Multiobjective control architecture to estimate optimal set points for user comfort and energy saving in buildings

Temperature control in buildings is usually driven by energy conservation although the occupants' comfort is also important considering its impact on productivity and health. However, energy efficiency and comfort are opposing objectives and therefore this type of problem can be resolved by means of a multiobjective optimization approach. The simulations we carried out indicate that set points optimization has the potential to reduce energy consumption in the order of 10% while also providing a comfortable work environment for the occupants.

Quality of life in glaucoma patients and normal subjects related to the severity of damage in each eye

OBJECTIVE

To assess the quality of life in glaucoma patients and normal subjects, and to assess its relationship with the severity of damage in each eye.

METHODS

A cross-sectional study was conducted with prospective selection of cases. The study included 464 subjects and were distributed into 4categories. Subjects included in group 1 had both eyes normal, that is with a normal intraocular pressure (IOP), optic disk and visual fields (VF), or mild glaucoma, defined as untreated IOP>21mmHg and abnormal VF with mean defect (MD) over -6dB. Group 2 consisted of patients with both eyes with mild or moderate glaucoma, defined as untreated IOP>21mmHg and abnormal VF with MD between -6 and -12dB. Group 3 included patients with moderate to severe glaucoma, that is, untreated IOP>21mmHg and abnormal VF with MD of less than -12dB in both eyes. Group 4 consisted of patients with asymmetric glaucoma damage, that is, they had one eye with severe glaucoma and the other eye normal or with mild glaucoma. All subjects completed 3 different questionnaires. Global quality of life was evaluated with EuroQol-5D (EQ-5D). Vision related quality of life was assessed with Visual Function Questionnaire (VFQ-25). Quality of life related to ocular surface disease was measured with Ocular Surface Disease Index (OSDI).

RESULTS

VFQ-25 showed that group 3 had significantly lower scores than group 1 in mental health (P=.006), dependence (P=.006), colour vision (P=.002), and peripheral vision (P=.002). EQ-5D showed no significant differences between any group, but a trend was found to greater difficulty in group 3 than in groups 1 and 2, and in all dimensions. OSDI showed a higher score, or which was the same as a major disability, in groups 2 and 3 than group 1 (P=.021 and P=.014, respectively). VFQ-25 only found significant differences between group 1 and group 4. Dimensions with significant differences were found between group 1 and 3 (both eyes with advanced or moderate glaucoma). These were not found between group 1 and group 4 (the group in which one eye has only mild glaucoma or no glaucoma). This finding confirms that the eye with less glaucoma damage determines the quality of life.

CONCLUSIONS

Our results demonstrate that quality of life is impaired in patients with glaucoma, and this alteration is greater the more advanced is glaucoma damage in the best or both eyes.

[Subfoveal perfluorocarbon liquid. Two new cases]

PURPOSE/METHODS

Subfoveal perfluorocarbon liquid (SPCL) causes vision loss and central scotoma. We present two clinical cases with this complication and we review the 5 clinical cases reported in the literature to analyse their potential prognostic factors.

RESULTS/CONCLUSIONS

SPCL extraction involves an early visual acuity recovery and a central scotoma disappearance. The visual acuity recovery degree does not depend on the patient's age, the onset visual acuity or the evolution time when this last one is less than 3 months.

Ethanol beverages containing polyphenols decrease nuclear factor kappa-B activation in mononuclear cells and circulating MCP-1 concentrations in healthy volunteers during a fat-enriched diet

AIMS

Different epidemiological studies have demonstrated that some ethanol containing beverages intake could be associated with a reduction of cardiovascular mortality, effect attributed in part to its antioxidant properties. Nuclear factor-kappa B (NF-kappaB) is a redox sensitive transcription factor implicated in the pathogenesis of atherosclerosis. We have examined the effect of four different ethanol containing beverages on the activation of NF-kappaB in peripheral blood mononuclear cells (PBMC) and circulating concentrations of monocyte chemoattractant protein-1 (MCP-1) in healthy volunteers receiving a fat-enriched diet.

