scholarly journals Astigmatism Characteristics and Surgical Outcomes in Younger Children With Severe Congenital Ptosis After Frontalis Suspension Surgery

2021 ◽  
Author(s):  
Yilan Tan ◽  
Xilang Wang ◽  
Jing Tang ◽  
Jianbo Xiang ◽  
Lijuan Tao ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Success Rate ◽  
Surgical Outcomes ◽  
Gradual Decrease ◽  
Congenital Ptosis ◽  
Younger Patients ◽  
Kaplan Meier ◽  
Before And After ◽  
Frontalis Suspension ◽  
Fellow Eyes

Abstract Background: To examine the astigmatism characteristics and surgical outcomes in patients with unilateral severe congenital ptosis following frontalis suspension surgery.Methods: We included 53 congenital ptosis patients who underwent frontalis suspension surgery in Hunan Children‘s Hospital. Each patient underwent a refractive examination before and after surgery to assess astigmatism. We also evaluated the effects and complications associated with the procedure.Results: Degree of astigmatism in ptotic and fellow eyes was -1.45±0.59 D and -0.66±0.51 D before surgery. Ratio of severe astigmatism in ptotic and fellow eyes was 51.3% and 12.8%. The fellow eyes presented with with-the-rule astigmatism (WR; 71.8%) and against-the-rule astigmatism (AR; 20.5%) types, with no cases of oblique astigmatism (OA). Ptotic eyes demonstrated higher frequencies of AR (59.0%) and OA (10.2%) than did fellow eyes. Furthermore, the former showed increased astigmatism, followed by a gradual decrease at the 6-month, before significantly decreasing at the 1-year postoperatively. The ratio of postoperative AR and OA astigmatism cases in ptotic eyes decreased to 35.9% and 7.7% 1 month postoperatively. However, there was a postoperative increase in the WR ratio from 30.8% to 56.4% after 1 month. Kaplan-Meier survival analysis showed a success rate of 81.4% at 6 months and 62.9% at 12 months which was influenced by the following complications: suture reaction, epithelial keratopathy, infection and granuloma, lid lag, and recurrence. Conclusion: Frontalis suspension surgery can effectively and safely correct congenital ptosis in younger patients, which may ameliorate the development of amblyopic astigmatism.

Germline BRCA1/2, PALB2, and ATM mutations in 3,030 patients with pancreatic adenocarcinoma: Survival analysis of carriers and noncarriers.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 280-280
Author(s):  
Pashtoon Murtaza Kasi ◽  
Fergus Couch ◽  
William R Bamlet ◽  
Chunling Hu ◽  
Steven Hart ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Pancreatic Adenocarcinoma ◽  
Final Analysis ◽  
Parp Inhibitors ◽  
P Value ◽  
Pathogenic Variants ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Before And After ◽  
Brca1 Brca2

280 Background: Patients with pancreatic adenocarcinoma (PDAC) can have mutations in breast cancer associated genes ( BRCA1/2) and other homologous recombination (HR) pathway genes. The therapeutic significance of these mutations for PDAC patients is not yet established. We performed a comprehensive survival analysis of 3,030 unselected PDAC patients comparing non-carriers and carriers of BRCA1/2, PALB2, and ATM mutations. Methods: We analyzed germline DNA samples and outcomes from confirmed PDAC patients recruited from 1999-2014 into the Mayo Clinic SPORE in Pancreatic Cancer registry. A total of 3,046 genomic DNA samples were analyzed by next generation sequencing. All pathogenic variants were validated by Sanger sequencing. Survival analysis of PDAC patients with and without BRCA1, BRCA2, PALB2, or ATM germline mutations was performed using the Kaplan-Meier method and log-rank tests. Hazard ratios (HR) were calculated using Cox proportional hazard modeling adjusted for co-variates including age, sex, and stage. A p-value < 0.05 was considered statistically significant. Pre- and post-FOLFIRINOX eras were defined as before and after June 1, 2011. Results: A total of 139 (4.6%) patients were noted to have deleterious mutations in BRCA1, BRCA2, PALB2, or ATM genes. After exclusion of patients with missing data, final analysis was restricted to 2,452 PDAC patients. Overall survival was slightly better (14.2 months versus 11.3 months) in patients with mutations as compared to those without mutations, although this finding was not statistically significant (p = 0.07). When stratified by FOLFIRINOX era, 40 patients with these mutations in the post-FOLFIRINOX era had better outcomes than 668 non-carriers (adjusted HR 0.62; 95% CI 0.43-0.89; p = 0.0062). Conclusions: Deleterious germline BRCA1/2, PALB2, and ATM mutations were seen in approximately 5% of patients with PDAC. Post-FOLFIRINOX era patients with these mutations had improved outcomes, possibly secondary to exposure to DNA-damaging chemotherapies. Germline screening of PDAC patients and development of trials incorporating this information (e.g., PARP inhibitors) has potential value for PDAC patients.

