Tear lipocalin, lysozyme and lactoferrin concentrations in postmenopausal women.

RATIONALE: Among the most frequently encountered pathologies examined by the ophthalmologist is dry eye syndrome (DE), which can be discovered particularly in the elderly. The initial diagnosis of DE is of high importance, but also challenging. This is because the biochemical changes in the tear film often develop before any detectable signs. OBJECTIVE: In this study, the possible relationship between ocular symptomatology, tear volume and tear break-up time (TBUT) and lipocalin, lactoferrin and lysozyme concentrations in the tear film were explored in a group of symptomatic dry-eyed postmenopausal (PM) women compared to age-matched controls. PATIENTS AND METHODS: Sixty-six healthy PM females with ages of at least 50 years were grouped in two homogeneous lots (by age, post-menopause, co-morbidities) of 33 females each, one lot presenting mild or moderate dry eye syndrome (DE) and one asymptomatic non-dry eye (NDE), based on their feedback to the Ocular Surface Disease Index (OSDI) questionnaire and noninvasive TBUT and Schirmer test results. Tears were collected via capillary tubes and an eye wash method. Tear lysozyme, lactoferrin and lipocalin concentrations were determined via electrophoresis. RESULTS: OSDI responses revealed 3 mild DE, 30 moderate DE and 33 NDE. The OSDI total score and sub scores for the DE group were significantly greater than for the NDE group (p < 0.001). The mild and moderate DE group exhibited significantly shorter TBUTs compared to NDE (p < 0.001). No difference in tear lysozyme or lipocalin concentrations was found between DE and NDE groups, irrespective of the tear collection method, but a significant difference was found in lactoferrin concentration (p<0.001). No significant correlations were found between symptoms or signs of DE compared to either lipocalin, lysozyme or lactoferrin concentrations. DISCUSSION: In a PM population, lipocalin and lysozyme are invariable, irrespective of the presence and severity of DE symptoms. However, lactoferrin shows a significant decrease. This is a comprehensive study of lipocalin, lactoferrin and lysozyme in dry-eyed PM women and our results suggested that lactoferrin could be used as a biomarker of DE in postmenopausal women. ABBREVIATIONS: PM = postmenopausal; DE = dry eye disease; NDE = non-dry eye; ELISA = Enzyme-linked immunosorbent assay.

Hydroxyapatite ocular implant and non-integrated implants in eviscerated patients.

INTRODUCTION: This study compares the outcomes and complications of hydroxyapatite ocular implant and non-integrated ocular implants following evisceration. MATERIALS AND METHODS: This is a retrospective study of 90 patients who underwent evisceration for different ocular affections, in the Ophthalmology Department of the University Emergency Hospital Bucharest, between January 2009 and December 2013. The outcomes measured were conjunctival dehiscence, socket infection, implant exposure and extrusion rate. RESULTS: Forty-three patients had the hydroxyapatite implant (coralline-Integrated Ocular Implants, USA or synthetic-FCI, France) and forty-seven received non-integrated ocular implants (24 acrylic and 23 silicone). Five cases of socket infection, thirteen cases of extrusion and two cases of conjunctival dehiscence were encountered. CONCLUSIONS: There was a higher rate of conjunctival dehiscence with hydroxyapatite ocular implant, but implant extrusion and socket infection were found in non-integrated ocular implants.

Correlations between eyelid tumors and tear lipocalin, lysozyme and lactoferrin concentrations in postmenopausal women.

