Trends in slipped capital femoral epiphysis: is the rate declining?

PURPOSE: Slipped capital femoral epiphysis (SCFE) is an adolescent hip condition with a high risk of complication. The purpose of this study was to evaluate trends in treatment using a prospectively collected paediatric nationally representative database. METHODS: A total of 9034 patients undergoing treatment for idiopathic SCFE were selected by querying the Healthcare Cost and Utilization Project's Kids' Inpatient Database for the years 1997, 2000, 2003, 2006, 2009 and 2012. The selected patients were separated based on operative approach and these cohorts were analyzed based on temporal and categorical differences in operative approach, patient demographics and clinical characteristics. Univariate and multivariate analyses were used when appropriate and the Mantel-Haenszel test for trend was used in temporal analysis. RESULTS: Overall SCFE procedures have decreased 27.5% (p < 0.001). Closed procedures have decreased 28.5% (p < 0.001), while open procedures have decreased 44.8% (p < 0.001). Bilateral closed procedures have increased 7.2% (p < 0.001). The ratio of open to closed procedures decreased in patients aged nine to 12 years and increased in patients aged 13 to 16 years (p < 0.001). CONCLUSION: Here we report age stratified trends in treatment for idiopathic SCFE using nationally representative data and show an overall decrease in admissions and procedures over time. LEVEL OF EVIDENCE: Level III, retrospective comparison study.

Unusual visual symptoms.

Three cases with unusual and interesting symptomatology are presented. In each case the symptoms alone can lead the physician to an accurate localization of the lesion.

Subretinal pigment cells in malignant melanoma of the choroid.

On examining 54 globes that harbored choroidal malignant melanomas, we found 28 tumors to be composed of spindle cells; 24, of mixed cells; and two, of epitheloid cells. In 80% of the tumors studied, pigment-laden cells had accumulated away from the tumor region and at the periphery of the subretinal space. The number of cells increased in proportion to the extent of retinal detachment, a finding that related directly to the size of the tumor.

Postoperative complications after Molteno implant surgery.

We performed Molteno implant surgery in one eye each of 41 patients with uncontrolled glaucoma. Intraocular pressure was controlled (intraocular pressure less than or equal to 18 mm Hg) in 32 eyes (78%). The mean preoperative intraocular pressure was 40 +/- 13.2 mm Hg, whereas the mean postoperative intraocular pressure was 16 +/- 6.6 mm Hg. Patients were followed up for an average of 16 months after the operation. Visual acuity was unchanged in 23 eyes (56%), improved in nine eyes (22%), and poorer in nine eyes (22%). The major complications included shallow anterior chamber and hypotony in six eyes (14.6%), vitreous hemorrhage in two eyes (4.9%), retinal detachment in one eye (2.4%), and malignant glaucoma in two eyes (4.9%). Less grave complications included hyphema in four eyes (9.8%), peripheral choroidal effusion in 15 eyes (36.6%), obstruction of the tube in six eyes (14.6%), recession of the tube into the angle in two eyes (4.9%), erosion of the tube in one eye (2.4%), and Tenon's cyst formation in three eyes (7.3%).

Identification, prevention, and treatment of silicone oil pupillary block after an inferior iridectomy.

We treated two patients in whom silicone oil pupillary block developed despite a patent inferior iridectomy. The clinical characteristics of this complication were a deep anterior chamber, specular reflexes from the iris surface, identification by biomicroscopy of aqueous trapped inferiorly in the vitreous cavity, and no convection currents in the anterior chamber. This complication may be prevented by early face-down positioning of the patient after the operation, and the avoidance of large, centrally located, inferior iridectomies. We recommend that the iridectomy be placed peripherally no larger than 2 mm and propose a new technique for breaking the silicone oil block, which was clearly successful in one of the patients.

Visual hallucinations associated with pituitary adenoma.

Visual hallucinations were the presenting symptom in three patients with pituitary adenoma. One patient reported only simple unformed hallucinations, which are a well-documented phenomenon occurring in lesions compressing the optic nerves and chiasm. The other two patients, however, experienced complex formed visual hallucinations believed to be of the release type. No evidence of seizure activity responsible for the hallucinations was found; the mechanism producing them is discussed with correlation to operative findings and electrophysiological studies.

Bilateral central and centrocaecal scotomata due to mass lesions.

Unilateral central or centrocaecal scotoma may result from optic nerve compression. However, such defects bilaterally usually indicate non-compressive optic neuropathy of toxic or nutritional, hereditary, or demyelinating origin. Three cases are reported of patients who presented with somewhat atypical bilateral central or centrocaecal scotomata and were found to have suprasellar mass lesions demonstrated by CT scan and confirmed neurosurgically.

Vitelliform macular dystrophy and butterfly-shaped epithelial dystrophy: a continuum?

We report the case of 22-year-old white female who presented for a routine ocular examination and displayed Best's disease in her right eye and butterfly-shaped macular dystrophy in her left eye. These diagnoses were confirmed by fluorescein angiography, EOG, and ERG. The fact that these 2 disorders are present in one person suggests that they are only different manifestations of the same underlying disease process.

Acute angle closure glaucoma precipitated by orbital pseudotumour.

A 62-year-old woman presented with acute angle closure glaucoma. After a poor response to conventional treatment the presenting signs were re-evaluated and a diagnosis of pseudotumour of the orbit was made. Treatment with oral steroids resolved both the glaucoma and the orbital pseudotumour. The presumed pathogenesis and literature are reviewed.

Oculomotor apraxia: the presenting sign of Gaucher disease.

