Proliferative vitreoretinopathy: risk factors and pathobiology

Proliferative vitreoretinopathy (PVR) is still a major cause of failure of retinal detachment surgery. Despite a dramatic increase in our pathobiologic knowledge of PVR during the last 10 years, little of this information has been used to modify the surgical management of the disease, and, thus, the anatomic and functional results are still unsatisfactory. Collaborative research involving clinicians and basic researchers must be encouraged. PVR must be considered a multifactorial disease caused by interaction of several cells and intra- and extraocular factors. Therefore, therapeutic options based on the inhibition of one factor or phenomenon may be regarded with scepticism. To prevent PVR, it is necessary to determine the factors involved in its development, and because of its relatively small prevalence, large, prospective, multicenter studies seem necessary. In addition, clinical research must not be underestimated. PVR affects both sides of the retina and the retina itself, a point to which little attention has been paid and that is critical for surgical results. Therefore, a new classification that provides information about clinical relevance, such as the evolutionary stages of the disease (biologic activity) and the degree of surgical difficulty (location of the fibrotic process), seems necessary.     

Investigation of the sorption properties and pharmaceutical application of alpha1-acid glycoprotein by liquid chromatography

The separation and quantitation of the enantiomers and also the determination of the enantiomeric purity are all current and indispensable tasks for the pharmaceutical analysis. The aim of this work was to study the sorption properties of the alpha 1-acid glycoprotein (AGP) based stationary phase, which may have crucial importance for the enantioselectivity. New binding data are presented for the mechanism of the chromatographic separation, which has not clarified in the literature yet. On the basis of these new findings the composition of the mobile phase for a given analytical separation can be designed, including the preparative separation, as well. Binding data for dioxane, known as a solvent with low dielectric constant, are determined at first time. It was found that the sorption of both acetonitrile and dioxane is pH-dependent: as at pH 7.2 the binding can be characterized by a saturation curve, while at pH 4.0 by a twostep, monotone curve. The pH-dependence of the adsorption has been explained by conformational changes of the selector, which were confirmed by CD-spectroscopic and fluorescence quenching study of the native AGP. In accordance with the binding study by increasing the acetonitrile percentage at pH 4.0 a tipical alpha-helical peak was observed in the CD-spectrum. Opposite that at pH 7.2 the increase in the acetonitrile content does not result in any changes in the spectra. Effective dynamic quenching constants of AGP have been determined at given acetonitrile concentrations using 2,2,2-trichloroethanol as fluorescence quencher. In agreement with the results of the CD measurements at pH 4.0 it was found that the degree of quenching enhanced by increasing the amount of the acetonitrile, that can be explained by enhanced exposure of the buried tryptophan residues. Taking these results into account, new optimized and validated HPLC methods have been developed for compendial control in testing the enantiomeric purity of an acidic (ibuprophen), a basic (propranolol) and a neutral (norgestrel) drug molecule.     

Analysis of antibiotic consumption of five different clinical departments,especially considering the features of hematology departments

The importance of antibiotic consumption and bacterial resistance analysis is unquestionable. Although the WHO has been recommending the use of ATC/DDD method for the analysis of drug utilization for about 20 years, only limited numbers of publications are available considering the antibiotic consumption of in-patients. In the present study--with the help of the mentioned method--we analysed the utilization of antibiotics in 5 clinical departments. We also investigated the connection between antibiotic consumption, bacterial resistance and enterococcal sepsis at the haematologic department. We could follow the successful impact of the implementation of the new guideline.     

Genetics and epidemiology of Wilms' tumor: The French Wilms' tumor study

A complete family history was obtained for 501 patients with Wilms' tumor, treated in departments of pediatric oncology in whole France. The information was collected by self-questionnaire and/or by interview of parents. The proportion of bilateral cases is 4.6% and there are 12 patients (2.4%) with a positive family history of Wilms' tumor. The affected relatives are most often distant and no first degree relative was affected. Apart from the well-known associations with aniridia, hemihypertrophy, genitourinary anomalies, Beckwith-Wiedeemann, and Drash syndromes, there is also a significant excess of congenital heart defects (P = .008) which remains to be explained. Several findings support the bimutational hypothesis such as earlier diagnosis and increased parental age in bilateral cases. No particular anomalies and no increased frequency of childhood cancer were found in patients' relatives. The frequency of Wilms' tumor in relatives was estimated to be less than 0.4% in sibs, 0.06% in unclesand aunts, and 0.04% in first cousins. These figures are very different from those found in retinoblastoma and suggest that the mechanism may be more complex in Wilms' tumor. This conclusion is in agreement with molecular biology studies in tumors and linkage analysis in multiple case families which suggest that more than one locus is involved. © 1992 Wiley-Liss, Inc.     