RATIONALE: Common ophthalmological problems are found in patients with eyelid tumors and include ocular surface diseases, such as dry eyes, eyelid disorders, excessive tearing and ocular inflammation. OBJECTIVE: The potential correlation between the symptomatology, tear break-up time (TBUT) and lipocalin, lactoferrin and lysozyme concentrations in the tear film were investigated in a group of symptomatic dry-eyed postmenopausal (PM) women compared to age-matched controls, considering the patients with eyelid tumors. METHODS AND RESULTS: 66 females were divided into two groups of 33 females each, one group having dry eye (DE) and one asymptomatic group (non-dry eye) (NDE), based on their responses to the OSDI questionnaire, TBUT and Schirmer test evaluation. Tears were collected via capillary tubes. Tear lysozyme, lactoferrin and lipocalin concentrations were determined via electrophoresis and the results for patients with or without eyelid tumors were compared. The results revealed significant differences in lysozyme concentration between patients with or without eyelid tumors in the DE group (p = 0.004). Lower levels for TBUT and lactoferrin in the DE group were also found, compared to the NDE group for eyelid tumors patients. Tear lipocalins were in the same range in both groups. DISCUSSION: Within a PM population, some components of the tear film were found to be at lower levels in patients with eyelid tumors, compared to patients without this pathology, which resulted in the development of DE or in the enhancement of the symptoms of an existing DE.

Comparison between the efficacy and side effects of intravitreal versus anterior chamber Bevacizumab injection in neovascular glaucoma patients.

Rationale. Neovascular glaucoma is the type of glaucoma most refractory to treatment. The most frequent causes are those associated with retinal hypoxia, which promotes the upregulation of the VEGF synthesis and produces fibrovascular membranes over the anterior chamber angle. Because the administration of anti VEGF products is still off label for neovascular glaucoma, there is not a single accepted way of treatment. There are differences between the site of administration (vitreal or anterior chamber or both at the same time), the dose or the setting of the procedure. Objective. The objective of our study was to asses the difference of efficacy and complications of bevacizumab injection for vitreal administration versus anterior chamber administration. Methods and results. Prospective study with 18 eyes from 18 patients with neovascular glaucoma associated with proliferative diabetic retinopathy or retinal vein occlusion. Group A (10 patients) received intravitreal injection with 0.05 ml Bevacizumab. Group B (8 patients) received anterior chamber injection with 0.03 ml Bevacizumab. There was a significant decrease of intraocular pressure (p<0.01 for group A, p<0.05 for group B) for both groups. Group A also had a statistically significant decrease of the macular edema (p<0.05). The side effects were reduced for both groups. Discussion. Our conclusion was that for the neovascular glaucoma, which associates significant macular edema, the intravitreal procedure should be performed, while for neovascular glaucoma patients without retinal edema, the anterior chamber procedure should be preferred because of reduced potential side effects.

Angioid streaks - a rare cause of neovascular glaucoma. Case report.

Rationale. Neovascular glaucoma is the type of glaucoma most refractory to treatment. The most frequent causes are those associated with retinal hypoxia, such as proliferative diabetic retinopathy, central retinal vein occlusion, branch retinal vein occlusion, central retinal arterial occlusion, ischemic ocular syndrome etc. Rare causes of neovascular glaucoma are multiple and are due to VEGF synthesis associated with chorioretinal inflammations or degenerations. We present a case with neovascular glaucoma associated with an extremely rare cause, angioid streaks Objective. The objective of our prsentation was to asses efficacy of the 5-FU associated trabeculectomy following bevacizumab intravitreal administration Methods and results. Case report of a 48 years old female patient which presented at the emergency room with painful red left eye. At presentation best corrected left eye visual acuity was 1/10, intraocular pressure was 36 mm Hg. Examination established the diagnosis of Neovascular glaucoma associated with angioid streaks. After intravenous Manitol, oral Acetazolamide and topical treatment with fixed combination timolol-brinzolamide, topical steroid and mydriatic intraocular pressure decreased. Intravitreal bevacizumab injection was performed, followed after 3 weeks by trabeculectomy. Discussion. Angioid streaks are an extremely rare cause of neovascular glaucoma. The treatment is similar to the treatment for other causes of neovascular glaucoma.

Topographic measurements of eyelids and orbit in enucleated eyes with hydroxyapatite integrated implant versus PMMA implant.

