“Stay Back Technique” of scleral fixation of decentred intraocular lensbag complex

Background: Even though rare, posterior chamber intraocular lens (IOL)?bag complex dislocation is a serious complication following cataract surgery. Preoperative trauma or zonular weakness, capsule contraction syndrome, and surgical or postoperative trauma to the zonules have been proposed as the causative mechanism. Various risk factors have been described such as pseudoexfoliation (PXF), aging, high myopia, uveitis, trauma, previous vitreoretinal surgery, retinitis pigmentosa, diabetes mellitus, and connective tissue disorders, among which PXF is the most common risk factor. The management of late IOL?bag complex dislocation poses a challenge even for an experienced surgeon. Purpose: To demonstrate the “stay back technique” of scleral fixation of decentered IOL?bag complex. Synopsis: We demonstrate three cases of scleral fixation of anteriorly dislocated IOL?bag complex. The first two cases are traumatic subluxation of IOL?bag complex and the third case is late decentration of both the haptics in a case of PXF. A scleral flap/groove is made along the area of haptic dislocation. Dislocated haptic is allowed to stay in the same position and one arm of 9?0 prolene suture is passed between the optic?haptic junction and docked in a 26?gauge needle passed beneath the scleral flap, 2 mm from the limbus. Haptic is then repositioned beneath the iris and the second arm of prolene suture is passed above the haptic. Sutures are pulled underneath the scleral flap and secured with 5 to 6 knots. Highlights: This is a simplified approach of scleral fixation of anteriorly dislocated IOL?bag complex. This novel technique gives better visualization of the optic?haptic junction during the passage of prolene suture

Complicación tardía por clips y cálculo, en paciente colesistectomisada / Late complication due to a clip and gallstone in a patient who underwent a cholecystectomy

RESUMEN Se presentó un caso con complicación tardía de una colecistectomía video-laparoscópica, cuatro años después de una colecistectomía laparoscópica. Se procedió a realizar la colangiopancreatografia retrograda endoscópica mediante la técnica convencional, por un especialista en Gastroenterología. Se procedió a realizar pre-corte papilar y se logró extraer el clip con pinza de biopsia. Se produjo la expulsión espontánea de un litio oscuro de aproximadamente 1 cm de diámetro (AU).

ABSTRACT We presented a case with late complication of a video-laparoscopic cholecystectomy, occurring four years after a laparoscopic cholecystectomy. A specialist in Gastroenterology carried out an endoscopic retrograde cholangiopancreatography using the conventional technique. A papillary pre-cut was done and the clip was extracted with biopsy clamp. A dark stone of around 1 cm of diameter was spontaneously passed (AU).

Adjuvant Radiotherapy Outcome of Stage I Testicular Seminoma: A Single Institution Study

PURPOSE: To analyze treatment outcome and side effects of adjuvant radiotherapy using radiotherapy fields and doses which have evolved over the last two decades in a single institution. MATERIALS AND METHODS: Forty-one patients received radiotherapy after orchiectomy from 1996 to 2007. At our institution, the treatment field for stage I seminoma has changed from dog-leg (DL) field prior to 2003 to paraaortic (PA) field after 2003. Fifteen patients were treated with the classic fractionation scheme of 25.5 Gy at 1.5 Gy per fraction. Other patients had been treated with modified schedules of 25.05 Gy at 1.67 Gy per fraction (n=15) and 25.2 Gy at 1.8 Gy per fraction (n=11). RESULTS: With a median follow-up of 112 months, the 5-year and 10-year survival rates were 100% and 96%, respectively, and 5-year and 10-year relapse-free survival rates were both 97.1%. No in-field recurrence occurred. Contralateral seminoma occurred in one patient 5 years after treatment. No grade III-IV acute toxicity occurred. An increased rate of grade 1-2 acute hematologic toxicity was found in patients with longer overall treatment times due to 1.5 Gy per fraction. The rate of grade 2 acute gastrointestinal toxicity was significantly higher with DL field than with PA field and also higher in the 1.8-Gy group than in the 1.5-Gy and 1.67-Gy groups. CONCLUSION: Patients with stage I seminoma were safely treated with PA-only radiotherapy with no pelvic failure. Optimal fractionation schedule needs to be explored further in order to minimize treatment-related toxicity.

