All –arthroscopic Repair of Atzei Class II and III Triangular Fibrocartilage Complex Tears Using the Fast-fix Suture Device

Abstract BackgroundThe study is aimed to propose an arthroscopic repair technique using a pre-tied suture device for peripheral TFCC tear with proximal component involvement.Methods Through a retrospective review in the medical records of patients who underwent unilateral arthroscopic repair for TFCC Palmer IB lesion between 2017 and 2019, 12 patients were arthroscopically diagnosed as proximal component tear and received more than one year follow-up postoperatively. The arthroscope was introduced from 6R portal to discriminate Atzei class II from III lesions by a “visualization test”, and to supervise the repair procedure using pre-tied FasT-Fix suture device from 3-4 portal. Two poly-ether-ether-ketone (PEEK) blocks were further advanced along the device needle to finally seat outside the ulnar joint capsule, followed by gradually tightening the pre-tied suture loop until the TFCC periphery was securely repositioned and held stably. Results Operation time averaged 87 minutes. Four patients were diagnosed to be Atzei class II lesion as full thickness tear of distal component was arthroscopically identified from 6R portal while the other 8 exhibited partial thickness tear and were categorized as class III lesion. Follow-up averaged 15 months with a range of 12 to 24 months. Myao modified wrist score improved from 61.3 preoperatively to 90.4 at the latest visit. Conclusion A novel technique for diagnosis and all-arthroscopic repair in TFCC Atzei class II and III lesions using a pre-tied suture device is a feasible and safe option with promising results.

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All-Arthroscopic Repair of Atzei Class II and III Triangular Fibrocartilage Complex Tears Using the FasT-Fix Suture Device

10.21203/rs.3.rs-61557/v1 ◽

2020 ◽

Author(s):

Mengchun Tsai ◽

Yi-Hsuan Lin ◽

Chih-Hao Chiu ◽

Chun-Ying Cheng ◽

Yi-Sheng Chan ◽

...

Keyword(s):

Operation Time ◽

Class Ii ◽

Arthroscopic Repair ◽

Class Iii ◽

Poly Ether Ether Ketone ◽

Repair Procedure ◽

Triangular Fibrocartilage ◽

One Year ◽

Suture Device

Abstract Background The study is aimed to propose an arthroscopic repair technique using a pre-tied suture device for peripheral TFCC tear with proximal component involvement. Methods Through a retrospective review in the medical records of patients who underwent unilateral arthroscopic repair for TFCC Palmer IB lesion between 2017 and 2019, 12 patients were arthroscopically diagnosed as proximal component tear and received more than one year follow-up postoperatively. The arthroscope was introduced from 6R portal to discriminate Atzei class II from III lesions by a “visualization test”, and to supervise the repair procedure using pre-tied FasT-Fix suture device from 3–4 portal. Two poly-ether-ether-ketone (PEEK) blocks were further advanced along the device needle to finally seat outside the ulnar joint capsule, followed by gradually tightening the pre-tied suture loop until the TFCC periphery was securely repositioned and held stably. Results Operation time averaged 87 minutes. Four patients were diagnosed to be Atzei class II lesion as full thickness tear of distal component was arthroscopically identified from 6R portal while the other 8 exhibited partial thickness tear and were categorized as class III lesion. Follow-up averaged 15 months with a range of 12 to 24 months. Myao modified wrist score improved from 61.3 preoperatively to 90.4 at the latest visit. Conclusions A novel technique for diagnosis and all-arthroscopic repair in TFCC Atzei class II and III lesions using a pre-tied suture device is a feasible and safe option with promising results.

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All-arthroscopic repair of Atzei class II and III triangular fibrocartilage complex tears using the FasT-Fix suture device

10.21203/rs.3.rs-61557/v3 ◽

2020 ◽

Author(s):

Mengchun Tsai ◽

Yi-Hsuan Lin ◽

Chih-Hao Chiu ◽

Chun-Ying Cheng ◽

Yi-Sheng Chan ◽

...

