Transabdominal Amniocentesis Is a Feasible and Safe Procedure in Preterm Prelabor Rupture of Membranes

Background: To evaluate safety, short and long-term graft patency, clinical success rates, and factors associated with patency, limb salvage and mortality after surgical reconstruction in patients younger than 50 years of age who had undergone unilateral iliac artery bypass surgery. Patients and methods: From January 2000 to January 2010, 65 consecutive reconstructive vascular operations were performed in 22 women and 43 men of age < 50 years with unilateral iliac atherosclerotic lesions and claudication or chronic limb ischemia. All patients were followed at 1, 3, 6, and 12 months after surgery and every 6 months thereafter. Results: There was in-hospital vascular graft thrombosis in four (6.1 %) patients. No in-hospital deaths occurred. Median follow-up was 49.6 ± 33 months. Primary patency rates at 1-, 3-, 5-, and 10-year were 92.2 %, 85.6 %, 73.6 %, and 56.5 %, respectively. Seven patients passed away during follow-up of which four patients due to coronary artery disease, two patients due to cerebrovascular disease and one patient due to malignancy. Limb salvage rate after 1-, 3-, 5-, and 10-year follow-up was 100 %, 100 %, 96.3 %, and 91.2 %, respectively. Cox regression analysis including age, sex, risk factors for vascular disease, indication for treatment, preoperative ABI, lesion length, graft diameter and type of pre-procedural lesion (stenosis/occlusion), showed that only age (beta - 0.281, expected beta 0.755, p = 0.007) and presence of diabetes mellitus during index surgery (beta - 1.292, expected beta 0.275, p = 0.026) were found to be significant predictors of diminishing graft patency during the follow-up. Presence of diabetes mellitus during index surgery (beta - 1.246, expected beta 0.291, p = 0.034) was the only variable predicting mortality. Conclusions: Surgical treatment for unilateral iliac lesions in patients with premature atherosclerosis is a safe procedure with a low operative risk and acceptable long-term results. Diabetes mellitus and age at index surgery are predictive for low graft patency. Presence of diabetes is associated with decreased long-term survival.

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Treatment of varicose tributaries with sclerotherapy with polidocanol 0.5 % foam

VASA ◽

10.1024/0301-1526/a000023 ◽

2010 ◽

Vol 39 (2) ◽

pp. 169-174 ◽

Cited By ~ 7

Author(s):

Reich-Schupke ◽

Weyer ◽

Altmeyer ◽

Stücker

Keyword(s):

Scientific Evidence ◽

Daily Practice ◽

Severe Adverse Effect ◽

Safe Procedure ◽

Efficacy And Safety ◽

Foam Sclerotherapy ◽

History Of ◽

One Year ◽

Additional Therapy

Background: Although foam sclerotherapy of varicose tributaries is common in daily practice, scientific evidence for the optimal sclerosant-concentration and session-frequency is still low. This study aimed to increase the knowledge on foam sclerotherapy of varicose tributaries and to evaluate the efficacy and safety of foam sclerotherapy with 0.5 % polidocanol in tributaries with 3-6 mm in diameter. Patients and methods: Analysis of 110 legs in 76 patients. Injections were given every second or third day. A maximum of 1 injection / leg and a volume of 2ml / injection were administered per session. Controls were performed approximately 6 months and 12 months after the start of therapy. Results: 110 legs (CEAP C2-C4) were followed up for a period of 14.2 ± 4.2 months. Reflux was eliminated after 3.4 ± 2.7 injections per leg. Insufficient tributaries were detected in 23.2 % after 6.2 ± 0.9 months and in 48.2 % after 14.2 ± 4.2 months, respectively. Only 30.9 % (34 / 110) of the legs required additional therapy. In 6.4 % vein surgery was performed, in 24.5 % similar sclerotherapy was repeated. Significantly fewer sclerotherapy-sessions were required compared to the initial treatment (mean: 2.3 ± 1.4, p = 0.0054). During the whole study period thrombophlebitis (8.2 %), hyperpigmentation (14.5 %), induration in the treated region (9.1 %), pain in the treated leg (7.3 %) and migraine (0.9 %) occurred. One patient with a history of thrombosis developed thrombosis of a muscle vein (0.9 %). After one year there were just hyperpigmentation (8.2 %) and induration (1.8 %) left. No severe adverse effect occurred. Conclusions: Foam sclerotherapy with injections of 0.5 % polidocanol every 2nd or 3rd day, is a safe procedure for varicose tributaries. The evaluation of efficacy is difficult, as it can hardly be said whether the detected tributaries in the controls are recurrent veins or have recently developed in the follow-up period. The low number of retreated legs indicates a high efficacy and satisfaction of the patients.

