Scleral melt following Retisert intravitreal fluocinolone implant

Intravitreal fluocinolone acetonide implant (Retisert) has a high potency, a low solubility, and a very short duration of action in the systemic circulation, enabling the steroid pellet to be small and reducing the risk of systemic side effects. Scleral melt has not been reported as a possible complication of Retisert implant. The authors describe the occurrence of scleral melt 18 months after the implantation of fluocinolone acetonide implant in a 42-year-old Caucasian woman. To the authors’ knowledge, this is the first report of this possible complication

The Association between TGF-β1 G915C (Arg25Pro) Polymorphism and the Development of Primary Open Angle Glaucoma: A Case-Control Study

The purpose of the current study was to identify the potential association between Single Nucleotide Polymorphism (SNP) TGFβ1 +915 (C or G) in codon 25 and Primary Open Angle Glaucoma (POAG). Overall, 88 cases with POAG and a control group of 52 healthy individuals were recruited from the First Ophthalmology Department of Athens University. DNA was isolated from whole blood samples and genotype frequencies for the polymorphism rs1800471 (G915C, Arg25Pro) of the TGF-β1 gene were assessed. Genotype distribution frequencies for the polymorphism rs1800471 (G915C, Arg25Pro) of the TGF-β1 gene were not statistically different between patients with POAG and control subjects. The present study failed to determine any significant genotypic association with POAG, despite the fact that the presence of the C allele was scarcely increased in the POAG when compared with the control group

The use of axially vascularised flaps in reconstructing dehiscent surgical wounds

Purpose: The purpose of the study is to present the indications and evaluate the effectiveness of axial regional flaps in treating dehiscent surgical traumas.Materials - Methods: During the last three years, 11 patients (7 male, 4 female) underwent a reconstructive operation for a dehiscent surgical wound, which resulted after an orthopaedic, vascular, cardiovascular or urological surgery. Trauma de­hiscence was related to ischemia due to prior radiotherapy, haematoma formation, infection or previous scarring. Prosthetic implants were exposed in five cases. All patients had one to three attempts for primary closure before they were seen by the plastic surgeon. In all cases, a pedicle axial flap was used: a muscle or musculocutaneous flap for managing traumas located over the torso (n = 7), and fasciocutaneous (n = 3) or muscle (n = 1) flaps for those located on the extremities.Results: Follow-up ranged from 2 to 7 months. In all cases, flaps provided safe closure and sufficient coverage of the wound; exposed implants were not removed. No recurrences were recorded. We had a partial necrosis of the skin island in a musculocutaneous pectoralis major flap used for covering a sternal defect; revision consisted in debridement and secondary coverage with a skin graft.Conclusion: Axial flaps offer reliable solutions when we face dehiscent surgical traumas. The appropriate flap is chosen according to the location, size and other characteristics of the defect. Muscle flaps are mostly indicated for reconstructing complicated wounds over the torso, especially in previously irradiated areas, while fasciocutaneous flaps are used for com­plicated traumas of the extremities

Trammel net catch species composition, catch rates and metiers in southern European waters: A multivariate approach

