Minimally Invasive Surgery with the Bentall-De Bono Technique. Initial Experience at Hospital Italiano de Buenos Aires / Cirugía de Bentall de Bono por abordaje miniinvasivo. Experiencia inicial del Hospital Italiano de Buenos Aires

ABSTRACT Background : Cardiac surgery avoiding full sternotomy began to emerge in the 1990s with the first hemi-sternotomies and mini-thoracotomies. Aortic valve and root surgery is one of the most common procedures in our field. In this paper, we analyze our experience in minimally invasive cardiac surgery (MICS) for the aortic root with the Bentall-De Bono technique (MICS-Bentall). Objective : To analyze the surgical results in the first 10 patients underwent a MICS-Bentall procedure at our site. Materials and Methods : A retrospective observational study was carried out including patients with valve disease and aortic root dilation who underwent a surgery with the MICS-Bentall procedure in a tertiary care hospital from December 2019 to December 2020. Continuous variables were expressed as mean and standard deviation or median and interquartile range according to the observed distribution. Categorical variables were expressed as absolute and relative frequency. Results : Out of 165 patients undergoing aortic root surgery, 10 patients were included. Mean age was 56 ± 17.03 years, 70% male; all cases were elective. Median (interquartile range, IQR) STS PROM % was 1.48 (1- 2.02). Eighty percent had bicuspid valve. Fifty percent of patients were extubated within 6 hours. In the 30-day follow-up, no death was recorded, and two complications were registered: one patient experienced atrial fibrillation without hemodynamic decompensation and another a wound infection. The mean hospital length of stay was 5 days. Conclusion : In our experience, MICS using the Bentall technique showed satisfactory results in terms of low perioperative mortality, early extubation, and short hospital stay.

RESUMEN Introducción : La cirugía cardíaca libre de esternotomía completa surge en los años 90 con las primeras esternotomías y toracotomías mínimas. La cirugía de la válvula y la raíz aórtica constituyen uno de los procedimientos más frecuentes en nuestro campo. En este trabajo analizamos nuestra experiencia en Cirugía Cardíaca Miniinvasiva (MICS) de la raíz aórtica con la técnica Bentall de Bono (MICS-Bentall). Objetivo : Analizar los resultados quirúrgicos en los primeros 10 pacientes intervenidos con MICS-Bentall en nuestra institución. Material y métodos : Se realizó un estudio observacional retrospectivo en el que se incluyeron los casos de valvulopatía y dilatación de la raíz aórtica intervenidos quirúrgicamente mediante MICS-Bentall en un hospital de alta complejidad durante el periodo diciembre 2019 - diciembre 2020. Las variables continuas se expresan como media y desvío estándar o mediana y rango intercuartílico según la distribución observada. Las variables categóricas como frecuencia absoluta y relativa. Resultados : Sobre 165 pacientes sometidos a cirugía de la raíz aórtica, se incluyeron 10 pacientes. La edad media fue de 56 ± 17,6 años, 70% de sexo masculino, todos fueron electivos. La mediana de STS PROM % fue de 1,48 (1-2,02). En el 80% la válvula aórtica era bicúspide. El 50% de los pacientes fue extubado dentro de las 6 horas. En seguimiento a 30 días no se registraron óbitos, y hubo 2 complicaciones: un paciente presentó fibrilación auricular sin descompensación hemodinámica, y otro, infección de herida. La estadía hospitalaria fue en promedio de 5 días. Conclusión : En nuestra experiencia con MICS con la técnica Bentall se obtuvieron resultados satisfactorios con baja mortalidad perioperatoria, extubación precoz y tiempos cortos de estancia hospitalaria.

Totally Endoscopic Pulmonary Valve Surgery / 日本心臓血管外科学会雑誌

Introduction: To date, totally 3D-endoscopy has primarily been employed in mitral, tricuspid, and aortic valve surgeries. Herein, we describe the first case of a pulmonary valve surgery using totally 3D-endoscopy. To the best of our knowledge, this is the first case of a totally endoscopic pulmonary valve surgery. Case report: A 56-year-old woman was provisionally diagnosed with a tumor arising from the left cusp of the pulmonary valve. Totally 3D-endoscopy was planned for tumor resection. The patient was placed in a modified right lateral decubitus position and underwent mild hypothermic cardiopulmonary bypass using the left femoral artery, right jugular vein, and right femoral vein. An on-pump beating-heart technique was used during this surgery. Trocars for the 3D-endoscopic system and surgical instruments were inserted through the third and fourth intercostal spaces. Upon incision of the pulmonary artery, the suspected tumor was revealed to be a hyperplastic left pulmonary cusp; therefore surgical resection was abandoned. The patient was discharged without any complications. Conclusion: This case demonstrates that a totally 3D-endoscopic approach may provide optimal views of the pulmonary valve. Moreover, this procedure would be a novelty in MICS.

