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In white wine production, the technique consisting of freezing whole or crushed grapes usually increases the levels of aroma-related compounds in the final wine products. However, this technique may affect phenolic compounds, among other chemical compounds. Phenolic compounds are crucial to white wines because of their susceptibility to oxidation and their role with regard to color stability. In this study, white wines made from Muscat of Alexandria grapes were subjected to two different freezing techniques: whole-bunch freezing and crushed-grape freezing. In addition, a pre-fermentative maceration was applied to each experiment in order to determine if the effects of freezing were comparable to those of maceration. The phenolic compounds studied were gallic acid, protocatechuic acid, caffeic acid, trans-coutaric acid, and epicatechin, which are the key compounds from the point of view of wine stability. The freezing of crushed grapes enhanced the extraction of phenolic compounds in comparison to the freezing of whole bunches of grapes without pre-fermentative maceration. On the other hand, the effect of pre-fermentative maceration was comparable to that resulting from freezing crushed grapes. This step made the must from whole frozen grapes having even larger levels of phenolic compounds. Without pre-fermentative maceration, freezing whole bunches of grapes only allowed a moderate extraction of phenolic compounds and produced wines with lower individual phenolic contents than those obtained through traditional winemaking procedures.

Background Foreign body aspiration (FBA) can be a life-threatening emergency and the cause of significant morbidity and mortality in children. Although rigid bronchoscopy is considered as the treatment of choice for the retrieval of foreign bodies (FBs) among pediatrics, extraction with the flexible fiberoptic bronchoscope (FFB) has become increased in popularity over the last few years. Recently, though there have been some reports about the use of cryoprobes as tools for the removal of FBs in adults, there is a limited experience concerning pediatrics, especially during the infancy period. The aim of this study is to describe the characteristics of FBs and cryoextraction as the new method of treatment. Methods This retrospective study was conducted on 50 pediatric patients with FBA who were managed by using the flexible cryoprobes to evaluate their outcomes between September 2013 and October 2018. Results A total of 50 children ranging in age from 7 months to 15 years underwent cryoextraction for the airway FBA retrieval with FFB using a cryoprobe. The main symptoms patients complained of were choking, cyanosis, cough, and noisy breathing. History, clinical examination, and finally radiologic examination were the diagnostic tools. The treatment consisted of FFB using cryoprobes under slight general anesthesia with maintaining the patient's spontaneous breathing. Using cryoextraction turned to be very useful. Conclusion Using cryoextraction can be a reliable and preferred method with minimal complications for extracting airway FBs among children, especially those that have a friable texture.

Benign orbital neoplasms comprise a wide spectrum of different entities. The origin of the tumours can be epithelial or mesenchymal. Epithelial neoplasms of the orbit originate from the lacrimal gland. The most important tumour is the pleomorphic adenoma, which should not be biopsied but resected in toto. The most common intraconal neoplasm in adults is the cavernous hemangioma. Symptomatic cavernous hemangiomas should be treated. The treatment of choice for most symptomatic benign neoplasms of the orbit is surgical resection. Suitable surgical approaches are anterior transconjunctival and lateral orbitotomy. Cryoextraction is a minimally invasive technique that is particularly suitable for cavernous hemangiomas.

A retrospective analysis of the results of surgical treatment of complicated uveal cataracts of different origin.The study analyzed the results of surgical treatment of uveal cataract in 30 patients (34 eyes) who were divided into three groups by uveitis etiology. The first group included 11 patients with spondyloarthritis associated with the HLA-B27 antigen; the second group included 10 patients with juvenile chronic arthritis and spondyloarthritis, negative for HLA-B27 antigen; the third group consisted of 9 patients with other systemic autoimmune diseases and uveitis of unknown etiology, also negative for the HLA-B27 antigen. The average age of the patients was 35.8±2.6; 30.8±3.8 and 34.0±2.3 years, respectively. Four patients (6 eyes) with juvenile chronic arthritis and severe ribbon-like corneal degeneration underwent standard intracapsular cataract cryoextraction with subsequent spectacle correction of aphakia. In other cases, ultrasound phacoemulsification with implantation of an intraocular lens (IOL) was used as a surgical aid.Regardless of the surgery technique and the cause of uveal cataract, a statistically significant decrease in the number of exacerbations per year (Surgical treatment of uveal cataracts of various etiologies with adequate pre- and postoperative therapy provides an improvement in visual acuity and a reduction in the frequency of inflammation recurrence. Considering the high likelihood of IOP decompensation in the long-term postoperative period, IOP control should be given attention in such cases.Ретроспективный анализ результатов хирургического лечения увеальных катаракт различного генеза.Проанализированы результаты хирургического лечения увеальной катаракты у 30 пациентов (34 глаза), которые были разделены на три группы по этиологии увеита. В 1-ю группу включены 11 пациентов со спондилоартритами, ассоциированными с HLA-B27 антигеном; 2-я группа — 10 пациентов с ювенильным хроническим артритом и спондилоартритами, отрицательными по HLA-B27 антигену; 3-я группа — 9 пациентов с другими системными аутоиммунными заболеваниями и увеитом неясной этиологии, также отрицательными по HLA-B27 антигену. Возраст пациентов в среднем составил 35,8±2,6; 30,8±3,8 и 34,0±2,3 года соответственно. Четырем пациентам (6 глаз) с ювенильным хроническим артритом и выраженной лентовидной дегенерацией роговицы была произведена стандартная интракапсулярная криоэкстракция катаракты с последующей очковой коррекцией афакии. В остальных случаях в качестве хирургического пособия использовали ультразвуковую факоэмульсификацию с имплантацией интраокулярной линзы.Независимо от методики операции и причины увеальной катаракты после ее удаления отмечено статистически достоверное уменьшение количества обострений в год (Хирургическое лечение увеальных катаракт различной этиологии при адекватной пред- и послеоперационной терапии обеспечивает улучшение остроты зрения и сокращение частоты рецидивов воспаления. Учитывая высокую вероятность декомпенсации офтальмотонуса в отдаленном послеоперационном периоде, следует уделять внимание контролю его уровня.

