RESUMO
BACKGROUND: This retrospective review focuses on peripartum anesthetic management and outcome of a series of five pregnant women with left ventricular noncompaction (LVNC). METHODS: The Mayo Clinic Advanced Cohort Explorer medical database was utilized to identify women diagnosed with LVNC who had been admitted for delivery at the Mayo Clinic in Rochester, Minnesota, between January 2001 and September 2021. Echocardiograms were independently reviewed by two board-certified echocardiographers, and those determined by both to meet the Jenni criteria and/or having compatible findings on magnetic resonance imaging (MRI) were included. Electronic medical records were reviewed for information pertaining to cardiac function, labor, delivery, and postpartum management. RESULTS: We identified 44 patients whose medical record included the term "noncompaction" or "hypertrabeculation" and who had delivered at our institution during the study period. Upon detailed review of the medical records, 36 did not meet criteria for LVNC, and three additional patients did not receive the diagnosis until after delivery, leaving five patients with confirmed LVNC who had undergone six deliveries during the study interval. All five patients had a history of arrhythmias or had developed arrhythmias during pregnancy. One patient underwent emergency cesarean delivery due to sustained ventricular tachycardia requiring three intra-operative cardioversions. CONCLUSIONS: This case series adds new evidence to that already available about pregnancies among women with LVNC. Favorable obstetrical outcomes were achievable when multidisciplinary teams were prepared to manage the maternal and fetal consequences of intrapartum cardiac arrhythmias and hemodynamic instability.
Assuntos
Anestésicos , Cardiopatias Congênitas , Miocárdio Ventricular não Compactado Isolado , Humanos , Feminino , Gravidez , Miocárdio Ventricular não Compactado Isolado/diagnóstico , Período Periparto , Ventrículos do Coração , EcocardiografiaRESUMO
BACKGROUND: There are only few reports about the safety of photodynamic therapy (PDT) with verteporfin in secondary neovascularisations and only scarce reports about the PDT in children, only one of them in preschool-age children. We add the case of a 5 and a half-year-old child with choroidal neovascularisation due to choroidal coloboma. We treated this condition with PDT. PATIENT: A 5 and a half-year-old-child with choroidal coloboma in both eyes showed a switch of fixation from the right to the left eye and divergent strabismus switched to convergent strabismus, in addition a decrease in visual acuity from 0.4 to 0.04 was recorded. This was caused by a clinically visible subfoveal choroidal neovascularisation from the upper edge of the coloboma. Because no standard therapy is available for this special condition, we decided to treat the child with PDT. RESULTS: PDT with verteporfin was performed without problems after motivation and support of the child by the parents (2.46 mL verteporfin, 4500 microm spot size, 83 seconds treatment time) and led to a complete scaring of the CNV after 14 days. At follow-up 3 and 6 months after therapy we documented only a moderate staining but no fluorescein leakage from the CNV and no macular oedema. Visual acuity increased after occlusion therapy within 24 months to 0.2 and fixation of the treated right eye was restored and resulted in intermittent fixation. Mean while the German "Bundessozialgericht" has decided on the reimbursement rules for this off-label use in very seldom diseases. No recurrence of the CNV was observed within the follow-up time of 5 and a half years. CONCLUSION: This case proves that PDT is possible and safe in cooperative children including those in preschool age. PDT not only induced scaring of a CNV secondary to choroidal coloboma but also a return of the lost visual acuity.
Assuntos
Corioide/anormalidades , Neovascularização de Coroide/tratamento farmacológico , Coloboma/complicações , Fotoquimioterapia , Criança , Pré-Escolar , Neovascularização de Coroide/etiologia , Feminino , Angiofluoresceinografia , Seguimentos , Humanos , Oftalmoscopia , Porfirinas/uso terapêutico , Retina/anormalidades , Verteporfina , Acuidade Visual/efeitos dos fármacosRESUMO
BACKGROUND AND OBJECTIVE: Since May 1998, small incision instruments for the implantation of intrastromal corneal ring segments (ICRS) are available enabling incisions only 1.2 mm in width instead of 1.8 mm to be made. After a follow-up period of 22 months in the conventional group and 8 months in the small incision group, the results of both groups were compared. PATIENTS AND METHODS: Since April 1997, 73 intrastromal corneal ring segments have been implanted, the first 43 ICRS implantations in 29 patients were performed using the conventional technique, the next 30 ICRS implantations in 22 patients were performed with the small incision technique. The average preoperative myopia was -3.5 D. RESULTS: After 6 months, 66.7% of the patients of both groups achieved the refraction target +/- 0.5 D. Even on the first postoperative day, the final refraction is achieved and shows stability for 1 year without regression. After 6 months, 80% of the conventionally operated patients and 77.8% of the patients operated on with the small incision technique showed an uncorrected visual acuity of 1.0 or better. With the small incision technique the preparation of the corneal dissection channel in 2/3 corneal stromal depth is significantly easier and can be carried out more safely. Perforations towards the inner or outer surface of the cornea can be practically excluded. Due to the smaller superficial wound in contrast to the conventional technique, a corneal suture is not necessary. Stromal depth of implantation was more than 50% and in both groups no decentration of 1.0 mm or more occurred. CONCLUSIONS: The small incision technique increases the intraoperative safety in the dissection of the stromal lamellae in the correct level. Both techniques are comparable with regards to visual acuity and refraction. The smaller corneal wound does not need a corneal suture. Because of these advantages we have completely switched our technique to the small incisions.
Assuntos
Córnea/cirurgia , Microcirurgia/instrumentação , Miopia/cirurgia , Próteses e Implantes , Adulto , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Refração Ocular , Instrumentos Cirúrgicos , Resultado do TratamentoRESUMO
We describe the use of echocardiographic imaging to assist in the placement of an aortic cannula that provides differential perfusion of the arch and descending aorta during cardiac surgery in adults.
