Michael C Morris | PubMed Health

PubMed2004

Pancreas transplantation.

Over the last 15 years whole organ pancreas transplantation has emerged as the treatment of choice for selected patients with uremia and Type I Diabetes Mellitus. Improvements in surgical technique, better understanding of transplant related complications and advances in immunosuppressive therapy have encouraged the application of this procedure to an increasing number of patients. Pancreas transplantation occurs under three primary scenarios: simultaneous kidney pancreas transplantation, pancreas transplantation after kidney transplantation, and pancreas transplant alone. Overall results are excellent with 90%-95% one-year patient survival, and 85%-90% of patients achieving normal glycemic control. There also exists a significant long-term survival advantage among the simultaneous kidney pancreas transplant group.

Diabetes Mellitus, Type 1↗

PubMed2003

Quality of life after kidney and pancreas transplantation: a review.

There is an increasing amount of data on quality of life (QOL) in most chronic illnesses; some of the instruments used are generic, but recently, there is a tendency to use disease-specific instruments. We propose that recipients of organ transplants be assessed routinely for QOL by means of the 36-Item Short-Form Health Survey or a disease-specific instrument; for compliance, by means of the Long-Term Medication Behavior Self-Efficacy Scale; and for psychological status, by means of the Beck Depression Inventory Brief Symptom Inventory or the Symptom Checklist. The widespread use of QOL data in recipients of organ transplants will increase accountability of service providers and eventually increase patient satisfaction because these instruments are patient reported.

Adult↗

PubMed2002

Up-slanting palpebral fissures and oblique astigmatism associated with A-pattern strabismus and overdepression in adduction in spina bifida.

PURPOSE: To describe the spectrum of adnexal and ophthalmologic features in spina bifida. METHODS: A retrospective review of the medical records of 73 patients was conducted. Data concerning ocular motility, palpebral fissure orientation, presence and axis of astigmatism, visual acuity, amblyopia, and stereopsis were analyzed. RESULTS: Forty-three (59%) of the 73 patients had strabismus: 28 (65%) had esotropia, 12 (28%) had exotropia, and 3 (7%) had orthotropia in primary gaze and a significant A-pattern. Of the strabismic patients, 20 (47%) had an A-pattern, of which 13 (65%) demonstrated overdepression in adduction. Twenty-seven (84%) of the 32 patients with documented palpebral fissure orientation had exaggerated up-slanting palpebral fissures. Forty-nine (77%) of 64 patients exhibited astigmatism greater than 0.75 D in at least 1 eye, with a mean power of 1.6 D. The axis of cylinder was oblique in 76% of these patients. The astigmatic axis was consistently oriented perpendicular to the eyelid fissure orientation in the group of patients with up-slanting palpebral fissures, with the mean axis of cylinder being incyclorotated (OD axis, 77; OS axis, 108). Up-slanting palpebral fissures were associated with a 15-fold increased chance that the axis of cylinder would be incyclorotated (P =.07, chi-square test). An orbital computed tomographic (CT) scan of a spina bifida patient with A-pattern esotropia, overdepression in adduction, and up-slanting palpebral fissures demonstrated significant incyclorotated extraocular muscle pulley heterotopy. CONCLUSIONS: Exaggerated up-slanting palpebral fissures are a prominent feature in spina bifida. Up-slanting palpebral fissures in spina bifida patients are associated with incyclorotated oblique astigmatism, A-pattern strabismus, and overdepression in adduction. These associations might be related to an anomaly of orbital skeletal or extraocular muscle pulley development. Further prospective study is encouraged.

Adolescent↗