METHODS AND RESULTS

Sixteen volunteers received 16 g/m(2) of ethanol in form of red wine, spirits (vodka, rum, and brandy) or no ethanol intake along with a fat-enriched diet during 5 days and all of them took all alcohols at different periods. NF-kappaB activation (electrophoretic mobility shift assay) and circulating MCP-1 levels (ELISA) were examined in blood samples taken before and after 5 days of ethanol intake. Subjects receiving a fat-enriched diet had increased NF-kappaB activation in PBMC at day 5. Furthermore, MCP-1 levels were increased in plasma at day 5. Red wine intake and some ethanol beverages containing polyphenols (brandy and rum) prevented NF-kappaB activation and decreased MCP-1 release.

CONCLUSION

Consumption of moderate amounts of alcoholic drinks containing polyphenols decreases NF-kappaB activation in PBMCs and MCP-1 plasma levels during a fat-enriched diet. Our results provide additional evidence of the anti-inflammatory effects of some ethanol containing beverages, further supporting the idea that its moderate consumption may help to reduce overall cardiovascular mortality.

Cilastatin protection against cyclosporin A-induced nephrotoxicity: clinical evidence

BACKGROUND

Several studies have documented the nephroprotective effect of cilastatin co-administered with imipenem in subjects treated with cyclosporin A. However, no large clinical studies are available to confirm this observation. Here the quality of the evidence on cilastatin nephroprotection against cyclosporin-induced nephrotoxicity is evaluated.

METHODS

The results of all studies where cyclosporin was used alone or combined with imipenem/cilastatin (Tienam) on the same clinical setting were systematically reviewed. Primary outcome was the reduction in serum creatinine concentration. Secondary outcome included development of acute renal failure. Medline was searched using three different retrieval systems (Pubmed, Silver Platter, Knowledge Finder) from January 1966 to February 2006. Attempts were made to contact authors of relevant studies to obtain additional data. Five clinical studies were found, including 125 patients under cyclosporin plus imipenem/cilastatin and 104 under cyclosporin alone.

RESULTS

Cyclosporin increased serum creatinine in all the studies. Average reduction of serum creatinine in cilastatin-treated versus untreated patients was Delta = -0.53 mg/dL (95%CI: -0.90 to -0.17) (Z = 2.84, p = 0.004). Variability between studies was large (from Delta = -0.21 to Delta= -1.59 mg/dL) and heterogeneity pronounced (chi(2) = 8.760, df = 4; p = 0.067). Meta-regression of serum creatinine reduction versus baseline serum creatinine explained 84% of this variability, by the variation in basal serum creatinine. When randomized and observational clinical studies were analyzed separately, conclusions were the same: serum creatinine in cilastatin treated patients was reduced by Delta = -0.98 mg/dL (95%CI: -1.57 to -0.38) in randomized studies (Z = 3.213, p = 0.001) and Delta= -0.32 mg/dL (95%CI: -0.63 to -0.01) in observational studies (Z = 2.013, p = 0.044). Odds Ratio for developing acute renal failure was 0.24 (95% CI: 0.11-0.53, p < 0.0001) on patients simultaneously treated with cyclosporin plus imipenem/cilastatin compared to patients treated with cyclosporin alone.

CONCLUSIONS

Administration of cilastatin may reduce acute cyclosporin nephrotoxicity.

[Systematic review of population-based studies of the prevalence of cataracts]

OBJECTIVE

The prevalence of cataracts has increased due to the progressive ageing of the population and the fact that cataracts affect a wide and increasing proportion of the population. The goal of the present study was to describe the prevalence of cataracts through a systematic and exhaustive review of population-based studies.

METHODS

A systematic review of population-based studies of the prevalence and incidence of cataracts was performed. Inclusion criteria were: a healthy non- institutionalised population, older than 40 years of age, of white race, with a sample size of greater than 1,000 and published between 1980 and 2002.

RESULTS

Ten studies met the inclusion criteria (3 European, 5 from the United States and 2 from Australia), and were performed between 1984 and 2001. The cataract prevalence, according to lens opacity criteria, ranged between 15% and 19%. When the cataract was defined as a lens opacity combined with a decreased visual acuity, the prevalence ranged from 15% to 30%. The overall prevalence increased with age, reaching 40% and more than 60% in populations older than 70 and 75 years respectively. The prevalence among women was higher than that among men, with a more marked increase being evident at older ages than for men.

CONCLUSIONS

There were variations among the criteria used to measure the prevalence of cataract, which made it difficult to compare all the studies. Overall the prevalence was higher in the older population, especially among women. The increasing prevalence associated with age predicts an increasing burden of cataract to health services, this being particularly related to the ageing of the population.

