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.     

Electrocardiographic and vectorcardiographic findings of patients undergoing reductive ventriculectomy (Batista operation)

BACKGROUND: The Batista operation, or partial ventriculectomy, has been designed by the Brazilian surgeon Dr. Randas Batista as an alternative method for treating patients with idiopathic dilated cardiomyopathy. HYPOTHESIS: This study aimed to analyze electro- and vectorcardiographic data obtained from patients who underwent such surgery, and to evaluate its electrical repercussions on the heart. METHODS: Pre- and postoperative electrocardiography (ECG) and vectorcardiography (VCG) were performed 45 days apart in 15 patients undergoing reductive ventriculectomy. RESULTS: All ECGs showed sinus rhythm, with unchanged QRS duration. Left atrial enlargement (86.6%) and left ventricular hypertrophy (100%) were the most common findings. Bundle-branch blocks (BBBs) were often demonstrated on preoperative studies, predominantly (46.7%) left BBBs. Left anterior fascicular blocks were seen in four patients (26.6%), one associated with right BBB. Electrocardiographic changes suggestive of myocardial infarction (MI) were seen in four patients preoperatively; postoperatively, all had extended to or within the lateral wall. Five additional patients developed lateral MIs postoperatively, for a total of 9 patients (60%) with postoperative signs of infarction (p < 0.05). Electro- and vectorcardiography also showed significant postoperative lowering of QRS voltages (mean 40.74%) in all patients and a consequent difficulty to diagnose left ventricular hypertrophy, although the morphologic features did not change. CONCLUSIONS: These important ECG and VCG alterations are reflections of both the surgical technique and its clinical consequences.     

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.     

Effect of simvastatin on monocyte adhesion molecule expression in patients with hypercholesterolemia

Increased monocyte adherence to the vessel wall is one of the earliest events in atherosclerosis. The mechanism by which hypercholesterolemia causes alterations in endothelial adhesiveness for monocytes is unclear. This study sought to determine if monocyte adhesion molecule expression is affected by low-density lipoprotein (LDL)-cholesterol levels. Patients with hypercholesterolemia and stable coronary artery disease were compared with those without major cardiovascular risk (control). Patients with hypercholesterolemia were treated with simvastatin 20--40 mg/day for 8--10 weeks. Blood samples were examined with flow cytometry assays at baseline and after cholesterol-lowering therapy. Monocyte CD11b and CD14 adhesion molecule expression, measured as fluorescence intensity, were significantly (P<0.0001) higher in hypercholesterolemic patients before the study (176.9+/-9.8 and 138.0+/-4.8, respectively) when compared with that in control subjects (97.2+/-8.1 and 84.0+/-6.4, respectively). Both decreased markedly with treatment: to 118.8+/-6.9 and 103.1+/-3.9, respectively. Monocyte L-selectin expression was significantly lower in patients with hypercholesterolemia before treatment (43.0+/-3.0) when compared with control subjects (79.9+/-2.7), and it increased markedly with treatment (54.2+/-2.5). LDL levels correlated directly with both CD11b and CD14 expression and correlated inversely with L-selectin expression. These data show that hypercholesterolemia affects monocyte adhesion molecule expression which, in turn, decreases with statin-induced plasmatic cholesterol reduction. Such perturbations in monocyte function likely represent a proinflammatory response to hypercholesterolemia and may have a role in the early progression of atherogenesis.     

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.