The Efficacy of 2.5% Phenylephrine and Flurbiprofen Combined in Inducing and Maintaining Pupillary Dilatation during Cataract Surgery

Purpose

To evaluate the effectiveness of phenylephrine 2.5% and flurbiprofen 0.03% combined in inducing and maintaining mydriasis during extracapsular cataract extraction (ECCE).

Methods

One hundred patients undergoing ECCE + intraocular lens (IOL) implantation were randomly divided into four groups. The first group was given phenylphrine 10%, the second group phenylephrine 10% + flurbiprofen, the third group phenylephrine 2.5% and fourth group phenylephrine 2.5% + flurbiprofen. Cyclopentolate 1% was used in all patients. Phenylephrine and cyclopentolate were instilled preoperatively four times during 1 hour and flurbiprofen was given four times the day before surgery and twice with an hour's interval before operation. Pre-operative and post-cortex aspiration horizontal pupil diameters were measured with callipers viewed through the operating microscope.

Results

Pupil diameters in pre-operative and post-cortex aspiration were no different in the 2.5% and 10% phenylephrine groups (p>0.05). Both diameters were larger and pupillary constriction was smaller in the flurbiprofen groups (p<0.05).

Conclusions

2.5% phenylephrine was as effective as 10% phenylephrine, with and without flurbiprofen, in inducing and maintaining pupil dilatation during ECCE surgery.

A comparison of two-dimensional radiography and three-dimensional computed tomography in angular cephalometric measurements

OBJECTIVES

The objective of this study was to assess the reliability of three-dimensional (3D) cephalometric approaches by comparing this method with authenticated traditional two-dimensional (2D) cephalometry in angular cephalometric measurements.

METHODS

CT images and lateral cephalometric radiographs of ten patients (five women, five men) were used in this study. Raw CT data of the patients were converted to 3D images with a 3D simulation program (Mimics 9.0, Leuven, Belgium). Lateral cephalometric radiographs were used manually for 2D measurements. The comparisons of the two methods were made using 14 cephalometric angular measurements. The Wilcoxon matched-pairs signed-ranks test (alpha = 0.05) was used to determine the difference between the two methods. To assess the intra- and interobserver reproducibility, two sets of recordings made by each observer, in each modality were used. Dahlberg's formula was used to determine the intraobserver reproducibility, and the Wilcoxon matched-pairs signed-rank test (alpha = 0.05) was used to assess the interobserver reproducibility.

RESULTS

The method errors of both observers ranged from 0.35 degrees to 0.65 degrees. In addition, there were no significant differences between the measurements of the two observers (P > 0.05). However, comparison of 2D and 3D parameters showed significant differences in U1-NA and U1-SN measurements (P < 0.05).

CONCLUSIONS

The 3D angular cephalometric analysis is a fairly reliable method, like the traditional 2D cephalometric analysis. Currently, the 3D system is likely to be more suitable for the diagnosis of cases with complex orthodontic anomalies. However, with the decrease in radiation exposure and costs in the future, 3D cephalometrics can be a suitable alternative method to 2D cephalometry.

The WHO global alliance against chronic respiratory diseases in Turkey (GARD Turkey)

In order to prevent and control non-communicable diseases (NCDs), the 61st World Health Assembly has endorsed an NCD action plan (WHA resolution 61.14). A package for essential NCDs including chronic respiratory diseases (CRDs) has also been developed. The Global Alliance against Chronic Respiratory Diseases (GARD) is a new but rapidly developing voluntary alliance that is assisting World Health Organization (WHO) in the task of addressing NCDs at country level. The GARD approach was initiated in 2006. GARD Turkey is the first comprehensive programme developed by a government with all stakeholders of the country. This paper provides a summary of indicators of the prevalence and severity of chronic respiratory diseases in Turkey and the formation of GARD Turkey.

A new visual field test in empty sella syndrome: rarebit perimetry

PURPOSE

Several visual field defects can be seen in empty sella syndrome (ESS). In this study, the authors aimed to evaluate the visual field defects in patients with ESS by rarebit perimetry and to compare the results with Humphrey perimetry.

METHODS

Left eyes of 13 patients with ESS and left eyes of 15 age-matched normal subjects were included in the study. Visual field testing was performed by Humphrey Visual Field Analyzer II (Fastpack 30-2 strategy) and rarebit perimetry (regular test). Statistical analysis was performed by independent-samples t-test, Mann-Whitney U test, receiver operating characteristic (ROC) curves, and Pearson correlation test.

RESULTS

Humphrey perimetry mean deviation was -3.67 dB in control group and -6.06 dB in patients with ESS (p=0.12). Mean hit rate calculated by rarebit test was 91.8% in control group and 75.9% in cases with ESS (p=0.005). Area under ROC curve was 0.756 for Humphrey visual field test and 0.827 for rarebit hit rate (p=0.59). There was a significant correlation between rarebit hit rate and Humphrey visual field test mean deviation (r=0.755, p<0.001).

CONCLUSIONS

Rarebit perimetry correlates significantly with Humphrey perimeter in detecting visual field defects related with ESS and has a higher sensitivity and specificity.

Evaluation of the change in accommodation amplitude in subjects with pseudoexfoliation

PURPOSE

To evaluate the changes in accommodation amplitude in cases with pseudoexfoliation.

MATERIALS AND METHODS

Twenty-nine eyes having pseudoexfoliation and 37 normal eyes aged between 40-60 years were included in the study. After ophthalmic examination, accommodation amplitude was measured using Powerrefractor II. Besides, axial length, anterior chamber depth, and lens thickness was measured by A-scan ultrasonography. The results obtained were evaluated by independent samples' t-test.

RESULTS

There was no difference in mean age between cases with pseudoexfoliation and normal cases (P=0.131). Mean accommodation amplitude was significantly lower in cases with pseudoexfoliation (P=0.002). Axial length, anterior chamber depth, and lens thickness measurements did not show significant change between groups (P=0.55, P=0.66, P=0.36, respectively).

CONCLUSION

In the presence of pseudoexfoliation, ciliary apparatus can be affected and accommodation amplitude can be decreased in earlier ages.

The effect of levodopa and dopamine agonists on optic nerve head in Parkinson disease

PURPOSE

To evaluate the effects of levodopa and dopamine agonists on retinal nerve fiber layer using scanning laser ophthalmoscope.

METHODS

Forty-four patients with the diagnosis of Parkinson disease and receiving levodopa or dopamine agonist monotherapy were included in this prospective study. The control group consisted of 21 normal cases. The optic nerve head images were taken with Heidelberg Retina Tomograph; rim area, rim volume, mean retinal nerve fiber layer thickness, and the results of Moorfields regression analysis were calculated. The measurement results were evaluated with Kruskal Wallis test and Mann-Whitney U-test.

