Management of traumatic retinal detachment with vitreon in children

Purpose: To report the use of perfluoroperhydrophenanthrene (vitreon) for traumatic retinal detachment in children. Methods: Vitreon was used as an intraoperative adjunct in 34 children with complicated retinal detachment secondary to penetrating and perforating trauma. The characteristics of the injuries, the final visual acuities, the postoperative complications and the rate of anatomic success were evaluated in a retrospective study. Results: Patients were followed-up an average of 20 months. Eighteen retinas (53%) were reattached, and the postoperative visual acuity was counting fingers or better in 9 cases (26%), and only 4 eyes saw better than 10/200 at last follow-up. Hypotony developed in 7 (21%) of 34 eyes. Conclusion: Management of traumatic retinal detachment in children is difficult. Vitreon, as other perfluorocarbons, may be an effectiveintraoperative tool for vitreoretinal surgery in pediatric eyes that suffer trauma.     

Increased collagen and aggrecan degradation with age in the joints of Timp3(-/-) mice

OBJECTIVE: To investigate the in vivo effect of an imbalance between metalloproteinases and their inhibitors, tissue inhibitors of metalloproteinases (TIMPs), in mouse articular cartilage. METHODS: Hind joints of Timp3(-/-) and wild-type mice were examined by routine staining and by immunohistochemical analysis using antibodies specific for type X collagen and for the neoepitopes produced on proteolytic cleavage of aggrecan (... VDIPEN and ... NVTEGE) and type II collagen. The neoepitope generated on cleavage of type II collagen by collagenases was quantitated in sera by enzyme-linked immunosorbent assay. RESULTS: Articular cartilage from Timp3-knockout animals (ages > or =6 months) showed reduced Safranin O staining and an increase in ...VDIPEN content compared with cartilage from heterozygous and wild-type animals. There was also a slight increase in ... NVTEGE content in articular cartilage and menisci of Timp3(-/-) animals. Chondrocytes showed strong pericellular staining for type II collagen cleavage neoepitopes, particularly in the superficial layer, in knockout mice. Also, there was more type X collagen expression in the superficial zone of articular cartilage, especially around clusters of proliferating chondrocytes, in the knockout mice. More type II collagen cleavage product was found in the serum of Timp3(-/-) mice compared with wild-type animals. This increase was significant in 15-month-old animals. CONCLUSION: These results indicate that TIMP-3 deficiency results in mild cartilage degradation similar to changes seen in patients with osteoarthritis, suggesting that an imbalance between metalloproteinases and TIMP-3 may play a pathophysiologic role in the development of this disease.     

Do we overestimate left ventricular ejection fraction by two‐dimensional echocardiography in patients with left bundle branch block?

Aims

Left bundle branch block (LBBB) causes a dyssynchronized contraction of left ventricle. This is a kind of regional wall‐motion abnormality and measuring left ventricular ejection fraction (LVEF) by two‐dimensional (2D) echocardiography could be less reliable in this particular condition. Our aim was to evaluate the role of dyssynchrony index (SDI), measured by three‐dimensional (3D) echocardiography, in assessment of LVEF and left ventricular volumes accurately in patients with LBBB.

Methods and Results

In this case–control study, we included 52 of 64 enrolled participants (twelve participants with poor image quality were excluded) with LBBB and normal LVEF or nonischemic cardiomyopathy. Left ventricular ejection fraction (LVEF) and left ventricular volumes were assessed by 2D (modified Simpson's rule) and 3D (four beats full volume analysis) echocardiography and the impact of SDI on results were evaluated. In patients with SDI ≥6%, LVEF measurements were significantly different (46.00% [29.50–52.50] vs 37.60% [24.70–45.15], P < .001) between 2D and 3D echocardiography, respectively. In patients with SDI < 6%, there were no significant differences between two modalities in terms of LVEF measurements (54.50% [49.00–59.00] vs 54.25% [40.00–58.25], P = .193). LV diastolic volumes were not significantly different while systolic volumes were underestimated by 2D echocardiography, and this finding was more pronounced when SDI ≥ 6%.

Conclusion

In patients with LBBB and high SDI (≥6%), LVEF values were overestimated and systolic volumes were underestimated by 2D echocardiography compared to 3D echocardiography.     