Late Infection from Anterior Cervical Discectomy and Fusion after Twenty Years

Anterior cervical discectomy and fusion (ACDF) has been performed for degenerative and traumatic cervical diseases to improve pain and neurologic symptoms including sensory change and motor weakness. Infection, however, is a rare complication of ACDF, and late infection is even much rarer. We present a case of late Infection from ACDF C4-5 using Biocompatible Osteoconductive Polymer (BOP) after twenty years in the absence of an esophageal perforation, Zenker's diverticulum, or recent surgery or bacteremia. Late infection from ACDF after 20 years is extremely rare in the literature. However, possibility of such a late complication should be appreciated during the follow-up period and surgical resection will be required for proper treatment.

Late Mandibular Angle Fracture After Impacted Third Molar Extraction: Case Report and Review of Predisposing Factors / Fractura Tardía de Ángulo de Mandibula Post Extracción de Tercer Molar Impactado: Reporte de un Caso y Revisión de Factores Predisponentes

Third molar surgery is the most common surgical procedure in the oral cavity. Whenever extraction is indicated, careful planning based on clinical and radiographic examinations is essential to guard against postoperative complications like: bleeding, alveolitis, infections, injury to adjacent teeth, oroantral communications, or even mandibular fractures. Although rare, the risk of postoperative mandibular fractures after third molar impaction surgery is related to some factors. Our case report a 50-year-old white female patient with a complaint of pain in the region of the left mandibular angle and stated that three weeks before she had the left mandibular third molar extracted, which computerized tomographic confirmed the presence of a fracture in the mandibular angle. However, our report contributes to showing the predisposing factors to cause this injury after a review of the literature, showing the clinician what they should take like consideration when they indicate the extraction of third molars. To avoid this complication, factors like bony impaction, depth of tooth within bone, proximity to the inferior dental canal, tooth position in relation to adjacent teeth, the presence of root dilacerations and others must be taken into account. A case of late mandibular fracture that occurred 21 days after third molar extraction is reported. Conservative treatment was adopted and after six-months of radiographic and clinical follow-up, the patient had fully preserved mandibular function, normal occlusion and no discomfort.

Cirugía del tercer molar es el procedimiento quirúrgico más común en la cavidad oral. Cuando se indica la extracción, una cuidadosa planificación basada en los exámenes clínicos y radiográficos es esencial para evitar complicaciones postoperatorias como sangrado, alveolitis, infecciones, lesiones a los dientes adyacentes, comunicaciones oroantrales o incluso fracturas mandibulares. Aunque es raro, el riesgo de fracturas mandibulares postoperatorias después de la cirugía del tercer molar impactado se relaciona con algunos factores. Reportamos el caso de un paciente de 50 años de edad con queja de dolor en la región del ángulo mandibular izquierdo, quien y declaró que tres semanas antes se había extraído el tercer molar inferior izquierdo. Por tomografía computarizada se confirmó la presencia de una fractura en el ángulo mandibular. Este informe contribuye a mostrar los factores que predisponen para provocar esta lesión después de una revisión de la literatura, que muestran que el clínico los debería tener como consideración cuando indican la extracción de los terceros molares. Para evitar esta complicación, factores como el grado de impactación ósea, profundidad del diente en el hueso, proximidad al canal mandibular, posición en relación a dientes adyacentes, presencia de dilaceraciones radiculares, entre otras, deben ser tomadas en cuenta. Se presenta un caso de fractura mandibular tardía que ocurrió 21 días después de la extracción del tercer molar. Se realizó un tratamiento conservador y después de seis meses de seguimiento radiográfico y clínico, el paciente conservó completamente la función mandibular, con una oclusión normal y sin molestias.

Development of a Pseudoaneurysm of the Thoracic Aorta at the Cannulation Site : Our Experience with Three Cases / 日本心臓血管外科学会雑誌

A pseudoaneurysm of the thoracic aorta after cardiac surgery is a rare complication, but can be life-threatening when it is ruptured. The pseudoaneurysm itself presents no symptoms in many cases, or may be similar to an atherosclerotic aortic aneurysm. Therefore, it is usually found incidently during imaging studies. We encountered 3 cases of pseudoaneurysm of the thoracic aorta that developed during the long-term follow-up after congenital cardiac surgery. None of the patients experienced specific symptoms associated with the pseudoaneurysm, and were diagnosed by chest roentgenograms and computed tomography. Most patients who undergo surgery for congenital heart defects as adolescents are free from medical treatment, and do not regularly see a doctor after the surgery. It is important to consider the possibility of a pseudoaneurysm in patients having a history of cardiac surgery.

