scholarly journals P009 BEYOND TANAKA INDEX: PREOPERATIVE ASSESSMENT WITH 3D TECHNOLOGY IN LARGE HERNIAS WITH LOSS OF DOMAIN

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Alexander Osorio Ramos ◽  
Rafael Diaz ◽  
Raquel Sanchez ◽  
Lorena Sanchón ◽  
Claudio Guariglia ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Abdominal Cavity ◽  
Volume Ratio ◽  
Preoperative Assessment ◽  
Patient Specific ◽  
Ileocecal Resection ◽  
3D Technology ◽  
Surgical Decision ◽  
Loss Of Domain ◽  
Significant Difference

Abstract Aim “Demonstrate step by step the planning that was carried out using 3D technology in pre-surgical assessment for complex hernia.” Material and Methods “57-year-old female, surgical record of laparoscopic uterine myomectomy 20 years ago, has an eventration with loss of domain on the left flank and a giant uterine myoma. A multidisciplinary assessment was carried out for surgical decision, myomectomy was rejected. Presurgical preparation was decided with progressive pneumoperitoneum (PPP) technique (1 week before surgery) associated with botulinum toxin (4 weeks before surgery). The patient specific volumes of the abdominal cavity and the eventration were measured with 3D technology resulting in a volume ratio (VR) of 34% pre-PPP, VR post-PPP and botulinum toxin was 9,8%. We compared these results to Tanaka index and we found a significant difference between the two techniques.” Results “During surgical intervention, multiple tumors were evidenced in the hernia content, distal ileum, cecum and omentum, peroperative pathological anatomy reported leiomyomas. An ileocecal resection+Omentectomy+TAR was performed. Patient was discharged on the 5th day without incidents. A definitive diagnosis of Diffuse Peritoneal Leiomyomatosis was made.” Conclusions “3D technology might represent a better tool to calculate intraabdominal and hernia volume, providing greater safety for the patient and the surgeon to avoid compartment syndrome. We found a significant difference between volumes measurements between Tanaka index and 3D technology. 3D technology gives us an unprecedented perspective for surgical planning in complex abdominal wall surgery The use of PPP and botulinum toxin is a safe and reproducible technique for hernia with loss of domain.”

scholarly journals Vibration Versus Ice to Reduce Cosmetic Botulinum Toxin Injection Pain—A Randomized Controlled Trial

2019 ◽  
Vol 98 (6) ◽  
pp. 351-355 ◽  
Author(s):  
Stephen R. Chorney ◽  
Jennifer A. Villwock ◽  
Amar C. Suryadevara
Keyword(s):  
Botulinum Toxin ◽  
Injection Site ◽  
Botulinum Toxin Injection ◽  
Pain Scale ◽  
Topical Anesthesia ◽  
Controlled Study ◽  
Patient Specific ◽  
Cosmetic Procedure ◽  
Significant Difference ◽  
Scale Scores

Botulinum toxin is the most commonly performed facial cosmetic procedure and pain at the injection site is a frequent patient concern. While various topical interventions have been described for analgesia, there have not been any studies comparing different techniques. We compared the use of a vibratory stimulus, ice pack application, and no intervention on injection site pain for cosmetic botulinum toxin injection. A prospective-, randomized-, individual-controlled study was conducted using a visual analog scale to assess pain. Patients received bilateral glabellar injections, with randomization into unilateral vibration, unilateral ice application, or vibration and ice on either side. We analyzed 88 injections on 22 patients. Mean visual analog scores were 26.5 (standard deviation [SD]: 23.1) among injections with vibration, 24.4 (SD: 22.9) with ice, and 29.4 (SD: 27.1) without analgesia. There was no significant difference in pain scale scores with the use of vibration, ice, or no topical anesthesia ( P = .737). Further, pain scale scores did not differ significantly between medial and lateral injections nor did patients have a reduction in pain on either side of the forehead regardless of which method was used. While there may be a role for topical interventions to improve injection site analgesia, we maintain that consistently proper technique plays a greater role in improving patient tolerance. Future studies will continue to investigate the role of topical anesthesia in cosmetic facial injections and address patient-specific factors contributing to discomfort.

