Isolated descemetorhexis for anterior synechiolysis prior to endothelial keratoplasty - case report and technique.

To describe the utilization of descemetorhexis for reformation of the anterior chamber in eyes with central iridocorneal synechiae before endothelial keratoplasty (EK). A 71-year-old man with a history of trabeculectomy complicated by hypotony presented with bullous keratopathy in the presence of extensive iridocorneal synechiae and a flat anterior chamber. In order to proceed with EK, synechiolysis with the use of viscoelastic and scissors was attempted. Despite successful dissection of the peripheral strands, the pupillary margin of the iris remained attached to the endothelium. Therefore, descemetorhexis was performed to detach the Descemet membrane along with central synechiae and create sufficient space for safe EK at a later stage. Corneal clarity was restored by ultrathin Descemet stripping automated endothelial keratoplasty, leaving a fibrous membrane in the pupillary plane, which was excised 2 months later, allowing an improvement of best-corrected visual acuity to 0.5. Isolated descemetorhexis was successfully employed to reform the anterior chamber and proceed with EK in a case of bullous keratopathy and resistant iridocorneal synechiae. This stepwise approach may be considered in similar cases in order to avoid a more invasive treatment, ie, penetrating keratoplasty and synechiolysis

Successful Treatment of a Severe Case of Fournier's Gangrene Complicating a Perianal Abscess

A 67-year-old male patient with diabetes mellitus and nephritic syndrome under cortisone treatment was admitted to our hospital with fever and severe perianal pain. Upon physical examination, a perianal abscess was identified. Furthermore, the scrotum was gangrenous with extensive cellulitis of the perineum and left lower abdominal wall. Crepitations between the skin and fascia were palpable. A diagnosis of Fournier's gangrene was made. He was treated with immediate extensive surgical debridement under general anesthesia. The patient received broad-spectrum antibiotics, and repeated extensive debridements were performed until healthy granulation was present in the wound. Due to the fact that his left testicle was severely exposed, it was transpositioned into a subcutaneous pocket in the inner side of the left thigh. He was finally discharged on the 57th postoperative day. Fournier's gangrene is characterized by high mortality rates, ranging from 15% to 50% and is an acute surgical emergency. The mainstay of treatment should be open drainage and early aggressive surgical debridement of all necrotic tissue, followed by broad-spectrum antibiotics therapy

Corneal Neovascularization with Associated Lipid Keratopathy in a Patient with Obstructive Sleep Apnea-Hypopnea Syndrome Using a Continuous Positive Airway Pressure Machine.

To report a case of corneal neovascularization with secondary lipid keratopathy in a patient treated with continuous positive airway pressure (CPAP) for obstructive sleep apnea-hypopnea syndrome (OSAHS). A 49-year-old male had been diagnosed with obstructive sleep apnea syndrome 10 years ago and has been treated with the application of a CPAP machine during night sleep ever since. For the past year, the patient had been complaining for ocular irritation and excessive tearing of the left eye on awakening. Slit-lamp biomicroscopy revealed the presence of neovascularization and lipid exudation in the inferior third of the cornea of the left eye. Ocular patching during night sleep resulted in recession of the reported symptoms and shrinkage of the neovascularization, while the area of lipid exudation ceased to enlarge. To the best of our knowledge, this is the first report of corneal neovascularization in a patient using a CPAP machine for OSAHS

Management dilemma; a woman with cystic fibrosis and severe lung disease presenting with colonic carcinoma: a case report

Introduction There are increasing reports of bowel cancer in cystic fibrosis, suggesting a possible causal link. Individuals with cystic fibrosis who have advanced lung disease present a high operative risk, limiting curative treatment options in early bowel malignancy. Case presentation We describe a 41-year-old Caucasian woman with cystic fibrosis and severe lung disease who had been considered for lung transplantation, who presented with rectal bleeding and was found to have a Stage I adenocarcinoma of the sigmoid colon. After considerable discussion as to the operative risks, she underwent a laparoscopic resection and remains relatively well 1 year postoperatively with no recurrence. Conclusion We discuss the complexity of the management decisions for cystic fibrosis patients with severe lung disease and early stage colonic malignancy, particularly in the context of potential need for lung transplantation. The case demonstrates that cystic fibrosis patients with very severe lung function impairment may undergo laparoscopic abdominal surgical interventions without compromising postoperative airway clearance

