Therapeutic and Tectonic Keratoplasty with Simple Cryopreserved Remnants of Donor Corneas: An 11 Year Retrospective Case Series

2021 ◽  
Author(s):  
Jae-Gon Kim ◽  
Jong Hwa Jun
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Corneal Ulcer ◽  
Medical Center ◽  
Case Series ◽  
Retrospective Case ◽  
Corneal Ulcers ◽  
The Past ◽  
Uncorrected Visual Acuity

Abstract This study sought to describe the use of deep-frozen donor corneal remnants preserved after keratoplasty procedures for therapeutic or tectonic keratoplasty without subsequent optical keratoplasty. This single-centre retrospective consecutive case series analyzed the electronic medical records of patients who had undergone therapeutic or tectonic keratoplasty using deep-frozen donor remains preserved in Optisol-GS, for the past 11 years at Keimyung University Dongsan Medical Center. Fifty-five surgical cases in 46 patients were included. Twenty-three surgical cases in 18 patients underwent therapeutic keratoplasty for refractory infectious corneal ulcer. Complete eradiation of primary infection was achieved in 14 patients (77.8%). Tectonic keratoplasty were performed 32 cases in 28 patients. Twenty-seven of 28 patients were ultimately able to maintain anatomical integrity (96.4%). Mean uncorrected visual acuity improved from 1.77 ± 0.94 preoperatively to 1.31 ± 0.95 at the last follow up postoperatively in the tectonic graft group by logarithm of the minimal angle of resolution (P = 0.002). There were no cases of graft rejection. Keratoplasty using cryopreserved donor tissue is a suitable surgical alternative for infectious or non-infectious corneal ulcers in elderly patients or patients with poor general condition. It could be a viable alternative to overcome the shortage of corneal donors.

scholarly journals Cost Analysis With Use of Expandable Cage or Cement in Single level Thoracic Vertebrectomy in Metastasis

2020 ◽  
pp. 219256822097537
Author(s):  
Miki Katzir ◽  
Tarush Rustagi ◽  
Jeffrey Hatef ◽  
Ehud Mendel
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Metastatic Cancer ◽  
Case Series ◽  
Retrospective Case ◽  
Single Level ◽  
Expandable Cage ◽  
Kyphosis Correction ◽  
Survival Differences ◽  
Surgical Cost

Study Design: Retrospective case series. Objective: Patient with metastatic cancer frequently require spinal operations for neural decompression and stabilization, most commonly thoracic vertebrectomy with reconstruction. Objective of the study was to assess economic aspects associated with use of cement versus expandable cage in patients with single level thoracic metastatic disease. We also looked at the differences in the clinical, radiological, complications and survival differences to assess non-inferiority of PMMA over cages. Methods: The electronic medical records of patients undergoing single level thoracic vertebrectomy and reconstruction were reviewed. Two groups were made: PMMA and EC. Totals surgical cost, implant costs was analyzed. We also looked at the clinical/ radiological outcome, complication and survival analysis. Results: 96 patients were identified including 70 one-level resections. For 1-level surgeries, Implant costs for use of cement—$75 compared to $9000 for cages. Overall surgical cost was significantly less for PMMA compared to use of EC. No difference was seen in clinical outcome or complication was seen. We noticed significantly better kyphosis correction in the PMMA group. Conclusions: Polymethylmethacrylate cement offers significant cost advantage for reconstruction after thoracic vertebrectomy. It also allows for better kyphosis correction and comparable clinical outcomes and non-inferior to cages.

scholarly journals Midterm Safety of Carbon Dioxide Insufflation of the Knee During Arthroscopic Cartilage–Based Procedures

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110354
Author(s):  
Judson L. Penton ◽  
Travis R. Flick ◽  
Felix H. Savoie ◽  
Wendell M. Heard ◽  
William F. Sherman
Keyword(s):  
Carbon Dioxide ◽  
Clinical Outcomes ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Knee Arthroscopy ◽  
Case Series ◽  
Osteochondral Allograft ◽  
Systemic Complications ◽  
Allograft Transplantation

