scholarly journals An Indigenous Method of Securing Ventriculoperitoneal Shunt Tube in Peritoneal Cavity

2021 ◽  
Author(s):  
Samir Kumar Kalra ◽  
Krishna Shah ◽  
Sneyhil Tyagi ◽  
Suviraj John ◽  
Rajesh Acharya
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Operation Time ◽  
Complication Rates ◽  
Effective Technique ◽  
Common Procedure ◽  
Shunt System ◽  
Shunt Tube ◽  
Csf Diversion ◽  
Median Operation Time

Abstract Introduction Ventriculoperitoneal shunt (VPS) is the most common procedure used for cerebrospinal fluid (CSF) diversion in hydrocephalus. Over the years, many technical, procedural, and instrument-related advancements have taken place which have reduced the associated complication rates. Shunt block is a very common complication irrespective of the shunt system used. The abdominal end of the shunt tube gets blocked usually due to plugging of omentum onto the shunt catheter. We describe a technique of catheter fixation and placement under vision coupled with omentopexy done laparoscopically to prevent this complication. Materials and Methods This technique was used in 23 patients (11 female, 12 male; range 16–73 years) afflicted with hydrocephalus from June 2016 and December 2019 after obtaining an informed consent, and the outcomes were noted in terms of shunt patency, complications, if any, and the need for revision. Results The median operation time was 90 minutes (range 35–160 minutes). All shunt catheters were still functional after a mean follow-up of 16.5 months (range 1–34 months) and none required revision. Conclusion Laparoscopic placement of shunt tube along with omental folding is a safe and effective technique for salvaging the abdominal end of VPS and may be helpful in reducing shunt blockage.

Plasmakinetic Vapor Enucleation of the Prostate with Button Electrode versus Plasmakinetic Resection of the Prostate for Benign Prostatic Enlargement >90 ml: Perioperative and 3-Month Follow-Up Results of a Prospective, Randomized Clinical Trial

2015 ◽  
Vol 95 (3) ◽  
pp. 260-264 ◽  
Author(s):  
Keqin Zhang ◽  
Dingqi Sun ◽  
Hui Zhang ◽  
Qingwei Cao ◽  
Qiang Fu
Keyword(s):  
Urine Volume ◽  
Operation Time ◽  
Urinary Flow ◽  
Benign Prostatic Enlargement ◽  
Effective Technique ◽  
Prostatic Enlargement ◽  
Postvoid Residual Urine ◽  
Maximum Urinary Flow

Objective: To evaluate plasmakinetic vapor enucleation of the prostate (PVEP) with button electrode and plasmakinetic resection of the prostate (PKRP) in patients with urinary symptoms due to benign prostatic enlargement (BPE) >90 ml. Methods: A total of 112 patients with symptomatic BPE were randomly assigned to either PKRP or PVEP prospectively from August 2012 to May 2014 in our department. Perioperative and postoperative data were investigated during a 3-month follow-up. Results: PVEP was significantly superior to PKRP in terms of operation time (63.9 ± 7.7 vs. 78.1 ± 13.6 min, p < 0.001), hemoglobin loss (1.18 ± 0.30 vs. 1.63 ± 0.38 g/dl, p < 0.001), serum sodium decrease (2.9 ± 0.7 vs. 4.3 ± 0.8 mmol/l, p < 0.001), catheterization duration (49.3 ± 12.2 vs. 78.1 ± 14.8 h, p < 0.001) and hospital stay (100.2 ± 28.3 vs. 116.0 ± 29.2 h, p = 0.004). There were no statistical differences in blood transfusion between the two groups. In addition, there were no statistical differences in maximum urinary flow rate, International Prostate Symptom Score, postvoid residual urine volume, quality-of-life score, transient incontinence, and urethral stricture at 3 months postoperatively. Conclusions: PVEP with button electrode is an equally effective technique for treatment of large BPE with PKRP, with more safety and faster recovery. It may become the superior alternative to PKRP for patients with large BPE.

