25,284 results on '"RD1-811"'
Search Results
2. Crossover replantation of a foot after bilateral traumatic lower-leg amputation
- Author
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Pan Zhou and Zhenbing Chen
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body regions ,RD1-811 ,Traumatic amputation ,Replantation ,Surgery - Abstract
A successful case of crossover replantation of the left foot to the stump of the right leg was described. The lower extremities were amputated at different levels. On the left side, there was a complete amputation in the distal part of the lower leg with comminuted fracture of the distal tibia. On the right side, there was a complete amputation in the hindfoot with comminuted fracture of both the talus and calcaneus. Since anatomical replantation was impossible, we performed crossover replantation of the left foot to the right lower leg. At the latest follow-up examination, forty-six months after the accident, the patient walked independently with a prosthesis on the stump of the left leg. Crossover replantation should be considered in bilateral amputations for the salvage of at least one extremity.
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- 2022
3. Deep inferior epigastric artery as a collateral pathway to the lower extremities: A case report
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Kaoru Tada, Atsuro Murai, Yuta Nakamura, Seigo Suganuma, and Hiroyuki Tsuchiya
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Deep inferior epigastric artery ,Rectus abdominis myocutaneous flap ,RD1-811 ,Collateral pathway ,Surgery ,Aortoiliac occlusive disease - Abstract
Summary: We describe a patient in whom the deep inferior epigastric artery served as a collateral pathway to the lower extremities, and free latissimus dorsi myocutaneous flap transfer was successfully used for reconstruction instead of the originally planned free rectus abdominis myocutaneous flap. A 74-year-old woman underwent subtotal tongue resection, followed by free flap tongue reconstruction for tongue cancer. Reconstruction using a free rectus abdominis myocutaneous flap was considered; however, preoperative contrast-enhanced computed tomography revealed complete occlusion of the bilateral external iliac arteries. Doppler ultrasonography revealed retrograde blood flow via the deep inferior epigastric artery, and the internal thoracic artery-deep inferior epigastric artery pathway served as a collateral pathway that supplied the lower extremities. The patient underwent reconstructive surgery using a free latissimus dorsi myocutaneous flap, and the flap completely survived. The internal thoracic artery-deep inferior epigastric artery pathway serves as a critical collateral pathway to the lower extremities in patients with aortoiliac occlusive disease. Blockage of the deep inferior epigastric artery in patients in whom this vessel shows retrograde blood flow may result in lower extremity ischemia. Therefore, preoperative Doppler ultrasonography is warranted to confirm the direction of the blood flow, in addition to evaluation of the deep inferior epigastric artery and its perforators before planning rectus abdominis myocutaneous flap or deep inferior epigastric artery perforator flap surgery.
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- 2022
4. Finite element method for the design of implants for temporal hollowing
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Federica Ruggiero, David Dunaway, Curtis Budden, Luke Smith, Noor Ul Owase Jeelani, Silvia Schievano, Juling Ong, and Alessandro Borghi
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RD1-811 ,Craniofacial surgery ,Trigonocephaly ,Surgery ,Temporal hollowing ,Finite element modelling - Abstract
Temporal indentations are the most impacting craniofacial complication after coronal flap dissection. It is mainly due to a temporal fat pad or temporalis muscle dissection.Because of the great improvements achieved recently in CAD-CAM-aided surgery and the possibility of performing accurate pre-surgical virtual planning, it is now possible to correct it with a customised virtual approach. Furthermore, advancements in material science have allowed surgeons to rely on biocompatible materials like PEEK (showing a low complication and recurrence rate) for the manufacturing of patient-specific implants.We hereby describe our experience on a case of secondary and corrective surgery after a fronto-orbital remodelling, in which we used PEEK implants designed by CAD and optimized by finite element modelling.
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- 2022
5. Thromboelastography in Microsurgical Reconstruction: A Systematic Review
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M. Thakkar, A. Rose, and B. Bednarz
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ROTEM ,Free flaps ,RD1-811 ,Thromboelastography ,Thromboelastometry ,Free tissue transfer ,TEG ,Surgery - Abstract
Summary: The aim of this review was to identify studies that used thromboelastography (TEG) or rotational thromboelastometry (ROTEM) in microsurgical free flap reconstruction and analyse whether it is a useful adjunct at predicting and identifying thrombotic complications.A search was conducted using the MEDLINE database using the keywords “thromboelastogram”, “TEG”, “thromboelastography”, “free flaps” and “free tissue transfer” using a two-component search with the Boolean operators “OR” and “AND”.Eight studies were retrieved using the search criteria. Seven studies met the inclusion criteria, and a further study was found citing several articles from the initial search. Combined, there were 528 patients who underwent 600 free flaps. A total of 10.3% (62) arterial and venous thromboses were reported in the studies, and the combined flap failure rate was 5.2% (26).A total of 67% (4/6) of the studies supported the use of TEG as a predictive tool to detect thromboses, including three retrospective case series and one prospective cohort, which were all statistically significant.There is low-quality evidence (level IV) that a pre-operative TEG and functional fibrinogen to platelet ratio of ≥42 can identify patients at risk of adverse post-operative thrombotic events following free flap surgery; however, further validation is required. Higher quality, standardised prospective or randomised control trials are required to further evaluate the predictive value of TEG. As a pre-operative screening tool, TEG can help to detect pathological changes in coagulation, aid in the transfusion of blood products, target anticoagulation therapy and predict possible adverse events aiding to further reduce patient morbidity.
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- 2022
6. 99mTc-GSA scintigraphy for assessing the functional volume ratio of the future liver remnant in the routine practice of liver resection
- Author
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Masatake Iida, MD, PhD, Yuzo Yamamoto, MD, PhD, Hiroki Katoh, BHSc, Naoto Taniguchi, BHSc, Yuki Abe, MD, PhD, Kenta Kumagai, MD, and Hiroshi Uchinami, MD, PhD
- Subjects
RD1-811 ,digestive, oral, and skin physiology ,Surgery - Abstract
Background: The significance of incorporating regional functional heterogeneity assessment by liver scintigraphy into the calculation of the future liver remnant has been reported. However, liver scintigraphy entails additional costs and radiation exposure. Nevertheless, studies describing when liver scintigraphy demonstrates an actual benefit over computed tomography liver volumetry are lacking. Thus, we evaluated the degree of agreement between future liver remnant % values calculated by technetium 99mTc diethylenetriaminepentaacetic acid-galactosyl human serum albumin scintigraphy (galactosyl human serum albumin–based future liver remnant %) and those by computed tomography volumetry and investigated the practical impact of performing regional functional heterogeneity assessment. Methods: The Bland–Altman method was used to retrospectively analyze the agreement between computed tomography– and galactosyl human serum albumin–based future liver remnant % measurements in 84 patients. Results: In ordinary patients with a computed tomography–based future liver remnant % greater than 50%, there was a good agreement between both measurements. However, in cases with a computed tomography–based future liver remnant % less than 40%, galactosyl human serum albumin–based measurements were significantly smaller than computed tomography–based values, with 88% of these patients exhibiting a galactosyl human serum albumin–based future liver remnant % less than 30%. After portal vein embolization, galactosyl human serum albumin–based measurements were primarily greater than or in agreement with computed tomography–based values, even in cases with a computed tomography–based future liver remnant % less than 40%. Conclusion: Adding 99mTc diethylenetriaminepentaacetic acid-galactosyl human serum albumin scintigraphy to computed tomography liver volumetry is advised when deciding on hepatectomy in patients with a computed tomography–based future liver remnant % less than 50%. If the computed tomography–based future liver remnant % is smaller than 40%, it is strongly recommended to check future liver remnant % by 99mTc diethylenetriaminepentaacetic acid-galactosyl human serum albumin scintigraphy. In other cases, computed tomography–based future liver remnant % calculation alone can be regarded as the gold standard of safe hepatectomy.