[Laser photocoagulation in idiopathic polypoidal choroidal vasculopathy. Over one year follow-up]

PURPOSE

Long term assessment of the evolution of Idiopathic Polypoidal Choroidal Vasculopathy (IPCV) in symptomatic patients treated by laser photocoagulation.

METHODS

We carried out a retrospective study involving seven eyes in six patients with visual impairment, affected by IPCV, confirmed by indocyanine green angiography. All were treated by laser photocoagulation and monitored during a period of at least one year. The controls were evaluated during the first, third, sixth and twelfth month, in order to assess whether it was necessary to repeat the treatment.

RESULTS

Of the six patients with IPCV lesions, two were men and four were women (1:2) aged between 58 and 81 years (mean = 73 years), and monitored for a time interval of 18 and 75 months (mean = 39 months). The average initial visual acuity was 0.25, and the final was 0.15. All the patients had the other eye also affected: three had a macular disciform scar, secondary to the previous haemorrhagic episodes, two had asymptomatic polyps and in one patient we defined active bilateral IPCV which was treated by laser photocoagulation. In two eyes it appeared as a macular haemorrhage, in four eyes as a serosanguinous retinal pigment epithelial (RPE) detachment and in one eye as a serous RPE detachment. Three eyes suffered a relapse which required further laser photocoagulation treatment.

CONCLUSIONS

Laser photocoagulation is a palliative treatment for IPCV. Final vision achieved is poor and relapse is frequent. Other procedures should be used to treat this disease.

Inhibition of brush border dipeptidase with cilastatin reduces toxic accumulation of cyclosporin A in kidney proximal tubule epithelial cells

BACKGROUND

Cilastatin reduces nephrotoxicity associated with cyclosporin A (CyA) in solid organ and bone marrow transplantation. This appears to be unrelated to changes in renal haemodynamics or CyA metabolism. How cilastatin induces this protection is unclear, but it could result from changes on accumulation of CyA proximal cells.

METHODS

We investigated the effects of cilastatin on primary cultures of pig kidney proximal tubule epithelial cells (PTECs) treated with CyA and FK506. Cell membrane fluidity and membrane-bound cholesterol-rich raft (MBCR) distribution were evaluated by fluorescence microscopy, and CyA transport by radioimmunoassay. Changes in CyA- and FK506-induced apoptosis were also evaluated by electron and light microscopy, flow cytometry, and detection of cytoplasmic nucleosones by enzyme-linked immuosorbent assay.

RESULTS

CyA caused a dose-dependent reduction of cell membrane fluidity, which was prevented by pre-treating PTECs with cilastatin. Cilastatin also inhibited CyA transport across membranes and reduced recovery of CyA in mitochondria and membrane-bound fractions from cilastatin-treated PTECs. This effect was not related to an altered distribution of MBCRs, which are essential for CyA transport. Cilastatin protected against CyA- and FK506-induced apoptosis.

CONCLUSIONS

Prevention of CyA-induced reduction of cell membrane fluidity and inhibition of CyA transport are features of cilastatin's direct effects on PTECs. Unaltered distribution of MBCRs in the presence of cilastatin suggests that cilastatin binding to raft-bound dipeptidases, rather than MBCR modifications, causes interference with CyA transport. These results provide additional insight into the mechanisms and scope of cilastatin nephroprotection.

Automatic quantification of viability in epithelial cell cultures by texture analysis

Quantification of live cells in phase contrast microscopy images allows in vivo assessment of the viability of cultured cells. An automatic screening procedure seems advisable because of the large number of cells that must be counted to achieve reasonable accuracy. This paper presents a method that quantifies necrosis in cell cultures by texture analysis of microscope images. The image is divided into regions of equal size that are classified by means of a segmentation algorithm based on texture analysis into three categories: live cells, necrotic cells and background. The classification uses three discriminant functions, built from parameters derived from the histogram and the co-occurrence matrix and calculated by performing an initial stepwise discriminant analysis on 21 sample images from a training set. The areas occupied by live and necrotic cells and number of live cells have been obtained for primary cellular cultures in intervals of 48 h during 2 weeks. The results have been compared with those obtained by an experienced observer, showing a very good correlation (Pearson's coefficient 0.95, kappa 0.87, N= 1600). A method has been developed that provides an accuracy similar to that provided by an expert, while allowing a much higher number of fields to be counted.

