Photorefractive keratectomy after DMEK for corneal decompensation by phakic IOL

Purpose To provide the first description of photorefractive keratectomy (PRK) for the correction of mild residual refractive error after Descemet membrane endothelial keratoplasty (DMEK). Methods Case report. Results A 45 year-old woman presenting with phakic intraocular lens (PIOL)-related corneal decompensation underwent staged DMEK surgery following PIOL explantation and cataract surgery. Eighteen months after DMEK, uncorrected distance visual acuity (UDVA) was 20/60 and best-corrected visual acuity (BCVA) was 20/22, with a stable refraction. The patient requested refractive surgery to decrease spectacle dependance, and wavefront-optimized PRK was performed. At last follow-up observation thirty-three months after PRK (54 months after DMEK surgery), UDVA was 20/20, the cornea remained clear without signs of rejection or endothelial failure, and the endothelial cell loss rate was not accelerated after PRK. Conclusion Since long-term visual and refractive stability can be expected after DMEK, PRK may be a particular safe and effective approach for the correction of mild residual refractive errors after DMEK. However, we consider that surgeons must exercise caution when considering keratorefractive surgery in these eyes due to postoperative changes in corneal curvature and thickness, and further studies are encouraged.

The diagnostic value of digital breast tomosynthesis with complementary ultrasound in comparison with magnetic resonance imaging in assessment of postoperative changes and locoregional recurrence of breast cancer

Background Digital breast tomosynthesis with complementary ultrasound is a powerful imaging modality in detection of breast cancer. Magnetic resonance imaging has many limitations due to its low specificity multiple pitfalls especially signal-to-noise ratio, as well as the spatial resolution. Our purpose of the study is to evaluate the role of digital breast tomosynthesis with complementary ultrasound compared to magnetic resonance imaging in the assessment of postoperative changes and locoregional recurrence of breast cancer. Results Our prospective study included thirty women who underwent conservative breast surgery. Digital breast tomosynthesis with complementary ultrasound revealed greater specificity (95.2%) than Magnetic resonance imaging (90.5%) in the detection of locoregional recurrence of breast cancer. On the other hand, it revealed the same sensitivity (88.9%). Subsequently, digital breast tomosynthesis with complementary ultrasound showed higher accuracy (93.3%) and higher positive predictive value (88.9%) than magnetic resonance imaging (90%), (80%), respectively. However, both of them revealed a comparable negative predictive value (95%). Conclusion Digital breast tomosynthesis with complementary ultrasound is a powerful imaging modality that can be used to detect any recurrence in patients who are surgically treated for breast cancer with higher specificity, accuracy than magnetic resonance imaging. Additionally, the use of these modalities enhances the diagnosis of surgically treated breast cancer for early detection of recurrence.

Postoperative Dietary Intake Achievement: A Secondary Analysis of a Randomized Controlled Trial

Sufficient postoperative dietary intake is crucial for ensuring a better surgical outcome. This study aimed to investigate the postoperative dietary intake achievement and predictors of postoperative dietary intake among gynecologic cancer patients. A total of 118 participants were included in this secondary analysis. Postoperative dietary data was pooled and re-classified into early postoperative dietary intake achievement (EDIA) (daily energy intake (DEI) ≥ 75% from the estimated energy requirement (EER)) and delay dietary intake achievement (DDIA) (DEI < 75% EER) There was a significant difference in postoperative changes in weight (p = 0.002), muscle mass (p = 0.018), and handgrip strength (p = 0.010) between the groups. Postoperative daily energy and protein intake in the EDIA was significantly greater than DDIA from operation day to discharged (p = 0.000 and p = 0.036). Four significant independent postoperative dietary intake predictors were found: preoperative whey protein-infused carbohydrate loading (p = 0.000), postoperative nausea vomiting (p = 0.001), age (p = 0.010), and time to tolerate clear fluid (p = 0.016). The multilinear regression model significantly predicted postoperative dietary intake, F (4, 116) = 68.013, p = 0.000, adj. R2 = 0.698. With the four predictors’ recognition, the integration of a more specific and comprehensive dietitian-led supportive care with individualized nutrition intervention ought to be considered to promote functional recovery.

