Use of Ultrasound Biomicroscopy to Predict Long-Term Outcome of Sub-Tenon Needle Revision of Failed Trabeculectomy Blebs: A Pilot Study

2011 ◽  
Vol 21 (6) ◽  
pp. 700-707 ◽  
Author(s):  
Sushmita Kaushik ◽  
Anamika Tiwari ◽  
Surinder Singh Pandav ◽  
Parul Ichhpujani ◽  
Amod Gupta
Keyword(s):  
Ultrasound Biomicroscopy ◽  
Successful Outcome ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Successful Group ◽  
Aqueous Flow ◽  
Needle Revision

Purpose. To evaluate the role of ultrasound biomicroscopy (UBM) in predicting the long-term outcome of sub-Tenon needling revision of failed trabeculectomy blebs. Methods. Adult patients with a failed trabeculectomy bleb and unsatisfactory intraocular pressure (IOP) control were recruited. The aqueous flow under the partial thickness scleral flap was looked for and the blebs classified on UBM as scleral route patent (SRP) or scleral route occluded (SRO). All blebs underwent needling revision with injection of 5 mg/0.1 mL 5-fluorouracil. Survival of the revision procedure at the end of 2 years follow-up with regards to the baseline UBM characterization of the bleb was noted. Successful outcome was defined as IOP <22.0 mmHg and/or 30% reduction of baseline IOP with or without medication. Results. A total of 13 eyes had SRP and 5 eyes had SRO blebs on UBM. Only SRP blebs survived the needling procedure by the end of 2 years. Of the 13 SRP blebs, 10 blebs survived (76.9%). Needling had failed in all 5 SRO blebs. The overall success rate was 55.6 % at 2 years. There was no difference in age, IOP, and time from initial trabeculectomy between the failed and successful group. The outcome correlated significantly to the patency of the scleral route assessed by UBM (p=0.07). Conclusions. Ultrasound biomicroscopy characterization of failed blebs appears to help in predicting the outcome of needle revision. In SRO blebs, it may be better to plan a full bleb revision rather than needling alone. Ultrasound biomicroscopy may help in avoiding an unnecessary needling procedure in SRO blebs where it is likely to fail.

The Role of ECT in Schizophrenia

2002 ◽  
Vol 10 (4) ◽  
pp. 385-388 ◽  
Author(s):  
Richard Keuneman ◽  
Rajiv Weerasundera ◽  
David Castle
Keyword(s):  
Acute Onset ◽  
Clinical Settings ◽  
Limited Data ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Affective Symptoms ◽  
Maintenance Ect ◽  
The Subject

Objective: To review the place of electroconvulsive therapy (ECT) in the treatment of schizophrenia. Conclusions: ECT is as effective, if not more so, than the antipsychotic drugs in certain clinical settings. It can be rapidly effective in acute episodes. When used alone, antipsychotics have comparable or superior efficacy to ECT alone in the short term. However, ECT possibly confers better long-term outcome. Combination treatment with antipsychotic medications and ECT is superior to either treatment alone, and is safe and effective, notably in medication resistant schizophrenia. Benefits of acute courses of ECT may be short-lived unless maintenance ECT is instituted, although there are limited data on the subject. Clinically, patients with acute onset, shorter episodes are more likely to respond to ECT. Catatonia, preoccupation with delusions and hallucinations, and a relative absence of premorbid schizoid and paranoid personality traits, are other clinical factors less strongly predictive of positive response. The presence of affective symptoms is often thought to be predictive of clinical response. However, there is little research evidence for this. While medications remain the mainstay of treatment in schizophrenia, ECT does have a clear and increasingly recognised role which requires further evaluation.

scholarly journals Tubercular meningitis with hydrocephalus with HIV co-infection: role of cerebrospinal fluid diversion procedures

2015 ◽  
Vol 122 (5) ◽  
pp. 1087-1095 ◽  
Author(s):  
Raman Mohan Sharma ◽  
Nupur Pruthi ◽  
Arivazhagan Arimappamagan ◽  
Sampath Somanna ◽  
Bhagavathula Indira Devi ◽  
...  
Keyword(s):  
Hiv Positive ◽  
Short Term ◽  
Tubercular Meningitis ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Shunt Placement ◽  
Poor Outcome ◽  
Hiv Negative

OBJECT Hydrocephalus is one of the commonest complications of tubercular meningitis (TBM), and its incidence is increasing with the HIV epidemic. Literature evaluating the role of ventriculoperitoneal shunts in HIV-positive patients with TBM and their long-term prognosis is scarce. METHODS Between June 2002 and October 2012, 30 HIV-positive patients with TBM and hydrocephalus underwent ventriculoperitoneal shunt placement. Thirty age-, sex-, and grade-matched HIV-negative patients with TBM and hydrocephalus were randomly selected as the control group. Outcome was analyzed at discharge (short-term outcome) and at follow-up (long-term outcome). Univariate and multivariate analyses were performed to look for predictors of outcome; p < 0.05 was considered significant. RESULTS There were no differences in the clinical, radiological, or biochemical parameters between the 2 groups. Short-term outcome was better in the HIV-negative group (76.7% improvement) than in the HIV-positive group (70%). However, the long-term outcome in HIV-positive patients was very poor (66.7% mortality and 76.2% poor outcome) compared with HIV-negative patients (30.8% mortality and 34.6% poor outcome). Seropositivity for HIV is an independent predictor of poor outcome both in univariate and multivariate analyses (p = 0.038). However, in contrast to previous reports, of 5 patients with TBM in good Palur grades among the HIV-positive patients, 4 (80%) had good outcome following shunt placement. CONCLUSIONS The authors recommend that shunt treatment should not be performed in HIV-positive patients in poor Palur grade with hydrocephalus. A trial of external ventricular drainage should be undertaken in such patients, and shunt treatment should be performed only if there is any improvement. However, HIV-positive patients in good Palur grades should undergo VP shunt placement, as these patients have better outcomes than previously reported.

