Comparison of subretinal aflibercept vs ranibizumab vs bevacizumab in the context of PPV, pneumatic displacement with subretinal air and subretinal tPA in naïve submacular haemorrhage secondary to nAMD. "The Submarine Study".

OBJECTIVE: To compare efficacy and safety profile of subretinal aflibercept, ranibizumab, and bevacizumab in the context of pars plana vitrectomy, pneumatic displacement with subretinal air and subretinal tPA for subretinal macular haemorrhage (SMH) due to naïve neovascular age-related macular degeneration (nAMD). DESIGN: Retrospective interventional cohort study. PARTICIPANTS: 123 eyes of 123 patients treated with subretinal aflibercept (n = 41, 33%), ranibizumab (n = 41,33%), and bevacizumab (n = 41, 33%). METHODS: Review of electronic medical records for best corrected visual acuity (BCVA), central subfoveal thickness (CST), and intraocular pressure (IOP) at baseline and 24 months after treatment. MAIN OUTCOME MEASURES: BCVA, CST, and number of intravitreal anti VEGF over 24 months. RESULTS: Mean age of patients was 80.5 ± 5.5 years, 43.9% were female. Mean time from symptom onset until surgery was 1.1 days (range 0-3 days). In all cases, the SMH did not reach the arcades. CST at baseline was 627 ± 140 µ, 739 ± 54 µ, and 793 ± 93 µ (p = 0.0001) for aflibercept, ranibizumab, or bevacizumab, respectively. Baseline BCVA (logMAR) was 0.65 ± 0.13, 0.69 ± 0.96, and 0.74 ± 0.81 (p = 0.0041) for aflibercept, ranibizumab, and bevacizumab, respectively. All three groups showed statistically significant improvement in BCVA and CST (for all groups: p < 0.001). There was no statistically significant difference at the final BCVA (p = 0.789). The mean number of anti VEGF given during follow-up period was 5.2 ± 0.81, 4.4 ± 0.63, and 5.5 ± 0.95 (p = 0.0001) for aflibercept, ranibizumab, and bevacizumab, respectively. CONCLUSION: This study shows that aflibercept, ranibizumab, and bevacizumab in a subretinal manner in the context of PPV, pneumatic displacement with subretinal air and subretinal tPA for subretinal macular haemorrhage secondary to naïve nAMD work with the same efficacy and safety profile.

Naïve subretinal haemorrhage due to neovascular age-related macular degeneration. pneumatic displacement, subretinal air, and tissue plasminogen activator: subretinal vs intravitreal aflibercept-the native study.

OBJECTIVE: We aimed to compare visual and anatomical outcome in subretinal aflibercept vs. intravitreal aflibercept in the context of Pars Plana Vitrectomy (PPV), pneumatic displacement with subretinal air and subretinal tPA in patients with naïve submacular haemorrhage (SMH) secondary to neovascular age-related macular degeneration (nAMD). DESIGN: Retrospective interventional cohort study. PARTICIPANTS: 80 patients treated with subretinal aflibercept vs. intravitreal aflibercept in the context of PPV, subretinal air and subretinal tPA in patients with SMH secondary to naïve nAMD. METHODS: Records were reviewed. Best corrected visual acuity (BCVA), central subfoveal thickness (CST), and intraocular pressure (IOP) were recorded at baseline and 24 months after treatment. MAIN OUTCOME MEASURES: BCVA, CST, and number of anti VEGF treatment over follow-up period. RESULTS: The average duration from onset of symptoms to surgery was 1.26 days (range 0-3 days). Based on review of OCT images, SMH was subretinal in all 80 patients (100%), and sub-RPE in 29 patients (36.3%). Forty-one patients (51.25%) were treated with subretinal aflibercept ("subretinal group"), and 39 patients (48.75%) were treated with intravitreal aflibercept injections ("intravitreal group"). The groups were well balanced for age and gender p = 0.6588, and p = 0.263, respectively). Both groups showed statistically significant improvement in BCVA and CST (for all groups: p < 0.001). The mean number of anti VEGF given during follow-up period was statistically significantly lower in the "subretinal group" (p < 0.0001). CONCLUSION: This study shows better management of the CNV, with a statistically significant lower need for anti-VEGF injections when treated with subretinal aflibercept compared to intravitreal application.

[Subcapsular hepatic hematoma after endoscopic retrograde cholangiopancreatography: a case report and review of the literature]. / Hematoma subcapsular hepático posterior a colangiopancreatografía retrógrada endoscópica. Reporte de caso y revisión de la literatura.

