scholarly journals Clinical and Radiological Predictors of Ventriculoperitoneal Shunt Insertion in Myelomeningocele Patients

2021 ◽  
Vol 9 (B) ◽  
pp. 522-532
Author(s):  
Ahmed M. F. El Ghoul ◽  
Ahmed Hamdy Ashry ◽  
Mohamed Hamdy El-Sissy ◽  
Ibrahim Mohamed Ibrahim Lotfy
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Repair ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Shunt Placement ◽  
Group A ◽  
Study Population ◽  
Group B ◽  
Increased Icp

BACKGROUND: Myelomeningocele (MMC) is one of the most common developmental anomalies of the CNS. Many of these patients develop hydrocephalus (HCP). The rate of cerebrospinal fluid diversion in these patients varies significantly in literature, from 52% to 92%. MMC repair conventionally occurs in the post-natal period. With the technological advances in surgical practice and fetal surgeries, intra uterine MMC repair IUMR is adopted in some centers. Cerebrospinal fluid shunting has numerous complications, most notably shunt failure and shunt infection. Studies have suggested that patients with greater numbers of shunt revisions have poorer performance on neuropsychological testing. There is also good evidence to suggest that the IQs of patients with MMC who do not undergo shunt placement are higher than that of their shunt treated counterparts. AIM: In this study, we are trying to identify strong clinical and radiological predictors for the need of ventriculoperitoneal (VP) shunt insertion in patients with MMC who underwent surgical repair and closure of the defect initially. This will decrease the overall rate of shunt placement in this group of patients through applying a strict policy adopting only shunt insertion for the desperately needing patient. METHODS: Prospective clinical study conducted on 96 patients with MMC presented to Aboul Reish Pediatric Specialized Hospital, Cairo University. After confirming the diagnosis through clinical and radiological aids, patients are carefully examined, if HCP is evident clinically and radiologically a shunt is inserted together with MMC repair at the same session after excluding sepsis or cerebrospinal fluid (CSF) infection, (GROUP A). If there are no signs of increased ICP, MMC repair shall be done alone (GROUP B). Those patients shall be monitored carefully postoperatively and after discharge and shall be followed up regularly to early detect and promptly manage latent HCP. Multiple clinical and radiological indices were used throughout the follow-up period and statistical significance of each was measured. RESULTS: Shunt placement was required in 45 (46.88%) of the 96 patients. Eighteen patients (18.75%) needed the shunt as soon as they presented to us (GROUP A), because they were having clinically active HCP. Twenty-seven (28.13%) patients were operated on by MMC repair initially without shunt placement because they did not have signs of increased ICP at the time of presentation. Yet, they developed latent HCP requiring shunt placement during the follow-up period (GROUP B2). Fifty-one patients of the study population (53.13%) underwent surgical repair of the MMC without the need of further VP insertion and they were followed up for 6 months period after the repair without developing latent HCP (GROUP B1). Patients of GROUP B were the study population susceptible for the development of latent HCP. Out of 78 patients in GROUP B, only 27 patients (34.62%) needed a VP shunt. CONCLUSION: In our study, we found that the rate of shunt insertion in patients with MMC is lower than the previously reported rate in the literature. A more thorough evaluation of the patient’s post-operative need for a shunt is mandatory. We suggest that we could accept postoperative (after MMC repair) ventriculomegaly provided it does not mean any deterioration in the patient’s clinical or developmental state. We assume that reduction of shunt insertion rate will eventually reduce what has previously been an enormous burden for a significant proportion of children with MMC.

scholarly journals Surgeon-operated ultrasonography in a one-stop shoulder clinic

2011 ◽  
Vol 93 (7) ◽  
pp. 528-531 ◽  
Author(s):  
R Seagger ◽  
T Bunker ◽  
P Hamer
Keyword(s):  
Rotator Cuff ◽  
Surgical Repair ◽  
Rotator Cuff Tears ◽  
Financial Cost ◽  
Time Saving ◽  
One Stop ◽  
Group A ◽  
Group B ◽  
Portable Ultrasonography

