Retrospective Case Series Analysis Research Articles

Bowel preparations for capsule endoscopy: a comparison between simethicone and magnesium citrate

Bowel preparation for capsule endoscopy (CE) has not been standardized. This study aimed to compare CE images between patients prepared by simethicone and those prepared by magnesium citrate. Retrospective analysis of case series of our hospital from 2004 to 2007. Single center. CE images of 75 patients receiving bowel preparation either by 200 mg of simethicone (n=39) or by 34 g of magnesium citrate (n=36) were retrospectively investigated. Grades of fluid transparency and mucosal invisibility by air bubbles and food residue were compared between the 2 preparations. Capsule transit time, frequency of positive findings, and interobserver variations between 2 observers were also investigated. Image quality and diagnostic yield of CE. Fluid transparency in the first and the third time segments of the small intestine was better in patients prepared by magnesium citrate than in those prepared by simethicone (P= .001 and P= .03, respectively). On the other hand, mucosal invisibility was not different in any part of the small intestine between the 2 groups. Neither gastric transit time nor small-bowel transit time was different between the 2 groups. The diagnostic yield of CE correlated significantly with fluid transparency (P= .04), but it did not correlate with mucosal invisibility. Single-center retrospective study. Magnesium citrate seems to be a recommended preparation for CE compared with simethicone. The fluid transparency, rather than the mucosal invisibility, may be a factor associated with the diagnostic yield of CE.

Outcomes Following Active Surveillance of Men With Localized Prostate Cancer Diagnosed in the Prostate Specific Antigen Era

We gained insights concerning outcomes associated with men who elect active surveillance for the management of localized prostate cancer. This is a retrospective case series analysis of 40 patients diagnosed with localized prostate cancer since 1990 who elected active surveillance. A total of 31 patients remained on active surveillance for a median of 48 months (range 12 to 168). The 5-year probability of remaining on active surveillance was 74%. Most patients who abandoned this strategy did so within 33 months of diagnosis (range 12 to 84). An increasing prostate specific antigen and anxiety were the 2 most common reasons. A delay in treatment did not appear to compromise subsequent outcomes. Men with low grade prostate cancer can elect active surveillance and have excellent long-term results.

Limbal transplantation: multicenter retrospective case series analysis

To report the results of limbal transplantation (LT) in patients with limbal stem cell deficiency (LSCD) in the context of ocular surface diseases. A multicenter (5 centers) retrospective case series analysis of patients who underwent LT between 1996 and 2004 was performed. Data were collected by the same researcher using a customized database. Success was defined by the absence of a persistent corneal epithelial defect, on-going inflammation or recurrence of a pterygium. Data from 72 LT performed in 61 patients (65 eyes) with a mean follow-up of 20.8 months (SD 23.5; range, 3-115) were analyzed. There were 33 males and 28 females with a mean age of 55.8 years (SD: 15.6; range, 20-89). Fifty-eight (80.6%) LT were autografts (40 pterygia, 12 alkali burns, 3 iatrogenic cases, 2 viral infections, 1 neoplasia case) and 14 (19.4%) were allografts from cadaveric donors (7 immune-based disorders, 6 alkali burns, 1 iatrogenic case); all patients receiving allografts also received systemic immunosuppression. Of the total number of LT, 48 (66.7%) were successful. This proportion increased to 81.0% (47/58) when autografts were used. However, only 7.1% (1/14) of all allografts were successful. The success rate was higher (80.0%) when performed for a pterygium and lower when done for immune-based inflammation (14.3%). Autograft tissue for LT is always preferable to allografts to surgically treat LSCD, as clinical success is significantly higher, and systemic immunosuppression is avoided. As expected, immune-based disorders are the most difficult cases to treat. LT has been shown to be an excellent option for recurrent pterygium, although prospective studies need to be performed to further corroborate these results.

