Office Examination Research Articles

CHRONIC CENTRAL SEROUS CHORIORETINOPATHY IN THE PEDIATRIC POPULATION: A CASE SERIES.

The purpose of this article was to describe 3 cases of chronic central serous chorioretinopathy (CSCR) in the pediatric patient population. Retrospective case series. The authors report three pediatric patients with CSCR. All patients initially presented after failed vision screens or during routine office examinations. All patients presented with macula-involving subretinal fluid (SRF) and multimodal imaging features consistent with CSCR. At the last follow-up, one patient had minimal residual SRF, one patient had a small recurrence of SRF, and one patient had persistent SRF. Although CSCR classically occurs in adults, it can be seen in pediatric patients. Given the rarity of this condition in the pediatric population, CSCR may go undetected and underreported, with diagnosis resulting from failed vision screens.

Experience With Extra-Tunical Grafting and Tunica Albuginea Plication for Correction of Indentation Deformity in Men With Peyronie's Disease

To further evaluate extra-tunical grafting (ETG), a relatively new surgical option to treat corporal indentation in those with Peyronie's disease without buckling or hinge effect, we report our experience, patient satisfaction, and surgical outcomes. Retrospective review of patients following ETG, including pre-operative deformity, type of graft, graft location (under or over Buck fascia), patient characteristics, and satisfaction. Overall cosmetic satisfaction with deformity correction between patients undergoing 2 different ETG locations and 3 different types of grafts, as well as perceived bother of graft visibility and palpability were assessed. From 2018-2023, 35 patients underwent ETG and tunica albuginea plication (TAP) with 89.6% of patients having persistent correction on office examination at a median (interquartile range) follow-up of 23.5 (15.2) months. Overall satisfaction with penile appearance by grafting location via patient-reported questionnaires showed no statistical difference (P=.47). Patients undergoing TAP and ETG were satisfied with their erect appearance regardless of graft material. Patients reported grafting tissue was palpable (74.3%) and visible (48.6%) in the flaccid state as compared to the erect state (8.6% and 5.7%). ETG presents a less invasive surgical option than traditional approaches to correct indentation deformities not associated with instability. Our experience shows high patient satisfaction rate following correction of indentation using graft tissue when placed under or over Buck fascia. At a median follow-up of almost 2years, patients had persistent correction, and while some report visibility of the graft and palpability in the flaccid state, this tends to disappear in the erect state.

V12-01 VISUALIZATION OF IDIOPATHIC LEAD MIGRATION RESULTING IN SNM DEVICE FAILURE

You have accessJournal of UrologyCME1 Apr 2023V12-01 VISUALIZATION OF IDIOPATHIC LEAD MIGRATION RESULTING IN SNM DEVICE FAILURE Nicholas Koch, Kayla Graham, Samuel Ivan, Heather Winn, Ryan Darvish, and Michael Kennelly Nicholas KochNicholas Koch More articles by this author , Kayla GrahamKayla Graham More articles by this author , Samuel IvanSamuel Ivan More articles by this author , Heather WinnHeather Winn More articles by this author , Ryan DarvishRyan Darvish More articles by this author , and Michael KennellyMichael Kennelly More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003347.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Twiddler’s syndrome is a well described phenomenon in cardiac literature where manipulation of pacemaker and implantable cardioverter-defibrillator (ICD) batteries results in twisting of the lead, ultimately causing knotting , fracture and/or malfunction. Twiddler’s syndrome is also identified in neuromodulation devices, though poorly studied and understood in urologic literature surrounding sacral neuromodulation (SNM). After a patient’s premature failure of a SNM device with twisted leads, we sought to identify the underlying etiology. METHODS: One patient experienced two SNM device failures within 5 months due to lead migration and extreme twisting. This video outlines our investigation into the patient's underlying etiology Twiddler’s syndrome, previously published instances of the phenomenon in cardiology and sacral neuromodulation, a discussion of risk factors, and a finding of spontaneous Twiddler’ syndrome captured via fluoroscopy and office examination on video, with realtime visualization of patients IPG flipping within it's pocket. RESULTS: After in office physical examination and fluoroscopic investigation captured live on video, she was found to have a mobile and easily manipulated battery with observed and recorded flipping of her battery associated with everyday behaviors, including dressing. CONCLUSIONS: Neuromodulator lead migration and malfunction can occur due to Twiddler’s syndrome, often associated with the intentional manipulation of the lead by patients, commonly with psychiatric diagnoses. However, our video demonstrates via physical exam and fluoroscopy an instance of unintentional manipulation likely due to device location, patient habitus and pocket size. Considering these findings, the evaluation of a patient’s body habitus for location of placement, as well as use of additional safety measures including limiting pocket size, anchoring of the device ± use of TYVK pouch, are important considerations for surgical planning that may aid in prevention of idiopathic Twiddler’s syndrome and premature device failure. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1065 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicholas Koch More articles by this author Kayla Graham More articles by this author Samuel Ivan More articles by this author Heather Winn More articles by this author Ryan Darvish More articles by this author Michael Kennelly More articles by this author Expand All Advertisement PDF downloadLoading ...

