Patterns of reflux in gastroesophageal reflux disease in pediatric population of New South Wales.

This study is to determine the association of ambulatory pH monitoring (24hr pH) with symptoms of gastroesophageal reflux and its other investigations. The clinical and epidemiological profiles of subjects referred for reflux disorders are also studied. Symptoms or group of symptoms, profiles and prior investigations of 1259 consecutive pediatric subjects (with 1332 24hr pH studies performed) referred for evaluation of reflux disorders between 1988 and 2012 were retrospectively studied. Chi-square or fisher exact test was used for hypothesis testing, student t-test for the comparison of means and the Wilcoxon rank-sum test for comparing medians of continuous variables. Gastroesophageal reflux disease (GERD), defined as reflux causing major symptoms and complications, was diagnosed in 57.5% subjects of the total sample. Forty-three percent were girls and 56.7% were boys. The most common age group was between 4 months and 2 years (51.2%). Vomiting (64.4%) and irritability (74%) were the most common symptoms with the neurological conditions (23.2%) being the most frequent underlying condition. The parameters used in 24hr pH were significantly higher in those diagnosed with GERD (P < 0.0001). The prevalence of GERD was found to be significantly higher when both gastrointestinal and respiratory symptoms were present (P = 0.008) at 66.4% than when compared with gastrointestinal (56.5%) and respiratory (52.2%) symptoms in isolation. Symptoms alone were not reliable in diagnosing GERD. Only 57.5% had GERD among patients referred for reflux disorders. 24hr pH is reliable and should be considered routine in reflux disorders, as it identifies patients with pathologic reflux and avoids a needless surgery.

Aganglionosis with the absence of hypertrophied nerve fibres predicts disease proximal to rectosigmoid colon.

PURPOSE: The gold standard for the diagnosis of Hirschsprung's disease (HSCR) is the pathologic evaluation of a rectal biopsy that demonstrates the absence of ganglion cells and nerve fibre hypertrophy. However, it has been frequently reported that hypertrophic nerves may not be present in some variants like long-segment HSCR, total colonic aganglionosis, premature and very young infants. The aim of this study was to determine this association. METHODS: We performed a retrospective review of the HSCR database at our tertiary care children's hospital from 2000 to 2013. In order to analyse the relationship between the diameter of the nerve fibres and the level of aganglionosis, we classified the patient sample into two groups-fibres ≤40 and >40 µm. The groups were statistically compared with P < 0.05 being significant. RESULTS: Rectal biopsies of 92 patients confirmed as HSCR with definitive operation performed at the same institution were reviewed. The mean nerve diameter was 50.1 µm (range 20-87.5 µm). Nerve fibre diameter ≤40 µm was predictive of transition zone above the sigmoid colon. A specificity of 77.3 % and a likelihood ratio of 2.03 supported this perception. No correlation was noted between nerve fibre diameter and gestational age at birth, birth weight or age at biopsy. CONCLUSION: The absence of nerve fibre hypertrophy in the presence of aganglionosis on rectal biopsy specimens is predictive of long-segment HSCR.

Diplopia as first symptom of multiple sclerosis / Diplopia como primeiro sintoma de esclerose múltipla

Purpose: To determine the frequency and clinical features of the extrinsic ocular motility changes in patients with multiple sclerosis living in the state of Sao Paulo (Brazil), consecutive cases series from 1996 to 2011. Methods: Eighty-three consecutive multiple sclerosis subjects were enrolled, aged from 17 to 59 years. All patients had a history taking and a comprehensive ocular exam. Results: Extrinsic ocular motility changes was detected in 17 (20,48%) out of 83 individuals. Diplopia as the first symptom of the disease occurred in 11 (13,25%) individuals. Conclusions: Frequency of diplopia as first symptom of multiple sclerosis is relevant. According to this statement, crucial importance should be given concerning spreading of knowledge and skills to internal medicine and general ophthalmology practicing physicians about early diagnosis of multiple sclerosis, which would reduce a delay in diagnosis of the disease and would help patients in the prognosis of the disease which they endure.

