Diagnostic test accuracy of magnetic resonance imaging and pelvic floor ultrasound for diagnosis of levator ani muscle avulsion

OBJECTIVE

To estimate the diagnostic test accuracy of magnetic resonance imaging (MRI) and pelvic floor ultrasound for levator ani muscle (LAM) avulsion in a general parous population, with view to establishing if ultrasound could substitute for MRI to diagnose LAM avulsion.

METHODS

This was a cross-sectional study of 135 women 4 years after their first delivery. Signs and symptoms of pelvic floor dysfunction were assessed using validated methods. All women underwent four-dimensional transperineal ultrasound (TPUS), three-dimensional endovaginal ultrasound (EVUS) and MRI. Images were acquired at rest, on pelvic floor muscle contraction (PFMC) and on maximum Valsalva maneuver, and analyzed by two blinded observers. Predefined cut-off values were used to diagnose LAM avulsion. In the absence of a reference standard, latent class analysis (LCA) was used to establish diagnostic test characteristics for LAM avulsion as the primary outcome measure. Secondary outcomes were kappa (κ) agreement between imaging techniques, intraclass correlation coefficients (ICC) for hiatal measurements at rest, on PFMC and on maximum Valsalva maneuver, and the association of LAM avulsion with signs and symptoms of pelvic floor dysfunction.

RESULTS

The prevalence of LAM avulsion was 23.0% for MRI, 11.1% for TPUS and 17.8% for EVUS. The prevalence of LAM avulsion using LCA was 15.7%. The sensitivity for LAM avulsion of TPUS (71% (95% CI, 50-90%)) and EVUS (91% (95% CI, 74-100%)) was lower than that of MRI (100% (95% CI, 84-100%)). The specificity of TPUS (100% (95% CI, 97-100%)) and EVUS (95% (95% CI, 91-99%)) was higher than that of MRI (91% (95% CI, 85-97%)). MRI and EVUS had high predictive values for the assessment of major LAM avulsion (positive predictive value (PPV), 95% and negative predictive value (NPV), 100%; PPV, 100% and NPV, 98%, respectively), while TPUS had high predictive values for minor LAM avulsion (PPV, 100% and NPV, 95%). Major LAM avulsion on MRI and EVUS was associated with anterior vaginal wall prolapse, which was not found for TPUS. The agreement in the diagnosis of LAM avulsion (κ, 0.69) and hiatal measurements (ICC, 0.60-0.81) was highest between MRI and EVUS.

CONCLUSIONS

Pelvic floor ultrasound can be implemented as a triage test to assess parous women for LAM avulsion because of its high specificity. Ultrasound cannot substitute for MRI because of its lower sensitivity. The predictive ability of ultrasound is moderate for the presence, and very good for the absence, of LAM avulsion. A positive test should be confirmed by a different observer or imaging technique. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Parathyroid hormone reference ranges in healthy individuals classified by vitamin D status

PURPOSE

Parathyroid hormone (PTH) concentrations are routinely measured in the diagnosis and management of bone and kidney diseases, but reference ranges can be overestimated if determined in otherwise healthy individuals for whom vitamin D deficiency was not evaluated. We establish PTH reference ranges in apparently healthy, normocalcemic, normophosphatemic individuals categorized by 25-hydroxyvitamin D (25(OH)D) status using the Elecsys^® PTH (cobas e 601) and Elecsys^® Vitamin D total II electrochemiluminescence immunoassays (cobas e 411).

METHODS

This prospective, non-interventional study measured PTH in serum from 653 apparently healthy adults [56.7% female; 68.2% white/Caucasian; 28.6% African American; median age 44 years (range 21-83)] from three diverse geographic sites across the USA during summer and winter months. Subjects were classified by concomitant vitamin D sufficiency (≥ 30 ng/mL), insufficiency (> 20 to < 30 ng/mL) or deficiency (≤ 20 ng/mL).

RESULTS

In vitamin D sufficiency, median PTH was 31.9 pg/mL [range (2.5th-97.5th percentile) 17.9-58.6] compared with 35.5 pg/mL (17.0-60.4) for insufficiency, and 39.8 pg/mL (19.5-86.4) for deficiency. A significant inverse relationship was found between PTH and 25(OH)D (P < 0.001). After accounting for vitamin D, potential effects of race or season as covariates were relatively small or absent.

CONCLUSIONS

Upper reference limits (URL) for PTH in vitamin D sufficiency/insufficiency were similar and lower than current values. Clinically important PTH elevations were observed in vitamin D deficiency, where revised reference ranges with a higher URL may be appropriate. These data may help to distinguish vitamin D-related PTH elevations from other causes [e.g., primary (normocalcemic) or secondary hyperparathyroidism].

Does 4D transperineal ultrasound have additional value over 2D transperineal ultrasound for diagnosing posterior pelvic floor disorders in women with obstructed defecation syndrome?

OBJECTIVE

To establish the diagnostic test accuracy of two-dimensional (2D) and four-dimensional (4D) transperineal ultrasound (TPUS) for diagnosis of posterior pelvic floor disorders in women with obstructed defecation syndrome (ODS), in order to assess if 4D ultrasound imaging provides additional value.

METHODS

This was a prospective cohort study of 121 consecutive women with ODS. Symptoms of ODS and pelvic organ prolapse on clinical examination were assessed using validated methods. All women underwent both 2D- and 4D-TPUS. Imaging analysis was performed by two blinded observers. Posterior pelvic floor disorders were dichotomized into presence or absence, according to predefined cut-off values. In the absence of a reference standard, a composite reference standard was created from a combination of results of evacuation proctography, magnetic resonance imaging and endovaginal ultrasound. Primary outcome measures were diagnostic test characteristics of 2D- and 4D-TPUS for rectocele, enterocele, intussusception and anismus. Secondary outcome measures were interobserver agreement, agreement between the two imaging techniques, and association of severity of ODS symptoms and degree of posterior vaginal wall prolapse with conditions observed on imaging.

