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França MED, Amorim MDS, Sinhorim L, Santos GM, do Nascimento IB. Myofascial release strategies and technique recommendations for athletic performance: A systematic review. J Bodyw Mov Ther 2023; 36:30-37. [PMID: 37949575 DOI: 10.1016/j.jbmt.2023.04.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/28/2023] [Accepted: 04/22/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To identify the effects of instrument-assisted soft tissue mobilization (IASTM) and foam roller self-myofascial release (FRSMR) strategies and verify their results in athletic performance. METHOD Systematic review conducted in four databases from 2017. The inclusion criteria were randomized controlled trials assessing the effects of two forms of soft tissue mobilization on athletes' performance. The risk of bias was analyzed using the Cochrane Handbook scale. RESULTS Ten studies were included for qualitative analysis. IASTM increased range of motion, knee joint kinetic force, peak torque, and angular velocity in dorsiflexion and plantar flexion. The technique increases isometric strength and isokinetic power in vertical jumping. FRSMR was relevant in counter movement jumping between the pre- and post-intervention conditions, mainly by increasing strength in the initial jumping phase. CONCLUSIONS IASTM should be used in sports preparation to improve muscle response and explosive force production. FRSMR increases flexibility as it tends to restore tissue elasticity, but it does not improve aerobic activity. The suggested time for strategy intervention is at least 90 s per muscle group.
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Liu B, Kong Y, Alimi OA, Kuss MA, Tu H, Hu W, Rafay A, Vikas K, Shi W, Lerner M, Berry WL, Li Y, Carlson MA, Duan B. Multifunctional Microgel-Based Cream Hydrogels for Postoperative Abdominal Adhesion Prevention. ACS Nano 2023; 17:3847-3864. [PMID: 36779870 PMCID: PMC10820954 DOI: 10.1021/acsnano.2c12104] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Postoperative abdominal adhesions are a common problem after surgery and can produce serious complications. Current antiadhesive strategies focus mostly on physical barriers and are unsatisfactory and inefficient. In this study, we designed and synthesized advanced injectable cream-like hydrogels with multiple functionalities, including rapid gelation, self-healing, antioxidation, anti-inflammation, and anti-cell adhesion. The multifunctional hydrogels were facilely formed by the conjugation reaction of epigallocatechin-3-gallate (EGCG) and hyaluronic acid (HA)-based microgels and poly(vinyl alcohol) (PVA) based on the dynamic boronic ester bond. The physicochemical properties of the hydrogels including antioxidative and anti-inflammatory activities were systematically characterized. A mouse cecum-abdominal wall adhesion model was implemented to investigate the efficacy of our microgel-based hydrogels in preventing postoperative abdominal adhesions. The hydrogels, with a high molecular weight HA, significantly decreased the inflammation, oxidative stress, and fibrosis and reduced the abdominal adhesion formation, compared to the commercial Seprafilm group or Injury-only group. Label-free quantitative proteomics analysis demonstrated that S100A8 and S100A9 expressions were associated with adhesion formation; the microgel-containing hydrogels inhibited these expressions. The microgel-containing hydrogels with multifunctionality decreased the formation of postoperative intra-abdominal adhesions in a murine model, demonstrating promise for clinical applications.
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Affiliation(s)
- Bo Liu
- Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, NE, 68198, USA
- Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Yunfan Kong
- Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, NE, 68198, USA
- Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Olawale A. Alimi
- Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, NE, 68198, USA
- Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Mitchell A. Kuss
- Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, NE, 68198, USA
- Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Huiyin Tu
- Department of Emergency Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Wenfeng Hu
- Department of Emergency Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Abu Rafay
- Mass Spectrometry & Proteomics Core, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Kumar Vikas
- Mass Spectrometry & Proteomics Core, University of Nebraska Medical Center, Omaha, NE, 68198, USA
- Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Wen Shi
- Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, NE, 68198, USA
- Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Megan Lerner
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - William L. Berry
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Yulong Li
- Department of Emergency Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Mark A. Carlson
- Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE, 68198, USA
- Department of Surgery-General Surgery, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Bin Duan
- Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, NE, 68198, USA
- Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, 68198, USA
- Department of Surgery-General Surgery, University of Nebraska Medical Center, Omaha, NE, 68198, USA
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, 68588, USA
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Li M, Yin Z, Hu B, Guo N, Zhang L, Zhang L, Zhu J, Chen W, Yin M, Chen J, Ehman RL, Wang J. MR Elastography-Based Shear Strain Mapping for Assessment of Microvascular Invasion in Hepatocellular Carcinoma. Eur Radiol 2022; 32:5024-5032. [PMID: 35147777 DOI: 10.1007/s00330-022-08578-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/30/2021] [Accepted: 01/03/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate the potential of MR elastography (MRE)-based shear strain mapping to noninvasively predict the presence of microvascular invasion (MVI) in hepatocellular carcinoma (HCC). METHODS Fifty-nine histopathology-proven HCC patients with conventional 60-Hz MRE examinations (+/-MVI, n = 34/25) were enrolled retrospectively between December 2016 and October 2019, with one subgroup comprising 29/59 patients (+/-MVI, n = 16/13) who also underwent 40- and 30-Hz MRE examinations. Octahedral shear strain (OSS) maps were calculated, and the percentage of peritumoral interface length with low shear strain (i.e., a low-shear-strain length, pLSL, %) was recorded. For OSS-pLSL, differences between the MVI (+) and MVI (-) groups and diagnostic performance at different MRE frequencies were analyzed using the Mann-Whitney test and area under the receiver operating characteristic curve (AUC), respectively. RESULTS The peritumor OSS-pLSL was significantly higher in the MVI (+) group than in the MVI (-) group at the three frequencies (all p < 0.01). The AUC of peritumor OSS-pLSL for predicting MVI was good/excellent in all frequency groups (60-Hz: 0.73 (n = 59)/0.80 (n = 29); 40-Hz: 0.84; 30-Hz: 0.90). On further analysis of the 29 cases with all frequencies, the AUCs were not significantly different. As the frequency decreased from 60-Hz, the specificity of OSS increased at 40-Hz (53.8-61.5%) and further increased at 30-Hz (53.8-76.9%), and the sensitivity remained high at lower frequencies (100.0-93.8%) (all p > 0.05). CONCLUSIONS MRE-based shear strain mapping is a promising technique for noninvasively predicting the presence of MVI in patients with HCC, and the most recommended frequency for OSS is 30-Hz. KEY POINTS • MR elastography (MRE)-based shear strain mapping has the potential to predict the presence of microvascular invasion (MVI) in hepatocellular carcinoma preoperatively. • The low interface shear strain identified at tumor-liver boundaries was highly correlated with the presence of MVI.
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Affiliation(s)
- Mengsi Li
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University (SYSU), No 600, Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Ziying Yin
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bing Hu
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University (SYSU), No 600, Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Ning Guo
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University (SYSU), No 600, Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Linqi Zhang
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University (SYSU), No 600, Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Lina Zhang
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University (SYSU), No 600, Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Jie Zhu
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University (SYSU), No 600, Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Wenying Chen
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University (SYSU), No 600, Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Meng Yin
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jun Chen
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Richard L Ehman
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jin Wang
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University (SYSU), No 600, Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China.
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Gómez D, Cabrera LF, Pedraza M, Mendoza A, Pulido J, Villarreal R, Urrutia A, Sanchez-Ussa S, Saverio SD. Minimal invasive surgery for multiple adhesive small bowel obstruction: Results of a comparative multicenter study. CIR CIR 2021; 89:710-717. [PMID: 34851576 DOI: 10.24875/ciru.20000895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM OF THE STUDY Laparoscopic adhesiolysis in small bowel obstruction (SBO) is getting increasingly normal. In patients with multiple adhesive SBOs (MASBO), laparoscopic approaches might increase the risk of bowel injury due to the distended and potentially compromised small bowel. It remains a challenge to the surgeons, entails an interdisciplinary team, trying to achieve the least complications as possible. The study aimed to compare surgical outcomes of laparoscopic procedures (multi-port vs. single-port) in the management of MASBO. PATIENTS AND METHODS Comparative study of 68 patients with post-operative MASBO treated with Single-Port single incision laparoscopic surgery (SILS) and Multi-port Laparoscopic Surgery in two centers of Bogota, Colombia between January 2013 and June 2018. RESULTS All patients underwent laparoscopic management, 27 patients by SILS, and 41 patients by multi-port. The average surgical time in the multiport approach was 167 min versus SILS with 129 min. Laparoscopic intestinal resection was performed in 4.4% of patients, through multi-port using intracorporeal anastomosis. Mean hospital stay of 3.2 days for the SILS approach versus multi-port in 2.2 days. CONCLUSIONS Both laparoscopic approaches, in MASBO treatment is feasible in qualified hands. Patient selection and medical judgment seem to be the most essential factors for a positive result.
