Background/Objectives Convention is to perform open globe injury (OGI) repair within 24 hours to minimize risk of endophthalmitis. However, there is limited data assessing how time to operative repair (OR) within 24 hours impacts postoperative visual acuity (VA). Subjects/Methods Manual retrospective chart review of 633 eyes at Massachusetts Eye and Ear (MEE) with a diagnosis of OGI between 2012–2022. Inclusion criteria were primary repair ≤ 24 hours after injury and ≥ one month up. Multivariate regression analysis was conducted with postoperative VA as primary outcome. Results Of the subjects, 489 (77.3%) were male and 496 (78.4%) were white. Demographics of OGI wounds included 320 (50.6%) rupture and 313 (49.4%) laceration; 126 (19.9%) with rAPD, 189 (29.9%) zone 3 injuries, 449 (71.2%) uveal prolapse, and 110 (17.4%) intraocular foreign body. Final postoperative LogMAR VAs consisted of 31% with a VA < 1.7, 9% with a VA of 1.9, 18% with a VA of 2.3, 27% with a VA of 2.7, and 11% with a VA of 3.0. Multivariate analysis showed no significant correlation between time to OR and postoperative VA (p = 0.800) [95%CI:-0.01,0.01]. Older age (p < 0.001) [95%CI:0.00,0.01], worse presenting VA (p < 0.001) [95%CI:0.17,0.32], rAPD (p < 0.001) [95%CI:0.65,1.0], mechanism of rupture (p < 0.001) [95%CI:0.19,0.54], higher zone of injury (p < 0.001) [95%CI:0.25,0.45], and uveal prolapse (p = 0.003) [95%CI:0.09,0.42] were significantly associated with worse final VA. Conclusions Time to repair of OGIs within 24 hours does not influence final VA. Optimization of surgical and patient factors may contribute more significantly to final VA than prioritizing more rapid time to OR.
Purpose: Isolated hypoaldosteronism is a rare cause of salt wasting in infancy caused by the loss of activity of aldosterone synthase (AS), which is encoded by the CYP11B2 gene. This condition may be life-threatening, especially in newborns. Methods: We are reporting the case of a newborn male born to consanguineous parents, who presented at the age of 1 month with severe dehydration, vomiting, and hypotonia. Results: Lab studies showed severe hyponatremia, hyperkalemia, and metabolic acidosis. Hormonal assessment confirmed a normal corticotrope axis with severe deficiency in aldosterone. Genetic analysis revealed a novel mutation in the CYP11B2 gene in the highly conserved donor splice site of exon 3 and confirmed the isolated aldosterone deficiency. The patient was subsequently treated with fludrocortisone and sodium only, without hydrocortisone. Conclusion: AS deficiency is a rare inherited disease. There should be a high index of suspicion of cases with life-threatening salt-wasting in infancy as dramatic clinical improvements and good long-term prognosis can be achieved with timely replacement treatment.
Prior to the advent of anesthesia, surgery was limited in scope due to the excruciating pain experienced by patients. This raised challenges for surgeons who were distressed by the inadvertent suffering caused by surgery. The first successful use of ether anesthesia by William Thomas Green Morton (1819–1868) in 1846 at Massachusetts General Hospital was a turning point for the profession. The innovation and proliferation of operations catalyzed by the introduction of anesthesia altered the landscape of surgical practice. Initially, the introduction of ether into the field was met with hesitation and resistance by several parties in the medical field. It took the efforts of prominent surgeons to ensure that ether achieved its full potential. The greatest supporter of ether during this epoch was the young surgeon Henry Jacob Bigelow (1818–1890), who spent 30 years of his career advocating for and experimenting with anesthesia. The efforts of Bigelow, a gifted surgeon renowned for his contributions to orthopedic surgery, were instrumental in the promotion of anesthesia and the advancement of the surgical profession. In this article, we discuss the life, career, and contributions of Bigelow, particularly in the context of the introduction of modern anesthesia.
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