Opacification of hydrophilic MemoryLens U940A intraocular lenses: analysis of 2 explanted lenses

PURPOSE: To determine the rate of opacification of hydrophilic MemoryLens U940A intraocular lenses (IOLs) (Mentor Ophthalmics, Inc.) in the given cohort and perform a histopathological and spectrophotometer analysis of 2 explanted opacified IOLs. SETTING: Ophthalmology Department, Faculty Hospital, Nitra, Slovakia. METHOD: This retrospective study comprised 182 patients (205 eyes) who had implantation of a MemoryLens U940A IOL from June 1997 to June 2000. The patients were examined using a slitlamp to detect the presence of IOL opacification. In 4 cases, the lenses were explanted because of significant opacification and patient-reported problems; 2 lenses were provided for further analysis. One unused reference MemoryLens U940A IOL was also evaluated. All IOL were stained with von Kossa to determine the presence of calcium in the opacification. To confirm the components presence of an ultraviolet (UV) absorber, the IOLs were examined with an Avatar 330 Fourier transfer infrared (IR) spectroscope and a UV visible spectrophotometer (Philips). The IR spectrums for the IOL were identified using an IR spectrum atlas. The opacified IOLs, reference IOL, and the IOL packaging were further examined to determine the presence of silicone. RESULTS: Various amounts of opacification were found on the MemoryLens U940A IOL in 30 eyes (30 patients) (14.63%). Two explanted IOLs were positive for von Kossa staining, proving the presence of calcium deposits; the reference lens staining was negative. Spectrophotometry showed that the reference IOL and opacified IOLs were of the same polymer. The presence of the UV absorber on the benzophenone base was seen in the reference lens but not the opacified IOLs. In contrast, an increased concentration of low-molecular-weight components generated during the degradation of the polymer was present in the opacified lenses. The white cover pf the IOL is of polydimethyl siloxane, a silicone rubber. However, no silicone rubber was present in any examined lens, perhaps because the IOLs were in contact with alcohol during the histopathologic examination. CONCLUSIONS: The results indicate opacification of the hydrophilic MemoryLens U940A was caused by premature consumption of the UV absorber in the polymer component of the IOLs optic, with a subsequent degradation of the polymer. Whether silicone from the white cover led to the IOL opacification, as reported with other types of hydrophilic IOLs, could not be confirmed.     

Elevated serum TNF-alpha levels in normal-weight women with polycystic ovaries or the polycystic ovary syndrome

OBJECTIVE: To compare the serum tumor necrosis factor-alpha (TNF-alpha) levels in nonobese women with those in women with polycystic ovaries (PCO) and polycystic ovary syndrome (PCOS) and healthy controls. STUDY DESIGN: Twenty-one sonographically and biochemically diagnosed women with PCOS, 19 with PCO and 14 healthy women were recruited for the study. Serum TNF-alpha levels were measured in all three groups. Insulin and glucose serum concentrations were analyzed before and after a 75-g oral glucose tolerance test in all samples. The serum TNF-alpha, glucose and insulin levels were compared in PCOS, PCO and controls. RESULTS: Serum TNF-alpha levels were similar in the PCOS and PCO groups (23.67 +/- 5.58 and 13.58 +/- 1.34 pg/mL, respectively) and significantly higher than in the control group. Serum TNF-alpha levels did not significantly correlated with body mass index, serum total testosterone, LH, DHEAS, fasting glucose and fasting insulin levels or glucose and insulin area under the curve values in the three groups. CONCLUSION: We found similar TNF-alpha levels in patients with PCOS and with PCO; however, there was no correlation between the TNF-alpha and insulin, glucose and androgen levels in the study.     

Short-term results from laparoscopic dissection of uterine vessels in women with symptomatic fibroids

