Conjunctival Hypertrophic Scar Following Cryotherapy for Retinopathy of Prematurity

A 6-year-old boy was referred to our hospital with symblepharon and lateral canthal deformity in both eyes, which developed 6 years ago. The patient was born at 27 weeks gestation. He had received cryotherapy for retinopathy of prematurity. One month after cryotherapy, he developed a conjunctival scar with symblepharon in both eyes and underwent symblepharon lysis at another hospital 5 years prior. Ocular examination revealed an extensive conjunctival hypertrophic scar with symblepharon and limitation of extraocular movements. An excisional biopsy, lateral canthoplasty, and symblepharon lysis with conjunctival autograft from the contralateral eye were performed in the left eye. Histopathologic examination revealed diffuse proliferation and infiltration of collagenous tissue.

Avaliação da sensibilidade cutânea palmar nas aplicações de crioterapia por bolsa de gelo e bolsa de gel / Evaluation of the cutaneous sensibility palmar in the cryotherapy applications for ice packs and gel packs

A crioterapia é muito utilizada nas afecções traumáticas, principalmente, nas lesões músculos-esqueléticas. Entretanto, se aplicada de forma incorreta, sem conhecimento dos fenômenos neuro-fisiológicos, musculares e vasculares, poderá trazer conseqüências indesejáveis, interferindo diretamente na qualidade do tratamento. Esse estudo teve como objetivo verificar se existe alteração da sensibilidade cutânea nas aplicações de bolsa de gelo e bolsa de gel e qual sua magnitude, comparando-as entre si para verificar se poderia, diante destas circunstâncias, ocorrer interferências significativas nas aplicações das terapias combinadas. Realizou-se uma série de casos com uma amostra de vinte voluntários que recebiam as duas formas de aplicação de crioterapia, uma logo após a outra. A aplicação da modalidade durava vinte e cinco minutos, sendo que a sensibilidade cutânea foi aferida antes, durante e depois da aplicação, utilizando-se os monofilamentos de Semmes-Weinstein. Os resultados revelaram uma alteração significativa da sensibilidade cutânea com a diminuição da temperatura, desta forma a bolsa de gelo obteve uma maior alteração da sensibilidade do que a bolsa de gel. Concluímos que a associação da crioterapia com qualquer outra terapia que necessite da sensibilidade preservada é contra-indicada. No entanto, cinco minutos após a retirada da modalidade fria, observou-se que podemos aplicar qualquer técnica sem perigo.

Cryotherapy is very used in the treatment of traumatism, mostly in the muscle-skeleton lesions. However, if applied without neuro-physiological, muscular and vascular knowledge, it may bring unwanted consequences which may directly chip in the quality of the treatment. The present study aimed to checkthe existence of alteration in the cutaneous sensibility with the application of ice packs and gel packs andto check in which extent it should be applied. A comparison among these techniques was done to check if there could be significant interferences in the application of combined therapies in these circumstances. A cases series was done with a sample of twenty volunteers which received both forms of cryotherapy one just after the other. The application was done for a period of twenty-five minutes and the skin sensibility was checked before, during and after the application, using Semmes-Weinstein monofilaments. The results revealed a significant alteration in the cutaneous sensibility with the decrease of temperature. The ice pack had a greater alteration of sensibility than the gel pack. The conclusion was that the association of cryotherapy with any other therapy that needs to preserve skin sensibility is not recommended. However, five minutes after the application of the cold therapy was observed that any technique may be applied without danger.

