Intrauterine myelomeningocele repair Postnatal results and follow-up at 3.5 years of age — initial experience from a single reference service in Brazil

Object Myelomeningocele (MMC) is characterized by a defect in caudal neurulation and appears at birth with a constellation of neuroanatomical abnormalities, including Chiari malformation Type II. The authors investigated the effects of antenatal versus postnatal repair of MMC through a quantitative analysis of morphometric changes in the posterior fossa (PF). Methods The authors retrospectively reviewed the records of 29 patients who underwent in utero MMC repair, 24 patients who underwent postnatal repair, and 114 fetal and pediatric controls. Tonsillar displacement, cerebellum length, pons length, clivus-supraocciput (CSO) angle, and PF area were compared in antenatal and postnatal MMC repair groups as well as in controls without neural tube defects by using t-tests and correlation coefficients. Results Initially, the in utero CSO angle was significantly more acute in all patients with MMC—prenatally and postnatally repaired—as compared with controls (57.8° vs 75.4°, p < 0.001); however, the angle rapidly changed and became similar to that in controls between 30 and 31 weeks' gestation to approximately 80°, with antenatal repair having little effect. Postnatally, the CSO angle decreased in controls (R = −0.58) and in the antenatal repair group (R = −0.17). The cerebellum and pons length demonstrated no significant differences in any group. Overall, tonsil descent was corrected in the antenatal repair group as compared with postnatal repair (p < 0.001), and the PF area increased in all 3 groups in utero. Growth was less rapid in patients with MMC compared with controls, but this was corrected by antenatal repair (p = 0.015). Conclusions Myelomeningocele was associated with tonsillar herniation and a smaller PF than in control fetuses. Antenatal surgical repair corrected both abnormalities. The CSO angle began significantly more acutely in patients with MMC, but normalized with development regardless of when surgery was performed. Determining the clinical effects of antenatal repair requires further follow-up.

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Endoscopic transcervical odontoidectomy for pediatric basilar invagination and cranial settling

Journal of Neurosurgery Pediatrics ◽

10.3171/ped/2008/1/4/337 ◽

2008 ◽

Vol 1 (4) ◽

pp. 337-342 ◽

Cited By ~ 42

Author(s):

Matthew J. McGirt ◽

Frank J. Attenello ◽

Daniel M. Sciubba ◽

Ziya L. Gokaslan ◽

Jean-Paul Wolinsky

Keyword(s):

Pediatric Patients ◽

Pediatric Population ◽

Tube Feeding ◽

Basilar Invagination ◽

Craniocervical Junction ◽

Consecutive Series ◽

Initial Experience ◽

Prolonged Intubation ◽

Alternative Approach

✓ Pediatric basilar invagination and cranial settling have traditionally been approached through a transoral–transpharyngeal route with or without extended maxillotomy or mandibulotomy for resection of the anterior portion of C-1 and the odontoid. The authors hypothesize that application of a recently described endoscopic transcervical odontoidectomy (ETO) technique would allow an alternative approach for the treatment of ventral pathological entities at the craniocervical junction in pediatric patients. The authors performed ETO in a consecutive series of pediatric patients presenting with myelopathy or bulbar dysfunction resulting from basilar invagination or cranial settling. All clinical, radiographic, surgical, and follow-up data were prospectively collected. The initial experience with ETO in the pediatric population is analyzed and outcomes are reported. Three patients required ETO for basilar invagination and 1 required ETO with anterior C-1 arch and distal clivus resection for cranial settling. All patients presented with myelopathy. One patient was wheelchair bound with severe quadriparesis. The mean age was 14 ± 3 years (mean ± standard deviation [SD]) in the 2 male and 2 female patients. The ETO and posterior fusion were performed as a 2-stage procedure in 2 (50%) and as a single-stage procedure in 2 (50%) cases. Prolonged intubation or postoperative placement of a gastrostomy tube was not needed in any case. The postoperative hospitalization lasted 9 ± 4 days (mean ± SD). At last follow-up (mean 5 months), head and neck pain had resolved and motor strength had improved or stabilized in all cases. All 4 children were independently functioning and ambulatory at the last follow-up. In the authors' initial experience, ETO has allowed ventral brainstem decompression without the need for prolonged intubation, worsening dysphagia requiring enteral tube feeding, or prolonged hospitalization, and has resulted in cosmetically appealing results. The ETO technique allows an alternative approach for the treatment of ventral pathological entities at the craniocervical junction in pediatric patients.

