Laparoscopic extravesical neoureterocystostomy and vesicopsoas hitch for infiltrative ureteric and vesical endometriosis: case report

We present a multidisciplinary approach to the management of a 41-year-old woman who presented with an acute on chronic history of pelvic pain and urinary tract symptoms. The underlying pathology was found to be infiltrative ureteric and vesical endometriosis. The extent of the disease had caused partial ureteric obstruction. The patient subsequently underwent laparoscopic excision of the endometriosis with a laparoscopic extravesical neoureterocystostomy and vesicopsoas hitch, performed by an advanced laparoscopic gynaecologist and a urologist.     

Dyskeratosis congenita with corneal limbal insufficiency

We describe a newly diagnosed Turkish adolescent female with Dyskeratosis congenita along with the novel ocular finding of corneal limbal insufficiency. Corneal limbal insufficiency was suggested to be a premature aging sign resulting from a deficiency in corneal stem cell activity, a biological process caused by underlying telomeric defect in this disease. Pediatr Blood Cancer 2009;53:95–97. © 2009 Wiley‐Liss, Inc.     

Female sexual dysfunction

Female sexual dysfunction is a common problem with detrimental effects on woman’s quality of life. It also has an economical and societal impact. It is defined as disorders of sexual desire, arousal, orgasm, and sexual pain, which lead to personal distress. The etiology of sexual dysfunction is frequently multifactorial as it relates to general physical and mental well-being, quality of relationship, past sexual functioning, social class, education, employment, life stressors, personality factors, the presence of a sexual partner, and partner’s age and health. It is very important to adopt the most efficient approach to gather information, and this may be achieved via standardized questionnaires or open-ended questions. Therapy should be tailored according to the patient’s needs and may involve a multidisciplinary team approach including psychosexual counselor/sexologist/therapist and the physician. There is still more work needed to optimize the care of women with this problem. Priority should be given to international standardization and training of health care professionals.     

Central muscarinic M2 cholinoceptors involved in cholinergic hypertension

Cholinomimetic agents increase blood pressure and heart rate via central muscarinic cholinoceptors in various aspects. It was reported that i.c.v. injection of the muscarinic M₁ and M₃ cholinoceptor selective antagonist, 4-DAMP (4-diphenylacetoxy-N-methyl-piperidine methiodide, inhibited the pressor response to physostigmine, while the M₁ selective antagonist, pirenzepine, was ineffective. In the present study, the involvement of muscarinic M₂ cholinoceptors in central cholinergic hypertension and tachycardia was investigated. Physostigmine (10–80 μg/kg i.v.), a cholinesterase inhibitor, and oxotremorine (20–40 μg/kg i.v.), a direct muscarinic cholinoceptor agonist, caused a dose-dependent increase in blood pressure. Additionally, physostigmine induced dose-dependent tachycardiac responses. I.c.v. administration of the muscarinic M₂ cholinoceptor antagonists, AF-DX 116 and methoctramine, inhibited both physostigmine (60 μg/kg) and oxotremorine (20 μg/kg)-induced pressor responses at their lower doses used in this study (100 nmol/rat and 10 nmol/rat, respectively). These findings indicate the partial involvement of postsynaptic muscarinic M₂ cholinoceptors. The higher doses of the antagonists (AF-DX 116 300 nmol/rat and methoctramine 30 nmol/rat) potentiated the blood pressure increase due to physostigmine but did not affect that due to oxotremorine. The physostigmine-induced tachycardiac responses were influenced similarly by these antagonists. These results suggest the presence and tonic influence of presynaptic inhibitory muscarinic M₂ cholinoceptors.     

Vitamin D levels in children with recurrent tonsillitis

Aim

Although recurrent tonsillitis can be the consequence of defects in immune system, the exact etiology of recurrent tonsillitis is not clear. In this study, our aim was to determine the serum vitamin D levels and vitamin D receptor polymorphism among children undergone tonsillectomy due to the recurrent tonsillitis.

Methods

A 106 children undergone tonsillectomy due to recurrent tonsillitis and a 127 healthy children aging between 2 and 12 years were enrolled in this study, to determine serum 25-hydroxyvitamin D level and vitamin D receptor gene polymorphisms (Apa1, Taq 1, fok1). Serum vitamin D level was measured with ELISA (nmol/L) and receptor gene polymorphism was determined by PCR. Vitamin D serum level below 80 nmol/L was accepted as insufficient.

Results

The average serum vitamin D level was 176 ± 79 nmol/L in recurrent tonsillitis group and 193 ± 56 nmol/L in control group. There was no significant difference between the groups (p = 0.13). In recurrent tonsillitis group, 18% (n = 15) of children had their serum vitamin D levels below 80 nmol/L. The vitamin D receptor gene polymorphism (APA1, TAQ 1, FOK 1) in each group was compared (AA, Aa, aa, TT, Tt, tt, FF, Ff, ff). There was no significant difference between the two groups. The vitamin D serum levels and receptor sub-genotypes are also compared, and there was no significant difference between the groups.

Conclusion

There is no difference between the serum vitamin D level and receptor gene polymorphism among children with recurrent tonsillitis and healthy children. But vitamin D insufficiency is more prevalent in children with recurrent tonsillitis group (18%).     

