Results of pars plana vitrectomy in closed-globe injuries.

BACKGROUND AND OBJECTIVE: To assess surgical and visual outcomes with pars plana vitrectomy (PPV) in closed-globe injuries resulting in anterior and posterior segment pathologies and evaluate the factors influencing the prognosis. PATIENTS AND METHODS: Retrospective observational study. Forty-seven eyes of 47 consecutive patients who underwent PPV because of closed-globe injury between January 1992 and August 2003 were reviewed. Surgical and visual outcomes and prognostic factors were analyzed according to the Ocular Trauma Classification System. RESULTS: Preoperative visual acuity was less than 4/200 in 49% of eyes, classified as grades IV to V. After surgery, this ratio was 23% (P < .05). Final visual acuity was statistically significantly better in grade I (P = .0001), grade II (P = .002), and relative afferent pupillary defect-negative (P = .0001) injuries. Maculopathy was the most common adverse outcome influencing final visual acuity (32%), followed by secondary glaucoma (13%) and proliferative vitreoretinopathy (8%). CONCLUSION: PPV is a favorable treatment modality in severe closed-globe injuries. Assessment of injuries with respect to the Ocular Trauma Classification System seemed to predict visual outcomes in this series.     

Photodynamic therapy for posterior capsule neovascularization

We report a 71-year-old man with posterior capsule opacification with severe neovascularization who was treated with photodynamic therapy and neodymium:YAG capsulotomy. Treatment was performed using a diode laser at 692 nm, a light dose of 50 J/cm(2), and 6 mg/m(2) body surface area verteporfin. The initial visual acuity was hand motions; 6 months after therapy, the visual acuity was stable at 20/200. In 9 months of follow-up, there was no recurrence of neovascularization and the pupil area remained clear; no retreatment was needed. Photodynamic therapy provided safe and effective occlusion of neovascular vessels in the posterior capsule area.     

Diagnosis of adenoid cystic carcinoma of the breast using fine‐needle aspiration cytology: A case report and review of the literature

Adenoid cystic carcinoma (ACC) of the breast is a rare variant of breast malignancy and is associated with an excellent prognosis. ACC accounts for 0.1% of all breast carcinomas. It has favorable biological characteristics and an excellent prognosis. A 77‐year‐old woman presented with a lump in the right breast. Ultrasonography and mammography showed a 12‐mm, well‐defined, lobulated mass in the retroareolar region of the right breast. The lump was diagnosed as ACC on the basis of immunohistochemical staining results for c‐kit (CD117), muscle‐specific actin, p63, estrogen receptor, and progesterone receptor using a fine‐needle aspiration cytology (FNAC) specimen. This diagnosis was subsequently confirmed by excision biopsy. To the best of our knowledge, this is the first case of ACC of the breast to date to be diagnosed on the basis of immunohistochemical staining of an FNAC cell block material. From our experience, we recommend the usage of cell block material for immunohistochemical studies to accurately diagnose ACC of the breast. Diagn. Cytopathol. 2015;43:722–726. © 2015 Wiley Periodicals, Inc.     

Intraocular pressure at a simulated altitude of 9000 m with and without 100% oxygen

INTRODUCTION: Exposure to high altitude may affect intraocular pressure (lOP). This study aimed to determine how IOP was altered by two different inspired oxygen tensions at altitude. METHODS: There were 34 healthy male pilots, ages 26-39 yr (mean 31.9 yr), who were studied at the Air Health Examination and Physiological Training Centre in Eskisehir, Turkey. They were studied at ground level, which is 792 m (2414 ft), and during a training session in a hypobaric chamber at a simulated altitude of 9144 m (30,000 ft). IOP was measured with a Tone-pen XL tonometer before subjects entered the chamber, at altitude while breathing 100% oxygen by mask and after removing the mask, and again 30 min after leaving the chamber. RESULTS: Ground level values for IOP (mean +/- SD) were 12.31 +/* 2.98 mmHg. Levels increased significantly at altitude on oxygen (16.75 +/- 4.14 mmHg) and decreased slightly on breathing ambient air (14.37 +/- 3.44 mmHg). In 30 min after leaving the chamber, IOP was 12.81 +/- 1.74 mmHg, indistinguishable from pre-test values. DISCUSSION: Healthy subjects whose baseline IOP is in the normal range experience only a small, temporary elevation of IOP during passive exposure to high altitude with either normoxia or acute hypoxia.     