Clinical and Investigative Profile of Biopsy-Proven Sarcoid Uveitis in India

Purpose: Retrospective analysis of the clinical features, investigative profile, response to treatment, and final visual outcome in histopathologically confirmed cases of sarcoid uveitis. Methods: Retrospective case series analysis was done of 15 eyes of 9 patients seen between July1999 and August 2003 with biopsy-proven sarcoid uveitis. There were 3 were males and 6 females. The mean age at presentation was 44.1 years (range 11–62 years), The mean follow-up was 28.4 months. Results: Six patients had bilateral ocular involvement and 3 had unilateral involvement. Five out of 9 patients had primarily ocular involvement. The most common presentation was intermediate uveitis and granulomatous anterior uveitis in 7 patients. Eight of 9 patients responded well to the medical treatment with systemic and periocular steroids. Conclusions: Ocular lesions can be the primary manifestation of systemic sarcoidosis. Sarcoid uveitis in the Asian Indian population often presents an intermediate uveitis with granulomatous anterior uveitis.

Correlation of IgE Autoantibody to BP180 With a Severe Form of Bullous Pemphigoid

To determine the prevalence, immunoglobulin subclass distribution, and clinical correlation of antibodies (Abs), especially of IgE Abs, to BP180 and BP230 in patients with bullous pemphigoid (BP). Retrospective case series analysis. Department of Dermatology, Nagasaki University Graduate School of Biomedical Science. Serum samples from 37 patients with BP, 6 with pemphigus vulgaris, 5 with pemphigus foliaceus, and 26 healthy controls (n = 26) were examined by enzyme-linked immunosorbent assay. Prevalence, immunoglobulin subclass distribution, and clinical correlation of Abs, especially of IgE Abs, to BP180 and BP230. IgG anti-BP180 and anti-BP230 Abs were detected in 35 (95%) and 26 (70%) of the 37 BP serum samples, respectively. IgG1 and IgG4 isotypes were positive in 32 (87%) and 25 (68%), respectively, of the BP serum samples for anti-BP180 Abs, while they were detected in 16 (44%) and 26 (70%), respectively, for anti-BP230 Abs. IgE anti-BP180 and anti-BP230 Abs were equally detected in 8 (22%) of the BP serum samples. Similar to IgG anti-BP180 Abs, the presence or levels of IgE anti-BP180 Abs was associated with broader skin lesions. Furthermore, patients with BP positive for IgE anti-BP180 Abs required longer duration for remission, higher dosage of prednisolone, and more intensive therapies for remission. By contrast, this was not true for those with of IgE anti-BP230 Abs. Remarkably, when analyzed in patients with BP who had a high titer of IgG anti-BP180 Abs, the presence or levels of IgE anti-BP180 Abs, but not IgG anti-BP180 Abs, were associated with a more severe form. The present study suggests that IgE anti-BP180 Abs are related to the disease severity and activity of BP. Moreover, it may be possible to identify treatment-refractory patients with BP more specifically by assessing the presence or levels of IgE anti-BP180 Abs in those with a high IgG anti-BP180 Ab titer.

Practical Issues with Amisulpride in the Management of Patients with Schizophrenia

Amisulpride is an atypical antipsychotic with a significantly greater effect size than first-generation, typical antipsychotics, and efficacy at least similar to that of olanzapine and risperidone in large-scale clinical trials in schizophrenia. Amisulpride provides greater improvement in positive and negative symptoms of schizophrenia, a better long-term outcome than typical antipsychotics, and distinct tolerability advantages over typical antipsychotics, which are reported to cause extrapyramidal symptoms (EPS) in 20-50% of patients. In addition, amisulpride is associated with significantly less weight gain than olanzapine and risperidone, does not increase body mass index, and favourably influences lipid profiles. In many patients with schizophrenia, adverse events impair adherence to treatment, and switching from typical or atypical antipsychotic therapy to amisulpride may be clinically appropriate. Observational drug-utilization studies suggest that many physicians switch to amisulpride because of fewer EPS and/or less weight gain and improved patient adherence. Cross-tapering (over 4 weeks), rather than abrupt cessation of pre-switch treatment, is preferred. Amisulpride has a low risk of drug-drug interactions, and, during cross-tapering, patients can remain on concurrent treatments (e.g. anticholinergics and antiparkinsonian agents) until the effective dosage has been reached. An appropriate amisulpride starting dose is 800 mg/day for patients with acute psychotic exacerbations, 400-800 mg/day for patients with predominantly positive symptoms, and 100-300 mg/day for predominantly negative symptoms. Amisulpride may be particularly suitable for clozapine-augmentation therapy in patients with refractory schizophrenia. Indeed, amisulpride is more effective than quetiapine as augmentation therapy in patients partially responsive to clozapine, and several prospective open-label studies and case series have reported promising results for amisulpride/clozapine combination therapy. In three prospective studies, addition of amisulpride 200-800 mg/day to clozapine significantly reduced mean scores on the Brief Psychiatric Rating Scale (BPRS) total (-33% to -35%), Clinical Global Impression (CGI)-Severity scale (-31%), Positive and Negative Syndrome Scale total (-22%), and Scale for the Assessment of Negative Symptoms (-34%). The proportion of responders (CGI score > or =3 or BPRS improvement >20%) was 71-86%. Retrospective case-series analyses have also reported improved psychopathological state, reduced adverse events, and lower clozapine dosage requirement with use of this combination. The pharmacological and clinical profiles of amisulpride suggest that this agent is a viable clinical option when a change of antipsychotic therapy is required in patients with schizophrenia because of lack of efficacy, adverse events and poor adherence to treatment, or for augmentation of clozapine in treatment-resistant illness.