PENERAPAN EKSAMINASI TERHADAP KASUS HUKUM DI LINGKUNGAN KEJAKSAAN

As an oversight, examination is not the only supervision in the Prosecutor's Office. There are still many other controls that are carried out both internally and externally. It's just whether the supervision is effective or not. The purpose of this study is to find out how the form of examination in the prosecutor's office is and how it is applied to cases that are rampant, then the research method used is the type of normative research and the approach method is the approach to legislation, conceptual approach and supported by historical and historical approaches. case. The results of the discussion that there are two types of examinations in the prosecutor's office, namely general examinations and special examinations, the conclusion of the discussion is that there are still many cases that have not been noticed so that they need to be examined.

Approach to primary congenital glaucoma: A perspective.

Primary congenital glaucoma (PCG) occurs worldwide and has a broad range of ocular manifestations. It poses a therapeutic challenge to the ophthalmologist. A proper diagnostic evaluation under anesthesia is advisable for all children who do not cooperate for an office examination. Medical therapy only serves as a supportive role, and surgical intervention remains the principal therapeutic modality. Angle incision surgery such as goniotomy or trabeculotomy ab externo is the preferred choice of surgery in the Caucasian population. Primary combined trabeculotomy-trabeculectomy with or without antifibrotic therapy is the preferred choice in certain regions such as India and the Middle East where the disease usually presents with severe forms of corneal edema along with megalocornea. In refractory cases, trabeculectomy with antifibrotic therapy or glaucoma drainage devices are available options in the armamentarium. Cycloablative procedures should be reserved for eyes with poor visual potential. Myopia is common among children with PCG, and appropriate optical refractive correction in the form of glasses or contact lenses should be provided. Amblyopia therapy should be instituted to ensure overall visual development in the early developmental years. Low-vision rehabilitation services should be provided to children with vision impairment. Long-term follow-up is mandatory and carers of children with PCG should be counseled and educated about this need. Regardless of the visual outcomes, clinicians should emphasize the need for education of these children during the clinic visit. The overall goal of the management should be to improve the overall quality of life of the children with PCG and their carers.

Directions of the laboratory diagnostics improving of the socially significant hemocontact viral infections in the military medical organizations

In this study we have shown the relevance of the nucleic acid testing for the diagnosis of the human immunodeficiency virus infection and hemocontact viral hepatitis in the military medical organizations as well as the experience of majority of the foreign countries that actively apply modern molecular methodologies for the diagnosis of infectious diseases. The possibility of using the rapid tests, molecular biology techniques and an alternative carrier of the biological material the dry drop method, the potential of this method of biological material preparation in infectious diseases diagnostics in case of laboratory remoteness and for follow-up observation of patients with socially significant hemocontact viral infections is shown.
 New algorithm of human immunodeficiency virus infection laboratory testing using polymerase chain reaction as an expert test followed by methods of determination of recency of acquisition of human immunodeficiency virus antibodies especially in questionable laboratory result cases are proposed.
 Promising molecular genetic methods for implementation in laboratories in military medical organizations such as nester-polymerase chain reaction, loop-mediated isothermal amplification, digital polymerase chain reaction, mass spectrometry of polymerase chain reaction amplicons, Deoxyribonucleic acid sequence are observed. We have defined the main approaches to improve laboratory diagnostics of social significant hemocontact viral infections in military medical organizations: optimization of logistics of pre-analytical step with expansion of validated biomaterial samples storage and delivery methods (including dry drop); reduction in the duration of analytical phase through increase in the clinical use of polymerase chain reaction testing (including isothermic variant); improving the sensitivity and accuracy of serological and molecular diagnostics; development of validation methodology and laboratory tests results interpretation While ensuring military medical expertise. The necessity of specialists training in new diagnostics techniques and result interpretation, improving regulatory framework on examination and registration of human immunodeficiency virus positive military officers, determination of the legal status of cases with unfinished human immunodeficiency virus diagnostic process in order to ensure timely preventive and treatment care events and to objectify statistical recording of this category.

