Pediatric Allergy and Immunology,Volume 0, Issue ja, -Not available-. (Source: Pediatric Allergy and Immunology)
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Δευτέρα 15 Οκτωβρίου 2018
Detection of genuine grass pollen sensitization in children by skin testing with a recombinant grass pollen hybrid
IL-21 Biased Alemtuzumab Induced Chronic Antibody-Mediated Rejection Is Reversed by LFA-1 Costimulation Blockade
Jean Kwun, Jaeberm Park, John S. Yi, Alton B. Farris, Allan D. Kirk, Stuart J. Knechtle (Source: Frontiers in Immunology)
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Unraveling the Molecular Mechanisms Underlying Complement Dysregulation by Nephritic Factors in C3G and IC-MPGN
Roberta Donadelli, Patrizia Pulieri, Rossella Piras, Paraskevas Iatropoulos, Elisabetta Valoti, Ariela Benigni, Giuseppe Remuzzi, Marina Noris (Source: Frontiers in Immunology)
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Host MyD88 signaling protects against acute graft ‐versus‐host disease after allogeneic bone marrow transplantation
Clinical&Experimental Immunology, EarlyView. (Source: Clinical and Experimental Immunology)
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NK1.1 Expression Defines a Population of CD4+ Effector T Cells Displaying Th1 and Tfh Cell Properties That Support Early Antibody Production During Plasmodium yoelii Infection
Daniel J. Wikenheiser, Susie L. Brown, Juhyung Lee, Jason S. Stumhofer (Source: Frontiers in Immunology)
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Targeting Immune Checkpoint Molecules to Eliminate Latent HIV
Zoe Boyer, Sarah Palmer (Source: Frontiers in Immunology)
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Prognostic Implications of Heterogeneity in Intra-tumoral Immune Composition for Recurrence in Early Stage Lung Cancer
Jyothi Thyagabhavan Mony, Matthew J. Schuchert (Source: Frontiers in Immunology)
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Modulating Iron for Metabolic Support of TB Host Defense
James J. Phelan, Sharee A. Basdeo, Simone C. Tazoll, Sadhbh McGivern, Judit R. Saborido, Joseph Keane (Source: Frontiers in Immunology)
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Respiratory Chlamydia Infection Induce Release of Hepoxilin A3 and Histamine Production by Airway Neutrophils
Katir K. Patel, Wilmore C. Webley (Source: Frontiers in Immunology)
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New miRNA Signature Heralds Human NK Cell Subsets at Different Maturation Steps: Involvement of miR-146a-5p in the Regulation of KIR Expression
Silvia Pesce, Margherita Squillario, Marco Greppi, Fabrizio Loiacono, Lorenzo Moretta, Alessandro Moretta, Simona Sivori, Patrizio Castagnola, Annalisa Barla, Simona Candiani, Emanuela Marcenaro (Source: Frontiers in Immunology)
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Regulatory T Cells in Systemic Sclerosis
Camelia Frantz, Cedric Auffray, Jerome Avouac, Yannick Allanore (Source: Frontiers in Immunology)
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The Chlamydia M278 Major Outer Membrane Peptide Encapsulated in the Poly(lactic acid)-Poly(ethylene glycol) Nanoparticulate Self-Adjuvanting Delivery System Protects Mice Against a Chlamydia muridarum Genital Tract Challenge by Stimulating Robust Systemic and Local Mucosal Immune Responses
Richa Verma, Rajnish Sahu, Saurabh Dixit, Skyla A. Duncan, Guillermo H. Giambartolomei, Shree R. Singh, Vida A. Dennis (Source: Frontiers in Immunology)
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Unraveling the Molecular Mechanisms Underlying Complement Dysregulation by Nephritic Factors in C3G and IC-MPGN
Roberta Donadelli, Patrizia Pulieri, Rossella Piras, Paraskevas Iatropoulos, Elisabetta Valoti, Ariela Benigni, Giuseppe Remuzzi, Marina Noris (Source: Frontiers in Immunology)
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Mild Hypogammaglobulinemia Can Be a Serious Condition
Lisanne M. A. Janssen, Paul Bassett, Thomas Macken, Jolanda van Esch, Hans Pruijt, Arnoud Knoops, Markus Sk öld, Antony Parker, Jolanda de Vries, Esther de Vries (Source: Frontiers in Immunology)
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Complementary Mechanisms Potentially Involved in the Pathology of Zika Virus
Chet Raj Ojha, Myosotys Rodriguez, Jessica Lapierre, Mohan Kumar Muthu Karuppan, Heather Branscome, Fatah Kashanchi, Nazira El-Hage (Source: Frontiers in Immunology)
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Conjunctival Inflammatory Gene Expression Profiling in Dry Eye Disease: Correlations With HLA-DRA and HLA-DRB1
Karima Kessal, Hong Liang, Ghislaine Rabut, Philippe Daull, Jean-S ébastien Garrigue, Mylene Docquier, Stéphane Melik Parsadaniantz, Christophe Baudouin, Françoise Brignole-Baudouin (Source: Frontiers in Immunology)
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IL-21 Biased Alemtuzumab Induced Chronic Antibody-Mediated Rejection Is Reversed by LFA-1 Costimulation Blockade
Jean Kwun, Jaeberm Park, John S. Yi, Alton B. Farris, Allan D. Kirk, Stuart J. Knechtle (Source: Frontiers in Immunology)
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Host MyD88 signaling protects against acute graft ‐versus‐host disease after allogeneic bone marrow transplantation
Clinical&Experimental Immunology, EarlyView. (Source: Clinical and Experimental Immunology)
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Detection of genuine grass pollen sensitization in children by skin testing with a recombinant grass pollen hybrid
Pediatric Allergy and Immunology,Volume 0, Issue ja, -Not available-. (Source: Pediatric Allergy and Immunology)
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Detection of genuine grass pollen sensitization in children by skin testing with a recombinant grass pollen hybrid
Pediatric Allergy and Immunology,Volume 0, Issue ja, -Not available-. (Source: Pediatric Allergy and Immunology)
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Detection of genuine grass pollen sensitization in children by skin testing with a recombinant grass pollen hybrid
Pediatric Allergy and Immunology,Volume 0, Issue ja, -Not available-. (Source: Pediatric Allergy and Immunology)
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[Orbital complications].
Authors: Graß S, Welkoborsky HJ, Möbius H, Plontke SK, Glien A Abstract A disease or symptom of disease spreading from the vicinity of the orbit to the internal structures of the orbit is referred to as an orbital complication. Orbital complications can have a traumatic, inflammatory, allergic, or autoimmunologic cause. They are more frequent in children than adults. The present review aims to provide a description of orbital complications, their etiology, pathogenesis, and treatment. Recent literature in the field is acknowledged and discussed, and results from the authors' own patient groups are analyzed. Particular attention is paid to orbital complications due to acute sinusitis and those caused by acute hemorrhage. The term "orbital phlegmon" frequently used for orbital c...
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Pretarsal roll augmentation with dermal hyaluronic acid filler injection
Abstract
Pretarsal roll augmentation with dermal hyaluronic acid filler injection focuses on restoring pretarsal fullness. This study aimed to introduce a method of pretarsal roll augmentation with dermal hyaluronic acid filler injection and establish the level of difficulty, safety, and effectiveness of this method. Eighty female patients were enrolled in this study. Hyaluronic acid filler was used to perform pretarsal roll augmentation. Physician and patient satisfaction at 1 month and 4 months after surgery was investigated. The level of satisfaction was graded from points 1 to 5. The patient satisfaction and physician scores were 4.7 ± 1.1 (mean ± standard deviation) points at 1 month and 4.8 ± 0.9 points at 4 months and 4.6 ± 0.9 points at 1 month and 4.8 ± 1.0 points at 4 months, respectively. No major complications were observed. Our technique provided a natural and younger appearance with pretarsal fullness. This technique was easy to perform for the restoration of pretarsal fullness, and it improved periorbital contouring, rejuvenated the pretarsal roll, and provided excellent esthetic results.
Level of Evidence: Level V, therapeutic study.
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The effectiveness of hyperbaric oxygen in patients with idiopathic sudden sensorineural hearing loss: a systematic review
Abstract
Objective
To evaluate the effectiveness of hyperbaric oxygen in the treatment of patients with idiopathic sudden sensorineural hearing loss (ISSHL).
Data sources
An Embase, MEDLINE and Cochrane search were utilised to identify various clinical trials on the treatment of ISSHL. Studies that were published between 2002 and 2018 and written in the English, Dutch or German language were included. Search terms included synonyms for idiopathic sudden hearing loss.
Data synthesis
A total of 16 articles were identified regarding hyperbaric oxygen therapy. All patients were evaluated with pure-tone audiometry. A major part of the cases presented with unilateral hearing loss(bilateral hearing loss less than 5%). In several studies, the average of the mean hearing gain at five contiguous frequencies was significantly higher in the hyperbaric oxygen (HBO) therapy and systemic steroid (SS) group in patients with severe or profound hearing impairment. They recorded a significant treatment effect (p = 0.005) of HBO + SS therapy on patients with an initial hearing loss of ≥ 81 dB.
Conclusions
On the whole group of ISSHL patients, no significant difference was demonstrated between the intervention and control group. However, in severe or profound hearing-impaired ISSHL patients, significant benefit was observed in the intervention group. These results likely indicate that adding HBO to steroid therapies might be of benefit in cases of severe and profound hearing impairment.
