Comparison of surgical outcomes of Carlevale sutureless scleral fixation and Artisan Aphakia intraocular lens.

PURPOSE: To compare intra- and postoperative results of sutureless scleral fixated Carlevale intraocular lens (IOL) with iris fixated Artisan IOL. METHODS: Monocentre, retrospective analysis of refractive outcomes and intra- and postoperative complications of patients who received a Carlevale or Artisan IOL between January 2019 and March 2022. RESULTS: 178 eyes of 169 patients were included (101 Carlevale and 77 Artisan IOLs). The standard follow-up time was 1 month. Two statistically significant differences were found: in the deviation of the postoperative spherical equivalent of the refraction from the preoperative chosen IOL target (p = 0.019; mean deviation was -0.46 in the Carlevale and 0.08 in the Artisan group), and the number of eyes with complications between the Carlevale and Artisan groups (p = 0.003; 33 in the Carlevale and 42 in the Artisan group). CONCLUSION: The current study is the largest so far comparing both refractive outcomes and complications after implantation of Carlevale and Artisan IOL. The Carlevale IOL does not carry a greater complication risk on the short-term follow-up. This provides additional evidence that the Carlevale IOL has to be added to the armamentarium of the ophthalmic surgeon.

Variation in social information use: the influences of information reliability and mass on decision making in a group-living fish Gambusia affinis.

The effect of the reliability of available social information was assessed by examining whether the age of social information changes its effects on a foraging decision in a group-living fish Gambusia affinis. Individuals switched their patch preference when faced with social information that conflicted with personal information in general; the age of the social information, however, did not significantly influence preference for feeding patch. The mass of decision makers was positively correlated with their use of available social information, with heavier individuals exhibiting a greater difference in patch preference than lighter individuals, suggesting that large and small G. affinis trade-off the benefits of information acquisition and the costs of competition from conspecifics differently.

Persistent subretinal fluid after surgery for rhegmatogenous retinal detachment: hypothesis and review.

BACKGROUND: Persistent subretinal fluid after rhegmatogenous retinal detachment (RRD) surgery is responsible for delayed recovery, and may affect the final visual outcome. Cause, consequences, and treatment remain elusive. DESIGN: Literature review and case series. METHODS: We reviewed the pathophysiological principles and therapeutic options from the literature, and we report the results from a subretinal fluid cytology study. Nine eyes from nine patients with macula-involving RRD underwent surgical repair. The cellular content of subretinal fluid (SRF) was studied by electron microscopy and anti-rhodopsin immunostaining. All eyes were assessed postoperatively with optical coherence tomography for the detection of persistent submacular fluid (PSF) (Ethics Committee Ghent University Hospital, registration number B6702006169). RESULTS: Certain patient characteristics as well as surgical methods were implicated. PSF appears to occur more frequently in patients with longstanding detachments treated with buckling surgery. Several therapeutic options have been suggested but safety and efficacy remain unclear. We found PSF in three eyes on postoperative OCT scans, which corresponded to the three cell-rich subretinal samples. CONCLUSIONS: PSF after successful RRD repair seems to be related to fluid composition. We hypothesize, in the absence of an effective treatment, that a modified surgical drainage, including a washout of the subretinal space, could evacuate the subretinal fluid more completely, and may prevent this complication.

Anti-TNF-alpha therapy for sight threatening uveitis.

AIM: To describe the effect of additional treatment with anti-TNF-alpha therapy in a case series of 13 patients with serious sight threatening uveitis. METHODS: 13 patients with serious sight threatening uveitis were included, of whom six had Behçet's disease, five had idiopathic posterior uveitis, one had sarcoidosis, and one birdshot retinochoroiditis. Onset and course of ocular inflammation, inflammatory signs, and visual acuity were assessed. Patients were treated with 200 mg (approximately 3 mg/kg) infliximab infusion. Repeat infusions were given based on clinical response. RESULTS: Infliximab treatment resulted in an effective suppression of ocular inflammation in all patients. In patients with non-Behcet's disease uveitis visual acuity in six out of eight improved or was stable. In patients with Behcet's disease visual acuity in five out of six improved or was stable. CONCLUSION: Anti-TNF-alpha treatment may be of value in the treatment of uveitis, and in patients with Behçet's disease, leading to suppression of ocular inflammation, vasculitis, and improvement of vision in the majority. Based on these results a controlled masked study is warranted.

Steroid therapy for idiopathic retroperitoneal fibrosis: dose and duration.

