bluuebunny/crossref_metadata_2025_split huggingface dataset:
Investigation of Corneal Topography after Deep Lamellar Endothelial Keratoplasty
Authors: Lombardo Marco , Terry Mark A. , Lombardo Giuseppe , Serrao Sebastiano , Ducoli Pietro 
Published: January 2018

Purpose To analyze the 6-month anterior and posterior topographic changes of the cornea after deep lamellar endothelial keratoplasty. Methods Orbscan topographies of 22 eyes from 21 patients with corneal decompensation were retrospectively analyzed: 11 eyes received a 9-mm scleral access incision (large-incision group) and 11 eyes received a 5-mm scleral access incision (small-incision group). All the preoperative and postoperative corneal raw data were imported into custom software which computed the average composite corneal maps and difference maps for both study groups in order to evaluate the corneal response to the surgery. The software delineated 2 concentric zones of the cornea to characterize the regional response following the surgery: the central and peripheral regions. Results There were no significant differences (analysis of variance, <0.35 D, p>0.05) between 6-month postoperative and preoperative average anterior central corneal topographies in either group. At the end of follow-up, the average posterior curvature tangential map did not significantly differ from before surgery in either group (<0.35 D, p>0.05). However, a significant increase (>0.60 D, p<0.01) in the average posterior central astigmatic power of the cornea was found in both groups. Conclusions Deep lamellar endothelial keratoplasty effectively preserves the preoperative keratometric corneal topography, minimizing changes in curvature and astigmatism of the cornea. The great predictability of corneal topography following deep lamellar endothelial keratoplasty is likely to be attributed to the minimal changes that occur in the anterior stroma, the portion of the cornea that appears to be mainly responsible for maintenance of corneal shape.
Meta-analysis of Timolol on Diurnal and Nighttime Intraocular Pressure and Blood Pressure
Authors: Lee Princeton Wen-Yuan , Doyle Aoife , Stewart Jeanette A. , Kristoffersen Caroline J. , Stewart William C. 
Published: January 2018

Purpose To evaluate the nighttime intraocular pressure (IOP) and blood pressure (BP) response to timolol treatment in patients with ocular hypertension or primary open-angle glaucoma. Methods This was a meta-analysis of previously published studies that must have been randomized, prospective, crossover or parallel, single or double-masked trials. The treatment period must have been ≥2 weeks with ≥19 patients per treatment arm for a crossover, and ≥50 patients for a parallel designed trial. Studies must have included both baseline and treated 24-hour curves. Results For the IOP analysis, we included 8 articles with 340 patients. A reduction from baseline was observed for timolol at each time point and for the 24-hour curve (p≤0.009). When 2 studies, in which timolol was used adjunctively were removed, a similar difference was observed as above at each time point and for the 24-hour curve (p≤0.003). In 2 studies, there were small reductions from baseline for the mean diastolic and systolic BPs at most time points and for the 24-hour curve (3.9 and 4.2 mmHg, respectively) with timolol treatment. The ocular perfusion pressure did not show any difference between baseline and timolol treatment at any time point or for the 24-hour curve (p>0.05). Conclusions This meta-analysis suggests that topical timolol therapy provides an ocular hypotensive effect over the 24-hour curve, including the nighttime hours, and while small reductions in the systolic and diastolic pressures occur, the ocular perfusion pressure is not altered over 24 hours.
Fine Needle Aspiration Biopsy with Liquid-Based Cytology and Adjunct Immunohistochemistry in Intraocular Melanocytic Tumors
Authors: Pelayes David E. , Zárate Jorge O. 
Published: January 2018

