Search

Purpose: The most important prognostic variable for early stage breast cancer is the status of axillary lymph nodes. The aim of this study was to evaluate the diagnostic accuracy of preoperative magnetic resonance imaging (MRI) for metastatic axillary lymph node in breast cancer cases with post-operative sentinel lymph node biopsy (SLNB) results., Materials and Methods: Women aged between 21 and 73 years who were diagnosed with malignant mass lesion of the breast between 2013 and 2015 were included in this study. The preoperative MR images of patients with diagnosis of breast cancer was evaluated to determine axillary lymph node status. Axillary lymph node size, long axis to short axis ratio, lymph node contours, cortical thickness to anteroposterior diameter ratio, the presence of a fatty hilum and contrast enhancement patterns (homogenous or heterogenous) was noted. Additionally, the presence of comet tail sign which a tail extending from an enhancing breast lesion into the parenchyma and might represent ductal infiltration on post-contrast series was also noted. All data obtained from this evaluation was compared with postoperative SLNB results., Results: Metastatic nodes were found to have a longer short axis when compared to reactive nodes (p = 0.042; p < 0.05). The long axis to short axis ratio was notably lower in metastatic nodes when compared to reactive nodes. Cortical thickness was higher in metastatic nodes when compared to reactive nodes (p = 0.024; p < 0.05). Comet sign was observed in 15 of metastatic nodes (73.3 %) and in one (5 %) reactive node. This difference was statistically significant (p = 0.001; p < 0.01). While fatty hilum was seen in 40 % of metastatic nodes (n = 6), it was seen in all (n = 20) reactive nodes. This difference was statistically significant (p = 0.001; p < 0.01)., Conclusions: MRI is a non invasive sensitive and specific imaging modality for evaluating the axilla. We have shown that with the help of comet tail sign and status of fatty hilum contrast enhanced MRI has the highest sensitivity of 84.7 % for detecting axillary lymph node metastases (Singletary et al. in Semin Surg Oncol 21(1):53-59, 2003).

Nowadays as more breast conserving surgeries and mastectomies are being performed, more breast implants are being used. Follow-up of these patients is as important as treatment. We, radiologists should be aware of normal imaging appearance of implants during follow ups. We should also be aware of complications which we may encounter during controls. In our essay, we aim to show the normal and pathological appearence of implants by sharing ultrasound, mammography and MR images from our clinic., Key Words: Breast, Implants, MRI, Rupture.

Good status of pulmonary perfusion is essential for a successful outcome after the Fontan procedure. Increased pulmonary pressure and vascular resistance, small size of the pulmonary arteries, and significant branch stenoses reflect some of the main problems causing failing Fontan circulation. Here we report a child who underwent a staged Fontan procedure with subsequent subtotal loss of the left-sided pulmonary perfusion, although branch stenosis was successfully treated by stent implantation. Oral sildenafil caused restoration of the capillary vascular bed, improved left-sided lung perfusion, and resulted in significant clinical benefit.

Bovine chymosin is an aspartic protease that selectively cleaves the milk protein kappa-casein. The enzyme is widely used to promote milk clotting in cheese manufacturing. We have developed models of residues 97-112 of bovine kappa-casein complexed with bovine chymosin, using ligand docking, conformational search algorithms, and molecular dynamics simulations. In agreement with limited experimental evidence, the model suggests that the substrate binds in an extended conformation with charged residues on either side of the scissile bond playing an important role in stabilizing the binding pose. Lys111 and Lys112 are observed to bind to the N-terminal domain of chymosin displacing a conserved water molecule. A cluster of histidine and proline residues (His98-Pro99-His100-Pro101-His102) in kappa-casein binds to the C-terminal domain of the protein, where a neighboring conserved arginine residue (Arg97) is found to be important for stabilizing the binding pose. The catalytic site (including the catalytic water molecule) is stable in the starting conformation of the previously proposed general acid/base catalytic mechanism for 18 ns of molecular dynamics simulations.

