Acute Sclerokeratitis After Cataract Surgery: Treatment with Topical Use of Cyclosporine – A

We would like to report an interesting case of acute sclerokeratitis following cataract surgery treated with topical use of Cyclosporine-A. A 61-year old woman with a past history of scleritis in her right eye had an uneventful phaco surgery in her right eye for cataract removal via a corneoscleral incision. Eight months after the initial surgery the patient had a sudden decrease in her visual acquity in the right eye with marked inflammatory signs in the sclera and cornea adjacent to the entry-site of the phaco surgery. Initially the patient was treated with systemic corticosteroids but due to serious side effects topical cyclosporine-A was added instead. Five months later the patient has a significant improvement in terms of visual acquity with marked reduction in the inflammatory signs both in sclera and corneal tissue. We think that topical Cyclosporine-A with its potent immunomodulating effects seems to be of benefit in those cases where systemic corticosteroids are contraindicated or have serious side-effects

Precursor Epithelial Subtypes of Adenocarcinoma Arising from Intraductal Papillary Mucinous Neoplasms (A-IPMN): Clinicopathological Features, Recurrence and Response to Adjuvant Chemotherapy

\ua9 The Author(s) 2024.Background: The clinico-oncological outcomes of precursor epithelial subtypes of adenocarcinoma arising from intraductal papillary mucinous neoplasms (A-IPMN) are limited to small cohort studies. Differences in recurrence patterns and response to adjuvant chemotherapy between A-IPMN subtypes are unknown. Methods: Clincopathological features, recurrence patterns and long-term outcomes of patients undergoing pancreatic resection (2010–2020) for A-IPMN were reported from 18 academic pancreatic centres worldwide. Precursor epithelial subtype groups were compared using uni- and multivariate analysis. Results: In total, 297 patients were included (median age, 70 years; male, 78.9%), including 54 (18.2%) gastric, 111 (37.3%) pancreatobiliary, 80 (26.9%) intestinal and 52 (17.5%) mixed subtypes. Gastric, pancreaticobiliary and mixed subtypes had comparable clinicopathological features, yet the outcomes were significantly less favourable than the intestinal subtype. The median time to recurrence in gastric, pancreatobiliary, intestinal and mixed subtypes were 32, 30, 61 and 33 months. Gastric and pancreatobiliary subtypes had worse overall recurrence (p = 0.048 and p = 0.049, respectively) compared with the intestinal subtype but gastric and pancreatobiliary subtypes had comparable outcomes. Adjuvant chemotherapy was associated with improved survival in the pancreatobiliary subtype (p = 0.049) but not gastric (p = 0.992), intestinal (p = 0.852) or mixed subtypes (p = 0.723). In multivariate survival analysis, adjuvant chemotherapy was associated with a lower likelihood of death in pancreatobiliary subtype, albeit with borderline significance [hazard ratio (HR) 0.56; 95% confidence interval (CI) 0.31–1.01; p = 0.058]. Conclusions: Gastric, pancreatobiliary and mixed subtypes have comparable recurrence and survival outcomes, which are inferior to the more indolent intestinal subtype. Pancreatobiliary subtype may respond to adjuvant chemotherapy and further research is warranted to determine the most appropriate adjuvant chemotherapy regimens for each subtype

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Health effects on human eye resulting from the increased ambient solar ultraviolet radiation

This review deals with total ozone depletion, increase in surface solar ultraviolet radiation and the impact of biologically active ultraviolet (UV-B) radiation on human health, with emphasis on eyes. Emphasis is on up to date results from experiments and observations

LAPAROSCOPIC TRANSCYSTIC PAPILLOTOMY UNDER ENDOSCOPIC CONTROL FOR BILE-DUCT STONES

We present here a laparoscopic transcystic papillotomy technique for the management of bile duct stones discovered either preoperatively or on intraoperative cholangiogram. Papillotomy is performed orthogradely with a hydrophilic wire-guided spincterotome inserted through the cystic duct, The correct position of the diathermic wire is verified with peroral duodenoscopy. The method has proved save and effective in our first 12 consecutive patients. Further evaluation is required to clarify its potential role in laparoscopic biliary surgery

Observed association between air pollution and the biologically effective solar ultraviolet irradiance

The interplay between solar ultraviolet irradiance at the Earth's surface and the air quality of the troposphere is explored. This attempt is focused mainly on the quantitative and qualitative dependence of the photochemical air pollution on the solar ultraviolet irradiance reaching different height levels and vice versa. To reach this target, observational data acquired in the greater Athens (Greece) area are employed. Special attention is paid to biologically effective solar ultraviolet radiation, focusing on the wavelengths that have an adverse impact on human eyes. © 2005 Taylor & Francis

N-BUTYL-2-CYANOACRYLATE (HISTOACRYL) PLUS SCLEROTHERAPY VERSUS SCLEROTHERAPY ALONE IN THE TREATMENT OF BLEEDING ESOPHAGEAL-VARICES - A RANDOMIZED PROSPECTIVE-STUDY

Background and Study Aims: N-2-cyanoacrylate (Histoacryl) and endoscopic sclerotherapy with polidocanol have both been reported to control variceal bleeding, The aim of the present study was to compare the effectiveness of the combination of Histoacryl and endoscopic sclerotherapy with polidocanol in the management of these patients regarding early rebleeding and hospital mortality rates. Patients and Methods: One hundred twenty-six consecutive patients with variceal hemorrhage treated with injection therapy between March 1990 and July 1993 were included in this randomized prospective study. Sixty-seven patients (Group A) were treated with Histoacryl and conventional sclerotherapy with polidocanol, acid 59 patients (Group B) were treated with conventional sclerotherapy with polidocanol alone, Histoacryl was injected intravariceally during the first session in the Group A patients. Results: A significantly lower bleeding recurrence rate was found in Group A patients who presented with active bleeding at the first treatment session (Group A: 2 of 20, Group B: 8 of 18, p < 0.05), The hospital mortality was also significantly lower in these patients (Group A: 3 of 21, Group B: 9 of 18, p < 0.05). Conclusions: The combination of Histoacryl with conventional sclerotherapy with polidocanol in patients with esophageal bleeding who present with active bleeding, at the initial injection therapy, can improve the results of endoscopic management