Characteristics of frequency-of-seeing curves for a motion stimulus in glaucoma eyes, glaucoma suspect eyes, and normal eyes.

This study compared frequency-of-seeing curves for a line displacement test in glaucoma patients and normals. Probit analysis of the frequency-of-seeing curves provided the motion thresholds and the slopes of the frequency-of-seeing curves, represented by the interquartile range. The thresholds and interquartile ranges were significantly elevated in the glaucoma eyes and suspect eyes, compared to controls. A logistic regression model incorporating both the interquartile range and threshold significantly improved the sensitivity of the motion test in the suspects. Abnormal shallowing of the slope of the motion frequency-of-seeing curve may represent one of the earliest changes in glaucoma.     

Low-birth-weight infants in the Cape Peninsula. A follow-up study at the age of 3 years

A sample of coloured children from the Cape Town City Council area who had been of low birth weight, although a weight appropriate for gestational age, was examined at the age of approximately 3 years. The children were compared with a control group of similar social background who had been of normal birth weight. Growth parameters were compared with the National Center for Health Statistics centiles. The low-birth-weight infants had compensated well. Although they were lighter, shorter in stature and had lower intelligence quotient scores than their normal-birth-weight contemporaries, when corrected for prematurity the growth parameters and IQ did not differ significantly from those of the controls. Six per cent of the preterm infants had major and 15% minor handicaps. Infants with very low birth weights (less than 1500 g) had no more handicaps than those with low birth weights. Iron deficiency was detected in 18% of the children overall but all those who were anaemic were from the low-birth-weight groups. Between 1 and 3 years of age the low-birth-weight infants had more illnesses but no more hospital admissions than the controls.     

Short‐term renal outcomes in African American and Caucasian donors following live kidney donation

Reeves‐Daniel A, Freedman BI, Assimos D, Hartmann EL, Bleyer A, Adams PL, Westcott C, Stratta RJ, Rogers J, Farney AC, Daniel KR. Short‐term renal outcomes in African American and Caucasian donors following live kidney donation.
Clin Transplant 2009 DOI: 10.1111/j.1399‐0012.2009.01170.x
© 2009 John Wiley & Sons A/S. Abstract: Introduction: Although African Americans (AA) are considered higher risk kidney donors than Caucasians, limited data are available regarding outcomes of AA donors. Methods: We performed a single‐center retrospective review of all kidney donors from 1993 to 2007 and evaluated race/ethnic differences in post‐donation changes in renal function, incident proteinuria, and systolic blood pressure (SBP) using linear mixed models. Results: A total of 336 kidney donors (63 AA, 263 Caucasian, 10 other) were evaluated. Before donation, AA had higher serum creatinine concentrations, estimated glomerular filtration rate (GFR) values, and SBP levels than Caucasians. No significant changes in SBP or renal function were observed between the two groups within the first year after donation, although results were limited by incomplete follow‐up. Conclusion: AA had higher pre‐donation serum creatinine, GFR, and SBP values compared to Caucasians; however, the degree of change in renal function and blood pressure did not differ between groups following kidney donation. Although long‐term studies are needed, our study suggests that AA and Caucasians experience similar short‐term consequences after donation. The incomplete data available on donor outcomes in our center and in prior publications also indicates a global need to implement systems for structured follow‐up of live kidney donors.     

Impact of race and gender on live kidney donation

Abstract: Background: African Americans (AA) and women are less likely to receive a live kidney donor (LKD) transplant than Caucasians or men. Reasons for non‐donation are poorly understood. Methods: A retrospective review of 541 unsuccessful LKD was performed to explore reasons for non‐donation and to assess for racial and/or gender differences. Results: We identified 138 AA and 385 Caucasian subjects who volunteered but did not successfully donate. Females (58.2%) were more likely to be excluded than males due to reduced renal function (glomerular filtration rate < 85 mL/min, 7.9% vs. 0.9%, p < 0.0001) or failure to complete the evaluation (6.4% vs. 1.8%, p = 0.01). AA were more commonly excluded due to obesity (body mass index ≥ 32 kg/m²; 30.4% AA vs. 16.6% Caucasian, p = 0.0005) or failure to complete the evaluation (12.3% AA vs. 1.8% Caucasian, p < 0.0001) whereas Caucasians were more often excluded due to kidney stones (1.5% AA vs. 7.3% Caucasian, p = 0.01). Conclusions: Significantly different reasons for exclusion of LKD exist between potential Caucasian and AA LKD, particularly among women. Among the differences that we observed are potentially modifiable barriers to donation including obesity and failure to complete the donor evaluation. A further understanding of these barriers may help point to strategies for more effective recruitment and successful LKD.     

Maxillofacial training is no longer than other surgical specialties

INTRODUCTION

There is a perception that the training pathway for oral and maxillofacial surgery (OMFS) is unduly long and arduous, as consultant oral and maxillofacial surgeons must be doubly qualified (that is, hold degrees in medicine and dentistry) and be holders of two higher fellowships.

