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Brinzeu A, Sindou M. Retrogasserian trigeminal radiofrequency-thermorhizotmoy for trigeminal neuralgia. Acta Neurochir (Wien) 2024; 166:209. [PMID: 38727725 PMCID: PMC11087336 DOI: 10.1007/s00701-024-06074-2] [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: 02/27/2024] [Accepted: 04/04/2024] [Indexed: 05/13/2024]
Abstract
Based on a personal experience of 4200 surgeries, radiofrequency thermocoagulation is useful lesional treatment for those trigeminal neuralgias (TNs) not amenable to microvascular decompression (idiopathic or secondary TNs). Introduced through the foramen ovale, behind the trigemnial ganglion in the triangular plexus, the needle is navigated by radiology and neurophysiological testing to target the retrogasserian fibers corresponding to the trigger zone. Heating to 55-75 °C can achieve hypoesthesia without anaesthesia dolorosa if properly controlled. Depth of anaesthesia varies dynamically sedation for cannulation and lesioning, and awareness during neurophysiologic navigation. Proper technique ensures long-lasting results in more than 75% of patients.
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Affiliation(s)
- A Brinzeu
- University of Lyon, Lyon, France.
- Neuroscience Research Centre, University of Pharmacy and Medicine Victor Babes Timisoara, Timișoara, Romania.
- Department of Neurosurgery, University of Pharmacy and Medicine Victor Babes Timisoara, Timișoara, Romania.
| | - M Sindou
- University of Lyon, Lyon, France
- ELSAN Clinique Breteché, Nantes, France
- Neuroscience Research Centre, University of Pharmacy and Medicine Victor Babes Timisoara, Timișoara, Romania
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Choi JY, Song TH, Suh JS. Outcome comparison of minimally invasive proximal and distal chevron Akin osteotomies in patients with severe hallux valgus deformity: A randomized prospective study. Int Orthop 2024:10.1007/s00264-024-06204-6. [PMID: 38705891 DOI: 10.1007/s00264-024-06204-6] [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] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/26/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE To date, the surgical treatment of severe hallux valgus deformity remains challenging despite the various methods presented. This study aimed to compare the effectiveness of minimally invasive distal chevron Akin osteotomies (d-MICA) and minimally invasive proximal chevron Akin osteotomies (p-MICA) in correcting severe hallux valgus deformities. METHODS This prospective follow-up study included patients randomly assigned to undergo p-MICA or d-MICA for hallux valgus deformities with a preoperative hallux valgus angle (HVA) ≥ 40° and/or a first to second intermetatarsal angle (IMA) ≥ 16°. After a minimum follow-up period of two years, we compared various clinico-radiographic parameters of patients whose HVA exceeded 15° at the final follow-up. RESULTS In the p-MICA and d-MICA groups, seven of 40 cases (17.5%) and 16 of 41 cases (39.0%), respectively, exhibited HVA > 15° at the final follow-up (P = 0.048). The preoperative parameters showed no significant differences. However, at the first weight-bearing assessment, the HVA, IMA, and relative second metatarsal length were significantly smaller, and the distal metatarsal articular angle (DMAA) was greater in the p-MICA group (all P < 0.05) compared with the d-MICA group. Postoperatively, both groups exhibited significant decreases in HVA and IMA at the final follow-up (P < 0.001 for all parameters). The p-MICA group showed no significant changes in DMAA and the relative length of the second metatarsal (P = 0.253 and 0.185, respectively). However, the d-MICA group showed a significant decrease in DMAA (P < 0.001) and an increase in the relative length of the second metatarsal at the final follow-up (P = 0.01). CONCLUSIONS p-MICA and d-MICA procedures demonstrated effective correction potential for severe hallux valgus deformities; however, the d-MICA procedure exhibited a notably higher incidence of unsatisfactory correction at the final follow-up than p-MICA. Therefore, d-MICA may be less predictable in achieving successful outcomes than p-MICA in treating severe hallux valgus deformities.
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Affiliation(s)
- Jun Young Choi
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, 170 Juhwa-Ro, Ilsanseo-Gu, Goyang-Si, Gyeonggi-Do, South Korea
| | - Tae Hun Song
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, 170 Juhwa-Ro, Ilsanseo-Gu, Goyang-Si, Gyeonggi-Do, South Korea
| | - Jin Soo Suh
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, 170 Juhwa-Ro, Ilsanseo-Gu, Goyang-Si, Gyeonggi-Do, South Korea.
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Williams-Clayson AM, Vane CH, Jones MD, Thomas R, Taylor C, Beriro DJ. Dermal absorption of high molecular weight parent and alkylated polycyclic aromatic hydrocarbons from manufactured gas plant soils using in vitro assessment. J Hazard Mater 2024; 469:133858. [PMID: 38493626 DOI: 10.1016/j.jhazmat.2024.133858] [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] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 03/19/2024]
Abstract
An enhanced in vitro human dermal bioavailability method was developed to measure the release of twenty parent and seven alkylated high molecular weight (HMW) polycyclic aromatic hydrocarbons (PAHs) from contaminated soils collected from five former manufactured Gas Plants (MGP) in England. GC-MS/MS was used to quantify HMW PAHs in soil, Strat-M artificial membrane representing skin, and synthetic receptor solution (RS) representing systemic circulation at 1-h, 10-h, and 24-h timesteps. Fluoranthene and pyrene exhibited the highest fluxes from soils to membrane (ranging from 9.5 - 281 ng/cm2/h) and soil to RS (
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Ravizzini PIC, Lino H, Fleury EDFC, Rangel DA, de Toledo LGM. Comparative analysis of ultrasound-guided percutaneous biopsy of native kidneys in children and adults using the free-flank supine antero-lateral decubitus positioning. Abdom Radiol (NY) 2024; 49:1638-1645. [PMID: 38658444 DOI: 10.1007/s00261-024-04316-6] [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: 12/27/2023] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE Ultrasound-guided percutaneous biopsy (USPB) of the native kidneys is the preferred diagnostic method for several nephrological conditions in both adult and pediatric populations. Conventionally, native kidney biopsies are conducted with patients in the prone position (PP). However, an alternative approach involving the supine oblique antero-lateral position (SALP) has been explored, particularly for individuals who are obese, elderly, or critically ill. METHODS This study aimed to assess the feasibility and outcomes of USPB performed in SALP with a Free-Flank setting (FF-SALP) in pediatric patients (Group A) compared to adults (Group B). Data from kidney biopsies conducted between 2008 and 2021 were gathered. The study focused on the safety and the prevalence of biopsy samples containing a minimum of 10 glomeruli, histopathological yield in both groups. RESULTS Complication rates were low in both groups (5.6% vs. 3.7%; p = 0.454), without major complications noted. The pediatric group achieved a significantly higher mean number of glomeruli per biopsy compared to the adult group (20.6 ± 12.3 vs. 15.7 ± 9.4; p < 0.001). However, when evaluating the minimum threshold of 10 glomeruli (76.3% vs. 68.5%; p = 0.072) and histopathologic yield (95.3% vs. 93.5%; p = 0.408), no differences were observed between groups. CONCLUSION USPB of native kidneys in the FF-SALP position is a safe and effective method for tissue sampling in patients with parenchymal disease. It demonstrated comparable diagnostic yields and complication rates in the pediatric and adult populations, providing advantages in terms of airway management, making it particularly useful for pediatric patients that require general anesthesia.
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Affiliation(s)
- Pedro Ivo C Ravizzini
- Department of Radiology, Faculty of Medical Sciences of Santa Casa de Misericordia de São Paulo, R. Jaguaribe, 155 - Vila Buarque, São Paulo, SP, 01224-001, Brazil.
- Department of Urology, Faculty of Medical Sciences of Santa Casa de Misericordia de São Paulo, São Paulo, Brazil.
| | - Henrique Lino
- Department of Radiology, Faculty of Medical Sciences of Santa Casa de Misericordia de São Paulo, R. Jaguaribe, 155 - Vila Buarque, São Paulo, SP, 01224-001, Brazil
| | - Eduardo de Faria Castro Fleury
- Department of Radiology, Faculty of Medical Sciences of Santa Casa de Misericordia de São Paulo, R. Jaguaribe, 155 - Vila Buarque, São Paulo, SP, 01224-001, Brazil
| | - Daniel Azevedo Rangel
- Department of Radiology, Faculty of Medical Sciences of Santa Casa de Misericordia de São Paulo, R. Jaguaribe, 155 - Vila Buarque, São Paulo, SP, 01224-001, Brazil
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Bürlukkara S, Kabalak AA, Ateş A, Baran Ö, Aykaç A, Özok HU. Comparative analysis of combined spinal-epidural anesthesia and general anesthesia in percutaneous nephrolithotomy: a prospective study on surgical team and operating room personnel satisfaction. World J Urol 2024; 42:262. [PMID: 38668757 PMCID: PMC11052852 DOI: 10.1007/s00345-024-04977-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 04/05/2024] [Indexed: 04/29/2024] Open
Abstract
OBJECTIVE We aimed to investigate the efficacy and complications of combined spinalepidural anesthesia and general anesthesia in percutaneous stone surgery prospectively. MATERIALS AND METHODS The study prospectively included patients who underwent percutaneous nephrolithotomy with general anesthesia (Group.1) or combined spinal-epidural anesthesia (Group.2) at the Department of Urology, Training and Research Hospital, Karabuk University. between December 2018 and December 2019. The effect of the anesthesia technique on the comfort and satisfaction of the operating room personnel, surgeon and anesthesia team were prospectively evaluated and recorded. RESULTS During the postoperative period, the spinal anesthesia group had a significantly lower visual analog score than the general anesthesia group. No patient in either group required narcotic analgesics during the postoperative period. In terms of overall satisfaction scores, the surgeon performing the surgical procedure had a significantly higher satisfaction score in the general anesthesia group than in the CSEA group. The score was considered good in the general anesthesia group and moderate in the CSEA group. Personnel satisfaction was higher in the patient group that underwent CSEA. In the general anesthesia group, the score was considered to be average. In the CSEA group, the satisfaction score was considered good, with a statistically significant difference (p < 0.05). The anesthesia team's satisfaction score was moderate, with no significant difference between the CSEA and general anesthesia groups (p > 0.05). CONCLUSION PCNL under CSEA can be performed safely in certain individuals. Different anesthetic techniques may have varied levels of satisfaction among the surgical team.
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Affiliation(s)
- Salih Bürlukkara
- Department of Urology, Karabuk University Medikal Faculty, Karabuk, Turkey.
| | - Afife Ayla Kabalak
- Department of Anesthesiology, Karabuk University Medikal Faculty, Karabuk, Turkey
| | - Alpay Ateş
- Department of Anesthesiology, Karabuk University Medikal Faculty, Karabuk, Turkey
| | - Özer Baran
- Department of Urology, Karabuk University Medikal Faculty, Karabuk, Turkey
| | - Aykut Aykaç
- Department of Urology, Eskişehir City Hospital, Eskişehir, Turkey
| | - Hakkı Uğur Özok
- Department of Urology, Karabuk University Medikal Faculty, Karabuk, Turkey
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Parvinian A, Thompson SM, Schmitz JJ, Welch BT, Hibbert R, Adamo DA, Kurup AN. Update on Percutaneous Ablation for Sarcoma. Curr Oncol Rep 2024:10.1007/s11912-024-01532-7. [PMID: 38647995 DOI: 10.1007/s11912-024-01532-7] [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] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW To provide an update on the current state of percutaneous thermal ablation in the treatment of sarcoma. RECENT FINDINGS Data continue to accrue in support of ablation for local control and palliation of specific sarcoma subtypes such as extra-abdominal desmoid fibromatosis and for broader indications such as the treatment of oligometastatic disease. The synergistic possibilities of various combination therapies such as cryoablation and immunotherapy represent intriguing areas of active investigation. Histotripsy is an emerging non-invasive, non-thermal ablative modality that may further expand the therapeutic arsenal for sarcoma treatment. Percutaneous thermal ablation is a valuable tool in the multidisciplinary management of sarcoma, offering a minimally invasive adjunct to surgery and radiation therapy. Although there remains a paucity of high-level evidence specific to sarcomas, ablation techniques are demonstrably safe and effective for achieving local tumor control and providing pain relief in select patients and are of particular benefit in those with metastatic disease or requiring palliative care.
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Affiliation(s)
- Ahmad Parvinian
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Scott M Thompson
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - John J Schmitz
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Brian T Welch
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Rebecca Hibbert
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Daniel A Adamo
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - A Nicholas Kurup
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
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Mastantuoni C, Martin NL, Tessitore E. Symptomatic lumbar Tarlov cyst resolution after computed tomography-guided percutaneous trans-sacral fibrin glue intracystic injection: A case report and literature review. Surg Neurol Int 2024; 15:137. [PMID: 38741984 PMCID: PMC11090592 DOI: 10.25259/sni_139_2024] [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: 02/26/2024] [Accepted: 03/27/2024] [Indexed: 05/16/2024] Open
Abstract
Background Perineural Tarlov cysts are extrathecal cerebrospinal fluid-filled cavities in the perineural recesses around dorsal spinal nerve roots. They are mostly asymptomatic but may occasionally cause back pain, radiculopathy, neurological deficits, and idiopathic intracranial hypotension. Case Description A 40-year-old female presented with a partial left foot drop attributed to a symptomatic L5 Tarlov cyst with an extension anterior to the sacrum. Following a computed tomography (CT)-guided percutaneous trans-sacral fibrin glue intracystic injection, the cyst was markedly reduced in size, and the patient's symptoms resolved. Conclusion Rarely, patients may present with symptomatic lumbar Tarlov cysts located anterior to the sacrum. Here, we present a patient whose left-sided foot drop resolved following the percutaneous trans-sacral CT-guided L5 intracyst injection of fibrin glue.
