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Meyer CH, Holstein R, McGeoch C, Hudak L, Smith RN. Patterns of firearm related injury in the elderly: A single institution analysis. Injury 2024; 55:111307. [PMID: 38342701 PMCID: PMC11023746 DOI: 10.1016/j.injury.2023.111307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 12/14/2023] [Accepted: 12/29/2023] [Indexed: 02/13/2024]
Abstract
BACKGROUND Firearm-related violence (FRV) is a public health crisis in the United States that impacts individuals across the lifespan. This study sought to investigate patterns of injury and outcomes of firearm-related injury (FRI) in elderly victims and the impact of social determinants of health on this age demographic. METHODS A retrospective review of the trauma registry at a large Level I center was performed from 2016-2021. Patients over age 18 were included and FRI was defined by ICD 9 and 10 codes. Comparisons were then made between elderly (age > 65 years) and non-elderly (age 18-64 years) victims. The primary outcome was mortality. Secondary outcomes included hospital and intensive care unit length of stay, in-hospital complications and the impact of distressed community index (DCI) and insurance status on discharge disposition. RESULTS 23,975 patients were admitted for traumatic injury and 4,133 (6 %) were elderly. Of these, 134 had penetrating injuries and 72 (54 %) were FRI. The elderly patients had a median age of 69y and they were predominantly black (50 %) males (85%). Over 75 % had some form of government insurance compared to less than 20% in non-elderly (p<0.001). 33 % of elderly FRIs were self-inflicted compared to only 4 % in the non-elderly cohort and their overall mortality rate was 25 % versus 15 % in non-elderly with FRI (p = 0.038). The median DCI for the non-elderly victims was 72.3 [IQR 53.7-93.1] compared to 63.7 [IQR 33.2-83.6] in the elderly (p < 0.001), however, over 50 % of elderly victims were living in "at risk" or "distressed" communities. CONCLUSION FRV is a public health crisis across the lifespan and elderly individuals represent a vulnerable subset of patients with unique needs and public health considerations. While many interventions target youth and young adults, it is imperative to not overlook the elderly in injury prevention efforts, particularly self-directed violence. Additionally, given most elderly victims were on government funded insurance and had a higher likelihood of requiring more costly discharge dispositions, new policies should take into consideration the potential financial burden of FRV in the elderly.
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Affiliation(s)
- Courtney H Meyer
- Grady Health System, Atlanta, GA, US; Emory University School of Medicine, Atlanta, GA, US; Rollins School of Public Health, Emory University, Atlanta, GA, US
| | | | | | - Lauren Hudak
- Grady Health System, Atlanta, GA, US; Emory University School of Medicine, Atlanta, GA, US; Rollins School of Public Health, Emory University, Atlanta, GA, US
| | - Randi N Smith
- Grady Health System, Atlanta, GA, US; Emory University School of Medicine, Atlanta, GA, US; Rollins School of Public Health, Emory University, Atlanta, GA, US.
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2
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Dantes G, Meyer CH, Ciampa M, Antoine A, Grise A, Dutreuil VL, He Z, Smith RN, Koganti D, Smith AD. Management of complex pediatric and adolescent liver trauma: adult vs pediatric level 1 trauma centers. Pediatr Surg Int 2024; 40:100. [PMID: 38584250 DOI: 10.1007/s00383-024-05673-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE Management of high-grade pediatric and adolescent liver trauma can be complex. Studies suggest that variation exists at adult (ATC) vs pediatric trauma centers (PTC); however, there is limited granular comparative data. We sought to describe and compare the management and outcomes of complex pediatric and adolescent liver trauma between a level 1 ATC and two PTCs in a large metropolitan city. METHODS A retrospective review of pediatric and adolescent (age < 21 years) patients with American Association for the Surgery of Trauma (AAST) Grade 4 and 5 liver injuries managed at an ATC and PTCs between 2016 and 2022 was performed. Demographic, clinical, and outcome data were obtained at the ATC and PTCs. Primary outcomes included rates of operative management and use of interventional radiology (IR). Secondary outcomes included packed red blood cell (pRBC) utilization, intensive care unit (ICU) length of stay (LOS), and hospital LOS. RESULTS One hundred forty-four patients were identified, seventy-five at the ATC and sixty-nine at the PTC. The cohort was predominantly black (65.5%) males (63.5%). Six injuries (8.7%) at the PTC and forty-five (60%) injuries at the ATC were penetrating trauma. Comparing only blunt trauma, ATC patients had higher Injury Severity Score (median 37 vs 26) and ages (20 years vs 9 years). ATC patients were more likely to undergo operative management (26.7% vs 11.0%, p = 0.016) and utilized IR more (51.9% vs 4.8%, p < 0.001) compared to the PTC. The patients managed at the ATC required higher rates of pRBC transfusions though not statistically significant (p = 0.06). There were no differences in mortality, ICU, or hospital LOS. CONCLUSION Our retrospective review of high-grade pediatric and adolescent liver trauma demonstrated higher rates of IR and operating room use at the ATC compared to the PTC in the setting of higher Injury Severity Score and age. While the PTC successfully managed > 95% of Grade 4/5 liver injuries non-operatively, prospective data are needed to determine the optimal algorithm for management in the older adolescent population. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Goeto Dantes
- Department of Surgery, Emory University, 3052 Trafalgar Way, Chamblee, Atlanta, GA, 30341, USA.
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
- Morehouse School of Medicine, Morehouse College, Atlanta, GA, USA.
| | - Courtney H Meyer
- Department of Surgery, Emory University, 3052 Trafalgar Way, Chamblee, Atlanta, GA, 30341, USA
- Morehouse School of Medicine, Morehouse College, Atlanta, GA, USA
- Department of Trauma and Acute Care Surgery, Grady Memorial Health, Atlanta, GA, USA
| | - Maeghan Ciampa
- Morehouse School of Medicine, Morehouse College, Atlanta, GA, USA
- Department of Trauma and Acute Care Surgery, Grady Memorial Health, Atlanta, GA, USA
| | - Andreya Antoine
- Morehouse School of Medicine, Morehouse College, Atlanta, GA, USA
- Department of Trauma and Acute Care Surgery, Grady Memorial Health, Atlanta, GA, USA
| | - Alison Grise
- Morehouse School of Medicine, Morehouse College, Atlanta, GA, USA
- Department of Trauma and Acute Care Surgery, Grady Memorial Health, Atlanta, GA, USA
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Valerie L Dutreuil
- Emory Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Morehouse School of Medicine, Morehouse College, Atlanta, GA, USA
| | - Zhulin He
- Emory Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Morehouse School of Medicine, Morehouse College, Atlanta, GA, USA
| | - Randi N Smith
- Department of Surgery, Emory University, 3052 Trafalgar Way, Chamblee, Atlanta, GA, 30341, USA
- Morehouse School of Medicine, Morehouse College, Atlanta, GA, USA
- Department of Trauma and Acute Care Surgery, Grady Memorial Health, Atlanta, GA, USA
| | - Deepika Koganti
- Department of Surgery, Emory University, 3052 Trafalgar Way, Chamblee, Atlanta, GA, 30341, USA
- Morehouse School of Medicine, Morehouse College, Atlanta, GA, USA
- Department of Trauma and Acute Care Surgery, Grady Memorial Health, Atlanta, GA, USA
| | - Alexis D Smith
- Department of Surgery, Emory University, 3052 Trafalgar Way, Chamblee, Atlanta, GA, 30341, USA
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Morehouse School of Medicine, Morehouse College, Atlanta, GA, USA
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Meyer CH, Aworanti E, Santos A, Castater C, Bauman ZM, Archer-Arroyo K, Sola R, Grant A, Smith RN, Sciarretta JD, Nguyen JH. Is Traumatic Anterior Stove-In Chest Truly so Rare? A Single Institution Experience. Am Surg 2024; 90:695-702. [PMID: 37853722 PMCID: PMC10922850 DOI: 10.1177/00031348231209530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
INTRODUCTION The anterior stove-in chest (ASIC) is a rare form of flail chest involving bilateral rib or sternal fractures resulting in an unstable chest wall that caves into the thoracic cavity. Given ASIC has only been described in a handful of case reports, this study sought to review our institution's experience in the surgical management of ASIC injuries. METHODS A retrospective review of patients with ASIC was conducted at our level I trauma center from 1//2021 to 3//2023. Information pertaining to patient demographics, fracture pattern, operative management, and outcomes was obtained and compared across patients in the case series. RESULTS 6 patients met inclusion criteria, all males aged 37-78 years. 5 suffered motor vehicle collisions, and 1 was a pedestrian struck by an automobile. The median injury severity score was 28. All received ORIF within 5 days of admission, most commonly for ongoing respiratory distress. Patients 2 and 4 underwent bilateral ORIF of the ribs and sternum while patients 1, 5, and 6 underwent left-sided repair. Patient 3 required ORIF of left ribs and the sternum to stabilize their injuries. 5 of 6 patients were liberated from the ventilator and survived to discharge. CONCLUSIONS This study demonstrates successful operative management of 6 patients with ASIC and suggests that early operative intervention with ORIF for affected segments may improve respiratory mechanics, ability to wean from the ventilator, and overall survival. Further research is needed to generate standardized guidelines for the management of this uncommon and complex thoracic injury.