Totally Endoscopic MICS via Left Atriotomy Using a Right-Side Approach for Patch Closure of an Unroofed Coronary Sinus Atrial Septal Defect / 日本心臓血管外科学会雑誌

A 51-year-old male was unexpectedly diagnosed with unroofed coronary sinus atrial septal defect (CSASD) by coronary computed tomography angiography for a complaint of epigastric pain. As there was no persistent left superior vena cava (LSVC), we planned to undertake a totally endoscopic MICS approach. A 4-cm skin incision was made on the right lateral chest wall under general anesthesia. The 4th intercostal space was used to enter the chest and the right femoral vessels were cannulated for cardiopulmonary bypass. After cross-clamping of the aorta, a right-sided atriotomy incision was made on the left atrium. The CSASD was located at the ventral and caudal regions of the mitral valve and the defect was closed using a bovine pericardial patch. No major postoperative complications were observed. The patient was discharged 7 days after the operation as postoperative transthoracic echocardiography revealed no residual shunt. We thus observed that totally endoscopic MICS patch closure via left atriotomy using a right-side approach for CSASD without LSVC was beneficial to the patient.

Tends of "Zero-dose" children aged 12-23 months in Togo from 2000 to 2017 and predictions for 2030

Guided by the principle of leaving no one behind by improving equitable access and use of new and existing vaccines, the Immunization Agenda 2030 aims, among other things, to halve the incidence of "zero-dose" at the national level. This study aimed at studying the tends of the prevalence of "zerodose" children from 2000 to 2017 and making predictions for 2030. The study consisted of secondary data analyses from the Multiple Indicator Cluster Surveys (MICS) conducted in Togo. The study population consisted of children aged 12-23 months surveyed during MICS2 in 2000, MICS3 in 2006, MICS4 in 2010 and MICS6 in 2017. The dependent variable was the "zero-dose" vaccination status (1=Yes vs 0=No). The explanatory variables were related to the child, mother, household and environment. The study generated the overall annual percentage changes (APC) and by the independent variables. As a result, the prevalence of children with "zero-dose" expected for 2030 was estimated using Excel 2013 and Stata 16.0 software. In total, 636, 864, 916 and 952 children aged 12-23 months were included for MICS2, MICS3, MICS4 and MICS7, respectively. The prevalence of "zerodose" children decreased from 37.15% in 2000 to 31.72% in 2006, then 30.10% in 2010 and 26.86% in 2017, with an overall APC= - 1.89%. The highest relative annual decrease was from 2000 to 2006. If the historical rate of decrease remains unchanged, we predict that percentage of "zero-dose" children aged 12-23 months will be 20.96% in 2030, with a decrease of 22% compared to 2017, against a target of 50%. We suggest that strengthening strategies to increase full immunization coverage of children will contribute to reducing the percentage of zero dose children. A prerequisite will be a better understanding of the predictors of the "zero-dose" phenomenon in children

The Six Cases of Redo Cardiac Surgery via Partial Lower Hemi-sternotomy / 日本心臓血管外科学会雑誌

In poststernotomy redo cardiac surgery, injury to cardiac structures during sternal division can lead to untoward results in the operation. These days, Minimally Invasive Cardiac Surgery (MICS) such as the right anterolateral thoracotomy approach is becoming popular. By using MICS technique in redo cardiac surgery, it may be possible to reduce the risk of injury to the vital structures because of avoiding full sternotomy with the reduction of the dissection area. Six redo cardiac surgery cases in which innominate vein or bypass graft was in close contact with the sternum were is considered difficult to perform via the right thoracotomy approach. We report the cases in which operations were safely conducted through the lower hemi-sternotomy.

