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Proteins' three-dimensional (3D) structures are analyzed traditionally using geometric descriptors such as torsional angles and inter-atomic distances. In this study a measure that is borrowed from computational geometry, aspect ratio of each tetrahedron in alpha shapes of proteins, is utilized. This geometric descriptor differentiates alpha and beta structural classes of proteins when combined with principal components analysis. The method converts the structures of individual proteins, 3D coordinates of the atoms, to points on a plane. It has a high degree of accuracy in differentiating R and T structures of hemoglobin. Therefore, it is anticipated that the geometric measure can be used successfully in a method that is extended to solve classification problems in machine learning., (© 2021 Wiley Periodicals LLC.)

Background: Liver tissue situated outside the liver with a hepatic connection is usually called an accessory liver, and that without a connection to the mother liver, is called ectopic liver tissue., Aim: To identify studies in the literature on ectopic liver tissue located on the gallbladder surface or mesentery., Methods: We present two patients and review published articles on ectopic liver tissue located on the gallbladder surface accessed via PubMed, MEDLINE, Google Scholar, and Google databases. Keywords used included accessory liver lobe, aberrant liver tissue, ectopic liver tissue, ectopic liver nodule, heterotopic liver tissue, hepatic choristoma, heterotopic liver tissue on the gallbladder, and ectopic liver tissue on the gallbladder. The search included articles published before June 2020 with no language restriction. Letters to the editor, case reports, review articles, original articles, and meeting presentations were included in the search. Articles or abstracts containing adequate information on age, sex, history of liver disease, preliminary diagnosis, radiologic tools, lesion size, surgical indication, surgical procedure, and histopathological features of ectopic liver tissue were included in the study., Results: A total of 72 articles involving 91 cases of ectopic liver tissue located on the gallbladder surface or mesentery were analyzed. Of these 91 patients, 62 were female and 25 were male (no gender available for 4 patients), and the age range was 5 d to 91 years. Forty-nine patients underwent surgery for chronic cholecystitis or cholelithiasis, and 14 patients underwent surgery for acute cholecystitis. The remaining 28 patients underwent laparotomy for other reasons. Cholecystectomy was laparoscopic in 69 patients and open in 11 patients. The remaining 19 patients underwent various other surgical procedures such as autopsy, liver transplantation, living donor hepatectomy, Whipple procedure, and liver segment V resection. Histopathologically, hepatocellular carcinoma was detected in the ectopic liver tissue of one patient., Conclusion: Ectopic liver tissue is a rare developmental anomaly which is usually detected incidentally. Although most studies suggest that ectopic liver located outside the gallbladder has a high risk of hepatocellular carcinoma, this is not reflected in statistical analysis., Competing Interests: Conflict-of-interest statement: There is no conflict of interest associated with the senior author or other coauthors who contributed to this manuscript., (©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: Influenza can cause severe acute respiratory illness (SARI), which occurs as local outbreaks or seasonal epidemics with high intensive care unit (ICU) admission and mortality rates. Mortality is mainly due to SARI., Objective: The aim of this study was to evaluate the outcome of patients admitted to ICU due to influenza-related SARI in 2017-2018 flu season in Turkey., Methods: A retrospective multicenter study was conducted in 13 ICUs with a total of 216 beds from 6 cities in Turkey. All adult patients (over 18 years) admitted to the ICUs in 2017-2018 flu season (between September 1, 2017, and April 30, 2018) because of SARI and with a positive nasopharyngeal swab for influenza were included in the study., Results: A total of 123 cases were included in the study. The mean age of patients was 64.5 ± 17.5 years, and 66 (53.7%) patients were older than 65 years. The ICU mortality was 33.9%, and hospital mortality was 35.6%. Invasive mechanical ventilation (IMV), acute kidney injury (AKI), hematologic malignancy, and >65 years of age were the factors affecting mortality in influenza., Conclusion: SARI due to influenza carries a high mortality rate, and IMV, AKI, presence of hematologic malignancy, and older age are independent risk factors for mortality., (© 2020 S. Karger AG, Basel.)

Purpose: To compare the inhibitory effects of dovitinib and bevacizumab for treatment of corneal neovascularization (CNV)., Methods: Thirty-nine adult female Sprague Dawley rats weighing 180 to 250 g were used. CNV was induced by silver nitrate in the right eye of each rat. After the chemical burn, the animals were randomized into 5 groups. Group 1 did not receive any chemical substance. Group 2 received dimethyl sulfoxide, group 3 received bevacizumab 5 mg/mL, group 4 received dovitinib 5 mg/mL, and group 5 received bevacizumab 5 mg/mL + dovitinib 5 mg/mL topically administered twice daily for 14 days. On the 14th day, slit-lamp examination was performed, and anterior segment photographs were taken. The corneal neovascular area was measured on photographs as the percentage of the cornea's total area using computer imaging analysis. The corneal sections were stained with hematoxylin and eosin for histopathological examination., Results: A statistically significant decrease in the percentage of CNV was found in all treatment groups (group 3, group 4, and group 5) compared with the control group (group 1) (P < 0.01). A statistically significant difference in the percentage of CNV was found among group 3, group 4, and group 5 (P = 0.003). The percentage of CNV in group 4 was significantly higher than that in group 3 and group 5 (P1 = 0.004; P2 = 0.006). There was no statistically significant difference in the percentage of CNV between group 3 and group 5 (P = 0.228)., Conclusions: Dovitinib is a newly developed multitargeted tyrosine kinase inhibitor. Topical administration of dovitinib effectively inhibited CNV, but this effect of dovitinib was found less than topical bevacizumab.

Aim: This study aims to evaluate the prognostic factors of different optical coherence tomography (OCT) parameters as well as the tamponade used in surgery, on postoperative anatomical and functional success., Methods: Twenty-nine eyes of 27 patients were included in this study. A three-port 23-gauge pars plana vitrectomy was performed on all eyes with peeling of the internal limiting membrane by visualization with brilliant blue dye by the same surgeon (E.U). Apical diameter (AD), base diameter (BD), and height (H) were manually measured by the same retina specialist (E.U) with using the software on OCT machine. Macular hole index (MHI), tractional hole index, diameter hole index, and macular hole volume (MHV) were calculated. The correlation between predictive factors and postoperative best corrected visual acuity (BCVA) was evaluated., Results: A statistically significant positive correlation was observed between preoperative BCVA, AD, BD, MHV, and postoperative BCVA scores. A statistically significant negative correlation was observed between preoperative MHI and postoperative BCVA scores ( r = -0.676, P = 0.001). The strongest positive correlation was between BD and postoperative BCVA (logMAR) ( r = 0.732, P = 0.001). The visual improvement was statistically better in patients treated with C3F8 than SF6., Conclusion: BD and MHV could be used as a strong predictive OCT parameters of postoperative functional success., Competing Interests: There are no conflicts of interest.

