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PurposeTo report a case of corneal neovascularization misdiagnosed as total limbal stem cell deficiency (LSCD).MethodsThis is a case report of a 61-year-old woman who has a history of bilateral idiopathic scleritis, keratitis, and uveitis for more than 20 years. She was diagnosed with total LSCD in her left eye based on clinical presentation alone and was confirmed as a candidate for limbal transplantation at several major tertiary eye care centers in the United States. After referral to the Stein Eye Institute, in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) were performed to clarify the diagnosis.ResultsSlit-lamp examination of the left eye revealed 360-degree severe thinning at the limbus and peripheral corneal pannus and neovascularization that spared the central cornea, a smooth epithelium without fluorescein staining at the central cornea, an uneven surface, and pooling of fluorescein at the peripheral cornea accompanied by minimal fluorescein staining of the sectoral peripheral epithelium. IVCM showed that epithelial cells in the central cornea exhibited a corneal phenotype and that the morphology of the epithelium in all limbal regions except the nasal limbus was normal. Epithelial cellular density and thickness were within the normal range. AS-OCT showed severe thinning in the limbus and a normal epithelial layer in the cornea and limbus. Based on the findings of IVCM and AS-OCT, we concluded that the patient had minimal LSCD, and limbal stem cell transplantation was not recommended.ConclusionsClinical presentation alone is insufficient to correctly diagnose LSCD in complex cases. Additional diagnostic tests, such as IVCM, are necessary to confirm the diagnosis before any surgical intervention.

Prosthetic heart valve (PHV) dysfunction remains difficult to recognise correctly by two-dimensional (2D) transthoracic and transoesophageal echocardiography (TTE/TEE). ECG-triggered multidetector-row computed tomography (MDCT), 18-fluorine-fluorodesoxyglucose positron emission tomography including low-dose CT (FDG-PET) and three-dimensional transoesophageal echocardiography (3D-TEE) may have additional value. This paper reviews the role of these novel imaging tools in the field of PHV obstruction and endocarditis. For acquired PHV obstruction, MDCT is of additional value in mechanical PHVs to differentiate pannus from thrombus as well as to dynamically study leaflet motion and opening/closing angles. For biological PHV obstruction, additional imaging is not beneficial as it does not change patient management. When performed on top of 2D-TTE/TEE, MDCT has additional value for the detection of both vegetations and pseudoaneurysms/abscesses in PHV endocarditis. FDG-PET has no complementary value for the detection of vegetations; however, it appears more sensitive in the early detection of pseudoaneurysms/ abscesses. Furthermore, FDG-PET enables the detection of metastatic and primary extra-cardiac inf

У хворих на ревматоїдний артрит із високим рівнем ангіотензину ІІ у крові при УЗД суглобів частіше зустрічалися випіт у порожнину суглоба, наявність гіперваскуляризації синовіальної оболонки з оцінкою 2–3 бали та наявність тендосиновітів, що характеризують запально-ексудативні процеси. У хворих з високим рівнем альдостерону в крові переважали гіперплазія синовії, наявність панусу та кістково-хрящові ерозії, що характеризують проліферативно-деструктивні процеси. Встановлені взаємозв’язки: зростання рівня ангіотензину ІІ у крові збільшує інтенсивність васкуляризації синовіальної оболонки та випіт у порожнину суглоба; збільшення концентрації альдостерону в крові впливає на показники товщини синовії, наявність панусу та кількість ерозій у суглобах., У больных ревматоидным артритом с высоким уровнем ангиотензина II в крови при УЗИ суставов чаще определяется выпот в полость сустава, наличие гиперваскуляризации синовиальной оболочки с оценкой 2–3 балла и наличие тендосиновитов, характеризующих воспалительно-экссудативные процессы. У больных с высоким уровнем альдостерона преобладали гиперплазия синовии, наличие паннуса и костно-хрящевые эрозии, характеризующие пролиферативно-деструктивные процессы. Выявленные корреляции показывают, что с ростом уровня ангиотензина II в крови нарастает интенсивность васкуляризации синовиальной оболочки, выпота в полость сустава, а увеличение концентрации альдостерона в крови влияет на показатели толщины синовии, наличие паннуса и количество костных эрозий., In patients with rheumatoid arthritis and high level of angiotensin II in the blood at ultrasound of joints there are often being detected effusion in the joint cavity, hypervascularization of synovium with 2–3 points and tenosynovitis characterizing inflammatory exudative processes. In patients with high level of aldosterone, hyperplasia of synovium, presence of pannus and bone and cartilage erosions, indicating proliferative-destructive processes, were predominated. Identified correlations show that with increasing levels of angiotensin II in the blood increases the intensity of the vascularization of the synovial membrane, joint effusion, and an increase in the concentration of aldosterone in the blood affects the synovial thickness indicators, the presence of pannus and bone erosions amount.