RESULTS

For diagnosis of all four posterior pelvic floor disorders, there was no difference in sensitivity or specificity between 2D- and 4D-TPUS (P = 0.131-1.000). Good agreement between 2D- and 4D-TPUS was found for diagnosis of rectocele (κ = 0.675) and moderate agreement for diagnoses of enterocele, intussusception and anismus (κ = 0.465-0.545). There was no difference in rectocele depth measurements between the techniques (19.9 mm for 2D vs 19.0 mm for 4D, P = 0.802). Interobserver agreement was comparable for both techniques, although 2D-TPUS had excellent interobserver agreement for diagnosis of enterocele and rectocele depth measurements, while this was only moderate and good, respectively, for 4D-TPUS. Diagnoses of rectocele and enterocele on both 2D- and 4D-TPUS were significantly associated with degree of posterior vaginal wall prolapse on clinical examination (odds ratio (OR) = 1.89-2.72). The conditions observed using either imaging technique were not associated with severity of ODS symptoms (OR = 0.82-1.13).

CONCLUSIONS

There is no evidence of superiority of 4D ultrasound acquisition to dynamic 2D ultrasound acquisition for the diagnosis of posterior pelvic floor disorders. 2D- and 4D-TPUS could be used interchangeably to screen women with symptoms of ODS. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Beneficial effect of combined spironolactone and quinapril treatment on thrombosis and hemostasis in 2K1C hypertensive rats

A strong correlation between raised aldosterone levels and increased risk of thrombotic disorders has been provided. Clinical studies have demonstrated the benefits of the addition of the aldosterone receptor antagonist to the standard therapy with angiotensin-converting enzyme inhibitor in the reduction of cardiovascular events in patients. We suggest that the benefits of this dual renin-angiotensin-aldosterone system (RAAS) blockade may be related to the drug's effects on the hemostatic and oxidative balance. Thus, we investigated the effect of combined spironolactone (SPIRO) and quinapril (QUIN) administration on thrombosis, hemostasis and oxidative stress in hypertensive rats. A two-kidney, one-clip model of renovascular hypertension in Wistar rats was used. QUIN, SPIRO, or QUIN + SPIRO were administered for 10 days. Venous thrombosis was induced by vena cava ligation. Thrombus weight and incidences of thrombosis were assessed. Bleeding time, platelet adhesion, tissue factor (TF), tissue plasminogen activator (t-PA), plasminogen activator inhibitor (PAI-1), thrombin activatable fibrynolysis inhibitor (TAFI), malonyl dialdehyde, and hydrogen peroxide plasma levels were assayed. Aortic expression of NADPH oxidase and superoxidase dismutase were measured. We observed significant RAAS activation associated with hypercoagulability and oxidative stress augmentation in renovascular hypertensive rats. Thrombosis was reduced only in rats treated with QUIN + SPIRO. In all groups, decreases in TF, PAI-1, and TAFI levels were observed, however in the QUIN + SPIRO group those changes were more pronounced. The inhibition of platelet adhesion was also stronger in rats treated with QUIN + SPIRO. The oxidative stress parameters were markedly reduced in rats treated with QUIN or SPIRO, although the most evident changes were observed in the QUIN + SPIRO group. Dual RAAS blockade with aldosterone receptor antagonist and angiotensin-converting enzyme inhibitor provides additional benefits for experimental thrombosis associated with the antiplatelet, anticoagulative, profibrinolytic, and antioxidative effects in renovascular hypertensive rats.

Cranial Nerve II–VII Injuries in Fatal Closed Head Trauma

PURPOSE

To study the distribution and mechanism of traumatic injuries to the nerves supplying the eye and muscles protecting the visual apparatus.

METHODS

Brain autopsy was carried out in 12 consecutive patients who died within three days after closed head injury. A segment of the brainstem with the entire intracranial portion of nerves II-VII was dissected out in each case and fixed in formalin. The specimens were stripped of the leptomeninges and inspected thoroughly under magnification.

RESULTS

Injuries to the nerves were seen in nine subjects. The oculomotor nerve was completely torn off from the midbrain unilaterally in three and bilaterally in two cases. In one patient only a portion of the superficial fibres on the medial aspect of the nerve was ripped out from the brainstem. In two patients the fourth nerve was ruptured. The root of the fifth cranial nerve was contused and the fibres between the brainstem and Gasserian ganglion crushed and separated in one case. Bilateral avulsion of the root of the sixth nerve from the brainstem was found in two cases. The initial segment of the facial nerve was crushed in two subjects. No visible injury to the optic nerves was found.

CONCLUSIONS

Cranial nerves related to the visual system are subject to serious injury in a large proportion of cases of severe head trauma resulting from automobile accidents. In the majority of cases damage results from ripping the roots of these nerves out of the brainstem.

Report Summary--Rio Political Declaration on Social Determinants of Health: A Snapshot of Canadian Actions 2015

In 2012, Canada and other United Nations (UN) Member States endorsed the "Rio Political Declaration on Social Determinants of Health" (Rio Declaration), a non-binding pledge which calls on World Health Organization (WHO) Member States to improve/influence the working and living conditions that affect health and well-being. The Rio Declaration sets out actions to address health inequities in five themes: to adopt better governance for health and development; to promote participation in policy making and implementation; to further reorient the health sector towards reducing health inequities; to strengthen global governance and collaboration; and to monitor and increase accountability. In 2013, following the endorsement of the Rio Declaration, the Government of Canada released a report to begin to document Canadian actions related to its five themes. Building on this first report, and in anticipation of WHO reporting on Member State implementation of the Rio Declaration at the May 2015 World Health Assembly, the Government of Canada developed the report, Rio Political Declaration on Social Determinants of Health: A Snapshot of Canadian Actions 2015, which showcases Canada's recent actions since 2013 contributing to the advancement of the five Rio Declaration themes. The report provides a current picture of the diverse spectrum of activities undertaken across levels of government and sectors to advance health equity and address social determinants of health in Canada, and intends to stimulate global and domestic exchange and uptake of promising practices to advance health equity.

