iosr-JDMS   Volume-14 ~ Issue-4 ~ April-2015

Abstract: Skin adnexal neoplasms are uncommon and are daunting diagnostic problems in view of the wide spectrum of lesions and their variants. Benign adnexal neoplasms are more common than malignant lesions. Aim: To study histopathology of skin adnexal neoplasms and to correlate with the clinical profile. Methodology: 51cases with a diagnosis of skin adnexal neoplasm over a 5 year period reported in the Department of Pathology, Mysore Medical College & Research Institute were included in the study. Histopathological examination was done on Haematoxylin& Eosin stained slides and corroborated with special stains wherever required.

[1]. K O Alsaad, N AObaidat, D Ghazarain, Skin adnexal neoplasms-part 1: An approach to tumours of pilosebaceous unit, J ClinPathol 2007; 60: 129:44
[2]. RTirumale, M O Roopa, Benign vs. Malignant Skin Adnexal Neoplasms: How Useful are Silhouettes? Indian Journal of Dermatology, 58 (1), 2013
[3]. A Sharma, D G Paricharak, J S Nigam, S Rewri, P B Soni, A Omhare et al, Histopathological Study of Skin Adnexal Tumours- Institutional Study in South India, Journal of Skin Cancer 2014(2014)
[4]. M K Reddy, A J Veliath, S Nagarajan, A L Aurora, A clinicopathological study of adnexal tumours of skin, Indian J Med Res 75, 1982, 882-9
[5]. K Radhika, B V Phaneendra, N Rukmangadha, M K Reddy A biopsy confirmed skin adnexal tumours: experience at a tertiary care teaching hospital, Journal of Scientific Research, 2, 2013, 132-138
[6]. P S Nair, A clinic-histopathological study of skin appendagealtumors, Indian Journal of Dermatology,Venerology and Leprology, 74 (550), 2008

Abstract: Haemophilia is one of the most common genetically inherited causes of bleeding disorders. The usual presentation is continous bleeding from a wound. Multicentric giant cell tumour (GCTs) of the extremity is rare in haemophilia. GCT can be primary, occurring incidentally with hemophilia in joints subjected to repeated haemarthrosis or a phenomenon secondary to repeated haemarthrosis.

[1]. Magallón M, Rodríguez Merchán C, López Barea F, Vicandi B, Atienza M, Lamas M, Sanjurjo MJ, "Unusual bone tumor in a hemophiliac patient. Diagnosis using aspiration biopsy of the lesion" 1990 Aug;35(4):317-20 PMID: 2274842 [PubMed - indexed for MEDLINE]
[2]. R. Garcia-Perez, G. Torres-Salmeron, F. Sanchez-Bueno, A. Garcia-Lopez and P. Parrilla-Paricio, "Intraabdominal Hemophilic Pseudotumor: Case Report," Revista Española de Enfermedades Digestivas, Vol. 102, No. 4, 2010, pp. 275-280. doi:10.4321/S1130-01082010000400009

Abstract: Patients with head and neck cancer are challenging not only in view of the airway management but also the secondary effects. Prior administration of radiotherapy, chemotherapy and opioids may also adversely affect the Intraoperative course and postoperative outcome. Thus there is always a need for safe & effective analgesia so as to provide better operative conditions and maintain stable hemodynamics not only intraoperatively but in postoperative period also for proper function of the reconstructive graft. Present study was aimed to study the role of dexmedetomidine as adjuvant in providing adequate perioperative analgesia and decreasing the dose of fentanyl postoperatively in head & neck cancer patients. To study the hemodynamic stability; and complications, if any.

[1]. JayantK, BalakrishnanV, SanghviL.D, JussawallaDJ. Quantification of the role of smoking and chewing tobacco in oral, pharyngeal and oesophagealcancers.BrJCancer.Feb1977; 35:232–235.

[2]. Petruzzelli G.J, Emami B. Nonsurgical Treatment of Advanced Metastatic Cervical Disease in Cancer of the Larynx.ORL 2000; 62:226–233
[3]. Benyamin R, Trescot AM, DattaS,BuenaventuraR,Adlaka R,Sehgal N,Glaser SE,Vallejo R. Opioid Complications and Side Effects. Pain Physician.2008; 11:105-120
[4]. Rodrigo C. Induced hypotension during anesthesia with special reference to orthognathic surgery. Anesth Prog. 1995; 42:41–58. [5]. Soo Bong Yu.Dexmedetomidine sedation in ICU. Korean J Anesthesiol. May 2012; 62(5): 405–411.