INTRODUCTION Nearly 1 in 40 of the population seeks medical advice related to a shoulder problem every year. The majority pertain to rotator cuff pathology. Prior to intervention in such patients it is imperative to define whether the tendons are intact or torn. Ultrasonography has become an essential adjunct to clinical assessment in diagnosing rotator cuff tears. This study was designed to investigate if a surgeon using a portable ultrasonography machine in a one-stop shoulder clinic could significantly reduce the time a patient waited from initial outpatient presentation to the end of the treatment episode (be it surgery, injection or conservative management). METHODS A total of 77 patients were allocated to one of two groups: Group A, consisting of 37 patients who were assessed and had ultrasonography as outpatients, and Group B, consisting of 40 patients who were assessed and referred for departmental ultrasonography where appropriate. Three clear outcome groups were defined: those who required surgical repair, those who had irreparable tears and those who declined surgery. RESULTS For all outcomes (surgery, irreparable tears and conservative treatment), the patients in Group A all completed their clinical episodes significantly quicker than those in Group B (p<0.02). As well as the time saving benefits, there was a substantial financial saving for Group A. By performing ultrasonography in the outpatients department, those patients avoided the requirement of departmental imaging (£120) and subsequent follow-up appointments (£73) to discuss results and management, resulting in a saving of nearly £200 per patient. CONCLUSIONS The use of a portable ultrasonography machine by an orthopaedic surgeon can significantly reduce the time to treatment and the financial cost for patients with rotator cuff tears.

Midterm Outcomes of Surgical Repair of Partial Anomalous Pulmonary Venous Connection to SVC

2019 ◽  
Vol 68 (01) ◽  
pp. 024-029
Author(s):  
Jie Hu ◽  
Renjie Hu ◽  
Haibo Zhang ◽  
Lei Zhang ◽  
Wen Zhang ◽  
...  
Keyword(s):  
Surgical Repair ◽  
Sinus Node ◽  
Vena Cava ◽  
Young Patients ◽  
Preschool Age ◽  
Patch Repair ◽  
Group A ◽  
Group B ◽  
Anomalous Pulmonary Venous Connection

Abstract Objectives We explore midterm results after surgical treatment of partial anomalous pulmonary venous connection (PAPVC) to superior vena cava (SVC) in our institution. Methods From 2008 to 2017, 78 patients underwent surgical repair for PAPVC to SVC. Patients were divided into three groups based on surgical techniques: Single-patch repair (n = 20, group A), double-patch repair (n = 31, group B), and Warden repair (n = 27, group C). Their median age was 1.9 years (range: 3 months–13.8 years); median weight was 11.4 kg (range: 4.4–39.7 kg). Clinical, electrocardiographic and echocardiographic were available for all patients. Results There were no early or late mortality. The mean follow-up duration was 1.8 ± 2.1 years (range: 0.6 months to 8 years). No pulmonary venous obstruction occurred and no residual left-to-right shunts sustained during the follow-up. Reoperation for SVC obstruction was required: 1 (5.3%) in group A, 1 (3.2%) in group B, and 2 (7.4%) in group C (p = 0.78). Four patients (3 in group B, 1 in group C, p = 0.7) presented transient rhythm disturbance at discharge and one patient in group B remains nonsinus rhythm during follow-up. Pacemaker was not required in all patients. Conclusion PAPVC to SVC can be safely managed by multiple techniques. Careful manipulation nearby sinus node must be emphasized during double-patch repair to prevent injury of sinus node. Obstruction of postoperative SVC stenosis should be paid attention to after Warden procedure. For young patients, operation should not be performed that early, but until preschool age.

Phalangeal Neck Fractures with Concurrent Vascular Injury

2008 ◽  
Vol 34 (1) ◽  
pp. 104-109 ◽  
Author(s):  
M. M. AL-QATTAN
Keyword(s):  
Vascular Injury ◽  
Excellent Result ◽  
Hand Surgery ◽  
Study Group ◽  
Digital Artery ◽  
Group A ◽  
Study Population ◽  
Red Flag ◽  
Group B

The outcome in 16 consecutive paediatric cases of phalangeal neck fractures with concurrent vascular injury was investigated. The study group had a mean age of 5 (range 3–11) years. At final follow-up, the outcome was assessed according to Al-Qattan’s grading system. The study population was divided into three groups. In group A ( n = 3), there was circumferential skin laceration with disruption of both digital arteries and all three patients ended up with an amputation. In group B ( n = 11), there was skin laceration on one side of the digit with one disrupted digital artery, and the outcome following surgery was considered good in six, fair in four and poor in the remaining patient. Group C ( n = 2) presented with “congested” digits and conservative management resulted in one good and one poor result. Reasons for failure to obtain a single excellent result are discussed. Phalangeal neck fractures with concurrent vascular injury should raise a “red flag” and outcomes may be limited, despite management in a specialist hand surgery facility.

