Corrigendum to "Going for a stroll on lurasidone: Considerations on an atypical case of acute compartment syndrome of both legs" [Heliyon 9(4) (April 2023) e15047]

[This corrects the article DOI: 10.1016/j.heliyon.2023.e15047.].

Going for a stroll on lurasidone: Considerations on an atypical case of acute compartment syndrome of both legs

Non-traumatic acute bilateral compartment syndrome is a rare condition that may lead to limb ischemia. We describe a case of this syndrome occurring after a five-kilometer walk in a young woman receiving chronic treatment with lurasidone, leading to a bilateral foot-drop and rhabdomyolysis of the anterolateral compartment of both legs. Due to her late presentation in the emergency department, we opted for a conservative approach, closely monitoring her renal function. We noticed a subsequent clinical and biochemical improvement over the following days, with the patient returning to her daily routine in a matter of weeks, despite a persisting bilateral foot drop. Since atypical antipsychotics are known to be associated with rhabdomyolysis, while possibly exerting a toxic effect on mitochondria, we hypothesize that a mild aerobic physical exertion might have triggered the event, in the context of an iatrogenic muscle susceptibility to oxidative distress.

The identification of pathogens associated with periprosthetic joint infection in two-stage revision

OBJECTIVE

Identification of periprosthetic joint infection (PJI)-related pathogens is crucial to decide what is the correct surgical strategies and the most secure timing to re-implant in case of two-stage revision. The purpose of the present study is to review the literature to identify the features of each exams which are used to identify the pathogens associated with PJI, to evaluate which are the most sensitive and specific and to set up an algorithm to decide when, in the field of two-stage revision, it's the ideal timing to re-implant.

MATERIALS AND METHODS

We did a systematic review of the literature to look for peer-reviewed papers of any evidence level focusing on: (1) Microbiological and molecular exams for identification of PJI-related pathogens. (2) Nuclear imaging methods, which can help in the identification of a PJI. Special attention was focused to analyse which is the sensitivity and specificity of these exams.

RESULTS

Overall, 64 manuscripts met the criteria of the systematic search at point 1 and 7 manuscripts at point 2. Among microbiological and molecular exams, the average of sensitivity and specificity were respectively 65.6% and 94.4% for cultural exams, 74.1% and 95.2% for molecular diagnosis and 86.9% and 96% for MicroDTTect. Among nuclear imaging methods, the average of sensitivity and specificity were respectively 94% and 69 % for three-phase bone scintigraphy and 100% and 62.5% for [18F] Fluoro-2-deoxyglucose-positron emission tomography/computed tomography.

CONCLUSIONS

In two-stage revision after PJI, taking into account the sensitivity and specificity values, just a few microbiological and molecular exams and nuclear imaging methods should be considered in the decision process to re-implant the components.

The basal to total insulin ratio in outpatients with diabetes on basal-bolus regimen

Objective

To evaluate the basal/total ratio of daily insulin dose (b/T) in outpatients with diabetes type 1 (DM1) and type 2 (DM2) on basal-bolus regimen, by investigating whether there is a relationship with HbA1c and episodes of hypoglycemia.

Methods

Multicentric, observational, cross-sectional study in Italy. Adult DM1 (n = 476) and DM2 (n = 541) outpatients, with eGFR >30 mL/min/1.73 m², on a basal-bolus regimen for at least six months, were recruited from 31 Italian Diabetes services between March and September 2016. Clinicaltrials.govID: NCT03489031.

Results

Total daily insulin dose was significantly higher in DM2 patients (52.3 ± 22.5 vs. 46 ± 20.9 U/day), but this difference disappeared when insulin doses were normalized for body weight. The b/T ratio was lower than 0.50 in both groups: 0.46 ± 0.14 in DM1 and 0.43 ± 0.15 in DM2 patients (p = 0.0011). The b/T was significantly higher in the patients taking metformin in both groups, and significantly different according to the type of basal insulin (Degludec, 0.48 in DM1 and 0.44 in DM2; Glargine, 0.44 in DM1 and 0.43 in DM2; Detemir, 0.45 in DM1 and 0.39 in DM2). The b/T ratio was not correlated in either group to HbA1c or incidence of hypoglycemia (<40 mg/dL, or requiring caregiver intervention, in the last three months). In the multivariate analysis, metformin use and age were independent predictors of the b/T ratio in both DM1 and DM2 patients, while the type of basal insulin was an independent predictor only in DM1.

Conclusion

The b/T ratio was independent of glycemic control and incidence of hypoglycemia.