Abstract: The present report describes a rare case of isolated bifid ureter with duplex kidney. The possible embryological and genetic grounds for the formation of this anomaly are considered. Duplication of the ureter in adults is often symptomless, however urinary tract infections, pyelonephritis occur more commonly due to vesicouretic or ureteroureteric reflex. They are often seat of calculi formation and ureterocele that can impede drainage.

Keywords: Bifid Ureter, Metanephros, Duplex kidney, Pelvicalyceal system.

[1]. Keith L. Moore, T.V.N Persaud. The Developing Human: Clinically Oriented Embryology, 6th ed. Saunders 1998
[2]. Langman, T.W.Sadler. Medical Embryology,11th ed. Lippincott Williams & Wilkins; 2009
[3]. Glassberg KI, Braren V, Duckett JW, et al. Suggested terminology for duplex systems, ectopic ureters and ureteroceles. J Urol. 1984;132:1153–1154
[4]. Dahnert W. Radiology Review Manual. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2007.
[5]. Prakash RT, Venkatiah J, Bhardwaj AK et al. Double ureter and duplex system: a cadaver and radiological study. J Urol. 2011;8:145–148.
[6]. Siomou E, Papadopoulou F, Kollios KD, et al. Duplex collecting system diagnosed during the first 6 years of life after a first urinary tract infection: a study of 63 children. J Urol. 2006; 175:678–681.

Abstract: Empty sella refers to radiological appearance of enlarged or deformed sella turcica that is partially or completely filled with cerebrospinal fluid. It is of 2 types – primary and secondary. Present case report refers to a middle aged female presenting with persistent headache and having obesity, hypertension, irregular menstrual cycles and infertility.CT scan revealed Empty sella turcica. Keywords: ESS, Sella turcica.

[1]. Empty sella syndrome - J.K.Agarwal, R.K.Sahai, Indian Academy of Clinical Medicine Vol-2:No. 3, July-September 2001.
[2]. Factors determining the clinical significance of an empty sella syndrome, American Journal of Roentgenology, 2013:200:1125-1131.
[3]. Pituitary function in patients with primary empty sella syndrome – Tomras Erbas (M.D), Sema Akalin (M.D), Turkish Neurosurgery 2:68-70, 1991.

Abstract: The aim of the present study was to estimate fetal weight antenatally at or near term by using Johnson's formula and Hadlock's formula and comparing the two methods after knowing the actual birth weights of these babies after delivery and their accuracy compared. The study was a prospective study conducted on 100 pregnant women selected by simple random sampling who attended the antenatal clinic or were admitted in the antenatal ward at government general hospital ,Guntur. Fetal weight was estimated by using Johnson and R.W formula clinically and Hadlock'sformula ultrasonogrphically. All 100 women were delivered within one week of ultrasound examination and clinical estimation of fetal weight. Finally comparative analysis of fetal weight was made. Accuracy of both the methods was evaluated using the actual birth weight of baby after delivery. The birth weight estimated by Hadlock's formula by ultrasonography is more accurate than that estimated clinically by Johnson's formula. However the results of Johnson's method were comparable to results of Hadlock's.

Keywords: Birth weight, Johnson's formula, Hadlock's formula.

[1]. Johnson R.W. : American journal of obstetrics and gynaecology, 76: 929,1957
[2]. Hadlock etal : sonographic estimation of fetal weight radiology 150 , 535-540 : 1984
[3]. Williams te xt book of obstetrics – 20 the edition
[4]. Frank P Hadlock etal sonographic estimation of fetal weight radiology 150 : 535-540 : 1984
[5]. Nelson text book of pediatrics 15 th edition
[6]. Practical guide to high risk pregnancy and delivery – Fernando arias -2 nd edition.

Abstract: As a general rule ideal suicidal poisons should be tasteless or pleasant in nature and capable of being easily taken in food or drink. Formalin has selective availability, strong taste and pungent odor. Formalin is an aqueous solution of formaldehyde containing 37-40% formaldehyde and 10-15% of methanol. Due to its reactive and unstable nature formaldehyde generally marketed in aqueous solution. Formalin is a protoplasmic poison and potent caustic substance; it causes coagulation necrosis, precipitation of protein, fixation of tissues and stabilizes the structural details of the cells. Ingestion of formalin and inhalation of fumes causes immediate deleterious effects on different systems of body.