Surgical Management of Patients With 22q11.2 Deletion Syndrome

2019 ◽  
Vol 4 (5) ◽  
pp. 857-869
Author(s):  
Oksana A. Jackson ◽  
Alison E. Kaye
Keyword(s):  
Surgical Management ◽  
Preoperative Evaluation ◽  
Preoperative Assessment ◽  
22Q11.2 Deletion Syndrome ◽  
Deletion Syndrome ◽  
22Q11.2 Deletion ◽  
Surgical Decision ◽  
Obstructive Sleep ◽  
Spine Abnormalities ◽  
Speech Assessment

Purpose The purpose of this tutorial was to describe the surgical management of palate-related abnormalities associated with 22q11.2 deletion syndrome. Craniofacial differences in 22q11.2 deletion syndrome may include overt or occult clefting of the palate and/or lip along with oropharyngeal variances that may lead to velopharyngeal dysfunction. This chapter will describe these circumstances, including incidence, diagnosis, and indications for surgical intervention. Speech assessment and imaging of the velopharyngeal system will be discussed as it relates to preoperative evaluation and surgical decision making. Important for patients with 22q11.2 deletion syndrome is appropriate preoperative screening to assess for internal carotid artery positioning, cervical spine abnormalities, and obstructive sleep apnea. Timing of surgery as well as different techniques, common complications, and outcomes will also be discussed. Conclusion Management of velopharyngeal dysfunction in patients with 22q11.2 deletion syndrome is challenging and requires thoughtful preoperative assessment and planning as well as a careful surgical technique.

Dry Needling Can Be An Alternative Treatment for Hemifacial Spasm

2020 ◽  
Vol 6 (2) ◽  
pp. 20-28
Author(s):  
Selly Marisdina ◽  
Henry Sugiharto ◽  
A Pradian
Keyword(s):  
Botulinum Toxin ◽  
Hemifacial Spasm ◽  
Alternative Treatment ◽  
Epidemiological Data ◽  
Clinical Severity ◽  
Decompression Surgery ◽  
Dry Needling ◽  
Significant Difference ◽  
Microvascular Decompression Surgery ◽  
Botulinum Toxin Injections

Back Ground: Hemifacial spasm is one of movement disorder case that commonly found in daily clinical practice. Epidemiological data are very limited, the average prevalence is 11 per 100,000 population, 14.5 per 100,000 in women and 7.4 per 100,000 in men. In Germany, the estimated prevalence is 8000 to 9000 peoples.1 The incidence of women is more than that of men with a ratio of 2:1. Based on Yaltho and Jankovic study in 2011, out of 215 patients, the ratio of men to women was 1:1.8.2 One study in Indonesia also reported that most of the subjects were female (64.7%).3 Treatment with botulinum toxin injections is preferred to microvascular decompression surgery therapy, but this injection is only effective in a few months and quite expensive. This study is the first study to assess the effectiveness of dry needling on clinical improvement of hemifacial spasm compared to standard therapy of botulinum toxin injection.Methods: The study design was quasi experimental. Total of 24 subjects were divided into two groups. The first group underwent dry needling intervention while the other had botulinum injection. Clinical severity before and after treatment in both groups was assessed using Jankovic and HFS7 scores.Results: In dry needling group there were significant differences between Jankovic and HFS7 score at baseline and at week 1, 2, 3 and 4. While in botox group significant differences were also Jankovic and HFS7 score at baseline and at weeks 2 and 4. There were also a significant difference of Jankovic and HFS7 score when we compared dry needling group to botulinum toxin group.Conclusion: Dry needling can be an alternative treatment for hemifacial spasm, although clinical improvements based on Jankovic and HFS7 scores in dry needling group were not as effective as those with botulinum toxin injections.

