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1.
Khirurgiia (Mosk) ; (4): 53-60, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32352669

RESUMO

Development of tracheal surgery was associated with introduction of fundamentally new procedures: two-level reconstruction, redo tracheal resection, tracheal resection with simultaneous dissection of tracheoesophageal fistula. There are combined and staged techniques when tracheal repair or endoscopic interventions are performed as a stage before circular resection of trachea. However, a single algorithm for prevention and correction of postoperative complications is still absent in tracheal surgery. Further development of tracheal surgery directly depends on introduction of preventive measures and analysis of adverse factors associated with increased risk of complications. In this regard, ongoing researches in this area are very perspective.


Assuntos
Traqueia/cirurgia , Estenose Traqueal/cirurgia , Cicatriz/diagnóstico , Cicatriz/etiologia , Cicatriz/terapia , Constrição Patológica/cirurgia , Dissecação , Humanos , Procedimentos Cirúrgicos Reconstrutivos , Estenose Traqueal/diagnóstico , Estenose Traqueal/etiologia , Estenose Traqueal/patologia , Fístula Traqueoesofágica/etiologia , Fístula Traqueoesofágica/cirurgia , Traqueotomia
2.
Anticancer Res ; 40(2): 1123-1126, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32014963

RESUMO

BACKGROUND: Merkel cell carcinoma (MCC) is an aggressive form of skin cancer that is often found in sun-exposed regions of the skin in older or immunocompromised individuals. To date there have only been four cases reported of MCC found in the nasal vestibule. CASE REPORT: We document an unusual case of MCC in the nasal vestibule of a 66-year-old female which was clinically believed to be an inflammatory reaction to a previous suture scar. The patient also had a history of dermatitis treated with UV light. The lesion was less than 5 mm in the greatest dimension and biopsied. There was small blue cell infiltrate in the dermis and the tumor cells were positive for synaptophysin, chromogranin and cytokeratin 20. They were negative for S100 proteins, melan A, human melanoma black 45 (HMB45) and lymphocyte common antigen CD45. For Ki-67, staining was positive in 90% of the tumor cells and tumor protein 53 immunoreactivity showed a wild type staining pattern. The pathological diagnosis was MCC and the patient underwent Mohs surgery with no tumor recurrence or metastasis identified at 2.5 years of follow-up. CONCLUSION: To the best of our knowledge, cases of MCC arising in the nasal vestibule with clinical features mimicking a suture scar have not been reported. The importance of early diagnosis and treatment of MCC to improve patient prognosis are discussed.


Assuntos
Carcinoma de Célula de Merkel/diagnóstico , Cicatriz/diagnóstico , Idoso , Biópsia , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons
4.
Am J Ophthalmol ; 209: 3-9, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31560878

RESUMO

PURPOSE: To characterize the clinical features of patients with direct immunofluorescence (DIF)-negative mucous membrane pemphigoid (MMP). DESIGN: Retrospective case series. METHODS: Thirty-six patients who underwent a conjunctival biopsy for suspected MMP were included. Demographic and clinical information was collected. Main outcome measures included visual acuity, Foster stages, presence of extraocular involvement, history of autoimmune disease, and durations of follow-up. RESULTS: Thirty-two patients had a negative DIF. Of those, 2 had a positive DIF on repeat biopsy. Eleven showed progression of conjunctival scarring during a median follow-up of 42 months (range, 8-100 months) and were diagnosed with biopsy-negative MMP. Another 11 patients with a median follow-up of 54 months (range, 15-138 months) were diagnosed with cicatrizing conjunctivitis of other causes. The median visual acuity of patients with biopsy-negative MMP at presentation was significantly lower compared to patients with cicatrizing conjunctivitis of other causes (20/400 vs 20/40, P = .02). Conjunctival scarring score at presentation in both biopsy-positive and biopsy-negative MMP groups was significantly higher compared to patients with cicatrizing conjunctivitis of other causes (median Foster stage, 3 vs 1, P = .009; and 3 vs 1, P = .01, respectively). CONCLUSIONS: Patients with progressive cicatrizing conjunctivitis likely have MMP in the absence of alternate diagnoses. Our findings emphasize that suspicion for MMP must remain high for patients who have Foster stage 3 conjunctival scarring on presentation or worsening of scarring during follow-up, even in the setting of negative DIF.