[1]. Pillay VV. Comprehensive medical toxicology 1st Ed. Hyderabad: Paras Medical Publishers; 2003.
[2]. Yanagawa Y, Kaneko N, Hatanaka K, Sakamoto T, Okada Y, Yoshimitu S. A case of attempted suicide from the ingestion of formalin. ClinToxicol (Phila). 2007; 45(1):72-6.
[3]. Sperhake J, Tsokos M, Sperhake K. Perimortem fixation of the gastric and duodenal mucosa: a diagnostic indication for oral poisoning. Int J Legal Med 1999; 112(5): 317-20.
[4]. Hawley CK, Harsch HH. Gastric outlet obstruction as a late complication of formaldehyde ingestion: a case report. Am J Gastroenterol. 1999; 94(8):2289-91.
[5]. Toxicological profile for formaldehyde. Agency for toxic substance and disease registry. Public Health Service.1657, (1999)
[6]. Onyije FM, Avwioro OG. Excruciating effects of formaldehyde exposure to students in gross anatomy dissection laboratory. Int J Occupat Environ Med, 3:92-95, (2012)

Abstract: Spinal anaesthesia is a routine procedure for lower limb and lower abdominal surgeries. Ropivacaine, a long acting amide type of local anaesthetic is newly available in isobaric form.This study was designed to compare the clinical efficacy of hyperbaric ropivacaine versus hyperbaric bupivacaine.100 ASA grade I-II patients undergoing elective lower limb and lower abdominal surgeries under spinal anaesthesia were randomized to receive 18 mg of hyperbaric ropivacaine or 12 mg of hyperbaric bupivacaine. Monitoring of vitals and observation for the block parameters were carried out. The data were presented as mean with standard deviation and frequency with percentage. P value <0.05 was considered as significant.Ropivacaine produced a faster onset of sensory block (ropivacaine 2.9 min; bupivacaine 4.2 min; P < 0.05) but the mean total duration of sensory block in ropivacaine group was significantly less (ropivacaine168.5 min; bupivacaine 196.6 min; P < 0.05). Patients in the ropivacaine group had significantly more rapid recovery from the motor blockade (ropivacaine128.3 min; bupivacaine 148.7 min; P < 0.05). Quality of analgesia and anaesthesia were comparable in both the groups..

[1]. Pollock JE, Neal JM, Stephenson CA and Wiley CE. Prospective study of the incidence of transient radicular irritation in patients undergoing spinal anesthesia, Anesthesiology 84,1996,1361–7.
[2]. Cappelleri G, Aldegheri G, Danelli G, Marchetti C, Nuzzi M, Iannandrea G et al. Spinal anesthesia with hyperbaric levobupivacaine and ropivacaine for outpatient knee arthroscopy: a prospective, randomized, double-blind study, Anesth Analg 101,2005, 77–82.
[3]. Singh S, Singh V.P. Jain M Gupta K, Rastogi B and Abrol S, Intrathecal 0.75% Isobaric Ropivacaine Versus 0.5% Heavy Bupivacaine for Elective Cesarean Delivery: A Randomized Controlled Trial, JPMS 2, 2012, 75-80.
[4]. Kallio H, Snall E-VT, Kero MP and Rosenberg PH, A comparison of intrathecal plain solutions containing ropivacaine 20 or 15 mg versus bupivacaine 10 mg, Anesth Analg 99,2004, 713 -7.
[5]. White side JB, Bruke D and Wildsimth JAW, Comparison of ropivacaine 0.5% (in glucose 5%) with bupivacaine 0.5% (in glucose 8%) for spinal anaesthesia for elective surgery,Br J Anaesth 90, 2003, 304-308.
[6]. Fettes PDW, Hovking G, Peterson MK, Luck JF and Wildsmith JAW, Comparison of plain and hyperbaric solutions of ropivacaine for spinal anaesthesia, Br J Anaesth 94, 2004, 107-111.

