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Cardiac implantable electronic devices are now widely used worldwide and the numbers are increasing exponentially. Subsequently, long-term complications have increased. Transvenous lead-extraction (TLE) is the gold standard for removing infected devices, treating systemic device-related infections including endocarditis, and removing devices for other non-infectious complications. Most patients still require device therapy after TLE for several indications, including lifesaving defibrillation or pacing in pacemaker-dependent patients. The decision to reimplant is challenging, particularly when the primary cause for device removal includes device-related infections and patients frequently are pacemaker dependent. We aim to present our strategy for reimplanting after performing TLE in 88 consecutive patients. We performed transvenous removal of 150 pacemaker and defibrillator leads, of which 74% for local or systemic infection. We report a 99.3% clinical success after TLE. Out of 88 patients who had undergone TLE and after reanalysing the device indication, 67 patients (76%) still had indication for device removal, but three of them refused to undergo reimplant and 58 were re-implanted. Of the re-implanted patients, 58.6% were implanted on the contra-lateral side, 38% on the ipsilateral side and two patients who had been previously implanted with ICD were reimplanted with a subcutaneous implantable cardioverter defibrillator (S-ICD). Up to 34.4% of patients were re-implanted during the same TLE procedure, which was performed for device up-grade in patients with venous occlusion, 24% were implanted during the same hospital admission for TLE but not during TLE, and 41.3% were discharged and reimplanted afterwards. With this strategy for reimplantation, we report no re-infections and no device-removal-related arrhythmic major events or deaths during one-year follow-up. In conclusion, most patients still require device therapy after TLE. In patients with previous infection of the device, the reimplantation strategy should be carefully analyzed to prevent infection relapse and limit the consequences of the absence of the device. [ABSTRACT FROM AUTHOR]

Ureteral stenosis is typically seen in the setting of genitourinary tract manipulation or nephrolithiasis. Bilateral idiopathic ureteral stenosis is an exceedingly rare clinical entity that has been described in only a small number of cases. More specifically, we describe a case of idiopathic bilateral, distal ureteral stenosis resulting in hydronephrosis and deterioration of renal function in an adolescent patient. The patient was successfully treated with robotic bilateral ureteral implants. This case brings to light a rare, but clinically relevant, cause of hydronephrosis, highlights the importance of early intervention in minimizing renal dysfunction, and describes a novel treatment option.

Introduction Techniques and armamentarium for intentional replantation have varied throughout the years with no universally accepted clinical treatment guidelines. A wide range of success rates has been reported, and accordingly, this treatment method has often been regarded as a treatment of last resort. However, recent studies have shown more consistent success rates as high as 88% to 95%. In light of these new studies, intentional replantation may now be considered a more commonly accepted treatment modality. The purpose of this review was to critically examine reported techniques for intentional replantation. Methods A search of the literature on intentional replantation techniques was performed using electronic databases including PubMed, Medline, and Scopus. A total of 3183 articles were generated and screened for relevance based on defined inclusion and exclusion criteria. Subsequently, 27 studies were included for critical review of technique. Results There has been an evolution in technique for intentional replantation over the decades. Conclusions Numerous aspects of the procedure exhibit variations, whereas other aspects exhibit considerable consistency. Few studies reported techniques consistent with modern endodontic surgical principles. [ABSTRACT FROM AUTHOR]

Reimplant procedure is a treatment of choice to avulsed or exarticulation or total luxation of teethfrom their socket. Splint is a part of reimplant thats important in stabilized and immobilized tooth for the time needed to ensure the healing of periodontal membrane. This clinical report describes a simplified wire-composite splinting procedure of avulsed upper anterior teeth due to fall 10 days ago of10 years old, boy. He visited to Pediatric Dentistry clinic, Faculty of Dentistry Universitas Indonesiaaccompannied by his mother without any pain and also no dilaceration around his face. Intra oral examination shows socketsregion 11 and 21 filled of blood cloth, and teeth 13,12,22,23 in good position and immobile. Treatment planned isreimplant of teeth 11 and 21, andsplinting by ligature wire-composite from 13 to 23. Procedures treatment of avulsed teeth are endodontic extra oral, reimplant, and wire-composite splintusing SS wire 0.18 inch and self-adhesif composite resin. Periodicallycontrolpost-reimplant and the wire-composite splint areonce a week on the first month, then on the third and sixth month. The wire-composite splint removed at the sixthcheck-up or 4 month post-reimplant due to fixation of 11 and 21 was completed. The ligature wire bondedwith resin-based composite works well for splinting avulsed teeth, in a boy aged 10 years old, dueto avulsed teeth 10 days prior the trauma. [ABSTRACT FROM AUTHOR]

