Deep sclerectomy after DSAEK: A cautionary tale

A 78-year-old pseudophakic women with pseudoexfoliation glaucoma and 6-year history of prior Descemet’s stripping automated endothelial keratoplasty (DSAEK) underwent deep sclerectomy for a poorly controlled glaucoma. Exposure of the trabeculo-Descemet’s window (TDW), showed a very poor drainage. An attempt to dissect the fibrous tissue off the TDW resulted in perforation of the window needing peripheral iridectomy, followed by a white fibrous band which had to be excised to prevent blockade of the filtration channel. Postoperatively, there was complete detachment of the endothelial graft on day 1 with an intraocular pressure of 20 mm Hg. She was commenced on topical steroids and listed for a revisionary DSAEK in 6 weeks but when reviewed in a month postoperatively, a spontaneous reattachment of the endothelial graft was seen.

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Descemet membrane suturing to manage recurrent graft detachment in a patient with Descemet membrane endothelial keratoplasty on failed penetrating keratoplasty

Therapeutic Advances in Ophthalmology ◽

10.1177/25158414211027705 ◽

2021 ◽

Vol 13 ◽

pp. 251584142110277

Author(s):

Zahra Ashena ◽

Thomas Hickman-Casey ◽

Mayank A. Nanavaty

Keyword(s):

Visual Acuity ◽

Penetrating Keratoplasty ◽

Anterior Segment ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Descemet Membrane ◽

Ocular Coherence Tomography ◽

Corrected Visual Acuity ◽

Intracameral Injection ◽

History Of

A 65-year-old patient with history of keratoconus, mild cataract and penetrating keratoplasty over 30 years ago developed corneal oedema subsequent of graft failure with best corrected visual acuity (BCVA) of counting fingers. He underwent a successful cataract surgery combined with a 7.25 mm Descemet’s Membrane Endothelial Keratoplasty (DMEK) with Sodium Hexafluoride (SF6) gas. His cornea remained oedematous inferiorly at 4 weeks, despite two subsequent re-bubbling due to persistent DMEK detachment inferiorly. This was managed by three radial full thickness 10-0 nylon sutures placed in the inferior cornea along with intracameral injection of air. Following this, his anterior segment ocular coherence tomography (OCT) confirmed complete attachment of the graft, and the sutures were removed 4 weeks later. Unaided visual acuity was 20/63 and BCVA was 20/32 after 8 months. DMEK suturing can be helpful in persistent DMEK detachments, which is refractory to repeated re-bubbling due to uneven posterior surface of previous PK.

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Chronic Endophthalmitis Caused by Pseudomonas stutzeri

Case Reports in Ophthalmology ◽

10.1159/000510129 ◽

2020 ◽

Vol 11 (3) ◽

pp. 595-599

Author(s):

Saeed T. Alshahrani ◽

J. Fernando Arevalo

Keyword(s):

Pseudomonas Stutzeri ◽

Posterior Chamber ◽

Topical Steroids ◽

Sensitivity Testing ◽

Corneal Incision ◽

Presumptive Diagnosis ◽

Lens Extraction ◽

History Of ◽

Sudden Decrease ◽

The Right

A patient presented with complaints of a sudden decrease in vision, ocular redness, and pain in the right eye. The patient had a history of clear lens extraction with intraocular lens (IOL) implantation for myopia 2 years previously. He had been prescribed topical steroids for episodes of inflammation that occurred repeatedly every 1–2 months. With a presumptive diagnosis of chronic endophthalmitis, a 23-G transconjunctival sutureless pars plana vitrectomy (PPV) with delivery of intravitreal antibiotics was performed the next day. Culture sensitivity testing of the vitreous sample indicated Pseudomonas stutzeri that was sensitive to ceftazidime and gentamicin. Two weeks later, the patient presented with sudden loss of vision and all the signs of recurrent endophthalmitis. 23-G transconjunctival sutureless PPV was performed along with removal of the posterior chamber IOL through a corneal incision. Complete resolution was only achieved after removal of the IOL, resulting in excellent visual recovery. Due to its chronic and fulminating nature, P. stutzeri can induce endophthalmitis and should be considered in the differential diagnosis. Aseptic measures are the best prevention.

