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Song J.,Long Beach Memorial Medical Center
Clinical Ophthalmology | Year: 2016

Selective laser trabeculoplasty is a laser treatment to treat glaucoma. It was initially indicated for open-angle glaucoma but has been proven to be efficacious for various types of glaucoma. This review article summarizes the few rare complications that can be seen with selective laser trabeculoplasty. It also makes recommendations on how to avoid these problems and how to treat patients when these rare complications arise. © 2016 Song.


Strauss M.B.,Long Beach Memorial Medical Center | Strauss M.B.,University of California at Irvine
Undersea and Hyperbaric Medicine | Year: 2012

Crush injuries represent a spectrum of injury to body parts as resutt of trauma. Presentations vary from minor contusions to timb-threatening damage. Typicatty, the injury invotves muttipte tissues, from skin and subcutaneous, to muscte and tendons, to bone and joints. In their most severe presentations, predictabte comptications - inctuding osteomyetitis, non-union of fractures, amputations and failed flaps - occur in approximatety 50 percent of the cases with standard of practice surgicat and medicat interventions [1-3]. Sketetat muscte-compartment syndrome (SMCS) is another consequence of trauma, but in this situation the target tissues are musctes and nerve. Edema and/or bleeding within the confines of the fasciat envelope can increase the pressure within the sketetat musctecompartment. When the tissue fluid pressure within the compartment exceeds the capittary perfusion pressure to the musctes and nerves in the compartment, these tissues are rendered ischemic and manifest the signs and symptoms of SMCS. The SMCS, especiatty in its incipient stages before a fasciotomy is required, is a therapeutic chattenge since no means to arrest its progression exist other than hyperbaric oxygen (HBO2). Unfortunatety, HBO2 is woefutty negtected as an adjunct for managing crush injury and SMCS. Strong arguments exist for its use based on evidenced-based information and how HBO2 mitigates the pathotogy of these conditions. Copyright © 2012 Undersea & Hyperbaric Medical Society, Inc.


Ulin K.,Review Centre | Urie M.M.,Review Centre | Cherlow J.M.,Long Beach Memorial Medical Center
International Journal of Radiation Oncology Biology Physics | Year: 2010

Purpose: Variability in computed tomography/magnetic resonance imaging (CT/MR) cranial image registration was assessed using a benchmark case developed by the Quality Assurance Review Center to credential institutions for participation in Children's Oncology Group Protocol ACNS0221 for treatment of pediatric low-grade glioma. Methods and Materials: Two DICOM image sets, an MR and a CT of the same patient, were provided to each institution. A small target in the posterior occipital lobe was readily visible on two slices of the MR scan and not visible on the CT scan. Each institution registered the two scans using whatever software system and method it ordinarily uses for such a case. The target volume was then contoured on the two MR slices, and the coordinates of the center of the corresponding target in the CT coordinate system were reported. The average of all submissions was used to determine the true center of the target. Results: Results are reported from 51 submissions representing 45 institutions and 11 software systems. The average error in the position of the center of the target was 1.8 mm (1 standard deviation = 2.2 mm). The least variation in position was in the lateral direction. Manual registration gave significantly better results than did automatic registration (p = 0.02). Conclusion: When MR and CT scans of the head are registered with currently available software, there is inherent uncertainty of approximately 2 mm (1 standard deviation), which should be considered when defining planning target volumes and PRVs for organs at risk on registered image sets. Copyright © 2010 Elsevier Inc.


Saver J.L.,University of California at Los Angeles | Starkman S.,University of California at Los Angeles | Eckstein M.,University of Southern California | Stratton S.J.,Los Angeles County Emergency Medical Services EMS Agency | And 8 more authors.
New England Journal of Medicine | Year: 2015

BACKGROUND: Magnesium sulfate is neuroprotective in preclinical models of stroke and has shown signals of potential efficacy with an acceptable safety profile when delivered early after stroke onset in humans. Delayed initiation of neuroprotective agents has hindered earlier phase 3 trials of neuroprotective agents. METHODS: We randomly assigned patients with suspected stroke to receive either intravenous magnesium sulfate or placebo, beginning within 2 hours after symptom onset. A loading dose was initiated by paramedics before the patient arrived at the hospital, and a 24-hour maintenance infusion was started on the patient's arrival at the hospital. The primary outcome was the degree of disability at 90 days, as measured by scores on the modified Rankin scale (range, 0 to 6, with higher scores indicating greater disability). RESULTS: Among the 1700 enrolled patients (857 in the magnesium group and 843 in the placebo group), the mean (±SD) age was 69±13 years, 42.6% were women, and the mean pretreatment score on the Los Angeles Motor Scale of stroke severity (range, 0 to 10, with higher scores indicating greater motor deficits) was 3.7±1.3. The final diagnosis of the qualifying event was cerebral ischemia in 73.3% of patients, intracranial hemorrhage in 22.8%, and a stroke-mimicking condition in 3.9%. The median interval between the time the patient was last known to be free of stroke symptoms and the start of the study-drug infusion was 45 minutes (interquartile range, 35 to 62), and 74.3% of patients received the study-drug infusion within the first hour after symptom onset. There was no significant shift in the distribution of 90-day disability outcomes on the global modified Rankin scale between patients in the magnesium group and those in the placebo group (P=0.28 by the Cochran-Mantel-Haenszel test); mean scores at 90 days did not differ between the magnesium group and the placebo group (2.7 in each group, P=1.00). No significant between-group differences were noted with respect to mortality (15.4% in the magnesium group and 15.5% in the placebo group, P=0.95) or all serious adverse events. CONCLUSIONS: Prehospital initiation of magnesium sulfate therapy was safe and allowed the start of therapy within 2 hours after the onset of stroke symptoms, but it did not improve disability outcomes at 90 days. Copyright © 2015 Massachusetts Medical Society.


Clark D.L.,Family Eye Medical Group | Clark R.A.,Family Eye Medical Group | Clark R.A.,Long Beach Memorial Medical Center
Experimental Eye Research | Year: 2013

Based on optical clarity and retinal cone density, the cat has a potential acuity of 20-30cycles per degree (cpd), yet most behavioral studies estimate feline acuity between 3 and 9cpd. Those studies, however, were limited by restrictive experimental conditions that may have inadvertently lowered the estimated grating acuity. Two domestic cats previously trained on a two-choice visual discrimination task were retrained on a grating detection/discrimination task with unlimited time, high luminance, high contrast targets, and adequate space to prevent poor accommodation from affecting the results. Initially, vertical gratings of increasing cpd were tested until failure. Then, horizontal gratings of increasing cpd were tested until failure. Finally, the finest horizontal grating resolved was confirmed with a third test requiring 24 correct out of 36 consecutive trials, yielding a binomial probability less than 0.02 of non-random occurrence. M1, a 7-year-old male gray tabby with+2.00 OU refraction, tested for a grating detection acuity of 15cpd for both vertical and horizontal gratings (binomial probability=0.009). F1, a 2-year-old female gray tabby with+0.25 OU refraction, tested for a grating orientation discrimination acuity of 20cpd for both vertical and horizontal gratings (binomial probability=0.004). These results demonstrate that a young cat with good focus is capable of discriminating 20cpd, in close agreement with the physiologic maximum. Uncorrected focusing errors appear to degrade visual performance. Optimum experimental conditions resulted in better grating acuity measurements than previously reported, emphasizing the importance of environmental factors in feline behavioral testing. © 2013 Elsevier Ltd.

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