Academic literature on the topic '577.098 82'

Objective: Intraoperative evaluation of sentinel lymph nodes (SLNs) for patients with breast cancer is widely performed with frozen section (FS), cytology, or a combination of both. Touch imprint cytology (TIC) reportedly has an equivalent sensitivity to FS. We studied its diagnostic utility to detect SLN metastases. Materials and Methods: Cases of 367 patients with breast cancer who underwent intraoperative valuation of SLNs (507 LNs) were evaluated. All FS and corresponding TIC slides of SLNs of each case were reviewed microscopically for the presence of metastases of any size. If present, the metastatic focus was measured on the FS. Results: Of these 507 SLNs, 82 LNs (16.2%) from 69 women were found to have metastases in the FS and consisted of 5 LNs of isolated tumor cells, 15 of micrometastasis, and 62 of macrometastasis. TIC identified metastases in 69 of these 82 SLNs (sensitivity: 84.1%, specificity: 100%, and accuracy: 97.4%). All macrometastases could be detected by TIC, whereas TIC identified approximately 50% of micrometastases and none of isolated tumor cells. The size detection limit of metastatic foci, defined as the smallest dimension of metastasis detected without false negatives, was 2 mm. The smallest metastatic focus identified was 0.8 mm. Conclusions: TIC of SLNs is of great use given its negative predictive value of 100% for identification of macrometastasis in our study. For intraoperative evaluation of SLNs, based on our data, a practical two-step approach is proposed: SLN evaluation should be initially performed by TIC and then proceed to FS histological analysis only when cytologically positive to determine the size of metastatic focus.

Abstract Background: Total lymphocyte count (TLC) has been shown to correlate with outcomes in patients (pts) with acute leukemia. The clinical correlation to TLC in pts with chronic myeloid leukemia in chronic phase (CML-CP) who were treated with a tyrosine-kinase inhibitor (TKI) is unclear. Methods: Lymphocyte data in pts with newly diagnosed CML-CP who were enrolled in consecutive or parallel clinical trials with front-line imatinib (IM), nilotinib (Nilo), or dasatinib (Dasa) were collected at the time of diagnosis, and 3 and 6 months (M) after the start of TKI. Relative lymphocytrosis (RLC) was defined as lymphocyte >150% at 3 or 6M compared with baseline at diagnosis. Absolute lymphocytosis (ALC) was defined as lymphocyte > 4,000 /µL at 3 or 6M after the start of TKI. Pts were assessed for response, overall survival (OS), event-free survival (EFS), transformation-free survival (TFS), and failure-free survival (FFS) based on ALC and RLC. The Kaplan-Meier method was used to calculate OS, EFS, TFS, and FFS. A log-rank test and Cox regression were used for univariate (UVA) and multivariate analysis (MVA), respectively. Results: A total of 483 pts were enrolled in this study: 271 in IM, 105 in Nilo, and 107 in Dasa. Patient characteristics and outcomes are summarized in Table 1. Median age at diagnosis was 48 years, and median follow-up was 85M and ongoing (5-154+). Time from diagnosis to start of TKI, Sokal risk score, and ALC at baseline between groups did not differ clinically. Of 481 pts, 93 (19%) developed RLC at 3 or 6M; IM, 38 (14%); Nilo, 23 (22%); Dasa, 32 (30%) (p= .001). ALC at 3 or 6M was observed in 15 (3%); IM, 3 (1%); Nilo, 1 (1%); Dasa, 11 (10%) (p<.001). Overall, cumulative incidence of complete cytogenetic response (CCyR) at 6M, major molecular response (MMR) at 12M, molecular response with 4.5 log reduction by IS (MR4.5) at 24M did not differ significantly between RLC and non-RLC (3 or 6M), or between ALC and non-ALC (3 or 6M). 