Development of Retinal Infarct Due to Intracameral Cefuroxime Injection Following Complicated Cataract Surgery

We present the case of a 60-year-old patient who underwent a complicated cataract surgery with cefuroxime injection (1 mg/0.1 mL) into the anterior chamber at the end of surgery. The patient presented to our hospital due to decrease in visual acuity (VA) after surgery. VA was counting fingers (CF) from 4 meters. There was extensive retinal hemorrhages and edema in addition to retinal vascular leakage detected with fluorescein angiography (FA). After negative microbiologic tests, the patient was treated with intravenous pulse and oral corticosteroids. Rheumatologic investigation was also negative. At month 5, VA was CF from 1 meter in addition to disseminated capillary loss in FA and optic nerve atrophy despite corticosteroid treatment. The patient developed retinal infarction due to cefuroxime injection following a complicated cataract surgery. Surgeons and surgical staff should be aware of the possibility of retinal toxicity while using cefuroxime, particularly in complicated cases

First-Year Outcomes of Cataract Surgery Combined with Intravitreal Ranibizumab Injection in Wet Age-Related Macular Degeneration

Objectives:To compare the first-year results of patients with active neovascular age-related macular degeneration (nAMD) under intravitreal ranibizumab (IVR) treatment who did and did not undergo cataract surgery.Materials and Methods:The records of 72 patients with active nAMD were reviewed retrospectively. Group 1 consisted of 23 patients who underwent uncomplicated cataract surgery and continued with IVR treatment and group 2 consisted of 49 patients without cataract who received only IVR treatment. The groups were compared according to pretreatment and first year best spectacle-corrected visual acuity (BCVA), central foveal thickness (CFT), number of injections, and nAMD activity (presence of subretinal or intraretinal fluid). Logarithm of minimum angle of resolution (LogMAR) was used for the determination of visual acuity. Activity findings were evaluated with optical coherence tomography.Results:Pretreatment BCVA was 0.94±0.21 in group 1 and 0.77±0.36 in group 2 (p=0.041). At the end of the first year, BCVA was 0.48±0.35 in group 1 and 0.49±0.33 in group 2 (p=0.902). BCVA change was 0.46±0.29 in group 1 and 0.28±0.31 in group 2 (p=0.026). Pretreatment CFT was 305±146 μm in group 1 and 340±120 μm in group 2 (p=0.292). At the end of the first year, CFT was 246±110 μm and 245±82 μm in group 2 (p=0.977). CFT change was 59±45 μm in group 1 and 92±97 μm in group 2 (p=0.135). Mean number of injections over 1 year was 6.2±1.9 in group 1 and 5.7±1.8 in group 2 (p=0.271). At the end of the first year, subretinal fluid was observed in 3 patients in group 1 (13%) and 5 patients in group 2 (10.2%) (p=0.721) and intraretinal fluid was present in 3 patients in group 1 (13%) and 4 patients in group 2 (8.2%) (p=0.515).Conclusion:Cataract surgery combined with IVR treatment yielded significant visual gain in patients with active nAMD. Anatomic results suggest that cataract surgery does not worsen nAMD

The impact of myofascial shoulder pain on hopelessness state among women in Turkey

One of the major complaints of patients for consulting primary healthcare providers is shoulder pain. The most common causes of this problem are subacromial impingement syndrome (SIS). The aim of the current study was to evaluate the hopelessness status of women with myofascial shoulder pain and to compare them with women suffering from traumatic pain. The prospective study design was used in the current study, 60 women were assigned equally to Myofascial group (group M), a group where women complain of shoulder pain, palpable, and tender myofascial trigger points, and 30 women who sustained traumatic shoulder pain in the control group (group T). Beck Hopelessness Scale was used to detect the hopelessness level. Mann Whitney U test was used for statistical analysis. P <0.05 was considered significant. The results showed that the mean was a statistically significant difference between the groups regarding hopelessness state (7.4) for the myofascial group and (3.8) for the traumatic group, P <0.05. Hopelessness status of women with myofascial shoulder pain should be acknowledged because women may need social and psychological support in addition to medical treatment to overcome their complaints

KEMANCILARDA SAĞ ÜST EKSTREMİTE EKLEMLERİNİN 3 BOYUTLU HAREKET ANALİZİNİN DİGİTAL FOTOGRAMETRİK YÖNTEMLE DEĞERLENDİRİLMESİ