Assuntos
Aorta Torácica , Ponte Cardiopulmonar , Cateterismo , Ecocardiografia Transesofagiana , Humanos , Masculino , Pessoa de Meia-Idade , PerfusãoRESUMO
BACKGROUND: In therapy-resistant fibrin reactions within the anterior chamber, especially following combined cataract and glaucoma surgery, injection of TPA is indicated. We report our results. PATIENTS AND METHODS: From August 1994 to August 1998 we applied TPA 185 times into anterior chambers. A total of 123 injections were for therapeutic reasons (if local therapy with eyedrops showed no fibrinolytic effect), 32 for prophylactic reasons at the end of operations with intensive manipulation of the iris and following postoperative fibrin risk, and 30 applications for nonfunctional filtering blebs following glaucoma surgery. We applied 10 microg/0.1 ml. RESULTS: On the first day after therapeutic application of TPA, the fibrin was completely dissolved in 61 % of the eyes, and in 36.6 % of the eyes partial fibrinolysis occurred (total 97.6 %). Only 2.4 % of the eyes showed no fibrinolysis. Seventy-five percent of the eyes showed no fibrin reaction within the anterior chamber after prophylactic application of TPA. In all eyes (100 %) we would have expected fibrin reactions. Application of TPA for a filtering blebs disorder after glaucoma surgery resulted in restoration of the filtering bleb function in two-thirds of the eyes. COMPLICATIONS: After 185 applications of TPA into the anterior chamber we saw ten occurrences anterior chamber bleeding (5.4 %). In six eyes (3.2 %) we saw transcient clouding of the corneal endothelium and/or corneal stroma. These complications were reversible, except for irreversible endothelial decompensation in one eye with Fuchs' corneal dystrophy. CONCLUSION: TPA is effective for treating fibrin formation within the anterior chamber and maintaining the function of the filtering bleb. To confirm and quantify the efficiency of prophylactic use, a controlled prospective study is recommended.
Assuntos
Câmara Anterior/efeitos dos fármacos , Extração de Catarata , Cirurgia Filtrante , Cuidados Pós-Operatórios , Ativador de Plasminogênio Tecidual/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Fibrina/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/efeitos adversos , Ativador de Plasminogênio Tecidual/efeitos adversos , Resultado do TratamentoRESUMO
PROBLEM: The Implantation of intracorneal ring segments (ICRS) offers the possibility of reversible, refractive surgery for correction of lower myopia up to -5.0 D. We report our first results 1 year after implantation of ICR segments. PATIENTS AND METHODS: From April 1997 to August 1998 we implanted ICRS in 48 eyes of 31 patients (12 male, 19 female) to correct myopia. The preoperative refraction (spherical equivalent) was between -1.0 and -5.0 D (astigmatism < 1.0 D). The average age was 34.0 years (range 19-48 years). ICRS implantation was performed in peribulbar anaesthesia. All operations were done by the same surgeon. RESULTS: The average follow-up was 10 months (ranges 1-12 months). After 6 months the deviation from the target refraction of all eyes was < 1.5 D; 26 of 27 eyes (96.3%) showed a deviation of < or = 1.0 D. Six months after surgery, 18 of 27 eyes (66.6%) showed an uncorrected visual acuity of 20/20 or better, 23 of 26 eyes (88.4%) showed 20/25 or better, and 25 of 26 eyes (96.2) 20/40 and better. Only 1 of 16 eyes showed an uncorrected visual acuity of 20/50. In all eyes, the best-corrected visual acuity was 20/20 or better. In 2 eyes an ICRS exchange and implantation of a thicker ring was necessary because the target refraction could not be achieved with the first implanted ring. In 2 eyes an ICRS reposition was done to optimize the location of the ring within the cornea. In 4 eyes we explanted the ring due to double vision (1 x) and distorted vision (3 x) caused by induced astigmatism. After explantation the preoperative refraction (+/- 0.15 D) was reached within 1 to 1.5 months. There was no regression after 6 months (n = 27) or after 1 year (n = 7). CONCLUSION: Our 1-year results of ICRS implantation show that myopia correction with the advantage of reversibility and lower complication rate is possible by this refractive surgical method. Ring exchange and explantation are possible. Earlier postoperative complaints like photophobia, unstable visual acuity or discomfort usually disappear rapidly. The decision of 95.0% of the patients to have ICRS implantation also into the second eye shows the high degree of satisfaction.
Assuntos
Córnea/cirurgia , Miopia/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Próteses e Implantes , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Refração Ocular , Reoperação , Acuidade VisualRESUMO
Killer strains of the yeast Hanseniaspora uvarum contain cytoplasmic double-stranded RNAs (dsRNAs) of 4.7-kbp L and 1.0-kbp M species, which were shown to be separately packaged into icosahedral virus-like particles exhibiting RNA-dependent RNA polymerase activity. The L genome of the H. uvarum L-dsRNA virion HuV-L was shown to encode a 77-kDa major capsid protein. Peptide maps of the purified HuV coat protein and the 81-kDa major capsid protein from K1 killer viruses of Saccharomyces cerevisiae revealed distinctly different peptide patterns, suggesting significant sequence divergence at the level of the capsid-coding L-dsRNAs. In vitro transcripts from purified HuV-L particles showed no cross-hybridization to denatured L(A), L(B), or L(C), indicating that L from H. uvarum represents a unique L-dsRNA species. Weak, but clearly detectable cross-hybridization of the 1.0-kb dsRNA of HuV-M, encoding the secreted 18-kDa anti-Candida toxin, to the toxin-coding M genomes of S. cerevisiae K1, K2, and K28 killers indicated partial sequence homology among all of the M-dsRNAs tested.