Central airway obstruction, a frequently encountered emergency, is usually associated with blood clots, tumors, foreign bodies or mucus plugs. Airway obstruction due to blood clots can be seen as a complication of lung malignancies, infections, bronchiectasis, arteriovenous malformations or pulmonary infarction. In patients with long standing blood clots, the thrombus gets organized and firmly adherent to the airway. The diagnosis is often misleading as these clots mimic tumors clinically and on imaging. Hemoptysis is the most common presenting symptom though many patients can be asymptomatic. Direct visualization with bronchoscopy is required to establish a diagnosis. Life-threatening respiratory impairment is an indication for emergent clot retrieval. Management of these blood clots, especially when organized, is challenging. Initial attempts at removal should include suctioning, lavage or forceps extraction. When unsuccessful, further management options include balloon catheter dislodgement, use of topical thrombolytics, rigid bronchoscopy and cryoextraction. Keywords: Airway obstruction, Blood clot, Bronchoscopy, Cryoextraction

The technology of grinding the frozen fish raw material using the useful model of a piston-type extrusion plant with cold working bodies for fodder minced fish (cryo minced fish feed) by the method of cryoextrusion has been developed. The possibility of replacing the standard manufacturing operations (defrosting and subsequent grinding of raw materials) to the one (cryoextrusion) has been substantiated. The optimal shape of holes of the die for forcing the raw material has been determined in the form of "hourglass", the hole diameter is 7 mm, the length of the process of pushing is 40 s. It has been established that the finished product (cryo minced fish feed) has a homogeneous grinding, juicy, crumbly texture, the temperature in the thickness of the product is equal to the temperature of the raw material before processing (–18 °C). The technological scheme of producing the minced fish feed by the method of cryoextrusion has been developed. Researching the chemical composition of fish and feed of mince produced by the traditional and developed methods it has been established that protein content in the cryo minced fish feed remains unchanged. The amino acid composition of cryo minced fish feed has been determined, the amount of essential amino acids is 365.6 mg/g of protein. In the proteins of the cryo minced fish feed methionine has been contained in the minimum quantity (10.0 mg/g protein) and in the maximum – serine (155.3 mg/g protein). In the protein of the cryo minced fish feed the only limiting amino acid is methionine. The coefficient of rationality of the cryo minced fish feed whiting is equal to 0.33. The product is not toxic, is not subject to contamination with dangerous microorganisms, has high biological value, contains necessary in animal nutrition mineral elements, the energy value per 100 g of the product is 87 kcal. The combination of the processes of cryoextrusion and lyophilization allows to obtain a new food product with high organoleptic properties. The draft technical specifications for production of the cryo minced fish feed and the technological instructions for production of minced fish for feed purposes have been developed.

Freezing grapes is a winemaking technique known as cryoextraction that intends to modify the composition of the final wines. The changes that take place in the frozen grapes facilitate the transfer of certain compounds from the grape skins into the musts because of the grape&rsquo, s unstructured tissues. For this study, the white grape variety Muscat of Alexandria was selected. Two different cryoextraction procedures have been analyzed as follows: (i) Ultrafast freezing, and (ii) liquid nitrogen freezing. The wines obtained using liquid nitrogen freezing exhibited higher levels of terpenoids, as well as higher levels of hydroxylic compounds and fatty acids than both the wines obtained through traditional methods and ultrafast freezing wines. In any case, both freezing techniques produced wines of a more intense aroma compared with those wines obtained by traditional methods. In fact, liquid nitrogen freezing produced the wines with the most intense aroma and were the best valued by the tasting panel.

