Ultrasound scanning in combination with ultrasonically guided fine needle aspiration biopsy is a well established method in the evaluation of patients with suspected pancreatic cancer. Fine needle puncture should be performed when a solid mass lesion is outlined by ultrasound. The dynamic scanning technique provides the best identification of the biopsy needle during its insertion. In a series 203 patients including 126 with malignant mass lesions of the pancreas or malignant periampullary tumors from a 10 yr period, false negative cytological diagnoses occurred in 24%. Two false positive cytological diagnoses occurred in patients with chronic pancreatitis. The technique is most valuable in the demonstration of cancer of the pancreas or of the periampullary region (pVpos = 98%) but less valuable in the exclusion of malignancy (pVneg = 69%).

Biopsy, Needle↗

PubMedDate not supplied

Central retinal vein occlusion and nonarteritic ischemic optic neuropathy in 2 patients with mild iron deficiency anemia.

We report on 2 patients with ophthalmologic complications associated with mild iron deficiency anemia. Case 1, a 37-year-old female patient, presented after 4 days of blurred vision in her left eye. Ophthalmoscopic and angiographic findings were consistent with the diagnosis of central retinal vein occlusion (CRVO). Further hematologic investigation into possible causes disclosed mild iron deficiency anemia (Hb 9.4 g/dl, hematocrit 30.5%). After the patient's visual acuity had worsened progressively to 20/50, an initial thrombolytic treatment and continuous intravenous heparinization was started on day 8, followed by oral substitution therapy with ferrous sulfate. On day 14, her visual acuity recovered to 20/20 OS and remained stable during follow-up. Case 2, a 50-year-old female patient, presented with a 1-week-history of blurred vision and metamorphopsia. Her visual acuity was 20/200. Further examination revealed a nonarteritic ischemic optic neuropathy and an iron deficiency anemia as the underlying disease (Hb 7.3 g/dl, hematocrit 25%). Despite intravenous heparinization and systemic treatment with steroids, there was no improvement in visual acuity. Clinicians involved in the management of chronic iron deficiency anemia should be aware of possible ophthalmic manifestations in this disease.

Adult↗

PubMedDate not supplied

Correlation of blood-glucose control with oxidative metabolites in plasma and vitreous body of diabetic patients.

PURPOSE: In diabetes hyperglycemia and other mechanisms lead to the production of oxidative metabolites that can enhance the production of growth factors, leading to increased proliferative activity. Strict blood-glucose control reduces the progression of retinopathy better than standard control. This study investigated patients with diabetic retinopathy for evidence of oxidative metabolites in plasma and the vitreous body, correlating these values with blood-glucose control. METHODS: The study comprised 136 patients suffering from proliferative diabetic retinopathy. They were grouped according to their mean glycosylated hemoglobin value for the last 9-12 months. Patients with values < or = 10% (mean 8.7%; n=64) were considered strict glucose control patients, those with values > 10% (mean 12.8%; n=72) were considered standard glucose control patients. Lipid peroxides were determined in blood plasma and the vitreous body by two methods (thiobarbituric acid reactive substances and malondialdehyde-like substances). If present, retinal traction with fibrovascular proliferations (>2 disk areas) was quantified and served as an indicator of proliferative activity. RESULTS: Patients with strict blood-glucose control had significantly (p < 0.01) lower lipid peroxide values in plasma and the vitreous body than standard glucose control patients. These latter had significantly (p<0.01) higher rate of fibrovascular proliferation (50%) than strict glucose control patients (9. 7%). DISCUSSION: Strict blood-glucose control leads to reduced oxidative tissue damage both systemically and locally in the eye, and reduced proliferative activity. Oxidative metabolites can stimulate proliferation by increasing the amounts of different growth factors an cytokines such as vascular endothelial growth factor. Thus, it can be speculated that in hyperglycemia the relative increase of oxidative metabolites contributes both to damage of retinal vessels and to more pronounced proliferative activity in diabetic retinopathy.

Blood Glucose↗

PubMedDate not supplied

Electron microscopic examination of prelathed, lyophilized tissue used for epikeratophakia in humans.

Morphologic changes secondary to cryolathing and lyophilization have been described in tissue lenses used for epikeratophakia. We report the electron microscopic findings of an aphakic tissue lens which could not be used because of sudden preoperative myocardial infarction of the patient. Scanning electron microscopy revealed the presence of three distinct zones (peripheral, intermediate, and central) on the stromal side of the lens. The surface of the central zone appeared to be the smoothest, as a consequence of the different angle of lathing. The Bowman's layer side of the tissue lens exhibited a uniform, smooth surface. Transmission electron microscopy revealed a largely normal collagenous structure of both stroma and Bowman's layer. Interfibrillary distances were within normal limits. Several giant stromal spaces of various dimensions filled with homogeneous material were observed. Variably preserved keratocytes were a regular finding among the lamellae. Our findings confirmed some of the structural changes previously observed in tissue lenses not used for epikeratophakia in humans. The limited size of a smooth central zone of the posterior surface could explain some postoperative complaints such as persistent glare phenomena, as well as prolonged visual rehabilitation time, especially in those cases where centration of the epi-lens onto the recipient cornea is not optimal.

Cornea↗

PubMedDate not supplied

Epikeratophakia for the correction of myopia: lenticule design and related histopathological findings.

In spite of the numerous changes in surgical technique, epikeratophakia for the correction of myopia is still far from achieving optimal results. The removal rate of myopic lenticules is much higher than that of aphakic or keratoconus lenticules and has prompted the FDA to deny its approval to the industrial production of epi-lenses for the correction of myopia. We report a patient who underwent epikeratophakia for the correction of high myopia in his left eye and required removal of the lenticule because of unsatisfactory visual outcome. The histologic and electron microscopic examination of the removed lenticule revealed the presence of folds in both Bowman's layer and superficial stroma. These had been described in the past and related to the surgical technique used at that time; they were thought to be the cause of poor visual acuity n two patients, and had prompted, therefore, a change in surgical technique. Our findings suggest that the present lenticule design could be responsible for the presence of folds and the consequent poor visual result.

Adult↗

PubMedDate not supplied

The limitation of screening effect. A review of cervical disorders in previously screened women.

In the Frederiksberg screening program from 1962 to 1972 invasive carcinoma, carcinoma in situ or severe dysplasia of the cervix were found in 155 previously unscreened women. In previously screened women 137 lesions were later elucidated, 53 of these at rescreening. If a failure of method of 10 per cent is anticipated, 21 cases were probably missed due to the method chosen. Patient failure was noted in six cases and two cases were missed by insufficient follow-up by the doctor. The importance of a high participation rate is emphasized. The cytologist's error was 19 per cent. Sixty-four cases were estimated to represent new cases developed between screenings. A reduction of cytologist's error is assumed to be the most accessible way of improving screening results.

Adult↗

PubMedDate not supplied

Single-use/multiple-use gowns and drapes: criteria for decision making.

1. Perioperative managers have more product choices for gowning and draping materials than ever before. Decision making is more difficult, yet more critical. The product/system selected must meet the patient care, employee protection, and cost expectations of the department. 2. Decision-making should be based on product characteristics, cost considerations, and availability of resources in the institution or service area. 3. Before deciding on any product, a criteria-based evaluation should be conducted. Product, characteristics should be weighed in terms of importance.

Bedding and Linens↗