Urinary diversions and bladder enlargements

Overall review that offers an integrated insight of the importance and repercussions of urinary by-pass and bladder replacement. Over the last decades there has been a growing interest in the possibility of reconstructing the urinary system and there are now an almost infinite number of surgical solutions. The history of the development of using the intestine for by-passes and the reconstruction of the urinary system is described. The secondary metabolic alterations, the possibility of secondary intestinal tumours and the rudiments of ureterointestinal anastomosis are dealt with. Bladder substitution techniques are highlighted, and the vast experience of the Urology Department of Hospital Miguel Servet explained, including criteria and conclusions that help to choose from the many urological surgery alternatives headed by urinary by-pass and bladder complications.     

Insulin-like growth factor I (somatomedin C) in premature infants on total parenteral nutrition. Relations with nutritional status and protein-energy intakes]

Insulin-like growth factor I (IGF I) is like prealbumin and transferrin a marker of nutritional status. Its level increases with gestational age. The levels of IGF I (96 times), transferrin (86 times) and prealbumin (69 times) were measured in blood samples from 26 premature infants aged 8 to 78 days (gestational age: 28 to 34 weeks, birth weight: 840 to 1,800 g). At the time of sampling, all the infants were on total parenteral nutrition (360 +/- 42 kJ/kg/day and 2.5 +/- 0.3 g of proteins/kg/day). The results were analysed with reference to anthropometric parameters (weight, height, head circumference, skinfolds and arm circumference). There was no correlation between plasma IGF I and anthropometric measurements. There were significant correlations between IGF I and transferrin (p less than 0.01), prealbumin (p less than 0.05), protein intake (p less than 0.01) an energy intake (p less than 0.05). Plasma IGF I increased at the end of the first week of parenteral nutrition in all the 5 infants having initial low values. The plasma IGF I was not correlated with the duration of parenteral nutrition in the 26 infants after the second week of nutrition. IGF I measurement is useful for evaluating the protein nutritional status of premature infants on total parenteral nutrition.     

Influence of ovarian cysts on the results of in vitro fertilization.

OBJECTIVE: To determine if ovarian cysts are associated with a particular basal endocrine profile and impair follicular growth. DESIGN: Retrospective study. SETTING: In Vitro Fertilization (IVF) Center. PATIENTS: Nine hundred fourteen stimulation cycles stimulated with a combination of luteinizing hormone-releasing hormone analogues (LH-RH-a) and human menopausal gonadotropins (hMG) in a long protocol in an IVF program. RESULTS: After 15 days of LH-RH-a therapy, ovarian cysts (> or = 20 mm) were observed in 8% of cases. These cysts were not related to a particular basal endocrine profile and did not impair follicular growth and IVF results. However, puncturing these cysts enhanced the quality of subsequent follicular growth. On the contrary, cysts appearing during hMG treatment (> or = 25 mm) were related with a lower LH:follicle-stimulating hormone ratio (0.79 +/- 0.52 versus 0.92 +/- 0.74 in absence of cyst) and to a lower ovarian response as assessed by the maximal estradiol level to the total number of hMG ampules ratio (51.6 +/- 36.5 versus 65.9 +/- 47.9 in absence of cyst). However, this difference had no influence on the pregnancy per stimulation rate (18% versus 16% in absence of cyst; not significant). CONCLUSIONS: Results show that the pathogens of ovarian cysts appearing during the blockage phase and during the stimulation phase are different. However, they do not impair the results of IVF, and thus it is not necessary to cancel the attempt in case of ovarian cyst.     

Cordocentesis and evaluation of fetal wellbeing in a very high-risk population (a very reliable index)]

In a population of 57 very high-risk pregnant women (severe clinical history and/or compromised fetus). A total of 240 tests for antepartum fetal evaluation were performed: baseline cardiotocography (CTG), biophysical profile scoring (BPS), doppler-velocimetry of umbilical artery and determination of blood gas analysis in venous umbilical cord blood obtained by cordocentesis. The results of the CTG, BPS, and umbilical artery doppler velocimetry showed a significant relation with those of pH and pO2. The sensitivity, specificity, false-abnormal value, and false-normal value of the CTG, PBS, and doppler velocimetry, used for the diagnosis of fetal acidosis, hypoxia, and asphyxia were comparable. The rate of fetal (asphyxia) was high if present severe/terminal CTG (85.0%), abnormal (4) BPS (82.0%), or absent-end diastole in umbilical artery doppler velocimetry (74.0%). The immediate complication rate due to cordocentesis procedure was minimal.     

Ovarian carcinoma preceded by cerebral metastasis: review of the literature.

A patient with an asymptomatic primary ovarian carcinoma preceded several months before by a solitary intracranial metastasis is reported. The rarity of this phenomenon, the therapeutic experience in this patient, and the possible mechanism of spread are discussed. Also, a review of the literature is made.