We identified and quantified the effect of season, depth, and inner and outer panel mesh size on the trammel net catch species composition and catch rates in four southern European areas (Northeast Atlantic: Basque Country, Spain; Algarve, Portugal; Gulf of Cadiz, Spain; Mediterranean: Cyclades, Greece), all of which are characterised by important trammel net fisheries. In each area, we conducted, in 1999-2000, seasonal, experimental fishing trials at various depths with trammel nets of six different inner/outer panel mesh combinations (i.e., two large outer panel meshes and three small inner panel meshes). Overall, our study covered some of the most commonly used inner panel mesh sizes, ranging from 40 to 140 mm (stretched). We analysed the species composition and catch rates of the different inner/outer panel combinations with regression, multivariate analysis (cluster analysis and multidimensional scaling) and other 'community' techniques (number of species, dominance curves). All our analyses indicated that the outer panel mesh sizes used in the present study did not significantly affect the catch characteristics in terms of number of species, catch rates and species composition. Multivariate analyses and seasonal dominance plots indicated that in Basque, Algarve and Cyclades waters, where sampling covered wide depth ranges, both season and depth strongly affected catch species compositions. For the Gulf of Cadiz, where sampling was restricted to depths 10-30 m, season was the only factor affecting catch species composition and thus group formation. In contrast, the inner panel mesh size did not generally affect multidimensional group formation in all areas but affected the dominance of the species caught in the Algarve and the Gulf of Cadiz. Multivariate analyses also revealed 11 different metiers (i.e., season-depth-species-inner panel mesh size combinations) in the four areas. This clearly indicated the existence of trammel net 'hot spots', which represent essential habitats (e.g., spawning, nursery or wintering grounds) of the life history of the targeted and associated species. The number of specimens caught declined significantly with inner panel mesh size in all areas. We attributed this to the exponential decline in abundance with size, both within- and between-species. In contrast, the number of species caught in each area was not related to the inner mesh size. This was unexpected and might be a consequence of the wide size-selective range of trammel nets. (c) 2006 Elsevier B.V All rights reserved

Correlation of intravitreal IL-6 with the formation of epiretinal membrane after successful retinal detachment repair

Introduction: Epiretinal membrane (ERM) formation following a successful rhegmatogenous retinal detachment (RRD) operation has been reported to occur in about 4%–15% of the cases. In this study, we collected vitreous samples from patients with RRD to identify whether the concentration of IL-6 is correlated with the presence of postoperative ERM. We aim is to identify whether the inflammatory cascade could be a potential key factor in the ERM pathogenesis. Methods: This was a prospective single-centre study where 42 eyes were enrolled. All patients underwent 25G PPV. The vitreous sample was collected before the infusion line was opened so that the sample would not be diluted. Then, the sample was centrifuged at 5000 g for 15 min at 15°C. Afterwards, the supernatant fluid was transferred to an Eppendorf tube and stored at −40°C. Electrochemiluminescence immunoassay (ECLIA) was employed for the measurement of IL-6 concentration (pg/ml). All patients had optical coherence tomography (OCT) scans at the macula at 4 weeks, 3 months and 1 year after primary RRD repair to identify the presence of the ERM. Results: All patients had a follow-up of at least 12 months. The mean BCVA of all 42 eyes at the end of follow-up period was 0.24 ± 0.31 LogMar. The presence of ERM was identified in 28.6% (n = 12) of the patients, and the mean IL-6 concentration was 573.96 ± 1179.58 pg/ml. It appears that the patients who developed a post op ERM had an IL-6 mean concentration value of 173.96 ± 191.25 pg/ml, and the patients with no post op ERM had 733.97 ± 1364.04 pg/ml with p-value = 0.04 < 0.05. Nevertheless, following a multivariate binary logistic regression model, the above results did not appear to be statistically significant. Conclusion: High concentration of IL-6 in the vitreous of eyes with RRD does not hold a significant role in the ERM pathogenesis. Our study identified the presence of a draining retinotomy as the most significant risk factor for ERM formation following a successful surgical RRD repair

The effect of prostaglandin analogs on the biomechanical properties and central thickness of the cornea of patients with open-angle glaucoma: a 3-year study on 108 eyes