RESULTS

There was no significant difference in mean age among groups (p=0.093). Retinal nerve fiber layer was measured to be significantly decreased in cases with Parkinson disease (p=0.004) while rim area and rim volume did not show a significant change (p=0.224, p=0.804 respectively). Rim area, rim volume, and retinal nerve fiber layer were significantly greater in the group treated with levodopa while it was the thinnest in the group receiving dopamine agonists.

CONCLUSIONS

Levodopa can have a protective affect to retinal nerve fiber layer in Parkinson disease compared to dopamine agonists.

Können zilioretinale Arterien altersabhängige Makuladegeneration beeinflussen?

PURPOSE

The aim of this study was to investigate the influence of the cilioretinal artery (CRA) on eyes with age-related macular degeneration (AMD).

METHODS

One hundred and seventy-five eyes with AMD and 170 eyes without AMD as a control were included in the study. The prevalence of a CRA was compared between the control subjects and the patients with AMD.

RESULTS

A CRA was established in 20.6 % of eyes that did not have AMD. 12.5 % of eyes with AMD had a CRA (p = 0.045). A CRA was observed in 13.6 % of eyes with wet AMD, in 10.5 % of eyes with dry AMD and in 19.2 % of eyes with drusen.

CONCLUSION

The presence of CRA may have protective effects against the development of AMD.

Doppler ultrasound assessment and serum cancer antigen 125 in the diagnosis of ovarian tumors

OBJECTIVE

To differentiate benign from malignant ovarian tumors based on sonographic detection of a solid component.

METHOD

Sixty-three women with ovarian masses were evaluated preoperatively by gray scale and power/color Doppler ultrasonographic examination, with specific predefined criteria for the solid component. Sensitivity, specificity, and positive and negative predictive values were calculated and assessed against the histopathologic outcome. The contribution of cancer antigen (CA) 125 levels to the diagnostic accuracy was also assessed.

RESULT

Sensitivity, specificity, and positive and negative predictive values were 100%, 95.2%, 91.3% and 100%, respectively, with two false-positive results. Had an elevated CA 125 level (>35 U/mL) been included in the malignancy criteria, the false-positive results would have been eliminated, giving an accuracy of 100%.

CONCLUSION

Sonographic evaluation with predefined specific criteria for the detection of a solid tumor component is an accurate method of preoperative discrimination between benign and malignant ovarian tumors. A serum CA 125 assay may assist in eliminating false-positive results.

Thickness Measurement of Worn Molar Cusps by Ultrasound

This study aimed to evaluate the effectiveness of an ultrasonic system for in vitro measurement of cusp tips of human teeth. Each worn cusp of 12 molar teeth was measured with an industrial ultrasonic system. The teeth were sectioned and measured by polarized light microscopy. The ultrasonic measurements and histological readings were moderately correlated (r = 0.601, p < 0.01). The ultrasonic system used in this study seemed a promising method for measuring thickness of worn cusp tips of extracted human molar teeth.

High association of congenital heart disease with indirect inguinal hernia

We evaluated 103 patients with indirect inguinal hernia (IIH) for the association of congenital heart disease by echocardiography. Congenital cardiac abnormalities were recognized in 32% of patients with inguinal hernia, which is significantly higher than that reported in a population-based study in Turkey and other population-based studies. Ventricular septal defect and valvular anomalies are the most frequently detected malformations. Our findings suggest that screening for congenital hearth disease is necessary in children with indirect inguinal hernia.

Comparing the efficacy and safety of phacoemulsification in white mature and other types of senile cataracts

AIM

To compare the intraoperative difficulty and postoperative outcome in patients who have white mature cataract in one eye and other types of senile cataract in the other eye undergoing clear corneal phacoemulsification and foldable intraocular lens implantation.

METHODS

82 patients who had white mature cataract in one eye, posterior subcapsular, cortical, nuclear, or mixed type cataract in the other eye were enrolled in this prospective study. Postoperative outcomes, intraoperative difficulties related to capsulorhexis, and phacoemulsification were analysed between the two groups of eyes. Postoperative examinations were done at 1 day, 1 week, 1 and 3 months.

RESULTS

Postoperative visual acuity, central corneal thickness, intraocular pressure, and rate of posterior capsule rupture were not significantly different between the two group of eyes (p>0.05). Mean effective phaco time, frequency of postoperative corneal oedema and posterior capsular plaque were found to be significantly higher in the mature cataract group (p<0.05).

CONCLUSIONS

A one stage, 5 mm continuous capsulorhexis was achieved using trypan blue and generous amounts of retentive viscoelastic agent in eyes with white mature cataract. Intraoperative difficulties and postoperative outcome of clear corneal incision phacoemulsification surgery and foldable intraocular lens implantation were similar in white mature and other types of senile cataract. Topical anaesthesia in phacoemulsification of eyes with white mature cataract is safe and well tolerated.

Microscopic examination and treatment outcomes of new pulmonary tuberculosis cases in Istanbul dispensaries between 1998 and 2000

SETTING

Twenty-four public tuberculosis dispensaries in Istanbul.

OBJECTIVE

To investigate microscopic examination of new pulmonary tuberculosis (TB) cases and treatment outcomes of smear-positive cases.

DESIGN

A retrospective analysis of 12572 new pulmonary tuberculosis cases between 1998 and 2000.

METHODS

Microscopic examination of sputum smears of all patients and treatment outcomes of smear-positive cases were evaluated.

RESULTS

Of 12572 new TB cases registered between 1998 and 2000, 78.1% (n = 9822) were pulmonary and 21.9% (n = 2750) were extra-pulmonary TB cases. Of 9822 new pulmonary TB cases, 5438 (55.4%) were sputum smear-positive and 2154 (21.9%) had no sputum examination. In smear-positive pulmonary cases, treatment outcomes were classified as follows: 2521 (46.4%) cured, 1926 (35.4%) treatment completed, 128 (2.4%) treatment failure, 514 (9.4%) default, 260 (4.8%) transfer out and 72 (1.3%) died. Treatment success was 81.8% (n = 4447). Between 1998 and 2000, the smear-positive case rate improved from 47.5% to 61.5% and the cure rate improved from 41.8% to 51.1%.

CONCLUSION

The microscopic diagnosis and cure rates are low in Istanbul dispensaries. The laboratories should be re-organised and directly observed treatment should be performed.

Effectiveness of oxygenation and suction in cataract surgery: is suction of CO2-enriched air under the drape during cataract surgery necessary?

PURPOSE

To investigate the effectiveness of aspiration of expired air by a suction system on peripheral oxygen saturation (SpO(2)) and end tidal carbon dioxide (EtCO(2)) during cataract surgery.

