To determine the incidence of intraoperative floppy-iris syndrome (IFIS) in patients taking tamsulosin who had surgery by resident physicians, the effect of prophylactic intracameral ...lidocaine-epinephrine on the incidence, and the relationship between preoperative dilated pupil diameter and the incidence.
Tertiary care hospital, Seattle, Washington, USA.
Charts of consecutive patients who had cataract extraction by resident physicians between January 2005 and July 2008 were reviewed. Operative notes for patients taking tamsulosin at the time of surgery were reviewed. Preoperative dilated pupil diameter; use of prophylactic intracameral lidocaine-epinephrine; and presence of billowing iris, iris prolapse, and pupil constriction were recorded. Intraoperative floppy-iris syndrome was defined as the occurrence of any of the 3 phenomena constituting the syndrome.
Review of 1163 charts identified 59 patients (81 eyes) taking tamsulosin at the time of surgery. The overall incidence of IFIS was 29.6%. Of those who received prophylactic intracameral lidocaine-epinephrine, the incidence of IFIS was 38.5%. The incidence of IFIS was 44.8% in eyes with preoperative dilated pupil diameter smaller than 6.5 mm and 21.7% in eyes with a preoperative dilated pupil diameter larger than 6.5 mm. A preoperative dilated pupil diameter smaller than 6.5 mm was significantly associated with IFIS (P = .032).
The incidence of IFIS was lower than previously reported. Use of prophylactic intracameral lidocaine-epinephrine did not reduce the incidence of IFIS. A preoperative dilated pupil diameter smaller than 6.5 mm was significantly associated with an increased incidence of IFIS.
Background: Thrombocytopenia can be seen in any patients irrespective of age and the causes are diverse. This study was done to determine the frequency of various conditions associated with ...thrombocytopenia and to assess the number and morphology of megakaryocytes in various cases of thrombocytopenia. Megakaryocytic alterations in myelodysplastic versus non-myelodysplastic conditions were also evaluated in this study.
Materials and methods: This was a prospective study conducted on 132 cases of bone marrow aspirates of thrombocytopenia over a duration of one year from 14th April 2017 to 13th April 2018 in Tribhuvan University Teaching Hospital, Kathmandu. All the statistical evaluation was done by using SPSS version 24.
Results: In this study of 132 cases, megakaryocytic thrombocytopenia was the most common cause of thrombocytopenia for which bone marrow aspiration was done. The most common dysplastic change observed in megakaryocytes was micro megakaryocyte which was more commonly seen in MDS. Nondysplastic changes frequently observed were immature forms followed by bare nuclei and were more frequently seen in megakaryocytic thrombocytopenia followed by in myelodysplastic syndromes.
Conclusions: Many similar morphological changes were observed in megakaryocytes among different hematological diseases. So, the presence of dysplastic megakaryocyte should not prompt an interpretation of myelodysplastic syndromes and should always be correlated with patient’s clinical and hematological parameter.
Pleomorphic adenomas are the most common neoplasms of the major salivary glands. They are also known as benign mixed tumors because of the presence of both epithelial and mesenchymal elements. In ...parotid gland, approximately 65%-75% of tumors are pleomorphic adenomas. In parotid gland, usually it occur lateral to the plane of facial nerve. They present in middle aged patients as well defined, solitary, painless mass and are slow growing tumors. Few subset of tumors may undergo malignant transformation.Carcinoma ex pleomorphic adenoma is a rare and aggressive malignancy that arises from primary or recurrent pleomorphic adenoma. It occurs in 6% of all pleomorphic adenomas. Diagnosis of malignancy and treatment is largely based on pathologic and radiographic features. Distant metastases have been reported mainly in the lung. . We present an unusual case of 68 yrs female patient with carcinoma ex pleomorphic adenoma of the parotid gland with cardiac metastasis.
This study aimed to assess the distribution of fine-needle-aspiration-cytology or biopsy findings through cytopathological patterns of lymph nodes aspirations in different age groups of the ...population visiting a tertiary level hospital in Kathmandu.
The retrospective study was conducted on the database of the 226 lymphadenopathy cases that underwent biopsy fine needle aspiration cytology from 1 January 2016 to 31 December 2019 at the Department of pathology of Helping Hand's Community Hospital, Kathmandu. A descriptive analysis was performed yielding proportions and counts for the quantitative variables. Chi-squared test was used to compare the proportions. Point estimates and confidence intervals for measures of association were assessed with 95% confidence interval and p-value ?0.05 was considered statistically significant.
The 20-40 years were the most common age group undergoing biopsy fone needle aspiration cytology procedures. Males recorded majority of cases (68%, 153 of 226). The highest incidence of Reactive lymphadenitis was obtained (50%, 113 of 226) and it was the most common findings in the age group of <20 and 40-60 years. The Cervical lymph node (86%) was the most common anatomical location followed by axillary lymph nodes (8%). Squamous cell carcinoma and Adenocarcinoma accounted for more than half (53%, 20 of 38) of all the diagnosed malignancy. The incidence of Non-Hodgkin lymphoma and Hodgkin lymphoma were 8% (n = 3 of 38) and 5% (n = 2 of 38) respectively.
Lymph node enlargement is associated with a wide range of etiologies with Reactive lymphadenitis as the most common cause and cervical lymph node as the common site.
Purpose: The effect of intraocular pressure—lowering surgery on the rate of visual field progression in normal-tension glaucoma (NTG) was studied.