Potential Adverse Effect Steven Johnson Syndrome with Supplemental Berberine Use

Steven-Johnson Syndrome is a rare adverse skin reaction, which may progress to critical conditions. The presentation of SJS is a widespread, type-IV hypersensitivity, skin reaction typically induced by infection and numerous medications which occurs approximately 12 hours after exposure to infection or medication. Patients typically initially present with fever, headache, and general malaise. In these patients, within 4 days to 4 weeks [1] of causative medication usage, a diffuse rash develops. Severe cases of SJS can place the patient in critical condition. Complications of SJS can include bacterial infection, excessive fluid loss from denuded skin (or loss of epidermis), hypovolemic shock, or septic shock. [1] Prompt diagnosis and immediate discontinuation of medication is essential to prevent life threatening complications. Herein, we document a case of a patient presenting to the Emergency Department (ED) three days prior to follow up in our office with bilateral leg rash for which the ED prescribed hydrocortisone cream. Upon examination in office, the erythematous eruption had spread to the entire body including her palms. She had started the herbal supplement berberine a month prior to the initial presentation of the rash. Upon cessation of the berberine and completion of a Medrol dose pack, the rash resolved.

A Qualitative Examination of Swedish Police Officers’ Perceptions of Victim Culpability

ABSTRACT Feminist and critical scholarships developed the concept of victim-blaming as a critical reaction to criminological theories which address victims’ culpability. The present study aims to expand the existing conceptual framework of victim culpability by exploring how Swedish police officers perceive victims’ culpability. 27 semi-structured interviews with Swedish police officers were analyzed using inductive thematic analysis. The findings suggest that firstly, officers discuss victims’ culpability in a wide range of victimizations beyond sexual victimization and domestic violence and secondly, that officers understand victims’ role in the victimization through victims’ choices and their ability to impact their exposure to crime.

Preprocedure and Immediate Postoperative Changes to Genital Hiatus Following Minimally Invasive Sacrocolpopexy.

This study assesses resting genital hiatus (GH) measurements under anesthesia as compared with in-office measurements for intraoperative planning purposes. The aim of this study was to determine the influence of general anesthesia and apical suspension on GH measurements compared with office measurements. This was a retrospective cohort of women who underwent minimally invasive sacrocolpopexy within an academic urogynecology practice. Genital hiatus for each patient was measured at 4 time points: (1) preoperative office examination (baseline) at rest (GH rest ) and with strain (GH strain ); (2) following anesthesia induction, at rest (GH induction ); (3) immediately after sacrocolpopexy, at rest (GH colpopexy ); and (4) 4- to 6-week postoperative visit, strain (GH postop ). Enlarged baseline GH strain was defined as ≥4 cm. Paired statistics and analysis of variance were used for comparisons. Fifty-one women were included, whose mean age was 61.3 ± 8.2 years; the majority had stage ≥3 prolapse (n = 39 [76.4%]). Concomitant procedures included hysterectomy (n = 33 [64.7%]) and posterior colporrhaphy or perineorrhaphy (n = 8 [15.7%]). The majority had an enlarged baseline GH strain (n = 39 [76.4%]), and overall cohort mean was 4.7 ± 1.3 cm. Compared with baseline GH rest , mean GH induction was larger (GH induction : 4.6 ± 1.4 cm vs GH rest : 3.8 ± 1.2 cm, P < 0.01) but not different from baseline GH strain (GH induction : 4.6 ± 1.4 cm vs GH strain : 4.7 ± 1.3 cm, P = 0.81). GH colpopexy was decreased from baseline GH strain with a mean difference of 1.1 ± 1.3 cm ( P < 0.01). This difference was driven by women with enlarged baseline GH strain who experienced a mean decrease of 1.5 ± 1.1 cm ( P < 0.01). Genital hiatus after induction of anesthesia does not significantly differ from preoperative straining GH. Apical suspension with sacrocolpopexy alone resulted in immediate reduction in GH measures, with greater decreases observed in women with enlarged preoperative GH.