Keyword(s):

Operation Time ◽

Class Ii ◽

Triangular Fibrocartilage Complex ◽

Arthroscopic Repair ◽

Class Iii ◽

Modified Technique ◽

Repair Procedure ◽

Triangular Fibrocartilage ◽

Suture Device

Abstract Background The study is aimed to propose an arthroscopic repair technique using a pre-tied suture device for peripheral TFCC (triangular fibrocartilage complex) tear with proximal component involvement. Methods Through a retrospective review in the medical records of patients who underwent unilateral arthroscopic repair for TFCC Palmer IB lesion between 2017 and 2019, 12 patients were arthroscopically diagnosed as proximal component tear and received more than one year follow-up postoperatively. The arthroscope was introduced from 6R portal to discriminate Atzei class II from III lesions by a “visualization test”, and to supervise the repair procedure using pre-tied FasT-Fix suture device from 3-4 portal. Two poly-ether-ether-ketone (PEEK) blocks were further advanced along the device needle to finally seat outside the ulnar joint capsule, followed by gradually tightening the pre-tied suture loop until the TFCC periphery was securely repositioned and held stably. Results Operation time averaged 87 minutes. Hook test and DRUJ arthroscopy confirmed proximal component tear in all 12 wrists.Four patients were diagnosed to be Atzei class II lesion as full thickness tear of distal component was arthroscopically identified from 6R portal while the other 8 exhibited partial thickness tear and were categorized as class III lesion. Follow-up averaged 15 months with a range of 12 to 24 months. Mayo modified wrist score improved from an average of 61.3 preoperatively to 90.4 at the latest visit. Conclusions A modified technique for diagnosis and all-arthroscopic repair in TFCC Atzei class II and III lesions using a pre-tied suture device is a feasible and safe option with promising results.

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All-arthroscopic repair of Atzei class II and III triangular fibrocartilage complex tears using the FasT-Fix suture device

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02046-1 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Mengchun Tsai ◽

Yi-Hsuan Lin ◽

Chih-Hao Chiu ◽

Chun-Ying Cheng ◽

Yi-Sheng Chan ◽

...

Keyword(s):

Operation Time ◽

Class Ii ◽

Triangular Fibrocartilage Complex ◽

Arthroscopic Repair ◽

Class Iii ◽

Modified Technique ◽

Repair Procedure ◽

Triangular Fibrocartilage ◽

Suture Device

Abstract Background The study is aimed to propose an arthroscopic repair technique using a pre-tied suture device for peripheral TFCC (triangular fibrocartilage complex) tear with proximal component involvement. Methods Through a retrospective review in the medical records of patients who underwent unilateral arthroscopic repair for TFCC Palmer IB lesion between 2017 and 2019, 12 patients were arthroscopically diagnosed as proximal component tear and received more than 1 year follow-up postoperatively. The arthroscope was introduced from 6R portal to discriminate Atzei class II from III lesions by a “visualization test” and to supervise the repair procedure using pre-tied FasT-Fix suture device from 3-4 portal. Two poly-ether-ether-ketone (PEEK) blocks were further advanced along the device needle to finally seat outside the ulnar joint capsule, followed by gradually tightening the pre-tied suture loop until the TFCC periphery was securely repositioned and held stably. Results Operation time averaged 87 min. Hook test and DRUJ arthroscopy confirmed proximal component tear in all 12 wrists. Four patients were diagnosed to be Atzei class II lesion as full thickness tear of distal component was arthroscopically identified from 6R portal while the other 8 exhibited partial thickness tear and were categorized as class III lesion. Follow-up averaged 15 months with a range of 12 to 24 months. Mayo modified wrist score improved from an average of 61.3 preoperatively to 90.4 at the latest visit. Conclusions A modified technique for diagnosis and all-arthroscopic repair in TFCC Atzei class II and III lesions using a pre-tied suture device is a feasible and safe option with promising results.

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All-arthroscopic repair of Atzei class II and III triangular fibrocartilage complex tears using the FasT-Fix suture device

10.21203/rs.3.rs-61557/v2 ◽

2020 ◽

Author(s):

Mengchun Tsai ◽

Yi-Hsuan Lin ◽

Chih-Hao Chiu ◽

Chun-Ying Cheng ◽

Yi-Sheng Chan ◽

...

