Short-Term Morpho-Functional Changes before and after Strabismus Surgery in Children Using Structural Optical Coherence Tomography: A Pilot Study.

PURPOSE: To evaluate the immediate alterations in the thickness of the macular ganglion cell-inner plexiform layer (mGCIPL), peripapillary retinal nerve fiber layer (RNFL), inner retinal layer (IRL), and outer retinal layer (ORL) using spectral domain optical coherence tomography (SD-OCT) subsequent to strabismus surgery in pediatric patients diagnosed with horizontal esotropia. METHODS: Twenty-eight eyes from twenty-one child patients who had undergone uncomplicated horizontal rectus muscle surgery due to strabismus were included. Measurements of RNFL, mGCL-IPL, IRL, and ORL using structural OCT were conducted both before the surgery and one month after the surgical procedure. Importantly, a control group comprising 14 healthy eyes, matched for age and significant refractive error (<3.00 diopters), was included in the current analysis. RESULTS: Our analysis indicated no significant disparity before and after surgery in terms of best-corrected visual acuity (BCVA), RNFL, IRL, and ORL. Conversely, concerning the macular ganglion cell layer-inner plexiform layer analysis, a substantial increase in mGCL-IPL was observed following the surgical intervention. The mean mGCL-IPL measured 60.8 ± 9.2 µm at baseline and 66.1 ± 13.2 µm one month after the surgery (p = 0.026). Notably, comparison between the strabismus group at baseline and the healthy group revealed a significant reduction in mGCL-IPL in the strabismus group (60.8 ± 9.2) compared to the healthy control group (68.3 ± 7.2; p = 0.014). CONCLUSIONS: Following strabismus surgery, our observations pointed towards a thickening of the mGCL-IPL layer, which is likely attributable to transient local inflammation. Additionally, we identified a significant differentiation in the mGCL-IPL complex between the pediatric patient group with strabismus and the control group.

Sympathetic Ophthalmia after Vitreoretinal Surgery without Antecedent History of Trauma: A Systematic Review and Meta-Analysis.

BACKGROUND: To evaluate the morbidity frequency measures in terms of the cumulative incidence of sympathetic ophthalmia (SO) triggered by single or multiple vitreoretinal (VR) surgery procedures in eyes without an antecedent history of trauma and previous ocular surgery, except for previous or concomitant uneventful lens extraction, and to further investigate the relationship between VR surgery and SO. METHODS: A literature search was conducted using PubMed, Embase, and Scopus from inception until 11 November 2022. The Joanna Briggs Institute (JBI) critical appraisal checklist for the case series and the Newcastle-Ottawa Scale were used to assess the risk of bias. The research was registered with the PROSPERO database (identifier, CRD42023397792). Meta-analyses were conducted using the measurement of risk and a 95% confidence interval (CI) for each study. RESULTS: A random-effect meta-analysis demonstrated that the pooled cumulative incidence of SO triggered by single or multiple VR surgery procedures in eyes without an antecedent history of trauma and previous ocular surgery, except for previous or concomitant uneventful lens extraction among patients who developed SO regardless of the main trigger, was equal to 0.14 with a CI between 0.08 and 0.21 (I2 = 78.25, z: 7.24, p < 0.01). The pooled cumulative incidence of SO triggered by single or multiple VR surgery procedures in eyes without an antecedent history of trauma and previous ocular surgery, except for previous or concomitant uneventful lens extraction among patients who underwent VR surgery, was equal to 0.03 for every 100 people, with a confidence interval (CI) between 0.02% and 0.004% (I2 = 27.77, z: 9.11, p = 0.25). CONCLUSIONS: Despite postsurgical SO being a rare entity, it is a sight-threatening disease. VR surgery should be viewed as a possible inciting event for SO and considered when counseling patients undergoing VR surgery.

Assessment of a circular powered stapler for creation of anastomosis in left-sided colorectal surgery: A prospective cohort study.

