Síndrome de contracción capsular bilateral / Bilateral capsule contraction syndrome

El síndrome de contracción capsular se describe como una reducción progresiva y acelerada del diámetro de la capsulorrexis y del saco capsular tras la extracción extracapsular del cristalino. Se reporta el caso de una paciente femenina, con antecedentes de miopía elevada, a quien se le realizó cirugía de catarata de ambos ojos sin complicaciones transquirúrgicas, y regresa con síndrome de contracción capsular bilateral al mes de operada. Se comenta la conducta seguida en ambos ojos(AU)

Capsule contraction syndrome is described as progressive, accelerated reduction in capsulorhexis and capsular bag diameter after extracapsular crystalline lens extraction. A case is presented of a female patient with a history of high myopia who underwent cataract surgery of both eyes without any intraoperative complication. One month after surgery the patient presents with bilateral capsule contraction syndrome. Comments are made on the clinical management of each eye(AU)

Successful cure of a patient with urosepsis using a combination of extracorporeal membrane oxygenation and continuous renal replacement therapy: A case report and literature review / 中华创伤杂志(英文版)

Holmium laser lithotripsy (HLL) is one of the common surgical methods for urolithiasis. It causes minor surgical trauma, but complications are not rare. Extracorporeal membrane oxygenation (ECMO) treatment of sepsis is common, but venoarterial (VA)-ECMO treatment of urosepsis has not been reported yet. In this article, we reported a 67-year-old female patient with refractory septic shock caused by HLL under percutaneous nephroscope, involving breathing, heart, kidney and other organs, and organs support treatment was ineffective for the patient. Finally, we successfully treated the patient under VA-ECMO with continuous renal replacement therapy (CRRT). Combined ECMO and CRRT may provide a solution for addressing refractory sepsis. Here we present the case and review relevant literature, so as to provide a treatment strategy for patients with refractory urogenic sepsis and to reduce the mortality rate.

Stress urinary incontinence post-holmium laser enucleation of the prostate: a single-surgeon experience

ABSTRACT Purpose To identify incidence and predictors of stress urinary incontinence (SUI) following Holmium laser enucleation of the prostate (HoLEP). Materials and Methods We performed a retrospective review of 589 HoLEP patients from 2012-2018. Patients were assessed at pre-operative and post-operative visits. Univariate and multivariate regression analyses were performed to identify predictors of SUI. Results 52/589 patients (8.8%) developed transient SUI, while 9/589 (1.5%) developed long-term SUI. tSUI resolved for 46 patients (88.5%) within the first six weeks and in 6 patients (11.5%) between 6 weeks to 3 months. Long-term SUI patients required intervention, achieving continence at 16.4 months on average, 44 men (70.9%) with incontinence were catheter dependent preoperatively. Mean prostatic volume was 148.7mL in tSUI patients, 111.6mL in long-term SUI, and 87.9mL in others (p <0.0001). On univariate analysis, laser energy used (p <0.0001), laser "on" time (p=0.0204), resected prostate weight (p <0.0001), overall International Prostate Symptom Score (IPSS) (p=0.0005), and IPSS QOL (p=0.02) were associated with SUI. On multivariate analysis, resected prostate weight was predictive of any SUI and tSUI, with no risk factors identified for long-term SUI. Conclusion Post-HoLEP SUI occurs in ~10% of patients, with 1.5% continuing beyond six months. Most patients with tSUI recover within the first six weeks. Prostate size >100g and catheter dependency are associated with increased risk tSUI. Larger prostate volume is an independent predictor of any SUI, and tSUI.

