Intravitreal Dexamethasone Implant for Postoperative Macular Oedema Secondary to Vitrectomy for Epiretinal Membrane and Retinal Detachment: A Systematic Review and Meta-Analysis

Purpose. To evaluate the efficacy of intravitreal dexamethasone implant (DEX) for the treatment of macular oedema secondary to vitrectomy for epiretinal membrane (ERM) and retinal detachment (RD) by conducting a systematic review with meta-analysis of published studies. Methods. Studies reporting clinical outcomes of DEX use for the treatment of macular oedema secondary to ERM and RD vitrectomy were searched on PubMed and Embase databases. The primary outcome was best-corrected visual acuity (BCVA) change between baseline and post-DEX treatment, reported as mean difference (MD) with 95% confidence interval (CI). Mean central macular thickness (CMT) change was assessed as a secondary outcome. Postimplant adverse events, including intraocular pressure rise and cataract development, were reported as well. Results. Five uncontrolled studies, 1 nonrandomized controlled study, and 1 randomized controlled study were included, with a total of 5 cohorts and 3 cohorts in the ERM group and RD group, respectively. Considering the last available follow-up, a significant improvement in postimplant BCVA was found in the overall population, irrespective of the indication for vitrectomy (MD = -0.28, 95% CI = -0.37, -0.20; p<0.001), but with significant heterogeneity. In either group, mean BCVA significantly improved following the implant (in the ERM group, MD = -0.31, 95% CI = -0.40, -0.22; in the RD group, MD = -0.22, 95% CI = -0.41, -0.03), with no difference between the two groups (p=0.41). However, there was significant heterogeneity in both groups. Considering the last available follow-up, a significant CMT reduction was found in the overall population, irrespective of the indication for vitrectomy (MD = -129.75, 95% CI = -157.49, -102.01; p<0.001). In the ERM group, a significant CMT reduction was shown following DEX (MD = -133.41, 95% CI = -155.37, -111.45; p<0.001), with no heterogeneity. In the RD group, mean CMT reduction was borderline significant (MD = -128.37, 95% CI = -253.57, -3.18; p=0.040), with significant heterogeneity. No difference in CMT improvement was found between the two groups (p=0.94). Conclusion. This meta-analysis showed that DEX yielded a significant improvement in visual and anatomical outcomes, even if limited by significant heterogeneity. Dexamethasone implant represents an effective treatment for postoperative macular oedema secondary to ERM and RD vitrectomy

Transanal microscopic surgery in the treatment of recurrent rectal cancer in the elderly

http://www.sciencedirect.com/science/article/pii/S0748798312009377# ------ Background: Transanal microscopic surgery is an important application of minimally invasive surgery of the rectum, allowing complex intervention by transanal excision of full-thickness resection with anastomotic reconstruction. Transanal endoscopic microsurgery (TEM) can have a diagnostic and therapeutic value in the treatment of relapse in the elderly. Methods: Between January 2002 and December 2010, 7 patients (5 men and 2 women; mean age, 66 years) with early rectal cancer recurrence were selected for this palliative surgical procedure for recurrent tumor from adenocarcinoma of the rectum. Four men and 1 woman had undergone ultra-low anterior resection, followed by chemo- or radiotherapy (T3N1M0); one woman had received TEM (T1NxM0) and one man underwent local excision after neoadiuvant chemo/radio therapy (T2NxM0). The patients were selected according to rigid sigmoidoscope, echo transrectal colonoscopy and abdominal echo ultrasound to rule out liver metastases, computed tomography (CT) and magnetic resonance imaging (MRI) of the abdomen and pelvis, with and without contrast material, and positron- emission tromography-CT. The lesions were superficial (<2 cm) and localized to the posterior wall of the rectum. Results: Follow-up was approximately 12-28 months; histopathologic staging confirmed the complete excision of recurrences. The patients were then referred for complementary therapies. Only 1 patient presented with retrorectal abscess, which was treated with conservative techniques. Conclusion: The significance of local recurrence for conservative treatment of adenocarcinoma of the rectum is still controversial because the recurrence is an expression of tumor spread uncontrolled by surgical and radio- or chemotherapy. The alternative to conservative surgery is an abdominoperineal resection according to Miles, but this highly invasive procedure can be considered palliative in the majority of recurrences. Based on equal cancer treatment, the reduction of surgical trauma and preservation of anatomical integrity are an important result

