Vitrectomy in Uveitis

Nowadays, with the development of modern vitreoretinal microsurgery techniques, indications of vitrectomy in uveitis have expanded significantly and visual results have improved. In selected cases, surgeries performed by suppressing inflammation in the required indications affect the visual prognosis positively. However, it should be kept in mind that anatomical and functional success rates are lower in eyes with uveitis compared to other eyes, and the risk of developing postoperative complications is higher. The purpose of this review is to discuss the role of vitrectomy in the treatment of uveitis.

2019 ◽  
Vol 4 (4) ◽  
pp. 158-166
Author(s):  
Stephan M. Freys ◽  
Esther Pogatzki-Zahn

AbstractThe incidence rates of adverse events secondary to any operation are a well-known problem in any surgical field. One outstanding example of such adverse events is postoperative pain. Thus, the incidence of acute postoperative pain following any surgical procedure and its treatment are central issues for every surgeon. In the times of Enhanced Recovery After Surgery (ERAS) programs, acute pain therapy became an increasingly well investigated and accepted aspect in almost all surgical subspecialties. However, if it comes to the reduction of postoperative complications, in the actual context of postoperative pain, surgeons tend to focus on the operative process rather than on the perioperative procedures. Undoubtedly, postoperative pain became an important factor with regard to the quality of surgical care: both, the extent and the quality of the surgical procedure and the extent and the quality of the analgesic technique are decisive issues for a successful pain management. There is growing evidence that supports the role of acute pain therapy in reducing postoperative morbidity, and it has been demonstrated that high pain scores postoperatively may contribute to a complicated postoperative course. This overview comprises the current knowledge on the role of acute pain therapy with regard to the occurrence of postoperative complications. Most of the knowledge is derived from studies that primarily focus on the type and quality of postoperative pain therapy in relation to specific surgical procedures and only secondary on complications. As far as existent, data that report on the recovery period after surgery, on the rehabilitation status, on perioperative morbidity, on the development of chronic pain after surgery, and on possible solutions of the latter problem with the institution of transitional pain services will be presented.


Author(s):  
Ricardo Santana ◽  
Enrique Onieva ◽  
Robin Zuluaga ◽  
Aliuska Duardo-Sánchez ◽  
Piedad Gañán

Background: Machine Learning (ML) has experienced an increasing use given the possibilities to expand the scientific knowledge of different disciplines, such as nanotechnology. This has allowed the creation of Cheminformatic models, capable of predicting biological activity and physicochemical characteristics of new components with high success rates in training and test partitions. Given the current gaps of scientific knowledge and the need of efficient application of medicines products law, this paper analyzes the position of regulators for marketing medicinal nanoproducts in European Union and the role of ML in the authorization process. Methods: In terms of methodology, a dogmatic study of the European regulation and the guidances of the European Medicine Agency on the use of predictive models for nanomaterials was carried out. The study has, as the framework of reference, the European Regulation 726/2004 and has focused on the analysis of how ML processes are contemplated in the regulations. Results: As result, we present a discussion of the information that must be provided for every case for simulation methods. The results show a favorable and flexible position for the development of the use of predictive models to complement the applicant's information. Conclusion: It is concluded that Machine Learning has the capacity to help to improve the application of nanotechnology medicine products regulation. Future regulations should promote this kind of information given the advanced state of art in terms of algorithms that are able to build accurate predictive models. This especially applies to methods such as Perturbation Theory Machine Learning (PTML), given that it is aligned with principles promoted by the standards of Organization for Economic Co-operation and Development (OECD), European Union regulations and European Authority Medicine. To our best knowledge this is the first study focused on nanotechnology medicine products and machine learning use to support technical European public assessment report (EPAR) for complementary information.


2001 ◽  
Vol 32 (3) ◽  
pp. 233-238
Author(s):  
Gagandeep S Brar ◽  
Jagat Ram ◽  
Suriner S Pandav ◽  
Ganjikunta S Reddy ◽  
Usha Singh ◽  
...  

Author(s):  
Donald Y. Ye ◽  
Thana Theofanis ◽  
Tomas Garzon-Muvdi ◽  
James J. Evans

Intracranial tumors reflect a broad range of benign and malignant processes that are often managed by neurosurgeons and medical oncologists. Patients presenting with new brain tumors will undergo biopsies or resection for tissue diagnosis and resolution of neurological symptoms. These patients have significant perioperative risk factors that must be addressed to ensure the best possible outcomes. Hospitalists play a pivotal role in identifying these risk factors and offering management strategies prior to the development of an operative plan. This chapter provides insight into the range of preoperative considerations and postoperative complications that a hospitalist may face when managing brain tumor patients.


