Retinopathy of prematurity in a tertiary center in south of Brazil

AIM: To investigate the incidence of retinopathy of prematurity(ROP) in the southern Brazil, the rate of treatment and outcomes in all premature infants born at Hospital de Clinicas de Porto Alegre, Brazil, from October 2002 to October 2006. · METHODS: A prospective cohort study was conducted on 323 premature children born at Hospital de Clinicas de Porto Alegre, Brazil, from October 2002 to October 2006 with birth weight equal to or less than 1 500g or a gestational age at birth of 32 weeks or less. All of the newborns were examined by indirect binocular ophthalmoscopy with the 28 diopters lens after pupil's dilation and a lid speculum after the sixth week of life with examinations repeated depending on the disease classification. The main clinical outcome was the occurrence of ROP at any stage. · RESULTS: ROP occurred in 82 infants with an incidence rate of 25.7%. Threshold disease occurred in only 17 of the patients (5.3%), all of them had the disease affecting posterior Zone II needing laser treatment. None of the treated children had Zone I or aggressive posterior disease despite that three of the treated children needed a second laser session. One patient of the re-treated group needed scleral buckling with an equatorial silicon band after progression to stage 4 of ROP. · CONCLUSION: The incidence of retinopathy and the threshold disease in this study was similar to the international results reported. This study showed a high survival rate (70.1%), high incidence of retinopathy, and high laser treatment necessity among newborns under 28 weeks of gestational age or under 1 000g of birth weight. This study drove attention about the no identification of any Zone I posterior disease in this cohort of patients.     

Optimization of the aerosolization properties of an inhalation dry powder based on selection of excipients

The aim of this study was to investigate the influence of formulation excipients on physical characteristics of inhalation dry powders prepared by spray-drying. The excipients used were a series of amino acids (glycine, alanine, leucine, isoleucine), trehalose and dipalmitoylphosphatidylcholine (DPPC). The particle diameter and the powder density were assessed by laser diffraction and tap density measurements, respectively. The aerosol behaviour of the powders was studied in a Multi-Stage Liquid Impinger. The nature and the relative proportion of the excipients affected the aerosol performance of the powders, mainly by altering powder tap density and degree of particle aggregation. The alanine/trehalose/DPPC (30/10/60 w/w/w) formulation showed optimal aerodynamic behaviour with a mass median aerodynamic diameter of 4.7 μm, an emitted dose of 94% and a fine particle fraction of 54% at an airflow rate of 100 L/min using a Spinhaler inhaler device. The powder had a tap density of 0.10 g/cm³. The particles were spherical with a granular surface and had a 4 μm volume median diameter. In conclusion, optimization of the aerosolization properties of inhalation dry powders could be achieved by appropriately selecting the composition of the particles.     

Leptomeningeal dissemination in children with progressive low-grade neuroepithelial tumors

Our purpose is to describe the incidence and clinical features of leptomeningeal dissemination (LM) in children with progressive low-grade neuroepithelial tumor (LGN). We have continuously tracked all patients with primary CNS tumors since 1986. Satisfactorily followed data were obtained on 427 of the 588 patients with localized LGN at diagnosis between 1986 and 1998, 177 (42%) of whom developed progressive or recurrent disease. LM was identified in 13/177 (7%). The median age at initial diagnosis was 5 years and at LM diagnosis was 8.5 years. The primary tumor sites were diencephalon (6), brainstem (3), cerebellum (2), cerebrum (1), and spinal cord (1). The histologies were pilocytic astrocytoma (4), ganglioglioma (4), fibrillary astrocytoma (3), mixed glioma (1), and glioneurofibroma (1). Management included chemotherapy (2) or radiotherapy (3) or both (7); 1 patient received only radical resections of symptomatic lesions. The 5-year progression-free survival rates for patients with localized versus LM disease at recurrence were 22% (95% confidence interval [CI], 13%-25%) versus 15% (95% CI, 0.1%-36%), respectively ( P = 0.28). The 5- and 10-year overall survival rates for patients with localized disease versus LM were 87% (95% CI, 82%-92%) and 83% (95% CI, 77%-89%) versus 68% (95% CI, 39%-91%) and 68% (95% CI, 39%-91%), respectively ( P = 0.05). The 7% incidence of LM is a low estimate because patients were not routinely staged at recurrence. Tumors arising from the diencephalon appeared to predispose to LM; no other predisposing features were identified. We strongly urge that for optimum treatment planning all patients with recurrent LGN be staged with an enhanced spine and brain MRI before adjuvant therapy is initiated. The good survival of patients with LGN and LM reflects a more indolent disease than malignant CNS tumors with LM.     

Treatment of lipid disorders after stroke

The efficacy of lipid disorder therapy for the primary and secondary prevention of coronary heart disease is established. There are, however, no completed studies specifically directed at reducing the risk of stroke with lipid therapy. Although observational cohort studies have failed to demonstrate an association between lipid disorders and stroke incidence, recently completed trials of subjects at risk for coronary heart disease have shown that statins and fibric acid derivatives reduce not only the risk of myocardial infarction and death, but also that of brain infarction and transient ischemic attacks. Lipid drugs are well tolerated and treatment complications are relatively low. It seems prudent to conclude that the stroke patient with an undesirable lipid profile who has a history of coronary heart disease should receive specific treatment for the lipid disorder. Recommendations are more problematic for stroke patients with lipid disorders but no history of coronary heart disease; most should receive therapy for primary prevention of heart disease. Lipid treatment trials focused on stroke risk reduction are urgently needed.     