MATERIALS AND METHODS

In total, 160 pre-medicated patients aged between 40 and 70 years (ASA I-III, classification of patients according to the American Society of Anesthesiologists) scheduled for cataract surgery under retrobulbar or peribulbar block were examined in a randomised, single-blind manner. The patients were sedated with 3 mg midazolam i.v. 15 min before operation and were monitored with an anaesthesia monitor. Heart rate (HR), non-invasive mean arterial pressure (MAP), SpO(2) and EtCO(2) were continuously measured using a standardised monitor. The first group (non-suction group, n = 80) received 4 L min(-1) O(2) with nasal cannule while the second group (suction group, n = 80) received 4 L min(-1) O(2) with nasal cannule, and the expired air was aspired with a Y-piece suction system. EtCO(2) was measured with the line of the sampling tube in the anaesthesia monitor. Respiratory rate (RR) was counted for a period of 1 min at each measurement time with thoracic excursions. The results were evaluated by unpaired t-test and analysis of variance.

RESULTS

Severe reduction of SpO(2) and raising of EtCO(2) were observed significantly in the first group during the operation. RR, HR and MAP increased due to hypoxaemia. In the second group, SpO(2) was stabilised at high levels and EtCO(2) did not increase. RR, HR and MAP levels remained within the normal limits. Differences between the two groups were statistically significant (P < 0.05).

CONCLUSION

During cataract surgery with local anaesthesia, SpO(2) decreases and RR, HR and MAP increase because of reinspiration of expired air under the drape. Insufflation of O(2) and aspiration of expired air with a suction system have prevented severe reduction of SpO(2) and raising of EtCO(2). It was suggested that O(2) delivery and use of an aspiration system decreased the risk of hypoxaemia significantly in the patients undergoing the cataract surgery.

Ultrastructure of human umbilical vessels in pre-eclampsia

OBJECTIVE

Our objective in this study was to investigate the ultrastructure of endothelial and muscle cells of human umbilical vessels in both normal and pre-eclamptic pregnancies.

METHODS

Ten umbilical cords from pre-eclamptic (36, 38 and 40 weeks) and four from normal pregnancies (40 weeks) were collected immediately after vaginal deliveries. Umbilical veins and arteries were isolated and fixed in phosphate-buffered 2.5% glutaraldehyde solution (pH 7.2) for 4 h and postfixed with 1% osmium tetroxide at 4 degrees C for 2 h. The sections were embedded in Araldit CY 212. Ultrathin sections were stained with uranyl acetate, examined and photographed.

RESULTS

Human umbilical vessel endothelial cells showed ultrastructural changes in pre-eclamptic patients. Weibel-Palade bodies and some organelles such as rough endoplasmic reticulum were found in increased numbers in venous endothelial cells. Accumulations of granular material were detected under the venous endothelium.

CONCLUSION

The endothelial and muscle cells of the umbilical vessels from pregnancies complicated by pre-eclampsia showed morphological changes.

Familial pathologic myopia, corneal dystrophy, and deafness: a new syndrome

BACKGROUND

Numerous syndromes with myopia and hearing loss have been described up to now. We present a family with pathologic myopia, corneal dystrophy, and deafness distinct from these syndromes.

CASES

Ten patients in the same Turkish family were evaluated by ophthalmologic, audiologic, physical, radiologic, genetic, serologic, and biochemical examinations.

OBSERVATIONS

Ophthalmic examination indicated that all the cases had myopia, 7 of them had pathologic myopia, 1 had intermediate, and 2 had mild. Four of the patients with pathologic myopia had corneal dystrophy that was bilaterally manifest as white opacities in the posterior stroma near Descemet's membrane in an axial distribution; 1 of these 4 patients also had a tilted disc. Otolaryngologic examination revealed conductive hearing loss in 3 cases, mixed hearing loss in 2, and sensorineural hearing loss in 1. The results of karyotypic analyses of all cases were normal. The pedigree analysis showed the disease was inherited through successive generations as an autosomal dominant trait. The results of biochemical, serologic, and radiologic investigations were normal. The same pathophysiologic process in all cases seemed to account for the myopia, the corneal dystrophy and the deafness.

CONCLUSIONS

To our knowledge, this type of case has not been reported in the literature. Therefore, we named this syndrome "familial pathologic myopia, corneal dystrophy and deafness."

Prevention of posterior capsule opacification by retinoic acid and mitomycin

BACKGROUND

Our aim was to evaluate the effect of an intraoperative single dose of retinoic acid (RA) or mitomycin C (MMC) in preventing posterior capsule opacification (PCO).

METHODS

Twenty-seven rabbits were divided randomly into three groups. RA (250 microg/ml) and MMC (0.04 mg/ml) were given 0.1 ml by hydrosection and 0.9 ml into the capsular bag after phacoemulsification. The third group served as a control group. Three months after intervention PCO was graded clinically. Furthermore, proliferation of lens epithelial cells was evaluated histologically.

RESULTS

Two eyes developed corneal edema in the MMC group. On clinical assessment, RA and MMC were significantly effective in preventing PCO compared with controls (P<0.005). On histological analysis, there was significantly reduced proliferative activity on posterior capsules in the treatment groups, in contrast to multilayer cells in the control group.

CONCLUSION

Intraoperative single-dose administration of RA and MMC significantly prevented the development of PCO in rabbit eyes. The optimal biocompatible dosage must be carefully determined by further investigation.

Pellagra: a sporadic pediatric case with a full triad of symptoms

Pellagra is clinically manifested by a photosensitive dermatitis, diarrhea, and dementia. The full triad of symptoms is usually not well developed in infants and children. We report a case of a 14-year-old boy with classic symptoms of pellagra. All his symptoms responded to treatment with nicotinic acid.

Prevention of posterior capsule opacification by intraoperative single-dose pharmacologic agents

PURPOSE

To determine whether an intraoperative single dose of dexamethasone, diclofenac, ethylenediaminetetraacetic acid (EDTA), a combination of EDTA and RGD peptide (arginine-glycin-aspartic acid sequence), or mitomycin-C (MMC) is a pharmacological means of preventing or reducing the development of posterior capsule opacification (PCO).

SETTING

Department of Ophthalmology, Celal Bayar University, School of Medicine, Manisa, and Department of Pathology, Dokur Eylül University, School of Medicine, Izmir, Turkey.

