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2.
J Med Case Rep ; 13(1): 211, 2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31291972

RESUMO

BACKGROUND: Giant bleb formation after glaucoma tube shunt surgery is a rare condition and consensus regarding its management has not been established. CASE PRESENTATION: A 66-year-old Japanese man with primary open-angle glaucoma underwent implantation of an Ahmed glaucoma valve to reduce the intraocular pressure in his left eye. At 4 weeks postoperatively, he presented with a foreign body sensation in his left eye. A slit-lamp examination revealed a giant conjunctival cyst at the superotemporal quadrant and dellen formation at the corneal limbus/conjunctiva adjacent to the anterior border of the giant cyst. Ocular pain was due to a giant bleb that bulged anteriorly from the Ahmed glaucoma valve plate. Eight days after the referral, he underwent surgery to reduce the bleb volume in his left eye. To recess the bleb, the anterior edge of the dissected bleb capsule was sutured using two interrupted 10-0 absorbable sutures back to the sclera to the anterior edge of the Ahmed glaucoma valve plate. Three months postoperatively, there was no bleb around the corneal limbus, but the bleb was present around the plate. CONCLUSIONS: The surgical technique reported here can be an option to relieve dellen-associated ocular pain due to a bleb formed after tube shunt surgery.


Assuntos
Vesícula/cirurgia , Doenças da Túnica Conjuntiva/cirurgia , Implantes para Drenagem de Glaucoma/efeitos adversos , Glaucoma de Ângulo Aberto/cirurgia , Idoso , Túnica Conjuntiva/patologia , Humanos , Pressão Intraocular , Masculino , Complicações Pós-Operatórias/cirurgia
3.
Neuroradiol J ; 32(5): 353-365, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31271334

RESUMO

INTRODUCTION: Blister and dissecting aneurysms may have a different pathological background but they are commonly defined by instability of the vessel wall and bear a high risk of fatal rupture and rerupture. Lack of aneurysm sack makes treatment challenging. PURPOSE: The purpose of this study was to assess the safety and feasibility of endovascular treatment of intracranial blister and dissecting aneurysms. METHODS: We retrospectively analysed all patients with ruptured and unruptured blister and dissecting aneurysms treated endovascularly between 2004-2018. Procedural details, complications, morbidity/mortality, clinical favourable outcome (modified Rankin Scale ≤2) and aneurysm occlusion rates were assessed. RESULTS: Thirty-four patients with endovascular treatment of 35 aneurysms (26 dissecting aneurysms and 9 blister aneurysms) were included. Five aneurysms were treated by parent vessel occlusion, and 30 aneurysms were treated by vessel reconstruction using stent monotherapy (n = 9), stent-assisted coiling (n = 7), flow diverting stents (n = 13) and coiling + Onyx embolization (n = 1). No aneurysm rebleeding and no procedure-related major complications or deaths occurred. There were five deaths in consequence of initial subarachnoid haemorrhage. Complete occlusion (79.2%) was detected in 19/24 aneurysms available for angiographic follow-up, and aneurysm recurrence in 2/24 (8.3%). The modified Rankin Scale ≤2 rate at mean follow-up of 15.1 months was 64.7%. CONCLUSION: Treatment of blister and dissecting aneurysms developed from coil embolization to flow diversion with multiple stents to the usage of flow diverting stents. Results using modern flow diverting stents encourage us to effectively treat this aneurysm entity endovascularly by vessel reconstruction. Therefore, we recommend preference of vessel reconstructive techniques to parent vessel occlusion.