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- 2022
7. Venous Tributaries of the Lip: Implications for Lip Filler Injection
- Author
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Amanda Moorefield, BA, Zak Rose-Reneau, DO, Barth W. Wright, PhD, and Christopher C. Surek, DO
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RD1-811 ,Surgery - Published
- 2023
8. Quadricuspid Aortic Valve with Ruptured Sinus of Valsalva Aneurysm: a Case Report
- Author
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Shuran Huang, Xiaolong Liu, and Zhanguo Sun
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RD1-811 ,Computed Tomography Angiography ,Medicine (miscellaneous) ,General Medicine ,Sinus of Valsalva ,Aortic Aneurysm ,Quadricuspid Aortic Valve ,Echocardiography ,RC666-701 ,cardiovascular system ,Diseases of the circulatory (Cardiovascular) system ,Surgery ,cardiovascular diseases ,Heart Atria ,Cardiology and Cardiovascular Medicine - Abstract
Quadricuspid aortic valve (QAV) and sinus of Valsalva aneurysm (SVA) are rare congenital anomalies. We report an elderly patient with QAV associated with a ruptured SVA to the right atrium. Transthoracic echocardiographic and computed tomographic images are presented. We emphasize the important role of computed tomography angiography in establishing and confirming the diagnosis and facilitating treatment planning. The patient was successfully operated by a minimally invasive approach.
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- 2023
9. A Rare Catastrophe: Three Cases of Aortic Root Dehiscence after Surgery
- Author
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Taner İyigün, Barış Timur, and Timuçin Aksu
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Rupture ,Dehiscence ,Cardiac Surgery ,RD1-811 ,Spontaneous ,RC666-701 ,Ascending Aorta ,Aortic Diseases ,Diseases of the circulatory (Cardiovascular) system ,Medicine (miscellaneous) ,Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Ascending aortic pathologies may be life-threatening. Postoperative aortic root dehiscence is a very rare but extremely dangerous complication with a high mortality rate, and redo surgery is mandatory due to high risk of spontaneous rupture. We present three cases that had undergone Bentall procedure and had postoperative aortic root dehiscence. One of the patients presented with hemiplegia caused by septic embolus while the others had mild symptoms. Dr. Yakut’s modified Bentall procedure, the flanged technique, was performed for each patient in redo surgery. Two patients were successfully discharged from the hospital, but one died due to intracranial hemorrhage and multiple organ failure.
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- 2023
10. Total Thoracoscopic Surgery for Late Mitral Paravalvular Leakage Repair in A Beating Heart
- Author
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Huanan Liu, Shengjie Liao, Zhaoming Lin, and Xiaoshen Zhang
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congenital, hereditary, and neonatal diseases and abnormalities ,RD1-811 ,Thoracoscopy ,Suture Techniques ,Medicine (miscellaneous) ,General Medicine ,Sternotomy ,Constriction ,Tricuspid Valve Insufficiency ,RC666-701 ,cardiovascular system ,Diseases of the circulatory (Cardiovascular) system ,Surgery ,cardiovascular diseases ,Cardiac Surgical Procedures ,Cardiology and Cardiovascular Medicine - Abstract
Paravalvular leakage (PVL) after mitral valve replacement is a troublesome complication that may lead to severe symptoms and reoperation. Previous case reports on total thoracoscopic cardiac surgery without aortic cross-clamping for repairing late PVL are rare. We describe a 64-year-old man who had undergone aortic and mitral valve replacement via median sternotomy eight years earlier, and who recently developed cardiac failure due to severe tricuspid regurgitation (TR) and PVL in the posterior mitral annulus. During total thoracoscopic surgery with using the beating heart technique, direct closure of the PVL was achieved via pledgeted mattress sutures, and tricuspid valvuloplasty was routinely performed to treat TR. This case indicated that total thoracoscopic surgery on a beating heart may be an excellent option for treating PVL concomitant with TR.
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- 2023
11. Mortality trends at the Kenyatta National Hospital surgical operating theaters: a 5-year retrospective study
- Author
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Nyamai Kituu, Susan Kerubo Omundi, and Thomas Muinga Chokwe
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kenya ,RD1-811 ,surgical safety checklist ,risk factors ,peri-operative mortality rate ,Surgery ,Theater death, Peri-operative mortality rate, Risk factors, Surgical safety checklist, Kenya ,theater death - Abstract
Background: Mortality studies inform hospital disease trends and predict possible poor outcome. This study aimed to establish mortality trends over the last 5 years and the associated risk factors at the Kenyatta National Hospital (KNH) surgical operating theaters and to establish the completeness of surgical safety checklist. Methods: In this analytical retrospective study, study population was 94,820 patients operated between January 2015 and December 2019 and a sample of all 145 patients who died intraoperatively. Sampling was done by census. Data were extracted from available 118 deceased patients’ records and analyzed using Statistical Package for Social Sciences version 25. Results: Theater mortality rate was 0.153%. Sex-specific mortality rate was higher in males than in females (23.7 and 7.4 per 10,000, respectively). The mortality rate slowly declined over the period. The risk of death in theater was higher in neonates and in patients older than 80 years (54.3 and 39.2 per 10,000, respectively), emergency patients, and general anesthesia (p
- Published
- 2022
12. Upper gastrointestinal bleeding in a Nigerian diagnostic center: a retrospective study of endoscopic records
- Author
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Emuobor Aghoghor Odeghe, Oluwafunmilayo Funke Adeniyi, Aderemi Omololu Oluyemi, Vivian Ngozi Nwude, and Samuel Olalekan Keshinro
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RD1-811 ,upper gastrointestinal bleeding ,Upper gastrointestinal bleeding, Endoscopy, Nigeria ,Surgery ,endoscopy ,nigeria ,digestive system diseases - Abstract
Background: Upper gastrointestinal bleeding (UGIB) is a common indication for endoscopy. We aimed to describe the endoscopic findings in patients referred to our center with UGIB. Methods: This was a singlecenter retrospective study of the endoscopic findings in patients with UGIB between August 1, 2017, and April 30, 2019, in Lagos, Nigeria. Data were analyzed using Statistical Package for Social Sciences version 23.0.Results: Eight hundred thirty-two patients underwent endoscopy, of which 129 (16%) were for UGIB, which occurred twice as frequently in males. Melena was the most frequent presentation. Endoscopic abnormalities including gastric/duodenal peptic ulcers (39%),gastroduodenal erosions (36%), and varices (12%), were identified in 83% of the participants. Most ulcers were ow risk. Conclusion: Patients presenting to our center with UGIB commonly have gastric/duodenal peptic ulcers or gastroduodenal erosions.
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- 2022
13. Beckwith-Wiedemann syndrome in a premature dizygotic female twin: a case report
- Author
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George Otieno Nyakiti and Brian Odhiambo Ooro
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macroglossia ,omphalocele ,facial nevus simplex ,RD1-811 ,Surgery ,twins ,beckwith-wiedemann syndrome ,Beckwith-Wiedemann syndrome, Macroglossia, Omphalocele, Facial nevus simplex, Twins - Abstract
Beckwith-Wiedemann Syndrome is a congenital disease that is rare and has low prevalence worldwide. It presents classically with features of macroglossia, abdominal wall defects (omphalocele), and macrosomia at birth. Other typical manifestations include facial nevus simplex, ear lobe abnormalities (creases and/or pits), transient hypoglycemia, and renal abnormalities seen on ultrasound. We report a case of a female preterm infant of twin gestation presenting at our level 4 hospital’s newborn unit with typical features of the syndrome. We aimed to create further awareness on the diagnosis in secondary health institutions and management of common features and complications of the syndrome. There is a paucity of pictorial evidence of morphology and literature related to the syndrome in an African child and this case report aims to improve that. No case has been previously reported in the Kenyan setting.
