Retinal tears associated with panuveitis and Behçet's disease

To report retinal tears formation in 3 eyes of 2 patients with active panuveitis and Beh?et's disease. We describe 2 patients that were diagnosed and treated for Beh?et's disease with active panuveitis. Retinal tears developed while the inflammation was active. The patients were treated with topical, oral steroids, and cyclosporine therapy for bilateral panuveitis. One patient presented with a retinal tear located at the periphery of the active retinal lesion. The other had multiple tears associated with active retinal lesions in both eyes. Argon laser photocoagulation was performed in both patients as soon as the tears were detected. Ocular inflammation was controlled with this therapy, and only a few mild flare-ups occurred. The patients have been followed up for 8 and 16 months, respectively. During this period no new retinal tears have developed. Although retinal tear formation is rarely associated with Beh?et's panuveitis, the clinician should be aware of this as a possible complication. When structural changes are present in the vitreous, detailed ophthalmoscopy is indicated to assess for retinal tears. If a tear is detected in a patient with panuveitis and Beh?et's disease, laser photocoagulation therapy should be performed immediately to prevent retinal detachment.     

The Efficacy of Fluoxetine in the Treatment of Premature Ejaculation: A Double-Blind Placebo Controlled Study

Purpose

The efficacy of the selective serotonin re-uptake inhibitor fluoxetine in the treatment of premature ejaculation was examined.

Materials and Methods

The study comprised 17 patients with premature ejaculation who presented to the urology clinic of our medical school. In this double-blind study the patients were randomized into treatment groups receiving 20 mg. fluoxetine daily for 1 week and 40 mg. daily afterward (group 1) or 1 capsule placebo daily for 1 week and 2 capsules daily afterward (group 2). The groups were evaluated according to the latent period of intravaginal ejaculation.

Results

The latent period of intravaginal ejaculation in group 1 was significantly longer than that in group 2. Nausea, headache and insomnia were reported side effects.

Conclusions

Fluoxetine may be regarded as a safe and effective alternative in the treatment of premature ejaculation.     

The effects of nisoldipine on the total ischaemic burden: the results of the ROCKET study

This study was designed to examine the effects of nisoldipine(relative to placebo), a new dihydropyridine calcium entry blockingagent, in the treatment of silent ischaemia in conventionaldoses. A total of 409 patients with proven coronary artery diseasewere screened and of this 64 had at least six episodes or atotal duration of 30 mm of ST segment depression (1 mm lastingat least 1 min) over 48 h. Fifty-two patients ultimately completeda randomized double-blind cross-over study comparing nisoldipine5 mg twice a day, nisoldipine 10 mg daily and placebo. There was a reduction in the ST segment integral and numberof episodes of ST segment depression when compared to placeboon treatment with nisoldipine 5 mg twice a day and nisoldipine10 mg daily. However, the confidence limits were wide and crossedthe no-treatment effect line. In addition, the nisoldipine dosesneither affected the circadian distribution of ischaemic episodesnor caused an alteration of the workload achieved either atpeak exercise or at 1 mm ST segment depression measured 24 hafter nidoldipine 10 mg or 12 h after nisoldipine 5 mg. We conclude that frequent silent ischaemia in patients withproven coronary artery disease is relatively uncommon, it accountsfor approximately 16% of patients with positive exercise. Inthese patients nisoldipine, given as 5mg twice a day and 10mg daily, showed no significant therapeutic effects, eitheron the frequency or severity of silent ischaemia. New formulationsof slow release nisoldipine are consequently being developedso that a fuller 24 h therapeutic profile may be obtained.     

