CHANGE OF SURGICALLY INDUCED CORNEAL ASTIGMATISM AND POSITION OF ARTIFICIAL INTRAOCULAR LENS OVER TIME

AIMS

To analyze changes in surgically induced corneal astigmatism and articial intraocular lens (IOL) stability over time following cataract surgery. To compare the interchangeability of measurements between an automatic keratorefractometer (AKRM) and a biometer.

MATERIAL AND METHODS

In this prospective observational study, the above-mentioned parameters were collected from 25 eyes (25 subjects) on the first day, first week, first and third month after uncomplicated cataract surgery. We used IOL-induced astigmatism (difference between refractometry and keratometry) as an indirect indicator of IOL stability change. We used the Blant-Altman method to analyze consistency between devices.

RESULTS

At the above time points, surgically induced astigmatism (SIA) decreased as follows: 0.65 D; 0.62 D; 0.60 D and 0.41 D (in the first day, week, month and third month respectively). Astigmatism induced by changes of the position of the IOL varied as follows: 0.88 D; 0.59 D; 0.44 D and 0.49 D. Changes in both parameters were statistically significant (p0.05).

CONCLUSION

Both surgically induced astigmatism and astigmatism induced by IOL decreased over time, in which both changes were statistically significant. The decrease in SIA was most pronounced between the first and third month after surgery. For IOL-induced astigmatism, the greatest decrease was within the first month after surgery. The differences in measurement between the biometer and AKRM were statistically insignificant, but the clinical interchangeability between the given methods is questionable, especially with regard to measurement of the astigmatism angle.

Use of Corneal Topography in Pediatric Ophthalmology

AIM

To introduce the topic of pediatric keratoconus, highlighting the importance of routine corneal topography and tomography in children and adolescents from predisposed groups. To attempt to ensure the early detection of keratoconus and its subclinical form, enabling early treatment, which brings better expected postoperative results.  Material and methods: Using the corneal tomograph Pentacam AXL we examined children and adolescents with astigmatism equal or greater than  2 diopters (in at least one eye) and patients with at least one risk factor such as eye rubbing in the case of allergic pathologies, positive family history of keratoconus or certain forms of retinal dystrophy. In total, we included 231 eyes (116 patients), of which 54 were girls and 62 were boys.

RESULTS

The Belin-Ambrósio deviation index parameter was evaluated, in which we classified a total of 41 eyes as subclinical keratoconus and 12 eyes as clinical keratoconus. Next, the corneal maps were evaluated individually, in which we included a total of 15 eyes as subclinical keratoconus and 6 eyes as clinical keratoconus. In our group, compared to the control group, subclinical and clinical keratoconus occurred most often in the group of patients with astigmatism and in the group of so-called "eye rubbers". After individual evaluation, keratoconus occurred more frequently in boys than in girls in our cohort.

CONCLUSION

Most patients with keratoconus are diagnosed when there is a deterioration of visual acuity and changes on the anterior surface of  the cornea. Corneal topography and tomography allows us to monitor the initial changes on the posterior surface of the cornea, and helps us to detect the subclinical form of keratoconus and the possibility of its early treatment. Therefore, it is important to determine which groups are at risk and groups in which corneal topography and tomography should be performed routinely.

AB0614 Late-onset neutropenia after rituximab treatment in patients with ANCA-associated systemic vasculitis: a retrospective analysis of a register-based patient cohort

Background

Anti-B-cell therapy with rituximab (RTX) plays an important role in the induction and maintenance therapy of ANCA- associated vasculitis (AAV). Late-onset neutropenia (LON) has been reported following RTX therapy.

Objectives

Based on a retrospective analysis of the register of AAV patients (pts) treated with RTX, to study the incidence and outcomes of LON.

Methods

140 AAV pts (median age 52 (20-83) years, 57% women) were treated with RTX between 2009 to 2021: 63 with granulomatosis with polyangiitis (GPA), 45 microscopic polyangiitis (MPA), 24 eosinophilic granulomatosis with polyangiitis (EGPA), and 8 unclassified AAV. The median total dose of RTX was 3.5 (0.5-45) g. As a rule, single 500-mg infusions were used with an interval of 4-6 months for retreatment courses. The duration of follow-up exceeded 6 months after the first dose of RTX. Regular pts monitoring every 3 months included estimation absolute neutrophil count (ANC). LON was defined as unexplained neutropenia occurring 3 weeks after the last RTX infusion.

Results

LON I-IV grade was noted in 16 (11.4%) AAV pts: 6 GPA, 4 MPA, 4 EGPA, and 2 unclassified AAV. In 7 out of 16 cases (43.7%) LON developed after the first course of RTX. Neutropenia grade I was observed in 3 pts (ANC 1.68-2.0x109/l, 2-15.5 months after the last RTX infusion), grade II - in 4 patients (1.1-1.5x109/l, 3-9 months after RTX). Neutropenia grade I-II resolved independently, without adverse reactions. LON grade IV was noted in 9 pts (0.06-0.3x109/l, 1.1-11 months after RTX), 3 of them received leukopoiesis-stimulating drugs with normalization of ANC. In one EGPA pt febrile LON grade IV developed twice (in 2017, 11 months after RTX; in 2019, 4 months after RTX and complicated by uterine bleeding). Fatal outcome occurred in 5 out of 16 cases (31.2%): 1 MPA, 3 GPA, and 1 EGPA. In 3 fatal cases LON was complicated by pneumonia (in 2 with septic shock), in one with acute myocardial infarction and another one with progression of chronic renal failure. According to our registry, the total mortality among 140 AAV pts receiving RTX was 11.4%, while 5 of 16 fatal cases (31.2%) had LON grade IV. Three of the 5 death were noted in 2013-2014, which attributed to the use of cyclophosphamide >2 gm before RTX, as well as insufficient awareness of the risk of LON, which contributed to the delay in control of a full blood count, untimely diagnosis of LON and late treatment. At the beginning, the original drug Mabthera was used, while after 2014 biosimilar Acellbia was mainly used.