A novel one lobe technique of thulium laser enucleation of the prostate: 'All-in-One' technique

PURPOSE: The thulium laser is the most recently introduced technology for the surgical treatment of benign prostatic hyperplasia (BPH). Until recently, most thulium laser enucleation of the prostate (ThuLEP) was performed by use of the three-lobe technique. We introduce a novel one-lobe enucleation technique for ThuLEP called the "All-in-One" technique. We report our initial experiences here. MATERIALS AND METHODS: From June 2013 to May 2014, a total of 47 patients underwent the All-in-One technique of ThuLEP for symptomatic BPH performed by a single surgeon. All patients were assessed with the International Prostate Symptom Score (IPSS), transrectal ultrasonography, serum prostate-specific antigen (PSA), maximal urine flow rate (Qmax), and postvoid residual urine volume (PVR) before and 1 month after surgery. We reassessed IPSS, Qmax, and PVR 3 months after surgery. To assess the efficacy of the All-in-One technique, we checked the PSA reduction ratio, transitional zone volume reduction ratio, and enucleation failure rate. RESULTS: The mean operative time was 82.1+/-33.3 minutes. The mean enucleation time and morcellation time were 52.7+/-21.7 minutes and 8.2+/-7.0 minutes, respectively. The mean resected tissue weight and decrease in hemoglobin were 36.9+/-24.6 g and 0.4+/-0.8 g/dL, respectively. All perioperative parameters showed significant improvement (p<0.05). No major complications were observed. The PSA reduction ratio, transitional zone volume reduction ratio, and enucleation failure rate were 0.81, 0.92, and 4.3%, respectively. CONCLUSIONS: The All-in-One technique of ThuLEP showed efficacy and effectiveness comparable to that of other techniques. We expect that this new technique could reduce the operation time and the bleeding and improve the effectiveness of enucleation.

Morphological alterations of the surfaces of enamel and dentin of deciduous teeth irradiated with Nd: YAG, C0(2)and diode lasers / Alteraciones morfológicas de las superficies de esmalte y dentina de dientes deciduos irradiados con láseres de Nd: YAG, C0(2) y diodo

In this work, we studied the effects of C0(2), Nd:YAG and diode lasers on the enamel and dentin of deciduous human teeth. After the irradiations, the samples were duly prepared and set up on metallic bases, covered with gold and examined in the scanning electron microscope. The results showed that the irradiation with the C0(2) mode locked laser with 1.0 W power caused melting and irregularities with small cavities on the surface of the enamel. The irradiated area on the dentin surface appeared circular and well delimited, containing blocks of dentin and cracks. By using the pulsed Nd:YAG laser with 1.0 W mean power and 10 Hz frequency, the enamel surface presented granules of molten enamel, with a typical melting look. The irradiated dentin surface presented a cavity with a margin elevated with granules and holes, and its bottom presented dentinary tubules with globules of melted dentin. Irradiation with the mode locked of diode laser with 1.0 W mean power, showed the formation of a melted and evenly resolidified enamel surface, and the dentin surface presented a block of melted dentin with adjacent regions of normal dentin, evidently with a relatively smooth surface.

El estudio presenta algunos resultados del efecto del láser de C0(2), Nd:YAG y Diodo sobre el esmalte y dentina de dientes deciduos humanos. Después de las irradiaciones, se prepararon las muestras y se montaron sobre bases metálicas, cubiertas con oro y examinadas en el microscopio electrónico de barrido. Los resultados mostraron que la irradiación con el láser C0(2) en modo conmutado con 1,0 W de potencia, provoca fusión e irregularidades con pequeños cráteres en la superficie del esmalte. En la superficie de la dentina, el área irradiada se mostró circular y bien definido, con bloques de dentina y grietas. Con el uso del láser Nd: YAG en el modo pulsado con 1,0 W de potencia media y frecuencia de 10Hz, la superficie del esmalte presentó granulos de esmalte fundido, dándole el aspecto de "melting" (derretido). La superficie de dentina irradiada presentó un cráter con borde elevado con gránulos y agujeros, y su fondo presentó túbulos dentinarios con glóbulos de dentina derretida. La irradiación del láser de Diodo en el modo conmutado con potencia media de 1,0 W, provocó la formación de una superficie de esmalte fusionada y resolidificada uniforme y la superficie de la dentina presentó un bloque de dentina fundida en la regiones adyacentes de dentina normal, mostrando una superficie bastante lisa.

