Retrospective Medical Record Study Research Articles

A New Era in Perforator Flap Surgery for Breast Reconstruction: A Comparative Study of Robotic versus Standard Harvest of Bilateral Deep Inferior Epigastric Artery Perforator Flaps.

Traditional deep inferior epigastric artery perforator (DIEP) flap harvest splits the anterior sheath, weakening the abdominal wall and predisposing patients to bulge or hernia. Abdominal wall morbidity may be decreased using minimally invasive techniques. We refined a transabdominal approach to the robotic harvest of bilateral DIEP flaps. A retrospective medical record study involving all patients who underwent bilateral or bipedicled robotic DIEP (rDIEP) or standard DIEP (sDIEP) flap harvest between July 2021 and September 2022. Outcomes included abdominal wall morbidity, total operative time, length of stay (LOS), and complications. Forty-seven patients were included (48 sDIEP flaps, 46 rDIEP flaps) with no significant difference in patient characteristics. Fascial incision length in the rDIEP group was shorter (4.1 vs. 11.7 cm, p < 0.001). Mesh reinforcement of the abdominal wall was used in 13/24 sDIEP and none in rDIEP patients (p < 0.001). Operative time was longer in the rDIEP cohort (739 vs. 630 minutes, p = 0.013), although subanalysis showed no difference in the second half of the cohort. The average robotic dissection time was 135 minutes, which decreased significantly with the surgeon's experience. There were no intraoperative complications from using the robot. LOS was shorter with rDIEP but not statistically significant (3.9 vs. 4.3 days, p = 0.157). This study represents the most extensive cohort analysis of bilateral rDIEP flap harvest, offering a comprehensive comparison to traditional sDIEP. The initial results underscore the viability of robotic techniques for flap harvesting, highlighting potential advantages including reduced fascial incision length and decreased abdominal disruption. Furthermore, using robotics may obviate the necessity for fascial reinforcement with mesh.

The reports of specific waking-state oral behaviours, including awake bruxism activities, and psychological distress have a dose-response relationship: A retrospective medical record study

ABSTRACT Objective To investigate if there are dose-response relationships between self-reported waking-state oral behaviours, including awake bruxism, and three indicators of psychological distress (depression, anxiety, stress). Methods The study sample consisted of 1,886 patients with function-dependent TMD pain. Relationships between six non-functional and six functional waking-state oral behaviours, scored on a 5-point ordinal scale, and the psychological factors were investigated using ordinal logistic regression. Results Mean age was 42.4 (±15.3) years, 78.7% being female. The odds of reporting the higher categories of non-functional oral behaviours depended on the severity of depression, anxiety, and stress. Most OR coefficients followed a quadratic dose-response distribution, the others increased linearly as the severity of the psychological scales increased. Almost no such associations were found with normal jaw function behaviours. Conclusion Within the limitations of this study, it may be concluded that non-functional waking-state oral behaviours, including awake bruxism, and psychological distress have a dose-response relationship, with higher levels of distress being associated with higher reports of oral behaviours.

Characteristics of non‐urgent neonatal presentations to an Australian metropolitan emergency department

To determine characteristics and risk factors for non-urgent presentations (NUPs) (triage categories 4 and 5) in neonates to a Western Sydney metropolitan mixed adult emergency department (ED) and the effect of COVID-19 on presentations and admissions. A retrospective medical record study examined neonates (age <4 weeks) presenting to the ED between October 2019 and September 2020 and assessed risk factors for NUPs including the impact of COVID-19. Regression analysis was used to determine which risk factors were significant for NUPs to ED and whether there were any significant differences in urgency of presentations and admissions during the post-COVID-19 time (on/after 11th March 2020). From 277 presentations, 114 (41%) were non-urgent. After regression analysis, being a mother born overseas (odds ratio 2.15, 95% confidence interval 1.13-4.12, P = 0.02) was a significant risk factor and maternal age (odds ratio 0.98, 95% confidence interval 0.96-0.1.00, P = 0.02) was a significant protective factor for NUPs in the neonatal period. There were 54 (47%) NUPs pre-COVID-19 and 60 (53%) NUPs post-COVID (P = 0.70). There were similar presenting complaints and diagnoses compared to the literature. Mothers born overseas and younger maternal age were found to be significant risk factors for NUPs in the neonatal period. There was no apparent impact on presentations and admissions to ED during the COVID-19 period. Further studies are warranted to further evaluate risk factors for NUPs in the neonatal period and further elucidate the impact of COVID-19 on presentations and admissions, specifically in later waves of the virus.