Purpose To determine the efficacy of liquid-based cytology (LBC) and immunohistochemistry in the evaluation of fine needle aspiration biopsy (FNAB) of intraocular melanocytic tumors. Methods Cytologic diagnosis was necessary in 25 patients with intraocular melanocytic tumors to deliver a therapeutic course of treatment. The patients’ clinical, cytologic, and histologic diagnoses were correlated. All samples were stained with hematoxylin and eosin, and studied through standardized monolayer techniques, with a mean cellular concentration of 60,000 cells/mm2. Immunohistochemistry was performed using Vimentin, S 100, HMB 45, Melan A, cytokeratin, and as prognostic factors, B and T lymphocyte, CD68 (macrophage), and antibody Ki 67 (growth factor). Results The positive predictive value was 100%; the negative predictive value was 80%. Sensitivity and specificity of LBC for detecting malignancy were 95.2% and 100%, respectively. The FNAB LBC with immunohistochemistry findings resulted in a revision of treatment in 32% of patients. There was no evidence of local tumor dissemination or a recurrence associated with biopsy in any patient. Conclusions Fine needle aspiration biopsy (LBC and immunohistochemistry) is a safe, sensitive, and specific method of establishing tissue diagnosis in a subset of patients with intraocular melanocytic tumors, particularly in cases where sample material is scarce. The routine use of immunohistochemical stain increases the diagnostic utility, and prognosis factor determination may change clinical management.
Efficacy of Brimonidine in Preventing Intraocular Pressure Spikes following Phacoemulsification in Glaucoma Patients
Authors: Kandarakis Artemios , Soumplis Vasileios , Karampelas Michalis , Panos Christos , Kyriakos Nikolaos , Baxevanakis Anastasios , Karagiannis Dimitrios 
Published: January 2018

Purpose To measure intraocular pressure (IOP) elevation 6 and 24 hours after phacoemulsification in patients with glaucoma and to investigate the efficacy of brimonidine tartrate 0.2% in preventing IOP rise on the first postoperative day following cataract surgery. Methods In this prospective randomized single-masked study, 86 eyes of 78 patients with well-con-trolled open-angle glaucoma were scheduled for phacoemulsification surgery. Patients were randomly assigned into 2 groups. Group A received 1 drop of brimonidine tartrate 0.2% and group B, which served as a control group, received 1 drop of artificial tears. Intraocular pressure was measured at baseline, before surgery, and 6 and 24 hours postoperatively. Results Within each group, we found a statistically significant difference in IOP between baseline and 6 hours postoperatively (p<0.01) and between 6 and 24 hours (p<0.01). There was no statistically significant difference between baseline IOP and 24-hour values. Comparing the 2 groups, there was no statistically significant difference in preoperative and 24-hour postoperative IOP. Six hours after surgery, the mean IOP in the brimonidine group was 18.52±4.58 mmHg, compared with 20.86±3.79 mmHg in the control group. Treatment with brimonidine tartrate 0.2% significantly reduced postoperative IOP elevation 6 hours following cataract extraction (p=0.009). Conclusions Patients with medically well-controlled glaucoma may experience a substantial increase in IOP shortly after phacoemulsification surgery. Instillation of brimonidine tartrate 0.2%, although it significantly reduced IOP elevation following cataract operation, did not completely prevent IOP spikes.
Prevalence of Exfoliation Syndrome in Estonia
Authors: Kaljurand Kuldar , Teesalu Pait 
Published: January 2018

Purpose To estimate the prevalence of exfoliation syndrome (XFS) in Estonia. Methods A total of 766 residents, representing the demographics of Tartu, Estonia, were chosen by random sampling from the Estonian Population Database, and invited to participate in this study. Each patient underwent careful slit-lamp examination including applanation tonometry before and after pupil dilatation. Presence of XFS was confirmed after mydriasis as typical white-gray fluffy material on the anterior lens surface, and on the pupillary border as well on the corneal endothelium. Results A total of 424 subjects, 277 female and 147 male, participated in this study. The median age was 70 years (70 years in women and 71 years in men). The overall prevalence of XFS among the study participants in 1 or both eyes was 25.5% (25.2% in men and 25.6% in women). Intraocular pressure measured before and after dilatation was significantly higher in the XFS group. Glaucoma was significantly more frequent in the XFS group than the non-XFS group; 35.7% and 11.3%, respectively. Fifty percent of all patients with glaucoma had exfoliative glaucoma. Cataract was detected in 57.0% of cases in the XFS group compared to 39.5% in the non-XFS group (p=0.002). We found similar prevalence of systemic diseases in both groups for both genders. There was no difference between the 2 groups in visual acuity. Conclusions In this population-based cross-section study, XFS was found to be a frequent finding in Estonia. Exfoliation syndrome is a risk factor for glaucoma and cataract formation.
Correlation between Optical Coherence Tomography Results and the Scoring Tool for Assessing Risk (STAR) Score in Patients with Ocular Hypertension
Authors: Yalvac Ilgaz Sagdic , Kulacoglu Destan N. , Satana Banu , Eksioglu Umit , Duman Sunay , Sokak Sakir Kesebir 
Published: January 2018

