Climatic droplet keratopathy (CDK) is a degenerative condition characterized by the accumulation of translucent material in the superficial corneal stroma within the interpalpebral strip, beginning peripherally and spreading centrally. Progressive accumulation in later life can lead to significant visual disability, and people leading an outdoor life are particularly at risk. The translucent corneal deposits are composed of protein, but although they share some of the staining characteristics of degenerated protein, such as that found in pingueculae, their exact histochemical nature remains uncertain. The corneal deposits are thought to be derived from plasma proteins, which diffuse into the normal cornea, and may be photochemically degraded by excessive exposure to ultra-violet light (UV). The degraded protein material may then be deposited in the superficial stroma. UV light is now widely accepted to be the main etiological factor in the pathogenesis of CDK. Sector iridectomy, corneal epithelial debridement, lamellar keratoplasty, and penetrating keratoplasty have all been employed in the treatment of visually incapacitating CDK.

Blood Proteins↗

PubMedDate not supplied

Correction of hemodynamic abnormalities by vesicoamniotic shunting in familial congenital megacystis.

Vesicoamniotic shunting is typically reserved for treatment of fetal obstructive uropathy. We report a case of congenital megacystis without anatomic urinary obstruction in whom a vesicoamniotic shunt was used to improve fetal hemodynamics as measured by Doppler velocimetry.

Adult↗

PubMedDate not supplied

Radionuclide ejection fraction in doxorubicin cardiotoxicity.

Serial assessment of cardiac function by radionuclide ejection fraction (EF), using a "first-pass" technique, was performed prior to each dose in 292 patients receiving doxorubicin. Detailed analysis was undertaken in 98 patients, consisting of all 91 patients who had received greater than 200 mg/m2 and seven with risk factors (RFs) who had received between 100 and 200 mg/m2. Thirty-two patients had RFs and 66 had no risk factors (NRFs). RFs were: (a) cardiovascular disease, (b) mediastinal irradiation within 6 months of starting doxorubicin treatment, and (c) total doxorubicin dose greater than 550 mg/m2. The criteria for discontinuing doxorubicin were EF less than 0.40 in RF patients or less than 0.35 in NRF patients or decrease in EF of greater than or equal to 0.14 over three successive readings. In the NRF group, no patient met these criteria nor did any develop cardiac failure. In the RF group, discontinuation was indicated in eight patients: two stopped receiving doxorubicin at total doses of 730 mg/m2 and 680 mg/m2, respectively, and it was discontinued in the other six at total doses ranging from 120 to 420 mg/m2. Prior to the first dose of doxorubicin, all patients should have a baseline EF and assessment of RFs. An EF study is required before each subsequent dose in patients with RFs or with initial EF less than 0.45, but in the remaining patients, serial studies are not required until there is a cumulative dose of 450 mg/m2. Use of these guidelines and our criteria for discontinuation may prevent development of doxorubicin cardiotoxicity.

Adolescent↗