Objetivo:Determinar a frequência e as características clínicas das alterações da motilidade ocular extrínseca em indivíduos portadores de esclerose múltipla, residentes no estado de São Paulo, em série de casos consecutivos de 1996 a 2011.Métodos:Foram selecionados oitenta e três indivíduos com esclerose múltipla, com idade entre 17 e 59 anos. Todos foram submetidos à anamnese e exame ocular completo.Resultados:Alterações da motilidade ocular extrínseca foram encontradas em 17 ( 20,48%) dos 83 indivíduos. A diplopia ocorreu como primeiro sintoma da doença em 11 (13,25%) indivíduos.Conclusão:A frequência de diplopia como primeiro sintoma de esclerose múltipla é relevante. Por esse fato, é fundamental ressaltar a importância da difusão do conhecimento desse achado para a realização de diagnóstico precoce de esclerose múltipla, tanto para o oftalmologista geral, como para o médico generalista, melhorando assim o prognóstico dos pacientes que dela padecem.

Adjunct ultrasonography in children with suspected acute appendicitis: identifying the optimal target group.

BACKGROUND: Role of ultrasonography in diagnosis of acute appendicitis in children is being debated. This study was conducted ahead of a clinical trial and aimed to evaluate the adjunctive role of ultrasonography in this group. METHODS: Retrospective chart review of consecutive children undergoing appendicectomy in an Australian tertiary children's hospital over 24 months. Two study groups were: clinical assessment and clinical assessment plus ultrasonography. The accuracy of diagnosis was compared by generating estimates for sensitivity and positive predictive value using histopathology of the appendix as the reference standard. The incremental value of ultrasonography was evaluated in subgroups of gender, age and clinical severity. RESULTS: Two hundred ninety-five children (170 boys, median age 10 years) were included in the study. Negative appendicectomy rate was 17.3%; 10.4% in the clinical assessment group (n = 134) and 23% in the ultrasonography group (n = 161). Overall sensitivity for diagnosis by clinical assessment (71.4%, 95% confidence interval (CI) 63.3-79.5) was not significantly different to that using adjunct ultrasonography (77.7%, 95% CI 69.7-85.7; P = 0.29). Adjunct ultrasonography was more sensitive between 7 and 11 years (81% versus 68%, P = 0.002) and possibly in girls (86% versus 73%, P = 0.1), but did not increase the sensitivity of the diagnosis in children who presented with milder symptoms and signs. CONCLUSIONS: Adjunct ultrasonography may not increase the overall accuracy of diagnosis of acute appendicitis in children but holds promise in certain subgroups viz. between 7 and 11 years and in girls. There is an increase in negative appendicectomies following a 'non-targeted' use of ultrasonography. Future prospective trials should take cognizance of these findings in designing the subgroup analysis.

Technical tips and advancements in pediatric minimally invasive surgical training on porcine based simulations.

BACKGROUND: Minimal access techniques have transformed the way pediatric surgery is practiced. Due to various constraints, surgical residency programs have not been able to tutor adequate training skills in the routine setting. The advent of new technology and methods in minimally invasive surgery (MIS), has similarly contributed to the need for systematic skills' training in a safe, simulated environment. To enable the training of the proper technique among pediatric surgery trainees, we have advanced a porcine non-survival model for endoscopic surgery. MATERIALS AND METHODS: The technical advancements over the past 3 years and a subjective validation of the porcine model from 114 participating trainees using a standard questionnaire and a 5-point Likert scale have been described here. Mean attitude scores and analysis of variance (ANOVA) were used for statistical analysis of the data. RESULTS: Almost all trainees agreed or strongly agreed that the animal-based model was appropriate (98.35%) and also acknowledged that such workshops provided adequate practical experience before attempting on human subjects (96.6%). Mean attitude score for respondents was 19.08 (SD 3.4, range 4-20). Attitude scores showed no statistical association with years of experience or the level of seniority, indicating a positive attitude among all groups of respondents. CONCLUSIONS: Structured porcine-based MIS training should be an integral part of skill acquisition for pediatric surgery trainees and the experience gained can be transferred into clinical practice. We advocate that laparoscopic training should begin in a controlled workshop setting before procedures are attempted on human patients.