scholarly journals Survival Pattern Among Venous Thromboembolism (VTE) Patients with Hematologic Malignancy in Alberta, Canada from 2003 to 2015

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 933-933
Author(s):  
Arafat Ul Alam ◽  
Mohammad Karkhaneh ◽  
Cynthia M. Wu ◽  
Haowei Linda Sun
Keyword(s):  
Survival Analysis ◽  
Solid Tumor ◽  
Hematologic Malignancy ◽  
Myeloproliferative Neoplasm ◽  
Hematologic Malignancies ◽  
Plasma Cell Dyscrasia ◽  
Vein Thrombosis ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Before And After

Introduction: Nearly 20% of all newly identified cases of VTE is associated with cancer. Hematologic malignancies are at increased risk of developing VTE. We aimed to identify the prevalence of hematologic malignancy in VTE patients and compare the survival between VTE and non-VTE patients with or without hematologic malignancy. Methods: Using linked administrative data and a validated algorithm we identified adult VTE cases in Alberta, Canada from 2003 to 2015. We also identified patients without VTE using the same database. Subjects having ICD-10 code for hematologic malignancy and solid tumor within one year before and after the VTE index event were further identified. Cox proportional hazard regression model was applied to estimate the hazard ratio (HR) of death. The Kaplan Meier survival analysis was performed to compare survival rate among patients with different diagnosis. Results: We identified 56,907 VTE patients. Of them 37,876 (66.6%), 18,502 (32.5%) and 529 (0.9%) cases were diagnosed as deep vein thrombosis (DVT), pulmonary embolism (PE), and both DVT & PE respectively. 57.4% of the VTE patients were female. Of all VTE cases, 1647 (2.9%) patients had hematologic malignancies and 5034 (8.8%) patients had solid tumor. Of the hematologic malignancy cases 853 (51.8%) , 164 (10%), 105 (6.4%), 302(28.3%) and 223 (13.5%) had Lymphoma, leukemia, myelodysplastic syndrome (MDS), myeloproliferative neoplasm (MPN) and plasma cell dyscrasia respectively. We identified 27,664 patients without any diagnosis of VTE. Among them 586 (2.1%) and 4065 (14.7%) patients had hematologic malignancy and solid tumor, respectively. In VTE group, the hazard of death for patients with hematologic malignancy and solid tumor were 5.2 (95% CI: 4.8-5.5) and 7.5 (95% CI: 7.2-7.8) times greater than that of patients with no cancer, respectively. In the patients with no VTE, hazard of death among people with hematologic malignancy and solid tumor were 7.4 (95% CI: 6.4-8.5) and 12.4 (95% CI: 11.6-13.2) times greater than that of people with no cancer, respectively. In all hematologic malignancy and solid tumor patients, the hazard of death for patients with VTE were 1.8 (95% CI: 1.5-2.1) and 1.6 (95% CI: 1.5-1.7) times greater than that of patients with no VTE, respectively. In all patients without any cancer, those with VTE had 2.6 (95% CI: 2.4-2.7) times increased hazard of death than those without VTE. The Kaplan Meier survival analysis showed the lowest survival probability among VTE patients with solid tumor and hematologic malignancy (Log rank p&lt;0.0001). Conclusion: Lymphoma is the most common hematologic malignancy in VTE patients. VTE patients with any type of malignancy have an increased hazard of death compared to those without VTE. Disclosures Wu: BMS-Pfizer: Honoraria; Bayer: Other: Local PI for trial ; Leo Pharma: Honoraria; BMS-Pfizer: Other: Local PI for trial ; Daiichi-Sankyo: Other: Local PI for trial ; Pfizer: Honoraria; Servier: Honoraria.