Renal functional reserve in insulin dependent diabetic children

Abstract Background: Microalbuminuria has been shown to be predictive for clinical diabetic nephropathy. Renal functional reserve (RFR), as a response to protein loading in a short period of time, is a parameter to assess the ability of kidneys to increase the glomerular filtration rate (GFR). The aim of this study was to predict the early phase of diabetic nephropathy by measuring urinary albumin level and RFR capacity in patients with insulin-dependent diabetes mellitus (IDDM).
Methods: Twenty-two patients with IDDM were studied: 11 with a disease duration of less than 5 years (group 1) and 11 with a disease duration of more than 5 years (group 2). As the control group, 15 healthy children (group 3) were included in the study. At the beginning of the study, glucose was measured and the urinary albumin/creatinine ratio was calculated. Average glycosylated hemoglobin (HbA₁c) over 1 year was determined. After protein loading (red meat containing 2 g/kg of protein), the creatinine clearance was calculated at each hour for a duration of 4 h. The RFR was accepted as the peak percentage increase in GFR over the baseline value.
Results: Although metabolic control in group 2 was better, the RFR in group 2 was significantly lower than in group 1 (P < 0.05). Urinary microalbumin levels between the groups did not differ (P < 0.05). In two patients in whom microalbuminuria was detected, the RFR was much lower.
Conclusions: Detecting lower RFR levels in patients with normal urinary albumin excretion, as well as in patients with microalbuminuria, may support the idea that the RFR capacity is more sensitive than microalbuminuria in assessing the early phase of diabetic nephropathy.     

体外受精—胚胎移植术后异位妊娠29例临床分析

目的 :探讨体外受精 -胚胎移植后异位妊娠的发生率及高危因素。方法 :对我院 1998年 9月～ 2 0 0 3年 3月接受体外受精 -胚胎移植后发生的异位妊娠 2 9例进行回顾性分析。结果 :异位妊娠发生率为 5 .8%。 2 9例异位妊娠中有 19例术前存在输卵管病变。结论 :体外受精 -胚胎移植术后发生异位妊娠的高危因素是输卵管病变、继发性不孕 ,年龄、子宫位置、移植术过程的困难程度等亦与之有关     

Tympanometric changes in an experimental myringosclerosis model after myringotomy.

HYPOTHESIS: The goal of this experimental study was to investigate the specific effect of myringosclerosis on tympanograms in the tympanic membranes of myringotomized rats by using otomicroscopy, tympanometry, and histopathology. BACKGROUND: Myringosclerosis is a common sequela of ventilation tube treatment of otitis media with effusion. The condition involves the hyalinization and calcification of the collagen layer in certain areas of the tympanic membrane. Previous animal experiments suggest an intimate relationship between the formation of myringosclerosis and an increased oxygen concentration in the environment of the wound after myringotomy. The result of a myringotomy therefore is an increased production of free oxygen radicals, initiating irreversible tissue damage involving fibrosis, hyalin degeneration, and finally apoptosis as observed in myringosclerosis. We propose an experimental model specific for creating sclerotic plaques solely on the tympanic membrane and for performing tympanometric measurements on this pure myringosclerosis model without creating any abnormality in the middle ear to test in what proportion myringosclerosis contributes to decrease of amplitude in tympanograms. METHODS: To assess the normal tympanometric values of Wistar albino rats, the pressure and peak admittance of the left middle ears were measured using a semiquantitative computerized clinical admittance meter using a sound frequency of 226 Hz. Twelve animals were randomly selected for the myringotomy group and perforations in the left ears were created. All tympanic membrane perforations in this group had healed and closed prior to the otomicroscopic examination and no pathologic reaction was observed in the external ear canals of rats. Otomicroscopic and tympanometric measurements were carried out on Day 15 and the degree of myringosclerosis was noted before the animals were killed. Twelve specimens in the myringotomy group were histopathologically examined for the presence of myringosclerotic plaques. RESULTS: Under light microscopy, extensive sclerotic lesions were found in the tympanic membranes of the myringotomy group, and these sclerotic deposits were located in the lamina propria. The myringosclerosis occurred predominantly adjacent to the handle of the malleus, but also near the annular region. In all ears with myringosclerosis, the magnitude of the maximum admittance reduced to approximately 50% of the Day-0 values, and this reduction was statistically significant (Z=-3.061, p=0.002). CONCLUSION: The present findings in this study are consistent with the fact that the movement of the tympanic membrane is hampered by lesions of sclerotic material, resulting in a decrease of amplitude in tympanograms (such as Type As) without any effusion or inflammation in the middle ear.