Postoperative Esotropia: Initial Overcorrection or Consecutive Esotropia?

2017 ◽  
Vol 27 (6) ◽  
pp. 652-657 ◽  
Author(s):  
Hyeshin Jeon ◽  
Heeyoung Choi
Keyword(s):  
Risk Factors ◽  
Medical Center ◽  
Case Series ◽  
Intermittent Exotropia ◽  
Retrospective Case ◽  
Vertical Deviation ◽  
Nonsurgical Management ◽  
Group 2 ◽  
Consecutive Esotropia ◽  
Group 1

Purpose To investigate the length of time required for diagnosing consecutive esotropia rather than initial overcorrection and examine risk factors for persistent postoperative esotropia after intermittent exotropia surgery. Methods This is a retrospective case series in a tertiary medical center. Fifty consecutive patients with postoperative esotropia ≥6 prism diopters at 1 week following exotropia surgery, managed with nonsurgical management and followed up for more than 6 months from 2014 to 2015, were included. Patients were allocated to 1 of 2 groups depending on whether the postoperative esotropia was resolved at 1 month after surgery. Patients with ongoing nonsurgical management were reevaluated monthly. Timing that significant resolution occurred was assessed. Clinical characteristics and motor and sensory successes were evaluated at 6 months after surgery. Results Thirty-two patients were allocated to group 1 and 18 to group 2. Significant resolution occurred between 1 week and 1 month after surgery. Patients were older and preoperative deviation at distance was larger in group 2 than in group 1 (p = 0.006 and 0.015). A significantly larger proportion of patients in group 2 showed combined vertical deviation (p = 0.019). Motor and sensory success rates were comparable. Conclusions When initial postoperative esotropia persists for more than 1 month, it should be regarded as consecutive esotropia. Older age, a larger preoperative deviation, and concurrent vertical deviation are risk factors for persistent postoperative esodeviations. Therefore, more postoperative attention should be given to these patients.

Abstract W P21: Should We Perform Thrombectomy In Patients With Wake-up Strokes? A Case Series Using Ct Perfusion For Patient Selection

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Gabriel Vidal ◽  
James Milburn ◽  
Garrett Bennett ◽  
Vivek Sabharwal ◽  
Mustafa Al Hasan
Keyword(s):  
Risk Factors ◽  
Ct Perfusion ◽  
Medical Center ◽  
Case Series ◽  
Stroke Severity ◽  
Vessel Occlusion ◽  
Single Center Experience ◽  
Aspiration Technique ◽  
Group 2

Background and objectives: Approximately 25% of patients who present with acute ischemic stroke are wake-up strokes. These patients are often not treated with IV thrombolytics because of unclear onset of symptoms. Little data exists on endovascular therapy as acute treatment for this population, particularly with an aspiration technique. The objective of this study is to compare outcomes of patients who presented with wake-up strokes due to large vessel occlusion treated with neuroendovascular procedures versus those who received conservative treatment, based on a 2-year (2012-2013), single center experience at Ochsner Medical Center in New Orleans, LA. Method: 24 consecutive patients, who presented with wake-up strokes, were outside the IV tPA window, and had both CTA confirmed intracranial LVO and CT-perfusion data upon arrival to our institution were retrospectively studied. Patients with hemorrhages, tandem lesions, or high-grade carotid stenosis were excluded from this analysis. Decision to perform endovascular treatment was made by the vascular neurologist and neuro-interventionalist based on stroke severity and CTA/perfusion data. Patients in group 1 (n = 8) underwent endovascular revascularization procedures; patients in group 2 (n = 16) were treated conservatively (medical management alone). Presentation NIHSS, risk factors, mortality, discharge NIHSS, discharge mRS, and follow up mRS were compared. Results: There were no statistical differences in patient population regarding age, gender, and risk factors. There was no statistical difference in their initial NIHSS (16.8 vs. 21.8, p=0.05162), or mortality (0% vs 21%, pr=0.262). The two groups were statistically different in their discharge NIHSS (7.25 vs 21.81, p<0.00045), discharge mRS (2 vs 5, p<0.00001), clinic follow up mRS (1.37 vs 4.94, p<0.00001), and good outcome at discharge (mRS 0-2)(75% vs 0%, pr<0.0002). Conclusion: Patients with wake-up strokes, LVO, and favorable CT-perfusion data who underwent neuroendovascular reperfusion treatment had significantly better outcomes in our population, despite similar stroke severity at presentation. This suggests that with careful selection, neuroendovascular therapy for wake-up strokes may lead to improved outcomes.

