Changes in Tear Volume after 3% Diquafosol Treatment in Patients with Dry Eye Syndrome: An Anterior Segment Spectral-domain Optical Coherence Tomography Study.

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Lee, Kwan Bok; Koh, Kyung Min; Kwon, Young A; Song, Sang Wroul; Kim, Byoung Yeop; Chung, Jae Lim

2017-08-01

To evaluate changes in the tear meniscus area and tear meniscus height over time in patients with dry eye syndrome, using anterior segment spectral-domain optical coherence tomography after the instillation of 3% diquafosol ophthalmic solution. Sixty eyes from 30 patients with mild to moderate dry eye syndrome were included. Tear meniscus images acquired by anterior segment spectral-domain optical coherence tomography were analyzed using National Institutes of Health's image-analysis software (ImageJ 1.44p). Tear meniscus area and tear meniscus height were measured at baseline, 5 minutes, 10 minutes, and 30 minutes after instillation of a drop of diquafosol in one eye and normal saline in the other eye. Changes in ocular surface disease index score, tear film break-up time, corneal staining score by Oxford schema, and meibomian expressibility were also evaluated at baseline, and after 1 week and 1 month of a diquafosol daily regimen. Sixty eyes from 30 subjects (mean age, 29.3 years; 8 men and 22 women) were included. In eyes receiving diquafosol, tear volume was increased at 5 and 10 minutes compared with baseline. It was also higher than saline instilled eyes at 5, 10, and 30 minutes. Changes in tear volume with respect to baseline were not statistically different after the use of diquafosol for 1 month. Ocular surface disease index score, tear film break-up time, and Oxford cornea stain score were significantly improved after 1 week and 1 month of daily diquafosol instillation, but meibomian expressibility did not change. Topical diquafosol ophthalmic solution effectively increased tear volume for up to 30 minutes, compared to normal saline in patients with dry eye syndrome. © 2017 The Korean Ophthalmological Society

Paired anterior spinal arteries in a case of locked-in syndrome

International Nuclear Information System (INIS)

Kawamura, J.; Matsubayashi, K.; Fukuyama, H.; Kitanaka, H.

1981-01-01

Paired anterior spinal arteries have rarely been demonstrated angiographically, although several anatomical studies have shown that they are not uncommonly observed. This report describes the angiographic and autopsy findings of such a variation, which was observed in a 65-year-old man with a locked-in syndrome. The paired trunks of the anterior spinal artery were visualized in a retrograde fashion through the left inferior thyroid artery and a radical branch at the 5th cervical level by left retrograde brachial angiography. The uppermost segments of either vertebral artery and the lower portion of the basilar artery were opacified through these channels. The autopsy confirmed the paired trunks of the anterior spinal artery, occlusion of the vertebral arteries just caudal to the origin of the main branches of the anterior spinal artery, and an old infarct involving the pontine tegmentum and cerebellum. (orig.)

Differences in neural crest sensitivity to ethanol account for the infrequency of anterior segment defects in the eye compared with craniofacial anomalies in a zebrafish model of fetal alcohol syndrome.

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Eason, Jessica; Williams, Antionette L; Chawla, Bahaar; Apsey, Christian; Bohnsack, Brenda L

2017-09-01

Ethanol (ETOH) exposure during pregnancy is associated with craniofacial and neurologic abnormalities, but infrequently disrupts the anterior segment of the eye. In these studies, we used zebrafish to investigate differences in the teratogenic effect of ETOH on craniofacial, periocular, and ocular neural crest. Zebrafish eye and neural crest development was analyzed by means of live imaging, TUNEL (terminal deoxynucleotidyl transferase dUTP nick end labeling) assay, immunostaining, detection of reactive oxygen species, and in situ hybridization. Our studies demonstrated that foxd3-positive neural crest cells in the periocular mesenchyme and developing eye were less sensitive to ETOH than sox10-positive craniofacial neural crest cells that form the pharyngeal arches and jaw. ETOH increased apoptosis in the retina, but did not affect survival of periocular and ocular neural crest cells. ETOH also did not increase reactive oxygen species within the eye. In contrast, ETOH increased ventral neural crest apoptosis and reactive oxygen species production in the facial mesenchyme. In the eye and craniofacial region, sod2 showed high levels of expression in the anterior segment and in the setting of Sod2 knockdown, low levels of ETOH decreased migration of foxd3-positive neural crest cells into the developing eye. However, ETOH had minimal effect on the periocular and ocular expression of transcription factors (pitx2 and foxc1) that regulate anterior segment development. Neural crest cells contributing to the anterior segment of the eye exhibit increased ability to withstand ETOH-induced oxidative stress and apoptosis. These studies explain the rarity of anterior segment dysgenesis despite the frequent craniofacial abnormalities in fetal alcohol syndrome. Birth Defects Research 109:1212-1227, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Segmentation and Quantification for Angle-Closure Glaucoma Assessment in Anterior Segment OCT.

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Fu, Huazhu; Xu, Yanwu; Lin, Stephen; Zhang, Xiaoqin; Wong, Damon Wing Kee; Liu, Jiang; Frangi, Alejandro F; Baskaran, Mani; Aung, Tin

2017-09-01

Angle-closure glaucoma is a major cause of irreversible visual impairment and can be identified by measuring the anterior chamber angle (ACA) of the eye. The ACA can be viewed clearly through anterior segment optical coherence tomography (AS-OCT), but the imaging characteristics and the shapes and locations of major ocular structures can vary significantly among different AS-OCT modalities, thus complicating image analysis. To address this problem, we propose a data-driven approach for automatic AS-OCT structure segmentation, measurement, and screening. Our technique first estimates initial markers in the eye through label transfer from a hand-labeled exemplar data set, whose images are collected over different patients and AS-OCT modalities. These initial markers are then refined by using a graph-based smoothing method that is guided by AS-OCT structural information. These markers facilitate segmentation of major clinical structures, which are used to recover standard clinical parameters. These parameters can be used not only to support clinicians in making anatomical assessments, but also to serve as features for detecting anterior angle closure in automatic glaucoma screening algorithms. Experiments on Visante AS-OCT and Cirrus high-definition-OCT data sets demonstrate the effectiveness of our approach.

Iris en sayuela signo clínico nuevo asociado al síndrome tóxico del segmento anterior: a new clinical sign associated to the anterior segment toxic syndrome Iris in underskirt

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Iván Hernández López

2010-01-01

Full Text Available OBJETIVO: Presentar un nuevo signo clínico como resultado del desprendimiento gigante del epitelio pigmentado posterior del iris en el curso de un síndrome tóxico del segmento anterior tras una cirugía de catarata. MÉTODOS: Presentamos un paciente intervenido de catarata mediante facoemulsificación con implante de lente intraocular de cámara posterior plegable, sin incidencias ni complicaciones transoperatorias. Se le realizó evaluación biomicroscópica en el posoperatorio inmediato diagnosticándosele un síndrome tóxico del segmento anterior asociado a un desprendimiento gigante del epitelio pigmentado posterior del iris. Se tomaron fotos durante la evolución del paciente para documentar este raro signo clínico. RESULTADOS: Al provocar la dilatación pupilar farmacológica nos encontramos con la retracción de todas las capas anteriores del iris, mostrando por debajo al epitelio pigmentado posterior del iris sinequiado al lente intraocular y tan extensamente desprendido que simulaba un segundo iris. No encontramos este hallazgo clínico reportado en la literatura revisada. Denominamos este signo como iris en sayuela. CONCLUSIONES: El desprendimiento del epitelio pigmentado posterior del iris constituye un hallazgo clínico que puede aparecer raramente asociado al síndrome tóxico del segmento anterior y cuando es muy extenso puede presentarse de forma insólita como el signo del iris en sayuela.OBJECTIVE: To present a new clinical sign as a result of a huge posterior pigmented epithelium detachment of the iris in the course of at toxic anterior segment syndrome after a successful cataract surgery. METHOD: A patient who had undergone a cataract surgery by phacoemulsification with posterior chamber foldable intraocular lens implantation, without any incidence or transoperative complication. He was evaluated through biomicroscopy in the immediate postoperative period where a huge posterior pigmented epithelium detachment of the iris

Maxillary anterior segmental distraction osteogenesis with 2 different types of distractors.

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Choi, Hye-Young; Hwang, Chung-Ju; Kim, Hee-Jin; Yu, Hyung-Seog; Cha, Jung-Yul

2012-05-01

Maxillary anterior segmental distraction osteogenesis (DO) has been the alternative treatment option for patients with midfacial retrusion. To investigate a potentially more effective maxillary anterior segmental DO, a newly designed intraoral alveolar distractor was applied. The objectives of this study were to investigate the skeletal and dental effects of maxillary anterior segmental DO and the relapse pattern. The study was carried out for 8 patients with unilateral cleft lip and palate (mean age, 16 years 7 months). Four patients were treated with an intraoral appliance (IA), and the remaining with a rigid external distractor (RED). Dental and skeletal measurements were obtained for both groups. These measurements were compared for different time points including pre-DO (T1), post-DO (T2), postconsolidation (T3), and 1-year follow-up (T4). Horizontal change of A point was significantly larger after distraction period (T2) in the RED group (mean, 11.0 mm; median, 10.1 mm) than in the IA group (mean, 6.6 mm; median, 7.4 mm) (P distraction, showing a significant difference between groups (P Maxillary anterior segmental DO is effective for the treatment of patients with cleft lip and palate. The alveolar space is regained, and the facial profile is improved without velopharyngeal problems. Superior results are obtained using the RED appliance for maxillary anterior segmental DO relative to the use of the intraoral distractor appliance.

Anterior pseudoarthrectomy for symptomatic Bertolotti's syndrome.

Science.gov (United States)

Malham, Gregory M; Limb, Rebecca J; Claydon, Matthew H; Brazenor, Graeme A

2013-12-01

Painful L5/S1 pseudoarthrosis has been previously managed with posterior excision and/or lumbar fusion. To our knowledge, the anterior approach for L5/S1 pseudoarthrectomy in the treatment of Bertolotti's syndrome has not been described. We present two patients with severe symptomatic L5/S1 pseudoarthroses that were successfully excised via an anterior retroperitoneal approach with 2 year clinical and radiological follow-up. The literature regarding surgical treatments for Bertolotti's syndrome is reviewed. The technique for an anterior retroperitoneal approach is described. This approach has been safe and effective in providing long term symptomatic relief to our two patients. Further studies comparing the outcomes of anterior versus posterior pseudoarthrectomy will guide the management of this condition. Copyright © 2013 Elsevier Ltd. All rights reserved.

Loading effects of anterior cervical spine fusion on adjacent segments

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Chien-Shiung Wang

2012-11-01

Full Text Available Adjacent segment degeneration typically follows anterior cervical spine fusion. However, the primary cause of adjacent segment degeneration remains unknown. Therefore, in order to identify the loading effects that cause adjacent segment degeneration, this study examined the loading effects to superior segments adjacent to fused bone following anterior cervical spine fusion. The C3–C6 cervical spine segments of 12 sheep were examined. Specimens were divided into the following groups: intact spine (group 1; and C5–C6 segments that were fused via cage-instrumented plate fixation (group 2. Specimens were cycled between 20° flexion and 15° extension with a displacement control of 1°/second. The tested parameters included the range of motion (ROM of each segment, torque and strain on both the body and inferior articular process at the superior segments (C3–C4 adjacent to the fused bone, and the position of the neutral axis of stress at under 20° flexion and 15° extension. Under flexion and Group 2, torque, ROM, and strain on both the bodies and facets of superior segments adjacent to the fused bone were higher than those of Group 1. Under extension and Group 2, ROM for the fused segment was less than that of Group 1; torque, ROM, and stress on both the bodies and facets of superior segments adjacent to the fused bone were higher than those of Group 1. These analytical results indicate that the muscles and ligaments require greater force to achieve cervical motion than the intact spine following anterior cervical spine fusion. In addition, ROM and stress on the bodies and facets of the joint segments adjacent to the fused bone were significantly increased. Under flexion, the neutral axis of the stress on the adjacent segment moved backward, and the stress on the bodies of the segments adjacent to the fused bone increased. These comparative results indicate that increased stress on the adjacent segments is caused by stress-shielding effects

Failure of cervical arthroplasty in a patient with adjacent segment disease associated with Klippel-Feil syndrome

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Ioannis D Papanastassiou

2011-01-01

Full Text Available Cervical arthroplasty may be justified in patients with Klippel-Feil syndrome (KFS in order to preserve cervical motion. The aim of this paper is to report an arthroplasty failure in a patient with KFS. A 36-year-old woman with KFS underwent two-level arthroplasty for adjacent segment disc degeneration. Anterior migration of the cranial prosthesis was encountered 5 months postoperatively and was successfully revised with anterior cervical fusion. Cervical arthroplasty in an extensively stiff and fused neck is challenging and may lead to catastrophic failure. Although motion preservation is desirable in KFS, the special biomechanical features may hinder arthroplasty. Fusion or hybrid constructs may represent more reasonable options, especially when multiple fused segments are present.

Changes in anterior segment morphology in response to illumination and after laser iridotomy in Asian eyes: an anterior segment OCT study

Science.gov (United States)

See, Jovina L S; Chew, Paul T K; Smith, Scott D; Nolan, Winifred P; Chan, Yiong‐Huak; Huang, David; Zheng, Ce; Foster, Paul J; Aung, Tin; Friedman, David S

2007-01-01

Aim Using the anterior segment optical coherence tomography (AS‐OCT) to quantify changes in anterior segment morphology going from light to dark and following laser iridotomy (LI). Methods Prospective observational study. 17 consecutive subjects without peripheral anterior synechiae undergoing LI were evaluated using gonioscopy and AS‐OCT. Angle configuration including angle opening distance (AOD) at 500 microns anterior to the scleral spur, AOD500, trabecular‐iris space area up to 750 microns from the scleral spur, TISA750 and the increase in angle opening going from dark to light conditions was determined. Results Both mean AOD500 and TISA750 increased nearly threefold going from dark to light. Both also significantly increased following LI (p<0.001) as did gonioscopic grading of the angle in all quadrants (p<0.001, McNemar's test). Angles were more than twice as wide on average in the dark after LI than before LI (p<0.05). Both the mean absolute change and the mean proportionate change in AOD500 and TISA750 when going from light to dark were greater after LI than before (p<0.05). Conclusion Increased illumination as well as LI resulted in significant widening of the anterior chamber angle. AS‐OCT (which does not require a water bath and can be performed with the patient at the slit lamp) identified similar magnitude changes as those previously reported using ultrasound biomicroscopy (UBM). Furthermore, the angle appears to open more both in absolute terms and and proportionate terms in response to illumination after LI. PMID:17504852

[Pigment dispersion syndrome and pigmentary glaucoma. Morphometric analysis of the anterior chamber segment with SL-OCT].

Science.gov (United States)

Birner, B; Tourtas, T; Wessel, J M; Jünemann, A G; Mardin, C Y; Kruse, F E; Laemmer, R

2014-01-01

The purpose of this study was to analyze if anterior chamber parameters are risk factors for the development of pigment dispersion syndrome (PDS) and/or for the conversion to pigmentary glaucoma (PG). This study included a total of 63 eyes from 35 patients with PDS and PG and 65 eyes from 49 unaffected volunteers as the control group. The following parameters were measured by slit lamp optical coherence tomography (SL-OCT): anterior chamber volume (ACV) and depth (ACD), angle opening distance (AOD) and the trabecular iris space area (TISA) at 500 µm and 750 μm from the scleral spur. Comparisons between the following groups were performed: between the PDS/PG and the control group, between PDS and PG and between male and female patients. The results of ACV, ACD, AOD and TISA were significantly higher in PDS/PG patients when compared to the control group. There were no significant differences between PDS and PG. The gender-specific comparison also showed no significant differences. Significantly higher anterior chamber parameters are a possible risk factor for development of PDS; however, a higher risk of conversion to PG does not seem to correlate with increased anterior chamber parameters. The parameters of the anterior chamber are apparently not associated with the male predominance of PDS and PG.

Clinical implications of anterior S-T segment depression in patients with acute inferior myocardial infarction

International Nuclear Information System (INIS)

Croft, C.H.; Woodward, W.; Nicod, P.; Corbett, J.R.; Lewis, S.E.; Willerson, J.T.; Rude, R.E.

1982-01-01

To assess various factors associated with anterior S-T segment depression during acute inferior myocardial infarction, 47 consecutive patients with electrocardiographic evidence of a first transmural inferior infarction were studied prospectively with radionuclide ventriculography an average of 7.3 hours (range 2.9 to 15.3) after the onset of symptoms. Thirty-nine patients (Group I) had anterior S-T depression in the initial electrocardiogram and 8 (Group II) did not have such reciprocal changes. There was no difference between the two groups in left ventricular end-diastolic or end-diastolic volume index or left ventricular ejection fraction. Stroke volume index was greater in Group I than in Group II. There were no group differences in left ventricular total or regional wall motion scores. A weak correlation existed between the quantities (mV) or inferior S-T segment elevation and reciprocal S-T depression. No relation between anterior S-T segment depression and the left ventricular end-diastolic volume index could be demonstrated; the extent of left ventricular apical and right ventricular wall motion abnormalities, both frequently associated with inferior infarction, did not correlate with the quantity of anterior S-T depression. These data show that anterior S-T segment depression occurs commonly during the early evolution of transmural inferior infarction, is not generally a marker of functionally significant anterior ischemia and cannot be used to predict left ventricular function in individual patients. Anterior S-T segment depression may be determined by reciprocal mechanisms

Refraction and eye anterior segment parameters in schizophrenic patients

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Tongabay Cumurcu

2015-06-01

Full Text Available ABSTRACT Purpose: To evaluate the difference in terms of refractive errors and anterior segment parameters between schizophrenic patients and healthy volunteers. Methods: This study compared 70 patients (48 men who were diagnosed with schizophrenia with a control group of 60 (35 men who were similar in terms of age, gender, education, and socioeconomic level. Anterior segment examination was performed using a Scheimflug system. Axial length and lens thickness (LT were measured using optic biometry. The following tests were administered to the psychiatric patient group: Brief Psychiatric Rating Scale (BPRS, Scale for the Assessment of Negative Symptoms (SANS, and Scale for the Assessment of Positive Symptoms (SAPS. Results: Mild myopia was detected in both the schizophrenic and control groups, with no statistically significant difference (p>0.005. Corneal volume (CV, anterior chamber volume (ACV, anterior chamber depth (ACD, and central corneal thickness (CCT values were lower in the schizophrenic group, and there was a statistically significant between-group difference (p=0.026, p=0.014, p=0.048, and p=0.005, respectively. LT was greater in schizophrenics, and the difference was found to be statistically significant (p=0.006. A statistically significant negative correlation was found between SAPS and cylinder values (p=0.008. The axial eye length, cylinder value, pupil diameter, mean keratometric value, and anterior chamber angle revealed no statistically significant difference between the groups (p>0.05. Conclusion: No statistically significant difference was detected in terms of refraction disorders between schizophrenics and the healthy control group, while some differences in anterior chamber parameters were present. These results demonstrate that schizophrenics may exhibit clinical and structural differences in the eye.

Sacral nerve stimulation can be an effective treatment for low anterior resection syndrome.

Science.gov (United States)

Eftaiha, S M; Balachandran, B; Marecik, S J; Mellgren, A; Nordenstam, J; Melich, G; Prasad, L M; Park, J J

2017-10-01

Sacral nerve stimulation has become a preferred method for the treatment of faecal incontinence in patients who fail conservative (non-operative) therapy. In previous small studies, sacral nerve stimulation has demonstrated improvement of faecal incontinence and quality of life in a majority of patients with low anterior resection syndrome. We evaluated the efficacy of sacral nerve stimulation in the treatment of low anterior resection syndrome using a recently developed and validated low anterior resection syndrome instrument to quantify symptoms. A retrospective review of consecutive patients undergoing sacral nerve stimulation for the treatment of low anterior resection syndrome was performed. Procedures took place in the Division of Colon and Rectal Surgery at two academic tertiary medical centres. Pre- and post-treatment Cleveland Clinic Incontinence Scores and Low Anterior Resection Syndrome scores were assessed. Twelve patients (50% men) suffering from low anterior resection syndrome with a mean age of 67.8 (±10.8) years underwent sacral nerve test stimulation. Ten patients (83%) proceeded to permanent implantation. Median time from anterior resection to stimulator implant was 16 (range 5-108) months. At a median follow-up of 19.5 (range 4-42) months, there were significant improvements in Cleveland Clinic Incontinence Scores and Low Anterior Resection Syndrome scores (P syndrome and may therefore be a viable treatment option. Colorectal Disease © 2017 The Association of Coloproctology of Great Britain and Ireland.

Anterior Lens Capsule and Iris Thicknesses in Pseudoexfoliation Syndrome.

Science.gov (United States)

Batur, Muhammed; Seven, Erbil; Tekin, Serek; Yasar, Tekin

2017-11-01

The aim of this study was to evaluate anatomic properties of the lens capsule and iris by anterior segment optical coherence tomography (AS-OCT) in patients with pseudoexfoliation (PEX). This prospective study included 62 eyes of 62 patients with PEX syndrome and 43 eyes of 43 age- and gender-matched controls. All subjects underwent full ophthalmologic examinations including AS-OCT. Pupillary diameter, midperipheral stromal iris thickness, central and temporal lens capsule thicknesses, and peripheral pseudoexfoliation material thickness on the anterior lens capsule surface were measured and recorded. Mean age was 66.8 ± 9.3 years in the PEX group and 65.5 ± 8.9 years in the control group (p = 0.44). The PEX group consisted of 62 patients: 38 men (61.3%) and 24 women (38.7%); the control group included 43 subjects: 25 men (58.1%) and 18 women (41.9%). Pupillary diameter after pharmacologic mydriasis was 21% smaller in the PEX group than controls. Mean midperipheral iris thickness was 36 ± 7.2 μm (7.8%) thinner in the PEX group than that of control group (p = 0.047). The central anterior capsule was a mean of 3.40 ± 0.51 μm (18%) thicker in the PEX group compared to the control group (p = 0.0001). The temporal anterior lens capsule was a mean of 0.17 ± 0.15 μm thicker in the PEX group compared to the control group (p = 0.81). With high-resolution OCT imaging, it has become possible to evaluate the anterior lens capsule without histologic examination and demonstrate that it is thicker than normal in PEX patients.

Clinical utility of anterior segment swept-source optical coherence tomography in glaucoma

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Dewang Angmo

2016-01-01

Full Text Available Optical coherence tomography (OCT, a noninvasive imaging modality that uses low-coherence light to obtain a high-resolution cross-section of biological structures, has evolved dramatically over the years. The Swept-source OCT (SS-OCT makes use of a single detector with a rapidly tunable laser as a light source. The Casia SS-1000 OCT is a Fourier-domain, SS-OCT designed specifically for imaging the anterior segment. This system achieves high resolution imaging of 10΅m (Axial and 30΅m (Transverse and high speed scanning of 30,000 A-scans per second. With a substantial improvement in scan speed, the anterior chamber angles can be imaged 360 degrees in 128 cross sections (each with 512 A-scans in about 2.4 seconds. We summarize the clinical applications of anterior segment SS-OCT in Glaucoma. Literature search: We searched PubMed and included Medline using the phrases anterior segment optical coherence tomography in ophthalmology, swept-source OCT, use of AS-OCT in glaucoma, use of swept-source AS-OCT in glaucoma, quantitative assessment of angle, filtering bleb in AS-OCT, comparison of AS-OCT with gonioscopy and comparison of AS-OCT with UBM. Search was made for articles dating 1990 to August 2015.

NONINVASIVE METHODS ASSESSMENT BLOOD FLOW IN ANTERIOR SEGMENT AND CLINICAL APPLICATION PERSPECTIVE

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T. N. Kiseleva

2017-01-01

Full Text Available The literature review contains information on the anatomical and physiological features of the vessels of the conjunctiva, iris, ciliary body. There are data on the development and application of new non-invasive methods for the study of hemodynamics in the microvessels of anterior eye segment. To study the blood flow of the anterior segment of the eye, biomycroscopy, photography and videobiomicroscopy, television biomicroscopy of vessels, darkfield visualization, application fluorescence angiography, photoacoustic angiography, orthogonal polarization spectroscopy, laser Doppler flowmetry and OCT-angiography were used in recent years. These methods allow to determine the qualitative and quantitative characteristics of conjunctiva, iris, ciliary body microcirculation. They are highly informative for assess of various drugs effect on the vascular eye system. Investigation of hemodynamics in the eye microvessels is necessary for a fundamental approach to the study of the pathophysiology of systemic circulatory pathologies (with arterial hypertension, diabetes, etc. and changes in regional blood flow in organ of vision disease. Monitoring of anterior segment microcirculation in clinical practice makes possible to monitor the effectiveness of drug and surgical treatment.

Ocular Adnexal and Anterior Segment Manifestations of HIV/AIDS ...

African Journals Online (AJOL)

Background: Benue State has the highest rate of sero-prevalence to human immuno virus (HIV) infections among the ten hyper-endemic states in Nigeria. This study evaluates the pattern of ocular adnexal and anterior segment manifestations in HIV/AIDS patients attending the HIV clinic at the NAF Hospital in Makurdi, ...

Haploinsufficient Bmp4 ocular phenotypes include anterior segment dysgenesis with elevated intraocular pressure

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Nusinowitz Steven

2001-11-01

Full Text Available Abstract Background Glaucoma is a blinding disease usually associated with high intraocular pressure (IOP. In some families, abnormal anterior segment development contributes to glaucoma. The genes causing anterior segment dysgenesis and glaucoma in most of these families are not identified and the affected developmental processes are poorly understood. Bone morphogenetic proteins (BMPs participate in various developmental processes. We tested the importance of Bmp4 gene dosage for ocular development and developmental glaucoma. Results Bmp4+/- mice have anterior segment abnormalities including malformed, absent or blocked trabecular meshwork and Schlemm's canal drainage structures. Mice with severe drainage structure abnormalities, over 80% or more of their angle's extent, have elevated IOP. The penetrance and severity of abnormalities is strongly influenced by genetic background, being most severe on the C57BL/6J background and absent on some other backgrounds. On the C57BL/6J background there is also persistence of the hyaloid vasculature, diminished numbers of inner retinal cells, and absence of the optic nerve. Conclusions We demonstrate that heterozygous deficiency of BMP4 results in anterior segment dysgenesis and elevated IOP. The abnormalities are similar to those in human patients with developmental glaucoma. Thus, BMP4 is a strong candidate to contribute to Axenfeld-Rieger anomaly and other developmental conditions associated with human glaucoma. BMP4 also participates in posterior segment development and wild-type levels are usually critical for optic nerve development on the C57BL/6J background. Bmp4+/- mice are useful for studying various components of ocular development, and may allow identification of strain specific modifiers affecting a variety of ocular phenotypes.

Stability of the anterior maxillary segment and teeth after segmental le fort I osteotomy and postoperative skeletal elastic fixation with or without occlusal splint

DEFF Research Database (Denmark)

Blæhr, Tue Lindberg; Jensen, Thomas; Due, Karen Margrethe

2014-01-01

OBJECTIVES: To assess the short term dental and skeletal stability of the anterior maxillary segment after segmental Le Fort I osteotomy with postoperative skeletal elastic fixation with or without occlusal splint. MATERIAL AND METHODS: 29 consecutive patients underwent segmental Le Fort I...... osteotomy and elastic skeletal fixation was applied. Patients were divided into two groups according to whether a fixed occlusal splint was used for six weeks (group A) or dismounted perioperatively (group B). Changes in landmarks and reference planes between the two timepoints were estimated on lateral.......83 to 1.69°). There was no statistically significant difference in stability between the two groups at the P value 0.05. CONCLUSIONS: The skeletal anterior fixation with postoperative elastics for eight weeks may not compromise the early postoperative dental and skeletal stability of the anterior segment...

Anterior segment sparing to reduce charged particle radiotherapy complications in uveal melanoma

International Nuclear Information System (INIS)

Daftari, Inder K.; Char, Devron H.; Verhey, Lynn J.; Castro, Joseph R.; Petti, Paula L.; Meecham, William J.; Kroll, Stewart; Blakely, Eleanor A.

1997-01-01

Purpose: The purpose of this investigation is to delineate the risk factors in the development of neovascular glaucoma (NVG) after helium-ion irradiation of uveal melanoma patients and to propose treatment technique that may reduce this risk. Methods and Materials: 347 uveal melanoma patients were treated with helium-ions using a single-port treatment technique. Using univariate and multivariate statistics, the NVG complication rate was analyzed according to the percent of anterior chamber in the radiation field, tumor size, tumor location, sex, age, dose, and other risk factors. Several University of California San Francisco-Lawrence Berkeley National Laboratory (LBNL) patients in each size category (medium, large, and extralarge) were retrospectively replanned using two ports instead of a single port. By using appropriate polar and azimuthal gaze angles or by treating patients with two ports, the maximum dose to the anterior segment of the eye can often be reduced. Although a larger volume of anterior chamber may receive a lower dose by using two ports than a single port treatment. We hypothesize that this could reduce the level of complications that result from the irradiation of the anterior chamber of the eye. Dose-volume histograms were calculated for the lens, and compared for the single and two-port techniques. Results: NVG developed in 121 (35%) patients. The risk of NVG peaked between 1 and 2.5 years posttreatment. By univariate and multivariate analysis, the percent of lens in the field was strongly correlated with the development of NVG. Other contributing factors were tumor height, history of diabetes, and vitreous hemorrhage. Dose-volume histogram analysis of single-port vs. two-port techniques demonstrate that for some patients in the medium and large category tumor groups, a significant decrease in dose to the structures in the anterior segment of the eye could have been achieved with the use of two ports. Conclusion: The development of NVG after

Effects of primary selective laser trabeculoplasty on anterior segment parameters

Science.gov (United States)

Guven Yilmaz, Suzan; Palamar, Melis; Yusifov, Emil; Ates, Halil; Egrilmez, Sait; Yagci, Ayse

2015-01-01

AIM To investigate the effects of selective laser trabeculoplasty (SLT) on the main numerical parameters of anterior segment with Pentacam rotating Scheimpflug camera in patients with ocular hypertension (OHT) and primary open angle glaucoma (POAG). METHODS Pentacam measurements of 45 eyes of 25 (15 females and 10 males) patients (12 with OHT, 13 with POAG) before and after SLT were obtained. Measurements were taken before and 1 and 3mo after SLT. Pentacam parameters were compared between OHT and POAG patients, and age groups (60y and older, and younger than 60y). RESULTS The mean age of the patients was 57.8±13.9 (range 20-77y). Twelve patients (48%) were younger than 60y, while 13 patients (52%) were 60y and older. Measurements of pre-SLT and post-SLT 1mo were significantly different for the parameters of central corneal thickness (CCT) and anterior chamber volume (ACV) (P0.05). CONCLUSION SLT leads to significant increase in CCT and decrease in ACV at the 1st month of the procedure. Effects of SLT on these anterior segment parameters, especially for CCT that interferes IOP measurement, should be considered to ensure accurate clinical interpretation. PMID:26558208

Skip segment Hirschsprung disease and Waardenburg syndrome

OpenAIRE

Gross, Erica R.; Geddes, Gabrielle C.; McCarrier, Julie A.; Jarzembowski, Jason A.; Arca, Marjorie J.

2015-01-01

Skip segment Hirschsprung disease describes a segment of ganglionated bowel between two segments of aganglionated bowel. It is a rare phenomenon that is difficult to diagnose. We describe a recent case of skip segment Hirschsprung disease in a neonate with a family history of Waardenburg syndrome and the genetic profile that was identified.

Comparison of anterior segment optical coherence tomography angiography and fluorescein angiography for iris vasculature analysis.

Science.gov (United States)

Zett, Claudio; Stina, Deborah M Rosa; Kato, Renata Tiemi; Novais, Eduardo Amorim; Allemann, Norma

2018-04-01

The aim of this study is to perform imaging of irises of different colors using spectral domain anterior segment optical coherence tomography angiography (AS-OCTA) and iris fluorescein angiography (IFA) and compare their effectiveness in examining iris vasculature. This is a cross-sectional observational clinical study. Patients with no vascular iris alterations and different pigmentation levels were recruited. Participants were imaged using OCTA adapted with an anterior segment lens and IFA with a confocal scanning laser ophthalmoscope (cSLO) adapted with an anterior segment lens. AS-OCTA and IFA images were then compared. Two blinded readers classified iris pigmentation and compared the percentage of visible vessels between OCTA and IFA images. Twenty eyes of 10 patients with different degrees of iris pigmentation were imaged using AS-OCTA and IFA. Significantly more visible iris vessels were observed using OCTA than using FA (W = 5.22; p Iris pigmentation was negatively correlated to the percentage of visible vessels in both imaging methods (OCTA, rho = - 0.73, p iris vasculature. In both AS-OCTA and IFA, iris pigmentation caused vasculature imaging blockage, but AS-OCTA provided more detailed iris vasculature images than IFA. Additional studies including different iris pathologies are needed to determine the most optimal scanning parameters in OCTA of the anterior segment.

Skip segment Hirschsprung disease and Waardenburg syndrome

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Erica R. Gross

2015-04-01

Full Text Available Skip segment Hirschsprung disease describes a segment of ganglionated bowel between two segments of aganglionated bowel. It is a rare phenomenon that is difficult to diagnose. We describe a recent case of skip segment Hirschsprung disease in a neonate with a family history of Waardenburg syndrome and the genetic profile that was identified.

Anterior Overgrowth in Primary Curves, Compensatory Curves and Junctional Segments in Adolescent Idiopathic Scoliosis.

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Schlösser, Tom P C; van Stralen, Marijn; Chu, Winnie C W; Lam, Tsz-Ping; Ng, Bobby K W; Vincken, Koen L; Cheng, Jack C Y; Castelein, René M

2016-01-01

Although much attention has been given to the global three-dimensional aspect of adolescent idiopathic scoliosis (AIS), the accurate three-dimensional morphology of the primary and compensatory curves, as well as the intervening junctional segments, in the scoliotic spine has not been described before. A unique series of 77 AIS patients with high-resolution CT scans of the spine, acquired for surgical planning purposes, were included and compared to 22 healthy controls. Non-idiopathic curves were excluded. Endplate segmentation and local longitudinal axis in endplate plane enabled semi-automatic geometric analysis of the complete three-dimensional morphology of the spine, taking inter-vertebral rotation, intra-vertebral torsion and coronal and sagittal tilt into account. Intraclass correlation coefficients for interobserver reliability were 0.98-1.00. Coronal deviation, axial rotation and the exact length discrepancies in the reconstructed sagittal plane, as defined per vertebra and disc, were analyzed for each primary and compensatory curve as well as for the junctional segments in-between. The anterior-posterior difference of spinal length, based on "true" anterior and posterior points on endplates, was +3.8% for thoracic and +9.4% for (thoraco)lumbar curves, while the junctional segments were almost straight. This differed significantly from control group thoracic kyphosis (-4.1%; P<0.001) and lumbar lordosis (+7.8%; P<0.001). For all primary as well as compensatory curves, we observed linear correlations between the coronal Cobb angle, axial rotation and the anterior-posterior length difference (r≥0.729 for thoracic curves; r≥0.485 for (thoraco)lumbar curves). Excess anterior length of the spine in AIS has been described as a generalized growth disturbance, causing relative anterior spinal overgrowth. This study is the first to demonstrate that this anterior overgrowth is not a generalized phenomenon. It is confined to the primary as well as the

Posterior microphthalmos pigmentary retinopathy syndrome.

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Pehere, Niranjan; Jalali, Subhadra; Deshmukh, Himanshu; Kannabiran, Chitra

2011-04-01

Posterior Microphthalmos Pigmentary Retinopathy Syndrome (PMPRS). Posterior microphthalmos (PM) is a relatively infrequent type of microphthalmos where posterior segment is predominantly affected with normal anterior segment measurements. Herein, we report two siblings with posterior microphthalmos retinopathy syndrome with postulated autosomal recessive mode of inheritance. A 13-year-old child had PM and retinitis pigmentosa (RP) and his 7-year-old sister had PM, RP, and foveoschisis. The genetics of this syndrome and variable phenotype is discussed. Importance of being aware of posterior microphthalmos and its posterior segment associations is highlighted.

Intravitreal bevacizumab (Avastin for post laser anterior segment ischemia in aggressive posterior retinopathy of prematurity

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Shah Parag

2007-01-01

Full Text Available Aggressive posterior retinopathy of prematurity (formerly known as fulminate/type II/rush disease occurs in zone 1 or posterior zone 2. Treatment involves extensive near confluent laser ablation of a large area of avascular retina. Anterior segment ischemia is a rare complication that can occur due to injury to the long posterior ciliary arteries in the horizontal meridians during aggressive posterior laser treatment. The outcome of this rare complication is very poor. This case describes a favorable outcome of intravitreal injection of bevacizumab (Avastin in a case of anterior segment ischemia.

Anterior Segmental Distraction Osteogenesis in the Hypoplastic Cleft Maxilla

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Rao (Janardhan), Sruthi; Kotrashetti, S. M.; Lingaraj, J. B.; Pinto, P. X.; Keluskar, K. M.; Jain, Siddharth; Sone, Piyush; Rao, Santhosh

2013-01-01

Orthognathic surgery and distraction osteogenesis play a prime role in the correction of maxillary hypoplasia in patients with cleft lip and palate (CLP). Advancement of the anterior maxilla alone without interfering with the velopharyngeal sphincter may be advantageous in cleft patients, who more commonly have speech deficits and dental crowding. We present a case series of anterior maxillary segmental distraction for maxillary hypoplasia in 5 CLP patients with a one-year follow-up. A custom-made tooth-borne distraction device with a hyrax screw positioned anteroposteriorly was used. The evaluation comprised of hard and soft tissue analysis and speech assessment. A stable occlusion with positive overjet and correction of dental-crowding without extraction was achieved at one year post-distraction. Facial profile and lip support improved. There was no deterioration in speech. PMID:23984033

Modeling the drug transport in the anterior segment of the eye.

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Avtar, Ram; Tandon, Deepti

2008-10-02

The aim of the present work is the development of a simple mathematical model for the time course concentration profile of topically administered drugs in the anterior chamber aqueous humor and investigation of the effects of various model parameters on the aqueous humor concentration of lipophilic and hydrophilic drugs. A simple pharmacokinetic model for the transient drug transport in the anterior segment has been developed by using the conservation of mass in the precorneal tear film, Fick's law of diffusion and Michaelis-Menten kinetics of drug metabolism in cornea, and the conservation of mass in the anterior chamber. An analytical solution describing the drug concentration in the anterior chamber has been obtained. The model predicts that an increase in the drug metabolic (consumption) rate in the corneal epithelium reduces the drug concentration in the anterior chamber for both lipophilic and hydrophilic molecules. A decrease in the clearance rate and distribution volume of the drug in the anterior chamber raises the aqueous humor concentration significantly. It is also observed that decay rate of drug concentration in the anterior chamber is higher for lipophilic molecules than that for hydrophilic molecules. The bioavailability of drugs applied topically to the eye may be improved by a rise in the precorneal tear volume, diffusion coefficient in corneal epithelium and distribution coefficient across the endothelium anterior chamber interface, and by reducing the drug metabolism, drug clearance rate and distribution volume in anterior chamber.

Anterior ST segment depression in acute inferior myocardial infarction as a marker of greater inferior, apical, and posterolateral damage

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Ruddy, T.D.; Yasuda, T.; Gold, H.K.; Leinbach, R.C.; Newell, J.B.; McKusick, K.A.; Boucher, C.A.; Strauss, H.W.

1986-01-01

The clinical significance of anterior precordial ST segment depression during acute inferior myocardial infarction was evaluated in 67 consecutive patients early after onset of symptoms with gated blood pool scans, thallium-201 perfusion images, and 12-lead ECGs. Patients with anterior ST depression (n = 33) had depressed mean values for left ventricular ejection fraction (54 +/- 2% [mean +/- S.E.M.] vs 59 +/- 2%; p = 0.02), cardiac index (3.1 +/- 0.2 vs 3.6 +/- 0.2 L/m2; p = 0.03), and ratio of systolic blood pressure to end-systolic volume (2.0 +/- 0.1 vs 2.5 +/- 0.3 mm Hg/ml; p = 0.04) compared to patients with no anterior ST depression (n = 34). Patients with anterior ST depression had (1) lower mean wall motion values for the inferior, apical, and inferior posterolateral segments (p less than 0.05) and (2) greater reductions in thallium-201 uptake in the inferior and posterolateral regions (p less than 0.05). However, anterior and septal (1) wall motion and (2) thallium-201 uptake were similar in patients with and without ST depression. Thus, anterior precordial ST segment depression in patients with acute inferior wall myocardial infarction represents more than a reciprocal electrical phenomenon. It identifies patients with more severe wall motion impairment and greater hypoperfusion of the inferior and adjacent segments. The poorer global left ventricular function in these patients is a result of more extensive inferior infarction and not of remote septal or anterior injury

Effects of primary selective laser trabeculoplasty on anterior segment parameters

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Suzan Guven Yilmaz

2015-10-01

Full Text Available AIM:To investigate the effects of selective laser trabeculoplasty (SLT on the main numerical parameters of anterior segment with Pentacam rotating Scheimpflug camera in patients with ocular hypertension (OHT and primary open angle glaucoma (POAG.METHODS: Pentacam measurements of 45 eyes of 25 (15 females and 10 males patients (12 with OHT, 13 with POAG before and after SLT were obtained. Measurements were taken before and 1 and 3mo after SLT. Pentacam parameters were compared between OHT and POAG patients, and age groups (60y and older, and younger than 60y.RESULTS: The mean age of the patients was 57.8±13.9 (range 20-77y. Twelve patients (48% were younger than 60y, while 13 patients (52% were 60y and older. Measurements of pre-SLT and post-SLT 1mo were significantly different for the parameters of central corneal thickness (CCT and anterior chamber volume (ACV (P<0.05. These parameters returned back to pre-SLT values at post-SLT 3mo. Decrease of ACV at post-SLT 1mo was significantly higher in younger than 60y group than 60y and older group. There was no statistically significant difference in Pentacam parameters between OHT and POAG patients at pre- and post-treatment measurements (P>0.05.CONCLUSION:SLT leads to significant increase in CCT and decrease in ACV at the 1st month of the procedure. Effects of SLT on these anterior segment parameters, especially for CCT that interferes IOP measurement, should be considered to ensure accurate clinical interpretation.

Morphometry of A1 segment of the anterior cerebral artery and its clinical importance.

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Krishnamurthy, A; Nayak, S R; Bagoji, I B; D'Costa, S; Pai, M M; Jiji, P J; Kumar, C G; Rai, R

2010-01-01

Anterior cerebral artery, one of the terminal branches of the internal carotid artery is an important vessel taking part in the formation of circle of Willis. It supplies a large part of the medial surface of the cerebral hemisphere containing the areas of motor and somatosensory cortices of the lower limb. Aim of this study was the morphometry of A1 segment of the anterior cerebral artery. 93 formalin fixed brain specimen of either sex and of Indian origin were studied. The mean length, mean external diameter and the anomalies present in A1 segment of the vessel were studied in detail and photographed. The mean length of A1 segment of the vessel was 14.49+/-0.28 mm and 14.22+/-0.22 mm on right and left side respectively. The mean external diameter of the vessel on right and left side was 2.12+/-0.07 mm and 2.32+/-0.06 mm respectively. Narrowing, aneurysm formation, buttonhole formation and median anterior cerebral artery were the anomalies seen with an occurrence of 15.05%, 5.37%, 3.22% and 12.9%, respectively. The above anomalies did not have any sex or side predilection. Knowledge of morphometry of the vessel will be of use to neurosurgeons while performing the shunt operation, in assessing the feasibility of such operations and in the choice of patients. From this study we infer that the morphometry of anterior cerebral artery varies in different population and that the neurosurgeons operating should have a thorough knowledge of the possible variations.

Etiology of the anterior ankle impingement syndrome: A descriptive anatomical study

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Tol, Johannes L.; van Dijk, C. Niek

2004-01-01

Background: In the anterior ankle impingement syndrome, recurrent traction to the anterior joint capsule is stated to be the cause of formation of talotibial osteophytes. This hypothesis involves the assumption that the osteophytes originate at the site where a capsular attachment is located. A soft

Stability of the anterior maxillary segment and teeth after segmental le fort I osteotomy and postoperative skeletal elastic fixation with or without occlusal splint.

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Blæhr, Tue Lindberg; Jensen, Thomas; Due, Karen Margrethe; Neumann-Jensen, Bjarne

2014-07-01

To assess the short term dental and skeletal stability of the anterior maxillary segment after segmental Le Fort I osteotomy with postoperative skeletal elastic fixation with or without occlusal splint. 29 consecutive patients underwent segmental Le Fort I osteotomy and elastic skeletal fixation was applied. Patients were divided into two groups according to whether a fixed occlusal splint was used for six weeks (group A) or dismounted perioperatively (group B). Changes in landmarks and reference planes between the two timepoints were estimated on lateral cephalometric radiographs. The upper incisor had a mean intrusion of -0.56 mm (SD 0.77; range -2.04 to 1.08 mm) and a mean posterior movement of -0.93 mm (SD 1.03; range -2.52 to 0.96 mm). The mean change in the axial inclination of the upper incisor was -0.33° (SD 2.56; range -6° to 4°) (95% CI: -1.75 to 1.08°). Group B: The upper incisor had a mean intrusion of -0.13 mm (SD 1.36; range -1.92 to 3.6 mm) and a mean anterior movement of 0.11 mm (SD 1.78; range -2.88 to 3.84 mm). The mean change in the axial inclination of the upper incisor was -0.07° (SD 3.05; range -5° to 5°) (95% CI: -1.83 to 1.69°). There was no statistically significant difference in stability between the two groups at the P value 0.05. The skeletal anterior fixation with postoperative elastics for eight weeks may not compromise the early postoperative dental and skeletal stability of the anterior segment in segmental Le Fort I osteotomy.

Stability of the Anterior Maxillary Segment and Teeth after Segmental Le Fort I Osteotomy and Postoperative Skeletal Elastic Fixation With or Without Occlusal Splint

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Tue Lindberg

2014-10-01

Full Text Available Objectives: To assess the short term dental and skeletal stability of the anterior maxillary segment after segmental Le Fort I osteotomy with postoperative skeletal elastic fixation with or without occlusal splint. Material and Methods: 29 consecutive patients underwent segmental Le Fort I osteotomy and elastic skeletal fixation was applied. Patients were divided into two groups according to whether a fixed occlusal splint was used for six weeks (group A or dismounted perioperatively (group B. Changes in landmarks and reference planes between the two timepoints were estimated on lateral cephalometric radiographs. Results: Group A: The upper incisor had a mean intrusion of -0.56 mm (SD 0.77; range -2.04 to 1.08 mm and a mean posterior movement of -0.93 mm (SD 1.03; range -2.52 to 0.96 mm. The mean change in the axial inclination of the upper incisor was -0.33° (SD 2.56; range -6° to 4° (95% CI: -1.75 to 1.08°. Group B: The upper incisor had a mean intrusion of -0.13 mm (SD 1.36; range -1.92 to 3.6 mm and a mean anterior movement of 0.11 mm (SD 1.78; range -2.88 to 3.84 mm. The mean change in the axial inclination of the upper incisor was -0.07° (SD 3.05; range -5° to 5° (95% CI: -1.83 to 1.69°. There was no statistically significant difference in stability between the two groups at the P value 0.05. Conclusions: The skeletal anterior fixation with postoperative elastics for eight weeks may not compromise the early postoperative dental and skeletal stability of the anterior segment in segmental Le Fort I osteotomy.

Risk Factors for the Development of Adjacent Segment Disease Following Anterior Cervical Arthrodesis

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Ezgi Akar

2015-06-01

Full Text Available Aim: The aim of this study was to clinically and radiologically evaluate the efficacy of anterior cervical discectomy and fusion (ACDF in the treatment of adjacent level degeneration. Methods: We retrospectively evaluated 89 patients (55 females, 34 males who underwent ACDF. Adjacent segment degeneration findings were evaluated by investigating new osteophyte formation, growth of existing osteophytes, ossification of the anterior longitudinal ligament, presence of intervertebral disc space narrowing, sagittal alignment and range of motion (ROM using serial radiographs and magnetic resonance imaging. Results: The mean age of the 89 patients was 41.3 (24-76 years. The mean follow-up duration was 34.3 (12-64 months. Radiographic evidence of adjacent segment degeneration was observed in 12 patients (13.4%. Nine (75% patients had new complaints. Of the patients who had degenerative changes, 7 were (58% were male, 5 (42% were female; the mean age was 46 (30- 62 years. It was observed that the level of fusion and the number of fusion did not increase the adjacent segment degeneration. All of 12 patients were observed to have a non lordotic cervical spine and increased ROM. Conclusion: Development of degeneration at the level adjacent to region anterior cervical discectomy and fusion performed is higher compared to non-adjacent levels. The level of fusion and the number of fusion levels have no effect on the development of degeneration. (The Medical Bulletin of Haseki 2015; 53:120-3

Anterior segment and external ocular disorders associated with HIV infections in the era of HAART in Chiang Mai University Hospital, a prospective descriptive cross sectional study.

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Singalavanija, Tassapol; Ausayakhun, Somsanguan; Tangmonkongvoragul, Chulaluck

2018-01-01

Human immunodeficiency virus (HIV) causes impairment to the human immune system which leads to immunocompromised conditions, including ocular complications. Several important HIV-associated disorders may involve the anterior segment, ocular surface, and adnexae organ such as dry eye, blepharitis which reduce quality of life of patients. In present, potent antiretroviral therapies HAART (highly active antiretroviral therapy) has improved the length and quality of life which may lead to an increased prevalence of anterior segment ocular disorders. Hence, this study has been undertaken to identify the prevalence and associated factors of anterior segment and external ocular disorder in HIV infected patients in the era of HAART. A prospective descriptive cross sectional study was carried out in HIV positive patients conducted at the Department of Ophthalmology, Chiang Mai University Hospital, from February 2014 to October 2015. Detail history and ocular examination was carried out to examine for anterior segment and external ocular disorders. A total number of 363 patients were included for this prospective cross-sectional study. From the total of 363 patients, 123 patients had an anterior segment and external ocular disorder which account as the prevalence of 33.9%. The most common anterior segment manifestations was dry eye seen in 36 patients (9.9%), followed by posterior blepharitis (Meibomian gland dysfunction) seen in 23 patients (6.3%) and anterior blepharitis seen in 12 patients (3.3%). Other ocular complications included microvasculopathy, immune recovery uveitis, conjunctivitis, papilloma, anterior uveitis, corneal ulcer, nevus, trichiasis, molluscum contangiosum, Kaposi sarcoma, interstitial keratitis, conjunctival lymphangiectasia, dacryocystitis, vernal keratoconjunctivitis and eyelid penicilosis. In this study, the prevalance of anterior segment disorders was higher than in the preHAART era. Dry eye, blepharitis and uveitis were the top three most common

Unrecognized anterior compartment syndrome following ankle fracture surgery: a case report.

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Seyahi, Aksel; Uludag, Serkan; Akman, Senol; Demirhan, Mehmet

2009-01-01

A 35-year-old male sustained a lateral malleolar fracture while playing football. The fracture was treated by open reduction and internal fixation with a tourniquet. The next day, the patient returned with pain and swelling of the ankle and was admitted again to the hospital with a suspected diagnosis of cellulitis. Ten hours later, the patient developed the symptoms of anterior compartment syndrome. Emergency open fasciotomy of the anterior compartment was performed. The retrospective analysis of the patient's history was suggestive of a predisposition to an exercise-induced compartment syndrome. We think that exertional increase of the compartmental pressure before the injury and the tourniquet used during surgery contributed together to the development of compartment syndrome. Physicians should be vigilant in identifying the features of compartment syndrome when managing patients injured during a sporting activity.

Long-term results of oral valganciclovir for treatment of anterior segment inflammation secondary to cytomegalovirus infection

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Wong VW

2012-04-01

Full Text Available Victoria WY Wong, Carmen KM Chan, Dexter YL Leung, Timothy YY LaiDepartment of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong, People's Republic of ChinaBackground: The purpose of this study was to assess the efficacy of oral valganciclovir in the treatment of anterior segment inflammation caused by cytomegalovirus (CMV infection.Methods: Consecutive patients with anterior segment inflammation due to CMV causing anterior uveitis or corneal endotheliitis treated with oral valganciclovir were reviewed. Diagnosis of CMV infection was confirmed by polymerase chain reaction of the aqueous aspirate prior to commencement of oral valganciclovir. All patients were treated with an oral loading dose of 900 mg valganciclovir twice daily for at least 2 weeks, followed by an additional 450 mg valganciclovir twice-daily maintenance therapy. Changes in visual acuity, intraocular pressure (IOP, use of antiglaucomatous eye drops, and recurrence were analyzed.Results: Thirteen eyes of 11 patients were followed for a mean of 17.2 months. Two patients had bilateral corneal endotheliitis. All eyes had absence of anterior segment inflammation within 3 weeks after treatment. Following treatment, the mean logMAR visual acuity improved significantly from 0.58 at baseline to 0.37 at the last follow-up (P = 0.048. The mean IOP and number of antiglaucomatous eye drops also decreased significantly (P = 0.021 and P = 0.004, respectively. Five (38.5% eyes had recurrence of anterior uveitis after valganciclovir was stopped and required retreatment with oral valganciclovir.Conclusion: Oral valganciclovir appeared to be effective in controlling CMV anterior uveitis, resulting in visual improvement and IOP reduction following control of inflammation. However, despite the initial clinical response in all cases, recurrence after cessation of oral valganciclovir could occur.Keywords: cytomegalovirus infection, inflammation

Anterior maxillary osteotomy: A technical note for superior repositioning: A bird wing segment

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V Sadesh Kannan

2014-01-01

Full Text Available Aim: The aim of this study is to evaluate the efficacy of a single piece bird wing osteotectomy segment during anterior maxillary osteotomy (AMO markedly reduces the duration of the surgery by nearly one-half of the time during bone removal with the conventional method thereby reducing the kinking effect to the palatal pedicle and gives good perfusion to the anterior segment. Materials and Methods: This study was conducted at Karpaga Vinayaga Institute of Dental Sciences composing of 20 patients in which male: female ratio was 8:12, with a mean age of 25-30 years. This bird wing segment technique is performed following presurgical orthodontics under the guidance of clinical assessment of the gummy smile with an incisal show when the lip is at repose (vertical maxillary excess, especially for the calculated amount of superior repositioning. It is calculated by subtracting 2 mm from the total amount of an incisor show when the lip is at repose. The normal incisal show when the lip is at repose is 2 mm. After conventional primary AMO cut was performed, the precise calculated. Results: All our cases were tested positive for pulp vitality, no relapse, and minimal edema and with no changes in the bite or dentoalveolar relation followed until 1 year postoperatively indicating a good perfusion to the anterior segment and all the patients were satisfied esthetically and free of complaints. Conclusion: This simple technique allows the precise amount of calculated bone removal in a single piece from the nasal floor markedly reduces the duration of the surgery by nearly one-half of the time during bone removal with the conventional method there by reducing the kinking effect to the palatal pedicle and maintains good perfusion.

Revesz syndrome

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Dayane Cristine Issaho

2015-04-01

Full Text Available Revesz syndrome is a rare variant of dyskeratosis congenita and is characterized by bilateral exudative retinopathy, alterations in the anterior ocular segment, intrauterine growth retardation, fine sparse hair, reticulate skin pigmentation, bone marrow failure, cerebral calcification, cerebellar hypoplasia and psychomotor retardation. Few patients with this syndrome have been reported, and significant clinical variations exist among patients. This report describes the first Brazilian case of Revesz syndrome and its ocular and clinical features.

Nongranulomatous anterior uveitis in a patient with Usher syndrome.

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Alzuhairy, Sultan Abdulaziz S; Alfawaz, Abdullah

2013-10-01

A 34-year-old female with Usher syndrome, but no family history of similar illness, presented with complaints of vision reduction, redness, and photophobia. Biomicroscopic examination showed mildly injected conjunctivae bilateral, small, round keratic precipitates; bilateral +2 cells with no flare reaction in the anterior chamber; and bilateral posterior subcapsular cataracts. No associated posterior synechiae, angle neovascularization, or iris changes were detected; normal intraocular pressures were obtained. Fundus examination demonstrated waxy pallor of both optic nerves, marked vasoconstriction in retinal vessels, and retinal bone spicule pigment formation, with a normal macula. Electroretinography confirmed the diagnosis of retinitis pigmentosa, optical coherent tomography was normal and otolaryngology consultation was conducted. To our knowledge, an association between Usher syndrome and bilateral nongranulomatous anterior uveitis has not been previously reported, and our purpose is to report this association.

A novel method for measuring anterior segment area of the eye on ultrasound biomicroscopic images using photoshop.

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Zhonghao Wang

Full Text Available To describe a novel method for quantitative measurement of area parameters in ocular anterior segment ultrasound biomicroscopy (UBM images using Photoshop software and to assess its intraobserver and interobserver reproducibility.Twenty healthy volunteers with wide angles and twenty patients with narrow or closed angles were consecutively recruited. UBM images were obtained and analyzed using Photoshop software by two physicians with different-level training on two occasions. Borders of anterior segment structures including cornea, iris, lens, and zonules in the UBM image were semi-automatically defined by the Magnetic Lasso Tool in the Photoshop software according to the pixel contrast and modified by the observers. Anterior chamber area (ACA, posterior chamber area (PCA, iris cross-section area (ICA and angle recess area (ARA were drawn and measured. The intraobserver and interobserver reproducibilities of the anterior segment area parameters and scleral spur location were assessed by limits of agreement, coefficient of variation (CV, and intraclass correlation coefficient (ICC.All of the parameters were successfully measured by Photoshop. The intraobserver and interobserver reproducibilities of ACA, PCA, and ICA were good, with no more than 5% CV and more than 0.95 ICC, while the CVs of ARA were within 20%. The intraobserver and interobserver reproducibilities for defining the spur location were more than 0.97 ICCs. Although the operating times for both observers were less than 3 minutes per image, there was significant difference in the measuring time between two observers with different levels of training (p<0.001.Measurements of ocular anterior segment areas on UBM images by Photoshop showed good intraobserver and interobserver reproducibilties. The methodology was easy to adopt and effective in measuring.

Role of the right dorsal anterior insula in the urge to tic in Tourette syndrome.

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Tinaz, Sule; Malone, Patrick; Hallett, Mark; Horovitz, Silvina G

2015-08-01

The mid-posterior part of the insula is involved in processing bodily sensations and urges and is activated during tic generation in Tourette syndrome. The dorsal anterior part of the insula, however, integrates sensory and emotional information with cognitive valuation and is implicated in interoception. The right dorsal anterior insula also participates in urge suppression in healthy subjects. This study examined the role of the right dorsal anterior insula in the urge to tic in Tourette syndrome. Resting-state functional magnetic resonance imaging was performed in 13 adult Tourette patients and 13 matched controls. The role of the right dorsal anterior insula within the urge-tic network was investigated using graph theory-based neural network analysis. The functional connectivity of the right dorsal anterior insula was also correlated with urge and tic severity. Even though the patients did not exhibit any overt tics, the right dorsal anterior insula demonstrated higher connectivity, especially with the frontostriatal nodes of the urge-tic network in patients compared with controls. The functional connectivity between the right dorsal anterior insula and bilateral supplementary motor area also correlated positively with urge severity in patients. These results suggest that the right dorsal anterior insula is part of the urge-tic network and could influence the urge- and tic-related cortico-striato-thalamic regions even during rest in Tourette syndrome. It might be responsible for heightened awareness of bodily sensations generating premonitory urges in Tourette syndrome. © 2015 International Parkinson and Movement Disorder Society.

Changes of the vasculature and innervation in the anterior segment of the RCS rat eye.

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May, Christian Albrecht

2011-12-01

Investigating the anterior eye segment vasculature and innervation of dystrophic RCS rats, two major unique findings were observed: in the iris, young adult animals with retinal dystrophy showed an increase in substance P nerve fibres and a dilation of arterioles and capillaries. This finding continued during ageing. In the pars plana region, the surface covered by venules decreased continuously with age. In older animals, this decrease was parallelled by a local decrease of sympathetic TH-positive nerve fibres supplying these venules. For both conditions, no comparable data exists so far in the literature. They might point to a unique situation in the anterior eye segment of the dystrophic RCS rat. Copyright © 2011 Elsevier Ltd. All rights reserved.

Acute coronary syndrome associated with Churg-Strauss syndrome

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Annette Doris Wagner

2007-11-01

Full Text Available Annette Doris Wagner1, Gerd Peter Meyer2, Markus Rihl3, Anke Rathmann2, Ulrike Wittkop1, Henning Zeidler4, Hermann Haller1, Joachim Lotz51Department Internal Medicine, Division of Nephrology; 2Division of Cardiology; 3Division of Rheumatology; 4Rheumatologikum Hannover; 5Department of Diagnostic Radiology; Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, GermanyAbstract: A 41-year old female patient was admitted with acute onset of dyspnea and chest pain. Previous history revealed asthma, chronic sinusitis and eosinophilic proctitis. Electrocardiogram showed anterior ST-segment elevations and inferior ST-segment depression. Immediate heart catheterization revealed a distally occluded left anterior descending coronary artery, the occlusion being reversible after nitroglycerine. Cardiac magnetic resonance imaging was consistent with perimyocarditis. Hypereosinophilia and IgE elevation were present and Churg-strauss syndrome was diagnosed.Keywords: Churg-Strauss syndrome (CSS, carditis, cardiac MRI

Anterior segment and external ocular disorders associated with HIV infections in the era of HAART in Chiang Mai University Hospital, a prospective descriptive cross sectional study.

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Tassapol Singalavanija

Full Text Available Human immunodeficiency virus (HIV causes impairment to the human immune system which leads to immunocompromised conditions, including ocular complications. Several important HIV-associated disorders may involve the anterior segment, ocular surface, and adnexae organ such as dry eye, blepharitis which reduce quality of life of patients. In present, potent antiretroviral therapies HAART (highly active antiretroviral therapy has improved the length and quality of life which may lead to an increased prevalence of anterior segment ocular disorders. Hence, this study has been undertaken to identify the prevalence and associated factors of anterior segment and external ocular disorder in HIV infected patients in the era of HAART. A prospective descriptive cross sectional study was carried out in HIV positive patients conducted at the Department of Ophthalmology, Chiang Mai University Hospital, from February 2014 to October 2015. Detail history and ocular examination was carried out to examine for anterior segment and external ocular disorders. A total number of 363 patients were included for this prospective cross-sectional study. From the total of 363 patients, 123 patients had an anterior segment and external ocular disorder which account as the prevalence of 33.9%. The most common anterior segment manifestations was dry eye seen in 36 patients (9.9%, followed by posterior blepharitis (Meibomian gland dysfunction seen in 23 patients (6.3% and anterior blepharitis seen in 12 patients (3.3%. Other ocular complications included microvasculopathy, immune recovery uveitis, conjunctivitis, papilloma, anterior uveitis, corneal ulcer, nevus, trichiasis, molluscum contangiosum, Kaposi sarcoma, interstitial keratitis, conjunctival lymphangiectasia, dacryocystitis, vernal keratoconjunctivitis and eyelid penicilosis. In this study, the prevalance of anterior segment disorders was higher than in the preHAART era. Dry eye, blepharitis and uveitis were the top

Prosthodontic Rehabilitation of Patient with Anterior Hyper Function Syndrome

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Vesna Korunoska-Stevkovska

2017-12-01

CONCLUSION: Anterior hyperfunction syndrome with its high incidence is a disease with the need of interdisciplinary therapy approach. Fast diagnosis, thorough clinical examination using all available diagnostic tools, and choosing the right treatment is very challenging.

DNA methyl transferases are differentially expressed in the human anterior eye segment.

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Bonnin, Nicolas; Belville, Corinne; Chiambaretta, Frédéric; Sapin, Vincent; Blanchon, Loïc

2014-08-01

DNA methylation is an epigenetic mark involved in the control of genes expression. Abnormal epigenetic events have been reported in human pathologies but weakly documented in eye diseases. The purpose of this study was to establish DNMT mRNA and protein expression levels in the anterior eye segment tissues and their related (primary or immortalized) cell cultures as a first step towards future in vivo and in vitro methylomic studies. Total mRNA was extracted from human cornea, conjunctiva, anterior lens capsule, trabeculum and related cell cultures (cornea epithelial, trabecular meshwork, keratocytes for primary cells; and HCE, Chang, B-3 for immortalized cells). cDNA was quantified by real-time PCR using specific primers for DNMT1, 2, 3A, 3B and 3L. Immunolocalization assays were carried out on human cornea using specific primary antibodies for DNMT1, 2 and 3A, 3B and 3L. All DNMT transcripts were detected in human cornea, conjunctiva, anterior lens capsule, trabeculum and related cells but showed statistically different expression patterns between tissues and cells. DNMT2 protein presented a specific and singular expression pattern in corneal endothelium. This study produced the first inventory of the expression patterns of DNMTs in human adult anterior eye segment. Our research highlights that DNA methylation cannot be ruled out as a way to bring new insights into well-known ocular diseases. In addition, future DNA methylation studies using various cells as experimental models need to be conducted with attention to approach the results analysis from a global tissue perspective. © 2014 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

A Rare Case of Morel-Lavallee Syndrome Complicating an Anterior Dislocation of Hip Joint.

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Nekkanti, Supreeth; Vijay, C; Theja, Sujana; Shankar, R Ravi; Verma, Anubhav

2016-01-01

Hip dislocations are serious injuries as hip joint is an extremely stable joint. It requires a significant amount of force to produce such an injury. Anterior dislocations are uncommon. Potential complications of anterior hip dislocations are a neurovascular injury to femoral vessels or acetabular fractures. We report a rare late complication of Morel-Lavallee syndrome occurring 3 weeks after an anterior dislocation of the hip in a 43-year-old male. The patient presented to us with history. Morel-Lavallee syndrome is a rare complication. However if diagnosed early can be successfully treated with minimal burden to the patient. The authors recommend surgeons to have a high index of suspicion for this syndrome and a stringent follow-up examination of the patient.

Ocular Manifestations of Acquired Immunodeficiency Syndrome.

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Kim, Young Shin; Sun, Hae Jung; Kim, Tae Hyong; Kang, Kui Dong; Lee, Sung Jin

2015-08-01

To investigate the patterns and risk factors of the ocular manifestations of acquired immunodeficiency syndrome (AIDS) and their correlation with CD4+ count in the era of highly active antiretroviral therapy (HAART). This retrospective study examined 127 AIDS patients who presented to Soonchunhyang University Hospital. Data were collected from patient interviews, clinical examinations, and laboratory investigations. Ophthalmologic examinations included the best-corrected visual acuity, intraocular pressure, anterior segment and adnexal examination, and dilated fundus examination. Of the 127 patients with AIDS, 118 were on HAART and 9 were not. The mean CD4+ count was 266.7 ± 209.1 cells/µL. There were ocular manifestations in 61 patients (48.0%). The incidence of anterior segment manifestations was higher than posterior segment manifestations at 28.3% and 19.7%, respectively. The mean CD4+ count was significantly (p AIDS. In this study, anterior segment and external ocular manifestations occurred more frequently than posterior segment manifestations. Also, the mean CD4+ count was significantly lower in patients with posterior segment ocular manifestations versus anterior segment ocular manifestations. We found that CD4+ count and age >35 years were independent risk factors for developing ocular manifestations.