Oculomotor apraxia may be idiopathic or a symptom of a variety of diseases. In Gaucher disease, oculomotor deficit is characterized by a failure of volitional horizontal gaze with preservation of vertical movements. We present 2 sisters, 6 1/2 and 5 1/2 years of age, in whom the presenting sign was oculomotor apraxia. Oculomotor apraxia has not been previously reported as the presenting manifestation of Gaucher disease.

[VIth nerve palsy associated with ipsilateral Horner's pupil].

A rare syndrome which includes VIth nerve palsy associated with ipsilateral Horner's pupil was foreseen by Parkinson and Johnston in the mid-seventies. They anticipated the occurrence of this syndrome on the basis of the unique anatomical relationships discovered by them in the cavernous sinus. The main finding consisted of very close proximity between the VIth nerve and a branch emerging from the carotid sympathetic plexus. Recently, several reports of this syndrome caused by a variety of pathologic processes in the cavernous sinus, proved that Parkinson and Johnston were correct. Since it is quite difficult to identify lesions in the cavernous sinus by X-ray or CT scan, the neuroradiologist should utilize special techniques. It is expected that the number of cases of this syndrome will soon increase, due to increasing familiarity with the syndrome and to improved imaging techniques.

Relation between distance-based topological indices.

The pi-index of the line graph of the molecular graph of an alkane is shown to be related to the pi, Harary, and reciprocal Wiener indices of that alkane. Thus a mathematical relation between several distance-based topological indices is obtained.

Quest for molecular graphs with maximal energy: a computer experiment.

If lambda(1), lambda(2),..., lambda(n) are the eigenvalues of a graph G, then the energy of G is defined as E(G) = the absolute value of lambda(1) + the absolute value of lambda(2) +.... + the absolute value of lambda(n). If G is a molecular graph, representing a conjugated hydrocarbon, then E(G) is closely related to the respective total pi-electron energy. It is not known which molecular graph with n vertices has maximal energy. With the exception of m = n - 1 and m = n, it is not known which molecular graph with n vertices and m edges has maximal energy. To come closer to the solution of this problem, and continuing an earlier study (J. Chem. Inf. Comput. Sci. 1999, 39, 984-996, ref 7), we performed a Monte Carlo-type construction of molecular (n,m)-graphs, recording those with the largest (not necessarily maximal possible) energy. The results of our search indicate that for even n the maximal-energy molecular graphs might be those possessing as many as possible six-membered cycles; for odd n such graphs seem to prefer both six- and five-membered cycles.

Modeling boiling points of cycloalkanes by means of iterated line graph sequences.

A class of models for predicting boiling points of cycloalkanes is put forward, based on iterated line graphs L(i), i = 1, 2,., of the molecular graph G = L(0). Let m(i) be the number of edges of L(i), i = 0, 1, 2,. The models analyzed are of the form a(0)m(i)()(0) + a(1)m(i)(1) + a(2)m(i)(2) +. + a(k)m(ik) + b. Our optimal QSPR formulas contain m(0), m(1), m(2), m(3), and/or m(4) but never m(5) and m(6). Their precision is as good as or better than the approximations recently reported by Rücker and Rücker (J. Chem. Inf. Comput. Sci. 1999, 39, 788-802).

On walks in molecular graphs.

Walks in molecular graphs and their counts for a long time have found applications in theoretical chemistry. These are based on the fact that the (i, j)-entry of the kth power of the adjacency matrix is equal to the number of walks starting at vertex i, ending at vertex j, and having length k. In recent papers (refs 13, 18, 19) the numbers of all walks of length k, called molecular walk counts, mwc(k), and their sum from k = 1 to k = n - 1, called total walk count, twc, were proposed as quantities suitable for QSPR studies and capable of measuring the complexity of organic molecules. We now establish a few general properties of mwc's and twc among which are the linear dependence between the mwc's and linear correlations between the mwc's and twc, the spectral decomposition of mwc's, and various connections between the walk counts and the eigenvalues and eigenvectors of the molecular graph. We also characterize the graphs possessing minimal and maximal walk counts.

Orbital tumor as a presenting symptom of occult carcinoma of the thyroid.

A rare case of thyroid carcinoma presenting as an orbital tumor is described. The diagnosis was made only through histopathologic examination of tissues removed during craniotomy. Thyroid scan confirmed the diagnosis. Thyroid carcinoma should be suspected in cases of orbital metastasis of unknown origin.

Optic nerve compression by carotid arteries in low-tension glaucoma.

Low-tension glaucoma (LTG) is manifested by glaucomatous optic nerve damage and visual field loss despite normal intraocular pressure (IOP). We describe 62 patients with classical signs of LTG. Computed tomography (CT) was performed in all patients. In 56 of the patients (90.3%), pathology of the intracavernous carotid arteries adjacent to the intracranial opening of the optic canal could be demonstrated. In 28 patients (45.2%) a clear asymmetry of the optic nerve cupping was found and could be correlated with the severity of the carotid artery pathology. A control group of 24 age-matched patients included five (20.8%) with intracavernous carotid artery calcification and only one (4.2%) with intracavernous ectasia. We suggest that calcification, dilatation and ectasia of the carotid artery into the optic canal may play an important role in the pathogenesis of many cases of LTG. The close proximity of the carotid artery to the optic nerve at this location may result in compressive neuropathy with subsequent glaucomatous damage of the optic nerve head.

Suggested mechanism for acute transient myopia after sulfonamide treatment.

This report describes the occurrence of acute transient myopia in a patient treated with sulfonamide. We followed this patient by performing A-scan ultrasonographic ocular measurements documenting the anterior chamber depth, lens thickness, and axial length during the acute and convalescent periods. The outstanding feature in this case was the documented ultrasonographically significant reduction of the anterior chamber depth combined with lens thickening. This could be caused by a forward displacement of the lens as a result of allergic ciliary body edema and rotation. These changes could explain the mechanism of drug-induced transient myopia.