5-y TFS, EFS and OS in ALC group were significantly worse than those in non-ALC group (p= .002, p=.016, p=.008, respectively). By UVA and MVA related to OS, age [p <.001; Hazard ratio (HR), 1.062; 95% confidence interval (95%CI), 1.036-1.089], presence of ALC at 3 or 6M [p = .028; HR, 10.948; 95%CI, 1.297-92.415], absence of MMR at 24M [p=.016; HR, 2.263; 95%CI, 1.165-4.393] were identified as adverse prognostic factors for OS. Conclusion: The presence of ALC ≥4,000/µL at 3 or 6M of TKI therapies is rare but is adversely associated with overall survival. Table 1. Patient Characteristics and Outcomes (N=483)a Overall [n= 481] IM [n= 271] Nilo [n= 105] Dasa [n= 107] Age, (year) 48 (15-85) 48 (15-85) 49 (17-82) 48 (16-83) Sokal Risk, No. (%) Low 334 (69) 175 (65) 79 (75) 80 (75) Intermediate 114 (24) 74 (27) 18 (17) 22 (21) High 32 (7) 20 (7) 8 (8) 4 (4) Time from diagnosis to start of TKI, (M) 0.9 (0-12.6) 1.0 (0-12.6) 0.5 (0-5.6) 0.7 (0.1-7.8) ALC at baseline, (/109L) 2.5 (0-86.6) 2.4 (0-16.7) 2.6 (0.4-9.2) 2.7 (0.3-86.6) Incidence of Relative Lymphocytosis, No. (%) At 3M 65 (14) 25 (9) 16 (15) 24 (22) At 6M 76 (16) 32 (12) 20 (19) 24 (22) Overall 93 (19) 38 (14) 23 (22) 32 (30) Incidence of Absolute Lymphocytosis, No. (%) At 3M 8 (2) 1 (0) 0 7 (7) At 6M 11 (2) 3 (1) 1 (1) 7 (7) Overall 15 (3) 3 (1) 1 (1) 11 (10) Outcomes of RLC and ALC at any time in each group, +/- (%/%) (p) <10% BCR-ABL/ABL at 3M RLC 36/40 (.596) 22/44 (.213) 50/37 (.280) 31/38 (.537) ALC 38/39 (.952) 0/42 (.394) 100/39 (.214) 36/35 (.952) Cumulative CCyR at 6M RLC 75/75 (.288) 50/66 (.063) 96/90 (.413) 90/87 (.628) ALC 67/75 (.711) 33/64 (.276) 0/92 (.001) 82/89 (.599) Cumulative MMR at 12M RLC 67/74 (.406) 53/70 (.030) 83/82 (.921) 72/74 (.903) ALC 60/73 (.488) 33/68 (.197) 0/83 (.033) 73/74 (.745) Cumulative MR4.5 at 24M RLC 46/52 (.564) 37/50 (.139) 57/55 (.889) 50/57 (.729) ALC 33/52 (.332) 33/48 (.610) 0/56 (.264) 36/57 (.252) 5-y FFS RLC 61/71 (.133) 56/69 (.167) 62/70 (.710) 61/74 (.285) ALC 50/69 (.076) 0/68 (<.001) 0/70 (<.001) 71/70 (.974) 5-y TFS RLC 90/93 (.369) 88/93 (.597) 91/88 (.115) 91/99 (.213) ALC 72/93 (.002) 67/93 (.014) 0/90 (<.001) 80/97 (.121) 5-y EFS RLC 80/86 (.213) 71/83 (.154) 84/87 (.450) 86/93 (.486) ALC 64/85 (.016) 33/82 (<.001) 0/87 (<.001) 80/92 (.574) 5-y OS RLC 89/93 (.068) 81/94 (.007) 100/84 (.126) 96/99 (.207) ALC 82/93 (.008) 67/93 (.001) 100/88 (.847) 83/99 (.040) a Two in IM and 1 in Dasa were not evaluable due to lack of differential data at 3 and 6M. Figure 1. OS in Pts with ALC Figure 1. OS in Pts with ALC Disclosures O'Brien: Amgen, Celgene, GSK: Consultancy; CLL Global Research Foundation: Membership on an entity's Board of Directors or advisory committees; Emergent, Genentech, Gilead, Infinity, Pharmacyclics, Spectrum: Consultancy, Research Funding; MorphoSys, Acerta, TG Therapeutics: Research Funding.