Purpose To correlate retinal nerve fiber layer thickness (RNFL) and optic nerve head (ONH) parameters measured with optical coherence tomography (OCT) with the Scoring Tool for Assessing Risk (STAR) threshold in patients with ocular hypertension (OH). Methods The study included 92 patients with OH. They were divided into low-risk (n=32), moderate-risk (n=36), and high-risk (n=24) groups according to STAR criteria. RNFL and ONH OCT protocols were used to evaluate all study participants. Major parameters for RNFL analysis were average RNFL thickness, superior quadrant, nasal quadrant, inferior quadrant, temporal quadrant, and segmental thickness per 12 o'clock hour position. ONH parameters were vertical integrated rim area (VIRA), horizontal integrated rim width (HIRW), disc diameter, disc area, cup area, rim area, cup-to-disc (CID) area ratio, horizontal CID ratio, and vertical CID ratio. Results The highest area under receiver operating characteristics curves for distinguishing the high-risk group from the other groups were vertical CID ratio (0.88), CID area (0.88), VIRA (0.87), and HIRW (0.81) for ONH parameters, and inferior (0.82) and 6 o'clock hour position (0.77) for peripapillary RNFL thickness measurements. Conclusions Inferior average, 6 o'clock hour position analyses for RNFL measurement, and VIRA, HIRW, CID area, and vertical CID ratio for ONH measurement were the best parameters for STAR staging in patients with OH.
Long-term quality of life evaluation of patients with total hip arthroplasty
Authors: Knahr K. , Jagsch R. , Kryspin-Exner I. 
Published: January 2018

The aim of the study was to evaluate the clinical and psychological situation of total hip arthroplasty (THA) patients before and one year and five years after surgery. Data of 101 patients were available for the one-year and of 69 patients for the five-year follow-up. Quality of Life (QoL) data were collected using the Nottingham Health Profile (NHP), functional capacity comprised patient's self-assessment (Functional Outcome Questionnaire Hannover, FFbH) and surgeon's assessment (Harris Hip Score, HHS). While all dimensions of QoL and functional capacity except social isolation showed significant improvement at the one-year follow-up, only pain scores showed further improvement at the five-year evaluation. Implantation of THA is accompanied by significant increases in QoL and functional capacity. Stabilised scores were found at the five-year evaluation while significant increases could be observed after one year.
Internal fixation of displaced femoral neck fractures in patients older than 70 years
Authors: Cordero-Ampuero J. , García-Cimbrelo E. , Munuera L. 
Published: January 2018

Introduction: To analyse results and risk factors for osteosynthesis of displaced femoral neck fractures in patients older than 70 years. Patients and Methods: From 1992 to 2000, 183 consecutive patients over 70 with displaced femoral neck fractures were treated by closed reduction and fixation with cannulated screws and followed up prospectively for two years. Pain at rest and pain with walking, return to previous functional and walking ability, and need for additional surgery were evaluated. Results: Six patients died, while 149 were followed up for a minimum of two years: 82 (55%) were asymptomatic, 19 (12.8%) had mild pain, 39 (26.1%) required arthroplasty and 9 (6%) were too ill for further surgery. Poor quality reduction (p=0.008) and poor quality osteosynthesis (p= 0.064) were risk factors for failure. Fifty patients (33.6%) presented with non-union: 6/50 were asymptomatic, 34/50 required arthroplasty, and 10/50 were very ill. Ischaemic necrosis appeared in ten cases (6.7%) (five asymptomatic and five requiring arthroplasty). Conclusions: Reduction and fixation of displaced femoral neck fractures achieved good results in 68% of patients over 70, but re-operation became necessary in 32% of them; this made internal fixation advisable only for selected patients who were very active. The main risk factors were poor-quality reduction followed by poor osteosynthesis.
Clinical and radiological results of impaction bone allograft technique in acetabular revisions associated with massive bone stock deficiencies: Four to seven years follow-up study
Authors: El-Kawy S. , Hay D. , Drabu K. 
Published: January 2018

