Effect of oral tranexamic acid on macular edema associated with retinal vein occlusion or diabetes.

PURPOSE: Tranexamic acid (TXA) is a widely used antifibrinolytic agent that can also cause a decrease in vascular permeability. We hypothesized that TXA could improve macular edema (ME) that is caused by an increase in retinal vascular permeability. The aim of this study is to evaluate the efficacy of oral TXA for ME associated with retinal vein occlusion (RVO) or diabetic ME (DME). PATIENTS AND METHODS: Oral TXA (1,500 mg daily for 2 weeks) was administered to patients with persistent ME secondary to RVO (7 eyes) and DME (7 eyes). After 2 weeks (ie, the final day of administration) and 6 weeks (ie, 4 weeks after the final administration), best-corrected visual acuity and central macular thickness (CMT) were measured and compared with baseline. Analyses were performed for RVO and DME cases. No other treatment was performed during the study period. RESULTS: In RVO cases, significant improvement in CMT was found between baseline (467.7±121.4 µm) and 2-week measurements after treatment (428.7±110.5 µm, p=0.024). No significant change was found in CMT between measurements taken at baseline and 6 weeks after treatment. In DME cases, no significant change was found in CMT between measurements taken at baseline and 2 or 6 weeks after treatment. In all analyses of best-corrected visual acuity, no significant change was observed. CONCLUSION: The results support the hypothesis that plasmin plays a role in the development of ME associated with RVO, and oral TXA administration may be useful as an adjuvant treatment when combined with other agents such as anti-vascular endothelial growth factor.

Rosmarinic acid inhibits the formation of reactive oxygen and nitrogen species in RAW264.7 macrophages.

Antioxidant action of Rosmarinic acid (Ros A), a natural phenolic ingredient in many Lamiaceae herbs such as Perilla frutescens, sage, basil and mint, was analyzed in relation to the Ikappa-B activation in RAW264.7 macrophages. Ros A inhibited nitric oxide (NO) production and inducible nitric oxide synthase (iNOS) protein synthesis induced by lipopolysaccharide (LPS), and also effectively suppressed phorbol 12-myristate 13-acetate (PMA)-induced superoxide production in RAW264.7 macrophages in a dose-dependent manner. Peroxynitrite-induced formation of 3-nitrotyrosine in bovine serum albumin and RAW264.7 macrophages were also inhibited by Ros A. Moreover, Western blot analysis demonstrated that LPS-induced phosphorylation of Ikappa-Balpha was abolished by Ros A. Ros A can act as an effective protector against peroxynitrite-mediated damage, and as a potent inhibitor of superoxide and NO synthesis; the inhibition of the formation of reactive oxygen and nitrogen species are partly based on its ability to inhibit the serine phosphorylation of Ikappa-Balpha.

Risk of elevated creatine kinase and myoglobulinemia due to incised muscles in patients who underwent urological surgery.

PURPOSE: We clarified the risk of elevated creatine kinase (CK) and myoglobulinemia during incised muscle urological operations. MATERIALS AND METHODS: We retrospectively reviewed 58 consecutive cases of radical nephrectomy with muscle incision and 89 consecutive radical prostatectomies or radical cystectomies without muscle incision. Operations with or without muscle incision were divided into 2 groups depending on operative time (200 minutes or less and 201 to 400). Increases in CK and myoglobin were compared between the 2 groups, and between muscle incision and no muscle incision at each operative time. RESULTS: CK and myoglobin were proportionally increased according to operative time in operations without muscle incision but not in muscle incision operations, in which high CK and myoglobin were seen even with short operative times. CK and myoglobin were more increased in muscle incision operations than in those without incision with significance at each operative time. However, maximum CK and myoglobin were 2,220 IU/L and 3,600 ng/ml, respectively, in muscle incision operations. CONCLUSIONS: Even with short operative times surgeries with muscle incision are associated with a marked increase in CK and myoglobulinemia. However, CK and myoglobin are not sufficiently high for rhabdomyolysis with acute renal failure to develop.

[Tuberculous epididymitis following intravesical Bacillus Calmette-Guérin therapy].

Bacillus Calmette-Guérin (BCG) immunotherapy is increasingly being accepted for management of some bladder transitional cell neoplastic lesions. Mild adverse reactions occur frequently. However, an unusual complication of tuberculous epididymitis is reported. A 64-year old man presented with bilateral epididymal mass. Four months earlier he had seven treatments with intravesical BCG instillation (Tokyo 172 strain) for a grade 2 transitional cell carcinoma in situ. Bilateral epididymectomy was performed. Microscopic examination of the epididymis revealed chronic inflammation and necrosis with granulomas and Langhans' giant cells. After the operation, there were no further complications.