[Diagnosis and evaluation of macular hole with the HRT 2 retina module]. / Diagnose und Evaluierung von Makulaforamina mit dem HRT 2 Retina Modul.

BACKGROUND: This prospective study analyzed the usefulness of the HRT 2 retina module as a diagnostic tool for macular hole diagnosis. The influence of the preoperative status on postoperative anatomic and functional results is also discussed. Preoperative and postoperative retinal tomography maps (HRT 2) were compared with optical coherent tomography (OCT III) and spectral optical coherent tomography (SOCT). METHODS: Fifty eyes of 46 consecutive patients with stage III/IV macular hole underwent vitrectomy with internal limiting membrane peeling and fluid/air exchange. HRT 2, OCT III, and, in eight cases, SOCT images were analyzed. RESULTS: The mean best corrected visual acuity 1 week before surgery was 0.086+/-0.074 (0.01-0.35). The final best corrected visual acuity 12 months after surgery was 0.32+/-0.24 (0.01-1.0). Anatomic success was noted in 46/50 eyes 1 month after the first surgery and in all eyes after the second intervention. In 33/50 eyes (66%), visual acuity improved over two lines. In 13 eyes visual acuity remained stable, and in four eyes worse visual acuity was noted postoperatively. The mean macular hole diameter in HRT 2 was 497.2 microm and in OCT III was 490 microm. Different values were observed in cases of oval macular holes. The mean macular hole area was 0.193 mm(2). The macular hole radius in HRT 2 can be compared with the minimal diameter in OCT III. It influences the final visual acuity 12 months after surgery. CONCLUSIONS: The HRT 2 macular module enables diagnosis of macular hole and evaluation of its postoperative status. This technique has some advantages because it enables measurement of the macular hole's radius, area, and depth. In cases when the macular hole's radius as measured in HRT and OCT III differs, HRT seems to give more exact data because it shows the entire surface rather than just a cross-section of the retina. Macular hole radius and area as measured with HRT 2 can influence postoperative functional results.

[Vitreous surgery with trypan blue staining of membranes in PVR retinal detachment surgery]. / Glaskörperchirurgie mit Trypanblau bei der Behandlung von PVR-Netzhautablösungen.

BACKGROUND: In our clinic we used trypan blue staining routinely for removal of internal limiting membranes (ILM) and epiretinal membranes (ERM) during vitreoretinal surgery for PVR retinal detachment. PATIENTS AND METHODS: We treated 27 eyes of 27 patients with severe PVR retinal detachment with vitreoretinal surgery. After complete vitrectomy and removal of epiretinal membranes we injected 0.15 % trypan blue solution and proceeded with further removal of the visualized remaining epiretinal membranes and ILM. We performed relaxing retinotomies in 14 eyes. Follow-up lasted six months. RESULTS: After the first surgery the retina was reattached in 24 of 27 eyes and after the second surgery in all eyes. The final visual acuity was: hand movements in 3 eyes, 1/50 or better in 24 eyes (eight of them had a visual acuity of 0.1 - 0.5). No case of macular pucker was observed during the follow-up. CONCLUSIONS: Trypan blue staining during vitreoretinal surgery in PVR retinal detachment therapy allows complete removal of ILM, ERM, and peripheral vitreous. It upgrades the quality of the surgery.

The role of transarterial embolization in the treatment of renal cell carcinoma.

OBJECTIVE: To review the role of transarterial renal embolization in our unit, assessing the indications, tolerability and efficacy of this technique for treating renal cell carcinoma (RCC). PATIENTS AND METHODS: Thirty patients undergoing transarterial embolization between 1991 and 1999 were identified and 25 case notes analysed retrospectively. RESULTS: Most patients (14 of 25) presented with less advanced (stage I-III) RCC who were unable or unwilling to undergo radical surgery; the remainder (11) presented with advanced (stage IV) disease. The embolizing agent was ethanol, usually combined with stainless steel coils (85% of cases). Procedural pain and fever was controlled successfully. The median hospital stay associated with the procedure was 4 days. At the time of analysis six of 11 stage IV and 11 of 14 stage I-III patients were alive (median follow-up 27 and 39 months, respectively). Symptoms from the primary tumour were well controlled. Overall, 17 of 25 (68%) of patients reported no problems while three (12%) required brief hospital admission for treatment of persistent haematuria. Fourteen patients were subsequently re-staged; the primary tumour in two had increased, in seven remained unchanged and in five it decreased. No patients without metastases developed them and metastases in two patients regressed. CONCLUSION: Transarterial embolization is associated with minimal morbidity and complications, and subsequent symptom control is good. The effect of palliative embolization on RCC progression is unknown and requires prospective investigation. Presently, there is no role for cytoreductive embolization; it should be included as a treatment option in clinical trials evaluating such options in patients with metastatic RCC.