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[Orbital complications].
Authors: Graß S, Welkoborsky HJ, Möbius H, Plontke SK, Glien A Abstract A disease or symptom of disease spreading from the vicinity of the orbit to the internal structures of the orbit is referred to as an orbital complication. Orbital complications can have a traumatic, inflammatory, allergic, or autoimmunologic cause. They are more frequent in children than adults. The present review aims to provide a description of orbital complications, their etiology, pathogenesis, and treatment. Recent literature in the field is acknowledged and discussed, and results from the authors' own patient groups are analyzed. Particular attention is paid to orbital complications due to acute sinusitis and those caused by acute hemorrhage. The term "orbital phlegmon" frequently used for orbital c...
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The effectiveness of hyperbaric oxygen in patients with idiopathic sudden sensorineural hearing loss: a systematic review
Abstract
Objective
To evaluate the effectiveness of hyperbaric oxygen in the treatment of patients with idiopathic sudden sensorineural hearing loss (ISSHL).
Data sources
An Embase, MEDLINE and Cochrane search were utilised to identify various clinical trials on the treatment of ISSHL. Studies that were published between 2002 and 2018 and written in the English, Dutch or German language were included. Search terms included synonyms for idiopathic sudden hearing loss.
Data synthesis
A total of 16 articles were identified regarding hyperbaric oxygen therapy. All patients were evaluated with pure-tone audiometry. A major part of the cases presented with unilateral hearing loss(bilateral hearing loss less than 5%). In several studies, the average of the mean hearing gain at five contiguous frequencies was significantly higher in the hyperbaric oxygen (HBO) therapy and systemic steroid (SS) group in patients with severe or profound hearing impairment. They recorded a significant treatment effect (p = 0.005) of HBO + SS therapy on patients with an initial hearing loss of ≥ 81 dB.
Conclusions
On the whole group of ISSHL patients, no significant difference was demonstrated between the intervention and control group. However, in severe or profound hearing-impaired ISSHL patients, significant benefit was observed in the intervention group. These results likely indicate that adding HBO to steroid therapies might be of benefit in cases of severe and profound hearing impairment.
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Pretarsal roll augmentation with dermal hyaluronic acid filler injection
Abstract
Pretarsal roll augmentation with dermal hyaluronic acid filler injection focuses on restoring pretarsal fullness. This study aimed to introduce a method of pretarsal roll augmentation with dermal hyaluronic acid filler injection and establish the level of difficulty, safety, and effectiveness of this method. Eighty female patients were enrolled in this study. Hyaluronic acid filler was used to perform pretarsal roll augmentation. Physician and patient satisfaction at 1 month and 4 months after surgery was investigated. The level of satisfaction was graded from points 1 to 5. The patient satisfaction and physician scores were 4.7 ± 1.1 (mean ± standard deviation) points at 1 month and 4.8 ± 0.9 points at 4 months and 4.6 ± 0.9 points at 1 month and 4.8 ± 1.0 points at 4 months, respectively. No major complications were observed. Our technique provided a natural and younger appearance with pretarsal fullness. This technique was easy to perform for the restoration of pretarsal fullness, and it improved periorbital contouring, rejuvenated the pretarsal roll, and provided excellent esthetic results.
Level of Evidence: Level V, therapeutic study.
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Factor XI Deficiency: The Key Is Individualization
Prospective, Randomized Comparison of the i-gel and the Self-Pressurized air-Q Intubating Laryngeal Airway in Elderly Anesthetized Patients
BACKGROUND: Age-related changes in upper airway anatomy may affect the overall performance of supraglottic airways significantly. The clinical performance of the i-gel and the self-pressurized air-Q intubating laryngeal airways with noninflatable cuffs for elderly populations remains unknown, unlike in children. Thus, we performed a prospective, randomized comparison of these 2 supraglottic airways in elderly patients undergoing general anesthesia. METHODS: We recruited 100 patients, 65–90 years of age, who were scheduled for elective surgery under general anesthesia with muscle relaxation. The enrolled patients were allocated to the i-gel or self-pressurized air-Q group. We assessed oropharyngeal leak pressure as the primary outcome and fiberoptic view after placement and fixation of the airway and at 10 minutes after the initial assessment. The fiberoptic view was scored using a 5-point scale as follows: vocal cords not visible; vocal cords and anterior epiglottis visible, >50% visual obstruction of epiglottis to vocal cords; vocal cords and anterior epiglottis visible,
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Hepatic Critical Care
Clinical Use of the Pictorial Baxter Retching Faces Scale for the Measurement of Postoperative Nausea in Children
BACKGROUND: Because nausea is difficult to evaluate in children, vomiting is used as the objective clinical end point in managing pediatric postoperative nausea and vomiting and postdischarge nausea and vomiting (PDNV). The recently developed pictorial Baxter Retching Faces (BARF) scale has content, construct, and convergent validity in quantifying pediatric nausea intensity. We determined its clinical usefulness in assessing pediatric postoperative nausea and vomiting and PDNV, establishing the lowest age associated with consistently reliable use, the score at which patients identify a need for therapy, and the minimum clinically relevant change in scores, and examined its test–retest reliability. METHODS: We obtained subject ratings of the severity of their nausea using the BARF and visual analog scales in the preoperative, postanesthesia care unit and postdischarge phases. Changes in nausea were rated on a 5-point Likert scale, along with responses to queries of a need for rescue antiemetics at these time points. RESULTS: Children ≥6 years of age had a consistently reliable ability to use the BARF scale (132/132 [100%] vs 59/76 [77.6%] for children ≥6 and 6) in 13 (6.7%). Emesis occurred in 8 (4.1%). Rescue antiemetics were administered to 16 (8.3%), including 2 with severe emesis (≥3 episodes) but in only 2 of 11 (18.2%) with severe nausea without vomiting. PDNV was reported in 39 of the 99 who returned diaries (39.4%), with nausea in 34 (34.3%), severe nausea in 15 (15.2 %), and emesis in 16 (16.2%). CONCLUSIONS: The pictorial BARF scale is easy to use in the clinical setting by children ≥6 years of age, has a minimum clinically relevant difference of 1.47, with scores of 4 or higher associated with a patient-identified need for rescue antiemetics. Assessment of postoperative nausea by the BARF scale has shown that clinically significant nausea occurs frequently in children but is not always treated unless accompanied by vomiting. Accepted for publication September 5, 2018. Funding: This work was supported by internal funding from the Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Houston, TX, and Baylor College of Medicine, Houston, TX. The authors declare no conflicts of interest. Clinical trials registration: The trial was registered before patient enrollment at clinicaltrials.gov (NCT 02421952, principal investigator: S.A.B.; date of registration: April 21, 2015). Reprints will not be available from the authors. Address correspondence to Mehernoor F. Watcha, MD, Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, 6621 Fannin St, Suite A 3300, Houston, TX 77030. Address e-mail to mwatcha@gmail.com. © 2018 International Anesthesia Research Society
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Attenuation of Unevoked Mechanical and Cold Pain Hypersensitivities Associated With Experimental Neuropathy in Mice by Angiotensin II Type-2 Receptor Antagonism
Recent findings from a phase II clinical trial showed analgesic effects of an angiotensin II type-2 receptor (AT2R) antagonist in postherpetic neuralgia patients. This study aimed to investigate whether AT2R antagonism could provide effective analgesia in voluntary measures of unevoked/ongoing pain-like behaviors in mice with experimental neuropathy. Mice were subjected to spared nerve injury to induce neuropathy and tested in 2 operant behavioral tests to measure ongoing mechanical and cold pain hypersensitivities. Systemic administration of an AT2R antagonist provided effective analgesia in these behavioral measures of mechanical and cold pain in spared nerve injury mice, suggesting its effectiveness in neuropathic pain. Accepted for publication September 6, 2018. Funding: This study was supported by a pilot and feasibility grant from the Washington University Nutrition Obesity Research Center National Institutes of Health grant P30DK056341 (to A.J.S.) and by start-up funds from the Department of Anesthesiology, Washington University Pain Center and Washington University School of Medicine (to D.P.M.). The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Andrew J. Shepherd, PhD, Department of Anesthesiology and Washington University Pain Center, Washington University School of Medicine in St Louis, St Louis, MO 63110. Address e-mail to a.shepherd@wustl.edu; and Durga P. Mohapatra, PhD, Department of Anesthesiology and Washington University Pain Center, Washington University School of Medicine in St Louis, St Louis, MO 63110. Address e-mail to d.p.mohapatra@wustl.edu. © 2018 International Anesthesia Research Society
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Anesthesia in Enhanced Recovery Pathways for Hip and Knee Arthroplasty: Where Is the Evidence?
