A chief morbidity of Graves eye disease is eyelid retraction and exophthalmus. Transpalpebral orbital fat removal accomplished with full thickness anterior blepharotomy was performed in 4 patients (5 ...orbits). Preoperative and postoperative ocular exposure symptoms, visual acuity, upper eyelid retraction and proptosis were evaluated. In all 5 operated orbits preoperative symptoms resolved; good results were achieved from the functional and cosmetic point of view. Full-thickness anterior blepharotomy combined with fat decompression is a safe and effective surgery for patients with upper eyelid retraction and exophthalmus due to enlarged orbital fat compartment.
The patients with uveitic glaucoma are at high risk for failure following drainage surgery because of young age of these patients, preoperative long-term control of inflammation and postoperative ...complications. Twenty-two trabeculectomies performed in 22 patients with uveitic glaucoma were retrospectively evaluated to analyze the effect of intraoperative application of mitomycin C (MMC). Success rates, postoperative levels of intraocular pressure (IOP) and postoperative complications were studied. After a mean follow-up of 10.6 months (range, 5-28 months), 15 patients (68.2%) achieved IOP of 21mmHg or less without antiglaucoma medications. There were statistically significant reduction in IOP postoperatively during the period studied (p < 0.001). Early postoperative complications included chorioidal detachment (9.1%), shallow anterior chamber (9.1%), hyphema (13.6%), macular edema (4.5%) and raised IOP (27.3%). Late postoperative complications included exacerbation of uveitis (4.5%), macular edema (4.5%), cataract (22.7%) and raised IOP (31.8%). The eyes with raised IOP needed additional antiglaucoma medication. The results of this retrospective and uncontrolled study suggest that intraoperative application of MMC may be a good option for enhancement of short-term trabeculectomy success rates in patients with uveitic glaucoma.
Patient with primary open angle glaucoma (PAOG), which is known to have a genetic predisposition, and their immediate relatives unaffected with PAOG, may have some changes in dermatoglyphic traits of ...the digito-palmar complex, since the trabecular meshwork develops at the same time and with the same hereditary base like dermatoglyphs, which have high genetic transmission. The objective of this study is to determine whether differences in quantitative dermatoglyphic traits of the digito-palmar complex exist between patients with glaucoma and the phenotipically healthy population and whether their family members have the same dermatoglyphic changes. The quantitative dermatoglyphic traits in patients suffering from glaucoma, first-degree members of their family and the phenotypically healthy population have been screened in this study. Descriptive statistics, univariate analysis of variance (ANOVA) and post hoc (Tukey HSD) method have been used. The results have shown that there is a link between the quantitative dermatoglyphic traits of the digito-palmar complex in patients affected by glaucoma and a first-degree healthy member of their family, as well as the difference between patients with glaucoma and their first-degree relatives, which may discriminate them from the phenotypically healthy population. The results of the study mostly affirm the existence of genetic predisposition for the development of primary open-angle glaucoma, thus emphasizing the relevance of hereditary factors in the etiopathogenesis of this disease.
