Union of the European Phoniatricians' position statement on the exit strategy of phoniatric and laryngological services: staying safe and getting back to normal after the peak of coronavirus disease 2019 (issued on 25th May 2020)

BACKGROUND

The following position statement from the Union of the European Phoniatricians, updated on 25th May 2020 (superseding the previous statement issued on 21st April 2020), contains a series of recommendations for phoniatricians and ENT surgeons who provide and/or run voice, swallowing, speech and language, or paediatric audiology services.

OBJECTIVES

This material specifically aims to inform clinical practices in countries where clinics and operating theatres are reopening for elective work. It endeavours to present a current European view in relation to common procedures, many of which fall under the aegis of aerosol generating procedures.

CONCLUSION

As evidence continues to build, some of the recommended practices will undoubtedly evolve, but it is hoped that the updated position statement will offer clinicians precepts on safe clinical practice.

Corneal sensitivity and subjective complaints of ocular pain in patients with fibromyalgia

PurposeFibromyalgia (FM) is a chronic pain disorder associated with pain and hypersensitivity in various parts of the body. The aim of this study was to understand whether changes in corneal sensitivity were associated with the subjective complaints of these patients.Patients and methodsIn this study, we included 36 patients with FM (30 female, 6 male, mean age: 46.7±9.2 years) and 39 healthy control subjects (33 females, 6 males, mean age: 44.3±7.6 years). We performed a detailed ophthalmological examination, measured tear film breakup time (TBUT), and performed Schirmer I test without anesthetic (SIT). Only patients that did not have any eye disease were included in this study. Subjective complaints of the patients were evaluated with ocular surface disease index (OSDI) scores and the corneal sensation was evaluated with Cochet-Bonnet esthesiometer.ResultsThere was no significant difference between the groups for age, sex, and visual acuity. Both SIT (16.1 mm vs 15.3 mm, P=0.36) and TBUT results (17.8 s vs 18.8 s, P=0.40) were similar in FM group and the controls subjects. However, corneal sensations in central (60.0 mm vs 55.0 mm, P=0.03), superior (57.5 mm vs 50.0 mm, P=0.005), and inferior (53.89 mm vs 46.03 mm, P<0.001) regions were significantly increased in FM patients. There was a significant positive correlation between corneal sensation and OSDI scores.ConclusionIn this study, we have demonstrated that the patients with FM have increased corneal sensitivity and have related ocular surface complaints similar to dry eye disease in the absence of it.

Limbal Conjunctival Mini-Autografting for Preventing Recurrence after Pterygium Surgery

PURPOSE

The aim of the present study was to evaluate limbal conjunctival mini-autografting procedure based on recurrence rates following pterygium surgery.

METHODS

A total of 63 eyes (53 patients) with pterygium, of which 60 were primary and 3 were recurrent, underwent surgery for the removal of pterygia with limbal conjunctival mini-autograft. After the pterygium excision, the limbal portion of the graft was oriented and sutured to the limbus at the recipient bed with the epithelial surface upside. Recurrence was defined as fibrovascular tissue of more than 1 mm over the cornea in the area of previous pterygium excision. The mean follow-up period was 12.5 months (ranging between 6 and 29 months).

RESULTS

The time required for the surgery was approximately 30 minutes (range 20-40 minutes). Recurrence of pterygium was observed in 6 of 63 eyes (9.52%). No eyes with recurrent pterygium developed recurrence postoperatively. There were no severe complications during the operative and postoperative period. Most patients had temporary graft edema, lasting a few days after the operation, and they experienced and complained of foreign body sensations and epiphora.

CONCLUSIONS

Limbal conjunctival mini-autografting appears to be an effective procedure for pterygium surgery resulting in a low recurrence rate.

Comparison of peritoneal closure techniques in laparoscopic transabdominal preperitoneal inguinal hernia repair: a prospective randomized study

PURPOSE

We aimed to compare tacker and suture techniques for peritoneal closure with respect to patient outcomes.

METHODS

A total of 64 patients were included in the study, 32 being in the tacker group and 32 in the suture group. All patients underwent laparoscopic TAPP inguinal hernia repair. Both groups were compared with respect to age, sex, duration of peritoneal closure and the operation, hernia type, the number of tackers used for mesh fixation, postoperative complication rate, visual analogue scale (VAS) scores on 1st, 7th, and 30th days, duration of follow-up, and recurrence rates.

