Archives of Ophthalmology
Temporary Sutureless Amniotic Membrane Patch for Acute Alkaline Burns
Objective: To evaluate the clinical outcome of a new sutureless approach for a temporary amniotic membrane patch (ProKera; Bio-Tissue, Inc, Miami, Florida) in eyes with acute burns.
Methods: Retrospective review of 5 eyes of 5 patients with grades I to III acute alkaline burns, receiving ProKera insertion within 8 days of injury.
Results: These eyes had either total (2 cases) or extensive (60%-75%, 3 cases) corneal epithelial defects with limbal (120°-360°) and conjunctival (30%-60%) epithelial defects. ProKera was inserted within a mean (SD) of 3.7 (3.1) days after burn and repeated 1 to 3 times for 3 cases. Conjunctival defects reepithelialized in 8.2 (5) days (range, 5-17 days), while limbal and corneal defects healed in 13.6 (8.3) days (range, 5-25 days). The latter was completed with circumferential closure of limbal defects followed by centripetal healing of corneal defects. In 3 eyes, early peripheral corneal neovascularization was followed by marked regression on completion of healing. During 16.8 (10.8) months of follow-up, all eyes retained a stable surface with improved corneal clarity, and without limbal deficiency or symblepharon.
Conclusion: This sutureless application of an amniotic membrane patch allows for early delivery of its biologic actions, which may help preserve remaining limbal stem cells for rapid expansion and prevent late cicatricial complications in eyes with mild and moderate acute alkaline burns.
Kheirkhah A, Johnson DA, Paranjpe DR, Raju VK, Casas V, Tseng SCG
2008;126(8):1059-1066
Archives of Otolaryngology–Head & Neck Surgery
The Jahrsdoerfer Grading Scale in Surgery to Repair Congenital Aural Atresia
Objective: To determine the predictive ability of the Jahrsdoerfer grading scale score in congenital aural atresia surgery.
Design: Retrospective review of medical records.
Setting: Tertiary referral center.
Patients: One hundred eight patients with aural atresia.
Main Outcome Measures: Demographic data, preoperative Jahrsdoerfer score, and postoperative audiometric outcomes were reviewed. One month postoperative, 4-tone pure-tone averages and speech reception thresholds were compared between ears scoring 6 or lower, 7, and 8 or higher on the Jahrsdoerfer grading scale. The percentage of ears with a speech reception threshold of 30 dB hearing level or lower for each group was calculated and compared between groups. Individual anatomical structures on the Jahrsdoerfer grading scale were evaluated for their ability to predict postoperative audiometric success.
Results: Of 116 ears evaluated, postoperative 4-tone pure-tone averages and speech reception thresholds were significantly poorer in ears scoring 6 or less on the Jahrsdoerfer grading scale compared with ears scoring 7 or higher (P < .02, t test). Ears scoring 6 or less had a 45% chance of achieving a postoperative speech reception threshold of 30 dB hearing level or lower, while ears scoring 7 or higher had an 89% chance (P < .01, 2 test). Lack of middle ear aeration was the only anatomical factor predictive of poor audiometric outcome.
Conclusions: Compared with patients with a Jahrsdoerfer score of 6 or lower, patients with a score of 7 or higher had significantly better hearing postoperatively. Middle ear aeration may be the most important predictor of postoperative hearing outcome. The Jahrsdoerfer grading scale is an invaluable tool in the preoperative evaluation of patients with congenital aural atresia.
Shonka DC Jr, Livingston WJ III, Kesser BW
2008;134(8):873-877
Archives of Dermatology
A Community-Based Study of Acne-Related Health Preferences in Adolescents
Objective: To examine preferences for acne-related outcomes in adolescents.
Design: Community-based, cross-sectional survey study.
Setting: Four public high schools in San Francisco, California.
Participants: Volunteer sample of 266 adolescents with acne.
Main Outcome Measures: Health utilities for current acne state and 3 hypothetical acne-related states (100% clearance, 50% clearance, and 100% clearance but with residual scarring) using time trade-off (TTO) and willingness to pay metrics. A self-administered written survey was used.
Results: The mean (median) utilities for current acne state using the TTO metric was 0.961 (0.985). One hundred percent acne clearance received a higher utility score (mean [median] score, 0.978 [0.994]) than 50% clearance (0.967 [0.992]; P < .001 by Wilcoxon signed rank test) and 100% clearance with scarring (0.965 [0.992]; P < .001). Although current acne state utility was not correlated with physician-rated severity (P = .23), a significant association with subject-rated severity was observed in both univariate analysis (P = .01) and after adjustment for duration of acne, having seen a physician for acne, and income (P = .05). Adolescents were willing to pay a median of $275 to have never had acne in their lifetime and were willing to pay significantly more for 100% clearance than for 50% clearance or 100% clearance but with scarring (P < .001 for both comparisons).
Conclusions: We describe adolescents' acne-related health state utilities. Compared with current acne state utility, both partial and total clearance with scarring are substantially less preferable than total clearance. Subjects' self-rated disease severity correlates with current acne state utility, whereas physician-rated severity does not. A self-administered paper instrument can effectively assess adolescents' acne-related preferences in community-based samples.
Chen CL, Kuppermann M, Caughey AB, Zane LT
2008;144(8):988-994
Dermoscopic Evaluation of Amelanotic and Hypomelanotic Melanoma
Objective: To determine the predictive dermoscopic features of amelanotic and hypomelanotic melanoma.
Design: A total of 105 melanomas (median Breslow thickness, 0.76 mm), 170 benign melanocytic lesions, and 222 nonmelanocytic lesions lacking significant pigment (amelanotic, partially pigmented, and light colored) were imaged using glass-plate dermoscopy devices and scored for 99 dermoscopic features. Diagnostic models were derived from and tested on independent randomly selected lesions.
Setting: Predominantly hospital-based clinics from 5 continents.
Main Outcome Measures: Sensitivity, specificity, and odds ratios for individual features and models for the diagnosis of melanoma and malignancy.
Results: The most significant negative predictors of melanoma were having multiple (>3) milialike cysts (odds ratio, 0.09; 95% confidence interval, 0.01-0.64), comma vessels with a regular distribution (0.10; 0.01-0.70), comma vessels as the predominant vessel type (0.16; 0.05-0.52), symmetrical pigmentation pattern (0.18; 0.09-0.39), irregular blue-gray globules (0.20; 0.05-0.87), and multiple blue-gray globules (0.28; 0.10-0.81). The most significant positive predictors were having a blue-white veil (odds ratio,13; 95% confidence interval, 3.9-40.0), scarlike depigmentation (4.4; 2.4-8.0), multiple blue-gray dots (3.5; 1.9-6.4), irregularly shaped depigmentation (3.3; 2.0-5.3), irregular brown dots/globules (3.2; 1.8-5.6), 5 to 6 colors (3.2; 1.6-6.3), and predominant central vessels (3.1; 1.6-6.0). A simple model distinguishing melanomas from all nonmelanomas had a sensitivity of 70% and a specificity of 56% in the test set. A model distinguishing all malignant lesions from benign lesions had a sensitivity of 96% and a specificity of 37%.
Conclusion: Although the diagnostic accuracy of dermoscopy for melanoma lacking significant pigment is inferior to that of more pigmented lesions, features distinguishing the former from benign lesions can be visualized on dermoscopic evaluation.
Menzies SW, Kreusch J, Byth K, et al
2008;144(9):1120-1127
