A randomized trial of low-dose, topical mitomycin-C in the treatment of severe vernal keratoconjunctivitis

OBJECTIVE: To evaluate the efficacy and safety of low-dose, topical mitomycin-C in patients with severe vernal keratoconjunctivitis. DESIGN: Placebo-controlled, double-masked, randomized clinical trial. PARTICIPANTS: Twenty-six patients with vernal keratoconjunctivitis refractory to combination of steroid and mast-cell stabilizer treatment. INTERVENTION: Patients were randomly assigned (2:1) to treatment with topical 0.01% mitomycin-C eye drops (n = 17) or placebo (n = 9) three times daily for 2 weeks. MAIN OUTCOME MEASURES: Symptoms (itching, tearing, photophobia, ropy mucous discharge, foreign body sensation) and signs (conjunctival hyperemia, epithelial punctate keratitis, Trantas' dots, limbal edema, and palpebral conjunctival giant papillae) of vernal keratoconjunctivitis recorded on the day of enrollment and at the end of the treatment period. RESULTS: There was a statistically significant decrease in ropy mucous discharge, photophobia, conjunctival hyperemia, and limbal edema in the mitomycin-C treated group compared with the placebo group at the end of the 2-week treatment period. In addition, none of the 17 treated patients, but all 9 of the placebo patients, required medication during the 4-week posttreatment follow-up period. No adverse effects of treatment with mitomycin-C were observed. CONCLUSIONS: Short-term, low-dose, topical mitomycin-C may be considered in the acute exacerbation periods of patients with severe vernal keratoconjunctivitis refractory to conventional treatment.     

Reliability of procalcitonin as a severity marker in critically ill patients with inflammatory response

Procalcitonin (PCT) is increasingly recognised as an important diagnostic parameter in clinical evaluation of the critically ill. This prospective study was designed to investigate PCT as a diagnostic marker of infection in critically ill patients with sepsis. Eighty-five adult ICU patients were studied. Four groups were defined on the basis of clinical, laboratory and bacteriologic findings as systemic inflammatory response syndrome (SIRS) (n = 10), sepsis (n = 16), severe sepsis (n = 18) and septic shock (n = 41). Data were collected including C-reactive protein (CRP), PCT levels and Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores on each ICU day. PCT levels were significantly higher in patients with severe sepsis and septic shock (19.25 +/- 43.08 and 37.15 +/- 61.39 ng/ml) than patients with SIRS (0.73 +/- 1.37 ng/ml) (P < 0.05 for each comparison). As compared with SIRS patients, plasma PCT levels were significantly higher in infected patients (21.9 +/- 47.8 ng/ml), regardless of the degree of sepsis (P < 0.001). PCT showed a higher sensitivity (73% versus 35%) and specificity (83% versus 42%) compared to CRP in identifying infection as a cause of the inflammatory response. Best cut-off levels were 1.31 ng/ml for PCT and 13.9 mg/dl for CRP. We suggest that PCT is a more reliable marker than CRP in defining infection as a cause of systemic inflammatory response.     

Compensation for failed sterilization

Two recent Court of Appeal decisions have modified the hitherto settled rules governing the compensation payable following failed and negligently performed sterilization. Compensation is now possible other than for the pain and suffering of the pregnancy where the child or mother is disabled.     

External metallic circle in microsurgical anastomosis of common bile duct

BACKGROUND: Biliary stricture development is one of the most serious problems following biliary tract surgery. Here, we present a new technique for biliary tract reconstruction with an external metallic circle, and the results of this new technique in a rat model. METHODS: Twelve male Sprague-Dawley rats (250 to 300 g) were divided into two groups. After transection of the bile duct, standard bile duct reconstruction (without the metallic circle) was performed in group 1 and reconstruction with the external metallic (silver) circle was performed in group 2. At the end of the fourth month, clinical, laboratory biochemical, and histopathologic parameters were compared between the groups. RESULTS: Serum concentrations of alkaline phosphatase (ALP) and operation time were higher in group 1 than in group 2. Differences were statistically significant. In histopathologic examination, biliary duct stricture was seen in group 1. Foreign body reaction and fibrosis in the bile duct wall were seen in group 2. CONCLUSION: An external metallic circle prevents development of biliary stricture after primary end-to-end bile duct anastomosis in this rat model.     