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- 2022
14. Pulmonary hydatidosis in children: a different pattern from adults?
- Author
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Nesrine Chebil, Sondes Sahli, Fatma Fitouri, Senda Houidi, Arij Zouaoui, Yasmine Houas, Yosra Kerkeni, and Riadh Jouini
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particularities ,children ,RD1-811 ,Hydatid cyst, Lung, Particularities, Children ,parasitic diseases ,Surgery ,hydatid cyst ,lung - Abstract
Background: Hydatidosis is a major health problem is many countries. It is a parasitic disease that can affect adults as well as children. Hydatid cyst often involves the lungs in children. Given the anatomical and physiological differences between children and adults, generalization from adult studies is inappropriate. Methods: To determine particularities of lung echinococcosis in children, we conducted a retrospective study of all cases treated for hydatid cyst of the lung at our department. Results: One hundred fifteen children (average age, 7 years 6 months; range, 3–15 years) were managed for pulmonary hydatid cyst, which corresponds to 66% of all hydatid localizations. Male predominance was noted (sex ratio=1.94). Cough (60.9%) and chest pain (59.1%) were the most common clinical features. Fever and fatigue were noted in 57 (49.5%) and 34 (29.5%) cases, respectively. Giant cysts were seen in 11 patients (10%). The cysts were mostlydiagnosed when they are intact (68.7%). Mixed hepatic and pulmonary cysts were noted in 27 cases (4.25%). Conservative muscle-sparing surgery was performed in all cases. Complications were noted in 20% of the cases. Conclusion: As hydatidosis has a different pattern in children, optimal management requires a better knowledge of its particularities in this age group.
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- 2022
15. Surgical management of an infected external iliac artery interposition graft with a bioengineered human acellular vessel
- Author
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Thomas C. Naslund and Christy M. Guth
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medicine.medical_specialty ,Biologic graft ,RD1-811 ,medicine.medical_treatment ,Asymptomatic ,Vascular bypass ,Pseudoaneurysm ,medicine.artery ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Medical history ,Interposition graft ,business.industry ,Bioengineered human acellular vessel ,External iliac artery ,medicine.disease ,Surgery ,Stenosis ,Infected vascular graft ,RC666-701 ,Hormone therapy ,Iliofemoral bypass ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Infection of prosthetic vascular grafts can manifest as pain, pseudoaneurysms, or arterial insufficiency in the leg. We present the case of a female patient with a medical history of a right external iliac artery endofibrosis, with a persistently infected synthetic iliofemoral bypass graft, which we replaced with a bioengineered human acellular vessel. At the 12-month follow-up visit, the clinical and radiologic studies demonstrated adequate human acellular vessel patency, with no signs of infection, stenosis, or pseudoaneurysm. Subsequent to the initiation of hormone therapy and cessation of antiplatelet therapy, the patient developed graft thrombosis. She continued to do well after restoration of patency with lytic therapy. At 22 months, secondary patency has been maintained with continued anticoagulation therapy, and the patient has remained asymptomatic.
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- 2022
16. Complete resection and arterial reconstruction for primary sarcoma arising from superior mesenteric artery
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Shota Hasegawa, Yoshikatsu Nomura, Takuya Okada, Hirochika Toyama, Takumi Fukumoto, and Kenji Okada
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Complete resection ,RD1-811 ,RC666-701 ,Case report ,Pleomorphic sarcoma ,Diseases of the circulatory (Cardiovascular) system ,Surgery ,Cardiology and Cardiovascular Medicine ,Arterial reconstruction - Abstract
In the treatment of retroperitoneal sarcoma involving major vessels, complete resection with vascular reconstruction is challenging. We describe the case of a 72-year-old man who presented with 8 months of abdominal pain. Diagnostic workup revealed occlusion of the celiac trunk and the origin of the superior mesenteric artery due to a soft tissue sarcoma. Radical resection of the tumor and vessels was performed. Guided by intraoperative angiography, arterial reconstruction was performed without mesenteric ischemia. All arterial margins were negative. At the 6-year follow-up, the patient was alive with no evidence of recurrence.
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- 2022
17. Endovascular treatment with an iliac branch endoprosthesis for a right subclavian artery aneurysm
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Kota Shukuzawa, Takao Ohki, Koji Maeda, and Takeshi Baba
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medicine.medical_specialty ,RD1-811 ,Arterial disease ,Right subclavian artery ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,medicine.artery ,Case report ,Stent graft ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Endovascular treatment ,cardiovascular diseases ,Subclavian artery ,Surgical repair ,Branched stent-graft ,TEVAR ,business.industry ,Perioperative ,medicine.disease ,Alternative treatment ,Surgery ,surgical procedures, operative ,Subclavian artery aneurysm ,RC666-701 ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,business - Abstract
Subclavian artery aneurysms are rare peripheral artery aneurysms, and open surgical repair is the reference standard treatment. We have reported the case a patient with a right subclavian artery aneurysm who was not indicated for open surgical repair because of comorbidities. Thus, endovascular treatment using the Gore Excluder Iliac Branch Endoprosthesis (WL Gore and Associates, Flagstaff, Ariz) was performed, leading to complete aneurysmal exclusion without perioperative complications. Although anatomic limitations exist, this technique could be alternative treatment option for right subclavian artery aneurysms.
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- 2022
18. Trainee and trainer experiences and recommendations for plastic surgery training: A qualitative pilot study
- Author
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Lilli Cooper, Asmat H Din, Edmund Fitzgerald O'Connor, Maleeha Mughal, Victoria Rose, and Paul Roblin
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Medical education ,Service (systems architecture) ,training ,RD1-811 ,business.industry ,Trainer ,education ,Equity (finance) ,Specialty ,COVID-19 ,Nonprobability sampling ,plastic surgery ,Medicine ,Original Article ,Surgery ,business ,Competence (human resources) ,Curriculum ,Diversity (business) - Abstract
Background: The Covid-19 pandemic has compounded existing training issues for plastic surgeons. The issues which exist result from a complex interplay of system, generational and individual factors, and can be hard to tease out by quantitative means. This pilot study aimed to investigate the perceptions of trainees and trainers of plastic surgical training in the UK. Methods: Ten semi-structured interviews were performed using purposive sampling in a central London plastic surgical unit. These were coded into and discussed in four themes: Medical directives and service demands; Sociocultural norms within plastic surgical training; Equity and access and Plastic surgery training methods. Results: This study demonstrated that current plastic surgery training is not optimised for learning or wellbeing, and that inequities are fostered, to the detriment of the specialty. Investment and planning is required to support our trainers and protect the diversity of our trainee group, with efficient and monitored learning essential to maintain our breadth and competence of practice. Conclusion: Expanding this work through a broader study could provide valuable information to contribute to the development of future training schemes and curricula within British plastic surgery.
- Published
- 2022
19. Endovascular repair of traumatic axillosubclavian artery injuries
- Author
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Jason Zhang, Rohan Basu, Andrew R. Bauder, Jon G. Quatramoni, Julia Glaser, Venkat Kalapatapu, and Ann C. Gaffey
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Subclavian artery ,RD1-811 ,RC666-701 ,Case report ,Axillary artery ,Diseases of the circulatory (Cardiovascular) system ,Surgery ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,Trauma - Abstract
Gun violence reached a 20-year peak in 2020, with the first-line treatment of axillosubclavian vascular injuries (SAVIs) remaining unknown. Traditional open exposure is difficult and exposes patients to iatrogenic venous and brachial plexus injury. The practice of endovascular treatment has been increasing. We performed a retrospective analysis of SAVIs at a level I trauma center. Seven patients were identified. Endovascular repair was performed in five patients. Technical success was 100%. The early results suggest that endovascular treatment of trauma-related SAVIs can be performed safely and effectively. However, complications such as stent thrombosis or occlusion can occur, demonstrating the need for surveillance.
