Evaluation of the Therapeutic Effects of the Hydroethanolic Extract of Portulaca oleracea on Surgical-Induced Peritoneal Adhesion.

OBJECTIVE: Peritoneal adhesion (PA) is an abnormal connective tissue that usually occurs between tissues adjacent to damaged organs during processes such as surgery. In this study, the anti-inflammatory and antioxidant effects of Portulaca oleracea (PO) were investigated against postoperative-induced peritoneal adhesion. METHODS: Thirty healthy male Wistar rats (220 ± 20 g, 6-8 weeks) were randomly divided into four groups: (1) normal, (2) control (induced peritoneal adhesion), and (3) and (4) PO extracts (induced peritoneal adhesion and received 100 or 300 mg/kg/day of PO extract for seven days). Finally, macroscopic and microscopic examinations were performed using different scoring systems and immunoassays in the peritoneal lavage fluid. RESULTS: We found that the levels of adhesion scores and interleukin- (IL-) 1ß, IL-6, IL-10, tumour necrosis factor- (TNF-) α, transforming growth factor- (TGF-) ß 1, vascular endothelial growth factor (VEGF), and malondialdehyde (MDA) were increased in the control group. However, PO extract (100 and 300 mg/kg) notably reduced inflammatory (IL-1ß, IL-6, and TNF-α), fibrosis (TGF-ß 1), angiogenesis (VEGF), and oxidative (MDA) factors, while increased anti-inflammatory cytokine IL-10, antioxidant factor glutathione (GSH), compared to the control group. CONCLUSION: Oral administration of PO improved postoperational-induced PA by alleviating the oxidative factors, fibrosis, inflammatory cytokines, angiogenesis biomarkers, and stimulating antioxidative factors. Hence, PO can be considered a potential herbal medicine to manage postoperative PA. However, further clinical studies are required to approve the effectiveness of PO.

Botulinum toxin injection for restrictive myopathy of thyroid-associated orbitopathy: success rate and predictive factors.

PURPOSE: To evaluate the rate of and predictive factors for successful treatment of restrictive myopathy in thyroid-associated orbitopathy (TAO) using botulinum toxin injection. METHODS: Twenty patients with restrictive myopathy of TAO were enrolled in the study. Abnormal thyroid function test results were not a prerequisite for inclusion. In each extraocular muscle 25 units of botulinum toxinA were injected. The success rate, calculated at 2 years or last follow-up before surgery, was defined as proportion of the cases with esotropia of <10(Δ), vertical deviation of <5(Δ), and no diplopia in primary position and downgaze for at least 1 year. Both univariate analysis and multivariate logistic regressions were performed to identify the factors associated with success. RESULTS: The procedure was successful in 11 cases (55%): in 8 patients with predominantly esotropia, 1 patient with predominantly hypotropia, and 2 patients of mixed type. Four factors were significantly associated with the success: type of deviation (P = 0.007), lower amounts of hypotropia (P = 0.001) and esotropia (P = 0.05), and lower degree of extorsion (P = 0.01). In the multivariate logistic regression, only lower amount of hypotropia was significantly associated with the success (P = 0.09, OR = 1.36). CONCLUSIONS: Botulinum toxin injection can be an effective alternative for the treatment of the restrictive myopathy in TAO. The best candidates for injection of the toxin are patients with esotropia, smaller angle of horizontal and vertical deviations, and lower degree of extorsion.

Medial rectus muscle elongation, a technique to treat very large-angle esotropia.

PURPOSE: The purpose was to describe the medial rectus muscle elongation (MRE) procedure to treat very large-angle esotropia (ET) with surgery on a lower number of muscles. METHODS: Twenty patients with very large-angle ET (more than 70 PD) underwent the MRE procedure. In the MRE procedure, the muscle was split longitudinally into three parts. The wider central part was sutured with 6/0 vicryl and disinserted. The distal end of the peripheral parts (still attached to the original insertion), 7-9 mm away from the insertion, was sutured to the proximal end of the central part. At the end of the procedure, the distance of the anastomosis site from the insertion was named as the final elongation. The dose-response effect of the final elongation was calculated in bilateral MRE cases. The mean of the dose-response effect, obtained in the binocular surgery group, was used in the monocular surgery group to calculate the resection effect of lateral rectus (LR) muscle. RESULTS: Eleven patients underwent bilateral MRE and nine patients underwent unilateral MRE and LR muscle resection. The mean preoperative far and near deviation was 94.10 ± 19.33 PD. The mean postoperative deviation was 14.60 ± 18.07 PD for far and 14.50 ± 18.23 PD for near deviation. In bilateral MRE cases, the mean dose-response effect of the elongation was 5.53 ± 0.67 PD/mm for far and 5.58 ± 0.69 PD/mm for near deviation. The mean LR muscle resection effect was 6.41 ± 1.99 PD/mm for far and 6.28 ± 1.93 PD/mm for near deviation. CONCLUSION: The MRE procedure seems an acceptable method to treat very large-angle ET with surgery on a lower number of muscles.

Combining rectus muscle recessions with a central tenectomy to treat large-angle horizontal strabismus.

PURPOSE: To report the effectiveness of incorporating a central tenectomy on the recessed rectus muscles when treating large-angle horizontal deviations. METHODS: Patients undergoing recession and central tenectomy from March 2010 to January 2013 were prospectively enrolled. The procedure entails making two longitudinal incisions, each 4 mm, on the muscle adjacent to sutures made during the recession procedure. With recession complete and muscle sutured to the sclera, the central flap (with approximately one-third of the insertion width) is excised. The following variables were analyzed: expected correction (according to surgical dose tables), achieved correction (preoperative deviation minus postoperative deviation), and tenectomy effect (achieved correction minus expected correction). RESULTS: A total of 16 horizontal rectus muscles of 16 eyes of 12 patients were included, 8 with exotropia and 4 with esotropia. No cases of significant limitation in duction in the field of the recessed muscle occurred. In all patients, the median achieved corrections at distance (55(Δ)) and at near (53.5(Δ)) were significantly higher than the median expected corrections (45(Δ) for both distance and near [P = 0.002]). The postoperative deviations at distance and near were lower in the unilateral surgery group (n = 8; statistically significant only for near deviation). The tenectomy effects in the esotropia group for both distance and near were more pronounced than those of the exotropia group (although not statistically significant). CONCLUSIONS: In our patients central tenectomy of the recessed rectus muscles increased the effect of recession procedures without limiting ductions. There were possible greater effects in esotropia patients and recession-resection procedures.