scholarly journals Clinical observations of acute onset of myopic optic neuropathy in a real-world setting

2021 ◽  
Vol 14 (3) ◽  
pp. 461-467
Author(s):  
Li Liao ◽  
◽  
Fang Fang ◽  
Xiao-Hua Zhu ◽  
◽  
...  
Keyword(s):  
Clinical Features ◽  
Optic Neuropathy ◽  
Real World ◽  
Vision Loss ◽  
Case Series ◽  
Acute Onset ◽  
Glucocorticoid Therapy ◽  
Glucocorticoid Treatment ◽  
Real World Setting ◽  
Systemic Glucocorticoid

AIM: To describe the clinical features of acute myopic onset of optic neuropathy and observe the effects of retrobulbar and systemic glucocorticoid therapy in a real-world setting. METHODS: A retrospective observational case series included 18 patients with a clinical diagnosis of acute onset of myopic optic neuropathy in a real-world setting. While the patients were using retrobulbar and systemic glucocorticoid therapy, various imaging examination data were analysed, and the clinical features of myopic optic neuropathy were summarized for 6mo to 2y. RESULTS: The included group of patients with acute onset of myopic optic neuropathy consisted mostly of females (n=11). The visual field (VF) showed abnormalities in bilateral eyes, including the spread of physiological blind spots, central and paracentral dark spots, and centripetal peripheral VF reduction; but central vision with no subjective changes. The visual evoked potential (VEP) was abnormal in all eyes with vision loss. The best corrected visual acuity (BCVA) was improved from 1.04±0.63 to 0.47±0.57 (logMAR) after glucocorticoid treatment (P<0.05). In patients with a short course (within 1wk), recovery was fast and achieved the same BCVA as recorded before the onset within 6d. However, in patients with the long course (1 to 2wk), recovery was slow and did not achieve the BCVA recorded before the onset within 10d. The changes of intraocular pressure (IOP) were not obvious before and after treatment (18.68±5.30 vs 19.55±5.34 mm Hg, P>0.05). There was no recurrence during long-term follow-up observation. CONCLUSION: The acute onset of myopic optic neuropathy is characterized by BCVA and VF abnormalities in bilateral eyes. Retrobulbar and systemic glucocorticoid therapy is effective.

A Direct Aspiration First Pass Technique in Japanese Real-World Clinical Setting

2018 ◽  
Vol 17 (2) ◽  
pp. 115-122 ◽  
Author(s):  
Junji Uno ◽  
Katsuharu Kameda ◽  
Ryosuke Otsuji ◽  
Nice Ren ◽  
Shintaro Nagaoka ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Real World ◽  
Cerebral Blood Volume ◽  
Mechanical Thrombectomy ◽  
Case Series ◽  
Entire Study ◽  
Stroke Treatment ◽  
Real World Setting ◽  
Hemorrhagic Complications ◽  
First Pass

Abstract BACKGROUND It is debatable whether mechanical thrombectomy has benefits in a real-world setting outside the more rigid and selective clinical trial environment. OBJECTIVE To evaluate clinical outcomes, efficacy, and safety of mechanical thrombectomy in single-center retrospective cohort case series. METHODS We reviewed prospectively collected data from our large-vessel occlusion stroke database to identify patients undergoing mechanical thrombectomy using Penumbra catheters (Penumbra, Almeida, California) as first-line devices. The primary outcomes were the modified Rankin Scale score at 90 d and recanalization rate. The secondary outcomes included the rates of hemorrhagic complications and mortality. RESULTS The entire study population included 298 patients. Thrombolysis in Cerebral Infarction Scale ≥2b was achieved in 86.6% of patients. Fifty-five patients (18.5%) were outside the 6 hr time window and 82 patients (27.5%) were over 80-yr old. The posterior circulation thrombectomy rate was 12.4%. At 90 d from onset, 49.3% of patients had favorable outcomes. The parenchymal hemorrhage type 2 (PH2) and subarachnoid hemorrhage rates were 2.3% and 11.7%, respectively. In multivariate analyses, cerebral blood flow/cerebral blood volume mismatch (odds ratio [OR] = 9.418; 95% confidence interval [CI], 3.680-27.726; P < .0001), onset to recanalization time (OR = 0.995; 95% CI, 0.991-0.998; P = .0003), and hemorrhagic complications including PH2 and subarachnoid hemorrhage (OR = 0.186; 95% CI, 0.070-0.455; P = .0002) were associated with favorable outcomes. CONCLUSION A direct aspiration first pass technique with an adjunctive device demonstrated high recanalization rates in old Japanese patients. Our patient cohort may reflect the application of endovascular techniques in acute ischemic stroke treatment in a real-world setting.

