Nothing is impossible if you have the right tools and techniques to support

Background: Zonular weakness is a known complication that a surgeon can encounter during cataract surgery. Purpose: The purpose of this video is to make surgeons aware about the different tools and techniques available to handle zonulopathy. Synopsis: This video describes the various causes of zonular weakness and different tools available to manage zonular weakness intraoperatively. The surgical technique of using the tools is also demonstrated in the video. Highlights: Causes of zonular weakness and surgical techniques to handle it intraoperatively.

Gerbode defect formation two decades after tetrology of fallot repair

Although most intracardiac defects are congenital, a small fraction may be acquired during life. The Gerbode defect is an abnormal anatomical connection between the left ventricle and the right atrium. We describe herein a patient who initially underwent repair of tetralogy of Fallot (TOF). Years after TOF repair, he developed severe dyspnea. Extensive evaluation revealed that he had developed a Gerbode defect. Very few cases of acquired Gerbode defect have been previously reported. Management options are predominantly surgical interventions

Sternal osteomyelitis by Gordonia Bronchialis in an immunocompetent patient after open heart surgery

Gordonia is a catalase-positive, aerobic, nocardioform, Gram-positive staining actinomycete that also shows weak acid-fast staining. Several Gordonia species are commonly found in the soil. The bacterium has been isolated from the saliva of domesticated/wild dogs as well. In hospitalized patients, most commonly it is found in the setting of intravascular catheter-related infections. However, recent reports show that it is being increasingly isolated from sternal wounds, skin/neoplastic specimens and from pleural effusions. Gordonia shares many common characteristics with Rhodococcus and Nocardia. Ergo, it is commonly misrecognized as Nocardia or Rhodococcus. Since this pathogen requires comprehensive morphological and biochemical testing, it is often difficult and cumbersome to isolate the species. Broad-range Polymerase Chain Reaction (PCR) and sequencing with genes like 16S rRNA or hsp65 are used to correctly identify the species. Identification is essential for choosing and narrowing the right antimicrobial agent. Herein, we report our experience with a patient who presented with sternal osteomyelitis after infection with this elusive bug.

A comparative study of safety and efficacy of ultrasound-guided infra-clavicular axillary vein cannulation versus ultrasound-guided internal jugular vein cannulation in adult cardiac surgical patients

Background: Ultrasound (US)-guided internal jugular vein (IJV) cannulation is a widely accepted standard procedure. The axillary vein (AV) in comparison to the subclavian vein is easily visualized, but its cannulation is not extensively studied in cardiac patients. Aims: This study is an attempt to study the efficacy of real-time US-guided axillary venous cannulation as a safe alternative for the time-tested US-guided IJV cannulation. Design: This is a prospective randomized controlled study. Materials and Methods: A total of 100 adult patients scheduled for cardiac surgery were divided equally in Group A-US-guided IJV cannulation, and Group B-US-guided axillary venous cannulation. Under local anesthesia and real-time US guidance the IJV or AV was secured. The access time, guidewire time, and procedure time were noted. Furthermore, the number of needle attempts, malposition, change of site, and complications were noted. Results: The data were analyzed for 49 patients in Group A and 48 patients in the Group B due to exclusions. The access time and the guidewire time were comparable in both groups. The first attempt needle puncture was successful for the IJV group in 98% of patients in comparison to 95% of patients in Group B. Guidewire was passed in the first attempt in 94% in Group A and 89% in the Group B. Except for arterial puncture in one case in group A, the complications were insignificant in both groups. Conclusion: The study shows that the US-guided AV cannulation may serve as an effective alternative to the IJV cannulation in cardiac surgery.

Association between anterior corneal astigmatism and posterior corneal astigmatism across age groups:a cross-sectional analysis / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To assess the anterior corneal astigmatism (ACA)and posterior corneal astigmatism (PCA) patterns across various age groups.We also evaluated the association between magnitudes and axes of the ACA and PCA across these age groups.METHODS:The present study was a cross-sectional analysis of clinical data of 381 eyes.We converted the clinical astigmatic notation to vector notation for analysis of ACA and PCA.We estimated the correlation between magnitude and axes of the ACA and PCA in the whole population and in four age groups (5-19,20-39,40-59,and ≥ 60y).We used random effects linear regression models for estimating the association between the magnitudes of ACA and PCA.RESULTS:The mean of the magnitude of the ACA (3.59D) and the PCA (0.50D) was highest in children (5 to 9y).Overall,the magnitude of the ACA ranged from 0D to 10.0 Diopters (D) and the magnitude of the PCA ranged from 0 to 3.5 D.There was a significant correlation between the ACA and the PCA in the younger age group (r=0.85,P＜0.001).In those 60y or older,the PCA increased by 0.04 units (95％ confidence intervals:0.005,0.07;P=0.03) with each unit increase in the ACA,the increase was the smallest in this age group.CONCLUSION:It will be prudent to measure the both the magnitude and axis of the PCA,particularly in those above 60y rather than rely on rule-of-thumb calculations based on ACA parameters for IOL power calculation.