The disadvantages of this study: the lack of information about the ANC in 4 cases with COVID-19 and fatal outcome.

Conclusion

LON after RTX therapy can develop in 11.4% of AAV pts, which exceeds the data for rheumatoid arthritis (1,3-3%) [1,2]. Our register data are lower than the rate of LON in AAV, presented by D. Tesfa et al. (23%) [1], which could be affected by the use of low-dose RTX for retreatment courses. LON accounts for a significant part in the structure of deaths of AAV pts (31.2%). It needs to careful monitoring of ANC in pts receiving RTX and awareness of both pts and physicians about the risk of LON.

References

[1]Tesfa D, Ajeganova S, Hägglund H, et al. Late-onset neutropenia following rituximab therapy in rheumatic diseases: association with B lymphocyte depletion and infections. Arthritis Rheum. 2011;63(8):2209-14.

[2]Salmon J.H., Cacoub P., Combe B., et al. Late-onset neutropenia after treatment with rituximab for rheumatoid arthritis and other autoimmune diseases: data from the Autoimmunity and Rituximab registry. RMD Open.2015; 1.

Disclosure of Interests

None declared

SARS-COV-2 PANDEMIC FROM THE OPHTHALMOLOGIST`S PERSPECTIVE. A REVIEW

In December 2019, a novel coronavirus (CoV) epidemic, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) emerged from China. Coronaviruses belong to enveloped ssRNA viruses and are classified into four genera: Alpha coronavirus, Beta coronavirus, Gamma coronavirus and Delta coronavirus. It is assumed that SARS-CoV-2 is spread primarily during a personal contact via bigger respiratory droplets. These droplets with viruses can be directly inhaled by other people or can lend on the surfaces with the possibility of further spreading. The ocular surface has been suggested as one of possible infection entries. Human eye has its own renin-angiotensin system with present ACE2 receptors, which bind the virus through spike protein. The most common symptoms of the SARS-CoV-2 infection are fever, cough and dyspnoea. Several clinical entities, such as conjunctivitis, anterior uveitis, retinitis, and optic neuritis have been associated with this infection. The most common ophthalmologic symptom associated with COVID-19 disease is conjunctivitis. Some studies indicate that eye symptoms are commonly present in patients with severe COVID-19 pneumonia and that it is possible to detect viral RNA from the conjunctival sac of these patients. In ophthalmologic praxis, we manage not only the therapy of the eye structures` inflammation in relation with this infection, but also the overall management of the visits and the supervision of the patients who are at risk and positive for coronavirus. Ophthalmologists could potentially have a higher risk of SARS-CoV-2 infection due to personal communication with the patients, frequent exposure to tears and eye secrets and the use of devices. We would like to provide an ophthalmologist`s perspective on this topic.

ENDOTHELIAL CELL LOSS AFTER PARS PLANA VITRECTOMY

AIMS

To analyse the changes in endothelial cell density (ECD) after pars plana vitrectomy (PPV) and to identify the factors implicated.

PATIENTS AND METHODS

This was a prospective, consecutive, and non-randomised, case-control study. All 23-gauge vitrectomies were performed by a single surgeon at a tertiary centre. ECD was measured at baseline before surgery and on postoperative Days 30, 90, and 180. The fellow eye was used as the control eye. The primary outcome was a change in ECD after PPV.

RESULTS

Seventeen patients were included in this study. The mean age of the patients was 65 years. The mean ECD count at baseline was 2340 cells/mm2. The median ECD loss in the vitrectomised eye was 3.6 %, 4.0 %, and 4.7 % at Days 30, 90, and 180, respectively, compared to +1.94 %, +0.75 %, +1.01 %, respectively, in the control eye. The relative risk of ECD loss after PPV was 2.48 (C.I. 1.05-5.85, p = 0.0247). The pseudophakic eyes lost more ECD than the phakic eyes, but this was not statistically significant. There were no significant differences in diagnosis, age, surgical time, or tamponade used after surgery.

CONCLUSIONS

Routine pars plana vitrectomy had an impact on the corneal endothelial cells until Day 180 post-op. The phakic status was slightly protective against ECD loss after PPV, although it was not statistically significant. The pathophysiology of corneal cell damage after routine PPV remains unclear. Further studies are required to confirm these findings.

