Relaxing retinotomies. Analysis of anatomic and visual results

The authors analyzed 100 consecutive eyes undergoing relaxing retinotomies to determine the anatomic and visual results associated with the use of this procedure. With a minimum follow-up of 6 months, 58 eyes were completely attached, 8 were partially attached (macula on), and 34 were detached. Thirty-four percent of all eyes and 50% of attached eyes obtained a visual acuity of 5/200 or greater at 6 months. At last examination, 29% of all eyes and 43% of attached eyes had a visual acuity of at least 5/200. Eyes that had circumferential relaxing retinotomies involving the entire temporal quadrant generally had lower visual acuities when compared with eyes that had relaxing retinotomies sparing the entire temporal quadrant. The use of a radial relaxing retinotomy also was associated with lower final visual acuity. The length of the relaxing retinotomy or the placement of the relaxing retinotomy either anterior or posterior to the encircling scleral buckle did not appear to influence the anatomic or visual results. Hypotony (intraocular pressure less than 5 mmHg) was seen in 43% of reattached eyes.     

Neoadjuvant chemotherapy in invasive bladder cancer: the evolving role of surgery

The role of an operation in patients receiving neoadjuvant chemotherapy for clinically localized but invasive transitional cell carcinoma of the bladder currently is evolving. An operation is essential for case selection and evaluation of local response but it also contributes to bladder preservation and survival. The procedure that is necessary to select for and assess response to chemotherapy may itself alter the actual or proceed to evolution of invasive bladder cancer. Neoadjuvant chemotherapy is a reasonable therapeutic strategy in selected patients but it remains to be seen whether the results will prove to be superior to those achieved with standard endoscopic and open operations.     

Bone disease in primary biliary cirrhosis: Lack of association with distal renal tubular acidosis

Background and Aims: Primary biliary cirrhosis (PBC) might be complicated by osteoporosis, whose etiology remains unknown but seems to be multifactorial. Prevalence rates of 30% to 60% for distal renal tubular acidosis (DRTA) have been reported in PBC patients, generally as incomplete DRTA. Although it is undisputed that a reduced bone mineral density (BMD) is the expected outcome among patients who have been suffering from longstanding chronic metabolic acidosis, it is unclear if incomplete DRTA is also associated with metabolic bone disease in PBC patients. The present study was undertaken to compare the BMD of PBC patients with and without DRTA.
Methods: The BMD of 23 PBC patients (11 with DRTA and 12 without), all with normal clearance of creatinine, was assessed by dual energy radiograph absorptiometry. The diagnosis of DRTA was made if the urine pH was above 5.4 in all samples after the oral acid overload, showing tubular inability to acidify urine in the presence of test-induced systemic metabolic acidosis.
Results: Densitometric signs of osteoporosis were found in 82% of DRTA cases and in 83% of patients without DRTA (difference not significant). There were no significant differences in BMD measurement, T and Z scores of patients with and without DRTA.
Conclusions: The present study could not support a correlation between the presence of DRTA and the bone loss observed in PBC patients.     

125iodine reimplantation for locally progressive prostatic carcinoma

We treated 13 patients with a second 125iodine implant for local recurrence of prostatic carcinoma. All patients had biopsy proved palpable recurrence without evidence of distant metastases. Full doses of irradiation were used (median matched peripheral dose 170 Gy.). Six patients had complete regression of palpable recurrence, 2 had partial regression, 2 had no apparent response and 3 were unevaluable for local response. Actuarial freedom from local disease progression at 5 years was 51%. Despite a relatively high rate of local disease control the actuarial rate of distant metastases reached 100% at 6 years after reimplantation. There were 2 severe rectal complications and 4 instances of mild to moderate urinary incontinence among the 13 patients. Local regression of recurrent prostatic carcinoma may be achieved with 125iodine reimplantation but most patients still had distant metastases.     

Evidence of alkaline phosphatase interference in a zidovudine radioimmunoassay.

Phosphorylated zidovudine (ZDV) concentrations may provide a link between drug exposure and clinical efficacy since these would include the active, intracellular form of the drug, ZDV triphosphate. Many groups are investigating the optimal methodology that can be used to accomplish this goal. The initial purpose of the present studies was to examine the effect of the inclusion of cell wash steps on the quantitation of intracellular ZDV. Ten milliliters of whole blood collected from healthy volunteers was spiked with increasing ZDV concentrations (0.187, 0.375, 1.87, and 3.75 microM), allowed to equilibrate at room temperature for 1 h, and separated into whole-blood components by a density gradient procedure. A mononuclear cell pellet was obtained, reconstituted with 2 ml of phosphate-buffered saline (PBS), and split into two aliquots, one of which was not washed at all and the other of which was washed four times with 1 ml of PBS. All samples were analyzed by ZDV radioimmunoassay (RIA) after a 1:1 dilution with either 1 mg of alkaline phosphatase (type 1-S; Sigma) per ml or PBS. Parent ZDV was measured in those samples which were not treated with the enzyme, while total ZDV was measured in those samples which were exposed to alkaline phosphatase (21 degrees C for 1 h). The result of the difference between the two samples is total phosphorylated ZDV. During the experiment, evidence of alkaline phosphatase interference with the RIA became apparent, confusing interpretation of intracellular ZDV concentrations. This evidence was based on three sets of data. First, wash samples showed increases in ZDV concentrations of as great as 0.127 microgramM after exposure to alkaline phosphatase, even though on microscopic inspection the wash samples were acellular. Second, the sum of total ZDV recovered from the four wash samples plus the washed cell pellet was as much as 14-fold greater than the total ZDV measured in the unwashed cell pellet. Theoretically, at least, these two entities should be equal. Finally, control samples of alkaline phosphatase in PBS (0.5 mg/ml) run directly through the assay measured false ZDV levels ranging from 0.002 to 0.075 microgramM (0.6 to 20 ng/ml). Alkaline phosphatase is frequently used to measure phosphorylated anabolites of ZDV in peripheral blood mononuclear cells. These data show that the particular form of alkaline phosphatase used may interfere with the ZDV RIA and may confuse the interpretation of phosphorylated anabolite concentrations of ZDV.