scholarly journals Corneal Endothelial Changes Following Early Capsulotomy Using Neodymium:Yttrium-Aluminum-Garnet Laser

Diagnostics ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 150
Author(s):  
Hung-Chi Chen ◽  
Chia-Yi Lee ◽  
Chun-Fu Liu ◽  
Yi-Jen Hsueh ◽  
Yaa-Jyuhn James Meir ◽  
...  
Keyword(s):  
Nd:Yag Laser ◽  
Corneal Thickness ◽  
Early Group ◽  
Early Application ◽  
Nd:Yag Laser Capsulotomy ◽  
Preoperative Status ◽  
Posterior Capsular Opacity ◽  
Neodymium:Yttrium Aluminum Garnet Laser ◽  
One Year ◽  
Late Group

We aimed to survey whether the timing of neodymium:yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy would alter the corneal endothelial morphology and density. A retrospective cohort study was conducted, and 48 patients with unilateral posterior capsular opacity (PCO) and Nd:YAG laser capsulotomy performance were enrolled. The participants were divided into the early Nd:YAG group (timing ≤ 12 months, n = 20) and late Nd:YAG group (timing > 12 months, n= 28) depending on elapsed months between phacoemulsification and Nd:YAG laser capsulotomy. Endothelial cell density (ECD), coefficient of variant (CV), hexagonality (HEX), and central corneal thickness (CCT) between the two groups were collected. A generalized estimate equation was conducted to evaluate the corneal endothelial parameters between the two groups with an adjusted odds ratio (aOR) and 95% confidence interval (CI). The CDVA was improved after treatment in both groups (both p < 0.001). Chronically, ECD in the early group was significantly decreased one week after treatment (2221.50 ± 327.73/mm2 vs. 2441.55 ± 321.80/mm2, p < 0.001), which recovered to 2369.95 ± 76.37/mm2 four weeks after the treatment but was still lower than the preoperative status (p < 0.001). In addition, the HEX percentage showed a significant reduction at four weeks after treatment (p = 0.028). The ECD in the early group was significantly lower than that in the late group (aOR: 0.167, 95% CI: 0.079–0.356, p = 0.003) in both week 1 (p < 0.001) and week 4 (p = 0.004) after laser treatment. In conclusion, the early application of Nd:YAG laser capsulotomy within one year after cataract surgery may be the reason for postoperative ECD decrement without known etiology.

Survival With Respect to Morphology in Pulmonary Atresia and Intact Ventricular Septum in Sweden

2021 ◽  
Vol 12 (1) ◽  
pp. 27-34
Author(s):  
Stina Manhem ◽  
Katarina Hanséus ◽  
Håkan Berggren ◽  
Britt-Marie Ekman-Joelsson
Keyword(s):  
Pulmonary Atresia ◽  
Early Time ◽  
Ventricular Septum ◽  
Intact Ventricular Septum ◽  
Early Group ◽  
Time Period ◽  
Medical Reports ◽  
One Year ◽  
Survival Risk ◽  
Late Group

Background: Patients born with pulmonary atresia and intact ventricular septum represent a challenge to pediatric cardiologists. Our objective was to study changes in survival with respect to morphology in all children born with pulmonary atresia and intact ventricular septum in Sweden during 36 years. Methods: A retrospective, descriptive study based on medical reports and echocardiographic examinations consisting of those born between 1980 and 1998 (early group) and those born between 1999 and 2016 (late group). Results: The cohort consists of 171 patients (early group, n = 86 and late group, n = 85) yielding an incidence of 4.35 and 4.46 per 100,000 live births, respectively. One-year survival in the early group was 76% compared to 92% in the late group ( P = .0004). For patients with membranous atresia, one-year survival increased from 78% to 98%, and for muscular pulmonary atresia, from 68% to 85%. In patients with muscular pulmonary atresia and ventriculocoronary arterial communications, there was no significant increase in survival. Risk factors for death were being born in the early time period hazard ratio (HR), 6; 95% CI (2.33-14.28) P = .0002, low birth weight HR, 1.26; 95% CI (1.14-1.4) P < .0001 and having muscular pulmonary atresia HR, 3.74; 95% CI (1.71-8.19) P = .0010. Conclusion: The incidence of pulmonary atresia and intact ventricular septum remained unchanged during the study period. Survival has improved, especially for patients with membranous pulmonary atresia, while being born with muscular pulmonary atresia is still a risk factor for death. To further improve survival, greater focus on patients with muscular pulmonary atresia and ventriculocoronary arterial communications is required.

