scholarly journals Recurrent epiphora after dacryocystorhinostomy surgery: Structural abnormalities identified with dacryocystography and long term outcomes of revision surgery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hannah M. Timlin ◽  
Swan Kang ◽  
Kailun Jiang ◽  
Daniel G. Ezra
Keyword(s):  
Flow Diagram ◽  
Decision Making Process ◽  
Success Rates ◽  
Long Term Outcomes ◽  
Nasal Sinus ◽  
Visual Tool ◽  
Structural Abnormalities ◽  
Postoperative Findings ◽  
Corrective Procedures

Abstract Background To investigate the aetiopathology of recurrent epiphora or stickiness after dacryocystorhinostomy (DCR) surgery, identifiable on dacryocystography (DCG), and to assess the success rates of secondary corrective surgeries. Methods Consecutive post-DCR DCG images from patients with recurrent symptoms were reviewed between 2012 and 2015. Results One hundred fifty-nine eyes of 137 patients were evaluated. Fifty-eight DCGs showed normal postoperative findings, 4 an upper/lower canalicular block, 13 a common canalicular block, 31 a completely closed anastomosis, 50 a narrow anastomosis, and 3 an anastomosis draining into a nasal sinus. The most successful corrective procedures for each failure category were: Lester Jones Tube (LJT) for a normal post-operative DCG (17/18 success), Sisler trephination with tubes for upper/lower canalicular block (1/2 success), redo-DCR with tube for common canalicular blockage (5/6 success), redo-DCR +/− tube for completely closed anastomosis (12/16 success), LJT followed by redo-DCR +/− tube for narrow surgical anastomosis (1/1 and 17/27 success respectively), and redo-external-DCR with tube for anastomosis into a nasal sinus (1/1 success). Redo-DCR was ineffective in patients who had good post-DCR anatomical patency (22% success). Conclusion This is the first study to report success rates of redo-DCR surgery according to anatomical findings confirmed by DCG. The outcome flow diagram help clinicians recommend procedures that are most likely to be successful for their patient’s specific anatomical abnormality. It also provides a visual tool for the shared decision-making process. Notably, symptomatic patients with a normal DCG post DCR are unlikely to benefit from redo-DCR, with a LJT being the recommended next step.

scholarly journals Recurrent Epiphora After Dacryocystorhinostomy Surgery: Structural Abnormalities Identified With Dacryocystography and Long Term Outcomes of Revision Surgery.

2021 ◽  
Author(s):  
Hannah Timlin ◽  
Swan Kang ◽  
Kailun Jiang ◽  
Daniel Ezra
Keyword(s):  
Flow Diagram ◽  
Decision Making Process ◽  
Success Rates ◽  
Long Term Outcomes ◽  
Nasal Sinus ◽  
Visual Tool ◽  
Structural Abnormalities ◽  
Postoperative Findings ◽  
Corrective Procedures

Abstract Background: To investigate the aetiopathology of recurrent epiphora or stickiness after dacryocystorhinostomy (DCR) surgery, identifiable on dacryocystography (DCG), and to assess the success rates of secondary corrective surgeries.Methods: Consecutive post-DCR DCG images from patients with recurrent symptoms were reviewed between 2012-2015.Results: 159 eyes of 137 patients were evaluated. 58 DCGs showed normal postoperative findings, 4 an upper/lower canalicular block, 13 a common canalicular block, 31 a completely closed anastomosis, 50 a narrow anastomosis, and 3 an anastomosis draining into a nasal sinus.The most successful corrective procedures for each failure category were: Lester Jones Tube (LJT) for a normal post-operative DCG (17/18 success), Sisler trephination with tubes for upper/lower canalicular block (1/2 success), redo-DCR with tube for common canalicular blockage (5/6 success), redo-DCR +/- tube for completely closed anastomosis (12/16 success), LJT followed by redo-DCR +/- tube for narrow surgical anastomosis (1/1 and 17/27 success respectively), and redo-external-DCR with tube for anastomosis into a nasal sinus (1/1 success). Redo-DCR was ineffective in patients who had good post-DCR anatomical patency (22% success).Conclusion: This is the first study to report success rates of redo-DCR surgery according to anatomical findings confirmed by DCG. The outcome flow diagram help clinicians recommend procedures that are most likely to be successful for their patient’s specific anatomical abnormality. It also provides a visual tool for the shared decision-making process. Notably, symptomatic patients with a normal DCG post DCR are unlikely to benefit from redo-DCR, with a LJT being the recommended next step.

