Invasive Treatment
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Dr. Carolina Diamandis ◽  
Adrian Tudor ◽  
David Rosenberg

As a conservative form of treatment for scoliosis and kyphosis (postural deficits), orthotic therapy still represents the gold standard of non-surgical orthopedics. In light of increasingly frequent complications due to dangerous wound infections caused by multi-resistant germs, it is to be expected that the treatment of clinically relevant postural deformities will again be increasingly conservative in the future. Apart from “saving” the patient from wearing an orthosis, surgical (invasive) treatment has not been proven to be superior.

Polymers ◽  
2021 ◽  
Vol 13 (20) ◽  
pp. 3568
Caroline Herron ◽  
Conn L. Hastings ◽  
Clodagh Herron-Rice ◽  
Helena M. Kelly ◽  
Joanne O’Dwyer ◽  

A reduction in blood supply to any limb causes ischaemia, pain and morbidity. Critical limb ischaemia is the most serious presentation of peripheral vascular disease. One in five patients with critical limb ischaemia will die within six months of diagnosis and one in three will require amputation in this time. Improving blood flow to the limb, via the administration of angiogenic agents, could relieve pain and avoid amputation. Herein, chitosan is combined with β-glycerophosphate to form a thermoresponsive formulation (chitosan/β-GP) that will flow through a syringe and needle at room temperature but will form a gel at body temperature. The chitosan/β-GP hydrogel, with or without the angiogenic molecule desferrioxamine (DFO), was injected into the mouse hind limb, following vessel ligation, to test the ability of the formulations to induce angiogenesis. The effects of the formulations were measured using laser Doppler imaging to determine limb perfusion and CD31 staining to quantify the number of blood vessels. Twenty-eight days following induction of ischaemia, the chitosan/β-GP and chitosan/β-GP + 100 µM DFO formulations had significantly (p < 0.001 and p < 0.05, respectively) improved blood flow in the ischaemic limb compared with an untreated control. Chitosan/β-GP increased vessel number by 1.7-fold in the thigh of the ischaemic limb compared with an untreated control, while chitosan/β-GP + 100 µM DFO increased vessel number 1.8-fold. Chitosan/β-GP represents a potential minimally invasive treatment for critical limb ischaemia.

Biomedicines ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1456
Kristina Sonnenschein ◽  
Stevan D. Stojanović ◽  
Nicholas Dickel ◽  
Jan Fiedler ◽  
Johann Bauersachs ◽  

Background: Peripheral artery disease (PAD) is a significant burden, particularly among patients with severe disease requiring invasive treatment. We applied a general Machine Learning (ML) workflow and investigated if a multi-dimensional marker set of standard clinical parameters can identify patients in need of vascular intervention without specialized intra–hospital diagnostics. Methods: This is a retrospective study involving patients with stable PAD (sPAD, Fontaine Class I and II, n = 38) and unstable PAD (unPAD, Fontaine Class III and IV, n = 18) in need of invasive therapeutic measures. ML algorithms such as Random Forest were utilized to evaluate a matrix consisting of multiple routinely clinically available parameters (age, complete blood count, inflammation, lipid, iron metabolism). Results: ML has enabled a generation of an Artificial Intelligence (AI) PAD score (AI-PAD) that successfully divided sPAD from unPAD patients (high AI-PAD in sPAD, low AI-PAD in unPAD, cutoff at 50 AI-PAD units). Furthermore, the probability score positively coincided with gold-standard intra-hospital mean ankle-brachial index (ABI). Conclusion: AI-based tools may be promising to enable the correct identification of patients with unstable PAD by using existing clinical information, thus supplementing clinical decision making. Additional studies in larger prospective cohorts are necessary to determine the usefulness of this approach in comparison to standard diagnostic measures.

2021 ◽  
Yuzhang Wu ◽  
Yan Zhao ◽  
Shengping Yu ◽  
Fan Li ◽  
Shifei Cai ◽  

Abstract Background Intracranial aneurysm(IA) is a serious disease.Analyze and review the cases of anterior circulation ruptured IA by supraorbital lateral keyhole approach, and summarize the experiences of this approach. Methods Retrospective analysis of 16 cases of ruptured anterior circulation IA in our department from January 2019 to June 2020, CT angiography (CTA) was performed before operation. Analyzing the IA’s parameters by 3D-CT reconstruction. The IA was clipped by supraorbital lateral keyhole approach combined with the 3D-skull reconstruction. Extraventricular drainage were performed before craniotomy. Intraoperative neurophysiological monitoring was performed during the operation. After operation, fluorescein angiography and vascular ultrasound were performed to check the clipping effect. Intracranial pressure monitor was performed postoperatively. CTA was reexamined one week after operation. The modified Rankin Scale (MRS) was performed 6 months after operation. Results There were 7 males (43.8%) and 9 females (56.2%) ,the average age is 52.3 years. Among them, 11 patients(68.8%) were anterior communicating artery aneurysms and 5 (31.2%) were middle cerebral artery aneurysms. All patients were out of hospital within 10 days without any death, without cerebral infarction, cerebrospinal fluid leakage and neurological impairments. About mRS score, after 6 months follow-up, 8 cases(50%) had 0 point, 4 cases (25%) had 1 point, 4 cases (25%) had 2 points. Conclusions For ruptured anterior circulation IA, the supraorbital lateral keyhole approach combined with ventricular drainage, intraoperative electrophysiological monitoring and intraoperative vascular ultrasound is a safe and minimally invasive treatment. The application of reconstruction clipping can reconstruct the diameter of parent vessel and reduce the recurrence rate of IA.

