scholarly journals Prepuce Transillumination: A Safety Tool in Forceps-guided Circumcision

2021 ◽  
Vol 18 (2) ◽  
pp. 75-78
Author(s):  
Maged Rihan
Keyword(s):  
Postoperative Bleeding ◽  
Penile Shaft ◽  
Related Complication ◽  
Surgical Exploration ◽  
Penile Injury ◽  
The Mean

Background: Injury or even amputation of the glans or the penile shaft occurs rarely but can be a tragic circumcision-related complication. The forceps-guided technique can cause this complication due to an inability to visualize the glans before incising. This study was designed to solve this problem by transilluminating the prepuce before the incision, thus exploring whether it contains any tissue between its layers and visualizing what is being done rather than performing the procedure blindly. Methods: Forceps-guided circumcision was done on 432 males, from August 2018 to July 2019.The mean age of patients was 15.57  (1–348) days. The pulled prepuce was transilluminated, showing the prepuce and verifying that no glanular or penile tissue was  involved in the forceps lock before incising. Results: The mean follow-up period was 12.45 (2–35) days. Twenty-one patients had postoperative bleeding, and six patients had a hematoma. Fourteen of the 21 patients were managed using a tight bandage; the remaining 7 patients needed surgical exploration. None of the patients had glanular or penile injury. Conclusion: Transilluminating the prepuce as a modification of forceps-guided circumcision is a protective safety step before cutting the prepuce, to eliminate the incidence of glanular or penile injuries. Keywords: Circumcision, Prepuce, Transillumination, Forceps, Complication

scholarly journals Posterior interhemispheric transfalcine transprecuneus approach for microsurgical resection of periatrial lesions: indications, technique, and outcomes

2015 ◽  
Vol 123 (4) ◽  
pp. 1045-1054 ◽  
Author(s):  
Bradley N. Bohnstedt ◽  
Charles G. Kulwin ◽  
Mitesh V. Shah ◽  
Aaron A. Cohen-Gadol
Keyword(s):  
Extent Of Resection ◽  
Metastatic Lesion ◽  
Related Complication ◽  
Postoperative Mri ◽  
Underlying Malignancy ◽  
Radiological Data ◽  
Data Points ◽  
Patient Series ◽  
The Mean

OBJECT Surgical exposure of the peritrigonal or periatrial region has been challenging due to the depth of the region and overlying important functional cortices and white matter tracts. The authors demonstrate the operative feasibility of a contralateral posterior interhemispheric transfalcine transprecuneus approach (PITTA) to this region and present a series of patients treated via this operative route. METHODS Fourteen consecutive patients underwent the PITTA and were included in this study. Pre- and postoperative clinical and radiological data points were retrospectively collected. Complications and extent of resection were reviewed. RESULTS The mean age of patients at the time of surgery was 39 years (range 11–64 years). Six of the 14 patients were female. The mean duration of follow-up was 4.6 months (range 0.5–19.6 months). Pathology included 6 arteriovenous malformations, 4 gliomas, 2 meningiomas, 1 metastatic lesion, and 1 gray matter heterotopia. Based on the results shown on postoperative MRI, 1 lesion (7%) was intentionally subtotally resected, but ≥ 95% resection was achieved in all others (93%) and gross-total resection was accomplished in 7 (54%) of 13. One patient (7%) experienced a temporary approach-related complication. At last follow-up, 1 patient (7%) had died due to complications of his underlying malignancy unrelated to his cranial surgery, 2 (14%) demonstrated a Glasgow Outcome Scale (GOS) score of 4, and 11 (79%) manifested a GOS score of 5. CONCLUSIONS Based on this patient series, the contralateral PITTA potentially offers numerous advantages, including a wider, safer operative corridor, minimal need for ipsilateral brain manipulation, and better intraoperative navigation and working angles.

scholarly journals Flexor Hallucis Longus Tendon Transfer for Reconstruction of Chronically Ruptured Achilles Tendons

2009 ◽  
Vol 17 (2) ◽  
pp. 194-198 ◽  
Author(s):  
Ravindra H Mahajan ◽  
Rakesh B Dalal
Keyword(s):  
Wound Healing ◽  
Tendon Transfer ◽  
Flexor Hallucis Longus ◽  
Related Complication ◽  
Hind Foot ◽  
The Mean ◽  
American Orthopaedic ◽  
One Year

