Photoscreener results with and without cycloplegia and their reliability according to biometric parameters.

PURPOSE: Our goal in this study is to compare the results of a photoscreener (Plusoptix A12C) with and without cycloplegia and to investigate its reliability as a function of biometric parameters. METHODS: In total, 250 eyes of 125 children with a mean age of 6.77±1.59years were included in the study. The results of cycloplegic and noncycloplegic Plusoptix A12C measurements and autorefractometer with cycloplegia (CA) were compared. The spherical equivalent (SE) differences between CA and noncycloplegic Plusoptix A12C measurements (NPO) with CA and cycloplegic Plusoptix A12C measurements (CPO) were compared with axial length (AL), anterior chamber depth (ACD), corneal radius of curvature (CR), mean keratometry (meanK) and axial length/corneal radius of curvature ratio (AL/CR) values. The relationships between these were examined. RESULTS: According to amblyopia risk factors (ARFs) based on the criteria in the 2013 AAPOS guidelines, 33 eyes (13%) in the NPO results and 34 eyes (13.6%) in the CPO results were found to be at risk for amblyopia. According to the CA results, the NPO had 67.3% sensitivity and 94.5% specificity, and the CPO 69.4% sensitivity and 89.1% specificity in detecting the values of refractive amblyopia factors determined by the AAPOS. In regard to refraction values determined by the AAPOS for amblyopia, according to CA results, the NPO had 71.4% sensitivity and 88.4% specificity in detecting myopia; 33.3% sensitivity and 93.6% specificity in detecting hyperopia; and 79.4% specificity and 71.2% sensitivity in detecting astigmatism. With regard to refraction values determined by the AAPOS for amblyopia, according to CA results, the CPO had 80.9% sensitivity and 90% specificity in detecting myopia; 13.3% sensitivity and 89.2% specificity in detecting hyperopia; and 44.9% sensitivity and 30.8% specificity in detecting astigmatism. When the SE differences between the CA and NPO values were compared with biometric parameters, a negative correlation was observed with ACD, AL, and especially AL/CR ratio. CONCLUSION: Both the NPO and CPO showed moderate sensitivity and high specificity in detecting ARFs based on the criteria in the 2013 AAPOS guidelines. Sensitivity for detecting hyperopic risk factors was lower than for myopia and astigmatism. The CPO has no additional clinical advantage. A negative correlation was found between biometric parameters and NPO results. Thus, the NPO is more reliable in myopic children with higher axial lengths, deeper anterior chambers, and increased AL/CR ratios.

How do the amblyopic and fellow eyes differ in adults?

OBJECTIVE: To investigate the differences between the amblyopic eye and the fellow eye in adults with anisometropic amblyopia. MATERIALS AND METHODS: Measurements of the central macular thickness [CMT], subfoveal choroidal thickness [SFCT], and retinal nerve fiber layer [RNFL] in patients with anisometropic amblyopia were obtained using optical coherence tomography [OCT]. Axial length [AL], anterior chamber depth [ACD], and central corneal thickness [CCT] were measured with optical biometry. All 12 parameters were compared between the amblyopic eye [Group 1] and the fellow eye [Group 2]. RESULTS: A total of 110 eyes of 55 patients [9 myopic, 46 hypermetropic] were analyzed retrospectively. The ages of the patients ranged from 17 to 55 years, with a mean of 30.8±10.7 years. 56.4% [n=31] of the patients were female, and 43.6% [n=24] were male. The mean spherical equivalent [SE] was 1.96±3.79 in Group 1 and 1.28±2.45 in Group 2. SFCT was 312.00±53.03 in Group 1 and 283.47±51.91 in Group 2. AL was 22.53±1.40 in Group 1 and 22.79±1.18 in Group 2. SE, SFCT, and AL were statistically significantly different between the two groups. There was no difference between the two groups in terms of CMT, RNFL, ACD and CCT values. CONCLUSION: In adults with anisometric amblyopia, the SFCT of the amblyopic eye is greater than that of the fellow eye. The choroid plays an important role in the nutrition of the retinal layers, the development of ocular function and refractive error, and its development may be affected by the refractive error. Since the majority of our patients were hyperopic, the AL was found to be shorter in the amblyopic eye. CMT, RNFL, ACD and CCT values were the similar in both groups. There was no clinically significant relationship between biometric parameters and OCT parameters.