Background: Severe pulmonary hemorrhage is a life-threatening complication in critically ill patients. Due to tracheobronchial obstruction, ventilation is often impaired. Traditionally, rigid bronchoscopy is an option for recanalization. However, in comparison to flexible bronchoscopy, the application of rigid bronchoscopy is more complex. Against this background we evaluated the use of flexible cryo-probes for blood clot removal in critically ill patients. Methods: Retrospectively, we identified 16 patients (median age: 60 years, 69% male patients), who suffered from severe airway obstruction due to blood clots. All patients required invasive ventilation and 11 patients depended on extracorporeal membrane oxygenation (ECMO). To remove blood clots, flexible bronchoscopic cryoextraction was performed in n=27 cases, whereas rigid bronchoscopy was only needed in two cases. Results: Whereas in 9 cases single flexible cryoextraction was successful immediately, the procedure had to be repeated again in 7 patients. In all cases, tracheobronchial obstruction was treated with success and conditions of invasive ventilation were improved. In no case severe complications were observed. Conclusions: In consideration of the underlying evaluation, we highly recommend flexible cryoextraction as both a safe and less complex technique for blood clot removal in critically ill patients.

In the past few decades, flexible bronchoscopy has largely replaced rigid bronchoscopy as the tool of choice for diagnosis and management of endobronchial disease.

Introduction We aimed to evaluate the efficacy of flexible bronchoscopic cryoextraction in the treatment of airw ay obstruction arise from mucus plugs and blood clots and present our experience. Materials and methods The present study evaluated patients who previously underwent unsuccessful flexible bronchoscopy for the removal of secretions and blood clots in the central airway and who underwent flexible bronchoscopic cryoextraction between January 2013-November 2017. Result The study included seven patients with a mean age of 58.29 ± 18.56 years (28-76). Three patients underwent bedside intervention in the intensive care unit, and four patients underwent an intervention in the bronchoscopy unit. Seven patients underwent a total of nine sessions of cryoextraction. Severe complications or mortality did not occur during the cryoextraction sessions. Conclusions Flexible bronchoscopic cryoextraction offers a safe treatment strategy as an alternative to rigid bronchoscopy in patients in whom airway patency cannot be achieved using other flexible bronchoscopic interventions. and accuracy of PET was higher compared to CT with this cut-off value.

Tadeusz Krwawicz (1910–1988) pioneered the use of cryosurgery in, as ophthalmology. The idea arose in 1959 while experimenting because on lyophilization to store corneas and lenses for transplantation it was difficult to remove the lens without damage the capsule was usually torn. Subsequent experiments on rabbits revealed that touching the lens with a wire cooled to 203°K (–70°C) resulted in firm attachment of the lens capsule and subcapsular masses. A cryoextractor was developed and employed for clinical use in cataract extraction, likewise in intumescent cataracts and lens subluxation. Cataract surgery utilizing cryoextraction led to substantial progress to ophthalmology by reducing the number of complications, particularly capsule rupture, and resulted in achieving better outcome compared to other methods. This surgery soon and for almost 20 years became a routine method used all around the world in cataract removal. Simultaneously, Krwawicz developed techniques for corneal refractive surgery—partial lamellar removal of the corneal stroma and temporary interlaminar introduction of a plastic disk in order to change the corneal curvature. Krwawicz presented other ophthalmic interests—his research concerned immunology, histology, histochemistry, biochemistry of ocular tissue, and mainly corneal and experimental surgery with a particular focus on the pathology of the cornea.

Background: The outcome of cataract surgery is determined by the patient, the technique, and the surgeon: the patient where there is coexisting morbidity; modern techniques (most notably the implantation of an intraocular lens and probably small incision methods) have transformed the quality of visual rehabilitation and dare we say the ‘better’ the surgeon the ‘better’ the results. Objective of the study is to study the efficacy of cryoextraction in various types of cataract and also the complications in immediate post-operative period and up to 6 weeks. Methods: A hospital based cross sectional study was carried out among 1000 cataract patients. Institutional Ethics Committee permission was obtained. Informed consent was taken from each patient. The study was carried out for a period of two years. Patients who were willing, not chronically ill, not bed ridden and having diagnosed as cataract were included in the study. The data was collected in the pre designed study questionnaire. The data was analyzed using proportions. Results: Majority of cases have undergone the Sector type of iridectomy (81.8%). Majority (85.4%) had no complications. Cryo adherence to the iris was the commonest complication (6.3%) followed by capsular rupture in 4.7% of cases. Majority (85.9%) had no complications. Hyphema (4.7%) was the most common complication followed by shallow anterior chamber in 3.8% of cases. 400 cases has come for follow up after 6 weeks post-operative period out of them 91.05% of patients had no complications. Iritis was most common late post-operative complication at the end of 6 weeks in 5% of cases. Conclusion: Cryoextraction of cataract with complete iridectomy has given good results in the present study. The young surgeon can achieve the results equal to that of master using cryoextraction as it is easy to apply and complications are less.

