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PubMed1996

The toxicology of mitomycin C on the ciliary body.

Over the past few years, the use of mitomycin C (MMC) to reduce surgical failures following filtering procedures has largely increased. After topical application, significant amounts of MMC can be detected intraocularly. In both rabbit and human eyes, a reduction of the normal and elevated intraocular pressures could be achieved with subconjunctival injections of MMC without filtering procedures. Histopathologic examination of the ciliary body in a human eye shortly after surgery with MMC revealed moderate, diffuse toxic changes of the two layers of the ciliary epithelium. By fluorophotometry, eyes after trabeculectomy with MMC had a decreased production of aqueous humor compared with eyes that underwent trabeculectomies without antimetabolites. Independent studies suggest that the toxicity of MMC for the ciliary epithelium may be a significant factor contributing to postoperative hypotony.

Animals↗
PubMed2002

[Vena cava filter in patients with gynecologic cancer complicated by pulmonary embolism and progressive hypercoagulability].

The aim of the study was to verify the validity of placement of a vena cava filter in patients with gynecologic cancer complicated by pulmonary embolism and progressive persistent hypercoagulability. The authors discuss two patients with pulmonary embolism. In this study, a gynecologic tumor was diagnosed, one presented endometrial carcinoma and the other ovarian papillary carcinoma, after the position of vena cava filter and treatment with urokinasi (2.800.000 UI/ml) it was possible to do surgery followed by radiation therapy in the first case and chemotherapy in the second. In these cases there are indications for the placement of a vena cava filter. This has enabled surgery and anticoagulation therapy and has prevented the movement of any other emboli, which were later dissolved by fibrinolytic agents, and the effectiveness result was the arrest of progressive hypercoagulability moved by tumor cell. The serious conditions that were related to prior embolism and to a persistent thrombotic state characterized by progressive hypercoagulability did not make it possible to perform surgery or any other type of therapy because of absolute contraindications. The decision to place the filter could thus become the first step towards subsequent improvements, that are also tied to the possibility of performing surgery for removing tumor, arrest of progressive hypercoagulability due to tumor cell, allow chemotherapy or radiation treatment.

Carcinoma, Adenosquamous↗
PubMedDate not supplied

5-Fluorouracil-needling and paracentesis through the failing filtering bleb.

BACKGROUND AND OBJECTIVE: Standard needle revision of the filtering bleb after glaucoma filtration surgery has many disadvantages. This study reports the technique and outcome of a modified needling of the failing bleb. PATIENTS AND METHODS: Consecutive patients who presented with increased intraocular pressure (lOP) and open internal ostium were included in this prospective study. When their IOP rose to levels >20 mm Hg despite various therapeutic regimens and visibility of the sclerostomy site was unclear, the modified needling technique was conducted. In each needling, a total dose of 1 mg (0.1 mL) of 5-fluorouracil (FU) was administered subconjunctivally, adjacent and into the bleb. The needle was then passed via the bleb, anterior to the sclera, through the anterior limbus to penetrate intracamerally. Standard treatment to inhibit bleb scarring followed. RESULTS: Twelve 5-FU-needle revisions were performed on 8 eyes. The first needle revision was performed 51.1+/-36.2 days (range, 5-117) postoperatively. IOP decreased from 31.0+/-5.7 (range, 25-43) mm Hg with 0.6+/-0.9 (range, 0-2) hypotensive medications to 15.5+/-2.6 mm Hg (range, 12-19) with 0.9+/-1.1 medications (range, 0-3), 11.3+/-4.9 months (range, 8-23) after the only or second (last) needling (P=0.012). In all eyes, the filtering bleb became diffused; in 7 eyes, it remained diffusely elevated or shallow-diffused. CONCLUSION: Relatively few needle revisions of the filtering bleb by a modified approach that bypassed the activated scarring tissue contributed to the restoration of IOP control. It is possible that the 5-FU-needle revision may offer advantages over the standard approach. A larger sample and a controlled study are required to validate these considerations.

Aged↗
PubMed1997

Intraocular pressure increments after cataract extraction in glaucomatous eyes with functioning filtering blebs.

