scholarly journals Clinical Aspects of Prevention and Management of Primary Inferior Oblique Muscle Overaction

2019 ◽  
Vol 4 (4) ◽  
pp. 77-82
Author(s):  
I. L. Plisov ◽  
V. B. Pushchina ◽  
N. G. Antsiferova ◽  
G. V. Gladysheva ◽  
D. R. Mamulat ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Rectus Muscle ◽  
Functional Results ◽  
Oblique Muscle ◽  
Clinical Aspects ◽  
Inferior Oblique Muscle ◽  
Infantile Esotropia ◽  
Group 2 ◽  
Clinically Significant ◽  
Group 1

Background. Primary inferior oblique muscle overaction (PIOOA) may occur for various reasons and happens to 72 % patients with infantile esotropia. The criterion for the first surgical step is prevalence of vertical or horizontal deviation. The choice of tactics weakening inferior oblique muscle is ambiguous.Aims: to carry out retrospective analysis of PIOOA frequency in patients with infantile esotropia; to assess influence of esodeviation reduction by a surgical, chemodenervational or prismatic method on the existing PIOOA dynamics; to assess clinical and functional results of PIOOA treatment.Methods and methods. The retrospective analysis of 572 patients’ cases lay in assessment of PIOOA frequency and rate in patients with infantile esotropia that manifested under 9 months, with different treatment tactics. The prospective part of the research included two groups of patients. Group 1 (106 patients, 222 eyes) – studying the influence of surgical treatment of PIOOA. Group 2 (127 patients, 207 eyes) – studying the effectiveness of surgical PIOOA treatment. Conclusion. PIOOA frequency in case of different treatment tactics for patients with infantile esotropia is from 17 to 69 %, and the degree of its clinical manifestation is from 1.2 ± 0.4 to 2.6 ± 0.8. Bilateral weakening of medial rectus muscle reduces its probability up to 17–19 %, and the degree of its manifestation up to 1.2 ± 0.4. In cases of combination of PIOOA with infantile esotropia from 20 to 25° with paretic component, it is reasonable to carry out esodeviation reduction by means of bilateral recession, chemorecession or prismatic correction as the first treatment stage, whereas the rate of existing PIOOA is credibly reduced. In cases of choice of tactics, which is necessary for clinically significant reduction or elimination of PIOOA, it is reasonable to carry out chemorecession, marginal partial myotomy or myectomy depending on the PIOOA manifestation.

scholarly journals The Results of Modified Hang Back Recession Surgery in Infantile Esotropia

2021 ◽  
Author(s):  
Diğdem BEĞENDİ ◽  
Burçin KAYA ◽  
Yaşar DURANOĞLU
Keyword(s):  
Surgical Treatment ◽  
Refractive Error ◽  
Rectus Muscle ◽  
Oblique Muscle ◽  
Modified Technique ◽  
Inferior Oblique Muscle ◽  
Infantile Esotropia ◽  
Time Of Surgery ◽  
Angle Of Deviation ◽  
The Difference

Abstract PURPOSE:Bimedial rectus recession is one of the surgical treatment options for infantile esotropia. It is mainly performed with the Hang-Back technique, which has undesirable side effects. In this study, this technique has been modified, and its results are discussed.METHODS:The files of 120 patients followed with the diagnosis of infantile esotropia and treated bimedial rectus muscle recession using the modified Hang-Back technique were reviewed retrospectively. Cases were evaluated by the time of surgery, coexistence with inferior oblique muscle weakening surgery, and presence of refractive error. The factors investigated on the results of surgical treatment were determined as age, gender, amount of hyperopic refractive error, application age, amount of horizontal deviation, amount of recession, stereopsis, fusion, age of surgery.RESULTS:When the cases were divided into subgroups which were the time of surgery, the operation performed with inferior oblique weakening surgery and presence of refractive error; the difference between preoperative and postoperative 1st month, 6th month, and 1st-year angle of deviation was statistically significant in all three groups (p < 0.001).CONCLUSION:This novel technique aims to prevent unwanted movement of the muscle in the horizontal and vertical axis and a gap in the middle of the recessed muscle, seen in the classical Hang-Back technique. The difference between the preoperative and postoperative angle of deviation was statistically significant. Also, over and under-correction and the development of alphabetic pattern deviation were less common in our modified technique.

