Moderne Therapieoptionen der Trikuspidalklappeninsuffizienz

ZusammenfassungDas fehlende Bewusstsein für die klinische Relevanz der Trikuspidalklappeninsuffizienz (TI) sowie die hohe intrahospitale Mortalität führten bis vor Kurzem zu einer späten Patientenvorstellung mit häufig bereits irreversibler rechtsventrikulärer Schädigung. Innovative Therapietechniken, neue Bildgebungstechniken und das bessere hämodynamische Verständnis des rechten Herzens revolutionierten in den letzten Jahren die Behandlungsmöglichkeiten der TI. Die vorliegende Arbeit diskutiert die Bedeutung der Rechtsherzfunktion für die Trikuspidalklappentherapie und stellt moderne interventionelle und minimal-invasive chirurgische Techniken vor. Zudem gibt sie einen Ausblick über die aktuelle Entwicklung der innovativen Transkatheter-Trikuspidalklappenersatz-Systeme.

Endoscopic Lumbar Discectomy Using Side-Viewing Conical Working Tube: An Institutional Experience

Objective The paradigm of surgical therapy for spinal disease especially for lumbar disc herniation (LDH) has gradually shifted from the traditional open surgeries to minimal invasive spinal surgeries. Endoscopic discectomy has been performed widely using various devices and techniques. In this study we present our experience of endoscopic discectomy using a unique device with separate side-viewing channel. Methods Twenty-six patients with LDH treated between March 2015 and April 2018 using the unique conical working tube with separate side-viewing endoscopic channel have been retrospectively analyzed. Their preoperative and postoperative Oswestry Disability Index (ODI) and Macnab scores were used to evaluate the outcome with a mean follow-up of 37.04 months. Results There were 18 males and 8 females with age ranging from 19 to 72 years (mean, 38.4 years). The follow-up ranged from 25 to 60 months with mean of 37.04 months. The mean preoperative ODI score was 72.4, which decreased to a mean of 7.6 and the outcome evaluated by Macnab criteria was 65.3% excellent, 19.2% good, 11.5% fair, and 3.8% poor. One patient underwent second surgery. None of the patients had to change their occupation postoperatively. Complications that occurred were dural tear in one patient and transient foot paresis in one, which improved spontaneously. Conclusion Endoscopic discectomy using conical working tube is a safe and effective technique for lumbar disc prolapse. The long-term results are comparable to the conventional techniques.

Fiber Optic RealShape (FORS) Technology for Endovascular Navigation in Severe Tortuous Vessels

Purpose: The purpose of this study was to describe the use of a wire and catheters embedded with optical fiber (Fiber Optic RealShape [FORS]) to catheterize tortuous target vessels avoiding radiation. Technique: A virtual biplane vies was simulated coupling traditional x-ray system, preoperative CT scan, and FORS system to treat an isolated hypogastric aneurysm. Despite the complex anatomy, catheterization of all target vessels was possible in 12 minutes with 19 seconds of fluoroscopy time (Radiation Exposure 3.8 mGy×cm2). A minimal invasive endovascular exclusion of the aneurysm was achieved through selective coil-embolization of the iliolumbar artery and implantation of balloon expandable covered stents, thus preserving the perfusion of the superior gluteal artery. Conclusion: FORS guidance allowed catheterization of a target vessel with challenging anatomy with a low radiation exposure.

Fractional model of MHD blood flow in a cylindrical tube containing magnetic particles

In recent years, the use of magnetic particles for biomedicine and clinical therapies has gained considerable attention. Unique features of magnetic particles have made it possible to apply them in medical techniques. These techniques not only provide minimal invasive diagnostic tools but also transport medicine within the cell. In recent years, MRI, drug supply to infected tissue, Hyperthermia are more enhanced by the use of magnetic particles. The present study aims to observe heat and mass transport through blood flow containing magnetic particles in a cylindrical tube. Furthermore, the magnetic field is applied vertically to blood flow direction. The Caputo time fractional derivative is used to model the problem. The obtained partial fractional derivatives are solved using Laplace transform and finite Hankel transform. Furthermore, the effect of various physical parameters of our interest has also been observed through various graphs. It has been noticed that the motion of blood and magnetic particles is decelerated when the particle mass parameter and the magnetic parameter are increased. These findings are important for medicine delivery and blood pressure regulation.