scholarly journals 438 Is Cerebrospinal Fluid Sampling Necessary at The Time of First Ventriculo-Peritoneal Shunt Insertion in Paediatric Patients?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
C W L Chia ◽  
P Leach
Keyword(s):  
Cerebrospinal Fluid ◽  
Shunt Infection ◽  
Antibiotic Prescribing ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Patient Demographics ◽  
Paediatric Patients ◽  
Future Risk ◽  
Fluid Sampling

Abstract We aim to evaluate whether intraoperative cerebrospinal fluid (CSF) sampling during ventriculo-peritoneal (VP) shunt insertion can predict future shunt infection or guide its management, as there is currently no evidence for this. 83 paediatric patients undergoing VP shunt insertion between February 2013 and July 2019 were retrospectively identified. Patient demographics, presence of pre-operative extra ventricular drain (EVD), pre-operative CSF results, and intra-operative CSF results were identified. All patients were followed up for a minimum of 6 months for identification of shunt infection. 90 VP shunt insertions were performed in 83 patients. Age at time of shunt insertion ranged from 5 days to 15.8 years (mean 44.2 months). Tumours were the most common aetiology for hydrocephalus (n = 24). 67 cases (74.4%) had intra-operative CSF samples, of which 2 revealed the presence of bacteria. Only 1 patient with intraoperative CSF sampling positive for growth developed shunt infection during follow up. Two cases developed a shunt infection despite normal intra-operative CSF results. Three cases did not have intra-operative CSF sampling but developed a shunt infection during follow up. Our results show that intraoperative CSF sampling as a method to predict future risk of shunt infection and to help inform future antibiotic prescribing is unreliable.

scholarly journals Comparison of Carbamazipine and Amitryptyline for the Reduction of Diabetic Neuropathic Pain: A Randomized Clinical Trial

2017 ◽  
Vol 33 (1) ◽  
pp. 6-12
Author(s):  
MM Rahman ◽  
RK Khan ◽  
N Rizvi ◽  
Md Arifuzzaman M ◽  
A Sharif ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Diabetic Neuropathy ◽  
Outpatient Department ◽  
Treatment Result ◽  
Diabetic Neuropathic Pain ◽  
Group A ◽  
Study Population ◽  
The Mean ◽  
Group B

Background: Diabetic neuropathy is very difficult to treat. Objective: The purpose of the present study was to compare the efficacy and safety of carbamazepine and amitryptyline for reduction of diabetic neuropathic pain. Methodology: This was a randomized controlled trial conducted in the department of Neurology including Neuropathy Clinic of BSMMU and in collaboration with department of Endocrinology, BSMMU, Dhaka from January 2012 to December 2013 for a period of two (2) years. Adult diabetic patients presented with neuropathic pain with symmetrical involvement of distal limbs from indoor and outpatient department of Neurology including Neuropathy clinic as well as indoor and outpatient department of Endocrinology, BSMMU were enrolled in the study population. The study population was divided into two groups named as group A and group B. The group A was experimental group. In this group, patients were treated with oral carbamazepine 400mg/day in two divided doses for initial 2 weeks, then 600mg/ day in three divided doses for further 4 weeks. The group B was control group. In this group, patients were treated with oral amitriptyline 25mg/ day at night for initial 2 weeks, then 50mg/day taking at night for further 4 weeks. During trial, three follow ups were taken at 2 weeks interval and encountered the clinical response by pain score (VAS) and the side effects. The first follow up after 2 weeks of treatment; the second follow up was after 4 weeks of treatment and the third follow up was after 6 weeks of treatment. Result: A total number of 110 cases clinically diagnosed as painful diabetic polyneuropathy, then 56 cases randomly selected for Group A and 54 cases randomly selected for Group B. During follow up of 6 weeks, 2 case of Group A developed skin rash for which they discontinued drug. From rest of cases, 2 from Group A and 4 from Group B were dropped out. Because they did not come for follow up. So finally 52 cases for Group A group and 50 cases for Group B group were studied. A total of 102 patients were included in the study. They were divided into four Groups according to their age. The mean age was found 52.17(±10.02) years in Group A and 53.41(±8.82) years in Group B. The mean (±SD) of percent improvement in Group A and Group B were 41.11(±11.29) vs. 31.76(±19.14) (P<0.05). Dizziness and Drowsiness were found in Group A as 33.3% and 37.0%. But in Group B dryness of mouth and constipation were found as 46.3% and 7.4%. Conclusion: In conclusion carbamazepine produced greater improvements than amitriptyline in relieving pain and paresthesia associated with diabetic neuropathy. Bangladesh Journal of Neuroscience 2017; Vol. 33 (1): 6-12