Bone damage induced by different cutting instruments: an in vitro study

The aim of this study was to compare the peripheral bone damage induced by different cutting systems. Four devices were tested: Er:YAG laser (2.94 mm), Piezosurgery, high-speed drill and low-speed drill. Forty-five bone sections, divided into 9 groups according to different parameters, were taken from pig mandibles within 1 h post mortem. Specimens were fixed in 10 percent buffered formalin, decalcified and cut in thin sections. Four different parameters were analyzed: cut precision, depth of incision, peripheral carbonization and presence of bone fragments. For statistical analysis, the Kruskal-Wallis test was applied to assess equality of sample medians among groups. All sections obtained with the Er:YAG laser showed poor peripheral carbonization. The edges of the incisions were always well-shaped and regular, no melting was observed. Piezosurgery specimens revealed superficial incisions without thermal damage but with irregular edges. The sections obtained by traditional drilling showed poor peripheral carbonization, especially if obtained at lower speed. There was statistically significant differences (p<0.01) among the cutting systems for all analyzed parameters. Er:YAG laser, gave poor peripheral carbonization, and may be considered an effective method in oral bone biopsies and permits to obtain clear and readable tissue specimens.

O objetivo deste estudo foi comparar o dano ósseo periférico produzido por diversos sistemas de corte. Foram avaliados 4 dispositivos: laser Er:YAG (2,94 mm), Piezo-cirurgia, broca em alta rotação e broca em baixa rotação. Para isto, foram utilizadas 45 seções ósseas retiradas de mandíbulas de suínos, até 1 h post-mortem, divididas em 9 grupos de acordo com diversos parâmetros. As amostras foram fixadas em formalina a 10 por cento tamponada, descalcificadas e cortadas em lâminas finas. Foram analisados 4 parâmetros diferentes: a precisão do corte, a profundidade da incisão, a carbonização periférica e presença de fragmentos ósseos. A análise estatística empregou o teste de Kruskal-Wallis para avaliar a similaridade das medianas entre os grupos. Todas as seções feitas com o laser Er:YAG exibiram pouca carbonização. As margens das incisões foram todas bem acabadas e regulares, sem apresentar pontos de fusão. As amostras obtidas por piezo-cirurgia apresentaram incisões superficiais sem danos térmicos, mas com margens irregulares. As seções obtidas pelas brocas convencionais apresentaram pouca carbonização marginal, particularmente as feitas em baixa rotação. Foram observadas diferenças estatisticamente significantes (p<0,01) entre todos os sistemas de corte para cada um dos parâmetros analisados. O laser Er:YAG apresentou pouca carbonização e pode ser considerado como um método eficaz para biópsias de ossos bucais, produzindo amostras de tecido limpas e fáceis de analisar.

Raised intraocular pressure; frequency after Nd: YAG laser capsulotomy

To measure the rise in intraocular pressure after neodymium:yttrium-aluminum-garnet [Nd:YAG] Laser capsulotomy in pseudophakic patients aged 50 years and above. Prospective study. Study was done from May 2005 to Dec 2005. [Eight months duration] Eye department Military Hospital Rawalpindi. A total of 100 patients, presenting in Eye department, Military Hospital Rawalpindi, fulfilling inclusion and exclusion criteria were included. With a minimum number of bursts of 3.6 mj / shot energy level with Nd: YAG laser, a 3 to 4 mm hole in the posterior capsule was created. The intraocular pressure was measured 1 hour, 3 hours, 1 day and 1 week after the laser. The rise in intraocular pressure was noticed in 6 [6%] patients after Nd:YAG laser capsulotomy. Five out of six patients had fibrous type of posterior capsular opacification while one patient had Elschnig's pearl. Male to female Ratio was 7:3. Our findings suggest that the rise in intraocular pressure is an infrequent complication of Nd:YAG Laser capsulotomy

Dystrophic Calcification and Stone Formation on the Entire Bladder Neck After Potassium-titanyl Phosphate Laser Vaporization for the Prostate: A Case Report

Dystrophic calcification can be defined as a calcification that occurs in degenerated or necrotic tissue. It is associated with multiple clinical conditions, such as collagen vascular diseases. It involves the deposition of calcium in soft tissues despite no generalized disturbance in the calcium or phosphorus metabolism, and this is often seen at sites of previous inflammation or damage. Potassium-titanyl phosphate (KTP) laser vaporization of the prostate is safe and relatively bloodless procedure that results in a shorter catheterization, immediate symptomatic improvement, and less severe postoperative irritative symptoms. However, longer follow-up studies or reports about complications are lacking. Here in we report a case of dystrophic calcification and stone formation on the entire bladder neck after performing KTP laser vaporization of benign prostate hyperplasia. That was treated by lithotripsy and transurethral resection.

