The use of intralesional injection of 5 fluorouracil to induce regression of recurrent pterygium
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Purpose To investigate the benefit of intralesional injections of 5FU for the treatment of recurrent pterygium Methods Retrospective case note review of patients following surgical excision for pterygium identified 6 patients with recurrence treated with 0.1-0.2ml (2.5-5mg) of intralesional 5 FU post operatively. The time to recurrence, post recurrence injections, grade of pterygium pre and post treatment and time to regression were identified. Results The study group consisted of 5 male and 1 female patients, affecting 6 right eyes. 3 patients developed primary recurrence. The other 3 patients had previous surgery with recurrence followed by further surgical excision and repeat recurrence. The average grade of recurrence was 3.5. All 6 patients showed regression of the fibrovascular tissue following intralesional 5FU injections with an average dose of 0.1-0.2 ml (2.5-5mg). 5 patients required 3 injections or less for regression, whilst one patient required 14 post recurrence 5FU injections. The average grade following regression was 1.7. This level of regression was maintained at an average of 9 months follow-up. No complications of 5FU were reported. Conclusion The use of 5FU for the treatment of recurrent pterygium is safe and effective in limiting both progression and inducing regression of recurrent pterygium.Keywords:
Pterygium
Limiting
Objectives: Pterygium is a wedge of conjunctival tissue ploughing across the limbus into the superficial cornea. Various surgical techniques are used to treat this condition. Conjunctival auto-transplant over the bare area is one of the techniques used. This trial was conducted to evaluate the results of conjunctival autotransplant in the treatment of pterygium.
Material & Methods: This study was conducted at Saidu Teaching Hospital, Saidu Sharif Swat and Kuwait Teaching Hospital Peshawar, from 1st July 2008 to 31th December 2009. Complete history and clinical examination was recorded on a pre-designed profroma. The diagnosis of pterygium was a clinical one. All the pterygia were examined with slit lamp to look for vascularity, advancement towards the cornea and congestion. The surgical technique comprised of surgical excision of pterygium, and conjunctival auto-transplant on the bare sclera. Nylon 10/0 was used for suturing the conjunctiva. Follow up period was 6 months.
Results: In this study 70 patients were operated; 51 males and 19 females with a male to female ratio of 2.9:1. Recurrences occurred in 6(9.52%) cases. Other post-operative complications were granuloma formation in 1(1.58%), conjunctival cyst formation 2(3.7%), and persistent irritation due to chronic inflammation in 2(3.17%) case. Minor post-operative temporary complications were graft edema, delayed wound healing and foreign body sensation.
Conclusion: Conjunctival auto-transplant is an effective and safe procedure for excision of pterygium.
Pterygium
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Seroma
Wound dehiscence
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Fat necrosis
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Methods for the treatment of tuberculous spondylitis still are controversial. The authors treated 32 consecutive patients with a two-stage surgical technique combined with antituberculous chemotherapy for 1 year. After anterior debridement, fusion with autogenous anterior iliac tricortical strut bone graft was done, and in a second stage, posterior instrumentation and fusion with autogenous posterior iliac corticocancellous bone graft was done 11 days (range, 4-22 days) later. Postoperatively, patients were encouraged to ambulate with brace protection as early as possible. Twenty-nine patients were followed up for a minimum of 2 years (median, 4.7 years; range, 2-10 years) of whom 28 patients achieved solid fusion (97%). All patients had improvement of back pain including the only patient with pseudarthrosis. Neurologic deficits completely recovered in 84% (16 of 19) of patients after 3 months. Kyphotic deformity improved in all 29 patients (34.6 degrees versus 17.3 degrees ) with the average correction angle of 17.3 degrees. Clinically, 27 patients had achieved a satisfactory outcome (93%). There were no evident surgical complications. The authors, therefore, recommend a two-stage surgical technique combined with antituberculous chemotherapy to treat patients with severe vertebral body destruction attributable to tuberculosis because of its high success rate and a low complication rate.
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We reviewed a consecutive series of 16 patients above 60 years of age (mean age 71 years) who underwent reconstruction with pedicled flaps in the lower extremity. The soft tissue defects ranged from 9 to 50 cm and were caused in 11 patients (70%) by surgical complications from previous surgeries. Of these, 5 patients underwent a total joint replacement of the knee (4 cases) and of the ankle (1 case). Surgery consisted of 19 muscular flaps, and 3 fasciocutaneous flaps. Six patients were treated with a combination of 2 flaps. The overall surgical complication rate after reconstruction was 44%. There was no perioperative mortality and there were no medical complications. One patient required an above-the-knee amputation because of uncontrollable postoperative bleeding. A thrombectomy was performed in another patient to treat a postoperative popliteal artery occlusion with critical ischemia of the leg. Other complications included recurrent total joint replacement infections (2 cases), marginal flap necrosis (4 cases), and skin necrosis at the donor site (1 case). The mean hospitalization stay was 46 days. All patients but 1 completely healed, although secondary surgery was performed in 7 patients. The occurrence of complications was not correlated with the preoperative morbidity or an age above 75 years. The local complication rate was higher than reported for free flap in the same age category, but the lack of perioperative mortality and medical complications make it a low-risk option for reconstruction of small- to middle-sized defects in the elderly.
