When vitrectomy is performed in eyes that have undergone glaucoma surgery, the site of sclerotomy often overlaps with the previous glaucoma operation site. It can lead to serious complications such as postoperative hypotony, leakage, and/or infection. Our technique involves modification of surgeon's position and two sclerotomy sites 45° away from the original position, with an infusion cannula inserted infranasally to avoid damage to the glaucoma drainage implant or filtering bleb. The modified approach was applied to seven eyes with various indications. Vitrectomy was successfully completed, and there were no sclerotomy site complications, leakage, or hypotony in any case. Good intraocular pressure control was maintained throughout the postoperative course in all cases.
Blister* ; Catheters ; Filtering Surgery ; Glaucoma Drainage Implants* ; Glaucoma* ; Humans ; Intraocular Pressure ; Vitrectomy*

Intermittent pneumatic compression (IPC) device is an effective method to prevent deep vein thrombosis. This method has been known to be safe with very low rate of complications compared to medical thromboprophylaxis. Therefore, this modality has been used widely in patients who underwent a hip fracture surgery. We report a patient who developed extensive bullae, a potentially serious skin complication, beneath the leg sleeves during the use of IPC device after hip fracture surgery.
Aged, 80 and over ; Blister/*etiology/pathology ; Female ; Hip Fractures/*surgery ; Humans ; Intermittent Pneumatic Compression Devices/*adverse effects ; *Postoperative Complications ; Venous Thromboembolism/prevention & control

Giant bullae are large bullae occupying at least one-third of the hemithorax and surgical bullectomy is the treatment of choice. We report a case with symptomatic giant bullae which were resected successfully. A 35-year-old man presented with bilateral giant bullae that occupied almost the entire left hemithorax and a third of the right hemithorax. He was a current smoker with a 30 pack-year history and he presented with dyspnea on exertion. An elective surgical bullectomy was performed with video-assisted thoracoscopic surgery. The patient recovered without any adverse events and stayed well for 1 month after surgery.
Adult ; Blister ; Dyspnea ; Humans ; Pulmonary Emphysema ; Thoracic Surgery, Video-Assisted ; Young Adult*

Here, we report a large, overhanging cystic bleb that compromised vision and induced a foreign body sensation in a patient who underwent a trabeculectomy surgery with anti-metabolite therapy 4 years prior. Ultrasound biomicroscopy revealed multiple loculations with thin septa inside the bleb and a high risk of damage to the bleb was anticipated with a straight forward surgical excision. We injected autologous blood and placed a compression suture 6 weeks prior to surgical excision of the overhanging portion of the bleb. The operation was successful in preserving excellent bleb function, restoring visual acuity, and alleviating symptoms in our patient with up to 9 months of follow-up.
Blister/pathology/*surgery ; Blood Transfusion, Autologous/*methods ; Conjunctiva/pathology/surgery ; Glaucoma/*surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications/*surgery ; *Suture Techniques ; Trabeculectomy/*adverse effects

Here, we report a large, overhanging cystic bleb that compromised vision and induced a foreign body sensation in a patient who underwent a trabeculectomy surgery with anti-metabolite therapy 4 years prior. Ultrasound biomicroscopy revealed multiple loculations with thin septa inside the bleb and a high risk of damage to the bleb was anticipated with a straight forward surgical excision. We injected autologous blood and placed a compression suture 6 weeks prior to surgical excision of the overhanging portion of the bleb. The operation was successful in preserving excellent bleb function, restoring visual acuity, and alleviating symptoms in our patient with up to 9 months of follow-up.
Blister/pathology/*surgery ; Blood Transfusion, Autologous/*methods ; Conjunctiva/pathology/surgery ; Glaucoma/*surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications/*surgery ; *Suture Techniques ; Trabeculectomy/*adverse effects

OBJECTIVETo assess the feasibility and safety of thoracoscopic bulla resection under laryngeal mask anesthesia with low tidal volume high-frequency lung ventilation.

METHODSSixty patients with pulmonary bulla were randomized into two groups (n=30) to undergo video-assisted thoracoscopic surgery (VATS) for bulla resection with laryngeal mask anesthesia and high-frequency low tidal volume lung ventilation general anesthesia and or with intubation anesthesia and one-lung ventilation through double-lumen endotracheal intubation.