Correction to: The basal to total insulin ratio in outpatients with diabetes on basal-bolus regimen

[This corrects the article DOI: 10.1007/s40200-018-0358-2.].

Two cases of colon LST in transplanted liver patients

Long-life immunosuppressive therapy increases the risk of de novo tumors in liver transplant recipients by decreasing the immune surveillance against malignant cells and oncogenic viruses. However, no cases of colon precancerous lesions have been reported in these subjects. Patient n. 1, a 73 yrs old male treated with calcineurin and purine synthesis inhibitors, showed at a per-protocol colono-scopy a 3 cm laterally spreading tumor (LST). Patient n. 2, a 73 yrs old male treated with calcineurin inhibitors, showed at a screening colonoscopy an LST occupying one third of the lumen circumference. Both subjects were asymptomatic, had been transplanted 14 years before, and in both cases, lesions showed severe dysplasia. LSTs represent 17.2% of advanced colorectal neoplasia (CRC) and risk factors are multifactorial. Immunosuppression may play a role which is however not completely understood. Based on this report, surveillance colonoscopy in liver transplanted patients should be considered.

Continuous intra jejunal infusion of levodopa-carbidopa intestinal gel by jejunal extension tube placement through percutaneous endoscopic gastrostomy for patients with advanced Parkinson's disease: a preliminary study

OBJECTIVE

Levodopa is the gold standard in the pharmacological treatment of Parkinson's disease (PD) and its oral administration is associated with the development of disabling motor and non-motor complications in advanced disease. Levodopa is rapidly metabolized and has a short plasma half-life thus requiring frequent, repeated dosing. Impaired gastric emptying is common in PD, and likely contributes to the unpredictable motor responses observed with orally-dosed levodopa. A new therapeutic protocol for patients with advanced PD include a carbidopa/levodopa combination using continuous, modulated enteral administration achieved inserting a Jejunal Extension Tube Placement through Percutaneous Endoscopic Gastrostomy (PEG-J). The aim of this work is to assess efficacy and safety of levodopa-carbidopa intestinal gel (LCIG) delivered continuously through an intrajejunal percutaneous tube (PEG-J).

PATIENTS AND METHODS

We enrolled 11 adults with advanced PD and preserved sensitivity to L-dopa. For pre-procedural endoscopic evaluation each patient underwent a diagnostic esophagogastroduodenoscopy (EGD) 7 days before PEG-J placement to evaluate the presence of gastric anatomical or wall anomalies and the presence of oesophageal or gastric varices. Treatment with LCIG, consisting of a water-based suspension containing micronized levodopa (20 mg/mL) and carbidopa (5 mg/mL) in methylcellulose (Duodopa®), was administered by continuous jejunal infusion for 12h/day using a portable pump (CADD-Legacy) by PEG-J. Clinical evaluations were performed at baseline (T0) before LCIG initiation, and after 3 (T3) and 6 (T6) months of therapy. The efficacy and safety outcomes were assessed by using the Unified Parkinson's Disease Rating Scale (UPDRS) parts II, III and IV.

RESULTS

Mean age of patients was 71.18 ± 5.4 SD at LCIG initiation. Out of the 11 patients, 2 (18%) dropped-out LCIG at T3. Patients showed statistically significant (p < 0.05) higher performances in activities of daily living and a statistically significant (p < 0.001) lower incidence and severity of motor fluctuations, as rating by UPDRS part IV, compared to their best oral therapy. During observational period, 5 patients experienced adverse events. Success rate for PEG-J placement was 100%.

CONCLUSIONS

Our work shows that continuous intrajejunal infusion of LCIG ensures a reduction in motor Fluctuations compared to oral administration of levodopa-carbidopa in advanced PD. Based on our results and on the evidence emerging in the literature, this therapeutic approach should be the gold standard for therapy in these patients.

