The suprachoroidal space in patients affected by retinitis pigmentosa.

BACKGROUND AND OBJECTIVE: The Suprachoroidal Space (SCS) is a theoretical structure which can be demonstrated between the inner border of the sclera and the outer boundary of the choroid. SCS is being studied for its potential uses as a route for drug delivery and innovative surgical techniques for the treatment of many retinal diseases. Retinitis pigmentosa (RP) is a group of inherited eye disorders characterized by a gradual loss of photoreceptors, resulting in vision impairment, which typically presents as night blindness and progressive visual field loss. The purpose of the study is to define the morphology of outer choroidal margins by means of SS-OCT in RP. MATERIAL AND METHOD: This is a retrospective observational study designed to evaluate the presence of SCS in RP. We performed Swept Source optical coherence tomography (SS-OCT) in a group of 55 patients affected by RP (26 males and 29 females, 110 eyes) with a mean age of 51.8 ±â€¯13.7 years. In the control group, we included 28 healthy subjects (6 males and 22 females, 56 eyes) with a mean age of 48,8 ±â€¯16,6 years. RESULTS: OCT scans allowed the outer choroidal margin and inner scleral margin to be delineated with certainty in all 110 eyes. In the RP group SCS was detected in 47 of 110 eyes (42,7%), in the control group SCS was detected in 11 eyes (19,6%). Subjects with SCS visible (RP group) had reduced retinal thickness (168.4 µm) compared to those with not visible SCL (211.2 µm, P = .007). CONCLUSIONS: SS-OCT can be successfully applied to assess the presence of SCS in RP and the high rate of SCS found in the RP patients is encouraging when considering future innovative therapies.

Are intravitreal injections essential during the COVID-19 pandemic? Global preferred practice patterns and practical recommendations.

Tertiary outpatient ophthalmology clinics are high-risk environments for COVID-19 transmission, especially retina clinics, where regular follow-up is needed for elderly patients with multiple comorbidities. Intravitreal injection therapy (IVT) for chronic macular diseases, is one of the most common procedures performed, associated with a significant burden of care because of the vigorous treatment regimen associated with multiple investigations. While minimizing the risk of COVID-19 infection transmission is a priority, this must be balanced against the continued provision of sight-saving ophthalmic care to patients at risk of permanent vision loss. This review aims to give evidence-based guidelines on managing IVT during the COVID-19 pandemic in common macular diseases such as age-related macular degeneration, diabetic macula edema and retinal vascular disease and to report on how the COVID-19 pandemic has affected IVT practices worldwide.To illustrate some real-world examples, 18 participants in the International Retina Collaborative, from 15 countries and across four continents, were surveyed regarding pre- and during- COVID-19 pandemic IVT practices in tertiary ophthalmic centers. The majority of centers reported a reduction in the number of appointments to reduce the risk of the spread of COVID-19 with varying changes to their IVT regimen to treat various macula diseases. Due to the constantly evolving nature of the COVID-19 pandemic, and the uncertainty about the normal resumption of health services, we suggest that new solutions for eye healthcare provision, like telemedicine, may be adopted in the future when we consider new long-term adaptations required to cope with the COVID-19 pandemic.

Ankle sprains: surgical treatment for recurrent sprains. Report of 10 patients treated with the Chrisman-Snook modification of the Elmslie procedure.

A group of 10 patients (3 women and 7 men; 17 to 57 years old, average 23.9; mean, 21 years) was evaluated preoperatively and postoperatively following surgical repair with a modification of the Elmslie procedure (i.e., by using one-half of the tendinous portion of the peroneus brevis ligament to reconstruct the anterior and middle fasciculi of the lateral ligament). The patients were athletes who participated in bicycling, boxing, tennis, hockey, basketball, football, soccer, or a combination of sports. Each patient gave a history of spraining the ankle numerous times. Stress films were obtained preoperatively and postoperatively. The talar tilt was generally reduced in postoperative films (average preoperatively, 12.5 degrees; average postoperatively, 5.6 degrees). We conclude that the Elmslie procedure, as modified by Chrisman and Snook, is simpler to perform than the Watson-Jones procedure and has provided the majority of our patients with satisfactory results.

[Hereditary non polyposis colon cancer (NHP CC) prevalence in South Italy (Campania). Report on a preliminary retrospective study]. / Prevalenza di cancro ereditario del colon non su poliposi (HNPCC) nel sud Italia (Campania). Studio retrospettivo pilota.

The aim of this study was to determine a prevalence of Hereditary Non Polyposis Colo-rectal Cancer (HNPCC) in consecutive one hundred twenty-eight patients living in Campania district and affected by first diagnosed colorectal cancer. Data on 128 patients and their relatives was collected and available for analysys. Our preliminary results seem to demonstrate a low prevalence of HNPCC in Campania and will be verified with a prospective multicentric study in the same area.

[Ulcerative rectocolitis diagnosed in the elderly. Case studies]. / La rettocolite ulcerosa diagnosticata nell'anziano. Contributo casistico.