Stabilization of the Amorphous Ezetimibe Drug by Confining Its Dimension

The purpose of this paper is to investigate the influence of nanoconfinement on the molecular mobility, as well as on the physical stability, of amorphous ezetimibe drug. Two guest/host systems, ezetimibe-Aeroperl 300 and ezetimibe-Neusilin US2, were prepared and studied using various experimental techniques, such as X-ray diffraction (XRD), differential scanning calorimetry (DSC), and broadband dielectric spectroscopy (BDS). Our investigation has shown that the molecular mobility of the examined anticholesterol agent incorporated into nanopore matrices strongly depends on the pore size of the host system. Moreover, it was found that the amorphous ezetimibe confined in 30 nm pores of Aeroperl 300 has a tendency to recrystallize, while the drug incorporated into the smaller--5 nm--pores of Neusilin US2 is not able to crystallize. It has been shown that this significant stabilization of ezetimibe drug can be achieved by an interplay of three factors: changes in molecular dynamics of the confined amorphous drug, the immobilization effect of pore walls on a part of ezetimibe molecules, and the use of host materials with pores that are smaller than the critical size of the drug crystal nuclei.

The value of pre-operative multicompartment pelvic floor ultrasonography: a 1-year prospective study

OBJECTIVE

Comprehensive assessment of the pelvic floor (PF) provides information and diagnoses of coexisting abnormalities that may affect operative decisions. Our aim was to establish if pre-operative PF ultrasonography (PFUS) in patients complaining of PF dysfunction can complement clinical findings and contribute to additional management strategies.

METHODS

Females were recruited from the urogynaecology/gynaecology clinics between July and October 2009 and underwent pelvic organ prolapse quantification (POPQ) by an independent examiner. PFUS was performed using two-dimensional (2D) transperineal ultrasound (TPUS), high-frequency 2D/three-dimensional (3D) endovaginal ultrasound (EVUS) using a biplane probe with linear and transverse arrays and a 360° rotational 3D-EVUS. The clinician performing PFUS was blinded to POPQ results. POPQ and PFUS were repeated at 1 year. Two clinicians analysed the scans independently.

RESULTS

158 of 160 females had a POPQ and PFUS. 105 females had pelvic organ prolapse and/or incontinence and 53 asymptomatic females were controls. 26 additional ultrasound diagnoses were noted at baseline and 46 at 1 year using 2D-TPUS and EVUS. Only one female with additional diagnoses on PFUS needed surgical intervention for this condition.

CONCLUSION

Multicompartment PFUS identifies additional conditions to that diagnosed on clinical assessment. However, it neither changes the initial surgical management nor the management at 1-year follow-up and therefore clinical assessment should not be substituted by PFUS.

ADVANCES IN KNOWLEDGE

PFUS can be helpful in providing additional information; however, it does not change the initial management of the patient and therefore should not replace clinical assessment.

Prevalence of self-reported hysterectomy among Canadian women, 2000/2001-2008

BACKGROUND

Hysterectomy is one of the most frequently performed surgical procedures among Canadian women. The consequence is a population that no longer requires cervical cancer screening. The objective of our analysis was to provide more accurate estimates of eligible participation in cervical screening by estimating the age-specific prevalence of hysterectomy among Canadian women aged 20 to 69 by province and territory between 2000/2001 and 2008.

METHODS

Self-reported hysterectomy prevalence was obtained from the 2000/2001, 2003 and 2008 Canadian Community Health Survey. Age-specific prevalence and 95% confidence intervals (CIs) were estimated for Canada and provinces and territories for the three time periods.

RESULTS

Interprovincial variations in hysterectomy prevalence were observed among women in each age group and time period. Among women aged 50 to 59, prevalence was as high as 35.1% (95% CI: 25.8-44.3) (p<.01) in 2008 and appeared to decrease in all provinces from 2000/2001 to 2008.

CONCLUSION

Interprovincial and time period variation suggest that using hysterectomy prevalence to adjust the population eligible for cervical cancer screening may be helpful to inform more comparable screening participation rates. In addition, both cervical cancer incidence and mortality rates can be adjusted by hysterectomy to ensure estimates across time and provinces and territories are also comparable.

Prevalence of self-reported hysterectomy among Canadian women, 2000/2001–2008

Background

Hysterectomy is one of the most frequently performed surgical procedures among Canadian women. The consequence is a population that no longer requires cervical cancer screening. The objective of our analysis was to provide more accurate estimates of eligible participation in cervical screening by estimating the age-specific prevalence of hysterectomy among Canadian women aged 20 to 69 by province and territory between 2000/2001 and 2008.

Methods

Self-reported hysterectomy prevalence was obtained from the 2000/2001, 2003 and 2008 Canadian Community Health Survey. Age-specific prevalence and 95% confidence intervals (CIs) were estimated for Canada and provinces and territories for the three time periods.

Results

Interprovincial variations in hysterectomy prevalence were observed among women in each age group and time period. Among women aged 50 to 59, prevalence was as high as 35.1% (95% CI: 25.8–44.3) (p $lt; .01) in 2008 and appeared to decrease in all provinces from 2000/2001 to 2008.

Conclusion

Interprovincial and time period variation suggest that using hysterectomy prevalence to adjust the population eligible for cervical cancer screening may be helpful to inform more comparable screening participation rates. In addition, both cervical cancer incidence and mortality rates can be adjusted by hysterectomy to ensure estimates across time and provinces and territories are also comparable.

A review of screening mammography participation and utilization in Canada

Introduction

Participation rate is an important indicator for a screening program’s effectiveness; however, the current approach to measuring participation rate in Canada is not comparable with other countries. The objective of this study is to review the measurement of screening mammography participation in Canada, make international comparisons, and to propose alternative methods.