Već je odavno poznato da je koncentracija HDL-kolesterola u krvi obrnuto razmjerna riziku od kardiovaskularnih bolesti (KVB) te da je sniženi HDL-kolesterol neovisni čimbenik rizika od KVB. Svrha je ...ovoga preglednog članka razjasniti ulogu HDL-čestica i važnost HDL-kolesterola. Podrobno su raspravljene glavne protuaterosklerotske uloge HDL-čestica – obrnuti prijenos kolesterola, njihova protuoksidacijska, protuupalna, protutrombotska i protuapoptotska svojstva, ali i uloga u poboljšanju funkcije endotela. Objašnjena je uloga promjene nezdravog načina života u povišenju koncentracije HDL-kolesterola, poglavito važnost redovite tjelesne aktivnosti i aerobne tjelovježbe, prestanka pušenja, smanjenja tjelesne težine u onih u kojih je prekomjerna, kao i prehrane, ali i umjerenog unosa alkohola s naglaskom na činjenicu da su HDL-čestice alkoholičara izmijenjene funkcije, tj. ne djeluju protuaterogeno. To valja naglasiti stoga što je dokazano da nije važna samo količina HDL-čestica, pa onda i HDL-kolesterola u krvi, već da je važna i njihova funkcija, osobito ako je izmijenjena. HDL-čestice u bolesnika s dijabetesom također gube neka protuaterogena svojstva, a u bolesnika s dijabetesom tipa 2 česta je pojava upravo aterogena dislipidemija obilježena smanjenom količinom HDL-kolesterola i povišenim trigliceridima u krvi. Bolesnici s dijabetesom koji imaju takvu dislipidemiju imaju posebno velik rizik od KVB, a rezultati novijih ispitivanja kao što je primjerice ACCORD-Lipid, upućuju da bi liječenje takvog poremećaja lipida u njih bilo osobito korisno. Na temelju objavljenih rezultata kliničkih ispitivanja raspravljaju se mogućnosti liječenja fibratima, posebice fenofibratom, ali i nijacinom te kombinacijama tih lijekova i drugih lijekova za dislipidemije.
Aim To assess perceptions, knowledge, and awareness of
cardiovascular disease (CVD) risk factors among medical
students (freshmen and graduating students).
Methods A descriptive cross-sectional ...survey based on
an anonymous self-administered questionnaire was conducted
in 2008 on 443 medical students – 228 freshmen
on their enrollment day and 214 students on the day of
their final exam at the University of Zagreb School of Medicine,
Croatia.
Results The perception and knowledge of some CVD risk
factors, eg, dyslipidemia, arterial hypertension, and metabolic
syndrome as well as of lipid-lowering therapy important
for CVD prevention was significantly better among
graduating students but was still not sufficient. Only 66%
of graduating students reported that they would prescribe
lipid-lowering therapy to high risk patients. Disappointingly,
many graduating students were smoking
(30.4%) and had low-awareness of obesity as an important
CVD risk factor.
Conclusion These results suggest an urgent need to improve
medical students’ knowledge of obesity and low
physical activity as important CVD risk factors and of the
methods for increasing low high-density lipoprotein-cholesterol
and for smoking cessation. All this provides a rationale
for modifying the university core curriculum to include
more information concerning these issues.
The results of two studies about knowledge
and awareness of risk factors for cardiovascular diseases
(CVD) of 1382 Croatian primary care physicians, internists and
cardiologists as well as 882 ...citizens have been presented. The
results show that although a great majority of physicians think
that the guidelines for the prevention of CVD are useful, only
more than a half of them use them in their daily work. Although more than four-fifths of physicians think that they provide good treatment to their patients suffering from dyslipidemia, only a half of them know what are the LDL target values
in the patients with a high risk for CVD and which HDL concentration is risky for CVD. Although the population die because of CVD twice as much than of malignant disease, the respondents in the group of general population are much more
afraid of malign diseases, although many of them know that
CVD are the main cause of death. Only more than one fifth of
patients have received advice from their physician in connection with lipid disorders as the CVD risk factor, while more
than a half of respondents have received no instructions about
the risk factors. We may conclude that physicians should
know more about risk factors and guidelines for prevention of
CVD and that the awareness of and knowledge about these
factors in Croatian population should also be improved. The
transfer of information about CVD risk factors between physicians and patients should be improved as well.
An unruptured giant intracranial aneurysm of the internal carotid artery may tend to present with late ocular symptoms. This is the case of a 58-year-old female patient with a giant unruptured ...aneurysm of the right internal carotid artery. The patient presented with exclusively progressive reduction of visual acuity and visual field defects due to the mass effect of the growing aneurysm. The rupture of the aneurysm occurred before planned treatment. Clinical suspicion and timely recognition as well as prompt treatment play an important role in the final outcome of the management of giant unruptured intracerebral aneurysms.