Fourteen patients with idiopathic ulcerative colitis (UC) diagnosis made over 60 years of age have been extrapolated from 255 (5.49%) consecutive. Some clinical parameters (sex; symptoms of onset; delay in diagnosis; extension of disease; density of relapses; therapy with cortisone) have been compared between the 14 patients with ultra sixtieth year of age diagnosis (A group) and the 241 patients with a diagnosis made previously (B group). There were no significant differences concerning the symptoms at onset and the delay in diagnosis. In group A a larger prevalence of the male (M/F 3.66 against 1.46) and distal localization (64% against 53%) have been reported. The density of relapse and therapy with cortisone (p < 0.025) prevailed in B group. In conclusion, limited to our experience, the UC in A group is less severe than in B group.

Contribution of the epiphyses of the greater trochanter to the growth of the femur.

We have demonstrated the interaction of the capital femoral epiphysis and the greater trochanteric epiphysis in rats to give length and shape to the proximal femur. These findings have practical applications in the treatment of congenital coxa vara and other disease entities of the femoral head.

Traumatic sternoclavicular dislocation.

Traumatic dislocations of the sternoclavicular joint may be anterosternal or retrosternal. Anterior dislocation is due to forces which retract and depress the clavicle. Posterior dislocation is due to either direct force on the medial end of the clavicle or to a force acting on the posterolateral aspect of the shoulder. From 1950 to 1974 we treated 16 patients with traumatic complete sternoclavicular dislocations. Twelve patients were followed and their cases are discussed. Treatment may be closed or open. In some cases we did not attempt reduction because it may be very difficult to maintain and dislocation may recur. Open reduction is extremely difficult and not recommended unless a serious intrathoracic problem also exists. Based on our cases, we conclude that stability of the sternoclavicular joint is not necessary to ensure normal function of the involved limb. The residual prominence of the medial portion of the clavicle does not cause pain and does not interfere with chest or shoulder function.

[Characteristics of surgically removed polyps in the course of follow-up after endoscopic polypectomy from the colon]. / Caratteristiche dei polipi asportati in corso di follow-up successivo a polipectomia endoscopica del colon.

Our experience refers to 188 patients submitted to endoscopic polypectomy, of whom 61 (32.4%) also to subsequent endoscopic controls. The polyps removed during follow-up compared to those previously removed showed the following characteristic: 1) Higher frequency in right colon (p > 0.01); 2) smaller size (p > 0.1); 3) lower frequency of adenomas, not statistically significant; 4) high frequency of relapse in juvenile polyps.

[Acute biocompatibility of hemodiafiltration with endogenous reinfusion (HFR)]. / Emodiafiltrazione con reinfusione endogena (HFR): profilo di biocompatibilità in acuto.

PURPOSE: In order to reduce the hemodialysis (HD)-induced pro-inflammatory activity we need to use a biocompatible dialysis membrane, avoid backfiltration and possibly use adsorbents. Hemodiafiltration reinfusion (HFR) is a new on-line hemodiafiltration (HDF) technique combining these aspects. This study aimed to evaluate the biocompatibility of the single dialysis session comparing standard HD and HFR. METHODS: Eighteen patients on chronic HD were enrolled in five Centers. Patients underwent one standard and two HFR study sessions; in each session we evaluated leukocyte activation at 0, 5, 15, 60 and 240 min; and interleukin-6 (IL-6), C-reactive protein (CRP) and IL-1 receptor antagonist (IL-1Ra) levels at 0, 60 and 240 min. RESULTS: Leukocyte activation was similar in HD and HFR, while the post-dialysis IL-6 increase was lower with HFR; CRP levels were stable during HFR, but increased after HD, and IL-1Ra did not demonstrate any difference. CONCLUSIONS: These preliminary data show that HFR still has a better biocompatibility in the single dialysis session.

Pancreatic carcinoma: differences between patients with or without diabetes mellitus.

In order to assess the prevalence and type of diabetes mellitus in patients with pancreatic carcinoma and if the risk factors for the cancer have a different distribution among diabetics and non-diabetics, we reviewed the charts of 127 histologically and/or cytologically proven pancreatic carcinomas consecutively diagnosed from 1977 to 1989 and referred to our Primary Care Hospital from the attending physician. 48 out of 127 (37.7%) subjects were found to be diabetic; 3 had long standing insulin dependent diabetes mellitus, 10 long standing non insulin dependent diabetes mellitus and 35 (73% of all diabetics) new onset diabetes mellitus. 5 out of 10 long standing non insulin dependent diabetics showed secondary failure to oral antidiabetic agents and weight loss in the last six months before the diagnosis of pancreatic carcinoma. When compared to non-diabetics, all diabetics were older (p = 0.05), drank less alcohol (p = 0.047) and had a higher rate of previous neoplasms (p = 0.005). New onset diabetics had a less advanced cancer than those of long standing (p = 0.009). Our study calls for a careful search for pancreatic carcinoma in new onset diabetes of elderly and in long standing, weight losing, non insulin dependent diabetics on secondary failure to oral antidiabetic agents and support the hypothesis that diabetes associated pancreatic carcinoma may bear an its own etiopathogenesis.