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RESULTS OF THE SUTURE OF THE PERFORATION BY SINGLE-PORT LAPAROSCOPIC SURGERY (SPLS) FOR THE PERFORATED DUODENAL ULCER TREATEMENT

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2014.4_5.18 ◽

2014 ◽

pp. 126-132

Author(s):

Huu Tri Nguyen ◽

Van Lieu Nguyen

Keyword(s):

Duodenal Ulcer ◽

Laparoscopic Surgery ◽

Single Port ◽

Previous History ◽

University Hospital ◽

Safe Procedure ◽

Perforated Duodenal Ulcer ◽

Analgesic Requirement ◽

Duodenal Ulcers ◽

The Mean

Background Single-port laparoscopic surgery (SPLS) was increasingly used on several surgical diseases. The aim of this study is evaluation of the results of the suture of the perforation by SPLS for the perforated duodenal ulcer treatement. Methods From January 2012 to July 2014, 35 patients with perforated duodenal ulcers underwent simple suture of the perforations by SPLS at Hue University Hospital and Hue Central Hospital. Results The mean age was 45.9 ± 14.4 years. The sex ratio (male/female) was 16.5 and the mean of BMI was 19.2 ± 2.3. There was one patient (2.9%) with previous history of laparoscopic repair of perforated duodenal ulcer. The duration of the symptoms was 9.9 ± 12.3 hours. 97.1% of patients had the perforations of the anterior wall of the duodenum. The mean size of the perforation was 4.7 ± 3.4 mm (2 – 22mm). 2.9% of patients had the perforations of the posterior wall of the duodenum. The rate of the conversion to the open surgery was 2.9%. The mean operative time was 75.8 ± 33.7min, and the mean hospital stay was 5.8 ± 1.4 days. The mean of the analgesic requirement time was 2.9 ± 0.8 days. The wound length was 1.9 ± 0.1 cm. There was 5.9% of the patients had wound infection. There was no operation-related mortality. Conclusions Simple suture of the perforation by single-port laparoscopic surgery is a feasible and safe procedure, and it may be a scarless surgical technique for perforated duodenal ulcers treatement. Key words: single-port laparoscopic surgery, perforated duodenal ulcer

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Exclusive Bilateral Internal Thoracic Artery Grafts for Myocardial Revascularization Requiring Four Anastomoses or More: Outcomes from a Single Center Experience

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0036-1584688 ◽

2016 ◽

Vol 65 (04) ◽

pp. 265-271

Author(s):

Andrea Perrotti ◽

Enrica Dorigo ◽

Camille Durst ◽

Djamel Kaili ◽

Sidney Chocron ◽

...

Keyword(s):

