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1.
Eye (Lond) ; 31(3): 430-436, 2017 Mar.
Article in English | MEDLINE | ID: mdl-27834965

ABSTRACT

PurposeThe purpose of the study was to evaluate the safety and efficacy of gamma-irradiated sterile cornea (GISC) for covering the tube in aqueous drainage device (ADD) surgery in a retrospective, multicenter case series.Patients and methodsParticipants included 297 patients (321 procedures) who had undergone ADD surgery for the first time using GISC patch at three clinic centers in the United States between April 2009 and July 2012. The medical records of those consecutive patients were reviewed. Preoperative, intraoperative, and postoperative parameters about GISC were collected and analyzed. The main outcome measures were patch graft failure (PGF) and postoperative complications related to GISC.ResultsThree hundred and nineteen eyes in 295 patients were included in the current analysis. Ten out of the 319 eyes experienced PGF with a mean follow-up of 15.4±9.8 (SD) months. The overall cumulative PGF proportion from Kaplan-Meier analysis was 2.6% (95% CI: 0.6-4.7%) at 18 months. We detected two cases of presumed endophthalmitis related to PGF.ConclusionsGISC appears to have a reasonable success rate for preventing tube exposure related to PGF over an 18-month period. This success rate, in combination with other features of GISC (transparency and storage at room temperature), makes it a viable choice for patch graft material during ADD.


Subject(s)
Cornea/radiation effects , Corneal Transplantation/methods , Gamma Rays , Glaucoma Drainage Implants , Sterilization/methods , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Glaucoma/surgery , Graft Survival , Humans , Infant , Kaplan-Meier Estimate , Male , Middle Aged , Retrospective Studies , Young Adult
2.
Clin Exp Dermatol ; 39(8): 894-9, 2014 Dec.
Article in English | MEDLINE | ID: mdl-25196833

ABSTRACT

BACKGROUND: Dupuytren contracture (DC) is a fibrocontractile disease of the palms, affecting approximately 4% of the population, while psoriasis is an immune-mediated disease, affecting 2% of the population. Through clinical observation in our psoriasis clinic, we found an apparent increased prevalence of DC in patients with psoriasis compared with the general population. This has not previously been statistically verified in a clinical study. AIM: To evaluate the prevalence of DC in the full range of clinical psoriasis phenotypes. METHODS: In total, 98 patients with psoriasis attending our psoriasis clinic were examined for DC, based on predetermined criteria. In addition, 84 patients with DC, obtained from a specialist hand clinic, were assessed using a validated psoriasis questionnaire. We utilized Bayes theorem and bootstrap simulation to calculate the conditional prevalence of DC, then we used the results to compare the prevalence of DC between patients with psoriasis and a nonpsoriasis population. RESULTS: The percentage of patients with DC was 19.6% in the psoriasis population and 3.6% in the nonpsoriasis population. Development of DC showed a phenotypic predilection, with 39.1% of patients with predominantly palmoplantar involvement and 38.9% of patients with intertriginous psoriasis developing DC compared with 12.7% of patients with psoriasis who did not have these two phenotypical presentations. CONCLUSIONS: Our data show a positive correlation between psoriasis and DC. Patients with the palmoplantar phenotype of psoriasis were more likely to develop DC. By understanding this relationship, dermatologists may diagnose DC early in its onset in patients with psoriasis, prompting referral to hand surgeons when appropriate.


Subject(s)
Dupuytren Contracture/epidemiology , Psoriasis/epidemiology , Adult , Aged , Bayes Theorem , Cohort Studies , Female , Humans , Male , Middle Aged , Prevalence , Sex Distribution , United States/epidemiology
3.
J Arthroplasty ; 26(3): 504.e1-3, 2011 Apr.
Article in English | MEDLINE | ID: mdl-20452182

ABSTRACT

Wires used in fracture fixation or elective procedures can migrate within the body, and some lethal complications have been reported in the literature. We report a case of knee discomfort caused by a broken cerclage wire that has migrated from the hip region to the popliteal fossa after trochanteric osteotomy used in revision hip surgery. The authors point to the potential risks of broken orthopedic hardware.


