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American Journal of Ophthalmology Aug 2021To determine classification criteria for varicella zoster virus (VZV) anterior uveitis. (Comparative Study)
Comparative Study
PURPOSE
To determine classification criteria for varicella zoster virus (VZV) anterior uveitis.
DESIGN
Machine learning of cases with VZV anterior uveitis and 8 other anterior uveitides.
METHODS
Cases of anterior uveitides were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on the diagnosis, using formal consensus techniques. Cases were split into a training set and a validation set. Machine learning using multinomial logistic regression was used on the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the anterior uveitides. The resulting criteria were evaluated on the validation set.
RESULTS
One thousand eighty-three cases of anterior uveitides, including 123 cases of VZV anterior uveitis, were evaluated by machine learning. The overall accuracy for anterior uveitides was 97.5% in the training set and 96.7% in the validation set (95% confidence interval 92.4, 98.6). Key criteria for VZV anterior uveitis included unilateral anterior uveitis with either (1) positive aqueous humor polymerase chain reaction assay for VZV; (2) sectoral iris atrophy in a patient ≥60 years of age; or (3) concurrent or recent dermatomal herpes zoster. The misclassification rates for VZV anterior uveitis were 0.9% in the training set and 0% in the validation set, respectively.
CONCLUSIONS
The criteria for VZV anterior uveitis had a low misclassification rate and seemed to perform sufficiently well for use in clinical and translational research.
Topics: Adolescent; Adult; Aqueous Humor; DNA, Viral; Eye Infections, Viral; Female; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Machine Learning; Male; Middle Aged; Uveitis, Anterior; Young Adult
PubMed: 33845010
DOI: 10.1016/j.ajo.2021.03.037 -
Trauma Case Reports Feb 2021Isolated anterior column and anterior wall fractures are a relatively rare subgroup of acetabular fractures. They represent 6,3% of all acetabular fractures. Surgical...
INTRODUCTION
Isolated anterior column and anterior wall fractures are a relatively rare subgroup of acetabular fractures. They represent 6,3% of all acetabular fractures. Surgical treatment is indicated for fractures with displacement more than 5 mm and when incongruence of the articular surface and/or instability of the joint is evident, in order to allow early mobilization and prevent further complications, such as posttraumatic hip arthritis. Open reduction and internal fixation is the usual standard of care. Closed reduction and percutaneous fixation can be performed in minimally displaced fractures. In the herein article, we describe the unique combination of anterior hip dislocation along with anterior column and anterior wall fractures in a middle-aged patient, after a fall from small height.
CASE REPORT
A 56-year-old female patient was brought to the emergency department after an accidental fall from height less than 2 m. Upon arrival her right hip was abducted, shortened and externally rotated. CT scan of the pelvis revealed anterior dislocation of the right hip, an impaction injury of the femoral head, and fractures of anterior column and anterior wall of the acetabulum. Closed reduction of the hip was performed. Open reduction and internal fixation of the fractures was carried out utilizing the extended Smith-Petersen approach in a scheduled manner 5 days after admission. At one-year follow-up after the injury the patient had returned to all of her pre-injury activities and she was able to walk exercising full weight bearing without residual pain.
CONCLUSION
Anterior hip dislocation with simultaneous isolated anterior column and anterior wall fracture is an injury of rare incidence. Orthopaedic surgeons treating fractures should be aware of this entity and the herein article can serve as a reference regarding the management of such an uncommon injury.
PubMed: 33385058
DOI: 10.1016/j.tcr.2020.100391 -
Arthroscopy, Sports Medicine, and... Jun 2021To determine whether anterior cable tears could be identified at the time of arthroscopic rotator cuff repair and determine the characteristics of the anterior cable...
PURPOSE
To determine whether anterior cable tears could be identified at the time of arthroscopic rotator cuff repair and determine the characteristics of the anterior cable tears identified.
METHODS
From 2016 to 2017 all shoulder arthroscopies had data collected prospectively at the time of surgery, specifically including injury to the capsular and tendon zones of insertion on the greater tuberosity. Anterior cable position and degree of injury and medialization were recorded, as well as complete findings of the diagnostic arthroscopy. The inclusion criterion was primary shoulder arthroscopy. The exclusion criterion was any revision shoulder arthroscopy. All arthroscopic rotator cuff repairs (ARCR) were grouped together and all other nonarthroscopic rotator cuff repair surgeries (non-ARCR) were grouped together.