Purpose. To report the mid-term results of flexor hallucis longus (FHL) tendon transfer for reconstruction of chronically ruptured Achilles tendons. Methods. 24 men and 12 women aged 56 to 78 (mean, 70) years underwent FHL tendon transfer for reconstruction of chronically ruptured Achilles tendons by a single surgeon. Ruptures were secondary to trauma (n=20), long-term steroid intake (n=12), or chronic renal failure (n=6). Two patients had bilateral ruptures. The mean interval from rupture to surgery was 15 (range, 12–24) weeks. Pre- and post-operative American Orthopaedic Foot and Ankle Society (AOFAS) hind foot scores were compared. Wound healing, push-off, and patient satisfaction were evaluated. Results. The mean follow-up period was one year. The mean AOFAS scores were 69 (range, 58–76) preoperatively and 88 (range, 79–94) postoperatively; the mean improvement was 19 (p<0.001). 28 patients had excellent and 8 had fair results. 33 patients graded their outcome as ‘very satisfactory’ and 3 as ‘satisfactory’. Five patients developed wound healing complications but only one needed debridement. There was no fixation-related complication or sural nerve injury. Conclusions. Transfer of the FHL for reconstruction of chronically ruptured Achilles tendons is effective, safe and easily performed in patients with low-to-moderate demands.

scholarly journals Stent-Assisted Coiling of Ruptured Wide-Necked Intracranial Aneurysms

2013 ◽  
Vol 19 (3) ◽  
pp. 283-288 ◽  
Author(s):  
Conghui Li ◽  
Youxiang Li
Keyword(s):  
Mortality Rate ◽  
Clinical Outcome ◽  
Scale Score ◽  
Coil Embolization ◽  
Glasgow Outcome Scale ◽  
Intracranial Aneurysms ◽  
Related Complication ◽  
The Mean

This study aimed to report the results and outcome of stent-assisted coiling of ruptured wide-necked intracranial aneurysms. We retrospectively reviewed 19 consecutive patients (11 men, eight women; mean age, 59.5 years; range, 43–78 years) with acutely ruptured wide-necked intracranial aneurysms who were treated with stent-assisted coil embolization. The mean length of angiographic follow-up was 5.2 months (range, 3–10 months). There was no technique-related complication and the 30-day mortality rate was 10.5% (two of 19). There was one case of rebleeding, and clinical outcome was poor for the patient (5.3% [one of 19] who had a Glasgow Outcome Scale score of 2 at the end of the study period). Stent-assisted coiling is a feasible treatment for ruptured wide-necked intracranial aneurysms that are difficult to treat surgically or with balloon-assisted embolization.

scholarly journals Early Treatment of Ruptured Blood Blister-Like Aneurysms of the Internal Carotid Artery With Flow Diverters Using Single Antiplatelet Therapy: A Single-Center Experience With Long-Term Follow-Up

2021 ◽  
Vol 12 ◽  
Author(s):  
Anil Tanburoglu ◽  
Cagatay Andic
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Early Treatment ◽  
Internal Carotid ◽  
Single Center ◽  
Related Complication ◽  
Single Center Experience ◽  
The Mean

