Does goitre size and delayed surgical intervention adversely affect surgical outcome? A multi-centric experience on thyroidectomy

Background: The aim of the present study was to assess the surgical outcome of Haglund’s disease by calcaneal osteotomy.Methods: 23 cases of Haglund’s disease who failed to respond to conservative treatment were considered for surgery. Parallel pitch lines were drawn in the lateral view radiograph of the calcaneum and the bursal projection to be resected was assessed. All cases were surgically treated with calcaneal osteotomy through lateral approach and followed.Results: 23 cases of Haglund’s disease were treated with this procedure and 21 were available for follow up. The mean follow-up was 15 months. The mean preoperative AOFAS score of 60.57 points (SD= 3.23) and postoperative score of 88.71 points (SD= 3.92) was obtained. Three minor complications were noted. Conclusions: The results of the current study suggest that calcaneal ostectomy produces outcomes that justify surgical intervention in cases of Haglund’s disease.

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Surgical Outcome of Laminoplasty for Cervical Spondylotic Myelopathy in an Elderly Population – Potentiality for Effective Early Surgical Intervention: A Meta-analysis

Neurologia medico-chirurgica ◽

10.2176/nmc.ra.2016-0302 ◽

2016 ◽

Vol 57 (7) ◽

pp. 366-373 ◽

Cited By ~ 3

Author(s):

Yasuhiro TAKESHIMA ◽

Ryuta MATSUOKA ◽

Ichiro NAKAGAWA ◽

Fumihiko NISHIMURA ◽

Hiroyuki NAKASE

Keyword(s):

Surgical Outcome ◽

Cervical Spondylotic Myelopathy ◽

Elderly Population ◽

Surgical Intervention ◽

Meta Analysis ◽

Early Surgical Intervention

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Benign prostatic hyperplasia: Who will benefit from surgical intervention? A single center experience

Urologia Journal ◽

10.1177/03915603211019987 ◽

2021 ◽

pp. 039156032110199

Author(s):

Farzaneh Sharifiaghdas ◽

Mohammad Reza Khoiniha ◽

Abbas Basiri ◽

Milad Bonakdar Hashemi ◽

Nasrin Borumandnia ◽

...

Keyword(s):

Benign Prostatic Hyperplasia ◽

Medical Treatment ◽

Flow Rate ◽

Surgical Outcome ◽

Surgical Intervention ◽

Peak Flow ◽

Bladder Wall ◽

Prostatic Hyperplasia ◽

Peak Flow Rate

Background: To evaluate the pre-operative factors affecting clinical response to prostate surgery in men with benign prostatic hyperplasia (BPH). Materials and methods: In this prospective cohort study, 172 patients who underwent surgical intervention for BPH (either as open prostatectomy ( n = 78) or monopolar-trans-urethral resection of prostate ( n = 94) from February 2017 to October 2019 were consecutively enrolled. Pre-operative conventional three-lumen urodynamic study and transabdominal sonography were performed for all patients to determine peak flow rate (Qmax), detrusor pressure at the peak flow rate (PdetQmax), post-void residual volume (PVR), presence of detrusor overactivity (DO), prostate volume and median lobe size, and bladder wall thickness with empty and full bladder. Uroflowmetry and cystoscopy were performed during follow-up, whenever indicated. Successful surgical outcome was defined as subjective satisfaction of the patient and a Qmax of more than 15 ml/s on post-operative uroflowmetry. Results: At 1-year follow-up, complete resolution of lower urinary tract syndrome (LUTS) was detected in 138 (80.2%) patients; however, 21 (12.2%) still had pure obstructive LUTS, 9 (5.2%) had pure storage LUTS, and 4 (2.3%) were still suffering from both storage and obstructive LUTS. After performing multivariable analysis, shorter duration of pre-operative medical treatment and higher pre-operative bladder contractility index (BCI) were found to be independent predictors of successful surgery ( p = 0.012 and p < 0.001, respectively). Results of the ROC curve analysis showed that a preoperative BCI level more than 90.95 and pre-surgical medical treatment duration less than 14.45 months have the most specificity and sensitivity to predict the success of surgical outcome. We also observed that the probability of recovery decreased considerably over time following surgery. Conclusion: Shorter duration of pre-operative medical treatment and increased pre-operative BCI can independently predict favorable outcome of BPH surgery. These factors could be used for better patient management and appropriate planning and consultation before BPH surgery.