Methods

Canadian breast cancer screening program data for women aged 50 to 69 years screened between 2004 and 2006 were extracted from the Canadian Breast Cancer Screening Database (CBCSD). The fee-for-services (FSS) mammography data (opportunistic screening mammography) were obtained from the provincial ministries of health. Both screening mammography program participation and utilization were examined over 24 and 30 months.

Results

Canada’s screening participation rate increases from 39.4% for a 24-month cut-off to 43.6% for a 30-month cut-off. The 24-month mammography utilization rate is 63.1% in Canada, and the 30-month utilization rate is 70.4%.

Conclusion

Due to the differences in health service delivery among Canadian provinces, both programmatic participation and overall utilization of mammography at 24 months and 30 months should be monitored.

A review of screening mammography participation and utilization in Canada

INTRODUCTION

Participation rate is an important indicator for a screening program's effectiveness; however, the current approach to measuring participation rate in Canada is not comparable with other countries. The objective of this study is to review the measurement of screening mammography participation in Canada, make international comparisons, and propose alternative methods.

METHODS

Canadian breast cancer screening program data for women aged 50 to 69 years screened between 2004 and 2006 were extracted from the Canadian Breast Cancer Screening Database (CBCSD). The fee-for-services (FSS) mammography data (opportunistic screening mammography) were obtained from the provincial ministries of health. Both screening mammography program participation and utilization were examined over 24 and 30 months.

RESULTS

Canada's screening participation rate increases from 39.4% for a 24-month cut-off to 43.6% for a 30-month cut-off. The 24-month mammography utilization rate is 63.1% in Canada, and the 30-month utilization rate is 70.4%.

CONCLUSION

Due to the differences in health service delivery among Canadian provinces, both programmatic participation and overall utilization of mammography at 24 months and 30 months should be monitored.

State of the art: an integrated approach to pelvic floor ultrasonography

Surgical management of pelvic floor disorders depends on a comprehensive understanding of the structural integrity and function of the pelvic floor. For visualizing this region, ultrasonography has emerged as a procedure that is relatively easy to perform, cost-effective and widely available. In this review, pelvic floor ultrasonography, including two-dimensional (2D), three-dimensional (3D) and 4D imaging as well as transvaginal, endoanal and transperineal techniques, is discussed from a global and multicompartmental perspective, rather than using a compartmentalized approach. The role of the different sonographic modalities in the major disorders of the pelvic floor-urinary and fecal incontinence, pelvic organ prolapse and obstructed defecation syndrome-is evaluated critically.

Self-organizing feature map (neural networks) as a tool to select the best indicator of road traffic pollution (soil, leaves or bark of Robinia pseudoacacia L.)

Concentrations of the elements Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb and Zn were measured in the leaves and bark of Robinia pseudoacacia and the soil in which it grew, in the town of Oleśnica (SW Poland) and at a control site. We selected this town because emission from motor vehicles is practically the only source of air pollution, and it seemed interesting to evaluate its influence on soil and plants. The self-organizing feature map (SOFM) yielded distinct groups of soils and R. pseudoacacia leaves and bark, depending on traffic intensity. Only the map classifying bark samples identified an additional group of highly polluted sites along the main highway from Wrocław to Warszawa. The bark of R. pseudoacacia seems to be a better bioindicator of long-term cumulative traffic pollution in the investigated area, while leaves are good indicators of short-term seasonal accumulation trends.

Bioindication of trace metals in Brachythecium rutabulum around a copper smelter in Legnica (Southwest Poland): Use of a new form of data presentation in the form of a self-organizing feature map

Concentrations of the elements Al, Be, Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, V, and Zn were measured in the terrestrial moss Brachythecium rutabulum and the soil on which it grew. Soil and moss plants were sampled at sites situated 1.5, 3, 6, 9 and 15 km to the north, south, east and west of the Legnica copper smelter (SW Poland). The self-organizing feature map (SOFM) or Kohonen network was used to classify the soil and moss samples according to the concentrations of the elements. The self-organizing map yielded distinct groups of B. rutabulum and soil samples, depending on the distance from and direction to the source of pollution. When the map-identified groups of sites with similar soil metal concentrations were combined with the map-identified groups of sites with similar metal concentrations in B. rutabulum, these maps were found to correspond closely. The SOFMs accurately represented the least polluted, moderately polluted and severely polluted sites, reflecting the distribution of metals that is typical of the smelter area, caused by the prevailing westerly and northerly winds.

Self-organizing feature map (neural networks) as a tool in classification of the relations between chemical composition of aquatic bryophytes and types of streambeds in the Tatra national park in Poland

Concentrations of the elements Al, Be, Ca, Cd, Co, Cr, Cu, Fe, K, Mg, Mn, Ni, Pb and Zn were measured in the aquatic bryophytes Fontinalis antipyretica, Platyhypnidium riparioides and Scapania undulata. These bryophytes were sampled from streams flowing through granites/gneisses, limestones/dolomites and sandstones in the Tatra national park in Poland. The Self-organizing feature map (SOFM) or Kohonen network was used to classify the bryophytes according to the concentrations of the elements. This method was verified using principal component analysis (PCA) to check whether this well-known technique would give similar results. Both the self-organizing map and ordination by PCA yielded distinct groups of aquatic bryophytes growing in streams flowing through different types of rock, groups which differed significantly in the concentrations of certain elements. Bryophytes from granites/gneisses were distinguished by higher concentrations of Cd and Pb, while those from sandstones had a higher concentration of Cr and those from limestones/dolomites had higher concentrations of Ca and Mg. The SOFM and PCA ordinations thus yield identical classifications of bryophytes from the Tatra mountains streams.

