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Seminars in Arthritis and Rheumatism Aug 2016A patulous esophagus on high-resolution computed tomography (HRCT) of the thorax is frequently observed in patients with systemic sclerosis (SSc). Microaspiration has...
OBJECTIVE
A patulous esophagus on high-resolution computed tomography (HRCT) of the thorax is frequently observed in patients with systemic sclerosis (SSc). Microaspiration has been purported to play a role in the development and progression of SSc interstitial lung disease (ILD), but studies examining the role of microaspiration in SSc ILD have yielded conflicting results. This study was conducted to determine the association between esophageal diameter and SSc ILD.
METHODS
A cross-sectional study of Northwestern Scleroderma Registry patients with available HRCT exams was conducted. The predictor variable was the widest esophageal diameter (WED) on HRCT, and the primary and secondary outcome variables were radiographic ILD and pulmonary function tests respectively. The degree of radiographic ILD was assessed using a semi-quantitative score adapted from published methods. Estimated regression coefficients adjusted for age, sex, race, body mass index, smoking; SSc disease subtype, serum autoantibodies, and disease duration; modified Rodnan skin score, proton pump inhibitor, and immune suppressant medication use and erythrocyte sedimentation rate were calculated.
RESULTS
A total of 270 subjects were studied. In the adjusted analyses, there were positive associations between WED and total ILD score (β = 0.27; 95% CI: 0.09-0.41), fibrosis (β = 0.15; 95% CI: 0.07-0.23), and ground glass opacities (β = 0.12; 95% CI: 0.04-0.20); there were negative associations between WED and FVC % predicted (β = -0.42; 95% CI: -0.69 to -0.13), and adjusted DLCO % predicted (β = -0.45; 95% CI: -0.80 to -0.09) after adjusting for potential confounders.
CONCLUSIONS
Increasing esophageal diameter on HRCT in patients with SSc is associated with more severe radiographic ILD, lower lung volumes, and lower DLCO % predicted. Longitudinal studies are needed to determine if esophageal dilatation is associated with the incidence and/or progression of ILD in patients with SSc.
Topics: Adult; Cross-Sectional Studies; Dilatation, Pathologic; Esophagus; Female; Humans; Lung Diseases, Interstitial; Male; Middle Aged; Scleroderma, Systemic; Tomography, X-Ray Computed
PubMed: 27033049
DOI: 10.1016/j.semarthrit.2016.02.004 -
African Health Sciences Mar 2021The importance of monocyte count-to-HDL-cholesterol ratio (MHR) in cardio- vascular diseases has been shown in various studies. Ascending aortic dilatation (AAD) is a...
BACKGROUND
The importance of monocyte count-to-HDL-cholesterol ratio (MHR) in cardio- vascular diseases has been shown in various studies. Ascending aortic dilatation (AAD) is a common complication in the patients with bicuspid aortic valve. In this study, we aimed to investigate the relationship between MHR and the presence of aortic dilatation in the patients with bicuspid aortic valve.
METHODS
The study population included totally 347 patients with bicuspid aortic valve.169 patients with aortic dilatation (ascending aorta diameter ≥ 4.0 cm) and 178 patients with no aortic dilatation. Echocardiographic and laboratory measurement was done and compared between groups.
RESULTS
The mean age of the participants was 44.7 ± 15.4 years and average ascending aorta diameter was 3.2 ± 0.3 cm in dilatation negative group and 4.4 ± 0.4 cm in positive group. MHR was significantly increased in in patients with aortic dilatation. MHR and uric acid level was independently associated with the presence of aortic dilatation in the patients with bicuspid aortic valve.
CONCLUSION
We found a significant relationship between MHR and aortic dilatation in the patients with bicuspid aortic valve.
Topics: Adult; Aged; Aorta; Aortic Valve; Bicuspid Aortic Valve Disease; Cholesterol, HDL; Cholesterol, LDL; Dilatation, Pathologic; Echocardiography; Female; Heart Valve Diseases; Humans; Male; Middle Aged; Monocytes
PubMed: 34394286
DOI: 10.4314/ahs.v21i1.14 -
Current Opinion in Ophthalmology Jul 2010To review the most recent management strategies for corneal ectasia after keratorefractive surgery. (Review)
Review
PURPOSE OF REVIEW
To review the most recent management strategies for corneal ectasia after keratorefractive surgery.