- Published
- 2022
20. The inhibition of the invasion and metastasis of colorectal cancer cells by taurine through regulation of the PTEN/AKT/GSK-3β pathway
- Author
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Chun-Xiang, Chen, Hui-Fang, Wan, Shu-Ying, Li, and Fu-Sheng, Wan
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Invasion and metastasis ,Glycogen synthase kinase-3β ,Glycogen Synthase Kinase 3 beta ,RD1-811 ,Taurine ,Epithelial–mesenchymal transition ,PTEN Phosphohydrolase ,Humans ,Surgery ,Colorectal Neoplasms ,Proto-Oncogene Proteins c-akt ,Colorectal cancer - Published
- 2022
21. The long-term progression of macrodactyly
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Chantal M.A.M. van der Horst, Merel L.E. Stor, Sophie E.R. Horbach, and M. M. Lokhorst
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Pediatrics ,medicine.medical_specialty ,Macrodactyly ,RD1-811 ,business.industry ,macrodystrophia lipomatosa ,PIK3CA ,Term (time) ,Medicine ,Original Article ,Surgery ,business ,overgrowth - Abstract
Background: Macrodactyly is a rare congenital disorder of overgrowth affecting the digits of the upper or lower extremity. Mostly, patients are surgically treated during childhood to reduce the digit or to stop growth. There are no standardized guidelines for the treatment and follow-up of macrodactyly. Consequently, follow-up may not be regularly scheduled into adulthood. Methods: A retrospective, descriptive analysis of patients with the long-term progression of macrodactyly who presented at our tertiary referral hospital between July 2018 and March 2020 was performed. All patients from our local macrodactyly database were screened for progression of macrodactyly since adulthood; this resulted in four patients. The aim of these case series is to highlight the clinical features and disease course at long-term follow-up. Results: All patients were surgically treated during childhood and showed progression of tissue overgrowth during adult life. All patients developed severe secondary degenerative bone changes in macrodactyly affected digits, such as ankyloses of joints, new bone formation, and bony spurs. Subsequently, tissue overgrowth and degenerative bone changes led to functional problems. Conclusion: Patients with macrodactyly may experience growth during adult life, which may progress to deforming changes. Consequently, patients should be informed about the possible growth, and the progressive growth should be monitored.
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- 2022
22. Usefulness of blood flow evaluation with indocyanine green fluorescence imaging during laparoscopic surgery for strangulated bowel obstruction: A cohort study
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Kota Ishida, Keigo Nakashima, Ryusuke Ito, Shunjin Ryu, Yukio Nakabayashi, Keigo Hara, and Atsuko Okamoto
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Indocyanine Green ,Laparoscopic surgery ,medicine.medical_specialty ,RD1-811 ,medicine.medical_treatment ,Perforation (oil well) ,Cohort Studies ,chemistry.chemical_compound ,Laparotomy ,Intestinal Stricture ,medicine ,Humans ,ICG ,business.industry ,Optical Imaging ,Blood flow ,medicine.disease ,Surgery ,Bowel obstruction ,chemistry ,Laparoscopy ,business ,Complication ,Cohort study ,Indocyanine green ,Intestinal Obstruction - Abstract
Introduction Intestinal blood flow evaluation during strangulated bowel obstruction is often based on the subjective assessment of the operator. Therefore, we aimed to comprehensively determine the presence or absence of intestinal blood flow based on normal light and indocyanine green (ICG) fluorescence imaging. Moreover, we ascertained whether the chosen surgical plan was appropriate, based on the patients' postoperative course and pathological findings. Methods All 14 patients diagnosed with strangulated bowel obstruction at our hospital who underwent laparoscopic surgery between July 2019 and January 2021 were enrolled. Surgical plans were chosen based on normal light imaging combined with near-infrared imaging after intravenous ICG injection. Intestinal resection was performed via a small laparotomy if resection was considered necessary. In the intestinal resection group, the presence of intestinal necrosis was examined based on the pathological findings of the resected specimens. In the intestinal preservation group, postoperative complications, such as delayed intestinal perforation and intestinal stricture, were examined. Results Intestinal resection was performed in 4 cases. The pathological findings of the resected specimens showed necrosis of the small intestine in all cases. No intra-abdominal complication occurred any of the cases, and the median postoperative hospital stay was 9.9 days. Conclusions The selection of a surgical plan in conjunction with ICG fluorescence findings was valid in all 14 cases. ICG fluorescence imaging is useful in laparoscopic surgery for strangulated bowel obstruction and may be a novel method for evaluating intestinal blood flow during surgery.
- Published
- 2022
23. A surprising complication of breast augmentation surgery
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Caroline Koan, Richard A. Murphy, and Rose Venegas
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Fungal infection ,Plastic surgery ,Immune status ,RD1-811 ,Critically ill ,business.industry ,Scedosporium apiospermum ,Implant Infection ,Case Report ,Scedosporium ,Implant infection ,Localized disease ,Immunology ,Breast augmentation complication ,Medicine ,Surgery ,Complication ,business ,Breast augmentation - Abstract
Infections caused by opportunistic fungal organisms such as Scedosporium spp. have been increasingly recognized over the last few decades. Most affected patients are immunocompromised or critically ill, but Scedosporium spp. infections have also been described in immunocompetent patients, such as localized disease from direct inoculation or in near-drowning events. We describe a case of a patient with no known underlying immune impairment who experienced significant infection with Scedosporium apiospermum at both sites of breast augmentation. Once identified, the choice of therapeutics can be challenging given the intrinsic resistance and variable activity of different antifungal agents; however, other factors also impact the outcome of this infection such as the host immune status. Thus, both the recognition and treatment of Scedosporium infections can be challenging.
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- 2022
24. Single institute experiences in anterior and posterior component separation technique for the large ventral hernia: A retrospective review
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Rajeshwari Bhat, Gayatri Muley, Jaini Gala, Ajay H. Bhandarwar, Nikhil N Dhimole, and Pramod D. Nichat
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medicine.medical_specialty ,Demographics ,RD1-811 ,Postoperative Complications ,Recurrence ,Medicine ,Humans ,Transversus abdominis ,Adverse effect ,Herniorrhaphy ,Abdominal Muscles ,Retrospective Studies ,Retrospective review ,business.industry ,Mean age ,Surgical Mesh ,Component separation ,Hernia, Ventral ,Surgery ,Ventral hernia ,TAR ,business ,Complication ,ACST - Abstract
Background Component separation techniques have recently gained popularity for the repair of complex ventral hernias. Anterior and posterior component separation techniques offer similar myofascial medialization, with a differing complication profile. The aim of this study is to compare the efficacy, patient morbidity and post-operative complications between anterior component separation (ACST) and transversus abdominis release (TAR) for large ventral hernias. Methods Between December 2017 and September 2019, data was collected and analysed for patients undergoing ACST and TAR, in terms of demographics, peri-operative events, adverse events and hernia recurrence. Results 25 patients each underwent ACST and TAR during our study period. Mean age was 53.5 and 52.8 years and mean BMI was 31.4 and 29.5 respectively. The mean defect area was 120.8 cm2 and 131.9 cm2, and average mesh size was 741.8 cm2 and 1429.04 cm2 respectively in the ACST and TAR groups. Four patients undergoing TAR had intra-operative complications with none in the ACST group. In the ACST group, 8 patients had an SSI, of which 5 patients needed operative intervention, while 3 patients in the TAR group had an SSI, all of whom were managed with bedside procedures. One patient in the ACST group had a recurrence. None of the patients in the TAR group had a recurrence. Conclusions Component separation techniques are gaining popularity in treatment of large ventral hernias. While they have comparable outcomes with respect to recurrence, wound morbidity is more frequent and severe in the ACST group.
- Published
- 2022
25. Primary aortoesophageal fistula from metallic bristle ingestion
- Author
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Chinmayee Potti, Abdul Kader Natour, Ann Woodward, and Loay Kabbani
- Subjects
Open surgical repair ,Barbeque brush bristle ,RD1-811 ,RC666-701 ,Case report ,Mycotic pseudoaneurysm ,cardiovascular system ,Aortoesophageal fistula ,Diseases of the circulatory (Cardiovascular) system ,Surgery ,Thoracic aorta ,Cardiology and Cardiovascular Medicine ,Foreign body ingestion - Abstract
Although many patients are treated for the removal of ingested foreign objects each year, ingestions that perforate the esophagus and lead to intra-abdominal complications are rare. Aortoesophageal fistulas and aortic pseudoaneurysms are deadly complications of esophageal foreign body impaction. However, the surgical approach to aortic repair from foreign object damage has not been standardized. We have described the diagnostic, open surgical, and therapeutic approach to treating a man who had accidentally ingested a 3-cm metallic bristle that lodged in his aortic wall. The patient recovered after excision of the aortic pseudoaneurysm with CryoGraft (CryoLife, Inc, Kennesaw, Ga) replacement, drainage of abscesses, and antibiotic treatment for multiple infections.
