Latanoprost-associated recurrent herpes simplex keratitis

PURPOSE/METHOD: We present a case of a patient who developed recurrent epithelial herpes simplex keratitis after starting treatment with latanoprost. Her ophthalmic history was only remarkable for a past episode of herpetic keratitis 21 years previously. RESULTS/CONCLUSIONS: Episodes of herpetic keratitis were under remission only when latanoprost was discontinued. No recurrences of herpes simplex keratitis have been observed since then. Latanoprost usage might be associated with recurrent episodes of herpes simplex keratitis in patients with previous history of ocular herpes simplex virus infection.     

Early expression of thyroid hormone deiodinases and receptors in human fetal cerebral cortex

Thyroid hormones are known to be important for optimal development of the human central nervous system. Classically, maternal thyroid hormones have not been thought to have a major role in defining central nervous system development. However, recent epidemiological evidence has indicated that subtle deficiencies in circulating maternal thyroid hormones in the first trimester of pregnancy are associated with adverse neurodevelopment. We have used real time PCR to quantitate the expression of mRNAs encoding the thyroid receptor isoforms (TR alpha1, alpha2, beta1 and beta2) and thyronine deiodinase subtypes (5'-DI, 5'-DII and 5-DIII) in human fetal cerebral cortex from the first and second trimesters of pregnancy. Deiodinase subtype activities have also been determined in these tissues and compared to 'normal' adult human cerebral cortex. Iodothyronine deiodinase mRNAs were expressed in human fetal cerebral cortex from 7 to 8 weeks of gestation. The expression of 5'-DI mRNA was variable in fetal life but increased relative to adult cortex (P<0.05), whereas the activity of this enzyme was below the level of assay detection. 5'-DII mRNA and activity in fetal cerebral cortex was detectable from as early as 7-8 weeks but not significantly different from that in adult life except at 15-16 weeks when mRNA expression increased (P<0.05). Fetal cortex 5-DIII mRNA expression was present from the early first trimester but less abundant than in adult tissue (P<0.01) and 5-DIII activity appeared greater in fetal cortex (P<0.01) as compared to adults. Only TR alpha1 mRNA was more abundantly expressed in fetal cortex than adult tissues (P<0.01). In contrast, the TR isoforms (alpha2 and beta1) were expressed significantly less than in adult tissues (P<0.05). Only 26% of fetal cerebral cortex samples expressed TR beta 1. There is evidence that the developing fetal brain, as early as the first trimester, expresses TRs and exhibits the mechanisms of pre-receptor control of thyroid hormone supply.     

Peripheral multineuritis pointing at systemic sarcoidosis

We report a patient with a peripheral neuropathy as the first symptom of sarcoidosis. The systemic illness was proved by the presence of typic granulomes in the bone marrow. The fact that sarcoidosis is the cause for the neuropathy is supported by the temporary relation and by the good response of all clinical picture to the corticosteroid therapy.Sarcoid neuropathy can rarely be the presenting feature of sarcoidosis.     

Randomized trial of concurrent oxytocin with a sustained-release dinoprostone vaginal insert for labor induction at term.

OBJECTIVE: The purpose of this study was to determine whether the concurrent administration of oxytocin with sustained-release dinoprostone results in shorter induction times when compared with oxytocin after the removal of the dinoprostone insert. STUDY DESIGN: Women with singleton pregnancies at > or = 36 weeks, vertex presentations, reactive nonstress tests, no prior uterine scar, intact membranes, and Bishop scores of < or = 6 were randomly assigned to receive oxytocin either immediately after placement of a sustained-release dinoprostone insert (immediate) or 30 minutes after its removal (delayed). The primary outcome was the time interval from induction to delivery. RESULTS: Seventy-one patients were enrolled (immediate, 34 patients; delayed, 37 patients). There were no differences between treatment groups in non-reassuring fetal heart tracings, excess uterine activity, and epidural use. The mean time from dinoprostone placement until delivery was 544 minutes, shorter in the immediate group (972 vs 1516 minutes; P =.001). The proportion of deliveries within 24 hours was higher (90% vs 53%; P =.002) in the immediate group. Cesarean delivery rates were similar between the immediate and delayed groups (16% vs 13%; P =.73). No adverse maternal or neonatal outcomes were observed with concurrent therapy. CONCLUSION: Oxytocin that is administered concurrently with sustained-release dinoprostone significantly shortens induction-to-delivery times and results in a higher proportion of vaginal deliveries of < or = 24 hours with no apparent adverse effects.     