Echocardiographic and pathological characteristics of cardiac metastasis in patients with lymphoma.

The purposes of this study were to investigate the patterns of lymphoma involvement in the heart and to correlate pathologic findings in the heart at autopsy with echocardiographic presentation prior to death in patients with malignant lymphoma. Lymphoma patients with complete echocardiographic records prior to death and conformed cardiac metastasis at autopsy were included in the study. Echocardiographic records were reviewed retrospectively. Pathological diagnoses were compared with echocardiographic findings using Fisher's exact test. Twenty-nine patients aged 19-71 (mean +/- SD, 51.5+/-12.7) years were included in the study. Among them 17 (58.6%) were male. There were 6 cases (20.7%) with Hodgkin's disease and 23 (79.3%) cases with non-Hodgkin's lymphoma. Twenty-two (75.9%) cases were diagnosed with cardiac metastases at autopsy by gross appearance of their hearts. The most common (41.4%) site of metastatic involvement was the pericardium. The frequency of tumor on the valves was significantly lower than in the chambers and on other parts of the heart (6.9% versus 93.1%). Metastatic masses in right heart were found in 8 (8/23, 34.8%) non-Hodgkin's lymphoma cases, which was higher than that in Hodgkin's lymphoma cases (0/6, 0%; p=0.15). The frequency of high-grade non-Hodgkin's disease metastasizing to the right ventricle was significantly higher than that for the other kinds of lymphoma (3/7, 42.9% versus 0/22, 0%; p=0.01). Sensitivity of echocardiographic examination to detect cardiac metastasis was 75.9%. Echocardiography has been shown to be a sensitive method for the diagnosis of cardiac involvement in the patients with lymphoma. Patterns of cardiac involvement vary by the types of lymphoma, suggesting that different pathologic types of lymphoma may have different mechanisms of metastasis to the heart.     

Arteriovenous fistula with a saphenous long loop

After radiation, chronic infection or previous operations recipient vessels for free tissue transfer become difficult to find. It may be necessary to locate vessels remote from the area of reconstruction and to construct long venous grafts. Long venous grafts can be compressed in the tissue tunnels that may be required. In this series of patients, an arteriovenous fistula was created with a long saphenous loop 10 to 21 days prior to tissue transfer. The saphenous loops were placed close to the area for reconstruction and when divided at the time of transplantation, provided one artery and one vein. In this series of 12 cases, adequate vascularization was achieved in 10 cases. In the other 2 cases, we believe that maturation of the fistula may have been necessary before proper function. The other advantages of the technique are: the procedure can be carried out under local anaesthesia, ease of positioning of the patient on the operating table, and a reduction in the time taken to perform the tissue transfer. © 1993 Wiley-Liss Inc.     

Prospective evaluation of remote, interactive videoconferencing to enhance urology resident education: the genitourinary teleteaching initiative

PURPOSE: Changes in referral patterns and resource allocation into Centers of Excellence affect the educational experience of urology trainees by altering resident exposure to patients and clinicians, especially at sites where subspecialty deficiencies exist. Access to educators at Centers of Excellence using interactive videoconferencing technology may facilitate residency training objectives and enhance trainees' overall educational experience. We prospectively evaluated the implementation of this technology at tertiary care teaching centers to enhance urology resident education. MATERIALS AND METHODS: Using videoconferencing technology, urology residents at the University of Western Ontario (London, Canada) participated in a series of didactic, interactive pediatric urology teleteaching seminars. These were presented by an expert pediatric urologist from the Hospital for Sick Children, Toronto, Canada. Using a 5-point Likert scale (1-strongly disagree, 5-strongly agree), participants responded to statements pertaining to seminar content, technology and ease of use at the completion of each session. The results were subsequently tabulated and evaluated to determine the effectiveness and accessibility of the program in providing expert pediatric urological education to residents at a remote urology training program. RESULTS: The entire urology resident staff from postgraduate year 1 to 5 participated in the seminar program. The overall acceptance of this medium was high (mean score 4.5). The quality of presentation, as well as picture and sound quality, all received mean scores greater than 4. Participants indicated that their ability to interact with the presenter was not inhibited by using this medium. All participants agreed that they would use this technology in the future (mean score 4.5) and that the presentation would not be improved if the presenter were on-site. Due to preexisting technology at both centers, no direct cost was incurred throughout the study. CONCLUSIONS: Our experience suggests that interactive teleteaching using readily available, existing technology, is a cost-effective and accepted method of providing trainees with an appropriate educational experience. In centers where subspecialty deficiencies exist, this medium may provide residents with the necessary education requirements of their respective programs without the need for costly teacher (or student) travel. Continual improvements in technology as well as the addition of multiple sites will increased this medium's impact in the future.