The vasodilator effect of coronary vascular endothelium in situ: its inactivation by hydroquinone

Studies were carried out to demonstrate the presence of the endothelium derived relaxing factor (EDRF) in coronary arteries in situ and the effect of hydroquinone on this factor. The studies revealed the presence of EDRF in coronary arteries of rabbit hearts remaining in situ. EDRF was inactivated by left atrial injection of hydroquinone. In situ constriction of coronary arteries by vasopressin was markedly increased following exposure to hydroquinone, and the dilatory response to acetylcholine was absent. The experiments confirm the presence of the endothelium derived relaxing factor in coronary arteries in situ and its inactivation by hydroquinone.     

Deep anterior lamellar keratoplasty for keratoconus

PURPOSE: To investigate surgical outcomes after deep anterior lamellar keratoplasty (DALKP) in eyes with keratoconus. METHODS: Retrospective review of 127 eyes of 118 keratoconus patients who underwent DALKP at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia between January 1, 1998 and November 30, 2001. The mean age of all patients was 25.9 years (range 11-70 years). The mean follow-up for all patients was 10.9 months (range 4-61 months). Baring of Descemet's membrane (DM) during DALKP was achieved in 47 (37%) eyes; some stroma was left during operation in the remaining 80 (63%) eyes. Snellen visual acuity, intraoperative complications, and postoperative graft status were assessed. RESULTS: At the last follow-up visit, 74% of all eyes were able to achieve a best-corrected visual acuity of 20/50 or better. This level of improvement was more statistically significant with baring of DM (P = 0.005). Intraoperative perforation of DM occurred in 16 (13%) cases and was statistically significant in eyes with deep corneal scars (P = 0.012). However, this perforation did not seem to have an impact on the final visual acuity (P = 0.48). Main graft-related complications included graft-host vascularization (7/127), stromal graft rejection (4/127), graft infection (1/127), and persistent epithelial defect (1/127). CONCLUSIONS: Deep lamellar keratoplasty provides a safer and successful alternative to penetrating keratoplasty for keratoconus patients but remains a challenging procedure. Endothelial graft rejection is absent after DALKP. However, stromal graft rejection, although very rare, does occur.     

Intravitreal bevacizumab for posterior capsule neovascularization

We report a case of rapid regression of extensive posterior capsule neovascularization in a 67-year-old diabetic male patient, who developed posterior capsule opacity with neovascularization one year post cataract surgery, after a single injection of intravitreal bevacizumab (Avastin) followed by neodymium:YAG capsulotomy. Rapid regression of the posterior capsule neovascularization, and visual improvement was observed 9 days after the intervention. Posterior capsulotomy was performed successfully without bleeding. Prior to posterior capsulotomy, intravitreal bevacizumab can result in rapid and dramatic regression of posterior capsule neovascularization.     

The response to sodium valproate of patients with sinus headaches with normal endoscopic and CT findings

The objectives of this study are to evaluate the patients who have sinus headaches, either self-ascribed or physician-diagnosed, and to determinate the response to sodium valproate in a prophylactic treatment of the patients without positive sino-nasal findings. “Sinus headache” is a patient’s complaint or physician-diagnosis that can have a variety of underlying causes. The patients are often treated with multiple courses of antibiotics and occasionally undergo a sinus surgery, often with little or no relief of their symptoms. One hundred and four patients with “sinus headaches” were evaluated prospectively. The patients with a normal rigid nasal endoscopy and a paranasal sinus computed tomography scan were treated with sodium valproate as a prophylactic treatment. After a 3-month follow-up, the patients’ response to the treatment was evaluated. Seventy-two patients (69.2%) did not have any positive sino-nasal findings in the nasal endoscopy and the computed tomography scanning. The response rate to the treatment for these patients was as follows: significant improvement in 44 patients (61.1%), partial response (9.7%), no response (15.3%), and ten patients (13.9%) withdrew or failed to follow-up. According to Wilcoxon test, the patients’ response rate to sodium valproate was statistically significant (P = 0.001). In conclusion, a majority of “sinus headache” patients do not show any positive sino-nasal pathologic finding. Therefore, we have to consider migraine headache as a considerable cause and sodium valproate as an effective conservative treatment.     

The large vestibular aqueduct syndrome: the role of cochlear implantation in its management.

