Sustained Dyskinesias Following Elective Cessation and Reactivation of Chronic Subthalamic Nucleus Deep Brain Stimulation for a Surgical Procedure

Objectives: Subthalamic nucleus deep brain stimulation (STN DBS) is effective for treatment of levodopa‐induced dyskinesias in patients with Parkinson's disease (PD). Medical or surgical procedures requiring electrocautery may require inactivation of the pulse generators to avoid damage to the lead or extension wire or possible reprogramming of the stimulators. This generally causes only mild and temporary disability. We report a patient with previously well‐controlled dyskinesias who had severe and prolonged dyskinesias following reactivation of deep brain stimulation (DBS) following an orthopedic procedure. Materials and Methods: Retrospective chart review. Results: The patient underwent two orthopedic procedures, each requiring inactivation of DBS. After reactivation of DBS, the patient experienced severe dyskinesias that ultimately required sedation and ventilation to control large‐amplitude dyskinesias. Conclusions: Clinicians caring for PD patients treated with STN DBS should be aware of the possible reappearance of severe dyskinesias arising from routine inactivation and reactivation of pulse generators for medical or surgical procedures.     

Juvenile Idiopathic Arthritis-associated Uveitis at an Italian Tertiary Referral Center: Clinical Features and Complications

Abstract

Purpose: To describe the frequencies and risk factors of ocular complications and poor visual outcomes in children with juvenile idiopathic arthritis (JIA).

Methods: Retrospective cohort study, including 69 consecutive children (116 eyes) affected by JIA-associated uveitis managed at a tertiary uveitis clinic.

Results: The incidence of visual loss to the 20/50 or worse threshold was 0.04/eye-year (EY) and to the 20/200 or worse threshold was 0.02/EY. The most common complications at baseline were posterior synechiae (52%), band keratopathy (38%), and cataract (12%). Risk factor for a visual acuity threshold of 20/50 or worse included hypotony (p?=?0.01; hazard ratio [HR] 3.7; 95% CI 1.3–10.4); anterior chamber flare >1 (p?=?0.04; HR 1.3; 95% CI 0.5–3.4); a positive antinuclear antibody (ANA) (p?=?0.02; HR1.4; 95% CI 0.8–2.4). Hypotony and positive ANA are also associated to the 20/200 or worse threshold (p?=?0.03; HR 5.1; 95% CI 1.1–23.9 and p?=?0.04; HR 1.0; 95% CI 0.4–2.3; respectively). Use of immunosuppressive drugs was associated with a reduced risk of visual loss of 20/200 or worse (odds ratio 0.14, 95% CI, 0.02–1.29; p?=?0.04).

Conclusions: Loss of vision and ocular complications still occur among children with JIA-related uveitis. Prompt diagnosis and a strict follow up associated to immunosuppressive therapy may decrease the poor visual outcome.     

Risk Factors for Postoperative Hemorrhage after Vitrectomy for Diabetic Retinopathy

Objective: To identify the potential risk factors for postvitrectomy diabetic vitreous hemorrhage (PDVH). Methods: A matched case-control nested into a retrospective follow-up study was done to review the surgical results in 68 consecutive eyes undergoing primary pars plana vitrectomy for vitreous hemorrhage. The eyes were divided into two groups based on the presence of PDVH (19 cases and 49 controls) and were matched on surgeon and the date of surgery. Twenty-three factors related to the preoperative examination and eight factors related to the operative procedure were analyzed. Statistical analysis was based on conditional logistic regression models with PDVH as the dependent variable. The mean follow-up interval was six months. Results: The factors associated with the incidence of PDVH were iris neovascularization (OR = 9.8, P = 0.03), lower extremity amputations (OR = 8.3, P = 0.02) and the use of antihypertensive agents within three months before vitrectomy (OR = 0.2, P = 0.04). Phakic and aphakic eyes of diabetic patients with lower extremity amputations would have a 70% probability of developing PDVH. This probability would have dropped to 30–40% had they been taking antihypertensive treatment. Conclusions: Iris neovascularization and lower extremity amputations increase the risk of PDVH. Antihypertensive treatment before vitrectomy decreases this risk.     

1021例腹腔镜胆囊切除术中术后并发症的原因分析

目的:探讨腹腔镜胆囊切除术并发症的原因。方法:回顾性分析某医院自1997年7月～2011年7月腹腔镜胆囊切除所出现的并发症的临床资料。结果:术中发现的急性期及解剖异常79例,术后2例出血,1例胆漏,胆囊管内结石残留1例,胆总管误扎1例,1例胆总管损伤,2例肝功能不正常。术后随访均恢复良好。结论:腹腔镜下切除胆囊是安全、有效的手术方式,具有恢复快、出血少等优点;急性发作期72h者不宜行急诊腔镜手术,米里齐综合征患者不宜行腹腔镜手术,解剖异常者手术要注意解剖层次。     

The ‘Hyperactive’ Child

A new, more apt designation, attentional deficit disorder (ADD), may help dispel some of the myths that have surrounded the “hyperactive” child. An abnormally high level of physical activity is a common but not universal finding in these children but is not their central problem. In most affected children, early diagnosis and specific drug treatment can ward off the often disastrous psychiatric and social consequences of ADD.     

