RESUMO
BACKGROUND: Tigecycline is a vital antibiotic treatment option for infections caused by multiresistant bacteria in the intensive care unit (ICU). Acute kidney injury (AKI) is a common complication in the ICU requiring continuous renal replacement therapy (CRRT), but pharmacokinetic data for tigecycline in patients receiving CRRT are lacking. METHODS: Eleven patients mainly with intra-abdominal infections receiving either continuous veno-venous hemodialysis (CVVHD, n = 8) or hemodiafiltration (CVVHDF, n = 3) were enrolled, and plasma as well as effluent samples were collected according to a rich sampling schedule. Total and free tigecycline was determined by ultrafiltration and high-performance liquid chromatography (HPLC)-UV. Population pharmacokinetic modeling using NONMEM® 7.4 was used to determine the pharmacokinetic parameters as well as the clearance of CVVHD and CVVHDF. Pharmacokinetic/pharmacodynamic target attainment analyses were performed to explore the potential need for dose adjustments of tigecycline in CRRT. RESULTS: A two-compartment population pharmacokinetic (PK) model was suitable to simultaneously describe the plasma PK and effluent measurements of tigecycline. Tigecycline dialysability was high, as indicated by the high mean saturation coefficients of 0.79 and 0.90 for CVVHD and CVVHDF, respectively, and in range of the concentration-dependent unbound fraction of tigecycline (45-94%). However, the contribution of CRRT to tigecycline clearance (CL) was only moderate (CLCVVHD: 1.69 L/h, CLCVVHDF: 2.71 L/h) in comparison with CLbody (physiological part of the total clearance) of 18.3 L/h. Bilirubin was identified as a covariate on CLbody in our collective, reducing the observed interindividual variability on CLbody from 58.6% to 43.6%. The probability of target attainment under CRRT for abdominal infections was ≥ 0.88 for minimal inhibitory concentration (MIC) values ≤ 0.5 mg/L and similar to patients without AKI. CONCLUSIONS: Despite high dialysability, dialysis clearance displayed only a minor contribution to tigecycline elimination, being in the range of renal elimination in patients without AKI. No dose adjustment of tigecycline seems necessary in CRRT. TRIAL REGISTRATION: EudraCT, 2012-005617-39 . Registered on 7 August 2013.
Assuntos
Terapia de Substituição Renal/métodos , Tigeciclina/farmacocinética , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/prevenção & controle , Idoso , Antibacterianos/farmacocinética , Antibacterianos/uso terapêutico , Estado Terminal/terapia , Feminino , Hemodiafiltração/efeitos adversos , Hemodiafiltração/métodos , Humanos , Unidades de Terapia Intensiva/organização & administração , Masculino , Pessoa de Meia-Idade , Farmacocinética , Terapia de Substituição Renal/estatística & dados numéricos , Tigeciclina/uso terapêuticoRESUMO
BACKGROUND: The frequency of intravitreal injection of drugs (IVI) has significantly increased recently and it is performed like cataract surgery as an outpatient procedure. The occurrence of postoperative endophthalmitis is rare, only few data of multicentre studies are available. METHODS: We analysed the data of 30 consecutive patients with endophthalmitis following cataract surgery (group 1, n = 20) and IVI (group 2, n = 10) requiring therapy in a referral eye clinic from January 2009 to December 2013. All patients received topical and systemic anti-inflammatory and anti-infective therapy. Due to vitreous opacification and severe loss of vision 83â% of the eyes underwent immediately pars plana vitrectomy with diagnostic microbiological probe and intravitreal application of vancomycin and gentamicin. RESULTS: Endophthalmitis occurred independently in both groups 1 to 10 days, on average 4 days, postoperatively. Group 1 showed conjunctival infection in 80â% (n = 16), group 2 in 20â% (n = 2). Hypopyon was found in group 1 in 65â% (n = 13), in group 2 in 40â% (n = 4). Group 1 presented retinal haemorrhages and epiretinal fibrin membranes in 15â% (n = 3), group 2 in 70â% (n = 7). Vitreous cultures were positive in 80â% (vancomycin-sensitive staphylococci). Staphylococcus was the most frequent bacteria, resistant to ceftazidime. In group 1 visual acuity was initially in 65â% (n = 13) of the eyes < 20/400 or worse, in group 2 90â% (n = 9) of the eyes had hand motions and in 10â% (n = 1) worse than 20/400. Visual outcome was 20/30 on average for group 1, PVR retinal detachment occurred once. In group 2 no patient achieved better visual outcome than < 20/400, 40â% of the eyes required permanent silicon oil tamponade because of PVR retinal detachment. The major pathogens were staphylococci resistant to ceftazidim. CONCLUSION: Endophthalmitis following IVI had poor visual outcome compared to endophthalmitis following cataract surgery and showed less anterior segment symptoms.
