Successful Fogarty venous thrombectomy without a skin incision for organized thrombi caused by May-Thurner syndrome

2020 ◽  
Author(s):  
Yuji Nishimoto ◽  
Masanao Toma ◽  
Yuta Matsui ◽  
Rei Fukuhara ◽  
Tadashi Miyamoto ◽  
...  
Keyword(s):  
Skin Incision ◽  
Venous Thrombectomy

Minimally Invasive Repair of Pectus Excavatum (MIRPE) - The Basel Experience

Swiss Surgery ◽  
2003 ◽  
Vol 9 (6) ◽  
pp. 289-295 ◽  
Author(s):  
Haecker ◽  
Bielek ◽  
von Schweinitz
Keyword(s):  
Minimally Invasive ◽  
Pectus Excavatum ◽  
Pulmonary Function Tests ◽  
Preoperative Evaluation ◽  
Skin Incision ◽  
Original Method ◽  
Restrictive Lung Disease ◽  
Cardiac Compression ◽  
Cardiac Evaluation ◽  
Indications For Operation

Purpose: Minimally invasive repair of pectus excavatum (MIRPE) was first reported in 1998 by D. Nuss. This technique has gained wide acceptance during the last 4-5 years. In the meantime, some modifications of the technique have been introduced by different authors. Our retrospective study reports our own experience over the last 36 months and modifications introduced due to a number of complications. Methods: From 3/2000 to 3/2003, 22 patients underwent MIRPE. Patients median age was 15.5 years (10.7 to 20.3 years). Standardised preoperative evaluation included 3D computerised tomography (CT) scan, pulmonary function tests, cardiac evaluation with electrocardiogram and echocardiography, and photo documentation. Indications for operation included at least two of the following: Haller CT index > 3.2, restrictive lung disease, cardiac compression, progression of the deformity and severe psychological alterations. Results: In 22 patients (2 girls, 20 boys) undergoing MIRPE procedure, a single bar was used in 21 patients and two bars in one boy. Lateral stabilisers were fixed with non resorbable sutures on both sides. Overall, postoperative complications occurred in six patients (27.3%). In two patients (9.1%) a redo-procedure was necessary due to bar displacement. An additional median skin incision was performed in two patients to elevate the sternum. Pneumothorax or hematothorax in two patients resulted in routine use of a chest tube on both sides. Long-term favourable results were noted in all patients. Conclusions: The MIRPE procedure is an effective method with elegant cosmetic results. Modifications of the original method help to decrease the complication rate and to accelerate acquirement of expertise.

Thrombin Generation Measured Ex Vivo Following Microvasculor Injury Is Increased in SLE Patients with Antiphospholipid-protein Antibodies

1997 ◽  
Vol 78 (04) ◽  
pp. 1173-1177 ◽  
Author(s):  
Jacek Musiał ◽  
Jakub Swadźba ◽  
Miłosz Jankowski ◽  
Marek Grzywacz ◽  
Stanisława Bazan-Socha ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Thrombin Generation ◽  
Ex Vivo ◽  
Skin Incision ◽  
Anticardiolipin Antibodies ◽  
Small Blood Vessel ◽  
Anionic Phospholipids ◽  
Increased Risk ◽  
High Concentrations

