Risk factors for anterior chamber membrane forma- tion after phacoemulsification

To investigate the risk factors for the development of membrane formation in the anterior chamber after phacoemulsification. METHODS: A total of 1 356 patients who underwent phacoemulsification with implantation of single piece polymethyl methacrylate (PMMA) IOL were prospectively evaluated. Presence of pseudoexfoliation syndrome, nuclear hardness, pupil size, phaco time, effective phaco time, systemic diseases, postoperative complications (capsulorhexis rupture, zonular dialysis, posterior capsule rupture with vitreous loss), location of IOL placement and postoperative complications(intraocular pressurechanges, synechiaformation) were analyzed as risk factors for development of membrane formation. ·RESULTS: In 111 (8.1%) patients postoperative fibrinous anterior uveitis with membrane formation was observed. The mean time for membrane formation was postoperative second day (range postoperative 1^st and 7^th day). Mean duration of the presence of membrane was 5.2 days (range 1 to 48 days). Among the patients who had membrane formation, +4 hardness of the nucleus was present in 45%, while it was present in only 13.5% of patients who did not have membrane formation. The difference was statistically significant ( <0.05). In the membrane-forming group, mean phaco time was 2.4 minutes and mean effective phaco time was 32.8 seconds, compared to 1.8 minutes and 22.1 seconds in the membrane-free group. Both parameters were significantly longer in the membrane-forming group ( <0.05). Posterior capsule rupture with vitreous loss and sulcus implantation of IOL was seen in 33% of membrane-forming patients and in 11%of membrane-free patients ( <0.05). Other risk factors were not statistically different between membrane-forming and membrane-free patients. On postoperative first and 7^th day, the mean best corrected visual acuity in the membraneforming group was 0.2 and 0.4 respectively, versus 0.4 and 0.6 in the membrane-free group on Snellen chard ( <0.05). But three months after surgery, the best corrected visual acuity was similar between the membrane-forming and membrane- free patients (0.8 and 0.9 respectively). ·CONCLUSION: Higher nucleus hardness, longer phaco time and effective phaco time, and posterior capsule rupture during surgery are risk factors which significantly associated with postoperative fibrinous membrane formation in the anterior chamber.     

Immunolocalization of cell signaling molecules in the granular cell ameloblastoma

BACKGROUND: Bone morphogenic protein (BMP) and Wnt signaling pathway molecules play important roles in cytodifferentiation and cell proliferation. We attempted to localize these signaling molecules in the granular cell ameloblastoma. MATERIALS AND METHODS: Four samples of paraffin-embedded ameloblastoma with granular cells were studied. Immunohistochemistry was performed to detect basement membrane type heparan sulfate (HS) (JM403), cell surface type HS (10E4), heparanase, Wnt-5a, Wnt-2, beta-catenin, and BMP-4. RESULTS: In all four samples, strong expression of beta-catenin and Wnt-5a was detected within the granular cells, while BMP-4 expression was weak and Wnt-2 was negative. Immunoreactivities of basement membrane type HS, cell surface type HS, and heparanase were variable within granular cells in ameloblastoma. CONCLUSION: Granular cells in ameloblastoma exhibit abnormal biological behaviors, particularly synthesis and secretion of protein. Synthesis of signaling molecules is upregulated, but secretion is arrested in some cases, while both are lost in other cases.     

Development and results of a questionnaire to measure carer satisfaction after stroke.

STUDY OBJECTIVE--To develop a carer satisfaction questionnaire for use as an outcome measure in stroke, to test the measure for reliability and validity, and to survey levels of carer satisfaction with services for stroke patients. DESIGN--Postal survey of carer satisfaction with stroke services was carried out using the questionnaire we developed and tested. Internal consistency was tested and construct validation was explored by examining correlations with other outcome measures (the Faces Scale, the Nottingham Health Profile, the short form of the Geriatric Depression Scale, and the patient's Barthel Index score). SETTING--Two adjacent districts in North East Thames Regional Health Authority. PARTICIPANTS--A total of 103 carers were identified from 219 people who had survived a stroke to six months. During the pilot stage, six of seven carers who were invited to participate in in depth interviews and 15 of 23 carers (65%) who were invited to completed the first draft of the questionnaire. MAIN RESULTS--The questionnaire was divided into two sections, one on inpatient services (Carer Hospsat) and one on services after discharge (Carer Homesat). The questionnaire had construct validity, providing significant correlations with the Faces Scale (Carer Hospsat r = 0.59, p < 0.00001 and Carer Homesat r = 0.68, p < 0.00001), the patients' Barthel score (Carer Hospsat r = 0.25, p = 0.01), and the patients' Nottingham extended Activities of Daily Living (ADL) scale (Carer Hospsat r = 0.31, p = 0.002). Internal consistency was high for both sections (Cronbach's alpha: Carer Hospsat 0.87, Carer Homesat 0.79). Most carers (77%) were satisfied with the care their relative or friend received while in hospital, but only 39% were satisfied with services after discharge. CONCLUSIONS--Carer satisfaction is an important outcome measure in stroke research. This study has shown that carers are dissatisfied with services after hospital discharge. Our questionnaire is valid, reliable, and sensitive and could be used to test interventions aimed at improving services.     

The association of life course socio-economic position with diagnosis, treatment, control and survival of women with diabetes: findings from the British Women's Heart and Health Study.

OBJECTIVES: To examine the association of socio-economic position (SEP) with the diagnosis, treatment and control of diabetes, and with survival in women with and without Type 2 diabetes. METHODS: Prospective cohort study of 4277 women from 23 centres in Great Britain, aged 60-79 years at baseline. RESULTS: Of the 4277 women, 220 (5.1%) were known to have Type 2 diabetes and a similar number [n = 188 (4.4%)] had undiagnosed diabetes based on a single fasting glucose level > or = 7.0 mmol/l. Neither childhood nor adult SEP was associated with being correctly diagnosed amongst the 408 women with either diagnosed or undiagnosed diabetes. In both women with and without diabetes, SEP was associated with more adverse levels of fasting insulin, triglycerides, high-density lipoprotein cholesterol and body mass index, but was not associated with glycated haemoglobin in either group. Over the follow-up period, 395 women died. The hazard ratio for all-cause mortality per additional indicator of adverse SEP in adulthood in women with diabetes [1.40 (1.05, 1.85)] was similar to that in women without diabetes [1.26 (1.12, 1.41], P for difference in the two estimates = 0.70). Childhood SEP was not associated with survival. CONCLUSION/INTERPRETATION: A considerable number of older women with Type 2 diabetes are not diagnosed, but SEP is not related to being correctly diagnosed. The marked socio-economic gradient for all-cause mortality is the same for women with and without diabetes and is not fully explained by conventional risk factors.