BACKGROUND AND OBJECTIVE: The effects of cataract extraction on intraocular pressure (IOP) were studied in glaucoma patients who had previously undergone trabeculectomy. PATIENTS AND METHODS: The files of 22 patients with 25 glaucomatous eyes with functioning filtering blebs who underwent cataract extraction were retrospectively reviewed. All patients had undergone pretrabeculectomy examination and had at least 18 months of follow-up after cataract surgery. Visual acuity, IOP, status of the filtering bleb, and the number of medications applied were recorded. RESULTS: The mean increase in IOP was 3.63 mm Hg, 3.84 mm Hg, 5.4 mm Hg, and 2.8 mm Hg at 3, 6, 12, and 18 months after cataract extraction, respectively. This elevation was statistically significant 3 months postoperatively (P < .001) and remained relatively constant thereafter. The postoperative IOP was still significantly lower than the pretrabeculectomy IOP (P < .001). CONCLUSIONS: Cataract extraction through corneal incisions in patients with functioning filtering blebs is followed by an increase in IOP. Cataract surgery in these patients does not neutralize the pressure-lowering effect achieved by the trabeculectomy, but it tends to elevate the post-trabeculectomy baseline pressure.

Aged↗
PubMed1999

Complications of treatment: pulmonary embolism following craniotomy for meningioma.

We present two case reports of patients who suffered a pulmonary embolism (PE) in the week following surgery for removal of a meningioma. Both patients were anticoagulated in the first week following surgery, and as a result, both suffered intracerebral bleeds requiring further surgery. An inferior vena caval (IVC) filter was then used in both patients to prevent further embolic events. Following our experience, we believe that it is dangerous to use intravenous anticoagulation within 6 days of cranial surgery for removal of a meningioma. We have reviewed the literature concerning the present guidelines for thromboembolic prophylaxis in patients requiring neurosurgery and believe that consideration of subcutaneous low-molecular-weight heparin should now be given to all patients requiring craniotomy for removal of a meningioma.

Anticoagulants↗
PubMed1996

Intracameral tissue plasminogen activator after glaucoma surgery. Indications, effectiveness, and complications.

PURPOSE: To describe the authors' clinical experience with intracameral tissue plasminogen activator (tPA) after glaucoma surgery. METHODS: Retrospective review of medical records of all patients who received intracameral tPA after glaucoma surgery at the Doheny Eye Institute from November 4, 1992, to June 14, 1994. There were 20 tPA administrations (18 eyes of 17 patients) in doses ranging from 6 to 25 microgram. Indication for tPA administration was decreased bleb function secondary to blood/fibrin clot in aqueous outflow pathway. RESULTS: Tissue plasminogen activator was given after trabeculectomy (5 drug administrations) and combined cataract extraction/trabeculectomy procedures (9 drug administrations), with increased filtration in 12 (86%). There were five (36%) instances of hyphema and three (21%) of hypotony. All hyphemas occurred after doses of 25 microgram. Final IOP of 18 mmHg or lower and 6 mmHg or higher was achieved in 11 (92%) of 12 patients after a mean follow-up interval of 4.2+/-4.7 months. The six remaining tPA irrigations were done in five patients after glaucoma drainage implant surgery (n=4) or surgical/needle revision of a filtering bleb (n=2). CONCLUSIONS: Aqueous outflow obstruction from blood/fibrin clot after glaucoma surgery may be treated effectively with intracameral tPA in doses of 6 to 25 microgram. The authors recommend using a dose of less than or equal to 6 to 12.5 microgram to minimize risk of hyphema.

Adolescent↗
PubMed2002

Disposable surgical face masks for preventing surgical wound infection in clean surgery.

BACKGROUND: Surgical face masks were originally developed to contain and filter droplets of microorganisms expelled from the mouth and nasopharynx of healthcare workers during surgery, thereby providing protection for the patient. However there are several ways in which surgical face masks could potentially contribute to contamination of the surgical wound. OBJECTIVES: To identify and review all randomised controlled trials evaluating disposable surgical face masks worn by the surgical team during clean surgery to prevent post-operative surgical wound infection. SEARCH STRATEGY: All relevant publications about disposable surgical face masks were sought through the Specialised Trials Register of the Cochrane Wounds Group (March 2001). Manufacturers and distributors of disposable surgical masks as well as professional organisations including the National Association of Theatre Nurses and the American Operating Room Nurses Association were contacted for details of unpublished and ongoing studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-randomised controlled trials comparing the use of disposable surgical masks with the use of no mask were included. DATA COLLECTION AND ANALYSIS: Data were extracted independently by AL and PE. MAIN RESULTS: Two randomised controlled trials were included involving a total of 1453 patients. In a small trial there was a trend towards masks being associated with fewer infections, whereas in a large trial there was no difference in infection rates between the masked and unmasked group. Neither trial accounted for cluster randomisation in the analysis. REVIEWER'S CONCLUSIONS: From the limited results it is unclear whether wearing surgical face masks results in any harm or benefit to the patient undergoing clean surgery.

