Papillary Abnormalities Research Articles

Patterns and management outcomes of intracranial extra-axial hematomas in low-resource setup: a 6-month prospective observational study at Jimma University Medical Center, Ethiopia

IntroductionIntracranial hematoma is the collection of blood in various intracranial spaces. Knowledge of patterns, origins, causes and outcomes of ICH conditions is important for decision-making for urgent surgical interventions such as craniotomy and hematoma evacuations. No prior study was conducted in our setup. Hence, this study aimed to assess the patterns and management outcomes of intracranial hematomas in low-resource setting and tailored our management approach at Jimma University Medical center.MethodsAn institution-based prospective observational study was conducted at Jimma University Medical Center, Ethiopia, for six consecutive months from June to December 2020. Different data sources and interview methods were used and analyzed using SPSS version 24. A bivariate and multivariate logistic regression was conducted to determine the association between the variables.ResultsA total of 91 eligible patients were recruited during the study period, with a mean age of 34 years. The majority of patients were males [73 (80.2%)] and more common in reproductive age groups (62.6%), from rural areas (50.5%). About 93.4% of patients reported a history of trauma, and road traffic accidents & fighting account for 63.8% of the trauma cases. Sixty-five percent of patients arrive in the hospital within 24 h. Upon presentation, there were loss of consciousness (48.4%), convulsion (11%), aspiration (9.9%) and increased ICP (12%). The majority (49.5%) of the patients had a mild head injury. The focal neurologic deficits were hemiparesis (29.7%) and hemiplegia (5.5%). Acute epidural hematoma (68.1%) was a common finding, followed by sub-acute subdural hematoma. Of the total study participants, 11% had died. All the surviving patients were accessed at 30 days after discharge and re-assessed, 66 patients had good neurologic recovery (62 upper and 4 lower good recovery), 11 patients had moderate disability (7 lower and 4 upper-moderate disabilities), two patients had a severe disability, and two patients (among those with severe disability) had died.ConclusionTrauma was invariably the cause of intracranial hematoma, and patients with low GCS, papillary abnormalities, aspiration and increased ICP had an increased risk of dying from their illness. It is good to formulate policies to enhance injury prevention and bring about health-oriented behavioral change.

Endoscopic Papillary Abnormalities and Stone Recognition (EPSR) during Flexible Ureteroscopy: A Comprehensive Review.

Introduction: The increasing efficiency of the different lasers and the improved performance of endoscopic devices have led to smaller stone fragments that impact the accuracy of microscopic evaluation (morphological and infrared). Before the stone destruction, the urologist has the opportunity to analyze the stone and the papillary abnormalities endoscopically (endoscopic papillary recognition (EPR) and endoscopic stone recognition (ESR)). Our objective was to evaluate the value for those endoscopic descriptions. Methods: The MEDLINE and EMBASE databases were searched in February 2021 for studies on endoscopic papillary recognition and endoscopic stone recognition. Results: If the ESR provided information concerning the main crystallization process, EPR provided information concerning the origin of the lithogenesis and its severity. Despite many actual limitations, those complementary descriptions could support the preventive care of the stone formers in improving the diagnosis of the lithogenesis mechanism and in identifying high-risk stone formers. Conclusion: Until the development of an Artificial Intelligence recognition, the endourologist has to learn EPSR to minimize the distortion effect of the new lasers on the stone analysis and to improve care efficiency of the stone formers patients.