Prohemostatic Activity of Factor X in Combination With Activated Factor VII in Dilutional Coagulopathy
BACKGROUND: Recombinant activated factor VII (rFVIIa) concentrate reduces allogeneic blood transfusions, but it may increase thromboembolic complications in complex cardiac surgery. The mixture of activated factor VII (FVIIa) and factor X (FX) (FVIIa/FX) (FVIIa:FX = 1:10) is a novel bypassing agent for hemophilia patients. We hypothesized that the combination of FX and FVIIa could improve thrombin generation (TG) in acquired multifactorial coagulation defects such as seen in cardiac surgery and conducted in vitro evaluation of FVIIa/FX in parallel with other coagulation factor concentrates using in vitro and in vivo diluted plasma samples. METHODS: Plasma samples were collected from 9 healthy volunteers and 12 cardiac surgical patients. We measured TG (Thrombinoscope) using in vitro 50% dilution plasma and in vivo dilution plasma after cardiopulmonary bypass, in parallel with thromboelastometry (ROTEM) and standard coagulation assays. In vitro additions of FVIIa/FX (0.35, 0.7, and 1.4 μg/mL, based on the FVIIa level), rFVIIa (1.4, 2.8, and 6.4 μg/mL), prothrombin complex concentrate (0.3 international unit), and 20% plasma replacement were evaluated. RESULTS: In diluted plasma, the addition of either FVIIa/FX or rFVIIa shortened the lag time and increased the peak TG, but the effect in lag time of FVIIa/FX at 0.35 μg/mL was more extensive than rFVIIa at 6.4 μg/mL. Prothrombin complex concentrate increased peak TG by increasing the prothrombin level but failed to shorten the lag time. No improvement in any of the TG variables was observed after 20% volume replacement with plasma. The addition of factor concentrates normalized prothrombin time/international normalized ratio but not with plasma replacement. In cardiac patients, similar patterns were observed on TG in post–cardiopulmonary bypass samples. FVIIa/FX shortened clotting time (CT) in a concentration-dependent manner on CT on thromboelastometry. Plasma replacement did not improve CT, but a combination of plasma and FVIIa/FX (0.35 μg/mL) more effectively shortened CT than FVIIa/FX alone. CONCLUSIONS: The combination of FVIIa and FX improved TG more efficiently than rFVIIa alone or plasma in dilutional coagulopathy models. The required FVIIa dose in FVIIa/FX was considerably lower than those reported during bypassing therapy in hemophilia patients (1.4–2.8 μg/mL). The combination of plasma could restore coagulation more efficiently compared to FVIIa/FX alone. Lesser FVIIa requirement to exert procoagulant activity may be favorable in terms of reducing systemic thromboembolic complications. Accepted for publication September 6, 2018. Funding: This work was supported by a grant-in-aid from the Japanese Society of Cardiothoracic Vascular Anesthesia. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Satoru Ogawa, MD, PhD, Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 8566, Japan. Address e-mail to s-ogawa@koto.kpu-m.ac.jp. © 2018 International Anesthesia Research Society
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Concepts for the Development of Anesthesia-Related Patient Decision Aids
Patient decision aids are educational tools used by health care providers to assist patients in choosing their treatment and care. The use of anesthesia-related patient decision aids can help practitioners provide patient-centered care by facilitating shared decision-making. The benefits of these aids have been well documented, yet a structured approach for developing patient decision aids in anesthesia has not been well established. Educating patients on various anesthesia-related options is paramount in their decision-making, yet accessible and validated resources are limited. In addition, many limitations exist with current patient decision aids that must be addressed. We have reviewed multiple processes for developing decision aids and have suggested a structured approach to their creation. We address the common limitations of current patient decision aids and provide improvements to the developmental process. Improvements include increasing patient input during development, thoroughly evaluating data included in the aids, and integrating a cyclic review of the aids before and after their use. Using the provided developmental process and checklist, anesthesia providers can create evidence-based patient decision aids in a standardized manner. It is important to evaluate decision aids and measure their decision quality, or patient-centeredness, to further improve them and maximize their effectiveness. Moving forward, development of proper metrics for patient participation and decision quality are required. Accepted for publication July 30, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Richard D. Urman, MD, MBA, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis St CWN L1, Boston, MA 02115. Address e-mail to rurman@bwh.harvard.edu. © 2018 International Anesthesia Research Society
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Rapid Titration of Intravenous Treprostinil to Treat Severe Pulmonary Arterial Hypertension Postpartum: A Retrospective Observational Case Series Study
BACKGROUND: Pulmonary hypertension during pregnancy carries high mortality rate. The relatively long-acting, specific pulmonary vasodilator treprostinil has been used to improve survival in these parturients. Slow uptitration is performed in most cases, and rapid titration has not been reported in the postpartum period. METHODS: We retrospectively reviewed 17 pregnant patients with severe pulmonary arterial hypertension who were treated with intravenous treprostinil in our institution between 2014 and 2016. Patients' demographic characteristics, etiology, functional status, mode of delivery, anesthetic administration, medical therapy, echocardiographic and hemodynamic measurements, subsequent clinical course, and maternal–fetal outcomes were assessed. The a priori primary outcome is maternal mortality in this study. RESULTS: Rapid titration of intravenous treprostinil was initiated at 1.25 ng/kg/min and increased to effective dose of 10 ng/kg/min by 1.25–2.5 ng/kg/min every 3 hours. In the next 24 hours, we adjusted the dosage to a median maximum dose of 15 ng/kg/min (interquartile range, 15–20 ng/kg/min) over a median uptitration period of 34 hours (interquartile range, 24–41 hours) for 17 parturients with severe pulmonary hypertension. Treprostinil was weaned off by 0.50–1.25 ng/kg/min every 3 hours in 94.3 ± 42.4 hours. Fifteen patients survived to discharge, and only 2 patients died of pulmonary hypertensive crisis (maternal mortality rate, 11.7%). No treprostinil infusion-related postpartum complication was observed. CONCLUSIONS: Our experience suggested that rapid uptitration of intravenous treprostinil combined with oral sildenafil in the postpartum period may be a safe and effective approach for these very sick parturients with severe pulmonary hypertension. Accepted for publication August 23, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). T. Wang and J. Lu contributed equally and share first authorship. Reprints will not be available from the authors. Address correspondence to Jiapeng Huang, MD, PhD, Department of Anesthesiology and Perioperative Medicine, University of Louisville, 200 Abraham Flexner Way, Louisville, KY 40202. Address e-mail to jiapenghuang@yahoo.com; and Jinglan Zhang, MD, Department of Surgical Intensive Care Medicine, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing AnZhen Hospital, Capital Medical University, No. 2 AnZhen Rd, Chaoyang District, Beijing 100029, People's Republic of China. Address e-mail to jinglanzhang2006@163.com. © 2018 International Anesthesia Research Society
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In Response
Electronic Audit and Feedback With Positive Rewards Improve Anesthesia Provider Compliance With a Barcode-Based Drug Safety System
BACKGROUND: We implemented a previously described barcode-based drug safety system in all of our anesthetizing locations. Providers were instructed to scan the barcode on syringes using our Anesthesia Information Management System before drug administration, but the rate of provider adherence was low. We studied an implementation intervention intended to increase the rate of scanning. METHODS: Using our Anesthesia Information Management System and Smart Anesthesia Manager software, we quantified syringe drug administrations by anesthesia providers with and without barcode scanning. We use an anesthesia team model in which an attending anesthesiologist is paired with a certified registered nurse anesthetist (CRNA) or a resident. Our system identified the pair of providers associated with a particular drug administration, but did not distinguish which providers actually administered the drug. Therefore, the rate of barcode scanning for a particular case was assigned to both providers equally. A baseline rate of scanning was established over a period of 17 months. An audit and feedback intervention was then performed that consisted of monthly performance reports sent by email to individual providers along with coffee gift card awards for top performers. The coffee gift cards were awarded in only the first 2 months of the intervention, while the email performance reports continued on a monthly basis. The coffee card awards were made public. The monthly emails reported the individual provider's rank order of performance relative to other providers, but was otherwise anonymous. The baseline rate of scanning was compared to the rate of scanning after the intervention for a period of 7 months. RESULTS: From November 2014 to March 2017, we accumulated 60,197 cases performed by 88 attending anesthesiologists, 65 CRNAs, and 148 residents. The total number of syringe drug administrations was 653,355. Average scanning performance improved from 8.7% of syringe barcodes scanned during the baseline period from November 2014 to February 2016 to 64.4% scanned during the period September 2016 to March 2017 (P
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Factor XI Deficiency: The Key Is Individualization
Prospective, Randomized Comparison of the i-gel and the Self-Pressurized air-Q Intubating Laryngeal Airway in Elderly Anesthetized Patients
BACKGROUND: Age-related changes in upper airway anatomy may affect the overall performance of supraglottic airways significantly. The clinical performance of the i-gel and the self-pressurized air-Q intubating laryngeal airways with noninflatable cuffs for elderly populations remains unknown, unlike in children. Thus, we performed a prospective, randomized comparison of these 2 supraglottic airways in elderly patients undergoing general anesthesia. METHODS: We recruited 100 patients, 65–90 years of age, who were scheduled for elective surgery under general anesthesia with muscle relaxation. The enrolled patients were allocated to the i-gel or self-pressurized air-Q group. We assessed oropharyngeal leak pressure as the primary outcome and fiberoptic view after placement and fixation of the airway and at 10 minutes after the initial assessment. The fiberoptic view was scored using a 5-point scale as follows: vocal cords not visible; vocal cords and anterior epiglottis visible, >50% visual obstruction of epiglottis to vocal cords; vocal cords and anterior epiglottis visible,