Airway obstruction from blood clots, airway secretions, and foreign bodies is a potentially life-threatening condition. Optimal management of this problem, whether by rigid or flexible bronchoscopy, has not been well studied. We report our single-center experience on the safety and clinical utility of cryoprobe extraction for this indication.We performed a retrospective chart review from January 2006 to November 2014 of all subjects aged 18 and older who underwent flexible bronchoscopic cryoprobe extraction. Subjects with obstruction due to benign or malignant neoplasm or airway stenosis were excluded.A total of 38 cryotherapy sessions performed on 30 subjects were identified for inclusion. Cryoprobe extraction was successful in reestablishing airway patency in 32/38 (84%) sessions overall and in 24/26 (92%) for blood clots, 4/6 (67%) for mucous plugging, 2/4 (50%) for foreign bodies, and 2/2 (100%) for plastic bronchitis. Twenty-one of 31 (68%) sessions resulted in improvement in oxygenation or ventilation. There was 1 complication related to sedation.We conclude that flexible bronchoscopic cryoprobe extraction of blood clots, mucous secretions, plastic bronchitis, and foreign bodies is a safe and effective option. It can be safely performed at the bedside and in many cases eliminates the need for rigid bronchoscopy.

Airway obstruction presents with dyspnea, cough, hemoptysis, and atelectasis. Removing or decreasing the size of the obstructing lesions improves patient’s symptoms and life quality. Assessing the efficacy and safety of sequential use of cryoextraction and electrocautery in achievement of airway patency using fiberoptic bronchoscopy (FOB). This study was conducted at the Chest Medicine Department, Mansoura University, Egypt and included 22 patients with central airway obstruction (15 males and seven females) with a mean age of 50.5 ± 18.3 years. After etiologic diagnosis of airway obstruction, they were divided into two groups: group A (nonmalignant); eight patients and group B (malignant); 14 patients. All patients were subjected to sequential use of cryoextraction after electrocautery. Operable, unfit patients or patients with extraluminal obstruction were excluded. Clinical, radiological, functional, and bronchoscopic data were evaluated before and after FOB. The improvement in performance scale was highly significant in group B (P < 0.001) and significant in group A (P = 0.001). Spirometric parameters improved in both groups but were highly significant in group B (P < 0.001). Radiological improvement occurred in four out of eight of group A and in three out of 14 of group B. FOB score improved in group B (P = 0.003) and was more significant in group A. The procedure was complicated with atrial fibrillation and hemoptysis in one case and postbronchoscopy hypoxemia in two cases with no deaths. Cryoextraction after electrocautery using FOB are effective, safe, easy, and cheap in achieving airway patency. Egypt J Broncho 2015 9:269–275

Introduction Retrieval of aspirated foreign bodies (FB) by flexible bronchoscopy is challenging. Many types of ancillary equipment, including forceps, grasping claws, snares, balloon-tipped catheters and magnets, have been developed to allow FB extraction using flexible bronchoscopes. The ability to remove a FB by flexible cryoprobe (cryoextraction) depends on the cryoadhesive properties of the retrieved object, which in turn depends on its physical properties. Objectives Our aim was to explore ex vivo on a lung model the cryoadhesive properties of various commonly aspirated objects. Methods The tested FB compromised of nine organic and nine inorganic commonly aspirated objects. An attempt was made to retrieve each object from a lung model by flexible cryoprobe at 5 and 10 s application time and following rinsing by normal saline. Results Whereas most organic objects (for example chicken and fish bones) were retrievable by cryoprobe, most inorganic objects (for example safety pin and paper clip) are not retrievable by cryoadhesion. On the other hand, several inorganic objects (for example dental cup) despite their low water content were cryoadhesive. Conclusion FB retrieval by cryoprobe is feasible for many organic and inorganic aspirated objects. However, the cryoadhesive properties of most inorganic FB and several organic objects is unpredictable, hence, if the nature of the FB is known, an identical object should be used to practice the technique of retrieval in vitro, prior to attempting to perform the procedure in the patient.

Angioleiomyomas are rare airway tumours with potential to cause central airway obstruction or haemoptysis. Methods described to manage them include surgical resection, or rigid bronchoscopy and thermal ablation techniques. We describe a case presenting with central airway obstruction, safely and effectively treated with cryoextraction of the tumour using flexible bronchoscopy.

Acute airway obstruction due to large blood clots is known to cause life threatening hypoxemic respiratory failure which can be challenging to diagnose and manage. Different bronchoscopic modalities like rigid bronchoscopy, forceps, snares and catheters can be used to extract these obstructing blood clots but each of these different methods have their own limitations. We describe a patient with iatrogenic endobronchial bleed with acute airway obstruction due to massive blood clot successfully managed using ‘cryoextraction’. This technique has been described as the treatment of choice for this clinical situation and this case highlights the fact that this technique can save patients from more aggressive invasive procedures.

