2004400 October 2004, Change Report and NCD Coding Policy
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12 Retina Gabriele K
299 12 Retina Gabriele K. Lang and Gerhard K. Lang 12.1 Basic Knowledge The retina is the innermost of three successive layers of the globe. It comprises two parts: ❖ A photoreceptive part (pars optica retinae), comprising the first nine of the 10 layers listed below. ❖ A nonreceptive part (pars caeca retinae) forming the epithelium of the cil- iary body and iris. The pars optica retinae merges with the pars ceca retinae at the ora serrata. Embryology: The retina develops from a diverticulum of the forebrain (proen- cephalon). Optic vesicles develop which then invaginate to form a double- walled bowl, the optic cup. The outer wall becomes the pigment epithelium, and the inner wall later differentiates into the nine layers of the retina. The retina remains linked to the forebrain throughout life through a structure known as the retinohypothalamic tract. Thickness of the retina (Fig. 12.1) Layers of the retina: Moving inward along the path of incident light, the individual layers of the retina are as follows (Fig. 12.2): 1. Inner limiting membrane (glial cell fibers separating the retina from the vitreous body). 2. Layer of optic nerve fibers (axons of the third neuron). 3. Layer of ganglion cells (cell nuclei of the multipolar ganglion cells of the third neuron; “data acquisition system”). 4. Inner plexiform layer (synapses between the axons of the second neuron and dendrites of the third neuron). 5. Inner nuclear layer (cell nuclei of the bipolar nerve cells of the second neuron, horizontal cells, and amacrine cells). 6. Outer plexiform layer (synapses between the axons of the first neuron and dendrites of the second neuron). -
Medical Review(S) Clinical Review
CENTER FOR DRUG EVALUATION AND RESEARCH APPLICATION NUMBER: 200327 MEDICAL REVIEW(S) CLINICAL REVIEW Application Type NDA Application Number(s) 200327 Priority or Standard Standard Submit Date(s) December 29, 2009 Received Date(s) December 30, 2009 PDUFA Goal Date October 30, 2010 Division / Office Division of Anti-Infective and Ophthalmology Products Office of Antimicrobial Products Reviewer Name(s) Ariel Ramirez Porcalla, MD, MPH Neil Rellosa, MD Review Completion October 29, 2010 Date Established Name Ceftaroline fosamil for injection (Proposed) Trade Name Teflaro Therapeutic Class Cephalosporin; ß-lactams Applicant Cerexa, Inc. Forest Laboratories, Inc. Formulation(s) 400 mg/vial and 600 mg/vial Intravenous Dosing Regimen 600 mg every 12 hours by IV infusion Indication(s) Acute Bacterial Skin and Skin Structure Infection (ABSSSI); Community-acquired Bacterial Pneumonia (CABP) Intended Population(s) Adults ≥ 18 years of age Template Version: March 6, 2009 Reference ID: 2857265 Clinical Review Ariel Ramirez Porcalla, MD, MPH Neil Rellosa, MD NDA 200327: Teflaro (ceftaroline fosamil) Table of Contents 1 RECOMMENDATIONS/RISK BENEFIT ASSESSMENT ......................................... 9 1.1 Recommendation on Regulatory Action ........................................................... 10 1.2 Risk Benefit Assessment.................................................................................. 10 1.3 Recommendations for Postmarketing Risk Evaluation and Mitigation Strategies ........................................................................................................................ -
Intraperitoneal Haemorrhagefrom Anterior Abdominal
490 CLINICAL REPORTS Postgrad Med J: first published as 10.1136/pgmj.69.812.490 on 1 June 1993. Downloaded from Postgrad Med J (1993) 69, 490-493 © The Fellowship of Postgraduate Medicine, 1993 Intraperitoneal haemorrhage from anterior abdominal wall varices J.B. Hunt, M. Appleyard, M. Thursz, P.D. Carey', P.J. Guillou' and H.C. Thomas Departments ofMedicine and 1Surgery, St Mary's Hospital Medical School, Imperial College, London W2 INY, UK Summary: Patients with oesophageal varices frequently present with gastrointestinal haemorrhage but bleeding from varices at other sites is rare. We present a patient with hepatitis C-induced cirrhosis and partial portal vein occlusion who developed spontaneous haemorrhage from anterior abdominal wall varices