Titrated cyclocryopexy - a report on long term results

To determine the efficacy and safety of a titrated cyclocryopexy in advanced glaucomatous eyes in term of intraocular pressure control and complications. Retrospective Cohort analysis of a titrated cyclocryopexy in 30 eyes of 25 patients with uncontrolled glaucoma during July 1996 to July 2003 at Hayatabad Medical Complex, Peshawar. Inclusion criteria applied was; patients having uncontrolled IOP with maximum medical therapy, previous trabeculectomy and a minimum follow-up of 2 years. All patients were assessed for glaucoma. Numbers of cryoapplications were determined according to the IOP. Four to 12 applications in one sitting were used. Repeat cryoapplication were applied at least after six-weeks of previous therapy if IOP was not controlled. A total of 30 eyes of 25 patients were studied. IOP control of less than 21 mm Hg was achieved in 83% of the eyes. Mean IOP was reduced from 29 ' 4.96 pre-op to 17 ' 7.36 at two years follow-up. Forty percent of the eyes ne eded single session, 40% received 2 sessions and other 20% needed sessions. All the patients lost at least one line of Snellen chart at 2 years follow-up, 70% retained useful vision, 20% retained light perception and 10% lost perception of light. Serious complications included phthisis, persistent vitreous hemorrhage with retinal detachment, and total retinal detachment and persistent vitreous hemorrhage in 1 eye each. Cyclocryopexy appears to be an effective procedure in cases of advanced glaucoma with an acceptable risk / benefit ratio. If done in a titrated manner the number of complications are reduced in severity

Extraocular muscle changes after cryotherapy for retinopathy of prematurity and the development of strabismus in premature infants

To find out whether the cryotherapy for the treatment of the retinopathy of prematurity (ROP) causes structural changes of the extraocular muscle (EOM), and also whether the changes are related with the occurrence of strabismus. To examine the acute stage change, we conducted a transconjunctival cryotherapy around the superior rectus muscle of a rabbit and resected it 0, 3, 7, 14, and 28 days after the cryotherapy. In observing chronic changes, we first categorized patients who had an esotropia surgery into groups, one of which combined prematurity and cryotherapy and one group affected by prematurity but without having had cryotherapy. Then we compared the change of EOM with that of a fullterm infant group. In a rabbit, edema, acute inflammatory cells and a large amount of degenerated muscle fibers were observed immediately after the cryotherapy and on the 3rd day. On the 7th day, regenerated muscle fibers were observed and on the 14th day, the inflammatory cells decreased and the amount of regenerated muscle fiber increased. On the 28th day, abnormal findings were not observed any more and the muscle was found to be normal. When chronic changes of EOM in human on 1 1/2 to 8 1/2 years after cryotherapy, there were no abnormal findings observed in three groups. From the study, we can infer that cryotherapy can cause acute inflammation and necrosis of muscle fiber but such an acute change will improve and does not result in structural change in the long term. Therefore, the occurrence of strabismus in patients with ROP is considered to be attributable to reasons other than injury of EOM.

Actualización de la enfermedad hemorroidaria / Current concepts on haemorroidal disease

1. Las hemorroides y la enfermedad hemorroidal son dos entidades distintas: las primeras son componentes normales del cuerpo humano no requiriendo, por consiguiente, tratamiento y la segunda lo necesitará en algún momento de su evolución de acuerdo a la magnitud de los síntomas que produzca. 2. El cirujano debe tener un claro conocimiento de la anatomía quirúrgica de la región. 3. Las hemorroides internas, ubicadas en la submucosa, están constituídas por un tejido altamente vascularizado, sinusoides venosos dentro de los cuales se vacían directamente pequeñas arteriolas (fístulas arteriovenosas), músculo liso, tejido conectivo elástico y colágeno. 4. Las hemorroides externas son venas recubiertas por el anodermo y están expuestas a las mismas complicaciones que sufren otras venas situadas en distintas regiones del organismo. 5. Las almohadillas anales son espesamientos de la submucosa dentro de las cuales se encuentra el paquete hemorroidal interno, están ancladas por fibras de tejido conectivo al esfínter interno del ano y al músculo longitudinal o interesfintérico del mismo; cumplen una función especializada manteniendo la continencia al completar el cierre del canal anal. 6. Es difícil conocer la real prevalencia de la enfermedad hemorroidal, variando los porcentajes según los estudios encontrándose entre el 63.3 por ciento y el 82.2 por ciento cuando el estudio se basa en el examen proctológico y entre el 2.8 por ciento y el 21.2 por ciento si se utiliza un cuestionario. 7. La etiología de la enfermedad no está aclarada aceptándose que la constitución y la herencia son factores predisponentes; los desencadenantes serían el modo de vida (ocupación, hábitos alimentarios, actividad física, etc.), los embarazos, toma de anticonceptivos, obesidad y ciertos trastornos metabólicos. 8. Hay estudios que demuestran que la diarrea y no la constipación es el factor etiológico de más peso en el desarrollo de la enfermedad. Actualmente se admite que en los pacientes con hipertensión portal no está aumentada la prevalencia de la enfermedad hemorroidal. 9. No se ha aclarado aún si una disfunción primaria del esfínter interno desempeña o no un papel fisiopatológico en el origen de las hemorroides. 10. Las teorías patogénicas actuales pueden reunirse en dos: a)la mecánica, según la cual se produce un desplazamiento hacia abajo del plexo hemorroidal debido a la degeneración y fragmentación progresiva de los elementos de sostén de la mucosa y submucosa del canal...

