Relevance of CT for the detection of septic foci: diagnostic performance in a retrospective cohort of medical intensive care patients.

AIM: To analyse the diagnostic yield of computed tomography (CT) in septic patients from a medical intensive care unit (ICU). MATERIALS AND METHODS: A full-text search of the department's radiological information system (RIS) retrieved 227 body CT examinations undertaken to search for a septic focus in 2018 from medical ICU patients. CT reports were categorised according to the identified foci. Clinical and laboratory information was gathered. Data were analysed statistically using descriptive statistics, diagnostic test quality criteria, binomial tests and chi-square test. RESULTS: A total of 227 CT examinations from 165 septic patients detected 264 foci, which were distributed as follows: 58.3% (n=154/264) chest, 26.5% (n=70/264) abdomen, 5.3% (n=14/264) genitourinary system, and 9.8% (n=26/264) other body regions. In 15.9% (n=36/227) no focus was identified on CT. Based on CT reports, 37.5% (n=99/264) of foci were graded as certain, 18.9% (n=50/264) as likely, and 15.9% (n=42/264) as possible infectious sources. Septic foci were detected using CT with 75.8% sensitivity (95% confidence interval [CI] 69.6-81.9%) and 59.46% specificity (95% CI 42.9-76.1%). The positive predictive value was 90.6% (95% CI 86-95.2%), with a negative predictive value of 32.4% (95% CI 21-43.8%). CONCLUSION: The present results confirm that body CT is a suitable rule-in test for septic patients in medical intensive care, although it cannot reliably rule out a septic focus. Follow-up CT examinations may reveal a septic source in the further course of a patient's hospital stay.

Thirty-six month follow-up of a contemporary phakic intraocular lens for the surgical correction of myopia.

Twenty-three eyes underwent implantation of a glass anterior chamber phakic myopic intraocular lens by one of the surgeon co-authors. The follow-up was 18 to 36 months. All refractions were unchanged and stable within six weeks after surgery. Best-corrected visual acuity was achieved in all cases; in 56% of operated eyes, a one-to-three line visual improvement was noted over the preoperative status. No operative complications were encountered; no postoperative complications were noted in either the immediate or delayed phase. No intraocular lenses were removed. There was a 5.3% loss in endothelial cell count which was unchanged throughout the study. The contemporary phakic myopic intraocular lens offers a seminal approach to the surgical treatment of myopia.

Innovations and creativity in contemporary ophthalmology: preliminary experience with the phakic myopic intraocular lens.

For years, American ophthalmology has considered alternative modes of treatment for myopia. Clearly, certain degrees of high myopia are unsuitable for spectacle correction. Contact lenses are an improvement over spectacles but are not without complications. The introduction of radial keratotomy by Fyodorov led to a proliferation of procedures for the treatment of myopia by surgically altering the cornea. Verzella later introduced the concept of clear lensectomy with low-power implants for the correction of myopia. Although phakic myopic intraocular lenses were tried and abandoned in the 1950s, it is my contention that this modality should be reconsidered. I discuss some preliminary experiences with the phakic myopic intraocular lens.

Copeland radial pan-chamber lens for anterior and posterior chamber implantation.

In order for a lens to achieve ecumenical use, it must be adapted for intracapsular, extracapsular, as well as secondary and exchange implantation techniques. In anterior chamber placement it must overcome the objections to early anterior chamber lenses, namely, pain, tenderness to touch, "UGH" syndrome, malrotation, "oil-canning" effect, and iris chafing. Ease of insertion and one uniform sizing which avoids lens inventories are now available. Reversing the lens into the posterior chamber after extracapsular extraction must also allow for each of insertion and avoidance of sunset syndrome and pupil trap. The Copeland radial pan-chamber lens has been used extensively by the author who reports on 103 eyes after posterior chamber placement and 43 eyes in which anterior chamber placement has been undertaken following uneventful extracapsular (phacoemulsification) lens extraction.

The reopening of closed filtering blebs using the neodymium: YAG laser.

Four eyes underwent cicatricial closure of the filtering bleb within the 6 weeks postoperatively. They failed to respond to digital massage and conventional therapy, resulting in loss of bleb and elevated intraocular pressure. The average pre-YAG laser treatment intraocular pressure was 34.5 mmHg. Three hundred to five hundred applications from the mode-locked Neodymium:YAG laser ( Meditec ) delivered at 3.5 mJ were directed through a goniocontact prism to the surgical area. Prompt vaporization of scar tissue and sclera resulted in a dramatic reversal of the pathology. Forty-eight hours after treatment and with a cessation of carbonic anhydrase inhibitors, an average 20 mm Hg drop in intraocular pressure was achieved. The bleb reformed in each case and maintained its patency for a minimum follow-up of 6 months.

Combined procedure: sub-scleral trabeculectomy with cataract extraction.

A sub-scleral trabeculectomy and cataract extraction were performed in 34 eyes of 28 patients. Postoperative visual acuity was 6/6 to 6/12 in 24 eyes. Nine of the remaining 10 eyes had pre-existing glaucomatous neuropathy or chorioretinal maculopathy. Duration of follow-up extended from a minimum of 12 months to a maximum of 68 months. Thirty eyes exhibited satisfactory glaucoma control (88.2%). Twenty-one eyes (61.7%) required no medication postoperatively. There were no significant postoperative complications from the combined procedure.