PUPILLOTONIA AND ADIE SYNDROME

The aim of the work is to approach the examination of the pupil with a focus on anisocoria, its characteristics and approach to the diagnosis of pupillotonia and Adie's syndrome and its clinical evaluation. Pupil function is important not only in neurophthalmological examination but also in general ophthalmological examination. First of all, we need to know how the reflex arc works in order to be able to exclude or confirm whether the parasympathetic or sympathetic is affected. It is also necessary to know the exact characteristics of the pupil, such as size, shape, placement, function and reaction to light and at close range. Only on this basis can we distinguish pathological features. We do not often encounter this diagnosis, but it is necessary to keep it in mind, especially in the field of neurophthalmology but also in general ophthalmology. We also present three cases of pupilotonia and Adie's syndrome, which we diagnosed at the Department of Ophthalmology, Faculty of Medicine, Comenius University, after the patient himself came by emergency admission or was sent directly to ophthalmology clinic. In the discussion, we present various other diagnoses, where the reflex arc may not be affected, but the pathological pupil is caused by intraocular tumors, general systemic diseases and, last but not least, local therapy or alkaloids.

P5545Predictors of 10-year mortality and re-intervention in patients with multivessel coronary disease, reduced systolic left ventricular function, after complete revascularization by PCI or CABG

Introduction

In patients with multivessel coronary disease, the decision on revascularization should be made through a heart team. Whether there is an optimal method and what are the predictors of mortality and repeated interventions is the subject of numerous studies.

Purpose

To determine what are the predictors of 10-year mortality and repeated interventions in patients with multivessel coronary disease and reduced systolic left ventricular function in which complete revascularization is done through percutaneous coronary intervention (PCI) and surgical aortocoronary bypass (CABG).

Methods

The survey included 178 patients who underwent elective revascularization of multivessel coronary disease in one center during 2008 through PCI or bypass, according to the heart team's decision. All subjects had a reduced left ventricular systolic function, ejection fraction less than 50%. The study excluded patients with acute coronary syndrome. The basic demographic and clinical characteristics of the subjects and risk factors were analyzed.

Results

Ten-year mortality was 31.4%, without a significant difference between the examined groups (in the PCI group 25 patients (30.5%) in the bypass group 30 (32.3%), p>0.05). In subjects with letal outcome during 10-year follow-up, lower hemoglobin levels in discharge, enlarged cardiac cavities, increased internal diameter of left ventricle in systole (LVIDs) and enlarged left atrium, lower systolic left ventricular function, higher EUROscore and higher NYHA class in discharge. The enlarged left ventricular diameter in systole (OR 2.28 (1.27–4.11), p=0.006) and the NYHA class (OR 2.49 (1.22–5.08), p=0.012) are independent predictors ten-year mortality. In the group of patients undergoing surgical revascularization, independent predictors of 10-year mortality are higher levels of uric acid (OR 1,006 (1,000–1,011), P=0,047) and lower serum hemoglobin at discharge (OR 0,959 (0,919–0,999), P=0.046), while in PCI group LVIDs (OR 2.89 (1.351–6.196), p=0.006). During the 10-year follow-up, repeated PCI was performed in 12 (14.5%) patients in the PCI group and in 3 (3.2%) patients in the CABG group, p=0.012. No surgical revascularization was performed during follow up. Diabetes mellitus is an independent predictor of reintervention in the PCI group (OR 4.12 (1.153–14.703), p=0.029).

Conclusion

Mortality predictors during ten years of follow-up in subjects following a revascularization of multivessel coronary disease, and with reduced left ventricular systolic function, are increased systolic left ventricular diameter and higher NYHA class in discharge. Reintervention is more commonly performed after PCI and the presence of diabetes mellitus is an independent predictor.

EFFECT OF MULTIPLE VARIABLES ON THE REFRACTIVE ERROR AFTER CATARACT SURGERY

PURPOSE

To analyze refractive results after cataract surgery in relation to used type of monofocal intraocular lens, calculation formula, to age, gender and laterality.

SETTINGS

Department of Ophthalmology, Comenius University and University hospital in Bratislava, Slovakia Methods: We analyzed 173 eyes (118 patients) after uneventful cataract surgery. We calculated prediction error (PE) and mean absolute error (MAE) of postoperative refraction.

RESULTS AND CONCLUSION

We found no statistically significant differences in PE and MAE in relation to types of used IOL, calculation formulas, gender, age or laterality. Key words: Optical biometry, monofocal IOL, IOL calculation, refractive error.

Sleep and disruptive mood dysregulation disorder: A pilot actigraphy study

OBJECTIVE

To explore the clinical characteristics and motor activity profile during sleep periods of children and adolescents presenting with disruptive mood dysregulation disorder (DMDD).

METHOD

Twenty-one youths (mean age±standard deviation, 11.7±3 years) wore a wrist actigraph for 9 consecutive days (including both school days and non-school days), to measure sleep parameters: sleep latency, sleep efficiency and the number and duration of periods of wakefulness after sleep onset (WASO). We divided the night-time actigraphy recording sessions into three sections and compared the first and last thirds of the night.

RESULTS

All the study participants had a psychiatric comorbidity (primarily attention deficit hyperactivity disorder, depressive disorder or anxiety disorder). On non-school days, bedrest onset and activity onset were shifted later by about 1h. There was no significant difference between school days and non-school days with regard to the total sleep time. Sleep efficiency was significantly greater on non-school days. Sleep was fragmented on both school days and non-school days. The mean number of episodes of WASO was 24.9 for school days and 30.9 for non-school days. Relative to the first third of the night, we observed a significantly greater number of episodes of WASO during the last third of the night, a period associated with a larger proportion of rapid eye movement (REM) sleep.