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Affiliation(s)
- Daniel Gómez
- Department of Advanced Laparoscopic Surgery, Centro Policlínico Olaya, Bogotá, Colombia.,Department of General Surgery, Cobos Medical Center, Bogotá, Colombia
| | - Luis F Cabrera
- Department of General Surgery, Cobos Medical Center, Bogotá, Colombia.,Department of Medicine, Universidad El Bosque, Bogotá, Colombia
| | - Mauricio Pedraza
- Department of General Surgery, Cobos Medical Center, Bogotá, Colombia.,Department of Medicine, Universidad El Bosque, Bogotá, Colombia
| | - Andres Mendoza
- Department of General Surgery, Cobos Medical Center, Bogotá, Colombia.,Department of Medicine, Universidad El Bosque, Bogotá, Colombia
| | - Jean Pulido
- Department of General Surgery, Cobos Medical Center, Bogotá, Colombia.,Department of Medicine, Universidad El Bosque, Bogotá, Colombia.,Surgery Department, Universidad El Bosque, Bogotá, Colombia
| | - Ricardo Villarreal
- Department of General Surgery, Cobos Medical Center, Bogotá, Colombia.,Department of Gastroenterology and Endoscopy, Cobos Medical Center, Bogotá, Colombia.,Department of Medicine, Universidad El Bosque, Bogotá, Colombia
| | - Andres Urrutia
- Department of General Surgery, Cobos Medical Center, Bogotá, Colombia.,Universidad Pedagógica y Tecnológica de Colombia, Tunja, Colombia
| | - Sebastian Sanchez-Ussa
- Department of General Surgery, Cobos Medical Center, Bogotá, Colombia.,Department of Medicine, Universidad El Bosque, Bogotá, Colombia
| | - Salomone Di Saverio
- Emergency and Trauma Surgery Unit, Maggiore Hospital Regional Emergency Surgery and Trauma Center-Bologna Local Health District, Bologna, Italy
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Yin Z, Lu X, Cohen Cohen S, Sui Y, Manduca A, Van Gompel JJ, Ehman RL, Huston J. A new method for quantification and 3D visualization of brain tumor adhesion using slip interface imaging in patients with meningiomas. Eur Radiol 2021; 31:5554-5564. [PMID: 33852045 DOI: 10.1007/s00330-021-07918-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/12/2021] [Accepted: 03/19/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To develop an objective quantitative method to characterize and visualize meningioma-brain adhesion using MR elastography (MRE)-based slip interface imaging (SII). METHODS This retrospective study included 47 meningiomas (training dataset: n = 35; testing dataset: n = 12) with MRE/SII examinations. Normalized octahedral shear strain (NOSS) values were calculated from the acquired MRE displacement data. The change in NOSS at the tumor boundary (ΔNOSSbdy) was computed, from which a 3D ΔNOSSbdy map of the tumor surface was created and the probability distribution of ΔNOSSbdy over the entire tumor surface was calculated. Statistical features were calculated from the probability histogram. After eliminating highly correlated features, the capability of the remaining feature for tumor adhesion classification was assessed using a one-way ANOVA and ROC analysis. RESULTS The magnitude and location of the tumor adhesion can be visualized by the reconstructed 3D ΔNOSSbdy surface map. The entropy of the ΔNOSSbdy histogram was significantly different between adherent tumors and partially/completely non-adherent tumors in both the training (AUC: 0.971) and testing datasets (AUC: 0.900). Based on the cutoff values obtained from the training set, the ΔNOSSbdy entropy in the testing dataset yielded an accuracy of 0.83 for distinguishing adherent versus partially/non-adherent tumors, and 0.67 for distinguishing non-adherent versus completely/partially adherent tumors. CONCLUSIONS SII-derived ΔNOSSbdy values are useful for quantification and classification of meningioma-brain adhesion. The reconstructed 3D ΔNOSSbdy surface map presents the state and location of tumor adhesion in a "clinician-friendly" manner, and can identify meningiomas with a high risk of adhesion to adjacent brain parenchyma. KEY POINTS • MR elastography (MRE)-based slip interface imaging shows promise as an objective tool to preoperatively discriminate meningiomas with a high risk of intraoperative adhesion. • Measurement of the change of shear strain at meningioma boundaries can provide quantitative metrics depicting the state of adhesion at the tumor-brain interface. • The surface map of tumor adhesion shows promise in assisting precise adhesion localization, using a comprehensible, "clinician-friendly" 3D visualization.
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Affiliation(s)
- Ziying Yin
- Department of Radiology, Mayo Clinic, 200 First St SW, Opus 2-149, Rochester, MN, 55905, USA.
| | - Xin Lu
- Department of Radiology, Mayo Clinic, 200 First St SW, Opus 2-149, Rochester, MN, 55905, USA
| | | | - Yi Sui
- Department of Radiology, Mayo Clinic, 200 First St SW, Opus 2-149, Rochester, MN, 55905, USA
| | - Armando Manduca
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Jamie J Van Gompel
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.,Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA
| | - Richard L Ehman
- Department of Radiology, Mayo Clinic, 200 First St SW, Opus 2-149, Rochester, MN, 55905, USA
| | - John Huston
- Department of Radiology, Mayo Clinic, 200 First St SW, Opus 2-149, Rochester, MN, 55905, USA
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Mooij R, Mwampagatwa IH, van Dillen J, Stekelenburg J. Association between surgical technique, adhesions and morbidity in women with repeat caesarean section: a retrospective study in a rural hospital in Western Tanzania. BMC Pregnancy Childbirth 2020; 20:582. [PMID: 33012289 PMCID: PMC7534160 DOI: 10.1186/s12884-020-03229-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 09/01/2020] [Indexed: 11/18/2022] Open
Abstract
Background The worldwide incidence of birth by Caesarean Section (CS) is rising. Many births after a previous CS are by repeat surgery, either by an elective CS or after a failed trial of labour. Adhesion formation is associated with increased maternal morbidity in patients with repeat CSs. In spite of large-scale studies the relation between the incidence of adhesion formation and CS surgical technique is unclear. This study aims to assess maternal and neonatal morbidity and mortality after repeat CSs in a rural hospital in a low-income country (LIC) and to analyse the effect of surgical technique on the formation of adhesions. Methods A cross-sectional, retrospective medical records study of all women undergoing CS in Ndala Hospital in 2011 and 2012. Results Of the 3966 births, 450 were by CS (11.3%), of which 321 were 1st CS, 80 2nd CS, 36 3rd CS, 12 4th and one 5th CS (71, 18, 8, 3 and 0.2% respectively). Adhesions were considered to be severe in 56% of second CSs and 64% of third CSs. In 2nd CSs, adhesions were not associated with closure of the peritoneum at 1st CS, but were associated with the prior use of a midline skin incision. There was no increase in maternal morbidity when severe adhesions were present. Adverse neonatal outcome was more prevalent when severe adhesions were present, but this was statistically non-significant (16% vs 6%). Conclusions Our results give insight into the practice of repeat CS in our rural hospital. Adhesions after CSs are common and occur more frequently after midline skin incision at 1st CS compared to a transverse incision. Reviewing local data is important to evaluate quality of care and to compare local outcomes to the literature.
