Transcaruncular orbital decompression for dysthyroid optic neuropathy

PURPOSE: To determine the efficacy of transcaruncular approach orbital apex decompression for treatment of dysthyroid optic neuropathy. METHODS: In this retrospective noncomparative interventional case series, charts for all patients undergoing orbital decompression surgery for dysthyroid optic neuropathy performed by one author between October 1999 and September 2001 were included in the study. Primary outcome measures included visual acuity, static perimetry, pupillary testing, and color plate testing before and after surgery. Records were also reviewed for changes in extraocular motility and proptosis after surgery and for surgical complications. RESULTS: Sixteen consecutive patients (6 unilateral, 10 bilateral, for a total of 26 cases) underwent orbital apex decompression for dysthyroid optic neuropathy through a transcaruncular approach. In each orbit, the optic neuropathy was refractory to oral corticosteroid therapy. Preoperative visual acuity remained stable or improved in each case. Preoperative Humphrey visual field testing revealed an average mean deviation of -10.3 +/- 6.5 (range, +0.76 to -25.45). Average postoperative mean deviation was -2.79 +/- 2.4 (range, +0.94 to -9.82). Before surgery, 7 of 23 eyes (30%) had full color plates. After surgery, 22 of 23 eyes (96%) had full color plates. Follow-up ranged from 2 to 26 months (mean, 10 months). New-onset diplopia developed in 2 of 10 (20%) patients without preexisting diplopia. CONCLUSIONS: Transcaruncular approach orbital apex decompression effectively treats dysthyroid optic neuropathy.     

Operative management of ankle instability: reconstruction with open and percutaneous methods

Chronic ankle instability affects a large number of young patients. A thorough history and clinical examination are key to proper patient selection. Once the patient decides to undergo operative intervention, the appropriate procedure should be selected according to their physical and lifestyle demands. The surgeon should gain familiarity with the full range of procedures, from open to percutaneous, and anatomic to nonanatomic. With proper patient selection, functional outcomes are excellent, with success rates from 80% to 90%.     

Pneumatic balloon dilation for esophageal achalasia

Pneumatic balloon dilation remains the medical treatment of choice for patients with achalasia. It is superior to other medical therapies including intrasphincteric botulinum toxin injection. The overall efficacy rate for long-term excellent or good result is 80 to 85%. It is extremely important that the endoscopist be quite experienced in the technique of pneumatic dilation and develop a standard protocol to minimize the complications. The technique of graded balloon dilation starting with 3.0-cm Rigiflex balloon as the initial dilator and progressing to 3.5-cm and 4.0-cm balloon in absence of response to previous balloon size offers the safest approach. Patients not responding to three serial dilations should be offered surgery, although some patients may prefer repeat dilations to surgery. The overall complication rate for Rigiflex dilation is about 3% and for Witzel dilation is about 6%. Some patients will develop GER when measured by 24-hour esophageal pH monitoring, but most patients remain asymptomatic.     

Impact of left ventricular hypertrophy on ventricular arrhythmias in the absence of coronary artery disease

Left ventricular hypertrophy has a grave prognosis. Ventricular arrhythmias may account for a large portion of this poor prognosis, but the contribution of coronary artery disease has not been excluded. The occurrence of ventricular arrhythmias was investigated by 24 h ambulatory electrocardiographic (ECG) monitoring in 49 hypertensive patients who had normal findings on coronary arteriography. The presence of left ventricular hypertrophy was assessed by both ECG and echocardiography. The frequency and complexity of ventricular arrhythmias were significantly related to the presence of left ventricular hypertrophy whether it was defined by wall thickness (interventricular septum or posterior wall greater than or equal to 1.2 cm) or by left ventricular mass indexed to height (left ventricular mass/height greater than or equal to 163 g/m in men and greater than or equal to 121 g/m in women). The relation between left ventricular mass or wall thickness to ventricular arrhythmia was graded and continuous; for every 1 mm increase in the thickness of interventricular septum or posterior wall there was an associated two- to threefold increase, respectively, in the occurrence and complexity of ventricular arrhythmias. In conclusion, left ventricular hypertrophy is associated with an increase in the frequency and complexity of ventricular arrhythmias in the absence of coronary artery disease, and the relation is graded and continuous.     

Granulosa cell proliferation is impaired in the Igf1 null ovary.

Insulin-like growth factor-I (IGF-I) expression is highly correlated with ovarian follicular growth and granulosa cell proliferation in both pre-pubertal and mature murine ovaries. Igf1 gene deleted mice are infertile, with ovarian follicles arrested at an early stage of development. To elucidate the cause of follicular dysfunction in Igf1 null mice, this study compared granulosa cell proliferation at baseline and in response to exogenous oestradiol (E2) in prepubertal Igf1 null and wild-type (WT) littermate mice. The basal granulosa cell mitotic index was 3.8+/-0.48 in WT and 1.3+/-0.7 in Igf1 null mice (P=0.03). After E2 treatment, WT granulosa mitotic index was 12.7+/-0.0 vs 5.5+/-0.8 for Igf1 null mice (P<0.001). Granulosal BRDU incorporation was also significantly reduced as were cyclin D2 and B1 immunoreactivities in Igf1 null compared with WT mice. The incidence of apoptosis was not increased in Igf1 null follicles, although BAX immunostaining was increased. These data suggest that IGF1 is essential for normal basal and oestrogen-induced granulosa cell proliferation and follicular growth.     

Acute Effect of Nicotine Patch on Gastric Emptying of Liquid and Solid Contents in Healthy Subjects

The effect of nicotine on gastric emptyingremains controversial. Gastric emptying is delayed inchronic smokers after smoking high-dose nicotinecigarettes, but it is unchanged after chewing nicotinegums. No information is available on the effect oftransdermal nicotine patches on the gastric emptying ofsolid and liquid contents in healthy nonsmokers. Ourobjective was to prospectively evaluate the effect of the nicotine patch on gastric emptying ofliquid and solid contents in healthy nonsmokers. Tenhealthy nonsmoking volunteers under-went a baselinedual-isotope gastric scintigraphy with[¹¹¹In]-diethylenetriaminepantaacetic acid (DTPA) and [^99mTc]sulfurcolloid isotopes to evaluate prospectively the gastricemptying of liquid and solid contents, respectively. Thegastric scintigraphy was repeated after placing a transdermal nicotine patch (Habitrol) for 12 hrdesigned to deliver 14 mg of nicotine per day. Plasmanicotine level was measured prior to baseline gastricscintigraphy and after 12 hr placing the nicotine patch. Plasma nicotine was absent in allsubjects at baseline and but was significantly elevatedafter 12 hr of nicotine patch (P < 0.009). The meanhalf-emptying times (T_1/2) for the gastricemptying of liquids before and after nicotine patchplacement were 31.2 ± 23.3 and 25.6 ± 8.4min, respectively (P = 0.498). The mean T_1/2sfor the gastric emptying of solids before and afternicotine patch placement were 70.1 ± 34.0 and 59.7± 31.4 min, respectively (P = 0.202). There wasno correlation between the plasma nicotine level andgastric emptying of liquid and solid contents(correlation coefficient = –0.23 and –0.01, respectively).In conclusion, acute transdermal delivery of nicotinedoes not affect the gastric emptying of solid and liquidcontents in healthy nonsmoking subjects.