Subject(s)
Arthroplasty, Replacement, Hip/instrumentation , Bone Wires/adverse effects , Femur/diagnostic imaging , Foreign-Body Migration/diagnostic imaging , Knee Joint/diagnostic imaging , Aged , Arthralgia/etiology , Femur/surgery , Humans , Male , Osteotomy/instrumentation , Reoperation , Tomography, X-Ray Computed
4.
Pak J Biol Sci ; 11(1): 17-25, 2008 Jan 01.
Article in English | MEDLINE | ID: mdl-18819588

ABSTRACT

This research has for object to study the influence of clay addition, i.e., Maghnian bentonite, like deposit clay, in the physical properties of sandy materials from Mostaganem plateau (North-West Algeria) submitted to salinity and sodicity. The first result was to show that the clay content changes drastically the physical properties of clay-sand mixtures. Important differences were observed as a function of the sand particle size distribution. At given clay content, the saturated Hydraulic Conductivity (HCs) was lower when the sand size was small and spread. For the coarse sand the salinity was maintained, even for high clay contents, a significant hydraulic conductivity. One of the main characteristics of Maghnia clay is the presence of calcium carbonates in the natural material. In comparison to that of Mostaganem clay of other deposit, it appears less sensitive to sodicity. An important aspect is the initial state of the clay when used in addition to sands, i.e., disturbance, conditions of preparation of sand clay mixtures and presence of associated components such as carbonates. Maghnia clay appeared to be adapted to the improvement of sandy soils, not because its mineralogical characteristics, but for its natural cationic form and obviously the presence of calcite in it.


Subject(s)
Bentonite , Soil , Mediterranean Region
5.
Am Surg ; 65(11): 1061-6, 1999 Nov.
Article in English | MEDLINE | ID: mdl-10551757

ABSTRACT

The optimal breast cancer screening program for women 40 to 49 years of age remains controversial. To help assess the value of screening mammography for this age group, we studied the relationship between the method of breast cancer detection and stage, therapy, and survival. Cases of breast cancer diagnosed at Sinai Hospital (Detroit, MI) between January 1985 and December 1994 were reviewed. A total of 181 cases involving 40- to 49-year-old women were available for analysis. The distribution of stage of disease significantly differed among the three methods of detection (P<0.0001). Breast-conserving surgery was more commonly performed in cases detected by screening mammography and clinical breast examination than in cases detected by breast self-examination (P = 0.001). Variation in the stage of disease resulted in improved survival for cases detected by screening mammography and clinical breast examination when compared with those detected by breast self-examination (P = 0.019). Women diagnosed with breast cancer between the ages of 40 and 49 years had earlier stage disease, were more likely to be treated with breast-conserving therapy, and had better survival if their disease was first recognized by screening mammography. Screening mammography has an important role for women of this age.


Subject(s)
Breast Neoplasms/diagnosis , Adult , Breast Neoplasms/mortality , Breast Neoplasms/pathology , Breast Neoplasms/therapy , Breast Self-Examination , Female , Humans , Life Tables , Mammography , Middle Aged , Neoplasm Staging , Retrospective Studies , Survival Analysis
6.
Am J Obstet Gynecol ; 181(4): 912-4, 1999 Oct.
Article in English | MEDLINE | ID: mdl-10521752

ABSTRACT

OBJECTIVES: This study compared the frequency, glucose tolerance test results, and parameters of blood glucose control in twin and singleton pregnancies associated with gestational diabetes mellitus and carbohydrate intolerance. STUDY DESIGN: Twin and singleton pregnancies associated with gestational diabetes mellitus and carbohydrate intolerance were compared as follows: frequency, maternal age, weight, 1-hour screen, glucose tolerance test results, posttreatment blood glucose values, insulin requirement, and insulin dose. Statistical analysis included the chi(2) and Student t tests. RESULTS: Gestational diabetes mellitus was increased in twins (7.7% vs 4.1%; P <.05). The maternal weight at first visit was significantly less, and the 3-hour glucose tolerance test value was significantly greater than that for singletons. The other parameters were not different. CONCLUSIONS: There is a significant increase in the incidence of gestational diabetes mellitus and disturbance of the 3-hour glucose tolerance test in twin pregnancies. However, insulin requirements were not different, suggesting a mild disturbance of carbohydrate tolerance that was effectively managed by the strategies used to achieve blood glucose control in singletons.


