Water dissection technique: experience at Assiut University Hospital

Water dissection technique [WDT] represents a minimally traumatic surgical method to cautiously open neurosurgical cleavage planes such as interhemispheric space or Sylvian fissure, and the interfaces between extraaxial masses and the adjacent brain such as meningiomas, AVMs and aneurysms. This study was performed to evaluate the clinical application of this technique as an adjunct to everyday microneurosurgical procedures, such as meningioma surgery. One hundred patients with meningioma, aneurysm and arteriovenous malformations were treated surgically with the aid of water dissection in combination with conventional neurosurgical procedures. Water is injected under microscopic control by a handheld syringe with a blunt needle. The irrigation pressure is hand-controlled according to the microscopical view of the ongoing dissection. The WDT of Toth has been used in Assiut in 100 microsurgical cases, in removal of meningiomas and to open Sylvian and interhemispheric fissure. This technique does not need special equipment, and it is easily adapted to everyday microsurgical practice with no noticeable intraoperative complications

Results of subtrochanteric fractures treated with dynamic hip screw and dynamic condylar screw

To study the results of 48 patients with subtrochanteric fractures of the femur, treated surgically with fixation by dynamic hip screw [DHS] in 25 patients [52%], and by dynamic condylar screw [DCS] in 23 patients [48%], at Al-Razi Orthopaedic Hospital in the period between January 1990 and June 1995. The patients were reviewed with the mean follow-up of 16 months [range 6-30 months]. The mean duration of union was 4 months in 46 patients [95.8%]. Non-union was evident in 2 patients [4.2%]. Two patients [4.2%] developed delayed union, which was successfully united after re-operation by autogenous bone graft. One patient [2.1%] had wound infection. Metal failure occurred in the 2 non-union patients [4.2%]. Excellent and good clinical and radiological scoring was achieved in 41 patients [85.4%], fair in 5 [10.4%], and failure in 2 patients [4.2%]. Conclusions: We concluded that DHS and DCS are among the best fixation devices in the armamentarium for subtrochanteric fracture management. Although all the complications in our series occurred in the DCS group, with better clinical and radiological scoring in the DHS group, we could not conclude that DHS is better than DCS because more complex and unstable subtrochanteric fracture types were treated by DCS [8 patients with type B and 8 patients with type C, 69.6%], comparable to 19 patients with type A [76%] and only 6 patients [24%] in type B in the DHS group. The small number of patients in each group makes also the difference between them statistically insignificant

Baerveldt implant in glaucoma

In this study Baerveldt implants were applied for 9 eyes [2 neovascular glaucoma, 2 aphakic glaucoma, 5 eyes with previous failed conventional filtering surgery]. Intraocular pressure [IOP] equal or less than 21 mmHg was achieved in 7 eyes [77.7% success]. The mean IOP dropped from 32.1 mmHg preoperatively to 16.1 mmHg postoperatively. The implant proved to be effective in case of refractory glaucoma

Corneal endothelium after photorefractive keratectomy

This study included 30 eyes of 22 patients. They underwent excimer photorefractive keratectomy for the correction of myopic errors ranging from -2.0 to 6.0 diopters [mean 4.8]. The corneal endothelium was studied preoperatively, 3 and 9 months after the procedure. There was no statistically significant difference between the endothelial cell count before the procedure and 3 or 9 months later. Also, there was no change in cell morphology. This proves that excimer laser photokeratectomy for correction of myopic errors up to -6.0 causes no endothelial cell damage

Intraocular pressure after retrobulbar and peribulbar anesthesia

This study included 80 eyes planned for cataract extraction with or without lens implantation. They were classified into 4 groups [A, A1, B, and B1], each included 20 eyes. Groups A and A1 received retrobulbar anesthesia, while groups B and B1 received peribulbar anesthesia. In groups A and B the Honan balloon was applied for ten minutes after the injection of the anesthetic solution. The intraocular pressure was measured before, immediately after and 10 minutes after injection of the anesthesia. It was found that both techniques lead to elevation of the intraocular pressure which is more significant in case of peribulbar anesthesia. The application of the Honan balloon leads to significant lowering of intraocular pressure