Clinical complications and outcomes of angiographically negative subarachnoid hemorrhage

Neurology ◽  
2019 ◽  
Vol 92 (20) ◽  
pp. e2385-e2394 ◽  
Author(s):  
Cody L. Nesvick ◽  
Soliman Oushy ◽  
Lorenzo Rinaldo ◽  
Eelco F. Wijdicks ◽  
Giuseppe Lanzino ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Confidence Interval ◽  
Ventriculoperitoneal Shunt ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Delayed Cerebral Ischemia ◽  
Tertiary Referral Center ◽  
Short And Long Term ◽  
Csf Diversion

ObjectiveTo define the in-hospital course, complications, short- and long-term functional outcomes of patients with angiographically negative subarachnoid hemorrhage (anSAH), particularly those with aneurysmal-pattern anSAH (aanSAH).MethodsRetrospective cohort study of patients with aneurysmal subarachnoid hemorrhage (aSAH), aanSAH, and perimesencephalic-pattern anSAH (panSAH) treated at a single tertiary referral center between January 2006 and April 2018. Ninety-nine patients with anSAH (33 aanSAH and 66 panSAH) and 464 patients with aSAH were included in this study. Outcomes included symptomatic hydrocephalus requiring CSF drainage, need for ventriculoperitoneal shunt, radiographic vasospasm, delayed cerebral ischemia (DCI), radiographic infarction, disability level within 1 year of ictus, and at last clinical follow-up as defined by the modified Rankin Scale.ResultsPatients with aanSAH and panSAH had similar rates of DCI and radiologic infarction, and patients with aanSAH had significantly lower rates compared to aSAH (p ≤ 0.018). Patients with aanSAH were more likely than those with panSAH to require temporary CSF diversion and ventriculoperitoneal shunt (p ≤ 0.03), with similar rates to those seen in aSAH. Only one patient with anSAH died in the hospital. Compared to those with aSAH, patients with aanSAH were significantly less likely to have a poor functional outcome within 1 year of ictus (odds ratio 0.26, 95% confidence interval 0.090–0.75) and at last follow-up (hazard ratio 0.30, 95% confidence interval 0.19–0.49, p = 0.002).ConclusionsDCI is very uncommon in anSAH, but patients with aanSAH have a similar need for short- and long-term CSF diversion to patients with aSAH. Nevertheless, patients with aanSAH have significantly better short- and long-term outcomes.

scholarly journals Ultrasound-Guided Thermal Ablation of Bethesda IV Thyroid Nodules: A Pilot Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Xinyang Li ◽  
Yu Lan ◽  
Nan Li ◽  
Lin Yan ◽  
Jing Xiao ◽  
...  
Keyword(s):  
Blood Loss ◽  
Thermal Ablation ◽  
Thyroid Nodules ◽  
Metastatic Lymph Node ◽  
Operation Time ◽  
Distant Metastases ◽  
Complication Rates ◽  
Incision Length ◽  
Hospitalization Time

ObjectiveThe purpose of our study was to evaluate the effectiveness of thermal ablation (TA) for Bethesda IV thyroid nodules, and to compare TA and surgery in terms of treatment outcomes, complications, and costs.MethodThis study was approved by the local ethics committee. From January 2017 to December 2019, 30 patients elected TA and 31 patients elected surgery for treatment of Bethesda IV thyroid nodules. Demographics information and conventional ultrasound before treatment for each patient was obtained. For the TA group, the ablation extent was 3 mm beyond the edge of the tumor to prevent marginal residual and recurrence. Patients were followed up at 1, 3, and 6 months after intervention, and every 6 months thereafter. Postoperative complications, operation time, hospitalization time, blood loss, and incision length were recorded.ResultsIn the TA group, the volume reduction ratio (VRR) was 94.63 ± 8.99% (range:76%-100%) at the final follow-up. The mean follow-up time was 16.4 ± 5.2months (range:12–24 months). No recurrences, no metastatic lymph node, and no distant metastases were detected during follow-up. The TA group had fewer complications, shorter operation time, smaller incision length, less blood loss, shorter hospitalization time, and lower treatment costs compared to the surgery group (all P&lt;0.001).ConclusionsTA is technically feasible for the complete destruction of Bethesda IV thyroid nodules, and also safe and effective during the follow-up period, with high VRR and low complication rates, especially in patients who were ineligible for or refused surgery.