OBJECTIVE: To assess the outcome, tissue trauma, clinical improvement and the reduction in size of fibroid following laparoscopic dissection of uterine vessels (LDUV). SETTING: Department of Obstetrics and Gynaecology, Endoscopic Training Centre, Baby Friendly Hospital, Kladno, Czech Republic. DESIGN: An uncontrolled case series of 17 consecutive women who underwent LDUV using ultrasonically activated shears for the treatment of fibroids over two years. Ultrasound imaging was carried out before and three and six months following treatment. The tissue markers (C-reactive protein (CRP), Interleukin-6 (IL-6), Creatin kinase (CK) and white blood cell count) were studied preoperatively, on the first and third postoperative day. RESULTS: All patients underwent successful LDUV without intraoperative complications. Tissue markers results show that the LDUV performed using ultrasonically activated shears is associated with insignificant tissue damage. Time of surgery ranged from 30 to 50min (mean 39min). Mean blood loss was less than 30ml and mean hospital stay was 2.3 days. Three and six months after surgery, respectively, average reduction in uterine volume was 23.6 and 36.8% and average reduction in dominant fibroid was 28.6 and 56.8%. 94.1% of women had improvement in menorrhagia or dysmenorrhoea, and 91.6% had improvement in bulk-related symptoms or pelvic pain six months after treatment. CONCLUSION: Uterine volume and dominant fibroid were reduced and symptoms were improved by LDUV. The procedure of laparoscopic dissection of uterine vessels can be completed within 30-40min with only minimal blood loss and short hospital stay if performed by experienced laparoscopists.     

Laparoscopically assisted modified radical vaginal hysterectomy (type II) with pelvic lymphadenectomy: ultrasonic operative technique

OBJECTIVE: The aim of this study was to incorporate an ultrasonic operative laparoscopic technique to complete a type II laparoscopically-assisted modified radical vaginal hysterectomy (LARVH) and pelvic lymph node dissection (PLND) in early cervical cancer. METHODS AND MATERIALS: LARVH type II and PLND using a laparoscopic ultrasonic operative technique and conventional vaginal surgery were indicated in five cases of early cervical cancer (IA2). RESULTS: Complete pelvic lymphadenectomy and the laparoscopic phase of modified radical vaginal hysterectomy were successfully performed using ultrasonic instruments in all women. Uterine artery and ureteral dissection with resection of the cervicovesical fascia, cardinal and uterosacral ligaments were successful with ultrasonically activated instruments only. CONCLUSION: Our initial experience with laparoscopically assisted radical vaginal hysterectomy type II confirmed that the use of a minimally invasive ultrasonic technique is feasible. Further investigations into the indications of disease where laparoscopic surgery is appropriate in the management of early cervical carcinoma are required.     

Expression of NM23 and tenascin in invasive ductal carcinomas of the breast

OBJECTIVE: In this series of ductal carcinoma of the breast, immunoexpression of antimetastasis gene nm23 and tenascin was examined and the role in prognosis was investigated by correlation with the tumour grade and stage, and ER/PR immunoexpression. MATERIAL AND METHODS: In this study 27 ductal carcinomas of the breast were analysed for expression of tenascin and nm23 antimetastasis genes by immunohistochemistry. RESULTS: The results of our study revealed a statistically significant correlation between nm23-H1 immunoexpression and lymph node metastasis. We also found a statistically significant correlation between tenascin and nm23-H1 immunoexpression. Our results suggest that tenascin limits tumour spread. CONCLUSION(S): Antimetastasis gene expression can be used in predicting lymph node metastasis in ductal carcinomas of the breast.     

Pharmacological treatment of diabetic patients with respect to prevention of macrovascular disease

Prevention of atherosclerosis in type 2 diabetes ideally should start a long time before the diagnosis of diabetes since type 2 diabetes and atherosclerosis have a common background of metabolic syndrome. Identifying subjects with metabolic syndrome and beginning with lifestyle and drug interventions in such subjects would most probably delay the development of both diabetes and atherosclerosis. After the clinical diagnosis of diabetes, it is necessary to continue with multifactorial interventions targeted on risk factors, such as hyperglycaemia, dyslipidaemia and hypertension. Some interventions appear to have a benefit beyond the effect on risk factors. Effects of these interventions can be explained by their influence on some pathogenic mechanisms, such as insulin resistance and endothelial dysfunction. Multifactorial interventions decrease the incidence of macrovascular disease in diabetes at least by one-half and should be routinely used in the majority of patients with type 2 diabetes.     