Purpose: We aimed to compare the neuroprotective effects of brimonidine tartrate (BRT) and melatonin (MEL) on retinal ganglion cells (RGCs) in a rat glaucoma model., Methods: Thirty-six adult Wistar albino rats were allocated into six groups: control (C), glaucoma (G), BRT, MEL, G + BRT and G + MEL. After establishing the glaucoma model, intraocular pressure (IOP) of all animals measured at day 4 and day 30 was compared statistically with day 0 and day 4, respectively. Prior to sacrification at day 30 for histological evaluation and TUNEL analysis, retrograde labeling of non-apoptotic RGCs with 3% Fluorogold was performed and RGCs were evaluated under fluorescein microscope., Results: IOP measurements at day 4 were significantly higher than basal measurements in all glaucoma groups. BRT alone induced a time-dependent decrease in IOP (p < 0.05), while MEL alone failed to reduce IOP. However, both BRT and MEL reduced IOP in the presence of glaucoma at day 30 (p < 0.05). BRT treatment significantly reversed the reduced non-apoptotic RGC counts (p < 0.01) and increased TUNEL-positive RGCs (p < 0.001) to control group levels in the presence of glaucoma. However, no statistical significance was found between groups G and G + MEL considering 3% Fluorogold-labeled cell counts and apoptotic index values., Conclusion: Our study revealed that systemic administration of BRT also has an IOP reducing effect. MEL has no neuroprotective effect on RGCs; on the other hand, BRT acts as a neuroprotective agent against glaucomatous injury, when applied systemically.

Introduction: An increased risk of cardiovascular complications has been defined in community-acquired pneumonia (CAP), but limited data is available for patients with severe CAP., Objective: The aim of the present study was to define the prevalence, characteristics, risk factors and impact on mortality of acute cardiac events in patients with severe CAP during short and long term., Method: This investigation was a multicenter, retrospective cohort sudy of patients with severe CAP. Cardiac events were defined as cardiac arrhytmia, congestive heart failure and myocardial infarction. A logistic regression analysis was performed to identify predictors for acute cardiac events and mortality., Results: Of 373 patients (mean age 68 ± 16, 61.4% male), 56 (15%) developed a cardiac event (43 arrhythmia, 11 congestive heart failure and 2 myocardial infarction). Patients who developed an acute cardiac event were older, had more severe disease, pleural effusion, hypoalbuminemia, hyponatremia and more acidosis. Also, beta-blocker and diuretic use were more significant in these patients. In-hospital mortality was significantly higher in patients who developed cardiac events (29.6% vs 11%, P < .001). According to the logistic regression analysis, haloperidol, vasopressor or diuretic use, hypoalbuminemia and age were the predictors for acute cardiac events. Acute cardiac events were significantly associated with in-hospital mortality (OR 2.1; 95%CI 1.03-4.61, P = .04), but not associated with 90-day mortality., Conclusion: Our findings demonstrated that acute cardiac events are seen in a substantial proportion of patients with severe CAP and their occurence significantly associated with in-hospital mortality., (© 2018 John Wiley & Sons Ltd.)

Gastrointestinal stromal tumors (GISTs) are the most common non-epithelial (mesenchymal) tumors of the gastrointestinal tract. Although GISTs appear as solid and well-circumscribed lesions in most patients, they may also appear as solid- cystic (mixed) or pure cystic lesions due to reasons like intra-tumor hemorrhage and necrosis in a very small percentage of patients. Hence, cystic GISTs mostly lead to a diagnostic dilemma. In this paper we aimed to report a case of pure cystic giant GIST that was drained percutaneously twice after being misdiagnosed as a mesenteric cyst. An 83-yearold man was operated for a pre-diagnosis of a recurrent mesenteric cyst. The operation was started with the three-trocar laparoscopic technique. Six thousand milliliters of purulent fluid were drained from the cystic lesion. Then, a mini incision was performed above the umbilicus and the cyst and the distal ileal segment where it was originated were removed from the abdominal cavity. After the resection of a 15-cm ileal segment together with the cystic lesion, an intestinal anastomosis was performed. The histopathological and immunohistochemical findings showed that the mass was a GIST (size: 20 cm, mitosis: 3/50 HPF, Ki 67: %15, CD117: positive, DOG-1: positive). The patient was closely followed without imatinib therapy. KEY WORDS: Abscess, Cystic Degeneration, GIST, Mistreatment.

Introduction: Isolated pancreatic trauma is a rare condition and commonly come up in children or young adults.The poor initial symptoms lead to delay diagnosis and treatment. The treatment of isolated distal pancreatic trauma including the Wirsung's duct is generally distal pancreatectomy. In an emergency setting, splenectomy is a common additional organ resection requirement with the distal pancreatectomy. However, in circumstances, spleen preserving distal pancreatectomy can provide advantages in these age groups even in emergency conditions., Case Report: Twenty-four-year old male was referred two days after a traffic accident. Acute abdominal findings required laparotomy and preoperative computed tomography revealed a isolated distal pancreatic trauma including the Wirsung. In the hemodynamically stable patient, a spleen preserving distal pancreatectomy (SPDP) was performed uneventfully., Conclusion: Spleen preserving distal pancreatectomy is a beneficial and safe surgical option in isolated distal pancreatic trauma. We propose this surgical procedure for children and young patients, who have good general condition, stable vital findings and without another intraabdominal injury., Key Words: Distal pancreatectomy, Isolated pancreatic injury, Spleen preservation.

Objective: The present study is an evaluation of cases of acute biliary pancreatitis that developed subsequent to cholecystectomy., Methods: Total of 44 patients were assessed in this retrospective study. Demographic characteristics, severity of illness, time elapsed between cholecystectomy and development of pancreatitis, whether endoscopic sphincterotomy (ES) was performed, surgical procedure used, duration of hospitalization, and mortality data were recorded., Results: Mean age of all patients was 60.14±16.4 years (range: 20-85 years), and female:male ratio was 28:16. Mean length of time elapsed between cholecystectomy and development of acute pancreatitis was 80.6 months (range: 5-230 months). Gallstones and biliary sand were found in the choledochi of 36 patients upon endoscopic retrograde cholangiopancreatography (ERCP), but not observed in the remaining 8 patients. ES was performed and material was extracted in 32 of the 36 patients, but stone extraction was unsuccessful in 4 cases; 3 patients underwent open surgery with choledochus exploration and 1 patient died. Excluding this patient, mean duration of hospitalization was 7.5±2.5 days., Conclusion: Stones in bile ducts may remain asymptomatic for long periods after cholecystectomy. However, some stones trigger acute pancreatitis months or years after cholecystectomy, causing risk of mortality. ERCP and ES are the standard treatments. If these are unsuccessful, the choledochus may be explored via open or laparoscopic surgery., Competing Interests: Conflict of Interest: None declared.

