Papillary in situ and intramucosal adenocarcinoma of the lower third of common bile duct. A report and review of the literature

We report the case of a 37-year-old woman with no relevant medical history. She was admitted to the hospital for epigastric pain related with food intake for 4 days; the pain did not improve with symptomatic management. A laparoscopic cholecystectomy due to acute lithiasic cholecystitis was performed. However, after 4 days, postoperative painless jaundice was evident; thus, endoscopic retrograde cholangiopancreatography was performed, which revealed an amputation of intrapancreatic common bile duct, as well as secondary intra- and extrahepatic bile duct dilatation. Brushing of the distal portion of the common bile duct revealed a well-differentiated adenocarcinoma. Therefore, a Whipple procedure with pylorus preservation was performed. Pathologic diagnosis of a papillary in situ adenocarcinoma with two microscopic foci of microinvasion was established. The pathologic Tumor-Node-Metastasis (TNM) stage was pT1, pN0, pM0, R0. The patient is asymptomatic and disease-free 24 months after surgery. In general, adenocarcinomas of the extrahepatic bile ducts are uncommon and have a poor prognosis. However, symptomatic patients with early disease stages are even rarer and can be cured surgically.

[Anatomical and functional outcomes of vitrectomy for the treatment of pseudophakic regmatogenous retinal detachment]

PURPOSE

To report the results obtained in a non-comparative series of pseudophakic patients with retinal detachment (RD) treated with vitrectomy with no associated scleral procedures.

METHODS

The clinical records of all pseudophakic patients with RD treated with vitrectomy were evaluated by one of the authors. Patients with primary regmatogenous RD with no signs of proliferative vitreoretinopathy were included. Patients with associated ocular pathologies or with less than 3 months follow-up were excluded. Main outcome measures were anatomical reattachment rate after one surgery, visual acuity change and surgical complications. The surgical procedure consisted of 20 g pars plana vitrectomy, with removal of peripheral vitreous up to the ora serrata. Laser photocoagulation of all retinal breaks was performed and 14% C3F8 was used as tamponade.

RESULTS

Thirty-one patients were included in the study. In 18 patients the macula was affected. Mean follow-up was 6.45 months (range 3 to 18). Retinal reattachment was achieved in all patients and only one patient experienced a re-detachment, 3 months after surgery. Visual acuity improved by a mean of 2.5 Snellen lines and 61.3% of patients reached a final visual acuity of 0.5 or better. Eight patients had an intraocular pressure rise after surgery, which was controlled with topical medication. No other complications were recorded.

DISCUSSION

Our results support the hypothesis that vitrectomy alone is a useful technique for the treatment of RD in pseudophakic eyes.

[Surgical treatment of Duane's syndrome type I by recession of the medial rectus of the affected eye and faden operation of the contralateral medial rectus]

PURPOSE

Different surgical approaches have been described for the treatment of Duane's syndrome. The purpose of our study is to report the results of patients undergoing recession of the medial rectus (MR) muscle of the affected eye and placement of contralateral MR faden posterior fixation sutures.

METHODS

Retrospective study of 11 patients treated by a 4-7 mm recession of the MR of the affected eye and 13 mm faden posterior fixation suture of the contralateral MR in order to correct abnormal head position and esotropia in primary position.

RESULTS

After surgery, there was no torticolis in 81.8% of patients, with less than 10 degrees of torticolis in the remainder. In all patients, postoperative esotropia was less than 5 prismatic dioptres.

CONCLUSION

This is a safe and effective procedure in Duane's syndrome type I to treat moderate esotropia and torticolis.

[Rebound tonometry in a clinical setting. Comparison with applanation tonometry]

PURPOSE

Rebound tonometry has recently been modified for its use in humans. The purpose of our study was to determine the precision of the ICare(R) rebound tonometer (RBT) as compared with the Goldmann applanation tonometer (GAT).

METHODS

Patients were recruited from our Hospital's Glaucoma Unit. In each patient, intraocular pressure (IOP) was measured without anaesthesia using the RBT and ten minutes later using the GAT. Central corneal thickness (CCT) was measured by pachymetry.

RESULTS

Sixty-eight patients were recruited (132 eyes). Mean IOP readings with RBT were 18.9 +/- 7.2 (SD) mmHg and were 15.5 +/- 5.7 mmHg with GAT (p<0.001). There was a good correlation between both instruments (r = 0.87, p<0.001). In most cases (84.6%) the IOP measured with the RBT was greater than that measured with the GAT. The mean difference between both instruments was 3.4 +/- 3.6 mmHg. There was a trend towards greater differences between those obtained using the RBT than the GAT when IOP values were higher. A statistically significant correlation was found between IOP readings with both tonometers and CCT, with higher differences being seen as the CCT increased.

CONCLUSION

The RBT can be employed in a clinical setting taking into account that it usually overestimates IOP as compared with the GAT. It could be especially useful in glaucoma screening campaigns since it can be operated by a trained technician.

[Choroidal melanoma in ocular melanosis]

CASES

We present four cases of ocular melanosis. Choroidal melanoma was detected in all of them. Three eyes had decreased visual acuity and were enucleated because of their large, active tumours. In the fourth case the melanoma was detected in a routine examination and we were able to apply a preserving treatment with I125 brachytherapy.

DISCUSSION

Melanosis oculi is often underestimated as a risk factor for uveal melanoma and glaucoma. Ophthalmic surveillance, every 6 or 12 months is important, in patients with ocular melanocytosis for early detection of high risk diseases.