- Published
- 2022
26. Oocyte cryopreservation in a patient with paroxysmal nocturnal hemoglobinuria
- Author
-
Qi, Wan, Xiang-Qian, Meng, Ya-Li, Chen, and Ai, Zheng
- Subjects
Cryopreservation ,Hematopoietic stem-cell transplantation ,Oocyte cryopreservation ,RD1-811 ,Hemoglobinuria, Paroxysmal ,Oocytes ,Anemia, Aplastic ,Humans ,Surgery ,Paroxysmal nocturnal hemoglobinuria - Published
- 2022
27. Trans-stent graft thrombectomy for the treatment of long stent graft thrombosis in the femoropopliteal artery
- Author
-
Hirotsugu Ozawa, Kota Shukuzawa, Takeshi Baba, Hiromasa Tachihara, and Takao Ohki
- Subjects
surgical procedures, operative ,RD1-811 ,RC666-701 ,Stent graft ,Diseases of the circulatory (Cardiovascular) system ,Reintervention ,Thrombosis ,Surgery ,Cardiology and Cardiovascular Medicine ,Femoropopliteal artery ,Thrombectomy - Abstract
At present, no consensus has been reached regarding the optimal management of stent graft thrombosis in the femoropopliteal artery. We present a case of long thrombosis of a Viabahn stent graft implanted in the superficial femoral artery that was successfully treated by thrombectomy using a trans-Viabahn approach at the mid-thigh segment. The advantages of this approach include that it preserves the common femoral artery and popliteal artery untouched without scarring, allowing for a future site of surgical anastomosis. This technique could be a reasonable approach when performing surgical thrombectomy for stent graft thrombosis in the femoropopliteal artery.
- Published
- 2022
28. Split Skin Grafting Precipitated Bullous Pemphigoid
- Author
-
K. Gohil, A. Moore, and W. Jaffe
- Subjects
integumentary system ,RD1-811 ,skin grafting ,plastic surgery ,autoimmune disease ,Surgery ,dermatopathology - Abstract
Summary: Bullous pemphigoid (BP) is an autoimmune subepidermal blistering dermatological condition that can be triggered by several external factors. Here, we present a case of an immunocompetent patient with no prior dermatological history, who developed BP as a result of autologous skin graft surgery. It is an uncommon surgical complication and was most likely triggered by the trauma of the surgery itself.Our patient's bullae first developed a month after his surgery at both surgical sites and subsequently became widespread. The diagnosis was confirmed histologically using punch biopsies of a bulla and the perilesional skin for direct immunofluorescence together with indirect immunofluorescence of the serum for anti-skin antibodies. Initial topical treatment and regular wound care were not improving the patient's condition at a satisfactory rate. Therefore, the patient was started on systemic steroids, which unfortunately resulted in a presumed split skin graft infection requiring admission. After histological diagnosis confirmation was achieved, the Dermatology team formulated a treatment plan, which combined both topical and systemic medication. The patient is currently making a good recovery and the graft loss resulting from the condition is only partial, requiring no further surgery.We present this case as a reminder to all clinicians that, although rare, BP can be triggered by skin grafting, even in patients with no prior history of it or any predisposing conditions. This autoimmune condition needs to be recognised and treated promptly to ensure optimal clinical outcomes and minimise graft loss.
- Published
- 2022
29. Complete neck vessel preservation using a fenestrated stent graft for the treatment of proximal anastomotic leakage after open frozen elephant trunk graft aortic arch repair
- Author
-
Hikaru Nakagawa, Takao Ohki, Naoki Toya, Eisaku Ito, and Tadashi Akiba
- Subjects
surgical procedures, operative ,RD1-811 ,RC666-701 ,cardiovascular system ,Anastomotic leakage ,Diseases of the circulatory (Cardiovascular) system ,Surgery ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,equipment and supplies ,Open stent graft ,Fenestrated stent graft ,Najuta - Abstract
We have reported a case of proximal anastomotic leakage excluded with the Najuta fenestrated stent graft after a surgeon-modified frozen elephant trunk aortic arch graft. The fenestrated stent graft was deployed at the zone 0 proximal site, preserving the cervical branches. Complete neck vessel preservation during endovascular repair using a Najuta fenestrated stent graft appears to be safe and effective for anastomotic leakage after aortic arch aneurysm repair.
- Published
- 2022
30. Late-onset spinal subdural hematoma following cerebrospinal fluid drainage tube removal
- Author
-
Masashi Hattori, Yasutoshi Tsuda, Masato Nakajima, Katsuyuki Shigehara, and Takahito Yokoyama
- Subjects
Paraparesis ,RD1-811 ,RC666-701 ,cardiovascular system ,Aortic dissection ,Thoracic endovascular aortic repair ,Diseases of the circulatory (Cardiovascular) system ,Cerebrospinal fluid drainage ,Surgery ,cardiovascular diseases ,Spinal subdural hematoma ,Cardiology and Cardiovascular Medicine - Abstract
Cerebrospinal fluid drainage is recommended for high-risk patients to prevent spinal cord ischemia during aortic surgery; however, it is associated with complications. We report a case of a late-onset spinal subdural hematoma that developed after removal of the cerebrospinal fluid drainage tube from a patient who undergon thoracic endovascular aortic repair. Spinal hematoma usually develop 2 to 3 days after tube removal; however, in our patient’s case, it developed after 7 days. Therefore, a spinal subdural hematoma can occur ≤1 week after drainage tube removal, necessitating prompt magnetic resonance imaging for patients with lower limb weakness or back pain.
- Published
- 2022
31. Long-term results of splenomegaly after surgery for biliary atresia in the native liver
- Author
-
Shunsuke Watanabe, Tomonori Tsuchiya, Tatsuya Suzuki, and Yasuhiro Kondo
- Subjects
Adult ,Liver Cirrhosis ,medicine.medical_specialty ,RD1-811 ,Spleen ,Gastroenterology ,Liver disease ,chemistry.chemical_compound ,Type IV collagen ,Biliary atresia ,Internal medicine ,Hyaluronic acid ,medicine ,Humans ,Aspartate Aminotransferases ,Liver transplant ,Receiver operating characteristic ,business.industry ,Infant ,Long term results ,Marker ,medicine.disease ,medicine.anatomical_structure ,Liver ,chemistry ,Native liver ,Splenomegaly ,Portal hypertension ,Surgery ,business - Abstract
Background Biliary atresia (BA) is a rare disorder characterized by obstructive jaundice in infants, shortly after birth. Postoperatively, some patients exhibit portal hypertension and progressive liver fibrosis. Splenomegaly is a symptom of portal hypertension. We aimed to investigate splenomegaly as a marker for complications of portal hypertension and the relationship between splenomegaly and liver fibrosis in the long-term native liver (NL). Methods Between 1977 and 2018, 71 patients underwent hepaticojejunostomy. We included 54 patients (34 NL group, 20 liver transplant (LT) group) who fulfilled the eligibility criteria. Spleen volume (SV), total bile acids, hyaluronic acid, type IV collagen, and aspartate aminotransferase-to-platelet ratio index (APRi) were measured. Data were analyzed using Student's t-test, regression analysis, and receiver operating characteristic (ROC) curve analysis (P Results Total bile acids, hyaluronic acid, type IV collagen, and APRi increased in NL patients with a large SV at >25 years. SV and type IV collagen were correlated with NL for >25 years (r = 0.79 [P = 0.006], y = 1.1 - [0.03 × type IV collagen] [P = 0.008]). In the ROC curve analysis, the cutoff value for type IV collagen was 165 ng/mL (P = 0.07). Conclusions We suggest that SV as a prognostic index for End-Stage Liver Disease may be useful in biliary atresia. Long-term follow-up is necessary because the clinical course may be favorable in childhood but worsen during adulthood.
