Resultados anatómicos y refractivos en pacientes tratados por retinopatía del prematuro / Anatomical and refractive outcomes in patients with treated retinopathy of prematurity

Objetivos: Describir los resultados anatómicos y refractivos en un grupo de pacientes tratados por retinopatía del prematuro (ROP) con bevacizumab intravítreo o láser. Métodos: Estudio multicéntrico, prospectivo y observacional. Se incluyó a pacientes tratados por ROP en el Hospital Roberto del Río. Los pacientes con menos de 6 meses de seguimiento fueron excluidos. Los pacientes con zona II posterior, zona I o retinopatía agresiva posterior (AP-ROP) fueron tratados con bevacizumab intravítreo. El resto fueron tratados con láser. El seguimiento fue hecho cada 3 meses, e incluyó fondo de ojo, refracción y test de Teller. Resultados: Se incluyeron 144 ojos de 72 pacientes. Un total de 49 fueron tratados con láser y 23 con bevacizumab. Un caso (1,4%) tratado con láser progresó a un desprendimiento de retina etapa 4 b y requirió vitrectomía bilateral. Otros 45 casos tuvieron ROP de tipo 1; 16 enfermedad umbral y 11 AP-ROP. La mediana de edad gestacional fue de 26 semanas (rango 23-30) y la mediana de peso de nacimiento fue de 800 g (rango 405-1.350). La mediana de seguimiento fue de 10 meses (rango 6-28). La mediana del Teller fue de 3,2 ciclos/cm (rango 0,32-13). Del total, 16 casos (22%) presentaron miopía de -6 D o más. La mediana de la esfera fue de -1,75 D (rango -16,00 a +3,50 D) y la mediana del cilindro fue de 0,00 (rango -4,5 a +1,5 D). El éxito anatómico se logró en 71 pacientes (98,6%). Conclusión: El tratamiento con láser o bevacizumab intravítreo como tratamiento primario en ROP es altamente eficaz. El éxito anatómico se alcanzó en la mayoría de los pacientes. Los resultados visuales obtenidos por test de Teller muestran buenos resultados (AU)

Objective: To describe the anatomical and refractive outcomes after treatment with intravitreal bevacizumab or laser in a patient cohort with retinopathy of prematurity (ROP). Methods: A multicentre, prospective, and observational study was performed on patients with ROP treated at Hospital Roberto del Río. Those patients with less than 6 months of follow-up were excluded. Cases with posterior zone II, zone I ROP, and aggressive posterior ROP (AP-ROP) were treated with intravitreal bevacizumab. All other patients were treated with laser. Follow-up was performed every 3 months, and included fondo evaluation, refraction, and Teller tests. Results: The treated group included 144 eyes of 72 patients, of whom 49 were treated with laser and 23 with intravitreal bevacizumab. One (1.4%) patient from the laser group progressed to stage 4 b retinal detachment and required bilateral vitrectomy. Of the remainder, 45 cases had type 1 ROP, 16 had threshold disease, and 11 had AP-ROP. The median of gestational age was 26 weeks (range 23-30), and median of birth weight was 800 g (range 405-1350). Median follow-up was 10 months (range 6-8). The Teller test median was 3.2 cycles/cm (range 0.32-13). There were 16 (22%) cases with a myopic refraction of -6 D or more. The sphere median was -1.75 D (range -16.00 to +3.50 D) and the cylindrical median was 0.00 (range -4.5 to +1.5 D). Anatomical success was achieved in 71 (98.6%) of patients. Conclusion: Treatment with laser or intravitreal bevacizumab is a highly successful primary treatment for ROP. Anatomical success can be achieved in most cases. Treated patients develop frequent and severe refractive defects, which should be corrected. Vision outcome, measured using the Teller preferential test, shows good results (AU)

Anatomical and refractive outcomes in patients with treated retinopathy of prematurity. / Resultados anatómicos y refractivos en pacientes tratados por retinopatía del prematuro.