RECENT FINDINGS
Management options for postoperative ectasia include conservative management with various types of contact lenses such as rigid gas permeable lenses, custom wave front-guided soft contact lenses, hybrid lenses and tandem soft contact lens-rigid gas permeable lenses. Minimally invasive surgical options including corneal ring segment implantation with Intacs, KeraRings or Ferrara rings have shown to have good results in the initial period after insertion. However, there appears to be some evidence that this initial effect may regress with time. Collagen cross-linking is also minimally invasive and has been documented to stop the progression of ectasia and in some cases may cause regression. Recently, techniques combining collagen cross-linking with intracorneal ring segments or with topography-guided excimer laser treatments have shown to have promising results.
SUMMARY
Early management of ectasia is essential to prevent its progression and to preserve visual potential. There are several management options that are available that may be used to reduce the need for corneal transplantation for these patients.
Topics: Corneal Diseases; Dilatation, Pathologic; Humans; Postoperative Complications; Refractive Surgical Procedures
PubMed: 20489623
DOI: 10.1097/ICU.0b013e32833a8bfe -
Pediatric Nephrology (Berlin, Germany) Nov 2020Antenatally diagnosed urinary tract dilatation (UTD) still burdens healthcare providers and parents. This study was conducted to establish long-term outcome in an...
BACKGROUND
Antenatally diagnosed urinary tract dilatation (UTD) still burdens healthcare providers and parents. This study was conducted to establish long-term outcome in an unselected group of children with antenatally detected UTD.
METHODS
Seventy-one out of 103 children born in 2003-2005 and diagnosed with antenatal UTD agreed to participate in a 12-15-year follow-up including blood and urine samples, a kidney ultrasound exam, and kidney scintigraphy. The records were searched for previous urinary tract infections.
RESULTS
Among children with an anteroposterior diameter (APD) ≤ 7 mm and no calyceal, kidney, ureteral, or bladder pathology in the early postnatal period, no one tested had reduced estimated glomerular filtration rate (eGFR), albuminuria, or UTD at the follow-up at a mean age of 13.6 years. One child had kidney damage not affecting kidney function. Among children with postnatal APD > 7 mm and/or kidney, calyceal, ureteral, or bladder pathology, 15% had persistent UTD and 32-39% (depending on the method used) had kidney damage. Major postnatal urinary tract ultrasound abnormalities and a congenital anomalies of the kidney and urinary tract (CAKUT) diagnosis were factors associated with an increased risk for permanent kidney damage (odds ratios 8.9, p = 0.016; and 14.0, p = 0.002, respectively). No one had reduced eGFR. One child (1/71, 1%) had a febrile urinary tract infection after the age of 2.
CONCLUSIONS
We conclude that in children with postnatal APD ≤ 7 mm, no calyceal dilatation, normal bladder, ureters, and kidney parenchyma, the outcome is excellent. There is no need for long-term follow-up in these patients.
Topics: Adolescent; Case-Control Studies; Cohort Studies; Dilatation, Pathologic; Disease Progression; Female; Follow-Up Studies; Glomerular Filtration Rate; Humans; Hydronephrosis; Male; Prenatal Diagnosis; Ultrasonography; Urinary Tract
PubMed: 32577807
DOI: 10.1007/s00467-020-04659-4 -
European Journal of Endocrinology Oct 2020Turner syndrome (TS) is a rare disorder affecting 1/2500 female newborn. Aortic dilatation (AD) and aortic dissection represent a major concern in TS. The aims of our...
OBJECTIVE
Turner syndrome (TS) is a rare disorder affecting 1/2500 female newborn. Aortic dilatation (AD) and aortic dissection represent a major concern in TS. The aims of our study were to describe the aortic root growth, potential aortic dilatation (AD) risk factors and cardiovascular outcomes in a cohort of patients with TS.
