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Purpose To evaluate the correlation of intraoperative neuromonitoring (IONM) data in surgery for tethered cord syndrome (TCS) in children to the neurological outcome at 1-year follow-up. Methods 208 consecutive patients operated on for TCS, between January 2011 to February 2020, under electrophysiological monitoring in the Division of Paediatric Neurosurgery, AIMS, Kochi, India, were included. Their preoperative neurological, urological and orthopaedic status were compared with the postoperative status at 1 year follow-up. Results Our study prospectively collected the IONM data and retrospectively correlated it to the children's neurological outcome on follow-up. Out of 208 children, 28% (n = 59/208) had motor, 35% (n = 73/208) had bladder and 26% (n = 54/208) had bowel disturbances. Postsurgery, at one-year follow-up, 91% (n = 52/57) of the patients who had motor deficits had improvement, 82.3% (n = 51/62) of patients who had bladder deficits showed an improvement, and 88.8% (n = 48/54) with bowel deficits showed improvement. The monitorability for motor and sphincter potentials were 99.4% and 89.3%, respectively. Except for four patients (3 with bladder and 1 with motor worsening), all the patients who were monitorable with no deficits remained intact except for four patients, all the patients who had deficits and were monitorable improved after detethering (at 1 year). Clinical worsening corresponded to those who had a drop in amplitude of baseline TcMEP (n = 4). 18 events showed an increase in amplitude compared to the baseline TcMEP. These patients improved clinically on follow-up (at 1 year). Conclusions IONM complements the preoperative clinical details in predicting immediate and long-term outcomes.

Study design Longitudinal cohort. Objective The aims of this study were to measure concordance between patients' and surgeons' preoperative expectations of lumbar surgery, and determine which member of the dyad more closely predicted fulfillment of expectations, defined as patient-reported status postoperatively. Summary of background data Concordant patient-surgeon expectations reflect effective communication and should foster better outcomes. Methods Preoperatively patients and surgeons completed identical surveys measuring expectations for improvement in symptoms and physical/psychosocial function. Responses ranged from "complete improvement" to "do not have this expectation"; scores for each survey ranged from 0 to 100 (greatest expectations). Concordance between pairs of patient-surgeon scores was measured with the intraclass correlation coefficient (ICC). Postoperatively, fulfillment of expectations was measured from patient-reported amount of improvement received and was calculated as the proportion of patient-reported postoperative score relative to patient-reported preoperative score, and surgeon-reported preoperative score (range 0 [no expectations fulfilled] to >1.2 [expectations surpassed]). Clinical measures included patient-reported spine-related disability. Results For 402 patient-surgeon pairs, mean survey scores were 73 ± 19 (patients) and 57 ± 16 (surgeons); 84% of patients had higher scores than surgeons, mainly due to expecting complete improvement, whereas surgeons expected a lot/moderate/little improvement. The ICC for the entire sample was .31 (fair agreement); for subgroups, the greatest difference in ICC was for patients with more spine-related disability (ICC = .10, 95% confidence interval [CI]:0.00-0.23) versus less disability (ICC = .46, 95% CI: 0.34-0.56). 96% of patients were contacted ≥2.0 years postoperatively. Proportions of expectations fulfilled were 0.79 (0-3.00) (patients) and 1.01 (0-2.29) (surgeons). Thus patients were less likely to anticipate subsequent postoperative status (odds ratio [OR] 0.34, 95% CI 0.25-0.45) versus surgeons who were more likely to anticipate patient-reported postoperative status (OR 2.98, 95% CI: 2.22-4.00). Conclusion Concordance between patients' and surgeons' expectations was fair; due mostly to patients expecting complete improvement whereas surgeons expected a lot/moderate/little improvement. Compared to patients' expectations, surgeons' expectations more closely coincided with patient-reported fulfillment of expectations 2 years postoperatively.Level of Evidence: 1.

Acute gastric dilatation (AGD) is usually related to eating disorders, postoperative status and mechanical obstruction of the duodenum. When intragastric pressure is augmented, it can lead to alteration of blood flow and result in transmural necrosis. However, there are very few reports on idiopathic AGD and so here we describe the case of a 26-year-old woman diagnosed with AGD without any apparent cause. Conservative treatment was initially conducted, but because of the persistence of dilatation, presence of gastric ulcer and gastric pneumatosis, a surgical approach was necessary. During surgery, gastric necrosis was observed in the greater curvature. A sleeve gastrectomy was conducted from the angle of His to the antrum. No complications were present during the postoperative course. Oeso-gastro-duodenal barium study showed no signs of gastric emptying and psychiatric evaluation ruled out any eating disorder.