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Affiliation(s)
- R Mooij
- Ndala Hospital, 15, Ndala, Tanzania. .,Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, The Netherlands.
| | - I H Mwampagatwa
- College of Health Sciences, University of Dodoma, 395, Dodoma, Tanzania
| | - J van Dillen
- Radboud University Medical Centre, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - J Stekelenburg
- Leeuwarden Medical Centre, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands.,University Medical Centre Groningen/University of Groningen, Antonius Deusinglaan 1, 9700 AD, Groningen, The Netherlands
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Boudreau C, LeVatte T, Jones C, Gareau A, Legere S, Bezuhly M. The Selective Angiotensin II Type 2 Receptor Agonist Compound 21 Reduces Abdominal Adhesions in Mice. J Surg Res 2020; 256:231-42. [PMID: 32711180 DOI: 10.1016/j.jss.2020.06.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/28/2020] [Accepted: 06/16/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Abdominal adhesions (AAs) are post-traumatic fibrous bands that connect visceral and/or peritoneal surfaces, leading to possible long-term complications. The effect of a novel antifibrotic selective angiotensin II type 2 receptor agonist, compound 21 (C21) on AA formation was assessed in a murine model. METHODS Female BALB/c mice were laparotomized and the cecum and overlying parietal peritoneum abraded. C21 (10 μg/kg) or saline (vehicle) were administered orally or intraperitoneally daily. Mice were sacrificed 8 days after surgery, adhesions graded, and peritoneal fluid collected for transforming growth factor (TGF)-β levels. Laparotomy incisions were excised for immunohistochemistry. In vitro, scratch assays were performed using primary parietal peritoneal fibroblasts and visceral mesothelial cells treated with C21 (10 μM), angiotensin II (1 μM), or both. Western blot analysis of primary cell lysates was performed for total and phosphorylated SMAD 2/3. RESULTS Oral and intraperitoneal C21 reduced AA formation and TGF-β levels in peritoneal fluid. Surgical incisions demonstrated decreased α-smooth muscle actin expression in C21-treated animals, but no difference in vascularity, macrophage infiltration, collagen I/III distribution and density, and dermal thickness. Migration and expression of phosphorylated SMAD 2/3 was reduced in parietal peritoneal fibroblasts and visceral mesothelial cells treated with C21. CONCLUSIONS Local and systemic C21 administration reduced or completely prevented AA formation. These findings may be attributed to decreased intraperitoneal TGF-β in vivo and decreased migration of peritoneal fibroblasts and visceral mesothelial cells. Importantly, C21 did not have histologically quantifiable effects on laparotomy wounds, suggesting C21 could reduce AA formation without compromising laparotomy healing.
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Abstract
Post-operative abdominal adhesions (PAA) are a condition that occurs in more than 90% of patients undergoing abdomen surgery; they can cause chronic abdominal pain, female infertility and repeated bowel obstruction, requiring repetitive surgical interventions causing morbidity and mortality, as well as high costs. The formation of the PAA is due to an imbalance between the fibrinogenesis and fibrinolysis in favor of the first, associated with tissue hypoxia secondary to aggression of the peritoneum, also due to the own inflammatory response and the increase in the population of adhesion fibroblasts which inhibit the degradation of the extracellular matrix and facilitate mature collagen and supporting connective tissue. The prevention of PAA will decrease secondary complications, as well as hospitalizations, surgeries and consequently, cost containment. The PAA pathophysiologic process allows establishing research strategies in order to prevent them.
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Affiliation(s)
| | - Eduardo Tena-Betancourt
- Bioterio y Cirugía Experimental. Facultad Mexicana de Medicina, Universidad La Salle, Ciudad de México, México
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Ito K, Araki H, Uchida T, Manabe Y, Miyazaki Y, Itoh H, Mishina M, Okuno H. Predictive factors and radiological findings of adrenohepatic adhesion during laparoscopic adrenalectomy. Investig Clin Urol 2020; 61:277-283. [PMID: 32377603 PMCID: PMC7189108 DOI: 10.4111/icu.2020.61.3.277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/03/2019] [Indexed: 02/04/2023] Open
Abstract
Purpose This retrospective study aimed to identify predictive factors and imaging features of adrenohepatic adhesion found during laparoscopic right adrenalectomy. Materials and Methods Altogether, 77 patients underwent laparoscopic right adrenalectomy between January 2005 and December 2018. Adrenohepatic adhesion was defined as strict adhesion that required either partial adrenalectomy with coagulation of residual tissue or partial hepatectomy to accomplish complete resection. We assessed their surgical video records to determine if adrenohepatic adhesion was present. Age, sex, body mass index, tumor size, tumor diagnosis and radiological findings (attachment between the liver and the adrenal gland, diameters of the right and left adrenal veins and its ratio) were evaluated as preoperative variables. Results Adrenohepatic adhesion was present in 11 of the 77 patients (14.3%). Age, sex, and body mass index were not statistically significant factors. Tumor size was significantly small in adhesion group (14.2 mm vs. 25.9 mm, p=0.02). Attachment to the liver and adrenal gland was frequently seen regardless of the adhesion. The mean right/left adrenal veins diameters ratio was significantly lower in the adhesion group (0.8 vs. 1.1, p=0.01). Multivariate logistic regression analysis demonstrated the right/left adrenal veins diameters ratio was the only significant predictor of adhesion. The sensitivity, specificity, negative predictive value and positive predictive value were 0.82, 0.76, 0.43, and 0.95 respectively when the optimal cutoff value for the ratio was 0.9 (area under the curve, 0.75; 95% confidence interval, 0.60–0.90). Conclusions The right/left adrenal veins diameters ratio was possible predictor of adrenohepatic adhesion.
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Affiliation(s)
- Katsuhiro Ito
- Department of Urology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Hiromasa Araki
- Department of Urology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Toshihiro Uchida
- Department of Urology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Yumi Manabe
- Department of Urology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Yu Miyazaki
- Department of Urology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Haruki Itoh
- Department of Urology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Mutsuki Mishina
- Department of Urology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Hiroshi Okuno
- Department of Urology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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Abstract
Normal function of the fingers and thumb depends on properly gliding flexor tendons and a free range of motion of the involved joints. This normal gliding function may be inhibited by adhesions due to damage of the tendon, tendon sheath and adjacent tissue. When digital function is still limited despite a long-term course of hand therapy and there are no signs of further improvement, surgical intervention should be considered. There are no absolute indications for tenoathrolysis of the flexor tendons. With respect to complications, such as secondary tendon rupture, loss of annular pulleys and scar formation, it is part of a stepwise reconstructive concept including further procedures, such as staged flexor tendon reconstruction. Important preconditions for tenoathrolysis are motivation of the patient, the possibility of readily available and frequent postoperative follow-up hand therapy, healed fractures and osteotomy, mature soft tissue, intact tendons and gliding tissue. Preoperatively, a maximum passive range of motion of the involved joints should be achieved. During the operative procedure all adhesive tissue surrounding the tendon within and outside the tendon sheath is consistently resected preserving the annular pulleys as far as possible. Therefore, extensive approaches, arthrolysis, dissolution of unfavorable scar tissue, resection of scarred lumbrical muscles and annular pulley reconstruction are frequently necessary. Salvage procedures, such as arthrodesis, amputation, ray resection or multistage flexor tendon reconstruction are recommended in failed cases and should be considered even preoperatively. In order to retain the intraoperative functional improvement hand therapy for at least 3-6 months should follow.
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11
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Cadena-Piñeros E, Parra-Charris JS. Radioguided Surgery of Non-palpable Neck Lymph Node in Lymphoma Patients. Indian J Otolaryngol Head Neck Surg 2019; 71:430-4. [PMID: 31750099 DOI: 10.1007/s12070-019-01591-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022] Open
Abstract
Lymphomas have frequent relapses; early diagnosis is important to treat and improve outcomes. Clinical exam and imaging are useful but confirmation with biopsy is always required. Minimally exploratory surgery is a tool to take good samples with precision and safety. Evaluate the use of ROLL technique to track non-palpable lesions on the neck which were suspicious of recurrence in lymphoma patients. A retrospective review of the patients with high probability of lymphoma relapse who were biopsied using ROLL technique. Suspicious lesions on the neck where identified on the follow up of five lymphoma patients. Roll technique was used successfully to guide the biopsy. There were no complications. Relapse was confirmed in two patients; the other three was reactive follicular hyperplasia. Management was redirected on relapsing patients. ROLL technique proved to be a simple, safe and effective method to detect and biopsy non- palpable lesions on the neck of patients with suspicious relapsing lymphoma.
