scholarly journals Securing aesthetic outcomes for composite grafts to alar margin and columellar defects: A long term experience

2014 ◽  
Vol 47 (03) ◽  
pp. 333-339 ◽  
Author(s):  
Rajeev B. Ahuja ◽  
Rajat Gupta ◽  
Pallab Chatterjee ◽  
Prabhat Shrivastava
Keyword(s):  
Informed Choice ◽  
Composite Graft ◽  
Nasal Reconstruction ◽  
Composite Grafts ◽  
Alar Base ◽  
Split Skin ◽  
Nasal Defects ◽  
Long Term Experience

ABSTRACT Introduction: Composite grafts for nasal reconstruction have been around for over a century but the opinion on its virtues and failings keeps vacillating with a huge difference on the safe size of the graft for transfer. Alar margin and columellar defects are more distinct than dorsal nasal defects in greater difficulty in ensuring a good aesthetic outcome. We report our series of 19 consecutive patients in whom a composite graft was used to reconstruct a defect of alar margin (8 patients), alar base (7 patients) or columella (4 patients). Patients and Methods: Patient ages ranged from 3-35 years with 5 males and 14 females. The grafts to alar margin and base ranged 0.6-1 cm in width, while grafts to columella were 0.7-1.2 cm. The maximum dimension of the graft in this series was 0.9 mm × 10 mm. Composite grafts were sculpted to be two layered (skin + cartilage), three layered wedges (skin + cartilage + skin) or their combination (two layered in a portion and three layered in another portion). All grafts were cooled in postoperative period for three days by applying an indigenous ice pack of surgical glove. The follow up ranged from 3-9 months with an average of 4.5 months. Results: All of our 19 composite grafts survived completely but they all shrank by a small percentage of their bulk. Eleven patients rated the outcome between 90-95% improvement. We noticed that composite grafts tended to show varied pigmentation in our patients, akin to split skin grafts. Conclusion: In our opinion, most critical to graft survival is its size and the ratio of the marginal raw area to the graft bulk. We recommend that graft width should not exceed 1 cm to ensure complete survival even though larger sized grafts have been reported to survive. We recommend cooling of the graft and justify it on the analogy of ‘warm ischemia time’ for a replantation, especially in warmer climes like ours in India. We have outlined several considerations in the technique, with an analysis of differing opinions that should facilitate a surgeon in making an informed choice.

scholarly journals Long-term follow-up of Bentall procedure using the Perimount bioprosthesis and the Valsalva graft

2020 ◽  
Vol 30 (5) ◽  
pp. 679-684
Author(s):  
Ilaria Chirichilli ◽  
Francesco Giosuè Irace ◽  
Salvatore D’Aleo ◽  
Giulio Folino ◽  
Luca Paolo Weltert ◽  
...  
Keyword(s):  
Aortic Root ◽  
Composite Graft ◽  
Root Diameter ◽  
Composite Grafts ◽  
Bentall Procedure ◽  
Structural Valve Deterioration ◽  
Long Term Follow Up ◽  
The Mean

Abstract OBJECTIVES Bentall procedure is the gold standard for aortic root pathologies when valve repair is not feasible. The development of durable bioprosthetic valves and improved vascular conduits allowed the implementation of bioprosthetic composite grafts; hereby, we performed a retrospective analysis of long-term follow-up of Bentall procedure using the Valsalva graft and the Perimount Magna Ease prosthesis. METHODS From June 2000 to March 2019, 309 patients received an aortic root and valve replacement with a bioprosthetic composite graft. The mean age was 69 ± 6.9 years, and the majority were men (88%); most of them were affected by aortic stenosis (86%) and the mean aortic root diameter was 48.6 ± 5.5 mm. RESULTS Freedom from cardiac death was 76.8% [confidence interval (CI) 32.5–94.0] at 16 years. Freedom from thromboembolism, haemorrhage, structural valve deterioration and infective endocarditis was 98.2% (CI 96.0–98.9), 95.2% (CI 87.1–98.2), 87.5% (CI 63.2–97.1) and 79.6% (CI 45.3–95.6) at 16 years, respectively. Freedom from reoperation was 74.7% (CI 41.9–90.6). CONCLUSIONS These data indicate that, in experienced centres, the Bentall procedure is a safe and effective intervention. This is the first long-term follow-up that analyses the results after implantation of a composite graft made with the Perimount Magna Ease aortic valve and the Valsalva graft.

