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

Full Thickness Macular Hole Closure after Exchanging Silicone-Oil Tamponade with C3F8 without Posturing

Purpose: To report a case of macular hole closure after the exchange of a silicone-oil tamponade with gas C3F8 14%. Method: A 64-year-old female patient with a stage IV macular hole underwent a three-port pars-plana vitrectomy and internal limiting membrane peeling. Due to the patient’s chronic illness (respiratory problems), a silicone-oil tamponade was preferred. However, the macula hole was still flat opened four months postoperatively. Therefore, the patient underwent an exchange of silicone oil with gas C3F8 14%. No face-down position was advised postoperatively due to her health problems. Results: Macular hole closure was confirmed with optical coherence tomography six weeks after exchanging the silicone oil with gas. Conclusions: Macular hole surgery using a silicone-oil tamponade has been proposed as treatment of choice for patients unable to posture. In our case, the use of a long-acting gas (C3F8 14%), even without posturing, proved to be more effective

Development of a Prognostic Model That Predicts Survival After Pancreaticoduodenectomy for Ampullary Cancer.

Objectives: The aims of this study were to i) identify independent predictors of survival following pancreaticoduodenectomy for ampullary cancer and ii) develop a prognostic model of survival. Methods: Data were analysed retrospectively on 110 consecutive patients who underwent pancreaticoduodenectomy between 2002-2013. Subjects were categorised into 3 nodal sub-groups as per the recently proposed nodal sub-classification: N0 (node negative), N1 (1-2 metastatic nodes) or N2 (≥3 metastatic nodes). Clinicopathological features and overall survival were compared by Kaplan Meier and Cox regression analyses. Results: The overall 1-, 3- and 5-year survival rates were 79.8%, 42.2% and 34.9% respectively. The overall 1-, 3- and 5-year survival rates for the N0 group were 85.2%, 71.9% and 67.4% respectively. The 1-,3-,5-year survival rates for the N1 and N2 subgroups were 84.6%, 58.4%, 56.4% and 80.2%, 38.8% and 8.0% respectively (log rank, p<0.0001). After performing a multivariate Cox regression analysis vascular invasion and lymph node ratio were the only independent predictors of survival. Hence a prediction model of survival was constructed based on those 2 variables. Conclusion: Using data from a carefully selected cohort of patients we created a pilot prognostic model of post-resectional survival. The proposed model may help clinicians to guide treatments in the adjuvant setting.Mr Siong S. Liau is funded by the Medical Research Council (MRC) and Academy of Medical Sciences Clinician Scientist Fellowship

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

The role of anorectal investigations in predicting the outcome of biofeedback in the treatment of faecal incontinence.

OBJECTIVE The current literature does not provide unequivocal evidence on prognostic factors of patients' response to biofeedback for management of faecal incontinence. The aim of this study was to identify independent predictors of patient response to biofeedback. MATERIAL AND METHODS Baseline demographic characteristics, symptomatology and anorectal investigation reports of 137 patients who completed biofeedback therapy were analysed retrospectively. Short-term response (<3 months) to biofeedback was assessed using subjective criteria (improvement/ no improvement). P Values < 0.05 were considered to be statistically significant. RESULTS At univariate analysis, age, duration of symptoms, severity of faecal incontinence, mean maximum squeeze and resting pressure differed significantly (p < 0.05) were associated with patients' response. However, after performing logistic regression analysis age, duration and severity of symptoms were the only variables associated with the outcome (p Values were 0.041, 0.022 and 0.025, respectively). CONCLUSION Three independent factors (younger age, shorter duration and lower severity of faecal incontinence) were associated with patient outcome after completing our unit's biofeedback protocol. Anorectal investigations are of questionable value in patient selection for biofeedback therapy