Assuntos
Doenças Autoimunes/diagnóstico , Cicatriz/diagnóstico , Conjuntivite/diagnóstico , Técnica Direta de Fluorescência para Anticorpo/métodos , Penfigoide Mucomembranoso Benigno/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibióticos Antineoplásicos/uso terapêutico , Doenças Autoimunes/tratamento farmacológico , Doenças Autoimunes/fisiopatologia , Biópsia , Cicatriz/tratamento farmacológico , Cicatriz/fisiopatologia , Conjuntivite/tratamento farmacológico , Conjuntivite/fisiopatologia , Ciclofosfamida/uso terapêutico , Progressão da Doença , Feminino , Seguimentos , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/uso terapêutico , Penfigoide Mucomembranoso Benigno/tratamento farmacológico , Penfigoide Mucomembranoso Benigno/fisiopatologia , Estudos Retrospectivos , Coloração e Rotulagem/métodos , Acuidade Visual/fisiologia
5.
Ophthalmic Surg Lasers Imaging Retina ; 50(12): 779-784, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31877223

RESUMO

BACKGROUND AND OBJECTIVE: Antenatal Zika virus (ZIKV) or toxoplasmosis infections may present with isolated eye abnormalities with absence of other apparent birth defects. The purpose of this article is to discuss the overlapping spectrum of clinical presentation and retinochoroidal scarring in congenital ZIKV and toxoplasmosis infections. PATIENTS AND METHODS: Prenatal ultrasound abnormalities seen from antenatal ZIKV and toxoplasmosis infections overlap and may include intracranial calcifications, microcephaly, and intrauterine growth restriction. The clinical spectrum of both infections in less severely affected infants and children may include nonspecific neurological impairment such as developmental delay and seizures. RESULTS: Inherent limitations in serological testing pose additional barriers in establishing a diagnosis. Retinal pigment epithelium (RPE) mottling in ZIKV infection can occur in isolation or adjacent to retinochoroidal atrophy. In contrast, RPE mottling outside of the borders of retinochoroidal atrophy is not typically seen in toxoplasmosis. To date, postnatal reactivation of congenital eye lesions as seen in toxoplasmosis have not been reported with ZIKV infection. CONCLUSIONS: As children infected with congenital ZIKV grow older, subclinical eye abnormalities may be indistinguishable from toxoplasmosis. Brazil has had high prevalence of both diseases with long-term information available on toxoplasmosis only. Surveillance guidelines for asymptomatic eye abnormalities will likely evolve. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:779-784.].


Assuntos
Coriorretinite/diagnóstico , Cicatriz/diagnóstico , Infecções Oculares Parasitárias/diagnóstico , Infecções Oculares Virais/diagnóstico , Complicações Infecciosas na Gravidez , Toxoplasmose Congênita/complicações , Infecção por Zika virus/complicações , Pré-Escolar , Coriorretinite/etiologia , Cicatriz/etiologia , Infecções Oculares Parasitárias/etiologia , Infecções Oculares Virais/etiologia , Feminino , Humanos , Lactente , Microcefalia/diagnóstico , Gravidez , Infecção por Zika virus/congênito
6.
Invest Ophthalmol Vis Sci ; 60(14): 4865-4871, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31747687