OBJECTIVE: To describe the anatomical and refractive outcomes after treatment with intravitreal bevacizumab or laser in a patient cohort with retinopathy of prematurity (ROP). METHODS: A multicentre, prospective, and observational study was performed on patients with ROP treated at Hospital Roberto del Río. Those patients with less than 6months of follow-up were excluded. Cases with posterior zone II, zone I ROP, and aggressive posterior ROP (AP-ROP) were treated with intravitreal bevacizumab. All other patients were treated with laser. Follow-up was performed every 3 months, and included fondo evaluation, refraction, and Teller tests. RESULTS: The treated group included 144 eyes of 72 patients, of whom 49 were treated with laser and 23 with intravitreal bevacizumab. One (1.4%) patient from the laser group progressed to stage 4b retinal detachment and required bilateral vitrectomy. Of the remainder, 45 cases had type 1 ROP, 16 had threshold disease, and 11 had AP-ROP. The median of gestational age was 26 weeks (range 23-30), and median of birth weight was 800g (range 405-1350). Median follow-up was 10 months (range 6-8). The Teller test median was 3.2 cycles/cm (range 0.32-13). There were 16 (22%) cases with a myopic refraction of -6 D or more. The sphere median was -1.75 D (range -16.00 to +3.50 D) and the cylindrical median was 0.00 (range -4.5 to +1.5 D). Anatomical success was achieved in 71 (98.6%) of patients. CONCLUSION: Treatment with laser or intravitreal bevacizumab is a highly successful primary treatment for ROP. Anatomical success can be achieved in most cases. Treated patients develop frequent and severe refractive defects, which should be corrected. Vision outcome, measured using the Teller preferential test, shows good results.

Long-term morbidity associated with delayed treatment of first admission schizophrenic patients: a re-analysis of the Camarillo State Hospital data.

BACKGROUND: The authors examined data from a follow-up study of first admission schizophrenic patients treated with and without antipsychotic medications, who were discharged from the hospital within 6 months. It was predicted that patients who did not require antipsychotic medications for discharge would have a more favourable long-term outcome. METHODS: The subjects were part of the Camarillo State Hospital study conducted by May and colleagues in the late 1950s and early 1960s. Patients had been randomly assigned to treatment with and without antipsychotic medications. The number of rehospitalization days and total prescribed chlorpromazine equivalents were calculated for each patient for the 2 years following discharge. In order to assess patients' continuing ability to function, 11 patients from each group who met DSM-IV criteria for schizophrenia were matched for age, educational status at first admission, race, and gender; their Global Assessment of Functioning Scale (GAF) score was estimated across a period of 6-7 years following discharge. RESULTS: During the second year following discharge, patients initially treated with antipsychotic medications required fewer rehospitalization days than the initially non-medicated patients. Furthermore, 6-7 years following initial discharge, those patients initially treated with medications were functioning at a higher level, as measured by GAF scores, than patients not initially treated with antipsychotic medications. CONCLUSIONS: The results of this study suggest that, at least for this subgroup of patients, early treatment with antipsychotic medications both decreases the immediate morbidity associated with schizophrenia, and prevents detrimental changes possibly related to prolonged untreated psychosis.

Research careers in child psychiatry: an update on five NIMH workshops.

To foster research in child psychiatry, the National Institute of Mental Health and the American Academy of Child and Adolescent Psychiatry sponsored three workshops in 1981-82 and two others in 1984. Overall, 60 trainees and several senior researchers participated. A 30-month follow-up of the careers of 34 residents who participated in the first three workshops and a description of the workshops were published earlier. This report summarizes the nature and degree of postworkshop activities of 23 additional child psychiatrists involved in the 1984 workshops, along with the needs, problems, and sources of help that they recognized as important. Promising is the fact that the vast majority were involved in research and research training and employed in academic settings.

Schizophrenia. A follow-up study of the results of five forms of treatment.

Two hundred twenty-eight first-admission schizophrenic patients were randomly assigned to the following five treatments: psychotherapy alone, drug alone, psychotherapy plus drug, electroconvulsive therapy (ECT, and milieu. A there- to five-year follow-up examined their course after release from the hospital. The drug alone and ECT groups tended to have the best outcome and the psychotherapy alone group the worst. The positive effect from prior drug treatment began to dissipate after three years postadmission. For the in-hospital treatment successes, the advantage from drug treatment and the disadvantage from psychotherapy were less apparent. Overall, the follow-up outcome is far from reassuring, whatever the type of treatment. Even though a few patients may do well, much remains to be done in and out of the hospital.

