Prognostic importance of the nutritional status and systemic inflammatory response in non-small cell lung cancer.

PURPOSE: Despite all primary prevention and therapeutic efforts around the world, non-small cell lung cancer (NSCLC) continues to be an important public health problem. In the treatment of patients, laboratory parameters can be used for the determination of treatment intensity. These laboratory parameters should be easily accessible, cheap and easy to use. For this purpose, the prognostic importance in NSCLC of serum albumin levels, neutrophil-lymphocyte ratio (NLR) and thrombocyte-lymphocyte ratio (TLR) was investigated in the present study. METHODS: Serum albumin levels and body mass index (BMI) were used to determine the nutritional status and NLR and TLR were used to determine the systemic inflammatory response (SIR). RESULTS: While median survival was 9.1 months in hypoalbuminemic patients, it was 16.4 months in normoalbuminemic patients (p=0.002). The relationship of positive or negative NLR as an indicator of SIR with median survival was statistically significant (p=0.006). While median survival was 7.8 months for patients with NLR ≥5, it was 14.7 for the patients with NLR <5 (p=0.006). TLR as a SIR indicator was not connected with median survival (p=0.072). CONCLUSION: Serum albumin, indicating the nutritional status and the NLR as an indicator of SIR, are significantly related with prognosis in locally advanced and metastatic NSCLC. Serum albumin measurement and calculation of NLR are easily accessible, cheap and easy to use laboratory methods. We consider that serum albumin levels and NLR can be utilized in the treatment planning of NSCLC patients.

ThinOptX vs AcrySof: comparison of visual and refractive results, contrast sensitivity, and the incidence of posterior capsule opacification.

PURPOSE: To evaluate the visual and refractive results, the changes in contrast sensitivity, and the incidence of posterior capsule opacification (PCO) after the implantation of UltraChoice 1.0 ThinOp-tX (ThinOptX Inc.) intraocular lens (IOL) and conventional acrylic foldable IOL (AcrySof MA30AC). METHODS: Twenty-five patients were randomized into two groups prospectively. In Group 1, microincisional phacoemulsification and the ThinOptX IOL implantation were applied in one eye, and in Group 2, conventional phacoemulsification and the AcrySof IOL implantation were applied in the fellow eye. Uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), surgically induced astigmatism (SIA), contrast sensitivity, and the incidence of PCO were observed in the two groups and comparisons were made. RESULTS: Mean follow-up period was 12.8+/-1.5 months (range 11 to 14 months). In the last follow-up examination, UCVA and BCVA were significantly lower and the PCO scores were significantly higher in Group 1 (p<0.05). Although SIA was lower in Group 1, the difference was not statistically significant. Contrast sensitivity in higher spatial frequencies was significantly lower in Group 1 in the 6th month and 12th month visits. Capsular contraction was seen in 3 eyes (12%) in Group 1 whereas there was no capsular contraction or phimosis in Group 2. CONCLUSIONS: Long-term evaluation of the ThinOptX IOL concludes with an increased rate of PCO, a diminished resistance to the capsular contraction vs the AcrySof IOL, and a decrease in visual performance. The poor after cataract performance of this rollable lens shows that microphacoemulsification and ThinOptX IOL implantation is not as effective as conventional hacoemulsification and AcrySof IOL implantation in the long term.

Radial keratotomy for the optical rehabilitation of mild to moderate keratoconus: more than 5 years' experience.