An evaluation of a shoulder rehabilitation class in a UK hospital following evidence-based modifications

2021 ◽  
pp. 1-8
Author(s):  
Emily Kell ◽  
John A. Hammond ◽  
Sophie Andrews ◽  
Christina Germeni ◽  
Helen Hingston ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Shoulder Pain ◽  
Management Strategies ◽  
Cost Effective ◽  
Rehabilitation Programme ◽  
Patient Specific ◽  
Satisfaction Survey ◽  
Evidence Based ◽  
Patient Satisfaction Survey ◽  
Significant Difference

OBJECTIVES: Shoulder pain is a common musculoskeletal disorder, which carries a high cost to healthcare systems. Exercise is a common conservative management strategy for a range of shoulder conditions and can reduce shoulder pain and improve function. Exercise classes that integrate education and self-management strategies have been shown to be cost-effective, offer psycho-social benefits and promote self-efficacy. This study aimed to examine the effectiveness of an 8-week educational and exercise-based shoulder rehabilitation programme following the introduction of evidence-based modifications. METHODS: A retrospective evaluation of a shoulder rehabilitation programme at X Trust was conducted, comparing existing anonymised Shoulder Pain and Disability Index (SPADI) and Patient-Specific Functional Scale (PSFS) scores from two cohorts of class participants from 2017-18 and 2018-19 that were previously collected by the physiotherapy team. Data from the two cohorts were analysed separately, and in comparison, to assess class efficacy. Descriptive data were also analysed from a patient satisfaction survey from the 2018-19 cohort. RESULTS: A total of 47 patients completed the 8-week shoulder rehabilitation programme during the period of data collection (2018-2019). The 2018-19 cohort showed significant improvements in SPADI (p 0.001) and PSFS scores (p 0.001). No significant difference was found between the improvements seen in the 2017-18 cohort and the 2018-19 cohort. 96% of the 31 respondents who completed the patient satisfaction survey felt the class helped to achieve their goals. CONCLUSION: A group-based shoulder rehabilitation class, which included loaded exercises and patient education, led to improvements in pain, disability and function for patients with rotator cuff related shoulder pain (RCRSP) in this outpatient setting, but anticipated additional benefits based on evidence were not observed.

scholarly journals An MRI-Based Patient-Specific Computational Framework for the Calculation of Range of Motion of Total Hip Replacements

2021 ◽  
Vol 11 (6) ◽  
pp. 2852
Author(s):  
Maeruan Kebbach ◽  
Christian Schulze ◽  
Christian Meyenburg ◽  
Daniel Kluess ◽  
Mevluet Sungu ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Internal Rotation ◽  
Computer Aided Design ◽  
External Rotation ◽  
Patient Specific ◽  
Computational Framework ◽  
Total Hip ◽  
Total Hip Replacements ◽  
Significant Difference ◽  
Hip Replacements

The calculation of range of motion (ROM) is a key factor during preoperative planning of total hip replacements (THR), to reduce the risk of impingement and dislocation of the artificial hip joint. To support the preoperative assessment of THR, a magnetic resonance imaging (MRI)-based computational framework was generated; this enabled the estimation of patient-specific ROM and type of impingement (bone-to-bone, implant-to-bone, and implant-to-implant) postoperatively, using a three-dimensional computer-aided design (CAD) to visualize typical clinical joint movements. Hence, patient-specific CAD models from 19 patients were generated from MRI scans and a conventional total hip system (Bicontact® hip stem and Plasmacup® SC acetabular cup with a ceramic-on-ceramic bearing) was implanted virtually. As a verification of the framework, the ROM was compared between preoperatively planned and the postoperatively reconstructed situations; this was derived based on postoperative radiographs (n = 6 patients) during different clinically relevant movements. The data analysis revealed there was no significant difference between preoperatively planned and postoperatively reconstructed ROM (∆ROM) of maximum flexion (∆ROM = 0°, p = 0.854) and internal rotation (∆ROM = 1.8°, p = 0.917). Contrarily, minor differences were observed for the ROM during maximum external rotation (∆ROM = 9°, p = 0.046). Impingement, of all three types, was in good agreement with the preoperatively planned and postoperatively reconstructed scenarios during all movements. The calculated ROM reached physiological levels during flexion and internal rotation movement; however, it exceeded physiological levels during external rotation. Patients, where implant-to-implant impingement was detected, reached higher ROMs than patients with bone-to-bone impingement. The proposed framework provides the capability to predict postoperative ROM of THRs.

scholarly journals Multiple peritoneal dissemination of T2 colorectal cancer without lymph node metastases: a case report