INFERIOR VENA CAVA FILTERS AND LOWER LIMB FLAP RECONSTRUCTIONS

This is the first ever study looking at the combination of inferior vena cava (IVC) filters and flap reconstruction in traumatic lower limb injuries. The use of IVC filters is increasing and they are now being used prophylactically in trauma patients who are at a high risk of developing thromboembolism disease. Although it has been postulated that IVC filters, through its positioning in the IVC, results in a higher incidence of venous congestion and possibly failure of lower limb flaps, the effect of IVC filters on lower limb flap reconstructions has not been addressed in the published works. The aim of this study was to determine whether IVC filters affect the outcome of lower limb flap reconstructions in the trauma patient. Retrospective case series analysis of consecutive patients at the Alfred Hospital (Melbourne, Australia) who had lower limb flap reconstruction(s) and IVC filter placement from 1 July 2001 to 22 March 2005 (44-month period). Seventeen patients (12 men and 5 women) had 23 lower limb flap reconstructions (10 free, 13 local flaps) and IVC filter insertion. All 23 flaps survived with no flap failures. A gracilis muscle free flap developed venous congestion but survived with conservative management. In our series, IVC filters were not associated with poor outcomes of lower limb flap reconstructions. These findings are encouraging, and based on the evidence to date, the presence of IVC filters should not deter lower limb flap reconstructions in trauma patients. In particular, free flap surgery to traumatized lower limbs is not an issue with patients who have IVC filters.

Success and complication rates of endoscopic third ventriculostomy for adult hydrocephalus: a series of 108 patients

Background The clinical response to ETV of adult patients with noncommunicating hydrocephalus may differ from that of children because of such factors as chronicity of hydrocephalus, physiologic differences in CSF dynamics, and changes in brain viscoelastic properties. We sought to determine which factors might predict clinical success and failure. Methods A retrospective single-surgeon case series analysis was performed. This was a consecutive case series for which the goal of the ETV procedures was shunt independence. One hundred ten ETV procedures were performed in 108 adult patients (mean, 48 years; range, 17-88 years). There were 52 cases of idiopathic aqueductal stenosis, 47 cases of mass lesions causing noncommunicating hydrocephalus, plus 9 other miscellaneous obstructive etiologies. Results Long-term shunt independence was achieved in 77% of patients. Two additional patients, who initially failed, later achieved success after reoperation and remained shunt free for the duration of their follow-up. Therefore, after reoperation, shunt independence was achieved in 79% of patients. Of the patients who ultimately failed, 11 failed within 1 month. Therefore, 52% who ultimately failed had more than 1 month of shunt-free existence (mean, 10 months). There were 6 surgical complications, including 2 deaths related to intracranial hemorrhage from brain tumors (not directly related to ETV per se), and 10 medical complications. The median hospital length-of-stay was 3 days. The median follow-up was 8 months (range, 0-95 months). Conclusions Endoscopic third ventriculostomy is an effective treatment option for adult patients with noncommunicating hydrocephalus. Although most procedures resulted in long-term shunt independence, more than half of the eventual failures were delayed, and therefore, appropriate follow-up is required.