Nonlinear dielectric properties and temperature stabilization effect near the ferroelectric phase transition in sodium trihydrogen selenite

The ferroelectric phase transition of crystalline sodium trihydrogen selenite has been characterized by domain observations and measurements of electric permittivity, pyroeffect and spontaneous polarization. The first-order character of the phase transition is clearly demonstrated by the phase coexistence and temperature autostabilization. The considerable heating effect at 50 Hz ac field is described. The electric field effect on the temperature variation of the electric permittivity, in the phase transition region, shows a considerable domain structure contribution to the permittivity value. It is demonstrated that the dielectric properties of x- and y-samples can be described by classical dielectric state equations: the set of coefficients has been determined. It is concluded that the x-component of spontaneous polarization plays a predominant role in the phase transition.

Angiotensin II via AT1 receptor accelerates arterial thrombosis in renovascular hypertensive rats

Although there are some in vitro evidence that angiotensin II (Ang II) may promote thrombosis, there is still no data concerning effect of Ang II on arterial thrombus formation. In the present study we have investigated the influence of Ang II on electrically induced arterial thrombosis in a common carotid artery of renovascular hypertensive rats. Furthermore, we examined if Ang II effect is mediated via AT1 receptor. We measured some coagulation and fibrinolytic parameters at the same time. Since platelets play crucial role in the initiation of arterial thrombosis their contribution in the mode of Ang II action was also determined. Intravenous infusion of Ang II caused significant increase in arterial thrombus weight, which was reversed by losartan, selective AT1 receptor antagonist. The prothrombotic effect of Ang II was accompanied by increase in haemostatic and decrease in fibrinolytic potential of rat plasma. While number of data has clearly demonstrated that Ang II can augment human platelets aggregation, at least in rats, platelets were not involved in the mechanism of Ang II action. Our study shows that Ang II via AT1 receptor accelerates arterial thrombosis in renovascular hypertensive rat, therefore may be considered as a risk factor of myocardial infarction or stroke.

[Thyroid cancer morbidity in the Olsztyn region in 1993-1999]

Olsztyn region (in the north of Poland) was classified as an iodine deficiency area with moderate endemic goiter prevalence. Following Chernobyl accident, the population had one of the highest radiation doses affecting thyroid. Aims of the study were to estimate the incidence of thyroid cancer and to determine its histopathological type. The register was carried out in Olsztyn region population including each newly diagnosed case of thyroid cancer in the calendar year. The personal data of patients were collected and processed on in computer. The incidence rate was calculated as the number of newly diagnosed cases in the calendar year per 100,000 inhabitants dependent on sex and age. The results were statistically evaluated. 242 newly diagnosed cases of thyroid cancer were registered including 8 young patients (up to 18 years of age) and 234 adults. The increase in the number of cancer cases was observed year by year. The predominant type of thyroid cancer was papillary carcinoma--66.8%. Follicular carcinoma constituted 17% of cases. A statistically significant increase of incidence rate was observed in women--from 2.8/100,000 to 11.1/100,000.

Green tea as a potent antioxidant in alcohol intoxication

Ethanol oxidation to acetaldehyde and next to acetate is accompanied by free radical generation. Free radicals can affect cell integrity when antioxidant mechanisms are no longer able to cope with the free radical generation observed in ethanol intoxication. Natural antioxidants are particularly useful in such a situation. The present study was designed to investigate the efficacy of green tea as a source of water-soluble antioxidants (catechins) on the liver and blood serum antioxidative potential of rats chronically (28 days) intoxicated with ethanol. Alcohol caused a decrease in liver superoxide dismutase, glutathione peroxidase and catalase activities and an increase in activity of glutathione reductase. Moreover, a decrease in the level of reduced glutathione, ascorbic acid, vitamins A and E and beta-carotene were observed. The activity of serum glutathione peroxidase decreased while glutathione reductase activity increased. The level of serum non-enzymatic antioxidants was also decreased in the liver. Alcohol administration caused an increase in the liver and serum lipid peroxidation products, measured as thiobarbituric acid-reactive substances. However, green tea prevents the changes observed after ethanol intoxication. Green tea also protects membrane phospholipids from enhanced peroxidation. These results indicate a beneficial effect of green tea in alcohol intoxication.

Antioxidant status and proteolytic-antiproteolytic balance in colorectal cancer

Free radicals participate in the development of cancer. When the antioxidant defence system is not longer capable to destroy free radicals they may cause lipid and protein oxidation. Lipid peroxidation products also modify proteins. In such a situation the proteolytic-antiproteolytic balance existing in the blood may be changed. Therefore the aim of this study was to examine the correlation between antioxidant status and activity of proteolytic enzymes and their inhibitors in cases of colorectal cancer. This study included 55 patients with colorectal cancer. The blood was taken before surgery and plasma was collected. Total antioxidant status, the levels of lipid peroxidation products (malondialdehyde and 4-hydroxynonenal) and activity of cathepsin G, elastase and their inhibitors (alpha-1-antitrypsin and alpha-2-macroglobulin) were determined in plasma. It was shown that during the development of cancer total antioxidant status was signficantly decreased while lipid peroxidation products were increased. Activity of alpha-2-macroglobulin was decreased and activity of determined enzymes was not significantly changed. The observed changes indicate a shift in proteolytic-antiproteolytic balance which may enhance carcinogenesis.

Antioxidant status and lipid peroxidation in colorectal cancer

Colon carcinogenesis is a multistep process where oxygen radicals were found to enhance carcinogenesis at all stages: initiation, promotion, and progression. Since insufficient capacity of protective antioxidant system can result in cancer, the aim of this study was to examine the activity of antioxidant enzymes (superoxide dismutase, catalase, glutathione peroxidase, and glutathione reductase) and the levels of reduced glutathione, vitamin C, and vitamin E. The lipid peroxidation products were also determined by measuring malondialdehyde and 4-hydroxynonenal levels in colorectal cancer tissue collected from 55 patients. In these cases the activity of superoxide dismutase, glutathione peroxidase, and glutathione reductase was significantly increased while the activity of catalase was significantly decreased in cancer tissue. However, the level of nonenzymatic antioxidant parameters (glutathione, vitamin C, and vitamin E) was significantly decreased in cancer tissue. Further lipid peroxidation was enhanced during cancer development, manifested by a significant increase in malondialdehyde and 4-hydroxynonenal levels. The obtained results indicate significant changes in antioxidant capacity of colorectal cancer tissues, which lead to enhanced action of oxygen radicals, resulting in lipid peroxidation.

