Prevention of Pernicious Vascular Event: Acetabular Component Screw Impinging on External Iliac Vessels - A Unique Case Report

Introduction

Revision total hip arthroplasty requires meticulous planning and execution to achieve the desired outcome. Pelvic vessel injury following total hip arthroplasty is rare, but a well-known and serious complication, having a very high morbidity (15%) and mortality (7%). This case demonstrates the rare occurrence of acetabular screw abutment to the external iliac vessels, which if removed during revision hip surgery without releasing the adhesions around it, will lead to avulsion injury of the vessels and a catastrophic event.

Case Report

We present this challenging and unique case of a 64-year-old female patient where the acetabular component screw was found to be adherent to the external iliac vessels, with vascular injury imminent. During revision surgery, the iliac vessels were first released free of all adhesions with the intrapelvis screw using an ilioinguinal incision and retroperitoneal approach. The prosthesis was removed using a posterior approach to the hip joint. Definitive surgery was performed after 2 weeks.

Conclusion

Surgeons should be cognizant of the possibility of an avulsion vascular injury in revision cases having intrapelvic screws or implants. The proximity of such an implant with the intrapelvic vasculature must be confirmed preoperatively. Management should be individualized. Dual approach and staged procedure help in a favorable outcome. Vascular injury, revision total hip arthroplasty, screw abutting iliac vessel, external iliac vessel, computed tomographic angiography.

Visual outcome after manual small-incision cataract surgery by viscoexpression technique

Purpose

Globally, cataracts have remained the major cause of blindness. Cataract accounts for 62.6% of blindness affecting 9-12 million people. The only treatment for cataracts is surgical removal of cataracts. The surgical procedures include phacoemulsification and extracapsular cataract extraction (ECCE). In India, there is a huge backlog of cataract patients. Phacoemulsification is preferred nowadays for early visual rehabilitation, but in developing countries like ours, where facilities are not widely available, small-incision cataract surgery (SICS) is a cost-effective alternative as no machine is required. Also, it provides early visual rehabilitation as it is sutureless when compared to ECCE. So, manual SICS has emerged as a substitute for phacoemulsification and ECCE. The aim of the study was to evaluate the visual acuity and surgically induced astigmatism in patients more than 40 years of age, undergoing manual SICS with nucleus management by viscoexpression technique.

Methods

This was a prospective study that included 50 patients over the age of 40 years undergoing manual SICS at a tertiary health-care center in North India by viscoexpression technique. Only those patients whose functional visual disability could be attributed to cataracts were included in the study. Preoperative and postoperative astigmatism were analyzed in the first, fourth, and sixth weeks.

Results

Fifty patients who were undergoing manual SICS were analyzed. Preoperative best-corrected visual acuity (BCVA) and astigmatism were compared to postoperative BCVA and astigmatism. Of 50 patients, 48 (96%) patients were able to gain good vision after 6 weeks.

Conclusion

This study showed early visual rehabilitation with less surgically induced astigmatism following manual SICS by viscoexpression technique.

Stability of the Shape of a Viscous Drop under Buoyancy-Driven Translation in a Hele-Shaw Cell

It has been shown (N. R. Gupta, A. Nadim, H. Haj-Hariri, and A. Borhan, J. Colloid Interface Sci. 218, 338 1999) that a circular drop translating in a Hele-Shaw cell under the action of gravity is linearly stable for nonzero interfacial tension. In this paper, we use the boundary integral method to examine the nonlinear evolution of the shape of initially noncircular drops translating in a Hele-Shaw cell. For prolate initial deformations, it is found that the drop reverts to a circular shape for all finite Bond numbers considered. Initially oblate drops, on the other hand, are found to become unstable and break up if the initial shape perturbation is of sufficiently large magnitude. The critical conditions for the onset of drop breakup are examined in terms of the magnitude of the initial deformation as a function of Bond number. Two branches of marginal stability are identified and the effects of viscosity ratio and asymmetric initial perturbations on the stability diagram are discussed. Copyright 2000 Academic Press.

On the Linear Stability of a Circular Drop Translating in a Hele-Shaw Cell

For the buoyancy-driven motion of a drop in a Hele-Shaw cell, a circle is an exact solution for the shape of the drop. The stability of the shape of a circular drop translating in a Hele-Shaw cell under the action of gravity is investigated. It is shown that for nonzero interfacial tension, the circular shape is linearly stable. Copyright 1999 Academic Press.

Valvular glottic obstruction following extubation

A case of glottic valvular obstruction following extubation is reported. The cause was bilateral dislocation of arytenoids due to coughing on the tracheal tube, which resolved automatically following a further bout of coughing.