A Case of Accidental Macular Injury by Nd: YAG Laser and Subsequent 6 Year Follow-Up

Here, we report the case of a patient who sustained Nd: YAG laser macular injury with subsequent 6 year follow-up evaluation. A 23-year-old female was accidentally exposed to a Q-switched Nd: YAG laser without protective goggles. Upon initial evaluation, the best-corrected visual acuity of her affected eye was 20/100 OD. Fundoscopic examination revealed a macular laser burn and vitreous hemorrhage. Corticosteroids, in the form of 60 mg prednisolone, were administered orally with a 10 mg per week taper. Nineteen days following exposure, fundoscopic examination revealed a distinct epiretinal membrane which resolved within six months. The best-corrected visual acuity of the affected eye remained 20/100 OD. This clinical course is similar to those of previously reported cases including vitreous hemorrhage and subsequent epiretinal membrane formation. However, visual acuity did not recover despite spontaneous regression of the epiretinal membrane and at 6 year follow-up, there was neither choroidal neovascularization nor macular hole formation.

Nd: yag laser capsulotomy and complications

To evaluate the complications of Nd: Yag laser when applied on postoperative posterior capsule opacification [PCO], following extra capsular cataract extraction [ECCE] with intraocular lens [IOL]. Analytical and descriptive study. Eye OPD of DHQ Hospital, PMC and Clinic of Professor Zia ud Din Ahmad, Faisalabad. From Jan 2006 to Jan 2007. There were 120 patients; age ranged from 15 years to 80 years with post operated extra capsular cataract extraction with posterior capsular opacification. A Proforma was made which included detailed history of diabetes, hypertension, time period of cataract extraction, other relevant surgical or medical history, and examination e.g. Visual acuity, slit lamp examination, intraocular pressure measurement [applanation tonometry] dilated posterior capsule examination and slit lamp biomicroscopy etc. The patients were kept under observation for 5 hour and called for follow up after one week. Out of 120 patient s 70 eyes showed visual improvement from 6/18 to 6/6 [58.34%], while 30 Shown visual acuity improvement from count figures to 6/24 [25%], mild anterior uveitis occurred in 8 cases [6.67%], corneal damage in 2 cases [1.6%] while transient raised Intraocular Pressure [IOP] in 7 cases [5.83%]. The damage to IOL observed in 3 [2.5%], the corneal damage was seen in 2 cases [1.67%]. The Nd; Yag Laser is very effective, cheap and easy mode of treatment for PCO with minimal post laser complications

Efficacy and safety of quasi-continuous, frequency-doubled Nd:YAG [532nm] laser therapy of port-wine stains

The quasi-continuous, frequency-doubled neodymium yttrium aluminum garnet [Nd:YAG] 532nm laser has been used for the first time in the treatment of port-wine stain [PWS]. To determine the efficacy and side effects of quasi-continuous Nd: YAG 532nm laser in the treatment of PWS. Twenty patients were enrolled in the study. The site and colour of PWS were recorded and assessed subjectively and by photography both before and after treatment. The patients had test areas treated and followed up after four weeks. Maximally eight treatments were given on any one site or until >75%improvement occurred. Final evaluation was done one month after the last treatment session on a four-point scale. Twenty patients were treated, age range 15-35 years wit 14 females. All the patients had PWS in the head and neck region and achieved >25%improvement.Patients underwent a mean of 7.55 treatment sessions. Overall, fifteen [75%] showed 75-100%improvement. The side effects seen in the study were hyperpigmentation in 65%cases, textural changes in six [30%] and eczematization after laser therapy in four [20%] of patients. Other complications included intraoperative hemorrhage and pyogenic granuloma-like lesions that occurred in two cases [10%] each. We have shown that frequency doubled Nd: YAG 532nm is effective and safe in the treatment of PWS