PURPOSE: To present the authors' long-term experience of radial keratotomy (RK) for the optical rehabilitation of patients with mild to moderate keratoconus--central corneal thickness of greater than 400 microm and without apical scarring. METHODS: In this observational, noncomparative series of cases, all consecutive patients with mild or moderate keratoconus, treated by RK between 1990 and 2002, with at least 1 year follow-up were included. A total of 170 eyes of 96 patients were investigated. Mean follow-up was 42.08 +/- 28.14 months. Visual acuity, refraction, corneal curvature, central corneal thickness, and complications were evaluated. RESULTS: In all of the control visits, mean uncorrected and best spectacle corrected visual acuities were better than preoperative values (p<0.0001). Preoperative myopic spherical refraction decreased significantly (p<0.0001), and remained relatively unchanged throughout the follow-up (p=0.43). A small but statistically significant decrease from baseline was ob-served in astigmatism (p=0.038), which almost disappeared 1 year after the surgery (p=0.47). The surgery produced a statistically significant flattening of the corneal curvature (p<0.0001). Central corneal thickness did not change significantly (p>0.05) in either control visit. In 33 eyes (19.4%), re-deepening of the incisions was required. In 3 eyes (1.8%) penetrating keratoplasty was performed, due to disease progression in 2 eyes (1.2%) and acute traumatic hydrops in 1 eye (0.6%). In 4 eyes (2.2%) microperforation, in 2 eyes (1.2%) macroperforation, in 1 eye (0.6%) infectious keratitis, and in 1 eye (0.6%) hyperopic shift occurred. CONCLUSIONS: RK surgery was found to be a reasonable option for the rehabilitation of a selected group of keratoconus patients in the early or moderate stages.

Phakic posterior chamber plate intraocular lenses for high myopia.

PURPOSE: Refractive correction of high myopia with phakic minus power intraocular lenses (IOLs) may give dramatic visual results. Various types of lenses developed for this purpose have not gained widespread use due to complications. Long-term results and complications of phakic posterior chamber lenses are yet unknown. The purpose of this study was to evaluate long-term refractive results and complications of early design phakic posterior chamber lenses. METHODS: Thirty-four high myopic eyes implanted with phakic posterior chamber IOLs designed by Fyodorov were evaluated retrospectively. Follow-up time ranged from 36 to 62 months. Corneal endothelial cell counts were made at the central cornea preoperatively and in the sixth month in 18 eyes and in the twelfth month in 14 eyes. RESULTS: Preoperative refractions were between -7.75 and -21.00 D; refractions at the end of the follow-up period were between -5.75 and +3.00 D. Sixty-three percent of eyes were in the +/-2.00-D range. Endothelial cell loss was 9% at 6 months and 10.22% at 12 month. The difference in endothelial cell counts at 6 and 12 months was not statistically significant. CONCLUSIONS: Early design phakic posterior chamber IOLs implanted in this study were developed by Fyodorov and are not used currently. These IOLs provided a stable and reversible refractive correction without leading to cataract formation. Endothelial loss was limited to surgical trauma. Moderate predictability of refractive correction and frequent decentrations with these lenses were linked to the early design of these IOLs.

Recurrences of retinal detachment after vitreoretinal surgery, and surgical approach.

PURPOSE: To investigate the causes and management of recurrences of complicated retinal detachment after vitreoretinal surgery. METHODS: Vitreoretinal surgery was performed in 61 patients with complicated retinal detachment who were followed up for 4-24 (mean 7) months. Liquid perfluorocarbon (PFC) was used in all 61, silicone oil in 40 and perfluoropropane (C3F8) in 18 patients. RESULTS: Retinal attachment was achieved in 58 patients (95%) during the first operation. Due to the recurrence of detachment 17 patients (29%) had to be operated for a second, 7 (12%) a third and 4 (7%) a fourth time. Anterior and posterior proliferative vitreoretinopathy, missed tear, retinal incarceration, subretinal membrane and perisilicone proliferation were the factors causing redetachment. CONCLUSIONS: The best anatomical and functional results are obtained by dissection of the anterior membranes. In order to properly remove the retinal periphery the crystalline or intraocular lens should be removed. Comparison of our results with others indicates that anatomical success depends, to a certain extent, on doing only one, radical operation on the pathology that leads to recurrence.

Diode laser transscleral retinopexy in rhegmatogenous retinal detachment surgery.

