Prevalence, risk factors and management of ocular hypertension or glaucoma in patients with Vogt-Koyanagi-Harada disease

2020 ◽  
pp. bjophthalmol-2020-316323
Author(s):  
Peizeng Yang ◽  
Chaokui Wang ◽  
Guannan Su ◽  
Su Pan ◽  
Yang Qin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Series ◽  
Chinese Patients ◽  
Time Interval ◽  
Inflammatory Factor ◽  
Surgical Interventions ◽  
Treatment Data ◽  
Uveitis Attack ◽  
Posterior Synechiae

Background/aimsThis study was performed to examine the prevalence, risk factors and treatment outcome of OHT/glaucoma in Chinese patients with Vogt-Koyanagi-Harada (VKH).MethodsRetrospective non-interventional case series were conducted on a total of 2281 patients with VKH referred from April 2008 to April 2019. Of these cases, 1457 had a minimum follow-up period of 3 months and were included for this study. Medical records were reviewed for demographic, ocular and treatment data.ResultsAmong 2914 eyes of 1457 patients with VKH, 695 (23.9%) eyes of 425 patients (29.2%) developed OHT/glaucoma. The risk factors of OHT/glaucoma included initial BCVA of 20/200 or worse (OR=4.826), final best-corrected visual acuity (BCVA) of 20/50–20/100 (OR=5.341) and final BCVA of 20/200 or worse (OR=4.235), the interval between uveitis attack and referral time interval being 2 months or more (OR=3.318), more than three recurrent episodes (OR=4.177) and posterior synechiae (OR=1.785). The main possible mechanisms of OHT/glaucoma were inflammatory factor-induced open-angle OHT/glaucoma in 277 eyes (39.9%) and pupillary block arising from complete posterior synechiae in 201 eyes (28.9%). In these 695 eyes with OHT/glaucoma, normalised intraocular pressure (IOP) was achieved in 389 eyes (56.0%) following medical treatment. In the remaining 306 eyes, various surgical interventions were performed and a normalised IOP could be achieved in 249 eyes (81.4%).ConclusionOHT/glaucoma is a common complication in Chinese patients with VKH. Risk factors of OHT/glaucoma included worse acuity at first and final visits, the longer interval between uveitis attack and referral, more recurrent episodes and posterior synechiae.

Bilateral ocular surface squamous neoplasia: A study of 25 patients and review of literature

2021 ◽  
pp. 112067212110071
Author(s):  
Vijitha S Vempuluru ◽  
Monalisha Pattnaik ◽  
Neha Ghose ◽  
Swathi Kaliki
Keyword(s):  
Risk Factors ◽  
Ocular Surface ◽  
Histopathological Examination ◽  
Topical Steroid ◽  
Case Series ◽  
Intraepithelial Neoplasia ◽  
Excisional Biopsy ◽  
Ocular Surface Squamous Neoplasia ◽  
Retrospective Case

Purpose: To describe the risk factors, clinical presentation, management, and outcomes of patients with bilateral ocular surface squamous neoplasia (OSSN). Methods: Retrospective case series. Results: Of the 25 patients with bilateral OSSN, the mean age at diagnosis of OSSN was 31 years (median, 24 years; range, 2–60 years). Risk factors for bilateral OSSN included xeroderma pigmentosum ( n = 15, 60%), human immunodeficiency virus infection ( n = 3, 12%), conjunctival xerosis ( n = 1, 4%), and topical steroid use ( n = 1, 4%). There were no identifiable ocular or systemic risk factors in 7 (28%) patients. Presentation was synchronous in 14 (56%) and metachronous in 11 (44%) patients. Tumor morphology was bilaterally similar in 12 (48%) patients. Histopathological examination ( n = 36) revealed conjunctival intraepithelial neoplasia (CIN) grade 1 in 4 (8%); grade 2 in 7 (14%); carcinoma in situ in 5 (10%), and invasive carcinoma in 20 (40%). Primary management of OSSN ( n = 49) included excisional biopsy ( n = 31, 62%), topical immunotherapy (IFN α2B) ( n = 11; 22%), topical Mitomycin C (MMC) ( n = 3, 6%), enucleation ( n = 1, 2%), orbital exenteration ( n = 2, 4%), and plaque brachytherapy (PBT) ( n = 1, 2%). One patient was lost to follow-up after detection of tumor in the second eye. Recurrent tumors were noted in 16 (32%) eyes and binocular globe salvage was achieved in 16 (64%) patients at a mean follow up of 41 months (median 30 months; range, 1–164 months). Conclusion: OSSN occurrence can be synchronous or metachronous. Meticulous examination of the fellow eye is important for an early diagnosis of OSSN.

