scholarly journals 1341 Outcomes of Sialendoscopic Stone Retrieval Under Local Anaesthesia in The Outpatient Setting- A Single Surgeon’s Experience

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
R Karia ◽  
T Pepper ◽  
F Ryba
Keyword(s):  
Success Rate ◽  
Local Anaesthetic ◽  
Case Series ◽  
Therapeutic Benefit ◽  
Treatment Session ◽  
Subsequent Treatment ◽  
General Anaesthetic ◽  
Major Salivary Gland ◽  
Retrospective Case ◽  
Parotid Duct

Abstract Aim The aim of this retrospective case series was to investigate the success rate of sialendoscopic stone retrieval under local anaesthetic. Method The records of 52 patients who underwent salivary endoscopy between September 2018 and February 2020 were reviewed. Included cases presented with at least one symptomatic major salivary gland, and sonographic or radiographic evidence of stone disease. Results A total of 25 patients (48%) and 27 stones were identified. Most cases (19/25) involved the submandibular gland, with a virtually even division between left and right sides. 19/25 patients underwent stone retrieval under local anaesthetic (LA) in the first instance (two of these patients had two stones). 6/25 patients underwent stone retrieval under general anaesthetic (GA) in the first instance, and this was successful in 5/6 cases. The overall success rate of LA sialendoscopic stone retrieval was 18/21 (86%), with 14/21 stones (66%) being successfully removed at the first treatment session and a further four at the subsequent treatment session. Under LA, 13/18 stones were removed intact, while the remaining 5 underwent fragmentation with an intraoral salivary pneumatic lithotripter (Cook Medical). Conclusions Sialendoscopic stone retrieval is a minimally invasive and effective treatment for both submandibular and parotid duct stones. It is possible to remove most stones under local anaesthetic at the first treatment session, using intraoral lithotripsy as an adjunct when indicated. This treatment modality provides therapeutic benefit with 86% success of stone retrieval under local anaesthetic with gland preservation in the vast majority of patients.

scholarly journals 1203 Sialendoscopy In Non-Stone Sialadenitis Is an Effective Therapeutic Approach

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
R Karia ◽  
T Pepper ◽  
F Ryba
Keyword(s):  
Imaging Modality ◽  
Acute Infection ◽  
Case Series ◽  
Symptomatic Improvement ◽  
Therapeutic Benefit ◽  
Stone Disease ◽  
Therapeutic Effectiveness ◽  
Major Salivary Gland ◽  
Retrospective Case

Abstract Introduction The aim of this retrospective case series was to investigate the therapeutic effectiveness of salivary endoscopy for non-stone related sialadenitis and obstructive symptoms. Method The records of 46 patients who underwent salivary endoscopy between September 2018 and December 2019 were reviewed. Included cases presented with at least one symptomatic major salivary gland, with no history or evidence of stone disease on clinical or radiologic examinations. Results A total of 22 patients (48%) and 26 glands were identified. These patients had a mean age of 50.8 years (range 27–74) and 73% were female. Most cases (19/26) involved the parotid gland. The primary imaging modality used was ultrasound, with sialography reserved for suspected strictures. The most common sonographic finding was ductal dilation (50%). Dexamethasone was instilled at completion of sialendoscopy in 23/26 cases. Outcomes included symptomatic improvement in 15/18 patients (4 patients have follow-up pending) with 5/15 experiencing complete symptom resolution. 2/18 patients did not have any symptomatic improvement, and 1/18 experienced acute infection that was treated with antibiotics. No patients required gland excision. Conclusions Salivary endoscopy is a minimally invasive and effective treatment for patients with non-stone sialadenitis that is refractory to conservative measures. Our review demonstrated 83% therapeutic benefit with gland preservation in all patients.

scholarly journals Comparative outcome analysis of bleb needling of fibrotic blebs in the clinic versus the operating room: a retrospective case series

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Vikram Ponnusamy ◽  
Van Nguyen ◽  
Jella A. An
Keyword(s):  
Success Rate ◽  
Operating Room ◽  
Complication Rate ◽  
Primary Outcome ◽  
Case Series ◽  
Outcome Analysis ◽  
Retrospective Case ◽  
Xen Gel Stent ◽  
Retrospective Case Series ◽  
Ab Interno