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Bats from Lebanon at the Natural History Museum, Vienna: a cautionary tale on the reliability of museum specimen data (Chiroptera)

Lynx, new series ◽

10.2478/lynx-2016-0002 ◽

2016 ◽

Vol 47 (1) ◽

pp. 17-43

Author(s):

Petr Benda ◽

Simon Engelberger

Keyword(s):

Natural History ◽

Natural History Museum ◽

Museum Specimen ◽

Historical Records ◽

Cautionary Tale ◽

History Museum ◽

Rhinolophus Ferrumequinum ◽

Myotis Myotis ◽

History Of ◽

To Come

Abstract Seven historical bat specimens of four species (Rhinolophus ferrumequinum, R. mehelyi, Taphozous nudiventris, Myotis myotis), attributed to originate from the territory of the present-day Lebanon, are deposited and documented in the modern database of the mammal collection of the Natural History Museum, Vienna, Austria (Naturhistorisches Museum Wien). Two of these species (R. mehelyi, T. nudiventris) have never been reported for Lebanon in the existing literature and recent surveys have also failed to find them in this country. Since these bats were collected in the period 1824–1885, the history of the all respective specimens was evaluated in detail. The revision brought rather unexpected results. Only one specimen (R. ferrumequinum) was found to come (most probably) from Lebanon, being collected by W. Hemprich and Ch. Ehrenberg in 1824. In the remaining six specimens, the origin could not be defined, thus rendering the statement that they were collected in Lebanon insecure. This case demonstrates that careful checks of modern interpretations of historical records are necessary when examining past distributions of organisms.

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Incidence of steroid modified tinea in pediatric age group at tertiary centre in North India

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20213343 ◽

2021 ◽

Vol 7 (5) ◽

pp. 677

Author(s):

Savita Chaudhary ◽

Chandni Jain ◽

Gaurav Paliwal ◽

Priyanka Shukla

Keyword(s):

Common Species ◽

North India ◽

Topical Steroids ◽

Age Group ◽

Pediatric Age ◽

Atypical Form ◽

Pediatric Age Group ◽

Tertiary Centre ◽

History Of ◽

Common Variety

Background: Uncontrolled use and abuse of topical steroids has led to increase in number of cases of superficial dermatophytosis of skin, hair and nail in pediatric age group as well. Our study aimed to analyse epidemiological and microbiological profile of steroid modified tinea (SMT) in pediatric age group.Methods: Clinically diagnosed tinea childhood patients with history of usage of topical steroids in children were included in our study. Detailed history was taken and clinical examination along with KOH mount and culture was done.Results: 112 patients were clinically diagnosed as tinea out of which 61cases gave the history of topical steroids and were included in our study. Most common age group was 12-18 years with female:male of ratio approximately 3:1 and disseminated and atypical form was the most common variety. KOH mount was positive in 73.2% cases and culture was positive in 69.6% cases. Most common species found out to be Tinea mentagrophytes followed by Tinea rubrum. Among non-dermatophyte group, Candida was the commonest.Conclusions: There is rise in incidence of dermatophytosis, especially steroid modified, atypical and disseminated.

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Cystoid macular oedema after descemet membrane endothelial keratoplasty

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2021-319455 ◽

2021 ◽

pp. bjophthalmol-2021-319455

Author(s):

Damien Guindolet ◽

Odile Huynh ◽

Gilles C Martin ◽

Hugo Disegni ◽

Georges Azar ◽

...

Keyword(s):