Cryotherapy is an evolving therapeutic and diagnostic tool used during bronchoscopy. Through rapid freeze-thaw cycles, cryotherapy causes cell death and tissue necrosis or tissue adherence that can be used via the flexible or rigid bronchoscope. This extreme cold can be used through the working channel of the bronchoscope via a specialized cryoprobe or directly with the use of spray cryotherapy. These properties allow for multiple bronchoscopic techniques, each with its own equipment and procedural, safety, and efficacy considerations. Bronchoscopic cryotherapy can be used in a variety of clinical scenarios, including the treatment of malignant and benign central airway obstruction and low-grade airway malignancy, foreign body removal or cryoextraction, endobronchial biopsy, and transbronchial biopsy. The bulk of the experience with bronchoscopic cryotherapy consists of uncontrolled case series of malignant central airway obstruction. There are also controlled data supporting the use of cryoadhesion for endobronchial biopsies, albeit with an increased risk of controllable bleeding. The use of cryoadhesion for transbronchial biopsies is an active area of investigation with limited controlled data. In addition, there are promising future directions using bronchoscopic cryotherapy, including chemosensitizing malignancy with cryotherapy and capitalizing on the synergy between cryotherapy and radiation.

Background: Cryoextraction is a procedure used for the recanalization of obstructed airways caused by visible exophytic endobronchial tumor. Biopsy samples obtained by this technique have been shown to be useful for histological assessment. Objectives: The aim of the present animal study was to systematically evaluate biopsy size, histological quality and bleeding risk after cryobiopsy with new, flexible cryoprobes in comparison with forceps biopsy, serving as the gold standard. Methods: Biopsies were obtained from anesthetized pigs with the flexible bronchoscopy technique, and evaluated histologically with respect to their size and quality. Bleeding frequency, bleeding duration and histological changes in the biopsy bed were also recorded. Results: Cryobiopsies were significantly larger than forceps biopsies. The size of cryobiopsies was dependent on the freezing time. The histological quality of the cryobiopsy specimenswas not impaired by the freezing process, whereas forceps biopsies showed typical crush artifacts. Despite the larger defects left in the tracheobronchial system after cryobiopsy, bleeding frequency and duration were not higher compared to forceps biopsy. Conclusions: Since cryobiopsy sampling is not associated with a higher bleeding risk compared with forceps biopsy, this new biopsy technique offers – in addition to a good specimen quality – a safe and valuable tool with the potential of improving the outcome of diagnostic endoscopy.

Acta Ophthalmol. 2010: 88: 675–680 Abstract. Purpose: To describe and evaluate a cryo-assisted, minimally invasive, anterior approach for orbital tumour surgery. Methods: Retrospective, non-comparative, consecutive, interventional case series of 103 patients who were operated on by the same surgeon for retroocular orbital tumours over the last 16 years. Results: A cryo-assisted, minimally invasive, anterior approach was employed in 63 out of the 103 patients (61.2%). In 37 patients (35.9%), anterior orbitotomy without the use of cryoprobe was employed for biopsy or excision of small, anteriorly located lesions. Lateral orbitotomy was used in three patients (2.9%). In a subgroup of 61 patients with circumscribed lesions (mainly cavernous haemangiomas and schwannomas), cryoextraction was used in 51 (83.6%). None of the procedures required conversion to lateral orbitotomy and there were no intraoperative complications. Conclusion: In contrast to other reports on the treatment of orbital lesions, in the current case series surgery of most solid tumours and many other cystic or infiltrative lesions was achieved here via an anterior, cryo-assisted approach, and thus with minimal trauma to the orbit. This approach warrants more favourable consideration because the combination of the anterior approach with the use of cryoprobe and surgical microscope can yield successful results, even in patients with large or deeply located tumours – obviating in most of them the need for lateral or transcranial orbitotomies with bone flaps.

Background Cavernous hemangioma is the most common benign intraorbital tumor found in adults. Most cavernous hemangiomas are located within the intraconal space. When indicated, complete surgical removal is the only treatment option. Several surgical techniques have been refined over the past decades. We describe our experience over transconjunctival approach in 24 patients with retrobulbar intraconal orbital cavernous hemangiomas. Method This retrospective study includes 24 nonrandomly selected patients who had retrobulbar intraconal tumors. The presumptive preoperative diagnosis was based on magnetic resonance imaging findings. Compression on the optic nerve and/or the globe and proptosis constituted indications for surgery. The tumor was exposed via a transconjunctival route after temporarily disinserting an extraocular muscle depending on the location of the lesion. Results In all patients, the tumor was in touch with the globe and in most cases extended to the orbital apex. All tumors were removed intact. In 14 patients, tumors were extirpated with the aid of a cryoprobe. Visual acuity increased in 8 patients and remained stable in the rest. No serious or permanent complications were observed during or after the operation. Conclusions Retrobulbar intraconal cavernous hemangiomas can be removed successfully through a transconjunctival approach with minimal damage to surrounding tissues. This method is best for tumors whose anterior borders are in contact or very close to the eye even if the posterior border abuts the orbital apex.