Disposable Equipment↗
PubMed2003

Fine structure and morphogenesis of asteroid hyalosis.

The fine structure and pathogenesis of asteroid hyalosis (AH) were investigated in this study. Samples were taken at vitreous surgery and trapped on membrane filters. Particles in the samples were observed with light and electron microscopes and processed by the focused ion-beam method. Chemical analysis was performed with an energy-dispersive X-ray microanalyzer. In vitro, reconstructive studies of hydroxylapatite were performed in simulated body fluid (SBF). AH is about 180 microm in diameter, spheric, and covered with a transparent vitreous matrix; its naked surface resembles reconstructed particles of hydroxylapatite (HOA). The asteroid bodies (AB) appeared as snowballs under the scanning electron microscope; the surface of the ABs was covered with clotted matrix of vitreous substances, and the structure under the covered substances showed a pumice stonelike structure. Artificial HOA produced by the biomimetic method built a surface pattern similar to the AH particles on a collagen-coated styrene plate. We concluded that AH was produced not only by changing of ionic tension in the vitreous fluid but also by changes of vitreous matrix in the aging process and in diseases. The AH is composed of HOA, which is produced by the body, and its chemical constitution is phosphate and calcium. These structural characters resemble stones in the living body (lithiasis); thus, we concluded that AH is a condition of lithiasis in the body.

Aged↗
PubMed2004

Effect of leukocyte depletion on endothelial cell activation and transendothelial migration of leukocytes during cardiopulmonary bypass.

BACKGROUND: Although leukocyte depletion from systemic circulation during cardiopulmonary bypass (CPB) has been studied, the effect of leukocyte depletion on the leukocyte-endothelial cascade remains poorly understood. So far, there has been no published work on the effects of leukocyte filters during cardiac operations from the viewpoint of endothelial activation and transendothelial neutrophil migration. METHODS: Thirty-two patients undergoing elective heart operations were randomly allocated to a leukocyte-depletion (LD) group or a control group. Blood samples were collected at seven time points: before sternotomy, at 30 minutes and at 60 minutes of CPB, at 5 minutes after coronary reperfusion, at the end of CPB, and at 2 hours and 24 hours after the cessation of CPB. The plasma concentrations of P-selectin, intercellular adhesion molecule-1 (ICAM-1), interleukin-8, and platelet-endothelial cell adhesion molecule-1 (PECAM-1) were measured using enzyme-linked immunosorbent assays. Plasma malondialdehyde (MDA) concentration was determined by measurement of thiobarbituric acid-reactive substances in plasma. In addition, blood samples collected at intervals before and after operation were used for arterial blood gases. RESULTS: Our studies show significant increases of plasma levels of P-selectin, ICAM-1, interleukin-8, PECAM-1, and MDA during and after CPB in the control group. Interestingly, a significant decrease of plasma levels of P-selectin, ICAM-1, interleukin-8, PECAM-1, and MDA, and better preservation of lung function could be found in the LD group compared with the control group. CONCLUSIONS: Our results demonstrate a rationale for using a leukocyte filter in patients undergoing cardiac surgery to attenuate the endothelial-mediated component of the CPB-induced inflammatory response by reducing endothelial activation and neutrophil transmigration.

Adult↗
PubMed1980

Steroid-induced ocular hypertension in patients with filtering blebs.

Four patients developed moderate to marked (25 to 42 mm Hg) elevation of intraocular pressure (IOP) while receiving chronic topical corticosteroids following filtration surgery. All of the eyes had good filtering blebs and no obvious reasons for the elevated IOP. The IOP dropped to 20 mm Hg or lower after the steroid drops were stopped. Our cases support the hypothesis that topical corticosteroid medication can cause an elevated IOP in eyes with functioning filtering blebs during the early postoperative period.

Adolescent↗
PubMed2001

Transitional cell carcinoma of the renal pelvis forming tumor thrombus in the vena cava.

A 47-year-old man presented with a left renal incidentaloma without hematuria. The tumor was complicated by inferior vena cava (IVC) thrombus extending from Th11 to L4. A temporary IVC filter was introduced prior to surgery. A midline incision was used to perform a left radical nephrectomy and en bloc lymphadenectomy with excision of the inferior vena cava from above the level of the left renal vein to 2.5 cm above the confluence of the common iliac veins. The pathological diagnosis was invasive transitional cell carcinoma. The tumor thrombus consisted of transitional cell carcinoma that histologically invaded the walls of the IVC. He died of cancer 17 months after the operation for the liver metastases. This is the 18th case report of such a presentation in the literature.