Evaluation of Bone Disease in Kidney Transplant Recipients.

BACKGROUND: Kidney transplant recipients are known to have bone disease, specifically osteoporosis. In this descriptive clinical study we aimed to evaluate the incidence of osteoporosis and to determine the risk factors among our transplant recipients. METHODS: A total of 109 patients (82 males and 27 females) aged from 19 to 70 years, who had undergone kidney transplantation 12 to 69 months previously, were included in the study. Bone mineral densitometry was performed using dual-energy X-ray absorptiometry. The correlation between femur and lumbar spine T-scores with age, gender, post-transplantation duration, serum 25 hydroxy vitamin D, parathyroid hormone, calcium, phosphorus, creatinine, and hemoglobin values were investigated. RESULTS: The incidence of osteoporosis was 22% (24 of 109 patients). The most common sites of osteoporosis were the femur (osteoporotic in 17 patients [15.5%] and osteopenic in 57 [52.2%]) and the lumbar spine (osteoporotic in 24 patients [22%] and osteopenic in 50 [45.8%]). Osteoporosis was found to have no relationship with age and gender. There was a significant negative correlation between serum parathyroid hormone levels with both femur and lumbar spine T-scores (P = .013 and .033, respectively). However, serum phosphorus levels were negatively correlated with only femur T-scores (P = .037). A positive correlation of hemoglobin with lumbar T-scores and a negative correlation with post-transplantation duration (P = .038 and .012, respectively) were also observed. CONCLUSION: Bone disease after transplantation is a frequent complication, which may decrease the quality of life, so we believe it is important to reduce the morbidity; it is required to detect and correct the risk factors of this complex pathophysiological situation.

Use of parenteral magnesium sulphate in eclampsia and severe pre-eclampsia cases in a rural set up of Bangladesh.

This was a quasi-experimental interventional study to see the role of injection magnesium sulphate in eclampsia and severe pre-eclampsia patients at community level in a rural set up before referral to the hospital. This study was conducted on 265 cases of eclampsia and severe pre-eclampsia over a period of six months from July 2001 to December 2001. Among 265 cases, 133 were in intervention group who had received loading dose of injection magnesium sulphate before referral and the rest 132 were in non-intervention group, had not received injection magnesium sulphate before admision in hospital. The number (mean +/- SD) of convulsion before treatment in intervention and non-intervention groups were 4.7 +/- 2.64 & 6.86 +/- 2.97 respectively. Recurrence of fits observed more in non-intervention group and the difference was statistically significant (p<.001). Mean (+/- SD) time taken to regain full consciousness was 12.0+9.6 and 17.4+7.4 hours in the intervention and non-intervention group respectively (p<.05). Control of convulsion by loading dose of 10 gm of injection magnesium sulphate was achieved in 94.0% of the intervention group and 74.0% in non-intervention group. There was only 3(2.3%) maternal death in study group whereas in non-intervention group maternal death was 14(10.4%) and the difference was highly significant (p<.005). Fourteen (13.7%) babies were still born in intervention group and 21(20%) in non-intervention group. The difference was statistically highly significant (p<.001). Remarkable achievements were obtained through use of magnesium sulphate at the community level at rural setting among the eclampsia and severe pre-eclampsia cases.

[Laparoscopic repair of inguinal hernia--experience in 54 consecutive cases].

We describe our experience in 54 consecutive patients who underwent laparoscopic repair of 86 inguinal hernias. Laparoscopic repair of inguinal hernia is technically feasible, does not prolong the length of the procedure nor of hospitalization and is not accompanied by increased morbidity. Although there is not yet general agreement, in our experience and that of others, it appears that laparoscopic repair will be the preferred approach to the treatment of inguinal hernia.

Electromyographic analysis of trunk and hip muscles during resisted lateral band walking.