METHODS

Fifty-four rabbits were randomly divided into 6 groups. Dexamethasone (4 mg/cc), diclofenac (2.5 mg/cc), EDTA (8 mg/cc), a combination of EDTA and RGD peptide (2.5 mg/cc), or MMC (0.04 mg/cc) was given, 0.1 cc by hydrodissection and 0.9 cc into the capsular bag after phacoemulsification. The sixth group served as a control group. After 3 months, the PCO was graded clinically and the proliferation of lens epithelial cells (LECs) was evaluated histologically.

RESULTS

The drugs were significantly effective in preventing PCO compared with the control (P <.005). Dexamethasone had a weaker effect than the other drugs. In histological analysis, although monolayer LECs in the dexamethasone and diclofenac groups were observed, there was no proliferative activity on the posterior capsules in the EDTA, EDTA+RGD, and MMC groups in contrast to the multilayer cells in the control.

CONCLUSIONS

Intraoperative single-dose application of EDTA, EDTA+RGD peptide combination, and MMC significantly prevented the development of PCO in rabbit eyes. Diclofenac was less effective but also reduced PCO. Although dexamethasone did not prevent the proliferation of LECs, it decreased PCO clinically.

Penetration of topical and oral ofloxacin into the aqueous and vitreous humor of inflamed rabbit eyes

PURPOSE

This study aimed to investigate the penetration of topical and oral ofloxacin into aqueous humor and vitreous humor in post-traumatic endophthalmitis model in rabbits.

METHODS

A standardized intraocular infection after penetrating injury was made in the right eyes of 16 rabbits. Intraocular infection was induced by intravitreal injection of a suspension of Staphylococcus aureus. The intact left eyes were maintained as controls. The animals were divided randomly into two groups. (1) In the topical group, two drops of ofloxacin 0.3% eyedrops were instilled to both eyes every 30 min for 4 h. (2) In the topical-oral group, two doses of 25 mg/kg of ofloxacin at 12-h intervals were given orally, then the protocol of the first group was applied. Aqueous and vitreous humor samples were taken 30 min after the last drop. Ofloxacin concentrations were measured by using HPLC.

RESULTS

Mean aqueous levels of ofloxacin in control eyes were: 3.25 +/- 2.55 microg/ml in topical group. 4.58 +/- 5.39 microg/ml in topical-oral group. Mean aqueous levels in inflamed eyes were: 5.21 +/- 4.55 microg/ml in topical group, 10.34 +/- 8.88 microg/ml in topical-oral group. Mean vitreous levels of ofloxacin in control eyes were: 0.17 +/- 0.07 microg/ml in topical group, 1.30 +/- 1.23 microg/ml in topical-oral group. Mean vitreous levels in inflamed eyes were: 0.35 +/- 0.22 microg/ml in topical group, 3.48 +/- 2.69 microg/ml in topical-oral group. There was no significant difference among the groups (P > 0.05), however.

CONCLUSIONS

The result of this study suggests that oral supplementation of ofloxacin to topical instillation increased the ocular levels of ofloxacin in the post-traumatic endophthalmitis model. Mean drug concentrations in aqueous and vitreous humors were above the 90% minimum inhibitory concentrations (MIC90) for most of the common microorganisms causing endophthalmitis in all eyes, except in the vitreous humors of the intact eyes instilled topically.

The effects of prolonged acute use and inflammation on the ocular penetration of topical ciprofloxacin

PURPOSE

To study the aqueous and vitreous penetration of ciprofloxacin after prolonged acute topical administration and to investigate the effects of inflammation on drug penetration.

METHODS

A standardized model of intraocular infection after penetrating injury was made in the right eyes of eight rabbits. The intact left eyes were maintained as the control. Two drops of ciprofloxacin 0.3% eyedrops were instilled topically every 1 h for 7 h to all eyes of the rabbits. Aqueous and vitreous samples (100 microl) were obtained half an hour after the last drop. Instillation was continued for 7 h more and samples were obtained as before. Drug concentrations were measured using HPLC.

RESULTS

The mean aqueous humor levels of ciprofloxacin were: in control eyes 1.31 +/- 0.78 microg/ml after 7 h and 1.85 +/- 1.69 microg/ml after 14 h of instillation: in inflamed eyes 2.18 +/- 1.02 microg/ml after 7 h and 2.91 +/- 2.12 microg/ml after 14 h. The mean vitreous humor levels were: in control eyes 0.65 +/- 0.44 microg/ml after 7 h and 0.72 +/- 0.8 microg/ml after 14 h of instillation; in inflamed eyes 0.67 +/- 0.77 microg/ml after 7 h and 1.01 +/- 0.43 microg/ml after 14 h. However, the differences among the groups were not significant (P > 0.05).

CONCLUSIONS

Ciprofloxacin penetration into aqueous humor was higher in 14-h topical application than that for 7 h. Inflammation increased the penetration of topical ciprofloxacin into aqueous while administered for 7 h and into both aqueous and vitreous humor while administered for 14 h. c

Detection of natural white spot caries lesions by an ultrasonic system

Ultrasound has been used in industrial business as one of the nondestructive measurement methods. It was hypothesized that nondestructiveness of the ultrasonics could be useful in determination of demineralization of noncavitated carious lesions on human enamel. This investigation was designed to determine the presence of natural carious lesions on proximal surfaces of human molar teeth using an ultrasonic system compared to radiography and histology as the gold standards. Measurements were made directly from proximal surfaces of 20 mandible molar teeth with white spot carious lesion by 2 examiners independently with the ultrasonic system. Ultrasonic evaluation of each natural white spot lesion had a sensitivity of 88%, specificity of 86%, positive predictive value of 88% and a negative predictive value of 86%, and the chance-corrected agreement was also satisfactory (kappa=0.74) compared to histology. The radiograph demonstrated chance-corrected agreement of 0.41:0.38 for the first and second examiners, respectively. Duncan test analysis of the numerical values was significantly different for the intact and the noncavitated carious surfaces (p<0.05). The results indicated that the ultrasonic evaluation is a sensitive method for the detection of the natural white spot carious lesions and can differentiate the changes in elastic properties of enamel numerically.

The effect of propolis extract in experimental chemical corneal injury

PURPOSE

To investigate the effect of propolis, a natural resin produced by honeybees, in the treatment of alkali-injured rabbit eyes.

METHOD

A corneal alkali burn was induced by applying filter paper immersed in 1 N NaOH on the central axis of the right corneas of 24 rabbits for 30 s. The animals were divided into three treatment groups: group 1 (control) was given 0.3% tobramycin and phosphate-buffered solution; group 2 was treated with antibiotic coverage and topical 1% ethanolic extract of propolis; group 3 received antibiotic coverage and topical 1% dexamethasone. The dexamethasone-treated group was maintained as the positive control. Drugs were instilled 4 times a day for 7 days. The corneal inflammation was evaluated by calculating the average inflammatory index obtained from clinical observation of the ciliary hyperemia, central and peripheral corneal edema at 24 h, 48 h, on day 5 and day 7, before sacrificing the animals. Then, the corneas underwent routine histological examination.