Methods: Seventeen patients with NTG who underwent ...trabeculectomy in one eye for worsening visual field loss were included in the first part of the study. All patients had Humphrey 24-2 visual fields at the rate of 2–3 fields per year. Pointwise linear regression analysis of the visual field data was done separately for the preoperative and postoperative periods. This was performed for both operated and fellow eyes. The mean slope (MS), which indicates rate of visual field progression, was calculated. Change in MS was correlated with change in intraocular pressure (IOP). For the second part of the study, 11 patients who had a minimum of 4 visual fields and 18 months of follow-up before surgery were identified. Using the preoperative fields, the rate of sensitivity loss for each visual field location in the operated eye was ascertained for every patient. This rate of loss was extrapolated to generate the expected visual fields, assuming an unchanged rate of progression. The mean sensitivity of the expected visual field was compared with that of the actual field at the last follow-up.
Results: The MS in the operated eyes improved from −2.97 ± 3.21 (mean ± SD) in the preoperative period to 0.53 ± 3.83 (P < 0.005; Student's t test) postoperatively. In the fellow eyes the IVIS changed from −1.78 ± 2.55 to −1.43 ± 3.01 (P = 0.754). There was a weak correlation between change in MS and percentage IOP decrease (correlation coefficient 0.39). The difference in mean sensitivity between the expected and actual visual fields was −3.72 dB (P = 0.002), and was better in the actual field.
Conclusions: In this study, surgical lowering of IOP resulted in a slower rate of visual field loss in the operated eye.
Phyllodes tumors are spectrum of tumors ranging from benign to malignant. Malignant spectrum pose a management challenge for clinicians due to high risks of recurrence and metastasis. Malignant ...phyllodes tumor with brain, lung and adrenal metastases at the same time is rare.
A 37 years-old unmarried female presented with an ulcerated huge lump in left breast with severe bleeding. Trucut biopsy showed necrosis with spindle cell proliferation with atypia for which she underwent modified radical mastectomy with final diagnosis of malignant phyllodes tumor. Three months after surgery, patient presented with headache, which on further evaluation showed masses in lung, right adrenal and brain.
We presented a rare case of malignant phyllodes tumor with clinical, imaging and histological findings with metastases to multiple sites early in course and poor outcome of the patient despite margin negative resection.
•Metastatic malignant phyllodes tumor have poor outcome.•Simultaneous metastasis to brain, lung and adrenal is rare.•Margin negative resection is feasible even in huge malignant phyllodes tumor.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Managing the broken capsule Wu, Michael C; Bhandari, Anuja
Current opinion in ophthalmology,
2008-January, 2008-Jan, 2008-01-00, 20080101, Volume:
19, Issue:
1
Journal Article
PURPOSE OF REVIEWPosterior capsular rupture is a common complication of cataract extraction surgery. Prompt management of anterior and posterior capsular tears may prevent associated complications or ...need for subsequent procedural intervention.
RECENT FINDINGSWhen tears develop in the anterior capsule, novel techniques allow predictable rescue of a capsulorhexis, preventing radial extension to the posterior capsule. Several case series now describe techniques and outcomes of posterior assisted levitation techniques for a dislocated nucleus. Triamcinolone staining of the vitreous improves visualization and removal of vitreous in the anterior segment following capsular rupture. Recently published studies further describe the increased risks of endophthalmitis and retinal detachment following capsular tears.
SUMMARYSeveral techniques may prove beneficial in the intraoperative management of an anterior capsular tear, a dislocated nucleus, or vitreous loss.
A virtual reality (VR) surgical simulator (EyeSi ophthalmosurgical simulator: VRMagic, Mannheim, Germany) was evaluated as a part-task training platform for differentiating and developing basic ...ophthalmic microsurgical skills.
Surgical novice performance (residents, interns, and nonmicrosurgical ophthalmic staff) was compared with surgical expert performance (practicing ophthalmic microsurgeons) on a basic navigational microdexterity module provided with the EyeSi simulator.
Expert surgeons showed a greater initial facility with all microsurgical tasks. With repeated practice, novice surgeons showed sequential improvement in all performance scores, approaching but not equaling expert performance.
VR simulator performance can be used as a gated, quantifiable performance goal to expert-level benchmarks. The EyeSi is a valid part-task training platform that may help develop novice surgeon dexterity to expert surgeon levels.
An 18-year-old woman developed pancreatitis and a thrombotic microangiopathy but no electrolyte abnormalities. She required intubation hours after admission and was not able to communicate for 8 ...days. Upon recovering consciousness, she reported severely impaired vision in both eyes, but ophthalmologic evaluation and neuroimaging were not obtained until several days later. Ophthalmologic examination documented retinal infarcts and profound binocular vision loss with hourglass bilateral homonymous hemianopic visual field loss. MRI showed signal abnormalities restricted to the area of the lateral geniculate bodies (LGBs) with characteristics most suggestive of hemorrhagic infarction. Very few cases of isolated bilateral LBG lesions have been reported. Damage has been attributed to myelinolysis from osmotic demyelination or to infarction from microvascular occlusion. This case conforms more to microvascular infarction. The vulnerability of the LGB to selective microvascular infarction may be based on a combination of its unique architecture and high metabolic demand.
Ophthalmic surgeons require years of training and continuous practice to successfully manipulate the delicate tissues of the human eye. Development of the fine motor skills is a crucial component of ...this training. Virtual eye surgery simulators have come on the market in recent years leveraging the advantages of virtual procedures. However adoption is limited by the high initial investment and availability of models. Our approach consists of a low cost hybrid approach that employs a standard porcine model for cataract training and a platform that is instrumented to record interaction forces and video. In a preliminary study we have recorded procedure data for a small number of experts which shows good signal-to-noise ratio suitable for development of objective skill assessment models.
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