Endoscopic retrograde cholangiopancreatography (ERCP) is currently considered a diagnostic and therapeutic procedure in obstructive lesions of the biliary tract, especially choledocholithiasis and stenosis, as well as in pancreatic diseases in general. However, it is known the development of certain complications such as acute pancreatitis, acute cholangitis, cholecystitis among others of lower incidence within which the hepatic subcapsular hematoma takes relevance due to its high mortality. We present the case of a 52-year-old male patient who three hours after undergoing ERCP develops abdominal pain of sudden onset with significant reduction of hematocrit, and imaging study shows a hepatic subcapsular hematoma. He was initially managed conservatively and then proceeded to a percutaneous drainage, subsequently showing residual descending contents by radiological follow-up.

Hematoma subcapsular hepático posterior a colangiopancreatografía retrógrada endoscópica. Reporte de caso y revisión de la literatura / Subcapsular hepatic hematoma after endoscopic retrograde cholangiopancreatography: a case report and review of the literature

RESUMEN La colangiopancreatografía retrógrada endoscópica (CPRE) es considerado actualmente un procedimiento diagnóstico y terapéutico en lesiones obstructivas del tracto biliar sobretodo coledocolitiasis y estenosis, así como en enfermedades pancreáticas en general. Sin embargo, es conocido el desarrollo de ciertas complicaciones tales como pancreatitis aguda, colangitis aguda, colecistitis entre otras de menor incidencia dentro de las cuales el hematoma subcapsular hepático toma relevancia por su elevada mortalidad. Presentamos el caso de un paciente varón de 52 años que luego de tres horas de ser sometido a CPRE desarrolla dolor abdominal de inicio repentino con reducción importante del hematocrito, y mediante estudio de imágenes se evidencia un hematoma subcapsular hepático. Es manejado inicialmente de forma conservadora y luego se procede a un drenaje percutáneo, evidenciándose posteriormente contenidos residuales en descenso mediante seguimiento radiológico.

ABSTRACT Endoscopic retrograde cholangiopancreatography (ERCP) is currently considered a diagnostic and therapeutic procedure in obstructive lesions of the biliary tract, especially choledocholithiasis and stenosis, as well as in pancreatic diseases in general. However, it is known the development of certain complications such as acute pancreatitis, acute cholangitis, cholecystitis among others of lower incidence within which the hepatic subcapsular hematoma takes relevance due to its high mortality. We present the case of a 52-year-old male patient who three hours after undergoing ERCP develops abdominal pain of sudden onset with significant reduction of hematocrit, and imaging study shows a hepatic subcapsular hematoma. He was initially managed conservatively and then proceeded to a percutaneous drainage, subsequently showing residual descending contents by radiological follow-up.

High-Definition Liposculpture: What are the Complications and How to Manage Them?

BACKGROUND: High-definition liposculpture is a novel surgical technique widely accepted among plastic surgeons. The aim of this article is to describe surgical outcomes with a special emphasis on complications in high-definition liposculpture patients. METHODS: An historical cohort of patients who underwent high-definition liposculpture from two senior surgeons was reviewed. Technique, patient selection criteria, preoperative marks and surgical outcomes are described. Postoperative complications are discussed. RESULTS: A total of 417 patients underwent high-definition liposculpture between 2015 and 2018. Primary liposuction and secondary liposuction were performed in 308 (74%) and 109 (26%), respectively. Combined surgeries were performed in 121 cases (29%). There were no systemic complications. Local complications included hyperpigmentation (n = 276), seroma (n = 125), nodular fibrosis (n = 83), unsatisfactory definition in superficial liposuction areas (n = 16), unnatural appearance of body contour (n = 17), VASER-related burns (n = 3) and Mondor's syndrome (n = 2). Most patients (94%) were satisfied with the results. CONCLUSION: High-definition liposculpture is a body contouring technique that has shown excellent results. Despite non-serious complications were frequent, most complications were local and safely treated without affecting surgical outcome. To know these complications will help to recognize them earlier and to adjust patient expectation about the postoperative period. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Winged Ribs: An Underestimated Problem That May Compromise Breast Augmentation Outcomes.

Chest wall shape is an important aspect to consider when planning a breast augmentation. Minor chest wall deformities are usually underestimated by the patient and surgeon and may compromise postoperative outcomes. Lower costal cartilage dysmorphia or winged rib is one of these minor underestimated chest wall deformities characterized by a visible and palpable cartilaginous prominence under the inframammary fold and causes discomfort in patients decreasing the satisfaction with the breast augmentation surgery. For these patients, the author utilized an innovative surgical technique that allows resection of the protruding cartilages and placement of breast implants through the same surgical incision. Six patients with winged ribs underwent breast augmentation and costal cartilage resection via this method and there were no intraoperative or early postoperative complications, and all patients were satisfied with the aesthetical result after 6 months of follow-up. The presented surgical technique has a short learning curve with excellent postoperative results. Cases are presented to demonstrate the improved postoperative chest wall contour combined with breast augmentation outcome.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .