scholarly journals Laparoscopic T-Plasty for the Treatment of Refractory Bladder Neck Stenosis

2019 ◽  
Vol 13 (5) ◽  
pp. 155798831987351
Author(s):  
Hui-Quan Shu ◽  
Lin Wang ◽  
Chong-Rui Jin ◽  
Xiao-Yong Hu ◽  
Jie Gu ◽  
...  
Keyword(s):  
Bladder Neck ◽  
Case Series ◽  
Free Flaps ◽  
Anterior Wall ◽  
Successful Outcome ◽  
Open Approach ◽  
External Urethral Sphincter ◽  
Voiding Difficulty ◽  
Effective Option

Preliminary results of a case series on refractory bladder neck stenosis treated with laparoscopic T-plasty are presented in this article. This study retrospectively identified nine patients with refractory bladder neck stenosis aged 60 to 80 years between May 2016 and December 2017, who had undergone laparoscopic T-plasty. All patients presented voiding difficulty and failed after two or more prior endoscopic treatments. Laparoscopic T-plasty was performed by incising the anterior wall of the bladder neck in a T-shaped manner and creating two well-vascularized and tension-free flaps, which offer the possibility to reconstruct a wide bladder neck. After a mean follow-up of 14.7 months (ranging 3–22 months), a successful outcome was achieved in eight patients without incontinence secondary to surgery. Recurrent voiding difficulty developed in one patient, which was cured after a following endoscopic treatment. Through these nine patients, a preliminary conclusion can be drawn that a wider bladder neck can be obtained through modified YV-reconstruction of the bladder neck, while avoiding external urethral sphincter injury. And laparoscopic T-plasty has clear advantages compared with an open approach. It is an available and effective option for refractory bladder neck stenosis.

Clinical Outcomes of Percutaneous Plantar Fasciotomy Using Microdebrider Coblation Wand

2019 ◽  
Vol 41 (2) ◽  
pp. 187-192
Author(s):  
Ricardo E. Colberg ◽  
Monte Ketchum ◽  
Avani Javer ◽  
Monika Drogosz ◽  
Melissa Gomez ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Plantar Fasciitis ◽  
Case Series ◽  
Successful Outcome ◽  
Oral Steroid ◽  
Tarsal Tunnel ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Plantar Fasciotomy

Background: Plantar fasciitis is the most common cause of heel pain in adults. Multiple conservative treatment plans exist; however, some cases do not obtain significant clinical improvement with conservative treatment and require further intervention. This retrospective case study evaluated the success rate of percutaneous plantar fasciotomy and confounding comorbidities that negatively affect outcomes. Methods: A series of 41 patients treated with percutaneous plantar fasciotomy using the Topaz EZ microdebrider coblation wand were invited to participate in this retrospective follow-up study, and 88% ( N = 36) participated. A limited chart review was completed and the patients answered a survey with the visual analog scale (VAS) for pain and the Foot and Ankle Ability Measure (FAAM) questionnaire. Average outcomes were calculated and 45 variables were analyzed to determine if they were statistically significant confounders. Patients had symptoms for an average of 3 years before the procedure and were contacted for follow-up at an average of 14 months after the procedure. Results: The average VAS for pain score was 1.3 ± 1.8 and the average FAAM score was 92 ± 15. Eighty-nine percent of patients had a successful outcome, defined as FAAM greater than 75. In addition, patients at 18 months postprocedure reported complete or near-complete resolution of symptoms with an FAAM score greater than 97. Concurrent foot pathologies (eg, tarsal tunnel syndrome), oral steroid treatment prior to the procedure, and immobilization with a boot prior to the procedure were statistically significant negative confounders ( P < .05). Being an athlete was a positive confounder ( P = .02). Conclusion: Percutaneous plantar fasciotomy using a microdebrider coblation was an effective treatment for plantar fasciitis, particularly without concurrent foot pathology, with a low risk of complications. Level of Evidence: Level IV, retrospective case series.