Features of surgical treatment of Brown's syndrome in children

2021 ◽  
pp. 11-16
Author(s):  
N.A. Malinovskaya ◽  
◽  
E.V. Semyonova ◽  
A. Toriya ◽  
P.A. Nikonorova ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Binocular Vision ◽  
Rectus Muscle ◽  
Oblique Muscle ◽  
Double Vision ◽  
Inferior Rectus ◽  
Inferior Oblique Muscle ◽  
Straight Position ◽  
Third Stage

Purpose. To study the features of surgical treatment of Brown's syndrome in children. Material and methods. 47 children with Brown's syndrome aged from one to 10 years were treated: 4 children had bilateral form, 43 had congenital form and 4 had acquired form. The operation was performed for 44 children. The indications for surgical treatment were double vision in a straight position, forced position of the head, impaired binocular vision. Results. Three children with acquired Brown's syndrome had a positive effect on the background of conservative treatment. Surgical treatment of Brown's syndrome was effective, but often required repeated interventions (31 patients, 70%): the first stage was weakening of the superior oblique muscle (tenotomy, recession, prolongation), the second stage was recession of the inferior oblique muscle, the third stage was recession of the contralateral inferior rectus muscles (4 patients, 9%). In a number of cases (5 children, 11%), at the outcome of surgical treatment, asymmetry of the palpebral fissures was noted due to mild enophthalmos in the operated eye (the result of weakening of the oblique muscles that «pull» the eyes out of the orbit and weakening of the contralateral inferior rectus muscle that «tightens» the eyeball). Conclusion. Surgery for Brown's syndrome is effective, but often requires reoperation. With acquired forms of Brown's syndrome, examination and the first stage of conservative treatment are required. The absolute indications for surgical treatment of Brown's syndrome are forced head position, double vision in a straight position and impaired binocular vision. Keywords: Brown's syndrome, double vision in a straight position, forced position of the head, impaired binocular vision, surgical treatment.

scholarly journals Patient-level detection of grade group ≥2 prostate cancer using quantitative diffusion MRI

2021 ◽  
Author(s):  
Allison Y Zhong ◽  
Leonardino A Digma ◽  
Troy Hussain ◽  
Christine H Feng ◽  
Christopher C Conlin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Characteristic Curve ◽  
Grade Group ◽  
Bootstrap Confidence Intervals ◽  
Patient Level ◽  
Apparent Diffusion ◽  
Spectrum Imaging ◽  
Group 2 ◽  
Clinically Significant ◽  
Group 1

Purpose: Multiparametric MRI (mpMRI) improves detection of clinically significant prostate cancer (csPCa), but the qualitative PI-RADS system and quantitative apparent diffusion coefficient (ADC) yield inconsistent results. An advanced Restrictrion Spectrum Imaging (RSI) model may yield a better quantitative marker for csPCa, the RSI restriction score (RSIrs). We evaluated RSIrs for patient-level detection of csPCa. Materials and Methods: Retrospective analysis of men who underwent mpMRI with RSI and prostate biopsy for suspected prostate cancer from 2017-2019. Maximum RSIrs within the prostate was assessed by area under the receiver operating characteristic curve (AUC) for discriminating csPCa (grade group ≥2) from benign or grade group 1 biopsies. Performance of RSIrs was compared to minimum ADC and PI-RADS v2-2.1via bootstrap confidence intervals and bootstrap difference (two-tailed α=0.05). We also tested whether the combination of PI-RADS and RSIrs (PI-RADS+RSIrs) was superior to PI-RADS, alone. Results: 151 patients met criteria for inclusion. AUC values for ADC, RSIrs, and PI-RADS were 0.50 [95% confidence interval: 0.41, 0.60], 0.76 [0.68, 0.84], and 0.78 [0.71, 0.85], respectively. RSIrs (p=0.0002) and PI-RADS (p<0.0001) were superior to ADC for patient-level detection of csPCa. The performance of RSIrs was comparable to that of PI-RADS (p=0.6). AUC for PI-RADS+RSIrs was 0.84 [0.77, 0.90], superior to PI-RADS or RSIrs, alone (p=0.008, p=0.009). Conclusions: RSIrs was superior to conventional ADC and comparable to (routine, clinical) PI-RADS for patient-level detection of csPCa. The combination of PI-RADS and RSIrs was superior to either alone. RSIrs is a promising quantitative marker worthy of prospective study in the setting of csPCa detection.

scholarly journals Differential Treatment of Nerve Root Compression Pain Caused by Lumbar Disc Herniation Applying Nucleoplasty

2010 ◽  
Vol 5;13 (5;9) ◽  
pp. 469-480
Author(s):  
Andrey Bokov
Keyword(s):  
Logistic Regression ◽  
Disc Herniation ◽  
Logistic Regression Model ◽  
Nerve Root Compression ◽  
Disc Protrusion ◽  
Group 3 ◽  
Group 2 ◽  
Clinically Significant ◽  
Disc Extrusion ◽  
Group 1