Assuntos
Extração de Catarata , Endoftalmite/etiologia , Injeções Intravítreas/efeitos adversos , Complicações Pós-Operatórias/etiologia , Infecções Estafilocócicas/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios , Anti-Inflamatórios/uso terapêutico , Bevacizumab/administração & dosagem , Bevacizumab/efeitos adversos , Resistência Microbiana a Medicamentos , Endoftalmite/terapia , Gentamicinas/uso terapêutico , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/terapia , Ranibizumab/administração & dosagem , Ranibizumab/efeitos adversos , Descolamento Retiniano/etiologia , Descolamento Retiniano/terapia , Estudos Retrospectivos , Óleos de Silicone/administração & dosagem , Infecções Estafilocócicas/terapia , Vancomicina/uso terapêutico , Acuidade Visual , VitrectomiaRESUMO
BACKGROUND: Absence of capsular support or extended zonulolysis is today the main indication for retroiridal enclavation of the unfoldable PMMA iris claw lens (Verisyse®/Artisan®) if there is sufficient iris support. Contraindications are uveitis or ischaemic retinopathies. PATIENTS AND METHODS: 'In-the-bag' IOL dislocation due to PEX zonulopathy usually occurring 8 years after phacoemulsification is the main indication. For complicated phacoemulsification with extended zonular defect the retroiridal iris claw lens (Verisyse®/Artisan®) has become the stand-by IOL of first choice. A rare indication for Verisyse is optical rehabilitation after lens luxation into the vitreous in combination with vitrectomy. RESULTS: 81 eyes were analysed. With laseroptic biometry target refraction was within 1 D for 100â% of the 'in-the-bag' luxation cases and in 62â% for the other more complicated cases. Wavefront analysis showed no significant difference for optical quality between retroiridal iris claw lens and a endocapsular fixated spherical for scotopic 5 mm pupil. Iris pigment atrophies of the enclavation site had no clinical significance. Risk for cystoid macular oedema is lower compared to sclera suture-fixated posterior chamber lenses. Intra- and postoperative complications were rare. Spontaneous or traumatic de-enclavation due to haptic defects may occur. After vitrectomy instable refraction may be caused by hypermobile iris diaphragma. CONCLUSIONS: Retroiridal iris claw lenses can be implanted atraumatically under topical anaesthesia. IOL related complications are minimal.
Assuntos
Afacia/cirurgia , Implante de Lente Intraocular/instrumentação , Implante de Lente Intraocular/métodos , Lentes Intraoculares Fácicas , Afacia/diagnóstico , Análise de Falha de Equipamento , Humanos , Implante de Lente Intraocular/efeitos adversos , Desenho de Prótese , Resultado do TratamentoRESUMO
BACKGROUND: The covered sclerotomy is a minimally invasive, standardized fistulating glaucoma surgical procedure with reduced risk of complications. Early postoperative bleb fibrosis is a main success-limiting problem. In this clinical study IOP follow-up and the one year success rate after primary application of mitomycin C (MMC) is analyzed. PATIENTS AND METHODS: In 76 eyes with advanced glaucoma and without previous fistulating surgery, a covered sclerotomy combined with 3-minute-application of MMC0,02â% was performed. Over a period of 12 months, bleb and pressure were controlled regularly. The success rates were compared primarily with data from an earlier study without application of MMC. RESULTS: The mean age of the patients was 70 ± 11 years. 45â% had a pseudoexfoliation syndrome while 41â% were pseudophakic. The mean intraocular pressure (IOP) was 27 ± 8,5 mmHg preoperatively. After 12 months it was 16,2 ± 4,3 mmHg (p < 0.05) with a mean IOP reduction of 40â%. The absolute success rate (intraocular pressure < 21 mmHg without antiglaucoma therapy) was 58â% and the relative success rate (intraocular pressure < 21 mmHg under treatment) was 71â%. A revision or a needling was performed in 22 eyes (29â%). MMC-related complications were not observed. CONCLUSION: Through the additional MMC application on the base of the primary covered sclerotomy a significant pressure reduction could be achieved. 58â% of the patients didn't need any glaucoma medicine. The absolute success rate was higher than without additional inhibitions of the fibrosis.