Carcinoma, Transitional Cell↗
PubMed2002

Movement-related neurons of the subthalamic nucleus in patients with Parkinson disease.

OBJECT: The subthalamic nucleus (STN) is a target in the surgical treatment of Parkinson disease (PD). Little is known about the neurons within the human STN that modulate movement. The authors' goal was to examine the distribution of movement-related neurons within the STN of humans by using microelectrode recording to identify neuronal receptive fields. METHODS: Data were retrospectively collected from microelectrode recordings that had been obtained in 38 patients with PD during surgery for placement of STN deep brain stimulation electrodes. The recordings had been obtained in awake, nonsedated patients. Antiparkinsonian medications were withheld the night before surgery. Neuronal discharges were amplified, filtered, and displayed on an oscilloscope and fed to an audio monitor. The receptive fields were identified by the presence of reproducible, audible changes in the firing rate that were time-locked to the movement of specific joint(s). The median number of electrode tracks per patient was six (range two-nine). The receptive fields were identified in 278 (55%) of 510 STN neurons studied. One hundred one tracks yielded receptive field data. Fourteen percent of 64 cells tested positive for face receptive fields, 32% of 687 cells tested positive for upper-extremity receptive fields, and 21% of 242 cells tested positive for lower-extremity receptive fields. Sixty-eight cells (24%) demonstrated multiple-joint receptive fields. Ninety-three cells (65%) with movement-related receptive fields were located in the dorsal half of the STN, and 96.8% of these were located in the rostral two thirds of the STN. Analysis of receptive field locations from pooled data and along individual electrode tracks failed to reveal a consistent somatotopic organization. CONCLUSIONS: Data from this study demonstrate a regional compartmentalization of neurons with movement-related receptive fields within the STN, supporting the existence of specific motor territories within the STN in patients suffering from PD.

Adult↗
PubMedDate not supplied

Combined temporal phacoemulsification and pars plana vitrectomy for the treatment of cataract and giant retinal tear in a buphthalmic eye.

The standard approach to a three-port to pars plana vitrectomy is by placing the sclerotomies in the superotemporal and superonasal quadrant and the infusion port in the inferotemporal quadrant. This approach may be adjusted in selected cases that exhibit structural abnormalities of the globe at the superior site by placement of the sclerotomies in the temporal quadrants. We describe a case of a buphthalmic eye with a huge filtering bleb from previous glaucoma surgery that successfully underwent combined cataract and vitreoretinal surgery from a temporal approach for the repair of a giant retinal tear with cataract.

Cataract↗
PubMed1988

A sequential strategy for achieving functional binocularity in strabismus.

The clinical approach to achieving functional binocularity for constant strabismus includes a series of sequential steps utilizing several therapy options. Passive therapy includes lenses, prisms, filters, occlusion, medications and strabismus surgery. Active therapy adds visual exercises and/or self-monitoring systems such as biofeedback. Consideration of commonly used options and an overall sequential strategy is presented as a practical guide to the successful management of strabismic patients.

Amblyopia↗
PubMed1997

[The inhibitory effects of Arg-Gly-Asp-Ser on attachment of fibroblasts].

Trabeculectomy often fails because of scarring of the filtering bleb, which is caused by the proliferation of fibroblasts. In this study, we investigated the inhibitory effect of Arg-Gly-Asp-Ser (RGDS) oligopeptide, a cell binding domain of fibronection molecules, on the attachment of fibroblasts in vitro and on scarring of filtering bleb after trabeculectomy on rabbits' eyes. The following results were obtained. 1. RGDS inhibited the attachment of rabbit conjunctival fibroblasts significantly (p < 0.01) when it was added to the culture medium at final concentrations of 2 and 5 mg/ml. 2. The administration of 0.2 ml of RGDS solution (5 mg/ml) into the filtering bleb 3 days after surgery caused significant reductions of intra ocular pressure compared with the control maintained the bleb more than 13 days whereas the blebs of the control eyes disappeared within 6 days (p < 0.01). 3. No complications were caused on the eyeballs of the rabbits by the administration of RGDS.

Animals↗
PubMed2005

Risk for postoperative infection after transfusion of white blood cell-filtered allogeneic or autologous blood components in orthopedic patients undergoing primary arthroplasty.