Abstract W P21: Should We Perform Thrombectomy In Patients With Wake-up Strokes? A Case Series Using Ct Perfusion For Patient Selection

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Gabriel Vidal ◽  
James Milburn ◽  
Garrett Bennett ◽  
Vivek Sabharwal ◽  
Mustafa Al Hasan
Keyword(s):  
Risk Factors ◽  
Ct Perfusion ◽  
Medical Center ◽  
Case Series ◽  
Stroke Severity ◽  
Vessel Occlusion ◽  
Single Center Experience ◽  
Aspiration Technique ◽  
Group 2

Background and objectives: Approximately 25% of patients who present with acute ischemic stroke are wake-up strokes. These patients are often not treated with IV thrombolytics because of unclear onset of symptoms. Little data exists on endovascular therapy as acute treatment for this population, particularly with an aspiration technique. The objective of this study is to compare outcomes of patients who presented with wake-up strokes due to large vessel occlusion treated with neuroendovascular procedures versus those who received conservative treatment, based on a 2-year (2012-2013), single center experience at Ochsner Medical Center in New Orleans, LA. Method: 24 consecutive patients, who presented with wake-up strokes, were outside the IV tPA window, and had both CTA confirmed intracranial LVO and CT-perfusion data upon arrival to our institution were retrospectively studied. Patients with hemorrhages, tandem lesions, or high-grade carotid stenosis were excluded from this analysis. Decision to perform endovascular treatment was made by the vascular neurologist and neuro-interventionalist based on stroke severity and CTA/perfusion data. Patients in group 1 (n = 8) underwent endovascular revascularization procedures; patients in group 2 (n = 16) were treated conservatively (medical management alone). Presentation NIHSS, risk factors, mortality, discharge NIHSS, discharge mRS, and follow up mRS were compared. Results: There were no statistical differences in patient population regarding age, gender, and risk factors. There was no statistical difference in their initial NIHSS (16.8 vs. 21.8, p=0.05162), or mortality (0% vs 21%, pr=0.262). The two groups were statistically different in their discharge NIHSS (7.25 vs 21.81, p<0.00045), discharge mRS (2 vs 5, p<0.00001), clinic follow up mRS (1.37 vs 4.94, p<0.00001), and good outcome at discharge (mRS 0-2)(75% vs 0%, pr<0.0002). Conclusion: Patients with wake-up strokes, LVO, and favorable CT-perfusion data who underwent neuroendovascular reperfusion treatment had significantly better outcomes in our population, despite similar stroke severity at presentation. This suggests that with careful selection, neuroendovascular therapy for wake-up strokes may lead to improved outcomes.

Clinical outcome of endoscopic treatment for symptomatic sterile walled-off necrosis

Endoscopy ◽  
2020 ◽  
Author(s):  
Lotte Boxhoorn ◽  
Jeska A. Fritzsche ◽  
Paul Fockens ◽  
Jeanin E. van Hooft ◽  
Pieter J. F. de Jonge ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Clinical Success ◽  
Necrotizing Pancreatitis ◽  
Outlet Obstruction ◽  
Case Series ◽  
Open Label ◽  
Surgical Interventions ◽  
Persistent Symptoms ◽  
Walled Off Necrosis

Background The majority of patients with symptomatic sterile walled-off necrosis (WON) can be treated conservatively. Although endoscopic transluminal drainage (ETD) is often performed in cases of persistent symptoms, post-procedural iatrogenic infection may occur. This study aimed to evaluate clinical outcomes after ETD of symptomatic sterile WON. Methods This was a retrospective, multicenter, open-label case series of 56 patients with necrotizing pancreatitis who underwent ETD for symptomatic sterile WON between July 2001 and August 2018 at two tertiary referral hospitals. Primary end point was clinically relevant post-procedural iatrogenic infection, defined as need for endoscopic transluminal necrosectomy. Secondary end points included mortality, total number of interventions, hospital stay, and resolution of symptoms at 1-year follow-up.  Results ETD of sterile WON was performed in 56 patients (median age 55 years, 57 % male), who presented with abdominal pain (71 %), gastric outlet obstruction (45 %), jaundice (20 %), and failure to thrive (27 %). A total of 41 patients (73 %) developed clinically relevant post-procedural iatrogenic infection, resulting in a median of 3 (interquartile range [IQR] 2 – 4) endoscopic, radiological, and/or surgical interventions. Mortality rate was 2 %. Median total hospital stay was 12 days (IQR 6 – 17). Resolution of symptoms was reported in 40 of 46 patients (87 %) for whom long-term follow-up data were available (median follow-up 13 months, IQR 6 – 29). Conclusions ETD of symptomatic sterile WON resulted in high clinical success. Nonetheless, the majority of patients required additional reinterventions for clinically relevant post-procedural iatrogenic infection.

