[Endovascular embolization for pulmonary artery pseudoaneurysms with massive hemoptysis].

Objective: To investigate the efficacy and safety of transcatheter embolization for the treatment of pulmonary artery pseudoaneurysms (PAPs) with massive hemoptysis via both arterial and venous access. Methods: The clinical data of 15 patients of pulmonary tuberculosis presenting with massive hemoptysis, who were confirmed by CTA/DSA with PAPs at the Second Affiliated Hospital of Hainan Medical University from January 2016 to February 2018, were retrospectively analyzed. The imaging presentation, technical and clinical success of endovascular treatment, and recurrence of hemoptysis within 1 year was recorded. Results: A total of 15 PAPs were involved. Fourteen PAPs were confirmed by pulmonary CTA and one by angiography. Six PAPs were visualized during bronchial artery angiography, 4 PAPs during pulmonary artery angiography, and 4 PAPs both. One PAP was not shown during catheter-directed angiography. Except for one patient who died of asphyxia due to severe hemoptysis undergoing embolization, hemoptysis relapse was achieved in 14 patients after endovascular treatment. During 12 months follow-up, one patient underwent surgical resection because of recurrent hemoptysis 2 weeks after embolization, and another patient with recurrence hemoptysis 3 months after embolization received repeated intervention and hemoptysis relapsed. Conclusion: Transcatheter embolization via dual access is effective and feasible for the treatment of PAPs with massive hemoptysis in patients with pulmonary tuberculosis, but still some risks.

Primary lymphoepithelioma-like carcinoma of ocular adnexa: clinicopathologic features and treatment.

BACKGROUND AND METHODS: Lymphoepithelioma-like carcinoma (lelc) is a rare malignancy in ocular adnexa. Here, we report 4 patients with lelc and review 11 patients reported in the literature. Clinical profiles, association with Epstein-Barr virus (ebv), treatment, and outcomes are analyzed. RESULTS: Lacrimal glands and the lacrimal drainage system, eyelid, and conjunctiva are potential primary sites for lelc. The tumours are characterized histologically by nests of undifferentiated malignant cells surrounded by lymphoid infiltrates. Infection with ebv was confirmed in lelc of ocular adnexa, and that association seemed to be restricted to Asian populations. Results from our centre uniformly showed expression of ebv-encoded small rnas in primary tumour, locally recurrent tumour, and metastatic lymph nodes. This disease had a tendency to relapse regionally. Postoperative radiotherapy seems to improve disease-free survival. Tumours appear to be sensitive to radiotherapy and chemotherapy based on cisplatin and 5-fluorouracil. At our centre, 3 patients were still living at 22, 33, and 76 months after surgery. One patient died of distant metastasis after a survival of 38 months. CONCLUSIONS: Lymphoepithelioma-like carcinoma is a heterogenous entity among ocular adnexal malignancies. Multimodality treatment provides a better chance at survival. Further investigation is required to achieve a better understanding of the biologic behavior of this entity and of its optimal treatment.

[Surgical management and its complications of the dislocated lens].

Dislocated lenses of 218 patients (230 eyes) were performed lens extraction and followed up 1-120 months, averaging 12 months. The results were satisfactory in that the visual acuity was improved in 160 eyes (69.6%), including 145 eyes (63.0%) of visual acuity 0.1 or over and 96 eyes (41.7%) 0.3 or over. Among the 70 eyes (30.4%) of poor results, 45 (64.3%) were due to preoperative conditions, and 25 (35.7%) due to surgical complications. It is important that intraocular hemorrhage, vitreous loss, inflammation and secondary glaucoma be guarded against during and after the operation.

[Vitreous loss and the incidence of cystoid macular edema].

81 patients (81 eyes) with senile cataract were performed intracapsular cataract extraction, and fluorescein angiography 1 to 6 months postoperative revealed the incidence of cystoid macular edema to be 68% (21/31 eyes) in cataract extractions with vitreous loss and 14% (7/50 eyes) in those without, the difference between the 2 groups was very significant (P less than 0.01).

[Complications following Nd: YAG laser posterior capsulotomy].

We used neodymium-YAG laser to perform discissions of the posterior capsules in 221 eyes of 203 patients who had undergone previous extracapsular cataract extractions. After a follow-up period ranging from 1-96 months, in the mean 10.5 months, 47.06% of the eyes achieved corrected visual acuities of > or = 0.5. The complications included rhegmatogenous retinal detachment in 3 eyes (1.36%) and bullous keratopathy in one eye (0.45%). Although cystoid macular edema and glaucoma were not seen in this series, they had been reported. The author suggests that patients undergoing Nd: YAG laser capsulotomies require ongoing medical observations to detect and treat these complications.

[Congenital cataract extraction with primary posterior chamber IOL implantation].

Congenital cataracts in 41 eyes were extracted with primary implantation of posterior chamber IOLs, of which 35 were the one-piece PMMA variety. The patients were followed up 3-28 months, averaging 9.5 months. Corrected visual acuities of 1.0-1.5 were achieved in 29.3% and 0.5 or better in 85.4% of the eyes. Postoperative complications were few. Among 34 eyes of preoperative low vision, visual acuities of 0.3 or over were restored to 31 eyes (91.2%) immediately after the operation.

[Intraocular lens implantation in Fuchs' syndrome].

10 patients of Fuchs' syndrome underwent ECCE with IOL implantation. The etiopathology of this disease, the prevention and management of intra- and post-operative complications were discussed. Three months after the operation, the rate of corneal endothelial cell loss was 23.96%. After an average follow-up of 20 months, 80% of the cases obtained corrected visual acuity of 0.5 and over, indicating that the procedure had been rewarding and safe.