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12
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Lee Y, Lee Y, Lee S, Jung S, Chon S. Correlation of preoperative biomarkers with severity of adhesion in endometriosis. J Gynecol Obstet Hum Reprod 2019; 49:101637. [PMID: 31520750 DOI: 10.1016/j.jogoh.2019.101637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/26/2019] [Accepted: 09/10/2019] [Indexed: 01/04/2023]
Abstract
This study was undertaken to evaluate the correlation between preoperative Serum markers and pelvic adhesions in endometriosis patients and to explore the markers' clinical value for outcome prediction. Preoperative blood Serum and CA 125 results were obtained and pelvic adhesion scores were calculated. The patient group with adhesion scores less than 28 points was defined as the mild adhesion group, and those with a score of 28 or more were members of the severe adhesion group. The CA 125 level was significantly higher in the severe adhesion group than in the mild adhesion group. The CA 125 level, size of the largest cyst, and WBC count were associated with the level of pelvic adhesion. Adhesion scores were significantly higher in the CA 125 ≥ 35 U/mL group than in the CA 125 < 35 U/mL group. Patients with a preoperative CA 125 level higher than 35 U/mL are at high risk for pelvic adhesion.
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Affiliation(s)
- Yoojung Lee
- Department of Obstetrics and Gynecology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Yaeheun Lee
- Department of Obstetrics and Gynecology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Seungho Lee
- Department of Obstetrics and Gynecology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.
| | - Sunyong Jung
- Department of Obstetrics and Gynecology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Seungjoo Chon
- Department of Obstetrics and Gynecology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
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González Porto SA, Domenech N, Blanco FJ, Centeno Cortés A, Rivadulla Fernández C, Álvarez Jorge Á, Sánchez Ibáñez J, Rendal Vázquez E. Intraneural IFG-1 in Cryopreserved Nerve Isografts Increase Neural Regeneration and Functional Recovery in the Rat Sciatic Nerve. Neurosurgery 2019; 85:423-431. [PMID: 30060164 DOI: 10.1093/neuros/nyy339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 06/25/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Insulin-like growth factor 1 (IGF-1) was found to stimulate Schwann cell mitosis. Exogenous IGF-1 may improve nerve regeneration after cryopreservation. OBJECTIVE To evaulate the effect of intraneural administration of IGF-1 in cryopreserved nerve isografts. METHODS Eighteen millimeter grafts were used for bridging an 18-mm defect in the rat sciatic nerve. A total of 57 rats were randomly divided into three groups: (1) autograft (Group 1); (2) cryopreserved isograft (Group 2); (3) cryopreserved isograft with intraneural IGF-1 administration (Group 3). 12 weeks after surgery, functional recovery (Sciatic functional index [SFI], Swing speed [SS], nerve conduction velocity [NCV], amplitude of compound motor action potentials [CMAP], and gastrocnemius muscle index [GMI]) and nerve regeneration (myelin sheath area, total fiber counts, fiber density, and fiber width) were all evaluated. RESULTS The intraneural injection of IGF-1 significantly improved SFI and SS at weeks 10 and 12. There were no statistical differences between Groups 1 and 3 in any of the SFI or SS evaluations. CMAP and NCV in Group 1 were significantly higher than in Groups 2 and 3, and Group 3 had significantly higher CMAP and NCV compared to Group 2. No significant differences were found in fiber width. The number of nerve fibers, percentage of myelinated fibers, fiber density, and GMI was significantly higher in Group 1 compared to Group 2, but no significant differences were found between Groups 1 and 3. CONCLUSION The results show that intraneural injection of IGF-1 in an 18 mm cryopreserved isograft improve axonal regeneration and functional recovery.
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Affiliation(s)
| | - Nieves Domenech
- Biobanco A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), Servicio Galego de Saúde (SERGAS), A Coruña, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Francisco J Blanco
- Grupo de Investigación de Proteómica-PBR2-ProteoRed/ISCIII-Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Servicio Galego de Saúde (SERGAS), Universidade da Coruña (UDC), A Coruña, Spain
| | - Alberto Centeno Cortés
- Centro Tecnológico de Formación XXIAC, Instituto de Investigacións Biomédicas de A Coruña (INIBIC), Servicio Galego de Saúde (SERGAS), A Coruña, Spain
| | - Casto Rivadulla Fernández
- Grupo de Neurociencia e Control Motor, NEUROcom, Facultade de Ciencias da Saúde, Departamento de Ciencias Biomédicas, Fisioterapia e Medicina, Instituto de Investigacións Biomédicas de A Coruña (INIBIC), A Coruña, Spain
| | - Ángel Álvarez Jorge
- Servicio de Cirugía Plástica, Complexo Hospitalario Universitario de A Coruña (CHUAC), Servicio Galego de Saúde (SERGAS), A Coruña, Spain
| | - Jacinto Sánchez Ibáñez
- Unidad de Criobiología, Banco de Tejidos, Complexo Hospitalario Universitario de A Coruña (CHUAC), Servicio Galego de Saúde (SERGAS), A Coruña, Spain
| | - Esther Rendal Vázquez
- Unidad de Criobiología, Banco de Tejidos, Complexo Hospitalario Universitario de A Coruña (CHUAC), Servicio Galego de Saúde (SERGAS), A Coruña, Spain
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14
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Wei XM, Feng GD, Gao ZQ. [The advance of materials for preventing adhesion in tympanoplasty]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2019; 54:550-553. [PMID: 31315367 DOI: 10.3760/cma.j.issn.1673-0860.2019.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
For otitis media patients with severe mucosal lesions, adhesion is the most common poor prognosis of tympanoplasty. We generally consider tympanic cavity adhesion is due to eustachian tube dysfunction and poor middle ear ventilation. The mechanism of adhesion is unclear so far, which we thought is mainly associated with wounded surface and activation of the fibrinolytic system. To solve the problem of adhesion, several materials have been used in the middle ear surgery, such as plastic sheet, silicone sheet and absorbable material. And there are some benefits. The most widely used is silicone sheet, and there are some researches focused on its thickness, shape and components to achieve better anti-adhesion effect. In this article, we will do a review for the research advances of anti-adhesion materials in tympanoplasty.
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Affiliation(s)
- X M Wei
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - G D Feng
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Z Q Gao
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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15
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Sebastian-Valverde E, Poves I, Membrilla-Fernández E, Pons-Fragero MJ, Grande L. The role of the laparoscopic approach in the surgical management of acute adhesive small bowel obstruction. BMC Surg 2019; 19:40. [PMID: 31014318 PMCID: PMC6480811 DOI: 10.1186/s12893-019-0504-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 04/09/2019] [Indexed: 12/18/2022] Open
Abstract
Background Postoperative adhesions represent 75% of all acute small bowel obstructions. Although open surgery is considered the standard approach for adhesiolysis, laparoscopic approach is gaining popularity. Methods A retrospective study with data from a prospectively maintained data base of all patients undergoing surgical treatment for adhesive small bowel obstruction (ASBO) from January 2007 to May 2016 was conducted. Postoperative outcomes comparing open vs laparoscopic approaches were analysed. An intention to treat analysis was performed. The aim of the study was to evaluate the potential benefits of the laparoscopic approach in the treatment of ASBO. Results 262 patients undergoing surgery for ASBO were included. 184 (70%) and 78 (30%) patients were operated by open and laparoscopic approach respectively. The conversion rate was 38.5%. Patients in the laparoscopic group were younger (p < 0.001), had fewer previous abdominal operations (p = 0.001), lower ASA grade (p < 0.001), and less complex adhesions were found (p = 0.001). Operative time was longer in the open group (p = 0.004). Laparoscopic adhesiolysis was associated with a lower overall complication rate (43% vs 67.9%, p < 0.001), lower mortality (p = 0.026), earlier oral intake (p < 0.001) and shorter hospital stay (p < 0.001). Specific analysis of patients with single band and/or internal hernia who did not need bowel resection, also demonstrated fewer complications, earlier oral intake and shorter length of stay. In the multivariate analysis, the open approach was an independent risk factor for overall complications compared to the laparoscopic approach (Odds Ratio = 2.89; 95% CI 1.1–7.6; p = 0.033). Conclusions Laparoscopic management of ASBO is feasible, effective and safe. The laparoscopic approach improves postoperative outcomes and functional recovery, and should be considered in patients in whom simple band adhesions are suspected. Patient selection is the strongest key factor for having success.