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Robot-assisted urologic surgeries have demonstrated safety and efficacy. While pioneered for urologic oncology cases, robot-assisted surgeries have subsequently been successfully applied in urologic pelvic reconstructive procedures. Robot assistance in reconstructive surgeries enables the surgeon's ability to handle delicate suturing, eliminating many challenges of pure laparoscopic suturing. Robotic technology also greatly improves visualization in the pelvis. Thus, robotics facilitates the possibility for minimally invasive techniques in reconstructive pelvic surgeries, reducing length of stay and blood loss and allowing faster recovery. As in all surgeries, positioning and setup contributes to the ease of the entire procedure. This article aims to discuss key points in robot-assisted bladder diverticulectomy, ureteral reimplants, urinary diversions, and repair of vesicovaginal fistulae. [ABSTRACT FROM AUTHOR]

PURPOSE: To investigate the effects of external gamma radiation on rat femoral artery reimplant. METHODS: Sixty-two male Wistar rats were distributed in two groups I (Control) and II (Irradiated), both formed by three observation subgroups: 2 (10 animals), 7 (11) and 21(10) postoperative days (PO). The right femoral artery of each animal was split up and reimplanted (end-to-end anastomosis), through microsurgery technique. In the first PO day group II animals were irradiated with a single dose of 15Gy, external source. The histological analysis, qualitative and descriptive analysis, was accomplished through hematoxylin and eosin (HE), Verhoeff and Masson trichromium methodology. Morphometric analysis was realized in the same slides used to histological analysis stained by HE. Computer software was used to quantify morphological alterations of the vascular wall, by processing captured images from a microscope. It was analyzed the intimal layer (intimal hyperplasia and endothelium cells formation) and the nuclei percentage of smooth muscular cell in the medium layer and in the intima hyperplasia. The data were treated applying the statistical tests: Fisher's exact, Chi-square, Mann-Whitney, Kruskal-Wallis and analysis of variance (p < .05). RESULTS: The patency graft was observed by microscope distal to the autograft in 93.5% (29/31). It was observed that the gamma-radiation reduced the degree of covering of the vascular wall for the neo-formed endothelium. The nuclei percentage of smooth muscular cells, in the media, was smaller compared to control animals, although it was no significant for the studied sample size. The irradiated group showed a significant lower luminal stenosis and the intimal hyperplasia occurrence. In this group the percentage of smooth muscular cells proliferation, in the media, were significantly lower for 7 and 21 days of observation. CONCLUSION: The external single dose of 15 Gy gamma-radiation delivered at first postoperative day may inhibit the endothelial cells regeneration and the percentage of lumen stenosis and prevents intimal hyperplasia, in the 2, 7 and 21 PO on femoral artery autograft in rats.

The da Vinci robot is being used for an increasing variety of reconstructive procedures. Robotic-assisted laparoscopic ureteral reconstruction is now performed routinely, and has been shown to have similar efficacy and safety profiles to open surgery in various studies. In this article, we focus on use of the robot to aid in distal ureteral reconstruction in the adult and pediatric population. Indications reviewed will include benign and malignant conditions. The appropriate pre-operative evaluation, the set-up of the operating room and patient positioning, the described techniques for ureteral reimplantation, and the appropriate post-operative care and follow-up will all be discussed. Literature for the past 10 years has been reviewed, and emphasis given to most recent publications and those describing novel approaches to using the robot for distal ureteral reconstruction. [ABSTRACT FROM AUTHOR]