Closure of Nasal Septal Perforations with a Polydioxanone Plate and Temporoparietal Fascia in a Closed Approach

2017 ◽  
Vol 31 (3) ◽  
pp. 190-195 ◽  
Author(s):  
Lorenz Epprecht ◽  
Christoph Schlegel ◽  
David Holzmann ◽  
Michael Soyka ◽  
Thomas Kaufmann
Keyword(s):  
Case Series ◽  
Invasive Technique ◽  
Flexible Plate ◽  
Open Approach ◽  
Septal Perforation ◽  
Temporoparietal Fascia ◽  
Closed Approach ◽  
First Time ◽  
Septal Perforations

Background Septal perforation closure is still often invasive and complex, with relatively low closure rates. Objectives We aimed to provide the first results of a case series of 20 patients with nasal septal perforations who underwent septal perforation repair by both an open and a minimally invasive technique by using a graft that consisted of temporoparietal fascia and a polydioxanone (PDS) plate without mucosal flaps. Between 2014 and 2016, we tested, for the first time, the feasibility of the insertion of this graft via a hemitransfixion incision at our institution. The rationale for the closed approach was to avoid any visible nasal scars. We reported our results of both approaches. Methods The septal perforations were closed by insertion of a graft, which consisted of a 0.25-mm PDS flexible plate enveloped by temporoparietal fascia, into the perforation. The insertion of the graft was performed either via a columellar incision (open approach) or via a cosmetically advantageous hemitransfixion incision (closed approach) in an underlay technique. No attempts were made to close the perforation by mucosal flap rotation and/or advancement. Protective silastic sheeting to both sides of the perforation provided fixation to the graft while natural mucosal healing occurred over the perforation in the course of 3 to 8 weeks. Results Eighteen of 20 perforations were closed by mucosa at the last follow-up. The mean follow-up was 8.7 months. Thirteen patients had surgery via the closed approach. Conclusion We showed, for the first time, that the insertion of a graft that consisted of a PDS flexible plate enveloped in temporoparietal fascia via a hemitransfixion incision was feasible and resulted in complete mucosal closure of nasal septal perforations in most patients. By performing the hemitransfixion incision, we avoided any visible nasal scars.

scholarly journals LAPAROSCOPIC DISTAL PANCREATECTOMY WITH SPLEEN PRESERVATION

2018 ◽  
Vol 31 (3) ◽  
Author(s):  
Sergio Renato PAIS-COSTA ◽  
Guilherme Costa Crispim de SOUSA ◽  
Sergio Luiz Melo ARAUJO ◽  
Olímpia Alves Teixeira LIMA
Keyword(s):  
Distal Pancreatectomy ◽  
Case Series ◽  
Laparoscopic Distal Pancreatectomy ◽  
Infectious Complications ◽  
Neoplasm Recurrence ◽  
Open Approach ◽  
Spleen Preservation ◽  
Long Term Outcome

ABSTRACT Background: Laparoscopic distal pancreatectomy has been the choice for resection of distal pancreas lesions due many advantages over open approach. Spleen preservation technique seems minimizes infectious complications in long-term outcome. Aim: To present the results of laparoscopic distal pancreatectomies with spleen preservation by Kimura´s technique (preservation of spleen blood vessels) performed by single surgical team. Methods: Retrospective case series aiming to evaluate both short and long-term outcomes of laparoscopic distal pancreatectomies with spleen preservation. Results: A total of 54 laparoscopic distal pancreatectomies were performed, in which 26 were laparoscopic distal pancreatectomies with spleen preservation by Kimura´s technique. Mean age was 47.9 years-old (21-75) where 61.5% were female. Mean BMI was 28.5 kg/m² (18-38.8). Mean diameter of lesion was 4.3 cm (1.8-7.5). Mean operative time was 144.1 min (90-200). Intraoperative bleeding was 119.2 ml (50-600). Conversion to laparotomy 3% (n=1). Postoperative morbidity was 11.5%. Postoperative mortality was null. Mean of hospital stay was 4.8 days (2-14). Mean time of follow-up period was 19.7 months (2-60). There was no neoplasm recurrence or mortality on evaluated period. There was no infectious complication. Conclusion: Laparoscopic distal pancreatectomy with spleen and splenic vessels preservation is feasible, safe, and effective procedure. This technique presented both low morbidity and null mortality on this sample. There were neither infectious complications nor neoplasm recurrence on long-term follow-up period.

