Laparoscopia con preservación de órgano en lesión esplénica en dos tiempos por traumatismo cerrado de abdomen / Laparoscopy with spleen preservation for delayed splenic rupture due to blunt abdominal trauma

RESUMEN El tratamiento no operatorio (TNO) de lesiones abdominales en traumatismo cerrado de abdomen (TCA) se basa en pilares clínicos y radiológicos. Presentamos el de caso de paciente masculino de 16 años que ingresa en el Servicio de Emergencias por dolor abdominal en hipocondrio izquierdo y antecedente de traumatismo cerrado de abdomen reciente. Se establece protocolo de TNO basado en cuadro clínico e imágenes pero, en forma posterior, ante la evolución desfavorable, se cambia la conducta y se realiza tratamiento laparoscópico conservador de órgano.

ABSTRACT Nonoperative management (NOM) of organ injuries in abdominal blunt trauma (ABT) is based on clinical and imaging test findings. We herein present a 16-year-old male patient with a history of recent blunt abdominal trauma was admitted to the emergency department for abdominal pain in the left hypochondrium. A protocol for NOM was established based on the clinical picture and imaging findings, but afterwards, in view of the unfavorable progression, the approach was modified to laparoscopic organ-preserving surgery.

First phytochemical description of essential oils from Piper cachimboense (Piperales, Piperaceae) / Primeira descrição fitoquímica de óleos essenciais de Piper cachimboense (Piperales, Piperaceae)

Piper cachimboense is recorded only for the Amazon region of Brazil and Colombia, and the objective of this study was to report the first phytochemical assessment of the composition of the essential oils (EOs) from this species collected in the Amazon rainforest, in Novo Progresso, Pará State, Brazil. Samples of leaves were subjected to hydrodistillation in a Clevenger-type apparatus. The chemical identification was carried out by gas chromatography. The yield of oils was of 11.03 ± 5.94% for fresh leaves, and 1.07 ± 0.27% for dry leaves. The analysis showed 36 volatile compounds from fresh leaves and 49 from dried leaves. Main constituents in EOs of both fresh and dried leaves from P. cachimboense were (E)-caryophyllene, germacrene-D, -amorfene, -cadinene and apiole.

Piper cachimboense é registrada apenas para a região amazônica do Brasil e Colômbia, e o objetivo deste estudo foi relatar, pela primeira vez, a composição fitoquímica dos óleos essenciais (OEs) desta espécie coletada na floresta amazônica, em Novo Progresso/PA, Brasil. Amostras de folhas foram submetidas a hidrodestilação em aparelho tipo Clevenger. A identificação química foi realizada por cromatografia gasosa e o rendimento dos óleos foi de 11,03 ± 5,94% para as folhas frescas e de 1,07 ± 0,27% para as folhas secas. A análise mostrou 36 compostos voláteis para folhas frescas e 49 para folhas secas. Os constituintes principais dos OEs de folhas frescas e secas de P. cachimboense foram (E)-cariofileno, germacreno-D, -amorfeno, -cadineno e apiol.

The relationship between color vision discrimination ability and depth perception among university students / 国际眼科杂志(Guoji Yanke Zazhi)