Expression, purification, refolding, and characterization of recombinant human interleukin-13: utilization of intracellular processing.

Interleukin-13 (IL-13) is a pleiotropic cytokine that elicits both proinflammatory and anti-inflammatory immune responses. Recent studies underscore its role in several diseases, including asthma and cancer. Solution studies of IL-13 and its soluble receptors may facilitate the design of antagonists/agonists which would require milligram quantities of specifically labeled protein. A synthetic gene encoding human IL-13 (hIL-13) was inserted into the pMAL-c2 vector with a cleavage site for the tobacco etch virus (TEV) protease. Coexpression of the fusion protein and TEV protease led to in vivo cleavage, resulting in high levels of hIL-13 production. hIL-13, localized to inclusion bodies, was purified and refolded to yield approximately 2 mg per liter of bacteria grown in minimal media. Subsequent biochemical and biophysical analysis of both the unlabeled and (15)N-labeled protein revealed a bioactive helical monomer. In addition, the two disulfide bonds were unambiguously demonstrated to be Cys29-Cys57 and Cys45-Cys71 by a combined proteolytic digestion and mass spectrometric analysis.

Long-term silencing of retroviral vectors is resistant to reversal by trichostatin A and 5-azacytidine.

One problem limiting the development of long-term gene replacement therapy is gene silencing. A variety of experiments have implicated DNA methylation and histone deacetylation in gene silencing and shown that the agents 5-azacytidine (5-Aza) and trichostatin A (TSA) are able to reverse these effects. To begin to investigate clinically relevant strategies to reverse silencing with these drugs, we transduced the MEL and FDCP-1 hematopoietic cell lines with Moloney murine leukemia virus (MMLV) and Harvey murine sarcoma virus (HMSV)-based retroviral vectors carrying the beta-galactosidase/neomycin resistance fusion gene (beta-geo). Fifty-one clones were isolated under G418 selection over 2 weeks and then allowed to grow without selection as beta-gal activity was monitored over time. More than 80% of these clones showed significant silencing over a period of 70-80 days. The clones were then exposed to a wide range of 5-Aza and TSA concentrations, both alone and in combination, in an effort to reverse silencing. Despite demonstration that the agents were able to decrease DNA methylation and increase histone acetylation, significant reversal of long-term silencing was not seen under any experimental condition. These results suggest that long-term retroviral silencing involves mechanisms in addition to DNA methylation and histone acetylation and that new pharmacologic strategies are needed to overcome the silencing process.

Evaluation of fine-needle aspiration cytology for renal masses.

OBJECTIVE: To evaluate the accuracy and use of fine-needle aspiration (FNA) cytology for the diagnosis of renal masses because with the improved quality and increasing use of ultrasonography and computed tomography (CT), asymptomatic renal masses, particularly small (< 5 cm) tumours, are being discovered more frequently. PATIENTS AND METHODS: Between 1995 and 1997, 49 patients (mean age 67.5 years, range 42-88, 34 men and 14 women) underwent FNA of a solid or complex cystic mass under radiological guidance. All masses were further evaluated and staged by CT. Solid masses were divided according to size (< 5 cm and >/= 5 cm). Patients were followed up to the determination of a final diagnosis on tissue histology, after nephrectomy where possible. RESULTS: Thirty-six patients had histologically confirmed carcinoma at nephrectomy, and nine had presumed carcinoma (four unfit for surgery, five with advanced malignancy). The remaining four patients had benign diagnoses. FNA produced insufficient sample in eight cases (16%). The sensitivity was 89% for large (>/= 5 cm) solid masses, 64% for small (< 5 cm) solid masses and 50% for complex cysts. CONCLUSION: FNA does not contribute to the diagnosis of malignancy in large (> 5 cm) masses, as good radiological imaging is nearly always diagnostic. For smaller (< 5 cm) masses and complex cysts, FNA can occasionally confirm malignancy, but lack of diagnostic yield and low sensitivity means that FNA is unreliable as a diagnostic tool and will rarely help in the routine management of these patients.

[Vitrectomy for treatment of ocular complications in diabetes. III. Factors influencing results of vitrectomy]. / Witrektomia w leczeniu powiklan ocznych cukrzycy. Czesc III. Czynniki wplywajace na wyniki operacyjne.

