scholarly journals Long-term visual pathway alterations after elemental mercury poisoning: report of a series of 29 cases

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Salvador Pastor-Idoate ◽  
Rosa M. Coco-Martin ◽  
Iratxe Zabalza ◽  
Yrbani Lantigua ◽  
Itziar Fernández ◽  
...  
Keyword(s):  
Case Series ◽  
Mercury Vapor ◽  
Visual Pathway ◽  
Acute Exposure ◽  
Control Group ◽  
Pattern Reversal ◽  
Mercury Poisoning ◽  
Full Field ◽  
Number Of Patients ◽  
High Concentrations

Abstract Background There are few clinical data on retinal involvement after acute exposure to high concentrations mercury and the available reports are based on a small number of patients suffering chronic exposure. The purpose of this paper is to report findings in workers acutely exposed to very high concentrations of mercury vapor with the aim of providing data on a possible direct retinal involvement. Methods Twenty-nine patients and 16 controls were evaluated in a comparative case series. Mercury levels in blood and urine samples, visual acuity (VA), contrast sensitivity (CS), visual field (VF), color discrimination and optical coherence tomography (OCT) were recorded. The pattern reversal visual-evoked potentials (PRVEP), full-field and multifocal electroretinography (ffERG/mfERG), pattern electroretinography (PERG), systemic symptoms, presence of erethism, and electromyography (EMG) were also gathered. A descriptive analysis was performed. The correlations between variables also were studied. In addition, electrophysiological data from those patients with deeper VF defects (group 1) were compared with a normal control group. Results Twenty-six workers exhibited symptoms of erethism. The EMG showed sensorimotor polyneuropathy and multiple mononeuropathy. The VA was slightly affected in 48.27% (n = 14) of subjects. Loss of CS in at least one of four spatial frequencies and color vision alterations occurred in 96.5% (n = 28) and 44.8% (n = 13), respectively. VF alterations were identified in 72.4% (n = 21) patients. No morphologic changes were seen in the OCT scans. Latencies over 100 milliseconds and reduced amplitudes of P100 were found in the PRVEP (p < 0.05). The reduced amplitude of the b wave at the ffERG, of the P50 at the PERG and of the P1 wave at the mfERG results (p < 0.05) suggested that the outer retina was involved. Significant negative correlations among blood mercury levels, VA, and ffERG were observed. Conclusions In this case series, showed that acute exposure to mercury vapor had a hazardous effect on the visual system. Although neurologic and visual pathway involvement was clearly demonstrated, the differences found compared to control support the existence of a direct functional retinal damage and participation in impaired vision in mercury poisoning.

scholarly journals Visual Pathway Alterations after Severe Acute Occupational Elemental Mercury Poisoning: Report of a Series of 29 Cases

2020 ◽  
Author(s):  
Salvador Pastor-Idoate ◽  
Rosa M Coco-Martin ◽  
Iratxe Zabalza ◽  
Yrvani Lantigua ◽  
Itziar Fernández ◽  
...  
Keyword(s):  
Case Series ◽  
Visual Pathway ◽  
Control Group ◽  
Entire Group ◽  
Pattern Reversal ◽  
Northern Spain ◽  
Full Field ◽  
Sensorimotor Polyneuropathy ◽  
Number Of Patients ◽  
High Concentrations