Background and Purpose: Blood Blister-like aneurysms (BBAs) of the internal carotid artery (ICA) are rare entities of cerebral aneurysms. FD use in acutely ruptured aneurysms, timing of treatment and antiplatelet regimen are main debate topics in clinical practice when the treatment decision is flow diversion. The aim of this study is to report the safety and efficacy of a single-center FD treatment for ruptured BBAs in the early phase of SAH using the SAPT regimen.Material and Method: This study involved a retrospective analysis of a prospectively collected database. Records of patients admitted to our clinic and treated by endovascular route on ruptured BBA between January 2013 and December 2020 were reviewed. Ruptured supraclinoid ICA BBAs treated with FD devices with SAPT within 48 h from ictus of SAH are included. BBA of atypical anatomic locations, other endovascular techniques performed, and delayed admissions (&gt;48 h) were excluded from the study. Demographic, clinical and angiographic features of patients and aneurysms, FD types and numbers, periprocedural complications, immediate and follow-up angiographic and clinical outcomes were recorded.Results: A total of six patients with ruptured BBAs treated via FDs within 48 h and used SAPT were included in the study. The mean age was 41.6 years (range from 34 to 45 years), and four of six patients were female. All patients were treated within 48 h after ictus, and the mean treatment day was 1.33 days. One patient received ticagrelor, and five patients received prasugrel as SAPT for one year after treatment. No procedure-related death and rebleeding were recorded. One (16.7 %) treatment responsive procedure-related complication occurred (transient ischemia). Overall good outcome rate was 83.3%. One patient died due to pneumonia. The immediate control angiograms showed complete occlusions of BBAs in one patient (16.6%). The complete occlusion rate was 100 % for five survivors at the control angiogram. The median follow-up was 49.5 months.Conclusion: This single-center experience suggests that early treatment (&lt;2 days) within SAH of ruptured BBAs with FDs using SAPT is safe and effective in terms of clinical and radiological long-term outcomes.

Phase II Trial on Extending the Maintenance Flushing Interval of Implanted Ports

2017 ◽  
Vol 13 (1) ◽  
pp. e22-e28 ◽  
Author(s):  
Jorge A. Diaz ◽  
Shesh N. Rai ◽  
Xiaoyoung Wu ◽  
Ju-Hsien Chao ◽  
Ajoy L. Dias ◽  
...  
Keyword(s):  
Phase Ii ◽  
Retrospective Studies ◽  
Patient Adherence ◽  
Related Complication ◽  
Oncologic Patients ◽  
The Mean ◽  
Chemotherapy Patients ◽  
Record Review ◽  
Mean Time

Purpose: Retrospective studies suggest that it may be safe to extend the maintenance flushing interval of implanted ports from once every month, as recommended by the manufacturer, to once every 3 months, but no prospective cohort studies have been done specifically assessing the safety and feasibility of this intervention. Methods: This was a phase II study in oncologic patients who retained a functional port after completion of systemic chemotherapy. Patients enrolled in the study had their port flushed once every 3 months and were observed until completion of five scheduled flushes (one on enrollment and four additional flushes, one every 3 months) or development of any port-related complication, including infections, thrombosis, and occlusions. The primary end points were frequency of port-related complications and port failure requiring removal. Results: A total of 87 patients were enrolled in the study. The median follow-up time was 308 days, accounting for a total of 24,202 catheter-days. There were 10 port-related complications (11.49%; 95% CI, 4.85% to 18.14%). No infection or symptomatic thrombosis occurred. The mean time to port-related complication was 184 days. No patients developed port failure while on protocol, but on subsequent medical record review, four patients developed a complication that required port removal or port revision within 30 days of being removed from the trial (4.6%; 95% CI, 0.4% to 8.8%; 0.17/1,000 catheter-days). Conclusion: Extending the maintenance flushes of implanted ports in adult oncologic patients to once every 3 months is safe, effective, and likely to increase patient adherence and satisfaction while decreasing the associated cost.

scholarly journals AN EARLY EGYPTIAN EXPERIENCEIN OZAKI TECHNIQUE

2020 ◽  
Vol 8 (11) ◽  
pp. 444-448
Author(s):  
Mohamed A. El-badawy ◽  
◽  
Mohamed R. Abdelbaky ◽  
Mostafa M. Abdalraouf ◽  
Hussein A. Zaher ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Postoperative Bleeding ◽  
Mechanical Valve ◽  
Mortality And Morbidity ◽  
Replacement Surgery ◽  
Significant Difference ◽  
The Mean

Background: The advantage of Ozaki technique for aortic valve replacement surgery over the conventional approach is still debated. This study aimed to evaluate early outcomes after aortic valve replacement using the Ozaki technique Methods: We prospectively included 20 patients who had aortic valve replacement May 2018 to June 2020. Postoperative bleeding, mechanical ventilation, ICU stay and echocardiographic outcomes were observed. Results: The mean age was 39.9±14.8 (20-69) years.13 patient had aortic regurge while 7 had aortic stenosis. Aortic cross-clamp (76.2±8.5 (60-100) and cardiopulmonary bypass times (103.8±15.3 (80-125).One patient (5%) was converted to aortic valve replacement by mechanical valve due to significant aortic regurge. Neither significant gradient nor regurge was found on one month follow-up echography. Freedom from infective endocarditis was found in all patients. No significant difference was found in the ejection fraction pre and post-operative. Conclusion: This novel technique seems to have a promising and favorable outcome with no need for anticoagulation and lesser post-operative complication compared to ordinary aortic valve replacement. This technique is associated with low mortality and morbidity.