Assuntos
Aneurisma Dissecante/terapia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/terapia , Adulto , Idoso , Vesícula/cirurgia , Embolização Terapêutica/instrumentação , Estudos de Viabilidade , Humanos , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , Segurança do Paciente , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
4.
J Surg Res ; 243: 206-212, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31195349

RESUMO

BACKGROUND: Giant pulmonary bullae (GPB) is rare. The aim of this study was to evaluate the functional results of video-assisted thoracic surgery (VATS) in the treatment of GPB and the factors associated with complications following VATS resection for GPB. MATERIALS AND METHODS: From January 2010 to January 2015, 44 GPB patients underwent surgery with VATS. Individual GPB patient characteristics and surgical outcomes were evaluated. The patients were separated into two groups (an emphysematous group and a nonemphysematous group), and differences between the respective groups were investigated. RESULTS: Although there were no mortalities within a 30-d postoperative period among the 44 GPB patients treated surgically with VATS, 28 experienced postoperative complications, of which the most common were air leaks. VATS for GPB resulted in obvious improvements in symptoms and lung function in the majority of cases. Among 26 patients with preoperative dyspnea, the symptoms of 22 patients (84.62%) improved after treatment with VATS resection for GPB, and the mean forced expiratory volume in 1 s increased from 2.24 L preoperatively to 2.5 L postoperatively (P = 0.02). The complication rate of patients aged >48 y, who smoked and had emphysema, was significantly higher than that of those who did not smoke and did not have emphysema (79.2% versus 45%, P = 0.019; 85.7% versus 25%, P < 0.05; 88% versus 31.6%, P < 0.05). These characteristics could be associated with complications. CONCLUSIONS: VATS resection is a safe and effective treatment for GPB and leads to improvements in symptoms and lung function. Patients >48 y, who smoked and had emphysema, were more likely to experience postoperative complications. There could be a relationship between these characteristics and the patients' postoperative complications.


Assuntos
Vesícula/complicações , Pneumotórax/cirurgia , Complicações Pós-Operatórias/epidemiologia , Cirurgia Torácica Vídeoassistida , Adolescente , Adulto , Idoso , Vesícula/cirurgia , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfisema Pulmonar/complicações , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
5.
BMC Pulm Med ; 19(1): 92, 2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088437

RESUMO

BACKGROUND: In patients with chronic obstructive pulmonary disease (COPD), bronchoscopic lung volume reduction (BLVR) techniques using unidirectional endobronchial valves improve lung function and increase exercise tolerance. BLVR treatment is included in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) treatment guidelines for COPD patients without interlobar collateral ventilation. However, BLVR using an endobronchial valve has not been attempted in patients with giant bullae. CASE PRESENTATION: We report successful and safe BLVR using an endobronchial valve in a patient with a huge bullous emphysema in the right middle lobe. A 65-year-old male was diagnosed with COPD 5 years prior and had a large bullae in the right middle lobe at that time. During regular follow-up, the symptoms of respiratory distress gradually worsened, and the size of the bullae gradually increased on computed tomography (CT). Therefore, we decided to treat the patient via BLVR using an unidirectional endobronchial valve. The Chartis system (Pulmonx, Inc., Palo Alto, CA) confirmed the absence of collateral ventilation of the right middle lobe. We successfully inserted an endobronchial valve into the right middle bronchus. After insertion, the bullae decreased dramatically in size, and the patient's symptoms and quality of life improved markedly. CONCLUSION: This case supports recent suggestions that BLVR can serve as a good alternative treatment for appropriately selected patients.


Assuntos
Vesícula/cirurgia , Broncoscopia , Doença Pulmonar Obstrutiva Crônica/complicações , Enfisema Pulmonar/cirurgia , Idoso , Vesícula/diagnóstico por imagem , Humanos , Pulmão/fisiopatologia , Medidas de Volume Pulmonar , Masculino , Pneumonectomia , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/etiologia , Qualidade de Vida , Tomografia Computadorizada por Raios X
6.
Radiol Med ; 124(9): 833-837, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31134432