Is catheter-directed foam sclerotherapy more effective than the usual foam sclerotherapy for treatment of the great saphenous vein?

2018 ◽  
Vol 33 (9) ◽  
pp. 646-652 ◽  
Author(s):  
Orsini Camillo
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Statistical Significance ◽  
Long Term Results ◽  
Complication Rates ◽  
Foam Sclerotherapy ◽  
Occlusion Rate ◽  
Long Term Experience

Objective This retrospective study presents the long-term results of catheter-directed foam sclerotherapy of the great saphenous vein. Method From January 2003 to June 2017, 277 patients with varices and great saphenous vein incompetence were treated with echo-guided foam sclerotherapy. Forty-six patients were treated with long-catheters guided by foam sclerotherapy. Foaming was carried out with sodium-tetra-decyl-sulphate. Results Results were examined in the two groups: A (long-catheters) and B (other procedures). The median overall follow-up was 52.1 months. In the A-group, the complete occlusion rate was 34/46 pts (73.9%) and partial occlusion was 10/46 (21.7%). In the B-group, respectively, 130/231 (56.2%) and 90/231 (38.9%). Comparisons between groups were statistically significant (p = 0.023; p = 0.021). Failures involved, respectively, 2/46 (4.3%) and 11/231 (4.7%) with no statistical significance. The complication rates were similar in the two groups. Conclusions In this long-term experience (median follow-up exceeding four years), foam-guided sclerotherapy of the great saphenous vein with a long-catheter turned out to be more effective than the usual foam-guided sclerotherapy.

scholarly journals Long term experience of treatment of renal tumours with cryotherapy. Follow-up with CT and contrast-enhanced ultrasound

2021 ◽  
Vol 33 ◽  
pp. S315-S316
Author(s):  
M. Santiago Gonzalez ◽  
I. Laso García ◽  
E. Sanz Mayayo ◽  
F. Arias Fúnez ◽  
C. Mínguez Ojeda ◽  
...  
Keyword(s):  
Contrast Enhanced Ultrasound ◽  
Contrast Enhanced ◽  
Renal Tumours ◽  
Long Term Experience

scholarly journals Effectiveness of Repair of Aortic Coarctation in Neonates: A Long-Term experience

2021 ◽  
Author(s):  
Chiara Minotti ◽  
Manuela Scioni ◽  
Biagio Castaldi ◽  
Alvise Guariento ◽  
Roberta Biffanti ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Aortic Coarctation ◽  
Surgical Repair ◽  
Nyha Class ◽  
Long Term Results ◽  
Relative Risk Ratio ◽  
Hypoplastic Aortic Arch ◽  
Long Term Experience

AbstractTo evaluate early and long-term results of surgical treatment of aortic coarctation (CoAo) in neonates. This is a retrospective clinical review of neonates with CoAo, who underwent surgery between 1995 and 2019. Data were retrieved from our institutional database, to identify preoperative and postoperative characteristics. Statistical analysis was performed by means of relative risk ratio and Cox and logistic multivariate analysis. 218 consecutive neonates (M/F: 129/89, median age 11 days, IQR 7–17 days) were included; 202 (92.7%) had a left thoracotomy; 178 underwent extended end-to-end anastomosis (EEEA, 81.6%). Hypoplastic aortic arch (HAA) was present in 102 patients (46.8%); complex cardiac anomalies in 85 (39%). Significant postoperative complications occurred in 20 (9.2%). Thirty-day mortality was 2.3% (most in complex types). At a median follow-up of 10.4 years (IQR 5.6–15.0 years; FU completeness 95.9%), there were 8 late deaths (3.7%), all associated to complex CoAo. Among 196 survivors, 177 (93.2%) were in NYHA class I; re-interventions on aortic arch occurred in 9.2% (2.0% were surgical). Freedom from mortality and re-intervention on aorta at 10 years were 94.3% and 96.7%, respectively. Surgical repair of CoAo in newborns without CPB in our series was safe and low-risk, with excellent early and late outcomes.