Biphasic insulin aspart 70/30 three times a day in older patients with type 2 diabetes not achieving optimal glycemic control on a twice-daily regimen: A retrospective case series analysis from clinical practice

This retrospective study was conducted to determine whether the addition of a third injection of biphasic insulin aspart 70/30 (BIAsp 30) just before lunch in older patients with type 2 diabetes who did not achieve goals with a twice-daily (BID) regimen would optimize glycemic control in a clinical practice setting. A retrospective chart analysis was conducted. In 12 patients aged 52 to 80 y with type 2 diabetes that had been diagnosed between 5 and 24 y earlier and who remained on oral antidiabetes agents, a third injection of BIAsp 30 was added because optimal glycemic control (glycosylated hemoglobin [HbA1c]<7%) was not achieved on a BID regimen. Changes in HbA1c, body weight, total insulin dose, and frequency of hypoglycemia were analyzed after 6 mo of three times daily (TID) treatment. Mean HbA1c decreased from 8.4% to 7.2%. An HbA1c goal of <7% was attained by 58% of patients. Although the total insulin dose increased by 11% with the TID regimen, pre-breakfast and predinner doses decreased by 15%. No patient experienced major hypoglycemia on BID or TID dosing. With the TID regimen, no minor hypoglycemic events were reported by patients and mean body weight decreased by 2.25 lb. The addition of a third injection of BIAsp 30 substantially improved HbA1c and decreased body weight and the incidence of hypoglycemia in 12 patients with type 2 diabetes who did not achieve optimal glycemic control on a BID regimen.

Poster 19: Supplementary Motor Area Syndrome After Left Medial Frontal Tumor Resection: Case Series, Clinical Features, and Literature Review

Objective: To illustrate the clinical features of supplementary motor area syndrome, we analyze a series of illustrative cases. Design: Retrospective case series analysis. Setting: Academic university medical center and rehabilitation hospital. Participants: 4 consecutive patients with resection of left medial frontal brain tumors treated between 2004 and 2005. Interventions: Not applicable. Main Outcome Measures: Volumetric brain lesion analysis, Geschwind Aphasia Categorization, manual motor testing, and FIM instrument scores.

Minimally Invasive Plating of High-Energy Metaphyseal Distal Tibia Fractures

The purpose of this study is to evaluate clinical results and outcomes of a strict cohort of high-energy injuries of the metaphyseal distal tibia with minimal or no intraarticular involvement treated using the minimally invasive plating concept. Level II trauma center. Retrospective analysis of a consecutive case series with limb-specific and whole-person outcomes measures. Minimally invasive medial plating for high-energy metaphyseal fractures of the distal tibia with little or no intraarticular involvement. Clinical and radiographic results were assessed at a minimum of 1 year, and outcomes measures were applied at final follow-up at a minimum of 2 years. Limbs were assessed with the American Orthopaedic Foot and Ankle Surgeons (AOFAS) ankle-hindfoot instrument and the method of Olerud and Molander. Patient outcomes were evaluated with the Short Form-36 (SF-36) and the Musculoskeletal Functional Assessment (MFA). Twenty-six patients were followed until healed at an average of 36 months (12-56 months). Mean fracture healing time was 35 weeks (12-112 weeks) with acceptable alignment restored (angulation<or=5 degrees or shortening<or=1 cm) in all but 1 case. Two patients (7%) had loss of fixation and 9 (35%) underwent secondary surgeries to achieve union. Risk factors for healing problems included high grades of fracture comminution, bone loss, and high-grade open injuries (P<0.05). SF-36 outcomes scores in 21 patients at >2 years were comparable to normative data of patients with uninjured limbs, whereas MFA results showed functional deficits in 4 of 10 subsections. Minimally invasive medial plating will restore limb alignment and yield successful clinical outcomes for high-energy metaphyseal fractures of the distal tibia. Despite the significant reoperation rate and prolonged time to union, most patients can expect a predictable return of function. Strong consideration should be given to adjunctive measures in at-risk patients, including those with highly comminuted fracture patterns, bone loss, or Type II or III open fractures.