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Clinical Use of the Pictorial Baxter Retching Faces Scale for the Measurement of Postoperative Nausea in Children
BACKGROUND: Because nausea is difficult to evaluate in children, vomiting is used as the objective clinical end point in managing pediatric postoperative nausea and vomiting and postdischarge nausea and vomiting (PDNV). The recently developed pictorial Baxter Retching Faces (BARF) scale has content, construct, and convergent validity in quantifying pediatric nausea intensity. We determined its clinical usefulness in assessing pediatric postoperative nausea and vomiting and PDNV, establishing the lowest age associated with consistently reliable use, the score at which patients identify a need for therapy, and the minimum clinically relevant change in scores, and examined its test–retest reliability. METHODS: We obtained subject ratings of the severity of their nausea using the BARF and visual analog scales in the preoperative, postanesthesia care unit and postdischarge phases. Changes in nausea were rated on a 5-point Likert scale, along with responses to queries of a need for rescue antiemetics at these time points. RESULTS: Children ≥6 years of age had a consistently reliable ability to use the BARF scale (132/132 [100%] vs 59/76 [77.6%] for children ≥6 and 6) in 13 (6.7%). Emesis occurred in 8 (4.1%). Rescue antiemetics were administered to 16 (8.3%), including 2 with severe emesis (≥3 episodes) but in only 2 of 11 (18.2%) with severe nausea without vomiting. PDNV was reported in 39 of the 99 who returned diaries (39.4%), with nausea in 34 (34.3%), severe nausea in 15 (15.2 %), and emesis in 16 (16.2%). CONCLUSIONS: The pictorial BARF scale is easy to use in the clinical setting by children ≥6 years of age, has a minimum clinically relevant difference of 1.47, with scores of 4 or higher associated with a patient-identified need for rescue antiemetics. Assessment of postoperative nausea by the BARF scale has shown that clinically significant nausea occurs frequently in children but is not always treated unless accompanied by vomiting. Accepted for publication September 5, 2018. Funding: This work was supported by internal funding from the Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Houston, TX, and Baylor College of Medicine, Houston, TX. The authors declare no conflicts of interest. Clinical trials registration: The trial was registered before patient enrollment at clinicaltrials.gov (NCT 02421952, principal investigator: S.A.B.; date of registration: April 21, 2015). Reprints will not be available from the authors. Address correspondence to Mehernoor F. Watcha, MD, Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, 6621 Fannin St, Suite A 3300, Houston, TX 77030. Address e-mail to mwatcha@gmail.com. © 2018 International Anesthesia Research Society
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Hepatic Critical Care
Concepts for the Development of Anesthesia-Related Patient Decision Aids
Patient decision aids are educational tools used by health care providers to assist patients in choosing their treatment and care. The use of anesthesia-related patient decision aids can help practitioners provide patient-centered care by facilitating shared decision-making. The benefits of these aids have been well documented, yet a structured approach for developing patient decision aids in anesthesia has not been well established. Educating patients on various anesthesia-related options is paramount in their decision-making, yet accessible and validated resources are limited. In addition, many limitations exist with current patient decision aids that must be addressed. We have reviewed multiple processes for developing decision aids and have suggested a structured approach to their creation. We address the common limitations of current patient decision aids and provide improvements to the developmental process. Improvements include increasing patient input during development, thoroughly evaluating data included in the aids, and integrating a cyclic review of the aids before and after their use. Using the provided developmental process and checklist, anesthesia providers can create evidence-based patient decision aids in a standardized manner. It is important to evaluate decision aids and measure their decision quality, or patient-centeredness, to further improve them and maximize their effectiveness. Moving forward, development of proper metrics for patient participation and decision quality are required. Accepted for publication July 30, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Richard D. Urman, MD, MBA, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis St CWN L1, Boston, MA 02115. Address e-mail to rurman@bwh.harvard.edu. © 2018 International Anesthesia Research Society
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Anesthesia in Enhanced Recovery Pathways for Hip and Knee Arthroplasty: Where Is the Evidence?
In Response
Attenuation of Unevoked Mechanical and Cold Pain Hypersensitivities Associated With Experimental Neuropathy in Mice by Angiotensin II Type-2 Receptor Antagonism
Recent findings from a phase II clinical trial showed analgesic effects of an angiotensin II type-2 receptor (AT2R) antagonist in postherpetic neuralgia patients. This study aimed to investigate whether AT2R antagonism could provide effective analgesia in voluntary measures of unevoked/ongoing pain-like behaviors in mice with experimental neuropathy. Mice were subjected to spared nerve injury to induce neuropathy and tested in 2 operant behavioral tests to measure ongoing mechanical and cold pain hypersensitivities. Systemic administration of an AT2R antagonist provided effective analgesia in these behavioral measures of mechanical and cold pain in spared nerve injury mice, suggesting its effectiveness in neuropathic pain. Accepted for publication September 6, 2018. Funding: This study was supported by a pilot and feasibility grant from the Washington University Nutrition Obesity Research Center National Institutes of Health grant P30DK056341 (to A.J.S.) and by start-up funds from the Department of Anesthesiology, Washington University Pain Center and Washington University School of Medicine (to D.P.M.). The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Andrew J. Shepherd, PhD, Department of Anesthesiology and Washington University Pain Center, Washington University School of Medicine in St Louis, St Louis, MO 63110. Address e-mail to a.shepherd@wustl.edu; and Durga P. Mohapatra, PhD, Department of Anesthesiology and Washington University Pain Center, Washington University School of Medicine in St Louis, St Louis, MO 63110. Address e-mail to d.p.mohapatra@wustl.edu. © 2018 International Anesthesia Research Society
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Rapid Titration of Intravenous Treprostinil to Treat Severe Pulmonary Arterial Hypertension Postpartum: A Retrospective Observational Case Series Study
BACKGROUND: Pulmonary hypertension during pregnancy carries high mortality rate. The relatively long-acting, specific pulmonary vasodilator treprostinil has been used to improve survival in these parturients. Slow uptitration is performed in most cases, and rapid titration has not been reported in the postpartum period. METHODS: We retrospectively reviewed 17 pregnant patients with severe pulmonary arterial hypertension who were treated with intravenous treprostinil in our institution between 2014 and 2016. Patients' demographic characteristics, etiology, functional status, mode of delivery, anesthetic administration, medical therapy, echocardiographic and hemodynamic measurements, subsequent clinical course, and maternal–fetal outcomes were assessed. The a priori primary outcome is maternal mortality in this study. RESULTS: Rapid titration of intravenous treprostinil was initiated at 1.25 ng/kg/min and increased to effective dose of 10 ng/kg/min by 1.25–2.5 ng/kg/min every 3 hours. In the next 24 hours, we adjusted the dosage to a median maximum dose of 15 ng/kg/min (interquartile range, 15–20 ng/kg/min) over a median uptitration period of 34 hours (interquartile range, 24–41 hours) for 17 parturients with severe pulmonary hypertension. Treprostinil was weaned off by 0.50–1.25 ng/kg/min every 3 hours in 94.3 ± 42.4 hours. Fifteen patients survived to discharge, and only 2 patients died of pulmonary hypertensive crisis (maternal mortality rate, 11.7%). No treprostinil infusion-related postpartum complication was observed. CONCLUSIONS: Our experience suggested that rapid uptitration of intravenous treprostinil combined with oral sildenafil in the postpartum period may be a safe and effective approach for these very sick parturients with severe pulmonary hypertension. Accepted for publication August 23, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). T. Wang and J. Lu contributed equally and share first authorship. Reprints will not be available from the authors. Address correspondence to Jiapeng Huang, MD, PhD, Department of Anesthesiology and Perioperative Medicine, University of Louisville, 200 Abraham Flexner Way, Louisville, KY 40202. Address e-mail to jiapenghuang@yahoo.com; and Jinglan Zhang, MD, Department of Surgical Intensive Care Medicine, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing AnZhen Hospital, Capital Medical University, No. 2 AnZhen Rd, Chaoyang District, Beijing 100029, People's Republic of China. Address e-mail to jinglanzhang2006@163.com. © 2018 International Anesthesia Research Society
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Prohemostatic Activity of Factor X in Combination With Activated Factor VII in Dilutional Coagulopathy
