[Early emulsification of silicone oil (2000 cs) in minimally invasive transconjunctival vitreoretinal surgery]. / Frühe Emulsifikation des 2000er-Silikonöls nach minimalinvasiver transkonjunktivaler vitreoretinaler Chirurgie.

BACKGROUND: The highly purified polydimethylsiloxane (PDMS) with a viscosity of 5000 centistokes (cs) is the preferred silicone oil endotamponade in vitreoretinal surgery (20 gauge) and shows high stability. In contrast in transconjunctival minimally invasive surgery (23 gauge) the application of 5000 cs. silicone oil shows substantial disadvantages because of time-consuming and difficult application procedure due to the small lumen of the used surgical equipment. Consequently silicone oils with lower viscosity like the 2000 cs silicone oil are being increasingly used in transconjunctival surgery. PATIENTS: We present two cases of early emulsification of the 2000 cs silicone oil (Siluron 2000 ©, Fluoron, Neu-Ulm, Germany) consisting of highly purified PDMS in the course of minimally invasive transconjunctival vitreoretinal surgery. In both cases 23 gauge vitrectomy with application of 2000 cs silicone oil was performed without any complication. The first case is a 34-year-old female with proliferative diabetic retinopathy who had already experienced several vitreoretinal operations. The present indication for vitrectomy was a persistent macular hole and vitreous haemorrhage. The second case is a 55-year-old pseudophakic patient with a retinal detachment after vitrectomy with gas endotamponade following rhegmatogenous retinal detachment. RESULTS: In the first case emulsification of silicone oil was seen on the second postoperative day. In the second case emulsification was discovered two weeks postoperatively. In both cases high intraocular pressure did not occur. CONCLUSION: With emerging performance of minimally invasive vitrectomy techniques the use of silicone oil with low viscosity in patients with conceivable endurance of the endotamponade appears to be beneficial. Up to now 10 patients have undergone 23 gauge vitrectomy with application of 2000 cs silicone oil without any complications in our clinic. In contrast, two cases demonstrated early emulsification of the 2000 cs silicone oil. To the best of our knowledge this complication has not been described before.

Intention to learn results of genetic testing for hereditary colon cancer.

INTRODUCTION: This report investigates the correlates of intention to find out genetic test results in colorectal cancer patients undergoing genetic counseling and testing for hereditary nonpolyposis colon cancer. Specifically, we investigated whether intention to learn genetic test results was associated with sociodemographic factors, medical history, psychosocial factors, attitudes, beliefs, and decisional considerations related to genetic testing. MATERIALS AND METHODS: Among 342 colorectal cancer patients who went through an informed consent process and gave blood for genetic testing and who were eligible for a psychosocial questionnaire study, 269 cases completed a baseline interview. Patients were contacted in person during a routine clinic visit or by letter and follow-up telephone call and were interviewed either in person or by telephone. RESULTS: In univariate analysis, intention to learn test results was positively associated with income, quality of life, a belief that being tested will help family members prevent cancer, being worried about carrying an altered gene, and a belief that one has the ability to cope with test results. It was negatively associated with a belief that genetic counseling is too much trouble relative to the benefits. Intention also was positively associated with scales measuring the pros of learning test results and the pros of informing relatives about test results; it was negatively associated with the cons of learning test results. In multivariable analysis, the belief that testing would help family members prevent cancer, being worried about carrying an altered gene, and the pros of learning test results remained statistically associated with intention when other variables were included in the model. CONCLUSIONS: Our findings showed that the positive aspects of genetic testing were more strongly associated with intention than were the negative aspects. They also showed that persons who stated an intention to learn their genetic test results were more likely than persons who did not to affirm both the benefits and the importance of such testing. These results are consistent with the literature on psychosocial aspects of genetic testing for breast cancer.

Doing the right thing at the right time? The interaction of stages and processes of change in successful smoking cessation.

Research on the transtheoretical model has provided substantial support for both stages of change and processes of change (coping strategies influencing successful behavior change). This study examined whether timing of process use (using particular change processes during one stage and not during others) influences quit success. Hypothesized patterns of optimal process use were those marked by more use of experiential processes and less use of behavioral processes during contemplation and preparation and by the reverse pattern during action. Participants (N = 388) began in contemplation or preparation and took action during a 4-6 week period. Multivariate analyses of covariance examined the relationship between patterns of process use and success in staying quit both at 1-month follow-up and 5-6 months later. For the most part, results supported the hypothesis that successful stage transitions involve doing the right thing at the right time: engaging in experiential process activities during contemplation and preparation stages and shifting to behavioral process activities during action.

Correlates of psychologic distress in colorectal cancer patients undergoing genetic testing for hereditary colon cancer.