Assuntos
Extração de Catarata/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Mitomicina/administração & dosagem , Pré-Medicação/métodos , Doenças da Esclera/etiologia , Doenças da Esclera/prevenção & controle , Esclerostomia/efeitos adversos , Idoso , Extração de Catarata/métodos , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Esclerostomia/métodos , Resultado do TratamentoRESUMO
BACKGROUND: Staining of the retinal surface has improved the intraoperative removal of semitransparent membranes during macular surgery. The purpose of this study was to evaluate the clinical experiences with brilliant blue G (BBG) staining of the retinal surface. METHODS: BBG (Brilliant peel, Fluoron) was applied during vitrectomy and macular surgery in 43 patients. In 47 % there was a macular hole (MH), whereas 53 % had epiretinal membranes (ERM). Intraoperatively BBG was applied on the retinal surface under infusion or air conditions for 30 - 60 s. In MH the internal limiting membrane (ILM) and in ERM the membrane was removed. Postoperatively all patients were examined on average after 9 weeks. RESULTS: Although intraoperative BBG staining was less intensive compared to ICG staining, the staining was sufficient to safely remove the semitransparent membranes in all cases. In all patients with MH hole closure was achieved, and in 96 % with ERM the metamorphopsiae decreased. The mean decimal visual acuity increased from 0.25 ± 0.13 to 0.37 ± 0.20 (p < 0.05) and improved in 63 % of the patients. Clinically, there were no toxic side-effects from BBG staining. CONCLUSIONS: BBG allowed a complete and selective staining of the retinal surface. Thus, ILM and ERM could be removed safely during macular surgery. No clinical retinal toxicity was observed.
Assuntos
Membrana Epirretiniana/patologia , Membrana Epirretiniana/cirurgia , Aumento da Imagem/métodos , Retinoscopia/métodos , Corantes de Rosanilina , Cirurgia Assistida por Computador/métodos , Vitrectomia/métodos , Idoso , Humanos , Coloração e RotulagemRESUMO
BACKGROUND: The purpose of this study was to assess uncorrected far and near vision after implantation of a multifocal intraocular lens (IOL) in the second eye in patients with a unilateral monofocal IOL. PATIENTS AND METHODS: 13 cataract patients with a monofocal intraocular lens in one eye (SA60AT, Alcon) and postoperative emmetropia received a multifocal lens in the second eye (ReSTOR, Alcon). Two and six months postoperatively the clinical examination, far and near vision, near aniseikonia (AWAYA-New Aniseikonia Test), stereo vision (Lang I test) and the mesopic contrast sensitivity (F. A. C.T) were tested. In addition, the grade of satisfaction without glasses in general, and with far and near vision were noted on a visual analogue scale (0 - 10). Furthermore, independence from glasses and the presence of optical phenomena were assessed. RESULTS: The mean uncorrected far visual acuity 6 months postoperatively was 1.06 +/- 0.28 for the monofocal lens, 0.88 +/- 0.23 for the multifocal lens, and 1.16 +/- 0.24 binocularly. The uncorrected near visual acuity was Nieden 1 binocularly for all patients and ranged from Nieden 1 - 3 for the multifocal lens to Nieden 2 - 11 for the monofocal lens. 77% of the patients received the multifocal lens in their far dominant eye. The mean uncorrected near aniseikonia was < 1%. The mesopic contrast sensitivity showed no significant differences between the two IOL types and compared to binocular values. The satisfaction with the uncorrected visual acuity was in general 8.88 +/- 1.21, with the far visual acuity 9.42 +/- 1.24, and 7.33 +/- 1.72 with the near visual acuity. After 6 months 67% of the patients used glasses only for periods of prolonged reading. Halos and a low degree of glare were noted by 38.5% of patients 2 months postoperatively. At the 6 months visit 33.3% still had halos and only 8% glare. CONCLUSIONS: This first experience with the combined implantation of a monofocal and a multifocal lens revealed a marked improvement of the uncorrected near visual acuity compared to bilateral monofocal IOL implantation along with a high patient satisfaction.