Tricyclic antidepressants (TCAs) have been used for decades, but their orientation within and molecular interactions with their primary target is yet unsettled. The recent finding of a TCA binding site in the extracellular vestibule of the bacterial leucine transporter 11 A above the central site has prompted debate about whether this vestibular site in the bacterial transporter is applicable to binding of antidepressants to their relevant physiological target, the human serotonin transporter (hSERT). We present an experimentally validated structural model of imipramine and analogous TCAs in the central substrate binding site of hSERT. Two possible binding modes were observed from induced fit docking calculations. We experimentally validated a single binding mode by combining mutagenesis of hSERT with uptake inhibition studies of different TCA analogs according to the paired mutation ligand analog complementation paradigm. Using this experimental method, we identify a salt bridge between the tertiary aliphatic amine and Asp(98). Furthermore, the 7-position of the imipramine ring is found vicinal to Phe(335), and the pocket lined by Ala(173) and Thr(439) is utilized by 3-substituents. These protein-ligand contact points unambiguously orient the TCA within the central binding site and reveal differences between substrate binding and inhibitor binding, giving important clues to the inhibition mechanism. Consonant with the well established competitive inhibition of uptake by TCAs, the resulting binding site for TCAs in hSERT is fully overlapping with the serotonin binding site in hSERT and dissimilar to the low affinity noncompetitive TCA site reported in the leucine transporter (LeuT).

The two enantiomers of the antidepressant citalopram inhibit the human serotonin transporter substantially differently. Previous studies revealed Tyr95 and Ile172 as important for citalopram binding, however, the overall orientation of the ligands in the binding site and the protein-ligand interaction points remain unknown. The binding of S- and R-citalopram to a human serotonin transporter homology model are herein examined via docking simulations including induced fit effects. For a better description of the formal charges of the ligand when bound inside the protein, polarization effects of the protein were included by additional quantum-polarized ligand docking calculations, where ligand charges are evaluated using QM/MM calculations. By this approach a much clearer picture emerged of the positions of the functional groups of citalopram. The two enantiomers are predicted to bind in the substrate binding pocket with opposite orientations of their aromatic groups. The predicted binding modes are experimentally validated using human wild type and 15 serotonin transporter mutants and 13 optically pure citalopram analogues. Important protein-ligand interaction points were identified validating one binding model for each enantiomer. In the validated model of the high affinity enantiomer, S-citalopram, the fluorine atom is located near Ala173 and Thr439 and the cyano group is in close proximity of Phe341; these contacts are found to be reversed for the R-enantiomer.

Left ventricular (LV) function is impaired by increased afterload in neonates with severe coarctation of the aorta, which may result in endocardial fibroelastosis. Repair of the coarctation usually solves the problem, with LV function normalizing after a few weeks. This report describes a patient who underwent successful repair of critical coarctation with normalization of LV function despite signs of endocardial fibroelastosis but with persisting elevation of cardiac troponin T. Cardiac catheterization showed the rare coincidence of anomalous origin of left coronary artery from the right pulmonary artery (ALCAPA) and coronary sinus orifice atresia with left superior vena cava.

Bone wax is a well-known agent used to prevent bleeding from the bone that can be used in different surgical procedures. Bone wax is a safe agent, but it may rarely lead to significant foreign body reactions. In this report, we present a patient who developed bone wax-related disc space foreign body granuloma following L4 total laminectomy, extremely rare complication.

Endocrine-disrupting compounds (EDCs) accumulating in nature are known to interact with nuclear receptors. Especially important is the human estrogen receptor alpha (hERalpha), and several EDCs are either known or suspected to influence the activity of the ligand-binding domain (LBD). We here present a comparative docking study of both well-known hERalpha ligands and small organic compounds, including selected polychlorinated biphenyls (PCBs), plasticizers, and pesticides, that are all potentially endocrine-disrupting,into different conformations of the hERalpha LBD. Three newly found quasi-stable structures of the hERalhpa LBD are examined along with three crystallographic conformations of the protein, either theapo structure or using a protein structure with a bound agonist or antagonist ligand. The possible interactions between the protein and the potentially EDCs are described. It is found that most suspected EDCs can bind in the steroid binding cavity, interacting with at least one of the two hydrophilic ends of the steroid binding site. DDE, DDT, and HPTE are predicted to bind most strongly to the hERalpha LBD. It is predicted that these compounds can interact with the three conformations of hERalpha LBD with comparable affinities.The metabolic hydroxylation of aromatic compounds is found to lead to an increase in the binding affinity of PCBs as well as DDT. Docking into the quasi-stable conformations of the hERalpha LBD leads to computed binding affinities similar to or better than those calculated for the three X-ray structures, revealing that the new structures may be of importance for assessing the function of the influence of EDCs on nuclear receptors.

