Value of Ultrasonographic Guidance For Operative Hysteroscopy on the Safety and Outcome of the Procedure: Randomized Control Trial

Abstract Background Hysteroscopy is a minimally invasive intervention that can be used to diagnose and treat many intrauterine and endocervical problems. Hysteroscopic polypectomy, myomectomy are just a few of the commonly performed procedures. Hysteroscopy has nearly replaced standard D&C for the management of abnormal uterine bleeding (AUB), as it allows for direct visualization and diagnosis of intrauterine abnormalities, and it often offers an opportunity for simultaneous treatment. Operative hysteroscopy is a safe procedure resulting in complication in 0.95-3% of cases. The most frequently observed complications include hemorrhage (2.4%), uterine perforation (1.5%), and cervical laceration (1-11%). Another rare complication is excessive fluid absorption with or without resultant hyponatremia. Can use of ultrasound guidance during operative hysteroscopy decrease the rate of the operative complication? Objective To assess the value of ultrasound guidance for operative hysteroscopy on decreasing the complication and improving the success rate of the procedure. Patients and Methods It is estimated that a sample size of 88 patients that were divided to 44 patients in the Ultrasound guidance group and 44 patients in the group that didn’t perform ultrasound. The patients were encountered from those presented at the gynecology clinic of the Ain Shams university hospital or those presented at ECDU with the inclusion criteria in the period between December 2017 to November 2018. The patients were approached to participate on study and a written informed consent was taken from all the patients. Results Comparative study between the 2 groups revealed; highly significant increase in success rate in ultrasound guided hysteroscopy (USH) group; compared to conventional hysteroscopy (CH) group; with highly significant statistical difference (p < 0.01) and non-significant difference as regards failure and complications rates (p > 0.05). Conclusion Our study found that ultrasound assistance for difficult hysteroscopy reported that ultrasound appears to be a safe and reliable method of assistance.

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Factors influencing the result of superior oblique weakening procedures in patients with superior oblique overaction in horizontal strabismus

BMC Ophthalmology ◽

10.1186/s12886-020-01687-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Junwoo Chun ◽

Seong-Joon Kim

Keyword(s):

Success Rate ◽

University Hospital ◽

Oblique Muscle ◽

Vertical Deviation ◽

Surgical Success ◽

Significant Difference ◽

National University ◽

Dissociated Vertical Deviation ◽

Superior Oblique Muscle ◽

Superior Oblique

Abstract Background Few studies have evaluated the surgical outcome of superior oblique weakening procedures in patients with superior oblique overaction associated with exotropia or esotropia. This study aimed to evaluate the outcome of superior oblique muscle weakening and the influencing factors in patients with superior oblique overaction. Methods The medical charts of 37 patients (55 eyes) with superior oblique overaction associated with esotropia or exotropia who were treated with a superior oblique weakening procedure at the Seoul National University Hospital from January 2010 to June 2017 were retrospectively reviewed. Superior oblique overaction was graded using, a 6-point scale ranging from + 0.5 to + 3, and pre- and postoperative grades were recorded for all patients. Results The mean age of the patients was 91.81 ± 59.37 months. Superior oblique muscle suture spacer and superior oblique posterior tenectomy were performed for 17 (23 eyes) and 20 (32 eyes) patients, respectively. Surgical success was achieved in 15 (65.2%) eyes in the suture spacer group and 23 (71.9%) eyes in the posterior tenectomy group. Surgical success was achieved for 69.1% (38/55 eyes) of patients. Dissociated vertical deviation exhibited a significant negative association with the surgical success rate (p < 0.001). Conclusions There was no significant difference in surgical success rate between the superior oblique posterior tenectomy and superior oblique suture spacer groups in superior oblique overaction associated with horizontal strabismus. Associated dissociated vertical deviation can affect the surgical success of the superior oblique weakening procedure.