Introdução: A anestesia opiod-free (OFA) é a prática anestésica sem o uso de opioides intraoperatórios, feita através de uma abordagem multimodal que resulta em anestesia satisfatória e uma melhor recuperação sem os danos amplamente conhecidos relacionados aos opióides. Contudo, essa técnica ainda precisa ser avaliada em diversos contextos cirúrgicos. Objetivo: Esta revisão sistemática teve como objetivo comparar abordagens de anestesia geral livre de opioides e anestesia com opióides e sua eficácia sobre variáveis de recuperação pós-operatória de colecistectomias laparoscópicas eletivas. Método: Utilizando os unitermos “opioid free anesthesia”, “nonopioid” e “laparoscopic cholecystectomy”, com o operador booleano ?AND?, foram encontrados 752 artigos nas bases de dados PubMed, Scielo, Cochrane, NBCI e Google Scholar. Os critérios de inclusão eram ensaios clínicos que avaliaram parâmetros de recuperação no pós-operatório de colecistectomias laparoscópicas eletivas como náuseas e vômitos, dor pós-operatória e necessidade de opioides de resgate, dentro do intervalo de 2015 a 2020. Ao final, 6 estudos atenderam aos critérios de inclusão e exclusão. Revisão de literatura: Bakan (2015), utilizando anestesia venosa total, concluiu que o grupo OFA apresentou menor consumo de fentanil no pós-operatório, e nenhum paciente precisou de ondansetrona para Náusea e Vômito no Pós-operatório (NVPO). Shalaby (2018), Elsayea (2019), Toleska (2019), Abdelmoniem (2020) e Ahmed (2020), utilizando abordagens balanceadas, encontraram resultados concordantes entre si. Quatro estudos mostraram menor necessidade de antieméticos para NVPO e todos concluíram que a anestesia sem opióides fornece melhor controle da dor e menor necessidade de opióides no pós-operatório, sem efeitos adversos significativos em comparação com os grupos baseados em opióides. Conclusão: A anestesia sem opióides foi superior à baseada em opioides em relação aos parâmetros analisados na recuperação de pacientes submetidos a colecistectomias laparoscópicas eletivas, promovendo melhor analgesia, menor necessidade de opioides, menor incidência de NVPO e, de acordo com os autores, sempre com estabilidade hemodinâmica.

The problem concerning the prediction of the aggressive status of prostate cancer (PCa) is examined on the basis of preoperative data. This problem is solved using data on 360 patients with the established (aggressive or indolent) postoperative status of the disease. The collection of factors containing five informative indicators of prediction (from primarily accessible sixteen) is revealed and employed to create the diagnostic index used to predict the aggressive PCa status. In compliance with cross-validation data, the prognostic algorithm enables us to find the group involving 55% of patients with an aggressive status in the absence of patients with an indolent PCa status. The three-class prediction algorithm making it possible to ascertain whether any patient belongs to the group with the low, high, or uncertain risk of the aggressive disease stage is proposed.

OBJECTIVEOccipital nerve stimulation (ONS) and deep brain stimulation (DBS) are widely used surgical treatments for chronic refractory cluster headache (CH). However, there is little literature regarding long-term follow-up of these treatments.METHODSThe authors describe two prospective cohorts of patients with refractory CH treated with ONS and DBS and compare preoperative to postoperative status at 6 and 12 months after the surgery and at final follow-up. Efficacy analysis using objective and subjective variables is reported, as well as medication reduction and complications.RESULTSThe ONS group consisted of 13 men and 4 women, with a median age of 44 years (range 31–61 years). The median number of attacks per week (NAw) before surgery was 28 (range 7–70), and the median follow-up duration was 48 months. The DBS group comprised 5 men and 2 women, with a median age of 50 years (range 29–64 years). The median NAw before surgery was 56 (range 14–140), and the median follow-up was 36 months. The NAw and visual analog scale score were significantly reduced for the ONS and DBS groups after surgery. However, while all the patients from the DBS group were considered responders at final follow-up, with more than 85% being satisfied with the treatment, approximately 29% of initial responders to ONS became resistant by the final follow-up (p = 0.0253).CONCLUSIONSONS is initially effective as a treatment for refractory CH, although a trend toward loss of efficacy was observed. No clear predictors of good clinical response were found in the present study. Conversely, DBS appears to be effective and provide a more stable clinical response over time with an acceptable rate of surgical complications.

Background: When diagnosing and treating spinal disorders, spine surgeons commonly utilize computed tomography (CT) scans preoperatively, intraoperatively, and postoperatively. Methods: This article reviews the literature regarding the potentially harmful effects of X-rays, specifically from CT scans. Results: The risk for damaging DNA and developing cancer increases with increasing scan length (e.g., increasing amount of radiation received). Conclusion: When assessing postoperative status, CT scans should be directed only through the area of specific interest to limit the total dose of radiation received by the patient.

There is an increasing impetus to perform primary total hip arthroplasty and total knee arthroplasty on an outpatient basis and in the outpatient setting. However, with recent federal regulatory changes, orthopedic surgeons must now evaluate patients on a case-by-case basis to determine whether an inpatient admission will be medically necessary and appropriate. We thus created our prototype Lower Extremity Inpatient-Outpatient (LET-IN-OUT) total joint replacement tool as a simple, consistent way for other clinicians to identify specific major preoperative patient comorbidities and thus to recommend independently and objectively to the orthopedic surgeon postoperative inpatient or outpatient status for a given patient.

Objective Postoperative fatigue is a common problem after otherwise uncomplicated surgery. It may defer patients from resuming their daily activities and is often reported to be among their most severe symptoms. There are few validated instruments for assessing postoperative fatigue. Our aim was to translate into Norwegian and explore a Short Form of the Identity-Consequences Fatigue Scale; a fatigue questionnaire specifically developed to assess postoperative fatigue. Methods The fatigue scale was translated to Norwegian through a forward-backward process, and subsequently validated in a large, mixed surgical population. We performed Principal Component Analyses on the complete 31-item scale and on the 10-item Short Form. The analyses were performed separately on pre- and postoperative data (n = 422 and n = 315, respectively). Results The factor analyses confirmed that the translation was valid and revealed three defined dimensions in the 10-item scale. There was no statistically significant difference between means of reported fatigue when measured with the 31- or 10-item scale. Ninety-eight% of change in fatigue from pre- to postoperative status was retained when using the 10-item scale as compared to the 31-item scale. Conclusion The abridged, 10-item Short Form performed equal to the 31-item scale and may replace the complete 31-item ICSF scale in exploring the incidence of pre- and post-operative fatigue.