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Affiliation(s)
- Ciro Mastantuoni
- Division of Neurosurgery, P.O. Santa Maria Delle Grazie, Naples, Italy
| | | | - Enrico Tessitore
- Department of Neurology, Neurosurgery, Acute Medicine, Intensive Care Unit, Division of Neuroradiology (MIV), and EEG and Epilepsy Unit (SV), Geneva University Hospitals, Geneva, Switzerland
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Zahra W, Nayar SK, Bhadresha A, Jasani V, Aftab S. Safety of tranexamic acid in surgically treated isolated spine trauma. World J Orthop 2024; 15:346-354. [PMID: 38680673 PMCID: PMC11045465 DOI: 10.5312/wjo.v15.i4.346] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/07/2024] [Accepted: 03/19/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Tranexamic acid (TXA), a synthetic antifibrinolytic drug, effectively reduces blood loss by inhibiting plasmin-induced fibrin breakdown. This is the first study in the United Kingdom to investigate the effectiveness of TXA in the surgical management of isolated spine trauma. AIM To assess the safety of TXA in isolated spine trauma. The primary and secondary outcomes are to assess the rate of thromboembolic events and to evaluate blood loss and the incidence of blood transfusion, respectively. METHODS This prospective observational study included patients aged ≥ 17 years with isolated spine trauma requiring surgical intervention over a 6-month period at two major trauma centers in the United Kingdom. RESULTS We identified 67 patients: 26 (39%) and 41 (61%) received and did not receive TXA, respectively. Both groups were matched in terms of age, gender, American Society of Anesthesiologists grade, and mechanism of injury. A higher proportion of patients who received TXA had a subaxial cervical spine injury classification or thoracolumbar injury classification score > 4 (74% vs 56%). All patients in the TXA group underwent an open approach with a mean of 5 spinal levels involved and an average operative time of 203 min, compared with 24 patients (58%) in the non-TXA group who underwent an open approach with an average of 3 spinal levels involved and a mean operative time of 159 min. Among patients who received TXA, blood loss was < 150 and 150-300 mL in 8 (31%) and 15 (58%) patients, respectively. There were no cases of thromboembolic events in any patient who received TXA. CONCLUSION Our study demonstrated that TXA is safe for isolated spine trauma. It is challenging to determine whether TXA effectively reduces blood loss because most surgeons prefer TXA for open or multilevel cases. Further, larger studies are necessary to explore the rate, dosage, and mode of administration of TXA.
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Affiliation(s)
- Wajiha Zahra
- Trauma and Orthopedics Department, University Hospital of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, United Kingdom
| | - Sandeep Krishan Nayar
- Trauma and Orthopedics Department, Royal London Hospital, Barts Health Institute, London E1 1BB, United Kingdom
| | - Ashwin Bhadresha
- Trauma and Orthopedics Department, Royal London Hospital, Barts Health Institute, London E1 1BB, United Kingdom
| | - Vinay Jasani
- Craniospinal Services, University Hospital of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, United Kingdom
| | - Syed Aftab
- Spine Department, Royal London Hospital, Barts Health Institute, London E1 1BB, United Kingdom
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Habaza FR, Salem EH, Abdelwahab M, El-Sisi H, Baz H, Carrau RL, Rakha A. Endoscopic-Guided Suture Lateralization for Bilateral Vocal Fold Paralysis: Surgical Tips for Better Outcome. J Voice 2024:S0892-1997(24)00065-1. [PMID: 38604900 DOI: 10.1016/j.jvoice.2024.02.026] [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: 12/24/2023] [Revised: 02/01/2024] [Accepted: 02/27/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE This study aims to describe a precise description of suture lateralization (SL) technique and evaluate its effectiveness and safety in management of bilateral vocal fold paralysis (BVFP). METHOD A preclinical cadaveric study followed by application on a case series of BVFP patients. After the preliminary study executed to precisely localize the optimal sites for needle insertion, a prospective interventional study was conducted on 19 subjects presenting with respiratory distress due to BVFP. Data collection included their clinical presentation and a detailed assessment including auditory perceptual assessment, laryngoscopy (rigid or flexible), and video fluoroscopic swallowing study. RESULTS Widening of the inter-glottic distance at the site of the sutures was statistically significant (P < 0.001). Decannulation was achieved in three out of four tracheotomized patients. The suturing led to a significant difference in loudness, jitter, and harmonic-to-noise ratio (P = 0.042, 0.004, and ≤0.001, respectively). CONCLUSION This study suggests that SL is a feasible and effective technique with low incidence of adverse events and the potential of reversibility. Optimal localization of the suture insertion points translated into less intraoperative manipulation of the cords and shorter operative time.
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Affiliation(s)
- Fedaey R Habaza
- Department of Otolaryngology - Head and Neck Surgery, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Eman H Salem
- Department of Otolaryngology - Head and Neck Surgery, Mansoura University, Mansoura, Dakahlia, Egypt.
| | | | - Hossam El-Sisi
- Department of Otolaryngology - Head and Neck Surgery, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Hemmat Baz
- Phoniatric Unit, Department of Otolaryngology - Head and Neck Surgery, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Ricardo L Carrau
- Department of Otolaryngology - Head and Neck Surgery, Wexner Medical Center at The Ohio State University Columbus, Columbus, OH
| | - Abdelwahab Rakha
- Department of Otolaryngology - Head and Neck Surgery, Mansoura University, Mansoura, Dakahlia, Egypt
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Khandelwal RCS, Avhad T, Syed Z, Chaudhary A, Bhangde S. A Novel Approach to Grade 2 Closed Olecranon Fractures (Oestern and Tscherne Classification) Through Percutaneous Tension Band Wiring: A Case Report. J Orthop Case Rep 2024; 14:140-144. [PMID: 38681912 PMCID: PMC11043972 DOI: 10.13107/jocr.2024.v14.i04.4390] [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: 01/23/2024] [Revised: 02/15/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Olecranon fractures with compromised overlying skin such as superficial and deep abrasions and puncture wounds pose a challenge to manage as they are at a higher risk of wound and hardware-associated complications such as wound dehiscence, infection, gaping, and prominent hardware. Management of such fractures requires a holistic approach with special attention to the skin and soft tissues. Case Report This case highlights a 28-year-old male with a history of falls from a bike resulting in the right comminuted displaced olecranon fracture with multiple superficial abrasions which was managed with a thorough wound wash, antibiotics for 3 days after which percutaneous tension band wiring was performed through a 3 cm incision to prevent any wound complications. Rehabilitation and physical therapy were started immediately and the patient restored the complete range of motion at the elbow thus resuming his activities of daily living. Conclusion Utilizing a percutaneous technique for fixation in closed olecranon fractures with compromised overlying skin is considered an innovative, secure, dependable, and effective approach.
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Affiliation(s)
- R C S Khandelwal
- Department of Orthopaedics, B.Y.L Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Tanmay Avhad
- Department of Orthopaedics, B.Y.L Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Zafar Syed
- Department of Orthopaedics, B.Y.L Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Arif Chaudhary
- Department of Orthopaedics, B.Y.L Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Saurabh Bhangde
- Department of Orthopaedics, B.Y.L Nair Charitable Hospital, Mumbai, Maharashtra, India
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Bulut EC, Coşkun Ç, Koparal MY, Aydın U, Karabacak N. Could pain change position choice? Comparison of pain level, analgesic requirement and hospitalization time in supine and prone percutaneous nephrolithotomy. Int Urol Nephrol 2024; 56:1273-1280. [PMID: 37973696 DOI: 10.1007/s11255-023-03873-x] [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: 09/25/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Investigation of how position affects postoperative pain levels and hospitalization in patients undergoing percutaneous nephrolithotomy (PNL) surgery. METHODS Between August 2019 and December 2022, a total of 156 patients who underwent prone (pPNL) and supine percutaneous nephrolithotomy (sPNL) due to kidney stones were included in the study. Demographic data, preoperative CT scans, laboratory results, transfusion rates, operation durations, complication rates, stone-free rates, analgesic use, nephrostomy removal time, hospitalization duration, fluoroscopy time, hemoglobin decrease and postoperative Visual Analog Scale (VAS) scores were evaluated for all patients. By comparing these data between the sPNL and pPNL groups, the effect of position selection in PNL on pain control, analgesic requirement, and hospitalization duration was examined. RESULTS In the comparison of the pPNL and sPNL groups, there was a significant difference between the two groups in body mass index, hounsfield unit, complication rate, analgesic rate, nephrostomy remove time, hospitalization time, operation time, fluoroscopy time and VAS score (p = 0.025, p < 0.001, p = 0.012, p = 0.012, p < 0.001, p < 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). CONCLUSION The shorter operation and hospitalization time in the sPNL group could be attributed to performing surgeries in a physiological position. Additionally, sPNL seems advantageous in terms of patients' pain levels, hospitalization time and VAS scores. One reason for this could be the different areas of access in sPNL and pPNL, which may correspond to different dermatome regions. Considering the low level of pain and reduced analgesic usage, sPNL appears to be advantageous.
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Affiliation(s)
- Ender Cem Bulut
- Department of Urology, School of Medicine, Gazi University, Gazi Hastanesi Sağlık, Araştırma Ve Uygulama Merkezi, 12. Kat Üroloji Polikliniği, Ankara, Turkey
| | - Çağrı Coşkun
- Department of Urology, School of Medicine, Gazi University, Gazi Hastanesi Sağlık, Araştırma Ve Uygulama Merkezi, 12. Kat Üroloji Polikliniği, Ankara, Turkey.
| | - Murat Yavuz Koparal
- Department of Urology, School of Medicine, Gazi University, Gazi Hastanesi Sağlık, Araştırma Ve Uygulama Merkezi, 12. Kat Üroloji Polikliniği, Ankara, Turkey
| | - Uğur Aydın
- Department of Urology, Ağrı Research and Training Hospital, Ağrı, Turkey
| | - Nihat Karabacak
- Department of Urology, School of Medicine, Gazi University, Gazi Hastanesi Sağlık, Araştırma Ve Uygulama Merkezi, 12. Kat Üroloji Polikliniği, Ankara, Turkey
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Jensen CG, Dybdahl M, Valtersson J, Mussmann BR, Duus LA, Junker T, Pietersen PI, Lund L, Welch BT, Graumann O. Percutaneous Image-Guided Cryoablation of Endophytic Renal Cell Carcinoma. Cardiovasc Intervent Radiol 2024; 47:453-461. [PMID: 38483602 PMCID: PMC10997531 DOI: 10.1007/s00270-023-03633-5] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 11/22/2023] [Indexed: 04/07/2024]
Abstract
PURPOSE Endophytic renal cancer treatment is a challenge. Due to difficulties in endophytic tumor visualization during surgical extirpation, image-guided percutaneous cryoablation (PCA) is an attractive alternative. The minimally invasive nature of PCA makes it favorable for comorbid patients as well as patients in which surgery is contraindicated. Oncological outcomes and complications after PCA of endophytic biopsy-proven renal cell carcinoma (RCC) were reviewed in this study. MATERIALS AND METHODS Patients were included after a multidisciplinary team conference from January 2015 to November 2021. Inclusion criteria were endophytic biopsy-proven T1 RCC treated with PCA with one year of follow-up. Complications were reported according to the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification system and the Clavien-Dindo classification (CDC) system. Major complications were defined as a grade ≥ 3 according to the CDC. RESULTS Fifty-six patients were included with a total of 56 endophytic tumors treated during 61 PCA sessions. The median RENAL nephrometry score was 9 (IQR 2), and the mean tumor size was 25.7 mm (SD ± 8.9 mm). Mean hospitalization time was 0.39 (SD ± 1.1) days. At a mean follow-up of 996 days (SD ± 559), 86% of tumors were recurrence free after one PCA. No patients progressed to metastatic disease. According to the CIRSE classification, 10.7% (n = 6) had grade 3 complications, and 5.4% (n = 3) had CDC major complications. CONCLUSION This study demonstrates that PCA of endophytic biopsy-proven T1 RCC is safe with few major complications and excellent local tumor control rates at almost three-year mean follow-up. LEVEL OF EVIDENCE 3: Retrospective cohort study.
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Affiliation(s)
- Christian Greve Jensen
- Faculty of Health Sciences, Medicine, University of Southern Denmark (SDU), Odense, Denmark
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
| | - Marco Dybdahl
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
| | - John Valtersson
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
| | - Bo Redder Mussmann
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
- Department of Radiology, OUH, Odense, Denmark
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Louise Aarup Duus
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
- Department of Radiology, OUH, Odense, Denmark
| | - Theresa Junker
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
- Department of Urology, OUH, Odense, Denmark
| | - Pia Iben Pietersen
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
- Department of Radiology, OUH, Odense, Denmark
| | - Lars Lund
- Department of Urology, OUH, Odense, Denmark
| | - Brian T Welch
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Ole Graumann
- Faculty of Health Sciences, Medicine, University of Southern Denmark (SDU), Odense, Denmark.
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark.
- Department of Radiology, Aarhus University, Arhus, Denmark.
- Aarhus University, Arhus, Denmark.
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13
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Keister A, Duru O, Grossbach A, S. Xu D. A novel technique for decortication of the lumbar facet joints for posterolateral fusion with percutaneous exposure: A cadaveric feasibility study. World Neurosurg X 2024; 22:100290. [PMID: 38455246 PMCID: PMC10918256 DOI: 10.1016/j.wnsx.2024.100290] [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: 03/04/2023] [Revised: 01/07/2024] [Accepted: 02/20/2024] [Indexed: 03/09/2024] Open
Abstract
Background Percutaneous approaches to the spine have been explored recently for various procedures, including transforaminal lumbar interbody fusion. It is known that facet decortication leads to higher rates of fusion, but effective percutaneous approaches have not been well documented. There are a set of instruments used in the cervical spine for percutaneous decortication, the CORUS™ Spinal System-X (DI# 00852776006508), which may be useful in this setting. Our aim was to investigate the feasibility of decorticating the lumbar facet joints with these instruments in cadavers to aid in minimally invasive lumbar fusion. Methods We performed percutaneous facet joint decortication at each facet joint in the lumbar spine in two adult cadavers. We tested varying degrees of laterality for entry points and angulation for access at each level to optimize the innovative procedure. Results When using the CORUS™ Spinal System-X to obtain percutaneous access for facet decortication in the lumbar spine, we successfully dissected down to the facet joint without neurovascular injury. At the L1-L2 and L2-L3 levels, access was best obtained at 4 cm from midline with an angulation of 10°. At the L3-L4 and L4-L5 level, access was best obtained at 4 cm from midline with an angulation of 20°. Conclusions This study demonstrates that percutaneous lumbar facet joint decortication is feasible with the CORUS™ Spinal System-X instruments, and warrants further, comparative study in the clinical setting.
