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 Intracameral Bevacizumab Versus Sub-Tenon’s Mitomycin C as Adjuncts to Trabeculectomy: 3-Year Results of a Prospective Randomized Study

2021 ◽  
Vol 10 (10) ◽  
pp. 2054
Author(s):  
Gerasimos Kopsinis ◽  
Dimitrios Tsoukanas ◽  
Dimitra Kopsini ◽  
Theodoros Filippopoulos
Keyword(s):  
Mitomycin C ◽  
Primary Outcome ◽  
Randomized Study ◽  
Primary Outcome Measure ◽  
Complication Rates ◽  
Filtration Surgery ◽  
Significant Difference ◽  
Exfoliative Glaucoma

Conjunctival wound healing determines success after filtration surgery and the quest for better antifibrotic agents remains active. This study compares intracameral bevacizumab to sub-Tenon’s mitomycin C (MMC) in trabeculectomy. Primary open-angle or exfoliative glaucoma patients were randomized to either bevacizumab (n = 50 eyes) or MMC (n = 50 eyes). The primary outcome measure was complete success, defined as Intraocular Pressure (IOP) > 5 mmHg and ≤ 21 mmHg with a minimum 20% reduction from baseline without medications. Average IOP and glaucoma medications decreased significantly in both groups at all follow-up points compared to baseline (p < 0.001), without significant difference between groups at 3 years (IOP: bevacizumab group from 29 ± 9.4 to 15 ± 3.4 mmHg, MMC group from 28.3 ± 8.7 to 15.4 ± 3.8 mmHg, p = 0.60; Medications: bevacizumab group from 3.5 ± 0.9 to 0.5 ± 1, MMC group from 3.6 ± 0.7 to 0.6 ± 1.1, p = 0.70). Complete success, although similar between groups at 3 years (66% vs. 64%), was significantly higher for bevacizumab at months 6 and 12 (96% vs. 82%, p = 0.03; 88% vs. 72%, p = 0.04, respectively) with fewer patients requiring medications at months 6, 9 and 12 (4% vs. 18%, p = 0.03; 6% vs. 20%, p = 0.04; 8% vs. 24%, p = 0.03, respectively). Complication rates were similar between groups. In conclusion, intracameral bevacizumab appears to provide similar long-term efficacy and safety results as sub-Tenon’s MMC after trabeculectomy.

scholarly journals 439 Conservative Versus Surgical Management of Complicated Diverticulitis - A Retrospective Study of Long-Term Outcomes

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
E Durity ◽  
G Elliott ◽  
T Gana
Keyword(s):  
Complicated Diverticulitis ◽  
Complication Rates ◽  
Long Term Outcomes ◽  
Female Ratio ◽  
Stoma Reversal ◽  
Group A ◽  
Grade 3 ◽  
Group B

Abstract Introduction Management of complicated diverticulitis has shifted towards a conservative approach over time. This study evaluates the feasibility and long-term outcomes of conservative management. Method We retrospectively evaluated a consecutive series of patients managed with perforated colonic diverticulitis from 2013-2017. Results Seventy-three (73) patients were included with a male to female ratio of 1:2. Thirty-one (31) underwent Hartmann’s procedure (Group A) and 42 patients were managed with antibiotics +/- radiological drainage (Group B). Mean follow-up was 64.9 months (range 3-7 years). CT Grade 3 and 4 disease was observed in 64.5% and 40.4% of Group A and Group B patients, respectively. During follow-up, 9 (21.4%) Group B patients required Hartmann’s. Group A had longer median length of stay compared to Group B (25.1 vs 9.2 days). Post-operative complications occurred in 80.6% with 40% being Clavien-Dindo grade III or higher in group A. Stoma reversal was performed in 8 patients (25.8%). Conclusions In carefully selected cases, complicated diverticulitis including CT grade 3 and 4 disease, can be managed conservatively with acceptable recurrence rates (16.7% at 30 days, 4.8% at 90 days, 19.0% at 5 years). Surgical intervention on the other hand, carries high post-operative complication rates and low stoma reversal rates.

scholarly journals Long-term outcomes of two-stage, immediate and delayed breast reconstruction with polyurethane-covered versus textured implants: protocol of a prospective, multicentre randomised controlled trial (TIPI trial)

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e044219
Author(s):  
J X Harmeling ◽  
Kevin Peter Cinca ◽  
Eleni-Rosalina Andrinopoulou ◽  
Eveline M L Corten ◽  
M A Mureau
Keyword(s):  
Randomised Controlled Trial ◽  
Breast Reconstruction ◽  
Controlled Trial ◽  
Capsular Contracture ◽  
Tissue Expander ◽  
Complication Rates ◽  
Two Stage ◽  
Randomised Controlled

IntroductionTwo-stage implant-based breast reconstruction is the most commonly performed postmastectomy reconstructive technique. During the first stage, a tissue expander creates a sufficiently large pocket for the definite breast implant placed in the second stage. Capsular contracture is a common long-term complication associated with implant-based breast reconstruction, causing functional complaints and often requiring reoperation. The exact aetiology is still unknown, but a relationship between the outer surface of the implant and the probability of developing capsular contracture has been suggested. The purpose of this study is to determine whether polyurethane-covered implants result in a different capsular contracture rate than textured implants.Methods and analysisThe Textured Implants versus Polyurethane-covered Implants (TIPI) trial is a multicentre randomised controlled trial with a 1:1 allocation rate and a follow-up of 10 years. A total of 321 breasts of female adults undergoing a two-stage breast reconstruction will be enrolled. The primary outcome is capsular contracture at 10-year follow-up which is graded with the modified Baker classification. It is analysed with survival analysis using a frailty model for clustered interval-censored data, with both an intention-to-treat and per-protocol approach. Secondary outcomes are other complication rates, surgical revision rate, patient satisfaction and quality of life and user-friendliness. Outcomes are measured 2 weeks, 6 months, 1, 2, 3, 5 and 10 years postoperatively. Interim analysis is performed when 1-year, 3-year and 5-year follow-up is completed.Ethics and disseminationThe trial has been reviewed and approved by the Medical Research Ethics Committee of the Erasmus MC, University Medical Centre Rotterdam (MEC-2018-126) and locally by each participating centre. Written informed consent will be obtained from each study participant. The results will be disseminated by publication in peer-reviewed journals.Trial registrationNTR7265.

