Preoperative and postoperative developmental attainment in patients with sagittal synostosis: 5-year follow-up

2011 ◽  
Vol 7 (2) ◽  
pp. 121-126 ◽  
Author(s):  
Maggie Bellew ◽  
Mark Liddington ◽  
Paul Chumas ◽  
John Russell
Keyword(s):  
Developmental Delay ◽  
Surgical Intervention ◽  
Surgical Correction ◽  
Control Group ◽  
Corrective Surgery ◽  
Developmental Assessment ◽  
Sagittal Synostosis ◽  
Locomotor Function ◽  
Locomotor Control

Object The object of this study was to clarify whether improved developmental attainment following surgical correction of sagittal synostosis (SS), previously identified at initial postoperative assessment, is maintained at longer-term follow-up at 5 years of age. Methods The study involved 32 children with SS who underwent corrective surgery at a mean (± SD) age of 8.5 ± 7.25 months (range 2.8–39.9 months). All the children were assessed preoperatively, at 7 months postoperatively, and at 5 years of age, using the Griffiths Mental Development Scales. A control group consisted of 23 children with SS who had received developmental assessment on 2 or more occasions without surgical intervention (8 of these children had had follow-up at 5 years of age). Results The data indicated that, prior to surgical correction, children with SS had poorer Gross Locomotor function than other areas of development and that, following surgical intervention, the deficit resolved (even where there was severe developmental delay). The results further showed that improvement in Gross Locomotor function observed at 7 months postoperatively was further improved upon by 5 years of age. The same was true for their overall General Quotient, even in those children exhibiting severe developmental delay. Lesser improvements across time were shown for other skill areas. The children with SS who did not undergo surgery did not show any improvement in development, and in fact a deterioration in fine locomotor control was identified in these patients. Conclusions The results of this study suggest that corrective surgery for SS has a positive early impact on development, which is maintained and improved upon by 5 years of age, and that this surgery therefore offers more than simply a cosmetic improvement. Furthermore, the results suggest that not operating on children with SS means not only that this opportunity for developmental gain is missed, but that it may also cause an actual deterioration in developmental attainment.

Development of secondary unilateral coronal suture synostosis with a sagittal suture synostosis in a nonsyndromic patient

2012 ◽  
Vol 9 (2) ◽  
pp. 116-118 ◽  
Author(s):  
Leonardo Rangel-Castilla ◽  
Steven W. Hwang ◽  
Andrew Jea ◽  
William E. Whitehead ◽  
Daniel J. Curry ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Early Stage ◽  
Sagittal Synostosis ◽  
Clinical Appearance ◽  
Syndromic Craniosynostosis ◽  
Intervention Failure ◽  
Frontoorbital Advancement ◽  
Coronal Synostosis ◽  
Second Procedure

Multiple-suture synostosis is typically associated with syndromic craniosynostosis but has been occasionally reported in large series of nonsyndromic children. The diagnosis of multiple fused sutures usually occurs at the same time, but rarely has the chronological development of a secondary suture synostosis been noted. The development of secondary bicoronal suture synostosis requiring surgical intervention has only been reported, to date, after surgical intervention and is hypothesized to arise from a disruption of inhibitory factors from the dura. The disinhibition of these factors permits the sutures to then fuse at an early stage. The authors report on a patient who developed secondary unilateral coronal synostosis after the diagnosis of an isolated sagittal synostosis. The secondary synostosis was identified at the time of the initial surgical intervention and ultimately required a second procedure of a frontoorbital advancement. The clinical appearance of this phenomenon may be subtle, and surgeons should monitor for the presence of secondary synostosis during surgery as it may require intervention. Failure to identify the secondary synostosis may necessitate another surgery or result in a poor cosmetic outcome. The authors recommend close clinical follow-up for the short term in patients with isolated sagittal synostosis.

scholarly journals Progressive Scoliosis and Syringomyelia - Questions of Surgical Approach

Folia Medica ◽  
2018 ◽  
Vol 60 (2) ◽  
pp. 261-269 ◽  
Author(s):  
Mikhail Mikhaylovskiy ◽  
Vyacheslav Stupak ◽  
Vadim Belozerov ◽  
Nikolay Fomichev ◽  
Anatoliy Lutsik ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Surgical Correction ◽  
Neurological Deficits ◽  
Spinal Deformities ◽  
Loss Of Correction ◽  
Scoliotic Deformity ◽  
Scoliosis Correction ◽  
The Moment ◽  
Comparison Of The Results

