Does vigabatrin treatment for infantile spasms cause visual field defects? An international multicentre study.

AIM: The aim of this study was to examine whether vigabatrin treatment had caused visual field defects (VFDs) in children of school age who had received the drug in infancy. METHOD: In total, 35 children (14 males, 21 females; median age 11y, SD 3.4y, range 8-23y) were examined by static Humphrey perimetry, Goldmann kinetic perimetry, or Octopus perimetry. The aetiologies of infantile spasms identified were tuberous sclerosis (n=10), other symptomatic causes (n=3), or cryptogenic (n=22). RESULTS: Typical vigabatrin-attributed VFDs were found in 11 out of 32 (34%) children: in one out of 11 children (9%) who received vigabatrin for <1 year (group 1), in three out of 10 children (30%) who received vigabatrin for 12 to 24 months (group 2), and in seven out of 11 children (63%) who received vigabatrin treatment for longer than 2 years (group 3). VFDs were mild in five and severe in six children. Patients with tuberous sclerosis were at higher risk of VFDs (six out of 10 children). The mean cumulative doses of vigabatrin were 140.5, 758.8, and 2712g in group 1, 2, and 3, respectively. INTERPRETATION: VFDs were found in 34% of the cohort of children in this study. The rate of VFD increased from 9% to 63% as duration of treatment increased. The results of this study showed that the risk-benefit ratio should always be considered when using vigabatrin.

Combined cataract surgery on a Marfan-syndrome patient (case report).

Combined cataract surgery of an ectopic lens was performed on a 10 years old girl with Marfan-syndrome. A Cionni capsular tension ring was implanted into the capsular bag, and the bag was pulled to its place and fixed with a scleral suture. Because of the young age of the patient a primary posterior capsulorhexis was performed, through which anterior vitrectomy was carried out and the artificial lens was implanted into the capsular bag. In the literature several surgical solutions are advised for the treatment of the ectopic lens in patients with Marfan-syndrome. We have performed a successful surgery combined with posterior capsulorhexis in our case. Because of its rarity and special surgical solution, we think this case report is interesting and can be helpful in such cases to be published.

[The characteristics of nurses' and caregivers' behaviour in different clinical settings with special attention to burnout syndrome]. / Apolói és gondozói magatartások alakulása különbözô ellátási helyzetekben, különös tekintettel a kiégés jelenségére.

UNLABELLED: The author draws attention to the up-to-datedness of the selected topic and its personal and institutional effects. Stress in work (workplace stress) has a significant role in the pathomechanism of burnout. Nurses are exposed to excessive stress burden in work so expected incidence of burnout is relatively high among them. Goal of this study is to draw a picture about the situation, condition of mental health, degree and rate of burnout in nurses in given health care situations. METHODS: Self-completed, anonymous questionnaire questioning the surveyed socio-demographic data while using three standardized questionnaires with the measurement of the degree of burnout, physical and mental exhaustion and fatigue as well as dysfunctional attitudes. RESULTS: The study surveyed 805 individuals analyzing the specific characteristics of supporting relationship and joining points between degree of burnout and (hospital) department care form. Among 374 nurses working in the intensive care unit 9.4% suffer from burnout, while among 155 nurses working in active care unit this rate is 0.6%. According to the findings of the study there are also other influential elements, namely the facts that nurses have part-time jobs (second jobs) besides their full-time jobs and the lack of moral and financial respect or recognition. Among the surveyed population 273 individuals--33.9%--are at risk regarding burnout, 44 individuals--5.5%--show signs of burnout and 7 individuals--0.9%--are in a condition where treatment is needed. The study supposed the influential role of certain personality factors (dysfunctional attitudes) in the development of burnout. Comparison showed that burnout phenomenon and dysfunctional attitudes are correlated. CONCLUSION: The survey results confirmed that socio-demographic factors had no effect on burnout development. The severity of patients' condition and the degree of permanent stressful situation in intensive care units are among determinant workplace factors.

Intracranial migration of silicone oil from an eye with optic pit.

BACKGROUND: The origin of subretinal fluid in eyes with optic pit remains controversial. METHODS: Case report. RESULTS: The authors found that silicone oil, implanted into an eye that developed proliferative vitreoretinopathy after surgery for optic pit-related macular detachment, has migrated into the subarachnoid space. CONCLUSIONS: As this case shows, cerebrospinal fluid may migrate into the submacular space in eyes with optic pits.