Although rare, the diagnosis of candidal vertebral osteomyelitis of the cervical spine should be considered in cases of quadriparesia occurring in hemodialysis patients. This disease leads to vertebral destruction and spinal cord compression. Candidal vertebral osteomyelitis constitutes a diagnostic problem for all physicians. The insidious progression of disease, the non-specificity of the clinic and laboratory findings, and the failure to recognize candida as a potential pathogen may lead to a diagnostic delay. Early diagnosis and treatment are fundamental points for prognosis. In this report, we present the fifth case of cervical vertebral osteomyelitis caused by Candida species in the literature. Our case is the second case of candidal vertebral osteomyelitis associated with epidural abscess of the cervical spine.

Molecular modeling and structure-activity relationship studies were performed to propose a model for binding of the neurotransmitter serotonin (5-HT) to the human serotonin transporter (hSERT). Homology models were constructed using the crystal structure of a bacterial homologue, the leucine transporter from Aquifex aeolicus, as the template and three slightly different sequence alignments. Induced fit docking of 5-HT into hSERT homology models resulted in two different binding modes. Both show a salt bridge between Asp98 and the charged primary amine of 5-HT, and both have the 5-HT C6 position of the indole ring pointing toward Ala173. The difference between the two orientations of 5-HT is an enantiofacial discrimination of the indole ring, resulting in the 5-hydroxyl group of 5-HT being vicinal to either Ser438/Thr439 or Ala169/Ile172/Ala173. To assess the binding experimentally, binding affinities for 5-HT and 17 analogues toward wild type and 13 single point mutants of hSERT were measured using an approach termed paired mutant-ligand analogue complementation (PaMLAC). The proposed ligand-protein interaction was systematically examined by disrupting it through site-directed mutagenesis and re-establishing another interaction via a ligand analogue matching the mutated residue, thereby minimizing the risk of identifying indirect effects. The interactions between Asp98 and the primary amine of 5-HT and the interaction between the C6-position of 5-HT and hSERT position 173 was confirmed using PaMLAC. The measured binding affinities of various mutants and 5-HT analogues allowed for a distinction between the two proposed binding modes of 5-HT and biochemically support the model for 5-HT binding in hSERT where the 5-hydroxyl group is in close proximity to Thr439.

Translocation through the extracellular vestibule and binding of leucine in the leucine transporter (LeuT) have been studied with molecular dynamics simulations. More than 0.1 mus of all-atom molecular dynamics simulations have been performed on different combinations of LeuT, bound substrate, and bound structural Na(+) ions to describe molecular events involved in substrate binding and in the formation of the occluded state and to investigate the dynamics of this state. Three structural features are found to be directly involved in the initial steps of leucine transport: a Na(+) ion directly coordinated to leucine (Na-1), two aromatic residues closing the binding site toward the extracellular vestibule (Tyr-108 and Phe-253), and a salt bridge in the extracellular vestibule (Arg-30 and Asp-404). These features account for observed differences between simulations of LeuT with and without bound substrate and for a possible pathway for leucine binding and thereby formation of the occluded LeuT binding site.

Purpose: To compare visual performance of the refractive Array SA40N and the diffractive CeeOn 811E multifocal intraocular lenses (IOLs) and to evaluate the potential benefits of combining both multifocal IOLs in the same patient., Methods: Two groups of cataract patients were unilaterally implanted with either the CeeOn diffractive (n = 10) or the Array refractive multifocal IOL (n = 10). Another group was bilaterally implanted with one of each multifocal IOLs (mix & match group, n = 10). Visual acuity, spectacle independence, depth of focus, contrast sensitivity, presence of photic phenomena, and patient satisfaction were assessed postoperatively., Results: All eyes achieved good distance visual acuity but better uncorrected near vision was achieved with the CeeOn diffractive design. Contrast sensitivity with either multifocal IOL was at the lower limit of the normal range but when multifocal IOLs were combined in the same patient, contrast sensitivity was not significantly different from phakic controls. Defocus curves revealed a superiority of CeeOn diffractive design for near and Array refractive design for intermediate but mix & match patients performed better overall than the other patients, particularly for intermediate distances, which was reflected by total independence from spectacles in 90% of patients compared to 60% in the other groups. Visual outcomes remained unchanged over time (1 month vs 6 month vs > 3 years)., Conclusions: Bilateral implantation with a diffractive multifocal IOL in one eye and a refractive multifocal IOL in the fellow eye is safe and could provide patients with better intermediate vision, increased depth of focus and contrast sensitivity, and also less dependence on spectacles.