RISK FACTORS FOR DEVELOPING UPPER LIMB CELLULITIS AFTER BREAST CANCER TREATMENT

Cellulitis is one of the most important troubling complications of breast cancer treatment. Therefore, elucidating the risk factors for cellulitis in patients that have undergone breast cancer treatment is crucial. This is a retrospective medical record study among 523 patients who had received breast cancer treatment and were referred to the Lymphedema Clinic. Data on age, height, weight, BMI (body mass index), education level, arm dominance, history of previous surgery, axillary lymph node dissection, radiotherapy, and chemotherapy were noted. The time between operation and onset of lymphedema, duration of lymphedema, history of cellulitis, and number of cellulitis attacks were recorded. Circumference measurements were taken at four points on the upper limb. Univariate analysis showed that longer duration of lymphedema, larger circumference of the unaffected arm and larger circumference of the arm with lymphedema were associated with higher risk of cellulitis (p=0.008, p=0.007, p< 0.001, respectively). The incidence of cellulitis was higher in patients with lymphedema than patients who had no lymphedema (p< 0.001). Moreover, the frequency of cellulitis was higher in patients with lower education level (p=0.015). It was deter-mined that patients with cellulitis needed more compression garments (p< 0.001) and multi-layered bandage therapy (p< 0.001) than those without. Regression analysis revealed that presence of lymphedema (p=0.036), duration of lymphedema (p=0.048), radiotherapy (p=0.01) and educational level (0.019) are significantly associated with developing upper extremity cellulitis. It is important to consider these risk factors for the prevention and management of cellulitis in patients who undergo treatment for breast cancer. Early detection and treatment of lymphedema also remains essential for these patients.

A simple risk score list can be used to predict the occurrence of delirium in patients admitted to inpatient hospice care: A medical record study.

This study aimed to examine whether the 10-item Risk Score List (RSL) accurately predicts delirium in patients admitted to inpatient hospice care and whether this instrument can be simplified. Determining the risk for developing delirium can help to treat these patients in a timely manner. This was a retrospective medical record study in patients who died in 2019 or 2020 in three hospices. Predictive values were examined using Cox regression analysis, crosstabs, and C-statistic. In total, 240 patients were included. Median age at admission was 78 (IQR 70-84) years. Primary diagnosis most often was cancer (n = 186, 78%); 173 (72%) patients had an increased risk of delirium according to RSL, of whom 120 (69%) developed delirium. Overall, 147 (61%) patients developed delirium. The RSL significantly predicted future delirium (HR 3.25, CI 1.87-5.65, p < 0.01) and had a sensitivity of 85%, a specificity of 43%, positive predictive value of 62%, negative predictive value of 73%, and a C-statistic of 0.64. Simplifying the RSL to four items still significantly predicted future delirium, with similar predictive values. Delirium occurs in more than half of patients admitted to hospice care. The RSL can be simplified to four items, without compromising on predictive accuracy.

Advance care planning in primary care: a retrospective medical record study among patients with different illness\xa0trajectories

BackgroundAdvance Care Planning (ACP) enables physicians to align healthcare with patients’ wishes, reduces burdensome life-prolonging medical interventions, and potentially improves the quality of life of patients in the last phase of life. However, little objective information is available about the extent to which structured ACP conversations are held in general practice.Our aim was to examine the documentation of ACP for patients with cancer, organ failure and multimorbidity in medical records (as a proxy for ACP application) in Dutch general practice.MethodsWe chose a retrospective medical record study design in seven primary care facilities. Medical records of 119 patients who died non-suddenly (55 cancer, 28 organ failure and 36 multimorbidity) were analysed. Other variables were: general characteristics, data on ACP documentation, correspondence between medical specialist and general practitioner (GP), and healthcare utilization in the last 2 years of life.ResultsIn 65% of the records, one or more ACP items were registered by the GP. Most often documented were aspects regarding euthanasia (35%), the preferred place of care and death (29%) and concerns and hopes towards the future (29%). Median timing of the first ACP conversation was 126 days before death (inter-quartile range (IQR) 30–316). ACP was more often documented in patients with cancer (84%) than in those with organ failure (57%) or multimorbidity (42%) (p = 0.000). Patients with cancer had the most frequent (median 3 times, IQR 2–5) and extensive (median 5 items, IQR 2–7) ACP consultations.ConclusionDocumentation of ACP items in medical records by GPs is present, however limited, especially in patients with multimorbidity or organ failure. We recommend more attention for – and documentation of – ACP in daily practice, in order to start anticipatory conversations in time and address the needs of all people living with advanced conditions in primary care.