Assuntos
Catarata/complicações , Catarata/reabilitação , Implante de Lente Intraocular/instrumentação , Implante de Lente Intraocular/métodos , Lentes Intraoculares , Presbiopia/complicações , Presbiopia/reabilitação , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
This article presents the results of an expert consultation meeting aimed at evaluating the safety and public health implications of administering supplemental iron to infants and young children in malaria-endemic areas. Participants at this meeting that took place in Lyon, France on June 12-14, 2006 reached consensus on several important issues related to iron supplementation for infants and young children in malaria-endemic areas. The conclusions in this report apply specifically to regions where malaria is endemic.
Assuntos
Anemia Ferropriva/prevenção & controle , Suplementos Nutricionais , Doenças Endêmicas , Ferro/uso terapêutico , Malária/prevenção & controle , Anemia Ferropriva/epidemiologia , Criança , Humanos , Lactente , Malária/epidemiologia , Organização Mundial da SaúdeRESUMO
BACKGROUND: Piggyback lens implantation is an alternative to exchange of the original intraocular lens (IOL) to treat high anisometropia in pseudophakic eyes. We present our results. PATIENTS AND METHOD: A second IOL (piggyback) was implanted in 27 patients from 2000 to 2006. Nineteen patients were clinically investigated late postoperatively, and data for the other eight patients were evaluated from the patients' files. RESULTS: The patients were 65+/-9 years old. Follow-up time was 38+/-25 months. The mean preoperative spherical equivalent (SE) in the myopic eyes was -7.86+/-3.82 D and in the hyperopic eyes was 1.64+/-0.74 D. After surgery, the mean SE in the myopic eyes was -1.77+/-1.82 D and in the hyperopic eyes was -0.09+/-0.51 D. Postoperative anisometropia was reduced from 4.64+/-3.3 D. to 0.9+/-0.82 D. CONCLUSION: Piggyback lens implantation is a safe and effective surgical procedure and is less traumatic than exchange of the original IOL.
Assuntos
Implante de Lente Intraocular/métodos , Refração Ocular , Idoso , Anisometropia/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Miopia/cirurgia , Pseudofacia , Estudos Retrospectivos , Fatores de Tempo , Acuidade VisualRESUMO
Sebaceous gland carcinoma can clinically mimic benign conditions such as chalazion and blepharoconjunctivitis. This carcinoma should be histologically excluded for every unilateral, recalcitrant chalazion and every unilateral, therapy refractory blepharitis. Autosomal dominant Muir-Torre syndrome should be considered in patients who develop sebaceous gland carcinoma of the ocular adnexa. In this case, the sebaceous gland carcinoma is combined with visceral carcinoma.
Assuntos
Blefarite/etiologia , Neoplasias Palpebrais/diagnóstico , Ceratoconjuntivite/etiologia , Neoplasias Orbitárias/diagnóstico , Neoplasias das Glândulas Sebáceas/diagnóstico , Idoso de 80 Anos ou mais , Biópsia , Colectomia , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Diagnóstico Diferencial , Neoplasias Palpebrais/patologia , Neoplasias Palpebrais/cirurgia , Pálpebras/patologia , Pálpebras/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Segunda Neoplasia Primária/diagnóstico , Segunda Neoplasia Primária/patologia , Segunda Neoplasia Primária/cirurgia , Órbita/patologia , Neoplasias Orbitárias/patologia , Neoplasias Orbitárias/cirurgia , Cuidados Paliativos , Neoplasias das Glândulas Sebáceas/patologia , Neoplasias das Glândulas Sebáceas/cirurgia , SíndromeRESUMO
PURPOSE: Visualization of the anterior chamber angle is an important diagnostic method in patients with angle-closure glaucoma. In this study, optical coherence tomography (OCT) was used to image the angle width, the iris configuration, and the iris thickness in patients with angle-closure glaucoma. METHODS: Thirteen eyes of 11 patients suffering from angle-closure glaucoma were studied with slitlamp-adapted OCT. All patients were treated with Nd:YAG laser iridotomy. The angle width ( degrees ), the angle opening distance (AOD) (microm), and the iris thickness (microm) were measured with OCT. The configuration of the iris was classified as steeply convex, convex, or flat. RESULTS: The mean angle width was preoperatively 5.1+/-5.0 degrees (0-15 degrees ) and enlarged significantly (p=0.007) to 10.4+/-5.5 degrees (0-19 degrees ) postoperatively. The AOD changed from 71+/-55 microm (0-157 microm) preoperatively to 143+/-74 microm (0-256 microm) postoperatively (p<0.001). The mean iris thickness was 338+/-33 microm. With the exception of two eyes the predominant iris configuration changed from convex to flat. CONCLUSIONS: OCT allowed visualization and noninvasive assessment of the anterior chamber angle region in patients with angle-closure glaucoma. Our results suggest that goniometry with OCT could improve the evaluation in patients with narrow or closed anterior chamber angles.