We present 158 ns of unrestrained all-atom molecular dynamics (MD) simulations of the human estrogen receptor alpha ligand binding domain (ERalpha LBD) sampling the conformational changes upon binding of estradiol. The pivotal role of His524 in maintaining the protein structure in the biologically active agonist conformation is elucidated. With His524 modeled as the epsilon-tautomer, a conserved hydrogen bond to the ligand is found in the active complex. Helices 3 and 11 are held together by a hydrogen-bonding network from His524 to Glu339 via Glu419 and Lys531, arresting the ligand in the binding pocket and creating the "mouse trap" binding site for helix 12 (H12). The simulations reveal how His524 serves as a communication point between the two. When estradiol is bound, His524 is positioned correctly for the hydrogen bond network to be established. H12 is then positioned for interaction with the co-activator protein, leading to the biologically active complex. The conformational dynamics of ERalpha LBD is further investigated from simulations of antagonist and apo conformations of the protein. These simulations suggest a likely sequence of events for the transition from the inactive apo structure to the transcriptionally active conformation of ERalpha LBD. Stable conformations are identified where H12 is placed neither in the "mouse trap" nor in the co-activator binding groove, as is the case for antagonist structures of ERalpha LBD. Finally, the influence of such conformations on the biological function of ERalpha is discussed in relationship to the interaction with selective estrogen receptor modulators and endocrine-disrupting compounds.

The functions of the serpin PAI-1 (plasminogen activator inhibitor-1) are based on molecular interactions with its target proteases uPA and tPA (urokinase-type and tissue-type plasminogen activator respectively), with vitronectin and with endocytosis receptors of the low-density-lipoprotein family. Understanding the significance of these interactions would be facilitated by the ability to block them individually. Using phage display, we have identified the disulfide-constrained peptide motif CFGWC with affinity for natural human PAI-1. The three-dimensional structure of a peptide containing this motif (DVPCFGWCQDA) was determined by liquid-state NMR spectroscopy. A binding site in the so-called flexible joint region of PAI-1 was suggested by molecular modelling and validated through binding studies with various competitors and site-directed mutagenesis of PAI-1. The peptide with an N-terminal biotin inhibited the binding of the uPA-PAI-1 complex to the endocytosis receptors low-density-lipoprotein-receptor-related protein 1A (LRP-1A) and very-low-density-lipoprotein receptor (VLDLR) in vitro and inhibited endocytosis of the uPA-PAI-1 complex in U937 cells. We conclude that the isolated peptide represents a novel approach to pharmacological interference with the functions of PAI-1 based on inhibition of one specific molecular interaction.

We describe 2 patients who were receiving antidepressant therapy before excimer laser surgery, at the time of surgery, and after surgery. Both patients experienced the ocular side effects of antidepressant drugs, ie, symptoms due to dry eyes and mydriasis.