RESULTS

The effects of dexamethasone and propolis on healing of injured corneas were similar (p>0.05) and significantly better than controls at 24 h (p<0.01, p< 0.05, respectively), and on day 7 (p<0.05) with respect to the inflammatory index. On histological observation, inflammatory cell infiltration was lower as compared to control in both the dexamethasone and propolis groups (p<0.001) and similar with each other (p>0.05).

CONCLUSIONS

Our study shows that propolis has an anti-inflammatory effect comparable to dexamethasone in chemical corneal injury.

Endoscopic dacryocystorhinostomy without stents

OBJECTIVE

The aim of this study is to present our endoscopic DCR operation method without the use of silicone tubing and our results on the patients suffering from chronic epiphora with postsaccal stenosis.

METHODS

Endoscopic dacryocystorhinostomy operations were performed to 21 sides of 18 patients who had chronic epiphora. No silicone tubing was used in any of the cases. In the postoperative healing period, the rhinostomy opening was maintained with frequent removal of nasal debris and using eyedrops. The patients were evaluated by fluoresceine test and endoscopic controls.

RESULTS

Symptomatic improvement was achieved in 19 out of 21 sides of the patients (90.5%) and the results were confirmed by the fluoresceine test under endoscopic control.

CONCLUSION

Our results of 21 sides of 18 cases underwent primary DCR without stents are as successful as those reported in the literature and the technique seems to be promising.

The effect of long-term use and inflammation on the ocular penetration of topical ofloxacin

PURPOSE

To study the penetration of ofloxacin into the aqueous and vitreous humors after long-term topical administration and to investigate the effects of inflammation on drug penetration in rabbits.

METHODS

A standardized model of intraocular infection after penetrating injury was achieved in the right eyes of 16 rabbits. The animals were randomly and equally divided into two groups. The intact left eyes of the groups were maintained as the control. Ofloxacin eyedrops (0.3%) were instilled into all eyes at a frequency of 2 drops every hour for 7 hours in the first group and for 14 hours in the second group. Half an hour after the last drop, samples of the aqueous and vitreous humors were taken and ofloxacin concentrations were measured by using HPLC.

RESULTS

The mean aqueous humor concentrations of ofloxacin in control eyes after 7 and 14 hours of instillation were: 1.45 +/- 0.93 microg/ml and 2.48 +/- 0.33 microg/ml, respectively; those in infected eyes 2.35 +/- 1. 84 microg/ml and 3.49 +/- 1.47 microg/ml, respectively. However the differences among the groups were not significant (p > 0.05). The vitreous ofloxacin concentrations in the control eyes were similar after 7 and 14 hours of instillation (0.23 +/- 0.14 microg/ml, 0.27 +/- 0.10 microg/ml, respectively). In infected eyes, the mean vitreous ofloxacin concentration after 14 hour of instillation was significantly higher than that in control eyes (p < 0.05; 0.4 +/- 0. 09 microg/ml, 0.29 +/- 0.11 microg/ml, respectively). The mean vitreous ofloxacin concentration in infected eyes after 14 hours instillation was not significantly higher than that after 7 hours instillation.

CONCLUSIONS

Topical ofloxacin instillation for 7 or 14 hours yields aqueous concentrations above the MIC(90) for common ocular pathogens. Prolonged application and the presence of inflammation increased the penetration of ofloxacin into the vitreous humor.

Axial length measurement and asteroid hyalosis

PURPOSE

To evaluate the effect of asteroid hyalosis on automated and manual A-scan axial length measurements.

SETTING

Celal Bayar University School of Medicine, Manisa, Turkey.

METHODS

A case-control study comprised 15 patients with unilateral asteroid hyalosis. The uninvolved eyes were used as controls. Axial length measurements by manual and automated A-scan biometry were performed in both eyes. The main outcome measures were comparisons between manual and automated measurements in asteroid hyalosis eyes with those in control eyes and the assessment of density of asteroid bodies on B-scan photographs.

RESULTS

Statistical analysis revealed no significant difference between axial lengths of asteroid hyalosis eyes and those in control eyes with automated (P = .524) or manual (P = .163) methods. Using automated biometry, 1 patient (7%) had a false (6.23 mm) short axial length measurement in the eye with asteroid hyalosis. There were no significant correlations between manual versus automated measurement differences and the density of the asteroid bodies.

CONCLUSIONS

The axial length of the eye without asteroid hyalosis can be used to calculate intraocular lens power if the patient has no history of clinical anisometropia.

Ofloxacin levels after intravitreal injection. Effects of trauma and inflammation

PURPOSE

This study was carried out to get an insight into the ofloxacin elimination after intravitreal injection in rabbits. We also studied the effects of trauma and inflammation on the vitreous ofloxacin levels after intravitreal injection of ofloxacin.

METHODS

A penetrating eye injury in the right eye was inflicted on 24 rabbits and another 12 animals were used as control. A standardized intraocular inflammation was induced by intravitreal injection of a suspension of Staphylococcus aureus in half of the traumatized eyes. Ofloxacin (200 microg/0.1 ml) was injected into the midvitreous cavity of both traumatized and control right eyes, and samples were obtained at 2, 8, 24 and 48 h after injection. Drug concentrations were measured using high-pressure liquid chromatography analysis.

RESULTS

Vitreous levels of ofloxacin were above the MIC(90) at 2 and 8 h in all groups for most of the common microorganisms causing endophthalmitis and also at 24 h in traumatized-infected eyes. At the second hour, the mean vitreous concentrations of ofloxacin both in traumatized and traumatized-infected eyes were lower than that in the control eyes (p < 0.05). At 8 h, the mean vitreous concentrations of ofloxacin in the traumatized and in the traumatized-infected eyes were higher than that in the control eyes (p < 0.05). At 24 h, the mean ofloxacin concentration was higher in the traumatized-infected eyes than that in control (p < 0.01) and traumatized eyes (p < 0.05), and also higher in the traumatized eyes than that in the control eyes (p < 0.05). The mean ofloxacin concentrations in the traumatized and traumatized-infected eyes were significantly higher (p < 0.01) than those in the controls at 48 h. The elimination half-life of ofloxacin in the control eyes was 5.65 h and trauma and inflammation prolonged the half-life to 9.47 and 9. 72 h, respectively.

CONCLUSION

Clearance of ofloxacin is fast and appears to be reduced by trauma and inflammation. Therapeutic drug levels in traumatized-infected eyes were maintained up to 24 h. This may be an important pharmacokinetic advantage in treating endophthalmitis unless the dose used has local toxicity and allows a longer dose interval when the dose is repeated.