Background: Nucleoplasty is a minimally invasive intervention use to perform disc decompression in cases of nerve root compression caused by disc herniation. It is important to find rational guidelines for choosing between nucleoplasty and microsurgery. Objective: To analyze factors that may impact the results of nucleoplasty, and to validate the rational guidelines between minimally invasive treatment and open surgery. Study Design: Prospective, non-randomized, cohort study with a minimal follow-up period of 18 months. Methods: Patients were given a neurological examination, visual analogue scale and Oswestry disability questionnaire, obligatory MRI, optional RCT, and discography, only before nucleoplasty. Patients have been divided into the following groups: Group 1 – patients with a disc protrusion treated with nucleoplasty (n = 46), which has been divided into Subgroup 1A, those with a disc protrusion size ≤ 5 mm (n = 24), and Subgroup 1B, those with a disc protrusion size 6 – 9 mm (n = 22); Group 2 – patients with a disc extrusion treated with nucleoplasty (n = 27); Group 3 – patients with a disc extrusion or sequester treated with microdiscectomy (n = 65). Outcome Measures: Clinically significant outcomes were a 50% relief of pain intensity and a 40% decrease of Oswestry Disability Index (ODI). Results: A decrease of pain intensity and disability was found in all groups of patients, P < 0.0001; SP (statistical power) = 99 – 100%. Subgroups 1A and 1B showed no clinically significant differences in outcome, P = 0.99; SP = 5.3. Clinically significant results: Group 1 – 78%; 95% CI (confidence interval) [66; 90%], Group 2 – 44%; 95% CI [25; 65%], Group 3 – 93%; 95% CI [85; 98%]. Total annulus disruption increases the rate of unsatisfactory results of nucleoplasty, OR (odds ratio) = 4.5; 95% CI [1.57; 12.87] (logistic regression model, P = 0.0034). Nucleoplasty performed in cases of uncontained disc herniation (disc extrusion) have a significantly higher rate of unsatisfactory results versus microdiscectomy, OR = 19.06; 95% CI [2.29; 68.73] (logistic regression model, P < 0.0001). Limitations: This study was limited by the small number of patients in each group. Conclusion: The size of the disc protrusion does not significantly affect the outcome of nucleoplasty. The rational guideline for choosing between the 2 types of surgery is the integrity of the annulus. Key words: disc herniation, nucleoplasty, microdiscectomy, annulus integrity

scholarly journals 1314. Neonatal Serum Gentamicin Concentrations following Maternal Once-daily Gentamicin Dosing

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S669-S669
Author(s):  
Genene A Wilson ◽  
Allison Nelson ◽  
Palak Bhagat ◽  
Deborah Bondi ◽  
Pooja Shah ◽  
...  
Keyword(s):  
Serum Concentration ◽  
Compliance Rate ◽  
Retrospective Chart Review ◽  
Population Based ◽  
Serum Concentrations ◽  
Once Daily ◽  
The Mean ◽  
Group 2 ◽  
Clinically Significant ◽  
Group 1

Abstract Background Gentamicin is commonly used for peripartum infections. Given literature supporting efficacy of once-daily dosing (ODD) of 5 mg/kg for chorioamnionitis, University of Chicago Medicine made the change from three times daily dosing (TIDD) to ODD. As gentamicin readily cross the placenta, it would be expected that maternal ODD would result in higher gentamicin neonatal serum concentrations following birth. Methods This was a single-center, retrospective chart review of all neonates born to mothers receiving peripartum ODD gentamicin within 12 hours of delivery between October 2019 and March 2020. A STAT random gentamicin serum concentration was obtained upon admission in neonates when initiation of antibiotics was desired. Specific dosing recommendations (Table 1) were developed utilizing neonatal population-based pharmacokinetics. The primary outcome was initial neonatal gentamicin serum concentration at birth. Other outcomes were also evaluated. Results were evaluated in two groups based on neonatal serum concentrations of less than 2 mcg/mL (Group 1) versus 2 mcg/mL or greater (Group 2). Table 1: Neonatal gentamicin dosing algorithm Results Thirty-two mother-newborn dyads were included in this study. Baseline demographics are shown in Table 2. Newborns had a median gestational age of 39.4 weeks and median birth weight of 3.39 kilograms. The mean initial gentamicin concentration was supratherapeutic at 3.06 + 1.92 mcg/mL among all newborns (Table 3). The mean maternal dose in Group 1 (n=11) was 3.52 mg/kg (3.34, 4.77) based on actual body weight and 4.78 mg/kg (4.34, 5.18) in Group 2 (n=21) (p=0.025). The median time between maternal gentamicin administration and time of delivery varied between the groups at 0.5 hours versus 2.63 hours, respectively (p=0.005). All newborn gentamicin concentrations were less than 2 mcg/mL for maternal doses given less than 1 hour prior to delivery (n=8) (Figure 1). Overall protocol compliance rate was 81.3%. There were no significant differences in nephrotoxicity or ototoxicity between groups. Table 2. Baseline Demographics Table 3. Outcomes Figure 1. Comparison of maternal gentamicin time from administration to delivery and neonatal serum gentamicin concentrations Conclusion This study suggests peripartum ODD of gentamicin may lead to clinically significant serum concentrations in neonates if administered between 1 to 12 hours of birth. Further studies are warranted to evaluate the effects of maternal ODD of gentamicin on newborns. Disclosures All Authors: No reported disclosures