5540 Background: Primary debulking surgery (PDS) has been considered the standard of treatment in advanced ovarian cancer, while neoadjuvant chemotherapy, three cycles followed by interval debulking (ID) surgery, is a valid treatment alternative for patients with non-resectable disease. This study aimed to show the efficacy and safety of six cycles of neoadjuvant chemotherapy (N-CT) followed by cytoreduction, a single institution experience. Methods: Aretrospective analysis was performed of all patients (pts) with advanced ovarian cancer treated with platinum based N-CT, between January/2004 and February/2012. Results: 97 pts underwent N-CT in our institution; 78.1% and 18.8% the patients had extensive stage IIIC or IV disease at diagnosis, respectively. Median age 60 years (36 – 82). Histologic types: serous 84.5%, adenocarcinoma not specified 11.3%, endometrioide 1.0%. A median of six cycles of chemotherapy were performed. Patients did not received chemotherapy after debulking surgery. During the treatment 31.4% had grade 3/4 toxicity, the most commonly observed toxicities were hematologic toxicities and nausea, four (4.1%) patients died during chemotherapy due to disease progression. After N-CT 24.7% achieved clinical complete response, 57.7% partial response and 12.4% disease progression. From this cohort 63.1% underwent a complete resection of all macroscopic and microscopic disease (R0). Median length of hospital stay and postoperative ICU stay was 5 and 0.8 days respectively, surgical complications were not common however five (7.1%) patients needed second surgery due to operatory complications and 19 pts (27.1%) needed blood transfusion after debulking. With a median follow up of 21.8 months (0.5-139.7), median overall survival and chemotherapy-free interval were 57,7 and 9,5 months, respectively. Conclusions: Six cycles of neoadjuvant carboplatin and paclitaxel is safe, effective and does not increase perioperative and postoperative complications for patients with stage IIIC-IV not candidates for optimal/R0 PDS. The overall survival of this cohort is higher than those treated with interval debulking surgery.

Background:Limited real world (RW) data are available for IL-17A blocker ixekizumab (Ixe), approved for psoriatic arthritis (PsA) in EU Feb 2018.Objectives:Describe RW outcomes for PsA patients (pts) receiving Ixe.Methods:Cross-sectional, observational study of PsA pts treated with Ixe in the 2020 Adelphi PsA Plus Program (FR, DE, ES & UK). Rheumatologists recruited the first 6 consecutive consulting Ixe pts and provided demographics, PsA manifestations, clinical measures (66 swollen joint count (SJC), 68 tender joint count (TJC), psoriasis area and severity index [PASI], body surface area [BSA] affected by psoriasis [PsO]), rheumatologist-recorded pt measures (skin/joint pain & fatigue [0-10 numeric rating scales (NRS)], health assessment questionnaire [HAQ-DI]) & prescribed dose. All outcomes recorded for pts with scores available at Ixe initiation (II) & at last assessment (LA).Results:124 rheumatologists provided data for 698 Ixe pts, mean age 49 years (19-79), 48% female, mean BMI 27 (18-44), 56% dermatologist co-managed and mean time diagnosed 6 years (0-35). At Ixe initiation, 78% of pts with known BSA had concomitant mod-sev-PsO defined as BSA≥10% (mean 19.8, n=428) and mean PASI 26.3 (n=164). The predominant PsA phenotype was polyarthritic in 49% (n=345), mono/oligoarthritic in 30% (n=208), axial in 12% (n=81) and enthesitic in 8% (n=55). Previous treatment before Ixe included ≥1 conventional synthetic DMARD (csDMARD) for 71% of pts. Of bio-experienced pts (57%), 40% had received ≥2 biologics. Mean Ixe treatment duration (n=698) 39.4 weeks (wks, 0-170), of which 575 (82%) had received >12 wks of Ixe. 71% of pts received label recommended dose (80mg every 4wks). 