Endocrine orbitopathy: 11 years retrospective study and review of 102 patients & 196 orbits

BackgroundEndocrine Orbitopathy (EO) is the most frequent and important extrathyroidal stigma of Graves’ disease. In the active stage of the orbitopathy fibrosis and hypertrophy of the extra-ocular muscles can lead to visual impairment and diplopia. In the stable phase of the disease surgical treatment by orbital expansion and/or orbital decompression can improve the quality of life and it is indicated for morpho-aesthetic and functional reasons.MethodsFrom 1998 to 2009 a consecutive series of 131 patients (251 orbits) with endocrine orbitopathy underwent surgery by different techniques.The medical records of 102 patients (78%) and 196 orbits were available to be assessed retrospectively.Ninety-four patients had bilateral involvement of the orbits and eight unilateral. A total of 556 operations were performed.ResultsMean pre-operative exophthalmos was 24.7 ± 2.5 mm (max–min 20–34), mean post-operative exophthalmos was 21 ± 1.8 mm (max–min 18–26), and mean differential exophthalmos was 3.9 ± 1.7 mm (max–min 1–9).The reduction in exophthalmos after surgery had a mean value of 3.8 mm (min 1, max 9).Kaplan Meier algorithm demonstrates that intra-operative cortisone injection had an adverse effect on post-operative diplopia.ConclusionsThe surgical technique used should be adapted to the individual patients’ needs. In severe cases intraorbital fat removal and bony decompression can be and carried out in one surgical procedure. An integrated global approach by a multidisciplinary team is strongly recommended.Strabismus surgery is a significant part of the overall treatment. The Authors suggest general surgical guidelines and an algorithm of treatment in EO.     

Bioenergetics of T cell activation and death in HIV type 1 infection

Regressive morphological lesions, found in peripheral lymphocytes from HIV(+) patients, clearly conflict with normal cycle progression and with the execution of basic housekeeping and immune functions. With these lesions, circulating lymphocytes are destined to spontaneous and energy-independent cell lysis. By means of confocal microscopy and morphometry, we have quantified the rate of circulating T cells that are probably destined to emocatheresis in vivo. This rate includes lymphocytes in which nucleolin fragments have been scattered out of the nuclear region as a result of prelethal alterations in the nuclear membrane permeability. In terms of bioenergetics, these cells show evident anomalies in the energy production machinery that make them unable to carry out ATP-requiring functions. The extent of damaged cell fraction in peripheral blood reflects the frequency with which T lymphocytes leave lymphoid tissue to be cleared in hemocatheretic processes.