Effect of mannitol on globe and orbital volumes in humans

2018 ◽  
Vol 28 (2) ◽  
pp. 163-167 ◽  
Author(s):  
Adam C. Weber ◽  
Alexander D. Blandford ◽  
Bryan R. Costin ◽  
Julian D. Perry
Keyword(s):  
Volume Change ◽  
Cleveland Clinic ◽  
Retrospective Chart Review ◽  
Consecutive Series ◽  
Orbital Volume ◽  
Computed Tomographic ◽  
Before And After ◽  
Pressure Lowering ◽  
Volume Measurements

Purpose: To determine the effect of intravenous mannitol on globe and orbital volumes. Methods: Retrospective chart review of a consecutive series of Cleveland Clinic Neurosurgical Intensive Care Unit patients who underwent computed tomographic imaging before and after intravenous mannitol administration. Volume measurements were performed according to a previously described technique by averaging axial image areas. Measurements before and after mannitol administration were compared using paired t-test. Results: Fourteen patients (28 eyes) met inclusion criteria. Average globe volume decreased 186 mm3 (-2.5%, p = 0.02) after mannitol administration, while average orbital volume increased 353 mm3 (+3.5%, p = 0.04). Average globe volume change for subjects with follow-up scan less than 4.7 hours (mean 1.9 hours; range 0.2-4.5 hours) after mannitol administration was -125 mm3 (-1.7%, p = 0.24) and average orbital volume change was +458 mm3 (+5.1%, p = 0.11). Average globe volume change after mannitol administration for those with follow-up more than 4.7 hours (average 13.9 hours, range 4.9-24.7 hours) was -246 mm3 (-3.3%, p = 0.05) and orbital volume change was +248 mm3 (+2.2%, p = 0.24). Dividing the study population into groups based on mannitol dose did not yield any statistically significant change. Conclusions: Human globe volume decreases after intravenous mannitol administration, while orbital volume increases. These volume changes occur during the time period when intraocular pressure normalizes, after the pressure-lowering effects of the drug. This novel volumetric information improves our understanding of mannitol’s mechanism of action and its effects on human ocular and periocular tissues.

Pallidal Deep Brain Stimulation for Primary Dystonia in Children

Neurosurgery ◽  
2011 ◽  
Vol 68 (3) ◽  
pp. 738-743 ◽  
Author(s):  
Abilash Haridas ◽  
Michele Tagliati ◽  
Irene Osborn ◽  
Ioannis Isaias ◽  
Yakov Gologorsky ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Clinical Improvement ◽  
Brain Stimulation ◽  
Functional Disability ◽  
Rating Scale ◽  
Retrospective Chart Review ◽  
Consecutive Series ◽  
Internal Globus Pallidus ◽  
Deep Brain

Abstract BACKGROUND: Deep brain stimulation (DBS) at the internal globus pallidus (GPi) has replaced ablative procedures for the treatment of primary generalized dystonia (PGD) because it is adjustable, reversible, and yields robust clinical improvement that appears to be long lasting. OBJECTIVE: To describe the long-term responses to pallidal DBS of a consecutive series of 22 pediatric patients with PGD. METHODS: Retrospective chart review of 22 consecutive PGD patients, ≤21 years of age treated by one DBS team over an 8-year period. The Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) was used to evaluate symptom severity and functional disability, pre- and post-operatively. Adverse events and medication changes were also noted. RESULTS: The median follow-up was 2 years (range, 1-8 years). All 22 patients reached 1-year follow-up; 14 reached 2 years, and 11 reached 3 years. The BFMDRS motor subscores were improved 84%, 93%, and 94% (median) at these time points. These motor responses were matched by equivalent improvements in function, and the response to DBS resulted in significant reductions in oral and intrathecal medication requirements after 12 and 24 months of stimulation. There were no hemorrhages or neurological complications related to surgery and no adverse effects from stimulation. Significant hardware-related complications were noted, in particular, infection (14%), which delayed clinical improvement. CONCLUSION: Pallidal DBS is a safe and effective treatment for PGD in patients <21 years of age. The improvement appears durable. Improvement in device design should reduce hardware-related complications over time.