SummaryAntiphospholipid-protein antibodies (APA) include lupus-type anticoagulant (LA) and antibodies recognizing complexes of anionic phospholipids (e.g. cardiolipin) and proteins (e.g. prothrombin and (β2-glycoprotein I). The presence of APA is associated with an increased risk of both arterial and venous thrombosis. However, the pathogenic mechanism leading to thrombosis in patients with APA remains unclear. We studied 32 patients with systemic lupus erythematosus (SLE) who were divided into two groups depending on the presence (n = 19) or absence (n = 13) of APA. Healthy volunteers (n = 12) matched by age and sex served as controls. In all subjects LA and IgG class anticardiolipin antibodies (ACA) were determined. Thrombin generation was monitored ex vivo measuring fibrinopeptide A (FPA) and prothrombin fragment F1 + 2 (F1 + 2) in blood emerging from a skin microvasculature injury, collected at 30 second intervals. In subjects with antiphospholipid antibodies mean FPA and F1 + 2 concentrations were signiF1cantly higher at most blood sampling times than in controls. In some SLE patients with APA the process of thrombin generation was clearly disturbed and very high concentrations of F1brinopeptide A were detected already in the F1rst samples collected. Two minutes after skin incision SLE patients without APA produced slightly more FPA, but not F1 + 2, as compared to healthy subjects. Mathematical model applied to analyze the thrombin generation kinetics revealed that APA patients generated signiF1cantly greater amounts of thrombin than healthy controls (p = 0.02 for either marker). In contrast, in the same patients generation of thrombin in recalciF1ed plasma in vitro was delayed pointing to the role of endothelium in the phenomenon studied. In summary, these data show for the F1rst time that in SLE patients with antiphospholipid-protein antibodies thrombin generation after small blood vessel injury is markedly increased. Enhanced thrombin generation might explain thrombotic tendency observed in these patients.

Prompt Return to Work after Bilateral Transforaminal Full-endoscopic Lateral Recess Decompression under Local Anesthesia: A Case Report

2020 ◽  
Author(s):  
Kosuke Sugiura ◽  
Kazuta Yamashita ◽  
Hiroaki Manabe ◽  
Yoshihiro Ishihama ◽  
Fumitake Tezuka ◽  
...  
Keyword(s):  
Return To Work ◽  
Local Anesthesia ◽  
Skin Incision ◽  
Leg Pain ◽  
Lateral Recess ◽  
Canal Stenosis ◽  
Transforaminal Approach ◽  
Lateral Recess Stenosis ◽  
Lumbar Spinal ◽  
Herniated Nucleus Pulposus

AbstractTransforaminal full-endoscopic lumbar diskectomy became established early in the 21st century. It can be performed under local anesthesia and requires only an 8-mm skin incision, making it the least invasive disk surgery method available. The full-endoscopic technique has recently been used to treat lumbar spinal canal stenosis. Here, we describe the outcome of simultaneous bilateral decompression of lumbar lateral recess stenosis via a transforaminal approach under local anesthesia in a 60-year-old man. The patient presented with a complaint of bilateral leg pain that was preventing him from standing and walking, and he had been able to continue his work as a dentist by treating patients while seated. Imaging studies revealed bilateral lumbar lateral recess stenosis with central herniated nucleus pulposus at L4/5. We performed simultaneous bilateral transforaminal full-endoscopic lumbar lateral recess decompression (TE-LRD) under local anesthesia. Both decompression and diskectomy were successfully completed without complications. Five days after TE-LRD, he was able to return to work, and 3 months after the surgery, he resumed playing golf. Full-endoscopic surgery under local anesthesia can be very effective in patients who need to return to work as soon as possible after surgery.

Impact of C-shaped skin incision on surgical operability in the retrosigmoid approach: when a good start is half of the job

2021 ◽  
Author(s):  
Filippo Gagliardi ◽  
Martina Piloni ◽  
Silvia Snider ◽  
Francesca Roncelli ◽  
Edoardo Pompeo ◽  
...  
Keyword(s):  
Skin Incision ◽  
Retrosigmoid Approach

scholarly journals Laparoscopic surgical management of a mature presacral teratoma: a case report

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Liming Wang ◽  
Yasumitsu Hirano ◽  
Toshimasa Ishii ◽  
Hiroka Kondo ◽  
Kiyoka Hara ◽  
...  
Keyword(s):  
Laparoscopic Resection ◽  
Mature Teratoma ◽  
Skin Incision ◽  
Histopathological Diagnosis ◽  
Tailgut Cyst ◽  
Resonance Imaging ◽  
Presumptive Diagnosis ◽  
Case Presentation ◽  
Contrast Enhanced ◽  
Magnetic Resonance Imaging Mri

