Bilateral Conjunctival Actinic Granuloma With Necrobiotic Vasculitic Pattern: A Diagnosis of Exclusion.

A 53-year-old Caucasian male presented with an inflamed-appearing limbal nodule in his OD, clinically compatible with nodular episcleritis, that was unresponsive to topical corticosteroid therapy. Excisional biopsy of the lesion was performed and histopathological examination revealed foci of necrotizing vasculitis and granulomatous inflammation in a background of intense actinic elastosis. Infectious stains for organisms were negative. A comprehensive systemic evaluation for vasculitides was negative. Three years later, the patient returned with a clinically and histopathologically identical lesion in his OS. Systemic evaluation was noncontributory again, and a diagnosis of bilateral conjunctival actinic granuloma with necrobiotic vasculitic pattern was made.

Tissue Glue Adhesion for Plaque Radiotherapy of Uveal Melanoma in Humans: An Initial Experience.

Purpose: The aims of this study were to study use of tissue glue instead of conventional suturing and to secure I-125 plaque in human eyes with uveal melanoma. Methods: We studied 6 patients with choroidal melanoma undergoing plaque radiotherapy who were found to have thin sclera intraoperatively. Following tumor localization and plaque placement, tissue glue was applied over and around the plaque surface. The plaque was held securely in all cases. Conjunctivoplasty was performed with 7-0 vicryl sutures to ensure complete coverage and stability of the plaque. At the time of plaque removal, the tissue glue clot was in place with plaque secured. The clot and plaque were removed without difficulty. Results: In all 6 cases, the tissue glue secured the plaque in place for the required radiation duration (mean 117.6 h (hrs), median 103.1 h, range 101.6-162.5 h) delivering a tumor apex dose (mean 63.6 cGy/h, median 69.6 cGy/h, range 44.7-70.5 cGy/h). At the time of plaque removal, the plaque was in the designated position without displacement in all cases. There were no toxicities from the tissue glue. Conclusions: Tissue glue can serve as an alternative for fixation of plaque radiotherapy to the sclera without the need for suturing. This technique might be useful in eyes with thin sclera.

A Simple Protocol to Effectively Manage Anal Fistulas with No Obvious Internal Opening.

PURPOSE: In some anal fistulas, the internal/primary opening cannot be located even after examination and assessment on MRI or transrectal ultrasound. The efficacy of a simple new protocol to manage such therapeutically challenging fistulas was tested. PATIENTS AND METHODS: All anal fistula patients operated consecutively over 7 years were included in the study. A simple two-step protocol was followed for fistulas in which the internal opening was not locatable after clinical examination and MRI assessment. First, the MRI was reassessed. The site where the fistula was closest to the internal sphincter was noted. It was assumed that the internal-opening was located at that position and the fistula was treated accordingly. Second, in horseshoe anal fistulas with no apparent internal opening, it was assumed that the internal opening was located in the midline. Low fistulas were treated by fistulotomy and high fistulas by a sphincter-sparing procedure. Incontinence was evaluated by objective incontinence scores (Vaizey scores). RESULTS: A total of 757 patients were operated (median follow-up-33 months). Of these, 57 patients were excluded due to short or inadequate follow-up. In 154/700 (22%) patients, the internal opening could not be located while in 546/700 (78%), the internal opening was found. Both the groups were similar in all parameters. In the "internal-opening found" group, the fistula healed completely in 486/546 (89%) and in the 'internal-opening not found group', the fistula healed in 140/156 (90.9%) (p=1.01). The objective continence scores did not change significantly after surgery in both the groups. CONCLUSION: This new protocol seems effective as a high cure rate could be achieved in 'internal-opening not found' fistulas which was comparable to fistula healing in the 'internal-opening found' group.