In this article the authors describe the demographic and psychosocial correlates of 2 measures of psychologic distress among 200 colorectal cancer patients undergoing genetic testing for hereditary nonpolyposis colon cancer. The prevalence of symptoms of depression on the Center for Epidemiologic Studies Depression (CES-D) Scale was 24%. In multivariate analysis, female sex, less formal education, fewer sources of social contacts, and less satisfaction with them were associated with high scores on the CES-D Scale. Characteristics associated with high scores on the State-Trait Anxiety Inventory were younger age, less formal education, non-White race, local-regional stage of disease, fewer social contacts, and less satisfaction with them. Information on psychosocial correlates of psychologic distress may prove useful in guiding genetic counseling sessions, in identifying subgroups that need more intensive follow-up, and in developing interventions to facilitate adjustment to genetic test results.

[Therapy of stage III retinal angiomatous proliferation. Intravitreal ranibizumab injections]. / Therapie der retinalen angiomatösen Proliferation im Stadium III. Intravitreale Ranibizumab-Injektionen.

Retinal angiomatous proliferation (RAP) is a subtype of exudative age-related macular degeneration which is characterized by an intraretinal origin of the lesion and a particularly poor prognosis. In this retrospective case study 33 eyes from 33 patients with stage III RAP lesions were included and initially treated with 3 intravitreal injections of 0.5 mg ranibizumab at monthly intervals. Criteria for extended treatment were visual deterioration, fresh bleeding, residual fluid or increase of the central retinal thickness in optical coherence tomography (OCT) as well as persisting activity in fluorescence angiography (FLA). The follow-up period was 8 months. The mean best corrected visual acuity (BCVA) increased insignificantly from logMAR 0.71 at the start of therapy to logMAR 0.67 after the first 3 intravitreal treatment injections and remained stable up to 8 months. The mean decrease of the central retinal thickness after 4 months (-90 µm) and after 8 months (-70 µm) was significant. Of the patients included in the study 67 % were treated repeatedly and the mean frequency of reinjections was 2.27 injections after 8 months. The intravitreal injection of ranibizumab in patients with stage III RAP lesions resulted in functional and anatomical stabilization. In most cases repeated treatment is necessary which underlines the urgent need for close surveillance in follow-up.

La Ecografia de Alta Resolucion y Doppler Color en la Patologia Nodular Tiroidea. Su Correlacion con la Anatomia Patologica / The Ultrasonography of high resolution and color Doppler in the Nodular Pathology Thyroid-correlato pathological anatomo

Objetivos:Los nodulos tienen una alta prevalencia en la poblacion general, especialmente en las mujeres y se incrementan con la edad. Para evaluar si la ecografia de alta resolucion y el Doppler color permiten diferenciar nodulos benignos de malignos, y dado que la conducta ante un nodulo menor de 1cm o no palpable, es motivo de controversias, relacionamos la ecografia de alta resolucion con la Anatomia Patologica (AP) de los pacientes operados. Metodologia:Se analizaron las ecografias de 83 pacientes operados por nodulo de tiroides:72 mujeres(m) y 11 varones(v), de ente 10 y 78 años de edad.Las mismas fueron realizadas con Ecografo ATL HDI 3500con Doppler color, Angiopower y Trnasductador LIneal 12/5 38 MHZ, tomandose 5 criterios sospechosos de malignidad:Hipoecogenicidad, Flujo Intranodular, Microcalcificaciones, Contornos Irregulares y Ausencia de Halo de Seguridad. Se las correlaciono con la AP, clasificandolas en tres grupos:Grupo I:Carcinoma (Ca), GrupoII:Adenoma Folicular(AF), y Grupo III:Bocio Multinodular(BMN)-Nodulo Hiperplasico (NH). Resultados: Grupo I: 37 pacientes: 44,5 por ciento ((33 Ca papilar: 9 v y 24 m; 4 de ellos variante folicular; 2 m Ca folicular; 1 m Ca medular y 1 m Ca indiferenciado). El 94,6 por ciento tenia entre 3 a 5 cirterios de malignidad : 94,6 por ciento Hipoecogenicos, 89,2 por ciento Hipervascularizados, 54 por ciento Calcificaciones finas, 62,1 por ciento Bordes irregulares y 67,5 por ciento Ausencia de Halo de Seguridad. Se detectaron 7 pac. con microcarcinoma papilar (ndulo <1cm:18,9 por ciento) 4 con MTS ganglionar y tenian 3 a 5 patrones de alarma.; 17 multinodulares (MN); 8 Ca multicentricos y 4 en nodulo no dominante(teniendo estos mayor grado de sospecha ecografica): 2 pac. se encontraban hipotiroideos y 6 con anticuerpo antiperoxidasa tiroidea (ATPO) (-). GrupoIIII:22 pac. (20m y 2v): 26,5 por ciento. El 27,2 por ciento con 3 a 5 criterios; 59 por ciento Hipoecogenicos, 54,5 por ciento Hipervascularizados, 13,6 por ciento Calcificaciones finas, 31,8 por ciento Bordes irregulares y 9 por ciento Ausencia de Halo; 14 MN, 2 pac hipotiroideos y 4 ATPO(+). Conclusiones: No existe ningun patron ecografico patognomonico de enfermedad nodular maligna, pero si el nodulo reune 3 o mas patrones de sospecha, la incidencia de malignidad aumenta de manera significativa. Aconsejamos...