FcγRIIIa-V/F 158 polymorphism in Turkish children with asthma bronchiale and allergic rhinitis

Fc receptors (FcR) play an important role in immune regulation. This might be linked to the variability in immune response, therefore relating to the pathogenesis of atopic diseases. The aim of the present study was to evaluate the Fc γ RIIIa gene polymorphism in Turkish children with asthma and allergic rhinitis. The study included 364 atopic children (184 bronchial asthma, 180 allergic rhinitis) and 234 healthy subjects as the control group, aged between 5 to 16 years. Patients were recruited from outpatient clinics of allergy and general pediatric care. Plasma IgE concentrations were measured by immunoassays and skin prick test was done in children with atopic diseases. The Fc γ RIIIa gene polymorphism was determined using the polymerase chain reaction method. Distribution of V158V genotype was significantly different among patient groups compared to controls (for asthmatic children OR: 5.33, 95% CI: 2.80–10.23, p < 0.001; for allergic rhinitis OR: 3.25, 95% CI: 1.75–6.07, p = 0.001). Distribution of 158 V allele was significantly different among asthmatic children (OR: 2.20, 95% CI: 1.65–2.92, p < 0.001) and allergic rhinitis patients (OR: 1.77, 95% CI: 1.32–2.35, p < 0.001) compared to healthy controls. Our study shows that the V158V genotype in Fc γ RIIIa gene polymorphism may be a genetic risk factor for the development of atopic diseases.     

Reactivity of individual stereoisomers based on 4-(3-buten-1-ynyl)-1,2,5-trimethyl-4-piperidinol in radical polymerization

The radical polymerization of individual stereoisomers of 4-(3-buten-1-ynyl)-1,2,5-trimethyl-4-piperidinol (1) was investigated. The reaction order with respect to the monomer and the initiator, and also the kinetic and energetic parameters of the polymerization reaction were determined. The values of constants of polymerization of the stereoisomers were found with the help of the “rotating sector” method. It was established that the spatial orientation of the reactive centres with respect to the six-membered heterocycle influences the reactivity of the monomers and leads to a change of the polymerization rate of the stereoisomers by a factor of about 1,5 to 3. To ascertain the influence of the spatial structure on the reactivity of the stereoisomers, quantum chemical calculations for model structures were performed. By means of IR and Raman spectroscopy it was established that the polymerization of 1 occurs via the double bond of the 3-buten-1-ynyl groups.     

The effect of pre-induction clonidine on platelet aggregation during minor surgery

Objective: This paper reports the results of a prospective randomized double-blind trial on the effects of pre-operative clonidine on platelet aggregation. Methods: Thirty adult (ASA I–II) patients undergoing elective minor orthopaedic surgery were randomly allocated into three groups of ten patients each. In group I clonidine 2 μg · kg⁻¹, in group II clonidine 4 μg · kg⁻¹ and in group III saline placebo was administered intravenously before the induction of anaesthesia. Anaesthesia was induced with propofol and vecuronium and maintained with halothane-nitrous oxide. Platelet counts and aggregation tests were performed before (t₀) and 1 h (t₁) and 24 h (t₂₄) after administration of the study drug. Results: Changes in platelet counts among the groups and values over time were not significant. Both maximum rate and intensity of collagen-induced aggregation in both clonidine groups and maximum intensity of adenosine 5′-diphosphate (ADP)-induced aggregation in the high-dose clonidine group increased significantly at t₁. However, all these increases in aggregation were within the normal ranges. Conclusion: The effects of both low and high doses of clonidine on platelet aggregation appeared to be minor, and we did not observe any increases above the normal ranges. Received: 16 December 1997 / Accepted in revised form: 9 May 1998