Periprocedural and Long-Term Outcomes of Stent Implantation for De Novo Subclavian Artery Disease

2019 ◽  
Vol 53 (4) ◽  
pp. 284-291
Author(s):  
Hirokazu Onishi ◽  
Toru Naganuma ◽  
Koji Hozawa ◽  
Tomohiko Sato ◽  
Hisaaki Ishiguro ◽  
...  
Keyword(s):  
Subclavian Artery ◽  
Stent Implantation ◽  
De Novo ◽  
Clinical Success ◽  
Primary Patency ◽  
Success Rates ◽  
Long Term Outcomes ◽  
Procedural Success

Introduction: The purpose of the current study was to investigate the periprocedural and long-term outcomes of stent implantation for de novo subclavian artery (SCA) disease. Material and Methods: We retrospectively investigated consecutive patients with de novo SCA lesions undergoing elective endovascular therapy procedures at our center between April 2004 and September 2015. All patients were included in the analyses of periprocedural outcomes, including procedural and clinical success. Subsequently, patients who completed the clinical follow-up and were assessed with brachial systolic pressure differences between the diseased and the contralateral arms, or angiographic stenosis, after stent implantation with procedural success were included in the analyses of long-term outcomes, including primary patency. Results: There were 62 patients (median 71.0 years, interquartile range 65.3-76.0 years; 45 men) with 62 de novo SCA lesions included in the analyses of periprocedural outcomes. There were 46 stenoses (74.2%) and 16 occlusions (25.8%). Our results indicated high procedural success rates for overall (95.2%), stenotic (97.8%), and occlusive (87.5%) lesions. Similarly, high clinical success rates were observed for overall (91.9%), stenotic (93.5%), and occlusive (87.5%) lesions. The median follow-up time was 6.0 years (interquartile range, 2.6-8.3 years). There were 48 patients with 48 de novo SCA lesions included in the analyses of long-term outcomes. Primary patency estimates were 97.7% (1 year), 97.7% (3 years), 93.1% (5 years), and 87.6% (7 years). Also, we observed a high estimate for freedom from reintervention for the target vessel (93.8%). Conclusion: Stent implantation for de novo SCA disease can be performed successfully and safely with favorable periprocedural and long-term outcomes.

Impact of iliac arterial calcification on procedure success and long-term outcomes among patients undergoing endovascular intervention

Vascular ◽  
2021 ◽  
pp. 170853812110209
Author(s):  
Omer Tasbulak ◽  
Mustafa Duran ◽  
Tugba Aktemur ◽  
Arda Guler ◽  
Serkan Kahraman ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Strong Association ◽  
Endovascular Intervention ◽  
Arterial Calcification ◽  
Success Rates ◽  
Long Term Outcomes ◽  
Iliac Arteries ◽  
Artery Disease ◽  
The Impact

Objectives Vascular calcification is a well-known phenomenon and affects coronary and carotid arteries as well as other arterial beds. Presence of arterial calcification is associated with major adverse events in patients undergoing percutaneous coronary artery or carotid artery intervention. Even though there is a clear association between worse outcome and coronary-carotid calcification, there is no research that interrogated the relationship between iliac arterial calcification and clinical outcomes because of lack of data. Therefore, in this study, we aimed to investigate the impact of iliac arterial calcification on procedure success rates and long-term outcomes among patients undergoing endovascular intervention. Methods The records of 453 consecutive patients who underwent endovascular intervention due to symptomatic peripheral artery disease were analyzed. Patients were divided into two groups based on the presence or absence of heavy calcification of iliac arteries. For each group, technical aspects of procedures and subsequent clinical outcomes were analyzed. Results According to our study, the rate of restenosis following endovascular intervention at 6 and 12 months were similar between two groups. On the other hand, long-term restenosis was significantly higher in patients with heavy calcification of iliac arteries as compared to patients with low calcification on iliac arteries (32.2% vs. 12.8%, p <  0.05). Conclusions Our data showed that there was a strong association between heavy calcification of iliac arteries and long-term restenosis in patients undergoing endovascular intervention.

scholarly journals Long-Term Outcomes of Initial Trabeculectomy in Glaucoma Associated with Granulomatous and Non-Granulomatous Uveitis

2021 ◽  
Author(s):  
Faisal A. Almobarak ◽  
Ali H. Alharbi ◽  
Ibrahim Aljadaan ◽  
Hassan Aldhibi
Keyword(s):  
Intraocular Pressure ◽  
Postoperative Complications ◽  
Late Onset ◽  
Success Rates ◽  
Long Term Outcomes ◽  
Granulomatous Uveitis ◽  
The Mean ◽  
Retrospective Comparative Study