Outcomes and costs of outpatient and inpatient cataract surgery: a randomised clinical trial

The aim of this study was to compare clinical and perceived health outcomes and cost between ambulatory and inpatient cataract surgery. An unmasked randomised clinical trial was undertaken. Cataract surgery patients of three public hospitals in Barcelona (Spain) who met inclusion criteria for ambulatory surgery were randomly assigned to two groups: outpatient hospital and inpatient hospital. Primary outcome measures were early and late postoperative surgical complications and visual acuity. Secondary outcome measures were perceived visual function, overall perceived health status, and costs. A total of 464 outpatients and 471 inpatients were analysed. No statistically significant differences were observed between the two groups in visual acuity (P =.48), nor for the other clinical and perceived health outcome measures, except for early postoperative complications. Outpatients presented at least one complication in the first 24 h after surgery more frequently than inpatients (64 vs. 43; RR 1.6, 95% CI 1.1, 2.4), but 4 months after surgery the differences in complications rates between groups disappeared. The cost of surgery was lower for outpatients than for inpatients (1001 vs. 1218 Euros; P <.001). Ambulatory cataract surgery was more cost-effective than inpatient surgery. Despite the higher risk of early complications in the outpatient hospital group, these differences may not be clinically relevant because the 4-month postoperative outcomes were not affected.

Potentiation by nitric oxide of cyclosporin A and FK506-induced apoptosis in renal proximal tubule cells

Proximal tubular epithelial cells (PTEC) exhibit a high sensitivity to undergo apoptosis in response to proinflammatory stimuli and immunosuppressors and participate in the onset of several renal diseases. This study examined the expression of inducible nitric oxide (NO) synthase after challenge of PTEC with bacterial cell wall molecules and inflammatory cytokines and analyzed the pathways that lead to apoptosis in these cells by measuring changes in the mitochondrial transmembrane potential and caspase activation. The data show that the apoptotic effects of proinflammatory stimuli mainly were due to the expression of inducible NO synthase. Cyclosporin A and FK506 inhibited partially NO synthesis. However, both NO and immunosuppressors induced apoptosis, probably through a common mechanism that involved the irreversible opening of the mitochondrial permeability transition pore. Activation of caspases 3 and 7 was observed in cells treated with high doses of NO and with moderate concentrations of immunosuppressors. The conclusion is that the cooperation between NO and immunosuppressors that induce apoptosis in PTEC might contribute to the renal toxicity observed in the course of immunosuppressive therapy.

Perfusate lactate dehydrogenase level and intrarenal resistance could not be adequate markers of perfusion quality during isolated kidney perfusion

The main goal of this work was to study the influence of perfusion pressure and flow waveform during kidney perfusion, and the relationship between renal vascular resistance (RVR) and lactate dehydrogenase (LDH) concentration in the perfusate. Simultaneous constant pressure kidney perfusions were performed with either pulsatile or continuous flow at either 30 or 80 mm Hg of constant perfusion pressure. Mean flow, pressure, and RVR were displayed online during perfusion. Perfusate samples for LDH, creatine phosphatase kinase (CPK), and alkaline phosphatase (AP) determinations were taken. At the end of the perfusion, 2 ml of Evans blue was injected into the circuit to obtain images of perfusate distribution, and the kidneys were weighed. Also, hematoxylin/eosine studies were performed, showing more Bowman's space and tubular dilation in kidneys perfused with high pressure. We did not find differences in RVR between kidneys perfused at 30 and 80 mm Hg; nevertheless, perfusate distribution was better in the 80 mm Hg perfusions. We did not find any correlation between enzyme release and RVR in kidneys perfused with different mean pressures. These findings suggest that vascular resistance and LDH concentration cannot be independently considered as adequate markers of perfusate distribution.

[Efficacy and cost of ambulatory cataract surgery: a systemic review]

BACKGROUND

A systematic review has been performed on the literature in order to assess efficacy and costs of cataract ambulatory surgery. The objective of the review were the randomized controlled trials comparing benefits, adverse effects and costs of ambulatory and inpatient cataract surgery, including, in addition, an original trial of our investigation group.