scholarly journals Congenital dysplasia involving both medial and inferior recti: clinical features and surgical outcomes

2021 ◽  
Vol 14 (10) ◽  
pp. 1628-1632
Author(s):  
Li-Cheng Fu ◽  
◽  
Jian-Hua Yan ◽  
Keyword(s):  
Success Rate ◽  
Clinical Features ◽  
Surgical Outcomes ◽  
Clinical Findings ◽  
Prism Diopter ◽  
Ocular Motility ◽  
Primary Position ◽  
Correction Rate ◽  
Before And After ◽  
Cover Test

AIM: To investigate the clinical features and surgical outcomes of congenital dysplasia involving both inferior recti (IR) and medial recti (MR) muscles. METHODS: A retrospective review was conducted including cases of simultaneous congenital dysplasia of IR and MR that were diagnosed and surgically treated at the Zhongshan Ophthalmic Center, Sun Yat-sen University, China, from July 2009 to November 2019. Ocular motility, ocular alignment at distance (6 m) and near (33 cm) by prism alternating cover test and stereoacuity were assessed in all patients before and after surgery. RESULTS: A total of five patients (four males and one female; three with right eye and two with left eye congenital dysplasia) were included in this review. The patients ranged in age from 10 to 42y (21±13.4y). The main clinical findings were hypertropia and exotropia of the affected eye, along with motility limitations in adduction and depression. Lateral rectus (LR) recession/transposition combined with IR resection was performed in one case. Two scheduled surgeries were performed in four cases, with one involving superior rectus recession and IR resection and the others LR recession and MR resection. Mean±SD pre-surgical exotropia of 51.0±31.11 prism diopter (PD) and hypertropia of 29.20±7.12 PD in the primary position were decreased to 3.6±12.90 and 3.2±10.09 PD, respectively, at two years after surgery, with a success rate of 60% and an under-correction rate of 40%. CONCLUSION: The main clinical features associated with simultaneous MR/IR congenital dysplasia are hypertropia and exotropia of the affected eye along with motility limitations in adduction and depression. Scheduled two-stage surgeries achieved a success rate of 60%.

scholarly journals Survival Analysis of Radiation Therapy in Ovarian Cancer: A SEER Database Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Lushi Yu ◽  
Hongyun Gong ◽  
Qian Li ◽  
Honggang Ren ◽  
Yi Wang ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Survival Analysis ◽  
Cox Regression ◽  
The Elderly ◽  
Large Sample Size ◽  
Seer Database ◽  
Radiotherapy Group ◽  
Kaplan Meier ◽  
Before And After ◽  
Risk Predictors