UNLABELLED: The aim of this study was to find factors influencing results of pars plana vitrectomy for proliferative diabetic retinopathy. MATERIAL AND METHODS: 25 general and local factors which could influence results of pars plana vitrectomy (ppV) were selected and compared with functional results of surgery of 168 eyes with diabetic retinopathy. RESULTS: The most significant general factor was the age during ppV and the age at diagnosis of diabetes. Glycosylated hemoglobin blood level had little influence on ppV results. The most important local factor was the morphological state of the retina before the surgery. Better functional results were also achieved in eyes treated with panretinal photocoagulation before ppV and treated with vitrectomy without silicone oil tamponade when visual acuity was better than 5/50. CONCLUSIONS: General state of patients before ppV has little influence on functional results of ppV. Local factors are the main factors influencing this results.

Monoclonal IgH gene rearrangement in microdissected nodules from nodular sclerosis Hodgkin disease.

Recently, single-cell PCR studies have demonstrated that Hodgkin and Reed-Sternberg (HRS) cells are clonally related in many cases of Hodgkin disease. To investigate the lineage and clonality of neoplastic cells in local environments in nodular sclerosis Hodgkin disease (NSHD), we microdissected multiple distinct nodules from patients with NSHD and analyzed them for IgH gene rearrangement by PCR. These results were correlated with immunophenotype, Epstein-Barr-encoded RNA (EBER) expression, and clinical outcome. Forty individual nodules from 10 patients with NSHD (11 specimens) were microdissected from formalin-fixed paraffin-embedded tissue. DNA extracts were analyzed for IgH gene rearrangement by using PCR with FRIIIa and JHa primers. Cases were immunophenotyped in paraffin sections with antibodies to CD20(L26), CD79a(HM57), CD45RO(A6), CD15 (Leu-M1), and CD30(Ber-H2). Infection of HRS cells by Epstein-Barr virus was evaluated by using EBER in situ hybridization (EBER-ISH). DNA extracts from 12 of 40 microdissected nodules from 8 of 10 patients demonstrated a monoclonal pattern by IgH-PCR. Three patients demonstrated 2 individual nodules with different monoclonal patterns. One patient demonstrated 2 nodules with bands that appeared similar in size but were found to be different from one another upon further testing. All 28 remaining nodules demonstrated a polyclonal pattern. Six of 10 patients were positive for the Epstein-Barr virus genome by EBER-ISH. No correlation was found between IgH monoclonality, immunophenotypic features, Epstein-Barr virus infection, or clinical outcome. It was concluded that a subset of NSHD cases contain detectable monoclonality within individual nodules by IgH-PCR, suggesting that HRS cells are clonally related within local microenvironments.

Pars plana vitrectomy, lensectomy, or extraction in transscleral intraocular lens fixation for the management of dislocated lenses in a family with Marfan's syndrome.

BACKGROUND AND OBJECTIVES: Congenital lens subluxation may be a difficult therapeutic problem. Surgical treatment options include iris manipulation or lens decision, aspiration, intracapsular or extracapsular extraction, and lensectomy through the pars plana. It is not established which kind of aphakic correction is the most appropriate in these cases. PATIENTS AND METHODS: A father and his two sons with Marfan's syndrome were operatively treated for lens dislocation in both eyes. Pars plana vitrectomy was done in all eyes. Dislocated lenses were removed by lensectomy in three eyes and with an intracapsular method in three eyes. The outside-in scleral fixation technique was used for primary posterior chamber intraocular lens (PC IOL) implantation in all cases. RESULTS: All eyes achieved good visual acuity (20/20-20/25). Time of observation ranged between 8 and 20 months. There were no intraoperative or post-operative complications. CONCLUSION: Pars plana vitrectomy and primary scleral-fixated IOL implantation is a safe procedure and gives good visual rehabilitation in adult patients with Marfan's syndrome.

[The importance of silicone oil removal in prophylaxis of the late complications of internal tamponade]. / Znaczenie usuniecia oleju sylikonowego w profilaktyce odleglych powiklan trwalej tamponady wewnetrznej.

PURPOSE: To present the functional and anatomical results after silicone oil removal. MATERIAL: Covers 32 patients (34 eyes), age 29-77 years. Silicone oil removal was performed between February 1993 and December 1994. The indication for silicone oil tamponade was: PDVR (17/34), rhegmatogenous retinal detachment (12/34), trauma (4/34) and vitreous haemorrhage (1/34). METHODS: The conditions of silicone oil removal were complete retinal attachment within at least 3 months, visual acuity not worse than 1/50, no proliferations, laser photocoagulation of peripheral retina. RESULTS: In postoperative period retina was attached in 30 cases (88%). Retinal detachment was observed in 4 cases (12%). Visual acuity remains unchanged in 27 cases. CONCLUSIONS: We found that silicone oil removal leads in the majority of eyes to a stabilisation of visual acuity and reduces the progress of silicone oil-related complications.

