Ileal J-Pouch Perforation: Case Report.

A 34-year-old male patient who had undergone total colectomy and J-pouch ileanal anastomosis subsequent to diagnosis of familial adenomatous polyposis five years previously was admitted to the emergency room with complaints of severe abdominal pain of a four-day duration. Physical examination revealed widespread tenderness throughout the abdomen, especially in the lower quadrant. Abdominal ultrasonography revealed fluid between intestinal loops and computed tomography revealed free air and fluid in the abdomen. During laparotomy to expand the ileal J-pouch to approximately 12 cm in diameter, a 2-mm perforation was detected in the blind end of the ileal J-pouch. The perforation was repaired primarily and protective ileostomy was performed. During postoperative endoscopy, neither obstruction nor stasis was observed, but pouchitis was observed in the ileal J-pouch. The patient was postoperatively discharged on the 20th day and followed endoscopically. The endoscopic findings were normal in the sixth month postsurgery.

The effect of TAP block use in postoperative analgesic in cesarean section.

OBJECTIVE: TAP (transversus abdominis plane) block is an important parameter of multimodal analgesia in the control of postoperative pain in cesarean section cases. In our study, we aimed to compare the analgesic consumption, patient satisfaction rate, vital signs, and visual analog scale (VAS) scores of ASA II patients with and without TAP block in cesarean surgery. PATIENTS AND METHODS: This study was designed as a retrospective review of prospectively collected data and an open-label and randomized clinical trial. The files of 180 patients who underwent elementary cesarean section between January 2019 and December 2019 were analyzed. The ASA score, anesthesia method, age, weight, height, parity, TAP block application, VAS score, analgesia duration, the additional analgesic requirement for maintenance, patient satisfaction, postoperative nausea, vomiting, urinary retention, and other complications were recorded. The 180 patients included in the study were divided into 6 groups: Group 1 - General anesthesia, Group 2 - General anesthesia + TAP block, Group 3 - Spinal anesthesia, Group 4 - Spinal anesthesia + TAP block, Group 5 - Epidural anesthesia, and Group 6 - Epidural anesthesia + TAP block. RESULTS: There was no significant difference between the groups in terms of demographic variables. The VAS scores of the first 24 hours were significantly different for Group 1. VAS scores in the 1st and 3rd hours were significantly higher in Group 1 than in the other groups. The groups without TAP block had significantly higher VAS scores at the 12th hour. Furthermore, the VAS score in Group 6 at 24 hours was significantly the lowest, and the earliest analgesic requirement was in Group 1. When the number of analgesic needs of the patients in 24 hours was examined, Group 1 was found to be significantly the highest, and Group 6 was significantly the lowest of all groups. CONCLUSIONS: The epidural anesthesia + TAP block Group had the lowest VAS score, the fewest analgesic requirements, the longest analgesia length, and the highest patient satisfaction.

Treatment of a full-thickness macular hole and retinal detachment secondary to toxoplasma chorioretinitis that developed shortly after COVID-19: A case report.

Although ocular toxoplasmosis is usually a self-limiting infection, it can lead to severe reduction in visual acuity due to intense vitreous inflammation or involvement of posterior segment structures. Depending on the severity of intraocular inflammation, serious complications, including epiretinal membrane or retinal detachment may develop. In this paper, we aim to present a case that complicated by both a full-thickness macular hole and retinal detachment secondary to toxoplasmosis chorioretinitis that developed shortly after the novel coronavirus disease (COVID-19) and discuss our treatment approach. After the patient was diagnosed based on a routine ophthalmological examination, fundus imaging, and serological examination, functional and anatomical recovery was achieved through systemic antibiotherapy and vitreoretinal surgery. Full-thickness macular hole and retinal detachment are rare complications of ocular toxoplasmosis. However, there are only few publications in the literature concerning these complications and their surgical treatment. In this case report, we demonstrated the success of vitreoretinal surgery combined with antibiotic therapy on the posterior segment complications of ocular toxoplasmosis.

Two doses of the Pfizer-BioNTech vaccine, two different side effects: Skin and eye.