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Affiliation(s)
- Alexander Keister
- The Ohio State University College of Medicine, Columbus, OH, USA
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Olivia Duru
- The Ohio State University College of Medicine, Columbus, OH, USA
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Andrew Grossbach
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - David S. Xu
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
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14
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Mong ER, Kethireddy S, Staudt MD. Spinal Cord Stimulator Paddle Lead Revision and Replacement for Misplaced or Displaced Electrodes. World Neurosurg 2024:S1878-8750(24)00540-0. [PMID: 38561030 DOI: 10.1016/j.wneu.2024.03.154] [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: 03/04/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Spinal cord stimulators (SCSs) are commonly implanted via a laminotomy or laminectomy. Revision surgery may be necessary in instances of hardware failure or loss of efficacy. It is uncommon for leads to have been initially misplaced in a suboptimal position and revision in these cases necessitates additional dissection for appropriate repositioning. Accordingly, there is concern with a more extensive revision for a potentially higher risk of associated complications. This study aims to describe a series of patients with failed paddle SCS electrodes due to misplacement who underwent revision and replacement. METHODS Patients who underwent SCS paddle replacement for misplaced paddles between 2021 and 2023 were identified. Medical charts were reviewed for demographic data, operative details, and incidence of complications. RESULTS Sixteen patients underwent thoracic SCS paddle revision and replacement. The mean age was 59.6 ± 12.6 years, with 11 females and 5 males. Misplaced paddles were too lateral (n = 12), too high (n = 2), or incompletely within the epidural space (n = 2). The mean duration from initial implantation to revision surgery was 44.8 ± 47.5 months. The mean operative duration was 126.1 ± 26.9 minutes and all patients required a "skip" laminectomy or laminotomy. No complications were encountered. The mean length of follow-up was 18.4 ± 7.3 months. Mean preoperative pain intensity was 7.9 ± 1.5 and at last follow-up was 3.6 ± 1.7 (P < 0.001). All but 1 patient continued to use their device in follow-up. CONCLUSIONS The revision and replacement of misplaced paddle SCS electrodes is a feasible and durable revision strategy, even in long-term implants with extensive scarring.
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Affiliation(s)
- Eric R Mong
- Department of Neurosurgery, Beaumont Neuroscience Center, Royal Oak, Michigan, USA
| | - Saini Kethireddy
- Department of Neurosurgery, Beaumont Neuroscience Center, Royal Oak, Michigan, USA
| | - Michael D Staudt
- Department of Neurosurgery, Beaumont Neuroscience Center, Royal Oak, Michigan, USA; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
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15
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Chauhan BPS, Dholakia B, Khan A, Hirani C, Kumar S, Mahakul DJ, Katyal A, Nazir W, Singh D. Percutaneous femoral access: Stuck guide wire, decannulation difficulty due to unravelling and knotting. J Cerebrovasc Endovasc Neurosurg 2024:jcen.2024.E2023.06.002. [PMID: 38528441 DOI: 10.7461/jcen.2024.e2023.06.002] [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: 06/27/2023] [Accepted: 12/20/2023] [Indexed: 03/27/2024] Open
Abstract
Percutaneous techniques for femoral arterial access are increasingly being performed due to advances in endovascular cerebral procedures, as they provide a less morbid and minimally invasive approach than open procedures. Common complications associated with this peripheral puncture include hematoma, bleeding, pseudoaneurysm, arteriovenous fistula, retroperitoneal bleeding, inadvertent venous puncture, dissection, etc. The retrograde femoral access is currently the most frequently used arterial access as it is technically straightforward, allows for the use of larger size sheaths and catheters, allows repeated attempts, etc. Although being technically less challenging, grave complications can occur due to hardware failure. Here, we present a case of unruptured posterior inferior cerebellar artery (PICA) aneurysm, who underwent uneventful diagnostic cerebral digital substraction angiography (DSA) via right femoral artery route on first attempt, but on second attempt for therapeutic intervention, landed up with stuck guide wire and faced decannulation difficulty due to unravelling of guide wire and multiple knot formation, which was finally removed after multiple attempts at pulling and improvised manoeuvres. Such cannulation and decannulation difficulties have been reported multiple times for central venous access, but extremely rarely for femoral routes, making this case a rarity and worth reporting.
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Affiliation(s)
- Bhanu Pratap Singh Chauhan
- Department of Neurosurgery, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Binita Dholakia
- Department of Neurosurgery, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Ashfaque Khan
- Department of Neurosurgery, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Chirag Hirani
- Department of Neurosurgery, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Satheesh Kumar
- Department of Neurosurgery, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Dibya Jyoti Mahakul
- Department of Neurosurgery, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Abhishek Katyal
- Department of Neurosurgery, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Wajid Nazir
- Department of Neurosurgery, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Daljit Singh
- Department of Neurosurgery, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
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16
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Maisano F, Hahn R, Sorajja P, Praz F, Lurz P. Transcatheter treatment of the tricuspid valve: current status and perspectives. Eur Heart J 2024; 45:876-894. [PMID: 38426859 DOI: 10.1093/eurheartj/ehae082] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 01/13/2024] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Transcatheter tricuspid valve interventions (TTVI) are emerging as alternatives to surgery in high-risk patients with isolated or concomitant tricuspid regurgitation. The development of new minimally invasive solutions potentially more adapted to this largely undertreated population of patients, has fuelled the interest for the tricuspid valve. Growing evidence and new concepts have contributed to revise obsolete and misleading perceptions around the right side of the heart. New definitions, classifications, and a better understanding of the disease pathophysiology and phenotypes, as well as their associated patient journeys have profoundly and durably changed the landscape of tricuspid disease. A number of registries and a recent randomized controlled pivotal trial provide preliminary guidance for decision-making. TTVI seem to be very safe and effective in selected patients, although clinical benefits beyond improved quality of life remain to be demonstrated. Even if more efforts are needed, increased disease awareness is gaining momentum in the community and supports the establishment of dedicated expert valve centres. This review is summarizing the achievements in the field and provides perspectives for a less invasive management of a no-more-forgotten disease.
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Affiliation(s)
- Francesco Maisano
- Division of Cardiac Surgery and Valve Center, IRCCS Ospedale San Raffaele, Università Vita Salute, Via Olgettina 60, 20132 Milano, Italy
| | - Rebecca Hahn
- Department of Medicine, Columbia University Irving Medical Center, New York, 161 Fort Washington Avenue, 10032 New York, NY, USA
| | - Paul Sorajja
- Minneapolis Heart Institute at Abbott Northwestern Hospital, 920 East 28th Street, Suite 100, 55407 Minneapolis, MN, USA
| | - Fabien Praz
- Bern University Hospital, University of Bern, Anna-Seiler-Haus Freiburgstrasse 20, 3010 Bern, Switzerland
| | - Philipp Lurz
- Department of Cardiology, Universitätsmedizin Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz, Germany
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17
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Pakdel A, Asgari F, Bahri RA, Aghamir SMK. Segmental artery angioembolization as an efficient treatment modality for delayed hematuria with normal angiography: two case reports. J Med Case Rep 2024; 18:101. [PMID: 38468299 DOI: 10.1186/s13256-024-04431-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/02/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Percutaneous nephrolithotomy is the most commonly used modality for the removal of kidney stones larger than 2 cm in size. Like other stone removal methods, percutaneous nephrolithotomy also has some complications, including bleeding and delayed hematuria. These complications are improved with conservative management and bed rest most of the time. However, it may require more invasive treatments. Angioembolization following an abnormal renal angiography is an efficient treatment modality for delayed hematuria. Furthermore, nephrectomy is suggested in uncontrolled cases of delayed hematuria when renal angiography is normal. CASE PRESENTATION We described two cases of uncontrolled delayed hematuria after percutaneous nephrolithotomy and angioembolization were carried out rather than potential nephrectomies. The first case was a 61-year-old Iranian man with left kidney stones, for whom percutaneous nephrolithotomy was planned. The patient was referred to the hospital after discharge with massive hematuria and had normal angiographic findings. An angioembolization was suggested for the patient and was carried out. His hematuria was dramatically improved within 30 minutes, and his hemoglobin level started to increase 2 days later. The second case was a 53-year-old Iranian man with kidney stones who was a candidate for right kidney percutaneous nephrolithotomy. The patient was referred to the hospital 4 days after discharge with a decreased hemoglobin level and massive hematuria. The patient had normal angiographic findings and was planned for angioembolization to control his hemorrhage, which dramatically decreased after the angioembolization within 60 minutes. CONCLUSION Embolization of the segmental arteries of the targeted calyx can eliminate hematuria of the patient and prevent further nephrectomy.
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Affiliation(s)
- Alireza Pakdel
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fardin Asgari
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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18
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Wu C, Cao B, He G, Li Y, Wang W. Stereotactic ablative brachytherapy versus percutaneous microwave ablation for early-stage non-small cell lung cancer: a multicenter retrospective study. BMC Cancer 2024; 24:304. [PMID: 38448897 PMCID: PMC10916219 DOI: 10.1186/s12885-024-12055-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 02/26/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND To analyze the efficacy of stereotactic ablative brachytherapy (SABT) and percutaneous microwave ablation (MWA) for the treatment of early-stage non-small cell lung cancer (NSCLC). METHODS Patients with early-stage (T1-T2aN0M0) NSCLC who underwent CT-guided SABT or MWA between October 2014 and March 2017 at four medical centers were retrospectively analyzed. Survival, treatment response, and procedure-related complications were assessed. RESULTS A total of 83 patients were included in this study. The median follow-up time was 55.2 months (range 7.2-76.8 months). The 1-, 3-, and 5-year overall survival (OS) rates were 96.4%, 82.3%, and 68.4% for the SABT group (n = 28), and 96.4%, 79.7%, and 63.2% for MWA group (n = 55), respectively. The 1-, 3-, and 5-year disease-free survival (DFS) rates were 92.9%, 74.6%, and 54.1% for SABT, and 92.7%, 70.5%, and 50.5% for MWA, respectively. There were no significant differences between SABT and MWA in terms of OS (p = 0.631) or DFS (p = 0.836). The recurrence rate was also similar between the two groups (p = 0.809). No procedure-related deaths occurred. Pneumothorax was the most common adverse event in the two groups, with no significant difference. No radiation pneumonia was found in the SABT group. CONCLUSIONS SABT provided similar efficacy to MWA for the treatment of stage I NSCLC. SABT may be a treatment option for unresectable early-stage NSCLC. However, future prospective randomized studies are required to verify these results.
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Affiliation(s)
- Chuanwang Wu
- Department of Interventional Medicine,The Second Hospital of Shandong University, Institute of Tumor Intervention,Cheeloo college of medicine, Shandong University, Jinan City, Shandong Province, China
- Department of Fifth Internal Medicine, People's Hospital of Shizhong District, No.156 Jiefang Road, Zaozhuang City, Shandong Province, China
| | - Binglong Cao
- Department of Oncology, Qufu Hospital of Traditional Chinese Medicine, No.129 Canggeng Road, Qufu City, Shandong Province, China
| | - Guanghui He
- Department of Interventional Medicine, Weifang Second People's Hospital, Weifang city, Shandong Province, China
| | - Yuliang Li
- Department of Interventional Medicine,The Second Hospital of Shandong University, Institute of Tumor Intervention,Cheeloo college of medicine, Shandong University, Jinan City, Shandong Province, China
| | - Wujie Wang
- Department of Interventional Medicine,The Second Hospital of Shandong University, Institute of Tumor Intervention,Cheeloo college of medicine, Shandong University, Jinan City, Shandong Province, China.
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19
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Al Adas Z, Uceda D, Mazur A, Zehner K, Agrusa CJ, Wang G, Schneider DB. Safety and learning curve of percutaneous axillary artery access for complex endovascular aortic procedures. J Vasc Surg 2024; 79:487-496. [PMID: 37918698 DOI: 10.1016/j.jvs.2023.10.048] [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: 08/29/2023] [Revised: 10/20/2023] [Accepted: 10/27/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Percutaneous axillary artery access is increasingly used for large-bore access during interventional vascular and cardiac procedures. The aim of this study was to evaluate the safety and learning curve of percutaneous axillary artery access in patients undergoing complex endovascular aortic repair (fenestrated and branched endovascular aneurysm repair [FBEVAR]) requiring large-bore upper extremity access and to discuss best practices for technique and complication management. METHODS One-hundred forty-six patients undergoing large-bore percutaneous axillary artery access during FBEVAR in a prospective, nonrandomized, Investigational Device Exemption study between September 2017 and January 2023 were analyzed. Ultrasound guidance and micropuncture were used to access the second portion of the axillary artery and 2 Perclose Proglide or Prostyle devices (Abbott Vascular) were predeployed before the insertion of the large-bore sheath. Completion angiography was performed in all patients to verify hemostatic closure. Axillary artery patency was also assessed on follow-up computed tomography angiography. Patient-related, procedural, and postoperative variables were collected and analyzed. RESULTS One-hundred forty-five patients underwent successful percutaneous axillary artery access; 1 patient failed axillary access and alternative access was established. The left axillary artery was accessed in 115 patients (79%), and the right axillary artery was accessed in 30 patients (21%). The largest profile sheath was 14 F in 4 patients (2.8%), 12F in 133 patients (91.7%), and 8F in 8 patients (5.5%). Ten patients (6.9%) required covered stent placement (Viabahn, W. L. Gore & Associates) for failure to achieve hemostasis; there were no conversions to open surgical repair. Additional adverse events included transient upper extremity weakness in two patients (1.3%) and transient upper extremity paresthesias in two patients (1.3%). Three patients (2%) suffered postoperative strokes, including one unrelated hemorrhagic stroke and two possibly access-related embolic strokes. On follow-up, axillary artery patency was 100%. There was a trend toward decreased closure failure over time, with seven patients (10%) in the early cohort and three (4%) in the late cohort. There was a significant negative correlation between the cumulative complication rate and the cumulative experience. CONCLUSIONS Large-bore percutaneous axillary artery access provides safe upper extremity large-bore access during FBEVAR, achieving successful closure in >90% of patients with a low incidence of access-related complications. There was a trend toward better closure rates with increasing experience, suggesting a learning curve effect. Application of best practices including ultrasound guidance and angiography may ensure safe application of the technique of percutaneous large-bore axillary artery access.