scholarly journals 353. A Comparison Study of Prevalence and Risk Factors for Nonalcoholic Fatty Liver Disease (NAFLD) and Nonalcoholic Steatohepatitis (NASH) by Transient Elastography (TE) in HIV-Infected Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S186-S186
Author(s):  
Sunny Choe ◽  
Hend Al-Saleh ◽  
James Fallon ◽  
Herbert Galang ◽  
Justin Mathew ◽  
...  
Keyword(s):  
Risk Factors ◽  
Transient Elastography ◽  
Medical Center ◽  
University Hospital ◽  
Lower Percentage ◽  
Strand Transfer ◽  
Nonalcoholic Fatty Liver ◽  
Virus Load ◽  
Group 2 ◽  
Group 1

Abstract Background There are limited data on the prevalence and risk factors of NAFLD and NASH in HIV-infected individuals receiving ART. A large study on this subject was presented at Glasgow 2018, from the University Hospital of Palermo (UHP). Methods We prospectively collected data on epidemiology, comorbidities, CD4, HIV virus load and ART from November 2017 to September 2018 in patients undergoing TE examination with Controlled Attenuation Parameter (CAP) in our HIV clinic at Saint Michael’s Medical Center in Newark, NJ. We used the same parameters to define NAFLD and fibrosis severity that were used for the UHP (CAP >248 dB/m and TE > 7.1 Kpa). We present comparative data between those 2 cohorts. Results We enrolled 624 consecutive HIV-infected individuals (group 1) their baseline epidemiologic characteristics were not significantly different from the UHP cohort (group 2) for age and sex. Prevalence of NAFLD was 51.6% in group 1compared with 42.7% in group 2, and the prevalence of significant fibrosis in those with NAFLD was 31% in group 1, and 23% in group 2. The main differences we found between those 2 cohorts were race: group 1, 68% black and group 2, 87% White, incidence of Diabetes mellitus was 20% in group 1, and 6% in group 2, despite the fact that BMI was not significantly higher in group 1. Other important differences were the mean time on ART, it was 5 years longer for group 1. Finally, there was a trend for a higher incidence of hypertension, a lower percentage of patients with Virus load < 20 c/mL, a lower mean CD4 count, and a higher percentage of integrase strand transfer inhibitors current users in group1. Conclusion NAFLD prevalence is alarming high in patients with HIV disease, it is of utmost importance to understand its natural history, in order to prevent the potentially severe consequences of NASH. Our study suggests that a longer duration on ART might correlate with higher incidence of NAFLD, which would suggest better monitoring of liver health with new ART. Disclosures All authors: No reported disclosures.

scholarly journals Sensor driven-position adaptive versus conventional spinal cord stimulation in failed back surgery syndrome: a retrospective case series

2019 ◽  
Vol 55 (1) ◽  
Author(s):  
Mert Akbas ◽  
Haitham Hamdy Salem ◽  
Tamer Hussien Emara ◽  
Bora Dinc ◽  
Bilge Karsli
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Case Series ◽  
Failed Back Surgery Syndrome ◽  
Retrospective Case ◽  
Treatment Groups ◽  
Failed Back Surgery ◽  
Back Surgery ◽  
Group 2 ◽  
Group 1