METHODS
Among 204 adult patients included, 197 were studied using a standardized 1.5 Tesla MRI protocol. AD was defined as an aortic diameter ≥20 mm/m2 at the Valsalva sinuses and/or at the ascending aorta, when indexed to body surface area.
RESULTS
At baseline, AD was present in 81/197 (41.1%) and 32/197 (16.2%) of patients, at the levels of Valsalva and ascending aorta, respectively. The aortic Valsalva diameter was larger in patients treated for thyroiditis (P < 0.001). Potential risk factors of AD were aging (P < 0.001) and the presence of bicuspid aortic valve (BAV) (P = 0.002). The hazard ratio (HR) of AD occurrence in the presence of BAV was 2.2 (95% CI: 1.33-3.71). After a median follow-up period of 5.1 years (n = 143), AD was present in 58/143 (40.6%) and 25/143 (17.5%) of patients at the levels of Valsalva and ascending aorta, respectively. The median aortic growth of the Valsalva sinuses remained stable. At the ascending aorta, it increased by 0.14 ± 0.61 mm/year. Only one aortic-related death was observed.
CONCLUSION
AD is common in adult patients with TS. However, our results are rather reassuring, as the median aortic diameters remained stable after 5.1 years and few aortic events were observed.
Topics: Adult; Aorta; Aortic Diseases; Aortic Valve; Bicuspid Aortic Valve Disease; Cohort Studies; Dilatation, Pathologic; Disease Progression; Female; France; Heart Valve Diseases; Humans; Male; Prevalence; Turner Syndrome; Young Adult
PubMed: 32822316
DOI: 10.1530/EJE-20-0284 -
Scientific Reports Nov 2021In this study, corneal findings regarding keratoconus (KC) and early KC among mothers with Down syndrome children (MDS) and a group of age-at-delivery-matched mothers... (Comparative Study)
Comparative Study
In this study, corneal findings regarding keratoconus (KC) and early KC among mothers with Down syndrome children (MDS) and a group of age-at-delivery-matched mothers with normal children (MNC) were compared. KC was diagnosed based on the presence of a clinical sign and at least one abnormal tomographic or biomechanical criterion. Early KC was defined as having no clinical sign in the presence of at least one abnormal tomographic or biomechanical criterion. The normal subgroups in each group were compared in terms tomographic and biomechanical parameters. In MDS and MNC, the prevalence rates were 6.5% and 1.6% for KC (P = 0.047), and 30.9% and 14.3% for early KC (P = 0.014), respectively. Comparison between the two normal subgroups showed significant differences in mean index of height asymmetry, irregularity index, anterior asphericity, pentacam random forest index, corneal stiffness parameters at first applanation, deformation amplitude ratios, integrated radius-1 mm, highest concavity deflection amplitude, biomechanical corrected IOP, peak distance, and radius (all P < 0.05). This study showed that MDS are more likely to have KC and also to have thinner, steeper and softer corneas compared to MNC. This results support the need for further work for determining the risk of delivering a child with DS.
Topics: Adult; Child; Cornea; Corneal Pachymetry; Corneal Topography; Dilatation, Pathologic; Down Syndrome; Female; Humans; Iran; Keratoconus; Middle Aged; Mothers; Prevalence; Retinoscopy
PubMed: 34789864
DOI: 10.1038/s41598-021-02035-2 -
International Ophthalmology Clinics 2013
Review
Topics: Corneal Stroma; Corneal Topography; Dilatation, Pathologic; Humans; Keratoconus; Keratomileusis, Laser In Situ; Postoperative Complications
PubMed: 23221883
DOI: 10.1097/IIO.0b013e3182774453 -
International Ophthalmology Clinics 2016
Review
Topics: Corneal Diseases; Dilatation, Pathologic; Humans; Keratomileusis, Laser In Situ; Postoperative Complications; Risk Factors
PubMed: 26938343
DOI: 10.1097/IIO.0000000000000102 -
The Cochrane Database of Systematic... 2001Intraventricular hemorrhage remains a serious complication of premature birth and post hemorrhagic hydrocephalus still has no satisfactory treatment. Acetazolamide and... (Review)
Review
BACKGROUND
Intraventricular hemorrhage remains a serious complication of premature birth and post hemorrhagic hydrocephalus still has no satisfactory treatment. Acetazolamide and furosemide, which both reduce the production of cerebrospinal fluid, have been suggested as non-invasive therapies to reduce hydrocephalus and the need for ventriculo-peritoneal (V-P) shunting.
