Efficacy and safety of percutaneous nephrolithotripsy in elderly patients: a retrospective study.

BACKGROUND: Percutaneous nephrolithotripsy (PCNL) is difficult to perform for elderly patients; thus, this study aimed to assess its efficacy and safety in elderly patients aged > 70 years, note any associations between outcomes and patient characteristics, and summarize relevant themes and observations. METHODS: Data from patients older than 70 years who had undergone PCNL for upper urinary tract calculi between January 2016 and January 2021 was retrospectively analyzed. Risk factors for postoperative complications and residual stones were analyzed using multivariate logistic regression. RESULTS: A total of 116 elderly patients underwent 122 PCNL operations, of which six underwent secondary PCNL operations, and all of which were successfully completed. The average age was 74.6 ± 4.3 years; the average stone size and operation time were 3.5 ± 1.8 (1.2-11 cm), and 71.8 ± 34.1 min, respectively. Of the participants, 16 or 13.8% had postoperative complications and 29 (25%) had residual stones after operation. The stone free rate was 75%. Multivariate analysis revealed that an American Score of Anesthesiology III was an independent risk factor for postoperative complications (odds ratio [OR] = 4.453, p = 0.031), and staghorn calculi were independent risk factors for postoperative residual calculi (OR = 31.393, p = 0.001). CONCLUSION: PCNL was shown to be safe and effective for elderly patients aged > 70 years. Further, ASA III was an independent risk factor for postoperative complications, and staghorn calculi were independent risk factors for postoperative residual calculi in elderly patients.

The effect of prior trabeculectomy on refractive outcomes of cataract surgery.

PURPOSE: To examine surgical and refractive outcomes of phacoemulsification with intraocular lens (IOL) implant in eyes with prior trabeculectomy. DESIGN: Retrospective observational case-control study. METHODS: The study compared eyes that underwent phacoemulsification with IOL implant at least 3 months post-trabeculectomy (n = 77) with eyes with either medically controlled glaucoma (n = 43) or no glaucoma (n = 50) at an academic institution. The main outcome measure was the difference between the expected and the actual postoperative refraction. RESULTS: Mean intraocular pressure (IOP) increased in trabeculectomy eyes from 8.7 ± 4.2 mm Hg to 10.7 ± 4.0 mm Hg (P < .0001), whereas it decreased in glaucoma control and normal control groups by 2.0 mm Hg (P = .003) and 2.1 mm Hg (P < .00001), respectively, with concurrent decrease in drops in the glaucoma control group (0.76 to 0.23, P < .0001). The difference from expected refractive outcome was -0.36 (more myopic) in trabeculectomy eyes compared with +0.23 (more hyperopic) in nonglaucoma controls and +0.40 in glaucoma controls (P < .0001). The correlation between change in IOP vs extent of refractive surprise was statistically significant (P = .01, r = -0.20). Final visual acuity was not affected by the difference in refractive error. CONCLUSIONS: The refractive surprise correlated to IOP change, with 2 mm Hg rise resulting in a -0.36 diopter shift between predicted and actual refraction. After cataract extraction, IOP decreased in controls and fewer drops were required, but IOP increased in the study group. Factors affecting refractive surprise in cataract surgery after trabeculectomy, especially IOP change and axial length, require further investigation.

Presumed primary orbital neuroblastoma in a 20-month-old female.

Neuroblastoma is the most common malignant disease of childhood, and it often arises from either the adrenal gland or along the sympathetic chain. The authors report a case of a 20-month-old female with a presumed primary neuroblastoma of the orbit. Radiologically, the tumor showed a brightly enhancing mass lesion of the left side with intraorbital, temporal extraorbital, transsphenoid, and intracranial components. Histopathologically, the tumor was composed of small round blue cells. Immunohistochemical staining was positive for neuron-specific enolase. To the best of the authors' knowledge, primary orbital neuroblastoma has only been previously reported once in children, although it has been reported twice in adults.

Caspase-8-mediated apoptosis in human RPE cells.

PURPOSE: Tumor necrosis factor (TNF)-alpha is an important cytokine associated with age-related macular degeneration (AMD) and proliferative vitreoretinopathy (PVR). TNF-alpha activates the extrinsic apoptotic pathway. In many cells, nuclear transcription factor (NF)-kappaB upregulates antiapoptotic proteins and prevents TNF-alpha-mediated apoptosis. However, retinal pigment epithelial (RPE) cells are resistant to TNF-alpha-induced apoptosis, even after specific NF-kappaB blockade. Herein, the authors investigated the role of caspase-8 in RPE cell resistance to TNF-alpha-mediated cell death. METHODS: Caspase-8 mRNA and protein expression were measured in human RPE cells, human lens epithelial cells, human trabecular meshwork (TM) cells, human choroidal endothelial cells, human uveal melanoma cells (OCM-1, 92.1 and MKT-BR), T-98G, OVCAR-3, HCT116, and Jurkat cancer cells by real-time reverse transcription-polymerase chain reaction and Western blot, respectively. RPE cells were coinfected with adenovirus encoding caspase-8 and Cre. RPE and T-98G cells were infected with adenovirus encoding mutant inhibitory (I)-kappaB and then were treated with media alone or with TNF-alpha. Cell viability was determined by WST-1 assay, and apoptosis was evaluated with DNA fragmentation assay and M30 assay. Caspase-3, -7, -9 expression and Bid protein expression after caspase-8 overexpression were examined by Western blot. RESULTS: Human RPE cell caspase-8 mRNA and protein levels were low compared with levels in nonneoplastic ocular cells and cancer cells. Overexpression of caspase-8 significantly decreased cell number, caused caspase-8 and caspase-3 activation, decreased full-length Bid, caspase-9, and caspase-7, and significantly increased DNA fragmentation and M30-positive RPE cells. Without TNF-alpha treatment, NF-kappaB blockade had no effect on caspase-8-mediated RPE cell death. In the presence of TNF-alpha, NF-kappaB blockade slightly but significantly enhanced caspase-8-mediated RPE cell death. CONCLUSIONS: RPE cell caspase-8 protein levels are low compared with levels for other cell types and may be regulated posttranscriptionally. Low caspase-8 levels may protect RPE cells from apoptosis normally and in diseases such as AMD and may promote the survival of abnormal cells in PVR. Introduction of caspase-8 into RPE cells may be a potential strategy to treat PVR.