RESUMO

Purpose: To evaluate the perfusion status of the retina and choriocapillaris in the area of laser scars on swept-source optical coherence tomography angiography (OCTA) images of eyes previously treated with panretinal photocoagulation (PRP). Methods: Cross-sectional exploratory analysis of swept-source OCTA images, which were retrospectively reviewed for laser scars. The appearance of the capillary networks in the area of previous laser were evaluated following a three-step grading system (normal/sparse/missing capillary network). The superficial and deep capillary plexus of the retina and the choriocapillaris were graded separately. Results: A total of 3140 laser scars in 54 eyes of 31 patients (13 female, mean age 57 ± 12 years) were included in this analysis. In the retina, 6.8% of the superficial and deep capillary network in the area evaluated appeared normal, 58% and 56% sparse, and 35% and 37% missing. Capillary dropout in the retina was not restricted to the area of prior laser treatment. The choriocapillaris decorrelation signal was either sparse (61%) or completely missing (38%) within the laser scar area. The perfusion of the choriocapillaris appeared normal in the area adjacent to laser scars. Conclusions: Capillary non-perfusion in the choriocapillaris was found within the laser scar area. Laser treatment seems to cause sustained non-perfusion of choriocapillaris in the area treated.


Assuntos
Corioide/irrigação sanguínea , Cicatriz/fisiopatologia , Retinopatia Diabética/fisiopatologia , Fotocoagulação a Laser , Vasos Retinianos/fisiologia , Idoso , Capilares/fisiologia , Cicatriz/diagnóstico , Estudos Transversais , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/cirurgia , Feminino , Angiofluoresceinografia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional/fisiologia , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos
7.
Medicine (Baltimore) ; 98(37): e17138, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517854

RESUMO

RATIONAL: Ehlers-Danlos syndrome (EDS) is a heritable connective tissue disorder. Currently, the genotype-phenotype correlations of classical EDS (cEDS) are still controversial. Hence, this study reported a case of cEDS with both clinical manifestations and COL5A2 gene mutation. PATIENT CONCERNS: A 30-year-old female presented to the plastic-surgery clinic with widen atrophic scars on forehead, elbows, knees and pretibial area that had developed since childhood. DIAGNOSIS: With the skin hyperextensibility, joint hypermobility, papyraceous scar revealed by physical examination, and the heterozygous pathogenic variant c1997G > A (p.P659P) in COL5A2 gene revealed by whole exome sequencing, the diagnosis of the classical Ehlers-Danlos syndrome was made. INTERVENTIONS: The patient underwent facial scar resection and sutured in minimizing tension and perfect apposition to avoid the post-surgery scar formation. OUTCOMES: Follow-up 6 months after surgery, the wound remained a fine line scar. LESSONS: Our findings suggested that COL5A2 gene mutation (c1997G > A p.P659P) may be associated with cEDS but did not reveal other severe complications.


Assuntos
Cicatriz/diagnóstico , Síndrome de Ehlers-Danlos/diagnóstico , Adulto , Cicatriz/genética , Cicatriz/patologia , Cicatriz/cirurgia , Diagnóstico Diferencial , Síndrome de Ehlers-Danlos/genética , Síndrome de Ehlers-Danlos/patologia , Síndrome de Ehlers-Danlos/cirurgia , Cotovelo , Feminino , Testa , Humanos , Joelho
9.
Int J Dermatol ; 58(10): 1212-1222, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31297798