[Application of numeric integration in waveform morphology of visual evoked potentials in optic nerve diseases. Numeric integration method]

PURPOSE

Presentation of new waveform analysis of pattern and flash visual evoked potentials (VEPs) in patients with optic neuropathy.

MATERIAL AND METHODS

The study involved 48 patients with acute optic neuritis (2nd group), 60 patients with demyelinating (3rd group), 32 patients with compressive (4th group), 24 patients with nonarteritic anterior ischemic optic neuropathy (5th group) and 32 healthy subjects (1st group). Using computer system UTAS E-1000 (pattern and flash stimulation) the VEPs tests were performed. Amplitude, latency of 8 VEP components, 4 gradients, mean waveform and 16 areas of numeric integrals were calculated. Results were analysed with the use of AN-STAT software.

RESULTS

Statistical difference recorded under pattern stimulation was obtained in latency of 3rd, 4th, 5th components of VEP in comparing 3th and 4th groups, as well as amplitude of 3rd waveform, second gradient, areas of integrals between cursors number 2 and 4 in comparing 3rd and 5th groups (p < 0.001). Statistical difference recorded under flash stimulation was obtained in latency of 4th component in comparing 2nd and 5th groups, in amplitude of 7th waveform, areas of integrals covering 160 and 224, 224 and 256 ms, between cursors number 2 and 4 in comparing 4th and 5th groups, as well as in a range of areas of integrals covering 160 and 192 ms in comparing 4th and 5th groups (p < 0.001).

CONCLUSION

Results prove clinical potency of the presented new comprehensive method in analysis of VEP in optic nerve diseases.

[Blood flow parameters in ocular vessels of patients with glaucoma]

PURPOSE

To determine Doppler flow parameters in ocular vessels of glaucomatous patients.

MATERIAL AND METHODS

38 glaucomatous patients, aged 64 +/- 16, and 57 healthy volunteers were examined with 7.5 MHz linear-array probe. Consistently identified arterial structures included ophthalmic artery, central retinal artery and short posterior ciliary arteries. The peak systolic, end-diastolic and mean velocities were measured from Doppler spectra. Resistance and pulsatility indices were also determined.

RESULTS

End-diastolic and mean velocities in central retinal artery of glaucomatous eyes were: 1.5 +/- 1.9 cm/s, 4.0 +/- 2.0 cm/s, whereas in healthy eyes they were significantly higher: 3.5 +/- 1.0 cm/s, 5.4 +/- 1.5 cm/s, respectively. These velocities in short posterior ciliary arteries in glaucomatous patients were significantly lower: 2.4 +/- 2.3 cm/s, 5.6 +/- 2.2 cm/s, comparing to healthy subjects: 4.8 +/- 1.7 cm/s, 7.3 +/- 2.2 cm/s. Resistance and pulsatility indices in central retinal artery and short posterior ciliary arteries were significantly higher in the group of patients: RI = 0.85 +/- 0.18, PI = 2.11 +/- 0.92--in central retinal artery and RI = 0.81 +/- 0.18, PI = 1.96 +/- 0.91--in short posterior ciliary arteries, comparing to healthy subjects: RI = 0.61 +/- 0.08, PI = 1.20 +/- 0.17--in central retinal artery, RI = 0.61 +/- 0.09, PI = 1.13 +/- 0.18--in short posterior ciliary arteries. Impedance indices were increasing progressively with intraocular pressure elevation. There were no significant differences of Doppler blood flow parameters in ophthalmic artery between patients and control group.

CONCLUSIONS

Blood flow velocities in central retinal and short posterior ciliary arteries are lower, and resistance and pulsatility indices are higher in glaucomatous eyes in comparison to healthy subjects, whereas in ophthalmic artery doppler parameters are similar in both groups.

[Late manifestations of the optic nerve damage after closed head trauma]

PURPOSE

A follow-up assessment of the visual system in patients who had undergone close head injury and in whom simple atrophy of the optic nerve occurred several months after the trauma.

PATIENTS

Among patients treated in Department of Ophthalmology in Białystok in the years 1984-1995 there were 2 women and 3 men, aged 19-61 years, who suffered from advancing simple atrophy of the optic nerve and who had undergone severe closed head trauma 3-5 months earlier. In one case the time interval between trauma and the visual sequelae amounted to 11 years.

METHODS

The patients underwent a follow-up examination at 3 to 11 years after their initial treatment in the Department of Ophthalmology. Besides a conventional ophthalmologic examination, a static perimetry was performed as well as ultrasonography in projection B and Colour-Coded Doppler sonography (TCCD) of the orbital vessels.

RESULTS

When compared to the findings at discharge, in 2 patients visual acuity improved to 5/12, in the remaining 3 no improvement was noted. In all patients the optic discs were white, while other structures of the globe appeared within normal limits. Blood flow in the central retinal artery, ophthalmic artery and in the long posterior cilliary arteries remained undisturbed, as assessed with TCCD.

CONCLUSIONS

1. Lack of visual disturbances immediately after head injury does not preclude their development in the protracted period after the trauma. 2. The reason of the late development of visual sequelae after head trauma is not clear. Normal flow, found in the major vessels of the globe, might indirectly suggest disturbances of microcirculation within the optic nerve with a consequent optic atrophy.

[Cathepsin A activity in the aqueous humor in patients with cataract, absolute glaucoma and intraocular tumors]

PURPOSE

To evaluate cathepsin A activity in the aqueous humor of patients with cataract, absolute glaucoma and intraocular tumors.