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Affiliation(s)
- Courtney H. Meyer
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Adora Santos
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
| | - Christine Castater
- Grady Health System, Atlanta, GA, USA
- Morehouse School of Medicine, Atlanta, GA, USA
| | | | - Krystal Archer-Arroyo
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
| | | | | | - Randi N. Smith
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jason D. Sciarretta
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
| | - Jonathan H. Nguyen
- Grady Health System, Atlanta, GA, USA
- Morehouse School of Medicine, Atlanta, GA, USA
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4
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Mlaver E, Meyer CH, Codner JA, Solomon G, Sharma J, Krause M, Vassy WM, Dente CJ, Todd SR, Ayoung-Chee P. Accuracy of Trauma Surgeons Prospective Estimation of the Injury Severity Score: A Pilot Study. Am Surg 2024:31348241241630. [PMID: 38523563 DOI: 10.1177/00031348241241630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Injury Severity Score (ISS) has limited utility as a prospective predictor of trauma outcomes as it is currently scored by abstractors post-discharge. This study aimed to determine accuracy of ISS estimation at time of admission. Attending trauma surgeons assessed the Abbreviated Injury Scale of each body region for patients admitted during their call, from which estimated ISS (eISS) was calculated. The eISS was considered concordant to abstracted ISS (aISS) if both were in the same category: mild (<9), moderate (9-15), severe (16-25), or critical (>25). Ten surgeons completed 132 surveys. Overall ISS concordance was 52.2%; 87.5%, 30.8%, 34.8%, and 61.7% for patients with mild, moderate, severe, and critical aISS, respectively; unweighted k = .36, weighted k = .69. This preliminarily supports attending trauma surgeons' ability to predict severity of injury in real time, which has important clinical and research implications.
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Affiliation(s)
- Eli Mlaver
- Department of Surgery, Emory University, Atlanta, GA, USA
- Georgia Quality Improvement Program, Madison, GA, USA
| | | | - Jesse A Codner
- Department of Surgery, Emory University, Atlanta, GA, USA
- Georgia Quality Improvement Program, Madison, GA, USA
| | - Gina Solomon
- Georgia Quality Improvement Program, Madison, GA, USA
| | - Jyotirmay Sharma
- Department of Surgery, Emory University, Atlanta, GA, USA
- Georgia Quality Improvement Program, Madison, GA, USA
| | - Morgan Krause
- Northeast Georgia Medical Center, Gainesville, GA, USA
| | - W Matthew Vassy
- Georgia Quality Improvement Program, Madison, GA, USA
- Northeast Georgia Medical Center, Gainesville, GA, USA
| | - Christopher J Dente
- Department of Surgery, Emory University, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
| | - S Rob Todd
- Department of Surgery, Emory University, Atlanta, GA, USA
- Georgia Quality Improvement Program, Madison, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
| | - Patricia Ayoung-Chee
- Grady Memorial Hospital, Atlanta, GA, USA
- Department of Surgery, Morehouse University, Atlanta, GA, USA
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5
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Meyer CH, Nguyen J, ElHabr A, Venkatayogi N, Steed T, Gichoya J, Sciarretta JD, Sikora J, Dente C, Lyons J, Coopersmith CM, Nguyen C, Smith RN. TiME OUT: Time-specific machine-learning evaluation to optimize ultramassive transfusion. J Trauma Acute Care Surg 2024; 96:443-454. [PMID: 37962139 PMCID: PMC10922246 DOI: 10.1097/ta.0000000000004187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Ultramassive transfusion (UMT) is a resource-demanding intervention for trauma patients in hemorrhagic shock, and associated mortality rates remains high. Current research has been unable to identify a transfusion ceiling or point where UMT transitions from lifesaving to futility. Furthermore, little consideration has been given to how time-specific patient data points impact decisions with ongoing high-volume resuscitation. Therefore, this study sought to use time-specific machine learning modeling to predict mortality and identify parameters associated with survivability in trauma patients undergoing UMT. METHODS A retrospective review was conducted at a Level I trauma (2018-2021) and included trauma patients meeting criteria for UMT, defined as ≥20 red blood cell products within 24 hours of admission. Cross-sectional data were obtained from the blood bank and trauma registries, and time-specific data were obtained from the electronic medical record. Time-specific decision-tree models predicating mortality were generated and evaluated using area under the curve. RESULTS In the 180 patients included, mortality rate was 40.5% at 48 hours and 52.2% overall. The deceased received significantly more blood products with a median of 71.5 total units compared with 55.5 in the survivors ( p < 0.001) and significantly greater rates of packed red blood cells and fresh frozen plasma at each time interval. Time-specific decision-tree models predicted mortality with an accuracy as high as 81%. In the early time intervals, hemodynamic stability, undergoing an emergency department thoracotomy, and injury severity were most predictive of survival, while, in the later intervals, markers of adequate resuscitation such as arterial pH and lactate level became more prominent. CONCLUSION This study supports that the decision of "when to stop" in UMT resuscitation is not based exclusively on the number of units transfused but rather the complex integration of patient and time-specific data. Machine learning is an effective tool to investigate this concept, and further research is needed to refine and validate these time-specific decision-tree models. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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Affiliation(s)
- Courtney H Meyer
- Department of Trauma & Surgical Critical Care, Grady Health System, Atlanta, GA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
- Department of Behavioral, Social and Health Sciences, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Jonathan Nguyen
- Department of Trauma & Surgical Critical Care, Grady Health System, Atlanta, GA
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA
| | - Andrew ElHabr
- Department of Operations Research, Georgia Institute of Technology, Atlanta, GA
| | - Nethra Venkatayogi
- Department of Biomedical Engineering, University of Texas at Austin, Austin, TX
| | - Tyler Steed
- Department of Trauma & Surgical Critical Care, Grady Health System, Atlanta, GA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Judy Gichoya
- Department of Trauma & Surgical Critical Care, Grady Health System, Atlanta, GA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Jason D Sciarretta
- Department of Trauma & Surgical Critical Care, Grady Health System, Atlanta, GA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - James Sikora
- Department of Trauma & Surgical Critical Care, Grady Health System, Atlanta, GA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Christopher Dente
- Department of Trauma & Surgical Critical Care, Grady Health System, Atlanta, GA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - John Lyons
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
- Department of Surgery and Emory Critical Care Center, Emory University School of Medicine, Atlanta, GA
| | - Craig M Coopersmith
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
- Department of Surgery and Emory Critical Care Center, Emory University School of Medicine, Atlanta, GA
| | - Crystal Nguyen
- Department of Trauma & Surgical Critical Care, Grady Health System, Atlanta, GA
| | - Randi N Smith
- Department of Trauma & Surgical Critical Care, Grady Health System, Atlanta, GA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
- Department of Behavioral, Social and Health Sciences, Rollins School of Public Health, Emory University, Atlanta, GA
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6
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Meyer CH, Bailey NM, Leslie SL, Thrasher K, Grady Z, Sanders M, Moore E, Nicely KW, Smith RN. Defining Ultra-Massive Transfusion through a Systematic Review. Am J Surg 2024; 228:192-198. [PMID: 38616968 PMCID: PMC11008908 DOI: 10.1016/j.amjsurg.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Background Despite the widespread use of ultra-massive transfusion (UMT) as an intervention for trauma patients in hemorrhagic shock, no standard definition exists. We performed a systematic review to determine a consensus definition for UMT. Methods A search was performed from 1979-2022. The authors screened studies defining UMT and associated outcomes as defined by our prespecified PICO questions. The PRISMA guidelines were used. Results 1662 articles met criteria for eligibility assessment, 17 for full-text review and eight for data extraction. Only two studies demonstrated a consensus definition of UMT, which used ≥20 units of red blood cell product within 24hrs. Parameters associated with increased mortality included lower blood pressure, lower pulse and lower Glasgow Coma Score at the time of presentation and a higher injury severity score and undergoing a resuscitative thoracotomy. Conclusions The absence of a consensus definition for UMT raises challenges from clinical, research and ethical perspectives. Based on our findings, the authors advocate for the feasibility of standardizing the definition of UMT as ≥20 units of red blood cell product within 24hrs.