Abstract Background Failed back surgery syndrome (FBSS) is a common problem affecting 20–40% of cases undergoing spine surgeries. Spinal cord stimulation (SCS) has been shown to be an efficient and relatively safe treatment in managing many intractable chronic pain syndromes. Objectives This study compares the efficacy and safety of MR-compatible sensor driven-position adaptive SCS and conventional SCS in treating FBSS. Methods This is a retrospective case series of 120 consecutive FBSS patients who underwent SCS between February 2011 and March 2018. Pain levels, analgesic/opioid use, and sleep problems were assessed before and 3 months after the procedure in patients who received either conventional SCS (group 1; n = 62) or sensor-driven position adaptive SCS (group 2; n = 34). The degree of patient satisfaction, the change in the activities of daily living (ADLs) together with the rate of complications were compared in both treatment groups. Results The two treatment groups were homogenous at baseline. Patients in both groups improved significantly regarding pain, opioid consumption, sleep, and ADLs. The magnitude of improvement was statistically higher in group 2. An absolute reduction of 6 points on the VAS in patients who received position adaptive SCS vs a 3.3 point reduction in conventional SCS cases (p < 0.0001). Half of the patients in group 2 (n = 17) showed excellent satisfaction after the procedure versus 14.5% of cases in group 1 (n = 9). Conclusion SCS is an efficient and reliable treatment in FBSS. MR-compatible sensor driven-position adaptive SCS can be a more effective treatment in this patient group.

scholarly journals Comparative Epidemiological Profile of Elderly and Non-elderly Patients Operated on Chronic Subdural Hematoma

2020 ◽  
Vol 31 (3) ◽  
pp. 191-200
Author(s):  
Mauro Takao Marques Suzuki ◽  
Mirian Conceição Moura ◽  
Luiz Augusto Casulari
Keyword(s):  
Elderly Patients ◽  
Hospital Stay ◽  
Subdural Hematoma ◽  
Young Patients ◽  
Case Series ◽  
Chronic Subdural Hematoma ◽  
Retrospective Case ◽  
Group 2 ◽  
Epidemiological Profile ◽  
Group 1

Background: Traumatic brain injury is a severe condition in elder patients. Young patients usually have better prognosis compared to the elderly. Head trauma might represent an initial event that leads to death in this population. Objective: To evaluate was to evaluate the epidemiological profile of elderly patients operated on chronic subdural hematoma (CSDH). Methods: This is a descriptive, observational and retrospective case series. The use of anticoagulant and antiplatelet drugs, length of hospital stay, mortality and CSDH recurrence, among others, were the evaluated variables. Results: A total of 328 patients had their records assessed. Patients younger than 60 years formed group 1 (n=102) and those older than 60 years formed group 2 (n=226). Ageing is correlated to higher mortality. Acetylsalicylic acid and anticoagulant drugs usage in both groups did not correlate to worse outcomes. In group 2, there were 33 deaths during hospital stay (14.6%) and 14 deaths within one year after surgery (6.2%). Only one death was registered in group 1. Conclusion: Ageing is an important isolated prognostic factor.

Predicting Failure of Nonoperative Treatment for Insertional Achilles Tendinosis

2017 ◽  
Vol 11 (3) ◽  
pp. 252-255 ◽  
Author(s):  
James F. Stenson ◽  
Christopher W. Reb ◽  
Joseph N. Daniel ◽  
Sundeep S. Saini ◽  
Mohammed F. Albana
Keyword(s):  
Risk Factors ◽  
Standard Deviation ◽  
Corticosteroid Injection ◽  
Case Series ◽  
Nonoperative Treatment ◽  
Retrospective Case ◽  
Duration Of Symptoms ◽  
Multiple Modalities ◽  
Achilles Tendinosis ◽  
Nonsurgical Management