Upper tract urothelial cancers account for 5% of all urothelial cancers. Among these, more than 90% of tumours are located in the renal pelvis, while ureteric tumours are extremely rare. The distal ureter is the most common location, although multifocal implants may also occur. Megaureter is a common cause of obstructive uropathy in neonates and children. Nevertheless, it may be unnoticed, if asymptomatic. Megaureter may be obstructing or refluxing. Long-standing urinary stasis and recurrent urinary tract infection in megaureter may cause chronic irritation of the ureteric mucosa leading to dysplasia and malignancy. We report a 55-year-old man diagnosed with bilateral obstructive megaureter with right lower ureteric urothelial cancer and review the current literature.

Avulsion cases reported in low percentage of dental accidents. When avulsion occurs, the permanence of the tooth in the socket, is forecasted for about10 years after being replanted. This forecast depends on the circumstances under which the reimplantation was performed and the duration of the tooth outside the alveolus. In the case presented, the left central incisor avulsed because of a karate chop to a 14 year old and the tooth lasted about 60 minutes out of the mouth, the patient kept the avulsed tooth under the tongue for the journey from the school to the dental office, where here he received canal treatment, and it was replanted and splinted for 15 days. It has been followed for 23 years, after which, external resorption observed radiographically in the following broad, clinically the tooth has no mobility and there is slight color change in the crown. [ABSTRACT FROM AUTHOR]

Introduction: There are many etiologies for bladder diverticulums such as infravesical obstruction, iatrogenic, or congenital defect. Regardless of the cause, it represents a bladder mucosa hernia. Clinical case: Six years old male with repeated UTI (Urinary Tract Infections), weak urinary stream, intermittency associated with pushing. USG with left ureteral ectasia located in the distal portion and bladder diverticulum. Cystogram with oval extra tissue in lateral lower side, with characteristics of a bladder diverticulum with little residual urine level. Left ureteral diverticulum resection and ureteral reimplantation is scheduled. Discussion: Hutch describes two types of bladder diverticulums (primary-secondary). Primaries: found in smooth wall bladders, appear isolated, they are intermittent and are found in children without infravesical obstruction. Secondary: they are multiple, always found in hypertrofic muscle wall bladders and are caused by infravesical obstruction predominantly in males. Its location is generally in the upper external side of the ureteral hiatus, it grows lateral and cranially oriented causing ureteral obstruction. If it later grows retrovesical, it moves the bladder to the front causing infravesical obstruction. Conclusion: The patient had an early diagnosis of a rare condition, with appropriate surgical treatment, which shows the decrease of comorbidities, providing proper urinary tract function. [ABSTRACT FROM AUTHOR]

New and often aggressive treatment schemes allow the successful healing of many young patients with cancer, but the price the young women have to pay is high: many of them lose ovarian function and fertility. Due to the improved long-term survival of adolescents and young women with malignancies undergoing gonadotoxic chemotherapy, preservation of future fertility has been the focus of recent ubiquitarian interest. A feasible solution is the cryopreservation of ovarian tissue. Ovarian tissue, after thawing, can be used in three different ways: 1. grafted into its normal site (orthotopic); 2. grafted into a site other than its normal position (heterotopic), necessitating recourse to in vitro fertilization (IVF); 3. grown and in vitro matured in order to obtain metaphase II oocytes for an IVF program. It is believed that protein supplementation, in cryopreservation solution, is essential for improving ovarian tissue cryopreservation. The aim of this study was to evaluate the ultrastructural appearance of human ovarian tissue cryopreserved in 1.5 M 1,2 propanediol (PROH), 0.2 M sucrose using different protein sources: fetal calf serum (FCS), plasmanate or syntetic serum substitute (SSS). Fresh and frozen/thawed ovarian tissues were compared by transmission electron microscope (TEM), to evaluate the appearance of stromal and follicle cells as affected by different protein sources. Our data indicate that FCS is a better protein support for ovarian tissue cryopreservation when compared to SSS or Plasmanate. In addition the follicles are more resistant to the cryopreservation with respect to stroma. [ABSTRACT FROM AUTHOR]