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Affiliation(s)
- Courtney H Meyer
- Grady Health System, Atlanta, GA
- Emory University School of Medicine, Atlanta, GA
- Emory University Rollins School of Public Health, Atlanta, GA
| | | | - Sharon L Leslie
- Emory University Woodruff Health Sciences Center Library, Atlanta, GA
| | - Kenya Thrasher
- Grady Health System, Atlanta, GA
- Morehouse School of Medicine, Atlanta, GA
| | - Zach Grady
- Grady Health System, Atlanta, GA
- Emory University School of Medicine, Atlanta, GA
| | - M Sanders
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - Erica Moore
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - K W Nicely
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - Randi N Smith
- Grady Health System, Atlanta, GA
- Emory University School of Medicine, Atlanta, GA
- Emory University Rollins School of Public Health, Atlanta, GA
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7
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Campbell B, Meyer CH, Novack JC, Kokabi N, Sciarretta J, Nguyen J. Partial Resuscitative Endovascular Balloon Occlusion of the Aorta Aids in the Successful Non-Operative Management of a Life-Threatening Penetrating Liver Injury. Am Surg 2024:31348241227187. [PMID: 38198603 DOI: 10.1177/00031348241227187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
In recent years, isolated non-operative management of penetrating liver injuries has become the standard of care for the hemodynamically stable patient. However, when the patient becomes hemodynamically unstable, adjuncts such as resuscitative endovascular balloon occlusion of the aorta (REBOA) deployed in Zone 1 can be used to achieve complete aortic occlusion from the celiac axis down. Unfortunately, hemorrhage control through REBOA comes at the risk of deadly intra-abdominal ischemia. Partial REBOA (pREBOA) introduces the opportunity to make targeted changes in volume and thus titrate the amount of aortic occlusion in real-time to adequately manage hemorrhage while allowing some distal blood flow. This is a novel approach and one which may give providers more time to gain definitive hemorrhage control while minimizing the morbidity of ischemia. Here, we present a case of life-threatening penetrating liver injury that was successfully managed non-operatively with the assistance of p-REBOA.
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Affiliation(s)
- Brandi Campbell
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
| | - Courtney H Meyer
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Joseph C Novack
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Nima Kokabi
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Jason Sciarretta
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Jonathan Nguyen
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
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Nguyen J, Archer-Arroyo K, Gross JA, Steenburg SD, Sliker CW, Meyer CH, Nummela MT, Pieracci FM, Kaye AJ. Improved chest wall trauma taxonomy: an interdisciplinary CWIS and ASER collaboration. Emerg Radiol 2023; 30:637-645. [PMID: 37700219 DOI: 10.1007/s10140-023-02171-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE Chest wall injury taxonomy and nomenclature are important components of chest wall injury classification and can be helpful in communicating between providers for treatment planning. Despite the common nature of these injuries, there remains a lack of consensus regarding injury description. The Chest Wall Injury Society (CWIS) developed a taxonomy among surgeons in the field; however, it lacked consensus and clarity in critical areas and collaboration with multidisciplinary partners. We believe an interdisciplinary collaboration between CWIS and American Society of Emergency Radiology (ASER) will improve existing chest wall injury nomenclature and help further research on this topic. METHODS A collaboration between CWIS and ASER gathered feedback on the consensus recommendations. The workgroup held a series of meetings reviewing each consensus statement, refining the terminology, and contributing additional clarifications from a multidisciplinary lens. RESULTS After identifying incomplete definitions in the CWIS survey, the workgroup expanded on and clarified the language proposed by the survey. More precise definitions related to rib and costal cartilage fracture quality and location were developed. Proposed changes include more accurate characterization of rib fracture displacement and consistent description of costal cartilage fractures. CONCLUSIONS The 2019 consensus survey from CWIS provides a framework to discuss chest wall injuries, but several concepts remained unclear. Creating a universally accepted taxonomy and nomenclature, utilizing the CWIS survey and this article as a scaffolding, may help providers communicate the severity of chest wall injury accurately, allow for better operative planning, and provide a common language for researchers in the future.
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Affiliation(s)
- Jonathan Nguyen
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA.
| | | | - Joel A Gross
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Scott D Steenburg
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Clint W Sliker
- Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Courtney H Meyer
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Mari T Nummela
- Department of Radiology, Helsinki University Hospital, Helsinki, Finland
| | - Fredric M Pieracci
- Department of Surgery, University of Colorado School of Medicine, Denver, CO, USA
| | - Adam J Kaye
- Department of Surgery, Overland Park Regional Medical Center, Overland Park, KS, USA
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Meyer CH, Noorbakhsh S, Jackson K, Holstein R, Sola R, Koganti D, Bliton J, Smith A, Doh KF, Chaudhary S, Sciarretta JD, Smith RN. Trends in Adolescent Firearm-Related Injury: A Time Series Analysis. Am Surg 2023; 89:3429-3432. [PMID: 36916309 PMCID: PMC10696842 DOI: 10.1177/00031348231157905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Firearm-related injury (FRI) became the leading cause of death among children/adolescents in 2019. PURPOSE This study sought to determine changes over time in the population of adolescents affected by FRI in Atlanta, Georgia, such that high risk cohorts could be identified. RESEARCH DESIGN City-wide retrospective cohort review. STUDY SAMPLE Adolescent victims (age 11-21 years of age) of FRI, defined by ICD9/10 codes, in Atlanta, Georgia. DATA ANALYSIS Descriptive, multivariate and time series analysis. RESULTS There were 1,453 adolescent FRI victims in this time period, predominantly Black (86%) and male (86.6%). Unintentional injury was higher among ages 11-14 years (43.1%) compared to 15-17 years (10.2%) and 18-21 years (9.3%) (P < .01). FRI affecting females increased at a rate of 8.1 injuries/year (P < .01), and unintentional injuries increased at by 7.6/year (P < .01). Mortality declined from 16% in 2016 to 7.7% in 2021. CONCLUSION Our data provides evidence for firearm policy reform. Interventions should target prevention of intentional injury among AQ4 females and seek to reverse the trend in unintentional injuries.