RESULTSNo significant differences were found in anesthesia time, surgery time, intraoperative lowest SpO2, intraoperative highest PetCO2, operative field, anesthetic effects, or blood loss between the two groups. The post-operative WBC and NEU% showed significantly smaller increments in the mask anesthesia group than in the intubation group, and the postoperative awake time, initial eating time, ambulation time, in-hospital stay, and drainage time were significantly shortened in the former group with also lower incidences of gastrointestinal reactions, throat discomfort and hoarseness.

CONCLUSIONThoracoscopic bulla resection under laryngeal mask anesthesia with low tidal volume high-frequency lung ventilation is safe and feasible and results in better patient satisfaction and shorter in-hospital stay than procedures performed under intubation anesthesia with one-lung ventilation.

Adolescent ; Adult ; Aged ; Anesthesia, General ; methods ; Blister ; Child ; Female ; High-Frequency Ventilation ; Humans ; Intubation, Intratracheal ; Laryngeal Masks ; Lung Diseases ; surgery ; Male ; Middle Aged ; One-Lung Ventilation ; Thoracic Surgery, Video-Assisted ; Young Adult

BACKGROUND: Chest tube drainage (CTD) is an indication for the treatment of pneumothorax, hemothroax and is used after a thoracic surgery. But, in the case of incomplete lung expansion, and/or persistent air leak from CTD, medical or surgical thoracoscopy or, if that is unavailable, limited thoracotomy, should be considered. We evaluate the efficacy of bronchoscopic injection of ethanolamine to control the persistent air leak in patients with CTD. METHODS: Patients who had persistent or prolonged air leak from CTD were included, consecutively. We directly injected 1.0 mL solution of 5% ethanolamine oleate into a subsegmental or its distal bronchus, where it is a probable air leakage site, 1 to 21 times using an injection needle through a fiberoptic bronchoscope. RESULTS: A total of 15 patients were enrolled; 14 cases of spontaneous pneumothorax [idiopathic 9, chronic obstructive pulmonary disease (COPD) 3, post-tuberculosis 2] and one case of empyema associated with broncho-pleural fistula. Of these, five were patients with persistent air leak from CTD, just after a surgical therapy, wedge resection with plication for blebs or bullae. With an ethanolamine injection therapy, 12 were successful but three (idiopathic, COPD and post-tuberculosis) failed, and were followed by a surgery (2 cases) or pleurodesis (1 case). Some adverse reactions, such as fever, chest pain and increased radiographic opacities occurred transiently, but resolved without any further events. With success, the time from the procedure to discharge was about 3 days (median). CONCLUSION: Bronchoscopic ethanolamine injection therapy may be partially useful in controlling air leakage, and reducing the hospital stay in patients with persistent air leak from CTD.
Blister ; Bronchi ; Bronchoscopy ; Chest Pain ; Chest Tubes ; Drainage ; Empyema ; Ethanolamine ; Fever ; Fistula ; Humans ; Length of Stay ; Lung ; Needles ; Oleic Acid ; Oleic Acids ; Pleurodesis ; Pneumothorax ; Pulmonary Disease, Chronic Obstructive ; Thoracic Surgery ; Thoracoscopy ; Thoracotomy ; Thorax

PURPOSE: To compare the histopathologic and morphologic findings of encapsulated blebs following Ahmed glaucoma valve implantation and primary standard trabeculectomy with mitomycin-C. METHODS: We reviewed the records of patients with otherwise uncontrollable glaucoma who had undergone Ahmed glaucoma valve implantation or trabeculectomy with mitomycin-C. Five eyes that underwent Ahmed valve implantation and three eyes that underwent trabeculectomy needed surgical revision of the initial surgery due to encapsulated bleb development with total loss of function. The surgically removed encapsulated blebs were analyzed macroscopically and microscopically. RESULTS: Removal of the encapsulated bleb was performed at a mean follow-up time of 26.6 +/- 19.4 weeks in the Ahmed valve implantation group and 12.0 +/- 11.4 weeks in the trabeculectomy group. The fibrotic wall of the encapsulated blebs had an overall thickness of 2.48 +/- 0.42 mm in the Ahmed valve implantation group and 1.62 +/- 0.37 mm in the trabeculectomy group. Macroscopically, the coconut flesh-like smooth surface was split into two layers, and the wall of the capsule was thicker in the Ahmed valve implantation group than in the trabeculectomy group. Histopathologically, the fibrotic capsule was composed of an inner fibrodegenerative layer and an outer fibrovascular layer, and there were no histopathological differences between the two groups. CONCLUSIONS: The fibrotic capsule wall was thicker in the Ahmed valve group, but there were no differences in histological findings between the two groups.
Adult ; Blister/*surgery ; Female ; Glaucoma/physiopathology/*surgery ; *Glaucoma Drainage Implants ; Humans ; Infant ; Male ; Middle Aged ; Mitomycin/*therapeutic use ; Nucleic Acid Synthesis Inhibitors/*therapeutic use ; Reoperation ; *Trabeculectomy ; Treatment Outcome