Coronary Artery ◽

Internal Thoracic Artery ◽

Artery Bypass ◽

Univariate Analysis ◽

Bypass Graft ◽

Myocardial Revascularization ◽

Wound Complication ◽

Safe Procedure ◽

Off Pump

Introduction Multivessel coronary artery bypass graft (CABG) with bilateral internal thoracic arteries (BITA) has only been uncommon and technically demanding. We describe our experience with BITA only CABGs requiring ≥ 4 anastomoses. Material and Methods The department's database was queried for patients undergoing isolated CABG with ≥ 4 anastomoses. The surgical technique included systematically a right internal thoracic artery (ITA) of left ITA Y graft. The multivariate model included variables with a p < 0.3 at univariate analysis. Results Between January 2006 and December 2009, 251 consecutive patients (71 ± 10 years) (on-pump: 130, off-pump: 121) had CABG with ≥ 4 anastomoses, representing 21% of total isolated CABGs for the same period; all patients received a totally arterial BITA only revascularization. Follow-up was 4.9 ± 1.6 years. Overall and cardiac cumulative survivals were 78 and 92%, respectively, at 5 years. The occurrence of any major postoperative complication was associated with overall and cardiac mortality (odds ratio [OR]: 3.6, 95% confidence interval [CI]: 1.3–9.9 and OR: 5.4, 95% CI: 1.3–21.9, respectively). Major sternal wound complication requiring surgical revision was not associated with impaired glucose control (n = 9; diabetics: 6/82, 7.3%; nondiabetics: 3/169, 1.8%, p = 0.06). Preoperative kidney failure was associated with incomplete revascularization (OR: 6.2; 95% CI: 1.2–33.5), that was unfailingly due to ungraftable right coronary artery targets. Discussion BITA only revascularization was a valuable and safe procedure, with favorable results in terms of morbidity and mortality at a 5 years' follow-up.

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Percutaneous Transhepatic Laser Lithotripsy for Biliary Stones in Patients with Altered Biliary Anatomy

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0041-1728985 ◽

2021 ◽

Author(s):

Jacob Indu ◽

Vikrama Amitha Kheda ◽

Deepak Bolbandi ◽

Sanjay Govil ◽

Ravisankar Bhat

Keyword(s):

Bile Duct ◽

Current Treatment ◽

Laser Lithotripsy ◽

Safe Procedure ◽

Bile Duct Stones ◽

Biliary Stones ◽

Endoscopic Retrograde ◽

Difficult Cases ◽

Transhepatic Biliary Drainage ◽

Variant Anatomy

AbstractEndoscopic retrograde cholangiopancreatography (ERCP) is the current treatment of choice in bile duct stones. Several factors such as variant anatomy of ampulla and surgical procedures like hepaticojejunostomy limit the success of ERCP in treating bile duct stones. Percutaneous transhepatic laser lithotripsy using interventional radiologic and endourologic techniques, which is uncommon, is a reasonable treatment option in such difficult cases. It is a minimally invasive, safe procedure accompanied by a high success rate, minimal morbidity, and a short hospital stay. We report our technique and experience in a series of three patients who underwent percutaneous transhepatic biliary drainage (PTBD) followed by percutaneous transhepatic laser lithotripsy in an attempt to avoid open surgery when ERCP was technically difficult.

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Long-Term Follow-Up of Early Cochlear Implant Device Activation

Audiology and Neurotology ◽

10.1159/000512760 ◽

2021 ◽

pp. 1-11

Author(s):

Stefanie Bruschke ◽

Uwe Baumann ◽

Timo Stöver

Keyword(s):

Speech Recognition ◽

Side Effects ◽

Cochlear Implant ◽

Surgical Techniques ◽

Control Group ◽

First Year ◽

Safe Procedure ◽

Sound Processor

Background: The cochlear implant (CI) is a standard procedure for the treatment of patients with severe to profound hearing loss. In the past, a standard healing period of 3–6 weeks occurred after CI surgery before the sound processor was initially activated. Advancements of surgical techniques and instruments allow an earlier initial activation of the processor within 14 days after surgery. Objective: Evaluation of the early CI device activation after CI surgery within 14 days, comparison to the first activation after 4–6 weeks, and assessment of the feasibility and safety of the early fitting over a 12 month observation period were the objectives of this study. Method: In a prospective study, 127 patients scheduled for CI surgery were divided into early fitting group (EF, n = 67) and control group (CG, n = 60). Individual questionnaires were used to evaluate medical and technical outcomes of the EF. Medical side effects, speech recognition, and follow-up effort were compared with the CG within the first year after CI surgery. Results: The early fitting was feasible in 97% of the EF patients. In the EF, the processor was activated 25 days earlier than in the CG. No major complications were observed in either group. At the follow-up appointments, side effects such as pain and balance problems occurred with comparable frequency in both groups. At initial fitting, the EF showed a significantly higher incidence of medical minor complications (p < 0.05). When developing speech recognition within the first year of CI use, no difference was observed. Furthermore, the follow-up effort within the first year after CI surgery was comparable in both groups. Conclusions: Early fitting of the sound processor is a feasible and safe procedure with comparable follow-up effort. Although more early minor complications were observed in the EF, there were no long-term wound healing problems caused by the early fitting. Regular inspection of the magnet strength is recommended as part of the CI follow-up since postoperative wound swelling must be expected. The early fitting procedure enabled a clear reduction in the waiting time between CI surgery and initial sound processor activation.