PURPOSE: To evaluate the safety and efficacy of transscleral diode laser for retinopexy in rhegmatogenous retinal detachment surgery. METHODS: Conventional retinal detachment surgery with transscleral diode laser retinopexy was performed on 52 eyes of 52 patients (22 female, 30 male), aged from 12 to 74 years (mean 51 + 4.1). RESULTS: Of the 52 eyes 36 (69%) were reattached in a single operation and adequate chorioretinal scars were achieved in 34 of them. Additional transpupillary laser photocoagulation was performed in two cases in the postoperative period. Retinal re-attachment was achieved with exoplant revision and transscleral laser retinopexy in six cases (12%). Ten cases (19%) with severe PVR were reattached with vitreoretinal surgery. CONCLUSIONS: Transscleral diode laser retinopexy was an effective and safe method, with accurate lesion location, concurrent permanent laser marks on the retina, and easy transmission through the extraocular muscles and solid buckling elements. Minor complications were minimized by gaining experience with the technique.

Radial keratotomy for the optical rehabilitation of mild to moderate keratoconus: More than 5 years experience.

PURPOSE: To present the authors long-term experience of radial keratotomy (RK) for the optical rehabilitation of patients with mild to moderate keratoconus central corneal thickness of greater than 400 m and without apical scarring. METHODS: In this observational, noncomparative series of cases, all consecutive patients with mild or moderate keratoconus, treated by RK between 1990 and 2002, with at least 1 year follow-up were included. A total of 170 eyes of 96 patients were investigated. Mean follow-up was 42.08 28.14 months. Visual acuity, refraction, corneal curvature, central corneal thickness, and complications were evaluated. RESULTS: In all of the control visits, mean uncorrected and best spectacle corrected visual acuities were better than preoperative values (p<0.0001). Preoperative myopic spherical refraction decreased significantly (p<0.0001), and remained relatively unchanged throughout the follow-up (p=0.43). A small but statistically significant decrease from baseline was ob-served in astigmatism (p=0.038), which almost disappeared 1 year after the surgery (p=0.47). The surgery produced a statistically significant flattening of the corneal curvature (p<0.0001). Central corneal thickness did not change significantly (p>0.05) in either control visit. In 33 eyes (19.4%), re-deepening of the incisions was required. In 3 eyes (1.8%) penetrating keratoplasty was performed, due to disease progression in 2 eyes (1.2%) and acute traumatic hydrops in 1 eye (0.6%). In 4 eyes (2.2%) microperforation, in 2 eyes (1.2%) macroperforation, in 1 eye (0.6%) infectious keratitis, and in 1 eye (0.6%) hyperopic shift occurred. CONCLUSIONS: RK surgery was found to be a reasonable option for the rehabilitation of a selected group of keratoconus patients in the early or moderate stages.

The viability of Scenedesmus bicellularis cells immobilized on alginate screens following nutrient starvation in air at 100% relative humidity.

The viability of algal cells immobilized on screens and starved in a water-saturated air stream was studied at the laboratory scale. This new process for wastewater biotreatment has been developed using immobilized cells, which were starved in air, to obtain a high rate of nutrient removal. A unicellular green microalgae, Scenedesmus bicellularis, was isolated from secondary decantation tanks at an urban wastewater treatment plant and grown in a synthetic medium for 12 days. The cells were then concentrated by centrifugation and immobilized on alginate screens. The screens were then inserted in a photochamber saturated at 100% relative humidity and subjected to a photoperiod of 16 h in the light and 8 h in the dark, with an illumination of 150 muE m(-2) s(-1) provided by fluorescent lamps. After 48 h of nutrient starvation, the immobilized cells were used for the removal of ammonium and orthophosphate from a synthetic secondary wastewater effluent in a plexiglass reactor. During the sequential operation of starvation followed by incubation in the presence of nutrients, fast growth of viable cells in the gel matrix was obtained and there was no appreciable decay of chlorophyll a or cell activity. When these immobilized and starved cells were incubated in wastewater, ammonium (NH(4) (+)) and orthophosphate (PO(4) (3-)) ions were quickly taken up from medium. After three successive 2-h exposures to wastewater, immobilized algal cells were freed by dissolving the Ca-alginate with phosphate as 0.2 M Na(3)PO(4) and resuspended in fresh culture medium. Results indicate that free cells transferred to rich medium remained viable, but the growth rate revealed that the viable cells decreased their culturability. (c) 1995 John Wiley & Sons, Inc.