The objective of this study is to measure, using digital photogrammetric methods, the angular changes in the wrist and elbow joints which are active in basic bow drives while playing the violin. This study consists of nine violin players. The Pictran software was used in the photogrammetric restitution. The wrist and elbow joints of the right upper extremity were filmed on a calibrated test field by using ametric cameras and then transferred to the computer environment. As a result of the evaluation of the markers in image, the movement angles of the joints as well as ulna and the fifth metacarpal bones were taken as the basis, and thus, the vertical inclination of the arm, forearm and hand were found out. The angular changes in the joint movements were reconstructed in 3D, and the results obtained were compared. When the standart deviations of the angular changes and inclinations are considered, it is possible to say that the angular changes do not vary much depending on the individuals, but, as for inclination, individual difference vary significantly. The fact that individual differences vary much in the playing techniques shows that to teach proper technique is so significant. When these active joints are used effectively and properly while playing, it will also help to eliminate possible problems in the future. In addition, it will, in a sense, provide angular standardisation.Bu çalışmada, keman çalma sırasında temel yay sürüşlerinde aktif olarak kullanılan el bileği ve dirsek eklemlerinin açısal değişikliklerinin, digital fotogrametrik yöntemler kullanılarak ölçülmesi amaçlanmıştır. Bu araştırma 9 kemancı üzerinde yapılmıştır. Fotogrametrik değerlendirmede Pictran yazılımı kullanılmıştır. Keman çalmada aktif olarak kullanılan sağ üst ekstremiteye ait el bileği ve dirsek eklemleri, kalibre edilmiş bir test alanı üzerinde metrik olmayan kameralarla görüntülenerek bilgisayar ortamına aktarılmıştır. Görüntüde kullanılan işaretleyicilerin değerlendirilmesi sonucunda eklemlerin hareket açıları ve aynı zamanda üst ekstremite kemiklerinden humerus, ulna ve 5. metakarp kemikleri baz alınarak kol, önkol ve elin düşey eğimleri ortaya çıkartılmıştır. Eklem hareketlerindeki açısal değişikliklerin üç boyutlu (3B) rekonstruksiyonu yapılarak, elde edilen sonuçlar karşılaştırmalı olarak sunulmuştur. Açısal ve eğimlerdeki değişikliklerdeki standart sapmalara bakıldığında açısal değişikliklerin kişilere göre fazla değişmediği ancak eğimlerde kişisel farklılıkların fazla olduğu gözlemlenmiştir. Çalma tekniklerinde çok fazla kişisel farklılıkların olması, doğru tekniğin öğretilmesinin önemini vurgulamaktadır. Çalma esnasında aktif olarak çalışan bu eklemlerin daha etkili ve bilinçli kullanılması ile ilerde oluşabilecek meslek problemlerine önlem olması yanında bir anlamda açısal standardizasyonun geliştirilmesi de sağlanmış olacaktır

Effects of obstructive sleep apnea on retinal microvasculature

AIM: To detect retinal microvascular variations in obstructive sleep apnea syndrome patients. METHODS: This prospective, observational case-control study included healthy controls and patients with mild, moderate, and severe obstructive sleep apnea syndrome. Vascular parameters, foveal avascular area, and flow areas in macula-centered, 6.00×6.00 mm2 scan size optical coherence tomography angiography images were compared. RESULTS: The control group had the highest whole image, parafoveal, and perifoveal vessel density among the groups in both superficial and the deep capillary plexus (all P<0.05). Rapid eye movement sleep apnoea-hypopnoea index was reversely correlated with whole (Rho=-0.195, P=0.034), parafoveal (Rho=-0.242, P=0.008), perifoveal (Rho=-0.187, P=0.045) vessel density in the superficial capillary plexus, and whole (Rho=-0.186, P=0.046), parafoveal (Rho=-0.260, P=0.004), perifoveal (Rho=-0.189, P=0.043) vessel density in the deep capillary plexus, though the mean and non-rapid eye movement sleep apnoea-hypopnoea index related with only parafoveal vessel density in the superficial capillary plexus (Rho=-0.213, P=0.020; Rho=-0.191, P=0.038) and the deep capillary plexus (Rho=-0.254, P=0.005; Rho=-0.194, P=0.035). CONCLUSION: This study shows decreased vessel density and its reverse correlation with the apnoea-hypopnoea index in patients with obstructive sleep apnea syndrome

Transverse Carpal Ligament and Forearm Fascia Release for the Treatment of Carpal Tunnel Syndrome Change the Entrance Angle of Flexor Tendons to the A1 Pulley: The Relationship between Carpal Tunnel Surgery and Trigger Finger Occurence