Hyperhidrosis is characterized by diaphoresis that is unrelated to the physiological thermo- regulatory requirements of the body. Primary hyperhidrosis is caused by an idiopathic overactivity of the sympathetic nervous system and can affect the axillae, in more than half of the cases, palms, soles and face. As a result, patients may develop psychologic disorders, such as anxiety and depression, or experience impaired quality of life (QOL). Set of indicators were therefore introduced to describe the relationship between QOL post-surgery for hyperhidrosis and daily life. Recently a World Health Organization study group developed a questionnaire made of 100 question ranging from physical, psychological, environmental and spiritual aspects (WHOQOL0-100); this has been followed by a shorter one (WHOQOL BREF) easier to be completed maintaining the same standard of psychometric assessment. This is made of 26 questions covering the same aspects as the WHOQOL-100 representing however a generic tool to assess QOL. Nevertheless there are other QOL indicators that have to be considered when assessing the impact of primary hyperhidrosis (PH) and postoperative status following surgery for PH.

Purpose Orbital decompression for thyroid-associated ophthalmopathy (TAO) is an ophthalmic plastic surgery technique to prevent optic neuropathy and reduce exophthalmos. Because the postoperative appearance can significantly change, sometimes it is difficult to make decisions regarding decompression surgery. Herein, we present a deep learning technique to synthesize the realistic postoperative appearance for orbital decompression surgery. Methods This data-driven approach is based on a conditional generative adversarial network (GAN) to transform preoperative facial input images into predicted postoperative images. The conditional GAN model was trained on 109 pairs of matched pre- and postoperative facial images through data augmentation. Results When the conditional variable was changed, the synthesized facial image was transferred from a preoperative image to a postoperative image. The predicted postoperative images were similar to the ground truth postoperative images. We also found that GAN-based synthesized images can improve the deep learning classification performance between the pre- and postoperative status using a small training dataset. However, a relatively low quality of synthesized images was noted after a readout by clinicians. Conclusions Using this framework, we synthesized TAO facial images that can be queried using conditioning on the orbital decompression status. The synthesized postoperative images may be helpful for patients in determining the impact of decompression surgery. However, the quality of the generated image should be further improved. The proposed deep learning technique based on a GAN can rapidly synthesize such realistic images of the postoperative appearance, suggesting that a GAN can function as a decision support tool for plastic and cosmetic surgery techniques.

A new classification is proposed for cerebral aneurysms treated with any endovascular technique, for example, coiling with or without adjunctive devices, flow diversion, intrasaccular flow modifiers, or any combination of the above. Raymond-Roy Occlusion Classification is expanded with novel subgroups such as class 1 represents complete occlusion and is subdivided if a branch is integrated to, or originated from, the aneurysm sac; class 2 represents neck filling; class 3 represents incomplete occlusion with aneurysm filling as in the previous classification; and class 4 describes the immediate postoperative status after extra- or intrasaccular flow modification treatment. A new concept, “stable remodeling,” is included as class 5, which represents filling in the neck region that stays unchanged or reduced, as shown with at least 2 consecutive control angiographies, at least 6 months apart, for not

Aim The present study investigated the accuracy of root canal preparation with regard to the integrity of the apical constriction (AC) using two different working length determination approaches: (1) the electronic method of working length determination (EWLD), and (2) the radiologic “gold standard” method (GS). Methodology Simulation models were constructed by arranging extracted human teeth by means of silicon bolstered gingiva masks, along with a conductive medium (alginate). Electronic working length determination (group 1; EWLD) and radiologic plus initial electronic working length determination for posterior comparability (group 2; GS) preceded manual root canal preparation of teeth in both groups. Master cones were inserted according to working lengths obtained from the group specific method. Subsequently, root apices (n = 36) were longitudinally sectioned using a diamond-coated bur. The distance between the achieved apical endpoint of the endodontic preparation and the apical constriction (AC) was measured using digital photography. Then, distances between radiologically identified apical endpoints and AC (GS–AC) were compared with the corresponding distances EWLD–AC. Moreover, the postoperative status of the AC was examined with regard to both preparation approaches. Results Differences between distances GS–AC and EWLD–AC were not statistically significant (p > 0.401) (Mann-Whitney-U). Among EWLD samples, 83% of the master cones exhibiting tugback at final insertion terminated close to the apical constriction (±0.5 mm), and no impairment of the minor diameter’s integrity was observed. Conclusions The sole use of EWLD allowed for a high accuracy of measurements and granted precise preparation of the apical regions.

Nasal packing is routinely used after septoplasty, but there are patient factors for which its use needs to be reconsidered. Effectiveness of nasal packing in trans-septal suturing technique in septoplasty. Prospective, comparative study, patients submitted to septoplasty were randomized to receive or not nasal packing postoperatively. Comparison in postoperative status for pain, headache, discomfort in swallowing, epiphora, bleeding, infection and pain on pack removal are assessed. In all the patients trans-septal suturing technique was used. Study group has 60 patients. Two groups were made group A in whom nasal packing done post operatively with merocel, group B in whom nasal packing was not done, in both groups quilting sutures were applied on to the septum. There was pain in nose and headache in all the patients in group A. Other symptoms in group A were epiphora, discomfort in swallowing due to ear discomfort. In addition to these there is pain on removal of packs. Routine use of nasal packing can be avoided instead sutures can be placed over the septum, which benefits in improving pain and symptoms due to pack in the postoperative period.

