The Enigma of Galileo's Eyesight: Some Novel Observations on Galileo Galilei's Vision and His Progression to Blindness

Galileo Galilei became blind. Before this happened he revealed that his left eye had always had less than perfect vision. A study of his written works, his handwriting, and the originals of the portraits undertaken during his lifetime indicate that this probably was the case. These portraits suggest that his left eye tended to lose fixation and that, at the age of 60, he suffered from a mucocoele of the right frontal sinus; but these conditions would not have caused blindness. Considering the systemic diseases from which he suffered over his lifetime, he could possibly have had a long standing uveitis with secondary pupillary block glaucoma, common in those with the group of conditions classified as sero-negative arthropathies. Posterior scleritis with secondary glaucoma is less likely. If either of these were the cause, then the disease was probably triggered by a well-documented, severe acute illness as a young adult, the inflammation being localized to the eye as a result of severe recurrent conjunctival infections in his youth. The intermittent nature of the visual loss, the normal appearance of the cornea and pupils in his portraits, the absence of any evidence of inflammatory joint disease, the presence of halos, and the severe nature of the pain—combined with the high level of visual acuity in between attacks and its persistence until the last few weeks of vision means that angle-closure glaucoma must also be considered. These suggestions might be confirmed or refuted by studying his remains. Application has been made for this to be done.     

A new approach to preexisting vertical midline abdominal scars with crossover DIEP flap breast reconstruction

Breast reconstruction using a free transverse rectus abdominis myocutaneous flap or a deep inferior epigastric perforator (DIEP) flap is a challenge in patients with a vertical midline abdominal scar due to the poor perfusion of the lower abdominal skin ellipse across the midline. In such patients, only one half of the abdominal skin ellipse can be used with certainty, and this limits the amount of tissue available for reconstructing the breast. Two cases of breast reconstruction in patients with a lower midline abdominal scar are presented using the DIEP flap, in which the poor perfusion across the midline scar was overcome by a technique of crossover anastomoses between the two deep inferior epigastric pedicles. Reliable perfusion of the entire lower abdominal skin ellipse was achieved. This crossover anastomoses technique overcomes the poor perfusion imposed by the vertical midline abdominal scar and enables DIEP flap breast reconstruction to be offered to women with midline abdominal scars. © 2009 Wiley‐Liss, Inc. Microsurgery, 2010.     

A Case of Multiple Thrombo-Emboli with a Non-Functioning Kidney revealed during a Brain Scanning Procedure and with an Intra-Hepatic Artery Occlusion

We report a case of multiple thrombo-emboli with embolic intrahepatic artery occlusion. Intrahepatic occlusion or stenosis is rarely reported but occurs commonly after cytoxic infusion after intrahepatic arterial catheterisation. Another interesting facet to this case is that his non-functioning kidney, secondary to renal artery occlusion, was first revealed during a brain scanning procedure. Most scanning isotopes are not organ-specific so pathology in other systems can be demonstrated by them. Multisystem disease is often vascular in origin and atherosclerosis is the commonest arterial pathology. However, atherosclerosis causing hepatic artery occlusion is very rare. Patients with multisystem disease causing cerebral symptoms often have a brain scan and it should be remembered that pathological processes in the urinary system can sometimes be demonstrated during the procedure. This is a case presentation in which the suspicion of renal artery occlusion was raised during the brain scanning procedure, and in the course of investigation of the multisystem disease, intrahepatic artery occlusion was noted.     

Resection of the pancreatic head with or without gastrectomy

Early and late results of proximal pancreatoduodenectomy were determined in a personal and consecutive series of 100 patients (64 men, 36 women, mean age 51.9 years). Final diagnoses were chronic pancreatitis in 35, idiopathic bile duct stricture in 1, carcinoma of the head of pancreas in 27, and other periampullary tumors in 37 (duodenal carcinoma 11, ampullary carcinoma 11, neuroendocrine tumor 10, cholangiocarcinoma 5). Mean follow-up period was 30.5 months (range 3.5–132.0 months). Resection was conventional (including distal gastrectomy) in 39 patients and conservative (retaining the stomach, pylorus, and duodenal cap) in 61 patients. Resection for inflammatory disease caused greater operative blood loss (mean 2.29 versus 1.75 L; p=0.054) and a longer operative time (6.2 versus 5.2 hours; p=0.040) than resection for neoplastic disease. There were four operative deaths, two from leakage of the pancreatic anastomosis; another two patients survived pancreatojejunostomy leaks. Twenty patients developed postoperative complications, seven of whom required reoperation. Good pain relief was obtained in 76% of patients with chronic pancreatitis, but five required completion distal pancreatectomy at a mean 22.8 months after the first resection. Mean survival of patients with pancreatic cancer was 13.2 months. Sixteen patients with other periampullary cancers are still alive 41.6 months after the operation.