Does the surgical approach change the need for a retrograde pyelogram prior to pyeloplasty?

OBJECTIVE: The opinion on the use of retrograde ureteropyelography (RUPG) prior to routine pyeloplasty for an ureteropelvic (UPJ) obstruction has been divided. This study analyses the efficacy of a preoperative RUPG and determines if a dorsal lumbotomy (DL) approach offers any advantage in this situation. METHODS: This is a retrospective analysis of application of RUPG prior to pyeloplasty in children with ages ranging from 42 days to 16.2 years who underwent surgery at the Children's Hospital at Westmead between 2009 and 2013. RESULTS: We identified a total of 95 children with isolated UPJ obstruction, with 59 (62.1%) boys and 36 (37.8%) girls. Overall, open pyeloplasties were performed in 89 (42 DL: 47 loin incision) and the rest (n = 6) laparoscopically. Preoperative RUPG was performed in 58 (61%) and it provided additional information in 11 (18.9%) patients for whom the surgical approach was modified. Hospital stay, operative time, and time to full diet were shorter with the DL approach (p < 0.05). CONCLUSIONS: The current study suggests that RUPG is avoidable if the approach for pyeloplasty is through the conventional loin incision. The short-term advantages might rationalize the use of RUPG if a DL incision is employed.

Hepaticoduodenostomy versus hepaticojejunostomy after resection of choledochal cyst: a systematic review and meta-analysis.

BACKGROUND: Excision has been established as a standard management practice for choledochal cysts in the last few decades. The two most commonly performed methods of reconstruction after excision are hepaticoduodenostomy (HD) and Roux-en-Y hepaticojejunostomy (HJ), of which the HJ is favored by most surgeons. Evidence concerning the optimal method of reconstruction is, however, sparse. MATERIALS AND METHODS: Studies comparing outcomes from HD and HJ after choledochal cyst excision were identified by searching Medline, Ovid, Search Medica, Elsevier Clinicalkey, Google Scholar and Cochrane library. Suitable studies were chosen and data extracted for meta-analysis. Outcomes evaluated included operative time, hospital stay and incidence of postoperative bile leak, cholangitis, reflux/gastritis, anastomotic stricture, bleeding, intestinal obstruction and re-operative rate. Pooled odds ratios (OR) were calculated for dichotomous variables; pooled mean differences (MD) were measured for continuous variables. RESULTS: Six retrospective studies were included in this meta-analysis, comprising a total of 679 patients, 412 of whom (60.7%) underwent HD, and the remainder, 267 (39.3%) underwent HJ. Although, HD group had slightly shorter hospital stay (MD: 0.30; 95% CI: -0.22-0.39; P < 0.00001) it showed a higher incidence of postoperative reflux/gastritis (OR: 0.08; 95% CI: -0.02-0.39; P = 0.002). However, the other outcomes such as bile leak, cholangitis, anastomotic stricture, bleeding, operative time, reoperation rate and adhesive intestinal obstruction did not differ between HD and HJ groups. CONCLUSIONS: HD shows higher postoperative reflux/gastritis than HJ but a shorter hospital stay. There are few good-quality studies that compare the outcomes from HD and HJ, meaning that caution should be exercised in the generalization of the results of this meta-analysis, which suggests HD to be comparable with HJ in terms of other complications, operative benefits and outcomes.

Low-grade fibromyxoid sarcoma, a deceptively benign tumor in a 5-year-old child.

Low-grade fibromyxoid sarcoma (LGFMS) is very uncommon in the pediatric population with only 20% of reported cases under the age of 18. The youngest reported case to date has been in a 4-year-old child. Lesions are usually slow growing and asymptomatic, and locations described in children have included paravertebral, thigh and intrathoracic. Although benign in appearance, these lesions can behave aggressively, with local recurrence and distant metastases primarily to lungs. These lesions can be resistant to the usual chemotherapy and radiotherapy with surgical resection being the treatment of choice. We report a case of a 5-year-old boy who presented with a mass in the left buttock.