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Affiliation(s)
- Courtney H. Meyer
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Soroosh Noorbakhsh
- Emory University School of Medicine, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Katie Jackson
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Richard Sola
- Grady Health System, Atlanta, GA, USA
- Morehouse University School of Medicine, Atlanta, GA, USA
| | - Deepika Koganti
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - John Bliton
- Jamaica Hospital Medical Center, Queens, NY, USA
| | - Alexis Smith
- Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Kiesha Fraser Doh
- Emory University School of Medicine, Atlanta, GA, USA
- Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Sofia Chaudhary
- Emory University School of Medicine, Atlanta, GA, USA
- Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Jason D. Sciarretta
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
| | - Randi N. Smith
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Meyer CH, Grant A, Sola R, Gills K, Mora A, Tracy BM, Muralidharan VJ, Koganti D, Todd SR, Butler C, Nguyen J, Hurst S, Udobi K, Sciarretta J, Williams K, Davis M, Dente C, Benjamin E, Ayoung-Chee P, Smith RN. Corrigendum to "Presentation, clinical course and complications in trauma patients with concomitant COVID-19 infection" [Am J Surg 224 (1 Pt B) (2022) 607-611]. Am J Surg 2023; 226:297. [PMID: 36384987 PMCID: PMC9659325 DOI: 10.1016/j.amjsurg.2022.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- C H Meyer
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States; Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - A Grant
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States
| | - R Sola
- Grady Health System, Atlanta, GA, United States; Morehouse School of Medicine, Atlanta, GA, United States
| | - K Gills
- Grady Health System, Atlanta, GA, United States; Morehouse School of Medicine, Atlanta, GA, United States
| | - A Mora
- Emory University School of Medicine, Atlanta, GA, United States; Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - B M Tracy
- The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | | | - D Koganti
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States
| | - S R Todd
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States
| | - C Butler
- Grady Health System, Atlanta, GA, United States; Morehouse School of Medicine, Atlanta, GA, United States
| | - J Nguyen
- Grady Health System, Atlanta, GA, United States; Morehouse School of Medicine, Atlanta, GA, United States
| | - S Hurst
- Grady Health System, Atlanta, GA, United States; Morehouse School of Medicine, Atlanta, GA, United States
| | - K Udobi
- Grady Health System, Atlanta, GA, United States; Morehouse School of Medicine, Atlanta, GA, United States
| | - J Sciarretta
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States
| | - K Williams
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States
| | - M Davis
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States
| | - C Dente
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States
| | - E Benjamin
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States
| | - P Ayoung-Chee
- Grady Health System, Atlanta, GA, United States; Morehouse School of Medicine, Atlanta, GA, United States
| | - R N Smith
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States; Rollins School of Public Health, Emory University, Atlanta, GA, United States.
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Meyer CH, Grant AA, Enofe N, Matey A, Frankinburger E, Sola R, Nguyen J, Andrade IFP, Veselsky SL, Sciarretta J, Williams KN, Kim S, Smith RN. Organ donation after self-inflicted injury: A single institution analysis. Clin Transplant 2022; 36:e14679. [PMID: 35533053 DOI: 10.1111/ctr.14679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study sought to determine the contribution of self-inflicted injury-related deaths to local organ donation rates and analyze contributing factors. METHODS A retrospective review of adult patients with traumatic self-inflicted injuries was performed at a Level I trauma center from 2013 to 2017. Data were obtained from the institutional trauma registry and cross-referenced with the local organ procurement organization (OPO). Referral rates were analyzed and outcomes, demographics and injury characteristics were compared between patients who underwent donation versus those who did not. RESULTS 142 adult patients presented with traumatic self-inflicted injury, and 100 (70.4%) had referral calls made to the local OPO. These patients were predominantly male (83%), and gunshot injuries accounted for 75% of all mechanisms. Sixty-four percent had organ referrals versus tissue referrals (34%), and 17 (26.6%) of those patients went on to donate. The median number of organs procured was 4 [IQR 0-5]. In multivariate analysis, for each year increase in age, patients were less likely to have an organ referral (OR = .96 [95% CI .93-.99]; p = .0134) and less likely to undergo donation (OR = .95 [95% CI .90-.99]; p = .0308). CONCLUSIONS Self-inflicted injury, though tragic, may provide a significant contribution to the limited organ donor registry.
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Affiliation(s)
- Courtney H Meyer
- Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Health System, Atlanta, Georgia, USA.,Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - April A Grant
- Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Health System, Atlanta, Georgia, USA
| | - Nosayaba Enofe
- Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Health System, Atlanta, Georgia, USA
| | | | - Emil Frankinburger
- Grady Health System, Atlanta, Georgia, USA.,Lifelink Foundation, Atlanta, Georgia, USA
| | - Richard Sola
- Grady Health System, Atlanta, Georgia, USA.,Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Jonathan Nguyen
- Grady Health System, Atlanta, Georgia, USA.,Morehouse School of Medicine, Atlanta, Georgia, USA
| | | | - Steven L Veselsky
- Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Health System, Atlanta, Georgia, USA.,West Virginia School of Osteopathic Medicine, Lewisburg, West Virginia, USA
| | - Jason Sciarretta
- Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Health System, Atlanta, Georgia, USA
| | - Keneeshia N Williams
- Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Health System, Atlanta, Georgia, USA
| | - Steven Kim
- Emory University School of Medicine, Atlanta, Georgia, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Randi N Smith
- Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Health System, Atlanta, Georgia, USA.,Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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12
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Meyer CH, Grant A, Sola R, Gills K, Mora AN, Tracy BM, Muralidharan VJ, Koganti D, Todd SR, Butler C, Nguyen J, Hurst S, Udobi K, Sciarretta J, Williams K, Davis M, Dente C, Benjamin E, Ayoung-Chee P, Smith RN. Presentation, clinical course and complications in trauma patients with concomitant COVID-19 infection. Am J Surg 2022; 224:607-611. [PMID: 35534294 PMCID: PMC8978444 DOI: 10.1016/j.amjsurg.2022.03.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/20/2022] [Accepted: 03/23/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study investigated the impact of COVID-19 infection on hospitalized trauma patients. METHODS A retrospective review of hospitalized trauma patients at a level I trauma center was performed from March-December 2020. Data pertaining to patient demographics, presentation and hospital course was compared between COVID positive and negative trauma patients. RESULTS There were 4,912 patients and 179 (3.64%) were COVID-19 positive. Demographics and clinical presentation did not differ significantly between those with and without concomitant COVID-19. However, COVID positive trauma patients had higher rates of acute kidney injury (p = 0.016), sepsis (p = 0.016), unplanned intubation (p = 0.002) and unplanned return to the ICU (p = 0.01). The COVID positive cohort also had longer hospital stays (p < 0.01) with no significant difference in mortality. CONCLUSIONS In the setting of an ongoing pandemic, awareness of the complications COVID positive trauma patients are predisposed to is important for providers.