Abstract? AIM: To evaluate the relationship between color discrimination ability ( CDA) and depth perception among university students with normal color vision.?METHODS:A total of 52 students, 33 males ( 63.46%) and 19 females (36.54%) from Baskent University Faculty of Medicine, aged 21.18 ±2.52y included in this study. Subject has normal visual acuity ( 20/20 ) and without congenital color vision deficiency ( CCVD ) . They were evaluated by Ishihara Pseudoisochromatic Plate Test (IPPT).Dominant eye (DE) was determined using the Gundogan Method. The CDA was examined by Farnsworth-Munsell 100 Hue Test ( FM100HT ) test for detecting total error score ( TES ) and local error score ( LES) for two eyes ( TE) open, the right eye ( RE) open and the left eye ( LE) open.The error scores were divided into the three groups: for the TE, for the dominant eye ( DE ) and for the non -dominant eye ( NDE ) . The presence of the binocularity and stereoscopic sensitivity ( SS ) were investigated by TNO test which were also divided into four groups according to the level of SS within a range of 480-15 arc/s.?RESULTS:The error scores of FM100HT without gender difference for TES, blue/yellow( b/y) LES and red/green (r/g) LES were found 61.22±30.32(58.50), 35.80±19.32 (36.50) and 25.42 ±14.65 (24.00) respectively.In male subjects (n=31) were found 67.45±29.95 (61.00), 40.25± 18.83 (39.00) and 27.19 ±14.30 (24.00) respectively.In female subjects (n=19) were found 51.05±28.84 (47.00), 25.52±18.32 (28.00) and 22.2±31.13 (23.00) respectively. Females had higher CDA than males according FM100HT error scores. CDA classification according to FM100HT were found to be higher ( 6%, TES=0-20 ) , medium (86%, TES=20-100), lower (8%, TES>100), the medium level was statistically more frequently observed (P<0.05). The r/g color LES for DE and NDE were 24.12±14.70 and 32.20±14.21, b/y color LES for DE and NDE were 34.68 ± 1.95 and 36.24±17.56 respectively.In female (n=19) r/g color LES for DE and NDE were 21.89 ±15.06 and 31.00 ± 22.42;in male (n=31) 25.48±14.55 and 32.93±17.31.In female (n=19) b/y color LES for DE and NDE were 29.63± 18.62 and 33.42±17.38; in male (n=31) 37.77±18.78 and 37.96±17.73 respectively.All students'TES of TE, DE and NDE subgroups and stereopsis level of were compared, the differences were not statistically significant ( P=1 ) . According to our research CDA and binocular depth perception does not effect on each other.?CONCLUSION: In normal subjects TES of FM100HT showed that no difference in the subject with different stereopsis level and the depth perception evaluated by TNO test which is based on color dissociation and the ability to color discrimination was not correlated. Our previous study DE's CDA was found superior to the NDE's.But in the presenting study showed that DE was not superior to NDE in terms of depth perception.

Horizontal lang two-pencil test as a screening test for stereopsis and binocularity.

Purpose: To assess the horizontal Lang two-pencil test as a bedside test to detect gross stereopsis. Materials and Methods: Eighty-four strabismic subjects divided into two groups based on the amount of deviation, and 40 normal subjects were studied. Sensory status examination including binocularity and stereopsis were evaluated with Bagolini, Titmus test and the Netherlands organisation for applied scientific research (TNO), Randot, synoptophore and horizontal Lang two-pencil test. Results: The subjects in the group with smaller deviation showed better performance on all the four stereo tests and over 90% demonstrated presence of fusion. When compared to TNO and Randot for determining presence of stereopsis, the horizontal Lang two-pencil test demonstrated sensitivity of 100% and 83.9%, specificity of 77.8% and 73.7%, and negative predictive value of 100% and 100% respectively. It also showed 100% specificity as a test for binocularity when compared with the Bagolini striated glass test. Conclusion: Horizontal Lang two-pencil test, an easily performed test with a high sensitivity and negative predictive value can be used as a screening test to detect gross stereopsis and binocularity.

Effect of Illunmination on Stereoacuity

PURPOSE: To investigate the effect of illumination on stereoacuity and to evaluate adequate illumination for each stereotest. METHODS: We measured stereoacuity by Titmus stereotest, TNO stereotest, Lang stereotest in normal group of 40 cases and strabismus group of 26 cases with five levels of illumination. The statistical analysis was performed to compare the mean stereoacuity between different levels of illumination using Student t-test. RESULT: In Titmus stereotest, stereoacuity improved as illumination increased up to 60 lux, which was statistically significant (P< 0.05). In TNO stereotest, stereoacuity significantly improved as illumination increased up to 200 lux in normal group (P< 0.01), and up to 60 lux in strabismus group (P=0.01). In Lang stereotest, 100% of normal group passed the test under 20 lux or more, and 100% of strabismus group passed the test under 60 lux or more. DISCUSSION: The illumination of 60 lux or more was required for Titmus stereotest and 200 lux or more for TNO stereotest, which was sufficient with the room illumination. Lang stereotest is less influenced by illumination and could be performed under lower illumination than other stereotests.

