A rare case of choroidal neovascularization following macular hole surgery

BACKGROUND

Choroidal neovascularization occurs in a wide spectrum of conditions, including degenerative, inflammatory, traumatic and hereditary conditions, all of which are characterized by breaks in Bruch's membrane. A few cases of choroidal neovascular membrane (CNVM) have been reported in the literature following macular hole surgery.

METHOD

We present a retrospective case study of a single patient who developed CNVM after successful macular hole surgery. The 70-year-old diabetic female underwent macular hole surgery in her right eye. Posterior hyaloid was separated with suction and vitrectomy was performed. Internal limiting membrane (ILM) was stained with trypan blue under air and ILM peeling was performed. Perfluoropropane (C3F8) gas was used as the tamponade. Six weeks post-operation, closure of macular hole was seen. Six months later, she presented with defective vision. Subfoveal classic CNVM was seen in the same eye.

DISCUSSION

About 1%-3% of patients who undergo macular hole surgery develop CNVM. Age-related changes and surgical trauma are considered to be the predisposing factors in reported cases. Injury to the retinal pigment epithelium (RPE) during surgery may be an important factor in our case, since there were no pre-existing age-related changes.

CONCLUSIONS

CNVM though rare can occur after macular hole surgery, especially in the setting of age-related changes. Injuries to the RPE should be avoided during surgery. We report a case of CNVM after macular hole in which trypan blue was used as a staining agent.

Structural studies of the biomineralized species of calcified pancreatic stones in patients suffering from chronic pancreatitis

The pancreatic stones (Pancreatic calculi) collected from patients suffering from chronic calcific pancreatitis were studied in a view to explore the constituents involved in the calcification. The calcified stones were characterized by XRD, EPR and IR spectroscopic techniques. The detailed studies indicate that these stones consist of calcium carbonate as a major component, besides phosphates and other protein content. The presence of aragonite phases in the biomineralized stones is also discussed. The EPR spectra gave an evidence of the presence of traces of manganese in different oxidation states, which is used as one of the EPR probes in the present work. The samples were sintered at different temperatures to remove all the organic matter, and their EPR spectra have been studied to obtain detailed information regarding the changes in the symmetry of these stone samples. The X-irradiated sample was also characterized by EPR and the resonance signals are attributed to freely rotating CO(2)(-) radicals. The infrared spectrum reveals the presence of many organic bands corresponding to the protein amides.

Paget's sarcoma: limb salvage by custom mega prosthesis: four case reports

Of 4 Paget's sarcoma patients (age range, 55-68 years) underwent limb salvage surgery by custom mega prosthesis, 3 had lesions in the upper extremity and one in the proximal femur. Three of the patients were at stage IIB of the disease, according to Enneking's system of staging musculoskeletal tumours. All 4 patients underwent wide resection with a mean length of 152.5 mm. The defects were reconstructed with custom-made prostheses: proximal humeral prostheses in 2 of the patients, total elbow prosthesis in one, and total hip prosthesis in one. During a mean postoperative follow-up period of 40 months, one died of disseminated disease 14 months after surgery; one remained disease-free; 2 had local recurrence and required amputation, of whom one died of disseminated disease one year after amputation, the other had no further evidence of the disease. We report the functional outcomes of the 2 patients who were alive at the latest follow-up. The 2-year patient survival rate was 50%.

Limb salvage in aggressive and malignant tumours of the fibula

We treated 25 patients with aggressive and malignant fibular tumours between April 1989 and May 2001. There were 11 osteosarcomas, seven Ewing's sarcoma and five chondrosarcomas. The tumours predominantly involved the upper one third; 16 were of Stage IIB. Neo-adjuvant and adjuvant chemotherapy were given to all patients with osteosarcoma and Ewing's sarcoma. In 20 patients, surgical margins were wide and in three radical. Mean follow-up was 71 (26-168) months. Local recurrences were met with in three patients requiring amputation. Three patients died of disease and one was lost to follow-up. Functional outcome was excellent in 12 patients and good in seven. The 5- and 10-year survival rates of patient and limb are reported based on Kaplan-Meier survival analysis.

Venous lakes of the vermillion lip treated by infrared coagulation

We reviewed the treatment of 20 venous lakes by infrared coagulation in 18 patients. Seventeen cleared after one treatment; in three patients a further treatment was required, and one patient needed a total of three sessions to clear the venous lake. At 1-6 months follow-up there was complete clearance with no discernible mark in all but four patients who had minimal scarring, including the patient who had three treatments.

Preoperative monitoring of warfarin in cutaneous surgery

BACKGROUND

We report a patient who developed postoperative bleeding as a result of inadvertent excessive warfarin intake. We subsequently introduced a policy of checking the international normalization ratio (INR) 24 h before cutaneous surgery for all patients on warfarin.

OBJECTIVES

To review the perioperative INR and outcome of all patients on warfarin who had cutaneous surgery from January 1999 to June 2002 at the Department of Dermatology, Sunderland Royal Hospital.

METHODS

A retrospective review was undertaken from patients' medical records.

RESULTS

Sixty-eight patients (1.84% of total) underwent 85 skin procedures comprising 33 excisions, 16 punch biopsies, 15 curettages, 13 diagnostic biopsies, five shave biopsies, two Mohs micrographic surgical excisions and one delayed reconstruction. Repairs included 50 direct closures, five secondary intention healing, seven local flaps, two full-thickness skin grafts and 20 by electrocautery. Forty-five surgical procedures were undertaken with the INR checked on the day of surgery, 37 procedures within 24 h, and three within 2 days. The preoperative INR ranged from 1.1 to 3.4, median 2.5. There was no excess intraoperative or postoperative bleeding or haematoma for all patients.