Background and Aims: Early diagnosis and treatment of central nervous system tuberculosis are important because of high mortality and morbidity. Airways must be carefully evaluated in differential diagnosis., Methods: We present a rare case of intracranial-endobronchial tuberculosis mimicking lung cancer with brain metastasis., Results: A vegetative mass lesion, confirmed as necrotic granulomatous inflammation, originating from the entrance of the right upper lobe entry, was coagulated and extracted by argon plasma coagulation and cryotherapy to prevent permanent upper lobe atelectasis. Mycobacterium tuberculosis complex was detected in bronchoscopic material. A four-drug initial anti-tuberculous treatment regimen was given in 2 months. The upper lobe atelectasis was resolved at the fourth month of therapy despite upper lobar bronchus patency. The patient was doing well and completed the two-drug maintenance therapy of 7 months with complete resolution., Conclusion: In such cases, tissue diagnosis should be achieved as early as possible and anti-tuberculous treatment was commenced along with advanced interventional techniques., (© 2015 John Wiley & Sons Ltd.)

LigaSure precise (LP) and harmonic scalpel (HS) are two energy-based devices used in thyroidectomy surgery. We aimed to compare the effect of these two devices in patients who had undergone total thyroidectomy, by highlighting the post-operative parathyroid function. A total of 201 consecutive patients for whom total thyroidectomy had been planned were prospectively classified into two groups. There were 104 patients in LP group and 97 patients in HS group. Hypoparathyroidism was followed up by serially measuring the levels of intact parathyroid hormone (iPTH) and serum calcium. The early iPTH level was 29 (8-50) pg/mL in group LP, and 17 (4-43) pg/mL in group HS. The early iPTH level was significantly lower in the HS group (p < 0.001). However, these levels were within the reference interval in both groups. The early iPTH level was lower than 20 pg/mL in 23 (23.1 %) patients in HS group, and 15 (13.7 %) patients in LP group (p < 0.001). Also, the late iPTH levels were not statistically significance between two groups. The early and late serum calcium levels were not statistically significant between groups. However, the amount of calcium replacement was higher in the HS group than the LP group and the duration of treatment was longer in the HS group than the LP group (p < 0.05). In conclusion, although parathyroid hormone levels impaired in the HS group more than LP group in the early period, these levels were in the normal limits in both groups. These levels were not significant between groups in the long time period.

Objective: To compare the diagnostic efficacy and agreement of the traditional tuberculin skin test with QuantiFERON-Tuberculosis Gold In-Tube test for latent tuberculosis infection in healthcare workers., Methods: The cross-sectional analytical study was conducted between March 1 and 31, 2008, at a specialist tuberculosis hospital in Istanbul, Turkey, and comprised healthcare workers who had been employed for at least one year at the hospital and volunteered to take part. Tuberculin skin test and QuantiFERON-Tuberculosis Gold In-Tube test were both performed simultaneously and their results were compared Using SPSS 12., Results: Out of 34 subjects, 20(58.8%) had a positive tuberculin skin test, and 7(20.6%) had a positive QuantiFERON-Tuberculosis Gold In-Tube test. The two tests agreed in only 15(44.1%) cases and disagreed in 19(55.9%). In 16(47.1%) subjects, the QuantiFERON-Tuberculosis Gold In-Tube test was negative and tuberculin skin testwas positive, while in 3(8.8%) participants QuantiFERON-Tuberculosis Gold In-Tube test was positive and tuberculin skin test was negative. Kappa test revealed discordance between the two tests (k=-0.13; p=0.92)., Conclusions: Latent tuberculosis infection prevalence was higher based on tuberculin skin test than QuantiFERON-Tuberculosis Gold In-Tube test. The results of the two tests were discordant.

Objective: The purpose of this study was to investigate the relationships among the pterygoid hamulus (PH), the maxillo-mandibular complex to the pharynx, the upper airway, and the soft palate and a possible connection to sleep apnea severity as assessed by polysomnography., Study Design: A total of 100 left and right sides of the PH were retrospectively measured by two observers from 50 cone beam computed tomography images by using three-dimensional rendering program in patients with obstructive sleep apnea (33 males and 17 females, with a mean age of 56.8 years; range 32-82 years)., Results: The mean apnea hypopnea index was 30.2 (range 0-95). A linear regression analysis on the apnea hypopnea index with the total length of the PH adjusted for gender, body mass index, neck circumference, and age showed a statistically significant association: (-0.234(∗); P = .005). None of the other variables reached formal significance., Conclusion: The pterygoid hamulus length is inversely associated with sleep apnea severity. Our study provides further insight into the pathophysiology of sleep apnea, with the result that PH length could be a future supplementary measurement to help clinicians to stratify and determine the best treatment options for patients with obstructive sleep apnea., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: To compare the macular thickness and volume of highly myopic children with healthy controls, using third generation optical coherence tomography (OCT)., Methods: OCT was performed on highly myopic (cycloplegic spherical equivalent refraction > -6.00 diopters [D]) children aged 3 to 7 years old and healthy controls (spherical equivalent refraction -2.00 to +4.00 D) between 2011 and 2013. OCT measurements of the average thicknesses of the fovea (central 1 mm) and inner (1 to 3 mm) and outer (3 to 6 mm) parafovea in superior, temporal, inferior, and nasal quadrants and total volume of the macular scan area were recorded. The differences between the two groups were tested with the Mann-Whitney U test., Results: There were 15 patients with high myopia and 11 controls. Foveal thickness (central 1 mm) was significantly greater in the high myopia group. The parafoveal thicknesses in all quadrants of the inner and outer circles were significantly thinner in the high myopia group. The average macular volume of the highly myopic eyes was significantly smaller than the control eyes., Conclusions: Anatomic changes in the retina occur even in young children with high myopia. Macular thickness characteristics of highly myopic children may influence the interpretation of data obtained with OCT., (Copyright 2015, SLACK Incorporated.)

Aim: We evaluated the aetiological factors, diagnoses and treatment outcomes of adult cases of invagination of the intestine, or intussusception. We elucidated the role of ultrasonography (USG), computed tomography (CT) and other techniques in the diagnosis of such cases., Patients and Methods: Six patients with sufficient medical data, all of whom were followed-up and treated for intussusception at Safa Hospital, General Surgery Clinic, Istanbul, Turkey, between July 2008 and December 2013, were enrolled., Results: The site of intussusception was the small bowel in five cases. The aetiopathology was benign in 5 (83.3%) cases and included inflammatory fibroid polyp (IFP) and adhesion. The malignant case was adenocarcinoma. The bowel segments involved were ileoileal in five cases and ileocolic in one case., Conclusions: USG and CT aided with the diagnosis. Although more rare in adults than in children, cases of ileus presenting with acute abdominal disorder, particularly those with an uncertain diagnosis, should be considered possible intussusception cases.