The effects of acetylcholine and propolis extract on corneal epithelial wound healing in rats

PURPOSE

To investigate the effects of topical acetylcholine and topical administration of propolis, a natural beehive product, on corneal epithelial wound healing.

METHODS

The whole corneal epithelium was debrided in 42 eyes of 21 rats by mechanical scraping with a dulled scalpel blade. Animals were divided into three groups. Group 1 received topical 1% water extract of propolis (WEP), group 2 received topical acetylcholine (ACh), and group 3 (control group) received topical phosphate-buffered saline, 6 times a day for 3 days, starting immediately after debridement. The area of the corneal epithelial defect was stained with fluorescein, photographed, and then measured every 12 h. The mean epithelial defect area and the mean percentage of epithelial defect remaining at each follow-up were compared between the groups.

RESULTS

The mean epithelial defect area and the mean percentage of epithelial defect remaining at each time were significantly smaller (p < 0.001, p < 0.05, respectively) in the ACh and propolis groups as compared with control groups. There was no statistically significant difference between the propolis or ACh groups at any time (p > 0.05). At 72 h, the mean percentage of defect remaining was 2.58% in the ACh group, 1.3% in the propolis-treated group, and 8.68% in the control group.

CONCLUSIONS

This study demonstrated that ACh and propolis facilitated corneal epithelial wound healing of rats. Although the mechanisms of the effect of propolis on wound healing and its clinical use still remain to be determined, ACh may have a place in the treatment of corneal epithelial injuries.

Effect of propolis on endotoxin-induced uveitis in rabbits

PURPOSE

To test the anti-inflammatory effect of propolis, a natural bee-produced compound, and compare it with corticosteroids for the treatment of endotoxin-induced uveitis (EIU).

METHODS

EIU was produced in all rabbits by unilateral intravitreal injection of 2,000 ng Salmonella typhimurium endotoxin. The animals were then divided randomly into three groups as follows: group A received no treatment (control); group B received methylprednisolone (5 mg/0.1 mL) (positive control); and group C received propolis (5 mg/0.16 mL) by anterior sub-Tenon injection at the time of uveitis induction and at 4 and 8 hours after induction. Inflammation was evaluated by clinical manifestations and by measuring the protein concentration and inflammatory cell content of the aqueous humor.

RESULTS

The clinical grade, cell count, and protein levels in the aqueous humor were: control group (6.0 +/- 0.8, 2,519 +/- 470 cells/microL, 32.9 +/- 2.4 mg/mL); methylprednisolone group (1.8 +/- 0.7, 572 +/- 137 cells/microL, 15.2 +/- 1.8 mg/mL); and propolis group (2.3 +/- 0.5, 503 +/- 124 cells/microL, 13.8 +/- 1.5 mg/mL). Statistically significant differences were recorded in the treatment groups when compared to the control group (P < .001). The effects of methylprednisolone and propolis on EIU were similar (P > .05).

CONCLUSIONS

Propolis showed significant anti-inflammatory effects on EIU in rabbits. The mechanism of its action warrants further investigation.

Penetration of topical and oral ciprofloxacin into the aqueous and vitreous humor in inflamed eyes

PURPOSE

To assess the aqueous and vitreous penetration of ciprofloxacin after topical and combined topical and oral administration and investigate the effects of inflammation on drug penetration.

METHODS

A standardized penetrating injury was made in the right eyes of 16 rabbits. Intraocular inflammation was induced by intravitreal injection of a suspension of Staphylococcus aureus in these eyes. The animals were divided into two groups according to treatment methodology: topical and topical-oral. The intact left eyes of the animals were maintained as controls. In the topical treatment group, two drops of ciprofloxacin 0.3% were instilled to both eyes every 30 minutes for 4 hours. In the topical-oral treatment group, animals were given two oral 40 mg/kg doses of ciprofloxacin at 12-hour intervals. After the last oral dose, the protocol of the topical group was applied to these eyes. Half an hour after the last drop, 100-microL samples were taken from aqueous and vitreous humor of all eyes. Drug concentrations were measured using high-pressure liquid chromatography.

RESULTS

Mean aqueous levels of ciprofloxacin in control eyes were 2.31 microg/mL (range, 1.02-6.27 microg/mL) in the topical group and 5.88 microg/mL (1.52-17.81) in the topical-oral group. Mean aqueous levels in inflamed eyes were 7.36 microg/mL (2.34-17.15) in the topical group and 14.43 microg/mL (2.18-18.66) in the topical-oral group. Mean vitreous levels in control eyes were 0.77 microg/mL (0.09-1.93) in the topical group and 1.01 microg/mL (0.49-1.57) in the topical-oral group. Mean vitreous levels in inflamed eyes were 0.95 microg/mL (0.18-1.27) in the topical group and 1.98 microg/mL (0.51-3.34) in the topical-oral group. There was no significant difference among the groups (P > 0.05). Mean aqueous levels in all eyes and mean vitreous levels in the combined topical and oral group of inflamed eyes were above the 90% minimum inhibitory concentration for most of the common microorganisms causing endophthalmitis.

CONCLUSION

There is an increase in both aqueous and vitreous humor concentrations with inflammation and with oral and topical administrations, as opposed to topical only, of ciprofloxacin. Using oral as well as topical treatment may be a beneficial method of antibiotic prophylaxis in ocular trauma once a patient has received intravenous or intravitreal therapy.

Effects of trauma and infection on ciprofloxacin levels in the vitreous cavity

OBJECTIVE

This study was designed to determine the effects of trauma and infection on vitreous ciprofloxacin levels after intravitreal injection of ciprofloxacin in rabbits.

METHODS

A penetrating injury was made in the right eyes of 24 rabbits. In the eyes of half of the traumatized animals, a standardized intraocular infection was induced by intravitreal injection of a suspension of Staphylococcus aureus. The intact left eyes of the traumatized group were maintained as controls. Ciprofloxacin (200 microg/0.1 mL) was injected into the midvitreous cavity of both eyes in all animals and samples were obtained at 2, 8, 24, and 48 hours after injection. Drug concentrations were measured using high-pressure liquid chromatography analysis.

RESULTS

At the second hour, the mean vitreous concentration of ciprofloxacin in the traumatized eyes was lower than that in control eyes (P<0.05). The mean ciprofloxacin concentrations were significantly higher (P<0.05) in the traumatized-infected eyes than were those in control or traumatized eyes at 24 and 48 hours. The elimination half-life of ciprofloxacin in control and traumatized eyes was 6.02 hours and 5.02 hours, respectively, and infection prolonged the half-life to 15.06 hours. Vitreous levels of ciprofloxacin were above the minimum inhibitory concentration (MIC90) for most of the common microorganisms causing endophthalmitis in all groups at 2 and 8 hours, but also at 24 and 48 hours in traumatized-infected eyes.

