectomy

Introduction

Reoperative parathyroidectomy is required when there is persistent or recurrent hyperparathyroidism following the initial surgery (at least 5% of parathyroidectomies nationally). By convention, ‘persistent disease’ is defined as the situation where the patient has not been cured by the first operation. The term ‘recurrent hyperparathyroidism’ is used when the patient was confirmed to be biochemically cured for six months from the first operation but has hyperparathyroidism after this date. Reoperative surgery is associated with higher rates of postoperative complications as well as a greater rate of failure to cure. The aim of our study was to review our departmental experience of reoperative parathyroidectomy, with a view to identify patterns of disease persistence and recurrence.

Methods

Using a departmental database, patients were identified who had undergone reoperative parathyroidectomy between 2006 and 2014. All the pre, intra and postoperative information was documented including the operative note so as to record the location of the abnormal parathyroid gland found at reoperation.

Results

Almost two-thirds (63%) of patients had negative, equivocal or discordant conventional imaging so secondary investigative tools were required frequently. The majority of abnormal glands were found in eutopic locations. The most common locations for ectopic glands were intrathyroidal, mediastinal and intrathymic. A third (33%) of the patients had multigland disease and over a quarter (28%) had coexisting thyroid disease.

Conclusions

Persistent hyperparathyroidism represents a challenging patient subgroup for which access to all radiological modalities and intraoperative parathyroid hormone monitoring are required. Patient selection for reintervention is a key determinant in the reoperation cure rate.