Refractory gastric antral vascular ectasia: a new endoscopic approach

Gastric antral vascular ectasia (GAVE) is an uncommon disorder observed in patients with liver cirrhosis, causing upper gastro-intestinal haemorrhage. GAVE is diagnosed through esophagogastroduodenoscopy and is characterized by the presence of visible columns of red tortuous enlarged vessels along the longitudinal folds of the antrum (i.e., so-called watermelon stomach). Pharmacological, endoscopic and surgical approaches have been proposed for the treatment of GAVE. Endoscopy represents the gold standard for GAVE treatment. The most widely used endoscopic approach is represented by Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser. Argon plasma coagulation (APC) has been proven to be more efficient in terms of costs and complication rates than and equally effective as Nd:YAG. Other endoscopic procedures proposed for this treatment are banding ligature (EBL) and sclerotherapy with Polidocanol. Refractory GAVE represents a therapeutic challenge because it may cause persistent anemia, often leading to repeated blood transfusions due to the inefficacy of pharmacological and endoscopic therapeutic approaches. Endoscopic band ligation (EBL) has been shown to be superior to APC in the treatment of refractory GAVE. Surgical antrectomy by Billroth I anastomosis can be considered in selected cases. In this study, we report a successful endoscopic treatment of refractory GAVE by using a combination of submucosal injection of 1% Polidocanol at the four antral quadrants and subsequent application of APC on the visible antral lesions in two patients.

A facebook survey to obtain alcohol-related information by young people and adolescents. An Italian study

BACKGROUND

Alcohol consumption by adolescents and young adults is an issue of significant public concern. Internet-based Social Networking sites, such as Facebook, are potential avenues to reach young people easily.

OBJECTIVE

to underline the innovation in proposing surveys to collect health-related information regarding young people alcohol consumption and other substances abuse by using Social Networking Websites, particularly Facebook.

METHODS

A questionnaire investigating modalities of alcohol consumption, drinking patterns' risk behaviors and other substances abuse was proposed through a "Facebook event" to young Italian Facebook users aged between 16 and 32. Each Facebook user invited to the event was free to participate, to answer to the questionnaire and to invite his "Facebook friends".

RESULTS

During the 89 days of permanence on the Social Network, 1846 Facebook users participated the event and 732 of them decided spontaneously to answer the questionnaire. The frequency of answering was 8.2 people per day. About 200 users wrote a positive comment to the initiative on the wall of the event. Sixty% of subjects participating the survey were females. Ninety-one% of people answering the questionnaire were alcohol consumers. More than 50% of alcohol consumers were also smokers. Approximately 50% of subjects were binge drinkers. Illegal drugs were used by the 22.2% of the interviewed people.

CONCLUSIONS

Facebook resulted an efficient and rapid tool to reach young people from all over Italy and to propose surveys in order to investigate alcohol consumption and alcohol-related health problems in the youth.

Impression cytology with scanning electron microscopy: a new method in the study of conjunctival microvilli

PURPOSE

Recent studies used impression cytology with scanning electron microscopy (SEM) to study the conjunctival surface of bovine eyes and normal human eyes. The purpose of this study was to evaluate the use impression cytology and SEM (ICSEM) in patients affected by tear film abnormalities.

METHODS

Forty-five patients were divided into three groups according to mild, moderate or severe subjective sensation of dry eye. Fifteen asymptomatic subjects served as control group. In all patients the tear film was evaluated with break-up time (BUT), Schirmer's, and Ferning test, whereas conjunctival epithelium was evaluated with impression cytology and optic microscopy (ICOM), and ICSEM. The Spearman rank correlation test was used to compare the outcome of these examinations with the subjective sensation of dry eye in each group, and to identify correlations among the five tests.

RESULTS

ICSEM findings highly correlated with subjective dry eye sensation (Spearman correlation coefficient, 796; P<0.01). ICSEM revealed incipient epithelial damage (reduction or absence of microvilli) before the appearance of alterations of nucleus and cytoplasm of epithelial cells revealed by optic microscopy. The number of microvilli was correlated with the degree of tear film abnormalities and subjective sensation of dry eye (Spearman correlation coefficient, 796; P<0.01).

CONCLUSION

ICSEM was very effective in detecting the reduction in the number of microvilli. Therefore, it could represent an effective method to detect alterations in the conjunctival epithelium resulting from tear film damage even before the epithelial damage occurs and is detected by optic microscopy.

Ocular surface changes induced by topical application of latanoprost and timolol: a short-term study in glaucomatous patients with and without allergic conjunctivitis

BACKGROUND

This study evaluated the conjunctival effects of latanoprost and timolol, both of which contain benzalkonium chloride, in patients with primary open-angle glaucoma (POAG), with and without a history of allergic conjunctivitis (AC).

METHODS

Two groups of 25 patients with and without a positive history for AC were studied. After a 21-day wash-out period patients were randomized to 14 days treatment with latanoprost or with timolol, in a cross-over fashion. The following parameters were evaluated on days 0 and 14: number of white blood cells, ferning test, conjunctival impression cytology, subjective symptoms, and objective ocular changes.