The purpose of this study was to simultaneously quantify bilateral activation/recruitment levels (% maximum voluntary isometric contraction [MVIC]) for trunk and hip musculature on both moving and stance lower limbs during resisted lateral band walking. Differential electromyographic (EMG) activity was recorded in neutral, internal, and external hip rotation in 21 healthy participants. EMG signals were collected with DE-3.1 double-differential surface electrodes at a sampling frequency of 1,000 Hz during three consecutive lateral steps. Gluteus medius average EMG activation was greater (p = 0.001) for the stance limb (52 SD 18% MVIC) than moving limb (35 SD 16% MVIC). Gluteus maximus EMG activation was greater (p = 0.002) for the stance limb (19 SD 13% MVIC) than moving limb (13 SD 9% MVIC). Erector spinae activation was greater (p = 0.007) in hip internal rotation (30 SD 13% MVIC) than neutral rotation (26 SD 10% MVIC) and the moving limb (31 SD 15% MVIC) was greater (p = 0.039) than the stance limb (23 SD 11% MVIC). Gluteus medius and maximus muscle activation were greater on the stance limb than moving limb during resisted lateral band walking. Therefore, clinicians may wish to consider using the involved limb as the stance limb during resisted lateral band walking exercise.

Laparoscopic repair of postoperation ventral hernia. Early postoperation results.

BACKGROUND: Laparoscopic repair is a new alternative approach to postoperation ventral hernia (POVH). Whether this procedure is accompanied with acceptable operation risk and recurrence rate is not yet established. METHODS: During 1996, we performed laparoscopic repair of POVH in 53 patients. Twenty-nine (55%) of these patients had a history of at least one failed hernia repair. The size of the abdominal wall defect varied from 4 x 5 cm to 15 x 20 cm (median, 13 x 9 cm). All operations were performed with the patient under general anesthesia. In all cases, the Gore-Tex(R) Dual Mesh (W. L. Gore & Associates, Flagstaff, AZ, USA) was used in sizes varying from 5 x 7 cm to 20 x 30 cm (median, 15 x 12 cm). RESULTS: No deaths occurred as a result of the operations. Intraoperative small bowel injury occurred in two patients (3.6%), which necessitated conversion to laparotomy and performance of small bowel resection in one case and simple suture in the other. Small bowel obstruction developed during the immediate postoperation period in two patients (3.6%). In one of these patients, laparoscopic lysis of adhesions had to be performed. Graft infection with subsequent graft removal occurred in one patient (1.8%), and abdominal wall hematoma developed in another patient (1.8%). Length of hospital stay varied from 2 to 8 days (median, 3.3 days). Follow-up period ranged from 10 to 22 months (median, 17 months). During this period, recurrence of hernia occurred only in one patient in which the mesh had been removed. CONCLUSIONS: Laparoscopic repair of POVH is technically feasible. According to our experience, it is the preferred method for patients who have had an earlier failed open repair and patients in whom it is the first repair. Cases with a high likelihood for small bowel injury must be recognized and converted to routine open repair.

The role of laparoscopy in the diagnosis and treatment of missed diaphragmatic rupture.

BACKGROUND: Diaphragmatic rupture is one of the most commonly missed injuries in trauma cases. Traditionally, laparotomy or thoracotomy has been the treatment of choice for this condition. METHODS: During the last 2 years, we treated three patients laparoscopically to address neglected diaphragmatic ruptures that caused herniation of the intraabdominal contents. RESULTS: In all three cases, laparoscopy succeeded in identifying the diaphragmatic defect, so that the herniated viscera could be released and the defect repaired primarily or with a prosthesis. The intraoperative and the postoperative courses were uneventful; there were no significant complications. CONCLUSION: Laparoscopy has an important role in the surgical treatment of missed diaphragmatic ruptures.

Successful treatment of severe aplastic anemia associated with human parvovirus B19 and Epstein-Barr virus in a healthy subject with allo-BMT.

Several reports have noted pancytopenia associated with Human parvovirus B19 (PVB19) or Ebstein-Barr virus (EBV) infections in patients who have no history of immunodeficiency. To our knowledge, we report the first case of severe aplastic anemia associated with both EBV and PVB19 infections in a previously healthy 22-year-old man. He was admitted to our hematology service due to anemia and thrombocytopenia. He had no symptoms or signs of infections of these viruses. His bone marrow biopsy revealed a hypocellular marrow. Specific IgM and IgG antibodies to EBV and PVB19 were elevated. EBV and PVB19 virus genomes were detected by PCR in the bone marrow nucleated cells and the peripheral blood lymphocytes. Two months after treatment with prednisone, acyclovir, and intravenous immune globulin (IVIg), the genomes of both these viruses disappeared. However, his transfusion requirement for platelet suspensions and packed red blood cells persisted. The patient underwent allogeneic bone marrow transplant (allo-BMT) and has had an enduring complete hematological response for 8 months.