Deep sclerectomy-trabeculectomy with mitomycin C in treating glaucoma: postoperative long-term results

AIM: To determine the long-term postoperative outcomes of deep sclerectomy-trabeculectomy (DST) with mitomycin C (MMC) in the treatment of glaucoma. METHODS: Patients who underwent DST with MMC between 2010 and 2017 were included in this retrospective observational study. Complete success was defined as postoperative intraocular pressure (IOP) ≤21 mm Hg or 30% reduction of IOP from baseline without any topical IOP-lowering agent, and qualified success defined as IOP≤21 mm Hg or 30% reduction of IOP from baseline with/without single topical agent. We evaluated the surgical success rates and complication rates of this procedure, as well as described the IOP profiles, best corrected visual acuity (BCVA) profiles and mean deviations (MD) of Humphrey visual field (HVF) 24-2 performance at each follow-up time point. Mixed linear regression models were constructed to determine estimated predictive values of demographic data, use of topical IOP-lowering agents, baseline and postoperative IOP and optical profiles (e.g., BCVA and MD). RESULTS: Totally 98 eyes (mean postoperative follow-up 67.5mo) showed mean IOP reduction at every follow-up interval. Both median BCVA and MD of visual fields were maintained throughout the follow-up intervals when comparing to baseline. The number of IOP-lowering medications decreased from 2.8±0.8 to 0.3±0.7 (P=0.068). Totally 84 (85.7%) eyes achieved complete success at final follow-up. Transient hyphaema and transient choroidal effusion developed in 15 eyes (15.3%) and 11 eyes (11.2%) respectively. Other complications included shallow anterior chamber in 5 eyes (5.1%), bleb leak in 4 eyes (4.1%), bleb revision in 7 eyes (7.1%), bleb needling in 9 eyes (9.2%) and repeat trabeculectomy in 1 eye (1.0%). There was no endophthalmitis, blebitis or macular oedema. There was no significant correlation between postoperative IOP control and postoperative BCVA. CONCLUSION: DST with MMC demonstrates effective and sustained long-term outcomes in the treatment of glaucoma with no major complication.     

Substance Use and Other Psychiatric Disorders in Impaired Practitioners

This paper describes the nature and comorbidity of substance use and other psychiatric disorders in 157 impaired practitioners notified to the Medical Practitioners Board of Victoria from 1983 to 1997. Diagnoses were reduced to three diagnostic categories, viz, substance use disorder (n = 62), other psychiatric disorder (n = 62), and combined substance use and other psychiatric disorder (n = 33). Sixty nine percent of those with other psychiatric disorders suffered either bipolar disorder (n = 27), schizophrenia (n = 22), or depression (n = 17). Psychiatric comorbidity in drug-related diagnoses was 26% and in alcohol-related diagnoses 64%. Sixty five percent of substance use disorders were notified more than 12 months after onset of impairment, and 49% of all practitioners (71% with substance use disorder) did not receive treatment prior to notification. This combined with a high relapse rate (41%) makes some impaired practitioners a risk to their patients.     

Long Saphenous Vein Stripping and Quality of Life – a Randomised Trial

OBJECTIVES: To assess the quality of life of patients undergoing sapheno-femoral junction (SFJ) ligation and long saphenous vein stripping (LSV), using two different techniques. DESIGN: Prospective, randomised trial. MATERIALS AND METHODS: Eighty patients were recruited and randomised to either Perforate Invagination (PIN) stripping (43) or Conventional stripping (37). Patients completed the Short Form 36 (SF-36) and EuroQol (EQ) questionnaires preoperatively, and postoperatively at 6 weeks and 6 months. RESULTS: Bodily pain, role function and physical summary were significantly improved at 6 months in the PIN stripping group. In the Conventional group, bodily pain and physical function were similarly improved, but not role function. EQ global quality of life was significantly and progressively improved at 6 weeks and 6 months in the PIN group (global score p<0.003; self-rated score p <0.001). In the Conventional group there was no overall improvement in global score or self-rated health. CONCLUSIONS: Primary varicose vein surgery is associated with significant and progressive improvements in quality of life scores. Whilst overall quality of health does improve in the Conventional group, this appears to be to a lesser extent than in the PIN group.     

