Ophthalmologic management of diabetic retinopathy

Changes in lung mechanics were measured in asthmatic adults before and after a 10-day course of daily and a three-week course of alternate day adrenocortical steroid therapy. All patients improved after the 10 days of therapy. This response continued during the a.m. measurements on the alternate day regimen with further improvement through the afternoon of the treatment day. In the afternoon of the day off corticosteroid therapy there was a deterioration in flow rates.     

Results of 20 years of research on the treatment of diabetic retinopathy

Diabetic retinopathy is the leading cause of blindness in young adults, ages 20-55. Without treatment 50% of those with proliferative diabetic retinopathy will be blind within 5 years. Over the last 2 decades the National Eye Institute has supported four different multicenter randomized clinical trials for diabetic retinopathy. Implementation of the results from these clinical trials can markedly reduce the risk of blindness.     

Secretion of GH and diabetic retinopathy

Recently it has been studied a possible pathogenetic role of GH in diabetic angiopathy. The purpose of the present study was to verify whether the diabetic retinopathy is associated or not with a high plasma GH level. In an attempt to answer this question we did the dosage of plasma GH after a oral glucose load (110 g), Insulin (0,1 U/Kg) i.v., and arginin i.v. (25 g/30'). The plasma GH measurements were approximately the same as in normal patients. The Authors underline the importance of GH in pathophysiology of diabetic angiopathy and report all recent literature on this argument.     

Current status of treatment for small hepatocellular carcinoma

In recent years ethanol injection therapy (PEI) and transcatheter hepatic arterial embolization (TAE) have come to be widely used in the treatment of small hepatocellular carcinoma, and the introduction of microwave coagulation therapy (MCT) more recently has made it possible to perform a variety of non-surgical treatments even in cases in which surgical resection has been indicated until now. There have also been reports based on survival rates that results comparable to those obtained by surgical resection can be achieved with non-surgical methods. The main issue is whether PEI or resection should be selected to treat small hepatocellular carcinomas. However, the recurrence rate after PEI is higher than after surgical resection, and according to our results, in patients with solitary lesions, especially when the tumor diameter is 2 cm or less, the level of malignancy in many cases is also low biologically, and postoperative survival rates (recurrence-free survival rates) are favorable [5 years : 85.0% (64.3%); 10 years: 67.9% (42.2%)]. After thoroughly evaluating liver function in these cases, while surgical resection should be considered first, it is also important to use a combination of various treatment methods rather than always resort to a single method.     

The Wisconsin Epidemiologic Study of diabetic retinopathy. XIV. Ten-year incidence and progression of diabetic retinopathy

OBJECTIVE: To examine the 10-year incidence and progression of diabetic retinopathy. DESIGN: Population-based incidence study. PARTICIPANTS: Seven hundred sixty-five insulin-taking diabetic persons diagnosed before age 30 years, 251 insulin-taking diabetic persons diagnosed at age 30 years or older, and 282 non-insulin-taking diabetic persons diagnosed at age 30 years or older who participated in baseline, 4-year, and 10-year follow-up examinations. MAIN OUTCOME MEASURES: The 10-year incidence of any retinopathy, progression of retinopathy, and progression to proliferative retinopathy were detected by masked grading of stereoscopic color fundus photographs using the modified Airlie House classification and the Early Treatment Diabetic Retinopathy Study severity scheme. RESULTS: The 10-year incidence of retinopathy (89%, 79%, and 67%), progression of retinopathy (76%, 69%, and 53%), and progression to proliferative retinopathy (30%, 24%, and 10%) were highest in the group diagnosed before age 30 years, intermediate in the insulin-taking group diagnosed at age 30 years or older, and lowest in the non-insulin-taking group, respectively. Increased risk of proliferative retinopathy was associated with more severe retinopathy at baseline. CONCLUSIONS: These data suggest relatively high 10-year rates of incidence and progression of retinopathy, and despite changes in the treatment of diabetes, there has been little change in the incidence and progression of diabetic retinopathy during the 10-year study period.     

