Proliferative diabetic retinopathy: Role of bevacizumab in decreasing the occurrence of vitreous hemorrhage after panretinal photocoagulation.

PURPOSE: To investigate the beneficial effect of bevacizumab injection one week prior to panretinal photocoagulation (PRP) on the occurrence of vitreous hemorrhage (VH) following PRP in high-risk proliferative diabetic retinopathy (PDR). METHODS: This was a case-control pilot study conducted on two groups: an anti-VEGF treatment group, treated with bevacizumab injection one week prior to the first PRP session, and a control group of treatment-naive PDR patients who underwent PRP treatment and were not given an intravitreal bevacizumab injection, consecutively recruited. In both groups, a complete ophthalmological examination was conducted prior to PRP and at 4, 9, and 16 weeks following treatment. The primary endpoint studied was the occurrence of VH. RESULTS: The control group included 69 patients (mean age 63±12.3 years) with high-risk PDR who received PRP treatment only, and the anti-VEGF treatment group included 67 patients (mean age 63.13±10.3 years). None of the demographic variables or comorbidities showed any significant difference between the two groups. The number of PRP sessions was not significantly correlated to the occurrence of VH in either of the groups (P=0.167). Vitreous hemorrhage within 16 weeks following laser treatment occurred in 10 patients (14.5%) in the control group and in only 3 patients (4.5%) in the anti-VEGF group (P=0.047). CONCLUSION: Our case-control pilot study demonstrates that a bevacizumab injection preceding the initial PRP session might be beneficial in reducing the occurrence of VH in the first 16 weeks following PRP.

Data on the relationship between internet addiction and stress among Lebanese medical students in Lebanon.

Stress and behavioral addiction are becoming major health problems growing in strength and prevalence. They are often associated with a large array of debilitating diseases and conditions including psychosocial impairments. Medical students remain a vulnerable territory for developing stress and addiction mainly relating to Internet use. Data was gathered from medical students around Lebanon on the relationship between stress and internet addiction. The data in this article provides demographic data about medical students in Lebanon, their stress levels, sources of stress as well as the level of internet addiction recorded in relation to their stress levels. The analyzed data is provided in the tables included in this article.

Secondary intraocular lens implantation with absence of capsular support: Scleral versus iris fixation.

PURPOSE: To assess the outcomes of iris fixated (IF) posterior chamber (PC) intraocular lens (IOL) versus scleral-fixated (SF) PC IOL implantation, and compare them with the results reviewed from the literature. SETTING: The study took place in the ophthalmology department of the Eye and Ear Hospital (Lebanon). DESIGN: This is a retrospective institutional study that collected the records of patients admitted for secondary IOL implantation between January 2007 and December 2016. METHODS: A total of 28 eyes that underwent PC IOL fixation were included, 13 of which underwent trans-scleral PC IOL fixation and 15 of which underwent iris PC IOL fixation. Data were analyzed over a period of 3 years. RESULTS: Of the 28 patients, 18 (64.3%) were male and 10 (35.7%) were female (mean age at intervention 36.78±23.47 [standard deviation, SD] years). There were no significant intergroup differences with regard to baseline values and demographic characteristics. Trauma was the most common etiology for posterior capsule insufficiency (82.1%). The mean preoperative baseline BCVA was 0.58±0.27 logMAR for SF and 0.27±0.20 logMAR for IF (P=0.07). Both groups had significant improvement in vision during the follow up period. No significant differences were noted regarding early or late postoperative complications between the two groups. CONCLUSION: SF and IF techniques for PC IOL have similar outcomes and result in a significant improvement in BCVA. When compared to AC (anterior chamber) IOL, both techniques seem to yield fewer complications.

The rate of intravenous cocaine administration alters c-fos mRNA expression and the temporal dynamics of dopamine, but not glutamate, overflow in the striatum.

The rapid entry of drugs into the brain is thought to increase the propensity for addiction. The mechanisms that underlie this effect are not known, but variation in the rate of intravenous cocaine delivery does influence its ability to induce immediate early gene expression (IEG) in the striatum, and to produce psychomotor sensitization. Both IEG induction and psychomotor sensitization are dependent upon dopamine and glutamate neurotransmission within the striatum. We hypothesized, therefore, that varying the rate of intravenous cocaine delivery might influence dopamine and/or glutamate overflow in the striatum. To test this we used microdialysis coupled to on-line capillary electrophoresis and laser-induced fluorescence, which allows for very rapid sampling, to compare the effects of a rapid (5 s) versus a slow (100 s) intravenous cocaine infusion on extracellular dopamine and glutamate levels in the striatum of freely moving rats. An acute injection of cocaine had no effect on extracellular glutamate, at either rate tested. In contrast, although peak levels of dopamine were unaffected by infusion rate, dopamine levels increased more rapidly when cocaine was administered over 5 versus 100 s. Moreover, c-fos mRNA expression in the region of the striatum sampled was greater when cocaine was administered rapidly than when given slowly. These data suggest that small differences in the temporal dynamics of dopamine neurotransmission may have a large effect on the subsequent induction of intracellular signalling cascades that lead to immediate early gene expression, and in this way influence the ability of cocaine to produce long-lasting changes in brain and behavior.