Aim: In this prospective study, we aimed at comparing the laparoscopic and conventional open inguinal hernia repair procedures in the population over 75 years of age., Materials and Methods: The medical data of 108 patients over 75 years of age who presented with inguinal hernia and underwent surgical treatment between July 2008 and December 2012 in Safa Hospital, General Surgery Department were prospectively recorded., Results: The mean age of patients in the open procedure group (n=75) and in the laparoscopic group (n=33) was 82 and 81 years, respectively. The mean American Society of Anaesthesiologists score was 2-7 in the open group and 2-4 in the laparoscopic group (P<0.005). There was no statistically significant difference between the groups with respect to perioperative complications. There was no mortality., Conclusion: Similar to the outcome of open procedure, laparoscopic inguinal hernia repair can safely be performed without an increase in morbidity and mortality in the advanced age population.

Purpose: To compare the postoperative early-stage complications of total and bilateral subtotal thyroidectomy for benign multi-nodular goiter., Material and Methods: There were 409 patients. The patients were divided into two groups. A total of 258 (63%) patients underwent total thyroidectomy, and 151 (37%) patients underwent bilateral subtotal thyroidectomy., Results: Recurrent laryngeal nerve palsy occurred in six (2.3%) of the total thyroidectomy patients and in three (1.9%) of the bilateral subtotal thyroidectomy patients (P>0.05). No permanent palsy was observed in either of the thyroidectomy groups. Hypocalcemia occurred in 40 (15.5%) of the total thyroidectomy patients and in 27 (17.8%) of those who underwent bilateral subtotal thyroidectomy (P>0.05). Also, no statistically significant differences were found between the two groups with respect to the development rates of hematoma and incision site infection (P>0.05)., Conclusion: Because of its low complication rates, total thyroidectomy is a safe procedure for benign multı-nodular goiter.

Aim: The aim of this study was to prospectively assess the outcome of early laparoscopic cholecystectomy (LC) in patients with acute cholecystitis., Materials and Methods: Between July 2005 and December 2012, of 623 patients who had symptoms of acute cholecystitis during the first 72 h of hospital admission and who did not respond to non-operative treatment, 302 underwent surgical treatment. After initial treatment, all patients were followed up for 21 months on average (range: 5-27 months). The clinical, biochemical, radiological, and operative data of the 302 consecutive patients with acute cholecystitis were recorded and analyzed prospectively., Results: Of the 302 patients who underwent LC for acute cholecystitis, 169 were females and 133 males. Their mean ages were 47.8 years (range: 17-79 years) and 53.3 years (range: 27-90 years) respectively. Conversion to open surgery was required in 32 patients (10.5%). The mean postoperative length of hospital stay was 2 days (range: 1-3 days) in the LC group and 3 days (range: 2-6 days) in the conversion group. Significant differences between the successful LC group and the conversion group were evident terms of the length of postoperative hospitalization and gallbladder wall thickness (P=0.023). Factors associated with conversion were male gender, pericholecystic collection observed via ultrasound, gangrenous cholecystitis, and gallbladder wall thickness >1 cm. We experienced two minor bile duct injury complications that were treated via T tube placement. No mortality occurred. Ten patients suffered infections at the incisional locations, and eight patients developed lung infections., Conclusion: Early LC is safe in patients with acute cholecystitis. Male gender, pericholecystic collection determined via ultrasound, gangrenous cholecystitis, and gallbladder wall thickness >1 cm are associated with a higher risk of conversion to open surgery.

Aim: To compare incision and drainage with oblique excision and primary closure in the treatment of pilonidal abscesses., Materials and Methods: In this prospective study, one of two surgeons at the same hospital performed incision and drainage as the treatment method for patients presenting with pilonidal abscesses. (Group A). The other surgeon performed oblique excision and primary closure (Group B). The rate of development of chronic pilonidal sinus and time to return to active work were assessed using the chi-square and Student's t-tests to compare the two methods of treatment. Of the 128 patients, incision and simple drainage was applied to 69 patients and primary closure was applied to 59 patients., Results: The rate of development of chronic pilonidal sinus was 78.8% in Group A and 6.0% in Group B (P < 0.001). In Group A, the average healing time and time to return to active work were 18 and 25 days, respectively. In Group B, these times were 22 and 27 days, respectively (P < 0.001)., Conclusion: Oblique excision and primary closure may be a preferable treatment for acute pilonidal abscesses because of its low rate of chronic sinus development.

Objective: To evaluate the effect of transepithelial corneal collagen cross-linking (CXL) with prolonged riboflavin application by in vivo confocal microscopy and to compare this effect with that of standard CXL with complete epithelial debridement., Methods: In eyes with progressive keratoconus, CXL procedure was performed with standard technique and transepithelial technique after prolonged riboflavin drop application for 2 hr. Patients were evaluated with in vivo confocal microscopic examination preoperatively and at postoperative months 1 and 6., Results: The depth of CXL effect was similar in both groups (i.e., 380.86 ± 103.23 μm in standard CXL group and 342.2 ± 68.6 μm in transepithelial CXL group) (P=0.4). The endothelial cell counts and morphological parameters (i.e., pleomorphism and polymegathism) were not significantly affected in both groups (P>0.05 for all). In the standard CXL group, in vivo confocal microscopy revealed anterior stromal acellular hyperreflective honeycomb edema with posteriorly gradually decreasing reflectivity and increasing number of keratocytes and some sheets of longitudinally aligned filamentary deposits. The keratocytes were seen to repopulate in the posterior-to-anterior direction. In transepithelial CXL group, although the depth of CXL effect was similar, less pronounced keratocyte damage, extracellular matrix hyperreflectivity, and sheets of filamentary deposits at the posterior stroma was observed., Conclusions: Transepithelial CXL with prolonged peroperative riboflavin application can achieve similar depth of effect in the stroma with less pronounced confocal microscopic changes as compared with the standard CXL with complete epithelial debridement.

Objective: The aim of this study was to assess the clinical features and high resolution computed tomography (HRCT) findings in smear-negative pulmonary tuberculosis (PTB) and to evaluate the correlation between these parameters and the culture results., Methods: We retrospectively studied 78 active smear-negative PTB patients. They were divided into two groups according to their culture results. The HRCT findings and clinical features at the beginning of the antituberculosis treatment were reviewed., Results: The mean age was 22.48±3.18 years. Micronodules (87%), large nodules (63%) and centrilobular nodules (62%) were the most common HRCT findings. HRCT findings were observed in the right upper (72%), left upper (56%), right lower (32%), and left lower lobes (29%). Cough (37%) and chest pain (32%) were the most frequent symptoms at presentation., Conclusions: There were no significant differences in the HRCT findings and clinical features between the two groups. Thus, in cases of smear-negative and culture-negative PTB, the patient with compatible clinical and radiological features should be considered for tuberculosis treatment.