Vitreoretinal surgery in diabetic patients on hemodialysis.

The present paper reports our first results after pars plana vitrectomy in patients with diabetic retinopathy and hemodialysis with a follow-up of 6 to 24 months. Between January 1992 and October 1994 we performed vitreoretinal surgery with silicone oil tamponade in nine eyes of seven patients with diabetic nephropathy on hemodialysis. All patients had had type I diabetes for 19-32 years. Over the observation period the retina was completely attached in eight eyes. Final visual acuity of 0.1-0.7 was attained in four eyes, 0.06 two, hand movements in one eye. Two eyes had no useful final visual acuity because of redetachment of the retina or secondary glaucoma with rubeosis iridis. The small number of complications shows that pars plana vitrectomy can be done in diabetic patients with nephropathy on hemodialysis. This significantly improves their quality of life.

A randomized controlled trial of transurethral microwave thermotherapy.

OBJECTIVE: To establish the short term clinical and urodynamic effect of transurethral microwave thermotherapy (TUMT) in men with symptomatic uncomplicated benign prostatic hyperplasia (BPH) using a randomized controlled trial comparing the treatment with both 'placebo-like' and untreated control groups. PATIENTS AND METHODS: The study comprised 120 symptomatic patients with BPH who were candidates for transurethral resection and TUMT. They were randomized to one of three groups: group 1 underwent a standard TUMT, group 2 underwent a simulated treatment identical to group 1 but with no emission of microwaves and group 3 received no treatment. The treatment of the first two groups was 'double-blind' and the heat experienced by the patients during treatment was simulated in both. Patients were assessed on entry to the study and 6 months after treatment using an identical protocol to measure the American Urological Association (AUA) symptom score, maximum urinary flow rate (Qmax), post-void residual urine volume (PVR), minimum urethral opening pressure (Pmuo) and maximum detrusor pressure (Pdet max). RESULTS: In the untreated group there were no clinically or statistically significant changes in the median AUA symptom score, Qmax, PVR, Pmuo and Pdet max. In group 1 the AUA score changed significantly, from 19 to 9.5, but the Qmax, PVR, Pmuo and Pdet max did not. In group 2, the AUA score also changed significantly, from 17.5 to 9.5, but Qmax, PVR, Pmuo and Pdet max did not. CONCLUSION: The untreated control group showed no clinically relevant deterioration or improvement. The standard and simulated TUMT groups showed little clinically relevant improvement in 'objective' variables, while the clinically significant symptom improvement was of a similar magnitude in both groups.

A study to determine the response of coronary atherosclerosis to raising low high density lipoprotein cholesterol with a fibric-acid derivative in men after coronary bypass surgery. The rationale, design, and baseline characteristics of the LOCAT Study. Lopid Coronary Angiography Trial.

Several clinical trials have shown that reducing serum cholesterol levels retards the progression of coronary atherosclerosis assessed by serial angiography. By contrast, as yet no studies have addressed the impact of increasing high density lipoprotein (HDL) cholesterol levels on progression of coronary artery disease (CAD). As HDL cholesterol is inversely related to the risk of CAD, we hypothesize that an intervention that raises low HDL cholesterol concentrations may have a beneficial effect on the course of CAD. Lopid Coronary Angiography Trial (LOCAT) was designed to test this hypothesis. Three hundred and ninety-five men, aged < or = 70 years, all of whom had previously undergone coronary bypass surgery, were randomly assigned to receive either slow-release gemfibrozil, 1200 mg once daily, or a matching placebo for on average 2 1/2 years. The lipid inclusion criteria were HDL cholesterol concentration < or = 1.1 mmol/L, low density lipoprotein (LDL) cholesterol < or = 4.5 mmol/L, and serum triglyceride < or = 4.0 mmol/L. Subjects were not accepted if they had manifest diabetes, body mass index > 30 kg/m2, uncontrolled hypertension, or if they were regular smokers. All randomized subjects underwent baseline coronary angiography, which will be repeated at the end of the study. The angiograms will be analyzed using the Cardiovascular Measurement System, a validated computer-assisted image-analysis and quantitation package. The primary endpoints are the changes in the per-patient mean of 1) the average diameter of evaluable native coronary segments, and 2) the minimal luminal diameter of evaluable stenoses, and 3) the appearance of new lesions. Extensive lipoprotein and other metabolic studies and analyses of genetic polymorphisms are carried out to study the determinants of CAD progression. At baseline, the study subjects were 59.1 +/- 6.8 (mean +/- standard deviation) years old, had a body mass index 26.4 +/- 2.2 kg/m2, and serum triglyceride, serum cholesterol, HDL cholesterol, and LDL cholesterol concentrations 1.64 +/- 0.64, 5.17 +/- 0.64, 0.82 +/- 0.14, and 3.61 +/- 0.53 mmol/L, respectively.