RESUMO

BACKGROUND: Scarring is a distressing outcome of acne, as it causes cosmetic and psychological problems to the patients. Unfortunately no single treatment is satisfactory; instead, employing multiple modalities may have better outcome. Autologous adipose tissue-derived adult stem cells (AT-ASCs) and their secretory factors can stimulate collagen synthesis; angiogenesis and migration of fibroblasts thus regenerate damaged tissues. Also, conventional treatments for acne scarring, such as lasers and topical regimens, induce new collagen synthesis via activation of dermal fibroblasts or growth factors. The aim of the study was to verify the effectiveness of AT-ASCs for the treatment of acne scarring vs. the fractional carbon dioxide laser (FxCR). SUBJECTS AND METHODS: Split face comparative study included 10 adult patients with post-acne scars on both sides of the face. One side received AT-ASCs single injection while the other received three sessions of FxCR. Scars were then assessed using the global scoring system Goodman and Baron, scar area percent using NIH ImageJ software and functional assessment by measuring the transepidermal water loss (TEWL) and skin hydration. Both sides were followed for three months. RESULTS: A significant improvement in the degree of scar severity, scar area percent, skin hydration, and TEWL after 3 months of treatment on both sides of the face with insignificant differences between both treatment modalities, provided that AT-ASCs treatment was employed once vs. three sessions of FxCR. CONCLUSION: One injection of AT-ASCs is as effective as three sessions of FxCR in the treatment of atrophic acne scars.


Assuntos
Acne Vulgar/complicações , Células-Tronco Adultas/transplante , Cicatriz/terapia , Terapia com Luz de Baixa Intensidade/métodos , Transplante de Células-Tronco/métodos , Tecido Adiposo/citologia , Adulto , Cicatriz/diagnóstico , Cicatriz/etiologia , Feminino , Seguimentos , Humanos , Lasers de Gás/efeitos adversos , Lipectomia/métodos , Terapia com Luz de Baixa Intensidade/efeitos adversos , Terapia com Luz de Baixa Intensidade/instrumentação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Pele/patologia , Pele/efeitos da radiação , Fatores de Tempo , Transplante Autólogo/métodos , Resultado do Tratamento , Perda Insensível de Água/efeitos da radiação , Adulto Jovem
10.
Taiwan J Obstet Gynecol ; 58(4): 541-544, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31307748

RESUMO

OBJECTIVE: The aim of the present study was to describe various hysteroscopic findings of previous cesarean delivery scar defects (PCDS), and evaluate the relationship between these findings and abnormal uterine bleeding. MATERIALS AND METHODS: This was a retrospective study including patients with abnormal uterine bleeding after a cesarean section. Transvaginal ultrasound and hysteroscopy were used to detect the origin of the symptoms, and the gynecological symptoms and hysteroscopic findings were recorded. Relationships between the hysteroscopic findings and abnormal uterine bleeding were evaluated. RESULTS: Ninety-six (82.8%) patients presented with intermenstrual bleeding. The most common findings of scar defects on hysteroscopy were increased local vascularization (74.1%) and oozing spots (47.4%). Increased local vascularization on the defect was significantly related to intermenstrual bleeding (p = 0.048). CONCLUSION: This study categorized different findings of PCDS under hysteroscopy. Increased local vascularization on the scar defect was significantly related to intermenstrual bleeding.


Assuntos
Cesárea/efeitos adversos , Cicatriz/diagnóstico , Cicatriz/etiologia , Histeroscopia/métodos , Hemorragia Uterina/epidemiologia , Adulto , Cesárea/métodos , Cicatriz/epidemiologia , Estudos de Coortes , Comorbidade , Feminino , Humanos , Incidência , Gravidez , Prognóstico , Estudos Retrospectivos , Medição de Risco , Taiwan , Hemorragia Uterina/etiologia , Hemorragia Uterina/cirurgia
11.
Rev Assoc Med Bras (1992) ; 65(5): 714-721, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31166450