52% pts received csDMARD in combination with Ixe. In the RW, Ixe improved TJC, SJC, joint pain, BSA, fatigue and HAQ-DI, Table 1.Table 1.Outcomes for pts receiving Ixe >12weeks (n=575)OverallBSA ≥10% at Ixe initiationMod-sev-PsO physician judgementPredominant mono/oligo arthritisPredominant polyarthritisWith csDMARDWithout csDMARDBSA, n35627025498184188168mean [SD]Ixe initiation (II)19.8 [14.8]24.7 [13.5]23.1 [13.6]17.4 [15.0]20.9 [15.0]21.8 [15.0]17.4 [14.2]Last Assessment (LA)6.6 [7.5]9.3 [8.7]7.9 [7.9]5.0 [6.0]7.6 [8.4]7.3 [7.9]5.9 [7.1]Mean weeks on Ixe43414150414146TJC*, n125728639725669mean [SD, %<5]II12.2 [10.6, 29]14.4 [11.3, 18]12.9 [11.1, 21]6.4 [8.2, 59]15.4 [10.8, 12]13.0 [9.9, 25]11.5 [11.1, 32]LA4.1 [6.4, 77]5.2 [7.7, 71]3.6 [6.3, 80]1.1 [1.4, 97]6.2 [7.7, 64]3.4 [3.9, 73]4.6 [7.8, 80]SJC*, n1458210244846085mean [SD, %<5]II14.8 [13.5, 33]18.8 [14.4, 22]16.3 [13.8, 26]7.2 [8.5, 68]18.2 [13.6, 12]14.5 [12.0, 37]15.1 [14.8, 31]LA4.8 [8.7, 79]7.0 [10.7, 66]5.1 [9.3, 75]0.9 [1.9, 95]6.6 [9.0, 68]3.1 [7.8, 90]5.9 [9.1, 71]Joint pain (NRS 0-10), n575270349166291294281mean [SD]II6.6 [1.7]6.7 [1.7]6.7 [1.7]6.2 [1.8]7.0 [1.5]6.6 [1.7]6.6 [1.6]LA2.7 [1.9]3.0 [2.1]2.8 [2.0]2.1 [1.6]3.0 [2.1]2.8 [1.9]2.5 [1.9]Fatigue (NRS 0-10), n575270349166291294281mean [SD]II5.4 [2.5]5.8 [2.4]5.7 [2.5]4.7 [2.5]5.7 [2.4]5.7 [2.4]5.1 [2.5]LA2.6 [2.1]2.7 [2.1]2.7 [2.2]2.0 [1.9]2.9 [2.2]2.7 [2.1]2.6 [2.1]HAQ DI, n59414210283128mean [SD, %<0.5]II1.8 [0.7, 5]1.9 [0.6, 0]1.8 [0.7, 2]1.9 [0.7, 10]1.8 [0.8, 7]1.9 [0.6, 3]1.7 [0.8, 7]LA0.8 [0.6, 41]0.8 [0.6, 32]0.8 [0.7, 45]0.7 [0.7, 60]0.7 [0.6, 36]0.7 [0.5, 32]0.7 [0.8, 50]*Additional analysis for pts whose fatigue/joint pain rating improved (from ≥4 at Ixe initiation to ≤3 at LA), their mean TJC was 2.7 & SJC 4.3 at LA for fatigue, TJC 1.7 & SJC 2.7 at LA for joint pain.When BSA was not recorded, physician judgement of PsO severity was used. No imputation of missing data.Conclusion:We report RW outcome data amongst pts treated with Ixe including mono/oligo arthritis and a limited sample of enthesitis and dactylitis pts. Our results are consistent with clinical trial populations across disease domains, including an improvement in joint pain.Disclosure of Interests:William Tillett Speakers bureau: AbbVie, Amgen, Celgene, Lilly, Janssen, Novartis, Pfizer Inc. and UCB, Consultant of: AbbVie, Amgen, Celgene, Lilly, Janssen, Novartis, MSD, Pfizer Inc. and UCB, Grant/research support from: AbbVie, Celgene, Eli Lilly & company, Janssen and UCB, Victoria Navarro-Compán Speakers bureau: AbbVie, BMS, Janssen, Eli Lilly & Co, MSD, Novartis, Pfizer, Roche and UCB, Consultant of: AbbVie, BMS, Janssen, Eli Lilly & Co, MSD, Novartis, Pfizer, Roche and UCB, Grant/research support from: AbbVie, BMS, Janssen, Eli Lilly & Co, MSD, Novartis, Pfizer, Roche and UCB, Nicola Booth: None declared., Thorsten Holzkaemper Shareholder of: Eli Lilly & Company, Employee of: Eli Lilly & Company, Julie Hill Shareholder of: Eli Lilly & Company, Employee of: Eli Lilly & Company, Ennio Lubrano Speakers bureau: Alfa-Sigma, Abbvie, Galapagos, Janssen Cilag, Lilly., Consultant of: Alfa-Sigma, Abbvie, Galapagos, Janssen Cilag, Lilly., Tamas Truer Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company.

