The efficacy of intravitreal antivascular endothelial growth factor as primary treatment of retinopathy of prematurity: Experience from a tertiary hospital.

BACKGROUND: Retinopathy of prematurity (ROP) is a vasoproliferative disease affecting premature babies and a major cause of blindness in childhood. Appropriate screening and treatment can prevent blindness. OBJECTIVE: To report on the efficacy of using antivascular endothelial growth factor (bevacizumab) as first-line therapy in ROP. METHODS: This was a retrospective analysis of patients with ROP treated at St John Eye Hospital, Johannesburg, South Africa, over a 3-year period. Outcome measures were the clinical response to intravitreal bevacizumab (IVB) as well as the economic impact of IVB therapy. RESULTS: Twenty-three patients were treated for active ROP or type 1 disease, in 44 eyes. Two patients required treatment in one eye only. The mean birth weight of these patients was 1 074 g (range 810 - 1 480). Response to treatment outcome was available for 22 patients (43 eyes). The mean follow-up period was 9 months (range 1 - 18). Forty-one eyes (95.3%) showed complete regression or non-progression of the disease. Two eyes (one eye each in two patients) progressed to advanced disease. There were no short-term adverse events. A cost-effective model showed that IVB treatment was much more economical than laser therapy. CONCLUSION: IVB is a safe and effective first-line treatment for ROP and should be considered in resource-limited centres.

The efficacy of intravitreal antivascular endothelial growth factor as primary treatment of retinopathy of prematurity: Experience from a tertiary hospital

Background. Retinopathy of prematurity (ROP) is a vasoproliferative disease affecting premature babies and a major cause of blindness in childhood. Appropriate screening and treatment can prevent blindness.Objective. To report on the efficacy of using antivascular endothelial growth factor (bevacizumab) as first-line therapy in ROP.Methods. This was a retrospective analysis of patients with ROP treated at St John Eye Hospital, Johannesburg, South Africa, over a 3-year period. Outcome measures were the clinical response to intravitreal bevacizumab (IVB) as well as the economic impact of IVB therapy.Results. Twenty-three patients were treated for active ROP or type 1 disease, in 44 eyes. Two patients required treatment in one eye only. The mean birth weight of these patients was 1 074 g (range 810 - 1 480). Response to treatment outcome was available for 22 patients (43 eyes). The mean follow-up period was 9 months (range 1 - 18). Forty-one eyes (95.3%) showed complete regression or non-progression of the disease. Two eyes (one eye each in two patients) progressed to advanced disease. There were no short-term adverse events. A cost-effective model showed that IVB treatment was much more economical than laser therapy.Conclusion. IVB is a safe and effective first-line treatment for ROP and should be considered in resource-limited centres

Bone donor site. Iliac crest or distal radius?

In a series of 18 patients requiring bone-grafting procedures to the wrist, bone structure and bone turnover characteristics were compared between samples of bone harvested from the iliac crest and the distal radius. Histologically and biologically the iliac crest bone was found to be superior to distal radial bone. Axial bone was also shown to be more resistant to the ravages of increasing age and chronic disease. However, in spite of these laboratory findings, clinically, radial bone is equally successful as graft material. This, in all probability, is due to the greater porosity of radial bone which allows better compaction, more accurate filling of defects and easier nourishment of the graft by surrounding body fluids.

Bone structure and turnover in the distal radius and iliac crest: a histomorphometric study.

In bone grafting procedures of the wrist, the distal radius would be a more convenient graft donor site than the conventionally used iliac crest. We compared tetracycline-labeled bone biopsies from these two sites in 18 white patients (12 males, 6 females, aged 26-66 years) undergoing bone grafting procedures of the wrist. Fourteen had had previous trauma, 1 osteonecrosis of the lunate, 2 mild rheumatoid arthritis, and 1 a brachial plexus palsy. The specimens were processed undecalcified and examined by routine histomorphometry for bone structure, static and dynamic bone turnover variables, and marrow cellularity. We found that bone from the distal radius had thinner cortices (p = 0.0001), lower bone volume (p = 0.01), thinner trabeculae (p = 0.029), greater trabecular separation (p = 0.015), and lower wall thickness (p = 0.0001), marrow cellularity (p = 0.0001), osteoid volume (p = 0.01), osteoid surface (p = 0.02), osteoid thickness (p = 0.0002), osteoblast surface (p = 0.001), eroded surface (p = 0.01), osteoclast surface (p = 0.012), mineral apposition rate (p = 0.0002), double-labeled surface (p = 0.0005), single-labeled surface (p = 0.006), bone formation rate (p = 0.0005), adjusted apposition rate (p = 0.0001), longer mineralization lag time (p = 0.012), and greater activation frequency (p = 0.003). Prolonged mineralization lag time in the radius was associated with thin osteoid seams and low adjusted apposition rates and was therefore attributable to a low level of osteoblast activity rather than to osteomalacia. We conclude that bone from the distal radius was structurally inferior to and had lower turnover than the iliac crest bone. We suggest that where a graft has to provide immediate structural integrity, the iliac crest is the preferred donor site. However, where bone graft is to be compacted into a small cavitary defect, distal radial bone may be an adequate alternative. A clinical study is needed to confirm this assumption.

Healthy masculinity starts in boyhood.

Addressing the crisis in men's health is more subtle than lecturing on lifestyle, diet or safety. Men's risk-taking behaviour is driven by deep unhappiness with life. Many of the mental health problems of men may be due to the estrangement between fathers and sons since the industrial revolution and the lack of self-worth this has created. Practical steps such as men's group are being fostered by GPs and others around Australia.

An analysis of proximal phalangeal fractures.