Primary Stenting of Embolic Occlusions in Iliac Arteries

2003 ◽  
Vol 10 (3) ◽  
pp. 629-635 ◽  
Author(s):  
Saim Yilmaz ◽  
Timur Sindel ◽  
Ersin Lüleci
Keyword(s):  
Cerebral Arteries ◽  
Balloon Dilation ◽  
Related Complication ◽  
Iliac Arteries ◽  
Middle Cerebral Arteries ◽  
Primary Stenting ◽  
The Common ◽  
The Mean ◽  
Primary Implantation

Purpose: To present our experience with the use of primary stenting to treat embolic iliac artery occlusions. Methods and Results: Six patients (5 men; mean age 50.6±14.1 years range 37–72) underwent primary stenting for embolic occlusions lodged in the common iliac and/or external iliac arteries and were retrospectively evaluated. The probable reason for the embolism was atrial fibrillation in 4 patients and acute myocardial infarction in 2. In 5 patients, an additional embolus was demonstrated in the renal, mesenteric, popliteal, and middle cerebral arteries. Iliac emboli were treated with primary implantation of self-expanding stents followed by very low-pressure balloon dilation. In all cases, primary stenting was technically successful and provided immediate recanalization with elimination or reduction of symptoms. There was no procedure-related complication. During the mean 11-month follow-up (range 1–18), all stented iliac arteries remained patient. One patient died due to cerebral embolism at 21 months. Conclusions: Although this experience is limited, excellent midterm results suggest that primary stenting may be a valuable alternative in the treatment of embolic occlusions of the iliac arteries in selected cases.

Stimulation of the subthalamic region for essential tremor

2004 ◽  
Vol 101 (1) ◽  
pp. 48-54 ◽  
Author(s):  
Puneet Plaha ◽  
Nikunj K. Patel ◽  
Steven S. Gill
Keyword(s):  
Essential Tremor ◽  
Upper Limb ◽  
Functional Disability ◽  
Rating Scale ◽  
Related Complication ◽  
Content Type ◽  
The Mean ◽  
Fine Print ◽  
Deep Brain

Object. The goal of this study was to determine the safety and efficacy of bilateral subthalamic region stimulation in the treatment of essential tremor (ET). Methods. Following induction of general anesthesia, four patients with disabling tremor that had proved to be refractory to pharmacotherapy underwent magnetic resonance imaging—guided deep brain stimulation (DBS) of the bilateral subthalamic region. Tremor was assessed by applying the Fahn-Tolosa-Marín Tremor Rating Scale at baseline and again at the 12-month follow-up examination. Following surgery the total tremor score improved by 80.1% (from a baseline mean score of 63 ± 15.1 to a score of 11.8 ± 3.9 at 12 months postoperatively). There was a significant improvement (p < 0.0001) in the mean tremor score of the upper limb (postural and action component) from a baseline score of 3 ± 0.9 to a score of 0.5 ± 0.5 at 12 months postoperatively. In two patients with Score 4 head tremor complete arrest of the tremor was observed at 12 months. Motor function scores of the upper limb for drawing spirals, pouring water, and drawing lines improved significantly (p < 0.05) by 66.7, 76.9, and 58.3%, respectively. Handwriting improved by 68%, but this gain was not significant. The mean activities of daily living score at baseline was 20 ± 3.2; there was an 88.8% improvement in this score to 2.3 ± 1.5 at the 12-month evaluation. The voltage required for effective tremor control was low (mean 1.8 ± 0.2 V) and, along with the other parameters of DBS (frequency and pulse width), did not change significantly over the 12-month period. Tolerance to the action component of tremor was not seen. There was no procedural or stimulation-related complication. Conclusions. Bilateral subthalamic region stimulation is effective in arresting tremor and head titubation, as well as functional disability in ET. Complications like dysarthria and disequilibrium were not seen. These patients required low voltages of stimulation and did not develop a tolerance to the treatment.