Bilateral Anterior Opercular Syndrome With Partial Kluver?Bucy Syndrome in a Stroke Patient: A Case Report

OpenAIRE

Cho, Ah-Ra; Lim, Young-Ho; Chung, Sae-Hoon; Choi, Eun-Hi; Lim, Jong Youb

2016-01-01

Bilateral anterior opercular syndrome and partial Kluver?Bucy syndrome are associated with bilateral middle cerebral artery lesions. The combination of these two syndromes has only been reported in a child with limbic encephalitis. In this case, a 44-year-old woman with bilateral middle cerebral artery infarction, which occurred 2 years prior, could walk independently. However, she showed automatic-voluntary dissociation and anarthria with preserved writing skills. She also presented hypersex...

[Are biometric parameters of anterior segment of the eyeball influenced by type 2 diabetes?].

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Dmuchowska, Diana A; Kraśnicki, Paweł; Mariak, Zofia

2012-01-01

To answer the question whether biometric parameters of anterior segment of the eyeball are influenced by type 2 diabetes, at the stage when the lens is still transparent, so before cataract development. Fifty subjects (28 women and 22 men), at the age of 63.3 +/- 11.3 years were enrolled in this prospective study. They were divided in 2 groups: patients with type 2 diabetes (24 subjects) and analogous age group in good general health - control group (26 subjects). None of the tested individuals presented lens opacities. The planned biometric measurements included: central corneal thickness, anterior chamber depth and axial lens thickness. The data were statistically analyzed. There was no difference between the groups of both proven and potential parameters that are associated with biometric measurements of the anterior segment of the eyeball, such as: gender, age, smoking and axial length of the eye. In diabetic patients, as opposed to the subjects in the control group, statistically significantly increased lens thickness (4.78 +/- 0.50 mm vs 4.43 +/- 0.50; p = 0.016), central corneal thickness (561.5 +/- 31.6 microm vs 542.2 +/- 35.2; p = 0.047), and the tendency for shallow anterior chamber (3.06 +/- 0.40 mm vs 3.22 +/- 0.38; p = 0.159), were observed. In patients with diabetes there was no association of the biometric parameters values with the duration of diabetes and presence of diabetic retinopathy. Type 2 diabetes contributes to increased axial corneal and lens thickness at the stage when the lens is transparent, albeit it does not significantly affect anterior chamber depth.

Agreement of Anterior Segment Parameters Obtained From Swept-Source Fourier-Domain and Time-Domain Anterior Segment Optical Coherence Tomography.

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Chansangpetch, Sunee; Nguyen, Anwell; Mora, Marta; Badr, Mai; He, Mingguang; Porco, Travis C; Lin, Shan C

2018-03-01

To assess the interdevice agreement between swept-source Fourier-domain and time-domain anterior segment optical coherence tomography (AS-OCT). Fifty-three eyes from 41 subjects underwent CASIA2 and Visante OCT imaging. One hundred eighty-degree axis images were measured with the built-in two-dimensional analysis software for the swept-source Fourier-domain AS-OCT (CASIA2) and a customized program for the time-domain AS-OCT (Visante OCT). In both devices, we examined the angle opening distance (AOD), trabecular iris space area (TISA), angle recess area (ARA), anterior chamber depth (ACD), anterior chamber width (ACW), and lens vault (LV). Bland-Altman plots and intraclass correlation (ICC) were performed. Orthogonal linear regression assessed any proportional bias. ICC showed strong correlation for LV (0.925) and ACD (0.992) and moderate agreement for ACW (0.801). ICC suggested good agreement for all angle parameters (0.771-0.878) except temporal AOD500 (0.743) and ARA750 (nasal 0.481; temporal 0.481). There was a proportional bias in nasal ARA750 (slope 2.44, 95% confidence interval [CI]: 1.95-3.18), temporal ARA750 (slope 2.57, 95% CI: 2.04-3.40), and nasal TISA500 (slope 1.30, 95% CI: 1.12-1.54). Bland-Altman plots demonstrated in all measured parameters a minimal mean difference between the two devices (-0.089 to 0.063); however, evidence of constant bias was found in nasal AOD250, nasal AOD500, nasal AOD750, nasal ARA750, temporal AOD500, temporal AOD750, temporal ARA750, and ACD. Among the parameters with constant biases, CASIA2 tends to give the larger numbers. Both devices had generally good agreement. However, there were proportional and constant biases in most angle parameters. Thus, it is not recommended that values be used interchangeably.

Maxillary Anterior Segmental Distraction Osteogenesis to Correct Maxillary Deficiencies in a Patient With Cleft Lip and Palate.

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Kageyama-Iwata, Asuka; Haraguchi, Seiji; Iida, Seiji; Aikawa, Tomonao; Yamashiro, Takashi

2017-07-01

This report describes a case of successful orthodontic treatment using maxillary anterior segmental distraction osteogenesis with an internal maxillary distractor and bilateral sagittal split ramus osteotomy in a girl with cleft lip and palate. A 16-year-old girl with unilateral cleft lip and palate exhibited midface retrusion because of growth inhibition of the maxillary complex and mandibular excess. After the presurgical orthodontic treatment, 6.0-mm advancement of the maxillary anterior segment and 4.0-mm set back of the mandible were performed. After a retention period, the patient's midface convexity was greatly improved and the velopharyngeal competence was preserved without relapse.

Frequency of left ventricular thrombus after anterior wall st-segment elevation acute myocardial infarction

International Nuclear Information System (INIS)

Iqbal, M.W.; Fayyaz, A.

2014-01-01

Left ventricular thrombus (LVT) formation is a well known complication seen in patients presenting with acute anterior wall ST-segment elevation myocardial infarction (STEMI). In previous studies the incidence of this complication, after acute myocardial infarction (AMI) has been reported to be 4% to 60% in large anterior wall STEMI, depending significantly upon the method as well as time of reperfusion therapy after STEMI. Objective: The objective of this descriptive case series study was to evaluate the frequency of left ventricular thrombus formation in patients after acute anterior wall ST-Segment elevation myocardial infarction. Methodology: In this study, 100 patients with anterior wall STEMI presenting to cardiac emergency or coronary care unit (CCU) of Cardiac complex, Gulab Devi Hospital, were selected on non-probability, purposive sampling meeting inclusion criteria, after taking written informed consent. All the patients were treated initially for management of acute STEMI, including use of thrombolytics where indicated. 2-D Transthoracic echocardiography (TTE) was performed during the same admission to assess presence of LV thrombus (LVT). Results: The mean age of the patients was 54.3 +- 11.4 years. There were 84(84%) male patients and 16 (16%) female patients. LVT was present in 28 (28%) patients on TTE. Among those, there were 23 (82.1%) male and 5 (17.9%) female patients. However, out of 84 male patients 27.4% develop LVT and among 16 female patients this ratio was 31.3%. The LV thrombus was independent of age and gender. LV thrombus was significantly less in thrombolytic group as compared to those who were not given this therapy, i.e. p value <0.05. Conclusion: Patients with anterior wall acute STEMI not infrequently develop the complication of development of LV thrombus. In this study the frequency of LV thrombus formation after anterior wall acute STEMI was 28%. (author)

Effects of 1% cyclopentolate hydrochloride on anterior segment parameters obtained with Pentacam in young adults

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Ceyhun Arici

2014-08-01

Full Text Available Purpose: To investigate the effects of topically applied 1% cyclopentolate hydrochloride on anterior segment parameters obtained with a Pentacam rotating Scheimpflug camera in healthy young adults. Methods: Anterior segment analyses of 25 eyes from 25 young adults (Group 1, before and after 45 min of 1% cyclopentolate hydrochloride application, were performed. For a control group (cycloplegia-free, Group 2, 24 eyes of 24 age- and sex-matched healthy cases were evaluated twice at 45 min intervals. The results obtained from the groups were compared statistically. Results: The mean ages of the groups were 23.04 ± 3.42 (range, 18-29 and 22.4 ± 2.05 (range, 18-27 years for Groups 1 and 2, respectively (p=0.259. In Group 1, measurements between the two analyses were significantly different for the values of anterior chamber depth (ACD, anterior chamber angle (ACA, and anterior chamber volume (ACV (p<0.05, whereas no statistical difference was found for the central corneal thickness (CCT and keratometry (K1, K2 measurements. In Group 2, none of these parameters were statistically different between the two analyses. Conclusions: Topically applied 1% cyclopentolate hydrochloride caused an increase in the ACD and ACV values, and a decrease in the ACA value. However, it had no significant effect on the CCT and keratometry measurements. It is important to consider these effects when using the Pentacam device on young adults with cycloplegia and when applying it for various reasons.

A prospective, comparative, observational study on optical coherence tomography of the anterior eye segment

NARCIS (Netherlands)

Theelen, T.; Hoyng, C.B.

2013-01-01

BACKGROUND: We compared two commercially available spectral-domain optical coherence tomography (OCT) devices according to their capacity of imaging the anterior segment of the eye with the same detail and quality. METHODS: A prospective, observational, single-visit study with individuals aged 18

MRI of anterior spinal artery syndrome of the cervical spinal cord

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Takahashi, S. (Dept. of Radiology, Tohoku Univ. School of Medicine, Sendai (Japan)); Yamada, T. (Dept. of Radiology, Tohoku Univ. School of Medicine, Sendai (Japan)); Ishii, K. (Dept. of Radiology, Tohoku Univ. School of Medicine, Sendai (Japan)); Saito, H. (Dept. of Neurology, Tohoku Univ. School of Medicine, Sendai (Japan)); Tanji, H. (Dept. of Neurology, Tohoku Univ. School of Medicine, Sendai (Japan)); Kobayashi, T. (Inst. of Rehabilitation Medicine, Tohoku Univ. School of Medicine, Miyagi (Japan)); Soma, Y. (Div. of Neurology, Takeda Hospital, Aizuwakamatsu (Japan)); Sakamoto, K. (Dept. of Radiology, Tohoku Univ. School of Medicine, Sendai (Japan))

1992-12-01

Cervical spinal cord lesions in the anterior spinal artery syndrome were delineated on magnetic resonance images (MRI) in four patients. The lesion was always seen anteriorly in the cervical cord. On T2-weighted images, the lesions appeared hyperintense relative to the normal spinal cord, while on T1-weighted images, two chronic lesions appeared hypointense, with local atrophy of the cord. In one case, repeated T1-weighted images showed no signal abnormality 4 days after the ictus, but the lesion became hypointense 18 days later, when contrast enhancement was also recognized after injection of Gd-DTPA; this sequence of intensity changes was similar to that of cerebral infarction. The extent of the lesion seen MRI correlated closely with neurological findings in all cases. Although the findings may not be specific, MRI is now the modality of choice for confirming the diagnosis in patients suspected of having an anterior spinal artery syndrome. (orig.)

Microscope-Integrated Intraoperative Ultrahigh-Speed Swept-Source Optical Coherence Tomography for Widefield Retinal and Anterior Segment Imaging.

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Lu, Chen D; Waheed, Nadia K; Witkin, Andre; Baumal, Caroline R; Liu, Jonathan J; Potsaid, Benjamin; Joseph, Anthony; Jayaraman, Vijaysekhar; Cable, Alex; Chan, Kinpui; Duker, Jay S; Fujimoto, James G

2018-02-01

To demonstrate the feasibility of retinal and anterior segment intraoperative widefield imaging using an ultrahigh-speed, swept-source optical coherence tomography (SS-OCT) surgical microscope attachment. A prototype post-objective SS-OCT using a 1,050-nm wavelength, 400 kHz A-scan rate, vertical cavity surface-emitting laser (VCSEL) light source was integrated to a commercial ophthalmic surgical microscope after the objective. Each widefield OCT data set was acquired in 3 seconds (1,000 × 1,000 A-scans, 12 × 12 mm 2 for retina and 10 × 10 mm 2 for anterior segment). Intraoperative SS-OCT was performed in 20 eyes of 20 patients. In six of seven membrane peels and five of seven rhegmatogenous retinal detachment repair surgeries, widefield retinal imaging enabled evaluation pre- and postoperatively. In all seven cataract cases, anterior imaging evaluated the integrity of the posterior lens capsule. Ultrahigh-speed SS-OCT enables widefield intraoperative viewing in the posterior and anterior eye. Widefield imaging visualizes ocular structures and pathology without requiring OCT realignment. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:94-102.]. Copyright 2018, SLACK Incorporated.

[Slit lamp optical coherence tomography study of anterior segment changes after phacoemulsification and foldable intraocular lens implantation].

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Yan, Pi-song; Zhang, Zhen-ping; Lin, Hao-tian; Wu, Wen-jie; Bai, Ling

2009-09-01

To investigate quantitative changes of the anterior segment configuration after clear corneal incision phacoemulsification and foldable intraocular lens (IOL) implantation with slit-lamp-adapted optical coherence tomography (SL-OCT). In prospective consecutive case series, clear corneal incision phacoemulsification and foldable intraocular lens implantation were performed in 44 eyes of 40 patients. The changes of the anterior segment configuration were performed by SL-OCT before and 1 day, 1 week, 2 weeks and 1 month after surgery. SPSS 16.0 software was used to analyze statistical difference. For all patients, the central corneal thickness (CCT) and the incisional corneal thickness (ICT) increased significantly 1 day after surgery (CCT increased 99.59 microm, ICT increased 234.57 microm; P = 0.490). At 1 month, the CCT almost had returned to baseline, but the ICT had been thicker about 19.25 microm than baseline(P = 0.001). The measurements of ACD, AOD500, AOD750, TISA500, TISA750 also increased significantly 1 day after surgery. Although the ACD had no changes within 2 weeks (all P 0.05). The SL-OCT could impersonality and quantificationally evaluate the anterior segment changes induced by cataract surgery.

Type V Pouch Colon, Prune Belly Syndrome, and Congenital Anterior Urethrocutaneous Fistula.

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Raj, Prince; Birua, Hirendra

2017-01-01

Congenital pouch colon (CPC) or short colon syndrome is a rare type of anorectal malformation(ARM). Type V is the rarest form of CPC. We present a 1-day-old male child with type V CPC with prune belly syndrome and congenital anterior urethrocutaneous fistula (CAUF).

Simultaneous right coronary artery spasm in a patient with Anterior ST-Segment Elevation Myocardial Infarction: a case report

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Zhiva Taherpour

2013-05-01

Full Text Available Please cite this article as: Taherpour Z, Seyedian M, Alasti M. Simultaneous right coronary artery spasm in a patient with Anterior ST-Segment Elevation Myocardial Infarction: a case report. Novel Biomed 2013;1:29-33.Simultaneous occlusion of two vessels causing infarction at different territories is an uncommon finding. We report simultaneous right ventricular and anterior ST-segment elevation myocardial infarction in a previously healthy young man.The angiographic results demonstrated the simultaneous occlusion of the right and left coronary arteries because of simultaneous occlusion of left anterior descending artery (LADA and spasm of right coronary artery (RCA. In this patient, we found simultaneous ST elevations in right and precordial leads so everyone should be careful about all leads of the surface electrocardiogram for decision making in the management of a patient.

Ocular Drug Delivery Barriers—Role of Nanocarriers in the Treatment of Anterior Segment Ocular Diseases

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Bachu, Rinda Devi; Chowdhury, Pallabitha; Al-Saedi, Zahraa H. F.; Karla, Pradeep K.; Boddu, Sai H. S.

2018-01-01

Ocular drug delivery is challenging due to the presence of anatomical and physiological barriers. These barriers can affect drug entry into the eye following multiple routes of administration (e.g., topical, systemic, and injectable). Topical administration in the form of eye drops is preferred for treating anterior segment diseases, as it is convenient and provides local delivery of drugs. Major concerns with topical delivery include poor drug absorption and low bioavailability. To improve the bioavailability of topically administered drugs, novel drug delivery systems are being investigated. Nanocarrier delivery systems demonstrate enhanced drug permeation and prolonged drug release. This review provides an overview of ocular barriers to anterior segment delivery, along with ways to overcome these barriers using nanocarrier systems. The disposition of nanocarriers following topical administration, their safety, toxicity and clinical trials involving nanocarrier systems are also discussed. PMID:29495528

Impact of metabolic syndrome on ST segment resolution after thrombolytic therapy for acute myocardial infarction

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Ayşe Saatçı Yaşar

2010-09-01

Full Text Available Objectives: It has been shown that metabolic syndrome is associated with poor short-term outcome and poor long-term survival in patients with acute myocardial infarction. We aimed to investigate the effect of metabolic syndrome on ST segment resolution in patients received thrombolytic therapy for acute myocardial infarction.Materials and methods: We retrospectively analyzed 161 patients, who were admitted to our clinics with acute ST-elevated-myocardial infarction and received thrombolytic therapy within 12 hours of chest pain. Metabolic syndrome was diagnosed according to National Cholesterol Education Program Adult Treatment Panel III criteria. Resolution of ST segment elevation was assessed on the baseline and 90-minute electrocardiograms. ST segment resolution ≥70% was defined as complete resolution.Results: Metabolic syndrome was found in 56.5% of patients. The proportion of patients with metabolic syndrome who achieved complete ST segment resolution after thrombolysis was significantly lower than that of patients without metabolic syndrome (32.9% versus 58.6%, p=0.001. On multivariate analysis metabolic syndrome was the only independent predictor of ST segment resolution (p=0.01, Odds ratio=2.543, %95 CI:1.248-5.179Conclusion: The patients with metabolic syndrome had lower rates of complete ST segment resolution after thrombolytic therapy for acute myocardial infarction. This finding may contribute to the higher morbidity and mortality of patients with metabolic syndrome.

Moyamoya disease associated with antiphospholipid syndrome

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Mahmut Abuhandan

2011-12-01

Full Text Available Moyamoya (MMD is a disease that often involves the vascular structures of anterior cerebral circulation, particularly the proximal segments of anterior and middle cerebral arteries. The etiology of the disease is unknown. MMD often presents with cerebral ischemia and rarely with cerebral hemorrhage. The pathology is termed Moyamoya syndrome (MMS when the pathological cerebral angiography findings are accompanied by meningitis, neurofibromatosis, neoplasm, Down syndrome or polycystic kidney disease. Autoimmune diseases including Graves’ disease, Behcet’s disease and antiphospholipid syndrome might also lead to the development of MMS. In this manuscript, we presented an interesting case of MMD associated with antiphospholipid syndrome, which is quite a rare cause of acute cerebral infarction in childhood

Anterior Segment Imaging Predicts Incident Gonioscopic Angle Closure.

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Baskaran, Mani; Iyer, Jayant V; Narayanaswamy, Arun K; He, Yingke; Sakata, Lisandro M; Wu, Renyi; Liu, Dianna; Nongpiur, Monisha E; Friedman, David S; Aung, Tin

2015-12-01

To investigate the incidence of gonioscopic angle closure after 4 years in subjects with gonioscopically open angles but varying degrees of angle closure detected on anterior segment optical coherence tomography (AS OCT; Visante; Carl Zeiss Meditec, Dublin, CA) at baseline. Prospective, observational study. Three hundred forty-two subjects, mostly Chinese, 50 years of age or older, were recruited, of whom 65 were controls with open angles on gonioscopy and AS OCT at baseline, and 277 were cases with baseline open angles on gonioscopy but closed angles (1-4 quadrants) on AS OCT scans. All subjects underwent gonioscopy and AS OCT at baseline (horizontal and vertical single scans) and after 4 years. The examiner performing gonioscopy was masked to the baseline and AS OCT data. Angle closure in a quadrant was defined as nonvisibility of the posterior trabecular meshwork by gonioscopy and visible iridotrabecular contact beyond the scleral spur in AS OCT scans. Gonioscopic angle closure in 2 or 3 quadrants after 4 years. There were no statistically significant differences in age, ethnicity, or gender between cases and controls. None of the control subjects demonstrated gonioscopic angle closure after 4 years. Forty-eight of the 277 subjects (17.3%; 95% confidence interval [CI], 12.8-23; P < 0.0001) with at least 1 quadrant of angle closure on AS OCT at baseline demonstrated gonioscopic angle closure in 2 or more quadrants, whereas 28 subjects (10.1%; 95% CI, 6.7-14.6; P < 0.004) demonstrated gonioscopic angle closure in 3 or more quadrants after 4 years. Individuals with more quadrants of angle closure on baseline AS OCT scans had a greater likelihood of gonioscopic angle closure developing after 4 years (P < 0.0001, chi-square test for trend for both definitions of angle closure). Anterior segment OCT imaging at baseline predicts incident gonioscopic angle closure after 4 years among subjects who have gonioscopically open angles and iridotrabecular contact on AS OCT at

Progressive bilateral anterior sacral meningoceles in Marfan syndrome

International Nuclear Information System (INIS)

Scheck, R.J.; Schramm, T.; Gloning, K.P.; Vogl, T.; Ostermayer, E.

1995-01-01

Anterior sacral meningoceles (ASM) in Marfan syndrome are rare. They may cause constipation, urinary frequency, dysmenorrhoea, and low back pain or numbness. This report describes bilateral ASM at the level of S1, S2 and S3 in a woman with Marfan syndrome who was admitted to the gynaecology department for evaluation of left lower abdominal pain. The magnetic resonance appearance of the meningoceles is discussed and compared with findings from transvaginal ultrasound and CT. As MRI offers excellent delineation of spinal and pelvic structures, it is the most useful technique available in establishing the diagnosis and planning the treatment of ASM. (orig.)

Progressive bilateral anterior sacral meningoceles in Marfan syndrome

Energy Technology Data Exchange (ETDEWEB)

Scheck, R J [Dept. of Radiology, Univ. Muenchen (Germany); Schramm, T [Dept. of Gynaecology and Obstetrics, 1. Frauenklinik, Univ. Muenchen (Germany); Gloning, K P [Dept. of Gynaecology and Obstetrics, 1. Frauenklinik, Univ. Muenchen (Germany); Vogl, T [Dept. of Radiology, Univ. Muenchen (Germany); Ostermayer, E [Dept. of Gynaecology and Obstetrics, 1. Frauenklinik, Univ. Muenchen (Germany)

1995-08-01

Anterior sacral meningoceles (ASM) in Marfan syndrome are rare. They may cause constipation, urinary frequency, dysmenorrhoea, and low back pain or numbness. This report describes bilateral ASM at the level of S1, S2 and S3 in a woman with Marfan syndrome who was admitted to the gynaecology department for evaluation of left lower abdominal pain. The magnetic resonance appearance of the meningoceles is discussed and compared with findings from transvaginal ultrasound and CT. As MRI offers excellent delineation of spinal and pelvic structures, it is the most useful technique available in establishing the diagnosis and planning the treatment of ASM. (orig.)

Lenticonus diagnosis in Alport's syndrome: Anterior capsule apical angle calculation using Scheimpflug imagery.

Science.gov (United States)

Jarrín, E; Jarrín, I; Arnalich-Montiel, F

2015-08-01

We describe a simplified method to detect anterior lenticonus. Three eyes of 2 patients with anterior lenticonus, plus 16 eyes from 16 healthy controls underwent Scheimpflug imaging of their anterior segment with Pentacam. The anterior capsule apex angle was manually identified and automatically measured by AutoCAD. The mean angle was 173.06° (SD: 1.91) in healthy subjects, and 158.33° (SD: 3.05) in anterior lenticonus eyes. The angle obtained from patients was more than 3 SD steeper than those from healthy subjects. The apical angle calculation method seems to discriminate well between normal eyes and eyes suspected of having anterior lenticonus. Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

Orthodontic Treatment and Maxillary Anterior Segmental Distraction Osteogenesis of a Subject with Williams–Beuren Syndrome and Isolated Cleft Palate: A Long-Term Follow-Up from the Age of 5 to 24 Years

Science.gov (United States)

Shirota, Tatsuo; Adel, Mohamed; Takahashi, Masahiro; Haga, Shugo; Nagahama, Ryo; Nakashima, Misato; Furuhata, Mayu; Kamatani, Takaaki; Maki, Koutaro

2017-01-01

Williams–Beuren syndrome (WBS) is a rare multisystem disorder caused by a hemizygous deletion of the elastin gene on chromosome 7q11.23. WBS patients have characteristic skeletal features and dental anomalies accompanied by mental retardation, a friendly outgoing personality, and mild to moderate intellectual disability or learning problems. In this case report, we present the combined orthodontic and surgical treatment of a WBS patient with an isolated cleft palate through a long-term follow-up from the age of 5 to 24 years. During the period of active treatment, comprehensive orthodontic treatment combined with maxillary anterior segmental distraction osteogenesis and prosthetic treatment using dental implants were effective in dramatically improving the patient's malocclusion. The patient's mental abilities and the cooperation shown by the patient and her family were crucial for the success of this complex and long-term treatment course. PMID:28744380

Orthodontic Treatment and Maxillary Anterior Segmental Distraction Osteogenesis of a Subject with Williams–Beuren Syndrome and Isolated Cleft Palate: A Long-Term Follow-Up from the Age of 5 to 24 Years

Directory of Open Access Journals (Sweden)

Tetsutaro Yamaguchi

2017-01-01

Full Text Available Williams–Beuren syndrome (WBS is a rare multisystem disorder caused by a hemizygous deletion of the elastin gene on chromosome 7q11.23. WBS patients have characteristic skeletal features and dental anomalies accompanied by mental retardation, a friendly outgoing personality, and mild to moderate intellectual disability or learning problems. In this case report, we present the combined orthodontic and surgical treatment of a WBS patient with an isolated cleft palate through a long-term follow-up from the age of 5 to 24 years. During the period of active treatment, comprehensive orthodontic treatment combined with maxillary anterior segmental distraction osteogenesis and prosthetic treatment using dental implants were effective in dramatically improving the patient’s malocclusion. The patient’s mental abilities and the cooperation shown by the patient and her family were crucial for the success of this complex and long-term treatment course.

A novel method for measuring anterior segment area of the eye on ultrasound biomicroscopic images using photoshop.

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Wang, Zhonghao; Liang, Xuanwei; Wu, Ziqiang; Lin, Jialiu; Huang, Jingjing

2015-01-01

To describe a novel method for quantitative measurement of area parameters in ocular anterior segment ultrasound biomicroscopy (UBM) images using Photoshop software and to assess its intraobserver and interobserver reproducibility. Twenty healthy volunteers with wide angles and twenty patients with narrow or closed angles were consecutively recruited. UBM images were obtained and analyzed using Photoshop software by two physicians with different-level training on two occasions. Borders of anterior segment structures including cornea, iris, lens, and zonules in the UBM image were semi-automatically defined by the Magnetic Lasso Tool in the Photoshop software according to the pixel contrast and modified by the observers. Anterior chamber area (ACA), posterior chamber area (PCA), iris cross-section area (ICA) and angle recess area (ARA) were drawn and measured. The intraobserver and interobserver reproducibilities of the anterior segment area parameters and scleral spur location were assessed by limits of agreement, coefficient of variation (CV), and intraclass correlation coefficient (ICC). All of the parameters were successfully measured by Photoshop. The intraobserver and interobserver reproducibilities of ACA, PCA, and ICA were good, with no more than 5% CV and more than 0.95 ICC, while the CVs of ARA were within 20%. The intraobserver and interobserver reproducibilities for defining the spur location were more than 0.97 ICCs. Although the operating times for both observers were less than 3 minutes per image, there was significant difference in the measuring time between two observers with different levels of training (pPhotoshop showed good intraobserver and interobserver reproducibilties. The methodology was easy to adopt and effective in measuring.

Anterior segment optical coherence tomography for evaluation of cornea and ocular surface

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Mittanamalli S Sridhar

2018-01-01

Full Text Available Current corneal assessment technologies make the process of corneal evaluation extremely fast and simple. Several devices and technologies allow to explore and manage patients better. Optical coherence tomography (OCT technology has evolved over the years, and hence a detailed evaluation of anterior segment (AS structures such as cornea, conjunctiva, tear meniscus, anterior chamber, iris, and crystalline lens has been possible in a noncontact and safe procedure. The purpose of this special issue is to present and update in the evaluation of cornea and ocular surface, and this paper reviews a description of the AS-OCT, presenting the technology and common clinical uses of OCT in the management of diseases involving cornea and ocular surface to provide an updated information of the clinical recommendations of this technique in eye care practice.

Hypereosinophilic syndrome: CT findings in patients with hepatic lobar or segmental involvement

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Lim, Jae Hoon; Lee, Won Jae [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Lee, Dong Ho [Kyunghee University Hospital, Seoul (Korea, Republic of); Nam, Kyung Jin [Donga University College of Medicine, Pusan (Korea, Republic of)

2000-06-01

The purpose of this study was to describe the CT findings of hepatic hypereosinophilic syndrome in which hepatic lobes or segments were involved. Seven patients with hypereosinophilic syndrome with hepatic lobar or segmental involvement were included in our study. In all seven, diagnosis was based on liver biopsy and the results of corticosteroid treatment. CT findings were retrospectively reviewed by three radiologists, who reached a consensus. Biopsy specimens were examined, with special reference to portal and periportal inflammation. CT demonstrated well-defined, homogeneous or heterogeneous low attenuation with a straight margin limited to a hepatic lobe (n = 2), segments (n = 3), or subsegments (n = 2), particularly during the portal phase. Where there was subsegmental involvement, lesions were multiple, ovoid or wedge-shaped, and showed low attenuation. In two patients with lobar or segmental involvement, segmental portal vein narrowing was observed. Histopathologic examination disclosed eosinophilic infiltration in the periportal area, sinusoids and central veins, as well as portal phlebitis. Hypereosinophilic syndrome may involve the presence of hepatic lobar, segmental, or subsegmental low-attenuated lesions, as seen on CT images. Their presence may be related to damage of the liver parenchyma and to portal phlebitis.

Hypereosinophilic syndrome: CT findings in patients with hepatic lobar or segmental involvement

International Nuclear Information System (INIS)

Lim, Jae Hoon; Lee, Won Jae; Lee, Dong Ho; Nam, Kyung Jin

2000-01-01

The purpose of this study was to describe the CT findings of hepatic hypereosinophilic syndrome in which hepatic lobes or segments were involved. Seven patients with hypereosinophilic syndrome with hepatic lobar or segmental involvement were included in our study. In all seven, diagnosis was based on liver biopsy and the results of corticosteroid treatment. CT findings were retrospectively reviewed by three radiologists, who reached a consensus. Biopsy specimens were examined, with special reference to portal and periportal inflammation. CT demonstrated well-defined, homogeneous or heterogeneous low attenuation with a straight margin limited to a hepatic lobe (n = 2), segments (n = 3), or subsegments (n = 2), particularly during the portal phase. Where there was subsegmental involvement, lesions were multiple, ovoid or wedge-shaped, and showed low attenuation. In two patients with lobar or segmental involvement, segmental portal vein narrowing was observed. Histopathologic examination disclosed eosinophilic infiltration in the periportal area, sinusoids and central veins, as well as portal phlebitis. Hypereosinophilic syndrome may involve the presence of hepatic lobar, segmental, or subsegmental low-attenuated lesions, as seen on CT images. Their presence may be related to damage of the liver parenchyma and to portal phlebitis

Relationship between intraocular pressure and angle configuration: an anterior segment OCT study.

Science.gov (United States)

Chong, Rachel S; Sakata, Lisandro M; Narayanaswamy, Arun K; Ho, Sue-Wei; He, Mingguang; Baskaran, Mani; Wong, Tien Yin; Perera, Shamira A; Aung, Tin

2013-03-05

To assess the relationship between intraocular pressure (IOP) and anterior chamber angle (ACA) configuration as assessed by gonioscopy and anterior segment optical coherence tomography (AS-OCT). A total of 2045 subjects aged 50 years and older, were recruited from a community clinic and underwent AS-OCT, Goldmann applanation tonometry, and gonioscopy. A quadrant was classified as closed on gonioscopy if the posterior trabecular meshwork could not be seen. A closed quadrant on AS-OCT was defined by the presence of any contact between the iris and angle wall anterior to the scleral spur. Customized software (Zhongshan Angle Assessment Program, Guangzhou, China) was used to measure AS-OCT parameters on AS-OCT scans, including anterior chamber depth, area, and volume; iris thickness (IT) and curvature; lens vault; angle opening distance; and trabecular-iris space area. IOP values were adjusted for age, sex, diabetes and hypertension status, body mass index, central corneal thickness, and presence of peripheral anterior synechiae. Mean age of study subjects was 63.2 ± 8.0 years, 52.6% were female, and 89.4% were Chinese. Mean IOP was 14.8 ± 2.4 mm Hg (range 826). IOP (mean ± SE) increased with number of quadrants with gonioscopic angle closure (none: 14.6 ± 0.2; one: 14.7 ± 0.3; two: 15.0 ± 0.3; three: 15.0 ± 0.3; four: 15.6 ± 0.3 mm Hg; P gonioscopy, with increasing IOP.

Clinical application of arthroscopy in the diagnosis and treatment of anterior impingement syndrome of the ankle joint in physical workers.

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Wu, Wen-Te; Chen, Zhi-Wei; Zhou, Yu-Cheng

2012-10-01

To evaluate the clinical application of arthroscopy in the diagnosis and treatment of anterior impingement syndrome of the ankle joint in physical workers. A retrospective study was carried out at the Department of Orthopedics, the First Hospital affiliated to Nanhua University, Hengyang, China from March 2005 to December 2011. Seventeen cases of anterior impingement syndrome of the ankle joint were confirmed, and treated through arthroscopy. All these patients conformed to regular follow-up postoperatively, and clinical details, as well as postoperative prognosis were retrieved and analyzed retrospectively. The efficacy was evaluated by the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot-ankle scoring system, and pain relief was assessed by visual analogue scoring (VAS). Anterolateral impingement syndrome was found in 11 patients, anteromedial impingement syndrome in 4, while anterior impingement syndrome in 2 via arthroscopic examination. The VAS was reduced from 5.2-1.1, and the AOFAS score was elevated from 76.4-95.8 postoperatively; both of which demonstrated statistical differences when compared to preoperative scores. It was also found that concomitant cartilage damage was an indicator of poor prognosis in arthroscopic treatment of impingement syndrome of the ankle joint. Satisfactory results could be achieved for physical workers with anterior impingement syndrome treated by arthroscopy. As the cartilage damage is an indicator of poor prognosis, an early operation is advocated when the prognosis of anterior impingement syndrome is confirmed.

Diagnostics of anterior eye segment in cats and dogs

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Hadži-Milić Milan

2006-01-01

Full Text Available Diagnostics of the anterior segment of the eye present the most frequent diagnostics implemented in ophthalmology and by most veterinary practicians as well. This paper presents the complete diagnostics in the most concise form possible. The procedure with animals is presented first, followed by the equipment, and then anamnesis. The following diagnostic methods are presented: examination in a lighted room which include an examination from a distance, taking a smear, the Schirmer tear test (STT, an examination from close by, examination in a dark room which comprises the elementary examinations, such as the use of focal lighting and examination using a direct ophthalmoscope, and special examination in a dark room, such as biomicroscopy, gonioscopy and keratoscopy. Additional examination methods are also included.

Diurnal Alterations of Refraction, Anterior Segment Biometrics, and Intraocular Pressure in Long-Time Dehydration due to Religious Fasting.

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Baser, Gonen; Cengiz, Hakan; Uyar, Murat; Seker Un, Emine

2016-01-01

To investigate the effects of dehydration due to fasting on diurnal changes of intraocular pressure, anterior segment biometrics, and refraction. The intraocular pressures, anterior segment biometrics (axial length: AL; Central corneal thickness: CCT; Lens thickness: LT; Anterior chamber depth: ACD), and refractive measurements of 30 eyes of 15 fasting healthy male volunteers were recorded at 8:00 in the morning and 17:00 in the evening in the Ramadan of 2013 and two months later. The results were compared and the statistical analyses were performed using the Rstudio software version 0.98.501. The variables were investigated using visual (histograms, probability plots) and analytical methods (Kolmogorov-Smirnov/Shapiro-Wilk test) to determine whether or not they were normally distributed. The refractive values remained stable in the fasting as well as in the control period (p = 0.384). The axial length measured slightly shorter in the fasting period (p = 0.001). The corneal thickness presented a diurnal variation, in which the cornea measured thinner in the evening. The difference between the fasting and control period was not statistically significant (p = 0.359). The major differences were observed in the anterior chamber depth and IOP. The ACD was shallower in the evening during the fasting period, where it was deeper in the control period. The diurnal IOP difference was greater in the fasting period than the control period. Both were statistically significant (p = 0.001). The LT remained unchanged in both periods. The major difference was shown in the anterior chamber shallowing in the evening hours and IOP. Our study contributes the hypothesis that the posterior segment of the eye is more responsible for the axial length alterations and normovolemia has a more dominant influence on diurnal IOP changes.

Extensive molecular differences between anterior- and posterior-half-sclerotomes underlie somite polarity and spinal nerve segmentation

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Keynes Roger J

2009-05-01

Full Text Available Abstract Background The polarization of somite-derived sclerotomes into anterior and posterior halves underlies vertebral morphogenesis and spinal nerve segmentation. To characterize the full extent of molecular differences that underlie this polarity, we have undertaken a systematic comparison of gene expression between the two sclerotome halves in the mouse embryo. Results Several hundred genes are differentially-expressed between the two sclerotome halves, showing that a marked degree of molecular heterogeneity underpins the development of somite polarity. Conclusion We have identified a set of genes that warrant further investigation as regulators of somite polarity and vertebral morphogenesis, as well as repellents of spinal axon growth. Moreover the results indicate that, unlike the posterior half-sclerotome, the central region of the anterior-half-sclerotome does not contribute bone and cartilage to the vertebral column, being associated instead with the development of the segmented spinal nerves.

Anterior segment morphology and morphometry in selected reptile species using optical coherence tomography.

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Rival, Franck; Linsart, Adeline; Isard, Pierre-François; Besson, Christian; Dulaurent, Thomas

2015-01-01

To provide new and original images of the anterior segment (AS) of the eye of selected Ophidian, Chelonian, and Saurian species and to compare the AS architecture among and within these three groups. 17 Saurians, 14 Ophidians, and 11 Chelonians with no concurrent systemic or eye disease were included in the study. Age, weight, nose-cloaca distance (NCD), and pupil shape were collected for each animal. The AS was examined by optical coherence tomography (OCT). After gross description of the appearance of the AS, the central and peripheral corneal thickness (CCT, PCT) and anterior chamber depth (ACD) were measured using the software provided with the OCT device. The ratio CCT/ACD was then calculated for each animal. Pupil shape was a vertical slit in all the crepuscular or nocturnal animals (except for 1 chelonian and 1 ophidian). Each group had its own particular AS architecture. Saurians had a regularly thin cornea with a flat anterior lens capsule and a deep anterior chamber. Ophidians had a thick cornea with a narrow anterior chamber due to a very anteriorly anchored spherical lens. The spectacle was difficult to identify in all ophidians except in Python molurus bivitattus in which it was more obvious. Chelonians displayed an intermediate architecture which more closely resembled the Saurian type than the Ophidian type. Despite grossly similar AS architecture, the three groups of reptiles in the study demonstrated differences that are suggestive of a link between anatomical disparities and variations in environment and lifestyle. © 2014 American College of Veterinary Ophthalmologists.

Nongranulomatous anterior uveitis in a patient with Usher syndrome

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Alzuhairy, Sultan Abdulaziz S.; Alfawaz, Abdullah

2013-01-01

A 34-year-old female with Usher syndrome, but no family history of similar illness, presented with complaints of vision reduction, redness, and photophobia. Biomicroscopic examination showed mildly injected conjunctivae bilateral, small, round keratic precipitates; bilateral +2 cells with no flare reaction in the anterior chamber; and bilateral posterior subcapsular cataracts. No associated posterior synechiae, angle neovascularization, or iris changes were detected; normal intraocular pressu...

The Effects of Ramadan Fasting on Anterior Segment Parameters, Visual Acuity and Intraocular Pressures of the Eye.

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Selver, Ozlem Barut; Palamar, Melis; Gerceker, Kevser; Egrilmez, Sait; Yagci, Ayse

2017-01-01

It is aimed to determine whether fasting during Ramadan has any significant effect on anterior chamber parameters, visual acuity and intraocular pressures. 31 fasting (Group 1) and 30 non-fasting healthy volunteers (Group 2) were enrolled. All cases underwent an ophthalmological examination and anterior segment parameter evaluation (central corneal thickness (CCT), anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA), pupil size) with Pentacam before and after the breaking of the Ramadan fast in Group 1, before and after dinner in Group 2. The mean age was 43.35 ± 13.20 in Group 1, 43.17 ± 12.90 in Group 2 (p= 0.955). No significant difference was detected in any of the parameters in both groups. There is a need for more detailed and associated studies to understand better about the influence of Ramadan fast on various ocular parameters.

Comparison of gonioscopy and anterior segment ocular coherence tomography in detecting angle closure in different quadrants of the anterior chamber angle.

Science.gov (United States)

Sakata, Lisandro M; Lavanya, Raghavan; Friedman, David S; Aung, Han T; Gao, Hong; Kumar, Rajesh S; Foster, Paul J; Aung, Tin

2008-05-01

To compare the performance of gonioscopy and anterior segment (AS) optical coherence tomography (OCT) in detecting angle closure in the different quadrants of the anterior chamber angle (ACA). Cross-sectional observational study. Five hundred two consecutive subjects more than 50 years of age with no previous ophthalmic problems recruited from a community clinic in Singapore. All subjects underwent gonioscopy and AS OCT imaging in the dark. Using gonioscopy, the ACA was graded using the Scheie system by a single examiner masked to AS OCT findings. The ACA in a particular quadrant was classified as closed if the posterior trabecular meshwork could not be seen on gonioscopy. A closed ACA on AS OCT imaging was defined by the presence of any contact between the iris and angle wall anterior to the scleral spur. After excluding eyes with poor image quality, a total of 423 right eyes were included in the analysis. A closed angle in at least 1 quadrant was observed in 59% of the eyes by AS OCT and in 33% of the eyes by gonioscopy (Pgonioscopy were 48% versus 29% superiorly, 43% versus 22% inferiorly, 18% versus 14% nasally, and 12% versus 20% temporally, respectively. Of the 119 of 1692 quadrants that were closed on gonioscopy but open on AS OCT, a steep iris profile was present in 61 (51%) of 119 quadrants on AS OCT, and of the 276 of 1692 quadrants that were open on gonioscopy but closed on AS OCT, 196 (71%) of 276 quadrants showed short iridoangle contact on AS OCT. The highest rates of closed angles on gonioscopy and AS OCT images were observed in the superior quadrant. Anterior segment OCT tended to detect more closed ACAs than gonioscopy, particularly in the superior and inferior quadrants. Variations in the iris profile and level of iridoangle contact also may explain some of the differences seen between gonioscopy and AS OCT.

[Visual rehabilitation of patients with large post-traumatic defects of the anterior eye segment through iris-lens diaphragm implantation].

Science.gov (United States)

Khodzhaev, N S; Sobolev, N P; Mushkova, I A; Izmaylova, S B; Karimova, A N

The diversity of methodological approaches and lack of pathogenetically reasonable tactics for patients with combined ocular injuries became the basis for the development and systematization of surgical rehabilitation stages of patients, in whom post-traumatic cataract is combined with post-traumatic aniridia and corneal scarring. to construct a visual rehabilitation approach to patients with post-traumatic defects of the anterior eye segment following optical-reconstructive surgery that involved implantation of an iris-lens diaphragm (ILD). We have analyzed 80 reconstructive cases with ILD implantation in patients with post-traumatic aniridia and corneal damage. These patients constituted the first study group (Group 1). We have also investigated 58 eyes with residual ametropy and stable visual function 1 year after ILD implantation before and after conducting a laser keratorefractive surgery. These patients were assigned to the second study group (Group 2). Rehabilitation approach to patients after anterior segment injuries that has been proposed allows to achieve high clinical and functional results and reduce the risk of intra- and postoperative complications. The proposed approach to patients after optical-reconstructive surgery with iris-lens diaphragm implantation followed by keratorefractive surgery is an effective method of visual rehabilitation of anterior eye segment post-traumatic defects.

Anterior Hypopituitarism and Treatment Response in Hunter Syndrome: A Comparison of Two Patients

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Munier A. Nour

2016-01-01

Full Text Available Hypopituitarism is a clinically important diagnosis and has not previously been reported in Hunter syndrome. We contrast two cases with anatomic pituitary anomalies: one with anterior panhypopituitarism and the other with intact pituitary function. Patient 1, a 10-year-old boy with Hunter syndrome, was evaluated for poor growth and an ectopic posterior pituitary gland. Endocrine testing revealed growth hormone (GH deficiency, secondary adrenal insufficiency, and tertiary hypothyroidism. An improvement in growth velocity with hormone replacement (GH, thyroxine, and corticosteroid was seen; however, final adult height remained compromised. Patient 2, a 13-year-old male with Hunter syndrome, was evaluated for growth failure. He had a large empty sella turcica with posteriorly displaced pituitary. Functional endocrine testing was normal and a trial of GH-treatment yielded no significant effect. Panhypopituitarism associated with pituitary anomalies has not been previously reported in Hunter syndrome and was an incidental finding of significant clinical importance. In the setting of documented anterior hypopituitarism, while hormone replacement improved growth velocity, final height remained impaired. In patient 2 with equivocal GH-testing results, treatment had no effect on linear growth. These cases highlight the importance of careful clinical assessment in Hunter syndrome and that judicious hormone replacement may be indicated in individual cases.

Acute thrombosis during left main stenting using tap technique in a patient presenting with non-ST-segment elevation acute coronary syndrome

International Nuclear Information System (INIS)

Natarajan, Deepak

2015-01-01

This case reports the sudden development of large burden of thrombi in the left anterior descending coronary artery immediately following distal left main stenting using TAP technique in a middle aged man who presented with non ST-segment elevation acute coronary syndrome despite having been administered 7,500 units of unfractionated heparin and being given 325 mg of aspirin and 60 mg of prasugrel prior to the procedure. The thrombi were managed effectively by giving an intra-coronary high bolus dose of tirofiban (25 mcg/kg) without the need for catheter thrombus extraction. Tirofiban intra-venous infusion was maintained for 18 hours, and the patient was discharged in stable condition on the third day. Importantly there is no controlled study on upstream administration of glycoprotein IIb/IIIa inhibitors in addition to the newer more potent anti-platelet agents in patients with unprotected distal left main disease presenting with non ST-segment elevation acute coronary syndrome, nor is there any data on safety and efficacy of mandatory usage of injectable anti-platelet agents at the start of a procedure in a catheterization laboratory in such a setting

Acute thrombosis during left main stenting using tap technique in a patient presenting with non-ST-segment elevation acute coronary syndrome

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Natarajan, Deepak, E-mail: deepaknatarajan@me.com

2015-06-15

This case reports the sudden development of large burden of thrombi in the left anterior descending coronary artery immediately following distal left main stenting using TAP technique in a middle aged man who presented with non ST-segment elevation acute coronary syndrome despite having been administered 7,500 units of unfractionated heparin and being given 325 mg of aspirin and 60 mg of prasugrel prior to the procedure. The thrombi were managed effectively by giving an intra-coronary high bolus dose of tirofiban (25 mcg/kg) without the need for catheter thrombus extraction. Tirofiban intra-venous infusion was maintained for 18 hours, and the patient was discharged in stable condition on the third day. Importantly there is no controlled study on upstream administration of glycoprotein IIb/IIIa inhibitors in addition to the newer more potent anti-platelet agents in patients with unprotected distal left main disease presenting with non ST-segment elevation acute coronary syndrome, nor is there any data on safety and efficacy of mandatory usage of injectable anti-platelet agents at the start of a procedure in a catheterization laboratory in such a setting.

Consideration of QRS complex in addition to ST-segment abnormalities in the estimated "risk region" during acute anterior myocardial infarction

DEFF Research Database (Denmark)

van Hellemond, Irene E. G.; Bouwmeester, Sjoerd; Olson, Charles W.

2011-01-01

a falsely low estimated total MaR if determined by using ST segment-based methods. The purpose of this study was to investigate if consideration of the abnormalities in the QRS complex, in addition to those in the ST segment, provides a more accurate estimated total MaR during anterior AMI than...

Evaluation of Descemet’s Membrane Detachment Using Anterior Segment Optical Coherence Tomography

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Halil Hüseyin Çağatay

2014-10-01

Full Text Available We report the use of anterior segment optical coherence tomography (ASOCT in Descemet’s membrane detachment (DMD. A patient who developed DMD after uneventful cataract surgery with posterior chamber lens implantation is presented in this case report. At the follow-up examination after cataract surgery, slit-lamp evaluation showed stromal striae, but it was impossible to diagnose the DMD due to the corneal edema. ASOCT imaging of the cornea revealed a DMD, and the patient underwent intracameral air injection to the anterior chamber through the site which was identified as intact by ASOCT. Follow-up ASOCT imaging revealed the reattachment of the Descemet’s membrane and reduced corneal thickness. If DMD is suspected in any cases, ASOCT can be useful to document and follow the postsurgical detachment of DMD and also to determine the site, configuration, and extent of the DMD, thus guiding the treatment method and monitoring the treatment outcome. (Turk J Ophthalmol 2014; 44: 407-9

Identification of the segmental artery feeding the anterior spinal artery. Correlation between helical CT and angiography

International Nuclear Information System (INIS)

Nishimura, Jun-ichi; Lee, Jin; Koike, Shigeomi

2005-01-01

We investigated whether identification of the segmental artery feeding the anterior spinal artery (ASA) is possible by single-slice helical CT. Enhanced CT and angiography were performed in 14 patients with retroperitoneal, liver, or bone tumor. A single-slice helical CT scanner with 7 mm collimation and a 1.0 helical pitch was used. Scanning was started 25 to 30 sec after an intravenous injection of 100 ml of contrast medium at a rate of 3.0 ml/sec. We predicted the segmental artery feeding the ASA in all 14 patients using enhanced CT images. In 12 of the 14 patients, the segmental artery feeding the ASA was angiographically identified. In 7 of these 12 patients, the level of the segmental artery feeding the ASA identified on segmental arteriogram was the same level as that predicted by enhanced CT. In the remaining 5 patients, the level of the segmental artery feeding the ASA identified on segmental arteriogram was one level higher or lower than the predicted spinal level. We could identify the segmental artery feeding the ASA by detailed examination and interpretation of single-slice helical CT images. (author)

Distal anterior inferior cerebellar artery syndrome after acoustic neuroma surgery.

Science.gov (United States)

Hegarty, Joseph L; Jackler, Robert K; Rigby, Peter L; Pitts, Lawrence H; Cheung, Steven W

2002-07-01

To define a clinicopathologic syndrome associated with persistent cerebellar dysfunction after acoustic neuroma (AN) excision. Case series derived from radiographic and clinical chart review. Tertiary referral center. In 12 patients with AN, persistent cerebellar dysfunction developed after AN removal. Each case demonstrated abnormality in the ipsilateral cerebellar peduncle on postoperative magnetic resonance imaging. Cerebellar function and ambulatory status over the first postoperative year. On magnetic resonance imaging scans, the extent of cerebellar peduncle infarcts was variable. It ranged from focal brain injury (2 cm) spanning the full thickness of the peduncle. Peduncular infarcts were associated with large tumor size (average 3.8 cm, range 2.0-5.5 cm diameter). The long-term functional outcomes (>1 yr) varied. Dysmetria was unchanged or improved in over half of the patients (6 of 11 patients). Gait recovered to normal or to preoperative levels in 5 patients. In the 6 patients with persistent impaired mobility, 2 had mild gait disturbance, 3 required regular use of a cane, and 1 has been dependent on a walker. One patient had sustained mild motor weakness. Three of 11 patients remained dependent on others for activities of daily living. Peduncle injury most likely stems from interruption of distal branches of the anterior inferior cerebellar artery (AICA). These small vessels are intimately related to the capsule of the tumor and may supply both the neoplasm and the brain parenchyma. It has long been recognized that interruption of the proximal segment of the AICA results in severe injury to the pons, with devastating neurologic sequelae. A limited AICA syndrome caused by loss of its distal ramifications seems a more plausible explanation for peduncular infarction than either venous insufficiency or direct surgical trauma.

Anterior maxillary segmental distraction for correction of maxillary hypoplasia and dental crowding in cleft palate patients: a preliminary report.

Science.gov (United States)

Wang, X-X; Wang, X; Li, Z-L; Yi, B; Liang, C; Jia, Y-L; Zou, B-S

2009-12-01

To evaluate the feasibility of anterior maxillary segmental distraction (AMSD) to correct maxillary hypoplasia and severe dental crowding in cleft lip and palate (CLP) patients, 7 patients (average age 16.4 years) with maxillary hypoplasia, shortened maxillary dental arch length and severe anterior dental crowding secondary to CLP were selected for this study. After anterior maxillary segmental osteotomy, 3 patients were treated using bilateral internal distraction devices, and 4 patients were treated using rigid external distraction devices. Photographs and radiographs were taken to review the improvement in facial profile and occlusion after distraction. An average 10.25 mm anterior maxillary advancement was obtained in all patients after 10-23 days of distraction and 9-16 weeks of consolidation. The sella-nasion-point A (SNA) angle increased from 69.5 degrees to 79.6 degrees. Midface convexity was greatly improved and velopharyngeal competence was preserved. The maxillary dental arch length was greatly increased by 10.1 mm (P<0.01). Dental crowding and malocclusion were corrected by orthodontic treatment. These results show that AMSD can effectively correct the hypoplastic maxilla and severe dental crowding associated with CLP by increasing the midface convexity and dental arch length while preserving velopharyngeal function, and dental crowding can be corrected without requiring tooth extraction.

The Effects of Smoking on Anterior Segment Parameters, Retinal Nerve Fiber Layer, and Pupillary Functions

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Bengü Ekinci Köktekir

2014-01-01

Full Text Available Objectives: To evaluate the alterations in the anterior segment parameters, retinal nerve fiber layer, and pupillary functions in smokers. Materials and Methods: In this case-control study, 45 eyes of 45 smokers and 45 eyes of 45 non-smoker control subjects were evaluated. All patients underwent measurement of anterior segment parameters with optical low coherence reflectometry (OLCR, mesopic and photopic pupillary diameter with an aberrometer device, retinal nerve fiber layer thickness with optical coherence tomography, and dry-eye assessment with Schirmer’s test. The results were compared with independent t-test by SPSS 16.0 Inc., and a p-value lower than 0.05 was determined as significant. Results: There was a significant difference between both groups in terms of mesopic pupil diameters that were measured with both OLCR and aberrometer device (p=0.03 and 0.02, respectively. Schirmer scores were also significantly decreased in smokers (p=0.001. The other measured parameters demonstrated no difference between smokers and non-smokers (p>0.05 for all. Conclusion: Smoking may affect pupillary functions, especially the mesopic pupillary diameter, and may cause a deficiency in pupil response under dark circumstances. (Turk J Ophthalmol 2014; 44: 11-4

Conditional deletion of AP-2β in mouse cranial neural crest results in anterior segment dysgenesis and early-onset glaucoma

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Vanessa B. Martino

2016-08-01

Full Text Available Anterior segment dysgenesis (ASD encompasses a group of developmental disorders in which a closed angle phenotype in the anterior chamber of the eye can occur and 50% of patients develop glaucoma. Many ASDs are thought to involve an inappropriate patterning and migration of the periocular mesenchyme (POM, which is derived from cranial neural crest cells (NCCs and mesoderm. Although, the mechanism of this disruption is not well understood, a number of transcriptional regulatory molecules have previously been implicated in ASDs. Here, we investigate the function of the transcription factor AP-2β, encoded by Tfap2b, which is expressed in NCCs and their derivatives. Wnt1-Cre-mediated conditional deletion of Tfap2b in NCCs resulted in post-natal ocular defects typified by opacity. Histological data revealed that the conditional AP-2β NCC knockout (KO mutants exhibited dysgenesis of multiple structures in the anterior segment of the eye including defects in the corneal endothelium, corneal stroma, ciliary body and disruption in the iridocorneal angle with adherence of the iris to the cornea. We further show that this phenotype leads to a significant increase in intraocular pressure and a subsequent loss of retinal ganglion cells and optic nerve degeneration, features indicative of glaucoma. Overall, our findings demonstrate that AP-2β is required in the POM for normal development of the anterior segment of the eye and that the AP-2β NCC KO mice might serve as a new and exciting model of ASD and glaucoma that is fully penetrant and with early post-natal onset.

Correlation between cervical lordosis and adjacent segment pathology after anterior cervical spinal surgery.

Science.gov (United States)

Lee, Soo Eon; Jahng, Tae-Ahn; Kim, Hyun Jib

2015-12-01

To evaluate the incidence and risk factors for adjacent segment pathology (ASP) after anterior cervical spinal surgery. Fourteen patients (12 male, mean age 47.1 years) who underwent single-level cervical disk arthroplasty (CDA group) and 28 case-matched patients (24 male, mean age 53.6 years) who underwent single-level anterior cervical discectomy and fusion (ACDF group) were included. Presence of radiologic ASP (RASP) was based on observed changes in anterior osteophytes, disks, and calcification of the anterior longitudinal ligament on lateral radiographs. The mean follow-up period was 43.4 months in the CDA group and 44.6 months in the ACDF group. At final follow-up, ASP was observed in 5 (35.7%) CDA patients and 16 (57.1%) ACDF patients (p = 0.272). The interval between surgery and ASP development was 33.8 months in the CDA group and 16.3 months in the ACDF group (p = 0.046). The ASP risk factor analysis indicated postoperative cervical angle at C3-7 being more lordotic in non-ASP patients in both groups. Restoration of lordosis occurred in the CDA group regardless of the presence of ASP, but heterotopic ossification development was associated with the presence of ASP in the CDA group. And the CDA group had significantly greater clinical improvements than those in the ACDF group when ASP was present. In both CDA and ACDF patients, RASP developed, but CDA was associated with a delay in ASP development. A good clinical outcome was expected in CDA group, even when ASP developed. Restoration of cervical lordosis was an important factor in anterior cervical spine surgery.

Anterior segment changes after pharmacologic mydriasis using Pentacam and optical coherence tomography in angle closure suspects

Directory of Open Access Journals (Sweden)

Jing-Min Guo

2015-10-01

Full Text Available AIM:To compare the dynamic changes of anterior segment parameters especially iris morphology induced by pharmacologic mydriasis between angle closure suspects and normal controls.METHODS:The study group comprised 19 eyes of 19 angle closure suspects and 19 eyes of 19 age- and sex-matched normal open-angle eyes. Pentacam and optical coherence tomography measurements before and 30min after instillation of compound tropicamide eye drop were performed and compared. Biometric evaluations of iris tomography and anterior chamber angle were estimated by a customized image-processing software.RESULTS:Baseline axial length, iris cross sectional area and volume did not differ significantly between angle closure suspects and normal controls. Angle closure suspects had smaller pupil size, narrower anterior segment dimension and axial length, thinner iris with greater curve in comparison with normal controls. Pharmacologic mydriasis led to significant increments in iris thickness at 750 μm, anterior chamber depth and volume, whereas significant decrements in iris curve, cross sectional area and volume in both groups. Angle opening distance at 500 μm was increased significantly in normal controls (from 0.465±0.115 mm to 0.539±0.167 mm, P=0.009, but not in angle closure suspects (from 0.125±0.100 mm to 0.145±0.131 mm, P=0.326. Iris volume change per millimeter of pupil dilation (△IV/△PD decreased significantly less in angle closure suspects than normal controls (-2.47±1.33 mm2 vs -3.63±1.58 mm2, P=0.019. Linear regression analysis showed that the change of angle opening distance at 500 μm was associated most with the change of central anterior chamber depth (β=0.841, P=0.002 and △IV/△PD (β=0.028, P=0.002, followed by gender (β=0.062, P=0.032.CONCLUSION:Smaller iris volume decrement per millimeter of pupil dilation is related significantly with the less anterior angle opening in angle closure suspects after pharmacologic mydriasis. Dynamic

Pars-plana fluid aspiration for positive vitreous cavity pressure in anterior segment surgeries

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Thomas Kuriakose

2018-01-01

Full Text Available Positive vitreous pressure due to misdirection of aqueous or choroidal effusion leads to shallowing of the anterior chamber (AC before or during anterior segment surgeries. This shallow AC if not addressed makes surgery difficult and increases the risk of surgical complications. Methods to prevent and manage this condition described in literature are not without problems. We describe a minimally invasive technique of passing a 30G needle through the pars-plana to aspirate misdirected fluid from vitreous cavity either as a prophylaxis just before surgery or during it, thereby decreasing positive vitreous pressure. This technique, used in 12 eyes, seems to be effective in patients with angle-closure glaucoma, malignant glaucoma, and per-operative sudden increase in vitreous pressure during surgery. Small-incision surgeries are ideally suited for this procedure. This minimally invasive technique is simple to perform and complications are unlikely to be more than what is seen with intravitreal injections.

Anterior Cruciate Ligament Reconstruction in Ehlers-Danlos Syndrome

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John Williams

2015-01-01

Full Text Available This report details the reconstruction of the anterior cruciate ligament in an 18-year-old man with Ehlers-Danlos syndrome (EDS. The reduced mechanical properties of the tissue in EDS can pose a challenge to the orthopaedic surgeon. In this case, we describe the use of a hamstring autograft combined with a Ligament Advanced Reinforcement System (LARS. There was a good radiographical, clinical, and functional outcome after two years. This technique gave a successful outcome in the reconstruction of the ACL in a patient with EDS and therefore may help surgeons faced with the same clinical scenario.

[Acute anterior myocardial infarction as presenting feature of antiphospholipid syndrome related lupus arthritis].

Science.gov (United States)

Capilla-Geay, E; Poyet, R; Brocq, F X; Pons, F; Kerebel, S; Foucault, G; Jego, C; Cellarier, G R

2016-05-01

Antiphospholipid syndrome is an autoimmune disorder causing venous and arterial thrombosis. Acute coronary complications are rare but potentially dramatic. We report a 39-year-old woman who presented with an acute anterior myocardial infarction after intravenous corticosteroids as part of the treatment of lupus arthritis and revealing antiphospholipid syndrome. Emergency coronary angiography was performed with drug-eluting stent angioplasty despite the need for anticoagulation and dual antiplatelet therapy. Antiplatelet and anticoagulant therapy management is pivotal in patients with antiphospholipid syndrome and acute coronary syndrome to prevent thrombosis recurrence. Copyright © 2015 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

In Vivo Confocal Microscopy and Anterior Segment Optic Coherence Tomography Findings in Ocular Ochronosis

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Elif Demirkilinc Biler

2015-01-01

Full Text Available Purpose. To report clinical and in vivo confocal microscopy (IVCM findings of two patients with ocular ochronosis secondary due to alkaptonuria. Materials and Methods. Complete ophthalmologic examinations, including IVCM (HRT II/Rostock Cornea Module, Heidelberg, Germany, anterior segment optical coherence tomography (AS-OCT (Topcon 3D spectral-domain OCT 2000, Topcon Medical Systems, Paramus, NJ, USA, corneal topography (Pentacam, OCULUS Optikgeräte GmbH, Wetzlar, Germany, and anterior segment photography, were performed. Results. Biomicroscopic examination showed bilateral darkly pigmented lesions of the nasal and temporal conjunctiva and episclera in both patients. In vivo confocal microscopy of the lesions revealed prominent degenerative changes, including vacuoles and fragmentation of collagen fibers in the affected conjunctival lamina propria and episclera. Hyperreflective pigment granules in different shapes were demonstrated in the substantia propria beneath the basement membrane. AS-OCT of Case 1 demonstrated hyporeflective areas. Fundus examination was within normal limits in both patients, except tilted optic discs with peripapillary atrophy in one of the patients. Corneal topography, thickness, and macular OCT were normal bilaterally in both cases. Conclusion. The degenerative and anatomic changes due to ochronotic pigment deposition in alkaptonuria can be demonstrated in detail with IVCM and AS-OCT. Confocal microscopic analysis in ocular ochronosis may serve as a useful adjunct in diagnosis and monitoring of the disease progression.

Morphometric Study of the Anterior Thalamoperforating Arteries

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Kim, Sung-Ho; Yeo, Dong-Kyu; Shim, Jae-Joon; Yoon, Seok-Mann; Chang, Jae-Chil

2015-01-01

Objective To evaluate the morphometry of the anterior thalamoperforating arteries (ATPA). Methods A microanatomical study was performed in 79 specimens from 42 formalin-fixed adult cadaver brains. The origins of the ATPAs were divided into anterior, middle, and posterior segments according to the crowding pattern. The morphometry of the ATPAs, including the premammillary artery (PMA), were examined under a surgical microscope. Results The anterior and middle segments of the ATPAs arose at mean intervals of 1.75±1.62 mm and 5.86±2.05 mm from the internal carotid artery (ICA), and the interval between these segments was a mean of 3.17±1.64 mm. The posterior segment arose at a mean interval of 2.43±1.46 mm from the posterior cerebral artery (PCA), and the interval between the middle and posterior segments was a mean of 3.45±1.39 mm. The mean numbers of perforators were 2.66±1.19, 3.03±1.84, and 1.67±0.98 in the anterior, middle, and posterior segments, respectively. The PMA originated from the middle segment in 66% of cases. A perforator-free zone was located >2 mm from the ICA in 30.4% and >2 mm from the PCA in 67.1% of cases. Conclusion Most perforators arose from the anterior and middle segments, within the anterior two-thirds of the posterior communicating artery (PCoA). The safest perforator-free zone was located closest to the PCA. These anatomical findings may be helpful to verify safety when treating lesions around the PCoA and in the interpeduncular fossa. PMID:26113962

Anterior subcutaneous transposition of the ulnar nerve improves neurological function in patients with cubital tunnel syndrome

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Wei Huang

2015-01-01

Full Text Available Although several surgical procedures exist for treating cubital tunnel syndrome, the best surgical option remains controversial. To evaluate the efficacy of anterior subcutaneous transposition of the ulnar nerve in patients with moderate to severe cubital tunnel syndrome and to analyze prognostic factors, we retrospectively reviewed 62 patients (65 elbows diagnosed with cubital tunnel syndrome who underwent anterior subcutaneous transposition. Preoperatively, the initial severity of the disease was evaluated using the McGowan scale as modified by Goldberg: 18 patients (28% had grade IIA neuropathy, 20 (31% had grade IIB, and 27 (42% had grade III. Postoperatively, according to the Wilson & Krout criteria, treatment outcomes were excellent in 38 patients (58%, good in 16 (25%, fair in 7 (11%, and poor in 4 (6%, with an excellent and good rate of 83%. A negative correlation was found between the preoperative McGowan grade and the postoperative Wilson & Krout score. The patients having fair and poor treatment outcomes had more advanced age, lower nerve conduction velocity, and lower action potential amplitude compared with those having excellent and good treatment outcomes. These results suggest that anterior subcutaneous transposition of the ulnar nerve is effective and safe for the treatment of moderate to severe cubital tunnel syndrome, and initial severity, advancing age, and electrophysiological parameters can affect treatment outcome.

Changes in intraocular pressure and anterior segment morphometry after uneventful phacoemulsification cataract surgery.