RESULTS

Duration of peritoneal closure and the operation was significantly shorter in the tacker group compared to the suture group (p < 0.001, p = 0.008, respectively). Statistical analysis with the two-way analysis of variance method revealed that mesh fixation with one or two tackers did not influence postoperative pain. VAS 1 was significantly lower in patients with peritoneal closure with suture compared to the patients undergoing peritoneal closure with tacker (p = 0.027). VAS 7 and VAS 30 were lower for peritoneal closure with suture versus tacker, although the difference did not reach statistical significance (p = 0.064, p = 0.294, respectively). We observed no recurrence at an average of 21-month follow-up.

CONCLUSIONS

Tacker and suture appeared to have a comparable safety for peritoneal closure in laparoscopic TAPP inguinal hernia operation. It can be suggested that peritoneal closure with tacker increased short-term pain, independent of the number of tackers used for mesh fixation. Long-term pain was similar in both groups.

Indirect hernial sac containing the uterus, ovary, and fallopian tube in association with a giant intraabdominal lipoma: report of a case

Presence of the ovary, fallopian tube, and uterus within an inguinal hernia is a rare condition. In this report, we describe the case of a 47-year-old female, multiparous patient with a giant omental lipoma (18 × 8 × 7 cm, 422 g) and left inguinal hernia. The uterus, left ovary, and fallopian tube were in the hernial sac. The presence of the uterus within the hernial sac accompanies mullerian anomalies, although, in this case, there was no such anomaly. To our knowledge, there have been no cases in the literature of a giant intraabdominal lipoma and a hernial sac containing the uterus, ovary, and fallopian tube, but a few cases of inguinal hernia involving the ovary, fallopian tube, and uterus have been reported. The aim of this case report was to call attention to the observation that the inguinal hernia seen in female patients may involve the ovary, fallopian tube, and uterus.

Evaluation of the detoxifying effect of yeast glucomannan on aflatoxicosis in broilers as assessed by gross examination and histopathology

We evaluated the efficacy of yeast glucomannan (Mycosorb), incorporated into the diet at 0.5 and 1 g/kg, in reducing the detrimental effects of 2 mg aflatoxin/kg diet on growing broiler chicks from 1 to 21 d of age. A total of 240 male broiler chicks (Ross-308) was divided into 6 treatment groups [Control, Aflatoxin (AF), Yeast glucomannan (YG; 0.5 g/kg), AF plus YG (0.5 g/kg), YG (1 g/kg), and AF plus YG (1 g/kg)]. Ten chicks from each of the 6 groups were slaughtered and pathological examinations were performed on the liver, bursa of Fabricius, thymus, spleen and kidney. The aflatoxin treatment caused moderate to severe hydropic/fatty degeneration in the hepatocytes of the liver and the tubular epithelium of the kidneys, and follicular depletion in the bursa of Fabricius, thymus and spleen. Yeast glucomannan added to the aflatoxin-containing diet at 0.5 and 1 g/kg diminished the severity of pathological changes, slightly and moderately, respectively. The number of affected organs was also reduced in the group given 1 g/kg yeast glucomannan, compared to the aflatoxin group. These results show that yeast glucomannan effectively diminished the adverse effects of aflatoxin on the pathological changes and that the higher concentration of yeast glucomannan (1 g/kg) was more effective than the lower concentration (0.5 g/kg) and itself had no adverse effect.

Urinary epidermal and insulin-like growth factor excretion in autistic children

Growth factors have been implicated in the pathogenesis of autism. We have investigated daily urinary excretion of insulin-like growth factor-1 (IGF-1), epidermal growth factor, and insulin-like growth factor binding protein-3 in autistic children (n=34, age 2-5 years) and age-matched control children (n=29). The mean urinary IGF-1 level was lower in the autism group than the control group (p=0.03). Height was normal. These findings suggest altered IGF-1 metabolism in young autistic children. The cause-effect relationship should be examined by longitudinal studies and insulin-like growth factor provocation tests.

Effects of gender difference in early cytokine levels in trauma patients

BACKGROUND

Experimental studies conducted on laboratory animals have demonstrated that gender differences affect the outcome following trauma-hemorrhage but, it is not clear yet whether the manipulation of sex steroids during clinical trauma affects the outcome. This study was designed to determine whether gender based changes occur in cytokine responses after trauma-hemorrhage.