Abstract Purpose To evaluate the outcomes of initial trabeculectomy in granulomatous and non-granulomatous uveitis. Methods Retrospective comparative study of 68 eyes that underwent an initial trabeculectomy. Results The mean follow-up was 74.18 and 74.86 months in both groups (p = 0.95). The intraocular pressure decreased from 40.03 mmHg (± 7.2) and 36.48 mmHg (± 11.3) to 14.00 mmHg (± 6.2) and 13.48 mmHg (± 5.7), the number of medications decreased from 3.73 (± 0.7) and 3.58 (± 0.9) to 1.00 (± 1.4) and 1.13 (± 1.4) on the last follow-up (p < 0.01) in the granulomatous and non-granulomatous groups, respectively. More eyes in the granulomatous uveitis group developed delayed postoperative complications like cataract, transient hypotony and glaucoma progression. Success rates were 64.9 and 71.0%, while failure rates were 35.1 and 29.0% in both groups (p = 0.84). Conclusions Trabeculectomy seems to have comparable IOP control and survival in granulomatous and non-granulomatous uveitis. Nevertheless, more eyes in the granulomatous uveitis group developed late onset complications.

scholarly journals Friend Request Pending: A Comparative Assessment of Engineering- and Social Science–Inspired Approaches to Analyzing Complex Birth Cohort Survey Data

2019 ◽  
Vol 5 ◽  
pp. 237802311882043 ◽  
Author(s):  
Claudia V. Roberts
Keyword(s):  
Academic Achievement ◽  
Social Science ◽  
Variable Selection ◽  
Fragile Families ◽  
Decision Making Process ◽  
Long Term Outcomes ◽  
Science Data ◽  
Mass Collaboration ◽  
Social Science Data

The Fragile Families Challenge is a mass collaboration social science data challenge whose aim is to learn how various early childhood variables predict the long-term outcomes of children. The author describes a two-step approach to the Fragile Families Challenge. In step 1, a variety of fully automated approaches are used to predict child academic achievement. In total 124 models are fit, which involve most possible combinations of eight model types, two imputation strategies, two standardization approaches, and two automatic variable selection techniques using two different thresholds. Then, in step 2, an attempt is made to improve on the results from step 1 with manual variable selection on the basis of a detailed review of the codebooks. A total of 3,694 variables believed to be predictive of academic achievement, using a comprehensive review of student success literature to guide the decision-making process, were manually selected. The best models from step 1 were reestimated using the manually selected variables. The results show that manual variable selection improved the majority of the top 10 models in step 1 but did not improve the best of the top 10. The results indicate that variable selection inspired by social science methodologies can, in most cases, significantly improve models trained completely automatically.

scholarly journals Endoscopic ultrasound-directed transgastric ERCP (EDGE): a retrospective multicenter study

Endoscopy ◽  
2020 ◽  
Author(s):  
Thomas M. Runge ◽  
Austin L. Chiang ◽  
Thomas E. Kowalski ◽  
Theodore W. James ◽  
Todd H. Baron ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Success Rates ◽  
Long Term Outcomes ◽  
Gastrointestinal Series ◽  
Objective Testing ◽  
Endoscopic Closure ◽  
Retrospective Multicenter Study

Abstract Background Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP; EDGE) is an alternative to enteroscopy- and laparoscopy-assisted ERCP in patients with Roux-en-Y gastric bypass anatomy. Although short-term results are promising, the long-term outcomes are not known. The aims of this study were: (1) to determine the rates of long-term adverse events after EDGE, with a focus on rates of persistent gastrogastric or jejunogastric fistula; (2) to identify predictors of persistent fistula; (3) to assess the outcomes of endoscopic closure when persistent fistula is encountered. Methods This was a multicenter retrospective study involving 13 centers between February 2015 and March 2019. Adverse events were defined according to the ASGE lexicon. Persistent fistula was defined as an upper gastrointestinal series or esophagogastroduodenoscopy showing evidence of fistula. Results 178 patients (mean age 58 years, 79 % women) underwent EDGE. Technical success was achieved in 98 % of cases (175/178), with a mean procedure time of 92 minutes. Periprocedural adverse events occurred in 28 patients (15.7 %; mild 10.1 %, moderate 3.4 %, severe 2.2 %). The four severe adverse events were managed laparoscopically. Persistent fistula was diagnosed in 10 % of those sent for objective testing (9/90). Following identification of a fistula, 5 /9 patients underwent endoscopic closure procedures, which were successful in all cases. Conclusions The EDGE procedure is associated with high clinical success rates and an acceptable risk profile. Persistent fistulas after lumen-apposing stent removal are uncommon, but objective testing is recommended to identify their presence. When persistent fistulas are identified, endoscopic treatment is warranted, and should be successful in closing the fistula.