PURPOSE: To evaluate the effect of prostaglandin analogs (PGAs) on the biomechanical properties (corneal hysteresis [CH], corneal resistance factor [CRF]) and central corneal thickness (CCT) of patients with open-angle glaucoma. METHODS: A total of 108 eyes were prospectively included for repeated measurements of intraocular pressure (IOP) with Goldmann applanation tonometry (GAT) and ocular response analyzer (ORA), CCT, followed by CH and CRF measurements by the ORA, during the same visit. Of these, 66 were treated with latanoprost, and 42 were treated with latanoprost and timolol. IOP, CH, CRF, and CCT were measured before treatment and at 6-month intervals. RESULTS: It appears that under local PGA treatment, IOP values decreased and CH and CCT significantly increased, whereas CRF did not. CCT slightly but significantly increased at all time points of the study (0.50–3.00 μm and 1.50–5.50 μm), and we observed a constant significant increase in CH (0.4–0.7 mmHg and 0.65–0.95 mmHg). Concerning the correlation of GAT IOP with CCT and CH, it was found that at the time points 0, 1, and 2 there were statistically significant correlations. CONCLUSION: The changes of CCT and CH under PGA treatment in clinical practice may influence IOP measurements and patient follow-up significantly. This should be investigated further to confirm the relationship between corneal properties and treatment of open-angle glaucoma

Optimal extent of initial parathyroid resection in patients with multiple endocrine neoplasia syndrome type 1: A meta-analysis

BACKGROUND: Hyperparathyroidism is an almost universal feature of multiple endocrine neoplasia type 1 syndrome. We present a systematic review and meta-analysis of the postoperative outcomes of patients undergoing initial operative treatment of primary hyperparathyroidism complicating multiple endocrine neoplasia 1. METHODS: A comprehensive literature search was performed with a priori defined exclusion criteria for studies comparing total parathyroidectomy, subtotal parathyroidectomy, and less than subtotal parathyroidectomy. RESULTS: Twenty-one studies incorporating 1,131 patients (272 undergoing total parathyroidectomy, 510 subtotal parathyroidectomy, and 349 less than subtotal parathyroidectomy) were identified. Pooled results revealed increased risk for long-term hypoparathyroidism in total parathyroidectomy patients (relative risk 1.61; 95% confidence interval, 1.12-2.31; P = .009) versus those undergoing subtotal parathyroidectomy. In the less than subtotal parathyroidectomy or subtotal parathyroidectomy comparison group, a greater risk for recurrence of hyperparathyroidism (relative risk 1.37; 95% confidence interval, 1.05-1.79; P = .02), persistence of hyperparathyroidism (relative risk 2.26; 95% confidence interval, 1.49-3.41; P = .0001), and reoperation for hyperparathyroidism (relative risk 2.48; 95% confidence interval, 1.65-3.73; P < .0001) was noted for less than subtotal parathyroidectomy patients, albeit with lesser risk for long-term for hypoparathyroidism (relative risk 0.47; 95% confidence interval, 0.29-0.75; P = .002). CONCLUSION: Subtotal parathyroidectomy compares favorably to total parathyroidectomy, exhibiting similar recurrence and persistence rates with a decreased propensity for long-term postoperative hypoparathyroidism. The benefit of the decreased risk of hypoparathyroidism in less than subtotal parathyroidectomy is negated by the increase in the risk for recurrence, persistence, and reoperation. Future studies evaluating the performance of less than subtotal parathyroidectomy in specific multiple endocrine neoplasia 1 phenotypes should be pursued in an effort to delineate a patient-tailored, operative approach that optimizes long-term outcomes

Virtual reality simulation training in laparoscopic suturing and knot-tying: a narrative review

Background and Objective: The evolving domain of surgical training, particularly in laparoscopic suturing, relies on technological advancements. This review explores the complex landscape of virtual reality (VR) simulators, focusing on their role in laparoscopic suturing training. The primary objective is to assess challenges and advancements within laparoscopic suturing methodologies, emphasizing the need for evidence-based approaches in VR surgical education. / Methods: A comprehensive literature search on 5 independent databases provided studies and reviews from the last decade. Recent advancements in laparoscopic suturing training were a key focus, with specific attention to haptic feedback challenges in VR simulations, technology integration in education, and evidence-based curriculum for skills development. The review aimed to offer a comprehensive overview of challenges, advancements and gaps in VR laparoscopic suturing training. / Key Content and Findings: VR simulation training emerges as pivotal for laparoscopic suturing skill development. While box trainers have limitations, VR provides immersive experiences, enhancing psychomotor abilities. The importance of trainee involvement, early exposure, and customized training durations is emphasized for effective skill development. This review explores heterogeneity in VR educational tools for laparoscopic suturing, emphasizing the significance of haptic feedback. Some studies show conflicting evidence on the effectiveness of haptic-enhanced VR, demanding further research and cost-benefit analyses. Examples provided highlight the need for evidence-based curriculum in laparoscopic suturing training. / Conclusions: Laparoscopic suturing skills demand innovative training tools. VR simulators prove transformative in simplifying complex information and engaging trainees effectively. While promising, achieving VR’s full potential requires ongoing efforts to refine haptic feedback realism, develop evidencebased curriculum, and comprehensively evaluate effectiveness. The review calls for wider delivery of relevant VR training programs. Ultimately, the goal is safer, more proficient, and patient-friendly minimally invasive surgical procedures through advanced training methodologies

