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PURPOSE: To report clinical, pathological, and laboratory analyses of two cases of single-piece hydrophobic acrylic intraocular lenses (IOLs), which presented with significant surface deposits during implantation. METHODS: The lenses were implanted with the manufacturer's recommended injector (loaded with Viscoat and Healon GV, respectively). Immediately after injection into the anterior chamber, areas on the lenses' surfaces were covered by deposits, which could not be entirely removed by irrigation/aspiration. The lenses were explanted and replaced with lenses of the same design. They underwent gross analyses, light microscopy, scanning electron microscopy, and energy dispersive X-ray spectroscopy for analysis of the elemental composition of the deposits. Liquid chromatography/mass spectroscopy was also performed to identify the presence of proteins. RESULTS: The deposits on the first lens had a granular appearance, forming a homogeneous layer mostly on the posterior lens surface. Larger crystal-like deposits were present mostly on the anterior surface of the second lens. Elemental analyses of the deposits in both cases revealed the presence of peaks of sodium, chloride, phosphate, and potassium, in addition to the peaks of carbon and oxygen (normal constituents of the lens material). Only protein components normally found in the anterior chamber during surgery, such as haemoglobin and albumin, were identified. CONCLUSIONS: The results obtained suggest that the deposits in both cases may have resulted from crystallization of the ophthalmic viscosurgical device normally used during the loading of the IOLs into the cartridges.

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With advances in the treatment of hydrocephalus, patients with ventriculoperitoneal shunts (VPS) often have normal life expectancies. They are therefore more commonly requiring abdominal surgery. Laparoscopic surgery has become the favored technique for performing many of these operations. However, the presence of a VPS has been considered a contraindication or hazard in performing many of these laparoscopic operations. We present a case report of a laparoscopic Toupet fundoplication in a patient with a VPS and describe a technique for the successful management of the VPS throughout the procedure with no adverse sequelae.

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The influence of diabetes on the risks associated with the operative treatment of acute cholecystitis has not been clearly defined. Therefore, a case-control study of 72 diabetics requiring urgent operation for acute cholecystitis was undertaken. Patients were matched for age, gender, and date of surgery with nondiabetic controls. Review of patient records revealed no significant difference in hospital stay or severity of operative and pathologic findings. However, diabetics suffered significantly more morbidity (38.9%) than nondiabetics (20.8%). Moreover, diabetic infection-related complications occurred at a rate nearly three times that of controls (19.4% vs 6.9%). The only mortalities were experienced by diabetics (4.2%) and were the direct result of the effects of sepsis. These findings suggest that acute cholecystitis in diabetics is associated with a higher incidence of infection-related complications and supports the need for expeditious operative therapy in symptomatic patients.

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To determine if cholecystectomy predisposes to colon cancer, & study of this operation's influence on chemically induced murine colonic neoplasia was conducted. One hundred mice underwent cholecystectomy or a sham operation. Equal groups received either ten weekly injections of 1,2-dimethylhydrazine (DMH) or injections of saline. Twenty-four weeks after operation, the site, histologic findings, and number of tumors were noted. Crypt metaphase index (CMI) and proliferative zone size (PZS) determinations served as markers of preneoplasia. Tumors were found in the majority of animals receiving DMH while no tumors were found in the saline groups. Both CMI and PZS were significantly increased by DMH administration. Within the saline group, cholecystectomy increased CMI and PZS two and three times, respectively, over levels seen in the sham-operated animals. This suggests that cholecystectomy alone induces preneoplastic changes in the murine colonic crypt.

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The chemical dissolution of gallstones cannot be accurately predicted since available biliary studies often do not distinguish stone types. To elucidate the predictive value of computed tomography (CT), 65 gallstones were studied in vitro. Thirty stones were analyzed by both CT and infrared spectroscopy. The CT number (Hounsfield unit [HU]) was significantly different for cholesterol and pigment stones (-87.3 +/- 14.5 vs 162 +/- 27.6 HU) and demonstrated a linear correlation with cholesterol content. Another 35 gallstones were tested for dissolution in a 200 mM chenodeoxycholate solution after CT analysis. Thirteen stones (50%) with CT values less than 50 HU completely dissolved in three weeks, whereas none of the stones with CT numbers greater than 50 HU dissolved. These findings suggest that the CT analysis of gallstones allows accurate gallstone classification and is useful in predicting solubility.

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