Abstract Background Mature presacral (retrorectal) teratoma is very rare. We report a case in which a mature retrorectal teratoma in an adult was successfully treated with laparoscopic surgery. Case presentation A 44-year-old woman was diagnosed with a presacral tumor during a physical examination. Endoscopic ultrasonography (EUS) revealed a multilocular cystic lesion; the lesion was on the left side of the posterior rectum and measured approximately 30 mm in diameter on both contrast-enhanced pelvic computed tomography (CT) and magnetic resonance imaging (MRI). The presumptive diagnosis was tailgut cyst. However, the histopathological diagnosis after laparoscopic resection was mature teratoma. It is still difficult to preoperatively diagnose mature retrorectal teratomas. Conclusions Laparoscopic resection of mature retrorectal teratomas is a feasible and promising method that is less invasive and can be adapted without extending the skin incision.

scholarly journals Analysis of Dynamic Changes in Cognitive Workload During Cardiac Surgery Perfusionists′ Interactions With the Cardiopulmonary Bypass Pump

2020 ◽  
pp. 001872082097629
Author(s):  
Lauren R. Kennedy-Metz ◽  
Roger D. Dias ◽  
Rithy Srey ◽  
Geoffrey C. Rance ◽  
Heather M. Conboy ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Heart Surgery ◽  
Time Windows ◽  
Open Heart Surgery ◽  
Real Life ◽  
Skin Incision ◽  
Cognitive Workload ◽  
Dynamic Changes ◽  
Pump Operation

Objective This novel preliminary study sought to capture dynamic changes in heart rate variability (HRV) as a proxy for cognitive workload among perfusionists while operating the cardiopulmonary bypass (CPB) pump during real-life cardiac surgery. Background Estimations of operators’ cognitive workload states in naturalistic settings have been derived using noninvasive psychophysiological measures. Effective CPB pump operation by perfusionists is critical in maintaining the patient’s homeostasis during open-heart surgery. Investigation into dynamic cognitive workload fluctuations, and their relationship with performance, is lacking in the literature. Method HRV and self-reported cognitive workload were collected from three Board-certified cardiac perfusionists ( N = 23 cases). Five HRV components were analyzed in consecutive nonoverlapping 1-min windows from skin incision through sternal closure. Cases were annotated according to predetermined phases: prebypass, three phases during bypass, and postbypass. Values from all 1min time windows within each phase were averaged. Results Cognitive workload was at its highest during the time between initiating bypass and clamping the aorta (preclamp phase during bypass), and decreased over the course of the bypass period. Conclusion We identified dynamic, temporal fluctuations in HRV among perfusionists during cardiac surgery corresponding to subjective reports of cognitive workload. Not only does cognitive workload differ for perfusionists during bypass compared with pre- and postbypass phases, but differences in HRV were also detected within the three bypass phases. Application These preliminary findings suggest the preclamp phase of CPB pump interaction corresponds to higher cognitive workload, which may point to an area warranting further exploration using passive measurement.

Endoscopy-assisted removal of periorbital inclusion cysts in children

2011 ◽  
Vol 7 (2) ◽  
pp. 161-164 ◽  
Author(s):  
George Chater-Cure ◽  
Caitlin Hoffman ◽  
Jared Knopman ◽  
Samuel Rhee ◽  
Mark M. Souweidane
Keyword(s):  
High Speed ◽  
Complete Removal ◽  
Skin Incision ◽  
Clinical Findings ◽  
Complete Excision ◽  
Alternative Approach ◽  
Cyst Recurrence ◽  
Scalp Incision ◽  
Access Technique

