To determine the diagnostic yield of tests commonly used for vitreous fluid analysis in eyes with suspected intraocular infection or malignancy.
Noncomparative interventional case series.
Forty-four ...consecutive patients (45 eyes) treated from 1998 through 2006 with posterior segment inflammation who underwent pars plana vitrectomy for diagnostic purposes.
Vitreous specimens obtained via pars plana vitrectomy were analyzed by microbiologic culture, cytologic analysis, and flow cytometry.
Diagnostic yield and sensitivity of each test performed on vitreous specimens and visual outcomes of eyes that underwent diagnostic vitrectomy (DVx).
Preoperative diagnoses were infection in 15 eyes and malignancy in 30 eyes. Overall, vitreous analysis identified a specific cause in 9 (20%) of 45 eyes. The overall sensitivity of DVx was 63.6%. The sensitivities of individual tests were: culture, 50%; cytologic analysis, 66.7%; and flow cytometry, 83.3%. The yields of diagnostic tests were: culture, 5.7%; cytologic analysis, 14.3%; and flow cytometry, 20.6%. Final diagnoses were infection in 6 eyes, malignancy in 9 eyes, and idiopathic in 30 eyes. Mean visual acuity improved significantly in the first 6 months after DVx. Visual acuity improved in 60% of eyes, with 37.8% of eyes improving by 3 lines or more.
Analysis of vitreous fluid by widely available tests is useful in identifying intraocular infection or malignancy. Most patients experienced a substantial improvement in vision.
Objective The objective of the study was to describe trends in hysterectomy route at a large tertiary center. Study Design We reviewed all hysterectomies performed at Magee-Womens Hospital from 2000 ...to 2010. This database was chosen over larger national surveys because it has been tracking laparoscopic procedures since 2000, well before laparoscopic hysterectomy International Classification of Diseases , ninth revision (ICD-9) procedure codes were developed. Results There were 13,973 patients included who underwent hysterectomy at Magee-Womens Hospital. In 2000, 3.3% were laparoscopic (LH), 74.5% abdominal (AH), and 22.2% vaginal hysterectomy (VH). By 2010, LH represented 43.5%, AH 36.3%, VH 17.2%, and 3.0% laparoscopic converted to open (LH→AH). Hysterectomies performed for gynecological malignancy represented 24.4% of cases. The average length of stay for benign LH and VH, 1.0 ± 1.0 and 1.6 ± 1.0 days respectively, was significantly shorter than the average 3.1 ± 2.3 day stay associated with AH ( P < .001). The average patient age was 46.9 ± 10.9 years for LH, 51.5 ± 12.1 years for AH, and 51.7 ± 14.1 years for VH, and over the study period there was a significant trend of increasing patient age (b1 = 0.517, 0.583, and 0.513, respectively P < .001 for all). Conclusion The percentage of LH increased over the last decade and by 2010 had surpassed AH. The 43.4% LH rate in 2010 is much higher than previously reported in national surveys. This likely is due to an increase in the number of laparoscopic procedures being performed over the last few years as well as the ability of our study to capture LH prior to development of appropriate ICD-9 procedure codes. Our unique ability to determine hysterectomy route, which predates appropriate coding, may provide a more accurate characterization of hysterectomy trends.
To evaluate the intraocular pressure (IOP) outcomes of patients with noninfectious posterior uveitis treated with a fluocinolone acetonide (FA) intravitreal implant over an 8-year period.
...Retrospective clinical case series.
Forty-seven eyes of 35 patients.
Retrospective review of medical records of all patients receiving FA implants between June 2001 and March 2009 was performed. Data were pooled to record visual acuity (VA) and to characterize the incidence and outcome of glaucoma surgical intervention.
Incidence of glaucoma surgery and IOP before and after glaucoma surgical intervention. Visual acuity before and after FA implant placement.
Nineteen of 42 eyes (45%) receiving FA implants over the course of the study period required glaucoma surgical intervention. Success of IOP-lowering surgery was achieved in 94%, 94%, and 92% of eyes at 6, 12, and 24 months postoperatively. No patient lost more than 1 line of VA. There was an average 2-line gain of acuity at 3 years after FA implant placement for those patients who underwent IOP-lowering surgery.
Patients receiving FA implants have a significant risk of increased IOP that frequently necessitates glaucoma surgery. Glaucoma surgery, when necessary, offers an effective method to decrease IOP.