A Comprehensive Comparative Study among Jammu Women Police Personnel between the Subjects with Metabolic Syndrome and without Metabolic Syndrome on the Basis of Demographic, Anthropometric and Clinical Parameters

Background: Police officers are civil servants meant for peace preservation, citizen protection, and promotion of violence reduction. Pre-employment examination of police officers includes intellectual, cognitive and personality assessment, physical examination, laboratory tests and social evaluation. In this study, we will compare subjects with MetS and without MetS among female police personnel on the basis of demographic parameters, anthropometric parameters and clinical parameters related to dyslipidemia, hypertension and overweight/ obesity. Materials and methods: The present study was conducted to find the prevalence of metabolic syndrome as per lipid parameters among female police personnel of J&amp;K Police. It was carried out in Post Graduate Department of Physiology, Government Medical College Jammu from 2019 to 2020. Results: We observe that there is a significant difference between the groups with respect to age, duration of service, weight, BMI, WC, Hip circumference, WHR, SBP, BSF, TG, HDL, TC/ HDL and LDL/HDL. Conclusion: The present study on women police of Jammu demonstrated that metabolic syndrome is comprised of endocrine metabolic disturbances characterised by Type-2 Diabetes Mellitus due to insulin resistance and impaired glucose regulation, hypertension, obesity and altered lipid profile consisting of elevated levels of triglyceride (TG) and low levels of high-density lipoprotein cholesterol [HDL-C]. Keywords: Metabolic syndrome, Lipid parameters, hypertension, diabetes.

Information constraints and examination quality in patent offices: The effect of initiation lags

Using an exogenous policy change in Japan that accelerated patent examination, we examined how information constraints in a patent office affect patent examination quality in terms of both type I errors (wrong grants) and type II errors (wrong rejections). We found that accelerated examination increased both types of errors, but the increase in the number of wrong grants dominated that in the number of wrong rejections. Furthermore, the effect was stronger for technology sectors wherein the information constraints on examiners were stronger (short technology cycles and early examination requests) before the policy change. Our main results held when using the examination and appeal panel data of the Japan Patent Office (JPO) as well as for the matched sample of the JPO and European Patent Office examinations. In conclusion, a better information gathering system is important for improving the quality of patent examination by patent offices.

Endoscopic ear examination improves self-reported confidence in ear examination skills among undergraduate medical students compared with handheld otoscopy.

Objectives: Handheld otoscopy is the standard tool used to teach ear examination in undergraduate and postgraduate medical education. Previous studies have shown that the undergraduate teaching of ear examination with handheld otoscopes is inadequate, resulting in low self-reported levels of student confidence in their diagnostic skills. With the increase in popularity of endoscopic ear surgery, an increasing number of otolaryngologists are using endoscopes for office examinations of the ear due to the method’s superior visualization and excellent image qualities. However, medical students usually do not receive exposure to endoscopic ear examination during their undergraduate curriculum. The aim of this study is to assess our preliminary experience with teaching endoscopic ear examination to undergraduate medical students.Methods: A two-hour-long pilot practical course on basic ear examination was administered to undergraduate medical students with little to no previous experience with ear examination. The course was designed to minimize the duration of campus attendance and patient contact during the COVID-19 pandemic. The course included theoretical didactics, exemplary digital endoscopic images and peer physical practice of ear examination with both a handheld otoscope and a 0-degree endoscope. At the end of the course, the students completed a survey questionnaire consisting of eight questions mainly relating to their subjective confidence level with ear examination using either handheld otoscopes or endoscopes and their overall preference for either examination tool.Results: Most students expressed a preference for ear examination with endoscopes over that with handheld otoscopes and reported an improved confidence level in their diagnostic ability with the former technique. The vast majority of students supported the teaching of endoscopic ear examination to future medical students.Conclusion: The findings of this pilot project report and survey study support the early exposure of novice medical learners to endoscopic ear examination, which may help improve the confidence and diagnostic skill of medical students with regard to ear examination. The findings may have implications for the undergraduate teaching of ear examination in the post-COVID-19 era.