Reoperation after Coronary Artery Bypass Grafting; On-Pump Beating Heart Minimally Invasive Mitral Valve Replacement for Single Leaflet Device Attachment after MitraClip Placement / 日本心臓血管外科学会雑誌

A 50-year-old man with a history of coronary artery bypass grafting (CABG) 5 years prior to presentation underwent MitraClip placement for severe mitral regurgitation. Subsequently, he underwent on-pump beating heart endoscopic minimally invasive cardiac surgery (MICS) for mitral valve replacement for acute heart failure secondary to single leaflet device attachment. Endoscopic MICS via a right small thoracotomy approach is useful for reoperation after CABG in patients with a high risk of graft injury. Beating-heart surgery may be an effective option to avoid the risks associated with prolonged cardiac arrest time in patients with low left ventricular function.

Determination of MICs of Methicillin-resistant and Methicillin-susceptible Staphylococcus aureus Isolated from a Tertiary-care Hospital in Guyana

Objective:Previous studies done in the hospital setting in Guyana have shown that the frequency of isolation of methicillin-resistant Staphylococcus aureusisolates far exceeds the worldwide estimate of 50%. These past studies have been based on the use of the Kirby-Bauer disk diffusion methodology. The present study was conducted to determine the minimum inhibitory concentration of clinical isolates of methicillin-susceptible and methicillin-resistant S. aureususing the broth microdilution method.Design andMethods:A total of 101 consecutive, non-repetitive S. aureusisolates obtained from the GPHC medical lab during a six-week period were included in thestudy. These isolates were identified as MRSA and MSSA by laboratory personnel using the cefoxitin disk diffusion method. The oxacillin MICs for all isolates obtained were determined using prepared oxacillin broth microdilution trays with concentrations ranging from 4μg/ml to 256μg/ml. All results were interpreted according to CLSI guidelines.Results:The prevalence of MRSA at GPHC was found to be 65.35% with a majority of the isolates being high level oxacillin resistant strains with MICs > 256μg/ml (84.85%). In our study, most resistant isolates were collected from patients admitted to the FSW (16.67%), Paediatric Wards (13.65%), MSW (13.64%), and FMW (12.12%). Additionally, 35 (79.55%) MSSA were suspected oxacillin susceptible with MIC < 4μg/ml. Therelationship between the cefoxitin disc diffusion and oxacillin broth microdilution results was found to be statistically significant with a p < 0.001.Conclusion:Methicillin-resistance continues to be a major problem in the hospital setting, and this study has should that commonly used conventional techniques are unlikely to identify all of the potentially resistant isolates.Recommendation:The high prevalence and high oxacillin MIC of MRSA at GPHC suggests that more emphasis should be placed on infection control and surveillance programs within the hospital setting.

Redo Aortic Valve Replacement through Right Anterior Mini-thoracotomy 15 Years after Aortic Valve Replacement via Partial Sternotomy : A Case Report / 日本心臓血管外科学会雑誌

A 65-year-old man with a history of severe aortic valve regurgitation had undergone aortic valve replacement (AVR) via partial upper hemisternotomy at the age of 50 years. At that time, bioprosthetic valve was implanted. Fifteen years after the valve implantation, he presented with palpitations and chest tightness. Examination revealed bioprosthetic valve failure with consequent severe aortic valve regurgitation. Redo AVR via right anterior mini-thoracotomy was decided as the treatment strategy, and the procedure was successfully completed without complications. The patient underwent extubation on the day of the operation. His postoperative course was unremarkable, and he was discharged 13 days postoperatively. In this case, the patient had previously undergone partial upper hemisternotomy (classified as a minimally invasive cardiac surgery [MICS]) and showed only few adhesions in the pericardium, suggesting that MICS could be beneficial in cases involving re-operation.