PURPOSE: Idiopathic retroperitoneal fibrosis is an uncommon disease of unknown etiology that may involve the ureters and other retroperitoneal structures. Surgical ureterolysis as well as medical treatment with steroids have been used to treat these patients. However, there is no agreement as to the dose and duration of steroid. We adopted a regimen of long-term steroid use in this prospective study. MATERIALS AND METHODS: We treated 12 patients with idiopathic retroperitoneal fibrosis with a regimen of steroids during a 10-year period. Tissue diagnosis was established by biopsy of all lesions and ureteral obstruction was managed with insertion of a nephrostomy tube or a ureteral stent. The initial dose of prednisolone was 60 mg. on alternate days for 2 months and was tapered during the following 2 months to a daily dose of 5 mg. The total duration of prednisolone use was 2 years. RESULTS: Of the 12 patients 11 who completed this treatment regimen have been followed for a duration of 26 to 132 months (median 63.1) after discontinuation of treatment. Good response in the form of relief of symptoms and regression of the mass occurred in 9 cases and there were 2 failures. In 1 case the retroperitoneal mass did not regress and surgical ureterolysis was required. In the 2nd case symptoms recurred after discontinuation of steroid and a further small dose of steroids was required. Function deteriorated in 1 of 19 functioning renal units. No steroid related serious side effects developed. CONCLUSIONS: This regimen of steroid may be used as the primary mode of treatment for the majority of patients with idiopathic retroperitoneal fibrosis with minimal complications. Patients with idiopathic retroperitoneal fibrosis should be followed periodically for the rest of their lives.

An unusual complication of penile prosthesis following urethroplasty.

We report a case of an adult who had undergone transpubic urethroplasty for a 5-cm long posterior urethral stricture. A malleable penile prosthesis (AMS 600R) was implanted 19 months later for the trauma-related impotence. The patient was discovered to develop a complete obliteration of the urethra after removal of infected penile prosthesis 18 months later. Perineal urethroplasty cured his restricture. Suggestions are made to prevent urethral restricture if penile prosthesis is required after urethroplasty.

Molecular genetic analysis of the von Hippel-Lindau and human peroxisome proliferator-activated receptor gamma tumor-suppressor genes in adenocarcinomas of the gastroesophageal junction.

We investigated whether 2 candidate tumor-suppressor genes, VHL at 3p25-26 and PPAR gamma at 3p24.2-25, are involved in GEJ adenocarcinogenesis. In 43 GEJ tumor samples from 40 patients, the entire coding sequence of the VHL gene and the 5' and part of the 3' UTR as well as exons 3 and 5 of the PPAR gamma gene were screened by PCR-SSCP analysis. LOH at 3p25-26 was analyzed with 2 polymorphic microsatellite markers and with the VHL exon 1 and intron 2 polymorphisms. The relationship between LOH and clinicopathologic parameters was assessed. Expression of VHL was investigated by immunohistochemistry with a VHL-specific antibody. PCR-SSCP analysis of VHL revealed 2 different aberrant patterns in 19 patients. Upon DNA sequencing, 1 pattern appeared to be a previously described exon 1 polymorphism. The other single aberrant pattern was an intron 2 polymorphism, not yet described. PCR-SSCP analysis of PPAR gamma showed no aberrant migration patterns. LOH analysis revealed 3p25-26 loss in 24/36 (67%) informative cases, but this was not significantly correlated with clinicopathologic parameters. By immunohistochemistry, all tumors showed expression of VHL protein. Despite the very frequent LOH of 3p in GEJ adenocarcinomas, mutations in VHL and PPAR gamma were not detected. Mutations outside the screened sequences, a gene dosage effect or involvement of another tumor-suppressor gene on 3p as the target of LOH should be considered.

Structure of the PPARalpha and -gamma ligand binding domain in complex with AZ 242; ligand selectivity and agonist activation in the PPAR family.

BACKGROUND: The peroxisome proliferator-activated receptors (PPAR) are ligand-activated transcription factors belonging to the nuclear receptor family. The roles of PPARalpha in fatty acid oxidation and PPARgamma in adipocyte differentiation and lipid storage have been characterized extensively. PPARs are activated by fatty acids and eicosanoids and are also targets for antidyslipidemic drugs, but the molecular interactions governing ligand selectivity for specific subtypes are unclear due to the lack of a PPARalpha ligand binding domain structure. RESULTS: We have solved the crystal structure of the PPARalpha ligand binding domain (LBD) in complex with the combined PPARalpha and -gamma agonist AZ 242, a novel dihydro cinnamate derivative that is structurally different from thiazolidinediones. In addition, we present the crystal structure of the PPARgamma_LBD/AZ 242 complex and provide a rationale for ligand selectivity toward the PPARalpha and -gamma subtypes. Heteronuclear NMR data on PPARalpha in both the apo form and in complex with AZ 242 shows an overall stabilization of the LBD upon agonist binding. A comparison of the novel PPARalpha/AZ 242 complex with the PPARgamma/AZ 242 complex and previously solved PPARgamma structures reveals a conserved hydrogen bonding network between agonists and the AF2 helix. CONCLUSIONS: The complex of PPARalpha and PPARgamma with the dual specificity agonist AZ 242 highlights the conserved interactions required for receptor activation. Together with the NMR data, this suggests a general model for ligand activation in the PPAR family. A comparison of the ligand binding sites reveals a molecular explanation for subtype selectivity and provides a basis for rational drug design.

