Steps of small incision cataract surgery (SICS)

SICS also known as small incision cataract surgery, is a popular method of cataract extraction in under developed country. Every year through the world many people suffer from cataract. Many of them are from under developed country. SICS is a solution for them as because this method of cataract extraction is very cheap. The steps of cataract extraction and posterior chamber intra ocular lens implantation are as below;

a)     Superior rectus suture is passed to fix the eye in downward gaze

b)    Conjunctival flap and exposure of sclera

c)     Homeostasis is achieved by applying gentle and just adequate field cautery

d)    Sclero corneal tunnel incision

SICS

e)     Side port entry of about 1.5mm valvular corneal incision is made at 9 o’ clock position

f)      Anterior capsulotomy

g)     Hydrodissection

h)    Nuclear management – Prolapse and delivery of the nucleus outside

i)       Aspiration of the cortex

j)       IOL (Intra Ocular Lens ) implantation

k)    Removal of the viscoelastic material

l)       Wound closure

Hepato Renal Syndrome

Hepato Renal Syndrome:

Hepato Renal syndrome is a severe condition usually occurring in chronic liver disease patient. Actually Hepato Renal syndrome occurs at the very end stage of chronic liver disease and the mortality rate of the patients, when hepato renal syndrome developed is very high. In short we can describe hepato renal syndrome as detoriation of the renal function at the late statage of chronic liver disease or fulminant liver failure.

Mechanism of Hepato Renal Syndrome (HRS) development:

The actual mechanism of the development of hepato renal syndrome is not so clear. It is thought that multiple factors play role inn the development of hepato renall syndrome. Constriction of the renal blood veasels is the main of them. Why the constriction of the renal blood vessels occur? The answer is not so clear. It is believed that activation of systemic vaso constrictor agents and the inactivation of the systemic vaso dilator agents are responsible for this. Though the renal blood vessels are constricted, there are no changes are seen in renal parenchyma.

The histological findings of the renal parenchyma appears to be normal where the histological picture of liver shows total loss of normal architecture.
In hepato renal syndrome there is a complete inverse relationship is seen between renal plasma flow and glomerular filtration rate. Though renal plasma flow is decreased, Glomerular filtration rate is still increasing. This is may be due to a very minimal and microscopic damage to glomerular basement membrane.

Open fracture and gustillo classification

Fracture: Fracture may be defined as a breach in the natural structure of a bone or a cartilage. Fracture is grossly classified into two major catagories, named open fracture and closed fracture. 

An Open Fracture 

Classification of Open Fracture 

Open fracture is one where the fracture fragments come in contact with the external environment. And close fracture is one where the fracture fragments do not come in contact with the external environment. A close fracture is better than an open fracture. An open fracture is dangerous because the chance off infection is more here. And this infection can result in ostiomyelitis or delayed unnion or malunion or non union.

All the open fractures are not equally dangerous. To know, how much dangerous an open fracture is, you have to know the gustillo open fracture classification properly. 

Gustillo open fracture classification is made on the basis of wound size, degree of communication, vascular injury, soft tissue injury and neuro vascular status. 

Type-I Open fracture: This is an open fracture where the wound size is less than 1cm. loss of blood is not so much. No crashing injury is present. 

Type-II Open fracture: This type of open fracture is worse than Type-I. Here the wound size is more than 1cm but less than 10cm. Soft tissue injury and bleeding is moderate.

Type-III Open fracture : Here the wound size is more than 10cm. Communication of the fracture fragment with the environment is more than the previous fracture. This Type-III fracture has some sub division.

Type-IIIa: Here adequate soft tissue is present to cover the fracture fragments. 

Type-IIIb: Here adequate soft tissue is not present to cover the fracture fragments. 

Type-IIIc: Here the vascular supply is compromised.  

Nevertheless the above discussion, one must keep in mind that any open fracture with vascular injury will treated as a Type-III open fracture.