XEN® stent complications: a case series

Abstract Background XEN® gel stent (Allergan, Dublin/Republic of Ireland) is a relatively new microinvasive glaucoma device providing an ab-interno approach to the subconjunctival space for aqueous drainage and reduction of intraocular pressure. It is thought to be less invasive, reduce surgical time and post-operative infection rates compared with traditional glaucoma procedures. Little information however, has been published regarding complications and subsequent management. Case presentation The authors highlight five complicated cases of XEN® stent insertion, how they were managed and key learning points. Cases include: entire stent found at the bottom of the anterior chamber several months after uncomplicated insertion, stent broke into multiple pieces during manipulation within subconjunctiva, XEN45 stent migrated into the anterior chamber 7 months post-operatively and a case of limbal-based conjunctival dissection during open revision which lead to additional scarring around the stent and subsequent raised intraocular pressure. Conclusions We present some new and interesting complications of XEN implant as well as potential management options. This can assist clinical decision-making and enable better pre-operative discussions with patients regarding risks of surgery.

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Vici syndrome in an Egyptian infant: case report and differential diagnosis of inherited hypopigmented disorders

Egyptian Journal of Medical Human Genetics ◽

10.1186/s43042-020-00103-2 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Marwa Abd Elmaksoud ◽

Aya Attya Abeesh ◽

Catarina Pereira ◽

Marwa El-Saeed El-Deeb

Keyword(s):

Differential Diagnosis ◽

Corpus Callosum ◽

Clinical Decision Making ◽

Clinical Decision ◽

Phenotype Correlation ◽

Multisystem Disease ◽

Case Presentation ◽

Correlation Studies ◽

Clinical Description ◽

Infant Case

Abstract Background Vici syndrome is a severe inherited multisystem disease caused by mutations in the EPG5 gene. The diagnosis depends on the constellation of cardinal features of agenesis of the corpus callosum, cataracts, oculocutaneous hypopigmentation, cardiomyopathy, and a combined immunodeficiency followed by confirmation by genetic testing. We report an Egyptian infant with Vici syndrome carrying a homozygous splice site variant (c.1252+1G>T; NM_020964.2) in the EPG5 gene, detailed clinical description, outcome, and differential diagnosis of inherited hypopigmentation disorders associated with neurological manifestations. Case presentation The infant initially presented with oculocutaneous hypopigmentation, agenesis of the corpus callosum, and immunodeficiency. A few months later, a diagnosis of dilated cardiomyopathy was made. Family history revealed 2 deceased siblings phenotypically matching our index infant. He died at the age of 15 months with acute respiratory failure. Conclusion The accurate diagnosis of such rare diseases with genetic confirmation is vital for proper clinical decision-making, genetic counseling of the affected families, and future genotype-phenotype correlation studies.

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Transducer-based comparisons of the prosthetic feet used by transtibial amputees for different walking activities: a pilot study

Prosthetics and Orthotics International ◽

10.1177/0309364612436408 ◽

2012 ◽

Vol 36 (2) ◽

pp. 203-216 ◽

Cited By ~ 21

Author(s):

Edward Schreiber Neumann ◽

Kartheek Yalamanchili ◽

Justin Brink ◽

Joon S Lee

Keyword(s):

Clinical Decision Making ◽

Research Question ◽

Case Series ◽

Clinical Decision ◽

Residual Limb ◽

Convenience Sample ◽

Loading Patterns ◽

Prosthetic Feet ◽

Transtibial Amputees ◽

Resultant Forces

Background: Knowledge of transtibial residual limb force and moment loading during gait can be clinically useful. The research question was whether a transducer attached between the socket and pylon can be used to detect differences in loading patterns created by prosthetic feet of different design and different walking activities in real-world environments outside the gait lab. Objectives: To develop methods for obtaining, processing, analyzing and interpreting transducer measurements and examining their clinical usefulness. Study Design: Case series design. Methods: A convenience sample of four K3-K4 transtibial amputees and a wireless tri-axial transducer mounted distal to the socket. Activities included self-selected comfortable speed walking, and ascending and descending ramps and steps. Measurements taken about three orthogonal axes were processed to produce plots of normalized resultant force versus normalized resultant moment. Within-subject differences in peak resultant forces and moments were tested. Results: Loading patterns between feet and subjects and among the activities were distinctly different. Optimal loading of peak resultant forces tentatively might occur around 25% and 69% to73% of stance during self-selected comfortable walking. Ascending and descending ramps is useful for examining heel and forefoot response. Conclusions: Force-moment plots obtained from transducer data may assist clinical decision making. Clinical relevance A pylon-mounted transducer distal to the socket reveals the moments and forces transmitted to the residual limb and can be used to evaluate the loading patterns on the residual limb associated with different foot designs and different everyday activities outside the gait lab.

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Aphakia Correction by Injection of Foldable Intra Ocular Lens in the Anterior Chamber

Ophthalmology and Eye Diseases ◽

10.4137/oed.s12672 ◽

2013 ◽

Vol 5 ◽

pp. OED.S12672

Author(s):

Kagmeni Giles ◽

Moukouri Ernest ◽

Domngang Christelle ◽

Nguefack-Tsague Georges ◽

Cheuteu Raoul ◽

...

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Anterior Chamber ◽

Teaching Hospital ◽

Case Series ◽

University Teaching ◽

Case Series Study ◽

The Mean ◽

The University

We assessed the outcomes of the use of anterior chamber foldable lens for unilateral aphakia correction at the University Teaching Hospital of Yaounde. In this retrospective, non-comparative, consecutive case series study, we reviewed the records of patients who underwent an operation for aphakia correction by the means of injection of an angular supported foldable lens between January 2009 and December 2011 in the University Teaching Hospital Yaounde. Student's paired t-test was carried out to compare preoperative and postoperative visual acuity (VA) and intraocular pressure (TOP). P-values less than 0.05 were considered statistically significant. Twenty-one patients were included in the study; twelve were male (57.1%) and nine were female (42.9%). The mean age was 55.38 ± 17.67 years (range 9–75 years). The mean follow-up duration was 5.95 ± 3.14 months (range 2–12 months). The mean logMAR visual acuity was 1.26 ± 0.46 pre-operatively and 0.78 ± 0.57 post-operatively ( P = 0.003). The change in intraocular pressure was not statistically significant. Complications included intraocular hypertension (over 21 mmHg) in 3 patients (14.3%) and macular edema, pupillar ovalization, and retinal detachment in one patient each. The results indicate that injection of an angular support foldable lens in the anterior chamber is a useful technique for the correction of aphakia in eyes without capsular support. More extended follow-up, however, and a larger series of patients are needed to ascertain the effectiveness and safety of this procedure.

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Manipulative and Manual Therapies in the Management of Patients with Prior Lumbar Surgery: A Systematic Review

10.21203/rs.3.rs-26281/v1 ◽

2020 ◽

Author(s):

Clinton J Daniels ◽

Zachary A. Cupler ◽

Jordan A Gliedt ◽

Sheryl Walters ◽

Alec L Schielke ◽

...

Keyword(s):

Systematic Reviews ◽

Clinical Decision Making ◽

Case Reports ◽

Data Extraction ◽

Case Series ◽

Clinical Decision ◽

Manual Therapies ◽

Lumbar Surgery ◽

Pilot Studies ◽

Surgical Interventions

Abstract BackgroundThe purpose was to identify, summarize, and rate scholarly literature that describes manipulative and manual therapy following lumbar surgery.MethodsThe review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was registered with PROSPERO. PubMed, Cochrane Database of Systematic Reviews, ICL, CINAHL, and PEDro were searched through July 2019. Articles were screened independently by at least two reviewers for inclusion. Articles included described the practice, utilization, and/or clinical decision making to post surgical intervention with manipulative and/or manual therapies. Data extraction consisted of principal findings, pain and function/disability, patient satisfaction, opioid/medication consumption, and adverse events. Scottish Intercollegiate Guidelines Network critical appraisal checklists were utilized to assess study quality.ResultsLiterature search yielded 1916 articles, 348 duplicates were removed, 109 full-text articles were screened and 50 citations met inclusion criteria. There were 37 case reports/case series, 3 randomized controlled trials, 3 pilot studies, 5 systematic/scoping/narrative reviews, and 2 commentaries. ConclusionThe findings of this review may help inform practitioners who utilize manipulative and/or manual therapies regarding levels of evidence for patients with prior lumbar surgery. Following lumbar surgery, the evidence indicated inpatient neural mobilization does not improve outcomes. There is inconclusive evidence to recommend for or against most manual therapies after most surgical interventions.Trial registrationProspectively registered with PROSPERO (#CRD42020137314). Registered 24 January 2020.

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Liposarcoma of the left hemithorax and implications of MDM2

Journal of Radiotherapy in Practice ◽

10.1017/s1460396919000372 ◽

2019 ◽

Vol 18 (4) ◽

pp. 397-399

Author(s):

Michael Stolten ◽

Deepak Sahasrabudhe ◽

Louis Constine

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Clinical Decision ◽

Adjuvant Radiation ◽

Left Hemithorax ◽

Case Presentation ◽

Close Observation ◽

Initial Biopsy ◽

Molecular Information ◽

Well Differentiated

AbstractBackground:Use of molecular information to guide clinical management of thoracic liposarcoma following resection.Case presentation:We present a case of a large liposarcoma of the left hemithorax. Initial biopsy consistent with lipoma however following resection pathology showed well-differentiated liposarcoma. Clinical data and molecular information including MDM2 from the tumour were employed in decision making regarding subsequent adjuvant radiation therapy versus close observation.Conclusion:Improved molecular characterisation has increased the precision of histological diagnoses and prediction of outcomes for many cancers. These may continue to help guide and strengthen clinical decision making and recommendations as they pertain to adjuvant therapy versus observation in the case of this patient.

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Effect of Hemifacial Spasm on Intraocular Pressure Measurement

Journal of Ophthalmology ◽

10.1155/2018/3621215 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Erdogan Cicik ◽

Rengin Yildirim ◽

Ceyhun Arici ◽

Funda Dikkaya ◽

Osman Sevki Arslan

Keyword(s):

Intraocular Pressure ◽

Healthy Volunteers ◽

Hemifacial Spasm ◽

Clinical Decision Making ◽

Corneal Thickness ◽

Clinical Decision ◽

Age And Gender ◽

Applanation Tonometer ◽

Iop Measurement ◽

And Gender

Purpose. To evaluate the effect of hemifacial spasm (HFS) on intraocular pressure (IOP) measurement. Methods. Twenty-four consecutive patients with HFS and 25 age- and gender-matched randomly selected eyes of healthy volunteers underwent corneal pachymetry and IOP measurements using Goldmann applanation tonometer (GAT) and noncontact tonometer (NCT). IOP measurements were performed before (during HFS) and 2 weeks after Botox injections in HFS patients and in healthy volunteers without Botox injections. Results. There was no statistical difference between involved eye side and uninvolved eye side of HFS patients in measured central corneal thickness. Similarly, no difference was found between involved eye side of HFS patients and controls. There were no statistically significant differences comparing IOP values before treatment and levels measured at 2 weeks of Botox injections, either with GAT (p=0.33, 0.11) or NCT (p=0.80, 0.43) devices in the involved eyes and uninvolved eyes of patients with HFS, respectively. There were also no significant differences in these parameters (GAT (p=0.63) and NCT (p=0.54)) in controls. Conclusions. Contractions in facial muscles may not lead to significant increase in IOP in HFS patients. This result may help clinical decision making in the treatment of glaucoma patients with HFS. This trial is registered with NCT03390803.

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Molecular Diagnostics in Pediatric Brain Tumors: Impact on Diagnosis and Clinical Decision-Making — A Selected Case Series

Klinische Pädiatrie ◽

10.1055/a-0637-9653 ◽

2018 ◽

Vol 230 (06) ◽

pp. 305-313 ◽

Cited By ~ 1

Author(s):

Heidi Bächli ◽

Jonas Ecker ◽

Cornelis van Tilburg ◽

Dominik Sturm ◽

Florian Selt ◽

...

Keyword(s):

Decision Making ◽

Molecular Diagnostics ◽

Clinical Management ◽

Clinical Decision Making ◽

Case Series ◽

Clinical Decision ◽

Cns Tumors ◽

Molecular Testing ◽

Cancer Predisposition Syndrome ◽

Pediatric Cns Tumors

AbstractCentral nervous system (CNS) tumors account for the highest mortality among pediatric malignancies. Accurate diagnosis is essential for optimal clinical management. The increasing use of molecular diagnostics has opened up novel possibilities for more precise classification of CNS tumors. We here report a single-institutional collection of pediatric CNS tumor cases that underwent a refinement or a change of diagnosis after completion of molecular analysis that affected clinical decision-making including the application of molecularly informed targeted therapies. 13 pediatric CNS tumors were analyzed by conventional histology, immunohistochemistry, and molecular diagnostics including DNA methylation profiling in 12 cases, DNA sequencing in 8 cases and RNA sequencing in 3 cases. 3 tumors had a refinement of diagnosis upon molecular testing, and 6 tumors underwent a change of diagnosis. Targeted therapy was initiated in 5 cases. An underlying cancer predisposition syndrome was detected in 5 cases. Although this case series, retrospective and not population based, has its limitations, insight can be gained regarding precision of diagnosis and clinical management of the patients in selected cases. Accuracy of diagnosis was improved in the cases presented here by the addition of molecular diagnostics, impacting clinical management of affected patients, both in the first-line as well as in the follow-up setting. This additional information may support the clinical decision making in the treatment of challenging pediatric CNS tumors. Prospective testing of the clinical value of molecular diagnostics is currently underway.