Proprietary or commercial disclosure may be found after the references.
Episiotomy in the United States: has anything changed? Frankman, Elizabeth A., MD; Wang, Li, MS; Bunker, Clareann H., MPH, PhD ...
American journal of obstetrics and gynecology,
05/2009, Letnik:
200, Številka:
5
Journal Article, Conference Proceeding
Recenzirano
Objective The objective of the study was to describe episiotomy rates in the United States following recommended changes in clinical practice. Study Design The National Hospital Discharge Survey, a ...federal data set sampling inpatient hospitals, was used to obtain data based on International Classification of Diseases , Clinical Modification , 9th revision, diagnosis and procedure codes from 1979 to 2004. Age-adjusted rates of term, singleton, vertex, live-born spontaneous vaginal delivery, operative vaginal delivery, cesarean delivery, episiotomy, and anal sphincter laceration were calculated. Census data for 1990 for women 15-44 years of age was used for age adjustment. Regression analysis was used to evaluate trends in episiotomy. Results The rate of episiotomy with all vaginal deliveries decreased from 60.9% in 1979 to 24.5% in 2004. Anal sphincter laceration with spontaneous vaginal delivery declined from 5% in 1979 to 3.5% in 2004. Rates of anal sphincter laceration with operative delivery increased from 7.7% in 1979 to 15.3% in 2004. The age-adjusted rate of operative vaginal delivery declined from 8.7 in 1979 to 4.6 in 2004, whereas cesarean delivery rates increased from 8.3 in 1979 to 17.2 per 1000 women in 2004. Conclusion Routine episiotomy has declined since liberal usage has been discouraged. Anal sphincter laceration rates with spontaneous vaginal delivery have decreased, likely reflecting the decreased usage of episiotomy. The decline in operative vaginal delivery corresponds to a sharp increase in cesarean delivery, which may indicate that practitioners are favoring cesarean delivery for difficult births.
Objective The purpose of this study was to describe national trends in surgery for female stress urinary incontinence (SUI). Study Design We used data from the National Hospital Discharge Survey, a ...federal dataset sampling patient discharges from US inpatient hospitals. We analyzed patient and hospital demographics and International Classification of Diseases , 9th revision , Clinical Modification (ICD-9-CM) diagnostic and procedures codes for 1979-2004. Age-adjusted rates per 1000 women were calculated with 1990 US Census population data. Results The number of women who have undergone SUI surgery each year increased from 48,345 in 1979 to 103,467 in 2004. In women ≥ 52 years old, the age-adjusted rate more than doubled from 0.64-1.60 procedures per 1000 women; in women < 52 years old, the age-adjusted rate fell from 0.57-0.47. Age-adjusted rates for retropubic urethral suspension (ICD-9-CM, 59.5) fell from 0.37 in 1979 to 0.14 in 2004. For suprapubic sling procedures (ICD-9-CM, 59.4), the age-adjusted rates rose from 0.02 in 1979 to a peak of 0.10 in 1997 and then fell to 0.03 in 2004. Age-adjusted rates for other repair of urinary stress incontinence (ICD-9-CM, 59.79) rose from 0.06 in 1979 to 0.64 in 2004. Conclusion The number of women who have undergone SUI surgery increased significantly from 1979-2004. Because the National Hospital Discharge Survey data do not include ambulatory procedures, accurate information on same-day surgeries is unavailable. Currently no ICD-9-CM procedure code exists specifically for midurethral sling procedures. Both missed sampling of same-day procedures and nonspecific or inaccurate coding may explain the surprising decline in suprapubic sling procedures and the rise in rates of other repair of SUI. A national ambulatory surgical database and a specific code for midurethral sling are needed to capture these important data.
To evaluate the rates of adverse ocular events after intravitreal triamcinolone acetonide (IVTA) injection in patients with and without uveitis.
Retrospective observational case series.
Two hundred ...twenty-two eyes of 173 patients were included in the study: 45 eyes of 31 patients with macular edema (ME) due to uveitis and 177 eyes of 142 patients with ME secondary to other etiologies.
Retrospective review of patients who received IVTA at the Cole Eye Institute for ME attributable to various causes between the years 2001 and 2005. Data review of clinical records included patient demographics, etiology of ME, and adverse outcomes after injection. Rates of adverse outcomes in patients with and without uveitis were compared.
