Live Donation of Corneal Tissue in the Setting of Orbital Exenteration for Malignancy.

Background. The availability of corneal tissue is a major limiting factor in utilizing keratoplasty for correction of corneal blindness. Viable corneal tissue is typically difficult to obtain as posthumous donation is required to avoid significant morbidity and loss of vision in live patients. As a result, the possibility of obtaining viable corneal tissue from a living donor is rarely discussed. This report describes a case in which corneal donation was completed in a living patient undergoing exenteration for invasive squamous cell carcinoma of the maxillary sinus. Performing corneal donation in similar patients in the future should be considered by head and neck surgeons as an opportunity to increase the availability of corneal tissue.

Immuno-Thrombotic Complications of COVID-19: Implications for Timing of Surgery and Anticoagulation.

Early in the coronavirus disease 2019 (COVID-19) pandemic, global governing bodies prioritized transmissibility-based precautions and hospital capacity as the foundation for delay of elective procedures. As elective surgical volumes increased, convalescent COVID-19 patients faced increased postoperative morbidity and mortality and clinicians had limited evidence for stratifying individual risk in this population. Clear evidence now demonstrates that those recovering from COVID-19 have increased postoperative morbidity and mortality. These data-in conjunction with the recent American Society of Anesthesiologists guidelines-offer the evidence necessary to expand the early pandemic guidelines and guide the surgeon's preoperative risk assessment. Here, we argue elective surgeries should still be delayed on a personalized basis to maximize postoperative outcomes. We outline a framework for stratifying the individual COVID-19 patient's fitness for surgery based on the symptoms and severity of acute or convalescent COVID-19 illness, coagulopathy assessment, and acuity of the surgical procedure. Although the most common manifestation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is COVID-19 pneumonitis, every system in the body is potentially afflicted by an endotheliitis. This endothelial derangement most often manifests as a hypercoagulable state on admission with associated occult and symptomatic venous and arterial thromboembolisms. The delicate balance between hyper and hypocoagulable states is defined by the local immune-thrombotic crosstalk that results commonly in a hemostatic derangement known as fibrinolytic shutdown. In tandem, the hemostatic derangements that occur during acute COVID-19 infection affect not only the timing of surgical procedures, but also the incidence of postoperative hemostatic complications related to COVID-19-associated coagulopathy (CAC). Traditional methods of thromboprophylaxis and treatment of thromboses after surgery require a tailored approach guided by an understanding of the pathophysiologic underpinnings of the COVID-19 patient. Likewise, a prolonged period of risk for developing hemostatic complications following hospitalization due to COVID-19 has resulted in guidelines from differing societies that recommend varying periods of delay following SARS-CoV-2 infection. In conclusion, we propose the perioperative, personalized assessment of COVID-19 patients' CAC using viscoelastic hemostatic assays and fluorescent microclot analysis.

Estudo comparativo entre uma medida isolada da circunferência abdominal e o aumento da resistência ao fluxo sanguíneo na artéria umbilical, no diagnóstico do crescimento intra-uterino retardado / Abdominal circunference, umbilical artery, intrauterine growth retardation

Os autores realizaram um estudo prospectivo com 174 pacientes de baixo risco onde compararam a medida isolada da circunferência abdominal e o aumento da resistência do fluxo sanguíneo da artéria umbilical para diagnóstico de crescimento intra-uterino retardado. Os autores encontraram os seguintes valores estatísticos para a circunferência abdominal: sensibilidade, 8 por cento; especificidade, 81 por cento; valor preditivo positivo, 35 por cento; valor preditivo negativo, 98 por cento e para o estudo da Dopplervelocimentria os seguintes valores: sensibilidade, 85 por cento; especificidade, 90 por cento; valor preditivo positivo, 54 por cento; valor preditivo negativo, 97 por cento. Conclui-se que poderia se obter melhores valores preditivos positivos em ambos os métodos se em vez de utilizar como terminologia o pequeno para a idade gestacional fosse utilizado o conceito crescimento intra-uterino inadequado