Keyword(s):

Operation Time ◽

Class Ii ◽

Triangular Fibrocartilage Complex ◽

Arthroscopic Repair ◽

Class Iii ◽

Modified Technique ◽

Repair Procedure ◽

Triangular Fibrocartilage ◽

Suture Device

Abstract Background The study is aimed to propose an arthroscopic repair technique using a pre-tied suture device for peripheral TFCC (triangular fibrocartilage complex) tear with proximal component involvement. Methods Through a retrospective review in the medical records of patients who underwent unilateral arthroscopic repair for TFCC Palmer IB lesion between 2017 and 2019, 12 patients were arthroscopically diagnosed as proximal component tear and received more than one year follow-up postoperatively. The arthroscope was introduced from 6R portal to discriminate Atzei class II from III lesions by a “visualization test”, and to supervise the repair procedure using pre-tied FasT-Fix suture device from 3-4 portal. Two poly-ether-ether-ketone (PEEK) blocks were further advanced along the device needle to finally seat outside the ulnar joint capsule, followed by gradually tightening the pre-tied suture loop until the TFCC periphery was securely repositioned and held stably. Results Operation time averaged 87 minutes. Four patients were diagnosed to be Atzei class II lesion as full thickness tear of distal component was arthroscopically identified from 6R portal while the other 8 exhibited partial thickness tear and were categorized as class III lesion. Follow-up averaged 15 months with a range of 12 to 24 months. Mayo modified wrist score improved from an average of 61.3 preoperatively to 90.4 at the latest visit. Conclusions A modified technique for diagnosis and all-arthroscopic repair in TFCC Atzei class II and III lesions using a pre-tied suture device is a feasible and safe option with promising results.

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Multimodal noninvasive evaluation in MRI-negative operculoinsular epilepsy

Journal of Neurosurgery ◽

10.3171/2018.12.jns182746 ◽

2020 ◽

Vol 132 (5) ◽

pp. 1334-1344

Author(s):

Shan Wang ◽

Yingying Tang ◽

Thandar Aung ◽

Cong Chen ◽

Masaya Katagiri ◽

...

Keyword(s):

Fdg Pet ◽

Class Ii ◽

Noninvasive Evaluation ◽

Class Iii ◽

Intracranial Eeg ◽

Unique Information ◽

One Year ◽

The Individual ◽

Class Ib

OBJECTIVEPresurgical evaluation of patients with operculoinsular epilepsy and negative MRI presents major challenges. Here the authors examined the yield of noninvasive modalities such as voxel-based morphometric MRI postprocessing, FDG-PET, subtraction ictal SPECT coregistered to MRI (SISCOM), and magnetoencephalography (MEG) in a cohort of patients with operculoinsular epilepsy and negative MRI.METHODSTwenty-two MRI-negative patients were included who had focal ictal onset from the operculoinsular cortex on intracranial EEG, and underwent focal resection limited to the operculoinsular cortex. MRI postprocessing was applied to presurgical T1-weighted volumetric MRI using a morphometric analysis program (MAP). Individual and combined localization yields of MAP, FDG-PET, MEG, and SISCOM were compared with the ictal onset location on intracranial EEG. Seizure outcomes were reported at 1 year and 2 years (when available) using the Engel classification.RESULTSTen patients (45.5%, 10/22) had operculoinsular abnormalities on MAP; 5 (23.8%, 5/21) had operculoinsular hypometabolism on FDG-PET; 4 (26.7%, 4/15) had operculoinsular hyperperfusion on SISCOM; and 6 (30.0%, 6/20) had an MEG cluster (3 tight, 3 loose) within the operculoinsular cortex. The highest yield of a 2-test combination was 59.1%, seen with MAP and SISCOM, followed by 54.5% with MAP and FDG-PET, and also 54.5% with MAP and MEG. The highest yield of a 3-test combination was 68.2%, seen with MAP, MEG, and SISCOM. The yield of the 4-test combination remained at 68.2%. When all other tests were negative or nonlocalizing, unique information was provided by MAP in 5, MEG in 1, SISCOM in 2, and FDG-PET in none of the patients. One-year follow-up was available in all patients, and showed 11 Engel class IA, 4 class IB, 4 class II, and 3 class III/IV. Two-year follow-up was available in 19 patients, and showed 9 class IA, 3 class IB, 1 class ID, 3 class II, and 3 class III/IV.CONCLUSIONSThis study highlights the individual and combined values of multiple noninvasive modalities for the evaluation of nonlesional operculoinsular epilepsy. The 3-test combination of MAP, MEG, and SISCOM represented structural, interictal, and ictal localization information, and constituted the highest yield. MAP showed the highest yield of unique information when other tests were negative or nonlocalizing.

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4307Lung ultrasound in stable ambulatory chronic heart failure patients

European Heart Journal ◽

10.1093/eurheartj/ehz745.0152 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Domingo ◽

L Conangla ◽

J Lupon ◽

M De Antonio ◽

P Moliner ◽

...