- Published
- 2022
32. Repair of a high-flow superficial femoral arteriovenous fistula using a bell-bottom iliac limb endoprosthesis
- Author
-
Sandeep Jhajj, Rahul Kar, Theodore H. Teruya, and Sheela T. Patel
- Subjects
RD1-811 ,Superficial femoral artery ,RC666-701 ,Diseases of the circulatory (Cardiovascular) system ,Surgery ,Stent-graft ,Cardiology and Cardiovascular Medicine ,Arteriovenous fistula - Abstract
A 50-year-old patient had presented with recalcitrant right lower extremity venous stasis ulceration, atrial fibrillation, and congestive heart failure. He had a history of a gunshot wound to the right thigh >30 years previously, which had been managed without surgery. Computed tomography angiography indicated a fistulous communication between the right superficial femoral artery and vein with massively dilated right iliofemoral venous and arterial systems. He was treated with stent-graft coverage of the superficial femoral arteriovenous fistula using a bell-bottom iliac limb endoprosthesis. This stent-graft accommodated the diameter asymmetry in the superficial femoral artery caused by the long-standing fistula and ameliorated the symptoms that had afflicted him for decades.
- Published
- 2022
33. Safety and feasibility of laparoscopic pancreaticoduodenectomy in octogenarians
- Author
-
Sung Hyun Kim, Ji-Su Kim, Sung Hoon Choi, Munseok Choi, and Chang Moo Kang
- Subjects
medicine.medical_specialty ,Octogenarians ,RD1-811 ,medicine.medical_treatment ,Pancreaticoduodenectomy ,Postoperative Complications ,Borderline resectable ,hemic and lymphatic diseases ,Octogenarian ,Overall survival ,Medicine ,Humans ,Laparoscopy ,Survival rate ,Periampullary tumor ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Significant difference ,Perioperative ,Length of Stay ,Surgery ,Pancreatic Neoplasms ,Feasibility Studies ,business ,Laparoscopic pancreaticoduodenectomy - Abstract
Introduction: With continued technical advances in surgical instruments and growing surgical expertise, many laparoscopic pancreaticoduodenectomies (LPDs) have been safely performed with favorable outcomes, and this approach is being used more frequently. With an increase in the life expectancy, interest in treatments for elderly patients has increased. In this study, we investigated the safety and feasibility of LPD in octogenarians. Methods: From September 2005 to February 2020, resectable/borderline resectable periampullary tumors (PATs) were diagnosed in 71 octogenarians at Sincheon Severance Hospital and CHA Bundang Medical Center. Patients were divided into two groups: those who underwent surgery (PD, N = 38) and those who did not (NPD, N = 33). The group that underwent surgery was further divided into two groups: those who underwent open PD (OPD, N = 19), and those who underwent LPD (LPD, N = 19). Perioperative outcomes, including long-term survival, were retrospectively compared between these groups. Results: There was no significant difference in age, sex, comorbidities, diagnosis, and chemo-radiotherapy between the surgery and non-surgery groups. The PD group had a better survival rate than the NPD group (p 0.999). There was no significant difference in overall survival and disease-free survival between the OPD and LPD groups (p = 0.816, p = 0.446, respectively). Conclusions: LPD is a good alternative for octogenarians with PAT requiring PD.
- Published
- 2022
34. Predictive value of 3D imaging to guide implant selection in immediate breast reconstruction
- Author
-
Brian Pinchuk, Monica Yu, Gordon S Soon, Ron B. Somogyi, and Mary-Helen Mahoney
- Subjects
medicine.medical_specialty ,RD1-811 ,business.industry ,Breast Implants ,medicine.medical_treatment ,Breast Neoplasms ,Predictive value ,Single surgeon ,Imaging, Three-Dimensional ,Chart review ,Implant size ,medicine ,Regression Analysis ,Original Article ,Surgery ,Radiology ,Implant ,skin and connective tissue diseases ,Breast reconstruction ,business ,Mastectomy - Abstract
SUMMARY: Background: Pre-operative estimation of breast mound volume for immediate breast reconstruction is necessary for operative planning, especially in direct-to-implant reconstruction. Our purpose was to investigate the relationship between pre-operative predictions of breast mound weight from 3D imaging and actual mastectomy weight and implant size. Methods: A retrospective chart review of all patients who had previously undergone nipple-sparing mastectomy (NSM) by a single surgeon was performed. Pre-operative 3D images were reviewed and calculations of breast mound weight were performed by three independent reviewers. Intra-operative mastectomy weight and final implant weight were collected from patient charts. A regression analysis between calculated and actual values was performed. Results: There were 59 reconstructed breasts included. Pre-operative 3D imaging-guided breast weight calculations were similar across reviewers (R=0.96). Pre-operative calculations of breast weight were 49.4g (SD=134.0) smaller than actual mastectomy specimens. Mastectomy specimens were 41.0g (SD=130.2) smaller than final implant sizes. Thereby, the relationship was as follows: Pre-operative calculated breast weight < actual Mastectomy weight < implant weight. Mastectomy weight and final implant size had linear relationships with pre-operative calculations of breast weight. Formulas for predicting mastectomy weight [mastectomy weight = 63.2 + 0.95 (pre-operative calculated weight)] and implant size [Implant weight = 209.7+ 0.56 (pre-operative calculated weight)] from pre-operative calculations of breast weight were generated. Conclusions: Three-dimensional scanning technologies may be a useful tool to predict implant sizes for direct-to-implant breast reconstruction. Final implant size was heavier than intra-operative mastectomy weight and pre-operative calculated breast mound weight.
- Published
- 2022
35. Resection of a giant mycotic left subclavian pseudoaneurysm
- Author
-
Sidney T. Le, Genna Beattie, and Shahram Aarabi
- Subjects
Pseudoaneurysm ,Subclavian artery ,RD1-811 ,RC666-701 ,Case report ,cardiovascular system ,Intravenous drug use ,Diseases of the circulatory (Cardiovascular) system ,Surgery ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,Sternotomy - Abstract
Subclavian artery pseudoaneurysm due to intravenous drug use is a rare pathologic entity. A 6.6-cm left subclavian artery pseudoaneurysm immediately distal to the origin of the vertebral artery was discovered in a 39-year-old man with neck swelling, bacteremia, and a history of intravenous drug use. The pseudoaneurysm was resected through a median sternotomy and left supraclavicular incision, without reconstruction. This operative approach was opted for given the presence of infection and the ongoing intravenous drug use.
- Published
- 2022
36. Listeria monocytogenes endograft infection after fenestrated endovascular aneurysm repair—a case report
- Author
-
Eric Farmer, P. Ghaly, Z. Ahadzada, and M. Ahmad
- Subjects
medicine.medical_specialty ,RD1-811 ,medicine.drug_class ,medicine.medical_treatment ,Antibiotics ,medicine.disease_cause ,Endovascular aneurysm repair ,Resection ,Mycotic aneurysm ,Listeria monocytogenes ,Antibiotic therapy ,Case report ,Rare case ,medicine ,Diseases of the circulatory (Cardiovascular) system ,EVAR ,business.industry ,Fenestrated endograft ,Surgery ,Graft infections ,RC666-701 ,Cardiology and Cardiovascular Medicine ,business - Abstract
An extremely uncommon cause of endograft infections, listeria monocytogenes graft infections are associated with high morbidity and mortality. Best managed with complete graft resection and long-term antibiotics, we present a rare case of listeria monocytogenes aortic graft infection managed successfully with direct sac drainage and lifelong suppressive antibiotic therapy.
- Published
- 2022
37. Optimising the Management of Malignant Melanoma during COVID-19
- Author
-
L Wrafter, A Dhannoonn, H Regan, C.M. Hurley, and P J Regan
- Subjects
2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,RD1-811 ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Melanoma ,MEDLINE ,Medicine ,Surgery ,business ,medicine.disease ,Virology ,Article - Published
- 2022
38. Transcatheter closure of congenital aortopulmonary window in young children: Debating on the occluder devices application
- Author
-
Yuting Wang, Li Yu, Yifei Li, and Yimin Hua
- Subjects
Treatment Outcome ,RD1-811 ,Aortopulmonary window ,Child, Preschool ,Device application ,ADO ,Humans ,Infant ,Transcatheter closure ,Surgery ,Safety ,Child ,Aortopulmonary Septal Defect - Published
- 2022
39. Cryopreserved venous allograft in the treatment of a mycotic abdominal aortic aneurysm caused by group B Streptococcus
- Author
-
Tyler Yan and Gary K. Yang
- Subjects
Group B Streptococcus ,medicine.medical_specialty ,RD1-811 ,Cryopreserved venous allograft ,Femoral vein ,medicine.disease_cause ,Group B ,Cryopreservation ,Streptococcus agalactiae ,Mycotic aortic aneurysm ,Case report ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Aortitis ,Streptococcus ,business.industry ,Cryopreserved femoral vein ,medicine.disease ,Abdominal aortic aneurysm ,Surgery ,RC666-701 ,cardiovascular system ,Invasive group ,Cardiology and Cardiovascular Medicine ,business - Abstract
We report a Case of a mycotic abdominal aortic aneurysm caused by invasive group B streptococcus. Given the anatomical suitability with healthy segments of aortoiliac vessels, in-situ repair was performed. A cryopreserved femoral vein graft was chosen due to risks of graft reinfection and negated the need for bilateral femoral vein harvest. The patient remained clinically well and the graft patent with no concerns at 6 months follow-up. A review of literature on group B streptococcus aortitis was performed.
