Péter Vargha

Risk factors for ulcerative colitis-associated colorectal cancer in a Hungarian cohort of patients with ulcerative colitis: results of a population-based study.

Background: There is an increased risk of colorectal cancer (CRC) in ulcerative colitis (UC). The prevalence of UC‐associated CRC is different in various geographic regions. The risk depends primarily on the duration and extent of disease. The aim of this study was to identify the risk factors for and the epidemiology of CRC in Hungarian patients with UC. Methods: We retrospectively evaluated the relevant epidemiological and clinical data of all patients with UC in Veszprem province in our 30‐year IBD database (723 patients with UC; male/female, 380/343; non‐CRC related colectomies, 3.7%). Results: CRC was diagnosed in 13 patients (13/8564 person‐year duration) during follow‐up. Age at diagnosis of CRC was at a median of 51 (range 27‐70) years. Eight patients are still alive, 4 died of CRC, and 1 died of an unrelated cause. Longer disease duration, extensive colitis, primary sclerosing cholangitis, and dysplasia found in the biopsy specimen were identified as risk factors for developing CRC. The cumulative risk of developing CRC after a disease duration of 10 years was 0.6% (95% confidence interval [CI] 0.2%‐1.0%); 20 years, 5.4% (95% CI 3.7%‐7.1%); and 30 years, 7.5% (95% CI 4.8%‐10.2%). CRC diagnosed at surveillance colonoscopy was associated with a tendency for longer survival (P = 0.08). Conclusions: The cumulative risk of CRC was high in our patients with UC; however, it was lower compared with that reported in Western European and North American studies. CRC developed approximately 15 years earlier compared with sporadic CRC patients in Hungary. Longer disease duration, extensive colitis, dysplasia, and primary sclerosing cholangitis were identified as important risk factors for developing CRC.

Reproducibility of Retinal Nerve Fiber Layer and Macular Thickness Measurement with the RTVue-100 Optical Coherence Tomograph

PURPOSE To evaluate the reproducibility of peripapillary retinal nerve fiber layer thickness (RNFLT) and ganglion cell complex (GCC) measurements made with the RTVue-100 Fourier-domain optical coherence tomography (OCT) device (Optovue, Inc., Fremont, CA) and to determine the influence of 4 factors: pupil dilation, subject age, experience in imaging examinations, and glaucoma severity. DESIGN Prospective study for evaluation of a diagnostic test. PARTICIPANTS Thirty-seven hospital-based participants (14 normal and ocular hypertensive subjects, 11 patients with moderate and 12 with severe glaucoma), all experienced in imaging examinations, and 40 consecutive screening trial participants lacking such experience. METHODS One eye of all participants was imaged 5 times. For the hospital-based participants, on the same day the measurement series was repeated after pupil dilation. For determination of intersession reproducibility, measurements were performed again 3 months later. MAIN OUTCOME MEASURES Intrasession and intersession coefficient of variation (CV), intraclass correlation coefficient (ICC), intratest variability, and test-retest variability. RESULTS For the average and quadrant RNFLT parameters and the GCC parameters, intrasession ICC varied between 93.9% and 99.0%, intrasession CV between 1.95% and 5.69%, and intratest variability varied between 3.11 and 9.13 microm. Most thickness values, all intrasession CV and intratest variability values, and the signal strength index were not changed significantly after pupil dilation. Intrasession CV of the 16 peripapillary RNFLT sectors varied between 4.90% and 11.66%. Most intrasession CV values increased significantly with increased disease severity, but intratest variability for average RNFLT and the quadrant RNFLT parameters, which are used for statistical comparison with the normative database, were unaffected by the severity of glaucoma. Patient age and experience in imaging examinations had no influence on intrasession CV. Intratest variability and intrasession CV represented 79.1% to 98.6% and 77.1% to 95.0% of test-retest variability and intervisit CV, respectively, for the average and quadrant RNFLT and the GCC parameters. CONCLUSIONS Intrasession and intersession reproducibility of RNFLT and GCC measurements with the RTVue-100 OCT are satisfactory for diagnostic purposes, both in normals and in patients with different glaucoma severity. Pupil dilation, age, and experience in imaging examinations did not influence reproducibility in a clinically significant manner. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.