Mini-Open Medial Reefing and Arthroscopic Lateral Release for the Treatment of Recurrent Patellar Dislocation

2005 ◽  
Vol 33 (2) ◽  
pp. 220-230 ◽  
Author(s):  
Ellis K. Nam ◽  
Ronald P. Karzel
Keyword(s):  
Case Series ◽  
Lateral Release ◽  
Open Approach ◽  
Level Of Evidence ◽  
Age At Surgery ◽  
Postoperative Dislocation ◽  
Tegner Score ◽  
Anatomical Restoration ◽  
Mini Open

Background: Although recurrent patellar dislocations are not uncommon, their pathophysiology and treatment are controversial. Hypothesis Stabilization of recurrent patellar dislocations can be successfully managed with a mini-open approach. Study Design Case series; Level of evidence, 4. Methods Twenty-two patients (23 knees) underwent a mini-open medial reefing and arthroscopic lateral release for the treatment of recurrent patellar dislocations with an average follow-up of 4.4 years (range, 1.4-14 years). The average age at the first dislocation was 15 years (range, 5-26 years), and the average age at surgery was 23 years (range, 12-65 years). Results There was 1 postoperative dislocation (4%) and 1 recurrent subluxation (4%). The average Kujala knee score was 88.2 ± 13.5, with overall good scores in each category. The lowest scores involved squatting (5.7), abnormal painful kneecap movements (subluxations) (7.1), and jumping (7.9). Overall, there was a statistically significant improvement in the Tegner score from 3.7 ± 1.8 before surgery to 6.9 ± 2.0 after surgery (P<. 001). Six knees (26%) were rated subjectively as excellent, 15 (65%) as good, 2 (9%) as fair, and 0 (0%) as poor. All 22 patients (100%) stated that the procedure was worthwhile. Radiographically, there was a statistically significant improvement in the congruence angle (normal, –8.0°± 6.0°) from 15.7°± 12.6° (range, 0.0° to +44.0°) before surgery to –11.5°± 8.7° (range, –20.0° to +10.0°) after surgery (P<. 001) and in the lateral patellofemoral angle (normal, > 0°) from –0.2°± 6.4° (range, –10° to +8°) before surgery to 7.9°± 2.6° (range, 0.0° to +11.0°) after surgery (P<. 001). Conclusion Our mini-open technique provides anatomical restoration with limited morbidity and cosmetically appealing results. Furthermore, our redislocation rates compare favorably with traditional, more extensile open approaches.

scholarly journals Maintainence Treatment of Opioid Dependence with Tramadol

2017 ◽  
Vol 08 (S 01) ◽  
pp. S098-S101
Author(s):  
Siddharth Sarkar ◽  
Mohit Varshney ◽  
Vaibhav Patil ◽  
Rakesh Lal
Keyword(s):  
Opioid Dependence ◽  
Case Series ◽  
New Delhi ◽  
Medical Sciences ◽  
National Drug ◽  
Effective Option ◽  
Treatment Centre ◽  
Complete Abstinence