GIANT CELL TUMOURS OF TENDON SHEATH OF HAND: CAUSES AND STRATEGIES TO PREVENT RECURRENCE

Hand Surgery ◽  
2011 ◽  
Vol 16 (02) ◽  
pp. 149-154 ◽  
Author(s):  
Azal Jalgaonkar ◽  
Baljinder Dhinsa ◽  
Howard Cottam ◽  
Ganapathyraman Mani
Keyword(s):  
Risk Factors ◽  
Local Recurrence ◽  
Giant Cell ◽  
Recurrence Rate ◽  
Case Series ◽  
Tendon Sheath ◽  
Giant Cell Tumours ◽  
High Incidence ◽  
The Mean

Giant cell tumours of tendon sheath of hand present a surgical dilemma due to their high incidence of local recurrence. We present a case series of 46 patients with 47 histologically confirmed giant cell tumours of tendon sheath over a ten-year period from 1998 to 2008. The mean follow-up was 47 months (range 25–124 months). We identified tumours with bony erosions and piecemeal resections as predictors of recurrence. Our recurrence rate of 9% was at the lower end of spectrum of previously published reports (range 7%–44%). We recommend "en-masse" excision of these tumours. All the patients with suspicion of these tumours should have preoperative radiographs to identify erosions. A thorough curettage of the bone should be done in cases with osseous erosion to prevent recurrence. Patients with these risk factors should be followed up annually for five years and be warned about recurrence.

Development of invasive disease in 433 women treated for vulvar, vaginal or perianal intraepithelial neoplasia

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 5043-5043
Author(s):  
M. K. Fehr ◽  
K. J. Dedes ◽  
S. Heinzl ◽  
M. D. Mueller ◽  
M. Baumann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Case Series ◽  
Intraepithelial Neoplasia ◽  
Invasive Disease ◽  
Malignant Potential ◽  
Initial Diagnosis ◽  
Laser Evaporation ◽  
High Grade

5043 Background: The incidence of intraepithelial neoplasia (IN) of the lower anogenital tract is increasing. Due to small case-series, the malignant potential of treated high-grade IN is not well defined and risk factors for progression are not established. Methods: Patients with IN of the vulva (VIN), vagina (VAIN) and perianal skin (PAIN) were identified in the electronic databases of three university colposcopy clinics. Inclusion criteria were biopsy proven IN grade 2–3 (high-grade) and no history of vaginal, vulvar or anorectal cancer. Excluded were patients with the diagnosis of invasive disease within one year from initial diagnosis of IN. Results: 442 patients were identified from 1977 to 2005 with a mean follow up of 69.9 ± 56.1 months. Initial diagnosis was VIN III in 75.3%, VIN II in 17.2%, VAIN II in 4.3%, VAIN III in 2%, and PAIN II/III in 1.1% of patients. Mean age at initial diagnosis was 47.1 ± 14.1 (range, 18–102). Initial treatment was biopsy and laser evaporation in 61.5%, surgical excision in 32.8%, and other locally destructive methods in 3.1% of patients. 9 patients refused any treatment (2.0%). In the 433 treated patients, recurrent disease (e.g. diagnosed >1 year after initial diagnosis) occurred in 32.2%. In patients with a follow up longer than 5 years, 14.4 % were still experiencing recurrences. In multivariate analysis, immunosuppression (OR: 2.33, 95% CI 1.06–5.06, p = 0.035) was associated with recurrence but not smoking, age or histological grade. Progression to invasive disease occurred in 3.8% of treated patients within a mean time of 7.9 ± 6.8 years (range, 1.3–24.5). In multivariate analysis, immunosuppression (OR:3.31, 95% CI 1.01–10.93, p = 0.049) and smoking (OR:3.12, 95% CI 1.07–9.08, p = 0.037) were independent risk factors for progression. Conclusions: Anogenital IN is a chronic disease in a substantial proportion of patients. The malignant potential is remarkably high despite repeated treatments. Therefore, long lasting surveillance is mandatory, especially in immunosuppressed or smoking patients. No significant financial relationships to disclose.

scholarly journals 10 patients, 10 years – Long term follow-up of cardiovascular risk factors in Glut1 deficiency treated with ketogenic diet therapies: A prospective, multicenter case series

