Cardiac effects of echinocandin preparations - three case reports.

WHAT IS KNOWN AND OBJECTIVE: Echinocandins are antifungal agents, routinely used in invasive candida infections in critically ill patients. Their excellent anticandidal activity and their low frequency of reported adverse events and drug interactions make them first-line guideline treatments of candidiasis especially in intensive care units (ICU). We report on three ICU patients who developed cardiac insufficiency and hemodynamic instability during administration of loading doses of an echinocandin. CASE SUMMARY: Three ICU patients showed a substantial drop in their cardiac index or a deterioration of the mean arterial pressure following start of echinocandin administration. The patients were 75 years (female), 71 years (male) and 66 years (male) old. One patient received caspofungin, and two patients received anidulafungin as empirical antifungal treatment for severe sepsis. WHAT IS NEW AND CONCLUSION: Our cases suggest that the observed cardiac impairment could be associated with echinocandin administration. Therefore, we recommend close hemodynamic monitoring of critically ill patients receiving echinocandins.

Current trends in newly registered blindness in Denmark.

Current pattern of blindness (i.e. visual acuity < or = 6/60) in Denmark was studied based on 1585 application forms for new membership to the Danish Society of the Blind during 1993. Statistics on blindness are very sensitive to the definitions used. A change of blindness definition to visual acuity < 6/60 reduced the number of formally blind subjects with 32%, and by using the definition of WHO (visual acuity < 3/60) only 562 subjects (35%) would have been considered blind. The prevailing causes of blindness were age-related macular degeneration with 1132 cases (71.4%), followed by diabetic retinopathy 133 cases (8.4%), and glaucoma 80 cases (5.0%). Among the younger subjects (133 persons) aged 20-59 years diabetic retinopathy comprised 36% and lesions of the optic pathways 26%, while myopia and retinitis pigmentosa accounted for 5% each. The majority of the applicants (92%) were > or = 60 years old. In this group, age-related macular degeneration was the main cause of blindness in 78%. Figures from 1993 were compared with six similar studies on newly registered blindness from the last 35 years. The annual number of registrations was doubled during the last 25 years. The annual number of registered blind due to diabetic retinopathy fell during the 60's and 70's followed by a constant rate during the last decades. Glaucoma blindness fell with a factor two, and declined from a relative frequency of 15% among the causes of blindness to 5%. The impact of age related macular degeneration increased from 20% to 70% during the same period.

The incidence of registered blindness caused by age-related macular degeneration.

Membership applications to the Danish Society of the Blind were used as a register source of legal blindness (visual acuity < or = 6/60). Based on application forms completed by specialists in ophthalmology 1585 subjects were recorded as blind in 1993. 1132 subjects (71.4%) had age-related macular degeneration. Only 5% of the registered subjects with age-related macular degeneration were below 70 years of age. The median age was 82, equal for both gender. A female overrepresentation of 2.8:1 was found. Five-year age-specific incidence rates demonstrated an exponential rise of registered blindness due to age-related macular degeneration from age 60 to 90. A decline in incidence after the age of 90 is assumed to reflect underregistration of very old persons. This tendency of non-registration was particularly pronounced in elderly males. Estimated prevalence rates of registered blindness due to age-related macular degeneration increased 100-fold from the age group 60-64 to the age group 80-84. The age specific incidence rate for the age group 60-99 years was 140:100,000 for females and only 66:100,000 for males. The corresponding incidence rate for both sexes was 108:100,000. It is still a matter of dispute whether 'true' prevalence rates of blindness are higher in females than in males. The sex difference seems not to be explained by differences in 'visual impairment threshold of registration' among the registered persons.

The effect of tranexamic acid on secondary haemorrhage after traumatic hyphaema.

During the period from March 1978 to November 1979, 232 consecutive patients with traumatic hyphaema were allocated by admission-date to conservative treatment and to treatment with the antifibrinolytic drug tranexamic acid. Secondary haemorrhage occurred in only two of 102 tranexamic acid treated patients, while secondary haemorrhage occurred in 12 out of 130 conservatively treated patients. This difference was statistically significant. Some clinical aspects of the rebleeding cases are presented and briefly discussed.

The effect of polyvinylpyrrolidone-iodine as an disinfectant in eye surgery.

105 patients admitted for cataract surgery were treated pre-operatively with polyvinylpyrrolidone-iodine (PVP-I) as a disinfectant, and consecutive bacterial cultures were obtained before initiating surgery and at the end of the operation. A control group (n = 99) only had a standard disinfection procedure of the eye (including instillation of Terramycin cum polymyxin B cream in the conjunctival sac the evening before surgery). The cultures obtained from the conjunctival sac of the control group principally showed growth of Staph. albus and Staph. aureus, and to a minor degree diphtheroids (Corynebacterium species). Proteus mirabilis, Escherichia coli and micrococci. There was a significant quantitative diminished growth (P less than 0.05) of bacteria in the group of patients treated with PVP-I compared to the control group. Concerning the growth of Staph. albus, this was reduced to almost one third and other bacteria were almost eliminated in the group receiving PVP-I. As we disclosed no toxic or allergic reaction post-operatively which could be related to the use of PVP-I as a disinfectant, this agent seems to constitute an effective pre-operative antimicrobial treatment, taking into consideration the broad antimicrobial spectrum of PVP-I shown by other authors.