Tooth-Implant Connection: A Review

2012 ◽  
Vol 38 (2) ◽  
pp. 194-200 ◽  
Author(s):  
Oliver Hoffmann ◽  
Gregory-George Zafiropoulos
Keyword(s):  
Clinical Studies ◽  
Biomechanical Study ◽  
Force Distribution ◽  
Success Rates ◽  
Long Term Outcomes ◽  
Long Term Stability ◽  
Manual Search ◽  
Rigid Connection ◽  
Natural Teeth

The aim of this review was to assess the long-term outcomes of restorations supported by implants and natural teeth with regard to complications associated with implants, teeth, and restorations, as well as the influence on these parameters of the connector type used. A net-based search in PubMed was combined with a manual search. Clinical studies, reviews, and biomechanical studies were included. Information on survival rate, complication rate, incidence of tooth intrusion, and, where applicable, type of connector used, was retrieved from the clinical studies. Force distribution and types of connectors used were retrieved from the biomechanical study. A summary of outcomes was retrieved from the reviews. A total of 25 articles were selected for inclusion in this review, including clinical studies (15), biomechanical studies (7), and reviews (3). Implant success rates ranged from 79.5%–100%. Tooth complications occurred in 5.4%–11.8% of cases. Complications in the suprastructure were observed in 5%–90% of cases. Tooth intrusion presented in a total of 0%–66% of all cases, more often in cases with nonrigid connection (0%–66%) than in cases with rigid connection (0%–44%). Biomechanical studies show a large difference in stress distribution and in dependence on the type of connector used, with most studies demonstrating that nonrigid connectors drastically reduce stress on the suprastructure while increasing forces on supporting teeth and implants. Long-term success rates for tooth-implant connections are lower than for solely implant-supported restorations with regard to prognosis for teeth, implants, and suprastructure. Use of rigid connectors leads to more favorable clinical outcomes in terms of long-term stability, occurrence of complications, and tooth intrusion.

Endoscopic-Powered Dacryocystorhinostomy Without Stenting: Long-term Outcomes of 120 Procedures

2018 ◽  
Vol 32 (4) ◽  
pp. 303-309 ◽  
Author(s):  
Ejder Ciğer ◽  
Mustafa K. Balci ◽  
Seçil Arslanoğlu ◽  
Erdem Eren
Keyword(s):  
Functional Outcomes ◽  
Nasolacrimal Duct ◽  
Long Term Results ◽  
Success Rates ◽  
Long Term Outcomes ◽  
Duct Obstruction ◽  
The Mean ◽  
Anatomical Success

Background The necessity of silicone stenting in endoscopic dacryocystorhinostomy (DCR) procedures is a controversial subject in the literature. Objective The purpose of the present study is to assess the long-term anatomical and functional outcomes of endoscopic-powered DCR (EP-DCR) without stenting or mucosal flaps. Methods One hundred twenty EP-DCR procedures were performed in 107 patients. Anatomical success was defined as a patent ostium on irrigation and functional success as free flow of dye from the ostium and resolution of epiphora. Results The mean follow-up was 46.5 months (range: 24–87). Of the 120 procedures, 13 were bilateral and 94 were unilateral. Anatomical and functional success rates of 92.5% were obtained. Conclusion EP-DCR without stenting is a safe and economic technique that provides satisfactory long-term results and could be considered as the treatment of choice for patients with postsaccal nasolacrimal duct obstruction.

scholarly journals The self’s choice: Priming attentional focus on bodily self promotes loss frequency bias

2021 ◽  
Author(s):  
Valeria Sebri ◽  
Stefano Triberti ◽  
Gabriella Pravettoni
Keyword(s):  
Decision Making ◽  
Iowa Gambling Task ◽  
Attentional Focus ◽  
The Body ◽  
Future Research ◽  
Decision Making Process ◽  
Long Term Outcomes ◽  
Decision Making Processes ◽  
Multiple Conditions

AbstractWhen attention is focused on self representation(s), the ability to evaluate one’s internal sensations is enhanced, according to previous research by Ainley and colleagues (Consciousness and Cognition, 22(4), 1231–1238, 2013). Self-representations are usually distinguished between bodily and narrative. Both bodily and narrative representations improve decision-making processes, in that the consideration of alternatives is informed by sensations experienced deep inside the body (e.g., anxiety) as suggest by the literature (Noël, Brevers & Bechara in Frontiers in Psychiatry, 4, 179,  2013). The objective of the present study is to analyze the decision-making process in multiple conditions of stimulated self-representations. Participants played the Iowa Gambling Task three times (a baseline without stimuli and two randomly ordered stimulations to prime bodily and narrative self-representations). While no significant differences emerged regarding advantageous choices, participants showed loss frequency bias in the condition with bodily-self representation priming. Two interpretations are proposed: bodily-self focus acted as a distractor diminishing participants’ commitment to long term outcomes or enhanced interoception promoted aversion to losses. Directions are given for future research and clinical implications.

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