Post Transplant Lymphoproliferative Disorders (PTLD) After Lung Transplantation: Comparison of Patients with Early Versus Late Disease.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3947-3947
Author(s):  
Kitsada Wudhikarn ◽  
Carol J Holman ◽  
Anne H Blaes ◽  
Jordan M Dunitz ◽  
Marshall I Hertz ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Treatment Response ◽  
Systemic Treatment ◽  
Performance Status ◽  
Lymphoproliferative Disorders ◽  
Early Group ◽  
Post Transplant ◽  
Lung Transplants ◽  
One Year ◽  
Late Group

Abstract Abstract 3947 Poster Board III-883 The incidence and natural history of post-transplant lymphoproliferative disorders (PTLD) vary considerably after different types of organ transplantation. Lung and heart-lung transplants pose a higher risk of PTLD than kidney, pancreas or liver transplantation, most likely due to higher intensity post transplant immunosuppression. While the number of lung transplants is growing, there are only a few studies that detail PTLD in this setting. We studied 33 PTLD patients identified among 639 lung transplant recipients (5.1%) seen at the University of Minnesota between January 1985 and December 2008. The median age at diagnosis was 52 years (20-67 years); 17 cases (51%) were male. The median interval from transplantation to PTLD was 95 months (3-242 months). The great majority (91%) presented with extranodal disease; bone marrow involvement was rare (6%). Eight patients (24%) developed PTLD within one year of transplantation (early group) and predominantly had PTLD involving the allograft or other intra-thoracic organs. These patients often presented with subacute respiratory symptoms and evidence of pulmonary infiltration, raising the question of infection or allograft rejection. Twenty five patients (76%) were diagnosed more than one year after transplantation (late group) with disease mainly affecting gastrointestinal organs. Their presentations predominantly included acute abdominal symptoms and GI bleeding. Patients in both the early and late groups had advanced stage disease and high International Prognostic Index scores at diagnosis. Thirteen percent of the early group and 44% of the late group had a poor performance status (PS > 2) (p=0.107). Median LDH was 1117 U/L in the early group and 1830 U/L in the late group (p=0.204). Monomorphic diffuse large B cell lymphoma was the most common pathological diagnosis (86%) in both early and late groups. Ebstein-Barr encoded RNA (EBER) stain was positive in 20 cases (61%) and was not different between the two groups (p=0.177). For management, 31 of the 33 patients (94%) had their immunosuppression reduced and 30 patients also underwent systemic treatment, including rituximab (31%), chemotherapy (36%) or both (33%). The 3 patients who did not receive systemic treatment had progressive disease and died. Eighty seven percent of the early group and 45% of the late group achieved remission. However, there was no statistical difference in treatment response in the two groups (p=0.137). A total of 25 patients (76%) died; median survival was 9 months (0-107 months). Again, there was no statistically significant difference in survival between early and late PTLD (p=0.230). Major causes of death were infection and PTLD. Univariate analysis using the Cox proportional hazards model revealed that treatment response (p<0.001), good performance status (p<0.001) and presence of CD20 (p=0.006) were significant predictors for survival. We conclude that the incidence of PTLD after lung transplantation is high. Although there are clinical differences between those who present early or late, pathologic subtype, treatment response and survival are similar. Patients developing PTLD after lung or heart-lung transplantation have a poor prognosis, with patients dying most commonly from PTLD or infection. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Descemet stripping endothelial keratoplasty: One-year follow-up

2010 ◽  
Vol 138 (11-12) ◽  
pp. 690-693
Author(s):  
Ljubisa Nikolic ◽  
Vesna Jovanovic
Keyword(s):  
Corneal Thickness ◽  
Long Term Results ◽  
Bullous Keratopathy ◽  
Endothelial Keratoplasty ◽  
Descemet Stripping Endothelial Keratoplasty ◽  
Air Bubble ◽  
Primary Graft Failure ◽  
Internal Side ◽  
One Year

Introduction. Sutureless transplantation of endothelium on a thin stromal carrier was introduced under the name of Descemet stripping endothelial keratoplasty (DSEK) in 2004. It has become the treatment of choice of corneal oedema due to endothelial dysfunction. Objective. To investigate posterior lamellar graft attachment, central corneal thickness (CCT), astigmatism, and best corrected visual acuity (BCVA) during one-year follow-up. Methods. Surgery was performed on one eye of 11 patients with pseudophakic bullous keratopathy and Fuchs? dystrophy. The graft thick 150-200 ?m and 8.0 mm in diameter was detached manually. The carrier of the recipient cornea was created by DSEK. The graft was folded in half, introduced into the anterior orbital chamber through a 5.0 mm cut on the limbus and attached by air bubble along the internal side of the recipient cornea. CCT and astigmatism were evaluated by corneal topography, and graft attachment by biomicroscopy. Results. One year after surgery, all grafts remained attached. Primary graft failure occurred in three eyes, probably due to the crushing effect of the forceps. BCVA was 20/30 (2 eyes), and 20/40 (6 eyes), CCT 643-728 ?m, and astigmatism 1.1 D to 2.9 D. The peak values were reached three months after surgery, and did not change much afterwards. Conclusion. This is the first report on the long-term results of DSEK in our literature. The results are similar to those obtained by more experienced DSEK surgeons, and suggest that this procedure is safe and successful.

scholarly journals Benefits of early intervention with catheter ablation in patients with atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Mohanty ◽  
C Trivedi ◽  
D G Della Rocca ◽  
C Gianni ◽  
B MacDonald ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Early Intervention ◽  
Catheter Ablation ◽  
Success Rate ◽  
Therapeutic Option ◽  
Superior Vena ◽  
Vena Cava ◽  
Posterior Wall ◽  
Early Group ◽  
Late Group