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Affiliation(s)
- Ziad Al Adas
- Division of Vascular and Endovascular Therapy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Domingo Uceda
- Division of Vascular and Endovascular Therapy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Alexa Mazur
- Division of Vascular and Endovascular Therapy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Kiera Zehner
- Division of Vascular and Endovascular Therapy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Christopher J Agrusa
- Division of Vascular Surgery, New York-Presbyterian Hospital/Weill, Cornell Medical Center, New York, NY
| | - Grace Wang
- Division of Vascular and Endovascular Therapy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Darren B Schneider
- Division of Vascular and Endovascular Therapy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
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Noy R, Shkedy Y, Simchon O, Gvozdev N, Roimi M, Miller A, Epstein D. Impact of radiological surveillance for major blood vessels on complications of percutaneous dilatational tracheostomy: A retrospective cohort study. Am J Otolaryngol 2024; 45:104146. [PMID: 38101131 DOI: 10.1016/j.amjoto.2023.104146] [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: 11/29/2023] [Accepted: 12/03/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE Percutaneous dilatational tracheostomy (PDT) is the preferred method for managing long-term ventilator-dependent patients in ICUs. This study aimed to evaluate the association between preprocedural screening (ultrasound Doppler [USD] or computed tomography [CT]) for major neck blood vessels and complications in ICU patients undergoing PDT. MATERIALS AND METHODS This was a retrospective cohort study of patients who underwent PDT between 2012 and 2023 at a tertiary referral center. We performed a multivariable analysis and created a propensity-matched cohort. The primary outcome was bleeding within the first seven days after PDT. Secondary outcomes included early and late PDT complications and PTD-related mortality. RESULTS A total of 1766 consecutive critically ill patients hospitalized at a tertiary academic hospital were evaluated for PDT. Of these, 881 (49.9 %) underwent only physical examination before PDT, while 885 (50.1 %) underwent additional imaging (CT/USD). A higher proportion of patients in the imaging group were referred to open surgery due to suspected major blood vessels interfering with the procedure (6.2 % vs. 3.0 %, p = 0.001). Among the 1685 patients who underwent PDT, there was no significant difference in the rate of early bleeding between the physical examination group and the imaging group (4.6 % vs. 6.3 %, p = 0.12). Similarly, the overall early complication rates (5.5 % vs. 7.6 %, p = 0.08), late complication rates (1.6 % vs. 2.2 %, p = 0.42), and PDT-related mortality rates (0.7 % vs. 0.6 %, p = 0.73) did not exhibit significant differences between the two groups. In a propensity score-matched cohort, results remained consistent. CONCLUSIONS Physical examination can effectively identify major neck blood vessels without increasing the risk of bleeding during and after PDT.
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Affiliation(s)
- Roee Noy
- Department of Otolaryngology-Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
| | - Yotam Shkedy
- Department of Otolaryngology-Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Omri Simchon
- Department of Anesthesiology, Rambam Health Care Campus, Haifa, Israel
| | - Natalia Gvozdev
- Department of Otolaryngology-Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Michael Roimi
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Critical Care Division, Rambam Health Care Campus, Haifa, Israel
| | - Asaf Miller
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Medical Intensive Care Unit, Rambam Health Care Campus, Haifa, Israel
| | - Danny Epstein
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Critical Care Division, Rambam Health Care Campus, Haifa, Israel
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21
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Alzubaidi S, Wallace A, Naidu S, Knuttinen MG, Kriegshauser SJ, Oklu R, Al-Ogaili M, Patel I. Single-arm prospective study comparing ablation zone volume between time zero and 24 h after microwave ablation of liver tumors. Abdom Radiol (NY) 2024:10.1007/s00261-024-04185-z. [PMID: 38400983 DOI: 10.1007/s00261-024-04185-z] [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: 11/20/2023] [Revised: 01/02/2024] [Accepted: 01/07/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE Percutaneous thermal ablation is an effective treatment for primary and metastatic liver tumors and is a recommended local therapy for early-stage hepatocellular carcinoma (HCC). Reported evidence shows an increase in the ablation zone volume over the first 24-h post-liver ablation. This report compares ablation zone volumes immediately at the completion (T = 0) of 26 microwave ablations of liver tumors to 24-h post-procedure (T = 24) volumes. MATERIALS AND METHODS 20 patients, 13 (65%) males, underwent a total of 26 hepatic microwave ablations (MWA) under ultrasound guidance. Contrast-enhanced CT (CECT) or MRI was performed immediately and another CECT 24 h post operatively. Evaluation of the ablation zone and comparison of the two post-operative scans were done using BioTrace software. The expansion of ablation zones on post-op CECTs was matched point by point per direction. The distance between each 2 points was measured and grouped by distance. The incidence of each specific distance was then converted into a percentage, first for each case separately, then for all cases altogether. Data were tested by a matched paired one-sided t test. RESULTS The median lesion diameter was 1.5 cm (range 0.5-3.3) with 16 (62%) HCC cases and 9 hepatic metastases (4 neuroendocrine carcinoma, 4 colorectal carcinomas, 1 breast carcinoma, 1 pancreatic cancer). The data show a consistent volume expansion greater than 30% (p = 7.7e-5) 24-h post-ablation, where the median expansion is 57%. Distances between T = 0 and T = 24 equal to 3-7 mm occur in over 35% of the cases. CONCLUSION The ablation zone expansion at 24-h post-op was not uniform. The final ablation zone is difficult to predict at the time of the procedure. The awareness of the ablation zone expansion is important when treating near-critical structures, managing the heat sink effect, and preserving liver parenchyma.
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Affiliation(s)
- Sadeer Alzubaidi
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, AZ, 85054, USA
| | - Alex Wallace
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, AZ, 85054, USA
| | - Sailendra Naidu
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, AZ, 85054, USA
| | - Martha-Garcia Knuttinen
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, AZ, 85054, USA
| | - Scott J Kriegshauser
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, AZ, 85054, USA
| | - Rahmi Oklu
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, AZ, 85054, USA
| | - Mustafa Al-Ogaili
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, AZ, 85054, USA.
| | - Indravadan Patel
- Division of Vascular and Interventional Radiology, Laboratory for Minimally Invasive Therapeutics, Mayo Clinic, Phoenix, AZ, 85054, USA
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Rong C, Zhang Q, Zhu S, Zhang G, Zeng J, Han Q, Guo Y. 3D printed guide-assisted percutaneous screw fixation for minimally displaced scaphoid waist fractures with delayed diagnosis or presentation. BMC Musculoskelet Disord 2024; 25:127. [PMID: 38341564 PMCID: PMC10858476 DOI: 10.1186/s12891-024-07243-1] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVES To Investigate the value of 3D printed guide-assisted percutaneous management of minimally displaced scaphoid waist fractures(Herbert's B2) with delayed diagnosis or presentation. METHODS From October 2018 to February 2022, 10 patients with established delayed diagnoses and presentation of minimally displaced scaphoid waist fractures were treated with 3D printed guides assisted with percutaneous internal fixation without bone grafting. This technique was based on the patient's preoperative CT and imported into the software. Based on Boolean subtraction, the most centralized screw placement position was identified and a customized guide was produced. Intraoperative percutaneous insertion of the guide wire was assisted by the custom guide. RESULTS All 10 patients were successful in one attempt. The fractures healed at a mean of 7.7 weeks postoperatively (range 6-10 weeks). At a mean follow-up of 7.7 months (6-13 months), patients had excellent recovery of wrist function with minimal pain reduction. There were no major postoperative complications and the patients all returned to their previous activities before the injury. CONCLUSIONS Percutaneous internal fixation based on 3D printed guides is a safe and effective technique for delayed diagnosis or presentation of patients with minimally displaced fractures of the scaphoid waist. This method allows for easy insertion of screws and avoids multiple attempts.
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Affiliation(s)
- Cunmin Rong
- Department of Hand and Foot Surgery, The Affiliated Hospital of Jining Medical University, Jining, 272029, Shandong, China.
| | - Qinglin Zhang
- Department of Hand and Foot Surgery, The Affiliated Hospital of Jining Medical University, Jining, 272029, Shandong, China
| | - Shaobo Zhu
- Department of Hand and Foot Surgery, The Affiliated Hospital of Jining Medical University, Jining, 272029, Shandong, China
| | - Guanghui Zhang
- Department of Hand and Foot Surgery, The Affiliated Hospital of Jining Medical University, Jining, 272029, Shandong, China
| | - Junhao Zeng
- Department of Hand and Foot Surgery, The Affiliated Hospital of Jining Medical University, Jining, 272029, Shandong, China
| | - Qingluan Han
- Department of Hand and Foot Surgery, The Affiliated Hospital of Jining Medical University, Jining, 272029, Shandong, China
| | - Yang Guo
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
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23
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Staudt MD. Spinal Cord Stimulation Paddle-to- Percutaneous Revision: Case Series and Technical Description. World Neurosurg 2024; 182:e891-e898. [PMID: 38128757 DOI: 10.1016/j.wneu.2023.12.080] [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: 10/23/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Spinal cord stimulators (SCSs) can be implanted via a percutaneous or paddle approach, the latter technique requiring a laminotomy or laminectomy. Revision surgery may be necessary in instances of migrated, misplaced, or failed stimulators. When revision of a percutaneous system is necessary, it is common to replace the electrodes with a paddle SCS. This study aims to describe a case series of patients with failed paddle SCS electrodes who underwent revision with percutaneous SCS hardware. METHODS A series of 5 patients were retrospectively analyzed. Medical records were reviewed for demographic data, operative technique, postoperative follow-up, and complications. RESULTS Five patients were included in this series. The median age was 63 (range 51-84), and the median duration from initial implantation to revision surgery was 19 months (range 5-60). The median operative duration was 92 minutes (mean 99 ± 19.6 minutes). The median length of follow-up after surgery was 24 months (mean 21.8 ± 6.0 months). All patients had improved pain relief and therapeutic coverage with no complications. CONCLUSIONS Paddle-to-percutaneous SCS surgery is a feasible and durable revision option in appropriately selected patients.
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Affiliation(s)
- Michael D Staudt
- Departments of Neurosurgery, Beaumont Neuroscience Center, Royal Oak, Michigan, USA; Departments of Neurosurgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.
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Jones JGA. Indications, Options, and Updates on Embolic Agents. Oral Maxillofac Surg Clin North Am 2024; 36:29-34. [PMID: 37806906 DOI: 10.1016/j.coms.2023.09.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Interventional approaches to head and neck vascular anomalies have evolved with our understanding of disease pathologic condition and advances in medical and surgical treatment. Embolization's role in the disease management ranges from stand-alone treatment with curative intent to adjunctive or even palliative, depending on the lesion. This decision is best made through multidisciplinary collaboration among surgeons, interventionalists, and medical specialists. Finally, setting realistic expectations with the patient and family is a crucial step preceding any intervention. This article elaborates on the considerations influencing a given treatment plan and specific interventional strategy.
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Affiliation(s)
- Jesse G A Jones
- University of Alabama at Birmingham, FOT 1007, 1720 2nd Avenue South, Birmingham, AL 35294-3410, USA.
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25
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Shabbir A, Travieso A, Mejía-Rentería H, Espejo-Paeres C, Gonzalo N, Banning AP, Serruys PW, Escaned J. Coronary Physiology as Part of a State-of-the-Art Percutaneous Coronary Intervention Strategy: Lessons from SYNTAX II and Beyond. Cardiol Clin 2024; 42:147-158. [PMID: 37949536 DOI: 10.1016/j.ccl.2023.07.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
The use of coronary physiology allows for rational decision making at the time of PCI, contributing to better patient outcomes. Yet, coronary physiology is only one aspect of optimal revascularization. State-of-the-art PCI must also consider other important aspects such as intracoronary imaging guidance and specific procedural expertise, as tested in the SYNTAX II study. In this review, we highlight the technical aspects pertaining to the use of physiology as used in that trial and offer a glimpse into the future with emerging physiologic metrics, including functional coronary angiography, which have already established themselves as useful indices to guide decision making.
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Affiliation(s)
- Asad Shabbir
- Interventional Cardiology Unit, Hospital Clínico San Carlos IDISCC, Complutense University of Madrid, Calle del Prof Martín Lagos, Madrid 28040, Spain
| | - Alejandro Travieso
- Interventional Cardiology Unit, Hospital Clínico San Carlos IDISCC, Complutense University of Madrid, Calle del Prof Martín Lagos, Madrid 28040, Spain
| | - Hernán Mejía-Rentería
- Interventional Cardiology Unit, Hospital Clínico San Carlos IDISCC, Complutense University of Madrid, Calle del Prof Martín Lagos, Madrid 28040, Spain
| | - Carolina Espejo-Paeres
- Interventional Cardiology Unit, Hospital Clínico San Carlos IDISCC, Complutense University of Madrid, Calle del Prof Martín Lagos, Madrid 28040, Spain
| | - Nieves Gonzalo
- Interventional Cardiology Unit, Hospital Clínico San Carlos IDISCC, Complutense University of Madrid, Calle del Prof Martín Lagos, Madrid 28040, Spain
| | - Adrian P Banning
- Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway, Ireland; National Heart and Lung Institute, Imperial College London, London, UK
| | - Javier Escaned
- Interventional Cardiology Unit, Hospital Clínico San Carlos IDISCC, Complutense University of Madrid, Calle del Prof Martín Lagos, Madrid 28040, Spain.
