Conjunctival impression cytology in pseudoexfoliative glaucoma and pseudoexfoliation syndrome

BACKGROUND: In this study, ocular surface changes and tear film functions in patients with pseudoexfoliative glaucoma (PEXG) and pseudoexfoliation (PEX) syndrome were evaluated. METHODS: This study is a randomized, double-blind and prospective study. Conjunctival impression cytology, tear film break-up time (TFBUT) test and basal Schirmer test (BST) were performed on 45 eyes of 45 subjects with PEXG (group I), 48 eyes of 48 subjects with PEX syndrome (group 2) and 50 eyes of 50 normal subjects (group 3). Impression cytology was graded 0-III based on the shape, eosinophilic-staining cytoplasm and nucleocytoplasmic ratio of the epithelial cells, and the shape, quantity and Periodic Acid Schiff-positive cytoplasm of the goblet cells. RESULTS: Impression cytology grading scores were 6.7% grade 0, 15.6% grade I, 37.7% grade II and 40% grade III in group 1, 6.3%, 18.7%, 43.8% and 31.2% in group 2 and 38%, 36.0%, 20% and 6% in group 3, respectively. The scores in groups 1 and 2 were significantly higher than in group 3 (P = 0.001, chi(2) = 39.84). The mean values of TFBUT of groups 1, 2 and 3 were 5.91 +/- 3.27, 7.39 +/- 4.82, 10.96 +/- 3.81 s and the mean values of BST were 7.82 +/- 3.56, 9.04 +/- 4.60 and 12.50 +/- 5.25 mm/5 min, respectively. The values of TFBUT and BST were lower in groups 1 and 2 than in group 3 (P = 0.001). CONCLUSION: The conjunctival changes in PEX and PEXG patients recorded in this study may explain the existence of tear film abnormalities in these patients. It has been shown that PEXG and PEX syndrome cause conjunctival surface changes and reduction of tear film functions.     

Non-traumatic colorectal perforations.

Over a 6 year period, between January 1992 and December 1997, 30 patients with non-traumatic colorectal perforations undergoing laparotomy were reviewed. The aim of this study was to evaluate predictions on the prognosis using the Mannheim Peritonitis Index (MPI) and to evaluate the risk of this complication. The mean age of the patients was 56.4 years (range 16-88 years). The male:female ratio was 19:11. All patients showed signs of peritonitis and underwent emergency operations. In 50% (15) of the patients, tumor was the cause. According to the MPI scoring, there were 18 patients with an MPI score of 26 or less and 12 patients with an MPI score of 27 or more. For patients with a score less than 27 the mortality rate was zero (0/18) and for score greater than 26, 66.6% (8/12). Overall mortality was 26.6% (8/30). Of 15 patients with perforated colorectal cancers, four patients died (26.6%). The mortality rate for benign perforations was 26.6% (4/15) also. In conclusion, colorectal cancers are the most common cause of the non-traumatic colorectal perforations. Patients with an MPI score greater than 26 represent the highest risk group.     

Current Allogeneic Hematopoietic Stem Cell Transplantation for Pediatric Acute Lymphocytic Leukemia: Success,Failure and Future Perspectives—A Single-Center Experience, 2008 to 2016

Hematopoietic stem cell transplantation (HSCT) is the only curative option for a subset of patients with high-risk or relapsed acute lymphoblastic leukemia (ALL). Given evolving practices, it is important to continually evaluate outcomes for pediatric ALL following HSCT. Outcomes after HSCT are influenced by the type of donor used as this determines the degree and method of T cell depletion used and, consequently, specific transplant-related morbidities. We retrospectively analyzed HSCT data from our center for transplants performed between January 2008 and May 2016, comparing outcomes among different donor types. One hundred and twenty-four pediatric patients underwent HSCT from a matched sibling donor (MSD; n?=?48), an unrelated matched donor (UMD; n?=?56), or a haploidentical donor (n?=?20). We observed a similar 3-year event-free survival (EFS) for MSD recipients (of .64) and for UMD recipients (.62), but a significantly lower EFS for recipients of haploidentical transplants (.35; P?=?.01). Relapse was the main cause of HSCT failure and was significantly higher in the haploidentical donor group (.47 versus .19 for MSD and .24 for UMD; P?=?.02). Treatment-related mortality was evenly distributed among the donor groups (.17, .16, and .15 for the MSD, UMD, and haploidentical groups, respectively). Rates of infection-related mortality were lower than previously reported. Relapse is the main obstacle for successful HSCT in the contemporary era, and this effect is most evident in recipients of haploidentical donor grafts. Newer methods to improve graft-versus-leukemia effect are being evaluated and will need to be incorporated into the management of high-risk patients.     

Avascular necrosis of the capitate

Although a large portion of the capitate is supplied by a single nutrient vessel, avascular necrosis of the capitatum is a rare condition. Its etiology is not clear, but a number of factors are linked to its pathogenesis including: repetitive trauma, dorsal instability of the carpus, Gaucher disease, systemic lupus erythematosus, gout, and steroid use. A 24-year-old woman presented with right wrist pain of 12 months duration. She reported no major trauma and reported that her pain had begun during the third month of her pregnancy. She had a history of hyperemesis gravidarum treated with 2 to 4 mg/daily of prednisone during her pregnancy for 6 weeks. She had 70° extension and 45° flexion of her wrist. Radiographs showed a hypodense area at the capitate head and midcarpal joint arthritis. Magnetic resonance imaging demonstrated avascular necrosis of the capitate and midcarpal collapse at the lunocapitate joint. Lunocapitate fusion with a partial scaphoidectomy was performed. At final follow-up 28 months postoperatively, she had 60° of volar flexion, and 50° of dorsiflexion. She was pain free in the majority of her activities of daily living. A small dose of steroid use during pregnancy, even in a short period of time, is a potential risk for avascular necrosis of the capitate and patients with a gradual onset of wrist pain during pregnancy may need to be investigated further if symptoms are not resolved with basic nonoperative measures within a reasonable time frame.