CONCLUSIONS

Our experience supports the continued and safe use of warfarin for a wide variety of cutaneous surgical procedures with a preoperative INR of < 3.5. We recommend a routine INR before the procedure, preferably within 24 h.

Peculiar artifacts mimicking carcinoma

Artifacts that mimic malignancy may lead to diagnostic difficulty and can cause serious consequences. We present 2 cases received in consultation which demonstrated peculiar artifacts that closely mimicked carcinoma. In case 1, contaminating products of conception were confused with squamous cell carcinoma. In case 2, artifactual signet ring cells induced by procedural trauma were suspicious for signet ring cell carcinoma. In both cases, clinical correlation failed to completely exclude carcinoma, and limited tissue prevented use of ancillary studies. Our final resolution of these artifacts required lengthy and detailed morphologic analysis.

Direct in situ observation of increasing structural dimensionality during the hydrothermal formation of open-framework zinc phosphates

The first time-resolved in situ X-ray diffraction studies of the hydrothermal crystallisation of open-framework zinc phosphates reveal a pathway of sequential crystallisation involving formation of a metastable low dimensional chain phase before the growth of three-dimensional zeolitic architectures.

Glycine sodium nitrate

The glycine molecule in the title compound, Na(NO(3)).C(2)H(5)NO(2), exists in the zwitterionic form. The Na atom exhibits eightfold coordination and the polyhedron may be visualized as a distorted hexagonal bipyramid. The glycine molecules are linked through head-to-tail hydrogen bonds and are found 'sandwiched' between the Na(NO(3)) layers.

Chlamydia trachomatis infection induces mucosal addressin cell adhesion molecule-1 and vascular cell adhesion molecule-1, providing an immunologic link between the fallopian tube and other mucosal tissues

The development of a protective vaccine against the sexually transmitted disease caused by Chlamydia trachomatis may prevent complications associated with insidious infection. Vaccination via the vaginal route may not be practical, and other routes should be investigated. To this end, the adhesion molecules induced on the fallopian tube endothelium during infection with C. trachomatis were characterized. Adhesion molecules were identified in fallopian tube biopsy specimens cultured with 5 x 10(6) infection-forming units of C. trachomatis serovar E. Frozen sections were prepared from these tissues and were stained by immunohistochemical techniques. Infection with live, but not UV-inactivated, C. trachomatis induced a significant increase in levels of vascular cell adhesion molecule-1 and the mucosal addressin cell adhesion molecule-1 but not of other adhesion molecules. Therefore, infection with C. trachomatis induces adhesion molecules that are associated with other mucosal tissues and inflammatory sites, which suggests that mucosal routes of immunization may be effective.

Transient myeloproliferative disorder in Down syndrome presenting with ascites: a case report

BACKGROUND

An increased frequency of acute myelogenous leukemia is a well known feature in children with Down syndrome. In addition, transient myeloproliferative disorders (TMD), which may mimic acute leukemia, also occur in neonates with Down syndrome. TMD is recognized shortly after birth or in the neonatal period and is characterized by leukocytosis and thrombocytopenia, which resolve spontaneously in four to six weeks.

CASE

A 1.5-month-old, male infant born with Down syndrome and patent ductus arteriosus presented with abdominal distention due to ascites. Cytology of the fluid revealed immature myeloid cells and megakaryocytes. Flow cytometry of the ascitic fluid confirmed the presence of immature myelomonocytic cells. A complete hematologic evaluation along with the clinical findings supported the diagnosis of TMD in Down syndrome.

CONCLUSION

TMD is an uncommon syndrome strongly associated with Down syndrome. Since the abnormal laboratory findings are seen primarily in the peripheral blood, it is usually diagnosed by a hematopathologist without much difficulty. Our case demonstrates the importance of cytopathologist familiarity with this entity so as not to erroneously diagnose a leukemic process. This is extremely important since most cases of TMD spontaneously resolve within a few weeks to months and do not require treatment other than supportive measures.

Placenta increta/percreta associated with uterine perforation during therapy for fetal death. A case report

BACKGROUND

Placenta accreta involves abnormal adherence of the placenta to the myometrium. Placenta increta and percreta are defined by the degree of trophoblastic penetration of the myometrium. These conditions are rarely observed in the first trimester; placenta increta and percreta are exceptionally infrequent.

CASE

A woman had a uterine perforation after suction curettage for fetal death at 11 weeks' gestation, requiring hysterectomy for control of a profuse hemorrhage. Histopathologic examination of the uterus revealed placenta increta involving the lower uterine segment and placenta percreta at the site of uterine perforation.

CONCLUSION

This is the first report of placenta percreta associated with uterine perforation during therapy for first-trimester fetal death.

DL-Alanine

A determination of the structure of the title compound, C3H7NO2, leads to an accurate description of its molecular dimensions and crystal packing. As in the structure of the L-isomer, the molecules aggregate into alternating layers, each consisting of only one type of isomer. The molecules in each layer are interconnected through head-to-tail sequences generated by a cell translation and a 2(1) screw axis. Adjacent layers are interconnected by head-to-tail sequences generated by a glide plane.

L-prolinium tartrate

In the title salt, C(5)H(10)NO(2)(+).C(4)H(5)O(6)(-), proline exists as a cation and the tartaric acid as a semi-tartrate anion. The semi-tartrate ions form hydrogen-bonded strings along the c axis. These strings are interconnected through the proline molecules, forming a layered network parallel to the bc plane. The proline molecules, however, do not directly interact among themselves, except for a weak C-H.O hydrogen bond.