Late Complications and Stone Recurrence Rates after Bile Duct Stone Removal by Endoscopic Sphincterotomy and Large Balloon Dilation are Similar to Those after Endoscopic Sphincterotomy Alone

BACKGROUND/AIMS: Between endoscopic sphincterotomy (ES) alone and combined endoscopic sphincterotomy and large balloon dilation (ES-LBD) groups, efficacy and long-term complications, difference in biliary stone recurrence rate, and risk factors of stone recurrence were compared. METHODS: Medical records of 222 patients who underwent ERCP for biliary stone removal were retrospectively reviewed. Patients with dilated CBD > or =11 mm and follow-up longer than 6 months were included. RESULTS: There were 101 patients in ES-LBD group and 121 patients in ES group. Mean follow-up duration was 25.0 (6-48) months and 13.0 (6-43) months, respectively (p=0.001). There was no difference in number of ERCP sessions, brown pigment stones, angle between mid and distal common bile duct (CBD angle) <135degrees, and lithotripsy rate. Complete retrieval success rate was excellent in both groups (100% vs. 99%). Early complication rate of ES-LBD and ES alone group was 4 and 4.1%, respectively (p=1.000). One patient in ES-LBD group died from delayed bleeding. Late complication rate was 5.9 and 3.3%, respectively (p=1.000). Stone recurrence rate was 6.9% and 5.8%, respectively (p=0.984). The only Independent risk factor of stone recurrence was presence of periampullary diverticulum. CONCLUSIONS: Late complication and stone recurrence rates were similar between ES-LBD and ES alone groups.

Multiple stone formation in a remnant choledochal cyst / 대한내과학회지

The recommended surgical method for treating congenital biliary dilation is excision of the entire extrahepatic bile duct, with a hepaticoenterostomy to stop reflux and stasis of pancreatic secretions in the gallbladder and dilated bile duct. Late complications of surgical treatment include anastomotic strictures, cholangitis, and stone formation in the intrahepatic bile ducts. This report describes a very rare late complication, in which protein stones formed in a remnant choledochal cyst in the pancreas 23 years after resection of a congenital choledochal cyst. Our case highlights the necessity for complete cyst resection as close as possible to the portion buried in the pancreatic bed at the time of primary choledochal cyst resection.

Development of 'De novo' Aneurysm after Therapeutic Carotid Occlusion

Carotid occlusion is an inevitable therapeutic modality for the treatment of complex aneurysms such as giant, traumatic, and intracavernous aneurysms. Late complications of carotid occlusion include 'de novo' aneurysm formation at a distant site because of hemodynamic changes in the circle of Willis. We report a case of de novo aneurysm in a vessel that appeared to be normal on initial angiography. The patient developed an anterior communicating artery aneurysm and marked growth of a basilar bifurcation aneurysm 9 years after trapping of the left internal carotid artery for the treatment of a ruptured large saccular aneurysm involving ophthalmic and cavernous segments. We propose that patients who undergo therapeutic carotid occlusion should be periodically followed by magnetic resonance angiography or computed tomographic angiography to evaluate the possibility of de novo aneurysm formation; this advice is in line with previous reports.

Long term prognosis of patients who had a Fontan operation / 소아과

PURPOSE: This study assessed the long term survival rate and long term complications of patients who had a modified Fontan operation for functionally univentricular cardiac anomaly. METHODS: Between June 1986 and December 2000, 302 patients with a functional single ventricle underwent surgical interventions and were followed up until February 2006. The mean follow-up period was 8.3+/-5.3 years (range 3.5-18 years). Their median age was 2.4 years at the Fontan operation. The survival rate, the incidence and the risk factor of late complications were evaluated retrospectively. RESULTS: The verall survival rate was 91 percent at 5 years and 87 percent at 10 years. In multivariate analysis, early calendar year of operation and significant regurgitation were risk factors of death. The surviving patients showed NYHA functional class I in 82 percent, class II in 15 percent, and class III in 3 percent. Redo Fontan operations were necessary in 8.8 percent of patients at average 12.8+/-3.6 years after initial Fontan operation. The most common cause of Fontan conversion was atrial arrhythmia. The incidence of thromboembolic events was 9.3% and these complications were associated with the occurrence of atrial tachyarrhythmia. Supraventricular tachycardia including atrial flutter or fibrillation were reported on the follow-up examination by 11.2 percent of survivors after 8.4+/-5.6 years. Atriopulmonary connection showed higher rates of late tachycardia than lateral tunnel operation. CONCLUSIONS: This study revealed that the recent survival rate of Fontan type operation was satisfactory, but the occurrence of late complications after a Fontan type operation increased with the longer survival. There is a need for strict follow up and early treatment of late complications in patients who had a Fontan operation.