Abstract: Background: Childhood obesity is an emerging problem worldwide. It was once considered a high income country problem, now its on the rise in the low and middle income countries.The increase in childhood overweight and obesity may be major contributors to the adult obesity epidemic. Aim: This study is conducted in a government school in Bhubaneswar city to understand the different variables contributing to overweight and obesity. Methodology: It is a cross sectional study conducted in a government school from 1st March 2014 to 31st July2014. 537 children from age 9-15years were selected for study and their dietary habits and lifestyle were analyzed. The data was collected by questionnaire cum interview technique.

[1]. Nutrition. Controlling the global obesity epidemic. Available from URL: http://www.who.int/nutrition/topics/obesity/en/ (accessed on 14thoct, 2011, 18:00).
[2]. WHO: Obesity and overweight. Available from URL:http://www.who.int/mediacentre/factsheets/fs311/en (accessed on 14th Oct, 2011).
[3]. Ribiero RC, Coutinho M, Bramorski MA, Giuliano IC, Pavan J. Association of the waist-to-height ratio with cardiovascular risk factors in children and adolescents: The three cities heart study. Int J PrevMednone. 2010;1:39–49. [PMC free article] [PubMed] [4]. Centers for Disease Control and Prevention, Overweight and obesity; Childhood overweight and obesity. [Last accessed on 2009]. Available from: http://www.cdc.gov/obesity/childhood/defining.html .
[5]. Sokol RJ. Childhood obesity and adolescent obesity :The sleeping giant has awakened. J Pediatr 2000;136:711-713.
[6]. World Health Organization,Global strategy on diet, physical activity and health, http://www.who.int/dietphysicalactivity/media/en/gsfs_obesity.pdf, updated on August 2014

Abstract: Primary Anorectal malignant melanoma (ARMM) is a rare and aggressive tumor that tends to invade locally and metastasize early in the course of the disease. Surgical excision remains the mainstay of therapy. Overall prognosis is poor with a 5 year survival rate of less than 20 %. We report a case of 65 year old female patient who presented with rectal bleeding. She was found to have a mass arising from the anal canal. The patient underwent abdominoperineal resection (APR) with subsequent histopathologicalexamination and immunohistochemistry confirmed the diagnosis of anorectal malignant melanoma.

Keywords:Anorectal, Malignant melanoma, Mucosal

[1]. Parra RS, de Almeida ALNR, Badiale GB, da Silva Moraes MMF, Rocha JJR, Féres O. Melanoma of the anal canal. Clinics. 2010;65(10):1063-1065.

[2]. Khan M, Bucher N, Elhassan A, et al. Primary Anorectal Melanoma. Case Reports in Oncology. 2014;7(1):164-170.

[3]. Van Schaik P, Ernst M, Meijer H, Bosscha K. Melanoma of the rectum: A rare entity. World Journal of Gastroenterology : WJG. 2008;14(10):1633-1635.

[4]. Gavriilidis P, Moula E, Nikolaidou A. Primary Rectal Malignant Melanoma-Case Report. Hippokratia. 2013;17(4):380-381.

[5]. Singer M, Mutch MG. Anal Melanoma. Clinics in Colon and Rectal Surgery. 2006;19(2):78-87.

[6]. Seetharamu N, Ott PA, Pavlick AC. Mucosal Melanomas: A Case-Based Review of the Literature. The Oncologist. 2010;15(7):772-781.

Abstract: Background: mid twentieth century observations that acceleration of the fetal heart rate in response to fetal activity reflect fetal well being, formed the basis of the Non Stress Test (NST). Freeman and Lee colleagues, 1975, introduced the NST to describe the fetal heart acceleration in response to fetal movement as a sign of fetal health. Aim: To study the antepartum fetal surveillance with NST and perinatal outcome in high risk pregnancies. To prove the efficacy of NST as an effective tool for evaluation of fetal well being. Methods: Hospital based prospective study. 100 pregnant women attending the antenatal OP clinic, or as emergency in the department of OBG, Government General Hospital, Vijayawada, from October 2011-October 2012, for their high risk factors, were randomly recruited into the study. NST was performed for all the cases with CTG (Cardiotocography) and results were analyzed..