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Fuchs heterochromic iridocyclitis-associated glaucoma: a retrospective comparison of primary Ahmed glaucoma valve implantation and trabeculectomy with mitomycin C

F1000Research ◽

10.12688/f1000research.15244.2 ◽

2018 ◽

Vol 7 ◽

pp. 876

Author(s):

Hamed Esfandiari ◽

Nils A. Loewen ◽

Kiana Hassanpour ◽

Ali Fatourechi ◽

Shahin Yazdani ◽

...

Keyword(s):

Success Rate ◽

Mitomycin C ◽

Outcome Measures ◽

Rare Complication ◽

Case Series ◽

Secondary Outcome ◽

Final Visit ◽

Cumulative Probability ◽

Ahmed Glaucoma Valve ◽

Significant Difference

Background: The aim of this study was to compare the safety and efficacy of primary trabeculectomy with mitomycin C and Ahmed glaucoma valve (AGV) implantation in patients with Fuchs heterochromic iridocyclitis (FHIC)-related glaucoma, a rare complication of an uncommon form of uveitis. Methods: In this retrospective comparative case series, 26 FHIC-associated glaucoma patients received trabeculectomy (n=12) or an AGV (n=14). Primary outcome measures were surgical success, defined as intraocular pressure (IOP) ≤21 mmHg, decreasing ≥20% from baseline, and no secondary glaucoma surgery. Secondary outcome measures were the number of glaucoma medications, complications, best corrected visual acuity (BCVA), and IOP. Results: The follow-up was 34.0±17.7 months in patients that received trabeculectomy and 33.4±18.6 months in AGV (P= 0.837). The cumulative probability of success rate was 41.7% for trabeculectomy and 85.7% for AGV, with no significant difference in complications (P>0.05). The IOP in patients that received trabeculectomy dropped from 23.4±3.3 mmHg to 21.6±5.2 mmHg at the final visit (P= 0.041). In patients that received AGV, the IOP decreased from 24±7.8 to 17.1±2.6 mmHg (P= 0.003). The number of glaucoma medications at baseline were 3.3±0.5 in those that received trabeculectomy and 3±0.6 in those that received AGV (P=0.233), and decreased to 2.4±1.0 (P=0.008) and 1.7±0.6 (P=0.002), respectively. BCVA was equal in both groups and did not change (P>0.05). Conclusion: Primary AGV had a higher success rate than trabeculectomy, with patients also needing fewer medications for the management of FHIC-associated glaucoma.

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Factors influencing the result of superior oblique weakening procedures in patients with superior oblique overaction in horizontal strabismus

10.21203/rs.3.rs-42850/v4 ◽

2020 ◽

Author(s):

Junwoo Chun ◽

Seong-Joon Kim

Keyword(s):

Success Rate ◽

University Hospital ◽

Oblique Muscle ◽

Vertical Deviation ◽

Surgical Success ◽

Significant Difference ◽

National University ◽

Dissociated Vertical Deviation ◽

Superior Oblique Muscle ◽

Superior Oblique

Abstract Background: Few studies have evaluated the surgical outcome of superior oblique weakening procedures in patients with superior oblique overaction associated with exotropia or esotropia. This study aimed to evaluate the outcome of superior oblique muscle weakening and the influencing factors in patients with superior oblique overaction. Methods: The medical charts of 37 patients (55 eyes) with superior oblique overaction associated with esotropia or exotropia who were treated with a superior oblique weakening procedure at the Seoul National University Hospital from January 2010 to June 2017 were retrospectively reviewed. Superior oblique overaction was graded using, a 6-point scale ranging from +0.5 to +3, and pre- and postoperative grades were recorded for all patients. Results: The mean age of the patients was 91.81 ± 59.37 months. Superior oblique muscle suture spacer and superior oblique posterior tenectomy were performed for 17 (23 eyes) and 20 (32 eyes) patients, respectively. Surgical success was achieved in 15 (65.2%) eyes in the suture spacer group and 23 (71.9%) eyes in the posterior tenectomy group. Surgical success was achieved for 69.1% (38/55 eyes) of patients. Dissociated vertical deviation exhibited a significant negative association with the surgical success rate (p<0.001). Conclusions: There was no significant difference in surgical success rate between the superior oblique posterior tenectomy and superior oblique suture spacer groups in superior oblique overaction associated with horizontal strabismus. Associated dissociated vertical deviation can affect the surgical success of the superior oblique weakening procedure.

