Shortterm and longterm visual and astigmatic results of an opposing 10-0 nylon double running suture technique for penetrating keratoplasty

BACKGROUND: In ophthalmic surgery, corneal transplantation (penetrating keratoplasty) may be employed when the clarity of the cornea has been significantly compromised by conditions such as scarring, edema, and variable corneal thickness. Irregularities in corneal curvature can occur postoperatively. This astigmatism is of concern, because it can impair visual acuity despite an otherwise good surgical result. Different suturing techniques have been developed to minimize astigmatism. The purpose of this study was to evaluate an opposing 10-0 nylon double running suture technique for penetrating keratoplasty. STUDY DESIGN: A retrospective study was undertaken of 91 records of patients who underwent penetrating keratoplasty performed by one surgeon (RNG). This represents 54.8% of 166 consecutive cases. Every eye with an opposing double running suture and a 1- to 3-month postsuture removal followup was selected and evaluated for best corrected visual acuity and astigmatism, excluding eyes that developed graft failure or corneal ulcer or that had lack of adequate followup. The cases were divided into five groups by preoperative diagnosis: pseudophakic bullous keratopathy (n = 43), aphakic bullous keratopathy (n = 5), keratoconus (n = 17), Fuchs dystrophy (n = 12), and miscellaneous (n = 14). The mean standard followup period was 13.7 months after penetrating keratoplasty. Thirty percent of the eyes had an extensive followup, with a mean of 33 months after penetrating keratoplasty. RESULTS: Eighty-two percent of the patients had a significant improvement of their visual acuity postoperatively, defined by a five-line improvement of best corrected visual acuity or a best corrected visual acuity of 20/40 or better. The mean astigmatic keratometric reading was 3.98 diopters, with a manifest refraction cylinder of 3.42 diopters at the 1- to 3-month postsuture removal visit. This study also shows that there is no statistically significant change in keratometric astigmatism or manifest refraction cylinder from the 1- to 3-month postsuture removal measurements to the more extensive followup of 18 to 66 months after penetrating keratoplasty (p > 0.10). CONCLUSIONS: This suture technique allows for excellent longterm stability of the wound with visual and astigmatic results that are comparable to those of previous studies. The use of the opposing double running suture is a viable alternative to some of the other widely used techniques and may be considered more stable and secure.     

Classification of neurovascular compression in typical hemifacial spasm: three-dimensional visualization of the facial and the vestibulocochlear nerves

OBJECT: In this paper, the authors introduce a method of noninvasive anatomical analysis of the facial nerve-vestibulocochlear nerve complex and the depiction of the variable vascular relationships by using 3D volume visualization. With this technique, a detailed spatial representation of the facial and vestibulocochlear nerves was obtained. Patients with hemifacial spasm (HFS) resulting from neurovascular compression (NVC) were examined. METHODS: A total of 25 patients (13 males and 12 females) with HFS underwent 3D visualization using magnetic resonance (MR) imaging with 3D constructive interference in a steady state (CISS). Each data set was segmented and visualized with respect to the individual neurovascular relationships by direct volume rendering. Segmentation and visualization of the facial and vestibulocochlear nerves were performed with reference to their root exit zone (REZ), as well as proximal and distal segments including corresponding blood vessels. The 3D visualizations were interactively compared with the intraoperative situation during microvascular decompression (MVD) to verify the results with the observed microneurosurgical anatomy. RESULTS: Of the 25 patients, 20 underwent MVD (80%). Microvascular details were recorded on the affected and unaffected sides. On the affected sides, the anterior inferior cerebellar artery (AICA) was the most common causative vessel. The posterior inferior cerebellar artery, vertebral artery, internal auditory artery, and veins at the REZ of the facial nerve (the seventh cranial nerve) were also found to cause vascular contacts to the REZ of the facial nerve. In addition to this, the authors identified three distinct types of NVC within the REZ of the facial nerve at the affected sides. The authors analyzed the varying courses of the vessels on the unaffected sides. There were no bilateral clinical symptoms of HFS and no bilateral vascular compression of the REZ of the facial nerve. The authors discovered that the AICA is the most common vessel that interferes with the proximal and distal portions of the facial nerve without any contact between vessels and the REZ of the facial nerve on the unaffected sides. CONCLUSIONS: Three-dimensional visualization by direct volume rendering of 3D CISS MR imaging data offers the opportunity of noninvasive exploration and anatomical categorization of the facial nerve-vestibulocochlear nerve complex. Furthermore, it proves to be advantageous in establishing the diagnosis and guiding neurosurgical procedures by representing original MR imaging patient data in a 3D fashion. This modality provides an excellent overview of the entire neurovascular relationship of the cerebellopontine angle in each case.     