Comparison of the results between two radiotherapeutic methods for cervical cancer patients / 中国癌症杂志

Purpose:To evaluate two different methods of radiotherapy, which affect the results of cervical cancers treated and complications of the rectum or bladder. Methods:From July 1991 to December 1996, 124 cases of cervical cancer were randomly allocated into two groups. Group A (59 cases:stage Ⅰ 1, Ⅱa 12, Ⅱb 30, Ⅲa 11, Ⅲb 5) received 45—55 Gy of external radiation(ER) to the parametrium and 50—65 Gy of intracavitary irradiation (4—5 Gy per fraction, 2 fractions per week). Group B(65 cases: stage Ⅰ 2, Ⅱa 15, Ⅱb 29, Ⅲa 10, Ⅲb 9) received 26—40 Gy ER to the whole pelvic and 30—40 Gy of intracavitary irradiation (4—5 Gy per fraction, 2 fractions per week), an additional 15—29 Gy ER to the parametrium. Results:In group A, 3 year and 5 year survival rates were 81.4% and 71.7%. In group B, they were 84.6% and 70.8%. The rates of complication for the rectum were 25.4%(3 year) and 21.7%(5 year) in group A, 10.8%(3 year) and 8.3%(5 year) in group B. The rates of rectal complication( P

Comparison of long-term results in three types of fraction radiotherapy for nasopharyngeal carcinoma / 解放军医学杂志

0.05). However, the 5-year local control rate appeared significantly different in three groups (?~2=7.239, P0.05). The 1-,3-,and 5-year disease-free survival rate among three groups were significantly different in the three groups (79.1%, 41.9% and 35.6% for CFR group, 85.7%, 57.1% and 38.1% for FHR group, and 95.4%, 62.8% and 58.1% for LAHR group) (?~2=6.60,P0.05). The incidence of loss of hearing, the radiation-induced temporomandibular joint lesion, and the radiation-induced brain injury was 31.3%, 41.9% and 9.3% in CFR group, and 25.0%, 35.7% and 7.1% in FRH group, and 22.7%, 35.7% and 7.0% in LAHR group, respectively. Conclusion A better 5-year local control rate and disease-free survival rate were achieved in patients in LAHR and FHR groups than those in CFR group. There are no differences in the incidence of late complications and overall survival rate among three groups.

APPRAISAL OF THE ROLE OF PROPHYLACTIC CRANIAL IRRADIATION IN MULTIMODALITY MANAGEMENT FOR SMALL CELL LUNG CANCER / 中华放射肿瘤学杂志

The value of prophylactic cranial irradiation (PCI) for small cell lung cancer (SCLC) remains controversial. From Nov.1987 to Jan. 1993, thirty-one patients with small cell lung cancer received PCI. PCI was given for complete remission SCLC patients after chemotherapy and chest radiotherapy. The total dose of PCI was 40Gy in 26 cases, 30～

The Late Complications of Prosthetic Replacement for the Femoral Neck Fractures / 대한정형외과학회잡지

The displaced femoral neck fractures remain a major challenge to orthopaedic surgeons as the elderly population is increasing. Successful union by internal fixation after adequate reduction without avascular necrosis is primary goal since the functional results having own femoral head are much superior to those having prosthetic femoral head, but prosthetic replacement is indicated for some patients with fresh fractures who need early ambulation as well as neglected fractures and failed internal fixations. The early result after prosthetic replacement was known to be very satisfactory but the late complications are becomming the major problem. Authors reviewed 21 cases of the prosthetic replacements for the femoral neck fractures which were followed for more than one year and managed at Fatima Hospital during the years between 1975-1984 and the following results were obtained. 1. The cases were 8 males and 13 females having ages from 42 to 87 years with average 69 years old. 2. The cases were 11 elderly fresh fractures, 6 neglected fractures, 2 failed osteosynthesis and 2 others. 3. Moore and Thompson prosthesis were used and 13 of them were fixed with bone cement. 4. The early result evaluated at 3 months after surgery revealed satisfactory in 90% but the final result at average 3 years and 5 months ranging from 1 year to 6 years and 2 months revealed satisfactory results in 58% 5. There was no significant early post-operative complications. 6. The late complications were 8 cases of acetabular erosions and these were combined with stem loosening in 2, subsidence in 2 and deep infection in 1 case. 7. The late complications started to reveal at about 3 years after surgery and occurred in younger and active patient. 8. The prosthetic replacement for femoral neck fracture is recommended for the inactive patient or the patient with expected activity less than 3 years.