MATERIALS AND METHODS

We reviewed the data regarding the average age of National Training Number (NTN) holders and GMC data on the year of first registration and the year of entry onto a specialist surgical list for all 9 surgical specialties.

RESULTS

The results showed the average age of the surgical SpR populations ranged from 33.5 to 38.2 years with an average age of 36.14 years. OMFS SpR''s average age is 37.69 years. The GMC data showed the average number of months from full to specialist registration ranged from 90.83 months to 135.24 months, with OMFS surgeons having the lowest average.

CONCLUSIONS

These data suggest that OMFS surgeons are of a similar age to other surgeons whilst in training. In addition, they have the shortest transit time between full GMC registration and entry onto the specialist list. The length of this training even with dual qualification is similar to other surgical specialties.     

Laparoscopic common bile duct exploration and holmium laser lithotripsy: a novel approach to the management of common bile duct stones

Background  

Endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic common bile duct exploration (LCBDE) have proved to be safe and effective ways of managing common bile duct (CBD) stones. Clearance of large or impacted CBD stones by routine endoscopic maneuvers can be challenging, often requiring more invasive techniques such as open CBD exploration, which increases morbidity. This report presents a novel approach to managing impacted CBD stones using laparoscopic transcystic common bile duct exploration and holmium laser lithotripsy with favorable outcomes.     

Effect of the duration of immunomodulatory therapy on the clinical features of recurrent episodes in Vogt–Koyanagi–Harada disease

Purpose: To evaluate the duration of immunomodulatory therapy (corticosteroids, immunosuppressive drugs) with regard to the rate of relapses and clinical features (exudative retinal detachment or anterior uveitis) in inflammatory episodes of Vogt–Koyanagi–Harada disease. Methods: Data of all 42 patients diagnosed with acute uveitis associated with VKH disease during the period of January 2005 to December 2008 at the Pitié‐Salpêtrière Hospital or at the Lariboisière Hospital in Paris, France were extracted by chart review. Results: There were 31 patients (73.8%) with episodes of recurrence and were included in the study. At the first recurrence, 81% (13 patients) of exudative retinal detachments (ERD) were associated with an initial immunomodulatory treatment conducted ≤6 months (3.76 months ± 2.67). Conversely, an initial treatment duration of >6 months was associated with anterior uveitis signs for 66% of patients (eight patients) with anterior first recurrence (p = 0.0061). On second episode of recurrence, 75% of patients (three patients) who developed exudative retinal detachment had been managed by immunomodulatory therapy for ≤6 months with the total duration of immunomodulatory treatment ≤6 months during previous inflammatory episodes. Conversely, all 16 patients who presented anterior uveitis with additional manifestations (optic disc oedema, macular oedema, vitritis and/or ‘Sunset glow’ fundus) have been treated for more than 6 months or treated during the initial occurrence lasting more than 9 months (p = 0.0035). Conclusions: The duration of systemic corticosteroids (and/or immunosuppressive drug therapy) for ≤6 months at first and second recurrence was associated with features of further exudative retinal detachment instead of anterior uveitis in VKH disease.     

Three-year randomized controlled trial of dipyridamole and low-dose warfarin in patients with IgA nephropathy and renal impairment

Summary: Activation of platelets and the coagulation pathway are factors which may contribute to the progression of renal disease in IgA nephropathy (IgAN). Of 21 patients with IgAN and serum creatinines between 1.6 and 3.0 mg/dL, 10 were assigned to treatment with dipyridamole and low-dose warfarin (keeping the thrombotest between 30 and 50%) and 11 to no treatment in a prospective randomized 3-year study. At entry into the trial, patients in the treatment group were younger (35 ± 6 years vs 42 ± 9 years) and had worse histological scores for tubular atrophy (1.7 ± 0.7 vs 1.1 ± 0.5) and arteriolar hyperplasia (1.4 ± 0.7 vs 0.7 ± 0.8) than those in the non-treatment group. There were no differences in serum creatinine values, creatinine clearances, urinary protein excretions, serum albumins or urinary erythrocyte counts. At the end of the trial, patients on treatment did not experience a significant increase in serum creatinine values (1.9 ± 0.3 mg/dL to 2.5 ± 1.2) or reduction in creatinine clearances (52 ± 20mL/min to 52 ± 27). Untreated patients, however, experienced a significant rise in serum creatinine values (2.1 ± 0.5 mg/dL to 3.3 ± 1.1, P < 0.01) and a fall in creatinine clearances (51 ± 26 mL/min to 31 ± 22, P = 0.06). There was no significant change in the proteinuria in either group (treatment group: 1.2 ± 1.2 g/day to 1.3 ± 1.1, non-treatment group: 1.9 ± 1.4 to 1.5 ± 1.1) and there was also no change in serum albumins and urinary erythrocyte counts. Four untreated and one treated patient developed end-stage renal failure during the course of the trial. This study suggests that treatment of patients with IgAN and renal impairment with dipyridamole and low-dose warfarin retards the deterioration of renal function, as measured by the serum creatinine and creatinine clearance.