Impact of depressive symptoms and hepatic encephalopathy on health-related quality of life in cirrhotic hepatitis C patients

Depression, common in chronic medical conditions, and hepatic encephalopathy (HE), a reversible neuropsychiatric syndrome due to liver dysfunction, are associated with impaired health-related quality of life (HRQOL) in cirrhosis and hepatitis C (HCV). This study investigated the impact of depression and HE on HRQOL in cirrhotic patients with HCV. A convenience sample of 43 ambulatory patients, with varying degrees of cirrhosis secondary to HCV, was prospectively enrolled in this study. Participants were assessed for any current depressive, fatigue, and daytime sleepiness symptoms and underwent a psychometric evaluation to determine the presence of HE symptoms. Participants reported current HRQOL on general health and liver disease-specific questionnaires. Diagnosis and current health status were confirmed via medical records. The associations between disease severity, depressive symptoms, HE, fatigue, and daytime sleepiness were measured. Predictors of HRQOL in this sample were determined. Depressive symptoms (70 %) and HE (77 %) were highly prevalent in this sample, with 58 % actively experiencing both conditions at the time of study participation. A significant positive association was found between depressive symptoms and HE severity (P = .05). Depressive symptoms were significantly associated with fatigue (P < .001), daytime sleepiness (P < .001), general HRQOL (P < .001), and disease-specific HRQOL (P < .001). HE was significantly associated with fatigue (P = .02), general HRQOL (P < .001), and disease-specific HRQOL (P < .001). Depressive symptoms and HE were significant predictors of reduced HRQOL (P < .001), with depressive symptoms alone accounting for 58.8 % of the variance. Depressive symptoms and HE accounted for 68.0 % of the variance. Findings suggest a possible pathophysiological link between depression and HE in cirrhosis, and potentially a wider-reaching benefit of treating minimal and overt HE than previously appreciated.     

Peeling of internal limiting membrane during vitrectomy for complicated retinal detachment prevents epimacular membrane formation

Background  To investigate the clinical benefit of internal limiting membrane (ILM) peeling at the macula for the prevention of epimacular membrane formation following vitreous surgery using silicone oil for the treatment of complicated retinal detachment. Methods  This was a non-randomized, retrospective, interventional study of a case series. Patient charts were reviewed retrospectively for 20 consecutively recruited patients who underwent successful primary vitrectomy with ILM peeling at the macula using silicone oil (group 1) and 22 consecutively recruited patients who underwent successful primary vitrectomy using silicone oil without ILM peeling at the macula for complicated rhegmatogenous retinal detachment (group 2). The main outcome measures were distant visual acuity and epimacular membrane formation. The data were analyzed and compared using Fisher’s Exact test, Pearson Chi-square test, independent t-test, Mann–Whitney U-test, and a repeated ANOVA. Results  The mean age of patients was 52.7 ± 12.6 years in group 1 and 53.2 ± 13.3 years in group 2 (p = 0.89). The mean follow-up time was 24.6 ± 7.6 weeks in group 1 and 34.1 ± 12.6 weeks in group 2 (p = 0.01). Preoperatively, ten eyes in group 1 and 10 eyes in group 2 were pseudophakic; the macula was detached in all cases. Silicone oil had been removed from all eyes of both groups at least 3 months before the final examination. There were no significant differences between the two groups with regard to sex (p = 0.44), mean duration of retinal detachment (p = 0.12), mean preoperative visual acuity (logMAR), mean number of retinal breaks (p = 0.43), and grade of proliferative vitreoretinopathy (p = 0.35). The final visual acuity (logMAR) was 0.60 ± 0.30 in group 1 and 0.72 ± 0.35 in group 2 (p = 0.49). Four eyes in group 1 and two eyes in group 2 underwent cataract surgery during silicone oil removal. Epimacular membrane formation was observed in two eyes before silicone oil removal and in four eyes within 8 weeks after silicone oil removal in group 2. No epimacular membrane formation was seen in group 1 (p = 0.02). Conclusion  ILM peeling at the macula during vitreous surgery with silicone oil for the treatment of complicated retinal detachment may prevent epimacular membrane formation without negatively affecting distant visual acuity. The results of this study were presented at the 8th Euretina Congress 2008, Vienna, Austria. The authors have no conflicting interests in the subject matter presented.     