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Affiliation(s)
- C H Meyer
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA; Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - A Grant
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | - Richard Sola
- Grady Health System, Atlanta, GA, USA; Morehouse School of Medicine, Atlanta, GA, USA.
| | - K Gills
- Grady Health System, Atlanta, GA, USA; Morehouse School of Medicine, Atlanta, GA, USA.
| | - Ariana N Mora
- Emory University School of Medicine, Atlanta, GA, USA; Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - B M Tracy
- The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | | | - D Koganti
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | - S R Todd
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | - C Butler
- Grady Health System, Atlanta, GA, USA; Morehouse School of Medicine, Atlanta, GA, USA.
| | - J Nguyen
- Grady Health System, Atlanta, GA, USA; Morehouse School of Medicine, Atlanta, GA, USA.
| | - S Hurst
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | - K Udobi
- Grady Health System, Atlanta, GA, USA; Morehouse School of Medicine, Atlanta, GA, USA.
| | - J Sciarretta
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | - K Williams
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | - M Davis
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | - C Dente
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | - E Benjamin
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | - P Ayoung-Chee
- Grady Health System, Atlanta, GA, USA; Morehouse School of Medicine, Atlanta, GA, USA.
| | - R N Smith
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA; Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Abstract
Purpose To present a symptomatic optic pit 3 months after a blunt ocular trauma. METHODS A 16-year-old male with unilateral decreased vision was examined with multiple cross-sectional scans using optical coherence tomography (OCT) and kinetic ultrasound at the optic disc and macula. Results Visual acuity was 20/30 OD and 20/20 OS. Fundus examination OD demonstrated an optic pit with a corresponding serous macular detachment. OCT disclosed a schisis-like separation of the inner retinal layer emanating from the optic disc and an outer layer detachment of the retina. B-scan ultrasound disclosed attached Choquet's canal at the optic pit. CONCLUSIONS Patients with optic pit and firm adherent posterior vitreous may develop schisis-like retinal detachments after blunt ocular trauma.
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Affiliation(s)
- C H Meyer
- The Department of Ophthalmology, Philipps-University Marburg, Marburg, Germany.
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14
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Handsfield GG, Knaus KR, Fiorentino NM, Meyer CH, Hart JM, Blemker SS. Adding muscle where you need it: non-uniform hypertrophy patterns in elite sprinters. Scand J Med Sci Sports 2016; 27:1050-1060. [PMID: 27373796 DOI: 10.1111/sms.12723] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2016] [Indexed: 11/30/2022]
Abstract
Sprint runners achieve much higher gait velocities and accelerations than average humans, due in part to large forces generated by their lower limb muscles. Various factors have been explored in the past to understand sprint biomechanics, but the distribution of muscle volumes in the lower limb has not been investigated in elite sprinters. In this study, we used non-Cartesian MRI to determine muscle sizes in vivo in a group of 15 NCAA Division I sprinters. Normalizing muscle sizes by body size, we compared sprinter muscles to non-sprinter muscles, calculated Z-scores to determine non-uniformly large muscles in sprinters, assessed bilateral symmetry, and assessed gender differences in sprinters' muscles. While limb musculature per height-mass was 22% greater in sprinters than in non-sprinters, individual muscles were not all uniformly larger. Hip- and knee-crossing muscles were significantly larger among sprinters (mean difference: 30%, range: 19-54%) but only one ankle-crossing muscle was significantly larger (tibialis posterior, 28%). Population-wide asymmetry was not significant in the sprint population but individual muscle asymmetries exceeded 15%. Gender differences in normalized muscle sizes were not significant. The results of this study suggest that non-uniform hypertrophy patterns, particularly large hip and knee flexors and extensors, are advantageous for fast sprinting.
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Affiliation(s)
- G G Handsfield
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - K R Knaus
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA
| | - N M Fiorentino
- Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, USA
| | - C H Meyer
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA.,Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - J M Hart
- Department of Kinesiology, University of Virginia, Charlottesville, VA, USA.,Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - S S Blemker
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, USA.,Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, USA.,Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
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15
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Affiliation(s)
- C H Meyer
- Klinik Pallas AG, Bahnhofplatz 4, 5000, Aarau, Schweiz,
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16
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Abstract
In March 2011 the new Nintendo 3DS went on sale in Switzerland and Germany. The game console features an attractive 3D display without the need of special glasses. By means of a so-called parallax barrier the depth perception can be increased or even turned off. In adults excessive use may cause symptoms such as headaches, dizziness or nausea. In children a visual impairment could be reinforced and an amblyopia could become manifest. Excessive, long hours of use especially in children could have its risks and the possible long-term effects remain unpredictable. On the other hand in the future it is likely that these kinds of 3D screens will be of considerable diagnostic value in orthoptics. The issue is likely to become a more important issue in everyday life in the future. As there is hardly any information available in the medical literature on this subject it is the aim of this article to provide an overview of the technology and physiology with the advantages and disadvantages.
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Affiliation(s)
- A Pallas
- Augenklinik, Kantonsspital St.Gallen, Rorschacherstr. 95, Haus 04, 9007, St. Gallen, Schweiz.
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17
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Baumüller S, Anhalm H, Müller MF, Meyer CH. [Long-term visual outcome comparison of bilateral implantation of apodised diffractive versus progressive multizonal refractive multifocal intraocular lenses after cataract extraction]. Klin Monbl Augenheilkd 2013; 230:791-5. [PMID: 23959510 DOI: 10.1055/s-0032-1328642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM The aim of this study was to evaluate the functional effect of bilateral implantation of apodised diffractive versus progressive multizonal refractive multifocal intraocular lenses compared to standard monofocal intraocular lenses. PATIENTS AND METHOD 229 patients underwent cataract extraction; 66 Array SA40N (AMO, Irvine, CA, USA), 76 SA60D3 ReSTOR (Alcon, Fort Worth, TX, USA), and 87 MA60AC (Alcon, Fort Worth, TX, USA) were implanted. In this retrospective trial the main outcome measures were near, intermediate, and distance visual acuity and assessment of subjective function by questionnaire. RESULTS Mean follow-up was 4.7 ± 1.4 years with monofocal, 6.6 ± 1.7 with Array and 4.3 ± 1.1 with ReSTOR implants. Uncorrected binocular distance visual acuity was equivalent in the three groups. Uncorrected binocular near and intermediate visual acuity and spectacle independence were significantly higher in the two multifocal groups (p < 0.001). Glare and halos were more bothersome with multifocal than monofocals implants (p < 0.05) and adverse visual symptoms at night with Array implants but equivalent between ReSTOR patients and monofocal patients. Between the two multifocal groups spectacle independence was higher and adverse visual symptoms lower in ReSTOR patients than in Array patients (p < 0.05). ReSTOR patients reported a higher overall visual satisfaction than the other groups (p < 0.001) and rated their vision at 8.8 ± 1.8. Monofocal patients reported a slightly higher satisfaction at 7.6 ± 1.7 compared to Array patients at 6.9 ± 2.6 (p = 0.05). CONCLUSION In this long-term study the highest overall visual satisfaction could be achieved by bilateral implantation of apodised diffractive intraocular lenses.
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Affiliation(s)
- S Baumüller
- Zentrum für Augenheilkunde, Pallas Klinik, Aarau, Switzerland
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18
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Abstract
INTRODUCTION Among the more than 1,500 "Apps" in the health sector numerous medical "Apps" and "Apps" for visually impaired persons are available. METHODS An Internet survey was performed to determine available medical "Apps" and evaluate their usability. The corresponding web pages were evaluated and the described "Apps" evaluated in a first analysis for the medical seriousness and usability. Identified "Apps" were entered again as key words to search for the most current and comprehensive assessment. In addition visual impaired persons possessing and using Smartphones were asked for their personal and subjective experiences and preference of selected "Apps". RESULTS The more than 50 "Apps" examined can be subdivided into different categories (A) stand-alone "Apps" and (B) global positioning system (GPS) driven navigation"Apps". Many "Apps" have only been available for a short time, still having some initial technical problems and are presently under further development. Medical "Apps" can support healthy and visually impaired people in many healthcare areas. A barrier-free access to these new technologies is essential for an unhindered utilization of "Apps" by visually impaired persons. Many "Apps" developed by and for visual impaired people received a high acceptance and popularity in practical applications. CONCLUSION The use of "Apps" in medical healthcare, especially for visually impaired persons, has a great potential to achieve a relief in the clinical provision for visually impaired persons with increasing distribution of smartphones and new technical developments.
