Diffuse endometritis in the setting of umbilical endometriosis: a case report

BACKGROUND: Umbilical endometriosis is rare and can be a challenging diagnosis in the absence of classic signs and symptoms. CASE: A case of severe, primary, spontaneous umbilical endometriosis with foci of plasma cell endometritis and diffuse stromal lymphovascular presence occurred. CONCLUSION: Despite a lengthy differential, endometriosis must be considered in the evaluation of an umbilical mass. The presence of plasma cell endometritis and stromal lymphovascular elements in the absence of pelvic endometriosis lends evidence to the theory of lymphovascular transport as an etiology of extrapelvic endometriosis.     

A modified Mainz II pouch technique for management of refractory vesicovaginal fistulas: patient focused outcomes.

OBJECTIVE: To follow-up the quality of life outcomes in 2 women who underwent a modified Mainz II pouch procedure for refractory vesicovaginal fistulas. METHOD: Two Nigerian patients were located after undergoing a modified Mainz II pouch procedure. They were interviewed 1-2 years postprocedure regarding subsequent sexual function, pregnancy outcomes, and daily life. RESULT: After undergoing the procedure the patients had resumed sexual function, had become pregnant, and had delivered viable neonates. They were also able to provide for their families. CONCLUSION: A urinary diversion procedure for management of refractory vesicovaginal fistula can restore quality of life.     

Toric intraocular lenses. Clinical results and rotational stability

Background. Correction of an astigmatism at the time of cataract surgery can be achieved in two different ways, by alteration of the corneal curvature or by implantation of a toric intraocular lens (toric IOL). In the latter, in addition to the wound architecture and IOL calculation, the influence of rotational stability in the capsular bag is most important for the refractive result. Patients and methods. This retrospective study included 26 eyes from24 patients with a corneal astigmatism of 2.5–11 D before cataract surgery of which 24 eyes showed a congenital astigmatism and 2 eyes an astigmatism after keratoplasty. After phakoemulsification a three-piece toric PMMA customised IOL (6.5/13.75 mm) was implanted into the capsular bag. Subjective and objective refraction as well as keratometry and corneal topography were performed pre- and postoperatively. The axis of the toric IOL cylinder was marked and could be measured precisely in the postoperative period. The surgically induced astigmatism (SIA) was calculated. Results. At a mean follow-up time of 12 months after the implantation of a toric IOL, all eyes showed a reduction of total astigmatism. The mean total refractive astigmatism could be reduced from 4.16 D±1.58 D preoperatively to 1.64 D±1.21 D postoperatively. In 6 out of the 26 eyes (23%) the toric IOL rotated more than 10° in the capsular bag and in all 6 cases the IOL rotation happened in the first 3 weeks postoperation. The IOL position was surgically corrected within 3–6 weeks after initial surgery and remained stable during the follow-up period. Conclusions. The implantation of a PMMA toric IOL is a promising procedure to correct higher levels of corneal astigmatism in cataract surgery. The initial rotational stability of the haptics in the capsular bag still has to be improved and the corneal SIA has to be reduced by smaller incisions. Therefore, three-piece foldable IOLs with a new haptic design are under development.     

Sphincter tears in primiparous women: is age a factor?

Anal sphincter tears during vaginal delivery may result in serious sequelae. We examined whether younger primiparous patients were at increased risk for sphincter tears during vaginal delivery. Data from an obstetric automated record were analyzed. Primiparous women delivering term infants (n = 5,937) were included to test for an association between age and sphincter tear rates. Three age groups were considered: young adolescents (≤16 years), older adolescents (17–20 years), and adults (≥21 years). No significant difference was found in tear rates among age cohorts (9.2%, 8.0%, and 9.6% respectively; p = 0.12). Logistic regression modeling revealed that young adolescents were not more likely to have sphincter tears compared to older cohorts. Younger adolescents may not be at increased risk of anal sphincter tears. Decisions regarding interventions to decrease sphincter tears during vaginal delivery should not be made on the basis of maternal age alone. Presented at the 2008 Annual Meeting of the Society of Gynecologic Surgeons, Savannah, GA, USA, April 14–16, 2008.     

Anal sphincter repair for fecal incontinence: effect on symptom severity, quality of life, and anal sphincter squeeze pressures

Introduction and hypothesis  

The objective of this study was to determine the effect of external anal sphincter repair on fecal incontinence symptoms, quality of life, and anal sphincter squeeze pressures.     

In-vitro- und In-vivo-Untersuchungen zur Presbyopiebehandlung mit Femtosekundenlasern

BACKGROUND: Ultrashort (femtosecond) laser pulses can generate precise cuts in biological tissue without damaging the surface. The application of femtosecond laser technology at the lens was evaluated with respect to a possible treatment of presbyopia. MATERIALS AND METHODS: Femtosecond laser lentotomy was performed on 150 pig lenses in vitro. Cutting geometry and laser settings were optimized to generate smooth cuts with a minimum of produced gas bubbles. Four rabbit lenses were treated afterwards in vivo and were controlled for 3 months post-treatment. The lenses were then extracted and evaluated. RESULTS: With suitable laser settings, light scattering due to residual gas bubbles could be almost completely avoided in pig lenses. A pulse energy of less than 1.2 microJ and a cutting geometry with spot separations of more than 5 microm are important. The rabbit lenses stayed macroscopically clear for 3 months in vivo. Only the cell structures directly adjacent to the laser focus were cut; structures 5-10 microm away appeared to be intact. No cataract formation occurred during this time. CONCLUSION: Femtosecond laser application allows precise and smooth cuts inside pig and rabbit lenses without damage to adjacent tissue.     

Retrospective study of retinal detachment following neodymium:YAG laser posterior capsulotomy

A retrospective study of 1,000 cases that had Nd:YAG laser posterior capsulotomy after cataract surgery is presented. We analyzed the correlation of the patient's age, axial length of the eye, method of cataract surgery, and laser parameters (exposures, energy, and burst mode) with the incidence of retinal detachment (1.6% overall). The highest risk for retinal detachment (12.3%) was in patients with an axial eye length of 26.1 mm to 28.0 mm. The average age of patients with retinal detachments was 60.6 years, ten years younger than the collective average age. Laser parameters, such as energy, exposures, and burst mode, and the method of cataract surgery (extracapsular or phacoemulsification) did not correlate with the incidence of retinal detachment. After surgical treatment of the 16 retinal detachments, a good postoperative visual acuity (better than 20/40) was achieved in most cases.