Spinal meningiomas are common spinal tumors; in most cases they are benign and with a good surgical prognosis. However, specific location, infiltration of spinal cord, vascular encasement, or spinal root involvement can bring to a less favorable progno‐ sis. We reviewed a series of 173 consecutive patients with spinal meningiomas treated from 1976 to 2011 in our institution, and data were stratified according to sex, age, symptoms, axial location, Simpson resection grade, and functional pre-/postoperative status. Particular attention was paid to description of those factors leading to a poor outcome. Functional improvement at follow-up was observed in 86.7% of cases, 6.4% of patients resulted stable, and 6.9% worsened; a low functional grade before surgery was connected to a lesser improvement after. Anterolateral meningiomas were the most represented (42.2%); a gross total resection (Simpson grade I and II) was conducted in 98.8% and a macroscopically complete removal without dural resection or coagula‐ tion (Simpson grade III) was performed in 1.2%. According to data from our series, negative prognostic factors seem to be: anterior or anterolateral axial implant, longlasting symptoms before diagnosis, WHO grade > I, Simpson grade II and III resec‐ tion, sphincter involvement, and worse functional grade at onset.

Purpose To determine the relationship between preoperative and postoperative characteristics and visual outcomes after successful surgery for unclosed macular hole (MH). Methods The medical charts of 166 eyes of 161 patients who underwent vitrectomy for a MH were reviewed. The MH was not closed in 9 eyes of 9 patients after the initial surgery. The second vitrectomy with additional internal limiting membrane (ILM) peeling and gas tamponade was performed. The preoperative and postoperative best-corrected visual acuity (BCVA), optical coherence tomographic images, MH size, duration of MH before the first operation, and area of ILM peeling were studied. Results The MH was closed in all eyes after the second surgery. The BCVA significantly improved from 0.77 to 0.25 logMAR units (20/118 to 20/36, p = 0.002). The postoperative subfoveal ellipsoid zone (EZ) was distinct and continuous in 3 eyes with good visual recovery. The final BCVA was not significantly correlated with the baseline characteristics and area of ILM peeling but was correlated with the postoperative status of the EZ. Conclusions All MHs were closed and the mean postoperative visual acuity was significantly improved. The reason for poor visual recovery was the reduced microstructural recovery after the second surgery.

Background: To investigate the feasibility and safety of the O eccentric shape occluder in the interventional occlusion treatment of intracristal ventricular septal defect (IVSD). Methods: A retrospective analysis of the clinical data of 56 IVSD patients treated by interventional occlusion at our center, as well as recording of their intraoperative and postoperative status, was performed. Results: Of the 56 patients, a total of 48 patients underwent successful occlusion during the first surgical attempt. Four patients were transferred to the Surgery Department after occlusion when the largest occluder failed because of large defects. Two patients exhibited aortic valve regurgitation; 1 patient had mild regurgitation, which was not worsened after 6 months of follow-up. One patient had severe aortic regurgitation, and 2 days after the operation, the patient underwent a second operation. One patient exhibited a residual shunt, which was above the occluder; after 1 year of follow-up, re-occlusion was successful and eliminated the shunt. One patient developed complete right bundle branch block. Conclusion: Most IVSD interventional occlusion treatments are feasible and safe.

Background: To determine whether the status of a macular hole can be determined by spectral-domain optical coherence tomography in gas-filled eyes. Design: Prospective study, university hospital setting. Participants: Twenty-six eyes with a macular hole, seven eyes with a macular hole retinal detachment and four eyes with a macular hole and myopic traction maculopathy underwent vitreous surgery. Methods: The macular area was examined by spectral-domain optical coherence tomography (OCT-4000) on postoperative days 1, 3, 7 and 30. Main Outcome Measures: Detection of macular hole closure. Results: The status of macular hole was able to be assessed in 24 eyes (92%) on postoperative day 1 and 23 were closed. The condition of the macular hole could not be determined in the other two eyes with a lower volume of gas (≤60%). The macular hole of seven eyes could be seen only when the patients looked upward or downward (P = 0.009). The 11 eyes with a macular hole retinal detachment or a myopic traction maculopathy had a posterior staphyloma, and the macular hole was visible in four eyes on day 1 (P = 0.001). When a closure of the macular hole was detected on day 1, the macular hole remained closed in all of these eyes on day 30. Conclusions: The status of a macular hole can be determined by spectral-domain optical coherence tomography on postoperative day 1 even in gas-filled eyes. The visibility depends on the volume of intravitreal gas and the absence of a posterior staphyloma.

The aim of this retrospective study was to investigate the efficacy of saireito for bilateral chronic subdural hematomas (B-CSDH). Between April 2006 and March 2010, a total of 18 patients undergoing unilateral burr hole drainage for B-CSDH took part in a controlled clinical study. Postoperative status of the nonsurgical side was subsequently evaluated, with (n = 10) and without (n = 8) saireito administration. Two in the saireito-treated group patients and four in the control group patients ultimately required contralateral surgical intervention. The remainder, including eight saireito-treated hematomas, resolved without further surgery, generally within eight weeks of the surgical side procedure. However, two of the four resolving control lesions took longer to regress. The hydragogue and anti-inflammatory/steroid-evoking properties ascribed to saireito may facilitate hematoma resolution. After unilateral surgery for B-CSDH, saireito administration may prevent symptomatic deterioration of a contralateral low-density CSDH, preempting subsequent surgery.

