ABSTRACT
BACKGROUND: SD-OCT is an important tool in the diagnosis of macular oedema (ME) due to retinal vein occlusion (RVO). Its high resolution makes it possible to distinguish various morphological characteristics and differences. The aim of this study is to evaluate the correlation between morphological patterns and the development of visual acuity (VA) after intravitreal treatment of ME due to RVO. METHODS: 81 patients on intravitreal treatment (dexamethasone: n = 53/ranibizumab: n = 28) due to ME associated with branch and central retinal vein occlusion ( BRVO: n = 38/CRVO: n = 43) were retrospectively reviewed. Preoperative SD-OCT images were analysed by vitreous adhesion, epiretinal membranes, foveal contour, height of intraretinal cystoid spaces, inner and outer segment integrity and presence of subretinal fluid. The influence of these patterns on VA improvement was analysed. RESULTS: In almost every morphological pattern, the data were highly variable. Therapy was effective, with a medium gain in VA of 9.51 letters ETDRS (dexamethasone: 9.62 letters/ranibizumab: 9.29 letters). The improvement in VA in patients with small intraretinal cystoid spaces (thickness ≤ 250 µm) was 19.44 letters ETDRS, compared to 7.23 letters ETDRS in patients with confluent cystoid spaces (p = 0.009). Patients with a convex fovea exhibited more pronounced reduction in central retinal thickness (CRT) (p = 0.004). CONCLUSION: Analysis of OCT has concentrated on demonstrating oedema and CRT. Our data indicate that detailed OCT morphology and the size of intraretinal cystoid spaces offer important information about VA prognosis after intravitreal therapy in ME due to RVO.
Subject(s)
Dexamethasone/administration & dosage , Macular Edema/pathology , Macular Edema/therapy , Ranibizumab/administration & dosage , Retinal Vein Occlusion/pathology , Retinal Vein Occlusion/therapy , Angiogenesis Inhibitors/administration & dosage , Drug Monitoring/methods , Female , Humans , Intravitreal Injections , Macular Edema/etiology , Male , Prognosis , Reproducibility of Results , Retinal Vein Occlusion/complications , Retrospective Studies , Sensitivity and Specificity , Tomography, Optical Coherence , Treatment Outcome , Visual Acuity/drug effectsABSTRACT
Gastric rupture is a poorly described complication following cardiopulmonary resuscitation. An incidence of 0.1% has been reported in the literature. Published reports describe traumatic gastric rupture after use of the CardioPump, after mouth-to-mouth ventilation, and in children after resuscitation performed by paramedics. We report on two patients who developed gastric rupture after successful standard cardiopulmonary resuscitation. Preexisting gastric ulcerations or osseous trauma during resuscitation had been excluded. Neither patient developed abdominal symptoms; in both cases the gastric rupture was diagnosed by routine chest X-ray and both patients underwent-after stabilization-surgical treatment. One patient recovered well, but the other developed cardiogenic shock due to malignant arrhythmias and severely impaired left ventricular function. This patient died on the 6th postinterventional day. Gastric rupture rarely occurs after cardiopulmonary resuscitation. The causes of gastric rupture and the means to avoid this complication will be discussed.
Subject(s)
Cardiopulmonary Resuscitation/adverse effects , Gastrointestinal Hemorrhage/diagnosis , Stomach Rupture/etiology , Aged , Diagnosis, Differential , Disease-Free Survival , Fatal Outcome , Female , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/surgery , Heart Arrest/therapy , Humans , Male , Stomach Rupture/diagnosis , Stomach Rupture/surgeryABSTRACT
17 of 525 patients (3.2%) showed an laryngoscopically established palsy of the recurrent laryngeal nerve after surgery for struma. The analysis of these operations, performed by five surgeons during or within three years after the period of surgical training, revealed that the operations performed under assistance of the senior surgeons were high grade selected (p = 0.026). Thus 14.8% of the operations performed because of simple goiter but only 4.8% of the operations performed because of thyroid cancer/recurrent goiter/extensive nodular goiter were assisted in this way. On the other hand it was necessary to call for help of a senior surgeon because of intraoperative difficulties in only 1.26% of the cases operated on for simple goiter, but in 19.6% of the more complex forms of goiter (p less than 0.001). The risk of recurrent laryngeal nerve palsy was nearly 10 times higher in the complex forms of goiter than in the simple forms (p less than 0.001). More extensive surgical training in the forms of complex goiters should be able to improve the results.
Subject(s)
Education, Medical, Graduate , General Surgery/education , Goiter/surgery , Laryngeal Nerve Injuries , Postoperative Complications/etiology , Recurrent Laryngeal Nerve Injuries , Thyroid Neoplasms/surgery , Thyroidectomy/education , Vocal Cord Paralysis/etiology , Clinical Competence , Follow-Up Studies , Humans , Risk FactorsABSTRACT
Of 525 patients 17 (3.2%) showed a laryngoscopically established palsy of the recurrent laryngeal nerve after surgery due to goiter. A laryngoscopic follow-up of all these patients, performed at least one year after the operation, revealed that 76.5% of the recurrent nerve palsies were temporary and 23.5% were permanent. Danger of permanent palsy increased in the sequence--uncomplicated nodular goiter--struma maligna--recurrent goiter. The outcome of long-term follow-up showed a palsy rate of 0.8%, which was much lower than the corresponding rate reported by short-term control (p = 0.005). Therefore laryngoscopic long-term follow-up in cases of postoperative abnormal laryngoscopic function should be a standard part of follow-up in thyroid gland surgery.