Compressive Optic Neuropathy

2019 ◽  
pp. 21-24
Author(s):  
Matthew J. Thurtell ◽  
Robert L. Tomsak
Keyword(s):  
Optic Nerve ◽  
Clinical Features ◽  
Optic Neuropathy ◽  
Vision Loss ◽  
Capillary Hemangioma ◽  
Optic Nerve Sheath ◽  
Optic Glioma ◽  
Compressive Optic Neuropathy ◽  
Nerve Sheath ◽  
Optic Nerve Sheath Meningioma

Optic nerve compression results in progressive, and often painless, vision loss. In this chapter, we begin by reviewing the clinical features of anterior and posterior compressive optic neuropathy. We next review the common causes of compressive optic neuropathy, which include orbital tumors (e.g., optic nerve sheath meningioma, optic glioma, and capillary hemangioma), orbital infection, orbital inflammation, intracranial tumors (e.g., pituitary macroadenoma, meningioma, and craniopharyngioma), aneurysm, and thyroid eye disease. We then review the workup for compressive optic neuropathy and discuss the various imaging options. Lastly, we discuss the clinical features, imaging findings, management options, and prognosis for visual recovery for patients with optic nerve sheath meningioma.

scholarly journals Early Outcomes of a Synthetic Cartilage Implant for Treatment of Hallux Rigidus: A Series of 87 Patients

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0015
Author(s):  
Michael A. Campbell
Keyword(s):  
Real World ◽  
Case Series ◽  
Hallux Rigidus ◽  
Time Interval ◽  
Pivotal Trial ◽  
Human Cartilage ◽  
First Metatarsophalangeal Joint ◽  
Real World Setting ◽  
Positive Results

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: Arthritis of the first metatarsophalangeal joint (MTPJ), or hallux rigidus, is the most common arthritic condition of the foot, affecting 1 in 40 people over 50 years of age. One surgical option is the implantation of a synthetic polyvinyl alcohol hydrogel implant that has water content, tensile strength, and biomechanical properties similar to those of healthy human cartilage. This implant is supported by positive outcomes in a Level 1 clinical trial out to over 5 years follow-up. The objective of this case series was to determine if the positive results seen in the pivotal trial could be recreated in a ‘real world’ setting. Methods: All patients implanted with a synthetic cartilage implant by a single surgeon between September 2016 and December 2018 were retrospectively reviewed. Consecutive adult patients diagnosed with hallux rigidus that failed nonoperative treatment were included in the analysis. Patient demographics, complications, Foot and Ankle Ability Measures (FAAM), and a 10-point visual analog score (VAS) were collected from the chart review. Results: A total of 87 patients were available for review during the time interval of interest with a mean length of follow-up of 38.7 weeks (range, 2-125). The average patient age was 56.6 years (range, 21-80). Two (2.3%) patients were converted to fusion. The first at 71 weeks and the second at 73 weeks following the initial surgery. Six (6.9%) patients experienced some complications: 3 cases of synovitis treated with corticosteroid injection; 1 case of sesamoiditis; 1 case of neuritis; and 1 insufficiency fracture at the plantar aspect of the MTPJ with implant subsidence. Patients had mean FAAM ADL and VAS scores of 81.2 (range 21-100) and 0.6 (range, 0-3), respectively, at final follow-up. Conclusion: This retrospective review is one of the first presentations of outcomes for a synthetic cartilage implant in a ‘real world’ setting. Patients experienced excellent pain relief, good functional outcomes, and a satisfactory survival rate. This case series confirms the positive results seen in the original pivotal trial for this device.

scholarly journals AB0353 ADRENAL INSUFFICIENCY AFTER GLUCOCORTICOID TREATMENT OF GIANT CELL ARTERITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1201.2-1201
Author(s):  
A. Hočevar ◽  
R. Jese ◽  
J. Kramarič ◽  
M. Tomsic ◽  
Z. Rotar
Keyword(s):  
Adrenal Insufficiency ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Cortisol Level ◽  
Adrenal Function ◽  
Glucocorticoid Therapy ◽  
Glucocorticoid Treatment ◽  
Systemic Glucocorticoid ◽  
The Mean ◽  
Corticotropin Stimulation