Abstract Background: The rate of scoliosis in syringomyelia patients ranges from 25 to 74.4%. In turn, syringomyelia occurs in 1.2% to 9.7% of scoliosis patients. Aim: To evaluate outcomes of surgical correction of the scoliotic deformity in syringomyelia patients. Materials and methods: Between 1996 and 2015, 3120 patients with scoliosis of various etiologies were treated at the Clinic for Child and Adolescent Vertebrology of the Novosibirsk Research Institute of Traumatology and Orthopedics. We conducted a retrospective analysis of syringomyelia-associated scoliosis cases that required surgical correction. Results: Syringomyelia was found in 33 patients (1.05%) out of 3120 patients with spinal deformities of various etiologies; in 21 patients (0.9%) with idiopathic scoliosis of 2334 patients. In identifying the neurological deficit, the recommended first step is to perform neurosurgery. Nineteen patients were operated using the CDI, 4 patients underwent correction VEPTR, in 1 case instrumentation could not be established, 9 patients are undergoing treatment in the department of neurosurgery at the moment. Worsening of neurological deficits was not observed in any patient. Conclusion: A comparison of the results of syringomyelia-associated scoliosis correction with the data of other authors was done. The choice of surgery tactics is strictly individual and depends on the size of the cavity. The result of surgical intervention is generally positive and the loss of correction by the end of follow-up is negligible.

scholarly journals Left Atrial Shape and Function after Endovascular Device and Surgical Closure of ASDs in Children

2021 ◽  
Author(s):  
Alexander Sokolov ◽  
Viktor Varvarenko ◽  
Evgeny Krivoshchekov ◽  
Andrey Smorgon
Keyword(s):  
Left Atrium ◽  
Left Atrial ◽  
Surgical Correction ◽  
Control Group ◽  
Surgical Closure ◽  
Younger Age ◽  
Asd Closure ◽  
And Function ◽  
Endovascular Device

Retrospective analysis of echocardiograms was performed in 756 children who received endovascular device or surgical ASD closure from 2006 to 2016 in the Cardiac Center in Tomsk Russia. 564 patients had an endovascular closure and 192 had surgical correction. Follow-up duration was from 1 day to 10 years, mean 3.6 yrs for the device group and 4.2 yrs for the surgery group. The control group consisted of 3393 age-matched healthy patients. In patients with endovascular closure of an ASD, 35% had a change in the shape of the left atrium in early follow-up. Changes in the shape of the left atrium at early follow-up were more often observed in the device group and in children of a younger age. The left atrial changes were a decrease in sphericity and an increase in ellipsoidy. Changes in the shape of the left atrium persisted in 22% after transcatheter correction in the long-term. The change in shape of the left atrium after the placement of ASD devices was accompanied by activation of the mechanical function of the atrium and an increase in the filling pressure of the left ventricle. These changes were not accompanied by any disturbance in the contractility and volume of the heart chambers. In the group with surgical correction of ASD, the contractility and volume of the heart chambers did not significantly differ from those in the device closure group

scholarly journals Procedure of complex braided wrapping of ascending aorta in her poststenotic dilation while doing correction of aortal stenosis

2020 ◽  
Vol 87 (9-10) ◽  
pp. 18-21
Author(s):  
V. V. Popov ◽  
A. A. Bolshak
Keyword(s):  
Ascending Aorta ◽  
Main Group ◽  
Surgical Correction ◽  
Control Group ◽  
Valve Prosthesis ◽  
Original Procedure ◽  
Aortal Valve ◽  
The Moment ◽  
Aorta Diameter

Objective. To study clinical possibilities of original procedure of the ascending aorta braid-like bandage for her poststenotic dilation while performance of the aortal stenosis surgical correction. Materials and methods. To the main Group 196 patients were included those, who were operated on for prevailing aortal stenosis, conjoined with poststenotic dilation of ascending aorta. In accordance to the echocardiographic investigation data the ascending aorta diameter preoperatively have constituted (47.7 ± 1.7) mm. In all the patients the aortal valve prosthesis was performed together with complex braided wrapping of ascending aorta. Into the control group 121 patients were included, in whom Bentall intervention was accomplished with vascular prosthesis of ascending aorta. Results. Hospital lethality in the main group have constituted 0.5%. Diameter of ascending aorta in the moment of hospital discharge have constituted (39.1 ± 1.5) mm, and in late follow-up period - (40.3 ± 1.1) mm. Conclusion. Basing on clinical experience gained, it is expedient to recommend the original procedure of braided wrapping of ascending aorta in presence of her poststenotic dilation while performing surgical correction of prevailing aortal stenosis.