Fight the silent thief of sight: glaucoma incidence in citizens of Sassari

PurposeTo identify the silent thief of sight in asymptomatic citizens of Sassari and assess the importance of the screening in glaucoma.MethodsSeven ophthalmologists performed free specialist examinations and included 322 asymptomatic subjects from 40 to 80 years. All volunteers attended the screening with assessment of intraocular pressure (IOP, air‐puff tonometer TX‐f Canon) and optic disc evaluation by fundus biomicroscopy. Subjects with optic nerve cupping underwent retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness examination (i‐Vue OptoVue OCT).ResultsSubjects with a diagnosis of hypertension or treated for glaucoma were excluded. Of the total 322 volunteers included, 23.6% had glaucoma familiarity, 8.7% declared that the screening was the first ophthalmological visit and 55,28% stated that they had never been examined with tonometry before. IOP was >21 mmHg in the 7% and optic disc showed abnormal cupping in 6.8% of the volunteers. The 2.48% of the subjects had both ocular hypertension (IOP>21 mmHg) and papillary abnormalities, and 7.4% of the 27 OCT performed showed anomalies.ConclusionsGlaucoma is one of the leading causes of irreversible blindness, but early detection and treatment could prevent severe vision loss. For these reasons, glaucoma screenings are fundamental even though they could have limited diagnostic power. In fact, subjects with OCT anomalies were directed to further examinations. The results of this screening are quite impressive, most of all the 8% of patients declaring that they had never underwent an ophthalmological visit and the 55% of patient that undertake a tonometry for the first time. The discrepancy between these data stresses the importance of a regular ophthalmological examination that is still confused with the visual acuity assessment made by opticians. Only a complete ophthalmological visit can diagnose conditions affecting irreversibly the vision, such as the silent thief of sight.

PT105 - Classification of the renal papillary abnormalities by flexible ureteroscopy: Evaluation of the 2016 version and update

To assess the use of the 2016 proposed classification of the renal papillary abnormalities during flexible ureteroscopy that aims to standardize their description. We performed a prospective monocentric single operator collection of the data using this classification during 88 consecutive flexible ureteroscopies required for renal stones treatment. Outcome measurements and statistical analysis: data of stones analysis (microscopy and infrared spectrophotometry) and of serum and urines biochemical samples have been compared with the results of the classified endoscopic descriptions. Mean duration of description was 81.4 s. We reported that 83% of the patients had Randall plaques (RP), as only 4.5% of the patients had no abnormality. Concerning the papillary stones and anchored stones were observed in 30.7% and aspect of intraductal crystallization (Sc) in 15.9%. Erosions were present in 55.7% and extrophic papillae in 8%. Sa1 and Pa2 were significantly correlated to RP, anchored stones (Sa) to papillary erosions and calcium phosphate stones to intraductal crystallization. Hypercalciuria was significantly higher in Sa2 than Sa1 stones. The different descriptions in the 2016 classification were confirmed by the results of this study. Papillary abnormalities are consequences of stones development. Their descriptions could also improve the follow-up and the diagnosis of a metabolic lithogenesis. We recommend their systematic description during ureteroscopy. Some improvements are proposed to update this classification.

P0175DETERMINANTS OF RENAL PAPILLARY APPEARANCE IN RENAL STONE FORMERS: AN IN-DEPTH EXAMINATION

Abstract Background and Aims Nephrolithiasis is a medical condition characterized by high prevalence among the general population both in Europe and in the U.S. and it is responsible for high costs reaching up to $10 billion per year. It is associated with specific comorbidities such as obesity, arterial hypertension, diabetes mellitus, metabolic syndrome and chronic kidney disease. Kidney stones development is believed to start either from Randall’s plaques or from stone plugs. Both these lesions can be seen on renal papillary surfaces, but what promotes the formation of plaques and plugs is not entirely understood. The aim of this study is to investigate the association between the urinary metabolic milieu and a published endoscopic papillary evaluation score (PPLA). We also evaluated the correlation of PPLA score with kidney stone recurrence during follow-up. Method We prospectively enrolled 31 stone forming patients who undergone retrograde intrarenal surgery procedures. Visual inspection of the accessible renal papillae was performed in order to calculate the PPLA score based on the appearance of ductal plugging, surface pitting, loss of papillary contour and Randall’s plaque extension. Demographic information, blood samples, 24h urine collections and kidney stone events during follow-up were collected. Stone composition was analyzed using infrared-spectroscopy. Relative urinary supersaturations (RSS) for calcium oxalate (CaOx), calcium phosphate (CaPi) and uric acid (UA) were calculated using the Equil2 software. PPLA score > 3 was defined as high. Results Median follow-up period was 11 (min/max 5, 34) months. PPLA score was inversely correlated with BMI (rho = −0.39, p = 0.035) and history of recurrent kidney stones (median PPLA 5.0 vs 2.5, p = 0.029), these results were confirmed when PPLA was considered as a categorical variable (median BMI 27 vs 24, recurrent stone disease 12 vs 62%, p= 0.006). Furthermore, high PPLA score was associated with lower odds of new kidney stone events during follow-up (OR 0.154, 95% confidence interval 0.024, 0.998, p = 0.05). No significant correlations were found between PPLA score, stone composition, blood parameters, 24h urine solute excretions and RSS for CaOx, CaPi and UA. Conclusion Different papillary abnormalities seem to be linked to specific mechanisms of stone formation. Although data regarding PPLA score are inconsistent, it may be a valid asset for both medical and surgical management of nephrolithiasis. Larger, long-term prospective clinical studies need to be conducted to assess the validity of PPLA score system in evaluating risk of stone recurrence.