RESULTS

Latanoprost caused: (a) an increase in eosinophils in both groups and reduction in lymphocytes only in the group with a history of AC; (b) alterations in ferning test and impression cytology only in AC patients; and (c) development of subjective symptoms and objective signs only in non-AC glaucomatous subjects. Timolol therapy was responsible only for the occurrence of subjective symptoms and objective signs in non-AC patients.

CONCLUSION

Latanoprost treatment induces ocular surface changes which are more evident in POAG patients who are also affected by AC. These findings are probably related to the very high latanoprost concentration of benzalkonium chloride and to its bedtime administration, which further amplifies the toxicity.

Anti-Fas (CD95/Apo-I) autoantibodies and soluble Fas levels concur in T cell depletion in HIV type 1 infection

Deregulation of the Fas/FasL pathway in activated T cells is suspected to contribute to the abnormal apoptosis that drives their progressive depletion during HIV-1 infection. However, the role of serum soluble Fas (sFas) is unclear. Here we investigated both sFas and anti-Fas IgG levels in a cohort of 227 HIV-1-infected patients with respect to their T cell apoptosis. By using optimized ELISAs, we found that serum titers of sFas and anti-Fas were linearly correlated in 17 severely lymphopenic subjects as compared with other patients grouped in relation to their single expression of anti-Fas and sFas, or with double-negative control patients. Cytofluorimetric measurement of the subdiploid DNA-containing cell population by both PI and TUNEL revealed an increased occurrence of cell death in vitro, in particular in patients with elevations of sFas. We also found that fresh CD4(+) cells from these patients showed high levels of both caspase 3 (CPP32) and its molecular targets, namely PARP and CK18. In addition, their in vitro proliferative rate was inhibited by sFas, in particular in patients with undetectable levels of the soluble receptor in vivo as well as in normal donors. In these subjects the Fas-related caspase 8 (FLICE) was significantly increased in cells treated with the recombinant Fas. These results support the contention that functionally exhausted T cells may undergo apoptosis in response to the persistent in vivo stimulation by sFas. This may elucidate the described occurrence of enhanced cell death in advanced HIV-1 infection in association with serum elevations of the soluble receptor.

Dendritic cells as a major source of macrophage-derived chemokine/CCL22 in vitro and in vivo

Macrophage-derived chemokine (MDC)/CCL22 is a CC chemokine active on dendritic cells (DC), NK cells and Th2 lymphocytes. The present study was aimed at comprehensively investigating MDC production in vitro and in vivo. DC were the most potent producers of MDC among leukocytes tested. Endothelial cells did not produce MDC under a variety of conditions. Signals that induce maturation (lipopolysaccharide, IL-1, TNF, CD40 ligand, recognition of bacteria and yeast) dramatically augmented MDC production, and dexamethasone and vitamin D3 blocked it. Prostaglandin E(2), which blocked the acquisition of IL-12 production and the capacity to promote Th1 generation, did not affect MDC production. Using mass spectrometry-based techniques, DC supernatants were found to contain N-terminally truncated forms of MDC [MDC(3-69), MDC(5-69) and MD(C7-69)] as well as the full-length molecule. In vivo, CD1a(+), CD83(+), MDC(+) DC were found in reactive lymph nodes, and in Langerhans' cell histiocytosis. Skin lesions of atopic dermatitis patients showed that CD1a(+) or CD1b(+) DC, and DC with a CD83(+) phenotype were responsible for MDC production in this Th2-oriented disorder. Thus, DC are the predominant source of MDC in vitro and in vivo under a variety of experimental and clinical conditions. Processing of MDC to MDC(3-69) and shorter forms which do not recognize CCR4 is likely to represent a feedback mechanism of negative regulation.

VEINCTR-N, an immunogenic epitope of Fas (CD95/Apo-I), and soluble Fas enhance T-cell apoptosis in vitro. II. Functional analysis and possible implications in HIV-1 disease

BACKGROUND

Recent studies indicate that soluble Fas (sFas) may modulate T-cell apoptosis, since it inhibits Fas-ligand (Fas-L)-mediated cytotoxicity in vitro. Here, we explored whether the soluble receptor and its major immunogenic domain, namely VEINCTR-N, interfered with apoptosis of T cells from human immunodeficiency virus-type 1 (HIV-1)+ subjects showing serum elevations of both the soluble receptor and anti-Fas antibodies, and with that of several T-cell lines.