Kecova, H. , A. Neaas: Phacoemulsification and Intraocular Lens Implantation: Recent Trends in Cataract Surgery. Acta Vet. Brno 2004, 73: 85-92. This review article summarizes the evolution of cataract surgery techniques and intraocular lens (IOL) implantation. It emphasizes the necessity of appropriate patient selection for the surgery and precise surgical technique for successful outcome of this procedure in dogs. The history of cataract surgery, factors critical for good outcome of the procedure, timing of surgery, preoperative medication, phacoemulsification technique and types of implanted intraocular lenses are discussed. Cataract, phacoemulsification, intraocular lens, dog Cataract (Plate XIII, Fig. 1) is a leading cause of unilateral and more often bilateral blindness in dogs. The only effective mean of its treatment is surgery – extraction of diseased lens (Dziezyc 1990) and its replacement by an artificial intraocular lens (IOL = “intraocular lens”). The opinions on cataract surgery have been changing continually with advancement of the procedure. The success rate of cataract surgery has risen significantly during last decades, especially thanks to development of more precise microsurgical techniques and with introduction of phacoemulsification (Boldy 1988; Dziezyc 1990) and IOL implantation. History of cataract surgery The initiation of “cataract surgery” is mentioned in ancient India as early as 2000 years B.C.; at that time the only attempt was to restore vision by iatrogenic posterior luxation of cataractous lens reclination. Until now reclination remains a method of choice of shamans in some parts of Africa (Ghana). In 1745 Daviel performed the first extracapsular cataract extraction (ECCE). In 1753 Sharp performed the first intracapsular cataract extraction (ICCE) by expression of the nucleus using a thumb. During the 17th, 19th and the beginning of 20th century, the most popular method of cataract extraction was ICCE (different methods of mechanical zonulolysis). After the 2nd World War, the ECCE became more popular with development of better operating microscopes. In 1949 Harold Ridley implanted first posterior chamber IOL in a 60-year-old woman after previous ECCE (Ridley 1952). However, due to a large degree of secondary cataract, glaucoma and anterior chamber inflammation following “primitive” ECCE (without irrigation/aspiration of remaining cortical material), this method was again replaced by intracapsular extraction. In 1957, Barraquer carried out the first ICCE using enzymatic zonulolysis (Barraquer 1958) and in 1961 first cryoextraction was done by Krawicz. In 1970s, with improved irrigation/aspiration devices and capsulotomy techniques, surgeons again returned to ECCE (now with complete removal of remaining cortical material). With the development of ultrasound machines creating low ACTA VET. BRNO 2004, 73: 85–92 Address for correspondence

With the development of mechanically stable cryoprobes, direct endoscopic removal of tissue from the bronchial system with cryotherapy is now possible. Tissue is frozen to the tip of the probe and removed by pulling on the probe together with the fiberscope. This procedure, also referred to as cryoextraction, additionally provides good quality biopsy specimens for histopathological examination. We report here on four patients with different forms of bronchial obstruction, in whom cryoextraction was performed for rapid recanalization. In addition to the immediate effect, the procedure has few complications and is cost-effective. Indications were mucoid impaction, foreign body aspiration, removal of suprastomal granulation tissue prior to decannulation after prolonged mechanical ventilation, and obstruction of the trachea and the main bronchi by a carcinosarcoma. In the latter case, the diagnosis was additionally based on a specimen obtained by cryobiopsy.

Hydatidosis of the orbit has been reported in about 1 % of all cases of hydatid disease. Its prevalence has been reported from 0.3 to 5 % of all the orbital diseases in the literature. Usually the cyst is located in the intraconal space of the orbit. Hydatidosis is common among children and young adults, who usually present with unilateral, progressive axial proptosis of a few months’ duration, associated with pain or discomfort and defective vision. Clinical suspicion and appropriate investigations are important. Serology may be positive but imaging is definitive for diagnosis. Computed tomography scan of orbit is preferred over orbital ultrasonography. Evaluation for associated systemic hydatidosis is mandatory. If neglected, the cyst can assume a very large size and lead to total loss of vision. Surgical excision of the cyst is recommended which is facilitated by aspiration of the fluid from the cyst after the cyst wall has been exposed and cryoextraction. Other modalities include percutaneous aspiration and injection of hypertonic saline and reaspiration and medical management.

A 55-year-old Caucasian woman presented with an orbital cavernous haemangioma superior to the optic nerve in the orbital apex. Preoperative imaging demonstrated a mass involving the superomedial and superolateral quadrants of the posterior orbit. A stereotactic fronto-orbital approach was performed by the neurosurgical team, and cryoextraction of the lesion was accomplished by the ocular plastic surgical team.

Samples of the hexagonal close-packed phase (h.c.p.) of fullerite C 60 with a low (less then 7%) content of more stable face-centered cubic (f.c.c.) phase were synthesized using cryoextraction with n -hexane. X-Ray diffraction analysis and thermogravimetry were applied for characterization of the samples. The role of n -hexane in the formation of the h.c.p. structure is discussed.