LENUS (Irish Health Repository)

Dooley, I

2012-02-01

PURPOSE: To study changes in anterior segment morphometry after uneventful phacoemulsification cataract surgery, and to investigate whether there is a relationship between any observed changes and intraocular pressure (IOP) reduction after the procedure. METHODS: The anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA), central corneal thickness (CCT), and IOP were measured in 101 non-glaucomatous eyes before and after uneventful phacoemulsification cataract surgery. RESULTS: After cataract surgery, the mean ACD, ACV, and ACA values increased by 1.08 mm, 54.4 mm(3), and 13.1 degrees , respectively, and the mean IOP (corrected for CCT) decreased by 3.2 mm Hg. The predictive value of a previously described index (preoperative ACD\\/preoperative IOP (corrected for CCT) or CPD ratio) for IOP (corrected for CCT) reduction after cataract surgery was confirmed, reflected in an r(2) value of 23.3% between these two parameters (P<0.001). Other indices predictive of IOP reduction after cataract surgery were also identified, including preoperative IOP\\/preoperative ACV and preoperative IOP\\/preoperative ACA, reflected in r(2) values of 13.7 and 13.7%, respectively (P<0.001 and P<0.001, respectively). CONCLUSIONS: Our study confirms the predictive value of the CPD ratio for IOP reduction after cataract surgery, and may contribute to the decision-making process in patients with glaucoma or ocular hypertension. Furthermore, two novel indices of preoperative parameters that are predictive for IOP reduction after cataract surgery were identified, and enhance our understanding of the mechanisms underlying IOP changes after this procedure.

Segmental stiff skin syndrome (SSS): A distinct clinical entity.

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Myers, Kathryn L; Mir, Adnan; Schaffer, Julie V; Meehan, Shane A; Orlow, Seth J; Brinster, Nooshin K

2016-07-01

Stiff skin syndrome (SSS) is a noninflammatory, fibrosing condition of the skin, often affecting the limb girdles. We present 4 new patients with SSS with largely unilateral, segmental distribution. To date, reported cases of SSS have been grouped based on generally accepted clinical and histopathologic findings. The purpose of this study was to analyze differences in clinical and histopathologic findings between previously reported SSS cases. This is a retrospective review of 4 new cases and 48 previously published cases of SSS obtained from PubMed search. Of 52 total cases, 18 (35%) were segmentally distributed and 34 (65%) were widespread. The average age of onset was 4.1 years versus 1.6 years for segmental versus widespread SSS, respectively. Limitation in joint mobility affected 44% of patients with segmental SSS and 97% of patients with widespread SSS. Histopathologic findings were common between the 2 groups. This was a retrospective study of previously published cases limited by the completeness and accuracy of the reviewed cases. We propose a distinct clinical entity, segmental SSS, characterized by a segmental distribution, later age of onset, and less severe functional limitation. Both segmental SSS and widespread SSS share common diagnostic histopathologic features. Copyright © 2016 American Academy of Dermatology, Inc. All rights reserved.

Optimal timing of coronary invasive strategy in non-ST-segment elevation acute coronary syndromes

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Navarese, Eliano P; Gurbel, Paul A; Andreotti, Felicita

2013-01-01

The optimal timing of coronary intervention in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) is a matter of debate. Conflicting results among published studies partly relate to different risk profiles of the studied populations.......The optimal timing of coronary intervention in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) is a matter of debate. Conflicting results among published studies partly relate to different risk profiles of the studied populations....

Fourier Domain Optical Coherence Tomography integrated into a slit lamp; a novel technique combining anterior and posterior segment OCT

NARCIS (Netherlands)

Stehouwer, M.; Verbraak, F. D.; de Vries, H.; Kok, P. H. B.; van Leeuwen, T. G.

2010-01-01

Purpose Fourier Domain Optical Coherence Tomography (FD-OCT) provides high resolution cross-sectional images of the retina and the anterior segment. It has become an important tool in ophthalmology in the examination, diagnosis, and treatment of important and common diseases. Present OCT imaging

Quantitative Fourier Domain Optical Coherence Tomography Imaging of the Ocular Anterior Segment

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McNabb, Ryan Palmer

Clinical imaging within ophthalmology has had transformative effects on ocular health over the last century. Imaging has guided clinicians in their pharmaceutical and surgical treatments of macular degeneration, glaucoma, cataracts and numerous other pathologies. Many of the imaging techniques currently used are photography based and are limited to imaging the surface of ocular structures. This limitation forces clinicians to make assumptions about the underlying tissue which may reduce the efficacy of their diagnoses. Optical coherence tomography (OCT) is a non-invasive, non-ionizing imaging modality that has been widely adopted within the field of ophthalmology in the last 15 years. As an optical imaging technique, OCT utilizes low-coherence interferometry to produce micron-scale three-dimensional datasets of a tissue's structure. Much of the human body consists of tissues that significantly scatter and attenuate optical signals limiting the imaging depth of OCT in those tissues to only 1-2mm. However, the ocular anterior segment is unique among human tissue in that it is primarily transparent or translucent. This allows for relatively deep imaging of tissue structure with OCT and is no longer limited by the optical scattering properties of the tissue. This goal of this work is to develop methods utilizing OCT that offer the potential to reduce the assumptions made by clinicians in their evaluations of their patients' ocular anterior segments. We achieved this by first developing a method to reduce the effects of patient motion during OCT volume acquisitions allowing for accurate, three dimensional measurements of corneal shape. Having accurate corneal shape measurements then allowed us to determine corneal spherical and astigmatic refractive contribution in a given individual. This was then validated in a clinical study that showed OCT better measured refractive change due to surgery than other clinical devices. Additionally, a method was developed to combine

Transforaminal lumbar interbody graft placement using an articulating delivery arm facilitates increased segmental lordosis with superior anterior and midline graft placement.

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Shau, David N; Parker, Scott L; Mendenhall, Stephen K; Zuckerman, Scott L; Godil, Saniya S; Devin, Clinton J; McGirt, Matthew J

2015-05-01

Transforaminal lumbar interbody fusion (TLIF) is a frequently performed method of lumbar arthrodesis in patients failing medical management of back and leg pain. Accurate placement of the interbody graft and restoration of lordosis has been shown to be crucial when performing lumbar fusion procedures. We performed a single-surgeon, prospective, randomized study to determine whether a novel articulating versus traditional straight graft delivery arm system allows for superior graft placement and increased lordosis for single-level TLIF. Thirty consecutive patients undergoing single-level TLIF were included and prospectively randomized to one of the 2 groups (articulated vs. straight delivery arm system). Three radiographic characteristics were evaluated at 6-week follow-up: (1) degree of segmental lumbar lordosis at the fused level; (2) the percent anterior location of the interbody graft in disk space; and (3) the distance (mm) off midline of the interbody graft placement. Randomization yielded 16 patients in the articulated delivery arm cohort and 14 in the straight delivery arm cohort. The articulating delivery arm system yielded an average of 14.7-degree segmental lordosis at fused level, 35% anterior location, and 3.6 mm off midline. The straight delivery arm system yielded an average of 10.7-degree segmental lordosis at fused level, 46% anterior location, and 7.0 mm off midline. All 3 comparisons were statistically significant (Plordosis compared with a traditional straight delivery arm system.

Anterior segment and retinal OCT imaging with simplified sample arm using focus tunable lens technology (Conference Presentation)

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Grulkowski, Ireneusz; Karnowski, Karol; Ruminski, Daniel; Wojtkowski, Maciej

2016-03-01

Availability of the long-depth-range OCT systems enables comprehensive structural imaging of the eye and extraction of biometric parameters characterizing the entire eye. Several approaches have been developed to perform OCT imaging with extended depth ranges. In particular, current SS-OCT technology seems to be suited to visualize both anterior and posterior eye in a single measurement. The aim of this study is to demonstrate integrated anterior segment and retinal SS-OCT imaging using a single instrument, in which the sample arm is equipped with the electrically tunable lens (ETL). ETL is composed of the optical liquid confined in the space by an elastic polymer membrane. The shape of the membrane, electrically controlled by a specific ring, defines the radius of curvature of the lens surface, thus it regulates the power of the lens. ETL can be also equipped with additional offset lens to adjust the tuning range of the optical power. We characterize the operation of the tunable lens using wavefront sensing. We develop the optimized optical set-up with two adaptive operational states of the ETL in order to focus the light either on the retina or on the anterior segment of the eye. We test the performance of the set-up by utilizing whole eye phantom as the object. Finally, we perform human eye in vivo imaging using the SS-OCT instrument with versatile imaging functionality that accounts for the optics of the eye and enables dynamic control of the optical beam focus.

MR-imaging of anterior tibiotalar impingement syndrome: Agreement, sensitivity and specificity of MR-imaging and indirect MR-arthrography

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Haller, Joerg [Department of Radiology, Hanusch Hospital, Heinrich Collin-Strasse 30, A-1140 Vienna (Austria); Ludwig Boltzmann Institute for Osteology, Hanusch Hospital, Heinrich Collin-Strasse 30, A-1140 Vienna (Austria); Bernt, Reinhard [Department of Radiology, Hanusch Hospital, Heinrich Collin-Strasse 30, A-1140 Vienna (Austria)]. E-mail: reinhard.bernt@wgkk.sozvers.at; Seeger, Thomas [Department of Trauma Surgery, Hanusch Hospital, Heinrich Collin-Strasse 30, A-1140 Vienna (Austria); Weissenbaeck, Alexander [Department of Trauma Surgery, Hanusch Hospital, Heinrich Collin-Strasse 30, A-1140 Vienna (Austria); Tuechler, Heinrich [Ludwig Boltzmann Institute for Hematology, Hanusch Hospital, Heinrich Collin-Strasse 30, A-1140 Vienna (Austria); Resnick, Donald [Department of Radiology, VA Medical Center, UCSD, 3350 La Jolla Village Dr, San Diego, CA 92161 (United States)

2006-06-15

Objective: To clarify the role of MR-imaging in the diagnosis of anterior ankle impingement syndromes. Materials and methods: We prospectively examined 51 consecutive patients with chronic ankle pain by MR-imaging. Arthroscopy was performed in 29 patients who previously underwent non-enhanced MR-imaging; in 11 patients, indirect MR-arthrography additionally was performed. MR-examinations were correlated with clinical findings; MR and arthroscopy scores were statistically compared, agreement was measured. Results: Arthroscopy demonstrated granulation tissue in the lateral gutter (38%) and anterior recess (31%), lesions of the anterior tibiofibular (31%) and the anterior talofibular ligament (21%) as well as intraarticular bodies (10%). Stenosing tenosynovitis and a ganglionic cyst were revealed as extraarticular causes for chronic ankle pain by MR-examination (17%). Agreement of MR-imaging and arthroscopy was fair for the anterior talofibular ligament and the anterior joint cavity (kappa 0.40). Major discrepancy was found for non-enhanced MR scans (kappa 0.49) when compared with indirect MR-arthrography (kappa 0.03) in the anterior cavity. The sensitivity for lesions of the anterior talofibular and calcaneofibular ligament and the anterior cavity (0.91-0.87) detected by MR-imaging was superior in comparison to lesions of the anterior tibiofibular ligament and anteromedial cavity (0.50-0.24). Conclusion: MR-imaging provides additional information about the mechanics of chronic ankle impingement rather than an accurate diagnosis of this clinical entity. The method is helpful in differentiating extra- from intra-articular causes of ankle impingement. Indirect MR-arthrography has little or no additional value in patients with ankle impingement syndrome.

MR-imaging of anterior tibiotalar impingement syndrome: Agreement, sensitivity and specificity of MR-imaging and indirect MR-arthrography

International Nuclear Information System (INIS)

Haller, Joerg; Bernt, Reinhard; Seeger, Thomas; Weissenbaeck, Alexander; Tuechler, Heinrich; Resnick, Donald

2006-01-01

Objective: To clarify the role of MR-imaging in the diagnosis of anterior ankle impingement syndromes. Materials and methods: We prospectively examined 51 consecutive patients with chronic ankle pain by MR-imaging. Arthroscopy was performed in 29 patients who previously underwent non-enhanced MR-imaging; in 11 patients, indirect MR-arthrography additionally was performed. MR-examinations were correlated with clinical findings; MR and arthroscopy scores were statistically compared, agreement was measured. Results: Arthroscopy demonstrated granulation tissue in the lateral gutter (38%) and anterior recess (31%), lesions of the anterior tibiofibular (31%) and the anterior talofibular ligament (21%) as well as intraarticular bodies (10%). Stenosing tenosynovitis and a ganglionic cyst were revealed as extraarticular causes for chronic ankle pain by MR-examination (17%). Agreement of MR-imaging and arthroscopy was fair for the anterior talofibular ligament and the anterior joint cavity (kappa 0.40). Major discrepancy was found for non-enhanced MR scans (kappa 0.49) when compared with indirect MR-arthrography (kappa 0.03) in the anterior cavity. The sensitivity for lesions of the anterior talofibular and calcaneofibular ligament and the anterior cavity (0.91-0.87) detected by MR-imaging was superior in comparison to lesions of the anterior tibiofibular ligament and anteromedial cavity (0.50-0.24). Conclusion: MR-imaging provides additional information about the mechanics of chronic ankle impingement rather than an accurate diagnosis of this clinical entity. The method is helpful in differentiating extra- from intra-articular causes of ankle impingement. Indirect MR-arthrography has little or no additional value in patients with ankle impingement syndrome

Recognizing Wellens’ syndrome, a warning sign of critical proximal LAD artery stenosis and impending anterior myocardial infarction

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Laura Hollar

2015-10-01

Full Text Available Wellens’ syndrome, also known as LAD coronary T-wave syndrome or the ‘widow maker’, is a pre-infarction syndrome with non-classical ischemic ECG changes and unremarkable cardiac biomarkers. This syndrome continues to be a ‘can't miss’ for the clinician as delay in urgent angiography and intervention can result in anterior myocardial infarction, left ventricular dysfunction, arrhythmias, and death. We describe a case followed by a discussion of identification criteria and clinical implications.

Atypical presentation of popliteal artery entrapment syndrome: involvement of the anterior tibial artery.

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Bou, Steven; Day, Carly

2014-11-01

Popliteal artery entrapment syndrome (PAES) is a rare condition that should be suspected in a young patient with exertional lower extremity pain. We report the case of an 18-year-old female volleyball player with bilateral exertional lower extremity pain who had been previously diagnosed with tendinitis and periostitis. Diagnostic studies showed entrapment of the left popliteal artery and the left anterior tibial artery. To our knowledge, there has only been 1 previous report of anterior tibial artery involvement in PAES. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

The change of adjacent segment after cervical disc arthroplasty compared with anterior cervical discectomy and fusion: a meta-analysis of randomized controlled trials.

Science.gov (United States)

Dong, Liang; Xu, Zhengwei; Chen, Xiujin; Wang, Dongqi; Li, Dichen; Liu, Tuanjing; Hao, Dingjun

2017-10-01

Many meta-analyses have been performed to study the efficacy of cervical disc arthroplasty (CDA) compared with anterior cervical discectomy and fusion (ACDF); however, there are few data referring to adjacent segment within these meta-analyses, or investigators are unable to arrive at the same conclusion in the few meta-analyses about adjacent segment. With the increased concerns surrounding adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis) after anterior cervical surgery, it is necessary to perform a comprehensive meta-analysis to analyze adjacent segment parameters. To perform a comprehensive meta-analysis to elaborate adjacent segment motion, degeneration, disease, and reoperation of CDA compared with ACDF. Meta-analysis of randomized controlled trials (RCTs). PubMed, Embase, and Cochrane Library were searched for RCTs comparing CDA and ACDF before May 2016. The analysis parameters included follow-up time, operative segments, adjacent segment motion, ASDeg, ASDis, and adjacent segment reoperation. The risk of bias scale was used to assess the papers. Subgroup analysis and sensitivity analysis were used to analyze the reason for high heterogeneity. Twenty-nine RCTs fulfilled the inclusion criteria. Compared with ACDF, the rate of adjacent segment reoperation in the CDA group was significantly lower (panalysis. There was no statistically significant difference in ASDeg between CDA and ACDF within the 24-month follow-up period; however, the rate of ASDeg in CDA was significantly lower than that of ACDF with the increase in follow-up time (p.05). Cervical disc arthroplasty provided a lower adjacent segment range of motion (ROM) than did ACDF, but the difference was not statistically significant. Compared with ACDF, the advantages of CDA were lower ASDeg and adjacent segment reoperation. However, there was no statistically significant difference in ASDis and adjacent segment ROM. Copyright © 2017 Elsevier Inc. All rights reserved.

Noonan syndrome: crossed fused ectopic kidneys and focal segmental glomerulosclerosis-a rare association.

Science.gov (United States)

Gupta, Ankur; Khaira, Ambar; Lal, Charanjit; Mahajan, Sandeep; Tiwari, Suresh C

2009-10-01

Noonan syndrome is characterised by short stature, typical facial dysmorphology and congenital heart defects. Urogenital abnormalities are reported in 10% of the cases. We present a 14-year-old girl with characteristic features of Noonan syndrome and nephrotic-range proteinuria. She had crossed fused ectopic kidneys. Renal biopsy showed focal segmental glomerulosclerosis. Oral steroids were instituted and she responded well. The case highlights this novel renal presentation of Noonan syndrome.

Tooth-borne distraction of the lower anterior subapical segment for correction of class II malocclusion, subsequent to genioplasty.

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Matsushita, Kazuhiro; Inoue, Nobuo; Yamaguchi, Hiro-o; Ooi, Kazuhiro; Totsuka, Yasunori

2011-09-01

Alveolar distraction is mainly used to increase height and width of the alveolar crest. This technique, however, is not typically used for lengthening the perimeter of the dental arch or improving teeth axes. We applied alveolar distraction in a tooth-borne manner in the second stage of our original method and obtained favorable results. We therefore present an outline of this method. Genioplasty was first performed to create an infrastructure for sequential advancement of the subapical alveolar segment. After bone union, anterior subapical alveolar osteotomy was performed. The stump of the osteotomized dentate segment was moved forward without changing the incisal edge position, and a box-type bioabsorbable plate with four holes was fixed only onto the dentate segment using two screws. After a latency period, two distraction devices were placed bilaterally to the brackets and activated at 1.0 mm/day. After reaching the desired position, the distractor was immobilized, and then replaced by resin temporary teeth to retain the created space. After the consolidation period, orthodontic treatment was restarted and teeth moved into the newly created space. Bimaxillary surgery was performed after completing pre-surgical orthodontic treatment. Finally, both desirable occlusion and functional masticatory function were obtained. This tooth-borne distraction system is one applicable method for patients with skeletal class II and crowding of lower anterior teeth, achieving good results particularly in combination with our original method.

Anterior Cutaneous Nerve Entrapment Syndrome in a Pediatric Patient Previously Diagnosed With Functional Abdominal Pain: A Case Report.

Science.gov (United States)

DiGiusto, Matthew; Suleman, M-Irfan

2018-03-23

Chronic abdominal pain is common in children and adolescents but challenging to diagnose, because practitioners may be concerned about missing serious occult disease. Abdominal wall pain is an often ignored etiology for chronic abdominal pain. Anterior cutaneous nerve entrapment syndrome causes abdominal wall pain but is frequently overlooked. Correctly diagnosing patients with anterior cutaneous nerve entrapment syndrome is important because nerve block interventions are highly successful in the remittance of pain. Here, we present the case of a pediatric patient who received a diagnosis of functional abdominal pain but experienced pain remittance after receiving a trigger-point injection and transverse abdominis plane block.

Detection of primary angle closure using anterior segment optical coherence tomography in Asian eyes.

Science.gov (United States)

Nolan, Winifred P; See, Jovina L; Chew, Paul T K; Friedman, David S; Smith, Scott D; Radhakrishnan, Sunita; Zheng, Ce; Foster, Paul J; Aung, Tin

2007-01-01

To evaluate noncontact anterior segment optical coherence technology (AS-OCT) as a qualitative method of imaging the anterior chamber angle and to determine its ability to detect primary angle closure when compared with gonioscopy in Asian subjects. Prospective observational case series. Two hundred three subjects were recruited from glaucoma clinics in Singapore with diagnoses of primary angle closure, primary open-angle glaucoma, ocular hypertension, or cataract. Both eyes (if eligible) of each patient were included in the study. Exclusion criteria were pseudophakia or previous glaucoma surgery. Images of the nasal, temporal, and inferior angles were obtained with AS-OCT in dark and then light conditions. Gonioscopic angle width was graded using the Spaeth classification for each quadrant in low lighting conditions. Angle closure was defined by AS-OCT as contact between the peripheral iris and angle wall anterior to the scleral spur and by gonioscopy as a Spaeth grade of 0 degree (posterior trabecular meshwork not visible). Comparison of the 2 methods in detecting angle closure was done by eye and by individual. Sensitivities and specificities of AS-OCT were calculated using gonioscopy as the reference standard. Complete data were available for 342 eyes of 200 patients. Of the patients, 70.9% had a clinical diagnosis of treated or untreated primary angle closure. Angle closure in > or =1 quadrants was detected by AS-OCT in 142 (71%) patients (228 [66.7%] eyes) and by gonioscopy in 99 (49.5%) patients (152 [44.4%] eyes). The inferior angle was closed more frequently than the nasal or temporal quadrants using both AS-OCT and gonioscopy. When performed under dark conditions, AS-OCT identified 98% of those subjects found to have angle closure on gonioscopy (95% confidence interval [CI], 92.2-99.6) and led to the characterization of 44.6% of those found to have open angles on gonioscopy to have angle closure as well. With gonioscopy as the reference standard

Comparison of high-resolution Scheimpflug and high-frequency ultrasound biomicroscopy to anterior-segment OCT corneal thickness measurements

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Kanellopoulos AJ

2013-11-01

Full Text Available Anastasios John Kanellopoulos,1,2 George Asimellis1 1Laservision.gr Eye Institute, Athens, Greece; 2New York University Medical School, New York, NY, USA Background: The purpose of this study was to compare and correlate central corneal thickness in healthy, nonoperated eyes with three advanced anterior-segment imaging systems: a high-resolution Scheimpflug tomography camera (Oculyzer II, a spectral-domain anterior-segment optical coherence tomography (AS-OCT system, and a high-frequency ultrasound biomicroscopy (HF-UBM system. Methods: Fifty eyes randomly selected from 50 patients were included in the study. Inclusion criteria were healthy, nonoperated eyes examined consecutively by the same examiner. Corneal imaging was performed by three different methods, ie, Oculyzer II, spectral-domain AS-OCT, and FH-UBM. Central corneal thickness measurements were compared using scatter diagrams, Bland-Altman plots (with bias and 95% confidence intervals, and two-paired analysis. Results: The coefficient of determination (r2 between the Oculyzer II and AS-OCT measurements was 0.895. Likewise, the coefficient was 0.893 between the Oculyzer II and HF-UBM and 0.830 between the AS-OCT and HF-UBM. The trend line coefficients of linearity were 0.925 between the Oculyzer II and the AS-OCT, 1.006 between the Oculyzer II and HF-UBM, and 0.841 between the AS-OCT and HF-UBM. The differences in average corneal thickness between the three pairs of CCT measurements were –6.86 µm between the Oculyzer II and HF-UBM, –12.20 µm between the AS-OCT and Oculyzer II, and +19.06 µm between the HF-UBM and AS-OCT. Conclusion: The three methods used for corneal thickness measurement are highly correlated. Compared with the Scheimplug and ultrasound devices, the AS-OCT appears to report a more accurate, but overally thinner corneal pachymetry. Keywords: anterior eye segment, high-frequency ultrasound biomicroscopy, optical coherence tomography, high-resolution Pentacam

The effect of pharmacologic pupillary dilatation on anterior segment parameters in patients with exfoliation syndrome

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Mehmet Cem Mocan

2014-01-01

Conclusion: Pupillary dilatation with a single drop of 1.0% cyclopentolate, 2.5% phenylephrine or 1% tropicamide is not associated with shallowing of the anterior chamber or narrowing of the ACA in patients with XFS who present with open angles.

Anterior uveitis and congenital fibrosis of the extraocular muscles in a patient with Noonan syndrome

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Elgohary Mostafa

2005-01-01

Full Text Available We describe a patient with Noonan syndrome who presented with Human Leukocyte Antigen B27-associated recurrent acute anterior uveitis and manifestations of congenital fibrosis of the extraocular muscles, which has not been reported before.

Genetics and aging; the Werner syndrome as a segmental progeroid syndrome.

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Martin, G M

1985-01-01

The maximum lifespan potential is a constitutional feature of speciation and must be subject to polygenic controls acting both in the domain of development and in the domain of the maintenance of macromolecular integrity. The enormous genetic heterogeneity that characterizes our own species, the complexities of numerous nature-nurture interactions, and the quantitative and qualitative variations of the senescent phenotype that are observed suggest that precise patterns of aging in each of us may be unique. Patterns of aging may also differ sharply among species (for example, semelparous vs. multiparous mammals). Some potential common denominators, however, allow one to identify progeroid syndromes in man that could lead to the elucidation of important pathways of gene action. (The suffix "-oid" means "like"; it does not mean identity.) Unimodal progeroid syndromes (eg., familial dementia of the Alzheimer type, an autosomal dominant) can help us understand the pathogenesis of a particular aspect of the senescent phenotype of man. Segmental progeroid syndromes (eg. the Werner syndrome, an autosomal recessive) may be relevant to multiple aspects of the senescent phenotype. Some results of research on the Werner syndrome may be interpreted as support for "peripheral" as opposed to "central" theories of aging; they are consistent with the view that gene action in the domain of development (adolescence, in this instance) can set the stage for patterns of aging in the adult; they point to the importance of mesenchymal cell populations in the pathogenesis of age-related disorders; finally, they underscore the role of chromosomal instability, especially in the pathogenesis of neoplasia.

Percutaneous Stent Implantation for Treating Multivessel Coronary Disease in Patients with and without Involvement of the Proximal Segment of the Anterior Descending Coronary Artery

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Salgueiro Sandro

2002-01-01

Full Text Available OBJECTIVE: To assess coronary stent placement in patients with multivessel coronary disease and involvement of the proximal portion of the anterior descending coronary artery. METHODS: We retrospectively analyzed the in-hospital and late evolution of 189 patients with multivessel coronary disease, who underwent percutaneous coronary stent placement. These patients were divided into 2 groups as follows: group I (GI - 59 patients with involvement of the proximal segment of the anterior descending coronary artery; and group II (GII - 130 patients without involvement of the proximal segment of the anterior descending coronary artery. RESULTS: No significant difference was observed in the success rate of the procedure (91.5% versus 97.6%, p=0.86, nor in the occurrence of major adverse cardiac events (5.1% versus 1.5%, p=0.38, nor in the occurrence of major vascular complications (1.7% versus 0%, p=0.69 in the in-hospital phase. In the late follow-up, the incidence of major adverse cardiac events (15.4% versus 13.7%, p=0.73 and the need for new revascularization (13.5% versus 10.3%, p=0.71 were similar for both groups. CONCLUSION: The in-hospital and late evolution of patients with multivessel coronary disease with and without involvement of the proximal segment of the anterior descending coronary artery treated with coronary stent placement did not differ. This suggests that this revascularization method is an effective procedure and a valuable option for treating these types of patients.

Novel occurrence of axenfeld: Rieger syndrome in a patient with blepharophimosis ptosis epicanthus inversus syndrome

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Bhavin M Shah

2014-01-01

Full Text Available Blepharophimosis ptosis epicanthus inversus syndrome (BPES is a complex eyelid malformation characterized by the classical tetrad of blepharophimosis, telecanthus, ptosis, and epicanthus inversus. It has been reported to be associated with other ocular anomalies such as euryblepharon, strabismus, nystagmus, amblyopia, microphthalmos, lacrimal drainage apparatus abnormality, extra ocular muscle abnormalities, microcornea, trabecular dysgenesis, optic nerve hypoplasias, and colobomas of the optic disk. We describe a case of BPES with Axenfeld-Rieger syndrome, a neurocristopathy characterized by maldevelopment of the anterior segment with predisposition to development of glaucoma. Interestingly, both syndromes are caused by mutations in the same class of genes, namely the winged-helix/forked transcription factors (FOX involved in a variety of developmental processes.

The concave iris in pigment dispersion syndrome.

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Liu, Lance; Ong, Ee Lin; Crowston, Jonathan

2011-01-01

To visualize the changes of the iris contour in patients with pigment dispersion syndrome after blinking, accommodation, and pharmacologic miosis using anterior segment optical coherence tomography. Observational case series. A total of 33 eyes of 20 patients with pigment dispersion syndrome. Each eye was imaged along the horizontal 0- to 180-degree meridian using the Visante Anterior Segment Imaging System (Carl Zeiss Meditec, Dublin, CA). Scans were performed at baseline and after focusing on an internal fixation target for 5 minutes, forced blinking, accommodation, and pharmacologic miosis with pilocarpine 2%. Quantitative analysis of the changes in the iris configuration. After 5 minutes of continual fixation, the iris became planar with the mean ± standard deviation curvature decreasing from 214 ± 74 μm to 67 ± 76 μm (P pigment dispersion syndrome after forced blinking, but the iris concavity recovered to 227 ± 113 μm (P = 0.34) and 238 ± 119 μm (P = 0.19) with the -3.0 and -6.0 diopter lenses, respectively. Pilocarpine-induced miosis caused the iris to assume a planar configuration in all subjects. This study shows that the iris in pigment dispersion syndrome assumes a planar configuration when fixating and that the concavity of the iris surface is not restored by blinking. Accommodation restored the iris concavity, suggesting that the posterior curvature of the iris in pigment dispersion syndrome is induced and probably maintained, at least in part, by accommodation. Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Adjacent segment pathology following anterior decompression and fusion using cage and plate for the treatment of degenerative cervical spinal diseases.

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Song, Kyung-Jin; Choi, Byung-Wan; Kim, Jong-Kil

2014-12-01

Retrospective study. To analyze the incidence and prevalence of clinical adjacent segment pathology (CASP) following anterior decompression and fusion with cage and plate augmentation for degenerative cervical diseases. No long-term data on the use of cage and plate augmentation have been reported. The study population consisted of 231 patients who underwent anterior cervical discectomy and fusion (ACDF) with cage and plate for degenerative cervical spinal disease. The incidence and prevalence of CASP was determined by using the Kaplan-Meier survival analysis. To analyze the factors that influence CASP, data on preoperative and postoperative sagittal alignment, spinal canal diameter, the distance between the plate and adjacent disc, extent of fusion level, and the presence or absence of adjacent segment degenerative changes by imaging studies were evaluated. CASP occurred in 15 of the cases, of which 9 required additional surgery. At 8-year follow-up, the average yearly incidence was 1.1%. The rate of disease-free survival based on Kaplan-Meier survival analysis was 93.6% at 5 years and 90.2% at 8 years. No statistically significant differences in CASP incidence based on radiological analysis were observed. Significantly high incidence of CASP was observed in the presence of increased adjacent segment degenerative changes (pdegenerative cervical disease is associated with a lower incidence in CSAP by 1.1% per year, and the extent of preoperative adjacent segment degenerative changes has been shown as a risk factor for CASP.

Unilateral congenital corneal keloid with anterior segment mesenchymal dysgenesis and subluxated lens: case report and review of literature.

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Vanathi, M; Sen, Seema; Panda, Anita; Dada, Tanuj; Behera, Geeta; Khokhar, Sudharshan

2007-01-01

To report the unusual association of unilateral congenital corneal keloid with anterior-segment mesenchymal dysgenesis and bilateral subluxated lens. A 20-year old man presented with a mass lesion involving the left cornea. The corneal lesion had been present since birth. On biomicroscopic examination, a well-defined vascularized, grayish-white mass occupying the whole of the left cornea was seen. The right eye showed multiple peripheral corneal opacities with iridocorneal adhesions, a poorly defined supranasal limbus, and a subluxated lens. Excision biopsy of the mass was done for histopathologic examination. Histopathologic examination of the excised corneal mass showed features consistent with that of a corneal keloid: thickened keratinized epithelium, absent Bowman membrane layer, and fibrovascular hyperplasia composed of hyalinized collagen fibers with irregular orientation of the collagen lamellae. During penetrating keratoplasty of the left eye, an anomalous iris pattern with poorly defined angle and a supranasal subluxated lens was also observed. Extraction of the subluxated lens was also done. The graft failed subsequent to a nonhealing persistent epithelial defect. Our case report highlights the rare association of a unilateral congenital corneal keloid with anterior-segment mesenchymal dysgenesis and bilateral subluxated lens.

Pigmentary glaucoma accompanied by Usher syndrome.

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Koucheki, Behrooz; Jalali, Kamran Hodjat

2012-08-01

To report a case of pigmentary glaucoma (PG) accompanied by Usher syndrome. Case report. The results were presented after standard ocular examination, visual field test, anterior segment and fundus photography, electroretinography, and otolaryngology consultation were conducted. Typical retinitis pigmentosa, flat electroretinography, congenital sensorineural hearing loss, high intraocular pressure, Krukenberg spindle, iris concavity, radial iris transillumination defect, severe pigment deposition on the trabecular meshwork, and glaucomatous optic nerve damage were indicative of PG accompanied by Usher syndrome. In some rare cases, PG may coexist with Usher syndrome. Common findings of Usher syndrome, including night blindness, impaired vision, visual field defects, and retinal changes may distract the clinician from considering the diagnosis of glaucoma. Such association should be borne in mind to make a timely diagnosis and treatment possible.

[Irritable bowel syndrome, levator ani syndrome, proctalgia fugax and chronic pelvic and perineal pain].

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Watier, Alain; Rigaud, Jérôme; Labat, Jean-Jacques

2010-11-01

To define functional gastrointestinal pain, irritable bowel syndrome (IBS), levator ani syndrome, proctalgia fugax, the pathophysiology of these syndromes and the treatments that can be proposed. Review of articles published on the theme based on a Medline (PubMed) search and consensus conferences selected according to their scientific relevance. IBS is very common. Patients report abdominal pain and/or discomfort, bloating, and abnormal bowel habit (diarrhoea, constipation or both), in the absence of any structural or biochemical abnormalities. IBS has a complex, multifactorial pathophysiology, involving biological and psychosocial interactions resulting in dysregulation of the brain-gut axis associated with disorders of intestinal motility, hyperalgesia, immune disorders and disorders of the intestinal bacterial microflora and autonomic and hormonal dysfunction. Many treatments have been proposed, ranging from diet to pharmacology and psychotherapy. Patients with various types of chronic pelvic and perineal pain, especially those seen in urology departments, very often report associated IBS. This syndrome is also part of a global and integrated concept of pelviperineal dysfunction, avoiding a rigorous distinction between the posterior segment and the midline and anterior segments of the perineum. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Progressive epicardial coronary blood flow reduction fails to produce ST-segment depression at normal heart rates.

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de Chantal, Marilyn; Diodati, Jean G; Nasmith, James B; Amyot, Robert; LeBlanc, A Robert; Schampaert, Erick; Pharand, Chantal

2006-12-01

ST-segment depression is commonly seen in patients with acute coronary syndromes. Most authors have attributed it to transient reductions in coronary blood flow due to nonocclusive thrombus formation on a disrupted atherosclerotic plaque and dynamic focal vasospasm at the site of coronary artery stenosis. However, ST-segment depression was never reproduced in classic animal models of coronary stenosis without the presence of tachycardia. We hypothesized that ST-segment depression occurring during acute coronary syndromes is not entirely explained by changes in epicardial coronary artery resistance and thus evaluated the effect of a slow, progressive epicardial coronary artery occlusion on the ECG and regional myocardial blood flow in anesthetized pigs. Slow, progressive occlusion over 72 min (SD 27) of the left anterior descending coronary artery in 20 anesthetized pigs led to a 90% decrease in coronary blood flow and the development of ST-segment elevation associated with homogeneous and transmural myocardial blood flow reductions, confirmed by microspheres and myocardial contrast echocardiography. ST-segment depression was not observed in any ECG lead before the development of ST-segment elevation. At normal heart rates, progressive epicardial stenosis of a coronary artery results in myocardial ischemia associated with homogeneous, transmural reduction in regional myocardial blood flow and ST-segment elevation, without preceding ST-segment depression. Thus, in coronary syndromes with ST-segment depression and predominant subendocardial ischemia, factors other than mere increases in epicardial coronary resistance must be invoked to explain the heterogeneous parietal distribution of flow and associated ECG changes.

Ceratoconjuntivite alérgica e complicações no segmento ocular anterior de pacientes Evaluation of anterior ocular segment complications in patients with allergic keratoconjunctivitis

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Patrícia Bezerra de Menezes Botelho

2003-01-01

with secondary anterior segment alterations. Data collected from the charts were: age, gender, kind of allergy, time of disease, time that complication appeared after treatment in our Service, side effects and ocular complications. RESULTS: Complications of anterior segment that caused reduction in visual acuity were: shield ulcers, 5 cases; cataract, 3 cases; corneal opacity, 6 cases; ocular perforation, 2 cases and keratoconus 13 cases. There were 7 surgeries: 2 tectonic penetrating keratoplasty, 4 optic keratoplasty, 4 optic penetrating keratoplasty and one superficial keratectomy. CONCLUSION: Patients with allergic keratoconjunctivitis should be treated in order to prevent ocular complications like keratitis, keratoconus, opacities and cataract.

Segmental wall-motion analysis in the right anterior oblique projection: comparison of exercise equilibrium radionuclide ventriculography and exercise contrast ventriculography

International Nuclear Information System (INIS)

Brady, T.J.; Thrall, J.H.; Keyes, J.W. Jr.; Brymer, J.F.; Walton, J.A.; Pitt, B.

1980-01-01

Thirty-nine patients with known or suspected coronary artery disease were studied at rest and during supine bicycle exercise with radionuclide and contrast left ventriculography. Analysis of regional wall motion was made by visual evaluation of the five standard 30 0 right anterior oblique (RAO) wall segments in the contrast images and the corresponding 10 0 RAO radionuclide segments. The radionuclide studies were evaluated independently by three observers using a five-point grading system. The interobserver wall-motion grading agreed completely in more than 80% of segments at rest and exercise, and agreed within one wall-motion grade in more than 95% of segments. The comparison of wall-motion grades between radionuclide and contrast ventriculograms showed complete agreement in 86% of segments at rest and in 78% during exercise, and agreement within one wall-motion grade in 97% of rest and 96% of exercise segments. Visual evaluation of 10 0 RAO rest and exercise radionuclide ventriculograms compares favorably with rest and exercise 30 0 RAO contrast ventriculograms and demonstrates satisfactory interobserver agreement

Pretreatment with prasugrel in non-ST-segment elevation acute coronary syndromes

NARCIS (Netherlands)

Montalescot, G.; Bolognese, L.; Dudek, D.; Goldstein, P.; Hamm, C.; Tanguay, J.F.; Berg, J.M. van den; Miller, D.L.; Costigan, T.M.; Goedicke, J.; Silvain, J.; Angioli, P.; Legutko, J.; Niethammer, M.; Motovska, Z.; Jakubowski, J.A.; Cayla, G.; Visconti, L.O.; Vicaut, E.; Widimsky, P.; Suryapranata, H.; et al.,

2013-01-01

BACKGROUND: Although P2Y12 antagonists are effective in patients with non-ST-segment elevation (NSTE) acute coronary syndromes, the effect of the timing of administration--before or after coronary angiography--is not known. We evaluated the effect of administering the P2Y12 antagonist prasugrel at

Optic atrophy, necrotizing anterior scleritis and keratitis presenting in association with Streptococcal Toxic Shock Syndrome: a case report

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Papageorgiou Konstantinos I

2008-02-01

Full Text Available Abstract Introduction We report a case of optic atrophy, necrotizing anterior scleritis and keratitis presenting in a patient with Streptococcal Toxic Shock Syndrome. Case presentation A 43-year-old woman developed streptococcal toxic shock syndrome secondary to septic arthritis of her right ankle. Streptococcus pyogenes (b-haemolyticus Group A was isolated from blood cultures and joint aspirate. She was referred for ophthalmology review as her right eye became injected and the pupil had become unresponsive to light whilst she was in the Intensive Therapy Unit (ITU. The iris appeared atrophic and was mid-dilated with no direct or consensual response to light. Three zones of sub-epithelial opacification where noted in the cornea. There where extensive posterior synechiae. Indirect ophthalmoscopy showed a pale right disc. The vision was reduced to hand movements (HM. A diagnosis of optic atrophy was made secondary to post-streptococcal uveitis. She subsequently developed a necrotizing anterior scleritis. Conclusion This case illustrates a previously unreported association of optic atrophy, necrotizing anterior scleritis and keratitis in a patient with post-streptococcal uveitis. This patient had developed Streptococcal Toxic Shock Syndrome secondary to septic arthritis. We recommend increased awareness of the potential risks of these patients developing severe ocular involvement.

[Contribution of confocal microscopy and anterior chamber OCT to the study of corneal endothelial pathologies].

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Fayol, N; Labbé, A; Dupont-Monod, S; Dupas, B; Baudouin, C

2007-04-01

To describe the appearance of various endothelial diseases with in vivo confocal microscopy and anterior chamber optical coherence tomography (AC OCT). In this study, ten patients with five different corneal endothelial pathologies were evaluated. Three patients had cornea guttata, three had corneal endothelial precipitates, two had irido-corneo-endothelial (ICE) syndrome, one had endothelial folds, and one had breaks in the Descemet membrane. All patients had bilateral ophthalmologic examinations, in vivo confocal microscopy, and AC OCT analysis. In cases of cornea guttata, AC OCT showed a finely embossed line corresponding to the empty intercellular cavities found with in vivo confocal microscopy. Corneal endothelium precipitates had the aspect of round formations suspended with the endothelium. Iris atrophy and irido-corneal synechiae resulting from ICE syndrome were precisely visualized with the AC OCT. High-resolution images of the anterior segment could be obtained using the AC OCT. Associated with in vivo confocal microscopy, these two new imaging techniques provide a precise evaluation of endothelial pathologies.

Efficacy of highly hydrophilic soft contact lenses for persistent corneal epithelial defects after anterior segment surgery

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Zhi-Wei Peng

2015-02-01

Full Text Available AIM:To investigate the efficacy of highly hydrophilic soft contact lenses for persistent corneal epithelial defects.METHODS:In this retrospective case analysis, 28 patients(28 eyeswith persistent corneal epithelial defects after anterior segment surgery from January 2011 to June 2013 in our hospital were reviewed. After regular treatment for at least 2wk, the persistent corneal epithelial defects were treated with highly hydrophilic soft contact lenses, until the corneal epithelial healing. Continued to wear the same lens no more than 3wk, or in need of replacement the new one. All cases were followed up for 6mo. Key indicators of corneal epithelial healling, corneal fluorescein staining and ocular symptoms improvement were observed.RESULTS: Twenty-one eyes were cured(75.00%, markedly effective in 5 eyes(17.86%, effective in 2 eyes(7.14%, no invalid cases, the total efficiency of 100.00%. Ocular symptoms of 25 cases(89.29%relieved within 2d, the rest 3 cases(10.71%relieved within 1wk. The corneal epithelial of 6 cases(21.43%repaired in 3wk, 13 cases(46.43%in 6wk, 7 cases(25.00%in 9wk, 2 cases(7.14%over 12wk. There were no signs of secondary infection. And no evidence of recurrence in 6mo. CONCLUSION: Highly hydrophilic soft contact lenses could repair persistent corneal epithelial defects after anterior segment surgery significantly, while quickly and effectively relieve a variety of ocular irritation.

Evaluation of the Anterior Segment Angle-to-Angle Scan of Cirrus High-Definition Optical Coherence Tomography and Comparison With Gonioscopy and With the Visante OCT.

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Tun, Tin A; Baskaran, Mani; Tan, Shayne S; Perera, Shamira A; Aung, Tin; Husain, Rahat

2017-01-01

To evaluate the diagnostic performance of the anterior segment angle-to-angle scan of the Cirrus high-definition optical coherence tomography (HD-OCT) in detecting eyes with closed angles. All subjects underwent dark-room gonioscopy by an ophthalmologist. A technician performed anterior segment imaging with Cirrus (n = 202) and Visante OCT (n = 85) under dark-room conditions. All eyes were categorized by two masked graders as per number of closed quadrants. Each quadrant of anterior chamber angle was categorized as a closed angle if posterior trabecular meshwork could not be seen on gonioscopy or if there was any irido-corneal contact anterior to scleral spur in Cirrus and Visante images. An eye was graded as having a closed angle if two or more quadrants were closed. Agreement and area under the curve (AUC) were performed. There were 50 (24.8%) eyes with closed angles. The agreements of closed-angle diagnosis (by eye) between Cirrus HD-OCT and gonioscopy (k = 0.59; 95% confidence interval (CI) 0.45-0.72; AC1 = 0.76) and between Cirrus and Visante OCT (k = 0.65; 95% CI 0.48-0.82, AC1 = 0.77) were moderate. The AUC for diagnosing the eye with gonioscopic closed angle by Cirrus HD-OCT was good (AUC = 0.86; sensitivity = 83.33; specificity = 77.78). The diagnostic performance of Cirrus HD-OCT in detecting the eyes with closed angles was similar to that of Visante (AUC 0.87 vs. 0.9, respectively; P = 0.51). The anterior segment angle-to-angle scans of Cirrus HD-OCT demonstrated similar diagnostic performance as Visante in detecting gonioscopic closed angles. The agreement between Cirrus and gonioscopy for detecting eyes with closed angles was moderate.

Fenestration of the anterior cerebral artery

International Nuclear Information System (INIS)

Ito, J.; Washiyama, K.; Hong Kim, C.; Ibuchi, Y.

1981-01-01

Three cases of angiographically demonstrated fenestration of the anterior cerebral artery are reported. Fenestration occurred at the medial half of the horizontal segment of the anterior cerebral artery in all cases. Its embryology and clinical significance are briefly discussed, and the anatomical and radiological literature on fenestration of the anterior cerebral artery is reviewed. (orig.)

Neuroimaging features of Cornelia de Lange syndrome

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Whitehead, Matthew T. [Department of Radiology, Washington, DC (United States); Nagaraj, Usha D. [Department of Radiology, Washington, DC (United States); Cincinnati Children' s Hospital, Department of Radiology, Cincinnati, OH (United States); Pearl, Phillip L. [Department of Radiology, Washington, DC (United States); Boston Children' s Hospital, Department of Neurology, Boston, MA (United States)

2015-08-15

Cornelia de Lange syndrome is a rare genetic disease characterized by distinctive facial dysmorphia and dwarfism. Multiple organ system involvement is typical. Various central nervous system (CNS) aberrations have been described in the pathology literature; however, the spectrum of neuroimaging manifestations is less well documented. To present neuroimaging findings from a series of eight patients with Cornelia de Lange syndrome. The CT/MR database at a single academic children's hospital was searched for the terms ''Cornelia'', ''Brachmann'' and ''de Lange.'' The search yielded 18 exams from 16 patients. Two non-CNS and six exams without available images were excluded. Ten exams from eight patients were evaluated by a board-certified neuroradiologist. All patients had skull base dysplasia, most with an unusual coronal basioccipital cleft (7/8). All brain MR exams showed microcephaly, volume loss and gyral simplification (5/5). Six patients had an absent massa intermedia. Four patients had small globe anterior segments; three had optic pathway hypoplasia. Basilar artery fenestration was present in two patients; vertebrobasilar hypoplasia was present in one patient. The inner ear vestibules were dysplastic in two patients. One patient had pachymeningeal thickening. Spinal anomalies included scoliosis, segmentation anomalies, endplate irregularities, basilar invagination, foramen magnum stenosis and tethered spinal cord. Typical imaging manifestations of Cornelia de Lange syndrome include skull base dysplasia with coronal clival cleft, cerebral and brainstem volume loss, and gyral simplification. Membranous labyrinth dysplasia, anterior segment and optic pathway hypoplasia, basilar artery fenestration, absent massa intermedia and spinal anomalies may also be present. (orig.)

Neuroimaging features of Cornelia de Lange syndrome

International Nuclear Information System (INIS)

Whitehead, Matthew T.; Nagaraj, Usha D.; Pearl, Phillip L.

2015-01-01

Cornelia de Lange syndrome is a rare genetic disease characterized by distinctive facial dysmorphia and dwarfism. Multiple organ system involvement is typical. Various central nervous system (CNS) aberrations have been described in the pathology literature; however, the spectrum of neuroimaging manifestations is less well documented. To present neuroimaging findings from a series of eight patients with Cornelia de Lange syndrome. The CT/MR database at a single academic children's hospital was searched for the terms ''Cornelia'', ''Brachmann'' and ''de Lange.'' The search yielded 18 exams from 16 patients. Two non-CNS and six exams without available images were excluded. Ten exams from eight patients were evaluated by a board-certified neuroradiologist. All patients had skull base dysplasia, most with an unusual coronal basioccipital cleft (7/8). All brain MR exams showed microcephaly, volume loss and gyral simplification (5/5). Six patients had an absent massa intermedia. Four patients had small globe anterior segments; three had optic pathway hypoplasia. Basilar artery fenestration was present in two patients; vertebrobasilar hypoplasia was present in one patient. The inner ear vestibules were dysplastic in two patients. One patient had pachymeningeal thickening. Spinal anomalies included scoliosis, segmentation anomalies, endplate irregularities, basilar invagination, foramen magnum stenosis and tethered spinal cord. Typical imaging manifestations of Cornelia de Lange syndrome include skull base dysplasia with coronal clival cleft, cerebral and brainstem volume loss, and gyral simplification. Membranous labyrinth dysplasia, anterior segment and optic pathway hypoplasia, basilar artery fenestration, absent massa intermedia and spinal anomalies may also be present. (orig.)

Early Invasive Versus Selective Strategy for Non-ST-Segment Elevation Acute Coronary Syndrome: The ICTUS Trial

NARCIS (Netherlands)

Hoedemaker, N.P.G.; Damman, P.; Woudstra, P.; Hirsch, A.; Windhausen, F.; Tijssen, J.G.; Winter, R.J. de; Verheugt, F.W.A.; et al.,

2017-01-01

BACKGROUND: The ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes) trial compared early invasive strategy with a selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and an elevated cardiac troponin T. No long-term

Agreement of angle closure assessments between gonioscopy, anterior segment optical coherence tomography and spectral domain optical coherence tomography

OpenAIRE

Tay, Elton Lik Tong; Yong, Vernon Khet Yau; Lim, Boon Ang; Sia, Stelson; Wong, Elizabeth Poh Ying; Yip, Leonard Wei Leon

2015-01-01

AIM: To determine angle closure agreements between gonioscopy and anterior segment optical coherence tomography (AS-OCT), as well as gonioscopy and spectral domain OCT (SD-OCT). A secondary objective was to quantify inter-observer agreements of AS-OCT and SD-OCT assessments. METHODS: Seventeen consecutive subjects (33 eyes) were recruited from the study hospital’s Glaucoma clinic. Gonioscopy was performed by a glaucomatologist masked to OCT results. OCT images were read independently by 2 ...

Relationship between screw sagittal angle and stress on endplate of adjacent segments after anterior cervical corpectomy and fusion with internal fixation: a Chinese finite element study.

Science.gov (United States)

Zhang, Yu; Tang, Yibo; Shen, Hongxing

2017-12-01

In order to reduce the incidence of adjacent segment disease (ASD), the current study was designed to establish Chinese finite element models of normal 3rd~7th cervical vertebrae (C3-C7) and anterior cervical corpectomy and fusion (ACCF) with internal fixation , and analyze the influence of screw sagittal angle (SSA) on stress on endplate of adjacent cervical segments. Mimics 8.1 and Abaqus/CAE 6.10 softwares were adopted to establish finite element models. For C4 superior endplate and C6 inferior endplate, their anterior areas had the maximum stress in anteflexion position, and their posterior areas had the maximum stress in posterior extension position. As SSA increased, the stress reduced. With an increase of 10° in SSA, the stress on anterior areas of C4 superior endplate and C6 inferior endplate reduced by 12.67% and 7.99% in anteflexion position, respectively. With an increase of 10° in SSA, the stress on posterior areas of C4 superior endplate and C6 inferior endplate reduced by 9.68% and 10.22% in posterior extension position, respectively. The current study established Chinese finite element models of normal C3-C7 and ACCF with internal fixation , and demonstrated that as SSA increased, the stress on endplate of adjacent cervical segments decreased. In clinical surgery, increased SSA is able to play important role in protecting the adjacent cervical segments and reducing the incidence of ASD.

Anterior ischemic optic neuropathy in a patient with Churg-Strauss syndrome.

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Lee, Ji Eun; Lee, Seung Uk; Kim, Soo Young; Jang, Tae Won; Lee, Sang Joon

2012-12-01

We describe a patient with Churg-Strauss syndrome who developed unilateral anterior ischemic optic neuropathy. A 54-year-old man with a history of bronchial asthma, allergic rhinitis, and sinusitis presented with sudden decreased visual acuity in his right eye that had begun 2 weeks previously. The visual acuity of his right eye was 20 / 50. Ophthalmoscopic examination revealed a diffusely swollen right optic disc and splinter hemorrhages at its margin. Goldmann perimetry showed central scotomas in the right eye and fluorescein angiography showed remarkable hyperfluorescence of the right optic nerve head. Marked peripheral eosinphilia, extravascular eosinophils in a bronchial biopsy specimen, and an increased sedimentation rate supported the diagnosis of Churg-Strauss syndrome. Therapy with methylprednisolone corrected the laboratory abnormalities, improved clinical features, and preserved vision, except for the right central visual field defect. Early recognition of this systemic disease by ophthalmologists may help in preventing severe ocular complications.

Pigment dispersion syndrome and pigmentary glaucoma: a review and update.

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Scuderi, Gianluca; Contestabile, Maria Teresa; Scuderi, Luca; Librando, Aloisa; Fenicia, Vito; Rahimi, Siavash

2018-05-02

Potential factors influencing stereopsis were investigated in patients with both refractive accommodative esotropia (RAE) and amblyopia. Pigment dispersion syndrome (PDS) is a condition where anomalous iridozonular contact leads to pigment dispersion throughout the anterior segment and the released pigment is abnormally deposited on various ocular structures. The clinical presentation of PDS is defined by the presence of pigmented cells on the corneal endothelium, an increase of pigmentation of the trabecular meshwork, and mid-periphery transillumination defects of the iris. This syndrome, more common in myopes, is usually bilateral and can be associated with ocular hypertension or glaucoma. Secondary open-angle pigmentary glaucoma (PG) can develop due to reduction of the outflow of aqueous humour and consequent increase in intraocular pressure leading to glaucomatous optic neuropathy. Diagnosis of PG is commonly between 40 and 50 years of age, occurring more frequently in men. The advent of ultrasound biomicroscopy and anterior segment optical coherence tomography has contributed to enhancing our knowledge on the condition. Typical alterations of the anterior segment are the posterior insertion of the iris and iris concavity. Treatment of PG should be initiated early to hinder disease progression, glaucomatous damage, and vision loss. Management is based on medical therapy, laser iridotomy, selective laser trabeculoplasty, and filtration procedures. The differential diagnosis of PDS with other disorders can be challenging and awareness of the condition together with meticulous ophthalmologic examination allows early diagnosis followed by appropriate management strategies. The present review is a comprehensive report on the clinical characteristics, pathogenesis, current management, and status quo of PDS and PG.

Early Invasive Versus Selective Strategy for Non-ST-Segment Elevation Acute Coronary Syndrome: The ICTUS Trial

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Hoedemaker, Niels P. G.; Damman, Peter; Woudstra, Pier; Hirsch, Alexander; Windhausen, Fons; Tijssen, Jan G. P.; de Winter, Robbert J.; Peters, R. J. G.; Dunselman, P. H. J. M.; Verheugt, F. W. A.; Janus, C. L.; Umans, V.; Bendermacher, P. E. F.; Michels, H. R.; Sadé e, A.; Hertzberger, D.; de Miliano, P. A. R. M.; Liem, A. H.; Tjon Joe Gin, R.; van der Linde, M.; Lok, D.; Hoedemaker, G.; Pieterse, M.; van den Merkhof, L.; Danië ls, M.; van Hessen, M.; Hermans, W.; Schotborgh, C. E.; de Zwaan, C.; Bredero, A.; de Jaegere, P.; Janssen, M.; Louwerenburg, J.; Veerhoek, M.; Schalij, M.; de Porto, A.; Zijlstra, F.; Winter, J.; de Feyter, P.; Robles de Medina, R.; Withagen, P.; Sedney, M.; Thijssen, H.; van Rees, C.; van den Bergh, P.; de Cock, C.; van 't Hof, A.; Suttorp, M. J.; Windhausen, F.; Cornel, J. H.

2017-01-01

The ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes) trial compared early invasive strategy with a selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and an elevated cardiac troponin T. No long-term benefit of an

Anterior pituitary lobe atrophy as late complication of hemorrhagic fever with renal syndrome

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Jovanović Dragan

2009-01-01

Full Text Available Introduction. Hemorrhagic fever with renal syndrome (HFRS is acute infective multisystemic disease followed by febrility, hemorrhages and acute renal insufficiency. Bleeding in the anterior pituitary lobe leading to tissue necrosis occurs in acute stage of severe clinical forms of HFRS, while atrophy of the anterior pituitary lobe with diminution of the gland function occurs after recovery stage. Case report. We presented a patient with the development of chronic renal insufficiency and hypopituitarism as complication that had been diagnosed six years after Hantavirus infection. Magnetic resonance of the pituitary gland revealed atrophy and empty sella turcica. Conclusion. Regarding frequency of this viral infection and its endemic character in some parts of our country partial and/or complete loss of pituitary function should be considered during the late stage of HFRS.

Low QRS Voltage on Presenting Electrocardiogram Predicts Multi-vessel Disease in Anterior ST-segment Elevation Myocardial Infarction.

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Kobayashi, Akihiro; Misumida, Naoki; Aoi, Shunsuke; Kanei, Yumiko

Low QRS voltage was reported to predict adverse outcomes in acute myocardial infarction in the pre-thrombolytic era. However, the association between low voltage and angiographic findings has not been fully addressed. We performed a retrospective analysis of patients with anterior ST-segment elevation myocardial infarction (STEMI). Low QRS voltage was defined as either peak to peak QRS complex voltage voltage. Patients with low voltage had a higher rate of multi-vessel disease (MVD) (76% vs. 52%, p=0.01). Patients with low voltage were more likely to undergo coronary artery bypass grafting (CABG) during admission (11% vs. 2%, p=0.028). Low voltage was an independent predictor for MVD (OR 2.50; 95% CI 1.12 to 6.03; p=0.032). Low QRS voltage was associated with MVD and in-hospital CABG in anterior STEMI. Copyright © 2017 Elsevier Inc. All rights reserved.

Spatial relationship between intrahepatic artery and portal vein based on the fusion image of CT-arterial portography (CTAP) and CT-angiography (CTA): New classification for hepatic artery at hepatic hilum and the segmentation of right anterior section of the liver

International Nuclear Information System (INIS)

Ibukuro, Kenji; Takeguchi, Takaya; Fukuda, Hozumi; Abe, Shoko; Tobe, Kimiko; Tanaka, Rei; Tagawa, Kazumi

2012-01-01

Purpose: To clarify the variations of the intrahepatic artery and portal vein and to verify the proper segmentation for the right anterior section of the liver. Materials and methods: CT during arterial portography and CT angiography were performed on 64-slice multi detector row CT in 147 patients. All images were transferred to a workstation for analysis using multi-image-fusion mode. We investigated the spatial relationship between hepatic artery and portal vein in the right hemiliver and the segmentation of the right anterior hepatic artery and portal vein. Results: The spatial anatomy of right hepatic arteries and portal vein was (1) anterior and posterior hepatic artery run superior and inferior to anterior portal vein, respectively (47.6%), (2) one anterior hepatic artery runs superior to and another one runs inferior to anterior portal vein (15%), (3) anterior and posterior hepatic arteries run superior to anterior portal vein (11.6%), (4) anterior and posterior hepatic arteries run inferior to anterior portal vein (7.5%), and (5) one posterior hepatic artery runs superior to and another one runs inferior to anterior portal vein (6.8%). The combined anatomy of right anterior artery and portal vein with regard to segmentation was classified as (1) dorso-ventral (26.5%), (2) dorso-ventral and inferior (10.9%), (3) multiple (18.4%), and (4) superior and inferior segments (1.4%). Conclusion: There are various types of spatial anatomy of intrahepatic artery and portal vein. The hepatic arteries as well as portal veins of right anterior section of the liver could be divided into dorsal and ventral, not superior and inferior.

Effects of Inclined Treadmill Walking on Pelvic Anterior Tilt Angle, Hamstring Muscle Length, and Trunk Muscle Endurance of Seated Workers with Flat-back Syndrome.

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Kim, Min-Hee; Yoo, Won-Gyu

2014-06-01

[Purpose] This study investigated the effects of inclined treadmill walking on pelvic anterior tilt angle, hamstring muscle length, and back muscle endurance of seated workers with flat-back syndrome. [Subjects] Eight seated workers with flat-back syndrome who complained of low-back pain in the L3-5 region participated in this study. [Methods] The subjects performed a walking exercise on a 30° inclined treadmill. We measured the pelvic anterior tilt angle, hamstring muscle length, and back muscle endurance before and after inclined treadmill walking. [Results] Anterior pelvic tilt angle and active knee extension angle significantly increased after inclined treadmill walking. Trunk extensor and flexor muscle endurance times were also significantly increased compared to the baseline. [Conclusion] Inclined treadmill walking may be an effective approach for the prevention or treatment of low-back pain in flat-back syndrome.

Aberrant origin of the upper left lobe anterior and superior lingular segmental pulmonary artery arising from the right pulmonary artery: A case report

International Nuclear Information System (INIS)

Cho, Yong Seok; Kang, Mi Jin; Bae, Kyung Eun; Lee, Jin Hae; Lee, Han Bee; Kim, Jae Hyung; Jeong, Myeong Ja; Kang, Tae Kyung

2013-01-01

Aberrant origins of the pulmonary artery are rare anomalies, but are being reported several times in the world literature. Among them, pulmonary artery sling is the most well known anomaly, which is the left pulmonary artery arising from the right pulmonary artery. In case of pulmonary artery sling, the left pulmonary artery causes compression of the trachea and esophagus while it courses in between. In this case, we describe a case on incidentally found aberrant origin of the upper left lobe anterior and superior lingular segmental pulmonary artery without any compressions of the esophagus or trachea. In the world literature, aberrant origins of the left pulmonary artery without pulmonary artery sling was reported at one time, but currently, this is the first case of aberrant origin of the upper left lobe anterior and superior lingular segmental pulmonary artery arising from the right pulmonary artery.

Aberrant origin of the upper left lobe anterior and superior lingular segmental pulmonary artery arising from the right pulmonary artery: A case report

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Cho, Yong Seok; Kang, Mi Jin; Bae, Kyung Eun; Lee, Jin Hae; Lee, Han Bee; Kim, Jae Hyung; Jeong, Myeong Ja; Kang, Tae Kyung [Sanggye Paik Hospital, Inje University College of Medicine, Seoul, (Korea, Republic of)

2013-10-15

Aberrant origins of the pulmonary artery are rare anomalies, but are being reported several times in the world literature. Among them, pulmonary artery sling is the most well known anomaly, which is the left pulmonary artery arising from the right pulmonary artery. In case of pulmonary artery sling, the left pulmonary artery causes compression of the trachea and esophagus while it courses in between. In this case, we describe a case on incidentally found aberrant origin of the upper left lobe anterior and superior lingular segmental pulmonary artery without any compressions of the esophagus or trachea. In the world literature, aberrant origins of the left pulmonary artery without pulmonary artery sling was reported at one time, but currently, this is the first case of aberrant origin of the upper left lobe anterior and superior lingular segmental pulmonary artery arising from the right pulmonary artery.

Early photoreceptor outer segment loss and retinoschisis in Cohen syndrome.

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Uyhazi, Katherine E; Binenbaum, Gil; Carducci, Nicholas; Zackai, Elaine H; Aleman, Tomas S

2018-06-01

To describe early structural and functional retinal changes in a patient with Cohen syndrome. A 13-month-old Caucasian girl of Irish and Spanish ancestry was noted to have micrognathia and laryngomalacia at birth, which prompted a genetic evaluation that revealed biallelic deletions in COH1 (VPS13B) (a maternally inherited 60-kb deletion involving exons 26-32 and a paternally inherited 3.5-kb deletion within exon 17) consistent with Cohen syndrome. She underwent a complete ophthalmic examination, full-field flash electroretinography and retinal imaging with spectral domain optical coherence tomography. Central vision was central, steady, and maintained. There was bilateral myopic astigmatic refractive error. Fundus exam was notable for dark foveolar pigmentation, but no obvious abnormalities of either eye. Spectral domain optical coherence tomography cross sections through the fovea revealed a normal appearing photoreceptor outer nuclear layer but loss of the interdigitation signal between the photoreceptor outer segments and the apical retinal pigment epithelium. Retinoschisis involving the inner nuclear layer of both eyes and possible ganglion cell layer thinning were also noted. There was a detectable electroretinogram with similarly reduced amplitudes of rod- (white, 0.01 cd.s.m -2 ) and cone-mediated (3 cd.s.m -2 , 30 Hz) responses. Photoreceptor outer segment abnormalities and retinoschisis may represent the earliest structural retinal change detected by spectral domain optical coherence tomography in patients with Cohen syndrome, suggesting a complex pathophysiology with primary involvement of the photoreceptor cilium and disorganization of the structural integrity of the inner retina.

Diagnostic impact of anterior segment angiography of limbal stem cell insufficiency in PAX6-related aniridia.

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Käsmann-Kellner, Barbara; Latta, Lorenz; Fries, Fabian N; Viestenz, Arne; Seitz, Berthold

2018-04-01

PAX6 is a master gene of ocular development and postnatal ocular equilibrium. Congenital aniridia is the hallmark of PAX6 gene haploinsufficiency (Chr. 11 p. 13), but PAX6-associated aniridia is a profound, progressive pan-ocular developmental disorder often leading to blindness. There is congenital visual impairment with advancing loss of vision mainly due to secondary glaucoma and to corneal blindness caused by limbal stem cell insufficiency (LSCI). LSCI leads to ARK (aniridia-related keratopathy), which typically develops in four stages. Incipient LSCI with vessels starting to grow into the cornea can be imaged by fluorescein anterior segment angiography, which enables fine vessels to be more easily detected than by routine slit lamp examination, especially in patients with nystagmus. Thus, clinical stage 1 ARK is often diagnosed at stage 2 by angiography. Corneal neovascularizations often start at the 12 and 6 positions and subsequently progress circumferentially, not at the 3 and 9 positions as previously believed. Anterior segment angiography can provide an easily standardizable tool for monitoring progress, treatment-induced regress or stabilization of ARK. Especially in children, angiography could be used to monitor new treatment regimens for reducing LSCI. Angiography could enable treatment to begin earlier to preserve corneal hemostasis. In addition, the fact that vascularization often starts at the subpalpebral 6 and 12 positions as opposed to the 3 and 9 positions raises more questions concerning factors that promote LSCI and related corneal injuries. Clin. Anat. 31:392-397, 2018. © 2018 Wiley Periodicals, Inc. © 2018 Wiley Periodicals, Inc.

