Risk factors for poor visual outcome in traumatic hyphema: Jakarta eye trauma study

Objective

: To report the risk factors for poor visual outcome in traumatic hyphema.

Materials and Methods

A retrospective study was done by collecting data from medical records between January 2011 and December 2015 in Jakarta, Indonesia. Clinical data included initial visual acuity (IVA), final VA at 3 months, slit lamp evaluation with grading of hyphema, intraocular pressure, and fundus findings on direct or indirect ophthalmoscopy.

Results

The study included 97 patients, with males showing a preponderance, the ratio being 9:1. Soft gun pellet was the most common cause (27.8%), others being workplace injuries (12.4%), sports injury (14.4%), traffic accident (2.1%), and other injuries (43.3%). Poor visual outcome was due to vitreous hemorrhage, cataract, iridodialysis, and choroidal rupture. On statistical analysis, significant risk factors were causality (P = 0.018), IVA (P = 0.026), onset of injury (0.000), and grade of hyphema (P = 0.000).

Conclusion

Grade of hyphema, IVA, causality, and onset of injury were significant risk factors related to poor visual outcome in traumatic hyphema.

Structural, electrical, electronic and optical properties of melanin films

We present thick, uniform and rather flat melanin films obtained using spray deposition. The morphology of the films was investigated using Scanning Electron Microscopy (SEM) and Atomic Force Microscopy (AFM). Temperature-dependent electrical resistance of melanin thin films evidenced a semiconductor-like character and a hysteretic behavior linked to an irreversible process of water molecule desorption from the melanin film. X-ray Photoelectron Spectroscopy (XPS) was carried out to analyze the role of the functional groups in the primary and secondary structure of the macromolecule, showing that the contribution of the 5,6-dihydroxyindole-2-carboxylic acid (DHICA) subunit to the molecule is about 35%. Comparison of the optical absorption of the thick (800nm) and thin (80nm) films showed a spectral change when the thickness increases. From in vacuum photoconductivity (PC) measured at controlled temperatures, we suggest that the melanin films exhibit a possible charge transport mechanism by means of delocalized pi states along the stacked planar secondary structure.

Prediction of functional capacity by low-dose dobutamine stress echocardiography in chronic heart failure

AIM

The aim of this study was to determine if low-dose dobutamine stress echocardiography (LD-DSE) is associated with functional capacity in unselected elderly patients with chronic heart failure.

METHODS

This was a prospective trial. Thirty five consecutive patients were included, with age >65 years and left ventricular dysfunction (12 ischemic), by blindly assessed LD-DSE and cardiopulmonary exercise testing (CPT). Contractile reserve was defined as a change (D) in wall motion score index (WMSI) = or <0.2 at peak dose dobutamine. At CPT treadmill exercise time, peak VO2, %Vo2 and VE/VCO2 slope were determined. Preserved functional capacity was defined as percent of maximal predicted O2 consumption (%VO2) >80%. Baseline NT-proBNP plasma levels were assessed.

RESULTS

CPT variables were not related to clinical and baseline echocardiography characteristics but were related to DWMSI (exercise time, P=0.004; peak VO2, P=0.008; %VO2, P<0.001; VE/Vco2, P<0.001). Contractile reserve was present in 16 of 17 patients with preserved functional capacity (sensitivity=94%) and in 2 of 13 patients without (specificity=85%). Baseline NT-proBNP levels were lower in patients with contractile reserve (476+/-365 pg/mL) than in those without (1 345+/-1 219 pg/mL) (P=0.019), but were mildly related to CPT variables (P=0.049 and 0.027 with exercise time and %VO2, respectively).

CONCLUSION

Contractile reserve elicited at LD-DSE is associated with functional capacity in unselected elderly patients with chronic heart failure.

Assessment of left ventricular systolic dysfunction by tissue Doppler imaging to detect subclinical cardiomyopathy early after anthracycline therapy

AIM

Anthracycline (ANT) chemotherapy for breast cancer, while associated with high response rates, is fraught by risks of irreversible cardiotoxicity. Unfortunately means to detect such cardiotoxicity early on and at a sublinical stage are lacking. We evaluated the role of systolic tissue Doppler imaging (TDI) in appraising postchemotherapy left ventricular (LV) remodelling.