BackgroundOsteochondral defects of the talus (ODT) is a relatively rare, mostly traumatic pathology, in 6.5 % of cases complicate the course of inversion and eversion injuries of the foot and ankle [1].ObjectivesTo conduct a clinical analysis of the effectiveness of autologous mosaic osteochondroplasty in the treatment of patients with osteochondral defects of the talus on the basis of determining the dynamics of pain and restoring the amplitude of ankle movements.MethodsThe study included 34 patients with post-traumatic osteochondral defects of the talus (27 men, 7 women, mean age 24.8 ± 2.1 years) who underwent osteochondroplasty. The duration of painful clinical symptoms before osteochondroplasty ranged from 4 to 18 months. Functional treatment outcomes were assessed over a period of 12 to 36 months using the International Foot and Ankle Surgery Scale (AOFAS), pain dynamics were assessed using the Visual Analog Scale (VAS), and ankle movement recovery dynamics were determined.ResultsOsteochondral autologic grafts were removed from the lateral condyle of the ipsilateral femur. Defect sizes: square from 82 to 129 mm2 (110,3 ± 0.8 mm2), depth from 7 to 16 mm (12 ± 0,8 mm). Incorporation of the graft in the recipient bed occurred within 1,5 – 3 months. Long-term follow-up was 12 – 36 months (22,8 ± 3,8 months). The level of pain was decreased from 5,7 ± 0,3 before to 0,9 ± 0,3 after the operation (p < 0.001; paired t-test). Improving of foot function according to AOFAS scale (hindfoot section) was established from 64,9 ± 1,4 to 95,9 ± 1,1 (p < 0.001; paired t-test). Extension increasing from 15,0 ± 0,9 to 18,4 ± 0,7 and flexion increasing from 22,9 ± 1,2 to 30,7 ± 1,1 was registered. There were no cases of implants failure or their instability neither the increasing of degenerative changes in the ankle joint.ConclusionOsteochondroplasty is the effective method of congruity restoration in cases of post-traumatic talus osteochondral defects, promotes a significant reduction in pain syndrome and an improvement in the function of the ankle. The unknown mechanism of the analgesic effect of osteochondroplasty requires further research.References[1]O’Loughlin PF, Heyworth BE, Kennedy JG. Current concepts in the diagnosis and treatment of osteochondral lesions of the ankle. Am J Sports Med. 2010;38:392-404. doi: 10.1177/0363546509336336.Disclosure of InterestsNone declared

Abstract The bifurcation of the pulmonary trunk and trachea were followed on 52 cases being appreciated on the dissection and corrosion pieces and CT examinations, the arterial bifurcation being made under an very variable angle, its value ranging from 30-1080. In 82% of cases the tracheal bifurcation was done under an acute angle, with lower value than the arterial bifurcation angle. In 41 cases (78.85% of cases) the pulmonary trunk bifurcation is done under the bifurcation of the trachea, at a distance of between 0,4 - 2,8 cm, and in 8 patients (15.38% of the cases) the two bifurcations was located at the same level. Only in 3 cases (5.77% of cases), all on CT angiography, we encountered the pulmonary trunk bifurcation above tracheal bifurcation, with 0.3-0.8 cm, bifurcation of the pulmonary trunk being left lying of the tracheal bifurcation. In these cases, the bifurcation angle of the pulmonary trunk is always greater than the angle of the trachea bifurcation. On the dissected and the corrosion pieces is found that when the bifurcation is situated at different levels, the tracheal one being located cranial, the most commonly between them form a rectangular area: rhombus, more frequently, and rectangular or trapezium and rarely a pentagon or triangle. Any geometric shape to be formed between the two junctions, it is often asymmetric.