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Analysis of Surgical Outcome in Patients with Firearm Injury to Spine

Indian Journal of Neurotrauma ◽

10.1055/s-0039-1677669 ◽

2018 ◽

Vol 15 (02/03) ◽

pp. 051-056

Author(s):

Dibya Jyoti Mahakul ◽

Ramesh Doddamani ◽

Rajesh Meena ◽

Deepak Agrawal

Keyword(s):

Blood Loss ◽

Surgical Outcome ◽

Surgical Intervention ◽

Thoracic Vertebrae ◽

Intraoperative Blood Loss ◽

Firearm Injury ◽

Neurologic Status ◽

Cord Injury ◽

Time Of Presentation

Abstract Aim of Study To see whether surgical intervention in gunshot injuries to the spine leads to recovery in neurologic status. Methods It is a retrospective study conducted at the Jai Prakash Narayan Apex Trauma Centre (JPNATC), All India Institutes of Medical Sciences (AIIMS), New Delhi, where case records of 20 patients with gunshot injury to the spine, admitted between January 2013 to March 2018, were analyzed. Result Out of 20 patients, 17 underwent surgical intervention. Entry wound was most common on the back, with the thoracic vertebrae being the most common segment involved. Nine patients had complete spinal cord injury (SCI) at the time of presentation and seven of them underwent surgery. However, only one of these patients showed neurologic improvement at follow-up. Seven patients with canal compromise underwent surgery, and only two of them showed improvement in neurologic status at follow-up. Early surgery was done in 8 out of 16 patients. All 16 patients underwent decompressive procedure, and 3 underwent additional stabilization procedure. Bullet was removed in nine cases. Intraoperative blood loss was minimal in 9 cases, and dural breach was noticed in 14 cases. At follow-up, 56.25% patients showed improvement in neurologic status. Conclusion Surgical intervention, timing of surgery, amount of intraoperative blood loss, and dural breach had no significant impact on the overall surgical outcome. Neurologic status at the time of presentation is the single most important factor that determines the ultimate outcome. Indication and type of surgical intervention is still an ambiguous topic. Owing to lack of conclusive evidence, we believe that there is role for surgery when it is done with an intention to restore the neurologic function.

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Predictors of Surgical Outcome of Abdominal Trauma in Tertiary Care Centres of Nepal

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v15i2.17204 ◽

2017 ◽

Vol 15 (2) ◽

pp. 54-61

Author(s):

Bikash Bikram Thapa ◽

Rajan Gurung ◽

Robin Basnet ◽

Narayan Thapa

Keyword(s):

Abdominal Trauma ◽

Surgical Outcome ◽

Injury Severity ◽

Surgical Intervention ◽

Tertiary Care ◽

Trauma System ◽

Abdominal Injury ◽

Organ Injury ◽

Female Ratio ◽

Trauma Score

Introduction: The abdominal trauma is a surgical emergency most of which are preventable and many of them could have good outcome with timely management by dedicated trauma system. It is not only the rising health problem but also the social and economic burden. A study on abdominal trauma can guide to cost-effective quality management of the patients. This study is undertaken to study and evaluate the predictors of surgical outcome in abdominal trauma patients in tertiary care centers in Nepal.Methods: Seventy five patients with abdominal trauma who underwent surgical intervention were evaluated prospectively inside the inclusion criteria. Ethical approval was obtained. The data on demographic pattern, clinic-radiological findings, abdominal trauma index, injury severity scale, operative findings, infectious complications, and mortality were collected. Chi square test was used for statistical analysis. Results: Out of 75 patients male to female ratio was 4.6 : 1. Blunt trauma (49) was the common cause of abdominal injury. Accidental abdominal injury happened in 73% (55) and fall from height was common mode of abdominal organ injury 40% (30). The overall morbidity and mortality were 30.6% and 9.3% respectively. Age > 30 years, Shock at presentation, Operative Delay > 24 hours, and trauma score (ATI>15 and ISS>15) were all good predictors of surgical outcome of patients with abdominal trauma (p <0.05).Conclusion: The predictors of surgical outcome were patient’s age, clinical status at presentation and delay in surgical intervention. Trauma score (both ATI and ISS) are equally important in predicting outcome which are necessary for monitoring patients care and the quality of trauma systems.

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Early Surgery for Epilepsy: Redefining Candidacy

Journal of Child Neurology ◽

10.1177/0883073894009002061 ◽

1994 ◽

Vol 9 (2_suppl) ◽

pp. 2S36-2S41 ◽

Cited By ~ 9

Author(s):

Trevor J. Resnick ◽

Michael Duchowny ◽

Prasanna Jayakar

Keyword(s):