MATERIALS AND METHODS

Both proliferation and apoptosis extent of T cells from 16 HIV-1+ patients showing serum anti-VEINCTR-N immunoglobulin G (IgG) and 15 controls were tested after incubation with sFas and three 8-mer peptides of its first consensus sequence that included VEINCTR-N. Several cell lines were also investigated by flow cytometry for their expression of Ki-67, the APO2.7-related mitochondrial protein, and the annexin-V. In addition, we evaluated the expression of Fas-L and caspases FLICE, CPP32 and ICE either by flow cytometry, immunoblotting, and/or reverse transcription polymerase chain reaction (RT-PCR).

RESULTS

Cell proliferation in cultures from both patients and controls was affected significantly by sFas and VEINCTR-N. However, a prevalent increase of the subdiploid DNA-containing cell population occurred within these cultures. Similarly, Jurkat, CEM cells, and a mouse WR19L transformant overexpressing native human Fas underwent prompt apoptosis, which was detected as enlargement of APO2.7-reactive and annexin-V-positive populations. By exploring the Fas pathway in Jurkat cells, we found that both apoptosis inducers acted through Fas, since Fas-L, as well as CPP32 and FLICE were activated. By contrast, ICE was up-regulated only in control cells treated with tumor necrosis factor alpha (TNFalpha).

CONCLUSIONS

These data suggest that the soluble molecular forms of Fas prime cell death in Fas-positive cells. Therefore, the shedding of high amounts of sFas in HIV- 1 disease is possibly entrusted with amplification of the death execution program by cells functionally exhausted and committed to die. It is conceivable that the appearance of anti-Fas antibodies reflects an attempt by the immune system to neutralize these effective forms of the receptor and its structurally degraded domains, such as VEINCTR-N.

Whipple's disease. Description of a case and survey of the literature

A case of Whipple's disease (WD) personally observed is described. A 28-year-old male was admitted to hospital for evaluation of weakness, intermittent fever and weight loss arisen since a month. On clinical investigation, he complained of vomit and diarrhea since three months. He had neither familial and personal past history of gastrointestinal diseases, nor any other important diseases. He denied use of drugs. Physical examination was negative. Laboratory findings showed anemia, low blood lymphocytes, low serum iron and total iron binding capacity, low total serum protein and low serum albumin and high level of ESR. Stool were negative for parasites and occult blood. Cultures of blood and urine were negative. Stool fat assay was > 7 g/24 h and D-xylose test showed a two-hour serum concentration < 25 mg/dl. Abdominal TC showed lumbo-aortic and mesenteric enlarged lymph nodes. An upper video endoscopy showed a duodenal lymphangectasia. Histological examination showed villar atrophy with massive infiltration of large PAS-positive diastase-resistant foamy cells. Ziehl-Nielsen staining was negative. WD was diagnosed and patient underwent therapy based on cotrimoxazole. This report emphasizes the difficulty to diagnose WD correctly, because of its rareness and clinical polymorphism. Recently, studies have identified a bacillus, Tropheryma whippelii, associated with WD, so that, in the next future, the diagnosis of WD will be faster and more accurate. Finally, it is important to administer antibiotics which can cross the blood brain barrier for at least one year, in order to prevent neurological relapse, often lethal.

Nef protein induces differential effects in CD8+ cells from HIV-1-infected patients

BACKGROUND

The Nef protein of HIV-1 is suspected to play a role in the depletion of uninfected CD4+ lymphocytes that leads to AIDS. By contrast its effect on CD8+ cells, whose functions are also deregulated during HIV-1 infection, is presently unclear. Here we describe a number of derangements induced in vitro by Nef in CD8+ cells from HIV-1-infected patients.

DESIGN

Peripheral lymphocytes from 16 HIV-1+ subjects and 9 uninfected individuals were cultivated on a Nef-transfected mouse fibroblast layer exposing the carboxyl-terminal region of the viral protein on cell membrane. The cultures were then measured for both apoptosis and proliferation by subdiploid DNA content and Ki67 expression, respectively, whereas the molecular analysis of purified CD8+ cells investigated the Fas-L mRNA levels in Nef-treated CTLs. In addition, we evaluated the Nef-induced variation in the extent of CD8+/HLA-DR+ subset, which includes non cytotoxic cells secreting T-cell antiviral factor (CAF) and a soluble factor inhibiting the HIV-1 replication.