Severe ocular trauma managed with primary pars plana vitrectomy and silicone oil.

PURPOSE: This study evaluated the outcome of severely injured eyes treated with early primary vitrectomy with silicone oil filling. METHODS: A total of 435 eye injuries, which required surgical intervention, were reviewed retrospectively. In 13 eyes (3%) pars plana vitrectomy and silicone oil filling were performed as primary surgical repair. Silicone oil filling was restricted to cases with laceration of the retina larger than 4 disc diameters (nine eyes), primary retinal detachment larger than two quadrants (two eyes) and/or persistent intrasurgical hemorrhage (12 eyes). All patients underwent surgery within 24 hours. RESULTS: After a mean follow-up period of 28.7 months (range, 9-70 months), 11 eyes achieved a visual acuity ranging from 20/25 to 20/200. Silicone oil was removed in 11 of 13 eyes after 5.8 +/- 4.6 months. Recurrent proliferative vitreoretinopathy developed in two eyes. CONCLUSIONS: Silicone oil tamponade after early primary pars plana vitrectomy may be an alternative for primary repair after trauma, especially in severely injured eyes with retinal lacerations larger than 4 disc diameters, persistent intrasurgical bleeding, and/or primary retinal detachments.

[Silicone oil tamponade in the treatment of retinal detachment with proliferative vitreoretinopathy]. / Tamponada wewnetrnza olejem silikonowym w leczeniu odwarstwienia siatkówki powiklanego proliferacyjna witreoretinopatia.

AIM: This paper presents early and later stage of the treatment of 93 eyes (89 patients) with retinal detachment in the course of PVR. All patients were treated in our department between February 1992 and February 1994. METHOD: Standard port pars plana vitrectomy was performed in all cases related earlier with sclear buckling procedure without success. RESULTS: One week, 6, 12, 24 months after surgery good anatomical results were achieved respectively in: 82%, 80%, 78%. One week, 6, 12, 24 months after surgery good functional results were achieved respectively in: 74%, 67%, 58%. CONCLUSIONS: Vitrectomy with silicone oil tamponade is method of choice in the treatment of retinal detachment in the course of PVR.

[Removal of the dislocated lens in patients with funnel-shaped retinal detachment]. / Usuniecie zwichnietej soczewki u chorych z lejkowatym odwarstwieniem siatkówki.

PURPOSE: Presentation of two cases of crystalline lens posterior dislocation with concomitant, total, funnel-shaped retinal detachment. MATERIAL AND METHODS: The described patients were myopes and both had lost vision of the other eye earlier due to the same cause. The operation of dislocated lens removal through the limbal incision with the use of pars plana vitrectomy and simultaneous retinal detachment surgery were performed. RESULTS: In one patient almost full visual acuity was achieved, and in the second case visual acuity was improved to 3/50. CONCLUSION: The use of vitrectomy methods, including subretinal fluid drainage and intraocular silicone oil tamponade, enables efficient treatment of patients with dislocated lenses even in cases with total retinal detachment.

Transscleral suture fixation and anterior chamber intraocular lenses implanted after removal of posteriorly dislocated crystalline lenses.

The surgical technique is described for simultaneous removal of posteriorly dislocated crystalline lenses and implantation of anterior chamber (AC) or scleral fixation posterior chamber (PC) intraocular lenses (IOL) using pars plana vitrectomy. Twenty-two patients underwent this complex operation. Observation time ranged from 2 to 10 months (mean 5 months). Best-corrected post-operative visual acuity was 1.0 in half the patients in the AC group (n = 12), and in 80% of the PC group (n = 10). It was less than 0.5 in 25% of cases in the AC group whereas all PC patients had visual acuity 0.5 or better. In nine cases with pre-operative ocular hypertension, post-operative intraocular pressure became normal, although topical glaucoma therapy was necessary in three patients in the AC group and in one from the PC group. No severe complications were found. Removal of posteriorly dislocated crystalline lens using pars plana vitrectomy and limbal incision is a safe procedure. Simultaneous AC or transscleral PC lens implantation is a good alternative to contact lenses. Visual rehabilitation was good in both groups of patients, although post-operative visual acuity was better after PC transscleral fixation than after AC surgery.