Variability of results of cavernous nerve stimulation during radical prostatectomy

PURPOSE: We assess the reliability of intraoperative cavernous nerve stimulation for producing an erectile response during radical prostatectomy. MATERIALS AND METHODS: In 61 patients cavernous nerve function was assessed during radical retropubic prostatectomy using a CaverMap nerve stimulator. Control stimulation was also performed before and after prostatic dissection by placing the nerve stimulator tip on the anterior bladder wall. An increase in penile circumference measured by the device was considered a tumescence response while any measurable detumescence was also categorized. RESULTS: Patient age ranged 43 to 72 years (mean 59.8). Before apical dissection 41% and 46% had tumescence, 31% and 21% had detumescence, and 28% and 33% had no response with stimulation of the neurovascular bundle and anterior bladder wall, respectively. After dissection 42% and 25% had tumescence, 16% and 18% had detumescence, and 42% and 57% had no response with stimulation of the neurovascular bundle and anterior bladder wall, respectively. CONCLUSIONS: A response to neurovascular bundle stimulation using this device does not necessarily correlate with the precise anatomical location of the cavernous nerves. There is considerable background variability related to anesthesia, surgical manipulation and other undefined factors that may cause minor but measurable changes in penile circumference.     

Electrical burn injuries in children

Aim: Electrical burns account for up to 10% of burns admissions worldwide. Although a potentially serious mechanism of injury in children, there exists limited Australian data. This study aimed to describe the epidemiology, presentation, management and complications of electrical burn injuries in children. Methods: We performed a retrospective case note review of all children under 16 years of age with electrical burns admitted to the New South Wales Paediatric Burns Centre over an 8‐year, 2‐month study period between November 1995 and December 2003. Results: Twenty‐two cases were identified. The mean age at presentation was 7.6 years (range 8 months to 14.3 years). Eighty‐six percent of cases were sustained from a Low Voltage (<1000 W) power source and 55% occurred in males. The total body surface area burnt ranged from 0.5% to 35% with an average of 4%. Fourteen children had their burns managed non‐operatively, but eight required various surgical procedures ranging from local debridement and primary closure to full‐thickness skin grafting. The average length of hospital stay was 6 days (range 1–58 days). Complications occurred in 4 of the 22 patients (18%) and included wound infections, acute renal failure because of myoglobinuria, permanent electrocardiogram changes and long‐term paraesthesia. Three patients (14%) suffered continued morbidity because of scarring, amputation and psychological disturbance. There was no mortality. Conclusions: Electrical injury was an infrequent but potentially serious cause of injury in children. Minor injuries were successfully managed non‐operatively. Neurological sequelae, cardiac arrhythmias and renal failure remain serious complications in up to 20% of cases.     

Fat-to-glucose interconversion by hydrodynamic transfer of two glyoxylate cycle enzyme genes

The glyoxylate cycle, which is well characterized in higher plants and some microorganisms but not in vertebrates, is able to bypass the citric acid cycle to achieve fat-to-carbohydrate interconversion. In this context, the hydrodynamic transfer of two glyoxylate cycle enzymes, such as isocytrate lyase (ICL) and malate synthase (MS), could accomplish the shift of using fat for the synthesis of glucose. Therefore, 20 mice weighing 23.37 ± 0.96 g were hydrodinamically gene transferred by administering into the tail vein a bolus with ICL and MS. After 36 hours, body weight, plasma glucose, respiratory quotient and energy expenditure were measured. The respiratory quotient was increased by gene transfer, which suggests that a higher carbohydrate/lipid ratio is oxidized in such animals. This application could help, if adequate protocols are designed, to induce fat utilization for glucose synthesis, which might be eventually useful to reduce body fat depots in situations of obesity and diabetes.