Methods Retrospective Review (methods + retrospective_review)

Distribution by Scientific Domains


Selected Abstracts


DPT vaccine-induced lipoatrophy: an observational study

INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 10 2007
Kabir Sardana MD, MNAMS
Introduction Diphtheria Pertussis Tetanus (DPT) vaccine is universally used in infants and children. It is generally safe and well tolerated. Local reactions such as erythema, induration, palpable nodules, and injection site abscess are well known. Injection site lipoatrophy has not been reported earlier. Patients and Methods Retrospective review of all cases presenting with lipoatrophy developing at injection site following DPT administration between 2000,2005 in 3 hospitals in New Delhi, India was performed. In each case, the patients were extensively evaluated for other possible causes of lipoatrophy. Results 8 infants (2 boys & 6 girls), age range 4,12 months, had presented with injection site lipoatrophy following DPT vaccination. The duration between the last injection and lipoatrophy ranged from 4 to 8 weeks. All had been administered the vaccine in the buttock instead of the thigh, as generally recommended in infants. Majority (6/8) developed lipoatrophy after the second dose. No systemic causes were found. Conclusion DPT vaccine may, in rare instances, lead to injection site lipoatrophy. Inadvertent administration into the subcutaneous fat of the buttock may have been causative. Other possible mechanisms are discussed. Paramedics and general practitioners need to be educated to administer intramuscular vaccines in the thigh in infants and young children. [source]


GS13P OUTCOME OF TRANS-ANAL EXCISION FOR RECTAL CANCER

ANZ JOURNAL OF SURGERY, Issue 2007
S. Banerjee
Aims The aim of this study is to assess the outcome of trans-anal excision of rectal cancer in a single Surgeon's practice and determine possible selection criteria for this procedure. Methods Retrospective review of hospital records, specimen histopathology and imaging of consecutive patients with rectal cancer undergoing trans-anal excision as the primary treatment. Results 25 patients had trans-anal excision of rectal cancer including 3 cases of carcinoid tumour and 1 case of gastro-intestinal stromal tumour (GIST). 5/25 proceeded to radical rectal resection because of the presence of adverse features including lympho-vascular and peri-neural invasion and poorly differentiated cell type; residual tumour was present in 4/5 cases, nodal metastases in 3/5 patients each of whom received pre-operative chemotherapy and radiotherapy. 2/25 patients developed recurrence at 12 and 48 months from excision. One of these patients had distant recurrence at 12 months having proceeded to radical rectal resection and the other patient (aged 99), managed with trans-anal excision alone, recurred locally at 48 months. Both cases of recurrence were T3 tumours. Overall, 19/20 cases managed with trans-anal excision alone had no recurrence with a follow-up period of 12,48 months. 16 of these patients had T1 malignancy. Conclusion T1 tumours may be treated with trans-excision alone in the absence of adverse pathological features. It is unclear from our study whether T2 should be managed in this way due to their small number in this study and T3 tumours are clearly at high risk of recurrence with this treatment alone. [source]


Rupture of the uterine scar during term labour: contractility or biochemistry?

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 1 2005
Catalin S. Buhimschi
Objective Vaginal birth after a prior low transverse caesarean section (VBAC) is advocated as a safe and effective method to reduce the total caesarean section rate. However, the risk of uterine rupture has dampened the enthusiasm of practising clinicians for VBAC. Uterine rupture occurs more frequently in women receiving prostaglandins in preparation for the induction of labour. We hypothesised that similar to the cervix, prostaglandins induces biochemical changes in the uterine scar favouring dissolution, predisposing the uterus to rupture at the scar of the lower segment as opposed to elsewhere. Design We tested aspects of this hypothesis by investigating the location of uterine rupture associated with prostaglandins and compared it with the sites of rupture in the absence of prostaglandins. Settings Two North American University Hospitals. Population Twenty-six women with a prior caesarean section, experiencing uterine rupture in active labour. Methods Retrospective review of all pregnancies complicated by uterine rupture at two North American teaching hospitals from 1991 to 2000. Main outcome measure Site of the uterine rupture. Results Thirty-four women experienced rupture after a previous caesarean section with low transverse uterine incision. Ten of the women who ruptured (29%) received prostaglandins for cervical ripening (dinoprostone: n= 8 or misoprostol: n= 2) followed by either spontaneous contractions (n= 3) or oxytocin augmentation during labour (n= 7). In 16 women (47%), oxytocin alone was sufficient for the induction/augmentation of labour. Eight (23%) women ruptured at term before reaching the active phase of labour in the absence of pro-contractile agents or attempted VBAC. There were no differences among the groups in terms of age, body mass index, parity, gestational age, fetal weight or umbilical cord pH measurements. Women treated with prostaglandins experienced rupture at the site of their old scar more frequently than women in the oxytocin-alone group whose rupture tended to occur remote from their old scar (prostaglandins 90%vs oxytocin 44%; OR: 11.6, 95% CI: 1.2,114.3). Conclusion Women in active labour treated with prostaglandins for cervical ripening appear more likely to rupture at the site of their old scar than women augmented without prostaglandins. We propose that prostaglandins induce local, biochemical modifications that weaken the scar, predisposing it to rupture. [source]


4235: Vitreoretinal considerations in OOKP

ACTA OPHTHALMOLOGICA, Issue 2010
E HUGHES
Purpose To present the difficulties of managing vitreoretinal complications in patients with OOKP and open a discussion about future strategies to prevent and deal with these problems. Methods Retrospective review of cases. Results Vitreo-retinal complications occurred in 14 of 54 patients receiving OOKP surgery. These included vitreous hemorrhage (4 patients), rhegmatogenous retinal detachment (3 patients), endophthalmitis with retinal detachment (5 patients), endophthalmitis without retinal detachment (1 patient) and intraoperative choroidal hemorrhage (1 patient). Most cases of endophthalmitis presented late and may result from lamina resorption, leak and hypotony. The prognosis of retinal detachment in an eye with OOKP was poor with successful repair in 1 of 3 cases not related to endophthalmitis and 0 of 5 cases with endophthalmitis. Overall, pars plana vitrectomy was performed on 10 occasions (8 patients), of which 2 were endoscopic and 2 utilised a temporary keratoprosthesis. Conclusion There is a relatively high rate of posterior segment problems in OOKP patients and their management is challenging both in assessment (limited view and ultrasound amenability) and surgical approach. Surgical outcomes were poor for these complications. Other concepts in management, including endoscopic vitrectomy at stage I surgery should be considered, which will be discussed. [source]


3334: Corneal dystrophies: the paediatric corneal specialist view

ACTA OPHTHALMOLOGICA, Issue 2010
KK NISCHAL
Purpose To describe the range of corneal dystrophies presenting to a tertiary refferral paediatric ophthalmology centre and the treatment approach to these various dystrophies Methods Retrospective review of case notes between Jan 1999 and March 2010 Results The range of corneal dystrophies presenting varied from Meesmans, Map-Dot , Reis-Buckler, Posterior polymorphous corneal dystrophy, congenital hereditary endothelial dystrophy, Granular and Lattice -Granular and the newly described x linked endothelial corneal dystrophy. The youngest child to present with symptoms was 14 months old. Management approach depended on the ultimate goal of allowing normal visual developemnt until the age of 8 years. Amblyopia plays a great role in the eventual visual outcome in children with corneal transplant surgery also riddled with difficulties in young children. Conclusion The classical descriptions of corneal dystrophies are not how they present in children . Certain symptoms and signs may tip the clinician off to the possibility of a corneal dystrophy. Visual rehabilitation in children is time limited and must be the priority for the treating physician. [source]