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Luo M, Yang Y, Liu Z, Tan J, Luo J, Long Z, Chen M, Liang C, Xiao Z. Percutaneous versus traditional open approaches for the treatment of thoracolumbar fractures in patients without neurologic deficits: a meta-analysis of 35 cohort studies. Neurosurg Rev 2024; 47:62. [PMID: 38263482 DOI: 10.1007/s10143-023-02259-y] [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: 10/23/2023] [Revised: 11/23/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024]
Abstract
At present, percutaneous surgery is widely used to treat thoracolumbar fractures. However, the actual safety, feasibility, and effectiveness of percutaneous surgery are not clear. Through systematic review and meta-analysis, we compared the efficacies of percutaneous pedicle screw fixation and open pedicle screw fixation in the treatment of thoracolumbar fractures without nerve root symptoms. We systematically searched the PubMed, Embase, and Cochrane libraries for articles published on or before June 2023. All results were evaluated by standard methods recommended for meta-analysis, continuous data were expressed by standard mean differences (SMDs), and binary variables were analyzed by odds ratios (ORs) and 95% confidence intervals (95% CIs). We also explored the main sources of heterogeneity and the stability of the results through sensitivity analysis, Begg's funnel plots, and Egger's test. Thirty-five cohort studies with a total of 3039 patients were included. The study found that patients who undergo percutaneous approaches have less intraoperative blood loss (IBL), shorter length of hospital stay (LOS), shorter operation time, and shorter incision. Moreover, percutaneous approaches had more advantages in terms of visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, and infection rates. However, there was no significant difference in anterior vertebral body height (AVB), Cobb angle (CA), or screw errors between the two groups. In the long run, the clinical and surgical results of the percutaneous approach are better than those of the open approach, but the radiological results of both operations do not seem to show an advantage for any specific approach. Because of publication bias and heterogeneity, our findings must be interpreted with caution. However, this paper will provide some support for clinicians to choose suitable surgical methods for the treatment of thoracolumbar fractures.
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Affiliation(s)
- Mingjiang Luo
- Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421000, Hunan, China
| | - Yuxin Yang
- Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Zhixuan Liu
- Department of Orthopedic Trauma, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Jiayi Tan
- Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Jiahui Luo
- Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Zifan Long
- Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Miaojue Chen
- Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Can Liang
- Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Zhihong Xiao
- Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421000, Hunan, China.
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Giurazza F, Ierardi A, Marra P, Lucatelli P, Corvino F, Pane F, Sironi S, Carrafiello G, Loffroy R, Niola R. Pseudoaneurysms embolization with glue via percutaneous direct puncture: a multicenter experience on 54 patients. CVIR Endovasc 2024; 7:11. [PMID: 38221592 PMCID: PMC10788324 DOI: 10.1186/s42155-024-00426-w] [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: 10/31/2023] [Accepted: 01/04/2024] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND This retrospective multicentric study aims to report on technical safety and effectiveness of pseudoaneurysms embolization with glue (N-butyl cyanoacrylate) adopting a percutaneous direct puncture approach. RESULTS Fifty-four patients data were collected from five centers. All patients at the time of treatment presented with unruptured PAs and were hemodynamically stable. True aneurysms and lesions treated with embolics other than glue were excluded. Pseudoaneurysms diagnosis was based on CT and anamnestic data; initial investigation with digital-subtracted arteriography was acquired in all cases; then, percutaneous embolizations were performed in the angio-suite (ultrasound, fluoroscopy, ConeBeam CT guidance) or in CT. Technical success was considered as complete pseudoaneurysm embolization at final imaging with sole percutaneous strategy, without need for additional endovascular embolization. Clinical success was intended as pseudoaneurysm resolution within one week follow-up with stabilization or restored clinical conditions. Pseudoaneurysms origins were traumatic (57.4%), inflammatory (24.1%) or spontaneous (18.5%); 39 patients (72.2%) were symptomatic, presenting with pain and/or pulsatile mass. Mean lesions diameter was 19.3 mm (range: 7-30); pseudoaneurysms were located in abdomen (48.1%), limbs (42.6%) and thorax (9.3%). Coagulation function was impaired in 16.6% and 48.1% was under antiplatelets/anticoagulation therapy. In 16.6% the percutaneous approach followed previous treatments failure. The image-guidance modality for percutaneous puncture was most often ultrasound combined with fluoroscopy (38%). Clinical success was obtained in all patients while technical success occurred in 94.4% because 3 patients required an additional endovascular embolization. Complications were registered in 14.8%, all of low grade without clinical sequelae neither prolonged recovery (7 non target embolizations, 1 post-embolization syndrome). CONCLUSIONS In this study, pseudoaneurysms embolization with glue via percutaneous direct puncture was safe and effective with a low rate of minor complications.
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Affiliation(s)
- Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, Naples, 80131, Italy.
| | - Annamaria Ierardi
- Radiology Department, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, 20122, Italy
| | - Paolo Marra
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, University of Milano Bicocca, Piazza OMS 1, Bergamo, 24127, Italy
| | - Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological, and Anatomo-Pathological Sciences, Sapienza University of Rome, Roma, 00161, Italy
| | - Fabio Corvino
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, Naples, 80131, Italy
| | - Francesco Pane
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, Naples, 80131, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, University of Milano Bicocca, Piazza OMS 1, Bergamo, 24127, Italy
| | - Gianpaolo Carrafiello
- Radiology Department, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, 20122, Italy
- Department of Health Sciences, Università degli Studi di Milano, Via F. Sforza 35, Milan, 20122, Italy
| | - Romaric Loffroy
- Image-Guided Therapy Center, ICMUB Laboratory, Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, BP 77908, 14 Rue Paul Gaffarel, Dijon, 21079, France
| | - Raffaella Niola
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, Naples, 80131, Italy
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Kaemmel J, Heck R, Lanmüeller P, Wert L, Falk V, Starck CT. Treatment of cardiac implantable electronic device endocarditis in pacemaker-dependent patients utilizing a percutaneous aspiration system. Multimed Man Cardiothorac Surg 2024; 2024. [PMID: 38193462 DOI: 10.1510/mmcts.2023.082] [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] [Indexed: 01/10/2024]
Abstract
With the increasing use of cardiac implantable electronic devices, the number of patients with cardiac implantable electronic device-related endocarditis is also rising. The treatment of this type of endocarditis is a challenging clinical task, in particular if device removal is required in patients who are pacemaker dependent. This video tutorial describes a treatment strategy for cardiac implantable electronic device-related endocarditis involving the tricuspid valve in pacemaker-dependent patients. The proposed treatment strategy consists of implanting an epicardial pacemaker via a minimally invasive subxiphoid approach, percutaneous aspiration of tricuspid valve vegetations and complete transvenous explantation of the infected cardiac implantable electronic device system using advanced lead extraction tools.
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Affiliation(s)
- Julius Kaemmel
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), 13353 Berlin, Germany Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Roland Heck
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), 13353 Berlin, Germany Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Pia Lanmüeller
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany. DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Leonhard Wert
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany
| | - Volkmar Falk
- Deutsches Herzzentrum Berlin Augustenburger Platz 1 13353 Berlin
| | - Christoph T Starck
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), 13353 Berlin, Germany Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
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Zhao J, Zhang Y, Fan M, Han X, Liu B, He D, Tian W. The positional consistency between guidewire and cannulated or solid screw in robot-assisted spinal internal fixation surgery. J Orthop Surg Res 2024; 18:708. [PMID: 38178197 PMCID: PMC10768200 DOI: 10.1186/s13018-023-04053-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/27/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND This study aimed to investigate the positional consistency between the guidewire and the screw in spinal internal fixation surgery. METHODS This study involved 64 patients who underwent robot-assisted thoracic or lumbar pedicle screw fixation surgery. Guidewires were inserted with the assistance of the Tirobot. Either cannulated screws or solid screws were inserted. Guidewire and screw accuracy was measured using CT images based on the Gertzbein and Robbins scale. The positional consistency between guidewire and screw was evaluated based on the fused CT images, which could graphically and quantitatively demonstrate the consistency. The consistency was evaluated based on a grading system that considered the maximum distance and angulation between the centerline of the guidewire and the screw in the region of the pedicle. RESULTS A total of 322 screws were placed including 206 cannulated ones and 116 solid ones. Based on the Gertzbein and Robbins scale, 97.5% of the guidewires were grade A, and 94.1% of the screws were grade A. Based on our guidewire-screw consistency scale, 85% in cannulated group, and 69.8% in solid group, were grade A. Both solid and cannulated screws may alter trajectory compared to the guidewires. The positional accuracy and guidewire-screw consistency in the solid screw group is significantly worse than that in the cannulated screw group. The cortical bone of the pedicle has a positive guide effect on either solid or cannulated screws. CONCLUSION The pedicle screws may alter trajectory despite the guidance of the guidewires. Solid screws show worse positional accuracy and guidewire-screw consistency compared with cannulated screws. Trial registration The study was retrospectively registered and approved by our center's institutional review board.
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Affiliation(s)
- Jingwei Zhao
- Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China.
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China.
| | - Yunxian Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Mingxing Fan
- Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoguang Han
- Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Bo Liu
- Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Da He
- Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital, Capital Medical University, 31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China.
- Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, China.
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Aukema TW, Teunissen EM, Janssen AM, Hol MKS, Mylanus EAM. Post-implantation clinical cost analysis between transcutaneous and percutaneous bone conduction devices. Eur Arch Otorhinolaryngol 2024; 281:117-127. [PMID: 37421428 PMCID: PMC10764476 DOI: 10.1007/s00405-023-08099-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/27/2023] [Indexed: 07/10/2023]
Abstract
INTRODUCTION Bone conduction devices (BCD) are effective for hearing rehabilitation in patients with conductive and mixed hearing loss or single-sided deafness. Transcutaneous bone conduction devices (tBCD) seem to lead to fewer soft tissue complications than percutaneous BCDs (pBCD) but have other drawbacks such as MRI incompatibility and higher costs. Previous cost analyses have shown a cost advantage of tBCDs. The purpose of this study is to compare long-term post-implantations costs between percutaneous and transcutaneous BCDs. MATERIALS AND METHODS Retrospective data from 77 patients implanted in a tertiary referral centre with a pBCD (n = 34), tBCD (n = 43; passive (tpasBCD; n = 34) and active (tactBCD; n = 9) and a reference group who underwent cochlear implantation (CI; n = 34), were included in a clinical cost analysis. Post-implantation costs were determined as the sum of consultation (medical and audiological) and additional (all post-operative care) costs. Median (cumulative) costs per device incurred for the different cohorts were compared at 1, 3 and 5 years after implantation. RESULTS After 5 years, the total post-implantation costs of the pBCD vs tpasBCD were not significantly different (€1550.7 [IQR 1174.6-2797.4] vs €2266.9 [IQR 1314.1-3535.3], p = 0.185), nor was there a significant difference between pBCD vs tactBCD (€1550.7 [1174.6-2797.4] vs €1428.8 [1277.3-1760.4], p = 0.550). Additional post-implantation costs were significantly highest in the tpasBCD cohort at all moments of follow-up. CONCLUSION Total costs related to post-operative rehabilitation and treatments are comparable between percutaneous and transcutaneous BCDs up to 5 years after implantation. Complications related to passive transcutaneous bone conduction devices appeared significantly more expensive after implantation due to more frequent explantations.
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Affiliation(s)
- Tjerk W Aukema
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
- Research School of Behavioral and Cognitive Neurosciences, Graduate School of Medical Sciences, University of Groningen, Groningen, The Netherlands.
- Department of Otorhinolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Emma M Teunissen
- Department of Otorhinolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Center for Neuroscience, Radboud University, Nijmegen, The Netherlands
| | - Arno M Janssen
- Department of Otorhinolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Center for Neuroscience, Radboud University, Nijmegen, The Netherlands
| | - Myrthe K S Hol
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
- Research School of Behavioral and Cognitive Neurosciences, Graduate School of Medical Sciences, University of Groningen, Groningen, The Netherlands
| | - Emmanuel A M Mylanus
- Department of Otorhinolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Center for Neuroscience, Radboud University, Nijmegen, The Netherlands
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Garg I, Wang D. Complications of Spinal Cord Stimulator Trials and Implants: A Review. Curr Pain Headache Rep 2023; 27:837-842. [PMID: 38010489 DOI: 10.1007/s11916-023-01190-7] [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] [Accepted: 11/16/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE OF REVIEW Spinal cord stimulation (SCS) has been used for decades to alleviate chronic pain. A growing body of literature suggests that the procedure is not without risks. Understanding the risks of SCS implantation can help treating physicians formulate individualized care plans that promote patient safety and minimize risks. RECENT FINDINGS The overall complication rate associated with SCS has been reported to be 31.9 to 43%. The most common complication in the literature appears to be electrode migration. Other complications ranging in rates of occurrence include hematoma formation, infection, spinal cord injury, and cerebrospinal fluid (CSF) leak. Case reports of syrinx formation, foreign body reaction, and fibrosis have also been described. Our review shows that there are strategies available to reduce and prevent complications. In addition, close monitoring and early intervention may prevent some of the adverse neurological outcomes. Nevertheless, additional research regarding patient and procedural factors is necessary to improve the safety profile of this intervention.