scholarly journals Extra-thoracal migration of the Nuss Bar in corrective surgery for pectus excavatum: a very rare late complication

2020 ◽  
Vol 2020 (10) ◽  
Author(s):  
Natalie Simon ◽  
Shyam Kolvekar ◽  
Amir Khosravi
Keyword(s):  
Pectus Excavatum ◽  
Surgical Intervention ◽  
Rare Complication ◽  
Late Complication ◽  
Nuss Procedure ◽  
Corrective Surgery ◽  
Chest Wall Deformity ◽  
X Ray ◽  
First Case

Abstract Pectus excavatum is a chest wall deformity with an incidence of around 1 in 400 live births. The Nuss procedure is a surgical intervention that aims to restore functional integrity in these patients. We report the first case of bar migration into the stomach necessitating further surgical intervention for removal. Our case presents a rare complication of pectus excavatum repair and highlights the importance of vigilant follow-up in these patients. If bar migration does occur, imaging in the form of X-ray and CT scans may be of use in early detection in order to expedite management.

The Upper Airway Nasal Complex: Structural Contribution to Persistent Nasal Obstruction

2019 ◽  
Vol 161 (1) ◽  
pp. 171-177 ◽  
Author(s):  
Ryan Williams ◽  
Vishal Patel ◽  
Yu-Feng Chen ◽  
Navarat Tangbumrungtham ◽  
Andrew Thamboo ◽  
...  
Keyword(s):  
Nasal Obstruction ◽  
Hard Palate ◽  
Surgical Intervention ◽  
Upper Airway ◽  
Sinus Surgery ◽  
Control Group ◽  
Maxillary Expansion ◽  
Retrospective Case ◽  
Nasal Floor

Objective To determine the contribution of the nasal floor and hard palate morphology to nasal obstruction for nonresponders to prior intranasal surgery. Study Design Retrospective case-control study. Setting Tertiary academic center. Methods Institutional review board–approved, retrospective institutional database analysis was obtained of a cohort of 575 patients who presented with nasal obstruction over a 21-year period. Of the patients, 89 met inclusion criteria: 52 were placed into the experimental group, defined as having persistent nasal obstruction following endoscopic sinus surgery (ESS), septoplasty, nasal valve repair, and/or turbinoplasty using validated subjective questionnaires, and 37 were placed into the control group, defined as having resolution of subjective nasal obstruction. Computed tomography imaging was presented to 3 blinded experts, who measured numerous nasal airway and hard palate morphology parameters, including anterior nasal floor width, anterior maxillary angle, maxilla width, anterior nasal floor width, and palatal vault height. Standard demographic information, comorbidities, perioperative 22-item Sinonasal Outcome Test (SNOT-22), and follow-up time were also assessed. Wilcox rank sum analysis or t test was performed where appropriate. Results Follow-up ranged from 2 to 36 months following surgical intervention. Several skeletal characteristics within the upper airway were significantly associated with persistent nasal obstruction, including acute maxillary angle ( P = .035), narrow maxillary width ( P = .006), and high arched palate ( P = .004). Conclusion Persistent nasal obstruction may be seen in patients with narrow, high arched hard palate despite prior nasal surgical intervention and may benefit from additional skeletal remodeling procedures such as maxillary expansion.

scholarly journals Effects of Psychiatric Factors on Patient-Reported Outcomes after Surgical Correction of Lumbar Degenerative Kyphosis

2018 ◽  
Vol 12 (1) ◽  
pp. 126-131 ◽  
Author(s):  
Tae Sik Goh ◽  
Jong Ki Shin ◽  
Myung Soo Youn ◽  
Jung Sub Lee
Keyword(s):  
Patient Reported Outcomes ◽  
Short Form ◽  
Surgical Correction ◽  
Osteotomy Site ◽  
Corrective Surgery ◽  
Mineral Density ◽  
Patient Reported ◽  
Psychiatric Problems ◽  
Component Scores