Objectives: There is a lack of data regarding whether edentulous subjects should remove dentures during spirometric measurements or not. The purpose of this study is to determine influences of complete dentures on spirometric parameters in edentulous subjects., Materials and Methods: A total of 46 complete denture wearers were included in this study. Respiratory functions of the subjects were evaluated by spirometric tests that were performed in four different oral conditions: without dentures (WOD), with dentures, lower denture only and upper denture only. Forced vital capacity (FVC), peak expiratory flow, forced expiratory volume in 1 s and forced expiratory flow between 25% and 75% were evaluated. The data were analyzed with Friedman, Wilcoxon and paired-samples t tests (α = 0.05)., Results: Significant differences were found between spirometric parameters in different oral conditions (p < 0.05). In all spirometric parameters, the most important significant differences were found between conditions WOD, FVC and with lower dentures (FVC), and WOD (forced expiratory volume in 1 s) and with upper dentures (forced expiratory volume in 1 s) (p < 0.001)., Conclusion: It was observed that complete dentures may unfavourably affect spirometric values of edentulous subjects. However, current findings need to be confirmed with advanced respiratory function tests., (© 2012 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.)

Background: Angiopoietin 2 (Ang-2) has an important role in tumor angiogenesis. In this study, Ang-2 levels of serum and bronchioloalveolar lavage fluids (BALF) in patients with lung cancer were measured and correlated with clinical and biochemical parameters., Methods: Thirty-five cases newly diagnosed with lung cancer and 18 controls with non-cancerous lung diseases were included in the study. Tumor histology, staging, metastasis, tumor markers, biochemical and clinical parameters were all recorded., Results: Serum Ang-2 levels were significantly higher in the lung cancer group compared to the control (lung cancer median: 2.42 ng/mL [2.19-2.98], control 0.67 [0.31-1.10]; P < 0.001), whereas Ang-2 levels in BALF were lower in the lung cancer group compared to the control (lung cancer median 0.41 ng/mL [0.22-0.79], control 0.67 [0.46-1.03]; P = 0.02). In the cancer group, higher serum Ang-2 levels (r = 0.52, P < 0.001) were associated with the stage of cancer. No significant correlation was observed between BALF Ang-2 levels and non-small cell lung cancer stages and small-cell lung cancer advanced stage (P = 0.793, r = 0.07). Serum Ang-2 levels were significantly higher in distant metastasis (M1) versus no distant metastasis (M0) (M1: 2.57 ng/mL [2.38-2.87], M0: 2.22 [1.49-2.40], P = 0.01). No significant correlation was observed between BALF Ang-2 levels and M1 (r = 0.11, P = 0.53)., Conclusions: Serum Ang-2 levels were significantly higher in lung cancer patients and positive correlations were observed between serum Ang-2, tumor stage, and metastasis., (© 2012 Tianjin Lung Cancer Institute and Wiley Publishing Asia Pty Ltd.)

Purpose: To analyze the visual and refractive outcomes of laser in situ keratomileusis (LASIK) after deep anterior lamellar keratoplasty (DALK) for keratoconus., Setting: Haydarpasa Numune Education and Research Hospital, Ophthalmology Clinic, Istanbul, Turkey., Design: Cohort study., Methods: Patients with compound myopic astigmatism after DALK and a spherical equivalent (SE) between -2.50 diopters (D) and -8.00 D had LASIK as a single-step procedure, correcting the manifest refraction error. The visual and refractive results at 1 month, 3 months, and the last follow-up were compared with preoperative values., Results: The mean follow-up was 11.17 months ± 3.61 (SD). The mean manifest refraction SE (MRSE) and autorefractometer measurements and the autokeratorefractometer and corneal topography keratometry readings decreased significantly from preoperatively to 1 month postoperatively (P<.01) but did not change significantly thereafter (P>.05). Preoperatively, the mean uncorrected (UDVA) and corrected (CDVA) distance visual acuities were 0.21 ± 0.08 and 0.73 ± 0.08, respectively; postoperatively, the means were 0.73 ± 0.10 and 0.98 ± 0.05, respectively. All eyes achieved a postoperative UDVA better than 0.5. No eye lost CDVA lines. The safety index was 1.34. The mean MRSE was -5.18 ± 1.74 D preoperatively and -1.05 ± 0.64 D postoperatively (P<.01). Postoperatively, 11 eyes (91.67%) were within ± 2.00 D of the SE, 8 (6.67%) were within ± 1.00 D, and 5 (41.67%) were within ± 0.50 D. No complications were encountered., Conclusion: Treatment of post-DALK keratoconus patients with LASIK to correct manifest refraction error seems to be a viable option., (Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Background and Objective: To examine the exact position of implanted Keraring (Mediphacos, Belo Horizonte, Brazil) segments by high-resolution anterior segment optical coherence tomography (AS-OCT)., Patients and Methods: This study included 17 eyes of 13 patients with keratoconus who underwent uneventful intracorneal ring segment implantation with the aid of femtosecond laser. Eyes were evaluated by AS-OCT at the third postoperative month. Distance from the apex of the triangular cross-section of the ring segment to the anterior corneal surface and distances from two basal corners to the posterior corneal surface were measured., Results: Distance from apex to anterior corneal surface (263.1 ± 42.9 μm) was significantly smaller than target depth calculated intraoperatively (356.9 ± 35.7 μm, P < .001). Distance between outer basal corner and posterior corneal surface was significantly greater than distance between inner basal corner and posterior corneal surface., Conclusion: High-resolution AS-OCT is a rapid, convenient, and valuable technique in the follow-up of patients with implanted Keraring segments that may be helpful in predicting ring-related complications., (Copyright 2012, SLACK Incorporated.)