The development of olfactory conditioned ejaculatory preferences in the male rat. II. Parametric manipulation of conditioning session number and duration.

We have previously demonstrated that repeated pairing of a neutral odor with copulation produces a subsequent conditioned ejaculatory preference (CEP) for females bearing that odor. The present study examines the course of CEP development. In Experiment 1, Long-Evans male rats were allowed access to almond-scented, sexually receptive females for either one, five, or nine conditioning sessions that were 30 min in duration. Males given five or nine sessions displayed significant CEPs. In Experiment 2, male rats were given a single conditioning session with multiple almond-scented females until either a duration (60, 120, 180, or 240 min) or copulatory criterion (two, four, or six ejaculatory series) was satisfied. Males that received 120-, 180-, or 240-min sessions or four ejaculations displayed significant CEPs; males that received two or six ejaculations displayed a trend for CEPs. Analysis of effect size estimates revealed that the strongest CEPs were produced by 120 min of copulation or four ejaculations. In Experiment 3, males receiving nine conditioning sessions each 30 min in duration displayed a more enduring CEP than did males receiving a single conditioning session 240 min in duration. These data suggest that early sexual experiences have particularly powerful influences on subsequent sexual preferences and that the development of sexual preferences are influenced by interactions between CS-UCS pairings and motivational variables.

Laparoscopic appendectomy in children: evaluation of different techniques.

Patients and surgeons frequently opt for laparoscopic appendectomy for treatment of acute appendicitis. Clinical studies have shown this approach to be a reasonable alternative to open appendectomy. The objective of the current study was to assess the outcome of laparoscopic appendectomy using three different techniques. The study sample consisted of 150 children with acute appendicitis who underwent surgery at Al-Azhar University Hospitals, Cairo, Egypt, and at Al Mishary Hospital in Riyadh, Saudi Arabia, between October 1997 and October 1999. The patients were allocated to undergo extracorporeal laparoscopic appendectomy, Endoloop laparoscopic appendectomy, or EndoGIA (Ethicon Endo-surgery, Inc., Cincinnati, OH, USA) laparoscopic appendectomy. All patients were assessed for the severity of the disease at baseline using clinical and hematologic indicators. The ages of the children ranged from 7 to 14 years, with a mean of 10 years (SD, 2.14 years). Of the children, 55.3% were female. The results showed that children who underwent laparoscopic appendectomy using the EndoGIA had statistically significant shorter operating times, did not have complications, and had the shortest duration of hospital stay (although duration of hospital stay did not reach the statistically significant level of P > 0.05). Therefore, the study showed that laparoscopic appendectomy using the EndoGIA is the procedure that is most recommended, except for the relatively high cost of the disposable materials. Endoloop laparoscopic technique was the second most preferable procedure, and the least preferred procedure was extracorporeal laparoscopically assisted appendectomy. The major drawback of the last technique is the high frequency of complications. Endoloop laparoscopic appendectomy with a purse-string suture can be performed safely if the EndoGIA is not available.

Corneal microsporidiosis. Report of case, including electron microscopic observations.

OBJECTIVE: To report a case of corneal stromal infection caused by a protozoon of the genus MICROSPORIDIA:, including clinical, histopathologic, and electron microscopic observations. DESIGN: Case report. METHODS: Light and electron microscopy studies were performed on keratectomy specimens from a 67-year-old immunocompetent man who had a unilateral chronic stromal keratitis that was refractory to medical treatment. Initial corneal biopsy followed by lamellar and penetrating keratoplasty were performed on the patient. All the specimens were studied histopathologically. RESULTS: Light microscopy of the corneal biopsy and the subsequent keratectomy specimens demonstrated myriad small, round to oval microsporidial organisms measuring 3.5 to 5.0 micrometer in length that stained positively with the periodic acid-Schiff, Grocott-methenamine silver, and acid-fast methods and were gram positive. Electron microscopic observations demonstrated viable blastospores that had a thin osmiophilic outer cell wall and contained 11 to 13 coils of the filament. The light and electron microscopic features, the tinctorial characteristics, and the selective corneal stromal involvement are consistent with microsporidial keratitis. CONCLUSIONS: Microsporidiosis should be considered in the differential diagnosis of a culture-negative stromal keratitis refractory to medical treatment. The diagnosis can be easily established based on the morphologic features of the protozoa in the keratectomy specimens. No effective medical treatment for the stromal disease is available. Full-thickness keratoplasty is suggested because, in our patient, lamellar keratoplasty did not preclude recurrence of the disease.

Requirement of endogenous basic fibroblast growth factor for sensitization to amphetamine.