<sec><title>Study Design</title><p>A prospective study.</p></sec><sec><title>Purpose</title><p>To identify associations between psychiatric factors and patient-reported outcomes after corrective surgery in patients with lumbar degenerative kyphosis (LDK).</p></sec><sec><title>Overview of Literature</title><p>Thus far, to the best of our knowledge, patient factors that may help predict patient-reported outcomes after corrective surgery for LDK have not been studied.</p></sec><sec><title>Methods</title><p>We prospectively investigated 46 patients with LDK who underwent surgical correction with a minimum follow-up of 2 years. Demographic data were collected. Short form-36, mental component scores (MCS), physical component scores (PCS), Scoliosis Research Society-22 (SRS-22) scores, and Roland-Morris Disability Questionnaire (RMDQ) scores were determined before the surgery and after 2 years of follow-up. Psychiatric conditions were preoperatively evaluated using the Zung depression scale (ZDS) and Zung anxiety scale (ZAS). Patients were divided into two groups (with or without psychiatric issues), according to baseline ZDS and ZAS scores.</p></sec><sec><title>Results</title><p>Patients included 43 women and 3 men. Twelve patients were deemed to have psychiatric problems (P group) and 34 patients had no psychiatric problems (NP group). No significant intergroup differences were found in MCS, PCS, SRS-22, and RMDQ scores preoperatively. However, at the 2-year follow-up, a significant intergroup difference was observed between PCS and RMDQ scores. Multiple regression analysis revealed that only the presence of a preoperative psychiatric problem can predict PCS and RMDQ scores. Other factors, such as, gender, age, body mass index, bone mineral density, osteotomy site, number of fusion segments, and instrumented levels did not affect PCS or RMDQ scores.</p></sec><sec><title>Conclusions</title><p>The presence of a psychiatric factor may be an important risk factor underlying poor physical and pain scores after corrective surgery in patients with LDK. The findings presented here suggest that psychiatric factors should be evaluated prior to surgery for determining the risk of a poor outcome.</p></sec>

scholarly journals Identifying Otosclerosis with Aural Acoustical Tests of Absorbance, Group Delay, Acoustic Reflex Threshold, and Otoacoustic Emissions

2017 ◽  
Vol 28 (09) ◽  
pp. 838-860 ◽  
Author(s):  
Douglas H. Keefe ◽  
Kelly L. Archer ◽  
Kendra K. Schmid ◽  
Denis F. Fitzpatrick ◽  
M. Patrick Feeney ◽  
...  
Keyword(s):  
Middle Ear ◽  
Otoacoustic Emissions ◽  
Group Delay ◽  
Surgical Intervention ◽  
Broadband Noise ◽  
Positive Pressure ◽  
Control Group ◽  
Corrective Surgery ◽  
Ear Canal ◽  
Reflex Threshold

AbstractOtosclerosis is a progressive middle-ear disease that affects conductive transmission through the middle ear. Ear-canal acoustic tests may be useful in the diagnosis of conductive disorders. This study addressed the degree to which results from a battery of ear-canal tests, which include wideband reflectance, acoustic stapedius muscle reflex threshold (ASRT), and transient evoked otoacoustic emissions (TEOAEs), were effective in quantifying a risk of otosclerosis and in evaluating middle-ear function in ears after surgical intervention for otosclerosis.To evaluate the ability of the test battery to classify ears as normal or otosclerotic, measure the accuracy of reflectance in classifying ears as normal or otosclerotic, and evaluate the similarity of responses in normal ears compared with ears after surgical intervention for otosclerosis.A quasi-experimental cross-sectional study incorporating case control was used. Three groups were studied: one diagnosed with otosclerosis before corrective surgery, a group that received corrective surgery for otosclerosis, and a control group.The test groups included 23 ears (13 right and 10 left) with normal hearing from 16 participants (4 male and 12 female), 12 ears (7 right and 5 left) diagnosed with otosclerosis from 9 participants (3 male and 6 female), and 13 ears (4 right and 9 left) after surgical intervention from 10 participants (2 male and 8 female).Participants received audiometric evaluations and clinical immittance testing. Experimental tests performed included ASRT tests with wideband reference signal (0.25–8 kHz), reflectance tests (0.25–8 kHz), which were parameterized by absorbance and group delay at ambient pressure and at swept tympanometric pressures, and TEOAE tests using chirp stimuli (1–8 kHz). ASRTs were measured in ipsilateral and contralateral conditions using tonal and broadband noise activators. Experimental ASRT tests were based on the difference in wideband-absorbed sound power before and after presenting the activator. Diagnostic accuracy to classify ears as otosclerotic or normal was quantified by the area under the receiver operating characteristic curve (AUC) for univariate and multivariate reflectance tests. The multivariate predictor used a small number of input reflectance variables, each having a large AUC, in a principal components analysis to create independent variables and followed by a logistic regression procedure to classify the test ears.Relative to the results in normal ears, diagnosed otosclerosis ears more frequently showed absent TEOAEs and ASRTs, reduced ambient absorbance at 4 kHz, and a different pattern of tympanometric absorbance and group delay (absorbance increased at 2.8 kHz at the positive-pressure tail and decreased at 0.7–1 kHz at the peak pressure, whereas group delay decreased at positive and negative-pressure tails from 0.35–0.7 kHz, and at 2.8–4 kHz at positive-pressure tail). Using a multivariate predictor with three reflectance variables, tympanometric reflectance (AUC = 0.95) was more accurate than ambient reflectance (AUC = 0.88) in classifying ears as normal or otosclerotic.Reflectance provides a middle-ear test that is sensitive to classifying ears as otosclerotic or normal, which may be useful in clinical applications.

