Objective To evaluate the anatomical and functional results of retinotomy in treatment of complicated retinal detachment. Methods Twenty three eyes were treated with retinectomy during vitrectomy for complicated retinal detachment with proliferative vitreoretinopathy when complete reattachment of retina was not obtained despite careful mambrane peeling. After released the peripheral vitreoretinal contraction or pulled subretinal membranes, perfluorocarbon liquid injection, laser retinopexy and silicone oil tamponade were performed. Retinotomy size ranged from 30 degree to 360 degree (average 132 degree). Results Retinal attachment were obtained in all of the operated eyes at the end of the operation. Silicone oil was removed from 15 eyes (65.0%) within 3～11 months postoperatively. After a minimum follow up of 6 months, the retinae were completely attached in 17 eyes ( silicone oil was not removed in 4 eyes ) and visual acuity of 0.02 or better was obtained in 11 eye (48.0%). Recurrent retinal detachment occurred in 2 eyes in which the silicone oil had been removed. The major complications were recurrence of the proliferation in 6 eyes (26.0%) and hypotony in 3 eyes (13.0%). Conclusion Retinotomy is beneficial to reattach the retina for eyes with advanced proliferative vitreoretinopathy in seemingly inoperable cases.

BACKGROUND: The patients with severe spleen rupture can save their spleen functions by auto-transplantation of the spleen tissues in the greater omentum. Whether the transplanted spleen tissues are regulated by nerves or not is still unclear. The growth associated protein, GAP-43, is a specific protein of the nervous system, and by testing the GAP-43 in the transplanted spleen tissues, nerve regeneration can be understood.OBJECTIVE: To study the mRNA expression of the GAP-43 in the regenerated spleen tissues at different phases after the auto-transplantation of the spleen tissues, and to find the regeneration regularity of the GAP-43 + nerves in the auto-transplanted spleen tissues.DESIGN: A randomized and controlled experiment SETTING: A teaching and research office of the surgical applied anatomy and operative surgery department in a university MATERIALS: The study was done in the Surgical Applied Anatomy and Operative Surgery Department of the Third Military Medical University of Chinese PLA from September 2002 to July 2003. A total of 120 Wistar mice were chosen. The mice were randomly divided into the experiment group and pseudo-operation group(control group) to make animal models. After the operation, mice of the two groups were fed under the same circumstances. The spleen tissues were respectively taken at the 15th, 30th, 60th,90th, 120th and 180th days after the operation for the study.METHODS: The general RNA was extracted from the tissues using the Tripure agent by the routine method. The general RNA was reverse transcribed into cDNA using the M-MLV reverse transcription kit. The mRNA of the GAP-43 was quantitatively measured using the gel pattern analysis.tern analysis.RESULTS: Totally 30 days after the transplantation of the spleen tissues, the mRNA of the GAP-43 was found to be expressed in the auto-transplanted spleen tissues. Ninety days after the operation, the expression reached the peak level. Totally 120 to 180 days after the operation the amount of the mRNA of the GAP-43 in the transplanted spleen tissues gradually got close to that in the normal spleen tissues.CONCLUSION: The expression of mRNA of the GAP-43 in the auto-transplanted spleen tissues suggests the regeneration of the nervous fiber in the transplanted spleen tissues.

The treatment of vesicovaginal fistula after radiotherapy is difficult. Surgical repair is challenging and the success rate is low. The gracilis flap is widely used in the repair surgery of the perineal region, while it is rarely reported for the repair of vesicovaginal fistula domestically. This article reports a case of vesicovaginal fistula after radiotherapy treated with gracilis flap tamponade. The patient was admitted to the hospital because of continuous vaginal leakage of urine for more than 3 years. Digital vaginal examination and urethroscopy showed that a fistula with a diameter of about 3 cm located at the bladder triangle leading to the vagina. The patient had history of cervical cancer surgery and 23 times of postoperative adjuvant radiotherapy. She underwent vesicovaginal fistula repair with gracilis muscle flap. The urethral catheter was removed 3 weeks after the operation. The patient could urinate normally without vaginal leakage. After 10 months of follow-up, there was no vaginal leakage of urine and patient remains continent.