DISCUSSION

Sleep appeared to be fragmented in the study population of youths with DMDD. The greater frequency of WASO in the last third of the night points to a possible impairment of the motor inhibition normally associated with REM sleep.

Combination of Intravitreal Corticosteroid with Anti-vegf in Macular Edema Secondary to Retinal Vein Occlusion

PURPOSE

functional and anatomical results after combination of intravitreal dexamethasone implant with anti-VEGF bevacizumab in macular edema secondary to retinal vein occlusion.

METHODS

Retrospective analysis of 50 patients, average age 72 years, 15 men and 35 women. Inclusion criteria for treatment were retinal vein occlusion, best corrected visual acuity (BCVA) more than 20/200 and macular edema more than 250 μm. Algorithm of treatment was dexamethason, anti-VEGF (bevacizumab), dexamethason. Application of anti-VEGF bevacizumab was in interval between two applications of dexamethasone, for the first time in every patient. If there were nonperfusion areas on fluoresceine angiography (FA), or ischemia on slit lamp, repeatedly. Patients observed for 12 months at least. This cohort included patients with branch retinal vein occlusion together with central retinal vein occlusion. This is an evaluation of nonperfusion areas based on FA, BCVA, macular edema on optical coherence tomography (OCT) and number of reapplication of anti-VEGF bevacizumab. Observed adverse effects are elevation of intraocular pressure and number of patients who underwent cataract surgery.

RESULTS

The gain of 8 letters in 1st month after 1st application of dexamethasone, central retinal thickness (CRT) reduced from 512 μm to 318 μm in average. 33 patients get 1, 3 patients get 2 and 14 patients 3 injections of bevacizumab. On the day of 2nd application of dexamethasone, in 7th month in average, the CRT increased on 465 μm, and 1th month after, the gain from the baseline was 10 letters and CRT reduced on 380 μm. All the patients were phackic at the baseline, 18 (36 %) patients underwent cataract surgery with intraocular lens implantation. Transient elevation of intraocular pressure in 15 (30 %) eyes, treated by local therapy.

CONCLUSION

Combination of intravitreal dexamethasone implant with anti-VEGF bevacizumab is functionally and anatomically effective. Key words: retinal vein occlusion, macular edema, dexamethasone, bevacizumab.

Thermal dissociation of ions limits the degree of the gas-phase H/D exchange at the atmospheric pressure

We present the application of the extended desolvating capillaries for increasing the degree of the gas-phase hydrogen/deuterium exchange reaction at atmospheric pressure. The use of the extended capillaries results in the increase of the time that ions spend in the high pressure region, what leads to the significant improvement of the efficiency of the reaction. For the small protein ubiquitin, it was observed that for the same temperature, the number of exchanges increases with the decrease of the charge state so that the lowest charge state can exchange twice the number of hydrogen than the highest one. With the increase of the temperature, the difference decreases, and eventually, the number of exchanges equalizes for all charge states. The value of this temperature and the corresponding number of exchanges depend on the geometric parameters of the capillary. Further increase of the temperature leads to the thermal dissociation of the protein ion. The observed b/y fragments are identical to those produced by collision-induced dissociation performed in the ion trap. Copyright © 2017 John Wiley & Sons, Ltd.

Prevalence of refractive errors in the Slovak population calculated using the Gullstrand schematic eye model

PURPOSE

A substantial part of the population suffers from some kind of refractive errors. It is envisaged that their prevalence may change with the development of society. The aim of this study is to determine the prevalence of refractive errors using calculations based on the Gullstrand schematic eye model.

METHODS

We used the Gullstrand schematic eye model to calculate refraction retrospectively. Refraction was presented as the need for glasses correction at a vertex distance of 12 mm. The necessary data was obtained using the optical biometer Lenstar LS900. Data which could not be obtained due to the limitations of the device was substituted by theoretical data from the Gullstrand schematic eye model. Only analyses from the right eyes were presented. The data was interpreted using descriptive statistics, Pearson correlation and t-test. The statistical tests were conducted at a level of significance of 5%.

RESULTS

Our sample included 1663 patients (665 male, 998 female) within the age range of 19 to 96 years. Average age was 70.8 ± 9.53 years. Average refraction of the eye was 2.73 ± 2.13D (males 2.49 ± 2.34, females 2.90 ± 2.76). The mean absolute error from emmetropia was 3.01 ± 1.58 (males 2.83 ± 2.95, females 3.25 ± 3.35). 89.06% of the sample was hyperopic, 6.61% was myopic and 4.33% emmetropic. We did not find any correlation between refraction and age.

CONCLUSION

Females were more hyperopic than males. We did not find any statistically significant hypermetopic shift of refraction with age. According to our estimation, the calculations of refractive errors using the Gullstrand schematic eye model showed a significant hypermetropic shift of more than +2D. Our results could be used in future for comparing the prevalence of refractive errors using same methods we used.Key words: refractive errors, refraction, Gullstrand schematic eye model, population, emmetropia.

