Frequently assessed and used prognostic factors for outcome after macular hole surgery: which is better?

BACKGROUND: The aim of this retrospective study was to evaluate commonly used clinical and OCT-morphological parameters, including perifoveal pseudocysts, as prognostic factors for postoperative outcome after macular hole surgery in a retinal referral clinic in North Rhine-Westphalia, Germany. METHODS AND MATERIAL: This was a retrospective analysis of all patients who underwent surgery because of idiopathic MH between 2011 and 2017 in Augenklinik Tausendfensterhaus, Duisburg, Germany. Statistical evaluation of clinical and OCT-based parameters, including the areas of intraretinal pseudocysts, was conducted. The main statistical outcomes were surgical success and visual acuity. Only parameters with a highly significant correlation to the outcome parameters (postoperative visual acuity (VA); surgical success) in univariate analysis were entered in linear and logistic regression analyses. RESULTS: A total of 189 eyes of 178 patients (71.4% female; mean age 67.5 ± 8.2 a) who underwent surgery because of MH were included. The overall closure rate was 86.8%. The mean best corrected VA increased from 0.7 ± 0.3 logMAR before surgery to 0.5 ± 0.3 logMAR (p < 0.0001). While several clinical and OCT-based parameters as well as calculated indices showed a significant correlation with the outcome measures, the regression analysis showed that the minimum linear diameter was the only parameter that both predicted surgical success (p = 0.015) and was correlated with postoperative VA (p < 0.001). CONCLUSION: The minimum linear diameter serves as an easily assessed prognostic factor with the best predictive properties. This result is of great importance for clinical practice, as it simplifies the postsurgical prognosis.

Root canal morphology of hypomineralised first permanent molars using micro-CT.

AIM: To investigate the root canal morphology of hypomineralised first permanent molars (FPMs) using micro-CT (µCT). METHODOLOGY: Twenty-four hypomineralised FPMs and five clinically sound FPMs were scanned using µCT and assessed using the following parameters: (i) root canal configuration, (ii) connecting canal frequency, (iii) enamel, dentin, and pulp volumes, (iv) cusp tip to pulp horn distance, root canal length, root canal width, and dentin thickness, and (v) the influence of the root canal system landmarks on access cavity outline forms and canal curvature. A two-way repeated-measures analysis of variance was employed with the statistical significance set at p < 0.05. RESULTS: The frequency of accessory and connecting canals was higher in hypomineralised FPMs. Mesio-buccal cusp horn was found to be the closest to its corresponding cusp tip in both groups. There was no significant difference between the root lengths, dentine widths, and pulp space measurements of hypomineralised FPMs compared to clinically sound FPMs. The best angulation to access FPMs was straight-line radicular, along the pulp horn. CONCLUSIONS: This study illustrates some variations in the root canal morphology in hypomineralised FPMs compared to clinically sound FPMs. Future studies should focus on assessing these parameters in larger samples.

[Laser membranotomy in the management of acute premacular hemorrhage : Case report and overview on the approach]. / Lasermembranotomie beim Management einer akuten prämakulären Blutung : Fallvorstellung und Überblick zum Vorgehen.

Acute premacular bleeding is often associated with vasoproliferative retinal changes, vascular anomalies or a Valsalva maneuver. The diagnosis is made during the funduscopic examination and can if necessary be confirmed with optical coherence tomography (OCT). This article presents a case example with a sub-inner limiting membrane (ILM)/sub-hyaloidal bleeding. Furthermore, we present various treatment options and give an overview on the use of the Nd:YAG laser for laser membranotomy as a minimally invasive treatment option with a low complication profile.

Acute Thyroid Swelling in Renal Transplant Recipient.

Tuberculosis (TB) of thyroid gland is rare entity even in solid organ transplant recipients who have a high risk of TB. Thyroid TB is easily diagnosed by fine needle aspiration cytology. The majority of cases require only antitubercular drugs for treatment, and surgical intervention is required only in few patients. We here describe a case of thyroid TB presenting as an acute abscess in postrenal transplant recipient with a background of acute rejection treated with steroid and antithymocyte globulin.