AbstractObjective:To determine risk factors for colonization with vancomycin-resistant enterococci (VRE) in a hospital outbreak.Design:Outbreak investigation and case-control study.Setting:A referral teaching hospital in Melbourne, Australia.Participants:Cases were inpatients colonized (with or without clinical disease) with VRE between July 26 and November 28, 1998; controls were hospitalized patients without VRE.Methods:Five cases of VRE were identified between July 26 and November 8, 1998, by growth of VRE from various sites. Active case finding by cultures of rectal swabs from patients surveyed in wards was commenced on July 26, after the first isolate of VRE.Results:There were 19 cases and 66 controls. All the VRE identified werevanB, and all wereEnterococcus faecium.One molecular type predominated (18/19 cases). In a logistic-regression model, being on the same ward as a VRE case was the highest risk factor (odds ratio [OR], 82; 95% confidence interval [CI95], 5.7-1,176;P=.001). Having more than five antibiotics (OR 11.9; CI95, 1.1-129.6;P<.05), use of metronidazole (OR 10.9; CI95, 1.7-69.8;P=.01), and being a medical patient (OR 8.1; CI95,1.4-47.6;P<.05) also were significant. Intensive care unit admission was associated with decreased risk (OR, 0.1; CI95, 0.01-0.8;P<.05).Conclusion:Our findings are consistent with an acute hospital outbreak. Monitoring and control of antibiotic use, particularly metronidazole, may reduce VRE in our hospital. Ongoing surveillance and staff education also are necessary.

Background: Chikungunya virus was introduced into the Dhaka city of Bangladesh and triggered a massive outbreak which affected millions of lives and forced upon significant damages in socioeconomic factors. Objectives: This community based descriptive study was conducted in selected area of Dhaka city to see the clinical profiles of chikungunya patients in Dhaka city. Methodology: This prospective observational study was carried out in the Department of Medicine OPD at Shaheed Suhrawardy Medical College & Hospital (ShSMC), Dhaka, Bangladesh. This cross-sectional study was conducted during the peak of chikungunya outbreak (1st March to 31st August, 2018) to document the clinical profiles of confirmed cases (laboratory test positive) and probable cases diagnosed by medical practitioners. Results: The study included 1133 patients (Male 51.9%and Female 48.1%). The main symptoms were Fever (66%), higher in patients with Joint pain (82%), Rash (21.3%) and others (10.1%).Sensitivity of the patients by acute chikungunya 14.3% and other 85.7%. Patients had post chikungunya complications 14.3% and no complications 85.7%. Chikungunya patients increasing month are March 0.5%, April 0.5%, May 3.4%, June 25.8%, July 50.8%, August 19.1%. In Dhaka cities the affected area were Mirpur 41.7%, Mohammadpur 28.9%, Agargaon 8.8%, Tejgoan 5.9%, Shamoly 5.7%, Adabar 4.4%, Savar 2.0%, Rayerbazar 0.9%, Dhanmondi 0.8%, Mohakhali 0.8%. Conclusions: The result found that gender and age are significantly associated with Chikungunya infection. This study will also help to provide support and services to public health science which will eventually contribute the country for the diagnosis, prevention and control of Chikungunya and similar viral diseases. Overall, it necessitates the importance of utilizing appropriate and reliable diagnostic methods, proper surveillance system and effective control measures that must be implemented to manage the disease outbreak situations. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 148-151

Background: Forearm fractures are one of the most common fractures in children. Over the last years, a tendency towards surgical treatment was seen, especially closed reduction and internal fixation with elastic stable internal nailing (ESIN). Despite an overall low complication rate being described, a risk of intraoperative complications remains. Material and Methods: A total of 237 patients (mean age 8.3 ± 3.4 (1–16) years) with forearm or radius fractures treated with ESIN between 2010 and 2020 were included in the study. The retrospective review of 245 focused on fracture pattern, pre- and postoperative fracture angulation, intra- and postoperative complications, and surgical approach for nail implant. The fracture pattern and pre- and postoperative angulation were measured radiographically. Complications such as ruptures of the extensor pollicis longus (EPL) tendon and sensibility disorders of the superficial radial nerve were further analyzed. Results: In 201 cases (82%), we performed a dorsal approach; 44 fractures (17.9%) were treated with a radial approach. In total, we found 25 (10%) surgery-related complications, of which 21 (8.6%) needed further surgical treatment. In total, we had 14 EPL ruptures (5.7%), 4 sensibility disorders of the superficial radial nerve (1.6%), 2 refractures after implant removal (0.8%), 2 superficial wound infections (0.8%), and 1 child with limited range of motion after surgery (0.4%). No statistical significance between pre- and postoperative angulation correlated to fracture patterns or diameter of the elastic nail was seen. As expected, there was a significant improvement of postoperative angulation. Using radial approach in distal radial fractures showed a lower rate of surgical related complications, 2.3% of which need further surgical treatment as well as better postoperative angulations compared to the dorsal approach (8.5%). Conclusion: Especially due to the low risk of damaging the EPL tendon, the radial approach showed a lower complication rate which needed further surgical treatment. The risk of lesions of the superficial radial nerve remains.