METHODS

The sources of information have been: MEDLINE (between 1985 and 1998), HealthStar (1975-98), Evidence-Based, the systematic review of the journals of ophthalmology (1992-98) and the review of the references in the documents or articles reviewed. The quality of the trials was assessed according to criteria proposed by the Evidence-Based Medicine Working Group. Data extracted from each study included: design, object population, setting, type of intervention and treatment, and follow-up period. Outcomes of ambulatory surgery were compared to those of inpatient surgery concerning to benefits (postoperative visual acuity), adverse effects (surgical complications) and costs of the surgery.

RESULTS

From 44 studies satisfying inclusion criteria, only 5 randomized controlled trials and 10 observational studies had the necessary information to be included in the review. In all the studies postoperative visual acuity was similar between the two groups (inpatients and outpatients). In the quantitative synthesis of the trials included in the review, outpatients presented a higher rate of perioperatory (48 hours after surgery) complications (OR = 1.4; IC 95%: 1.1-1.8) and of increase of intraocular pressure (OR = 2.3; IC 95%: 1.3-3.9). The ambulatory surgery costs were from a 15 to a 30% lower, depending on the study analyzed.

CONCLUSIONS

Ambulatory cataract surgery patients present a benefit in visual acuity similar to inpatients. However, the higher risk of surgical complications among outpatients suggests the appropriateness of improving their immediate postoperative care. Even though some variability exists in the method to calculate costs, the results suggest that ambulatory surgery is the most efficient alternative.

Clinical outcomes and costs of cataract surgery performed by planned ECCE and phacoemulsification

PURPOSE

To compare clinical outcomes and costs of cataract surgery between patients operated with standard extracapsular extraction (ECCE) and those undergoing phacoemulsification.

SETTING

Patients from the Ophthalmology Department of a teaching hospital in Barcelona (Spain) scheduled for cataract surgery, not combined with any other ophthalmic procedure.

METHODS

A retrospective analysis has been performed on a database of 1046 patients undergoing ECCE and phacoemulsification. The outcome measures used were: surgical complications, visual acuity and costs of surgery and of follow-up. Overall rate of all complications and postoperative visual acuity were compared between the two groups, adjusting for age, preoperative visual acuity, medical and ocular comorbidity.

RESULTS

31.9% of the patients (334) underwent phacoemulsification, and 68.1% (712) underwent ECCE. Patients undergoing phacoemulsification presented a frequency of intra- and postoperative complications lower than those undergoing ECCE (odds ratio 0.57, 95%CI 0.37-0.87 and 0.66, 95%CI 0.46-0.96, respectively), specifically for intraoperative iris trauma (3.1% vs 0.3%, p = 0.004), residual posterior capsular opacity (2% vs 0.3%, p = 0.035) and postoperative corneal edema (7.4% vs 3.6%, p = 0.016). Costs of intervention and follow-up were lower for phacoemulsification compared with ECCE (23.9% and 14%, respectively). But global costs were slightly higher for phacoemulsification (4.87%), due to supply costs, which were more than twice those of ECCE.

CONCLUSIONS

Phacoemulsification, when performed by an experienced surgeon, has better clinical outcomes than planned extracapsular extraction, and costs may be lower since supply costs are expected to decrease as the phacoemulsification technique becomes more widespread.

Factors associated with second eye cataract surgery

AIMS

To analyse the clinical and sociodemographic characteristics associated with second eye cataract surgery.

METHODS

An observational, longitudinal study of patients scheduled for first eye cataract surgery that did not involve a combined procedure was carried at two teaching hospitals and one non-teaching hospital in Barcelona, Spain. Patients were followed for 2 years after first eye cataract surgery to assess whether and when they had undergone second eye cataract surgery. Clinical characteristics, perceived health characteristics (perceived visual function and overall health status), and sociodemographic characteristics were compared between two patient groups-those with surgery in only one eye and those who had undergone surgery in both eyes by the end of the 2 year follow up period.

RESULTS

Of the 242 patients studied, 125 (51.7%) underwent second eye surgery during the 2 year observation period. Patients with visual acuity 6/18 (0.3) or worse in the second eye compared with those with visual acuity over 6/12 (0.5) and patients younger than 65 years compared with patients aged 65-74 were more likely to undergo second eye surgery (adjusted odds ratio 3.9 and 1. 8, respectively). 52 (44.5%) patients in the only one eye surgery group had a visual acuity less than 6/18 (0.3) in the second eye.