Surgical and Anatomic Consideration in Endoscopic Dacryocystorhinostomy of a Patient with Damaged Sinonasal Anatomy Post–Caldwell-Luc Surgery: A Case Report

Background: The Caldwell-Luc (CL) procedure, an outdated operative procedure that is used to treat inflammatory sinus diseases, is rarely performed presently. However, physicians may encounter patients with a history of CL surgery who develop considerable postoperative changes that may lead to diagnostic confusion in imaging evaluation; increase the difficulty of future surgery, such as sinonasal surgery; and increase the incidence of future intraoperative complications. Case summary: A 67-year-old man with a surgical history of chronic sinusitis reported epiphora of the left eye for five years. Balloon dacryocystoplasty was attempted but failed. Endo-DCR (Endoscopic dacryocystorhinostomy) was indicated; however, preoperative CT (computed tomography) imaging and nasal endoscopic examination showed sinonasal anomalies and the loss of internal landmarks for localizing the lacrimal sac. Preoperative CT results indicated previous CL surgery. Endo-DCR was performed with the aid of nasal forceps and a 20-gauge vitreoretinal fiberoptic endoilluminator. A six-month follow-up revealed the complete resolution of symptoms and no signs of recurrence. Conclusions: Epiphora might be a delayed complication of the CL procedure. Before performing endo-DCR, ophthalmologists should be familiar with the sinonasal anatomy and carefully assess preoperative imaging to identify anatomical variations. Nasal forceps and transcanalicular illumination can assist in determining the precise location of the lacrimal sac during endo-DCR.

Questionnaire-Based Assessment of the Masticatory Function and Facial Nerve Recovery Post Pterional Approach in Brain Tumors Surgery

Background: The pterional approach for craniotomy, one of the most used surgical intervention in neurosurgery, results in a series of postoperative changes that, if they persist, affect the patient’s life, social reintegration, and his/her physical and mental recovery. The aim of the present study was to develop and validate a questionnaire for indicating directly affected masticatory muscles groups and facial nerve branches, in patients undergoing the pterional approach in neurosurgery, so that the recovery therapy can be monitored and personalized. Methods: A self-reporting questionnaire consisting of 18 items (12 for postoperative masticatory status and 6 for facial nerve branches involvement), validated on fifteen patients, following three steps: items development, scale development, and scale evaluation, was prospectively applied twice, at a one-year interval (T0 and T1), with thirty-two patients suffering from vascular or tumoral pathology and surgically treated through a pterional approach. Results: No statistically significant correlation could be found between postoperative outcomes and age or gender. Facial nerve branch involvement could not be correlated with any of the assessed variables. Pathology and time elapsed from surgery were statistically significantly correlated to preauricular pain on the non-operated side (p = 0.008 and p = 0.034, respectively). Time elapsed from surgery was statistically significantly correlated to the ability to chew hard food, pain while yawning, and preauricular pain during back and forward jaw movements and gradual mouth opening. Conclusions: We created and validated a valuable patient-centered questionnaire that can be employed as a tool for postoperative assessment of directly affected masticatory muscles and groups of facial nerve branches.

Improvement in body composition of adult postbariatric surgery patients at one-year follow-up at a public hospital in United Arab Emirates

