Comparison of Risk Factors and survival of Type 1 and Type II Endometrial Cancers.

OBJECTIVE: To compare risk factors and progression free survival of type 1 & 2 endometrial cancers. METHODS: A retrospective analysis of 149 patients with early stage endometrial carcinoma treated between 1997 and 2012 in Aga Khan University Hospital, Karachi was performed. RESULTS: A total of 149 patients were analyzed. Type I tumors accounted for 92% of cases in the study while 8% were type II tumors. The mean age, BMI, parity, co-morbidities (hypertension & Diabetes), family history and history of polycystic disease were comparable in both groups. Overall better survival (113 Vs 24 months) was observed for type I endometrial cancer. CONCLUSION: Both types of endometrial cancer may share common etiologic factors. Despite the limitation of small numbers in one group this study confirms better survival in type 1 endometrial cancer.

The BIG Score and Prediction of Mortality in Pediatric Blunt Trauma.

OBJECTIVES: To examine the association between in-hospital mortality and the BIG (composed of the base deficit [B], International normalized ratio [I], Glasgow Coma Scale [G]) score measured on arrival to the emergency department in pediatric blunt trauma patients, adjusted for pre-hospital intubation, volume administration, and presence of hypotension and head injury. We also examined the association between the BIG score and mortality in patients requiring admission to the intensive care unit (ICU). STUDY DESIGN: A retrospective 2001-2012 trauma database review of patients with blunt trauma ≤ 17 years old with an Injury Severity score ≥ 12. Charts were reviewed for in-hospital mortality, components of the BIG score upon arrival to the emergency department, prehospital intubation, crystalloids ≥ 20 mL/kg, presence of hypotension, head injury, and disposition. RESULTS: 50/621 (8%) of the study patients died. Independent mortality predictors were the BIG score (OR 11, 95% CI 6-25), prior fluid bolus (OR 3, 95% CI 1.3-9), and prior intubation (OR 8, 95% CI 2-40). The area under the receiver operating characteristic curve was 0.95 (CI 0.93-0.98), with the optimal BIG cutoff of 16. With BIG <16, death rate was 3/496 (0.006, 95% CI 0.001-0.007) vs 47/125 (0.38, 95% CI 0.15-0.7) with BIG ≥ 16, (P < .0001). In patients requiring admission to the ICU, the BIG score remained predictive of mortality (OR 14.3, 95% CI 7.3-32, P < .0001). CONCLUSIONS: The BIG score accurately predicts mortality in a population of North American pediatric patients with blunt trauma independent of pre-hospital interventions, presence of head injury, and hypotension, and identifies children with a high probability of survival (BIG <16). The BIG score is also associated with mortality in pediatric patients with trauma requiring admission to the ICU.

The Auckland cataract study: co-morbidity, surgical techniques, and clinical outcomes in a public hospital service.

AIM: To prospectively assess cataract surgery in a major New Zealand public hospital by defining presenting clinical parameters and surgical and clinical outcomes in a cohort of subjects just below threshold for treatment, based upon a points based prioritisation system. METHODS: The prospective observational study comprised 488 eyes of 480 subjects undergoing consecutive cataract operations at Auckland Hospital. All subjects underwent extensive ophthalmic examination before and after surgery. Details of the surgical procedure, including any intraoperative difficulties or complications, were documented. Postoperative review was performed at 1 day and 4 weeks after surgery. Demographic data, clinical outcomes, and adverse events were correlated by an independent assessor. RESULTS: The mean age at surgery was 74.9 (SD 9.6) years with a female predominance (62%). Significant systemic disease affected 80% of subjects, with 20% of the overall cohort exhibiting diabetes mellitus. 26% of eyes exhibited coexisting ocular disease and in 7.6% this affected best spectacle corrected visual acuity (BSCVA). A mean spherical equivalent of -0.49 (1.03) D and mean BSCVA of 0.9 (0.6) log MAR units (Snellen equivalent approximately 6/48) was noted preoperatively. Local anaesthesia was employed in 99.8% of subjects (94.9% sub-Tenon's). The majority of procedures (97.3%) were small incision phacoemulsification with foldable lens implant. Complications included: 4.9% posterior capsule tears, 3.8% cystoid macular oedema, and one case (0.2%) of endophthalmitis. Mean BSCVA after surgery was 0.1 (0.2) log MAR units (6/7.5 Snellen equivalent), with a mean spherical equivalent of -0.46 (0.89) D, and was 6/12 or better in 88% of all eyes. A drop in BSCVA, thought to be directly attributable to the surgical intervention, was recorded in a small percentage of eyes (1.5%) after surgery. CONCLUSION: This study provides a representative assessment of the management of cataract in the New Zealand public hospital system. A predominantly elderly, female population, frequently exhibiting significant systemic illness and coexisting ocular disease, relatively advanced cataracts, and poor BSCVA, presented for cataract surgery. The majority of subjects underwent small incision, phacoemulsification, day case surgery. While almost 90% achieved at least 6/12 BSCVA post-surgery, approximately 5% sustained an adverse intraoperative event and 1.5% of eyes exhibited a reduction in BSCVA postoperatively.