Porcine models for pediatric minimally invasive surgical training--a template for the future.

Pediatric minimally invasive surgery is a rapidly developing field with a steep learning curve for each new procedure that is developed and integrated into practice. The European consensus is that the training across the learning curve should not be on the patients. Simulation is a widely accepted methodology to shorten the learning curve. Training on animal models is an advanced form of simulation. This helps to reduce morbidity and the costs of patient care. This article describes our 3 years of experience in the development of animal models for training in pediatric minimally invasive surgery.

The validity of testicular catch-up growth and serum FSH levels in the long-term postoperative assessment of laparoscopic varicocele correction in adolescents.

BACKGROUND: Postoperative assessment after varicocele surgery in adolescence is commonly centred around catch-up growth of the testis. There is paucity of evidence on the correlation of catch-up growth with underlying testicular function in these patients. AIMS: To assess the reliability of catch-up growth of the testis as an indicator of normalization of testicular function and the utility of serum FSH levels in the long-term postoperative assessment of varicocele surgery in adolescence. MATERIALS AND METHODS: Prospective cohort study of young adults (18-27 years) who had laparoscopic varicocele correction in adolescence (11-16 years). Evaluation included serum FSH levels, scrotal ultrasonography and semen analysis. ANALYSIS: Anatomical and functional parameters of participants with equal and normal testicular size were compared to those of participants with persistent testicular hypotrophy or hypertrophy. Sensitivity and positive predictive value of postoperative serum FSH levels were estimated and elevated levels of serum FSH were checked for association with suboptimal outcomes of varicocele correction. RESULTS: The serum FSH levels of participants with unequal testicular sizes (n=6, median 6.65 IU/l), which included testicular hypertrophy (n=3, median 7.2 IU/l) and persistent testicular hypotrophy (n=3, median 6.1 IU/l), were significantly higher than the group with equal testicular sizes (n=8, median 3.5 IU/l; P=0.014, Mann-Whitney U test). Postoperative elevated serum FSH levels were significantly associated with suboptimal outcomes of varicocele surgery (P=0.015, Fisher's exact test). The test also had a high positive predictive value. CONCLUSIONS: Testicular catch-up growth may not be a reliable postoperative assessment criterion by itself. Serum FSH levels may be of value in detecting suboptimal outcomes of varicocele surgery in adolescents.

Carbon dioxide absorption and elimination in breath during minimally invasive surgery.

Carbon dioxide (CO(2)) is the gas most commonly used to inflate the body cavities during 'keyhole' surgery (e.g. laparoscopy and thoracoscopy). However, CO(2) can be absorbed, leading to increased arterial CO(2) and increased CO(2) elimination from the lungs. These increases in CO(2) are observed following a wide variety of procedures both in adults and in infants and children. Although it is usually assumed that increases in arterial or end-tidal CO(2) directly reflect absorption of CO(2) from body cavities, this is not necessarily true, as either increases in metabolically produced CO(2) or respiratory compromise making it more difficult to eliminate CO(2) could also be responsible for these changes. Recently, a new technique has been introduced which enables absorbed CO(2) to be distinguished from metabolic CO(2).

Impact of minimally invasive surgery on the pediatric surgical profession.

We conducted a survey among pediatric surgeons to examine the impact of the advent of minimally invasive surgery (MIS) on the pediatric surgical profession with respect to job satisfaction and training challenges. An invitation to participate in a web-based questionnaire was sent out to 306 pediatric surgeons. Apart from demographic details and training recommendations, parameters relevant to job satisfaction, including patient interaction, peer pressure, ethical considerations, academic progress, ability to train residents, and financial remuneration, were studied. The response rate was 38.2%. Working in a unit performing MIS was identified by 71% of respondents as the most effective and feasible modality of training in MIS. Inability to get away from a busy practice was the most common reason cited for inability to acquire MIS training. The overall responses to the job satisfaction parameters showed a positive trend in the current MIS era for patient interaction, ethical considerations, academic progress, and training residents, with a negative trend for peer pressure and financial remuneration. The enthusiastic minimally invasive surgeons (EMIS) were defined as those having more than 5 years of MIS experience and also performing more than 10% of their work using MIS. Of the 113 responses analyzed, 67 belonged to the EMIS category. Those belonging to the EMIS group were less likely to feel inadequate in training their residents, in meeting the felt needs of the patients, or to complain about peer pressure. They were more likely to consider MIS to be as relevant and beneficial in children as in adults. Embracing MIS, as represented by the EMIS group, correlated with an overall greater job satisfaction.