Background: Microincisional cataract surgery is a safe procedure with a very short learning period for an experienced cataract surgeon and rollable ultrathin intraocular lenses eliminate the need for enlargement of corneal incision. The purpose of the study was to evaluate the safety and efficacy of cataract surgery through a corneal microincision and implantation of rollable ultrathin intraocular lenses. The setting was Dokuz Eylul University Medical Faculty, Ophthalmology Department, Izmir, Turkey and SSK Okmeydani Hospital, Ophthalmology Clinic, Istanbul, Turkey., Patients and Methods: Ninety eyes in 85 patients were operated on through clear corneal microincisions with sleeveless phacoemulsification and rollable intraocular lenses were implanted. Forty-six of the patients were men and 39 were women between the ages of 27 and 83, with a mean of 51 years. Two eyes had atrophic senile macular degeneration, 4 eyes had nonspecific retinal pigment epithelial changes with chorioretinal atrophy, and 4 patients had diabetes mellitus without retinopathy. Three eyes had posterior capsular opacifications of unknown etiology. Two eyes had primary open angle glaucoma (PAAG) with cup to disc ratios of about 0.5. Three eyes had dense nuclear sclerosis of grade 4 with very low visibility of retinal structures. Other patients had no ocular or systemic pathology other than nuclear/corticonuclear cataract of grade 2-3. Uncorrected and best spectacle-corrected distance and near visual acuities, keratometric values, and refractive status were noted preoperatively and 1 week, 1 month, and 6 months postoperatively. Statistical analysis of keratometric changes between preoperative and postoperative findings was performed using the paired samples t test., Results: At 6 months postoperatively, 1 patient had a best spectacle-corrected visual acuity (BSCVA) of 0.2, the patient with atrophic senile macular degeneration. The rest of the eyes achieved a BSCVA of 0.63 or better. At 6 months postoperatively, 55 (61.11%) eyes had uncorrected visual acuities (UCVA) equal to or better than 0.8 and 83 (92.22%) eyes had BSCVA equal to or better than 0.8 according to the Snellen chart. The mean postoperative corneal astigmatisms at 1 week, 1 month, and 6 months were 0.69+/-0.43 D, 0.66+/-0.46 D and 0.65+/-0.48 D respectively. Statistical analysis revealed a significant change in corneal astigmatisms at the 1st week visit (p<0.05), but not at the 1st and 6th month visits (p>0.05) compared with preoperative findings., Conclusion: Based on the limited data in the literature and in this study, it is not possible to make concrete decisions about the benefits and disadvantages of the ThinOptx IOL for longer durations. Intraoperatively, this IOL apparently eliminates the need for enlargement of the corneal incision during implantation. However, the statistical insignificance of induced astigmatisms after microincisions and classical phacoincisions should also be taken into consideration. We conclude that ThinOptx IOL is a pioneering intraocular lens implant that will contribute to the exciting future of cataract refractive surgical procedures. However, both clinical and laboratory investigations are needed to clearly describe the long-term effectiveness of this new rollable IOL.

Purpose: To determine the neodymium:YAG (Nd:YAG) laser energy threshold to fracture the haptic of various currently marketed intraocular lenses., Setting: Dokuz Eylul University, Ophthalmology Department, Izmir, Turkey., Methods: Four haptic materials-poly(methyl methacrylate) (PMMA), hydrophobic acrylic, hydrophilic acrylic, and polyvinylidene fluoride-were tested. The intraocular lenses (IOLs) were grouped according to haptic material. Each group comprised 9 IOLs. Beginning laser energy was 4 mJ. If no crack was noted, energy was increased by 0.5 mJ at every 20 shots and the procedure continued until a fracture was noted. If the fracture could not be developed despite reaching an energy level of 10 mJ, the procedure was terminated. Statistical analysis was performed to determine the differences within groups., Results: Hydrophobic acrylic and polyvinylidene fluoride haptics required higher energy and more laser shots to create a fracture than hydrophilic acrylic and PMMA haptics., Conclusions: Neodymium:YAG laser haptic fracturing can be a viable option to cut the fibrosed haptic before explanting any IOL. It was demonstrated in vitro that it is easier to fracture hydrophilic acrylic and PMMA haptics than hydrophobic acrylic and polyvinylidene fluoride haptics.