into the rectus abdominus muscle and peritoneal cavity. Introduction Portal hypertension is most often seen in patients abdominal pain of sudden onset. Over the pre- with chronic liver disease but may also occur in ceding 3 months he had noticed abdominal and those with portal vein occlusion. Thrombosis ofthe ankle Four years earlier chronic active swelling. by copyright. portal vein is recognized in both cirrhotic patients,' hepatitis had been diagnosed in Egypt and treated those with previous abdominal surgery, sepsis, with prednisolone and azathioprine. neoplasia, myeloproliferative disorders,2 protein Examination revealed a well nourished, jaun- C3 or protein S deficiency.4 diced man with stigmata of chronic liver disease Oesophageal varices develop when the portal who was anaemic and shocked with a pulse of pressure is maintained above 12 mmHg.5 Patients 100mm and blood pressure 60/20 mmHg. The with oesophageal varices often present with severe abdomen was distended, diffusely tender and there haematemesis. -
MOC PORT/DOCK Practice Core Modules Content Outline
MOC PORT/DOCK Practice Core Modules Content Outline 1 Cataract and Anterior Segment (10%) 1.1 Basic Anatomical and Scientific Aspects 1.1.1 The Normal Lens 1.1.1.1 Anatomy 1.2 Assessment Techniques 1.2.1 History-Taking and Preoperative Examination of Ocular Structures 1.2.1.1 Take patient history 1.2.1.2 Examine ocular structures 1.2.1.3 Signs and symptoms 1.2.1.4 Indications for surgery 1.2.1.6 External examination 1.2.1.7 Slit-lamp examination 1.2.1.8 Fundus evaluation 1.2.1.9 Impact on visual functioning and quality of life 1.2.2 Measurement of Visual and Macular Function 1.2.2.1 Visual acuity testing 1.2.2.2 Test visual acuity 1.2.2.5 Visual field testing 1.2.2.6 Test visual field 1.2.2.7 Cataract's effect on visual acuity 1.2.2.8 Estimate cataract's effect on visual acuity 1.2.2.10 Measure visual (and macular) function 1.2.4.3 Evaluate glare disability: subjective and objective 1.3 Clinical Disease Conditions and Manifestations 1.3.1 Types of Cataract 1.3.1.1 Identify types of cataracts 1.3.2 Anterior Segment Disorders 1.3.2.1 Diagnose anterior segment disorders 1.3.2.2 Cataract associated with uveitis 1.3.2.3 Diabetes mellitus and cataract formation 1.3.2.4 Lens-induced glaucoma 1.3.2.4.1 Lens particle 1.3.2.4.2 Phacolytic 1.3.2.4.3 Phacomorphic Copyright and Use Policy for ABO Content Outlines © 2017 – American Board of Ophthalmology. -
Familial Hypercholesterolemia and Xanthomatosis Associated with Diabetes Mellitus: a Case Report and Review of the Literature Ch
Familial Hypercholesterolemia and Xanthomatosis Associated with Diabetes Mellitus: A Case Report and Review of the Literature Ching-Hsiang Leung, Tien-Ling Chen*, Chao-Hung Wang, Kun-Wu Tsan, and Daniel T. H. Chin** Division of Endocrinology and Metabolism, Department of Internal Medicine; *Division of Allergy, Immunology & Rheumatology, Department of Internal Medicine; **Department of Pathology; Mackay Memorial Hospital, Taipei, Taiwan Abstract Familial hypercholesterolemia is an autosomal dominant disorder due to mutations in the low-density lipoprotein receptor gene, characterized by skin and tendon xanthomas, xanthelasma and premature arcus corneae. It is associated with an increased risk of premature coronary heart disease, which is further increased if there is co-existing diabetes mellitus. A 35-year-old female who developed cutaneous and tendon xanthomas since the age of 12 was diagnosed as having mixed primary familial hypercholesterolemia and secondary hyperlipidemia due to diabetes mellitus, and osteomyelitis. However, familial hypercholesterolemia remains seriously under-diagnosed, delaying treatment. Screening of first-degree relatives and extended family members plays an important role in early detection and treatment. ( J Intern Med Taiwan 2003;14:23-30 ) Key Words:Familial hypercholesterolemia, Xanthomatosis, Diabetes mellitus, LDL receptor, Osteomyelitis Introduction Familial hypercholesterolemia is a monogenic 1 , autosomal dominant 2 disorder due to mutations in the gene for the LDL receptor 3, characterized by xanthomas 4, xanthelasma and premature arcus corneae 5. Our report concerns a 35-year-old female patient who developed xanthomas since the age of 12 and was diagnosed as having mixed primary familial hypercholesterolemia and secondary hyperlipidemia due to diabetes mellitus, and osteomyelitis. The significance, characteristic features, diagnosis and treatment of familial hypercholesterolemia are discussed. -