Immediate Postoperative Intraocular Pressure Adjustment Reduces Risk of Cystoid Macular Edema after Uncomplicated Micro Incision Coaxial Phacoemulsification Cataract Surgery

PURPOSE: To determine the accuracy of visual estimation of immediate postoperative intraocular pressure (IOP) following microincision cataract surgery (MICS) and the effect of immediate postoperative IOP adjustment on prevention of cystoid macular edema (CME). SETTING: Ambulatory surgical center. METHODS: Prospective, randomized analysis of 170 eyes in 135 patients with MICS, performed in a Medicare approved outpatient ambulatory surgery center. Surgical parameters included a keratome incision of 1.5 mm to 2.8 mm, topical anesthetic, case completion IOP estimation by palpation and patient visualization of light, and IOP adjustment before exiting the operating theater. IOPs were classified into three groups: low (21 to 30 mmHg). IOP measurements were repeated 1 day after surgery. Optical coherence tomography (Stratus OCT, Zeiss) was measured at 2 weeks. An increase in foveal thickness greater than 15 µm was used to indicate CME. Statistical analysis was performed using one- and two-tailed Student's t-tests. RESULTS: Mean minimal foveal thickness averaged 207.15 µm in the low pressure group, 205.14 µm in the normal IOP group, and 210.48 µm in the elevated IOP group 2 weeks following surgery. CME occurred in 14 of 170 eyes (8.2%) at 2 weeks (low IOP, 35.7%; normal IOP, 14.2%; elevated IOP, 50.0%). Change in IOP from the operating theater to 1 day after surgery was within +/−5 mmHg in 54 eyes (31.7%), elevated by 6 to 15 mmHg in 22 eyes (12.9%), and elevated more than 15 mmHg in four eyes (2.3%). IOP was reduced by 6 mmHg to 15 mmHg in 39 eyes (22.9%) and reduced by more than 15 mmHg in nine eyes (5.3%). CONCLUSIONS: Immediate postoperative adjustment of IOP may prevent CME in MICS. Physicians can improve their ability to estimate postoperative IOP with experience in tonometry to verify immediate postoperative IOP. There are patient safety and economic benefits to immediate IOP adjustment in the operating theater. SYNOPSIS: Immediate postoperative IOP adjustment following cataract surgery before the patient leaves the operating theater may reduce the incidence of CME and provide patient safety and economic benefits.

Time-kill kinetics and biocidal effect of Euclea crispa leaf extracts against microbial membrane

OBJECTIVE@#To evaluate antimicrobial potential of the fractions partitioned from Euclea crispa leaf extract and determination of their impact on cell membrane disruption.@*METHODS@#Antimicrobial potentials were evaluated via susceptibility test, determination of minimum inhibitory concentrations (MICs) and time-kill kinetics of the potent fractions. Degree of membrane disruption was determined by the amount of proteins and nucleotides released from within the cells and SEM images of the membrane after 120 min of treatment.@*RESULTS@#The largest inhibition zone (25.5 ± 0.50 mm) was obtained by ethylacetate fraction against Aeromonas hydrophilla at 10 mg/mL. The lowest MIC (0.16 mg/mL) was exhibited by n-butanol and ethylacetate fractions against test bacteria while all fractions exhibited MIC values between 0.31 and 1.25 mg/mL against susceptible yeast. n-Butanol fraction achieved absolute mortality against Bacillus pumulis (B. pumulis) and Klebsiella pneumoniae (K. pneumoniae) after 90 and 120 min contact time respectively at 1 × MIC. Total mortality also achieved by n-hexane fraction against B. pumulis and K. pneumoniae after 90 and 120 min respectively at 2 × MIC. Ethylacetate fraction achieved absolute mortality against both bacteria after 120 min at 2 × MIC. n-Hexane fraction achieved total mortality against Candida albicans after 120 min at 1 × MIC. Maximum amount of proteins (0.566 μg/mL) was released from K. pneumoniae by n-butanol fraction at 2 × MIC after 120 min of treatment while the maximum amount of nucleotides released (4.575 μg) was from B. pumulis by n-hexane fraction under similar condition.@*CONCLUSION@#This study suggests the leaf of Euclea crispa a source of bioactive compound with membrane attack as one of the mechanisms of its biocidal action.