Subject(s)
Blood Glucose/metabolism , Diabetes, Gestational/blood , Pregnancy, Multiple/blood , Twins , Body Weight , Diabetes, Gestational/drug therapy , Female , Glucose Intolerance/blood , Glucose Tolerance Test , Humans , Insulin/administration & dosage , Insulin/therapeutic use , Kinetics , Maternal Age , Pregnancy
7.
Ultrasound Obstet Gynecol ; 2(5): 325-8, 1992 Sep 01.
Article in English | MEDLINE | ID: mdl-12796930

ABSTRACT

The amniotic fluid index (AFI) is a rapid and simple technique that is commonly used to assess amniotic fluid volume. It is commonly used in conjunction with other tests of fetal well-being that extend over a variable time interval. The data on interobserver and intraobserver variability have not stated the interval between measurements, although it is likely that they have been repeated immediately. In this study an AFI was repeated after a short time interval to assess whether a significant difference exists, as this may be clinically relevant. In 91 patients, the AFI was performed at the beginning and end of an ultrasound scan for either growth and development, or for Doppler velocimetry. The interval between the two measurements was 30-45 min, and the respective results were as follows: mean 18.4 vs. 18.7; standard deviation 4.2 vs. 3.9; minimum value 10.1 vs. 11.0 and maximum value 35.0 vs. 30.0. There were no significant differences between the two measurements (p > 0.133; d.f. = 90) and the correlation coefficient was 0.874 (p < 0.0001). These results validate the reproducibility of the AFI over a 30-45 min interval, during which time most adjunctive tests are usually completed. Therefore, the timing of the AFI in relation to the other tests is not critical.

8.
Eur J Obstet Gynecol Reprod Biol ; 40(2): 97-103, 1991 Jul 01.
Article in English | MEDLINE | ID: mdl-2070957

ABSTRACT

Fetal heart rate reactivity was evaluated following acoustic stimulation testing (AST). The AST and NST (non-stress test) were compared with regards to certain adverse perinatal outcome criteria, and in a selected sample of cases, to other surveillance tests. These tests were the oxytocin challenge test (OCT) and biophysical profile (BPP). 479 tests were performed on 240 high-risk patients. The AST significantly increased fetal heart rate reactivity. With regards adverse perinatal outcome criteria, there was no significant difference between the AST and NST in relation to sensitivity, specificity or predictive values. In the 38 patients with both non-reactive NSTs and reactive ASTs, 5 (13.5%) had immediate follow-up surveillance tests (OCTs and/or BPPs) that were non-reassuring and necessitated delivery. In four of the five cases, there was evidence of potential fetal compromise. These preliminary observations suggest that the AST may have evoked reactivity in fetuses with early compromise, and raise concerns about replacing the NST with the AST as a primary screening test of fetal well-being.


Subject(s)
Fetal Monitoring/methods , Heart Rate, Fetal , Prenatal Diagnosis/methods , Acoustic Stimulation , Adult , Apgar Score , Female , Gestational Age , Humans , Infant, Newborn , Meconium , Perinatology , Pregnancy
9.
J Reprod Med ; 36(6): 419-24, 1991 Jun.
Article in English | MEDLINE | ID: mdl-1865397

ABSTRACT

Of 131 women with hormonally related migraines unresponsive to standard medication, 67 (51.1%) noted profound relief after a 12-month, phased study using danazol for migraine prevention. The first three phases consisted of two-month cycles: dietary control and acetazolamide, the addition of danazol and danazol discontinuation. Eighty-three women (63.36%) reported control of their hormonal migraines while using danazol. In phase IV, 81 women whose headaches were controlled by danazol restarted danazol for an additional six months. Sixty-seven (82.7%) reported continued success with this medication. Danazol proved highly successful in the control of women's cyclic migraine. Its effectiveness remained consistent throughout the treatment course. In the prophylactic treatment of women's hormonal migraine, 400 mg of danazol administered daily for 25 days each month can prove effective when standard medical therapy fails. Furthermore, the response to danazol supported the concept that hormonal migraine should be treated as a distinct clinical entity.