Background: When compared with fluid arthroscopy, carbon dioxide (CO2) insufflation offers an increased scope of view and a more natural-appearing joint cavity, and it eliminates floating debris that may obscure the surgeon’s view. Despite the advantages of CO2 insufflation during knee arthroscopy and no reported cases of air emboli, the technique is not widely used because of concerns of hematogenous gas leakage and a lack of case series demonstrating safety. Purpose/Hypothesis: To investigate the safety profile of CO2 insufflation during arthroscopic osteochondral allograft transplantation of the knee and report the midterm clinical outcomes using this technique. We hypothesized that patients undergoing CO2 insufflation of the knee joint would have minimal systemic complications, allowing arthroscopic cartilage work in a dry field. Study Design: Case series; level of evidence, 4. Methods: A retrospective chart review was performed of electronic medical records for patients who underwent arthroscopic osteochondral allograft transplantation of the knee with the use of CO2 insufflation. Included were patients aged 18 to 65 years who underwent knee arthroscopy with CO2 insufflation from January 1, 2015, to January 1, 2021, and who had a minimum follow-up of 24 months. All procedures were performed by a single, fellowship-trained and board-certified sports medicine surgeon. The patients’ electronic medical records were reviewed in their entirety for relevant demographic and clinical outcomes. Results: We evaluated 27 patients (14 women and 13 men) with a mean age of 38 and a mean follow-up of 39.2 months. CO2 insufflation was used in 100% of cases during the placement of the osteochondral allograft. None of the patients sustained any systemic complications, including signs or symptoms of gas embolism or persistent subcutaneous emphysema. Conclusion: The results of this case series suggest CO2 insufflation during knee arthroscopy can be performed safely with minimal systemic complications and provide an alternative environment for treating osteochondral defects requiring a dry field in the knee.

Candidiasis Causing Vocal Fold Leukoplakia: Review of Clinical and Pathological Results of 289 Cases With Vocal Fold Leukoplakia

2019 ◽  
Vol 128 (10) ◽  
pp. 903-910 ◽  
Author(s):  
Murat Gumussoy ◽  
Ulku Kucuk
Keyword(s):  
Vocal Fold ◽  
Inhaled Corticosteroids ◽  
Medical Center ◽  
Age Groups ◽  
Significant Risk ◽  
Case Series ◽  
Predisposing Factors ◽  
Retrospective Case ◽  
Vocal Fold Leukoplakia

Objective: In laryngology practice, vocal fold leukoplakia is frequently evaluated by suspension laryngoscopy and biopsy examination upon the patient’s complaints of hoarseness and dysphonia. The purpose of the present study is to investigate and analyze risk factors, diagnosis, treatment, and follow-up results of cases with Candida leukoplakia. Study Design: Retrospective case control study. Setting: Tertiary medical center. Subjects and Methods: Patients with a diagnosis of vocal fold leukoplakia who underwent direct laryngoscopy and biopsy between 2007 and 2017 and diagnosed as candida or noncandida in their histopathology were assigned into 2 groups. Then they were compared in terms of their demographic characteristics, predisposing factors, diagnosis, treatment, and follow-up results. Results: Of the 289 vocal fold leukoplakia cases, 36 were candida, and 253 were noncandida. The mean age of the patients with Candida leukoplakia was 60.86 years. As for the age groups, the largest group (26.1%) was in the seventh decade ( P < .001). The use of inhaled corticosteroids was a significant risk factor ( P < .001). For their medical therapy, the patients were administered fluconazole 200 mg per day for 3 weeks, and the treatment yielded successful results in 91.66% of them. In 5 of the patients, candida leukoplakia and superficial epithelial dysplasia were observed, and no malignant transformation was observed during a mean follow-up of 28 ± 13 months. Conclusion: Candidiasis causing vocal fold leukoplakia is rare, and we report the findings of the largest published case series to date. Eliminating predisposing factors and administrating oral fluconazole 200 mg for 3 weeks are sufficient for medical treatment.

scholarly journals 1015. Hemophagocytic Lymphohistiocytosis: A Contemporary Single Center Case Series

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S598-S599
Author(s):  
Ra’ed Jabr ◽  
Miriam Ryan ◽  
Ghulam Rehman Mohyuddin ◽  
Kassem Hammoud ◽  
Heather Male ◽  
...  
Keyword(s):  
Hemophagocytic Lymphohistiocytosis ◽  
Medical Center ◽  
Univariate Analysis ◽  
Case Series ◽  
Case Fatality ◽  
Male Gender ◽  
P Value ◽  
Retrospective Case ◽  
Retrospective Case Series