Grading osteoarthritic tissue has, until now, been a laboratory process confined to research activities. This thesis establishes a scientific protocol that extends osteoarthritic tissue ranking to surgical practice. The innovative protocol, which now incorporates the structural degeneration of collagen, enhances the traditional Modified Mankin ranking system, enabling its application to real time decision during surgery. Because it is fast and without time consuming laboratory process, it would potentially enable the cataloguing of tissues in osteoarthritic joints in all compartments of diseased joints during surgery for epistemological study and insight into the manifestation of osteoarthritis across age, gender, occupation, physical activities and race.

Prevalence of morbid obesity is rising. Along with it, the adipose associated co-morbidities increase - included panniculus morbidus, the end stage of obesity of the abdominal wall. In the course of time panniculus often develop a herniation of bowel. An incarcerated hernia and acute exacerbation of a chronic inflammation of the panniculus must be treated immediately and presents a surgical challenge. The resection of such massive abdominal panniculus presents several technical problems to the surgeon. Preparation of long standing or fixed hernias may require demanding adhesiolysis. The wound created is huge and difficult to manage, and accompanied by considerable complications at the outset. We provide a comprehensive overview of a possible approach for panniculectomy and hernia repair and overlook of the existing literature., Mit der weltweiten Zunahme der Adipositas haben insbesondere auch die Patienten in ihrer Anzahl zugenommen, die eine Adipositas Grad III (BMI >=40 kg/m2) aufweisen.Neben den bekannten adipositas-assoziierten Co-Morbiditäten werden Chirurgen dabei mit Patienten konfrontiert, die einen massiven Pannus aufweisen, der neben dem hohen Gewicht auch zu lebensbedrohlichen Komplikationen führen kann (inkarzerierte Bauchwandhernien, rezidivierende Infektionen im Fettgewebe). Eine in den Pannus inkarzerierte Hernie sowie eine schwere akute Exazerbation einer chronischen Entzündung bedürfen einer umgehenden chirurgischen Therapie und stellen eine chirurgische Herausforderung dar. Diese Arbeit möchte eine Einführung in den Umgang mit einem Pannus und den daraus resultierenden Komplikationen aufzeigen, die peri- und intraoperativ besondere Anforderungen an die behandelnden Therapeuten stellen. Weiterhin soll ein kurzer Überblick über die Literatur gegeben werden.

Complications of any mechanical prosthesis include thrombus or pannus formation. In our case report we demonstrate that prosthetic aortic valve regurgitation due to pannus formation may be intermittent and non-cyclic in pattern and therefore not obvious at the time of original clinical examination. Under these conditions and as transesophageal echocardiography cannot be repeated promptly, transthoracic 2-D and Doppler echocardiography should be available at any time when symptoms occur and present the method of choice for acute patient evaluation. Thrombolysis seems to be the first treatment of choice in case of thrombus formation and re-do surgery in case of pannus formation.