METHODS

Plasma cytokine, estradiol, and prolactin levels of 100 consecutive abdominal trauma patients admitted to an emergency unit were measured to determine if there is a gender based difference.

RESULTS

There was no significant difference in trauma severity between male and female patients. Plasma interleukin-1beta levels were found to be significantly higher in male patients compared to females following trauma hemorrhage (p = 0.003). On the other hand, there was no significant difference in plasma interleukin-6, tumor necrosis factor-*, and prolactin levels between the male and female patients (p > 0.05).

CONCLUSION

These results suggest that the role of sex steroids on immunomodulatory processes following trauma-hemorrhage should be further investigated before studies are undertaken to evaluate the effect of hormonal manipulation in patients with trauma (Tab. 1, Fig. 1, Ref. 26).

Occurrence of aflatoxins in layer feed and corn samples in Konya province, Turkey

The natural occurrence of aflatoxin was investigated in layer feed and corn samples brought to Konya Veterinary Control and Research Institute Laboratory between 15 April and 15 December 2002. Seventy-eight samples (52 feeds, 26 corn samples) were analysed for total aflatoxin (B1 + B2 + G1 + G2) by an ELISA screening method. Aflatoxin contamination was deter-mined in 37 feed samples (71.1%) and 15 corn samples (57.7%), with a range of 1.5-133 microg kg(-1). However, a majority of the aflatoxin contamination was less than 5 microg kg(-1) (50% within the positive samples). Two feed samples and two corn samples exceeded the maximum tolerated levels in feed (20 microg kg(-1)) and feedstuffs (50 microg kg(-1)) for total flatoxin.

Biological suppression of aflatoxicosis in Japanese quail (Coturnix coturnix japonica) by dietary addition of yeast (Saccharomyces cerevisiae)

The amelioration of aflatoxicosis in Japanese quails was examined by the dietary addition of live yeast (Saccharomyces cerevisiae; SCE). Yeast incorporated into the diet at 1 g kg(-1) was evaluated for its ability to reduce the deleterious effects of 2.5 mg total aflatoxin (AF; 82.30 per cent AFB1, 2.06 per cent AFB2, 7.68 per cent AFG1 and 7.96 per cent AFG2) kg(-1)diet on growing Japanese quail chicks from 10 days to 45 days of age. Forty 10-day-old Japanese quail chicks were assigned to 2x2 factorial arrangement of treatments (control, AF, SCE, AF plus SCE) each consisting of 10 quails. The performances of birds were evaluated. The AF treatment significantly and dramatically decreased food consumption and body-weight gain from the first week onwards. The significant adverse effect of AF on the food conversion ratio was also determined from week 1 to the end of the experiments. The addition of SCE to the AF -containing diet significantly reduced these deleterious effects of AF on food consumption, body-weight gain and food conversion ratio. Compared to controls, the cumulative body weight gain was reduced by 37 per cent among the quails consuming AF without SCE, but increased 15 per cent for the birds fed AF plus SCE. Interestingly, the single inclusion of SCE to the AF-free diet provided significant improvements in all the investigated growth performances of birds (approximately 40 per cent) compared to controls.

Experimental intravitreal application of trovafloxacin in rabbits

This study was performed to examine the retinal toxicity of trovafloxacin, a broad-spectrum fourth-generation fluoroquinolone, in rabbit eyes after intravitreal injection. The left eyes of 20 albino rabbits were divided into four groups, and each was injected intravitreally with 0.1 ml of trovafloxacin in a 50-microg, 100-microg, 250-microg or 500-microg concentration. The right eyes of these rabbits served as control and received normal saline solution. Retinal function was assessed from the electroretinogram (ERG), and retinal structure was also examined by ophthalmoscopy and histologic study (light microscopy). The intravitreal injections of 50 microg, 100 microg, and 250 microg trovafloxacin did not significantly change the ERG a-wave, b-wave or the oscillatory potential throughout the follow-up period of 4 weeks. While no ERG changes were observed at 4 weeks after injection, in the 3 eyes that received trovaloxacin 500 microg/0.1 ml, the a-wave amplitudes showed a diminution of 56-49% and those of b-waves one of 53-44% of the preinjection amplitudes at 4 weeks after injection, but oscillatory potentials remained unchanged in the other 2 rabbits intravitreally injected with 500 microg trovafloxacin. However, in none of the injected eyes and the control eyes in all groups were ophthalmoscopically visible fundus changes and histologic abnormality observed. The results suggest that intravitreally injected trovafloxacin at a dose of up to 500 microg is nontoxic to the rabbit retina. If future studies in other species confirm our findings, intravitreal trovafloxacin may be a good alternative in the treatment and prevention of clinical bacterial endophthalmitis.

