Prospective analysis of photokeratoscopy for arcuate keratotomy to reduce postkeratoplasty astigmatism

Seven eyes of seven patients with visually disabling postkeratoplasty astigmatism underwent arcuate keratotomy to reduce astigmatism. Keratotomy length was prospectively determined by comparing the corneal shape change needed by each patient with shape changes in cadaver eyes induced by arcuate keratotomy. Keratograph ring ovality quantified corneal shape change. Keratotomies were placed in the wound interface using a diamond knife with blade length set to 100% of corneal thickness. Prekeratotomy keratometric astigmatism was 9.27 +/- 2.14 D (mean +/- SD), and at 2.0 to 18.4 months after keratotomy, astigmatism was 2.75 +/- 2.25 D (mean +/- SD). All corneas had decreased keratometric astigmatism and less oval keratoscope rings. Five corneas had 3.00 D or less residual keratometric astigmatism. Change in ring ovality was significantly correlated with keratotomy length and keratometric astigmatism change. The utility of keratoscope ring ovality as a corneal topography metric was demonstrated by systematically investigating the response to arcuate keratotomy.     

Omega 3 fatty acids: biological activity and effects on human health

Polyunsaturated fatty acids (PUFAs) have an important role in human diet, both for the prevention and the therapy of different pathologies. In this review, a critical evaluation of PUFAs dietary sources and biological functions in human organism has been done. In particular, the efficacy of omega-3 fatty acids in the improvement of the lipidic pattern and in the excitability of myocardium has been analyzed, and, therefore, their usefulness in the prevention of cardiovascular diseases and postinfarction arrhythmias. As PUFAs are precursors of prostaglandins and leucotriens, which are involved in phlogosis and immune response, a diet rich in fish oil reduces the production of PGE2 involved in many phlogosis events. Moreover, an increase in the eicosapentaenoic acid (EPA) intake leads to a reduction in the production of inflammatory cytokines (interleukin 1, 2, 6 and tumor necrosis factor); so, it is important to use omega-3 in chronic inflammatory diseases, as the rheumatoid arthritis. It seems that omega-3 could prevent the onset of hormone-dependent tumours (i.e. breast and prostatic cancer); in vitro observations, in fact, have shown that the PG of the series 2, derived from omega-6, have a carcinogenic action; instead, the anticancer effect of omega-3 could derive from their effect in antagonizing the formation of such PG; it can be useful, therefore, to increase the dietary omega-3/omega-6 ratio. Moreover, the effects of omega-3 on the anatomic and functional central nervous system development and of their possible therapeutical use in some psychiatric pathologies were evaluated.     

Dupuytren's contracture: an update of biomolecular aspects and therapeutic perspectives

The so-called fibrogenic cytokines, able to induce the growth of fibroblasts and their differentiation into myofibroblasts and to stimulate their production of extracellular matrix, are involved in the genesis of Dupuytren's contracture. Although many studies have been made of biomolecular aspects of palmar fibromatosis, practical applications from them are still far from imminent because of the real difficulty of blocking their action in vivo, even in a chronic, progressive lesion such as Dupuytren's disease. Consequently, surgical excision of the palmar fascia still remains the treatment of choice.     

Dupuytren's contracture as result of prolonged administration of phenobarbital

Dupuytren's disease is a fibroproliferative condition involving the superficial palmar fascia, leading to a progressive and irreversible flexion of the fingers. In literature, there are different opinions regarding the phenobarbital, a common antiepileptic drug, and its effective role in the genesis and development of Dupuytren's disease. In this retrospective investigation the association between phenobarbital and Dupuytren's contracture is discussed. Three patients in treatment with phenobarbital who had no others significant risk factors for Dupuytren's contracture were included in this study. The disease occurred after one to four years of drug therapy, at dosage of 100 mg/day. After surgery, Dupuytren's disease showed different evolutions in relation to dosage and type of antiepileptic drug used. Phenobarbital causes a dose and time-dipendent profibrotic effect. A clinical regression was observed when phenobarbital was substituted by carbamazepine, maintaining the same dosage (100 mg/day). This data confirms that not all the antiepileptic drugs are implicated in palmar fibrosis, and suggests that, according to the efficacy and adverse effects, the administration of benzodiazepine reduces the risk of Dupuytren's recurrence.     

The "Jacobsen Flap" for the treatment of stages III-IV Dupuytren's disease: a review of 98 cases

The treatment of severe Dupuytren's disease of the little finger is controversial: several techniques have been described with variable reported results and postoperative complications. This paper reviews 98 cases that underwent surgery between 2001 and 2006 using the Jacobsen flap procedure, a modification of the McCash technique. We found this technique relatively simple and it allowed significant correction of the contracture, with a low rate of complication. We believe this is an excellent alternative to dermofasciectomy or amputation.     