Large Enterolith Complicating a Meckel Diverticulum Causing Obstructive Ileus in an Adolescent Male Patient

We present a unique case of a 16-year-old male patient who was eventually diagnosed with a large enterolith arising from a Meckel’s diverticulum. The enterolith had caused intermittent intestinal symptoms for three years before resulting in small bowel obstruction requiring surgical intervention. Meckel’s enterolith ileus is very rare with only few cases described in the literature. To our knowledge, this is only the second case of Meckel’s enterolith which had caused intermittent symptoms over a period of time, before resulting in ileus, and the first case where the intermittent symptoms lasted several years before bowel obstruction. The patient had been evaluated with colonoscopy, computerized tomography (CT), and magnetic resonance imaging enterography (MRIE); a calcified pelvic mass had been found, but no further diagnosis other than calcification was established. The patient presented at our emergency department, with symptoms of obstructive ileus and underwent exploratory laparotomy, where a large enterolith arising from a Meckel’s diverticulum (MD) was identified, causing the obstruction. A successful partial enterectomy, enterolith removal, and primary end-to-end anastomosis took place; the patient was permanently relieved from his long-standing symptoms. Consequently, complications of Meckel’s diverticulum and enterolithiasis have to be included in the differential diagnosis of abdominal complaints

Is Precision Surgery Applicable to Colorectal Liver Metastases?:A Systematic Review and Meta-analysis of Studies that Investigate the Association of Surgical Technique with Outcomes in the Context of Distinct Tumor Biology

Background. Although some data suggest that patients with mutRAS colorectal liver metastases (CRLM) may benefit from anatomic hepatectomy, this topic remains controversial. We performed a systematic review and meta-analysis to determine whether RAS mutation status was associated with prognosis relative to surgical technique [anatomic resection (AR) vs. nonanatomic resection (NAR)] among patients with CRLM.Patients and methods. A systematic review and meta-analysis of studies were performed to investigate the association of AR versus NAR with overall and liver-specific disease-free survival (DFS and liver-specific DFS, respectively) in the context of RAS mutation status.Results. Overall, 2018 patients (831 mutRAS vs. 1187 wtRAS) were included from five eligible studies. AR was associated with a 40% improvement in liver-specific DFS [hazard ratio (HR) = 0.6, 95% confidence interval (CI) 0.44-0.81, p = 0.01] and a 28% improvement in overall DFS (HR = 0.72, 95% CI 0.54-0.95, p = 0.02) among patients with mutRAS tumors; in contrast, AR was not associated with any improvement in liver-specific DFS or overall DFS among wtRAS patients. These differences may have been mediated by the 40% decreased incidence in R1 resection among patients with mutRAS tumors who underwent AR versus NAR [relative risk (RR): 0.6, 95% CI 0.40-0.91, p = 0.02]. In contrast, the probability of an R1 resection was not decreased among wtRAS patients who underwent AR versus NAR (RR: 0.93, 95% CI 0.69-1.25, p = 0.62).Conclusions. The data suggest that precision surgery may be relevant to CRLM. Specifically, rather than a parenchymal sparing dogma for all patients, AR may have a role in individuals with mutRAS tumors