Tear functions in patients with pinguecula

PURPOSE

To investigate the tear flow, tear film stability and condition of mucus in patients with pinguecula.

METHODS

The Schirmer I and ferning tests were performed and break-up time (BUT) was determined in 57 patients with pinguecula [random eyes; 34 males and 23 females, 18 to 70 years of age (mean +/- SD: 39.1 +/- 13.5 years)] and in 57 age-matched subjects (control) [random eyes; 35 males and 22 females, 11 to 70 years of age (mean +/- SD: 37.8 +/- 15.2 years)], and the test results were statistically analysed.

RESULTS

The mean Schirmer test value was 22.72 +/- 12 mm in the eyes with pinguecula and 22.7 +/- 8.5 mm in the control eyes. There was no statistically significant difference (t = 0.01, p = 0.99) between the groups. The mean BUTs were 11.42 +/- 6.89 s in the eyes with pinguecula and 15.46+/-5.85 s in the control eyes. Comparison of BUTs between the groups revealed a statistically significant difference (t = 3.37, p = 0.0010). Also, ferning types were found to be significantly abnormal in the eyes with pinguecula (p < 0.01).

CONCLUSION

The alteration in the mucin layer is a possible change inducing pinguecula formation, or it may reflect an already existing pathology in the cells on the ocular surface.

The antibacterial effect of topical anesthetic proparacaine on conjunctival flora

PURPOSE

To investigate the antibacterial effect of topical anesthetic proparacaine on conjunctival flora.

METHODS

One hundred and forty-four eyes of 72 patients awaiting cataract surgery were included in the study. A commercially available solution of proparacaine, preserved with benzalkonium chloride 0.01%, was instilled in one eye of all subjects while the vehicle solution, including the same concentration of preservative in aqueous solution, was administered to the other eye. Conjunctival cultures were taken from all eyes before and 15 minutes after the instillation of proparacaine and the vehicle.

RESULTS

Of the 144 eyes, 76 (52.8%) had positive-conjunctival cultures with the most commonly isolated organisms being coagulase-negative staphylococci in each group. Of the 76 culture-positive eyes, 40 (52.6%) received proparacaine and 36 (47.4%) the vehicle preparation. Fifteen minutes after the instillation of proparacaine and the vehicle eyedrops, four eyes (10%) and 12 eyes (33.3%) had culture-positive conjunctival smears, respectively. Proparacaine significantly reduced the number of culture-positive eyes (p = 0.0003), in contrast to the vehicle (p = 0.21).

CONCLUSION

A topical anesthetic, proparacaine, demonstrates antibacterial effects on the conjunctival flora.

Effect of taurolidine on the normal eyelid and conjunctival flora

PURPOSE

The effectiveness of the topical taurolidine was evaluated in eradicating or reducing microorganisms in the normal flora of human eyes in a randomized controlled study and analyzed also the irritating effects of taurolidine on the ocular surface.

METHODS

One hundred and twenty eyes of 110 patients awaiting cataract surgery were randomly divided into four groups consisting of 30 eyes each. The first group received 0.05% taurolidine, the second received 0.3% gentamicin, the third received vehicle eyedrops and the fourth received saline to the preoperative eye four times daily for two days. Cultures were obtained from the eyelids and conjunctivas of all subjects prior to the therapy and again at the end of 48 hours. Micro-biological identification and colony counts were performed by standard laboratory methods, and the results were compared. The patients were clinically evaluated for symptoms and signs at the end of therapies.

RESULTS

Taurolidine and gentamicin produced a significant decrease from the basal bacteriological state: the number of colonies (p < 0.01 for taurolidine, p < 0.01 for gentamicin) was reduced by both agents. Staphylococcus epidermidis was the most common microorganism isolated before therapy, and the number of its colonies was significantly reduced in taurolidine-treated (p < 0.001) and gentamicin-treated (p < 0.01) subjects. There was no significant difference in terms of the irritating effects for all therapies tested (p > 0.05).

CONCLUSIONS

Taurolidine solution with its unique properties is an effective antimicrobial agent for reducing the number of bacteria in the flora of the eye. Taurolidine appears to be well tolerated and offers promise as a potential new antimicrobial drug.

