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Application of different Scheimpflug-based lens densitometry methods in phacodynamics prediction
Get PDFPURPOSE:
To evaluate the correlations between preoperative Scheimpflug-based lens densitometry metrics and phacodynamics.
METHODS:
The Lens Opacities Classification System III (LOCS III) was used to grade nuclear opalescence (NO), along with different methods of lens densitometry evaluation (absolute scale from 0% to 100%): three-dimensional (3D), linear, and region of interest (ROI) modes. Cumulative dissipated energy (CDE) and total ultrasound (US) time were recorded and correlated with the different methods of cataract grading. Significant correlations were evaluated using Pearson or Spearman correlation coefficients according to data normality.
RESULTS:
A positive correlation was detected between the NO score and the average density and the maximum density derived from the 3D mode (r=0.624, P<0.001; r=0.619, P<0.001, respectively) and the ROI mode (r=0.600, P<0.001; r=0.642, P<0.001, respectively). Regarding the linear mode, only the average density parameter presented a significant relationship with the NO score (r=0.569, P<0.001). The 3D-derived average density and maximum density were positively correlated with CDE (rho =0.682, P<0.001; rho =0.683, P<0.001, respectively) and total US time (rho =0.631 and rho =0.668, respectively). There was a linear relationship between the average density and maximum density of the ROI mode and CDE (rho =0.686, P<0.001; rho =0.598, P<0.001, respectively) and total US time (rho =0.642 and rho =0.644, respectively). The average density was the only parameter derived from the linear mode that showed a significant correlation with CDE (rho =0.522, P<0.001) and total US time (rho =0.450, P<0.001).
CONCLUSION:
Specific Scheimpflug-derived densitometric parameters of the nucleus correlated with phacoemulsification parameters. The use of the appropriate densitometry approach can predict more efficiently the phacodynamics
CSF Tau proteins reduce misdiagnosis of sporadic Creutzfeldt-Jakob disease suspected cases with inconclusive 14-3-3 result
Get PDFCerebrospinal fluid (CSF) 14-3-3 protein supports sporadic Creutzfeldt-Jakob (sCJD) diagnosis, but often leads to weak-positive results and lacks standardization. In this study, we explored the added diagnostic value of Total Tau (t-Tau) and phosphorylated Tau (p-Tau) in sCJD diagnosis, particularly in the cases with inconclusive 14-3-3 result. 95 definite sCJD and 287 patients without prion disease (non-CJD) were included in this study. CSF samples were collected in routine clinical diagnosis and analysed for 14-3-3 detection by Western blot (WB). CSF t-Tau and p-Tau were quantified by commercial ELISA kits and PRNP and APOE genotyping assessed by PCR-RFLP. In a regression analysis of the whole cohort, 14-3-3 protein revealed an overall accuracy of 82 % (sensitivity = 96.7 %; specificity = 75.6 %) for sCJD. Regarding 14-3-3 clear positive results, we observed no added value either of t-Tau alone or p-Tau/t-Tau ratio in the model. On the other hand, considering 14-3-3 weak-positive cases, t-Tau protein increased the overall accuracy of 14-3-3 alone from 91 to 94 % and specificity from 74 to 93 % (p < 0.05), with no sensitivity improvement. However, inclusion of p-Tau/t-Tau ratio did not significantly improve the first model (p = 0.0595). Globally, t-Tau protein allowed a further discrimination of 65 % within 14-3-3 inconclusive results. Furthermore, PRNP MV genotype showed a trend to decrease 14-3-3 sensitivity (p = 0.051), but such effect was not seen on t-Tau protein. In light of these results, we suggest that t-Tau protein assay is of significant importance as a second marker in identifying 14-3-3 false-positive results among sCJD probable cases
"Assessment of effectiveness and security in high pressure postdilatation of bioresorbable vascular scaffolds during percutaneous coronary intervention. Study in a contemporary, non-selected cohort of Spanish patients"
Get PDFOBJECTIVES:
To determine security and benefits of high pressure postdilatation (HPP) of bioresorbable vascular scaffolds (BVS) in percutaneous coronary intervention (PCI) of complex lesions whatever its indication is.
BACKGROUND:
Acute scaffold disruption has been proposed as the main limitation of BVS when they are overexpanded. However, clinical implications of this disarray are not yet clear and more evidence is needed.
METHODS:
A total of 25 BVS were deployed during PCI of 14 complex lesions after mandatory predilatation. In all cases HPP was performed with NC balloon in a 1:1 relation to the artery. After that, optical coherence tomography (OCT) analyses were performed.