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Affiliation(s)
- Ishan Garg
- Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Dajie Wang
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
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Garcia-Maya B, Pérez-Barragans F, Lainez Galvez JR, Paez Gallego J, Vaquero-Picado A, Barco R, Antuña S. Percutaneous plate fixation of displaced proximal humerus fractures: Do minimally invasive techniques improve outcomes and reduce complications? Injury 2023; 54 Suppl 7:111042. [PMID: 38225161 DOI: 10.1016/j.injury.2023.111042] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 08/19/2023] [Accepted: 09/09/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVE The aim of this study was to analyze the outcomes and complications of minimally invasive plate osteosynthesis (MIPO) for displaced proximal humerus fractures and elucidate if the percutaneous technique reduces the rate of avascular necrosis (AVN) without jeopardizing fracture reduction. MATERIAL AND METHODS 118 patients with a displaced proximal humerus fracture were treated with a polyaxial locking-plate through a standardized percutaneous approach. 73 % were women and mean age was 63 years (18-89) with an average follow-up of 51 months (12-256). There were 32 two-part fractures (27 %), 57 three-part fractures (48 %) and 24 four-part fractures (25 %). Shoulder function at the last follow-up, including ROM and ability to perform daily living activities, was objectively evaluated with an adjusted Constant Score (CS). Subjective patient satisfaction was rated with an Visual Analogic Scale from 0 to 10 and the degree of residual pain with a Verbal Rating Scale (VRS). Radiographic analysis at the most recent follow-up evaluated the presence of AVN, degree of residual medial calcar displacement, and the cervicodiaphiseal angle. RESULTS Forty patients (34 %) had a complication, 25 of them (21 %) requiring further surgery. ROM at the last follow-up was 131° of elevation (40°-180°), 38° of external rotation (SD: 17.7) and internal rotation to L3. Average adjusted Constant Score was 68 (SD: 17.76). Twenty-one patients (18 %) complained of shoulder pain (14 moderate and 7 severe) and seven were not satisfied. Radiographically, 29 patients (25 %) had varus malunion and 17 patients (14 %) showed some degree of AVN. Patients with varus malunion (CS 64.3 versus 69.8, p = 0.16) and AVN (CS 56.9 versus 70.4, p = 0.005) had lower CS. The presence of a varus malunion was directly related to the degree of initial medial calcar displacement (p = 0.001) and deficient calcar reduction at surgery (p = 0.004). AVN was statistically more prevalent when the medial calcar was inadequately reduced (p = 0.01). CONCLUSIONS MIPO surgery for proximal humerus fractures through an anterolateral approach does not reduce the rate of mechanical complications or AVN compared with standard ORIF techniques. Moreover, percutaneous plating may preclude adequate medial calcar reduction, leading to humeral head malunion and a worse clinical outcome.
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Affiliation(s)
- B Garcia-Maya
- Department of Orthopedic Surgery, Upper Limb Unit, Hospital Universitario Infanta Elena, Avda. Reyes Católicos 21 28340 Valdemoro Madrid, Spain.
| | - F Pérez-Barragans
- Department of Orthopedic Surgery, Upper Limb Unit, Hospital Universitario La Paz. Paseo de la Castellana 261, CP 28046, Madrid, Spain
| | - J R Lainez Galvez
- Department of Orthopedic Surgery, Upper Limb Unit, Hospital Universitario La Paz. Paseo de la Castellana 261, CP 28046, Madrid, Spain
| | - Javier Paez Gallego
- Statistical Science Department, Universidad Nacional de Educacion a Distancia, Madrid, Spain
| | - A Vaquero-Picado
- Department of Orthopedic Surgery, Upper Limb Unit, Hospital Universitario La Paz. Paseo de la Castellana 261, CP 28046, Madrid, Spain
| | - R Barco
- Department of Orthopedic Surgery, Upper Limb Unit, Hospital Universitario La Paz. Paseo de la Castellana 261, CP 28046, Madrid, Spain
| | - S Antuña
- Department of Orthopedic Surgery, Upper Limb Unit, Hospital Universitario La Paz. Paseo de la Castellana 261, CP 28046, Madrid, Spain
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Narendran N, Nilssen PK, Walker CT, Skaggs DL. New technique and case report: Robot-assisted intralaminar screw fixation of spondylolysis in an adolescent. N Am Spine Soc J 2023; 16:100284. [PMID: 38025938 PMCID: PMC10654584 DOI: 10.1016/j.xnsj.2023.100284] [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] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 12/01/2023]
Abstract
Introduction Management of spondylolysis in adolescents is generally successful with conservative management. Uncommonly, surgical fixation is necessary for refractory cases. Direct repair with intralaminar screws is one commonly utilized technique. Recently, less invasive spinal procedures are becoming viable with the enabling of technologies, including robotics. Case description A 14-year-old baseball player and surfer presented with low back pain, diagnosed by MRI as bony edema and stress fractures of the posterior spinal elements. After 18 months, the pain was unresponsive to rest, physical therapy, and bracing. There was no radicular pain or neurologic symptoms. Computed tomography (CT) revealed bilateral, chronic nonhealing pars defects at L5. He underwent outpatient, robot-assisted percutaneous intralaminar fixation with hydroxyapatite-coated screws through a 2 cm skin incision. Outcome On postoperative day 1, the patient reported relief of his preoperative pain and he was ambulating without difficulty. At 2 weeks follow-up, the patient was completely pain free and surfing. At 2 months follow-up, low-dose CT demonstrated partial incorporation of the hydroxyapatite-coated screws, and the patient returned to sports. At 6 months follow-up, the patient had no pain and was swinging his baseball bat with full force. Low-dose CT revealed complete healing of the defects with full incorporation of the hydroxyapatite-coated screws. Conclusions A novel minimally invasive robotic percutaneous approach for direct spondylolysis repair using hydroxyapatite-coated screws is a potential surgical treatment option for non-healing pars defects in adolescent patients.
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Affiliation(s)
- Nakul Narendran
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, 444 South San Vicente Blvd, Los Angeles, CA, United States
| | - Paal K. Nilssen
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, 444 South San Vicente Blvd, Los Angeles, CA, United States
| | - Corey T. Walker
- Department of Neurosurgery, Cedars-Sinai Medical Center, 444 South San Vicente Blvd, Los Angeles, CA, United States
| | - David L. Skaggs
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, 444 South San Vicente Blvd, Los Angeles, CA, United States
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Duguay T, Housset V, Bouché PA, Hardy A, Bauer T. Prospective observational analysis of intraoperative radiation exposure with a mini C-arm intensifier in percutaneous forefoot surgery. Orthop Traumatol Surg Res 2023; 109:103705. [PMID: 37832868 DOI: 10.1016/j.otsr.2023.103705] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 05/13/2023] [Accepted: 05/17/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION Percutaneous forefoot surgery has been associated with higher radiation exposure than the conventional approach. However, there is little data on forefoot surgery using a mini C-arm intensifier. We, therefore, conducted a prospective study to (1) evaluate the intraoperative radiation received by the surgeon during percutaneous forefoot surgery with a mini C-arm; (2) compare the radiation received by the surgeon with the guidelines for occupational exposure issued by the International Commission on Radiological Protection (ICRP) (20 millisieverts per year [mSv/year] for the whole body, 500mSv/year for the hands, and 20mSv/year for the lens of the eye); and (3) compare the radiation received during percutaneous forefoot surgery with that of the open approach, which has already been reported in the literature. HYPOTHESIS The radiation received by the surgeon during percutaneous forefoot surgery with a mini C-arm is lower than the ICRP guidelines, and the findings reported in the literature. MATERIALS AND METHODS This prospective single-center study was conducted from September 2020 to May 2021. A total of 639 feet (i.e., 435 patients) were included. Of these 639 feet, 336 (52%) were hallux valgus repairs, 49 (8%) were stand-alone procedures of the lateral rays, and 124 (19%) were a combination of both. The radiation dose data was retrieved from the mini C-arm daily: dose-area product (DAP) in centigray per square centimeter (cGy/cm2) and radiation exposure duration in seconds. The doses received by the surgeon were collected every month by 4 passive dosimeters (hand, eye lens, and chest [on and under the lead apron]) and 2 active dosimeters (on and under the lead apron). RESULTS The DAP emitted by the mini C-arm during an operating day was 0.10±0.01cGy/cm2 (range, 0.0-3.9), and the mean daily radiation duration was 34.7±19.3seconds (range, 0.7-226.8). There was a mean of 8±8 (range, 1-18) elective procedures per operating day. The daily reading on the active dosimeter worn on the lead apron was 0.002±0 microSv (range, 0-0.04), while the one worn under the apron was 0.001±0 microSv (range, 0-0.03). The equivalent doses over the 7-month study period for the hand, eye lens, and chest (over and under the apron) were 0.14mSv, 0mSv, 0.22mSv, and 0mSv, respectively. DISCUSSION/CONCLUSION The radiation exposure in percutaneous forefoot surgery with a mini C-arm intensifier observed in our study was lower than the ICRP recommendations and literature findings during open surgery. LEVEL OF EVIDENCE IV; prospective study without a control group.
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Affiliation(s)
- Tristan Duguay
- Clinique du Landy, 23, rue du Landy, 93400 Saint-Ouen-sur-Seine, France.
| | - Victor Housset
- Orthopaedic and Traumatologic Department, Hôpital Ambroise Paré, 9, avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Pierre Alban Bouché
- Orthopaedic and Traumatologic Department, Hôpital Lariboisière, 2, rue Ambroise Paré, 75010 Paris, France
| | - Alexandre Hardy
- Clinique du Sport, 36, boulevard Saint Marcel, 75005 Paris, France
| | - Thomas Bauer
- Orthopaedic and Traumatologic Department, Hôpital Ambroise Paré, 9, avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
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Scharll Y, Böhler D, Laimer G, Schullian P, Bale R. Laser Target System in Combination with an Aiming Device for Percutaneous CT-Guided Interventions - An Accuracy Study. Acad Radiol 2023; 30:3047-3055. [PMID: 37117142 DOI: 10.1016/j.acra.2023.03.028] [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: 01/19/2023] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 04/30/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the targeting accuracy of laser-guided punctures in combination with an aiming device for computed tomography (CT) interventions during in vitro experiments. MATERIALS AND METHODS: A total of 600 CT-guided punctures were performed using a laser target system, half of them with the additional help of an aiming device. Conically shaped targets in a plexiglass phantom were punctured. The planning CT data sets were acquired with 1.25, 2.5 and 5 mm slice thickness. Needle placement accuracy, as well as procedural time, was assessed. The Euclidean (ED) and normal distances (ND) were calculated at the target point. RESULTS Using the aiming device, the accomplished mean ND at the target for the 1.25, 2.5 and 5 mm slice thickness was 1.76 mm (SD ± 0.92), 2.09 mm (SD ± 1.06) and 1.93 mm (SD ± 1.38), respectively. Without aiming device, the corresponding results were 2.55 mm (SD ± 1.42), 2.7 mm (SD ± 1.43) and 2.31 mm (SD ± 1.64). At a slice thickness of 1.25 mm and 2.5 mm, punctures with the aiming device were significantly more accurate for both the ED and ND as compared to the punctures without aiming device (p < 0.001). The mean time required to complete the procedure, including image acquisition, trajectory planning, the placement of 10 needles, and the control-CT scan was 24.8 min without and 29.8 min with the aiming device. CONCLUSION The additional use of the aiming device in combination with the commercially available laser guidance system significantly increased the level of accuracy during this in vitro experiment compared to freehand passes.
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Affiliation(s)
- Yannick Scharll
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria (Y.S., D.B., G.L., P.S., R.B.)
| | - Daniel Böhler
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria (Y.S., D.B., G.L., P.S., R.B.)
| | - Gregor Laimer
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria (Y.S., D.B., G.L., P.S., R.B.)
| | - Peter Schullian
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria (Y.S., D.B., G.L., P.S., R.B.)
| | - Reto Bale
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria (Y.S., D.B., G.L., P.S., R.B.).
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Rozenbaum Z, Gholam A, Helmcke F, Anwar A, Irimpen A, Alsaad AA. Percutaneous debulking of tricuspid valve infective endocarditis vegetations using a large bore manual aspiration device - AlphaVac. J Cardiol Cases 2023; 28:236-238. [PMID: 38126052 PMCID: PMC10730267 DOI: 10.1016/j.jccase.2023.08.008] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/21/2023] [Accepted: 08/02/2023] [Indexed: 12/23/2023] Open
Abstract
Most infectious endocarditis patients can be managed medically. However, non-responders to antibiotics and ongoing sequelae such as septic emboli, may require mechanical interventions. AngioVac (Angiodynamics, Latham, NY, USA) is a percutaneous aspiration device used for removal of thrombi, emboli, masses, and vegetations. Main drawbacks are the requirement for a perfusionist, two large-bore accesses, and meticulous de-airing. These drawbacks make the procedure more time-consuming and possibly increase the risk of complications. AlphaVac (Angiodynamics) omits the motor element, thereby overcoming several of the limitations. In the current report, we describe two cases of percutaneous aspiration of tricuspid valve vegetations using AlphaVac. Learning objective To consider manual percutaneous aspiration of infective valvular vegetations using the AlphaVac cannula in case of insufficient response to antibiotics or for prevention of emboli.
