Twofold technique for iridodialysis repair

Background: Disinsertion of iris leads to debilitating sequelae like diplopia and glare. Hence, iridodialysis repair is essential to optimize the visual quality. Iris base repair often leads to corectopia that necessitates an additional procedure to optimize the pupil shape and size. Twofold technique helps to achieve both the aspects. Purpose: To highlight the technique of twofold iridodialysis repair. Synopsis: The video highlights the method of twofold iridodialysis repair, wherein nonappositional repair is followed by single?pass four?throw (SFT) pupilloplasty thatallows adequate closure of varied degrees of iridodialysis along with centration of eccentric pupil. Highlights: The twofold technique is a combination of nonappositional iris repair and SFT procedure. It can be clinically applied in all cases of iridodialysis with varied degrees of severity

Innovation Urrets-Zavalia syndrome

Background: Surgeons often notice unexplained dilation of the pupil following an uncomplicated intra-ocular surgery. No definite line of treatment has been proposed for managing Urrets-Zavalia syndrome (UZS). The authors have previously documented the results of surgical pupilloplasty and have outlined this modality of treatment for cases with UZS. Purpose: To highlight the aspect of development of UZS post-operatively in the eyes following an intra-ocular surgery. Synopsis: The video highlights the aspect of prevalence of the persistently dilated pupil that is non-responsive to topical miotics. Apart from associated glare, these cases often have raised intra-ocular pressure because of appositional closure of the anterior chamber angle. Surgical pupilloplasty pulls the iris tissue centrally, eventually releasing the mechanical blockage and often breakage of the peripheral anterior synechias as demonstrated by intra-operative gonioscopy and anterior segment optical coherence tomography. Highlights: Performing a surgical pupilloplasty can resolve the UZS, and timely intervention can also prevent the development of secondary glaucoma because of fallback of the iris tissue on the structures of the anterior chamber angle.

Clinical characteristics and prognosis of solitary fibrous tumor in the retroperitoneum / 西安交通大学学报(医学版)

【Objective】 To investigate the clinicopathological characteristics and prognosis of solitary fibrous tumor (SFT) in the retroperitoneum. 【Methods】 We summarized the clinical and prognostic data of nine patients admitted to The First Affiliated Hospital of Xi’an Jiaotong University between January 2007 and December 2017 who were diagnosed with SFT by surgical resection and pathological examination. Nine cases of retroperitoneal SFT were detected by HE and immunohistochemical SP method. The expressions of Vimintin (Vim), CD34, CD99, Ki-67, Bcl-2 and S-100 in tumor cells were analyzed for their clinicopathological characteristics and prognosis. 【Results】 Among the nine patients, four were male and five were female, aged 37-69 years old. Five of them showed abdominal distension, while the other four had no obvious clinical symptoms. The tumor size was (1.0 cm×1.0 cm×2.0 cm)-(30.0 cm×25.0 cm×10.0 cm). There were seven single cases and two multiple cases. Histology showed bundle-shaped, braided spindle cells and collagen fibers of varying degrees, accompanied by mucinous degeneration and hemangiopericytoma-like morphology. Immunohistochemical results were as follows: The positive rate was 100% (9/9) for Vim, CD34 and CD99, 77% (7/9) for Ki-67, 67% (6/9) for Bcl-2, and 22% (2/9) for S-100. All the patients were followed up effectively. Two of them died (the cause of death was not related to the disease studied, and the survival time from postoperative to death was 6.5 years and 8.3 years, respectively). One surviving case relapsed 3 years after the operation, but did not recur after the second operation. No recurrence or metastasis was found in the remaining cases. 【Conclusion】 Retroperitoneal SFT is rare in the clinic, and there are no typical clinical symptoms in the early stage. Most of them are detected in physical check-ups. Ultrasound and CT examinations are the main preoperative examination methods, but they are not specific to SFT. Pathological examination is the only method for diagnosis. Radical resection is the first-choice of treatment. The preferred method for this disease is effective in early radical surgery and regular postoperative review.

Phacoemulsification with single-pass four-throw pupilloplasty and pre-Descemet's endothelial keratoplasty for management of cosmetic iris implant complication

Placement of an anterior chamber iris implant for cosmetic reasons has been associated with development of various complications. Even after the implant has been explanted from the eye, it leaves a trail of after effects that necessitate surgical management. We describe a technique that comprises of performing phacoemulsification with single-pass four-throw pupilloplasty and a pre-Descemet's endothelial keratoplasty procedure for this eye with cosmetic iris implant complication.