BACKGROUND: Recombinant activated factor VII (rFVIIa) concentrate reduces allogeneic blood transfusions, but it may increase thromboembolic complications in complex cardiac surgery. The mixture of activated factor VII (FVIIa) and factor X (FX) (FVIIa/FX) (FVIIa:FX = 1:10) is a novel bypassing agent for hemophilia patients. We hypothesized that the combination of FX and FVIIa could improve thrombin generation (TG) in acquired multifactorial coagulation defects such as seen in cardiac surgery and conducted in vitro evaluation of FVIIa/FX in parallel with other coagulation factor concentrates using in vitro and in vivo diluted plasma samples. METHODS: Plasma samples were collected from 9 healthy volunteers and 12 cardiac surgical patients. We measured TG (Thrombinoscope) using in vitro 50% dilution plasma and in vivo dilution plasma after cardiopulmonary bypass, in parallel with thromboelastometry (ROTEM) and standard coagulation assays. In vitro additions of FVIIa/FX (0.35, 0.7, and 1.4 μg/mL, based on the FVIIa level), rFVIIa (1.4, 2.8, and 6.4 μg/mL), prothrombin complex concentrate (0.3 international unit), and 20% plasma replacement were evaluated. RESULTS: In diluted plasma, the addition of either FVIIa/FX or rFVIIa shortened the lag time and increased the peak TG, but the effect in lag time of FVIIa/FX at 0.35 μg/mL was more extensive than rFVIIa at 6.4 μg/mL. Prothrombin complex concentrate increased peak TG by increasing the prothrombin level but failed to shorten the lag time. No improvement in any of the TG variables was observed after 20% volume replacement with plasma. The addition of factor concentrates normalized prothrombin time/international normalized ratio but not with plasma replacement. In cardiac patients, similar patterns were observed on TG in post–cardiopulmonary bypass samples. FVIIa/FX shortened clotting time (CT) in a concentration-dependent manner on CT on thromboelastometry. Plasma replacement did not improve CT, but a combination of plasma and FVIIa/FX (0.35 μg/mL) more effectively shortened CT than FVIIa/FX alone. CONCLUSIONS: The combination of FVIIa and FX improved TG more efficiently than rFVIIa alone or plasma in dilutional coagulopathy models. The required FVIIa dose in FVIIa/FX was considerably lower than those reported during bypassing therapy in hemophilia patients (1.4–2.8 μg/mL). The combination of plasma could restore coagulation more efficiently compared to FVIIa/FX alone. Lesser FVIIa requirement to exert procoagulant activity may be favorable in terms of reducing systemic thromboembolic complications. Accepted for publication September 6, 2018. Funding: This work was supported by a grant-in-aid from the Japanese Society of Cardiothoracic Vascular Anesthesia. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Satoru Ogawa, MD, PhD, Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 8566, Japan. Address e-mail to s-ogawa@koto.kpu-m.ac.jp. © 2018 International Anesthesia Research Society
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In Response
Electronic Audit and Feedback With Positive Rewards Improve Anesthesia Provider Compliance With a Barcode-Based Drug Safety System
BACKGROUND: We implemented a previously described barcode-based drug safety system in all of our anesthetizing locations. Providers were instructed to scan the barcode on syringes using our Anesthesia Information Management System before drug administration, but the rate of provider adherence was low. We studied an implementation intervention intended to increase the rate of scanning. METHODS: Using our Anesthesia Information Management System and Smart Anesthesia Manager software, we quantified syringe drug administrations by anesthesia providers with and without barcode scanning. We use an anesthesia team model in which an attending anesthesiologist is paired with a certified registered nurse anesthetist (CRNA) or a resident. Our system identified the pair of providers associated with a particular drug administration, but did not distinguish which providers actually administered the drug. Therefore, the rate of barcode scanning for a particular case was assigned to both providers equally. A baseline rate of scanning was established over a period of 17 months. An audit and feedback intervention was then performed that consisted of monthly performance reports sent by email to individual providers along with coffee gift card awards for top performers. The coffee gift cards were awarded in only the first 2 months of the intervention, while the email performance reports continued on a monthly basis. The coffee card awards were made public. The monthly emails reported the individual provider's rank order of performance relative to other providers, but was otherwise anonymous. The baseline rate of scanning was compared to the rate of scanning after the intervention for a period of 7 months. RESULTS: From November 2014 to March 2017, we accumulated 60,197 cases performed by 88 attending anesthesiologists, 65 CRNAs, and 148 residents. The total number of syringe drug administrations was 653,355. Average scanning performance improved from 8.7% of syringe barcodes scanned during the baseline period from November 2014 to February 2016 to 64.4% scanned during the period September 2016 to March 2017 (P
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Improving outcomes in ambulatory anesthesia by identifying high risk patients
Purpose of review Currently, outcome data in ambulatory anesthesia are somewhat limited though results are quite good with low reported rates of mortality and major morbidity. As patient comorbidities and surgical invasiveness increase, identifying those patients at higher risk will help to focus quality improvement energy and research where most effective. Better data collection and analysis will refine patient and procedure selection and improve outcomes going forward. Recent findings Complications after ambulatory surgery are associated with age, higher American Society of Anesthesiologists physical status, obstructive sleep apnea, and obesity. Frailty has recently been linked to increased complications in ambulatory surgery as well. Newer ambulatory procedures such as spine and total joint arthroplasty require careful patient selection. Summary Identifying high-risk ambulatory patients can help facilitate development of a strategy to triage these patients, optimize their conditions prior to surgery, and manage their care and disposition postoperatively. Inpatient surgery or admission should be considered for higher risk patients having high invasive surgery. Correspondence to Michael T. Walsh, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Tel: +507 284 9700; fax: +507 284 0120; e-mail: walsh.michael1@mayo.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.
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Improving outcomes in ambulatory anesthesia by identifying high risk patients
Purpose of review Currently, outcome data in ambulatory anesthesia are somewhat limited though results are quite good with low reported rates of mortality and major morbidity. As patient comorbidities and surgical invasiveness increase, identifying those patients at higher risk will help to focus quality improvement energy and research where most effective. Better data collection and analysis will refine patient and procedure selection and improve outcomes going forward. Recent findings Complications after ambulatory surgery are associated with age, higher American Society of Anesthesiologists physical status, obstructive sleep apnea, and obesity. Frailty has recently been linked to increased complications in ambulatory surgery as well. Newer ambulatory procedures such as spine and total joint arthroplasty require careful patient selection. Summary Identifying high-risk ambulatory patients can help facilitate development of a strategy to triage these patients, optimize their conditions prior to surgery, and manage their care and disposition postoperatively. Inpatient surgery or admission should be considered for higher risk patients having high invasive surgery. Correspondence to Michael T. Walsh, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Tel: +507 284 9700; fax: +507 284 0120; e-mail: walsh.michael1@mayo.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.
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Pretarsal roll augmentation with dermal hyaluronic acid filler injection
Abstract
Pretarsal roll augmentation with dermal hyaluronic acid filler injection focuses on restoring pretarsal fullness. This study aimed to introduce a method of pretarsal roll augmentation with dermal hyaluronic acid filler injection and establish the level of difficulty, safety, and effectiveness of this method. Eighty female patients were enrolled in this study. Hyaluronic acid filler was used to perform pretarsal roll augmentation. Physician and patient satisfaction at 1 month and 4 months after surgery was investigated. The level of satisfaction was graded from points 1 to 5. The patient satisfaction and physician scores were 4.7 ± 1.1 (mean ± standard deviation) points at 1 month and 4.8 ± 0.9 points at 4 months and 4.6 ± 0.9 points at 1 month and 4.8 ± 1.0 points at 4 months, respectively. No major complications were observed. Our technique provided a natural and younger appearance with pretarsal fullness. This technique was easy to perform for the restoration of pretarsal fullness, and it improved periorbital contouring, rejuvenated the pretarsal roll, and provided excellent esthetic results.
Level of Evidence: Level V, therapeutic study.
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Pretarsal roll augmentation with dermal hyaluronic acid filler injection
Abstract
Pretarsal roll augmentation with dermal hyaluronic acid filler injection focuses on restoring pretarsal fullness. This study aimed to introduce a method of pretarsal roll augmentation with dermal hyaluronic acid filler injection and establish the level of difficulty, safety, and effectiveness of this method. Eighty female patients were enrolled in this study. Hyaluronic acid filler was used to perform pretarsal roll augmentation. Physician and patient satisfaction at 1 month and 4 months after surgery was investigated. The level of satisfaction was graded from points 1 to 5. The patient satisfaction and physician scores were 4.7 ± 1.1 (mean ± standard deviation) points at 1 month and 4.8 ± 0.9 points at 4 months and 4.6 ± 0.9 points at 1 month and 4.8 ± 1.0 points at 4 months, respectively. No major complications were observed. Our technique provided a natural and younger appearance with pretarsal fullness. This technique was easy to perform for the restoration of pretarsal fullness, and it improved periorbital contouring, rejuvenated the pretarsal roll, and provided excellent esthetic results.
Level of Evidence: Level V, therapeutic study.
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Improving outcomes in ambulatory anesthesia by identifying high risk patients
Purpose of review Currently, outcome data in ambulatory anesthesia are somewhat limited though results are quite good with low reported rates of mortality and major morbidity. As patient comorbidities and surgical invasiveness increase, identifying those patients at higher risk will help to focus quality improvement energy and research where most effective. Better data collection and analysis will refine patient and procedure selection and improve outcomes going forward. Recent findings Complications after ambulatory surgery are associated with age, higher American Society of Anesthesiologists physical status, obstructive sleep apnea, and obesity. Frailty has recently been linked to increased complications in ambulatory surgery as well. Newer ambulatory procedures such as spine and total joint arthroplasty require careful patient selection. Summary Identifying high-risk ambulatory patients can help facilitate development of a strategy to triage these patients, optimize their conditions prior to surgery, and manage their care and disposition postoperatively. Inpatient surgery or admission should be considered for higher risk patients having high invasive surgery. Correspondence to Michael T. Walsh, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Tel: +507 284 9700; fax: +507 284 0120; e-mail: walsh.michael1@mayo.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.
