No significant retinal damage induced by major orthopedic surgery - a pilot study.

BACKGROUND: Perioperative visual loss is one of the rare but devastating complications of anesthesia and surgery. The incidence of less severe or even subclinical postoperative visual dysfunction is unknown. Therefore, we decided to perform a pilot prospective observational clinical study to evaluate whether structural changes of the retina can be detected in patients undergoing elective orthopaedic surgery by optical coherence tomography (OCT). METHODS: Adult patients indicated for elective knee replacement surgery with the absence of known retinal or optic nerve disease were included. Each patient underwent baseline OCT examination of the eyes one day before surgery and it was repeated 4-7 days after the surgery. The surgery was done under general and epidural anesthesia. RESULTS: A total of 18 patients (6 men and 12 women) at the age of 70.8±7.1 years were enrolled. We found statistically significant changes in the Macular central thickness and in a few areas of the Retinal Nerve Fiber Layer between the baseline and postoperative measurements. CONCLUSIONS: Even though we found significant changes in some parameters, we did not confirm that general anesthesia and/or surgical damage causes significant damage of the retina using OCT measurement. TRIAL REGISTRATION: ClinicalTrials.gov (NCT04311801).

Lung Point Sign in Ultrasound Diagnostics of Pneumothorax: Imitations and Variants.

BACKGROUND: Pulmonary ultrasound plays a key role in the diagnosis of pneumothorax in emergency and intensive-care medicine. The lung point sign has been generally considered a pathognomonic diagnostic sign. Recently, several other situations have been published that can mimic the lung point, as well as a few different variants of the true lung point sign. MATERIALS AND METHODS: Based on years of monitoring the literature and collecting our database of ultrasound findings, we prepared a review of ultrasound findings mimicking the lung point sign and ultrasound variants of the true lung point sign. RESULTS: We present four imitations of the lung point sign (physiological lung point sign, pseudo-lung point sign, bleb point sign, and pleurofascial point sign) and two variants of the true lung point sign (double lung point sign and hydro point sign) documented by images and video records. CONCLUSIONS: Knowledge of ultrasound imitations and variants of the lung point sign may increase the reliability of pneumothorax diagnosis and may reduce the risk of performing unindicated interventions.

Subcostal TAPSE measured by anatomical M-mode: prospective reliability clinical study in critically ill patients.

BACKGROUND: Tricuspid annular plane systolic excursion (TAPSE), evaluated from a four-chamber apical view, is an echocardiographic parameter for the detection of right ventricular systolic dysfunction (RVD). We decided to assess the reliability of TAPSE measured from subcostal view (sTAPSE) by anatomical M-mode imaging (AMM) for evaluation of right ventricular systolic function and prediction of RVD in the critically ill patients by comparison with other echocardiographic parameters. METHODS: We conducted an observational, prospective clinical study in 100 patients hospitalized in the intensive care unit. TAPSE, doppler tissue imaging-derived tricuspid lateral annular systolic velocity (DTI-S' wave), two-dimensional fraction area change (2D FAC) and DTI-right ventricular index of myocardial performance (DTI-RIMP) were measured by transthoracic echocardiography. A subcostal four-chamber view was recorded for sTAPSE measurement. For that purpose, the cursor of AMM was aligned along the direction of the tricuspid lateral annulus movement and the amplitude of the movement was measured. RESULTS: In a group of patients aged 64±16 years with a 31% prevalence of RVD we identified strong correlation between TAPSE and sTAPSE (r=0.963, P<0.001). sTAPSE correlated well with other measures of right ventricular systolic function (DTI-S' wave: r=0.765; 2D FAC: r=0.701; DTI-RIMP: r=-0.661, P<0.001, respectively). The value of sTAPSE ≤15 mm predicted the presence of RVD defined by TAPSE with a sensitivity of 94.7% and specificity of 100.0%. CONCLUSIONS: The sTAPSE measured by AMM in a population of critically ill patients has been found to be a reliable parameter of right ventricular systolic function and predicted RVD with high reliability.