Abstract BACKGROUND: There are almost no available data on retinal involvement after acute exposure to high concentrations mercury and the available reports are on a small number of patients that suffered chronic expposure. The purpose of this paper is to report visual findings in 29 workers exposed to very high concentrations of mercury vapor in a factory in northern Spain in 2012.METHODS: Twenty-nine patients and 16 controls were evaluated in a comparative case series. Fifteen of the 29 workers underwent belated chelation for heavy metal intoxication, only 3 in a prompt way. The mercury levels in blood and urine samples, visual acuity (VA), contrast sensitivity (CS), visual field (VF), color discrimination and optical coherence tomography (OCT) data were recorded. The pattern reversal visual-evoked potentials (PRVEP), full-field and multifocal electroretinography (ffERG/mfERG), pattern electroretinography (PERG), systemic symptoms, presence of erethism, and electromyography (EMG) were also gathered. A descriptive analysis was performed. The evolution of patients who did not undergo chelation (group 1), those who underwent late chelation (group 2), and those with deep VF defects (group 3) were compared with a control group. The correlations between variables also were studied.RESULTS: The VA was affected slightly. The loss of CS in at least one of four spatial frequencies and color vision alterations occurred in 96.5% (n=28) and 44.8% (n=13), respectively, in the entire group. VF alterations were identified in 72.4% (n=21). No morphologic changes were seen in the OCT scans. Latencies over 100 milliseconds and reduced amplitudes of P100 were found in the PRVEP. The ffERG and PERG results suggested that both the outer and inner retinal processes were involved. The mfERG indicated reduced parafoveal retinal function. Twenty-six workers exhibited symptoms of erethism. The EMG showed sensorimotor polyneuropathy and multiple mononeuropathy alterations. Significant negative correlations among blood mercury levels, VA, and ffERG were observed.CONCLUSION: Advanced visual functions were impaired significantly independent of the mercury levels. Delayed chelation was not beneficial. Although neurologic and visual pathway involvement was clearly demonstrated, this study also showed clear functional retinal participation in impaired vision.

scholarly journals Autologous Platelet-Rich Fibrin (PRF) as an Adjunct in the Management of Osteoradionecrosis and Medication-Related Osteonecrosis of Jaws. Case Series in A Single Centre

2021 ◽  
Vol 11 (8) ◽  
pp. 3365
Author(s):  
Benjie Law ◽  
Hui Yuh Soh ◽  
Syed Nabil ◽  
Rama Krsna Rajandram ◽  
Abd Jabar Nazimi ◽  
...  
Keyword(s):  
Case Series ◽  
Cost Effective ◽  
Control Group ◽  
Platelet Rich Fibrin ◽  
Tissue Healing ◽  
Number Of Patients ◽  
Short Period ◽  
Oral And Maxillofacial Region ◽  
Surgical Adjunct ◽  
Autologous Platelet

Osteoradionecrosis (ORN) of the jaws and medication-related osteonecrosis of the jaws (MRONJ) are uncommon but serious diseases affecting the oral and maxillofacial region with clinically similar appearance but distinct pathophysiology. Management of ORN and MRONJ is inherently challenging and the treatment outcomes are unpredictable. The use of autologous platelet concentrates (APCs) to promote hard and soft tissue healing is well described in the literature, and the efficacy of leucocyte and platelet-rich fibrin (L-PRF) has been well documented in a number of clinical studies. The aim of this study was to present our treatment strategy and the outcomes of incorporating L-PRF as a surgical adjunct in management of ORN and MRONJ in our centre. Methods: eight cases of ORN and MRONJ were treated with a combination of sequestrectomy and L-PRF as a surgical adjunct. Results: the overall success was 87.5%. Using L-PRF as an adjunct, we were able to predictably manage ORN and MRONJ without causing significant morbidity. Conclusion: our experience shows that L-PRF may be used as a valuable and cost-effective adjunct to surgical management of ORN and MRONJ. However, due to a limited number of patients, and a short period of review, the true effectiveness of the method is yet to be demonstrated in a longer follow-up study including a greater number of patients, besides the inclusion of a control group.

scholarly journals Incidence and surgical care of retinal detachment during the first SARS-CoV-2 lockdown period at a tertiary referral center in Austria

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248010
Author(s):  
Markus Schranz ◽  
Michael Georgopoulos ◽  
Stefan Sacu ◽  
Adrian Reumueller ◽  
Gregor S. Reiter ◽  
...  
Keyword(s):  
Reference Group ◽  
Case Series ◽  
Surgical Care ◽  
Control Group ◽  
Tertiary Referral ◽  
Total Delay ◽  
Tertiary Referral Center ◽  
Referral Center ◽  
Time Period ◽  
Number Of Patients

Purpose To assess the influence of the SARS-CoV-2 lockdown in spring on frequency, severity and quality of care of rhegmatogeneous retinal detachments (RRD) in a tertiary referral center in Vienna, Austria. Methods Single center, consecutive case series with historical controls. Patients presenting with primary RRD during the first Austrian SARS-CoV-2 lockdown (March 16th–May 3rd 2020) and a corresponding control group consisting of the same time period of the preceding 3 years. Results The mean number of patients with RD in the reference group (RG) was 22 (± 1) and in the lockdown group (LG) 15. Median total delay, defined as onset of symptoms until surgery, in the RG was 5 (lower quartile: 3.0; upper quartile: 8.0) compared to 7 (3.0; 12.0) days in the LG, (p = 0.740). During the lockdown 67% of patients were referred from an external ophthalmologist compared to 52% in the RG, (p = 0.395). 34% of patients in the RG presented with an attached macula compared to 33% in the LG (p = 0.597). PVR was present in 49% of cases in the RG compared to 73% in the LG. Single surgery success (SSS) rates were lower in the LG (73.3%) compared to the RG (85.3%), (p = 0.275). Conclusion Patients with RRD during the SARS-CoV-2 lockdown presented and were treated within acceptable time limits, showed the same macula-on ratios but a higher PVR rate and a tendency towards worse SSS rates compared to the time period of the preceding 3 years.

scholarly journals A new device for bone cranial flap fixation: Technical note and surgical remarks. A multicentric experience

2021 ◽  
Vol 12 ◽  
pp. 74
Author(s):  
Manolo Piccirilli ◽  
Giannantonio Spena ◽  
Enrico Marchese ◽  
Maria Pia Tropeano ◽  
Antonio Santoro
Keyword(s):  
Case Series ◽  
Technical Note ◽  
Bone Flap ◽  
Cranial Bone ◽  
Control Group ◽  
New Device ◽  
Number Of Patients ◽  
Case Series Study ◽  
Flap Fixation ◽  
Fixation System

Background: Fixation of bone flaps after craniotomy is a routine part of every neurosurgical procedure. The ideal fixation device should be safe, reliable, biologically inert, easy to use, and inexpensive and should not produce artifacts on neuroimaging. The authors describe a new device that meets these criteria. Methods: This is an observational, multicentric, and case series study of 56 patients who underwent a craniotomy and were subject to cranial bone flap fixation with the NT cranial small fixation system. A case–control group in whom titanium miniplates and screws were implanted was collected. All patients underwent CT scans of the head with 3D reconstruction at day 1 and day 90 postoperatively to evaluate bone flap position and fusion. Results: A total of 140 NT cranial small were implanted in 56 patients (mean age 44.2, range 22–63 years). The new device has shown stronger fixation qualities with optimal bone flap fusion and good cosmetic features. No surgical or relevant postsurgical follow-up complications have been associated with the device. Conclusion: Although this is a preliminary report in a relatively small number of patients, NT cranial small provides a safe, reliable, and easily applied postoperative cranial bone flap fixation system.

scholarly journals Occipital Petalia and Albinism: A Study of Interhemispheric VEP Asymmetries in Albinism with No Nystagmus

2019 ◽  
Vol 8 (6) ◽  
pp. 802 ◽  
Author(s):  
Alkiviades Liasis ◽  
Sian E. Handley ◽  
Ken K. Nischal
Keyword(s):  
Right Hemisphere ◽  
Normal Subjects ◽  
Visual Pathway ◽  
Field Pattern ◽  
Pattern Reversal ◽  
Full Field ◽  
Pathway Function ◽  
Left And Right ◽  
The Right ◽  
Stimulation Of

The purpose of this study was to assess chiasmal misrouting in a cohort of children with albinism with no nystagmus using hemifield visual evoked potentials (VEP) measures. Methods: Monocular VEPs were recorded and analyzed from three electrodes (O1, Oz, and O2 referred to Fz) from 16 children with albinism without nystagmus. Pattern reversal (full field and hemifield stimulation), full field pattern appearance and flash stimuli were used to evoke VEPs for each eye. Results: The amplitude of the pattern reversal VEPs to stimulation of the hemifield corresponding to the crossing pathways were as expected significantly larger than those to the non-crossing in each eye ((right eye p = 0.000004), (left eye p = 0.001)). Pattern reversal VEPs recorded from the left hemisphere were also larger than those from the right and most evident when comparing the crossing pathways of each eye (p = 0.004). Conclusions: This study has demonstrated electrophysiological differences in visual pathway function of the left and right hemisphere in subjects with albinism like that previously described in controls. Nasal field stimulation activated crossing and non-crossing pathways in patients with albinism and as a result, nasal hemifield VEPs in albinism are less lateralized compared to what is found in normal subjects.

scholarly journals P1760EXTRACORPOREAL PHOTOPHERESIS AND KIDNEY ALLOGRAFT REJECTION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Saulo Jesús Fernández Granados ◽  
Ernesto Fernández Tagarro ◽  
Ana Ramirez Puga ◽  
Rita Guerra Rodriguez ◽  
Selene Gonzalez Nuez ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Graft Loss ◽  
Graft Function ◽  
Solid Organ Transplantation ◽  
Case Series ◽  
Control Group ◽  
Solid Organ ◽  
Antibody Mediated Rejection ◽  
Number Of Patients ◽  
Case Series Study

Abstract Background and Aims Extracorporeal photopheresis (ECP) is an apheresis modality that in the field of solid organ transplantation (SOT) has an indication in the treatment or prophylaxis of pulmonary, cardiac or hepatic graft rejection. The usefulness of ECP in renal transplantation (RTx) remains contradictory because of the few studies that evaluate the effectiveness and safety of this technique. Method Case series study of kidney transplant patients with histological diagnosis of rejection who have been treated with ECP during the 2013-2018 period (n = 8 patients). The technical characteristics of the ECP sessions (n = 89) were studied, including tolerance and complications in each of them. Results Demographic and clinical characteristics are shown in Table 1. The indication of FEC was the contraindication to conventional treatment (n = 4), mainly due to concomitant infection (50%), or refractoriness (n = 4) to the treatment prescribed in each case and it is specified in Table 1. The initial schedule was 2 consecutive weekly sessions for 5 weeks, with additional sessions depending on the evolution at the end of the first batch. The scheduled sessions could be completed in most patients (n = 5). The 3 reasons for discontinuation were the lack of response to treatment, hospital admission and thrombosis of the arteriovenous fistula (AVF). The improvement of graft function in terms of creatinine reduction at the end of therapy occurred among patients presenting with acute cellular rejection (ACR) (n = 4) and it remained 3 months after the end of the treatment. The only late ACR (&gt; 3 months post-transplant) could not complete the initial programming. No graft with humoral component showed improvement in renal function. Graft loss and dialysis restart occurred in a patient with chronic active antibody-mediated rejection (cAMR). The other patient with cAMR is in a pre-dialysis situation. A total of 89 procedures were studied, all performed with the THERAKOS® CELLEX® Photopheresis System, with the administration of the methoxsalen solution (UVADEX®) and photoactivation with ultraviolet A light. Vascular access per session was the AVF (76% ) or the central vascular catheter (CVC) (24%), under no circumstances was peripheral access used. Each procedure lasted on average 112.72 +/- 13.85 minutes (range, 86-145). The volume of treatment (“buffy coat”) was 189.11 +/- 28.67 mL per session, and the total volume of fluids administered (NaCl and anticoagulation) was 559.40 +/- 41.17 mL. The complications observed during the sessions were fever (n = 2), thrombosis of the AVF (n = 1), coagulation of the extracorporeal system (n = 1) and anemization (n = 1). Interprocedure there was a case of urinary infection that conditioned hospital admission and discontinuation of therapy. One patient died of cardiovascular cause with a functioning graft 4 years after therapy. Conclusion The utility of the ECP seems to be in cases of cell rejection, probably related to the triggering of an immunomodulatory response of lymphocytes. It can be considered a well-tolerated and safe treatment. Special care should be taken with patients who require water restriction (infusion of 560 mL on average per session). We need more studies with a greater number of patients and a control group to be able to confirm the effectiveness and safety of PEC in RTx and to be considered a useful therapeutic tool as in other SOT.