[1]. Role of Non Stress Test in Monitoring High Risk Pregnancy – Abhijit Biswas, Soma Biswas et al; Indian Medical Gazette, Feb 2013, Page 43-48.
[2]. Roll of Non Stress Test in High Risk Pregnancy - Dr Devangi munshi, Dr Rajita Munshi et al; GlobalResearch Analysis, Volume : 2 | Issue : 8 | Aug 2013 • ISSN No 2277 – 8160
[3]. Correlation of non stress test with fetal outcome in term pregnancy (37-42 weeks) – Richa U. Lohana, Meena Khatri et al; International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2013; 2(4): 639-645
[4]. Everston L.R. Paulrh — Antepartum fetal heart rate test testing, non-stress test. Am. J. Obst. and Gynecol. 133-129, 1978.
[5]. Flynn A. M. and Kelly J. — Evaluation of fetal wellbeing by antepartum fetal heart rate monitoring. Br Med J. 12936, 1977.

Abstract: Uterine leiomyoma , most common estrogen dependent benign tumour of the uterus. 5 to 20% occur in the reproductive age group. It is composed of smooth muscle and fibrous tissue. Asymptomatic myomas present in 50% of cases, it causes mainly menstrual problems like- menorrhagia, metrorrhagia, dysmenorrhoea and also infertility. Incisional hernia is one that develops in the scar of surgical incision. We are presenting a case of fibroid uterus with incisional hernia in a 40 year old woman, P3 L3, delivered vaginally, following which she had puerperal sterilization on 3rd post-natal day- 16 years back. She came with complaint of swelling in the lower abdomen associated with pain, history of menorrhagia and pain during menstruation. She was subjected to Ultrasound and CT abdomen which confirmed fibroid uterus with incisional hernia. Management of the case is discussed.

Keywords: Uterine fibroids, Incisional hernia, Total Abdominal Hystrectomy, Repair of incisional hernia.

[1]. Abrahamson J. Hernias in Michel J Zinner, Seymour I. Schwartz, Harold Ellis, editors . In Maingot's, Abdominal Operations Vol 1,10th ed.Appleton and Lounge,1997,548-72.
[2]. Wegienka G,etal, self-reported heavy bleeding associated with uterine leiomyomata. Obstet Gynecol.2003 Mar; 101(3) 431-7.
[3]. Parker WH, Fu YS. Berek JS Uterine sarcoma in patients operated on for presumed leiomyoma and rapidly growing leiomyoma. Obstet gynecol, 1994 Mar; 83(3): 414-8.
[4]. NakamuraY, Yoshimura Y. Treatment of uterine leiomyomas in perimenopausal women with gonadotropin-releasing hormone agonists. Clin Obstet gynecol.1993 sep; 36 (3): 660-7.
[5]. Friedman AJ, Haas ST. Should uterine size is an indication for surgical Intervention in women with myomas? Am J Obstet Gynecol. 1993 Mar; 168( 3 Pt 1 ); 751-5.
[6]. Marret. H, Fritel X, Ouldamer L, Bendifallah S, Brun JL, De Jesus I et al. Therapeutic management of uterine fibroid tumours: updated French guidelines , Eur J obstet Gynecol Reprod Biol.2012;165(2) : 156-64.

Abstract: Background: Clinically solitary thyroid nodule may be defined as a goitre which on clinical examination appears to be a single nodule in an otherwise normal gland. In reality, solitary thyroid nodule is not a single disease process but a constellation of processes encountered in a variety of clinical diseases such as dominant nodule of a multi nodular goitre, true adenoma, malignancy, thyroiditis and cyst. Aim: 1. To study the epidemiology, different clinical and pathological types of presentations in solitary thyroid nodule. 2. To study the management of solitary thyroid nodule. Material and Method: The study material consisted of 56 cases of solitary thyroid nodule who were admitted in General Surgery wards at SVRR Govt. General Hospital, Tirupati.

[1]. Cole W.H., Majarakis J.D., et al 1949; "Incidence of carcinoma of the thyroid in nodular goiter". JClin Endocrinol, 9:1007-1011.
[2]. Rains, Harding A.J, and Charles V. Mann "The thyroid gland and the thyroglossal tract" Chapter-37 in Bailey and Love's short practice of Surgery, 20 edn, 1989, H.K.Lewis and Co. Ltd., 669-670pp.
[3]. Zaman N. and Bhagabat J.N. 1971 : "Carcinoma in a solitary thyroid nodule". Indian J Med Sci, 25: 329-33.
[4]. Hoffman G.L., Thompson N.W. and Heefron c, 1972 : "The solitary thyroid nodule". Arch Surg, 105: 379-84.
[5]. Brown C.L. and Kantounis S, 1975 : "The thyroid nodule, :view from the community hospital". Am J Surg, 129: 532-6.