RESUMO

An isthmocele, a cesarean scar defect or uterine niche, is any indentation representing myometrial discontinuity or a triangular anechoic defect in the anterior uterine wall, with the base communicating to the uterine cavity, at the site of a previous cesarean section scar. It can be classified as a small or large defect, depending on the wall thickness of the myometrial deficiency. Although usually asymptomatic, its primary symptom is abnormal or postmenstrual bleeding, and chronic pelvic pain may also occur. Infertility, placenta accrete or praevia, scar dehiscence, uterine rupture, and cesarean scar ectopic pregnancy may also appear as complications of this condition. The risk factors of isthmocele proven to date include retroflexed uterus and multiple cesarean sections. Nevertheless, factors such as a lower position of cesarean section, incomplete closure of the hysterotomy, early adhesions of the uterine wall and a genetic predisposition may also contribute to the development of a niche. As there are no definitive criteria for diagnosing an isthmocele, several imaging methods can be used to assess the integrity of the uterine wall and thus diagnose an isthmocele. However, transvaginal ultrasound and saline infusion sonohysterography emerge as specific, sensitive and cost-effective methods to diagnose isthmocele. The treatment includes clinical or surgical management, depending on the size of the defect, the presence of symptoms, the presence of secondary infertility and plans of childbearing. Surgical management includes minimally invasive approaches with sparing techniques such as hysteroscopic, laparoscopic or transvaginal procedures according to the defect size.


Assuntos
Cesárea/efeitos adversos , Cicatriz/diagnóstico , Cicatriz/terapia , Doenças Uterinas/diagnóstico , Doenças Uterinas/terapia , Cicatriz/etiologia , Feminino , Humanos , Histeroscopia/métodos , Metrorragia/diagnóstico , Metrorragia/etiologia , Metrorragia/terapia , Fatores de Risco , Doenças Uterinas/etiologia
13.
Saudi Med J ; 40(6): 590-594, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31219493

RESUMO

OBJECTIVES: To translate and validate an Arabic version of the patient scar assessment scale (PSAS). The cosmetic appearance of a thyroidectomy scar can critically influence a patient's self-esteem. Moreover, scar evaluation tools are necessary for an evidence-based approach to scar management. METHODS: This  quantitative, observational, cross-sectional study was conducted by administering an Arabic-translated version of the PSAS. The translation process included a forward translation into Arabic by 3 fluently bilingual otolaryngologists, a back-translation into English, and a comparison with the original items. The questionnaires were distributed to patients who underwent thyroidectomies. We included patients who underwent surgery at least 2 months previously. RESULTS: A total of 50 patients were included in this research. The internal consistency was 0.89, with a 95% confidence interval (CI) of 0.88-0.90. The score distributions showed high correlations for all items. The Arabic-translated PSAS showed good test-retest reliability, and the Pearson correlation coefficient between the test and retest administrations was 0.84 (p<0.001). With a possible range of 6-60 points, the standard error of the mean was 5.14, and the minimal detectable change was 14.2. CONCLUSION: This Arabic version of the PSAS was reliable for use in Arabic-speaking communities. It will allow for comparisons between the results of investigations conducted in different countries, which aids in the exchange of information within the international scientific community.


Assuntos
Cicatriz/diagnóstico , Cicatriz/psicologia , Cultura , Psicometria/métodos , Autoimagem , Autoavaliação , Tireoidectomia/psicologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Arábia Saudita , Inquéritos e Questionários , Traduções , Adulto Jovem
16.
Eur Arch Otorhinolaryngol ; 276(8): 2149-2154, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31037388

RESUMO

PURPOSE: To compare the local and intracranial complications, migration of the IRS, surgical duration, and quality of life with the subperiosteal pocket technique and the one-layer flap (OLF) technique using the Patient and Observer Scar Assessment Scale (POSAS). METHODS: Eight patients who underwent cochlear implantation. The patients were applied subscales of the POSAS and were asked to respond to the questionnaire items via a telephone conservation conducted by a physician. Another researcher evaluated the patients' photographs using OSAS. POSAS was applied to the patients to compare the differences of scar assessment in subperiosteal pocket technique and the OLF technique. RESULTS: The surgical duration was 72.7 ± 12.3 min in the OLF group and 51.3 ± 11.7 min in the subperiosteal pocket group. The difference was statistically significant. No migration or intracranial complications were observed in either group. Patients in group 1 who underwent the subperiosteal technique were more satisfied than patients who received the OLF technique. However, there was no superiority between the two methods for the observer in scar assessment. CONCLUSION: Although the surgical time is longer, the lack of difference in terms of scar formation from smaller incisions, and few intra- and post-operative complications in experienced hands ensure that the OLF technique is a safe and reliable method in cochlear implantation surgery.