INTRODUCTION: This study reports our results relating to palpebral eyelid fissure and orbital measurements following evisceration with orbital implantation of hydroxyapatite integrated implant and PMMA implant. MATERIALS AND METHODS: This study is a prospective study of 43 patients that underwent evisceration for different ocular affections at University Emergency Hospital Bucharest, Ophthalmology department between January 2009 and September 2010 (Group A comprising of twenty patients had the coralline hydroxyapatite implant -Integrated Ocular Implants, USA and Group B comprising of twenty-three received non-integrated PMMA ocular implants) .The outcomes measured were the degree of exo /enophthalmos, horizontal eyelid fissure and palpebral fissure height at 4 years after surgical intervention related to measurement to the contralateral eye. RESULTS: Horizontal eyelid fissure (HEF) was suffering a shortening of 7.4% in the group B versus the contralateral eye, and only 1.9% in the group A related to the contralateral eye. Eyelid fissure height was greater in the group B with 5.2% regarding the contralateral eye, and 1.2% in group A. The degree of enophthalmia was higher in the group B of 4 mm versus the contralateral eye and lower in group A 1.5 mm regarding the contralateral eye. CONCLUSIONS: . Although a hydroxyapatite implant may be not as economic as a PMMA implant, a patient must be warned about the effect on its ocular structures in time and that cosmetic appearance over years will change more dramatically than in the fellow normal eye. Therefore preoperative counseling of the patient is crucial in long term patient satisfaction.

Electron microscopy of the morphological changes in rat viscera during experimental hyperthermic shock.

Hyperthermic shock is a thermoregulatory disorder that affects living organisms that are acutely or chronically exposed to high temperatures or when performing intense physical activity in a hot environment. In this paper, we will show the changes embodied in hyperthermic shock caused by multiple injuries to vital organs in Wistar rats that were suddenly exposed to high temperatures of up to 410 for about 10-15 minutes, their central temperature rising above 40.60C. This process resulted in multiple injuries of the vital organs, evidenced by electron microscopy. In addition, this suggested that most changes caused by hyperthermic shock are incompatible with life.

[Myasthenia--ocular type]. / Miastenia--forma oculara.

The authors present a case of ocular myastenia, suspected by an ophthalmologist and confirmed as diagnosis by a neurologist. There are discussion regarding the latest possibilities of treatment.

Morphological changes during acute experimental short-term hyperthermia.

Wistar rats have been exposed to progressively higher temperatures for 30 minutes to 40.5 degrees Celsius. The animals were sacrificed 30 minutes after cessation of exposure. Harvested organs (heart, lung, liver, pancreas, kidneys, and adrenal gland) show numerous vascular lesions. Massive red blood cells extravasation and vascular stasis partially fragments the myocardial fibers. Pulmonary capillary dilatation and red blood cells intra-alveolar extravasation cause a hemorrhagic alveolitis that tends to a red hepatization. The liver responds by dilating centrolobular veins, vessels in port area and by granulo-vacuolar dystrophy. Pancreas seems less affected. Vascular hyperemia is discrete while in kidney the vascular spaces are narrowed and the proximal and distal tubules cloudy intumescent appears. In suprarenal gland appear many interstitial capillary dilatation and blood cells extravasation among cell nests of medulla. All these changes induce functional organ failure.

[Optic nerve melanocytoma--associated with age related macular degeneration]. / Melanocitom de nerv optic asociat cu DMLV.

We report the case of a 73 year old patient who presented for decreased vision in his right eye, ocular examination revealed a pigmented tumour in the left optic disc (optic nerve melanocytoma). We briefly mention another case of optic nerve melanocytoma in a 6 year old, Caucasian patient.

Morphological study of congenital megaureter.