Transcranial resection of tumors of the paranasal sinuses and nasal cavity

1989 ◽  
Vol 71 (1) ◽  
pp. 10-15 ◽  
Author(s):  
J. Bob Blacklock ◽  
Randal S. Weber ◽  
Ya-Yen Lee ◽  
Helmuth Goepfert
Keyword(s):  
Nasal Cavity ◽  
Paranasal Sinuses ◽  
Free Tissue Transfer ◽  
Complication Rates ◽  
Effective Technique ◽  
Content Type ◽  
The Face ◽  
Variable Success ◽  
Fine Print

✓ Combined cranial and facial procedures for resection of malignancies of the paranasal sinuses and nasal cavity have been used with variable success and complication rates in the last 25 years. A series of nine patients undergoing 10 exclusively transcranial procedures for these tumors is presented, and an effective technique for reconstruction without free tissue transfer is described. The patients in this series suffered no major complications, and all have remained free of disease during the short follow-up period. The technique described in this report offers the advantage of wide exposure, symmetrical approach to the superstructures of the face and orbits, the potential for resection of a large portion of the anterior cranial floor, and substantial reconstruction which is a major factor in avoiding complications.

scholarly journals Management of upper ureteral stones exceeding 15 mm in diameter: Shock wave lithotripsy versus semirigid ureteroscopy with holmium:yttrium–aluminum–garnet laser lithotripsy

2016 ◽  
Vol 4 ◽  
pp. 205031211668518 ◽  
Author(s):  
Hamdy Aboutaleb ◽  
Mohamed Omar ◽  
Shady Salem ◽  
Mohamed Elshazly
Keyword(s):  
Shock Wave ◽  
Shock Wave Lithotripsy ◽  
Perioperative Complications ◽  
Operation Time ◽  
Laser Lithotripsy ◽  
Ureteral Stones ◽  
Complication Rates ◽  
Stone Free Rate ◽  
Free Rate

Objectives: We conducted a retrospective study to evaluate the efficacy and outcome of shock wave lithotripsy versus semirigid ureteroscopy in the management of the proximal ureteral stones of diameter exceeding 15 mm. Methods: During the 2009−2014 study period, 147 patients presenting with the proximal ureteral stones exceeding 15 mm in diameter were treated. Both shock wave lithotripsy and ureteroscopy with laser lithotripsy were offered for our patients. A 6/8.9 Fr semirigid ureteroscope was used in conjunction with a holmium:yttrium–aluminum–garnet laser. The stone-free rate was assessed at 2 weeks and 3 months post-treatment. All patients were evaluated for stone-free status, operation time, hospital stay, perioperative complications, and auxiliary procedures. Results: Of the 147 patients who took part in this study, 66 (45%) had undergone shock wave lithotripsy and 81 (55%) underwent ureteroscopy. At the 3-month follow-up, the overall stone-free rate in the shock wave lithotripsy group was 39/66 (59%) compared to 70/81 (86.4%) in the ureteroscopic laser lithotripsy group. Ureteroscopic laser lithotripsy achieved a highly significant stone-free rate ( p = 0.0002), and the mean operative time, auxiliary procedures, and postoperative complication rates were comparable between the two groups. Conclusion: In terms of the management of proximal ureteral stones exceeding 15 mm in diameter, ureteroscopy achieved a greater stone-free rate and is considered the first-line of management. Shock wave lithotripsy achieved lower stone-free rate, and it could be used in selected cases.

Single-Stage Augmentation Mastopexy With Composite Reverse Inferior Muscle Sling Technique for Autologous Reinforcement of the Inferior Pole: Technical Refinements and Outcomes

2019 ◽  
Author(s):  
Alexandre Mendonça Munhoz ◽  
Ary Marques Filho ◽  
Orlando Ferrari
Keyword(s):  
Three Dimensional ◽  
Single Stage ◽  
Complication Rates ◽  
Lower Pole ◽  
Breast Ptosis ◽  
Common Procedure ◽  
Inferior Pole ◽  
Augmentation Mastopexy