Hepatic derangement following N-Acetylcysteine enemas in an infant with cystic fibrosis.

We discuss an infant with MI secondary to cystic fibrosis, who was managed surgically by a double barrel ileostomy for mid - small bowel atresia and developed severe faecal impaction in the post - operative period. The faecal impaction was treated successfully with oral NAC and 0.2% NAC contrast enemas. The patient's liver function tests revealed a dramatic increase in transaminases and bilirubin contemporaneous with the administration of the enemas. The levels showed a spontaneous improvement after discontinuation. This is only the second reported case of hepatotoxicity secondary to NAC enemas in the literature. While our experience offers modest support for the use of NAC, its efficacy is not yet proven and paediatric surgeons using NAC in the enema form need to closely monitor liver function contemporaneous with this agent's administration and adjust their treatment accordingly.

Two decades of minimally invasive pediatric surgery-taking stock.

BACKGROUND: The past 2 decades have seen a rapid integration of minimally invasive surgery (MIS) to pediatric surgical practice. This study endeavored to delineate the current status of MIS in pediatric surgery. METHODS: Three hundred six pediatric surgeons were invited to participate in an anonymous Web-based survey. Apart from demographic details and opinion regarding robotic surgery, surgeons were asked to choose between "perform MIS," "do not perform MIS but recommend it," and "MIS not indicated" for common pediatric surgical conditions. RESULTS: Responses were received from 117 pediatric surgeons (38.2%). Sixty-one percent of respondents did more than 10% of their work using MIS, and 85% had more than 5 years experience in MIS. Cholecystectomy, nonpalpable testis, and exploration for abdominal pain scored highest among the positive recommendations for MIS, whereas liver tumors, biliary atresia, Wilms' tumor, and inguinal hernia scored highest among the negative recommendations for MIS. Fifty-one percent of the respondents had more than 20 years experience as a pediatric surgeon and were categorized as "senior" surgeons. Compared with the young surgeons, the senior surgeons were more likely to recommend MIS as a contraindication for simple and complicated appendicitis, reduction of intussusception, gastrostomy, fundoplication, pyloromyotomy, adhesiolysis, splenectomy, adrenalectomy, nephrectomy for dysplastic kidneys, heminephrectomy, pyeloplasty, anorectal malformations, pyeloplasty, achalasia cardia, hiatal hernia repair, lung resection, and diaphragmatic hernia repair. More than half the respondents believed that robotic surgery has a role for children in the future. CONCLUSIONS: A widespread integration of MIS into the pediatric surgical practice is evident from this study. Current practice and recommendations of the surveyed surgeons have been outlined. Significant differences between the young and senior surgeons reflect the evolving nature of the recommendations.

An optimum animal model for neonatal thoracoscopy.

PURPOSE: This study attempted to define an optimum animal model for neonatal thoracoscopy. MATERIALS AND METHODS: Seven rabbits and three 5-7-kg piglets were subjected to thoracoscopy by three pediatric surgeons. The outcome for the successful completion of esophageal anastomosis and additional procedures, including diaphragmatic plication and lung biopsy, were noted. RESULTS: Whereas esophageal anastomosis could be accomplished in all piglets, it could be achieved in only 1 rabbit. Additional procedures were possible in 2 piglets and no rabbits. Anesthetic complications were seen in 4 rabbits and 1 piglet. CONCLUSION: Our findings suggest that the piglet may be the optimum animal model for replicating neonatal thoracoscopy. The fragility of the rabbit, coupled with a limited intrathoracic working space, limits its use for thoracoscopy.