High-dose Ifosfamide (HDIFX) as a 14-day continuous infusion (ci) in advanced adult soft tissue sarcoma (STS): A single- institution retrospective case series analysis

10067 Background: High-dose IFX (≥12 g/sqm) is active even in STS patients pretreated with standard-dose IFX, though with substantial toxicity. Prolonged continuous infusion, through a portable pump, may be an alternative way of administration. A Phase II study thereof is ongoing in Italy, but some pts have been treated off the study, either prior to its start or for practical reasons. Such consecutive pts seen at a single institution have been retrospectively reviewed. Methods: Between July 2001 and September 2006, 45 adult patients (M:F = 25:20; mean age 47 yrs; PS 0–1) with progressing advanced/metastatic STS, all previously treated with anthracyclines and standard-dose IFX, were given ciHDIFX, at the dose of 14 g/sqm as a 14-day continuous infusion every 4 weeks, using two portable infusional devices, with equidose Mesna, lasting 7 days each. Diagnosis was leyomiosarcoma in 12 patients, synovial sarcoma in 9, liposarcoma in 5, and other histological types in 19. Disease was advanced inoperable in 6 pts, and metastatic in 39. The total number of cycles was 176 (median number per pt: 4). Results: A PR was seen in 5 pts (synovial sarcoma, 2; leyomiosarcoma, 1, liposarcoma, 1; chondrosarcoma, 1), and SD in 22 (&gt;6 mos in 12), for a clinical benefit rate = 37%. PFS at 6 months was 35%. Median PFS was 11 mos in pts with PR and 6 in those with SD. Median PFS was 8 months in 9 patients undergoing complete tumor resection. Most common side effects were nausea (G1–2 in 14 pts) and asthenia (G1–2 in 15 pts). G2 anemia was seen in 8 pts, G2 neutropenia in 6. One pt with a single kidney had a reversible G2 hypercreatininemia. No grade 3–4 toxicity were recorded. Conclusions: In this series, ciHDIFX was associated with a PR and 6-mos PFS rate in the range of active second-line agents in advanced STS. This regimen was exceedingly well tolerated. No significant financial relationships to disclose.

Removal of etonogestrel contraceptive implants in the operating theater: report on 28 cases

Objectives We describe removal procedures for etonogestrel contraceptive implants in the operating theater. In addition, we discuss the management of removal of contraceptive implants that are difficult to palpate or are impalpable. Design We conducted a retrospective single-center case series analysis of Implanon™ removals conducted at a university hospital between January 2002 and April 2005. Materials and Methods We analyzed case notes for 28 patients who had their contraceptive implant removed in the operating theater. Results Intermenstrual bleeding was the principal reason for removal (52.4%). Ten patients already had one attempted removal of their implant. Preoperative ultrasound localized the implant in all cases. Half of the removals were done under local anesthetic, with three cases progressing to general anesthesia (11%). Thirty percent of the implants had migrated from their initial implantation, 37% were in intramuscular tissue and 11% were in the humeral neurovascular sheath. The only postoperative complications were one small seroma and transient paresthesia in the territory of the ulnar nerve. The implant was not found in one case. Conclusions The removal of an implant that is not palpable or difficult to palpate should take place in the operating theater following localization by ultrasound. Patients must be fully informed about the procedure, including its complications and the risk for failure.

CT31 HYPERBARIC OXYGEN IN POST‐CARDIAC SURGERY STROKE PATIENTS – THE CHRISTCHURCH EXPERIENCE

Introduction Post‐operative strokes occur in a small percentage of adult cardiac surgical patients and have devastating consequences for these patients. There is evidence to suggest that Cerebral Arterial Gas Embolism (CAGE) is an important aetiological factor in most of these cases.Hyperbaric Oxygen therapy (HBOT) is the administration of 100% oxygen at greater than atmospheric pressure. It is accepted as the definitive treatment for CAGE related to SCUBA diving accidents. The similarities between this and the pathophysiology of post cardiac‐surgical strokes due to iatrogenic CAGE suggest that beneficial effects from HBOT may accrue to these patients.Purpose The purpose of this study is to review the experience of treating post cardiac‐surgical stroke patients in our local hyperbaric oxygen facility, including their presentation, delay before treatment and outcomes. The current evidence base is reviewed.Method A retrospective case series analysis was conducted.Results Over a 10 year period, patients with post cardiac‐surgical strokes and who presented within the first 48 hours were referred for HBOT, of whom 12 were treated. The neurological outcomes were excellent in all but one case who died.A review of the literature provides a rational basis for the potential benefits of HBOT in this scenario, but at present there is only limited clinical data to support its use.Conclusion The postulated mechanisms for the development of post cardiac‐surgical strokes provide a sound theoretical basis for the suggestion that the use of HBOT is associated with improved outcomes. However there is no prospective data to support such a claim. Such a trial would be problematic and until more evidence is available, HBOT should be considered on a case by case basis.