In the feedlot, there can be a decrease in dry matter intake (DMI) associated with reimplanting cattle that negatively affects growth performance. This study was conducted to determine the mechanisms causing a decrease in DMI after reimplanting and identify a strategy to mitigate the decrease. Crossbred steers ( n  = 200; 10 pens/treatment; initial bodyweight [BW] = 386 ± 4.9 kg) were used in a randomized complete block design experiment. Cattle were implanted with Revalor-IS on day 0. Treatments included a Revalor-200 implant on day 90 before feeding with the following management practices imposed: 1) steers were returned to their home pen immediately after reimplant (PCON); 2) steers were placed in pens and restricted from feed and water for 4 h (RES); 3) steers were walked an additional 805 m after reimplant and then returned home (LOC); 4) steers were restricted from feed and water for 4 h and walked an additional 805 m (RES + LOC); 5) steers were given an oral bolus of Megasphaera elsdenii (Lactipro; MS Biotec, Wamego, KS) and were restricted from feed and water for 4 h, and then walked an additional 805 m (LACT). One hundred steers were given an ear tag to record minutes of activity (ESense Flex Tags, Allflex Livestock Intelligence, Madison, WI). As a percentage of BW, DMI was 5% greater ( P  = 0.01) from reimplant to end for PCON vs. RES, LOC, and RES + LOC treatments. Likewise, as a percentage of BW, DMI was 6.6% greater ( P  = 0.03) from reimplant to end and 4.0% greater ( P  = 0.05) overall for the PCON treatment vs. the LOC treatment. Overall, DMI as a percentage of BW was 3.3% greater ( P  = 0.02) for PCON vs. RES, LOC, and RES + LOC treatments. There was an increase in G:F from reimplant to end ( P  = 0.05) for RES + LOC vs. the LACT treatment. From these data, we conclude that restricting cattle from feed and water for 4 h after reimplanting did not alter subsequent DMI. Increasing locomotion had the greatest negative effect on DMI and growth performance. Management strategies to decrease locomotion associated with reimplanting would be beneficial to DMI and overall growth performance of finishing beef steers., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Society of Animal Science.)