MATERIAL AND METHODS

The studies were performed on human aqueous humor taken from anterior chamber of eye balls of patients operated because of cataract, absolute glaucoma and intraocular tumors. Cathepsin A activity was determined by the ninhydrin method with synthetic substrate (N-Cbz-Phe-Ala) at its optimum pH 5.0.

RESULTS

In the human aqueous humor of the eye with cataract cathepsin A activity was more than three times higher than in the eye with choroid tumors and absolute glaucoma. No differences of enzyme activity in aqueous humor between patients with glaucoma and intraocular tumors were found.

CONCLUSION

The increasing proteolytic activity of cathepsin A in aqueous humor of patients with cataract suggests its importance in cataract pathogenesis. This implies that cathepsin A is involved in development of lens opacity and is found in the aqueous humor due to diffusion from cataractous lens in which the proteolytic process prevails.

[Cathepsin A activity in the vitreous body of patients with absolute glaucoma and intraocular tumors]

PURPOSE

To evaluate cathepsin A activity in the vitreous body of patients with absolute glaucoma and intraocular tumors.

MATERIAL AND METHODS

The studies were performed on human vitreous body taken from eye balls which were enucleated because of absolute glaucoma (18 eyes) and intraocular tumors (14 eyes). Cathepsin A activity was determined by the ninhydrin method with synthetic substrate (N-Cbz-Phe-Ala) at its optimum pH 5.0.

RESULTS

Cathepsin A activity in the human vitreous body in absolute glaucoma was twice as high as in intraocular tumors.

CONCLUSION

Our results suggest that cathepsin A may participate in the pathogenesis of absolute glaucoma and that proteolysis may play a significant role in local destruction of the retina and the optic nerve.

[Content of certain sugars and polyols in cataractous nucleus in non-diabetics and diabetic patients with type II diabetes]

PURPOSE

Sugars and polyols content assessment in cataractous nucleus in diabetics and non-diabetics.

MATERIAL AND METHODS

Cataractous nucleus was obtained during extracapsular cataract extraction derived from 52 diabetic and 58 non-diabetic patients. The content of glucose, fructose, sorbitol and mioinositol in examined material was determined using iquid gas chromatography.

RESULTS

Average contents of sorbitol, glucose and fructose in cataractous nucleus diabetic patients (ZSC) are significantly higher than in non-diabetics (ZS). No changes were observed in mioinositol content in both studied groups.

CONCLUSION

The role of the polyol pathway in the development of diabetic cataract is considerable.

[Color Doppler ultrasonography in diagnosis of post-traumatic optic neuropathy]

PURPOSE

To evaluate the parameters of blood flow in orbital arteries of patients with traumatic optic neuropathy.

MATERIAL AND METHODS

Colour Doppler imaging of the ophthalmic artery, central retinal artery and posterior ciliary arteries was carried out in 13 patients with traumatic injury of the optic nerve. The peak-systolic, end-diastolic flow velocities and resistance index were measured.

RESULTS

In 4 patients, whose vision was intact immediately after the injury and later deteriorated, the parameters of blood flow in the central retinal artery (CRA) were normal. Also in 3 patients with loss of vision to 1/50-3/50 after the injury the parameters of blood flow in the CRA were in the normal limit. In 3 other patients, who had only light perception after injury, there was decreased peak systolic blood flow and only trace or no flow was demonstrated in the CRA during the diastolic phase. In the remaining 3 patients, who displayed no light perception after the injury, no flow was observed in the CRA with Colour Doppler method.

CONCLUSION

Colour Doppler ultrasonography is a useful supplementary method in diagnostics of traumatic optic neuropathy. The Colour Doppler findings seem to correlate well with clinical pathologies of the optic nerve after its traumatic injury.

[The role of apoptosis in physiology and pathology of the retina]

Apoptosis is a genetically regulated form of cell death. Specific morphological and biochemical changes characterize apoptosis, including nuclear chromatin condensation, cytoplasmatic condensation, membrane blebbing and, on the molecular level, internucleosomal fragmentation of nuclear DNA. Cell death by apoptosis is essential for normal development and tissue homeostasis, and it is involved also in a variety of pathologic processes. Apoptosis is the final common pathway of photoreceptor cell death in retinal dystrophies and degeneration, retinal detachment, vitreoretinal proliferation, retinoblastoma and retinal injury. The authors present a brief literature review concerning studies on the role of apoptosis in pathogenesis on retinal diseases.

[Sub-retinal fluid interleukin-10 (Il-10) and interleukin-13 (Il-13) concentration in patients with retinal detachment]

PURPOSE

To evaluate the presence of IL-10 and IL-13 in subretinal fluid of patients with rhegmatogenous retinal detachment.

MATERIAL AND METHOD

The studies comprised 14 patients on with retinal detachment operated. The presence of cytokines was evaluated using immunoenzymatic assay.

RESULTS

IL-10 and IL-13 were found in all subretinal fluid samples. Our results suggest that the presence of IL-10 and IL-13 has the influence on suppression of inflammatory agent release and activity during retinal detachment.

[Evaluation of some clinical parameters in patients with retinitis pigmentosa in relationship to the type of inheritance]

PURPOSE

Analysis of selected clinical parameters in patients with various types of retinitis pigmentosa.

PATIENTS AND METHODS

We examined 51 patients aged 8-67 suffering from different genetic forms of RP identified on the ground of pedigree analysis. We analyzed onset of nyctalopia, degree of retinal degeneration, degree of visual field loss, dark adapted electroretinographic testing flicker (ERG) and presence of posterior subcapsular cataract.

CONCLUSIONS

XLRP is one of the most severe RP forms. In the groups with ADRP and sRP, the patients have varied expression of disease.

[The results of surgery on squint with pathological muscle attachment]

The aim of our study was to evaluate the results of the operation on squint with pathological attachment of lateral rectus revealed during surgery.