Erdheim-Chester Disease and Eyes
Erdheim-Chester Disease and Eyes OMAR OZGUR, MD OCTOBER 10, 2015 9:30- 10:00AM OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGERY AND ORBITAL ONCOLOGY FELLOW DEPARTMENT OF PLASTIC SURGERY THE UNIVERSITY OF TEXAS MD ANDERSON CANCER CENTER HOUSTON, TX, UNITED STATES Outline Anatomy and function of the eye and orbit Background and overview of ECD What can ECD do to the eye? DoubleDouble visionvision Pain Exophthalmos Overview of an eye exam General eye conditions that may also occur Droopy eyelids Dry eye syndrome Cataracts Refractive error Questions Please ask anytime! www.nasa.gov – Cat’s Eye Nebula Background anatomy https://c2.staticflickr.com/2/1363/542580866_940d2f9a02.jpg http://fiftylives.org/blog/wp- content/uploads/2012/08/Cornea.jpg Eye anatomy https://c2.staticflickr. com/2/1363/5425808 66_940d2f9a02.jpg http://www.retina-doctors.com/galleries/splash_patients/Eye%20anatomy%20-%20AN0003.jpg Optic nerves http://antranik.org/wp-content/uploads/2011/11/optic-nerve-lateral- geniculate-nucleus-of-thalamus-optic-radiation-visual-cortex.jpg?9873a6 http://www.vision-and-eye-health.com/images/GCA-AION.jpg Orbital anatomy http://www.leventefe.com.au/portfolio /mi-tec-medical-media-3/ http://msk- anatomy.blogspot.com/2014/12/ cranial-nerves-anatomy.html Eyelid structure http://eyestrain.sabhlokcity.com/2011/ 09/meibomian-gland-disease-mgd/ http://www.mastereyeassociates.com/blepharitis http://www.medindia.net/patients/patientinfo/gran ulated-eyelids.htm CT and MRI http://www.ijri.org/articles/2012/2 2/3/images/IndianJRadiolImaging_ -
Diagnosis and Management of Primary Biliary Cholangitis Ticle
REVIEW ArtICLE 1 see related editorial on page x Diagnosis and Management of Primary Biliary Cholangitis TICLE R Zobair M. Younossi, MD, MPH, FACG, AGAF, FAASLD1, David Bernstein, MD, FAASLD, FACG, AGAF, FACP2, Mitchell L. Shifman, MD3, Paul Kwo, MD4, W. Ray Kim, MD5, Kris V. Kowdley, MD6 and Ira M. Jacobson, MD7 Primary biliary cholangitis (PBC) is a chronic, cholestatic, autoimmune disease with a variable progressive course. PBC can cause debilitating symptoms including fatigue and pruritus and, if left untreated, is associated with a high risk of cirrhosis and related complications, liver failure, and death. Recent changes to the PBC landscape include a REVIEW A name change, updated guidelines for diagnosis and treatment as well as new treatment options that have recently become available. Practicing clinicians face many unanswered questions when managing PBC. To assist these healthcare providers in managing patients with PBC, the American College of Gastroenterology (ACG) Institute for Clinical Research & Education, in collaboration with the Chronic Liver Disease Foundation (CLDF), organized a panel of experts to evaluate and summarize the most current and relevant peer-reviewed literature regarding PBC. This, combined with the extensive experience and clinical expertise of this expert panel, led to the formation of this clinical guidance on the diagnosis and management of PBC. Am J Gastroenterol https://doi.org/10.1038/s41395-018-0390-3 INTRODUCTION addition, diagnosis and treatment guidelines are changing and a Primary biliary cholangitis (PBC) is a chronic, cholestatic, auto- number of guidelines have been updated [4, 5]. immune disease with a progressive course that may extend over Because of important changes in the PBC landscape, and a num- many decades. -
Mimickers of Acute Appendicitis