Natural History ◽

Temporal Lobe Epilepsy ◽

Surgical Outcome ◽

Surgical Intervention ◽

Early Surgery ◽

The Poor ◽

Natural History Studies ◽

Structural Lesion ◽

Abundant Data ◽

Biologic Factors

Surgical resection for localization-related epilepsy has recently become a generally accepted treatment in children. Evidence of the poor outcome in natural history studies of temporal lobe epilepsy in childhood initiated consideration of surgical intervention. Subsequent favorable outcome following surgery was encouraging. A number of variables differentiate adults with focal seizures from children. Evolving biologic factors modify the clinical and electroencephalographic expression of seizures in childhood. The pathologic substrate is different, and there is a higher incidence of extratemporal epilepsy. Chronic seizures beginning under age 2 years rarely remit, especially when associated with a demonstrable structural lesion. Behavioral consequences of chronic seizures are significant and become a major problem by adolescence if seizures are not controlled. Early surgery results in superior functional outcome, although subtle deficits persist postoperatively. Surgical outcome is as favorable as in adults with improvements in behavioral status and socialization. Abundant data exist to more adequately assess the benefits and risks of surgery in children so that intervention is not deferred longer than it needs to be. (J Child Neurol 1994;9(Suppl):2S36-2S41)

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Magnetic resonance imaging predictors of outcome after surgical intervention for cervical spondylotic myelopathy

International Surgery Journal ◽

10.18203/2349-2902.isj20203992 ◽

2020 ◽

Vol 7 (10) ◽

pp. 3219

Author(s):

Sushil Bhogawar ◽

Prasanth Asher ◽

Sunilkumar Balakrishnan Sreemathyamma ◽

Anilkumar Peethambaran

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Magnetic Resonance ◽

Surgical Outcome ◽

Signal Intensity ◽

Cervical Spondylotic Myelopathy ◽

Surgical Intervention ◽

Resonance Imaging ◽

Group A ◽

Group B

Background: Cervical spondylotic myelopathy (CSM) is a commonly seen spinal cord disease. There are no well-defined indications and optimal timing for surgical intervention. Therefore, defining predictors for outcome after surgical intervention will have great advantage in taking decisions for interventions.Methods: A consecutive series of all patients having signs and symptoms of cervical spondylotic myelopathy admitted to Department of Neurosurgery, Medical College, Thiruvananthapuram who underwent decompressive surgery with or without stabilization in one year were studied. Pre-operative magnetic resonance imaging (MRI) findings were correlated with post-operative surgical outcomes (Nurick grade) after 3 months of follow up. The pattern of spinal cord signal intensity was classified as: group A (MRI N/N) - no SI T1WI or T2WI, group B (MRI N/Hi) - no SI T1WI and high SI on T2WI and, group C (MRI Lo/Hi) - low SI T1WI and high SI on T2WI. CSM clinical outcomes were evaluated using Nurick grading system, which was used pre- and post-operatively (pre op and post op).Results: Post operatively improvement was seen in 75% of group A and 61.35 % of group B patients, but among group C only 25% patient improved according to Nurick grading pre op and post op.Conclusions: Patients with high intramedullary signal intensity on T2WI may experience a good surgical outcome. A less favorable surgical outcome is predicted by the presence of low intramedullary signal on T1WI.

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Management of Hydromyelia

Neurosurgery ◽

10.1227/00006123-198910000-00009 ◽

1989 ◽

Vol 25 (4) ◽

pp. 562-571 ◽

Cited By ~ 30

Author(s):

Jeffrey H. Wisoff ◽

Fred Epstein

Keyword(s):

Spinal Cord ◽

Neurological Deficit ◽

Surgical Outcome ◽

Surgical Intervention ◽

Intraoperative Ultrasound ◽

Sensory Loss ◽

Thoracic Spinal Cord ◽

Thoracic Spinal ◽

Chiari Ii ◽

Chiari I

Abstract The authors review their experience in the management of 22 patients with hydromyelia over a 26-month period. Ten children had Chiari I malformations and hydromyelia; 4 children had myelomeningoceles (3 with large thoracic spinal cord cavitations and 1 with cervical hydromyelia); 6 children had distal hydromyelia associated with tethered cords and occult dysraphism; and 2 patients had cavitation subsequent to arachnoiditis. All patients were investigated preoperatively with MRI and intraoperatively with ultrasound. These neurodiagnostic examinations dictated the type of surgical intervention. Patients with Chiari I or Chiari II malformations, cervical hydromyelia, or basal arachnoiditis underwent decompression of the hindbrain malformations, myelotomy with drainage of the cyst, and placement of a stent. When the area of hydromyelia extended to the obex, as demonstrated by intraoperative ultrasound, the obex was plugged. Cyst-pleural shunts were placed in the children who had myelomeningoceles and thoracic hydromyelia. Patients with distal hydromyelia underwent modified terminal ventriculostomy. The classical presentation of brachial amyotrophy and dissociated sensory loss was present in only 3 patients. Progressive scoliosis without neurological deficit, pain, and Lhermitte's phenomenon were common presentations. The patients with tethered cords were generally asymptomatic from their cysts. The authors discuss operative technique, utilization of intraoperative ultrasound, and surgical outcome.

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