Objectives: To compare the time of operation and the postoperative intraocular pressure (IOP) using a 27- versus 25-gauge three-port vitrectomy in eyes with epiretinal membrane (ERM).
Methods: The clinical records of eyes with ERM that underwent combined cataract surgery and vitrectomy from January to April 2016 were analyzed. Thirteen eyes were treated using a 27-gauge system (27-g group) and 12 eyes were treated using a 25-gauge system (25-g group). The operating times were determined from video recordings.
Results: The time of vitreous removal was significantly longer in the 27-g group (141.1 ± 34.1 s) than in the 25-g group (106.2 ± 24.1 s; P = 0.009). The IOP was significantly lower in the 25-g group than in the 27-g group on postoperative day 1 (27-g group, 18.3 ± 6.2 mmHg; 25-g group, 12.6 ± 3.6 mmHg; P = 0.008), but there was no significant difference on postoperative day 7. The times needed for removing the trocar and closing the port were not significantly different, but the number of the ports that required pressure to close was significantly greater in the 25-g group (35/36 ports) than in the 27-g group (31/39 ports; P = 0.0027), and the duration of pressure was significantly longer in the 25-g group (21.7 ± 13.8 s) than in the 27-g group (11.3 ± 5.2 s; P = 0.0183).
Conclusions: The 27-g system is better regarding closure of the scleral port, which may reduce postoperative complications, but the prolonged surgical time may be a disadvantage.
Objectives: Minimally invasive haemodynamic monitoring is important in goal-directed therapy. The algorithms used by the FloTrac/Vigileo (FV) and lithium dilution cardiac output rapid (LiDCOrapid) (LR) measurement systems for cardiac output (CO) monitoring differ. We examined correlations of FV and LR measurements with thermodilution measurements and determined responsiveness to phenylephrine using both systems.
Methods: The FV system was used as the main arterial pressure line, and a second line was connected to the LR system. First, we measured CO at multiple time points using thermodilution and compared these measurements with those obtained simultaneously using the LR and FV systems. Second, CO, systemic vascular resistance and stroke volume (SV) were simultaneously measured using the LR and FV systems after phenylephrine administration.
Results: Measurements obtained at 38 time points in 3 patients were compared. There were strong correlations of LR and FV measurements with thermodilution measurements. Bland–Altman analysis indicated that LR (percentage error, PE, 29.8%) and FV (PE, 31.6%) system measurements were equivalent to thermodilution measurements. Following phenylephrine administration, the LR system detected an increase in blood pressure following an increase in vascular resistance, with negligible change in SV. Conversely, the FV system detected little change in vascular pressure and a marked increase in SV.
Conclusions: Compared with thermodilution, both the LR and FV systems demonstrated sufficient accuracy and precision for clinical use. The LR system was more accurate than the FV system in reflecting rapid changes in blood pressure, vascular resistance and CO following phenylephrine administration.
Objective: Previous studies have suggested that transpulmonary thermodilution (TPTD) measurements are influenced by extracorporeal circulation methods, such as blood purification. Using pigs, we investigated the effect of extracorporeal circulation on hemodynamic measurements at two sites of cold saline injection.
Methods: Six female outbred pigs were included in the study. A vascular access site was made in the left external jugular vein. Cold saline was injected in the right external jugular vein or the right femoral vein. Hemodynamic monitoring was performed using TPTD (EV1000). Cardiac output (CO), global end-diastolic volume (GEDV), and extravascular lung water (EVLW) values were compared between extracorporeal circulation and no extracorporeal circulation. All data are expressed as median values.
Results: The following data were obtained when cold saline was injected into the jugular vein (circulation on vs. circulation off): CO, 2.7 vs. 2.9 L/min (P = 0.04); GEDV, 403 vs. 438 ml (P = 0.04); and EVLW, 310 vs. 306 ml (P = 0.92). The following data were obtained when cold saline was injected into the femoral vein (circulation on vs. circulation off): CO, 2.6 vs. 2.8 L/min (P = 0.18); GEDV, 497 vs. 500 ml (P = 0.18); and EVLW, 341 vs. 345 ml (P = 0.44).
Conclusions: Extracorporeal circulation has an effect on the accuracy of measurement of TPTD injection through the jugular vein. In contrast, no effect of extracorporeal circulation was observed when the femoral vein was used.
Ovarian cancer arising from an ovarian endometriotic cyst is frequently encountered; however, this condition has rarely been reported in young patients. We herein report a case of malignant transformation of an ovarian endometriotic cyst in a 26-year-old woman (gravida 0, para 0). During the initial examination at our hospital, ultrasound revealed an endometriotic cyst in the right ovary measuring 49×44×29 mm and an endometriotic cyst in the left ovary measuring 59×53×32 mm with no marked mural nodules on either side. The patient was followed up every 3 months while receiving hormone therapy. At the 6-month follow-up, ultrasound revealed 10-mm mural nodules within the endometriotic cyst of the left ovary. At 10 months, ultrasound revealed that these the mural nodules had enlarged to 15 mm. Pelvic magnetic resonance imaging revealed that the tumor in the left ovary was 64×63 mm in size, which was slightly larger than in the previous scan. The patient underwent laparotomy because of the potential for malignant transformation. Pathological examination revealed clear cell adenocarcinoma. Although malignant transformation of this cancer is rare in women in their 20s, its possibility should be considered; this is true even when cyst enlargement can be controlled during hormone therapy. Magnetic resonance imaging is extremely useful in the diagnosis of malignant transformation.
Objectives: Treatment choices in children with cleft palate include maintenance of speech therapy or surgery for correction of hypernasality and articulation disorders caused by velopharyngeal insufficiency. In this study, we aimed to determine the optimal treatment choice based on the measurement of aerodynamic velopharyngeal competence in children with cleft palate and velopharyngeal insufficiency after cleft palate closure.
Methods: Maximal nasal airflow leakage during articulation was measured by rhinomanometry and compared between children who received only speech therapy after cleft palate closure and those who underwent additional pharyngeal flap construction after cleft palate closure.
Results: The mean airflow leakage values during articulation were significantly higher in the children who received surgical therapy than in those who received only speech therapy.
Conclusions: The appropriate threshold of maximum nasal airflow leakage must be determined to facilitate identification of the optimal treatment choice in children with cleft palate and hypernasality.