Macular Oedema ◽

Univariate Analysis ◽

Cystoid Macular Oedema ◽

Bullous Keratopathy ◽

Endothelial Keratoplasty ◽

Descemet Membrane Endothelial Keratoplasty ◽

Descemet Membrane ◽

Spectral Domain Oct ◽

History Of ◽

Clinically Significant

AimsTo determine the incidence and risk factors of cystoid macular oedema (CMO) following descemet membrane endothelial keratoplasty (DMEK) with or without combined cataract surgery (triple-DMEK).MethodsWe reviewed the records of patients who underwent DMEK surgery alone or triple-DMEK performed at the Rothschild Foundation Hospital (Paris, France) between January 2019 and March 2020. Patients with pre-existing CMO observed on the preoperative macular optical coherence tomography (OCT) were excluded. Spectral-domain OCT was performed in patients with postoperative visual impairment. Data regarding comorbidities, intraoperative characteristics and postoperative treatments or complications were collected and analysed. Univariate and multivariate analyses were performed.ResultsTwenty three of 246 eyes (9.36%) developed clinically significant (cs)-CMO after DMEK. Triple-DMEK was not associated with a higher risk to develop CMO (12.2% in DMEK alone and 6.1% in triple-DMEK). Pseudophakic bullous keratopathy (PBK ; 39.1% vs 9%; OR=3.5 (1.0 to 11.8), p=0.045) and epiretinal membrane (ERM; 39.1% vs 7.7%; OR=10.5 (3.4 to 32.3), p<0.001) were more frequently observed in patients who developed CMO. The occurrence of hyphaema during surgery was statistically associated with postoperative CMO (13% vs 1.3%; OR=7.1 (1.0 to 48.8) p=0.045). Peroperative epithelial debridement was statistically associated with postoperative CMO (65.2% vs 33.2%, p=0.005), but only in univariate analysis.ConclusionsWe identified a clinically significant CMO incidence of 9.35% after DMEK. Patients with a history of ERM, PBK and intraoperative hyphaema may be at risk of developing CMO after DMEK surgery and should be monitored.

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Ruger’s ‘Old Model’ Single-action Revolvers: A Cautionary Tale of Reproducing Historical Firearms in a Litigious Age

Armax: The Journal of Contemporary Arms ◽

10.52357/armax15225 ◽

2021 ◽

Vol VII (1) ◽

pp. 61-76

Author(s):

Ashley Hlebinsky

Keyword(s):

World War Ii ◽

Product Liability ◽

Cautionary Tale ◽

World War ◽

Single Action ◽

Handling Characteristics ◽

History Of ◽

Safety Precaution ◽

The Subject ◽

Initial Line

In 1953, Ruger released a single-action revolver—patterned after the original Colt Single Action Army. Whilst some changes had been made, this firearm possessed, for all intents and purposes, the handling characteristics of the original Colt design. As a result, the safety precaution was as per the original: the revolver should be loaded with five rounds, rather than six, and the hammer positioned such that it rested over an empty chamber. Despite outlining the recommended carry methods in their instruction manual, Ruger became the subject of product liability lawsuits from purchasers who incorrectly loaded and carried the firearm, resulting in negligent discharges. This article explores the history of Colt-type single-action revolvers in the post-World War II period, analyses the availability of historic mechanical safety mechanisms for double-action revolvers in the 19th and 20th centuries, and summarises the patents on single-action safeties that Ruger had received by 1973. That year, the company discontinued their initial line of Single Action Army-style revolvers—known as ‘Old Models’—for a visibly similar, but mechanically different, ‘New Model’ line of single-action revolvers featuring newly developed safety mechanisms.

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Tricuspid valve infective endocarditis in a non-IVDU patient with atopic dermatitis

Oxford Medical Case Reports ◽

10.1093/omcr/omaa045 ◽

2020 ◽

Vol 2020 (7) ◽

Author(s):

Heerani Woodun ◽

Sarah Bouayyad ◽

Sura Sahib ◽

Nadir Elamin ◽

Steven Hunter ◽

...

Keyword(s):

Atopic Dermatitis ◽

Infective Endocarditis ◽

Tricuspid Valve ◽

Intravenous Drug User ◽

Blood Cultures ◽

Topical Steroids ◽

Foramen Ovale ◽

History Of ◽

The Right ◽

Systemic Infections

Abstract A 29-year-old male, with chronic atopic dermatitis (AD), presented with a 2-week history of fatigue, pyrexia and weight loss. Examination showed eczematous patches with lichenified papules, erosions on the right shin and a new murmur. Blood cultures isolated methicillin-sensitive Staphylococcus aureus. Transthoracic echocardiography showed vegetation on the tricuspid valve (TV) that was adherent to the septal leaflet. He was treated for infective endocarditis, attributed to poorly controlled AD, with intravenous Flucloxacillin. Due to ongoing sepsis and pulmonary septic emboli, Clindamycin was added. He underwent TV repair; the septal leaflet was excised, and the remnant two leaflets were brought together with a ring. His patent foramen ovale was closed. His skin was treated with topical steroids and emollients. Right-sided endocarditis of an intact TV is uncommon in a non-intravenous drug user. Therefore, this novel case portrays the importance of aggressively managing AD as it is a risk factor for significant systemic infections.