Assuntos
Glaucoma de Ângulo Fechado/diagnóstico , Glaucoma de Ângulo Fechado/cirurgia , Gonioscopia/métodos , Interpretação de Imagem Assistida por Computador/métodos , Iridectomia/métodos , Terapia a Laser/métodos , Tomografia de Coerência Óptica/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios/métodos , Prognóstico , Resultado do TratamentoRESUMO
AIM: To assess the value of slit lamp adapted optical coherence tomography (OCT) for the management of malignant glaucoma following filtration surgery. METHODS: Two patients (three eyes) developed malignant glaucoma following filtration surgery for primary open angle glaucoma (POAG). With slit lamp adapted OCT it was possible to image non-invasively the anterior chamber angle structures during the malignant glaucoma episode, and after pars plana vitrectomy (PPV) with anterior chamber reformation. RESULTS: OCT revealed in both patients a markedly decreased anterior chamber angle with extreme shallowing of the anterior chamber depth during the acute malignant glaucoma phase. This critical closure of the anterior chamber angle resolved after PPV and deepening of the anterior chamber with viscoelastic. After PPV the quantitative values of the anterior chamber angle (ACA) and the anterior chamber opening distance (AOD) increased from 0 to an ACA of 35 degrees (SD 14 degrees ) and an AOD of 426 (SD 162) micro m. CONCLUSIONS: Non-contact slit lamp adapted OCT was helpful to evaluate the anterior chamber structures in malignant glaucoma, and thus could improve management of this serious clinical disorder.
Assuntos
Cirurgia Filtrante/efeitos adversos , Glaucoma/diagnóstico , Tomografia/métodos , Idoso , Câmara Anterior/patologia , Câmara Anterior/cirurgia , Feminino , Glaucoma/etiologia , Glaucoma/patologia , Glaucoma de Ângulo Aberto/cirurgia , Humanos , Pessoa de Meia-Idade , VitrectomiaRESUMO
During a period of 24 months, 211 patients were investigated in our radiological clinic by emergency CT of the spine on the day of the injury. In 128 (61%) a traumatic lesion could be demonstrated. Most frequently involved were the transitional zones of the spine (occipito-atlanto-axial segment, cervico-thoracic and thoracolumbar segments). In 68% of these patients, conventional radiographs of the spine of these critical zones proved to be inadequate. 20% of the lesions demonstrated by CT could not be seen on conventional radiographs and 41% were shown incompletely. In 61% of cases CT provided additional information when compared with conventional radiography.
Assuntos
Mielografia , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Emergências , Humanos , Luxações Articulares/diagnóstico por imagem , Traumatismo Múltiplo/diagnóstico por imagem , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Estenose Espinal/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagemRESUMO
"Dynamic" double contrast arthro-CT in internal and external rotation was performed on 42 patients with recurrent subluxation of the shoulder. The differential distribution of contrast and air caused by the rotation resulted in optimal demonstration of the capsulo-labrale components responsible for joint stability. In 22 patients there appeared to be an indication for arthroscopy; this confirmed the previous findings. In all cases the anterior part of the capsule and the middle and lower labrum were seen best during internal rotation. In this way all the 15 anterior capsule lesions could be seen, as well as 16 out of 17 Bankart lesions; it also showed one lesion of the middle labrum which had been masked by a haemarthrosis during external rotation. The study also defined lesions of the upper labrum caused by a different pathological mechanism which was present in 7 patients (6 Andrews and 1 S.L.A.P. lesion). These and 2 posterior labrum tears could be diagnosed during external rotation. Sensitivity for lesions of the anterior labrum was 95%.
Assuntos
Luxação do Ombro/diagnóstico por imagem , Articulação do Ombro/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Iopamidol , Cápsula Articular/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Recidiva , Rotação , Tomografia Computadorizada por Raios X/instrumentaçãoRESUMO
101 portangiographies in patients with liver metastases from colorectal primaries who underwent hepatic intraarterial or intraperitoneal chemotherapy were performed and studied between January 1991 and February 1992. 81% of the examinations did not involve complications. In 19% of the angiographies abnormalities of the arterial perfusion of the liver, like occlusion, dissection or narrowing of hepatic arteries, were found. We conclude that portangiography is a very important investigation before regional chemotherapy.