METHODS

Patients undergoing ANT-chemotherapy for breast cancer were enrolled, and underwent baseline and >6-months echocardiography (standard and TDI). According to the pattern of LV-TDI systolic remodelling from baseline to follow-up, patients were stratified in: group 1 (no LV-TDI worsening), group 2 (minor LV-TDI worsening), and group 3 (major LV-TDI worsening). Fifty-six patients were included (follow-up 9+/-6 months).

RESULTS

At baseline, no patient had abnormal LV ejection fraction (LVEF), LV-TDI systolic dysfunction or New York Heart Association (NYHA) >1. Follow-up overall analysis showed significant deterioration in LVEF, end-diastolic diameter (EDD) end-systolic diameter (ESD), and TDI-systolic parameters (all P<0.05). Specifically, 29 (51.8%) patients showed no adverse LV-TDI systolic remodelling, while 17 (30.4%) were in group 2, and 10 (17.9%) in group 3. All groups shared similar conditions at baseline. Patients with adverse LV-TDI remodelling had significant increases in EDD and ESD, as well as a significantly decreased LVEF (all P<0.05). No patient in group 1 had abnormal LVEF at follow-up, while 1 patient in group 2 and 2 patients in group 3 had abnormal LVEF (P<0.05).

CONCLUSION

Subclinical systolic dysfunction occurs in almost 50% of patients early after chemotherapy for breast cancer, with a more adverse by LV-TDI remodelling implying a more pronounced deterioration of standard echocardiographic parameters.

[Cardiorespiratory fitness and arterial stiffness in sedentary and not sedentary hypertensive workers]

In hypertensive subjects, arterial stiffness and arterial wave early reflection are thought to be the major factor limiting cardiac reserve and exercise capacity. Aortic augmentation index (AIx) is a measure of arterial wave reflection and stiffness, and has been associated with decreased cardiorespiratory fitness. We investigated the role of physical activity at work and its effect on such association. 25 hypertensive middle-aged workers, without history of diabetes, cardiovascular disease, renal failure and inflammatory diseases, were studied. Our study confirms that AIx provides information for the prediction of VO2 peak, being also gained with a non-invasive and practical test. Inside the two groups of sedentary and non sedentary workers, the relation between AIx and VO2 peak is still significant; whereas the non sedentary group showed a worse cardiorespiratory fitness without significantly differences in arterial stiffness.

Dipyridamole stress echocardiography vs dipyridamole sestamibi scintigraphy for diagnosing coronary artery disease in left bundle-branch block

STUDY OBJECTIVES

To evaluate dipyridamole stress echocardiography (DSE) for predicting coronary artery diseases (CADs) in patients with complete left bundle-branch block (LBBB).

DESIGN

Comparison of DSE and dipyridamole sestamibi myocardial perfusion scintigraphy (sestamibi).

SETTING

Tertiary-care cardiac referral center.

PATIENTS

Fifty-four consecutive patients (26 men; mean [+/- SD] age, 59 +/- 7 years) with complete LBBB (14 patients with left ventricular [LV] dilatation) and intermediate probability of CAD.

METHODS

Simultaneous single photon emission CT scan (20 mCi technetium Tc 99m stress/rest sestamibi) and echocardiography (second harmonic imaging) during a two-step (0.56 to 0.84 mg/kg) dipyridamole infusion protocol. Two sestamibi readings were performed. The first reading considered only those studies with reversible defects (sestamibi-1) to be positive. The second reading considered those studies with any defect (sestamibi-2) to be positive. CAD was defined as a >or= 50% reduction in diameter in at least one major vessel seen on coronary angiography.

RESULTS

CAD was present in 17 patients (31.5%). The global predictive accuracy for CAD was significantly higher for DSE (87.0%) and sestamibi-1 (79.6%) than for sestamibi-2 (57.4%) [p < 0.01 vs DSE; p < 0.05 vs sestamibi-1]. No significant differences in sensitivity were present, but specificity was significantly higher for DSE (94.6%) and sestamibi-1 (81.1%) than for sestamibi-2 (43.2%; p < 0.01 vs both the other two tests). Of 14 patients with LV dilatation, 26.8% were falsely positive for CAD (in some cases for posterior defects) as determined by sestamibi-1 and 64.3% were falsely positive for CAD by sestamibi-2 vs none by DSE.

CONCLUSIONS

DSE is at least as accurate as dipyridamole sestamibi scintigraphy for predicting CAD in patients with complete LBBB and tends to be more specific in those patients with underlying LV dilatation.