An Unusual Course of Segmental Renal Artery Displays a Rare Case of Hilar Nutcracker Phenomenon

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Devendra A. Sawant

2015-01-01

Full Text Available Nutcracker phenomenon or renal vein entrapment is classically seen as a compression of renal vein in between abdominal aorta and superior mesenteric artery with patients being asymptomatic or clinically manifested in the form of nutcracker syndrome as proteinuria, hematuria, flank pain, pelvic congestion in women, and varicocele in men. In this report, we are presenting a case of rare variant of nutcracker phenomenon along with brief review of anatomy, pathophysiology, public health, and clinical significance of nutcracker syndrome. On a routine dissection of an adult male cadaver, we noticed an unusual arrangement of the structures at the hilum of the left kidney showing entrapment of renal vein between left anterior inferior and posterior segmental renal arteries. The variation in the course of left anterior inferior segmental renal artery leads to compression of left renal vein at renal hilum. Therefore, we have named this rare abnormal anatomical entity as hilar nutcracker phenomenon. The structures in the right renal hilum are normal. The objective of this paper is to report an unusual but important variant of nutcracker phenomenon and also give collective knowledge of such anatomical variations in renal vasculature that will help in diagnosing and treating such rare renal disorder.

Comparison of immersion ultrasonography, ultrasound biomicroscopy and anterior segment optical coherence tomography in the evaluation of traumatic phacoceles

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Harikrishna Vodapalli

2012-01-01

Full Text Available Blunt ocular trauma in the elderly can result in anterior dislocation of the crystalline lens into the subconjunctival space (phacocele. Although rare, this presentation can be missed, especially if the patient presents several days after the injury and if the lid is not everted on examination. While a careful clinical examination is adequate in the diagnosis, imaging techniques can be put to use for the accurate location of the associated sclera rupture. We report three cases of post-traumatic phacocele wherein ultrasound biomicroscopy (UBM was compared to the anterior segment optical coherence tomography (AS-OCT and B-scan ultrasonography (B-scan, in order to establish the best imaging tool for this condition. We concluded, based on image quality, that UBM could be the imaging modality of choice to aid in the diagnosis of phacocele.

Acute Appendicitis, Somatosensory Disturbances ("Head Zones"), and the Differential Diagnosis of Anterior Cutaneous Nerve Entrapment Syndrome (ACNES).

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Roumen, Rudi M H; Vening, Wouter; Wouda, Rosanne; Scheltinga, Marc M

2017-06-01

Anterior cutaneous nerve entrapment syndrome (ACNES) is a neuropathic abdominal wall pain syndrome typically characterized by locally altered skin sensations. On the other hand, visceral disease may also be associated with similar painful and altered skin sensations ("Head zones"). Aim of the study was to determine if patients with acute appendicitis demonstrated somatosensory disturbances in the corresponding right lower quadrant Head zone. The presence of somatosensory disturbances such as hyperalgesia, hypoesthesia, altered cool perception, or positive pinch test was determined in 100 patients before and after an appendectomy. Potential associations between altered skin sensations and various items including age, sex, history, body temperature, C-reactive protein (CRP), leukocyte count, and type of appendicopathy (normal, inflamed, necrotic, or perforated) were assessed. A total of 39 patients demonstrated at least one right lower abdominal quadrant skin somatosensory disturbance before the laparoscopic appendectomy. However, locoregional skin sensation normalized in all but 2 patients 2 weeks postoperatively. No differences were found concerning patient characteristics or type of appendicopathy between populations with or without altered lower abdominal skin sensations. A substantial portion of patients with acute appendicitis demonstrate right lower abdominal somatosensory disturbances that are similar as observed in acute ACNES. Both may be different sides of the same coin and are possibly expressions of segmental phenomena as described by Head. McBurney's point, a landmark area of maximum pain in acute appendicitis, is possibly a trigger point within a Head zone. Differentiating acute appendicitis from acute ACNES is extremely difficult, but imaging and observation may aid in the diagnostic process.

Reproducibility of Scleral Spur Identification and Angle Measurements Using Fourier Domain Anterior Segment Optical Coherence Tomography

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Ricardo J. Cumba

2012-01-01

Full Text Available Purpose. To evaluate intraobserver and interobserver agreement in locating the scleral spur landmark (SSL and anterior chamber angle measurements obtained using Fourier Domain Anterior Segment Optical Coherence Tomography (ASOCT images. Methods. Two independent, masked observers (SR and AZC identified SSLs on ASOCT images from 31 eyes with open and nonopen angles. A third independent reader, NPB, adjudicated SSL placement if identifications differed by more than 80 μm. Nine months later, SR reidentified SSLs. Intraobserver and interobserver agreement in SSL placement, trabecular-iris space area (TISA750, and angle opening distance (AOD750 were calculated. Results. In 84% of quadrants, SR’s SSL placements during 2 sessions were within 80 μm in both the X- and Y-axes, and in 77% of quadrants, SR and AZC were within 80 μm in both axes. In adjudicated images, 90% of all quadrants were within 80 μm, 88% in nonopen-angle eyes, and 92% in open-angle eyes. The intraobserver and interobserver correlation coefficients (with and without adjudication were above 0.9 for TISA750 and AOD750 for all quadrants. Conclusions. Reproducible identification of the SSL from images obtained with FD-ASOCT is possible. The ability to identify the SSL allows reproducible measurement of the anterior chamber angle using TISA750 and AOD750.

Low Anterior Resection Syndrome: Current Management and Future Directions.

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Ridolfi, Timothy J; Berger, Nicholas; Ludwig, Kirk A

2016-09-01

Outcomes for rectal cancer surgery have improved significantly over the past 20 years with increasing rates of survival and recurrence, specifically local recurrence. These gains have been realized during a period of time in which there has been an increasing emphasis on sphincter preservation. As we have become increasingly aggressive in avoiding resection of the anus, we have begun accepting bowel dysfunction as a normal outcome. Low anterior resection syndrome, defined as a constellation of symptoms including incontinence, frequency, urgency, or feelings of incomplete emptying, has a significant impact on quality of life and results in many patients opting for a permanent colostomy to avoid these symptoms. In this article, we will highlight the most recent clinical and basic science research on this topic and discuss areas of future investigation.

[Microsurgical anatomy importance of A1-anterior communicating artery complex].

Science.gov (United States)

Monroy-Sosa, Alejandro; Pérez-Cruz, Julio César; Reyes-Soto, Gervith; Delgado-Hernández, Carlos; Macías-Duvignau, Mario Alberto; Delgado-Reyes, Luis

2013-01-01

The anterior cerebral artery originates from the bifurcation of the internal carotid artery lateral to the optic chiasm, then joins with its contralateral counterpart via the anterior communicating artery. A1-anterior communicating artery complex is the most frequent anatomical variants and is the major site of aneurysms between 30 to 37%. Know the anatomy microsurgical, variants anatomical and importance of complex precommunicating segment-artery anterior communicating in surgery neurological of the pathology vascular, mainly aneurysms, in Mexican population. The study was performed in 30 brains injected. Microanatomy was studied (length and diameter) of A1-anterior communicating artery complex and its variants. 60 segments A1, the average length of left side was 11.35 mm and 11.84 mm was right. The average diameter of left was 1.67 mm and the right was 1.64 mm. The average number of perforators on the left side was 7.9 and the right side was 7.5. Anterior communicating artery was found in 29 brains of the optic chiasm, its course depended on the length of the A1 segment. The average length of the segment was 2.84 mm, the average diameter was 1.41 mm and the average number of perforators was 3.27. A1-anterior communicating artery complex variants were found in 18 (60%) and the presence of two blister-like aneurysms. It is necessary to understand the A1-anterior communicating artery complex microanatomy of its variants to have a three-dimensional vision during aneurysm surgery.

The effect of bevacizumab for anterior segment neovascularization after silicone oil removal in eyes with previous vitreoretinal surgery.

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Batman, C; Ozdamar, Y

2010-07-01

To report the outcomes of the use of intracameral bevacizumab for iris neovascularization occurring after silicone oil (SO) removal in eyes undergoing vitreoretinal surgery (VRS). This study included 12 eyes that had iris neovascularization after SO removal. The clinical outcomes of 12 eyes after intravitreal bevacizumab injection were reviewed. There were eight men and four women with an average age of 41.58+/-12.68 years. All eyes had VRS for various vitreoretinal diseases. After the mean follow-up period of 9.7+/-5.3 months, SO removal was performed. Then, the patients were followed for more than 2 months and detailed retinal examinations and intraocular pressure (IOP) were normal during this period, but rubeosis iridis (RI) developed. RI was treated with 1 dose of 1.25 mg bevacizumab into the anterior chamber. After a mean follow-up period of 4.8+/-2.2 months, the regression of iris neovacularization was detected and IOP was below 21 mmHg in all eyes. Anterior segment neovascularization (ASNV) may develop through various mechanisms in patients with VRS after SO removal, and anterior chamber injection of bevacizumab may lead to regression of ASNV.

Control of anterior segment using an antero-posterior lingual sliding retraction system: a preliminary cone-beam CT study

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Min Hwang

2018-01-01

Full Text Available Abstract Background This study was performed to evaluate the treatment effects of the antero-posterior lingual retractor (APLR, focusing on the 3-dimensional (3D tooth movement of the maxillary anterior teeth and their alveolar bone levels. Methods En masse retraction was performed using either the C-lingual retractor (CLR, C-group, n = 9 or the antero-posterior lingual retractor (APLR, AP-group, n = 8. We evaluated 3D movement of the maxillary anterior teeth and alveolar bone levels, root length of the central incisors, long axes of the maxillary canines, and occlusal plane changes from CBCT images. Results After retraction, the central incisors were more significantly intruded and their root apex was more retracted in the AP-group. The long axis of the canine was well maintained in the AP-group. There were no differences in the steepness of occlusal plane and the incidence of alveolar bone loss or of root resorption during en masse retraction with the two retractors. Conclusions The clockwise bowing effect of the anterior segment was less with the APLR, which prevented unwanted canine movement.

Alport's syndrome with focal segmental glomerulosclerosis lesion - Pattern to recognize.

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Alsahli, Afnan A; Alshahwan, Sara I; Alotaibi, Amal O; Alsaad, Khaled O; Aloudah, Nourah; Farooqui, Mahfooz; Al Sayyari, Abdullah A

2018-01-01

The association between Alport's syndrome (AS) and focal segmental glomerulosclerosis (FSGS) in the same patient is complex and rarely reported. We report a case of a 42-year-old male presenting with proteinuria, microscopic hematuria, elevated serum creatinine and hypertension with unremarkable physical examination apart from obesity. The renal biopsy showed well-established FSGS pattern of injury with mild interstitial fibrosis and tubular atrophy, while the electron microscopic examination demonstrated glomerular basement membranes (GBM) changes compatible with AS. AS can be complicated by segmental glomerular scarring, which can mimic primary FSGS, while familial FSGS can result from mutations in collagen IV network of the GBM. This overlap can complicate histopathological interpretation of renal biopsy, which should be accompanied by mutational analysis for accurate diagnosis and proper therapeutic intervention.

Comparison of anterior segment measurements using Sirius Topographer® and Nidek Axial Length-Scan® with assessing repeatability in patients with cataracts

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Resat Duman

2018-01-01

Full Text Available Purpose: The purpose of this study is to evaluate anterior segment measurements obtained using CSO Sirius Topographer® (CSO, Firenze, Italy and Nidek Axial Length (AL-Scan® (Nidek CO., Gamagori, Japan. Methods: A total of 43 eyes of 43 patients were included in this prospective study. The central corneal thickness (CCT, anterior chamber depth (ACD, white-to-white distance (WTW, flat keratometry (K1, steep keratometry (K2, and mean keratometry (K values were randomly measured three times with each device by the same examiner. The intraclass correlation coefficient of repeatability was analyzed. The compatibility of both devices was evaluated using the 95% limits of the agreement proposed by Bland and Altman. Results: Examiner achieved high repeatability for all parameters on each device except the WTW measured by Sirius. All measurements except WTW and K1 taken with the Sirius were higher than that taken with the Nidek AL-Scan®. The difference in CCT, ACD, and WTW values was statistically significant. Conclusion: High repeatability of the measurements was achieved on both devices. Although Km, K1, and K2 measurements of the Sirius and the AL-Scan® showed good agreement, WTW, CCT, and ACD measurements significantly differed between two devices. Thus, anterior segment measurements except for Km, K1, and K2 cannot be used interchangeably between Sirius and Nidek AL-Scan® devices.

Effects of Inclined Treadmill Walking on Pelvic Anterior Tilt Angle, Hamstring Muscle Length, and Trunk Muscle Endurance of Seated Workers with Flat-back Syndrome

OpenAIRE

Kim, Min-hee; Yoo, Won-gyu

2014-01-01

[Purpose] This study investigated the effects of inclined treadmill walking on pelvic anterior tilt angle, hamstring muscle length, and back muscle endurance of seated workers with flat-back syndrome. [Subjects] Eight seated workers with flat-back syndrome who complained of low-back pain in the L3–5 region participated in this study. [Methods] The subjects performed a walking exercise on a 30° inclined treadmill. We measured the pelvic anterior tilt angle, hamstring muscle length, and back mu...

The prognostic significance of early and late right precordial lead (V4 R) ST-segment elevation in patients with acute anterior myocardial infarction.

Science.gov (United States)

Keskin, Muhammed; Uzun, Ahmet Okan; Börklü, Edibe Betül; Hayıroğlu, Mert İlker; Türkkan, Ceyhan; Tekkeşin, Ahmet İlker; Kozan, Ömer

2018-03-01

The predictive significance of ST-segment elevation (STE) in lead V 4 R in patients with anterior ST-segment elevation myocardial infarction (STEMI) has not been well-understood. In this study, we evaluated the prognostic value of early and late STE in lead V 4 R in patients with anterior STEMI. A total 451 patients with anterior STEMI who treated with primary percutaneous coronary intervention (PPCI) were prospectively enrolled in this study. All patients were classified according to presence of STE (>1 mm) in lead V 4 R at admission and/or 60 min after PPCI. Based on this classification, all patients were divided into three subgroups as no V 4 R STE (Group 1), early but not late V 4 R STE (Group 2) and late V 4 R STE (Group 3). In-hospital mortality had higher rates at group 2 and 3 and that had 2.1 and 4.1-times higher mortality than group 1. Late V 4 R STE remained as an independent risk factor for cardiogenic shock (odds ratio [OR] 2.6; 95% confidence interval [CI] 1.9-4.3; p < .001) and in-hospital mortality (OR 2.3; 95% CI 1.8-4.1; p < .001). The 12-month overall survival for group 1, 2, and 3 were 91.1%, 82.4%, and 71.4% respectively. However, the long-term mortality also had the higher rate at group 3; late V 4 R STE did not remain as an independent risk factor for long-term mortality (OR 1.5; 95% CI 0.8-4.1; p: .159). Late V 4 R STE in patients with anterior STEMI is strongly associated with poor prognosis. The record of late V 4 R in patients with anterior STEMI has an important prognostic value. © 2017 Wiley Periodicals, Inc.

Presentation of a case with Wellens syndrome

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Luis A. Rodríguez López

2016-06-01

Full Text Available This case report is about a 56-year-old male, farm worker with a history of being a smoker and suffering from high blood pressure, who was admitted at the Cardiology Care Department with the diagnosis of coronary artery disease –unstable angina–, because of chest pain related to physical effort and changes in the appearance threshold. Rest-electrocardiogram, painless, shows deep, symmetric negative T waves in anterior wall, without enzyme elevation; but during admission the patient evolves quickly, clinically and electrically, to an extensive anterior wall acute myocardial infarction, without responding to the fibrinolytic reperfusion therapy, and showing a ventricular tachycardia degenerating into ventricular fibrillation. There was no response to the maneuvers of cardiovascular resuscitation, thus, he dies. It is diagnosed postmortem as a Wellens syndrome, because necropsy showed severe atherosclerotic disease of the proximal segment of the left anterior descending coronary artery with extensive anterior transmural infarction.

The eye of the magellanic penguin (Spheniscus magellanicus): structure of the anterior segment.

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Suburo, A M; Scolaro, J A

1990-11-01

We undertook a light and scanning electron microscopic study of the eye in the Magellanic penguin (Spheniscus magellanicus). The anatomical peculiarities of the eyeball shape in Sphenisciformes have been previously described by others; here, we show that they are accompanied by several modifications in the organization of the anterior segment of the eye. The main change was found in the portion of opaque sclera extending from the cornea to the anterior border of the scleral ossicles, which was much broader than in other avian eyes. This scleral region was made of a very dense fibrous tissue and was as difficult to cut as the ossicles. The corneo-scleral boundary was also different from that of other birds, since the aqueous humor channel and the pectinate ligament were located 1.0-1.5 mm posterior to the cornea. The osseous ring was formed by 13 bones, including three pairs of over- and underplates. There was a single ciliary muscle, with meridionally oriented striated fibers. They were inserted on a circumference along the boundary between the fibrous sclera and the ossicles, far away from the wall of the aqueous humor channel. On their posterior end, the muscle fibers formed a tendinous structure attached to the inner surface of the sclera and to the outer surface of the ciliary body. Only short zonular fibrils were observed. These anatomical features are probably relevant for the adaptation of penguin eyes to vision on land and in the aquatic environment.

Brothers with hypospadias, vertebral segmentation defects, and intellectual disability: new syndrome?

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Phadke, Shubha R; Ranganath, Prajnya; Boggula, Vijay Raju; Gupta, Divya; Phadke, Rajendra V; Sloman, Melissa; Turnpenny, Peter D

2012-12-01

We report on two brothers (born to nonconsanguineous parents) with short stature, hypospadias, scoliosis, vertebral segmentation defects of "spondylocostal dysostosis" type, and intellectual disability. Results of cytogenetic and molecular genetic tests performed, including routine karyotype, MLPA (multiplex ligation-dependent probe amplification) for common microdeletions and subtelomeric copy number variants, microarray-CGH analysis, and sequencing of four Notch signaling pathway genes (DLL3, MESP2, LFNG, and HES7), were all normal. We present a comparison of the condition in the two boys with known syndromes and suggest that they may represent a hitherto unreported syndrome, most likely following autosomal recessive inheritance, though X-linked inheritance is not excluded. Copyright © 2012 Wiley Periodicals, Inc.

Comparison of Scheimpflug imaging and spectral domain anterior segment optical coherence tomography for detection of narrow anterior chamber angles.

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Grewal, D S; Brar, G S; Jain, R; Grewal, S P S

2011-05-01

To compare the performance of anterior chamber volume (ACV) and anterior chamber depth (ACD) obtained using Scheimpflug imaging with angle opening distance (AOD500) and trabecular-iris space area (TISA500) obtained using spectral domain anterior segment optical coherence tomography (SD-ASOCT) in detecting narrow angles classified using gonioscopy. In this prospective, cross-sectional observational study, 265 eyes of 265 consecutive patients underwent sequential Scheimpflug imaging, SD-ASOCT imaging, and gonioscopy. Correlations between gonioscopy grading, ACV, ACD, AOD500, and TISA500 were evaluated. Area under receiver operating characteristic curve (AUC), sensitivity, specificity, and likelihood ratios (LRs) were calculated to assess the performance of ACV, ACD, AOD500, and TISA500 in detecting narrow angles (defined as Shaffer grade ≤1 in all quadrants). SD-ASOCT images were obtained at the nasal and temporal quadrants only. Twenty-eight eyes (10.6%) were classified as narrow angles on gonioscopy. ACV correlated with gonioscopy grading (P<0.001) for temporal (r=0.204), superior (r=0.251), nasal (r=0.213), and inferior (r=0.236) quadrants. ACV correlated with TISA500 for nasal (r=0.135, P=0.029) and temporal (P=0.160, P=0.009) quadrants and also with AOD500 for nasal (r=0.498, P<0.001) and temporal (r=0.517, P<0.001) quadrants. For detection of narrow angles, ACV (AUC=0.935; 95% confidence interval (CI) =0.898-0.961) performed similar to ACD (AUC=0.88, P=0.06) and significantly better than AOD500 nasal (AUC=0.761, P=0.001), AOD500 temporal (AUC=0.808, P<0.001), TISA500 nasal (AUC=0.756, P<0.001), and TISA500 temporal (AUC=0.738, P<0.001). Using a cutoff of 113 mm(3), ACV had 90% sensitivity and 88% specificity for detecting narrow angles. Positive and negative LRs for ACV were 8.63 (95% CI=7.4-10.0) and 0.11 (95% CI=0.03-0.4), respectively. ACV measurements using Scheimpflug imaging outperformed AOD500 and TISA500 using SD-ASOCT for detecting narrow angles.

ST–Segment elevation: Not always an acute coronary syndrome

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Érico Costa

2017-01-01

Full Text Available Cardiac tumors can be primary or metastatic, the latter being more frequent and usually of pulmonary or hematologic origin. These patients’ clinical signs are non-specific and the electrocardiogram (ECG can assume many patterns, among which, ST-segment elevation. Nevertheless, associated occlusion of the coronary arteries is rare in these situations.We present a 79-year-old woman with a history of pulmonary neoplasia who was admitted to the emergency department due to atypical chest pain, cough and worsening dyspnea in the previous 3 days. The ECG revealed an ST-segment elevation in the anterolateral and inferolateral leads, despite normal blood work, namely normal troponin. Due to the disparity between the patient’s symptoms and the ECG findings, a decision was made not to proceed to primary angioplasty, but to further investigate with echocardiography, which revealed a mass localized in the anterolateral and inferolateral left ventricle walls, confirmed by computed tomography. The patient was admitted in the medical ward for symptomatic management. Her clinical condition gradually deteriorated due to the disease’s natural evolution and she died two weeks later.This case highlights the importance to keep in mind differential diagnoses to acute coronary syndromes, when a ST-segment elevation is encountered on an ECG.

Usher syndrome type 1-associated cadherins shape the photoreceptor outer segment.

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Schietroma, Cataldo; Parain, Karine; Estivalet, Amrit; Aghaie, Asadollah; Boutet de Monvel, Jacques; Picaud, Serge; Sahel, José-Alain; Perron, Muriel; El-Amraoui, Aziz; Petit, Christine

2017-06-05

Usher syndrome type 1 (USH1) causes combined hearing and sight defects, but how mutations in USH1 genes lead to retinal dystrophy in patients remains elusive. The USH1 protein complex is associated with calyceal processes, which are microvilli of unknown function surrounding the base of the photoreceptor outer segment. We show that in Xenopus tropicalis , these processes are connected to the outer-segment membrane by links composed of protocadherin-15 (USH1F protein). Protocadherin-15 deficiency, obtained by a knockdown approach, leads to impaired photoreceptor function and abnormally shaped photoreceptor outer segments. Rod basal outer disks displayed excessive outgrowth, and cone outer segments were curved, with lamellae of heterogeneous sizes, defects also observed upon knockdown of Cdh23 , encoding cadherin-23 (USH1D protein). The calyceal processes were virtually absent in cones and displayed markedly reduced F-actin content in rods, suggesting that protocadherin-15-containing links are essential for their development and/or maintenance. We propose that calyceal processes, together with their associated links, control the sizing of rod disks and cone lamellae throughout their daily renewal. © 2017 Schietroma et al.

Sphincter-saving extrasphincteric rectal dissection and proximal segmental sphincteric excision techniques by using combined abdominal and transvaginal anterior perineal access in female patients who have lower rectal cancer (Transvaginal low anterior rectal resection

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Ali Naki Yücesoy

2017-10-01

Full Text Available Background: Combined abdominal and transvaginal anterior perineal approaches have been used as an alternative surgical method for the surgical treatment of the lower rectal cancer. The main aim of this paper is to describe the surgical stages of the combined abdominal and transvaginal approaches performed for lower rectal cancer, especially in transvaginal anterior perineal stage. Method: We have performed sphincter-saving surgical operations by using transvaginal anterior perineal access by combining with the abdominal access in four female patients who had lower rectal cancer. Results: Sphincter-saving extrasphincteric dissection and proximal segmental sphincteric excision techniques were performed in four female patients operated with combined abdominal and transvaginal anterior perineal approach. All patients were found to have continence. Postoperatively, one patient was converted to abdominoperineal rectal amputation due to the detected distal resection margin positivity. Conclusion: Transvaginal anterior perineal access provides the extrasphincteric rectal dissection possibility in the ischioanal fossa. Therefore, the combined abdominal and transvaginal anterior perineal approaches have been based on the different anatomical and surgical features when compared to intersphincteric dissection technique which is the most common used surgical procedure in lower rectal cancer surgery. Resumo: Introdução: Uma combinação de abordagens abdominal e perineal anterior transvaginal tem sido empregada como método cirúrgico alternativo para o tratamento cirúrgico do câncer de reto baixo. O principal objetivo do presente artigo é a descrição dos estágios cirúrgicos das abordagens abdominal e transvaginal combinadas realizadas para câncer de reto baixo, especialmente no estágio perineal anterior transvaginal. Método: Realizamos operações cirúrgicas com preservação de esfíncter com o uso do acesso perineal anterior transvaginal, em

The Palatal Approach to Distraction Osteogenesis of the Anterior Maxillary Alveolus.

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Bell, Robert E

2015-07-01

This report describes the palatal approach to gain access for osteodistraction of the anterior maxilla to improve the vector of force during distraction. This case report illustrates a novel approach to anterior maxillary osteodistraction. The palatal approach allows the maxillary segment to be moved anteriorly and inferiorly. This is in contrast to the buccal approach, in which the palatal tissue creates a vector of force toward the palate. The vascular pedicle for the transport segment is the labial mucosa and musculature. In the present case, the alveolar segment was advanced 3.6 mm anteriorly and 12.2 mm inferiorly as measured by pre- and postoperative computed tomograms. This patient with a large vertical alveolar defect and high smile line had successful restoration with dental implants. The result has been stable for 14 months. In this case, the palatal approach to the anterior maxillary osteotomy was shown to be an effective method of reconstructing a large vertical anterior defect. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Assessment of narrow angles by gonioscopy, Van Herick method and anterior segment optical coherence tomography.

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Park, Seong Bae; Sung, Kyung Rim; Kang, Sung Yung; Jo, Jung Woo; Lee, Kyoung Sub; Kook, Michael S

2011-07-01

To evaluate anterior chamber (AC) angles using gonioscopy, Van Herick technique and anterior segment optical coherence tomography (AS-OCT). One hundred forty-eight consecutive subjects were enrolled. The agreement between any two of three diagnostic methods, gonioscopy, AS-OCT and Van Herick, was calculated in narrow-angle patients. The area under receiver-operating characteristic curves (AUC) for discriminating between narrow and open angles determined by gonioscopy was calculated in all participants for AS-OCT parameter angle opening distance (AOD), angle recess area, trabecular iris surface area and anterior chamber depth (ACD). As a subgroup analysis, capability of AS-OCT parameters for detecting angle closure defined by AS-OCT was assessed in narrow-angle patients. The agreement between the Van Herick method and gonioscopy in detecting angle closure was excellent in narrow angles (κ = 0.80, temporal; κ = 0.82, nasal). However, agreement between gonioscopy and AS-OCT and between the Van Herick method and AS-OCT was poor (κ = 0.11-0.16). Discrimination capability of AS-OCT parameters between open and narrow angles determined by gonioscopy was excellent for all AS-OCT parameters (AUC, temporal: AOD500 = 0.96, nasal: AOD500 = 0.99). The AUCs for detecting angle closure defined by AS-OCT image in narrow angle subjects was good for all AS-OCT parameters (AUC, 0.80-0.94) except for ACD (temporal: ACD = 0.70, nasal: ACD = 0.63). Assessment of narrow angles by gonioscopy and the Van Herick technique showed good agreement, but both measurements revealed poor agreement with AS-OCT. The angle closure detection capability of AS-OCT parameters was excellent; however, it was slightly lower in ACD.

Intra-cameral level of ganciclovir gel, 0.15% following topical application for cytomegalovirus anterior segment infection: A pilot study.

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Waduthantri, Samanthila; Zhou, Lei; Chee, Soon-Phaik

2018-01-01

To investigate the intra-cameral level of ganciclovir following topical application of ganciclovir gel, 0.15% for cytomegalovirus (CMV) anterior segment infection. Non-randomized, prospective, interventional clinical study. Patients with active CMV anterior segment infection seen at Singapore National Eye Centre, confirmed by positive CMV real time PCR (RT-PCR) of the aqueous humor, that had not been treated with any form of ganciclovir in the preceding 1 month were recruited. They were treated with ganciclovir gel, 0.15% 1cc 5 times a day. Following 6 weeks of treatment, CMV load in the aqueous humor was measured using CMV RT-PCR and the ganciclovir drug levels in tears and aqueous humor were measured using high-performance liquid chromatography-mass spectrometry. The clinical features of the disease activity and the central corneal thickness (CCT) were recorded at the baseline and post-treatment. There were 29 eyes of 29 patients, of which 23 eyes had CMV anterior uveitis and 6 eyes had CMV endotheliitis. At the end of week 6, 26 eyes had undetectable CMV titre in the aqueous humor and no anterior chamber (AC) activity. Two patients had an increased CMV titre and increased AC inflammation. Both of these patients were non-compliant with the treatment. One patient had a reduced CMV titre in the aqueous humor with minimal AC inflammation. The mean ganciclovir concentration in the aqueous humor and the tears were 17.4 ± 30.6 ng/ml and 20,420.9 ± 33,120.8 ng/ml respectively. Mean CCT was 552.2 ± 42.3 microns. There was a weak correlation between the ganciclovir concentration in the aqueous humor and CCT (Spearmen's r = + 0.42, p = 0.025). There was no significant correlation between the ganiclovir concentration in the tears and CCT (Spearmen's r = + 0.39, p = 0.11). Ganciclovir levels in the aqueous humor was below the 50% inhibitory dose (ID50) for CMV replication, following topical application of the ganciclovir gel, 0.15%. SingHealth Centralized Institutional

Segmental reversal of distal small intestine in short bowel syndrome

DEFF Research Database (Denmark)

Grave, Pernille Kock; Thomsen, Sabrina Valentin; Clark, Pia Susanne

2018-01-01

were the influence on cell proliferation and mucosal architecture shown by histological analysis. Methods: Sixteen piglets underwent a 60% resection of the distal small intestine and were randomized into two groups. Group 1 short bowel syndrome alone (SBS) (n = 8) and group 2 with reversal of a distal...... small intestinal segment (SBS-RS) (n = 8). Body weight was measured daily and the pigs were euthanized after 1 month. Crypt depths, villus heights and muscle layers thicknesses were measured. For the evaluation of microvilli of the brush border of the epithelium and cell proliferation...... was found in the SBS group and increase in the thickness of the circular and longitudinal muscle layers in the SBS-RS group. In the distal ileal segment the longitudinal muscle layer thicknesses were increased in the SBS group. Otherwise, no significant changes were found. Conclusion: Reversal of a 20-cm...

Plasma bilirubin values on admission and ventricular remodeling after a first anterior ST-segment elevation acute myocardial infarction.

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Miranda, Berta; Barrabés, José A; Figueras, Jaume; Pineda, Victor; Rodríguez-Palomares, José; Lidón, Rosa-Maria; Sambola, Antonia; Bañeras, Jordi; Otaegui, Imanol; García-Dorado, David

2016-01-01

Bilirubin may elicit cardiovascular protection and heme oxygenase-1 overexpression attenuated post-infarction ventricular remodeling in experimental animals, but the association between bilirubin levels and post-infarction remodeling is unknown. In 145 patients with a first anterior ST-segment elevation acute myocardial infarction (STEMI), we assessed whether plasma bilirubin on admission predicted adverse remodeling (left ventricular end-diastolic volume [LVEDV] increase ≥20% between discharge and 6 months, estimated by magnetic resonance imaging). Patients' baseline characteristics and management were comparable among bilirubin tertiles. LVEDV increased at 6 months (P bilirubin tertiles (10.8 [30.2], 10.1 [22.9], and 12.7 [24.3]%, P = 0.500). Median (25-75 percentile) bilirubin values in patients with and without adverse remodeling were 0.75 (0.60-0.93) and 0.73 (0.60-0.92) mg/dL (P = 0.693). Absence of final TIMI flow grade 3 (odds ratio 3.92, 95% CI 1.12-13.66) and a history of hypertension (2.04, 0.93-4.50), but not admission bilirubin, were independently associated with adverse remodeling. Bilirubin also did not predict the increase in ejection fraction at 6 months. Admission bilirubin values are not related to LVEDV or ejection fraction progression after a first anterior STEMI and do not predict adverse ventricular remodeling. Key messages Bilirubin levels are inversely related to cardiovascular disease, and overexpression of heme oxygenase-1 (the enzyme that determines bilirubin production) has prevented post-infarction ventricular remodeling in experimental animals, but the association between bilirubin levels and the progression of ventricular volumes and function in patients with acute myocardial infarction remained unexplored. In this cohort of patients with a first acute anterior ST-segment elevation myocardial infarction receiving contemporary management, bilirubin levels on admission were not predictive of the changes in left

Early vitrectomy effective for bilateral combined anterior and posterior persistent fetal vasculature syndrome.

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Walsh, Mark K; Drenser, Kimberly A; Capone, Antonio; Trese, Michael T

2010-04-01

The purpose of this study was to review our surgical experience with patients with bilateral combined anterior and posterior persistent fetal vasculature syndrome (PFVS). We retrospectively reviewed the charts of all patients seen in our tertiary care pediatric retinal practice from 1988 to 2008 with a potential diagnosis of bilateral PFVS with posterior involvement. Clinical diagnosis required the presence of either bilateral persistent hyaloidal stalk tissue with retinal involvement or bilateral dense retrolental fibrovascular plaques (usually with no posterior view preoperatively) without a family history or genetic testing consistent with Norrie disease or familial exudative vitreoretinopathy. Chart review showed 22 vitrectomized patients with clinical findings consistent with bilateral PFVS with posterior involvement who did not have a family history or genetic testing consistent with Norrie disease or familial exudative vitreoretinopathy. All 22 of these patients with posterior retinal involvement also had anterior findings and thus can be classified as combined anterior and posterior PFVS. Of the 13 patients with visual acuity follow-up data, 9 patients (69%) maintained at least light perception vision in at least 1 eye at last follow-up. Of the 28 operated eyes in 16 patients with follow-up data, 3 eyes (11%) were phthisical at last follow-up. Children with bilateral PFVS with posterior retinal involvement have a dismal visual prognosis if left unoperated. In this relatively large series of a rare condition, we find that vitrectomy with or without lensectomy is beneficial in bilateral combined anterior and posterior PFVS in two regards: maintenance or restoration of vision and avoidance of phthisis bulbi.

Tonic and phasic changes in anteromedial globus pallidus activity in Tourette syndrome.

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Israelashvili, Michal; Smeets, Anouk Y J M; Bronfeld, Maya; Zeef, Dagmar H; Leentjens, Albert F G; van Kranen-Mastenbroek, Vivianne; Janssen, Marcus L F; Temel, Yasin; Ackermans, Linda; Bar-Gad, Izhar

2017-07-01

Tourette syndrome is a hyperkinetic neurodevelopmental disorder characterized by tics. Assess the neuronal changes in the associative/limbic GP associated with Tourette syndrome. Neurophysiological recordings were performed from the anterior (associative/limbic) GPe and GPi of 8 awake patients during DBS electrode implantation surgeries. The baseline firing rate of the neurons was low in a state-dependent manner in both segments of the GP. Tic-dependent transient rate changes were found in the activity of individual neurons of both segments around the time of the tic. Neither oscillatory activity of individual neurons nor correlations in their interactions were observed. The results demonstrate the involvement of the associative/limbic pathway in the underlying pathophysiology of Tourette syndrome and point to tonic and phasic modulations of basal ganglia output as a key mechanisms underlying the abnormal state of the disorder and the expression of individual tics, respectively. © 2017 International Parkinson and Movement Disorder Society. © 2017 International Parkinson and Movement Disorder Society.

Expanding the clinical spectrum of ocular anomalies in Noonan syndrome: Axenfeld-anomaly in a child with PTPN11 mutation.

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Guerin, Andrea; So, Joyce; Mireskandari, Kamiar; Jougeh-Doust, Soghra; Chisholm, Caitlin; Klatt, Regan; Richer, Julie

2015-02-01

Ocular anomalies have been frequently reported in Noonan syndrome. Anterior segment anomalies have been described in 57% of PTPN11 positive patients, with the most common findings being corneal changes and in particular, prominent corneal nerves and cataracts. We report on a neonate with a confirmed PTPN11 mutation and ocular findings consistent with Axenfeld anomaly. The patient initially presented with non-immune hydrops and subsequently developed hypertrophic cardiomyopathy and dysmorphic features typical of Noonan syndrome. While a pathogenic mutation in PTPN11 was confirmed, prior testing for the two common genes associated with Axenfeld-Rieger syndrome, PITX2, and FOXC1 was negative. This finding expands the spectrum of anterior chamber anomalies seen in Noonan syndrome and perhaps suggests a common neural crest related mechanism that plays a critical role in the development of the eye and other organs. © 2014 Wiley Periodicals, Inc.

Segmental trisomy of chromosome 17: a mouse model of human aneuploidy syndromes

Czech Academy of Sciences Publication Activity Database

Vacík, Tomáš; Ort, Michael; Gregorová, Soňa; Strnad, P.; Conte, N.; Bradley, A.; Blatný, Radek; Bureš, Jan; Forejt, Jiří

2005-01-01

Roč. 102, č. 12 (2005), s. 4500-4505 ISSN 0027-8424 R&D Projects: GA ČR(CZ) GA309/03/0715 Grant - others:Howard Hughes Medical Institute(US) 55000306 Institutional research plan: CEZ:AV0Z5011922; CEZ:AV0Z50110509 Keywords : dosage-sensitive genes * Down's syndrome * mouse segmental trisomy Subject RIV: EB - Genetics ; Molecular Biology Impact factor: 10.231, year: 2005

Dynamic changes of anterior segment in patients with different stages of primary angle-closure in both eyes and normal subjects.

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Jialiu Lin

Full Text Available To compare changes in anterior segment parameters under light and dark (light-to-dark conditions among eyes with chronic primary angle-closure glaucoma (CPACG, fellow eyes with confirmed or suspect primary angle-closure (PAC or PACS, and age-matched healthy eyes.Consecutive patients with CPACG in one eye and PAC/PACS in the fellow eye, as well as age-matched healthy subjects were recruited. Anterior segment optical coherence tomography measurements were conducted under light and dark conditions, and anterior chamber, lens, and iris parameters compared. Demographic and biometric factors associated with light-to-dark change in iris area were analyzed by linear regression.Fifty-seven patients (mean age 59.6±8.9 years and 30 normal subjects matched for age (60.6±9.3 years and sex ratio were recruited. In regards to differences under light-to-dark conditions, angle opening distance at 500 μm (AOD500μm and iris area during light-to-dark transition were smaller in CPACG eyes than fellow PACS/PAC eyes and normal eyes (P<0.017. Pupil diameter change was largest in normal eyes, and larger in PACS/PAC eyes than CPACG eyes (P<0.017. There was an average reduction of 0.145 mm2 in iris area for each millimeter of pupil diameter increase in CPACG eyes, 0.161 mm2 in fellow PAC/PACS eyes, and 0.165 mm2 in normal eyes. Larger iris curvature in the dark and diagnosis of PACG were significantly associated with less light-to-dark iris area changes.Dynamic changes in iris parameters with light-to-dark transition differed significantly among CPACG eyes, fellow PAC/PACS eyes, and normal eyes. Greater iris curvature under dark conditions was correlated with reduced light-to-dark change in iris area and pupil diameter, which may contribute to disease progression.

Neurodynamic responses to the femoral slump test in patients with anterior knee pain syndrome.

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Lin, Pei-Ling; Shih, Yi-Fen; Chen, Wen-Yin; Ma, Hsiao-Li

2014-05-01

Matched-control, cross-sectional study. The purpose of this study was to compare the responses to the femoral slump test (FST), including the change in hip range of motion and level of discomfort, between subjects with and without anterior knee pain. Anterior knee pain syndrome is a common problem among adults. The FST is the neurodynamic test used to assess the mechanosensitivity of the femoral component of the nervous system. However, as of yet, there is no literature discussing the use of the FST in patients with anterior knee pain. Thirty patients with anterior knee pain and 30 control participants, matched by gender, age, and dominant leg, were recruited. The subjects received the FST, during which the hip extension angle and the location and intensity of pain/discomfort were recorded. Reproduction of symptoms that were alleviated by neck extension was interpreted as a positive test. Differences in hip extension angle and pain intensity between groups were examined using a 2-way, repeated-measures analysis of variance and a Kruskal-Wallis analysis. The level of significance was set at α = .05. Subjects with anterior knee pain had a smaller hip extension angle than that of controls (-3.6° ± 5.3° versus 0.6° ± 6.1°; mean difference, 4.2°; 95% confidence interval [CI]: 1.24°, 7.15°; P = .006). Eight patients with anterior knee pain showed a positive FST, and those with a positive FST had a smaller hip extension angle (-5.7° ± 4.5°) than that of controls (mean difference, 6.3°; 95% CI: 0.8°, 11.8°; P = .007). There was no difference in the hip extension angle between the positive and negative FST groups (mean difference, 2.9°; 95% CI: -8.5°, 2.0°) or between the negative FST and control groups (mean difference, 3.4°; 95% CI: -0.4°, 7.3°). Results of this study suggest that altered mechanosensitivity of the femoral nerve occurred in the patients with anterior knee pain who presented with a positive FST. The role of increased mechanosensitivity

Usher syndrome type 1–associated cadherins shape the photoreceptor outer segment

Science.gov (United States)

Parain, Karine; Aghaie, Asadollah; Picaud, Serge

2017-01-01

Usher syndrome type 1 (USH1) causes combined hearing and sight defects, but how mutations in USH1 genes lead to retinal dystrophy in patients remains elusive. The USH1 protein complex is associated with calyceal processes, which are microvilli of unknown function surrounding the base of the photoreceptor outer segment. We show that in Xenopus tropicalis, these processes are connected to the outer-segment membrane by links composed of protocadherin-15 (USH1F protein). Protocadherin-15 deficiency, obtained by a knockdown approach, leads to impaired photoreceptor function and abnormally shaped photoreceptor outer segments. Rod basal outer disks displayed excessive outgrowth, and cone outer segments were curved, with lamellae of heterogeneous sizes, defects also observed upon knockdown of Cdh23, encoding cadherin-23 (USH1D protein). The calyceal processes were virtually absent in cones and displayed markedly reduced F-actin content in rods, suggesting that protocadherin-15–containing links are essential for their development and/or maintenance. We propose that calyceal processes, together with their associated links, control the sizing of rod disks and cone lamellae throughout their daily renewal. PMID:28495838

Intracranial arteries in individuals with the elastin gene hemideletion of Williams syndrome.

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Wint, D P; Butman, J A; Masdeu, J C; Meyer-Lindenberg, A; Mervis, C B; Sarpal, D; Morris, C A; Berman, K F

2014-01-01

Williams syndrome, a rare genetic disorder with a striking neurobehavioral profile characterized by extreme sociability and impaired visuospatial construction abilities, is caused by a hemideletion that includes the elastin gene, resulting in frequent supravavular aortic stenosis and other stenotic arterial lesions. Strokes have been reported in Williams syndrome. Although the extracranial carotid artery has been studied in a sample of patients with Williams syndrome, proximal intracranial arteries have not. Using MRA, we studied the intracranial vessels in 27 participants: 14 patients with Williams syndrome (age range, 18-44 years; mean age, 27.3 ± 9.1; 43% women) and 13 healthy control participants with similar age and sex distribution (age range, 22-52 years; mean age, 33.4 ± 7.6; 46% women). All participants with Williams syndrome had hemideletions of the elastin gene. Blinded to group allocation or to any other clinical data, a neuroradiologist determined the presence of intracranial vascular changes in the 2 groups. The Williams syndrome group and the healthy control group had similar patency of the proximal intracranial arteries, including the internal carotid and vertebral arteries; basilar artery; and stem and proximal branches of the anterior cerebral artery, MCA, and posterior cerebral arteries. The postcommunicating segment of the anterior cerebral artery was longer in the Williams syndrome group. Despite the elastin haploinsufficiency, the proximal intracranial arteries in Williams syndrome preserve normal patency.

Ultrasound biomicroscopic evaluation of anterior segment cysts as a risk factor for ocular hypertension and closure angle glaucoma

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Abdurrahim Dusak

2013-08-01

Full Text Available AIM:To investigate the relationship between the ultrasound biomicroscopic (UBM features of anterior-segment cysts (ASCs and increased intraocular pressure (IOP as a risk factor for closed-angle glaucoma (CAG.METHODS:Totally 24 eyes with recently diagnosed ASCs were divided into two groups . First group with ASC and ocular normotension (n=13, second group with ASC and ocular hypertension (n=11. An ophthalmologic examination, including tonometry, slit-lamp biomicroscopy (SLBM, gonioscopy, fundoscopy, pentacam, and UBM, was performed. The features of the ASCs were compared with the IOP.RESULTS:ASCs were accurately diagnosed and delineated in 24 eyes using UBM. IOP was elevated in those ASCs with a secondary aetiology (P=0.027, iridociliary location (P=0.006, deformed shape (P=0.013, increased size (P=0.001 and elongated pupillary aperture (P=0.009. However, the count (P=0.343 of ASCs, anterior chamber depth (ACD; P=0.22 and axial lenght (AL; P=0.31 were not associated with ocular hypertension. Correlations were found between the IOP and ASC size (r=-0.712; P=0.003, anterior chamber angle (ACA; r=-0.985; Pr=0.885; Pr=-0.776, Pr =-0.655, P=0.002.CONCLUSION:Ocular hypertension in some eyes with ASC might be associated with various mechanisms, including secondary aetiology, iridociliary location, deformed shape, increased size and elongated pupill, which can be determined by UBM.

Agreement between Gonioscopic Examination and Swept Source Fourier Domain Anterior Segment Optical Coherence Tomography Imaging

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Mohammed Rigi

2016-01-01

Full Text Available Purpose. To evaluate interobserver, intervisit, and interinstrument agreements for gonioscopy and Fourier domain anterior segment optical coherence tomography (FD ASOCT for classifying open and narrow angle eyes. Methods. Eighty-six eyes with open or narrow anterior chamber angles were included. The superior angle was classified open or narrow by 2 of 5 glaucoma specialists using gonioscopy and imaged by FD ASOCT in the dark. The superior angle of each FD ASOCT image was graded as open or narrow by 2 masked readers. The same procedures were repeated within 6 months. Kappas for interobserver and intervisit agreements for each instrument and interinstrument agreements were calculated. Results. The mean age was 50.9 (±18.4 years. Interobserver agreements were moderate to good for both gonioscopy (0.57 and 0.69 and FD ASOCT (0.58 and 0.75. Intervisit agreements were moderate to excellent for both gonioscopy (0.53 to 0.86 and FD ASOCT (0.57 and 0.85. Interinstrument agreements were fair to good (0.34 to 0.63, with FD ASOCT classifying more angles as narrow than gonioscopy. Conclusions. Both gonioscopy and FD ASOCT examiners were internally consistent with similar interobserver and intervisit agreements for angle classification. Agreement between instruments was fair to good, with FD ASOCT classifying more angles as narrow than gonioscopy.

Agreement between Gonioscopic Examination and Swept Source Fourier Domain Anterior Segment Optical Coherence Tomography Imaging

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Nguyen, Donna; Minnal, Vandana R.

2016-01-01

Purpose. To evaluate interobserver, intervisit, and interinstrument agreements for gonioscopy and Fourier domain anterior segment optical coherence tomography (FD ASOCT) for classifying open and narrow angle eyes. Methods. Eighty-six eyes with open or narrow anterior chamber angles were included. The superior angle was classified open or narrow by 2 of 5 glaucoma specialists using gonioscopy and imaged by FD ASOCT in the dark. The superior angle of each FD ASOCT image was graded as open or narrow by 2 masked readers. The same procedures were repeated within 6 months. Kappas for interobserver and intervisit agreements for each instrument and interinstrument agreements were calculated. Results. The mean age was 50.9 (±18.4) years. Interobserver agreements were moderate to good for both gonioscopy (0.57 and 0.69) and FD ASOCT (0.58 and 0.75). Intervisit agreements were moderate to excellent for both gonioscopy (0.53 to 0.86) and FD ASOCT (0.57 and 0.85). Interinstrument agreements were fair to good (0.34 to 0.63), with FD ASOCT classifying more angles as narrow than gonioscopy. Conclusions. Both gonioscopy and FD ASOCT examiners were internally consistent with similar interobserver and intervisit agreements for angle classification. Agreement between instruments was fair to good, with FD ASOCT classifying more angles as narrow than gonioscopy. PMID:27990300

Wellen’s syndrome: Challenges in diagnosis

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Abhishek Agarwal

2015-07-01

Full Text Available Wellen’s syndrome is a pre-infarction stage of coronary artery disease characterised by predefined clinical and electrocardiographic (ECG criteria of a subgroup of patients with myocardial ischaemia. Early recognition and appropriate intervention of this syndrome carry significant diagnostic and prognostic value. We report this unusual syndrome in an elderly man who presented with recurrent angina and characteristic ECG changes as T-waves inversion in the precordial leads, especially in V2–V6 during pain-free periods and ECG obtained during episodes of pain demonstrating upright T-waves with possible elevated ST segments from V1–V4. Cardiac enzymes were positive and coronary angiography revealed critical stenosis in the proximal left anterior descending artery. It is important to timely identify this condition and intervene appropriately as these patients may develop extensive myocardial infarction that carries a significant morbidity and mortality

Segmental trisomy of mouse chromosome 17: introducing an alternative model of Down syndrome

Czech Academy of Sciences Publication Activity Database

Forejt, Jiří; Vacík, Tomáš; Gregorová, Soňa

2003-01-01

Roč. 4, - (2003), s. 647-652 ISSN 1531-6912 R&D Projects: GA MŠk LN00A079; GA ČR GV204/98/K015 Grant - others:HHMI(US) 555000306 Institutional research plan: CEZ:AV0Z5052915 Keywords : segmental aneuploidy * Down ´s syndrome * gene dosage Subject RIV: EB - Genetics ; Molecular Biology Impact factor: 1.297, year: 2003

Anterior segment parameters as predictors of intraocular pressure reduction after phacoemulsification in eyes with open-angle glaucoma.

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Hsia, Yen C; Moghimi, Sasan; Coh, Paul; Chen, Rebecca; Masis, Marisse; Lin, Shan C

2017-07-01

To evaluate intraocular pressure (IOP) change after cataract surgery in eyes with open-angle glaucoma (OAG) and its relationship to angle and anterior segment parameters measured by anterior segment optical coherence tomography (AS-OCT). University of California, San Francisco, California, USA. Prospective case series. Eyes were placed into a narrow-angle group or open-angle group based on gonioscopy grading. Biometric parameters were measured using AS-OCT (Visante) preoperatively, and IOP 4 months after surgery was obtained. The IOP change and its relationship to AS-OCT parameters were evaluated. Eighty-one eyes of 69 patients were enrolled. The mean age of the patients was 76.8 years. The preoperative IOP was 15.02 mm Hg on 1.89 glaucoma medications. The average mean deviation of preoperative visual field was -4.58 dB. The mean IOP reduction was 2.1 mm Hg (12.8%) from a preoperative mean of 15.0 mm Hg. The IOP reduction was significantly greater in eyes with narrow angles than in eyes with open angles (20.4% versus 8.0%) (P = .002). In multivariate analysis, preoperative IOP (β = -0.53, P < .001, R 2  = 0.40), angle-opening distance at 500 mm (β = 5.83, P = .02, R 2  = 0.45), angle-opening distance at 750 mm (β = 5.82, P = .001, R 2  = 0.52), and lens vault (β = -0.002, P = .009, R 2  = 0.47) were associated with IOP reduction postoperatively. In eyes with OAG, IOP reduction after cataract surgery was greater in eyes with narrower angles. Preoperative IOP, angle-opening distance, and lens vault were predictors for IOP reduction. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Utility of bleb imaging with anterior segment optical coherence tomography in clinical decision-making after trabeculectomy.

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Singh, Mandeep; Aung, Tin; Aquino, Maria C; Chew, Paul T K

2009-08-01

To determine if imaging of blebs with anterior segment optical coherence tomography (ASOCT) affects clinical decision-making with regard to laser suture lysis (LSL) after trabeculectomy. In this prospective observational case series, we included patients with poorly controlled intraocular pressure (IOP) after standardized trabeculectomy from May to November 2006. One observer assessed IOP, anterior chamber depth and bleb formation, and recorded a decision of whether or not to undertake LSL based on clinical grounds. A second observer masked to clinical data recorded a decision of whether or not to perform LSL based on ASOCT assessment of scleral flap position, presence of a sub-flap space, patency of the internal ostium, and bleb wall thickening. We compared the 2 observers' decisions to determine how ASOCT influenced decision-making. Seven eyes of 7 patients were included. On the basis of clinical examination, LSL was recommended in all 7 (100.0%) cases due to presence of elevated IOP, deep anterior chambers and poorly formed blebs. Using ASOCT, LSL was recommended in 5/7 (71.4%) cases with apposed scleral flaps, absent sub-flap spaces, and absent bleb wall thickening. In 2/7 (28.7%) cases, LSL was not recommended based on ASOCT findings of an elevated scleral flap, a patent sub-flap space, and bleb wall thickening. All 7 patients had good IOP control and formed blebs at a mean of 8.4+/-2.6 months after trabeculectomy, with a mean IOP of 14.3+/-3.2 mm Hg with no medications. This small study suggests that ASOCT imaging may affect decision-making with regard to LSL by providing information not apparent on clinical examination.

Incidence and Significance of Spontaneous ST Segment Re-elevation After Reperfused Anterior Acute Myocardial Infarction　- Relationship With Infarct Size, Adverse Remodeling, and Events at 1 Year.

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Cuenin, Léo; Lamoureux, Sophie; Schaaf, Mathieu; Bochaton, Thomas; Monassier, Jean-Pierre; Claeys, Marc J; Rioufol, Gilles; Finet, Gérard; Garcia-Dorado, David; Angoulvant, Denis; Elbaz, Meyer; Delarche, Nicolas; Coste, Pierre; Metge, Marc; Perret, Thibault; Motreff, Pascal; Bonnefoy-Cudraz, Eric; Vanzetto, Gérald; Morel, Olivier; Boussaha, Inesse; Ovize, Michel; Mewton, Nathan

2018-04-25

Up to 25% of patients with ST elevation myocardial infarction (STEMI) have ST segment re-elevation after initial regression post-reperfusion and there are few data regarding its prognostic significance.Methods and Results:A standard 12-lead electrocardiogram (ECG) was recorded in 662 patients with anterior STEMI referred for primary percutaneous coronary intervention (PPCI). ECGs were recorded 60-90 min after PPCI and at discharge. ST segment re-elevation was defined as a ≥0.1-mV increase in STMax between the post-PPCI and discharge ECGs. Infarct size (assessed as creatine kinase [CK] peak), echocardiography at baseline and follow-up, and all-cause death and heart failure events at 1 year were assessed. In all, 128 patients (19%) had ST segment re-elevation. There was no difference between patients with and without re-elevation in infarct size (CK peak [mean±SD] 4,231±2,656 vs. 3,993±2,819 IU/L; P=0.402), left ventricular (LV) ejection fraction (50.7±11.6% vs. 52.2±10.8%; P=0.186), LV adverse remodeling (20.1±38.9% vs. 18.3±30.9%; P=0.631), or all-cause mortality and heart failure events (22 [19.8%] vs. 106 [19.2%]; P=0.887) at 1 year. Among anterior STEMI patients treated by PPCI, ST segment re-elevation was present in 19% and was not associated with increased infarct size or major adverse events at 1 year.

Alport’s syndrome with focal segmental glomerulosclerosis lesion – Pattern to recognize

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Afnan A Alsahli

2018-01-01

Full Text Available The association between Alport’s syndrome (AS and focal segmental glomerulosclerosis (FSGS in the same patient is complex and rarely reported. We report a case of a 42-year-old male presenting with proteinuria, microscopic hematuria, elevated serum creatinine and hypertension with unremarkable physical examination apart from obesity. The renal biopsy showed well-established FSGS pattern of injury with mild interstitial fibrosis and tubular atrophy, while the electron microscopic examination demonstrated glomerular basement membranes (GBM changes compatible with AS. AS can be complicated by segmental glomerular scarring, which can mimic primary FSGS, while familial FSGS can result from mutations in collagen IV network of the GBM. This overlap can complicate histopathological interpretation of renal biopsy, which should be accompanied by mutational analysis for accurate diagnosis and proper therapeutic intervention.

Right bundle branch block and anterior wall ST elevation myocardial infarction.

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Trofin, Monica; Israel, Carsten W; Barold, S Serge

2017-09-01

We report the case of an acute anterior wall ST elevation myocardial infarction with new left anterior fascicular block and pre-existing right bundle branch block. Due to a wide right bundle branch block, no ST segment elevation was visible in lead V1. The left anterior fascicular block was caused by proximal occlusion of the left artery descending and disappeared after acute revascularization. However, also the R' of the right bundle branch block became significantly shorter after revascularization, dismanteling a minor ST segment elevation. The ST elevation in lead V1 in anterior wall infarction and right bundle branch block may merge with the R' and cause a further QRS widening as an "equivalent" to the ST elevation.

Guyon's canal syndrome due to tortuous ulnar artery with DeQuervain stenosing tenosynovitis, ligamentous injuries and dorsal intercalated segmental instability syndrome, a rare presentation: a case report

OpenAIRE

Zeeshan, Muhammad; Ahmed, Farhan; Kanwal, Darakhshan; Khalid, Qazi Saad Bin; Ahmed, Muhammad Nadeem

2009-01-01

The Guyon's canal syndrome is a well known clinical entity and may have significant impact on patient's quality of life. We report a case of 43-year-old male who presented with complaints of pain and numbness in right hand and difficulty in writing for past one month. On imaging diagnosis of Guyon's canal syndrome because of tortuous ulnar artery was made with additional findings of DeQuervain's stenosing tenosynovitis and dorsal intercalated segmental instability syndrome with ligamentous in...

Axenfeld-Rieger syndrome.

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Seifi, M; Walter, M A

2018-06-01

Axenfeld-Rieger syndrome (ARS) is a clinically and genetically heterogeneous group of developmental disorders affecting primarily the anterior segment of the eye, often leading to secondary glaucoma. Patients with ARS may also present with systemic changes, including dental defects, mild craniofacial dysmorphism, and umbilical anomalies. ARS is inherited in an autosomal-dominant fashion; the underlying defect in 40% of patients is mutations in PITX2 or FOXC1. Here, an overview of the clinical spectrum of ARS is provided. As well, the known underlying genetic defects, clinical diagnostic possibilities, genetic counseling and treatments of ARS are discussed in detail. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

CT-findings in pain syndromes originated from thoraco-lumbar junction

International Nuclear Information System (INIS)

Dimitrov, I.; Karadjova, M.; Malchanova, V.

2007-01-01

The thoraco-lumbar junction syndrome imitates, as far as clinical symptoms are concerned, low back pain, caused by disc protrusion in the lower lumbar vertebral segments. It is manifested by referred pain in the area, innervated by posterior and anterior primary rami (dorsal and ventral rami), belonging to thoraco-lumbar junction vertebral segments (Th11-L2). Eighty one patients with clinically diagnosed thoraco-lumbar junction syndrome underwent CT-investigations, that aimed establishing pathological processes, leading to this clinical symptomatology. 148 vertebral levels were examined. In 67 patients we scanned two consecutive levels to find the type of change of the zygapophyseal joints. We found facet tropism (asymmetry) in 72 patients (88.8%) or in 117 levels (79.6%), degenerated faced joints in 63 patients (77.8%), pathology of the intervertebral disc - in 33 patients (43.1%) including 5 patients (6.2%) with disc prolapse. When investigating on two subsequent segments (Th11-Th12 and Th12-L1) sudden anatomical change in orientation of facets occurred in 55 patients (82%). Our findings support the hypothesis of the facet-joint origin of this ailment. (authors)

Ocular Manifestations of Noonan Syndrome: A Prospective Clinical and Genetic Study of 25 Patients.

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van Trier, Dorothée C; Vos, Anna M C; Draaijer, Renske W; van der Burgt, Ineke; Draaisma, Jos M Th; Cruysberg, Johannes R M

2016-10-01

To determine the full spectrum of ocular manifestations in patients with Noonan syndrome (NS). Prospective cross-sectional clinical and genetic study in a tertiary referral center. Twenty-five patients with NS (mean age, 14 years; range, 8 months-25 years) clinically diagnosed by validated criteria. All patients were examined by the same team following a detailed study protocol. Genetic analyses were performed in 23 patients. Ocular abnormalities of vision and refraction, external ocular features, ocular position and motility, anterior segment, posterior segment, and intraocular pressure. Ocular features of vision and refraction were amblyopia (32%), myopia (40%), and astigmatism (52%). External ocular features were epicanthic folds (84%), hypertelorism (68%), ptosis (56%), high upper eyelid crease (64%), lower eyelid retraction (60%), abnormal upward slanting palpebral fissures (36%), downward slanting palpebral fissures (32%), and lagophthalmos (28%). Orthoptic abnormalities included strabismus (40%), abnormal stereopsis (44%), and limited ocular motility (40%). Anterior segment abnormalities included prominent corneal nerves (72%) and posterior embryotoxon (32%). Additional ocular features were found, including nonglaucomatous optic disc excavation (20%), relatively low (Noonan syndrome is a clinical diagnosis with multiple genetic bases associated with an extensive variety of congenital ocular abnormalities. Ocular features of NS are characterized by 1 or more developmental anomalies of the eyelids (involving the position, opening, and closure) associated with various other ocular abnormalities in childhood, including amblyopia, myopia, astigmatism, strabismus, limited ocular motility, prominent corneal nerves, and posterior embryotoxon. Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Pigment dispersion syndrome masquerading as acute anterior uveitis.

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Gonzalez-Gonzalez, Luis Alonso; Rodríguez-García, Alejandro; Foster, C Stephen

2011-06-01

Signs and symptoms of pigment dispersion may be confused with those of acute anterior uveitis. This case series is intended to aid the ophthalmologist in the clinical differentiation between these two disorders. The authors present a series of 6 patients with pigment dispersion who were initially diagnosed as having acute anterior uveitis and treated with anti-inflammatory medication, including corticosteroids. The patients were referred for a second opinion due to poor or no response to therapy and were found to have pigment dispersion instead of uveitis. Symptoms of pigment dispersion may consist of blurred vision, redness, ocular pain, and photophobia, all of which are also symptoms of acute anterior uveitis. These symptoms, plus the fact that pigment floating in the aqueous humor can be mistaken for inflammation, make diagnosis challenging. Moreover, the possible co-existence of true anterior uveitis and pigment dispersion makes the diagnosis and treatment more difficult.

Transforaminal Anterior Release for the Treatment of Fixed Sagittal Imbalance and Segmental Kyphosis, Minimum 2-Year Follow-Up Study.

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Sweet, Fred A; Sweet, Andrea

2015-09-01

Retrospective review of prospectively accrued patient cohort. To report minimum 2 years' follow-up after a single-surgeon series of 47 consecutive patients in whom fixed sagittal imbalance or segmental kyphosis was treated with a novel unilateral transforaminal annular release. Fixed sagittal imbalance has been treated most recently with pedicle subtraction osteotomy with great success but is associated with significant blood loss and neurologic risk. Forty-seven consecutive patients with fixed sagittal imbalance (n = 29) or segmental kyphosis (n = 18) were treated by a single surgeon with a single-level transforaminal anterior release (TFAR) to effect an opening wedge correction. Sagittal and coronal correction was performed with in situ rod contouring. An interbody cage was captured in the disc space with rod compression. Radiographic and clinical outcome analysis was performed with a minimum 2-year follow-up (range 2-7.8 years). The average increase in lordosis was 36° (range 24°-56°) in the fixed sagittal deformity group. Coronal corrections averaged 34° (range 18°-48°). The average improvement in plumb line was 13.6 cm. There were four pseudarthroses, one at the TFAR. Average blood loss was 578 mL (range 200-1,200). One patient had a transient grade 4/5 anterior tibialis weakness. There were no vascular injuries or permanent neurologic deficits. There were significant improvements in the Oswestry Disability Index (p imbalance with relatively low blood loss and was found to be neurologically safe in this single-surgeon series. Therapeutic study, Level IV (case series, no control group). Copyright © 2015 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

Segmental small bowel necrosis associated with antiphospholipid syndrome: a case report.

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Wang, Qun-Ying; Ye, Xiao-Hua; Ding, Jin; Wu, Xiao-Kang

2015-04-07

Antiphospholipid syndrome is a multi-system disease characterized by the formation of thromboembolic complications and/or pregnancy morbidity, and with persistently increased titers of antiphospholipid antibodies. We report the case of a 50-year-old, previously healthy man who presented with fever and new-onset, dull abdominal pain. A contrast-enhanced computed tomography scan showed segmental small bowel obstruction, for which an emergency laparotomy was performed. Histopathologic examination of resected tissues revealed multiple intestinal and mesenteric thromboses of small vessels. Laboratory tests for serum antiphospholipid (anticardiolipin IgM) and anti-β2-glycoprotein I antibodies were positive. Despite proactive implementation of anticoagulation, steroid, and antibiotic therapies, the patient's condition rapidly deteriorated, and he died 22 d after admission. This case highlights that antiphospholipid syndrome should be suspected in patients with unexplainable ischemic bowel and intestinal necrosis presenting with insidious clinical features that may be secondary to the disease, as early diagnosis is critical to implement timely treatments in order to ameliorate the disease course.

REPERFUSION THERAPY IN ACUTE CORONARY SYNDROME WITH ST SEGMENT ELEVATION

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A. L. Alyavi

2016-01-01

Full Text Available Aim. To compare effect of percutaneous balloon angioplasty (PCA and a systemic thrombolysis (STL on the central and intracardiac hemodynamics in patients with acute coronary syndrome (ACS with ST segment elevation.Material and methods. 80 patients with ACS with ST segment elevation were included in the study. Patients were split into 2 groups depending on reperfusion strategy. PCA was performed in 55 patients (first group. 25 patients of the second group had STL with Streptokinase, i/v, 1 500 000 units per hour. Echocardiography was performed in all patients at admission and after 3 and 7 days of treatment to evaluate intracardiac hemodynamics.Results. Both reperfusion methods significantly increase of ejection fraction (EF and maximal output speed of left ventricle (LV. Increase of LV EF in patients after PCA was higher than this in patients after STL. PCA improved LV diastolic function; STL did not change this characteristic. After PCA working diagnosis of ACS was transformed to the following final diagnosis: acute myocardial infarction (AMI with Q, AMI without Q and unstable angina in 37,5, 30,4 and 32,1% of patients, respectively. After STL diagnosis of AMI with Q was defined in all patients.Conclusion. PCA in patients with ACS with ST segment elevation results in fast improvement of global systolic and diastolic LV function. Besides, PCA prevents AMI with Q in a half of these patients.

Guyon's canal syndrome due to tortuous ulnar artery with DeQuervain stenosing tenosynovitis, ligamentous injuries and dorsal intercalated segmental instability syndrome, a rare presentation: a case report.

Science.gov (United States)

Zeeshan, Muhammad; Ahmed, Farhan; Kanwal, Darakhshan; Khalid, Qazi Saad Bin; Ahmed, Muhammad Nadeem

2009-12-23

The Guyon's canal syndrome is a well known clinical entity and may have significant impact on patient's quality of life. We report a case of 43-year-old male who presented with complaints of pain and numbness in right hand and difficulty in writing for past one month. On imaging diagnosis of Guyon's canal syndrome because of tortuous ulnar artery was made with additional findings of DeQuervain's stenosing tenosynovitis and dorsal intercalated segmental instability syndrome with ligamentous injury and subsequently these were confirmed on surgery.Although it is a rare syndrome, early diagnosis and treatment prevents permanent neurological deficits and improve patient's quality of life.