2018 ◽  
Vol 37 (6) ◽  
pp. 2246-2251 ◽  
Author(s):  
Nicole Heussinger ◽  
Adela Della Marina ◽  
Andreas Beyerlein ◽  
Baerbel Leiendecker ◽  
Sofia Hermann-Alves ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Ketogenic Diet ◽  
Case Series ◽  
Glut1 Deficiency ◽  
Long Term Follow Up

Predictors of Patient-Reported Function and Pain Outcomes in Operative Ankle Fractures

2017 ◽  
Vol 38 (5) ◽  
pp. 496-501 ◽  
Author(s):  
Daniel M. Dean ◽  
Bryant S. Ho ◽  
Albert Lin ◽  
Daniel Fuchs ◽  
George Ochenjele ◽  
...  
Keyword(s):  
Risk Factors ◽  
Physical Function ◽  
Functional Outcomes ◽  
Case Series ◽  
Ankle Fractures ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Class B ◽  
Pain Outcomes

Background: Risk factors associated with short-term functional outcomes in patients with operative ankle fractures have been established. However, no previous studies have reported the association between these risk factors and functional outcomes outside of the first postoperative year. We identified predictors of functional and pain outcomes in patients with operative ankle fractures using the Patient Reported Outcomes Measurement System (PROMIS) physical function (PF) and pain interference (PI) measures. Methods: We retrospectively reviewed a multicenter cohort of patients ≥18 years old who underwent operative management of closed ankle fractures from 2001 to 2013 with a minimum of a 2-year follow-up. Patients with pilon variants, Maisonneuve fractures, Charcot arthropathy, prior ankle surgery, and chronic ankle fractures were excluded. Patients meeting inclusion criteria were contacted and evaluated using the PROMIS PF and PI computerized adaptive tests. Patient demographic and injury characteristics were obtained through a retrospective chart review. Univariate and multivariate regression models were developed to determine independent predictors of physical function and pain at follow-up. Included in this study were 142 patients (64 women, 78 men) with a mean age of 52.7 years (SD = 14.7) averaging 6.3 years of follow-up (range 2-14). Results: Patients had a mean PF of 51.9 (SD = 10.0) and a mean PI of 47.8 (SD = 8.45). Multivariate analysis demonstrated that independent predictors of decreased PF included higher age (B = 0.16, P = .03), higher American Society of Anesthesiologists (ASA) class (B = 10.3, P < .01), and higher body mass index (BMI; B = 0.44, P < .01). Predictors of increased PI included higher ASA class (B = 11.5, P < .01) and lower BMI (B = 0.41, P < .01). Conclusion: At follow-up, increased ASA class, increased BMI, and higher age at time of surgery were independently predictive of decreased physical function. Factors that were associated with increased pain at follow-up include lower BMI and higher ASA class. ASA class had the strongest effect on both physical function and pain. Level of Evidence: Level IV, case series.

scholarly journals Case series on the on the onset of transient hypo-parathyroidism after thyroidectomy

2017 ◽  
Vol 4 (12) ◽  
pp. 3849
Author(s):  
Kannan Rajendran ◽  
S. Saravana Kumar ◽  
Robinson Smile
Keyword(s):  
Risk Factors ◽  
Total Thyroidectomy ◽  
Serum Calcium ◽  
Statistical Significance ◽  
Case Series ◽  
Medical College ◽  
Number Of Patients ◽  
Common Operation ◽  
Gandhi Medical College

Background: Surgery for thyroid disorders is the common operation in general surgery and total thyroidectomy is widely performed both for carcinoma as well as benign bilateral diseases of the thyroid and the most common complication is transient hypocalcaemia. A preliminary study was conducted to assess the risk factors for transient hypocalcaemia in our hospital.Methods: This was a prospective observational study conducted from February 2013 to April 2014 at the Mahatma Gandhi Medical College and Research Institute, Pondicherry and have included all patients undergone any type of thyroid surgery with a normal pre-operative serum calcium level. After initial clinical assessment, blood samples were drawn for estimation of thyroid function and serum calcium and albumin. Postoperative hypocalcemia was assessed by eliciting Chovstek’s and Troussea’s sign and biochemically estimating serum calcium and albumin at 6,24, and 24 hours intervals and 1st and 3rd months during follow-up. The risk factors involved are also studied like sex, age, type of thyroidectomy, identification of parathyroid, Identification of recurrent laryngeal nerve and their histology.Results: A total of 50 patients who underwent thyroidectomy were included in the study. The hypocalcemia occurred in 28% of patients studied showed that 66.7% of patients developed hypocalcemia at 48-72 hours. There was no statistical significance for the parameters of age or gender, benign and malignant conditions of thyroid. The analysis of type surgery performed showed a significant number of patients developing transient hypocalcaemia after near or total thyroidectomy (p-0.002).Conclusions: The present study, though consisted of a small group of patients has shown that transient hypocalcaemia after near or total thyroidectomy occurs in early post-operative days. Hence, on an average 2-5 days of hospital stay is mandatory. Near total or total thyroidectomy is a risk factor. Early diagnosis and replacement with calcium intra-venous reduce the morbidity and mortality of hypocalcaemia. 