RESUMO

OBJECTIVES: Chest computed tomography is commonly used in patients with primary spontaneous pneumothorax to detect the presence of pulmonary blebs or bullae. The aim of this study is to calculate the accuracy of chest computed tomography to detect surgically resectable blebs or bullae in patients with primary spontaneous pneumothorax. METHODS: This is a retrospective study includes all patients with primary spontaneous pneumothorax who underwent chest computed tomography evaluation for their disease over the period from January 2005 to December 2015. Patients who underwent surgical exploration were sub-grouped to calculate the sensitivity and the specificity of the chest computed tomography to detect surgically resectable pulmonary blebs or bullae. RESULTS: A total of 143 patients were included in the study. Among them, 120 patients underwent surgical exploration with the finding of 95.7% sensitivity and 42.3% specificity for the chest computed tomography in detection of surgically resectable pulmonary blebs or bullae. CONCLUSION: The sensitivity of the chest computed tomography scan is high in detecting surgically resectable pulmonary blebs or bullae. However, the specificity is low. This may lead to overdiagnosis of the patients to have pulmonary blebs and bullae. Therefore, the routine use of chest computed tomography scan before the surgical exploration in patients with primary spontaneous pneumothorax should depend on the clinical judgment.


Assuntos
Pneumotórax/complicações , Pneumotórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Vesícula/diagnóstico por imagem , Vesícula/etiologia , Vesícula/cirurgia , Feminino , Humanos , Masculino , Pneumotórax/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
7.
Medicine (Baltimore) ; 98(20): e15661, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096495

RESUMO

RATIONALE: At present, data regarding refractory pneumothorax treated with video-assisted thoracic surgery (VATS) in combination with extracorporeal membrane oxygenation (ECMO) in critically ill patients with H7N9 pneumonia have never been reported. PATIENT CONCERNS: A laboratory-confirmed case of human infection with avian influenza A (H7N9) virus was treated in our hospital. Acute respiratory distress syndrome (ARDS) developed and the patient was oxygenated via veno-venous ECMO due to the failure of mechanical ventilation. Unfortunately, a right refractory pneumothorax occurred. Despite treatment with pleural drainage and select bronchial occlusion, the patient still failed to improve. DIAGNOSIS: Fatal H7N9 pneumonia complicated with severe ARDS, pulmonary bullae, and refractory pneumothorax. INTERVENTIONS: Successful combination of ECMO with VATS of pulmonary bullae resection was performed and pneumothorax was cured. OUTCOMES: One week after the operation, ECMO was removed. However, the patient finally developed multiorgan failure (MOF) complicated by refractory hypoxemia due to progressive lung fibrosis and died 36 days after admission. LESSONS: Although the patient died of MOF triggered by severe lung fibrosis at last, the successful treatment of refractory pneumothorax by combination of ECMO with VATS is encouraging. Thus, when refractory pneumothorax in a patient with severe pulmonary dysfunction fails to improve through routine therapy, the treatment of pneumothorax by VATS based on ECMO support can be considered as a feasible selection.


Assuntos
Vesícula/complicações , Estado Terminal , Oxigenação por Membrana Extracorpórea/métodos , Pneumonia Viral/complicações , Pneumotórax/complicações , Pneumotórax/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Vesícula/cirurgia , Humanos , Subtipo H7N9 do Vírus da Influenza A , Masculino , Síndrome do Desconforto Respiratório do Adulto/complicações
8.
World Neurosurg ; 128: e956-e965, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31100528

RESUMO

BACKGROUND: Microsurgical management of blood blister aneurysms of the internal carotid artery is challenging because of the special characteristics of these aneurysms. We reviewed our diverse surgical methods with long-term clinical and radiologic follow-up. METHODS: We retrospectively reviewed all patients with blood blister aneurysms presenting with subarachnoid hemorrhage that were treated with microsurgical obliteration between 1993 and 2017. Baseline characteristics of patients and aneurysms, surgical methods, and clinical and radiologic outcomes were analyzed. RESULTS: This study included 36 patients. The patients were treated using microsurgery with direct clipping (2 patients; 5.6%), cotton-assisted clipping (24 patients; 66.7%), wrapping-clipping (5 patients; 13.9%), or wrapping-clipping with suturing (5 patients; 13.9%). Complete occlusion of aneurysm was achieved in 34 of 36 patients (94.4%). Severe vasospasm developed in 18 of 36 patients (50%). Ischemic events occurred in 8 patients (22.2%), 2 of whom remained with severe disability. Regrowth or recurrence occurred in 1 patient (0.28%), which required additional stent-assisted coil embolization. Mean modified Rankin Scale score was 2.0 (median, 1.0; range, 0-4) at discharge and 1.3 (median, 1.0; range, 0-4) at the last follow-up. CONCLUSIONS: Direct clipping is ideal if possible; however, direct clipping is challenging in most blood blister aneurysms. Assisted clipping with cotton is mainly used and could be an effective technique for reinforcement of the friable wall, with good clinical outcomes in our series. Moreover, suturing followed by wrapping-clipping is also useful for managing intraoperative rupture.