scholarly journals The role of monocyte to HDL ratio in predicting clinically significant carotid stenosis in patients with asymptomatic carotid artery disease

2020 ◽  
Vol 66 (8) ◽  
pp. 1043-1048
Author(s):  
Mustafa Yurtdaş ◽  
Yalin Tolga Yaylali ◽  
Mahmut Özdemir
Keyword(s):  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Artery Disease ◽  
Monocyte Count ◽  
Asymptomatic Carotid ◽  
Markers Of Inflammation ◽  
Group 2 ◽  
Clinically Significant ◽  
Artery Disease ◽  
Group 1

SUMMARY OBJECTIVE Monocyte count to HDL-C Ratio (MHR) and Fibrinogen to Albumin Ratio (FAR) have recently emerged as markers of inflammation in atherosclerotic diseases. Our goal was to investigate the relationships of MHR and FAR with the severity of carotid artery stenosis (CAS) in patients with asymptomatic carotid artery disease. METHODS This retrospective study consisted of 300 patients with asymptomatic CAS. Pre-angiographic MHR, FAR, and high-sensitive C-reactive protein (hsCRP) were measured. Carotid angiography was performed in patients with ≥50% stenosis on carotid ultrasonography. Patients were first split into 2 groups based on the degree of CAS and then tertiles (T) of MHR. RESULTS 96 patients had clinically insignificant CAS (<50%) (Group-1), and 204 patients had clinically significant CAS (≥50%) (Group-2). Group-2 had higher MHR, FAR, and hsCRP than group-1. Patients in T3 had higher MHR, FAR, and hsCRP than in T1 and T2. MHR, FAR, and hsCRP were correlated with each other (p<0.001, for all). MHR, FAR, and hsCRP were independent predictors of significant CAS. MHR better predicted a significant CAS than FAR and hsCRP (p<0.05). CONCLUSION Pre-angiographic MHR may be a better predictor than FAR and hsCRP in identifying a clinically significant carotid stenosis in patients with asymptomatic CAS. Patients with asymptomatic CAS and a high level of MHR should be followed-up closely to supervise risk-factor control and intensify treatment.

scholarly journals Autopsy Patients With Obesity or Metabolic Syndrome as Basic Cause of Death: Are There Pathological Differences Between These Groups?

2018 ◽  
Vol 11 ◽  
pp. 117955571879157
Author(s):  
Lucas Braz Gonçalves ◽  
Helio Amante Miot ◽  
Maria Aparecida Custódio Domingues ◽  
Cristiano Claudino Oliveira
Keyword(s):  
Metabolic Syndrome ◽  
Cause Of Death ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Clinical Aspects ◽  
Macroscopic Findings ◽  
Group 2 ◽  
Definition Of ◽  
Death Group ◽  
Group 1

Background: The objectives of this study were the evaluation of pathological characteristics of patients with obesity or metabolic syndrome (MS) as basic cause of death, associating the autopsy findings with some clinical aspects and the abdominal adipose panicle thickness. Methods: A total of 88 autopsy cases were studied, divided into 2 groups based on the main cause of death: group 1 (n = 15) obesity and group 2 (n = 73) MS. Clinical summaries of autopsy requests, macroscopic findings, and histologic sections were reviewed. Results: The definition of obesity as the basic cause of death is associated with larger thickness of the abdominal adipose panicle, being 8.5 cm ( P = .001) the best measurement, according to the receiver operating characteristic curve. Hypertensive cardiopathy ( P = .001), ischemic cardiopathy ( P = .003), coronary ( P = .008)/systemic ( P = .005) atherosclerosis, and arterial ( P = .014)/arteriolar ( P = .027) nephrosclerosis are associated with the diagnosis of MS. Steatohepatitis is associated with the diagnosis of obesity ( P = .030); however, its association with the thickness of the abdominal adipose panicle is not statistically significant ( P = .211). Conclusions: In the context of an obese patient in autopsy, pathologist may use the information about abdominal adipose panicle associated with heart, kidney, and liver findings, even macroscopic ones, to decide the basic cause death between obesity and MS.

Sign in / Sign up

Export Citation Format

Share Document