Nursing care of the cataract patient: today's outpatient approach.

Total cataract patient care encompasses nursing assessment, clinical management, emotional support, and the accessibility of the nurse to the patient. Because ophthalmic nurses develop a close relationship with the cataract patient, they are often the first health care professional the patient calls for advice. Patient education and adequate time to listen and respond are integral components in an outpatient cataract surgical approach. All aspects of the nursing care of the cataract patient provide challenge and satisfaction as the ophthalmic registered nurse experiences surgery with the patient and supervises the return to improved vision and quality of life. The nurse must always remember that there is a whole person attached to the eye. Although ophthalmic nursing is specialized and highly technical, patience, empathy, and encouragement are essential in the care of the patient before, during, and after cataract surgery.     

Experimental pneumococcal meningitis: impaired clearance of bacteria from the blood due to increased apoptosis in the spleen in Bcl-2-deficient mice

Necrotic and apoptotic neuronal cell death can be found in pneumococcal meningitis. We investigated the role of Bcl-2 as an antiapoptotic gene product in pneumococcal meningitis using Bcl-2 knockout (Bcl-2(-/-)) mice. By using a model of pneumococcal meningitis induced by intracerebral infection, Bcl-2-deficient mice and control littermates were assessed by clinical score and a tight rope test at 0, 12, 24, 32, and 36 h after infection. Then mice were sacrificed, the bacterial titers in blood, spleen, and cerebellar homogenates were determined, and the brain and spleen were evaluated histologically. The Bcl-2-deficient mice developed more severe clinical illness, and there were significant differences in the clinical score at 24, 32, and 36 h and in the tight rope test at 12 and 32 h. The bacterial titers in the blood were greater in Bcl-2-deficient mice than in the controls (7.46 +/- 1.93 log CFU/ml versus 5.16 +/- 0.96 log CFU/ml [mean +/- standard deviation]; P < 0.01). Neuronal damage was most prominent in the hippocampal formation, but there were no significant differences between groups. In situ tailing revealed only a few apoptotic neurons in the brain. In the spleen, however, there were significantly more apoptotic leukocytes in Bcl-2-deficient mice than in controls (5,148 +/- 3,406 leukocytes/mm2 versus 1,070 +/- 395 leukocytes/mm2; P < 0.005). Bcl-2 appears to counteract sepsis-induced apoptosis of splenic lymphocytes, thereby enhancing clearance of bacteria from the blood.     

Impact of antiangiogenic treatment on the erectile function in patients with advanced renal cell carcinoma

We longitudinally assessed erectile function as well as the willingness to use pro-erectile treatment in a cohort on AAT for advanced RCC. Thirty-seven patients with advanced RCC completed the five-item version of the International Index of Erectile Function (IIEF-5) and other interview items before (T0) and 12 weeks into therapy (T12) with AAT. Patients were further asked if they were willing to use and pay out-of-pocket for on-demand treatment with phosphodiesterase-5-inhibitors (PDE-5i). Statistical analysis was performed using nonparametric hypothesis testing. The IIEF-5 score at T12 was significantly decreased compared with T0 (p < .001). Subjective patient satisfaction regarding their sexual lives was associated with higher IIEF-5 scores at both time points (p = .006 and p = .03, respectively). At T12, subjective sexual contentment showed a nonsignificant trend towards decline (p = .074). Patients who opted for medical treatment of ED showed significantly better IIEF-5 scores at both time points compared with the rest of the cohort (p < .001 and p = .005, respectively). In summary, AAT seems to have a negative effect on erectile function in RCC patients, however, the role of psychosocial issues warrants further elucidation. Affected patients may benefit from a proactive approach promoting medical treatment of erectile dysfunction during AAT.     