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Pterygium
Pingyangmycin
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BACKGROUNDPterygium is a conjunctival disease, an abnormal triangle fold of membrane secondary to elastotic degenerative condition of the subconjunctival tissue proliferates as vascularised tissue encroaches upon the cornea destroying the superficial layers of the stroma and Bowman's membrane.Recently, it has become clear that ultraviolet light exposure is the most important environmental influence.Surgical excision is the principal mode of therapy for Pterygium.But the high incidence of recurrence following excision remains a challenge unmet and a problem unsolved.The aim of this study is to evaluate the efficacy of limbal conjunctival autografting in the surgical management of Pterygium in farmers and to analyse the recurrence rates and complications of conjunctival autografting in farmers. MATERIALS AND METHODSProspective observational study of 50 cases of Pterygium.The patients were randomly selected.After pre-operative assessment, patients were taken up for the surgical procedure by a single surgeon.All the patients followed up post-operatively for 1 year.A recurrence was defined as a fibrovascular tissue crossing the corneo-scleral limbus on to clear cornea in the area of previous Pterygium excision. RESULTSIn this study, 60% of patients were in the age group of 21 to 40 years.The commonest indication for surgery was cosmetic disfigurement 56% followed by ocular irritation and recurrent inflammation.The recurrence rate is 16.00% in the study.The complications in conjunctival autograft were granuloma at donor site, graft displacement, graft retraction and suture irritation. CONCLUSIONLimbal conjunctival autograft is a safe, effective and affordable procedure in the management of Pterygium in farmers those who are at the risk of UV exposure.The recurrence rate could be reduced by health education, lifestyle modification and precautions.Complications can be avoided by simple precautions and refinement in surgical technique.
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Eighty eight eyes of 70 male and 18 female patients with primary pterygium were selected for the study. All of them were applied 0.04% of Mitomycin C intra-operatively for 03 minutes. Same surgical technique was used in all patients. Recurrence rate was 17% at on average of 14.3 months of follow up. Two patients had persistent epitheliopathy for six months, which then healed. other minor complications included mild pain and lacrimation in twenty patients and postoperative infection in one patient. there was no case of sight threatening complication like cornea scleral necrosis.
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Abstract Some 114 patients (median age 52 years) underwent laparoscopic hernia repair as a day-case procedure. Twenty-one patients had bilateral and 11 recurrent hernias. Some 113 patients underwent transabdominal preperitoneal mesh repair but one required conversion to open operation. Mean operating time was 24 min for unilateral and 38 min for bilateral repair. In an operating session of 3·5 h, up to five patients (mean 4·4) underwent surgery and as many as seven hernias were repaired. More than 10 per cent of patients were found to have a previously undiagnosed hernia on the opposite side. A total of 111 patients were discharged home on the day of surgery. Major complications included one omental bleed and one small bowel obstruction. Seroma was the commonest minor complication and occurred in 7 per cent of patients. More than 35 per cent of patients needed no postoperative analgesia. To date there has been one recurrence (follow-up range 2–18 months).
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Incisional hernias develop in up to 11% of surgical abdominal wounds with a possible recurrence following repair of 44%. We describe our experience with a combined fascial and prosthetic mesh repair. Thirty-five patients (16M:19F) have been treated. The original operation was bowel related in 19 cases, gynaecological in 8, hepatopancreaticobiliary in 3 patients, aortic aneurysm repair in 2 and involved a thoraco-laparotomy in 3. The incisions were midline in 26 cases, transverse in 6, paramedian in 2 and rooftop in one patient. The hernias were considered subjectively to be large in 15, medium in 14 and small in 6 of the patients. A proforma was completed for each patient noting intra-operative and post-operative complications, post-operative hospital stay and analgesic requirements. Post-operative complications included seroma formation in 6 patients, deep vein thrombosis in one and a non-fatal pulmonary embolism in another. One patient developed a wound haematoma and one had a superficial wound infection. Post-operative in-hospital stay ranged from 1 to 27 days with a mean of 6.2 days. Of the 35 patients 33 were available for follow-up. Follow-up was for a median of 20.3 months (range 6.0 to 54.1 months). Two of these (6%) patients reported a persistent lump and one (3%) reported persistent pain but none of the remaining 33 was found to have a recurrence. We advocate this technique because it is applicable to all hernias, most of the mesh is behind the rectus sheath and has 2 points of fixation, it is relatively pain-free allowing early mobilisation, has a modest complication rate and a low recurrence rate.
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