Successful renal transplantation from a brain-dead deceased donor who died from snakebite: a case report.

Even though India is the country with the highest annual number of deaths (50,000) from snakebite, there is contradictory evidence regarding acceptance of deceased donors (DD) who died from this cause. We present 2 successful renal transplantations (RTx) from a brain-dead DD who died from a neurotoxic snakebite without manifestations of a viper bite. We accepted the donor as he exhibited no evidence of hematoxic snakebite. Rather the findings were consistent with a neurotoxic bite (probably krait), which can cause hypoxic brain injury. Both recipients established good diuresis intraoperatively and did not require hemodialysis. The patients were discharged with good diuresis and normal serum creatinines. After 3-month follow-up, both recipients show normal graft function. According to our experience of favorable RTx outcomes from a brain-dead DD who died from neurotoxic snakebite may expand the donor pool.

Testosterone replacement for fatigue in hypogonadal ambulatory males with advanced cancer: a preliminary double-blind placebo-controlled trial.

BACKGROUND: Uncontrolled studies show fatigue, anorexia, depression, and mortality are associated with low testosterone in men with cancer. Testosterone replacement improves quality of life and diminishes fatigue in patients with non-cancer conditions. The primary objective was to evaluate the effect of testosterone replacement on fatigue in hypogonadal males with advanced cancer, by the Functional Assessment of Chronic Illness Therapy-Fatigue subscale (FACIT-Fatigue) at day 29. METHODS: This is a randomized, double-blinded placebo-controlled trial. Outpatients with advanced cancer, bioavailable testosterone (BT) <70 ng/dL and fatigue score >3/10 on the Edmonton Symptom Assessment Scale were eligible. Intra-muscular testosterone or sesame seed oil placebo was administered every 14 days to achieve BT levels 70-270 ng/dL. RESULTS: Sixteen placebo and 13 testosterone-treated subjects were evaluable. No statistically significant difference was found for FACIT-fatigue scores between arms (-2 ± 12 for placebo, 4 ± 8 for testosterone, p = 0.11). Sexual Desire Inventory score (p = 0.054) and performance status (p = 0.02) improved in the testosterone group. Fatigue subscale scores were significantly better (p = 0.03) in those treated with testosterone by day 72. CONCLUSIONS: Four weeks of intramuscular testosterone replacement in hypogonadal male patients with advanced cancer did not significantly improve quality of life. Larger studies of longer duration are warranted.

Post-renal transplant cytomegalovirus infection: study of risk factors.

OBJECTIVES: Cytomegalovirus (CMV) is a common opportunistic infection following renal transplantation (RTx). It responds promptly to antiviral treatment. The mortality rate reaches 90% if untreated. Identification of risk factors helps in the early diagnosis of CMV. We studied demographic features, risk factors, and outcomes associated with CMV infection in RTx recipients despite ganciclovir prophylaxis. MATERIALS AND METHODS: We reviewed 720 RTx recipients between 2007 and 2009. We examined the serostatus of the donor and recipient before transplantation using an enzyme-linked immunosorbent assay, and diagnosed CMV infections in recipients by CMV DNA detection with a polymerase chain reaction. RESULTS: A total of 42 of 750 (5.6%) patients were identified to display CMV infection (69.1%) or disease (30.9%). Their mean age was 34 ± 13.5 years, with 80.9% men. CMV serologic status was D+/R- in 21.4% and D+/R+ in 59.5% patients. Fever, malaise (76.2%), and leukopenia (52.3%) were the commonest presenting symptoms; diabetes (30.9%) and hepatitis C virus (28.6%) the commonest comorbid conditions. Risk factors were triple drug immunosuppression (47.6%), antithymocyte globulin ATG induction (54.8%), and a rejection episode (26.1%) and methylprednisolone (76.2%) which were more common in CMV disease than infection. Mean CMV DNA at diagnosis was 78,803; 71.2% patients developed CMV within 6 months posttransplantation, the majority occurring after 3 months. With a mean follow-up of 4 ± 1.9 years, patient and graft survival rates were 85.7% and 81% with a mean serum creatinine value of 1.83 ± 12 mg/dL. CONCLUSIONS: Universal CMV prophylaxis was associated with a low incidence (5.6%) and mild form of CMV disease among our patients.