Contractility Dispersion in Long QT Syndrome

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MH Nikoo

2009-09-01

Full Text Available Background: Previous studies, using M mode echocardiography, provided unexpected evidence of a mechanical alteration in patients with long QT syndrome. The aim of this study was to evaluate entire left ventricular (LV wall motion characteristics in patients with long QT syndrome using tissue Doppler imaging. Methods: We enrolled 17 patients with congenital long QT syndrome [11 female and 6 male], aged 21 to 45 years. 10 subjects without cardiac disease were also selected as a control group. Two-dimensional tissue Doppler imaging (TDI recording of the LV was obtained from the basal and mid-segments from apical four-chamber, two-chamber, and long-axis views. ‘Myocardial Contraction Duration’ [MCD] was defined as the time from start of R wave on ECG to end of S wave on TDI. MCD was measured in the six LV wall positions: septal, anteroseptal, lateral, inferior, posterior and anterior positions.Results: LV contractility dispersion was significantly greater in long QT syndrome patients compared to control group [0.051 ± 0.011 vs. 0.016 ± 0.06; P < 0.001]. Conclusion: Our study evaluated left ventricular dispersion of contractility duration in patients with long QT syndrome. This mechanical dispersion may be a reflection of the inhomogeneity of repolarisation in the long QT syndrome.

Comparison of EyeCam and anterior segment optical coherence tomography in detecting angle closure.

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Baskaran, Mani; Aung, Tin; Friedman, David S; Tun, Tin A; Perera, Shamira A

2012-12-01

To compare the diagnostic performance of EyeCam (Clarity Medical Systems, Pleasanton, CA, USA) and anterior segment optical coherence tomography (ASOCT, Visante; Carl Zeiss Meditec, Dublin, CA, USA) in detecting angle closure, using gonioscopy as the reference standard. Ninety-eight phakic patients, recruited from a glaucoma clinic, underwent gonioscopy by a single examiner, and EyeCam and ASOCT imaging by another examiner. Another observer, masked to gonioscopy findings, graded EyeCam and ASOCT images. For both gonioscopy and EyeCam, a closed angle in a particular quadrant was defined if the posterior trabecular meshwork was not visible. For ASOCT, angle closure was defined by any contact between the iris and angle anterior to the scleral spur. An eye was diagnosed as having angle closure if ≥2 quadrants were closed. Agreement and area under the receiver operating characteristic curves (AUC) were evaluated. The majority of subjects were Chinese (69/98, 70.4%) with a mean age of 60.6 years. Angle closure was diagnosed in 39/98 (39.8%) eyes with gonioscopy, 40/98 (40.8%) with EyeCam and 56/97 (57.7%) with ASOCT. The agreement (kappa statistic) for angle closure diagnosis for gonioscopy versus EyeCam was 0.89; gonioscopy versus ASOCT and EyeCam versus ASOCT were both 0.56. The AUC for detecting eyes with gonioscopic angle closure with EyeCam was 0.978 (95% CI: 0.93-1.0) and 0.847 (95% CI: 0.76-0.92, p < 0.01) for ASOCT. The diagnostic performance of EyeCam was better than ASOCT in detecting angle closure when gonioscopic grading was used as the reference standard. The agreement between the two imaging modalities was moderate. © 2012 The Authors. Acta Ophthalmologica © 2012 Acta Ophthalmologica Scandinavica Foundation.

Intrastromal Corneal Ring Segments for Astigmatism Correction after Deep Anterior Lamellar Keratoplasty

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Júlio C. D. Arantes

2017-01-01

Full Text Available Background. To evaluate the change in corneal astigmatism after intrastromal corneal ring segment (ICRS implantation in keratoconus patients with previous deep anterior lamellar keratoplasty (DALK. Design was a longitudinal, retrospective, interventional study. The study included 25 eyes of 24 patients with keratoconus who had DALK performed at least two years prior to ICRS implantation. All patients had a clear corneal graft with up to 8.00 D of corneal astigmatism and intolerance to contact lenses. The studied parameters were age, sex, corrected distance visual acuity (CDVA, maximum keratometry (K1, minimum keratometry (K2, spherical equivalent, and astigmatism. There was a statistically significant decrease in the postintervention analysis as follows: 3.5 D reduction in K1 (p<0.001; 1.53 D in K2 (p=0.005; and 2.52 D (p<0.001 in the average K. The spherical equivalent reduced from −3.67 D (±2.74 to −0.71 D (±2.35 (p<0.001. The topographic astigmatism reduced from 3.87 D preoperatively to 1.90 D postoperatively (p<0.001. The CDVA improved from 0.33 (±0.10 to 0.20 (±0.09, p<0.001. ICRS implantation is a useful option for the correction of astigmatism after DALK as it yields significant visual, topographic, and refractive results.

Lesiones traumáticas de los anexos y del segmento anterior del ojo en los boxeadores Traumatic lesions of the adnexa and of the anterior segment of the eye in fighters

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Agustín Fernández Sánchez

2003-06-01

Full Text Available Se realizó un estudio retrospectivo con una muestra de 71 boxeadores a los cuales se les examinaron las estructuras de referencia mediante oftalmoscopia directa y biomicroscopia ocular, antes de las 6 horas posteriores al término de sus peleas; donde se obtuvo como resultado que los anexos afectados fueron los párpados con 5 hematomas, 4 edemas y 1 excoriación; y la conjuntiva con 4 hiperemias y 8 hemorragias. En el segmento anterior del ojo sólo se afectó la córnea con 13 lesiones en total, divididas en 10 excoriaciones superficiales y 3 profundas. Las lesiones traumáticas predominantes en los anexos del ojo son las de los párpados y las de la conjuntiva y las del segmento anterior del ojo, las de la córnea. El ojo más afectado fue el izquierdo y las lesiones más frecuentes fueron en las categorías de 13 y 14, 17 y 18 y 19 y 34 años las corneales, las conjuntivales y la de los párpados, respectivamente.A retrospective study was carried out with a sample of 71 fighters, whose reference structures were examined by direct ophthalmoscopy and ocular biomicroscopy within the 6 hours following their fights. As a result, it was observed that the affected adnexa were the eyelids with 5 hematomas, 4 edemas and 1 excoriation; and the conjunctiva with 4 hyperemias and 8 hemorrhages. In the anteriro segment, only the cornea was affected with 13 lesions in all, divided into 10 superficial and 3 deep excoriations.The traumatic lesions prevailing in the adnexa of the eye are those of the eyelids and the conjunctiva, whereas the predominating traumatic lesions of the anterior segment of the eye are those of the cornea. The left eye was the most affected and the most frequent lesions were in the categories 13 and 14, 17 and 18 and 19 and 34 years old in the cornea, the conjunctiva and the eyelids, respectively.

Differential diagnosis at admission between Takotsubo cardiomyopathy and acute apical-anterior myocardial infarction in postmenopausal women.

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Zorzi, Alessandro; Baritussio, Anna; ElMaghawry, Mohamed; Siciliano, Mariachiara; Migliore, Federico; Perazzolo Marra, Martina; Iliceto, Sabino; Corrado, Domenico

2016-08-01

Takotsubo cardiomyopathy (TTC) typically affects postmenopausal women and clinically presents with chest pain, ST-segment elevation, elevated cardiac enzymes and apical left ventricular (LV) wall motion abnormalities that mimic 'apical-anterior' acute myocardial infarction (AMI). This study assessed whether at-admission clinical evaluation helps in differential diagnosis between the two conditions. The study compared at-admission clinical, electrocardiographic (ECG) and echocardiographic findings of 31 women (median age 67 years, interquartile range (IQR) 62-76) with typical TTC and 30 women (median age 73 years, IQR 61-81) with apical-anterior AMI due to acute occlusion of the mid/distal left anterior descending coronary artery. Women with TTC significantly more often showed PR-segment depression (62% versus 3%, p<0.001), J-waves (26% versus 3%, p=0.03), maximum ST-segment elevation ⩽2 mm (84% versus 37%, p<0.001) and ST-segment elevation in lead II (42% versus 10%, p=0.01) than those with AMI. At multivariate analysis, PR-segment depression (odds ratio (OR)=37.2, 95% confidence interval (CI)=3.4-424, p=0.002) and maximum ST-segment elevation ⩽2 mm (OR=11.1, 95% CI=1.7-99.4, p=0.01) remained the only independent predictors of TTC and the co-existence of both parameters excluded AMI with a 100% specificity. The two groups did not differ with regard to age, first troponin-I value, echocardiographic LV ejection fraction and distribution of hypo/akinetic LV segments. At-admission electrocardiogram (but no clinical, laboratory and echocardiographic features) allows differential diagnosis between TTC and apical-anterior AMI in postmenopausal women. The combination of PR-segment depression and mild (⩽2 mm) ST-segment elevation predicted TTC with greater accuracy than traditional parameters such as localisation of ST-segment elevation and reciprocal ST-segment depression. © The European Society of Cardiology 2015.

Anterior corpectomy via the mini-open, extreme lateral, transpsoas approach combined with short-segment posterior fixation for single-level traumatic lumbar burst fractures: analysis of health-related quality of life outcomes and patient satisfaction.

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Theologis, Alexander A; Tabaraee, Ehsan; Toogood, Paul; Kennedy, Abbey; Birk, Harjus; McClellan, R Trigg; Pekmezci, Murat

2016-01-01

The authors present clinical outcome data and satisfaction of patients who underwent minimally invasive vertebral body corpectomy and cage placement via a mini-open, extreme lateral, transpsoas approach and posterior short-segment instrumentation for lumbar burst fractures. Patients with unstable lumbar burst fractures who underwent corpectomy and anterior column reconstruction via a mini-open, extreme lateral, transpsoas approach with short-segment posterior fixation were reviewed retrospectively. Demographic information, operative parameters, perioperative radiographic measurements, and complications were analyzed. Patient-reported outcome instruments (Oswestry Disability Index [ODI], 12-Item Short Form Health Survey [SF-12]) and an anterior scar-specific patient satisfaction questionnaire were recorded at the latest follow-up. Twelve patients (7 men, 5 women, average age 42 years, range 22-68 years) met the inclusion criteria. Lumbar corpectomies with anterior column support were performed (L-1, n = 8; L-2, n = 2; L-3, n = 2) and supplemented with short-segment posterior instrumentation (4 open, 8 percutaneous). Four patients had preoperative neurological deficits, all of which improved after surgery. No new neurological complications were noted. The anterior incision on average was 6.4 cm (range 5-8 cm) in length, caused mild pain and disability, and was aesthetically acceptable to the large majority of patients. Three patients required chest tube placement for pleural violation, and 1 patient required reoperation for cage subsidence/hardware failure. Average clinical follow-up was 38 months (range 16-68 months), and average radiographic follow-up was 37 months (range 6-68 months). Preoperative lumbar lordosis and focal lordosis were significantly improved/maintained after surgery. Patients were satisfied with their outcomes, had minimal/moderate disability (average ODI score 20, range 0-52), and had good physical (SF-12 physical component score 41.7% ± 10

Postnatal development of the anterior skull base and nasal septum: CT study

International Nuclear Information System (INIS)

Kim, Kwan Soo; Kim, Hyung Jin; Lee, Kyung Hee; Roh, Hong Gee; Lim, Myung Kwan

2002-01-01

To know the normal CT appearance of the anterior skull base and nasal septum after birth. Coronal CT scans with a helical mode were performed from the nasal bone to the sphenoid sinus in 99 children whose ages ranged from 27 days to 14 years. We investigated the CT appearance of the developing anterior skull base and nasal septum with particular attention to the anteroposterior length of the anterior skull base and the ossification patterns of the cribriform plate, perpendicular plate, crista galli, and vomer. The anteroposterior length of the anterior skull base statistically significantly increased with age. The cribriform plate showed partial or complete ossification in at least one segment at more than 3 months of age and in all three segments at more than 6 months of age. Ossification of the cribriform plate occurred earlier in the middle segment than in the anterior and posterior segments. It began exclusively in the region of the lateral mass of the ethmoid and proceeded medially toward the crista galli. Partial ossification of the perpendicular plate was noted as early as 9 months of age, and complete ossification as early as 13 months of age. All children at 18 months and older showed at least partial ossification of the perpendicular plate. Partial ossification of the crista galli was noted as early as 27 days of age, and complete ossification as early as 3 months of age. CT showed complete ossification of the crista galli in all but two children at 6 months and older. The superior aspect of the vomer exhibited a V- or Y-shape on all CT scans in 66%(65/99) of children at any age. It appeared as an undivided single lump anteriorly and a V or Y posteriorly in 34%(34/99). Knowledge of the normal developing patterns of ossification of the anterior skull base and nasal septum could help prevent errors in interpreting CT scans in this region, especially in infants and young children

Perawatan Ortodontik Gigi Anterior Berjejal dengan Tulang Alveolar yang Tipis

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Miesje K. Purwanegara

2015-09-01

Full Text Available Anterior teeth movement in orthodontic treatment is limited to labiolingual direction by very thin alveolar bone. An uncontrolled anterior tooth movement to labiolingual direction can cause alveolar bone perforation at its root segment. This case report is to remind us that alveolar bone thickness limits orthodontc tooth movement. A case of crowded anterior teeth with thin alveolar bone in malocclusion I is reported. This case is treated using adgewise orthodontic appliance. Protraction of anterior teeth is anticipated due to thin alveolar bone on the anterior surface. The conclusion is although the alveolar bone surrounding the crowded anterior teeth is thin, by controlling the movement the teeth reposition is allowed.

Segmentation of knee injury swelling on infrared images

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Puentes, John; Langet, Hélène; Herry, Christophe; Frize, Monique

2011-03-01

Interpretation of medical infrared images is complex due to thermal noise, absence of texture, and small temperature differences in pathological zones. Acute inflammatory response is a characteristic symptom of some knee injuries like anterior cruciate ligament sprains, muscle or tendons strains, and meniscus tear. Whereas artificial coloring of the original grey level images may allow to visually assess the extent inflammation in the area, their automated segmentation remains a challenging problem. This paper presents a hybrid segmentation algorithm to evaluate the extent of inflammation after knee injury, in terms of temperature variations and surface shape. It is based on the intersection of rapid color segmentation and homogeneous region segmentation, to which a Laplacian of a Gaussian filter is applied. While rapid color segmentation enables to properly detect the observed core of swollen area, homogeneous region segmentation identifies possible inflammation zones, combining homogeneous grey level and hue area segmentation. The hybrid segmentation algorithm compares the potential inflammation regions partially detected by each method to identify overlapping areas. Noise filtering and edge segmentation are then applied to common zones in order to segment the swelling surfaces of the injury. Experimental results on images of a patient with anterior cruciate ligament sprain show the improved performance of the hybrid algorithm with respect to its separated components. The main contribution of this work is a meaningful automatic segmentation of abnormal skin temperature variations on infrared thermography images of knee injury swelling.

Comparison between a New Optical Biometry Device and an Anterior Segment Optical Coherence Tomographer for Measuring Central Corneal Thickness and Anterior Chamber Depth

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Jinhai Huang

2016-01-01

Full Text Available Purpose. To compare between a new optical biometer (AL-Scan, Nidek Co., Aichi, Japan and an anterior segment optical coherence tomographer (Visante AS-OCT, Carl Zeiss Meditec, Dublin, USA for measuring central corneal thickness (CCT, anterior chamber depth (ACD, and aqueous depth (AD. Methods. Sixty-three eyes of 63 normal subjects were examined with AL-Scan and Visante AS-OCT in this prospective study. One eye per subject was measured three times with both devices to record their CCT, ACD, and AD. All procedures were performed by the same operator. Agreement between the two devices was assessed using paired t-tests, Bland-Altman plots, and 95% limits of agreement (LoA. Results. The mean CCT, ACD, and AD measured by AL-Scan were 538.59±27.37 μm, 3.70±0.30 mm, and 3.16±0.30 mm, respectively. The mean values obtained by the Visante OCT were 536.14±26.61 μm for CCT, 3.71±0.29 mm for ACD, and 3.17±0.29 mm for AD. The mean CCT by the AL-Scan was higher than that obtained by the Visante AS-OCT (difference = 2.45±6.07 μm, P<0.05. The differences in ACD and AD measurements were not statistically significant. The 95% LoA of CCT, ACD, and AD were between −9.44 and 14.35 μm, −0.15 and 0.12 mm, and −0.15 and 0.12 mm, respectively. Conclusions. Since these two devices were comparable for measuring CCT, ACD, and AD, their results can be interchangeably used in the clinic.

Segment polarity gene expression in a myriapod reveals conserved and diverged aspects of early head patterning in arthropods.

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Janssen, Ralf

2012-09-01

Arthropods show two kinds of developmental mode. In the so-called long germ developmental mode (as exemplified by the fly Drosophila), all segments are formed almost simultaneously from a preexisting field of cells. In contrast, in the so-called short germ developmental mode (as exemplified by the vast majority of arthropods), only the anterior segments are patterned similarly as in Drosophila, and posterior segments are added in a single or double segmental periodicity from a posterior segment addition zone (SAZ). The addition of segments from the SAZ is controlled by dynamic waves of gene activity. Recent studies on a spider have revealed that a similar dynamic process, involving expression of the segment polarity gene (SPG) hedgehog (hh), is involved in the formation of the anterior head segments. The present study shows that in the myriapod Glomeris marginata the early expression of hh is also in a broad anterior domain, but this domain corresponds only to the ocular and antennal segment. It does not, like in spiders, represent expression in the posterior adjacent segment. In contrast, the anterior hh pattern is conserved in Glomeris and insects. All investigated myriapod SPGs and associated factors are expressed with delay in the premandibular (tritocerebral) segment. This delay is exclusively found in insects and myriapods, but not in chelicerates, crustaceans and onychophorans. Therefore, it may represent a synapomorphy uniting insects and myriapods (Atelocerata hypothesis), contradicting the leading opinion that suggests a sister relationship of crustaceans and insects (Pancrustacea hypothesis). In Glomeris embryos, the SPG engrailed is first expressed in the mandibular segment. This feature is conserved in representatives of all arthropod classes suggesting that the mandibular segment may have a special function in anterior patterning.

Invasive strategies and outcomes for non-ST-segment elevation acute coronary syndromes: a twelve-year experience from SWEDEHEART

NARCIS (Netherlands)

Damman, Peter; Jernberg, Tomas; Lindahl, Bertil; de Winter, Robbert J.; Jeppsson, Anders; Johanson, Per; Held, Claes; James, Stefan K.

2016-01-01

Despite recommendations in recent guidelines for a routine invasive strategy for non-ST-segment elevation acute coronary syndrome (NSTE-ACS), long-term data on the implementation of treatment strategies in clinical practice are not available. Our aim was to provide long-term data on the

Nonnecrotizing anterior scleritis mimicking orbital inflammatory disease

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Lynch MC

2013-08-01

Full Text Available Michelle Chen Lynch,1 Andrew B Mick21Optometry Clinic, Ocala West Veterans Affairs Specialty Clinic, Ocala, FL, USA; 2Eye Clinic, San Francisco VA Medical Center, San Francisco, CA, USABackground: Anterior scleritis is an uncommon form of ocular inflammation, often associated with coexisting autoimmune disease. With early recognition and aggressive systemic therapy, prognosis for resolution is good. The diagnosis of underlying autoimmune disease involves a multidisciplinary approach.Case report: A 42-year-old African American female presented to the Eye Clinic at the San Francisco Veteran Affairs Medical Center, with a tremendously painful left eye, worse on eye movement, with marked injection of conjunctiva. There was mild swelling of the upper eyelid. Visual acuity was unaffected, but there was a mild red cap desaturation. The posterior segment was unremarkable. The initial differential diagnoses included anterior scleritis and orbital inflammatory disease. Oral steroid treatment was initiated with rapid resolution over a few days. Orbital imaging was unremarkable, and extensive laboratory work-up was positive only for antinuclear antibodies. The patient was diagnosed with idiopathic diffuse, nonnecrotizing anterior scleritis and has been followed for over 5 years without recurrence. The rheumatology clinic monitors the patient closely, as suspicion remains for potential arthralgias including human leukocyte antigen-B27-associated arthritis, lupus-associated arthritis, seronegative rheumatoid arthritis, recurrent juvenile idiopathic arthritis, and scleroderma, based on her constitutional symptoms and clinical presentation, along with a positive anti-nuclear antibody lab result.Conclusion: Untreated anterior scleritis can progress to formation of cataracts, glaucoma, uveitis, corneal melting, and posterior segment disease with significant risk of vision loss. Patients with anterior scleritis must be aggressively treated with systemic anti

Transthoracic ultrasonic tissue indices identify patients with severe left anterior descending artery stenosis. Correlation with fractional flow reserve. Pilot study.

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Dobrowolski, Piotr; Kowalski, Mirosław; Rybicka, Justyna; Lech, Agnieszka; Tyczyński, Paweł; Witkowski, Adam; Hoffman, Piotr

2016-01-01

The aim of this study was to evaluate the potential clinical application of ultrasonic tissue indices, with a focus on systolic strain (SS) and systolic strain rate (SSR) parameters derived from transthoracic echocardiography, in the assessment of left anterior descending artery (LAD) stenosis. The data of 30 patients with significant LAD stenosis were analysed. All patients underwent transthoracic echocardiography to obtain systolic myocardial velocity (Sm), longitudinal SS, and SSR from basal, mid, and apical segments of anterior and inferior walls in two-chamber apical view. Severity of LAD obstruction was measured by means of fractional flow reserve (FFR) during coronary catheterisation. Systolic velocities, strain, and strain rate measured in basal, middle, and apical segments of the anterior left ventricular (LV) wall were lower when compared to those obtained from the corresponding, i.e. unaffected, inferior LV wall. There was a significant correlation between FFR and the value of SS, SSR characterising the apical LV segment of the anterior wall (r = -0.583, p = 0.01; r = -0.598, p = 0.01, respectively). Moreover, we found significant correlation between FFR and Sm in the mid-segment of the LV anterior wall (r = 0.611, p = 0.009). We conclude that SS and SSR obtained from the apical segment of the anterior LV wall may be related to the severity of LAD stenosis.

Anterior chest wall examination reviewed

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F. Trotta

2011-09-01

Full Text Available Anterior chest wall involvement is not infrequently observed within inflammatory arthropaties, particularly if one considers seronegative spondiloarthritides and SAPHO syndrome. Physical examination is unreliable and conventional X-rays analysis is an unsatisfactory tool during diagnostic work-up of this region. Scintigraphic techniques yield informations both on the activity and on the anatomical extent of the disease while computerized tomography visualize the elementary lesions, such as erosions, which characterize the process. Moreover, when available, magnetic resonance imaging couple the ability to finely visualize such lesions with the possibility to show early alterations and to characterize the “activity” of the disease, presenting itself as a powerful tool both for diagnosis and follow-up. This review briefly shows the applications of imaging techniques for the evaluation of the anterior chest wall focusing on what has been done in the SAPHO syndrome which can be considered prototypical for this regional involvement since it is the osteo-articular target mainly affected by the disease.

Cost-effectiveness of early versus selectively invasive strategy in patients with acute coronary syndromes without ST-segment elevation

NARCIS (Netherlands)

Dijksman, L. M.; Hirsch, A.; Windhausen, F.; Asselman, F. F.; Tijssen, J. G. P.; Dijkgraaf, M. G. W.; de Winter, R. J.

2009-01-01

AIMS: The ICTUS trial compared an early invasive versus a selectively invasive strategy in high risk patients with a non-ST-segment elevation acute coronary syndrome and an elevated cardiac troponin T. Alongside the ICTUS trial a cost-effectiveness analysis from a provider perspective was performed.

Bilateral anterior tarsal tunnel syndrome variant secondary to extensor hallucis brevis muscle hypertrophy in a ballet dancer: a case report.

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Tennant, Joshua N; Rungprai, Chamnanni; Phisitkul, Phinit

2014-12-01

We present a case of bilateral anterior tarsal tunnel syndrome secondary EHB hypertrophy in a dancer, with successful treatment with bilateral EHB muscle excisions for decompression. The bilateral presentation of this case with the treatment of EHB muscle excision is the first of its type reported in the literature. Copyright © 2014 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

PLATEAU IRIS SYNDROME--CASE SERIES.

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Feraru, Crenguta Ioana; Pantalon, Anca Delia; Chiselita, Dorin; Branisteanu, Daniel

2015-01-01

Plateau iris is characterized by closing the anterior chamber angle due to a large ciliary body or due to its anterior insertion that alters the position of iris periphery in respect to the trabecular meshwork. There are two aspects that need to be differentiated: plateau iris configuration and plateau iris syndrome. The first describes a situation when the iris root is flat and the anterior chamber is not shallow, the latter refers to a post laser iridotomy condition in which a patent iridotomy has removed the relative pupillary block, but goniscopically confirmed angle closure recurs without central shallowing of the anterior chamber. Isolated plateau iris syndrome is rare compared to plateau iris configuration. We hereby present two case reports of plateau iris syndrome in young patients who came to an ophthalmologic consult by chance.

Progressive non-infectious anterior vertebral fusion in a baby with Saethre-Chotzen-acrocephalosyndactyly type III syndrome

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Ali Al Kaissi

2015-09-01

Full Text Available We report on a 3-months old baby of Austrian origin and product of non-consanguineous parents. Abnormal craniofacial contour was the main deformity. The overall clinico-radiographic features were consistent with Saether-Chotzen-acrocephalosyndactyly type III syndrome. Bi-directional sequencing of the exon 8 and of the FGFR3-genes, exons 7 of FGFR3 (Fibroblast growth factor receptor3 genes, the exon 5 of the FGFR1 gene, revealed no mutations. Sagittal MRI imaging of the spine showed anterior vertebral fusion along the thoraco-lumbar vertebrae compatible with the non-infectious type.

Evaluation of segmental left ventricular wall motion by equilibrium gated radionuclide ventriculography.

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Van Nostrand, D; Janowitz, W R; Holmes, D R; Cohen, H A

1979-01-01

The ability of equilibrium gated radionuclide ventriculography to detect segmental left ventricular (LV) wall motion abnormalities was determined in 26 patients undergoing cardiac catheterization. Multiple gated studies obtained in 30 degrees right anterior oblique and 45 degrees left anterior oblique projections, played back in a movie format, were compared to the corresponding LV ventriculograms. The LV wall in the two projections was divided into eight segments. Each segment was graded as normal, hypokinetic, akinetic, dyskinetic, or indeterminate. Thirteen percent of the segments in the gated images were indeterminate; 24 out of 27 of these were proximal or distal inferior wall segments. There was exact agreement in 86% of the remaining segments. The sensitivity of the radionuclide technique for detecting normal versus any abnormal wall motion was 71%, with a specificity of 99%. Equilibrium gated ventriculography is an excellent noninvasive technique for evaluating segmental LV wall motion. It is least reliable in assessing the proximal inferior wall and interventricular septum.

Optical Coherence Tomography Examination of the Anterior Segment in a Case of Corneal Perforation and Lens Trauma by Chestnut Burr

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Takashi Ono

2018-02-01

Full Text Available Chestnut burrs, the thorny encapsulation of chestnut fruit, can sometimes cause corneal injuries and ulceration, with poor prognoses. We report a case of corneal perforation and damaged anterior lens capsule due to a chestnut burr, using anterior segment optical coherence tomography (AS-OCT. A 67-year-old woman with a chestnut burr injury in her right eye was referred to our hospital. Her right best-corrected visual acuity (BCVA was 0.8. Slit-lamp examination and AS-OCT showed perforation involving the endothelial layer at the center of the cornea. The iris and anterior lens capsule were damaged. Cell infiltration was observed around the wound. Bacterial examination showed gram-positive cocci but no fungi. The patient was diagnosed with a corneal perforation and bacterial keratitis. Levofloxacin 1.5% and cefmenoxime treatments were initiated and a soft contact lens was placed to seal the wound. On day 3, there was no improvement in the corneal cell infiltration, but AS-OCT suggested that the inner wound had closed. A culture test revealed the presence of Propionibacterium acnes, which was sensitive to both levofloxacin and cefmenoxime. Therefore, we continued the same antibiotic treatment. On day 26, the opacification and cell infiltration at the center of the cornea had improved. AS-OCT showed healing of the corneal wound with reduction in the central corneal thickness. Her BCVA improved to 1.0. AS-OCT was a valuable tool to noninvasively observe wound shape and detect the presence of any intracorneal foreign bodies.

Automatic anterior chamber angle assessment for HD-OCT images.

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Tian, Jing; Marziliano, Pina; Baskaran, Mani; Wong, Hong-Tym; Aung, Tin

2011-11-01

Angle-closure glaucoma is a major blinding eye disease and could be detected by measuring the anterior chamber angle in the human eyes. High-definition OCT (Cirrus HD-OCT) is an emerging noninvasive, high-speed, and high-resolution imaging modality for the anterior segment of the eye. Here, we propose a novel algorithm which automatically detects a new landmark, Schwalbe's line, and measures the anterior chamber angle in the HD-OCT images. The distortion caused by refraction is corrected by dewarping the HD-OCT images, and three biometric measurements are defined to quantitatively assess the anterior chamber angle. The proposed algorithm was tested on 40 HD-OCT images of the eye and provided accurate measurements in about 1 second.

In silico evo-devo: reconstructing stages in the evolution of animal segmentation

NARCIS (Netherlands)

Hogeweg, Paulien; ten Tusscher, Kirsten H. W. J.; Davis, GK; Patel, NH; Peel, A; Akam, M; Couso, JP; Budd, GE; Seaver, EC; Minelli, A; Fusco, G; Tautz, D; Jacobs, DK; Hughes, NC; Fitz-Gibbon, ST; Winchell, CJ; Blair, SS; Wanninger, A; Kristof, A; Brinkmann, N; Chipman, AD; Richmond, DL; Oates, AC; Gold, DA; Runnegar, B; Gehling, JG; Jacobs, DK; Rivera, A; Weisblat, D; Williams, T; Blachuta, B; Hegna, TA; Nagy, LM; Balavoine, G; Peel, A; Bénazéraf, B; Pourquié, O; Mayer, G; Kato, C; Quast, B; Chisholm, RH; Landman, KA; Quinn, LM; Nakamoto, A; Hester, SD; Constantinou, SJ; Blaine, WG; Tewksbury, AB; Matei, MT; Nagy, LM; Williams, TA; Graham, A; Butts, T; Lumsden, A; Kiecker, C; François, P; Hakim, V; Siggia, ED; Fujimoto, K; Ishihara, S; Kaneko, K; Tusscher, KH; Hogeweg, P; Crombach, A; Hogeweg, P; Salazar-Ciudad, I; Newman, SA; Solé, RV; Pankratz, MJ; Jäckle, H; Crampin, EJ; Hackborn, WW; Maini, PK; Harper, JL; Rosen, BR; White, J; Tusscher, KHWJ; Petersen, CP; Reddien, PW; Martin, BL; Kimelman, D; Young, T; Rowland, JE; Ven, C; Bialecka, M; Novoa, A; Carapuco, M; Nes, J; Graaff, W; Duluc, I; Freund, J-N; Beck, F; Mallo, M; Deschamps, J; Meinhardt, H; Kappen, C; Schughart, K; Ruddle, FH

2016-01-01

The evolution of animal segmentation is a major research focus within the field of evolutionary–developmental biology. Most studied segmented animals generate their segments in a repetitive, anterior-to-posterior fashion coordinated with the extension of the body axis from a posterior growth zone.

A patient with Bartter syndrome accompanying severe growth hormone deficiency and focal segmental glomerulosclerosis.

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Akil, Ipek; Ozen, Serkan; Kandiloglu, Ali Riza; Ersoy, Betul

2010-06-01

Bartter syndrome is a rare autosomal recessive, salt-losing disorder characterized by hypokalemic hypochloremic metabolic alkalosis. A 10-year-old boy had severe growth retardation (height standard deviation score -8.15). He had a thin, triangular face, prominent ears and forehead, and big eyes. Megacystis, bilateral hydroureteronephrosis, and residual urine were detected in ultrasonography, but there was no vesicoureteral reflux. Lumbosacral magnetic resonance (MR) showed posterior disc bulging at L4-5. Serum sodium and chloride levels were normal, but mild hypokalemia was overlooked initially. During follow-up, hypokalemic hypochloremic metabolic alkalosis developed, with high urinary chloride and potassium excretion (52 and 43 mEq/L, respectively). The patient, with renal salt loss, was thought to have classic Bartter syndrome due to absence of nephrocalcinosis, presence of persistent hypercalciuria and sensorineural deafness, and presence of relatively mild clinical and laboratory findings, except polyuria initially. The child was treated with indomethacin, spironolactone, and oral potassium in addition to growth hormone (GH). During treatment, he had considerable increase in weight and height compared with the period of GH therapy only. We present this case because, although growth retardation is a major feature of Bartter syndrome, associated GH deficiency is rarely reported in the literature. Diagnosis of Bartter syndrome was made later, as our patient was followed for megacystis and megaureter secondary to the neurogenic bladder and GH deficiency initially; and proteinuria associated with focal segmental glomerulosclerosis responded to treatment for Bartter syndrome.

[Fixed appliance therapy in patients with impaired short-circuit in the anterior part of the maxilla].

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Matthews-Brzozowska, Teresa; Pobol-Aidi, Małgorzata; Cudziło, Dorota

2015-03-01

Malocclusion in the anterior segment of maxilla and mandible are easily visible not only for dentists but also for the doctors of other specialties. Early diagnosis and appropriate therapy is important not only for occlusion but also for aesthetic reasons. The aim of the paper is to evaluate the anterior segment of maxilla and mandible in patients with malocclusion in this part and correct occlusion in the lateral segments. Medical documentation, i.e. medical history, extra- and intraoral radiograms, diagnostic casts, panoramic and lateral cephalometric radiograms of patients aged 7-12 diagnosed with malocclusion in the anterior segment of maxilla and mandible and who were treated with a fixed sectional appliance and facemask was analyzed. Descriptive and cephalometric features were analyzed before (T1) and after (T2) the treatment in 25 children. The differences between the status before and after the treatment, and the extent of change between T1 and T2 were analyzed. Statistical analysis of mean values of selected metrical features before (at T1) and after (at T2) the treatment has revealed that all metrical features concerning soft, bony and dental tissues determining the facial profile, the shape of the bony and dental structures have changed and have reached values which are closer to the norm for the population for selected features. The changes were statistically significant (p<0.0001). Treatment with fixed appliances segment facemask resulted in statistically significant improvement in the parameters investigated, which demonstrates the applicability of this therapy in the treatment of anterior maxillary segment in patients with mixed dentition. © 2015 MEDPRESS.

Klippel-Feil Syndrome

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... proteins that are involved in bone development and segmentation of the vertebrae. × Definition Klippel-Feil Syndrome is a rare disorder characterized ... proteins that are involved in bone development and segmentation of the vertebrae. View Full Definition ... Treatment Treatment for Klippel-Feil Syndrome is symptomatic ...

Anterior internal impingement of the shoulder in rugby players and other overhead athletes

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Siddharth R. Shah, MBBS, MSc Sports Medicine (UK, MRCS-Ed

2017-04-01

Conclusion: This series of anterior internal impingement, which we believe is the largest in the literature to date, demonstrates the value of an to assess and successfully treat overhead athletes with anterior impingement syndrome.

Establishing Age-Adjusted Reference Ranges for Iris-Related Parameters in Open Angle Eyes with Anterior Segment Optical Coherence Tomography.

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Jeffrey R Peterson

Full Text Available Define criteria for iris-related parameters in an adult open angle population as measured with swept source Fourier domain anterior segment optical coherence tomography (ASOCT.Ninety-eight eyes of 98 participants with open angles were included and stratified into 5 age groups (18-35, 36-45, 46-55, 56-65, and 66-79 years. ASOCT scans with 3D mode angle analysis were taken with the CASIA SS-1000 (Tomey Corporation, Nagoya, Japan and analyzed using the Anterior Chamber Analysis and Interpretation software. Anterior iris surface length (AISL, length of scleral spur landmark (SSL to pupillary margin (SSL-to-PM, iris contour ratio (ICR = AISL/SSL-to-PM, pupil radius, radius of iris centroid (RICe, and iris volume were measured. Outcome variables were summarized for all eyes and age groups, and mean values among age groups were compared using one-way analysis of variance. Stepwise regression analysis was used to investigate demographic and ocular characteristic factors that affected each iris-related parameter.Mean (±SD values were 2.24 mm (±0.46, 4.06 mm (±0.27, 3.65 mm (±0.48, 4.16 mm (±0.47, 1.14 (±0.04, 1.51 mm2 (±0.23, and 38.42 μL (±4.91 for pupillary radius, RICe, SSL-to-PM, AISL, ICR, iris cross-sectional area, and iris volume, respectively. Both pupillary radius (P = 0.002 and RICe (P = 0.027 decreased with age, while SSL-to-PM (P = 0.002 and AISL increased with age (P = 0.001. ICR (P = 0.54 and iris volume (P = 0.49 were not affected by age.This study establishes reference values for iris-related parameters in an adult open angle population, which will be useful for future studies examining the role of iris changes in pathologic states.

Evaluation of the Effects of Menstrual Cycle on Anterior Chamber Parameters as Measured with Pentacam

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Arzu Seyhan Karatepe

2013-01-01

Full Text Available Pur po se: To evaluate the effects of endogenous gonadotropic hormones (follicle-stimulating hormone, luteinizing hormone and sex steroids (progesterone, estrogen to anterior segment parameters. Ma te ri al and Met hod: Thirty healthy females who had a menstrual cycle of 28±1 day and with a mean age of 36.5±7.56 (range, 20 – 46 years were included in the study. Starting from the first day of their cycle, Pentacam Scheimpflug camera measurements were performed on the 1st, 3rd, 7th, 12th, 16th, 21st, 26th, and 28th days. The central corneal thickness, anterior chamber depth, anterior segment volume, keratometric values, anterior chamber angle value, and pupilla diameter of both eyes were evaluated. Repeated measures analysis of variance test was used for statistical analysis. Re sults: No difference that reaches statistical significance was found in the means of central corneal thickness, anterior chamber volume, keratometric values, anterior chamber angle, and pupilla diameter between the days. Mean anterior chamber depth measurement of the right eyes on the 1st day was 2.72±0.44 mm, whereas it was 2.77±0.46 mm on the 26th day. Mean anterior chamber depth measurement of the left eyes on the 1st day was 2.74±0.42 mm, whereas it was 2.80±0.43 mm on the 26th day. This increment of anterior chamber depth value from the 1st to the 26th days was found to be statistically significant (p≤0.05. Dis cus si on: Progesterone and estrogen that rise in the second half of the menstrual cycle might have a deepening effect on the anterior chamber. These findings should be further investigated with more profound studies that also evaluate the hormonal values and their correlations with anterior segment parameters. (Turk J Ophthalmol 2013; 43: 15-8

Scalloping at the lumbosacral canal

International Nuclear Information System (INIS)

Reinhardt, R.

1987-01-01

Scalloping is an indentation of the dorsal side of the vertebral body (anterior wall of the lumbosacral or sacral canal) which typically involves several adjacent lumbal vertebral body segments and the anterior wall of the canalis sacralis. Occurrence without underlying disease is rare; it occurs most frequently with chondrodystrophy, neurofibromatosis, Morquio's syndrome, Hurler's syndrome, acromegaly, Ehlers-Danlos syndrome, Marfan's syndrome, cysts, tumors and in peridural lipomas. (orig.) [de

Anterior capsulotomy using the CO2 laser

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Barak, Adiel; Ma-Naim, Tova; Rosner, Mordechai; Eyal, Ophir; Belkin, Michael

1998-06-01

Continuous circular capsulorhexis (CCC) is the preferred technique for removal of the anterior capsule during cataract surgery due to this technique assuring accurate centration of the intraocular lens. During modern cataract surgery, especially with small or foldable intra ocular lenses, centration of the lens is obligatory. Radial tears at the margin of an anterior capsulotomy may be associated with the exit of at least one loop of an intraocular lens out of the capsular bag ('pea pod' effect) and its subsequent decentration. The anterior capsule is more likely to ream intact if the continuous circular capsulorhexis (CCC) technique is used. Although manual capsulorhexis is an ideal anterior capsulectomy technique for adults, many ophthalmologists are still uncomfortable with it and find it difficult to perform, especially in complicated cases such as these done behind small pupil, cataract extraction in children and pseudoexfoliation syndrome. We have developed a technique using a CO2 laser system for safe anterior capsulotomy and tested it in animal eyes.

Anterior segment optical coherence tomography changes with introduction and discontinuation of tamsulosin.

Science.gov (United States)

Al-Kharashi, Abdullah; Azimzadeh, Amir A; Leung, Jerry; Radomski, Sidney; Radomski, Lenny; Lam, Wai-Ching

2016-01-01

The aim of this study was to quantify changes and reversibility in pupil dilation and iris dilator muscle region thickness associated with introduction and subsequent discontinuation of tamsulosin in patients naïve to this drug with the aid of an anterior OCT system. The study was carried out on 7 patients (14 eyes) naïve to tamsulosin and with benign prostatic hypertrophy (BHP). Measurements taken by Vistante OCT were done pre- and post-dilation of the following: pupil size, iris dilator muscle region (DMR) thickness, sphincter muscle region (SMR) thickness, and anterior chamber depth. These measurement were taken at Day 0 (tamsulosin naive), Day 30 (after one month of tamsulosin, the treatment period) and day 60 (after one month of no tamsulosin, the discontinuation period). Post-dilation pupil diameter significantly increased during the discontinuation period ( P  = 0.047). Iris DMR thickness measurements post-dilation significantly decreased during treatment ( P  = 0.00044), discontinuation (0.00011), and combined periods ( P  = 0.000050). Anterior chamber depth measurements in post-dilation were significantly decreased during treatment ( P  = 0.0016), discontinuation ( P  = 0.017), and combined periods ( P  = 0.00022). Tamsulosin discontinuation effectively increases dilated pupil size, a measure that has been inversely linked to IFIS incidence pre-operatively. Decreased DMR thickness in this short term likely illustrates changes aside from atrophy, such as vascular changes. Decreased anterior chamber depths suggest aqueous humor production is decreased as well.

Carotid-anterior cerebral artery anastomosis on MR angiography: a university hospital-based study

Energy Technology Data Exchange (ETDEWEB)

Uchino, Akira; Saito, Naoko; Okada, Yoshitaka; Inoue, Kaiji [Saitama Medical University International Medical Center, Department of Diagnostic Radiology, Hidaka, Saitama (Japan)

2012-01-15

Rarely in the anterior circulation, an anastomosis of the carotid and anterior cerebral arteries occurs when an anomalous branch arises from the ophthalmic segment of the internal carotid artery and anastomoses with the A1-A2 junction of the anterior communicating artery. Right-side predominance is known. To our knowledge, the incidence of carotid-anterior cerebral artery anastomosis has not been reported, so we researched cases in our institution records to determine incidence and investigated characteristic features of the condition on magnetic resonance (MR) angiography. To isolate such cases, we retrospectively reviewed cranial MR angiographic images of 3,491 consecutive patients in our institution. We found three cases with carotid-anterior cerebral artery anastomosis (two men, one woman), representing an incidence of 0.086%. The anastomosis was on the right in all three cases. A normal A1 segment of the anterior cerebral artery (ACA) was present in two cases but could not be identified in the remaining case on MR angiographic images that included source images. Two of the three patients demonstrated associated arterial variations in their carotid systems. On MR angiography, we observed a 0.086% incidence of carotid-anterior cerebral artery anastomosis in our institution and reaffirmed the right-side predominance of this anomaly. We found a high frequency of other associated arterial variations in the carotid system. (orig.)

Anterior ST depression with acute transmural inferior infarction due to posterior infarction. A vectorcardiographic and scintigraphic study

International Nuclear Information System (INIS)

Mukharji, J.; Murray, S.; Lewis, S.E.; Croft, C.H.; Corbett, J.R.; Willerson, J.T.; Rude, R.E.

1984-01-01

The hypothesis that anterior ST segment depression represents concomitant posterior infarction was tested in 49 patients admitted with a first transmural inferior myocardial infarction. Anterior ST depression was defined as 0.1 mV or more ST depression in leads V1, V2 or V3 on an electrocardiogram recorded within 18 hours of infarction. Serial vectorcardiograms and technetium pyrophosphate scans were obtained. Eighty percent of the patients (39 of 49) had anterior ST depression. Of these 39 patients, 34% fulfilled vectorcardiographic criteria for posterior infarction, and 60% had pyrophosphate scanning evidence of posterior infarction. Early anterior ST depression was neither highly sensitive (84%) nor specific (20%) for the detection of posterior infarction as defined by pyrophosphate imaging. Of patients with persistent anterior ST depression (greater than 72 hours), 87% had posterior infarction detected by pyrophosphate scan. In patients with inferior myocardial infarction, vectorcardiographic evidence of posterior infarction correlated poorly with pyrophosphate imaging data. Right ventricular infarction was present on pyrophosphate imaging in 40% of patients with pyrophosphate changes of posterior infarction but without vectorcardiographic evidence of posterior infarction. It is concluded that: 1) the majority of patients with acute inferior myocardial infarction have anterior ST segment depression; 2) early anterior ST segment depression in such patients is not a specific marker for posterior infarction; and 3) standard vectorcardiographic criteria for transmural posterior infarction may be inaccurate in patients with concomitant transmural inferior myocardial infarction or right ventricular infarction, or both

Roentgenological diagnoss of central segmental lung cancer

International Nuclear Information System (INIS)

Gurevich, L.A.; Fedchenko, G.G.

1984-01-01

Basing on an analysis of the results of clinicoroentgenological examination of 268 patments roentgenological semiotics of segmental lung cancer is presented. Some peculiarities of the X-ray picture of cancer of different segments of the lungs were revealed depending on tumor site and growth type. For the syndrome of segmental darkening the comprehensive X-ray methods where the chief method is tomography of the segmental bronchi are proposed

Scalloping at the lumbosacral canal

Energy Technology Data Exchange (ETDEWEB)

Reinhardt, R.

1987-07-01

Scalloping is an indentation of the dorsal side of the vertebral body (anterior wall of the lumbosacral or sacral canal) which typically involves several adjacent lumbal vertebral body segments and the anterior wall of the canalis sacralis. Occurrence without underlying disease is rare; it occurs most frequently with chondrodystrophy, neurofibromatosis, Morquio's syndrome, Hurler's syndrome, acromegaly, Ehlers-Danlos syndrome, Marfan's syndrome, cysts, tumors and in peridural lipomas.

Segmental Colitis Complicating Diverticular Disease

Directory of Open Access Journals (Sweden)

Guido Ma Van Rosendaal

1996-01-01

Full Text Available Two cases of idiopathic colitis affecting the sigmoid colon in elderly patients with underlying diverticulosis are presented. Segmental resection has permitted close review of the histopathology in this syndrome which demonstrates considerable similarity to changes seen in idiopathic ulcerative colitis. The reported experience with this syndrome and its clinical features are reviewed.

Anterior Pituitary Aplasia in an Infant with Ring Chromosome 18p Deletion

Directory of Open Access Journals (Sweden)

Edward J. Bellfield

2016-01-01

Full Text Available We present the first reported case of an infant with 18p deletion syndrome with anterior pituitary aplasia secondary to a ring chromosome. Endocrine workup soon after birth was reassuring; however, repeat testing months later confirmed central hypopituitarism. While MRI reading initially indicated no midline defects, subsequent review of the images confirmed anterior pituitary aplasia with ectopic posterior pituitary. This case demonstrates how deletion of genetic material, even if resulting in a chromosomal ring, still results in a severe syndromic phenotype. Furthermore, it demonstrates the necessity of close follow-up in the first year of life for children with 18p deletion syndrome and emphasizes the need to verify radiology impressions if there is any doubt as to the radiologic findings.

Is pseudoexfoliation syndrome associated with coronary artery disease?

Science.gov (United States)

Emiroglu, Mehmet Yunus; Coskun, Erol; Karapinar, Hekim; Capkın, Musa; Kaya, Zekeriya; Kaya, Hasan; Akcakoyun, Mustafa; Kargin, Ramazan; Simsek, Zeki; Acar, Göksel; Aung, Soe Moe; Pala, Selcuk; Özdemir, Burak; Esen, Ali Metin; Kırma, Cevat

2010-01-01

Background: Pseudoexfoliation syndrome (PEX) is recognised by chronic deposition of abnormal pseudoexfoliation material on anterior segment structures of the eye, especially the anterior lens capsule. In recent years, several studies have shown the presence of vascular, cardiac and other organ pseudoexfoliative material in patients with ocular pseudoexfoliation. Aims: The purpose of this study is to determine whether an association exists between ocular pseudoexfoliation and coronary artery disease, aortic aneurysms and peripheric vascular disease. Patients and Methods: 490 patients who underwent coronary angiography (CAG) at Kosuyolu Cardiovascula Research and Training Hospital were included in the study. Patients were evaluated for conventional risk factors such as age, sex, family history, hypertension, diabetes, dislipidemia and smoking. Detailed eye examinations including evaluation of lens were done in all patients. The presence of PEX material in the anterior segment was best appreciated by slit lamp after pupillary dilation. The patients were divided into two groups according to the presence of PEX, and compared for the presence of CAD and other risk factors. Results: CAD was present in 387 patients. 103 patients had normal coronary angiography. 20 (5.2 %) of CAD patients and 4 (3.9%) of normal CAG patients were found to have PEX (p>0.05). There was no significant relationship between CAD and the presence of PEX (p>0.05). When patients were grouped according to the presence of PEX, only age was significantly different between the two groups (r: 0.25, p<0.001). Conclusion: There is no significant relationship between the presence of PEX and CAD. Further studies in larger scales with elderly population may be more valuable. PMID:22558552

The change of volume of each hepatic segment in liver cirrhosis

International Nuclear Information System (INIS)

Arai, Kazunori; Takashima, Tsutomu; Matsui, Osamu; Kadoya, Masumi; Kameyama, Tomiaki; Nishijima, Hiroshi; Takanaka, Tsuyoshi; Gabata, Toshifumi

1986-01-01

We studied morphological changes of liver due to liver cirrhosis by evaluating the volume of liver and each hepatic segments (left lateral, left medial, right anterior, right posterior, and caudate lobe) divided using dynamic sequential CT during arterial portography. In liver cirrhosis, left lateral segment and caudate lobe were relatively enlarged, while right lobe and left medial segment showed significant shrinkage. But when posterior inferior right hepatic vein was evident on CT, right posterior segment did not shrink. (author)

Anterior Cervical Osteophytes Causing Dysphagia and Dyspnea: An Uncommon Entity Revisited

OpenAIRE

Giger, Roland; Dulguerov, Pavel; Payer, Michael

2007-01-01

Large anterior cervical osteophytes can occur in degeneration of the cervical spine or in diffuse idiopathic skeletal hyperostosis (DISH). We present the case of an 83-year-old patient with progressive dysphagia and acute dyspnea, necessitating emergency tracheotomy. Voluminous anterior cervical osteophytes extending from C3 to C7 and narrowing the pharyngoesophageal segment by external compression and bilateral vocal fold immobility were diagnosed radiologically and by fiberoptic laryngoscop...

Case report of a rarely seen long-segment middle aortic syndrome.

Science.gov (United States)

Yakut, Kahraman; Erdoğan, İlkay

2017-03-01

Middle aortic syndrome (MAS) follows a course with distal thoracic and abdominal aorta stenosis. It is a rare disease that is usually diagnosed after the first decade of life. Clinical reflection of MAS is often in the form of hypertension and claudication in the lower extremities. Its etiology is unclear, but is known to be associated with congenital or acquired diseases. This pathology, which is accompanied by malignant hypertension, often does not respond to medical treatment. In patients with MAS, surgical treatment is first line recommendation to prevent complications such as hypertension, heart failure, intracranial bleeding, or aortic rupture. In order to draw attention to this disease, presently described is case of high blood pressure detected during routine examination of a child who had no complaint, and discovery of long-segment stenosis in the abdominal aorta identified with echocardiography and conventional angiography.

Influence of inpatient service specialty on care processes and outcomes for patients with non ST-segment elevation acute coronary syndromes.

Science.gov (United States)

Roe, Matthew T; Chen, Anita Y; Mehta, Rajendra H; Li, Yun; Brindis, Ralph G; Smith, Sidney C; Rumsfeld, John S; Gibler, W Brian; Ohman, E Magnus; Peterson, Eric D

2007-09-04

Since the broad dissemination of practice guidelines, the association of specialty care with the treatment of patients with acute coronary syndromes has not been studied. We evaluated 55 994 patients with non-ST-segment elevation acute coronary syndromes (ischemic ST-segment changes and/or positive cardiac markers) included in the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines) Quality Improvement Initiative from January 2001 through September 2003 at 301 tertiary US hospitals with full revascularization capabilities. We compared baseline characteristics, the use of American College of Cardiology/American Heart Association guidelines class I recommendations, and in-hospital outcomes by the specialty of the primary in-patient service (cardiology versus noncardiology). A total of 35 374 patients (63.2%) were primarily cared for by a cardiology service, and these patients had lower-risk clinical characteristics, but they more commonly received acute (processes were improved when care was provided by a cardiology service regardless of the propensity to receive cardiology care. The adjusted risk of in-hospital mortality was lower with care provided by a cardiology service (adjusted odds ratio 0.80, 95% confidence interval 0.73 to 0.88), and adjustment for differences in the use of acute medications and invasive procedures partially attenuated this mortality difference (adjusted odds ratio 0.92, 95% confidence interval 0.83 to 1.02). Non-ST-segment elevation acute coronary syndrome patients primarily cared for by a cardiology inpatient service more commonly received evidence-based treatments and had a lower risk of mortality, but these patients had lower-risk clinical characteristics. Results from the present analysis highlight the difficulties with accurately determining how specialty care is associated with treatment patterns and clinical outcomes for patients with acute

Pregnancy associated plasma protein A, a potential marker for vulnerable plaque in patients with non-ST-segment elevation acute coronary syndrome

DEFF Research Database (Denmark)

Iversen, Kasper K; Teisner, Ane S; Teisner, Borge

2009-01-01

OBJECTIVES: To describe the presence and time-related pattern of circulating pregnancy associated plasma protein A (PAPP-A) levels in patients with non ST-segment elevation acute coronary syndrome (NSTE-ACS). DESIGN AND METHODS: Consecutively admitted patients (N=573) with clinical signs of NSTE-...

Failed back surgery syndrome: the role of symptomatic segmental single-level instability after lumbar microdiscectomy.

Science.gov (United States)

Schaller, B

2004-05-01

Segmental instability represents one of several different factors that may cause or contribute to the failed back surgery syndrome after lumbar microdiscectomy. As segmental lumbar instability poses diagnostic problems by lack of clear radiological and clinical criteria, only little is known about the occurrence of this phenomenon following primary microdiscectomy. Retrospectively, the records of 2,353 patients were reviewed according to postoperative symptomatic segmental single-level instability after lumbar microdiscectomy between 1989 and 1997. Progressive neurological deficits increased (mean of 24 months; SD: 12, range 1-70) after the initial surgical procedure in 12 patients. The mean age of the four men and eight women was 43 years (SD: 6, range 40-77). The main symptoms and signs of secondary neurological deterioration were radicular pain in 9 of 12 patients, increased motor weakness in 6 of 12 patients and sensory deficits in 4 of 12 patients. All 12 symptomatic patients had radiological evidence of segmental changes correlating with the clinical symptoms and signs. All but one patient showed a decrease in the disc height greater than 30% at the time of posterior spondylodesis compared with the preoperative images before lumbar microdiscectomy. All patients underwent secondary laminectomy and posterior lumbar sponylodesis. Postoperatively, pain improved in 8 of 9 patients, motor weakness in 3 of 6 patients, and sensory deficits in 2 of 4 patients. During the follow-up period of 72+/-7 months, one patient required a third operation to alleviate spinal stenosis at the upper end of the laminectomy. Patients with secondary segmental instability following microdiscectomy were mainly in their 40s. Postoperative narrowing of the intervertebral space following lumbar microdiscectomy is correlated to the degree of intervertebral disc resection. It can therefore be concluded that (1) patients in their 40s are prone to postoperative narrowing of the intervertebral

Lens thickness assessment: anterior segment optical coherence tomography versus A-scan ultrasonography

Directory of Open Access Journals (Sweden)

Nikoo Hamzeh

2015-12-01

Full Text Available AIM: To assess lens thickness measurements with anterior segment-optical coherence tomography (AS-OCT in comparison with A-scan ultrasonography (A-scan US. METHODS: There were 218 adult subjects (218 eyes aged 59.2±9.2y enrolled in this prospective cross-sectional study. Forty-three eyes had open angles and 175 eyes had narrow angles. Routine ophthalmic exam was performed and nuclear opacity was graded using the Lens Opacities Classification System III (LOCS III. Lens thickness was measured by AS-OCT (Visante OCT, Carl Zeiss Meditec, Dublin, CA, USA. The highest quality image was selected for each eye and lens thickness was calculated using ImageJ software. Lens thickness was also measured by A-scan US. RESULTS: Interclass correlations showed a value of 99.7% for intra-visit measurements and 95.3% for inter-visit measurements. The mean lens thickness measured by AS-OCT was not significantly different from that of A-scan US (4.861±0.404 vs 4.866±0.351 mm, P=0.74. Lens thickness values obtained from the two instruments were highly correlated overall (Pearson correlation coefficient=0.81, P<0.001, and in all LOCS III specific subgroups except in grade 5 of nuclear opacity. Bland-Altman analysis revealed a 95% limit of agreement from -0.45 to 0.46 mm. Lens thickness difference between the two instruments became smaller as the lens thickness increased and AS-OCT yielded smaller values than A-scan US in thicker lens (β=-0.29, P<0.001 CONCLUSION: AS-OCT-derived lens thickness measurement is valid and comparable to the results obtained by A-scan US. It can be used as a reliable noncontact method for measuring lens thickness in adults with or without significant cataract.

Update on pigment dispersion syndrome and pigmentary glaucoma.

Science.gov (United States)

Okafor, Kingsley; Vinod, Kateki; Gedde, Steven J

2017-03-01

The present article reviews the clinical features and pathogenesis of pigment dispersion syndrome and pigmentary glaucoma and provides an update regarding their diagnosis and management. Newer imaging modalities including ultrasound biomicroscopy and anterior segment optical coherence tomography facilitate visualization of the iris concavity characteristic of eyes with pigment dispersion syndrome and pigmentary glaucoma. Patients with pigmentary glaucoma may be distinguished from those with other glaucoma types by the presence of typical symptoms, personality type, and patterns of diurnal intraocular pressure fluctuation. Although laser iridotomy has been shown to alter iris anatomy in pigmentary glaucoma, it is not proven to slow visual field progression. Multiple trials have validated the safety and efficacy of filtering surgery in treating pigmentary glaucoma, with fewer studies published on the role of micro-invasive glaucoma surgery. Literature from the review period has further defined the unique clinical characteristics of pigment dispersion syndrome and pigmentary glaucoma. Laser surgery has a limited role in the management of these entities, whereas trabeculectomy remains an acceptable first-line surgical treatment. Further studies are needed to define the potential application of the newer micro-invasive glaucoma procedures in pigmentary glaucoma.

Churg-Strauss syndrome presenting with acute kidney injury in a case of primary focal segmental glomerulosclerosis.

Science.gov (United States)

Patil, Sachin B; Vanikar, Aruna V; Gumber, Manoj R; Kute, Vivek B; Shah, Pankaj R; Patel, Himanshu V; Trivedi, Hargovind L

2014-01-01

Churg-Strauss syndrome (CSS) also called allergic granulomatosis and angiitis is a multisystem disorder. Churg-Strauss syndrome is defined as an eosinophil-rich, granulomatous inflammation involving the respiratory tract, along with necrotizing vasculitis affecting small- to medium-sized vessels, and is associated with asthma and eosinophilia. Renal involvement in CSS varies from 26 to 88 % but is usually of mild to moderate stage, and advanced renal failure is uncommon. We encountered an unusual case of 27-year-old man with asthma and primary focal segmental glomerulosclerosis diagnosed as CSS showing myeloperoxidase anti-neutrophil cytoplasmic antibody-associated acute kidney injury with crescentic glomerulonephritis. Patient responded to steroid and cyclophosphamide. Over a follow-up of 2 months, he has no hematuria/eosinophilia and serum creatinine of 2.3 mg/dL has decreased to 1.7 mg/dL.

Alterations of the outer retina in non-arteritic anterior ischaemic optic neuropathy detected using spectral-domain optical coherence tomography.

Science.gov (United States)

Ackermann, Philipp; Brachert, Maike; Albrecht, Philipp; Ringelstein, Marius; Finis, David; Geerling, Gerd; Aktas, Orhan; Guthoff, Rainer

2017-07-01

A characteristic disease pattern may be reflected by retinal layer thickness changes in non-arteritic anterior ischaemic optic neuropathy measured using spectraldomain optical coherence tomography. Retinal layer segmentation is enabled by advanced software. In this study, retinal layer thicknesses in acute and chronic non-arteritic anterior ischaemic optic neuropathy were compared. A single-centre cross-sectional analysis was used. A total of 27 patients (20 age-matched healthy eyes) were included: 14 with acute (optic neuropathy. Macular volume and 12° peripapillary ring optical coherence tomography scans were used. The peripapillary thicknesses of the following layers were determined by manual segmentation: retinal nerve fibres, ganglion cells + inner plexiform layer, inner nuclear layer + outer plexiform layer, outer nuclear layer + inner segments of the photoreceptors and outer segments of the photoreceptors to Bruch's membrane. Macular retinal layer thicknesses were automatically determined in volume cubes centred on the fovea. Peripapillary retinal swelling in acute nonarteritic anterior ischaemic optic neuropathy was attributable to retinal nerve fibre layer, ganglion cell layer/inner plexiform layer and outer nuclear layer/segments of the photoreceptors thickening. In chronic cases, peripapillary retinal nerve fibre layer, macular ganglion cell layer and inner plexiform layer thinning were observed. In acute non-arteritic anterior ischaemic optic neuropathy, the inner and outer peripapillary retinal layers are affected by thickness changes. In chronic cases, atrophy of the ganglion cells and their axons and dendrites is evident by inner retinal layer thinning. © 2017 Royal Australian and New Zealand College of Ophthalmologists.

Comparative Study of Anterior Eye Segment Measurements with Spectral Swept-Source and Time-Domain Optical Coherence Tomography in Eyes with Corneal Dystrophies.

Science.gov (United States)

Nowinska, Anna K; Teper, Sławomir J; Janiszewska, Dominika A; Lyssek-Boron, Anita; Dobrowolski, Dariusz; Koprowski, Robert; Wylegala, Edward

2015-01-01

To compare anterior eye segment measurements and morphology obtained with two optical coherence tomography systems (TD OCT, SS OCT) in eyes with corneal dystrophies (CDs). Fifty healthy volunteers (50 eyes) and 54 patients (96 eyes) diagnosed with CD (epithelial basement membrane dystrophy, EBMD = 12 eyes; Thiel-Behnke CD = 6 eyes; lattice CD TGFBI type = 15 eyes; granular CD type 1 = 7 eyes, granular CD type 2 = 2 eyes; macular CD = 23 eyes; and Fuchs endothelial CD = 31 eyes) were recruited for the study. Automated and manual central corneal thickness (aCCT, mCCT), anterior chamber depth (ACD), and nasal and temporal trabecular iris angle (nTIA, tTIA) were measured and compared with Bland-Altman plots. Good agreement between the TD and SS OCT measurements was demonstrated for mCCT and aCCT in normal individuals and for mCCT in the CDs group. The ACD, nTIA, and tTIA measurements differed significantly in both groups. TBCD, LCD, and FECD caused increased CCT. MCD caused significant corneal thinning. FECD affected all analyzed parameters. Better agreement between SS OCT and TD OCT measurements was demonstrated in normal individuals compared to the CDs group. OCT provides comprehensive corneal deposits analysis and demonstrates the association of CD with CCT, ACD, and TIA measurements.

Aphasia following anterior cerebral artery occlusion

International Nuclear Information System (INIS)

Shimosaka, Shinichi; Waga, Shiro; Kojima, Tadashi; Shimizu, Takeo; Morikawa, Atsunori

1982-01-01

We have report two cases of aphasia that had infarcts in the distribution of the left or right anterior cerebral artery, as confirmed by computed tomography. Case 1 is a right-handed, 65-year-old man in whom computerized tomographic scanning revealed an infarction of the territory of the left anterior cerebral artery after the clipping of the anterior communicating artery aneurysm. The standard language test of aphasia (SLTA) revealed non-fluent aphasia with dysarthria, good comprehension, almost normal repetition with good articulation, and a defectiveness in writing. This syndrome was considered an instance of transcortical motor aphasia. Although three years had passed from the onset, his aphasia did not show any improvement. Case 2 is a 37-year-old man who is right-handed but who can use his left hand as well. He was admitted because of subarachnoid hemorrhage from an anterior communicating aneurysm. Because of postoperative spasm, an infarction in the distribution of the right anterior cerebral artery developed. He was totally unable to express himself vocally, but he could use written language quite well to express his ideas and had a good comprehension of spoken language. This clinical picture was considered that of an aphemia. After several weeks, his vocalization returned, but the initial output was still hypophonic. (J.P.N.)

Assessment of Corneal and Tear Film Parameters in Rheumatoid Arthritis Patients Using Anterior Segment Spectral Domain Optical Coherence Tomography.

Science.gov (United States)

El-Fayoumi, Dina; Youssef, Maha Mohamed; Khafagy, Mohamed Mahmoud; Badr El Dine, Nashwa; Gaber, Wafaa

2018-01-01

To study the corneal changes in rheumatoid arthritis (RA) patients in vivo, using spectral domain anterior segment optical coherence tomography (AS-OCT). A case-control study was done on 43 RA patients and 40 controls. The disease activity score (DAS28-ESR) was calculated and all participants had lower tear meniscus, corneal thickness, and epithelial thickness evaluation using AS-OCT. The lower tear meniscus height (LTMH) and the lower tear meniscus area (LTMA) were significantly lower in the RA patients than in controls (p < 0.001). RA patients also had a significantly thinner central corneal thickness (p = 0.02) and their epithelium was found to be thinner in the superotemporal peripheral sector. The LTMH and LTMA are significantly reduced in RA patients, despite the absence of clinical diagnosis of dry eye. RA patients have thinner corneal thickness and epithelial thickness than controls, which did not correlate with either disease duration or activity.

Diagnostic accuracy of the electromyography parameters associated with anterior knee pain in the diagnosis of patellofemoral pain syndrome.