Abstract Background Single-stage augmentation mastopexy (SAM) is a common procedure, but revision rates are high. Muscle slings have been used in SAM, but despite satisfactory outcomes, most studies in the literature do not contain objective or accurate measurements of implant/breast position. This article describes a surgical technique for SAM using a composite reverse inferior muscle sling (CRIMS). Objectives To assess outcomes from primary SAM procedures using the CRIMS technique in a cohort of patients operated on by a single surgeon. Methods Thirty-two patients (60 breasts) with a mean age of 43.1 ± 6.8 years underwent primary CRIMS mastopexy to treat severe ptosis (grade III–IV) in 25 patients (78.1%). The average implant volume was 255 cc (range, 215-335 cc). Three-dimensional imaging obtained from the Divina scanner system was used to evaluate lower pole stretch and lower pole arc, and to determine long-term ptosis. Results Four cases of complications were observed in 3 patients (9.3%): minor dehiscence in 2 and capsular contraction in 1, during a mean follow-up of 42 months. The value for lower pole stretch was 5.5% (p <0.0001) between 10 days and 1 year, with the majority occurring early in the first 6 months, indicating that lower pole arc remains steady during the last months of follow-up. Conclusions Advances in techniques have led to improvements in aesthetic outcomes following SAM, and CRIMS can play a useful role. Our results show this procedure to be suitable for patients with breast ptosis, with acceptable complication rates and the added bonus of implant stabilization within the pocket.

scholarly journals Complete retroperitoneal laparoscopic nephroureterectomy with bladder cuff excision for upper tract urothelial carcinoma without patient repositioning: a single-center experience

2020 ◽  
Vol 48 (11) ◽  
pp. 030006052097391
Author(s):  
Gang Wu ◽  
Tianqi Wang ◽  
Jipeng Wang ◽  
Hejia Yuan ◽  
Yuanshan Cui ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Operation Time ◽  
Upper Tract Urothelial Carcinoma ◽  
Upper Tract ◽  
Single Center Experience ◽  
Hospitalization Period ◽  
Median Operation Time ◽  
Laparoscopic Nephroureterectomy

Objective This study was performed to evaluate the outcome of complete retroperitoneal laparoscopic nephroureterectomy with bladder cuff excision (RLNU-BCE), which is performed to treat urothelial carcinomas in the renal pelvis or in the ureter higher than the crossing of the common iliac artery without patient repositioning. Methods We retrospectively analyzed the clinical data of 48 patients with upper tract urothelial carcinoma who underwent complete RLNU-BCE in our institution from May 2017 to September 2019. Results RLNU-BCE was successfully performed in all 48 patients. The median operation time was 110 minutes [interquartile range (IQR), 100–130 minutes], and the median postoperative anesthesia recovery time was 10 minutes (IQR, 7–15 minutes). The median postoperative hospitalization period was 5 days (IQR, 4–6 days). Pathologic examination revealed that the margin of all resected specimens was negative. After a median follow-up of 13 months (IQR, 7–20 months), no local recurrence or distant metastasis was found. No complications occurred during follow-up. Conclusion Based on our experience with this technique, RLNU-BCE deserves application and promotion in clinical practice. Long-term comparative studies are required to confirm its superiority over other techniques.

scholarly journals A clinical study comparing BIVAP saline vaporization of the prostate with bipolar TURP: Early complications, physiological changes and postoperative follow-up outcomes

2014 ◽  
Vol 8 (7-8) ◽  
pp. 485 ◽  
Author(s):  
Ozgu Aydogdu ◽  
Ayhan Karakose ◽  
Yusuf Ziya Atesci
Keyword(s):  
Flow Rate ◽  
Statistical Significance ◽  
Operation Time ◽  
Urinary Flow Rate ◽  
Urinary Flow ◽  
Complication Rates ◽  
Serum Electrolyte ◽  
Hospitalization Time ◽  
Significant Difference

Introduction: We compare BIVAP saline vaporization of the prostate with bipolar transurethral resection of the prostate (TURP) in the treatment of benign prostatic hyperplasia.Methods: In total, we included 86 patients treated with BIVAP (n = 44) and bipolar TURP (n = 42). The inclusion criteria were maximum urinary flow rate (Qmax) ≤10 mL/s, International Prostate Symptom Score (IPSS) ≥16, and prostate volume measured with transrectal ultrasound scan between 30 and 80 mL. Serum electrolyte, hemoglobin, and hematocrit levels were determined preoperatively and postoperatively. All patients were evaluated at the postoperative first and third months and the IPSS score, post-void residual urinary volume (PVR), Qmax, and average urinary flow rate (Qave) were compared. Statistical analyses were performed using SPSS 16.0 program and statistical significance was set at p < 0.05.Results: Preoperative demographic characteristics were similar in the 2 groups. The mean operation time was significantly higher (p = 0.02) and hospitalization time was significantly lower (p = 0.04) in the BIVAP group when compared to the bipolar TURP group. There was no significant difference between 2 groups in terms of preoperative and postoperative serum electrolyte, hemoglobin and hematocrit levels. Postoperative complication rates were similar in the 2 groups. The only exception was the rate of severe dysuria, which was significantly higher in the BIVAP group. No statistical difference was noted between the groups in terms of postoperative follow-up results.Conclusion: Bipolar TURP is a safe and highly effective technique which can be used in the surgical treatment of benign prostatic obstruction with minimal side effects. BIVAP saline vaporization of the prostate seems to be a potential alternative to bipolar TURP with shorter hospitalization time.