RESULTS

The viral protein induced in peripheral blood lymphocytes (PBL) a moderate tendency to proliferate, as measured by the increment of Ki67 antigen, particularly on the CD8+ subset of HIV-1 infected individuals (P < 0.05). This profile was particularly evident in cultures from patients with severe CD4+ lymphopenia and paralleled an apparent expansion of the CD8+/CD57+ suppressor cell subset. Molecular analysis of purified CD8+ cells revealed a defective expression of Fas-L mRNA in Nef-cultured CTLs, whereas the viral protein exerted a down modulatory effect on the CD8+/HLA-DR+ subset (P < 0.05), thus suggesting a potential inhibition of CAF.

CONCLUSIONS

These results support a potential role of Nef in the progression of HIV-1 infection as a number of cellular functions are affected in the CD8+ subset. In particular, the defective functions of CD8+ cells induced by the viral protein could contribute, at least partly, to the escape of HIV-1 from the immune control of these cells.

Detectability of cochlear, acoustic nerve and brainstem potentials in a group of 'normal' preterm newborns recorded with insert earphone

Thirty-four 'normal' preterm newborns were tested at 40 weeks postconceptional age. To separate electromagnetic artifacts from cochlear potentials and subsequent auditory brainstem responses, a test was given using an insert earphone at 90, 70, 50, 30 dB nHL. The detectability of receptor potentials, waves I, III, V, as a function of stimulus intensity is described: at 90 dB nHL exclusively, we could always identify these peaks because of the better morphological distinctiveness of each potential. When trying to evaluate the acoustic pathway in premature newborns, we suggest that brainstem response audiometry should be performed at 90 dB nHL with an insert earphone.

The corneal endothelium 12 months after photorefractive keratectomy in high myopia

PURPOSE

To determine if photorefractive keratectomy with a 193 nm excimer laser could cause human corneal endothelial changes, mainly in high dioptric treatments.

METHODS

18 patients underwent a treatment ranging from 7 to 13 diopters at the corneal apex (mean 10.3 +/- 1.4 SD) with an estimated corneal thinning ranging from 62 to 116 microns (mean 90.7 +/- 12 SD). In these patients a comparison between the number and shape of the corneal endothelial cells has been performed before and 12 months after PRK.

RESULTS

The mean cell density was 2818 +/- 337 mm2, before surgery, and 2894 +/- 301 mm2 after 12 months. The polymorphic index was 79.0 +/- 2.3, before surgery, and 81.0 +/- 5.0 after 12 months with no significant changes (p = 0.16 and P = 0.09, respectively).

CONCLUSIONS

These results show that photorefractive keratectomy does not cause any significant observable damage to the central corneal endothelium up to 12 months after surgery, even in high myopic treatments.

Endothelial cells evaluation two years after photorefractive keratectomy

To evaluate long-term corneal endothelium damages after myopic photorefractive keratectomy (PRK) a morphometric analysis of corneal endothelial cells was performed in 41 patients before and at least 24 months after photorefractive keratectomy. These patients underwent a treatment ranging from -2.5 to -14 dpt with a mean of 8.9 +/- 2.8 dpt at the corneal apex, with an estimated corneal thinning ranging from 23 to 123 microns with a mean of 78 +/- 24.4 microns. Our results showed that the density of endothelial cells ranged from 2,334 to 3,554/mm2 with a mean of 2,819 +/- 351/mm2 before surgery, and from 2,051 to 3,461/mm2 with a mean of 2,774 +/- 330/mm2 after surgery without any significant changes (p = 0.16). The polymorphic index ranged from 58 to 84 with a mean of 77 +/- 5.7 before PRK and from 57 to 89 with mean of 77.7 +/- 7.2 after treatment without any significant changes (p = 0.61). In conclusion, we can state that there is no long-term corneal endothelial damage after PRK even in highly myopic eyes.

Postsurgical dyskeratosis treated with topical and parenteral administration of vitamin A

A severe case of conjunctival dyskeratosis was resolved by treatment with high doses of vitamin A administered both topically and parenterally. This result, which was confirmed by cytology, and the lack of adverse effects suggest that vitamin A administration might be a valid alternative to surgery in cases of dyskeratosis.