BACKGROUND: Circular staplers perform a critical function for creation of anastomoses in colorectal surgeries. Powered stapling systems allow for reduced force required by surgeons to fire the device and may provide advantages for creating a secure anastomosis. The objective of this study was to evaluate the clinical performance of a novel circular powered stapler in a post-market setting, during left-sided colectomy procedures. MATERIALS AND METHODS: Consecutive subjects underwent left-sided colorectal resections that included anastomosis performed with the ECHELON CIRCULAR™ Powered Stapler (ECP). The primary endpoint was the frequency in which a stapler performance issue was observed. Secondary endpoints included evaluation of ease of use of the device via a surgeon satisfaction questionnaire, and monitoring/recording of procedure-related adverse events (AEs). RESULTS: A total of 168 anastomoses were performed with the ECP. Surgical approaches included robotic-assisted (n = 74, 44.0%), laparoscopic (n = 71, 42.3%), open (n = 20, 11.9%), and hand-assisted minimally invasive (n = 3, 1.8%) procedures. There were 22 occurrences of device performance issues in 20 (11.9%) subjects during surgery. No positive intraoperative leak tests were observed, and only 1 issue was related to a procedure-related AE or surgical complication, which was an instance of incomplete surgical donut necessitating re-anastomosis. Postoperative anastomotic leaks were experienced in 4 (2.4%) subjects. Clavien-Dindo classification of all AEs indicated that 92.0% were Grades I or II. Participating surgeons rated the ECP as easier to use compared to previously used manual circular staplers in 85.7% of procedures. CONCLUSION: The circular powered stapler exhibited few clinically relevant performance issues, an overall favorable safety profile, and ease of use for creation of left-sided colon anastomoses.

Laparoscopic Colorectal Training Gap in Colorectal and Surgical Residents.

BACKGROUND AND OBJECTIVES: Laparoscopic colorectal surgery is an established safe procedure with demonstrated benefits. Proficiency in this specialty correlates with the volume of cases. We examined training in this surgical field for both general surgery and colon and rectal surgery residents to determine whether the number of cases needed for proficiency is being realized. METHODS: We examined the Accreditation Council for Graduate Medical Education (ACGME) and American Board of Colorectal Surgeons (ABCRS) operative statistics for graduating general surgery and colon and rectal surgery residents. RESULTS: Although the number of advanced laparoscopy cases had increased for general surgery residents, there was still a significant gap in case volume between the average number of laparoscopic colorectal operations performed by graduating general surgery residents (21.6) and those performed by graduating colon and rectal surgery residents (81.9) in 2014. CONCLUSION: There is a gap between general surgery and colon and rectal surgery residency training for laparoscopic colorectal surgery. General surgery residents are not meeting the volume of cases necessary for proficiency in colorectal surgery. This deficit represents a structural difference in training.

Enfrentamento religioso e política: as lições da resposta à Aids / Religious coping and politics: lessons from the response to Aids / Afrontamiento religioso y política: las lecciones de la respuesta al Sida

O enfrentamento do adoecimento e a interação com diferentes religiosidades são desafios para a prática profissional, especialmente quando a sexualidade está envolvida. Que lições o enfrentamento religioso da Aids poderia oferecer? Baseado em pesquisa documental, estudos de caso, oficinas e entrevistas, este artigo discute o enfrentamento da Aids nas primeiras décadas de epidemia em São Paulo na perspectiva de religiosos. Lideranças de várias tradições religiosas co-construíram a resposta social à epidemia, incluindo a prevenção centrada no uso do preservativo. Noções de solidariedade, direitos humanos e ecumenismo expressavam a mobilização democrática pós-ditadura paralela à emergência da doença. "Católico-humanistas" no governo compartilhavam essa perspectiva com seus pares da hierarquia católica, estimulando um enfrentamento religioso de estilo "colaborativo". Doentes com Aids, inclusive padres e seminaristas, foram acolhidos com apoio da Arquidiocese, enquanto acirrado debate interno opunha pastoralistas e adeptos da teologia da libertação aos canonistas (vaticanistas) que, desde então, disseminaram um discurso de enfrentamento de "estilo delegante" e moralista, especialmente no campo da prevenção. Religiosos em qualquer posição (fiéis, clérigos, autoridades) produzem e reproduzem discursos implicados em estilos de enfrentamento religiosos disponíveis em seus contextos socioculturais e políticos; seus simbolismos permanecem no enfrentamento pessoal - com efeitos cognitivo-emocionais e comportamentais. O enfrentamento religioso não pode ser reduzido ao comportamento individual e à relação pessoal com o dogma, o sagrado e o transcendental. Uma compreensão mais ampla das suas dimensões psicossociais e político-institucionais, assim como a interação do discurso técnico com a religiosidade viva, enriquecerão a pesquisa e a prática profissional na promoção da saúde.(AU)