RESULTS:
Mean and maximal postdilatation pressure were 17±3.80 and 20 atmospheres (atm) respectively. Postdilatation balloon/scaffold diameter ratio was 1.01. A total of 39,590 struts were analyzed. Mean, minimal and maximal scaffold diameter were respectively: 3.09±0.34mm, 2.88±0.31mm and 3.31±0.40mm. Mean eccentricity index was 0.13±0.05. ISA percentage was 1.42% with a total of 564 malapposed struts. 89 struts were identified as disrupted, which represents a percentage of disrupted struts of 0.22%. At 30days, none of our patients died, suffered from stroke, stent thrombosis or needed target lesion revascularization (TLR).
CONCLUSIONS:
NC balloon HPP of BVS at more than 17atm (up to 20atm) is safe during PCI and allows to achieve better angiographic and clinical results
Laparoscopic Repair of Duodenal Atresia with Annular Pancreas
Get PDFDuodenal atresia is the most common cause of congenital bowel obstruction. Often it is associated with other congenital anomalies, such as annular pancreas. The laparoscopic approach, although technically demanding, brings about clear benefits to the newborn. The authors report the case of a newborn with prenatal diagnosis of duodenal atresia, proposed for a laparoscopy, during which an annular pancreas was identified and a laparoscopic diamond-shaped duodenal anastomosis was performed
Partial Transphyseal Technique for Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients
Get PDFWith more and more children participating in competitive sports at younger and younger ages, we have seen an increase in the incidence and diagnosis of intrasubstance ruptures of the anterior cruciate ligament. As in adults, the instability of the ligaments predisposes children to a potential risk of meniscos and chondral injuries with
consequent early degenerative alterations. The timely treatment of these injuries is crucial and the surgical technique depends directly on the patient’s physiological age. The authors present a clinical case of the complete rupture of the anterior cruciate ligament in a skeletally immature child, surgically treated by a partial transphyseal technique, with an excellent functional result
Laparoscopic Repair of Duodenal Atresia with Annular Pancreas
Get PDFA atresia duodenal é a causa mais comum de obstrução intestinal congénita. Frequentemente associa-se a outras malformações, como o pâncreas anular. A abordagem laparoscópica, ainda que tecnicamente exigente, traz para o recém-nascido benefícios evidentes. Os autores reportam o caso de um recém-nascido com diagnóstico pré-natal de atresia duodenal proposto para laparoscopia, durante a qual foi constatada a existência de pâncreas anular, e realizada a duodeno-duodenostomia em diamante
Infectious complications in head and neck surgery: Porto oncology center retrospective analysis
Get PDFRotura Uterina às 18 Semanas de Gravidez no Contexto de Útero Malformado
Get PDFBirth defects of the female genital tract are relatively common and often asymptomatic. Despite the pregnancy outcome can be favorable, adverse obstetric outcomes are described in women with uterine malformations. The authors report the case of an obstetric emergency which enhances the possibility of a very adverse and rare outcome of uterine rupture in a left hemi-cavity of a bicornuate uterus away from the term, at 18 weeks of pregnancy, in a pregnant woman with history of caesarean in the right hemi-cavity and with placenta increta. A malformed uterus with a primitive type cavity has lower distensibility of the wall with the progression of the pregnancy and facilitates the development of abnormal placentation forms, increasing the risk of uterine rupture in the first and second trimesters. The knowledge of the existence of a congenital uterine anomaly in the preconceptional period is of primary importance.info:eu-repo/semantics/publishedVersio
Diabetes and outpatient surgery ‐ protocol in the perioperative period
No full textA diabetes mellitus é uma doença crónica de elevada prevalência em todo o mundo. Dado que os procedimentos cirúrgicos em regime de ambulatório têm aumentado significativamente, surge a necessidade de elaboração de um protocolo para o controlo glicémico destes doentes neste contexto. A avaliação cuidadosa pré‐operatória é fundamental e permite antecipar alterações no controlo glicémico e evitar complicações perioperatórias. Existe evidência crescente de que a otimização do controlo glicémico no período perioperatório se associa a diminuição da morbilidade e mortalidade.
Com este artigo pretende‐se divulgar um protocolo atualizado, como proposta de atuação no controlo glicémico de pessoas com diabetes submetidas a procedimentos cirúrgicos em unidades de ambulatório.
Abstract
Diabetes mellitus is a chronic disease highly prevalent throughout the world. Since outpatient surgical procedures have significantly increased, there is a need to formulate a protocol for glycemic control of these patients in this context. Careful preoperative evaluation is crucial and allows us to anticipate changes in glycemic control and avoid perioperative complications. There is growing evidence that the optimization of glycemic control in the perioperative period is associated with decreased morbidity and mortality.
With this article we intend to publish an updated protocol as an acting proposal on glycemic control in diabetic patients undergoing surgical procedures in outpatient units.info:eu-repo/semantics/publishedVersio