In recent years the large vestibular aqueduct syndrome has become an increasingly recognized cause of a progressive sensorineural hearing loss. Cochlear implantation, although not correcting the bony abnormality, does offer an avenue for rehabilitation for affected individuals and initial results are encouraging. Of 15 patients identified with the large vestibular aqueduct syndrome we have implanted seven (five adults and two children). All patients underwent an uneventful electrode insertion with uncomplicated postoperative periods. Three of our adult patients are showing very good initial results with BKB speech recognition scores of 100%, 74% and 66% with the implant alone. It is still early days with the children, but initial results are encouraging. A full review of the large vestibular aqueduct syndrome is given along with our results.     

Acquired immune deficiency syndrome (AIDS) presenting as a nasal septal perforation.

Patients infected with the Human Immunodeficiency Virus (HIV) and those with AIDS may present with many head and neck manifestations. We report a case of an undiagnosed HIV positive male who presented with symptoms due to a nasal septal perforation, and rapidly developed AIDS. The histopathology of the perforation margins revealed active chronic inflammation with no evidence of neoplasia or granuloma. No viral or fungal infection was demonstrable on immunological testing and fungal stain. This is the first reported case of a patient developing AIDS presenting with a nasal septal perforation.     

Delayed surgical treatment of displaced midshaft clavicle fracture using Herbert cannulated screw with intramedullary bone graft

There is an increasing trend towards operative treatment for displaced midshaft clavicle fractures. This retrospective study was performed to assess the outcome of delayed fixation of displaced midshaft clavicle fractures and test the null hypothesis that there is no difference in results between early and delayed surgical treatment for displaced midshaft clavicle fractures. Using the hospital database, two groups of patients who were surgically treated using Herbert cannulated screw for displaced midshaft clavicle fractures were identified. There were 114 cases in acute (median time to operation of 5?days) and 21 cases in delayed groups (median time to operation 10.5?weeks). Thirty-five cases were available for follow-up in the acute and 16 cases in the delayed series. The primary outcome was assessed by the Disabilities of the Arm, Shoulder and Hand (DASH) score, American Shoulder and Elbow Surgeons score (ASES) and Constant-Murley score. Union occurred in 14 cases in the delayed group. The median DASH, mean ASES and Constant-Murley scores were 4.1, 97 and 88.7, respectively. Compared with the delayed group, the early group had a higher union rate (P?=?0.033), trend towards lower DASH score (P?=?0.051), and higher ASES score (P?=?0.047). The delayed group had significantly more problems with prominent, symptomatic screws that required removal (P?=?0.002). There were no significant differences in union time and complication rate. Delayed fixation of displaced midshaft fractures using the Herbert cannulated bone screw and bone graft is effective and provides a good functional outcome that only slightly reduced from that recorded for early fixation.     

Functional recovery of sciatic nerve through inside-out vein graft in rats

Objective: Present study aimed at further comprehensive functional, histomorphometrical and immunohistochemical assessment of peripheral nerve regeneration using rat sciatic nerve transection model.Methods: The 10-mm rat sciatic nerve gap was created in rats. In control group nerve stumps were sutured to adjacent muscle and in treatment group the gap was bridged using an inside-out vein graft. In sham-operated group the nerve was manipulated and left intact. All animals underwent walking track analysis test 4, 8, and 12 weeks after surgery.Subsequently, muscle mass measurement was performed to assess reenervation, histological examination to observe the sciatic nerve regeneration morphologically and immunohistochemistry to detect Schwann cells using anti S-100. Results were analyzed using a factorial ANOVA with two between-subjects factors. Bonferroni test for pairwise comparisons was used to examine the effect of treatments.Results: Functional analysis ofmyelinated nerve fibers showed that nerve function improved significantly in the time course in treatment group. However, quantitative morphometrical analysis of myelinated nerve fibers showed that there was no significant difference between 8 and 12 weeks in treatment group. Muscle weight ratio was bigger and weight loss of the gastrocnemius muscle was ameliorated by inside-out vein grafting. The position of positive immunohistochemical reactions further implied that regenerated axons and Schwann cell-like cells existed after vein grafting was performed, and was accompanied by the process of myelination and structural recovery of regenerated nerves.Conclusion: Functional analysis of peripheral nerve repair is far more reliable than quantitative morphometrical analysis