Background and purpose. A large sample size study on survival analysis of radiotherapy in ovarian cancer is deficient. This study aimed to explore the survival impact of radiotherapy in ovarian cancer. Materials and methods. Data of patients diagnosed with ovarian cancer between 2010 and 2015 were collected from Surveillance, Epidemiology, and End Results (SEER) Database. Survival comparisons were analyzed using Kaplan–Meier analysis and log-rank tests. Univariate and multivariate Cox regression analyses were used to select predictors associated with survival. Propensity score matching (PSM) analysis was employed to balance baseline variables. Results. A total of 20031 ovarian cancer patients were included, with 291 (1.45%) patients who received radiotherapy. The median overall survival (OS) in patients who received radiotherapy was shorter than which in patients without radiotherapy (23 vs. 75 months, P < 0.001 ). The Elderly, nonepithelial pathology, advanced American Joint Committee on Cancer (AJCC) stage, elevated level of CA125, and receiving radiotherapy were risk predictors to survival in both multivariable analyses before and after PSM. Among 11872 patients with III/IV stage, the radiotherapy group also showed a significantly worse prognosis (median OS: 19 vs. 44 months in patients without radiotherapy, P < 0.001 ). Consistent results were observed in stratification analyses on pathology and stage among patients with III/IV stage. Conclusions. For patients with ovarian cancer, radiotherapy was associated with a poor prognosis regardless of pathology or stage. Considering this is a retrospective study, future studies concerning radiotherapy combination with other new agents in ovarian cancer are needed.

scholarly journals Surgical Outcomes in Cases of Marcus-Gunn Jaw-Winking Phenomenon

2015 ◽  
Vol 13 (1) ◽  
pp. 34-37 ◽  
Author(s):  
RP Sthapit ◽  
R Saiju
Keyword(s):  
Surgical Outcomes ◽  
Refractive Errors ◽  
Repeat Surgery ◽  
Congenital Ptosis ◽  
Frontalis Suspension ◽  
Upper Lid ◽  
One Year ◽  
Age Range ◽  
Ptosis Surgery

Background Markus-Gunn Jaw-winking Phenomenon (MGJW) is a congenital ptosis associated with synkinetic movement of upper lid on masticating movements of jaw. It results from aberrant connection between motor division of trigeminal nerve and oculomotor nerve.Objective To investigate the clinical characteristics of MGJW phenomenon and evaluate its surgical outcomes of unilateral levator excision and frontalis suspension.Method It is a retrospective analysis of nine cases of MGJW phenomenon seen from 2007 to 2013 AD. The clinical features were recorded and analysed. Unilateral levator excision and frontalis suspension for the correction of synkinesis and ptosis was done for all the patients. The result of surgery was analysed.Result MGJW phenomenon was seen more in males. All the cases had unilateral ptosis with jaw winking phenomenon. Ipsilateral hypotropia and refractive errors were seen in 44%. One week post operative margin reflex distance was good in 67% of cases. Persistent jaw-winking was seen in 3 cases, two underwent repeat surgery to abolish the synkinesis. At one year follow up, 33% had good margin reflex distance of more than 4mm and 22% had fairly good margin reflex distance of 3mm.Conclusion Patients with Marcus Gunn jaw winking synkinesis can present at a wide age range. There may be an associated vertical muscle imbalance, which should be managed before ptosis surgery to avoid ptosis under correction. Unilateral frontalis flap suspension combined levator excision can correct ptosis very well for patients with Marcus-Gunn syndrome.Kathmandu University Medical Journal Vol.13(1) 2015; 34-37

Surgical correction of severe congenital ptosis using a modified frontalis muscle advancement technique: A single-arm trial

2021 ◽  
pp. 112067212199575
Author(s):  
Lei Zhang ◽  
Mingyu Ren ◽  
Yuqing Yan ◽  
Wenjuan Zhai ◽  
Lihong Yang ◽  
...  
Keyword(s):  
Success Rate ◽  
Advancement Flap ◽  
Orbicularis Muscle ◽  
Congenital Ptosis ◽  
Inferior Margin ◽  
Field Of Vision ◽  
Vertical Incision ◽  
Registration Number ◽  
The Mean