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Affiliation(s)
- C H Meyer
- Augenklinik Universität Bonn, Bonn, Deutschland.
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Abstract
Endogenous and exogenous glucocorticoids are suspected to play a key role in the development of central serous chorioretinopathy (CSC), which is characterized by a serous detachment of the neurosensory retina caused by the accumulation of fluid between the retinal pigment epithelium and the photoreceptor layer. We report the case of a patient with pansinusitis who was treated with high-dose corticosteroids and developed CSC. Patients under systemic corticosteroid therapy should be informed about the associated risk and symptoms of CSC.
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Affiliation(s)
- F Alten
- Universitäts-Augenklinik Bonn, Ernst-Abbe-Strasse 2, 53127, Bonn, Deutschland.
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20
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Schmidt JC, Mennel S, Rodrigues EB, Meyer CH. Enhanced visualisation of the vitreous during bimanual vitreous shaving by trans-scleral illumination. Br J Ophthalmol 2010; 94:140; author reply 140-1. [PMID: 20385538 DOI: 10.1136/bjo.2009.160770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Meyer CH. Wie schnell fällt die Avastinkonzentration im Auge ab? Messungen der Pharmakokinetik von Bevacizumab im menschlichen Auge. Klin Monbl Augenheilkd 2009. [DOI: 10.1055/s-0029-1242954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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Lang GE, Mennel S, Spital G, Wachtlin J, Jurklies B, Heimann H, Damato B, Meyer CH. [Different indications of photodynamic therapy in ophthalmology]. Klin Monbl Augenheilkd 2009; 226:725-39. [PMID: 19603375 DOI: 10.1055/s-0028-1109514] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) in eye disease was approved 10 years ago for age-related macular degeneration (AMD). Thereafter it was approved for choroidal neovascularisation (CNV) in pathological myopia. The treatment regimen is based on two prospective, multicentre trials (TAP and VIP studies). MATERIAL AND METHODS In the meantime PDT has been successfully used also in several other ocular diseases. PDT is minimally invasive and has an excellent side effect profile. Different diseases and their treatment with PDT are discussed. RESULTS The treatments of idiopathic CNV, secondary CNV in inflammatory diseases of the retina and choroid, choroidal haemangioma, vasoproliferative tumours, malignant melanoma of the choroid, and central serous chorioretinopathy with PDT are described. In most patients the disease progression can be stopped and in some the PDT treatment results in visual improvement. The prognosis is better in patients with early disease detection and small lesions. CONCLUSION Several retinal and choroidal diseases can be treated successfully with PDT. Except for AMD and pathological myopia, PDT is an off label treatment.
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Affiliation(s)
- G E Lang
- Augenklinik, Universitätsklinikum Ulm.
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23
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Meyer CH, Schalnus R. [Choriodermie in an asymptomatic heterozygotic female conductor]. Klin Monbl Augenheilkd 2009; 226:195-7. [PMID: 19294594 DOI: 10.1055/s-0028-1109077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- C H Meyer
- Augenklinik, Universität Bonn, Bonn.
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Lüchtenberg M, Hoppe T, Ohrloff C, Meyer CH, Schalnus R. [Accessibility of information on eye diseases on the internet for the visually impaired user]. Klin Monbl Augenheilkd 2008; 225:1075-83. [PMID: 19085789 DOI: 10.1055/s-2008-1027636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The number of visually impaired people who use the internet for obtaining health information around the eye, is rising continuously. For this reason the accessibility for visually impaired persons to such websites is an important factor. Our investigation deals with the question: How good is the accessibility for the visually impaired to gather information on eye diseases on the Internet and how could this be improved? MATERIALS AND METHOD After identification using the the search engine "Google", 20 websites of German university eye hospitals have been checked for their accessibility using the modified BITV test which is based upon 52 test criteria. RESULTS On average 70.75 % (+/- 6.19 % min. 56.6 %, max; 86.79 %) of the required accessibility criteria have been fulfilled. This corresponds to an average accessibility value of 70.58 % (+/- 6.69 % min. 56.31 %, max. 89.32 %). According to the BITV test, this means that the average of the analysed websites is not accessible. The improper use of mark-up languages, unclear document or web page titles or missing alternative texts for pictures, graphics and navigation elements and misleading navigational architecture are frequent findings. This builds up the greatest accessibility barriers, although these barriers could be eliminated even with a relatively low expense. CONCLUSION Good accessibility allows not only a barrier-free access to information for visually impaired users but is also a most important feature related to search engine optimisation.
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Affiliation(s)
- M Lüchtenberg
- Klinik für Augenheilkunde, Klinikum der Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
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Meyer CH, Mester U, Ohrloff C. [Dedicated to Professor Peter Knoll on his retirement--a pragmatic innovator]. Klin Monbl Augenheilkd 2008; 225:1001-2. [PMID: 19085776 DOI: 10.1055/s-2008-1027935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Intravitreal injection is generally regarded as safe. Many of the potential complications caused by this procedure are extremely rare and can be avoided by careful inspection beforehand and proper performance of the injection. In rare cases, however, the administered drugs may cause various pharmacological side effects. This article summarizes the safety profiles of Macugen and Lucentis from the drug approval studies and describes initial findings on possible or observed side effects after intravitreal administration of Avastin. In addition, important points to observe in order to avoid intra- and postoperative complications are provided.
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Affiliation(s)
- C H Meyer
- Augenklinik, Universitätsklinikum Bonn, Ernst-Abbe-Strasse 2, 53127, Bonn, Germany.
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Schmidt JC, Meyer CH, Hörle S. Glaukomdrainagesystem nach Molteno bei therapieresistentem Glaukom - eine zweizeitige Operationstechnik zur Vermeidung einer postoperativen Hypotonie. Klin Monbl Augenheilkd 2007; 224:641-6. [PMID: 17717780 DOI: 10.1055/s-2007-963181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The treatment of therapy-resistant secondary glaucoma with cyclodestructive approaches may give rise to unsatisfactory intraocular pressure results, leading to phthisis. A final option may be the implantation of an external glaucoma drainage system (GDS). A consecutive positioning of the drainage system under the conjunctiva and implantation of the drainage tube into the anterior chamber, may result in an uncontrolled reduced of intraocular pressure leading to intraocular haemorrhages into the anterior chamber or vitreous cavity. In particular, expulsive haemorrhages are feared as deleterious complication. PATIENTS AND METHODS 15 patients (15 eyes) with secondary glaucoma received a GDS. All patients were previously unsuccessfully treated by numerous approaches (mean 2.7 times). The mean preoperative intraocular pressure was 37 mmHg (range: 22 to 55 mmHg). We performed a sequential approach: during the first operation we implanted and fixed the resorption site of a Molteno GDS onto the sclera close to the equator in the superotemporal quadrant. After an inflammation-free interval of 2 - 3 weeks we placed the drainage tube into the anterior chamber. The average postoperative follow-up period was 20.5 months (range: 3 to 62 months). RESULTS The implantation of the GDS using a sequential approach was well tolerated by all patients. While 14 out of 15 eyes achieved an IOP of 15 mmHg (range: 12 to 18 mmHg), 2 of them still required additional topical glaucoma treatment. An unsatisfactory IOP regulation was observed in only one eye although a revision surgery was performed postoperatively. Four eyes developed a light anterior chamber haemorrhage that resorbed without serious complications within 3 weeks. A choroidal effusion in one eye was treated by an anterior chamber injection of a viscoelastic gel. CONCLUSION The potential disadvantage of the GDS can be almost completely avoided using a sequential approach. The implant heals well in the subtenon space during the first postoperative week, thus preventing an overfiltration of anterior chamber fluid. Our positive results show that the GDS is an important treatment option in selected patients.