A 47-year-old male patient presented to our clinic with the complaints of eye pain, reduced vision and redness in the right eye three days after administration of the second dose of the Pfizer-BioNTech vaccine. The patient was diagnosed with uveitis associated with the Pfizer-BioNTech vaccine and inflammatory glaucoma due to the uveitis. In addition, an erythematous, morbilliform rash had developed three days after the first dose of the vaccine. This is the first case report in the literature to show both skin and eye side effects after the Pfizer-BioNTech vaccine.

Evaluations of the radial peripapillary, macular and choriocapillaris microvasculature using optical coherence tomography angiography in patients with systemic sclerosis.

PURPOSE: To analyze the macular microvascular (MMV) architecture, radial peripapillary capillary (RPC) network and choriocapillaris using optical coherence tomography angiography (OCT-A) in patients with systemic sclerosis (SSc) without systemic comorbidities. METHODS: The vessel densities (VDs) of the MMV, foveal avascular zone (FAZ) parameters, choriocapillaris flow areas (CCFAs), RPC VDs, and optic nerve head (ONH) parameters were measured by OCT-A. Retinal thickness and subfoveal choroidal thickness (SFCT) were measured by spectral-domain optical coherence tomography (SD-OCT). The SD-OCT and OCT-A measurements of 53 eyes of 30 SSc patients were compared with 61 eyes of 33 healthy controls. RESULTS: In the MMV analysis, a decrease in the VDs of the superficial capillary plexus and an increase in the FAZ area, FAZ perimeter and non-flow area were detected in the SSc group compared to the controls (P=0.007, P=0.001, P=0.029, P=0.018, and P=0.039, respectively). While there was a decrease in SFCT, no change was found in CCFA (P=0.001 and P=0.902, respectively). The RPC analysis revealed a decrease in the VDs of all vessels for the entire area and the intradisc area, as well as the VDs of the small vessels for the intradisc area (P=0.021, P=0.001, and P=0.003, respectively). In the ONH analysis, there was an increase in the C/D area ratios and cup volumes, and a decrease in the rim areas and nasal quadrant retinal nerve fiber layer thickness (P=0.004, P=0.004, P=0.013, and P=0.032, respectively). CONCLUSION: Decreases in RPC and MMV VDs and changes in ONH parameters were found in OCT-A measurements in patients with SSc.

Internal limiting membrane graft in full-thickness macular hole secondary to macular telangiectasia type 2.

We present a case report of an autologous internal limiting membrane (ILM) graft transposition technique in a 60-years-old female patient who with a full-thickness macular hole (FTMH) secondary to idiopathic macular telangiectasia type 2 (MacTel type 2). To our knowledge, our case is the first report of ILM graft transposition to treat persistent FTMH secondary to MacTel type 2. MacTel type 2 is an acquired disease characterized by macular capillary abnormalities and retinal neurodegeneration. FTMH is an infrequent complication of MacTel type 2. Pars plana vitrectomy (PPV) with ILM peeling and gas endotamponade is the standard treatment of FTMH to help restore macular anatomy and visual function. The technique of autologous ILM graft transposition is a useful alternative to repair large, persistent macular holes that have failed to close with previous ILM peeling. In the present case, our patient with persistent FTMH secondary to MacTel type 2 after the previous standard macular hole surgery was admitted to our clinic. We performed 23-gauge PPV with extramacular ILM peeling and ILM graft transposition into the macular hole. 2 months after the surgery, her visual acuity had improved and anatomic closure of the FTMH was observed. In our opinion, ILM grafting might support reorganization of the retinal structure that has been affected by Muller cell degeneration.

Change in retinal and choroidal microvascular structures after rhegmatogenous retinal detachment surgery and effects on visual recovery.