Abstract: Objective-Latency and amplitude of P100 of VEP recording is affected by various variables like age, refractive errors, eye dominance, sex hormones etc. so we tried to evaluate the effect of refractive error on VEP by using LED goggle as stimulation source. Method: We studied 130 healthy volunteers of age between 17-21yrs of both sex and they grouped as without refractive error N=69 (F=36 & M=33) and with refractive error N=61 (F=31 & M=30). We evaluated the results.

[1]. B Jorn Johansson ; A study of some temporal properties of the human visual evoked potential & their relation to binocular function, Linkoping University Medical dissertations No 964, 2006.
[2]. Truette Allison , Charls C. Wood; Brainstem auditory, pattern reversal visual and short latency somatosensory evoked potentials: Latencies in relation to age, sex & brain and body size; Electroencephalography & Clinical Neurophysiology 1983,55 : 619-636.
[3]. Ruchi Kothari, Pradeep Bokariya; Refractive errors and their effects on visual evoked potentials; Journal of Clinical Ophthalmology & Research 2014, vol-2, issue 1,pg 3-6.
[4]. Kothari Ruchi, Bokariya Pradeep; Influence of refractive error on Pattern reversal VEPs of Myopes and Hypermetropes; International Journal of Physiology ,2013,vol-1,issue-1,pg 57-61.
[5]. S A Montgomery, R McAuley;Effect of refractive error on the visual evoked response; British Medical Journal, 1979,231-232

Abstract: Objectives: To assess the fetomaternal outcome of pregnancy in mothers with gestational diabetes mellitus (GDM) Method: A cross sectional study, conducted in 123 patients, where 62 were normal pregnant women and 61 pregnant women with risk factors for GDM attending antenatal clinic and admitted in antenatal ward , was carried out in the department of obstetrics & gynecology of RIMS; a tertiary health care referral centre, MANIPUR, over a period of 2 years from AUGUST 2012 to AUGUST 2014.

[1]. Powers AC .Diabetes mellitus. Braunwald, Kasper, Hauser, Longo, Jamesonet et al. Harrison principles of Internal Medicine 17th ed.vol 2.New York: Mc Graw –Hill;2005:2275.
[2]. O'Sullivan ,Mahan CM. Criteria for oral glucose tolerance test in pregnancy. Diabetes 1964;13:278.
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[4]. Fernando A, Daftary SN, Bhide AG. Diabees in pregnancy. In practical guide to high risk pregnancy and delivery.3rd edition. Noida: Saunders Elsevier 2008;17:440.
[5]. Abha S. Screening of diabetes mellitus-Why? When? and How? Obstetrics and Gynaecology today 2009;14:233-4.

Abstract: Purpose – To have an overview of SICS in relevance to modern cataract surgical technique. Method: The present study was conducted in 506 cases in upgraded department of Ophthalmology, N.S.C.B Medical College, Jabalpur(M.P.) during the academic session July 2005 to September 2006. Cataract surgeries were carried out in patients after screening and patients not found fit for surgery were excluded. Patients underwent manual SICS with posterior chamber intraocular lens implantation. Postoperatively all patients received routine postoperative medications for 6 weeks. Patients were followed up at regular interval for 6 weeks.

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[3]. Benjamin F. Boyd: Management of Complications during phacoemulsification. Highlights of Ophthalmology. 2000; No.3, p.3-13
[4]. Blumenthal M.: Manual Extra capsular Cataract extraction. The present state Of Art Klin Monatsbl Augenheikd 1994 Nov. 205(5) 266-270.
[5]. Bryant W.R.: The sclera pocket incision. George W. Rozakis. Alternative small Incision Techniques New Delhi; Jaypee Brothers 1995, 1st Ind edition P.1-44.
[6]. Centurion V.: Management of Complications during phacoemulsification Highlights of Ophthalmology 2000 No. 3, P.4-13
[7]. Cravy T.V: Routine use of lateral approach to cataract extraction to achieve Rapid And sustained stabilization of postoperative astigmatism J. cataract Refract Surg. 1991; 17; 415-423.