Vitreous rebleed following sutureless vitrectomy: Incidence and risk factors

Purpose: This study aims to evaluate the incidence and risk factors for vitreous rebleed (VRB) following 25-gauge sutureless vitrectomy for vitreous hemorrhage (VH) in diabetic retinopathy. Methods: A retrospective review of 190 diabetic patients having undergone vitrectomy for VH at a tertiary eye care center was analyzed. Demographic data of patients along with risk factors such as blood sugar levels (BSL), blood pressure (BP), anticoagulant use, and pan-retinal photocoagulation status (PRP) were tabulated. Depending on the commencement of VRB, patients were divided into immediate rebleed-within 2 weeks and delayed rebleed-beyond 2–4 weeks. Results: Forty-one patients had VRB, out of which 18 patients had immediate VRB and 23 patients had delayed VRB. The average duration between vitrectomy and VRB was 3.28 months. Twenty-eight patients were male and 13 were females. Average age at presentation was 53.8 years. Thirty-four patients (82.9%) were found to have high BSL and 28 patients (68.3%) had high BP and they developed rebleed (P < 0.01) after an initial hemorrhage-free period (average = 5.15 months). Fifteen patients (36.6%) underwent first time PRP intraoperatively, and they had immediate rebleed (P < 0.01) without any hemorrhage-free period (average = 0.9 months). Eight patients (19.5%) were on perioperative anticoagulants; however, their statistical significance did not persist in the multivariable model. There were neither age nor gender predilection toward rebleed (P > 0.05). Conclusion: The incidence rate of VRB was found to be 21.6%. Age and gender did not contribute to rebleed. Intraoperative PRP was a risk factor for immediate rebleed. Poor glycemic and BP control was a risk factor for delayed rebleed.

The MESS: is it must.

Massive lower extremity trauma presents an immediate and complex decision making challenge. Significant advancements have made in the field of reconstructive surgery over the past 30 years. Severely traumatised limbs which would have been treated by primary amputation 20 years ago are beginning to be saved. On the contrary, such extensive reconstructive procedures may not always produce the best of results in terms of functional outcomes. Thus the management of a severely crushed extremity presents a therapeutic dilemma as whether to amputate or to attempt salvage. Methods: All Prospective study of 40 patients with severe crush injury to the lower extremities treated in Sri Ramachandra Medical College, Chennai between June 2012 and June 2014. The inclusion criteria were grade IIIb and grade IIIc open fractures of the lower extremity with a Mangled extremity severity score (MESS) of 7 and above with minimum of 12 months follow up. All the fractures were classified according to the Gustilo and Anderson classification system and Mangled extremity severity score. Out of the 40 patients 18 of them had their limbs salvaged and 22 underwent primary amputation. Results: The lowest MESS in this study was 7 and highest MESS was 12. The mean score in the limb salvage group was 8 and in the amputated group was 9.7. Complication rates in salvage group were higher. The mean SF score for amputated group for physical component summary was 40.15 and mental component summary was 44.30 while for limb salvage group score for physical component summary was 30.91 and mental component summary was 36.90. Conclusions: The MESS scheme provides excellent guidelines to the treating surgeon when faced with a dilemma of whether to attempt salvage or amputate a severely injured limb. The decision of whether to amputate or salvage an injured limb must be made very early in the course of treatment. This is because immediate amputation is most often viewed by the patient as a result of injury; whereas, delayed amputation is often considered as a failure of treatment.

Functional outcome of minimally invasive posterior stabilisation in dorsal and lumbar spine fractures.

Minimally invasive spinal surgery will be a highlight of operative approaches in the twenty-first century and already has been popularized worldwide. This procedure will provide surgical options that address several pathological conditions in the spinal column without producing the types of morbidity commonly seen in open surgical procedures. The objective was to assess the outcomes of minimally invasive posterior stabilization of dorsal and lumbar spine fractures. Methods: This was a prospective study of twenty patients with dorsal or lumbar fractures who were admitted at Sri Ramachandra University. All patients having dorsal and lumbar spinal fractures with intact neurology were included in the study. All the patients underwent minimally invasive posterior stabilization by freehand technique. Functional outcomes were measured by VAS scale, ASIA scoring (neurology), and their ability to mobilize. Results: The average duration of surgery was 85.50 minutes. The average blood loss in our study group was 77 ml. The average operation to mobilization time was 2.2 days. The average post-operative Cobb’s angle was 0.6 degree of kyphosis. The average post-operative gain was 12 degree. Conclusion: Minimally invasive percutaneous stabilization of the spine helps to minimize approach related morbidity and secondary iatrogenic soft tissue trauma. It enables early mobilization, which contributes to improved outcome.

Gastric wall necrosis in an HIV-positive patient.

Perforation of the gastrointestinal tract is rare in HIV infection and occurs most often in the colon and small intestine. Gastric perforation in HIV-positive patients has not been reported so far. We report an HIV-positive patient who developed gastric perforation.