Neuroadrenergic activation and response to dobutamine in congestive heart failure secondary to idiopathic dilated cardiomyopathy

Detection of contractile reserve is important in heart failure patients. To determine if detection of contractile reserve is influenced by neuroadrenergic activation, we examined the relation between dobutamine stress echocardiography (DSE) findings and plasma norepinephrine levels (NE) at rest in 35 patients with nonischemic left ventricular (LV) dysfunction (New York Heart Association class >III in all; LV ejection fraction 0.27 +/- 0.5). Changes in global wall motion score (WMS), and separately in WMS of hypokinetic segments and akinetic segments, were analyzed. A patient was considered to be responsive to dobutamine if the change in global WMS was >/=4. Twenty-three patients were responsive and 12 were not responsive to dobutamine. Plasma NE and baseline heart rate were significantly higher in nonresponsive patients (p <0.001). Changes in global WMS and in hypokinetic segment WMS were inversely related to either plasma NE (r -0.68 and -0.67, respectively) or baseline heart rate (r -0.60 and -0.66, respectively). The change in akinetic segment WMS was related to plasma NE only (r -0.50). Changes in WMS were not related to age, diastolic and systolic LV volume, baseline global WMS, or number of akinetic segments at baseline. Plasma NE >602 pg/ml predicted a blunted or absent contractile reserve at DSE (sensitivity 92%; specificity 87%). Neuroadrenergic activation may influence contractile reserve found at DSE in patients with heart failure due to nonischemic LV dysfunction.

Echocardiographic imaging in coronary artery disease: new techniques

When analyzing left ventricular wall motion and thickening, two-dimensional echocardiography (2DE) represents a useful non-invasive tool for diagnosing and stratifying ischemic heart disease. New important technical advancements, such as harmonic imaging, allow to overcome limitations due to poor echocardiographic image quality in a large proportion of patients. Combination of exercise or pharmacological stress test with on-line echo images monitoring expands 2DE diagnostic and prognostic value in both ischemia or viability assessment. Study of contrast agents distribution is very promising for clarifying the complex interaction between myocardial perfusion and functional correlates, including myocardial stunning, hibernation and no-reflow phenomena. Direct visualization of epicardial coronary arteries and assessment of coronary artery blood flow has recently been demonstrated to be possible by either transthoracic (TTE) or transesophageal echocardiography (TEE). Acoustic quantification (AQ), automatic border detection (ABD), tissue Doppler imaging (TDI), and color kinesis are other technical modalities which may result to be useful for clinical evaluation of patients with either acute or chronic coronary syndromes.

Prognostic role of heart rate variability in patients with a recent acute myocardial infarction

A low heart rate variability (HRV) has been shown to be a powerful predictor of cardiac events in patients surviving an acute myocardial infarction (MI), but it is not clear yet which among the HRV parameters has the best predictive value. Time domain and frequency domain HRV was assessed on 24-hour predischarge Holter recording of 239 patients with a recent MI. Patients were followed up for 6 to 54 months (median 28), during which 26 deaths (11%) occurred, 19 of which were cardiac in origin and 12 were sudden. Most HRVs did not show any difference between patients with or without mortality end points, but the average low-frequency and low-frequency/high-frequency ratio was lower in patients with events. However, when dichotomized according to cut points that maximized the risk of sudden death, several HRVs were significantly predictive of clinical end points. Overall, the mean of the standard deviations of all RR intervals for all 5-minute segments and the standard deviation of the mean RR intervals for all 5-minute segments were the time domain variables most significantly associated with mortality end points, whereas very low frequency was the most predictive frequency domain variable. Compared with the best time domain variables, very low frequency showed a better sensitivity (0.27 to 0.42 vs 0.19 to 0.33) for end points with only a small loss in specificity (0.92 vs 0.96). On multivariate Cox proportional analysis, a left ventricular ejection fraction <40% and a number of ventricular premature beats > or = 10/hour were the most powerful independent predictors for all end points, whereas no HRV was independently associated with the events. A low frequency/high frequency ratio < 1.05 only had a borderline association with sudden death (RR = 2.86, p = 0.076). Our data show a strong association between HRV and mortality in patients surviving a recent MI, with a slight better sensitivity of frequency domain analysis. In our study, however, HRV did not add independent prognostic information to more classic prognostic variables (e.g., left ventricular function and ventricular arrhythmias).

