Indications and results of relaxing retinotomy

The authors report their results of a consecutive series of 40 eyes undergoing relaxing retinotomy during vitrectomy to achieve retinal reattachment for the following indications: proliferative vitreoretinopathy (PVR), 21 eyes (52%); trauma, 10 eyes (25%); diabetic retinopathy, 6 eyes (15%); and expulsive choroidal hemorrhage, 3 eyes (8%). Thirty eyes (75%) had undergone previous vitreoretinal procedures. Extended tamponade was achieved in all cases with either silicone oil (27 eyes, 68%) or long-acting gas (13 eyes, 32%). Retinotomy size ranged from 45 degrees to 360 degrees. Intraoperative retinal attachment was possible in all eyes with 33 (83%) achieving total or subtotal retinal attachment including the macula for 5 months or more. Twenty-seven eyes (68%) achieved 3/200 visual acuity or better and 10 (37%) achieved 20/400 or better. Thirteen eyes (32%) failed to achieve 3/200 visual acuity secondary to recurrent detachment (18%), corneal decompensation (8%), macular dysfunction (5%), and glaucoma (3%).     

The role of donor and recipient factors in initial renal graft non-function

ATN is a deleterious problem in the outcome of kidney transplantation. This complication is usually related to multiple factors including donor parameters, surgical technique, ischemic time, and recipient variables. In order to develop prophylactic measures, out of 430 kidney transplants performed in our Department, a series of 90 consecutive cadaveric renal allografts has been considered in this study. The overall incidence of IGNF was 23/90 (25.5%). Kidneys from MOD revealed a lower rate of IGNF (7/35 = 20%) when compared with organs from SOD (16/55 = 29%, P = NS). No difference was noted when kidneys were removed together with heart and/or liver and/or pancreas. Out of the donor factors, only CID was significant (17 +/- 9 hours in IGNF v 11 +/- 10 hours in patients with IGF, P = less than .05). Analysis of data concerning the fate of paired kidneys revealed two cases of IGNF in both kidneys from the same donor v 14 cases of IGNF in only one of the two paired grafts (P = NS). We conclude that: 1. Donor factors are clearly associated with a minority of IGNF. 2. The introduction of multiorgan procurement programs does not complicate early function. 3. Recipient factors (immunological events and intraoperative fluid management) provides important additive effects on initial graft nonfunction.     

Immunopathology of ocular sarcoidosis

Summary Sarcoidosis is a multisystem disease characterized by enhanced immune responses at sites of involvement. To elucidate the immunopathogenesis of ophthalmic lesions, cell infiltrates in biopsies from conjunctiva and other tissues involved (lungs, lymph nodes, skin) were studied in 26 patients with active sarcoidosis in order to define the surface phenotype and the distribution of cells in granulomatous lesions. Biopsy specimens were also stained for detection of immunoglobulins, complement and fibrinogen deposits. The data demonstrate a lymphocytes/macrophages interaction in the central core of granulomatous areas as the crucial event that initiates the maintains the state of inflammation: at all sites of disease activity is present a compartmentalization of T-cells expressing a helper-related phenotype which account for the great majority of infiltrating cells both in the early lesions (aggregate of macrophages surrounded by lymphocytic infiltrate) and in well-organized sarcoid granulomata. The presence of plasma cells and immunoglobulin deposits may represent an epiphenomenon in line with the helper infiltration, suggesting a local hyper-reactivity of the B-cells immune system. This study suggests some immunopathogenetic mechanisms leading to the formation and growth of conjunctival sarcoid granulomata.     

Epidemiologic surveillance of congenital abnormalities using the EUROCAT Register

The EUROCAT programme is a concerted action of the European Economic Community for the epidemiologic surveillance of congenital anomalies. Surveillance is based on a network of regional registries coordinated by a central registry. The programme started in 1979 and by 1987, 23 centres were participating, covering together more than 300,000 births per year. The surveillance process implies the selection of the anomalies possibly associated with environmental teratogens or mutagens, the definition of abnormal variations in the rate of these anomalies (the alarms), the establishment of base-line rate and the continuous monitoring of rate. The programme is evaluated by reference to four criteria: the sensitivity of the system in detecting teratogens or mutagens, the specificity of alarms, the rapidity in warning of alarm and in investigating their causes, and the programme efficiency expressed as its cost-utility ratio.     

Implantation of the inflatable penile prosthesis AMS 700 CX

The paper demonstrate the surgical approach used by the authors to implant the AMS 700CX penile prosthesis. Pre- and postoperative management are also discussed.     

Immunochemical characterization of the formyl peptide receptor moieties on human neutrophils.

The neutrophil (PMN) receptor for formylated peptides such as N-formyl-l-methionyl-l-leucyl-l-phenylalanine (FMLP) is involved in binding and subsequent response to certain chemotactic stimuli. The receptor on human PMN has been reported to consist of several glycoprotein components, ranging in size from 43-94 kDa. Furthermore, FMLP receptors on human PMN have been shown to contain both high and low affinity states. In this study, the receptor was purified by subjecting solubilized PMN plasma membrane components to FMLP-affinity chromatography, and was found to be comprised of four components, one of 68 kDa, and the others of 94, 48, and approximately 40 kDa. Only the 68, the 94, and the approximately 40 kDa components specifically bound a radioiodinated FMLP analogue. To further characterize these components, a battery of monoclonal antibodies reactive against the FMLP receptor was prepared. Seven monoclonal antibodies were selected on the basis of their reactivity with the 68 kDa receptor component. Some of these antibodies also cross-react with the 48 kDa component, suggesting that the 68 and the 48 kDa receptor moieties are immunologically related. These antibodies reacted with normal human neutrophils, but not with lymphocytes, or unstimulated HL-60 cells. Furthermore, the presence of 20 nmol of FMLP inhibited the binding of five of the anti-receptor antibodies to whole PMN. These results suggest that the epitopes recognized by these five antibodies may possibly be involved in FMLP binding.     

Kinetic aspects of release of fibrinopeptides AP and AY by human alpha-thrombin

The time-dependent release by human alpha-thrombin of the physiological variants of fibrinopeptide A, i.e. fibrinopeptide A-3-phosphate (FPAP) and des-Ala-fibrinopeptide A (FPAY), has been measured in order to study the kinetic pathway for their hydrolysis. The best-fit kinetic model for the release of FPAP and FPAY is consistent with a simple pseudo first-order reaction, as observed with FPA. These findings indicate that FPAP and FPAY are also released from intact fibrinogen before release of FPB. The values of the specificity constants, i.e. k(at)/Km, for the enzymatic reaction between thrombin and the various alpha-chains showed that AP alpha- and AY alpha-chain are hydrolyzed with a 0.2-and 0.4-fold higher specificity constant respectively than that of A alpha-chain. Such minor differences observed with the various chains suggest that the 1-3 NH2-terminal residues of the chain do not significantly contribute to the catalytic efficiency of thrombin toward the alpha-chains of fibrinogen.