Prevention of blindness in diabetic retinopathy]

PURPOSE: This study aimed to determine the clinical significance of echogenic amniotic fluid. METHODS: We prospectively studied 19 twin pregnancies in which the amniotic fluid in 1 sac was anechoic and that in the other sac was echogenic. Morphologic characteristics of amniotic fluid were assessed from samples taken at amniocentesis or upon delivery within 48 hours after sonographic examination. RESULTS: In twins with echogenic amniotic fluid, assessment revealed clear fluid in 6 cases (32%), vernix caseosa in 12 (63%), and meconium in 1 (5%). In co-twins with anechoic amniotic fluid, assessment revealed clear fluid in 9 cases (47%), vernix caseosa in 6 (32%), and meconium in 4 (21%). CONCLUSIONS: Echogenic amniotic fluid on prenatal sonography is not predictive of meconium.     

Progression of diabetic retinopathy after cataract extraction

A prospective study of the effect of cataract extraction with intraocular lens implantation on the course of diabetic retinopathy (DR) in 44 patients (59 eyes) was carried out. It showed that in the 1-3 years following surgery, there was progression of DR (including development of newly formed retinopathy) in 35% of the patients (28.8% of eyes). Progression was more marked in patients with pre-operative bilateral DR compared to those without bilateral DR (77% and 16% respectively). Insulin dependence did not play a role in progression. Final visual acuity was better in patients without pre-operative DR, as well as in eyes without progressive retinopathy.     

The role of vitrectomy for diabetic retinopathy

BACKGROUND: Diabetic retinopathy is an important cause of severe vision loss. The risk of vision loss from diabetic retinopathy is substantially reduced by intensive control of diabetes and appropriate laser surgery for proliferative diabetic retinopathy and diabetic macular edema. METHODS: The Diabetic Retinopathy Vitrectomy Study (DRVS) helped identify the indications and most propitious time for performing diabetic vitrectomy for nonresolving vitreous hemorrhage. The DRVS also highlighted the risks and potential complications of vitrectomy surgery. RESULTS: Diabetic persons with severe vision loss from severe proliferative diabetic retinopathy are candidates for vitrectomy after vitreous hemorrhage and severe fibrous changes in the retina. CONCLUSION: In cases in which vision loss occurs, pars plana vitrectomy frequently can restore useful vision, and reduce the risk of vision loss from traction retinal detachment.     

Levodopa-stimulated growth hormone secretion and diabetic retinopathy

Since growth hormone has been implicated as a possible etiologic factor in the development of diabetic retinopathy, we examined growth hormone levels in two groups of growth-onset diabetics matched for age and duration of disease. The experimental group had definite proliferative diabetic retinopathy; the control group of growth-onset diabetics had no significant retinopathy. Basal and levodopa-stimulated levels of growth hormone were determined for each group. Growth hormone response could not be correlated with the presence or absence of diabetic retinopathy (P less than .05).     

The plasma levels of endothelin in diabetic retinopathy and their changes after treatment with doxium

Apolipoprotein E (APOE) has been identified as a major susceptibility marker for Alzheimer's disease (AD) and it has been proposed that a common polymorphism in the alpha1-antichymotrypsin (ACT) gene increases the risk of developing AD, when the combination of ACT/AA genotype and APOE epsilon4 allele segregate together. The ACT polymorphism was analysed in 218 sporadic late-onset AD patients and 101 healthy control subjects from Eastern Finland. Samples of the ACT polymorphism were divided into three subgroups according to their APOE genotypes and the genotyping of samples was done using the polymerase chain reaction (PCR) method. Any association between the AD group and the controls was tested with the chi2 test. Our data failed to detect any effect of polymorphism in the ACT genotypes associated with the APOE alleles, suggesting that in this population ACT does not increase the risk of AD.     

The epidemiology of diabetes mellitus and diabetic retinopathy

The paper presents the results of examining the hydrodynamics of artificial heart valves (AHVs) manufactured in Russia and foreign countries. All the AHVs under study have been used in clinical practice for over 10 years and they are different in design. The hydrodynamics of AHVs was examined under static and pulsating flow through the valve. Photochromic imaging (PCI) was used for flow imaging. PCI is based on preparation of simulating blood (model physiological solution) in the medium, colour labels under laser radiation. The recording of colour label movement in the flow behind the valve using a speed camera makes it possible to follow flow hydrodynamics behind AHVs. The advantage of PCI over other methods is that the instant structure of flow behind the valve can be recorded just in the same section at any moment of an operating cycle. Based on the experimental data obtained by PCI, a procedure for comparative analysis of the hydrodynamic characteristics of AHVs was developed.