Menstrual and reproductive factors and the risk of myocardial infarction in women under fifty-five years of age

The relationship between menstrual and reproductive factors and subsequent risk of coronary heart disease was investigated in a hospital-based case-control study of 202 women with acute myocardial infarction and 374 control subjects admitted for a wide spectrum of acute conditions unrelated to any of the established risk factors for ischemic heart disease. No consistent association was observed with age at menarche or menopausal status, but women with a lifelong irregular menstrual cycle pattern were at significantly elevated risk of myocardial infarction (relative risk = 1.8, 95% confidence interval = 1.1 to 2.9). No clear trend in risk was evident with the number of livebirths, miscarriages, or induced abortions. However, women whose first pregnancy or livebirth occurred before age 20 years showed elevated risks of subsequent myocardial infarction compared with nulliparous ones (relative risks = 2.3; 95% confidence interval = 1.1 to 4.9), and there was a significant trend of increasing risk with earlier first birth. These associations were evident in both younger and middle-age women and were not explained by allowance for several identified potential confounding factors.     

Radioimmunologic assay of PRL,E2 and prosterone,before and after pregnancy termination by metergoline and sulpiride

The authors have assayed plasma prolactin, estradiol, and progesterone in 30 women undergoing voluntary termination of pregnancy by vacuum aspiration under general anesthesia, in order to study in more detail, the correlations between PRL and sexual steroid hormones during the 1st trimester of pregnancy. Results obtained in the various plasma samples taken at intervals until 5 hours following vacuum curettage show a marked increase in PRL in the control group, from 80 to 3000 ng/ml, with a progressive decrease at the 5th hour. A much slighter increase was found in patients treated with Metergoline, compared to that of the former group, with an increase from 90 to 180 ng/ml, while in those patients treated with Sulpiride, the maximum increase ranges between 160-340 ng/ml. The plasma level of E2 decreased significantly and progressively after the sample taken at 30 minutes, with a similar pattern in the 3 groups. The plasma progesterone concentrations showed a similar patern in the groups treated with Metergoline and Sulpiride, with a progessive decrease in comparison with basal levels. On the contrary, the increase was found in the control groups, in comparison with basal values, in samples taken at 30 minutes, with a slow, progressive decrease in subsequent samples. It can be concluded from these results that the stress caused by vacuum curettage under anesthesia causes a stronger stimulation of PRL than the inhibition of this hormone caused by the fall of E2 and P concentrations; the inhibitory effect of Metergoline on PRL did not completely annul the effect of anesthesia and vacuum curettage on PRL production. While E2 shows a progressive decrease compared to basal values, with a similar behavior in all 3 groups, P, which decreases in the 2 groups that have undergone pharmacological treatment, shows a peak increase in the sample taken at 30 minutes. THe significance of this observation is not yet clear, and will be the subject of further study. (author's modified)     

Hepatic toxicity of propafenone: a case description

A case of acute liver injury associated with the use of the antiarrhythmic drug propafenone in a 62-year-old woman undergoing clinical observation for recurrent atrial fibrillation is reported. Propafenone hydrochloride, a class 1C antiarrhythmic drug widely used in the clinical practice for the treatment of supraventricular and ventricular arrhythmias, rarely (0.1-0.2% of incidence) causes liver injury characterized by a rise in hepatic cell enzymes or cholestatic enzymes or both. Within 2 months of the discontinuation of therapy the liver function tests return to normal, therefore there are no known fatalities secondary to propafenone liver injury including fulminant hepatitis and death. The close temporal relationship between the administration of the drug and the acute onset of signs of liver injury, the marked rise in liver function tests following the increase of the drug dosage and their gradual normalization after its withdrawal strongly suggest that propafenone is involved in the pathogenesis of this syndrome. Although rare, hepatotoxicity due to this widely used antiarrhythmic drug should be borne in mind in the differential diagnosis of sudden hepatocellular or cholestatic syndrome of obscure origin. It seems prudent to obtain baseline liver function before starting therapy with propafenone and then follow up laboratory tests some months later at least in patients with known liver disease.     

Endogenous endophthalmitis following disseminated fungemia due to Fusarium solani in a patient with acute myeloid leukemia

We report the case of a young man with a resistant acute myeloid leukemia (AML) who developed a disseminated fungemia due to Fusarium solani involving the skin and lungs, during the neutropenic phase following a chemotherapy course. Despite continuous therapy with liposomal amphotericin B, he developed a bilateral endophthalmitis that rapidly evolved to complete blindness. The patient underwent two procedures of vitrectomy, with detection of F. solani in the vitreous fluid, and continued antifungal therapy, without any recovery of visual acuity. When he eventually died due to recurrence of leukemia and hemorrhagic shock, autopsy revealed a diffuse fusarial involvement of the central nervous system.     