Assuntos
Cicatriz , Implante Coclear , Complicações Pós-Operatórias , Qualidade de Vida , Retalhos Cirúrgicos , Adulto , Cicatriz/diagnóstico , Cicatriz/etiologia , Cicatriz/psicologia , Implante Coclear/efeitos adversos , Implante Coclear/métodos , Implante Coclear/psicologia , Feminino , Perda Auditiva/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Satisfação do Paciente , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle
17.
Indian J Ophthalmol ; 67(6): 908-911, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31124513

RESUMO

Purpose: To report anatomical and functional results of vitreoretinal surgery in our case series of late cicatricial retinopathy of prematurity (ROP) patients with subtotal retinal detachment. Methods: This is a retrospective, consecutive case series. Eleven eyes of 10 patients presented with partial tractional retinal detachment secondary to late cicatricial ROP (cicatricial stage 4B) who underwent vitreoretinal surgery were retrospectively reviewed. Anatomical and functional outcomes were evaluated. Results: The mean gestational age at birth was 28.6 (26-32) weeks. The mean age at surgery was 79 (4-213) months. Patients were followed up for 21.7 (6-40) months. Six eyes (55%) had lens-sparing vitrectomy and five eyes (45%) had lensectomy + vitrectomy. Anatomical success was achieved in 10 eyes (91%). Improvement in visual acuity was noted in nine eyes (82%). Conclusion: Eye grows but fibrotic tissue does not grow with age, and during this period retinal traction may get worse. Relieving these tractions may lead to good anatomical and visual outcomes in selected late cicatricial ROP cases.


Assuntos
Cicatriz/cirurgia , Descolamento Retiniano/cirurgia , Retinopatia da Prematuridade/cirurgia , Acuidade Visual , Cirurgia Vitreorretiniana/métodos , Criança , Pré-Escolar , Cicatriz/diagnóstico , Cicatriz/etiologia , Progressão da Doença , Feminino , Seguimentos , Idade Gestacional , Humanos , Lactente , Masculino , Oftalmoscopia , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/etiologia , Retinopatia da Prematuridade/complicações , Retinopatia da Prematuridade/diagnóstico , Estudos Retrospectivos , Resultado do Tratamento
18.
Medicine (Baltimore) ; 98(15): e15142, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30985684

RESUMO

RATIONALE: Traumatic neuroma is a reparative proliferative response of the nerve after trauma or surgery, which rarely occurs in the breast. However, it must be distinguished from tumor recurrence. PATIENT CONCERNS: A 78-year-old woman underwent left-sided modified radical mastectomy for invasive carcinoma, 7 years before this case. Two painless nodules near the mastectomy scar were discovered in regular follow-up physical examination. A 62-year-old woman had received right-sided modified radical mastectomy for intraductal carcinoma, 4 years before this case. An asymptomatic nodule near the mastectomy scar was detected during follow-up ultrasound (US) examination. DIAGNOSIS: The lesions in both patients were diagnosed as traumatic neuroma. INTERVENTIONS: The first patient underwent excisional biopsy. The second patient underwent US guided core-needle aspiration, followed by conservative therapy. OUTCOMES: Neither patient complained of any discomfort, nor both exhibited normal physical and US findings during follow-up examinations. LESSONS: Newly discovered nodules with the benign imaging features near the mastectomy site of a patient, especially with the tail sign, traumatic neuromas should be taken into consideration. Routine US examination is important for follow-up of breast cancer patients who have undergone mastectomy.