Factors associated with hyperhomocysteinemia in relatively healthy Taiwanese adults: A retrospective medical record study.

Elevated homocysteine levels have been proposed as a risk factor for cardiovascular disease. The aim of this study was to evaluate factors associated with hyperhomocysteinemia in relatively healthy Taiwanese adults.A retrospective cross-sectional study was conducted using data from the health examination database in a medical center located in southern Taiwan. Hyperhomocysteinemia was defined as a plasma homocysteinemia level >15 μmol/L. Factors associated with hyperhomocysteinemia were evaluated using univariate and multiple stepwise logistic regression analyses.A total of 817 adults with a mean age of 55.5 years were included in the present study, and of them, 67 (8.2%) had hyperhomocysteinemia. Results from multiple logistic regression analysis showed that male sex (Odd ratio [OR] = 12.28, 95% CI = 2.94–51.27, P = .001), advanced age (OR = 1.37 per 10 years, 95% CI = 1.06–1.77, P = .017), triglycerides (OR = 1.02 per 10 mg/dL, 95% CI = 1.01–1.04, P = .010), and uric acid (OR = 1.27, 95% CI = 1.09–1.49, P = .004) were significantly and independently associated with hyperhomocysteinemia.In this retrospective medical record study, male sex, advanced age, higher plasma level of triglyceride, and uric acid were significantly associated with hyperhomocysteinemia in relatively healthy Taiwanese adults.

Emergency Department visits due to intoxications in a Dutch university hospital: Occurrence, characteristics and health care costs.

BackgroundIntoxications with alcohol and drugs are common in the Emergency Department. This study aimed to describe the occurrence and characteristics of intoxications (alcohol, Drugs of Abuse (DOA), pharmaceutical and chemical) presented to the Emergency Department and the health care costs of these intoxications.MethodsThis was a retrospective medical record study of all patients (≥ 16 years) who presented to the Emergency Department of an inner-city academic hospital in the Netherlands due to single or multiple intoxication(s) as the primary or secondary reason in the year 2016. An intoxication was reported as present if the attending physician described the intoxication in the patient’s medical record.ResultsA total of 783 patients were included, accounting for 3.2% of the adult Emergency Department population (age ≥ 16 year). In 30% more than one substance was used. Intoxications with alcohol, Drugs of Abuse and pharmaceuticals was reported in respectively 62%, 29% and 21% of the intoxicated patients. The mean costs per patient presenting with an intoxication to the Emergency Department was € 1,490. The mean costs per patient were highest for pharmaceutical intoxications (€ 2,980), followed by Drugs of Abuse (€ 1,140) and alcohol (€ 1,070).ConclusionsIntoxications among patients aged 16 years and older are frequently seen at the Emergency Department and are frequently caused by multiple substances. Alcohol is the most common intoxication. Substantial healthcare costs are involved. Therefore, this study suggests that further research into hazardous alcohol consumption and DOA abuse is warranted.