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Double transcatheter balloon-expandable valve implantation for severe valve dysfunction in high-risk patients: initial experience

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa142 ◽

2020 ◽

Vol 31 (4) ◽

pp. 461-466

Author(s):

João Bosco Breckenfeld Bastos Filho ◽

Roney Orismar Sampaio ◽

Felipe Reale Cividanes ◽

Vitor Emer Egypto Rosa ◽

Leonardo Paim Nicolau da Costa ◽

...

Keyword(s):

Academic Research ◽

Functional Class ◽

Heart Valve Disease ◽

Initial Experience ◽

Valve Dysfunction ◽

Nyha Functional Class ◽

Number Of Patients ◽

Research Consortium ◽

Mitral Bioprosthesis

Abstract OBJECTIVES Concomitant valvular heart valve disease is a frequent finding, with higher morbidity and mortality among patients undergoing redo surgical procedures. Our goal was to report our initial experience with combined transcatheter Inovare bioprosthesis implants for severe valve dysfunction. METHODS Among 300 transcatheter procedures, a total of 6 patients had concurrent simultaneous transcatheter bioprosthesis implants for severe mitral bioprosthesis failure (valve-in-valve), with a second valve procedure that included native aortic (n = 2) or degenerated bioprostheses in the aortic position (n = 4). During the procedures, all patients were treated with a balloon-expandable Inovare transcatheter valve, using the transapical approach. RESULTS Patients were highly symptomatic [New York Heart Association (NYHA) functional class IV: 100%], with a mean age of 62 ± 5 years, yielding a mean European System for Cardiac Operative Risk II (EuroSCORE II) of 24.0 ± 10.1%. There was a mean of 1.6 ± 0.4 prior valve operations/patient, with a median time from prior mitral bioprosthesis surgery of 13.0 (9.2–20.0) years. Device success was 100% according to the Mitral Valve Academic Research Consortium and the Valve Academic Research Consortium-2 criteria. During the hospital stay, only 1 patient required dialysis, and the median intensive care unit and hospital lengths of stay were 5.0 (3.2–6.7) days and 16.0 (12.2–21.2) days, respectively. No deaths occurred at 30 days; at a median follow-up of 287 (194–437) days, 1 patient died of a non-cardiac cause and the rest of patients were in NYHA functional class I or II, with normofunctioning bioprostheses. CONCLUSIONS Transcatheter double valve interventions using the Inovare bioprosthesis in this initial series were shown to be a reasonable alternative to redo surgical operations. The short- and mid-term clinical and echocardiographic outcomes demonstrate promising results, although future studies with a larger number of patients and longer follow-up are warranted.

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Breastfeeding and the anthropometric profile of children with sickle cell anemia receiving follow-up in a newborn screening reference service

Revista Paulista de Pediatria (English Edition) ◽

10.1016/s2359-3482(15)30045-2 ◽

2015 ◽

Vol 33 (2) ◽

pp. 154-159

Author(s):

Zeni Drubi Nogueira ◽

Ney Boa-Sorte ◽

Maria Efigênia de Queiroz Leite ◽

Márcia Miyuki Kiya ◽

Tatiana Amorim ◽

...