Congenital anomalies of the kidney and urinary tract are frequent. They can be detected once every 500 ultrasonography fetal examinations. Causes that determine a dilated ureter compared to the rest of the urinary tract are still partly unknown. If concerning the exploration and the clinical diagnosis of these anomalies important progresses have been made, the morphological research is still able to bring forth data that, together with genetic researches, may help reveal the pathogeny of the disease and may ease the planning of the screening genetic tests for early diagnosis. Material and methods. During the surgical operations realized in order to recalibrate the ureter, ureter fragments have been harvested, colored with 1% tionin, in sections thinner then 1 micron and examinated through immersion, ob. 100x. Other fragments have been prepared and examinated through electronic microscope. We have followed the structural modifications of the muscular tissue, nervous tissue, connective tissue and the rapports between these components. Results. Congenital megaureter presents qualitative and quantitative anomalies of the connective tissue and muscular tissue, and also structural modifications of the nervous tissue. Connective tissue. We have noticed the abundance of the connective tissue in congenital megaureter. Connective tissue, with an important representation of typical elements, such as fibroblasts, mastocytes and plasmocytes is partly hyalinated, dissociating muscular fiber bundles and nervous fiber bundles. Connective tissue/muscular tissue report is evidently increased. Muscular tissue. Muscular fibers are hypoplasic, smooth endoplasmic reticulum is present in the tubular form, rare mitochondria are vacuolized. Dense corps are increased in number, plasmatic membranes are folded. Sarcoplasm contains vacuolized organites. The nuclei are rigged with visible nucleoli. Nervous structures. We have noticed varied alterations of the axons and myelin. In some axons there are multiple cavities that may produce the opacifiation of the entire axonal structure. The proliferation of the myelin sheath under the nodular form or vortex form produces the destruction of the axonal structure. Mitochondria are condensed, partially vacuolized. The modifications in the axonal structure and those of the myelin sheath determine modifications of the nervous excitability and conductibility. All the lesions we have pointed out in congenital megaureter participate in compromising of the peristaltic. Nervous and muscular structures lesions indicate a process of incomplete development of the ureter. They are structures that do not achieve functional maturation. We may consider congenital megaureter as a digenesis with hypoplasia.

[Macular hole--a rare complication of toxocariasis]. / Gaura maculara--consecinta rara a infectiei toxocarozice.

Macular hole is a condition that characterizes older patients, being rare in adolescent patients and exceptionally at children. The etiopathogenic mechanism of most macular holes in children and adolescent is idiopathic. The suggested etiopathogenic mechanism is vitreoretinal traction due to a toxocara granuloma for a 9 years old girl.

The histological changes of digestive organs in experimental decreases of hepatic venous outflow at the rat.

The hepatic venous outflow may be diminishing in right-sided heart diseases, constrictive pericarditis, obstruction of suprahepatic veins or an inferior vena cave. It was created an experimental model by obstruction of the suprahepatic veins lumen and inferior vena cave, too, at the adult Wistar rats. The animals were sacrificed in the 30 days after operation. At the iterative laparatomy it was found the liver more increased in volume, a little amount of ascites in peritoneal cavity, oedema of the digestive organs walls. Liver and stomach fragments were prelevated and were processed for optic microscopy and electronic microscopy. The morphological study using by usual technics has highlighted vascular stasis in gastric submucosa. In liver it is standed out the pericentrolobular vascular stasis, inflammatory lymphoplasmocytic infiltrate around the end of hepatic vein. In the gastric submucosa have found vascular stasis, and within the chorion mucosa, the high capillary hyperemia. There is a discreet vacuolar feature on epithelium surface of the gastric mucosal in pyloric region. In the other layers, at rats the epithelium multistratum keratinizated of the stomach is without changes, in this region is maintaining the hyperemia in mucosal chorion.

[Diagnostic criteria in acute neuromyelitis]. / Criteriile de diagnostic revizuite pentru neuromielita optica.

Neuromyelitis optica, also known as Devic disease, was identified in the 19th century, is one of the inflammatory idiopathic demyelinating diseases of the central nervous system, often mistaken for severe multiple sclerosis. In 1999 it had been proposed diagnostic criteria for neuromyelitis optica, but in 2006 these criteria were revised by Dean Wingerchuck. These criteria are 99% sensitive and 90% specific for differentiating neuromyelitis optica from multiple sclerosis that present with optic neuritis or a myelitis syndrome. In the following article we present clinical, spinal and cerebral MR imaging, serological and aspects of cerebrospinal fluid examination features of neuromyelitis optica and the revised criteria of neuromyelitis optica established in 2006. The recently identified serum antibody biomarker: neuromyelitis optica immunoglobulin G (NMO Ig G), which target aquaporin 4 water channel, distinguish neuromyelitis optica from multiple sclerosis, is one of the revised criteria of neuromyelitis optica.