CONCLUSION

Infection appears to decrease the clearance of ciprofloxacin. Therapeutic drug levels in traumatized-infected eyes were maintained up to 48 hours. Assuming that the animal model used may have a predictive value for the drug elimination in traumatized-infected human eyes, we suggest that local administration of ciprofloxacin every 2 days may be relevant from the therapeutic perspective.

Ophthalmic findings in GAPO syndrome

BACKGROUND

The main manifestations of GAPO syndrome are growth retardation (G), alopecia (A), pseudoanodontia (P), and optic atrophy (O).

CASES

This syndrome has been described in 21 patients from 16 different families. Four cases are from Turkey and have been presented by Sayli and Gül. The purpose of our study is to document the cases from Turkey and discuss the ophthalmological and neuro-ophthalmolgical findings of these and other reported GAPO cases.

OBSERVATIONS

All patients in the literature and our 4 cases have severe growth retardation with delayed bone age in infancy, characteristic facial appearance (high and bossed forehead, midface hypoplasia), alopecia or severe hypotrichosis, and pseudoanodontia. Optic atrophy was present in 1 of our cases and in 5 previous cases. Glaucoma was present in 5 cases, including 2 of ours. Buphthalmia and keratopathy secondary to glaucoma were also observed. White eyelashes, seen only in our cases, may be a sign of "early senility."

CONCLUSIONS

Optic atrophy is not a constant finding in GAPO syndrome. Glaucoma may accompany the ocular findings. This syndrome has been attributed to either ectodermal dysplasia or the accumulation of extracellular connective tissue matrix, due to an enzyme deficiency involved in its metabolism. Current studies show that an elastin defect and secondary changes in collagen may be important in the pathogenesis of the disease.

Extrapontine myelinolysis in a nine-year-old child

Extrapontine myelinolysis in the pediatric age group is very rare. We report a nine-year-old girl with the classical clinical syndrome of pontine and extrapontine myelinolysis following liver trauma due to a traffic accident. She was referred to our hospital for further investigation of convulsions due to severe postoperative hyponatremia. She had no hypoxic event or other identifiable cause for the neurological symptoms. Neurological deterioration began about two days after correction of hyponatremia and followed a period of temporary improvement in hyponatremic encephalopathy. Diagnosis of extrapontine myelinolysis was confirmed with the identification of typical features on magnetic resonance imaging. The rapid correction of hyponatremia seemed the most likely cause since other biochemical tests including liver function tests were all within normal ranges. The long term clinical outcome was good. It is important to carefully monitor the rate of correction in electrolyte disturbances, and to consider the individual variation in response to therapy.

Evaluation of intraocular pressure and cataract formation following the long-term use of nasal corticosteroids

It is possible that corticosteroids administered via nasal spray might reach ocular structures in levels sufficient to provoke an ocular hypertensive response and cause posterior subcapsular cataracts (PSCs) in susceptible individuals. In the present study, 26 patients who had undergone endoscopic sinus surgery were evaluated prospectively with respect to intraocular pressure and PSC formation following the use of nasal steroids for at least three months. Eighteen patients (69%) self-administered 200 micrograms/day of budesonide nasal spray twice daily, and eight patients (31%) self-administered 200 micrograms/day of beclomethasone dipropionate nasal spray twice daily, for a period of three to 19 months (mean 8.8 +/- 3.6 months). Ophthalmologic examination, tonometry, visual field testing and biomicroscopic studies revealed no evidence of ocular hypertension or PSCs during postoperative follow-up. We conclude that intranasal corticosteroids can be used safely for prolonged periods without increasing the risk of ocular hypertension or PSCs.

Acquired secondary syphilis in a 6-year-old girl with no history of sexual abuse

A case of secondary syphilis acquired by nonsexual household contact in a prepubertal girl is presented.

Comparative study of the effect of ultrasound and electrostimulation on bone healing in rats

This study was performed to compare the effects of direct current with ultrasound on fracture healing. Thirty-two rats were subjected to the experiment. Each rat's right legs were used as the experimental sample, and their left legs were used as the control. Four groups were formed, each consisting of 16 ultrasound, 16 electrostimulation, 16 ultrasound control, and 16 electrostimulation control animals. Fibular osteotome was applied to the rats under anesthesia. In the electrostimulation and electrostimulation control groups, a stainless steel cathode electrode was installed in the fractured side. In the electrostimulation group, 10 microA of direct current for 30 min, using a semi-invasive method, was given one day after fracture, for 15 days. On the control side, the aforementioned protocol was followed but sham treated. The ultrasound group was treated with 0.1 W/cm2 ultrasound for 2 min every second day for 6 days after fracture (4 times). Rats were killed on the 7th and 14th days to investigate the macroscopic, radiologic, and histopathologic parameters of fracture healing. There was a difference (P < 0.05) between the electrostimulation and the electrostimulation control groups on the 7th day. There was a difference (P < 0.05) between the ultrasound and ultrasound control groups on the 14th day. After statistical evaluation of the experimental results, it was found that in both the ultrasound and the electrostimulation groups, the fracture healing had been accelerated more so than in the control groups. There was no observed statistical difference between ultrasound and electrostimulation effects.

Lymphocytic hypophysitis in a patient with Graves' disease

A case of lymphocytic hypophysitis is described in a patients with Graves' disease and diabetes mellitus. The 62-year-old man was admitted to hospital with the complaints compatible with hyperthyroidism in April 1993. His medical history, physical examination, thyroid function tests, thyroid scintigraphy and thyroid ultrasonography revealed Graves' disease. The patient had also suffered from diabetes mellitus for three years. After this, the patient's progress was not monitored for two years. The patient presented himself again in September 1995 with complaints of hypothyroidism, hypogonadism and hypoadrenalism. Hormonal investigation showed panhypopituitarism. A magnetic resonance imaging of the pituitary gland disclosed an enlarged pituitary and a thickened infundibulum. The high intensity signal of the neurohypophysis was absent. Transsphenoidal hypophysectomy was performed which revealed a grey-white, relatively avascular pituitary mass. Histology showed diffuse infiltration of the anterior pituitary by numerous lymphocytes. The neurohypophysis also showed evidence of lymphocytic infiltration. On the basis of these findings we suggest that lymphocytic hypophysitis may be associated with Graves' disease.

