Bleb window cryopexy for the management of oversized, misplaced blebs

PURPOSE: To describe a new technique for revising oversized blebs after trabeculectomy. METHODS: A chart review of consecutive patients undergoing bleb window cryopexy was conducted. Patients with symptomatic oversized blebs were candidates for the technique, regardless of the intraocular pressure. Under topical anesthesia, the bleb was incised and a 3 mm x 3 mm conjunctival window was removed using 0.12 forceps and Vannas scissors. Light cryotherapy was applied to the sclera through the window. A soft bandage contact lens was then placed for compression, and a patch was applied. All patients were given antibiotic drops the first day after surgery. Topical corticosteroid drops were used to minimize postoperative inflammation. Outcome measures included relief of symptoms, adequate control of intraocular pressure, and restoration of filtering bleb function without further antiglaucoma medication or surgical bleb revision. RESULTS: Nine patients met the inclusion criteria. All patients had flattening of the bleb with symptomatic relief within 2 weeks. No loss of bleb function occurred. One patient developed aqueous misdirection after the procedure. CONCLUSION: Early results showed that bleb window cryopexy is safe and effective. This minimally invasive technique can be useful for selected patients with large. symptomatic, overhanging blebs.     

The source of aromatic ketoacids in tyrosinaemia and phenylketonuria

The studies reported here support the observation that elevated excretion of p-hydroxyphenylpyruvic acid could occur in the presence of deficient hepatic tyrosine aminotransferase activity. The ketoacid need not have come either from the liver or from the kidney. It appears possible that the urinary ketoacid, both in tyrosine aminotransferase deficiency and in phenylketonuria, originates not in the liver but in other tissues which possess transaminase but which lack hydroxylase activity. What emerges from these studies is the view that the consequence of a single enzyme deficiency in one tissue may be modified by the distribution of isozymes or related enzymes in that tissue as well as in other tissues.     

Dermatitis herpetiformis associated with relapsing polychondritis

A 35-year-old woman developed typical relapsing polychondritis within a year following the onset of dermatitis herpetiformis. This occurred during a reduction in the dapsone dose regimen. To our knowledge, the coexistence of these two conditions in a single patient has not yet been reported in the literature. Both the parallel course and the good response to dapsone suggest a pathogenic link between these two diseases.     

Trends in alcohol consumption in Singapore 1992 2004

AIMS: To present trends in alcohol consumption between 1992 and 2004 in Singapore. METHODS: Alcohol consumption data were derived from national health surveys conducted in 1992, 1998 and 2004. Age-adjusted prevalence of frequent (drinking 1-4 days a week), regular (drinking more than 4 days a week) and binge (having five or more drinks during a drinking session at least once in the month) drinking by gender and age group for the three surveys were compared. Multivariate analyses for binge drinking in 2004 were performed using logistic regression models. RESULTS: Prevalence of frequent, regular and binge drinking increased between 1992 and 2004. Prevalence increase in binge drinking was highest (from 5.1 to 10.0%), followed by frequent drinking (from 4.5 to 7.5%) and regular drinking (from 2.9 to 3.1%). Uptake in binge drinking increased in both genders and across all age groups but was most evident among adults aged 18-29. Frequent drinking increase was observed for both genders but was most pronounced among women aged 18-29. The level of regular drinking declined in men but increased in women, especially those aged 18-29 and 30-49. Being younger, male, separated, divorced or widowed, a current smoker, or having a monthly household income of S$6000 and above were attributes positively associated with binge drinking. CONCLUSIONS: Alcohol consumption, especially binge drinking, has increased among Singaporeans between 1992 and 2004. There is gender convergence in alcohol consumption.     

Auditory temporal grouping in newborn infants

Adults normally perceive auditory scenes in terms of sound patterns emitted by concurrently active sources. Thus pattern formation is an important process of auditory object perception. The aim of the present study was to determine whether neonates group sounds by repeating pitch patterns. Standard ("S"; p=80%) and deviant tones ("D", p=20%) differing only in pitch were delivered either in a randomized order (random condition) or in a repeating SSSSD pattern (grouped condition). Both event-related brain potentials and gamma-band activity differed between the S and D tones in the random condition but not in the grouped condition. These results suggest that in the grouped condition, the S and D tones were processed as part of the same higher order regularity by the neonate auditory system. Also, for the first time, we observed oscillatory gamma-band activity in neonates, which was sensitive to infrequent pitch changes.     

Oncologic outcomes of patients with positive surgical margin after partial nephrectomy: a 25-year single institution experience

Purpose

To evaluate oncologic outcomes and management of patients with microscopic positive surgical margin (PSM) after partial nephrectomy (PN) for renal cell carcinoma (RCC).

Methods

We reviewed our database to identify patients who underwent PN between 1990 and 2015 for RCC and had PSM on final pathology. A 1:3 matching was performed to a negative surgical margin (NSM) cohort. Kaplan–Meier method and log-rank test were used to estimate survival and differences in outcomes, respectively. Cox proportional hazards models were conducted to estimate the Hazards ratio.

Results

A total of 2297 patients underwent PN at our institution, of which 1863 (81%) had RCC. Microscopic PSM was found in 34 (1.8%) RCC patients who were matched to 100 patients with NSM. Of these 34 patients, local recurrence (n = 4), distant kidney recurrences (n = 4), and metastases (n = 5) developed during a median follow-up of 62 months. Bilateral tumors/tumors in a solitary kidney (n = 12/13, 92%), and multifocal tumors (n = 7/13, 54%) were found in patients who developed recurrence/metastasis. PSM patients were at a higher risk of shorter overall survival (p = 0.001), local recurrence-free survival (p = 0.003), distant recurrence-free survival (p = 0.032) and metastasis-free survival (p = 0.018). There was statistically significant association between PSM and bilateral tumors, prior treated RCC at presentation and higher nephrometry score in multivariable model.

Conclusions

There was a low rate of microscopic PSM in our large cohort of patients undergoing PN despite tumor complexity. Higher nephrometry score, bilateral tumors, and prior treated RCC independently predicted PSM which showed worse survival, recurrence and metastasis compared to patients with NSM.