Assuntos
Aneurisma Roto/cirurgia , Vesícula/cirurgia , Artéria Carótida Interna/cirurgia , Revascularização Cerebral/métodos , Aneurisma Intracraniano/cirurgia , Adolescente , Adulto , Idoso , Embolização Terapêutica , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Hemorragia Subaracnóidea/cirurgia , Instrumentos Cirúrgicos , Suturas , Resultado do Tratamento , Vasoespasmo Intracraniano/etiologia , Vasoespasmo Intracraniano/terapia , Adulto Jovem
9.
J Cardiothorac Surg ; 14(1): 71, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30971282

RESUMO

BACKGROUND: Rapid rehabilitation surgery has become a widely accepted approach. Thoracic surgeons have attempted in many ways to make surgery less invasive. We combined tubeless technology, single-port technology and mediastinum approach for the treatment of simultaneous bilateral primary spontaneous pneumothorax(PSP)or pulmonary bullae. And we evaluated its therapeutic effect. This study aimed to investigate if tubeless single-port video-assisted thoracic surgery (Tubeless-SPVATS) via anterior mediastinum can be used as an alternative surgical treatment for bilateral lung diseases, especially for concurrent or contralateral recurrence PSP. METHODS: From November 2014 to December 2016, 18 patients with simultaneous bilateral PSP or pulmonary bullae were treated with tubeless -SPVATS via anterior mediastinum. They were 13 males and 5 females with an average age of 20.2 ± 2.3 years (17 to 24 years). They all had preoperative chest CT and were diagnosed with simultaneous bilateral PSP or pulmonary bullae. RESULTS: Fifteen patients underwent bilateral bullae resection with Tubeless-SPVATS via anterior mediastinum. Three patients underwent bilateral single-port video-assisted thoracic surgery. No thoracotomy was performed. No death and grade 3-4 mobidity were found. All the patients started eating 6 hours after surgery. The average operation time was 44.56±17.8min. The patients were discharged 3. 5±1.0 days postoperatively. CONCLUSIONS: Tubeless-SPVATS via anterior mediastinum is a safe and feasible treatment for patients with simultaneous bilateral PSP or pulmonary bullae. However,contralateral thoracic is not explored fully enough. And when contralateral lung bullae are located near the hilum, endoscopic linear stapler cannot be easily used to conduct suture. Thus, the recurrence rate after performing Tubeless-SPVATS may be increased compared to performing thoracotomy. However, compared to bilateral thoracic surgery, this method reduced postoperative pain. And it took significantly less time than bilateral thoracic surgery. Thus, this method has some clinic value.