Subject(s)
Danazol/therapeutic use , Menstrual Cycle , Migraine Disorders/drug therapy , Acetazolamide/administration & dosage , Acetazolamide/therapeutic use , Adult , Combined Modality Therapy , Danazol/administration & dosage , Danazol/adverse effects , Drug Therapy, Combination , Female , Humans , Middle Aged , Migraine Disorders/diet therapy , Migraine Disorders/etiology
10.
Am J Obstet Gynecol ; 164(6 Pt 1): 1461-9; discussion 1469-71, 1991 Jun.
Article in English | MEDLINE | ID: mdl-1646568

ABSTRACT

Criticism of the Papanicolaou smear in the lay press and recent federal legislation regulating cytology laboratories indicate a need to reappraise cervical cancer screening programs. This study directly compares three potential screening tests, used alone or in combination. A total of 1012 women aged 18 to 35 years were screened by cytologic testing, cervicography, and hybridization for human papillomavirus deoxyribonucleic acid, with discrepancies being referred by the last two authors. After findings from the entire lower genital tract were combined, 116 women (11.5%) showed definite clinical abnormalities (either exophytic vulvovaginal condylomas or cervical squamous intraepithelial lesions). Another 72 (7.2%) had positive Southern blot hybridizations without accompanying viral expression, yielding a cumulative frequency for established disease or latent infection of 18.6%. When associated vulvovaginal condylomas are disregarded, final groupings with regard to cervical pathologic classification were: 23 high-grade and 71 low-grade squamous intraepithelial lesions, 164 cases of equivocal atypia (34 of which had detectable human papillomavirus deoxyribonucleic acid), and 754 cases with negative results (38 of which had detectable human papillomavirus deoxyribonucleic acid). Cervical screening tests were compared principally by plotting increasingly liberal recall criteria onto receiver operating characteristic curves (i.e., graphs of true-positive results on the Y axis versus false-positive results on the X axis). Used individually, each screening test was valid, but none was substantially better than the others. No matter how liberal the recall criteria, no single test was able to detect all of the 23 definite precursors in this sample. Applying conventional recall criteria (i.e., high- or low-grade lesion suspected), cytologic testing alone detected 12 high-grade squamous intraepithelial lesions (52.2%), at a cost of having to perform colposcopy in 8.7% of the sample. Combining all three tests and setting the end point as just a high-positive result by at least one test, 19 high-grade squamous intraepithelial lesions (83%) were detected, with a recall of 7%. Optimal test performance (96% sensitivity, 4% recall) would have been attained by recalling all patients with high-grade cytologic results or positive cervicography results, plus any patients with low-grade morphologic atypia in which hybridization detected an oncogenic human papillomavirus type. Our conclusions are as follows: (1) Cytologic detection rates are markedly improved by a second or third test; (2) increased screening costs could be offset by not recalling patients with minor lesions with no apparent potential for progression.


Subject(s)
Cervix Uteri/cytology , DNA, Viral/analysis , Papillomaviridae/genetics , Adolescent , Adult , Cervix Uteri/metabolism , Female , Humans , Mass Screening/methods , Mass Screening/standards , Prevalence , Prospective Studies , Sensitivity and Specificity , Tumor Virus Infections/epidemiology
11.
Obstet Gynecol ; 76(3 Pt 1): 439-48, 1990 Sep.
Article in English | MEDLINE | ID: mdl-2166264