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Bounded action: Hannah Arendt on the history of science and the limits of freedom

Philosophy & Social Criticism ◽

10.1177/0191453719840762 ◽

2019 ◽

Vol 46 (4) ◽

pp. 431-451

Author(s):

Roni Hirsch

Keyword(s):

Hannah Arendt ◽

Modern Science ◽

Professional Community ◽

Human Condition ◽

Political Community ◽

Cautionary Tale ◽

History Writing ◽

History Of ◽

Post War ◽

Experimental Scientist

The article asks why and how Hannah Arendt framed The Human Condition as a history of modern science. It answers that, in telling the history of instrumental rationality and the work of the experimental scientist, Arendt accomplished three main things. First, by identifying science as a form of ‘work’ she could demonstrate the significance of her threefold division of human activity into labour, work and action, highlighting the dangers of their indistinction. Second, Arendt used the form of organization typical of scientists – a professional community founded on standards of objectivity – to warn against the substitution of the appearance of publicity for true openness. Finally, she identified the transgression of the boundaries of action as the site where a political community might become visible to itself, taking the unsuccessful attempts of post-war ‘public scientists’ to reckon with their past as a cautionary tale. Her account of modern science thus allows her to define freedom through its dependence on human-made boundaries, politicizing the very act of history-writing.

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Post Inflammatory Medial Canal Fibrosis: A Case Report

Nepalese Journal of Radiology ◽

10.3126/njr.v2i2.7689 ◽

2013 ◽

Vol 2 (2) ◽

pp. 69-71

Author(s):

A Kumar ◽

K Santosh

Keyword(s):

Conductive Hearing Loss ◽

Fibrous Tissue ◽

External Auditory Meatus ◽

Solid Core ◽

Medial Part ◽

Review Of The Literature ◽

Soft Tissue Density ◽

History Of ◽

Conductive Hearing ◽

Bony Erosion

Medial canal fibrosis is an interesting type of acquired meatal atresia that is characterized by formation of a solid core of fibrous tissue in the medial part of the external auditory meatus abutting the tympanic membrane. A review of the literature showed that many different terms have been used interchangeably to report the same or similar condition. This is a case of medial canal fibrosis being reported to emphasize the importance in diagnosing this rare but easily treatable disease. A 16 yrs old female presented with bilateral conductive hearing loss & history of recurrent rhinitis & sinusitis. CT Temporal bone showed soft tissue density lesions in bilateral bony EAC (External auditory canal) with no bony erosion & normal middle ear. A diagnosis of Medial canal fibrosis was given. The patient was operated & biopsy of the specimen came out to be inflammatory granulation tissue. Nepalese Journal of Radiology; Vol. 2; Issue 2; July-Dec. 2012; 69-71 DOI: http://dx.doi.org/10.3126/njr.v2i2.7689

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Triquetral Impingement Ligament Tear (Tilt)

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.1999.0070 ◽

1999 ◽

Vol 24 (3) ◽

pp. 321-324 ◽

Cited By ~ 22

Author(s):

H. K. WATSON ◽

J. WEINZWEIG

Keyword(s):

Surgical Repair ◽

Fibrous Tissue ◽

Complex Problem ◽

Mechanism Of Injury ◽

Wrist Motion ◽

Ligament Tear ◽

Ulnar Wrist Pain ◽

History Of ◽

Pain History ◽

Injury Causes

Ulnar wrist pain is a complex problem whose cause often remains elusive. A diagnostic triad of localized triquetral pain, history of a wrist hyperflexion injury, and normal radiographs, accompanied by ulnar wrist swelling and limited wrist motion, is often attributable to a syndrome we have termed triquetral impingement ligament tear (TILT). The mechanism of injury causes a cuff of fibrous tissue to be displaced distally from the ulnar sling mechanism, resulting in chronic impingement on the triquetrum that causes hyperaemia, loss of articular cartilage, and softening of the bone. Surgical repair consists of simply excising the impinging fibrous cuff. The outcome of 44 patients treated for TILT over a 6-year period is reviewed. In all cases, TILT repair resulted in improved wrist motion and strength. Ninety-five percent of patients reported a significant improvement in pain both at rest and with activity.

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