Purpose: To evaluate the beneficial effects of triamcinolone-assisted vitrectomy during management of retained nuclei with phacofragmentation., Setting: Dokuz Eylul University, Medical Faculty, Ophthalmology Department, and Retina Eye Center, Izmir, Turkey., Methods: Twelve eyes of 12 patients were operated on between January 2002 and September 2003. Eleven patients were referred because of nucleus drop during phacoemulsification surgery. Six of these patients had mature white cataracts, and in 5 cases total nucleus luxation into vitreous cavity had occurred. In 1 case, approximately half of the nucleus was luxated. Five of the referred patients had pseudoexfoliation (PEX), 3 of whom also had phacodonesis. All of these patients had luxated nucleus segments of more than half. One patient was referred with an intraocular lens (IOL) implanted in the sulcus region. One patient who was not referred also had PEX, iridodonesis, and phacodonesis; total drop of nucleus had occurred in this case. All patients were treated with pars plana vitrectomy with triamcinolone acetonide staining of the vitreous material and phacofragmentation of the dropped nucleus segments. In 2 cases, transscleral foldable IOL fixation surgery was combined simultaneously. One patient already had an IOL at the time of referral. Nine patients were left aphakic for secondary procedures., Results: All patients except 1 with subretinal neovascular membrane achieved best corrected visual acuities of equal or better than 0.5. No intraoperative or postoperative retinal complications were observed after 9 to 15 months of follow-up., Conclusion: Staining of the vitreous material with triamcinolone acetonide during vitrectomy and phacofragmentation surgery for luxated nuclei helped in total removal of the vitreous body, thus preventing the aspiration of peripheral vitreous fibrils by the phaco tip, which might induce retinal detachment intraoperatively or postoperatively.

We have performed long-term molecular dynamics simulations of pyruvate decarboxylase from Zymomonas mobilis. Nine structures were modeled to investigate mechanistic questions related to binding of the cofactor, thiamin diphosphate (ThDP), and the substrate in the active site. The simulations reveal that the proposed three ThDP-tautomers all can bind in the active site and indicate that the equilibrium is shifted toward 4'-aminopyrimidine ThDP in the absence of substrate. 4'-Aminopyrimidinium ThDP is found to be a likely intermediate in the equilibrium. Mutations of important active site residues, Glu473Ala and Glu50Ala, were modeled to further elucidate their catalytic role. Formation of the catalytic important ylide by deprotonation of ThDP(C2) is investigated. Only the less favored tautomer, 1',4'-iminopyrimidine ThDP (imino-ThDP), could be deprotonated. The two other tautomers of ThDP could not be activated at the C2-position, thus, explaining the mechanistic importance of the less stable imino-ThDP. Finally, binding of pyruvate in the active site with the cofactor modeled as the nucleophilic ylide (ylide-ThDP) is studied. The carbonyl group of the substrate forms a hydrogen bond to Tyr290(OH). No hydrogen bond could be identified between ThDP(N4') and the substrate. The geometry of the substrate binding is well-suited for a nucleophilic attack by ylide-ThDP(C2). We propose that a proton relay from His113 via Asp27 and Tyr290 to the carbonyl oxygen atom of the substrate may be involved in the mechanism.

A prospective in vitro study was conducted to investigate the potential for various perfluorocarbon liquids to support the growth of microbes, which may be introduced into these liquids as contaminants during intraocular surgery. Perfluorodecaline, perfluoro-noctane, and perfluorophenanthrene were tested for the growth of Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans by using tryptone soy broth, pancreatic digest of casein, and Sabouraud broth as culture media for up to 10 days. No microbial growth was observed in any of these perfluorocarbon liquids. Perfluorocarbon liquids do not promote microbial growth. Thus, they do not increase the risk of endophthalmitis in vitreoretinal surgery.

Scimitar syndrome is a rare congenital disorder. It is characterized by partial or total abnormal venous drainage of the right lung into the inferior vena cava, which is often associated with anomalous systemic arterial supply to the right lung, congenital cardiac anomalies, hypoplasia of the right lung and bronchial anomalies. Symptoms depend on the degree of the shunt and severity of the associated anomalies, which determine the treatment. We present a 6-year-old boy who was diagnosed as having the adult form of scimitar syndrome during evaluation for recurrent pulmonary infections, and underwent embolization with a detachable silicon balloon of the anomalous systemic arterial supply from the abdominal aorta to the right lower lung lobe. Successful elective surgery was performed 6 months later, in which right pulmonary veins were directed to the left atrium using a Gore-Tex patch by creating an intra-atrial tunnel. The patient has been symptom-free period during 6 months of follow-up, which supports the idea that recurrent pulmonary infections can be eliminated by embolization of the anomalous arterial supply.