Background: Data on postoperative follow-ups and bariatric surgery (BS) outcomes performed in the United Arab Emirates (UAE) are crucial for registry. This study assessed the one-year postoperative changes in body composition and metabolic profiles in BS patients. Methods: The medical and dietetics records of 51 adult patients who underwent BS in the largest public hospital in Sharjah, UAE were reviewed. Data on body weight and composition, as well as metabolic profile (blood glucose and lipid levels) from the initial until the last hospital visit were recorded. Results: The median (interquartile range) follow-up period was 6.0 (8.0) months. The patients had significant total weight loss [19.3 (12.6)%] and reduction in body mass index (BMI) [18.0 (13.6)%] of approximately 7 BMI points. Moreover, the patients’ body composition improved significantly; loss was the highest in fat mass [–30.9 (22.1)%] and the least in lean body mass [–8.6 (8.4)%]. There was a steady decline in all body composition variables with a longer duration of follow-up visits from 1–3 months to 10–12 months. The fat mass (–40.3%):lean body mass (–10.7%) loss ratio was 3.8:1 at 10–12 months. The patients’ metabolic status was normal during the last postoperative visit. Conclusions: Incremental improvements in body composition of patients were evident with longer follow-up visits up to one year after BS. Hence, patients should attend regular follow-up visits after BS. Moreover, accurate and complete documentations of medical and dietetics visits are mandated.

Ultrasound examination of myometrial changes after conservative myomectomy, with the aim of predicting the course of pregnancy and choosing the optimal method of delivery

Introduction. The article provides a methodology for assessing and predicting complications during pregnancy for selectionof the optimal method of delivery.Goals and objectives. The work assessed the degree of myometrium changes, according to ultrasound studies, after using standard instrumentation and electrocoagulation, in order to predict the course of pregnancy and select the optimal method of delivery.Materials and methods. The details of the surgical anatomy, the plan of the surgeon’s action before the operation, formed according to the data of ultrasound diagnostics and operative surgery, were analyzed. Ultrasound was performed using GE Logiq S8 (USA) and Medisan Accuvix (South Korea) devices with 3,5 MHz convex transducers for transabdominal examination and with a frequency of 5 MHz for transvaginal examination.Research results. Laparoscopic myomectomy was performed in 18 women, 31 patients underwent laparotomic myomectomy, in 11 patients a combined operation technique was used: laparoscopy with minilaparotomy. According to our data, in half of the cases considered, the effects of interventions were absent or minimal. We assigned these results to group I (A — A1, A2, A3). In all other observations, cicatricial changes were revealed — group II (B, C, D, E). To predict the possible consequences, we proposed a point assessment of the ultrasound postoperative changes in the uterus, with the help of which it is possible to assess the degree of risk when planning pregnancy for each patient individually. Each group corresponds to a certain number of points.Conclusions. The presented division according to the degree of severity into groups can make it possible to individualize the approach to each patient and ensure the safest possible management of her during pregnancy and childbirth. This assessment can be used by ultrasound doctors and obstetricians-gynecologists of antenatal clinics and hospitals. The assessment presented by us at the moment is of a recommendatory nature.

Perioperative changes of FGF23 in patients undergoing surgery for primary hyperparathyroidism

Background: Fibroblast growth factor-23 (FGF23) is a key regulator of urine phosphate excretion. The aim of the study was to investigate the perioperative (intraoperative and postoperative) changes of plasma intact and C-terminal FGF23 (iFGF23, cFGF23) concentrations in patients with primary hyperparathyroidism (pHPT) submitted to surgery. Materials and methods: Study involved 38 adult patients with pHPT caused by adenoma. PTH levels were investigated intraoperatively (just before the incision and 10 minutes after adenoma excision). cFGF23, iFGF23, phosphate, eGFR and P1NP were measured intraoperatively and postoperatively (next day after the surgery). Results: PTH levels decreased intraoperatively (13.10 vs. 4.17 pmol/L, P<0.0001). FGF23 levels measured intraoperatively were at the upper level of reference interval. cFGF23 decreased postoperatively compared with values measured just before the incision (cFGF23: 89.17 vs. 22.23 RU/mL, P<0.0001). iFGF23 decreased as well, but postoperative values were low. Postoperative inorganic phosphate values increased (1.03 mmol/L vs. 0.8 mmol/L, P=0.0025). We proved significant negative correlation of perioperative FGF23 with inorganic phosphate (cFGF23: Spearman r=-0.253,P=0.0065; iFGF23: Spearman r =-0.245, P=0.0085). We also found FGF23 values just before incision correlated with eGFR (cystatin C) (cFGF23: Spearman r=-0.499, P=0.0014; iFGF23: Spearman r=-0.413, P=0.01). Conclusion: Intraoperative iFGF23 and cFGF23 did not change despite PTH decreased significantly. cFGF23 and iFGF23 significantly decreased one day after parathyroidectomy and are associated with increase of inorganic phosphate in pHPT patients. cFGF23 and iFGF23 just before incision correlated with eGFR (cystatin C). The similar results found in both iFGF23 and cFGF23 suggest each could substitute the other.

