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117 ASSOCIATION OF KEARNS-SAYRE SYNDROME AND OPEN-ANGLE GLAUCOMA ZARNOWSKI T, ZAGORSKI Z Tadeusz Krwawicz Chair of Ophthalmology and 1st Eye Hospital, Medical School Background: In Kearns-Sayre syndrome KSS ; the triad of external ophthalmoplegia, heart block and retinal pigmentary changes remains the cornerstone of diagnosis, although numerous additional signs have been recognized. A significant proportion of these patients shows deletions in the mitochondrial DNA, but the role of the deletions in the pathogenesis of KSS remains still unknown. Case report: We report on a 34-year-old woman presenting with bilateral ptosis, generalized facial weakness, characteristic retinal pigment clumping and heart block, i.e. Kearns-Sayre syndrome. Additionally, the syndrome was associated with glaucomatous optic neuropathy. Decreased corneal endothelial density with polymegathism and pleomorphism in both eyes were also found. No familial, structural or vascular risk factors were found to explain glaucoma. Intraocular pressure readings were always within normal range. Genetic investigations revealed mitochondrial DNA deletion consistent with the clinical diagnosis, however, respiratory chain activities and muscle biopsy analyses were normal. Conclusion: It is unknown, if this association is accidental or if mitochondrial DNA deletion presents a risk factor for normal tension glaucoma. 118 MACROGLIAL CHANGES IN THE CHRONIC OCULAR HYPERTENSION DE HOZ R, SALAZAR JJ, ROJAS B, RAMREZ AI, GONZALEZ A, RAMREZ JM, TRIVIO A Instituto de Investigaciones Oftalmolgicas Ramn Castroviejo. UCM Purpose: To study the modifications in retinal glial cells in two experimental models of chronic ocular hypertension rats, rabbits ; . Methods: Experimental glaucoma was induced by injecting a-chymotrypsin into the posterior chamber. After the induction of glaucoma, rabbits were killed at day 15 and at 1, 2, 2.5 and 8 months, and rats at days 15 and 30. Immunohistochemistry anti-GFAP ; was used in retinal wholemounts. Results: Rabbits: Perivascular astrocytes Type I ; , that are located over the vessels, increased in size and GFAP reactivy and formed vascular sheaths during the first month of glaucoma. Beyond this period, they progressively degenerated and decreased in number until they became absent from the vascular walls. Type II astrocytes, located between the blood vessels, increased in number, size and GFAP reactivy beyond the first month of glaucoma; they migrated from the margin of the optic disc to those vascular areas lacking Type I astrocytes. GFAP expression in the Mller cell was detected in all retinas at the different time points analyzed. Rats: At earlier stages, the astrocytes exhibited an increased expression of GFAP, specially in the peripapillary area. There was a major decrease in astrocyte numbers in the advanced phase; those remaining presented intense GFAP reactivity and were in contact with the retinal vessel. GFAP expression in Mller cells was detected. Conclusions: Chronic ocular hypertension induce a similar reaction in Type I rabbit and rat retina astrocytes. However, the greater capacity to respond to ischemic injury was due toType II astrocytes in rabbit retina. The scientists searched for studies and reviews of the medical literature that tested methotrexate in people with rheumatoid arthritis. Not all studies and reviews found were of a high quality and so only those studies that met high standards were selected. Studies were randomised controlled trials where a group of patients receiving methotrexate were compared to a group of patients receiving a sugar pill placebo ; or another drug. The reviews were done systematically and examined the results from randomised controlled trials and norvasc.

