Conjunctival flap advancement with or without scleral graft for hypotony maculopathy after trabeculectomy

AIM: To introduce a novel technique for transscleral fixation of the PC-IOL that requires no sutures on the IOL haptics. METHODS: Instead of suturing polypropylene onto the IOL haptics, the method simply winds the thread on the haptics. Fifteen eyes of 15 patients underwent this technique and were followed up for more than 18 months. Surgical outcomes and post-operative complications were evaluated and compared with those of the conventional transscleral fixation method. RESULTS: Postoperative cylinder was significantly lower in the thread winding group than in the conventional transscleral fixation method group (-1.02±0.46 diopters vs -1.57±0.77 diopters; P=0.01). Further, no postoperative complications, such as optic capture, IOL dislocation, and hyphema, were detected in the thread winding group. CONCLUSION: We believe that our thread winding technique is better than previously reported methods because it is simple, mechanically stable, and free from suture-related complications.     

The course of pregnancy among mothers above 35 years and its outcome in Kafr-El-Zayat.

A group of pregnant mothers above 35 years old were collected from the MCH centre in Kafr-El Zayat during a period of 10 months (82). A control group of mothers aged 20-30 years old were also selected during the same period (62). Those with specific diseases from both groups were excluded. During the repeated visits of those mothers to the MCH centre they were subjected to complete history taking, physical examination plus urine analysis & haemoglobin levelling. A special visit was performed by the researcher to the mothers on 7th day after labour to report on the outcome of labour. The present study revealed significant differences between mothers over 35 years and those of 20-30 years in the course of pregnancy, labour and their outcomes where the former group showed greater tendency to be at a higher risk.     

How we do it: Implementing change – a multi‐centre audit of an evidence‐based protocol on post‐thyroidectomy calcium maintenance

? Our previous retrospective audit (Clinical Otolaryngology, December 2004) identified considerable variation in post‐thyroidectomy calcium assessment. This led to a well‐structured protocol. ? The protocol was introduced into two trusts. The results were prospectively collated for 64 thyroid procedures over a period of 6 months. ? All patients that warranted it were tested on day 1, and 71% were tested on day 2 – highlighting a more structured approach, and avoiding unnecessary vene‐ puncture in all thyroid lobectomy patients. ? Such protocols have been proven to be an important tool in the effort to improve the quality and lower the cost of care. ? Resistance to change, established practise and lack of data collection resources prevented this protocol from becoming established in more regional trusts.     

44Sacral extracorporeal magnetic stimulation is an effective treatment for pelvic floor dyssynergia; Comparative study with biofeedback therapy

Background: Recent development of extracorporeal magnetic stimulation (ECMS) which uses current‐changing magnetic fields allows the induction of electrical stimulation in the desired deep tissue. Recent study showed the sacral nerve stimulation reduces corticoanal excitability that may play a functional role in anal continence mechanisms. Preliminary study shows that ECMS of sacral nerve can modify pelvic floor function and expel rectal balloon in patients with pelvic floor dyssynergia (PFD). Aims: To evaluate the effect of ECMS compared with biofeedback therapy (BF) in patients with PFD. Methods and Materials: Thirty‐eight patients who fulfilled Rome II criteria for PFD by colon transit time and anorectal function tests, were randomly treated with 8 sessions of ECMS (2/weeks; n = 19) at prone position or BF (2/weeks; n = 19) at sitting position. Stimulation parameters were set at 50–80% of maximum intensity, 10 and 50 Hz frequency, 3 s burst length with 3 and 6 s off using arm‐typed stimulator (BioCom‐1000, Mcube Co., Korea). Symptom scores for constipation with/without anorectal function test were repeatedly measured after each treatment. Response was defined as 50% or more decreased symptom score after treatment (partial response: 30–50%, poor: <30%). Results: Fifteen patients (age 49.1 ± 13.4 years, mean ± SD; 4 men) completed 8 session of BF and 14 patients (54.5 ± 17.6 years, 3 men) completed 8 session of ECMS. Four patients of BF group discontinued treatment due to unsatisfactory therapeutic effect (n = 1) and withdrew consent (n = 3) and 5 patients of ECMS group discontinued treatment because of same reasons (n = 1, 4). Total symptom scores were significantly decreased after treatment of 8 session in both treatment groups (13.4 ± 6.6 vs. 4.3 ± 4.0 for BF, p = 0.009; 14.9 ± 5.6 vs. 3.4 ± 4.0 for ECMS, p < 0.001). Bowel movements per week were also significantly increased after treatment in both groups (median 2 vs. 7 for BF, p = 0.035; median 2 vs. 7 for ECMS, p = 0.008). Thirteen out of 15 patients showed response in BF group and 12 out of 14 showed good response in ECMS group. No adverse effects in both groups. Conclusions: ECMS is as effective as BF for the treatment of PFD. Long‐term effect of ECMS for the patients with pelvic floor dyssynergia need to be evaluated in the near future.     

The effect of prolonged blood stasis on a microarterial repair

There is much controversy in the literature about the effect of blood stasis on the patency rate following microvascular repair. Sixty Sprague Dawley rats underwent transection and repair of their femoral arteries. The rats were divided into three groups, which had their repaired arteries clamped for 1 1/2, 2, and 2 1/2 hours. Patency was evaluated by the "stripping test," and the presence of a "flicker" both immediately and on the second day of the experiment. At the time of evaluation on the second day, all arteries in Group I were patent, in Group II two were thrombosed and in Group III, five out of 20 thrombosed. The only significant statistical difference was found between Groups I and III in both immediate (p less than 0.0025) and second day (p less than 0.05) evaluations. Results indicate that the "safe limit" for blood stasis in a repaired artery of 0.8 mm diameter is 1 1/2 hours.