Prostatic carcinoma: a nutritional disease? Conflicting data from the Kingdom of Saudi Arabia.

PURPOSE: The incidence of prostate cancer in Saudi Arabia has been reported to be low at 1.4 to 2.1/100,000 person-years. We prospectively evaluated the true incidence of this disease and its association with dietary factors. MATERIALS AND METHODS: From 1994 to 1997 inclusive Saudi men older than 50 years treated at our institution for various presenting symptoms and diseases were randomly selected from various departments. They were examined prospectively with digital rectal examination, and total and free prostate specific antigen measurement. Transrectal ultrasound and prostatic biopsy were performed when either test was abnormal. Nutrition questionnaires and detailed interviews with a nutritionist were completed to assess the type of diet, and amount of saturated and polyunsaturated fat consumption of patients with prostatic carcinoma and controls. RESULTS: For the 2,270 Saudi men screened we noted an incidence of 3.1/100,000 person-years. Our nutritional survey revealed that recent fat consumption was greater than 120 gm. per person daily, of which about 40% was from meat and dairy products. Saturated fat comprised about 50% of the total fat intake. There was no difference in the amount of fat in the diet of men with and without prostatic carcinoma. CONCLUSIONS: The incidence of prostatic carcinoma in the Kingdom of Saudi Arabia is low despite a high saturated fat diet in recent years. This finding contradicts most western clinical studies, which indicate a positive association of a high fat diet with prostatic carcinoma.

Prospective phase II trial of alternating intravesical Bacillus Calmette-Guérin (BCG) and interferon alpha IIB in the treatment and prevention of superficial transitional cell carcinoma of the urinary bladder: preliminary results.

BACKGROUND AND OBJECTIVE: Evaluate the efficacy and toxicity of alternating intravesical instillation of Bacillus Calmette-Guerin(BCG) and Interferon alpha2-b (IFN) in the treatment and prevention of recurrence of superficial transitional cell carcinoma (TCC) of the urinary bladder. METHODS: Patients with Ta, T1 tumors and carcinoma in situ, either recurrent (TaG1, T1G1) or primary/recurrent TaG2 TaG3, T1G2, T1G3 and Tis (T: Tumor stage, G: grade) are eligible. All patients received intravesical BCG 81 mg on Weeks 1, 3, 5 and 7 and IFN 100 million units on Weeks 2, 4, 6 and 8. Cystoscopy performed 4 weeks after completion of therapy, and every 3 months thereafter. RESULTS: There was a total of 37 patients. Thirteen had TaG2, 13 T1G2, 1 T1G1, 4 TaG1, 1 TaG3, 3 T1G3 and 7 Tis (5 concurrent with other above tumors). Index lesion cleared in 7/10 patients. With a median follow-up of 26.2 month, 22 patients (59%) failed above therapy. Median time to treatment failure was 7 months. Seven, 6 and 9 patients recurred at a higher, lower and same stage or grade respectively. No grade 3 or 4 toxicity was encountered. CONCLUSIONS: Alternating intravesical BCG and IFN is effective and well tolerated therapy for superficial TCC of urinary bladder.

Assessment of visual acuity in children aged 1 1/2-6 years, with normal and subnormal vision.