The role of oxidative stress in diabetic retinopathy

PURPOSE

To investigate the role of oxidative stress in the development of diabetic retinopathy.

METHODS

This study included 25 patients with diabetic retinopathy (group I), 34 patients with non-insulin-dependent diabetes mellitus without any angiopathy complications (group II) and 26 healthy subjects (group III). The serum malondialdehyde (MDA)-like metabolite levels as an index of lipid peroxidation, the erythrocyte glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) and serum vitamin C levels of the patients and healthy subjects were measured.

RESULTS

The mean serum concentration of MDA-like metabolites of patients in group I was 4.38 +/- 1.31 nmol/ml, in group II was 3.38 +/- 0.95 nmol/ml and in group III was 2.61 +/- 0.85 nmol/ml. There were significant differences between the groups (p = 0.001 for group I compared with group II, p = 0.0001 for group I compared with group III and p = 0.002 for group II compared with group III). There was a significant correlation between the serum lipid peroxidation concentrations and duration of the disease (r = 0.36, p = 0.047). The mean erythrocyte GSH-Px and SOD levels of group I were respectively 68.97 +/- 18.04 and 1597.78 +/- 296.46 U/g Hb, of group II were 64.30 +/- 19.26 and 1581.33 +/- 278.08 U/g Hb, and of group III were 65.52 +/- 17.58 and 1587.44 +/- 281.17 U/g Hb. There were no significant differences among the antioxidant enzyme levels in the three groups (p > 0.05). The mean serum vitamin C level in group I was 42.72 +/- 8.90 mumol/l, in group II was 49.26 +/- 11.52 mumol/l and in group III was 58.57 +/- 9.75 mumol/l. There were significant differences among the mean serum vitamin C levels of the three groups (p = 0.02 for group I versus group II p = 0.001 for group I versus group III and p = 0.002 for group II versus group III).

CONCLUSIONS

Free radicals forming in diabetes mellitus and increasing over time may play a role in the development of diabetic retinopathy, which is an important complication of the disease.

Prevalence of Chlamydia trachomatis pooled serotypes BDE and FGK in children with chronic follicular conjunctivitis

PURPOSE

To evaluate type-specific antichlamydial antibody IgG in children with chronic follicular conjunctivitis.

METHODS

A total of 90 serum samples from juvenile patients with chronic follicular conjunctivitis were collected in the Southeastern Anatolian region of Turkey where trachoma is still endemic. These samples were investigated regarding Chlamydia trachomatis pooled serotype-specific IgG by using the micro-immunofluorescence test. A titer of 1/32 or higher was considered positive.

RESULTS

Specific IgG seropositivity to Chlamydia trachomatis titer was found in 33 (36.1%) of the 90 subjects. A higher titer was observed frequently in the serotypes pooled in BDE (21 subjects), CHIJ (10 subjects), and FGK (2 subjects), respectively.

CONCLUSIONS

The presence of antichlamydial antibodies in blood should always be interpreted in accordance with the history of the patient, the clinical picture, and the course of the disease. In the diagnosis of Chlamydia trachomatis infections in a patient with chronic follicular conjunctivitis, not only genus-specific antibodies but also the presence of the subspeciespecific antibodies should be investigated.

The effects of experimentally induced anisometropia on stereopsis

PURPOSE

To determine the effects of experimentally induced anisometropia on stereopsis in healthy adults to assess the potentially detrimental effects of uncorrected anisometropia on the development of stereoacuity during childhood.

METHODS

Twenty-one healthy adult volunteers ranging in age from 22-34 years (mean: 27 years) and free of ocular disease participated in the study. Four different types of anisometropia (unilateral myopia, unilateral hyperopia, or unilateral astigmatism [90 degrees or 45 degrees]) were induced in random order by placing trial lenses over the right eye in 1 diopter (D) increments ranging from 1-3 D. Stereoacuity was measured using the Titmus stereotest with patients placing the cross-polarizing stereoacuity glasses over their lenses or trial frames.

RESULTS

Stereoacuity levels were reduced in proportion to the degree of anisometropia in all patients. One diopter of spherical anisometropia reduced stereoacuity to an average 57-59 arc seconds; 1 D of cylindrical anisometropia reduced stereoacuity to an average 51-56 arc seconds. Three diopters of anisometropia, regardless of type, produced a marked reduction of stereoacuity in all patients.