Surgical reconstruction of ectrodactyly deformity in four dogs

2001 ◽  
Vol 14 (04) ◽  
pp. 201-209 ◽  
Author(s):  
W. M. McKee ◽  
R. A. S. Mitchell ◽  
J. F. Innes ◽  
B. D. X. Lascelles ◽  
K. A. Johnson
Keyword(s):  
Surgical Treatment ◽  
Distraction Osteogenesis ◽  
Surgical Correction ◽  
Viable Alternative ◽  
Surgical Reconstruction ◽  
Corrective Surgery ◽  
Limb Function

Four immature dogs were presented with ectrodactyly. Two dogs were initially treated with distraction osteogenesis of a hypoplastic ulna and all had surgical correction of the cleft deformity. In each case proximal metacarpal apposition with or without carpal arthrodesis formed the basis of surgical treatment. Follow-up information was available for three cases and all showed improved limb function. Corrective surgery appears to be a viable alternative to amputation for treatment of ectrodacty1y.

scholarly journals The predictive value of universal preschool developmental assessment in identifying children with later educational difficulties: A systematic review

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247299
Author(s):  
David G. Cairney ◽  
Aun Kazmi ◽  
Lauren Delahunty ◽  
Louise Marryat ◽  
Rachael Wood
Keyword(s):  
Systematic Review ◽  
Child Health ◽  
Cohort Studies ◽  
Developmental Delay ◽  
Birth Cohort ◽  
Predictive Value ◽  
Educational Outcomes ◽  
Developmental Assessment ◽  
Health Programmes

Background Developmental delay affects substantial proportions of children. It can generally be identified in the pre-school years and can impact on children’s educational outcomes, which in turn may affect outcomes across the life span. High income countries increasingly assess children for developmental delay in the early years, as part of universal child health programmes, however there is little evidence as to which measures best predict later educational outcomes. This systematic review aims to assess results from the current literature on which measures hold the best predictive value, in order to inform the developmental surveillance aspects of universal child health programmes. Methods Systematic review sources: Medline (2000 –current), Embase (2000 –current), PsycInfo (2000 –current) and ERIC (2000 –current). Additional searching of birth cohort studies was undertaken and experts consulted. Eligibility criteria: Included studies were in English from peer reviewed papers or books looking at developmental assessment of preschool children as part of universal child health surveillance programmes or birth cohort studies, with linked results of later educational success/difficulties. The study populations were limited to general populations of children aged 0–5 years in high income countries. Study selection, data extraction and risk of bias assessment were carried out by two independent authors and any disagreement discussed. PROSPERO registration number CRD42018103111. Results Thirteen studies were identified for inclusion in the review. The studies were highly heterogeneous: age of children at first assessment ranged from 1–5 years, and at follow-up from 4–26 years. Type of initial and follow-up assessment also varied. Results indicated that, with the exception of one study, the most highly predictive initial assessments comprised combined measures of children’s developmental progress, such as a screening tool alongside teacher ratings and developmental histories. Other stand-alone measures also performed adequately, the best of these being the Ages and Stages Questionnaire (ASQ). Latency between measures, age of child at initial measurement, size of studies and quality of studies all impacted on the strength of results. Conclusions This review was the first to systematically assess the predictive value of preschool developmental assessment at a population level on later educational outcomes. Results demonstrated consistent associations between relatively poor early child development and later educational difficulties. In general, specificity and Negative Predictive Value are high, suggesting that young children who perform well in developmental assessment are unlikely to go on to develop educational difficulties, however the sensitivity and Positive Predictive Values were generally low, indicating that these assessments would not meet the requirements for a screening test. For surveillance purposes, however, findings suggested that combined measures provided the best results, although these are resource intensive and thus difficult to implement in universal child health programmes. Health service providers may therefore wish to consider using stand-alone measures, which also were shown to provide adequate predictive value, such as the ASQ.

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