Evaluation of pediatric patients presenting with acute-onset unilateral transient acquired blepharoptosis

| Purpose: To evaluate the clinical features of pe diatric patients with acute-onset, unilateral transient acquired blepharoptosis. Methods: In this retrospective study, the clinical records of patients between April 2015 and June 2020 were reviewed for evaluation of demographic features, accompanying neurological and ophthalmologic manifestations, symptom duration, etiological cause, and imaging findings. Patients with congenital and acquired blepharoptosis with chronic etiologies were excluded. Results: Sixteen pediatric patients (10 boys and 6 girls) with acquired acute-onset unilateral transient blepharoptosis were included in this study. The patients??? mean age was 6.93 ?? 3.16 years. The most commonly identified etiological cause was trauma in 7 patients (43.75%) and infection (para-infection) in 5 patients (31.25%). In addition, Miller Fisher syndrome, Horner syndrome secondary to neuroblastoma, acquired Brown???s syndrome, and pseudotumor cerebri were identified as etiological causes in one patient each. Additional ocular findings accompanied blepharoptosis in 7 patients (58.33%). Blepharoptosis spontaneously resolved, without treatment, in all the patients, except those with Miller Fisher syndrome, neuroblastoma, and pseudotumor cerebri. None of the patients required surgical treatment and had ocular morbidities such as amblyopia. Conclusion: This study demonstrated that acute-onset unilateral transient blepharoptosis, which is rare in childhood, may regress without the need for surgical treatment in the pediatric population. However, serious pathologies that require treatment may present with blepharoptosis

Stent-Assisted Coiling In Endovascular Treatment Of 500 Consecutive Cerebral Aneurysms With Long-Term Follow-Up

BACKGROUND AND PURPOSE: Stent-assisted coil embolization has become one of the most preferred techniques in the treatment of wide-neck intracranial aneurysms; however, long-term patency and safety of the self-expanding neurostents and their role in durability of the endovascular treatment has remained ambiguous. We sought to retrospectively examine the long-term results of self-expanding stent usage in conjunction with coil embolization in treatment of wide-neck cerebral aneurysms. MATERIALS AND METHODS: We coiled 500 wide-neck cerebral aneurysms with different types of self-expanding neurostent assistance in 468 patients. Patient and aneurysm characteristics, pharmacologic therapy protocol, complications, and initial occlusion grades were analyzed. Patients underwent angiographic follow-up at 6 months to 7 years after treatment. DSA or MRA images of all patients were analyzed to assess the occlusion rate of aneurysms and patency of the parent artery. RESULTS: Enterprise (n = 340), Solitaire (n = 98), Wingspan (n = 41), LEO (n = 16), and Neuroform (n = 5) stent systems were used in this series. Stent-related thromboembolic events occurred in 21 patients and intraoperative rupture occurred in 4 patients. Initially, complete occlusion was achieved in 42.2% of the aneurysms, and, according to the last follow-up data, the rate had progressed to 90.8%. Recanalization rate at 6 months was 8%, whereas the late recanalization rate was 2%. CONCLUSIONS: The use of stents in endovascular treatment provides high rates of complete occlusion and low rates of recurrence at a long-term follow-up study.WoSScopu

GASTROINTESTINAL BLEEDING ASSOCIATED WITH PHARMACOLOGIC TREATMENT OF PATENT DUCTUS ARTERIOSUS IN PRETERM NEONATES

ABSTRACT Objectives. A persistently patent ductus arteriosus (PDA) is a major complication of prematurity. A prompt PDA closure is crucial to reduce related risk of morbidity and mortality. Cycloxygenase inhibitors (COXi) are the a therapy of choice for PDA. However, the use of COXi is characterized by a high risk of gastrointestinal bleeding. Recently paracetamol was proposed as alternative treatment to reduce side effects of the COX-inhibitors therapy for PDA. We performed a systematic review and meta-analysis of all the available evidence to assess the risk of gastrointestinal bleeding during the treatment of PDA with paracetamol vs. COXi. Methods We conducted electronic searches in Medline, Scopus, and ISI web of Knowledge databases, using the following medical subject headings and terms: paracetamol, acetaminophen, and patent ductus arteriosus. Additionally, we performed electronic and manual screening of conference abstracts from international meetings of relevant organizations and manual search of the reference lists of all eligible articles. We considered eligible all studies comparing paracetamol vs. COXi (i.e. ibuprofen or indomethacin), or vs. placebo, for the treatment of PDA. Data regarding safety were collected and analyzed. Results Sixteen studies were included: two randomized controlled trials (RCTs) and 14 uncontrolled studies. Quality of selected studies is poor. A meta-analysis of RCT demonstrated a reduction of the risk of gastrointestinal bleeding in subjects receiving paracetamol vs. COXi (2/125 vs 9/125, RR 0.2, 0.1-1.0 95%CI). No data on gastrointestinal bleeding were reported by uncontrolled studies. Contemporarily, the meta-analysis of the data on the efficacy do not demonstrate any difference between the two therapeutic options on ductal closure (Arch Dis Child Fetal Neonatal Ed 2015; fetalneonatal-2014-307312). Conclusions The use of paracetamol may reduce the risk of gastrointestinal bleeding in preterm neonates receiving pharmacologic treatment for PDA. These results should be interpreted with caution taking into account the non-optimal quality of the studies analyzed and the limited number of neonates treated with paracetamol so far