Comparison of Computing Capability and Information System Abilities of State Hospitals Owned by Ministry of Labor and Social Security and Ministry of Health

The main purpose of this study is to give an idea to the readers about how big and important the computing and information problems that hospital managers as well as policy makers will face with after collecting the Ministry of Labor and Social Security (MoLSS) and Ministry of Health (MoH) hospitals under single structure in Turkey by comparing the current level of computing capability of hospitals owned by two ministries. The data used in this study were obtained from 729 hospitals that belong to both ministries by using a data collection tool.The results indicate that there have been considerable differences among the hospitals owned by the two ministries in terms of human resources and information systems. The hospital managers and decision makers making their decisions based on the data produced by current hospital information system (HIS) would more likely face very important difficulties after merging MoH and MoLSS hospitals in Turkey. It is also possible to claim that the level and adequacy of computing abilities and devices do not allow the managers of public hospitals to use computer technology effectively in their information management practices. Lack of technical information, undeveloped information culture, inappropriate management styles, and being inexperienced are the main reasons of why HIS does not run properly and effectively in Turkish hospitals.     

Management of retinal detachment due to closed globe injury by pars plana vitrectomy with and without scleral buckling

BACKGROUND AND PURPOSE: To investigate the effect of circumferential scleral buckling on the prognosis for patients undergoing pars plana vitrectomy and lensectomy for severe closed globe injury. METHODS: A total of 33 cases in which pars plana vitrectomy and lensectomy were performed after severe closed globe injury between January 1990 and January 2003 were studied retrospectively. All patients had zone III contusion type injury according to The Ocular Trauma Classification Group criteria. Of the 33 patients, 15 (group 1) also underwent peripheral scleral buckling; 18 did not (group 2). RESULTS: The mean age +/- SD was 34.8 +/- 17.5 years (range, 8-73 years). There were 6 female (18%) and 27 male (82%) patients. The two groups did not differ significantly in terms of preoperative visual acuity (P = 0.76) or postoperative visual improvement (P = 0.46). In groups 1 and 2, 4 (26%) and 3 (17%) patients developed recurrent retinal detachment for which they underwent reoperation. Other postoperative complications were as follows: group 1-phthisis (1 patient; 7%), proliferative vitreoretinopathy (1 patient; 7%), and optic atrophy (1 patient; 7%); group 2, proliferative vitreoretinopathy (2 patients; 11%) and optic atrophy (2 patients; 11%). CONCLUSION: Circumferential scleral buckling did not appear to offer advantages for patients undergoing pars plana vitrectomy and lensectomy for severe closed ocular injury involving the posterior chamber.     

The effects of blood pressure lowering on P-wave dispersion in patients with hypertensive crisis in emergency setting

Hypertensive emergency refers to a severe hypertension (HT) that is associated with new or progressive end-organ damage. In these clinical situations, blood pressure (BP) should be reduced immediately to prevent or minimize organ dysfunction. The present study evaluated the diagnostic value of two electrocardiographic indices in detecting patients, who are at risk for paroxysmal atrial fibrillation (PAF), in the setting hypertensive crisis. The study population consisted of 30 consecutive patients aged ≥40 years, who were admitted to the emergency room with hypertensive crisis. Electrocardiographic (ECG) recordings of the patients were performed before and after the treatment. The minimum (Pmin) and maximum (Pmax) P wave duration on ECG, and P-wave dispersion (P(d)), which was defined as the difference between Pmin and Pmax, were measured. The mean P(d) was 118.0 ± 32.1 and 94.0 ± 44.3 before and after the treatment, respectively. The decrease observed in the mean P(d) was statistically significant (p = 0.005). The mean Pmax was 214.7 ± 37.1 before the treatment, while it was 194.0 ± 47.3 after the treatment, and the difference was significant (p = 0.021). The mean Pmin was 96.7 ± 26.3 and 100.0 ± 41.0 before and after the treatment, respectively; however, the difference was not significant (p = 0.624). Pmax and P(d) display significant changes with acute treatment of HT. There is a need for larger prospective studies to clearly elucidate the diagnostic value of ECG indices, Pmax and P(d) as indicators of future PAF.