ABSTRACT

Although most human papillomavirus infections can be managed satisfactorily by office methods, extensive, refractory, and dysplastic vulvar disease poses frustrating problems. This observational cohort study evaluated the efficacy of extended laser ablation (vaporization of both clinically apparent and adjacent subclinical changes) among 160 women drawn from 1000 referrals between 1982-1987. During the final 2 years, the protocol incorporated two different 5-fluorouracil (5-FU) regimens: routine once-weekly applications as prophylaxis against postoperative recurrence, and twice-weekly dosing to avoid further laser surgery among patients with early but diffuse failures. One hundred seven patients (66.9%) were controlled by a single operation. Subsequent therapy for the remaining 53 women involved 44 additional superficial photovaporizations, 38 courses of therapeutic 5-FU, four deep laser destructions with skin grafting, and six trials of systemic alpha-interferon. Eventually, 158 patients (98.7%) entered stable clinical remission. Adjuvant 5-FU improved success rates among the 76 women with two or more adverse prognostic factors (87.5 versus 55.8%; P less than .01) but had no prophylactic value in the other 84 women. In contrast, the therapeutic 5-FU regimen was generally effective, avoiding the need for further surgery in 22 (57.9%) of 38 inevitable failures, compared with only four successes (10.3%) among 39 historic controls managed with caustic agents (chi 2 = 19.5; P less than .001). Improvements in laser technology had no impact upon outcome, but more sophisticated heat containment strategies reduced postoperative pain, healing time, and morbidity. Given adequate technique and an appropriate indication, we find extended laser ablation to be an excellent primary control method. However, the availability of an effective adjuvant regimen would be a valuable complement.


Subject(s)
Fluorouracil/therapeutic use , Laser Therapy , Tumor Virus Infections/drug therapy , Tumor Virus Infections/surgery , Vulva/surgery , Vulvar Diseases/drug therapy , Vulvar Diseases/surgery , Cohort Studies , Combined Modality Therapy , Drug Administration Schedule , Female , Fluorouracil/administration & dosage , Humans , Papillomaviridae , Reoperation , Tumor Virus Infections/pathology , Vulvar Diseases/pathology
12.
Am J Obstet Gynecol ; 158(6 Pt 1): 1407-16, 1988 Jun.
Article in English | MEDLINE | ID: mdl-3381865

ABSTRACT

Genital condylomas in pregnancy pose several management problems for the obstetrician, including the mechanical problems of large condylomas and the issues relating to transmission of the human papillomavirus to the fetus during delivery. Transmission of papillomavirus occurs infrequently, but respiratory papillomatosis can result in mortality or lifelong morbidity. We evaluate our experience in treating condylomas in 32 pregnant women, using carbon dioxide laser therapy and 85% trichloroacetic acid. Condylomas in 31 (97%) of 32 women were controlled with this combination therapy. The only maternal complication was an episode of acute pyelonephritis secondary to urethral catheterization. One patient had premature rupture of the membranes 4 days after laser therapy and subsequently was delivered of a healthy neonate at 36 4/7 weeks. Prenatal photovaporization of condylomas appears to offer a method of treatment with a low complication and recurrence rate and helps avert the dilemma of whether patients with extensive genital condylomas should be delivered by cesarean section.


Subject(s)
Condylomata Acuminata/drug therapy , Condylomata Acuminata/surgery , Laser Therapy , Pregnancy Complications, Neoplastic/drug therapy , Pregnancy Complications, Neoplastic/surgery , Trichloroacetic Acid/therapeutic use , Vaginal Neoplasms/drug therapy , Vaginal Neoplasms/surgery , Vulvar Neoplasms/drug therapy , Vulvar Neoplasms/surgery , Adolescent , Adult , Combined Modality Therapy , Condylomata Acuminata/mortality , Drug Evaluation , Female , Humans , Infant Mortality , Infant, Newborn , Michigan , Postoperative Complications/epidemiology , Pregnancy , Pregnancy Complications, Neoplastic/mortality , Retrospective Studies , Vaginal Neoplasms/mortality , Vulvar Neoplasms/mortality
13.
J Reprod Med ; 33(6): 523-32, 1988 Jun.
Article in English | MEDLINE | ID: mdl-3404514