scholarly journals Prognostic role of acute kidney injury on long-term outcome in infants with hypoxic-ischemic encephalopathy

2019 ◽  
Vol 35 (3) ◽  
pp. 477-483 ◽  
Author(s):  
Francesco Cavallin ◽  
Giulia Rubin ◽  
Enrico Vidal ◽  
Elisa Cainelli ◽  
Luca Bonadies ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Hypoxic Ischemic Encephalopathy ◽  
Prognostic Role ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Ischemic Encephalopathy

P1813CLINICAL CHARACTERIZATION OF CONGENITAL SOLITARY FUNCTIONING KIDNEY IN CHILDREN

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Francesca Becherucci ◽  
Francesca Guzzi ◽  
Luigi Cirillo ◽  
Alessandra Bettiol ◽  
Arianna Zuccato ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Compensatory Hypertrophy ◽  
Functional Adaptation ◽  
Renal Scintigraphy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Functioning Kidney

Abstract Background and Aims Congenital anomalies of the kidney and urinary tract (CAKUT) are the major cause of chronic kidney disease and end-stage kidney disease in childhood. Solitary functioning kidney (SFK) is part of the spectrum of CAKUT. Congenital SFK is mainly due to unilateral renal agenesis (URA) and multi-cystic dysplastic kidney (MCDK). With the implementation of routine fetal ultrasound screening, SFK is increasingly recognized before birth, significantly raising the number of patients referred to paediatric nephrology units for clinical monitoring during childhood. Understanding the pathophysiology of SFK is pivotal for guiding the clinical management and informing long-term outcome. However, observational studies performed in children with SFK are controversial, especially about the need, methodology and timing of functional assessment. This may be at least in part due to the fact that different models of SFK, including congenital and acquired after unilateral nephrectomy, are often grouped together. The aim of this study was to assess the clinical, laboratory and functional features of congenital SFK caused by URA and MCDK in children, with a particular focus on the role of renal scintigraphy in estimating kidney function during childhood and adolescence. Method We retrospectively collected clinical, laboratory and instrumental records of all consecutive pediatric patients (aged 0-18 years) affected by congenital SFK caused by URA or MCDK referred to the Nephrology and Dialysis Unit of Meyer Children’s Hospital of Florence (Italy) from 1992 to 2019. Patients with unilateral kidney hypodysplasia were excluded. In particular, we reviewed data from ultrasound scanning and sequential renal scintigraphy over time. URA and MCDK were compared for clinical features, long-term course and outcome. Results A total of 155 patients with congenital SFK were included in the study and divided in two groups according to the cause of SFK (URA, n=100; MCDK, n=55). The median length of follow-up was 47 and 45 months, respectively. Male sex and ethnicity were equally distributed in the two groups. Prenatal diagnosis was more frequent in MCDK group. We did not observe either preterm birth or low birth weight in patients enrolled. Overall, the clinical features were not statistically different between the two groups. In particular, SFK associated CAKUT, including vesicoureteral reflux, occurred at a comparable frequency. Also, measurement of kidney length by ultrasound scanning, which is often considered suggestive of compensatory hypertrophy, did not differ between groups. Although renal clearance from sequential renal scintigraphy appeared not statistically different between URA and MCDK, the latter seems to reach complete functional adaptation more rapidly and earlier in the first two years of life. Conclusion The clinical course and long-term outcome of SFK has been a topic of extensive debate. Due to poor-quality of data (unclear inclusion/exclusion criteria, lack of uniformity in data collection and outcome definition), generalization of findings from observational studies to all patients with SFK could be inappropriate. Congenital SFK could represent the most unbiased group to analyze and this study provides a thorough clinical characterization of a large and strictly selected cohort. Insights from sequential renal scintigraphy suggest a different trend in reaching single kidney complete functional adaptation in URA and MCDK. These results could potentially reveal significant differences in the pathophysiologic mechanisms of reaching compensatory hypertrophy and functional adaptation by the solitary kidney in the two models. Whether confirmed in larger cohorts, these findings could provide important implications for follow-up planning, informing the need, methodology and timing for function assessment, tailoring the clinical management and understanding long-term prognosis.

scholarly journals Cribriform neuroepithelial tumor: molecular characterization of a SMARCB1-deficient non-rhabdoid tumor with favorable long-term outcome

2016 ◽  
Vol 27 (4) ◽  
pp. 411-418 ◽  
Author(s):  
Pascal D. Johann ◽  
Volker Hovestadt ◽  
Christian Thomas ◽  
Astrid Jeibmann ◽  
Katharina Heß ◽  
...  
Keyword(s):  
Molecular Characterization ◽  
Rhabdoid Tumor ◽  
Term Outcome ◽  
Long Term Outcome
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