An arteriovenous fistula (AVF) is an abnormal connection between an artery and a vein which may result from a traumatic injury or occur as a congenital abnormality. It may be asymptomatic or may present with a variety of symptoms. Surgical or endovascular treatment can be preferred. We present a case of unsuccessful percutaneous treatment of a femoral AVF due to misplacement of the stent-grafts, necessitating surgical correction.

Purpose: Topical anesthesia is increasingly being used for cataract surgery. However, it is believed that topical anesthesia causes an increased risk of intraoperative complications from unrestricted eye movement and insufficient pain control and more need for sedation. It is difficult to compare pain and anxiety experienced by individual patients; therefore, the authors used the method of patient-controlled sedation to determine whether there is a difference in sedation requirements under topical or retrobulbar anesthesia., Methods: In this prospective study, patients received either topical anesthesia (n=87) or retrobulbar block (n=104) and self-administered a mixture of midazolam (0.5 mg) and fentanyl (25 microg) in increments using a patient controlled analgesia infuser to achieve sedation. At the end of surgery, patients rated their pain on a 10-point numerical rating scale and their comfort on a 5-point scale. The number of demands and deliveries were noted from the patient controlled analgesia infuser display., Results: Pain scores were between 0 and 2 in 95.4% in the topical and in 94.2% in the retrobulbar group (p>0.05). Patient comfort was equal in both groups with 2.94+/-0.92 in the topical group and 2.92+/-0.99 in the retrobulbar group (p>0.05). Mean sedation requirements were similar in both groups: 26.4% of patients in the topical group and 19.2% in the retrobulbar group did not request any sedation (not significant, p>0.05)., Conclusions: Sedation requirements were similar for cataract surgery under topical and retrobulbar anesthesia.

Purpose: Topical anesthesia is increasingly being used for cataract surgery. However, it is believed that topical anesthesia causes an increased risk of intraoperative complications from unrestricted eye movement and insufficient pain control and more need for sedation. It is difficult to compare pain and anxiety experienced by individual patients; therefore, the authors used the method of patient-controlled sedation to determine whether there is a difference in sedation requirements under topical or retrobulbar anesthesia., Methods: In this prospective study, patients received either topical anesthesia (n=87) or retrobulbar block (n=104) and self-administered a mixture of midazolam (0.5 mg) and fentanyl (25 g) in increments using a patient controlled analgesia infuser to achieve sedation. At the end of surgery, patients rated their pain on a 10-point numerical rating scale and their comfort on a 5-point scale. The number of demands and deliveries were noted from the patient controlled analgesia infuser display., Results: Pain scores were between 0 and 2 in 95.4% in the topical and in 94.2% in the retrobulbar group (p>0.05). Patient comfort was equal in both groups with 2.94 0.92 in the topical group and 2.92 0.99 in the retrobulbar group (p>0.05). Mean sedation requirements were similar in both groups: 26.4% of patients in the topical group and 19.2% in the retrobulbar group did not request any sedation (not significant, p>0.05)., Conclusions: Sedation requirements were similar for cataract surgery under topical and retrobulbar anesthesia. (Eur J Ophthalmol 2004; 14: #-7).

The present study was initiated to determine whether dietary supplemental L-carnitine and niacin affect growth performance, carcass yield, abdominal fat and plasma L-carnitine concentration of broiler chicks. One-day-old broiler chicks (COB500) were used in the experiment. A two by two factorial arrangement was employed with two levels (0 and 50 mg/l) of supplemental L-carnitine and two levels (0 or 50 mg/l) of supplemental niacin in drinking water as main effects. Body weight gain was significantly improved by L-carnitine, or L-carnitine + niacin supplementation during the first 3 weeks. However, supplemental L-carnitine and niacin did not change body weight gain during the last 3 weeks of the experimental period. Supplemental L-carnitine significantly improved feed intake during the first 3 weeks. Supplemental L-carnitine or niacin did not influence carcass weight, carcass yield and abdominal fat weight. L-carnitine content in the plasma was significantly higher in the groups receiving supplemental L-carnitine and L-carnitine + niacin. It is concluded that dietary supplemental L-carnitine or L-carnitine + niacin could have positive effects on body weight gain and feed intake during the early stages of growing. However, supplemental L-carnitine or L-carnitine + niacin were not of benefit regarding the complete growth period.