Longevity, legacy, and lament: Learning from longstanding educators in an innovative curriculum

2021 ◽  
Vol 2021 (April) ◽  
pp. 1-20
Author(s):  
Gillian Maudsley
Keyword(s):  
Student Outcomes ◽  
Medical Curriculum ◽  
Research Question ◽  
System Integrity ◽  
Semistructured Interviews ◽  
Innovative Curriculum ◽  
The Impact ◽  
Long Term Experience

Research about problem-based learning (PBL) tutoring in medicine has prioritized quantifying relationships between tutor characteristics or learning environment and tutoring behaviour or student outcomes. Longitudinal studies and qualitative research about how such tutors conceptualize their long-term experience are rare. The research question was thus: What educator outlooks do inaugural PBL tutors develop after substantial experience in a problem-based medical curriculum? At16 year-follow-up of interviews with an inaugural cohort of PBL tutors, semistructured interviews with the remaining ten explored their outlooks as educators now versus then. Two years later, an open-ended e-questionnaire (E-interview) reviewed their outlooks, particularly about the curriculum being replaced. Tutors viewed their role now through a more discerning, reflective, and constructivist ‘good educator’ lens. They articulated principles for facilitating active learning. When that curriculum was replaced, tutors were positive about its legacy but also lamented flawed educational governance for maintaining and renewing whole-system integrity. Educator development should prompt critical reflection about ‘the good educator’ identity, the related enthusiasms, discomforts, and uncertainties, and the impact of curriculum shifts.

Active surveillance of postradical prostatectomy biochemical recurrence: Long-term assessment of outcomes.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 5081-5081
Author(s):  
Tom Edward Ahlering ◽  
Erica Huang ◽  
Linda My Huynh ◽  
Huang Wei Su
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Biochemical Recurrence ◽  
Treatment Intervention ◽  
Cancer Death ◽  
Metastatic Progression ◽  
Prostate Cancer Death ◽  
Long Term Experience

5081 Background: Biochemical recurrence (BCR) following radical prostatectomy (RP) is an unreliable predictor of distant metastatic progression/prostate cancer death, resulting in potential complications & expenses of overtreatment. Little has been published on management decisions & outcomes of active surveillance (AS). We characterize our long term experience with AS following post-RP BCR without radiation/androgen deprivation therapy. Methods: From June 2002 - September 2019, 1865 men underwent RP. 406 experienced BCR; of these, 138 (34%) were observed without treatment intervention. BCR defined as PSA>0.2 ng/dl, x2. PSAs checked every 1-3 months and entered into a PSADT graph. Men were considered to be formally AS after 3+ years of increasing DT following RP. Men with decreasing DT were treated and censored. Results: The table depicts demographics of the AS patients; median follow-up was 7.3 years (IQR: 4.6-10.6) post-RP. Of patients on AS, average age was 63.7 +/- 7.2 years and 86%, 48%, 40%, 51% and 14% were GG 1 through 5, respectively. Current DT of AS patients averages 20 months, with 0% PCSM. Only 10% of patients with decreasing DT began treatment after average 4 years following BCR. Conclusions: Of 406 patients experiencing post-RP BCR, 34% of patients are effectively managed with AS, with 0% PCSM across all GG. Presently 69 (50%) AS men have been under observation for 7.3 to 18 years. This suggests that significant portion of patients display benign recurrence, characterized by increasing DT following BCR and can be managed safely with observation alone.[Table: see text]

scholarly journals SIMPLE CYSTECTOMY AND ORTHOTOPIC CONTINENT URINARY DIVERSION FOR NON MALIGNANT UROLOGICAL CONDITIONS: OUR LONG TERM EXPERIENCE

2021 ◽  
Author(s):  
cathbert mudimu
Keyword(s):  
Renal Function ◽  
Urinary Diversion ◽  
Surgical Intervention ◽  
Obstructive Uropathy ◽  
Bladder Capacity ◽  
Continent Urinary Diversion ◽  
Urinary Schistosomiasis ◽  
Long Term Experience

Chronic urinary schistosomiasis may lead to obstructive uropathy, contracted bladder secondary to ureteral calcific fibrosis. Appropriate surgical intervention , guided by renal function, bladder capacity and meticulous follow-up may lead to excellent long term urogenital outcomes , following simple cystectomy with orthotopic continent neocystoplasty

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