Temporary diplopia upon hyoscine-N-butyl bromide administration: Case report

Hyoscine-N-butyl bromide is a widely used antispasmodic belonging to the belladonna alkaloid class of semisynthetic quaternary ammonium compounds. These compounds exert a spasmolytic action on the smooth muscles of the bile-gastrointestinal tract, genitourinary tract, salivary glands (xerostomia), and also on the visual apparatus-in particular, the irido-ciliary complex. As a consequence, they provoke collateral effects such as mydriasis and accommodation disturbances. We report the case of a 23-year-old woman who complained of not only "dry mouth" but also "cloudy vision" and a "diplopia", both of temporary type, 2 hours after oral administration of hyoscine-N-butyl bromide. © 2013 Migliorini et al, publisher and licensee Dove Medical Press Ltd

Le Uveiti intermedie in un centro di riferimento terziario : studio clinico ed epidemiologico.

L'uveite intermedia è una flogosi uveale che colpisce ogni età, con un incidenza maggiore nei giovani adulti. La maggior parte delle forme è idiopatica (pars-planite), ma si conferma una associazione con la sclerosi multipla. La prognosi visiva è nel complesso favorevole e la terapia deve essere individualizzata ed ha lo scopo di contenere la flogosi vitreale e retinica al fine di limitare il decremento visivo correlato soprattutto alla presenza dell'edema maculare cistoide

Waardenburg Syndrome: a review of literature and case reports

Waadernburg syndrome (WS) is an autosomal dominant disease clinically and genetically heterogeneous. It is characterized by non-progressive sensorineuronal hearing loss of variable degree and anomalous pigmentation (of the eyes, skin and stria vascularis of cochlear duct) caused by melanocytes absence. The syndrome is caused by mutations in genes that regulate the melanocytes differentiation from the neural crest during embriogenetic development. This study will review the literature on WS and explain more in detail the ocular findings in WS, while reporting new findings on two newly diagnosed cases. Clin Ter 2012; 163(2):e85-9

Vitreous and plasma changes of endothelin-1, adrenomedullin and vascular endothelium growth factor in patients with proliferative diabetic retinopathy

Abstract. – OBJECTIVE: To assess vitre- ous and plasma changes of vascular endothe- lial growth factor A (VEGF-A), adrenomedullin (ADM) and endothelin-1 (ET-1) in proliferative di- abetic retinopathy (PDR). PATIENTS AND METHODS: 9 patients with PDR in type 2 diabetes (T2DM) and 11 age-matched non-diabetic patients were enrolled. The levels of VEGF-A, ADM and ET-1 were measured us- ing an enzyme (ELISA) and a radioimmunoassay (RIA) both in vitreous and plasma samples. RESULTS: Vitreous ADM and VEGF-A levels were significantly higher in PDR patients (p=0.04 and p=0.02), whereas no differences were found in ET-1 levels (p=0.29). Plasma ADM levels were significantly higher in the PDR group (p<0.01), whereas no significant differences were found in the plasma ET-1 and VEGF-A levels (p=0.30 and p=0.37). The ADM vitreous/plasma ratio was significantly reduced in PDR group. CONCLUSIONS: The role of ET-1 in advanced PDR is still controversial; it has been supposed a role limited to induce hypoxic state and pro- mote angiogenesis in the early phases. Once the neo-angiogenic process starts, other mediators are mainly involved as VEGF and ADM. Our find- ings suggest that ADM is an important marker of advanced PDR as well as VEGF. Conversely, ET-1 is not significantly involved in the advanced stage of PDR

Clinical Presentation and Outcome in a Contemporary Cohort of Patients with Acute Myocarditis: The Multicenter Lombardy Registry