Paresia del nervio peróneo inducida por crioterapia / Lateral poplitea here palsy due to cryotherapy

Se presenta el caso de un paciente que cursó con una parálisis temporal del nervio ciático poplíteo externo debido al uso de crioterapia con sistema CRYO-CUFFmr en el postoperatorio de una osteosíntesis de platillo tibial

Métodos no quirúrgicos en el tratamiento de las hemorroides : crioterapia / Non surgical methods in the treatment of hemorrhoids : cryotherapy

En forma prospectiva se randomizaron dos grupos de pacientes con hemorroides sintomáticas para ser tratados por crioterapia (76) y cirugía (66). La crioterapia mostró una mayor prolongación del dolor postratamiento (7 días o más), acentuado edema (92,1 por ciento) y hemorragia (11,84 por ciento) con respecto a la cirugía (2 o 3 días, 27,27 y 1,5 por ciento respectivamente). También fueron mayores las fístulas anales postoperatorias (9,2 vs. 1,5 por ciento), las fístulas anales (21,05 vs. 7,57 por ciento) y las recidivas y secuelas (6,5 y 13,15 por ciento vs. O y 7,57 por ciento). En base a estos resultados se considera a la crioterapia como un método terapéutico no ideal para las hemorroides.

Crioterapia: por que sua aplicaçäo na fase aguda / Criotherapy: why your utilization in the acute phase

O presente artigo visa expor informaçöes sobre a utlizaçäo da crioterapia principalmente na fase aguda do trauma. Observou-se que, em funçäo das alteraçöes fisiológicas provocadas pela crioterapia, tais como vasoconstriçäo e diminuiçäo do metabolismo, os quais promovem reduçäo do edema e da hipóxia secundária ocorridos na lesäo primária, seus melhores resultados se fazem presentes quando esta é aplicada na fase aguda do traumatismo. Evitando, desta forma, que a lesäo se complique, favorecendo a mobilizaçäo precose e a reabilitaçäo

Tratamiento de las hemorroides por crioterapia / Treatment of hemorrhoids by cryotherapy

El autor examina 150 pacientes tratados por crioterapia para evaluar los resultados inmediatos y a largo plazo. El estudio incluyó 92 hombres y 58 mujeres. La edad media fue de 48 años. Tenían hemorroides de primer grado el 55 por ciento; el 30 por ciento de segundo grado y el 15 por ciento restante de tercer grado. Se analiza la técnica empleada y los efectos producidos en los tejidos por la aplicación de la crioterapia. Los reultados obtenidos muestran que el procedimiento produce dolor severo en el 40 por ciento de los casos, moderado en el 35 por ciento, leve en el 20 por ciento y sólo el 5 por ciento no tuvo dolor postoperatorio. Existió un drenaje serosanguinolento que produjo molestia a los pacientes durante 3 a 6 semanas. El 25 por ciento tuvo plicomas. El 5 por ciento hizo retención urinaria. La curación de las heridas demoró de 3 a 6 semanas. El control a los siete años de operados mostró un 45 por ciento de recidivas y este porcentaje se elevó al 70 por ciento a los quince años. De los resultados obtenidos se concluye que la crioterapia es un procedimiento alternativo para tratar las hemorroides sólo cuando se le asocia a las ligaduras elásticas.