ABSTRACT
PURPOSE: To report the clinical course of a patient with acute retinal necrosis resulting from a multidrug-resistant strain of herpes simplex virus 2. METHODS: Observational case report. RESULTS: A 17-year-old man with no identifiable immune deficiency presented with pain and decreased vision in his left eye. He had dense anterior and posterior segment inflammation with retinal whitening suggestive of acute retinal necrosis, which progressed despite treatment with intravenous acyclovir, methylprednisolone, and ganciclovir. A transition to intravitreal and intravenous foscarnet led to clinical improvement. Genetic analysis revealed the etiology to be a multidrug-resistant strain of herpes simplex virus 2. CONCLUSION: Antiviral resistance is an uncommon finding among viruses causing acute retinal necrosis in immunocompetent patients. Patients with these infections may be adequately treated with prompt recognition and a change in therapy to alternative antiviral agents such as foscarnet.
Subject(s)
Antiviral Agents/therapeutic use , Drug Resistance, Viral , Eye Infections, Viral/drug therapy , Foscarnet/therapeutic use , Herpes Simplex/drug therapy , Herpesvirus 2, Human/drug effects , Retinal Necrosis Syndrome, Acute/virology , Adolescent , Herpesvirus 2, Human/isolation & purification , Humans , Male , Treatment OutcomeABSTRACT
BACKGROUND: Complications after cholecystectomy in children are poorly characterized. The aim of this study was to assess risk factors for major surgical complications for children undergoing cholecystectomy. STUDY DESIGN: All children 4 to 18 years old with gallbladder disease who underwent cholecystectomy from 1999 to 2006 were identified from the California Patient Discharge Database. Patient, hospital, and surgical factors were analyzed using multivariate logistic regression analysis to identify factors predictive of bile duct injury (BDI) and postoperative ERCP. RESULTS: A cohort of 6,931 children treated at 360 hospitals was evaluated. Most children underwent cholecystectomy at a non-children's hospital (84%). Intraoperative cholangiogram (IOC) was performed in 2,053 (30%) children. Of 5,101 children tracked through the year after cholecystectomy, 153 (3%) required readmission for surgical complications. Bile duct injury occurred in 25 (0.36%) children, and postoperative ERCP was performed in 711 (10%) children. Older age (odds ratio = 0.80; 99% CI, 0.67-0.95) was associated with decreased risk of BDI. Increased hospital tendency for routine IOC use was associated with increased likelihood of BDI (odds ratio = 12.92; 99% CI, 1.31-127.15). Receiving surgical care at a children's hospital was associated with a decreased likelihood of postoperative ERCP (odds ratio = 0.39; 99% CI, 0.23-0.66). As anticipated, choledocholithiasis, cholecystitis, IOC, and laparoscopic cholecystectomy were associated with increased risk of postoperative ERCP (p < 0.01). CONCLUSIONS: Serious complications and readmissions from pediatric cholecystectomy are uncommon. Surgeons performing cholecystectomy in young children must have an elevated concern about BDI. Routine IOC or surgical volume might not be helpful in lowering BDI rates.
