ABSTRACT
We describe 2 case reports of keratoconus patients showing Descemet's folds persisting more than 2 years after deep anterior lamellar keratoplasty (DLK). One patient had worse best corrected visual acuity postoperatively whereas the other did not improve beyond 6/24. We attribute this to the Descemet's folds. We believe the latter to be a complication following DLK consequent to the degree of localised corneal tissue expansion that may occur in advanced keratoconus in a pathological setting. We also discuss possible mechanisms to try to prevent such a complication.
Subject(s)
Anterior Eye Segment/injuries , Anterior Eye Segment/surgery , Descemet Stripping Endothelial Keratoplasty/adverse effects , Vision Disorders/diagnosis , Vision Disorders/etiology , Adult , Humans , Male , Treatment OutcomeABSTRACT
A retrospective study was undertaken of the different treatment modalities for bladder tumours under the care of 3 consultants in the urology department of a district general hospital. The aim was to review the results of the various forms of treatment. In all, 261 patients' case records were reviewed and 19 variables extracted. There was an average delay of 4.2 months from the onset of symptoms to the initial cystoscopy. Over 50% of high grade tumours were invasive on initial presentation (G3T2/G3T3). A range of treatments for the more aggressive tumours was adopted by the urologists, ranging from a conservative resection (TURBT) to an aggressive approach (cystourethrectomy) at the earliest sign of progression. A strong association between aggressive treatment and higher survival was noted. This study has proved valuable in demonstrating to the urology team the value of routine audit and questioning "established" surgical practice. As a result, a more standard regime for the treatment of bladder tumours has been advocated and a prospective randomised controlled trial will be introduced.
Subject(s)
Medical Audit/methods , Treatment Outcome , Urinary Bladder Neoplasms/surgery , Adult , Age Factors , Aged , Cystectomy , Cystoscopy , England , Humans , Middle Aged , Palliative Care/methods , Prognosis , Retrospective Studies , Time Factors , Urinary Bladder Neoplasms/pathology , Urinary Bladder Neoplasms/radiotherapyABSTRACT
A prospective study was made of 40 consecutive patients who presented with peripheral arterial embolism to the Vascular Surgical Service in UKM. Atrial fibrillation was the most common source of the embolus. Twelve patients did not present until the affected limb(s) were in established gangrene. Thirty-two embolectomies were performed on 25 patients. Only 10 of these patients were discharged well with their limbs intact. Four patients required amputation because embolectomy did not restore viability of the limbs. Eleven patients died following embolectomy. The overall mortality for arterial embolism was 50%. Among the survival (n = 20), only 11 patients were discharged with their limbs intact. The cause of the poor result was related to the delay in definitive treatment and the poor general state of the patients. It was concluded that the prognosis for arterial embolism was very poor. This result needs to be improved and recommendations are made to achieve this.