Navigating the Retinal Periphery
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Summary Benchmarks for Preferred Practice Pattern® Guidelines
SUMMARY BENCHMARKS FOR PREFERRED PRACTICE PATTERN® GUIDELINES TABLE OF CONTENTS Summary Benchmarks for Preferred Practice Pattern Guidelines Introduction . 1 Glaucoma Primary Open-Angle Glaucoma (Initial Evaluation) . 3 Primary Open-Angle Glaucoma (Follow-up Evaluation) . 5 Primary Open-Angle Glaucoma Suspect (Initial and Follow-up Evaluation) . 6 Primary Angle-Closure Disease (Initial Evaluation and Therapy) . 8 Retina Age-Related Macular Degeneration (Initial and Follow-up Evaluation) . 10 Age-Related Macular Degeneration (Management Recommendations) . 11 Diabetic Retinopathy (Initial and Follow-up Evaluation) . 12 Diabetic Retinopathy (Management Recommendations) . 13 Idiopathic Epiretinal Membrane and Vitreomacular Traction (Initial Evaluation and Therapy) . 14 Idiopathic Macular Hole (Initial Evaluation and Therapy) . 15 Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration (Initial and Follow-up Evaluation) . 17 Retinal and Ophthalmic Artery Occlusions (Initial Evaluation and Therapy) . 18 Retinal Vein Occlusions (Initial Evaluation and Therapy) . 19 Cataract/Anterior Segment Cataract (Initial and Follow-up Evaluation) . 20 Cornea/External Disease Bacterial Keratitis (Initial Evaluation) . 22 Bacterial Keratitis (Management Recommendations) . 23 Blepharitis (Initial and Follow-up Evaluation) . 24 Conjunctivitis (Initial Evaluation) . 25 Conjunctivitis (Management Recommendations) . 26 Corneal Ectasia (Initial Evaluation and Follow-up) . 27 Corneal Edema and Opacification (Initial Evaluation) . 28 Corneal Edema -
Glossary for Narrative Writing
Periodontal Assessment and Treatment Planning Gingival description Color: o pink o erythematous o cyanotic o racial pigmentation o metallic pigmentation o uniformity Contour: o recession o clefts o enlarged papillae o cratered papillae o blunted papillae o highly rolled o bulbous o knife-edged o scalloped o stippled Consistency: o firm o edematous o hyperplastic o fibrotic Band of gingiva: o amount o quality o location o treatability Bleeding tendency: o sulcus base, lining o gingival margins Suppuration Sinus tract formation Pocket depths Pseudopockets Frena Pain Other pathology Dental Description Defective restorations: o overhangs o open contacts o poor contours Fractured cusps 1 ww.links2success.biz [email protected] 914-303-6464 Caries Deposits: o Type . plaque . calculus . stain . matera alba o Location . supragingival . subgingival o Severity . mild . moderate . severe Wear facets Percussion sensitivity Tooth vitality Attrition, erosion, abrasion Occlusal plane level Occlusion findings Furcations Mobility Fremitus Radiographic findings Film dates Crown:root ratio Amount of bone loss o horizontal; vertical o localized; generalized Root length and shape Overhangs Bulbous crowns Fenestrations Dehiscences Tooth resorption Retained root tips Impacted teeth Root proximities Tilted teeth Radiolucencies/opacities Etiologic factors Local: o plaque o calculus o overhangs 2 ww.links2success.biz [email protected] 914-303-6464 o orthodontic apparatus o open margins o open contacts o improper -
X Linked Retinoschisis
British Joumal of Ophthalmology 1995; 79: 697-702 697 PERSPECTIVE Br J Ophthalmol: first published as 10.1136/bjo.79.7.697 on 1 July 1995. Downloaded from X linked retinoschisis N D L George, J R W Yates, A T Moore Background XLRS had a carrier prevalence of 14 per 10 000 popula- Haas first described what is now acknowledged as being X tion'4 and it was considered to be the commonest X linked linked retinoschisis (XLRS) nearly a century ago in a paper condition in that country before the increased recognition entitled 'Ueber das Zusammenvorkommen von of fragile X syndrome.'5 XLRS is fully penetrant'4 and Veranderungen der Retina und Choroidea'. I although retinal signs have been described in infants as Accompanying his description of the disease in two males young as 3 months of age,'6 17 affected males usually was a beautiful drawing of the typical radiating cystic mac- present at school age when reading difficulties are