PURPOSE: To investigate changes in retinal and choroidal microvascular structures in the macular region after surgery for rhegmatogenous retinal detachment (RRD) and their relationship to visual function at 3months. METHODS: This prospective, cross-sectional study included 37 eyes of 37 patients who underwent surgery for RRD (pneumatic retinopexy and/or pars plana vitrectomy). All patients underwent a comprehensive ophthalmologic examination, including measurement of best-corrected visual acuity (BCVA, logMAR), anterior segment and fundus examination, and optical coherence tomography angiography (OCTA) imaging 3months postoperatively. The healthy fellow eyes formed the control group. OCTA was used for the assessment of macular vessel density (VD), foveal avascular zone (FAZ), central macular thickness, and choroidal and outer retinal flow rates. RESULTS: The findings showed that the VD of the superficial and deep capillary plexuses were lower in the RRD group compared to the control group (P=0.012; P<0.001). The FAZ was larger in the RRD group (P=0.035). The choroidal flows in the 1 and 3mm2 were lower in the RRD group (P<0.001). Superficial FAZ area and choroidal flow rate (1 and 3mm2 areas) were moderately negatively correlated with BCVA (P=0.008; P=0.035; P=0.008). CONCLUSIONS: Our study demonstrated that the FAZ was larger, and the choroidal flow rate was lower, in the RRD group compared to the control group. Choroidal flow rate was negatively correlated with postoperative BCVA. Ischemic events resulting from the RRD were likely the reason for these changes.

Comparison of anterior segment parameter values obtained with Scheimpflug-Placido topographer, optical low coherence reflectometry and noncontact specular microscopy in morbid obesity.

OBJECTIVE: To investigate the measurement of anterior segment parameters using Sirius Scheimpflug-Placido topographer, Lenstar optical low coherence reflectometry (OLCR), and noncontact specular microscopy (SM) in morbidly obese and nonobese subjects. PATIENTS AND METHODS: Twenty-eight morbidly obese subjects (BMI ≥ 40; Group 1) and 28 age- sex-matched healthy nonobese subjects (BMI 18.50-24.99; Group 2) were included in this study. Anterior segment parameters were measured by Scheimpflug-Placido topographer and OLCR. Corneal endothelial cell parameters were measured by non-contact SM. The group data were analyzed using the Mann-Whitney U test and Student's t-test. Bland-Altman plots were used to assess agreement among the instruments, and 95% limits of agreement (LoA) for each comparison were calculated. RESULTS: In group 1, the mean CCT by Scheimpflug-Placido topographer, OLCR, and noncontact SM were 549.44±30.10 µm, 544.15±31.48 µm, and 541.59±29.87 µm respectively. In group 2, the mean CCT by Scheimpflug-Placido topographer, OLCR, and noncontact SM were 531.0±22.09 µm, 523.15±21.39 µm, and 521.12±21.70 µm respectively. Mean CCT values obtained by the three methods were significantly higher in the morbidly obese than the nonobese subjects. In both groups, mean CCT was significantly higher when measured by Scheimpflug-Placido topographer than by OLCR and noncontact SM, and mean AD and ACD were significantly higher when measured by Scheimpflug-Placido topographer than OLCR. No significant differences were found between mean corneal curvature and corneal astigmatism when measured by Scheimpflug-Placido topographer and OLCR. CONCLUSIONS: The mean CCT of the morbidly obese subjects were significantly higher than the nonobese subjects when measured by all three methods. The CCT values obtained by Scheimpflug-Placido topographer were significantly higher than those by OLCR and SM.

Comparison of effects of nebivolol, carvedilol and irbesartan on left ventricular hypertrophy associated with hypertension.

OBJECTIVES: The aim of this study was to investigate if the new generation beta-blockers are as effective as irbesartan, which is an angiotensin receptor blocker (ARB), on left ventricular hypertrophy (LVH). PATIENTS AND METHODS: The study included 85 patients (average age: 56.6±9.6 year) with stage 1 and 2 hypertension, who previously didn't receive an antihypertensive treatment, but diagnosed with LVH echocardiographically. The patients were divided into three different treatment groups: irbesartan (n=28), nebivolol (n=25) and carvedilol (n=32). The patients were reassessed clinically and echocardiographically at 3, 6 and 12 months after the treatments. RESULTS: There was no statistically significant difference in baseline left ventricular mass index (LVMI) and other parameters among the three treatment groups (p > 0.05). Although there was no significant decrease in LVMI in irbesartan and carvedilol groups at 3 months after the treatment (p > 0.05), the values measured at 6 and 12 months (p < 0.0001) were significant. The decrease in LVMI in the nebivolol group was significant at 3, 6 and 12 months (p < 0.0001). There was a significant difference in measurements at 12 months (p < 0.05). CONCLUSIONS: Both of the new generation beta-blockers were more effective than irbesartan in the regression of LVH. A significant regression in LVH was observed 3 months after nebivolol treatment and 6 months after irbesartan and carvedilol treatments.