Second-look arthroscopy after ACL reconstruction is one of the most reliable types of examination to provide valuable prognostic information on a graft such as synovial coverage and damage of the graft. Second-look arthroscopy shows that synovial coverage of the grafts differs substantially between cases and that graft loosening or partial tear can occur even in clinically successful knees. Second-look arthroscopy is also the most dependable procedure to evaluate the postoperative status of meniscal repairs. Moreover, this examination is the most precise way to determine the condition of the articular cartilage. Osteoarthritis is typically diagnosed using radiography. However, by using arthroscopy, even minimal articular cartilage damage consistent with incipient osteoarthritis can be detected long before the classic criteria of osteoarthritis are fulfilled. Arthroscopy demonstrates that although proper ACL reconstruction is clearly important, meniscal repair should be performed, where possible, to limit the progression of articular cartilage damage. This chapter describes the procedure and advantages of second-look arthroscopy and also reviews the literature on second-look arthroscopic findings after ACL reconstruction.

In the study we use the image of three dimensional computed tomography (3D-CT) to assess the different widths of the bony framework of congenital nasal pyriform aperture stenosis (CNPAS).We select 17 infants under 4 months old diagnosed as CNPAS for this study. There were four categories of distance measurement. The distance between the caudal end of the nasal bone (nasal tip) and the anterior nasal spine (NPAH). The distance between bilateral bony inner wall of the nasal pyriform aperture at the midpoint of the aperture height (MIVD). The interprocess distance at the level of lower 1/4 of the pyriform aperture height (IPD). The narrowest distance between the bilateral nasal processes (NIPD).There were 17 infants, nine males and eight females. At the time of performing 3D-CT, the mean age was 49.5+/-35.9 days. The results of measurement were: NPAH: 10.9+/-1.23mm, MIVD: 8.2+/-0.89mm, IPD: 4.9+/-0.93mm, and NIPD: 4.4+/-0.73mm. The MIVD is significantly wider than both IPD and NIPD (p0.01). There is high correlation between IPD and NIPD. There is no significant difference on age between gender in this study. However, the IPD (4.4+/-0.74) and NIPD (3.9+/-0.47) of male patients are broader, respectively, than those of female patients with significant difference (p0.05).The measurement of CNPAS by means of 3D-CT may provide useful data for evaluation of the width in different parts of nasal pyriform aperture. These may be used for evaluation of pre- and postoperative status and future investigation in CNPAS patients.

Late recognition of severe acute respiratory syndrome (SARS) was associated with no known SARS contact, hospitalization before the nosocomial outbreak was recognized, symptom onset while hospitalized, wards with SARS clusters, and postoperative status. SARS is difficult to recognize in hospitalized patients with a variety of underlying conditions in the absence of epidemiologic links.

OBJECTIVE Since the 1980s, it has been discussed whether the preoperative treatment of prolactinomas with dopamine agonists (DAs) is beneficial or detrimental regarding postoperative residue or recurrence. Many neurosurgeons have emphasized the difficulties caused by fibrosis during the ablation of such prolactinomas. METHODS From February to December 2012, the authors searched electronic databases and book chapters published from 1991 to 2012; a total of 3,771 articles and 37 book chapters were searched. Ten articles that explicitly addressed this issue were identified. RESULTS Five articles reported that preoperative treatment did not affect postoperative status. One article described a positive influence of preoperative treatment with DAs (P < .01), and 3 articles found a negative influence (P = .040, P = .02, no significance value reported). One article described histopathological evidence of tumor fibrosis that was found intraoperatively after preoperative DA treatment. CONCLUSIONS This systematic review did not identify any strong evidence that preoperative treatment of prolactinomas with DAs is harmful or beneficial. Therefore, further studies are needed.

Ten knees in nine patients underwent gradual soft tissue expansion prior to major knee surgery. All patients had multiple prior operative procedures around the knee. The resultant multiple skin incisions were felt to potentially jeopardize the postoperative status of the soft tissues. Each knee underwent the surgical placement of a tissue expander through a bed of adjacent healthy soft tissue followed by the gradual inflation of the expander over an average of 64.5 days. The average volume of soft tissue expansion was 313.7 mL per knee. Subsequent major knee surgery requiring an arthrotomy was performed at the time of expander removal followed by uncomplicated soft tissue closure. All wounds healed without any complications.

Laparoscopic adjustable gastric banding (LAGB) is a standard restrictive bariatric procedure. Previous studies have shown that patients lost to follow-up do worse than patients who remain in follow-up. However, it is unknown if this is purely because of a lack of band adjustments. The aim of this study was to study the relation between number of adjustments and results.Patients who underwent primary LAGB from October 2006 until March 2009 were included. The following parameters were collected: demographic characteristics, preoperative and postoperative weight, preoperative and postoperative status of co-morbidities, type of band, short- and long-term complications, reoperations, date, number and volume of adjustments, total amount of inserted volume, and last measured volume.One hundred seventy-four patients underwent primary LAGB. Twelve patients did not attend follow-up visits after 24 months (8.1%). Mean follow-up was 46 months, and excess weight loss, 47%. Eleven patients (8.1%) developed long-term complications, and 12 patients (8.8%) underwent revisional surgery. Patients underwent a mean number of 5 adjustments with a range of 0 to 18. The mean volume of totally inserted milliliters was 8 mL, with a range of 0 to 14 mL. There was a strong positive relation between number of adjustments and weight loss as well as reduction in obesity-related co-morbidities (r = .22; P.01). There was no significant relation between number of adjustments and complications or revisional surgery.There is a strong relation between the number of band adjustments and weight loss, whereas complications and reoperations seem to be independent of the number of adjustments. A continual and lifelong follow-up of LAGB patients, including regular band volume adjustments, is necessary.