CONCLUSIONS

Low levels of anisometropia, both spherical and astigmatic, can have potentially significant adverse effects on high-grade binocular interaction in adults. Foveal suppression, which is directly related to the degree of anisometropia, may be responsible for the loss of stereopsis. The data suggest the effects of anisometropia on stereopsis should be considered in the empiric correction of anisometropic refractive errors in children.

The height and radius of the tear meniscus and methods for examining these parameters

PURPOSE

To investigate the relationship between the radius of tear meniscus curvature (TMR) and tear meniscus height (TMH).

METHODS

Twenty-nine eyes of dry-eye patients (all left eyes; two males, 27 females, aged 26 to 85 years [mean +/- SD; 60 +/- 14.4]) were enrolled in the study. TMR was measured at the tear meniscus of the central lower lid with a newly developed videomeniscometer. At the same region of the eye, TMHs were measured without fluorescein (TMH-M) and after 5 minutes with fluorescein (TMH-MF), using a slit lamp equipped with a micrometer. TMHs were also measured on cross-sectional photographs of the fluorescein-stained meniscus (TMH-P).

RESULTS

The values of TMR, TMH-M, TMH-MF, and TMH-P (mean +/- SD, mm) were 0.22 +/- 0.09, 0.19 +/- 0.09, 0.21 +/- 0.14, and 0.24 +/- 0.09, respectively. There was significant correlation between TMR and TMH-M, TMH-MF, and TMH-P values (TMR versus TMH-M: r = 0.596, p = 0.0005; TMR versus TMH-MF: r = 0.587, p = 0.0006; TMR versus TMH-P: r = 0.605, p = 0.0003).

CONCLUSION

There is a significant correlation between TMR and TMH. Videomeniscometry has some merits over conventional methods for obtaining tear meniscus parameters.

Diabetic retinopathy in pregnancy: effects on the natural course

Pregnancy can cause changes in the functioning of the eye in health and in disease and also affect preexisting ocular conditions, such as diabetic retinopathy. Progression of retinopathy in pregnancy depends on a variety of factors, including severity of retinopathy at conception, adequacy of treatment, duration of diabetes, metabolic control before pregnancy, and the presence of additional vascular damage (ie, preexisting or concomitant hypertensive disorder). Developments in medical, obstetrical, and ophthalmologic management of the pregnant diabetic have greatly improved the prognosis for successful pregnancies and maintaining vision.

Effect of clinoptilolite on performance of Japanese quail (Coturnix coturnix japonica) during experimental aflatoxicosis

Clinoptilolite (CLI, a natural zeolite), incorporated into the diet at 50 g/kg, was evaluated for its ability to reduce the deleterious effects of 2.0 mg total aflatoxin (AF;83.06% AFB1, 12.98% AFB2, 2.84% AFG1 and 1.12% AFG2)/kg diet on growing Japanese quail chicks from 10 to 45 d of age. A total of 40 Japanese quail chicks were divided into 4 treatment groups (control, AF, CLI, AF plus CLI) each consisting of 10 chicks. The performance of the birds was evaluated. The AF treatment significantly decreased food consumption and body weight gain from the 3rd week onwards. The adverse effect of AF on food conversion ratio was also significant from week 4 of the experiment. The addition of CLI to an AF-containing diet significantly reduced the deleterious effects of AF on food consumption, body weight gain and food conversion ratio. Food consumption was reduced by 14% in quail chicks consuming the AF diet without CLI, but by only 6% for quail chicks consuming the AF plus CLI diet. Similarly, overall body weight gain was reduced by 27% in birds consuming the AF diet without CLI, but by only 8% for birds consuming the AF plus CLI diet. The addition of CLI to the AF-free diet significantly decreased food consumption and body weight gain during week 4, but these parameters were similar to the controls in week 5. No mortality was observed in any of the groups. These results suggest that CLI effectively diminished the detrimental effects of AF on the variables investigated in this study.

