Normal bacterial flora can be isolated from the conjunctiva in 60-98% of healthy adults. Normal conjunctival flora can be reduced to around 20% by using the conventional procedures of disinfecting the eyelid and ocular surface with povidone-iodine prior to surgery and physically washing the operative field with saline during surgery. Since bacteria on the ocular surface can gain entrance into the eye via instruments and other means, endophthalmitis occurs in 1 in 2,000 cases (0.05%) after cataract surgery. Endophthalmitis is the most serious postoperative infection, and the visual outcome is often poor, even with appropriate treatments. Reports of experimental studies in the literature suggest that povidone-iodine concentrations ranging from 0.05 to 0.5% are highly bactericidal and non-toxic to eye tissues. From these basic scientific data, we proposed a method of “transient sterilization of the operative field” by repeated irrigation of the surgical field with 0.25% povidone-iodine during intraocular surgery. Our irrigation method combines the effect of physically washing off bacteria, as achieved with conventional saline washing, together with the bactericidal effect of povidone-iodine. We have used this method in a large number of intraocular surgeries, and have encountered no cases of endophthalmitis and no ocular complications, such as corneal injury. This simple and low-cost technique is also an infection prevention method that has no risk of inducing resistant bacteria.
Background: Rapid and accurate diagnosis is essential for containing an influenza pandemic. Rapid diagnostic tests are routinely available but sometimes give false-negative results, especially during the early phase of influenza infection. The usefulness of the presence of pharyngeal “influenza follicles” on physical examination for the diagnosis of influenza A/ H1N12009 was evaluated. Methods: Between August 16, 2009 and January 31, 2010, 453 patients with influenza-like symptoms were evaluated, of whom 110 were diagnosed as having type A influenza (99.33% were diagnosed as having influenza A/H1N1 2009 in Ibaraki Prefecture). We previously reported 23 patients that had been diagnosed as having influenza between August 16 and October 29, 2009 (first period).4) Between November 2, 2009 and January 31, 2010 (second period), 87 of 348 patients with influenza-like symptoms were diagnosed as having influenza and were subsequently evaluated. Results: Of the 87 patients diagnosed as having influenza, 86 were found to have influenza follicles during the initial evaluation. Rapid diagnostic testing was positive in 77 patients upon initial examination, 8 became positive on the second day, and 2 became positive on the third day. Even though no influenza follicles were found in 1 of the patients that had been diagnosed as having influenza, no follicles were found in any of the 261 patients that were diagnosed as not having influenza. The sensitivity of diagnosing influenza with influenza follicles was 87/88 = 98.8%, the specificity was 261/0 + 261=100%, the positive predictive value was 86/86 + 0 = 100%, the negative predictive value was 1/1 + 261 = 0.37%, LR + was (86/[86 +1] / (0/[0 + 261]) = ∞, and LR- was (1/[86 +1]) / (261/[0 + 261]) = 1.1%. Interobserver reliability was demonstrated by κ = 0.557 (p < 0.001). Conclusion: Determining the presence of “influenza follicles” provides higher sensitivity and specificity than rapid diagnostic tests and is promising as a clinical tool for worldwide use in a pandemic situation. Considering modern advances in technology, both the meaning and value of the physical examination require re-evaluation.
We developed a new method, the Micro Catheter (MC) Target Method, for running a guidewire through chronic total occlusion (CTO) of the coronary artery, and succeeded in achieving percutaneous coronary intervention in one case. The case was a male in his early 70’s, with CTO in the right coronary artery AHA segment 2-3. The antegrade MC (ASAHI Corsair) was put into the CTO in seg. 2 as a target, and the retrograde guidewire (ASAHI Gaia Second, a remarkably good torque-transmission guidewire) was advanced to the surface of the antegrade Corsair without difficulty. The Gaia Second was then advanced easily into the true lumen of proximal seg. 2 by sliding it on the extremely slippery surface of the Corsair. The MC target method is an easy way to run a guidewire through the CTO, and is considered as a valuable first-line approach before attempting reverse CART (controlled antegrade retrograde tracking).
The case was a 50-year-old woman who had been diagnosed as having ulcerative colitis 19 years ago. She had been successfully treated solely with administration of 5-ASA (5-Aminosalicylic acid) for 5 years but was suddenly complicated by perforation and toxic megacolon. Therefore, we performed emergency operation and were successful in saving her. Toxic megacolon frequently complicates perforation and it is very important to properly determinine the timing of operation because the mortality is high in cases complicated with perforation. There is the potential for cancer with chronic progression of ulcerative colitis. Accordingly we must carefully decide the timing and procedure for a possible secondary operation in the future.