MATERIAL AND METHODS

The study involved 22 children (12 girls and 10 boys) out of 320 children operated on for squint in the years 1993-1996, who had pathological attachment of lateral rectus. Alternating convergent squint was found in 12 children, unilateral in 10. Muscle exposure showed dislocation of lateral rectus attachment--upwards by c. 1.5 mm in 11 children, downwards and obliquely by c. 2 mm in 10 children, in 1 child the upper part of the attachment was shifted forward by 1 mm. During the surgery, in addition to the reduction of squint angle, physiological attachment of the rectus was reconstructed.

RESULTS

The operation restored parallel position of the eyes in 22 children, very good vision was obtained in 12 (54%) with alternating convergent squint, significant improvement in 5 (22%) with unilateral convergent squint, and only slight improvement in the remaining 5 (22.7%) with high initial amblyopia and squint angle from +15 degrees to +30 degrees.

[Physiology and pathology of tear film in the course of dry eye syndrome]

Due to the grow-up of number of patients suffering from signs of dry-eye syndrome we are obligated to investigate physiology and pathology of tear film. Data obtained from patients with Sjögren Syndrome and other types of lacrimal dysfunction shows that the expectations for break-up in dry-eye treatment strategy are very high. In our review we are presenting contemporary views concerning tear film production and tear deficiency with special look at the treatment possibilities.

[Visual evoked potentials and static perimetry in functional visual deficits]

The author presents application of visual evoked potentials and static perimetry in hysterical amblyopia, psychical blindness, malingerers, amblyopia, cortical blindness and visual acuity assessment in infants. The author emphasizes the influence of multiple factors on the results and interpretation of the examination.

[Remote results of conservative treatment of traumatic optic neuropathy]

The problem of pathogenesis and effective treatment of traumatic optic neuropathy (TON) is still an open question. According to current opinions the immediate results of conservative treatment with megadose corticosteroids are similar to those obtained with surgical decompression. No data on late results of both modes of treatment are at present available. This study was undertaken to assess the late results of conservative treatment of traumatic optic neuropathy. The clinical material comprised 15 patients (3 women and 12 men, age 14-64 years), who developed clinical symptoms of TON as a consequence of closed head trauma. All were treated conservatively with megadose steroid therapy. 10 patients presented to follow-up examination performed 3-11 years after the injury. A full ophthalmologic survey and colour-coded Doppler (CCD) examination of the orbital vessels were performed in all subjects. In 6 patients there was full blindness of the affected eye since the injury. Their visual acuity did not improve despite vigorous treatment and their eyes were still blind at the late follow-up examination. No flow found with CCD in their central retinal arteries at follow-up might suggest structural disruption of the nerve. In 5 of these patients ocular atrophy evolved between the injury and follow-up examination. 4 patients, who on admission displayed merely light sensation, responded to 2-3 weeks of steroid therapy with improvement of visual acuity to 3/50, 5/50, 5/10, 5/7. After 4-6 years however, visual acuity of all these patients deteriorated again to mere light perception in three and 1/50 in another one. Optic atrophy was diagnosed in all the affected eyes. Our results indicate that conservative treatment of TON, even if giving satisfactory relief of the symptoms, may not be reliable in permanent restrainment of the sequela of traumatic optic neuropathy.

[Use of color Doppler ultrasonography for evaluation of blood flow in orbital vessels]

PURPOSE

The aim of this study was to establish the normal values of blood flow velocities in ophthalmic and central retinal vessels.

PATIENTS AND METHODS

29 healthy subjects: 18 men and 11 women, mean age 55 +/- 20 years, were examined in Color Doppler technique with spectral analysis with the 7.5 MHz linear transducer. The peak systolic, end diastolic and mean flow velocities were measured. The resistance index (RI) and pulsatility index (PI) were also estimated.

RESULTS

The values of velocities are comparable with results of other authors, especially when the similar frequency of the transducers was used. No significant differences of flow parameters were found between genders and right and left eyes when comparing the means. Ophthalmic artery velocities significantly declined as a function of age, but the RI and PI indices were similar. There were age-related differences between flow parameters in central retinal vessels.

CONCLUSIONS

Ultrasound system characteristics, methodology of the examination and age factor should be considered in clinical evaluation of orbital vessels with color Doppler imaging.

[Incidence of cataract and risk factors in Northeastern Poland]

PURPOSE

Retrospective analysis of the incidence and risk factors of senile and pre-senile cataract in patients from North-East Region of Poland, operated on cataract in the years 1986-1995.

MATERIAL AND METHODS

In the analysed decade, 6038 patients were operated on cataract in the Ophthalmology Department of the Clinical Hospital and Ophthalmology Department of the District Hospital in Bialystok. There were 2603 males and 3435 females, mean age amounted to 69 +/- 11 years. 44% of the patients came from rural communities (560.000 inhabitants in the region), whereas 56% of the patients were of urban province (796.000 inhabitants). Statistical analysis was performed on such variables like age, gender, place of residence, cataract history and presence of concomitant diseases: arterial hypertension, diabetes, lung and joints disorders, intestinal diseases.

RESULTS AND CONCLUSIONS

Residence in rural communities increases the risk of cataract, although the condition in this environment tends to develop in older age. Gender distribution of the patients does not differ from male/female ratio in the population of the region, so both genders are exposed to similar risk of cataract. Females contract cataract in older age, on average about 3 years later than males. Age is the most important risk factor of cataract; 52% of the patients are older than 70, 43% are in the age of 51-70 years. Mean value of duration of cataract history before operation decreased during the analysed 10 years from 3.8 years in 1986 to 2.2 years in 1995. In 14% of patients cataract coexisted with arterial hypertension, in 8% with diabetes, and in 15% with other diseases. During the analysed 10 years period the number of patients with cataract increased in the same degree in all examined communities. The mean age of patients operated on cataract decreased in this period by 2 years in spite of increasing number of patients older than 75 years. This result can be explained by the fact that the disease tends now to develop earlier and by concomitant decreasing of the time between onset of the disease and decision for operation.