Subject(s)
Bile Ducts/injuries , Cholecystectomy/adverse effects , Choledocholithiasis/etiology , Cholestasis/etiology , Gallbladder Diseases/surgery , Postoperative Complications/etiology , Adolescent , Child , Child, Preschool , Cholangiography/statistics & numerical data , Cholangiopancreatography, Endoscopic Retrograde/statistics & numerical data , Cholecystectomy/methods , Cholecystectomy, Laparoscopic/adverse effects , Cholecystectomy, Laparoscopic/statistics & numerical data , Choledocholithiasis/diagnostic imaging , Choledocholithiasis/epidemiology , Choledocholithiasis/therapy , Cholestasis/diagnostic imaging , Cholestasis/epidemiology , Cholestasis/therapy , Female , Follow-Up Studies , Gallbladder Diseases/diagnostic imaging , Humans , Incidence , Intraoperative Care/methods , Intraoperative Care/statistics & numerical data , Logistic Models , Male , Multivariate Analysis , Patient Readmission/statistics & numerical data , Postoperative Complications/diagnostic imaging , Postoperative Complications/epidemiology , Postoperative Complications/therapy , Retrospective Studies , Risk FactorsABSTRACT
PURPOSE: To report the occurrence of chronic hypotony as a complication following Boston type 1 keratoprosthesis (KPro) implantation and to determine associated risk factors. DESIGN: Retrospective case series. METHODS: The medical records of all patients undergoing KPro implantation between January 2004 and November 2010 at the Wilmer Eye Institute were reviewed. Patients who developed chronic hypotony following Boston type 1 KPro implantation not attributable to anatomic problems (eg, retinal detachment, overfiltering glaucoma tube shunts, tissue necrosis with aqueous leak) or other causes were identified. Demographics and preoperative, intraoperative, and postoperative clinical findings were analyzed. Light microscopic examination of an enucleated globe as well as fibrous retroprosthetic membranes excised at the time of vitrectomy from another patient was performed. RESULTS: Sixty-eight eyes received KPro implantation over the study period. Six eyes experienced chronic hypotony, with a median time of 18.5 months between KPro implantation and the onset of hypotony. The incidence of chronic hypotony in this series was calculated to be 3.7% at 1 year (95% CI = 0.9%-14.0%) and 13.3% at 2 years (95% CI = 5.5%-30.0%). Of the 6 eyes that developed chronic hypotony, 5 had a previous history of glaucoma or ocular hypertension, but only 3 had a glaucoma drainage implant. All eyes progressing to chronic hypotony were noted to have a retroprosthetic membrane prior to the onset of hypotony. Cox regression modeling demonstrated an increased risk of chronic hypotony in eyes with retroprosthetic membranes (P < .01) but no increase in risk for older patients (P > .1), eyes with glaucoma drainage implants (P > .5), or a previous history of multiple donor corneal transplants (P > .5). CONCLUSION: Chronic hypotony can be a significant complication of KPro implantation and should be assessed carefully in eyes with retroprosthetic membranes. Further study of an association between hypotony and retroprosthetic membrane formation may be useful to gain insight into the mechanism of this complication and potential prevention or treatment options.
Subject(s)
Cornea , Ocular Hypotension/etiology , Postoperative Complications , Prosthesis Implantation/adverse effects , Adult , Aged , Anterior Eye Segment/diagnostic imaging , Artificial Organs , Chronic Disease , Corneal Diseases/surgery , Female , Glaucoma Drainage Implants , Humans , Incidence , Intraocular Pressure , Male , Membranes/pathology , Middle Aged , Ocular Hypotension/diagnosis , Retrospective Studies , Risk Factors , UltrasonographySubject(s)
Asperger Syndrome/diagnosis , Crisis Intervention , Suicide, Attempted/psychology , Adjustment Disorders/diagnosis , Adjustment Disorders/psychology , Adult , Asperger Syndrome/psychology , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Diagnosis, Differential , Emotions , Humans , Interpersonal Relations , Male , Personality Disorders/diagnosis , Personality Disorders/psychology , Stereotyped Behavior , Violence/psychologyABSTRACT
Competing hypotheses exist concerning the influence of ranging patterns on parasitism. More intensive use of a home range could result in greater exposure to infectious agents that accumulate in the soil. Alternatively, when more intensive ranging is associated with territorial defence, this could decrease home range overlap and produce lower levels of parasitism. We tested these hypotheses using phylogenetic comparative methods and parasite richness data for 119 primate species. Helminth richness increased with the defensibility index, a quantitative measure of home range use that correlates with the degree of territoriality in primates. This association was independent of other host traits that influence parasite richness in primates. Results involving non-vector transmitted helminths produced the most significant results, suggesting that the relationship between territorial behaviour and parasitism is driven by accumulation of parasites in defended home ranges. In addition, costs associated with greater ranging could increase susceptibility to infectious agents.