Efficacy of lodoxamide eye drops on tear fluid cytology of patients with vernal conjunctivitis

A double-masked, randomized, placebo-controlled study was conducted to evaluate the effectiveness of lodoxamide tromethamine 0.1% eyedrops in preventing inflammatory cell accumulation in the tear fluid of patients with vernal conjunctivitis. A 1-week baseline period was followed by 4 weeks of treatment with either lodoxamide tromethamine 0.1% ophthalmic solution or placebo in 30 symptomatic subjects with vernal conjunctivitis. Cytological evaluation of tear fluid was performed before and after the treatment. In the lodoxamide-treated group, but not in the placebo-treated group, the number of neutrophils (P = 0.051) and eosinophils (P = 0.020) in the tears significantly decreased at the end of 4 weeks when compared with baseline (Wilcoxon-signed rank test). It was concluded that lodoxamide treatment was significantly more effective than the placebo in terms of reducing inflammatory cells in the tear fluid in vernal conjunctivitis. This objective inhibition of inflammatory cells may be associated with clinical relief.

Microbiologic analysis of aqueous humor in phacoemulsification

PURPOSE

This study was designed as a microbiologic survey of the fluids aspirated from the anterior chamber at the end of cataract extraction performed by phacoemulsification, and to correlate the contamination rate of the anterior chamber to the surgical technique used.

METHODS

One hundred and one consecutive patients (126 eyes) who underwent cataract extraction by phacoemulsification and posterior chamber intraocular lens implantation were included in the study. Microscopical examination, culture, and determination of the number of colonies were carried out on the bacteria and fungi in the anterior chamber fluids aspirated at the end of surgery, before final suture placement.

RESULTS

Anterior chamber fluids yielded positive cultures in nine specimens (8.14%), six of which were identified as coagulase-negative staphylococci. Quantification disclosed colony counts ranging between 2-10 and 10-40 per mL.

CONCLUSIONS

Preliminary results in a small population show that the contamination of the aqueous humor is significantly less frequent if the cataract extraction is performed by phacoemulsification.

Intraoperative application versus postoperative mitomycin C eye drops in pterygium surgery

PURPOSE

Postoperative recurrence of pterygium occurs in many patients. Intraoperative and postoperative mitomycin therapy are two adjuvant treatment methods shown to lessen the high pterygium recurrence rate seen with simple excision alone. The authors designed a prospective, randomized study to explore the recurrence rate of pterygium after a single dosage of mitomycin C at the completion of pterygium excision, comparing it to postoperative mitomycin C therapy.

METHODS

Thirty-six patients with 40 primary and recurrent pterygia were randomized to 1 of 2 treatment groups: intraoperative mitomycin 0.2 mg/ml for 5 minutes (group 1) and postoperative mitomycin 0.2 mg/ml four times a day for 7 days (group 2). The mean follow-up time was 15 months (range, 6 to 24 months).

RESULTS

The pterygium recurred in 3 (15%) of 20 eyes in group 1 and in 4 (20%) of 20 eyes in group 2 (p=0.41). One patient in group 1 had a mild scleral melting (1 x 1 mm) and a delay of reepithelialization for three weeks. Moderate superficial punctate keratitis (two eyes) and mild anterior chamber reaction (one eye) developed in group 2.

CONCLUSION

This study indicates possible advantages of administration of a single dosage of 0.02% mitomycin C over postoperative mitomycin therapy. If the decision is made to use adjunctive mitomycin, the authors recommend intraoperative over postoperative administration.

Thermoablation treatment for trichiasis in trachoma using the semiconductor diode pumped laser

PURPOSE

The aim of this prospective study was to verify the efficacy of laser therapy for trichiasis in trachoma. Trichiasis is one of the most important complications of trachoma which is endemic in Sanliurfa, a city in the southeast of Turkey.

METHODS

Twenty-eight eyelids of 22 patients - 15 males and 7 females - with trichiasis related to trachoma involving the upper, lower, or both lids, were included in the study and treated with a semiconductor diode-pumped, frequency-doubled, solid-state laser operating true CW at 532 nm.

RESULTS

19 (67.9%) of the lids were successfully treated in two sessions or less. Six lids (21.4%) required a third laser session and three (10.7%) a fourth session. Mild notching or dimpling occurred in two eyelids (5.6%). Postoperative swelling was minimal or absent.

CONCLUSIONS

The results show that laser treatment may be successful for trichiasis caused by trachoma. Laser thermoablation is an effective and safe method, with many advantages over other modalities.

