An unusual presentation of a foreign body in the urinary bladder: A migrant intrauterine device.

A 35-year-old woman, who had had an intrauterine device inserted 7 years earlier, presented with dysuria, pollakiuria, suprapubic pain and urethral irritation. The intrauterine device was found in the bladder with stone formation and was removed by endoscopy.     

The bronze baby syndrome: evidence of increased tissue concentration of copper porphyrins

A case regarding a newborn infant with severe Rh haemolytic disease, who presented with the bronze baby syndrome and eventually died, is reported. The postmortem examination showed marked extramedullary haematopoiesis in the liver and spleen, heavy hepatic haemosiderosis and mild intralobular cholestasis. The porphyrin content, which was assayed in different tissues. was very high in the liver, suggesting that the increased erythropoiesis seen in Rh haemolytic disease leads to an increased synthesis of porphyrins as by-products of haem synthesis. Phototherapy causes photodestruction, sensitized by bilirubin, of porphyrins (mainly copper porphyrins), yielding brown photoproducts.     

Enhancement of the success rate in trabeculectomy: large-area mitomycin-C application

Background: To compare the effects of variable mitomycin‐C (MMC) applications during trabeculectomy on target intraocular pressure (IOP), number of antiglaucomatous therapy, bleb morphology and surgical complications. Methods: 66 glaucoma cases who underwent trabeculectomy combined with small‐area (Group 1) or large‐area (Group 2) MMC application were included. This study is a retrospective case series comparison. In Group 1, MMC had only been applied to the scleral flap area, whereas additional MMC applications were performed on upper temporal and nasal quadrant in Group 2. The cases with diabetes, narrow angle glaucoma, secondary glaucoma, history of previous ocular surgery and follow‐up period less than 2 years were exluded from the study. A routine ophthalmological examination was performed in all cases and IOP measurements, morphology and the function of the blebs, necessity for antiglaucomatous medications and complications at first month and second year were evaluated. Results: There were 32 cases (48.5%) in Group 1 and 34 cases (51.5%) in Group 2. The mean IOPs were 12.6 ± 5.5 and 10.8 ± 5.3 mmHg at first month (P > 0.05), whereas 14.4 ± 2.8 and 10.1 ± 2.6 mmHg at second year, respectively (P < 0.05). The mean number of medications were 3.3 ± 1.6 and 3.2 ± 0.2 preoperatively (P > 0.05), whereas 0.8 ± 1.2 and 0.26 ± 0.70 at second year (P < 0.05). The number of diffuse blebs was higher in Group 2 whereas the number of cystic blebs was higher in Group 1 (P > 0.05). There was no difference between two groups with regards to the number of eyes with hypotonia (P > 0.05). Conclusions: Large‐area MMC application seems to increase long‐term success without increasing the complication rates in trabeculectomy.     

Changes in intraocular pressure,and corneal and retinal nerve fiber layer thickness during hemodialysis

The aim of this study is to evaluate the changes in intraocular pressure (IOP), central corneal thickness (CCT), and retinal nerve fiber layer thickness (RNFLT) in patients with chronic renal failure undergoing hemodialysis (HD). A complete ophthalmological examination together with IOP, CCT, and RNFLT measurements were performed for each patient both before and after HD sessions. RNFLT parameters were detected by scanning laser polarimeter. Total body weight and serum osmolality were also measured. Only the left eyes were recruited for statistical analysis. Thirty-three eyes of 33 patients were enrolled in the study. Mean IOP decreased from 14.7 ± 3.1 to 13.4 ± 2.4 mmHg after HD (paired t test, P = 0.005). Mean CCT also decreased significantly after HD, from 556.5 ± 33.5 to 550.2 ± 34.6 μm (paired t test, P = 0.002). CCT change in the left eyes was found to be correlated with total body volume loss (Pearson correlation test, R = 0.391 and P = 0.030). Considering RNFLT parameters before and after HD, no significant alterations were detected by scanning laser polarimeter (paired t test, P > 0.05). We conclude that IOP may decrease to some extent after HD. CCT may be affected by fluid loss after HD sessions, with a resultant decrease in corneal thickness. In patients with chronic renal failure undergoing HD, RNFLT parameters can be measured as in healthy individuals. Underestimation of intraocular pressure values after HD sessions should be taken into account, especially in patients with chronic renal failure.     

Expression and functional role of adenosine receptors in regulating inflammatory responses in human synoviocytes

Background and purpose:

Adenosine is an endogenous modulator, interacting with four G-protein coupled receptors (A₁, A_2A, A_2B and A₃) and acts as a potent inhibitor of inflammatory processes in several tissues. So far, the functional effects modulated by adenosine receptors on human synoviocytes have not been investigated in detail. We evaluated mRNA, the protein levels, the functional role of adenosine receptors and their pharmacological modulation in human synoviocytes.

Experimental approach:

mRNA, Western blotting, saturation and competition binding experiments, cyclic AMP, p38 mitogen-activated protein kinases (MAPKs) and nuclear factor (NF)-κB activation, tumour necrosis factor α (TNF-α) and interleukin-8 (IL-8) release were assessed in human synoviocytes isolated from patients with osteoarthritis.

Key results:

mRNA and protein for A₁, A_2A, A_2B and A₃ adenosine receptors are expressed in human synoviocytes. Standard adenosine agonists and antagonists showed affinity values in the nanomolar range and were coupled to stimulation or inhibition of adenylyl cyclase. Activation of A_2A and A₃ adenosine receptors inhibited p38 MAPK and NF-κB pathways, an effect abolished by selective adenosine antagonists. A_2A and A₃ receptor agonists decreased TNF-α and IL-8 production. The phosphoinositide 3-kinase or G_s pathways were involved in the functional responses of A₃ or A_2A adenosine receptors. Synoviocyte A₁ and A_2B adenosine receptors were not implicated in the inflammatory process whereas stimulation of A_2A and A₃ adenosine receptors was closely associated with a down-regulation of the inflammatory status.

Conclusions and implications:

These results indicate that A_2A and A₃ adenosine receptors may represent a potential target in therapeutic modulation of joint inflammation.