The objective of this study is to establish normal ranges for the assessment of lung permeability, using 99mTc DTPA (diethylene triamine penta acetate) aerosol by measuring the half-time of transfer from the lung in asymptomatic HIV-positive patients. Also to audit the use of the test in the clinical management of outpatients with symptoms suggestive of Pneumocystis carinii pneumonia (PCP). A retrospective analysis of data from outpatients' notes for the audit of symptomatic patients, and prospective acquisition of 'normal' data for HIVpositive asymptomatic patients who were non-smokers and smokers was performed. Over a period of 8 years, DTPA scans were performed on 400 asymptomatic HIV-positive patients (121 non-smokers and 279 smokers) and 188 symptomatic HIV-positive patients with symptoms suggestive of PCP. A biphasic curve of transfer of 99mTc DTPA with a half-time of less than 4 min, was considered diagnostic of PCP. The mean half-times ( SEM) for asymptomatic non-smokers was 61.4 3 min and for smokers was 21.9 0.8 min. In the symptomatic patients, 106 were treated for PCP and in 97 (91.5%) of these, the transfer was biphasic. Of the remaining 82 patients with respiratory pathology other than PCP, 71 (86.6%) had normal scans. The results show that smokers may have abnormal baseline scans 16/ 279 (5.7%) and therefore a baseline scan before symptoms should be recorded or a higher false positive rate can be expected. The test is however highly sensitive for the detection of PCP and allows the attending physician to initiate PCP treatment without delay.

Current imaging techniques based on optical coherence tomography (OCT) angiography are useful for observing different retinal microcirculation patterns. The primary purpose of this chapter was to describe the functional, structural, and serial perfusion postoperative outcomes of successfully reattached macula-off tractional retinal detachment (TRD). Patients who underwent a successful diabetic vitrectomy were analyzed. The mean differences between the preoperative best-corrected visual acuity (BCVA), 3-month BCVA, and final postoperative BCVA were statistically significant (p < 0.05). The duration of vision loss before surgery was 11.6 ± 2.3 weeks (mean ± standard deviation (SD)). The mean duration (± SD) of the resolution of macular detachment was 3.6 ± 1.7 weeks in the pure macular TRD group and 1.8 ± 0.8 weeks in the combined tractional and rhegmatogenous macular detachment (p < 0.05) group. The mean follow-up duration of all patients was 11.4 ± 5.7 months (mean ± SD). Longitudinal multimodal imaging tests revealed abnormal superficial and deep microcirculation patterns with multiple microabnormalities in the foveal avascular zone and different but distinct areas of the non-perfused macula in different OCT angiography slabs. Additionally, disorganization of the retinal inner layers and chronic ischemic macular edema were observed in 82% of eyes examined using the spectral domain (SD) OCT. Therefore, these data suggest that despite the successful anatomical reattachment of the macula, long-term postoperative microcirculatory abnormalities were detected in both groups; however, these abnormalities were predominantly accompanied by severe persistent ischemia in the recurrent TRD group due to the presence of multiple microcirculatory defects.