Abstract P2-09-18: Exploration of the diagnostic utility of next generation sequencing with TruSight cancer panel for BRCA negative hereditary breast and ovarian cancer patients

Background. Breast cancer is the most commonly diagnosed malignancy and the most frequent cause of death in women due to cancer. About 5% to 10% of breast cancers are thought to be hereditary. Pathogenic mutations in BRCA1/2 genes across Hereditary Breast and Ovarian Cancer (HBOC) patients estimates are at around 15-20%. Other less common genes have also been associated with an increased risk of developing breast cancer, such as mutations in the TP53, PTEN, RAD51C, CDH1, ATM, CHEK2 or PALB2 tumor suppression genes. NGS based sequencing panels allow fast and simultaneous screening of large number of high- and low-penetrance susceptibility genes in these patients.

Methods. In the current study we included a group of 31 Bulgarian female breast cancer patients, selected following the strict BCLC and NCCN criteria for hereditary cancer. All of them were prescreened by direct sequencing and MLPA analysis, and tested negative for pathogenic mutations in BRCA1 and BRCA2 genes. Next generation target resequencing using a panel of 94 cancer related genes (Illumina TruSight cancer panel) was performed to explore the hereditary component beyond BRCA1/2 genes in these patients. All detected mutations and variants of unknown clinical significance (VUSs) were confirmed by Sanger sequencing method.

Results. Pathogenic and likely pathogenic mutations were found in 14 out of 31 BRCA1/2 negative patients: 1 new frameshift mutation in ATM gene; 6 new likely pathogenic missense mutations in PTCH1, RAD51C, MET, MUTYH, ATM and CHEK2; 7 previously reported pathogenic missense variants in WRN, ERCC4, PALB2, PRF1, RET, SDHB and AIP genes. In addition 27 VUSs (one new splice donor variant in ALK gene and 26 missense variants) were found.

Conclusions. The use of next generation target resequencing with TruSight Cancer panel lead to identification of clinically relevant pathogenic variants in 45% of the investigated patients. This could be the preferred diagnostic method in HBOC patients, carefully selected according the strict BCLC and NCCN criteria.

Citation Format: Dacheva D, Dodova R, Mitkova A, Kamenarova K, Tzveova R, Popov I, Vlahova A, Taushanova – Hadjieva M, Valev S, Dikov T, Timcheva K, Christova S, Mitev V, Kaneva R. Exploration of the diagnostic utility of next generation sequencing with TruSight cancer panel for BRCA negative hereditary breast and ovarian cancer patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-09-18.

The role of the confined water in the dynamic crossover of hydrated lysozyme powders

This work presents combined dielectric and calorimetric measurements of hydrated lysozyme powders with different levels of hydration in a broad temperature interval.

[Bilateral pneumothorax, cervicofacial and mediastinal emphysema after surgical tracheostomy]

Tracheotomy is a surgical procedure for various indications, such as ventilator dependence and airway obstruction. Reported rates in the literature of complications of tracheostomy vary widely. We report an unusual presentation of serious complication after surgical tracheostomy. The correct timing of tracheostomy is still controversial in the literature. A 74-year-old male had emergency surgical tracheostomy under general anesthesia. At the end of the procedure, in recovery room, he developed subcutaneous emphysema of the eyes. There was no pneumothorax seen on chest X-ray. Bronchoscopic examination through the tracheostomy tube showed no evidence of damage to the posterior tracheal wall. Three hours later patient had difficulty breathing requiring sedation with respiratory assistance. X-ray of the chest at this stage showed a right pneumothorax and extensive subcutaneous emphysema of the chest wall. Pneumothorax was managed using a chest tube. Two days after, a control CT scan of the chest showed a left pneumothorax and pneumomediastinum. The pneumothorax was managed using a chest tube. Bronchoscopic examination showed no obvious lesion in the tracheobronchial tree. The patient was treated successfully with supportive care and large doses of antibiotic to prevent mediastinitis. Seven days later, recovery was rapid and complete and CT scan of the chest was completely normal. The patient was discharged from the hospital on the 13th postoperative day. This case illustrates that complications occurring after surgical tracheostomy could be dramatic. Management of tracheotomy is important to prevent complications. There is still debate on optimal timing of tracheotomy. The last three trials have shown no interest to perform an early tracheotomy, neither in terms of vital prognosis nor in terms of the duration of mechanical ventilation.

[Unanticipated difficult extubation]

Complications at extubation remain an important risk factor in anaesthesia. Airway related complications at extubation are relatively frequent but are usually dealt with by simple basic measures. We report a new case of respiratory complications associated with tracheal extubation in a 59-year-old woman. Her medical history included obesity, no criteria difficult intubation and no adverse events during her previous anesthetic procedures. At the end of surgery, immediately after extubation, the patient developed respiratory distress requiring reintubation. A second extubation performed in postoperative recovery room was complicated by a new respiratory distress with reintubation. The patient was then admitted to the ICU. The examination on admission was unremarkable. Chest X-ray and a chest CT scan were performed in search of an etiology. Both tests showed a large thyroid "goitre plongeant" (plunging goiter) and compressive. In the suites, a thyroidectomy was performed with excision of a large cervical plunging goiter para- and retropharyngeal bilateral chest, allowing extubation successfully. The postoperative course was uneventful.