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Anterior Segment Imaging – Anterior Chamber Angle Assessment

European Ophthalmic Review ◽

10.17925/eor.2010.04.01.60 ◽

2010 ◽

Vol 04 (01) ◽

pp. 60

Author(s):

Lisandro Sakata ◽

Kenji Sakata ◽

◽

Keyword(s):

Anterior Chamber ◽

Clinical Decision Making ◽

Anterior Segment ◽

Clinical Decision ◽

Ultrasound Biomicroscopy ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Decision Making Process ◽

Anterior Chamber Angle ◽

Anterior Segment Imaging

Angle closure is a visually destructive form of glaucoma that accounts for approximately half of the worldwide blindness caused by this disease. Angle-closure glaucoma tends to occur in anatomically pre-disposed eyes, and the evaluation of the anterior segment morphology may help identify eyes at risk of angle closure. Ultrasound biomicroscopy is one of the devices developed for anterior-segment imaging, and it helped to provide better understanding of the mechanisms of angle closure. Recently, optical coherence tomography (OCT) technology became available for evaluating the anterior segment of the eye, enabling rapid non-contact imaging of the anterior chamber. Interestingly, anterior segment OCT (AS-OCT) technology appears to detect more eyes with angle closure compared with gonioscopy, and further studies should address how anterior segment imaging findings should be incorporated into the clinical decision-making process. In summary, this article reviews most of the previously published papers on the use of anterior segment imaging in angle-closure glaucoma and tackles some relevant points for the interpretation of imaging exams in daily clinical practice.

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Best practice guidelines for management of spinal disorders in skeletal dysplasia

10.21203/rs.2.23876/v1 ◽

2020 ◽

Author(s):

Klane White ◽

Michael B Bober ◽

Tae-Joon Cho ◽

Michael J Goldberg ◽

Julie Hoover-Fong ◽

...

Keyword(s):

Decision Making ◽

Practice Guidelines ◽

Skeletal Dysplasia ◽

Best Practice ◽

Clinical Decision Making ◽

Case Series ◽

Clinical Decision ◽

Spinal Disorders ◽

Best Practice Guidelines ◽

Group A

Abstract Background: Disorders of the spine present a common and difficult management concern in patients with skeletal dysplasia. Due to the rarity of these conditions however, the literature, largely consisting of small, single institution case series, is sparse in regard to well-designed studies to support clinical decision making in these situations. Methods: Using the Delphi method, an international, multi-disciplinary group of individuals, with significant experience in the care of patients with skeletal dysplasia, convened to develop multi-disciplinary, “best practice” guidelines in the care of spinal disorders in patients with skeletal dysplasia. Results: Starting with 33 statements, the group a developed a list of 31 “best practice” guidelines. Conclusions: The guidelines are presented and discussed to provide context for clinicians in their decision making in this often-challenging realm of care.

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Point-of-Care Cardiac Ultrasound in COVID-19 Intensive Care Unit

Central European Annals of Clinical Research ◽

10.35995/ceacr2010004 ◽

2020 ◽

Vol 2 (1) ◽

pp. 1

Author(s):

Rosanna Carmela De Rosa ◽

Antonio Romanelli ◽

Roberto Colonna ◽

Annunziata Minale ◽

Antonio Corcione

Keyword(s):

Intensive Care Unit ◽

Length Of Stay ◽

Wall Motion ◽

Clinical Decision Making ◽

Point Of Care ◽

Case Series ◽

Clinical Decision ◽

Cor Pulmonale ◽

Cardiac Ultrasound ◽

Clinical Conditions

(1) Background: Coronavirus disease 2019 (COVID-19) is associated with the development of Acute COVID-19 Cardiovascular Syndrome (ACovCS) in critically ill patients. In this case series, we evaluated the incidence of ACovCS by ultrasound in critically COVID-19 ill patients. (2) Methods: This case series included all patients with confirmed COVID-19 requiring admission to the ICU at Monaldi Hospital (AORN Ospedale dei Colli, Naples), between March 14th, 2020, and May 1st, 2020. On admission, in stable clinical conditions, an experienced and certified intensivist performed Point-Of-Care Cardiac Ultrasound (POC-CU). The exam was performed daily in every patient and repeated according to clinical evolution and intensivist’s judgment during the length of stay. Ex-Novo ACovCS echocardiographic patterns were noted. (3) Results: POC-CU evaluation performed on 19 patients revealed that, on admission, five patients (26.3%) presented an echocardiographic pattern like cor pulmonale. During the length of stay, seven patients (36.8%) presented ex-Novo echocardiographic alterations, suggesting ACovCS. Pericardial effusion (26.3%), acute right impairment due to pulmonary embolism (5.3%) and acute left impairment by wall motion alteration (5.3%) were the most common findings. (4) Conclusions: Ex-Novo cardiac abnormalities shown by POC-CU were common in patients with severe COVID-19. Competence in POC-CU is essential in identifying ACovCS in COVID-ICU and clinical decision-making.

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