Abstract Background To compare 6 month outcomes of bleb needling performed in the clinic vs. the operating room (OR) in adult glaucoma patients with failed bleb. Methods A retrospective case series of 47 eyes from 41 glaucoma patients who received needling with mitomycin C (MMC) of scarred bleb from prior bleb-forming procedures in clinic (32 eyes) vs. the OR (15 eyes), including trabeculectomy (14 eyes), ExPress shunt (16 eyes), and ab-interno XEN gel stent (17 eyes). The primary outcome was needling success, defined as IOP ≤ 18 mmHg on 0 glaucoma medications without requiring an additional IOP lowering procedure within 6 months after needling. Results At 6 months, bleb needling success rate was similar when performed in the clinic vs. in the OR (28% vs. 20%, P = 0.54). Success rate was not statistically different in patients with prior trabeculectomy, ExPress shunt, and XEN gel stent (29% vs. 38% vs. 12%, P = 0.26). When comparing clinic vs. the OR needling procedures at 6 months, there was no difference in mean IOP (14.2 vs. 14.9 mmHg, P = 0.73), mean glaucoma medications (1.4 vs. 1.7, P = 0.69), additional IOP-lowering procedure rate (16% vs. 27%, P = 0.37), or complication rate (0% vs. 7%, P = 0.32). Conclusion Bleb needling with MMC in clinic may be a safe and effective way to revise failed bleb after trabeculectomy, ExPress shunt, and XEN gel stent procedures when compared to needling in the OR.

scholarly journals External dacryocystorhinostomy

2019 ◽  
Vol 16 (3) ◽  
pp. 179-185
Author(s):  
Li Ying Long ◽  
Safinaz Mohd Khialdin ◽  
Nazila Binti Ahmad Azli
Keyword(s):  
Surgical Technique ◽  
Success Rate ◽  
Case Series ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Retrospective Case ◽  
Duct Obstruction ◽  
Posterior Flap ◽  
External Dacryocystorhinostomy ◽  
External Dcr

Aim: To analyse the epidemiological data, surgical technique, success rate, and complications of patients who underwent external DCR in Hospital Selayang from January 2015 to December 2016. Method: Retrospective case series. Results: A total of 21 eyes of 20 patients who underwent external DCR from January 2015 to December 2016 were identified and reviewed. There were 15 females (75%) and 5 males (25%). Age ranged from 5 to 75 years old, with a median age of 56 years old (IQR 23). Twelve patients presented with epiphora while eight patients presented with symptoms of dacryocystitis. One case was congenital, two were secondary nasolacrimal duct obstruction and the rest were primary nasolacrimal duct obstruction. All patients underwent external DCR under general anaesthesia. Silicone tube were inserted in 21 eyes, of which all were removed 3 months after the surgery except one patient whom had his tube dislodged accidentally. The overall success rate was 90.5% (n = 19), which was defined as no or minimal intermittent epiphora or no reflux on lacrimal irrigation at 12 months postoperative. There was one patient who had a cerebrospinal fluid leak treated successfully with intravenous antibiotics. Conclusion: The surgical success rate for external dacryocystorhinostomy was comparable to that of the global success rate of external DCR. This is attributed to the application of surgical technique such as anterior suspended flap modification and posterior flap excision.

scholarly journals 1196 Sonographic Assessment Versus Direct Clinical Measurement of Sialolith Size and Its Influence on Modality of Endoscopic Removal

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
T Pepper ◽  
R Karia ◽  
F Ryba
Keyword(s):  
Single Case ◽  
Case Series ◽  
Stone Disease ◽  
Major Salivary Gland ◽  
Retrospective Case ◽  
Radiographic Evidence ◽  
Stone Size ◽  
Cook Medical ◽  
Left And Right ◽  
Endoscopic Stone Removal

Abstract Aim The aim of this retrospective case series was to investigate the influence of sialolith size on the potential for endoscopic stone removal. Method The records of 52 patients who underwent salivary endoscopy between September 2018 and February 2020 were reviewed. Included cases presented with at least one symptomatic major salivary gland, and sonographic or radiographic evidence of stone disease. Results A total of 25 patients (48%) and 27 stones were identified. These patients had a mean age of 45.2 years (range 16–72); 52% were female. Most cases (19/25) involved the submandibular gland, with a virtually even division between left and right sides. The overall success rate of sialendoscopic retrieval was 23/27 (85%), with 17/27 stones removed intact and 6/27 undergoing fragmentation with an intraoral salivary pneumatic lithotripter (Cook Medical). Median (sonographic) stone size in the largest dimension for those stones removed intact was 4mm (range 3-12mm), while for those undergoing fragmentation it was 7mm (range 3-11mm). Ultrasound provided an accurate assessment of stone size in most cases, but underestimated diameter by an average of 1mm in 6/27 cases, and overestimated size by 1mm in a single case. Conclusions Sialendoscopic stone retrieval is a minimally invasive and effective treatment for sialolithiasis. It is possible to remove most stones using a basket, with intraoral lithotripsy employed for larger stones. Ultrasound is a reliable diagnostic tool for predicting stone size but may underestimate size in a small proportion of cases.