Abdominoplasty may be applied to achieve aesthetic outcome and it also can be combined with other surgeries. In addition, liposuction has been offered to patients to improve contour. Liposuction combined with abdominoplasty gives us the advantage of higher patient satisfaction, better aesthetic outcome, and one-staged surgery. The authors performed a retrospective study to evaluate the outcomes. A total of 6 patients who underwent lipoabdominoplasty were included. The patients were all female and the mean age of the patients was 50.5 years old(age range, 32 to 58 years). This study surveyed lipoabdominoplasty based on the purpose of operation, type of suture, and application of quilting suture. Complication rates, patient satisfaction, and postoperative contour of the abdomen were questioned. A mild abdominal complication occurred in one patient, flap bullae, but this was healed within a week and overall flap survival was excellent with good satisfactory outcome. It appears that complication rates of simple lipoabdominoplasty group is low(1/6), and only minor complication occurs. Preservation of perforators during liposuction accounts for improved flap survival. In addition, abdominoplasty may be combined with other abdominal surgeries since other abdominal surgeries usually involve the lower abdomen, which will eventually be cut away curing the abdominoplasty stage.
Abdomen ; Abdominal Wall ; Abdominoplasty ; Adipose Tissue ; Blister ; Female ; Humans ; Imidazoles ; Lipectomy ; Nitro Compounds ; Patient Satisfaction ; Retrospective Studies ; Surgery, Plastic ; Sutures

PURPOSE: Pemphigus vulgaris, a rare autoimmune blistering disease of the skin and mucous membranes remains a challenging disease to treat. Management is focused on immunotherapy against autoimmune antibodies that target keratinocyte cell adhesion molecules, and antibiotics preventing secondary infections. There is no established dressing protocol and skin is usually manipulated the least amount possible in order to minimize irritation. The authors suggest that early initiation of aggressive bathing and debridement of skin lesions, with nutritional support, is essential in accelerating resolution. METHODS: A 40 year-old male previously diagnosed with pemphigus vulgaris was admitted due to exacerbation of mucocutaneous lesions involving the epidermis and mucosa of the whole body. Steroids, immunosuppressants, intravenous immunoglobulin and antibiotics were administrated, but infection and de-epithelialization progressed, while his general condition deteriorated with a weight loss of over 20 kilograms. The plastic surgery department intervened with daily bathing, debridement of unhealthy debris and non-traumatizing coverage of growing epithelium. Total parenteral nutrition and mobilization with rehabilitation therapy was initiated as early as possible. RESULTS: After bathing, healthy epithelium gradually covered the patient's entire body, while his general condition improved with a corresponding weight gain of 14 kgs. CONCLUSION: Treatment of pemphigus vulgaris focuses on immunotherapy and infection control. However, an equal amount of attention should be laid on early intervention with daily dressings including bathing and irrigation, nutritional support, and exercise as this accelerates resolution of existing infections, promotes healthy epithelialization and leads to faster recovery.
Anti-Bacterial Agents ; Antibodies ; Bandages ; Baths ; Blister ; Cell Adhesion Molecules ; Coinfection ; Debridement ; Early Intervention (Education) ; Epidermis ; Epithelium ; Humans ; Immunoglobulins ; Immunosuppressive Agents ; Immunotherapy ; Infection Control ; Keratinocytes ; Male ; Mucous Membrane ; Nutritional Support ; Parenteral Nutrition, Total ; Pemphigus ; Skin ; Steroids ; Surgery, Plastic ; Weight Gain ; Weight Loss