Pars Plana Vitrectomy with Internal Limiting Membrane Peeling for Refractory Diffuse Diabetic Macular Edema

Purpose: To evaluate the effect of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for management of refractory diffuse diabetic macular edema (DME). Methods: In this prospective interventional case series, eyes with refractory diffuse DME unresponsive to macular photocoagulation and/or intravitreal bevacizumab, and best corrected visual acuity (BCVA) ≥20/200 and ≤20/60 underwent triamcinoloneassisted PPV with ILM peeling. Pre- and postoperative evaluations included a complete ophthalmologic examination, fluorescein angiography and optical coherence tomography (OCT). Main outcome measures were BCVA and central macular thickness (CMT). Results: Twelve eyes of 12 patients with mean age of 59.6±3.9 (range, 55-68) years were operated and followed for a mean period of 4.9±1.0 (range, 4-6) months. Mean BCVA at final examination was 0.82 ± 0.18 logMAR which was not significantly better than its preoperative value of 1.00 ± 0.80 logMAR (P=0.959). Visual acuity improved by at least 2 lines in 3 eyes (25%), remained stable in 7 eyes (58%) and decreased by at least 2 lines in 2 eyes (17%). Mean CMT at final examination was 315±95 μm, which was significantly less than its preoperative value of 467±107 μm (P=0.004). Complications included vitreous hemorrhage in 2 and cataract progression in 5 eyes. Conclusion: PPV with ILM peeling for refractory diffuse DME seems to reduce macular thickness, but does not significantly improve visual acuity as observed after an intermediate-term follow up of about 6 months

Optimal location of workstations in tandem automated-guided vehicle systems

The way workstations are located in a tandem automated-guided vehicle (AGV) systems affect the total lateness of the system. So far, almost all studies have focused on either minimizing the total flow or minimizing the total AGV transitions in each zone. This study presented a novel approach to locate the workstations in a tandem AGV zones by developing a new mixed-integer programming (MIP) formulation. The objective is to minimize total waiting time of all workstations which is equivalent to minimizing the total lateness of each zone. Lateness is defined as the total idle time of a workstation waiting to be supplied by an AGV. The proposed MIP formulation is very competitive and has the capability to solve instances of up to 25 workstations to optimality in a reasonable amount of time

Exact and Heuristic Solutions to Minimize Total Waiting Time in the Blood Products Distribution Problem

This paper presents a novel application of operations research to support decision making in blood distribution management. The rapid and dynamic increasing demand, criticality of the product, storage, handling, and distribution requirements, and the different geographical locations of hospitals and medical centers have made blood distribution a complex and important problem. In this study, a real blood distribution problem containing 24 hospitals was tackled by the authors, and an exact approach was presented. The objective of the problem is to distribute blood and its products among hospitals and medical centers such that the total waiting time of those requiring the product is minimized. Following the exact solution, a hybrid heuristic algorithm is proposed. Computational experiments showed the optimal solutions could be obtained for medium size instances, while for larger instances the proposed hybrid heuristic is very competitive

Extravesical seromuscular ureteroneocystostomy: an effective and simple operation for treatment of vesicoureteral reflux

To evaluate the success rate of extravesical seromuscular ureteroneocystostomy in the treatment of children with vesicoureteral reflux (VUR). In a prospective study from August 2005 to January of 2006, 15 patients (11 girls, 4 boys), median age of 9.5 years (range: 1-24 years), with high-grade VUR underwent operation. Urinary tract ultrasonography and voiding cystoureterography (VCUG) were the main diagnostic tools to detect VUR before the operation and at 3 months after the operation. No VUR was detected at evaluation of 3-month postoperative VCUGs (14 cases, 93%). However, one child (7%) still had persistent VUR. This patient underwent reoperation and the length of the seromuscular tunnel was increased more with a favorable result. The overall success rate of this technique was about 93%. Extravesical seromuscular ureteroneocystostomy is simple and effective method for the treatment of VUR in children

Renal cell carcinoma in a child

Renal cell carcinoma is a rare disease in children and adolescent. Less than <i> 2&#x0025; </i> of cases occur in childhood and no treatment protocols exist among urologists and oncologists for management. We present a case of renal cell carcinoma in a child with uncommon presentation

The role of renal autotransplantation in treatment of nutcracker syndrome

To report our experience with renal autotransplantation in treatment of gross hema-turia caused by nutcracker Syndrome (NCS). Between September 2005 and January 2008, four pa-tients of mean age 25.5 years (range: 23-28) with gross hematuria were diagnosed to have NCS. Investigations revealed isolated hematuria on urinalysis, a bloody efflux from left ureteral orifice by urethrocystoscopy, dilatation of left renal vein (LRV) with significant difference in peak sys-tolic velocity in Colour Doppler UltraSonography (CDUS) and dilatation and compression of LRV between aorta and superior mesenteric artery in MRA. After operation, hematuria dis-appeared in all patients. No vascular or urological complication was seen. Follow up ranged from 4 to 24 months. In conclusion, autotransplatation of left kidney is very effective for the treatment of symptomatic NCS

Epididymal Inflammatory Pseudotumor: A Case Report

Inflammatory pseudotuomr refers to a group of benign tumor like lesions that they are composed of a mixed inflammatory infiltrates. The diagnosis of these lesions and differentiation of them from malignant process may be difficult. We report on a 35-yearoldman who presented with multiple painless palpable masses in his right hemiscrotum for about 6 months. Right epididymal involvement with intact testicle and spermatic cord were observed during scrotal exploration. After classic right epididymectomy, histopathologic studies revealed inflammatory pseudotumor of the right epididymis.No remarkable abnormal signs and symptoms were observed in the follow up visits after 8 months

Primary Realignment of Posterior Urethral Rupture

Introduction: We report the results of treatment of posterior urethral rupture (PUR) by primary realignment with some modifications of the technique.Materials and Methods: In this prospective study, 25 patients (mean age, 33.5 years; range, 18 to 70 years) in whom PUR had been proved underwent primary urethral realignment. All patients were evaluated postoperatively for urinary incontinence, erectile dysfunction, and urethral stricture. They were followed for a mean of 20 months (range, 9 to 27 months).Results: In 20 of 25 patients (80%), posterior urethral rupture was associated with pelvic fractures and in 2 (8%), bladder rupture also was present. None of the patients had urinary incontinence. Six patients (24%) had evidence of postoperative stricture that required urethral dilatation and/or direct vision internal urethrotomy in 2 or 3 procedures under local anesthesia. Erectile dysfunction (which all responded to sildenafil) was reported by 4 patients (16%) as a decreased quality of erection. Conclusion: We believe that primary realignment of PUR is a simple procedure associated with low morbidity. It is recommended for patients who are stable and have no other significant intra-abdominal and pelvic organ injuries.</p