Deep sclerectomy with mitomycin C in eyes with failed glaucoma surgery and pseudophakia

PURPOSE

To report outcomes of deep sclerectomy (DS) with intraoperative mitomycin C (MMC) application in eyes with previous failed glaucoma surgery (GS) and/or cataract extraction (CE).

PATIENTS AND METHODS

Single-surgeon case series of 82 eyes of 82 patients undergoing DS with MMC. The patients had previous CE with IOL and/or conjunctival GS and treated intraocular pressure (IOP) >18 mm Hg. MMC (0.2 mg/ml) was applied for 2-3 min before scleral flap dissection. Complete success was defined as IOP between 6 and 21 mm Hg or a reduction of 20% from baseline without medications. Reoperation for glaucoma or related complications, or loss of light perception vision was considered as failure.

RESULTS

Mean follow-up was 57.7 ± 22.4 months with 78% of patients completing the 3-year follow-up. Mean IOP decreased from 24.0 mm Hg (22.3-25.6, 95% confidence intervals) to 13.4 mm Hg (12.0-14.2) at 3 years after surgery (P<0.001). There was a significant decrease in the number of glaucoma medications from 2.0 ± 1 preoperatively, to 0.3 ± 0.7, 3 years after surgery. Kaplan-Meier cumulative success rates were 85.6% at 1 year, 80.0% at 2 years, and 76% at 3 years. At 3 years, IOP was maintained <19 and 15 mm Hg in 83 and 70% of eyes, respectively. Fourteen eyes (17.1%) had complications. Delayed hypotony (IOP <6 mm Hg) was the commonest complication in five eyes (6.1%).

CONCLUSION

DS with MMC appears to be a safe and effective surgical procedure for eyes with previous intraocular surgery.

Occurrence of the angiotensin-converting enzyme inhibiting tripeptides Val-Pro-Pro and Ile-Pro-Pro in different cheese varieties of Swiss origin

The contents of the 2 antihypertensive peptides Val-Pro-Pro (VPP) and Ile-Pro-Pro (IPP) were determined in 101 samples from 10 different Swiss cheese varieties using HPLC with subsequent triple mass spectrometry. In the category of extra hard and hard cheeses, the Protected Denomination of Origin cheeses Berner Alpkäse and Berner Hobelkäse, L'Etivaz à rebibes, Le Gruyère, Sbrinz, Emmentaler (organic and conventional) and in the category of semihard cheeses, the varieties Tilsiter, Appenzeller 1/4 fat and full fat, Tête de Moine, and Vacherin fribourgeois were screened in the study. The average concentration of the sum of VPP and IPP in the screened cheese varieties varied to a large extent, and substantial variations were obtained for individual samples within the cheese varieties. The lowest average concentration of the 2 tri-petides was found in L'Etivaz à rebibes (n = 3) at 19.1 mg/kg, whereas Appenzeller 1/4 fat (n = 4) contained the greatest concentration at 182.2 mg/kg. In individual samples, the total concentration of VPP and IPP varied between 1.6 and 424.5 mg/kg. With the exception of a 10-yr-old cheese, VPP was always present at greater concentrations than IPP. Milk pretreatment, cultures, scalding conditions, and ripening time were identified as the key factors influencing the concentration of these 2 naturally occurring bioactive peptides in cheese. The results of the present study show that various traditional cheese varieties contain, on average, similar concentrations of the 2 antihypertensive peptides to the recently developed fermented milk products with blood pressure-lowering property. This may serve as a basis for the development of a functional cheese with blood pressure-lowering property.

[Acute pancreatitis from the aspect of the surgeon]

The authors provide evidence of the extreme increase of the frequency of acute pancreatitis. At the First Surgical Clinic in Brno in 1934 the frequency of acute pancreatitis (AP) was 0.2 pro mille (in the course of 3 years 4 patients among 20 000 hospitalized patients), at present (65 years later) in 1999 - 2001 it is 0.7%--74 patients among 10 676 hospitalized patients. This is 35 times more, 48 men (65%) and 26 women (35%). The mean age was 48.6 years, range 26 - 83 years. The lethality of the whole group was 9.5%. From the total number of 74 patients seriously ill patients (Atlanta II classification) 25 patients--34%, Atlanta I--49 patients--66%. 7 patients with acute necrotizing infected pancreatitis died--28% of the whole group. Initial treatment of AP is based on adherence to three principles:(a) intensive treatment, (b) elimination of etiological factors and (c) control of complications. Contrary to other affectios in AP, there is no specific surgical treatment. Indications for surgical treatment of AP: I. early stage--explorative laparotomy if stabilization of patient by adequate treatment to resolve comorbidity (NPB etc.) is impossible, II. advanced stage--evacuation of infected necroses, abscesses, infected or bleeding pseudocyst, elective sanation of biliary tract. The optimal timing is between the 2nd and 3rd week of the disease. Premature surgery does not have a favourable effect on the subsequent course of the disease.

Preliminary investigation of the visuo-motor recall test

This pilot study yielded no differences in performance on the Wechsler Visuo-motor Recall Test associated with sex or age and no interaction of these variables among 80 Negro pre-school children in the sample studied. Further, the findings suggested that work is needed to arrange items in the order of difficulty. Finally, the influence of response “set” needs to be taken into consideration in future studies with this instrument.