Purpose: To compare phacoemulsification-related endothelial cell loss in eyes with previous penetrating keratoplasty (PKP), previous deep anterior lamellar keratoplasty (DALK), or no previous corneal surgery., Setting: Ophthalmology Clinic, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey., Design: Comparative case series., Methods: Eyes with previous PKP (Group 1), previous DALK (Group 2), or no previous ocular surgery (Group 3) had extracapsular cataract extraction by phacoemulsification. The endothelial cell count was evaluated 1, 3, 6, and 12 months after cataract surgery., Results: Group 1 comprised 16 eyes and Group 2 and Group 3, 20 eyes each. The endothelial cell density (ECD) decreased progressively throughout the follow-up in all groups (P<.01). The amount of change in ECD was significantly greater in Group 1 than in Group 2 and Group 3 from preoperatively to 1 month postoperatively, from 1 to 3 months postoperatively, from 3 to 6 months postoperatively, and from 6 to 12 months postoperatively (all P<.01). The changes were similar in Group 2 and Group 3 at all time points (P>.05)., Conclusions: Eyes with previous PKP had significantly greater endothelial cell loss than eyes with previous DALK or no previous surgery. Preservation of the patient's endothelium seems to be an advantage of DALK in terms of increasing corneal safety in future intraocular surgery., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the corneal biomechanical properties of patients with pseudoexfoliation syndrome (PEX syndrome)., Methods: Fifty-two eyes of 52 patients (27 unilateral and 25 bilateral) and 42 eyes of 42 age-matched control subjects were enrolled in the study. Metrics of corneal biomechanical properties, including corneal hysteresis (CH) and corneal resistance factor (CRF), were measured with the ocular response analyzer (ORA). The ORA also determined the values of Goldmann-correlated intraocular pressure and corneal-compensated intraocular pressure. Central corneal thickness (CCT) was measured by the ORA integrated handheld ultrasonic pachymeter. The values recorded by the ORA were compared between eyes with PEX syndrome and those without PEX syndrome. Eyes with unilateral PEX syndrome and fellow eyes without PEX syndrome were also compared., Results: The mean CH and CRF of all eyes with PEX syndrome were significantly lower than those of control eyes (P < 0.05). Neither corneal-compensated intraocular pressure nor Goldmann-correlated intraocular pressure showed a statistically significant difference in both the groups. Mean CCT values also did not show significant difference. Comparison of the unilateral eyes with PEX syndrome with the apparently normal fellow eyes revealed no significant difference between the mean CCT, mean CH, and mean CRF values (P > 0.05). However, the mean corneal-compensated intraocular pressure and Goldmann-correlated intraocular pressure were relatively higher in the PEX syndrome eye (P < 0.05). There was no significant difference between the mean CCT values of these groups (P > 0.05)., Conclusions: The CH and CRF decrease in both unilateral and bilateral PEX syndrome suggested that PEX syndrome has a weakening effect on corneal biomechanical properties. Moreover, in subjects with clinically unilateral PEX syndrome, these properties were closer to eyes with PEX syndrome than to normal control eyes.

Background and Objective: This study examined the repeatability of and agreements between central corneal thickness measurements obtained by four different non-contact pachymetry devices., Patients and Methods: Seventy-eight eyes of 39 subjects were included. Central corneal thickness of each eye was measured by Visante optical coherence tomography (OCT) (Carl Zeiss Meditec Inc., Dublin, CA), Pentacam (Oculus Optikgeräte GmbH, Wetzlar, Germany), Orbscan IIz topography (Bausch & Lomb Surgical Inc., San Dimas, CA), and slit-lamp OCT (SL-OCT) (Heidelberg Engineering GmbH, Heidelberg, Germany). Inter-device agreements and correlations and repeatability of each device were examined., Results: All measurement methods correlated well with each other with a correlation coefficient greater than 0.90 and P value of less than .001 for all comparisons. However, Pentacam overestimated central corneal thickness: 546.7 ± 38.2, 535.5 ± 42.7, 531.7 ± 37.6, and 531.2 ± 36.0 μm for Pentacam, Orbscan IIz, Visante OCT, and SL-OCT, respectively (P < .001 for all comparisons versus Pentacam). Despite good correlation, magnitude of differences was high and this bias was proportional (ie, not constant across a range of corneal thickness values) for the following pairs: Orbscan versus Visante OCT, Orbscan versus SL-OCT, and Orbscan versus Pentacam (P < .001 for all comparisons)., Conclusion: Although measurements obtained by various non-contact methods correlate well, numerical agreement of the results may not be sufficient for their interchangeable use in clinical practice., (Copyright 2011, SLACK Incorporated.)

Background: A prospective evaluation of the pattern of fundus autofluorescence in cases of acute versus chronic central serous chorioretinopathy (CSR)., Methods: A prospective, cross-sectional, single-centre investigation was performed using three diagnostic techniques, namely, fundus autofluorescence, optical coherence tomography and fundus fluorescein angiography to evaluate a sample of patients (n = 42 eyes) with both acute (n = 25 eyes) and chronic (n = 17 eyes) CSR., Results: Hypoautofluoresecence was found in 80 per cent (20 eyes) and 88.2 per cent (15 eyes) of eyes in the acute and chronic central serous chorioretinopathy groups, respectively, corresponding to the leakage points depicted by fluorescein angiography. Hypoautofluoresence corresponding to the areas of subretinal fluid accumulation was seen in 92 per cent (23 eyes) and 82.3 per cent (14 eyes) of the acute and chronic central serous chorioretinopathy groups, respectively. In two eyes (11.6 per cent) with chronic CSR, hyperautofluorescent changes were noted at the previous leakage points. In the acute CSR group, speckled hyperautofluorescence was detected in nine eyes (36 per cent) after the resolution of subretinal fluid. In the chronic CSR group, simultaneous speckled hyperautofluorescence was detected in the previous areas of subretinal fluid accumulation in 12 eyes (70.5 per cent)., Conclusion: Fundus autofluorescence imaging delineates endogenous fluorescence derived mainly from lipofuscin within the retinal pigment epithelium (RPE) layer and therefore permits evaluation of functional alterations in the RPE in numerous retinal diseases. Data from fundus autofluorescence revealed distinctive findings in acute and chronic CSR. Fundus autofluorescence imaging may be used as a supplementary diagnostic tool for identifying patients with CSR and differentiation may be made between acute and chronic cases., (© 2011 The Authors. Clinical and Experimental Optometry © 2011 Optometrists Association Australia.)

Background and Objective: to investigate the efficacy of anterior segment optical coherence tomography (AS-OCT) for calculating flap thickness in femtosecond laser-assisted laser in situ keratomileusis., Patients and Methods: fifty-one eyes of 26 patients with myopia and myopic astigmatism were included in this prospective study. High-resolution corneal images were evaluated at 1 week and 1 month postoperatively. Images along the horizontal meridian were measured with the flap tool at seven points., Result: measurements at vertex and at 1 mm nasally and temporally from the vertex were indistinct but easily defined. Although statistically not significant, flaps were found to be thinner in the central cornea and thicker in the periphery (P > .05)., Conclusion: AS-OCT provides detailed high-resolution images for quantitative evaluation of the flap-stroma relationship, but it may not be precise in the central 2-mm area of the cornea. Despite this, AS-OCT is an imaging tool with significant utility.