scholarly journals Computed Tomography and Bronchoscopy in Endobronchial Tuberculosis

2003 ◽  
Vol 10 (8) ◽  
pp. 445-448 ◽  
Author(s):  
Halil Yanardag ◽  
Cüneyt Tetikkurt ◽  
Seza Tetikkurt ◽  
Sabriye Demirci ◽  
Tuncer Karayel
Keyword(s):  
Computed Tomography ◽  
Retrospective Study ◽  
Therapeutic Response ◽  
Histopathological Examination ◽  
Computed Tomographic ◽  
Before And After ◽  
Endobronchial Tuberculosis ◽  
Age Range

BACKGROUND: The therapeutic response to endobronchial tuberculosis is usually evaluated by bronchoscopy. Currently, there are no published studies investigating the use of computed tomography for the evaluation of therapeutic response in endobronchial tuberculosis.OBJECTIVE: A retrospective study was performed to evaluate the bronchoscopic and computed tomographic features of endobronchial tuberculosis before and after treatment. The aim of this study was to investigate the usefulness of computed tomography for the assessment of treatment.METHODS: The clinical, pathological and bronchoscopic features of endobronchial tuberculosis were evaluated in 55 patients. The age range of the patients was 21 to 52 years. Computed tomography and bronchoscopy were performed before and after treatment.RESULTS: Diagnosis of tuberculosis was confirmed by culture and histopathological examination. Bronchoscopic examination revealed 89 endobronchial lesions of various types in 55 patients. The exudative type was the most common. Follow-up bronchoscopy revealed that exudative-, ulcerative- and granular-type lesions healed completely. Computed tomography performed after treatment correlated well with the follow-up bronchoscopic findings.CONCLUSION: The results suggest that follow-up computed tomography is useful for the evaluation of therapeutic response and complications associated with endobronchial tuberculosis, and may replace bronchoscopy.

Efficacy and tolerability of clobazam in adults with drug-refractory epilepsy

2020 ◽  
pp. 10.1212/CPJ.0000000000000992
Author(s):  
Alisha Jamil ◽  
Noah Levinson ◽  
Michael Gelfand ◽  
Chloe E. Hill ◽  
Pouya Khankhanian ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Seizure Frequency ◽  
Retrospective Chart Review ◽  
Adjunctive Treatment ◽  
Drug Resistant ◽  
Before And After ◽  
Initial Cohort ◽  
Epilepsy Classification ◽  
Drug Resistant Epilepsy

ObjectivesTo evaluate the effectiveness and tolerability of clobazam as an adjunctive treatment for adults with drug-resistant epilepsy.MethodsWe performed a single-center, retrospective chart review of patients ≥18 years of age with drug-resistant epilepsy who started clobazam between 2010 and 2018. Included patients had outpatient visits both before and ≥1 month after clobazam initiation. Epilepsy classification, seizure frequency before and after clobazam, duration of clobazam treatment, and adverse effects were analyzed.ResultsA total of 417 patients met inclusion criteria. Mean age was 37.5 years, and 54% of patients were female. Patients were on a mean of 2.4 antiepileptic drugs at time of initiation of clobazam. Epilepsy types were focal (56.8%), Lennox-Gastaut syndrome (LGS) (21.1%), generalized (15.1%), and unclassified (7.0%). At the first follow-up visit ≥1 month after clobazam initiation, 50.3% of patients had >50% reduction in seizure frequency, and 20.5% were seizure-free. Of the initial cohort, 17.1% were followed >1 year and were seizure-free at last follow-up. Response rates did not differ between different epilepsy classifications. Fifty-one percent of patients experienced ≥1 side effect, most commonly lethargy/fatigue (30.7%) or mood changes (10.8%). A total of 178 (42.6%) patients discontinued clobazam, most commonly due to adverse effects (55%).ConclusionsClobazam is effective and safe as a long-term adjunctive therapy for adults with drug-resistant epilepsy; efficacy in off-label use is similar to that in LGS.Classification of evidenceThis study provides Class IV evidence that clobazam is an effective treatment for adults with drug-resistant epilepsy, independent of epilepsy classification.