Sound Production Treatment for Acquired Apraxia of Speech: An Examination of Dosage in Relation to Probe Performance

2020 ◽  
pp. 1-16
Author(s):  
Julie L. Wambaugh ◽  
Lydia Kallhoff ◽  
Christina Nessler
Keyword(s):  
Retrospective Analysis ◽  
Sound Production ◽  
Apraxia Of Speech ◽  
Practice Schedule ◽  
Practice Schedules ◽  
Baseline Performance ◽  
The Mean ◽  
Number Of Treatment ◽  
The Impact

Purpose This study was designed to examine the association of dosage and effects of Sound Production Treatment (SPT) for acquired apraxia of speech. Method Treatment logs and probe data from 20 speakers with apraxia of speech and aphasia were submitted to a retrospective analysis. The number of treatment sessions and teaching episodes was examined relative to (a) change in articulation accuracy above baseline performance, (b) mastery of production, and (c) maintenance. The impact of practice schedule (SPT-Blocked vs. SPT-Random) was also examined. Results The average number of treatment sessions conducted prior to change was 5.4 for SPT-Blocked and 3.9 for SPT-Random. The mean number of teaching episodes preceding change was 334 for SPT-Blocked and 179 for SPT-Random. Mastery occurred within an average of 13.7 sessions (1,252 teaching episodes) and 12.4 sessions (1,082 teaching episodes) for SPT-Blocked and SPT-Random, respectively. Comparisons of dosage metric values across practice schedules did not reveal substantial differences. Significant negative correlations were found between follow-up probe performance and the dosage metrics. Conclusions Only a few treatment sessions were needed to achieve initial positive changes in articulation, with mastery occurring within 12–14 sessions for the majority of participants. Earlier occurrence of change or mastery was associated with better follow-up performance. Supplemental Material https://doi.org/10.23641/asha.12592190

Drug-eluting stents for treatment of focal infrapopliteal lesions

VASA ◽  
2012 ◽  
Vol 41 (2) ◽  
pp. 90-95 ◽  
Author(s):  
Rastan ◽  
Noory ◽  
Zeller
Keyword(s):  
Limb Salvage ◽  
Bare Metal Stents ◽  
Target Lesion ◽  
Drug Eluting Stents ◽  
Metal Stents ◽  
Target Lesion Revascularisation ◽  
Randomized Studies ◽  
Drug Eluting ◽  
The Mean

We have investigated the role of drug-eluting stents on patency rates after treatment of focal infrapopliteal lesions in patients with intermittent claudication and critical limb ischemia. Reports indicate that drug-eluting stents reduce the risk of restenosis after percutaneous infrapopliteal artery revascularization. A Pub Med, EMBASE, Cochrane database review search of non-randomized studies investigating patency rates, target lesion revascularisation rates, limb salvage rates and mortality rates in an up to 3-year follow-up period after drug-eluting stent placement was conducted. In addition, preliminary results of randomized studies comparing drug-eluting stents with bare-metal stents and plain balloon angioplasty in treatment of focal infrapopliteal lesions were included in this review. A total of 1039 patients from 10 non-randomized and randomized studies were included. Most commonly used drug-eluting stents were sirolimus-eluting. The mean follow-up period was 12.6 (range 8 - 24). The mean 1-year primary patency rate was 86 ± 5 %. The mean target lesion revascularization rate and limb salvage rate was 9.9 ± 5 % and 96.6 %±4 %, respectively. Results from non-randomized and preliminary results from prospective, randomized trials show a significant advantage for drug-eluting stents in comparison to plain balloon angioplasty and bare-metal stents concerning target lesion patency and in parts target lesion revascularisation. No trial reveals an advantage for drug-eluting stents with regard to limb salvage and mortality.

Sign in / Sign up

Export Citation Format

Share Document