Scintigraphic varieties in Hashimoto's thyroiditis and comparison with ultrasonography

The scintigraphic findings in Hashimoto's thyroiditis are highly variable and can mimic any thyroid abnormality. In this study, we compared the scintigraphic findings with ultrasonography in 48 patients with Hashimoto's thyroiditis. Thyroid scintigrams revealed diffuse hyperplasia in 12 patients, multinodular goiter in 20 patients and a solitary nodule in 16 patients (toxic adenoma, n = 1; hypoactive nodule, n = 4; hyperactive nodule with no suppression, n = 3; normoactive nodule, n = 8). Ultrasonography revealed diffuse hyperplasia in 19 patients, multinodular goiter in 20 patients and a solitary nodule in 9 patients. The thyroid scan and ultrasonography revealed the same findings of diffuse hyperplasia in 12 patients and multinodular goiter in 20 patients. Of the 16 patients with a solitary nodule on scintigraphy, only 9 showed the same finding on ultrasonography, with the other 7 showing diffuse hyperplasia. The difference in nodularity between thyroid scanning (74.9%) and sonography (60.4%) has been attributed to pseudonodularity in Hashimoto's thyroiditis. In conclusion, our results confirmed that Hashimoto's thyroiditis can mimic any thyroid abnormality, including diffuse hyperplasia, nodular goiter and multinodular goiter on scintigraphy. Therefore, scintigraphy, ultrasonography and serum thyroid hormone estimation alone may not be helpful for the final diagnosis of Hashimoto's disease. To eliminate unnecessary surgical intervention, all patients should be evaluated by means of physical examination and thyroid autoantibodies, in addition to a thyroid scan, ultrasonography, serum thyroid hormones and fine-needle aspiration biopsy when necessary.

Propylthiouracil-induced cutaneous vasculitis

Cutaneous reactions to propylthiouracil and methimazole occur in 3%-5% of adults. Generalized maculopapular and papular purpuric eruptions are perhaps the most common thionamide-induced reactions. We report 3 patients who developed cutaneous vasculitis which is a rare and serious side-effect during antithyroid drug therapy. The observation of cutaneous vasculitis during administration of propylthiouracil suggested that clinical awareness of this complication should be of considerable importance.

Age-related differences in serum insulin-like growth factor-I (IGF-I) and IGF-binding protein-3 levels in congenital hypothyroidism

It is well established that thyroid hormones play a fundamental role in normal growth and development. The complex relationship between thyroid hormone and the growth hormone-insulin-like growth factor axis is not completely understood. We investigated age-related differences in serum insulin-like growth factor-I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3) levels in 43 patients with primary congenital hypothyroidism. These patients were classified into five age groups (Group I: 0-1 month, Group II: 1 month-1 year, Group III: 1-5 years, Group IV: 5-9 years, Group V: 9-13 years). Patients diagnosed in the first month of life did not display a significant difference in serum IGF-I and IGFBP-3 levels compared to age-matched controls (p > 0.05). However, in groups II to V, IGF-I and IGFBP-3 levels were significantly lower than in controls (p < 0.05). Thyroid hormone replacement therapy increased serum IGF-I and IGFBP-3 levels significantly in 26 hypothyroid children (p < 0.05). Although serum IGF-I and IGFBP-3 levels increase in an age dependent manner in normal children, this increment was not observed in hypothyroid children.

The effect of high-dose methylprednisolone treatment on GM-CSF level in children with acute leukemia: a pilot study

High-dose methylprednisolone therapy (HDMP) induces acceleration of leukocyte recovery in acute lymphoblastic leukemia (ALL) and the differentiation of myeloblasts to mature granulocytes in acute myeloblastic leukemia (AML). These effects of corticosteroids have been shown to be due to the enhanced colony-stimulating activity (CSA) and responses to corticosteroids in some patients with aplastic anemia and myelodysplastic syndromes (MDS) have been related to increased CSA activity. We measured the serum (granulocyte-macrophage colony-stimulating factor (GM-CSF) levels by a sandwich linked immunoabsorbent assay (ELISA) in patients with ALL and AML at presentation and following high-dose methylprednisolone (HDMP) therapy. Serum GM-CSF levels at presentation in the ten cases studied ranged between 160 and 700 pg/ml (mean 418.5 +/- 252.5). One week following HDMP therapy GM-CSF levels increased to between 260 and 950 pg/ml (733.5 +/- 203.2). Four weeks after therapy the GM-CSF levels increased to between 470 and 1350 pg/ml (911 +/- 278.7). GM-CSF levels were markedly elevated one week after HDMP in the patients with ALL, suggesting that in addition to the lymphotoxic effects on leukemic blasts, the acceleration in neutrophil recovery may be due to release of GM-CSF induced by HDMP and its effects on myeloid progenitors.