A simple method to reduce infection of ventriculoperitoneal shunts

2010 ◽  
Vol 5 (6) ◽  
pp. 569-572 ◽  
Author(s):  
Atiq-ur Rehman ◽  
Tausif-ur Rehman ◽  
Hassaan H. Bashir ◽  
Vikas Gupta
Keyword(s):  
Shunt Infection ◽  
Control Group ◽  
Simple Method ◽  
Vp Shunt ◽  
Shunt Placement ◽  
Shunt Catheter ◽  
Skin Flora ◽  
Group A ◽  
Group B ◽  
Shunt Infections

Object Postoperative shunt infection is the most common and feared complication of ventriculoperitoneal (VP) shunt placement for treatment of hydrocephalus. The rate of shunt infection is highest in the 1st postoperative month. The most common organisms responsible for shunt infection include coagulase-negative Staphylococcus and Staphylococcus aureus. This suggests a transfer of patient's skin flora via the surgeons' glove as a possible means of infection. The authors conducted a study to determine if the rate of postoperative shunt infections could be reduced simply by changing gloves before handling the shunt catheter. Methods A total of 111 neonates born with congenital hydrocephalus requiring a VP shunt were enrolled retrospectively and divided into 2 groups: a control group of 54 neonates treated with standard protocol VP shunt placement (Group A) and a treatment group of 57 neonates in whom, after initially double gloving, the outer pair of gloves was removed before handling the shunt catheter (Group B). Shunt infection rates were compared up to 6 months postoperatively. Results There was a statistically significant reduction of infection rate from 16.33% in Group A (control) to 3.77% in Group B (p = 0.0458). Conclusions The study shows that a changing of gloves before handling the shunt catheter may be a simple and cost-effective way to reduce the burden of postoperative shunt infections.

A Comparative Study of Local Ultrasound Therapy and Local Steroid Injection in Patients of Carpal Tunnel Syndrome

2016 ◽  
Vol 27 (4) ◽  
pp. 98-103
Author(s):  
Neeraj Gupta ◽  
Sunil Goenka ◽  
Manoj Verma
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Grip Strength ◽  
Carpal Tunnel ◽  
Steroid Injection ◽  
Ultrasound Therapy ◽  
Group A ◽  
Study Population ◽  
Tunnel Syndrome ◽  
Group B

Abstract Introduction Carpal tunnel syndrome is the most common compressive neuropathy of upper extremity affecting predominantly females of middle age group. Symptoms include pain, paracsthesia, numbness in median nerve distribution of hand. Study design Comparative type of interventional study. Study area Department of Physical Medicine and Rehabilitation, SMS Medical College and attached group of hospitals, Jaipur. Duration of study One and a half years April 2014-October 2015. Aims and objective To compare the efficacy of local ultrasound therapy and local corticosteroid injection for carpal tunnel syndrome management. Study population A total of sixty patients with CTS (agep>18 years) were randomly assigned to the steroid treatment plus splinting(group A) or ultrasound treatment plus splinting(group B). Results The mean age of study population was 45.47±12.24 years with males comprising 13.3% and females 86.6% of whole study. At baseline all outcome variables were comparable statistically in both the groups (p>0.05). In follow-up assessment at 8th week, statistically significant improvement was obtained in all clinical and electrophysiological parameters in group A: Grip strength, symptom severity score, functional status score, median DML, sensory nerve conduction velocity (p<0.001 for each). Also the group B showed improvement in all parameters except grip strength. At the end of 24th week all outcome variables showed decline in improvement as comparative to 8th week, but still they were better than baseline in both groups. There was no significant difference between the groups in outcome variables except for the grip strength. Conclusion Ultrasound treatment provided improvement comparable to steroid injection in all clinical and electrophysiological parameters in patients with CTS except grip strength. Overall steroid therapy is more effective than ultrasound therapy. Effectiveness of treatment persist for at least 6 months then it lessens, so long follow-up is required.