Time-kill kinetics and biocidal effect of Euclea crispa leaf extracts against microbial membrane

Objective To evaluate antimicrobial potential of the fractions partitioned from Euclea crispa leaf extract and determination of their impact on cell membrane disruption. Methods Antimicrobial potentials were evaluated via susceptibility test, determination of minimum inhibitory concentrations (MICs) and time-kill kinetics of the potent fractions. Degree of membrane disruption was determined by the amount of proteins and nucleotides released from within the cells and SEM images of the membrane after 120 min of treatment. Results The largest inhibition zone (25.5 ± 0.50 mm) was obtained by ethylacetate fraction against Aeromonas hydrophilla at 10 mg/mL. The lowest MIC (0.16 mg/mL) was exhibited by n-butanol and ethylacetate fractions against test bacteria while all fractions exhibited MIC values between 0.31 and 1.25 mg/mL against susceptible yeast. n-Butanol fraction achieved absolute mortality against Bacillus pumulis (B. pumulis) and Klebsiella pneumoniae (K. pneumoniae) after 90 and 120 min contact time respectively at 1 × MIC. Total mortality also achieved by n-hexane fraction against B. pumulis and K. pneumoniae after 90 and 120 min respectively at 2 × MIC. Ethylacetate fraction achieved absolute mortality against both bacteria after 120 min at 2 × MIC. n-Hexane fraction achieved total mortality against Candida albicans after 120 min at 1 × MIC. Maximum amount of proteins (0.566 μg/mL) was released from K. pneumoniae by n-butanol fraction at 2 × MIC after 120 min of treatment while the maximum amount of nucleotides released (4.575 μg) was from B. pumulis by n-hexane fraction under similar condition. Conclusion This study suggests the leaf of Euclea crispa a source of bioactive compound with membrane attack as one of the mechanisms of its biocidal action.

The Technique of Adult Atrial Septum Defect Closure Supported by Minimally Invasive Cardiac Surgery (MICS) and Three Dimensional Endoscopy / 日本心臓血管外科学会雑誌

<p>The efficacy of minimally invasive cardiac surgery (MICS) has often been reported. However, in Japan most of these procedures are supported with robotic systems, which are expensive. We report the technique of atrial septum defect (ASD) closure by MICS and a three-dimensional endoscope without the aid of a robotic system. From March 2012 to April 2015, we performed ASD closure using this method in 7 patients. The use of a three-dimensional endoscope enables cardiac surgery to be performed through smaller incisions (≤5 cm in width). We have adopted this method of ASD closure with the Maze procedure for patients complicated by atrial fibrillation. The operation time will decrease as we improve our surgical technique. Our current practice is to attempt ASD closure with totally endoscopic support.</p>

Anti-biofilm activity of the marine bacterium Pseudoalteromonas ruthenica KLPp3 against Serratia marcescens and Vibrio alginolyticus

Aims: Pseudoalteromonas ruthenica KLPp3 is the marine Gram-negative strain isolated from the surface of mud crab at Pulau Perhentian Malaysia. In this work, the anti-biofilm activity of P. ruthenica supernatant was examined on Serratia marcescen and Vibrio alginolyticus. Methodology and results: The crude extract of P. ruthenica KLPp3 was obtained using ethyl acetate. The subminimum inhibitory concentration (MIC) of the crude extract was determined using the minimum inhibitory test. The subMIC crude extract was tested against two of the S. marcescen virulence factors, which are the swarming ability and production of prodigiosin. The crystal violet assay was used to test the anti-biofilm activity of the sub-MIC crude extract against S. marcescen and V. alginolyticus. The productions of prodigiosin were reduced by 72%. The swarming area was reduced by 56.06%. It inhibits 26.9% and 48.5% of biofilm production in S. marcescens and V. alginolyticus respectively. The crude extract was heat stable. Conclusion, significance and impact of study: Besides combating the S. marcescens virulence factor, P. ruthenica KLPp3 crude extract in sub-MIC reduces the formation of biofilm of S. marcescens and V. alginolyticus, which may find applications in biofilm inhibition and prevention.

A Case of Ascending Aorta Replacement for Chronic Aortic Dissection by Minimally Invasive Cardiac Surgery / 日本心臓血管外科学会雑誌

The number of surgical treatments for acute aortic dissection in octogenarians is increasing. They should return to their daily life as soon as possible after the operation without any complications. Some literature reported that minimally invasive cardiac surgery (MICS) helps quick recovery for the patients. We report a case of minimally invasive ascending aorta replacement for Stanford type A chronic thrombosed aortic dissection in an octogenarian to help quick recovery. An 81-year-old man was admitted in our hospital suffering from chest and back pain. Enhanced CT scan showed Stanford type A acute thrombosed aortic dissection. The diameter of ascending aorta was 45 mm and the diameter of false lumen was 7 mm. Therefore we decided on medical treatment for this patient according to the guideline. After four weeks medical treatment, ascending aorta was dilated to 49 mm and the false lumen also expanded to 9 mm. He underwent minimally invasive ascending aorta replacement to help quick recovery considering his age. He was discharged 11 days postoperatively without any complications. MICS offers a better cosmetic result, less blood loss, less pain, better respiratory function and quick recovery. Thus, minimally invasive operation for the elderly is also very satisfactory.