scholarly journals Comparison of Intracranial Neuroendoscopic Procedures in Children versus Adults

2015 ◽  
Vol 42 (6) ◽  
pp. 427-435 ◽  
Author(s):  
Fady Girgis ◽  
Roberto Diaz ◽  
Walter Hader ◽  
Mark Hamilton
Keyword(s):  
Pediatric Patients ◽  
Endoscopic Third Ventriculostomy ◽  
Adult Population ◽  
Major Complication ◽  
Adult Patients ◽  
Therapeutic Modality ◽  
Third Ventriculostomy ◽  
Complication Rates ◽  
Common Procedure

AbstractBackground:The emphasis regarding intracranial neuroendoscopy has been traditionally advocated and focused on the role in pediatric patients, although a significant usage has developed in adult patients. In this study, we examine and contrast the role of predominantly intracranial neuroendoscopy in both a pediatric and adult population with a minimum postprocedure follow-up of 5 years.Methods:A retrospective review was conducted for patients in the two hospitals that manage neurosurgical care for Southern Alberta, Canada, undergoing neuroendoscopic surgery between 1994 and 2008. The pediatric group was defined as age ≤17 years and the adult group as age ≥18 years.Results:A total of 273 patients who underwent a total of 330 procedures with a mean postprocedure follow-up of 12.9 years were identified. There were 161 adult and 112 pediatric patients, and both groups underwent surgery by the same surgeons. The most common procedure was endoscopic third ventriculostomy, accounting for 55% of procedures. One postoperative death occurred in an adult patient. Endoscopic third ventriculostomy success 1-year postprocedure was 81%, with only three late-term failures. Postoperative infection was the most common serious complication (two pediatric/four adult patients). Adult and pediatric patients had similar major complication rates (4.2% vs 5.7%, p=0.547).Conclusions:Neuroendoscopy overall had a similar role in both pediatric and adult neurosurgical populations, with the most commonly associated complication being infection. Neuroendoscopy is an important therapeutic modality in the management of appropriate adult patients.

scholarly journals Complex hypospadias reconstruction: Ulaan Baatar technique revisited

2021 ◽  
Vol 8 (11) ◽  
pp. 3354
Author(s):  
Asim K. Das ◽  
Saurav Karmakar ◽  
Tapan K. Mandal ◽  
Tapas K. Majhi ◽  
Vishal Kashyap ◽  
...  
Keyword(s):  
Complication Rates ◽  
Hypospadias Repair ◽  
Penile Skin ◽  
Tunica Vaginalis ◽  
Effective Technique ◽  
Second Stage ◽  
Cosmetic Outcomes ◽  
The Mean ◽  
Mean Time

Background: Complex hypospadias repair is a challenging issue for the urologists. In Ulaan Baatar technique a distal neourethral tube along with glans is reconstructed in first stage with formation of a controlled fistula between neourethral tube and native urethra proximally. Later in second stage the fistula is closed by traditional technique. Therefore glans and distal urethral tube are not being manipulated during second stage repair and thus it has better cosmetic outcomes.Methods: We reviewed the records of 33 different patients with proximal hypospadias who had undergone Ulaan Baatar repair in last 3 years. 21 patients had multiple previous attempts of hypospadias repair and 12 were primary (naïve) cases with proximal hypospadias.Results: Mean follow up was 18.5 months after first stage and 12.4 months after the second stage. The mean age was 14.1years (ranged 8 to 22 years). Mean time between stage I and stage II was 8 months (range 6-9 months). None of the patients developed fistula, glans dehiscence, meatal stenosis or diverticula formation. All patients had satisfactory cosmetic appearance of glans, distal meatus and shaft.Conclusions: The Ulaan Baatar technique is very safe and effective technique with better cosmetic outcomes and least complication rates. Also the vascularized tunica vaginalis flaps may be used for construction of urethral lumen in complex hypospadias cases when local penile skin is deficient.

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