Keyword(s):

Cox Regression ◽

Functional Class ◽

Class Iii ◽

Nyha Functional Class ◽

End Point ◽

Ambulatory Patients ◽

Beta Coefficient ◽

One Year ◽

B Lines

Abstract Background The role of lung ultrasound (LUS) in diagnosis and response to diuretic treatment of patients with acute HF has been widely studied, but less is known about its value in chronic HF. Purpose To assess the prognostic value of LUS in a cohort of chronic HF stable ambulatory patients and to explore the relationship of LUS findings with clinical data, such as NYHA functional class, left ventricular ejection fraction (LVEF) and NTproBNP. Methods Consecutive stable ambulatory patients who attended a scheduled follow-up visit in a HF clinic were included. LUS were performed with a pocket device and examined 4 chest areas per side (two anterior and two lateral). Scans were analysed offline by two investigators blinded to clinical data, who evaluated the number of B-lines of each area. The addition number of B-lines of each area and the quartiles of such addition were used for the analyses. The primary outcome end-point was the composite of all-cause death or hospitalization due to HF at one year. Linear regression and Cox regression analyses were performed. Results Five-hundred seventy-seven patients were included between July 2016 and July 2017 (age 69±12 years, 72% men). The main HF aetiology was ischemic heart disease (43%) followed by dilated cardiomyopathy (20%). Median HF duration was 79 months (Q1-Q3 38–144). Mean LVEF was 45%±13 (mean LVEF when admitted at the Unit 34%±13). Most patients were in NYHA functional class II (70%), 13% were in class I and 17% in class III. Median NTproBNP was 722 ng/L (Q1-Q3 262–1760). Mean number of B-lines was 5±6 (Q1, 0; Q2, 1–3; Q3, 4–7; Q4, ≥8). The number of B-lines was associated with age (beta-coefficient 0.11, p<0.001), NYHA functional class (beta-coefficient 1.75, p<0.001), and logNTproBNP (beta-coefficient 1.40, p<0.001). Mean number of B-lines according to NYHA functional class was: class I, 3.5±6; class II, 4.9±6; and class III, 7.1±7. During the one year follow-up 47 patients suffered the primary end-point. In total there were 24 HF related hospitalizations and 26 deaths. In Cox regression analysis, Q4 of B-lines showed a double risk of suffering the primary end-point (HR 2.13 [95% CI 1.18–3.84], p=0.01). However, statistically significance was not maintained for LUS results in the multivariable analysis when age, NYHA functional class and logNTproBNP were included in the model, although a 38% increase in the risk of suffering the primary end-point for Q4 was observed (HR 1.38 [95% CI 0.75–2.54], p=0.31). Conclusion In outpatients with stable chronic HF, the number of B-lines detected in LUS was associated with age, NYHA functional class and NTproBNP. Patients having ≥8 B-lines had a significant double risk of HF related hospitalization or all-cause death at one year. However, when strongly powerful prognostic variables such as NYHA class and NTproBNP were included in the model LUS did not retain an independent prognostic role.

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A Minimally-Invasive, Simple, Rapid, and Effective Surgical Technique for the Treatment of Ingrown Toenails: A Reminder of the Original Winograd Procedure

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18010278 ◽

2021 ◽

Vol 18 (1) ◽

pp. 278

Author(s):

Jahyung Kim ◽

Sanghyeon Lee ◽

Jeong Seok Lee ◽

Sung Hun Won ◽

Dong Il Chun ◽

...

Keyword(s):

Patient Outcomes ◽

Simple Procedure ◽

Wedge Resection ◽

Operation Time ◽

University Hospital ◽

Wound Infections ◽

Germinal Matrix ◽

One Year ◽

Ingrown Toenails

(1) Background: Ingrown toenail is a common disorder of the toe that induces severe toe pain and limits daily activities. The Winograd method, the most widely used operative modality for ingrown toenails, has been modified over years to include wedge resection of the nail fold and complete ablation of the germinal matrix. We evaluated the outcomes of original Winograd procedure without wedge resection with electrocautery-aided matrixectomy. (2) Methods: We retrospectively analyzed the outcomes of patients who underwent surgery for ingrown toenails at a university hospital for two years from November 2015 to October 2017. Surgery was performed in 76 feet with a mean operation time of 9.34 min. (3) Results: The minimal interval from surgery to return to regular activities was 13.26 (range 7 to 22) days. Recurrence and postoperative wound infections were found in 3 (3.95%) and 2 (2.63%) patients, respectively. Evaluation of patient satisfaction at one-year follow-up showed that 40 (52.63%) patients were very satisfied, 33 (43.42%) were satisfied, 3 (3.95%) were dissatisfied, and none of them were very dissatisfied. The average follow-up duration was 14.66 (range 12 to 25) months. (4) Conclusions: Therefore, it is believed that this less-invasive and simple procedure could be easily performed by clinicians, with satisfactory patient outcomes.