The present study was initiated to determine whether dietary supplemental L-carnitine and ascorbic acid affect growth performance, carcass yield and composition, abdominal fat and plasma L-carnitine concentration of broiler chicks reared under normal and high temperature. During the experiment, two temperature regimes were employed in two experimental rooms, which were identical but different in environmental temperature. The regimes were thermoneutral (20-22 degrees C for 24 h) or recycling hot (34-36 degrees C for 8 h and 20-22 degrees C for 16 h). One-day-old broiler chicks (ROSS) were used in the experiment. A 2 x 2 x 2 factorial arrangement was employed with two levels (0 and 50 mg/kg) of supplemental L-carnitine and two levels (0 or 500 mg/kg) of supplemental ascorbic acid in drinking water under thermoneutral or high temperature regimes. Body weight gain was affected by high temperature. However, body weight gain was significantly improved in animals receiving supplemental L-carnitine, ascorbic acid or L-carnitine + ascorbic acid compared to animals receiving unsupplemented diet under high temperature. On the other hand, supplemental L-carnitine or L-carnitine + ascorbic acid reduced body weight gain under thermoneutral condition. Supplemental ascorbic acid significantly improved feed conversion efficiency, the improvement was relatively greater under high temperature. The L-carnitine content in the plasma was higher in the groups receiving supplemental L-carnitine and ascorbic acid under high temperature, while broilers fed supplemental L-carnitine and ascorbic acid had a decreased level of plasma L-carnitine concentration under normal temperature. It is concluded that dietary supplemental L-carnitine or L-carnitine + ascorbic acid may have positive effects on body weight gain, carcass weight under high temperature conditions.

The aim of this study was to document the magnetic resonance imaging (MRI) findings of cases with a history of severe neonatal indirect hyperbilirubinemia. Ten cases (eight cases with neurologic findings, two normal cases) with a history of severe neonatal indirect hyperbilirubinemia were studied. Neurologic findings and MRI results were described and correlated. Seven of eight cases with neurologic findings demonstrated symmetric and uniform increased T2 signal changes limited to globus pallidi. MRI scans of two cases without neurologic findings showed no abnormality. Severe neonatal indirect hyperbilirubinemia should be considered in the differential diagnosis of bilateral symmetric hyperintense signal changes in the globus pallidus on MRI. However, high levels of unconjugated bilirubin concentrations in the neonatal period may not always cause such lesions of globus pallidus on MRI despite the presence of neurologic findings.

We reviewed the CT findings of 13 patients with histologically proved alveolar echinococcosis of the liver. Seven of these patients had hilar involvement, which caused dilatation of intrahepatic bile ducts and invasion of the portal vein or portal branches. In two of these patients we found marked atrophy of the right lobe and in one patient marked atrophy of the left lobe in addition to various CT findings previously reported for alveolar echinococcosis of the liver. The occurrence of lobar atrophy of the liver caused by alveolar echinococcosis has not been previously reported. We concluded that, when a mass lesion with hilar infiltration causing lobar atrophy is found in endemic areas, alveolar echinococcosis should be considered in the differential diagnosis in addition to malignant neoplasms.

Twenty-eight patients with colon carcinoma (excluding the recto-sigmoid region) underwent preoperative staging with computed tomography (CT). The CT had a sensitivity and a specificity of 60 and 67% for detection of extramural invasion, 75% sensitivity and specificity for lymph node metastases and a sensitivity of 87% and specificity of 95% for liver metastases. Compared with the modified Dukes classification, CT correctly staged 50% of the patients with Dukes A lesions; 40% with Dukes B; 75% with Dukes C and 85% with Dukes D lesions. The data presented in this study showed that CT has limitations in the sensitivity and accuracy of staging local colonic carcinoma. However, we recommend its use for patients who are clinically suspected of having extensive disease.

Balloon dilatation of the urethra was performed in five patients with iatrogenic urethral strictures. The urethral strictures were successfully negotiated and dilated in all patients. Redilatation became necessary in a period ranging from 3 to 10 months. The authors believe that balloon dilatation of the urethra can be safely and successfully performed; the procedure produces minimal trauma and immediate relief of symptoms.