Clinical outcome of renal transplantation in end-stage renal disease patients with positive pretransplantation hepatitis B surface antigen.

BACKGROUND: Renal transplantation (RTx) is the best therapeutic modality for patient suffering from end-stage renal disease (ESRD) with positive pretransplantation hepatitis B surface antigen (HbsAg). We report 11 years of single-center experience on RTx vis-à-vis patient/graft survival, graft function in terms of serum creatinine (SCr), and rejection episodes in 35 ESRD patients with pretransplantation HbsAg positivity. PATIENTS AND METHODS: Thirty-five ESRD patients with pretransplantation HbsAg positivity underwent RTx at our center between 2000 and 2010. Mean recipient age was 36.06 ± 12.22 years; 30 were males and 5 were females. Mean donor age was 43.51 ± 13.63 years; 13 were males and 22 were females. The majority of donors were parents (31.42%) and spouses (22.85%). Mean HLA match was 2 ± 1.37. The most common recipient diseases leading to ESRD were chronic glomerulonephritis (51%) and diabetes (17.5%). Posttransplantation immunosuppression consisted of a calcineurin inhibitor-based regimen. RESULTS: Over mean follow-up of 6.16 ± 3.69 years, patient and graft survival rates were 71.42% and 71.42%, respectively, with mean SCr of 1.92 ± 0.62 mg% with 20% biopsy-proven acute rejection episodes. In total, 10 (28.57%) patients were lost, mainly to infections. CONCLUSION: RTx for ESRD with pretransplantation HbsAg positivity has acceptable graft function and patient/graft survival over 11 years follow-up and should be encouraged.

Outcome and prognostic factors of malaria-associated acute kidney injury requiring hemodialysis: A single center experience.

Acute kidney injury (AKI) is one of the most dreaded complications of severe malaria. We carried out prospective study in 2010, to describe clinical characteristics, laboratory parameters, prognostic factors, and outcome in 59 (44 males, 15 females) smear-positive malaria patients with AKI. The severity of illness was assessed using Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA) score, Multiple Organ Dysfunction Score (MODS), and Glasgow Coma Scale (GCS) scores. All patients received artesunate and hemodialysis (HD). Mean age of patients was 33.63 ± 14 years. Plasmodium falciparum malaria was seen in 76.3% (n = 45), Plasmodium vivax in 16.9% (n = 10), and mixed infection in 6.8% (n = 4) patients. Presenting clinical features were fever (100%), nausea-vomiting (85%), oliguria (61%), abdominal pain/tenderness (50.8%), and jaundice (74.5%). Mean APACHE II, SOFA, MODS, and GCS scores were 18.1 ± 3, 10.16 ± 3.09, 9.71 ± 2.69, and 14.15 ± 1.67, respectively, all were higher among patients who died than among those who survived. APACHE II ≥20, SOFA and MODS scores ≥12 were associated with higher mortality (P < 0.05). 34% patients received blood component transfusion and exchange transfusion was done in 15%. Mean number of HD sessions required was 4.59 ± 3.03. Renal biopsies were performed in five patients (three with patchy cortical necrosis and two with acute tubular necrosis). 81.3% of patients had complete renal recovery and 11.8% succumbed to malaria. Prompt diagnosis, timely HD, and supportive therapy were associated with improved survival and recovery of kidney functions in malarial with AKI. Mortality was associated with higher APACHE II, SOFA, MODS, GCS scores, requirement of inotrope, and ventilator support.

Outcome of deceased donor renal transplantation in diabetic nephropathy: a single-center experience from a developing country.