Religious coping with illness and the interactions among diverse forms of religiosity have posed challenges for the practice of health professionals, especially when sexuality is involved. What lessons can coping with AIDS offer? Based on archival research, case studies, workshops, and interviews, this article discusses the response to AIDS through the perspective of religious leaders who lived through its first decades in São Paulo, Brazil. Notions of solidarity, human rights, and ecumenicalism were articulated in the construction of the social response to the epidemic, including prevention efforts centered on condom use. These ideas expressed the historical period when mobilization for democracy post-dictatorship paralleled the AIDS crisis emergence. As in other religious traditions, "humanist-Catholics" in the government shared this perspective with their peers in the higher rungs of the Church, producing a "collaborative" religious coping style. In the Catholic responses, people with AIDS, including priests and seminarians, were cared for with the support from the Archdiocese, while the strained internal debate created opposition among "pastoralists" and followers of Liberation Theology and "canonists", especially in the field of prevention in which the Vatican delivered a discourse of a moral and "delegating" style of coping. Religious followers in whatever position - followers, clergy, authorities - produce and reproduce discourses on religious coping available in their socio-cultural and political contexts; its symbolisms remain implicated in personal coping - with cognitive, emotional and behavioral effects. Religious coping cannot be reduced to individual behavior and its relationship with dogma, the sacred and the transcendental. A broader comprehension of its psychosocial and institutional-political dimensions, as well as the interaction with the lived religiosity will enhance the research and the professional practice.(AU)

Afrontamiento con la enfermedad y las interacciones entre diversas formas de religiosidad son desafíos para la práctica de los profesionales de la salud, sobre todo cuando se trata de la sexualidad. ¿Qué lecciones ofrece el afrontamiento con el SIDA? Basado en estudio documental, estudios de casos, talleres y entrevistas, este artículo discute la respuesta al SIDA a través de la perspectiva de los líderes religiosos que vivieron sus primeras décadas en São Paulo, Brasil. Las nociones de solidaridad, los derechos humanos y ecumenismo se articularon en la construcción de la respuesta social a la epidemia, incluyendo los esfuerzos de prevención centradas en el uso del condón. Estas ideas expresan el período histórico en el que la movilización de la democracia post-dictadura apareció paralelamente a la crisis del SIDA. Tal como en otras instituciones religiosas, "católico-humanistas", dentro y fuera del gobierno y de la jerarquía de la Iglesia, han producido un "estilo colaborativo" de afrontamiento religioso. En el campo católico, personas enfermas de SIDA, inclusive padres y seminaristas, fueron amparados con apoyo de la Arquidiócesis, mientras un intenso debate interno oponía a "pastorialistas" y adeptos a la teología de la liberación, a los "canonistas" y seguidores del Vaticano, especialmente en la prevención campo donde los "vaticanistas" diseminaban un discurso de afrontamiento moralista de estilo "delegante". Religiosos en cualquier posición - fieles, clérigos, autoridades - producen o reproducen discursos con estilos de afrontamiento religioso a la enfermedad disponibles en sus contextos socio-culturales e políticos; sus simbolismos permanecen implicados en el enfrentamiento personal - con repercusiones cognitivas, emocionales y de comportamiento...(AU)

Enfrentamento religioso e política: as lições da resposta à Aids / Religious coping and politics: lessons from the response to Aids / Afrontamiento religioso y política: las lecciones de la respuesta al Sida