‘This is not what I signed up for’ – Danish prison officers’ attitudes towards more punitive penal policies

A humane approach to punishment has been integral to the work of the Danish Prisons and Probation Service. However, Danish penal policy has recently taken a punitive turn. What happens when punitive policies are adopted by a penal regime built on a humane approach to punishment? To address this question, this article focuses on prison officers at Vestre prison and how they adapt to punitive political decisions and prison policies. The increased focus on security in Danish prisons is considered, together with limitations set on welfare services available to non-citizen prisoners. Examination of officers’ subjectivities at Vestre prison shows that punitive penal policies have produced an environment fraught with tensions that affect prison work, institutional culture, and the officers’ professional identity. These findings also raise questions about the shifting nature of Danish penal power.

Practice Patterns of Pediatric Ophthalmologists During the COVID-19 Pandemic.

To report the use of protective personal equipment (PPE) during the coronavirus disease 2019 (COVID-19) pandemic. A 12-question multiple-choice survey was posted on a discussion board used by members of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS). Respondents provided information about their experience, PPE use, office equipment, and approach to care during the COVID-19 pandemic. One hundred twenty-eight pediatric ophthalmologists completed the survey. Eighty-seven (68.0%) identified as in private practice, whereas 41 (32.0%) identified as in an academic setting. Sixty-nine pediatric ophthalmologists (53.9%) reported routinely using N95 respirators, 72 (56.3%) reported wearing medical scrubs, 41 (32.0%) reported using disposable gloves, 33 (25.7%) reported wearing goggles, and 12 (9.4%) reported using face shields during office examinations. One hundred twenty-one pediatric ophthalmologists (94.5%) reported having slit lamps with plastic shields and 52 (40.6%) reported having phoropters with plastic shields. Ninety-nine (77.3%) responded that they would see a patient older than 2 years who refused to wear a mask for a nonemergency visit. Practice patterns of pediatric ophthalmologists have varied during the COVID-19 pandemic. [J Pediatr Ophthalmol Strabismus. 2022;59(3):145-150.].

Patent Screening, Innovation, and Welfare

Abstract Critics claim that patent screening is ineffective, granting low-quality patents that impose unnecessary social costs. We develop an integrated framework, involving patent office examination, fees, and endogenous validity challenges in the courts, to study patent screening both theoretically and quantitatively. In our model, some inventions require the patent incentive while others do not, and asymmetric information creates a need for screening. We show that the endogeneity of challenges implies that courts, even if perfect, cannot solve the screening problem. Simulations of the model, calibrated on U.S. data, indicate that screening is highly imperfect, with almost half of all patents issued on inventions that do not require the patent incentive. While we find that the current patent system generates positive social value, intensifying examination would yield large welfare gains. The social value of the patent system would also be larger if complemented by antitrust limits on licensing.

Recurrent Paravaginal Abscess: An Unusual Presentation of a Distal Ectopic Ureteral Remnant after Prior Nephrectomy

