1/59. Double anterior chamber deep lamellar keratoplasty: case report.PURPOSE AND methods: We report a case in which, although we planned to perform a penetrating keratoplasty for corneal stromal opacity with normal corneal endothelium, the host's Descemet's membrane became inadvertently detached and the operation resulted in double anterior chamber deep lamellar keratoplasty (DLKP). RESULT: After surgery, the patient's corrected visual acuity was 20/30. CONCLUSION: Double anterior chamber DLKP is safe and valuable.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
2/59. Aortopulmonary collateral artery embolization during postoperative extracorporeal membrane oxygenation after arterial switch procedure.Aortopulmonary collateral arteries sometimes complicate cyanotic congenital heart defects. Combined with a relevant left-right shunt, this could result in massive airway bleeding during and after corrective surgery. A preoperatively diagnosed 1.2 mm small aortopulmonary collateral artery in a newborn suffering from transposition of the great arteries caused life-threatening airway bleeding during surgery. Postoperative extracorporeal membrane oxygenation (ECMO) was necessary, and coil embolization was performed on ECMO to terminate pulmonary bleeding.- - - - - - - - - - ranking = 5keywords = membrane (Clic here for more details about this article) |
3/59. Accumulation of irrigation fluid in the calf as a complication during high tibial osteotomy combined with simultaneous arthroscopic anterior cruciate ligament reconstruction.Extravasation of irrigation fluid during arthroscopy is a well-known complication. We report a case of accumulation of fluid into the calf during open wedge high tibial osteotomy combined with simultaneous arthroscopic anterior cruciate ligament (ACL) reconstruction. The main cause for fluid extravasation was the drilling of the tibial tunnel, which allowed the fluid to cross the osteotomy gap and invade the flexor compartments. Although an elevation of the intracompartmental pressure was measured, there was no clinical evidence of compartment syndrome. A subcutaneous release of the flexor compartment of the leg was performed. The patient suffered no further sequelae. High tibial osteotomy combined with simultaneous arthroscopic ACL reconstruction has to be performed carefully, and potential complications must be detected immediately to prevent compartment syndrome.- - - - - - - - - - ranking = 39.367947053223keywords = ligament (Clic here for more details about this article) |
4/59. Pseudoaneurysm of a lateral internal carotid artery in the middle ear.We report a case where a 7-year-old girl suffered significant aural bleeding following myringotomy of the tympanic membrane. Investigations by computed tomography scan, carotid angiography, and magnetic resonance angiography showed a lateral aberrant internal carotid artery (LACI) with a little pseudoaneurysm in the middle ear. The anomaly of the internal carotid artery was supposed to be congenital, and the pseudoaneurysm was supposed to be traumatic, formed after incision into the wall of the artery. Considerations about diagnosis, symptoms, and treatment are discussed. The patient was treated by balloon embolization in the internal carotid artery without sequelae.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
5/59. Surgical treatment for severe diabetic macular edema with massive hard exudates.PURPOSE: Massive diabetic macular exudates respond poorly to conventional laser treatment. The purpose of this study was to analyze the surgical results of eyes with massive hard exudates secondary to diabetic macular edema treated with combined pars plana vitrectomy, posterior hyaloid removal, focal endolaser treatment, and panretinal photocoagulation. methods: The author retrospectively analyzed the surgical outcome of 13 consecutive eyes (11 patients) with massive diabetic macular exudates. All patients had had at least one session of focal and/or grid laser treatment without any effect. Pars plana vitrectomy, posterior hyaloid removal, focal macular endolaser treatment, and intraoperative panretinal photocoagulation were performed. Postoperative visual acuity, evolution of macular edema, and hard exudates were recorded. RESULTS: All 13 eyes showed significant decreases in macular edema and hard exudates, a process that became clinically obvious 3 months after the operation. Eleven eyes had improved vision of at least two lines during an average follow-up period of 14.8 months. Intraoperative and postoperative complications included angle closure glaucoma (one eye), persistent vitreous hemorrhage (two eyes), choroidal detachment (one eye), intravitreal fibrin formation (one eye), epiretinal membrane formation (one eye), and neovascular glaucoma (one eye). CONCLUSION: Combined surgery may offer an opportunity for improvement of vision and reduction of massive macular exudates in patients with severe diabetic macular edema.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