What causes intrathoracic gastric dilatation in a late-presenting diaphragmatic hernia?

A 13-year-old previously asymptomatic patient presented with abdominal pain and vomiting. Chest radiogram revealed a left intrathoracic stomach. Laparotomy confirmed a dilated, hypertrophic stomach herniating through a left Bochdalek hernia. The patient recovered after a period of prolonged gastric paresis. While highlighting the importance of considering this condition in the differential diagnosis of a cystic lesion in the chest, this article also postulates a mechanism for the hypertrophic gastric dilatation in a late presentation of a congenital diaphragmatic hernia.

Factors affecting 13C-natural abundance measurement of breath carbon dioxide during surgery: absorption of carbon dioxide during endoscopic procedures.

The aim of this paper is to review the factors which may affect breath (13)CO(2)/(12)CO(2) natural abundance in patients undergoing surgery or intensive care. Intravenous glucose administration is a major determinant of the (13)CO(2)/(12)CO(2) of breath as intravenous glucose preparations are almost all derived from cornstarch. In addition, the oxidation of endogenous substrates can affect the (13)CO(2)/(12)CO(2) ratio. During many endoscopic procedures, such as laparoscopic surgery, carbon dioxide insufflation is used to provide a working space. As medical CO(2) is relatively depleted in (13)CO(2) compared with endogenous and exogenous metabolic CO(2) sources, breath (13)CO(2)/(12)CO(2) measurements can be used to estimate CO(2) absorption during these procedures. However, all these factors may also be affected by the bicarbonate pool, making a definitive attribution of changes in breath (13)CO(2)/(12)CO(2) to a single factor problematic.

Sensibilidade do estímulo de tamanho I na perimetria computadorizada acromática para a detecção de defeitos glaucomatosos no campo visual: análise comparativa com as perimetrias de ondas curtas e acromática convencional (SITA) / Sensitivity of size I stimulus in achromatic automated perimetry for detection of glaucomatous visual field defects: a comparative analysis with short wavelength automated perimetry and standard automated perimetry (SITA)

OBJETIVO: Comparar a sensibilidade e especificidade da perimetria acromática com estímulo de tamanho I (BB-I) com a perimetria acromática convencional (estratégia SITA) e a perimetria azul-amarelo (SWAP) para o diagnóstico precoce do glaucoma. MÉTODOS: Setenta e três olhos de 73 pacientes suspeitos, glaucomatosos e normais foram submetidos às perimetrias SITA 24-2, BB-I e SWAP. Após aplicação de critérios específicos de anormalidade para interpretação dos resultados, calculou-se a sensibilidade, a especificidade e a área sob a curva ROC (Receiver Operating Characteristic) para cada um dos exames. As áreas sob as curvas ROC foram comparadas aos pares com o teste Z univariável e significância 5 por cento. RESULTADOS: O BB-I demonstrou maior sensibilidade (100 por cento) e menor especificidade (75,7 por cento). O SWAP revelou menor sensibilidade (69,4 por cento), porém maior especificidade (89,2 por cento). A comparação pareada entre as curvas ROC não revelou diferença estatisticamente significante entre as três técnicas perimétricas estudadas. CONCLUSÕES: O BB-I revelou-se eficaz na detecção de defeitos precoces de campo visual no glaucoma. Esta técnica soma-se ao armamentário semiológico disponível para o diagnóstico funcional precoce da neuropatia óptica glaucomatosa.