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.

Strut remodeling with hypercompliant balloon: A new approach to Y stent-assisted coil embolization in the treatment of complex wide-neck bifurcation aneurysms

2020 ◽  
pp. 159101992098433
Author(s):  
Ali Burak Binboga ◽  
Mehmet Onay ◽  
Cetin Murat Altay
Keyword(s):  
Coil Embolization ◽  
Complication Rates ◽  
Thromboembolic Complications ◽  
New Approach ◽  
Long Term Follow Up ◽  
Safety Effectiveness ◽  
Wide Neck

Background The objective of this study was to present the long-term safety and effectiveness of strand remodelling with a hypercompliant balloon. Methods Patients with complex wide-neck bifurcation aneurysms (WNBAs) who underwent strand remodelling with a hypercompliant balloon via Y-stent-assisted coil embolization (Y-SACE) between September 2016 and January 2020 were included in the study. The feasibility, safety, effectiveness, and complication rates of the strand remodelling technique were investigated. Results A total of 12 patients (6 females, 6 males) were included in this study. Significant expansion was obtained in the intersection zone after remodelling. No regression was observed in the expansion rates during follow-up. There was no additional morbidity or mortality. No delayed thromboembolic complications occurred in our patients during long-term follow-up. Conclusions Performing strand remodelling to reduce thromboembolic complications triggered by structural faults caused by the Y-stent configuration is feasible, safe, and effective. This new approach can aid in the prevention of thromboembolic complications in Y-SACE.

Management of Canine Y-T Humeral Fractures Using Titanium Polyaxial Locking Plates in 17 Dogs

2022 ◽  
Vol 58 (1) ◽  
pp. 7-16
Author(s):  
Claudio Motta ◽  
Philip Witte ◽  
Andrew Craig
Keyword(s):  
Functional Impairment ◽  
Complication Rates ◽  
Load Testing ◽  
Inclusion Criteria ◽  
Long Term Outcomes ◽  
Long Term Follow Up ◽  
Mild Impairment ◽  
Condylar Fractures

ABSTRACT The objective of this study was to document the short- and medium-to-long-term outcomes and complication rates of Y-T humeral condylar fractures fixed using titanium polyaxial locking plate (T-PLP). A retrospective review was performed of the medical records and radiographs of dogs with a Y-T humeral condylar fracture treated with T-PLP at a single veterinary referral center (2012–2018). Seventeen cases met the inclusion criteria. Medium- to long-term follow-up (.6 mo) information was derived using the Liverpool Osteoarthritis in Dogs (LOAD) questionnaire. Recorded complications were catastrophic (1/17) and minor (2/17). Gait at 10–12 wk following surgery was subjectively assessed as good or excellent for 13 cases. Radiographic bone union was achieved in 7/12 cases at 4–6 wk. LOAD scores obtained a mean of 15 mo (range 6–29 mo) following surgery and indicated no or mild impairment in 15/16 and moderate functional impairment in 1. The application of T-PLP for the treatment of Y-T humeral condylar fractures resulted in adequate stabilization allowing successful fracture healing and medium- to long-term outcomes comparable to previous reports. According to results of LOAD testing, the medium- to long-term follow-up suggests that clients were aware of mild to moderate functional impairment in all cases.

scholarly journals Successful in a conservative treatment of osteoradionecrosis of the jaw: a case report and review of literature

2016 ◽  
Vol 64 (2) ◽  
pp. 212-218
Author(s):  
Paulo de Camargo MORAES ◽  
Luiz Alexandre THOMAZ ◽  
Milena Bortolotto Felippe SILVA ◽  
José Luiz Cintra JUNQUEIRA ◽  
Rubens Gonçalves TEIXEIRA
Keyword(s):  
Conservative Management ◽  
Three Dimensional ◽  
Clinical Aspect ◽  
Dental Extraction ◽  
Review Of Literature ◽  
Nonoperative Therapy ◽  
Exposed Bone ◽  
Regular Review

ABSTRACT Osteoradionecrosis of jaws is one of the most serious complications of radiation therapy for head and neck malignancies. The management of osteoradionecrosis continues to be debated and there are few cases which can be resolved with conservative management. This paper presents a case of osteoradionecrosis after a dental extraction affecting the mandible of a 58-year-old man and highlights the conservative therapeutic management and 3-year follow-up period. We combined a conservative nonoperative therapy, including long-term antibiotic therapy and daily irrigation with chlorhexidine mouthrinses in a case of osteoradionecrosis after a dental extraction affecting the mandible of a 58-year-old man. At the follow-up, clinical aspect was resolved. A CBCT scan image and a three-dimensional (3D) reconstructed image revealed bone remodeling in a 3-year follow-up period .No sign of exposed bone could be seen. Follow-up 3 years later revealed that the conservative management posed was successful for osteoradionecrosis and the patient is currently under regular review.

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