Appendicitis Mimics, Thompson et al. Mimickers of Acute Appendicitis Joel P. Thompson, M.D., MPH, Dhana Selvaraj, M.D., Refky Nicola, D.O. Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY Introduction of patients.2,3 The presence of intravenous and enteric contrast aids in identification of the appendix.3 Acute abdominal pain is the most common reason The appendix arises from the cecum inferior to the for an emergency department visit among patients age ileocecal junction (Fig. 1). MDCT signs of acute 15 and older, a large portion of them will complain of 1 appendicitis include appendiceal diameter > 7 mm pain localizing to the right lower quadrant. While with peri-appendiceal stranding of the mesenteric fat appendicitis is the most common cause of the surgical (Fig. 2A).4 Both findings are present in up to 93% of abdomen, a wide variety of acute gastrointestinal, appendicitis cases identified on MDCT.5 The diagnosis genitourinary, and gynecological pathologic processes of appendicitis should not be made using appendiceal can present in similar fashion (Table 1). Acute diameter alone; wall thickening and increased gastrointestinal diseases, such as Crohn’s disease, enhancement should also be present.6 Additional infectious enterocolitis, mesenteric adenitis, cecal findings include the presence of an appendicolith, diverticulitis, Meckel’s diverticulitis, epiploic cecal apical thickening (“arrowhead sign”), mesenteric appendagitis, and omental infarcts can present with adenopathy, fluid in the paracolic gutter, and the right lower quadrant. In addition, acute genitourinary presence of phlegmon.5 A focal wall defect, diseases, such as pyelonephritis and ureterolithiasis, extraluminal air, or presence of an abscess are signs of can present with similar symptoms. -
Hemoperitoneum in Peritoneal Dialysis, a Red Flag? Case Report
Rev. Colomb. Nefrol. 2015; 2(1): 70 -75. http//www.revistanefrologia.org Rev. Colomb.Case Nefrol. report 2015; 2(1): 70 - 75 http//doi.org/10.22265/acnef.2.1.200 Hemoperitoneum in peritoneal dialysis, a red flag? Case report. Sylvia Quiñones Sussman1, Carolina Larrarte Arenas1, Freddy Ardila Celis2 1 Department, Unit missing, RTS-Agencia Santa Clara, Bogotá, Colombia. 2 Department, Unit missing, Clinical Development RTS / Baxter Colombia. Abstract Hemoperitoneum is a complication of peritoneal dialysis. Its differential diagnosis is broad and the approach is based on its clinical manifestation and severity. It is important to evaluate all the causes of hemoperito- neum and to consider that it may be life risking. This is a case of a patient on long term peritoneal dialysis with hemoperitoneum, whose study showed calcifying peritonitis as the underlying condition. Key words: hemoperitoneum, peritoneal dialysis, calcifying peritonitis, sclerosing encapsulating peritonitis. ¿Hemoperitoneo en diálisis peritoneal, un signo de alarma? Resumen El hemoperitoneo es una complicación de la diálisis peritoneal. Su diagnóstico diferencial es amplio y el enfoque se basa en el cuadro clínico y su severidad. Es necesario evaluar todas las causas del hemoperitoneo y tener en cuenta que tienen manifestaciones diferentes y que algunas arriesgan la vida del paciente. A con- tinuación se describe un caso de un paciente con largo tiempo en diálisis peritoneal con hemoperitoneo, en quien el estudio sugiere peritonitis calcificante como enfermedad de base. Palabras -
Peritoneal Sclerosis and Massive Hemoperitoneum: Case Report and Short Review
Urology & Nephrology Open Access Journal Case Report Open Access Peritoneal sclerosis and massive hemoperitoneum: case report and short review Abstract Volume 7 Issue 3 - 2019 Secondary Peritoneal Sclerosis has been reported in several cases but is especially frequent Daniel Gonzalez Nunez, Jhordan Guzman, among chronic peritoneal dialysis users, being its most serious complication. Clinical suspicion in chronic PD users is no challenge as intestinal symptoms and hypoalbuminemia Felipe Matteus Acuna, Juan Guillermo Ramos, appear and radiological confirmation is usually achieved before the need for surgery and Juliana Ordonez intra abdominal findings prove confirmatory. A case report of a 37-year-old male patient Department of Surgery, Hospital Universitario Clinica San Rafael, Universidad Militar Nueva Granada, Bogota, Colombia with a 13 year long peritoneal dialysis in whom laparotomy findings were a massive hemoperitoneum, parietal/visceral peritoneum, small/large bowel and mesentery with Correspondence: Daniel Gonzalez Nunez, Department of chronic inflammatory changes, thickening and dark-brown coloration. As a distinctive Surgery, Hospital Universitario Clinica San Rafael, Universidad feature a gastroepiploic artery branch in the gastric curvature was identified with persistent Militar Nueva Granada, Bogota, Colombia, Tel +5713108667653, oozing and hemostasis was achieved. No intestinal obstruction was evident. Postoperative Email was uneventful. In patients undergoing peritoneal dialysis a hemorrhagic effluent from the catheter or -