Evaluation of the Effect of a Novel β3-Adrenergic Agonist on Choroidal Vascularity

PurposeTo determine the effect of the new β₃-agonist (mirabegron), which is used for overactive bladder (OAB) treatment, on central retinal thickness (CRT) and choroidal vascularity.Material and MethodsThe 26 eyes of 26 cases using 50 mg tablet mirabegron once per day for OAB were included in this prospective case control study. The CRT, choroidal thickness (ChT), and choroidal vascularity were measured at baseline, week 1 (W1), month 1 (M1), month 2 (M2), and month 3 (M3). Subfoveal ChT measurement included the total subfoveal choroidal thickness (SFCT), and the small and large choroidal vessel layer (SCVL and LCVL) thickness. The total choroidal area (TCA), lumen area (LA), stromal area (SA), stroma/lumen ratio, and choroidal vascularity index (CVI) were measured with the Image-J software.ResultsThe largest SFCT increase compared to baseline was at M1 (26.8 ± 40.8 µm, P = 0.001). The subfoveal SCVL thickness showed a significant decrease at M2 and M3 (−6.0 ± 8.9 µm, P = 0.002; −7.8 ± 13.4 µm, P = 0.046, respectively). LCVL thickness showed a significant increase at W1, M1, and M2, with the largest at M1. CVI showed a significant increase at M1, M2, and M3 (P < 0.05 for all). The TCA, LA, and SA showed a significant increasing trend at all follow-up periods. LA/SA decreased at W1 because of stromal expansion but increased at M3 with more prominent vascular dilatation. CRT values showed no significant change.ConclusionsMirabegron had a significant effect on choroidal thickness. Choroidal vascular response is in the form of narrowing in the choriocapillaris and enlargement in the Haller''s layer.     

The effect of age and cataract surgery on macular pigment optic density: a cross-sectional,comparative study

Background

To analyze the effects of age, cataract surgery and postoperative period on macular pigment optical density (MPOD).

Methods

The study included cases referred to Ankara University Department of Ophthalmology, between April and June 2012, who had a transparent natural lens or had undergone cataract surgery at least a year ago with their best corrected visual acuity of ≥ 0.5 based on Snellen chart. Presence of an ocular disease that might affect lens, retina and optic nerve (cataract, macular degeneration, diabetic retinopathy, glaucoma etc.), cataract surgery within the previous year, light-colored iris, smoking and use of micronutrition supplementation were determined as exclusion criteria. After detailed opthalmologic examination of all patients, they were divided into three groups based on their age and their lens status as: group 1, patients < 50 years of age having a clear lens; group 2, patients > 50 years of age having a clear lens; and group 3, patients > 50 years of age who had cataract surgery. Age, gender, and postoperative period of the patients as well as the MPOD values of the eyes measured with heterochromatic flicker photometric (HFP) method (MacularMetricsTM) were included in the analysis.

Results

Sixty-eight eyes of 37 cases with a mean age of 53.4?±?15.3 years were enrolled in the study. Group 1 included 20 eyes of 10 cases (mean age 29.4?±?9.5); group 2 included 32 eyes of 16 cases (mean age 60.3?±?6.8); and group 3 included 16 eyes of 11 cases (mean age 65.2?±?9.7). The mean macular pigment optical density value of all cases was 0.511?±?0.192 log unit, while the mean MPOD values of groups 1, 2 and 3 were 0.570?±?170, 0.528?±?203 and 0.400?±?180 log units, respectively. The mean MPOD values of the patients with clear lens aged < 50 and aged > 50 years did not reveal a statisticially significant difference (p?=?1). However, the mean MPOD value of the cataract surgery group (group 3) was found to be statistically significantly lower than the group 1 and group 2 (p?=?0.022, p?=?0.039, respectively). The correlations between MPOD values and postoperative periods of the patients in group 3 showed that a decrease in MPOD values in parallel with duration of the postoperative period and this negative correlation was found to be statistically significant (r: ?0.66, p?=?0.005).

Conclusion

Our study has demonstrated that a significant correlation does not exist between age of the patients and MPOD values. MPOD values were lower than age-matched patients who had undergone cataract surgery and finally an inverse correlation existed between duration of the postoperative period after cataract surgery and MPOD values.     

Deep neck abscess in neonatal period: Case report and review of literature

Deep neck abscess is very rare in neonatal period. We reported a deep neck abscess caused by methicillin-sensitive Staphylococcus aureus infection (MSSA) in a neonate. A 10-day male infant was admitted to our neonatal unit with the complaints of fever, irritability, and refused to food intake. Ultrasonography and magnetic resonance imaging revealed as an abscess in the neck. Needle aspiration from abscess revealed pus. Antibiotics and drainage were applied. We also reviewed the neonatal deep neck abscess reported in English literature and clinical presentation, risk factors, causing microorganisms, treatment, complication and outcome of deep neck abscesses were discussed.     

Venlafaxine versus amitriptyline in the prophylactic treatment of migraine: randomized, double-blind, crossover study

In patients with migraine with or without aura the prophylactic effect of amitriptyline (AMT) and venlafaxine (VLF) was compared in a randomized double-blind crossover study. Intolerable side effects resulted in drop out of five patients on AMT (due to hypersomnia, difficulty in concentration and orthostatic hypotension) and one patient on VLF (because of nausea and vomiting). Following the run-in period the patients (n = 52) were randomly treated with one of the study medications for 12 weeks. After a wash-out period lasting 4 weeks the patients were treated with the other drug for further 12 weeks. Both drugs had significant beneficial effect on pain parameters. Total number of side effects of VLF was low when compared with the side effect profile of AMT. In conclusion, it is suggested that VLF may be considered for the prophylaxis of migraine because of its low and/or tolerable side effect properties.