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Improving outcomes in ambulatory anesthesia by identifying high risk patients
Purpose of review Currently, outcome data in ambulatory anesthesia are somewhat limited though results are quite good with low reported rates of mortality and major morbidity. As patient comorbidities and surgical invasiveness increase, identifying those patients at higher risk will help to focus quality improvement energy and research where most effective. Better data collection and analysis will refine patient and procedure selection and improve outcomes going forward. Recent findings Complications after ambulatory surgery are associated with age, higher American Society of Anesthesiologists physical status, obstructive sleep apnea, and obesity. Frailty has recently been linked to increased complications in ambulatory surgery as well. Newer ambulatory procedures such as spine and total joint arthroplasty require careful patient selection. Summary Identifying high-risk ambulatory patients can help facilitate development of a strategy to triage these patients, optimize their conditions prior to surgery, and manage their care and disposition postoperatively. Inpatient surgery or admission should be considered for higher risk patients having high invasive surgery. Correspondence to Michael T. Walsh, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Tel: +507 284 9700; fax: +507 284 0120; e-mail: walsh.michael1@mayo.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.
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Simultaneous fat‐free isotropic 3D anatomical imaging and T2 mapping of knee cartilage with lipid‐insensitive binomial off‐resonant RF excitation (LIBRE) pulses
Journal of Magnetic Resonance Imaging, EarlyView.
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Hemodynamic measurements with an abdominal 4D flow MRI sequence with spiral sampling and compressed sensing in patients with chronic liver disease
Journal of Magnetic Resonance Imaging, EarlyView.
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MRI in donor candidates for living donor liver transplant: Technical and practical considerations
Journal of Magnetic Resonance Imaging, EarlyView.
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Hepatic R2* is more strongly associated with proton density fat fraction than histologic liver iron scores in patients with nonalcoholic fatty liver disease
Journal of Magnetic Resonance Imaging, EarlyView.
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Longitudinal evaluation of tumor microenvironment in rat focal brainstem glioma using diffusion and perfusion MRI
Journal of Magnetic Resonance Imaging, EarlyView.
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Detecting perfusion deficit in Alzheimer's disease and mild cognitive impairment patients by resting‐state fMRI
Journal of Magnetic Resonance Imaging, EarlyView.
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Pincer‐type MRI morphology seen in over a third of asymptomatic healthy volunteers without femoroacetabular impingement
Journal of Magnetic Resonance Imaging, EarlyView.
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MRI‐guided treatment in the breast
Journal of Magnetic Resonance Imaging, EarlyView.
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MRI in donor candidates for living donor liver transplant: Technical and practical considerations
Journal of Magnetic Resonance Imaging, EarlyView.
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Heating sensation in patients with and without spinal fixation devices during MRI examination at different magnetic field strengths
Journal of Magnetic Resonance Imaging, EarlyView.
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Pincer‐type MRI morphology seen in over a third of asymptomatic healthy volunteers without femoroacetabular impingement
Journal of Magnetic Resonance Imaging, EarlyView.
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Detecting perfusion deficit in Alzheimer's disease and mild cognitive impairment patients by resting‐state fMRI
Journal of Magnetic Resonance Imaging, EarlyView.
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Summarizing the 4D image stack of ultrafast dynamic contrast enhancement MRI of breast cancer in 3D using color intensity projections
Journal of Magnetic Resonance Imaging, EarlyView.
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Hepatic R2* is more strongly associated with proton density fat fraction than histologic liver iron scores in patients with nonalcoholic fatty liver disease
Journal of Magnetic Resonance Imaging, EarlyView.
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Simultaneous fat‐free isotropic 3D anatomical imaging and T2 mapping of knee cartilage with lipid‐insensitive binomial off‐resonant RF excitation (LIBRE) pulses
Journal of Magnetic Resonance Imaging, EarlyView.
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Hemodynamic measurements with an abdominal 4D flow MRI sequence with spiral sampling and compressed sensing in patients with chronic liver disease
Journal of Magnetic Resonance Imaging, EarlyView.
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Heating sensation in patients with and without spinal fixation devices during MRI examination at different magnetic field strengths
Journal of Magnetic Resonance Imaging, EarlyView.
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Summarizing the 4D image stack of ultrafast dynamic contrast enhancement MRI of breast cancer in 3D using color intensity projections
Journal of Magnetic Resonance Imaging, EarlyView.
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MRI‐guided treatment in the breast
Journal of Magnetic Resonance Imaging, EarlyView.
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Longitudinal evaluation of tumor microenvironment in rat focal brainstem glioma using diffusion and perfusion MRI
Journal of Magnetic Resonance Imaging, EarlyView.
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The student who is allergic to almost EVERYTHING
Cheyanne Perry, from South Carolina, has mast cell activation syndrome (MCAS) which sends the immune system haywire and causes her to have reactions to everyday smells like perfumes. (Source: the Mail online | Health)
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The student who is allergic to almost EVERYTHING
Cheyanne Perry, from South Carolina, has mast cell activation syndrome (MCAS) which sends the immune system haywire and causes her to have reactions to everyday smells like perfumes. (Source: the Mail online | Health)
MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.
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A Case of Diprosopus Tetraophthalmos: Ocular Findings and Surgical Treatment of Exposure Keratopathy
Diprosopus is a rare variation of conjoined twinning. In this report, ophthalmic findings in an infant with diprosopus tetraophthalmos are presented. A male infant who was born at 33 weeks of gestation to a nonconsanguineous 42-year-old mother and 47-year-old father was examined for orbital abnormalities. The infant had a large head, 2 faces, and 4 eyes, of which 2 were placed laterally and 2 were fused in the midline. In the laterally placed eyes, the pupils were unresponsive to light, and the optic discs were hypoplastic. In the fused eyes, the lower and upper eyelids were also fused, horizontally wide, vertically short, and immobile, resulting in a progressive exposure keratopathy. On the 33rd day of life, a modified total tarsorrhaphy was performed with the use of inhalational mask anesthesia. The patient died due to pneumonia and septicemia on the 45th day of life. Accepted for publication August 14, 2018. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Bulent Yazici, M.D., Izmir Yolu Senyurt Is Merk, no: 87/4, 16110 Bursa, Turkey. E-mail: byazici@uludag.edu.tr © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
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A Case of Diprosopus Tetraophthalmos: Ocular Findings and Surgical Treatment of Exposure Keratopathy
Diprosopus is a rare variation of conjoined twinning. In this report, ophthalmic findings in an infant with diprosopus tetraophthalmos are presented. A male infant who was born at 33 weeks of gestation to a nonconsanguineous 42-year-old mother and 47-year-old father was examined for orbital abnormalities. The infant had a large head, 2 faces, and 4 eyes, of which 2 were placed laterally and 2 were fused in the midline. In the laterally placed eyes, the pupils were unresponsive to light, and the optic discs were hypoplastic. In the fused eyes, the lower and upper eyelids were also fused, horizontally wide, vertically short, and immobile, resulting in a progressive exposure keratopathy. On the 33rd day of life, a modified total tarsorrhaphy was performed with the use of inhalational mask anesthesia. The patient died due to pneumonia and septicemia on the 45th day of life. Accepted for publication August 14, 2018. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Bulent Yazici, M.D., Izmir Yolu Senyurt Is Merk, no: 87/4, 16110 Bursa, Turkey. E-mail: byazici@uludag.edu.tr © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
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Nontraumatic Orbital Hemorrhage During Uncomplicated Labor
Socket Reconstruction With Bleomycin, Gentamicin, and Gelatin Sponges Following Eyelid-Sparing Orbital Exenteration for a Colobomatous Macrocyst in an Infant
Microphthalmia is defined by a globe axial length greater than or equal to 2 standard deviations below the age-adjusted mean and can occur as part of a broader syndrome. The presence of a colobomatous cyst with microphthalmia signifies failure of the embryonic neuroectodermal fissure to close appropriately during development of the globe, creating a protuberant globular appendage that inhibits normal growth and development of the eye itself. Cystic reaccumulation of fluid is common after aspiration or surgical removal. Here, the authors describe a case of a young boy with a colobomatous cyst who underwent eyelid-sparing orbital exenteration followed by reconstruction with absorbable gelatin sponge (Gelfoam, Pfizer, Inc.) and the chemotherapeutic agent bleomycin to promote scarring, achieving the equivalent of a biointegrated implant and facilitating satisfactory placement of an ocular prosthesis. A 2-year follow-up MRI revealed adequate volume in the posterior orbit. Accepted for publication August 23, 2018. All authors attest that they meet the current ICMJE criteria for Authorship. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Alon Kahana, M.D., Ph.D., Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, 1000 Wall St., Ann Arbor, MI. E-mail: akahana@med.umich.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
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Septic Cavernous Sinus Thrombosis Associated With Orbital Cellulitis: A Report of 6 Cases and Review of Literature