Outpatient vascular clinic management in COVID-19 pandemic

INTRODUCTION: The recent Sars-CoV2 pandemic has dramatically slowed patients' access to our clinic for vascular pathology when the contagion curve peaked. The need to restore the assistance activity has led us to adopt new individual prophylaxis and hygiene measures. METHODS: Doctors and staff must wear dedicated clothes. Mask and gloves are mandatory for patients. A visit is scheduled every 60 minutes to allow the sanitation of the rooms. The day before the visit patients are contacted by telephone for the Covid-19 risk triage. In the presence of symptoms the visit is postponed. In the presence of other risk factors a IgG/IgM Rapid Test for Covid-19 is performed on admission to the clinic. In the presence of fever, if an extraordinary rapid test cannot be performed, the visit must be postponed. Rapid test positive patients cannot be visited: they are placed in solitary confinement at their home waiting for a nasopharyngeal swab for Covid-19. When the rapid test is positive, immediate room sanitation also occurs. The rooms dedicated to the outpatient clinic as well as medical and not medical instruments are disinfected. CONCLUSION: The one adopted can be a useful management model for any type of care activity in order to guarantee the safety of patients and all the staff. KEY WORDS: COVID-19, Management, vascular, Outpatient clinic

Compression and surgery: indications and limits in patient with PAOD

Patients undergoing surgery for varicose disease of the lower limb are generally treated with elastic compression. Nevertheless, in surgical practice, there are no mandatory indications concerning the type of compression to perform and its duration. Particular attention must be paid when it is present a concomitant chronic obstructive disease. We performed an evaluation of elastic compression tolerability on 10 patients with varicose veins (CEAP C2) and PAOD (stage IIa) and calculated, for each of them, Winsor Index, Actual Claudication Distance and recovery time without and with elastic compression. Compression therapy did not influence statistically significantly Winsor Index. Compression therapy was well-tolerated by 9 of 10 patients

Percutaneous treatment with radiofrequency ablation of varicose veins recurring after vein stripping surgery A preliminary study

AIM: The aim of our study was to evaluate the efficacy of a new treatment of recurrent varicose vein after stripping of the great saphenous vein with rigid radiofrequency needles. MATERIAL OF STUDY: 37 patients enrolled (11 males and 26 females). 10 patients had recurrent varicose veins for the presence of residual reflux in the Saphenous-Femoral Junction (SFJ) stump, whilst 21 patients for the presence of a single or multiple re-chanalized and refluxing perforator veins, and 6 had mixed rechanalization due to perforator veins and refluxing saphenous stump. All patients have been treated by percutaneous ultrasound-guided obliteration with radiofrequency needles. Treatment efficacy have been assessed by US evaluation, and/or the appearance of recurrent varicose veins and classified as REVAS questionnaire. Follow up has been carried out at 30, 60, 180 days and 1 year after treatment. RESULTS: A complete obliteration of the perforators) stump(s) was observed in 12 procedures immediately after the treatment, and confirmed at 30 and 60 days. In 1 case (7.69 %) obliteration was not complete at 60 days. After 1 year of follow-up 3 perforators (23.07%) showed an incomplete or failed obliteration. A complete obliteration of the treated SFJ was observed in 27 cases at the end of the procedure and confirmed after 60 days of follow-up patients (Fig. 4). In 2 cases (6.89%), obliteration was non complete at 60 days. After 1 year of follow up 5 treated SFJ (17.24%) stumps showed an incomplete or a failed obliteration. DISCUSSION: Results show a reduction of the number of limbs affected by ulcer, skin pigmentation and stasis eczema, demonstrating correction of haemodynamic overload to be effective. CONCLUSIONS: This treatment is a new and effective solution to the problem of post-stripping recurrent varicose veins