ABSTRACT

Of 105 women referred for vulvar discomfort, 77 had idiopathic vulvodynia (pain, dyspareunia, burning or pruritus not explicable by a standard diagnosis). Physical examination showed that patients with those complaints fell into one of two categories: (1) diffuse, irritative acetowhitening of both the cutaneous and mucosal surfaces (42 patients), and (2) painful vestibular erythema, with or without acetowhitening (35 patients). The physical findings appeared to be predictive of therapeutic response. Among women with only diffuse, irritative acetowhitening, low-dose topical 5 fluorouracil was about 75% effective in milder cases, while CO2 laser photovaporization controlled 77% of cases with moderate and severe symptomatology. In contrast, medical regimens succeeded in just 8% of women with painful vestibular erythema, and only 59% were cured by hymenal resection. Several of the remaining cases have responded to selective argon laser photocoagulation of the hyperemic blood vessels within symptomatic areas.


Subject(s)
Dyspareunia/etiology , Pain/etiology , Vulvar Diseases/etiology , Adolescent , Adult , Aged , Aged, 80 and over , Colposcopy , Female , Humans , Middle Aged , Vulvar Diseases/pathology
14.
Obstet Gynecol Clin North Am ; 14(2): 589-99, 1987 Jun.
Article in English | MEDLINE | ID: mdl-2829086

ABSTRACT

Genital condylomas complicating pregnancy pose several management problems for the obstetrician, including the issues of mechanical difficulties in women with large lesions and possible viral transmission to the fetus during delivery. Although respiratory papillomatosis is infrequent, this complication can be catastrophic and produce significant long-term morbidity in affected children. Hence, we believe that condylomas in pregnancy should not be ignored. In view of the precision, high success rate, and low risk of complications, CO2 laser surgery appears to offer the best option in patients with extensive condylomas and those whose disease proves resistant to simpler therapies.


Subject(s)
Condylomata Acuminata/therapy , Genital Neoplasms, Female/therapy , Pregnancy Complications, Neoplastic/therapy , Condylomata Acuminata/congenital , Delivery, Obstetric/methods , Female , Fetal Diseases , Follow-Up Studies , Humans , Laser Therapy , Obstetric Labor Complications/etiology , Papillomaviridae , Pregnancy
15.
Am J Obstet Gynecol ; 156(1): 212-22, 1987 Jan.
Article in English | MEDLINE | ID: mdl-3026185

ABSTRACT

Multiple colposcopic biopsy specimens were collected from 160 women, with sampling of principal cervical and vulvar lesions as well as secondary areas of either minor acetowhitening or normal epithelium. Papillomaviral deoxyribonucleic acid was detected by Southern blot hybridization in 197 (90%) of the 218 principal biopsy specimens and 93 (46%) of 198 secondary biopsy specimens. Although different papillomaviruses were found at different sites in 31 women, only six of 416 specimens contained multiple types within the same sample. Specific viral types were associated with specific disease patterns. Only one of 80 type 6 or 11 infections had a diagnosis greater than cervical intraepithelial neoplasia, grade 2. In contrast, 42 of 48 (90%) biopsy specimens of cervical intraepithelial neoplasia, grade 3, or invasive cancer contained type 16, 18, or 31. Nonetheless, 12 of 124 (10%) cases of condyloma and cervical intraepithelial neoplasia, grade 1, were associated with types 16, 18, and 31 infections. Of 58 women with multicentric disease, 46 had positive hybridizations for both cervical and vulvar lesions (32 showing the same type in both samples and 14 showing different viruses). Differing patterns of papillomavirus-induced disease arise partly from the predilection of specific viral types for certain anatomic sites and partly through variations in host response. Detection of viral deoxyribonucleic acid in 46% of the secondary biopsy specimens suggests that disease expression may represent focal breakdown of host surveillance within a field of latent papillomaviral infection.


Subject(s)
Condylomata Acuminata/pathology , DNA, Viral/analysis , Sexually Transmitted Diseases/pathology , Tumor Virus Infections/pathology , Uterine Cervical Neoplasms/pathology , Vulvar Neoplasms/pathology , Biopsy , Cervix Uteri/pathology , Female , Humans , Papillomaviridae/isolation & purification , Uterine Cervical Neoplasms/etiology , Vulva/pathology , Vulvar Neoplasms/etiology
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