RESULTS
In total, 118 shoulder arthroscopies had data collected prospectively at the time of surgery: 90 primary shoulder arthroscopies met the inclusion criteria; 28 were excluded because they were revision surgeries. There were 42 patients in the ARCR group (Group 1). Six of these were partial tears, and 36 were full-thickness tears. There were 48 patients in the non-ARCR group (Group 2). The non-ARCR Group 2 served as an anatomic baseline for ARCR Group 1. In all 90 shoulders, the rotator cable and anterior cable were identified. Group 1 (ARCR) incidence of anterior cable tears with abnormal position was 71.4% compared to 2.1% in group 2 (non-ARCR) ( < .001) Group 1 (ARCR) incidence of anterior cable tears with normal anterior cable position (n = 12) was compared to abnormal anterior cable position (n = 30). Injury to the anterior footprint capsular and tendon zones were compared. Normal anterior cable position correlated with no or low-grade injury to anterior footprint capsular zone. (Nimura zone C1). Abnormal anterior cable displacement graded as moderate (n = 20) and severe (n = 10) were compared for injury to the anterior footprint. Moderate displacement correlated with complete or high grade injury to C1 in 85% and complete injury to R1 in 45% ( < .001 and .049). In severe displacement complete C1 injury was 100%, and complete R1 injury was 100% ( < .001 and .001).
CONCLUSIONS
Anterior cable tears are universally identified in ARCR. Three patterns of medial displacement severity correlated with injury to a crucial insertion zone (C1) at the anterior footprint. The degree of anterior cable disruption at the anterior footprint and displacement was commonly disproportionately greater than the injury to the supraspinatus.
LEVEL OF EVIDENCE
Level III, diagnostic study.
PubMed: 34195634
DOI: 10.1016/j.asmr.2021.01.007 -
Orthopaedic Journal of Sports Medicine Apr 2018Glenohumeral instability is a common abnormality, especially among athletes. Previous studies have evaluated outcomes after arthroscopic stabilization in patients with...
BACKGROUND
Glenohumeral instability is a common abnormality, especially among athletes. Previous studies have evaluated outcomes after arthroscopic stabilization in patients with anterior or posterior shoulder instability but have not compared outcomes between groups.
PURPOSE
To compare return-to-sport and other patient-reported outcomes in patients after primary arthroscopic anterior, posterior, and combined anterior and posterior shoulder stabilization.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
Patients who underwent primary arthroscopic anterior, posterior, or combined anterior and posterior shoulder stabilization were contacted at a minimum 2-year follow-up. Patients completed a survey that consisted of return-to-sport outcomes as well as the Western Ontario Shoulder Instability Index (WOSI), Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Sur'geons (ASES) score, and Shoulder Activity Scale.
RESULTS
A total of 151 patients were successfully contacted (anterior: n = 81; posterior: n = 22; combined: n = 48) at a mean follow-up of 3.6 years. No significant differences were found between the groups with regard to age at the time of surgery or time to follow-up. No significant differences were found between the groups in terms of WOSI (anterior: 76; posterior: 70; combined: 78; = .28), SANE (anterior: 87; posterior: 85; combined: 87; = .79), ASES (anterior: 88; posterior: 83; combined: 91; = .083), or Shoulder Activity Scale (anterior: 12.0; posterior: 12.5; combined: 12.5; = .74) scores. No significant difference was found between the groups in terms of the rate of return to sport (anterior: 73%; posterior: 68%; combined: 75%; = .84).
CONCLUSION
Athletes undergoing arthroscopic stabilization of anterior, posterior, or combined shoulder instability can be expected to share a similar prognosis. High patient-reported outcome scores and moderate to high rates of return to sport were achieved by all groups.
PubMed: 29637085
DOI: 10.1177/2325967118763754 -
Transactions of the American... 2007To review the parameters for quantitative assessment of the anterior segment and iridocorneal angle and to develop a comprehensive schematic for the evaluation of angle... (Review)
Review
PURPOSE
To review the parameters for quantitative assessment of the anterior segment and iridocorneal angle and to develop a comprehensive schematic for the evaluation of angle anatomy and pathophysiology by high-resolution imaging.
METHODS
The published literature of the last 15 years was reviewed, analyzed, and organized into a construct for assessment of anterior segment processes.
RESULTS
Modern anterior segment imaging techniques have allowed us to devise new quantitative parameters to improve the information obtained. Ultrasound biomicroscopy, slit-lamp optical coherence tomography, and anterior segment optical coherence tomography provide high-resolution images for analysis of physiologic and pathologic processes. These include iridocorneal angle analysis (eg, angle opening distance, angle recess area, trabecular-iris space area), anterior and posterior chamber depth and area, iris and ciliary body cross-sectional area and volume, quantitative anatomic relationships between structures, and videographic analysis of iris movement and accommodative changes under various conditions. Modern devices permit imaging of the entire anterior chamber, allowing calculation of anterior chamber and pupillary diameters and correlating these with measurement of anterior chamber dynamics in light vs dark conditions. We have tabulated all reported anterior segment measurement modalities and devised a construct for assessment of normal and abnormal conditions.