The ability of bacteria to use Na-hyaluronate as a nutrient

The objective of this study was to test bacteria ability to use Na-hyaluronate as a nutrient in vitro. Thirteen bacteria strains were tested in three different media: specific culture medium, agar-Healon medium and agar-Healon GV medium. The bacterial growth criteria were determined by counting the number of new colonies appearing at each observation time (0, 24, 48 and 72 h). The results were expressed as the percentage of growth in agar-Na-hyaluronate compared to each corresponding specific culture medium. After 24 h in the medium containing agar-Healon, S. aureus, S. epidermidis, S. pyogenes and S. viridans grew using hyaluronic acid as a nutrient. The percentage of growth of these species remained constant over the follow-up period. The other bacteria strains tested were unable to use Healon as a nutrient. After 24 h of incubation in the medium containing agar-Healon GV, S. aureus, S. epidermidis, S. pyogenes, and S. viridans exhibited about 20% growth. Subsequently, this percentage slowly increased to about 50%. The other bacteria stains tested were unable to employ Healon GV as a nutrient. With the exception of Staphylococci and Streptococci, the other species do not synthesize the necessary enzymes to break glucosidic bonds, therefore neither concentration of hyaluronic acid can be utilized as a source of carbohydrate for their survival in culture media.

[Therapy of neonatal infection caused by group B beta-hemolytic Streptococcus]

Expectant therapy for early Group B Streptococcus onset septicemia must provide coverage against other microorganism, such as L. Monocytogenes, H. Influenzae and S. Pneumoniae. It is possible to administer a combination of antimicrobial agents with activity against all or the most likely pathogens. Thus initial expectant therapy includes a broad spectrum semisynthetic penicillin (e.g. ampicillin) and an aminoglycoside (e.g. netilmicin). Vancomicin, teicoplanin and cefotaxime may also be used. Supportive therapy consists on temperature control, i.v. administration of fluids, acid-base balance and electrolytes monitoring, seizures control and ventilation. IV immunoglobulins, granulocyte and serum transfusion are also used. The G-Colony Stimulating Factor (G-CSF, filgastrim) usage is also reported.

Effects on the corneal endothelium six months following photorefractive keratectomy

Photorefractive keratectomy (PRK) with a 193-nm excimer laser has been shown not to destroy endothelial cells in vivo. However, this laser could damage endothelial cell metabolism, and result in damage over a longer term. In this paper, a comparison between the number and shape of corneal endothelial cells has been performed in 25 patients before and 6 months after PRK. These patients underwent treatment with myopic correction ranging from 2.5 to 17 dpt and with an estimated corneal thinning ranging from 25 to 170 microns. No significant changes in the number (p = 0.167) and shape (p = 0.075) of endothelial cells have been found. These results show that there are no long-term damages after PRK even in severely myopic eyes.

Local specific immunotherapy in allergic conjunctivitis

We evaluated the effect of local specific immunotherapy in 40 patients suffering from seasonal allergic conjunctivitis. Twenty patients received saline solution in both eyes; and 20 others received local specific immunotherapy in both eyes. Sodium cromoglycate drops were instilled in both eyes in all patients. Subjective and objective symptoms, and cytological findings had significantly improved after 1 year in the group treated with local specific immunotherapy plus sodium cromoglycate compared to the group treated with sodium cromoglycate and saline solution.

Evaluation of corneal thickness and endothelial cells before and after excimer laser photorefractive keratectomy

BACKGROUND

The possible endothelial damage induced by photorefractive keratectomy was investigated in myopic eyes.

METHODS

A morphometric analysis of the endothelial cells was performed in 19 patients before and 2 months after photorefractive keratectomy for the correction of various degrees of myopia. Central ultrasonic pachometry was also recorded at the same examination times.

RESULTS

No significant changes (p = .816) of the endothelial cell density were found between preoperative and postoperative measurements. The pleomorphic index did not show any significant changes after treatment (p = .955). Central corneal thickness was reduced to a various extent (range from 50 microns to 250 microns) according to the amount of myopic correction intended.

CONCLUSIONS

Our preliminary data suggest that photorefractive keratectomy for the correction of myopia does not induce endothelial cell damage, at least in the short term.

Direct immunofluorescence and scraping conjunctival cytology in the study of 912 patients affected by microfollicular conjunctivitis

912 patients affected by microfollicular conjunctivitis were submitted to a scraping conjunctival cytology before taking specimens for direct immunofluorescence. 264 patients proved to be positive to the direct immunofluorescence test for Chlamydia trachomatis (CT). In all cases the infection turned out to be bilateral with different degrees of positivity between one eye and the other. In 43 patients out of the 264 positive ones, the cytological examination showed the presence of eosinophils in both eyes. The presence of eosinophils poses the problem of a certain allergizing power of Chlamydia and of the possibility that the CT infection might easily develop in subjects with a preexistent allergic conjunctivitis.

