1/15. Severe penetrating ocular injury from ninja stars in two children.The authors describe two cases of penetrating ocular trauma in children resulting from ninja stars. In the first case, despite a scleral laceration, loss of iris tissue, and a vitreous hemorrhage, the child had a good result with a final best corrected visual acuity of 20/20. Unfortunately, the child in the second case did not fare as well. In this case, the child suffered a large corneal laceration and traumatic cataract. He ultimately required a penetrating keratoplasty, and he is currently being treated for amblyopia, strabismus, and elevated intraocular pressures. His best corrected visual acuity is 20/70.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/15. iris prolapse at the surgical site: a late complication of nonpenetrating deep sclerectomy.To investigate the occurrence and management of late-onset iris prolapse through the surgical wound after nonpenetrating deep sclerectomy. Two cases of iris prolapse that presented 8 and 10 months, respectively, after surgery for glaucoma were reviewed. One of the cases was associated with mild trauma. The postoperative follow-up was 5 and 24 months, respectively. The iris tissue bulge did not progress and there were no other complications. The visual acuity was not affected and the intraocular pressure was controlled with medical therapy. These cases demonstrate that the eye is weaker than normal at the surgical site after nonpenetrating deep sclerectomy, allowing iris protrusion. iris prolapse should be added to the list of late postoperative complications of nonpenetrating deep sclerectomy.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/15. Double trouble: prolapsing epiglottis and unexpected dual pathology in an infant.A 3-week-old full-term female neonate was admitted with a 4-day history of episodic stridor, desaturations and difficult feeding. Initial assessment using fluoroscopy suggested distal tracheomalacia. Inhalational induction for examination under anaesthesia of the upper airway at 4 weeks of age caused almost complete airway obstruction due to severe anterior, or epiglottic, laryngomalacia. This airway obstruction was unresponsive to continuous positive airway pressure, the use of an oropharyngeal airway and hand ventilation and required urgent tracheal intubation using suxamethonium. Epiglottopexy, a relatively unknown procedure, was performed uneventfully 2 days later, with complete relief of the respiratory compromise. However, the infant remained desaturated postoperatively. A ventilation perfusion scan subsequently revealed multiple pulmonary arteriovenous malformations, unsuitable for embolization and requiring nocturnal home oxygen therapy. review at 3 months of age found a thriving infant with no airway obstruction and good epiglottic positioning on examination under anaesthesia. Although the patient's oxygen requirements had diminished, the long-term outcome remains uncertain.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/15. Complications of neodymium:YAG laser goniopuncture after deep sclerectomy.PURPOSE: To study the complications of neodymium:YAG (Nd:YAG) goniopuncture after deep sclerectomy with collagen implant (DSCI). methods: All patients who underwent a Nd:YAG goniopuncture after a successful DSCI for primary open-angle glaucoma were included in a non-randomized clinical study. RESULTS: Nd:YAG goniopuncture was performed in 31 patients. The mean time from surgery to goniopuncture was 3.2 /- 3.2 months. The mean intraocular pressure (IOP) before goniopuncture was 32.0 /- 10.8 mmHg (SD); the mean IOP 1-2 hours after goniopuncture was 16.5 /- 6.3 mmHg. After a mean follow-up of 5.4 /- 2.8 months, the mean IOP was 17.8 /- 11.6 mmHg. Three patients had a spontaneous iris prolapse after Nd:YAG goniopuncture and consequently high IOP. No signs of severe hypotension were observed. CONCLUSION: There are potentially serious complications relating to Nd:YAG goniopuncture after deep sclerectomy. However, further studies are needed to determine the safest time and level of IOP at which to perform Nd:YAG goniopuncture.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/15. Fibrocartilaginous embolism--an uncommon cause of spinal cord infarction: a case report and review of the literature.Fibrocartilaginous embolism is a rare cause of spinal cord infarction. It is postulated that an acute vertical disk herniation of the nucleus pulposus material can lead to spinal cord infarction by a retrograde embolization to the central artery. An increased intradiskal pressure resulting from axial loading of the vertebral column with a concomitant valsalva maneuver is thought to be the initiating event for the embolus. We present a previously healthy 16-year-old boy with sudden onset of back pain and progressive paraparesis within 36 hours after lifting exercises in a squat position. His clinical presentation and neuroimaging studies were consistent with spinal cord infarction resulting from a central artery embolus at the T8 spinal cord level. Laboratory investigation showed no evidence of infectious, autoimmune, inflammatory, or neoplastic causes. Although no histologic confirmation was obtained, lack of evidence for other plausible diagnoses in the setting of his clinical presentation and in the magnetic resonance imaging findings made fibrocartilaginous embolism myelopathy the most likely diagnosis. We postulated that some cases of transverse myelitis might actually be fibrocartilaginous embolism, making it a more prevalent cause of an acute myelopathy than commonly recognized. Relevant literature and current theories regarding the pathogenesis of fibrocartilaginous embolism myelopathy are reviewed.