Evaluation of Criteria of Stereoacuity for Titmus, Randot & TNO Stereotests

The commonly used tests for stereopsis are Titmus-fly, Randot, and TNO tests. In this study, 50 normal subjects were tested with these tests in order to set a criterion for normal stereopsis. The value of mean, mode and 75% point of these three tests were derived and compared.These three tests were also performed in 23 intermittent exotropes and 32 accommodative esotropes who showed gross stereopsis in the range of 60 to 400 seconds of arc by Titmus-fly testing. The aim was to obtain standards for clinical applicability and accuracy of these tests.This study cincludes that the appropriate criteria for normal stereopsis are less than 60 seconds of arc for Titmus-fly or Randot test, and 120 seconds of arc fot TNO test. Accurate testing for stereopsis in patients with gross stereopsis requires both Titmus-fly and Randot tests together. TNO test was inferior to the other two tests in terms of the accuracy and clinical applicability.

Stereopsis in Child Amblyopes

The authors performed Titmus and TNO stereopsis tests in the group of children amblyopes aged from 3 to 11 year old in order to evaluate clinical usefulness of stereopsis in amblyopia and preschool vision screening. 36(72%) and 42(84%) amblyopes could not pass the Titmus 100 see and TNO 120 see each and if 6 amblyopes who had 0.8 or better vision were excluded, the sensitivity were 82%(36/44) and 95%(42/44). Each visions of amblyopic eyes gave the main influence to decide stereoacuity in the Titmus test(correlation coefficient=0.69) and all of the amblyopes who had 3 or more interocular acuity differences could not pass the TNO 120 sec. As a result Titmus test had too low sensitivity to use as the screening test but it was useful to evaluate the vision of amblyopiceye. TNO was sensitive to interocular acuity differences and the authors thought that TNO 120 see can be used in the screening.

Comparisons of the Lang, Randot, TNO and New Stereo Tests in Screening and Office use in Children

Stereoacuity has given a reliable clue of detacting clinically important strabismus, amblyopia and anisometropia in children. There are many tests of stereoacuity in common use, and comparisions of these tse tests are needed for clinical application. Stereoacuity was investigated in 2 to 14-year-old children by using commercially available stereotests(Lang, Randot, TNO and New stereo tests). Each test was held exactly at right angles and at a distance of about 40 cm in front of the examinee and was illuminated about 160 lux. Various tests of stereopsis were discussed and their practicalities for clinical use was considered. Comparative analysis was done with each stereotest, and factors influencing stereoacuity threshold difference among the different tests were discussed. We knew many statistically interesting results and those were described in our study. Lang stereotest was simple and useful screening test in younger children. Randot stereotest was useful single method for screening and quantitative test.

The Stereoacuity on Child Strabismus 1. Aflalysis of Horizontal Deviations

Eighty children who had horizontal strabismus were examined with Titmus and random-dot stereogram(TNO) for the stereoacuity. The patients were analyzed about visual acuity and types of strabismus. In addition, we also analyzed thirty three patients who received correction surgery for the strabismus for evaluation of the changes of postoperative visual acuity and its relationship to the stereoacuity. The results were as follows: 1. The stereoacuity tested by the TNO was proportional to the change of visual acuity, but that of the Titmus was not proportional. 2. The stereoacuity in the exodeviation was higher than the esodeviation. The stereoacuity in the intermittent exotropia was higher than the constant exotropia, and there was no difference in stereoacuity between the accommodative and nonaccommodative esotropia. 3. The visual acuity was improved postoperatively. 4. The postoperative stereoacuity was also improved. The patients with esodeviation showed more improvement in the stereoacuity compared with that of the patients with exodeviation.