scholarly journals Superior gluteal vein syndrome: an intrapelvic cause of sciatica

2019 ◽  
Vol 6 (2) ◽  
pp. 104-108
Author(s):  
Nucelio Lemos ◽  
Laura Cancelliere ◽  
Adrienne L K Li ◽  
Renato Moretti Marques ◽  
Gustavo L Fernandes ◽  
...  
Keyword(s):  
Success Rate ◽  
Scale Score ◽  
Visual Analog Scale ◽  
Task Force ◽  
Case Series ◽  
Visual Analog Scale Score ◽  
Neurovascular Conflict ◽  
Analog Scale ◽  
Retrospective Case ◽  
Pain Scores

Abstract The role of malformed or dilated branches of iliac vessels in causing pelvic pain is not well understood. Such vessels may entrap nerves of the lumbosacral (LS) plexus against the pelvic sidewalls, producing symptoms not typically encountered in gynecological practice, including sciatica and refractory urinary and/or anorectal dysfunction. We describe cases of sciatica in which laparoscopy revealed compression of the LS plexus by variant superior gluteal veins (SGVs). In demonstrating an improvement in patient symptoms after decompression, we identify this neurovascular conflict as a potential intrapelvic cause of sciatica. This study is a retrospective case series (Canadian Task Force Classification II-3). Nerve decompression laparoscopies were performed in São Paulo, Brazil. Thirteen female patients undergoing laparoscopy for sciatica with no clear spinal or musculoskeletal causes were included in this study. In all cases, we identified LS entrapment by aberrant SGVs, and performed decompression by vessel ligation. The average preoperative visual analog scale score of 9.62 ± 0.77 decreased significantly to 2.54 ± 2.88 post-operatively (P < 0.001). The success rate (defined as ≥ 50% improvement in visual analog scale score) was 92.3%, over a follow-up of 13.2 ± 10.6 months. Our case series demonstrates a high success rate and significant decrease in pain scores after laparoscopic intrapelvic decompression, thereby identifying pelvic nerve entrapment by aberrant SGVs as a potential yet previously unrecognized cause of sciatica. This intrapelvic neurovascular conflict—the SGV syndrome—should be considered in cases of sciatica with no identifiable spinal or musculoskeletal etiology.

Prehospital Ketamine is a Safe and Effective Treatment for Excited Delirium in a Community Hospital Based EMS System

2016 ◽  
Vol 31 (5) ◽  
pp. 563-569 ◽  
Author(s):  
Thomas R. Scaggs ◽  
David M. Glass ◽  
Megan Gleason Hutchcraft ◽  
William B. Weir
Keyword(s):  
Sudden Death ◽  
Effective Treatment ◽  
Community Hospital ◽  
Case Series ◽  
Subsequent Treatment ◽  
Qtc Interval ◽  
Publication Type ◽  
Retrospective Case ◽  
Airway Control ◽  
Excited Delirium