Elevated International Normalized Ratio Is Not Associated With Increased Perioperative Morbidity in Podiatric Limb Salvage Surgery: A Retrospective Analysis

The risk of hemorrhage always exists in anticoagulated patients with an elevated international normalized ratio (INR), a risk that must be measured against the necessity for surgical procedures. The objective of the present retrospective medical record study was to assess the safety with which limb salvage procedures can be conducted in patients with an INR >1.4. The medical records of 231 patients who had undergone limb salvage procedures by 1 surgeon at the Yale New Haven Health System from November 2008 through July 2014 were reviewed. All patients were administered foot blocks with monitored intravenous sedation. The patients' demographic data, comorbidities, preoperative anticoagulant use, coagulation profile, intraoperative analgesic administration, estimated blood loss, total operating room time, total postanesthesia care unit time, intraoperative ankle tourniquet use, and postoperative complications within the initial 72 hours were reviewed. We found no differences in intraoperative bleeding, total intraoperative time, or recovery time between the INR <1.4 group (n = 212) and the INR >1.4 group (n = 19). None of the patients experienced any postoperative complications, defined as any cardiac or pulmonary event, the need for invasive monitoring, or admission to the intensive care unit within the initial 72-hour period. Our findings suggest that patients are suitable for undergoing peripheral procedures with foot blocks and monitored intravenous sedation even in the presence of an elevated INR.

Factors associated with emergency services use in Taiwanese advanced cancer patients receiving palliative home care services during out-of-hours periods: a retrospective medical record study

BackgroundFor patients receiving palliative home care, the need to visit the emergency department is considered to be an indicator of poor quality care. The situation can be particularly distressing when it occurs outside of normal hours of palliative home care service. The aim of this study was to investigate the factors for emergency department use during out-of-hours periods of palliative home care service among advanced cancer patients in Taiwan.MethodsThis case-control study was based on a retrospective medical chart review (January 2010 to December 2012) of advanced cancer patients who were receiving palliative home care in a community hospital in south Taiwan. The use of emergency medical services by these patients was dichotomized into either normal hours (8 a.m. to midnight, Monday to Friday, excluding public holidays) of palliative home care or outside normal hours. Logistic regression analyses were performed to evaluate factors associated with emergency services use during out-of-hours period of palliative home care.Results: Of the 94 patients receiving palliative home care, 65 had used emergency services at least once during the 3-year study period. Of these 65 patients, 40% used emergency services during out-of-hours of palliative home care. Patients with distressing conditions (defined as the occurrence of any two conditions of dyspnea, change of consciousness, or gastrointestinal bleeding) were significantly more likely to use emergency services during out-of-hours of palliative home care.ConclusionsPatients at risk of developing dyspnea, change of consciousness, or gastrointestinal bleeding should be provided with relevant information regarding these symptoms and signs.

Implementation and Outcomes of a Community-Based Pulmonary Rehabilitation Program in Rural Appalachia.

To report on the implementation and clinical outcomes of a community-based pulmonary rehabilitation program in rural Appalachia. Three rural health centers and a large referral hospital worked together to establish pulmonary rehabilitation services based on AACVPR guidelines. Each site hired at least 1 respiratory therapist. To measure clinical outcomes, a retrospective medical record study compared pre- and post-program values for the modified Medical Research Council dyspnea level, 6-minute walk test (6MWT), negative inspiratory force (NIF), respiratory disease knowledge, St George Respiratory Questionnaire (SGRQ), BODE index (body mass index, airflow obstruction, dyspnea and exercise capacity), and smoking status. The percentages of persons completing the program and participating in maintenance exercise after the program were recorded. During the first 20 months of the program, 195 unduplicated persons with qualifying chronic lung diseases started the program. Of these, 111 (57%) completed the program. Mean improvements for all 6 measures were highly significant (P < .001) and compared favorably with published results from hospital-based programs: dyspnea level, -1.2; 6MWT, +259 ft; NIF, +11.3 cm H2O; knowledge test, +1.9; SGRQ, -6.2; BODE index, -1.1. Of the 23 smokers, 5 quit by the end of the program. Community-based pulmonary rehabilitation in rural health centers is feasible and achieves clinical outcomes similar to programs in large hospitals and academic centers. Furthermore, the addition of respiratory therapists to these primary care teams provides important collateral benefits for the evidence-based care of patients with chronic lung diseases.

Cardiovascular comorbidities of rheumatoid arthritis in Taiwanese adults: A retrospective single-center study.

