Hepatic Resection for Large Hepatic Metastasis of Adrenocortical Carcinoma after Cyberknife Treatment

Surgical resection is the best treatment for operable metastatic liver cancer. Large metastatic cancer usually has low operability, so a debulking modality of mass is needed to increase operability. Chemotherapy and radiotherapy were commonly used as neoadjuvant treatments. Cyberknife stereotactic radiosurgery systems were only considered as one of the palliative treatment modalities for inoperable or surgically complex tumors. But, in this case, we applied Cyberknife as the preoperative debulking modality for large hepatic metastasis of adrenocortical carcinoma. After Cyberknife treatment 3 cyclex2,700 cGY, tumor size decreased (metastatic liver mass decreased to 15x9 cm from 19x12.5 cm, adrenal mass decreased to 5x3 cm from 7.4x4.5 cm). We could then resect the tumor completely by extended right hemihepatectomy & right adrenalectomy. A preoperative multidisciplinary approach, including chemotherapy and radiation therapy can be considered to increase operability. So, cyberknife can be considered an additional modality as a neoadjuvant radiotherapy.

Antiadhesive Effect of the Mixed Solution of Hyaluronate and Sodium Carboxymethylcellulose After Strabismus Surgery

PURPOSE: To evaluate the effect of the mixed solution of hyaluronate and sodium carboxymethylcellulose (HACMC, Guardix-sol(R)) in reducing postoperative adhesion following strabismus surgery. METHODS: In 16 rabbits out of 20 rabbits, 3 mm recession of the superior rectus muscle was performed on both eyes and HACMC solution was applied only to one eye which was randomly chosen. The rabbits were divided into a surgery-HACMC group and a surgery-no HACMC group. As a control group, the remaining 4 rabbits had no procedures performed. After 3 weeks, both eyes of 8 rabbits with surgery and 2 rabbits of the control group were enucleated. After staining with hematoxylin-eosin and Masson's trichrome, a histologic examination was performed. In the remaining 10 rabbits, the severity of adhesion in muscle and adjacent tissues was observed by blunt dissection. A researcher blind to the experiments performed all the examinations. RESULTS: A significant reduction in the degree of adhesion (P=0.005) as well as decreased fibrosis (P=0.015) was observed in the surgery-HACMC group. CONCLUSIONS: The mixed solution of HACMC was effective in reducing postoperative adhesion after strabismus surgery in rabbits.

Pericardium Plug in the Repair of the Corneoscleral Fistula After Ahmed Glaucoma Valve Explantation

We report four cases in which a pericardium (Tutoplast(R)) plug was used to repair a corneoscleral fistula after Ahmed Glaucoma Valve (AGV) explantation. In four cases in which the AGV tube had been exposed, AGV explantation was performed using a pericardium (Tutoplast(R)) plug to seal the defect previously occupied by the tube. After debridement of the fistula, a piece of processed pericardium (Tutoplast(R)), measured 1 mm in width, was plugged into the fistula and secured with two interrupted 10-0 nylon sutures. To control intraocular pressure, a new AGV was implanted elsewhere in case 1, phaco-trabeculectomy was performed concurrently in case 2, cyclophotocoagulation was performed postoperatively in case 3 and anti-glaucomatous medication was added in case 4. No complication related to the fistula developed at the latest follow-up (range: 12~26 months). The pericardium (Tutoplast(R)) plug seems to be an effective method in the repair of corneoscleral fistulas resulting from explantation of glaucoma drainage implants.

Malignant Hyperthermia in a Patient with Partially Accommodative Esotropia

PURPOSE: Malignant hyperthermia is hypermetabolic disorder of skeletal muscle that manifests during general anesthesia. Strabismus and ptosis are important risk factors in ophthalmology field for malignant hyperthermia. We report a case of malignant hyperthermia in patient with partially accommodative esotropia. CASE SUMMARY: A 6-year-old patient was supposed to undergo a surgical correction for 20 prism diopters of right esotropia after correction of hypermetropia. Because the patient showed tachycardia and hyperthermia just after inhalation of sevoflurane, we interrupted general anesthesia and cancelled the surgery. The patient was transferred to the intensive care unit. In this case, no significant familial and past histories were found. Intractable tachycardia and hyperthermia that had not responded to conservative management improved after two administration of dantrolene sodium. The patient was returned to the ward three days later. As the patient showed no other complication, he was discharged. CONCLUSIONS: In malignant hyperthermia, early diagnosis, appropriate management, and prompt administration of dantrolene sodium are important factors for better prognosis. Preoperatively, full explanation of possible complication and history taking are needed. Careful observation is necessary during anesthesia and surgery.