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During the last two years from April 2004 to April 2006 ; patients with respiratory symptoms who were referred from the transplantation clinic to our department and underwent a HRCT scan of the lungs were reviewed. In ten of the patients scanned, lung lesions compatible with CMV pneumonia were present. Diagnosis was based on the clinical features, the positive laboratory studies examination of bronchoalveolar lavage and serologic testing ; and the corresponding HRCT findings. HRCT is the preferred radiologic modality as it is particularly sensitive in the detection and characterization of pulmonary lesions. Moreover, with HRCT, no contrast material is intravenously administered, thus avoiding any possible further compromise of renal function in renal transplant patients. The abnormalities detected on HRCT in patients with CMV pneumonia fall into three main patterns: ground glass opacification, areas of airspace consolidation and presence of small or large nodules. Most patients presented with a combination of these findings leading to a mixed pattern appearance. Pleural effusion was also observed. In one patient, superinfection of the lung with Aspergillus occurred; diagnosis was based on the characteristic features of pulmonary aspergillosis on HRCT. Conclusively, radiologic evaluation with HRCT is an indispensable component in the evaluation of patients with possible CMV pneumonia and in combination with the clinical and laboratory findings can lead to the correct diagnosis. O58 DAYTIME SLEEPINESS AND QUALITY OF LIFE IN AUTOMATED PERITONEAL DIALYSIS AND CONTINUOUS AMBULATORY PERITONEAL DIALYSIS PATIENTS Bilgic 1, B. Akman 1, S. Sezer 1, R. Ozelsancak 1, Z. Arat 1, F.N. Ozdemir 1 Department of Nephrology, Baskent University Faculty of Medicine, Ankara, Turkey Automated peritoneal dialysis APD ; is a preferred dialysis therapy as it offers better flexibility during daytime. However APD procedure continues throughout the night so it may cause sleep disorders and daytime sleepiness. In this study we compared APD and continuous ambulatory peritoneal dialysis CAPD ; therapies for excessive daytime sleepiness and QoL. This cross-sectional study included 59 PD patients CAPD APD 30 29, M F 33 26; age 4515 years, PD duration 42.033.6 months ; . Epworth Sleepiness Scale ESS ; was used. ESS scores higher than 9 were accepted as excessive daytime sleepiness. QoL parameters were assessed by short-form SF-36 health survey questionnaire. Concurrently, possible risk factors for sleep disturbance were analyzed. CAPD and APD groups were similar regarding the factors affected sleep quality age, gender, PD duration, smoking, alcohol intake, socioeconomic status, body mass index, presence of comorbid disease and laboratory parameters ; p 0.05 ; . Although 1 3.3% ; patient in CAPD and 4 13.8% ; in APD had excessive daytime sleepiness, there was no significant difference between CAPD and APD in terms of ESS scores 3.92.5 vs 4.64.2, p 0.05 ; . Also no significant difference was present in QoL scores in CAPD and APD patients p 0.05 ; . Correlation analysis revealed that ESS scores were negatively correlated with total QoL -.291, p 0.04 ; , social functioning -.384, p 0.004 ; and roleemotional -.344, p 0.009 ; subscale scores. Although the incidence of excessive daytime sleepiness is slightly higher in APD patients due to nighttime dwells, it does not reach significant levels. So, APD can be preferred PD modality as it doesn't have negative impact on daily activities and QoL by increasing daytime sleepiness. OP59 HEALTH RELATED QUALITY OF LIFE IN HEMODIALYSIS PATIENTS WITH SECONDARY HYPERPARATHYROIDISM. Popular medications accutane alprazolam ambien ativan bactrim bromazepam buspirone carisoma celebrex cialis citalopram clonazepam codeine depakote diazepam dormicum effexor fludrocortisone flurazepam hydroxyzine imovane lasix levothyroxine lexotanil lipitor lorazepam meridia midazolam modafinil naltrexone neu5ontin paxil phenergan propecia proscar provigil prozac risperdal rivotril sibutramine sildefil soma strattera tamiflu tegretol tramadol trazodone tryptanol valium valtrex viagra xanax xenical zoloft zolpidem zyprexa zyrte tegretol atretol, carbamazepine, depitol, epitol ; -without prescription 400mg tabs-100 10 x 10 ; manufacturer-novartis eedom rx pharm and oxycontin. Danco Laboratories, LLC P.O. Box 4816 New York, NY 10185 1.877.4 EARLY OPTION 1.877.432.7596 ; earlyoptionpill.

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Mooradian AD, McLaughlin RD, Boyer CC, Winter J. Diabetes Care for Older Adults. Diabetes Spectrum 1999 12 2 ; : 70-77. Morisaki N, Watanabe S, Kobayashi J, Kanzaki T, Takahashi, K, Yokote K: Diabetic control and progression of retinopathy in elderly patients: five year follow-up study. J Geriatr Soc 1994 42: 142-45. Morley GK, Mooradian AD, Levine AS, Morley JE: Why is diabetic peripheral neuropathy painful? The effect of glucose on pain perception in humans. J Med 1984 77: 79-83. Murata GH, Shah JH, Hoffman RM, et al. Intensified blood glucose monitoring improves glycemic control in stable, insulin-treated veterans with type 2 diabetes: The diabetes outcomes in veterans study DOVES ; . Diabetes Care 2003 26 6 ; : 1759-63. Olson DE, Norris SL. Diabetes in Older Adults: Overview of AGS Guidelines for the treatment of diabetes mellitus in geriatric populations. Geriatrics April 2004 59 4 ; : 18-24. Piturro, Disease Management for the Frail Elderly. AMDA, January 2003, Vol 4 No 1 Pulsinelli WA, Levy DE, Sigsbee B, Scherer P, Plum F: Increased damage after ischemic stroke in patients with or without established diabetes mellitus. J Med 1983 74: 540-44. Reed RL, Mooradian AD: Nutritional status and dietary management of elderly diabetic patients. Clin Geriatr Med 1990 6: 883-901. Reichard P, Nilsson BY, Rosenqvist U. The effect of long-term intensified insulin treatment on the development of microvascular complications of diabetes mellitus. N Eng J Med 1993 329 5 ; : 304-309. Shorr RI, Ray WA, Daugherty JR, et al. Incidence and risk factors for serious hypoglycemia in older persons using insulin or sulfonylureas. Arch Int Med 1997 157: 1681-86. Sidorov J, Shull R, Tomcauage J, et.al. Does diabetes disease management save money and improve outcomes? Diabetes Care 2002 25: 684-689. Sinclair AJ, Diabetes in the elderly: a perspective from the United Kingdom. Clin Geriatr Med 1999 15 2 ; : 225-237. Smith NL, Savage PJ, Heckbert SR, et al. Glucose, blood pressure and lipid control in older people with and without diabetes mellitus. The Cardiovascular Health Study. J Geriatr Soc 2002 50 3 ; : 416-423. Stolk RP, Vingerling JR, deJong PTVM, Dielemans I, Hofman A, Lamberts SWJ, Pols HAP, Grobbee DE: Retinopathy, glucose and insulin in an elderly population: the Rotterdam Study. Diabetes 1995 44: 11-15. Tun PA, Nathan DM, Perlmuter LC 1990 ; , Cognitive and affective disorders in elderly diabetics. Clin Geriatr Med 6 4 ; : 731-746. Tanaka Y, Atsumi Y, Matsuoka K, Onuma T, Tohjima T, Kawamori R: Role of glycemic control and blood pressure in the development and progression of nephropathy in elderly Japanese NIDDM patients. Diabetes Care 1998 21: 116-20. United Kingdom Prospective Diabetes Study Group: Intensive blood glucose control with sulfonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes UKPDS 33 ; . Lancet 1998 352 9131 ; : 837-53 and penicillin.
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Department of Rheumatology, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, TelAviv University, 6 Weizman St., 64239 Tel-Aviv, Israel and pepcid.

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