Construction and characterization of a hybrid mouse mammary tumor virus/murine leukemia virus-based retroviral vector

Mouse mammary tumor virus (MMTV)-based vectors are characterized by low titers. In an effort to transfer MMTV-specific regulation of gene expression to a more efficient murine leukemia virus (MLV) vector, we have replaced the complete 3' U3 region of MLV with the complete U3 region of MMTV. Virus titers were not significantly affected by this modification, there was no impairment of reverse transcription and integration, and after infection of cells, the MMTV promoter is duplicated and translocated to the 5' long terminal repeat, resulting in glucocorticoid-regulatable RNA expression.

A strange condition: postmenopausal pregnancy

Climacterium is characterized by symptoms that occur as a result of the differentiation of hormonal equilibrium. It begins around the age of 40 and continues up to the age of 60. In this period cycles are usually anovulatory. This paper presents a case which may be diagnosed as abortus incompletus despite the patient being in menopause for five years previously.

Predictive value of a 24 hour tuberculin skin test evaluation

The predictive value of induration 24 hours after administration of purified protein derivative (PPD) was examined. Altogether 1082 healthy schoolchildren were tested using 5 tuberculin units of PPD. Induration was measured at 24, 48, and 72 hours. At 24 hours, induration of any size had a relatively low positive predictive value (63%), although indurations > 5 mm had a higher (86%) positive predictive value.

Castleman's disease. A case report

Angiofollicular lymph node hyperplasia or Castleman's Disease (CD) is a rare lymphoproliferative disorder that manifests itself as a local or generalized tumor-like condition affecting both lymph nodes and non-nodal tissues, usually in the chest and abdomen. Hyaline vascular and plasma cell types have been identified histologically. A new clinical form of CD with multisystemic involvement has been defined as multicentric Castleman's disease. It is very rare in childhood. In this paper we present an eight-year-old boy with multicentric Castleman's disease.

Development of collaterals in intermittent and permanent ischemia of the liver

The ischemia caused by the hepatic dearterialization as therapy for hepatic malignancies is transient because of the rapid formation of collaterals. In order to prevent this transient repeated ischemia has been suggested. An experimental study was planned to compare the collateral occurrence in persistent ischemia and transient repeated ischemia of the liver. Fourteen dogs (seven persistent ischemia, seven transient repeated ischemia) were used in this study. Hepatic dearterialization were performed in both groups. In the first group (persistent ischemia), the hepatic artery was ligated proximal to the gastroduodenal artery. In the second group (transient repeated ischemia), the hepatic artery was occluded externally in the same region as the first group by means of a device modified from 8 guage Foley catheter and after occlusion for one hour it was reopened. Occlusions were repeated twice in a day. Five dogs in the first group and six dogs in the second group completed a three week ischemia period and angiography were then performed in all. The dogs were sacrificed after the angiography and examined for possible abscess formation, arterial thrombosis, peritoneal adhesions and liver necrosis. After angiography, the two groups were also examined for collateral occurrence. Only one collateral occurred in the transient repeated ischemia group, but in the persistent ischemia group, collaterals occurred in all dogs. This difference between two groups is statistically significant (Fischer Absolute Chi Square Test, p = 0.013). Transient repeated ischemia is superior to persistent ischemia because of fewer collaterals, but in practise, total dearterialization of the liver is impossible.

Carcinoid syndrome due to a malignant somatostatinoma

Somatostatinoma is one of the rarest tumours of the endocrine pancreas. Cardinal manifestations of a somatostatinoma include gallstones, mild diabetes mellitus, steatorrhoea, diarrhoea and dyspepsia. Like any other pancreatic islet cell carcinoma, a somatostatinoma may also produce several different hormones such as adrenocorticotropic hormone, calcitonin, vasoactive intestinal polypeptide, pancreatic polypeptide, gastrin, insulin, and glucagon. In many cases, the clinical picture is dominated by the effect of these other hormones. We present a patient with somatostatinoma in which an immunocytochemical study of the specimens from pancreas and liver showed a weak positive reaction for gastrin besides a strong positive reaction for somatostatin. Interestingly, this patient also showed the signs of carcinoid syndrome which was successfully treated with octreotide.

Hepatitis B seroprevalence among children in a Turkish hospital

Hepatitis B surface antigen (HBsAg) and antibodies to HBsAg (anti-HBs) were examined using enzyme-linked immunosorbent assay methods in 1316 patients from Onkoduz Mayis University Children's Hospital to investigate the epidemiology of hepatitis B in children from our region. The age range was from one month to 16 years. Seroprevalence of HBsAg and anti-HBs was 3.2 and 13.3%, and increased with age. None of the children had received hepatitis B vaccine. Hepatitis B is an important health problem in our region, and all children should be vaccinated.

Limbal-conjunctival autograft transplantation in cases with recurrent pterygium

This prospective study was undertaken to evaluate limbal conjunctival autotransplantation in the management of cases with recurrent pterygium. At present, new surgical techniques to prevent pterygium recurrence following surgery are in investigation. In recent years, it has been postulated that pterygium is due to hypofunction of limbal stem cells. Thirty-one out of 49 patients with recurrent pterygium were treated by limbal-conjunctival autograft transplantation and the other 18 treated by Czermak technique, including two line of limbal cauterization intraoperatively, and used as a control group. During a mean follow-up period of 10 months (ranging 3-18 months), 4 recurrences (13.3%) in the limbal-conjunctival autograft transplantation group and 9 recurrences (50%) in the control group were observed. We conclude that this was a successful method to prevent secondary recurrence in the management of recurrent pterygium patients under 40 years of age.

Prevention of adhesions after laminectomy: an experimental study in dogs

An experimental study was designed to compare the efficacy of Vicryl mesh and autogenous fat in minimizing postoperative epidural scar formation. Three-level noncontiguous laminectomies were performed on ten adult dogs. Exposed dura at the three levels was covered with (1) nothing (control group), (2) fat, and (3) Vicryl mesh. Animals were sacrificed 6 and 12 weeks postoperatively and the specimens were examined histologically. Compared with the use of free fat grafts after laminectomy in dogs, Vicryl mesh produced slightly more scarring, but consistently less than observed in controls. Although no surgical zone treated with Vicryl mesh exhibited evidence of neural compression, one of the ten fat-grafted zones showed gross evidence of neural compression. These findings indicate that the use of Vicryl mesh at laminectomy sites may be an alternative method of minimizing postoperative epidural scar formation.

Acute adrenocortical failure due to tuberculosis

A 55-year-old woman presented with acute adrenal failure, active pulmonary tuberculosis and an enlarged adrenal mass which was subsequently removed surgically. Histopathologic examination disclosed adrenal tuberculoma. It was concluded that tuberculosis might result not only in chronic adrenocortical insufficiency but also in acute adrenal failure.