Durability and Failure Types of S2-Alar-Iliac Screws: An Analysis of 312 Consecutive Screws

2020 ◽  
Vol 20 (1) ◽  
pp. 91-97
Author(s):  
Seung-Jae Hyun ◽  
Jong-myung Jung ◽  
Ki-Jeong Kim ◽  
Tae-Ahn Jahng
Keyword(s):  
Clinical Outcomes ◽  
Screw Fixation ◽  
Patient Characteristics ◽  
Shaft Fracture ◽  
Consecutive Series ◽  
Computed Tomographic ◽  
Spinopelvic Fixation ◽  
Iliac Screws ◽  
Failure Types

Abstract BACKGROUND S2-alar-iliac (S2AI) screws improve stability across the lumbosacral junction in spinopelvic fixation procedures by crossing the cortical surfaces of the sacroiliac joint (SIJ), thereby increasing the biomechanical strength of the instrumentation. OBJECTIVE To investigate the durability and failure types of S2AI screws after spinopelvic reconstruction surgery. METHODS A single-center, single-surgeon consecutive series of patients who underwent spinopelvic fixation using bilateral S2AI screws with a ≥1-yr follow-up and at least 1 postoperative computed tomographic scan were retrospectively reviewed. Patient characteristics, radiographic parameters, operative data, clinical outcomes, and complications were analyzed. RESULTS In total, 312 S2AI screws in 156 patients were evaluated (mean follow-up, 26.1 mo; range 12-71 mo). There were no significant differences in screw diameter, length, or insertion angle between right-side and left-side screws. Visual analogue scale scores for back pain, ambulatory status, and Oswestry Disability Index scores significantly improved. A total of 10 patients (3.2%) experienced SIJ pain after S2AI screw installation. SIJ pain improved in 8 of them following SIJ block. In total, 7 screws (2.2%) showed partial periscrew lucency. Set screw dislodgement occurred in 7 screws (2.2%). Screw fracture occurred in 6 screws (1.9%): 5 neck fractures and 1 shaft fracture. A total of 5 patients (1.6%) underwent revision surgery for S2AI screw failure. Distal device (L4-pelvis region) breakage occurred in 5 patients. CONCLUSION The radiographic and clinical outcomes of S2AI screw fixation were acceptable. However, S2AI screw fixation has several drawbacks, including screw fracture and dislodgement of the set screw. SIJ irritation symptoms after S2AI screw fixation occurred with considerable frequency.

scholarly journals Chronological Impact of Earthquakes on Blood Pressure: A Literature Review and Retrospective Study of Hypertension in Haiti Before and After the 2010 Earthquake

2021 ◽  
Vol 8 ◽  
Author(s):  
Ayman R. Fath ◽  
Amro Aglan ◽  
Jeri Platt ◽  
Jordan R. Yaron ◽  
Kyle S. Varkoly ◽  
...  
Keyword(s):  
Literature Review ◽  
Chart Review ◽  
Retrospective Studies ◽  
Retrospective Chart Review ◽  
Chronic Effects ◽  
Significant Difference ◽  
Before And After ◽  
Early Health ◽  
Significant Change