Anesthesia with etomidate and remifentanil for cesarean section in a patient with severe peripartum cardiomyopathy--a case report

Patients with peripartum cardiomyopathy may require analgesia/anesthesia for delivery or cesarean section. Many different methods of anesthesia has been used for this purpose. Remifentanil was used safely in peripartum cardiomyopathic patients, but there is not any report about etomidate usage in such patients. We report on a 19 years old patient, at 32 weeks of gestation, with severe peripartum cardiomyopathy, in uncompensated heart failure and pulmonary edema. She was scheduled for emergency cesarean section becaue of threatening mother's life and fetal distress. General anesthesia was induced with etomidate and maintained with remifentanil infusion safely, without any adverse outcome on mother or newborn.     

Respiratory epithelial adenomatoid hamartoma associated with inflammatory nasal polyposis: a case report

Respiratory epithelial adenomatoid hamartoma (REAH) is an uncommon benign lesion of the nasal cavity and paranasal sinuses. The etiology is unclear, however it is considered to be secondary to chronic sinonasal inflammation. Although it is rare, REAH should be taken into consideration in differential diagnosis of the nasal lesions. Complete surgical excision of the lesion is generally enough for the cure. A detailed pathological examination is necessary to prevent unnecessary surgical interventions. In this article, we present a 60-year-old female patient with REAH in the left nasal cavity associated with inflammatory polyp in the right nasal cavity.     

Validation of the Thessaly test for detecting meniscal tears in anterior cruciate deficient knees

Meniscal injuries are frequently associated with anterior cruciate ligament (ACL) tears. Clinical tests that are useful for detecting meniscal tears may not be valid in this setting. The Thessaly test, a newly described dynamic clinical examination, has been shown to have a very high diagnostic accuracy for detecting meniscal tears. This study evaluates the accuracy of the Thessaly test in patients with combined ACL and meniscus injuries. We examined eighty patients with ACL deficiency for meniscal injuries using the Thessaly test (at 20° of knee flexion), the lateral and medial joint line tenderness tests, and the McMurray test. Examiners were blinded to the MRI report on the conditions of the menisci. All patients underwent arthroscopic ACL reconstruction during which the menisci were evaluated by direct vision and probing. During the Thessaly test, six patients developed severe pain and could not complete the test. Sensitivity, specificity, likelihood ratios and predictive values were calculated for all tests. The Thessaly test had a sensitivity of 79%, specificity of 40%, positive predictive value of 56%, negative predictive value of 66%, positive likelihood ratio of 1.33, negative likelihood ratio of 0.51%, and overall accuracy of 60%. We concluded that the Thesally test has a low specificity in patients with combined ACL and meniscal injuries and can not be recommended as a diagnostic test in this setting.     

Determining the effect of obstructive sleep apnea syndrome on peripheral vestibular system and hearing

There have been studies in the literature regarding the effect of obstructive sleep apnea syndrome on hearing function, but studies on the effect of obstructive sleep apnea syndrome on the peripheral vestibular system are limited. The aim of the present study was to determine whether obstructive sleep apnea syndrome causes functional neurological changes, particularly in the peripheral vestibular system, using the video head impulse test. Overall, 57 patients with obstructive sleep apnea syndrome were included; the ‘Snorers’ group comprised 20 volunteers diagnosed with simple snoring in the polysomnography test. The severity of apnea was assessed by monitoring cardiac and respiratory functions during sleep in both groups. The video head impulse test and audiological evaluations were performed in both groups. Statistically significant differences were found in the cochlea and semicircular canals of our patients in the video head impulse test and audiological battery tests. It may be assumed that decreased blood oxygen concentrations and chronic hypoxaemia have negative effects on the vestibule, cochlear sensory epithelium, and the auditory pathways. We think that inner ear structures and pathways may be affected due to hypoxia in obstructive sleep apnea syndrome. Therefore, screening patients with obstructive sleep apnea syndrome with an audiometry battery may help to detect inner ear pathologies early.