CONCLUSION
Quantitative measurement of static and dynamic anterior segment parameters, both normal and abnormal, provides a broad range of parameters for analysis of the numerous aspects of the pathophysiology of the anterior segment of the eye.
Topics: Animals; Anterior Chamber; Anterior Eye Segment; Disease Models, Animal; Humans; Macular Degeneration; Radiography; Software; Tomography, Optical Coherence
PubMed: 18427599
DOI: No ID Found -
Neurospine Sep 2020Cervical spine deformity is an uncommon yet severely debilitating condition marked by its heterogeneity. Anterior reconstruction techniques represent a familiar approach...
Cervical spine deformity is an uncommon yet severely debilitating condition marked by its heterogeneity. Anterior reconstruction techniques represent a familiar approach with a range of invasiveness and correction potential-including global or focal realignment in the sagittal and coronal planes. Meticulous preoperative planning is required to improve or prevent neurologic deterioration and obtain satisfactory global spinal harmony. The ability to perform anterior only reconstruction requires mobility of the opposite column to achieve correction, unless a combined approach is planned. Anterior cervical discectomy and fusion has limited focal correction, but when applied over multiple levels there is a cumulative effect with a correction of approximately 6° per level. Partial or complete corpectomy has the ability to correct sagittal deformity as well as decompress the spinal canal when there is anterior compression behind the vertebral body. If pathoanatomy permits, a hybrid discectomy-corpectomy construct is favored over multilevel corpectomies. The anterior cervical osteotomy with bilateral complete uncinectomy may be necessary for angular correction of fixed cervical kyphosis, and is particularly useful in the midcervical spine. A detailed understanding of the patient's local anatomy, careful attention to positioning, and avoiding long periods of retraction time will help prevent complications and iatrogenic injury.
PubMed: 33022158
DOI: 10.14245/ns.2040380.190 -
Neurology and Therapy Dec 2019Currently established and employed biomarkers of Alzheimer's disease (AD) predominantly mirror AD-associated molecular and structural brain changes. While they are... (Review)
Review
Currently established and employed biomarkers of Alzheimer's disease (AD) predominantly mirror AD-associated molecular and structural brain changes. While they are necessary for identifying disease-specific neuropathology, they lack a clear and robust relationship with the clinical presentation of dementia; they can be altered in healthy individuals, while they often inadequately mirror the degree of cognitive and functional deficits in affected subjects. There is growing evidence that synaptic loss and dysfunction are early events during the trajectory of AD pathogenesis that best correlate with the clinical symptoms, suggesting measures of brain functional deficits as candidate early markers of AD. Resting-state electroencephalography (EEG) is a widely available and noninvasive diagnostic method that provides direct insight into brain synaptic activity in real time. Quantitative EEG (qEEG) analysis additionally provides information on physiologically meaningful frequency components, dynamic alterations and topography of EEG signal generators, i.e. neuronal signaling. Numerous studies have shown that qEEG measures can detect disruptions in activity, topographical distribution and synchronization of neuronal (synaptic) activity such as generalized EEG slowing, reduced global synchronization and anteriorization of neuronal generators of fast-frequency resting-state EEG activity in patients along the AD continuum. Moreover, qEEG measures appear to correlate well with surrogate markers of AD neuropathology and discriminate between different types of dementia, making them promising low-cost and noninvasive markers of AD. Future large-scale longitudinal clinical studies are needed to elucidate the diagnostic and prognostic potential of qEEG measures as early functional markers of AD on an individual subject level.
PubMed: 31833023
DOI: 10.1007/s40120-019-00169-0 -
Clinical & Experimental Optometry Mar 2007Acute anterior uveitis is an important ocular disease of considerable interest to therapeutically and non-therapeutically qualified optometrists. This review examines... (Review)
Review
Acute anterior uveitis is an important ocular disease of considerable interest to therapeutically and non-therapeutically qualified optometrists. This review examines the role of optometrists in the primary care setting and gives guidelines for appropriate care of patients with anterior uveitis. Diagnosis and differentiation from other forms of anterior segment inflammation are the initial requirement. In parallel, possible medical conditions associated with acute anterior uveitis must be considered, with appropriate referral to medical practitioners. In uncomplicated cases of recurrent acute anterior uveitis, optometrists can initiate topical treatment and monitor resolution of inflammation, while being aware of possible complications of both the disease and its treatment. It is especially important in new attacks of anterior uveitis to liaise with the patient's general practitioner about medical investigation for underlying disease. Atypical, complicated or severe anterior uveitis should be promptly referred for specialist care.