Background:Adrenal insufficiency is frequently neglected and underappreciated, potentially severe complication of systemic glucocorticoid therapy.Objectives:We aimed to evaluate the prevalence of glucocorticoid induced adrenal insufficiency in giant cell arteritis (GCA).Methods:We analysed adrenal function data in a cohort of GCA patients diagnosed between July 2014 and July 2019, in whom discontinuation of methylprednisolone therapy was planned. Adrenal function was tested by Corticotropin stimulation test (CST). To perform the CST, methylprednisolone was substituted with hydrocortisone (20mg qd in three divided doses) for one to four weeks before the test. Adrenal insufficiency was defined as cortisol level <450 nmol/l measured 30 minutes after the corticotropin injection; additionally, the result of the CST was defined as borderline when the cortisol level 30 minutes after corticotropin injection was between 450 nmol/l and 500 nmol/l.Results:Adrenal function was tested in 74/215 GCA patients before definite methylprednisolone withdrawal (after a median 13.5 (12.9 – 22.4) months of glucocorticoid therapy). The mean (SD) methylprednisolone dose, prior to substitution with hydrocortisone and subsequent CST, was 3.1 (1.6) mg. Adrenal insufficiency was detected in 36/74 patients (48.6%); additionally, 10/74 patients (13.5%) had a borderline CST result. Seventeen patients with either adrenal insufficiency or borderline CST result, had a repeated CST after median (IQR) 11.6 (8.9; 12.6) months. Adrenal insufficiency persisted in 11/17 (64.7%) patients, and 1/17 patients had a borderline CST. A third CST was performed in 4/12 patients with abnormal second CST after median (IQR) 8.3 (6.9; 10.6) months. Adrenal function recovered in one patient, while the adrenal insufficiency persisted in the remaining 3 patients.Conclusion:Adrenal insufficiency is a common and potentially long-lasting glucocorticoid induced adverse event in GCA patients.Disclosure of Interests:None declared

scholarly journals Surgical aspects of thoracic aortic aneurysms: A case series from a real-world setting

2021 ◽  
pp. 103099
Author(s):  
Aniss Seghrouchni ◽  
Noureddine Atmani ◽  
Younes Moutakiallah ◽  
Youssef El Bekkali ◽  
Mahdi Ait Houssa
Keyword(s):  
Real World ◽  
Case Series ◽  
Aortic Aneurysms ◽  
Thoracic Aortic Aneurysms ◽  
Real World Setting ◽  
Surgical Aspects

Hemorrhagic Presentation of Rathke Cleft Cysts: A Surgical Case Series

2019 ◽  
Vol 18 (5) ◽  
pp. 470-479 ◽  
Author(s):  
Lauren Schooner ◽  
Michelle A Wedemeyer ◽  
Phillip A Bonney ◽  
Michelle Lin ◽  
Kyle Hurth ◽  
...  
Keyword(s):  
Vision Loss ◽  
Pituitary Apoplexy ◽  
Clinical Symptoms ◽  
Case Series ◽  
Acute Onset ◽  
Oculomotor Nerve Palsy ◽  
Rare Presentation ◽  
Presenting Symptoms ◽  
Endocrine Disturbances

Abstract BACKGROUND Rathke cleft cysts (RCCs) are benign sellar and suprasellar lesions commonly presenting as asymptomatic incidental findings. Rarely, RCCs hemorrhage and mimic pituitary apoplexy on presentation. OBJECTIVE To review a series of hemorrhagic RCCs for physicians encountering this rare presentation. METHODS A database review of &gt;1700 transsphenoidal pituitary operations was performed at the USC Pituitary Center to identify patients with pathologically confirmed RCCs presenting with acute symptoms and evidence of hemorrhage at the time of surgery. Surgical treatment involved transsphenoidal RCC fenestration and drainage. Clinical, endocrine, and imaging outcomes were reviewed. RESULTS A total of 119 RCCs were identified, and 6 (5.0%) presented with hemorrhage mimicking pituitary apoplexy. Presenting symptoms included acute onset headaches (5/6), vision loss (2/6), and oculomotor nerve palsy (n = 1). Endocrine disturbances at presentation included pre-existing amenorrhea in all female patients (3/3), hypothyroidism (n = 2), panhypopituitarism (n = 2), and one with profound hyponatremia (Na 116 meq/L). All patients underwent endonasal transsphenoidal fenestration and drainage with no major complications. Over mean follow-up of 38.4 mo, 2/2 patients with vision loss reported improvement, and 2/5 patients with headaches reported improvement. Although all women resumed menses, patients with preoperative hypopituitarism did not experience pituitary axis improvement. Follow-up magnetic resonance imaging showed no instances of RCC recurrence with a mean imaging follow-up of 38.6 mo. CONCLUSION RCCs occasionally present with hemorrhage and clinical symptoms that may be confused with apoplexy. Outcomes following hemorrhagic RCC treatment are excellent when treated at tertiary pituitary centers. Although hyperprolactinemia often improves following surgery, other pituitary axis deficits typically do not.