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Affiliation(s)
- Enric Sebastian-Valverde
- Department of Surgery, Hospital del Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain.
| | - Ignasi Poves
- Department of Surgery, Hospital del Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Estela Membrilla-Fernández
- Department of Surgery, Hospital del Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - María José Pons-Fragero
- Department of Surgery, Hospital del Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Luís Grande
- Department of Surgery, Hospital del Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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16
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Li JL, Hang YF. [Fornix reconstruction with conjunctival inclusion cyst marsupialization in severe symblepharon]. Zhonghua Yan Ke Za Zhi 2018; 54:897-901. [PMID: 30526788 DOI: 10.3760/cma.j.issn.0412-4081.2018.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Objective: To report the efficacy of fornix reconstruction with conjunctival inclusion cyst marsupialization in severe symblepharon. Methods: Retrospective cases series study. Four patients (4 eyes) with Conjunctival Inclusion Cyst Marsupialization and severe Symblepharon during June 2016 to June 2018 at the PLA General Hospital were included. All of them were treated with Conjunctival Inclusion Cyst Marsupialization. The morphology, depth of the conjunctival sac and the degree of symblepharon before and after treatment were compared to observe the surgical results. Results: After operation, the conjunctival sacs were deepened, and the average depth was 4.75 mm. After follow-up, 2 cases of conjunctival sac were basically normal, and 2 cases of conjunctival sac became shallow, but still better than before surgery. Conclusions: For the patients with large Conjunctival Inclusion Cyst and severe symblepharon, the Conjunctival Inclusion Cyst Marsupialization have many positive effects of deepening conjunctival sac, relieving symblepharon, increasing the degree of eye movement, improving appearance and relieving dry eyes. At the same time, this operation can avoid recurrence due to incomplete cystectomy. (Chin J Ophthalmol, 2018, 54: 897-901).
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Affiliation(s)
- J L Li
- The General Hospital of Chinese PLA, Medical School of Chinese PLA, Beijing 100853, China
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17
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Marchesini M, Flaviano E, Bellini V, Baciarello M, Bignami EG. Complication of epiduroscopy: a brief review and case report. Korean J Pain 2018; 31:296-304. [PMID: 30310555 PMCID: PMC6177533 DOI: 10.3344/kjp.2018.31.4.296] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/13/2018] [Accepted: 09/13/2018] [Indexed: 11/05/2022] Open
Abstract
Epiduroscopy is defined as a percutaneous, minimally invasive endoscopic investigation of the epidural space. Periduroscopy is currently used mainly as a diagnostic tool to directly visualize epidural adhesions in patients with failed back surgery syndrome (FBSS), and as a therapeutic action in patients with low back pain by accurately administering drugs, releasing inflammation, washing the epidural space, and mechanically releasing the scars displayed. Considering epiduroscopy a minimally invasive technique should not lead to underestimating its potential complications. The purpose of this review is to summarize and explain the mechanisms of the side effects strictly related to the technique itself, leaving aside complications considered typical for any kind of extradural procedure (e.g. adverse reactions due to the administration of drugs or bleeding) and not fitting the usual concept of epiduroscopy for which the data on its real usefulness are still lacking. The most frequent complications and side effects of epiduroscopy can be summarized as non-persistent post-procedural low back and/or leg discomfort/pain, transient neurological symptoms (headache, hearing impairment, paresthesia), dural puncture with or without post dural puncture headache (PDPH), post-procedural visual impairment with retinal hemorrhage, encephalopathy resulting in rhabdomyolysis due to a dural tear, intradural cyst, as well as neurogenic bladder and seizures. We also report for first time, to our knowledge, a case of symptomatic pneumocephalus after epiduroscopy, and try to explain the reason for this event and the precautions to avoid this complication.
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Affiliation(s)
- Maurizio Marchesini
- Unit of Pain Therapy, Salvatore Maugeri Foundation, Scientific Institute of Pavia, Pavia, Italy
| | - Edoardo Flaviano
- Anaesthesia, Intensive Care and Pain Therapy Service, Azienda Ospedaliera Universitaria Parma Hospital, Parma, Italy
| | - Valentina Bellini
- Anaesthesia, Intensive Care and Pain Therapy Service, Azienda Ospedaliera Universitaria Parma Hospital, Parma, Italy
| | - Marco Baciarello
- Anaesthesia, Intensive Care and Pain Therapy Service, Azienda Ospedaliera Universitaria Parma Hospital, Parma, Italy
| | - Elena Giovanna Bignami
- Department of Surgical Sciences, Azienda Ospedaliera Universitaria Parma Hospital, University of Parma, Parma, Italy
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18
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Kaya C, Alay I, Guraslan H, Gedikbasi A, Ekin M, Ertaş Kaya S, Oral E, Yasar L. The Role of Serum Caspase 3 Levels in Prediction of Endometriosis Severity. Gynecol Obstet Invest 2018; 83:576-585. [PMID: 30071521 DOI: 10.1159/000489494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 04/21/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS To identify the role of serum caspase 3, Annexin A2 (ANXA2), and Soluble Fas Ligand (sFasL) levels in the prediction of endometriosis severity. METHODS The study was performed on 90 women who were candidates for laparoscopic surgery due to endometrioma or any other benign ovarian cysts detected by ultrasound examination, pelvic pain, or infertility. The control group comprised 29 patients. The second group comprised 29 patients with stage I-II endometriosis and the third group comprised 30 patients with stage III-IV endometriosis. RESULTS Significant differences were detected between the control and stage III-IV endometriosis groups and between stage I-II and stage III-IV endometriosis groups in terms of caspase-3 levels (both, p < 0.001), ANXA2 levels (p = 0.007 and p = 0.002), and sFasL levels (p = 0.022 and p = 0.044). After receiver operating characteristic analysis, the area under curve was 93% (95% CI 57-82) at 10.7 ng/mL cut-off level for caspase-3 with 90% sensitivity and 87% specificity. CONCLUSION Serum caspase-3 level may be a reliable predictor of endometriosis severity.
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Affiliation(s)
- Cihan Kaya
- Department of Obstetrics and Gynecology, University of Health Sciences, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul,
| | - Ismail Alay
- Department of Obstetrics and Gynecology, University of Health Sciences, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Hakan Guraslan
- Department of Obstetrics and Gynecology, University of Health Sciences, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Asuman Gedikbasi
- Department of Obstetrics and Gynecology, University of Health Sciences, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Department of Biochemistry, Istanbul, Turkey
| | - Murat Ekin
- Department of Obstetrics and Gynecology, University of Health Sciences, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Sinem Ertaş Kaya
- Department of Obstetrics and Gynecology, VKV American Hospital, Istanbul, Turkey
| | - Engin Oral
- Department of Obstetrics and Gynecology, Istanbul University, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Levent Yasar
- Department of Obstetrics and Gynecology, University of Health Sciences, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Hartl TT, Ospina J, Janjua A. Silastic "Spring" Spacers for Use Following Endoscopic Sinus Surgery. Indian J Otolaryngol Head Neck Surg 2018; 71:233-237. [PMID: 31275836 DOI: 10.1007/s12070-018-1459-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022] Open
Abstract
The prevention of middle turbinate lateralization, and middle meatal synechiae formation, is the key to maintain a patent ostiomeatal complex following endoscopic sino-nasal surgery (ESS). Different techniques have been described to prevent this undesirable outcome, however, most of them are invasive, expensive, uncomfortable and/or obstructive. We present our technique to modified silastic sheets to circumvent these problems and improve ventilation and drainage of sinuses after surgery. The aim of this paper is to present how this silastic sheeting can be easily customized to the shape of the ethmoid cavity after ESS, allowing for ventilation of the aerated sinonasal cavities and at the same time preventing problematic synechiae/scar formation. A practical and easy technique to customize silastic stents following ESS is presented. Silastic sheets could be easily customized of the ethmoid cavity after ESS providing an excellent alternative to reduce middle turbinate lateralization and synechiae formation.