Purpose: To describe our experience with a modified frontal muscle advancement flap to treat patients with severe congenital ptosis. Methods: Analysis of the clinical charts of 154 patients who underwent a modified frontal muscle advancement flap. The FM was exposed by a crease incision. The FM flap was created by deep dissection between the orbicularis muscle and orbital septum from the skin crease incision to the supraorbital margin and subcutaneous dissection from the inferior margin of the eyebrow to 0.5 cm above the eyebrow. No vertical incision was made on the FM flap to ensure an intact flap wide enough to cover the entire upper tarsal plate. Contour, symmetry of height, marginal reflex distance (MRD1), and complications were assessed. Mean follow-up was 10 months. Results: The mean patient age was 7.6 ± 5.6 (range, 2–18) years. The mean MRD1 was 3.2 ± 1.3 mm after the operation. All bilateral cases achieved symmetry and optimal lid contour; 17 unilateral cases were under corrected, with a success rate of 89.0%. Complications such as entropion, exposure keratitis, FM paralysis, frontal hypoesthesia, severe haematoma, and entropion were not observed in our series. Conclusion: A modified frontal muscle advancement flap produced a high success rate with a clear field of vision, mild trauma, and few complications. This technique is relatively simple and should be considered for correcting severe congenital ptosis. Date of registration: 29-03-2020 Trial registration number: ChiCTR2000031364 Registration site: http://www.chictr.org/

scholarly journals A85 THE CLINICAL IMPACT OF COVID-19 DELAYS ON PLASTIC BILIARY STENT REMOVAL IN NOVA SCOTIA

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 54-56
Author(s):  
D R Lim ◽  
M Tsai ◽  
S E Gruchy ◽  
J Jones ◽  
G Williams ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Nova Scotia ◽  
Stent Placement ◽  
Biliary Stent ◽  
Biliary Stents ◽  
Stent Occlusion ◽  
Stent Removal ◽  
Kaplan Meier ◽  
And Migration

Abstract Background The COVID-2019 pandemic continues to restrict access to endoscopy, resulting in delays or cancellation of non-urgent endoscopic procedures. A delay in the removal or exchange of plastic biliary stents may lead to stent occlusion with consensus recommendation of stent removal or exchange at three-month intervals [1–4]. We postulated that delayed plastic biliary stent removal (DPBSR) would increase complication rates. Aims We aim to report our single-centre experience with complications arising from DPBSR. Methods This was a retrospective, single-center, observational cohort study. All subjects who had ERCP-guided plastic biliary stent placement in Halifax, Nova Scotia between Dec 2019 and June 2020 were included in the study. DPBSR was defined as stent removal &gt;=90 days from insertion. Four endpoints were assigned to patients: 1. Stent removed endoscopically, 2. Died with stent in-situ (measured from stent placement to documented date of death/last clinical encounter before death), 3. Pending removal (subjects clinically well, no liver enzyme elevation, not expired, endpoint 1 Nov 2020), and 4. Complication requiring urgent reintervention. Kaplan-Meier survival analysis was used to represent duration of stent patency (Fig.1). Results 102 (47.2%) had plastic biliary stents placed between 2/12/2019 and 29/6/2020. 49 (48%) were female, and the median age was 68 (R 16–91). Median follow-up was 167.5 days, 60 (58.8%) subjects had stent removal, 12 (11.8%) died before replacement, 21 (20.6%) were awaiting stent removal with no complications (median 230d, R 30–332), 9 (8.8%) had complications requiring urgent ERCP. Based on death reports, no deaths were related to stent-related complications. 72(70.6%) of patients had stents in-situ for &gt;= 90 days. In this population, median time to removal was 211.5d (R 91-441d). 3 (4.2%) subjects had stent-related complications requiring urgent ERCP, mean time to complication was 218.3d (R 94–441). Stent removal &gt;=90 days was not associated with complications such as occlusion, cholangitis, and migration (p=1.0). Days of stent in-situ was not associated with occlusion, cholangitis, and migration (p=0.57). Sex (p=0.275), cholecystectomy (p=1.0), cholangiocarcinoma (p=1.0), cholangitis (p=0.68) or pancreatitis (p=1.0) six weeks prior to ERCP, benign vs. malignant etiology (p=1.0) were not significantly associated with stent-related complications. Conclusions Plastic biliary stent longevity may have been previously underestimated. The findings of this study agree with CAG framework recommendations [5] that stent removal be prioritized as elective (P3). Limitations include small sample size that could affect Kaplan-Meier survival analysis. Despite prolonged indwelling stent time as a result of COVID-19, we did not observe an increased incidence of stent occlusion or other complications. Funding Agencies None