Topics: Acute Disease; Anterior Eye Segment; Chronic Disease; Diagnosis, Differential; Humans; Inflammation; Optometry; Practice Guidelines as Topic; Primary Health Care; Professional Role; Referral and Consultation; Uveitis, Anterior; Vision Disorders
PubMed: 17311570
DOI: 10.1111/j.1444-0938.2006.00128.x -
Transactions of the American... 1995To identify relationships among age-independent ocular biometric variables which contribute to ocular refraction in adult human eyes, and to identify differences in...
PURPOSE
To identify relationships among age-independent ocular biometric variables which contribute to ocular refraction in adult human eyes, and to identify differences in those relationships between emmetropes and ametropes.
METHODS
Manifest refraction (DRS methodology), corneal refractive power (keratometry), and axial anterior segment (anterior cornea to posterior lens), vitreous cavity (posterior lens to anterior sclera) and total globe (anterior cornea to anterior sclera) length (A-scan ultrasonography) were determined in 185 unaccommodated right eyes of adult humans aged 18 to 70 years. There were 136 emmetropes with absolute refractive error < or = 2.0 diopter, and 49 ametropes (47 myopes, 2 hyperopes) with absolute refractive error of 2.25-11.0 diopters.
RESULTS
Refraction decreased significantly with increasing globe and vitreous cavity length in emmetropes and ametropes. Anterior segment length was also significantly negatively correlated with refraction in emmetropes, but not in ametropes. Corneal refractive power was not correlated with refraction in either group, but decreased significantly with increasing globe length in both, more strongly in emmetropes. Globe and vitreous cavity length were significantly positively correlated in both groups, more strongly in ametropes. Anterior segment length increased significantly with increasing globe length in emmetropes but not in ametropes. Anterior segment length decreased significantly with increasing vitreous cavity length in ametropes but not in emmetropes.
CONCLUSION
These findings indicate an "inflatable anterior segment" as well as the classic "inflatable globe" mechanism of emmetropization. This newly described anterior segment mechanism involving increased separation between the cornea and the lens with increasing globe size appears to be absent in adult human myopia.
Topics: Accommodation, Ocular; Adolescent; Adult; Aged; Aging; Anterior Eye Segment; Cornea; Eye; Female; Humans; Male; Middle Aged; Ocular Physiological Phenomena; Refraction, Ocular; Refractive Errors
PubMed: 8719673
DOI: No ID Found -
The Journal of International Medical... Dec 2019To investigate the clinical indications of ultrasound biomicroscopy (UBM) and anterior segment optical coherence tomography (AS-OCT) in eyes with inflammatory glaucoma. (Observational Study)
Observational Study
OBJECTIVE
To investigate the clinical indications of ultrasound biomicroscopy (UBM) and anterior segment optical coherence tomography (AS-OCT) in eyes with inflammatory glaucoma.
METHODS
Sixteen patients (16 eyes) with inflammatory glaucoma were analysed retrospectively. All of the subjects underwent UBM and AS-OCT scans, measuring the following parameters: central corneal thickness (CCT), central anterior chamber depth (ACD), angle-opening distance (AOD500), and trabecular-iris angle (TIA500) in four quadrants.
RESULTS
Both the UBM and AS-OCT generated detailed, high-resolution images of the anterior segments of the eyes with inflammatory glaucoma. Moreover, the UBM and AS-OCT exhibited statistically similar measurement results for all of the indices. A Bland–Altman analysis showed a high level of agreement between the two imaging techniques. Additionally, the UBM was able to visualize the ciliary body and pars plana, while the cells and the flare in the anterior chamber appeared more pronounced in the UBM images.
CONCLUSIONS
Both the UBM and AS-OCT are useful tools for anterior segment imaging and taking measurements needed for evaluating inflammatory glaucoma. The AS-OCT has the advantages of being noninvasive and fast, whereas the UBM is presently unparalleled in the visualization of the ciliary body and pars plana.
Topics: Adult; Anterior Chamber; Female; Glaucoma; Humans; Inflammation; Male; Microscopy, Acoustic; Middle Aged; Tomography, Optical Coherence; Uveitis; Young Adult
PubMed: 31594445
DOI: 10.1177/0300060519867808