Analyzing small-incision cataract surgery by Orbscan II fourth-dimensional pachymetry mapping.

PURPOSE: To assess the changes in pachymetry after routine corneal and scleral tunnel phacoemulsification. SETTING: Discipline of Ophthalmology, University of Auckland, Auckland, New Zealand. METHOD: This prospective study comprised 174 eyes of 174 consecutive patients having uneventful, small-incision, sutureless, phacoemulsification cataract surgery; 124 patients had a clear corneal incision and 50, a superior scleral tunnel incision. Difference pachymetry maps were derived from Orbscan II elevation topography data obtained before and 4 weeks after surgery. Corneal thickness changes at 12 midperipheral areas located in 12 meridians were derived from difference (subtraction) maps. The mean corneal thickness within a single area corresponding to the center of the surgical incision was compared to the mean pachymetry readings of all 12 midperipheral measurements. RESULTS: The overall mean midperipheral corneal thickness (12 samples per cornea) increased by a mean of 5.89 microm +/- 16.09 (SD) in the clear corneal incision group and 6.89 +/- 14.50 microm in the scleral tunnel group. The mean central corneal thickness increased by 7.28 +/- 20.98 microm and 7.74 +/- 21.34 microm, respectively. The corneal thickness in the meridian closest to the incision was significantly higher than the mean value of the 12 meridians measured in both groups, with means of 14.95 +/- 26.86 microm in the clear corneal group (P =.001) and 16.22 +/- 21.23 microm in the scleral tunnel group (P =.002). There were no statistically significant postoperative differences in the central, midperipheral, or incision-site corneal thickness measurements between the 2 surgical techniques (P =.77). CONCLUSIONS: Time-dependent (fourth-dimensional) pachymetry subtraction maps are useful for following corneal dynamics over time. This study found that small-incision phacoemulsification techniques--scleral and corneal tunnel--had a minor but similar effect on corneal thickness 4 weeks after surgery.

Sub-Tenon's anesthetic administration for cataract surgery: how much stays in?

UNLABELLED: We performed a prospective, randomized trial assessing the "remaining" volume of anesthetic solution that stays within the sub-Tenon's space after administration of 2 different volumes: 3 mL and 5 mL. The remaining volume correlated with motor block (r = 0.72; P < 0.001). The volume lost through the incision as a percentage of total volume injected was similar in both groups, suggesting sub-Tenon's space is not limited to a finite injected volume less than 5 mL and may be capable of receiving larger volumes of anesthetic to improve motor block. IMPLICATIONS: The volume of anesthetic solution remaining within sub-Tenon's space correlates with motor block. The amount of volume lost as a percentage of total administered is independent of the volume injected, suggesting sub-Tenon's space is not limited to a finite injected volume less than 5 mL and may be capable of receiving larger volumes of anesthetic to improve motor block.

Effect of volume used in sub-Tenon's anaesthesia on efficacy and intraocular pressure: a randomized clinical trial of 3 mL versus 5 mL.

PURPOSE: To compare the effect of volume used in sub-Tenon's anaesthesia on efficacy and intraocular pressure (IOP). METHODS: A prospective, randomised clinical trial was conducted on 52 eyes of 52 consecutive patients undergoing sub-Tenon's anaesthetic for cataract surgery. Eyes were randomly assigned to either 3 mL or 5 mL volume of anaesthetic solution (0.5% bupivacaine/2% lidocaine in a 50:50 mixture). The main outcome measures were akinesia 5 min post-administration of anaesthetic, changes in IOP immediately after and 5 min after anaesthetic administration, and patient pain perception during procedure. RESULTS: The level of kinesia was greater in the 3 mL group (n = 25) compared to the 5 mL group (n = 27) (P = 0.001, Mann-;Whitney U-test). There was no significant difference in pain perception between the two groups (P = 0.464, student t-test). Although there was great variation in IOP changes following sub-Tenon's anaesthetic, there was a trend for a larger rise in mean IOP immediately after anaesthetic administration in the 5 mL group (mean +/- SD +5.6 +/- 4.2 mmHg) compared to the 3 mL group (+4.3 +/- 3.8 mmHg), but this did not reach statistical significance (P = 0.25, student t-test). CONCLUSIONS: A 5 mL volume of anaesthetic provides akinesia superior to a 3 mL volume in sub-Tenon's anaesthesia for cataract surgery.