Science.gov (United States)

Ferrari, Deisi; Kuriki, Heloyse Uliam; Silva, Cristiano Rocha; Alves, Neri; Mícolis de Azevedo, Fábio

2014-08-01

To assess the diagnostic accuracy of the surface electromyography (sEMG) parameters associated with referred anterior knee pain in diagnosing patellofemoral pain syndrome (PFPS). Sensitivity and specificity analysis. Physical rehabilitation center and laboratory of biomechanics and motor control. Pain-free subjects (n=29) and participants with PFPS (n=22) selected by convenience. Not applicable. The diagnostic accuracy was calculated for sEMG parameters' reliability, precision, and ability to differentiate participants with and without PFPS. The selected sEMG parameter associated with anterior knee pain was considered as an index test and was compared with the reference standard for the diagnosis of PFPS. Intraclass correlation coefficient, SEM, independent t tests, sensitivity, specificity, negative and positive likelihood ratios, and negative and positive predictive values were used for the statistical analysis. The medium-frequency band (B2) parameter was reliable (intraclass correlation coefficient=.80-.90), precise (SEM=2.71-3.87 normalized unit), and able to differentiate participants with and without PFPS (Ppain showed positive diagnostic accuracy values (specificity, .87; sensitivity, .70; negative likelihood ratio, .33; positive likelihood ratio, 5.63; negative predictive value, .72; and positive predictive value, .86). The results provide evidence to support the use of EMG signals (B2-frequency band of 45-96 Hz) of the vastus lateralis and vastus medialis muscles with referred anterior knee pain in the diagnosis of PFPS. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Short-term variation in ocular anterior chamber angle using Scheimpflug photography

OpenAIRE

A. Rubin

2010-01-01

Purpose: To investigate short-term variation of ocular Anterior Chamber Angle (ACA) within and across the different meridians of young, healthy eyes. Method: Scheimpflug photography (via an  Oculus Pentacam) was used to repeatedly measure the anterior segment of the right eyes of three young females, all aged 22 years.  For each individual, ten consecutive maps were determined over a short time period and each map contained information for the chamber angles of different meridians acr...

Spontaneous coronary artery dissection in a young woman with polycystic ovarian syndrome.

Science.gov (United States)

Mirra, Marco; Kola, Nertil; Mattiello, Giacomo; Morisco, Carmine; Spinelli, Letizia

2017-06-01

Polycystic ovarian syndrome (PCOS) affects 4% to 12% of women in reproductive age, representing a clinical condition that could predispose to cardiovascular diseases. We report a case of a 34-year-old woman with PCOS, presenting with chest pain, onset two days before, and ST segment-elevation myocardial infarction. She was not pregnant or in a postpartum state. Subsequent cardiac angiography revealed spontaneous left anterior descending coronary artery dissections, managed by conservative approach. The patient was discharged in medical therapy after 5days. This is the first observation of spontaneous coronary artery dissection occurring in a PCOS patient. Copyright © 2016 Elsevier Inc. All rights reserved.

ST-segment deviation on the admission electrocardiogram, treatment strategy, and outcome in non-ST-elevation acute coronary syndromes - A substudy of the Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) Trial

NARCIS (Netherlands)

Windhausen, Fons; Hirsch, Alexander; Tijssen, Jan G. P.; Cornel, Jan Hein; Verheugt, Freek W. A.; Klees, Margriet I.; de Winter, Robbert J.

2007-01-01

Background: We assessed the prognostic significance of the presence of cumulative (Sigma) ST-segment deviation on the admission electrocardiogram (ECG) in patients with non-ST-elevation acute coronary syndrome and an elevated troponin T randomized to a selective invasive (SI) or an early invasive

Is it possible to differentiate between Takotsubo cardiomyopathy and acute anterior ST-elevation myocardial infarction?

DEFF Research Database (Denmark)

Vervaat, Fabienne E; Christensen, Thomas E; Smeijers, Loes

2015-01-01

. The latter group was divided into the following subgroups: 46 patients with proximal, 47 with mid and 10 with distal LAD occlusion. Three ST-segment based ECG features were investigated: (1) Existing criterion for differentiating anterior STEMI from TC: ST-segment depression >0.5mm in lead aVR...

[Two cases of Vogt-Koyanagi-Harada disease presenting shallow anterior chamber].

Science.gov (United States)

Takemoto, Daisuke; Ijiri, Shigeyuki; Shimizu, Michiharu; Higashide, Tomomi; Sugiyama, Kazuhisa

2015-05-01

We report two cases of Vogt-Koyanagi-Harada disease (VKH) in which shallow anterior chambers were improved after steroid pulse therapy. The patients were women aged 65 and 72. They had headaches, decreased visual acuity and shallow anterior chamber in both eyes. There was no inflammation in the anterior chamber. Ultrasound biomicroscopy (UBM) showed ciliary edema, ciliochoroidal detachment, and angle closure. One case showed high intraocular pressure (IOP), and a diagnosis of acute primary angle closure was made. Although cataract surgery was performed in the left eye, postoperative optical coherence tomography (OCT) revealed serous retinal detachment in both eyes. The shallow anterior chamber and UBM findings were improved and serous retinal detachment disappeared after steroid pulse therapy in both cases. VKH may cause shallow anterior chamber and angle closure. The inflammatory changes of VKH in the anterior segment, i. e. ciliary edema and ciliochoroidal detachment, may exacerbate the shallow anterior chambers and narrow angles and result in an acute increase in IOP in eyes with short axial length. VKH associated with shallow anterior chamber may be misdiagnosed as acute primary angle closure. For differential diagnosis, examinations of the ocular fundus including OCT are useful.

In vivo architectural analysis of clear corneal incisions using anterior segment optical coherence tomography.

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Dupont-Monod, Sylvère; Labbé, Antoine; Fayol, Nicolas; Chassignol, Alexis; Bourges, Jean-Louis; Baudouin, Christophe

2009-03-01

To use anterior segment optical coherence tomography (AS-OCT) to analyze the in vivo architecture of clear corneal incisions after phacoemulsification using different techniques. Department of Ophthalmology, Quinze-Vingts National Ophthalmology Hospital, Paris, France. This prospective observational study analyzed clear corneal incisions used in phacoemulsification. All wounds were evaluated 1 day and 8 days postoperatively by AS-OCT (Visante). Incision architecture and pachymetry at the wound level were analyzed. Thirty-five clear corneal incisions were analyzed. Six eyes had 2.75 mm coaxial phacoemulsification, 19 had 2.20 mm microincision coaxial phacoemulsification, and 10 had 1.30 mm bimanual microincision phacoemulsification. The 1.30 mm incision had a straight-line configuration. The 2.20 mm and 2.75 mm incisions had an arcuate configuration. The angles of incidence of 1.30 mm incisions were greater than those of 2.20 mm incisions (P<.001). All incisions had slight corneal edema limited to the incision area. The edema was slightly greater around 1.30 mm incisions (mean pachymetry 1143 microm +/- 140 [SD]) than around 2.20 mm incisions (mean 1012 +/- 101 microm) (P = .001). Bimanual procedures had satisfactory endothelial apposition in the enlarged areas, where stromal edema was less than that surrounding the unenlarged 1.30 mm incisions. The 3 phacoemulsification techniques induced gaping of the endothelial edge, minor inadequate endothelial apposition, and mild stromal edema in the area of the clear corneal incisions. Bimanual microincision sleeveless phacoemulsification may alter the wound slightly more than coaxial 2.75 mm and microcoaxial 2.20 mm sleeved-tip phacoemulsification.

The DD genotype of the angiotensin converting enzyme gene independently associates with CMR-derived abnormal microvascular perfusion in patients with a first anterior ST-segment elevation myocardial infarction treated with thrombolytic agents.

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Bodi, Vicente; Sanchis, Juan; Nunez, Julio; Aliño, Salvador F; Herrero, Maria J; Chorro, Francisco J; Mainar, Luis; Lopez-Lereu, Maria P; Monmeneu, Jose V; Oltra, Ricardo; Chaustre, Fabian; Forteza, Maria J; Husser, Oliver; Riegger, Günter A; Llacer, Angel

2009-12-01

The role of the angiotensin converting enzyme (ACE) gene on the result of thrombolysis at the microvascular level has not been addressed so far. We analyzed the implications of the insertion/deletion (I/D) polymorphism of the ACE gene on the presence of abnormal cardiovascular magnetic resonance (CMR)-derived microvascular perfusion after ST-segment elevation myocardial infarction (STEMI). We studied 105 patients with a first anterior STEMI treated with thrombolytic agents and an open left anterior descending artery. Microvascular perfusion was assessed using first-pass perfusion CMR at 7+/-1 days. CMR studies were repeated 184+/-11 days after STEMI. The ACE gene insertion/deletion (I/D) polymorphism was determined using polymerase chain reaction amplification. Overall genotype frequencies were II-ID 58% and DD 42%. Abnormal perfusion (> or = 1 segment) was detected in 56% of patients. The DD genotype associated to a higher risk of abnormal microvascular perfusion (68% vs. 47%, p=0.03) and to a larger extent of perfusion deficit (median [percentile 25 - percentile 75]: 4 [0-6] vs. 0 [0-4] segments, p=0.003). Once adjusted for baseline characteristics, the DD genotype independently increased the risk of abnormal microvascular perfusion (odds ratio [95% confidence intervals]: 2.5 [1.02-5.9], p=0.04). Moreover, DD patients displayed a larger infarct size (35+/-17 vs. 27+/-15 g, p=0.01) and a lower ejection fraction at 6 months (48+/-14 vs. 54+/-14%, p=0.03). The DD genotype associates to a higher risk of abnormal microvascular perfusion after STEMI.

Diffuse Anterior Retinoblastoma with Sarcoidosis-Like Nodule

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Koji Kitazawa

2015-12-01

Full Text Available Background: Retinoblastomas account for 4% of malignancies in children, 1-2% of which are diffuse infiltrating retinoblastomas. Diffuse anterior retinoblastoma is rare and does not involve the retina. Here, we report on a diffuse anterior retinoblastoma with large sarcoidosis-like nodules on the iris that were responsive to anti-inflammatory therapy. Case: We present a 6-year-old girl who had anterior uveitis with white nodules on the iris and posterior surface of the cornea in her right eye. The nodules initially responded well to anti-inflammatory treatment. However, anterior segment optical coherence tomography (AS-OCT showed that the nodules gradually grew, shrinking the iris. We then collected the aqueous humor for diagnosis. A biopsy revealed clusters of small cells with a high nuclear-to-cytoplasm ratio with partial rosette formation. Therefore, we diagnosed diffuse anterior retinoblastoma without retinal involvement and performed enucleation of the right eye. The histopathology demonstrated undifferentiated cells similar to those seen on the biopsy, and tumor cells invaded the iris stroma, posterior surface of the cornea, ciliary body, and sclera. After the enucleation, she underwent chemotherapy and remains alive. Conclusion: A differential diagnosis of retinoblastoma should be considered when white nodules refractory to anti-inflammatory therapy occur in the eye, even in the absence of obvious retinal masses. AS-OCT findings are useful in assessing retinoblastoma.

Repeatability and comparison of clinical techniques for anterior chamber angle assessment.

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Campbell, Peter; Redmond, Tony; Agarwal, Rishi; Marshall, Lewis R; Evans, Bruce J W

2015-03-01

To assess the repeatability of gonioscopy, van Herick method and anterior segment Optical Coherence Tomography (AS-OCT) and determine the agreement between these techniques within a community optometry setting. Gonioscopy, van Herick method and AS-OCT imaging were performed by an optometrist on two occasions, 1 month apart, on 80 subjects aged over 40 years recruited from community optometry practices. Anterior segment images were captured with a spectral domain OCT (Topcon 3D OCT-2000; wavelength 840 nm) set to the Anterior Segment (AS) mode. Eyes were graded as open or occludable for each method. AS-OCT images from both visits were graded by a second optometrist masked to the gonioscopy and van Herick method results, and the visit on which the images were acquired. Cohen's kappa (κ) was used to describe the intra-observer repeatability. Likelihood ratios, sensitivity and specificity of van Herick method and AS-OCT were calculated, using gonioscopy as the reference standard. Measurements were obtained from 80 eyes of 80 subjects. In four cases, AS-OCT images were un-gradable due to difficulty in locating the scleral spur. The repeatability of gonioscopy was fair κ = 0.29, while that of the van Herick method (κ = 0.54) and AS-OCT (κ = 0.47) were somewhat better. The van Herick method showed good sensitivity (visit 1: 75%, visit 2: 69%) and high specificity (visit 1: 88%, visit 2: 96%). The sensitivity of AS-OCT was fair (visit 1: 46%, visit 2: 25%), but specificity was high (visit 1: 87%. visit 2: 89%). Intra-observer repeatability was better for van Herick method and for AS-OCT than for gonioscopy, despite the latter being considered the gold standard method. The van Herick method appeared to be more sensitive than AS-OCT when identifying eyes at risk of angle closure. A standalone anterior segment OCT with a longer wavelength laser could afford better visualisation of the angle, and might therefore be expected to enable the examiner to make more

Comparative Study of Anterior Eye Segment Measurements with Spectral Swept-Source and Time-Domain Optical Coherence Tomography in Eyes with Corneal Dystrophies

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Anna K. Nowinska

2015-01-01

Full Text Available Purpose. To compare anterior eye segment measurements and morphology obtained with two optical coherence tomography systems (TD OCT, SS OCT in eyes with corneal dystrophies (CDs. Methods. Fifty healthy volunteers (50 eyes and 54 patients (96 eyes diagnosed with CD (epithelial basement membrane dystrophy, EBMD = 12 eyes; Thiel-Behnke CD = 6 eyes; lattice CD TGFBI type = 15 eyes; granular CD type 1 = 7 eyes, granular CD type 2 = 2 eyes; macular CD = 23 eyes; and Fuchs endothelial CD = 31 eyes were recruited for the study. Automated and manual central corneal thickness (aCCT, mCCT, anterior chamber depth (ACD, and nasal and temporal trabecular iris angle (nTIA, tTIA were measured and compared with Bland-Altman plots. Results. Good agreement between the TD and SS OCT measurements was demonstrated for mCCT and aCCT in normal individuals and for mCCT in the CDs group. The ACD, nTIA, and tTIA measurements differed significantly in both groups. TBCD, LCD, and FECD caused increased CCT. MCD caused significant corneal thinning. FECD affected all analyzed parameters. Conclusions. Better agreement between SS OCT and TD OCT measurements was demonstrated in normal individuals compared to the CDs group. OCT provides comprehensive corneal deposits analysis and demonstrates the association of CD with CCT, ACD, and TIA measurements.

[Clinical application of stand-alone MC+PEEK cage in the anterior cervical fusion].

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Jiang, Bing; Cao, Yan-Qing; Pan, Hong; Zhu, Cheng-Run; Zhang, Xiao-Jun; Tao, Yue-Feng; Liu, Zhen

2015-04-01

To explore the effect of clinical application of stand-alone MC+PEEK cage in anterior cervical fusion. From January 2011 to January 2014,50 patients were treated with the MC+PEEK cage filled with autogenous cancellous illic-bone graft after anterior cervical discectomy. There were 22 patients with cervical spondylosis,26 patients with traumatic cervical disc herniation, 2 patients with cervical instability in these patients. There were 32 males and 18 females, aged from 30 to 79 years old with an average of 53.30 years old. There were 32 patients with single segment, 15 patients with double segments and 3 patients with three segments. Cervical AP and lateral and the flexion-extension X-rays were regularly taken in order to assess the cervical physiological curvature, the graft fusion and internal fixation related complications. Nerve function, clinical effect and bone fusion were respectively evaluated according to Japan Orthopedic Association (JOA), Otani grade and Suk method. All patients were followed up from 6 to 36 months with an average of 20 months. No correlated surgical complications were found and all patients obtained bony fusion with an average time of 4.30 months. JOA score had significantly improvement after surgery (P cervical fusion can obtain satisfactory clinical effect with less operation injury and reduce the complications. It is a better fusion method in anterior cervical fusion.

Longitudinal Evaluation of Wound Healing after Penetrating Corneal Injury: Anterior Segment Optical Coherence Tomography Study.

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Zheng, Kang Keng; Cai, Jianhao; Rong, Shi Song; Peng, Kun; Xia, Honghe; Jin, Chuan; Lu, Xuehui; Liu, Xinyu; Chen, Haoyu; Jhanji, Vishal

2017-07-01

Ocular imaging can enhance our understanding of wound healing. We report anterior segment optical coherence tomography (ASOCT) findings in penetrating corneal injury. Serial ASOCT was performed after repair of penetrating corneal injury. Internal aberrations of wound edges were labeled as "steps" or "gaps" on ASOCT images. The wound type was characterized as: type 1: continuous inner wound edge or step height ≤ 80 µm; type 2: step height > 80 µm; type 3: gap between wound edges; and type 4: intraocular tissue adherent to wound. Surgical outcomes of different wound types were compared. 50 consecutive patients were included (6 females, 44 males; mean age 33 ± 12 years). The average size of wound was 4.2 ± 2.6 mm (type 1, 8 eyes; type 2, 27 eyes; type 3, 12 eyes; type 4, 3 eyes). At the end of 3 months, 70% (n = 35) of the wounds were type 1. At the end of 6 months, all type 1 wounds had healed completely, whereas about half of type 2 (48.1%) and type 3 (50%) wounds had recovered to type 1 configuration. The wound type at baseline affected the height of step (p = 0.047) and corneal thickness at 6 months (p = 0.035). ASOCT is a useful tool for monitoring wound healing in cases with penetrating corneal injury. Majority of the wound edges appose between 3 and 6 months after trauma. In our study, baseline wound configuration affected the healing pattern.

Very Long-Term Prognostic Role of Admission BNP in Non-ST Segment Elevation Acute Coronary Syndrome

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Fernando Bassan

2016-01-01

Full Text Available Abstract Background: BNP has been extensively evaluated to determine short- and intermediate-term prognosis in patients with acute coronary syndrome, but its role in long-term mortality is not known. Objective: To determine the very long-term prognostic role of B-type natriuretic peptide (BNP for all-cause mortality in patients with non-ST segment elevation acute coronary syndrome (NSTEACS. Methods: A cohort of 224 consecutive patients with NSTEACS, prospectively seen in the Emergency Department, had BNP measured on arrival to establish prognosis, and underwent a median 9.34-year follow-up for all-cause mortality. Results: Unstable angina was diagnosed in 52.2%, and non-ST segment elevation myocardial infarction, in 47.8%. Median admission BNP was 81.9 pg/mL (IQ range = 22.2; 225 and mortality rate was correlated with increasing BNP quartiles: 14.3; 16.1; 48.2; and 73.2% (p 72 years (OR = 3.79, 95% CI = 1.62-8.86, p = 0.002, BNP ≥ 100 pg/mL (OR = 6.24, 95% CI = 2.95-13.23, p < 0.001 and estimated glomerular filtration rate (OR = 0.98, 95% CI = 0.97-0.99, p = 0.049 were independent late-mortality predictors. Conclusions: BNP measured at hospital admission in patients with NSTEACS is a strong, independent predictor of very long-term all-cause mortality. This study allows raising the hypothesis that BNP should be measured in all patients with NSTEACS at the index event for long-term risk stratification.

Evans syndrome with non-ST segment elevation myocardial infarction complicated by hemopericardium

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Filiz Kizilirmak

2016-09-01

Full Text Available Evans syndrome (ES is a rare hematological disease characterized by autoimmune hemolytic anemia, immune thrombocytopenia, and/or neutropenia, all of which may be seen simultaneously or subsequently. Thrombotic events in ES are uncommon. Furthermore, non-ST segment-elevation myocardial infarction (NSTEMI during ES is a very rare condition. Here, we describe a case of a 69-year-old female patient presenting with NSTEMI and ES. Revascularization via percutaneous coronary intervention (PCI was scheduled and performed. Hemopericardium and cardiac tamponade occurred 5 h after PCI, and urgent pericardiocentesis was performed. Follow-up was uneventful, and the patient was safely discharged. Early recognition and appropriate management of NSTEMI is crucial to prevent morbidity and mortality. Coexistence of NSTEMI and ES, which is associated with increased bleeding risk, is a challenging scenario and these patients should be closely monitored in order to achieve early recognition and treatment of complications.

Anisometropic amblyopia in a case of type 2 Waardenburg syndrome

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Akal, Ali; Göncü, Tugba; Boyaci, Nurefsan; Yılmaz, Ömer Faruk

2013-01-01

This study presents a case of an 8-year-old boy with iris heterochromia and anisometropic amblyopia who was diagnosed with Waardenburg syndrome (WS) type 2. An ophthalmic examination revealed iris heterochromia and anisometropic amblyopia in our patient. In the systemic examination, a white forelock and vitiligo on the arms and body were observed and neurosensory hearing loss was revealed, for which the patient used hearing aids. Identification and typing of patients with WS is crucial to address neurosensory hearing loss, glaucoma and fundus changes. While it might be challenging to communicate with a patient with speech and hearing problems, visual acuity should be examined carefully and probable amblyopia should be identified. Anterior segment changes and signs of glaucoma should also be evaluated in detail. PMID:24351514

Anisometropic amblyopia in a case of type 2 Waardenburg syndrome.

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Akal, Ali; Göncü, Tugba; Boyaci, Nurefsan; Yılmaz, Ömer Faruk

2013-12-18

This study presents a case of an 8-year-old boy with iris heterochromia and anisometropic amblyopia who was diagnosed with Waardenburg syndrome (WS) type 2. An ophthalmic examination revealed iris heterochromia and anisometropic amblyopia in our patient. In the systemic examination, a white forelock and vitiligo on the arms and body were observed and neurosensory hearing loss was revealed, for which the patient used hearing aids. Identification and typing of patients with WS is crucial to address neurosensory hearing loss, glaucoma and fundus changes. While it might be challenging to communicate with a patient with speech and hearing problems, visual acuity should be examined carefully and probable amblyopia should be identified. Anterior segment changes and signs of glaucoma should also be evaluated in detail.

Dutch validation of the low anterior resection syndrome score.

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Hupkens, B J P; Breukink, S O; Olde Reuver Of Briel, C; Tanis, P J; de Noo, M E; van Duijvendijk, P; van Westreenen, H L; Dekker, J W T; Chen, T Y T; Juul, T

2018-04-21

The aim of this study was to validate the Dutch translation of the low anterior resection syndrome (LARS) score in a population of Dutch rectal cancer patients. Patients who underwent surgery for rectal cancer received the LARS score questionnaire, a single quality of life (QoL) category question and the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire. A subgroup of patients received the LARS score twice to assess the test-retest reliability. A total of 165 patients were included in the analysis, identified in six Dutch centres. The response rate was 62.0%. The percentage of patients who reported 'major LARS' was 59.4%. There was a high proportion of patients with a perfect or moderate fit between the QoL category question and the LARS score, showing a good convergent validity. The LARS score was able to discriminate between patients with or without neoadjuvant radiotherapy (P = 0.003), between total and partial mesorectal excision (P = 0.008) and between age groups (P = 0.039). There was a statistically significant association between a higher LARS score and an impaired function on the global QoL subscale and the physical, role, emotional and social functioning subscales of the EORTC QLQ-C30 questionnaire. The test-retest reliability of the LARS score was good, with an interclass correlation coefficient of 0.79. The good psychometric properties of the Dutch version of the LARS score are comparable overall to the earlier validations in other countries. Therefore, the Dutch translation can be considered to be a valid tool for assessing LARS in Dutch rectal cancer patients. Colorectal Disease © 2018 The Association of Coloproctology of Great Britain and Ireland.

Involuntary masturbation and hemiballismus after bilateral anterior cerebral artery infarction.

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Bejot, Yannick; Caillier, Marie; Osseby, Guy-Victor; Didi, Roy; Ben Salem, Douraied; Moreau, Thibault; Giroud, Maurice

2008-02-01

Ischemia of the areas supplied by the anterior cerebral artery is relatively uncommon. In addition, combined hemiballismus and masturbation have rarely been reported in patients with cerebrovascular disease. We describe herein a 62-year-old right-handed man simultaneously exhibiting right side hemiballismus and involuntary masturbation with the left hand after bilateral infarction of the anterior cerebral artery territory. Right side hemiballismus was related to the disruption of afferent fibers from the left frontal lobe to the left subthalamic nucleus. Involuntary masturbation using the left hand was exclusively linked to a callosal type of alien hand syndrome secondary to infarction of the right side of the anterior corpus callosum. After 2 weeks, these abnormal behaviours were completely extinguished. This report stresses the wide diversity of clinical manifestations observed after infarction of the anterior cerebral artery territory.

Prognostic Usefulness of Low Ischemic Risk SPECT in non-ST Segment Elevation Acute Coronary Syndromes

International Nuclear Information System (INIS)

Castillo Costa, Yanina; Mauro, Victor; Perez, Roberto; Charask, Adrian; Fairman, Enrique; Gomez Santamaria, Hector; Goral, Jorge; Barrero, Carlos

2009-01-01

Background: Myocardial perfusion imaging tests are used for the clinical assessment of patients hospitalized with non-ST segment elevation acute coronary syndromes (NSTACS) who have favorable in-hospital outcomes with medical therapy. However, the prognostic relevance of a .low ischemic risk. (LR) single photon emission computed tomography (SPECT) in patients with NSTACS managed with a conservative approach is uncertain, as most of the information derives from patients with chronic coronary artery disease. Objectives: 1) To analyze the outcomes of patients with NSTACS and LR SPECT at discharge, 2) to compare the results of a normal SPECT with transient perfusion defects (TPDs), permanent perfusion defects (PPDs) or combined defects (CDs), and 3) to determine the additional value of SPECT to classic risk variables. Material and Methods: Patients admitted to the CCU with a NSTACS were included. Follow-up was continued during 12 months. Definitions: Clinical risk based on TIMI risk score. LR SPECT (under exercise or pharmacological stress): TPDs ≤ 3/17 segments, PPDs ≤ 3/17 segments, CPDs: TPDs + PPDs and normal: absence of defects. Clinical events (CEs): death/infarction or rehospitalization due to angina. Results: A total of 137 patients were included (median age 59 years, 60% were men). A low TIMI risk score was present in 54% of patients and 46% presented a moderate risk. CE: 5.8%. The incidence of clinical events related to perfusion defects was as follows: normal: 2.1%, TPD: 4.5%, PPD: 5.9% and CPD: 25% (p [es

Permissive and instructive anterior patterning rely on mRNA localization in the wasp embryo.

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Brent, Ava E; Yucel, Gozde; Small, Stephen; Desplan, Claude

2007-03-30

The long-germ mode of embryogenesis, in which segments arise simultaneously along the anteriorposterior axis, has evolved several times in different lineages of the holometabolous, or fully metamorphosing, insects. Drosophila's long-germ fate map is established largely by the activity of the dipteran-specific Bicoid (Bcd) morphogen gradient, which operates both instructively and permissively to accomplish anterior patterning. By contrast, all nondipteran long-germ insects must achieve anterior patterning independently of bcd. We show that bcd's permissive function is mimicked in the wasp by a maternal repression system in which anterior localization of the wasp ortholog of giant represses anterior expression of the trunk gap genes so that head and thorax can properly form.

Anterior maxillary segmental distraction in the treatment of severe maxillary hypoplasia secondary to cleft lip and palate.

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Li, Hongliang; Dai, Jiewen; Si, Jiawen; Zhang, Jianfei; Wang, Minjiao; Shen, Steve Guofang; Yu, Hongbo

2015-01-01

Anterior maxillary segmental distraction (AMSD) is an effective surgical procedure in the treatment of maxillary hypoplasia secondary to cleft lip and palate. Its unique advantage of preserving velopharyngeal function makes this procedure widely applied. In this study, the application of AMSD was described and its long-term stability was explored. Eight patients with severe maxillary hypoplasia secondary to CLP were included in this study. They were treated with AMSD using rigid external distraction (RED) device. Cephalometric analysis was performed twice at three time points for evaluation: before surgery (T1), after distraction (T2), and 2 years after treatment (T3). One-way analysis of variance was used to assess the differences statistically. All the distractions completed smoothly, and maxilla was distracted efficiently. The value of SNA, NA-FH, Ptm-A, U1-PP, overjet and PP (ANS-PNS) increased significantly after the AMSD procedure (P 0.05). Changes of palatopharyngeal depth and soft palatal length were insignificant. AMSD with RED device provided an effective way to correct maxillary hypoplasia secondary to CLP, extended the palatal and arch length, avoided damage on velopharyngeal closure function and reduced the relapse rate. It is a promising and valuable technique in this potentially complicated procedure.

MRI findings of Guillain-Barre syndrome

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Park, Won Kyu; Lee, Hwa Jin; Byun, Woo Mok [Yeungnam Univ. College of Medicine, Taegu (Korea, Republic of)

1997-04-01

To evaluate MRI findings of Guillain-Barre syndrome. In six patients with Guillain-Barre syndrome diagnosed by clinical, cerebrospinal fluid and electrophysiologic findings, a retrospective review of MR findings was conducted. Follow-up MRI scans were carried out in two patients showing minimal clinical improvement. Marked or moderate enhancement of thickened nerve roots was seen in all cases on gadopentetate dimeglumine enhanced axial T1-weighted images. Two patterns were seen; one was even enhancement of both anterior and posterior nerve roots (n=1) and the other was enhancement of anterior nerve roots only (n=5). Enhancement and thickness of nerve roots was seen to have slightly decreased on MRI follow-up at 32 and 50 days; clinical and electrophysiologic examination showed minimal improvement. Although MRI findings of nerve root enhancement are nonspecific and can be seen in neoplastic and other inflammatory diseases, the enhancement of thickened anterior nerve roots within the cal sac suggests Guillain-Barre syndrome.

MRI findings of Guillain-Barre syndrome

International Nuclear Information System (INIS)

Park, Won Kyu; Lee, Hwa Jin; Byun, Woo Mok

1997-01-01

To evaluate MRI findings of Guillain-Barre syndrome. In six patients with Guillain-Barre syndrome diagnosed by clinical, cerebrospinal fluid and electrophysiologic findings, a retrospective review of MR findings was conducted. Follow-up MRI scans were carried out in two patients showing minimal clinical improvement. Marked or moderate enhancement of thickened nerve roots was seen in all cases on gadopentetate dimeglumine enhanced axial T1-weighted images. Two patterns were seen; one was even enhancement of both anterior and posterior nerve roots (n=1) and the other was enhancement of anterior nerve roots only (n=5). Enhancement and thickness of nerve roots was seen to have slightly decreased on MRI follow-up at 32 and 50 days; clinical and electrophysiologic examination showed minimal improvement. Although MRI findings of nerve root enhancement are nonspecific and can be seen in neoplastic and other inflammatory diseases, the enhancement of thickened anterior nerve roots within the cal sac suggests Guillain-Barre syndrome

Studies on clinical significance of exercise-induced ST-segment depression at non-infarct-related leads in the patients with prior myocardial infarction using the stress scintigraphy

International Nuclear Information System (INIS)

Ohkubo, Toshitaka

1988-01-01

Stress Tl-201 myocardial imaging and stress radionuclide ventriculography were performed in a total of 67 patients with prior myocardial infarction (MI) to assess the clinical significance of exercise induced ST-segment depression at non-infarct-related leads on ECG during the chronic stage. The patients consisted of 12 with inferior MI with single vessel disease (SVD) that showed no precordial ST-segment depression; 7 with inferior MI with SVD accompanied by precordial ST-segment depression; 13 with inferior MI with multivessel disease (MVD); 20 with anterior MI with SVD that showed no inferior ST-segment depression; 4 with anterior MI with SVD accompanied by inferior ST-segment depression; and 11 with anterior MI with MVD. In cases of SVD, the incidence of ST-segment depression at non-infarct-related leads was higher for inferior MI (36.8%) than anterior MI (16.7%). Myocardial imaging revealed large infarct and infarct extending into the inferoseptal wall of the left ventricle (LV) in cases of exercise induced precordial ST-segment depression; and infarct extending into the lateral wall of LV in cases of exercise induced inferior ST-segment depression. In detecting MVD, stress Tl-201 myocardial imaging was superior to exercise electrocardiography and stress radionuclide ventriculography, but this was not statistically significant. Prognostic value of error rate for detecting MVD was significantly improved with a discriminant analysis. Exercise induced ST-segment depression on ECG should be of clinical significance in reflecting myocardial ischemia around an infarcted area. (Namekawa, K)

Damage to the anterior arcuate fasciculus predicts non-fluent speech production in aphasia.

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Fridriksson, Julius; Guo, Dazhou; Fillmore, Paul; Holland, Audrey; Rorden, Chris

2013-11-01

Non-fluent aphasia implies a relatively straightforward neurological condition characterized by limited speech output. However, it is an umbrella term for different underlying impairments affecting speech production. Several studies have sought the critical lesion location that gives rise to non-fluent aphasia. The results have been mixed but typically implicate anterior cortical regions such as Broca's area, the left anterior insula, and deep white matter regions. To provide a clearer picture of cortical damage in non-fluent aphasia, the current study examined brain damage that negatively influences speech fluency in patients with aphasia. It controlled for some basic speech and language comprehension factors in order to better isolate the contribution of different mechanisms to fluency, or its lack. Cortical damage was related to overall speech fluency, as estimated by clinical judgements using the Western Aphasia Battery speech fluency scale, diadochokinetic rate, rudimentary auditory language comprehension, and executive functioning (scores on a matrix reasoning test) in 64 patients with chronic left hemisphere stroke. A region of interest analysis that included brain regions typically implicated in speech and language processing revealed that non-fluency in aphasia is primarily predicted by damage to the anterior segment of the left arcuate fasciculus. An improved prediction model also included the left uncinate fasciculus, a white matter tract connecting the middle and anterior temporal lobe with frontal lobe regions, including the pars triangularis. Models that controlled for diadochokinetic rate, picture-word recognition, or executive functioning also revealed a strong relationship between anterior segment involvement and speech fluency. Whole brain analyses corroborated the findings from the region of interest analyses. An additional exploratory analysis revealed that involvement of the uncinate fasciculus adjudicated between Broca's and global aphasia

Anterior cervical osteophytes causing dysphagia and dyspnea: an uncommon entity revisited.

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Giger, Roland; Dulguerov, Pavel; Payer, Michael

2006-10-01

Large anterior cervical osteophytes can occur in degeneration of the cervical spine or in diffuse idiopathic skeletal hyperostosis (DISH). We present the case of an 83-year-old patient with progressive dysphagia and acute dyspnea, necessitating emergency tracheotomy. Voluminous anterior cervical osteophytes extending from C3 to C7 and narrowing the pharyngoesophageal segment by external compression and bilateral vocal fold immobility were diagnosed radiologically and by fiberoptic laryngoscopy. Surgical removal of all osteophytes led to the resolution of symptoms. Dyspnea with or without dysphagia caused by hypertrophic anterior cervical osteophytes is an uncommon entity. The exhaustive diagnostic workup proposed in the literature could be simplified by using fiberoptic laryngoscopy and dynamic videofluoroscopy. The causes, treatment, and outcome are discussed.

Coronary arterio-venous fistula associated acute coronary syndrome: A case-report and review of literature

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V.H. Contreras-Gutiérrez

2017-01-01

Full Text Available A 56-year-old woman with no medical history presented to the emergency department complaining of oppressive chest pain of three hours of duration triggered by walking. An electrocardiogram (ECG performed at hospital admission showed ST-segment depression and T-wave inversion in left precordial and inferior leads. Serum troponin I levels were above the normal values. Non ST-segment elevation acute coronary syndrome (NSTEACS was diagnosed and an invasive approach with a percutaneous coronary intervention was performed. No obstructive coronary lesions were observed. However a tortuous coronary fistula emerging from the left-anterior descending coronary artery to the pulmonary artery was observed. Coronary arterio-venous fistulas are present in 0.002% of the general population and in 0.25% of patients undergoing cardiac catheterization for any cause. Most of them are asymptomatic. Ischemic symptoms may develop but are infrequent in patients with no atherosclerotic disease.

Expansion of the clinical ocular spectrum of Wolfram Syndrome in a family carrying a novel WFS1 gene deletion.

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Chacón-Camacho, Oscar; Arce-Gonzalez, Rocio; Granillo-Alvarez, Mariella; Flores-Limas, Sanjuanita; Ramírez, Magdalena; Zenteno, Juan C

2013-12-01

To present the results of the clinical and molecular analyses of a familial case of Wolfram Syndrome (WFS) associated with a novel ocular anomaly. Full ophthalmologic examination was performed in two WFS siblings. Visante OCT imaging was used for assessing anterior segment anomalies. Genetic analysis included PCR amplification and exon-by-exon nucleotide sequencing of the WFS1 gene. Ocular anomalies in both affected siblings included congenital cataract, glaucoma, and optic atrophy. Interestingly, microspherophakia, a feature that has not been previously associated with WFS, was observed in both siblings. Genetic analysis disclosed a novel c.1525_1539 homozygous deletion in exon 8 of WFS1 in DNA from both affected patients. The recognition of microspherophakia in two siblings carrying a novel WFS1 mutation expands the clinical and molecular spectrum of Wolfram syndrome.

Postural Tachycardia Syndrome and Vasovagal Syncope: A Hidden Case of Obstructive Cardiomyopathy without Severe Septal Hypertrophy.

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Mayuga, Kenneth A; Ho, Natalie; Shields, Robert W; Cremer, Paul; Rodriguez, L Leonardo

2018-01-01

A 36-year-old female with symptoms of orthostatic intolerance and syncope was diagnosed with vasovagal syncope on a tilt table test and with postural tachycardia syndrome (POTS) after a repeat tilt table test. However, an echocardiogram at our institution revealed obstructive cardiomyopathy without severe septal hypertrophy, with a striking increase in left ventricular outflow tract gradient from 7 mmHg at rest to 75 mmHg during Valsalva, with a septal thickness of only 1.3 cm. Cardiac MRI showed an apically displaced multiheaded posteromedial papillary muscle with suggestion of aberrant chordal attachments to the anterior mitral leaflet contributing to systolic anterior motion of the mitral valve. She underwent surgery with reorientation of the posterior medial papillary muscle head, resection of the tethering secondary chordae to the A1 segment of the mitral valve, chordal shortening and tacking of the chordae to the A1 and A2 segments of the mitral valve, and gentle septal myectomy. After surgery, she had significant improvement in her prior symptoms. To our knowledge, this is the first reported case of obstructive cardiomyopathy without severe septal hypertrophy with abnormalities in papillary muscle and chordal attachment, in a patient diagnosed with vasovagal syncope and POTS.

Postural Tachycardia Syndrome and Vasovagal Syncope: A Hidden Case of Obstructive Cardiomyopathy without Severe Septal Hypertrophy

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Kenneth A. Mayuga

2018-01-01

Full Text Available A 36-year-old female with symptoms of orthostatic intolerance and syncope was diagnosed with vasovagal syncope on a tilt table test and with postural tachycardia syndrome (POTS after a repeat tilt table test. However, an echocardiogram at our institution revealed obstructive cardiomyopathy without severe septal hypertrophy, with a striking increase in left ventricular outflow tract gradient from 7 mmHg at rest to 75 mmHg during Valsalva, with a septal thickness of only 1.3 cm. Cardiac MRI showed an apically displaced multiheaded posteromedial papillary muscle with suggestion of aberrant chordal attachments to the anterior mitral leaflet contributing to systolic anterior motion of the mitral valve. She underwent surgery with reorientation of the posterior medial papillary muscle head, resection of the tethering secondary chordae to the A1 segment of the mitral valve, chordal shortening and tacking of the chordae to the A1 and A2 segments of the mitral valve, and gentle septal myectomy. After surgery, she had significant improvement in her prior symptoms. To our knowledge, this is the first reported case of obstructive cardiomyopathy without severe septal hypertrophy with abnormalities in papillary muscle and chordal attachment, in a patient diagnosed with vasovagal syncope and POTS.

Hemodynamic patterns of anterior communicating artery aneurysms: a possible association with rupture

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Castro, Marcelo A.; Putman, Christopher M.; Cebral, Juan R.

2007-03-01

The aim of this study is to characterize the different flows present at anterior communicating artery (AcoA) aneurysms and investigate possible associations with rupture. For that purpose, patient-specific computational models of 26 AcoA aneurysms were constructed from 3D rotational angiography images. Bilateral images were acquired in 15 patients who had both A1 segments of the anterior cerebral arteries and models were created by fusing the reconstructed left and right arterial trees. Computational fluid dynamics simulations were performed under pulsatile flow conditions. Visualizations of the flow velocity pattern were created to classify the aneurysms into the following flow types: A) inflow from both A1 segments, B) flow jet in the parent artery splits into three secondary jets, one enters the aneurysm and the other two are directed to the A2 segments, C) the parent artery jet splits into two secondary jets, one is directed to one of the A2 segments and the other enters the aneurysm before being directed to the other A2 segment, and D) the parent artery jet enters the aneurysm before being directed towards the A2 segments. The maximum wall shear stress in the aneurysm at the systolic peak (MWSS) was calculated. Most aneurysms in group A were unruptured and had the lowest MWSS. Group B had the same number of unruptured and ruptured aneurysms, and a low MWSS. Groups C and D had high rupture ratios, being the average MWSS significantly higher in group C. Finally, it was found that the MWSS was higher for ruptured aneurysms of all flow types.

Do stable non-ST-segment elevation acute coronary syndromes require admission to coronary care units?

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van Diepen, Sean; Lin, Meng; Bakal, Jeffrey A; McAlister, Finlay A; Kaul, Padma; Katz, Jason N; Fordyce, Christopher B; Southern, Danielle A; Graham, Michelle M; Wilton, Stephen B; Newby, L Kristin; Granger, Christopher B; Ezekowitz, Justin A

2016-05-01

Clinical practice guidelines recommend admitting patients with stable non-ST-segment elevation acute coronary syndrome (NSTE ACS) to telemetry units, yet up to two-thirds of patients are admitted to higher-acuity critical care units (CCUs). The outcomes of patients with stable NSTE ACS initially admitted to a CCU vs a cardiology ward with telemetry have not been described. We used population-based data of 7,869 patients hospitalized with NSTE ACS admitted to hospitals in Alberta, Canada, between April 1, 2007, and March 31, 2013. We compared outcomes among patients initially admitted to a CCU (n=5,141) with those admitted to cardiology telemetry wards (n=2,728). Patients admitted to cardiology telemetry wards were older (median 69 vs 65years, PST-segment myocardial infarction or unstable angina. There were no differences in clinical outcomes observed between patients with NSTE ACS initially admitted to a ward or a CCU. These findings suggest that stable NSTE ACS may be managed appropriately on telemetry wards and presents an opportunity to reduce hospital costs and critical care capacity strain. Copyright © 2016 Elsevier Inc. All rights reserved.

PREVENTION OF LEFT VENTRICLE SYSTOLIC DYSFUNCTION IN PATIENTS WITH ACUTE CORONARY SYNDROME WITH ST SEGMENT ELEVATION AFTER CARDIAC REVASCULARIZATION

OpenAIRE

A. L. Alyavi; B. A. Alyavi; M. L. Kenzhaev; S. R. Kenzhaev

2009-01-01

Aim. To study effects of bioflavonoid quercetin (corvitin) on left ventricle (LV) systolic dysfunction in patients with acute coronary syndrome with ST segment elevation (ACS+ST) after cardiac revascularization.Material and methods. 60 patients with ACS+ST (44,2±1,3 y.o.) were examined. Patients were admitted to hospital within 6 hours after complaints beginning. Patients were randomized in two groups. 30 patients of group A had standard therapy and cardiac revascularization. 30 patients of g...

Neutrophil to lymphocyte ratio is associated with proximal/middle segment of the LAD lesions in patients with ST segment elevation infarction

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Ozlem Arican Ozluk

2017-01-01

Full Text Available Introduction: Neutrophil to lymphocyte ratio (NLR was revaled to have a close relation with atherosclerotic cardiovascular disease. The relationship between NLR and culprit plaque localization has never been studied. Aim of the study : To evaluate the association between NLR and unstable plaque localization of left anterior descending artery (LAD in anterior miyocardial infarction patients. Material and methods : Patients admitted to our hospital with acute anterior STEMI were included. Fifhy-eight patients who have single-vessel disease at LAD and their hematological parameters were analyzed retrospectively. Proximal segment of LAD lesions were groupped as Group I and mid segment of the LAD lesion groupped as Group II. The groups were compared according to their NLR and other parameters. Results : Between group I (n = 41, mean age 52.5 ±12.7 and group II (n = 17, mean ages 52.0 ±10.8; NLR, were significantly higher in group I compared to the group II (6.9 ±5.6 vs. 3.3 ±2.0, p = 0.01. In group I, left ventricular ejection fraction (LVEF was significantly lower (p = 0.02. In correlation analyzes, NLR was positively correlated with CK MB (r = 0.32, p = 0.01 and negatively correlated with LVEF (r = –0.28, p = 0.03. Conclusions : The present study demonstrated that anterior myocardial infarction patients with high NLR had a greater possibility having proximal culprit lesion on the LAD. Therefore NLR can be used as a useful tool to culprit plaque localization in patients with acute miyocardial infarction patients.

The Peters' plus syndrome: a review

NARCIS (Netherlands)

Maillette de Buy Wenniger-Prick, Liesbeth J. J. M.; Hennekam, Raoul C. M.

2002-01-01

Peters' plus syndrome is an infrequently described entity that combines anomalies in the anterior chamber of the eye with other multiple congenital anomalies, and a developmental delay. Major symptoms are extremely variable anterior chamber anomalies, cupid bow of the upper lip, cleft lip and

Extraluminal biodegradable splint to treat upper airway anterior malacia: A preclinical proof of principle.

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Gorostidi, François; Courbon, Cécile; Burki, Marco; Reinhard, Antoine; Sandu, Kishore

2018-02-01

Upper airway malacia highly complicates the treatment of benign laryngotracheal stenosis, and no ideal option is available to date. We here explore the use of extraluminal biodegradable splints in an animal model of long-segment anterior tracheomalacia (TM). We show the efficacy, as well as the tissue tolerance, of a custom-made biodegradable extraluminal device surgically inserted around the trachea. Preclinical animal study. Anterior TM was induced in rabbits through an anterior neck approach by removing eight consecutive anterior tracheal rings without damaging the underlying mucosa. Malacia was corrected during the same surgery by pexy sutures, suspending the tracheal mucosa to an experimental biodegradable device. Symptoms, survival, and tissue reaction were compared to healthy and sham surgery controls. The model induced death by respiratory failure within minutes. Ten animals received the experimental treatment, and those who survived the perioperative period remained asymptomatic with a maximum follow-up of 221 days. Histological studies at programmed euthanasia showed complete degradation of the prosthesis, with significant remnant fibrosis around the trachea. However, the tracheal stiffness of test segments was comparatively less than that of control segments. Extraluminal biodegradable splints rescued animals with a condition otherwise incompatible with life. It was well tolerated, leaving peritracheal fibrosis that was not as stiff as normal trachea. The external tracheal stiffening was sufficient for the test animals to live through the phase of severe acute hypercollapsibility. This represents a valid option to help pediatric patients with laryngotracheal stenosis and associated cartilaginous airway malacia. NA. Laryngoscope, 128:E53-E58, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Anterior and posterior ocular biometry in healthy Chinese subjects: data based on AS-OCT and SS-OCT.

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Wenbin Huang

Full Text Available To measure the anterior and posterior ocular biometric characteristics concurrently and to determine the relationship between the iris and choroid in healthy Chinese subjects.A total of 148 subjects (270 eyes were enrolled in this cross-section study. The anterior and posterior ocular biometric characteristics were measured simultaneously by anterior segment optical coherence tomography (AS-OCT and swept-source optical coherence tomography (SS-OCT.Compared with male eyes, female eyes had narrower anterior biometric parameters that presented with smaller anterior segment parameters [including anterior chamber depth (ACD, width (ACW, area (ACA, and volume (ACV; (all p<0.001], narrower anterior chamber angle parameters [including angle opening distance (AOD750, trabecular-iris space area (TISA750, and angle recess area (ARA; (all p<0.001], higher iris curvature (ICURV (p = 0.003, and larger lens vaults (LV (p = 0.019. These anterior ocular biometric parameters were correlated with increasing age (p<0.01. Iris thickness (IT750 and iris area (IAREA were associated with age, ACW, and pupil diameter (all p<0.05, while choroidal thickness (CT was associated with age, gender, and axial length (all p<0.05. Univariate regression analysis showed that greater CT was significantly associated with smaller IAREA (p = 0.026.Compared with male eyes, female eyes had narrower anterior biometric parameters that correlated with increasing age, which would be helpful in explaining the higher prevalence of angle closure rates in the female gender and in aging people. Increased CT might be associated with smaller iris area; however, this possibility needs to be investigated in future studies before this conclusion is made.

Síndrome do coração partido (síndrome de Takotsubo Broken-heart syndrome (Takotsubo syndrome

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Alessandra Edna Teófilo Lemos

2008-01-01

Full Text Available A cardiopatia induzida por estresse (precipitada por estresse emocional, também chamada de balonamento apical transitório do ventrículo esquerdo, síndrome do coração partido e, no Japão, síndrome de takotsubo, é caracterizada pela presença de movimento discinético transitório da parede anterior do ventrículo esquerdo, com acentuação da cinética da base ventricular. O curso clínico da cardiomiopatia de takotsubo pode se assemelhar ao do infarto agudo do miocárdio, com dor torácica típica e alterações eletrocardiográficas, sendo a cineangiocoronariografia realizada para distinguir as duas condições na fase aguda.Stress-induced cardiomyopathy, also know as reversible left ventricular apical ballooning, " Broken-Heart" syndrome, and in Japan, Takotsubo, is characterized by the presence of a transient left ventricular dyskinetic movement of the anterior wall of with hypercontraction of the ventricular basilar segments precipitated by emotional stress. The clinical course of Takotsubo cardiomyopathy is similar to that of an acute myocardial infarct with typical chest pain and electrocardiographic changes, and during the acute phase, coronary angiography is used to distinguish between the two conditions.

An unusual case of bilateral anterior uveitis related to moxifloxacin: the first report in Latin America

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Rangel, Carlos M.

2017-07-01

Full Text Available Objective: To report a case of bilateral anterior uveitis secondary to oral moxifloxacin.Methods: Case report.Results: A 54-year-old female presented bilateral anterior uveitis following a 10-day course of oral moxifloxacin. She developed a bilateral anterior uveitis associated with pigment dispersion syndrome and iris transillumination.Conclusions: Drug-induced uveitis is one of the causes of anterior uveitis. Uveitis related to fluoroquinolones is a rare entity, there are few cases reported in the literature, this is the first case reported in Latin America.

Effects of hyper- and hypo- thyroidism on oxidative stress of the eye in experimental acute anterior uveitis.

Science.gov (United States)

Bilgihan, K; Bilgihan, A; Diker, S; Ataoglu, O; Dolapci, M; Akata, F; Hasanreisôglu, B; Turkozkan, N

1996-02-01

Glutathione peroxidase activities and malondialdehyde levels were measured in the homogenated anterior segment of rat eyes with endotoxin induced acute anterior uveitis in euthyroid, hyperthyroid and hypothyroid rats. Malondialdehyde concentrations were found to be significantly increased (p 0.05). These results suggest that excess or deficiency of the thyroid hormones cause alterations in the malondialdehyde levels and glutathione peroxidase activities of the rat eyes in endotoxin induced uveitis, and hyperthyroidism may increase the oxidative stress in endotoxin induced acute anterior uveitis.

The anterior cingulate cortex

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Pavlović D.M.

2009-01-01

Full Text Available The anterior cingulate cortex (ACC has a role in attention, analysis of sensory information, error recognition, problem solving, detection of novelty, behavior, emotions, social relations, cognitive control, and regulation of visceral functions. This area is active whenever the individual feels some emotions, solves a problem, or analyzes the pros and cons of an action (if it is a right decision. Analogous areas are also found in higher mammals, especially whales, and they contain spindle neurons that enable complex social interactions. Disturbance of ACC activity is found in dementias, schizophrenia, depression, the obsessive-compulsive syndrome, and other neuropsychiatric diseases.

Sagittal Alignment As a Predictor of Clinical Adjacent Segment Pathology requiring Surgery after Anterior Cervical Arthrodesis

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Park, Moon Soo; Kelly, Michael P.; Lee, Dong-Ho; Min, Woo-Kie; Rahman, Ra’Kerry K.; Riew, K. Daniel

2014-01-01

BACKGROUND CONTEXT Postoperative malalignment of the cervical spine may alter cervical spine mechanics, and put patients at risk for clinical adjacent segment pathology requiring surgery. PURPOSE To investigate whether a relationship exists between cervical spine sagittal alignment and clinical adjacent segment pathology requiring surgery (CASP-S) following anterior cervical fusion (ACF). STUDY DESIGN Retrospective matched study. PATIENT SAMPLE One hundred twenty two patients undergoing ACF from 1996 to 2008 were identified, with a minimum of 2 year follow-up. OUTCOME MEASURES Radiographs were reviewed to measure the sagittal alignment using C2 and C7 sagittal plumb lines, distance from the fusion mass plumb line to the C2 and C7 plumb lines, the alignment of the fusion mass, caudally adjacent disc angle, the sagittal slope angle of the superior endplate of the vertebra caudally adjacent to the fusion mass, T1 sagittal angle, overall cervical sagittal alignment, and curve patterns by Katsuura classification. METHODS One hundred twenty two patients undergoing ACF from 1996 to 2008 were identified, with a minimum of 1 year follow-up. Patients were divided into groups according to the development of CASP requiring surgery (Control / CASP-S) and by number/location of levels fused. Radiographs were reviewed to measure the sagittal alignment using C2 and C7 sagittal plumb lines, distance from the fusion mass plumb line to the C2 and C7 plumb lines, the alignment of the fusion mass, caudally adjacent disc angle, the sagittal slope angle of the superior endplate of the vertebra caudally adjacent to the fusion mass, T1 sagittal angle, overall cervical sagittal alignment, and curve patterns by Katsuura classification. Appropriate statistical tests were performed to calculate relationships between the variables and the development of CASP-S. No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related

Management of Cleft Maxillary Hypoplasia with Anterior Maxillary Distraction: Our Experience.

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Chacko, Tojan; Vinod, Sankar; Mani, Varghese; George, Arun; Sivaprasad, K K

2014-12-01

Maxillary hypoplasia is a common developmental problem in cleft lip and palate deformities. Since 1970s these deformities have traditionally been corrected by means of orthognathic surgery. Management of skeletal deformities in the maxillofacial region has been an important challenge for maxillofacial surgeons and orthodontists. Distraction osteogenesis is a surgical technique that uses body's own repairing mechanisms for optimal reconstruction of the tissues. We present four cases of anterior maxillary distraction osteogenesis with tooth borne distraction device-Hyrax, which were analyzed retrospectively for the efficacy of the tooth borne device-Hyrax and skeletal stability of distracted anterior maxillary segment.

Subacute anterior spinal cord ischemia with lower limb monoplegia: a clinical dilemma and challenging scenario.

LENUS (Irish Health Repository)

Waters, Peadar S

2012-12-01

A 70-year-old woman presented with crescendo right lower limb monoplegia. Magnetic resonance imaging depicted anterior spinal artery syndrome with an 8.5 cm Crawford type II thoracoabdominal aortic aneurysm (TAAA). A staged hybrid procedure was performed, following which she had total exclusion of her TAAA and full resolution of her monoplegia. Clinical presentations of TAAAs can be diverse and require detailed clinical knowledge and lateral thinking to unearth unorthodox presentations. This erratic presentation of a TAAA with anterior spinal artery syndrome outlines particular challenges with management and portrays the need for tailored utilization of contemporary techniques to deal with the growing complexity of TAAAs.

[PHACES syndrome].

Science.gov (United States)

Morcillo Azcárate, J; Bernabeu-Wittel, J; Fernández-Pineda, I; Conejo-Mir, M D; Tuduri Limousin, I; Aspiazu Salinas, D A; de Agustín Asensio, J C

2010-04-01

PHACES syndrome associates a segmental facial hemangioma with cerebral malformations, aortic branches/cranial arteries anomalies, cardiac defects, eye anomalies or ventral wall defects. The aim of this study is to analyze our experience with this syndrome. Retrospective study of the cases seen at our unit in the last year. We treat 4 cases; 3 girls and 1 child. Besides the segmental hemangioma they presented: 3 vascular cerebral malformations; 2 structural cardiopathies; 2 cerebral malformations, 1 microftalmia. We did not find ventral wall defects. A case received treatment with two cycles of metilprednisolone i.v. and oral prednisone, with favourable course; two cases received initial treatment with oral prednisone continued of oral propanolol in rising pattern up to 2 mg/kg/day, Obtaining both the detention of the tumour growth and regression of the lesion, with very good tolerance. A 7-year-old patient has been treated with colouring pulse laser for her residual lesions. When we see a segmental facial hemangioma we must perform a wide diagnostic study in order to discard a PHACES syndrome. Multidisciplinar approach to the patient by a wide expert's group gets an earlier diagnose and improves the outcome. Propranolol is a promising therapeutic alternative.

Morphologic Patterns Formed by the Anomalous Fibers Occurring Along the Anterior Capsule of the Crystalline Lens in People With the Long Anterior Zonule Trait.

Science.gov (United States)

Roberts, Daniel K; Yang, Yongyi; Morettin, Christina E; Newman, Tricia L; Roberts, Mary F; Wilensky, Jacob T

2017-07-01

People with the long anterior zonule (LAZ) trait, which may have prevalence near 2%, have zonular fibers that extend more central than usual along the anterior capsule of the crystalline lens. The anomalous fibers can be observed in vivo with clinical slit lamp biomicroscopy after pharmacologic pupil dilation, and although minimally studied, the LAZ trait may have importance to glaucoma, retinal degeneration, and cataract surgery. To further characterize LAZ morphology, a custom computer program was used to trace LAZ fibers seen on retro-illumination photos acquired during previous study at an academic, urban eye care facility in Chicago, IL. There were 59 African-Americans (54 female; median age = 70 years, 53-91 years) included in the analysis. After initial review of the zonule tracings, we identified three basic LAZ patterns. We called one pattern (47% of right eyes) a "non-segmental LAZ pattern," which was predominated by fibers that could be visually traced to the dilated pupil border where they became obscured by the iris. Another pattern (35% of right eyes), the "segmental LAZ pattern," was predominated by fibers that appeared to terminate abruptly without detectable extension to the pupil border. The third pattern (18% of right eyes), the "mixed LAZ pattern," had a more equivalent mixture of the other two fiber morphologies. Compared to the "non-segmental" group, the "segmental" LAZ eyes had smaller central zonule-free zones (P < 0.0001), and they tended to exhibit fewer LAZ fibers (P = 0.07). These data improve understanding of LAZ clinical anatomy and may be helpful to future investigation. Anat Rec, 300:1336-1347, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Comparative study of unilateral versus bilateral inferior oblique recession/anteriorization in unilateral inferior oblique overaction.

Science.gov (United States)

Mostafa, Attiat M; Kassem, Rehab R

2018-05-01

To compare the effect of, and the rate of subsequent development of iatrogenic antielevation syndrome after, unilateral versus bilateral inferior oblique graded recession-anteriorization to treat unilateral inferior oblique overaction. Thirty-four patients with unilateral inferior oblique overaction were included in a randomized prospective study. Patients were equally divided into 2 groups. Group UNI underwent unilateral, group BI bilateral, inferior oblique graded recession-anteriorization. A successful outcome was defined as orthotropia, or within 2 ∆ of a residual hypertropia, in the absence of signs of antielevation syndrome, residual inferior oblique overaction, V-pattern, dissociated vertical deviation, or ocular torticollis. A successful outcome was achieved in 11 (64.7%) and 13 (76.5%) patients in groups UNI and BI, respectively (p = 0.452). Antielevation syndrome was diagnosed as the cause of surgical failure in 6 (35.3%) and 2 (11.8%) patients, in groups UNI and BI, respectively (p = 0.106). The cause of surgical failure in the other 2 patients in group BI was due to persistence of ocular torticollis and hypertropia in a patient with superior oblique palsy and a residual V-pattern and hypertropia in the other patient. The differences between unilateral and bilateral inferior oblique graded recession-anteriorization are insignificant. Unilateral surgery has a higher tendency for the subsequent development of antielevation syndrome. Bilateral surgery may still become complicated by antielevation syndrome, although at a lower rate. In addition, bilateral surgery had a higher rate of undercorrection. Further studies on a larger sample are encouraged.

Takotsubo cardiomyopathy associated with Miller-Fisher syndrome.

Science.gov (United States)

Gill, Dalvir; Liu, Kan

2017-07-01

51-year-old female who presented with progressive paresthesia, numbness of the lower extremities, double vision, and trouble walking. Physical exam was remarkable for areflexia, and ptosis. Her initial EKG showed nonspecific ST segment changes and her Troponin T was elevated to 0.41ng/mL which peaked at 0.66ng/mL. Echocardiogram showed a depressed left ventricular ejection fraction to 35% with severely hypokinetic anterior wall and left ventricular apex was severely hypokinetic. EMG nerve conduction study showed severely decreased conduction velocity and prolonged distal latency in all nerves consistent with demyelinating disease. She was treated with 5days of intravenous immunoglobulin therapy to which she showed significant improvement in strength in her lower extremities. Echocardiogram repeated 4days later showing an improved left ventricular ejection fraction of 55% and no left ventricular wall motion abnormalities. Takotsubo cardiomyopathy is a rare complication of Miller-Fisher syndrome and literature review did not reveal any cases. Miller-Fisher syndrome is an autoimmune process that affects the peripheral nervous system causing autonomic dysfunction which may involve the heart. Due to significant autonomic dysfunction in Miller-Fisher syndrome, it could lead to arrhythmias, blood pressure changes, acute coronary syndrome and myocarditis, Takotsubo cardiomyopathy can be difficult to distinguish. The treatment of Takotsubo cardiomyopathy is supportive with beta-blockers and angiotensin-converting enzyme inhibitors are recommended until left ventricle ejection fraction improvement. Takotsubo cardiomyopathy is a rare complication during the acute phase of Miller-Fisher syndrome and must be distinguished from autonomic dysfunction as both diagnoses have different approaches to treatment. Published by Elsevier Inc.

Changes in Anterior Segment Morphology and Predictors of Angle Widening after Laser Iridotomy in South Indian Eyes.

Science.gov (United States)

Zebardast, Nazlee; Kavitha, Srinivasan; Krishnamurthy, Palaniswamy; Friedman, David S; Nongpiur, Monisha E; Aung, Tin; Quigley, Harry A; Ramulu, Pradeep Y; Venkatesh, Rengaraj

2016-12-01

To compare anterior segment optical coherence tomography (ASOCT) angle morphology before and after laser peripheral iridotomy (LPI) in a cohort of South Indian subjects with primary angle-closure suspect (PACS) or primary angle-closure/primary angle-closure glaucoma (PAC/PACG) and to examine baseline parameters associated with angle widening. Prospective observational study. A total of 244 subjects aged ≥30 years with PACS or PAC/PACG in at least 1 eye. The ASOCT images and angle gonioscopic grades were analyzed for all subjects at baseline and 2 weeks after LPI. Multivariable linear and logistic regression models were used to determine predictors of angle widening (change in mean angle opening distance [AOD750]) and angle opening (all 4 quadrants with trabecular meshwork [TM] visible on gonioscopy after LPI). Change in ASOCT parameters with LPI and baseline predictors of angle widening. Laser peripheral iridotomy resulted in angle widening on ASOCT with significant increases in AOD750, angle recess area, and trabecular iris surface area (P gonioscopy, although some degree of persistent iridotrabecular contact was present in approximately half of PACS eyes and approximately two thirds of PAC/PACG eyes on gonioscopy. The greatest widening by ASOCT was observed in eyes with features most consistent with greater baseline pupillary block. Copyright © 2016 American Academy of Ophthalmology. All rights reserved.

The hippocampi of children with chromosome 22q11.2 deletion syndrome have localized anterior alterations that predict severity of anxiety.

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Scott, Julia A; Goodrich-Hunsaker, Naomi; Kalish, Kristopher; Lee, Aaron; Hunsaker, Michael R; Schumann, Cynthia M; Carmichael, Owen T; Simon, Tony J

2016-04-01

Individuals with 22q11.2 deletion syndrome (22q11.2DS) have an elevated risk for schizophrenia, which increases with history of childhood anxiety. Altered hippocampal morphology is a common neuroanatomical feature of 22q11.2DS and idiopathic schizophrenia. Relating hippocampal structure in children with 22q11.2DS to anxiety and impaired cognitive ability could lead to hippocampus-based characterization of psychosis-proneness in this at-risk population. We measured hippocampal volume using a semiautomated approach on MRIs collected from typically developing children and children with 22q11.2DS. We then analyzed hippocampal morphology with Localized Components Analysis. We tested the modulating roles of diagnostic group, hippocampal volume, sex and age on local hippocampal shape components. Lastly, volume and shape components were tested as covariates of IQ and anxiety. We included 48 typically developing children and 69 children with 22q11.2DS in our study. Hippocampal volume was reduced bilaterally in children with 22q11.2DS, and these children showed greater variation in the shape of the anterior hippocampus than typically developing children. Children with 22q11.2DS had greater inward deformation of the anterior hippocampus than typically developing children. Greater inward deformation of the anterior hippocampus was associated with greater severity of anxiety, specifically fear of physical injury, within the 22q11.2DS group. Shape alterations are not specific to hippocampal subfields. Alterations in the structure of the anterior hippocampus likely affect function and may impact limbic circuitry. We suggest these alterations potentially contribute to anxiety symptoms in individuals with 22q11.2DS through modulatory pathways. Altered hippocampal morphology may be uniquely linked to anxiety risk factors for schizophrenia, which could be a powerful neuroanatomical marker of schizophrenia risk and hence protection.

Anterior dural ectasia mimicking a lytic lesion in the posterior vertebral body in ankylosing spondylitis.

Science.gov (United States)

Bele, Keerthiraj; Pendharkar, Hima Shriniwas; Venkat, Easwer; Gupta, Arun Kumar

2011-12-01

Anterior dural ectasia is an extremely rare finding in ankylosing spondylitis (AS). The authors describe a unique case of AS in which the patient presented with cauda equina syndrome as well as an unusual imaging finding of erosion of the posterior aspect of the L-1 (predominantly) and L-2 vertebral bodies due to anterior dural ectasia. Symptomatic patients with long-standing AS should be monitored for the presence of dural ectasia, which can be anterior in location, as is demonstrated in the present case.

Do Lordotic Cages Provide Better Segmental Lordosis Versus Nonlordotic Cages in Lateral Lumbar Interbody Fusion (LLIF)?

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Sembrano, Jonathan N; Horazdovsky, Ryan D; Sharma, Amit K; Yson, Sharon C; Santos, Edward R G; Polly, David W

2017-05-01

A retrospective comparative radiographic review. To evaluate the radiographic changes brought about by lordotic and nonlordotic cages on segmental and regional lumbar sagittal alignment and disk height in lateral lumbar interbody fusion (LLIF). The effects of cage design on operative level segmental lordosis in posterior interbody fusion procedures have been reported. However, there are no studies comparing the effect of sagittal implant geometry in LLIF. This is a comparative radiographic analysis of consecutive LLIF procedures performed with use of lordotic and nonlordotic interbody cages. Forty patients (61 levels) underwent LLIF. Average age was 57 years (range, 30-83 y). Ten-degree lordotic PEEK cages were used at 31 lumbar interbody levels, and nonlordotic cages were used at 30 levels. The following parameters were measured on preoperative and postoperative radiographs: segmental lordosis; anterior and posterior disk heights at operative level; segmental lordosis at supra-level and subjacent level; and overall lumbar (L1-S1) lordosis. Measurement changes for each cage group were compared using paired t test analysis. The use of lordotic cages in LLIF resulted in a significant increase in lordosis at operative levels (2.8 degrees; P=0.01), whereas nonlordotic cages did not (0.6 degrees; P=0.71) when compared with preoperative segmental lordosis. Anterior and posterior disk heights were significantly increased in both groups (Plordosis (lordotic P=0.86 vs. nonlordotic P=0.25). Lordotic cages provided significant increase in operative level segmental lordosis compared with nonlordotic cages although overall lumbar lordosis remained unchanged. Anterior and posterior disk heights were significantly increased by both cages, providing basis for indirect spinal decompression.