Re: Classification of the Renal Papillary Abnormalities by Flexible Ureteroscopy: Evaluation of the 2016 Version and Update.

Re: Classification of the Renal Papillary Abnormalities by Flexible Ureteroscopy: Evaluation of the 2016 Version and Update.

Classification of the renal papillary abnormalities by flexible ureteroscopy: evaluation of the 2016 version and update

IntroductionTo assess the use of the 2016 proposed classification of the renal papillary abnormalities during flexible ureteroscopy that aims to standardize their description.Patients and methodsWe performed a prospective monocentric single operator collection of the data using this classification during 88 consecutive flexible ureteroscopies required for renal stones treatment. Outcome measurements and statistical analysis: data of stones analysis (microscopy and infrared spectrophotometry) and of serum and urines biochemical samples have been compared with the results of the classified endoscopic descriptions.ResultsMean duration of description was 81.4 s. We reported that 83% of the patients had Randall plaques (RP), as only 4.5% of the patients had no abnormality. Concerning the papillary stones and anchored stones were observed in 30.7% and aspect of intraductal crystallization (Sc) in 15.9%. Erosions were present in 55.7% and extrophic papillae in 8%. Sa1 and Pa2 were significantly correlated to RP, anchored stones (Sa) to papillary erosions and calcium phosphate stones to intraductal crystallization. Hypercalciuria was significantly higher in Sa2 than Sa1 stones.ConclusionsThe different descriptions in the 2016 classification were confirmed by the results of this study. Papillary abnormalities are consequences of stones development. Their descriptions could also improve the follow-up and the diagnosis of a metabolic lithogenesis. We recommend their systematic description during ureteroscopy. Some improvements are proposed to update this classification.

Renal Papillary Mapping and Quantification of Randall's Plaque in Pediatric Calcium Oxalate Stone Formers.

Introduction: Randall's plaque (RP) with attached stones is recognized as a primary mechanism for stone formation in adult calcium oxalate stone formers (CaOx SFs). The role of RP in pediatric stone pathogenesis is unknown, with no reported studies to date. The purpose of this study is to investigate renal papillary abnormalities and quantify RP in pediatric CaOx SFs. Methods: Eight pediatric CaOx SFs underwent ureteroscopy for symptomatic urolithiasis. The collecting system was mapped using a digital ureteroscope. Video for each patient was then reviewed using a retrograde pyelogram to confirm the location of each papilla. A single investigator (N.L.M.) reviewed the video to quantify RP. Each papilla was graded as having mild, moderate, or severe amount of RP. Patient history was recorded. Results: An average of nine papillae were mapped per patient. RP was present in 100% of patients and in 88.8% (64/72) of all papillae examined. When present, RP was uniformly distributed throughout the kidney without preferential distribution to a region or pole. The amount of RP on the papillae was graded as mild in 60%, moderate in 20.8%, and severe in 8.3%. The mean fractional RP coverage ranged from 0.39% to 9.34%. No correlation was found between the amount of plaque and age at first stone episode or number of prior stone episodes (p = 0.84). Attached stones were rare (1/8 patients). The two patients with severe RP had a small amount of calcium phosphate in their stone analysis. Conclusions: RP is common in pediatric CaOx SFs. Compared with adult CaOx SFs wherein up to 75% of stones are found attached to RP, attached stones were rare. The significance of these findings in the pathogenesis of pediatric stone formation remains unclear and will require longer term follow-up.