Human pericardium graft in the management of bleb's complication performed in childhood: a case report

<p>Abstract</p> <p>Background</p> <p>To report a case with hypotony due to late leakage of the filtering bleb performed during childhood and treated surgically using human pericardium graft.</p> <p>Case Presentation</p> <p>A man with hypotony related to bleb's leakage in his right eye was presented. During his childhood trabeculectomy was performed to manage ocular hypertension due to pediatric glaucoma. Biomicroscopy revealed choroidal tissue incarcerated in the sclerectomy under the conjunctiva. Bleb revision was performed. Human pericardium graft was used to cover the sclerectomy and a new bleb with controlled outflow was created. The intraocular pressure (IOP) and Seidel test represent the main outcomes. Intraoperative and postoperative complications were recorded. Fifteen days postoperatively the IOP was of 7 mmHg and the bleb seemed to filter properly. Five months later the IOP was 9 mmHg and no complications were noticed. During the follow up time, the Seidel test was negative.</p> <p>Conclusion</p> <p>We used human pericardium graft with no complications in a case of bleb leakage performed for pediatric glaucoma.</p

Cube law, condition factor and weight-length relationships: history, meta-analysis and recommendations

This study presents a historical review, a meta-analysis, and recommendations for users about weight–length relationships, condition factors and relative weight equations. The historical review traces the developments of the respective concepts. The meta-analysis explores 3929 weight–length relationships of the type W = aLb for 1773 species of fishes. It shows that 82% of the variance in a plot of log a over b can be explained by allometric versus isometric growth patterns and by different body shapes of the respective species. Across species median b = 3.03 is significantly larger than 3.0, thus indicating a tendency towards slightly positive-allometric growth (increase in relative body thickness or plumpness) in most fishes. The expected range of 2.5 < b < 3.5 is confirmed. Mean estimates of b outside this range are often based on only one or two weight–length relationships per species. However, true cases of strong allometric growth do exist and three examples are given. Within species, a plot of log a vs b can be used to detect outliers in weight–length relationships. An equation to calculate mean condition factors from weight–length relationships is given as Kmean = 100aLb−3. Relative weight Wrm = 100W/(amLbm) can be used for comparing the condition of individuals across populations, where am is the geometric mean of a and bm is the mean of b across all available weight–length relationships for a given species. Twelve recommendations for proper use and presentation of weight–length relationships, condition factors and relative weight are given

Trammel net catch species composition, catch rates and metiers in southern European waters: A multivariate approach

We identified and quantified the effect of season, depth, and inner and outer panel mesh size on the trammel net catch species composition and catch rates in four southern European areas (Northeast Atlantic: Basque Country, Spain; Algarve, Portugal; Gulf of Cadiz, Spain; Mediterranean: Cyclades, Greece), all of which are characterised by important trammel net fisheries. In each area, we conducted, in 1999-2000, seasonal, experimental fishing trials at various depths with trammel nets of six different inner/outer panel mesh combinations (i.e., two large outer panel meshes and three small inner panel meshes). Overall, our study covered some of the most commonly used inner panel mesh sizes, ranging from 40 to 140 mm (stretched). We analysed the species composition and catch rates of the different inner/outer panel combinations with regression, multivariate analysis (cluster analysis and multidimensional scaling) and other 'community' techniques (number of species, dominance curves). All our analyses indicated that the outer panel mesh sizes used in the present study did not significantly affect the catch characteristics in terms of number of species, catch rates and species composition. Multivariate analyses and seasonal dominance plots indicated that in Basque, Algarve and Cyclades waters, where sampling covered wide depth ranges, both season and depth strongly affected catch species compositions. For the Gulf of Cadiz, where sampling was restricted to depths 10-30 m, season was the only factor affecting catch species composition and thus group formation. In contrast, the inner panel mesh size did not generally affect multidimensional group formation in all areas but affected the dominance of the species caught in the Algarve and the Gulf of Cadiz. Multivariate analyses also revealed 11 different metiers (i.e., season-depth-species-inner panel mesh size combinations) in the four areas. This clearly indicated the existence of trammel net 'hot spots', which represent essential habitats (e.g., spawning, nursery or wintering grounds) of the life history of the targeted and associated species. The number of specimens caught declined significantly with inner panel mesh size in all areas. We attributed this to the exponential decline in abundance with size, both within- and between-species. In contrast, the number of species caught in each area was not related to the inner mesh size. This was unexpected and might be a consequence of the wide size-selective range of trammel nets. (c) 2006 Elsevier B.V All rights reserved