ulopathy. The fact that subsequent authors failed to detected. Less commonly the disorder may present in early observe these macular changes and instead described the infancy with squint, nystagmus, and bilateral highly peripheral retinal features of the disease2-4 is testimony elevated bullous retinoschisis often with haemorrhage perhaps to his shrewd powers of observation. Although within the schisis cavity or into the vitreous.18 19 The Haas believed the retinal and choroidal changes were bullous peripheral retinoschisis may subsequently undergo inflammatory in origin, Pagenstecher published a pedigree spontaneous reattachment20 leaving pigment demarcation some 15 years later which showed an X linked pattern of lines and a visual prognosis that is often better than the inheritance.5 The variable clinical manifestations of the initial appearance would suggest.2' disease are exemplified by the wide variety of names that Foveal schisis (Figs 1A and B) is characteristic of have been ascribed to XLRS in the past. -
Description of Alternative Approaches to Measure and Place a Value on Hospital Products in Seven Oecd Countries
OECD Health Working Papers No. 56 Description of Alternative Approaches to Measure Luca Lorenzoni, and Place a Value Mark Pearson on Hospital Products in Seven OECD Countries https://dx.doi.org/10.1787/5kgdt91bpq24-en Unclassified DELSA/HEA/WD/HWP(2011)2 Organisation de Coopération et de Développement Économiques Organisation for Economic Co-operation and Development 14-Apr-2011 ___________________________________________________________________________________________ _____________ English text only DIRECTORATE FOR EMPLOYMENT, LABOUR AND SOCIAL AFFAIRS HEALTH COMMITTEE Unclassified DELSA/HEA/WD/HWP(2011)2 Health Working Papers OECD HEALTH WORKING PAPERS NO. 56 DESCRIPTION OF ALTERNATIVE APPROACHES TO MEASURE AND PLACE A VALUE ON HOSPITAL PRODUCTS IN SEVEN OECD COUNTRIES Luca Lorenzoni and Mark Pearson JEL Classification: H51, I12, and I19 English text only JT03300281 Document complet disponible sur OLIS dans son format d'origine Complete document available on OLIS in its original format DELSA/HEA/WD/HWP(2011)2 DIRECTORATE FOR EMPLOYMENT, LABOUR AND SOCIAL AFFAIRS www.oecd.org/els OECD HEALTH WORKING PAPERS http://www.oecd.org/els/health/workingpapers This series is designed to make available to a wider readership health studies prepared for use within the OECD. Authorship is usually collective, but principal writers are named. The papers are generally available only in their original language – English or French – with a summary in the other. Comment on the series is welcome, and should be sent to the Directorate for Employment, Labour and Social Affairs, 2, rue André-Pascal, 75775 PARIS CEDEX 16, France. The opinions expressed and arguments employed here are the responsibility of the author(s) and do not necessarily reflect those of the OECD. -
Physiology H Digestive
2/28/18 Introduction • Provides processes to break down molecules into a state easily used by cells - A disassembly line: Starts at the mouth and ends Digestive System at the anus • Digestive functions are initiated by the parasympathetic division Chapter 29 - Digestion occurs during periods of low activity - Produces more energy than it uses Copyright © 2016 by Elsevier Inc. All rights reserved. 1 Copyright © 2016 by Elsevier Inc. All rights reserved. 2 Anatomy The Digestive System • Oral cavity • Pharynx • Esophagus • Stomach • Small intestine and large intestine • Accessory organs: Pancreas, liver, and gallbladder From Herlihy B: The human body in health and illness, ed 4, St. Louis, 2011, Saunders. Copyright © 2016 by Elsevier Inc. All rights reserved. 3 Copyright © 2016 by Elsevier Inc. All rights reserved. 4 Physiology Gastrointestinal Tract • Ingestion: Taking materials into mouth by • Muscular tube throughout digestive system eating/drinking • Accessory organs and glands secrete • Digestion: Breaking down food into molecules substance to aid in digestion that can be used by the body • GI tract wall has four layers: - Includes mechanical and enzymatic action - Mucosa • Absorption: Simple molecules from the - Submucosa gastrointestinal (GI) tract move into the - Muscle layer: Responsible for peristalsis bloodstream or lymph vessels and then into - Serosa body cells • Defecation: Eliminating indigestible or unabsorbed material from the body Copyright © 2016 by Elsevier Inc. All rights reserved. 5 Copyright © 2016 by Elsevier Inc. All rights reserved. 6 1 2/28/18 Peristalsis Oral Cavity • First portion of GI tract • Contains: - Teeth - Tongue - Openings for salivary glands From Thibodeau GA, Patton KT: Anatomy & physiology, ed 6, St. -