- Published
- 2022
40. Lower extremity aneurysmal degeneration of great saphenous venous allograft bypass in an adolescent boy
- Author
-
William J. Sharp, Rachael Nicholson, and Nicole Gensicke
- Subjects
medicine.medical_specialty ,RD1-811 ,Ischemia ,Degeneration (medical) ,Case report ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Allograft bypass ,Pediatric vascular surgery ,Surgical approach ,business.industry ,Great saphenous vein ,Critical limb ischemia ,Thrombosis ,Venous degeneration ,medicine.disease ,Surgery ,Popliteal artery thrombosis ,RC666-701 ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Pediatric population - Abstract
Chronic limb-threatening ischemia in the pediatric population is a rare phenomenon. When open repair is necessitated, an autogenous conduit is preferred. However, venous grafts are prone to their own long-term complications. We have presented the case of a 10-year-old boy with chronic limb-threatening ischemia due to popliteal artery thrombosis that was treated with an ipsilateral great saphenous vein bypass. Seven years after the initial procedure, the venous graft had developed aneurysmal degeneration with acute thrombosis, necessitating bypass revision. Through the present case, we have discussed the surgical approach and highlighted the importance of long-term postoperative surveillance after open repair in the pediatric population.
- Published
- 2022
41. Ipsilateral distal third femoral shaft fracture and retrograde intramedullary fixation are not absolute contraindications to anterolateral thigh flap harvest: A case report
- Author
-
Ping-ping Jiang, Yu-xiang Zhao, Shan Xue, Peng Gao, and Zhao-hui Pan
- Subjects
medicine.medical_specialty ,RD1-811 ,medicine.medical_treatment ,Case Report ,Free flap ,Thigh ,femoral shaft fracture ,law.invention ,Intramedullary rod ,law ,medicine.artery ,medicine ,Internal fixation ,Fixation (histology) ,free flap ,business.industry ,Femoral fracture ,Fascia ,Anterolateral thigh ,medicine.disease ,Lateral circumflex femoral artery ,Surgery ,lower extremity reconstruction ,body regions ,medicine.anatomical_structure ,trauma ,business - Abstract
Despite the advantages of anterolateral thigh (ALT) flaps, many surgeons are hesitant to choose a thigh with ipsilateral femoral fracture and internal fixation as the flap donor site. To cover the right mid-upper leg wound, a free ALT flap was harvested from the left thigh of a 55-year-old man who initially underwent closed retrograde intramedullary fixation for a left distal third femoral shaft fracture. The flap was based on a musculocutaneous perforator located in the mid thigh, which was approximately 10 cm above the proximal fracture level. No adhesion or scar formation between the fascia and adipose tissue was noted when the flap was raised supra-fascially, and the adipose tissue surrounding the trunk of the descending branch of the lateral circumflex femoral artery was found to have mild oedema. The patient regained good aesthetic outcomes and a complete range of active motion in both lower extremities. Based on current evidence of the vascular anatomy of the ALT flap in the literature and our experience, an ipsilateral thigh with distal third femoral shaft fracture and closed retrograde intramedullary fixation should not be considered an absolute contraindication to ALT flap harvesting.
- Published
- 2022
42. Reconstruction of Sphenoid Wing Dysplasia in Neurofibromatosis Type-1 Patients: An Evolving Technique
- Author
-
Jonathan Dunne, Simon Eccles, Samim Ghorbanian, and Naveen Virin Goddard
- Subjects
Titanium implant ,Neurofibromatosis type-1 ,reconstruction ,RD1-811 ,business.industry ,Sphenoid wing ,arachnoid cyst decompression ,Case Reports and Short Communication ,Anatomy ,medicine.disease ,Dysplasia ,Medicine ,sphenoid wing dysplasia ,Surgery ,Neurofibromatosis ,business ,titanium implant - Published
- 2022
43. Role of late renal revascularization in functional renal salvage
- Author
-
Craig Weinkauf, David Chiapaikeo, Tze-Woei Tan, Lorela Weise, Wei Zhou, and Kaoru R. Goshima
- Subjects
medicine.medical_specialty ,RD1-811 ,business.industry ,Renal parenchyma ,medicine.medical_treatment ,Ischemia ,Renal function ,Renal revascularization ,urologic and male genital diseases ,medicine.disease ,Revascularization ,RENAL ARTERY OCCLUSION ,Surgery ,Renal artery occlusion ,RC666-701 ,Functional salvage ,Diseases of the circulatory (Cardiovascular) system ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Late renal revascularization - Abstract
The duration that renal parenchyma will tolerate ischemia has continued to be debated. We have reported the cases of three patients who had undergone revascularization procedures with successful return of baseline renal function after prolonged renal artery occlusion of 14 days to 3 months. These cases highlight that aggressive revascularization can lead to successful renal salvage in selected patients. We examined the characteristics of these patients and those of others in the literature and reviewed the factors favoring recovery.
- Published
- 2022
44. Law of Diminishing Returns in Ventral Hernia Repair: Fact or Fiction?
- Author
-
Viren, Patel, Hanna, Jia, Arturo J, Rios-Diaz, Adrienne N, Christopher, Martin P, Morris, Fortunay, Diatta, Jessica R, Cunning, Robyn B, Broach, and John P, Fischer
- Subjects
Postoperative Complications ,Treatment Outcome ,RD1-811 ,Recurrence ,Quality of Life ,Humans ,Incisional Hernia ,Surgery ,Hernia, Ventral ,Herniorrhaphy ,Retrospective Studies - Abstract
Repeated ventral hernia repair is associated with increased risk of complications and recurrence. The authors present the first study looking at how repeated ventral hernia repair affects quality of life, and whether there is a relationship between the number of prior repairs and quality-of-life improvement after surgery.A retrospective chart review was conducted of patients undergoing ventral hernia repair between August of 2017 and August of 2019, who completed at least one preoperative and postoperative Abdominal Hernia-Q. Patients were split into four cohorts based on number of prior repairs (zero, one, two, or three or more). Categorical data were compared using chi-square and Fisher's exact tests, and continuous data were analyzed using Kruskal-Wallis tests.Ninety-three patients met inclusion criteria, with 19 (20 percent), 45 (48 percent), 15 (16 percent), and 14 patients (15 percent) in each cohort, ranging from zero to three or more prior repairs. Patients with more prior repairs were significantly more likely to be readmitted and undergo reoperation (p = 0.04 and p = 0.01, respectively), in addition to significantly higher cost of care (p = 0.004). Patients with three or more prior repairs had significantly lower preoperative quality of life when compared to patients with two or fewer prior repairs (p = 0.04). However, all patients reported a similar absolute level of quality of life postoperatively, irrespective of prior repairs (p = 0.34).Treatment of recurrent hernia remains a challenge because of poor clinical outcomes and higher risk of recurrence. This study shows that patients with multiple prior ventral hernia repairs report similar postoperative quality of life as patients undergoing primary repair. This information is valuable in determining appropriate surgical candidates and improving preoperative counseling.Risk, II.