Objective:To evaluate the association between rheumatoid arthritis (RA) and cardiovascular comorbidities, including hyperlipidemia, hypertension, and diabetes, in Taiwanese patients based on the data from medical records.Materials and Methods:A retrospective study was performed using the computerized medical records from a regional hospital located in southern Taiwan. A total of 2293 patients (age range 30–79 years) with a diagnosis of RA (International Classification of Diseases, Ninth Revision, Clinical Modification code 714.0) treated since the opening of the study hospital in July 2000 until February 2013 were included. The RA cases were frequency matched for age and sex with 9172 patients without RA. The associations of RA with hyperlipidemia, hypertension, and diabetes were evaluated using multiple logistic regression analysis.Results:Significant associations between RA and hyperlipidemia (adjusted odds ratio [OR] = 2.05, 95% confidence interval [CI] = 1.77–2.38, P < 0.001) and hypertension (adjusted OR = 2.76, 95% CI = 2.43–3.14, P < 0.001) were observed. However, diabetes was not significantly associated with RA in either male or female patients.Conclusion:Findings from this retrospective medical record study indicated that hyperlipidemia and hypertension were significant cardiovascular comorbidities of RA.

Prevalence and Epidemiological Factors Involved in Cellulitis in Korean Patients With Lymphedema

ObjectiveTo evaluate the prevalence and associated factors involved in cellulitis with lymphangitis among a group of Korean patients who were being treated for lymphedema. We present our epidemiologic research and we also report a systematic review of these types of cases.MethodsThis was a retrospective medical record study among 1,246 patients diagnosed with lymphedema. The study was carried out between January 2006 and December 2012 at the Kosin University Gospel Hospital and Seoul National University Bundang Hospital. Cases were examined for onset time, affected site, seasonal trend, and recurrence pattern of lymphedema, lymphangitis, and cellulitis. We also evaluated the history of blood-cell culture and antibiotic use.ResultsNinety-nine lymphedema patients experienced complications such as cellulitis with accompanying lymphangitis. Forty-nine patients had more than two recurrences of cellulitis with lymphangitis. The incidence and recurrence of cellulitis with lymphangitis were significantly higher in the patients with lower-extremity lymphedema. There was a significant trend toward higher cellulitis prevalence in the lower-extremity lymphedema group according to the time of lymphedema onset. Among the cellulitis with lymphangitis cases, 62 cases were diagnosed through blood-cell culture; 8 of these 62 cultures were positive for β-hemolytic streptococci.ConclusionThe prevalence rate of cellulitis with lymphangitis in patients with lymphedema was 7.95%, and the prevalence of recurrent episodes was 3.93%. Especially, there was high risk of cellulitis with lymphangitis after occurrence of lower-extremity lymphedema with passage of time. Lymphedema patients should be fully briefed about the associated risks of cellulitis before treatment, and physicians should be prepared to provide appropriate preventive education.

Characteristics and outcomes of patients with eclampsia and severe pre-eclampsia in a rural hospital in Western Tanzania: a retrospective medical record study.

BackgroundEclampsia and pre-eclampsia are well-recognized causes of maternal and neonatal mortality in low income countries, but are never studied in a district hospital. In order to get reliable data to facilitate the hospital’s obstetric audit a retrospective medical record study was performed in Ndala Hospital, Tanzania.MethodsAll patients diagnosed with severe pre-eclampsia or eclampsia between July 2011 and December 2012 were included. Medical records were searched immediately following discharge or death. General patient characteristics, medical history, obstetrical history, possible risk factors, information about the current pregnancy, antenatal clinic attendance and prescribed therapy before admission were recorded. Symptoms and complications were noted. Statistical analysis was done with Epi Info®.ResultsOf the 3398 women who gave birth in the hospital 26 cases of severe pre-eclampsia and 55 cases of eclampsia were diagnosed (0.8 and 1.6 %). Six women with eclampsia died (case fatality rate 11 %). Convulsions in patients with eclampsia were classified as antepartum (44 %), intrapartum (42 %) and postpartum (15 %). Magnesium was given in 100 % of patients with eclampsia and was effective in controlling convulsions. Intravenous antihypertensive treatment was only started in 5 % of patients. Induction of labour was done in 29 patients (78 % of women who were not yet in labour). Delivery was spontaneous in 67 %, assisted vaginal (ventouse) in 14 % and by Caesarean section in 19 % of women. Perinatal deaths occurred in 30 % of women with eclampsia and 27 % of women with severe pre-eclampsia and were associated with low birth weight and prolonged time between admission and birth.Conclusions2.4 % of women were diagnosed with severe pre-eclampsia or eclampsia. The case fatality rate and overall perinatal mortality were comparable to other reports. Better outcomes could be achieved by better treatment of hypertension and starting induction of labour as soon as possible.