Case Report - Neonatal progeroid syndrome (Wiedemann ...

African Journals Online (AJOL)

Case Report - Neonatal progeroid syndrome (Wiedemann-Rautenstrauch syndrome) in an Egyptian child with premature loss of teeth, and café au lait skin ... pads in the suprabuttock areas, triangular face, pseudohydrocephalous, sparse scalp hair and eyebrows, prominent scalp veins, greatly widened anterior fontanels, ...

Capsid Mutated Adeno-Associated Virus Delivered to the Anterior Chamber Results in Efficient Transduction of Trabecular Meshwork in Mouse and Rat.

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Barbara Bogner

Full Text Available Adeno associated virus (AAV is well known for its ability to deliver transgenes to retina and to mediate improvements in animal models and patients with inherited retinal disease. Although the field is less advanced, there is growing interest in AAV's ability to target cells of the anterior segment. The purpose of our study was to fully articulate a reliable and reproducible method for injecting the anterior chamber (AC of mice and rats and to investigate the transduction profiles of AAV2- and AAV8-based capsid mutants containing self-complementary (sc genomes in the anterior segment of the eye.AC injections were performed in C57BL/6 mice and Sprague Dawley rats. The cornea was punctured anterior of the iridocorneal angle. To seal the puncture site and to prevent reflux an air bubble was created in the AC. scAAVs expressing GFP were injected and transduction was evaluated by immunohistochemistry. Both parent serotype and capsid modifications affected expression. scAAV2- based vectors mediated efficient GFP-signal in the corneal endothelium, ciliary non-pigmented epithelium (NPE, iris and chamber angle including trabecular meshwork, with scAAV2(Y444F and scAAV2(triple being the most efficient.This is the first study to semi quantitatively evaluate transduction of anterior segment tissues following injection of capsid-mutated AAV vectors. scAAV2- based vectors transduced corneal endothelium, ciliary NPE, iris and trabecular meshwork more effectively than scAAV8-based vectors. Mutagenesis of surface-exposed tyrosine residues greatly enhanced transduction efficiency of scAAV2 in these tissues. The number of Y-F mutations was not directly proportional to transduction efficiency, however, suggesting that proteosomal avoidance alone may not be sufficient. These results are applicable to the development of targeted, gene-based strategies to investigate pathological processes of the anterior segment and may be applied toward the development of gene

Craniofacial morphology in Turner syndrome patients treated with growth hormone

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Jovana Julsoki

2015-05-01

Full Text Available ABSTRACT Introduction: In addition to well-established physical characteristics, Turner syndrome patients have distinct craniofacial morphology. Since short stature is the most typical characteristic, Turner syndrome patients are commonly treated with growth hormone in order to increase final height. At the same time, growth hormone treatment was found to influence craniofacial growth and morphology in various groups of treated patients. Whereas craniofacial characteristics of Turner syndrome patients are well documented, comparatively little is known of craniofacial morphology of those who are treated with growth hormone. Aim: The aim of this study was to investigate craniofacial morphology in Turner syndrome patients treated with growth hormone in comparison to healthy females. Materials and methods: The cephalometric evaluation was conducted on twenty lateral cephalograms of Turner syndrome patients (13.53 ± 4.04 years treated with growth hormone for at least one year (4.94 ± 1.92 years in average. As a control group, forty lateral cephalograms of healthy female controls, who matched Turner syndrome patients by chronological (11.80 ± 2.37 years and skeletal age, were used. Eleven angular, seven linear measurements and six dimensional ratios were measured to describe craniofacial morphology. Results: The results obtained for angular measurements, in cephalometric analyses for Turner syndrome patients treated with growth hormone, revealed bimaxillary retrognathism. The linear measurements indicated longer mandibular ramus, anterior cranial base and both anterior and posterior facial heights. However, posterior cranial base and maxilla were in proportion to the anterior cranial base, when comparing dimensional ratios. Anterior cranial base, maxilla and mandibular ramus were larger in proportion to mandibular body; as well as posterior facial height was when compared to anterior facial height. Turner syndrome patients treated with growth

ANTERIOR OPEN-BITE TREATMENT BY MEANS OF ZYGOMATIC MINIPLATES: A CASE REPORT

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Kadir BEYCAN

2017-01-01

Full Text Available This case report presents the treatment of a patient with skeletal Cl II malocclusion and anterior open-bite who was treated with zygomatic miniplates through the intrusion of maxillary posterior teeth. A 16-year-old female patient with a chief complaint of anterior open-bite had a symmetric face, incompetent lips, convex profile, retrusive lower lip and chin. Intraoral examination showed that the buccal segments were in Class II relationship, and there was anterior open-bite (overbite -6.5 mm. The cephalometric analysis showed Class II skeletal relationship with increased lower facial height. The treatment plan included intrusion of the maxillary posterior teeth using zygomatic miniplates followed by fixed orthodontic treatment. At the end of treatment Class I canine and molar relationships were achieved, anterior open-bite was corrected and normal smile line was obtained. Skeletal anchorage using zygomatic miniplates is an effective method for open-bite treatment through the intrusion of maxillary posterior teeth.

External Snapping Hip Syndrome: Emphasis on the MR Imaging

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Choi, Jung Eun; Lee, Bae Young; Sung, Mi Sook; Lee, Ki Haeng; Yoo, Won Jong; Lim, Hyun Wook; Chung, Myung Hee; Park, Jeong Mi; Kim, Jee Young

2010-01-01

The aim of this study is to evaluate the MR imaging features of patients with external snapping hip syndrome. We retrospectively reviewed 63 hip MR images. The images were analyzed according to the thickness and contour of the iliotibial band and the gluteus maximus, the presence of bone marrow edema, bursitis, joint effusion and other associated findings. The MR imaging of 22 hips with snapping hip syndrome depicted the causes of external snapping hip syndrome in twenty cases (90%). The MR imaging features of the snapping hip included thickening of the iliotibial band in twelve cases (55%) and/or thickening of the anterior band of the gluteus maximus in nineteen (86%), and a wavy contour of the iliotibial band or the anterior band of the gluteus maximus in ten cases (45%). These findings show a significant p value (<0.01). The majority of patients with snapping hip syndrome revealed thickening of the iliotibial band, thickening of the anterior band of the gluteus maximus and wavy contour of the those structures on MR imaging

External Snapping Hip Syndrome: Emphasis on the MR Imaging

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Choi, Jung Eun; Lee, Bae Young [Catholic University St. Paul' s Hospital, Seoul (Korea, Republic of); Sung, Mi Sook; Lee, Ki Haeng; Yoo, Won Jong; Lim, Hyun Wook; Chung, Myung Hee [Catholic University Bucheon St. Mary' s Hospital, Bucheon (Korea, Republic of); Park, Jeong Mi [Catholic University St. Mary' s Hospital, Seoul (Korea, Republic of); Kim, Jee Young [Catholic University St. Vincent' s Hospital, Suwon (Korea, Republic of)

2010-02-15

The aim of this study is to evaluate the MR imaging features of patients with external snapping hip syndrome. We retrospectively reviewed 63 hip MR images. The images were analyzed according to the thickness and contour of the iliotibial band and the gluteus maximus, the presence of bone marrow edema, bursitis, joint effusion and other associated findings. The MR imaging of 22 hips with snapping hip syndrome depicted the causes of external snapping hip syndrome in twenty cases (90%). The MR imaging features of the snapping hip included thickening of the iliotibial band in twelve cases (55%) and/or thickening of the anterior band of the gluteus maximus in nineteen (86%), and a wavy contour of the iliotibial band or the anterior band of the gluteus maximus in ten cases (45%). These findings show a significant p value (<0.01). The majority of patients with snapping hip syndrome revealed thickening of the iliotibial band, thickening of the anterior band of the gluteus maximus and wavy contour of the those structures on MR imaging.

A Case of Yellow Nail Syndrome Accompanying Idiopathic Interstitial Pneumonia; Successful Treatment with Clarithromycin, Methylprednisolone, and Alpha-Tocopherol

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Bilge Yılmaz Kara

2017-12-01

Full Text Available A 51-year-old woman presented with complaints of dyspnea, fatigue, and non-productive cough. Chest X-ray showed bilateral lung infiltrates. Nonspecific air-space consolidation on anterior segment of the right lower lobe, bilateral bronchiectasis and infiltrates, patchy ground-glass opacities, and interstitial thickening were reported on thorax computed tomography which was non-responsive to antibiotics. After tru-cut biopsy which only revealed a single granuloma in a particular area, alveolar septal thickening and fibrosis, slight chronic inflammation with findings of congestion, lung involvement was considered to be associated with nonspecific interstitial pneumonia. The nails on all fingers displayed yellow discoloration with mild edema in the face and the legs. The final diagnosis was yellow nail syndrome. Short-term clarithromycin and long-term oral methylprednisolone with vitamin E treatment were successful. After 4 months, all components of the syndrome almost completely regressed.

Hemimegalencephaly in the Klippel-Trenaunay-Weber syndrome

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Urui, Seishiro; Oi, Shizuo

1987-01-01

The Klippel-Trenaunay-Weber syndrome is characterized by skeletal and soft-tissue hypertrophy, segmentally distributed cutaneous nevi, and vascular anomalies. Only a few cases of this syndrome associated with hemimegalencephaly have been reported previously. However, we have experienced such a case of Klippel-Trenaunay-Weber syndrome with hemicranial hypertrophy, and so have analyzed this case from the neuroradiological point of view. The patient was a 6-month-old female with hemihypertrophy and hemimegalencephaly on the same, right side. A skull X-ray showed that the skull and facial bones were all hypertrophic on the right side and that all the sutures were open. A CT scan demonstrated that all the intracranial structures, including the ventricle on the right, were larger than those on the left. On the right side, we noticed a periventricular low-density area and spotted a calcified high-density region adjacent to the anterior horn of the lateral ventricle. Metrizamide CT cisternography exhibited ventricular stasis at 6 hours and a delayed clear-up in the subarachnoid space over the cerebral convexity in 24 hours. When we used the inversion recovery method on magnetic resonance imaging, the white matter on the right, especially in the periventricular area, was shown by a lower signal intensity than was that on the left. This could be thought to indicate the poor progress of the myelination process on the right side of the cerebrum. (author)

Interferon Induced Focal Segmental Glomerulosclerosis

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Yusuf Kayar

2016-01-01

Full Text Available Behçet’s disease is an inflammatory disease of unknown etiology which involves recurring oral and genital aphthous ulcers and ocular lesions as well as articular, vascular, and nervous system involvement. Focal segmental glomerulosclerosis (FSGS is usually seen in viral infections, immune deficiency syndrome, sickle cell anemia, and hyperfiltration and secondary to interferon therapy. Here, we present a case of FSGS identified with kidney biopsy in a patient who had been diagnosed with Behçet’s disease and received interferon-alpha treatment for uveitis and presented with acute renal failure and nephrotic syndrome associated with interferon.

Pathophysiology, diagnosis, and management of glaucoma associated with Sturge-Weber syndrome.

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Javaid, Usman; Ali, Muhammad Hassaan; Jamal, Samreen; Butt, Nadeem Hafeez

2018-02-01

Sturge-Weber syndrome (SWS), also known as encephalotrigeminal angiomatosis, is a condition which includes leptomeningeal hemangioma, facial angiomatosis or nevus flammeus, and ocular changes. SWS can lead to severe complications of anterior segment involving conjunctiva and eyelids, whereas posterior segment of the eye may also be affected by diffuse choroidal hemorrhages. This article was written with the objectives to determine the pathophysiology, diagnosis, and treatment of glaucoma associated with this rare and challenging disorder. A detailed literature search was conducted on PubMed, EMBASE, Cochrane Library, and Google Scholar using the key words. Forty-five articles matched our inclusion criteria that were included in this systematic review. Glaucoma is the one of the commonest ocular manifestations of SWS. It is caused by anterior chamber malformations, increased pressure in the episcleral veins, and changes in ocular hemodynamics. Glaucoma associated with SWS is usually congenital but can develop adults as well. The treatment of glaucoma associated with SWS is quite challenging because of early-onset, severe visual field impairment at the time of diagnosis, and unresponsiveness to standard medical treatment. Several surgical procedures have been devised but the long-term control of the intraocular pressure and visual function remain unsatisfactory. Modifications in the filtration surgery techniques and use of newer anti-fibrotic agents have produced good control of intraocular pressure. Management of glaucoma associated with SWS is multi-dimensional and needs both medical and surgical interventions for better control. The treatment should be devised on case to case basis depending upon the intraocular pressure, stage of the disease, and type of glaucoma.

Frequency and clinicopathological correlations of histopathological variants of idiopathic focal segmental glomerulosclerosis in nephrotic adolescents

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Shakeel, S.; Mubarak, M.; Kazi, J.I.

2014-01-01

Objective: To determine the frequency and clinicopathological correlations of focal segmental glomerulosclerosis variants in adolescents with idiopathic nephrotic syndrome. Methods: All consecutive adolescents (12 to 18 years) who presented with idiopathic nephrotic syndrome in the period, January 2009 to December 2012, and in whom the histological diagnosis of focal segmental glomerulosclerosis was made on renal biopsies, were included in this prospective study. Their clinical, laboratory and histopathological features at the time of presentation or biopsy were noted from the case files and the biopsy reports. Results: Among 50 adolescents, 34 (68%) were males and 16 (32%) females. The mean age was 15.14+-2.3 years. The mean duration of disease was 6.3+-11.2 months. The mean serum creatinine was 0.96+-0.82 mg/dl. The mean 24-hour urinary protein excretion was 3.8+-0.68 grams. Biopsy indications were steroid-resistant nephritic syndrome in 15 (30%), steroid-dependant nephritic syndrome in 19 (38%) and adolescent nephritic syndrome in 16 (32%) cases. Among the focal segmental glomerulosclerosis variants, 40 (80%) were not otherwise specified, followed by the collapsing variant, which accounted for 8 (16%) cases. The tip and cellular variants, both were found in one (2%) case each. Among the histological features, global glomerulosclerosis was found in 23 (46%) cases, and segmental scarring/collapse in all (100%). A variable degree of tubular atrophy and interstitial fibrosis was noted in 44 (88%) cases. Conclusion: The results from this study indicate that the pattern of focal segmental glomerulosclerosis variants differs markedly in adolescents compared with younger children. (author)

Anterior migration of dexamethasone implant in a pseudophakic patient with intact posterior capsule

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Nilufer Kocak

2014-01-01

Full Text Available Intravitreal application of Ozurdex ® (Allergan, Inc., Irvine, CA, USA which is a biodegradable, sustained-release dexamethasone implant has been reported to be effective in the treatment of macular edema. Migration of such implant into the anterior chamber has been recently described in cases without perfect zonular or the posterior capsular integrity. Herein, we report the first case with anterior migration of Ozurdex ® implant that mislocated just behind the intraocular lens (IOL in an intact capsular bag. It is thought that such implant migrated anteriorly towards into the posterior chamber through weak zonules as the present case had a medical history of uneventful phacoemulsification surgery with the implantation of posterior chamber IOL. However, the migrated implant was well tolerated since there was no sign of the corneal complication, rise in intraocular pressure, and anterior chamber reaction. Close follow-up was scheduled to find out any signs of anterior segment pathology. Meanwhile dexamethasone implant completely degraded at the 4 th month of postoperative follow-up.

Rare Complications of Cervical Spine Surgery: Horner's Syndrome.

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Traynelis, Vincent C; Malone, Hani R; Smith, Zachary A; Hsu, Wellington K; Kanter, Adam S; Qureshi, Sheeraz A; Cho, Samuel K; Baird, Evan O; Isaacs, Robert E; Rahman, Ra'Kerry K; Polevaya, Galina; Smith, Justin S; Shaffrey, Christopher; Tortolani, P Justin; Stroh, D Alex; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

2017-04-01

A multicenter retrospective case series. Horner's syndrome is a known complication of anterior cervical spinal surgery, but it is rarely encountered in clinical practice. To better understand the incidence, risks, and neurologic outcomes associated with Horner's syndrome, a multicenter study was performed to review a large collective experience with this rare complication. We conducted a retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network. Medical records for 17 625 patients who received subaxial cervical spine surgery from 2005 to 2011 were reviewed to identify occurrence of 21 predefined treatment complications. Descriptive statistics were provided for baseline patient characteristics. Paired t test was used to analyze changes in clinical outcomes at follow-up compared to preoperative status. In total, 8887 patients who underwent anterior cervical spine surgery at the participating institutions were screened. Postoperative Horner's syndrome was identified in 5 (0.06%) patients. All patients experienced the complication following anterior cervical discectomy and fusion. The sympathetic trunk appeared to be more vulnerable when operating on midcervical levels (C5, C6), and most patients experienced at least a partial recovery without further treatment. This collective experience suggests that Horner's syndrome is an exceedingly rare complication following anterior cervical spine surgery. Injury to the sympathetic trunk may be limited by maintaining a midline surgical trajectory when possible, and performing careful dissection and retraction of the longus colli muscle when lateral exposure is necessary, especially at caudal cervical levels.

Mobious syndrome: MR findings

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Maskal Revanna Srinivas

2016-01-01

Full Text Available Möbius syndrome is an extremely rare congenital disorder. We report a case of Möbius syndrome in a 2-year-old girl with bilateral convergent squint and left-sided facial weakness. The characteristic magnetic resonance imaging (MRI findings of Möbius syndrome, which include absent bilateral abducens nerves and absent left facial nerve, were noted. In addition, there was absence of left anterior inferior cerebellar artery (AICA and absence of bilateral facial colliculi. Clinical features, etiology, and imaging findings are discussed.

Histologic Anatomy of the Anterior Vagina and Urethra.

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Mazloomdoost, Donna; Westermann, Lauren B; Mutema, George; Crisp, Catrina C; Kleeman, Steven D; Pauls, Rachel N

Vaginal and urethral histology is important to understanding the pathophysiology of the pelvic floor. En bloc removal of 4 female cadaveric pelvises was performed, with 18 to 25 serial sections obtained from each. The vaginal and urethral lengths were divided into distal and proximal sections; urethra was divided into anterior and posterior segments as well. Innervation and vasculature were qualified as small and large and quantified per high-power field. The mean vaginal length was 7.45 cm, and the mean urethral length was 3.38 cm. A distinct vaginal fibromuscular layer was noted, without evidence of a dense sheet of continuous collagen. An epithelial, lamina propria, and muscular layer surrounded the urethral lumen. Adipose and loose fibroconnective tissue separated the urethra from the anterior vagina in 41% of slides. Nerves and vasculature were concentrated in the lamina propria. More small nerves and vessels were grossly seen compared with larger counterparts in both the vagina and urethra. No significant differences in layer thickness, innervation, or vasculature were observed along the vaginal length. The posterior urethra had greater innervation than did the anterior (P = 0.012). The distal posterior urethra had more large vessels than did the proximal posterior urethra (P = 0.03). No other differences were noted in urethral sections. A vaginal fibromuscular layer was confirmed, refuting a true fascia. Innervation and vasculature were quantitatively the same along the anterior vagina. However, the posterior urethra had greater innervation than did anterior and is most innervated proximally. Nerve and vascular histology may relate to pelvic floor disorder etiology.

Frank-ter Haar syndrome--additional findings?

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Köse, Taha Emre; İşler, Cemil; Şenel, Ş Neslihan; Şitilci, Tolga; Özcan, İlknur; Aksakallı, Nihan

2016-01-01

Frank-ter Haar syndrome is a genetic disease that is transmitted by autosomal recessive pattern with characteristic features such as megalocornea or glaucoma, a prominent coccyx, heart defects, developmental delays, brachycephaly, a wide anterior fontanel, finger flexion deformities, full cheeks and micrognathia. Dentomaxillofacial features of this syndrome are not well documented in the literature. We present of a 21-year-old male with Frank-ter Haar syndrome and some features that may be linked with this syndrome not reported before in the literature.

Evaluation of the anterior chamber angle in glaucoma: a report by the american academy of ophthalmology.

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Smith, Scott D; Singh, Kuldev; Lin, Shan C; Chen, Philip P; Chen, Teresa C; Francis, Brian A; Jampel, Henry D

2013-10-01

To assess the published literature pertaining to the association between anterior segment imaging and gonioscopy and to determine whether such imaging aids in the diagnosis of primary angle closure (PAC). Literature searches of the PubMed and Cochrane Library databases were last conducted on July 6, 2011. The searches yielded 371 unique citations. Members of the Ophthalmic Technology Assessment Committee Glaucoma Panel reviewed the titles and abstracts of these articles and selected 134 of possible clinical significance for further review. The panel reviewed the full text of these articles and identified 79 studies meeting the inclusion criteria, for which the panel methodologist assigned a level of evidence based on a standardized grading scheme adopted by the American Academy of Ophthalmology. Three, 70, and 6 studies were rated as providing level I, II, and III evidence, respectively. Quantitative and qualitative parameters defined from ultrasound biomicroscopy (UBM), anterior segment optical coherence tomography (OCT), Scheimpflug photography, and the scanning peripheral anterior chamber depth analyzer (SPAC) demonstrate a strong association with the results of gonioscopy. There is substantial variability in the type of information obtained from each imaging method. Imaging of structures posterior to the iris is possible only with UBM. Direct imaging of the anterior chamber angle (ACA) is possible using UBM and OCT. The ability to acquire OCT images in a completely dark environment allows greater sensitivity in detecting eyes with appositional angle closure. Noncontact imaging using OCT, Scheimpflug photography, or SPAC makes these methods more attractive for large-scale PAC screening than contact imaging using UBM. Although there is evidence suggesting that anterior segment imaging provides useful information in the evaluation of PAC, none of these imaging methods provides sufficient information about the ACA anatomy to be considered a substitute for

Brain white matter changes associated with urological chronic pelvic pain syndrome: Multi-site neuroimaging from a MAPP case-control study

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Huang, Lejian; Kutch, Jason J.; Ellingson, Benjamin M.; Martucci, Katherine T.; Harris, Richard E.; Clauw, Daniel J.; Mackey, Sean; Mayer, Emeran A.; Schaeffer, Anthony J.; Apkarian, A. Vania; Farmer, Melissa A.

2016-01-01

Clinical phenotyping of urological chronic pelvic pain syndromes (UCPPS) in men and women has focused on end-organ abnormalities to identify putative clinical subtypes. Initial evidence of abnormal brain function and structure in male pelvic pain has necessitated large-scale, multi-site investigations into potential UCPPS brain biomarkers. We present the first evidence of regional white matter (axonal) abnormalities in men and women with UCPPS, compared to positive (irritable bowel syndrome, IBS) and healthy controls. Epidemiological and neuroimaging data was collected from participants with UCPPS (n=52), IBS (n=39), and healthy, sex- and age-matched controls (n=61). White matter microstructure, measured as fractional anisotropy (FA), was examined with diffusion tensor imaging (DTI). Group differences in regional FA positively correlated with pain severity, including segments of the right corticospinal tract and right anterior thalamic radiation. Increased corticospinal FA was specific and sensitive to UCPPS, positively correlated with pain severity, and reflected sensory (not affective) features of pain. Reduced anterior thalamic radiation FA distinguished IBS from UCPPS patients and controls, suggesting greater microstructural divergence from normal tract organization. Findings confirm that regional white matter abnormalities characterize UCPPS and can distinguish between visceral diagnoses, suggesting that regional axonal microstructure is either altered with ongoing pain or predisposes its development. PMID:27842046

Management of Long-Segment and Panurethral Stricture Disease

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Francisco E. Martins

2015-01-01

Full Text Available Long-segment urethral stricture or panurethral stricture disease, involving the different anatomic segments of anterior urethra, is a relatively less common lesion of the anterior urethra compared to bulbar stricture. However, it is a particularly difficult surgical challenge for the reconstructive urologist. The etiology varies according to age and geographic location, lichen sclerosus being the most prevalent in some regions of the globe. Other common and significant causes are previous endoscopic urethral manipulations (urethral catheterization, cystourethroscopy, and transurethral resection, previous urethral surgery, trauma, inflammation, and idiopathic. The iatrogenic causes are the most predominant in the Western or industrialized countries, and lichen sclerosus is the most common in India. Several surgical procedures and their modifications, including those performed in one or more stages and with the use of adjunct tissue transfer maneuvers, have been developed and used worldwide, with varying long-term success. A one-stage, minimally invasive technique approached through a single perineal incision has gained widespread popularity for its effectiveness and reproducibility. Nonetheless, for a successful result, the reconstructive urologist should be experienced and familiar with the different treatment modalities currently available and select the best procedure for the individual patient.

A method of segment weight optimization for intensity modulated radiation therapy

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Pei Xi; Cao Ruifen; Jing Jia; Cheng Mengyun; Zheng Huaqing; Li Jia; Huang Shanqing; Li Gui; Song Gang; Wang Weihua; Wu Yican; FDS Team

2011-01-01

The error caused by leaf sequencing often leads to planning of Intensity-Modulated Radiation Therapy (IMRT) arrange system couldn't meet clinical demand. The optimization approach in this paper can reduce this error and improve efficiency of plan-making effectively. Conjugate Gradient algorithm was used to optimize segment weight and readjust segment shape, which could minimize the error anterior-posterior leaf sequencing eventually. Frequent clinical cases were tasted by precise radiotherapy system, and then compared Dose-Volume histogram between target area and organ at risk as well as isodose line in computed tomography (CT) film, we found that the effect was improved significantly after optimizing segment weight. Segment weight optimizing approach based on Conjugate Gradient method can make treatment planning meet clinical request more efficiently, so that has extensive application perspective. (authors)

Cephalometrics in children with Down's syndrome

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Quintanilla, Juan Suarez; Biedma, Benjamin Martin; Rodriguez, Maximino Quintans; Mora, Maria Teresa Jorge; Cunqueiro, Maria Mercedes Suarez; Pazos, Mayte Abeleira

2002-01-01

Heading AbstractAims. To describe the craniofacial morphology of a group of patients with Down's syndrome using a cephalometric analysis of the lateral skull radiograph.Materials and methods. The studied sample consisted of 39 patients with Down's syndrome (24 boys, 15 girls) ranging from 7 to 18 years of age. The computerized cephalometric study of the lateral skull radiograph of each patient was carried out using the method described by Ricketts.Results.Anterior cross-bite was observed in 38.4% of patients and diminished interincisal angle in 77%. Skeletal parameters matched the clinical norm, indicating mesofacial biotype, i.e., normal maxillomandibular growth. The lower incisors protruded in 84.6% of the individuals studied and were proinclined in 77%; upper incisors were protruded in 77% of the sample. The lower lip protruded in 84.6%. Analysis of craniofacial parameters showed average values within the clinical norm. Analysis of the inner cranium demonstrated normal inclination of the cranial base, while the length of the anterior skull base was diminished in 53.8%.Conclusions. From the skeletal perspective, patients with Down's syndrome who are in a period of growth demonstrate a reduction of the anterior skull base. From the dentoalveolar perspective, they show protrusion and proinclination of lower incisors, which is related to a tendency to anterior cross-bite and, to a lesser extent, to diminished overbite. Likewise, the lower lip protrusion observed in this study is related to the position of the lower incisor. (orig.)

Segmental kyphosis after cervical interbody fusion with stand-alone polyetheretherketone (PEEK) cages: a comparative study on 2 different PEEK cages.

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Kim, Chi Heon; Chung, Chun Kee; Jahng, Tae-Ahn; Park, Sung Bae; Sohn, Seil; Lee, Sungjoon

2015-02-01

Retrospective comparative study. Two polyetheretherketone (PEEK) cages of different designs were compared in terms of the postoperative segmental kyphosis after anterior cervical discectomy and fusion. Segmental kyphosis occasionally occurs after the use of a stand-alone cage for anterior cervical discectomy and fusion. Although PEEK material seems to have less risk of segmental kyphosis compared with other materials, the occurrence of segmental kyphosis for PEEK cages has been reported to be from 0% to 29%. There have been a few reports that addressed the issue of PEEK cage design. A total of 41 consecutive patients who underwent single-level anterior discectomy and fusion with a stand-alone cage were included. Either a round tube-type (Solis; 18 patients, S-group) or a trapezoidal tube-type (MC+; 23 patients, M-group) cage was used. The contact area between the cage and the vertebral body is larger in MC+ than in Solis, and anchoring pins were present in the Solis cage. The effect of the cage type on the segmental angle (SA) (lordosis vs. kyphosis) at postoperative month 24 was analyzed. Preoperatively, segmental lordosis was present in 12/18 S-group and 16/23 M-group patients (P=0.84). The SA was more lordotic than the preoperative angle in both groups just after surgery, with no difference between groups (P=0.39). At 24 months, segmental lordosis was observed in 9/18 S-group and 20/23 M-group patients (P=0.01). The patients in M-group were 7.83 times more likely than patients in S-group (P=0.04; odds ratio, 7.83; 95% confidence interval, 1.09-56.28) not to develop segmental kyphosis. The design of the PEEK cage used may influence the SA, and this association needs to be considered when using stand-alone PEEK cages.

Anterior Segment Optical Coherence Tomography for Tear Meniscus Evaluation and its Correlation with other Tear Variables in Healthy Individuals

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Dhasmana, Renu; Nagpal, Ramesh Chander

2016-01-01

Introduction Dry eye is one of the most common ocular diseases in this cyber era. Despite availability of multiple tests, no single test is accurate for the diagnosis of dry eye. Anterior segment optical coherence tomography is the recent tool which can be added in the armentarium of dry eye tests. Aim To evaluate tear meniscus with anterior segment optical coherence tomography and its correlation with other tear variables in normal healthy individuals. Materials and Methods In this prospective cross-sectional observational study, right eye of 203 consecutive patients were studied. All the patients were divided into three groups Group 1, 2 and 3 according to their age ≤20 years, 21-40 years and >40 years respectively. All patients underwent routine ophthalmologic examinations along with slit-lamp bio-microscopy for tear meniscus height measurement, tear film break up time, Schirmer’s I test (with anaesthesia) and optical coherence tomography imaging of inferior tear meniscus height. After focusing of the instrument with a Cross Line (CL) centered on lower tear meniscus at 6’0 clock of cornea, a 6 mm long scan was obtained. The tear meniscus height (μm) and tear meniscus area (mm2) were measured manually with help of callipers by joining upper corneo-meniscus junction to the lower lid-meniscus junction and tear meniscus height and area within the plotted line respectively and calculated by using the integrated analysis available in the custom software. Results There was significant decrease in the all tear variables with the increase in the age. According to age groups in group 1, the mean Schirmer’s (24.0±4.9)mm, tear film break up time (11.1±1.9) sec, tear meniscus height on slit lamp (600.2±167.3)mm were higher but decreased in group 2 (21.5±5.4,10.8±1.4, 597.5±186.3) and group 3 (19.8 ± 5.1, 10.2 ± 1.6, 485.6 ± 157.7) respectively. Schirmer’s test values and tear film break up time were similar in both sexes (p=0.1 and p= 0.9). Tear meniscus

Reactive histiocytosis of the orbit and posterior segment in a dog.

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Pumphrey, Stephanie A; Pizzirani, Stefano; Pirie, Christopher G; Sato, Amy F; Buckley, Faith I

2013-05-01

We present a case of reactive histiocytic disease involving the orbit, optic nerve, retina, and choroid in a Border Collie dog initially presenting for vision loss. Long-term partial return of vision has been achieved with systemic immunosuppression. Anterior segment and ocular surface manifestations of reactive histiocytic disease in dogs are relatively common. Posterior segment and orbital involvement, however, are minimally documented in the existing literature. To the authors' knowledge, this is the first report of disease confined to the orbit and posterior segment as well as the first report of vision loss as a presenting complaint for reactive histiocytic disease. Clinical, magnetic resonance imaging, cytologic, and histopathologic findings are reviewed. © 2012 American College of Veterinary Ophthalmologists.

Capsular phimosis with complete occlusion of the anterior capsular opening after intact continuous curvilinear capsulorrhexis

International Nuclear Information System (INIS)

Al-Kharashi, Soliman A.; Al-Obailan, Majed

2009-01-01

Shrinkage and whitening of the anterior capsule opening - capsular contraction syndrome - is a well-known complication after continuous curvilinear capsulorrhexis. A 72-year-old women underwent continuous curvilinear capsulorrhexis, phacoemulsification, and implantation of posterior chamber intraocular lens with polymethylmethacrylate haptics. Four months postoperatively, the patient reported deterioration in visual acuity that was resulted due to complete occlusion of anterior capsular opening by fibrotic tissue. The fibrous membrane was excised surgically in capsulorrhexis fashion. (author)

Treatment of anterior communicating artery aneurysms with Guglielmi detachable coils

International Nuclear Information System (INIS)

Xu Yi; Liu Jianmin; Hong Bo; Zhao Wenyuan; Huang Qinghai; Zhang Xin; Zhang Long

2003-01-01

Objective: To summarize the experience on endovascular treatment of anterior communicating artery aneurysms with Guglielmi detachable coils (GDCs) in 262 cases. Methods: All aneurysms were embolized with GDCs. Catheterization at both ICA was used to monitor the patency of parent arteries for patients with well-developed A1 segment of both ACAs. Microcatheter-assisted or microwire-assisted technique was undertaken to keep patency of parent arteries if the aneurysmal neck was involved with A2 segment. Thirty-four cases with multiple aneurysms had been treated successfully only in one session. Results: Complete embolization was achieved in 160 cases, while subtotal in 56 (>90%) and partial in 46 (<90%). Occlusion of parent arteries developed in 10 cases because of over-occlusion, and cerebral infarction was found in 16 cases after the procedure. Three cases with procedure-related thrombosis were revascularized by urokinase profusion. Follow-up angiograms of 3-6 months showed recanalization in 8 cases requiring a second time session. One case of recurrent aneurysm after GDC treatment was cured by surgical clipping. Conclusions: The result of endovascular treatment of anterior communicating artery aneurysms is fruitful and seems to be an alternative method in improving the rate of occlusion and reducing the cerebral infarction

The anterior temporal artery: an underutilized but robust donor for revascularization of the distal middle cerebral artery.

Science.gov (United States)

Tayebi Meybodi, Ali; Lawton, Michael T; Griswold, Dylan; Mokhtari, Pooneh; Payman, Andre; Benet, Arnau

2017-10-01

OBJECTIVE The anterior temporal artery (ATA) supplies an area of the brain that, if sacrificed, does not cause a noticeable loss of function. Therefore, the ATA may be used as a donor in intracranial-intracranial (IC-IC) bypass procedures. The capacities of the ATA as a donor have not been studied previously. In this study, the authors assessed the feasibility of using the ATA as a donor for revascularization of different segments of the distal middle cerebral artery (MCA). METHODS The ATA was studied in 15 cadaveric specimens (8 heads, excluding 1 side). First, the cisternal segment of the artery was untethered from arachnoid adhesions and small branches feeding the anterior temporal lobe and insular cortex, to evaluate its capacity for a side-to-side bypass to insular, opercular, and cortical segments of the MCA. Any branch entering the anterior perforated substance was preserved. Then, the ATA was cut at the opercular-cortical junction and the capacity for an end-to-side bypass was assessed. RESULTS From a total of 17 ATAs, 4 (23.5%) arose as an early MCA branch. The anterior insular zone and the frontal parasylvian cortical arteries were the best targets (in terms of mobility and caliber match) for a side-to-side bypass. Most of the insula was accessible for end-to-side bypass, but anterior zones of the insula were more accessible than posterior zones. End-to-side bypass was feasible for most recipient cortical arteries along the opercula, except for posterior temporal and parietal regions. Early ATAs reached significantly farther on the insular MCA recipients than non-early ATAs for both side-to-side and end-to-side bypasses. CONCLUSIONS The ATA is a robust arterial donor for IC-IC bypass procedures, including side-to-side and end-to-side techniques. The evidence provided in this work supports the use of the ATA as a donor for distal MCA revascularization in well-selected patients.

Heparin monotherapy or bivalirudin during percutaneous coronary intervention in patients with non-ST-segment-elevation acute coronary syndromes or stable ischemic heart disease: results from the Evaluation of Drug-Eluting Stents and Ischemic Events registry.

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Bangalore, Sripal; Pencina, Michael J; Kleiman, Neal S; Cohen, David J

2014-06-01

The use of bivalirudin versus unfractionated heparin monotherapy in patients without ST-segment-elevation myocardial infarction is not well defined. The study population consisted of patients enrolled in the Evaluation of Drug-Eluting Stents and Ischemic Events (EVENT) registry with either non-ST-segment-elevation acute coronary syndromes or stable ischemic heart disease, who underwent percutaneous coronary intervention with either unfractionated heparin or bivalirudin monotherapy. Propensity score matching was used to adjust for baseline characteristics. The primary bleeding (in-hospital composite bleeding-access site bleeding, thrombolysis in myocardial infarction major/minor bleeding, or transfusion) and primary (in-hospital death/myocardial infarction) and secondary ischemic outcomes (death/myocardial infarction/unplanned repeat revascularization at 12 months) were evaluated. Propensity score matching yielded 1036 patients with non-ST-segment-elevation acute coronary syndromes and 2062 patients with stable ischemic heart disease. For the non-ST-segment-elevation acute coronary syndrome cohort, bivalirudin use was associated with lower bleeding (difference, -3.3% [-0.8% to -5.8%]; P=0.01; number need to treat=30) without increase in either primary (difference, 1.2% [4.1% to -1.8%]; P=0.45) or secondary ischemic outcomes, including stent thrombosis (difference, 0.0% [1.3% to -1.3%]; P=1.00). Similarly, in the stable ischemic heart disease cohort, bivalirudin use was associated with lower bleeding (difference, -1.8% [-0.4% to -3.3%]; P=0.01; number need to treat=53) without increase in either primary (difference, 0.4% [2.3% to -1.5%]; P=0.70) or secondary ischemic outcomes, including stent thrombosis (difference, 0.0% [0.7% to -0.7%]; P=1.00) when compared with unfractionated heparin monotherapy. Among patients with non-ST-segment-elevation acute coronary syndromes or stable ischemic heart disease undergoing percutaneous coronary intervention, bivalirudin use

Anomalous brain functional connectivity contributing to poor adaptive behavior in Down syndrome.

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Pujol, Jesus; del Hoyo, Laura; Blanco-Hinojo, Laura; de Sola, Susana; Macià, Dídac; Martínez-Vilavella, Gerard; Amor, Marta; Deus, Joan; Rodríguez, Joan; Farré, Magí; Dierssen, Mara; de la Torre, Rafael

2015-03-01

Research in Down syndrome has substantially progressed in the understanding of the effect of gene overexpression at the molecular level, but there is a paucity of information on the ultimate consequences on overall brain functional organization. We have assessed the brain functional status in Down syndrome using functional connectivity MRI. Resting-state whole-brain connectivity degree maps were generated in 20 Down syndrome individuals and 20 control subjects to identify sites showing anomalous synchrony with other areas. A subsequent region-of-interest mapping served to detail the anomalies and to assess their potential contribution to poor adaptive behavior. Down syndrome individuals showed higher regional connectivity in a ventral brain system involving the amygdala/anterior temporal region and the ventral aspect of both the anterior cingulate and frontal cortices. By contrast, lower functional connectivity was identified in dorsal executive networks involving dorsal prefrontal and anterior cingulate cortices and posterior insula. Both functional connectivity increases and decreases contributed to account for patient scoring on adaptive behavior related to communication skills. The data overall suggest a distinctive functional organization with system-specific anomalies associated with reduced adaptive efficiency. Opposite effects were identified on distinct frontal and anterior temporal structures and relative sparing of posterior brain areas, which is generally consistent with Down syndrome cognitive profile. Relevantly, measurable connectivity changes, as a marker of the brain functional anomaly, could have a role in the development of therapeutic strategies addressed to improve the quality of life in Down syndrome individuals. Copyright © 2014 Elsevier Ltd. All rights reserved.

Lumbar segmental nerve blocks with local anesthetics, pain relief, and motor function: a prospective double-blind study between lidocaine and ropivacaine.

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Wolff, André P; Wilder Smith, Oliver H G; Crul, Ben J P; van de Heijden, Marc P; Groen, Gerbrand J

2004-08-01

Selective segmental nerve blocks with local anesthetics are applied for diagnostic purposes in patients with chronic back pain to determine the segmental level of the pain. We performed this study to establish myotomal motor effects after L4 spinal nerve blocks by lidocaine and ropivacaine and to evaluate the relationship with pain. Therefore, 20 patients, of which 19 finished the complete protocol, with chronic lumbosacral radicular pain without neurological deficits underwent segmental nerve blocks at L4 with both lidocaine and ropivacaine. Pain intensity scores (verbal numeric rating scale; VNRS) and the maximum voluntary muscle force (MVMF; using a dynamometer expressed in newtons) of the tibialis anterior and quadriceps femoris muscles were measured on the painful side and on the control side. The median VNRS decrease was 4.0 (P segmental nerve (L4) block is associated with increased quadriceps femoris and tibialis anterior MVMF, without differences for lidocaine and ropivacaine.

Two cases of Cantrell's syndrome

International Nuclear Information System (INIS)

Yu, Yun Jeong; Yeon, Kyung Mo

1982-01-01

Congenital absence of the lower sternum, defect of the abdominal wall, defects of the anterior diaphragm, pericardial defects and cardiac anomalies had been described as a syndrome by Cantrell et al. Developing mechanism of the syndrome was embryologically defined. These defects arise apparently from combined anomalies of developing of the dorsal mesoderm. The authors present two cases of Cantrell's syndrome developed in one day old and eight months old female patient in which angiocardiography was done at the Department of Radiology, Seoul National University Hospital

Genetic disorders of the anterior pituitary gland.

Science.gov (United States)

Teller, W M

1985-01-01

This survey deals with disorders caused by genetically disturbed function of the anterior pituitary gland. Genetic Dwarfism may be caused by isolated growth hormone deficiency (IGHD) or panpituitary diseases, such as congenital absence of the pituitary or familial panhypopituitarism. Genetic disturbances of isolated pituitary hormone secretion without dwarfism may occur as isolated gonadotropin deficiency (IGD), isolated luteinizing hormone deficiency ("fertile eunuch"), Kallmann syndrome (olfactogenital dysplasia), isolated thyrotropin deficiency (ITD) and isolated corticotropin deficiency (ICD). Pituitary dysfunction may also be associated with other genetic disease entities.

Waardenburg-Shah Syndrome: a rare case in an Indian child.

Science.gov (United States)

Pattebahadur, Rajesh; Singhi, Shipra; Maharana, Prafulla Kumar

2016-09-30

A 7-year-old male child presented with a history of discolouration of right eye since birth. On examination visual acuity was 6/6 on Snellen's chart in both eyes; anterior segment was within normal limits except for the brilliant blue discolouration of the inferior quadrant and superior quadrant of right iris and left eye iris, respectively. Both eyes had a clear lens and fundus findings were within normal limits. A detailed history from parents revealed that the child had difficulty in hearing and slurring of speech. In addition, the child had repeated episodes of constipation with bilious vomiting during infancy for which a diagnosis of fungal sepsis with Hirschsprung's disease was made and the child had to undergo a mid-sigmoid loop colostomy for that. A diagnosis of Waardenburg--Shah Syndrome was made and the child was referred for hearing and speech rehabilitation. 2016 BMJ Publishing Group Ltd.

A novel fibrillin-1 mutation in an egyptian marfan family: A proband showing nephrotic syndrome due to focal segmental glomerulosclerosis

Directory of Open Access Journals (Sweden)

Mohammad Al-Haggar

2017-01-01

Full Text Available Marfan syndrome (MFS, the founding member of connective tissue disorder, is an autosomal dominant disease; it is caused by a deficiency of the microfibrillar protein fibrillin-1 (FBN1 and characterized by involvement of three main systems; skeletal, ocular, and cardiovascular. More than one thousand mutations in FBN1 gene on chromosome 15 were found to cause MFS. Nephrotic syndrome (NS had been described in very few patients with MFS being attributed to membranoproliferative glomerulonephritis secondary to infective endocarditis. Focal segmental glomerulosclerosis (FSGS had been reported in NS in conjunction with MFS without confirming the diagnosis by mutational analysis of FBN1. We hereby present an Egyptian family with MFS documented at the molecular level; it showed a male proband with NS secondary to FSGS, unfortunately, we failed to make any causal link between FBN dysfunction and FSGS. In this context, we review the spectrum of renal involvements occurring in MFS patients.

[Scimitar syndrome. Correlation anatomo-embryological].

Science.gov (United States)

Muñoz-Castellanos, Luis; Kuri-Nivon, Magdalena

2016-01-01

To describe morphologically a toracoabdominal visceral block of a scimitar's syndrome case. We propose a pathogenetic theory wich explains the development of the pulmonary venous connection in this syndrome. The anatomic specimen was described with the segmental sequential system. The situs was solitus, the connections between the cardiac segments and the associated anomalies were determined. The anatomy of both lungs, including the venous pulmonary connection, was described. A pathogenetic hypothesis was made, which explains the pulmonary venous connection throw a correlation between the pathology of this syndrome and the normal development of the pulmonary veins. The situs was solitus, the connections of the cardiac chambers were normal; there were hypoplasia and dysplasia of the right lung with sequestration of the inferior lobe; the right pulmonary veins were connected with a curved collector which drainaged into the suprahepatic segment of the inferior vena cava; the left pulmonary veins were open into the left atrium. The sequestered inferior lobe of the right lung received irrigation throw a collateral aortopulmonary vessel. There was an atrial septal defect. The pathogenetic hypothesis propose that the pulmonary venous connection in this syndrome represent the persistent of the Streeter's horizon xiv (28-30 days of development), period in which the sinus of the pulmonary veins has double connection, with the left atrium and with a primitive collector into the right viteline vein which forms the suprahepatic segment of the inferior vena cava. Copyright © 2015 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

Reconstruction of a Post Traumatic Anterior Maxillary Defect by Transport Distraction Osteogenesis.

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Rajkumar, K; Neelakandan, R S; Devadoss, Pradeep; Bandyopadhyay, T K

2017-03-01

Rehabilitation of segmental defects of maxilla presents a reconstructive challenge to obtain an ideal osseous form and height with adequate soft tissue investment. Though variety of prosthetic and surgical reconstructive options like the use of vascularized and non vascularized bone grafts are available they produce less than optimal results. Bone transport distraction is a reliable procedure in various maxillofacial bony defect reconstruction techniques. We describe herein a technique of maxillary bone transport distraction using an indigenously designed, custom made trifocal transport distractor performed in a post traumatic avulsive defect of the anterior maxilla. Transport distraction was successful for anterior maxillary alveolar bony regeneration, with excellent soft tissue cover and vestibular depth, which also helped close an oroantral/oronasal fistula.

CHRONIC COMPARTMENT SYNDROME OF LOWER LEG. AN UNUSUAL CASE IN NON ATHLETIC PATIENT.

Directory of Open Access Journals (Sweden)

Andrea Schiavone

2016-10-01

Full Text Available Chronic exertional anterior compartment syndrome is debilitating disease of lower limb. The clinical picture is characterised by limited symptomology at rest, pain during sporting activities, tumefaction and contractures of limb as well impotency by pain of the entire forefoot and hypoesthesia. Usually the most affected patients are athletes. We analyse a case of chronic post traumatic compartment syndrome of the anterior tibial muscle in an unsportsmanlike patient.

Iris concavity, corneal biomechanics, and their correlations with ocular biometry in a cohort of 10- to 12-year-old UK school boys: baseline data.

Science.gov (United States)

Shah, Ameet; Low, Sancy; Garway-Heath, David F; Foster, Paul J; Barton, Keith

2014-04-17

Pigment dispersion syndrome is associated with iris concavity. This study investigated the prevalence of iris concavity, defined as a measurement of ≤-0.1 mm, in a cohort of 10- to 12-year-old boys, and explored the relationship between iris curvature and anterior segment biometry. Associations with corneal biomechanical parameters also were explored. A cohort of school boys (n = 96) was recruited from a local school. Anterior segment optical coherence tomography (AS-OCT) was performed under accommodative and nonaccommodative conditions, and iris curvature quantified. Corneal hysteresis (CH) and corneal resistance factor (CRF) were measured with the ocular response analyzer (ORA). Noncontact axial biometry was performed using laser interferometry. The prevalence of iris concavity was 24% on distance fixation, increasing to 65% on accommodation. Variables significantly associated with nonaccommodating iris curvature were lens vault (P = 0.02) and mean keratometry (P = 0.02). For both variables acting jointly, R(2) = 0.30. Variables associated significantly with accommodating iris curvature were anterior chamber depth (P = 0.009), lens vault (P = 0.049), and mean scleral spur angle (P Iris concavity was a common finding in this cohort and related to anterior segment biometric parameters. Further work is required to clarify whether anatomical differences exist between iris concavity seen in the adolescent eye and that found in adults with pigment dispersion syndrome. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

Diverging associations of an intended early invasive strategy compared with actual revascularization, and outcome in patients with non-ST-segment elevation acute coronary syndrome: the problem of treatment selection bias.

NARCIS (Netherlands)

Hirsch, A.; Windhausen, F.; Tijssen, J.G.P.; Oude Ophuis, A.J.M.; Giessen, W.J. van der; Zee, P.M. van der; Cornel, J.H.; Verheugt, F.W.A.; Winter, R.J. de

2009-01-01

AIMS: In several observational studies, revascularization is associated with substantial reduction in mortality in patients with non-ST-segment elevation acute coronary syndrome (nSTE-ACS). This has strengthened the belief that routine early angiography would lead to a reduction in mortality. We

Surgical results of a one-stage combined anterior lumbosacral fusion and posterior percutaneous pedicle screw fixation

Directory of Open Access Journals (Sweden)

Chien-Yuan Huang

2018-01-01

Full Text Available Objectives: Lumbosacral fusion through either an anterior or a posterior approach to achieve good lordosis and stability is always a challenging surgical operation and is often accompanied by a higher rate of pseudarthrosis than when other lumbar segments are involved. This study evaluated the clinical and radiological results of lumbosacral fusions achieved through a combined anterior and posterior approach. Materials and Methods: From June 2008 to 2012, 20 patients who had L5–S1 instability and stenosis were consecutively treated, first by anterior interbody fusion using an allogenous strut bone graft through the pararectus approach and then by posterior pedicle screw fixation. A minimum of 1-year of clinical and radiological follow-up was conducted. Intraoperative blood loss, surgical time, and any surgery-related complications were recorded. Clinical outcomes were assessed using a visual analog scale (VAS and the patient's Oswestry Disability Index (ODI score. After 1 year, radiological outcomes were assessed by analyzing pelvic incidence, lumbar lordosis, and segmental lordosis using static plain films, while fusion stability was assessed using dynamic plain films. Results: The mean operative time and blood loss were 215 min and 325 cc, respectively. After 1 year, the VAS and ODI scores had significantly improved, and stable fusion with good lordotic curvature was obtained in all cases. Conclusion: The surgical results of the combined procedure are satisfactory in terms of the functional and radiological outcomes. Our method offers advantages regarding both anterior fusion and posterior fixation.

Rare Complications of Cervical Spine Surgery: Horner’s Syndrome

Science.gov (United States)

Malone, Hani R.; Smith, Zachary A.; Hsu, Wellington K.; Kanter, Adam S.; Qureshi, Sheeraz A.; Cho, Samuel K.; Baird, Evan O.; Isaacs, Robert E.; Rahman, Ra’Kerry K.; Polevaya, Galina; Smith, Justin S.; Shaffrey, Christopher; Tortolani, P. Justin; Stroh, D. Alex; Arnold, Paul M.; Fehlings, Michael G.; Mroz, Thomas E.; Riew, K. Daniel

2017-01-01

Study Design: A multicenter retrospective case series. Objective: Horner’s syndrome is a known complication of anterior cervical spinal surgery, but it is rarely encountered in clinical practice. To better understand the incidence, risks, and neurologic outcomes associated with Horner’s syndrome, a multicenter study was performed to review a large collective experience with this rare complication. Methods: We conducted a retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network. Medical records for 17 625 patients who received subaxial cervical spine surgery from 2005 to 2011 were reviewed to identify occurrence of 21 predefined treatment complications. Descriptive statistics were provided for baseline patient characteristics. Paired t test was used to analyze changes in clinical outcomes at follow-up compared to preoperative status. Results: In total, 8887 patients who underwent anterior cervical spine surgery at the participating institutions were screened. Postoperative Horner’s syndrome was identified in 5 (0.06%) patients. All patients experienced the complication following anterior cervical discectomy and fusion. The sympathetic trunk appeared to be more vulnerable when operating on midcervical levels (C5, C6), and most patients experienced at least a partial recovery without further treatment. Conclusions: This collective experience suggests that Horner’s syndrome is an exceedingly rare complication following anterior cervical spine surgery. Injury to the sympathetic trunk may be limited by maintaining a midline surgical trajectory when possible, and performing careful dissection and retraction of the longus colli muscle when lateral exposure is necessary, especially at caudal cervical levels. PMID:28451480

The anterior hypothalamus in cluster headache.

Science.gov (United States)

Arkink, Enrico B; Schmitz, Nicole; Schoonman, Guus G; van Vliet, Jorine A; Haan, Joost; van Buchem, Mark A; Ferrari, Michel D; Kruit, Mark C

2017-10-01

Objective To evaluate the presence, localization, and specificity of structural hypothalamic and whole brain changes in cluster headache and chronic paroxysmal hemicrania (CPH). Methods We compared T1-weighted magnetic resonance images of subjects with cluster headache (episodic n = 24; chronic n = 23; probable n = 14), CPH ( n = 9), migraine (with aura n = 14; without aura n = 19), and no headache ( n = 48). We applied whole brain voxel-based morphometry (VBM) using two complementary methods to analyze structural changes in the hypothalamus: region-of-interest analyses in whole brain VBM, and manual segmentation of the hypothalamus to calculate volumes. We used both conservative VBM thresholds, correcting for multiple comparisons, and less conservative thresholds for exploratory purposes. Results Using region-of-interest VBM analyses mirrored to the headache side, we found enlargement ( p cluster headache compared to controls, and in all participants with episodic or chronic cluster headache taken together compared to migraineurs. After manual segmentation, hypothalamic volume (mean±SD) was larger ( p cluster headache compared to controls (1.72 ± 0.15 ml) and migraineurs (1.68 ± 0.19 ml). Similar but non-significant trends were observed for participants with probable cluster headache (1.82 ± 0.19 ml; p = 0.07) and CPH (1.79 ± 0.20 ml; p = 0.15). Increased hypothalamic volume was primarily explained by bilateral enlargement of the anterior hypothalamus. Exploratory whole brain VBM analyses showed widespread changes in pain-modulating areas in all subjects with headache. Interpretation The anterior hypothalamus is enlarged in episodic and chronic cluster headache and possibly also in probable cluster headache or CPH, but not in migraine.

Vascular affection in relation to oxidative DNA damage in metabolic syndrome.

Science.gov (United States)

Abd El Aziz, Rokayaa; Fawzy, Mary Wadie; Khalil, Noha; Abdel Atty, Sahar; Sabra, Zainab

2018-02-01

Obesity has become an important issue affecting both males and females. Obesity is now regarded as an independent risk factor for atherosclerosis-related diseases. Metabolic syndrome is associated with increased risk for development of cardiovascular disease. Urinary 8-oxo-7,8-dihydro-2'-deoxyguanosine concentration has been used to express oxidation status. Twenty-seven obese patients with metabolic syndrome, 25 obese patients without metabolic syndrome and 31 healthy subjects were included in our study. They were subjected to full history and clinical examination; fasting blood sugar (FBS), 2 hour post prandial blood sugar (2HPP), lipid profile, urinary 8-oxo-7,8-dihydro-2'-deoxyguanosine and carotid duplex, A/B index and tibial diameters were all assessed. There was a statistically significant difference ( p = 0.027) in diameter of the right anterior tibial artery among the studied groups, with decreased diameter of the right anterior tibial artery in obese patients with metabolic syndrome compared to those without metabolic syndrome; the ankle brachial index revealed a lower index in obese patients with metabolic syndrome compared to those without metabolic syndrome. There was a statistically insignificant difference ( p = 0.668) in the 8-oxodG in the studied groups. In obese patients with metabolic syndrome there was a positive correlation between 8-oxodG and total cholesterol and LDL. Urinary 8-oxodG is correlated to total cholesterol and LDL in obese patients with metabolic syndrome; signifying its role in the mechanism of dyslipidemia in those patients. Our study highlights the importance of anterior tibial artery diameter measurement and ankle brachial index as an early marker of atherosclerosis, and how it may be an earlier marker than carotid intima-media thickness.

Genetics Home Reference: Prader-Willi syndrome

Science.gov (United States)

... caused by a phenomenon called genomic imprinting. Most cases of Prader-Willi syndrome (about 70 percent) occur when a segment of ... More about Mutations and Health Inheritance Pattern Most cases of Prader-Willi syndrome are not inherited, particularly those caused by a ...

Linking gene regulation to cell behaviors in the posterior growth zone of sequentially segmenting arthropods.

Science.gov (United States)

Williams, Terri A; Nagy, Lisa M

2017-05-01

Virtually all arthropods all arthropods add their body segments sequentially, one by one in an anterior to posterior progression. That process requires not only segment specification but typically growth and elongation. Here we review the functions of some of the key genes that regulate segmentation: Wnt, caudal, Notch pathway, and pair-rule genes, and discuss what can be inferred about their evolution. We focus on how these regulatory factors are integrated with growth and elongation and discuss the importance and challenges of baseline measures of growth and elongation. We emphasize a perspective that integrates the genetic regulation of segment patterning with the cellular mechanisms of growth and elongation. Copyright © 2016 Elsevier Ltd. All rights reserved.

Interdisciplinary treatment for an adult patient with anterior open bite, severe periodontitis, and intellectual disability.

Science.gov (United States)

Kang, Da-Young; Choi, Sung-Hwan; Jung, Young-Soo; Hwang, Chung-Ju

2015-05-01

This case report describes the beneficial effects of the interdisciplinary treatment of an adult patient with severe skeletal periodontal problems. A 30-year-old female patient presented with anterior open bite, gummy smile, and facial asymmetry. The patient had chronic generalized severe periodontitis with pathologic maxillary anterior teeth migration and mild intellectual disability. Treatment included 6 months of periodontal treatment, followed by presurgical orthodontic treatment, a Le Fort I osteotomy with anterior segmental osteotomy, a bilateral sagittal split ramus osteotomy, and postsurgical orthodontic treatment. After treatment completion, the patient exhibited functional and aesthetic improvements. Her periodontal condition improved and was maintained after the treatment. Here, we demonstrate a successful treatment outcome in a complicated case following a systematic interdisciplinary approach performed with the correct diagnosis and treatment planning.

Eye Complications of Acquired Immune Deficiency Syndrome (AIDS ...

African Journals Online (AJOL)

Skoludek_R

The introduction of highly active anti-retroretroviral therapy (HAART) has changed the epidemiology of AIDS from ... Diagnosis and treatment of anterior segment disorders ... Carbamazepine 200 mg every night. .... AIDS and cancer in Africa.

Comparative Evaluation of the Corneal and Anterior Chamber Parameters Derived From Scheimpflug Imaging in Arab and South Asian Normal Eyes.

Science.gov (United States)

Prakash, Gaurav; Srivastava, Dhruv; Avadhani, Kavitha; Thirumalai, Sandeep M; Choudhuri, Sounak

2015-11-01

To evaluate the differences in the normal corneal and anterior segment Scheimpflug parameters in Arab and South Asian eyes. This hospital-based study was performed at a cornea and refractive surgery service in Abu Dhabi. A total of 600 consecutive normal candidates of South Asian (group 1, n = 300) and Arab (group 2, n = 300) origins underwent Scheimpflug imaging (Sirius; Costruzione Strumenti Oftalmici, Italy). One eye was randomly selected for evaluation. The age and sex distributions in both groups were comparable. The pachymetric variables were statistically higher in group 2 (group 2 vs. group 1, 544.3 ± 32.2 μm vs. 535.1 ± 31.4 μm for central corneal thickness, 541.0 ± 32.6 μm vs. 531.9 ± 31.5 μm for minimum corneal thickness, 571.7 ± 43.2 μm vs. 558.1 ± 42.3 μm for apical thickness, and 58.1 ± 4.2 vs. 57.3 ± 4.3 mm³ for the corneal volume; P Arab ethnicity tend to have statistically thicker and flatter corneas and less-crowded anterior segments than those of the South Asian counterparts. These epidemiological differences have a mild to moderate biological effect size (Cohen d), but they should be considered when evaluating these eyes for anterior segment or corneal procedures.

Optimization of the precordial leads of the 12-lead electrocardiogram may improve detection of ST-segment elevation myocardial infarction.

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Scott, Peter J; Navarro, Cesar; Stevenson, Mike; Murphy, John C; Bennett, Johan R; Owens, Colum; Hamilton, Andrew; Manoharan, Ganesh; Adgey, A A Jennifer

2011-01-01

For the assessment of patients with chest pain, the 12-lead electrocardiogram (ECG) is the initial investigation. Major management decisions are based on the ECG findings, both for attempted coronary artery revascularization and risk stratification. The aim of this study was to determine if the current 6 precordial leads (V(1)-V(6)) are optimally located for the detection of ST-segment elevation in ST-segment elevation myocardial infarction (STEMI). We analyzed 528 (38% anterior [200], 44% inferior [233], and 18% lateral [95]) patients with STEMI with both a 12-lead ECG and an 80-lead body surface map (BSM) ECG (Prime ECG, Heartscape Technologies, Bangor, Northern Ireland). Body surface map was recorded within 15 minutes of the 12-lead ECG during the acute event and before revascularization. ST-segment elevation of each lead on the BSM was compared with the corresponding 12-lead precordial leads (V(1)-V(6)) for anterior STEMI. In addition, for lateral STEMI, leads I and aVL of the BSM were also compared; and limb leads II, III, aVF of the BSM were compared with inferior unipolar BSM leads for inferior STEMI. Leads with the greatest mean ST-segment elevation were selected, and significance was determined by analysis of variance of the mean ST segment. For anterior STEMI, leads V(1), V(2), 32, 42, 51, and 57 had the greatest mean ST elevation. These leads are located in the same horizontal plane as that of V(1) and V(2). Lead 32 had a significantly greater mean ST elevation than the corresponding precordial lead V(3) (P = .012); and leads 42, 51, and 57 were also significantly greater than corresponding leads V(4), V(5), V(6), respectively (P mean ST-segment elevation; and lead III was significantly superior to the inferior unipolar leads (7, 17, 27, 37, 47, 55, and 61) of the BSM (P optimal placement for the diagnosis of anterior and lateral STEMI and appear superior to leads V(3), V(4), V(5), and V(6). This is of significant clinical interest, not only for ease and

Gomez-Lopez-Hernandez syndrome

International Nuclear Information System (INIS)

Whetsell, William; Saigal, Gaurav; Godinho, Savio

2006-01-01

We describe a case of Gomez-Lopez-Hernandez syndrome in an 18-month-old boy. Imaging findings included rhombencephalosynapsis with a single dentate nucleus. In addition, MR angiography revealed an azygous anterior cerebral artery. The clinical presentation, MRI findings and pathogenesis are discussed. (orig.)

Evaluation of anterior chamber angle under dark and light conditions in angle closure glaucoma: An anterior segment OCT study.

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Masoodi, Habibeh; Jafarzadehpur, Ebrahim; Esmaeili, Alireza; Abolbashari, Fereshteh; Ahmadi Hosseini, Seyed Mahdi

2014-08-01

To evaluate changes of nasal and temporal anterior chamber angle (ACA) in subjects with angle closure glaucoma using Spectralis AS-OCT (SAS-OCT) under dark and light conditions. Based on dark-room gonioscopy, 24 subjects with open angles and 86 with narrow angles participated in this study. The nasal and temporal angle opening distance at 500 μm anterior to the scleral spur (AOD500), nasal and temporal ACA were measured using SAS-OCT in light and dark conditions. In 2 groups, ACA and AOD500 in nasal and temporal quadrants were significantly greater in light compared to dark (all with p=0.000). The AOD500 and ACA were significantly higher in nasal than temporal in measured conditions for 2 groups except the ACA and AOD500 of normal group measured in light. The difference between nasal and temporal in dark (29.07 ± 65.71 μm for AOD500 and 5.7 ± 4.07° for ACA) was greater than light (24.86 ± 79.85 μm for AOD500 and 2.09 ± 7.21° for ACA) condition. But the difference was only significant for ACA (p=0.000). The correlation analysis showed a negative correlation between AOD500 and pupil diameter in temporal and nasal quadrants (both with p=0.000). While temporal AOD500 difference correlated with spherical equivalent, temporal and asal gonioscopy, nasal AOD correlated with IOP, temporal and nasal gonioscopy. Clinically important changes in ACA structure could be detected with SAS-OCT in nasal and temporal quadrants under different illumination intensity. The results could help in improvement of examination condition for better and more accurate assessment of individuals with angle closure glaucoma. Copyright © 2014 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Anterior interosseous nerve syndrome diagnosis and intraoperative findings: A case report

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Abdulla Aljawder

2016-01-01

Conclusion: Clinical suspicion should arise in the presence of isolated paralysis of the AIN-supplied muscles. MRI and electrodiagnostic studies will confirm the diagnosis and identify the etiology. The optimal treatment of AIN syndrome has not been established. We recommend surgical intervention in confirmed AIN syndrome from compression neuropathy, refractive to conservative therapy.

A and B mode ultrasonography in preoperative evaluation of lens and posterior segment of dogs eyes with cataract

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Bianca C. Martins

2010-02-01

Full Text Available Ultrasonography of the lens and posterior segment is an indispensable step in the preoperative evaluation of dogs with cataracts, since ophthalmoscopy is not feasible when there is opacification of the lens. This study evaluated the echographic conditions of cataractous lens and fundus of the eye in dogs affected by cataracts. The study was conducted in 30 dogs (56 eyes, 10 males and 20 females, with different types of cataracts at different stages of development. Echography in A and B modes, simultaneously, was carried out for the examination of the lens and posterior segment. The examinations revealed anterior cortical, posterior cortical and nuclear cataract in 12 eyes (21.4%, anterior cortical, posterior cortical, nuclear and posterior capsular in 23 eyes (41%, anterior cortical, posterior cortical and posterior capsular cataract in one eye (1.7%, anterior cortical and nuclear cataract in one eye (1.7%, anterior cortical, nuclear and posterior capsular cataract in five eyes (8.9%, and anterior cortical cataract in seven eyes (12.5%. Abnormal ultrasonographic alterations were observed in the posterior segment in 26 eyes evaluated (46.4%. Vitreal degeneration was detected in 12 eyes (21.4%, images of vitreal exudate or hemorrhage in seven eyes (12.5%, persistence of hyaloid artery in four eyes (7.1% and lens subluxation in three eyes (5.3%. The results obtained reiterate the importance of ultrasonography in canine patients presented for cataract surgery given that alterations of the posterior segment are difficult to identify in a clinical examination when the lens is opacified.A ultrassonografia do segmento posterior do bulbo do olho é etapa indispensável na avaliação de cães com catarata que serão submetidos à facectomia, uma vez que a oftalmoscopia não é factível quando há opacificação da lente, notadamente nas cataratas maduras. Este estudo avaliou as condições ecográficas da lente cataratogênica e do fundo de olho de c

Anterior segment dysgenesis (Peters' anomaly) in two snow leopard (Panthera uncia) cubs

DEFF Research Database (Denmark)

Hamoudi, Hassan; Rudnick, Jens-Christian; Prause, Jan Ulrik

2013-01-01

remnant of the hyaloid artery. The male had hydrocephalus and thus some of the features of Peters' plus syndrome (Peters' anomaly in addition to systemic malformations). The histological findings in the eyes of these snow leopard siblings are identical with those described in humans with Peters' anomaly....