ABSTRACT Background: Although tramadol has been used in the management of acute withdrawal in patients with opioid dependence, its use for maintenance treatment as a harm reduction approach has not been assessed systematically. This case series describes patients with opioid dependence who were treated with tramadol for long-term maintenance. Methods: Patients with opioid dependence who received treatment at the National Drug Dependence Treatment Centre of All India Institute of Medical Sciences, New Delhi, were included in the study. Patients who received at least 6 months of tramadol and had follow-up adherence of more than 80% were included in the case series. Results: A total of 25 cases were included, all of whom were males. The types of opioids being taken at the time of initiation of tramadol were natural opiates (poppy husk and raw opium), followed by heroin. The median dose of tramadol at initiation and maintenance was 300 mg/day. Nineteen patients were able to achieve complete abstinence to other opiates on tramadol. Conclusion: Tramadol may be an effective option in the long-term management of patients with opioid dependence. Further studies are required for establishing the efficacy of tramadol for agonist management of patients with opioid dependence.

scholarly journals Treatment of fracture-related infection of the lower extremity with antibiotic-eluting ceramic bone substitutes: case series of 35 patients and literature review

Infection ◽  
2020 ◽  
Vol 48 (3) ◽  
pp. 333-344 ◽  
Author(s):  
Sebastian Pesch ◽  
Marc Hanschen ◽  
Frederik Greve ◽  
Michael Zyskowski ◽  
Fritz Seidl ◽  
...  
Keyword(s):  
Literature Review ◽  
Task Force ◽  
Distal Tibia ◽  
Case Series ◽  
Free Flaps ◽  
Bone Substitutes ◽  
Consensus Conference ◽  
Non Union ◽  
The Mean

Abstract Introduction The current treatment concepts of fracture-related infection (FRI) [Consensus Conference (Anti-Infection Task Force (AITF)) on the definition of acute or chronic osteomyelitis (cOM)] are associated with unsolved challenges and problems, underlining the need for ongoing medical research. Method Literature review of treatments for FRI and description of own cases. Results We could include eight papers with 394 patients reporting treatments and outcome in FRI. The infection was resolved in 92.9% (mean) of all treatments. The mean follow-up was 25 months with a persistent non-union in 7% of the patients. We diagnosed 35 (19f/16m; 56.4 ± 18.6 years) patients with bone infections anatomically allocated to the proximal and distal femur (12×), the pelvis (2×), distal tibia (3×), tibial diaphysis (11×), the ankle joint (4×) and calcaneus (3×). These 35 patients were treated (1) with surgical debridement; (2) with antibiotic-eluting ceramic bone substitutes; (3) bone stabilization (including nail fixation, arthrodesis nails, plates, or external ring fixation), (4) optionally negative pressure wound therapy (NPWT) and (5) optionally soft tissue closure with local or free flaps. The mean follow-up time was 14.9 ± 10.6 months (min/max: 2/40 month). The overall recurrence rate is low (8.5%, 3/35). Prolonged wound secretion was observed in six cases (17.1%, 6/35). The overall number of surgeries was a median of 2.5. Conclusion The results in the literature and in our case series are explicitly promising regarding the treatment of posttraumatic fracture-related infection.

Treatment of Ruptured Intracranial Aneurysms With the Pipeline Embolization Device

Neurosurgery ◽  
2014 ◽  
Vol 76 (2) ◽  
pp. 165-172 ◽  
Author(s):  
Nohra Chalouhi ◽  
Mario Zanaty ◽  
Alex Whiting ◽  
Stavropoula Tjoumakaris ◽  
David Hasan ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Case Series ◽  
Invasive Procedure ◽  
Complication Rates ◽  
Pipeline Embolization Device ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Effective Option ◽  
Ruptured Intracranial Aneurysms