Purpose: To evaluate retrospectively the cosmetic and functional effects on success of lacrimal diaphragm and periosteum suturation after the anastomosis of anterior flaps before skin closure in external dacryocystorhinostomy (ext-DCR)., Methods: During ext-DCR, lacrimal diaphragm was separated from periosteum over anterior lacrimal crest before entering lacrimal fossa. At the end of ext-DCR, the separated periosteum and lacrimal diaphragm were sutured in the study group (270 patients) and were left unsutured in the age-matched control group (96 patients). The effects of this approach on postoperative appearance of incision area at the 6-month postoperative controls, and functional success (assessed by fluorescein disappearing test) and anatomical success rates (assessed by lacrimal syringing) at the 12-month postoperative controls were evaluated., Results: The anatomic success rate between the 2 groups were found to be similar (94.8% and 92.7% in the study and control groups, respectively, p = 0.447). Fluorescein disappearing test was detected to be normal in 246 patients (91.1%) and 78 patients (81.2%) in the study and control groups, respectively (p = 0.009). Postoperative skin scar was found to develop significantly greater in the control group (p = 0.001). Significant hypertrophic scar was seen in 3 patients (1.1%) and 8 patients (8.3%) in the study and control groups, respectively. No epicanthal fold or webbing occurred in the study group., Conclusion: The preservation of the lacrimal sac wall's attachments at the end of ext-DCR to the medial canthal tendon, orbicularis oculi muscle, and lacrimal diaphragm allows the lacrimal pump to function more effectively. Ext-DCR with suturation of the periosteum and lacrimal diaphragm method may provide an excellent functional and aesthetic outcome in the majority of patients.

Aim: Anemia of chronic disease is the second most encountered anemia following iron deficiency in patients who develop acute or chronic immune activation. Pulmonary tuberculosis is an infectious disease which results in an inflammatory response frequently causing anemia. We investigated whether prohepcidin can be used successfully to disclose the cause of anemia and to monitor the result of the therapy in patients with pulmonary tuberculosis., Material and Methods: The study was performed in 40 male patients and 15 healthy controls that had a diagnosis of tuberculosis with a positive sputum smear and did not receive any previous treatment. They were treated for 6 months., Results: The study revealed a significant elevation of prohepcidin in patients with tuberculosis in comparison to those of healthy control subjects. Additionally, prohepcidin levels significantly decreased after treatment in the patient group but remained high in comparison to control group., Conclusion: We conclude that prohepcidin is high in pulmonary tuberculosis and might be a marker for monitoring the response to treatment.

Purpose: The purpose of this study was to determine the effectiveness of the microfracture technique in the treatment of full-thickness articular cartilage lesions of the knee., Methods: In this study the midterm results of 90 patients (47 women and 43 men) with focal full-thickness articular cartilage lesions who had been managed with the microfracture technique are presented. The mean age of our patients was 34.5 years (range, 20 to 58), and 51 right and 39 left knees were treated. All of the articular lesions involved medial femoral condyles., Results: On the basis of follow-up at a mean of 68 months (range, 24 to 108 months), mean improvements in Lysholm knee scores (from 54.2 to 84.6 points), Tegner activity scale scores (from 2.6 to 5.2 points), and Oxford knee interrogation scores (from 23.1 to 44.8 points) were observed (P < .0001). Moreover, there was a strong and significant correlation between functional results and age younger than 35 years, size of defect less than 2 cm(2), non-weight-bearing surface, and body mass index lower than 25 kg/m(2), respectively (P < .001)., Conclusions: According to our midterm results, the microfracture technique is quite effective with regard to the improvement of daily activities with a favorable impact on pain relief and better functional results. Furthermore, we found that there was a correlation between functional results and age, size of defect, location of defect, and body mass index as prognostic parameters., Level of Evidence: Level IV, therapeutic case series.

Background: The histologic features of tuberculin skin test site is not uniform. It may be related to status of tuberculosis., Methods: Forty-eight purified protein derivative (PPD) positive-cases were chosen for the study. Thirty of the subjects had active tuberculosis. As previously reported, the histologic pattern of inflammatory reaction seen in the test site classified into three type: (a) Perivascular (PV)-type, (b) Basal spongiotic dermatitis (BSD)-type and (c) Erythema multiforme (EM)-type. The frequencies of histological patterns in active tuberculosis and latent tuberculosis were statistically analyzed., Results: In active tuberculosis group including 30 patient, 17 (56.7%) EM-type, 9 (30%) BSD-type and 4(13.3%) PV-type inflammation were seen. Among 18 latent tuberculosis, there were 2 (11.1%) EM-type, 7 (38 8%) BSD-type and 9 (50%) PV-type inflammatory reactions. The EM-type inflammation was more common in active tuberculosis group. Bulla formation was seen in seven subjects with active tuberculosis., Conclusion: The histological pattern of PPD reaction site may be an important sign reflecting the nature of the tuberculosis, which may be either latent or active. The bulla formation is an important sign for active pulmonary tuberculosis. Further, detailed immunohistopathologic studies of PPD reaction with large number of cases may give important clues about tuberculosis immunology.

Background: Low serum total cholesterol (TC) concentrations in patients with pulmonary tuberculosis (PTB) have been demonstrated. It was shown that a cholesterol-rich diet might accelerate the sterilization rate of sputum cultures in PTB patients. It is known that smear positivity might be related to the radiological extent of disease (RED) in PTB patients., Objective: We hypothesized that there might be a relationship between initial serum TC concentrations; the degree of RED (DRED) and the degree of smear positivity (DSP) in PTB patients., Method: Eighty-three PTB patients and 39 healthy controls were included in the study. Serum TC, TG, HDL-C, VLDL-C and LDL-C concentrations were determined in all subjects. PTB patients were classified for their chest X-ray findings as minimal/mild, moderate and advanced. Correlations between serum lipid concentrations, DRED and DSP (0, 1+, 2+, 3+, 4+) were investigated. PTB patients and controls were also compared for serum lipid concentrations., Results: Significant differences between PTB patients and controls were detected for serum TC, HDL-C and LDL-C concentrations. On stepwise logistic regression analysis, DRED was found as one of the significant independent predictors of serum TC levels. We also found significant correlations between DRED and serum HDL-C concentrations (r=-0.60, p=0.0001) and between DRED and serum LDL-C concentrations (r=-0.28, p=0.011). There were also significant correlations between DSP and serum lipid concentrations., Conclusion: Our study suggests that serum TC, HDL-C and LDL-C concentrations are generally lower in patients with PTB than those in healthy controls. In addition, changes in these parameters might be related to DRED and DSP in PTB patients.

