Unilateral Punctate Keratitis Secondary to Wallenberg Syndrome

We studied three patients who developed left unilateral punctate keratitis after suffering left-sided Wallenberg Syndrome. A complex evolution occurred in two of them. In all cases, neurophysiological studies showed damage in the trigeminal sensory component at the bulbar level. Corneal involvement secondary to Wallenberg syndrome is a rare cause of unilateral superficial punctate keratitis. The loss of corneal sensitivity caused by trigeminal neuropathy leads to epithelial erosions that are frequently unobserved by the patient, resulting in a high risk of corneal-ulcer development with the possibility of superinfection. Neurophysiological studies can help to locate the anatomical level of damage at the ophthalmic branch of the trigeminal nerve, confirming the suspected etiology of stroke, and demonstrating that prior vascular involvement coincides with the location of trigeminal nerve damage. In some of these patients, oculofacial pain is a distinctive feature.     

Isolated primary squamous cell carcinoma of the tympanic membrane

INTRODUCTIONPrimary squamous cell carcinoma (SCC) of the tympanic membrane is exceptionally rare. We describe the history, investigation and management of this disease.PRESENTATION OF CASEA 68-year-old woman presented with a three month history of intermittent otorrhoea and external ear canal (EAC) pruritus. Otoscopy revealed a polypoidal granular nodule, confined to the posterior aspect of the tympanic membrane. Examination under anaesthesia (EUA) confirmed that the lesion was confined to the tympanic membrane, with a surrounding rim of normal drum. Biopsies were consistent with well differentiated SCC.DISCUSSIONFollowing discussion at multi-disciplinary team meeting for treatment planning, the patient underwent lateral temporal bone resection with ipsilateral superficial parotidectomy and selective neck dissection. Post-operative histology confirmed an SCC confined to the tympanic membrane.CONCLUSIONSCC of the tympanic membrane is an extremely rare condition. As with early temporal bone SCC, surgical resection with adjacent structure clearance remains the primary treatment modality.     

Locking plates for displaced fractures of the lateral end of clavicle: Potential pitfalls

Roughly a quarter of all clavicle fractures occur at the lateral end. Displaced fractures of the lateral clavicle have a higher rate of nonunion. The management of fractures of the lateral clavicle remains controversial. Open reduction internal fixation with a superiorly placed locking plate is a recently developed technique. However, there are no randomized controlled trials to evaluate the efficacy of this procedure. We present a series of four cases which highlight the technical drawbacks with this method of fixation for lateral clavicle fractures. Two cases show that failure of the plate to negate the displacing forces at the fracture site can lead to plate pullout. Two cases illustrate an unusual complication of an iatrogenic injury to the acromioclavicular joint capsule which led to joint instability and dislocation. We advise caution in using this method of fixation. Recent studies have described the success of lateral clavicle locking plate fixation augmented with a coracoclavicular sling. This augmentation accounts for the displacing forces at the fracture site. We would recommend that when performing lateral clavicle locking plate fixation, it should be reinforced with a coracoclavicular sling to prevent plate failure by lateral screw pullout.     

How directional change in reading/writing habits relates to directional change in displayed pictures

It has been suggested that reading/writing habits may influence the appreciation of pictures. For example, people who read and write in a rightward direction have an aesthetic preference for pictures that face rightward over pictures that face leftward, and vice versa. However, correlations for this phenomenon have only been found in cross-cultural studies. Will a directional change in reading/writing habits within a culture relate to changes in picture preference? Korea is a good place to research this question because the country underwent gradual changes in reading/writing direction habits, from leftward to rightward, during the 20th century. In this study, we analyzed the direction of drawings and photos published in the two oldest newspapers in Korea from 1920–2013. The results show that the direction of the drawings underwent a clear shift from the left to the right, but the direction of the photos did not change. This finding suggests a close psychological link between the habits of reading/writing and drawing that cannot be accounted for simply by an accidental correspondence across different cultures.     

Learning curve analysis for lateral pelvic lymph node dissection in rectal cancers – Outcomes improve with experience

IntroductionLateral pelvic lymph node dissection (LPLND) is a technically challenging procedure and its learning curve has not been analysed against an oncologically relevant outcome. The purpose of the study was to determine the learning curve for LPLND in rectal cancers using nodal retrieval as performance measure.MethodsConsecutive LPLND for rectal adenocarcinomas from a single institution were retrospectively analysed. Cumulative sum (CUSUM) control charts were used to detect difference in performance with respect to lymph node yield. Negative binomial regression was used to determine factors influencing nodal harvest using Incidence Risk Ratios (IRR). Separate CUSUM curves were generated for open and minimally invasive surgeries (MIS).ResultsOne-hundred and twenty patients were included and all received preoperative radiation. MIS was used in 53.3%. Median lymph node yield was 6 with 20% nodal positivity. Increasing experience (IRR – 1.196) and MIS (IRR – 1.586) were the only factors that influenced nodal harvest. CUSUM charts revealed that learning curve was achieved after the 83rd case overall and after the 19 operations in MIS. There was a 20% increase in nodal yield after every 30 MIS LPLND performed.ConclusionsLearning curve for LPLND is relatively long and only increasing experience and minimally invasive operations increased nodal yield.     

椎旁与侧隐窝注射在腰椎间盘突出症治疗中的应用比较

目的比较椎旁与侧隐窝注射在腰椎间盘突出症治疗中的疗效及安全性。方法选择腰椎间盘突出症患者200例,随机分为经椎旁注射组(Ⅰ组,n=100)和经侧隐窝注射组(Ⅱ组,n=100),用药均为消炎镇痛复合液。两组均结合针灸推拿等中医疗法,观察两组治疗效果、安全性以及不良反应。结果Ⅰ组的有效率和优良率分别为90%和77%,Ⅱ组的有效率和优良率分别为92%和78%。两组的治疗效果比较无显著性差异。Ⅰ组的神经激惹征发生率更少。结论两组均可应用于腰椎间盘突出症的治疗,并均可获得满意疗效,但经椎旁较经侧隐窝入路操作相对简单、容易掌握,且不良反应更少。