Non-Syndromic Occurrence of True Generalized Microdontia with Mandibular Mesiodens - a Rare Case Seema D Bargale* and Shital DP Kiran
Bargale and Kiran Head & Face Medicine 2011, 7:19 http://www.head-face-med.com/content/7/1/19 HEAD & FACE MEDICINE CASEREPORT Open Access Non-syndromic occurrence of true generalized microdontia with mandibular mesiodens - a rare case Seema D Bargale* and Shital DP Kiran Abstract Abnormalities in size of teeth and number of teeth are occasionally recorded in clinical cases. True generalized microdontia is rare case in which all the teeth are smaller than normal. Mesiodens is commonly located in maxilary central incisor region and uncommon in the mandible. In the present case a 12 year-old boy was healthy; normal in appearance and the medical history was noncontributory. The patient was examined and found to have permanent teeth that were smaller than those of the average adult teeth. The true generalized microdontia was accompanied by mandibular mesiodens. This is a unique case report of non-syndromic association of mandibular hyperdontia with true generalized microdontia. Keywords: Generalised microdontia, Hyperdontia, Permanent dentition, Mandibular supernumerary tooth Introduction [Ullrich-Turner syndrome], Chromosome 13[trisomy 13], Microdontia is a rare phenomenon. The term microdontia Rothmund-Thomson syndrome, Hallermann-Streiff, Oro- (microdentism, microdontism) is defined as the condition faciodigital syndrome (type 3), Oculo-mandibulo-facial of having abnormally small teeth [1]. According to Boyle, syndrome, Tricho-Rhino-Phalangeal, type1 Branchio- “in general microdontia, the teeth are small, the crowns oculo-facial syndrome. short, and normal contact areas between the teeth are fre- Supernumerary teeth are defined as any supplementary quently missing” [2] Shafer, Hine, and Levy [3] divided tooth or tooth substance in addition to usual configuration microdontia into three types: (1) Microdontia involving of twenty deciduous and thirty two permanent teeth [7]. -
Skeletal Malocclusion: a Developmental Disorder with a Life-Long Morbidity
Elmer ress Review J Clin Med Res. 2014;6(6):399-408 Skeletal Malocclusion: A Developmental Disorder With a Life-Long Morbidity Nishitha Joshia, Ahmad M. Hamdanb, Walid D. Fakhouric, d Abstract Keyword: Skeletal malocclusion; Micrognathia; Retrognathia; Prognathia; Late-onset diseases The likelihood of birth defects in orofacial tissues is high due to the structural and developmental complexity of the face and the sus- ceptibility to intrinsic and extrinsic perturbations. Skeletal maloc- clusion is caused by the distortion of the proper mandibular and/or Introduction maxillary growth during fetal development. Patients with skeletal malocclusion may suffer from dental deformities, bruxism, teeth Disorders of the head and face are very common birth de- crowding, trismus, mastication difficulties, breathing obstruction fects in all racial populations, and can appear as isolated phe- and digestion disturbance if the problem is left untreated. In this notype or as part of a syndrome. The prevalence of cranio- review, we focused on skeletal malocclusion that affects 27.9% of facial anomalies varies among different ethnicities based on the US population with different severity levels. We summarized genetic background, geography, socio-economical status and the prevalence of class I, II and III of malocclusion in different ethnic groups and discussed the most frequent medical disorders environmental factors. Because of the structural complexity associated with skeletal malocclusion. Dental anomalies that lead of the craniofacial region, variations in genetic and environ- to malocclusion such as tooth agenesis, crowding, missing teeth mental factors may have a profound effect on development, and abnormal tooth size are not addressed in this review. We pro- and could lead to congenital birth defects. -