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Bilateral Simultaneous Endoscopic Dacryocystorhinostomy: Outcome and Impact on the Quality of Life of the Patients

International Archives of Otorhinolaryngology ◽

10.1055/s-0038-1675394 ◽

2019 ◽

Vol 23 (02) ◽

pp. 191-195

Author(s):

Islam R. Herzallah ◽

Osama A. Marglani ◽

Ameen Z. Alherabi ◽

Nuha S. Faraj ◽

Deemah H. Bukhari

Keyword(s):

Quality Of Life ◽

Success Rate ◽

Symptom Score ◽

Nasolacrimal Duct ◽

Nasolacrimal Duct Obstruction ◽

Safe Procedure ◽

Duct Obstruction ◽

Endoscopic Dacryocystorhinostomy ◽

Significant Difference

Introduction Bilateral simultaneous endoscopic dacryocystorhinostomy (endo-DCR) has received little attention in the literature, thus many surgeons continue to address bilateral nasolacrimal duct obstruction at two stages, rather than in the same setting. Objective To evaluate the feasibility and the outcome of simultaneous bilateral Endo-DCR and its impact on the quality of life of the patients. Methods We have conducted a retrospective analysis of patients who underwent bilateral simultaneous endo-DCR between March 2013 and February 2017 at our tertiary care institution. The reviewed data included clinical presentation; operative details; success rate; pre and postoperative evaluation of the symptoms of the patients, using the Nasolacrimal Duct Obstruction Symptom Score Questionnaire; satisfaction of the patients, and improvement in the quality of life, assessed by the Glasgow Benefit Inventory (GBI) questionnaire. Results Out of 128 cases in which endo-DCRs were performed, 13 were bilateral (26 sides). Postoperative success was documented in 24 of the 26 sides (92.3%), with a mean follow-up duration of 16.2 months. The two failed sides were reported in the same case. The preoperative symptom score ranged between 12 and 80 (mean ± standard deviation [SD]: 38.23 ± 15.7). The postoperative symptom score was significantly lower (mean ± SD: 5.4 ± 12.9). The success rates in unilateral and bilateral cases were comparable, with no statistically significant difference. A notable improvement in the quality of life of the patients was also reported, with a mean GBI score of 81.38 ± 12.37. Conclusion Our results support that a simultaneous bilateral endo-DCR is a safe procedure that offers a high success rate, spares the patient from the stress of a second surgery, provides the patient with a bilateral resolution of the symptoms, and confers an immediate improvement in the quality of life of the patients.

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Factors Influencing the Result of Superior Oblique Weakening Procedures in Patients with Superior Oblique Overaction in Horizontal Strabismus

10.21203/rs.3.rs-42850/v5 ◽

2020 ◽

Author(s):

Junwoo Chun ◽

Seong-Joon Kim

Keyword(s):