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Affiliation(s)
- Trevor T Hartl
- Department of Surgery, Otolaryngology - Head and Neck Surgery, University of British Columbia, 4th Floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9 Canada
| | - Javier Ospina
- Department of Surgery, Otolaryngology - Head and Neck Surgery, University of British Columbia, 4th Floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9 Canada
| | - Arif Janjua
- Department of Surgery, Otolaryngology - Head and Neck Surgery, University of British Columbia, 4th Floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9 Canada
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Abstract
Fractures of fingers and metacarpals are among the most frequent injuries. Many fractures can be successfully treated conservatively. Nevertheless, various malformations, such as malrotation, spur development, bone shortening, deviation of the axis and combinations of these individual deformities may appear in the course of time. Corrective osteotomy can correct these deformities with clinically impaired function and improve/optimize hand function. Prerequisites for corrective osteotomy are a precise analysis of the deformity, precise osteotomy, exercise stable osteosynthesis and intensive follow-up treatment of the hand. Complications, such as implant failure, postoperative tendon and joint adhesions, joint contracture and nonunion are however possible.
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Affiliation(s)
- Frank Unglaub
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland. .,Medizinische Fakultät Mannheim, Universität Heidelberg, Heidelberg, Deutschland.
| | - Martin F Langer
- Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - Julia M Unglaub
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
| | - Christian K Spies
- Handchirurgie, Vulpius Klinik, Vulpiusstr. 29, 74906, Bad Rappenau, Deutschland
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21
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Asuzu D, Pei KY, Davis KA. A simple predictor of post-operative complications after open surgical adhesiolysis for small bowel obstruction. Am J Surg 2018; 216:67-72. [PMID: 29548529 DOI: 10.1016/j.amjsurg.2018.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 02/23/2018] [Accepted: 02/28/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Small bowel obstruction is common and often requires surgical management. Simple preoperative models are lacking to predict post-operative complications after surgical management of adhesive small bowel obstruction. METHODS We retrospectively analyzed data from 15,036 patients who underwent open lysis of adhesions for small bowel obstruction from 2005 to 2013 using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. Predictors of post-operative complications were identified using logistic regression. Predictive models were compared using areas under the receiver operating characteristic curves (AUROC). RESULTS A three-parameter model was constructed, termed FAS: Functional status, American Society of Anesthesiologists (ASA) classification, and prior Sepsis. FAS predicted post-operative complications with odds ratio (OR) 1.11, 95% CI (1.10, 1.12), P < 0.001 and AUROC of 0.69, 95% CI (0.67, 0.70). CONCLUSIONS FAS predicts post-operative complications after open lysis of adhesions using three readily available clinical parameters.
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Affiliation(s)
- David Asuzu
- Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA; Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.
| | - Kevin Y Pei
- Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA; Section of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery, Yale School of Medicine, 20 York St, New Haven, CT, 06510, USA.
| | - Kimberly A Davis
- Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA; Section of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery, Yale School of Medicine, 20 York St, New Haven, CT, 06510, USA.
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22
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Kim YW, Kim IY. Comparison of the Short-Term Outcomes of Laparoscopic and Open Resections for Colorectal Cancer in Patients with a History of Prior Median Laparotomy. Indian J Surg 2017; 79:527-533. [PMID: 29217904 DOI: 10.1007/s12262-016-1520-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/28/2016] [Indexed: 01/30/2023] Open
Abstract
This study aimed to investigate the short-term outcomes of laparoscopic resection in comparison with those of open resection for colorectal cancer in patients with a history of prior median laparotomy (PML). Eighty-seven consecutive patients (87/1121, 7.8 %) with a history of PML who underwent major colorectal cancer resection were enrolled (laparoscopy, n = 40; open, n = 47). The conversion rate to open surgery was 25 % (n = 10). The laparoscopy group had a higher proportion of female patients (57.5 vs. 36.2 %), a lower rate of American Society of Anesthesiologists (ASA) score for physical status of ≥3 (7.5 vs. 25.5 %), and a lower pT4 tumor rate (15 vs. 38.3 %) than the open resection group. Regarding the reasons for PML, radical hysterectomy with extended lymphadenectomy for gynecologic cancer was more common (32.5 vs. 4.3 %), but gastrointestinal surgeries, such as gastrectomy and colectomy, were less frequent in the laparoscopy group. Regarding intraoperative outcomes, the laparoscopy group showed a similar operative time (197 vs. 204 min), intraoperative enterotomy rate (2.5 vs. 2.1 %), and bowel resection rate (2.5 vs. 2.1 %) with the open resection group. Regarding postoperative outcomes, the laparoscopy group showed a lower complication rate (20 vs. 40.4 %), significantly reduced time to soft diet (5 vs. 7 days), and shorter hospital stay (12 vs. 18 days). Despite the high rate of open conversion, favorable short-term outcomes were observed in the laparoscopic group. Laparoscopy may be chosen as the primary approach in selected patients with a history of non-gastrointestinal PML (prior abdominal surgery for gynecological cancer).
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Affiliation(s)
- Young Wan Kim
- Division of Gastrointestinal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju-si, Gangwon-do 26426 Republic of Korea
| | - Ik Yong Kim
- Division of Gastrointestinal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju-si, Gangwon-do 26426 Republic of Korea
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23
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Dokur M, Uysal E. Evaluation of botulinum toxin type A effectiveness in preventing postoperative intraperitoneal adhesions. Ann Surg Treat Res 2017; 93:50-56. [PMID: 28706891 PMCID: PMC5507791 DOI: 10.4174/astr.2017.93.1.50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/20/2017] [Accepted: 01/24/2017] [Indexed: 12/20/2022] Open
Abstract
Purpose Postoperative intraperitoneal adhesions (PIAs) are one of the most important problems surgeons have to face after laparotomies. In this study, we aimed to evaluate the effectiveness of local application of botulinum toxin type A (BoNT-A) in various dosages on the prevention of intra-abdominal adhesions in rats with experimental intra-abdominal adhesions. Methods Forty Wistar Albino female rats were randomly separated into 4 groups. The 4 groups were determined as follows: Control (group 1, n = 10); Sham (group 2, n = 10); 10-µg/kg low-dose BoNT-A (group 3, n = 10) and 30-µg/kg high-dose BoNT-A (group 4, n = 10). Subserosal injuries were created on the caecum of all rats. Laparotomy was performed on the fifth day. Adhesion scores, histopathological examination, and E-cadherin expression levels were evaluated. Results General adhesion scores for groups 1 and 2 were determined to be significantly high when compared to group 4 (P < 0.001). A significant difference was also determined between groups 3 and 4 in terms of general adhesion scores (P < 0.05). In pair comparisons, a significant decrease in high-dose BoNT-A group (group 4) when compared to groups 1 and 2 in terms of neovascularization, fibroblast density, collagen deposition and inflammatory cell count was determined (P < 0.05). Conclusion A significant decrease was observed only in postoperative PIAs in the high-dose BoNT-A group between all 4 rat-groups with experimentally created postoperative PIAs. In this study, high-dose BoNT-A is determined to be an effective agent in preventing postoperative PIAs.
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Affiliation(s)
- Mehmet Dokur
- Department of Emergency Medicine, Necip Fazil City Hospital, Kahramanmaras, Turkey
| | - Erdal Uysal
- Department of General Surgery, Sanko University School of Medicine, Gaziantep, Turkey
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Abstract
OBJECTIVE Completion lobectomy after radical segmentectomy is relatively rare, with no systematic evaluation of this challenging procedure. We aimed to clarify the details of this operation performed in 3 Japanese institutions. METHODS Completion lobectomy after segmentectomy in the same lobe was performed in 11 patients (9 lung cancers and 2 metastatic lung tumors) between 2007 and 2013. Surgical outcomes were analyzed retrospectively. RESULTS The 11 patients accounted for 1.37% of the 805 segmentectomies performed in the 3 institutions. The reasons for completion lobectomy were postoperative complications in the remaining lobe (n = 3), positive pathological lymph node metastasis found by permanent section (n = 3), and malignancy in the remaining lobe (n = 5). The patients were divided into two groups according the interval between segmentectomy and completion lobectomy: group A (3-35 days, n = 5) and group B (56-1470 days, n = 6). There was a tendency for more severe adhesions around the hilum (p = 0.061) in group B, resulting in increased operative bleeding (p = 0.055), more usage of fibrin glue (p = 0.080), and significantly longer operative time (p = 0.036). Injury to the pulmonary arteries was experienced only in group B (3/6 cases). There was no operation-related mortality. CONCLUSIONS Completion lobectomy may become more difficult approximately 5 weeks after segmentectomy, due to severe adhesions, but it can be performed safely with careful manipulation.