Aspergillus Terreus Postoperative Endophthalmitis
386 Theodossiadis, Koutsandrea, Theodossiadis Figure 3 B scan thus preventing the fluid flow from the optic pit ultrasonography 41/2 years after the operation. Note the to the submacular space (Fig 3). characteristic picture ofthe This procedure should be an alternative solu- silastic sponge as well as the tion for the management of secondary macular height ofthe chorioretinal of optic disc. Br J Ophthalmol: first published as 10.1136/bjo.77.6.386 on 1 June 1993. Downloaded from indentation produced by the elevation caused by the pit the explant at the posterior pole. The location ofthe sponge 1 Gass JDM. Serous detachment of the macula secondary to seems to provide a barrier congenital pit ofthe optic nervehead. Amj Ophthalmol 1969; between the optic nerve pit 67: 821-41. and the macula. 2 Brown GC, Tasman WS. Congenital abnormalities of the optic disc. New York: Grune and Stratton, 1983: 97-126. 3 Lincoff H, Lope R, Kreissig I, Yanuzzi L, Cox M, Burton T. Retinoschisis associated with optic nerve pit. Arch Ophthalmol 1988; 106: 61-7. 4 Theodossiadis G. Evolution of congenital pit of the optic disc with macular detachment in photocoagulated and non- photocoagulated eyes. Am3J Ophthalmol 1977; 840: 620-31. macular hole leading to a rhegmatogenous retinal 5 Theodossiadis GP, Panopoulos M, Kollia AK, Georgopoulos G. Long-term study of patients with congenital pit of the detachment, as happened in our case. This was optic nerve and persistent macular detachment. Acta probably due to a defect ofthe outer retinal layer Ophthalmol (Kbh) 1992; 70: 495-505. 6 Cox MS, Witherspoon CD, Morris RE, Flynn HW. -
National Correct Coding Initiative's (Ncci) General
NATIONAL CORRECT CODING INITIATIVE’S (NCCI) GENERAL CORRESPONDENCE LANGUAGE AND SECTION-SPECIFIC EXAMPLES (FOR NCCI PROCEDURE TO PROCEDURE (PTP) EDITS AND MEDICALLY UNLIKELY EDITS (MUE)) EFFECTIVE: April 1, 2017* *INCLUDES 2017 HCPCS/CPT CODES Current Procedural Terminology (CPT) codes, descriptions and other data only are copyright 2016 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. Applicable FARS\DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for the data contained or not contained herein. TABLE OF CONTENTS Section Page Introduction 5 General Correspondence Language for NCCI PTP Edits and Medically Unlikely Edits (MUEs) Standard preparation/monitoring services for anesthesia 8 HCPCS/CPT procedure code definition 8 CPT Manual or CMS manual coding instruction 8 Mutually exclusive procedures 9 Sequential procedure 9 CPT “Separate procedure” definition 9 More extensive procedure 9 Gender-specific procedures 10 Standards of medical/surgical practice 10 Anesthesia service included in surgical procedure 10 Laboratory panel 10 Deleted/modified edits for NCCI 11 Misuse of column two code with column one code 11 Medically Unlikely Edits (MUE) (Units of Service) 11 Deleted/modified edits -
OCULAR GENE THERAPY TRIALS ADVANCE Results of the First Phase 3 Trial Were Announced
OCULAR GENE THERAPY TRIALS ADVANCE Results of the first phase 3 trial were announced. BY ARON SHAPIRO INNOVATIONS IN RETINA INNOVATIONS “We used to think that our fate was in our AAV FACILITATES GENE DELIVERY stars, but now we know that, in large measure, The nonpathogenic adeno-associated virus (AAV) has our fate is in our genes.” to date been a safe and effective vector for gene delivery. –James Watson1 The recombinant AAV (rAAV) vector has demonstrated increased specificity and efficiency in ocular AAV-mediated Genetic alterations are known to be respon- gene therapy interventions. Recombinant AAV2 (rAAV2) sible for numerous diseases, and so it follows vectors used for gene therapy are derived from the wild-type logically that the best cures for these diseases virus by deleting the entire viral coding region and replac- might lie in correcting genetic anomalies by the process of ing it with the reporter or therapeutic