PURPOSE: To compare sensitivity and specificity of achromatic perimetry with size I stimulus (WW-I) with standard automated perimetry (SITA strategy) and blue on yellow perimetry (SWAP) for early diagnosis of glaucoma. METHODS: Seventy-three eyes of 73 suspects, glaucomatous and normal subjects underwent automated perimetry with SITA 24-2, WW-I and SWAP. After application of specific criteria of abnormality, sensitivity, specificity, and the area under ROC (Receiver Operating Characteristic) curve were calculated for each of the examinations. The areas under the ROC curve were compared pair-wisely with the univariable Z test and significance set at 5 percent. RESULTS: WW-I displayed the greatest sensitivity (100 percent) and the lowest specificity (75.7 percent). SWAP revealed less sensitivity (69.4 percent); specificity, however, was higher (89.2 percent). Pairwise comparison of ROC curves showed no difference. CONCLUSION: WW-I revealed good sensitivity for the detection of early glaucomatous visual field defects. This technique adds to the available armamentarium for early functional diagnosis of glaucomatous optic neuropathy.

Correlação clínica entre estrutura e função no glaucoma: classificação estrutural de Armaly e o sistema de estadiamento funcional de Brusini / Clinical correlation between structural and functional assessment in glaucoma: Armaly cup to disk ratio and Brusini glaucoma staging system

OBJETIVO: Avaliar a correlação entre a análise estrutural de Armaly e o estadiamento funcional de Brusini em pacientes glaucomatosos. MÉTODOS: Setenta e oito olhos de 42 pacientes com glaucoma de ângulo aberto realizaram exame de campo visual com o campímetro Humphrey Field Analyzer II (programa SITA 24-2) e avaliação do disco óptico com lente Volk 78D por dois examinadores independentes. O disco óptico foi classificado de acordo com a relação escavação/disco (C/D), de 0,1 a 1,0. Os valores do "Mean Deviation" (MD) e "Pattern Standard Deviation" (PSD) de cada olho foram inseridos na avaliação de estadiamento de Brusini, para estabelecer um valor de gravidade do glaucoma. A relação escavação/disco e os valores de Brusini foram colocados em diagrama para serem correlacionados (coeficiente de correlação de Spearman, rho). Os valores de Armaly foram transformados em escala logarítmica e os dados foram inseridos em um diagrama com os valores de Brusini para cada paciente. RESULTADOS: As análises de Armaly e Brusini apresentaram baixa correlação (rho=0,340). A correlação, não-logarítmica e logarítmica, entre Armaly e Brusini mostrou-se linear e baixa. CONCLUSÃO: Apesar da baixa correlação, a avaliação estrutural de Armaly e a análise funcional do estadiamento de Brusini proporcionaram medidas não independentes do glaucoma.

PURPOSE: To evaluate the correlation between Armaly's structural systems with Brusini's functional staging in glaucomatous patients. METHODS: Seventy-eight eyes of forty-two patients with primary open-angle glaucoma underwent visual field testing with the Humphrey Field Analyzer II (program SITA 24-2) and optic disc evaluation with the 78D Volk lens by two independent observers. Optic disc was stratified according to cup/disc ratio (C/D), from 0.1 to 1.0. Mean deviation (MD) and pattern standard deviation (PSD) values from each eye were plotted on Brusini's staging system to derive a value for glaucoma severity. Both cup/disc ratio and Brusini's values were plotted on a diagram to assess correlation (Spearman's rho correlation coefficient). Armaly's values were logged in a logarithmic figure and the data plotted on a diagram with Brusini's values for each patient. RESULTS: Armaly's and Brusini's systems dysplayed a poor correlation (rho=0.340). Both unlogged and logged, Armaly's versus Brusini's plots resulted in a linear and weak correlation. CONCLUSION: Despite the weak correlation, Armaly's structural system and Brusini's staging system provided non-independent measures for glaucoma evaluation.

An eighteen year follow-up after surgery for congenital microgastria--case report and review of literature.

Congenital microgastria is a rare disorder with only 59 previously reported cases in the literature. The best results are achieved by definitive surgery in the form of a Hunt-Lawrence (HL) jejunal pouch for gastric augmentation. Only 12 patients have previously undergone a HL pouch for microgastria. Long-term results after a HL pouch are not well known. We report a patient who underwent a HL pouch 18 years ago, now having a good quality of life and eating normal meals, though having a suboptimal somatic growth. It is likely that long-term results can be optimized by early gastric augmentation with a HL pouch.