The evaluation of chronic progressive external ophthalmoplegia with computerized tomography

Introduction: Chronic progressive external ophthalmoplegia is characterised by limitation of ocular motility in all directions of gaze and ptosis. Innervational or myogenic factors were claimed to be responsible for this motility disorder. The aim of this study was to investigate the extraocular muscles in CPEO with computerized tomography in an attempt to distinguish extraocular muscle morphology caused by this disorder from that occurring in normal individuals. Methods: Eighteen orbits from 9 patients diagnosed with CPEO were included in the study. Axial and coronal scans were obtained for CT evaluation of extraocular muscles and the dimensions of extraocular muscles were measured. The control group consisted of 40 orbits belonging to 20 individuals and, the results were compared with a student's t test. Results: The thickness (the vertical dimension of vertical recti and the horizontal dimension of horizontal recti) of all rectus muscles was significantly decreased in comparison with the control group, whereas the width (the horizontal dimension of vertical recti and the vertical dimension of horizontal recti) was similar in both the diseased and normal orbits. In all the rectus muscles of the diseased orbits, the normal fusiform shape was lost and the muscles appeared as thin bands. Discussion: The differentiation of CPEO from other myogenic and neurogenic disorders may present difficulty, and a cluster of criteria are required for a final diagnosis. CT has proven to be a valuable tool in assessing extraocular muscles [1, 2]. In this study, an extreme atrophy of all rectus muscles was demonstrated by means of CT. This diagnostic method may consequently contribute to a proper diagnosis of CPEO

Body mass index and complications following major gastrointestinal surgery: A prospective, international cohort study and meta-analysis

Aim Previous studies reported conflicting evidence on the effects of obesity on outcomes after gastrointestinal surgery. The aims of this study were to explore the relationship of obesity with major postoperative complications in an international cohort and to present a metaanalysis of all available prospective data. Methods This prospective, multicentre study included adults undergoing both elective and emergency gastrointestinal resection, reversal of stoma or formation of stoma. The primary end-point was 30-day major complications (Clavien\u2013Dindo Grades III\u2013V). A systematic search was undertaken for studies assessing the relationship between obesity and major complications after gastrointestinal surgery. Individual patient meta-analysis was used to analyse pooled results. Results This study included 2519 patients across 127 centres, of whom 560 (22.2%) were obese. Unadjusted major complication rates were lower in obese vs normal weight patients (13.0% vs 16.2%, respectively), but this did not reach statistical significance (P = 0.863) on multivariate analysis for patients having surgery for either malignant or benign conditions. Individual patient meta-analysis demonstrated that obese patients undergoing surgery formalignancy were at increased risk of major complications (OR 2.10, 95% CI 1.49\u20132.96, P < 0.001), whereas obese patients undergoing surgery for benign indications were at decreased risk (OR 0.59, 95% CI 0.46\u20130.75, P < 0.001) compared to normal weight patients. Conclusions In our international data, obesity was not found to be associated with major complications following gastrointestinal surgery. Meta-analysis of available prospective data made a novel finding of obesity being associated with different outcomes depending on whether patients were undergoing surgery for benign or malignant disease

Body mass index and complications following major gastrointestinal surgery: A prospective, international cohort study and meta-analysis

Aim Previous studies reported conflicting evidence on the effects of obesity on outcomes after gastrointestinal surgery. The aims of this study were to explore the relationship of obesity with major postoperative complications in an international cohort and to present a metaanalysis of all available prospective data. Methods This prospective, multicentre study included adults undergoing both elective and emergency gastrointestinal resection, reversal of stoma or formation of stoma. The primary end-point was 30-day major complications (Clavien–Dindo Grades III–V). A systematic search was undertaken for studies assessing the relationship between obesity and major complications after gastrointestinal surgery. Individual patient meta-analysis was used to analyse pooled results. Results This study included 2519 patients across 127 centres, of whom 560 (22.2%) were obese. Unadjusted major complication rates were lower in obese vs normal weight patients (13.0% vs 16.2%, respectively), but this did not reach statistical significance (P = 0.863) on multivariate analysis for patients having surgery for either malignant or benign conditions. Individual patient meta-analysis demonstrated that obese patients undergoing surgery formalignancy were at increased risk of major complications (OR 2.10, 95% CI 1.49–2.96, P < 0.001), whereas obese patients undergoing surgery for benign indications were at decreased risk (OR 0.59, 95% CI 0.46–0.75, P < 0.001) compared to normal weight patients. Conclusions In our international data, obesity was not found to be associated with major complications following gastrointestinal surgery. Meta-analysis of available prospective data made a novel finding of obesity being associated with different outcomes depending on whether patients were undergoing surgery for benign or malignant disease