Success Rate ◽

University Hospital ◽

Oblique Muscle ◽

Vertical Deviation ◽

Surgical Success ◽

Significant Difference ◽

National University ◽

Dissociated Vertical Deviation ◽

Superior Oblique Muscle ◽

Superior Oblique

Abstract Background Few studies have evaluated the surgical outcome of superior oblique weakening procedures in patients with superior oblique overaction associated with exotropia or esotropia. This study aimed to evaluate the outcome of superior oblique muscle weakening and the influencing factors in patients with superior oblique overaction. Methods The medical charts of 37 patients (55 eyes) with superior oblique overaction associated with esotropia or exotropia who were treated with a superior oblique weakening procedure at the Seoul National University Hospital from January 2010 to June 2017 were retrospectively reviewed. Superior oblique overaction was graded using, a 6-point scale ranging from +0.5 to +3, and pre- and postoperative grades were recorded for all patients. Results The mean age of the patients was 91.81 ± 59.37 months. Superior oblique muscle suture spacer and superior oblique posterior tenectomy were performed for 17 (23 eyes) and 20 (32 eyes) patients, respectively. Surgical success was achieved in 15 (65.2%) eyes in the suture spacer group and 23 (71.9%) eyes in the posterior tenectomy group. Surgical success was achieved for 69.1% (38/55 eyes) of patients. Dissociated vertical deviation exhibited a significant negative association with the surgical success rate (p<0.001). Conclusion There was no significant difference in surgical success rate between the superior oblique posterior tenectomy and superior oblique suture spacer groups in superior oblique overaction associated with horizontal strabismus. Associated dissociated vertical deviation can affect the surgical success of the superior oblique weakening procedure.

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Is It Rational to Study Coagulations Test Routinely before Operations and Invasive Procedure: Single Center Retrospective Study

International Journal of Hematology-Oncology and Stem Cell Research ◽

10.18502/ijhoscr.v13i3.1272 ◽

2019 ◽

Author(s):

Fergün Yılmaz ◽

Tuğçe Karslı ◽

Demet Kiper ◽

Fusun Gediz ◽

Bahriye Payzın

Keyword(s):

Invasive Procedure ◽

Abnormal Uterine Bleeding ◽

Bleeding Risk ◽

University Hospital ◽

Coagulation Cascade ◽

Significant Difference ◽

Coagulation Tests ◽

Life Threatening ◽

Abnormal Bleeding ◽

Bleeding History

Background: Detailed history taking, physical examination and laboratory tests are useful tools to document any abnormal bleeding risk before an operation or an invasive procedure. Although coagulation tests are routinely used to demonstrate the pathological situations at the coagulation cascade or to follow-up the anticoagulation therapies, their role in determining the bleeding risk in preoperative patients is controversial. Materials and Methods: In this study, we aimed to evaluate the patients referring to our hematology clinic at Izmir Katip Celebi University Hospital for preoperative consultation due to elevated levels of coagulation tests. Results: Fifty-six patients with high PT/PTT levels were enrolled in this study. Twenty-six (46.4%) patients were male and 30 (53.6%) were female. The median age was 34 (18-75) years. We documented bleeding history in 12 (21.4%) patients. The patients having a bleeding history revealed mostly abnormal uterine bleeding, epistaxis, and gingival bleeding. Life threatening bleeding was not reported in any of the patients. The operations were cancelled or postponed at least one month in 38 (67.8%) and 10 (17.8%) patients, respectively. Per-operative or post-operative abnormal bleeding was not documented. We did not find any statistically significant difference between groups with or without elevated coagulation tests in terms of abnormal bleeding in the operations. Conclusion: Coagulations tests should be studied in selected group of patients. Additionally, mildly elevated results should be interpreted carefully to decrease the rate of cancellation and delay in operations and unnecessary increase in costs.

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Factors Influencing the Result of Superior Oblique Weakening Procedures in Patients with Superior Oblique Overaction in Horizontal Strabismus

10.21203/rs.3.rs-42850/v2 ◽

2020 ◽

Author(s):

Junwoo Chun ◽

Seong-Joon Kim

Keyword(s):