Use of intravesical valrubicin in clinical practice for treatment of nonmuscle-invasive bladder cancer, including carcinoma in situ of the bladder.

The objective was to conduct a US multicenter, retrospective medical record study examining the effectiveness, safety, and patterns of use of valrubicin for treatment of nonmuscle-invasive bladder cancer (NMIBC) by clinicians since the 2009 reintroduction of valrubicin. Patients ≥ 18 years with NMIBC who received had one or more instillations of valrubicin (October 2009- September 2011) were eligible. The primary endpoint was event-free survival (EFS). Safety and tolerability were also assessed. The medical records of 113 patients met the inclusion criteria; 100 patients (88.5%) completed valrubicin treatment. The median age was 75 years (range 42-95 years). The median NMIBC duration was 31 months since diagnosis: 51.3% (58/113) had carcinoma in situ (CIS) alone, and 31.9% (36/113) had unspecified NMIBC. Most patients, 94.7% (107/113), had more than three valrubicin instillations and 70.8% (80/113) completed a full course. The EFS rate (95% confidence interval) was 51.6% (40.9-61.3%), 30.4% (20.4-41.1%), and 16.4% (7.9-27.5%) at 3, 6, and 12 months, respectively. Median time to an event was 3.5 (2.5-4.0) months after the first valrubicin instillation. Local adverse reactions (LARs) were experienced by 49.6% (56/113) of patients; most LARs were mild (93.6%). The most frequent LARs were hematuria, pollakiuria, micturition urgency, bladder spasm, and dysuria. In total, 4.4% (5/113) of patients discontinued valrubicin because of adverse events or LARs. Data from the present retrospective study are consistent with previous prospective clinical trials that demonstrated valrubicin effectiveness and tolerability for select patients with CIS, before considering cystectomy. Additional prospective studies are warranted to evaluate valrubicin safety and efficacy in the broader patient population with NMIBC.

Metastatic Carcinoma of the Neck of Unknown Primary Origin: Evolution and Efficacy of the Modern Workup

To assess the efficacy of various diagnostic modalities in detecting occult primary tumor location. Retrospective medical record study. Academic head and neck oncology practice. A total of 183 consecutive patients with metastatic carcinoma of the neck from an unknown primary tumor during a 10-year period, after exclusion of those with previous history of head and neck cancer, a primary tumor site evident on physical examination, or primary tumors of the neck. Identification of primary tumor location by various imaging modalities and panendoscopy with directed biopsies. Primary tumor location was identified in 84 patients (45.9%). Preoperative imaging (computed tomography [CT], magnetic resonance imaging, positron emission tomography [PET], and/or PET-CT fusion scan) identified sites suggestive of primary tumor location in 69 patients. Subsequent directed biopsy of these sites yielded positive results in 42 cases (60.9%). The rate of successful identification of a primary tumor for each of the imaging modalities was as follows: CT scan of the neck, 14 of 146 patients (9.6%); magnetic resonance imaging of the neck, 0 of 13 patients (0%); whole-body PET scan, 6 of 41 patients (14.6%); and PET-CT fusion study, 23 of 52 patients (44.2%) (P = .001). The highest yield in identifying primary tumor sites was obtained in patients who had undergone PET-CT plus panendoscopy with directed biopsies with or without tonsillectomy: 31 of 52 patients (59.6%). Diagnostic workup including PET-CT, alongside panendoscopy with directed biopsies including bilateral tonsillectomy, offers the greatest likelihood of successfully identifying occult primary tumor location.