transgene. Combined gene therapy. This approach involves the introduction of AAV serotypes have also been developed. This diversity genes into existing cells in attempts to prevent or cure a of serotypes may lead to more specific and more efficient wide range of diseases previously thought to be incurable.1 transduction. However, successful and efficient transfection Posterior segment disorders are challenging to treat, and of particular cell types in the eye still depends on other fac- current therapies have numerous shortcomings. Many are tors, such as the AAV titer, the site of injection, the amount invasive, run the risk of complications, offer only short-term of passenger DNA, and the specific gene promoters where relief from symptoms, or are unable to directly treat vision transcription initiation takes place.2 loss. -
Retinal Pigment Epithelial Tear Resembling Retinal Tear
Correspondence 333 References 5University of Washington/Fred Hutchinson 1 Dean WH, Banda L, Kambewa ES, Sherwin JC. Increased Cancer Research Center, Seattle, WA, USA intraocular pressure on the first post-operative day 6Department of Ophthalmology and Visual following sutureless extracapsular cataract surgery in Sciences, The University of Texas Medical Branch, Africa. Eye 2012; 26: 332. Galveston, TX, USA 2 Kim JY, Jo MW, Brauner SC, Ferrufino-Ponce Z, Ali R, 7Ophthalmic Consultants of Boston, Harvard Cremers SL et al. Increased intraocular pressure on the first Medical School, Boston, MA, USA postoperative day following resident-performed cataract E-mail: [email protected] surgery. Eye (Lond) 2011; 25: 929–936. Eye (2012) 26, 332–333; doi:10.1038/eye.2011.274; JY Kim1,2,3, M-W Jo4, SC Brauner3, Z Ferrufino-Ponce5, published online 11 November 2011 R Ali6, SL Cremers3 and BA Henderson7 1Department of Ophthalmology, University of Sir, Ulsan College of Medicine, Asan Medical Center, Retinal pigment epithelial tear resembling retinal Seoul, Republic of Korea tear 2Research Institute for Biomacromolecules, University of Ulsan College of Medicine, Case report Asan Medical Center, Seoul, Republic of Korea A 74-year-old Caucasian female with history of advanced 3Massachusetts Eye and Ear Infirmary, Harvard age-related macular degeneration presented with Medical School, Boston, MA, USA decreased vision in the right eye. The patient was 4Department of Preventive Medicine, University of treated with two ranibizumab injections for choroidal Ulsan College of Medicine, Seoul, Republic of Korea neovascularization 5 months prior without Figure 1 (a) SD-OCT showing RPE defect with overlying intact retina. -
E Pleura and Lungs
Bailey & Love · Essential Clinical Anatomy · Bailey & Love · Essential Clinical Anatomy Essential Clinical Anatomy · Bailey & Love · Essential Clinical Anatomy · Bailey & Love Bailey & Love · Essential Clinical Anatomy · Bailey & Love · EssentialChapter Clinical4 Anatomy e pleura and lungs • The pleura ............................................................................63 • MCQs .....................................................................................75 • The lungs .............................................................................64 • USMLE MCQs ....................................................................77 • Lymphatic drainage of the thorax ..............................70 • EMQs ......................................................................................77 • Autonomic nervous system ...........................................71 • Applied questions .............................................................78 THE PLEURA reections pass laterally behind the costal margin to reach the 8th rib in the midclavicular line and the 10th rib in the The pleura is a broelastic serous membrane lined by squa- midaxillary line, and along the 12th rib and the paravertebral mous epithelium forming a sac on each side of the chest. Each line (lying over the tips of the transverse processes, about 3 pleural sac is a closed cavity invaginated by a lung. Parietal cm from the midline). pleura lines the chest wall, and visceral (pulmonary) pleura Visceral pleura has no pain bres, but the parietal pleura covers