Changes in thoracolumbar computed tomography and radiography utilization among trauma patients after deployment of multidetector computed tomography in the emergency department

BACKGROUND: Diagnostic-quality thoracolumbar spine (TLS) images, generated from routine thoracoabdominal multidetector computed tomography (MDCT) data, have been demonstrated superior to conventional radiography (CR) for TLS injury. We evaluated thoracoabdominal computed tomography (CT) and TLS utilization among trauma patients after deployment of MDCT. We hypothesized that reformatted MDCT images replaced CR for evaluation of TLS trauma among patients undergoing chest or abdominal CT, and that utilization of thoracoabdominal CT and TLS screening in trauma increased postMDCT. METHODS: We reviewed all TLS imaging for trauma patients undergoing chest or abdominal CT for 18 months pre- and postMDCT. We compared the relative use of CR and CT in TLS imaging, and the volume of TLS screening, and chest and abdominal CT across the study period. We also reviewed TLS CR in patients not undergoing chest or abdominal CT. RESULTS: After MDCT deployment, CT replaced CR for TLS imaging among those undergoing chest or abdominal CT for trauma. Utilization of chest and abdominal CT and TLS screening significantly increased, despite unchanged volume and severity of trauma patients during the study period. There was a corresponding decrease in patients evaluated with thoracic spine CR alone CONCLUSIONS: Reformatted TLS images using thoracoabdominal CT data have replaced CR in our evaluation of TLS trauma. However, reasons for increased utilization remain unclear. Further studies are needed to determine whether clinical yield and cost-effectiveness warrant these changes in utilization.     

Chest injury in victims of Bam earthquake

Objective:To analyze the data of trauma patients with thoracic injury in the earthquake of Bam admitted to hospitals of Tehran University of Medical Science (TUMS) for better understanding the type and consequence of thoracic injuries in a major earthquake. Methods:After Bam earthquake registering 6.5 on the Richter scale, 526 trauma patients were admitted to hospitals of TUMS. Among them, 53 patients sustained thoracic injury. Results: This group was composed of 21 females (39.6%) and 32 males (60.4%). Fifteen patients (28.3%) had isolated chest injuries. Rib fracture (36.4%) was the most common injury in our patients and haemo/pneumothorax (25.5%) followed. Superficial injury was the most common accompanying injury. Multipletrauma patients with chest injury had higher injury severity score (ISS) versus patients with isolated chest injury (P=0.003). Conclusions:Chest wall injuries and haemo/ pneumothorax comprise a considerable number of injuries in survival victims of earthquakes. Consequently, the majority of these patients can be treated with observation or tube thoracostomy. We should train and equip the health workers and members of rescue teams to treat and manage these patients in the field.     

Influence of the HMG-CoA-reductase inhibitor lovastatin on cholesterol saturation index and nucleation time of duodenal bile

Owing to the presence of hyperlipoproteinemia IIa, twelve patients without gallstones were treated daily with 20 mg, 40 mg and 80 mg of Lovastatin, each dose being administered for 4 weeks. At the conclusion of each 4-week treatment phase, bile was obtained from the fasting patient following injection of 5 micrograms ceruletid i.v. with the aid of a duodenal tube. The long nucleation time of bile was not shortened by the therapy. The bile cholesterol saturation index showed a decline with Lovastatin, which was particularly obvious in patients with an initially oversaturated bile. In contrast to other lipid-reducing agents (e.g. fibrates), Lovastatin does not lead to increased lithogenesis of the bile, but may in certain circumstances have an prophylactic effect against the formation of gallstones.     