Introduction: We conducted this retrospective study to evaluate the medium-term results of impaction bone allograft technique when used on its own with cemented cups in acetabular revisions associated with massive bone loss. Patients and Methods: This study involved 28 hips in 27 patients classified as severe acetabular deficiencies (Paprosky type 3) secondary to aseptic loosening. All were revised with impacted morsellised bone allograft using fresh-frozen and freeze-dried bone together with cemented rim bearing UHMWP (28 mm I.D.) cups and followed for an average of 72 months (range 48 to 91 m). Clinical assessment was based on the Harris Hip Score (HHS). Radiological assessment included measurement of cup migration using image analysis computer software as well as assessment of graft incorporation. Results: Clinically, HHS improved from pre-operative average of 24.9 to average of 78 at the last follow-up. One hip was revised at 12 months postoperatively due to aseptic loosening. Survivorship for the cup with endpoint revision for any reason was 96.4%. Radio-logically, the average of superior migration was 1.53 mm; average of medial migration was 0.59 mm. 92.8% of hips showed radiographic evidence of graft incorporation. Cup survival rate with aseptic loosening as endpoint was 92.85%. Conclusion: The technique of impaction bone grafting using morsellised fresh frozen bone allograft appears to be a valuable biological option in such patients, with encouraging results, but further follow-up is required to establish the longer term outcome of these reconstructions.
Radiological study of THA after mini-incision technique
Authors: Hart R. , ŠtipčÁk V. , Janeček M. , Višňa P. 
Published: January 2018

Mini-incision procedures reduce perioperative blood loss, postoperative pain, time of the postoperative recovery, length of the surgical scar, and hospitalisation time. Implant malposition and poor stability are potential risks for compromising long-term results. Between September 2000 and February 2002 (18 months), 120 cemented primary total hip arthroplasties for primary osteoarthritis were performed at the authors' institutions. In 60 of these cases selected at random, a posterolateral mini-incision up to 10 cm was used. Sixty other THAs were implanted through a standard posterolateral approach. The radiological measurements of the inclination and anteversion of the cup and stem position were performed and statistically evaluated by use of Mann-Whitney U and Bartlett tests. In the mini-incision group the average inclination angle was 42.3° (range 36° to 52°) and the anteversion angle 13.6° (range 6° to 21°). The femoral component coronal alignment was within 3° of neutral position in 54 cases (90.0 %). In the standard implanted group the average cup inclination angle was 42.4° (range 35° to 50°) and anteversion angle 13.6° (range 8° to 24°). Fifty-three stems (88,3 %) were implanted correctly. Statistical analysis found no significant difference in component position between the two groups. There are therefore no potential risks of compromising long-term results after the mini-incision procedure. The authors are encouraged to continue this technique.
Pain and Satisfaction after Hip Replacement: The Patient's Perspective at 5 - 12 Years
Authors: Mehta J. S. , Kiryluk S. , Fordyce M. J. F. 
Published: January 2018

We present the results of a postal evaluation of 1700 hip replacements performed in 1560 patients at a specialist joint replacement centre. This 5 – 12 year follow-up assesses the patient's perspective of satisfaction, pain levels, revision and dislocation rates, subjective issues related to the prosthetic hip and limitations to daily activities. Our adjusted response rate was 81.4%, with 89.2% of the respondents being satisfied with their hip replacement; 4.1% were dissatisfied, and 5.0% were unsure. 79% of patients reported no pain or slight pain, 14.5% had moderate pain and 2.6% had severe pain. 4.6% of the hip replacements had been revised, and 4.1% had dislocated. The hip was felt to be a limiting factor in their life by 18.4% of patients. The use of a questionnaire has provided long-term follow-up data at far less cost and considerably less inconvenience to the patient than a clinical review. We conclude that pain and patient satisfaction could be used as a simple screening tool for the vast majority of the patients. In those that have moderate or severe pain or express a lack of satisfaction for any reason, further clinical and radiological assessments could be carried out.
Primary hip replacement in young osteoarthritic patients – current practices in one UK region
Authors: Mundy G.M. , Esler C.N.A. , Harper W.M. 
Published: January 2018

