Although both transfusion programs were well tolerated, our finding of more frequent major adverse neurologic events in the restrictive RBC-transfusion group suggests that the practice of restrictive transfusions may be harmful to preterm infants.

Objective-To investigate systematically the various associated systemic and ophthalmic abnormalities in different types of retinal artery occlusion (RAO). Design-Cohort study.Participants-439 consecutive untreated patients (499 eyes) with RAO, first seen in our clinic from 1973 to 2000.Methods-At first visit, all patients had a detailed ophthalmic and medical history, and comprehensive ophthalmic evaluation. Visual evaluation was done by recording visual acuity, using the Snellen visual acuity chart, and visual fields with a Goldmann perimeter. Initially they also had carotid Doppler/angiography and echocardiography. The same ophthalmic evaluation was performed at each follow-up visit.Main Outcome Measures-Demographic features, associated systemic and ophthalmic abnormalities and sources of emboli in various types of RAO.Results-RAO was classified into various types of central (CRAO) and branch (BRAO) artery occlusion. In both nonarteritic CRAO and BRAO the prevalence of diabetes mellitus, arterial hypertension, ischemic heart disease, and cerebrovascular accidents were significantly higher compared to the prevalence of these conditions in the matched US population (all p<0.0001). Smoking prevalence, compared to the US population, was significantly higher for males (p=0.001) with nonarteritic CRAO and for females with BRAO (p=0.02). Ipsilateral internal carotid artery had ≥50% stenosis in 31% of nonarteritic CRAO patients and 30% of BRAO, and plaques in 71% of nonarteritic CRAO and 66% of BRAO. Abnormal echocardiogram with embolic source was seen in 52% of nonarteritic CRAO and 42% of BRAO. Neovascular glaucoma developed in only 2.5% of nonarteritic CRAO eyes.Conclusion-This study showed that in CRAO as well as BRAO the prevalence of various cardiovascular diseases and smoking was significantly higher compared to the prevalence of these conditions in the matched US population. Embolism is the most common cause of CRAO and BRAO;Correspondence to: Dr. S.S. Hayreh, Department of Ophthalmology and Visual Sciences, University Hospitals & Clinics, 200 Hawkins Drive, Iowa City, Iowa 52242-1091, Telephone No. 319-356-2947 sohan-hayreh@uiowa.edu. The authors have no conflict of interest.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptOphthalmology. Author manuscript; available in PMC 2010 October 1. Published in final edited form as:Ophthalmology . 2009 October ; 116(10): 1928-1936. doi:10.1016/j.ophtha.2009.006. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript plaque in the carotid artery is usually the source o...

It is not known if a surgical lung biopsy is necessary in all patients for the diagnosis of idiopathic pulmonary fibrosis (IPF). We conducted a blinded, prospective study at eight referring centers. Initially, cases were evaluated by clinical history and examination, transbronchial biopsy, and high-resolution lung computed tomography scans. Pulmonologists at the referring centers then assessed their certainty of the diagnosis of IPF and provided an overall diagnosis, before surgical lung biopsy. The lung biopsies were reviewed by a pathology core and 54 of 91 patients received a pathologic diagnosis of IPF. The positive predictive value of a confident (certain) clinical diagnosis of IPF by the referring centers was 80%. The positive predictive value of a confident clinical diagnosis was higher, when the cases were reviewed by a core of pulmonologists (87%) or radiologists (96%). Lung biopsy was most important for diagnosis in those patients with an uncertain diagnosis and those thought unlikely to have IPF. These studies suggest that clinical and radiologic data that result in a confident diagnosis of IPF by an experienced pulmonologist or radiologist are sufficient to obviate the need for a lung biopsy. Lung biopsy is most helpful when clinical and radiologic data result in an uncertain diagnosis or when patients are thought not to have IPF.