Expression of dUTP nucleotidohydrolase (dUTPase) and thymidylate synthase (TS) in stage III colon cancer patients treated with either bolus 5-FU or infusional 5-FU in the adjuvant setting: Results of a translational study of the PETACC-2 trial

417

Background: Pts with stage III colon cancer have been treated with either infusional 5-FU or bolus 5- FU in the adjuvant setting (PETACC-2 trial). DUTPase and TS demonstrated potential as predictive markers for 5-FU efficacy in pts with advanced colorectal cancer. Here we aimed to explore whether TS or dUTPase protein levels may predict recurrence of disease for stage III colon pts treated with 5-FU.

Methods: Tumor (T) blocks of 324 pts were analyzed for protein expression of dUTPase and TS. For analysis monoclonal antibodies DUT415 and TS106 were used. T were evaluated by two investigators as follows. Only nuclear staining for both, TS and dUTPase, was analyzed. If tumor cells (TC) showed a nuclear dUTPase expression in >10% of cells, the sample was scored positive. Positive nuclear staining for >20% of TC, when using the TS antibody, determined a positive sample.

Results: Analysis for dUTPase was successful in 308 samples (95.1%, 308/324). 263 out of those 308 pts showed a positive dUTPase expression (85.3%). 297/324 samples (91.7%) could be evaluated for TS. In the TS group 62.3% (185/297) showed a positive expression for TS protein. In 281 cases analyses were successful for both TS and dUTPase. We observed a significant association between dUTPase and TS expression with a majotity of 71.4% (172/241) dUTPase positive T also being positive for TS as compared to 32.5% (13/40) of dUTPase negative T that showed positivity for TS protein expression (p< 0.0001). Of pts with dUTPase positive T 64.7% showed no recurrence of disease as compared to 44.7% of those with dUTPase negative T 5 years after completion of therapy (HR 0.61 [95% CI 0.36, 1.03], p=0.06). No associations between TS and DFS were observed. Both TS and dUTPase expression did not correlate with OS in this patient cohort.

Conclusions: High TS protein levels appeared to be significantly correlated with high protein levels of dUTPase in stage III colon cancer pts. Neither dUTPase nor TS protein levels appeared to be significantly associated with DFS or OS of stage III colon cancer pts that received adjuvant chemotherapy with 5-FU.

No significant financial relationships to disclose.

Strontium hexaferrite nanomagnets suspended in a cosmetic preparation: a convenient tool to evaluate the biological effects of surface magnetism on human skin

BACKGROUND/PURPOSE

Magnetic therapy has been popular for ages, but its therapeutic abilities remain to be demonstrated. We aimed to develop a homogeneous, stable dispersion of magnetic nanoparticles in a skin-care preparation, as a tool to analyze the biological and physiological effects of superficial magnetism in skin.

METHODS

SrFe(12)O(19) nanoparticles were generated by ultrasound, dispersed in glycerol, stabilized in Dermud cream and permanently magnetized. The magnetic cream was applied on the epidermis of human skin organ cultures. The effects on UV-induced cell toxicity, apoptosis and inflammatory cytokine expression were analyzed. A clinical test was performed to check skin moisturization.

RESULTS

Nanomagnets were found to be homogenously and stably dispersed. After magnetization, the preparation generated a magnetic field of 1-2 G. Upon cream application, no cytotoxicity and no impairment of cellular vitality were found after 24 and 48 h, respectively. The anti-apoptotic and anti-inflammatory properties of Dermud were not modified, but its long-term effect on moisturization in vivo was slightly increased.

CONCLUSION

Nanomagnetic Dermud cream can be used as a tool to analyze the biological effects of nanomagnets dispersed on the skin surface at the cellular and molecular levels, thus allowing to explore the possible therapeutic uses of superficial magnetism for skin care.

Monitoring levels of nephrotoxicity of different aminoglycosides during febrile neutropenia caused by nephrotoxic chemotherapy: a single centre study

PURPOSE

To investigate the possible existence of increased nephrotoxicity caused by once-daily aminoglycosides in febrile neutropenic patients who were previously treated with cisplatin-based nephrotoxic chemotherapy.

METHODS

Thirty-one patients with metastatic tumors received chemotherapy and, as a result, developed febrile neutropenia. Patients were stratified with regard to chemotherapy with cisplatin (n=15) or without cisplatin (n=16). Both groups received i.v. empiric antibiotic treatment which included combinations of once-daily aminoglycosides (amikacin vs. gentamicin) with beta-lactams.

RESULTS

Increased nephrotoxicity due to administered aminoglycosides appeared significantly more frequently (p<0.05) in patients who received cisplatin-based chemotherapy. Increased nephrotoxicity differed significantly between various aminoglycosides regimens (p<0.05), being greater in the gentamicin group.

CONCLUSION

These results showed that cisplatin-based chemotherapy followed by a once-daily aminoglycosides regimen caused increased renal toxicity, which was more pronounced in patients treated with gentamicin vs. those treated with amikacin.

Acute spinal cord injury in pregnancy: an illustrative case and literature review

Acute trauma is not all that uncommon in pregnancy. It accounts for 15% of non-obstetric maternal deaths. Moreover, about 15% of acute spinal cord injuries involve young women of childbearing age (Gilson et al., 1995). Most of the existing literature on spinal cord injury in pregnancy is concerned with the management of patients with pre-existing lesions; very few articles deal with acute injuries. We report the management of a case of acute spinal cord injury in the third trimester of pregnancy and review the major clinical issues associated with such cases.