Repeated exposure to amphetamine produces long-lasting increases in sensitivity to its effects. We reported previously that repeated amphetamine treatment results in increased astrocytic expression of basic fibroblast growth factor (bFGF) in the ventral tegmental area (VTA) and substantia nigra compacta (SNc) and that this effect is prevented by coadministration of a nonspecific glutamate receptor antagonist. Here we show that the development of sensitization to amphetamine is prevented when amphetamine injections are preceded by infusions of a neutralizing antibody to bFGF into the VTA. In addition, we show that astrocytic bFGF expression is increased in the VTA and SNc of animals that exhibit behavioral sensitization and that the number of bFGF-immunoreactive astrocytes in these regions is strongly and positively correlated with the magnitude of sensitization. Cotreatment with an NMDA glutamate receptor antagonist blocks both the development of behavioral sensitization and bFGF induction. These results show that endogenous bFGF is necessary for the development of sensitization to amphetamine and suggest that bFGF mediates the glutamatergic-dopaminergic interaction that initiates the long-term consequences of repeated drug use.

Tick infestation of the eyelid.

PURPOSE: To report the rare occurrence of tick infestation of the eyelid margin. METHODS: A 58-year-old woman was initially examined with a small yellow lesion of the left upper eyelid margin that appeared after she felt a sting near her eye. Close examination disclosed an insect body attached to the eyelid margin. En bloc excision of the insect with part of the eyelid was performed. RESULT: Gross examination of the specimen identified the organism as the nymph stage of a bloated tick of the genus Hyalomma but of an uncertain species. CONCLUSION: Ticks (Hyalomma) can become embedded in the meibomian gland orifice and manifest as a mass at the eyelid margin.

Post immunization Hib antigen detection in the CSF of a patient with meningococcal meningitis.

We report a case of meningococcal meningitis where the cerebrospinal fluid was negative for Neisseria meningitidis but positive for Haemophilus influenzae type b by rapid antigen detection test. We believe that this was due to prior immunization with Haemophilus influenzae type b vaccine. We recommend caution in interpretation of the rapid antigen detection tests especially in patients who had been vaccinated against organisms screened by these tests.

Retroaortic renal vein with tumor thrombus: MR findings.

The magnetic resonance (MR) findings in a case of tumor extension into a retroaortic renal vein from a renal cell carcinoma are reported. The signal characteristics of the tumor thrombus paralleled those of the renal mass, and the preoperative recognition of the anomalous vessel lead to an altered surgical approach.

Carbon dioxide milliwatt laser in the vasovasostomy of vas deferens in dogs: Part I.

This is the first arm of a two prong study conducted to learn two different aspects of vasovasostomy in dog vas deferens using the milliwatt carbon dioxide laser. The first study involved the evaluation of patency without collection of sperm. Six dogs were evaluated and all underwent vasectomy and subsequently had vasovasostomies performed between 4 and 12 weeks utilizing two approximating sutures and welding with the milliwatt carbon dioxide laser. Metal clips were used for both X-ray analysis and localization of the vasovasostomy site. In this investigation a vasogram was performed. Dogs were sacrificed at 4, 6, and 8 weeks postvasovasostomy. The vasovasostomy specimens were studied with electron microscopy and histological evaluation. The vasovasostomy was completed in under 120 minutes using this laser-assisted technique and was found to be a viable and promising technique for vasovasostomy.

The pH analysis of papaverine-phentolamine and prostaglandin E1 for pharmacologic erection.

Although papaverine-phentolamine preparations are being employed for pharmacologic erection programs across the nation, their chemical properties have not been described in the literature. We found that the pH of papaverine-phentolamine solution in all concentrations tested remained less than 4.0. Attempts to buffer the solution resulted in a precipitate at a pH greater than or equal to 5.0. The pH of prostaglandin E1 was less than 5.0 but could be easily buffered to pH 7.4 or even 10.75 and remained stable. The effect of an acidic solution on corporal connective tissue and smooth muscle meshwork is unknown. We believe that buffering by blood will lead to the precipitation of papaverine-phentolamine and may cause primary intracorporal scarring. Extravasation or improper injection into the subcutaneous tissue exposes the mixture to blood and may secondarily result in additional scarring for the same reason. Therefore, prostaglandin E1 may be a more appropriate agent for penile injection.

Congenital pelvic arteriovenous malformation with massive prostatic hemorrhage: a case report.

Congenital arteriovenous malformations in the true pelvis are extremely rare: only 7 cases have been described in male patients. We report on a patient who presented with massive hemorrhage after transrectal prostatic biopsy and transurethral resection of the prostate. Diagnosis was established by means of magnetic resonance imaging and confirmed by arteriography. Our attempt at management by embolization and subsequent surgical ligation is described. A literature review and discussion of arteriovenous anomalies are presented.

Effect of prostaglandins E2 and 15-methyl F2 alpha on human pregnant and non-pregnant cervix.

Forty-two women of reproductive age were studied in two equal groups (group I, first-trimester pregnant; group II, non-pregnant). Each group included three equal sub-groups; subgroup A received intra-cervical 15-Me PGF2 alpha gel, B received intracervical PGE2 gel and C received intra-cervical gel alone as placebo. Three different staining techniques were employed to study the histological picture and histochemical alterations of cervical biopsies. These showed that PG-treated cervices presented significant changes compared to placebo in terms of more widely dissociated connective tissue bundles that are separated by clear spaces and an increase in the amount of ground substance. Moreover, the observed changes in pregnant sub-groups were more evident than in the corresponding non-pregnant cases.