To attain accurate reduction in the proximal phalanx as opposed to the other phalanges, we have found open reduction and internal fixation to be necessary in a large proportion of cases in our series. The cause of injury in the majority of cases was blunt assault, possibly a unique spectrum in this type of trial and a probable influence on treatment choice. There were 50 fractured proximal phalanges in 40 patients analyzed according to their modes of treatment, immobilization, and functional results. Treatment for proximal phalangeal fractures have been structured according to these results.

Early postoperative mobilization of flexor tendon injuries using a modification of the Kleinert technique.

The results of 99 flexor tendon repairs in all zones of injury in 36 patients are reported. Both superficialis and profundus tendons were repaired in all cases. Postoperatively patients were managed by an immediate active extension program using a modification of the Kleinert technique and physiotherapy. Results of the study are based on the Buck-Gramcko system of evaluation of flexor tendon repair. In the 70 digits that underwent operations, the results were excellent in 31% of the cases, good in 30%, fair in 20%, and poor in 19% of the cases. There were two tendon ruptures. This study corroborates evidence that early mobilization and hand therapy appear to play an important part in the postoperative management of flexor tendon injuries.

The extensor sling procedure for an unstable carpometacarpal joint.

An unstable carpometacarpal joint of the thumb may present with pain and interfere significantly with normal function. Weakness of the intermetacarpal ligament may result in partial or complete dislocation. A procedure that reinforces this ligament more accurately than those previously published is described. A sling is made by routing part of the extensor carpi radialis longus tendon through the interspace between the second and third metacarpals and around the base of the first metacarpal. The ligament returns to its point of entry where it is sutured to itself. The entire ligament is situated deep to the adductor pollicis longus and restores stability without interfering with the first metacarpal excursion. All 10 patients who had this procedure had full metacarpal excursion and could oppose to the base of the small finger.

Relationship between finger and wrist deformities in rheumatoid arthritis.

The present study was undertaken to test the hypothesis that there is a significant correlation between the position of the wrist and metacarpophalangeal angulation in the common rheumatoid hand deformities. Measurements were carried out on radiographs of the hand from 2 comparative groups: 67 patients (134 hands) with classical or definite rheumatoid arthritis (RA), and a control series of 50 adults (100 hands) attending the routine fracture clinic. Rheumatoid patients were unselected and included those with a variety of hand deformities. The results showed a statistically significant relationship between finger and wrist deformities in patients with RA but not in the normal controls.

The effect of the Futuro wrist brace in pain conditions of the wrist.

In a study to assess the effects of the Futuro wrist brace (Adcock-Ingram) in 22 patients with osteoarthritis, rheumatoid arthritis, tenosynovitis and gout of the wrist, grip and pinch dynamometers were used to measure improvement in function. The study confirmed the efficacy of the wrist brace by demonstrating an average of 23.7% improvement in grip strength over the 10-day study, as well as a significant average improvement in pinch strength of 14.8% (P less than 0.05). In the subgroup of 8 rheumatoid arthritis patients a significant average increase in grip strength of 48.9% (P less than 0.025) was obtained. Both day and night pain was reduced and there was improvement in patients' ability to carry out their daily activities. The brace was found to be comfortable and easy to use.

The neuro vascular flap in finger tip injuries.

The Kutler technique to restore skin cover in finger tip injuries was modified by mobilising the lateral triangular flap completely on its neuro-vascular bundle. Resultant increased mobility permitted greater advancement of the flap to allow adequate cover of the denuded finger tip. A unilateral flap is often sufficient.

Extensor indicis proprius transfer to supplement replacement arthroplasty of the rheumatoid hand.

A new procedure is described to cope with the rotation deformity so often seen after replacement arthroplasty of the destroyed metacarpophalangeal joints in rheumatoid arthritis. The same procedure, in combination with a similar transfer to the ring and little fingers, but using extensor digiti minimi as the motor, can be used as a suspension procedure to stabilise the early unstable metacarpophalangeal joint. Thirty hands have been treated with the longest follow-up of two-and-a-half years; so far the results have been encouraging.

A microautoradiographic study of Ca(45) and S (35) distribution in the intact bean root.

Microautoradiographic techniques were used to determine the distribution of Ca(45) and S(35) in regions of the bean root where anatomical features may influence the processes of ion uptake and translocation. Root tissue from intact plants was prepared by methods that preserve both soluble and insoluble Ca and S. Ca(45) distribution was determined after 1 hour and 15 min, of uptake, after 2 efflux periods, and after replacement by non-tracer Ca.S(35) distribution was determined after 1 hour and 15 min of uptake.The quantity of Ca(45) that entered the root was greater than the quantity of S(35). Ca(45) concentration within the root increased with linear distance from the 8-mm level behind the tip. The pathways of Ca and S across the cortex appeared to be different since Ca(45) was particularly associated with cell walls and S(35) was distributed more evenly through the cells. There was no evidence that the endodermis was a diffusion barrier for Ca; the small parenchyma cells associated with conducting elements acquired a high concentration of Ca(45) and thus appear to be implicated in absorption and perhaps in transfer to the xylem. The evidence suggests that the endodermis may have been a barrier for S, but if so, certain parenchyma cells inside the stele, especially at xylem poles, were equally involved. The region from 30 to 80 mm from the tip appeared to participate in Ca uptake and transfer to the xylem; because of tissue immaturity the 8-mm region, which contained the least Ca(45), was thought not to translocate to the shoot. Deposition of Ca(45) in oxalate crystals represented almost complete immobilization. Calcium oxalate metabolism was most active in the 30-mm region of secondary roots and in their small branches. S(35)-labelled nuclei occurred in the cortex 2.5 to 3 mm behind the root tip.