Study Objective Describe a patient with OHVIRA syndrome and demonstrate the surgical technique used to treat her paravaginal abscess and remnant ectopic ureter. Design Video case-presentation. Setting Academic hospital. Patients or Participants Single patient. Interventions Surgery. Measurements and Main Results We describe a patient who initially presented at the onset of menarche with cyclic abdominopelvic pain. She was diagnosed with uterine didelphys with obstructed right hemivagina. She underwent a vaginoplasty, which was followed by postoperative urinary incontinence. Further work-up indicated a dysplastic right kidney with ectopic ureter to the right vaginal sidewall, correlating with diagnosis of OHVIRA syndrome. She then represented at 21 years old with chronic vaginal drainage. She underwent an extensive evaluation including imaging as well diagnostic procedures, including: cystovaginoscopy, hysteroscopy and laparoscopy. She was tested for sexually transmitted diseases, put on multiple courses of antibiotics, and had two drains placed with recurrence of drainage. When she finally presented to our facility, there was concern for abscess secondary to remnant distal ectopic ureter into the vagina. She underwent an office examination and vaginoscopy, confirming drainage from a right vaginal ostium. She was counseled and ultimately underwent a robotic assisted laparoscopic excision of paravaginal abscess and remnant of distal right ectopic ureter. She did well postoperatively. Interval CT scan on post-operative day 15 demonstrated fluid collection, which was drained by interventional radiology. The fluid collection resolved, drain removed and she has had no further recurrence of drainage. Conclusion This is an unusual presentation of a recurrent paravaginal abscess in the setting of prior partial right ectopic ureterectomy. We describe the innovative and successful surgical technique used to identify and excise the paravaginal abscess and distal ectopic ureter. Highlighting this patient's unique anatomy and the importance of complete resection of an ectopic ureter to the vagina at the time of nephrectomy due to potential risk of ascending chronic infection and abscess formation. Describe a patient with OHVIRA syndrome and demonstrate the surgical technique used to treat her paravaginal abscess and remnant ectopic ureter. Video case-presentation. Academic hospital. Single patient. Surgery. We describe a patient who initially presented at the onset of menarche with cyclic abdominopelvic pain. She was diagnosed with uterine didelphys with obstructed right hemivagina. She underwent a vaginoplasty, which was followed by postoperative urinary incontinence. Further work-up indicated a dysplastic right kidney with ectopic ureter to the right vaginal sidewall, correlating with diagnosis of OHVIRA syndrome. She then represented at 21 years old with chronic vaginal drainage. She underwent an extensive evaluation including imaging as well diagnostic procedures, including: cystovaginoscopy, hysteroscopy and laparoscopy. She was tested for sexually transmitted diseases, put on multiple courses of antibiotics, and had two drains placed with recurrence of drainage. When she finally presented to our facility, there was concern for abscess secondary to remnant distal ectopic ureter into the vagina. She underwent an office examination and vaginoscopy, confirming drainage from a right vaginal ostium. She was counseled and ultimately underwent a robotic assisted laparoscopic excision of paravaginal abscess and remnant of distal right ectopic ureter. She did well postoperatively. Interval CT scan on post-operative day 15 demonstrated fluid collection, which was drained by interventional radiology. The fluid collection resolved, drain removed and she has had no further recurrence of drainage. This is an unusual presentation of a recurrent paravaginal abscess in the setting of prior partial right ectopic ureterectomy. We describe the innovative and successful surgical technique used to identify and excise the paravaginal abscess and distal ectopic ureter. Highlighting this patient's unique anatomy and the importance of complete resection of an ectopic ureter to the vagina at the time of nephrectomy due to potential risk of ascending chronic infection and abscess formation.

Surgical Outcomes of Visco-Circumferential-Suture-Trabeculotomy Versus Rigid Probe Trabeculotomy in Primary Congenital Glaucoma: A 3-Year Randomized Controlled Study.

The aim was to compare the long-term surgical outcomes of visco-circumferential-suture-trabeculotomy (VCST) and rigid probe viscotrabeculotomy (VT) in patients with primary congenital glaucoma (PCG). The study was conducted on 84 (47 right) eyes of 49 (32 males) children PCG to the pediatric ophthalmology unit of Mansoura Ophthalmic Center of Mansoura University, Egypt between 2015 and 2018. An initial office examination was followed by an examination under general anesthesia to establish the diagnosis of PCG. The children were then scheduled for surgery and the eyes randomly assigned to VCST or VT. Follow-up visits were scheduled at the first day, first week, first, and third months and then every 3 months for 1 year. The mean±SD age of the study children at presentation was 4.8±2.1 and 4.9±1.7 months in the VCST and the VT groups, respectively (P=0.827). The mean±SD preoperative intraocular pressure (IOP) was 29.13±3.3 and 29.89±3.2 mm Hg in the VCST and VT groups, respectively (P=0.292) and 11.9±1.3 and 13.8±1.2 mm Hg at the end of 36 moths of follow-up (P<0.001). The IOP at all follow-up time points (except at the third month, P=0.924) was statistically significantly less in the VCST group than in the VT group (at week 1, month 1, 6, 9, 12, 18, 24, 30, and 36 the P<0.001). The cumulative probability of success was 100%, 95%, 90%, and 90%, respectively in VSCT and 100%, 72.7%, 97.7%, 90.9%, and 84% in VT at 12, 24, 30, and 36 months. Both VCST and VT were effective and safe for lowering the IOP in PCG with VCST providing a marginal advantage over VT.