Application of metabonomics in cardiovascular pharmacology research / 中国药理学与毒理学杂志

Metebonomics is a branch of system biology,which,based on group index analysis, aims to analyze low molecular weight metabolites of the body both qualitatively and quantitatively through high flux and data processing.In recent years,the application of metabonomics to research of cardio-vascular pharmacology has been attracing more attention.This paper,by researching do mestic and overseas literature,summarizes the applications of metabonomics in the prevention and treatment of co mmon cardiovascular diseases such as hypertension,hyperlipide mia,atherosclerosis and myocardial ische mia.Related pharmacological researches targeted at patients,ani mal models and cell models clas-sified.Evidence for evaluation of effects and mechanis ms of drugs is provided by analyzing the patterns of change of metabolites in the progression of diseases.Finally,meaningful biomarkers are proposed.

Minimally Invasive Approach (Para-sternum Small Incision) for Aortic Valve Replacement / 日本心臓血管外科学会雑誌

Minimally invasive surgery is associated with a faster postoperative recovery because of reduced postoperative pain and improved respiratory function, especially in elderly patients. We began using a minimally invasive approach (small parasternal incision) for isolated aortic valve replacement (MICS AVR) from January 2011. Between January 2011 and February 2012, 32 patients underwent MICS AVR surgery. The mean age was 73 years (range 57-85 years) ; 69% were women. MICS AVR was performed through a skin incision of 6.5±0.5 cm along the third intercostal space. Cardiopulmonary bypass was established through the right femoral artery and vein. The patients were cooled to 28°C, the aorta was crossclamped with a flex clamp, and antegrade cardioplegic solution was given into the aortic root or selectively into the coronary ostia. The aortic valve procedure was performed in a standard fashion. If the distance to the aortic valve was too far, we used surgical instruments for minimally invasive surgery. Conversion to a conventional approach was not necessary in any patient. Mean overall operative time was 250±49 min, cardiopulmonary bypass 140±34 min, and crossclamp time 99±22 min. Mean ICU stay was 1.2±0.5 days and length of hospital stay was 10.3±2.2 days. There was no re-operation for bleeding or surgical site infection. MICS AVR was safe and feasible with excellent outcome. The advantages of this procedure include reduced bed rest, decreased postoperative pain, avoidance of deep sternal wound infection, and cosmetically attractive results. We now use the minimally invasive approach whenever possible. We report an early outcome, experience, strategy, and surgical technique.

Comparison of Clinical Outcomes Between Torsional Phacoemulsification of Infiniti(R) and Longitudinal Phacoemulification of Stellaris(R) Through 2.2 mm Microincision

PURPOSE: To compare clinical outcomes of a 2.2 mm microcoaxial cataract surgery, using torsional mode and longitudinal mode. METHODS: In this comparative study, patients with bilateral cataract were assigned to get microcoaxial cataract surgery by torsional mode of infiniti in one eye and longitudinal mode of Stellaris(R) in the other eye. Primary outcome measures were US time (UST), cumulative dissipated energy (CDE), mean amount of balanced salt solution (BSS) used and surgical complications. Patients were seen 1, 7, 30, and 60 days after surgery. Postoperative outcome measures were the final best corrected visual acuity (BCVA), central corneal thickness (CCT), endothelial cell count and surgically induced astigmatism (SIA). RESULTS: The study evaluated 68 eyes of 34 patients (nuclear opalescence (NO)2: 40 eyes, and NO3: 28 eyes). CDE was significantly lower in torsional mode (3.52 +/- 2.93) than in longitudinal mode (6.20 +/- 3.32) (p = 0.001). Torsional mode (60.88 +/- 21.18 ml) had more BSS use than longitudinal mode (34.58 +/- 13.54 ml) (p 0.05). CONCLUSIONS: The torsional mode may provide lower level of phacoemulsification energy than the longitudinal mode and Torsional mode is considered effective and safe phacoemulsification. However the surgical outcomes were not significantly different in 2.2 mm microcoaxial cataract surgery of moderate cataract. So surgeon can choose any phaco machine based on experience and preference.