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Affiliation(s)
- Zach Rozenbaum
- Department of Cardiology, Tulane University, New Orleans, LA, USA
| | - Ali Gholam
- Department of Cardiology, Tulane University, New Orleans, LA, USA
| | | | - Asif Anwar
- Department of Cardiology, Tulane University, New Orleans, LA, USA
| | - Anand Irimpen
- Department of Cardiology, Tulane University, New Orleans, LA, USA
| | - Ali A. Alsaad
- Department of Cardiology, Tulane University, New Orleans, LA, USA
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Jadhav P, Choi PM, Gollin G. Percutaneous Pigtail Catheter Drainage of Spontaneous Intestinal Perforation in Premature Infants. J Surg Res 2023; 291:265-269. [PMID: 37480754 DOI: 10.1016/j.jss.2023.06.010] [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: 12/02/2022] [Revised: 05/24/2023] [Accepted: 06/13/2023] [Indexed: 07/24/2023]
Abstract
INTRODUCTION Peritoneal drainage is an established management strategy for spontaneous intestinal perforation (SIP) in premature infants. We sought to evaluate the safety and efficacy of percutaneous pigtail catheter placement as an alternative to drain insertion via a lower quadrant incision. METHODS Patients less than 32 weeks gestational age who underwent peritoneal drain placement for SIP at two neonatal intensive care units between 2011 and 2022 were identified. Incisional drainage (ID) or percutaneous pigtail catheter drainage (PD) was used based upon the usual practices of the surgeons. ID (n = 19) was performed via a 5-mm right lower quadrant incision into which a one-fourth-inch Penrose or red rubber catheter was placed. PD (n = 18) was accomplished using a Seldinger technique by which a 6.0 or 8.5 F pigtail catheter was passed through the left lower quadrant. Demographics and physiological parameters at the time of drainage were recorded and short-term and long-term outcomes were evaluated. RESULTS Thirty seven infants were identified. There were no differences in demographics or physiological derangement between the groups. Patients who underwent ID had more frequent stool drainage, a greater transfusion requirement, and a longer time to full feedings (60.6 v 37.7 d, P = 0.04). Incisional hernias (n = 3, 16%) only developed after ID. The duration of drain placement, length of stay, and time to resolution of pneumoperitoneum were similar with ID and PD as was the incidence of premature drain dislodgement and subsequent laparotomy. CONCLUSIONS Percutaneous drain placement provided effective drainage in infants with SIP and was associated with more rapid feeding advancement and no incidence of incisional hernia.
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Affiliation(s)
- Priyanka Jadhav
- University of California San Diego, School of Medicine, San Diego, California
| | | | - Gerald Gollin
- University of California San Diego, School of Medicine, San Diego, California; Rady Children's Hospital, San Diego, California.
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Machado do Amaral F, Angeli Malavolta E, Brandao Andrade E Silva F, Garcia JC, da Silva Moura J, Assunção JH, Pecora JR. Comparative study of patients with midshaft clavicle fracture fixed with a locked plate via an open versus percutaneous approach. Injury 2023; 54 Suppl 6:110746. [PMID: 38143119 DOI: 10.1016/j.injury.2023.04.033] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/23/2023] [Accepted: 04/14/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVE To compare the results of surgical treatment of midshaft clavicle fractures, treated with the technique of minimally invasive plate osteosynthesis (MIPO) with locking compression plate versus open reduction and internal fixation (ORIF) with locked plate. METHODS Quasi-randomized comparative study, evaluating displaced midshaft clavicle fractures treated with MIPO versus ORIF, with procedures performed by a single surgeon. We evaluated patients at 12 months using the University of California at Los Angeles (UCLA) scale and radiographically at 8, 12, 26 and 52 weeks, in addition to describing complications. RESULTS We evaluated 44 patients; 22 submitted to MIPO and 22 to ORIF. The median UCLA scores at 12 months were 35 in the ORIF group and 35 in the MIPO group (p = 0.712). All patients had fracture healing at 3 months (p > 0.999). The mean surgery time was 87.5 min in the ORIF group and 47.5 in the MIPO (p < 0.001) group. As complications, 1 suture dehiscence (4.5%), 2 protruding plates (9.1%) and 1 change in sensitivity around the surgical wound (4.5%) were observed in the MIPO group, while in the ORIF group, 15 changes in sensitivity (68.2%) and 3 hypertrophic scars (13.6%) were observed. The only complication that showed a difference between the groups was the change in sensitivity (p < 0.001). No cases of pseudarthrosis or failure of osteosynthesis were identified in either technique. CONCLUSION This study demonstrated that the two treatments, ORIF and MIPO, are equally effective in the treatment of displaced middle third clavicle fractures. However, MIPO is superior to ORIF in regard to reduced surgical time and preservation of supraclavicular nerve sensitivity.
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Affiliation(s)
- Felipe Machado do Amaral
- Hospital Universitário HU, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Eduardo Angeli Malavolta
- Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; HCor - Hospital do Coração, São Paulo, SP, Brazil
| | | | | | | | - Jorge Henrique Assunção
- Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Jose Ricardo Pecora
- Hospital Universitário HU, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Ortner G, Somani BK, Güven S, Kitzbichler G, Traxer O, Giusti G, Proietti S, Liatsikos E, Kallidonis P, Ulvik Ø, Goumas IK, Duvdevani M, Baard J, Kamphuis GM, Ferretti S, Dragos L, Villa L, Miernik A, Tailly T, Pietropaolo A, Hamri SB, Papatsoris A, Gözen AS, Herrmann TRW, Nagele U, Tokas T. Experts' recommendations in laser use for the treatment of upper tract urothelial carcinoma: a comprehensive guide by the European Section of Uro-Technology (ESUT) and Training Research in Urological Surgery and Technology (T.R.U.S.T.) group. World J Urol 2023; 41:3367-3376. [PMID: 37777981 DOI: 10.1007/s00345-023-04632-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 07/07/2023] [Accepted: 09/14/2023] [Indexed: 10/03/2023] Open
Abstract
PURPOSE To highlight and compare experts' laser settings during endoscopic laser treatment of upper tract urothelial carcinoma (UTUC), to identify measures to reduce complications, and to propose guidance for endourologists. METHODS Following a focused literature search to identify relevant questions, a survey was sent to laser experts. We asked participants for typical settings during specific scenarios (ureteroscopy (URS), retrograde intrarenal surgery (RIRS), and percutaneous treatment). These settings were compared among the reported laser types to find common settings and limits. Additionally, we identified preventive measures commonly applied during surgery. RESULTS Twenty experts completed the survey, needing a mean time of 12.7 min. Overall, most common laser type was Holmium-Yttrium-Aluminum-Garnet (Ho:YAG) (70%, 14/20) followed by Thulium fiber laser (TFL) (45%, 9/20), pulsed Thulium-Yttrium-Aluminum-Garnet (Tm:YAG) (3/20, 15%), and continuous wave (cw)Tm:YAG (1/20, 5%). Pulse energy for the treatment of distal ureteral tumors was significantly different with median settings of 0.9 J, 1 J and 0.45 J for Ho:YAG, TFL and pulsed Tm:YAG, respectively (p = 0.048). During URS and RIRS, pulse shapes were significantly different, with Ho:YAG being used in long pulse and TFL in short pulse mode (all p < 0.05). We did not find further disparities. CONCLUSION Ho:YAG is used by most experts, while TFL is the most promising alternative. Laser settings largely do not vary significantly. However, further research with novel lasers is necessary to define the optimal approach. With the recent introduction of small caliber and more flexible scopes, minimal-invasive UTUC treatment is further undergoing an extension of applicability in appropriately selected patients.
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Affiliation(s)
- Gernot Ortner
- Department of Urology and Andrology, General Hospital Hall i.T, Milser Straße 10, 6060, Hall in Tirol, Austria.
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, England
| | - Selcuk Güven
- Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Gerhard Kitzbichler
- Department of Urology and Andrology, General Hospital Hall i.T, Milser Straße 10, 6060, Hall in Tirol, Austria
| | - Olivier Traxer
- Sorbonne University, GRC n°20 Lithiase Renale, AP-HP, Hôpital Tenon, Paris, France
| | - Guido Giusti
- Department of Urology, San Raffaele Hospital, Milan, Italy
| | | | | | | | - Øyvind Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | | | - Mordechai Duvdevani
- Department of Urology, Hadassah Ein-Kerem University Hospital, The Hebrew University, Jerusalem, Israel
| | - Joyce Baard
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Guido M Kamphuis
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Stefania Ferretti
- Department of Urology, Hospital and University of Modena, Modena, Italy
| | - Laurian Dragos
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Luca Villa
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Thomas Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, England
| | - Saeed Bin Hamri
- Urology Department at Specialized Medical Center SMC2, Riyadh, Saudi Arabia
| | - Athanasios Papatsoris
- 2nd Department of Urology, Sismanoglio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ali Serdar Gözen
- Department of Urology, Medius Kliniken, Ruit, Baden-Württemberg, Germany
| | - Thomas R W Herrmann
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Udo Nagele
- Department of Urology and Andrology, General Hospital Hall i.T, Milser Straße 10, 6060, Hall in Tirol, Austria
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
| | - Theodoros Tokas
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Greece
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40
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Abid N, Conort P, Franquet Q, Roustan FR, Meria P, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Percutaneous nephrolithotomy. Prog Urol 2023; 33:854-863. [PMID: 37918984 DOI: 10.1016/j.purol.2023.08.010] [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: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
Percutaneous nephrolithotomy (Labate et al.) is the standard procedure for the treatment of large (≥2cm) kidney stones. The patient can be in prone or modified supine position. The puncture is performed under fluoroscopy and/or ultrasound guidance. The stone-free rate seems to be comparable between miniaturized and standard PCNL. Procedures performed with smaller diameter instruments tend to be associated with significant lower blood loss, but longer procedure times. The limitation of the number of percutaneous tracts results in better preservation of the kidney function and lowers the risk of complications. The use of tranexamic acid during PCNL may be interesting for reducing the bleeding risk, the transfusion rate, and possibly the intervention duration. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis [EAU 2022]) and their adaptability to the French context.
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Affiliation(s)
- N Abid
- Department of Urology and Transplantation Surgery, Edouard-Herriot Hospital, hospices civils de Lyon, Lyon, France
| | - P Conort
- Service d'urologie, hôpital La-Pitié-Salpêtrière, AP-HP, Sorbonne université, Paris, France
| | - Q Franquet
- Urology Department, University Hospital Grenoble, Grenoble, France
| | | | - P Meria
- Service d'urologie, hôpital Saint-Louis, AP-HP, centre université Paris-Cité, Paris, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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41
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Yun JH, Fang A, Khorshidi F, Habibollahi P, Kutsenko O, Etezadi V, Hunt S, Nezami N. New Developments in Image-Guided Percutaneous Irreversible Electroporation of Solid Tumors. Curr Oncol Rep 2023; 25:1213-1226. [PMID: 37695398 DOI: 10.1007/s11912-023-01452-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Accepted: 08/21/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE OF REVIEW This review will describe the various applications, benefits, risks, and approaches of conventional irreversible electroporation (IRE), as well as highlight the new technological developments of this procedure along with their clinical applications. RECENT FINDINGS Minimally invasive image-guided percutaneous IRE ablation has emerged as a newer, non-thermal ablation technique for tumors in the solid organs, particularly within the liver, pancreas, kidney, and prostate. IRE allows for ablation near heat-sensitive structures, including major blood vessels and nerves, and is not susceptible to the heat sink effect. However, it is limited by certain requirements, such as the need for precise parallel placement of at least two probes with a maximum inter-probe distance of 2.5 cm to reduce the risk of arching phenomenon, the requirement for general anesthesia with muscle relaxant, and the need for cardiac synchronization. However, new technological advancements in the ablation system and image guidance tools have been introduced to improve the efficiency and efficacy of IRE. IRE is a safe and effective treatment option for solid tumor ablation within the liver, pancreas, kidney, and prostate. Compared with other ablation techniques, IRE has several advantages, such as the absence of heat sink effect and minimal injury to blood vessels and bile ducts while activating the immune system. Novel techniques such as H-FIRE, needle placement systems, and robotics have enhanced the accuracy and performance in placement of IRE probes. IRE can be especially beneficial when combined with chemotherapy, immunomodulation, and immunotherapy.
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Affiliation(s)
- Jung H Yun
- Division of Vascular and Interventional Radiology, Jefferson Einstein Hospital, Philadelphia, PA, USA
| | - Adam Fang
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD, N2W79A, USA
| | - Fereshteh Khorshidi
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD, N2W79A, USA
| | - Peiman Habibollahi
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Vahid Etezadi
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD, N2W79A, USA
| | - Stephen Hunt
- Division of Interventional Radiology, Department of Radiology, the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD, N2W79A, USA.
- Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA.
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Bitkin A, Özlü DN, Ekşi M, Kargı T, Fakir AE, Ayten A, Polat H, Taşçı Aİ. A comparative analysis of the efficacy and safety of mini- percutaneous nephrolithotomy performed in the supine and prone positions for the treatment of pediatric kidney stones: a single-center experience. Urolithiasis 2023; 51:122. [PMID: 37847257 DOI: 10.1007/s00240-023-01497-5] [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: 09/04/2023] [Accepted: 09/29/2023] [Indexed: 10/18/2023]
Abstract
Mini-percutaneous nephrolithotomy (MPCNL), which has a smaller tract size (14-20 Fr) than conventional percutaneous nephrolithotomy, has been shown to be safe and effective in pediatric patients with large and complex upper urinary tract stones. This study aimed to compare the efficacy and safety of MPCNL between the supine and prone positions in a pediatric population. The data of pediatric patients who underwent MPCNL at our center between January 2010 and March 2023 were retrospectively analyzed. According to the surgical position, the patients were divided into the prone (Group P) and supine (Group S) groups. In both groups, dilatation was performed using 14-18 Fr metallic dilators. The two groups were compared in terms of perioperative data, postoperative stone-free rates (SFRs), and complications. There were 36 (59%) patients in Group P and 25 (41%) patients in Group S. Stones were mostly located in the pelvis (49.2%) and second most frequently in the lower pole (27.9%). Fluoroscopy time was shorter in Group S but did not statistically significantly differ compared to Group P (p = 0.181). However, operation time was statistically significantly shorter in Group S (73.8 ± 35 vs. 99.8 ± 37.4 min, p = 0.008). Although there was no significant difference, relatively higher SFR were detected in Group S (88% vs. 83%, p = 0.725). Endoscopic combined intrarenal surgery (ECIRS) was performed on six (24%) patients in Group S, and the SFR was 100% among these patients. There was no significant difference between the two groups in terms of the presence of complications (16.7% vs. 16%, p = 0.945). Both supine and prone MPCNL appear to be safe and effective in the pediatric age group, with similar stone-free and complication rates. In the supine procedure, the operation time is shortened compared to the prone. In addition, simultaneous retrograde access has the potential to increase the overall success rate of surgery.