New autopsy signs in violent death

In forensic medicine subtle observation has often resulted in the detection of single findings which are of great significance regarding the mechanisms of development of the incidence or its vitality. Thus, empiricism is an accepted method to gain new insights. Nevertheless the value and the significance of empirically gained insights have to be proven either by retrospective or prospective analysis of important case series or by experiments. It is often a long and difficult way from observation to proof. But without a detailed and evidence-based scientific argumentation the level of empirical methods could not be exceeded.

A retrospective analysis of case series using home‐prepared and chicken hydrolysate diets in the diagnosis of adverse food reactions in 181 pruritic dogs

The purpose of this retrospective study was to compare home-prepared and chicken hydrolysate diets in the diagnosis of canine adverse food reactions (AFR). Seventy-two dogs were fed home-prepared diets and 109 were fed hydrolysate. Owners chose the type of diet at presentation, and ingredients of home-prepared diets were selected depending on each dog's dietary history. Ectoparasitic infestations and microbial infections were treated during the trials. Cutaneous and gastrointestinal signs and pruritus scores were recorded before starting the diet, 6 weeks into the trials and after provocation with the original diets. AFR was diagnosed if pruritus resolved during the trial and recurred on dietary provocation. The dropout rate was lower for home-prepared diets although not statistically significant (18.1% home prepared; 24.7% hydrolysate, P=0.377). AFR alone was diagnosed in 10 dogs (17%) using home-prepared diets and in 15 (18.3%) fed the hydrolysate. Gastrointestinal problems were more frequent in dogs with AFR than in dogs without AFR (P=0.001). Another 11 dogs (18.6%) in the home-prepared diet group and 20 (24.4%) in the hydrolysate diet group had AFR concurrent with other pruritic diseases, mainly atopy. The similar frequencies of AFR diagnosis in the two groups (P=0.837 AFR; P=0.416 concurrent AFR) indicate that the chicken hydrolysate diet may be a valuable alternative to home-prepared diets in the diagnosis of canine AFR. Prospective cross-over studies are warranted to confirm these findings.

Developmental delay and outcomes in paediatric cochlear implantation: Implications for candidacy

Criteria for paediatric cochlear implant candidacy continue to evolve, as research indicates an increasingly broad range of children for whom the procedure can produce benefit. Children with difficulties in addition to their deafness, or global developmental delay, are not routinely excluded. The aim of this study is to explore the association between developmental delay in young paediatric cochlear implant candidates and progress with the device. The study is a retrospective case series analysis of 32 children, aged between 1.2 and 2.8 years at pre-implant assessment. Children were assessed using the Schedule of Growing Skills II and IT-MAIS before implantation. Progress in speech perception and Speech Intelligibility was monitored using the E2L toy test and Speech Intelligibility Rating (SIR), respectively, 1 and 2 years after switch-on. Data were subjected to regression analyses, with either the E2L or SIR as the outcome variables, and variables derived from the Schedule of Growing Skills II (general development and cognitive functioning), IT-MAIS, age at switch-on and average aided hearing loss pre-implant as the predictor variables. In each analysis the strongest (and statistically significant) predictors of speech perception and Speech Intelligibility were the measures of general development and cognitive functioning, accounting for around 40% of the variance in outcomes. This study indicates the value of routinely assessing the general development of young paediatric cochlear implant candidates, as part of the pre-implant decision-making process. Significant developmental delay is predictive of poor outcomes, but children with a mild delay do make appreciable progress. Developmental assessment of young deaf children is therefore important in terms of candidacy decisions and counselling parents regarding potential benefit from a cochlear implant.