Comparison of Olanzapine and Risperidone in 367 First-Episode Patients with Non-Affective or Affective Psychosis: Results of an Open Retrospective Medical Record Study

Previous studies comparing olanzapine (OLZ) and risperidone (RIS) have tended to focus on multiple-episode patients, with no studies examining their comparative efficacy in a non-selective sample of first-episode psychosis. The Early Psychosis Prevention and Intervention Centre in Australia had admitted 786 first-episode psychosis (FEP) patients between 1998-2000. Data were collected from the medical records (MR) of 367 patients, which met inclusion criteria. The primary objective was to evaluate the efficacy of OLZ vs. RIS as measured by CGI-S, CGI-BP (symptomatic level), GAF and SOFAS (functioning level). 367 FEP patients were entered into the study, 278 in the RIS- (2.7 mg/day) and 89 in the OLZ group (10.2 mg/day). No between-group differences were found in non-affective FEP (n = 273). In affective FEP patients (n = 94), mainly treated for acute mania (86.7 %), OLZ treatment was related to better response on the symptomatic (CGI-S; p = .002), but not on the functioning level (GAF and SOFAS; ns). There were trends in the OLZ group towards a higher rate of remission of positive symptoms ( p = .054) and a shorter treatment duration to reach this remission in affective FEP patients ( p = .077). More extrapyramidal side effects ( p <.001) were related to RIS and more weight gain to OLZ-treatment ( p <.001). Despite the limitations of a retrospective MR design, study results suggest equal therapeutic efficacy of OLZ and RIS in non-affective FEP and some therapeutic advantages of OLZ compared to RIS in affective FEP patients, especially in those with acute mania. Results may serve as hypotheses for future randomised controlled trials.

Comparison of olanzapine and risperidone in 367 first-episode patients with non-affective or affective psychosis: results of an open retrospective medical record study

Comparison of olanzapine and risperidone in 367 first-episode patients with non-affective or affective psychosis: results of an open retrospective medical record study

Posterior lamellar keratoplasty for treatment of deep stromal absesses in nine horses

Abstract Objective To describe and evaluate the use of posterior lamellar keratoplasty as a surgical treatment for deep corneal stromal abscesses in horses. Animals studied Nine horses of various breeds and ages that presented with corneal stromal abscesses located in the posterior one‐third of the cornea. Procedure Retrospective medical record study. Results Nine horses had deep corneal stromal abscesses that were treated with posterior lamellar keratoplasty. Median patient age was 3 years. Six patients were females and three were geldings. Medical therapy alone had been attempted prior to surgery in all nine animals. Corneal abscess culture and histopathology were performed in 8/9 horses. Cultures were positive for an infectious etiology in 4/8 (50%). Histopathology was positive for an infectious etiology in 5/8 (62.5%). Mean surgical time was 71.0 ± 18.8 min and the average healing time was 23.7 ± 5.2 days. Visual outcome was positive in 8/9 cases. Conclusion Posterior lamellar keratoplasty is a promising procedure for treatment of deep corneal stromal abscesses in horses. The procedure resulted in considerable shorter surgery time and healing time than had been observed with full‐thickness penetrating keratoplasty. Scar formation with this procedure was not significantly different than with penetrating keratoplasty.

Posterior lamellar keratoplasty for treatment of deep stromal absesses in nine horses.

OBJECTIVE: To describe and evaluate the use of posterior lamellar keratoplasty as a surgical treatment for deep corneal stromal abscesses in horses. Animals studied Nine horses of various breeds and ages that presented with corneal stromal abscesses located in the posterior one-third of the cornea. Procedure Retrospective medical record study. RESULTS: Nine horses had deep corneal stromal abscesses that were treated with posterior lamellar keratoplasty. Median patient age was 3 years. Six patients were females and three were geldings. Medical therapy alone had been attempted prior to surgery in all nine animals. Corneal abscess culture and histopathology were performed in 8/9 horses. Cultures were positive for an infectious etiology in 4/8 (50%). Histopathology was positive for an infectious etiology in 5/8 (62.5%). Mean surgical time was 71.0 +/- 18.8 min and the average healing time was 23.7 +/- 5.2 days. Visual outcome was positive in 8/9 cases. Conclusion Posterior lamellar keratoplasty is a promising procedure for treatment of deep corneal stromal abscesses in horses. The procedure resulted in considerable shorter surgery time and healing time than had been observed with full-thickness penetrating keratoplasty. Scar formation with this procedure was not significantly different than with penetrating keratoplasty.