scholarly journals 1003. BIC/FTC/TAF Maintains Viral Suppression in Patients with Documented M184V/I Mutations: A Real World Experience

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S530-S530
Author(s):  
Nicholas Chamberlain ◽  
James B Brock ◽  
Leandro A Mena
Keyword(s):  
Real World ◽  
Viral Suppression ◽  
Group Analysis ◽  
Case Series ◽  
Common Mutation ◽  
Research Support ◽  
Adherence To Medication ◽  
Sustained Viral Suppression ◽  
Real World Setting ◽  
Level Resistance

Abstract Background The M184V/I mutation is a common mutation in treatment-experienced patients with HIV and confers high-level resistance to lamivudine and emtricitabine. Our objective is to assess the effectiveness of bictegravir (BIC)/emtricitabine (FTC)/tenofovir alafenamide (TAF) in a real-world setting in achieving and maintaining viral suppression in patients with documented M184V/I mutations. Methods This case series is comprised of treatment-experienced HIV-positive patients with documented historical or newly-identified M184V/I mutations who were placed on BIC/FTC/TAF as a switch strategy or as therapy for patients who had failed a prior regimen. Patients with any resistance to tenofovir or bictegravir were excluded. Our primary outcome was sustained viral suppression at 12 months after initiation of BIC/FTC/TAF. Results We included 33 patients (94% black, 52% male, median age 49, range 36-63) with an M184V/I mutation. The majority (91%) showed sustained viral suppression at 12 months of treatment. Non-adherence to medication was the common factor in all three cases of treatment failure. One patient developed an R263K mutation while on therapy, which conferred low-level resistance to bictegravir. There were no other instances of newly-acquired resistance to any of the components of BIC/FTC/TAF. Conclusion Our results demonstrate high success rates of BIC/FTC/ATF in achieving and maintaining viral suppression in patients with documented M184V/I mutations who adhere to medications in a real-world setting with a single instance of new treatment-emergent resistance to bictegravir. These findings are congruent with reported sub-group analysis in clinical trial data and support the use of BIC/FTC/TAF in patients with M184V/I mutations. Disclosures Leandro A. Mena, MD, MPH, Binx Health (Grant/Research Support)Evofem (Grant/Research Support)Gilead Science (Consultant, Grant/Research Support, Speaker’s Bureau)GSK (Grant/Research Support)Janssen (Grant/Research Support)Merck (Consultant, Grant/Research Support)Roche Molecular (Consultant, Grant/Research Support)SpeedDx (Grant/Research Support)ViiV Healthcare (Consultant, Grant/Research Support, Speaker’s Bureau)

Arteritic Ischemic Optic Neuropathy

2019 ◽  
pp. 9-14
Author(s):  
Matthew J. Thurtell ◽  
Robert L. Tomsak
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Clinical Features ◽  
Optic Neuropathy ◽  
Vision Loss ◽  
Medical Emergency ◽  
Management Approach ◽  
High Dose ◽  
Ischemic Optic Neuropathy ◽  
Dose Corticosteroid

Arteritic ischemic optic neuropathy occurs in the setting of giant cell arteritis and often produces devastating irreversible vision loss. It is a medical emergency because there is a high risk of fellow eye involvement if high-dose corticosteroid treatment is not initiated in a timely fashion. In this chapter, we begin by reviewing the clinical features of anterior and posterior ischemic optic neuropathy. We next review the clinical features of arteritic ischemic optic neuropathy. We then discuss the clinical features and workup for giant cell arteritis. Lastly, we review the initial and long-term management approach for ischemic optic neuropathy occuring in the setting of giant cell arteritis.

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