Clinical, Investigative, Postoperative Status in Cervical Precancer and Cancer Early diagnosis and accurate staging are essential for appropriate management of cervical cancer, one of the most common cancers and leading cause of cancer deaths worldwide. The objective of present study was to know the correlation between clinical,investigative, surgical and histopathological diagnosis in suspicious and staging in obvious cancer cases. Study subjects were of 20-64 years, diagnosed over 2 years with aid of visual inspection (VI), vaginal and cervical cytology, visual inspection after application of acetic acid (VIA), VI after application of Lugol’s iodine (VILI), followed by colposcope guided cervical biopsy, intraoperative and postoperative staging after histopathology of specimen in clinically suspicious and obvious cancer cases.

This article presents an analysis of 27 patients who had endoscopic sinus surgery in 1989 and were followed for 2 years postoperatively. To measure clinical improvement, two parameters were used: the frequency of physician visits for chronic sinusitis, and the number of courses of antibiotics. Data on both measures were collected for 1 year before and 2 years after endoscopic sinus surgery. This retrospective study demonstrates both a statistically significant and practically important decrease in physician visits and courses of antibiotics following endoscopic sinus surgery. Two years postoperatively 78% of the patients undergoing surgery had a greater than 50% reduction in physician visits for sinusitis, and 67% had a greater than 50% reduction in courses of antibiotics for sinusitis.

Background Dynamic radiographs are recommended to investigate non-healing evidence such as the dynamic mobility or intravertebral clefts in osteoporotic vertebral compression fractures (VCFs). However, it is difficult to examine standing flexion and extension lateral radiographs due to severe pain. The use of prone cross-table lateral radiographs (PrLRs) as a diagnostic tool has never been proposed to our knowledge. The purpose of this study is to clarify the usefulness of PrLRs in diagnosis and treatment of VCFs. Methods We reviewed 62 VCF patients examined with PrLRs between January 1, 2008 and June 30, 2011. To compare the degree of pain provoked between standing extension lateral radiographs (StLRs) and PrLRs, numeric rating scale (NRS) scores were assessed and compared by a paired t-test. Vertebroplasty was done for 40 patients and kyphoplasty was done for 9 patients with routine manners. To assess the degree of postural reduction, vertebral wedge angles (VWA) and vertebral height ratios (VHR) were calculated by using preoperative StLRs, PrLRs, and postoperative lateral radiographs. Two variables derived from changes in VWA and VHR between preoperative and postoperative radiographs were compared by a paired t-test. Results The average NRS scores were 6.23 ± 1.67 in StLRs and 5.18 ± 1.47 in PrLRs. The degree of pain provocation was lower in using PrLRs than StLRs (p < 0.001). The average changes of VWA between preoperative and postoperative status were 5.24° ± 6.16° with PrLRs and 3.46° ± 3.47° with StLRs. The average changes of VHR were 0.248 ± 0.178 with PrLRs and 0.148 ± 0.161 with StLRs. The comparisons by two variables showed significant differences for both parameters (p = 0.021 and p < 0.001, respectively). The postoperative radiological status was reflected more precisely when using PrLRs than StLRs. Conclusions In comparison with StLR, the PrLR was more accurate in predicting the degree of restoration of postoperative vertebral heights and wedge angles, and provoked less pain during examination. The PrLR could be a useful diagnostic tool to detect intravertebral cleft or intravertebral dynamic instability.

Few studies compare the direct impact of pancreatoduodenectomy (PD) on the patient’s quality of life (QOL). The effect of PD in QOL, comparing the preoperative vs. postoperative status, was analyzed. A prospective single-center study was performed. PD patients in a 2-year period were included. A general QOL instrument was applied preoperative, 1, 3, 6, and 12 months after surgery and compared with national norms. Thirty-seven patients were recruited. Twenty of 37 were female. Ampullary carcinoma 14/37, ductal adenocarcinoma in 9/37, and other malignant neoplasms 14/37 were diagnosed. Mortality was absent; 48.6 % had complications, 13.5 % required reoperation. Three (median) and 4 (mode) questionnaires were answered per individual. 85 % answered the last questionnaire. 4/37 had cancer related death before a year. Median follow-up was 29 (3–72) months. QOL diminished a month after surgery, physical function (67 vs 40, p

Deceased donor liver transplantation has been an established surgical procedure since the 1960s. More recently, the technique of living donor liver transplantation (LDLT) was introduced, and it is being performed with increasing frequency. However, there is a paucity of information on the clinical outcomes of donor patients. In this study, which was conducted at a single university hospital, the relationship between potentially relevant factors (eg, patient characteristics, preoperative status, and operation characteristics) and postoperative developments in donor patients was examined. We used electronic critical pathways, which are charts of medical process that include favorable states (defined as outcomes) to be achieved during the hospital stay of a patient; predefined outcomes that are not achieved are recorded as variances. With the electronic critical pathway system, objective data about the conditions of patients and relevant clinical processes could be collected readily. Using data from the electronic critical pathways for LDLT donor patients and applying multiple logistic regression analysis, we examined factors that were related to the variance of each outcome measure for postoperative developments. Among the various donor characteristics, the duration of the operation was related to variance in 5 types of health outcomes, age and blood loss volume were related to variance in 2 types of health outcomes, and other characteristics (ie, sex, body surface area, operation urgency, and volume ratio of the remnant liver) were related to variance in 1 type of health outcome. In conclusion, the findings in this study may facilitate improvements in the postoperative status of LDLT donor patients. Further studies that incorporate analogous data from other medical facilities are necessary to verify these findings.