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Affiliation(s)
- Mitsugu Omasa
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoshihiro Miyata
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
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25
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Pei KY, Asuzu D, Davis KA. Will laparoscopic lysis of adhesions become the standard of care? Evaluating trends and outcomes in laparoscopic management of small-bowel obstruction using the American College of Surgeons National Surgical Quality Improvement Project Database. Surg Endosc 2016; 31:2180-2186. [PMID: 27585468 DOI: 10.1007/s00464-016-5216-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/23/2016] [Indexed: 01/19/2023]
Abstract
Small-bowel obstruction (SBO) is a common disorder and constitutes a significant healthcare burden. Laparoscopic lysis of adhesions (LLOA) for SBO is predicted to decrease complications, shorten hospital stay, and cut healthcare costs compared with the open lysis of adhesions (OLOA); however, large comparison studies are lacking. We evaluated the nationwide adoption of LLOA and compared outcomes with OLOA. We retrospectively analyzed data from 9920 OLOA and 3269 LLOA cases from 2005 to 2013 using the American College of Surgeons prospective National Surgical Quality Improvement Program data set. Annual trends were evaluated using linear regression. Surgery outcomes were compared using two-sample t tests or Mann-Whitney tests. Post-surgical complications were compared using multivariable logistic regression adjusting for comorbidities. The proportion of SBO cases treated by LLOA increased nationwide by 1.6 percent per year (R 2 0.87), from 17.2 % in 2006 to 28.7 % in 2013. Patients undergoing OLOA had longer operations (66 vs 60 min, P < 0.001), longer hospital stay (8.9 vs 4.2 days, P < 0.001), and higher post-surgical complication rates (adjusted odds ratio 2.73 95 % CI 2.36-3.15, P < 0.001) when compared to LLOA. Despite the lack of prospective randomized trials comparing LLOA to OLOA, we found progressive nationwide adoption of LLOA for SBO treatment. Our large retrospective analysis demonstrated clinical benefit and reduced resource utilization for LLOA.
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Affiliation(s)
- Kevin Y Pei
- Section of General Surgery, Trauma and Surgical Critical Care, Department of Surgery, Yale School of Medicine, 330 Cedar Street, BB310, New Haven, CT, 06510, USA. .,Yale School of Medicine, New Haven, CT, USA.
| | - David Asuzu
- Yale School of Medicine, New Haven, CT, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kimberly A Davis
- Section of General Surgery, Trauma and Surgical Critical Care, Department of Surgery, Yale School of Medicine, 330 Cedar Street, BB310, New Haven, CT, 06510, USA.,Yale School of Medicine, New Haven, CT, USA
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26
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Abstract
BACKGROUND Properly gliding flexor tendons is mandatory for the normal functioning of the finger and thumb. Any damage to tendons, tendon sheath or adjacent tissue can lead to the formation of adhesions that inhibit the normal gliding function. If adhesions limit the digital function and adequate hand therapy does not provide further progress, then surgical intervention should be considered. AIM The authors' strategy and treatment algorithm for flexor tenolysis are presented in the context of the current literature. METHODS There is no absolute indication for flexor tenolysis. The decision should be made in a motivated patient who has access to adequate postoperative hand therapy. It should be based on healed fractures and osteotomies, mature soft tissue coverage, intact tendons and gliding tissues, and a full range of passive flexion, and preferably extension of the affected joints. The principle of flexor tenolysis is the consequent resection of all adhesive tissue around the tendon inside and outside the tendon sheath, with preservation of as many pulley sections as possible. Therefore, extensive approaches are frequently necessary. Arthrolysis and the resolution of unfavorable scars, the resection of scarred lumbricals, and pulley reconstruction are additional procedures that are frequently performed. RESULTS In the literature, improvement in the range of motion is between 59 and 84 %. Good and excellent functional results are reported in 60-80 % of the cases. Nevertheless, in selected cases, functional deterioration occurs. Flexor tendon ruptures after tenolysis were observed in 0-8 % of the patients. DISCUSSION With regard to complications such as secondary tendon ruptures, loss of pulleys, and scar formation, flexor tenolysis is part of a reconstructive ladder that includes further procedures. In the case of failure or complications, salvage procedures such as arthrodesis, amputation, and ray resection or staged flexor tendon reconstruction including tendon grafting are recommended. After successful flexor tenolysis long-term hand therapy for at least 3-6 months is mandatory to maintain the intraoperative gain of function.
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Affiliation(s)
- T Pillukat
- Klinik für Handchirurgie Bad Neustadt an der Saale, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Deutschland.
| | - R Fuhrmann
- Klinik für Fußchirurgie Bad Neustadt an der Saale, Bad Neustadt an der Saale, Deutschland
| | - J Windolf
- Klinik für Unfall- und Handchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - J van Schoonhoven
- Klinik für Handchirurgie Bad Neustadt an der Saale, Salzburger Leite 1, 97616, Bad Neustadt an der Saale, Deutschland
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Calleja Aguayo E, Moreno Montero A, García Baglietto A, Hernández Calvarro AE, Bregante Ucedo J, Marhuenda Irastorza C. [Administration of water-soluble contrast for the treatment of adhesive intestinal occlusion]. Cir Pediatr 2015; 28:118-122. [PMID: 27775304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The water-soluble contrast has shown its effectiveness for the resolution of adhesive small bowel obstruction (SBO) in adults. The objective of this study is to compare the value of water-soluble contrast in children with SBO versus control group. METHODS We conducted a case-control trial. Patients with a history of abdominal surgery and SBO diagnosed between 2008 and 2013 were included as controls. Conservative treatment or surgery depending on clinical evolution was performed in control group. The patients with SBO diagnosed from December 2012 were treated with water-soluble contrast. The main variable was the number of patients requiring surgery and the hospital stay and complications were the secondary variable. RESULTS Twenty controls and 8 cases were admitted with SBO. Surgery was required in 50% of control group patients and 25% in the contrast group (p>0.05). The hospital stay length was 6 days in control group versus 4 days in study group (p>0.05). No complications were attributed to the use of water-soluble contrast and 20% of complications happened in control group. CONCLUSIONS The need for surgery was lower in study group but not statically significant due to the small size of the sample. We concluded that water-soluble contrast is safe and effective in the management of SBO in children. We propose a multicentre study.
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Affiliation(s)
- E Calleja Aguayo
- Servicio de Cirugía Pediátrica. Hospital Son Espases. Palma de Mallorca
| | - A Moreno Montero
- Servicio de Cirugía Pediátrica. Hospital Son Espases. Palma de Mallorca
| | | | | | - J Bregante Ucedo
- Servicio de Cirugía Pediátrica. Hospital Son Espases. Palma de Mallorca
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28
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Nikeghbalian S, Vafaei H, Moradian F, Kazemi K, Tanideh N, Shayan L, Nikeghbalian Z. Administration of Intravenous Inf liximab for Prevention of Peritoneal Adhesions Formation in Rats. Bull Emerg Trauma 2015; 3:97-103. [PMID: 27162911 PMCID: PMC4771249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 04/18/2015] [Accepted: 06/03/2015] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVES To investigate the effects of intravenous infliximab in preventing the formation of peritoneal adhesions in an animal model of rat. METHODS This was an experimental study being performed in animal laboratory of Shiraz University of Medical Sciences during 2012. Sixty albino rats were randomly assigned in to three groups by Random Design Method. The first group received single infliximab injection (n=20), the second one received double infliximab injection (n=20) and the third received nothing (n=20), after receiving intra-peritoneal injection of talc for induction of peritoneal adhesions. All the animals were sacrificed after 6 weeks and the peritoneal adhesions were evaluated according to Nair classification. RESULTS We observed that the mean adhesion grade was lower in those who received double dose of infliximib when compared to single dose and controls. However the difference did not reach a significant value (p=0.178). The grade of peritoneal adhesion was also comparable between the three study groups (p=0.103). The mean number of 1st WBC count was also comparable between three study groups (p=0.382). We observed that 2nd WBC count was also comparable between two study groups (p=0.317). CONCLUSION Administration of intravenous infliximab after intraabdominal surgicalprocedures would not prevent the formation of peritoneal adhesions in animal model of albino rat.