Object Surgical treatment for periorbital inclusion cysts typically involves a brow, pterional, or partial bicoronal scalp incision for sufficient exposure. The authors have recently employed an endoscopy-assisted technique as an alternative approach intended to minimize the length of the skin incision and avoid scarring in the brow. Methods Children having typical clinical findings of a dermoid cyst located on the hairless forehead were selected to undergo endoscopy-assisted cyst removal. For suspected intradiploic lesions, MR imaging was used to assess osseous involvement. After induction of general anesthesia, a 1–2-cm curvilinear incision was made posterior to the hairline. A 30°-angled endoscope (4 mm) was then used for dissection in the subgaleal compartment. Subgaleal dissection was followed by a circumferential periosteal incision in which the authors used an angled needle-tip unipolar cautery. For lesions within the diploe, a high-speed air drill was used to expose the lesion. Complete removal was accomplished with curettage of either the skull or dural surface. Results Eight patients (5–33 months of age) underwent outpatient endoscopic resection. Seven cysts were extracranial, and 1 cyst extended through the inner table. In all patients complete excision of the cyst was achieved. There was negligible blood loss, no dural violation, and no postoperative infection. There have been no recurrences at a mean follow-up of 15 months. Conclusions Endoscopy-assisted resection of inclusion cysts of the scalp and calvaria is a safe and effective surgical approach. The technique results in negligible incisions with less apparent scarring compared with previously described incisions. This limited-access technique does not appear to be associated with a higher incidence of cyst recurrence.

scholarly journals 511 Choosing the optimal skin incision for cesarean delivery in patients with morbid obesity

2021 ◽  
Vol 224 (2) ◽  
pp. S322-S323
Author(s):  
Karl E. Seif ◽  
Katherine Goetzinger ◽  
Ozhan Turan
Keyword(s):  
Morbid Obesity ◽  
Cesarean Delivery ◽  
Skin Incision

scholarly journals Surgery out of office hours for type A aortic dissection: does night-time and weekend surgery worsen outcome?

2020 ◽  
Vol 31 (6) ◽  
pp. 806-812
Author(s):  
Simone Gasser ◽  
Lukas Stastny ◽  
Markus Kofler ◽  
Vitalijs Zujs ◽  
Christoph Krapf ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Emergency Surgery ◽  
Odds Ratio ◽  
Surgical Repair ◽  
Type A ◽  
Skin Incision ◽  
Night Time ◽  
Femoral Access ◽  
Type A Aortic Dissection ◽  
Malperfusion Syndrome

Abstract OBJECTIVES Immediate surgical repair for type A aortic dissection is gold standard and at most centres is performed by the surgeon on call during night-time and weekends. The objective was to evaluate whether emergency surgery during night-time or weekends has an influence on 30-day mortality. METHODS In 319 patients undergoing surgery for type A aortic dissection, skin incision was documented. Patients were divided into 2 groups according to the time point of skin incision (05:00 a.m. to 07:00 p.m. = daytime group; 07:01 p.m. to 04:59 a.m. = night-time group). We also noted whether their surgeries were started on weekdays (Monday 00:00 to Friday 23:59) or weekends (Saturday 00:00 to Sunday 23:59). RESULTS The median age was 61 years (interquartile range 49–70) and 69.6% (n = 222) were male. Almost 50% (n = 149) of patients presented in a critical preoperative state. Forty-one percent of patients (n = 131) underwent night-time surgery. There were no differences in baseline data, time from onset of symptoms to surgery or surgical treatment between groups, except from preferred femoral access for arterial cannulation during night-time. Advanced age [odds ratio 1.042, 95% confidence interval (CI) 1.014–1.070], preoperative malperfusion syndrome (odds ratio 2.542, 95% CI 1.279–5.051) and preoperative tamponade (odds ratio 2.562, 95% CI 1.215–5.404) emerged as risk factors for 30-day mortality. Night-time or weekend surgery did not have any impact on 30-day mortality when covariates were considered. CONCLUSIONS Based on the natural course of the disease and our results, surgery for type A aortic dissection should be performed as an emergency surgery regardless of time and day.

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