Objective: We review prior studies on the incidence of hypertension (HTN) after earthquakes and present a retrospective analysis of HTN after the 2010 earthquake in Haiti.Methods: Prior reports on HTN incidence were reviewed and a retrospective chart review for diagnosis of HTN in 4,308 patient charts was performed over a 7 year period (five clinics). A retrospective cohort study (RCS) was then performed on 11 patients with linear follow-up.Results: The Literature review revealed a significant increase in acute and subacute HTN following earthquakes. However, the chronic effects of earthquakes varied. Our chart review uncovered no significant difference in diagnosed HTN in a Fort-Liberté clinic 128 kilometers (km) distant and 4 weeks post-event. A secondary linear RCS for 11 individuals, prior to and after the earthquake, also did not detect a significant change in HTN prevalence.Conclusion: Prior studies demonstrate acute and subacute, increases in HTN after earthquakes, but late changes have varied. Retrospective studies in the Fort-Liberté clinic, 128 km distant and 4 weeks post-event, revealed no significant change in HTN, confirming prior findings that changes in HTN after earthquakes are early and local events. Further work examining HTN after earthquakes is needed to improve early health care after natural disasters.

scholarly journals MON-LB84 Validation of TI-RADS (Thyroid Imaging, Reporting and Data System) Follow-Up Recommendations

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Sindhura Ravindra ◽  
Esra Karslioglu French ◽  
Linwah Yip
Keyword(s):  
Thyroid Cancer ◽  
Volume Change ◽  
Retrospective Chart Review ◽  
Needle Aspiration ◽  
Endocrine Surgery ◽  
Ultrasound Images ◽  
Surgical Data ◽  
Stratification System ◽  
Benign Nodules

Abstract Background:Thyroid nodules are exceedingly common, leading to costly interventions for many lesions that ultimately prove benign. Therefore, a reliable, noninvasive method to identify which nodules warrant fine needle aspiration and/or follow-up on the basis of a reasonable likelihood of malignancy is highly desirable. American College of Radiology (ACR) created a standard terminology (lexicon) to describe all thyroid nodules on sonography and standardized TI-RADS risk-stratification system to identify nodules that warrant biopsy and/or follow-up. Many healthcare institutions including UPMC adapted the TI-RADS scoring system in order to identify most clinically significant malignancies while reducing the number of biopsies and follow-up ultrasounds performed on benign nodules. According to ACR, TI-RADS category 3 nodules <1.5 cm and TI-RADS category 4 nodules <1 cm do not warrant follow-up imaging. There are no validation studies on TI-RADS follow-up recommendations. Methods:We completed a retrospective chart review from UPMC endocrine surgery thyroid nodule database from 2002 to 2012. We identified 57 nodules that showed a change in size during follow-up and had surgical data. Patient demographics, nodule baseline TI-RADS category, size, follow-up volume change and histopathological data were recorded. We reviewed ultrasound images and calculated TI-RADS category at baseline and during follow-up. Results:TI-RADS category 1-2 (TR1 and TR2) nodules(n=4) did not show any change in size over an average of 6.5 years confirming the recommendations that TR1 and TR2 nodules do not need follow-up.TI-RADS category (TR3) nodules (n=22) showed an average 225% change in volume over 4 years of follow-up. TR3 nodules <1.5 cm showed 397% volume change; 3 out of 15 (20%) nodules that showed a change in size proved to have thyroid cancer >1cm. TI-RADS category (TR4) nodules(n=31) showed a 786% volume change over 2.6 years of follow-up. TR4 nodules <1 cm, 5/14(35%) proved to have thyroid cancer >1 cm in follow up. Conclusions:TR1 and TR2 nodules did not show thyroid cancer during follow-up validating ACR recommendations not to follow these nodules. 3/15(26.5%) TR3 nodules <1.5 cm that showed a change in volume proved to have thyroid cancer. 5/14(35%) TR4 nodules <1cm that changed in volume were found to have thyroid cancer. Further studies are needed to identify nodules that require follow-up in order to decrease the misdiagnosis of thyroid cancer.