Intraocular pressure (IOP) elevation and posterior subcapsular cataract (PSC) progression.
Uveitis patients were significantly younger, more likely to be female, and more likely to have had prior posterior sub-Tenon's capsule steroid injection and/or glaucoma therapy than their nonuveitis counterparts. In a multivariate analysis adjusting for the differences in these factors, the presence of uveitis was the strongest risk factor for an adverse IOP event (odds ratio, 2.5; 95% confidence interval CI, 1.0-6.1; P = 0.05). The odds of having a documented increase in PSC after IVTA injection were 5.6 times greater in uveitis eyes (P = 0.007; 95% CI, 1.6-19.6).
Intraocular pressure elevation and PSC progression occurred with greater frequency in uveitis patients receiving IVTA. Patients with uveitis treated with IVTA should be counseled about these risks and monitored closely.
Objective The purpose of this study was to describe national rates and trends of prophylactic bilateral oophorectomy or remaining oophorectomy (BO/RO) at hysterectomy in women without specific ...gynecologic disease. Study Design Data from the National Hospital Discharge Survey were analyzed for 1979-2004. Hysterectomies were divided into 2 groups: (1) hysterectomy with BO/RO and (2) hysterectomy alone (≥1 ovary remaining). Age-adjusted rates (AARs) were calculated with 2000 US census data. Results Approximately 3,686,000 hysterectomies with BO/RO were performed from 1979-2004. AARs of hysterectomy with BO/RO decreased during this period; the AARs in women ≥50 years old increased. The number of hysterectomies alone was 5,461,100, and AARs of hysterectomy alone decreased significantly from 2.9 per 1000 women in from 1979-1981 to 1.1 per 1000 women in 2001 ( P < .001). The proportion of women who underwent hysterectomy with BO/RO increased from 29% in 1979 to 45% in 2004. Conclusion Although AARs of prophylactic BO/RO decreased from 1979-2004, the actual proportion of BO/RO at hysterectomy increased.
Lower urinary tract injury in women in the United States, 1979–2006 Frankman, Elizabeth A., MD, MSc; Wang, Li, MS; Bunker, Clareann H., MPH, PhD ...
American journal of obstetrics and gynecology,
05/2010, Letnik:
202, Številka:
5
Journal Article, Conference Proceeding
Recenzirano
Odprti dostop
Objective We sought to determine age-adjusted rates (AARs) of lower urinary tract injury and incidence in selected inpatient gynecologic and obstetric procedures. Study Design We utilized the ...National Hospital Discharge Survey, 1979–2006. AARs of nonobstetric bladder and ureteral injuries and incidence of lower urinary tract injury for various hysterectomy types and deliveries were calculated for women >18 years old. Results Overall AARs of ureteral injury decreased from 0.06–0.03 per 1000 women (1979–2006). AARs of inpatient gynecologic procedures decreased from 24.9–11.8 per 1000 women (1979–2006). By hysterectomy type, bladder injury was highest in laparoscopic-assisted vaginal hysterectomy (VH) (13.8 per 1000) and VH (13.1 per 1000). Ureteral injury recognized during hysterectomy was most common with radical hysterectomy (7.7 per 1000) and least common with laparoscopic-assisted VH (0 per 1000). Conclusion Ureteral injuries at time of inpatient surgical procedures have decreased from 1979–2006. This corresponds with a sharp decrease in inpatient gynecologic procedures.
Purpose To report a case of cytomegalovirus (CMV) retinitis after placement of a fluocinolone acetonide (Retisert™) implant. Design Interventional case report. Methods Retrospective chart review. ...Results A 65-year-old man with a history of Adamantiades-Behcet disease and bilateral recurrent uveitis that was unresponsive to systemic corticosteroid-sparing immunosuppressive therapy developed clinical evidence of CMV retinitis after receiving his second intravitreal Retisert™ implant in the left eye, while on no systemic immunosuppression. He did not develop CMV retinitis in the right eye despite multiple intraocular and periocular steroid injections. The patient responded well to intravitreal foscarnet followed by placement of an intravitreal ganciclovir implant. Conclusions Ophthalmologists should be aware of the potential risk for development of CMV retinitis after local ocular immunosuppressive therapy.
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