Assuntos
Neoplasias Colorretais/patologia , Neoplasias Hepáticas/secundário , Angiografia , Cateterismo Venoso Central/instrumentação , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/tratamento farmacológico , Seguimentos , Alemanha/epidemiologia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/tratamento farmacológico , Sistema Porta/diagnóstico por imagem , Estudos RetrospectivosRESUMO
Segmental aplasias of the inferior vena cava, thrombosis of the vena cava, tumour infiltration (e.g. renal neoplasms via the renal vein) and external compression (e.g. large hepatic metastases) may produce similar radiomorphologic changes in chest x-ray DSA and CT. These radiomorphological changes are described by case reports. DSA clearly demonstrates the course of the vessels and the collaterals involved. CT may elucidate the paracaval vascular changes. It is only a synopsis of cavography (DSA) and CT with reference to embryogenesis that will lead to a reliable diagnosis and enable a definite decision on therapy and prognosis.
Assuntos
Angiografia Digital , Neoplasias Renais/patologia , Neoplasias Hepáticas/secundário , Trombose/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Veia Cava Inferior , Veia Cava Inferior/anormalidades , Adolescente , Adulto , Idoso , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/etiologia , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologiaRESUMO
93 patients with 102 intraarticular calcaneus fractures (ICF) were examined by CT from 1986 to 1992. The images were evaluated with the use of a modified classification based on the number of fractured heel bone facets (2 facets in 4.8%, 3 facets in 53.9%, 4 facets in 32.3%, comminution in 8.8% of the fractures), the involvement of the calcaneus-cuboid joint (60.8%) and the fracture mechanism (tongue-type in 28.4%, joint depression in 62.7%) with the weight-bearing calcaneal compartments taken into special consideration. In that way, each intraarticular calcaneus fracture could be scored, enabling a fast diagnosis comprising factors relevant for the therapy and prognosis.
Assuntos
Calcâneo/diagnóstico por imagem , Calcâneo/lesões , Fraturas Ósseas/classificação , Fraturas Ósseas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Feminino , Fraturas Ósseas/epidemiologia , Alemanha Ocidental/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodosRESUMO
PURPOSE: Anteversion of the femoral neck was measured by MRI in 19 children (37 hips) preoperatively before femoral rotation osteotomies. MATERIAL AND METHODS: The results of this new technique were compared with values for anteversion obtained by CT and ultrasound. The measurements were performed independently by two observers to determine the correlation between the three different methods and to assess their reliability. RESULTS: It was possible to show a high correlation coefficient (Pearson) between MRI and CT (r = 0.77) as well as MRI and sonography (r = 0.81). The mean angles obtained by CT (34 degrees, range +5 to +82 degrees) and ultrasound (25.6 degrees, range +10 to +40 degrees) appeared larger than the MRI values (mean angle 23.2 degrees, range 0 to +65 degrees), which can be explained by the different measurement techniques. Mean inter- and intra-variability was low for MRI (r = 0.97 and r = 0.97) and CT (r = 0.99 and r = 0.96) but slightly higher for sonography (r = 0.88 and r = 0.88). MRI is a new reliable and precise method to evaluate femoral anteversion that does not require ionising radiation. CONCLUSION: MRI is recommended for preoperative planning of paediatric femoral rotation osteotomy patients.
Assuntos
Colo do Fêmur/patologia , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Adolescente , Fenômenos Biomecânicos , Criança , Pré-Escolar , Feminino , Colo do Fêmur/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética/métodos , Imageamento por Ressonância Magnética/estatística & dados numéricos , Masculino , Variações Dependentes do Observador , Estudos Prospectivos , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Anormalidade Torcional , UltrassonografiaRESUMO
PURPOSE: Currently the microkeratome incision and the ablation depth are unpredictable in laser in situ keratomileusis (LASIK). Online optical coherence pachymetry is a high-resolution and non-contact method, which enables the corneal thickness changes to be monitored intraoperatively. METHOD. In 12 patients undergoing myopic LASIK, online optical coherence pachymetry with a wavelength of 1310 nm and a measurement frequency of 74 Hz was studied. The central corneal thickness changes were determined continuously. RESULTS: Online optical coherence pachymetry enabled intraoperative visualization and assessment of the central corneal thickness, the flap thickness after the microkeratome pass, the time-resolved ablation and the residual stromal thickness. Intraoperatively the mean flap thickness was 113+/-31 microm and the residual stromal thickness was 277+/-49 microm. The optically determined ablation depth was 116+/-30 micro m, which corresponded to 33 microm higher mean values than the nominal ablation depth. CONCLUSIONS: Online optical coherence pachymetry enabled the flap and residual stromal thickness to be measured intraoperatively. Also the individual ablation depth and possible dehydration effects of the cornea were monitored continuously. Thus, online optical coherence pachymetry could contribute to improve the safety standards during LASIK.