A comparative study between endoscopic and microscopic type 1 tympanoplasty

<p><strong>Background:</strong> The current study aims to compare type 1 microscopic tympanoplasty and endoscopic tympanoplasty and draws an evidence-based conclusion regarding the outcome.</p><p><strong>Methods:</strong> This randomized controlled clinical study consists of 60 patients, in which 30 cases allocated as group 1 underwent endoscopic myringoplasty, and 30 cases allocated as group 2 underwent conventional myringoplasty. Tympanic membrane (TM), pure tone audiometry (PTA) evaluated preoperatively and at 3 months postoperative follow-up.</p><p><strong>Results:</strong> Demographic distribution between the groups does not show a significant difference (χ2=6.67, p=0.16). There was no significant difference observed between TM perforation size between the groups (χ2=2.32, p=0.51). For the preoperative AB gap in group 1, the mean ABG was 28.20±2.67 and in group 2 was 28.20±0.80. The postoperative AB gap in group 1, the mean ABG was 17.40±3.01, and in group 2, the mean ABG was 19.67±2.93. The mean difference is 9.13, and it shows a statistically significant difference (p=0.001). The mean duration of surgery in group 1 was 130.83±34.84 and in group 2 was 168.33±16.88 min (p=0.001). In both groups, 90% have intact graft, and in 10% of patients’ residual perforation is present. The mean duration of hospitalization in group1 is 4.10±0.09 days and in group 2 is 4.97±0.18 days.</p><p><strong>Conclusions:</strong> By using the endoscopic addition, minimal invasive tympanoplasty can made possible the similar graft success rate with minimal pain. Endoscopic tympanoplasty uses very less operative time than microscopic surgery.</p><p> </p>

Advances in lung cancer diagnosis and treatment - a review

Lung cancer is the second and third most common cancer in Iceland for females and males, respectively. Although the incidence is declining, lung cancer still has the highest mortality of all cancers in Iceland. Symptoms of lung cancer can be specific and localized to the lungs, but more commonly they are unspecific and result in significant diagnostic delay. Therefore, majority of lung cancer patients are diagnosed with non-localized disease. In recent years, major developments have been made in the diagnosis and treatment of lung cancer. Positive emission scanning (PET) and both transbroncial (EBUS) or transesophageal ultrasound (EUS) biopsy techniques have resulted in improved mediastinal staging of the disease and minimal invasive video-assisted thoracic surgery (VATS) has lowered postoperative complications and shortened hospital stay. Technical developments in radiotherapy have benefitted those patients who are not candidates for curative surgery. Finally, and most importantly, recent advances in targeted chemotherapeutics and development of immunomodulating agents have made individual tailoring of treatment possible. Recent screening-trials with low-dose computed tomography show promising results in lowering mortality. This evidence-based review focuses on the most important developments in the diagnosis and treatment of lung cancer, and includes Icelandic studies in the field.

Short Term Clinical Outcome of Micro Lumbar Discectomy in Tertiary Care Center

Background: Minimal invasive open lumbar microdiscectomy has been associated with good success rate and low morbidity. The present study is aimed to evaluate the clinical outcome of patients who underwent open minimal invasive open lumbar microdiscectomy for herniated intervertebral disc. Materials and Methods: This is a prospective observational hospital based study of prolapsed lumbar intervertebral disc operated in the department of neurosurgery at Nobel Medical College Teaching Hospital, Biratnagar, Nepal from January 2018 to June 2021. All patients of lumbar herniated intervertebral disc subjected for surgery were included. Recurrent prolapsed intervertebral disc, Disc surgery requiring stabilization was excluded from the study. During surgery types of prolapsed intervertebral disc, level and operative time were noted. In the post-operative period Visual Analogue Scale was used to assess the change in severity of pain. Duration of hospital stay and the complications occurred were also noted. Results: The mean age of the study population was was 41.50 (±14.56) years ranging from 20 years to 79 years. The commonest lumbar prolapsed intervertebral disc was at L4-L5 level. The mean operative time was 42 minutes excluding the time for anaesthesia preparation. There was statistically significant difference (p<0.001) in pre-operative and post-operative Visual Analogue Scale. Mean duration of hospital stay was 5.58 (1.87) days. Conclusion: A through workup and surgical planning is associated with better outcome avoiding complications in minimal invasive open micro lumbar discectomy.

Safety and Performance Evaluation of Su2ura Approximation, a New Suturing Device, in Pigs

One of the challenging aspects of minimal invasive surgery (MIS) is intracorporal suturing, which can be significantly time-consuming. Therefore, there is a rising need for devices that can facilitate the suturing procedure in MIS. Su2ura Approximation Device (Su2ura Approximation) is a novel device developed to utilize the insertion of anchors threaded with stitches to allow a single action placement of a suture. The objective of this study was to evaluate the long-term safety and tissue approximation of Su2ura Approximation in comparison to Endo Stitch + Surgidac sutures in female domestic pigs. All incision sites were successfully closed by both methods. Firm consolidation within and around the incision site was noted in several animals in both treatment groups, which corresponded histopathologically to islands of ectopic cartilage or bone spicules within the fibrotic scar. These changes reflect heterotopic ossification that is commonly seen in the healing of abdominal operation sites in pigs. No other abnormal findings were observed throughout the study period. In conclusion, the use of Su2ura Approximation under the present experimental conditions revealed no safety concerns.