A phase 1 study of adoptive transfer of autologous CD8+ T lymphocytes in patients with acquired immunodeficiency syndrome (AIDS)-related complex or AIDS

Based on preclinical studies showing that CD8+ T lymphocytes of human immunodeficiency syndrome (HIV)-infected subjects have anti-HIV activities, a phase 1 study was undertaken to determine the safety and feasibility of infusing in vitro purified, activated, and expanded CD8+ cells as a therapeutic measure in seven patients with acquired immunodeficiency syndrome (AIDS)-related complex (ARC) or AIDS. Autologous CD8+ cells were first selectively isolated in monoclonal antibody-coated flasks from peripheral blood mononuclear cells recovered by leukapheresis. They were then cultured and expanded with phytohemagglutinin and recombinant interleukin-2 (rIL-2) before infusion. Five cycles of isolations and infusions of increasing numbers of CD8+ T cells were achieved in five of seven subjects. Five cycles could not be completed in two subjects with AIDS whose CD4+ cell counts were < or = 48/microliters. Infusions of CD8+ cells alone were well tolerated. Four patients received rIL-2 by continuous infusion for 5 days with their final cycle of CD8+ cells. All developed reversible adverse effects attributable to rIL-2. After infusion, 111In-labeled CD8+ cells quickly accumulated in the lungs, with less than 10% of the labeled cells remaining in the circulation. After 24 hours, labeled CD8+ cells were reduced in the lungs, but increased and persisted in liver, spleen, and bone marrow. Four of five patients who were treated with multiple infusions of CD8+ cells have improved or remained clinically stable, and the fifth developed Pneumocystis carinii pneumonia but recovered. This study demonstrated that infusion of autologous, in vitro expanded and activated CD8+ cells was feasible and clinically well tolerated in five of seven subjects with advanced HIV infections.     

Elbow arthroscopy in stiff elbow

Purpose

The purpose of this study was to evaluate and review the functional outcomes after arthroscopic surgery in post-traumatic and degenerative elbow contractures.

Methods

Between 2004 and 2008, 243 patients with post-traumatic or degenerative elbow stiffness were treated with arthroscopic surgery. A total of 212 patients were reviewed at an average of 58 months follow-up (SD ± 17.3). The patients were divided into two groups: group A with post-traumatic stiffness, and group B with degenerative stiffness. Arthroscopic procedures performed included: synovectomy, debridement of osteophytes, removal of loose bodies, anterior and posterior capsulectomy, radial head excision. Ulnar nerve neurolysis was usually performed. The following data were recorded and analysed: sex, age, paraesthesia, previous surgical treatment and complications. Patient outcome was assessed pre- and post-operatively by a visual analogue scale and by the Mayo Elbow Performance Index (MEPI), which assesses pain, ROM, stability and function.

Results

The total average ROM improved by 33° in group A and 20° in Group B. The MEPI improved from 60 to 81 in group A, and from 65 to 91 in group B.

Conclusions

Arthroscopic surgery in post-traumatic and degenerative elbow contractures can be considered a safe, useful, with a long learning curve procedure that offers important improvement of the ROM decreasing surgical morbidity.

Level of evidence

IV.     

Markers of airway inflammation in primary ciliary dyskinesia studied using exhaled breath condensate

Macroscopically, the airways in primary ciliary dyskinesia (PCD) are inflamed and infected, and the eventual result is bronchiectasis. The measurement of noninvasive markers of inflammation in PCD may allow determination of mechanisms of tissue damage, and even allow monitoring of therapy. The aim of this study was to measure in exhaled breath condensate (EBC) of children with PCD the concentrations of the neutrophil chemoattractants leukotriene (LT) B4 and interleukin (IL)-8 and the marker of oxidative stress 8-isoprostane (8-IP), and to try determining whether these markers can be used to assess mechanisms of airway inflammation in these patients. Concentrations of LTB4, IL-8, and 8-IP in the EBC of 23 PCD and 11 age-matched healthy children were measured using an enzyme immunoassay (EIA). The children also performed spirometry and underwent sputum induction, the latter for differential cell count. The concentrations of 8-IP in EBC of children with stable PCD were significantly increased compared to normal controls (median, 7.8 pg/ml vs. 3.1 pg/ml; P = 0.004). There was no difference in the median concentrations of EBC LTB4 between PCD subjects and healthy controls (28 pg/ml vs. 28 pg/ml; P = 0.5). IL-8 levels were below the detection limit of the assay, and were not analyzed further. There was no correlation between concentrations of either 8-IP or LTB(4) in EBC and forced expired volume in 1 sec in PCD children. Sputum induction was successful in 83% of the subjects; the median induced sputum neutrophil count was 69% (interquartile range, 59.3-73.6). No significant correlation was found between sputum neutrophils and either EBC 8-IP or LTB4 concentrations in PCD children. This study showed that oxidative stress, as reflected by increased exhaled 8-IP concentration, is increased in PCD children. The mechanism of airway neutrophilia is unclear, but is unlikely to be related to increased production of LTB4, at least in stable PCD patients.