CONCLUSIONS

Worse visual acuity in the second eye and younger ages are strongly associated with both eyes cataract surgery. There may be a potential increase of demand for this procedure in the near future since almost half of the patients with only one eye surgery presented a low visual acuity in the second eye.

Comparison of the results of first and second cataract eye surgery

OBJECTIVE

To compare the outcomes of second eye cataract surgery with those of first eye surgery. In particular, to evaluate changes in visual acuity (VA), visual function, and health status after the first and second eye surgeries.

DESIGN

A cohort (case series) analysis of patients recruited in a clinical trial.

PARTICIPANTS

A total of 403 consecutive patients with indication of noncombined first eye or second eye cataract surgery were recruited in 3 public hospitals in Barcelona, Spain. First eye surgery patients are compared to second eye surgery patients.

INTERVENTION

Patients were evaluated both before surgery and 4 months after surgery by a standardized telephone interview and clinical examination.

MAIN OUTCOME MEASURES

Visual acuity, visual function index (VF-14), a 14-item instrument designed to measure visual function, and the Sickness Impact Profile (SIP), a generic measure of health status.

RESULTS

Full data were obtained from 315 (78%) patients: 249 who underwent first eye surgery only and 66 different patients who underwent second eye surgery. Significant improvement was found in both groups of patients for best-corrected VA in the operated eye (4.4 Snellen lines, P < 0.001; 4.2 Snellen lines, P < 0.001, respectively), VA in the better eye (2.8 Snellen lines, P < 0.001; 1.4 Snellen lines, P < 0.001), and visual function (26.3 Snellen lines, P < 0.001; 17.0 Snellen lines; P < 0.001). Four months after the operation, the VF-14 of the second eye group was slightly better (93.4 vs. 88.5; P = 0.09; score range: 0, worst, to 100, best). Psycho-social SIP scores improved in both groups (4.8, P < 0.001; 3.1, P = 0.016). Physical SIP score improved only in the first eye surgery group (1.8, P = 0.003) but not in the second eye surgery group (-1.0, P = 0.338; score range: 0, best, to 100, worst).

CONCLUSIONS

The results of our study suggest that patients undergoing second eye cataract surgery show significant improvements in VA, visual function, and psycho-social health status. However, global and physical health status does not change after second eye cataract surgery.

Manual nucleofragmentation and endothelial cell loss

PURPOSE

To compare corneal endothelial cell loss with two cataract surgery techniques: manual nucleofragmentation performed with the Keener nucleus divider and planned extracapsular extraction.

SETTING

Department of Ophthalmology "Memorial Cristóbal Garrigosa," Hospital de l'Esperança, Universitat Autònoma de Barcelona, Spain.

METHODS

Contact specular microscopy was performed before and 8 weeks after surgery in 51 patients who had been prospectively randomized into 2 groups: 26 patients had manual nucleofragmentation (NF) with the Keener divider and 25, planned extracapsular cataract extraction (ECCE). The analyzed parameters were preoperative and postoperative endothelial cell density and variations in cell size (polymegethism) and cell shape (pleomorphism). The results were compared and statistically analyzed.

RESULTS

The mean percentage of endothelial cell loss in the NF group was 11.08% and in the ECCE group, 9.86%. This difference was not statistically significant. Postoperative variation in cell shape and size did not differ significantly between the two groups and was fairly constant.

CONCLUSION

The percentage of endothelial cell loss that occurred with manual NF using the Keener nucleus divider was similar to the one that occurs with other cataract surgery techniques. The small variation detected in postoperative endothelial morphology suggests that this endothelial cell population is stable.

Ocular hypertension after cataract surgery: a comparison of three surgical techniques and two viscoelastics

BACKGROUND AND OBJECTIVE

To evaluate the incidence and course of ocular hypertension after cataract surgery using two different viscoelastics and three different surgical techniques.

PATIENTS AND METHODS

Thirty-six patients who had undergone extracapsular cataract extraction (ECCE), 22 who had undergone phacoemulsification (PHACO), and 16 who had undergone manual nucleofragmentation (MNF) were randomized to receive either a low-viscosity viscoelastic (LVV) or a high-viscosity viscoelastic (HVV) intraoperatively. Post-operative evaluation included anamnesis, intraocular pressure (IOP) measurement, and slit-lamp examination at 3, 6, 24, and 72 hours and 7 days.