OBJECTIVES
The aim of this review was to determine whether the use of acetazolamide and furosemide improves outcome, especially shunt dependence, in infants developing post-hemorrhagic ventricular dilatation.
SEARCH STRATEGY
The standard search strategy of the Cochrane Collaboration was used.
SELECTION CRITERIA
Randomised, or quasi-randomised trials, of acetazolamide and/or furosemide compared with standard therapy in infants with IVH or post-hemorrhagic ventricular dilatation
DATA COLLECTION AND ANALYSIS
Data were extracted independently by each author and were analysed by the standard methods of the Cochrane Collaboration using relative risk (RR) and risk difference (RD), a fixed effect model and sensitivity analyses where appropriate.
MAIN RESULTS
There were two eligible trials: one randomized 16 infants and the other, 177. Neither showed a decreased risk for V-P shunt or for V-P shunt or death associated with acetazolamide and furosemide therapy. The larger trial showed that acetazolamide and furosemide treatment resulted in a borderline increase in the risk for motor impairment at one year (RR 1.27, CI 1.02 to 1.58; RD 0.16, CI 0.02 to 0.31), but did not significantly affect the risk for the combined outcome of delay, disability or motor impairment among survivors, or the risk of the combined outcome of death, delay, disability or impairment at one year. The larger trial showed that diuretic treatment increased the risk for nephrocalcinosis (RR 5.31, CI 1.90 to 14.84; RD 0.19, CI 0.09 to 0.29); meta-analysis confirmed this result.
REVIEWER'S CONCLUSIONS
Acetazolamide and furosemide therapy is neither effective nor safe in treating post hemorrhagic ventricular dilatation. Acetazolamide and furosemide cannot be recommended as therapy for post hemorrhagic hydrocephalus.
Topics: Acetazolamide; Cerebral Hemorrhage; Cerebral Ventricles; Dilatation, Pathologic; Diuretics; Furosemide; Humans; Hydrocephalus; Infant; Infant, Newborn; Randomized Controlled Trials as Topic; Ventriculoperitoneal Shunt
PubMed: 11406041
DOI: 10.1002/14651858.CD002270 -
Journal of Cataract and Refractive... Dec 2018This review compared the clinical results of transepithelial corneal crosslinking (CXL) to epithelium-off (epi-off) CXL in progressive corneal ectasia using a... (Review)
Review
This review compared the clinical results of transepithelial corneal crosslinking (CXL) to epithelium-off (epi-off) CXL in progressive corneal ectasia using a metaanalysis. The Cochrane databases and Medline were searched for randomized controlled trials (RCTs). Seven RCTs involving 505 eyes that met the eligibility criteria were identified. The epi-off CXL group showed significantly better outcomes in postoperative changes in maximum keratometry (K) during 1-year observation periods. Transepithelial CXL resulted in significantly greater post-treatment central corneal thickness and best spectacle-corrected visual acuity (BSCVA). The presence of a postoperative demarcation line was significantly more frequent after epi-off CXL than that after transepithelial CXL. No statistically significant difference was found between other parameters. Although patients in the transepithelial CXL group demonstrated a greater improvement in BSCVA compared with patients in the epi-off CXL group at the 1 year follow-up, transepithelial CXL had less impact on halting progressive corneal ectasia in terms of maximum K than epi-off CXL.
Topics: Collagen; Corneal Diseases; Corneal Topography; Cross-Linking Reagents; Dilatation, Pathologic; Epithelium, Corneal; Humans; Photochemotherapy; Photosensitizing Agents; Riboflavin
PubMed: 30314751
DOI: 10.1016/j.jcrs.2018.08.021