Diagnostic accuracy of nerve fibre layer, macular thickness and optic disc measurements made with the RTVue-100 optical coherence tomograph to detect glaucoma.

PurposeTo evaluate the diagnostic accuracy of retinal nerve fibre layer thickness (RNFLT), ganglion cell complex (GCC), and optic disc measurements made with the RTVue-100 Fourier-domain optical coherence tomography (OCT) to detect glaucoma in a Caucasian referral population.MethodsOne randomly selected eye of 286 Caucasian patients (93 healthy, 36 ocular hypertensive, 46 preperimetric glaucoma, and 111 perimetric glaucoma eyes) was evaluated.ResultsUsing the software-provided classification, for the total population sensitivity did not exceed 73.6% for the optic nerve head parameters, and 62.7% for the other parameters. Specificity was high (94.6–100%) for most RNFLT and GCC parameters, but low (72.0–76.3%) for the optic disc parameters. Positive predictive value varied between 98.1 and 100% for the main RNFLT parameters, 92.6 and 100% for the 16 RNFLT sectors, 92.4 and 99.0% for the GCC parameters, but did not exceed 86.3% for any of the optic disc parameters. Positive likelihood ratio (PLR) was higher than 10 for average, inferior and superior RNFLT (25.5 to infinite), 12 of the 16 RNFLT sectors (12.6 to infinite), and three of the four GCC parameters (40.0 to 48.6). No optic disc parameter had a PLR higher than 3.0.ConclusionsRNFLT and GCC parameters of the RTVue-100 Fourier-domain OCT showed moderate sensitive but high specificity, positive predictive value and PLR for detection of glaucoma. The optic disc parameters had lower diagnostic accuracy than the RNFLT and GCC parameters.

Risks and Predictors of Blood Transfusion in Pediatric Patients Undergoing Open Heart Operations

BACKGROUND Blood transfusion in adults is associated with increased mortality and morbidity after cardiac operations. The aim of this study was to identify the main predictors of blood transfusion and explore the relationship between blood transfusion and adverse outcomes in a pediatric population. METHODS We retrospectively analyzed a prospectively collected database (January 2002 to December 2003) of 657 consecutive pediatric patients undergoing open heart procedures in a tertiary pediatric cardiac center. Risk models were calculated for each blood product and for the total amount of blood transfused during the operation and in the first 24 hours. Postoperative adverse events were investigated after propensity score adjustment. RESULTS During the postoperative period, 30 patients (4.6%) died, 80 (12.2%) sustained nonvascular pulmonary complications, and 113 (17.2%) had infection. The risk model for the total amount of blood transfusion included weight, preoperative creatinine clearance, preoperative mechanical ventilation, duration of operation and cross-clamp, surgeon, delayed chest closure, inotropic dose, and nitric oxide administration. Univariate analyses demonstrated significant associations between blood transfusion and occurrence of every complication except of neurologic events. After adjustment for propensity score and disease severity, the total amount of blood transfusion was independently associated with an increased risk for infections (odds ratio, 1.01; 95% confidence interval, 1.002 to 1.02; p = 0.01). Transfusion of platelets was associated with lower incidence of nonvascular pulmonary complications (odds ratio, 0.89; 95% confidence interval, 0.79 to 0.99; p = 0.049). CONCLUSIONS The amount of blood transfusion is independently associated with infections but not with mortality.