Tamoxifen induces cellular stress in the nervous system by inhibiting cholesterol synthesis

Background: Tamoxifen (TAM) is an important cancer therapeutic and an experimental tool for effecting genetic recombination using the inducible Cre-Lox technique. Despite its widespread use in the clinic and laboratory, we know little about its effects on the nervous system. This is of significant concern because TAM, via unknown mechanisms, induces cognitive impairment in humans. A hallmark of cellular stress is induction of Activating Transcription Factor 3 (Atf3), and so to determine whether TAM induces cellular stress in the adult nervous system, we generated a knock-in mouse in which Atf3 promoter activity drives transcription of TAM-dependent Cre recombinase (Cre-ERT2); when crossed with tdtomato reporter mice, Atf3 induction results in robust and permanent genetic labeling of cells in which it is up-regulated even transiently. Results: We found that granular neurons of the olfactory bulb and dentate gyrus, vascular cells and ependymal cells throughout the brain, and peripheral sensory neurons expressed tdtomato in response to TAM treatment. We also show that TAM induced Atf3 up-regulation through inhibition of cholesterol epoxide hydrolase (ChEH): reporter expression was mitigated by delivery in vitamin E-rich wheat germ oil (vitamin E depletes ChEH substrates), and was partially mimicked by a ChEH-specific inhibitor. Conclusions: This work demonstrates that TAM stresses cells of the adult central and peripheral nervous systems and highlights concerns about clinical and experimental use of TAM. We propose TAM administration in vitamin E-rich vehicles such as wheat germ oil as a simple remedy

Biodegradable collagen matrix implant vs mitomycin-C as an adjuvant in trabeculectomy: a 24-month, randomized clinical trial

AIM: To verify the safety and efficacy of Ologen (OLO) implant as adjuvant compared with low-dosage mitomycin-C (MMC) in trabeculectomy. METHODS: This was a prospective randomized clinical trial with a 24-month follow-up. Forty glaucoma patients (40 eyes) were assigned to trabeculectomy with MMC or OLO. Primary outcome includes target IOP at ≤21, ≤17, and ≤15 mm Hg; complete (target IOP without medications), and qualified success (target IOP regardless of medications). Secondary outcomes include bleb evaluation, according to Moorfields Bleb Grading System (MBGS); spectral domain optical coherence tomography (SD-OCT) examination; number of glaucoma medications; and frequency of postoperative adjunctive procedures and complications. RESULTS: The mean preoperative IOP was 26.5 (±5.2) in MMC and 27.3 (±6.0) in OLO eyes, without statistical significance. One-day postoperatively, the IOP dropped to 5.2 (±3.5) and 9.2 (±5.5) mm Hg, respectively (P=0.009). The IOP reduction was significant at end point in all groups (P=0.01), with a mean IOP of 16.0 (±2.9) and 16.5 (±2.1) mm Hg in MMC and OLO, respectively. The rates and Kaplan-Meier curves did not differ for both complete and qualified success at any target IOP. The bleb height in OLO group was higher than MMC one (P<0.05). SD-OCT analysis of successful/unsuccessful bleb in patients with or without complete success at IOP ≤17  mm Hg indicated a sensitivity of 83% and 73% and a specificity of 75% and 67%, respectively, for MMC and OLO groups. No adverse reaction to OLO was noted. CONCLUSIONS: Our results suggest that OLO implant could be a new, safe, and effective alternative to MMC, with similar long-term success rate