Primary gastric lymphoma: a case report

In this case report the Authors describe a case of primary gastric lymphoma in a 62 years old patient who presented with dyspepsia and weigh loss. Primary gastric lymphoma is a rare neoplasm which of 1-10% of the malignant gastric neoplasms in the gastroenteric tract. The clinic presentation is usually aspecific. The infection by H. pylori is a factor of predisposition for this kind of disease. The diagnostic pathway consists in x-ray examination of the gastrointestinal tract, the endoscopy with biopsies, the computerized tomography and the echo-endoscopy. However obtaining a preoperative diagnosis is often difficult because of the submucosal localization of the lymphoma. There is not a common strategy among the Authors for the treatment of the disease, which can be surgical, radiotherapic or chemotherapic.     

ARDS as an unusual presentation of bronchiolitis obliterans organizing pneumonia

We report the case of a 46-year-old patient with liver transplantation who developed an acute respiratory distress syndrome (ARDS). The commonly associated clinical disorders, those associated with direct injury to the lung and those that cause indirect lung injury in the setting of a systemic process, were not responsible for the clinical picture. Finally, because of progressive clinical deterioration, an open-lung biopsy was performed and revealed a bronchiolitis obliterans with organizing pneumonia (BOOP). Physicians should be aware of this rare aetiology of ARDS.     

Scleral buckling technique without retinopexy for treatment of rhegmatogeneous: a pilot study

PURPOSE: To evaluate the role of retinopexy in the surgical management of primary rhegmatogenous retinal detachment (RD) without proliferative vitreoretinopathy. The primary outcome was retinal attachment, and secondary outcomes were visual acuity results and complications. METHODS: A randomized controlled trial including 60 patients with RD caused by a break or a group of breaks no larger than one clock hour. Thirty eyes received no retinopexy (group 1), and 30 eyes received transscleral cryotherapy (group 2). An encircling buckle was placed in all eyes. In eyes with posterior breaks, segmental buckles were also added. In some eyes, subretinal fluid drainage or anterior chamber paracentesis and/or intravitreal air bubble injection was performed. RESULTS: No differences were found between the groups in terms of the preoperative clinical variables evaluated: age; sex; axial length; lens status; type, number, and location of breaks; extension of detachment; and macula status. There were no differences in the surgical procedures performed. The reattachment rate in group 1 was 90%, and in group 2, it was 87% (a difference that was not significant [P = 1.00]). Final visual acuity improved by two lines or more in 22 patients in group 1 and in 20 patients in group 2 (P = 0.317). CONCLUSIONS: Our results indicate that primary rhegmatogenous RD can be successfully treated with scleral buckling without retinopexy.     

Cytoprotective effects of hyaluronic acid and Carbomer 934P in ocular surface epithelial cells

PURPOSE: To investigate in vitro the cell toxicity and antioxidant effects of two major tear substitutes, hyaluronic acid and a widely used carbomer, with and without preservative. METHODS: Chang conjunctival cells were treated with different concentrations of unpreserved or preserved carbomer 934P (0.03% and 0.3%), unpreserved or preserved hyaluronic acid (0.018% and 0.18%), and benzalkonium chloride (BAC 0.0005% and 0.005%) for 15 minutes or for 15 minutes with 24 hours of cell recovery, according to previously validated methods. Microplate cold light cytofluorometry was performed to evaluate cell viability (neutral red test), chromatin condensation (Hoechst 33342 test), and reactive oxygen species (ROS) production (dichlorofluorescein diacetate and hydroethidine tests). Confocal microscopy was used to explore morphologic changes. RESULTS: No alterations were found with unpreserved and preserved hyaluronic acid at all concentrations and times tested. A decrease in cell viability with chromatin condensation appeared with 0.3% preserved carbomer 934P at the two times tested. This cytotoxicity, however, was significantly less than that observed with BAC alone, although the same concentrations of preservative were used. Unpreserved carbomer 934P induced no modification of cell viability after 15 minutes but a significant decrease in chromatin condensation, reversible after 24 hours of cell recovery, when a delayed decrease in cell viability was observed. Production of reactive oxygen species (ROS) decreased with the four formulations of tear substitutes tested at their usual concentrations, whereas a significant production of ROS occurred with BAC. CONCLUSIONS: These two ophthalmic hydrogels have no cytotoxicity but possess antioxidant properties and tend to reduce the toxic effects of preservatives. These results may allow use of hydrogels, not only in dry eye but also in ocular surface disorders involving oxidative stress and in ophthalmic drug therapy to improve ocular tolerance.