Relationship between hyperglycemia and retinopathy of prematurity in very low birth weight infants.

Retinopathy of prematurity (ROP) is a multifactorial vasoproliferative retinal disorder that increases in incidence with decreasing gestational age. Recently, an association between hyperglycemia and severe ROP was found in extremely low birth weight infants (ELBWI). The purpose of this study was to evaluate the possible relation between hyperglycemia and ROP at any stage in very low birth weight infants (VLBWI). We analyzed the data of 201 VLBWI. The incidence of ROP and hyperglycemia was detected and the chi2 test was applied to investigate the association between the two variables. The Clinical Risk Index for Babies (CRIB) score was attributed as a marker of illness severity. The incidence of ROP and hyperglycemia in VLBWI was 35.3 and 19.4%, respectively. ROP developed more frequently in hyperglycemic infants (p < 0.001). The gestational age, birth weight, and Apgar scores were significantly lower, the CRIB score was higher in ROP patients. In hyperglycemic ROP patients the CRIB score was significantly higher compared to euglycemic ROP patients (mean (SD) 8.1 (4.2) vs. 5.5 (3.3); p < 0.01). A logistic regression model revealed that gestational age (OR 0.59; 95% CI 0.46-0.76; p < 0.001) and hyperglycemia (OR 3.15; 95% CI 1.12-8.84; p < 0.05) are independent risk factors in ROP development. When ELBWI were analyzed separately, gestational age (OR 0.38; 95% CI 0.20-0.72; p < 0.01) and CRIB score (OR 1.58; 95% CI 1.02-2.45; p < 0.05) were found as significant contributors. Further studies are needed to elucidate the pathophysiological role of hyperglycemia in the development of vasoproliferative retinal disorder.

First Report of Phytophthora Root and Collar Rot of Alder in Hungary.

In June 1999, a disease associated with mortality of Alnus glutinosa, was observed in a 12- to 18-year-old peatland plantation in northwest Hungary. The root and collar rot symptoms were similar to those caused by Phytophthora cambivora in tree species other than alders. Nine isolations were made from diseased roots and soil samples using the Rhododendron leaf baiting method. Three isolates recovered from two sites, approximately 2 km apart, exhibited similar growth and morphology in vitro and were pathogenic to 2-year-old trees of A. glutinosa following inoculation of root collars. All three isolates had amphigynous long, two-celled antheridia. The mean diameter of oogonia ranged from 39.5 to 64.6 µm. They also produced nonpapillate, ellipsoid, non-caducous sporangia 26.9 to 50.5 µm long and 19.3 to 38.5 µm wide with broad exit pores in soil filtrate. These characteristics were similar to those reported for Phytophthora on alder from elsewhere in Europe and for P. cambivora that is not a pathogen of alder (1,2). However, Hungarian isolates from alder, in contrast to P. cambivora, were homothallic like previously recorded isolates from alder, formed nonornamented oogonia and developed colonies at lower optimum (approximately 25°C) and maximum (approximately 30°C) temperatures on carrot agar. A comparison with Phytophthora from alder from other countries (courtesy of C. M. Brasier) showed that the Hungarian isolates have smooth-walled oogonia typical of Swedish isolates rather than the ornamented oogonia of U.K. isolates, but have the appressed, slightly woolly colony morphology like U.K. isolates rather than the fluffy growth found in Swedish isolates. Moreover, cellulose acetate electrophoresis of glucose-6-phosphate isomerase revealed one homodimer band in Hungarian isolates that was identical with that of the Swedish isolate from alder P876 and isolates P1010 and P1011 of P. cambivora (courtesy of C. M. Brasier). This band comigrated with the middle one of the five-banded U.K. standard isolate P772. Molecular evidence (2) indicates that the Phytophthora from alder with its unusual characteristics is not a species in the strict sense but comprises natural hybrids that may have originated in an interspecific hybridization event between a P. cambivora-like species and an unknown species similar to P. fragariae. On this basis, the Hungarian Phytophthora from alder might have evolved similarly. It remains to be determined whether the pathogen was introduced or has developed independently. References: (1) C. M. Brasier et al. Plant Pathol. 44:999, 1995. (2) C. M. Brasier et al. Proc. Natl. Acad. Sci. USA 96:5878, 1999.