O enfrentamento do adoecimento e a interação com diferentes religiosidades são desafios para a prática profissional, especialmente quando a sexualidade está envolvida. Que lições o enfrentamento religioso da Aids poderia oferecer? Baseado em pesquisa documental, estudos de caso, oficinas e entrevistas, este artigo discute o enfrentamento da Aids nas primeiras décadas de epidemia em São Paulo na perspectiva de religiosos. Lideranças de várias tradições religiosas co-construíram a resposta social à epidemia, incluindo a prevenção centrada no uso do preservativo. Noções de solidariedade, direitos humanos e ecumenismo expressavam a mobilização democrática pós-ditadura paralela à emergência da doença. "Católico-humanistas" no governo compartilhavam essa perspectiva com seus pares da hierarquia católica, estimulando um enfrentamento religioso de estilo "colaborativo". Doentes com Aids, inclusive padres e seminaristas, foram acolhidos com apoio da Arquidiocese, enquanto acirrado debate interno opunha pastoralistas e adeptos da teologia da libertação aos canonistas (vaticanistas) que, desde então, disseminaram um discurso de enfrentamento de "estilo delegante" e moralista, especialmente no campo da prevenção. Religiosos em qualquer posição (fiéis, clérigos, autoridades) produzem e reproduzem discursos implicados em estilos de enfrentamento religiosos disponíveis em seus contextos socioculturais e políticos; seus simbolismos permanecem no enfrentamento pessoal - com efeitos cognitivo-emocionais e comportamentais. O enfrentamento religioso não pode ser reduzido ao comportamento individual e à relação pessoal com o dogma, o sagrado e o transcendental. Uma compreensão mais ampla das suas dimensões psicossociais e político-institucionais, assim como a interação do discurso técnico com a religiosidade viva, enriquecerão a pesquisa e a prática profissional na promoção da saúde.

Religious coping with illness and the interactions among diverse forms of religiosity have posed challenges for the practice of health professionals, especially when sexuality is involved. What lessons can coping with AIDS offer? Based on archival research, case studies, workshops, and interviews, this article discusses the response to AIDS through the perspective of religious leaders who lived through its first decades in São Paulo, Brazil. Notions of solidarity, human rights, and ecumenicalism were articulated in the construction of the social response to the epidemic, including prevention efforts centered on condom use. These ideas expressed the historical period when mobilization for democracy post-dictatorship paralleled the AIDS crisis emergence. As in other religious traditions, "humanist-Catholics" in the government shared this perspective with their peers in the higher rungs of the Church, producing a "collaborative" religious coping style. In the Catholic responses, people with AIDS, including priests and seminarians, were cared for with the support from the Archdiocese, while the strained internal debate created opposition among "pastoralists" and followers of Liberation Theology and "canonists", especially in the field of prevention in which the Vatican delivered a discourse of a moral and "delegating" style of coping. Religious followers in whatever position - followers, clergy, authorities - produce and reproduce discourses on religious coping available in their socio-cultural and political contexts; its symbolisms remain implicated in personal coping - with cognitive, emotional and behavioral effects. Religious coping cannot be reduced to individual behavior and its relationship with dogma, the sacred and the transcendental. A broader comprehension of its psychosocial and institutional-political dimensions, as well as the interaction with the lived religiosity will enhance the research and the professional practice.

Afrontamiento con la enfermedad y las interacciones entre diversas formas de religiosidad son desafíos para la práctica de los profesionales de la salud, sobre todo cuando se trata de la sexualidad. ¿Qué lecciones ofrece el afrontamiento con el SIDA? Basado en estudio documental, estudios de casos, talleres y entrevistas, este artículo discute la respuesta al SIDA a través de la perspectiva de los líderes religiosos que vivieron sus primeras décadas en São Paulo, Brasil. Las nociones de solidaridad, los derechos humanos y ecumenismo se articularon en la construcción de la respuesta social a la epidemia, incluyendo los esfuerzos de prevención centradas en el uso del condón. Estas ideas expresan el período histórico en el que la movilización de la democracia post-dictadura apareció paralelamente a la crisis del SIDA. Tal como en otras instituciones religiosas, "católico-humanistas", dentro y fuera del gobierno y de la jerarquía de la Iglesia, han producido un "estilo colaborativo" de afrontamiento religioso. En el campo católico, personas enfermas de SIDA, inclusive padres y seminaristas, fueron amparados con apoyo de la Arquidiócesis, mientras un intenso debate interno oponía a "pastorialistas" y adeptos a la teología de la liberación, a los "canonistas" y seguidores del Vaticano, especialmente en la prevención campo donde los "vaticanistas" diseminaban un discurso de afrontamiento moralista de estilo "delegante". Religiosos en cualquier posición - fieles, clérigos, autoridades - producen o reproducen discursos con estilos de afrontamiento religioso a la enfermedad disponibles en sus contextos socio-culturales e políticos; sus simbolismos permanecen implicados en el enfrentamiento personal - con repercusiones cognitivas, emocionales y de comportamiento. Estudios y prácticas profesionales en el campo del afrontamiento religioso se enriquecerían al considerar dimensiones que no pueden reducirse al comportamiento individual y a la relación con el dogma, lo sagrado y lo transcendental. Una comprensión más amplia de las dimensiones psicosociales, institucionales, y políticas, también la interacción con la religiosidad viva, enriquecerá la investigación y la práctica profesional.