scholarly journals Unilateral lateral rectus recession is an effective surgery for intermittent exotropia in young children

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Oriel Spierer ◽  
Abraham Spierer
Keyword(s):  
Young Children ◽  
Success Rate ◽  
Lateral Rectus ◽  
Intermittent Exotropia ◽  
Age At Surgery ◽  
Surgical Methods ◽  
Before And After ◽  
The Mean ◽  
Consecutive Esotropia

Abstract Background Different surgical methods have been suggested for the correction of intermittent exotropia. Unilateral lateral rectus recession has been described as a surgical alternative for small and moderate-angle exotropia. In general, previous studies did not focus on the outcomes of unilateral lateral rectus recession in young children with intermittent exotropia. The purpose of this study is to evaluate the surgical outcomes of unilateral lateral rectus recession in the treatment of moderate-angle exotropia (≤ 25 PD (prism diopters)) in children. Methods The charts of all patients younger than 12 years of age with moderate-angle exotropia (up to 25 PD) who were operated during the years 2006–2018 were retrospectively reviewed. Fifty-eight patients underwent unilateral lateral rectus recession and had a minimum follow up of 6 months. The angle of exotropia (PD) before and after surgery and the success rate were documented. Results Mean age at surgery was 6.4 ± 1.9 (range 3.5–11.0) years. Exotropia improved from a preoperative angle of 21.4 ± 4.0 PD to 3.5 ± 5.9 PD postoperatively (p < 0.001). Success rate, defined as deviation of ≤ 10 PD, was achieved in 86.2%. There were 2 (3.4%) cases of overcorrection (consecutive esotropia). There were no intra- or postoperative complications. The mean follow-up duration after surgery was 2.3 ± 1.7 years. Conclusions In children with moderate angle exotropia, good postoperative success rate was achieved by performing unilateral lateral rectus recession.

Survival Analysis of Geriatric Patients with Low Digestive Hemorrhage Attending an Emergency Department

Gerontology ◽  
2021 ◽  
pp. 1-6
Author(s):  
Ana Fernandez-Suárez ◽  
Oriol Yuguero Torres
Keyword(s):  
Emergency Department ◽  
Survival Analysis ◽  
Retrospective Study ◽  
Survival Rate ◽  
Life Expectancy ◽  
Antiplatelet Therapy ◽  
Geriatric Patients ◽  
Digestive Hemorrhage ◽  
Kaplan Meier ◽  
Number Of Individuals

<b><i>Background:</i></b> The increase in life expectancy and low mortality have doubled the number of individuals older than 65 in the last 30 years. <b><i>Methods:</i></b> We conducted a retrospective study of 101 patients older than 80 years of age treated by low digestive hemorrhage (LDH) in an emergency department during 2018. Sociodemographic variables were evaluated, as well as comorbidity and survival at 18 months. Survival was assessed by a Kaplan-Meier test. <b><i>Results:</i></b> 52.5% of the subjects were women. The average comorbidity of the sample was 1.97. The survival rate per year was 60%. The finding on colonoscopy shows no association with mortality. However, those patients on anticoagulant/antiplatelet therapy have a higher survival rate. <b><i>Conclusion:</i></b> Survival per year is high, so urgent colonoscopy for an LDH should be performed after evaluating the patient’s stability and functional status in a scheduled and outpatient manner.

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