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Vertebral Metastasis Treated by Vertebroplasty, a Cause of Respiratory Failure: Case Report and Literature Review

Case Reports in Oncology ◽

10.1159/000513492 ◽

2021 ◽

pp. 279-283

Author(s):

Mathieu Chevallier ◽

Chloé Chevallier-Lugon ◽

Alex Friedlaender ◽

Alfredo Addeo

Keyword(s):

Spinal Fractures ◽

Safe Procedure ◽

Vertebral Metastasis ◽

Minimally Invasive Surgical Procedure ◽

Venous Circulation ◽

Minimally Invasive Surgical ◽

Life Threatening ◽

Frequent Site ◽

The Right ◽

Substantial Morbidity

Bone is a frequent site of metastases in advanced cancers including lung, breast, prostate, kidney, or myeloma. Lesions are commonly located on the spine. Neoplastic invasion of the vertebral body can result in painful vertebral fractures, leading to disability and substantial morbidity. Percutaneous vertebroplasty is a minimally invasive surgical procedure used to treat spinal fractures due to osteolytic tumors. It could result in pain reduction or resolution in 80–90% of patients with fractures, and it improves stability. Although considered safe, vertebroplasty has been associated over the years with life-threatening complications. We have reported the case of a 55-year-old patient with lung adenocarcinoma, who underwent vertebroplasty for a pathological neoplastic fracture of L2. The procedure was complicated by a leak of cement into the systemic venous circulation, characterized by an 11-cm filament in the right heart chambers and multiple pulmonary emboli. To our knowledge, only one similar case was previously reported, involving an intracardiac cement filament longer than 10 cm. The data are scant, hence the importance of collecting and reporting possible complications about what is perceived as a rather safe procedure. The case highlights the need for a robust postprocedure imaging plan to detect complications, which can impact patients’ morbidity and survival.

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Insertion of central venous catheters in children undergoing bone marrow transplantation: is there a platelet level for a safe procedure?

Annals of Pediatric Surgery ◽

10.1186/s43159-020-00056-6 ◽

2020 ◽

Vol 16 (1) ◽

Author(s):

Ahmed Elgendy ◽

Ahmed M. Ismail ◽

Eslam Elhawary ◽

Ahmed Badran ◽

Mohammed Ramadan El-Shanshory

Keyword(s):