Policosanol is an agent that includes mixtures of aliphatic primary alcohols extracted primarily from sugercane wax.
Policosanol has been shown to lower total and LDL cholesterol in animal models, ...healthy volunteers and hypercholesterolemic
patients. However, these findings have been challanged recently. Up to now, there has been no study investigating
the effects of policosanol on blood coagulation factors.This study investigated the effects of rice policosanol (Oryza
sp.) 10 mg/day on blood coagulation factors in 66 hypercholesterolemic patients of both sexes aged 20 to 78 years in a single
center, randomized, double-blind, placebo-controlled, crossover trial. After an 8-week run-in period in which patients
were placed on therapeutic lifestyle changes, in particular a cholesterol-lowering diet, they were randomly assigned to receive
rice policosanol 10 mg tablets or placebo tablets once daily with the evening meal for 8 weeks. During next 8 weeks
those receiving policosanol during the first 8 weeks, received placebo and those taking placebo during the first 8 weeks,
received policosanol. Plasma fibrinogen, factors VII,VIII, XII and XIII were measured before and after the treatment.
Rice policosanol treatment did not change significantly neither fibrinogen nor factors VII,VIII, XII and XIII.
Diabetes mellitus is a metabolic disorder primarily characterized by elevated blood glucose levels and by microvas- cular and macrovascular complications which increase the morbidity and ...mortality.The aim of this study was to assess whether in high risk patients with type 2 diabetes mellitus whose blood pressure and lipid levels are well controlled still exist risk factors for microvascular changes and target organ damage (nephropathy and retinopathy). In this case con- trol retrospective study 326 patients (111 with nephropathy and/or retinopathy and 215 controls) were enrolled. Nephro- pathy or retinopathy was present in 10.1% and 26.9% cases, respectively. Only 71% of patients (no significant difference between cases and controls) were treated with antidiabetic drugs. Therefore their diabetes was not properly controlled (hemoglobin A1c was 7.96% in cases and 7.58% in controls). Patients with microvascular changes had significantly lon- ger diabetes than the controls (p < 0.05) but there were no significant differences between these two groups concerning lipids concentrations. Statins and fibrates were used by significantly less (p < 0.05) patients with microvascular compli- cations than by those without them (21.6% vs. 36.3% and 1.8% vs. 17.2% respectively). The results of this study suggest that the duration of the disease and adequate control of glycaemia in patients with type 2 diabetes mellitus are more im- portant for microvascular complications than the serum lipoproteins levels. Lipid-lowering treatment might have an im- pact on microvascular complications in patients with type 2 diabetes, irrespectively of their serum lipid levels.
Cilj studije bio je procijeniti učinkovitost intralezijskog injektiranja triamcinolon acetonida kod primarnog i recidivirajućeg halaziona. U ispitivanje je bilo uključeno 30 bolesnika s primarnim i ...recidivirajućim halazionom (37 slučajeva) i 24 bolesnika kao kontrolna skupina. Bolesnici s primarnim i recidivirajućim halazionom primili su intralezijsku injekciju 0,1 do 0,2 mL triamcinolon acetonida (40 mg/mL), dok su bolesnici kontrolne skupine primili intralezijsku injekciju 0,1 do 0,2 mL 0,9%-tne NaCl. Podatci o veličini lezije, uključujući digitalnu fotografiju u boji, regresiji ili recidivu lezije te o cjelokupnom oftalmološkom pregledu bilježili su se u vrijeme injektiranja te nakon jednog ili dva tjedna do povlačenja ili kirurškog odstranjenja lezije. Uspješnost je definirana kao najmanje 80%-tno smanjenje veličine lezije bez recidiva. Povlačenje lezije utvrđeno je u 35 slučajeva nakon jedne ili dvije injekcije, srednje vrijeme do povlačenja od 15,27±6,12 dana. Potkožno injektiranje steroida triamcinolon acetonida kod primarnog i recidivirajućeg halaziona pokazalo se jednostavnom i učinkovitom terapijom za halazion.