Endoscopic observations as a tool to define underlying pathology in kidney stone formers

PurposeAdvancements in endoscopy offer the possibility of inspection of intrarenal anatomy and pathology. The aim of the study was to evaluate renal papillary appearance in kidney stone formers and to correlate papillary findings with stone type and patient metabolic data.Materials and methodsA consecutive cohort of 46 kidney stone formers undergoing retrograde intrarenal surgery was enrolled. During surgery, renal papillae were characterized in the domains of ductal Plugging (DP), surface Pitting, Loss of papillary contour, and Amount of Randall’s plaque (RP, PPLA scoring). Stone material was analyzed using micro-CT and infrared spectroscopy, and blood and urine were collected for metabolic evaluation.ResultsIn all patients, renal papillae had changes in at least one of the domains of the PPLA score. Examining the total population, it was evident that patients with predominantly plugging (DP > 0) all had very low RP scores. There were no significant trends between mean PPLA scores and urinary analytes for the total group.ConclusionEfforts to prevent renal stone formation have so far been insufficient in majority of patients. Digital endoscopy reveals that kidney stone formers have different and distinct papillary morphologies that seem to be linked to specific stone-forming pathways. Since renal papillary abnormalities may be easily identified during endoscopy, this may in the future prove to be an important method for tailoring prevention strategies in kidney stone patients.

MP19-16 RENAL PAPILLARY PLUGGING IN CALCIUM STONE FORMERS MAY ARISE VIA RANDOM AND INDEPENDENT CRYSTALLIZATION EVENTS

You have accessJournal of UrologyStone Disease: Basic Research & Pathophysiology II1 Apr 2017MP19-16 RENAL PAPILLARY PLUGGING IN CALCIUM STONE FORMERS MAY ARISE VIA RANDOM AND INDEPENDENT CRYSTALLIZATION EVENTS Melanie Adamsky, Andrew Cohen, Glenn Gerber, Elaine Worcester, and Frederic Coe Melanie AdamskyMelanie Adamsky More articles by this author , Andrew CohenAndrew Cohen More articles by this author , Glenn GerberGlenn Gerber More articles by this author , Elaine WorcesterElaine Worcester More articles by this author , and Frederic CoeFrederic Coe More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3258AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The causes of renal papillary abnormalities observed endoscopically within a single kidney are incompletely known. One testable theory is that plugging, and perhaps Randall's plaque (RP), are random and independent events of crystallization whose risk is increased by local supersaturations. If so, their occurrence in the papillae of a kidney must follow the Gaussian distribution. Using scores from a previously introduced and validated papillary grading system, we sought to test if this is true. METHODS We reduced papillary grading scores from patients who had undergone unilateral ureteroscopic stone treatment to ″present″ or ″absent″ for each variable in the grading system - pitting, plugging, loss of contour, and RP. From this we calculated the proportion of graded papillae in a given kidney involved. Probability density functions were generated and Shapiro-Wilks (SW) and Anderson-Darling AD) tests of normality were applied. RESULTS Our cohort included 42 patients (42 kidneys), all of whom had calcium stones - 28 calcium oxalate and 14 calcium phosphate - on subsequent analysis. The mean number of papilla graded per kidney was 5.97 (95% CI 5.40-6.55). The mean proportion of papillae with plugging was 51.7% (±4.3), pitting was 20.1% (±3.0), loss of contour was 22.7% (±3.6), and RP was 33.7% (±4.0). Probability density functions are shown in Figure 1. Unlike pitting, loss of contour, and RP, plugging is uniquely normally distributed (SW and AD tests p>0.01). CONCLUSIONS Unlike pitting, loss of contour, and RP, plugging is uniquely normally distributed (SW and AD tests p>0.01), supporting that plugging is a random and independent process in individual papillae and plaque, pitting, and contour changes cannot be. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e236 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Melanie Adamsky More articles by this author Andrew Cohen More articles by this author Glenn Gerber More articles by this author Elaine Worcester More articles by this author Frederic Coe More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

7 - Endoscopic description of renal papillary abnormalities in stone disease by flexible ureteroscopy: A proposed classification of severity and type

Introduction The goal of this original work was to describe papillary abnormalities using flexible ureteroscopy into a new classification and to assess their relation with stone composition.