Tumor necrosis factor system in insulin resistance in gestational diabetes

OBJECTIVE The aim of the study was to investigate the pathophysiological role of the tumor necrosis factor (TNF) system in insulin resistance in patients with gestational diabetes (GDM) and during the course of normal pregnancy. PATIENTS AND METHODS Thirty women with GDM (16-39 gestational weeks), 35 healthy pregnant women (15 first, nine second and 11 third trimester) and 25 healthy age-matched non-pregnant women were studied. Serum TNF-alpha, and its soluble receptors 1 and 2 (sTNFR-1 and -2) were measured. RESULTS In non-diabetic pregnant women in the third trimester all measures were significantly higher (P<0.05 or less) than in the first trimester and in non-pregnant women (BMI 27.6 +/- 4.1 (+/- S.D.), 24.1 +/- 2.6, 22.4 +/- 2.4 kg/m(2)), serum TNF-alpha (4.6 +/- 0.6, 4.1 +/- 0.4, 4.1 +/- 0.4 ng/l), sTNFR-1 (2.7 +/- 0.9, 2.0 +/- 0.5, 2.0 +/- 0.1 microg/l), sTNFR-2 (5.6 +/- 2.6, 4.6 +/- 2.1, 3.3 +/- 0.2 microg/l), C-peptide (3.1 +/- 1.7, 1.1 +/- 0.7, 1.1 +/- 0.8 microg/l), and C-peptide:blood glucose ratio (0.6 +/- 0.2, 0.2 +/- 0.1, 0.2 +/- 0.1 microg/mmol). In GDM these measures were even higher than in any subgroup of healthy pregnant women (BMI) (33.4 +/- 6.4 kg/m(2), TNF-alpha) (6.3 +/- 0.6 microg/l), sTNFR-1 (3.0 +/- 0.5 microg/l), sTNFR-2 (10.0 +/- 6.9 microg/l, C-peptide 6.0 +/- 2.7 microg/l, C-peptide:blood glucose ratio: 1.2 +/- 0.5 microg/mmol, P<0.01). Significant (P<0.01) positive linear correlations were found in gestational diabetic and non-diabetic women between serum TNF-alpha, C-peptide levels, and BMI. In gestational diabetic women, in multivariate analysis studying the dependency of C-peptide only BMI remained significant (r(2)=0.67, P=0.01). CONCLUSIONS Our observation emphasizes the obesity-related component of insulin resistance driven by adipocytokines, such as TNF-alpha and its receptors during the course of normal pregnancy and GDM.

Scanning laser polarimetry of the retinal nerve fibre layer in primary open angle and capsular glaucoma

AIMS To evaluate the clinical value of scanning laser polarimetry with the nerve fibre analyser type II in primary open angle glaucoma (POAG) and capsular glaucoma. METHODS Scanning laser polarimetry was performed on one eye of 30 patients suffering from POAG, 25 patients suffering from capsular glaucoma, and on 35 healthy control subjects. The retinal nerve fibre layer (RNFL) thickness values were compared among the groups. Reproducibility of the measurements was calculated and the influence of pilocarpine induced miosis on the results was investigated. RESULTS RNFL thickness in the superior and inferior sectors, as well as along the total circumference was significantly lower in both glaucoma groups than in the control eyes (p<0.05). None of the thickness values differed between the two glaucoma groups. Reproducibility was comparable in all groups; the coefficient of variation varied between 3.0% and 8.9% for the different sectors investigated. Miosis had no significant impact either on the thickness values or on the reproducibility (p>0.05). CONCLUSION The results suggest that scanning laser polarimetry is a useful method for nerve fibre layer analysis in glaucoma, and that it is not influenced by the pupil size.

Evaluation of the peripapillary circulation in healthy and glaucoma eyes with scanning laser Doppler flowmetry

In order to study peripapillary perfusion, one randomly selected eye of 34 healthy volunteers and 40 glaucoma patients (27 suffering from primary open-angle glaucoma (POAG) 10 from normal pressure glaucoma (NPG) and three from other types of glaucoma) was studied with a Heidelberg Retina Flowmeter. Temporal flow adjacent to the disc edge was significantly higher than the nasal flow (p < 0.01). It was reduced significantly in myopia both in controls (p < 0.05) and in glaucoma patients (p < 0.001). However, there was no difference between either controls and glaucoma patients or between POAG and NPG patients. It was independent of treatment type in glaucoma. Within the temporal peripapillary area extremely high flow values (values higher than the mean + 2 SD of the corresponding individual retinal flow) seemed to represent deep peripapillary vascular rings. They were significantly more frequent in glaucoma (72%) than in healthy volunteers (44%, p < 0.05). Their frequency was 83% in myopic and 23% in non-myopic eyes in the control group (p < 0.001). However, in glaucoma patients they were common both in myopic eyes (71%) and in non-myopic ones (75%). The results suggest that capillary perfusion adjacent to the temporal edge of the disc is significantly reduced in myopia. Deep peripapillary vascular structures can be measured on images focused on the surface of the retina, especially if the retina is thinner than normal (healthy myopic eyes and glaucomatous eyes independently of the refraction). This may mask a deficient function of the retinal capillary bed.

