Pairwise Multiple Comparison Adjustment Procedure for Survival Functions with Right-Censored Data

The aim of this study is to propose a new pairwise multiple comparison adjustment procedure based on Genz’s numerical computation of probabilities from a multivariate normal distribution. This method is applied to the results of two-sample log-rank and weighted log-rank statistics where the survival data contained right-censored observations. We conducted Monte Carlo simulation studies not only to evaluate the familywise error rate and power of the proposed procedure but also to compare the procedure with conventional methods. The proposed method is also applied to the data set consisting of 815 patients on a liver transplant waiting list from 1990 to 1999. It was found that the proposed method can control the type I error rate, and it yielded similar power as Tukey’s and high power with respect to the other adjustment procedures. In addition to having a straightforward formula, it is easy to implement

Evaluation of choroidal thickness in cases with age-related macular degeneration

AIM: To compare subfoveal choroidal thickness(SFCT)between cases with non-neovascular age-related macular degeneration(AMD)and neovascular AMD by optical coherence tomography(OCT)and to evaluate the contribution of choroidal thickness(CT)measurements to the understanding of pathogenesis of neovascularization in AMD.<p>METHODS: Fourty-eigth eyes of 24 patients who had neovascular AMD in one eye and non-neovascular AMD in the other eye were included in this retrospective, cross- sectional study as study group. Forty eyes of healthy,age and axial length matched individuals were selected as the control group. Eyes with drusen and/or pigmentary changes were included in the non-neovascular AMD subgroup. Eyes with subretinal or intraretinal fluid and/orlipid exudation due to the choroidal neovascularization were included in the neovascular AMD subgroup. OCT measurements were performed with RTVue 100-2(V 5.1, Optovue, Fremont, CA, USA)perpendicularly from the outer part of the hyperreflective line(retinal pigment epithelial layer)to the line corresponding to the choroido- scleral junction. Choroidal thickness was measured at 7 different points, 500μm intervals up to 1500μm temporal and nasal to the fovea in the study group and compared statistically between subgroups.<p>RESULTS: The mean age of patients was 72.4±8.97(60- 82)y. The mean age of healthy individuals was 71.2±8.8(58-81)y. Mean SFCT of neovascular AMD group were significantly thicker than non-neovascular AMD group(<i>P</i><0.05). In non-neovascular AMD group, there was no statistically significant difference between the mean SFCT and the mean temporal-nasal choroid thickness(<i>P</i>>0.05). In neovascular AMD group, there was a statistically significant difference between the mean SFCT and the mean temporal-nasal choroid thickness(<i>P</i><0.05).<p>CONCLUSION: Choroidal thickness measurements with OCT device can make a contribution to the understanding the phatophysiology of AMD and large prospective studies should be conducted to understand why SFCT was thicker in neovascular AMD

Granulocytic sarcoma of finger: a case report

Granulocytic sarcoma is an extramedullary tumor of immature myeloid cells. Such tumors may be located in any part of the body. We report a case of isolated granulocytic sarcoma of finger; which, to our knowledge, is the first report of that localization. A thirty-year-old woman with acute myeloid leukemia (AML) presented with progressive swelling and onychoptosis at her right fourth finger. The distal phalanx was excised and the tumor turned out to consisted of atypical myeloid cells, infiltrating bone trabeculae. Despite its rarity, considering myeloid sarcoma of the finger as a possible diagnosis may prevent inappropriate treatment in leukemia patients

Audio-vestibular and radiological analysis in Meniere’s disease

Objective: Intravenous gadolinium-enhanced inner ear magnetic resonance imaging (IV Gd-enhanced inner ear MRI) is a new technique for diagnosing Meniere’s disease (MD). Vestibular tests have also long been used for MD, but which tests should be included in the oto-neurological test battery remains controversial. The evaluation method to be used to confirm the clinical diagnosis in MD is not clear. This study aimed to examine the results of vestibular tests and IV Gd-enhanced inner ear MRI in individuals diagnosed with unilateral definite Meniere's disease. Methods: IV Gd-enhanced inner ear MRI (Endolymphatic Hydrops [EH] and Perilymphatic Enhancement [PE]), conventional audiometry (0.25–8 kHz), video Head Impulse Test (vHIT), cervical Vestibular Evoked Myogenic Potential (cVEMP), air caloric test, and dizziness handicap inventory were applied to 16 adult patients diagnosed with unilateral definite MD. Results: Among the patients with definite MD, EH (cochlear and/or vestibular) was identified in 93.7% and 68.7% of the symptomatic and the asymptomatic ears, respectively. There was a positive correlation between the hearing thresholds at 2, 4, 6 and 8 kHz and the degree of cochlear EH (p < 0.05). PE (cochlear and/or vestibular) was observed in 37.5% of the asymptomatic and symptomatic ears. The sensitivity of the vestibular test battery (vHIT, cVEMP, and caloric test) was 100% and its specificity was 50%, while the sensitivity of the IV Gd-enhanced inner ear MRI (EH and PE together) was 93.8% and the specificity was 81.3%. Conclusion: MRI had higher sensitivity and specificity than the vestibular test battery. PE or vHIT alone was not considered to be reliable in the diagnosis of MD. In suspected MD, the clinical history, hearing tests, and IV Gd-enhanced inner ear MRI are sufficient for diagnosis. If MRI technique is not possible, vestibular tests (caloric test and cVEMP, not vHIT) can provide reliable results when evaluated together

Long Term Follow-Up Of Children With Chronic Hepatitis B: A Single Center Experience

Chronic Hepatitis B infection is an important clinical issue because of the associated risk of developing cirrhosis and hepatocellular carcinoma. Especially in children, there is no consensus about the optimal treatment. Clinical features and long-term outcomes of 165 children diagnosed with chronic hepatitis B at our institution between January 1993 and June 2012 were analysed retrospectively. Patients were divided into four groups according to their treatment protocols. The first group received Interferon (IFN) only, the second group started lamivudine (LMV) first then IFN+LMV combined and then continued with LMV only, the third group started with IFN+LMV combined then continued with LMV only and the fourth group received LMV only. After a median follow-up period of 7 years (1-19 years) the highest e-seroconversion (the loss of HBeAg followed by gain of antiHBe antibody) rate, biochemical and virological response was observed with combined (IFN+LMV) treatment regimens. Patients with higher ALT levels were better treatment responders (p: 0.003). Identification of the patients who need to be treated in order to determine the most effective therapy with optimal treatment duration is important to reduce the risk of developing future complications like cirrhosis and hepatocellular carcinoma.WoSScopu

Evaluation Of Central Nervous System In Patients With Glycogen Storage Disease Type 1A

We aimed to evaluate structure and functions of central nervous system (CNS) in children with glycogen storage disease (GSD) type 1a. Neurological examination, psychometric tests, electroencephalography (EEG), magnetic resonance imaging (MRI), visual evoked potentials (VEP) and brainstem auditory evoked potentials (BAEP) were performed. The results were compared between patients with good and poor metabolic control and healthy children. Twenty-three patients with GSD type 1a were studied. Twelve patients were in poor metabolic control group and 11 patients in good metabolic control group. Five patients had intellectual disability, 10 had EEG abnormalities, seven had abnormal VEP and two had abnormal BAEP results. MRI was abnormal in five patients. There was significant correlation between the number of hypoglycemic attacks and MRI abnormalities. Central nervous system may be affected in GSD type 1a even in patients with normal neurologic examination. Accumulation of abnormal results in patients with poor metabolic control supports the importance of metabolic control in GSD type 1a.WoSScopu