Relationship between retinal nerve fiber layer and visual field function in human immunodeficiency virus-infected patients without retinitis.

PURPOSE: To evaluate the spatial association between visual field (VF) sensitivity loss and retinal nerve fiber layer (RNFL) thinning in patients infected by the human immunodeficiency virus. METHODS: Fifty-one eyes of 51 human immunodeficiency virus-infected patients and 22 eyes of 22 control subjects were enrolled. Patients were evaluated using the Fast RNFL scan strategy on Stratus OCT and the 24-2 full-threshold program on the Humphrey Matrix frequency doubling technology (FDT) perimeter. Associations between RNFL thickness and VF sensitivity were evaluated globally, in 12 clock-hour optical coherence tomography sectors and in 21 VF zones; linear and quadratic regression models were used in the statistical analysis. RESULTS: The linear and quadratic regression associations between the FDT Matrix pattern standard deviation and the average RNFL thickness in human immunodeficiency virus-infected patients were r2 = 0.185 and r2 = 0.218 (P < 0.05), respectively. The correlation between the FDT Matrix mean deviation and the average RNFL thickness was not significant (P > 0.05). Stronger associations were found when regional RNFL thinning was compared with locally measured FDT Matrix pattern deviation, especially between nasal RNFL measurements and temporal VF zones, and between superior RNFL measurements and inferior VF zones. CONCLUSION: Retinal nerve fiber layer thinning was related to VF sensitivity loss in human immunodeficiency virus-infected patients and regional associations between optical coherence tomography and FDT Matrix sectors were stronger than the associations between global measurements.

Stroke: bowel dysfunction in patients admitted for rehabilitation.

AIM: to assess the prevalence of diminished frequency of bowel movements, lumpy or hard stools, intestinal constipation, straining, incomplete evacuation, incontinence (bowel dysfunctions) in patients with brain injury resulting from cerebrovascular accident, either self-reported or reported by their caregivers; to describe the type and frequency of such dysfunctions; and the prevalence of laxative use both before and after stroke. METHOD: cross-sectional study with 98 hospitalized patients admitted for rehabilitation between December 2009 and May 2010. RESULTS: the prevalence of bowel dysfunctions before stroke was 23.96% whereas after the lesion it was 55.21% (p<0.0001). As reported by patients/caregivers, the chances of developing bowel dysfunctions increase sevenfold after stroke, 95% CI (2.44-24.26). The most frequent dysfunctions before stroke were intestinal constipation (73.91%) and diminished frequency of bowel movements (17.39%). After stroke, constipation remains to be the most frequent dysfunction reported (50%), followed by diminished frequency of bowel movements (26.79%), incomplete evacuation (12.50%), and lack of privacy (5.36%). The use of laxatives was 19,15% after the lesion, but not statisticaly significant (p=0.0736). CONCLUSION: Bowel dysfunctions increases significantly after stroke. Therefore, further studies are needed to better understand and characterize such dysfunctions, which are scarcely described in the literature.

Nelson's syndrome: complete remission with cabergoline but not with bromocriptine or cyproheptadine treatment.

A woman affected by Cushing's disease underwent bilateral adrenalectomy followed by radiotherapy of the hypothalamic-pituitary area when she was 18 years old. Thereafter, she used hydrocortisone acetate replacement therapy (35.5 mg divided into two daily doses). At the age of 26 years, the patient exhibited the clinical signs of the Nelson's syndrome, i.e. skin and gingival hyperpigmentation accompanied by amenorrhea, and elevated ACTH plasma levels (2,850 pg/ml, normal range 15-80 pg/ml). The magnetic resonance imaging (MRI) analysis of the sellar region evidenced a pituitary macroadenoma, measuring 14 x 13 mm. The patient was initially treated with cyproheptadine hydrochloride (12 mg/day) for 18 months. There was a partial improvement of the symptoms, with a reduction of the ACTH plasma levels to 112 pg/ml, but without any modification of the tumor mass. Due to sleepiness and weight gain, the cyproheptadine treatment was interrupted and substituted by a cabergoline (0.5 mg twice a week) therapy. Soon after cabergoline was applied an improvement of the clinical symptoms and signs was observed such as a regression of the tumor mass and the normalization of the ACTH plasma titers (38 pg/ml). Later, cabergoline was substituted by bromocriptine (7.5 mg/day) and the plasma levels of ACTH increased again (247 pg/ml), and headache and cutaneous hyperpigmentation were recorded. When cabergoline was reintroduced there was a clinical improvement and normalization of ACTH plasma levels (64 pg/ml). The MRI analysis of the sella region demonstrated a complete remission of the pituitary adenoma. The results obtained show for the first time that a long-term treatment with cabergoline also brings about a complete remission of Nelson's syndrome in the presence of a pituitary macroadenoma.