Nonoperative treatment for midportion Achilles tendinosis is well defined by the literature. Multiple modalities are described for the management of insertional Achilles pathology, but no consensus exists regarding efficacy. Surgical intervention for insertional Achilles tendinosis (IAT) is successful greater than 80% of the time. Our objective was to risk stratify patients who would fail nonsurgical management of IAT and thus benefit progressing to surgery. We reviewed the records of 664 patients with IAT. The cohort was 53% male and 80% obese. Mean age was 53.7 years (standard deviation 14.7 years). Average duration of symptoms was 10.4 months (standard deviation 28 months). Of the parameters collected, 4 were found to correlate with failing nonoperative treatment: visual analog scale, limited ankle range of motion, previous corticosteroid injection, and presence of Achilles tendon enthesophyte. We found that as the number of risk factors increased so did the chance of failing nonoperative treatment. With all 4 parameters, chance of failing conservative treatment was only 55%. Thus, nonoperative management should be exhausted until surgery is the only remaining option. However, the presence of one of the aforementioned risk factors can aid a surgeon in the decision to pursue surgery in the appropriate clinical scenario. Levels of Evidence: Level IV: Retrospective Case series

Minimal renal pelvis dilation in cats diagnosed with benign ureteral obstruction by antegrade pyelography: a retrospective study of 82 cases (2012–2018)

2021 ◽  
pp. 1098612X2098398
Author(s):  
Charles Lemieux ◽  
Catherine Vachon ◽  
Guy Beauchamp ◽  
Marilyn E Dunn
Keyword(s):  
Renal Pelvis ◽  
Ureteral Obstruction ◽  
Urine Culture ◽  
Case Series ◽  
Clinical Findings ◽  
Retrospective Case ◽  
Antegrade Pyelography ◽  
Imaging Results ◽  
Group 2 ◽  
Group 1

Objectives The aim of the study was to describe renal pelvis (RP) and ureteral ultrasonographic measurements in a population of cats with confirmed benign ureteral obstruction (UO) by antegrade pyelography. The secondary objective was to further describe clinical findings associated with minimally dilated obstructed kidneys in an attempt to better understand its occurrence. Methods Retrospective case series of cats diagnosed with benign UO were confirmed by antegrade pyelography. Medical records were reviewed and signalment, diagnostic imaging results, serum creatinine (SCr) concentration and urine culture results were recorded. Each obstructed kidney was categorized into two groups: group 1 included all RP measurements ⩽4 mm and group 2 included all RP measurements >4 mm. Results A total of 82 cats with 114 obstructed ureters met the inclusion criteria. Fifty (61%) cats had a unilateral UO and 32 (39%) had a bilateral UO. Thirty (26%) kidneys were included in group 1 while 84 (74%) were included in group 2. Nine (8%) kidneys had an RP dilation ⩽2 mm. Median RP and ureteral diameters were 6.6 mm (range 1.1–37.0 mm) and 3.2 mm (range 0.0–11.0 mm), respectively. RP size correlated positively with ureteral diameter in the study population ( P <0.0001), but not in group 1 when analyzed separately ( P = 0.47). UO was secondary to stones in 80 (70%) ureters. Seventeen (21%) cats had a positive urine culture. At admission, 79 (96%) cats were azotemic with a median preoperative SCr concentration of 444 µmol/l (range 108–1326 μmol/l). The mean (95% confidence interval [CI]) preoperative SCr concentration was significantly higher in group 1 (762 µmol/l [498–1165 μmol/l]) than in group 2 (409 µmol/l [333–502 μmol/l]). RP size in the two groups correlated negatively with preoperative SCr concentration ( P = 0.0002). Conclusions and relevance Feline UO may be associated with minimal RP dilation and the severity of RP and ureteral dilation can be highly variable. Absence of significant RP dilation does not rule out UO in cats.

scholarly journals Chronic Parenchymal Lung Changes after COVID-19 Infection

2021 ◽  
Author(s):  
Abdelfattah Touman ◽  
Mohammed Khayat ◽  
Adeeb Bulkhi ◽  
Mutaz Khairo ◽  
Wael Alyamani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Multivariate Analyses ◽  
Invasive Mechanical Ventilation ◽  
Nasopharyngeal Swab ◽  
Retrospective Case ◽  
Medical City ◽  
Group 2 ◽  
Parenchymal Lung ◽  
Group 1

