Effect of capsule tension ring on short-term refractive stabilization and visual performance in trifocal intraocular lens implantation.

PURPOSE: To provide refractive stability and increase visual performance with the use of a capsular tension ring in trifocal intraocular lens implantation. METHODS: This prospective randomized study was conducted in the Yeniyüzyil university ophthalmology department between February 2018 and September 2019. Eighty-six eyes of 43 patients with visual loss due to uncomplicated cataract in both eyes were randomly divided into two groups, A and B. The eyes in both groups underwent refractive lens exchange with implantation of the same design of trifocal IOL (plate haptic design). In group B, a capsular tension ring was inserted into the capsular bag before trifocal IOL implantation. Both groups were examined at 1day, 1week, 1month, and 3months postoperatively. At 3months after surgery, visual acuity, refractive errors and refractive prediction errors were analyzed and compared between groups A and B. RESULTS: The postoperative values in group A were spherical equivalent (mean±SD), 0.07±0.79 diopters (D); refractive sphere (mean±SD), 0.43±0.84 diopters (D); uncorrected distance acuity, 0.20±0.04 (logMAR); best-corrected distance acuity, 0±0.02 (logMAR). Group B values were 0.14±0.5 diopters (D), 0.61±0.45 diopters (D), 0.25±0.20 (logMAR), 0.01±0.04 (logMAR), respectively. There was no significant difference between the two groups with respect to the postoperative evaluation. CONCLUSION: The use of CTR in the implantation of the trifocal intraocular lens had no statistically significant impact on refractive stability.

Evaluation of antibody response of sheep to foot-and-mouth disease vaccine prepared by using different MontanideTM oil adjuvants.

Despite the widespread use of the conventional inactivated foot-and-mouth disease (FMD) vaccine, its immunogenicity is poor and the duration of its protection is short. In this study, humoral response to commercial ready-to-use MontanideTM ISA 201 VG and MontanideTM ISA 61 VG oil adjuvants and a common adjuvant MontanideTM ISA 206 VG developed by Seppic Inc., were evaluated for FMD antigens in sheep and double oil emulsion (w/o/w) formulations of MontanideTM ISA 201 and 206 and single oil emulsion (w/o) of MontanideTM ISA 61 have been prepared by using current FMDV antigens (O/TUR/07, A/ASIA/G-VII, A/TUR/16 and ASIA/ TUR/15). The animals (n=48) were vaccinated subcutaneously with formulations and five sheep were maintained as an unvaccinated control group. Blood samples were taken at day 0, 7, 14, 21, 28, 60, 90, 120 and 150. Virus neutralization and liquid phase blocking ELISA tests were used to compare antibody response to vaccines prepared by using different MontanideTM mineral oils. The results showed that vaccines prepared by using MontanideTM ISA 61 and 201 gave better antibody response to FMD antigens than MontanideTM ISA 206 formulation, although results were not statistically significant for certain days of sampling. Moreover, the overall type O antibody response of MontanideTM ISA 201 was found to be superior to MontanideTM ISA 61.

Approach of forensic medicine to gossypiboma.

OBJECTIVE: The aim of this study was to assess the risk factors and preventive measures for gossypibomas and their medico-legal implications in forensic medicine in the Turkish legal system. MATERIAL AND METHODS: This study involved a retrospective analysis of the records of 39 patients with gossypiboma. Records were available from the Istanbul Forensic Medicine Institution and were surveyed for faulty treatment between 2008 and 2012. Parameters such as distribution of the cases according to specializations, elective and emergency procedures, surgical procedures, radio-opaque sponge and fluoroscopy availability, routine sponge and instrument counting, number of nurses for counting, and control of the operative field by a second surgeon were investigated. RESULTS: All cases were evaluated by the Istanbul Forensic Medicine Institute 3rd Expertise Committee. This committee comprised of specialists from the departments of forensic medicine, orthopedics and traumatology, general surgery, neurology, internal medicine, pediatrics, chest disease, and infectious diseases. All cases were considered as poor medical practice (malpractice) and surgeons were found to be responsible. In 16 of these 39 cases (41%) emergency procedures were performed. No unexpected event was reported in any procedure. In 16 cases (41%), sponge count was performed and was reported to be complete. Operation notes were available in 16 (41%) cases. Control of the operative field was performed by 1 surgeon, and sponge and instrument count was performed by 1 scrub nurse. Radio-opaque sponge and fluoroscopy were available in 9 (23%) centers in these cases. CONCLUSION: Gossypiboma can be prevented not only with surgeons' care but also with adequate support of medical device and material. However, it is considered as a poor medical practice. Presence of only 1 general surgeon in the expertise committee and ignorance of the working conditions by the surgeons should be questioned.

