Surgical therapy of chronic glaucoma in aphakia and pseudophakia

Most glaucoma surgical procedures are less successful in aphakic or pseudophakic eyes. The authors reviewed 91 consecutive initial glaucoma procedures in aphakic patients from 1979 to 1986 to determine successful outcomes and complications. Success was defined as an intraocular pressure (IOP) of at least 30% below the preoperative value and less than 21 mmHg, less than 2 lines of Snellen acuity loss, and no further surgical intervention. At 9 months, success rates were: trabeculectomy, 4 of 15 patients; cyclodialysis, 3 of 20 patients; neodymium:YAG (Nd:YAG) cyclophotocoagulation, 1 of 8 patients; cyclocryotherapy, 9 of 22 patients; anterior chamber tube shunt (Schocket procedure), 3 of 6 patients; and argon laser trabeculoplasty, 2 of 20 patients. Severe complications included phthisis bulbi in 11% of cyclocryotherapy and severe visual loss in 20% with cyclodialysis and 14% with cyclocryotherapy. Results confirm the difficulty of surgical therapy in these patients.     

Porcine dermal collagen graft in abdominal-wall reconstruction.

We describe the use of a porcine dermal collagen graft in the reconstruction of a large abdominal-wall defect in a woman. The graft was not rejected and, after 1 year, was not associated with incisional hernia. This graft may become an alternative to synthetic-mesh and flap reconstructions because, despite being of a similar tensile strength, it promotes less adhesion, is incorporated into the host tissue and is less prone to infection.     

Obstructive uropathy secondary to calcified metastatic adenocarcinoma of colon

The first reported case of complete obstruction of the ureter secondary to calcified metastatic lymph nodes is reported. Clinical diagnosis was made on the basis of x-ray studies and confirmed at postmortem examination. The nodes showed a coarse granular type of calcification which is characteristic of metastatic mucin-producing adenocarcinoma of the colon. If this type of calcification is noted in the pelvis, an intravenous urogram should be performed to exclude hydronephrosis secondary to nodal compression and obstruction.     

Successful outcome of advanced abdominal pregnancy with exclusive omental insertion.

We report the case of an advanced abdominal pregnancy with exclusive omental insertion whose extrauterine location was not established until delivery by Cesarean section at 35 weeks' gestation. It is hard to believe that omental placentation alone would be sufficient to sustain a pregnancy beyond a gestation where the fetus is viable. However, this report challenges such myths and opens the debate as to what represents the minimal placental maternal viscus contact necessary to achieve fetal viability. The case also demonstrates the continuing difficulty in diagnosing this rare but serious condition despite advances in obstetric imaging, and advocates methods to avoid missing the diagnosis, which could be easily incorporated at booking and mid-trimester scans. Apart from this case, few reports describe normal umbilical artery Doppler velocimetry in advanced abdominal pregnancy. There is a paucity of research on suitable clinical investigations prognostic for abdominal pregnancy, although this case provides further evidence for the use of Doppler as a useful surveillance tool in such cases. Finally, this case propagates the ethical and clinical controversy that exists in managing abdominal pregnancy, particularly when diagnosed late after attaining fetal viability. Expectant management may represent a feasible alternative to surgical termination provided the woman is fully informed of the attendant risks and close surveillance of the pregnancy is undertaken.