Surgical correction for adult spinal deformity increases acetabular lateral coverage of femoral heads

Background Studies explaining the relationship between hip and spine reported that spinal corrective surgery affected acetabular orientation and changes in pelvic tilt were capable of influencing radiographic measures of acetabular coverage. This study aimed to assess the change in coronal parameters for acetabular coverage as a result of adult spinal deformity (ASD) correction and to analyze the relationship between the postoperative changes in sagittal spinopelvic parameters and coronal acetabular coverage parameters. Methods Fifty-two consecutive patients who had undergone multilevel spinal surgical correction were enrolled and evaluated. Coronal acetabular coverage parameters included Tönnis angle (TA), lateral center edge angle (LCEA), and the angle of Sharp (SA). All radiographic parameters were evaluated at the preoperative and the postoperative 1 year. Paired t test was used to determine whether there were significant changes between the time points. Bivariate correlation and linear regression analysis were used to assess the relationship between the postoperative changes of spinal alignment and acetabular orientation. Results The surgical correction resulted in significant decrease of TA, increase of LCEA and SA, respectively (p < 0.001). The changes in pelvic tilt (PT) demonstrated weak correlation on TA (β = 0.117, p < 0.001 for right; β = 0.111, p < 0.001 for left). Conclusions Although the surgical correction of ASD significantly changed PT resulting in increased acetabular lateral coverage parameters, the correlation between the changes of PT following sagittal correction of ASD and acetabular coverage parameters was low. Trial registration This study was retrospectively registered with approval by the institutional review board (IRB) of our institution (approval number: KHNMC-2020-10-010).

The Impact of Segmentectomy Versus Lobectomy on Pulmonary Function in Patients With Non-small-cell Lung Cancer: a Meta-analysis

Objective: Segmentectomy has been reported as an alternative to lobectomy for small-sized NSCLC without detriment to survival. The long-term benefits of segmentectomy over lobectomy on pulmonary function have not been firmly established. This meta-analysis aims to compare postoperative changes in pulmonary function in NSCLC patients undergoing segmentectomy or lobectomy.Methods: Medline, Embase, Web of Science and Scopus were searched through March 2021. Statistical comparisons were made when appropriate.Results: Fourteen studies (2412 participants) out of 324 citations were included in this study. All selected studies were high quality, as indicated by the Newcastle–Ottawa scale for assessing the risk of bias. Clinical outcomes were compared between segmentectomy and lobectomy. ΔFEV1 [10 studies, P<0.01, WMD = 0.40 (0.29, 0.51)], ΔFVC [4 studies, P<0.01, WMD = 0.16 (0.07, 0.24)], ΔFVC% [4 studies, P<0.01, WMD = 4.05 (2.32, 5.79)], ΔFEV1/FVC [2 studies, P<0.01, WMD = 1.99 (0.90, 3.08)], and ΔDLCO [3 studies, P<0.01, WMD = 1.30 (0.69, 1.90)] were significantly lower in the segmentectomy group than in the lobectomy group. Subgroup analysis showed that in stage IA patients, the ΔFEV1% [3 studies, P<0.01, WMD = 0.26 (0.07, 0.46)] was significantly lower in the segmentectomy group. The ΔDLCO% and ΔMVV% were incomparable.Conclusion: Segmentectomy preserves more lung function than lobectomy. There were significantly smaller decreases in FEV1, FVC, FVC%, FEV1/FVC and DLCO in the segmentectomy group than in the lobectomy group.