Detection of early onset neonatal hypocalcaemia in low birth weight infants by Q-Tc and Q-oTc interval measurement.

In 26 infants born in the 28th to 34th (mean 32nd) week of gestation, with a weight ranging from 1130 to 1980 (mean 1560) g, the correlation between the plasma level of total calcium and the Q-Tc and Q-oTc ECG intervals was studied within 72 (mean 12.5) hours after birth. The Q-Tc interval correlated with the total calcium (r = -0.41, p less than or equal to 0.01) and so did the Q-oTc interval (r = 0.56, P less than or equal to 0.01). Sensitivity of the detection of hypocalcaemia when using the Q-Tc interval sensitivity was 77% and specificity 94.4%. After administration of calcium to five infants suffering from an early form of symptomatic hypocalcaemia, a shortening of the corrected intervals occurred in four cases, while in one a paradoxical prolongation ensued. The changes were not seen on the display. The use of Q-oTc is suitable for the screening of early hypocalcaemia in low birth weight infants and it allows a timely initiation of therapy without delay.

And if that doesn't work, what next ...? A study of treatment failures in schizophrenia.

A systematic study of schizophrenic patients who did not respond satisfactorily to one of five different forms of treatment given under controlled conditions showed that almost all of them responded satisfactorily to subsequent treatment with the combination of ataraxic drugs and group psychotherapy. Whatever the original form of treatment, and despite subsequent retreatment with drugs and group psychotherapy, there was a treatment-resistant core--a few patients who either responded very slowly or who improved relatively little.

Therapist characteristics and the outcome of treatment in schizophrenia.

The broad task of identifying and characterizing specific components of personality and behaviours of therapists that may be differentially helpful in the treatment of schizophrenia still remains to be addressed. This report presents data systematically collected in the course of a controlled study of the outcome of five different treatment methods in schizophrenia. Therapists seem to play a significant role in determining the outcome of the treatment of schizophrenia by drugs and by psychotherapy plus drugs. The salient therapist behaviors that seem to make a difference in outcome are yet to be identified and studied. The A-B dimension as customarily defined seems of little value for this task. The findings show a distinct need to identify cognitive and affective personality characteristics of the therapist relevant to eliciting patient cooperation, and the degree of knowledge and sophistication in the use of particular methods of treatment necessary for good results.

For better or for worse? Outcome variance with psychotherapy and other treatments for schizophrenia.

It has been suggested that psychotherapy makes some persons better and some worse, and that this might account for the findings of some studies that there was no significant difference between the mean improvement scores of psychotherapy and control groups. The results of a controlled study indicate, however, that psychotherapy alone did not significantly increase outcome variance in schizophrenia by comparison to a control group. In fact, there was a nonsignificant tendency to decreased variability. Ataraxic drugs alone, psychotherapy plus ataraxic drugs, and ECT had significant variance-reducing effects. There is no convincing evidence, either in the literature or from the findings of this study, that a greater outcome variability results from psychotherapy than that resulting from hospitalization and nursing care (control). Our findings support the view that by comparison with a control group, a treatment for schizophrenia reduces outcome variance in proportion to its efficacy on the particular criterion under study.

Schizophrenia--a follow-up study of results of treatment. I. Design and other problems.

This is the first of a series of articles on a follow-up study of the results of treatment of schizophrenia, studied over a period of two to five years after first admission and first release. The study compares the follow-up outcome of five different treatment methods given to first-admission male and female schizophrenic patients in the hospital. The design of the study is used as a basis for description and discussion of the practical, ethical, and statistical problems involved. A distinction is made between follow-up and continued treatment design, and it is concluded that both pose massive problems in execution, analysis, presentation, and interpretation.

Schizophrenia--a follow-up study of results of treatment.

This is the second article from a study of the outcome of five different methods of treatment for schizophrenia; patients were followed up over a period of two to five years after first admission and the first release. Patients who had been originally treated in hospital with psychotherapy alone stayed longer in hospital over the follow-up period than those who had received electroconvulsive therapy (ECT), drug alone, or drug plus psychotherapy. Those who had been treated with milieu therapy also had a longer stay dated from the time of admission. Patients treated initially with drugs or ECT showed a trend toward spending less time in hospital after their release.