Civilian penetrating gunshot injury to the neurocranium in Enugu

Introduction:Civilian penetrating gunshot injuries to the neurocranium are no longer uncommon in Nigeria. Such injuries are however poorly reported. They are associated with poor outcome and, at close range, are frequently fatal, especially when inflicted by high-velocity weapons. Prompt transfer to neurosurgical service and urgent intervention may improve outcome in those that are not mortally wounded.Materials and Methods:Fifty-two patients with civilian penetrating gunshot wounds seen over a 10-year period (2004–2014) at the University of Nigeria Teaching Hospital and Memfys Hospital for Neurosurgery Enugu were reviewed retrospectively, and their data were analyzed to evaluate factors that impacted on outcome. Only patients with clinical and imaging evidence of cranial gunshot injuries who reached hospital alive were included in the study. The overall mortality and Glasgow outcome score were analyzed.Results:Fifty-two patients with isolated civilian penetrating gunshot wounds were identified (M:F = 7.7:1); mean (standard deviation) age was 32.8 (11.9) years. There was a high correlation (0.983) between the sex of the patients and the outcome. The overall mortality was 30.8%, whereas the mortality for patients with postresuscitation Glasgow coma scale (GCS) score ≤8 was 57%, as against 12.9% in those in whom postresuscitation GCS was >8; meaning that 87.1% of patients in whom postresuscitation GCS was >8 survived. Thirty-one patients (59.6%) had papillary abnormalities. Majority of patients with monohemispheric lesions survived while all those with diencephalic, transventricular, and posterior fossa involvement had 100% mortality.Conclusions:Admitting GCS and bullet trajectory were predictive of outcome.

Endoscopic Evidence That Randall's Plaque is Associated with Surface Erosion of the Renal Papilla.

This study was conducted to assess the reliability and precision of an endoscopic grading scale to identify renal papillary abnormalities across a spectrum of equipment, locations, graders, and patients. Intra- and interobserver reliability of the papillary grading system was assessed using weighted kappa scoring among 4 graders reviewing a single renal papilla from 50 separate patients on 2 occasions. Grading was then applied to a cohort of patients undergoing endoscopic stone removal procedures at two centers. Patient factors were compared with papillary scores on the level of the papilla, kidney, and patient. Graders achieved substantial (kappa >0.6) intra- and inter-rater reliability in scored domains of ductal plugging, surface pitting, and loss of contour. Agreement for Randall's Plaque (RP) was moderate. Papillary scoring was then performed for 76 patients (89 kidneys, 533 papillae). A significant association was discovered between pitting and RP that held both within and across institutions. A general linear model was then created to further assess this association and it was found that RP score was a highly significant independent correlate of pitting score (F = 7.1; p < 0.001). Mean pitting scores increased smoothly and progressively with increasing RP scores. Sums of the scored domains were then calculated as a reflection of gross papillary abnormality. When analyzed in this way, a history of stone recurrence and shockwave lithotripsy were strongly predictive of higher sums. Renal papillary pathology can be reliably assessed between different providers using a newly described endoscopic grading scale. Application of this scale to stone-forming patients suggests that the degree of RP appreciated in the papilla is strongly associated with the presence of pitting. It also suggests that patients with a history of recurrent stones and lithotripsy have greater burdens of gross papillary disease.

Endoscopic description of renal papillary abnormalities in stone disease by flexible ureteroscopy: a proposed classification of severity and type.

The goal of this original work was to describe papillary abnormalities using flexible ureteroscopy into a new classification and to assess their relation with stone composition. We performed a prospective monocentric single-operator study aiming to describe various aspects of renal papillae. Data have been prospectively collected during consecutive 164 sequential flexible ureterorenoscopies required for the treatment of renal stones from May 2011 to March 2015. The collected stones have been examined by microscopy and infrared spectrometry. Serum and urine biochemical samples have been systematically analyzed. A total of 74 patients (45.1%) had renal papillary abnormalities on at least one papilla, excluding typical Randall's deposits alone. Various abnormalities were reported, some of them being present in the same patient: tip papillary erosions (51.3%), anchored papillae calculi (47.3%), subepithelial stones (18.9%), cryptic papillae (10.8%), extrophic papillae (9.46%) and intraductal deposits (2.7%). Associations between papillary abnormalities and stone types were found. Intraductal deposits were systematically associated with carbonate apatite IVa2 stones and hypocitraturia. A "first step" classification has been established to standardize the description of these papillary abnormalities for future reports and studies. This study highlights the necessity of papillary abnormalities description in further multicentric studies and ureteroscopy's reports. The established classification needs multicentric evaluation and validation. The endoscopic observation and knowledge of pathological aspects of the papillae should help to better understand pathogenesis of nephrolithiasis. Medical or surgical treatments of some abnormalities should be also discussed and evaluated to improve the prevention of stone recurrence.