The objective of this study was to compare feedlot performance and carcass traits between two implant programs in heifers harvested at 3 different days on feed (DOF; 179, 200, or 221 d). Crossbred beef heifers (n = 3,084; 291 + 3.9 kg) were used in a 2×3 factorial arrangement of treatments in a randomized complete block design. Revalor-IH (80 mg TBA and 8 mg E2) was administered on arrival followed by Revalor-200 (200 mg TBA and 20 mg E2) 94 d before harvest (IH/200) or Revalor-XH (80 mg TBA and 8 mg E2, uncoated; 120 mg TBA and 12 mg E2, coated) was administered on arrival (XH). No implant × DOF interaction was detected (P ≥ 0.09) for any parameter. Heifers subjected to IH/200 had greater (P ≤ 0.01) final BW, ADG (P < 0.01) and G:F (P = 0.01). As DOF increased, BW increased (P ≤ 0.01) while ADG (P<0.01) and G:F (P ≤ 0.01) decreased. Hot carcass weight was greater (P = 0.01) for IH/200 compared with XH (367 vs. 361 kg, respectively). Heifers receiving XH had greater marbling scores (P = 0.02; 582 vs. 568) and BF (P = 0.01; 1.78 vs 1.70 cm) compared with IH/200 while re-implanted heifers had increased (P = 0.01) REA (86.5 vs. 83.2 cm2). Heifers implanted with XH tended to be fatter than those implanted with IH/200 having a greater (P = 0.01) proportion of USDA Prime and fewer (P<0.01) USDA Select. Increasing DOF increased (P ≤ 0.03) HCW, DP, BF, REA, marbling, and proportion of USDA Prime carcasses. Growth performance and HCW were increased for IH/200 compared with XH heifers. Increasing DOF resulted in poorer ADG and G:F but increased HCW. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the optimal time to reimplant following an initial implant on performance and carcass characteristics when steers were fed for 180 d. Crossbred steers (n = 800; initial BW = 330 ± 25 kg) were utilized in a generalized randomized block design and assigned randomly to pen, and pen assigned randomly to one of five treatments. Treatments included 5 different days on terminal (DOT) implant (160, 120, 100, 80 or 40 DOT). All steers were given an initial implant (80 mg trenbolone acetate (TBA) + 16 mg estradiol; Revalor-IS) on d 1. Terminal implant consisted of 200 mg TBA + 20 mg estradiol (Revalor-200). Dry matter intake was the least for 40 DOT (P ≤ 0.04), with no differences between the other treatments (P ≥ 0.11). Carcass-adjusted final BW responded quadratically (P = 0.03) with 100 DOT having the greatest final BW but was not different from 120 DOT (P = 0.82). Carcass-adjusted ADG and G:F responded quadratically (P = 0.02 and P < 0.01, respectively). When solved for the first derivative, carcass-adjusted ADG and G:F were maximized at 99 and 87 DOT, respectively. However, there was less than a 2% difference in carcass-adjusted ADG and G:F between 80 and 120 DOT. Hot carcass weight responded quadratically (P = 0.03), with the greatest HCW at 100 DOT. Solving for the first derivative, HCW was optimized at 104 DOT. There were no differences in back fat, marbling, or yield grade (P ≥ 0.27). Overall, administering an initial implant followed by a terminal implant 85 to 105 d prior to harvest increased gain, efficiency, and HCW in steers when fed for 180 d. Minimal changes in performance and carcass characteristics when steers are reimplanted 80 to 120 d prior to harvest suggests flexibility in reimplanting windows. [ABSTRACT FROM AUTHOR]

Objective: To examine whether long-term renal function and overall survival outcomes vary according to management approach for ureteral anastomotic stricture (UAS) after cystectomy and urinary diversion.Methods: We conducted a retrospective cohort study of patients with benign UAS following cystectomy and urinary diversion using our institutional database. We compared time to stricture, renal function, rates of renal loss, and overall survival between patients undergoing ureteral reimplantation vs. those undergoing nonoperative management (nephrostomy tube or ureteral stent). A multivariable Cox proportional hazard model was used to determine whether reimplantation was independently associated with overall survival.Results: We identified 87 UAS in 69 patients. Reimplantation was performed in 26 patients (37.7%), and 43 patients (62.3%) were managed nonoperatively. The interval between cystectomy and stricture diagnosis was similar in the reimplanted and nonoperative groups (3.06 vs. 4.34mo, P = 0.42). The differences between baseline and follow-up creatinine levels (+0.40 vs.+0.40mg/dl, P = 0.72) and estimated glomerular filtration rate (-25.0 vs.-18.9ml/min/1.73m2, P = 0.66) were similar between groups, as were rates of renal loss (34.6% vs. 39.5%, P = 0.68); however, mortality was significantly higher in the nonoperative group. After multivariable adjustment, overall survival remained significantly higher among UAS patients who underwent reimplantation (adjusted hazard ratio [aHR] for risk of death = 0.32, 95% CI: 0.13-0.80).Conclusion: Reimplantation was associated with improved overall survival but not with improved long-term renal functional outcomes compared with nonoperative management. Nonrenal complications of nonoperative UAS management may play an important role in reducing longevity. [ABSTRACT FROM AUTHOR]

Distal ureteral reconstruction is increasingly being performed by minimally-invasive surgical techniques. The robotic surgical platform provides an additional modality for repairing distal ureteral defects with the associated benefits of a minimally-invasive approach. This article reviews and describes the technical aspects of robotic distal ureteral reconstruction. In addition to discussion of the operative technique, factors such as patient selection, preoperative and postoperative evaluation, and published outcomes are addressed., (Copyright © 2013 Elsevier Inc. All rights reserved.)