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Affiliation(s)
- J C Schmidt
- Klinik für Augenheilkunde, Philipps-Universität Marburg.
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Schüller C, Schneider M, Meyer CH. Pannusartige Hornhauttrübungen und multiple mesodermale Fehlbildungen bei einem 6-jährigen Jungen. Ophthalmologe 2007; 104:601-2. [PMID: 17096102 DOI: 10.1007/s00347-006-1438-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C Schüller
- Philipps-Universität Marburg, Robert-Koch-Strasse 4, 35037 Marburg, Deutschland
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Affiliation(s)
- C H Meyer
- Zentrum für Augenheilkunde, Philipps-Universität Marburg, 35037, Marburg
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Abstract
BACKGROUND More than 50% of vitrectomies are performed in pseudophakic eyes. There is free communication between the anterior segment of the eye and the vitreous cavity through the zonular fibres of the lens. This means it is possible to use a primary anterior chamber infusion for pars-plana vitrectomy. METHODS For some years, therefore, we have used an anterior chamber approach for the infusion cannula when carrying out such simple vitreo-retinal procedures as silicone oil removal or macular pucker peeling in pseudophakic eyes. RESULTS In all eyes the anterior chamber access was placed via a corneal paracenthesis and during all vitrectomies it was held in place by corneal tissue tone with no need for suturing. Secure wound closure was also achieved without suturing by simply swelling the paracentesis. Conventional sclerotomies were closed with absorbable sutures. During vitrectomy the infusional flow was sufficient to ensure adequate intraocular pressure regardless of intraocular lens type and diameter. CONCLUSIONS In pseudophakic eyes the anterior chamber infusion approach by way of a paracentesis is a safe way of reducing surgical trauma during vitrectomy. It must, however, be borne in mind that when an endotamponade is applied it is necessary to switch the infusion to one of the sclerotomies.
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Affiliation(s)
- J C Schmidt
- Klinik für Augenheilkunde, Philipps-Universität Marburg, Robert-Koch-Strasse 4, 35037 Marburg.
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Abstract
PURPOSE Idiopathic thrombocytopenic purpura (ITP) is characterized by refractory thrombocytopenia, production of autoantibodies, and persistent predisposition to bleeding affecting virtually all mucocutaneous tissues and various organs. METHODS A 50-year-old man with chronic ITP and diabetic maculopathy developed massive preretinal, intraretinal, and numerous subretinal hemorrhages accompanied by impaired vision to 20/400. His platelet count was 1100/microL, hemoglobin concentration was 4.6 mg/dL, however his blood clotting and activated partial thromboplastin time (APTT) maintained a normal 26 sec. RESULTS After a splenectomy the patient was placed on high-dose oral corticosteroids (40 mg/day), immunoglobulin, and CellCept. The platelet count was restored to 25,000/microL within months. Four months later the unaffected retina received a panretinal photocoagulation and intravitreal triamcinolone injection (25 mg). Two years after the thrombolytic event the hemorrhages resolved completely and the patient's vision recovered to 20/100. CONCLUSIONS Repetitive treatments with immunoglobulins and high-dose corticosteroids may increase the platelet count, inducing a complete resorption of the retinal hemorrhages and visual recovery during a long-term follow-up.
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Affiliation(s)
- C H Meyer
- Department of Ophthalmology, University of Bonn, Bonn, Germany.
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Meyer CH, Mennel S, Schmidt JC, Kroll P. Acute retinal pigment epithelial tear following intravitreal bevacizumab (Avastin) injection for occult choroidal neovascularisation secondary to age related macular degeneration. Br J Ophthalmol 2006; 90:1207-8. [PMID: 16929069 PMCID: PMC1857397 DOI: 10.1136/bjo.2006.093732] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Schmidt JC, Mennel S, Hörle S, Meyer CH. High incidence of vitreomacular traction in recurrent choroidal neovascularisation after repeated photodynamic therapy. Br J Ophthalmol 2006; 90:1361-2. [PMID: 16854830 PMCID: PMC1857483 DOI: 10.1136/bjo.2006.094201] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The causes of recurrent choroidal neovascularisation (CNV) after photodynamic therapy (PDT) remain controversial. Subretinal surgery was carried out after unsuccessful PDT. AIMS To determine intraoperatively the status of the posterior vitreous interface. DESIGN Interventional case series. METHODS Conventional three-port vitrectomy was carried out in 10 eyes with CNV that had undergone 1-4 PDT sessions. The vitreous cutter was held close to the edge of the optic nerve to evaluate the status of the posterior vitreous. RESULTS Lesion size showed an increase from 1.5 (standard deviation (SD) 0.53) to 2.3 (SD 0.83) macular photocoagulation study disc diameters, between the first and the last PDT. Intraoperative findings during vitrectomy showed little liquefaction of the vitreous gel and an incomplete posterior-vitreous detachment, with remarkably firm attachments at the macula in all cases (10/10). CONCLUSION We determined an abnormally high incidence of vitreous attachments in eyes with recurrent CNV. Vitreomacular attachments may trigger the progression or recurrence of CNV.
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Affiliation(s)
- J C Schmidt
- Department of Ophthalmology, Philipps-University Marburg, Robert-Koch-Strasse 4, 35037 Marburg, Germany
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Mennel S, Thumann G, Peter S, Meyer CH, Kroll P. Einfluss von Vitalfarbstoffen auf die Funktion der äußeren Blut-Retina-Schranke in vitro. Klin Monbl Augenheilkd 2006; 223:568-76. [PMID: 16855939 DOI: 10.1055/s-2006-926479] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The use of vital dyes in "chromovitrectomy" allows the easier removal of less recognizable structures like epiretinal membranes (EM) or the inner limiting membrane (ILM). In recent years numerous studies demonstrated the use of indocyanine green (ICG), trypan blue (TB) and patent blue (PB) for this indication. Reports of the possible risk of these dyes, i. e. especially ICG, in respect of reduced visual acuity results, possible visual field defects or alterations of the retinal pigment epithelium (RPE) resulted in limitations in their application. MATERIAL AND METHODS Human RPE cells and choroidal endothelial cells were cultured in monolayers on semipermeable membranes representing an in vitro model of the outer blood-retinal barrier. By measurement of the transepithelial electrical resistance (TER) the stable barrier function was determined. Two different models representing an air-filled and a fluid-filled eye were tested on the one hand by addition of the dye to the culture medium and, on the other, by direct application on the cell monolayer. In these two models ICG (5 mg/ml, 0.5 mg/ml, 0.125 mg/ml), TB (1.5 mg/ml, 0.15 mg/ml) and PB (2.4 mg/ml, 0.24 mg/ml) were applied for three minutes and the influence on the barrier function was determined. RPE cell growth was also tested in these two models after the application of ICG, TB and PB. Finally, monolayers of RPE cells were evaluated by transmission electron microscopy (TEM). RESULTS After application of TB, PB and the lowest concentration of ICG of 0.125 mg/ml, the TER remained stable in both models. In contrast, ICG in a concentration of 5 mg/ml and 0.5 mg/ml caused a significant TER decrease in the model of the air-filled eye, whereas no influence on the function of the outer blood-retinal barrier was noted in the model of the fluid-filled eye. RPE cell growth rates were not influenced by the addition of the vital dyes, with the exception of ICG in a concentration of 5 mg/ml in the model of the air-filled eye, resulting in a temporary reduction of the cell count. In good correspondence to these results also in TEM intercellular blisters were noted after application of 5 mg/mL ICG for 3 minutes in the model of the air-filled eye. However, damage to the RPE cells themselves was not obvious. No pathological changes in the TEM were noted after application of TB and PB. CONCLUSIONS The use of PB and TB at the posterior eye segment seems to be safe concerning damage to the PRE and its barrier function. In contrast, ICG in higher concentrations and with longer application times may cause a toxic effect on RPE morphology and function.