Prognostic factors in patients with primary brainstem hemorrhage

ObjectivePrimary brainstem hemorrhage (PBH) frequently causes severe disturbances of consciousness, papillary abnormalities, as well as respiratory and motor disturbances. The prognosis has been reported to be highly dependent on the clinical severity at presentation and the presence of certain radiological markers. However, the number of PBH patients enrolled in previous reports tended to be small, and precise statistical analyses were also lacking. The aim of this study was to analyze the impact of clinical or radiologic parameters on the outcome of patients with PBH. MethodsWe retrospectively reviewed 212 consecutive patients with PBH and analyzed the impact of the clinical or radiological parameters on the outcome of patients with PBH. ResultsOf the 212 patients, 134 (63.2%) were male and 78 (36.8%) were female, with an age range of 17–97 years (mean, 60.3 years). The median admission GCS score was 4. The outcomes included a good recovery in 13 patients (6.1%), moderate disability in 27 (12.7%), severe disability in 27 (12.7%), a vegetative state in 23 (10.8%), and death in 122 (57.5%). A multivariate analysis demonstrated bilateral hematoma extension, a GCS score ≤8, the presence of hydrocephalus, gender, and the hematoma volume to all be significantly associated with the 3-month mortality, while the GCS score ≤8, the presence of a pupillary abnormality, and the hematoma volume were found to be associated with the 3-month poor outcome. ConclusionThe identification of these factors is therefore considered to be useful for managing patients with PBH.

"Time is brain" the Gifford factor - or: Why do some civilian gunshot wounds to the head do unexpectedly well? A case series with outcomes analysis and a management guide

Background:Review of intracranial gunshot wounds (GSWs) undergoing emergent neurosurgical intervention despite a very low Glasgow Coma Scale (GCS) score on admission in order to identify predictors of good outcome, with correlates to recent literature.Methods:A retrospective review of select cases of GSWs presenting to our trauma center over the past 5 years with poor GCS requiring emergent neurosurgical intervention and a minimum of 1-year follow-up.Results:Out of a total of 17 patients who went to the operating room (OR) for GSW to the head during this period, 4 cases with a GCS < 5 on admission were identified. All cases required a hemicraniectomy to alleviate cerebral swelling. Two cases presented with a unilaterally blown pupil due to raised intracranial pressure. The remaining 2 cases had equal and reactive pupils. One patient with a GCS of 3 and a significant bilateral pattern of parenchymal bullet injury was initially assessed in moribund status but rallied and received a delayed hemicraniectomy on day 7. Three out of 4 patients are functionally independent at 1-year follow-up. The fourth patient who received a delayed decompression remains wheelchair dependent.Conclusion:Victims of GSWs can have good outcomes despite having a very poor admission GCS score and papillary abnormalities. Factors predicting good outcomes include the following: time from injury to surgical intervention of < 1 h; injury to noneloquent brain; and absence of injury to midbrain, brainstem, and major vessels.

Congenital Mitral Valve Regurgitation in Adult Patients

Congenital mitral valve regurgitation (MVR) is a rare disease found in adults. We report on our 5-year surgical experience with congenital MVR in adults. We reviewed the data for 48 consecutive patients (26 men), aged >18 years (median, 42 years; range, 18-78 years) who underwent operations for severe congenital MVR between June 2005 and May 2010. Patients with atrioventricular septal defect were excluded. Congenital MVR was preoperatively diagnosed in 28 cases (58%). The lesions consisted of annular dilation (100%), valvular cleft (58%), prolapsed leaflet (40%), papillary muscle abnormality (5%), commissure fusion (2%), and leaflet deficiency (2%). Mitral valve repair was performed in 42 cases (88%) by means of Carpentier techniques. The other 6 patients underwent mitral valve replacement; one of these patients died of ventricular fibrillation 2 days after surgery. There were no other hospital deaths or late mortality. At the last follow-up (median, 38 months; range, 2-50 months), all 47 patients were in New York Heart Association functional class I or II. Echocardiography evaluations for the 42 patients who underwent the repairs revealed that 32 (76%) of the patients had no or trivial MVR and 10 patients (24%) had mild MVR. No patient underwent reoperation. Congenital MVR is rare and often misdiagnosed in adults. Mitral valve repair is feasible in the majority of patients, with excellent immediate and medium-term results.