A phase I study of human natural interferon-beta in cancer patients

In this phase I study 15 patients with metastatic tumors were given interferon (IFN)-beta by i.v. bolus injections. Twelve individual doses of 1, 2, 3.3, 5, 7, 9, 12, 16, 21, 27, 35, and 46 x 10(6) IU were administered every other day. The single maximal tolerated dose ranged from 9 to 46 x 10(6) IU. Eight patients tolerated the dose of 46 x 10(6) IU without side effects. Disturbances of cardiac rhythm were observed, but were closely related temporally to severe chills and appeared to be the consequence of adrenergic stimulation associated with this side-effect. In addition, no significant variations in the left ventricular function as assessed by nuclear stethoscope were observed. Neurotoxicity was not a major side-effect. The toxicity of IFN-beta given as scheduled in this study was significant, but acceptable.

[Contribution to study of plasmocytomas of the upper respiratory tract. 3 cases (author's transl)]

The authors studied the solitary plasmocytoma, since it would appear to pose a triple problem: diagnostic, prognostic and therapeutic. 1. From a diagnostic standpoint, histological interpretation, even by experienced histopathologists would appear to be extremely difficult since study of the course showed that in a significant number of cases a carcinoma develops, indicating that the previous diagnosis was erroneous. 2. From a prognostic standpoint, the course would appear to be extremely variable in terms of survival, this being described in both the French as well as the American literature. However, there is a wide variation in differential statistical studies with regard to mean survival periods. 3. Finally, there is a wide range of opinions concerning therapy. Certain authors adopt a surgical approach only, whilst others use radiotherapy only. Few use a combination of radiotherapy and surgery even though this would appear to be logical since it falls in line with the standard attitude of oncologists concerning solid tumours. Rather than draw any conclusions, it would appear to be desirable to follow up this study with an adequate statistical number in order to define an overall position from both a prognostic as well as therapeutic standpoint.

[Rupture of the fenestra cochleae of traumatic origin during diving with apnea (author's transl)]

Value of rapid surgical exploration after ear trauma during under water diving in apnea. The concept of a post-surgical fistula was perfect from both a cochlear as well as a vestibular standpoint with maintenance of results after 2 years, under water activity having been authorized after a test in a hyperbaric chamber.

[Salivary myasis (author's transl)]

Myasis is due to parasitic infestation of the human body by the larvae of brachycere diptera commonly known as maggots. The particular case is described on an anecdotal basis, since the practising ENT specialist may bear the diagnosis in mind, in particular if the patient comes from an area of proximity to a breeding establishment. The interest of the present publication thus lies in the need to bear the diagnosis in mind, since the key is essentially a request for a serological examination. Treatment consists of simple and careful surgical removal of the lesions. The best treatment is prophylactic, by destruction of the insect by organic phosphorous insecticides on the skin of animals.

[Ewing's papillomatosis. 3 cases (author's transl)]

The authors describe 3 clinical cases of Ewing's papilloma. The first presented with unilateral epistaxis related to a tumour implanted on the nasal septum. This was widely resected under general anesthesia. Ten years later there has been no recurrence. The second case began with nasal obstruction due to the presence of Ewing's papillomatosis in the posterior part of the right nasal fossa with marked dysplastic changes leading to a wide surgical operation by lateral rhinotomy, revealing a second process, a cavernous hemangioma. Such a combination had never been described. Finally, the third case of Ewing's papilloma began with sinusitis with polyps, which were removed in a first stage, but a second wide excision was necessary as a result of recurrence. The histological and clinical characteristics of Ewing's papilloma are reviewed.

[Malignant melanoma of the nasal fossae with a course of more than 8 years (author's transl)]

Two important points are emphasized:--1 to 2% of tumours of the nasal fossae are melanomas.--40% of melanomas of the cervico-facial region are situated in the nasal fossae. This case was felt worthy of publication, its course being remarkable by virtue of its duration:--9 years. In addition, the various therapeutic procedures were not followed by the classical acute exacerbations. These enabled this patient to have a virtually normal life for an extremely long period.

[Neuroma of the larynx. One case (author's transl)]

Neuroma of the larynx is an isolated nerve tissue tumour in the majority of cases. Such tumours are relatively infrequent in the ENT area, but become extremely rare with regard to a laryngeal site. The present case is reported for its statistical interest. The present case is reported for its statistical interest. From a therapeutic standpoint, the authors share the general attitude that the treatment of a solitary neuroma is surgical, but that wide excision at the outset is essential, as demonstrated by this case which revealed that limited operation proved to be inadequate and that is was finally necessary to perform a total laryngectomy, which at first sight appears to be somewhat radical for a theoretically benign tumour.