Carotid intima-media thickness in type 2 diabetes is more strongly related to serum apoprotein A-I in females

BACKGROUND: Dyslipidemia in type 2 diabetes has been shown to be related to the incidence of macrovascular events. Increased carotid intima-media thickness is considered to be a marker of macrovascular disease. MAIN PURPOSE: To investigate a possible relationship between lipoprotein levels and carotid intima-media thickness as a marker of early atherosclerosis in patients with type 2 diabetes. METHODS: Seventy-one consecutively selected eligible patients (31 males, 40 females) with type 2 diabetes were studied. Common carotid intima-media thickness was measured bilaterally by high-resolution ultrasound and the mean value from both sides was used for further analysis. Fasting blood samples were taken from each individual and their serum was analyzed for lipoprotein levels. RESULTS: In the entire group of patients, intima-media thickness was inversely related to apoprotein A-I (r = -0.33, p = 0.008) and HDL cholesterol (r = -0.23, p = 0.059) in univariate correlation analysis, and a positive correlation between intima-media thickness and apoprotein B/apoprotein A-I ratio was found (r = 0.33, p = 0.007). When genders were analyzed separately, intima-media thickness was significantly correlated with apoprotein A-I and apoprotein B/apoprotein A-I ratio in females, while no significant correlation of any lipid variable with intima-media thickness was observed in males. In multiple linear regression analysis, age (p = 0.005), male gender (p = 0.002) and apoprotein A-I (p = 0.035) were the only risk factors in the entire group of diabetic patients, which significantly predicted carotid intima-media thickness in models adjusted for demographic and other known risk factors. As was the case in the univariate analysis, no risk factor significantly predicted carotid intima-media thickness in males while age, apoprotein A-I and B significantly predicted intima-media thickness in females. CONCLUSIONS: In the present study, low serum apoprotein A-I, a major protein component of HDL, was found to be related to increased carotid intima-media thickness. This relationship was stronger in females than in males, which suggests possible gender differences in the relationship between apoprotein A-1 and early atherosclerotic lesions in subjects with type 2 diabetes mellitus.     

Neonatal cerebral venous thrombosis coexisting with bilateral adrenal hemorrhage

We report a case of severe perinatal asphyxia with both cerebral venous thrombosis and adrenal hemorrhage who survived with severe sequela including multicystic encephalomalasia, acquired microcephaly and blindness. Hematological investigations showed normal levels of anticardiolipin antibodies, protein C and S levels and activity, antithrombin III levels. Factor V Leiden mutation was negative. The adrenal hemorrhage resolved within three months with glucocorticoid therapy, the cerebral venous thrombosis resolved within two months without treatment. The literature on neonatal cerebral venous thrombosis is also reviewed.     

Epidemic and endemic spread of Klebsiella pneumoniae producing SHV-5 beta-lactamase in Dubrava University Hospital, Zagreb, Croatia

Plasmid-encoded resistance to broad-spectrum cephalosporins and aztreonam is becoming a widespread phenomenon in clinical medicine. These antibiotics are inactivated by an array of different extended-spectrum beta-lactamases (ESBLs) which have evolved by point mutations of parental TEM or SHV beta-lactamases. In a previous study conducted during 1994-1995, SHV-2, SHV-2a and SHV-5 beta-lactamases were found among Klebsiella pneumoniae isolates in Dubrava University Hospital. High prevalence of ESBLs among K. pneumoniae strains in this hospital (20%) required further investigation. In this investigation, beta-lactamases from 42 K. pneumoniae strains collected in 1997 and 15 in 2004 from Dubrava University Hospital, were characterized in order to study the evolution of plasmid-encoded resistance to extended-spectrum cephalosporins and aztreonam in that hospital over a prolonged study period. Susceptibility to antibiotics was determined by disk-diffusion and broth microdilution method. beta-lactamases were characterized by isoelectric focusing, determination of hydrolysis of beta-lactam substrates, polymerase chain reaction and sequencing of bla(SHV) genes. All K. pneumoniae strains and their Escherichia coli transconjugants produced beta-lactamase with an isoelectric point of 8.2. Based on sequencing of bla(SHV) genes enzymes of all transconjugants were identified as SHV-5 beta-lactamase which conferred on the producing isolates high level of ceftazidime and aztreonam resistance. In this study, an outbreak of nosocomial infections caused by SHV-5 producing K. pneumoniae was described in 1997 which evolved to endemic spread of SHV-5 producing K. pneumoniae due to multiple plasmid transfer in the Dubrava University Hospital. The strains from 1997 and 2004 were not clonally related. Hospital hygiene measures should be applied in order to control the spread of epidemic strains through the hospital wards and the consumption of the broad-spectrum cephalosporins needs to be restricted to reduce the selection pressure which enables the proliferation of ESBL producers in hospital.