Adjacent segment degeneration after lumbar spinal fusion: the impact of anterior column support: a randomized clinical trial with an eight- to thirteen-year magnetic resonance imaging follow-up.

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Videbaek, Tina S; Egund, Niels; Christensen, Finn B; Grethe Jurik, Anne; Bünger, Cody E

2010-10-15

Randomized controlled trial. To analyze long-term adjacent segment degeneration (ASD) after lumbar fusion on magnetic resonance imaging and compare randomization groups with and without anterior column support. ASD can be a long-term complication after fusion. The prevalence and the cause of ASD are not well documented, but ASD are one of the main arguments for introducing the use of motion-preserving techniques as an alternative to fusion. Anterior lumbar interbody fusion combined with posterolateral lumbar fusion (ALIF+PLF) has been proved superior to posterolateral fusion alone regarding outcome and cost-effectiveness. Between 1996 and 1999, 148 patients with severe chronic low back pain were randomly selected for ALIF+PLF or for PLF alone. Ninety-five patients participated. ASD was examined on magnetic resonance imaging with regard to disc degeneration, disc herniation, stenosis, and endplate changes. Disc heights on radiographs taken at index surgery and at long-term follow-up were compared. Outcome was assessed by validated questionnaires. The follow-up rate was 76%. ASD was similar between randomization groups. In the total cohort, endplate changes were seen in 26% of the participants and correlated significantly with the presence of disc degeneration and disc herniation. Disc degeneration and dorsal disc herniation were the parameters registered most frequently and were significantly more pronounced at the first adjacent level than at the second and the third adjacent levels. Patients without disc height reduction over time were significantly younger than patients with disc height reduction. Disc degeneration and stenosis correlated significantly with outcome at the first adjacent level. The cause of the superior outcome in the group with anterior support is still unclear. Compared with the findings reported in the literature, the prevalence of ASD is likely to be in concordance with the expected changes in a nonoperated symptomatic population and therefore

Quantifying coordination among the rearfoot, midfoot, and forefoot segments during running.

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Takabayashi, Tomoya; Edama, Mutsuaki; Yokoyama, Erika; Kanaya, Chiaki; Kubo, Masayoshi

2018-03-01

Because previous studies have suggested that there is a relationship between injury risk and inter-segment coordination, quantifying coordination between the segments is essential. Even though the midfoot and forefoot segments play important roles in dynamic tasks, previous studies have mostly focused on coordination between the shank and rearfoot segments. This study aimed to quantify coordination among rearfoot, midfoot, and forefoot segments during running. Eleven healthy young men ran on a treadmill. The coupling angle, representing inter-segment coordination, was calculated using a modified vector coding technique. The coupling angle was categorised into four coordination patterns. During the absorption phase, rearfoot-midfoot coordination in the frontal planes was mostly in-phase (rearfoot and midfoot eversion with similar amplitudes). The present study found that the eversion of the midfoot with respect to the rearfoot was comparable in magnitude to the eversion of the rearfoot with respect to the shank. A previous study has suggested that disruption of the coordination between the internal rotation of the shank and eversion of the rearfoot leads to running injuries such as anterior knee pain. Thus, these data might be used in the future to compare to individuals with foot deformities or running injuries.

Posterior alien hand syndrome: case report

International Nuclear Information System (INIS)

Rohde, S.; Weidauer, S.; Lanfermann, H.; Zanella, F.

2002-01-01

The alien hand syndrome (AHS) is involuntary uncontrolled movement of an arm with a sense of estrangement from the limb itself. AHS was initially used to describe interhemispheric disconnection phenomena in patients with lesions in the anterior corpus callosum, but it has been found in patients with posterior cerebral lesions without involvement of the corpus callosum, for example parietal infarcts or corticobasal degeneration. The posterior alien hand syndrome is less frequent and presents with nonpurposive behaviour like lifting the arm or writhing fingers. We report an 80-year-old woman with a posterior AHS of the dominant right hand. MRI showed atrophy of the pre- and postcentral gyri without involvement of the corpus callosum. We discuss the aetiology of the posterior AHS and the differences from the anterior varieties. (orig.)

A rare cause of acute coronary syndrome: Kounis syndrome.

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Almeida, João; Ferreira, Sara; Malheiro, Joana; Fonseca, Paulo; Caeiro, Daniel; Dias, Adelaide; Ribeiro, José; Gama, Vasco

2016-12-01

Kounis syndrome is an acute coronary syndrome in the context of a hypersensitivity reaction. The main pathophysiological mechanism appears to be coronary vasospasm. We report the case of a patient with a history of allergy to quinolones, who was given ciprofloxacin before an elective surgical procedure and during drug administration developed symptoms and electrocardiographic changes suggestive of ST-segment elevation acute coronary syndrome. The drug was suspended and coronary angiography excluded epicardial coronary disease. Two hours after withdrawal of the drug the symptoms and ST elevation had resolved completely. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

Brugada-like Precordial ST Elevation on ECG by Anterior Mediastinal Infective Mass Lesion

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Yuji Nakazato

2003-07-01

Full Text Available Several causes are known to induce the right precordial ST elevation mimicking Brugada syndrome. Right ventricular outflow area is assumed to be responsible for such ECG changes. We experienced a case of anterior mediastinal infective mass lesion with a Brugada-like ECG. A 52-year-old female, who has pulmonary stenosis and recurrent episodes of right ventricular heart failure, complained of high fever, abdominal discomfort, and edema. On physical examination, jugular vein dilation, hepatomegaly, and facial and leg edema were noted. Leucocytosis was also noted on blood examination. An ECG showed right ventricular hypertrophy, incomplete right bundle branch block pattern and marked ST elevation on precordial leads mimicking Brugada syndrome. Magnetic resonance imaging revealed an abnormal mass shadow located on the anterior mediastinum and compressing the right ventricle (Figure 1A. Trans-thoracic echocardiography also showed the high echogenic mass lesion at the anterior side of right ventricle and the vicinity of pulmonary valve. After treatment with antibiotics, the mass lesion gradually shrunk. Concomitantly, the ST elevation disappeared with improvement of inflammatory markers (Figure 1B. The symptoms suggesting right ventricular failure were also ameliorated. The mechanism of Brugada-like ST elevation in this patient was considered to be compression, by the abnormal infective mass, of the right ventricular outflow tract with/without focal pericardial inflammation.

Diagnosis and Management of Iridocorneal Endothelial Syndrome

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Sacchetti, Marta; Mantelli, Flavio; Macchi, Ilaria; Ambrosio, Oriella; Rama, Paolo

2015-01-01

The iridocorneal endothelial (ICE) syndrome is a rare ocular disorder that includes a group of conditions characterized by structural and proliferative abnormalities of the corneal endothelium, the anterior chamber angle, and the iris. Common clinical features include corneal edema, secondary glaucoma, iris atrophy, and pupillary anomalies, ranging from distortion to polycoria. The main subtypes of this syndrome are the progressive iris atrophy, the Cogan-Reese syndrome, and the Chandler syndrome. ICE syndrome is usually diagnosed in women in the adult age. Clinical history and complete eye examination including tonometry and gonioscopy are necessary to reach a diagnosis. Imaging techniques, such as in vivo confocal microscopy and ultrasound biomicroscopy, are used to confirm the diagnosis by revealing the presence of “ICE-cells” on the corneal endothelium and the structural changes of the anterior chamber angle. An early diagnosis is helpful to better manage the most challenging complications such as secondary glaucoma and corneal edema. Treatment of ICE-related glaucoma often requires glaucoma filtering surgery with antifibrotic agents and the use of glaucoma drainage implants should be considered early in the management of these patients. Visual impairment and pain associated with corneal edema can be successfully managed with endothelial keratoplasty. PMID:26451377

Comparison of Central Corneal Thickness Measured by Standard Ultrasound Pachymetry, Corneal Topography, Tono-Pachymetry and Anterior Segment Optical Coherence Tomography.

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González-Pérez, Javier; Queiruga Piñeiro, Juan; Sánchez García, Ángelx; González Méijome, José Manuel

2018-04-10

To compare central corneal thickness (CCT) measured by standard ultrasound pachymetry (USP), and three non-contact devices in healthy eyes. A cross-sectional study of CCT measurement in 52 eyes of 52 healthy volunteers was done by a single examiner at Ocular Surface and Contact Lens Laboratory. Three consecutive measurements were done by standard USP, non-contact tono-pachymeter, Pentacam corneal topographer, and Anterior Segment Optical Coherence Tomography (AS-OCT). The mean values were used for assessment. The results were compared using multivariate ANOVA, linear regression, and Pearson correlation. Agreement among the devices was analyzed using mean differences and Bland-Altman analysis with 95% limits of agreement (LoA). Finally, reliability was analyzed using intraclass correlation coefficient (ICC). Mean CCT by ultrasound pachymeter, tono-pachymeter, corneal topographer and AS-OCT were 558.9 ± 31.2 µm, 525.8 ± 43.1 µm, 550.4 ± 30.5 µm, and 545.9 ± 30.5 µm respectively. There was a significant positive correlation between AS-OCT and USP (Pearson correlation = 0.957, p device, and USP. Mean CCT among USP, Pentacam and AS-OCT were comparable and had significant linear correlations. In clinical practice, these three modalities could be interchangeable in healthy patients.

Anterior perineal hernia after anterior exenteration

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Ka Wing Wong

2017-10-01

Full Text Available Perineal hernia is a rare complication of anterior exenteration. We reported this complication after an anterior exenteration for bladder cancer with bleeding complication requiring packing and second-look laparotomy. Perineal approach is a simple and effective method for repair of perineal hernia.

Summation and Cancellation Effects on QRS and ST-Segment Changes Induced by Simultaneous Regional Myocardial Ischemia.

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Vives-Borrás, Miquel; Jorge, Esther; Amorós-Figueras, Gerard; Millán, Xavier; Arzamendi, Dabit; Cinca, Juan

2018-01-01

Simultaneous ischemia in two myocardial regions is a potentially lethal clinical condition often unrecognized whose corresponding electrocardiographic (ECG) patterns have not yet been characterized. Thus, this study aimed to determine the QRS complex and ST-segment changes induced by concurrent ischemia in different myocardial regions elicited by combined double occlusion of the three main coronary arteries. For this purpose, 12 swine were randomized to combination of 5-min single and double coronary artery occlusion: Group 1: left Circumflex (LCX) and right (RCA) coronary arteries ( n = 4); Group 2: left anterior descending artery (LAD) and LCX ( n = 4) and; Group 3: LAD and RCA ( n = 4). QRS duration and ST-segment displacement were measured in 15-lead ECG. As compared with single occlusion, double LCX+RCA blockade induced significant QRS widening of about 40 ms in nearly all ECG leads and magnification of the ST-segment depression in leads V1-V3 (maximal 228% in lead V3, p ST-segment elevation in precordial leads (maximal attenuation of 60% in lead V3 in LAD+LCX and 86% in lead V5 in LAD+RCA, p ST-segment elevation in leads V7-V9 was a specific sign of single LCX occlusion. In conclusion, concurrent infero-lateral ischemia was associated with a marked summation effect of the ECG changes previously elicited by each single ischemic region. By contrast, a cancellation effect on ST-segment changes with no QRS widening was observed when the left anterior descending artery was involved.

Hong's grading for evaluating anterior chamber angle width.

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Kim, Seok Hwan; Kang, Ja Heon; Park, Ki Ho; Hong, Chul

2012-11-01

To compare Hong's grading method with anterior segment optical coherence tomography (AS-OCT), gonioscopy, and the dark-room prone-position test (DRPT) for evaluating anterior chamber width. The anterior chamber angle was graded using Hong's grading method, and Hong's angle width was calculated from the arctangent of Hong's grades. The correlation between Hong's angle width and AS-OCT parameters was analyzed. The area under the receiver operating characteristic curve (AUC) for Hong's grading method when discriminating between narrow and open angles as determined by gonioscopy was calculated. Correlation analysis was performed between Hong's angle width and intraocular pressure (IOP) changes determined by DRPT. A total of 60 subjects were enrolled. Of these subjects, 53.5 % had a narrow angle. Hong's angle width correlated significantly with the AS-OCT parameters (r = 0.562-0.719, P < 0.01). A Bland-Altman plot showed relatively good agreement between Hong's angle width and the angle width obtained by AS-OCT. The ability of Hong's grading method to discriminate between open and narrow angles was good (AUC = 0.868, 95 % CI 0.756-0.942). A significant linear correlation was found between Hong's angle width and IOP change determined by DRPT (r = -0.761, P < 0.01). Hong's grading method is useful for detecting narrow angles. Hong's grading correlated well with AS-OCT parameters and DRPT.

Left ventricular ejection fraction to predict early mortality in patients with non-ST-segment elevation acute coronary syndromes.

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Bosch, Xavier; Théroux, Pierre

2005-08-01

Improvement in risk stratification of patients with non-ST-segment elevation acute coronary syndrome (ACS) is a gateway to a more judicious treatment. This study examines whether the routine determination of left ventricular ejection fraction (EF) adds significant prognostic information to currently recommended stratifiers. Several predictors of inhospital mortality were prospectively characterized in a registry study of 1104 consecutive patients, for whom an EF was determined, who were admitted for an ACS. Multiple regression models were constructed using currently recommended clinical, electrocardiographic, and blood marker stratifiers, and values of EF were incorporated into the models. Age, ST-segment shifts, elevation of cardiac markers, and the Thrombolysis in Myocardial Infarction (TIMI) risk score all predicted mortality (P model improved the prediction of mortality (C statistic 0.73 vs 0.67). The odds of death increased by a factor of 1.042 for each 1% decrement in EF. By receiver operating curves, an EF cutoff of 48% provided the best predictive value. Mortality rates were 3.3 times higher within each TIMI risk score stratum in patients with an EF of 48% or lower as compared with those with higher. The TIMI risk score predicts inhospital mortality in a broad population of patients with ACS. The further consideration of EF adds significant prognostic information.

Inflammation: a trigger for acute coronary syndrome

International Nuclear Information System (INIS)

SAGER, Hendrik B.; NAHRENDORF, Matthias

2016-01-01

Atherosclerosis is a chronic inflammatory disease of the vessel wall and a major cause of death worldwide. One of atherosclerosis’ most dreadful complications are acute coronary syndromes that comprise ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction, and unstable angina. We now understand that inflammation substantially contributes to the initiation, progression, and destabilization of atherosclerosis. In this review, we will focus on the role of inflammatory leukocytes, which are the cellular protagonists of vascular inflammation, in triggering disease progression and, ultimately, the destabilization that causes acute coronary syndromes.

The Tolosa-Hunt syndrome | Sandyk | South African Medical Journal

African Journals Online (AJOL)

The Tolosa-Hunt syndrome. or painful ophthalmoplegia. is a rare condition caused by a granulomatous nonspecific process at the level of anterior cavernous sinus. superior orbital fissure and orbital apex. The syndrome is characterized by pain behind. above or around the eye. involvement of the cranial nerves which pass ...

A STUDY ON OCULAR FINDINGS IN CHILDREN WITH NEPHROTIC SYNDROME

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Jezeela K

2018-03-01

Full Text Available BACKGROUND Nephrotic syndrome occurs when the filtering units of the kidneys- the glomeruli are damaged. The annual incidence of nephrotic syndrome ranges from 2-7 per 100,000 children. Oral corticosteroids form the cornerstone for management of most children with nephrotic syndrome. Long-term steroid therapy in childhood is associated with a number of significant adverse effectsmajor ophthalmic adverse effects include decreased vision, recurrent hordeolum, posterior subcapsular cataract, pseudotumour cerebri, visual hallucinations. This study aims to analyse the ocular findings in children with nephrotic syndrome, and their treatment related ocular abnormalities. MATERIALS AND METHODS This is a cross sectional study, conducted at The Department of Ophthalmology, Government Medical College Thrissur of 1-year duration. Study participants include patients who attended outpatient department of Paediatrics, Govt. Medical College, Thrissur, with clinical and objective investigational evidence of nephrotic syndrome. 70 children who were included in the study were interviewed with a questionnaire; Detailed history was taken from the patients and their parents, regarding the onset of the disease, treatment details, year of starting steroids, history of hypertension, additional drugs, history of defective vision, headache, allergic diseases of eye, eyelid swellings and use of spectacles. Visual acuity was assessed with Snellen s’ chart. Best corrected visual acuity was noted. Acuity was also measured with spectacles if the child was wearing them. Anterior segment was examined under torchlight and later in slit lamp and in all cases fundus examination and retinoscopy were done after dilating pupils with homatropine. Intraocular pressure was measured with Goldman Applanation Tonometer. RESULTS Since the sample size is small, the exact sex distribution cannot be ascertained. History of headache was present in 45 children (64.3%. Visual acuity was assessed

A rare cause of pancytopenia: Sheehan′s syndrome

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Mustafa Volkan Demir

2015-01-01

Full Text Available Sheehan′s syndrome is characterized by varying degrees of anterior pituitary dysfunction due to postpartum ischemic necrosis of the pituitary gland after massive bleeding. Pancytopenia is rarely observed in patients with Sheehan′s syndrome. We present a patient of Sheehan′s syndrome presenting with pancytopenia. Complete recovery of pancytopenia was observed after the treatment. Clinicians should consider the possibility of hypopituitarism as a cause of pancytopenia and indicate a series of hormonal examinations. A high index of suspicion is required in women with pancytopenia for possible treatable cause like Sheehan′s syndrome.

A case report: Familial glucocorticoid deficiency associated with familial focal segmental glomerulosclerosis

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Ram Nanik

2012-12-01

Full Text Available Abstract Background Familial glucocorticoid deficiency (FGD is a rare autosomal recessive disorder characterized by isolated glucocorticoid deficiency in the presence of normal plasma renin and aldosterone level. Focal segmental glomerulosclerosis (FSGS is a form of glomerular disease associated with proteinuria and nephritic syndrome. This is the first case of familial glucocorticoid deficiency associated with familial focal segmental glomerulosclerosis. Case presentation An eight month old boy presented with increased genital pigmentation. Initial investigation revealed that he was glucocorticoid deficient and was started on hydrocortisone and fludrocortisone with a diagnosis of primary adrenal insufficiency. Later fludrocortisone was withdrawn and he was diagnosed to have isolated glucocorticoid deficiency. He later developed focal segmental glomerulosclerosis for which he underwent renal transplantation at the age of five years. Now at the age of twelve years, this boy is doing well on hydrocortisone treatment. His two siblings and a first degree cousin also had isolated glucocorticoid deficiency. One of the above two siblings died due to renal failure secondary to focal segmental glomerulosclerosis. Conclusion Patients with familial glucocorticoid deficiency should be carefully followed for development of features of nephrotic syndrome.

A Clinical Assessment of Corticotomy Facilitated Orthodontics in the Retraction of Maxillary Anterior Segment

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Chagam Manjunatha Reddy

2014-01-01

Full Text Available Corticotomy facilitated orthodontics has been practising for longer periods, but a novel approach of a periapical incision to make horizontal cuts 5 mm above the apex of the maxillary anteriors along with vertical cuts requires a detailed investigation. The purpose of this study was to assess the outcome of skeletal cases with spacing in the anteriors using a novel method of modified surgical approach utilizing the corticotomy facilitated orthodontics. Patients for this study were randomly selected from a very intensive screening in the Department of Orthodontics, Saveetha Dental College and Hospital, Chennai, out of which seven patients were selected for this procedure. The patients were subjected for corticotomy procedure under local anesthesia after the leveling and aligning stage (0.019" × 0.025" stainless steel wire, and the retraction was continued still the space was closed. AutoCAD and palatal rugae assessment programs were used to assess the orthodontic tooth movement. The results of the study demonstrated that when compared to conventional orthodontics alone, the corticotomy facilitated approach produced faster tooth movements in all the seven patients reducing the overall treatment time by 60%. The use of this modified technique of labial, palatal and apical cuts could be beneficial for adult patients with difficult surgical access from the lingual side.

A case-control evaluation of fungiform papillae density in burning mouth syndrome.

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Naud, Jason M; Benca, Laura; Drangsholt, Mark T; LeResche, Linda; Coldwell, Susan E

2018-04-01

It has been hypothesized that high fungiform papillae density may be a risk factor for developing the taste and pain alterations characteristic of burning mouth syndrome. Evaluate whether fungiform papillae density, taste sensitivity, and mechanical pain sensitivity differ between burning mouth syndrome cases and controls. This case-control study compared cases diagnosed with primary burning mouth syndrome with pain-free controls. Participants (17 female cases and 23 female controls) rated the intensity of sucrose, sodium chloride, citric acid, and quinine applied separately to each side of the anterior tongue and sampled whole mouth. Mechanical pain sensitivity was assessed separately for each side of the tongue using weighted pins. Digital photographs of participants' tongues were used to count fungiform papillae. Burning mouth syndrome cases had increased whole mouth taste intensity. Cases also had increased sensitivity to quinine on the anterior tongue, as well as increased mechanical pain sensitivity on the anterior tongue. Fungiform papillae density did not differ significantly between cases and controls. Fungiform papillae density on the left and right sides of the tongue were correlated in controls; however, there was no left/right side correlation in cases. Cases had increased pain and taste perception on the anterior tongue. The lack of correlation between left and right fungiform papillae density in cases may be an indication of asymmetrical lingual innervation in these patients. 3b. Laryngoscope, 128:841-846, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Lifespan extension by dietary intervention in a mouse model of Cockayne syndrome uncouples early postnatal development from segmental progeria.

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Brace, Lear E; Vose, Sarah C; Vargas, Dorathy F; Zhao, Shuangyun; Wang, Xiu-Ping; Mitchell, James R

2013-12-01

Cockayne syndrome (CS) is a rare autosomal recessive segmental progeria characterized by growth failure, lipodystrophy, neurological abnormalities, and photosensitivity, but without skin cancer predisposition. Cockayne syndrome life expectancy ranges from 5 to 16 years for the two most severe forms (types II and I, respectively). Mouse models of CS have thus far been of limited value due to either very mild phenotypes, or premature death during postnatal development prior to weaning. The cause of death in severe CS models is unknown, but has been attributed to extremely rapid aging. Here, we found that providing mutant pups with soft food from as late as postnatal day 14 allowed survival past weaning with high penetrance independent of dietary macronutrient balance in a novel CS model (Csa(-/-) | Xpa(-/-)). Survival past weaning revealed a number of CS-like symptoms including small size, progressive loss of adiposity, and neurological symptoms, with a maximum lifespan of 19 weeks. Our results caution against interpretation of death before weaning as premature aging, and at the same time provide a valuable new tool for understanding mechanisms of progressive CS-related progeroid symptoms including lipodystrophy and neurodysfunction. © 2013 the Anatomical Society and John Wiley & Sons Ltd.

Automatic segmentation of abdominal organs and adipose tissue compartments in water-fat MRI: Application to weight-loss in obesity.

Science.gov (United States)

Shen, Jun; Baum, Thomas; Cordes, Christian; Ott, Beate; Skurk, Thomas; Kooijman, Hendrik; Rummeny, Ernst J; Hauner, Hans; Menze, Bjoern H; Karampinos, Dimitrios C

2016-09-01

To develop a fully automatic algorithm for abdominal organs and adipose tissue compartments segmentation and to assess organ and adipose tissue volume changes in longitudinal water-fat magnetic resonance imaging (MRI) data. Axial two-point Dixon images were acquired in 20 obese women (age range 24-65, BMI 34.9±3.8kg/m(2)) before and after a four-week calorie restriction. Abdominal organs, subcutaneous adipose tissue (SAT) compartments (abdominal, anterior, posterior), SAT regions along the feet-head direction and regional visceral adipose tissue (VAT) were assessed by a fully automatic algorithm using morphological operations and a multi-atlas-based segmentation method. The accuracy of organ segmentation represented by Dice coefficients ranged from 0.672±0.155 for the pancreas to 0.943±0.023 for the liver. Abdominal SAT changes were significantly greater in the posterior than the anterior SAT compartment (-11.4%±5.1% versus -9.5%±6.3%, pabdominal adipose tissue and organ segmentation, and allowed the detection of SAT and VAT subcompartments changes during weight loss. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Cephalometrics in children with Down's syndrome

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Quintanilla, Juan Suarez; Biedma, Benjamin Martin; Rodriguez, Maximino Quintans; Mora, Maria Teresa Jorge; Cunqueiro, Maria Mercedes Suarez; Pazos, Mayte Abeleira [Faculty of Medicine and Dentistry, University of Santiago, San Francisco s/n, 15705 Santiago de Compostela (Spain)

2002-09-01

Heading AbstractAims. To describe the craniofacial morphology of a group of patients with Down's syndrome using a cephalometric analysis of the lateral skull radiograph.Materials and methods. The studied sample consisted of 39 patients with Down's syndrome (24 boys, 15 girls) ranging from 7 to 18 years of age. The computerized cephalometric study of the lateral skull radiograph of each patient was carried out using the method described by Ricketts.Results.Anterior cross-bite was observed in 38.4% of patients and diminished interincisal angle in 77%. Skeletal parameters matched the clinical norm, indicating mesofacial biotype, i.e., normal maxillomandibular growth. The lower incisors protruded in 84.6% of the individuals studied and were proinclined in 77%; upper incisors were protruded in 77% of the sample. The lower lip protruded in 84.6%. Analysis of craniofacial parameters showed average values within the clinical norm. Analysis of the inner cranium demonstrated normal inclination of the cranial base, while the length of the anterior skull base was diminished in 53.8%.Conclusions. From the skeletal perspective, patients with Down's syndrome who are in a period of growth demonstrate a reduction of the anterior skull base. From the dentoalveolar perspective, they show protrusion and proinclination of lower incisors, which is related to a tendency to anterior cross-bite and, to a lesser extent, to diminished overbite. Likewise, the lower lip protrusion observed in this study is related to the position of the lower incisor. (orig.)

Myocardial Bridges and their Relationship to the Anterior Interventricular Branch of the Left Coronary Artery

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Lima Vanildo Júnior de Melo

2002-01-01

Full Text Available OBJECTIVE: To analyze the relationship between myocardial bridges and the anterior interventricular branch (anterior descending of the left coronary artery. METHODS: The study was carried out with postmortem material, and methods of dissection and observation were used. We assessed the perimeter of the anterior interventricular branch of the left coronary artery using a pachymeter, calculated its proximal and distal diameters in relation to the myocardial bridge, and also its diameter under the myocardial bridge in 30 hearts. We also observed the position of the myocardial bridge in relation to the origin of the anterior interventricular branch. RESULTS: The diameters of the anterior interventricular branch were as follows: the mean proximal diameter was 2.76±0.76 mm; the mean diameter under the myocardial bridge was 2.08±0.54 mm; and the mean distal diameter was 1.98±0.59 mm. In 33.33% (10/30 of the cases, the diameter of the anterior interventricular branch under the myocardial bridge was lower than the diameter of the anterior interventricular branch distal to the myocardial bridge. In 3.33% (1/30 of the cases, an atherosclerotic plaque was found in the segment under the myocardial bridge. The myocardial bridge was located in the middle third of the anterior interventricular branch in 86.66% (26/30 of the cases. CONCLUSION: Myocardial bridges are more frequently found in the middle third of the anterior interventricular branch of the left coronary artery. The diameter of the anterior interventricular branch of the left coronary artery under the myocardial bridge may be smaller than after the bridge. Myocardial bridges may not provide protection against the formation of atherosclerotic plaque inside the anterior interventricular branch of the left coronary artery.

Nasolabial and Interincisal Angle Evaluation in Anterior Maxillary Distraction Osteogenesis: A Case Study

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Tojan Chacko Thekkekara

2014-01-01

Full Text Available Maxillary hypoplasia is a common developmental problem in cleft lip and palate deformities. These deformities have traditionally been corrected by means of orthognathic surgery. Management of skeletal deformities in the maxillofacial region has been a challenge for maxillofacial surgeons and orthodontists. Distraction osteogenesis (DO is a surgical technique that uses body′s own repairing mechanisms for optimal reconstruction of the hard and soft tissues. We present four cases of anterior maxillary distraction osteogenesis with tooth-borne distraction device— Hyrax, which were analyzed retrospectively using cephalometrics. Changes in nasolabial angle and interincisal angle after distraction of anterior maxillary segment were studied to conclude that there was no much change in the the nasolabial angle while the interincisal angle showed marked improvement.

Anterior open-bite orthodontic treatment in an adult patient: A clinical case report.

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Gracco, Antonio; Siviero, Laura; de Stefani, Alberto; Bruno, Giovanni; Stellini, Edoardo

2016-06-01

A 45-year-old woman presented with an anterior open-bite complaining chiefly of her unpleasant smile esthetics and masticatory and speech problems. Treatment included speech therapy initiated immediately after bonding. Lingual spurs were positioned on the mandibular incisors in order to help tongue rehabilitation. During the working phase, temporary anchorage devices (TADs) were used at the mandibular anterior segment to intrude the lower left premolars. A splint was used to ensure retention in the upper and lower arches; an enveloppe linguale nocturne (ELN) was provided. Non-surgical open-bite treatment could offer a valid alternative to orthognanthic surgery when cephalometric evaluation shows no vertical growth pattern; patient compliance is essential to prevent relapse. Copyright © 2016 CEO. Published by Elsevier Masson SAS. All rights reserved.

Adie's syndrome: some new observations.

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Thompson, H S

1977-01-01

Adie's syndrome is a disease of unknown etiology. We known where the damage is, and which nerves are involved. We even know something of how the nerves react after the damage is done, but we don't known what causes the primary injury. The first step in working a jigsaw puzzle is to getall of the pieces right side up and take a good look at them. Some of the jigsaw pieces handled in this paper are listed below. Some of them are new observations; many of them are old concepts, partly modified and partly made secure by new facts. 1. Not all "tonic pupils" are due to "Adie's syndrome"; some are due to local injury and some to a generalized peripheral neuropathy (Table II). 2. All patients should have serologic tests for shyphilis. In this series one in six had positive serology. 3. The incidence of Adie's syndrome in Iowa in the early 1970's was approximately 4.7 per 100,000 population per year. 4. The prevalence of Adie's syndrome, therefore, was approximately 2 per 1000. 5. The mean age of onset of Adie's syndrome was about 32.2 years (Figure 1A). 6. The sex ratio was 2.6 females to each male. 7. Right eyes and left eyes were involved at approximately the same rate (Figure 2). 8. The incidence of second eye involvement in unilateral cases was about 4% per year during the first decade of the disease (Figure 18). 9. If this rate of second eye involvement (4% per year) persists during subsequent decades, then most Adie's pupils will eventually become bilateral. 10. The incidence of Adie's syndrome in a largely caucasian patient group is independent of iris color (Figure 4). 11. Only 10% of patients with Adie's syndrome had completely normal muscle stretch reflexes. 12. The muscle stretch reflexes in the arms were just as frequently imparied as those in th elegs, but the degree of impariment tended to be more severe in the ankles and triceps. 13. When there was any light reaction remaining in an Adie's pupil, a segmental paralysis of the sphincter muscle could be seen

Exfoliation syndrome in Northern Nigeria

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Idakwo U

2018-01-01

Full Text Available Ugbede Idakwo,1 Olusola Olawoye,2 Benedictus GK Ajayi,1 Robert Ritch3 1Eleta Eye Institute, Ibadan, Nigeria; 2Department of Ophthalmology, College of Medicine, University of Ibadan, Ibadan, Nigeria; 3Einhorn Clinical Research Center, Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA Purpose: To estimate the frequency of exfoliation syndrome (XFS and its association with ocular diseases in Northern Nigeria.Materials and methods: Consecutive patients who presented to the outpatient department of ECWA Eye Hospital Kano from February 2015 to May 2015 were included in the study. Each patient had a complete ophthalmic examination. The anterior segment examination included tonometry, gonioscopy, and detailed slit-lamp examination to assess for the presence or absence of exfoliation material, inflammatory cells, and other abnormal findings. Patients with exfoliation material on the anterior lens surface and/or pupillary margin in either or both eyes were considered to have XFS. Statistical analysis was performed using the Statistical Package for the Social Sciences version 16.0.Results: A total of 620 patients living in Northern Nigeria from the 6 geopolitical zones were examined. The majority of them (34.5% were indigenous Hausas. There was a male preponderance of 56.6%, while the mean age at presentation for examination in all age groups was 55.7±13.7 years. There were 9 patients with XFS; the frequency was 1.5%, with most of the patients being 70–80 years old. In patients who were ≥50 years, the frequency was 2.5%. Patients with XFS had a higher mean age of 68±4.9 years. The frequency of XFS among glaucoma patients was 4.4%, while among cataract patients it was 3.7%. No other associated ocular disease was found in the patients with XFS.Conclusion: This study shows that XFS does exist in Northern Nigeria, as was found in the South. The prevalence of XFS was, however, not reported in the Nigerian

Research on simulation calculation method of biomechanical characteristics of C1-3 motion segment damage mechanism

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HUANG Ju-ying

2013-11-01

Full Text Available Objective To develop the finite element model (FEM of cervical spinal C1-3 motion segment, and to make biomechanical finite element analysis (FEA on C1-3 motion segment and thus simulate the biomechanical characteristics of C1-3 motion segment in distraction violence, compression violence, hyperextension violence and hyperflexion violence. Methods According to CT radiological data of a healthy adult, the vertebrae and intervertebral discs of cervical spinal C1-3 motion segment were respectively reconstructed by Mimics 10.01 software and Geomagic 10.0 software. The FEM of C1-3 motion segment was reconstructed by attaching the corresponding material properties of cervical spine in Ansys software. The biomechanical characteristics of cervical spinal C1-3 motion segment model were simulated under the 4 loadings of distraction violence, compression violence, hyperextension violence and hyperflexion violence by finite element method. Results In the loading of longitudinal stretch, the stress was relatively concentrated in the anterior arch of atlas, atlantoaxial joint and C3 lamina and spinous process. In the longitudinal compressive loads, the maximum stress of the upper cervical spine was located in the anterior arch of atlas. In the loading of hyperextension moment, the stress was larger in the massa lateralis atlantis, the lateral and posterior arch junction of atlas, the posterior arch nodules of the atlas, superior articular surface of axis and C2 isthmus. In the loading of hyperflexion moment, the stress was relatively concentrated in the odontoid process of axis, the posterior arch of atlas, the posterior arch nodules of atlas, C2 isthmic and C2 inferior articular process. Conclusion Finite element biomechanical testing of C1-3 motion segment can predict the biomechanical mechanism of upper cervical spine injury.

Management of Cervical Kyphosis in Larsen Syndrome: A Case Report

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Ebrahim Ameri

2016-10-01

Full Text Available Introduction Larsen syndrome is a congenital skeletal disorder manifested by several facial, ligamentous and spinal complications. Cervical kyphosis is one of the serious manifestations of the Larsen syndrome. However, there is no consensus regarding the best procedure of cervical kyphosis management in these patients. Case Presentation A 1-year-old boy with the diagnosis of the Larsen syndrome was admitted to our hospital and undergone several corrective surgeries for knee, hip and foot deformities. At the age of 2 years, scoliosis was diagnosed and surgically managed. At the same time, cervical kyphosis was observed and monitored until the symptoms of neurological deficit due to cord compression led to the correction of cervical Kyphosis at the age of 4.5 years. Accordingly, an anterior/posterior (360 degree cervical spinal fusion surgery was performed. Subsequently, cervicothoracic fusion was performed to correct cervicothoracic instability. No neurological complications were reported afterward. Conclusions In spite of existing controversy around the best method of cervical kyphosis management in Larsen syndrome’s patients older than 2- year old, anterior release and posterior fixation followed by anterior spinal fusion and strut grafting led to the satisfactory result in our case.

A Rare Manifestation of Uveitis-glaucoma-hyphema Syndrome.

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Sousa, David Cordeiro; Leal, Inês; Faria, Mun Yueh; Pinto, Luís Abegão

2016-01-01

To report a case of a patient who developed uveitis-glaucoma-hyphema (UGH) syndrome after an uneventful cataract surgery and to discuss risk factors, diagnostic challenges, management options, and clinical implications. Uveitis-glaucoma-hyphema syndrome is a rare but potentially serious cataract surgery complication. Clinical manifestations include increased intraocular pressure (IOP), anterior chamber inflammation, and recurrent hyphema or microhyphema. Uveitis-glaucoma-hyphema Plus syndrome also includes accompanying vitreous hemorrhage. Although classically associated with rigid anterior chamber intraocular lenses (lOLs), cases of malpositioning and subluxated posterior chamber lOLs have also been described as possible triggers. We report a case of a 70-year-old Caucasian man who developed UGH Plus syndrome after an uneventful cataract surgery with an lOL implanted in the capsular bag. During postoperative follow-up, persistent intraocular inflammation, increased IOP, hyphema, and vitreous hemorrhage were consistent with this diagnosis. Slit-lamp examination demonstrated progressive localized iris atrophy, compatible with chafing of the posterior iris by the IOL haptic as the trigger for UGH syndrome. A pars plana vitrectomy was performed and a retropupillary intraocular lens was implanted. No further complications occurred during follow-up. Given the increasing prevalence of single-piece lOLs implanted in the capsular bag, it is important to recognize UGH syndrome as a rare but potentially serious complication. How to cite this article: Sousa DC, Leal I, Faria MY, Pinto LA. A Rare Manifestation of Uveitis-glaucoma-hyphema Syndrome. J Curr Glaucoma Pract 2016;10(2):76-78.

Agreement of angle closure assessments between gonioscopy, anterior segment optical coherence tomography and spectral domain optical coherence tomography.

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Tay, Elton Lik Tong; Yong, Vernon Khet Yau; Lim, Boon Ang; Sia, Stelson; Wong, Elizabeth Poh Ying; Yip, Leonard Wei Leon

2015-01-01

To determine angle closure agreements between gonioscopy and anterior segment optical coherence tomography (AS-OCT), as well as gonioscopy and spectral domain OCT (SD-OCT). A secondary objective was to quantify inter-observer agreements of AS-OCT and SD-OCT assessments. Seventeen consecutive subjects (33 eyes) were recruited from the study hospital's Glaucoma clinic. Gonioscopy was performed by a glaucomatologist masked to OCT results. OCT images were read independently by 2 other glaucomatologists masked to gonioscopy findings as well as each other's analyses of OCT images. Totally 84.8% and 45.5% of scleral spurs were visualized in AS-OCT and SD-OCT images respectively (Pgonioscopy was fair at k=0.31 (95% confidence interval, CI: 0.03-0.59) and k=0.35 (95% CI: 0.07-0.63) for reader 1 and 2 respectively. The agreement for angle closure between SD-OCT and gonioscopy was fair at k=0.21 (95% CI: 0.07-0.49) and slight at k=0.17 (95% CI: 0.08-0.42) for reader 1 and 2 respectively. The inter-reader agreement for angle closure in AS-OCT images was moderate at 0.51 (95% CI: 0.13-0.88). The inter-reader agreement for angle closure in SD-OCT images was slight at 0.18 (95% CI: 0.08-0.45). Significant proportion of scleral spurs were not visualised with SD-OCT imaging resulting in weaker inter-reader agreements. Identifying other angle landmarks in SD-OCT images will allow more consistent angle closure assessments. Gonioscopy and OCT imaging do not always agree in angle closure assessments but have their own advantages, and should be used together and not exclusively.

Reflections on the pathogenesis of Down syndrome.

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Opitz, J M; Gilbert-Barness, E F

1990-01-01

Present efforts to identify, isolate, and characterize in molecular terms the "consensus" segment of 21q sufficient to cause most of the major and some of the most characteristic minor manifestations of Down syndrome will soon provide answers to many questions. However, we think that a reductionist approach to explain the Down syndrome phenotype in a "linear" manner from the DNA sequence of the segment will be doomed to failure from the outset because of the open, complex, nonlinear, hierarchical nature of morphogenetic systems. Neo-Darwinism is under strong attack; most genetic changes accumulated over time may very well be of neutral effect, and detailed studies in several related groups of vertebrate species has shown that molecular and organismal evolution are largely independent of one another. It has been pointed out recently that biology lacks a theory of ontogenetic and phylogenetic development, and that a purely "genocentric" view of biology at the expense of the complexly hierarchical intrinsic epigenetic attributes of developmental systems is "out of focus with respect to ... biological organization and morphogenesis," and may be "a residue of nineteenth century romantic idealism." Down syndrome impresses us as a paradigm of increased developmental variability due to a deceleration of the rate of development (neoteny) with many anomalies of incomplete morphogenesis (vestigia), atavisms, increased morphometric variability with many decreased means, increased variances, and increased fluctuating asymmetry. These abnormalities, together with highly increased risk of prenatal death and postnatal morbidity, impaired growth, and abnormal CNS and gonadal structure and function characteristic of most aneuploidy syndromes, suggest to us that the pathogenesis of Down syndrome is best viewed in terms of the mechanisms of speciation. Transgenic experiment involving sequential or overlapping pieces of "the consensus segment" on distal 21q22.1-22.3 may help decide to

Preliminary results of anterior lumbar interbody fusion, anterior column realignment for the treatment of sagittal malalignment.

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Hosseini, Pooria; Mundis, Gregory M; Eastlack, Robert K; Bagheri, Ramin; Vargas, Enrique; Tran, Stacie; Akbarnia, Behrooz A

2017-12-01

OBJECTIVE Sagittal malalignment decreases patients' quality of life and may require surgical correction to achieve realignment goals. High-risk posterior-based osteotomy techniques are the current standard treatment for addressing sagittal malalignment. More recently, anterior lumbar interbody fusion, anterior column realignment (ALIF ACR) has been introduced as an alternative for correction of sagittal deformity. The objective of this paper was to report clinical and radiographic results for patients treated using the ALIF-ACR technique. METHODS A retrospective study of 39 patients treated with ALIF ACR was performed. Patient demographics, operative details, radiographic parameters, neurological assessments, outcome measures, and preoperative, postoperative, and mean 1-year follow-up complications were studied. RESULTS The patient population comprised 39 patients (27 females and 12 males) with a mean follow-up of 13.3 ± 4.7 months, mean age of 66.1 ± 11.6 years, and mean body mass index of 27.3 ± 6.2 kg/m 2 . The mean number of ALIF levels treated was 1.5 ± 0.5. Thirty-three (84.6%) of 39 patients underwent posterior spinal fixation and 33 (84.6%) of 39 underwent posterior column osteotomy, of which 20 (60.6%) of 33 procedures were performed at the level of the ALIF ACR. Pelvic tilt, sacral slope, and pelvic incidence were not statistically significantly different between the preoperative and postoperative periods and between the preoperative and 1-year follow-up periods (except for PT between the preoperative and 1-year follow-up, p = 0.018). Sagittal vertical axis, T-1 spinopelvic inclination, lumbar lordosis, pelvic incidence-lumbar lordosis mismatch, intradiscal angle, and motion segment angle all improved from the preoperative to postoperative period and the preoperative to 1-year follow-up (p < 0.05). The changes in motion segment angle and intradiscal angle achieved in the ALIF-ACR group without osteotomy compared with the ALIF-ACR group with osteotomy

Anterior Overgrowth in Primary Curves, Compensatory Curves and Junctional Segments in Adolescent Idiopathic Scoliosis

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Schlösser, Tom P C; van Stralen, M; Chu, Winnie C W; Lam, Tsz-Ping; Ng, Bobby K W; Vincken, Koen L; Cheng, Jack C Y; Castelein, RM

2016-01-01

INTRODUCTION: Although much attention has been given to the global three-dimensional aspect of adolescent idiopathic scoliosis (AIS), the accurate three-dimensional morphology of the primary and compensatory curves, as well as the intervening junctional segments, in the scoliotic spine has not been

[Pre-surgical orthodontic treatment of skeletal class II patients with gingival smile corrected by anterior maxillary segmental osteotomy].

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Li, Xiaobing; Xiao, Liwei; Chen, Song; Chen, Yangxi

2002-11-01

To discuss the pre-surgical orthodontic treatment of skeletal class II patients with gingiva smile corrected by AMSO. We analyzed the clinical features of 20 skeletal class II patients treated by AMSO combined with Orthodontic treatment and evaluated the effects of AMSO by means of cephalometric analysis. After the AMSO treatment, ANB angle, the height of anterior maxilla, the protrusion of the upper anterior teeth, and the of A point had reduced significantly (P orthodontically to make arch relationship. Extract the upper bicuspid half a year before the surgery was recommended. When necessary, genioplasty could be performed.

Segmentation of ribs in digital chest radiographs

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Cong, Lin; Guo, Wei; Li, Qiang

2016-03-01

Ribs and clavicles in posterior-anterior (PA) digital chest radiographs often overlap with lung abnormalities such as nodules, and cause missing of these abnormalities, it is therefore necessary to remove or reduce the ribs in chest radiographs. The purpose of this study was to develop a fully automated algorithm to segment ribs within lung area in digital radiography (DR) for removal of the ribs. The rib segmentation algorithm consists of three steps. Firstly, a radiograph was pre-processed for contrast adjustment and noise removal; second, generalized Hough transform was employed to localize the lower boundary of the ribs. In the third step, a novel bilateral dynamic programming algorithm was used to accurately segment the upper and lower boundaries of ribs simultaneously. The width of the ribs and the smoothness of the rib boundaries were incorporated in the cost function of the bilateral dynamic programming for obtaining consistent results for the upper and lower boundaries. Our database consisted of 93 DR images, including, respectively, 23 and 70 images acquired with a DR system from Shanghai United-Imaging Healthcare Co. and from GE Healthcare Co. The rib localization algorithm achieved a sensitivity of 98.2% with 0.1 false positives per image. The accuracy of the detected ribs was further evaluated subjectively in 3 levels: "1", good; "2", acceptable; "3", poor. The percentages of good, acceptable, and poor segmentation results were 91.1%, 7.2%, and 1.7%, respectively. Our algorithm can obtain good segmentation results for ribs in chest radiography and would be useful for rib reduction in our future study.

PLATEAU IRIS--DIAGNOSIS AND TREATMENT.

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Stefan, Cornel; Iliescu, Daniela Adriana; Batras, Mehdi; Timaru, Cristina Mihaela; De Simone, Algerino

2015-01-01

The objective of our study was to review the current knowledge on the diagnosis and treatment options of plateau iris configuration and syndrome. Relevant publications on plateau iris that were published until 2014. Plateau iris syndrome is a form of primary angle closure glaucoma caused by a large or anteriorly positioned ciliary body that leads to mechanical obstruction of trabecular meshwork. This condition is most often found in younger patients. Plateau iris has been considered an abnormal anatomic variant of the iris that can be diagnosed on ultrasound biomicroscopy or optical coherence tomography of anterior segment. Patients with plateau iris syndrome can be recognized by the lack of response in angle opening after iridotomy. The treatment of choice in these cases is argon laser peripheral iridoplasty.

PREVENTION OF LEFT VENTRICLE SYSTOLIC DYSFUNCTION IN PATIENTS WITH ACUTE CORONARY SYNDROME WITH ST SEGMENT ELEVATION AFTER CARDIAC REVASCULARIZATION

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A. L. Alyavi

2016-01-01

Full Text Available Aim. To study effects of bioflavonoid quercetin (corvitin on left ventricle (LV systolic dysfunction in patients with acute coronary syndrome with ST segment elevation (ACS+ST after cardiac revascularization.Material and methods. 60 patients with ACS+ST (44,2±1,3 y.o. were examined. Patients were admitted to hospital within 6 hours after complaints beginning. Patients were randomized in two groups. 30 patients of group A had standard therapy and cardiac revascularization. 30 patients of group B received corvitin additionally to standard therapy before cardiac revascularization. Echocardiography initially and stress-echocardiography with dobutamine after status stabilization (at 8-10 days of disease were performed.Results. Dobutamine test (with low and high doses showed myocardial viability in patients of group B. Patients of group A had irreversible LV systolic dysfunction in 32 % of segments. Corvitin slowed down LV dilatation progression in patients with ACS+ST. It resulted in the end-diastolic and end-systolic indexes did not change within 10 days. The LV ejection fraction was more increased in patients of group B in comparison with patients of group A.Conclusion. The early corvitin prescribing has positive effects on LV systolic function and prevents post-reperfusion complications. 

PREVENTION OF LEFT VENTRICLE SYSTOLIC DYSFUNCTION IN PATIENTS WITH ACUTE CORONARY SYNDROME WITH ST SEGMENT ELEVATION AFTER CARDIAC REVASCULARIZATION

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A. L. Alyavi

2009-01-01

Full Text Available Aim. To study effects of bioflavonoid quercetin (corvitin on left ventricle (LV systolic dysfunction in patients with acute coronary syndrome with ST segment elevation (ACS+ST after cardiac revascularization.Material and methods. 60 patients with ACS+ST (44,2±1,3 y.o. were examined. Patients were admitted to hospital within 6 hours after complaints beginning. Patients were randomized in two groups. 30 patients of group A had standard therapy and cardiac revascularization. 30 patients of group B received corvitin additionally to standard therapy before cardiac revascularization. Echocardiography initially and stress-echocardiography with dobutamine after status stabilization (at 8-10 days of disease were performed.Results. Dobutamine test (with low and high doses showed myocardial viability in patients of group B. Patients of group A had irreversible LV systolic dysfunction in 32 % of segments. Corvitin slowed down LV dilatation progression in patients with ACS+ST. It resulted in the end-diastolic and end-systolic indexes did not change within 10 days. The LV ejection fraction was more increased in patients of group B in comparison with patients of group A.Conclusion. The early corvitin prescribing has positive effects on LV systolic function and prevents post-reperfusion complications. 

Value and limitations of segmental analysis of stress thallium myocardial imaging for localization of coronary artery disease

International Nuclear Information System (INIS)

Rigo, P.; Bailey, I.K.; Griffith, L.S.C.; Pitt, B.; Borow, R.D.; Wagner, H.N.; Becker, L.C.

1980-01-01

This study was done to determine the value of thallium-201 myocardial scintigraphic imaging (MSI) for identifying disease in the individual coronary arteries. Segmental analysis of rest and stress MSI was performed in 133 patients with ateriographically proved coronary artery disease (CAD). Certain scintigraphic segments were highly specific (97 to 100%) for the three major coronary arteries: anterior wall and septum for the left anterior descending (LAD) coronary artery; the inferior wall for the right coronary artery (RCA); and the proximal lateral wall for the circumflex (LCX) artery. Perfusion defects located in the anterolateral wall in the anterior view were highly specific for proximal disease in the LAD involving the major diagonal branches, but this was not true for septal defects. The apical segments were not specific for any of the three major vessels. Although MSI was abnormal in 89% of these patients with CAD, it was less sensitive for identifying individual vessel disease: 63% for LAD, 50% for RCA, and 21% for LCX disease (narrowings > = 50%). Sensitivity increased with the severity of stenosis, but even for 100% occlusions was only 87% for LAD, 58% for RCA and 38% for LCX. Sensitivity diminished as the number of vessels involved increased: with single-vessel disease, 80% of LAD, 54% of RAC and 33% of LCX lesions were detected, but in patients with triple-vessel disease, only 50% of LAD, 50% of RCA and 16% of LCX lesions were identified. Thus, although segmented analysis of MSI can identify disease in the individual coronary arteries with high specificity, only moderate sensitivity is achieved, reflecting the tendency of MSI to identify only the most severely ischemic area among several that may be present in a heart. Perfusion scintigrams display relative distributions rather than absolute values for myocardial blood flow

Interventional and surgical management of abdominal compartment syndrome in severe acute pancreatitis.

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Dambrauskas, Zilvinas; Parseliūnas, Audrius; Maleckas, Almantas; Gulbinas, Antanas; Barauskas, Giedrius; Pundzius, Juozas

2010-01-01

Management of the abdominal compartment syndrome during severe acute pancreatitis by the open abdomen method is associated with considerable morbidity and resource utilization. Thus, the aim of this study was to evaluate the safety and efficacy of the ultrasound-guided percutaneous interventions and/or minimally invasive surgery in the treatment of abdominal compartment syndrome. Forty-four patients with severe acute pancreatitis were enrolled into a prospective study and treated according to the standard management protocol. Interventional and/or surgical management of abdominal compartment syndrome was employed in 6 (13.6%) cases. In the context of this study, we assessed the feasibility and effectiveness of subcutaneous fasciotomy of the anterior m. rectus abdominis sheath, as well as the role of ultrasound-guided drainage of intra-abdominal and peripancreatic fluid collections in the management of abdominal compartment syndrome. Subcutaneous fasciotomy of the anterior m. rectus sheath and ultrasound-guided drainage of intra-abdominal and peripancreatic fluid collections seem to be safe (minor risk of bleeding or infection, closed abdomen, and easy care for the patient) and effective (resulted in a sustained decrease of intra-abdominal pressure to 13-16 mm Hg and regression of organ failures after intervention). Subcutaneous anterior m. rectus fasciotomy may appear to be beneficial in case of refractory abdominal compartment syndrome avoiding morbidity associated with the open abdomen technique. Both the subcutaneous fasciotomy and ultrasound-guided drainage of intra-abdominal and/or peripancreatic fluid collections seem to be safe and effective alternatives in the management of abdominal compartment syndrome; however, prospective studies are needed to further evaluate their clinical role.

Characterization of rat model of acute anterior uveitis using optical coherence tomography angiography

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Choi, Woo June; Pepple, Kathryn L.; Zhi, Zhongwei; Wang, Ruikang K.

2015-03-01

Uveitis, or ocular inflammation, is a cause of severe visual impairment. Rodent models of uveitis are powerful tools used to investigate the pathological mechanisms of ocular inflammation and to study the efficacy of new therapies prior to human testing. In this paper, we report the utility of spectral-domain optical coherence tomography (SD-OCT) angiography in characterizing the inflammatory changes induced in the anterior segment of a rat model of uveitis. Acute anterior uveitis (AAU) was induced in two rats by intravitreal injection of a killed mycobacterial extract. One of them received a concurrent periocular injection of steroids to model a treatment effect. OCT imaging was performed prior to inflammation induction on day 0 (baseline), and 2 days post-injection (peak inflammation). Baseline and inflamed images were compared. OCT angiography identified swelling of the cornea, inflammatory cells in the anterior and posterior chambers, a fibrinous papillary membrane, and dilation of iris vessels in the inflamed eyes when compared to baseline images. Steroid treatment was shown to prevent the changes associated with inflammation. This is a novel application of anterior OCT imaging in animal models of uveitis, and provides a high resolution, in vivo assay for detecting and quantifying ocular inflammation and the response to new therapies.

Functional MRI study of diencephalic amnesia in Wernicke-Korsakoff syndrome.

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Caulo, M; Van Hecke, J; Toma, L; Ferretti, A; Tartaro, A; Colosimo, C; Romani, G L; Uncini, A

2005-07-01

Anterograde amnesia in Wernicke-Korsakoff syndrome is associated with diencephalic lesions, mainly in the anterior thalamic nuclei. Whether diencephalic and temporal lobe amnesias are distinct entities is still not clear. We investigated episodic memory for faces using functional MRI (fMRI) in eight controls and in a 34-year-old man with Wernicke-Korsakoff syndrome and diencephalic lesions but without medial temporal lobe (MTL) involvement at MRI. fMRI was performed with a 1.5 tesla unit. Three dual-choice tasks were employed: (i) face encoding (18 faces were randomly presented three times and subjects were asked to memorize the faces); (ii) face perception (subjects indicated which of two faces matched a third face); and (iii) face recognition (subjects indicated which of two faces belonged to the group they had been asked to memorize during encoding). All activation was greater in the right hemisphere. In controls both the encoding and recognition tasks activated two hippocampal regions (anterior and posterior). The anterior hippocampal region was more activated during recognition. Activation in the prefrontal cortex was greater during recognition. In the subject with Wernicke-Korsakoff syndrome, fMRI did not show hippocampal activation during either encoding or recognition. During recognition, although behavioural data showed defective retrieval, the prefrontal regions were activated as in controls, except for the ventrolateral prefrontal cortex. fMRI activation of the visual cortices and the behavioural score on the perception task indicated that the subject with Wernicke-Korsakoff syndrome perceived the faces, paid attention to the task and demonstrated accurate judgement. In the subject with Wernicke-Korsakoff syndrome, although the anatomical damage does not involve the MTL, the hippocampal memory encoding has been lost, possibly as a consequence of the hippocampal-anterior thalamic axis involvement. Anterograde amnesia could therefore be the expression of

Assessment of the anterior chamber parameters after laser iridotomy in primary angle close suspect using Pentacam and gonioscopy.

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Esmaeili, Alireza; Barazandeh, Behzad; Ahmadi, Sina; Haghi, Alireza; Ahmadi Hosseini, Seyed Mahdi; Abolbashari, Fereshteh

2013-01-01

To evaluate the changes in the anterior segment parameters of the subjects with primary angle closure suspect (PACS) before and after laser iridotomy (LI) using the Pentacam and gonioscopy. Forty-eight eyes of 48 PACS were included. Anterior chamber angle (ACA), central anterior chamber depth (ACD), anterior chamber volume (ACV) and central corneal thickness (CCT) were recorded from the Pentacam before and one month after LI. ACA was graded according to Shaffer classification using the Goldmann gonioscopy. ACA increased significantly from 25.59±4.41 to 26.46±4.33 degrees (P=0.009) and ACV changed from 85.97±16.07mm(3) to 99.25±15.83mm(3) (P=0.000). The changes in ACD, CCT and intraocular pressure were non-significant (P>0.05). Gonioscopy showed significant widening of the Shaffer angle in 4 quadrants (P<0.001). Pentacam can serve as the objective instrument in assessing the efficacy of LI.

Anterior cervical fusion: the role of anterior plating.

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Daffner, Scott D; Wang, Jeffrey C

2009-01-01

Treatment of cervical pathology requires a clear understanding of the biomechanical benefits and limitations of cervical plates, their indications, and their associated complications. The use of anterior cervical plates has evolved significantly since their early application in cervical trauma. They have become widely used for anterior cervical decompression and fusion for cervical spondylosis. Plate design has undergone significant refinement and innovation, from the initial unlocked plates requiring bicortical purchase to the latest rotationally and translationally semiconstrained dynamic plates. Excellent clinical results have been reported for single-level anterior cervical decompression and fusion with or without plate fixation; however, the addition of an anterior cervical plate clearly leads to earlier fusion and better clinical results in longer fusions. Longer fusions should ideally consist of corpectomies and strut grafting because the decreased number of fusion surfaces tends to lead to higher fusion rates. Although anterior plate fixation leads to higher fusion rates in fusions of three or more levels, the associated pseudarthrosis rate is still high. The use of dynamic plates, through increased load sharing across the graft and decreased stress shielding, may improve fusion rates, particularly in long fusions. Nevertheless, adjuvant posterior fixation is recommended for fusions of more than three vertebral levels. Anterior plate fixation may be of particular benefit in the management of traumatic injuries, in revision settings, and in the treatment of smokers. Complications unique to plate fixation include hardware breakage and migration as well as ossification of the adjacent disk levels.

Idiopathic mitral valve disease in a patient presenting with Axenfeld-Rieger syndrome.

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Antevil, Jared; Umakanthan, Ramanan; Leacche, Marzia; Brewer, Zachary; Solenkova, Natalia; Byrne, John G; Greelish, James P

2009-05-01

A 33-year-old, previously healthy male presented with respiratory distress and underwent intubation. A physical examination revealed a holosystolic murmur and pupillary abnormalities. Echocardiography revealed a flail anterior mitral valve leaflet with ruptured chordae and severe mitral regurgitation. The patient underwent urgent mitral valve replacement and tolerated the procedure well. The mitral valve leaflet was myxomatous and calcified -- an unusual find in such a patient. An ophthalmology consultation was obtained and the patient diagnosed with Axenfeld-Rieger syndrome, a disorder of the anterior ocular chamber that has been associated with cardiac malformations. The present case report adds to the body of literature which suggests a correlation between Axenfeld-Rieger syndrome and valvular abnormalities. Hence, it is believed prudent that patients with Axenfeld-Rieger syndrome should undergo echocardiographic screenings for valvular abnormalities.

Clinical characteristics and outcomes of acute coronary syndrome patients with left anterior hemiblock.

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Zhang, Hanfei; Goodman, Shaun G; Steg, Gabriel P; Budaj, Andrzej; Lopez-Sendon, Jose; Dorian, Paul; Huynh, Thao; Mangat, Iqwal; Wong, Graham C; Spencer, Frederick A; Yan, Andrew T

2014-09-15

We aimed to study the relationships between left anterior hemiblock (LAHB) and the patient characteristics, management, and clinical outcomes in the setting of acute coronary syndromes (ACS). Admission ECGs of patients enrolled in the Global Registry of Acute Coronary Events (GRACE) ECG substudy, and the Canadian ACS Registry I, were analysed independently at a blinded core laboratory. Multivariable logistic regression analysis was performed to assess the independent associations between LAHB on the admission ECG and in-hospital and 6-month mortality. Of the 11 820 eligible ACS patients, 692 (5.9%) patients had LAHB. The presence of LAHB on admission was associated with older age, male sex, prior myocardial infarction, prior heart failure, worse Killip class, higher creatinine level, and higher GRACE risk score (all pcoronary revascularisation or reperfusion therapy (all p<0.05). The LAHB group had higher in-hospital (6.9% vs 3.9%, p<0.001) and 6-month mortality (12.5% vs 7.7%, p<0.001). However, after adjusting for the known predictors of mortality in the GRACE risk models, LAHB was not independently associated with in-hospital death (OR 1.07, 95% CI 0.76 to 1.52, p=0.70), or death at 6 months (OR 1.00, 95% CI 0.75 to 1.34, p=0.99). Across the broad spectrum of ACS, LAHB was associated with significant comorbidities, high-risk clinical features on presentation, and worse unadjusted outcomes. However, LAHB was not an independent predictor of in-hospital and 6-month mortality and did not carry incremental prognostic value beyond the known prognosticators in the GRACE risk models. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Iliotibial band friction syndrome after anterior cruciate ligament reconstruction using the transfix device: report of two cases and review of the literature.

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Pelfort, Xavier; Monllau, Joan C; Puig, Lluís; Cáceres, Enric

2006-06-01

The use of hamstrings is increasing as a treatment for anterior cruciate ligament (ACL) injuries. There are a lot of new devices and techniques that try to fix the graft without causing further injury or increased morbidity. We report two cases in relation to the transfix device for reconstructing the ACL. The first case is a 38-year-old female who was treated with an autologous hamstring graft for chronic ACL instability brought on by a sport trauma. The patient developed iliotibial band friction syndrome 3 months after the operation. MRI showed incorrect positioning and a rupture of the femoral bio-absorbable cross-pin. The hamstring graft always had good fixation and did not produce instability of the knee. We removed the cross-pin fragment in a second surgery and the patient returned to her daily lifestyle after 3 weeks. The second case is a 52-year-old female with a painful and unstable knee due to a previous lateral meniscectomy and failure of an ACL reconstruction. We performed an ACL reconstruction with an autologous hamstring graft and a lateral meniscus transplantation. Some months after the procedure she also developed this syndrome. MRI showed the same features as shown in the first case and a second surgery was needed. To our knowledge this clinical and technical problem has not been previously described.

Case Report: Cervical Klippel-Feil syndrome predisposing an ...

African Journals Online (AJOL)

Case Report: Cervical Klippel-Feil syndrome predisposing an elderly African man to central cord myelopathy following minor trauma. ... unique presentation of this case of Klippel-Feil syndrome further supports the impression that following fusion (congenital or acquired) of one segment of the spinal column, hypermobility of ...

Agreement of angle closure assessments between gonioscopy, anterior segment optical coherence tomography and spectral domain optical coherence tomography

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Elton Lik Tong Tay

2015-04-01

Full Text Available AIM: To determine angle closure agreements between gonioscopy and anterior segment optical coherence tomography (AS-OCT, as well as gonioscopy and spectral domain OCT (SD-OCT. A secondary objective was to quantify inter-observer agreements of AS-OCT and SD-OCT assessments. METHODS: Seventeen consecutive subjects (33 eyes were recruited from the study hospital’s Glaucoma clinic. Gonioscopy was performed by a glaucomatologist masked to OCT results. OCT images were read independently by 2 other glaucomatologists masked to gonioscopy findings as well as each other’s analyses of OCT images. RESULTS: Totally 84.8% and 45.5% of scleral spurs were visualized in AS-OCT and SD-OCT images respectively (P<0.01. The agreement for angle closure between AS-OCT and gonioscopy was fair at k=0.31 (95% confidence interval, CI: 0.03-0.59 and k=0.35 (95% CI: 0.07-0.63 for reader 1 and 2 respectively. The agreement for angle closure between SD-OCT and gonioscopy was fair at k=0.21 (95% CI: 0.07-0.49 and slight at k=0.17 (95% CI: 0.08-0.42 for reader 1 and 2 respectively. The inter-reader agreement for angle closure in AS-OCT images was moderate at 0.51 (95% CI: 0.13-0.88. The inter-reader agreement for angle closure in SD-OCT images was slight at 0.18 (95% CI: 0.08-0.45. CONCLUSION: Significant proportion of scleral spurs were not visualised with SD-OCT imaging resulting in weaker inter-reader agreements. Identifying other angle landmarks in SD-OCT images will allow more consistent angle closure assessments. Gonioscopy and OCT imaging do not always agree in angle closure assessments but have their own advantages, and should be used together and not exclusively.

DRG Spinal Cord Stimulation as Solution for Patients With Severe Pain Due to Anterior Cutaneous Nerve Entrapment Syndrome: A Case Series.

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Mol, Frédérique Mathilde Ulrike; Roumen, Rudi M H

2018-04-01

Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) is a debilitating neuropathic pain condition. A small portion of patients do not respond to any currently available treatment modalities. These patients, often young women, might benefit from targeted spinal cord stimulation of the dorsal root ganglion (DRG). This retrospective case series describes five ACNES patients who were referred from a Dutch dedicated tertiary referral center to collaborating sites with extensive experience in DRG stimulation to be implanted with a DRG Axium System (St. Jude/Abbott, IL, USA) in the period of 2013-2016. Numeric pain rating scores at routine 6- and 12-month follow-up visits were analyzed. Three patients experienced >50% pain reduction at 12 months follow-up. Four patients experienced device-related complications, such as lead dislocation, lead breakage, pain at the battery site, and overstimulation. This case series suggests DRG spinal cord stimulation can be safe and effective for some patients with persistent pain due to ACNES. © 2017 International Neuromodulation Society.

Sensory Loss Mimicking Cauda Equina Syndrome due to Cervical Spinal Lesion in a Patient with Clinically Isolated Syndrome

OpenAIRE

Vinceti, Giulia; Zini, Andrea; Nichelli, Paolo; Mandrioli, Jessica