Deiverting ileostomy was initially introduced and used by Turnbull and Weakley to provide fecal diversion in patients with toxic megacolon. Traditionally, transverse colostomy has been the preferred method for temporary proximal diversion in patients with colonic obstruction. However, recently, diverting ileostomy has been popularized for proximal diversion, mainly for lack of an offensive odor of the ileostomy effluent compared with fecal material from a colostomy. We have used diverting ileostomy routinely for protection of ileorectal anastomoses, especially when tension exists at the site of anastomoses or for those patients who have been on steroids.

Dear Editor Scuba diving is associated with an important risk of developing Decompression sickness secondary to formation of gas bubbles inside the body. The latter is formed mainly by nitrogen in the body on the diver’ s way to the surface (1, 2). In some cases, it might injure the central nervous system. Several Decompression cases that have been associated with neurologic symptoms are described in the literature; however, brain multi-infarct with lethal outcome has never been described...

Graves ophthalmopathy can cause proptosis, cosmetic problems, and visual impairment. The aim of this study was to assess the validity and limitation of transnasal endoscopic orbital Decompression in Graves ophthalmopathy. Between 1997 and 2003, 20 female and one male patients with Graves ophthalmopathy underwent simultaneous bilateral transnasal endoscopic orbital Decompression. All patients were nonresponders to medical management (including steroid therapy) but none of them received orbital irradiation. Preoperative and postoperative ophthalmologic examinations were recorded for all patients. In addition, photographs and CT scans of orbit and sinuses were done. After operation, visual acuity improved following orbital Decompression with this technique. Diplopia in lateral gaze developed in 15 patients but only one of them required corrective surgery. The mean retrodisplacement was 4.1 mm that compares favorably with other series. After an average follow-up of 49 months, none of the patients developed sinusitis or mucocele. Endoscopic Decompression provides excellent visualization without external incisions, and facilitates maximal Decompression without the increased risk of hemorrhage, visual impairment, or infections.

Background: There is still no standard of care to manage thoracolumbar burst fractures. With all the recent advances, posterior approaches are still one of the mainstays of treatment. On the other hand, while spinal canal Decompression in neurological impaired patients is an important goal of treatment, its technique remains controversial. This study compared the effects of direct laminectomy Decompression against ligamentotaxis/indirect canal Decompression on neurological and radiographic improvements.    Methods: A prospective double-blind randomized clinical trial was conducted on 60 thoracolumbar burst-fracture patients meeting our inclusion and exclusion criteria. They were randomized into 2 treatment arms: (1) direct Decompression using laminectomy and (2) indirect Decompression using ligamentotaxis/distraction. Each patient was observed for 6 months, and their neurological and radiographical data were collected prospectively. Statistical analysis was done by the Student t test, Friedman test, Mann Whitney-U test, Wilcoxon ranked test, and 1-way analysis of variance.    Results: Among 60 patients enrolled in our study, each treatment arm had an improvement in Frankel scores but there was no difference between the groups at any given time. After 6 months of surgery, local sagittal kyphosis improved in both groups (from 32.2 to 7.43 and 29.93 to 8.77 for the indirect and direct groups, respectively), as well as anterior vertebral height ratio (from 57.73 to 70.7 and 62.17 to 66.27 for the indirect and direct group, respectively) and posterior vertebral height ratio (from 61.17 to 74.87 and 64 to 67.5 for the indirect and direct group, respectively). For between-group comparisons after 6 months, there was a significant difference only for posterior vertebral height ratio (P = 0.040).    Conclusion: Posterior approaches with ligamentotaxis have shown to be safe and may present the same outcome as direct Decompression techniques using wide laminectomy.

Purpose: Orbital Decompression and lower eyelid retraction surgery are traditionally performed separately in staged fashion, which may be unnecessary. Herein, we evaluate the safety and efficacy of combined orbital Decompression and lower eyelid retraction surgery. Methods: Retrospective analysis of patients undergoing combined orbital Decompression and lower eyelid retraction surgery in patients with or without Graves orbitopathy, by one surgeon from 2016 to 2017. Patients with previous orbital or lower eyelid surgery were excluded. Surgical technique for orbital Decompression included eyelid crease lateral-wall Decompression, transconjunctival inferolateral-wall Decompression, or transcaruncular medial-wall Decompression, or combination. Surgical technique for lower eyelid retraction surgery described previously. Analysis included 34 surgeries (19 patients). Preoperative and postoperative photographs at longest follow-up visit were standardized and analyzed. Results: Etiologies of lower eyelid retraction included thyroid eye disease (13 patients) and inherited (6 patients). Etiologies of proptosis included thyroid eye disease (13 patients) and inherited with shallow orbits and/or poor maxilla (6 patients). All 34 eyelids demonstrated improvement of lower eyelid position. The mean improvement of marginal reflex distance was 2. 4 mm (range, 1. 7e2. 9 mm). There was one case of mild overcorrection and once case of prolonged chemosis. The average follow-up was 9 months (range, 6 months to 1 year). Conclusions: This study demonstrates improvement of lower lid position in patients undergoing simultaneous orbital Decompression and correction of lower eyelid retraction, irrespective of the etiology of lower eyelid retraction and proptosis or orbital Decompression technique. Combined procedures may reduce the number of total procedures, patient anxiety, recovery time, and costs, without compromising the results.