Assuntos
Astigmatismo/cirurgia , Ceratomileuse Assistida por Excimer Laser In Situ , Miopia/cirurgia , Adulto , Idoso , Algoritmos , Córnea/anatomia & histologia , Córnea/cirurgia , Substância Própria/anatomia & histologia , Substância Própria/cirurgia , Interpretação Estatística de Dados , Humanos , Ceratomileuse Assistida por Excimer Laser In Situ/instrumentação , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Pessoa de Meia-Idade , Monitorização Intraoperatória , Óptica e Fotônica , Estudos Prospectivos , Reprodutibilidade dos Testes , Processamento de Sinais Assistido por Computador , Retalhos CirúrgicosRESUMO
BACKGROUND: Combined topical and intracameral anaesthesia has become increasingly popular in cataract surgery. The purpose of this study was to determine the risk of capsular lesions with an intact motility during surgery. PATIENTS AND METHODS: In a prospective clinical study, we analyzed 2000 phacoemulsifications with IOL implantation performed by an experienced surgeon with combined sponge and intracameral lidocain anaesthesia. Preoperatively two grades of difficulty of the surgical procedure were defined. RESULTS: Operations were carried out on 1,658 patients with a (grade 1) low degree and 342 patients (grade 2) with a high degree of difficulty (17.1%). Capsular lesions occurred in 17 operations (0.85%), 15 in cases with a high degree of difficulty (88%). In 12 of these, an anterior vitrectomy was necessary and in 1 operation a pars plana vitrectomy after application of additional retrobulbar anaesthesia was performed. CONCLUSIONS: In this study the incidence of capsular lesions was not increased compared to other methods of anaesthesia. Anterior vitrectomy with the patient under combined sponge and intracameral anaesthesia, was possible without retrobulbar anaesthesia.
Assuntos
Anestesia Local , Complicações Intraoperatórias/etiologia , Cápsula do Cristalino/lesões , Lentes Intraoculares , Lidocaína , Idoso , Idoso de 80 Anos ou mais , Câmara Anterior , Feminino , Humanos , Complicações Intraoperatórias/cirurgia , Cápsula do Cristalino/cirurgia , Masculino , Estudos Prospectivos , VitrectomiaRESUMO
BACKGROUND: Iridodonesis is the clinical sign of lens subluxation. Acute glaucoma caused by a ciliolenticular block may develop. YAG iridotomy or peripheral iridectomy are rarely effective in controlling intraocular pressure. The results of phacoemulsification and posterior lens implantation for subluxated lens and glaucoma are reported. PATIENTS AND METHODS: Seven patients aged 69+/-9.5 years were followed up. All 10 eyes with subluxated lens and glaucoma had phacoemulsification and posterior chamber lens implantation. Two different groups relating to axial length could be analyzed. Intraoperative findings and postoperative glaucoma situation are reported. RESULTS: Six eyes had average axial length of 21.5+/-0.17 mm and previous acute glaucoma. Five of these eyes had therapeutic YAG iridotomy and one, peripheral iridectomy. All eyes had dysregulated glaucoma despite antiglaucomatous medications. After cataract surgery five of six eyes had regular intraocular pressure without any medication. Four eyes had average axial length of 24. 4+/-1.1 mm and chronic glaucoma. After complicated phacoemulsification three of these eyes had regular intraocular pressure with antiglaucomatous medication, one eye without. CONCLUSIONS: For short eyes with subluxated lens and preceding acute glaucoma, cataract surgery with posterior chamber lens implantation is an effective therapeutic procedure for IOP regulation. For chronic glaucoma with subluxated lens, conventional or surgical approach to glaucoma remains dominant.