The Use of Posterior Pericardiotomy Technique to Prevent Postoperative Pericardial Effusion in Cardiac Surgery

2012 ◽  
Vol 15 (2) ◽  
pp. 84 ◽  
Author(s):  
Canturk Cakalagaoglu ◽  
Cengiz Koksal ◽  
Ayse Baysal ◽  
Gokhan Alici ◽  
Birol Ozkan ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Pericardial Tamponade ◽  
Anxiety Level ◽  
Control Group ◽  
Echocardiographic Study ◽  
Number Of Patients ◽  
Hospital Stays

<p><b>Aim:</b> The goal was to determine the effectiveness of the posterior pericardiotomy technique in preventing the development of early and late pericardial effusions (PEs) and to determine the role of anxiety level for the detection of late pericardial tamponade (PT).</p><p><b>Materials and Methods:</b> We divided 100 patients randomly into 2 groups, the posterior pericardiotomy group (n = 50) and the control group (n = 50). All patients undergoing coronary artery bypass grafting surgery (CABG), valvular heart surgery, or combined valvular and CABG surgeries were included. The posterior pericardiotomy technique was performed in the first group of 50 patients. Evaluations completed preoperatively, postoperatively on day 1, before discharge, and on postoperative days 5 and 30 included electrocardiographic study, chest radiography, echocardiographic study, and evaluation of the patient's anxiety level. Postoperative causes of morbidity and durations of intensive care unit and hospital stays were recorded.</p><p><b>Results:</b> The 2 groups were not significantly different with respect to demographic and operative data (<i>P</i> > .05). Echocardiography evaluations revealed no significant differences between the groups preoperatively; however, before discharge the control group had a significantly higher number of patients with moderate, large, and very large PEs compared with the pericardiotomy group (<i>P</i> < .01). There were 6 cases of late PT in the control group, whereas there were none in the pericardiotomy group (<i>P</i> < .05). Before discharge and on postoperative day 15, the patients in the pericardiotomy group showed significant improvement in anxiety levels (<i>P</i> = .03 and .004, respectively). No differences in postoperative complications were observed between the 2 groups.</p><p><b>Conclusion:</b> Pericardiotomy is a simple, safe, and effective method for reducing the incidence of PE and late PT after cardiac surgery. It also has the potential to provide a better quality of life.</p>

The Toxicity of Castor Beans and its Treatment with Doxycycline in Local Rabbits

2018 ◽  
Vol 9 (2) ◽  
Author(s):  
Nael Mohammed Sarheed ◽  
Osamah Faisal Kokas ◽  
Doaa Abd Alabas Muhammed Ridh
Keyword(s):  
Castor Bean ◽  
The Body ◽  
Control Group ◽  
High Concentration ◽  
Biochemical Tests ◽  
Doxycycline Treatment ◽  
High Concentrations ◽  
Physiological Tests ◽  
Animal House ◽  
Physiological And Biochemical

The plant of castor is widely spread in the Iraqi land, and characterized with containing ricin toxin, which has a very serious effects, and because the seeds of this plant scattered in the agricultural soil and rivers water, which increases the exposure of humans and animals to these beans. Objective: This experiment was designed to study the effect of high concentration of castor bean powder in some physiological and biochemical parameters and changes in some tissues of the body, as well as trying to use doxycycline to reduce the effects of ingestion of these seeds. Materials and Methods: In the experiment, 24 local rabbits were raised and fed in the Animal House of the Faculty of Medicine / Al-Muthanna University, then divided into four groups and treated for three weeks (21 days), Control group: treated with normal saline solution (0.9) orally throughout the experiment, G1: was treated orally with a concentration of 25 mg / kg of castor bean powder daily during the experiment, G2 : orally treated 25 mg / kg of castor bean and 25 mg / kg of doxycycline, G3: orally treated 25 mg / kg of castor powder with 50 mg / kg of doxycycline daily throughout the trial period. Results: The results of the experiment showed significant changes (P less than 0.05) in all physiological and biochemical blood tests when compared with control group. There was a significant decrease in PCV, Hb, RBC, T.protein and body weights, while demonstrated a significant increase in WBC, Urea, Creatinine, ALT, AST and ALP, with distortions in liver and kidney of animals that treated with Castor beans. In contrast, the treatment with doxycycline and caster beans showed significant improvement reflected by a normal proportion in physiological tests and biochemical tests with improvement in the tissues when compared to control group. Conclusions: It can be concluded from this study that castor bean has high toxic and pathogenic effects that may be dangerous to the life of the organism. Therefore, it is advisable to be cautious of these pills and avoid exposure to them, also recommended to take high concentrations of doxycycline treatment when infected with castor bean poisoning.

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