Percutaneous Mechanical Thrombectomy of Submassive Pulmonary Embolism and Extensive Deep Venous Thrombosis for Early Thrombus Removal

Traditional treatment with anticoagulation in nonfatal submassive pulmonary embolism can result in serious sequelae of chronic thromboembolic pulmonary hypertension or poor exercise tolerance, and functional impairment. To prevent long-term complications in previously healthy young patients, other treatment options to actively resolve existing thrombi should be considered. Despite recommendations for use in only severe clinical presentations, endovascular interventional techniques could serve as suitable treatment options for such patients. Here we report the case of a previously healthy 23-year-old female with submassive pulmonary embolism and extensive deep vein thrombosis in the inferior vena cava down to the right popliteal vein. The patient was initially treated with catheterdirected thrombolysis. However, she continued to show extensive venous thrombosis and pulmonary embolism. Percutaneous thrombectomy and aspiration using an AngioJet successfully removed the main pulmonary artery embolism and venous thrombus. The patient’s recovery was uneventful, and 3-month follow-up showed no signs of recurrence or discomfort.

Better Efficacy of Balloon Assisted Maturation in Radial-Cephalic Arteriovenous Fistula for Hemodialysis

Purpose@#Native arteriovenous fistula (AVF) is the first choice for hemodialysis access; however, the maturation failure rate remains high. Hence, balloon-assisted maturation (BAM) is increasingly being used to overcome maturation failure. This study evaluated the outcomes of BAM and compared the differences between radial-cephalic (RC) and brachial-cephalic (BC) AVF. @*Materials and Methods@#Between January 2013 and December 2017, 1,622 new AVFs were created. BAM was considered if the AVF did not satisfy the criteria for hemodynamic maturation (6-mm diameter and 500-mL/min flow rate within 8 weeks after the operation). @*Results@#Of the 1,622 AVFs, BAM was performed in 142 patients (8.75%). There were 92 RC and 50 BC AVFs. Multivariate analyses revealed that ipsilateral central vein catheter history was the sole risk factor for maturation failure after BAM. Oneyear functional primary patency (FPP) and functional secondary patency (FSP) in RC AVFs were higher than those in BC AVFs without statistical significance (FPP, RC vs. BC: 70.9% vs. 50.9%, P=0.099; FSP, 95.5% vs. 81.1%, P=0.146). Further, based on the multivariate analysis, the independent risk factors for FPP in the RC and BC AVFs were the number of BAMs (odds ratio [OR], 3.05; 95% confidence interval [CI], 1.11-8.37; P=0.03) and age (OR, 1.04; 95% CI, 1.00-1.07; P=0.04), respectively. @*Conclusion@#BAM is a relatively good salvage method with tolerable patency. However, the risk factors for patency and the outcomes of BAM differ between RC and BC AVFs.

Better Efficacy of Balloon Assisted Maturation in Radial-Cephalic Arteriovenous Fistula for Hemodialysis

Purpose@#Native arteriovenous fistula (AVF) is the first choice for hemodialysis access; however, the maturation failure rate remains high. Hence, balloon-assisted maturation (BAM) is increasingly being used to overcome maturation failure. This study evaluated the outcomes of BAM and compared the differences between radial-cephalic (RC) and brachial-cephalic (BC) AVF. @*Materials and Methods@#Between January 2013 and December 2017, 1,622 new AVFs were created. BAM was considered if the AVF did not satisfy the criteria for hemodynamic maturation (6-mm diameter and 500-mL/min flow rate within 8 weeks after the operation). @*Results@#Of the 1,622 AVFs, BAM was performed in 142 patients (8.75%). There were 92 RC and 50 BC AVFs. Multivariate analyses revealed that ipsilateral central vein catheter history was the sole risk factor for maturation failure after BAM. Oneyear functional primary patency (FPP) and functional secondary patency (FSP) in RC AVFs were higher than those in BC AVFs without statistical significance (FPP, RC vs. BC: 70.9% vs. 50.9%, P=0.099; FSP, 95.5% vs. 81.1%, P=0.146). Further, based on the multivariate analysis, the independent risk factors for FPP in the RC and BC AVFs were the number of BAMs (odds ratio [OR], 3.05; 95% confidence interval [CI], 1.11-8.37; P=0.03) and age (OR, 1.04; 95% CI, 1.00-1.07; P=0.04), respectively. @*Conclusion@#BAM is a relatively good salvage method with tolerable patency. However, the risk factors for patency and the outcomes of BAM differ between RC and BC AVFs.

The Effect of Experimental Silicone Encircling on Intraocular Pressure and Electroretinogram

