Posterior polar cataract: A review

Posterior polar cataract is a rare form of congenital cataract. It is usually inherited as an autosomal dominant disease, yet it can be sporadic. Five genes have been attributed to the formation of this disease. It is highly associated with complications during surgery, such as posterior capsule rupture and nucleus drop. The reason for this high complication rate is the strong adherence of the opacity to the weak posterior capsule. Different surgical strategies were described for the handling of this challenging entity, most of which emphasized the need for gentle maneuvering in dealing with these cases. It has a unique clinical appearance that should not be missed in order to anticipate, avoid, and minimize the impact of the complications associated with it.     

CO-ADMINISTRATION OF FUROSEMIDE AUGMENTS TACROLIMUS-INDUCED IMPAIRMENT IN KIDNEY FUNCTION IN RATS

Sodium-depletion in rats reproduces functional and morphological tacrolimus nephrotoxicity observed in man. Potent diuretics induce sodium-depletion. Our objective was to determine the effect of a loop diuretic furosemide on tacrolimus-mediated functional and pathological impairment of the kidney in rats. Sprague-Dawley rats were divided into four groups; group 1, rats received vehicle (saline) only; group 2, rats were treated with tacrolimus (1mg/kg body weight) and furosemide (5mg/kg body weight); group 3, rats were treated with tacrolimus alone; and group 4, rats were treated with furosemide (5mg/kg body weight) alone. On day 28, tail blood pressure was measured and the rats were placed in metabolic cages for urine collection. After 24 hr the rats were sacrificed. Tacrolimus alone tended to cause growth retardation, hypotension, hypomagnesemia and a rise in blood urea nitrogen. Furosemide co-administration enhanced the effects of tacrolimus on hypotension, hypomagnesemia and a rise in blood urea nitrogen. The renal histology characterized by cytoplasmic vacuolization of the proximal tubules was not different between the rats treated with both tacrolimus and furosemide and the rats treated with tacrolimus alone. A strong immunostaining for FKBP-12, a tacrolimus-binding protein, was observed in the medulla of the kidneys of rats treated with tacrolimus either with or without furosemide.These results indicate that furosemide further augments tacrolimus induced impairment in kidney function, and that furosemide should be used with discretion in patients on tacrolimus therapy.     

Y型留置针单手置管法在桡动脉穿刺中的应用

目的探讨Y型留置针单手置管法应用于桡动脉穿刺中的优势。方法选择150例需行有创动脉监测的危重疑难患者,分为三组各50例。试验组(T组)采用Y型留置针单手置管法,对照组(M组)采用Y型留置针传统操作法,对照组(N组)采用动脉留置针传统操作法。观察每组操作一次性成功率以及操作过程中是否有血液溢出造成血液污染。结果一次穿刺成功率T组明显高于M、N组,差异有统计学意义(P<0.05);血液污染例数T、M组明显少于N组(P<0.05)。结论 Y型留置针单手置管法用于桡动脉穿刺可以提高一次性穿刺成功率,并且可以减少由血液溢出管道造成的血液污染。     

Effects of a nurse-led transitional care program on clinical outcomes,health-related knowledge,physical and mental health status among Chinese patients with coronary artery disease: A randomized controlled trial

BackgroundCoronary artery disease is a major cause of morbidity and mortality among adults worldwide, including China. After a hospital stay, transitional care could help to ensure improved patient care and outcomes, and reduce Medicare costs. Nevertheless, the results of the existing transitional care are not always satisfactory and our knowledge of how to perform effective transitional care for patients with coronary artery disease is limited in mainland China.ObjectivesTo examine the effectiveness of a nurse-led transitional care program on clinical outcomes, health-related knowledge, and physical and mental health status among Chinese patients with coronary artery disease.DesignRandomized controlled trial.MethodsThe Omaha system and Pender’s health promoting model were employed in planning and implementing this nurse-led transitional care program. The sample was comprised of 199 Chinese patients with coronary artery disease. The experimental group (n = 100) received nurse-led transitional care intervention in addition to routine care. The nurse-led transitional care intervention included a structured assessment and health education, followed by 7 months of individual teaching and coaching (home visits, telephone follow-up and group activity). The control group (n = 99) received a comparable length routine care and follow-up contacts. Evaluations were conducted at baseline and completion of the interventions using the perceived knowledge scale for coronary heart disease, the medical outcomes study 36-item short-form health survey and clinical measures (blood pressure, blood glucose, lipids, body mass index). Data were collected between March and October 2014.ResultsCompared with the control group, participants in the experimental group showed significant better clinical outcomes (systolic blood pressure, t = 5.762, P = 0.000; diastolic blood pressure, t = 4.250, P = 0.000; fasting blood glucose, t = 2.249, P = 0.027; total cholesterol, t = 4.362, P = 0.000; triglyceride, t = 3.147, P = 0.002; low density lipoprotein cholesterol, t = 2.399, P = 0.018; and body mass index, t = 3.166, P = 0.002), higher knowledge scores for coronary artery disease (total knowledge score, t = −7.099, P = 0.000), better physical health status (t = −2.503, P = 0.014) and mental health status (t = −2.950, P = 0.004).ConclusionsThis study provides evidence for the value of a nurse-led transitional care program using both the Omaha system and Pender’s health promoting model as its theoretical framework. The structured interventions in this nurse-led transitional care program facilitate the use of this program in other settings.     

Tapia's Syndrome after Posterior Cervical Spine Surgery under General Anesthesia

We present a case report to remind surgeons of this unusual complication that can occur in any surgery, even posterior cervical spine surgery under general anesthesia and discuss its causes, treatment methods, and the follow-up results in the literature. The peripheral Tapia''s syndrome is a rare complication of anesthetic airway management. Main symptoms are hoarseness of voice and difficulty of tongue movement. Tapia''s syndrome after endotracheal general anesthesia is believed to be due to pressure neuropathy of the vagus nerve and the hypoglossal nerve caused by the endotracheal tube. To our knowledge, no report has been published or given an explanation for Tapia''s syndrome after posterior cervical spine surgery. Two patients who underwent posterior cervical surgery complained hoarseness and tongue palsy postoperatively. There is no direct anatomical relation between the operation, the vagus nerves and the hypoglossal nerves, and there is no record of displacement or malposition of the endotracheal tube. After several months, all symptoms are resolved. To avoid this problem in posterior cervical spine surgery, we suggest paying special attention to the position of the endotracheal tube to avoid excessive neck flexion before and during the positioning of the patient.     

Predisposing factors for chronic syndesmotic instability following syndesmotic fixation in ankle fracture: Minimum 5-year follow-up outcomes

BackgroundThis study aimed to identify risk factors for chronic syndesmotic instability following syndesmotic fixation.MethodsWe performed a retrospective review of consecutive patients who had sustained ankle fractures requiring syndesmotic fixation. Patients available for a minimum 5 years of follow-up were classified into 2 groups according to the presence of syndesmotic instability. Statistical binary logistic regression analyses were performed to investigate the significance of various risk factors. Functional outcomes were assessed using the FAOS.ResultsIn total, 166 patients who met the study inclusion criteria underwent analysis. The overall postoperative instability rate was 20.5%, which was significantly affected due to BMI (p = 0.018; OR 6.72), and concomitant posterior malleolar fracture (p = 0.032, OR 2.77). The mean scores in the syndesmotic instability (SI) group were significantly lower than those in the no syndesmotic instability (NSI) group (p = 0.021).ConclusionsObesity and concomitant posterior malleolar fracture were significant risk factors for postoperative syndesmotic instability.