Abstract Background: Persistent parenchymal lung changes are an important long-term sequela of COVID-19. There are limited data on the disease characteristics and trajectories. This study aims to evaluate persistent COVID-19-related parenchymal lung changes after 10 weeks of acute viral pneumonia and to identify its risk factors. Methods: This was a retrospective case-control observational study involving 38 COVID-19 confirmed cases using nasopharyngeal swab reverse-transcriptase-polymerase-chain-reaction (RT-PCR) at King Abdullah Medical City (KAMC) hospital, Makkah. Patients were recruited from the Post-COVID interstitial lung disease (ILD) clinic. Referral to this clinic was based on the pulmonology consultants’ assessment of hospitalized patients suspected of developing COVID-19-related ILD changes during hospitalization. Measurements and Main Results: Nineteen patients with persistent parenchymal lung changes after 10 weeks of the acute illness (group-1) were compared with 19 control patients referred for assessment of post-COVID-19 ILD and had accelerated clinical and/or radiological features (group-2). Group-1 was found to have more severe clinical and radiological disease, with higher peak value of inflammatory biomarkers. Two risk factors were identified, NLR >3.13 at admission increases the odds ratio (OR) of chronic parenchymal changes by 6.42 and 13.09 in the univariate and multivariate analyses, respectively. Invasive mechanical ventilation had a more profound effect with ORs of 5.92 and 44.5 in the univariate and multivariate analyses, respectively.Conclusion: Herein, persistent parenchymal lung changes were observed in several patients 10 weeks after acute COVID-19 infection. We found that only receiving invasive mechanical ventilation and NLR >3.13 at admission were strong risk factors for persistent parenchymal lung changes.

Preservation of retinoblastoma group E eyes with neovascular glaucoma using intravenous chemotherapy: risk factors and outcomes

2019 ◽  
pp. bjophthalmol-2018-313442 ◽  
Author(s):  
Raksha Rao ◽  
Santosh G Honavar ◽  
Vijayanand Palkonda Reddy
Keyword(s):  
Risk Factors ◽  
Univariate Analysis ◽  
Case Series ◽  
Neovascular Glaucoma ◽  
Orbital Cellulitis ◽  
Intravenous Chemotherapy ◽  
Duration Of Symptoms ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Background/aimTo report the outcomes of retinoblastoma group E eyes with neovascular glaucoma (NVG) treated conservatively with intravenous chemotherapy and investigate factors associated with eye salvage and secondary enucleation.MethodsThis is a retrospective, comparative, interventional case series. The outcome measures were life salvage, eye salvage and vision salvage.ResultsOf the 37 eyes managed by intravenous chemotherapy, secondary enucleation was necessary in 21 eyes (group 1) and eye salvage was possible in 16 eyes (group 2). A comparison of both groups revealed significant difference with group 1 demonstrating greater duration of symptoms (18.8 weeks vs 5.4 weeks, p=0.016), greater intraocular pressure (IOP) at presentation (36 mm Hg vs 30 mm Hg, p=0.044), greater increase in corneal diameter (1.52 mm vs 0.50 mm, p=0.013) and the presence of sterile orbital cellulitis (9 vs 1, p=0.023). Further, the risk factors for secondary enucleation by univariate analysis were duration of symptoms >10 weeks (p=0.003), presenting IOP >26 mm Hg (p=0.045), buphthalmos (p=0.014) and sterile orbital cellulitis (p=0.023) and by multivariate analysis were age at presentation >6 months (p=0.012) and buphthalmos (p=0.017). At a mean follow-up of 20.5 months, none of the patients in either group developed systemic metastasis.ConclusionFor retinoblastoma group E eyes presenting with NVG, the chance of eye salvage with intravenous chemotherapy is better when the age at diagnosis is <6 months, duration of symptoms is <10 weeks, IOP is <26 mm Hg, and in the absence buphthalmos and sterile orbital inflammation.

scholarly journals Experience with Alpha-1 Proteinase Replacement Post-Lung Transplantation in Alpha-1 Antitrypsin Deficiency: A Single Center Case Series

