Photodynamic therapy and photodiagnosis for Barrett''s oesophagus and early oesophageal carcinoma

Over the last few decades the there has been a huge increase in the incidence of oesophageal adenocarcinoma, surpassing that of any other solid tumour. Barrett's oesophagus is recognised as a pre-malignant cursor. Surveillance programmes have evolved to monitor Barrett's oesophagus, with the intention to detect early malignant transformation. Using photosensitive agents photodiagnosis is developing to detect this transformation before it is visible endoscopically to allow early treatment. Photodynamic therapy is a non-thermal endoscopic ablative technique, which incorporates the same photosensitive agents to treat Barrett's oesophagus as well as malignant disease. In this article we review the present status of photodiagnosis and photodynamic therapy in the management of Barrett's oesophagus and early oesophageal carcinoma.     

Ultrasound biomicroscopic features of spherophakia

Background: Spherophakia is an uncommon diagnosis. This is the first case report of spherophakia evaluated by ultrasound biomicroscopy.
Methods: Ultrasound biomicroscopy is a new diagnostic technique developed by one of the authors and provides images with microscopic resolution of the anterior segment. A patient with spherophakia was evaluated by ultrasound biomicroscopy (Zeiss-Humphrey, 50MHz) before and after YAG laser iridotomy.
Results: Ultrasound biomicroscopic assessment revealed a shallow anterior chamber, a very steep anterior lens curvature, iridolenticular contact, elongated zonules, and an increased distance between the lens equator and the ciliary processes. Angle closure glaucoma was due to a pupil block mechanism. The pupil block was relieved by YAG laser iridotomy.
Conclusions: Ultrasound biomicroscopy is a useful technique to confirm the diagnosis of spherophakia. The pupil block in spherophakia is relieved by YAG laser iridotomy.     

Waiting list hurdles and the role of the pre-surgical booking clinic

Patients requiring surgery have two main hurdles to cross--long waiting lists and the risk of late cancellation when dates become available. A study was conducted to investigate the inconvenience caused by late cancellation, and to show how the pre-surgical assessment clinic can be utilised to reduce the dissatisfaction and disappointment of the current waiting list system in surgery.     

Filtration of fentanyl is not the cause of the elevation of arterial blood pressure associated with post-bypass ultrafiltration in children

Modified ultrafiltration after cardiopulmonary bypass in children has been shown to be associated with an increase in arterial blood pressure. As part of a series of studies to investigate the possible causes of this blood pressure elevation, the hypothesis that if filtration was removing a significant amount of fentanyl, then the increase in blood pressure might be due to pain was proposed. Ten children, aged between 0.5 and 9.3 years (median 3.8 years), weighing 5.9 to 25..5 kg (median 15.7 kg), underwent corrective cardiac surgery (incorporating modified ultrafiltration). A standard anesthetic protocol was followed, with up to 78 μg/kg of fentanyl given prebypass for analgesia. After completion of cardiopulmonary bypass, modified ultrafiltration was commenced at 100 mL/min until a hematocrit of 35% was reached. Samples were taken of arterial blood (prefiltration, 3, 10, and 20 minutes postfiltration), the venous reservoir blood (prefiltration) and the filtrate (5 and 10 minutes into filtration). Hemodynamic data were recorded both prefiltration and postfiltration. The hemodynamic data showed the expected rise in both systemic arterial pressure and cardiac index after ultrafiltration. The plasma fentanyl concentrations did not significantly change after ultrafiltration: 1.59 to 12.39 ng/mL (median 6.27 ng/mL) prefiltration and 2.05 to 15.59 ng/mL (6.29 ng/mL) at 3 minutes, 2.22 to 12.64 ng/mL (6.87 ng/mL) at 10 minutes, and 1.83 to 11.52 ng/mL (5.85 ng/mL) at 20 minutes postfiltration. The concentration of fentanyl in the venous reservoir, 2.06 to 11.64 ng/mL (7.04 ng/mL), was not significantly different from the plasma levels. The level of fentanyl in the filtrate was significantly less than the plasma levels, 0.243 to 1.87 ng/mL (0.894 ng/mL) at 5 minutes and 0.385 to 1.688 ng / mL (0.952 ng / mL) at 10 minutes into filtration; (P < 0.02 by the Wilcoxon signed-rank method). The data show that the plasma fentanyl concentration was not significantly reduced by modified ultrafiltration. The fentanyl levels found prefiltration were maintained postfiltration, and the observed changes in systemic arterial pressure were not due to an acute fall in the plasma concentration of analgesic drug.     

Internal fixation of a capitate fracture with Herbert screws

A case of an isolated, displaced fracture of the capitate is described. This rare carpal injury was treated by internal fixation with two Herbert screws. The fracture united and the patient achieved an excellent range of wrist motion. The Herbert screw is useful in the treatment of displaced fractures of the capitate since the screw maintains reduction, compresses the fracture site, and allows early wrist motion.