BACKGROUND: This study was designed to obtain data on the incidence of postoperative infection in patients undergoing elective orthopedic surgery and receiving white blood cell (WBC)-filtered blood components prepared according to current standards. STUDY DESIGN AND METHODS: A total of 308 consecutive orthopedic patients who opted for preoperative autologous blood donation (PAD) for primary unilateral hip and knee replacement surgery were enrolled in a prospective observational study of the incidence of postoperative infection. Patients with contraindications for PAD or with any infectious disease were not included in the study. To identify probably confounding factors, differences between patient groups were analyzed first. Identified factors, which differed between groups, and variables describing blood supply were further tested in uni- and multivariate logistic regression analysis for their independent influence on development of postoperative infection. Infection rates were compared on the basis of actual transfusion groups. RESULTS: Of the 308 study patients, 101 were not transfused, 85 received their PAD, 100 received allogeneic WBC-filtered red blood cells (RBCs), and 22 were given autologous RBCs and additionally allogeneic WBC-filtered RBCs. Overall the infection rate was 6.82 percent (21/308). Infection rates varied significantly between transfusion groups (no transfusion, 6.9%; autologous RBCs, 1.2%; allogeneic WBC-filtered RBCs, 12.0%; both transfusion types, 4.6%; p = 0.03). Allogeneic recipients showed significantly more infections compared to autologous recipients (p = 0.0053). Multivariate regression analysis confirmed transfusion of allogeneic WBC-filtered RBCs as an independent variable predicting postoperative infection (odds ratio, 23.65; confidence interval, 1.3-422.1; p = 0.01). CONCLUSION: Differences in postoperative infection rates between allogeneic and autologous recipients are still observable, although universal WBC filtration has been introduced into clinical practice.

Aged↗
PubMed2004

Peri-operative filtration of disseminated cytokeratin positive cells in patients with colorectal liver metastasis.

BACKGROUND: Liver resection is the only potential cure for patients with colorectal liver metastasis. However, more than 30% of patients will develop tumour recurrence, probably caused by tumour cells disseminated before or during surgery. As prevention of cell dissemination is barely obtainable, alternative concepts have to be discussed. METHODS: The potential of leukocyte adhesion filters for the removal of cytokeratin positive cells (CK+) from blood was studied in 18 patients undergoing liver resection for colorectal liver metastasis. Blood sampling was done via a liver venous catheter during hepatic mobilisation. Filtration was done with an in-line WBF2 filter system. To define the relation between surgery and cell release we compared patients' pre-operative and intra-operative blood and bone marrow (BM) samples with their CK expression using immunochemical staining. RESULTS: CK+ cells were detected in BM samples of nine of 14 patients before surgery, indicating early dissemination. In ten of 18 patients CK+ cells were detected in blood samples during hepatic mobilisation; all ten patients underwent major liver surgery (R0 resection). In those patients recurrent disease was observed more often (P < or = 0.05). In 17 of 18 patients CK+ cells were not detectable after filtration procedure, which indicated cell adhesion to the filter medium. CONCLUSION: Liver resection due to metastasis leads to frequent intra-operative tumour cell shedding. As the detection of CK+ cells is correlated with disease recurrence, modification of surgical techniques to prevent cell dissemination, and additional therapeutic concepts such as advanced filtration technology, have to be discussed.

Bone Marrow↗
PubMed2003

Changes in medical and surgical treatments of glaucoma between 1997 and 2000 in France.

PURPOSE: To analyze quantitative changes in glaucoma treatment strategies between 1997 and 2000 in France. METHODS: Numbers of ab externo trabeculectomies and other glaucoma surgeries were extracted from the national database of the French Diagnosis Related Group system, which includes data for both public and private hospitals. Mean lengths of stay and hospital costs were estimated using national cost scales published by the French Ministry of Health. Numbers of patients treated per year with latanoprost, brimonidine, or the fixed combination of dorzolamide + timolol were estimated from drug unit sales using defined daily doses for each drug. RESULTS: Between 1997 and 2000, the number of patients treated with a glaucoma drug increased from 410,000 to 734,000 patients per year. This increase was associated with the introduction of three new glaucoma drugs: 245,000 patients received latanoprost (71.0%), brimonidine (28.8%), or the fixed combination of dorzolamide + timolol (0.2%). During the same period, the surgery rate in patients receiving medical treatment declined by 47%, from 5.9% to 3.1% . The total number of glaucoma interventions declined by 4.6% (-12% in public hospitals and 0% in private hospitals). This relative stability resulted mostly from a shift from trabeculectomies to other procedures, mainly to new filtering procedures in private hospitals. CONCLUSIONS: Between 1997 and 2000, new glaucoma drugs, primarily latanoprost and brimonidine, improved intraocular pressure control and delayed surgery, reducing the glaucoma procedure rate in patients receiving glaucoma-related medical treatment by 47%.

Antihypertensive Agents↗