The retrospective documentation of legal cases with bile duct injury that were submitted for consideration to Istanbul Forensic Medicine Institute by the courts between 2008-2012.

OBJECTIVE: The aim was to evaluate the parameters that were considered by Forensic Medicine in bile duct injury as well as the issues that the physicians were found to be faulty. MATERIAL AND METHODS: The following parameters were investigated in 21 files that were referred to Istanbul Forensic Medicine Institute with request of expert opinion between 2008-2012; expert decisions, patient's age, gender, written patient consent, diagnosis, type of first surgery, surgical complications, timing of complication diagnosis within the scope of complication management, patient's referral timing, troubleshooting procedures and mortality rate. RESULTS: Physicians were found to be faulty in all files. The reason for physician fault was failure to show the necessary professional care and attention in one (4.7%) file, late recognition of injury and late transfer of the patient in 20 (95.3%) files. Written consent had not been obtained in any of the files. Thirteen patients were female (61.9%) and 8 (30.1%) were male, with a mean age of 43.3 years. Nineteen patients had cholelithiasis (90.4%), and two patients (9.5%) had a mass in the head of the pancreas. Cholecystectomy was performed laparoscopically in 15 patients (78.9%), and with open surgery in 4 patients (21.1%). The Whipple procedure was performed in two patients. The diagnosis was made during the operation in one patient (4.7%), and in the post-operative period in 20 patients (95.3%). The time to diagnosis after surgery was between 3-6 days. All of the patients had been referred to third level health care facilities. The timing of transfer was 1 day in the patient who was diagnosed during the operation, and ranged between 4-10 days in those who were diagnosed postoperatively. Reasons for late referral were delays related to pending test results in 12 patients, vague signs in 3 patients, and following-up patients with the thought that the biliary fistula will heal by itself in 5 patients. Mortality was not observed in any of the examined files. CONCLUSION: The issues where physicians were most frequently found to be faulty were failure to obtain written patient consent, late recognition of injury and late transfer of the patient.

Investigation and comparison of the effects of rehabilitation on balance and coordination problems in patients with posterior fossa and cerebellopontine angle tumours.

BACKGROUND: This study was planned to investigate and compare the effects of acute rehabilitation programme on balance and coordination problems in patients with posterior fossa and cerebellopontine angle tumours. METHODS: This study was carried out at Hacettepe University, School of Physical Therapy and Rehabilitation, neurosurgical rehabilitation unit on 40 patients whose ages varied between 18-60 years. Subjects were subdivided into two groups. Group I consisted of 20 patients with posterior fossa tumour, while the group II was composed of 20 patients with cerebellopontine angle tumour. Patients were evaluated according to the localisation of the tumour, the number of the surgical operations, the level of the surgical excision of the tumour, percent of having shunt, radiotherapy and chemotherapy. Balance problems were assessed according to Mokken's functional independence assessment scale in 5 selected positions and standing balance was also evaluated according to the method of Bohannon. The rehabilitation of the patients included balance and coordination training. The patients were re-evaluated before their discharge and the results of the two evaluations were compared. RESULTS: A significant improvement was found in the second group when pre- and post-treatment evaluations were compared. There were more coordination problems in group 1 in the pretreatment period. Both groups showed significant improvement of coordination problems after the treatment. However, this improvement was more obvious in the second group (p<0.05). There was a negative significant correlation between the decrease of balance problems and the amount of the tumour excided (I Group r=-0.51, II Group r=-0.57). CONCLUSIONS: It can be concluded that rehabilitation approaches are effective in balance and coordination problems observed in both tumour groups, but the responses to treatment are more obvious in the cerebellopontine angle tumours, which have better prognosis.