Polypoid fragment lined with nonkeratinized squamous epithelium with an atypical lymphoid infiltrate with nodular pattern (A, HE 2×). The atypical lymphoid cells are variable in size with small to medium centrocyte-like cells admixed with scattered larger centroblast-like cells. Single cell necrosis and mitotic figures are noted (B, HE 40×). The atypical cells are B cells that express strong CD20, CD10, and BCL6 as well as uniform BCL2. Fewer CD3+ T cells are noted surrounding the nodular areas. The CD21 staining highlights expanded and disrupted follicular dendritic cell meshwork consistent with atypical follicles. The proliferation index of the B cells (Ki-67) is moderate, approximately 60%. DNA PCR analysis using BIOMED2 immunoglobulin heavy chain gene consensus primers confirmed the presence of a clonal B-cell population
I describe a simple technique for performing capsulorhexis without viscoelastic material or expensive instruments. A slightly barbed, bent, 30-gauge needle is used to directly puncture clear cornea and create a capsulorhexis without the need for a groove or stab incision. Hydrodissection is carried out with the attached 1 cc syringe (tuberculin) filled with a balanced salt solution. Hydrodissection, hydrodelineation, and mobilization of the nucleus can be carried out before the eye is entered with a blade. With direct puncture, the technique is immune to the effects of high intraocular pressure and a shallow anterior chamber. The Technique is ideally suited for bimanual microincision phacoemulsification.
Capsulorhexis is becoming the favored technique for performing anterior capsulectomy. This report describes a simple method for performing capsulorhexis and nuclear hydrodissection without the use of viscoelastics or specialized instruments.
* BACKGROUND AND OBJECTIVE: The appropriate surgical treatment for the enormous number of patients in developing nations who are blind due to cataract is a hody debated issue. The authors' objective is to demonstrate that modern surgical techniques (extracapsular cataract extraction and intraocular lens implantation, phacoemulsification and intraocular lens implantation) can be performed in a high-volume, costeffective manner, even in temporary settings. The authors believe that the approach to cataract blindness is not simple intracapsular cataract extraction, but rather the challenge of (1) training all ophthalmic personnel in modern techniques (microsurgery, biometry), (2) training managers in higher levels of organizational skill, and (3) doing these things in the face of limited resources. * PATIENTS AND METHODS: A total of 1298 surgeries were performed in a public eye camp in Ganeshpuri, India (50 miles north of Bombay). Of these, 1214 (93.5%) of the patients received intraocular lens (IOL) implants. Ninety-three percent (1032/1 108) of the patients who underwent extracapsular cataract extraction (ECCE) and IOL implantation and 89% (83/93) of the patients who underwent phacoemulsification and IOL implantation returned for follow-up. * RESULTS: Postoperatively, 48% (498/1032) of the patients who underwent ECCE and IOL implantation achieved corrected vision of 6/12 or better and 65% (671/1032) attained corrected vision of 6/ 1 8 or better. Of the patients who underwent phacoemulsification and IOL implantation, 59 of 83 (71%) attained vision of 6/12 or better with correction and 68 of 83 (79%) achieved vision of 6/18 or better with correction. These results are almost identical to those obtained by the authors in their Ganeshpuri 1991 camp. Surgical complication rates were comparable to those reported in hospitalbased studies. * CONCLUSION: For this type of camp to operate efficiently, there must be standardization of skills among ophthalmic personnel, costs must be contained, and the organizational skills necessary to ensure smooth functioning of the camp must exist. However, on the basis of their data, these authors believe that with suitable organizational and surgical facilities, IOL implantation can be successfully performed in high-volume surgical eye camps. [Ophthalmic Surg Lasers 1996;27:200-208.]
Where an obstetrician attempts a forceps delivery on the labour ward, rather than as a 'Trial of Instrumental Delivery' in theatre with the mother fully prepared for Caesarean section, he will have the burden of justifying his actions where he fails to deliver the baby, precipitates an acute bradycardia and is unable to deliver by Caesarean section before permanent brain damage ensues. The Bolitho test will apply to experts judging the question: was the Obstetrician's decision defensible having regard to the comparative risks and benefits? See Kingsberry [2005] EWHC (QB) 2253. Even where an obstetrician correctly decides to carry out a Trial of Operative Delivery, in theatre, he must not delay unreasonably in converting to Caesarean section when an acute bradycardia is precipitated. He should bear in mind the '10-minute rule': Purver v Winchester & Eastleigh NHS Trust [2007] LS Law Med 193.
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