2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
Yosuke Namba ◽  
Yuzo Hirata ◽  
Shoichiro Mukai ◽  
Toshihiro Nishida ◽  
Syo Ishikawa ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
Peritoneal Dissemination ◽  
Abdominal Cavity ◽  
Muscularis Propria ◽  
Ileocecal Resection ◽  
Pathology Report ◽  
Ascending Colon ◽  
Node Metastases

Abstract Most cases of peritoneal dissemination of colorectal cancers are from T3 or T4 tumors. A 61-year-old woman was admitted for examination of a positive fecal occult blood test. Colonoscopy showed an ascending colon tumor that was diagnosed as an adenocarcinoma with massive submucosal invasion. Imaging modality revealed numerous nodules throughout the abdominal cavity. Peritoneal dissemination of the ascending colon or ovarian cancer and pseudomyxoma peritonei were considered in the preoperative differential diagnoses, and laparoscopic ileocecal resection was performed. Intraperitoneal observation revealed numerous white nodules in the peritoneum, omentum and Douglas fossa. Both the nodules and tumor were diagnosed as mucinous carcinoma based on a pathology report. The tumor invasion depth was limited to muscularis propria, and no regional lymph node metastasis was detected. Peritoneal dissemination of the ascending colon cancer was considered. We report a rare case of multiple peritoneal dissemination of T2 colorectal cancer without lymph node metastases.

scholarly journals Quantitative CT imaging features for COVID-19 evaluation: The ability to differentiate COVID-19 from non- COVID-19 (highly suspected) pneumonia patients during the epidemic period

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0256194
Author(s):  
Shengkun Peng ◽  
Lingai Pan ◽  
Yang Guo ◽  
Bo Gong ◽  
Xiaobo Huang ◽  
...  
Keyword(s):  
Volume Ratio ◽  
Ct Imaging ◽  
Lesion Volume ◽  
Component Ratio ◽  
Imaging Features ◽  
Quantitative Ct ◽  
Epidemic Period ◽  
Significant Difference ◽  
Sensitivity Specificity ◽  
Ct Features

Objectives COVID-19 and Non-Covid-19 (NC) Pneumonia encountered high CT imaging overlaps during pandemic. The study aims to evaluate the effectiveness of image-based quantitative CT features in discriminating COVID-19 from NC Pneumonia. Materials and methods 145 patients with highly suspected COVID-19 were retrospectively enrolled from four centers in Sichuan Province during January 23 to March 23, 2020. 88 cases were confirmed as COVID-19, and 57 patients were NC. The dataset was randomly divided by 3:2 into training and testing sets. The quantitative CT radiomics features were extracted and screened sequentially by correlation analysis, Mann-Whitney U test, the least absolute shrinkage and selection operator (LASSO) logistic regression (LR) and backward stepwise LR with minimum AIC methods. The selected features were used to construct the LR model for differentiating COVID-19 from NC. Meanwhile, the differentiation performance of traditional quantitative CT features such as lesion volume ratio, ground glass opacity (GGO) or consolidation volume ratio were also considered and compared with Radiomics-based method. The receiver operating characteristic curve (ROC) analysis were conducted to evaluate the predicting performance. Results Compared with traditional CT quantitative features, radiomics features performed best with the highest Area Under Curve (AUC), sensitivity, specificity and accuracy in the training (0.994, 0.942, 1.0 and 0.965) and testing sets (0.977, 0.944, 0.870, 0.915) (Delong test, P < 0.001). Among CT volume-ratio based models using lesion or GGO component ratio, the model combining CT lesion score and component ratio performed better than others, with the AUC, sensitivity, specificity and accuracy of 0.84, 0.692, 0.853, 0.756 in the training set and 0.779, 0.667, 0.826, 0.729 in the testing set. The significant difference of the most selected wavelet transformed radiomics features between COVID-19 and NC might well reflect the CT signs. Conclusions The differentiation between COVID-19 and NC could be well improved by using radiomics features, compared with traditional CT quantitative values.

scholarly journals The assessment of the stability of the corneal structure after LASIK correction of myopia by different optical zone diameters