[Effect of small-doses ketamine on postoperative pain management with combinations morphine/ketoprofen or lidol/ketoprofen after major gynecological surgery] [corrected]

We examine the potential beneficial effect of small-doses ketamine on postoperative pain management with combinations morphine/ketoprofen or lidol/ketoprofen after major gynecological surgery. After patient written consent, 50 healthy women, which were scheduled for abdominal gynecological surgery were randomly allocated into two groups depending of postoperative analgesic technique--morphine/ ketoprofen or lidol/ketoprofen. The quality of postoperative analgesia, total opioid consumption for the first postoperative day and unwished side effects were assessed. Demographic and surgical data were identical in the groups. Using ketamine during the anesthesia improve quality of postoperative analgesia in accordance with less opioid consumption for the combination morphine/ ketoprofen, but not for the combination lidol/ketoprofen. Adding small doses ketamine to combination morphine/ketoprofen improve postoperative analgesia; reduce morphine consumption and incidences of morphine-related side effects after major gynecological surgery.

Biweekly oxaliplatin, fluorouracil and leucovorin versus cisplatin, fluorouracil and leucovorin in patients with advanced gastric cancer

PURPOSE

To compare a bi-weekly infusion of leucovorin (LV) 5-fluorouracil (5-FU) for 2 days, plus oxaliplatin (LV5- FU2-oxaliplatin) and LV5-FU2-cisplatin (CDDP) regimens with respect to toxicity, objective response rates, time to progression (TTP) and overall survival (OS) in patients with advanced gastric cancer.

PATIENTS AND METHODS

Patients received LV5-FU2- oxaliplatin (oxaliplatin 85 mg/m(2), day 1; folinic acid 200 mg/m(2), days 1-2; 5-FU 400 mg/m(2), i.v. bolus, days 1-2; 5-FU 600 mg/m(2), 22-hour continuous infusion, days 1-2) or LV5- FU2-CDDP (CDDP 50 mg/m(2), day 1; plus LV5-FU2). A total of 72 patients were enrolled into this study (36 vs. 36).

RESULTS

A total of 305 cycles were administered in the LV5-FU2-oxaliplatin arm (median 8) and 272 cycles in the LV5-FU2-CDDP arm (median 8). Grades 3-4 toxicity were as follows (LV5-FU2-oxaliplatin %/LV5-FU2-CDDP %; p<0.05): neutropenia 5/49, thrombocytopenia 2/6, anemia 6/16 nausea/vomiting 2/15, and mucositis 0/3. Response rate of LV5-FU2-oxaliplatin was 41% (partial response/PR 41%, stable disease/SD 31%, progressive disease/PD 28%; 95% confidence internal/95% CI 27-58) and of LV5-FU2-CDDP was 25% (PR 25%, SD 36%, PD 39%; 95% CI 14-41; p =0.013). The median TTP of the patients in the LV5-FU2-oxaliplatin arm was 8 months and 6 months for those in the LV5- FU2-CDDP arm (p=0.073). The median survival time of the patients in the LV5-FU2-oxaliplatin arm was 10 months and 7 months for those in the LV5-FU2-CDDP arm (p=0.003).

CONCLUSION

Our study showed that oxaliplatin may be substituted for cisplatin with LV5-FU2 with favorable safety and efficacy profile. The encouraging results from our study support the effectiveness of oxaliplatin-fluoropyrimidine- containing chemotherapy in gastric cancer and could provide a new core on which to add other agents in future investigations.

[The study of ovarian autoimmunity and ovarian reserve in women with uncertain sterility]

Ovarian autoimmunity can be induce ovarian function, which is shown clinically with premature ovarian failure, unknown sterility and unsuccessful in vitro fertilizations. Antiovarian antibodies are directed to antigens functional zones of zona pellucida and granulose cells with important part in follicle genesis and fertilization.

AIM

We have to investigate the influence of ovarian autoimmunity, antiovarian and antizona pellucida antibodies on endocrinology markers of ovarian reserve: inhibin B, FSH, LH by the women with unknown sterility.

MATERIALS AND METHODS

340 women were investigated with unknown sterility and 60 women were investigated with only one successful pregnancy at least. We investigated them for presence of antiovarian antibodies, antizona pellucida antibodies, and of course the levels of FSH, LH, inhibin B on the third day of menstrual cycle. Serological methods were used: ELISA- biochemical technique to detect the presence of antiovarian antibodies and antizona pellucida antibodies, inhibin B, FSH, LH. Statistical methods for analysis were also used.

RESULTS

In investigated group was found the presence of antiovarian antibodies in 58 women (17.05%) and in control group was not found. Antizona pellucida antibodies presence was found in 43 women (12.64%) in investigated group and in control found was not found. It was not found important difference in levels of FSH, LH, inhibin B on the third day of menstrual cycle between women with and women without antiovarian antibodies.

CONCLUSION

Antiovarian antibodies were observed only in women who have had laparoscopic ovarian drilling. The frequency of antiovarian antibodies among the Bulgarian women with unknown sterility is 17.05%. The presence of antiovarian antibodies is not associated with poor ovarian reserve as we investigated the levels of FSH, LH, inhibin B on the third day of the menstrual cycle.