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/15. Gastroesophageal intussusception: a new cause of acute esophageal obstruction in children.Gastrointestinal intussusception with obstruction is common in the small bowel and colon; however, such a process is not known to cause esophageal obstruction. Recent experience with gastroesophageal intussusception permits discussion of diagnosis and consideration of treatment options. A 3-year-old child presented with acute esophageal obstruction. physical examination was significant for epigastric tenderness and excessive salivation. Chest x-ray showed a posterior mediastinal fullness. Esophagram documented a smooth crescent-filling defect, which caused obstruction of the esophagus at the level of the carina with proximal esophageal dilatation. Chest computed tomography of the thorax showed a soft tissue mass of the distal esophagus. esophagoscopy confirmed occlusion of the midesophagus with the mucosa intact. A right thoracotomy permitted visualization of dilated proximal esophagus and a palpation of an intraluminal mass in the distal esophagus. Mobilization of the distal esophagus and gentle manual pressure cleared the obstruction to a point below the diaphragm. After a normal intraoperative esophagram, final treatment consisted of a longitudinal esophagomyotomy. The child recovered without complication and continues without recurrence for 18 months. This is the first report of gastroesophageal intussusception in children. Management by thoracotomy, manual reduction, and esophageal myotomy reestablished intestinal continuity and appears to eliminate recurrence; fundoplication or gastropexy may be alternative options. Preoperative recognition of gastroesophageal intussusception may allow nonoperative reduction or treatment by minimally invasive surgery.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/15. Lacrimal gland prolapse in craniosynostosis syndromes and poor function congenital ptosis.Lacrimal gland prolapse is an important, though uncommon, feature found in craniofacial abnormalities as well as in cases of poor function congenital ptosis. It occurs secondary to a number of conditions, including increased posterior pressure secondary to decreased orbital volume; also, supportive structures of the gland often may be weak in conjunction with a poor function ptosis or as a result of trauma at the time of major reconstruction. Recognition of the prolapsed gland and its replacement into the lacrimal gland fossa in craniosynostosis syndromes, as well as in cases of poor function congenital ptosis in general, allows the temporal eyelid to approach a more normal position, yielding an improved functional and cosmetic result.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/15. umbilical cord prolapse: a true obstetrical emergency.The case of a 23-year-old woman with umbilical cord prolapse and fetal distress is described. This serious obstetrical complication is unfamiliar to many emergency physicians although it represents an acute emergency with high mortality. Appropriate prehospital, emergency department, and obstetrical suite care is discussed including a bladder-filling technique and tocolysis that can buy valuable time by temporarily relieving pressure on the cord.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/15. Spontaneous rupture of the distal colon with evisceration of small intestine through the anus: report of two cases and review of the literature.Two cases of evisceration of the small intestine through a spontaneous perforation of the distal large bowel are presented, and the literature is reviewed. The condition is associated with a sudden increase in intra-abdominal pressure and a past history of rectal prolapse. The etiology and management of this problem are discussed.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/15. Medical treatment of urethral prolapse in children.Urethral prolapse denotes the complete circular eversion of the urethral mucosa through the external meatus. Two different entities exist: premenarcheal and menopausal urethral prolapse. Premenarcheal prolapse is predominantly asymptomatic and is usually brought to medical attention by vaginal bleeding. Trauma and medical conditions predisposing a patient to increased abdominal pressure are associated with prolapse in children. The menopausal group seeks medical attention primary because of the severity of urinary symptoms, ie, nocturia, urgency, tenesmus, dysuria, and frequency. Therapy for both groups has been traditionally accomplished by surgical manipulation-excision, surgical ligation, cautery, fulguration, and cryosurgery. The authors treated 5 premenarcheal female children with antibiotics, estrogen cream, and sitz baths for 2 weeks. In all the patients prolapse was resolved. The results, with follow-up for 4 to 12 months without recurrence, suggest that urethral prolapse in children can be managed without surgical intervention.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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