BACKGROUND: Type 2 diabetes mellitus (DM) is the commonest cause of end-stage renal disease (ESRD) worldwide. Renal transplantation (RTx) is the best therapeutic modality for such patients. First-degree relatives of patients with type 2 DM have high risk of diabetes/pre-diabetes. Parents are often too old to be suitable donors, and siblings/children/spouse are either not suitable/acceptable or do not come forward for organ donation. This leaves deceased donation (DD) as only suitable donors. Data scarcity on DDRTx outcome in diabetic nephropathy (DN) prompted us to review our experience. This retrospective single-center 10-year study was undertaken to evaluate patient/graft survival, graft function, rejection episodes, and mortality in these patients. MATERIALS AND METHODS: Between January 2001 and March 2011, thirty-five DN-ESRD patients underwent DDRTx in our center following cardiac fitness assessment of recipients. All patients received single-dose rabbit-anti-thymocyte globulin for induction and steroids, calcineurin inhibitor, and mycophenolate mofetil/azathioprine for maintenance immunosuppression. Mean recipient age was 49.66 ± 6.76 years, and 25 were men. Mean donor age was 50 ± 16.45 years, 23 were men. RESULTS: Over a mean follow-up of 2.28 ± 2.59 years, patient and graft survival rates were 68.5% and 88.5%, respectively, with mean SCr of 1.9 ± 0.62 mg/dl. Delayed graft function was observed in 34.3% patients, and 25.7% had biopsy-proven acute rejection; 31.5% patients died, mainly because of infections (22.8%), coronary artery disease (2.86%), and cerebrovascular events (5.7%). CONCLUSION: DDRTx in patients with DN has acceptable graft function and patient/graft survival over 10-year follow-up in our center and, therefore, we believe it should be encouraged.

Comparison of rat, mouse, guinea-pig and human slow reacting substance of anaphylaxis (SRS-A).

Slow reacting substance of anaphylaxis obtained from rat, mouse, guinea-pig and human tissues have exhibited similar biological activity and have reacted in the same way to chemical and enzymatic treatments. It is concluded that they appear to be the same substance or a similar class of compounds.

The release of prostaglandins and thromboxanes from guinea-pig lung by slow reacting substance of anaphylaxis, and its inhibition.

1 Rabbit aorta contracting substance (RCS; consisting mainly of thromboxane A2) and prostaglandin-like material were released from guinea-pig isolated perfused lungs by injection of slow reacting substance of anaphylaxis (SRS-A). 2 SRS-A was resistant to boiling and proteolytic enzymes and was therefore distinguished from rabbit aorta contracting substance releasing factor (RCS-RF). 3 The release of RCS and prostaglandin-like material by SRS-A was anatagonized by indomethacin (1 microgram/ml), betamethasone and dexamethasone (4 to 50 microgram/ml). 4 Imidazole (200 microgram/ml) inhibited the formation of thromboxane A2 but not that of prostaglandins. 5 The activity of SRS-A on guinea-pig ileum and its ability to release RCS and prostaglandins were destroyed by incubation with arylsulphatase (0.83 microgram to 1 mg/ml) and with lipoxidase (16.5 to 50 microgram/ml): SRS-A lost activity on incubation with bovine serum albumin (9 microgram/ml) due to protein binding.

Release of mediators of anaphylaxis: inhibition of prostaglandin synthesis and the modification of release of slow reacting substance of anaphylaxis and histamine.

1 When isolated perfused lungs from sensitized guinea-pigs were challenged with antigen, histamine, slow reacting substance of anaphylaxis (SRS-A) and prostaglandin-like substances were released into the effluent. 2 Treatment of the lungs before and during challenge with indomethacin (0.5--10 microgram/ml), sodium aspirin (1--10 microgram/ml), sodium meclofenamate (0.1--1 microgram/ml) or ketoprofen (0.5--5 microgram/ml) inhibited the release of prostaglandins while increasing the output of histamine and SRS-A between three- and five-fold. 3 Diethylcarbamazine (0.2--1 mg/ml) reduced the release of SRS-A and histamine but increased the amount of prostaglandin-like substances produced. 4 Eicosatetraynoic acid (10 microgram/ml) inhibited formation of prostaglandins but did not modify release of histamine and SRS-A. 5 The results with non-steroid anti-inflammatory drugs and diethylcarbamazine suggest that prostaglandins, or some other product of the cyclo-oxygenase system, depress the anaphylactic release of SRS-A and histamine.