Aortic arch calcification: a novel parameter for prediction of masked hypertension.

Masked hypertension is directly related to increased cardiovascular morbidity and mortality but remains underdiagnosed in clinical practice. The aim of the study was to search the role of aortic arch calcification (AAC) in the diagnosis of masked hypertension. Among the patients who underwent ambulatory blood pressure monitoring (ABPM) in our clinic, those with office blood pressure (OBP) <140/90 mmHg were included in the study population. According to OBP, they were divided into two groups as normal (<130/85 mmHg) and high normal (130-139/85-89 mmHg) OBP groups. Subjects were also investigated for the presence of masked hypertension with ABPM and searched in masked hypertension and control groups. Masked hypertension was defined as in the latest 2017 ACC/AHA Hypertension guideline and was diagnosed as the daytime BP ≥ 135/85 mmHg and nighttime BP ≥ 120/70 mmHg. AAC was evaluated on direct X-ray telecardiography. Diagnosis of masked hypertension was searched depending on the presence of AAC and OBP measurements as well. A total of 216 volunteers were involved in the study [mean age 45.2 ± 12.2 years; female gender 120 (55.5%)]. One hundred ten volunteers (50.9%) had masked hypertension according to the ABPM. AAC was significantly more common in the masked hypertension group (44.5% vs. 26.4%) (P = 0.005). AAC had a positive predictive value of 79% in those with high normal OBP in the diagnosis of masked hypertension, and also AAC had a negative predictive value of 74% in those with normal OBP. AAC can be used as a reliable diagnostic tool to exclude and predict masked hypertension during office examination.

A comparison of artificial urinary sphincter outcomes after primary implantation and first revision surgery

ObjectiveThe artificial urinary sphincter (AUS) is the gold standard for severe male stress urinary incontinence, though evaluations of specific predictors for device outcomes are sparse. We sought to compare outcomes between primary and revision AUS surgery for non-infectious failures. MethodsWe identified 2045 consecutive AUS surgeries at Mayo Clinic (Rochester, MN, USA) from 1983 to 2013. Of these, 1079 were primary AUS implantations and 281 were initial revision surgeries, which comprised our study group. Device survival rates, including overall and specific rates for device infection/erosion, urethral atrophy and mechanical failure, were compared between primary AUS placements versus revision surgeries. Patient follow-up was obtained through office examination, written correspondence, or telephone correspondence. ResultsDuring the study period, 1079 (79.3%) patients had a primary AUS placement and 281 (20.7%) patients underwent a first revision surgery for mechanical failure or urethral atrophy. Patients undergoing revision surgery were found to have adverse 1- and 5-year AUS device survival on Kaplan–Meier analysis, 90% vs. 85% and 74% vs. 61%, respectively (p<0.001). Specifically, revision surgery was associated with a significantly increased cumulative incidence of explantation for device infection/urethral erosion (4.2% vs. 7.5% at 1 year; p=0.02), with similar rates of repeat surgery for mechanical failure (p=0.43) and urethral atrophy (p=0.77). ConclusionsOur findings suggest a significantly higher rate of overall device failure following revision AUS surgery, which is likely secondary to an increased rate of infection/urethral erosion events.

Diagnosis and Treatment of Anal Squamous Cell Carcinoma.

A 61-year-old woman with ongoing tobacco use was referred to a colorectal surgery clinic after a screening colonoscopy found irregular lesions at the dentate line with biopsies revealing a high-grade squamous intraepithelial lesion. She reported scant bleeding and irregular bowel function, but no incontinence. She has a history of abnormal Papanicolaou tests, but has since undergone a hysterectomy and has no history of immunosuppressive treatment or HIV. She was taken for an examination under anesthesia that revealing a 2.5-cm mass in the anal canal and was biopsied. Pathological examination confirmed anal squamous cell carcinoma (ASCC) with strongly positive p16 staining. A CT of her chest, abdomen, and pelvis did not reveal metastatic disease. She was referred to medical and radiation oncology for radiation therapy with concurrent chemotherapy (5-fluorouracil (5-FU) and mitomycin C). Subsequent office examination with anoscopy 3 months after treatment demonstrated an anterior scar without residual tumor.