THE CONTRIBUTION OF VITRECTOMY IN THE COMPREHENSION AND TREATMENT OF ACUTE DIABETIC RETINOPATHY

ONE HUNDRED (100) CASES OF PROLIFERATIVE DIABETIC RETINOPATHY, COMPLICATED BY VITREOUS HEMORRHAGE AND/OR TRACTION RETINAL DETACHMENT, UNDERWENT VITRECTOMY. FROM THESE CASES, 38 WERE ONLY VITREOUS HEMORRHAGE, 26 TRACTION REFINAL DETACHMENT, 31 FRACTION RETINAL DETACHMENT WITH HEMORRHAGE AND FINALLY 5 CASES OF RHEGMATOGENOUS DETACHMENT. DURING VITRECTOMY WE USED 20 G SYSTEM AND SPECIAL MICROSURGICAL INSTRUMENTS FOR PEELING AND REMOVING EPIRETINAL MEMBRANES. IN 48 CASES OUT OF 100 WE APPLIED THREE NEW TECHNIQUES. HORIZONTAL DISSECTION OF MEMBRANES, ASPECIAL TECHNIQUE TO CLEAR EPIRETINAL BLOOD ELEMENTS AND ENDOPHOTOANGULATION ARGON LASER. WE ACHIEVED 66% SUCCESS RATE IMMEDIATE POSTOPERATIVELY AND 53% IN THE LONG TERM. THE FOLLOW UP OF OUR CASES WAS BETWEEN TWO MONTHS AND TWO YEARS. COMPLICATIONS AND RESULTS ARE DISCUSSED IN DETAILS.ΕΚΑΤΟ (100) ΠΕΡΙΣΤΑΤΙΚΑ ΥΠΕΡΠΛΑΣΤΙΚΗΣ ΔΙΑΒΗΤΙΚΗΣ ΑΜΦΙΒΛΗΣΤΡΟΕΙΔΟΠΑΘΕΙΑΣ ΜΕ ΕΠΙΠΛΟΚΗ ΑΙΜΟΡΡΑΓΙΑ ΥΑΛΟΕΙΔΟΥΣ 'Η/ΚΑΙ ΕΛΚΤΙΚΗ ΑΠΟΚΛΗΣΗ ΤΟΥ ΑΜΦΙΒΛΗΣΤΡΟΕΙΔΗ (ΟΞΕΙΑ ΔΙΑΒΗΤΙΚΗ ΑΜΦΙΒΛΗΣΤΡΟΕΙΔΟΠΑΘΕΙΑ ΥΠΟΒΛΗΘΗΚΑΝ ΣΕ ΕΓΧΕΙΡΗΣΗ ΥΑΛΟΕΙΔΕΚΤΟΜΗΣ. ΑΠΟ ΤΑ 100 ΠΕΡΙΣΤΑΤΙΚΑ ΤΑ 38 ΗΤΑΝ ΥΠΕΡΠΛΑΣΤΙΚΗ ΔΙΑΒΗΤΙΚΗ ΑΜΦΙΒΛΗΣΤΡΟΕΙΔΟΠΑΘΕΙΑ (ΥΔΑ) ΚΑΙ ΑΙΜΟΡΡΑΓΙΑ ΥΑΛΟΕΙΔΟΥΣ (ΑΙΜ), ΤΑ 26 ΗΤΑΝ ΥΔΑ ΚΑΙ ΕΛΚΤΙΚΗ ΑΠΟΚΟΛΛΗΣΗ ΩΧΡΑΣ (ΕΛΚΤ), ΤΑ 31 ΗΤΑΝ ΥΔΑ+ΑΙΜ+ΕΛΚΤ ΚΑΙ ΤΕΛΟΣ ΤΑ ΥΠΟΛΟΙΠΑ 5 ΗΤΑΝ ΥΔΑ ΚΑΙ ΡΗΓΜΑΤΟΓΕΝΗΣ ΑΠΟΚΟΛΛΗΣΗ (ΡΗΓΜ) ΕΠΙ ΕΔΑΦΟΥΣ ΕΛΚΤΙΚΗΣ. ΚΑΤΑ ΤΗΝ ΕΓΧΕΙΡΗΣΗ ΧΡΗΣΙΜΟΠΟΙΗΘΗΚΕ ΣΥΣΤΗΜΑ ΥΑΛΟΕΙΔΕΚΤΟΜΗΣ 20 G KAI ΕΙΔΙΚΑ ΜΙΚΡΟΧΕΙΡΟΥΡΓΙΚΑ ΟΡΓΑΝΑ ΓΙΑ ΑΦΑΙΡΕΣΗ ΑΜΦΙΒΛΗΣΤΡΟΕΙΔΙΚΩΝ ΜΕΜΒΡΑΝΩΝ . ΕΠΙ ΠΛΕΟΝ ΣΕ 46 ΠΕΡΙΣΤΑΤΙΚΑ ΕΦΑΡΜΟΣΑΜΕ ΤΡΕΙΣ ΚΑΙΝΟΥΡΓΙΕΣ ΤΕΧΝΙΚΕΣ, ΤΗΝ ΟΡΙΖΟΝΤΙΟ ΔΙΑΤΟΜΗ ΤΩΝ ΜΕΜΒΡΑΝΩΝ, ΕΙΔΙΚΗ ΤΕΧΝΙΚΗ ΕΝΔΟΦΩΤΟΠΗΞΙΑ ARGON LASER. ΑΜΕΣΟ ΚΑΛΟ ΜΕΤΕΓΧΕΙΡΗΤΙΚΟ ΑΠΟΤΕΛΕΣΜΑ ΕΠΕΤΕΥΧΘΗ ΣΕ ΠΟΣΟΣΤΟ 66%, ΕΝΩ ΟΨΙΜΑ ΤΟ ΠΟΣΟΣΤΟ ΕΠΙΤΥΧΙΑΣ ΚΑΤΕΒΗΚΕ ΣΕ 53%. Ο ΧΡΟΝΟΣ ΠΑΡΑΚΟΛΟΥΘΗΣΗΣ ΤΩΝ ΠΕΡΙΣΤΑΤΙΚΩΝ ΗΤΑΝ ΔΥΟ ΜΗΝΕΣ ΕΩΣ ΚΑΙ ΔΥΟ ΧΡΟΝΙΑ. ΣΥΖΗΤΟΥΝΤΑΙ ΟΙ ΕΠΙΠΛΟΚΕΣ, ΕΓΧΕΙΡΗΤΙΚΕΣΚΑΙ ΜΕΤΕΓΧΕΙΡΗΤΙΚΕΣ, ΚΑΘΩΣ ΚΑΙ ΤΑ ΑΠΟΤΕΛΕΣΜΑΤΑ

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

Experimental isolation and transplantation of mesenchymal stem cells in rats with hepatic injury: specialized biochemical research

Isolation of mesenchymal stem cells from subcutaneous fat of male Wistar rats and transplantation in female Wistar rats with acute acetaminophen induced hepatic injury. Successful tracing of the transplanted stem cells with FISH for the Y chromosome, limitation of the extent of hepatic injury on the histopathological examination, amelioration of biochemical markers of hepatic damage and incrementation of the regenerative rate of hepatocytes.Απομόνωση μεσεγχυματικών βλαστοκυττάρων από υποδόριο λίπος αρσενικών αρουραίων του γένους Wistar και μεταμόσχευση σε θυληκούς αραουραίους του ίδιου γένους σε έδαφος οξείας ηπατικής βλάβης από ακεταμινοφαίνη. Επιτυχής εντοπισμός των μεταμοσχευμένων βλαστοκυττάρων με τη μέθοδο του in situ υβριδισμού για το Υ χρωμόσωμα, περιορισμός της έκτασης της ηπατικής βλάβης στην παθολογοανατομική εξέταση, βελτίωση των βιοχημικών παραμέτρων ηπατικής βλάβης και αύξηση του αναγεννητικού ρυθμού των ηπατοκυττάρων