6/59. Is the loss of gallstones during laparoscopic cholecystectomy an underestimated complication?Laparoscopic cholecystectomy entails an increased risk of gallbladder rupture and consequent loss of stones in the abdominal cavity. Herein we report the case of a 51-year-old male patient, who underwent laparoscopic cholecystectomy 2 years before presentation to our hospital. He had experienced tension sensation and epigastric pain since 4 months postoperatively. A well-defined epigastric mass, which was hard and painful on palpation, was detected and later confirmed by ultrasonography and CT scan.Explorative laparotomy revealed a mass in the area of the gastrocolic ligament,resulting from biliary gallstones in conjunction with a perimetral inflammatory reaction. A review of the literature showed that the incidence of gallbladder lesions during laparoscopy is 13-40%. In order to prevent this complication, meticulous isolation of the gallbladder, proper dissection of the cystic duct and artery, and careful extraction through the umbilical access are required. ligation after the rupture or use of an endo-bag may be helpful. The loss of gallstones and their retention in the abdominal cavity should be noted in the description of the surgical procedure.- - - - - - - - - - ranking = 7.8735894106446keywords = ligament (Clic here for more details about this article) |
7/59. Initial experience with fenoldopam in children.fenoldopam is a direct-acting vasodilator that acts at the postsynaptic dopamine 1 receptors in renal, coronary, cerebral, and splanchnic vasculature resulting in arterial dilation and a lowering of the mean arterial pressure (MAP). Preliminary evidence suggests its efficacy in the treatment of hypertensive urgencies and emergencies in adults. We present four children in whom fenoldopam was used to control MAP in various clinical scenarios, including hypertensive emergencies and urgencies, intraoperative reduction of MAP for controlled hypotension, and control of MAP during extracorporeal membrane oxygenation. The possible applications of fenoldopam and suggested dosing regimens in children are reviewed.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
8/59. Intraosseous radial nerve entrapment complicating total elbow revision.A 43-year-old man underwent revision of a loose total elbow arthroplasty in 1995. The arthroplasty had been implanted 20 years previously for post-traumatic osteoarthritis after a gunshot wound complicated by permanent ulnar nerve palsy. The patient suffered a minimally displaced periprosthetic fracture 4 years after implantation that was treated closed. The patient subsequently developed severe loosening with bony dilation. During revision surgery, while grasping and removing the periprosthetic membrane from within the humeral medullary canal with a Kerrison rongeur, dorsiflexion of the wrist and hand occurred. Close inspection of the membrane revealed that the radial nerve was encased inside the bone. Although not divided, the traction and contusion of the nerve caused a radial nerve palsy that partially resolved by 4 years of follow-up.- - - - - - - - - - ranking = 2keywords = membrane (Clic here for more details about this article) |
9/59. Surgically induced necrotizing scleritis after pterygium excision and conjunctival autograft.PURPOSE: To report a case of surgically induced necrotizing scleritis (SINS) after pterygium excision and conjunctival autograft. methods: A 55-year-old man presented 2 weeks after excision of primary pterygium with conjunctival autograft in the right eye with severe pain in that eye. He had undergone cataract surgery in that eye 8 months before. The graft was pale and white. The underlying sclera was white and avascular. There was marked inflammation adjacent to the site of surgery and graft. A scraping from the graft surface revealed no organisms in smears, and culture revealed no growth. The conjunctival graft was removed. Amniotic membrane transplantation was performed. After surgery, the amniotic membrane was avascular and pale. Systemic steroid therapy was initiated. RESULTS: Three days after initiation of systemic steroid therapy, the graft became vascularized. Over the next 10 days, the eye quietened, conjunctival and scleral inflammation lessened, and the graft was well accepted. CONCLUSIONS: Surgically induced necrotizing scleritis is a rare complication of pterygium excision with conjunctival autograft. A pale graft with underlying avascular sclera and surrounding inflammation should arouse suspicion of this complication.- - - - - - - - - - ranking = 2keywords = membrane (Clic here for more details about this article) |
10/59. Descemet's membrane detachment associated with inadvertent viscoelastic injection in viscocanalostomy.We report a case of Descemet's membrane detachment, a rare complication of viscocanalostomy. During the operation, the injection cannula was directed slightly oblique to the Schlemm's canal rather than parallel to it. Localized corneal whitening developed adjacent to the injection site during viscoelastic injection. One week postoperatively, corneal edema decreased and Descemet's membrane detachment was noted. Nine months after surgery, the cornea was clear while the Descemet's membrane detachment remained. And IOP was 19 mmHg without any medications. We think that improper cannula positioning during viscoelastic injection may cause Descemet's membrane detachment, a rare complication of viscocanalostomy.- - - - - - - - - - ranking = 8keywords = membrane (Clic here for more details about this article) |
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