Background -There is controversy regarding outcome of patients with acute myocarditis (AM), and lack of data on how patients admitted with suspected AM are managed. We report characteristics, in-hospital management and long-term outcome of patients with AM based on a retrospective multi-center registry from 19 Italian hospitals. Methods -A total of 684 patients with suspected AM and recent onset of symptoms (70 years and those older than 50 years without coronary angiography were excluded. The final study population comprised 443 patients (median age 34 years, 19.4% female) with AM diagnosed either by endomyocardial biopsy (EMB) or increased troponin plus edema and late gadolinium enhancement at cardiac magnetic resonance (CMR). Results -At presentation, 118 patients (26.6%) had either left ventricular (LV) ejection fraction (EF) <50%, sustained ventricular arrhythmias (VA) or a low cardiac output syndrome (LCOS) whilst 325 (73.4%) had no such complications. EMB was performed in 56/443 (12.6%), and a baseline CMR was performed in 415/443 (93.7%) of patients. Cardiac mortality plus heart transplant (HTx) at 1 and 5 years were 3.0% and 4.1%. Cardiac mortality plus HTx were 11.3% and 14.7% in patients with complicated presentation and 0% in uncomplicated cases (Log-rank p<0.0001). Major AM-related cardiac events after the acute phase (post-discharge death and HTx, sustained VA treated with electrical shock or ablation, symptomatic heart failure needing device implantation) occurred in 2.8% at 5-year follow up, with a higher incidence in patients with complicated forms (10.8% vs. 0% in uncomplicated AM, Log-rank p<0.0001). Beta adrenoceptor blockers were the most frequently employed medications both in complicated (61.9%) and in uncomplicated forms (53.8%, p=0.18). After a median time of 196 days, 200 patients had follow-up CMR and 8/55 (14.5%) with complications at presentation had LVEF<50% compared with 1/145 (0.7%) of those with uncomplicated presentation. Conclusions -In this contemporary study, overall serious adverse events after AM were lower than previously reported. However, patients with LVEF<50%, VA or LCOS at presentation were at higher risk compared with uncomplicated cases that had a benign prognosis and low risk of subsequent LV systolic dysfunction

Contemporary antithrombotic strategies in patients with acute coronary syndromes managed without revascularization: Insights fromthe EYESHOT study

Aims Patients with acute coronary syndromes (ACSs) whoare managed without coronary revascularization represent a mixed and understudied population that seems to receive suboptimal pharmacological treatment. Methods and results We assessed patterns of antithrombotic therapies employed during the hospitalization and in-hospital clinical events of medically managed patients withACS enrolled in the prospective, multicentre, nationwideEYESHOT(EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in Italian cardiac care units) registry.Among the 2585 consecutive ACS patients enrolled in EYESHOT, 783 (30.3%) did not receive any revascularization during hospital admission. Of these, 478 (61.0%) underwent coronary angiography (CA), whereas 305 (39.0%) did not. The median GRACE and CRUSADE risk scores were significantly higher among patients who did not undergo CA compared with those who did (180 vs. 145, P, 0.0001 and 50 vs. 33, P, 0.0001, respectively). Antithrombotic therapies employed during hospitalization significantly differ between patients who received CA and those who did not with unfractioned heparin and novel P2Y12 inhibitors more frequently used in the first group, and low-molecular-weight heparins and clopidogrel in the latter group. During the index hospitalization, patients who did not receive CA presented a higher incidence of ischaemic cerebrovascular events and of mortality compared with those who underwent CA (1.6 vs. 0.2%, P = 0.04 and 7.9 vs. 2.7%, P = 0.0009, respectively). Conclusion Almost one-third of ACS patients are managed without revascularization during the index hospitalization. In this population, a lower use of recommended antiplatelet therapy and worse clinical outcome were observed in those who did not undergo CA when compared with those who did

Antithrombotic strategies in the catheterization laboratory for patients with acute coronary syndromes undergoing percutaneous coronary interventions: Insights from the EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in Italian cardiac care units Registry

Aims: In the last decades, several new therapies have emerged for the treatment of acute coronary syndromes (ACS). We sought to describe real-world patterns of use of antithrombotic treatments in the catheterization laboratory for ACS patients undergoing percutaneous coronary interventions (PCI). Methods: EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in Italian cardiac care units was a nationwide, prospective registry aimed to evaluate antithrombotic strategies employed in ACS patients in Italy. Results: Over a 3-week period, a total of 2585 consecutive ACS patients have been enrolled in 203 cardiac care units across Italy. Among these patients, 1755 underwent PCI (923 with ST-elevation myocardial infarction and 832 with non-ST-elevation ACS). In the catheterization laboratory, unfractioned heparin was the most used antithrombotic drug in both ST-elevation myocardial infarction (64.7%) and non-ST-elevation ACS (77.5%) undergoing PCI and, as aspirin, bivalirudin and glycoprotein IIb/IIIa inhibitors (GPIs) more frequently employed before or during PCI compared with the postprocedural period. Any crossover of heparin therapy occurred in 36.0% of cases, whereas switching from one P2Y12 inhibitor to another occurred in 3.7% of patients. Multivariable analysis yielded several independent predictors of GPIs and of bivalirudin use in the catheterization laboratory, mainly related to clinical presentation, PCI complexity and presence of complications during the procedure. Conclusion: In our contemporary, nationwide, all-comers cohort of ACS patients undergoing PCI, antithrombotic therapies were commonly initiated before the catheterization laboratory. In the periprocedural period, the most frequently employed drugs were unfractioned heparin, leading to a high rate of crossover, followed by GPIs and bivalirudin, mainly used during complex PCI