AbstractExcited delirium syndrome (ExDS) is defined by marked agitation and confusion with sympathomimetic surge and incessant physical struggle, despite futility, which may lead to profound pathophysiologic changes and sudden death. Severe metabolic derangements, including lactic acidosis, rhabdomyolysis, and hyperthermia, occur. The pathophysiology of excited delirium is a subject of ongoing basic science and clinical research. Positive associations with ExDS include male gender, mental health disorders, and substance abuse (especially sympathomimetics).Excited delirium syndrome patients often exhibit violent, psychotic behavior and have “superhuman” strength which can result in the patient fighting with police and first responders. Continued struggle can cause a patient with ExDS to experience elevated temperature (T) and acidosis which causes enzymes to fail, leading to sudden death from cardiovascular collapse and multi-system organ failure. Therefore, effective early sedation is optimal to stop this fulminant process.Treatment of ExDS must be focused on rapidly, safely, and effectively sedating the patient and providing intensive, supportive care. Benzodiazepines, like midazolam, may not be ideal to sedate ExDS patients since their onset takes several minutes, and their side effects include loss of airway control and respiratory depression. Injectable antipsychotic medications have a relatively slow onset and may cause prolongation of the QTc interval. Ketamine is the ideal medication to sedate patients with ExDS. Ketamine has a rapid, predictable onset within three to four minutes when given by intramuscular (IM) injection. It does not adversely affect airway control, breathing, heart rate, or blood pressure (BP).In this retrospective case series, prehospital scenarios in which ExDS patients received ketamine by paramedics for sedation, and their subsequent treatment in the emergency department (ED) and hospital, are described. It is demonstrated that ketamine administered by paramedics in the prehospital setting of a community hospital based Emergency Medical Services (EMS) system is a safe and effective treatment for ExDS.ScaggsTR, GlassDM, HutchcraftMG, WeirWB. Prehospital ketamine is a safe and effective treatment for excited delirium in a community hospital based EMS system. Prehosp Disaster Med. 2016;31(5):563–569.

scholarly journals Conjunctival Sparing Ptosis Correction by White-Line Advancement Technique

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Fatima A. Habroosh ◽  
Habibullah Eatamadi
Keyword(s):  
Success Rate ◽  
Recovery Period ◽  
Young Patients ◽  
Case Series ◽  
Late Recurrence ◽  
Modified Technique ◽  
Retrospective Case ◽  
White Line ◽  
Eyelid Skin

Purpose. To describe a modified technique of white line advancement posterior ptosis surgery and to report the success rate of the procedure. Methods. A retrospective case series of 60 patients who presented with ptosis with good levator function. The success rate was defined as an MRD1 of greater than or equal to 3.5 mm, symmetrical eyelid position with an intereyelid height asymmetry of ≤1 mm, and a satisfactory eyelid contour at 3 months follow-up. Results. Sixty patients (91 eyelids) met the inclusion criteria. Mild postoperative complications occurred in 11 patients that resolved without surgical intervention. Seven patients had recurrence of ptosis: four patients had early recurrence and 3 had late recurrence. The success rate was 88.33% with an average follow-up of 9 months. Conclusion. This procedure is a promising technique in cosmetic and functional ptosis correction. The advantage of this posterior approach procedure is that there is no conjunctival resection; it is suitable for young patients who do not have excess eyelid skin. The procedure is quick with a short recovery period. Additionally, it can be combined with another procedure and in different pathology.

scholarly journals Ahmed Glaucoma Valves versus EX-PRESS Devices in Glaucoma Secondary to Silicone Oil Emulsification

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Zhuyun Qian ◽  
Kai Xu ◽  
Xiangmei Kong ◽  
Huan Xu
Keyword(s):  
Success Rate ◽  
Silicone Oil ◽  
Case Series ◽  
Clinical Effects ◽  
Retrospective Case ◽  
Case Series Study ◽  
The Difference ◽  
Series Study ◽  
Glaucoma Implants

Objective. To evaluate and compare the clinical effects of Ahmed glaucoma valves (AGVs) and EX-PRESS implants on glaucoma secondary to silicone oil (SO) emulsification. Methods. A retrospective case-series study was designed. A total of 23 eyes with late intraocular pressure (IOP) elevation secondary to SO emulsification were included in the study. Antiglaucoma surgery with implantation of AGVs or EX-PRESS devices was performed. Pre- and postoperative ocular parameters were recorded at each visit during a 1-year follow-up period. The rates of complete success (IOP < 21 mmHg without medication) and qualified success (IOP < 21 mmHg with ≤3 glaucoma medications) were analyzed. Results. A total of 14 eyes underwent AGV implantation, and 9 underwent EX-PRESS implantation. The mean IOP and number of medications used at the last follow-up decreased significantly compared with that before surgery (P<0.001). The total success rate for all eyes including complete success (7/23) and qualified success (7/23) was 60.9% (14/23) at 1 year. The total success rate in the AGV group was 78.6% (11/14), whereas it was 33.3% (3/9) in the EX-PRESS group; the difference between the 2 groups was significant (P<0.05). Conclusion. For glaucoma secondary to SO emulsification, glaucoma implants could be effective at lowering IOP, and AGVs might produce better outcomes than EX-PRESS devices.

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