Bone Marrow ◽

Platelet Count ◽

Bone Marrow Transplantation ◽

Postoperative Complications ◽

Marrow Transplantation ◽

Central Venous Catheters ◽

Bleeding Complications ◽

Safe Procedure ◽

Central Venous ◽

Platelet Transfusions

Abstract Background Bone marrow transplantation (BMT) is a therapeutic procedure for the management of several hematological diseases and malignancies in pediatric population. Central venous catheters (CVCs) play a pivotal role during the process of BMT. The aim of this study was to compare the complications of CVCs placements in children undergoing BMT with platelet levels above and below 50,000/μL and also to detect if there is a platelet count for a safe insertion. This prospective study included all children who had placements of tunneled CVCs during BMT at our hospital between March 2017 and March 2020. Procedures were divided into two groups accordingly to preoperative platelet counts (above and below 50,000/μL). Data were compared between both groups regarding postoperative complications including bleeding or catheter-related blood stream infections (CRBSIs). Results Forty-six CVC insertions were performed in 40 patients. There were 20 procedures below 50,000/μL (median 27,500; range 5000–42,000) inserted with perioperative platelet transfusions, and their postoperative levels were median 59,500/μL, range 18,000–88,000. Allogeneic BMT was adopted in 39 patients (97.5%). Beta thalassemia major was the commonest indication (21/40, 52.5%), followed by acute lymphocytic leukemia in six patients (15%). There were nine postoperative complications (bleeding n = 2 and CRBSIs n = 7) encountered in all placements. Four of them occurred in insertions below 50,000/μL (two bleeding complications that managed conservatively, and two CRBSIs). Post-procedural morbidities regarding bleeding or CRBSIs did not differ significantly between both groups (p value = 0.099 and 0.695, respectively). Conclusions Postponement of CVC insertions in thrombocytopenic children due to the fear of potential complications seems unwarranted, as it has no significant impact on the morbidity. Placements of such catheters can be safe under cover of perioperative platelet transfusions irrespective of the preoperative platelet count.

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Robotic Pneumonectomy for Lung Cancer: Perioperative Outcomes and Factors Leading to Conversion to Thoracotomy

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984520978227 ◽

2021 ◽

pp. 155698452097822

Author(s):

Byron D. Patton ◽

Daniel Zarif ◽

Donna M. Bahroloomi ◽

Iam C. Sarmiento ◽

Paul C. Lee ◽

...

Keyword(s):

Lung Cancer ◽

Statistical Significance ◽

Patient Characteristics ◽

Perioperative Outcomes ◽

Safe Procedure ◽

Open Approach ◽

Robotic Approach ◽

Robotic Group ◽

Robot Assisted ◽

Estimated Blood Loss

Objective In the tide of robot-assisted minimally invasive surgery, few cases of robot-assisted pneumonectomy exist in the literature. This study evaluates the perioperative outcomes and risk factors for conversion to thoracotomy with an initial robotic approach to pneumonectomy for lung cancer. Methods This study is a single-center retrospective review of all pneumonectomies for lung cancer with an initial robotic approach between 2015 and 2019. Patients were divided into 2 groups: surgeries completed robotically and surgeries converted to thoracotomy. Patient demographics, preoperative clinical data, surgical pathology, and perioperative outcomes were compared for meaningful differences between the groups. Results Thirteen total patients underwent robotic pneumonectomy with 8 of them completed robotically and 5 converted to thoracotomy. There were no significant differences in patient characteristics between the groups. The Robotic group had a shorter operative time ( P < 0.01) and less estimated blood loss ( P = 0.02). There were more lymph nodes harvested in the Robotic group ( P = 0.08) but without statistical significance. There were 2 major complications in the Robotic group and none in the Conversion group. Neither tumor size nor stage were predictive of conversion to thoracotomy. Conversions decreased over time with a majority occurring in the first 2 years. There were no conversions for bleeding and no mortalities. Conclusions Robotic pneumonectomy for lung cancer is a safe procedure and a reasonable alternative to thoracotomy. With meticulous technique, major bleeding can be avoided and most procedures can be completed robotically. Larger studies are needed to elucidate any advantages of a robotic versus open approach.

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Stent Embolization Mimicking Acute Myocardial Infarction

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/23247096211036537 ◽

2021 ◽

Vol 9 ◽

pp. 232470962110365

Author(s):

Syed Arqum Huda ◽

Sara Akram Kahlown ◽

Anojan Pathmanathan ◽

Muhammad Saad Farooqi ◽

Mark Charlamb

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Stent Migration ◽

Safe Procedure ◽

Significant Morbidity ◽

Fatal Complication ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Venous Stents

Venous thromboembolism is associated with significant morbidity and mortality if left untreated. Anticoagulation is the cornerstone of treatment. Venous stents are a relatively newer entity that are increasingly being used to treat venous stenosis/occlusion. It is a safe procedure, but complications include vein rupture, arterial puncture, retroperitoneal bleeding, and in-stent thrombosis. Stent migration is a rare but potentially fatal complication. We present a case of venous stent embolization to the heart that presented as a non-ST segment elevation myocardial infarction.

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