Preserving dentine in minimally invasive access cavities does not strength fracture resistance of restored mandibular molars

Background: Diagnosis of abdominal tuberculosis as well as histopathological confirmation is difficult because of suboptimal access to the intraperitoneal pathology. Laparoscopy provides minimally invasive access to the peritoneal cavity and materials can be collected for confirmation of diagnosis. Objectives: To study the importance of laparoscopy as a tool for the diagnosis of abdominal tuberculosis and initiation of appropriate treatment without delay. Materials & Methods: In this study 25 patients with suspected abdominal tuberculosis were selected within the period of May, 2014 to October, 2014. Diagnostic laparoscopy performed on all patients with biopsy of tissue from accessible sites. Results: Diagnostic laparoscopy with biopsy confirmed the diagnosis in 24 (96%) patients, 23 of these patients (96%) had nodules at different site of abdominal cavity and 19 of these patients (76%) had ascites. In two cases there were nodules over liver surface; biopsy was taken also from both liver nodules. One nodule revealed fibrosis and another nodule revealed tuberculosis. Conclusion: Imaging and culture of ascitic fluid may fail to confirm or exclude abdominal tuberculosis in clinically suspected cases. Laparoscopy with peritoneal tissue biopsy provided rapid and correct diagnosis of abdominal tuberculosis and should be performed early in suspected cases. KYAMC Journal.2021;12(01): 14-17

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Abstract 12048: Minimally Invasive Access for Aortic Valve Surgery in Octogenarians: Is it Still Justified in the Days of TAVI ?

Circulation ◽

10.1161/circ.132.suppl_3.12048 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Udo Boeken ◽

Sudharson Rajah ◽

Jan Philipp Minol ◽

Payam Akhyari ◽

Artur Lichtenberg

Keyword(s):

Aortic Valve ◽

Minimally Invasive ◽

Hospital Stay ◽

Surgical Techniques ◽

Valve Surgery ◽

Aortic Valve Surgery ◽

Partial Sternotomy ◽

Number Of Patients ◽

Duration Of Surgery ◽

Minimally Invasive Access

Introduction: Increasing life expectancy in the western world and improvements in surgical techniques and postoperative care have resulted in a significant number of patients aged over 80 undergoing cardiac operations. At times of transapical and transfemoral AVR we aimed to evaluate the feasibility of partial sternotomy for patients over 80 years of age and to compare these results with a historical group of octogenarians who underwent aortic valve surgery via full sternotomy in our department between 1998 and 2006. Methods: 72 of the 275 patients (26.2 %) who underwent aortic valve replacement (AVR) after partial sternotomy between 8/2009 and 05/2013 were octogenarians. Mean age was 83.1 ± 3.9 years (group ps). We compared this group with 165 patients (mean age 81.6 ± 3.1 years) who underwent AVR via full sternotomy between 1998 and 2006 (group fs). Results: ICU- and hospital stay were significantly reduced in patients with partial sternotomy (ps: 28 ± 9 hours, 12.8 ± 4.7 days vs. fs: 59 ± 15 h, 14.7 ± 3.5 d, p<0.05). We found a higher in-hospital mortality in group fs, but without significance (4.2 vs. 2.8 % in ps). Duration of operation, of extracorporeal circulation, and of aortic cross-clamping was tendentially prolonged in patients with partial sternotomy (p>0.05). Necessity for re-operation due to bleeding was comparable in both groups (ps: 2.8 % vs. fs: 3.0 %). The incidence of postoperative complications did not differ significantly between both groups: neurological complications (ps: 2.8 vs. fs: 3.0 %), sternal wound infections (2.8 % vs. 2.4 %) and postoperative LCOS (4.2 % vs. 5.5 %). Conclusions: We could prove the feasibility of ministernotomy for aortic valve surgery for patients over 80 years of age. Despite a tendentially prolonged duration of surgery compared to procedures via full sternotomy, we found a comparable morbidity and a reduced mortality after partial sternotomy. From an economic perspective, the reduction of intensive care unit- and hospital stay after minimally invasive access was the most interesting finding. Moreover, our results after minimally invasive AVR have to be considered carefully when selecting patients for a conventional or for a TAVI procedure.

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