“White dot syndromes”, an inappropriate and outdated misnomer

International Ophthalmology -     

Laparotomic versus laparoscopic Duhamel pull-through for Hirschsprung disease in infants and children

PURPOSE: The aim of this study was to analyze the results from laparotomic and laparoscopic Duhamel pull-through in the treatment of Hirschsprung disease. MATERIALS AND METHODS: In our department, the Duhamel pull-through technique was adopted in most patients and the laparoscopic technique used since 1999 follows the original Duhamel procedure. Patients were identified retrospectively and followed up in our outpatient clinic. Preoperative, operative, and postoperative data were collected and analyzed. RESULTS: Between January 1992 and March 1999, 21 children with Hirschsprung disease underwent primary surgical correction using the classic open Duhamel pull-through. The mean age at operation was 14 months, the median operating time was 297 minutes, and the average postoperative stay was 10 days. From April 1999 to December 2003, 22 children underwent laparoscopic Duhamel pull-through. The mean age at operation was 14.6 months, the mean operative time was 253 minutes, and the mean postoperative stay was 6.8 days. The rates of early (4.7% vs. 4.7%) and late (19% vs. 23.8%) complications were similar in the two groups, but in the laparoscopic group the mean operative time and postoperative hospital stay were lower. CONCLUSION: With these encouraging results, laparoscopic Duhamel pull-through has become our procedure of choice in the surgical management of Hirschsprung's disease.     

The Vascular Join: a new sutureless anastomotic device to perform end-to-end anastomosis. Preliminary results in an animal model

Standard vascular techniques don't meet new surgeons' needs for the more complex vascular reconstructions, minimal invasive approaches and robotic surgery. Therefore, alternative ways to perform vascular anastomosis are always welcome. We present a new sutureless vascular connector and the first animal study. The Vascular Join consists of two metallic rings fixed to the extremity of two conduits being joined together, connected with a snap-on system. The key element that makes this device different from all other sutureless devices is that there is no foreign material inside the vessel lumen. In 10 adult sheep, both carotid arteries were prepared and severed after heparinisation. Twenty end-to-end vascular anastomoses were performed and controlled with intravascular ultrasound and colour-Doppler. Animals were sacrificed and a histopathological analysis was carried out. All anastomoses were successfully completed without bleedings, stenosis or occlusions. The histological results confirmed the perfect vessel edges apposition and absence of foreign material in the vessel lumen. The intimal layer was intact. Vascular Join can easily perform sutureless end-to-end anastomoses and it can be used either with biological or prosthetic materials. Further animal studies are underway to assess the long-term results. Following the same technical criteria, we are developing an end-to-side anastomotic device.     

Spinal cord stimulation and quality of life in patients with refractory angina]

BACKGROUND: Spinal cord stimulation (SCS) is a treatment that exploits the antalgic and vasodilatory effects on the microcirculation produced by a stimulating electrode positioned in the peridural space. This therapy has been used for years in the treatment of refractory angina pectoris. The aim of this study was to monitor the clinical effectiveness of the technique in terms of symptomatic benefits and, above all, improved quality of life in angina patients undergoing SCS. METHODS: From November 1998 to December 2000 we used SCS to treat 17 patients with refractory angina (functional class III or IV Canadian Cardiovascular Society) with onset more than one year earlier. All patients had undergone one or more traditional revascularisation procedures and were receiving maximum drug therapy. Patients were assigned to SCS because it was not technically possible to perform other revascularisation procedures. Quality of life was measured before and after treatment using a multidimensional index (QL Spitzer's index). We also noted the mortality, acceptance and morbidity of the procedure during a follow-up lasting 10 months on average. Lastly, the number of weekly anginal pain attacks, weekly nitrate consumption and CCS functional class were recorded before treatment and 1, 3 and six months after therapy. RESULTS: SPC was effective in 13 patients out of 17 (76.47%). In responders the quality of life improved by 70%: in these patients, the number of weekly angina attacks reduced from 11.76+/-7.56 to 2.14+/-2.54, and the functional class from 3.30+/-0.75 to 1.5+/-0.53. No major periprocedural complications were reported. The annual mortality rate was 6.6%. The technique was easy to use. CONCLUSIONS: The results of this study show that SCS is effective, safe, easy to use and well tolerated by patients with refractory angina who fail to respond to traditional revascularisation. This technique substantially improves the quality of life of patients suffering from refractory angina.     

Long-term control of choroidal neovascularization in quiescent congenital toxoplasma retinochoroiditis with photodynamic therapy: 4-year results

Purpose To evaluate the efficacy and safety of photodynamic therapy (PDT) in the long-term control of subfoveal choroidal neovascularization (CNV) associated with toxoplasmic retinochoroiditis. Methods The records of 13 patients with classic subfoveal CNV associated with toxoplasmic retinochoroiditis treated with PDT were reviewed. All patients were followed up for at least 48 months. Postoperative visual acuity was defined as a gain or loss of two or more lines of best-corrected visual acuity (BCVA), respectively. Post-treatment CNV size was dichotomized into “increased” if the major CNV diameter (CMD) had increased by ≥300 μm, and as “stable/reduced” if it had decreased by ≥300 μm or had not changed by >300 μm. Results Nine patients [four males (44.4%) and five females (55.6%)] with a mean age of 20.1 ± 4.3 years (range 14–27 years) were enrolled in the study. All had unilateral involvement. The median follow-up was 55 months (minimum 48, maximum 65 months). At the 48-month follow-up, all patients had stable/improved BCVA and a mean stable/reduced CMD (846 ± 326.5 μm), with the BCVA having improved significantly (p < 0.0001) from 0.29 ± 0.19 at baseline to 0.54 ± 0.16 at 48 months. Conclusion Photodynamic therapy seems to be a safe and effective approach to the long-term control of subfoveal CNV associated with toxoplasmic retinochoroiditis. Further trials are needed to validate these findings.