Assuntos
Pneumopatias/cirurgia , Pneumotórax/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Vesícula/diagnóstico por imagem , Vesícula/cirurgia , Feminino , Humanos , Pneumopatias/diagnóstico por imagem , Masculino , Mediastino/cirurgia , Duração da Cirurgia , Dor Pós-Operatória , Pneumotórax/diagnóstico por imagem , Recidiva , Cirurgia Torácica Vídeoassistida/efeitos adversos , Tomografia Computadorizada por Raios X , Adulto Jovem
10.
World Neurosurg ; 128: 376-380, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30986585

RESUMO

BACKGROUND: The optimal approach of blood blister-like aneurysms (BBAs) is debated. Wrapping has been reported to be an effective strategy, but artificial materials have often been used. In addition, perforator protection is difficult using this technique. In this case, we report a ruptured BBA of the left internal carotid artery (ICA) treated with a clip-reinforced wrapping technique using Y-shaped autologous temporalis fascia to protect the posterior communicating artery (PComA). The outcome was favorable. CASE DESCRIPTION: A 48-year-old woman was admitted for subarachnoid hemorrhage. Digital subtraction angiography (DSA) revealed a BBA located opposite the PComA origin. A frontotemporal craniotomy was performed. The temporalis fascia was isolated from the temporalis muscle, and then tailored into a Y shape for the PComA to pass through. The diseased segment and the BBA were then wrapped by the Y-shaped temporalis fascia circumferentially. Two clips were applied to the fascia to reinforce the wrapping to fit snugly enough around the parent artery subsequently. DSA and computed tomography angiography scan postoperation showed that the BBA had not recurred, the supraclinoid segment of the left ICA had reconstructed well, and the PComA was unobstructed. The patient recovered without any sequelae during the 1-year follow-up period. CONCLUSIONS: A clip-reinforced wrapping technique using Y-shaped temporalis fascia may be an effective method for treating BBAs located opposite the PComA origin. Long-term follow-up and large sample size studies, however, are necessary to validate this approach.


Assuntos
Vesícula/cirurgia , Aneurisma Intracraniano/cirurgia , Instrumentos Cirúrgicos , Angiografia Digital , Artéria Carótida Interna/cirurgia , Craniotomia , Feminino , Humanos , Complicações Intraoperatórias/prevenção & controle , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Ruptura/cirurgia , Resultado do Tratamento
11.
PLoS One ; 14(3): e0213811, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30889194

RESUMO

PURPOSE: To investigate the potential of colchicine to improve bleb function after trabeculectomy. METHODS: To find the maximum usable colchicine concentration, an ocular irritation study was performed with the Draize test at concentrations of 0.001%, 0.01% and 0.1%. Additionally, the synergistic effect of topical colchicine instillation and MMC application to surgical site was evaluated in a rabbit model by measuring changes after trabeculectomy in intraocular pressure (IOP) and bleb morphology score at 3, 7, 14, 21, 28, 35, 42, and 49 days. RESULTS: Experiments with a rabbit model of trabeculectomy showed that 0.04% MMC plus 0.01% colchicine was more effective than saline and 0.04% MMC alone in maintaining IOP reduction at days 7-49 (P < 0.01 at all time points) and day 49 (P < 0.05), respectively, while 0.04% MMC alone was more effective than saline only at days 7-35 (P < 0.05 at all time points). 0.04% MMC plus 0.01% colchicine and 0.04% MMC alone were more effective than saline at preserving bleb score at days 7-21 and 35-49 (P < 0.05 at all time points) and at days 7-35 (P < 0.05 at all time points), respectively. CONCLUSION: Colchicine may be a promising adjuvant for strengthening the effect of MMC and improving the survival of the filtering bleb in trabeculectomy.


Assuntos
Vesícula/tratamento farmacológico , Colchicina/uso terapêutico , Oftalmopatias/tratamento farmacológico , Mitomicina/uso terapêutico , Neovascularização Patológica/tratamento farmacológico , Trabeculectomia/métodos , Alquilantes/uso terapêutico , Animais , Vesícula/fisiopatologia , Vesícula/cirurgia , Quimioterapia Combinada , Oftalmopatias/cirurgia , Masculino , Neovascularização Patológica/cirurgia , Coelhos , Moduladores de Tubulina/uso terapêutico
15.
Gen Thorac Cardiovasc Surg ; 67(5): 464-469, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30523543