2021 ◽  
Vol 05 (04) ◽  
pp. 1-1
Author(s):  
Kamyar Afshar ◽  
◽  
Michelle Bremer ◽  
Bharath Ravichandran ◽  
Ashley A. Feist ◽  
...  
Keyword(s):  
Pulmonary Function Tests ◽  
Case Series ◽  
Post Transplantation ◽  
Retrospective Case ◽  
Antitrypsin Deficiency ◽  
Alpha 1 Antitrypsin Deficiency ◽  
Group 2 ◽  
Lung Transplants ◽  
Alpha 1 Antitrypsin ◽  
Group 1

Alpha-1 antitrypsin deficiency (AATD) accounts for approximately 5% of lung transplants (LTx) performed annually. No studies have addressed the potential benefit of ongoing alpha-1 proteinase inhibitor (A1-PI) replacement to AATD patients post-LTx. Our primary objective was to assess potential benefits of continually administering A1-PI from pre- to post-transplantation for AATD LTx recipients. A retrospective case series was performed on AATD LTx recipients between 2002 and 2018. Data reviewed included date of A1-PI initiation, pulmonary function tests, and surveillance bronchoscopies. Endpoints included the change of forced expiratory volume in one-second (FEV1), infective episodes, chronic lung allograft dysfunction (CLAD), and acute rejection episodes. Out of the 13 AATD LTx recipients, 6 continually received A1-PI beginning prior to transplant (Group 1), and 7 were re-introduced to Α1-PI a number of years after LTx (Group 2). After two years, Group 1 experienced a median FEV1% predicted decline of 0.0%, and Group 2 experienced a median decline of 15.0%. No differences noted in frequency of infective episodes. One patient in Group 1 developed CLAD about 2.5 years post-LTx, whereas all Group 2 patients developed CLAD at a mean of 5.4 years post-LTx. No Group 1 patients experienced acute lung rejection episodes noted from surveillance bronchoscopies, corresponding data not available for Group 2. We report that the continual use of Α1-PI in AATD LTx recipients is associated with better maintenance and stabilization of lung function and potentially less acute lung rejection episodes early post-LTx. Prospective studies should be performed to confirm possible benefits.

scholarly journals Continued anti-VEGF treatment does not prevent recurrences in eyes with stable neovascular age-related macular degeneration using a treat-and-extend regimen: a retrospective case series

Eye ◽  
2021 ◽  
Author(s):  
Justus G. Garweg ◽  
Peter G. Traine ◽  
Richard A. Garweg ◽  
Juliana Wons ◽  
Christin Gerhardt ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Stable Disease ◽  
Case Series ◽  
Age Related Macular Degeneration ◽  
Retrospective Case ◽  
Anti Vegf ◽  
Age Related ◽  
Group 2 ◽  
Group 1

Abstract Background The continuation of anti-vascular endothelial growth factor (anti-VEGF) treatment after achieving stability in patients with neovascular age-related macular degeneration has generally been advocated. In our own patients, we thought to assess whether continued anti-VEGF treatment is capable of preventing recurrences. Methods In this retrospective observational case series, patients with stable disease either opted to continue treatment every 12–14 weeks (Group 1) or stopped treatment with subsequent follow-up visits every 8–12 weeks (Group 2). Results Of the 103 eyes of 103 patients achieving stability, 49 eyes continued treatment (Group 1), whereas treatment was stopped in 54 eyes undergoing regular follow-up (Group 2). Recurrent disease was observed in 21 (42.9%) and 33 (61.1%) cases in Group 1 and Group 2, respectively (p = 0.08). Time between achieving stable disease and recurrence was comparable between Group 1 and Group 2 (11.1 ± 8.2 months vs. 9.2 ± 6.7 months; p = 0.43). The number of visits between achieving stability and disease recurrence was similar, but not the number of injections (3.5 ± 2.0 vs. 0.2 ± 0.4; p < 0.001). Conclusions Continuing anti-VEGF therapy after achieving functional and morphological stability every 12–14 weeks does not prevent recurrences. Patients deserve to be informed of a potential lifetime risk of recurrences, even under continued therapy.

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