A step-by-step description of a surgical technique for episcleral Miragel® buckle removal is reported. After dissection of the conjunctiva and the capsule surrounding the Miragel® element, the extremity of the buckle is pulled out with a cryoprobe. The removal of Miragel® episcleral buckle with the cryoprobe is a safe and effective technique with a low fragmentation rate and a reduction of the surgical risk related to the use of sharp forceps near a possibly weakened sclera. Procedure time seems also to be reduced. [Ophthalmol Surg Lasers 2002;33:237-239]

Purpose The aim of this course is to share our experience with transconjunctival or transcutaneous anterior orbitotomy using surgical microscope and cryoextraction approach for surgery of retroocular orbital tumors. Methods Data regarding the used of this anterior surgical approach to retro-ocular orbital tumors was collected from our case series of 103 patients who, over 16 years, were operated on for retroocular orbital tumors and from a newer case series of 24 patients who, over the last 5 years were operated on for orbital cavernous hemangioma. Results A cryo-assisted, minimally invasive, anterior approach was employed in most patients. During more than 20 years lateral orbitotomy was needed only in 3 patients. The operations with anterior approach lasted 57.9 + 15.0 minutes. In none there was need for transformation into lateral orbitotomy and there were no intra-operative complications. No post operative deterioration of visual acuity was evident. Conclusion In contrast to other reports on treatment of orbital lesions, in our experience, surgery of most solid tumors and of many other cystic or infiltrative lesions can be achieved via an anterior, cryo-assisted approach, and thus with minimal trauma to the orbit. This approach warrants more favorable consideration as it can yield successful results even in cases with large or deeply located tumors. In most cases it obviates the need for extra-ocular muscle disinsersion and lateral or transcranial orbitotomies with bone flaps.

Cryoextraction is a procedure for recanalization of obstructed airways caused by exophytic growing tumors. Biopsy samples obtained with this method can be used for histological diagnosis. The objective of this study was to evaluate the parameters influencing the size of cryobiopsies in an in vitro animal model. New flexible cryoprobes with different diameters were used to extract biopsies from lung tissue. These biopsies were compared with forceps biopsy (gold standard) in terms of the biopsy size. Tissue dependency of the biopsy size was analyzed by comparing biopsies taken from the lung, the liver, and gastric mucosa. The effect of contact pressure exerted by the tip of the cryoprobe on the tissue was analyzed on liver tissue separately. Biopsy size was estimated by measuring the weight and the diameter. Weight and diameter of cryobiopsies correlated positively with longer activation times and larger diameters of the cryoprobe. The weight of the biopsies was tissue dependent: lung < liver < stomach. Only little tissue dependency was found for the biopsy diameter. The biopsy size increased when the probe was pressed on the tissue during cooling. Cryobiopsies can be taken from different tissue types with flexible cryoprobes. The size of the samples depends on tissue type, probe diameter, application time, and pressure exerted by the probe on the tissue. Even the cryoprobe with the smallest diameter can provide larger biopsies than a forceps biopsy in lung. It can be expected that the same parameters influence the sample size of biopsies in vivo.

Vitreoretinal surgery allows the effective removal of soft to moderately dense crystalline lens fragments, using the vitrectomy probe and the ultrasonic fragmentation probe. Hard lenses cannot be removed with these instruments. Previously described techniques for removal of hard lenses include trapping the lens anteriorly with needles, cryoextraction of the lens in an air-filled eye, and manipulation with sodium hyaluronate. These methods are difficult and dangerous in some cases. We used perfluorocarbon liquid to facilitate the safe removal of a surgically luxated hard crystalline lens. Injection of the perfluorocarbon liquid floated the lens off the retinal surface and into the anterior vitreous cavity. In this location, the lens was delivered by using standard extracapsular cataract extraction techniques. This technique allowed removal of the hard crystalline lens with minimal manipulation, and was helpful in the setting of poor media clarity.

BACKGROUND The cavernous haemangioma (cavernoma) is the most common orbital tumour in adults. Various surgical approaches have been described so far. We prefer a transconjunctival approach and analyse herein how our outcomes compare with those of transcutaneous or transosseous approaches. METHODS A retrospective series of 10 cases was analysed with regard to surgical success and complications. RESULTS The tumour could be completely removed in all cases. In one case, preoperative diplopia disappeared after surgery. Another case suffered from postoperative diplopia, which resolved within two months. Two cases developed a long-lasting partial tonic pupil. CONCLUSION A retrobulbar cavernoma can be safely removed via a transconjunctival approach through shrinkage by coagulation and subsequent cryoextraction.

The authors report a case of an infant in whom orbital capillary hemangioma was diagnosed using technetium-99m-labeled red blood cell scintigraphy. The tumor was subsequendy removed by transconjunctival cryoextraction. [Ophthalmic Surg Lasers 1997;28:954-956.]