- Published
- 2022
45. Sex-Based Difference in Clinical Presentation and Outcomes—A Single-Center Experience
- Author
-
Harini Anandan, Rashmi Maharajan, Shahina Begam, and Suma M. Victor
- Subjects
st-elevation myocardial infarction ,RD1-811 ,cardiovascular disease ,diabetes mellitus ,Immunology ,Surgery - Abstract
Background and Aim The aim of this study was to compare the gender-based differences in baseline characteristics, clinical presentation, and outcomes among patients who underwent percutaneous coronary intervention (PCI) in our institute. Methods This is a single-center, retrospective observational study. A total of 1,595 patients underwent PCI from a period of January 2019 to December 2019, in which 1,293 were males and 302 were females. Demographic characteristics, clinical and procedural details, and their in-hospital outcomes were all collected and analyzed. Results Females presenting with symptoms were older than males (58 vs. 60.8 years, p p p p p-0.009) and the rate of thrombolysis is low in women who presented with ST-elevation myocardial infarction (13.5 vs. 6.3%, p p-0.006). Conclusion Women who underwent PCI tend to be older and had higher rates of diabetes, hypertension, and obesity. Although mortality rates did not differ between groups, bleeding risk is higher in women.
- Published
- 2022
46. Multiple Linear Filling Defects in Coronary Artery: Differential Diagnosis
- Author
-
Hetan C. Shah and M. Jyotsna
- Subjects
coronary artery ,RD1-811 ,Immunology ,Surgery ,cardiovascular diseases ,linear filling - Abstract
A 60-year-old male, diabetic, nonhypertensive, tobacco chewer, presented with a history of inferior wall myocardial infarction in 2007. Patient underwent percutaneous transluminal coronary angioplasty with stent to right coronary artery in 2007, but no reports available. Now, patient was admitted with new onset crescendo angina for the last 1 month.
- Published
- 2022
47. Minimally Invasive Discectomy and Decompression for Lumbar Spine using Tubular Retractor System: Technique, Learning Curve and Outcomes
- Author
-
V A Kumar, Ramanadha Reddy, Vamsi Krishna Yerramneni, Swapnil Kolpakawar, K.S. Vishwa Kumar, and Patlolla Pratyusha
- Subjects
minimally invasive tubular discectomy of spine ,Microbiology (medical) ,lumbar disc disease ,RD1-811 ,Immunology ,Immunology and Allergy ,Surgery ,Neurology. Diseases of the nervous system ,minimally invasive tubular decompression ,RC346-429 - Abstract
Objective To study the indications, technical nuances, learning curve, and outcomes associated with minimally invasive tubular discectomy of spine (MITDS) and minimally invasive tubular decompression (MITD) using the tubular retractor system and compare the outcomes with open microdiscectomy and open decompression. Materials and Methods All patients who underwent MITDS and MITD received a trial of conservative management for 6 weeks prior to surgery. Patients who had undergone open microdiscectomy and open decompression during the same period were used as controls. Operating time, intraoperative blood loss, preop and postop visual analogue scale (VAS) scores, preop and postop Oswestry disability index (ODI) scores, duration of hospital stay, complications, and need for redo surgery were analyzed. Results Thirty-two patients who underwent MITDS and 8 patients who underwent MITD were compared with an equal number of patients who underwent open microdiscectomy and open decompression, respectively. MITDS and MITD were associated with shorter hospital stay. Short-term pain outcome was better in MITDS and MITD group, although it was not statistically significant in MITD group. Functional outcome measured in terms of ODI at 6 months was not statistically significant between minimally invasive and open procedures. Conclusion Both MITDS and MITD have a significant learning curve and have a distinct advantage of shorter hospital stay. MITDS has the distinct advantage of better short-term pain relief compared with open procedures. For MITD, comparison of short-term pain relief requires a larger sample size. To establish long-term advantages of MITDS and MITD, larger sample size and long-term follow-up are needed.
- Published
- 2022
48. Incidence of Cardiovascular Events and Mortality in COVID-19 Patients Admitted in NIMS Intensive Care Unit during Second Wave
- Author
-
N. Srikanth, M. Jyotsna, Padmaja Durga, and Achukatla Kumar
- Subjects
cardiovascular events ,covid-19 ,RD1-811 ,Immunology ,food and beverages ,pulmonary thromboembolism ,Surgery ,mortality - Abstract
Prevalence of pulmonary thromboembolism (PTE) is very high when we compare the coronavirus disease 2019 positive patients with the other patients who are admitted in intensive care unit for other different infection. Thorough evaluation of the different causative factors for PTE should be better evaluated and prevention can be tried accordingly. Incidence of subclinical PTE that can give rise to future cardiac disease needs to be studied and plan of action can be done accordingly. Newer modalities of detecting PTE using non-invasive or simple invasive techniques need to be investigated to cope up in pandemic situation. Abstract Image
- Published
- 2022
49. Utility of Administrative Databases and Big Data on Understanding Glioma Treatment—A Systematic Review
- Author
-
Monica-Rae Owens, Sarah Nguyen, and Michael Karsy
- Subjects
Microbiology (medical) ,administrative database ,RD1-811 ,glioma ,Immunology ,glioblastoma ,Immunology and Allergy ,Surgery ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background Gliomas are a heterogeneous group of tumors where large multicenter clinical and genetic studies have become increasingly popular in their understanding. We reviewed and analyzed the findings from large databases in gliomas, seeking to understand clinically relevant information. Methods A systematic review was performed for gliomas studied using large administrative databases up to January 2020 (e.g., National Inpatient Sample [NIS], National Surgical Quality Improvement Program [NSQIP], and Surveillance, Epidemiology, and End Results Program [SEER], National Cancer Database [NCDB], and others). Results Out of 390 screened studies, 122 were analyzed. Studies included a wide range of gliomas including low- and high-grade gliomas. The SEER database (n = 83) was the most used database followed by NCDB (n = 28). The most common pathologies included glioblastoma multiforme (GBM) (n = 67), with the next category including mixes of grades II to IV glioma (n = 31). Common study themes involved evaluation of descriptive epidemiological trends, prognostic factors, comparison of different pathologies, and evaluation of outcome trends over time. Persistent health care disparities in patient outcomes were frequently seen depending on race, marital status, insurance status, hospital volume, and location, which did not change over time. Most studies showed improvement in survival because of advances in surgical and adjuvant treatments. Conclusions This study helps summarize the use of clinical administrative databases in gliomas research, informing on socioeconomic issues, surgical outcomes, and adjuvant treatments over time on a national level. Large databases allow for some study questions that would not be possible with single institution data; however, limitations remain in data curation, analysis, and reporting methods.
- Published
- 2022
50. Nasal floor augmentation for empty nose syndrome
- Author
-
Munetaka Ushio, Junko Ishimaru, Sayaka Omura, Yasushi Ohta, and Mitsuya Suzuki
- Subjects
Otorhinolaryngology ,RF1-547 ,RD1-811 ,nasal floor ,rhinomanometry ,otorhinolaryngologic diseases ,empty nose syndrome ,Surgery ,nasal resistance ,respiratory system ,General Economics, Econometrics and Finance - Abstract
Background Empty nose syndrome (ENS) can be relieved by conservative therapeutic modalities such as nasal hygiene, nasal moisturizers, or nasal irrigation; however, surgery may be required for reestablishing nasal resistance and physiologic airflow. Surgical operation for ENS is often accompanied by procedural difficulties and complications. Aims To introduce and evaluate the use of nasal floor augmentation as a simple method to increase nasal resistance and ameliorate the symptoms of ENS. Materials and methods In this prospective study, the nasal floor in six patients with ENS was augmented with pieces of auricular cartilage. Subjective symptoms were examined using questionnaire assessments performed before and 3 months after surgery. Pre- and postoperative nasal resistance was evaluated using rhinomanometry. Results The nasal floor was successfully augmented in all six cases. At 3 months after surgery, the total questionnaire score reduced, and the nasal resistance increased. Conclusions and significance The findings of this study suggest that nasal floor augmentation for ENS is effective in increasing nasal resistance and reducing the nasal symptoms causally related to ENS. Informed consent statement This study was approved by the institutional Ethics Committee Review Board. All the patients provided full written and informed consent to participate in this study. The project conforms to the Code of Ethics of the World Medical Association (Declaration of Helsinki).
- Published
- 2022
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