scholarly journals Five-Year Clinical Outcomes of Trabectome Surgery at a Single Glaucoma Center

2018 ◽  
Author(s):  
Hamed Esfandiari ◽  
Priyal Shah ◽  
Pooya Torkian ◽  
Ian P. Conner ◽  
Joel S. Schuman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Success Rate ◽  
Retention Rate ◽  
Case Series ◽  
Series Data ◽  
Cumulative Probability ◽  
Single Center ◽  
Trabectome Surgery ◽  
Ab Interno

Purpose: To analyze the five-year results of Trabectome ab interno trabeculectomy of a single glaucoma center. Method: In this retrospective interventional single-center case series, data of 93 patients undergoing ab interno trabeculotomy between September 2010, and December 2012 were included. Kaplan-Meier analysis was performed using success criteria defined as postoperative intraocular pressure (IOP) &le;21 mm Hg, or &gt;20% reduction from preoperative IOP, and no need for further glaucoma surgery. Risk factors for failure were identified using Cox proportional hazards ratio (HR). Results: The retention rate for five years follow-up was 66%. The cumulative probability of success at 1, 2, 3, 4 and 5 years was 82.6%, 76.7%, 73.9%, 72.3%, and 67.5%. Risk factors for failure were lower baseline IOP (HR=0.27, P=0.001), younger age (HR=0.25, P=0.02), and higher central corneal thickness (HR=0.18, P= 0.01). Pseudoexfoliation was associated with a higher success rate (HR= 0.39, P=0.02). IOP was decreased significantly from 20.0&plusmn;5.6 mmHg at baseline to 15.6&plusmn;4.6 mmHg at 5-year follow-up (P=0.001). The baseline number of glaucoma medications was 1.8&plusmn;1.2, which decreased to 1.0&plusmn;1.2 medications at 5 years. Conclusion: Trabectome surgery was associated with a good long-term efficacy and safety profile in this single-center case series with a high retention rate. A higher baseline IOP, older age, thinner cornea, and pseudoexfoliation glaucoma were associated with a higher success rate.

scholarly journals Risk Factor and Surgical Outcome of Petersen’s Hernia After Gastrectomy in Gastric Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Song Liu ◽  
Qiongyuan Hu ◽  
Peng Song ◽  
Liang Tao ◽  
Shichao Ai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Risk Factor ◽  
Distal Gastrectomy ◽  
Univariate Analysis ◽  
Time Interval ◽  
Bowel Necrosis ◽  
Surgical Interventions ◽  
Petersen’S Hernia ◽  
Factor Evaluation

BackgroundPetersen’s hernia is a life-threatening complication after gastrectomy. This study is dedicated to identify risk factors for Petersen’s hernia and compare clinical outcomes between patients receiving early or delayed surgical interventions.MethodsData from all patients who received gastrectomy due to gastric cancer were collected. Clinical characteristics were compared between Petersen and non-Petersen groups, bowel necrosis and non-necrotic groups. Propensity score matching (PSM) was conducted to generate two comparative groups. Univariate analysis and multivariate logistic regression were performed for risk factor evaluation.ResultsA total of 24 cases of Petersen’s hernia were identified from 1,481 cases of gastrectomy. PSM demonstrated that lower body mass index [BMI; odds ratio (OR) = 0.2, p &lt; 0.01] and distal gastrectomy (OR = 6.2, p = 0.011) were risk factors for Petersen’s hernia. Longer time interval from emergence visit to laparotomy (p = 0.042) and elevated preoperative procalcitonin (p = 0.033) and C-reactive protein (CRP; p = 0.012) were associated with higher risk of bowel necrosis in Petersen’s hernia. Early surgical intervention resulted in less bowel necrosis rate (p = 0.012) and shorter length of necrotic bowel (p = 0.0041).ConclusionsLow BMI and distal gastrectomy are independent risk factor for Petersen’s hernia after gastrectomy. Curtailing observing time and executing prompt surgery are associated with bowel viability and better outcome in patients with Petersen’s hernia.

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