Bob Broomer

Prevalence of myocilin mutations in adults with primary open-angle glaucoma in Ghana, West Africa.

PurposeInvestigators have noted that primary open-angle glaucoma (POAG) in West Africa has an earlier age of onset and appears to be more clinically severe than in the United States and Europe. Primary open-angle glaucoma patients with mutations in myocilin have a similar phenotype. Therefore, we investigated the role of mutations in myocilin in patients with POAG in a West African population. Materials and MethodsPatients seen at the Emmanuel Eye Clinic in Accra, Ghana, were recruited for this study. Informed consent was obtained from all study patients. Glaucoma specialists from the sponsoring institution (PC, LWH, or RRA) ascertained all POAG and control patients. Age-matched unaffected controls were obtained in patients with an IOP < 22 mm Hg and normal-appearing optic nerves. PCR amplification of each of the three myocilin exons was performed. Denaturing high-performance liquid chromatography (Transgenomics Corp.) was used to detect allelic differences and samples demonstrating a mobility shift were sequenced in both directions. ResultsNinety unrelated affecteds with POAG and 76 control patients were recruited. Four individuals with severe POAG were found to have novel missense mutations in exon 3. Two exhibit an Asp380Asn mutation and two an Arg342Lys mutation. These changes were not detected in 152 ethnically matched control chromosomes. Fourteen affected individuals and eight controls exhibit a translationally silent polymorphism in codon 325 (Thr325Thr). ConclusionsA total of 4.4% of patients with POAG have novel disease-associated mutations in myocilin. Mutations in myocilin appear to play a limited role in the pathogenesis of POAG in this region of West Africa.

Comparison of visually estimated blood loss with direct hemoglobin measurement in multilevel spine surgery.

Estimates of blood loss in the operating room are typically performed as a visual assessment by providers, despite multiple studies showing this to be inaccurate. Use of a less subjective measurement of blood loss such as direct measurement of the hemoglobin (Hb) mass lost from the surgical field may better quantify surgical bleeding. The objective of this investigation was to compare anesthesiologist estimates of intraoperative blood loss with measured Hb loss.

Survey of glaucoma in an eye clinic in Ghana, West Africa.

PurposeTo report the various types of glaucoma among West African patients presenting to an eye clinic in Ghana. MethodsA complete evaluation was performed in 198 consecutive Ghanaian glaucoma patients. Main outcome measures included intraocular pressure, visual acuity, gonioscopy findings, visual field, and total number of glaucoma medications. ResultsThe most common form of glaucoma was primary open-angle glaucoma (44.2%). Open-angle glaucoma suspects also comprised a large percentage of the group (30.5%). Chronic angle-closure glaucoma was diagnosed in 6.6% of the patients. ConclusionsPrimary open-angle glaucoma is the most common form of glaucoma being treated in this outpatient eye clinic in Ghana. Chronic angle-closure glaucoma was the second most common form of glaucoma in this series and was usually undiagnosed due to a lack of gonioscopic evaluation. Gonioscopy is an important diagnostic tool that should be promoted to guide more effective glaucoma treatment in this region. Pseudoexfoliation and pseudoexfoliation-associated glaucoma were not seen in this population.

Jehovah's Witnesses and cardiac surgery: A single institution's experience

Based on biblical doctrines, patients of the Jehovahs Witness faith refuse allogeneic blood transfusion. Cardiac surgery carries a high risk of blood transfusion, but has been performed in Jehovahs Witnesses for many years. The literature contains information on the outcomes of this cohort, but does not detail the perioperative care of these patients. This article describes a single institutions experience in perioperative care of Jehovahs Witnesses undergoing cardiac surgery.

Bipolar tissue sealant device decreases hemoglobin loss in multilevel spine surgery

BACKGROUND: Traditional techniques for obtaining hemostasis during orthopedic surgery, such as conventional electrocautery and sealants, have limited clinical effectiveness in reducing hemoglobin (Hb) loss and requirement for transfusion. The bipolar tissue sealant device studied in this trial combines radiofrequency energy with saline irrigation to hemostatically seal both cut bone and soft tissue, potentially aiding hemostasis.

Costs and outcomes after cardiac surgery in patients refusing transfusion compared with those who do not: a case-matched study.

Although numerous studies have demonstrated the feasibility of cardiac surgery for blood refusal patients, few studies match to controls, and fewer examine cost. This historical cohort study aims to compare costs and outcomes after cardiac surgery in Jehovahs Witness patients who refuse blood transfusion with a group of matched patients accepting transfusion.

Blood conservation techniques: where to begin.

Blood conservation techniques are used to reduce the need for allogeneic blood transfusion. One of the most important blood conservation techniques is the optimization of blood counts prior to invasive procedures with anticipated blood loss. Infusion nurses need to understand the importance of treating patients who require the use of parenteral iron to attempt to optimize their blood counts before procedures. Infusion nurses provide a vital link to patient safety and treatment. This article will also discuss other methods of blood conservation frequently used to protect a scarce resource and reduce inappropriate transfusions.

Comparison of radiologists and technologists in the performance of air-contrast barium enemas.

OBJECTIVE The purpose of this study was to determine whether the rate of polyp detection and the quality of air-contrast barium enema (ACBE) procedures performed by technologists differ from those performed by radiologists. CONCLUSION Our results showed that well-trained certified technologists can perform ACBE similar in overall quality and accuracy to ACBE performed by attending physicians and residents. Training technologists to perform ACBE may help to alleviate the radiology staffing shortage in the United States.

Myocilin Mutations in Families with Late-Onset Primary Open-Angle Glaucoma

Late-onset primary open-angle glaucoma (POAG) is a bilateral disease, which typically has its onset in the fifth or sixth decade of life. The clinical course usually consists of mild to moderately elevated intraocular pressure (IOP), although a significant number of patients may not have a measured IOP greater than the normal range [1]. Optic nerve damage and visual field loss, which may culminate in blindness, occur over many years, usually decades after onset of the disease. The mode of inheritance for late-onset POAG is not known. POAG is considered a complex trait that results from interaction of multiple genes in conjunction with environmental influences.