RESULTS

The incidence of increased IOP over baseline after cataract surgery was 74.3%. The study of both viscoelastics revealed a trend for higher IOP during the first 24 hours for patients who received HVV (P < .05). Greater differences were observed when comparing surgical techniques. Small-incision techniques showed higher mean postoperative IOPs, and more severe hypertensions (PHACO 5/22 [22.7%] and MNF 2/16 [12.5%] vs ECCE 3/36 [8.3%]) (P < .05).

CONCLUSIONS

Ocular hypertension is a frequent postoperative complication. It is slightly more common when using HVV. Small-incision techniques show higher mean postoperative IOPs and more severe hypertensions.

Gallbladder dyskinesia in acalculous biliary colic

AIMS

To test the hypotheses that: 1) postprandial gallbladder emptying might be abnormal in patients with acalculous biliary colic; and 2) that hymecromone, a drug that increases bile flow and relaxes biliary muscle might improve symptoms.

METHODS

Twenty-four women were studied. Twelve patients presented recurrent biliary type of pain in the absence of gallstones, and persistence of contrast in the gallbladder, 24 hours after an oral cholecystogram, suggesting cholesterolosis. Twelve healthy volunteers used as controls had no symptoms and the gallbladder was not visible the day after an oral cholecystogram. Gallbladder emptying induced by an oral meal was studied with ultrasound in both groups before and after the administration of hymecromone.

RESULTS

Gallbladder volumes were similar in both groups (23 +/- 10 ml vs. 31 +/- 11 ml; NS). Gallbladder emptying in the control group was simple exponential (R2 = 0.948 +/- 0.059) with a rate of 32 +/- 16 minutes. Gallbladder emptying was bimodal in patients. Gallbladder volume increased to 120% in the first 10 minutes, to empty exponentially thereafter (R2 = 0.964 +/- 0.040. Rate: 29 +/- 22 minutes). This resulted in a marked reduction in gallbladder volume emptied at 40 minutes when compared to controls (30% +/- 27% vs. 54% +/- 14%; p = 0.012). Pretreatment of controls with hymecromone induced an emptying pattern similar to that of patients. In patients, emptying after hymecromone did not change but symptoms were improved.

CONCLUSIONS

An abnormal emptying pattern of the gallbladder was identified in patients with acalculous biliary colic, and hymecromone was partly effective to reduce pain, despite a minor effect on gallbladder emptying pattern.

Intraoperative complications of planned extracapsular cataract extraction versus manual nucleofragmentation

PURPOSE

To compare the intraoperative complications of planned extracapsular cataract extraction (ECCE) with those of manual nucleofragmentation.

SETTING

Hospital de la Esperanza, Universitat Autónoma de Barcelona, Spain.

METHODS

This retrospective study comprised 567 eyes; 444 had planned ECCE and 123, manual nucleofragmentation through a scleral tunnel incision.

RESULTS

No significant differences between techniques were found in terms of intraoperative complications (P < .05). Manual nucleofragmentation did not increase the risk of intraoperative complications (P < .05).

CONCLUSIONS

Although phacoemulsification is the procedure of choice in many cases, manual nucleofragmentation is a safe and valid alternative that achieves the goals of small incision cataract surgery.

Endoscope-assisted transscleral suture fixation of intraocular lenses

We describe a new method for placing transscleral sutures when fixating posterior chamber intraocular lenses to the sulcus. An intraocular microendoscope with an 18 gauge probe is used for direct sulcus observation and needle position assessment. The straight needle of a 10-0 polypropylene suture and the tip of the probe are placed in a 16 gauge silicone rubber tube to hold them together. Fixing the needle to the endoscope allows a direct view of its tip and requires only one hand. The other hand is used to grasp the tip of the needle when it comes out under the scleral flap after passing through the sulcus. Assessment of needle position with an endoscope avoids surgically induced iris root or ciliary body damage. Fixing the needle to the endoscope simplifies the surgical technique.

Preoperative testing practice in healthy cataract surgery patients. Results of a survey of ophthalmologists in Barcelona, Spain. Barcelona I-PORT Investigators

AIMS/BACKGROUND

Many preoperative ophthalmic and medical tests lack proven effectiveness in the evaluation of cataract surgery patients. Variation in use has been described in the USA, but little information is available for countries with different health systems. The objectives of the study were to assess variation in ophthalmologists' use of preoperative testing on cataract surgery patients and to identify ophthalmologists' characteristics associated with it.