Absorbable suture material in carotid surgery

VASA ◽  
2015 ◽  
Vol 44 (6) ◽  
pp. 451-457 ◽  
Author(s):  
Vincenzo Gasbarro ◽  
Luca Traina ◽  
Francesco Mascoli ◽  
Vincenzo Coscia ◽  
Gianluca Buffone ◽  
...  
Keyword(s):  
Suture Material ◽  
Absorbable Suture ◽  
Paediatric Surgery ◽  
Carotid Surgery ◽  
Suture Materials ◽  
Absorbable Suture Material ◽  
Absorbable Sutures ◽  
Group A ◽  
Group B

Abstract. Background: Absorbable sutures are not generally accepted by most vascular surgeons for the fear of breakage of the suture line and the risk of aneurysmal formation, except in cases of paediatric surgery or in case of infections. Aim of this study is to provide evidence of safety and efficacy of the use of absorbable suture materials in carotid surgery. Patients and methods: In an 11 year period, 1126 patients (659 male [58.5 %], 467 female [41.5 %], median age 72) underwent carotid endarterectomy for carotid stenosis by either conventional with primary closure (cCEA) or eversion (eCEA) techniques. Patients were randomised into two groups according to the type of suture material used. In Group A, absorbable suture material (polyglycolic acid) was used and in Group B non-absorbable suture material (polypropylene) was used. Primary end-point was to compare severe restenosis and aneurysmal formation rates between the two groups of patients. For statistical analysis only cases with a minimum period of follow-up of 12 months were considered. Results: A total of 868 surgical procedures were considered for data analysis. Median follow-up was 6 years (range 1-10 years). The rate of postoperative complications was better for group A for both cCEA and eCEA procedures: 3.5 % and 2.0 % for group A, respectively, and 11.8 % and 12.9 % for group B, respectively. Conclusions: In carotid surgery, the use of absorbable suture material seems to be safe and effective and with a general lower complications rate compared to the use of non-absorbable materials.

Laparoscopic Incisional and Ventral Hernia Repair with Absorbable Tacks in a Long Term Follow-up: A Retrospective Control Study

2019 ◽  
Vol 14 (2) ◽  
pp. 141-146
Author(s):  
Simone Zanella ◽  
Enrico Lauro ◽  
Francesco Franceschi ◽  
Francesco Buccelletti ◽  
Annalisa Potenza ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Ventral Hernia ◽  
Ventral Hernia Repair ◽  
The Elderly ◽  
Long Term Follow Up ◽  
Group A ◽  
Group B ◽  
Absorbable Tacks

Background: Laparoscopic Incisional and Ventral Hernia Repair (LIVHR) is a safe and worldwide accepted procedure performed using absorbable tacks. The aim of the study was to evaluate recurrence rate in a long term follow-up and whether the results of laparoscopic IVH repair in the elderly (≥65 years old) are different with respect to results obtained in younger patients. Methods: One hundred and twenty-nine consecutive patients (74 women and 55 men, median age 67 years, range = 30-87 years) with ventral (N = 42, 32.5%) or post incisional (N = 87, 67.5%) hernia were enrolled in the study. Patients were divided into two groups according to their age: group A (N = 55, 42.6%) aged <65 years and group B (N = 74, 57.4%) aged ≥65 years. Results: The mean operative time was not significantly different between groups (66.7 ± 37 vs. 74 ± 48.4 min, p = 0.4). To the end of 2016, seven recurrences had occurred (group A = 3, group B = 4, p = 1). Complications occurred in 8 (16%) patients in group A and 21 (28.3%) patients in group B. Conclusion: In conclusion, our results confirm that the use of absorbable tacks does not increase recurrence frequency and laparoscopic incisional and ventral repair is a safety procedure also in elderly patients.

A Study on Frozen Shoulder and its clinical management through Nasaapana and Nasya

2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Praveenkumar H. Bagali ◽  
A. S. Prashanth
Keyword(s):  
Medical Science ◽  
Frozen Shoulder ◽  
Signs And Symptoms ◽  
Treatment Modalities ◽  
Animal Kingdom ◽  
Shoulder Joints ◽  
Group A ◽  
Group B

The unique position of man as a master mechanic of the animal kingdom is because of skilled movements of his hands and when this shoulder joints get obstructed, we call it as Apabahuka (Frozen shoulder), we do not find satisfactory management in modern medical science. Various effective treatment modalities have been mentioned which reverse the pathogenesis, Shodhana is advised initially followed by Shamana therapies. In the present study 30 patients were selected incidentally and placed randomly into two groups A and B, with 15 subjects in each group. Group A received Amapachana with Panchakola Churna, Jambeera Pinda Sweda and Nasya Karma. Group B received Amapachana with Panchakola Churna, Jambeera pinda Sweda and Nasaapana. In both the groups two months follow up was done. Both groups showed significant improvement in the signs and symptoms of Apabahuka as well as the activities of daily livings, thereby improving the quality of life of the patients. Nasya Karma and Nasaapana provided highly significant results in all the symptoms of Apabahuka. In the present study as per the clinical data, Nasaapana is found to be more effective than Nasya Karma.

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