[Does the micropulse laser have an effect on chronic CSC?] / Hat der Mikropulslaser bei chronischer CCS einen Effekt?

INTRODUCTION: Central serous chorioretinopathy (CSC) is the fourth most common cause of vision loss without an evidence-based treatment recommendation. A positive effect of micropulse laser (MPL) treatment has been described in the literature in recent years. This study aimed to reappraise these results in a patient population with chronic CSC. METHODS: Patients suffering from chronic CSC with a source point detectable in fluorescein angiography (longer than 3 months duration and unresponsive to treatment with eplerenone and carbonic anhydrase inhibitors) were identified and included in this prospective and consecutive case study. Patients were controlled with a yellow laser (577 nm) after 6 weeks, 12 weeks and then every 3 months. RESULTS: A total of 28 patients were included (28 eyes). The mean duration of anamnesis was 444 days (90-1412 days) and the mean duration of the observation period after MPL was 257 days (42-909 days). The foveal retinal thickness measured 351.7 ± 82.4 µm before, compared to 253.6 ± 86.48 µm after MPL (mean of all patients over the whole observation period). Visual acuity was 0.33 ± 0.21 logMAR prior to MPL and 0.30 ± 0.22 logMAR posttreatment. Of the patients two underwent a second MPL and three patients underwent photodynamic treatment (PDT) after insufficient clinical improvement and were consequently excluded from the study. CONCLUSION: Retinal thickness in this patient population with chronic CSC was significantly reduced after MPL treatment with no significant changes of visual acuity. No side effects of MPL were observed. Larger studies including control groups are warranted to quantify the effects of MPL further.

Is bark pH more important than tree species in determining the composition of nitrophytic or acidophytic lichen floras?

To study the pH preference of epiphytic lichens, the bark pH of Fraxinus, Tilia, Quercus and Ulmus trees in an urban environment was measured using a flat surface electrode. The total number of trees was 253. A survey was made of the lichens in a 40 × 40 cm quadrat surrounding the pH measurement point. Our data analysis using multivariate and univariate statistical techniques indicates that the tree species is the most important factor influencing lichen colonisation, and that bark pH alone is of less importance. We hypothesize that the changed pollution climate, with strong decreases in both sulphur dioxide and ammonia concentrations over the past two decades and a concomitant general increase in bark pH, has made epiphytes less sensitive to pH.

Traumatic rupture of an aberrant right subclavian artery.

We describe a patient who sustained a traumatic rupture of an aberrant right subclavian artery. An interposition graft was used to restore continuity of the artery to the descending thoracic aorta.

Bilateral abdominoscrotal hydrocele: a case report.

A 13-month-old boy, who had been diagnosed in utero as having bilateral hydroceles, was found to have bilateral abdominoscrotal hydroceles. To date, there has been only one previous case of bilateral abdominoscrotal hydroceles in an infant. Magnetic resonance imaging was used to make the diagnosis: bilateral dumbell shaped fluid filled masses were seen in a coronal image. The patient had the abdominoscrotal hydroceles excised through bilateral groin incisions. The postoperative course was uneventful, without complication. The etiology and diagnosis of abdominoscrotal hydroceles are discussed.

Aortic dissection: rupture into right ventricle and right pulmonary artery.

Rupture of an acute ascending aortic dissection into a surrounding cardiac chamber or pulmonary artery is an uncommon occurrence, and is often only diagnoses post mortem. Although fistulization (aortopulmonary and aorta-right atrial) after acute aortic dissection has been well documented in the literature, acute aortic dissection fistulizing into both the right ventricle and pulmonary artery has not. We report on a 75-year-old woman who presented with an acute ascending aortic dissection with both aortopulmonary and aorta-right ventricular fistulas who underwent repair and had long-term survival.

A prospective randomized comparison of Dacron and polytetrafluoroethylene aortic bifurcation grafts.

BACKGROUND: The purpose of this study was to compare the long-term results of Dacron and polytetrafluoroethylene (PTFE) aortic bifurcation grafts in a prospective randomized manner. METHODS: Sixty patients with aortoiliac occlusive disease were randomized to receive Dacron or PTFE bifurcation grafts. Preoperative risk factors, perioperative blood loss and fluid requirements, and postoperative complications were compared. A mean follow-up of 57 months was achieved. RESULTS: The immediate postoperative morbidity and mortality rates were similar in the two groups, and the long-term complications were low in number and comparable. The cumulative patency rate for Dacron graft limbs was 86% versus 95% for PTFE graft limbs. CONCLUSIONS: No significant differences were noted between the results achieved with Dacron and PTFE aortic bifurcation grafts.

Entrapment of small bowel after laparoscopic herniorrhaphy.

As laparoscopic hernia repair continues to evolve as an operative procedure, papers will continue to be published discussing new variations and new techniques which will better the operative procedure as a whole and quite possibly decrease its associated complications (i.e., morbidity and mortality). We present a case of laparoscopic bilateral herniorrhaphy in which after uncomplicated surgery and an immediate, uneventful postoperative course, the patient returned to our institution with both a rectus sheath hematoma and small bowel obstruction. The patient, who was initially treated conservatively, ultimately required laparotomy for persistent small bowel obstruction. Laparotomy revealed incarcerated small bowel in a cavity between the posterior rectus fascia and the rectus muscle proper. The patient did well after laparotomy and was discharged home with no further complications.