Abstract Background Hemophagocytic lymphohistiocytosis (HLH) is a syndrome of excessive inflammation due lack of normal downregulation of activated macrophages and lymphocytes. We describe clinical and laboratory features, underlying conditions, prognostic factors and outcomes of a contemporary cohort of adults with HLH. Methods We performed a retrospective case series of adults diagnosed and treated for HLH at the University of Kansas Medical Center from January 1, 2006 through September 30, 2017. Patients were identified by ICD9/10 search of our HERON database, followed by manual review of electronic medical records using the HLH-04 criteria for inclusion. Patients were followed until February 20, 2018. Descriptive statistics and Cox survival model for mortality were used for data analyses. Results Among 76 patients reviewed, 39 met the HLH-04 criteria and were included in the cohort. Median age was 46 years , 26 (66.7%) were male, 26 (66.7%) were white, 5 (12.8%) were Asian, and 5 (12.8%) were African American. Twenty-one patients (53.8%) had HLH associated with an infection and 11 patients (28.2%) had HLH associated with malignancy. Median follow up time was 180 days (range 1 – 4002 days). Twenty patients died with case fatality rate of 51.3%, and among those who died, median survival was 17 days (range 1 –180 days). On univariate analysis, variables associated with mortality were: male gender (hazard ratio (HR) 5.32, 95% confidence interval (CI) 1.51-18.78, p=0.004), age ≥ 65 years (HR 2.51, 95% CI 0.99-6.39, p-value 0.005) and bilirubin ≥ 5 mg/dL at diagnosis (HR 3.27, 95% CI 1.34-8.00, p=0.006). These remained significantly associated with mortality on multivariate analysis: male gender (HR 12.34, 95% CI 1.87-29.73, p=0.020) and age ≥ 65 years (HR 7.45, 95% CI 1.87-29.73, p=0.008) and bilirubin ≥ 5 mg/dL (HR 4.75, 95% CI 1.09-20.72, p=0.002). Conclusion In this retrospective case series of adults with HLH, mortality at a median follow up of 180 days remained high (53%) and is associated with older age age ( &gt;65 years), male gender, and elevated bilirubin ≥ 5mg/dL at diagnosis. Better therapeutic options for this syndrome are needed. Disclosures All Authors: No reported disclosures

scholarly journals Intermediate-term outcome of placement of Baerveldt glaucoma implant for refractory glaucoma in a Malaysian population

2020 ◽  
Vol 17 (1) ◽  
pp. 108-119
Author(s):  
Clarissa Ern Hui Fang ◽  
Seng Kheong Fang
Keyword(s):  
Medical Therapy ◽  
Medical Records ◽  
Case Series ◽  
Glaucoma Drainage Device ◽  
Retrospective Case ◽  
Term Outcome ◽  
Baerveldt Glaucoma Implant ◽  
Baseline Characteristics ◽  
Maximal Medical Therapy

Objective: To report baseline characteristics and surgical outcomes of placement of Baerveldt glaucoma implant (BGI) in Asian eyes with considerably elevated intraocular pressure (IOP) despite maximal medical therapy. Design: Retrospective case series of surgical cases from a single surgeon. Retrospective review of medical records of last clinic visits. Participants: One hundred and ninety-seven eyes of patients underwent placement of 350-mm2 Baerveldt implant. Methods: The medical records of consecutive patients who underwent placement of a Baerveldt 350-mm2 glaucoma drainage device (GDD) at the International Specialist Eye Centre from 2007 to 2014 were reviewed. Patients with a minimum 1-year follow-up were included. Baseline characteristics, pre-operative and post-operative IOP, number of glaucoma medications, visual acuity (VA) and complications were recorded. The pre-operative IOP is compared with the IOP at 1, 2, 3 and 5 years. Measures: The IOP, VA, supplemental medical therapy, complications and success and failures were recorded. Results: One hundred and ninety-seven patients were followed up at 1-year post-operation, 157 patients at 2 years, 120 at 3 years and 37 at 5 years. The mean baseline IOP of 29.2 ± 10.6 mmHg was significantly reduced at all time points post-operatively. Mean number of glaucoma medications was significantly lower at last follow-up than pre-operatively (1.8 vs. 2.7). Conclusions: Placement of GDDs effectively reduces IOP without much long-term complication and may be useful in glaucomatous eyes with considerably elevated pre-operative IOP not well controlled with maximal medical therapy in the Asian population.

scholarly journals Effects of COVID-19 on the Gut and the Liver - A Case Series of 711 Patients in New York City

2020 ◽  
Author(s):  
Sher Nazir Baig ◽  
Fuad Abaleka ◽  
Stephanie Herrera ◽  
Mina Daniel ◽  
Nigusse ◽  
...  
Keyword(s):  
New York ◽  
Abdominal Pain ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Medical Center ◽  
Laboratory Data ◽  
Case Series ◽  
Mild Degree ◽  
Digestive Disturbance ◽  
Upper Abdominal

Abstract Background As the COVID-19 epidemic is wreaking havoc with a staggering number of infections and fatalities worldwide, digestive symptoms are increasingly coming to the limelight. However, the data on the extent of gut and liver involvement has been variable and somewhat conflicting.Methods We identified 711 adults who had tested positive for COVID-19 at Richmond University Medical Center in New York between March 13 and May 13, 2020. We analyzed their clinical and laboratory data from electronic medical records.Results The average age of the patients was 60.5 years; 55% were men. 27.1% reported a gastrointestinal (GI) symptom and 56.9% had at least one abnormal liver enzyme. The most common was diarrhea with a frequency of 17.3% followed by nausea 16.2% and vomiting/anorexia 13.7%. Abdominal pain 5.6%, dysgeusia 3.2%, and GI bleeding 2.2% was the least common. Symptoms were mostly mild and lasted 3-5 days. The liver function was deranged in more than half of the patients. AST alone was elevated in 16.6%, both AST/ALT 15.7%, alkaline phosphatase 23%, and bilirubin 10%. Potential confounders were rare but included preexisting liver disease and hepatotoxic medications. Prothrombin time (PT) was mildly elevated in 13.4%. The lipase was elevated in 2.4% without upper abdominal pain. In 75%-90% of cases, liver test abnormalities were mild (1.5-3 x normal). Overall, 86.6% of patients were admitted primarily with respiratory failure and 28.5% died of their illness.Conclusions 27% of COVID-19 patients experienced a digestive disturbance and >55% showed a predominantly mild degree of liver dysfunction and cholestasis.

scholarly journals Noninvasive thermal evaluation for shunt failure in the emergency room

2019 ◽  
Vol 10 ◽  
pp. 254
Author(s):  
Jordan Xu ◽  
Cassie Poole ◽  
Ronald Sahyouni ◽  
Jefferson Chen
Keyword(s):  
Emergency Room ◽  
Medical Center ◽  
Case Series ◽  
Shunt Revision ◽  
Thermal Sensor ◽  
Shunt Failure ◽  
Retrospective Case ◽  
Cerebrospinal Fluid Flow ◽  
Shunt Flow

Background: Ventriculoperitoneal shunts (VPSs) have been the mainstay of treating hydrocephalus since the 1950s. However, shunts have a reported complication rate reaching nearly 50%. Devices have been developed that utilize noninvasive thermal transcutaneous diffusion technology. These shunt evaluation devices measure temperature gradients to detect shunt cerebrospinal fluid flow. We assessed the utility using a thermal diffusion technique to work up shunt failure in the emergency room (ER). Methods: This was a retrospective case series at a single medical center ER. We included consecutive patients with possible VPS malfunction who were evaluated with a thermal sensor. The time period of data collection included September 2015–April 2018. Results: Eight patients were reviewed, including four males and four females. The average age of reviewed patients was 35.1 (+/− ; 16.5). In our case series, three patients had adequate shunt flow as assessed by the shunt evaluation device, and the decision was made to discharge the patient and follow-up in clinic. In two patients, the flow was diminished, but due to other reassuring signs, the patients were still discharged with follow-up. Two patients were noted to have poor flow and were admitted for shunt revision. Conclusion: It is important to determine whether a malfunction is present and whether an intervention is necessary for patients who present to the emergency department with possible symptoms of shunt failure. A thermal sensor is a fast and noninvasive tool in the evaluation of shunt flow and helps determine whether it is safe to send a patient home or intervene appropriately.

Medium-term tamponade with vitrectomy and perfluorodecalin for the management of complex retinal detachments

2020 ◽  
pp. 112067212094510
Author(s):  
Luke K Chehade ◽  
Brad Guo ◽  
Weng Chan ◽  
Jaqjit Gilhotra
Keyword(s):  
Retinal Detachment ◽  
Medical Records ◽  
Case Series ◽  
Visual Outcome ◽  
Medium Term ◽  
Retrospective Case ◽  
Retinal Tears ◽  
Safe Technique ◽  
Anatomical Success

Purpose: To describe the clinical presentation, anatomical and visual outcome of a series of patients in our department with complex retinal detachments, managed with vitrectomy and perfluorodecalin (PFD) for medium-term tamponade. Study design: Retrospective case series. Methods: Retrospective analysis of the medical records of all patients in the last 6 years presenting with complex retinal detachment managed with vitrectomy where PFD was used as a medium-term tamponade. Results: A total of 85 eyes in 85 patients were included in the study, with a mean follow-up period of 16.0 ± 2.67 months (range 3–59). About 26 detachments presented with associated PVR-C, and 10 had giant retinal tears. The location of the retinal detachment was inferior in 40% of cases, and total in 18.9% of cases. Anatomical success, defined as retinal reattachment at 12 months, was achieved in 98.8% of cases, and there was a mean improvement in BCVA of logMAR 0.64 ± 0.20, which was statistically significant ( p < 0.001, paired t-test 6.23). Of the 41 phakic eyes included in the study, 20 underwent cataract surgery within the follow-up period. Conclusion: In this case series, we have demonstrated a 98.8% anatomical success and significant improvement in BCVA, with no reports of retinal toxicity. Medium-term tamponade PFD appears to be an efficacious and safe technique for management of a variety of complex retinal detachments, including those secondary to GRT, the presence of PVR-C, inferior location, tractional, traumatic, and re-detachments.

Odontogenic Keratocyst: A Clinical Entity With Favorable Response to Active Decompression and Distraction Sugosteogenesis

2021 ◽  
pp. 194338752110352
Author(s):  
Juan-Pablo Porte ◽  
Lidia M. Guerrero ◽  
Bonifacio Rivera ◽  
Andres Wiscovitch ◽  
Jaime Castro-Núñez
Keyword(s):  
Medical Center ◽  
Maxillofacial Surgery ◽  
Case Series ◽  
Signs And Symptoms ◽  
Oral And Maxillofacial Surgery ◽  
Retrospective Case ◽  
Area Index ◽  
Average Percentage ◽  
Case Series Study

Objective: The purpose of this study was to determine the usefulness of active decompression and distraction sugosteogenesis (ADDS) for the management of non-syndromic odontogenic keratocysts (OKC). Materials and Methods: A retrospective case series study was designed and implemented. The study observed the Declaration of Helsinki on medical protocol and ethics and it was approved by the university’s Institutional Review Board (IRB). The medical files of all patients who underwent ADDS for OKCs of the jaws at the Department of Oral and Maxillofacial Surgery of a tertiary university-affiliated medical center were reviewed. Data were collected on patient’s age, gender, presenting signs and symptoms, lesion location, locularity, pre-ADDS, size of the lesion, post-ADDS, pain, days with bloody discharge and/or proteinaceous fluid inside the system’s external unit, days to achieve hermetic seal, size of the lesion 2 weeks after ADDS, percentage of reduction, patient’s complaints/complications, and follow-up period. Pre- and post-ADDS panoramic radiographs were reviewed for reduction parameters. Results: Six patients, 5 males and 1 female, with an average age of 45.16 years (range 16-74 years) were studied. ADDS was performed during 4 weeks in all patients. During the therapy, the extraoral unit collected blood during 2.83 days in average. In average, after the third day, the cystic cavity started to drain a proteinaceous fluid for about 9.33 days (range 6-15 days). The average pre-ADDS Standard Lesional Area Index (SLAI) was 18.17 cm2 (range 4.40 cm2-34.58 m2) and, after 2 weeks of ADDS, the average SLAI was 5.47 cm2 (range 0.49 cm2-15.39 cm2). The average percentage of reduction, after 2 weeks, was 73.93% (range 55.49%-97.51%), which yielded an overall good reaction of OKCs to ADDS. No significant reduction of the lesions was observed from week 2 to week 4, when ADDS ceased. All lesions were enucleated after 3 months. After an average of 14 months of follow-up (12 to 17 months), no signs of recurrence have been observed.

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