Fungal keratitis due to Scopulariopsis brevicaulis in an eye previously suffering from herpetic keratitis

In the case reported, herpes virus I after having caused relapsing keratitis in an eye promoted the formation of a severe corneal ulcer caused by Scopulariopsis brevicaulis, a saprophytic mycete found in soil, which only once has been described as the cause of keratitis in man. Scopulariopsis was identified microscopically after culturing the conjunctival secretion on Sabouraud dextrose agar medium, while DNA probe tests confirmed the absence of herpes virus I. Topical and oral administration of miconazole and scraping of the corneal infiltrate dispersed the infection. Subsequently local steroids were given to reduce the neovascularization, and a therapeutic contact lens was applied because of intercurrent corneal thinning. Three months after beginning antifungal therapy, the visual acuity had increased from 1/120 to 1/10. The case described confirms that S. brevicaulis can cause opportunist infections in a cornea previously damaged by a different agent.

Long-term effects of befunolol on the corneal endothelium and the consensual ophthalmotonic reaction

In a double-blind study, 30 patients with ocular hypertension were randomly assigned to receive one drop of 0.5% befunolol or placebo (the drug vehicle) in each eye twice daily for 120 days. The befunolol used contained no preservatives. Before and after treatment the number and shape of the endothelial cells of the five corneal sectors were evaluated. After 120 days of twice-daily application of befunolol or placebo, no changes in the shape or density of the corneal cells were found in any patient. No differences in the patients receiving befunolol or placebo were noted. The consensual ophthalmotonic reaction was studied in 15 of the patients before and after befunolol administration. A significant decrease in intraocular pressure was noted at 30 minutes and at 1, 2, 3, 4, 5, and 6 hours after befunolol. Intraocular pressure also decreased significantly at 1 to 4 hours after placebo, and then returned to pretreatment levels at 6 hours.

Surgical treatment and desensitization therapy of giant papillary allergic conjunctivitis

We found that three cases of giant papillary conjunctivitis responded well to local specific desensitization therapy and transplantation of the conjunctiva with saphenous vein tissue.

[Monitoring of body temperature during fiber optics phototherapy]

Fiberoptic phototherapy is a new technique for treatment of neonatal hyperbilirubinemia; in comparison with conventional phototherapy this new technique shouldn't increase body temperature during treatment. We have recorded body temperature of 13 term newborns with hyperbilirubinemia during 18 periods of treatment and compared the records with physiologic body temperature in the same babies. No increase over normal value during treatment nor significative difference during and after treatment has been observed.

Topically applied levobunolol does not cause changes in the corneal endothelium

The corneal endothelium was examined in ten patients suffering from ocular hypertension before, during and after four months of topical levobunolol treatment. The untreated fellow eye served as a control. The number of endothelial cells, determined with a McIntyre eyepiece and an Eisner's contact lens, was not affected by levobunolol therapy. In addition, the morphology of the cell did not appear to be affected by the drug.

Laboratory survey of Chlamydia trachomatis ocular infections

The authors used immunofluorescence and immunoperoxidase tests to study a group of 101 patients with acute or chronic conjunctivitis, etiologically unrelated to conventional bacterial pathogens, and a control group of 30 healthy adults. Positive titers of IgG in serum and of IgA in lacrimal secretions against Chlamydia, detected by IPA, correlated with the identification of microorganisms by direct immunofluorescence. The use of both tests allows a precise evaluation of the stage of the infection and of its evolutive pattern.

The AC/A ratio and convergence in hypermetropia corrected with spectacles or contact lenses

Some hypermetropes, when corrected with contact lenses, appear to have a much smaller AC/A ratio than when corrected with spectacle lenses. Ocular convergence measured with contact lenses is greater than that measured with spectacles. Studies were carried out to establish the cause of these effects. Theoretical considerations are compared with the experimental results obtained. This study emphasizes the importance of the different amounts of magnification induced by contact lenses as compared with spectacles.

Genetic study and surgical correction of euryblepharon

Euryblepharon is a rare congenital anomaly of the palpebral fissure which consists of an increase in its width. A case has been described in which this characteristic is very marked, and associated with ectropion, lagophthalmos, corneal ulcers; also congenital malformations as twisted feet, hypospadia and inguinal hernia. Apart from a limited increase of the palpebral fissure in the mother, the familiar anamnesis is negative, and likewise examination of the cariogram and research of eventual metabolic modifications. An estimation of the various surgical techniques proposed revealed insufficient strictness regarding the standards generally followed in palpebral plastic surgery. Consequently, a technical variation was set up that will satisfy the needs of correct anatomical-surgical practice.