Purpose: To describe risk factors, clinical parameters, treatment, and prognosis for patients with septic cavernous sinus thrombosis presenting with orbital cellulitis. Methods: Retrospective case series of 6 patients identified with septic cavernous sinus thrombosis and orbital cellulitis confirmed by magnetic resonance imaging at a tertiary care center from January 1980 to December 2016. Medical records were reviewed for demographics, risk factors, symptoms, etiology, radiographic diagnosis, complications, treatments, and outcomes. In addition, a literature review was performed from 2005 to 2018, and 119 cases of septic cavernous sinus thrombosis confirmed by imaging were included for aggregate comparison. This study adheres to the tenets of the Declaration of Helsinki, and institutional review board approval was obtained. Results: All 6 cases presented with headache, fever, ocular motility deficit, periorbital edema, and proptosis. The primary source of infection included sinusitis (n = 4) and bacteremia (n = 2). Identified microorganisms included methicillin resistant Staphylococcus aureus (n = 3) and Streptococcus anginosus (n = 1). All cases were treated with broad-spectrum intravenous antibiotics and anticoagulation, and one case underwent endoscopic sinus surgery. The mean time between initial presentation to diagnosis of cavernous sinus thrombosis was 2.8 days, and the average length of hospital admission was 21 days. The mortality rate was 0%, but 4 cases were discharged with neurological deficits including vision loss (n = 1) and ocular motility disturbance (n = 3). Literature review produced an additional 119 cases. Conclusions: Early diagnostic imaging with contrast-enhanced CT or MRI should be initiated in patients with risk factors and ocular symptoms concerning for cavernous sinus thrombosis. Treatment entails early administration of broad-spectrum intravenous antibiotics, anticoagulation, and surgical drainage when applicable. Accepted for publication July 31, 2018. The authors have no financial or conflicts of interest to disclose. Presented as a poster at the American Academy of Ophthalmology Annual Meeting on October 16, 2016 in Chicago, IL. Address correspondence and reprint requests to R. Patrick Yeatts, M.D., Wake Forest University Eye Center, Janeway Clincal Science Building, 6th flr, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: pyeatts@wakehealth.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
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Pituitary Adenoma Apoplexy of the Orbit, Diagnosis, and Management With Presurgical Embolization
Orbital invasion of pituitary adenomas has been previously reported. In this report, the authors describe a 71-year-old female with a prolactinoma that presented with invasion of and apoplexy within the orbit. The patient underwent exenteration, followed by rapid tumor recurrence and growth. Given the hemorrhagic nature of the tumor, she subsequently underwent preoperative embolization and surgical resection. This case is notable in that it illustrates both apoplexy of a pituitary tumor within the orbit and the benefit of presurgical embolization. Accepted for publication August 15, 2018. The authors have no financial or conflicts of interest to disclose. Presented at Spring ASOPRS 2018, May 31 to June 2, 2018, Austin, TX. Address correspondence and reprint requests to Timothy J. McCulley, M.D., Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, MD. E-mail: Tmccull5@jhmi.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
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Orbitocerebral Mucormycosis in a Patient With Central Nervous System Lymphoma
A 61-year-old man with well-controlled diabetes mellitus type 2, cirrhosis from hepatitis C, alcohol abuse, and portal hypertension presented with painful vision loss and left orbital swelling. Imaging showed diffuse orbital, perineural, and pachymeningeal inflammation. He was initially diagnosed with neurosarcoidosis. However, cerebrospinal fluid analysis revealed central nervous system lymphoma, and lacrimal gland biopsy showed fungal organisms consistent with mucormycosis. The authors describe a case of Mucorales infection lacking sinonasal involvement and discuss the differential diagnosis and management of patients presenting with orbital and central nervous system inflammation from this uncommon fungal infection. Accepted for publication August 1, 2018. Supported in part by National Eye Institute Vision Core Grant P30EY010608 and the Hermann Eye Fund. No authors declare no conflicts of interest. Previously presented in part at the North American Neuro-Ophthalmology Society 43rd Annual Meeting on April 1–6, 2017 in Washington, DC. Address correspondence and reprint requests to Ore-ofe O. Adesina, M.D., Robert Cizik Eye Clinic, 6400 Fannin St, Suite 1800, Houston, TX 77030. E-mail: ore-ofeadesina@cizikeye.org © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
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Nontraumatic Orbital Hemorrhage During Uncomplicated Labor
Septate Dermoid Cyst Mimicking Septate Lacrimal Sac Diverticulum
A Case of Hyaluronic Acid Induced Blindness With Ophthalmoplegia and Ptosis
Hyaluronic acid injection can lead to skin necrosis, visual loss, and other complications. The blindness with ophthalmoplegia and ptosis is a rare, but terrible and devastating complication. The disfigured appearance usually has significant impact on patient's social life. There is no standard treatment. A patient with hyaluronic acid induced blindness, ophthalmoplegia, and ptosis is reported. Six days after the onset, peribulbar/retrobulbar injections of high dosage hyaluronidase were performed. The orbital edema and ptosis immediately improved. The ophthalmoplegia and ptosis improved significantly within a month and resolved completely within 3 months, although the right vision remained blind. Peribulbar/retrobulbar injection of hyaluronidase is a potential rescue therapy for the hyaluronic acid induced ophthalmoplegia and ptosis. Accepted for publication August 9, 2018. Supported by the National Basic Research Program of China (973 Program, No. 2015CB554100), National Natural Science Foundation of China (No. 81271035/H1205), and Foundation for Returned Personals Studying Abroad of Sichuan Province in 2015. The authors have no financial or conflicts of interest to disclose. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (www.op-rs.com.). Hui Chen and Huan Wang are co-authors. Address correspondence and reprint requests to Hui Chen, M.D., Ophthalmology Department, Sichuan Provincial People's Hospital, No. 32, 1st Ring Road, 2nd West Section, Chengdu City, Sichuan 610072, People's Republic of China. E-mail: 540685790@qq.com; Zhenglin Yang, Ph.D., Sichuan Provincial Key Laboratory for Human Disease Gene Study, Sichuan Provincial People's Hospital, No. 32, 1st Ring Road, 2nd West Section, Chengdu City, Sichuan 610072, People's Republic of China. E-mail: zliny@yahoo.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
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Orbitocerebral Mucormycosis in a Patient With Central Nervous System Lymphoma
A 61-year-old man with well-controlled diabetes mellitus type 2, cirrhosis from hepatitis C, alcohol abuse, and portal hypertension presented with painful vision loss and left orbital swelling. Imaging showed diffuse orbital, perineural, and pachymeningeal inflammation. He was initially diagnosed with neurosarcoidosis. However, cerebrospinal fluid analysis revealed central nervous system lymphoma, and lacrimal gland biopsy showed fungal organisms consistent with mucormycosis. The authors describe a case of Mucorales infection lacking sinonasal involvement and discuss the differential diagnosis and management of patients presenting with orbital and central nervous system inflammation from this uncommon fungal infection. Accepted for publication August 1, 2018. Supported in part by National Eye Institute Vision Core Grant P30EY010608 and the Hermann Eye Fund. No authors declare no conflicts of interest. Previously presented in part at the North American Neuro-Ophthalmology Society 43rd Annual Meeting on April 1–6, 2017 in Washington, DC. Address correspondence and reprint requests to Ore-ofe O. Adesina, M.D., Robert Cizik Eye Clinic, 6400 Fannin St, Suite 1800, Houston, TX 77030. E-mail: ore-ofeadesina@cizikeye.org © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
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Socket Reconstruction With Bleomycin, Gentamicin, and Gelatin Sponges Following Eyelid-Sparing Orbital Exenteration for a Colobomatous Macrocyst in an Infant
Microphthalmia is defined by a globe axial length greater than or equal to 2 standard deviations below the age-adjusted mean and can occur as part of a broader syndrome. The presence of a colobomatous cyst with microphthalmia signifies failure of the embryonic neuroectodermal fissure to close appropriately during development of the globe, creating a protuberant globular appendage that inhibits normal growth and development of the eye itself. Cystic reaccumulation of fluid is common after aspiration or surgical removal. Here, the authors describe a case of a young boy with a colobomatous cyst who underwent eyelid-sparing orbital exenteration followed by reconstruction with absorbable gelatin sponge (Gelfoam, Pfizer, Inc.) and the chemotherapeutic agent bleomycin to promote scarring, achieving the equivalent of a biointegrated implant and facilitating satisfactory placement of an ocular prosthesis. A 2-year follow-up MRI revealed adequate volume in the posterior orbit. Accepted for publication August 23, 2018. All authors attest that they meet the current ICMJE criteria for Authorship. The authors have no financial or conflicts of interest to disclose. Address correspondence and reprint requests to Alon Kahana, M.D., Ph.D., Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, 1000 Wall St., Ann Arbor, MI. E-mail: akahana@med.umich.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
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Septic Cavernous Sinus Thrombosis Associated With Orbital Cellulitis: A Report of 6 Cases and Review of Literature
Purpose: To describe risk factors, clinical parameters, treatment, and prognosis for patients with septic cavernous sinus thrombosis presenting with orbital cellulitis. Methods: Retrospective case series of 6 patients identified with septic cavernous sinus thrombosis and orbital cellulitis confirmed by magnetic resonance imaging at a tertiary care center from January 1980 to December 2016. Medical records were reviewed for demographics, risk factors, symptoms, etiology, radiographic diagnosis, complications, treatments, and outcomes. In addition, a literature review was performed from 2005 to 2018, and 119 cases of septic cavernous sinus thrombosis confirmed by imaging were included for aggregate comparison. This study adheres to the tenets of the Declaration of Helsinki, and institutional review board approval was obtained. Results: All 6 cases presented with headache, fever, ocular motility deficit, periorbital edema, and proptosis. The primary source of infection included sinusitis (n = 4) and bacteremia (n = 2). Identified microorganisms included methicillin resistant Staphylococcus aureus (n = 3) and Streptococcus anginosus (n = 1). All cases were treated with broad-spectrum intravenous antibiotics and anticoagulation, and one case underwent endoscopic sinus surgery. The mean time between initial presentation to diagnosis of cavernous sinus thrombosis was 2.8 days, and the average length of hospital admission was 21 days. The mortality rate was 0%, but 4 cases were discharged with neurological deficits including vision loss (n = 1) and ocular motility disturbance (n = 3). Literature review produced an additional 119 cases. Conclusions: Early diagnostic imaging with contrast-enhanced CT or MRI should be initiated in patients with risk factors and ocular symptoms concerning for cavernous sinus thrombosis. Treatment entails early administration of broad-spectrum intravenous antibiotics, anticoagulation, and surgical drainage when applicable. Accepted for publication July 31, 2018. The authors have no financial or conflicts of interest to disclose. Presented as a poster at the American Academy of Ophthalmology Annual Meeting on October 16, 2016 in Chicago, IL. Address correspondence and reprint requests to R. Patrick Yeatts, M.D., Wake Forest University Eye Center, Janeway Clincal Science Building, 6th flr, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: pyeatts@wakehealth.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