Endovascular stent-grafts for superficial femoral artery disease: results of 1-year follow-up

PURPOSE: To document a preliminary study to assess the deployment and outcomes of endoluminal stent grafting in the superficial femoral artery (SFA) with use of a prototype device. MATERIALS AND METHODS: Twenty patients with lifestyle-limiting intermittent claudication were selected for treatment with a balloon-mounted expansive polytetrafluoroethylene graft. All patients had angiographically proven SFA disease (median length, 17 cm) with normal arterial inflow and at least two calf vessels patent to the ankle. Follow-up was by means of ankle brachial pressure index (ABPI), duplex ultrasound, and angiography. RESULTS: Fourteen patients were successfully treated. Six patients were excluded: five by the study protocol and one because the procedure was a technical failure. ABPI rose from 0.6 before treatment to 1.0. The treated limbs became asymptomatic. Twelve-month primary, primary assisted, and secondary patency rates of treated patients were 29%, 50%, and 64%. CONCLUSION: Endovascular stent grafting of SFA lesions is technically feasible, but the patency rates obtained with this design are inferior to those obtained with conventional surgical bypass.     

Elevated soluble thrombomodulin in the febrile stage related to patients at risk for dengue shock syndrome

BACKGROUND: Children with dengue hemorrhagic fever (DHF) are at risk to develop dengue shock syndrome (DSS) for which neither marker has been demonstrated. OBJECTIVE: The study was designed to investigate the markers of vascular endothelial cell injuries and dysfunction that might be used as early predictors of the subsequent manifestation of DSS. METHODS: The blood samples from 111 patients with dengue fever, DHF and other febrile illness (OFI) were collected daily from the day of admission until discharge and at convalescent stage. The sample from the day of defervescence was defined as day 0, 1 day before defervescence was defined as day -1 and so on. Also, 1 day after defervescence was defined as day +1 and so on. RESULTS: Increased soluble thrombomodulin (sTM) was demonstrated in dengue-infected patients via an enzyme-linked immunosorbent assay. Patients with DSS (DHF grades III and IV) had higher concentrations of sTM than those with dengue fever, DHF grade I, II and OFIs from day -3 until day +2. Increased circulating endothelial cells were detected from day 0 until day +2 in DSS patients as compared with other groups. In addition, increased soluble vascular cell adhesion molecule-1, soluble intercellular adhesion molecule-1 and soluble E-selectin were also found in dengue virus-infected patients as compared with OFIs. CONCLUSION: Blood sTM may be useful as an early predictor of DSS in dengue infected patients in the febrile stage. However, a further evaluation in a large prospective series is needed.     

Clinically significant but unsuspected restless legs syndrome in patients with sleep apnea.

In this prospective study, the prevalence of clinically significant restless legs syndrome (RLS) with symptoms at least 2 to 3 days per week was 8.3% in 60 sequentially polysomnographically studied patients with clinically significant sleep apnea (Apnea Index score > 5 or Respiratory Disturbance Index score > 10). Age-matched spouses were used as a control group and showed a comparable prevalence of RLS at 2.5% (not significant). Although RLS appears to be only slightly more common in sleep apnea patients than in controls, the importance of this study lies in the fact that clinically significant RLS occurred in 1 of every 12 patients with sleep apnea and, in every case, the RLS was unsuspected before polysomnography. We recommend that all patients undergoing polysomnography to rule out sleep apnea be screened for the symptoms of RLS. We have found the MEMO-NIH consensus conference questionnaire administered at the time of polysomnography to be useful in this regard.     

A model for compound action potentials and currents in a nerve bundle III: A comparison of the conduction velocity distributions calculated from compound action currents and potentials

In this paper, we present the experimentally measured Compound Action Current (CACs) and Compound Action Potentials (CAPs) from frog sciatic nerves and earthworm nerve cords. We used histologically prepared cross sections of these nerve bundles to determine the distribution of fiber diameters. A modified volume conduction model that includes frequency-dependent conductivities was used to compute the Single Fiber Action Signals (SFASs). The recorded CACs and CAPs are used to predict the Conduction Velocity Distributions (CVDs) from the nerve bundles. The predicted CVDs are then compared with the histological CVDs. Analysis of Compound Action Signals from the three giant axons in the earthworm nerve cord and microelectrode data for the transmembrane action potential demonstrate the validity of our mathematical model. We found that the CVDs predicted from the recorded CACs and CAPs differ from the histological CVD for a variety of reasons. The validity of the assumption of a linear relationship between axon diameter and conduction velocity of a propagating action signal was investigated using CVDs from both the CAC and CAP. Variations of the CVDs with the propagation distance of the CASs and the recording temperature were investigated.     

MEDICAL MANAGEMENT OF ASPERGILLUS FLAVUS ENDOCARDITIS

An 11-year-old boy underwent a matched unrelated bone marrow transplant for refractory acute myeloid leukemia. He developed invasive aspergillus pneumonia and endocarditis post-transplant. The fungal endocarditis was successfully eradicated with liposomal amphotericin at the dose of 10 mg/kg/day. Surgical intervention was not required and no serious side effects of liposomal amphotericin were observed at this dose.