控制性超排卵中卵巢高反应与辅助生殖的安全运行

控制性超排卵是辅助生殖技术的重要步骤,有效的提高了助孕效果,同时也带来了卵巢高反应及卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)。卵巢高反应备受关注,对之具有一定的认识,但仍缺乏统一的判断标准及有效的临床应对策略。卵巢高反应带来了辅助生殖中最严重的并发症,其对亲代健康的影响重大,对子代的影响有待阐明。重视卵巢高反应及其导致的安全问题,是辅助生殖临床中的重要课题。     

Treatment strategies in controlling strongyloidiasis

Strongyloidiasis is an intestinal parasite infection caused by Strongyloides stercoralis. Spontaneous cure cannot be expected due to the unique life cycle of the parasite, termed autoinfection. The disease occurs worldwide, but especially in tropical and subtropical regions. Serious clinical problems with complications and refractory strongyloidiasis are observed, especially in immunocompromised patients, such as those infected with human T cell leukaemia virus Type 1 (HTLV-1) or HIV, or corticosteroid-treated patients. Thiabendazole is effective against S. stercoralis infection; however, serious side effects have been reported. Recently, ivermectin, which has been introduced for the treatment of human onchocerciasis, has been reported to be effective against strongyloidiasis, without serious side effects. The interval of administration is important for treatment, because if autoinfective migrating larvae are not eradicated, S. stercoralis will resume its life cycle and multiply again. To evaluate the results of treatment of S. stercoralis, stool examinations and S. stercoralis-specific antibody titres should be examined for at least 1 or 2 years if possible. This article provides a review of treatments and methods of evaluation of patients infected with S. stercoralis.     

The Perioperative von Willebrand Factor Activity and Factor VIII Levels Among Alcohol Use Disorder Patients Undergoing Total Knee or Hip Replacement

Alcohol use disorder patients have a five-fold higher risk of postoperative bleeding complications. We measured the perioperative von Willebrand factor and factor VIII levels in consecutive patients with alcohol use disorder. In one university hospital, 105 patients scheduled for arthroplasty were screened, and 25 fulfilled inclusion criteria. Postoperatively, we found significantly decreased von Willebrand factor ristocetin cofactor values over time among alcohol use disorder patients and significantly different time courses of factor VIII levels between patients with and without a diagnosed alcohol use disorder. Blood loss was significantly increased among alcohol use disorder patients on their first postoperative day.     

The safety and usefulness of low molecular weight heparins and unfractionated heparins in patients with acute stroke

Stroke is a common cause for morbidity and mortality, causing substantial economic costs. Because thrombosis plays a key role in the pathogenesis of ischaemic stroke, heparins, platelet inhibitors and anticoagulants have been used in stroke management. There were high hopes that patients might benefit from the use of heparins. Unfortunately, these expectations have not been met. Instead, thrombolytics have been shown to result in an improvement of outcome in a considerable fraction of patients with ischaemic stroke. Yet, in other areas of stroke management, such as the prevention of venous thromboembolism after stroke, heparins have found their niche. In this review, we report on the currently available literature on heparins for the reduction of stroke-related morbidity and mortality, the prevention of recurrent stroke as well as the prevention of venous thromboembolism in both ischaemic and haemorrhagic stroke with respect to their risks, such as the haemorrhagic transformation of ischaemic strokes.     

Randomized sham‐controlled trial of acupuncture for postoperative pain control after stapled haemorrhoidopexy

Aim Haemorrhoidectomy usually causes moderate to strong postoperative pain. Chinese studies have found that acupuncture may have an analgesic effect in posthaemorrhoidectomy patients. This is the first Western study aiming assess the efficacy of acupuncture as an adjunct analgesic therapy after stapled haemorrhoidopexy. Method In a randomized controlled trial, 50 patients were allocated to three groups. Conventional drug therapy (oral diclofenac and metamizol, local lidocaine) served as baseline analgesia. In the control group (n = 17) only this regimen was used. In addition to baseline analgesia, 17 patients received verum acupuncture. Sham acupuncture was performed on 16 patients. Being the primary outcome measure, pain was measured twice daily using the numerical rating scale (NRS) and compared statistically by repeated‐measures analysis of variance. The study was registered (DRKS00003116). Results After verum acupuncture, pain intensity was not significantly lower when compared with conventional analgesia (primary hypothesis, P = 0.057), but was when compared to sham acupuncture (P = 0.007). In the afternoon of postoperative day 1, for example, NRS was 2.7 (SD 1.5) in the verum group, but 4.0 (1.0) in the sham group and 4.1 (1.9) under conventional analgesia. Furthermore, significantly fewer rescue analgesics were necessary if verum acupuncture was applied. Cardiovascular parameters were stable in all three groups, and no complications were recorded. Conclusions In posthaemorrhoidectomy patients, acupuncture appears to be an effective adjunct to conventional analgesia. Further studies are necessary to confirm these observations and to refine the acupuncture technique.