2016 ◽  
Vol 73 (6) ◽  
pp. 572-576 ◽  
Author(s):  
Milorad Milivojevic ◽  
Vladimir Petrovic ◽  
Miroslav Vukosavljevic ◽  
Ivan Marjanovic ◽  
Mirko Resan
Keyword(s):  
Structural Parameters ◽  
Preoperative Assessment ◽  
Laser In Situ Keratomileusis ◽  
Group I ◽  
Significant Difference ◽  
Optical Zone ◽  
Corneal Structure ◽  
The Stability ◽  
Corneal Thinning

Background/Aim. Enlargement of optical zone (OZ) diameter during laser in situ keratomileusis (LASIK) correction of myopia postoperatively improves the optical outcome, however, it also leads to the increased stroma tissue consumption - progressive corneal thinning. The aim of this investigation was to present the possibility of safe OZ enlargement without impairing the structural stability of the cornea, while obtaining an improved optical outcome with LASIK treatment of shortsightedness. Methods. Preoperative assessment of the cornea structure and prediction of the ablated stroma tissue consumption was conducted in 37 patients (74 eyes) treated for shortsightedness by means of the LASIK method. With the eyes that, according to their cornea structure, had the capacity for OZ diameter enlargement of 0.5 mm, LASIK treatment was performed within the wider OZ diameter of 7.0 mm compared to the standard 6.5 mm. The following two groups were formed, depending on the diameter of the utilized OZ: the group I (the eyes treated with the OZ 6.5 mm, n = 37) and the group II (the eyes treated with the OZ 7.0 mm, n = 37). Results. No significant difference in the observed structural parameters of the cornea was detected between the groups of patients treated with different OZ diameters. The values of all the parameters were significantly bellow the threshold values for the development of postoperative ectasia. Conclusion. Diameter enlargement of the treated OZ, if there is a preoperative cornea capacity for such enlargement, will not impair the postoperative stability of the cornea structure, and will significantly improve the optical outcome.

scholarly journals Anatomical conditions and patient-specific locked navigation templates for TSS placement

2020 ◽  
Author(s):  
Chao Wu ◽  
jiayan deng ◽  
jian pan ◽  
tao li ◽  
Lun Tan
Keyword(s):  
Entry Point ◽  
Screw Placement ◽  
Patient Specific ◽  
Short Axis ◽  
Sacroiliac Screw ◽  
Nerve Root Injury ◽  
Significant Difference ◽  
Sacroiliac Screws ◽  
Ct Data ◽  
Navigation Template

Abstract Objective To analyse the anatomical conditions of transverse sacroiliac screws about the S1 and S2 segments in order to develop and validate a locked navigational template for transverse sacroiliac screw placement. Methods The CT data of 90 normal sacra were analysed. The long axis, short axis and lengths of transverse sacroiliac screw cancellous corridors were measured through 3D modelling. A patient-specific locked navigation template based on simulated screws was designed and 3D printed and then used to assist in transverse sacroiliac screw placement. The operative time, intraoperative blood loss, incision length, and radiation times were recorded. The Matta criteria and grading score were evaluated. The entry point deviation of the actual screw placement relative to the simulated screw placement was measured, and whether the whole screw was in the cancellous corridor was observed.Results S1 screws with a diameter of 7.3 mm could be inserted into 69 pelvises, and S2 screws could be inserted in all pelvises. The S1 cancellous corridor had a long axis of 25.44±3.32 mm in males and 22.91±2.46 mm in females, a short axis of 14.21±2.19 mm in males and 12.15±3.22 mm in females, a corridor length of 153.07±11.99 mm in males and 151.11±8.73 mm in females, and a proportional position of the optimal entry point in the long axis of the cancellous corridor of 35.96±10.31% in males and 33.28±7.2% in females. There were significant differences in the corridor long axis and corridor short axis between sexes (p<0.05), and there were no significant differences in corridor length and proportional position of the optimal entry point in the long axis of the cancellous corridor between sexes (p>0.05). The S2 cancellous corridor had a long axis of 17.58±2.36 mm in males and 16±2.64 mm in females, a short axis of 14.21±2.19 mm in males and 13.14±2.2 mm in females, a corridor length of 129.95±0.89 mm in males and 136.5±7.96 mm in females, and a proportional position of the optimal entry point in the long axis of the cancellous corridor of 46.77±9.02% in males and 42.25±11.95% in females. There were significant differences in the long axis, short axis and corridor length (p<0.05). There was no significant difference in the proportional position of the optimal entry point in the long axis of the cancellous corridor (p>0.05). A total of 20 transversal sacroiliac screws were successfully inserted into 10 patients with the assistance of locked navigation templates. Nineteen screws were grade 0, 1 screw was grade 1, and there were no postoperative complications of infection or nerve root injury. All screw entry point deviations were shorter than the short axis of the cancellous corridor, and all screws were located completely within the cancellous corridor.Conclusion Approximately 76% of males and females can accommodate screws with diameters of 7.3 mm in S1, and all persons can accommodate the same screw in S2. From the standard lateral perspective of the sacrum, the optimal entry point of the transverse screw is in the first 1/3 of the cancellous corridor for S1 and the centre of the cancellous corridor for S2. The patient-specific locked navigation template assisted in transverse sacroiliac screw placement with little trauma and fluoroscopy radiation and secure screw placement.