Histopathologic examination of a globe containing an intraocular implant.

A patient had both cataracts removed and a Copeland pseudophakos was implanted in one eye. Both globes were retained at autopsy for histopathologic study. The globe containing the implant did not show evidence of acute or chronic inflammation of the anterior segment, nor did it display signs suggesting secondary glaucoma. Some erosion of the iris pigment epithelium was present. In general, the globe appeared to tolerate the implant.

Recent advances in cataract surgery.

Cataract surgery has undergone profound changes in the past ten to twenty years. Not only are these changes evident in the technique and methods of extraction, but it has become critical for the well-versed ophthalmic surgeon to be concerned with the optical correction of aphakia. New instruments, highly refined microscopes, and better diagnostic techniques have all contributed to significant improvement in the result of the procedure. Sophisticated surgical instruments are now available for highly trained surgeons. Intraocular lens implantation (pseudophakia) has introduced one of the greatest controversies in ophthalmic surgery. The advantages and disadvantages of this process are set forth.

Five years' follow-up in the surgical management of cataracts in high myopia treated with the Kelman phacoemulsification technique.

With the advent of phacoemulsification, much interest has again been rekindled in extracapsular cataract surgery and its effects on the vitreoretinopathies associated in high myopia. Since 1972, 278 patients with high myopia greater than --7.50 D, as as determined by axial length echography, have been operated on by the author. The five-year follow-up with statistical analysis of these cases is presented. Comments as to the merits of extracapsular versus intracapsular surgery in high myopia will be set forth.

Extracapsular cataract extraction with simultaneous implantation of 300 Copeland iris plane lenses: five-year follow-up--a retrospective study.

Three hundred cases of extracapsular cataract extraction with Copeland iris plane lens implantation were reviewed. Two hundred sixty-six patients were followed objectively from 180-1,420 days with a mean follow-up of 1,026 days. 12.4% necessitated secondary operations, most of these being posterior capsulotomies. 89.5% of patients with a mean age of 73.6 years achieved visual acuity of 6/6-6/12. Using an extracapsular cataract extraction with a Copeland iris plane lens, the results obtained were considerably improved over that of intracapsular surgery. A similar retrospective study of a larger series using extracapsular cataract extraction with the Binkhorst iridocapsular lens is currently being carried out.

Updated concepts in extracapsular pseudophakia: posterior chamber pseudophakia.

Some concepts regarding posterior chamber pseudophakia have been set forth. Clearly, this is still investigational, and it is for that reason that I would urge the readers to exercise great judgement and wait for the results of laboratory testing of this rhetorical hypothesis. Currently, I am proceeding most patiently with posterior chamber pseudophakia in Rhesus monkeys using the Harris-McGhan lens, the Praeger suture style modification, and the Shearing posterior chamber lens. The ultimate answers will probably be answered over a due course of time in the human subject, but suffice it to say that the scientific approach to this problem must first be meticulously studied by the ocular histopathologist after surgery has been accomplished in primates. If, after an adequate trial with primates, the ocular histopathologist establishes this to be a safe and effective technique, then a conservative study should be undertaken wherein a number of humans will have this procedure done using different types of lenses by surgeons familiar with the lens and technique.

Praeger micro irrigating hook for intraocular lens implantation.

A new micro blunt irrigating hook is introduced for utilization in intraocular lens implant surgery. It is simple, inexpensive, and requires no previous experience. It allows for adequate reposition of the superior loop of any type of lens along with the recovery of the proximal loop of a McCannel suture. Finally, it allows the most inexperienced operator to center a lens ideally in a totally deep chamber, avoiding the vicissitudes of either perforation of the posterior capsule, anterior hyloid, or damage to the delicate endothelium.

Praeger irrigating micro intraocular scissors.

The Praeger Irrigating Micro Mini Irrigating Scissors is a valuable instrument particularly in phacoemulsification with or without intraoucular lens implantation and when used with microscopy. Secondary procedures such as a posterior capsulotomy may be safely carried out on very dense posterior capsules either beneath a pseudophakosis or following extracapsular cataract extraction. Inferior sphincterotomies through the superior incision and resection of anterior capsule through a 3.0-mm incision during the course of phacoemulsification can be easily accomplished without fear of perforation to the posterior capsule or damage to the overlying corneal endothelium. Additional intraocular manipulations such as direct observation and resection of a McCannel suture in the lower 6 o'clock meridian can be accomplished under direct visualization without excessive traction on the suture.

One man's experience with the Choyce Mark VIII anterior chamber lens.

Twenty implantations of the Choyce Mark VIII lens were accomplished over a one-year period, with an implant moratorium then being placed on this lens by this particular surgeon. I have set forth a tenable explanation for the disheartening results I achieved.

Corneal thickness measurements following intraocular lens implantation.

Corneal thickness measurements were carried out on patients who had undergone combined phacoemulsification cataract extraction with simultaneous intraocular lens implantation in one eye at least six months prior to the date of measurement. The unoperated eye served as control. Another group of patients who had undergone simultaneous phacoemulsification cataract extraction combined with intraocular lens implantation were followed over a two-month period of time, serial corneal thickness measurements being performed. The results indicate that, in surgery performed by experienced surgeons on carefully selected patients, phacoemulsification cataract extraction using the Kelman technique combined with intraocular lens implantation had no significant effect on corneal endothelial function as reflected in corneal thickness changes.