Keyword(s):

Newborn Screening ◽

Sickle Cell ◽

Sickle Cell Anemia ◽

Reference Service ◽

Anthropometric Profile

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Single-Center Experience of Cerecyte Coils in the Treatment of Intracranial Aneurysms: Initial Experience and Early Follow-Up Results

American Journal of Neuroradiology ◽

10.3174/ajnr.a0736 ◽

2007 ◽

Vol 29 (1) ◽

pp. 53-56 ◽

Cited By ~ 24

Author(s):

D. Butteriss ◽

A. Gholkar ◽

D. Mitra ◽

D. Birchall ◽

V. Jayakrishnan

Keyword(s):

Intracranial Aneurysms ◽

Initial Experience ◽

Single Center ◽

Single Center Experience

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Radial Arterial Access for Hepatobiliary and Gastrointestinal Arterial Interventions: Initial Experience

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0038-1641676 ◽

2018 ◽

Vol 02 (01) ◽

pp. 013-016

Author(s):

Vamsidhar Rachapalli ◽

Sriram Jaganathan ◽

Mohnish Palaniswamy ◽

Deepashree Tiruchunapalli ◽

Sridhar Chappidi ◽

...

Keyword(s):

Radial Artery ◽

Indian Subcontinent ◽

Initial Experience ◽

Technical Success ◽

Arterial Access ◽

Selective Catheterization ◽

Visceral Arteries ◽

Femoral Arterial Access ◽

Peripheral Arterial

Abstract Introduction Radial artery access is being more commonly used for visceral and peripheral arterial interventions. Its use in the Indian subcontinent is not well reported. The aim of this study was to report outcomes of radial arterial access during arterial interventions of the hepatobiliary and gastrointestinal system. Methods In this retrospective study, patients who underwent radial artery access for hepatobiliary and gastrointestinal interventions from January 2015 to June 2017 were identified from the interventional database. Complications related to radial artery access and catheter placement in the visceral arteries, procedural modifications, and conversion to the standard femoral arterial access were analyzed. Results Total 32 patients were included in this study. Total 46 procedures (radial artery access) were performed. Nine patients had radial artery access on more than two occasions; 95% of the procedures involved interventional oncologic treatments. Patients were followed up for an average of 4 months following radial arterial access. Technical success was 98.7%. One patient developed radial artery spasm, and the access was abandoned. This patient subsequently underwent brachial arterial access. No patient required conversion to a femoral arterial access. No other complications were encountered during the follow-up. Compared with femoral arterial access, radial arterial access required longer catheters were needed for super selective catheterization of the visceral arteries. Conclusion Radial arterial access for arterial interventions in the hepatobiliary and gastrointestinal systems was technically feasible with no significant complications. Long catheters are required for selective catheterization of the visceral arteries with this approach.

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Transoral Incisionless Fundoplication: Initial Experience in Patients Referred to an Integrated Academic Institution

The American Surgeon ◽

10.1177/000313481107701026 ◽

2011 ◽

Vol 77 (10) ◽

pp. 1386-1389 ◽

Cited By ~ 2

Author(s):

Allan Nguyen ◽

Thomas Vo ◽

Xuan-Mai T. Nguyen ◽

Brian R. Smith ◽

Kevin M. Reavis

Keyword(s):

Gastric Surgery ◽

Late Complications ◽

Initial Experience ◽

Additional Time ◽

Transoral Incisionless Fundoplication ◽

Working Space ◽

Symptom Scores ◽

The Mean ◽

New Treatment

Transoral incisionless fundoplication is a new treatment for patients with gastroesophageal reflux disease. We present our initial experience with 10 patients undergoing this procedure with varying past surgical histories. All procedures were performed under general nasotracheal anesthesia. RAND-36 and Visual Analog Scale symptom scores were collected at pre and postoperative appointments for a mean of 9.2 months. The mean procedure time was 68 minutes. There were no intraoperative or postoperative complications. Patients with prior pancreaticoduodenectomy had observed reduced working space due to prior distal gastrectomy and required additional insufflation due to no pyloric resistance to insufflation of the small bowel. The patient with prior fundoplication required additional time and force for fastener penetration of the resultant scar from the partially disrupted fundoplication. All patients were discharged within 23 hours of the procedure. Throughout the follow-up period, patients reported gradual changes in medication requirements and symptom scores. There were no late complications. Transoral incisionless fundoplication is technically safe in well-selected patients including those with prior esophageal and gastric surgery.

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