Single-pass four-throw pupilloplasty for angle-closure glaucoma

Angle-closure glaucoma is characterized by appositional or synechial closure of the anterior chamber angle with glaucomatous field defects that may or may not be associated with a pupillary block. Surgical pupilloplasty with single-pass four-throw technique helps to alleviate the appositional closure along with the breakage of peripheral anterior synechia, thereby increasing the aqueous outflow and decreasing intraocular pressure.

Huge Solitary Fibrous Tumor of the Left Ventricular Epicardium / 日本心臓血管外科学会雑誌

<p>An 89-year-old woman had undergone a medical examination and treatment due to exertional dyspnea symptom and cardiac enlargement, but her symptoms had not improved. According to images from a computed tomography scan, a huge intrapercardial mass excluding the heart was detected, and the patient was referred to our department for surgical treatment. Because of cardiac failure due to the mass excluding the heart, we planned to excise the tumor for cure and also for diagnosis. We did not distinguish the tumor before operation as is often the case with cardiac tumor. The tumor arose from the epicardium of the left ventricular (LV) anterior wall, and was attached to the LV wall with a broad stalk (approximately 3×10 cm) along the left anterior descending coronary artery (LAD). We had to operate under cardiopulmonary bypass and cardiac arrest, since the tumor involved the LAD, so we underwent resection of a part of the LAD. The patient was discharged uneventfully on postoperative day 37. On histopathology, the tumor was diagnosed as a solitary fibrous tumor (SFT) of the epicardium. Cardiac SFTs are rare. Above all, SFTs arising from LV epicardium are very rare. We report this case with some literature review.</p>

A Simple Computed Tomography Scoring System to Predict Histological Malignancy of Solitary Fibrous Tumors of the Pleura.

Purpose: The aim of the present study was to define the very first score enabling discrimination between benign and malignant solitary fibrous tumors of the pleura (SFTPs), on the basis of reliable preoperative CT features. Methods: Between December 2004 and November 2012, 56 patients underwent complete resection for SFTP at six institutes. CT scans were reviewed retrospectively, and a diagnostic scoring system for predicting malignant SFTP preoperatively was designed. Results: Univariate analysis revealed seven significant predictors of malignant SFTP: tumor size ≥ 10 cm (p=0.002), tumor heterogeneity spontaneously (p=0.019) or after contrast medium injection (p=0.029), existence of intratumoral fluid density areas (p=0.011), a pleural effusion (p=0.01), measurable (diameter >1 mm) intratumoral vessels (p=0.019), a hypervascular character (visible intratumoral vessels and/or intense enhancement) (p=0.001). A scoring system based on these seven CT features, each assigned 1 point, and with a cut-off of 4 points, could predict malignant SFTP with a specificity of 85% and a sensitivity of 48%. Conclusion: Our scoring system using seven CT features (tumor size ≥ 10 cm, tumor heterogeneity with or without contrast injection, intratumoral fluid density areas, pleural effusion, measurable intratumoral vessels, and a hypervascular character of the tumor) may be helpful for predicting histological malignancy of solitary fibrous tumors of the pleura.

Alterations in body composition of obese females following in-community supervised exercise program

BACKGROUND: A variety of techniques for assessing human composition have been developed. However, the validity of these methods has not been compared in the same subjects after training program. In this study, the dependent variable used as a criterion of changes in body composition is body weight (BW), which consists of fat-free weight (FFW) and body fat (BF) in the two compartment model, on the assumption that FFM does not change significantly during the exercise program. The purpose of this investigation was to evaluate the validity of percentage body fat using indirect methods - bioelectrical impedance (Bl) analyzer and skinfold thickness (SFT) and to discuss the accuracy of each method. METHODS: The subjects were 13 obese women, aged 42 to 63 fears (52.4+/-6.4yr) . The subjects participated in supervised physical conditioning program 3 days per week, 30 to 60 min each session, for a period of 14 weeks. RESULTS: Small decrements were observed in BW (0.5+/-1.9 kg, p>0.05) , body mass index (BMI, 0.6+/-1.8, p>0.05), waist girth (2.1 cm, P<.06), and SFT at the triceps (2.9mm, P<0.05) and subscapular (2.9mm, P<0.05) . There were significant changes in BF (P<0.001) and FFM (P<0.001) calculated by the SFT method, while mean FFM computed by Bl technique remained essentially unchanged. Correlational analysis indicated that the absolute amount of change in BW (i.e., delta BW) was significantly associated with delta abdominal girth and delta BF estimated by the BI technique. The relationship between delta BW and delta BF estimated by the SFT method technique was not statistically significant, thereby questioning the validity of using individual skinfold measurements solely to estimate alterations in body composition. CONCLUSIONS: From these results, it is concluded that Bl technique may provide more accurate estimates of changes in BF than SFT method.