Revision Stapedotomies: the Role of Periprosthetic Scar Tissue Formation in the Development of Unsatisfactory Hearing Results after Stapedotomy

Introduction Revision stapes surgeries are difficult to perform, and their audiological results are inferior to primary surgeries. Objective Our goal was to identify the most common and most influential postoperative reasons that cause persistent air-bone gap (ABG) after the primary surgery. Our focus was concentrated on the mechanical dysfunctions in the middle ear, with special regard to postoperative adhesion formation. Methods We performed a retrospective case series study with 23 cases that underwent revision stapedotomies. Results A significant improvement was seen in ABG and air conduction levels after surgery. The periprosthetic adhesion formation was seen in 65% of the cases, and it was the primary cause behind the unsatisfactory hearing result in 30% of cases. There was no significant difference in the level of persistent ABGs after the primary surgery, in case of the intratympanic adhesion presence, compared with the presence of other surgical failures. Concerning hearing and ABG gain after revision surgery, the non-inferiority of the negative effect associated with adhesion was shown compared with the other reasons. Conclusion The revision stapedotomy is an efficient treatment option in case of persistent ABG. Periprosthetic adhesions are the most common intratympanic reasons for compromised audiological outcomes after stapedotomy.Adhesion formations have the same negative effect on ABG development as any other surgical failure, and the revision could be more challenging in these cases. These findings highlight the use of the most atraumatic surgical technique and preservation of intact intratympanic mucosa during middle ear surgery.

Analysis of Related Problems of Pelvic Abdominal Adhesion

Pelvic abdominal adhesion is a major problem in obstetrics and gynecology. The occurrence of adhesion complications, the difficulty and risk of adhesion reoperation, and the problem of postoperative adhesion not only cause great trouble to the physical and mental health of patients, but also increase the economic burden for the family and social medical system.

Immunocompetent cells in the tissue of adhesives of patients with adhesion process in the small pelvis

Objective: To study the morphological features and subpopulation composition of immunocompetent cells of adhesion tissue in women with adhesions of the pelvic organs.Materials and Methods: Th e study was carried out using surgical material obtained from 70 women aged 23 to 40 years. Of these, 50 tissue samples of peritoneal adhesions from patients with adhesions of organs in the small pelvis of I – II degree who underwent adhesiolysis and 20 samples of parietal peritoneum from healthy women who underwent endoscopic sterilization for contraception or completion of generative function. Th e authors used histological, immunohistochemical, and morphometric research methods.Results: Immunological changes in adhesion tissue were characterized by the activation of the T-cell link of immunity. It was confi rmed by a signifi cant increase in the content of CD4+ (p <0.001), CD8+ (p <0.001), a shift in the balance of immunoregulatory subpopulations towards CD8+, a lower indicator of the immunoregulatory index (p = 0.015), and insuffi ciency of the humoral link of immunity, namely, the absence of CD20+ content against the background of a slight increase in the CD138+ pool.Conclusion: To prevent the postoperative adhesion process in the small pelvis in patients of reproductive age, it is necessary to apply immunomodulatory therapy in the early postoperative period, which will improve the results of surgical treatment and is pathogenetically justifi ed.

The Protective Effect of Epimysium Preservation and FTY720 on Functional Gracilis Transfer: Experimental Rabbit Study

Background Free functional gracilis transfer (FFGT) is one of the most important methods for the treatment of total brachial plexus avulsion. However, postoperative adhesion and fibrosis of the transferred muscle compromise the effectiveness. This study is to investigate whether intact epimysium and FTY720 could reduce adhesion and fibrosis following FFGT in rabbits.Methods A total of 60 New Zealand White rabbits were randomly divided into 4 groups: Group 1 was set as control, and orthotopic gracilis transfer models were established in Group 2-4, with different interventions: epimysium resection (Group 2), epimysium preservation (Group 3) and epimysium preservation combined with FTY720 treatment (Group 4). After that, at each time points (1, 3, 7, 14, and 56 days postoperatively), three rabbits in each group were selected to harvest their gracilis and adjacent muscles for histological analysis including hematoxylin & eosin (HE) staining, Masson staining, and anti-transforming growth factor beta 1 (TGF-β1) immuno-histochemical staining. Additionally, the thickness of extragracilis adhesion band by ultrasonography were also assessed at days 56.Results All of HE, Masson and TGF-β1 stains confirmed that there were least inflammatory cell infiltration, adhesion and fibrosis of the transferred gracilis in Group 4 than those in Groups 2 and 3. At the 56 days postoperatively, the thickness of the adhesion band of gracilis was lightest in group 4 than that in Groups 2 and 3. Conclusions For the functional gracilis transfer, epimysium preservation and FTY720 could relieve the inflammatory response between gracilis and adjacent muscles, reduce the fibrosis and adhesion.

Antithrombin Together with NETs Inhibitor Protected Against Postoperative Adhesion Formation in Mice

BACKGROUND/AIMS: Postoperative adhesions may induce adverse outcomes in patients. Adhesion formation is initiated by fibrin accumulation at the surgical site which is followed by local neutrophilia and the establishment of neutrophil extracellular traps (NET). Previous reports have suggested that the preventive efficacy of reagents designed to reduce postoperative adhesion is inversely correlated with neutrophilia and NET production. Antithrombin (AT) is a natural inhibitor of thrombin, a key factor in coagulation. Here, we evaluate whether treatment with AT and/or NET inhibitors prevent or reduce postoperative adhesion formation in mice. METHODS: Mice were treated with AT and/or NET inhibitors before and/or after cecum cauterization and their adhesion scores were evaluated on day 7 post-operation. Immunochemistry/ immunofluorescence analyses were also performed and we used GSK484, an inhibitor of peptidyl arginine deiminase 4 (PAD4), as the NET inhibitor. RESULTS: AT or GSK484 partially rescued postoperative adhesion formation in mice. AT prevented thrombin-induced plasminogen activator inhibitor 1 and interleukin-6 expression in mesothelial cells in vitro. However, AT could not prevent neutrophilia or NETs formation around the injured serosa. Finally, we investigated a combination of AT and a PAD4 inhibitor and found that this could inhibit almost all adhesion formation in these animals. Since AT-inactivating proteases are liberated following NET release, they might dampen the biological action of the AT treatment. This suggests that NET inhibitors might allow AT to exert its full action in the surgically injured serosa.

Anterior endoscopic transcortical approach to a pineal region cavernous hemangioma

A 57-year-old female presented with headache and dizziness for 3 months. Preoperative MRI revealed a lesion located at the pineal region and back side of the third ventricle, accompanied by hydrocephalus. The infratentorial supracerebellar approach may cause visuomotor, acousticomotor, and hearing disturbances. With the patient in a supine position, the authors used a frontal linear incision that was 3 cm anterior to the coronal suture and 2 cm away from the midline and an anterior endoscopic transcortical approach, which could achieve endoscopic third ventriculostomy, alleviating and preventing hydrocephalus due to postoperative adhesion and resection of the lesion at the same time. The pathological diagnosis was cavernous hemangioma. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID215.