Success Rate ◽

University Hospital ◽

Oblique Muscle ◽

Vertical Deviation ◽

Surgical Success ◽

Significant Difference ◽

National University ◽

Dissociated Vertical Deviation ◽

Superior Oblique Muscle ◽

Superior Oblique

Abstract Background Few studies have evaluated the surgical outcome of superior oblique weakening procedures in patients with superior oblique overaction associated with exotropia or esotropia. This study aimed to evaluate the outcome of superior oblique muscle weakening and the influencing factors in patients with superior oblique overaction. Methods The medical charts of 37 patients (55 eyes) with superior oblique overaction associated with esotropia or exotropia who were treated with a superior oblique weakening procedure at the Seoul National University Hospital from January 2010 to June 2017 were retrospectively reviewed. Superior oblique overaction was graded using, a 6-point scale ranging from +0.5 to +3, and pre- and postoperative grades were recorded for all patients. Results The mean age of the patients was 91.81 ± 59.37 months. Superior oblique muscle suture spacer and superior oblique posterior tenectomy were performed for 17 (23 eyes) and 20 (32 eyes) patients, respectively. Surgical success was achieved in 15 (65.2%) eyes in the suture spacer group and 23 (71.9%) eyes in the posterior tenectomy group. Surgical success was achieved for 69.1% (38/55 eyes) of patients. Dissociated vertical deviation exhibited a significant negative association with the surgical success rate (p<0.001). Conclusion There was no significant difference in surgical success rate between the superior oblique posterior tenectomy and superior oblique suture spacer groups in superior oblique overaction associated with horizontal strabismus. Associated dissociated vertical deviation can affect the surgical success of the superior oblique weakening procedure.

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Fuchs heterochromic iridocyclitis-associated glaucoma: a retrospective comparison of primary Ahmed glaucoma valve implantation and trabeculectomy with mitomycin C

F1000Research ◽

10.12688/f1000research.15244.1 ◽

2018 ◽

Vol 7 ◽

pp. 876 ◽

Cited By ~ 3

Author(s):

Hamed Esfandiari ◽

Nils A. Loewen ◽

Kiana Hassanpour ◽

Ali Fatourechi ◽

Shahin Yazdani ◽

...

Keyword(s):

Success Rate ◽

Mitomycin C ◽

Outcome Measures ◽

Rare Complication ◽

Case Series ◽

Secondary Outcome ◽

Final Visit ◽

Cumulative Probability ◽

Ahmed Glaucoma Valve ◽

Significant Difference

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P975Safety and clinical outcomes of rotational atherectomy: an eleven-year centre experience

European Heart Journal ◽

10.1093/eurheartj/ehz747.0569 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A R Pereira ◽

R Cale ◽

P Santos ◽

A R Almeida ◽

A Marques ◽

...

Keyword(s):

Success Rate ◽

Clinical Outcomes ◽

Rotational Atherectomy ◽

Safe Procedure ◽

Access Site ◽

Significant Difference ◽

Coronary Lesions ◽

Procedural Success ◽

Calcified Coronary Lesions

Abstract Introduction Rotational atherectomy (RA) is an adjunctive tool for the management of heavily calcified coronary lesions during percutaneous coronary intervention (PCI), but the clinical outcomes remain unclear. Access site choice is also poorly defined and there is growing evidence that transradial approach (TRA) is associated with lower complications and lower mortality. Objectives To assess the safety and long-term outcomes of RA for calcified coronary lesions and to investigate the influence of vascular access site in the efficacy and safety of the procedure. Methods Retrospective single-centre study that included consecutive PCI with RA performed from January 2006 to December 2017. Endpoint was a composite of major adverse cardiac events (MACE), defined as cardiovascular death, nonfatal myocardial infarction, nonfatal stroke and target vessel revascularization, at 1- and 5-year. Results 246 procedures were included in a total of 236 patients (pts): mean age 70.1±9.7 years, 73.6% male; 36.2% had previous PCI, 12.2% vascular peripheral disease (VPD), 24% reduced left ventricle ejection fraction (LVEF) and 6.9% were under hemodialysis. PCI with RA was mostly performed due to stable angina (48.9%) and via TRA (55.3%), with a total of 371 treated segments and a median number of 1 vessel treated per intervention. The left anterior descending artery was the most frequently treated artery (67.5%). Single burr was used in 76% of cases (mean number of burrs 1.23; mean burr size 1.5 mm). Procedural success rate was 94.7%. Complications were recorded in 9.3%, with no procedure related death. Clinical follow-up was complete in 98.8% of pts at 1-year and 81.3% at 5-year (mean time 62.3±41.8 months). Survival free of MACE at 1- and 5-year were 83.7% and 73.2%, respectively. Multivariate Cox regression identified 6 independent predictors (only 1 protector) for 1-year MACE (Fig. A) and 6 independent predictors (all of increased risk) for 5-year MACE (Fig. B). TRA was protector of 1-year MACE and Kaplan-Meier curves showed benefit for both 1- and 5-year MACE occurrence (Fig. C and D), without significant difference in procedural success (p=0.92) and complications (p=0.45) rate comparing to transfemoral approach. Conclusions RA followed by stenting was a safe procedure with a high immediate success rate but an increased number of long-term cardiovascular events. Some clinical conditions, such as previous PCI, VPD and reduced LVEF, seems to adversely influence the long-term outcome while TRA appears to be protective.

