Endoscopic submucosal dissection for premalignant lesions and noninvasive early gastrointestinal cancers

AIM: To investigate the indication, feasibility, safety, and clinical utility of endoscopic submucosal dissection (ESD) in the management of various gastrointestinal pathologies. METHODS: The medical records of 60 consecutive patients (34 female, 26 male) who underwent ESD at the gastroenterology department of Kocaeli University from 2006-2010 were examined. Patients selected for ESDhad premalignant lesions or non-invasive early cancers of the gastrointestinal tract and had endoscopic and histological diagn...     

Trabeculectomy for advanced glaucoma

The objective of this study is to evaluate the visual prognosis and postoperative course in advanced glaucoma patients who underwent trabeculectomy. The records of 30 patients with advanced visual field (VF) defects undergoing trabeculectomy were retrospectively reviewed. Severe VF defects were defined as those with a sensitivity of ≤5 dB either in more than 85% of test points, excluding the central four points, or in >75% of test points, including three of the central four points with threshold automated perimetry. Main outcome measures were intraocular pressure (IOP), corrected visual acuity (VA) and mean deviation (MD) of VF tests. Mean preoperative IOP, VA and MD values were compared with their respective postoperative values. The latest examination of each patient was used to determine postoperative outcome measures. In addition, any complications encountered were recorded. A total of 34 trabeculectomies were performed. The mean age was 59.3 years (13–80 years). The mean follow-up time was 41.1 months (3–120 months). Preoperatively the mean IOP was 28.4 ± 13.1 mmHg, and the mean postoperative IOP was 14.8 ± 5.0 mmHg (P = 0.001). Preoperatively the mean VA was 0.87 ± 80, and the mean value of the MD was −24.5 ± 6.7 dB. At the latest follow-up there was no significant difference in VA (0.89 ± 79, P = 0.699) and MD (−23.9 ± 6.7, P = 0.244) values. Transient hypotony occured in five eyes while one eye with mitomycin C trabeculectomy experienced extended hypotony. Ten eyes showed reduction of VA between 1 and 5 lines due to cataracts and five eyes had late bleb failure with uncontrolled IOP. One patient had late endophthalmitis and one patient presented with blebitis, both of which were successfully treated. No patients experienced wipe-out phenomenon. In conclusion, our study of advanced glaucoma patients undergoing trabeculectomy, vision was preserved with no cases of unexplained loss of central vision. IOP was largely controllable, with cataract being the leading factor decreasing VA at late term.     

Fabrication of a retrievable cement- and screw-retained implant-supported zirconium fixed partial denture: a case report

It can be difficult to achieve superior esthetics in implant-supported fixed partial dentures (FPDs). Zirconia ceramics with high flexural strength and esthetic can be treatment options for implant-supported FPDs. This article describes a simple and reliable method to fabricate a retrievable cemented implant-supported zirconia FPD.     

A Rare Cause of Pulmonary Hypertension: Congenital Bilateral Atresia of the Superior Pulmonary Arteries and Bilateral Stenosis of the Inferior Pulmonary Arteries

Bilateral absence (atresia) of the superior pulmonary arteries, combined with bilateral stenosis of the inferior pulmonary arteries, has not to our knowledge been reported before now. We report such a case in a 48-year-old woman, together with the medical and percutaneous catheter interventions used to treat her condition.Key words: Adult, echocardiography, heart defects, congenital/diagnosis/therapy, hypertension, pulmonary, pulmonary angiography, pulmonary artery/abnormalitiesThe absence of a main branch of the pulmonary artery (PA) was first described by Fraentzel in 1868.¹ The patient who survives to adulthood with this condition usually presents with an abnormal chest radiograph, but with no concomitant cardiovascular abnormalities, with few symptoms, and with any of a variety of erroneous diagnoses.² When pulmonary hypertension is present in the absence of a PA branch, the patient''s condition can be improved by revascularization of the side with the absent artery. In stenotic PAs, intravascular stents have been used to good effect. We report a case of combined bilateral atresia and stenosis, a condition that to our knowledge has not previously been reported. Further, we describe the medical and percutaneous catheter interventions used to treat the patient, and their effectiveness.     

Lumbar Epidural Varix Mimicking Disc Herniation

Lumbar radiculopathy is generally caused by such well-recognized entity as lumbar disc herniation in neurosurgical practice; however rare pathologies such as thrombosed epidural varix may mimic them by causing radicular symptoms. In this case report, we present a 26-year-old man with the complaint of back and right leg pain who was operated for right L4–5 disc herniation. The lesion interpreted as an extruded disc herniation preoperatively was found to be a thrombosed epidural varix compressing the nerve root preoperatively. The nerve root was decompressed by shrinking the lesion with bipolar thermocoagulation and excision. The patient''s complaints disappeared in the postoperative period. Thrombosed lumbar epidural varices may mimic lumbar disc herniations both radiologically and clinically. Therefore, must be kept in mind in the differential diagnosis of lumbar disc herniations. Microsurgical techniques are mandatory for the treatment of these pathologies and decompression with thermocoagulation and excision is an efficient method.