RESUMO

OBJECTIVE: For patients with recurrent primary spontaneous pneumothorax, surgery has been thought to be an acceptable treatment. However, even if bulla is completely resected, postoperative recurrence is relatively common due to bulla neogenesis. Bulla neogenesis seems to develop naturally in younger patients compared with the elderly, as theorized till date. If the complete development of bulla neogenesis is confirmed, surgical resection can be performed as the radical treatment. Then, we evaluated the relationship between bulla neogenesis and age. METHODS: Between February 2009 and July 2018, we consecutively enrolled 276 patients who underwent primary bullectomy for primary spontaneous pneumothorax in our hospital. Finally, high-resolution computed tomography findings/observations of 155 eligible patients were evaluated retrospectively. The relationship between bulla neogenesis and age was evaluated using univariate and multivariate analyses and an inverse probability of treatment-weighted method using the propensity score. RESULTS: The study included 58 patients aged < 20 years and 97 aged ≥ 20 years. Bulla neogenesis was present in 34 patients (21.9%). Bulla neogenesis developed significantly at age < 20 compared with age ≥ 20 (44.8 vs. 8.2%). Univariate and multivariate analyses showed that age < 20 years was a significant factor associated with bulla neogenesis (P < 0.001 and P = 0.018, respectively). The inverse probability of treatment-weighted method showed that age < 20 years was a significant factor associated with bulla neogenesis (P = 0.0057, hazard ratio 4.79). CONCLUSIONS: Surgical treatment may be delayed in young patients (age < 20 years), because bulla neogenesis is not completely developed by this time for primary spontaneous pneumothorax.


Assuntos
Vesícula/cirurgia , Pneumotórax/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Vesícula/diagnóstico , Feminino , Humanos , Masculino , Análise Multivariada , Período Pós-Operatório , Pontuação de Propensão , Modelos de Riscos Proporcionais , Recidiva , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
16.
Kyobu Geka ; 71(11): 944-947, 2018 10.
Artigo em Japonês | MEDLINE | ID: mdl-30310007

RESUMO

57-year-old man with bilateral giant lung bullae was admitted to our hospital for dyspnea on exertion as his chief complaint. The size and shape of right lung bullae were bigger and more complicated than those of left lung bullae. He underwent 2-staged bullectomy by video-assisted thoracoscopic surgery (VATS). Left lung bullectomy was expected to be more safely done, and was performed with veno-venous extracorporeal membrane oxygenation( V-V ECMO) prior to right side without any complications. The right lung bullectomy was performed 6 months after 1st operation without V-V ECMO. These reoperations were necessary due to postoperative air leak, however, his respiratory condition was well maintained by his left lung which had already been remarkably improved.


Assuntos
Vesícula/cirurgia , Oxigenação por Membrana Extracorpórea/métodos , Pneumopatias/cirurgia , Cirurgia Torácica Vídeoassistida , Vesícula/patologia , Dispneia/etiologia , Humanos , Pneumopatias/patologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Reoperação
18.
Pediatr Dermatol ; 35(6): 864-865, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30187964

RESUMO

Kindler disease is a type of epidermolysis bullosa associated with acral blistering, diffuse cutaneous atrophy, poikiloderma, mucosal stenosis, and photosensitivity. This is the first case report in the literature to describe constriction bands associated with Kindler disease causing ischemia of the fingertips requiring urgent release and full-thickness skin grafts. Dermatologists reviewing such patients need to be aware of this condition and refer to a children's hand surgeon early to avoid leaving patients with prolonged periods of pain.