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Study on the Aging Dynamics of the Periorbital Region: From Observation to Knowledge of Physiopathology
Purpose: Several anatomical and physio-pathologic studies of eyelid region have allowed the creation of theories on facial tissues aging dynamics, which have not been clarified yet. We assessed the signs of aging in the region over the time by observing the characteristics in the same person at different times of his/her life. Methods: We compared the position of the main anatomical landmarks of the eyelid region of 80 patients by overlaying their photographs when they were 20, 40, and 60 years old. Then we made comparisons in the group of men (40 people) and in the group of women (40 people) and between men and women. Results: The medial portion of the eyebrow was higher in the photograph taken at 60 years of age than in the one taken at 20 years old in 56.2% of cases; it was higher in 47.5% of cases when comparing the images at 20 and 40. The lateral portion of the eyebrow was seen higher in women in the 20 to 40 group, and it was seen lower in men at 60 years in statistical significance. In more than half of the patients observed, there was not a real descent of the eyebrow and the presence of a more or less accentuated form of upper eyelid's ptosis in the photograph at 60 (globally 47.5%, 55.0% of women and 40.0% of men). This condition was observed in 27.5% of the photographs at 40. There were changes in the horizontal dimension of the palpebral fissure (shortening in 53.7%, preserved in 33.7%, and increased in 12.5% of cases at 60 years old). The position of lateral canthus appeared lower in 40.0% of patients photographed at 60, but it was stable in those photographed at 40. The herniation of the upper eyelid bags was observed in 31.2% of the patients photographed at 60 years old but only in 13.7% at 40. Dermatochalasis of the upper eyelid was present in 67.5% of the people at 60 years old and in 55.0% of those seen when they were 40. Comparing men and women groups 20 to 40, dermatochalasis is more present in men than women at 40 years old with statistical significance. The eyelid-cheek junction was seen to be lower in 75.0% of cases at 60 and in 48.7% of cases at 40, and it is more represented in men than in women. Conclusion: We have highlighted some interesting elements, partly agreeing with the data already recorded by other authors', and our data suggest an important role of the eyelid structures senescence and its impact on the surrounding structures. Accepted for publication August 25, 2018. All authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationship, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this artilce. Address correspondence and reprint requests to Nicola Zingaretti, M.D, Department of Plastic Reconstructive Surgery, c/o Ospedale "S. Maria della Misericordia", piazzale santa maria della misericordia 15, 33100 Udine, Italy. E-mail: zingarettin@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
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Pituitary Adenoma Apoplexy of the Orbit, Diagnosis, and Management With Presurgical Embolization
Orbital invasion of pituitary adenomas has been previously reported. In this report, the authors describe a 71-year-old female with a prolactinoma that presented with invasion of and apoplexy within the orbit. The patient underwent exenteration, followed by rapid tumor recurrence and growth. Given the hemorrhagic nature of the tumor, she subsequently underwent preoperative embolization and surgical resection. This case is notable in that it illustrates both apoplexy of a pituitary tumor within the orbit and the benefit of presurgical embolization. Accepted for publication August 15, 2018. The authors have no financial or conflicts of interest to disclose. Presented at Spring ASOPRS 2018, May 31 to June 2, 2018, Austin, TX. Address correspondence and reprint requests to Timothy J. McCulley, M.D., Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, MD. E-mail: Tmccull5@jhmi.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
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Study on the Aging Dynamics of the Periorbital Region: From Observation to Knowledge of Physiopathology
Purpose: Several anatomical and physio-pathologic studies of eyelid region have allowed the creation of theories on facial tissues aging dynamics, which have not been clarified yet. We assessed the signs of aging in the region over the time by observing the characteristics in the same person at different times of his/her life. Methods: We compared the position of the main anatomical landmarks of the eyelid region of 80 patients by overlaying their photographs when they were 20, 40, and 60 years old. Then we made comparisons in the group of men (40 people) and in the group of women (40 people) and between men and women. Results: The medial portion of the eyebrow was higher in the photograph taken at 60 years of age than in the one taken at 20 years old in 56.2% of cases; it was higher in 47.5% of cases when comparing the images at 20 and 40. The lateral portion of the eyebrow was seen higher in women in the 20 to 40 group, and it was seen lower in men at 60 years in statistical significance. In more than half of the patients observed, there was not a real descent of the eyebrow and the presence of a more or less accentuated form of upper eyelid's ptosis in the photograph at 60 (globally 47.5%, 55.0% of women and 40.0% of men). This condition was observed in 27.5% of the photographs at 40. There were changes in the horizontal dimension of the palpebral fissure (shortening in 53.7%, preserved in 33.7%, and increased in 12.5% of cases at 60 years old). The position of lateral canthus appeared lower in 40.0% of patients photographed at 60, but it was stable in those photographed at 40. The herniation of the upper eyelid bags was observed in 31.2% of the patients photographed at 60 years old but only in 13.7% at 40. Dermatochalasis of the upper eyelid was present in 67.5% of the people at 60 years old and in 55.0% of those seen when they were 40. Comparing men and women groups 20 to 40, dermatochalasis is more present in men than women at 40 years old with statistical significance. The eyelid-cheek junction was seen to be lower in 75.0% of cases at 60 and in 48.7% of cases at 40, and it is more represented in men than in women. Conclusion: We have highlighted some interesting elements, partly agreeing with the data already recorded by other authors', and our data suggest an important role of the eyelid structures senescence and its impact on the surrounding structures. Accepted for publication August 25, 2018. All authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationship, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this artilce. Address correspondence and reprint requests to Nicola Zingaretti, M.D, Department of Plastic Reconstructive Surgery, c/o Ospedale "S. Maria della Misericordia", piazzale santa maria della misericordia 15, 33100 Udine, Italy. E-mail: zingarettin@gmail.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
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A Case of Hyaluronic Acid Induced Blindness With Ophthalmoplegia and Ptosis
Hyaluronic acid injection can lead to skin necrosis, visual loss, and other complications. The blindness with ophthalmoplegia and ptosis is a rare, but terrible and devastating complication. The disfigured appearance usually has significant impact on patient's social life. There is no standard treatment. A patient with hyaluronic acid induced blindness, ophthalmoplegia, and ptosis is reported. Six days after the onset, peribulbar/retrobulbar injections of high dosage hyaluronidase were performed. The orbital edema and ptosis immediately improved. The ophthalmoplegia and ptosis improved significantly within a month and resolved completely within 3 months, although the right vision remained blind. Peribulbar/retrobulbar injection of hyaluronidase is a potential rescue therapy for the hyaluronic acid induced ophthalmoplegia and ptosis. Accepted for publication August 9, 2018. Supported by the National Basic Research Program of China (973 Program, No. 2015CB554100), National Natural Science Foundation of China (No. 81271035/H1205), and Foundation for Returned Personals Studying Abroad of Sichuan Province in 2015. The authors have no financial or conflicts of interest to disclose. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (www.op-rs.com.). Hui Chen and Huan Wang are co-authors. Address correspondence and reprint requests to Hui Chen, M.D., Ophthalmology Department, Sichuan Provincial People's Hospital, No. 32, 1st Ring Road, 2nd West Section, Chengdu City, Sichuan 610072, People's Republic of China. E-mail: 540685790@qq.com; Zhenglin Yang, Ph.D., Sichuan Provincial Key Laboratory for Human Disease Gene Study, Sichuan Provincial People's Hospital, No. 32, 1st Ring Road, 2nd West Section, Chengdu City, Sichuan 610072, People's Republic of China. E-mail: zliny@yahoo.com © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
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Septate Dermoid Cyst Mimicking Septate Lacrimal Sac Diverticulum
Κυριακή 14 Οκτωβρίου 2018
Aberrant gastroduodenal artery with splenic origin
Abstract
Purpose
Knowledge of the wide variability in celiac trunk branches is of paramount importance when planning an abdominal surgery.
Methods
We, hereby, report a previously undescribed origin of the gastroduodenal artery discovered on an abdominal angio-CT.
Results
CT-angiogram performed on a 33-year-old female randomly revealed a new variant of gastroduodenal artery arising directly from the splenic artery along with other vascular aberrations. The latter were previously described in medical literature.
Conclusion
High-quality preoperative imaging is crucial for identification of visceral artery variations, as those can technically modify the surgical or interventional procedure.
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Bilateral brachiocephalic trunks
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Different phenotypes of non-classical monocytes associated with systemic inflammation, endothelial alteration and hepatic compromise in patients with dengue.
This article is protected by copyright. All rights reserved. PMID: 30315653 [PubMed - as supplied by publisher] (Source: Immunology)
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