ABSTRACT
Purpose@#To report a case of a successful secondary Descemet membrane endothelial keratoplasty in failed penetrating keratoplasty. Case summary: A 46-year-old male with keratoconus in both of his eyes underwent penetrating keratoplasty in his right eye 30 years ago and in his left eye 14 years ago. From one and a half year ago, the patient’s visual acuity decreased in his left eye due to graft failure. For treatment, secondary Descemet membrane endothelial keratoplasty was performed. Partial detachment of Descemet membrane was observed at 13 days after the operation, and an additional air injection was performed. At 8 months after the operation, the patient’s uncorrected visual acuity improved to 0.5 and the cornea maintained its clearance without rejection. @*Conclusions@#Secondary Descemet membrane endothelial keratoplasty was successfully performed in a patient with failed penetrating keratoplasty.
ABSTRACT
Purpose@#To report a case of a successful secondary Descemet membrane endothelial keratoplasty in failed penetrating keratoplasty. Case summary: A 46-year-old male with keratoconus in both of his eyes underwent penetrating keratoplasty in his right eye 30 years ago and in his left eye 14 years ago. From one and a half year ago, the patient’s visual acuity decreased in his left eye due to graft failure. For treatment, secondary Descemet membrane endothelial keratoplasty was performed. Partial detachment of Descemet membrane was observed at 13 days after the operation, and an additional air injection was performed. At 8 months after the operation, the patient’s uncorrected visual acuity improved to 0.5 and the cornea maintained its clearance without rejection. @*Conclusions@#Secondary Descemet membrane endothelial keratoplasty was successfully performed in a patient with failed penetrating keratoplasty.
ABSTRACT
Purpose@#We report the clinical outcomes of Korean patients who were diagnosed with orbital malignancies and underwent orbital exenteration. @*Methods@#We retrospectively reviewed the tumor origins, histopathological diagnoses, local/regional recurrences, distant metastases, surgical margin clearances, overall and event-free survivals, and adjuvant chemotherapy or radiation therapy statuses of 14 patients who underwent orbital exenteration in our center from February 2009 to March 2020. @*Results@#We enrolled seven men and seven women of mean age at the time of exenteration of 68 years (range, 37 to 80 years). The mean follow-up period was 44.6 months (range, 10 to 133 months). Most tumors had arisen in the eyelid (seven cases, 50.0%). The most common pathological diagnosis was malignant melanoma (five cases, 35.7%). We observed no local or regional recurrence after exenteration, but distant metastases developed in seven cases, of which four were malignant melanomas (80% of all melanomas). Positive surgical margins were observed in six cases (42.9%). The distant metastasis rate was 42.9%; the overall survival rate was 60%. The 1-year overall survival rate was 100%, the 2-year survival rate was 81.8%, and the 5-year survival rate was 56.1%. The 1-year event-free survival (EFS) rate was 100%, the 2-year EFS rate was 72.7%, and the 5-year EFS rate was 49.9%. Nine patients received adjuvant radiation or chemotherapy and six patients received combined chemoradiation. @*Conclusions@#Patients underwent orbital exenteration to treat orbital malignancies and received postoperative chemotherapy and/or radiation exhibited differences in clinical outcomes and survival rates depending on the tumor type.
ABSTRACT
Hyperamylasemia may follow hepatic resection; Akagi reports 15(62.5%) of his 24 patients with hepatic resection experienced hyperamylasemia, and almost none of those patients had clinical symptoms or complications. The mechanism of postoperative hyperamylasemia is not clear yet, but Makuuchi states that the cause of hyperamylasemia is pancreatic congestion due to vascular occlusion methods used during hepatic resection. The frequency of hyperamylasemia, occurrence of pancreatitis, and factors likely to cause hyperamylasemia following hepatic resection were studied by the authors. The subjects consisted of 31 patients without history of pancreatitis or DM who underwent hepatic resection. In all of the cases, serum amylase levels were measured on the preoperative day, operative day, and postoperative days 1, 3, 5 and 7. Total serum amylase level was found to be significantly elevated postoperatively in 14(42.5%) of 31 patients undergoing hepatic resection. These patients did not have pancreatitis nor fatal complications. The serum amylase was at its lowest level(153+/-79U/L) immediately after operation, and highest(321+/-176U/L) on postoperative day 1, and eventually returned to preoperative level. When the difference in serum amylase level based on the patient's preoperative state was considered, patient's in the liver cirrhosis group(n=17) had significantly elevated postoperative serum amylase level on postoperative days 3, 5 and 7 in comparison with the group of patients without liver cirrhosis (p<0.05). The differences in the level of serum amylase based on ICG R15 retention rate, extent of hepatic resection, age and vascular occlusion time used during hepatic resection did not show any statistical signifcance. Since postoperative hyperamylasemia was not related to vascular occlusion time used during hepatic resection, and the level of serum amylase was higher in the liver cirrhosis group than in the normal liver group, the cause of hyperamylasemia following hepatic resection cannot be explained by pancreatic congestion due to vascular occlusion time used during hepatic resection.
Subject(s)
Humans , Amylases , Estrogens, Conjugated (USP) , Hepatectomy , Hyperamylasemia , Liver , Liver Cirrhosis , PancreatitisABSTRACT
Conventional hemorrhoidectomy is still the main stairway to the treatment of the third or the fourth degree hemorrhoids. Among the various methods of hemorrhoidectomy, open hemonhoidectomy is claimed to decrease postoperative pain and wound infection, but to have disadvantage of long period of wound healing. Semi-closed hemorrhoidectomy has the advantage of rapid wound healing without increased risk of wound infection, but more painful postoperative course than open hemorrhoidectomy is suggested. To assess this conventional concept, two hundreds of patients were randomly allocated to either an open hemorrhoidectomy(Group 4, Operated by modified Goligher method, n=100) or a semi-closed hemorrhoidectomy(Group B, Operated by modified Nesselrod method, n=100), and postoperative results were analyzed. In group 4, the average time for disappearance of wound edema was 4.9days, average time for disappearance of wound pain was 9.0days, average time for painless defecation was 14.1 days, average time for complete wound healing was 28.4days. The main complications were overgranulation, skin tag, anal discharge and pruritus. The overgranulation requires curettage, the skin tags were resected under local anesthesia. Anal discharge and pruritus were spontaneously disappeared after the healing of the wound. In group B, the average time for disappearance of wound edema was 6.1 days, average time for disappearance of wound pain was 6.3days, average time for painless defecation was 9.2days, average time for complete wound healing was 20.7days. The main complications were skin tags, more prevalent than group 4, requiring resection under local anesthesia. No infectious complications were noted in both groups. Consequently, the old concept that open hemorrhoidectomy has advantage of less painful postoperative course than semiclosed hemorrhoidectomy cannot be accepted. Semi-closed hemorrhoidectomy offers more rapid loss of pain and more rapid healing of the wound than open hemorrhoidectomy, without increased risk of infectious complications. In conclusion, semi-closed hemorrhoidectomy is superior method to open hemorrhoidectomy in third or fourth degree hemorrhoids.