Assuntos
Vesícula/complicações , Epidermólise Bolhosa/complicações , Dedos/patologia , Doenças Periodontais/complicações , Transtornos de Fotossensibilidade/complicações , Pele/patologia , Adolescente , Vesícula/cirurgia , Constrição Patológica , Epidermólise Bolhosa/cirurgia , Feminino , Dedos/cirurgia , Humanos , Doenças Periodontais/cirurgia , Transtornos de Fotossensibilidade/cirurgia
19.
Medicine (Baltimore) ; 97(34): e11824, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30142772

RESUMO

The purpose of this study was to objectively evaluate the anterior chamber depth (ACD) after trabeculectomy and to correlate its variations with the intraocular pressure (IOP) and bleb functionality.Fifty eyes (46 patients) were included in this prospective study. ACD was documented with the use of a non-contact optical device (IOL Master-Carl Zeiss Meditec) and IOP was measured with the Goldmann applanation tonometer.Ophthalmological examination, IOP, and ACD measurements were performed before surgery, the day after and weekly thereafter.Linear regression Analysis between the 2 variables was performed and correlation coefficients were estimated. A 2-tailed t test was used and a P value < .05 was considered as statistically significant.Correlation coefficients between ACD and IOP, during the follow-up period, resulted in a moderate to strong positive relationship (r = 0.2-0.7), which since the 1st week resulted statistically significant at 5%.Twenty seven eyes (54%) needed at least 1 needling procedure. Considering each group separately, until the 3rd post-op week, the correlation coefficients in the needling group resulted higher than those in the non-needling group. Furthermore, in the needling group, the relationship between ACD and IOP, for the 1st, 2nd, 3, and 4th week was statistically significant at 5%.The objective documentation of the ACD in the early post-trabeculectomy period presents a moderate to strong positive correlation with the IOP.Furthermore, the brisk deepening of the ACD during the first 2 to 4 post-operative weeks is strongly correlated with the increase of the IOP and early signs of bleb encapsulation.


Assuntos
Câmara Anterior/fisiopatologia , Vesícula/cirurgia , Glaucoma/cirurgia , Trabeculectomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Vesícula/etiologia , Documentação , Feminino , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Punções/métodos , Tonometria Ocular/métodos , Trabeculectomia/efeitos adversos , Cicatrização
20.
Am J Ophthalmol ; 193: 156-165, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29963996

RESUMO

PURPOSE: To compare long-term outcomes of repeated corneal transplantations (CT), based on primary indication (Fuchs endothelial dystrophy [FED] vs pseudophakic bullous keratoplasty [PBK]), surgical technique (penetrating keratoplasty [PK] vs endothelial keratoplasty [EK]), and indication for repeated grafting. METHODS: In this nonrandomized treatment comparison with national registry data (Netherlands Organ Transplantation Registry, NOTR), data on all consecutive repeated CT following primary PK or EK for FED and PBK between 1994 and 2015 were analyzed, with a maximal follow-up of 5 years. Regraft survival was analyzed using Kaplan-Meier survival curves and univariable and multivariable Cox regression analysis. Secondary outcomes best-corrected visual acuity, spherical equivalent, and refractive astigmatism were compared using linear mixed-model analysis. RESULTS: A total of 332 repeated CT were analyzed. The number of regrafts increased significantly between 2007 and 2015 (P = .001). Overall 5-year regraft survival was 60% and was higher for FED vs PBK (77% vs 45%, HR = 0.40, P = .001), and re-EK vs re-PK (81% vs 55%, HR = 0.51, P = .041). However, multivariable analysis showed no significant difference in survival based on primary indication, surgical technique, and indication for regrafting. Corrected for baseline, secondary outcomes also did not differ between groups. CONCLUSIONS: We found a significant increase in repeated CT, coinciding with the introduction of EK in the Netherlands. While univariable analysis suggested better overall regraft survival for FED and (re-)EK, multivariable analysis showed no such difference. This may be owing to allocation of favorable cases to undergo (re-)EK. Similarly, secondary outcomes were determined by the primary CT technique.


Assuntos
Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Distrofia Endotelial de Fuchs/cirurgia , Ceratoplastia Penetrante/métodos , Idoso , Idoso de 80 Anos ou mais , Astigmatismo/fisiopatologia , Vesícula/cirurgia , Doenças da Córnea/cirurgia , Feminino , Seguimentos , Sobrevivência de Enxerto/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Estudos Prospectivos , Sistema de Registros , Reoperação , Resultado do Tratamento , Acuidade Visual/fisiologia
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