Acute stroke after intravitreal bevacizumab to treat choroidal neovascularization due to angioid streaks in pseudoxanthoma elasticum : a severe systemic adverse event after an off-label procedure.

To report the occurrence of acute stroke after intravitreal bevacizumab administration to treat choroidal neovascularization due to angioid streaks in a patient affected by pseudoxanthoma elasticum. A 54-year-old man with pseudoxanthoma elasticum had vision loss because of choroidal neovascularization due to angioid streaks. He underwent two intravitreal bevacizumab injections. Three days after the second procedure the patient was afflicted by acute stroke. Intravitreal injection of bevacizumab to treat choroidal neovascularization due to angioid streaks in pseudoxanthoma elasticum could lead to severe systemic adverse events.

A metastatic colon cancer model using nonoperative transanal rectal injection.

BACKGROUND: This study aimed to develop a noninvasive orthotopic model for metastasis of colon and rectal cancer using a transanal approach. Currently, the most accurate orthotopic representation of metastatic human colon cancer is via a cecal injection. The transanal model allows for further examination of systemic immune responses, tumor take, and onset of metastasis without prior surgical intervention. METHODS: For this study, 60 Balb/c mice were anesthetized and subjected to gentle anal dilation using blunt-tipped forceps at the anal opening. Murine colon cancer parental CT26 or luciferase-labeled CT26 (CT26-luc) cells were injected submucosally into the distal posterior rectum (30 CT26 and 30 CT26 injections) at concentrations of 2.5 x 10(4), 1 x 10(5), and 1 x 10(6) in a volume of 50 microl. Tumor growth and metastatic development was monitored at 5-day intervals for 50 days. All the remaining mice were killed on postinjection day 50. RESULTS: The optimal concentration for metastasis and survival of the mice was 2.5 x 10(4) cells. Higher concentrations of cells yielded higher mortality but did not result in metastasis. The overall success of tumor growth in both experiments using the transanal rectal injection was 65%. Histology showed that all tumors were poorly differentiated adenocarcinomas. Two mice (3.3%) from the 2.5 x 10(4) CT26-luc group showed metastatic colonic adenocarcinoma to the liver on postinjection day 50. CONCLUSION: Transanal rectal injection of colon cancer cells offers a nonoperative orthotopic murine model for colon cancer that may lead to the development of metastasis. By using an orthotopic model, more aspects of metastatic colon cancer can be evaluated without the influence of a previous abdominal incision. These results warrant more investigation.

Combined cataract extraction and intravitreal bevacizumab in eyes with choroidal neovascularization resulting from age-related macular degeneration.