Despite remarkable improvement of surgical and cardiopulmonary bypass technique, nonsurgical bleeding is still a serious complication following cardiac surgery. As nonthrombotic material or an ideal anticoagulant preventing contact activation of the blood has not been found, a method to reduce'whole body inflammatory response' and postoperative bleeding is an appealing option to improve the postoperative status of patients undergoing cardiac surgery. Discussing the rationale behind preoperative leucocyte-plasmapheresis the possible benefits of this new method are explained. Reviewing the literature, possibilities of future development is outlined.

With increasing numbers of professional, collegiate, and high school athletes developing low back pain, isokinetic back testing could prove to be a way of preventing the development of severe problems and extended stays on injured lists. Isokinetic testing provides an advantage over other testing procedures by more closely simulating the way muscles perform functional activities. This type of testing allows comparison between patients, normals, preoperative and postoperative status, and prerehabilitation and postrehabilitation protocols.

Objective: To study postoperative status of the mastoid cavity after cochlear implantation by the suprameatal approach method. Methods: Pre- and postoperative protocolair prepared CT-scans of the mastoid cavity of patients who were operated for cochlear implantation were studies. 79 patients were included in this study. All patients were operated by the two authors using a mastoid saving surgical suprameatal approach for cochlear implantation, The postoperative CT-scans were evaluated after 6 months or more after surgery. Changes of the state of the mastoid observed by CT scan were documented. Results: In 76 cases no abnormalities were observed in the mastoid of the operated ear for cochlear implantation. The delicate structures of the mastoid cavity were kept intact without any sign of mucosal reaction. In two cases of implantation for deafness due to otosclerosis swollen mucosa was observed in the mastoid without any clinical relevance. In one case (a child) opicafication of the whole mastoid and middle ear was observed without destruction of the structures of the mastoid. Treatment with oral antibiotics cured this otitis media without rest reactions in the mastoid . Conclusions: The delicate structures of the mastoid cavity can be kept intact using a mastoid saving suprameatal surgical approach in cochlear implant surgery, In almost all the cases we could demonstrate by CT-scan that there is not any reaction of the mucosa in the mastoid and middle ear after cochlear implantation. There were no differences in the postoperative state of the small or large pneumatized mastoid.

The most challenging component of spinal dysraphism is cord tethering. Tethering can occur due to single or multiple lesions within the same patient. It is imperative to aggressively identify and release all the tethering lesions in order to provide maximum benefit to the patient. With increasing number of tethering lesions, the clinical profile and outcome show significant differences, and this difference is significantly more when more than two tethering lesions coexist in the same patient. Out of the 248 patients of spinal dysraphism who underwent surgical management at Sanjay Gandhi Institute of Medical Sciences, Lucknow, India, between 1997 and 2007, 160 were included in the study. Patients were classified into two groups based on the number of tethering lesions. The first group (Group A) comprised cases of spinal dysraphism with tethering demonstrable at one or two sites. The second group (Group B) comprised patients with radiological or intraoperative evidence of multiple tethering lesions (more than two). There were 119/160 patients in Group A, while 41/160 patients were in Group B (with more than two sites of tethering). The preoperative neurological examination revealed significant differences between the two study groups. The clinical profile and the surgical outcomes have shown significant differences in the two study groups. These differences are statistically significant. We strongly believe that the mere presence or absence of tethering is not a sufficient documentation to predict its effect on the cases of spinal dysraphism. Tethering is a complex entity that needs to be further classified in terms of the number of tethering lesions, which significantly affect the pre- and postoperative status of the patients. We would like to suggest the term “Spina Bifida Multiplex” for the cases where more than two lesions are found to be responsible for tethering.

Purpose The purpose of this study was to investigate the outcome of combined phototherapeutic keratectomy and amniotic membrane grafting in the management of painful symptomatic bullous keratopathy. Methods We conducted a retrospective consecutive interventional case series. Combined phototherapeutic keratectomy and amniotic membrane grafting was performed in 18 eyes of 17 patients who were symptomatic because of bullous keratopathy. Data analysis was done for only 12 eyes that were followed up for more than 5 weeks and when the postoperative status of the amniotic membrane was known. Results The mean preoperative duration of the symptoms was 164.17 +/- 179.39 weeks (range, 24-480 weeks). Eleven of 12 eyes (91.67%) were totally symptom-free during the entire postoperative follow-up period of 38.08 +/- 47.95 weeks (range, 5-156 weeks). One patient (8.33%) had mild irritation, which had started at his last postoperative follow up, at 8 months. His amniotic membrane had absorbed at 16 weeks. The amniotic membrane was completely absorbed in 58.33% (7 of 12 eyes) of eyes, partially absorbed in 33.33% eyes (4 of 12 eyes), and not absorbed at all in one eye (8.33 %). None of the patients required any repeat or additional procedure. Conclusion Phototherapeutic keratectomy when combined with amniotic membrane grafting provides a viable alternative in the management of painful symptomatic bullous keratopathy.