Assuntos
Cicatriz/etiologia , Mastectomia Radical Modificada , Neuroma/diagnóstico , Neuroma/etiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Idoso , Neoplasias da Mama/cirurgia , Carcinoma/cirurgia , Cicatriz/diagnóstico , Cicatriz/patologia , Cicatriz/terapia , Diagnóstico Diferencial , Feminino , Humanos , Neuroma/patologia , Neuroma/terapia , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/terapia
19.
J Pediatr Ophthalmol Strabismus ; 56: e34-e37, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31034087

RESUMO

The authors report a rare case of slipped medial rectus muscle with stretched scar in the left eye of a 45-year-old woman following pterygium surgery. There was total limitation of adduction in her left eye with complaints of diplopia in all gazes with maximum separation of images in dextroversion on diplopia charting. Hess charting showed underaction of the medial rectus muscle of the left eye and overaction of the lateral rectus muscle of the right eye. Based on the history and findings, a diagnosis of medial rectus muscle disinsertion of the left eye during pterygium surgery was made. Medial rectus muscle exploration was done and the slipped medial rectus muscle was found attached to its original insertion site via pseudotendon/stretched scar. The capsule was dissected, the scar tissue was excised, and the slipped medial rectus muscle was identified, hooked, and secured with sutures. The muscle was reattached with advancement. Postoperatively, the patient was orthotropic and there was no diplopia. Accidental medial rectus muscle disinsertion during pterygium surgery is a rare but serious complication. Proper care should be taken intraoperatively during pterygium surgery to avoid this complication. However, meticulous surgical exploration and reattachment of the muscle yields satisfactory results. [J Pediatr Ophthalmol Strabismus. 2019;56:e34-e37.].


Assuntos
Cicatriz/complicações , Exotropia/etiologia , Músculos Oculomotores/fisiopatologia , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Complicações Pós-Operatórias , Pterígio/cirurgia , Visão Binocular , Cicatriz/diagnóstico , Exotropia/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade
20.
Ophthalmic Epidemiol ; 26(4): 251-256, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31018742

RESUMO

Purpose: To determine the repeatability and reproducibility of anterior segment optical coherence tomography (AS-OCT) and Scheimpflug photography for several measurements of corneal scars, including scar size, scar depth, and corneal thickness. Methods: A series of patients treated for fungal keratitis at a tertiary eye care center in South India were recalled two years after successful treatment. Eyes with corneal scars had a slit lamp examination performed by two ophthalmologists masked to the other's examination. For AS-OCT and Scheimpflug photography, each eye had two scans taken by one technician and a third scan taken by a separate technician. Scar measurements were subsequently assessed from AS-OCT images by three graders masked to each other's results. Repeatability and reproducibility were assessed by calculating the intra-class correlation coefficient (ICC) from mixed effects linear regression models. Results: Fifty eyes had all measurements taken. The corneal scar size, measured as the geometric mean of the two longest perpendicular meridians, ranged from 0.8 to 5.4 (mean 2.8 mm, 95%CI 2.6 to 3.1). Scar size measurements taken by two separate individuals were most reproducible when the border of the scar was traced from the OCT (ICC 0.90, 95%CI 0.86 to 0.94), and least repeatable when assessed from slit lamp examination (ICC 0.80, 95%CI 0.70 to 0.90). Conclusions: AS-OCT and Scheimpflug imaging of corneal scars produced measurements with acceptable reproducibility that could be useful as cornea-specific outcomes for clinical trials.


Assuntos
Cicatriz/diagnóstico , Córnea/patologia , Paquimetria Corneana/métodos , Úlcera da Córnea/complicações , Infecções Oculares Fúngicas/complicações , Microscopia com Lâmpada de Fenda/métodos , Tomografia de Coerência Óptica/métodos , Adulto , Antifúngicos/uso terapêutico , Cicatriz/etiologia , Úlcera da Córnea/diagnóstico , Úlcera da Córnea/tratamento farmacológico , Infecções Oculares Fúngicas/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
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