Syndrome of malnutrition-inflammation complex in chronic alcoholics.

Several studies have reported elevated serum ferritin levels in patients of chronic alcohol abuse. We hypothesized that serum ferritin may be acting as a marker of acute phase reactant, reflecting the inflammatory status of patients of chronic alcohol abuse, rather than as a marker of iron overload . Hence we correlated serum ferritin levels with interleukin 6 (IL-6), interleukin 1 (IL-1) and tumor necrosis factor alpha (TNF -α ) which are markers of inflammation. Serum ferritin and IL-6 levels were significantly elevated at the time of admission. The elevation of IL-6 correlated well with the increase in ferritin levels (r=0.78, p<0.01). Serum iron levels were not significantly different before and after abstinence from alcohol. We also speculated that the inflammatory status was associated with the malnutrition that is observed in alcohol abuse. Therefore we studied serum total protein, albumin, prealbumin and transferrin levels as markers of nutrition in patients of chronic alcohol abuse. Serum levels of all these nutritional parameters increased significantly after 8 weeks of abstinence from alcohol and were accompanied by reduced levels of ferritin and IL-6. Hence it is possible that a malnutrition inflammation complex like syndrome exists in patients of alcohol abuse.

Comparison Between Bimanual Microincisional Cataract Surgery and Conventional Coaxial Phacoemulsification

PURPOSE: To evaluate corneal endothelial cell changes after conventional coaxial phacoemulsification and bimanual microincision cataract surgery (MICS). METHODS: Forty patients were divided into 2 groups, coaxial phacoemulsification (Group 1, n=20), and MICS (Group 2, n=20). To evaluate corneal endothelial cell changes after coaxial phacoemulsification and bimanual MICS, intraoperative phacoemulsification power and volume of intraoperative irrigation solution (balanced salt solution, BSS(R), Alcon, U.S.A) were measured. Central corneal thickness and endothelial cell count were also evaluated, preoperatively and at 1 week, and 2 months postoperatively. RESULTS: Between the 2 groups, there was no statistically significant difference in intraoperative phacoemulsification power and volume of intraoperative irrigation solution (balanced salt solution, BSS(R), Alcon, U.S.A.) (p>0.05). In addition, there was no statistically significant difference between the 2 groups in endothelial cell count and central corneal thickness (p>0.05). CONCLUSIONS: When comparing bimanual MICS and conventional coaxial phacoemulsification, bimanual MICS appears to have similar endothelial cell changes. In conclusion, MICS has the same safety as compared to coaxial phacoemulsification.

Clinical Results of Rollable IOL Implantation After Bimanual Microincision Phacoemulsification

PURPOSE: To retrospectively evaluate the clinical results of insertion of a hydrophilic acrylic plate posterior chamber intraocular lens (ThinOptX) after bimanual microincision phacoemulsification. METHODS: Thirty-four eyes of 30 patients who underwent bimanual phacoemulsification and ThinOptX implantation through a 2.0 mm incision between July 2004 and May 2006 were followed-up for more than 12 months. We examined best corrected visual acuity (BCVA), refractive errors, corneal endothelial cell density, halo and contrast sensitivity, posterior capsule opacification (PCO), and intraoperative and postoperative complications. RESULTS: The preoperative mean logMAR BCVA was 0.43+/-0.24, and the postoperative BCVA was 0.04+/-0.09 after 6 months and 0.14+/-0.12 after 12 months. The preoperative corneal endothelial cell density was 2562+/-347.90 cells/mm2, and decreased to 2241+/-294.88 (cells/mm2) at 12 months postoperative. Postoperative contrast sensitivity at 6 months was increased in both photopic and mesopic condition. Halo was noted in all examined eyes. A PCO of 29% was evaluated at 6 months postoperative and a PCO of 52% was evaluated at 12 months postoperative. CONCLUSIONS: Bimanual phacoemulsification and ThinOptX implantation through a 2.0 mm incision resulted in good initial visual outcome and correction of refractive errors. However, problems such as halo and PCO associated with IOL design were noted. Therefore, further evaluation and correction of the IOL are needed.