Progressive-toric IOL design reduces residual astigmatism with increasing pupil size: a ray-tracing simulation based on corneal topography data

Population studies indicate that astigmatism decreases from the corneal center toward the periphery. A standard toric intraocular lens (IOL) with a constant cylinder power cannot correct uniformly across this gradient. We built an astigmatic eye model based on corneal topography data. A progressive-toric lens with gradually decreasing cylinder power was compared with an identically designed lens but featuring conventional astigmatism correction. Residual astigmatism did not differ significantly (P=0.06) at 3 mm, and the Strehl ratio was identical for both lenses (0.51 ±0.15, P=0.88). At 5 mm, the progressive IOL yielded significantly lower residual astigmatism by 0.10 D (P<0.001). The Strehl ratio was 0.30 ±0.08 with the progressive and 0.29 ±0.08 with the standard lens (P<0.001). At 3 mm, the optical performance was comparable for both IOLs. However, at 5 mm, the progressive-toric was more effective in correcting astigmatism, and it yielded reduced residual astigmatism compared to a standard toric lens.     

Comparative evaluation of effects of different surface treatment methods on bond strength between fiber post and composite core

PURPOSE

Debonding of a composite resin core of the fiber post often occurs at the interface between these two materials. The aim of this study was to evaluate the effects of different surface treatment methods on bond strength between fiber posts and composite core.

MATERIALS AND METHODS

Sixty-four fiber posts were picked in two groups (Hetco and Exacto). Each group was further divided into four subgroups using different surface treatments: 1) silanization; 2) sandblasting; 3) Treatment with 24% H₂O₂, and 4) no treatment (control group). A cylindrical plexiglass matrix was placed around the post and filled with the core resin composite. Specimens were stored in 5000 thermal cycles between 5℃ and 55℃. Tensile bond strength (TBS) test and evaluation using stereomicroscope were performed on the specimen and the data were analyzed using two-way ANOVA, Post Hoc Scheffe tests and Fisher''s Exact Test (α=.05).

RESULTS

There was a significant difference between the effect of different surface treatments on TBS (P<.001) but different brands of post (P=.743) and interaction between the brand of post and surface treatment (P=.922) had no significant effect on TBS. Both silanization and sandblasting improved the bonding strength of fiber posts to composite resin core, but there were not any significant differences between these groups and control group.

CONCLUSION

There was not any significant difference between two brands of fiber posts that had been used in this study. Although silanization and sandblasting can improve the TBS, there was not any significant differences between surface treatments used.     

Factors associated with external ventricular drain placement accuracy: data from an electronic health record repository

Background

We evaluated external ventricular drain placement for factors associated with placement accuracy. Data were acquired using an electronic health record data requisition tool.

Method

Medical records of all patients who underwent ventriculostomy from 2003 to 2010 were identified and evaluated. Patient demographics, diagnosis, type of guidance and number of catheter passes were searched for and recorded. Post-procedural hemorrhage and/or infection were identified. A grading scale was used to classify accuracy of catheter placements. A multiple logistic regression model was developed to assess features associated with accurate catheter placement.

Results

One hundred nine patients who underwent 111 ventriculostomies from 2003 to 2010 were identified. Patient diagnoses were classified into vascular (63 %), tumor (21 %), trauma (14 %), and cyst (2 %). Procedures were performed freehand in 90 (81 %), with the Ghajar guide in 17 (15 %), and with image guidance in 4 (4 %) patients. Eighty-eight (79 %) catheters were placed in the correct location. Trauma patients were more likely to have catheters misplaced (p?=?0.007) whereas patients in other diagnostic categories were not significantly associated with misplaced catheters. Post-procedural hemorrhage was noted in 2 (1.8 %) patients on post-procedural imaging studies. Five (4.5 %) definite and 6 (5.4 %) suspected infections were identified.

Conclusions

External ventricular drain placement can be performed accurately in most patients. Patients with trauma are more likely to have catheters misplaced. Further development is required to identify and evaluate procedure outcomes using an electronic health record repository.