[The importance of the presence of antisperm antibodies in serum and ejaculate of men with infertility]

There are multiple insults to the male genital tract that have been associated with an increased risk of antisperm antibodies (ASA) formation. The presence of ASA has been regarded as typical and specific for the immunological infertility. It has been suggested that the presence of agglutinated spermatozoa is suggestive of the existence of an immunological cause of infertility such as the existence of ASA.

AIM

The objective of this study was to determine the clinical significance of serum and seminal plasma ASA as well as whether varying degrees of sperm agglutination can be a predictive indicator of positive serum and/or seminal plasma ASA.

PATIENTS AND METHODS

100 infertile and 30 fertile men were tested for ASA in seminal plasma and serum. The evaluation of patients included complete history, physical examination, scrotal ultrasound and semen analysis. ASA in serum and seminal plasma were tested by ELISA (Biosource, Belgium) and results were compared with the data of the semen analysis.

RESULTS

44 (44%) of the patients tested positive for ASA in seminal plasma, 9 of them had positive serum ASA. In the control group, seminal plasma ASA were not detected and two men (6.7%) tested positive for serum ASA. Correlation was established between seminal plasma ASA and two of the semen analysis markers: agglutination and increased viscosity.

CONCLUSION

ASA in seminal plasma are much more predictive than ASA in serum and have major role in the pathogenesis and diagnostics of male infertility.

[Therapeutical management of the most frequent gynaecological diseases and chronic pelvic pain in the Gynaecological Clinic, UMPHAT "Dr. G. Stransky"-Pleven in the period 2004-2007]

OBJECTIVE

To determine the trend in application of the basic therapeutical procedures in the most common gynaecological diseases combined or not with chronic pelvic pain /CPP/.

MATERIALS AND METHODS

In the prospective study conducted in the Gynaecological Clinic at the Department of Obstetrics and Gynaecology, MU-Pleven in the period 01.03.2004-01.07.2007, 1356 women with leiomyomatosis /L/, endometriosis /E/, adenomyosis /A/, pelvic congestion syndrome /PCS/, Allen-Masters syndrome /AMS/, pelvic inflammatory disease /PID/ and adhaesion syndrome /AS/, were included in it. They were grouped according to their age, type of disease, presence of CPP, type of therapeutical procedure and histological verification of the condition. For the purpose of the study the following methods were used: documentary method, R-AFS classification of E, inquiry method-by a questionnaire /form/, based on instruments for pain assessment, accepted worldwide.

RESULTS AND DISCUSSION

The highest frequency was determined for L, E and A, and AS. In the majority of the total number of consecutively admitted patients with those diseases an operative intervention was done, and almost one-sixth of women underwent conservative treatment. The same trend was observed in patients with chronic pain symptomatic, regarding their operative and conservative management. Histological verification of the condition was closely related with etiological reason and diagnostic approach.

CONCLUSION

A balance between conservative and operative treatment should be set in the basis of therapeutical management, consistent with modern diagnostic procedures. Determination of the trend in treatment of women with CPP will lead to falling off of indiscriminate application of operative methods prior to exact diagnostic specification and setting of multidisciplinary approach. That will serve as a background for the future conduct to that group of patients.

[Chronic pelvic pain and combined oral hormonal contraception]

PURPOSE OF THE STUDY

To determine the frequency of usage of combined oral hormonal contraception/COHC/ and its efficiency in women with chronic pelvic pain/CPP/.

MATERIALS AND METHODS

Three-hundred and seventy, consecutively admitted in the Clinic women with CPP, were included in the study. They were divided into 2 groups--group A/n = 80/--women that had used COHC, and group B/n = 290/--women that had not used COHC in order to cope with pain symptomatic. The patients from the both groups were compared according to their socio-demographic, menstrual and reproductive characteristics, type of disease, duration of CPP assessment of pain intensity and McGill pain indices, subjective rating of efficiency of the used COHC by the means of 5-rate scale in diseases, manifested with chronic pain symptomatic/leiomyoma /L/ endometriosis/E, pelvic congestion syndrome/PCS/, adhaesion syndrome/AS, Allen-Masters syndrome and other gynaecologic pathology/OGP/--chronic pelvic inflammatory disease/ CPID/, ovarian cysts /OC/, etc./.

RESULTS AND DISCUSSION

Duration of CPP /in months/ was comparatively longer in group A /50,74 +/- 10,33/in comparison wit group B/41,38 +/- 5,97/. No significant difference was found in quantitative pain assessment, but in group A higher values of all pain indices/sensory, affective, total pain rating index/and of evaluative overall pain intensity of total pain experience were set, compared with those of group B. It was ascertained a bigger number of types of used medicines in group A/analgesics, spasmolytics, gestagenes and GnRH-agonists/. Efficiency of COHC was assessed by the patients in the range "good-/basically/very good-excellent", and that was well demonstrated by women with L, E, AS and OGP/CPID, etc./.

CONCLUSION

COHC was administered to patients with more heavily demonstrated chronic pelvic pain symptomatic, that required combination of more than two medicines in order to obtain a better therapeutic effect. Diseases, manifesting with CPP like E, L and OGP/CPID, OC, AS, etc/are of great priority in treatment with COHC.