Preservation of erectile function after permanent radioactive seed implantation for treatment of prostate cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15596-15596
Author(s):  
R. D. Steinmetz ◽  
W. L. Barrett
Keyword(s):  
Prostate Cancer ◽  
Erectile Function ◽  
Retrospective Chart Review ◽  
Prostate Brachytherapy ◽  
Testosterone Levels ◽  
Before And After ◽  
Adenocarcinoma Of The Prostate ◽  
Pretreatment Score ◽  
Function Assessment

15596 Purpose: Assess erectile function before and after prostate brachytherapy. Materials and Methods: A total 241 patients were treated with permanent I-125 prostate brachytherapy for T1 and T2 adenocarcinoma of the prostate. A retrospective chart review was undertaken to assess erectile function before and after treatment using the scoring system of, 1- complete inability to have erections, 2 - can sometimes have erections sufficient for intercourse with or without medication, and 3 - has normal erectile function. Pretreatment testosterone levels were reviewed for correlation with pretreatment erectile function. Results: The median age was 68. At presentation, the median age of patients with erectile scores of 1, 2 and 3 was 70, 67 and 67 respectively. The median time of follow-up was 48 months. Pretreatment erectile function assessment revealed scores of 1 in 28%, 2 in 27% and 3 in 45% of patients. Median pretreatment testosterone levels were 296 ng/dl in the patients with pretreatment score of 1 compared to 360 ng/dl in patients with a score of 2 and 370 ng/dl in patients with a score of 3. The normal testosterone range for this age group is 165 ng/dl to 830 ng/dl. After 12 months erectile function assessment revealed scores of 1 in 29%, 2 in 42% and 3 in 29% of patients. After 24 months erectile function assessment revealed scores of 1 in 30%, 2 in 41% and 3 in 29% of patients. After 36 months erectile function assessment revealed scores of 1 in 32%, 2 in 45% and 3 in 23% of patients. After 48 months erectile function assessment revealed scores of 1 in 39%, 2 in 36% and 3 in 25% of patients. After 48 months, the median age of patients with erectile scores of 1, 2 and 3 was 75, 69 and 66 respectively. After 60 months erectile function assessment revealed scores of 1 in 32%, 2 in 47% and 3 in 21% of patients. After 72 months erectile function assessment revealed scores of 1 in 24%, 2 in 52% and 3 in 24% of patients. 49% of patients were given sildenafil, vardenafil, or tadalafil to improve erectile function. Conclusion: The rate of potency preservation in this cohort declined in an expected manner after permanent brachytherapy for prostate cancer. No significant financial relationships to disclose.

scholarly journals Comparative Orbital Volumes between a Single Incisional Approach and a Double Incisional Approach in Patients with Combined Blowout Fracture

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Hyun Ho Han ◽  
Sang Wook Park ◽  
Suk-Ho Moon ◽  
Bommie F. Seo ◽  
Jong Won Rhie ◽  
...  
Keyword(s):  
Surgical Outcomes ◽  
Retrospective Chart Review ◽  
Medial Wall ◽  
Orbital Fracture ◽  
Orbital Volume ◽  
Blowout Fracture ◽  
Significant Difference ◽  
Double Approach ◽  
Single Approach

Purpose. Blowout fracture characterized by concurrent floor and medial wall fractures is a rare entity. We compared surgical outcomes between a single approach and a double approach in patients with orbital fracture by measuring the postoperative orbital volume.Methods. We confirmed that 21 (8.5%) of a total of 246 patients with orbital fractures had fractures of the medial wall and floor through a retrospective chart review. Of these, 10 patients underwent the single approach and the remaining 11 patients had the double approach. We performed a statistical analysis of changes between the preoperative and postoperative orbital volumes at a 6-month follow-up.Results. Compared with the contralateral, nonaffected side, the orbital volume was 115.3 (±6.09)% preoperatively and 106.5 (±6.15)% postoperatively in the single approach group and 118.2 (±11.16)% preoperatively and 108.6 (±13.96)% postoperatively in the double approach. These results indicated that there was a significant difference between the preoperative and postoperative orbital volumes in each group (P<0.05). However there was no significant difference between the single approach and the double approach (P>0.05).Conclusions. Our results showed that there were no significant differences in surgical outcomes between the two modalities. The treatment modality may be selected based on the surgeons’ preference, as well as the fracture type.