2021 ◽  
Vol 8 ◽  
Soraya El Yaagoubi ◽  
Morchad Bouabid ◽  
Amal El Yamani

Resin bonded bridge technique was first introduced in 1963 by Rochette. It was the first type of non-invasive fixed dental prosthesis because the abutment tooth didn’t undergo any prior preparation. As early as 1996, Hussey and Linden studied cantilever resin bonded bridges and showed that there was no significant difference in the survival rates of a conventional bridge and cantilever resin bonded bridges. The main indications for a resin bonded bridge in children are post-traumatic edentulousness, during the early detection of agenesis and pre-implant temporization situations. Resin bonded bridges are also recommended in adults when the implant context is unfavourable or contraindicated (periodontal diseases and / or anatomical and prosthetic obstacles). Cantilever resin bonded bridge has many advantages compared to the traditional bridge: simpler and faster to make, more economical for the patient, easier hygiene and absence of partial detachment that can lead to secondary caries lesion.The preparation criteria will be adapted to the clinical situation, which will take into account the patient's age, the extent of edentulousness, the extent of occlusal loads and dental mobility. Thus, when the joint is subject to excessive stress, retention devices will complete the preparation. With the continuous development of materials as well as new minimally invasive treatment modalities, the alternative solution of the bonded bridge in the anterior region now corresponds to the realization of an all-ceramic zirconia cantilever bridge with a single wing.

Children ◽  
2021 ◽  
Vol 8 (10) ◽  
pp. 898
Rebecca Pulvirenti ◽  
Costanza Tognon ◽  
Silvia Bisoffi ◽  
Filippo Ghidini ◽  
Federica De Corti ◽  

Pediatric abdominal surgery is constantly evolving, alongside the advent of new surgical technologies. A combined use of new tools and traditional surgical approaches can be useful in the management of complex cases, allowing less invasive procedures and sometimes even avoiding multiple interventions. This combination of techniques has implications even from the anesthetic point of view, especially in post-operative pain control. Thereby, tertiary level centres, including highly-specialized professionals and advanced equipment, can maximize the effectiveness of treatments to improve the final outcomes. Our paper aims to present some possible combinations of techniques recently used at our institution to provide a one-session, minimally invasive treatment within different areas of abdominal surgery.

2021 ◽  
Vol 29 (3) ◽  
pp. 389-396
Roman E. Kalinin ◽  
Igor A. Suchkov ◽  
Nina D. Mzhavanadze ◽  
Olga Zhurina ◽  
Emma A. Klimentova ◽  

AIM: To evaluate the level and activity of von Willebrand factor (vWF) in patients with peripheral artery disease (PAD) who underwent endovascular or open bypass grafting. MATERIAL AND METHODS: The study included 115 patients with chronic lower limb ischemia due to PAD, stage IIb-IV according to A.V. PokrovskyFontaine. Fifty-five participants underwent endovascular treatment, while sixty underwent open bypass procedures using synthetic grafts. Peripheral blood samples were collected from all patients at baseline and three months after invasive treatment to determine the vWF antigen and activity. All patients were monitored every three months for a year to detect the development of unfavorable outcomes including disease progression, restenosis, graft thrombosis, oncology, myocardial infarction (MI), limb loss, stroke, and lethal outcomes. RESULTS: The highest values of vWF antigen in patients who underwent endovascular treatment were detected in patients with multilevel lesions1.25 g/mL (vs 0.2 g/mL, 95% confidence interval (CI) 0.723.21 mcg/mL p = 0.019); with a similar trend observed after a 3month follow-up. Baseline vWF antigen was higher in endovascular group patients who developed myocardial infarction (MI) within a year following the procedures as compared to those without MI: 1.15 mcg/mL (95% CI 1.051.175 mcg/mL) and 0.9 mcg/mL (95% CI 0.781.01 mcg/mL), respectively (p = 0.015). Moreover, vWF antigen was increased at the 3-month follow-up in patients with lethal outcomes1.06 mcg/mL (95% CI 0.961.18 mcg/mL, р = 0.031). vWF activity in endovascular group patients with developed MI was four times higher than those without MI (р = 0.022); a similar trend was detected in the development of lethal outcomes (р = 0.009). Those who underwent open bypass grafting presented with high activity of vWF with maximum values detected in participants with proximal iliofemoral lesions (1200%, 95% CI 640%1200%) and stage IV disease (770%, 95% CI 320%1200%, p 0.05). ROC analysis revealed that vWF activity at least 6.2 times higher in patients who underwent endovascular treatment associated with the development of lethal outcomes within one year after invasive treatments; sensitivity and specificity of the method were 83.3% and 75.5%, accordingly. CONCLUSION: Patients with PAD presented with increased vWF antigen and activity with maximum values detected in patients with multilevel lesions and critical lower limb ischemia. Increased vWF antigen and activity was associated with development of MI and lethal outcomes within one year following endovascular procedures on lower extremity arteries.

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