Adjunctive use of mitomycin C in endoscopic revision dacryocystorhinostomy

PubMedID: 22896931Objectives: Success rates for revision dacryocystorhinostomy (DCR) are lower than primary DCR. Scarring of the sac may limit the surgeon's ability to achieve good nasal and lacrimal mucosa apposition. The aims of this study were to assess the long term safety and efficacy of intra-operative use of adjunctive mitomycin C (MMC) treatment in endoscopic revision DCR surgery over 12-24 (mean 17) months. Methodology: This was a prospective, nonrandomized consecutive case series that included 20 adult patients (20 eyes) with failed primary external DCR who underwent revision surgery under assisted local anaesthesia. During revision endoscopic DCR, intra-operative adjunctive MMC (0.2 mg/mL) was applied to the osteotomy site of the lacrimal sac and scar tissue surrounding the surgical osteum for 5 minutes. Results: The surgical success rate was determined based on the patency of the nasolacrimal system by irrigation and resolution of patient symptoms. Endoscopic revision DCR surgery with MMC was successful in 90% of cases (18 of 20 cases). No adverse effects (eg, abnormal nasal bleeding, mucosal necrosis, infection) or any other surgical adverse events were observed. Conclusions: Adjunctive intra-operative MMC application with endoscopic DCR surgery had a good success rate in patients with nasolacrimal duct obstruction that required revision surgery. Further large, double blind, placebo controlled, randomized studies are needed to confirm these findings

An atypical cause of shoulder pain [Omuz ağrısının atipik bir nedeni]

Shoulder pain is a very frequently encountered clinical situation, and it constitutes 16% of all musculoskeletal system complaints. Various underlying causes that may or may not be associated with the structures of the shoulder joint may lead to serious shoulder pain. Here, in this article, we are presenting an atypical case of shoulder pain. A 52-year-old patient whose sole complaint was shoulder pain and who was subsequently diagnosed with a left subclavian artery aneurysm is presented. The computed tomographic (CT) and CT-angiographic (CTA) examinations are presented in this article. © 2014 by Turkish Society of Physical Medicine and Rehabilitation