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Affiliation(s)
- S Mennel
- Zentrum für Augenheilkunde, Philipps-Universität Marburg, Robert-Koch-Strasse 4, 35037 Marburg.
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Mennel S, Schulze S, Meyer CH. Asymptomatische konzentrische Gesichtsfelddefekte und Optikusatrophie. Ophthalmologe 2006; 103:530-2. [PMID: 16132992 DOI: 10.1007/s00347-005-1263-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- S Mennel
- Klinik für Augenheilkunde, Philipps-Universität, Robert-Koch-Strasse 4, 35037 Marburg.
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Schmidt JC, Meyer CH, Mennel S, Hörle S. Ist die Implantation von 7 mm PMMA-Linsen in der vitreoretinalen Chirurgie up to date? Klin Monbl Augenheilkd 2006. [DOI: 10.1055/s-2006-947025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mennel S, Meyer CH, Schroeder FM. Choriorétinite multifocale, papillite et névrite récurrente dans la maladie des griffes du chat. J Fr Ophtalmol 2005; 28:e10. [PMID: 16395190 DOI: 10.1016/s0181-5512(05)81149-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
To evaluate the causative factor for multifocal chorioretinitis, papillitis, and recurrent optic neuritis. A 41-year-old patient presenting multifocal choroiditis, papillitis, and recurrent optic neuritis was evaluated with funduscopy, angiography (FA), optical coherence tomography (OCT), visual evoked potentials (VEP), and numerous blood laboratory tests. FA and OCT showed multifocal pigment epithelial detachments. VEP showed typical changes for optic neuritis and papillitis. Indirect fluorescent antibody assay disclosed Bartonella henselae. Although cat-scratch disease frequently presents with optic neuritis or neuroretinitis, additional multifocal chorioretinal lesions associated with serous pigment epithelial detachments may occur. In case of recurrent episodes, a detailed laboratory work-up is mandatory to define the appropriate diagnosis and treatment.
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Affiliation(s)
- S Mennel
- Department of Ophthalmology, Philipps-University Marburg, Marburg, Germany.
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Affiliation(s)
- S Mennel
- Klinik für Augenheilkunde, Philipps-Universität Marburg.
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Meyer CH, Rodrigues EB, Mennel S, Schmidt JC. Entwicklungsmuster und klinische Bedeutung von gruppierten kongenitalen Hyperplasien des retinalen Pigmentepithels (CHRPE) „Bärentatzen“. Klin Monbl Augenheilkd 2005. [DOI: 10.1055/s-2005-922153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mennel S, Meyer CH, Schmidt JC. Photodynamische Therapie: Erweiterte Indikationen. Klin Monbl Augenheilkd 2005. [DOI: 10.1055/s-2005-922144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mennel S, Callizo J, Schmidt JC, Meyer CH. Einfluss von Latanoprost auf die Funktion der äußeren Blut-Retina-Schranke – ein in vitro Modell. Klin Monbl Augenheilkd 2005. [DOI: 10.1055/s-2005-922159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schmidt JC, Meyer CH, Mennel S. Der Einfluss des Linsenstatus auf die Makulatransposition. Klin Monbl Augenheilkd 2005. [DOI: 10.1055/s-2005-922152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Meyer CH, Müller C, Mennel S. Einseitige Gesichtsschwellung und Visusminderung. Ophthalmologe 2005; 102:1102-4. [PMID: 15480697 DOI: 10.1007/s00347-004-1132-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- C H Meyer
- Zentrum für Augenheilkunde, Philipps-Universität, Marburg.
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Meyer CH, Mennel S. Vitreomacular traction, macular hole formation, and subfoveal choroidal neovascularization in a patient with age-related macular degeneration. Eye (Lond) 2005; 20:1090-2. [PMID: 16215539 DOI: 10.1038/sj.eye.6702121] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Mennel S, Callizo J, Meyer CH, Kroll P. [Subjective decrease of visual acuity after photodynamic therapy: documentation by optical coherence tomography and its correlation with visual acuity]. Arch Soc Esp Oftalmol 2005; 80:413-6. [PMID: 16059818 DOI: 10.4321/s0365-66912005000700006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
CASE REPORT A 68-year-old patient complained of decreased visual acuity (VA) two days after photodynamic therapy (PDT) had been performed. VA decreased from the pre-operative value of 0.4 to 0.1 on the second postoperative day. With additional + 1.75 diopters, VA was 0.32. Optical coherence tomography (OCT) disclosed a subneuroretinal fluid accumulation causing a serous retinal detachment 600 microm in height. One week postoperatively, neither decreased vision nor retinal elevation were noted. DISCUSSION The temporary subjective decreased VA could be predominantly reduced by adequate refraction. OCT and VA measurements excluded ischemia of the neuroretina or the choroid as a causative factor.
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Affiliation(s)
- S Mennel
- Augenklinik der Philipps Universität Marburg, Germany.
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Mennel S, Droutsas K, Meyer CH, Schmidt JC, Kroll P. Radial optic neurotomy in combined cilioretinal artery and central retinal vein occlusion. Br J Ophthalmol 2005; 89:642-3. [PMID: 15834104 PMCID: PMC1772631 DOI: 10.1136/bjo.2004.054858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
BACKGROUND After photodynamic therapy (PDT) some patients complain about a transient decrease of visual acuity during the first postoperative week. PATIENTS AND METHODS Prior to and at 2 days and 1 week after PDT the following parameters were measured: (1) best corrected visual acuity (VA), (2) changes in refraction, and (3) A scan ultrasound biometry was carried out. Linear and 3-D optical coherence tomography was performed in three cases. A total of 53 PDT treatments were followed-up in 24 patients. RESULTS Comparison of the pre- and postoperative refraction demonstrated a mean hyperopic shift of +0.35 diopters (dpt) in 43% of treatments (23/53) on the second postoperative day. The hyperopic shift reduced to +0.07 dpt after 1 week. The best corrected VA remained stable or was even better in 68% (36/53) on the second postoperative day. A decrease in VA could be noticed in 32% (17/53) at this time which declined to 23% (12/53) after 1 week. Measurement of the cornea-retina distance using A-scan ultrasound biometry disclosed a mean axial reduction of 0,13 mm at the second postoperative day. This correlates closely with an average hyperopic shift of 0,35 dpt. OCT examination disclosed a transient macular edema in the treated retinal areas. CONCLUSIONS A transient hyperopic shift can be measured in 43% on the second postoperative day. The subjective decrease in visual acuity measured over the postoperative days was mainly due to a transient hyperopic shift in our patients. OCT findings disclosed a transient macular edema of the retina treated with PDT, which may relate to a hyperopic shift.
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Affiliation(s)
- S Mennel
- Klinik für Augenheilkunde, Philipps-Universität, Marburg.
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