2007 ◽  
Vol 73 (3) ◽  
pp. 281-283 ◽  
Author(s):  
Leila Thanasoulis ◽  
Juliane Bingener ◽  
Kenneth Sirinek ◽  
Melanie Richards

The role of the intraoperative parathyroid hormone (IOPTH) assay in patients with tertiary hyperparathyroidism (3HPT) is not well defined. To evaluate the utility of the IOPTH in 3HPT, we compared its use in 72 patients with primary hyperparathyroidism (1HPT) and 3HPT undergoing parathyroidectomy. Sixty-three patients with 1HPT and nine patients with 3HPT were identified. There were 30 men and 42 women (mean age, 58 years). The mean serum calcium and preoperative intact PTH levels in 1HPT were 11.1 mg/dL and 214 pg/mL compared with 11.2 mg/dL and 849 pg/mL in 3HPT (Ca, non significant; PTH, P < 0.05). Intraoperatively, a solitary abnormal gland was found in 62 of 72 (86%) patients. Seven patients with 3HPT had three- or four-gland hyperplasia. The two groups were compared to determine if a 10-minute postexcision IOPTH decline >50 per cent would have similar success rates. Seventy-one of 72 (98.6%) patients had a >50 per cent decline from the baseline IOPTH at the end of the operation. The average reduction from baseline was 85.3 per cent in 1HPT and 88.6 per cent in 3HPT (not significant). Average follow-up was 9.8 months for 1HPT and 11.1 months in 3HPT. Three of 63 patients (4.8%) with 1HPT and five of nine patients (55.6%) with 3HPT had inappropriate elevations in PTH ( P < 0.05). All patients with 3HPT were normocalcemic compared with 62 of 64 (97%) patients with 1HPT (not significant). The IOPTH assay can be used in 3HPT in an identical fashion with an equivalent rate of normocalcemia compared with its applications in 1HPT.


2019 ◽  
Vol 17 (5) ◽  
pp. 402-407 ◽  
Author(s):  
Cosimo De Nunzio ◽  
Antonio Cicione ◽  
Laura Izquierdo ◽  
Riccardo Lombardo ◽  
Giorgia Tema ◽  
...  

Medicina ◽  
2008 ◽  
Vol 44 (9) ◽  
pp. 678 ◽  
Author(s):  
Saulius Grižas ◽  
Antanas Gulbinas ◽  
Giedrius Barauskas ◽  
Juozas Pundzius

The role of postoperative supplementary enteral nutrition after gastrointestinal surgery is controversial. Therefore, a randomized clinical trial with attempts to address the question of plenitude of routine application of postoperative enteral feeding on rate of postoperative complications following pancreatoduodenectomy was performed. Sixty patients undergoing pancreatoduodenectomy were blindly randomized into two groups: 30 patients in the first group received early enteral nutrition (EEN), while 30 patients in the second group were given early natural nutrition (ENN). The complications were evaluated according to definition criteria. All complications were further subdivided into infectious and noninfectious complications. Our data showed that patients in EEN group gained a larger amount of energy in kcal a day during the first five days after surgery in comparison to ENN group. There was a higher rate of postoperative complications in ENN group (53.3% vs 23.3%, P=0.03). This difference occurred mainly due to the higher incidence of infectious complications in ENN group (46.7% vs 16.7%, P=0.025). There were six cases of bacteriemia in this group of patients, while only one case was observed in EEN group (6 (20.0%) vs 1 (3.3%), P=0.1). The overall risk for the development of any type of infectious complication was 1.5 times higher in ENN group. In conclusion, this study suggests that supplementary postoperative enteral nutrition helps to decrease the rate of infectious complications in patients undergoing pancreatoduodenectomy, especially in those with a plasma albumin level of less than 34.5 g/L and/or ASA class III or higher, since natural nutrition is insufficient in this ca.


2007 ◽  
Vol 17 (4) ◽  
pp. 601-604 ◽  
Author(s):  
Z. Szijártó ◽  
B. Haszonits ◽  
Z. Biró ◽  
B. Kovács

Purpose To provide an overview of intraoperative and postoperative complications during phacoemulsification cataract surgery and to evaluate the visual results in patients having pars plana vitrectomy (PPV) with 10 years of follow-up. Methods Retrospective evaluation of intraoperative and postoperative complications and postoperative visual results in 134 consecutive patients who underwent phacoemulsification after PPV. Of 11,498 eyes treated with phacoemulsification, 143 (1.2%) had previous PPV during the 10-year period (January 1, 1995-December 31, 2004). A total of 134 eyes were included in this study. Results The phacoemulsification procedure seemed to be difficult where there was a deep or fluctuating anterior chamber (93%) and primary posterior capsule opacification (19%). The most frequent intraoperative complications were posterior capsule rupture (9%) and incomplete capsular rhexis (5%). Postoperative intraocular pressure elevation (7%), retinal detachment (6%), and posterior capsule opacification (8%) occurred most frequently during the mean follow-up period of 18.2 months (1.5–110 months). Best-corrected visual acuity (BCVA) increased two or more Snellen E lines in 55% of the cases or became better than or equal to 0.5 in 10% of the cases. Conclusions Despite the well-known difficulties encountered in vitrectomized eyes such as zonular damage, increased mobility of the lens-iris diaphragm, and altered intraocular fluid dynamics, phacoemulsification proved to be a safe procedure in the hands of experienced surgeons.


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