Detection of early glaucomatous progression with different parameters of the RTVue optical coherence tomograph

Purpose:To investigate the ability of different parameters of the RTVue-100 Fourier-domain optical coherence tomograph (RTVue-OCT) to detect early glaucomatous progression. Methods:One eye of 17 healthy and 51 perimetric glaucoma patients was imaged prospectively at 6-month intervals for 1.5 to 3 years. Progression was determined by Octopus normal G2 visual field progression criteria. Results:Ten of the 51 glaucoma eyes progressed based on visual field criteria. Median visual field mean defect change was −0.300 dB/y for the controls, −0.120 dB/y for all glaucoma eyes (P=0.461 vs. controls), and 1.231 dB/y for the 10 functionally progressing glaucoma eyes (P<0.001 vs. controls). Ganglion cell complex (GCC), focal loss volume, and GCC global loss volume showed significantly faster rate of progression in the glaucoma group than in controls (P=0.004 and P=0.001, respectively). No optic nerve head, retinal nerve fiber layer thickness, and average GCC parameter separated the rate of progression between the groups. Conclusions:Early structural progression of glaucoma may be better detected with pattern-based GCC parameters of the RTVue-OCT than with the optic nerve head, retinal nerve fiber layer thickness or average GCC parameters of the same instrument.

Aprotinin and renal dysfunction after pediatric cardiac surgery

Background:  Aprotinin is a potent antifibrinolytic drug, which reduces postoperative bleeding and transfusion requirements. Recently, two observational studies reported increased incidence of renal dysfunction after aprotinin use in adults. Therefore, the aim of the study was to investigate the safety of aprotinin use in pediatric cardiac surgery patients.

Comparison of repeatability of retinal nerve fiber layer thickness measurement made using the rtvue fourier-domain optical coherence tomograph and the gdx scanning laser polarimeter with variable or enhanced corneal compensation

PurposeTo compare repeatability of measurements of peripapillary retinal nerve fiber layer thickness (RNFLT) made using the RTVue-100 Fourier-domain optical coherence tomograph against repeatability of those made using scanning laser polarimetry with variable corneal compensation or enhanced corneal compensation (GDx-VCC and GDx-ECC, respectively). MethodsOne eye of each of 37 participants (14 normal and ocular hypertensive subjects, 11 patients with moderate, and 12 with severe glaucoma; groups 1, 2, and 3, respectively) was imaged using the RTVue Optic Nerve Head Map scan, GDx-VCC, and GDx-ECC, each 5 times on the same day. The coefficient of variation (CV) were compared. The P values <1% were considered as significant. ResultsFor average RNFLT CV was significantly lower with RTVue (2.11%) than with GDx-ECC (3.22%, P=0.004), for all participants. For temporal quadrant RNFLT in all participants, and group 1, CV with RTVue (4.88% and 3.30%) was significantly lower than with GDx-ECC (7.40% and 5.88%; P=0.004), and tended to be lower than with GDx-VCC (6.81% and 5.80%; P=0.011 and 0.016, respectively). For all participants, CV for inferior quadrant RNFLT was significantly lower with RTVue (3.49%) than with GDx-VCC (5.20%, P=0.002). No other difference was seen for any other parameter in any subject group. ConclusionsRepeatability characterized by CV of RNFLT measurement with the RTVue Optic Nerve Head Map scan and GDx-VCC/GDx-ECC was similar, and sufficient for clinical purposes, both in normal subjects and in glaucoma patients with different disease severity. For average peripapillary RNFLT and temporal quadrant RNFLT, repeatability of RTVue was better than that of GDx-ECC, and tended to be better than that of GDx-VCC.