scholarly journals Botulinum Toxin Injection with Conjunctival Microincision for the Treatment of Acute Acquired Comitant Esotropia and Its Effectiveness

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Hongjia Xu ◽  
Weifeng Sun ◽  
Shuying Dai ◽  
Yanyan Cheng ◽  
Jing Zhao ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Binocular Vision ◽  
Botulinum Toxin A ◽  
Botulinum Toxin Injection ◽  
Age At Onset ◽  
Brain Magnetic Resonance Imaging ◽  
Significant Difference ◽  
Angle Of Deviation ◽  
The Mean

Purpose. To report on an improved botulinum toxin injection with conjunctival microincision for beginners, and to determine the effectiveness of botulinum toxin A (BTXA) in the treatment of patients with acute acquired comitant esotropia (AACE). Methods. Medical records of 29 AACE patients were retrospectively analyzed. BTXA was injected into the unilateral or bilateral medial rectus muscle with conjunctival microincision without electromyographic guidance. Success was defined as total horizontal deviation ≤10 prism diopters (PD) and evidence of binocular vision. Results. Twenty-nine patients were included, of whom 22 were male and 7 were female. The mean age at onset was 14.2 ± 7.4 (range, 4–34) years. The mean time from onset of AACE to injection was 18.4 ± 20.3 (range, 1–96) weeks. All patients completed at least 6 months of follow-up, and the mean follow-up after BTXA injection was 12.3 ± 4.8 months (range, 7–24 months). Neurological evaluation and brain magnetic resonance imaging (MRI) were unremarkable in all patients. The mean spherical equivalent refraction was −1.22 ± 2.85D and −0.97 ± 2.80D in the right and left eyes, respectively. Mean preinjective esotropia was 38.4 ± 18.9 PD (range, +10–+80 PD) at near and 40.2 ± 17.7 PD (range, +20–+80 PD) at far distance. The mean angle of deviation at 6 months after injection was 0.6 ± 4.1 PD (range, −3–+15 PD) at near and 3.0 ± 5.9 PD (range, 0–+20 PD) at far distance. There was significant difference in the angle of deviation at near and far fixation between pre-BTXA and post-BTXA 6 months ( p < 0.001 , p < 0.001 , resp.). There was no significant difference in the angle of deviation at near and far fixation between post-BTXA 6 months and post-BTXA at final follow-up ( p  = 0.259 and 0.326, resp.). Mean stereoacuity improved from 338 to 88 arc seconds. During the follow-up period, 5 of 29 patients had recurrent esotropia. Two patients refused all further treatment, and the other 3 patients required incisional strabismus surgery. The success rates were 86.2% (25/29) at 6 months and 82.8% (24/29) at final follow-up. Conclusion. Conjunctival microincision injection of botulinum toxin is a practical and safe method for beginners to locate an extraocular muscle, which is as effective as the traditional methods. Botulinum toxin injection can be preferred as the first-line treatment for AACE patients with potential binocular vision.

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