ABSTRACT BACKGROUND: The pipeline embolization device (PED) has been used for treatment of unruptured aneurysms. Little is known about the use of the PED in ruptured aneurysms. OBJECTIVE: To assess the safety and efficacy of the PED in ruptured intracranial aneurysms. METHODS: This is a case series with prospective data collection on 20 patients with freshly ruptured aneurysms who were treated with PED (with or without adjunctive coiling) at 2 cerebrovascular centers. Patients were loaded with aspirin and clopidogrel or received an infusion of tirofiban intraoperatively. RESULTS: Hunt and Hess grades were I in 7 patients (35%), II in 9 (45%), and III in 4 (20%). The mean duration from hemorrhage to PED placement was 7 ± 7.0 days. A single device was used in all but 1 patient (95%). The procedure was staged in 20%. There was only 1 complication (5%); this was a fatal intraoperative aneurysm dome rupture that occurred during adjunctive coil deployment. Adjunctive coiling was used in 30%. No patient required an invasive procedure after PED placement. Follow-up angiography (mean, 5.3 ± 4.2 months; range, 2-12 months) showed 100% occlusion in 12 (80%) and incomplete occlusion in 3 patients (20%). At latest follow-up, 19 patients achieved a favorable outcome (modified rankin scale 0–2). CONCLUSION: In our preliminary experience, treatment of ruptured aneurysms with the PED was associated with low complication rates, high occlusion rates, and favorable outcomes. These findings suggest that PED may be a safe and effective option for patients with favorable Hunt and Hess grades and aneurysms difficult to treat with conventional methods.

scholarly journals Surgical Management of Orbital Abscesses in Domestic Rabbits (Oryctolagus cuniculus): A report of seven cases

2020 ◽  
Vol 71 (3) ◽  
pp. 2251
Author(s):  
ALN THOMAS ◽  
GM KAZAKOS ◽  
D. PARDALI ◽  
MN PATSIKAS ◽  
A. TH. KOMNENOU
Keyword(s):  
Surgical Management ◽  
Pasteurella Multocida ◽  
Case Series ◽  
Successful Outcome ◽  
Abscess Drainage ◽  
Ocular Symptoms ◽  
Domestic Rabbits ◽  
Lost To Follow Up ◽  
Staphylococcus Spp

A case series of seven domestic rabbits with profound exophthalmos and epiphora are presented. Appetite and physical activity of the animals were mildly or severely reduced. Clinical and detailed ophthalmic examination including intraocular pressure measurements were performed, along with radiographic and ultrasonographic examination. In all animals retrobulbar masses were diagnosed forcing the globe to protrude. Teeth malocclusion was also noticed in most of the animals. Surgical intervention under general anaesthesia, included abscess drainage,flushing and teeth removal. During surgery, samples for bacterial culture and cytology exanimation were obtained. Pasteurella multocida, Staphylococcus spp and Pseudomonas spp were isolated, while cytology confirmed the clinical diagnosis of abscess formation. Surgical management resulted in retropulsion of ocular bulbi and infection elimination. Marsupialization of the abscesses facilitated flushing and topical antibiotic application postoperatively. Animals were treated postoperatively with antibiotics for at least one month, analgesics, daily wound flushing by the owner and regular debridement. Six months after surgery three rabbits had no ocular symptoms while two died in the first two months post surgically, one was lost to follow up and the other died due to unrelated cause. In conclusion, treatment of retrobulbar abscesses in rabbits may be challenging and unrewarding. Surgical management of retrobulbar abscesses without enucleation is a feasible approach, permitting vision-retaining, whereas a multimodal approach consisting of a combination of surgical and medical treatment is often necessary for a successful outcome. Τhe owner should be informed for the long lasting postoperative care as well as the high percentage of relapse.