Patient A 35-years-old female patient with Marfan's syndrome presented with fast progressive reduction of visual acuity (hand movements) of her right eye and lens-related glaucoma on both eyes. On examination, subluxation of the lens and nuclear cataract were seen on both eyes. Diurnal pressure curve showed great fluctuations in pressure with normal IOP in the morning and elevated pressure in the evening. Pressure measurement revealed great fluctuations depending on positioning. Because of cataractous lens in the right eye blocking the visual axis and uncontrollable, phacogenic glaucoma removal of the lens by cryoextraction was necessary. Visual acuity increased to 0.5 and IOP was normal after three weeks. To improve safety of topical medication of lens-related glaucoma in Marfan's syndrome regular measurement of IOP at different times of the day is especially important. Measurement of IOP at different positions seems to be an effective provocation test in cases of phacogenic glaucoma in Marfan's syndrome. Examination of all members of a family with Marfan's syndrome should include regular measurement of IOP at different times of the day. In suspected cases, measurement of IOP at different positions that may provoce IOP-increase could be useful in the early detection of lens-related glaucoma.

This article is dedicated to the life and work (research, medical, educational) of V.V. Shmeleva, professor and Great Patriotic War participant. She was the head of ophthalmology department at the City Clinical Hospital No 67 and promoted the implementation of cataract cryoextraction into clinical practice. As a professor at the Order of Lenin Central Institute of Advanced Medical Training she was engaged in postgraduate training of ophthalmologists. V.V. Shmeleva is the author of Cataract monograph and many scientific articles. She was also the senior secretary of the Vestnik oftal'mologii journal for more than 25 years.

Four patients with relatively large orbital tumors are described. These patients had superomedial rhabdomyosarcoma, inferomedial cavernous hemangioma, lateral primitive neuroectodermal tumor, and superior neurofibroma, respectively. Continuing enlargement and encroachment upon vital ocular structures and suspicion of malignancy warranted surgical intervention. Following exposure of the anterior portions of these tumors, a cryoprobe was used for the complete removal of the mass. Cryoextraction greatly facilitates the excision of well-defined, solid, encapsulated, benign or malignant tumors excluding the lacrimal gland and thus minimizes trauma to adjacent tissues. More importantly, the tumor can be removed intact without capsular rupture and risk of tumor spill-over or hemorrhage. At the histopathological level, the application of a cryoprobe did not alter the microscopic structures of the lesions and did not cause any difficulty for histopathologic interpretation.

In India are approximately 4 million blind people by advanced or mature cataract. For only 10 US$ one patient can be operated in eye camps in the villages by an intracapsular cataract cryoextraction an + 12.00 dptr. aphakia glasses. Also estimated four million people are blind by xerophthalmia. The project is to examine all the babies and little children in the villages and to give them for 2 years each month vitamin-A-medication. On the other side the parents of children suffering from xerophthalmia are instructed to plant vegetables rich in vitamin A. The goal of both projects is to make a cataract and xerophthalmia free zone in Uttar Pradesh, which should spread over the entire country. Both projects are sponsored by Combat Blindness Foundation, P.O. Box 5, 332 Madison Wisconsin 53705 USA, Professor Suresh Chandra, chairman.

The extraction of aspirated foreign bodies can prove challenging at times, requiring even rigid bronchoscopy. Cryotherapy probes have been reported to help with extraction of foreign bodies. We present a case where successful "cryoextraction" was performed on an aspirated chewing gum. The case highlights the fact that this technique is useful to extract all materials that have water content. This technique can be performed through flexible bronchoscopy and can save patients from more aggressive approaches.

Owing to the use of wide-angle observation systems 1,2 the lens can be preserved during the vast majority of pars plana vitrectomies. When such lenses later develop cataracts, they frequently exhibit nuclear sclerosis of such a degree that phacoemulsification would no longer be a safe procedure, even for experienced anterior-segment surgeons who are more and more comfortable emulsifying denser and denser lenses. The vitreous cavity of these eyes is filled with aqueous or silicone oil. This fact renders standard extracapsular cataract extraction with expression of the lens nucleus potentially hazardous because pressure on the globe may lead to collapse of the posterior segment in eyes filled with aqueous or to a localized rupture of the zonule and subsequent formation of a persistent pathway through which silicone oil can pass from the vitreous cavity into the anterior chamber. To avoid such complications, extracapsular cryoextraction, followed by an irrigation-aspiration procedure, has proven

A surgical technique is described for cryoextraction of the inner germinal layer of orbital hydatid cysts. The technique was adopted in two cases. It is simple and effective and causes minimal postoperative reaction or complications. There were no recurrences over a period of 24 and 18 months respectively.

In 123 cases of lens luxation the lens was removed from the vitreous by cryoextraction. It was a success in 119 cases, always intracapsular, and in the majority of cases without or only with a minimal loss of vitreous. A vitrectomy or vitreous suction was never necessary. Evaluating these results, one would advise to employ this procedure early before an advanced vitreous destruction may occur.