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Orthodontic camouflage of skeletal Class III malocclusion with miniplate: a case report

Dental Press Journal of Orthodontics ◽

10.1590/2177-6709.21.4.089-098.oar ◽

2016 ◽

Vol 21 (4) ◽

pp. 89-98 ◽

Cited By ~ 4

Author(s):

Marcel Marchiori Farret ◽

Milton M. Benitez Farret ◽

Alessandro Marchiori Farret

Keyword(s):

Orthognathic Surgery ◽

Class Iii ◽

Class Iii Malocclusion ◽

Lower Lip ◽

Facial Profile ◽

Skeletal Class ◽

Mandibular Teeth ◽

One Year ◽

Angle Class Iii Malocclusion

ABSTRACT Introduction: Skeletal Class III malocclusion is often referred for orthodontic treatment combined with orthognathic surgery. However, with the aid of miniplates, some moderate discrepancies become feasible to be treated without surgery. Objective: To report the case of a 24-year-old man with severe skeletal Angle Class III malocclusion with anterior crossbite and a consequent concave facial profile. Methods: The patient refused to undergo orthognathic surgery; therefore, orthodontic camouflage treatment with the aid of miniplates placed on the mandibular arch was proposed. Results: After 18 months of treatment, a Class I molar and canine relationship was achieved, while anterior crossbite was corrected by retraction of mandibular teeth. The consequent decrease in lower lip fullness and increased exposure of maxillary incisors at smiling resulted in a remarkable improvement of patient's facial profile, in addition to an esthetically pleasing smile, respectively. One year later, follow-up revealed good stability of results.

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Long-Term Outcomes of All-Arthroscopic Pre-Tied Suture Device Triangular Fibrocartilage Complex Repair

Journal of Wrist Surgery ◽

10.1055/s-0039-1688949 ◽

2019 ◽

Vol 08 (05) ◽

pp. 403-407 ◽

Cited By ~ 3

Author(s):

Eric J. Sarkissian ◽

Matthew B. Burn ◽

Jeffrey Yao

Keyword(s):

Range Of Motion ◽

Grip Strength ◽

Triangular Fibrocartilage Complex ◽

Study Cohort ◽

Inclusion Criteria ◽

Level Of Evidence ◽

Triangular Fibrocartilage ◽

Suture Device

Background A pre-tied suture device has been utilized for all-arthroscopic peripheral triangular fibrocartilage complex (TFCC) repairs with promising early clinical results. Purpose The purpose of this study was to evaluate long-term functional outcomes of these repairs. Patients and Methods A retrospective review of patients undergoing arthroscopic TFCC repair was performed. Inclusion criteria were the Palmer type 1B TFCC tears diagnosed on arthroscopy and repaired using the all-arthroscopic pre-tied suture device. Patients with any evidence of concomitant wrist injury at the time of surgery, history of prior wrist surgery, or nonrepairable and nonperipheral TFCC tears were excluded. Postoperative complications, range of motion, grip strength, and outcome assessments were recorded for each patient. Results Eleven patients (mean age, 36 years; range, 20–64 years) satisfied our inclusion criteria and comprised the study cohort. The mean follow-up period was 7.0 years (range, 4.3–10.9 years). Mean range of motion of the wrist revealed flexion of 76 ± 11 degrees and extension of 73 ± 12 degrees. Mean grip strength was 98 ± 15% of the nonsurgical extremity. QuickDASH, modified Mayo, and patient-rated wrist evaluation (PRWE) average scores were 9 ± 8, 80 ± 6, and 12 ± 12, respectively. No surgical complications were observed and no patient required any further surgical intervention. Conclusions Our cohort of patients following all-arthroscopic pre-tied suture device repair of isolated Palmer type 1B TFCC tears demonstrated excellent clinical function at a mean follow-up of 7 years. These findings indicate that the pre-tied suture device is a reliable, safe, effective, and most importantly, durable treatment option for repair of peripheral TFCC tears. Level of Evidence This is a Level IV, therapeutic study.

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