In this study, the results of open-wedge osteotomy with Puddu plate for the treatment of varus gonarthrosis have been evaluated prospectively. This study assessed 65 knees of 60 patients with varus gonarthrosis who underwent high tibial osteotomies. Our study population consisted of 13 male and 47 female patients with a mean age of 54 (range 39-76) years. For the clinical evaluation of the patients Hospital of Special Surgery (HSS) score, American Knee Society and Oxford knee scores, and for the radiological assessment mechanical axis deviation (MAD), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), femorotibial angle and Insall-Salvati index were basically taken into consideration. Our patients were followed up for an average of 34 (range 18-60) months. In the last assessments of our cases, mean improvements detected in HSS scores, Oxford knee scores, knee and functional scores of Knee Society were 26.72, 19.18, 49.9, and 30 points, respectively. The radiological examinations revealed that their mechanical axes on the average passed 5.09 mm laterally achieving an average of 6.5 degrees genu valgum, and a mean Insall-Salvati index of 1.09. As complications, superficial wound infection in two patients (3%), implant infections in one patient (1.5%), deep vein thrombosis in two patients (3%), peroperative lateral tibial plateau fracture in one patient (1.5%), and postoperative lateral tibial plateau fracture due to a falling down were encountered. According to the results obtained, postoperative pain resolves promptly and a significant degree of improvement of knee functions of the patients are achieved. Therefore, we believe that high tibial osteotomy with a Puddu plate is a valuable alternative to total knee arthroplasty in cases with varus gonarthrosis. Although early results are satisfactory, long-term follow-up studies are required especially in the middle aged and elderly patient populations.

Trigger toe is a rare entity, with only a few cases reported in the literature. It is usually seen in ballet dancers as a result of compression of the flexor hallucis longus tendon in the tarsal tunnel beneath the medial malleolus. We report a case of trigger toe due to a constricting lesion on the extensor hallucis longus tendon.

Background: Wind instrument playing requires a strenuous respiratory activity. Previous studies investigating effect of wind instrument playing on pulmonary function are equivocal., Methods: In the present study, 34 male, non-smoker wind players in a military band were compared with 44 healthy non-smoker males by pulmonary function testing., Results: All spirometric values including forced expiratory volume in 1 sec (FEV1), forced vital capacity (FVC), FEV1/FVC, peak expiratory flow rate, forced expiratory flow in 25, 50, 75% of FVC, and during the middle half of the FVC were found significantly diminished in wind players. The class of wind instrument, brass or wood, showed no significant differences. FVC was significantly and negatively correlated with duration of practice., Conclusions: It was concluded that pulmonary function in wind players might be diminished probably due to development of asthma or constant barotrauma during their playing. This fact should be considered in clinical evaluation of wind instrument players.

Aims: To investigate the effect of artificial tear application on central corneal thickness (CCT) in dry and normal eyes., Methods: Forty eyes of 40 patients with symptomatic dry eyes and 20 eyes of 20 controls were included in the study. A combination artificial tear therapy was given to both groups for 1 week. The CCT was measured with ultrasonic pachymetry before and after the therapy. In addition, at the beginning of the study, 11 dry eye patients and eight control patients were evaluated separately as a subgroup: they received artificial tears every 10 min for an hour to determine whether this might constitute a diagnostic criterion. Results were analysed with a Wilcoxon test, accepting p < 0.01 as significant., Results: The mean CCT in the dry eye group before and after 1-week therapy was 531.5 +/- 16.5 and 559.6 +/- 26.1 microm, respectively (p < 0.0001); thus yielding an average CCT increase of 28.1 +/- 9.4 microm (=5.30%: 1.65% minimum; 7.03% maximum) from baseline. The mean CCT in the control group before and after 1-week therapy was 549.2 +/- 37.8 and 552.3 +/- 39.8 microm, respectively (p = 0.001); thus, yielding an average CCT increase of 3.1 +/- 1.9 microm (=0.56%: 0.00% minimum; 1.18% maximum) from baseline. When the subgroup was evaluated separately, the average increase from baseline in 11 dry eye patients was 10.4 +/- 4.0 microm (=1.89%: 0.60% minimum; 4.26% maximum) after 1 h of artificial tear application, while it was 2.9 +/- 2.0 microm (=0.51%: 0.00% minimum; 0.58% maximum) in eight control patients (p < 0.0001)., Conclusion: The CCT in dry eyes increases rapidly and significantly compared to normal eyes after application of artificial tears. It is suggested that this increase could be used as a criterion in the diagnosis and follow up of dry eyes, and that this increase in thickness should be considered in intra-ocular pressure measurements as well as in refractive surgical procedures.

Purpose: To explore the relationship between the refractive state of the eye and high blood pressure in a representative population., Design: Case-control study., Methods: Three hundred twenty-one patients with essential hypertension (mean age 53.9 +/- 15.5 years) and 188 age-matched and sex-matched healthy control subjects (mean age 50.9 +/- 7.3 years) from the same regional Health Maintenance Organization were consecutively included for the study (P > .05 for age and sex). The refractive state of the eyes was identified objectively by an autorefractometer and retinoscopic examination, recording the autorefractometer values. Spherical equivalents between -0.50 (included) and +0.50 (included) diopters were regarded as emmetropia. Values below or above this interval were regarded as either myopia or hypermetropia. Mean spherical equivalents of the groups were compared using independent samples t test; distributions of refraction were compared with chi(2) test., Results: The mean spherical equivalent of the patients with essential hypertension was +0.88 +/- 1.34 diopters (range -3.75 to +6.38 diopters), whereas the mean spherical equivalent of the control subjects was -0.26 +/- 1.12 diopters (range -5.00 to +3.38 diopters) (P < .0001). Whereas 61.4% of hypertensive patients were hypermetropic, 18.1% of normotensive patients were hypermetropic (P < .0001)., Conclusions: There is a strong association of essential arterial hypertension with hypermetropia, which has not been previously reported. Given the findings of this study, we recommend that patients who have hypermetropia and have had no recent systemic examination should at least have their blood pressure checked.

Purpose: To compare the effectiveness, complications, and patient acceptance of local anesthesia with general anesthesia in young patients for external dacryocystorhinostomy (DCR)., Methods: Data were prospectively collected over an 8-year period (1996-2004) on young patients (mean age: 22.64+/-1.71) undergoing external DCR in Gulhane Military Medical Academy. Patients were randomly allocated in two groups: general anesthesia (GA) and local anesthesia (LA). Of the 480 DCR procedures, 182 were performed with general anesthesia (44 bilateral), 298 were performed with local anesthesia (32 bilateral). Visual analogue scales were recorded in the postoperative 2-hour period. Postoperative nausea and vomiting (PONV), epistaxis, length of hospital stay, and intraoperative bleeding were noted., Results: Patients in both groups reported being comfortable during and immediately after surgery. Only 2 patients in the LA group required additional local anesthetic because of pain. Intraoperative bleeding was lower in the LA group. Analgesic requirement and signs of nausea and vomiting in the GA group were higher in the early postoperative period (p<0.05). The incidence of PONV was higher (p<0.05) in the GA group. Postoperative epistaxis was observed in 12 patients in the GA group and just 2 patients in the LA group. Length of hospital stay was 2.29+/-0.46 days in the GA group, and 1.23+/-0.42 days in the LA group (p<0.01)., Conclusions: Local anesthesia in DCR is safe and comfortable when proper anatomical approach to nerve blocks is performed correctly. Local anesthesia in young patients undergoing external DCR is a good alternative because it is cost-effective and it eliminates the complications of general anesthesia.