PURPOSE: To evaluate the safety and efficacy of phacoemulsification, intraocular lens (IOL) implantation, and a single intravitreal injection of bevacizumab in patients with coexisting visually significant cataract and subfoveal neovascularization due to age-related macular degeneration. SETTING: Department of Ophthalmology, University of Bari, Bari, Italy. METHODS: Eyes with predominantly classic subfoveal neovascularization and cataract had phacoemulsification, IOL implantation, and a 1.25 mg intravitreal injection of bevacizumab. One month after combined surgery, corrected distance visual acuity (CDVA), anterior chamber reaction, and intraocular pressure were evaluated and central foveal thickness was measured by optical coherence tomography. RESULTS: Twenty eyes of 20 patients were evaluated. One month postoperatively, the mean CDVA improved significantly, from 20/100 (range 20/160 to 20/80) at baseline to 20/63 (range 20/125 to 20/50) (P<.0001). The mean central foveal thickness decreased significantly, from 353.75 microm +/- 12.50 (SD) (range 334 to 375 microm) at baseline to 275.7 +/- 17.3 microm (range 255 to 323 microm) at 1 month (P<.0001). Intraocular pressure did not change significantly, and anterior chamber reaction was absent. No ocular or systemic adverse events were observed. CONCLUSION: Combined phacoemulsification, IOL implantation, and intravitreal bevacizumab was a safe and efficacious treatment in patients with visually significant cataract and active subfoveal neovascularization.

Stapled transanal rectal resection vs. transvaginal rectocele repair for treatment of obstructive defecation syndrome.

PURPOSE: Stapled transanal rectal resection has been introduced as a new technology for the management of obstructive defecation syndrome. In this study we observed the clinical outcomes for stapled transanal rectal resection as compared with transvaginal rectocele repair for obstructive defecation syndrome. METHODS: This study is a retrospective review of patients who received transvaginal rectocele repair for obstructive defecation syndrome from June 1997 to February 2002 as compared with patients who received stapled transanal rectal resection from June 2005 to August 2007. The clinical outcomes observed were operative time, estimated blood loss, length of stay, complication rate, procedure failure rate, recurrence rate, time to recurrence, and dyspareunia rate. RESULTS: Thirty-seven patients had transvaginal rectocele repair for management of obstructive defecation syndrome, and 36 patients had stapled transanal rectal resection. There was no difference in the age of patients receiving either procedure (transvaginal rectocele repair, 57.92 years old; stapled transanal rectal resection, 53.19 years old; P = 0.1096). Evaluation of the clinical outcomes showed that transvaginal rectocele repair had a longer operative time (transvaginal rectocele repair, 85 minutes; stapled transanal rectal resection, 52 minutes; P = or<0.0001), greater estimated blood loss (transvaginal rectocele repair, 108 ml; stapled transanal rectal resection, 43 ml; P = 0.0015), and a lower complication rate (transvaginal rectocele repair, 18.9 percent; stapled transanal rectal resection, 61.1 percent; P = 0.0001). CONCLUSION: The stapled transanal rectal resection procedure can be done with shorter operative times and less blood loss than transvaginal rectocele repair, however, it has a higher complication rate.

Novel murine model for colon cancer: non-operative trans-anal rectal injection.

BACKGROUND: This study was conducted to develop a modified murine model of colon cancer that is non-operative. Currently, the most accurate orthotopic murine model of colon cancer requires an invasive procedure involving cecal injection of colon cancer cells and therefore limits the ability to perform immunological studies subsequent to cecal resections. MATERIALS AND METHODS: Murine colon cancer (CT26) cells were injected submucosally into the distal, posterior rectum of BALB/c mice. Care was taken not to pass transmurally into the pelvic cavity. Different magnifications (10x versus 100x) were used for injection, and primary tumor growth and metastatic disease were studied. RESULTS: In the initial study, 3/7 mice injected using 10x magnifications had notable, large tumor originating from the rectal wall, and histology revealed that all excised tumors were poorly differentiated adenocarcinoma. In the second study, 8/10 mice injected using 100x magnifications had notable tumor originating from the rectal well, and 4/8 mice had abnormal lung tissue with pathological evidence of hemorrhagic pulmonary edema. The use of 10x magnification resulted in 43% tumor take. In sharp contrast, 80% tumor take was observed with 100x magnification. The overall success of tumor take was 65% using the trans-anal rectal injection model. CONCLUSIONS: Our modified orthotopic murine model of colon cancer offers an alternative non-operative murine model for colon cancer and is less invasive than the traditional orthotopic model (i.e., cecal injection). This model may allow for more accurate investigations of inflammation and immune responses to surgical intervention without the influence of previous abdominal surgery.