Quantifying image quality at breast periphery vs mammary gland in mammography using wavelet analysis.

Use of high contrast film-screen systems in mammography, in combination with the fact that exposure parameters are selected to ensure good visualization of the mammary gland, results in overexposure of the film area corresponding to the breast periphery, therefore decreasing image quality. The aim of this work was to provide a quantitative evaluation of image quality at the breast periphery compared with the mammary gland. To deal with the difficulties in quantification of image quality introduced by low contrast encountered at the breast periphery, wavelet analysis has been used for derivation of a contrast indicator (CI) and a noise indicator (NI), taking into account local grey level variations. Gradient magnitude coefficients corresponding to region of interest (ROI) grey level values are the basis of CI definition. Mammary gland and breast periphery were sampled by equally spaced ROIs, the quantity of which was determined by a heuristic method. For NI definition, the power values of gradient magnitude coefficients corresponding to the ROI were utilized. Image quality at the breast periphery compared with the mammary gland was evaluated using 150 craniocaudal images from the Digital Database for Screening Mammography. Measurements were carried out using a tool developed in our department. A 50% contrast decrease at the breast periphery was observed, while noise decreased by approximately 2%.

Chronobiology of pituitary-thyroid functions.

One hundred ninety four children, 11 +/- 1.5 years of age and 166 elderly men and women, 77 +/- 8 years of age were studied over one or (in the case of some of the elderly subjects) over several (up to 4) 24-hours spans. All subjects were diurnally active and rested at night and followed their regular three meal pattern. The subjects were studied in subgroups of 20-25 during all four seasons of the year. During each study, blood was collected at 4 hour intervals over one 24-hour span (6 samples). Circadian and circannual variations were found and described by cosinor analysis in the children as well as in the elderly subjects. The children with endemic goiter (134) as compared to those without endemic goiter (60) showed a slight circadian phase advance in plasma total and free T3, a lower circadian amplitude of total T4 concentrations and the absence of a detectable circadian rhythm in free T4. The children with goiter showed a phase delay in serum TBG. There was no difference between the children with and without goiter in the circadian MESOR of any thyroid parameter or of TSH. The children with endemic goiter in the region of Dimbovita, Romania, are in clinical and biochemically euthyroid condition with some slight poral abnormalities of thyroid function. Seasonal variations in children and elderly patients showed the highest values of TSH during summer and fall, while the highest values in the plasma concentrations of thyroid hormones were found during the cold season of the years. Thyroglobulin in the children showed a circadian rhythm but no seasonal variation.

[Chronic reactive inflammations in the etiopathogenesis of malignant hematologic proliferations]. / Inflamatile cronice reactive în etiopatogenia proliferarilor maligne hematologice.

The malignant proliferations are induced by a multitude of etiological factors and possible pathogenic mechanisms. Three new clinical cases and other four previously reported cases of haematological malignant proliferations occurring during the evolution of some chronic reactive inflammatory processes due to various forms of immune deficit are discussed. A review of the literature and of the opinions regarding the pathogenic mechanism responsible for the occurrence and growth of malignant proliferations, especially in the cases with inborn or acquired immunodeficiency, are also included. The authors' pathogenic hypothesis for the cases with various acquired immune deficits and with secondary infectious or allergic reactions is that altered immune responses made possible a lasting antigenic stimulation of certain cell clones of the reactive inflammatory process. By this excessive demand, and instability of the genes has occurred and during their rearrangement a mutation with the depression of an oncogene, responsible for malignant growth, has resulted.

Diagnosis difficulties in multiple myeloma.

Some difficulties in the diagnosis of multiple myeloma are presented. The atypical onset (pseudorheumatismal, anaemic, renal or neurological one) as well as the presence of a biological syndrome during some other diseases which may generate the confusion with the multiple myeloma are discussed with reference to the personal casuistry (30 cases of multiple myeloma in a lapse of 12 years). Some peculiar cases of the two categories of difficulties are presented in detail. A careful clinical and biological examination should be performed in every case, as both situations may involve, affect, the prognosis quo ad vitam of the patient.