Abstract Background Radiofrequency catheter ablation, a widely recognized therapeutic option for atrial fibrillation (AF) has limited success rate as it is influenced by several factors including duration of AF. Purpose We evaluated the ablation success in AF patients intervened early versus late in the disease course. Methods Consecutive AF patients undergoing their first catheter ablation in 2015–16 at our center were included in the analysis. Patients were classified into two groups based on the time to ablation after AF diagnosis; 1) early: ≤12 months and 2) late: &gt;12 months. All received PV isolation plus isolation of posterior wall and superior vena cava. Additionally, in non-paroxysmal AF cases, non-PV triggers were identified with isoproterenol-challenge and ablated. Patients were prospectively followed up for 3 years with regular rhythm monitoring. Results A total of 752 and 1248 patients were included in the “early” and “late” group respectively. Baseline characteristics of the study population is provided in Table 1 A. At 4 years of follow-up, overall success rate off-antiarrhythmic drugs was significantly higher in the “early” group (65.4% vs 57%, p&lt;0.001). After stratification by AF type, “early” group was still associated with significantly higher success rate compared to the “late” group (Table 1B). Conclusion In this large series with standardized ablation strategy, early intervention with catheter ablation was associated with higher success rate in all AF types. FUNDunding Acknowledgement Type of funding sources: None. Table 1

Delaying an Appendectomy: Is it Safe?

2012 ◽  
Vol 78 (8) ◽  
pp. 897-900 ◽  
Author(s):  
Kamal Nagpal ◽  
Navalkishor Udgiri ◽  
Niraj Sharma ◽  
Ernesto Curras ◽  
John Morgan Cosgrove ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Patient Outcomes ◽  
Early Group ◽  
Perforation Rate ◽  
Exclusion Criteria ◽  
Open Conversion ◽  
Urgent Operation ◽  
The Mean ◽  
The Relationship ◽  
Late Group

Appendicitis has always been an indication for an urgent operation, as delay is thought to lead to disease progression and therefore worse outcomes. Recent studies suggest that appendectomy can be delayed slightly without worse outcomes, however the literature is contradictory. The goal of our study was to examine the relationship between this delay to surgery and patient outcomes. We reviewed all patients that underwent an appendectomy in our institution from January 2009 to December 2010. We recorded the time of surgical diagnosis from when both the surgical consult and the CT scan (if done) were completed. The delay from surgical diagnosis to incision was measured, and patients were divided into two groups: early (≤6 hours delay) and late (>6 hours delay). Outcome measures were 30-day complication rate, length of stay, perforation rate, and laparoscopic to open conversion rate. Three hundred and seventy-seven patients had appendectomies in the study period, and 35 patients were excluded as per the exclusion criteria leaving 342 in the study: 269 (78.7%) in the early group and 73 (21.3%) in the late group. Complications occurred in 21 patients (6.1%) with no difference between the groups: 16/253 (5.9%) in the early group and 5/73 (6.8%) in the late group ( P = 0.93, χ2). The mean (± standard deviation) length of stay was 86.1 ± 67.1 hours in the early group, and 95.9 ± 73.0 hours in the late group. This difference was not significant ( P = 0.22). Delaying an appendectomy more than 6 hours, but less than 24 hours from diagnosis is safe and does not lead to worse outcomes. This can help limit the disruption to the schedules of both the surgeon and the operating room.

Inhibition of liver protein synthesis during laparoscopic surgery

1999 ◽  
Vol 277 (4) ◽  
pp. E591-E596 ◽  
Author(s):  
Hans Barle ◽  
Björn Nyberg ◽  
Stig Ramel ◽  
Pia Essén ◽  
Margaret A. McNurlan ◽  
...  
Keyword(s):  
Protein Synthesis ◽  
Laparoscopic Surgery ◽  
Synthesis Rate ◽  
Protein Synthesis Rate ◽  
Liver Protein ◽  
Early Group ◽  
Total Liver ◽  
Elective Laparoscopic Cholecystectomy ◽  
Absolute Synthesis ◽  
Late Group

Previous studies have indicated that laparoscopic surgery is associated with a decline in liver protein synthesis. In this study, the fractional synthesis rate (FSR) of total liver protein and albumin was measured in patients undergoing elective laparoscopic cholecystectomy at different times after commencing the procedure ( n = 8 + 8). Liver biopsy specimens were taken after 15 min of surgery in an “early” group and after 49 min of surgery in a “late” group. The liver FSR was higher in the early group (24.1 ± 4.7%/day) compared with the late group (19.0 ± 2.8%/day, P < 0.02). The fractional and absolute synthesis rates of albumin were similar in the two groups, 6.4 ± 1.5 vs. 6.5 ± 1.0%/day and 97 ± 19 vs. 96 ± 18 mg ⋅ kg−1⋅ day−1for the early and late groups, respectively. It is concluded that laparoscopic surgery was accompanied by a decrease in total liver protein synthesis rate, which developed rapidly during surgery. In contrast, no change in the synthesis rate of albumin was apparent during the course of surgery.

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