Treatment of recurrent retinal angiomatous proliferation with intravitreal triamcinolone acetonide followed by photodynamic therapy with verteporfin: A retrospective case series.

OBJECTIVE: The aim of this study was to report the effect on tolerability of combined treatment with intravitreal triamcinolone acetonide (IVT) and photodynamic therapy (PDT) with verteporfin in patients with stage II retinal angiomatous proliferation (RAP) who had been treated previously with PDT and presented with recurrent RAP (R-RAP). METHODS: This was a retrospective case series of patients with R-RAP after PDT (1-5 treatments) treated once with IVT followed 1 month later by PDT. A visual acuity test, fluorescein and indocyanine green angiography, and optical coherence tomography were performed at baseline and at 1, 3, and 6 months. RESULTS: Five patients (4 men, 1 woman; mean [SD] age, 76.8 [3.9] years) with 6 eyes diagnosed with stage II R-RAP who had previously been treated with PDT and who received an IVT injection and PDT within 1 month were included in the study. Best corrected visual acuity (BCVA) remained stable after IVT in 5 eyes (83%) and deteriorated in 1 eye (17%). After PDT, BCVA remained stable in 2 eyes (33%) and deteriorated in 4 eyes (67%). IVT treatment combined with PDT also reduced fluorescein leakage. Median lesion size increased 24% before PDT and 61% at 6 months after PDT. One eye had intraocular hypertension at 3 months, and 1 eye developed a pigment epithelial tear after PDT. CONCLUSION: The results were limited by the number of eyes and relatively short follow-up, but in this study, PDT after IVT did not appear to be as effective or well tolerated in 5 patients who had already been treated with PDT and presented with R-RAP.

Orfandade e estigma: vivências de jovens órfãos em decorrência da aids / Orphans and stigma: young orphans living with aids

A epidemia da aids afeta a vida de crianças e jovens, independentemente da presença do HIV/Aids, através do adoecimento, perda dos pais, estigma, discriminação, entre outros. Este estudo teve como objetivo compreender o significado de ser órfão para jovens que perderam um ou ambos os pais em decorrência da aids e compreender os processos de estigmatização decorrentes dessa morte. Foram analisadas 19 entrevistas em profundidade realizadas com jovens órfãos, com idade entre 15 e 22 anos, residentes na cidade de São Paulo, entre os anos de 2005 e 2007. O sentido atribuído à morte e todo o ritual que a cerca é concebido como socialmente construído e a morte em decorrência da aids permeada pelo estigma que acompanha a aids desde o início da epidemia. Foram encontrados cinco significados associados à orfandade: dificuldade de falar sobre a orfandade ligada à aids; sentir falta do cuidado materno; o desafio de ser independente; não se sentir órfão e sentir tristeza em decorrência da morte. Os processos de estigmatização foram divididos em estigma sentido e efetivado e aconteceram na escola, na casa de amigos, na rua e com a namorada. Todos os relatos e cenas de estigma foram de estigma por associação, pois decorriam da causa da morte do(s) pai(s). Percebe-se que a orfandade em decorrência da aids impacta a vida dos jovens. Eles convivem com as adversidades com apoio da família, na maioria das vezes, materna. Não se conhece muito sobre os órfãos, principalmente se eles não viverem com HIV/Aids, pois os serviços de saúde perdem o contato a partir do momento que a pessoa da família que vive com aids morre. É importante que os programas de aids incorporarem as visões e as perspectivas destes jovens em seus projetos para garantir-lhes seus direitos.

The gap in laparoscopic colorectal experience between colon and rectal and general surgery residency training programs.