METHODS

A postal survey was made in a representative sample (response rate of 70%) of the Barcelona Medical Association of Ophthalmologists performing cataract surgery during 1993 (N = 89). The questionnaire included information about common preoperative, intraoperative and postoperative practice and sociodemographic and professional data. Appropriateness of preoperative ophthalmic tests was classified in 3 levels (indicated tests, tests with unproven benefit, and non-indicated tests) according to recommendations of the Cataract Management Guideline Panel [1] and the American Academy of Ophthalmology Preferred Practice Pattern [2].

RESULTS

Almost all the ophthalmologists reported performing Fundus exam plus A-scan in the preoperative evaluation of cataract surgery patients (indicated tests). Up to 20% reported performing 'frequently' or 'always' some non-indicated or unproven benefit ophthalmic tests. Additionally, an average of 7 medical tests were 'routinely' included. Private practice and cataract subspeciality were the ophthalmologists' characteristics more frequently associated with the use of inappropriate ophthalmic tests (p < 0.05).

CONCLUSIONS

In Barcelona, Spain, some ophthalmic tests of unproven effectiveness are frequently performed preoperatively on cataract surgery patients without ocular comorbidity. Also, a generalized utilization of several medical tests was reported. There is potential for some cost containment and more appropriate care of cataract patients without diminishing the quality of care, in a location with low surgery rates.

The wound epithelium of regenerating limbs of Pleurodeles waltl and Notophthalmus viridescens: studies with mAbs WE3 and WE4, phalloidin, and DNase 1

The wound epithelium of regenerating limbs of the American newt, Notophthalmus viridescens (Nv), up-regulates a number of antigens, including those recognized by mAbs WE3 and WE4. In the present study, we show that the WE3 antigen is up-regulated in a similar fashion in the wound epithelium of the European newt, Pleurodeles waltl (Pw). mAb WE3 and WE4 reactivities to secretory/transport body cell types, including integumentary glands, perineurium, endothelium, and conjunctiva, are also similar in these two species of newt. However, mAb WE4 reacts to both the epidermis and wound epithelium in Pw, whereas in Nv, mAb WE4 reacts only to the wound epithelium. Because the WE3 antigen is cytoskeleton-associated and Western blots reveal a 43 kDa species, we compared mAb WE3 reactivity with that of rhodamine-labeled phalloidin, a known actin-binding compound. Phalloidin did not react preferentially to the wound epithelium, conjunctiva, or other cell types strongly reactive to mAb WE3. Pretreatment of sections and tissue extracts with DNAse 1, a protein known to bind to actin, nearly abolished mAb WE3 reactivity in tissue sections and both WE3 and WE4 reactivity in ELISA assays, respectively. The results lead to the hypothesis that the WE3 and WE4 antigens are actin-binding proteins unique to the wound epithelium and other secretory/transport cell types.

[Comparative study of the behavior of isoflurane and halothane in pediatric anesthesia]

This study involves 60 patients below the age of 14 years who were subjected to short duration surgical procedures under inhalation anesthesia with halothane and isoflurane at equivalent CAM in 50% protoxide. The objectives of the study were: a) to establish which of the two inhalational agents produced the more rapid anesthetic induction; b) to determine which exerted the more marked potentiation of the neuromuscular blockade induced by succinylcholine, and c) to compare the anesthetic quality during the induction and recovery periods of both halogenated agents. Induction was more rapid after halothane (mean induction time of 2.91 +/- 0.97 min) than after isoflurane (mean induction time of 6.24 +/- 2.88 min; p less than 0.001). Potentiation of succinylcholine induced neuromuscular blockade was greater after isoflurane than after halothane: the mean time of apnea was 4.56 +/- 1.82 min for isoflurane and 3.41 +/- 1.63 min for halothane (p less than 0.05). Undesirable effects were larger in patients treated with isoflurane than in patients anesthetized with halothane (mean score: 12.60 +/- 3.53 points vs 14.41 +/- 2.33 points; p less than 0.001). The analysis of anesthetic quality during the recovery period gave a mean punctuation of 16.62 +/- 2.21 to patients treated with halothane, whereas patients anesthetized with isoflurane showed a lower score of 14.25 +/- 1.99 points (p less than 0.001). The higher scores corresponded to the most well tolerated anesthetic induction and recovery. The highest attainable score in this study was 18.