Simple limbal epithelial transplantation (SLET) in failed cultivated limbal epithelial transplantation (CLET) for unilateral chronic ocular burns

2018 ◽  
Vol 102 (12) ◽  
pp. 1640-1645 ◽  
Author(s):  
Sayan Basu ◽  
Sashwanthi Mohan ◽  
Swapnil Bhalekar ◽  
Vivek Singh ◽  
Virender Sangwan
Keyword(s):  
Case Series ◽  
Primary Outcome Measure ◽  
Successful Outcome ◽  
Kaplan Meier ◽  
Limbal Stem Cell ◽  
Prospective Case Series ◽  
Ocular Burns ◽  
Cultivated Limbal Epithelial Transplantation ◽  
Better Than

AimsCultivated limbal epithelial transplantation (CLET) fails in around 20%–30% of cases. This study aimed to report the clinical outcomes of autologous simple limbal epithelial transplantation (SLET) in eyes with recurrent unilateral limbal stem cell deficiency (LSCD) due to failure of CLET.MethodsThis was a prospective case series which included 30 eyes of 30 patients who underwent SLET between 2010 and 2016 after failure of one (n=24) or two (n=6) previous CLET procedures for chronic unilateral ocular burns. The primary outcome measure was success of SLET defined on the basis of relative improvement in five objective criteria: best corrected visual acuity (BCVA), and grades of symblepharon, corneal conjunctivalisation, vascularisation and opacification.ResultsAt a mean follow-up of 2.3 years, 24 (80%) of the 30 eyes maintained a successful outcome. Kaplan-Meier analysis showed a 5-year survival probability of 77%±8%. At 1 year postoperatively statistically significant improvement was noted in BCVA (logarithm of the minimum angle of resolution of 3 to 1) and in the median grades of corneal conjunctivalisation (2 to 0), vascularisation (2 to 0) and opacification (2 to 1) (P≤0.0026). In 62.5% of successful cases, BCVA improved to 20/200 or better. The success rate of SLET in failed CLET was better than that of repeat CLET (53.5%, P=0.011). None of the donor eyes developed any complications.ConclusionSLET is an effective alternative to CLET in eyes with recurrence of LSCD after previously failed CLET procedures. Since SLET is single-staged and less expensive, it is probably preferable to repeating CLET.

scholarly journals Closed Chest Convergent Epicardial–Endocardial Ablation of Non-paroxysmal Atrial Fibrillation – A Case Series and Literature Review

2013 ◽  
Vol 2 (1) ◽  
pp. 65 ◽  
Author(s):  
Amit J Thosani ◽  
Paul Gerczuk ◽  
Emerson Liu ◽  
William Belden ◽  
Robert Moraca ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Multidisciplinary Approach ◽  
Case Series ◽  
Closed Chest ◽  
Effective Option ◽  
Long Term Follow Up ◽  
Cardiac Surgeon ◽  
Magnetic Resonance Imaging Mri

The closed chest convergent procedure is a multidisciplinary approach to atrial fibrillation (AF) treatment. Epicardial posterior left atrial (PLA) ablation is performed by a cardiac surgeon using a transdiaphragmatic endoscope, immediately followed by percutaneous pulmonary vein (PV) isolation performed by a cardiac electrophysiologist. Interim outcomes for the treatment of non-paroxysmal AF (NPAF) were evaluated based on peri-procedural safety and complications, freedom from recurrent AF, and need for cardioversion or repeat catheter ablation at three, six and 12 months post-procedure. A total of 43 patients (86 % NPAF) underwent the convergent procedure. Patients were 84 % male, with mean age 58.6 ± 8.7 years. Mean AF duration was 45.4 ± 40.3 months. Pre-procedure left atrium (LA) volumetric data using cardiac magnetic resonance imaging (MRI) or computed tomography (CT) was available for 30 patients (70 %). Average LA volume was 155.5 ± 48.4 millilitres (ml); two-thirds of patients had a LA volume >130 ml. There was no operative or peri-operative mortality. Sinus rhythm (SR) was recorded at three months in 31 of 39 (79 %) patients, at six months in 24 of 27 (89 %) patients and at 12 months in nine patients. The convergent procedure is a safe and effective option for both PV isolation and PLA substrate ablation in NPAF patients. Long-term follow-up is required and randomised clinical trials warranted.

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