The Damus-Kaye-Stansel operation is a useful technique for the treatment of complex cyanotic congenital heat disease when there is obstruction between the systemic ventricle and the aorta. Modifications of the technique include transection of the aorta and the pulmonary artery, anastomosis of the contiguous aortic and pulmonary walls, and connection of the distal aorta to the perimeter of the new bivalved proximal great artery. In addition, the bidirectional cavopulmonary shunt technique can be used with or without the Fontan procedure. Six patients underwent a Damus-Fontan operation, and all survived. Two patients underwent the Damus-cavopulmonary shunt (hemi-Fontan) procedure, and 1 survived. The postoperative status of the 7 survivors is good to excellent. Follow-up ranges from 2 months to 7 1 / 2 years.

OBJECTIVE: To evaluate the postoperative status of the patients after endolymphatic sac decompression (ESD) for intractable unilateral definite Meniere's disease (MD) using the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) 1995 criteria and to discuss the current status of ESD in the management of MD, especially after the wide use of intratympanic administration of gentamicin for the treatment of intractable MD. STUDY DESIGN: Retrospective questionnaire-based analysis. METHODS: Thirty-nine patients who had undergone ESD between 1996 and May 2003 at Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India, were evaluated via a set format according to AAO-HNS 1995 guidelines. Their preoperative and postoperative data were compared. RESULTS: We found significant improvement in functional level scales (FLSs) in 84.6%, Class A vertigo control in 82%, and improved disability outcome in 87% of cases after surgery at a median postoperative follow-up of 29 months. All the patients showing significant improvement in FLS were preoperatively in scale 4 or more, and all the patients whose treatment failed were in scale 3 or less. CONCLUSION: We recommend continued use of ESD in indicated patients. We found a positive relation between preoperative distress level of the patient and postoperative improvement in FLSs; any such relationship should be investigated with a larger sample.

Objective Transnasal endoscopic surgery is the most common approach to removal of pituitary tumors. This study evaluated the transnasal transethmosphenoidal approach (TTES) in terms of its operative manipulability and the postoperative status of the paranasal cavities. Methods A total of 132 patients with pituitary tumors underwent surgery by one of the following three approaches: (1) bilateral TTES, in which the surgical procedures were performed via the bilateral paranasal cavities, (2) unilateral TTES, in which the procedures were performed via one side only, and (3) unilateral TTES and resection of the posterior portion in the nasal septum approach (RPS), which is a modification of approach (2) and enables performance of the procedures from both sides. Results The degree of freedom for the surgical procedures with each of the approaches decreased in the following order: bilateral TTES, unilateral TTES and RPS, and unilateral TTES. The postoperative CT images and endoscopic findings were good with each of the surgical approaches, but the incidences of olfactory disturbance and nasal dryness were significantly higher with the bilateral TTES compared with the unilateral TTES and RPS and the unilateral TTES. Conclusion The unilateral TTES and RPS was for us most suitable approach of the three methods. In the case of advanced tumors, the bilateral TTES should be selected because it permits superior operative manipulability. Finally, the unilateral TTES is most appropriate for removal of tumors that are deviated to one side and localized within the sella.

Accurate interpretation of the postoperative status of the knee cannot be achieved without a working knowledge of the utilised surgical procedures and techniques, as well as familiarity with the expected imaging appearances of the structures that have been repaired, resected or replaced. A thorough understanding of these two areas is therefore a prerequisite to the identification and correct interpretation of recurrent or new problems in the postoperative knee. This chapter will focus primarily on the postoperative assessment of the knee following surgery to the menisci, cruciate ligaments and articular cartilage.

Purpose: To investigate the ability to determine the postoperative status of macular hole (MH) in gas-filled eyes using swept source optical coherence tomography (SS-OCT). Methods: Ten eyes of 10 patients who underwent vitrectomy, internal limiting membrane peeling and gas tamponade for idiopathic MH were included in this study. The macular area was examined using SS-OCT on postoperative days 1, 2 and 30. Results: MH status was assessed in 6 eyes (60%) on postoperative day 1 and MH closure was confirmed in 5 of the 6 eyes (83%). MH remained closed in all 5 eyes at 1 month after surgery. Only gas-retinal interface was obtained in 4 eyes (40%) and unclosed MH was found in 1 of the 4 eyes (25%) at 1 month after surgery. Conclusions: The MH status can be determined using SS-OCT in the early postoperative period even in gas-filled eyes. Confirming early MH closure with SS-OCT can serve as an important guide to significantly shorten the duration of prone positioning while maintaining high closure rates. J Korean Ophthalmol Soc 2015;56(9):1386-1391

Plastic surgeons have associated themselves closely with photography almost since the inception of medical photography. Photographs are used for documentation of medical records and comparison of pre- and postoperative status. Digital photography allows instant picture viewing and printing as well as Web-based mailing and, as a result, it facilitates interconsultant communication between the dermatologist, surgeon, and pathologist during the surgical treatment of cutaneous neoplasms. Moreover, it enhances patient monitoring during long-term follow-up.

The present study was undertaken to evaluate and compare three surgical methods to relocate labial frena to a more apical position. Thirty patients with frenum insertion at the gingival margin were selected for the study. All had been peridontally treated prior to frenum surgery. Stone casts from rubber base impressions in individual trays were used to measure the differences in frenum insertion before surgery and 2, 12, 26 and 52 weeks afterwards. The surgical methods, each carried out in 10 cases, consisted of frenum excision, vestibular extension of Z-plasty. The results showed that a significant reduction of the frenum was obtained with all three methods used, although after 52 weeks, the difference between the pre- and postoperative status were most marked where Z-plasty had been carried out and least so after frenum excision. Post-surgical symptoms were most frequent after vestibular sulcus extension and fewest after frenum excision.