A Phase Ib Study Evaluating Cobimetinib Plus
Official Title: A Phase Ib Study Evaluating Cobimetinib Plus Atezolizumab in Patients With Advanced BRAF V600 Wild-Type Melanoma Who Have Progressed During or After Treatment With Anti−PD-1 Therapy and Atezolizumab Monotherapy in Patients With Previously Untreated Advanced BRAF V600 Wild-Type Melanoma NCT Number: NCT03178851 Document Date: Protocol Version 5: 26-October-2018 PROTOCOL TITLE: A PHASE IB STUDY EVALUATING COBIMETINIB PLUS ATEZOLIZUMAB IN PATIENTS WITH V600 ADVANCED BRAF WILD-TYPE MELANOMA WHO HAVE PROGRESSED DURING OR AFTER TREATMENT WITH ANTI−PD-1 THERAPY AND ATEZOLIZUMAB MONOTHERAPY IN PATIENTS WITH PREVIOUSLY UNTREATED ADVANCED V600 BRAF WILD-TYPE MELANOMA PROTOCOL NUMBER: CO39721 VERSION NUMBER: 5 EUDRACT NUMBER: 2016-004402-34 IND NUMBER: 135,717 TEST PRODUCTS: Cobimetinib (RO5514041) Atezolizumab (RO5541267) MEDICAL MONITOR: M.D. SPONSOR: F. Hoffmann-La Roche Ltd DATE FINAL: 14 December 2016 DATES AMENDED: Version 2: 23 June 2017 Version 3: 19 September 2017 Version 4: 3 February 2018 Version 5: See electronic date stamp below. PROTOCOL AMENDMENT APPROVAL Approver's Name Title Date and Time (UTC) Company Signatory 26-Oct-2018 10:19:14 CONFIDENTIAL This clinical study is being sponsored globally by F. Hoffmann-La Roche Ltd of Basel, Switzerland. However, it may be implemented in individual countries by Roche’s local affiliates, including Genentech, Inc. in the United States. The information contained in this document, especially any unpublished data, is the property of F. Hoffmann-La Roche Ltd (or under its control) and therefore is provided to you in confidence as an investigator, potential investigator, or consultant, for review by you, your staff, and an applicable Ethics Committee or Institutional Review Board. -
Management of Hyperlipidemias: an Update
Review MManagementanagement ofof hyperlipidemias:hyperlipidemias: AnAn updateupdate Article NNitinitin RRanjananjan Department of Dermatology, ABSTRACT Jawaharlal Nehru Medical College, Aligarh Muslim The discovery of the key enzymes, receptors, and transporters in cholesterol biosynthesis University, Aligarh, India has enabled us to assemble fragments of knowledge concerning lipids and lipoproteins into dynamic pathways, leading to the development of a multitude of lipid-lowering drugs. AAddressddress forfor ccorrespondence:orrespondence: Dr. Nitin Ranjan, Department After a brief recapitulation of the pathways of cholesterol metabolism and the dermatologic of Dermatology, Jawaharlal manifestations of lipid derangement, we shall review drugs which modify intestinal cholesterol Nehru Medical College, and bile-acid reabsorption, and hepatic lipoprotein biosynthesis and catabolism. The current Aligarh Muslim University literature is examined to determine future therapeutic targets in lipid metabolism, as well as (AMU), Aligarh - 202 001, the role of traditional foods as lipid-lowering agents. The latest National Cholesterol Education Uttar Pradesh, India. E-mail: [email protected] Program guidelines for managing hypercholesterolemia are also discussed. DOI: 10.4103/0378-6323.55387 Key words: Guidelines, Lipid metabolism, Low-density lipoprotein cholesterol, Statins PMID: ***** IINTRODUCTIONNTRODUCTION nascent CMs acquire cholesteryl esters (ChE), apo-C, and apo-E from HDL to form CMs. These CMs come Cholesterol serves not only as an essential component in contact with lipoprotein lipase (LPL) located on the of the cell membrane but also as the precursor luminal surface of vascular endothelium of skeletal molecule from which steroid hormones, bile salts, muscle and adipose tissue. LPL breaks down the and vitamin D are synthesized. It is both derived from triglyceride component of CMs into free fatty acids the diet and synthesized within the body, mainly in (FFA) and monoglycerides, in the process converting the liver.