Approximately 10% of primary hip replacements performed each year for osteoarthritis are in patients aged 55 or younger. These patients have a longer life expectancy and a higher activity level than an older cohort, which may translate to higher revision rates. We utilized a regional hip register (Trent and Welsh Arthroplasty Audit Group (TWAAG)) to review current surgical practice in this age group. From 01/01/2000 – 31/12/2002, we were notified of 7,678 primary THRs for osteoarthritis. Of these 911 (11.7%) were performed on patients aged 55 or less. Age, gender, grade of lead operating surgeon, type of femoral and acetabular prostheses implanted, fixation method, femoral head size and bearing surfaces were recorded. There were 434 males and 477 females, with an age range of 16–55. Thirty-five femoral and 33 acetabular components were identified: 61.7% of femoral prostheses were cemented; 67.4 % of acetabular prostheses were uncemented. Fifty per cent of implants had a metal/UHMWPE bearing. Other bearing surfaces comprised ceramic/UHMWPE 28.7%, metal/metal resurfacing 13.8% and ceramic/ceramic 7.5%. Consultants performed 84.5% of procedures. The study indicates that there does not appear to be a clear consensus as to component choice or optimum fixation method in the younger patient.
Mortality after proximal hip fracture in the Singapore population
Authors: Lin K.H. , Lim Y.W. , Wu Y.J. , Lam K.S. 
Published: January 2018

The aims were to prospectively assess the mortality risk following proximal hip fractures, identify factors predictive of increased mortality and to investigate the time trends in mortality with comparison to previous studies. Prospectively collected data from 68 consecutive patients who had been admitted to a regional hospital from May 2001 to September 2001 were reviewed. The mean age of the patients was 79.3 years old (range, 55–98) and 72.1% females. Patients were followed prospectively to determine the mortality risk associated with hip fracture over a two-year follow-up period. The acute in-hospital mortality rate at six months, one year and two years was 5.9% (4/68), 14.7% (10/68), 20.6% (14/68) and 25% (17/68) respectively. One-year and two-year mortality for those patients who were 80 or older was significantly higher than for other patients and the number of co-morbid illnesses also had significant effect. Cox regression was performed to determine the significant predictors for survival time. It was noted that patients 80 years or older were at higher risk of death compared with those less than 80 years as well as those with higher number of co-morbid illnesses. Our mortality rates have not declined in the past 10 years when compared with previous local studies. We conclude that for this group of patients studied, their mortality at one year and two years could be predicted by their age group and their number of co-morbid illnesses.
MRSA-free Elective Orthopaedic Surgery. A Dedicated Elective Orthopaedic Ward Free from MRSA Alexandra Hospital, Redditch, UK
Authors: Datta A. , Gardner A. , Bell K. 
Published: January 2018

Deep infection complicating arthroplasty surgery carries a heavy financial and emotional burden on any orthopaedic service. The cost of hospital acquired infection is estimated at £1 billion per year by the National Audit Office. Healthcare associated infection is an area currently under great scrutiny. The Alexandra Hospital, Redditch, has developed a dedicated elective orthopaedic ward free from methicillin-resistant Staphylococcus aureus (MRSA) that delivers high quality and high volume major joint replacement surgery through rigorous infection control. Between October 2001 and December 2002, the Alexandra Hospital had an infection rate of 0.21% for total knee replacements compared to the national rate of 2.1% p= 0.002 (CI 0.00005-0.01) The infection rate for total hip replacements was 1.31% compared to 3.8% nationwide. p= 0.01 (CI 0.004- 0.03). The total number of joint replacements performed per year, utilising the same number of elective beds, increased from 482 in 2001 to 629 in 2002. We believe that the MRSA screening policy and subsequent altered bed utilisation have contributed to lowering the rate of infection and improved efficiency. We have developed a safe, effective and efficient orthopaedic unit within the framework of an acute NHS trust. We believe the practical changes and modest investment that have been made within our department can be repeated in other units around the country with relative ease.
Outcome of hip arthroplasty in octogenarians compared with younger patients
Authors: Gray A. , Walmsley P. , Moran M. , Brenkel I.J. 
Published: January 2018

This prospective study aimed to ascertain if octogenarians undergoing primary hip arthroplasty experienced a similar clinical outcome and complication rate as younger patients. Significantly better (p=0.019) improvement in mean Harris hip score (SD) was seen 18 months after surgery in the younger cohort: 43.4 (SD 13.8) compared with 39.8 (SD 10.6). Length of hospital stay was longer (p<0.001) in the octogenarians: 12.9 days (SD 7.0) days versus 10.1 (SD 4.7) with a higher blood transfusion rate of 40% compared with 28% (p = 0.009). No significant differences in infection, dislocation, thromboembolism or 90-day mortality rates were found. Conclusions: octogenarians are more likely to require blood transfusions and a longer hospital stay, with less improvement in clinical outcome at 18 months after primary hip arthroplasty.