The aim of the study was to assess different visual acuity tests in the age group 1 1/2-6 years in 105 children with assumed normal vision, visual impairment due to ocular disease or strabismus. Acuity tasks for young children can be divided into three subtypes according to the kind of stimulus used. For "detection acuity", the stimulus should be detected or distinguished from the background, as assessed with the Stycar Rolling Balls. For "resolution acuity", the stimulus pattern should be resolved, as assessed with the Preferential Looking procedure (Teller Acuity Cards). For "recognition acuity", the stimulus must be recognized by the subject as assessed with the BUST-D symbol test, Sheridan Gardiner (S-G) single letters, LH single symbols and line tests, and also the HVOT test. Different acuity values were obtained with regard to detection, resolution and recognition acuities. Assessment with the Stycar Rolling Balls only gave a rough estimate of the visual function. There was an overestimation of the acuity values in all groups of children when using the Preferential Looking technique. Good agreement was found between the LH line and HVOT tests. The BUST-D test, S-G single letters, and LH single symbols gave slightly better acuity values than linear recognition tests. A "crowding ratio" was calculated by dividing the single optotype acuity by the linear acuity, and also by dividing the grating acuity by the optotype linear and single acuity. The crowding ratio varied in the individual children and in the different groups, being highest for strabismic amblyopia. The general conclusion is that reliable visual acuity measurements were not obtained until the visual acuity could be assessed with a recognition test using linear letters or symbols.

Feasibility of adrenalectomy with radical nephrectomy.

OBJECTIVES: To evaluate the justification of routine removal of ipsilateral adrenal gland as part of radical nephrectomy for renal cell carcinoma (RCC). METHODS: The medical records, pathologic specimens, and computed tomographic (CT) scans of 77 patients who underwent radical nephrectomy and ipsilateral adrenalectomy for RCC were reviewed. Comparison was made between radiologic analysis and pathologic findings regarding involvement of the adrenal gland. RESULTS: The size of the renal tumor varied between 3.5 and 19 cm (mean 8.5). The upper pole was involved in 45%, the lower pole in 28%, and the midpole in 18% of the patients, and in 9% the whole kidney was involved by the tumor. Histologic findings showed that 72 (94%) of the 77 adrenal glands were normal and 70 of these were normal on CT as well. Two adrenal glands involved by metastases showed heterogeneous contrast entrancement on CT. The benign lesions of three adrenal glands were also picked up as abnormal on CT. In 2 patients adrenal glands could not be visualized on CT because of a paucity of retroperitoneal fat. CONCLUSIONS: Adrenalectomy with nephrectomy may not be performed in patients with RCC in whom CT demonstrates normal adrenal glands. In patients with adrenal abnormality on CT, magnetic resonance imaging can separate metastases from incidental benign adrenal adenoma, further reducing the number of patients requiring removal of the adrenal gland.

Metastatic transitional cell carcinoma of the ovary from superficial bladder tumour.

A 60-year-old female underwent transurethral resection of superficial grade 2 transitional cell carcinoma (TCC) of the urinary bladder. Six months later, intravesical Mitomycin C instillation was given following two superficial recurrences. A further recurrence of TCC grade I was resected transurethrally 39 months later. Forty-eight months after the original diagnosis the patient developed an abdominal mass, which turned out to be TCC grade 3 involving the left ovary. She underwent laparotomy which showed a left ovarian mass. Total abdominal hysterectomy, bilateral oophorectomy and partial omentectomy were carried out. She developed pelvic metastases 3 months later and died.

Prevalence of autoantibodies associated with glomerulonephritis, unaffected after extracorporeal shock wave lithotripsy for renal calculi, in a three-year follow-up.

Extracorporeal shock wave lithotripsy (ESWL) has become a useful tool in the treatment of renal calculi, but side effects may occur. Hitherto, two case reports have been published of an anti-glomerular basement membrane disease resulting in end-stage renal failure following ESWL treatment. In this prospective study of 59 consecutive patients undergoing ESWL for renal calculi, the prevalence of autoantibodies associated with glomerulonephritis was investigated before ESWL and at 3-year follow-up. The prevalences of antinuclear, anti-glomerular basement membrane, anti-neutrophil cytoplasmic and thyroid antibodies were found to be within the respective normal ranges prior to the first ESWL treatment and to be unaffected at follow-up.

Successful treatment of idiopathic retroperitoneal fibrosis with steroids.

Idiopathic retroperitoneal fibrosis (IRF) may cause ureteric obstruction with renal damage. Ureterolysis with intraperitonealization of the ureter is commonly used as primary treatment. We gave corticosteroids for two years to six patients, four males and two females, between 40 and 56 years of age. one of the patients is in his tenth month of treatment and another in the fourth month. Between 4 and 74 months (mean 40.4 months) after initiation of treatment, kidney function had improved, or was preserved in previously functioning renal units, and the patients were free from symptoms. We conclude that steroids may be used as primary treatment of IRF after histological or cytological diagnosis to exclude retroperitoneal malignancy. Steroids should also be part of the treatment strategy in patients with a more aggressive disease who may need surgery. Patients with IRF should be followed for the rest of their lives after discontinuation of steroid therapy.