Strabismus and diplopia as complications after cataract surgery with IOL implantation

Summary In our Department of Orthoptics we have seen an increasing number of patients suffering from diplopia after cataract surgery with IOL implantation. Between 1993 and 1997 the total number of patients with this problem was 24 (2.7 % of all patients, mean age 71 years, age range 38–88). We addressed the question of whether there is a common pattern of motility dysfunction. Methods: After evaluation of the clinical history and the basic ophthalmological findings the following parameters were examined: binocular function (Bagolini test), squint angles (Maddox cross), ocular motility. Results: The 24 patients could be divided up into three groups. Group 1 consisted of 9 patients (mean age 82 years, range 64–88) who complained about diplopia because of strabismus incomitans with vertical deviation and restricted motility on the first day after surgery. In 8 of the 9 patients strabismus surgery was done. Group II consisted of 10 patients (mean age 66 years, range 38–77) who noticed diplopia and strabismus within 7 days after surgery. We found various kinds of heterotropia. Seven of these patients were operated on and two had a prism correction. Group III consisted of 5 patients (mean age 67 years, range 61–78). Their already known strabismus paralyticus or concomitans deteriorated, leading to diplopia in some cases. All patients in this group were operated on. Discussion: For group I we believe that retro-, para- or peribulbar anesthesia caused the motility dysfunction. In groups II and III it is unlikely that local anesthesia had a causative role. The prolonged disruption of binocular vision and the abrupt change in the sensory situation after the cataract operation with lens implantation may be the leading causes for strabismus or deterioration of a preexisting strabism, respectively. Conclusions: These patients need a subtil meticulous diagnostic work-up and follow-up because of the possibility of early surgical therapy, which has a good prognosis. Evaluation of binocular vision and eye movements prior to cataract surgery appears to be helpful for later strabismic surgery.      

Abdominal infections in patients with acute leukaemia: a prospective study applying ultrasonography and microbiology

A prospective study of 62 chemotherapy-induced neutropenic episodes in patients with acute leukaemia was conducted to determine the incidence and causes of abdominal infections, and to assess the diagnostic value of the combined use of ultrasonography (US) and microbiology. Each patient underwent US of liver, gallbladder and complete bowel before chemotherapy, on days 2-4 after the end of chemotherapy and in cases of fever, diarrhoea or abdominal pain. US was combined with a standardized clinical examination and a broad spectrum of microbiological investigations. From January to August 2001, 243 US examinations were performed. The overall incidence of abdominal infectious diseases was 17.7% (11 out of 62, 95% confidence interval (CI): 9-29%). Four patients (6.5%) developed neutropenic enterocolitis; two of them died, two survived. Bowel wall thickening (BWT) > 4 mm in these four patients ranged from 5.8 to 23.6 mm and was detected only in one patient with mucositis. In three other patients (4.8%) Clostridium difficile, and in one patient (1.6%) Campylobacter jejuni, caused enterocolitis without BWT. Cholecystitis was diagnosed in three patients (4.8%) and hepatic candidiasis was strongly suspected in one patient. Abdominal infections caused by gastroenteritis viruses, cytomegalovirus (CMV) or Cryptosporidium were not observed. We conclude that in neutropenic patients with acute leukaemia receiving chemotherapy: (i) BWT is not a feature of chemotherapy-induced mucositis and should therefore be considered as sign of infectious enterocolitis; (ii) viruses, classic bacterial enteric pathogens (Salmonella, Shigella, Yersinia, Campylobacter, Aeromonas, Vibrio subsp., enterohaemorrhagic Escherichia coli) and Cryptosporidium have a very low incidence; and (iii) abdominal infections may be underestimated when US is not used in every patient with abdominal pain.     

Combined anti-PD-1 and anti-CTLA-4 checkpoint blockade: Treatment of melanoma and immune mechanisms of action

Cytotoxic T-lymphocyte associated protein-4 (CTLA-4) and the Programmed Death Receptor 1 (PD-1) are immune checkpoint molecules that are well-established targets of antibody immunotherapies for the management of malignant melanoma. The monoclonal antibodies, Ipilimumab, Pembrolizumab, and Nivolumab, designed to interfere with T cell inhibitory signals to activate immune responses against tumors, were originally approved as monotherapy. Treatment with a combination of immune checkpoint inhibitors may improve outcomes compared to monotherapy in certain patient groups and these clinical benefits may be derived from unique immune mechanisms of action. However, treatment with checkpoint inhibitor combinations also present significant clinical challenges and increased rates of immune-related adverse events. In this review, we discuss the potential mechanisms attributed to single and combined checkpoint inhibitor immunotherapies and clinical experience with their use.     

Treatment outcomes after uncomplicated and complicated crown fractures in permanent teeth

Clinical Oral Investigations - The objectives of this retrospective clinical study were to describe characteristics of crown fractures in permanent teeth and to investigate the survival of pulp...