Les vrais et les faux glaucomes unilatéraux de l’adulte

The diagnosis of unilateral glaucoma essentially requires an etiologic investigation primarily to make sure that the deterioration is truly glaucomatous, thus specifically ruling out other optical neuropathies and papillary abnormality, such as tilted disc or drusen, which can mimic glaucomatous perimetric defects. Nonetheless, some apparent unilateral glaucomas can become bilateral later, as with primary open-angle glaucoma, though more frequently with primary closed-angle glaucoma in the absence of prophylaxis, and with exfoliative glaucoma. Genuine unilateral glaucomas concern the pigmentary glaucomas, the contusive glaucomas, the secondary closed-angle glaucomas, which encompass iridocorneoendothelial syndromes, ocular inflammations with opened angle, and glaucomas with an increase in the venous episcleral pressure.

Management of neuro‐ophthalmology cases in children

AbstractNeuro‐ophthalmological conditions in children must be analyzed carefully and some emergencies must be recognized. Clinical and practical cases are illustrated. On that basis the most important aspects of the field of neuro‐ophthalmology are covered succinctly but sufficiently to enable the practitioner to determine an appropriate diagnosis and course of treatment. Rare and unusual diseases are included but those that are especially critical to the patient’s vision or general health and life. Some specific clinical signs and symptoms need to be carefully evaluated as papilledema, papillary abnormalities, ptosis, diplopia or ocular motility abnormalities. Each clinical case deals with a symptom that leads the patient to seek medical attention or a sign that is demonstrated on physical examination. The proper diagnosis is frequently made with the imaging but must be repeated if necessary. Specific techniques in children are described including oculomotor and electrical testing, tomodensitometry and magnetic resonance imaging. Different treatment as medical surgical and neurosurgical are discussed. The physician evaluating neuro‐ophtalmic patients needs to have a broad background of medical information. So the patient’s workup is properly managed and therapeutic orientations can be done.

Reactive Pancreatitis Following Endoscopic Retrograde Cholangiopancreatography: Diagnosis, Prevention and Treatment

Objective: to study the risk factors, clinical, laboratory, and functional manifestations, course, prevention, treatment, and outcome of reactive pancreatitis (RP) following endoscopic retrograde cholangiopancreatography (ERCP). Subjects and methods: A study group comprised 207 patients (156 males and 51 females; mean age, 54.5±12.7 years) treated at the N. N. Burdenko Main Military Hospital and undergone ERCP with and without papillosphincterotomy (PST). The patients’ status, the presence and pattern of subjective and objective symptoms and laboratory parameters (blood amylase, urinary diastase, leukocytosis) were dynamically estimated after ERCP. Results: 58 (28.0%) patients developed post-ERCP RP, the severe course of pancreatitis being observed in 4.3%. There were no cases of pancreatic necrosis or fatal outcomes. RP was significantly more common in females, persons under 50 years of age, patients with chronic pancreatitis, cholelithiasis, or major duodenal papillary abnormalities (duodenal papillitis, choledochal stricture), choledocholithiasis, in the absence of the dilated common bile duct. RP less frequently occurred in patients only when adequate or combined PST had been performed. RP was characterized by an acute course, with a significant pain syndrome occurring, by altered health status, fever, hyperamylasemia, and leukocytosis within the first-second days following ERCP, and delayed urinary diastase elevation. Just after ERCP, all the patients were given a combination of octreotide and a protease inhibitor to prevent RP. The efficiency of prevention was directly confirmed by the fact that there were no cases of pancreatic necrosis and fatal outcomes. To treat RP, the authors gave a combination of antisecretory agents, protease inhibitors (contrycal, ingitril), antibacterial drugs (cephalosporins, fluoroquinolones), and proton pump inhibitors during starvation, in the use of analgesics and spasmolytics, and during active infusion therapy. In all cases RP was benign and ended with the patients recovery 5—14 days after initiation of the therapy. Conclusion: ERCP is a serious endoscopic operation characterized by a high risk of life-threatening complications (first of all RP). Before ERCP, the risk factors of RP should be assessed. All patients to undergo ERCP need a complex RP prevention including endoscopy, drugs, and intensive monitoring. In evolving RP, early multimodality therapy comprising antisecretory drugs, protease inhibitors, antibiotic therapy, analgesia, infusion therapy, and starvation.