Avaliaçäo da pressäo intra-ocular no pós-operatório imediato da trabeculoplastia seletiva / Immediate postoperative intraocular pressure response after selective laser trabeculoplaty

Objetivo: Estudar a variaçäo inicial da pressäo intra-ocular (Po), bem como a frequência e hipertensäo intra-ocular, 1 hora, 2 horas e 24 horas após trabeculoplastia seletiva. Métodos: 22 olhos de 22 pacientes portadores de glaucoma de ângulo aberto, com pressöes intra-oculares mal controladas com tratamento medicamentoso, foram submetidos à trabeculoplastia seletiva com Nd: YAG laser (Q-Switched, doubled-frequency, l=532nm). Parâmetros utilizados: tempo=3ns, tamanho-400 micra e energia=0,6 a 1,2 mJ/pulso. Trataram-se os 180 (graus) inferiores do trabeculado, com 45 a 55 tiros adjacentes, näo sobrepostos. A pressäo intra-ocular foi avaliada pré-laser, 1 hora, 2 horas e 24 horas pós-laser. Resultados: A média das po pré-laser foi 20,86 ñ 1,93 mmHG. As Médias das Po pós-laser foram: 1 hora=21,36 ñ 4,68 mmHG; 2 horas=19,72 ñ 4,56 mmHG e 24 horas=14,86 ñ 2,55 mmHG. Houve variaçäo estatisticamente significativa (Friedman, p<0,0001) das pressöes no período estudado. No teste de comparaçöes múltiplas näo houve diferença estatisticamente significativa entre as pressöes medidas 1 hora e 2 horas pós-laser e as pressöes pré-laser. Observou-se, no entanto, diferença statisticamente significativa entre as pressöes medidas 24 horas pós-laser e as pressöes pré-laser (p<0,0001), com uma reduçäo de 28,8 (por cento) em relaçäo à Po pré-laser (média DPo= -6 ñ 3,2 mmHG). No período estudado näo foram observados picos hipertensivos > 10 mmHG. O aumento máximo de Po observado foi de 8 mmHG (38,1 (por cento) da Po inicial)) em apenas 1 olho 4,5 (por cento). Uma hora ap2s o laser foram observados aumentos da Po em 10 olhos 45,5 (por cento), 6 dos quais apresentaram aumentos de Po < 5 mmHG e 4 18,1 (por cento) apresentaram aumento > 5 mmHG e 8 mm HG. Duas horas ap2s o laser a Po manteve-se aumentada em relaçäo às Po inicial em 6 olhos 26,2 (por cento), 5 dos quais com aumento < 5 mmHG e 1 com aumento = 7 mmHG. Vinte e quatro horas após o laser 21 olhos 95,5 (por cento) apresentavam Po < Po pré-laser e em 1 olho 4,5 (por cento) a Po manteve-se inalterada. Conclusäo: Observou-se uma resposta inicila satisfatória da pressäo intra-ocular após trabeculoplstia seletiva, com baixa frequência de picos hipertensivos significativos no período pós- operatório imediato, e com reduçäo significativa dos níveis de Po 24 horas após laser

Acidentes domiciliares com graves lesöes de nervos periféricos / Domestic accidents with severe injuries of peripheral nerves

Analisam-se 28 casos de lesöes de nervos periféricos ocorridos em ambiente domiciliar. Observa-se que na metade dos mesmos o acidente aconteceu em indivíduos com menos de 20 anos de idade. Em 11 circunstâncias estava relacionado com vasos sanitários, bidês, pias e banheiras. Em 10 com portas e janelas de vidro. Em 22 pacientes houve secçäo total de nervos, sendo todos eles submetidos à cirurgia para exploraçäo e reparo. O nervo mais comprometido foi o ulnar ao nível do antebraço. Os resultados foram bons em 15 de 17 casos acompanhados por mais de 2 anos. Analisando-se detalhadamente os acidentes e os objetivos envolvidos, observou-se que as suas causas decorreram de defeitos de instalaçäo e uso inapropriado dos mesmos. Säo sugeridas orientaçöes básicas, no sentido de se evitar tais acidentes