scholarly journals The Role of Subthreshold Micropulse Yellow Laser as an Alternative Option for the Treatment of Refractory Postoperative Cystoid Macular Edema

2020 ◽  
Vol 9 (4) ◽  
pp. 1066
Author(s):  
Tommaso Verdina ◽  
Rossella D’Aloisio ◽  
Andrea Lazzerini ◽  
Cecilia Ferrari ◽  
Edoardo Valerio ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Cystoid Macular Edema ◽  
Retrospective Chart Review ◽  
Topical Steroids ◽  
Before And After ◽  
Laser Treatments ◽  
Posterior Capsule Rupture ◽  
Yellow Laser

Background: To evaluate the efficacy and the safety of subthreshold micropulse yellow laser (SMYL) in the treatment of chronic postoperative cystoid macular edema (PCME), which is refractory to standard therapies. Methods: A retrospective chart review of ten eyes of ten patients affected by refractory PCME who underwent SMYL was performed. Five PCME cases were subsequent to uncomplicated cataract surgery (CS), two cases to complicated CS (CCS) with posterior capsule rupture and three cases occurred after retinal detachment surgery (RD). All conditions were refractory to conventional treatments prior to SMYL interventions for at least 4 months, including nonsteroidal anti-inflammatory eyedrops, topical steroids, oral indomethacin, sub-Tenon’s triamcinolone injections and Dexamethasone intravitreal implants. All patients underwent one or more treatments with 577 nm SMYL photo-stimulation, with 7 × 7 grids with confluent spots and a 5% duty cycle covering the whole edematous retina, including the foveal center. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were obtained using OCT, and evaluated before and after the treatment at 1, 2, 3 and 6-month follow-ups. Results: A complete subfoveal macular edema resolution was observed in all of the eyes, with statistically significant improvements in terms of BCVA and CMT in all of the follow-up timelines (at 6 months, p = 0.002 and p = 0.005, respectively). The mean number of laser treatments was 1.3. At the final follow-up, a complete subfoveal edema reabsorption was observed in all patients with visual acuity improvement. No complications were observed in any case. Conclusions: SMYL seems to be a safe and effective treatment for the long-term resolution of refractory PCME and may be a useful alternative to expensive and invasive therapeutic options.

scholarly journals Laparoscopic fixation of biological mesh at hiatus with glue and suture during hiatal hernia repair

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yusheng Nie ◽  
Yao Xiong ◽  
Lei Guan ◽  
Xin Yuan ◽  
Fuqiang Chen ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Hiatal Hernia ◽  
Recurrence Rate ◽  
Mesh Fixation ◽  
Retrospective Chart Review ◽  
Biological Mesh ◽  
Hiatal Hernia Repair ◽  
Consecutive Series ◽  
Crural Closure

Abstract Background Laparoscopic paraesophageal hernia repair is associated with higher recurrence rate. Mesh is used to reduce the recurrence rate. This retrospective study is to review our experience of biological mesh fixed with suture and medical glue in hiatal hernias repairs. Methods A retrospective chart review was conducted for a consecutive series of patients undergoing laparoscopic hiatal herniorrhaphy between January 2018 and January 2019. After hiatus closure, a piece of biological prosthesis was fixed with medical glue and suture for reinforcement of the crural closure. Clinical outcomes were reviewed, and data were collected regarding operative details, complications, symptoms, and follow-up imaging. Radiological evidence of any size of hiatal hernia was considered to indicate a recurrence. Results Thirty-six patients underwent surgery uneventfully without any serious complication. There was no mortality. The follow-up was, on average, 18.4 months, and there was no symptomatic recurrence. There was one anatomical recurrence without any related presentation. The method of mesh fixation with medical glue and suture took 12 min on average, and the handling was fairly easy. Conclusions Biological mesh fixed with suture and medical glue was safe and effective for repairing large hiatal hernias. Of course, a longer follow-up is still needed for determining long-term outcomes.

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