Non‐penetrating deep sclerectomy for glaucoma associated with Sturge–Weber syndrome

To report the results of non-penetrating deep sclerectomy (NPDS) in the treatment of glaucoma associated with Sturge-Weber syndrome (SWS). We carried out a retrospective case series analysis of patients who underwent NPDS for glaucoma associated with SWS between 1998 and 2003. The control of glaucoma after NPDS, the results of surgery on intraocular pressure, the need for additional medical treatment and surgical complications were studied. Twelve eyes of nine patients, aged 11 days to 24 years, underwent filtering surgery: nine NPDS procedures were performed and three surgical procedures had to be converted to trabeculectomy because NPDS was not technically achievable. The mean follow-up after surgery was 26.3 months (range 6-48 months). Two trabeculectomies were complicated by choroidal effusion, which resolved in both cases. Good control of glaucoma was obtained during follow-up. Non-penetrating deep sclerectomy is transiently efficient in the treatment of SWS-associated glaucoma. Further studies of NPDS for the treatment of glaucoma associated with SWS are warranted.

Complications Associated With Minimally Invasive Decompression for Lumbar Spinal Stenosis

Surgical strategies for the decompression of lumbar spinal stenosis have evolved to include minimally invasive techniques providing for adequate and safe decompression while reducing perioperative morbidity. Retrospective case series analysis of 220 consecutive patients with lumbar spinal stenosis who underwent microscopic or microendoscopic minimally invasive decompression was performed. The objective was to evaluate the risks associated with performing a minimally invasive decompression for spinal stenosis in a large group of patients. Two hundred twenty patients with symptomatic neurogenic claudication from lumbar spinal stenosis failing nonoperative treatment received a minimally invasive decompression surgery. Intraoperative data, postoperative data through hospital discharge, and clinical follow-up were analyzed. The average age was 74.2 years (range 49-98 years). There were 379 spinal levels decompressed in 220 patients. Sixty-nine patients (31.4%) had a grade 1 degenerative spondylolisthesis. One hundred sixty-eight patients (76%) received spinal anesthesia, and 52 received general anesthesia. Eighty-seven patients (40%) had a preoperative American Society of Anesthesiologists score of 3 or 4. Average operative blood loss was 92 mL. There were 17 intraoperative durotomies (4.5% rate). The average length of stay before discharge was 1.2 days. Ten patients went to inpatient rehabilitation at discharge. One hundred ninety-four patients (88.2%) were discharged within 24 hours. There were five readmissions within the first month after discharge, four of those for medical complications. There were 24 minor complications and 14 major complications. Forty-two patients (19%) took no oral or parenteral narcotic pain medications in the postanesthesia to discharge period. Minimally invasive decompression strategies for spinal stenosis seem consistently to result in short hospital lengths of stay, minimal requirements for narcotic pain medications, and a low rate of readmission and complications.

Efficiency of occlusion therapy for management of amblyopia in older children

To analyse results of full time occlusion therapy for amblyopia in children older than 6 years. This was a retrospective consecutive case series analysis of children treated for amblyopia at a tertiary care center. All children received full time occlusion (FTO) for the dominant eye. Eighty-eight children older than 6 years at the time of initiation of therapy were included. Age at initiation of therapy ranged from 6 to 20 years (9.45 +/- 3.11 years). Forty-two children (47.7%) had strabismic amblyopia, 37 (42.0%) had anisometropic amblyopia and 9 (10.2%) had a combination of strabismic and anisometropic amblyopia. Eighty out of 88 eyes (90.0%) had improvement in visual acuity following FTO. Visual acuity (VA) improved from 0.82 +/- 0.34 at presentation to 0.42 +/- 0.34 (P < 0.001) after FTO. In children with strabismic amblyopia, VA improved from 0.81 +/- 0.42 to 0.42 +/- 0.39 (P <0.001). In children with anisometropic amblyopia, visual acuity of the amblyopic eye improved fron 0.82 +/- 0.24 to 0.36 +/- 0.29 (P< 0.001) following FTO. Out of 13 children older than 12 years, only 6 children (46.1%) had improvement in VA. Mean follow-up after complete stoppage of occlusion was 8.37 +/- 1.78 months. Occlusion therapy yields favorable results in strabismic and/or anisometropic amblyopia, even when initiated for the first time after 6 years of age. After 12 years of age, some children may still respond to occlusion of the dominant eye.