Purpose. The appearance of trigger finger after decompression of the carpal tunnel without a preexisting symptom has been reported in a few articles. Although, the cause is not clear yet, the loss of pulley action of the transverse carpal ligament has been accused mostly. In this study, we planned a biomechanical approach to fresh cadavers. Methods. The study was performed on 10 fresh amputees of the arm. The angles were measured with (1) the transverse carpal ligament and the distal forearm fascia intact, (2) only the transverse carpal ligament incised, (3) the distal forearm fascia incised to the point 3 cm proximal from the most proximal part of the transverse carpal ligament in addition to the transverse carpal ligament. The changes between the angles produced at all three conditions were compared to each other. Results. We saw that the entrance angle increased in all of five fingers in an increasing manner from procedure 1 to 3, and it was seen that the maximal increase is detected in the middle finger from procedure 1 to procedure 2 and the minimal increase is detected in little finger. Discussion. Our results support that transverse carpal ligament and forearm fascia release may be a predisposing factor for the development of trigger finger by the effect of changing the enterance angle to the A1 pulley and consequently increase the friction in this anatomic area. Clinical Relevance. This study is a cadaveric study which is directly investigating the effect of a transverse carpal ligament release on the enterance angle of flexor tendons to A1 pulleys in the hand

Atypical Cogan’s Syndrome: A Case Report

Cogan’s Syndrome is a rare autoimmune disease that presents with multi-system involvement including the eyes and ears. It is typically characterized by attacks of vertigo resembling Meniere, sensorineural hearing loss and interstitial keratitis. Ocular findings may vary widely, other than interstitial keratitis in the manner of atypical form which is less frequently seen and has a less favourable prognosis. Here, a 52-year-old male patient with atypical Cogan’s Syndrome is reported. In Cogan’s Syndrome, especially if diagnosis is delayed, hearing diminishes progressively and deafness usually occurs despite therapy, while ocular findings usually respond to topical therapy and persistent blindness does not occur. Persistent sensorineural hearing loss can be prevented by early diagnosis and immediate high dose systemic steroid administration with other immunosuppressive agents if required

Tendon Interposition and Ligament Reconstruction with ECRL Tendon in the Late Stages of Kienböck’s Disease: A Cadaver Study

Background. The optimal surgical treatment for Kienböck’s disease with stages IIIB and IV remains controversial. A cadaver study was carried out to evaluate the use of coiled extensor carpi radialis longus tendon for tendon interposition and a strip obtained from the same tendon for ligament reconstruction in the late stages of Kienböck’s disease. Methods. Coiled extensor carpi radialis longus tendon was used to fill the cavity of the excised lunate, and a strip obtained from this tendon was sutured onto itself after passing through the scaphoid and the triquetrum acting as a ligament to preserve proximal row integrity. Biomechanical tests were carried out in order to evaluate this new ligamentous reconstruction. Results. It was biomechanically confirmed that the procedure was effective against axial compression and distributed the upcoming mechanical stress to the distal row. Conclusion. Extensor carpi radialis longus tendon has not been used for tendon interposition and ligament reconstruction in the treatment of this disease before. In view of the biomechanical data, the procedure seems to be effective for the stabilization of scaphoid and carpal bones

A Novel System for Transcutaneous Application of Carbon Dioxide Causing an “Artificial Bohr Effect” in the Human Body

BACKGROUND: Carbon dioxide (CO(2)) therapy refers to the transcutaneous administration of CO(2) for therapeutic purposes. This effect has been explained by an increase in the pressure of O(2) in tissues known as the Bohr effect. However, there have been no reports investigating the oxygen dissociation of haemoglobin (Hb) during transcutaneous application of CO(2)in vivo. In this study, we investigate whether the Bohr effect is caused by transcutaneous application of CO2 in human living body. METHODS: We used a novel system for transcutaneous application of CO(2) using pure CO(2) gas, hydrogel, and a plastic adaptor. The validity of the CO(2) hydrogel was confirmed in vitro using a measuring device for transcutaneous CO(2) absorption using rat skin. Next, we measured the pH change in the human triceps surae muscle during transcutaneous application of CO(2) using phosphorus-31 magnetic resonance spectroscopy ((31)P-MRS) in vivo. In addition, oxy- and deoxy-Hb concentrations were measured with near-infrared spectroscopy in the human arm with occulted blood flow to investigate O2 dissociation from Hb caused by transcutaneous application of CO(2). RESULTS: The rat skin experiment showed that CO(2) hydrogel enhanced CO(2) gas permeation through the rat skin. The intracellular pH of the triceps surae muscle decreased significantly 10 min. after transcutaneous application of CO(2). The NIRS data show the oxy-Hb concentration decreased significantly 4 min. after CO(2) application, and deoxy-Hb concentration increased significantly 2 min. after CO(2) application in the CO(2)-applied group compared to the control group. Oxy-Hb concentration significantly decreased while deoxy-Hb concentration significantly increased after transcutaneous CO(2) application. CONCLUSIONS: Our novel transcutaneous CO(2) application facilitated an O(2) dissociation from Hb in the human body, thus providing evidence of the Bohr effect in vivo