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Resumen Se determinaron los resultados tempranos y a largo plazo de la pancreatoduodenectomía proximal en una serie personal y consecutiva de 100 pacientes (64 hombres, 36 mujeres, edad promedio 61.9 años). Los diagnósticos fueron pancreatitis crónica en 35, estrechez idiopática del colédoco en 1, carcinoma de la cabeza del páncreas en 27 y otros tumores periampulares en 37 (carcinoma duodenal 11, carcinoma ampular 11, tumor neoendocrino 10, colangiocarcinoma 5). El período promedio de seguimiento fue 30.5 meses (range 3.5–132.0 meses). La resección fue convencional (incluyendo gastrectomía distal) en 39 pacientes y conservadora (preservando el estómago, el píloro y la primera porción del duodeno en 61 pacientes). La resección por enfermedad inflamatoria causó mayor sangrado operatorio (promedio 2.29 vs 1.75 L; p=0.054) y un tiempo operatorio más prolongado (6.2 vs 5.2 horas; p=0.040) que la resección por enfermedad neoplásica. Se presentaron 4 muertes operatorias, 2 por falla de la anastomosis pancreática; otros 2 pacientes tuvieron fuga de la pancreatoyeyunostomía y sobrevivieron. Veinte pacientes desarrollaron complicaciones postoperatorias, 7 de las cuales requirieron reoperación. Se logró un buen control del dolor en 76% de los pacientes con pancreatitis crónica, pero 5 requirieron completar la pancreatectomía a los 22.8 meses, en promedio, luego de la primera resección. El promedio de sobrevida de los pacientes con cáncer pancreático fue 13.2 meses. Dieciseis pacientes con otros cánceres periampulares se encuentran todavía vivos a los 41.6 meses luego de la operación.

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Résumé Les résultats précoces èt tardifs d'une série consécutive, personnelle, de 100 patients (64 hommes, 36 femmes, âge moyen = 51.9 ans) ayant eu une pancréatectomie proximale sont présentés. II s'agit (diagnostic final) de pancréatite chronique dans 35 cas, de sténose biliaire idiopathique dans un cas, de cancer de la tête du pancréas dans 27 cas, et d'autres tumeurs périampullaires dans 37 cas (cancer duodénal: 11; cancer ampullaire: 11; tumeur neuroendocrine: 10; cholangiocarcinome: 5). Le suivi moyen a été de 30.5 mois (extrêmes: 3.5 à 132 mois). La résection a été conventionnelle (comprenant une gastrectomie distale) chez 39 patients et conservatrice (conservant l'estomac, le pylore et D1) dans 61 cas. Il y a eu plus de perte hémorragique (moyenne 2.29 vs. 1.75 1; p=0.054) et la durée d'intervention était plus longue (6.2 vs. 5.2 heures; p=0.040) en cas de résection pour maladie inflammatoire que lorsqu'il s'agissait de maladie néoplasique. Il y a eu quatre décès opératoires, deux par fuite de l'anastomose pancréatique. Deux autres patients avec fuite anastomotique ont survécu. Vingt patients ont développé des complications postopératoires, parmi lesquels sept ont nécessité une réintervention. Une amélioration de la douleur a été obtenue chez 76% des patients ayant une pancréatite chronique, mais cinq ont nécessité une pancréatectomie distale complémentaire, 22.8 mois en moyenne après la première résection. La survie moyenne des patients ayant un cancer pancréatique à été de 13.2 mois. Seize patients ayant un cancer périampullaire sont encore en vie à 41.6 mois après l'intervention.