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A Comparative Study Of Surgical Outcome In Different Approaches For Hysterectomy

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v17i1.25312 ◽

2019 ◽

Vol 17 (1) ◽

pp. 28-33

Author(s):

Suman Raj Tamrakar

Keyword(s):

Operating Time ◽

Abnormal Uterine Bleeding ◽

Laparoscopic Hysterectomy ◽

University Hospital ◽

Gynecologic Surgery ◽

Laparoscopic Assisted Vaginal Hysterectomy ◽

Significant Difference ◽

Long Time ◽

Laparoscopic Assisted ◽

Selection Of

Introduction: Globally, hysterectomy has been the commonest gynecologic surgery since a long time. One of the most remarkable innovations in surgery has been the changeover from laparotomy to laparoscopy. The first reported laparoscopic hysterectomy was in 1989 by Harry Reich, for endometriosis. As laparoscopic procedure has various important advantages over laparotomy, it has become a preferred surgical method. But open hysterectomy or laparoscopic hysterectomy has been chosen based on various factors and the surgeon's experience and skill. Earlier hysterectomies were done in conventional way at Kathmandu University Hospital. But Laparoscopic assisted vaginal hysterectomy and total laparoscopic hysterectomy were started from 2011 and 2015 respectively. Method: This retrospective study was undertaken to compare the demographic parameters, operative particulars, postoperative outcomes including complications of different hysterectomy approaches done from 2011 to 2018 at Kathmandu University Hospital. Result: A total of 756 hysterectomy cases with 461 of open hysterectomy and 295 of laparoscopic hysterectomy were done in over 8 years. There was no significant difference in mean age of patients who underwent different types of hysterectomies (46.29±6.50 and 45.52±8.15 years, p=0.6829). There was significant increase in Brahmin/Chhetri caste seeking laparoscopic hysterectomy (p=0.0001) and significant decrease in other janajati caste undergoing laparoscopic hysterectomy (p=0.0004). The indications of different type of hysterectomy were almost comparable; with fibroids/adenomyosis (49.7%) followed by abnormal uterine bleeding (19.7%) were common indications. Laparoscopic hysterectomies have significantly increased since 2016. There were significant differences in operating time, blood loss and hospital stay between open and laparoscopic hysterectomy cases with 143.63±43.25 vs 67.56±25.75 minutes, 294.78±51.37 vs 470.24±102.99 ml and 2.61±0.66 vs 5.64±0.69 days respectively (all p<0.0001). There were 30 major complications in open and 10 in laparoscopic hysterectomy respectively with 9 minor complications in both. Eleven laparoscopy cases (3.7%) had to be converted to laparotomy. Conclusions: Laparoscopic hysterectomies are possible with equivalent advantages. A good laparoscopic experiences for surgeons and a careful selection of the cases are the obligatory prerequisites.

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