The purpose of this study is to evaluate the course and prognosis of secondary glaucoma due to silicone encircling surgery for retinal detachment. The experiment was performed by observing the changes of elevated intraocular pressure and electroretinogram produced by silicone encircling in 20 rabbits. The rabbits were divided into 4 groups according to the elevattd level of intraocular pressure which was obtaintd by tightening of #240 silicone bands around the equator of the eyeball. The intraocular pressure was measured with a Schiotz tonometer and electroretinogram was recorded with a set of preamplifier, (freqwoncy reSponse 0.3-240 Hz, gain 80 decibel). Tektronix 5A18N dual trace amplifier, 5B12N dual time base, and 5103N oscilloscope. From the experiments, fo1lowing findings were obtained. 1. The effect on intraocular pressure. a) The elevated intraocular pressure returned to the preoperative level within 5-15 minutes in 35-45 mmHg group, 3-4 hours in 55-65 mmHg group, 4-6 hours in 75-85 mmHg group, and 7-8 hours in 95-105 mmHg group. b) In all the groaps, rapid fall of the intraocular pressure was observed within 10 minutes and relatively slow decrease was followed. From the second postoperative day, the intraocular pressure was maintained at a lower level than the preoperative intraocular pressure. 2. The effect on electroretinogram. a) In 35-45 mmHg group, supernormal wave was recorded during the 3 postoperative hours and then the wave returned to the preoperative amplitude. b) In 55-65 mmHg group, the electroretionogram reduced immediately after operation to 70% of the preoperative amplitude in 'a' wave and to 60% of the preoperative amplitude in 'b' wave' The reduced amplitude recovered to the preoperative level on the postoperative 1-2 days. c) In 75-85 mmHg group, both 'a' and 'b' wave were abolished immediately after the operation. The 'a' wave started to recover when the intraocular pressure decreased to 57.6-67.2 mmHg and 'b' wave started to recover when the intraocular pressure decreased to 49.9-57.6 mmHg. d) In 95-105 mmHg group, both 'a' and 'b' wave were abolished immediately after the oreration. The 'a' wave started to recover when the intraocular pressure decreased to 49.9-66.2 mmHg and 'b' wave started to recover when the intraocular pressure decreased to 37.2-40.2 mmHg. Consequently, it was found that the intraocular pressure over 75 mmHg caused irreversible damage to the function of retina, though the increased intraocular pressure due to silicone encircling returned to the preoperative level within 8 hours, and the visual cell layer of retina was more resistant to the increased intraocular pressure than the inner nuclear layer of retina.

Orbital Venography

Orbital venography was performed on four eyes which showed the unilateral exophthalmos and were suspected as orbital tumors. One eye was confirmed in the nature and location of tumor by the tophographic finding and tumor-staining figure of venography. One eye was confirmed in only the location of the tumor by surgery, which is consistent with the venographic picture. The other two eyes were not confirmed by surgery but we can speculate the some space occupying lesion by viewing the topogra phic findings of venography. Neither complication nor sequela was observed during or after the venographic procedures. We think orbital venography is preferably valuable for diagnosing the orbital lesion.

The Effect of Ophthalmic Solution and Ointment on Healing of Experimental Wound of Rabbit Corneal Epithelium

The effect of 1% atropine solution and 1% atropine ointment on healing of corneal epithelium in 20 rabbits was studied. Corneal epithelium was removed by #15 blade in central area of 7mm in diameter under topical anesthesia with 0.5% pontocaine. 1% atropine solution was applied three times daily to Rt. eyes, and 1% atropine ointment to Lt. eyes. Progress of epithelial healing was observed by fluorescent staining of the wound. At the end of 24 hours, fluorescent staining area was 46.90% in average for Rt. eyes, and 51.90% in average for Lt. eyes. At the end of 48 hours, it was 7.83% for Rt. eyes, and 11.0% for Lt. eyes. At the end of 72 hours, All of Rt. eyes did not stain, but 2 of 10 Lt. eyes were faintly stained. Difference between ophthalmic solution and ointment on the effect of corneal epithelial healing was not significant.

Failure in Retinal Detachment Surgery

An anaysis has been made of 86 eyes of retinal detachment treated surgically in our hospital during the last 3yrs. The final complete failure rate was 16.6% (14 eyes), and the failure rate in the first operation was 25.5% (24 eyes). The preoperative factors that were found to be significant in leading to failure were young age, delay of surgery over 6 months, large extent of detachment, giant tear and fibrosis of vitreous or retina. The failure rate in the first operation due to inadequate surgical techniques was 32%, and subretinal fluid drainage was not contributory to the failure rate. It was noteworthy that 64% of failed cases were due to M.V.R. Adnavces in knowledge of pathophysiology of vitreous in complicated retinal detachment and in technique of vitreous surgery may reduce the failure rate.

Some Studies on the Non-Swelling Cornea

Non-swelling cornea was prepared according to the method of Payrau. 1) Rabbit cornea without epithelium was treated with the vapor of 0.04% formalin at 4 degrees C for 48 hours, and then dehydrated with silica gel at room temperature for 48 hours. 2) Dehydrated cornea was soaked in the neutral solution of 0.5% L-lysine HCI for one hour, and in the neutral solution of 0.5% L-arginin HCl for one hour successively. 3) Non-swelling cornea was preserved in the desiccator with silica gel or in 0.02% merthiolate solution. Authors compared the hydration ratio of the non-swelling cornea with untreated cornea. Authors employed the chromotropic acid method to measure the amount of formaldehyde in the non-s-welling cornea and compared with the cornea treated only with formalin showed that: 1) Non-swelling cornea became hydrated within 30 minutes and remained constant thereafter in 0.9% saline solution at room temperature, whereas formalin treated cornea hydrated enormously within 3 hours. 2) The amount of formaldehyde in the non-swelling cornea was on the average 0.129 micro M/mg dry weight, and 3) The amount of formaldehyde in the formalin treated cornea was on the average 0.325 micro M/mg dry weight.

The Effect of Mydriatics and Miotics Using Soft Contact Lenses

The therapeutic applications of Soft Contact Lenses including its optical use are most popular, devices in Ophthalmological field. The presoaked soft contact lenses (Bionite Lens) by 1% pilocarpine,10% phenylnephrine. 1% homatropine, and 1% atropine for 4 minutes are inserted into the albino rabbit and the size of pupil was measured using mm. caliper under the dim red light in the dark room. Hourly measurements were carried out and were stopped in each subject when the pupil size of both eyes had returned to normal. The pupil size of control group, which only the above drug were instilled into the conjunctival cuI de sac, was also measured as the same method. As conclusion using soft contact lens in the therapeutic purpose, it potentiate the effect of medication and prolong the time of drug effect compared with the control groups.