[Cataract extraction and intraocular lens implantation in patients with uveitis].

Thirty two patients with uveitis had a posterior chamber intraocular lens implantation after extracapsular cataract extraction. After a mean follow-up period of 5.4 months (range 3 to 29 months), the corrected visual acuity in 93.7% of the patients reached to 0.5 or better. Postoperative complications included posterior capsule opacification and iris posterior synechiae. The results suggest that careful selection of candidates for IOL implantation be crucial for successful cataract surgery in uveitis patients.

Causes of inpatient death for patients with warfare-related limb trauma and logistic regression analysis of the risk factors.

OBJECTIVES: To explore the causes and risk factors of inpatient death for patients with warfare-related limb trauma. METHODS: A retrospective study involving 339 patients with warfare-related limb trauma who were admitted to our hospital from 1998 to 2002 was conducted. Autopsy was performed for 15 cases who died in order to investigate the cause of death. Furthermore, based on the clinical features of warfare-related trauma patients, 11 factors were selected for further analysis: X1: causes of trauma, X2: shock after injury, X3: time from injury to hospital admission, X4: injured sites, X5: combined trauma (including head, thorax, abdomen, and vascular injury), X6: number of surgical procedures, X7: foreign body remaining, X8: fracture, X9: amputation, X10: duration of tourniquet homeostasis, X11: infection. All variables were available in all cases, and all parameters were quantified and fed into a computer. Multivariate statistical analysis was performed with a logistic regression model to elucidate the risk factors influencing death. RESULTS: Fifteen of the 339 inpatient cases died (4.4%). The causes were primarily acute renal failure (ARF) (seven cases, 46.7%), pulmonary embolism (PE) (three cases, 20.0%), multiple organ system failure (MOSF) (two cases, 13.3%), and gas gangrene (three cases, 20.0%). There was one case of gas gangrene with concomitant ARF, and one of gas gangrene with MOSF. The primary risk factors influencing death included shock, amputation, and complicating infection (P < 0.05). CONCLUSION: The primary cause of death from warfare-related limb trauma is ARF. The appropriate and prompt management of shock patients, the correct timing of amputation, and the prevention and correct handling of infection are important in reducing mortality.

Position of myopic iris-claw phakic intraocular lens by Scheimpflug photography and ultrasound biomicroscopy.

PURPOSE: To evaluate the position of iris-claw phakic intraocular lens (ICPIOL) in highly myopic eyes by Scheimpflug photography (SP) and ultrasound biomicroscopy (UBM). METHODS: Nine eyes of five patients aged 31+/-10 years with average spherical equivalent of -16.04+/-5.46 D (range -7.88 to - 22.88 D) were enrolled in this prospective study and implanted with Verisyse ICPIOLs (AMO). The anterior segment was evaluated by SP and UBM preoperatively and for at least 1 month postoperatively. The statistical significance may be questionable due to the limited number (nine) of eyes. RESULTS: By SP and UBM, the distance between corneal endothelium and lens (anterior chamber depth) preoperatively was 3.10+/-0.14 and 3.07+/-0.11 mm, respectively; between ICPIOL and corneal endothelium (pseudo-anterior chamber depth), 1.88+/-0.09 and 1.99+/-0.12 mm, respectively; between lens and posterior surface of ICPIOL (IL), 0.76+/-0.13 and 0.67+/-0.06 mm, respectively; between superior optic edge and iris (SOEI), 0.23+/-0.23 and 0.58+/-0.24 mm, respectively; between inferior optic edge and iris (IOEI), 0.07+/-0.13 and 0.41+/-0.22 mm, respectively; between ICPIOL haptics and the angle of anterior chamber (HA), 0.90+/-0.17 and 1.45+/-0.13 mm, respectively. ACD was well correlated between the two methods, but PACD, IL, OEI, HA were not. The postoperative measures, except IL, were significantly different between the two methods. CONCLUSION: The differences between measurements by SP and UBM reveal the ICPIOL's position variations with change of body position. Nevertheless, it seems adequate that space is maintained between ICPIOL and corneal endothelium, angle, and crystalline lens. The ICPIOL implanted in phakic eyes seems a safe alternative for treatment of high myopia.

[Early ocular hypertension after cataract extraction].

The intraocular pressure (IOP) course during the first postoperative month was measured with Goldmann applanation tonometry in 93 eyes. The patients include 30 eyes of intracapsular cataract extraction (ICCE), 32 eyes of extracapsular cataract extraction (ECCE) and 31 eyes of ECCE combined with posterior chamber intraocular lens (PC-IOL) implantation. The preoperative average IOP was 13.30 +/- 3.24 mmHg in 93 eyes. The first day after cataract extraction was 25.33 +/- 8.18 mmHg and 59 eyes (63.44%) had an IOP higher than 23 mmHg. On the second day it was 16.03 +/- 7.54 mmHg. On the third day it was 14.69 +/- 5.45 mmHg. On the seventh day it was 13.32 +/- 3.44 mmHg and only 2 eyes (2.14%) IOP was higher than 23 mmHg. The first postoperative month average IOP was 12.93 +/- 1.31 mmHg and it was above 23 mmHg in only one eye. When compared with preoperation a significant increase in IOP was found postoperatively. But on the seventh day and after the first month there was no significant difference (P greater than 0.05). The IOP rise among ICCE group, ECCE group and PC-IOL group did not differ significantly.