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Affiliation(s)
- Saman Nikeghbalian
- Department of Transplantation, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Homeira Vafaei
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farid Moradian
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kourosh Kazemi
- Animal Laboratory, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nader Tanideh
- Animal Laboratory, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Shayan
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Nikeghbalian
- Department of Anesthesiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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29
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Eren T, Boluk S, Bayraktar B, Ozemir IA, Yildirim Boluk S, Tombalak E, Alimoglu O. Surgical indicators for the operative treatment of acute mechanical intestinal obstruction due to adhesions. Ann Surg Treat Res 2015; 88:325-33. [PMID: 26029678 PMCID: PMC4443264 DOI: 10.4174/astr.2015.88.6.325] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 11/06/2014] [Accepted: 12/03/2014] [Indexed: 12/18/2022] Open
Abstract
Purpose Our aim was to investigate the predictive factors indicating strangulation, and the requirement for surgery in patients with acute mechanical intestinal obstruction due to adhesions. Methods This study retrospectively evaluated the records of patients with adhesive acute mechanical intestinal obstruction. The surgical treatment (group S), conservative treatment (group C), intraoperative bowel ischemia (group I), and intraoperative adhesion only (group A) groups were statistically evaluated according to the diagnostic and surgical parameters. Results The study group of 252 patients consisted of 113 women (44.8%), and 139 men (55.2%). The mean age was 62.79 ± 18.08 years (range, 20-98 years). Group S consisted of 50 patients (19.8%), and 202 (80.2%) were in group C. Group I consisted of 19 patients (38%), where as 31 (62%) were in group A. In group S, the prehospital symptomatic period was longer, incidence of fever was increased, and elevated CRP levels were significant (P < 0.05). Plain abdominal radiography, and abdominal computerized tomography were significantly sensitive for strangulation (P < 0.05). The elderly were more prone to strangulation (P < 0.05). Fever, rebound tendernes, and urea & creatinine levels were significantly higher in the presence of strangulation (P < 0.05, P < 0.05, and P < 0.05, consecutively). Conclusion Fever, rebound tenderness, urea & creatinine levels, plain abdominal radiography, and abdominal computerized tomography images were important indicators of bowel ischemia. Longer prehospital symptomatic period was related with a tendency for surgical treatment, and the elderly were more prone to strangulation. CRP detection was considered to be useful for the decision of surgery, but not significantly predictive for strangulation.
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Affiliation(s)
- Tunc Eren
- Department of General Surgery, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - Salih Boluk
- Department of General Surgery, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - Baris Bayraktar
- Department of General Surgery, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - Ibrahim Ali Ozemir
- Department of General Surgery, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - Sumeyra Yildirim Boluk
- Department of General Surgery, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - Ercument Tombalak
- Department of General Surgery, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - Orhan Alimoglu
- Department of General Surgery, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
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30
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Kim HM, Bae JY, Cho YJ, Kim MJ, Cha HH, Seong WJ. Vaginal adhesions in a woman with the history of dystocia. Obstet Gynecol Sci 2014; 57:70-2. [PMID: 24596821 DOI: 10.5468/ogs.2014.57.1.70] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 08/05/2013] [Accepted: 08/06/2013] [Indexed: 11/08/2022] Open
Abstract
Postpartum genital tract adhesions are unusual, and their cause has not been evaluated. However, severe dystocia and numerous pelvic examinations have been suggested as possible causes. Here, we report a case of vaginal adhesions following a difficult labor that presented as dyspareunia for 5 months. Pelvic examination and ultrasonography revealed a transverse vaginal septum that obstructed the vaginal cavity, and fluid collection proximal to this septum. The patient was successfully treated with surgical resection and administration of antibiotics.
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31
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Kim JY, Cho WJ, Kim JH, Lim SH, Kim HJ, Lee YW, Kwon SW. Efficacy and safety of hyaluronate membrane in the rabbit cecum-abdominal wall adhesion model. J Korean Surg Soc 2013; 85:51-7. [PMID: 23908960 PMCID: PMC3729986 DOI: 10.4174/jkss.2013.85.2.51] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 03/29/2013] [Accepted: 05/06/2013] [Indexed: 11/30/2022]
Abstract
Purpose Tissue adhesion is a well-known postsurgical phenomenon, causing pain, functional obstruction, and difficult reoperative surgery. To overcome these problems, various synthetic and natural polymer membranes have been developed as postoperative tissue adhesion barriers. However, limitation in their use has hindered its actual application. We prepared a hyaluronate membrane (HM) to evaluate its efficacy and safety as an adhesion barrier compared to a commercialized product (Interceed, Ethicon). Methods To evaluate the antiadhesion effect, a cecum-abdominal wall abrasion model was adopted in a rabbit. The denuded cecum was covered by Interceed or HM or neither and apposed to the abdominal wall (each, n = 10). Four weeks after surgery, the level of adhesion was graded. Acute and chronic toxicity of the three groups were also evaluated. Results Blood samples drawn to evaluate acute toxicity at postoperative day 3 and 7 showed no significant difference among the three groups. The grade and area of adhesion were significantly lower in the HM compared to those of the control and Interceed at four weeks after surgery. Histologic evaluations, which was carried out to estimate tissue reactions at the site of application, as well as to assess chronic toxicity for the major organs, were not significantly different in the three groups. Conclusion This study showed that the antiadhesion efficacy of HM was superior to commercialized antiadhesion membrane, Interceed. Low inflammatory response and nontoxicity were also demonstrated. From these results, we suggest that the HM is a good candidate as a tissue adhesion barrier.
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Affiliation(s)
- Jae Young Kim
- Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Kim JY, Joo SW, Sunwoo JH, Kim ES, Kim MJ, Tchah H. Lower energy to make a corneal flap with a 60 kHz femtosecond laser reduces flap inflammation and corneal stromal cell death but weakens flap adhesion. Korean J Ophthalmol 2013; 27:120-5. [PMID: 23543236 PMCID: PMC3596615 DOI: 10.3341/kjo.2013.27.2.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 06/27/2012] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare corneal flaps created in rabbits with a 60 kHz femtosecond (FS) laser using different levels of raster energy and to measure early inflammation, corneal stromal cell death, and late postoperative adhesion strength. Methods Sixty rabbits were divided into three groups of 20 each. A flap 110 µm thick and 9.0 mm in diameter was made in one eye of each rabbit at raster energies of 0.7 µJ, 1.1 µJ, and 2.4 µJ. Histopathological evaluation for inflammation and apoptosis using terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining was performed at 4 and 24 hours after flap creation. The adhesion strength of the flaps was measured with a tension meter at 1 and 3 months. Results Twenty four hours after flap creation, the 2.4 µJ group had more inflammatory and CD11b-positive cells than the 0.7 and 1.1 µJ groups. The number of TUNEL-positive cells increased with raster energy at 4 and 24 hours. The grams of force (gf) needed to detach the flaps at 3 months was significantly higher in 2.4 µJ group (170 gf) than in 0.7 µJ group (97.5 gf) and 1.1 µJ group (100 gf, p = 0.03). Conclusions Using raster energy lower than 1.1 µJ to make a flap with a 60 kHz FS laser decreases inflammatory cell infiltration and corneal stromal cell death in the central cornea but may result in a weaker flap than using higher raster energy (2.4 µJ).
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Affiliation(s)
- Jae Yong Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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