PURPOSE: In this article, we review the laparoscopic experience of general surgery and colorectal residency training programs in the United States during the past 5 and 12 years, respectively. The purpose of this study was to determine whether an adequate experience was being provided, and at what level of training, to safely and effectively perform advanced laparoscopy. METHODS: General Surgery Operative Reports from the training years 2000 to 2004 were obtained from the Accreditation Council for Graduate Medical Education. Similarly, colorectal operative performance logs from the training years 1994 to 2005 were obtained from the American Board of Colon and Rectal Surgery. RESULTS: From 2000 to 2004, basic and advanced laparoscopic cases (as designated by the Accreditation Council for Graduate Medical Education) have increased from 10.1 to 12.2 percent and 2.1 to 3.7 percent, respectively. Within this period, the number of laparoscopic colon cases/resident/career has increased from 1.8 to 4.6. The percentage of cases performed laparoscopically increased from 3.9 to 22.5 percent from 1993-1994 to 2004-2005 training years. From 1993 to 2001, the average number of laparoscopic cases/resident increased from 6.3 to 16.1. In 2004, the average number of cases/resident increased to 45.3. Of this number, 30 were colon, 9.4 were rectal, and the remaining 5.9 were miscellaneous colorectal procedures. CONCLUSIONS: Learning curves for laparoscopic colectomy are reported in the range of 20 to 60 cases. Based on the most recent data reviewed, colon and rectal resident experience is tending toward this threshold. Recent general surgery graduates may be lacking the appropriate volume to reach proficiency in laparoscopic colorectal surgery.

Prospective comparison of laparoscopic vs. open resections for colorectal adenocarcinoma over a ten-year period.

PURPOSE: The aim of this study was to define the long-term oncologic outcomes of laparoscopic resections for colorectal cancer. METHODS: We analyzed our experience via a prospective, nonrandomized, longitudinal cohort study. The period of study extended from April 1991 to May 2001. Laparoscopic resection was offered selectively in the absence of a large mass, invasion into abdominal wall or adjacent organs, and multiple prior abdominal operations. Every laparoscopic resection performed with curative intent for adenocarcinoma was included. Twenty percent of patients whose procedures were converted to open resection were included in the laparoscopic-resection group because of intention to treat. Oncologic outcome measures of this group were compared with a computerized, case-matched, open-resection group, the case-matching variables being age, gender, site of primary tumor (colon vs. rectum), and TNM stage. The laparoscopic-resection group was followed up prospectively, and data were updated regularly. The follow-up techniques consisted of a combination of office visits, telephone calls, and the United States Social Security Death Index database. RESULTS: The laparoscopic-resection group consisted of 172 patients with a mean age of 67 (range, 27-85) years. The open-resection group consisted of 172 patients with a mean age of 69 (range, 30-90) years. Mean follow-up was 52 (range, 3-128) months. Complete (100 percent) follow-up data were available. The TNM stage distribution was 63 Stage I (37 percent), 51 Stage II (30 percent), 47 Stage III (27 percent), and 11 Stage IV (6 percent) tumors for the laparoscopic-resection group and 65 Stage I (38 percent), 48 Stage II (28 percent), 51 Stage III (29 percent), and 8 Stage IV (5 percent) tumors for patients in the open-resection group (P = 0.75, not significant). Thirty-day mortality was 1.2 percent (2 deaths) in the laparoscopic-resection group and 2.4 percent (4 deaths) in the open-resection group (P > 0.05, not significant). Early and late complication incidences were comparable. Local recurrence was observed in three patients (1.7 percent) in the laparoscopic resection group with the primary tumor in the colon and in three patients (1.7 percent) with the primary tumor in the rectum, for a total incidence of local recurrence in the laparoscopy group of 3.5 percent (6 patients). In the open-resection group, local recurrence was observed in two patients (1.2 percent) among those with primary tumor site in the colon and in three patients (1.7 percent) in the group with primary tumor in the rectum, for a total incidence of local recurrence in the open-resection group of 2.9 percent (5 patients). One of the local recurrences in the laparoscopy group occurred in the port/extraction site, for an incidence of 0.6 percent. Metastasis occurred in 18 patients (10.5 percent) in the open group and in 21 (12.2 percent) in the laparoscopy group. Stage-for-stage overall five-year survival rates were similar in the two groups. The Kaplan-Meier statistical analysis performed for colonic vs. rectal primary adenocarcinoma confirmed that TNM stage for stage-overall survival was similar in the laparoscopic and open-resection groups (log-rank P = 0.22). CONCLUSIONS: Notwithstanding the drawbacks of a nonrandomized study, no adverse long-term oncologic outcomes of laparoscopic resections for colorectal cancer were observed in a single center's experience during a ten-year period.