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Affiliation(s)
- Alper Bitkin
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mah, Dr. Tevfik Sağlam Cd No:11, 34147, Bakırköy, Istanbul, Turkey.
| | - Deniz Noyan Özlü
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mah, Dr. Tevfik Sağlam Cd No:11, 34147, Bakırköy, Istanbul, Turkey
| | - Mithat Ekşi
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mah, Dr. Tevfik Sağlam Cd No:11, 34147, Bakırköy, Istanbul, Turkey
| | - Taner Kargı
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mah, Dr. Tevfik Sağlam Cd No:11, 34147, Bakırköy, Istanbul, Turkey
| | - Ali Emre Fakir
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mah, Dr. Tevfik Sağlam Cd No:11, 34147, Bakırköy, Istanbul, Turkey
| | - Ali Ayten
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mah, Dr. Tevfik Sağlam Cd No:11, 34147, Bakırköy, Istanbul, Turkey
| | - Hakan Polat
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mah, Dr. Tevfik Sağlam Cd No:11, 34147, Bakırköy, Istanbul, Turkey
| | - Ali İhsan Taşçı
- Department of Urology, University of Health Sciences Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba Mah, Dr. Tevfik Sağlam Cd No:11, 34147, Bakırköy, Istanbul, Turkey
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Zhang L, Jiang H, Zhou J, Jing J. Comparison of Modified K-wire Fixation with Open Reduction and Internal Fixation (ORIF) for Unstable Colles Fracture in Elderly Patients. Orthop Surg 2023; 15:2621-2626. [PMID: 37620967 PMCID: PMC10549793 DOI: 10.1111/os.13847] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/10/2023] [Accepted: 06/18/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVE Open reduction and internal fixation (ORIF) is the standard treatment of unstable Colles fracture among the elderly. Modified percutaneous K-wire fixation is becoming increasingly popular in recent years. However, there is controversy concerning its appropriate use. This study aimed to compare the early safety and efficacy of the two different treatments and provide an alternative method for the treatment of unstable Colles fracture among the older population. METHODS Electronic medical records of 60 consecutive unstable Colles fractures patients who underwent surgery from June 2019 to October 2021, by modified percutaneous K-wire fixation (30 patients) or ORIF (30 patients), were reviewed retrospectively. All cases were followed up for 3 months. The outcomes of patients were assessed with operation time, intraoperative blood loss, visual analog score (VAS) for wrist joint pain, palmar tilt (PT), radial inclination (RI), radial height (RH), Gartland-Werley score, total hospitalization costs, hospital stays, postoperative complications, and patient subjective satisfaction. General patient information was also collected. Independent Student's t-test or Mann-Whitney U test were used to compare continuous data. Pearson's chi-square test or Fisher's exact test were used to analyze the categorical data. RESULTS The operation time and intraoperative blood loss were significantly shorter in the K-wire group than in the ORIF group (p < 0.05). Compared with the ORIF group, the VAS of the K-wire group was significantly lower at 1 and 3 days postoperatively (p < 0.05), and no significant differences were observed in VAS between the two groups preoperatively and 7 days postoperatively (p > 0.05). There were no significant differences in the PT, RI, and RH between the two groups preoperatively and at 1, 4, and 8 weeks postoperatively (p > 0.05). Patients in the K-wire group had significantly shorter hospital stays and lower total hospital costs (p < 0.05). All patients were followed up for 3 months, and there was no significant difference in the Gartland-Werley score between the two groups (p > 0.05). Compared with the ORIF group, postoperative complications were lower, and patient subjective satisfaction was higher in the K-wire group, but there were no significant differences (p > 0.05). CONCLUSIONS Modified percutaneous K-wire fixation in the treatment of unstable Colles fracture among the elderly is a safe, effective, rapid, and minimally invasive surgical option for surgeons.
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Affiliation(s)
- Lin Zhang
- Department of OrthopedicsThe Third Affiliated Hospital of Shenzhen UniversityShenzhenChina
| | - Haoming Jiang
- Department of OrthopedicsThe Third Affiliated Hospital of Shenzhen UniversityShenzhenChina
| | - Jin Zhou
- Department of OrthopedicsShenzhen Luohu District Hospital of Traditional Chinese MedicineShenzhenChina
| | - Jingti Jing
- Department of OrthopedicsThe Third Affiliated Hospital of Shenzhen UniversityShenzhenChina
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Saththianathan M, Mallinson PI, Munk PL, Heran MKS. Percutaneous spine biopsy: reaching those hard-to-reach places. Skeletal Radiol 2023; 52:1803-1814. [PMID: 35840815 DOI: 10.1007/s00256-022-04120-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 02/02/2023]
Abstract
Cancer is a leading cause of death, with the spine being the most common site for skeletal metastasis. The spine is also a site for primary malignancy, such as sarcoma and chordoma, as well as non-neoplastic pathologies. An accurate diagnosis of spinal neoplastic diseases is crucial in determining appropriate management. With the advent of personalised oncology, the need to establish a definitive histopathologic diagnosis to guide management is more important than ever. Percutaneous biopsy has proven to be safe and efficient in establishing a reliable histopathologic diagnosis. The spine, however, can be a challenging site to biopsy, due to the proximity of critical neurovascular, respiratory, and gastrointestinal structures. Successful spine biopsy depends on several factors: suspected diagnosis, size of the lesion, location within the spine, modality for best imaging guidance, operator experience, technical equipment considerations, and desired approach and associated limitations. The specimen must also be obtained with a biopsy route amenable to any future surgical intervention, with surgical input often sought, frequently in a multidisciplinary setting, to confirm procedure-specific goals and expectations. Knowledge of the requisite local anatomy, procedural and patient-specific indications, and contraindications and various approaches that may be used to access different segments of the spine, potential complications, and how to address these are keys to a successful percutaneous spinal biopsy, even in the most challenging of circumstances.
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Affiliation(s)
- Mayuran Saththianathan
- Department of Radiology, University of British Columbia, Vancouver General Hospital, 899 W 12th Ave., Vancouver, BC, V5Z 1E9, Canada
| | - Paul Ian Mallinson
- Department of Radiology, University of British Columbia, Vancouver General Hospital, 899 W 12th Ave., Vancouver, BC, V5Z 1E9, Canada
| | - Peter Loren Munk
- Department of Radiology, University of British Columbia, Vancouver General Hospital, 899 W 12th Ave., Vancouver, BC, V5Z 1E9, Canada
| | - Manraj Kanwal Singh Heran
- Department of Radiology, University of British Columbia, Vancouver General Hospital, 899 W 12th Ave., Vancouver, BC, V5Z 1E9, Canada.
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Maffulli N, Sammaria G, Ziello S, Migliorini F, Oliva F. Percutaneous cruciate repair of ruptured Achilles tendon. J Orthop Surg Res 2023; 18:677. [PMID: 37700324 PMCID: PMC10496360 DOI: 10.1186/s13018-023-04167-9] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 09/05/2023] [Indexed: 09/14/2023] Open
Abstract
Percutaneous repair is a safe and reliable method to restore continuity after acute Achilles tendon ruptures, with a lower incidence of wound complications compared to open techniques. We describe a novel percutaneous cruciate suture performed through 5 stab skin incisions, four of which are longitudinal and parallel to the course of the sural nerve to minimize the risk of injury and one transverse incision at the site of rupture, with a total of 16 suture threads and the knot outside the tendon body, increasing the tensile strength of the suture and minimizing the risk of re-rupture. Clinical studies are necessary to ascertain whether the theoretical advantages of the cruciate suture technique translate into better clinical outcomes compared to established percutaneous techniques.
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Affiliation(s)
- Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi d'Aragona, 84131, Salerno, Italy
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London, E1 4DG, UK
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Thornburrow Drive, Stoke on Trent, ST4 7QB, UK
| | - Giuliano Sammaria
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi d'Aragona, 84131, Salerno, Italy
| | - Salvatore Ziello
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi d'Aragona, 84131, Salerno, Italy
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy.
| | - Francesco Oliva
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, Rome, Italy
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Maeno R, Taniguchi R, Suhara M, Mochizuki Y, Takayama T, Hoshina K. Area reduction of perforation with a small-size sheath technique for iatrogenic femoral artery pseudoaneurysm with a large perforation. J Vasc Surg Cases Innov Tech 2023; 9:101235. [PMID: 37408947 PMCID: PMC10319320 DOI: 10.1016/j.jvscit.2023.101235] [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: 01/19/2023] [Accepted: 05/15/2023] [Indexed: 07/07/2023] Open
Abstract
Open surgery for femoral artery pseudoaneurysms is invasive, and complications can be detrimental. Several cases of treatment of iatrogenic femoral artery pseudoaneurysms using percutaneous suture-mediated closure devices have been reported. However, it is difficult to properly deploy the foot of the device to the arterial wall when the perforation area is large. We developed a technique using a double guidewire to partially occupy the perforation with a small-size sheath, which reduces the area of the perforation. This AREPAS (area reduction of perforation with a small-sized sheath) technique might allow for minimally invasive closure of perforations even in patients with large perforation areas.
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Affiliation(s)
| | - Ryosuke Taniguchi
- Correspondence: Ryosuke Taniguchi, MD, PhD, Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Tokyo 113-8655, Japan
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47
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Fogwe DT, AbiMansour JP, Truty MJ, Levy MJ, Storm AC, Law RJ, Vargas EJ, Fleming CJ, Andrews JC, Cleary SP, Kendrick ML, Martin JA, Bofill-Garcia AM, Dayyeh BKA, Chandrasekhara V. Endoscopic ultrasound-guided versus percutaneous drainage for the management of post-operative fluid collections after distal pancreatectomy. Surg Endosc 2023; 37:6922-6929. [PMID: 37322361 DOI: 10.1007/s00464-023-10188-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 11/25/2022] [Accepted: 05/30/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Post-operative pancreatic fluid collections (POPFCs) can be drained using percutaneous or endoscopic approaches. The primary aim of this study was to compare rates of clinical success between endoscopic ultrasound-guided drainage (EUSD) with percutaneous drainage (PTD) in the management of symptomatic POPFCs after distal pancreatectomy. Secondary outcomes included technical success, total number of interventions, time to resolution, rates of adverse events (AEs), and POPFC recurrence. METHODS Adults who underwent distal pancreatectomy from January 2012 to August 2021 and developed symptomatic POPFC in the resection bed were retrospectively identified from a single academic center database. Demographic data, procedural data, and clinical outcomes were abstracted. Clinical success was defined as symptomatic improvement and radiographic resolution without requiring an alternate drainage modality. Quantitative variables were compared using a two-tailed t-test and categorical data were compared using Chi-squared or Fisher's exact tests. RESULTS Of 1046 patients that underwent distal pancreatectomy, 217 met study inclusion criteria (median age 60 years, 51.2% female), of whom 106 underwent EUSD and 111 PTD. There were no significant differences in baseline pathology and POPFC size. PTD was generally performed earlier after surgery (10 vs. 27 days; p < 0.001) and more commonly in the inpatient setting (82.9% vs. 49.1%; p < 0.001). EUSD was associated with a significantly higher rate of clinical success (92.5% vs. 76.6%; p = 0.001), fewer median number of interventions (2 vs. 4; p < 0.001), and lower rate of POPFC recurrence (7.6% vs. 20.7%; p = 0.007). AEs were similar between EUSD (10.4%) and PTD (6.3%, p = 0.28), with approximately one-third of EUSD AEs due to stent migration. CONCLUSION In patients with POPFCs after distal pancreatectomy, delayed drainage with EUSD was associated with higher rates of clinical success, fewer interventions, and lower rates of recurrence than earlier drainage with PTD.
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Affiliation(s)
- Delvise T Fogwe
- Department of Internal Medicine, Mayo Clinic, Rochester, USA
| | - Jad P AbiMansour
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Mark J Truty
- Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, USA
| | - Michael J Levy
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Andrew C Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ryan J Law
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Eric J Vargas
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Chad J Fleming
- Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, USA
| | - James C Andrews
- Division of Vascular and Interventional Radiology, Mayo Clinic, Rochester, USA
| | - Sean P Cleary
- Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, USA
| | - Michael L Kendrick
- Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, USA
| | - John A Martin
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Aliana M Bofill-Garcia
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Vinay Chandrasekhara
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Masson D, Mezjan I, Pretat PH, Colnat-Coulbois S, Civit T, Mansouri N. Mono-segmental percutaneous screw fixation in the management of AoSpine thoracolumbar type B fracture in patients with ankylosing spondylitis: A new treatment. Neurochirurgie 2023; 69:101464. [PMID: 37393989 DOI: 10.1016/j.neuchi.2023.101464] [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: 02/27/2023] [Revised: 06/10/2023] [Accepted: 06/13/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE To assess the viability and effectiveness of mono-segmental percutaneous screw fixation in the treatment of unstable type B thoracolumbar fracture due to ankylosing spondylitis. METHODS We report here all 40 patients treated by mono-segmental screw fixation in this indication, between January 2018 and January 2022, with follow-up at 3 and 9 months. Study variables comprised operating time, length of stay, fusion, stabilization quality, and peri-operative morbidity and mortality. RESULTS One patient showed early displacement of rods caused by technical error. None of the others showed secondary displacement of rods or screws. Mean age was 73 years (range 18-93), mean hospital stay 4.8 days (range 2-15), mean operative time 52minutes (range 26-95minutes) and mean estimated blood loss 40ml. There were 2 deaths caused by intensive care unit complications. All patients except those in intensive care were verticalized within 24hours after surgery. Parker score was unchanged for each patient before and after surgery and during follow-up. CONCLUSION Mono-segmental percutaneous screw fixation in the treatment of unstable type B thoracolumbar fracture due to ankylosing spondylitis was safe and effective. This study showed that this surgery reduced length of hospital stay, operative time, blood loss and complications compared to open or extended percutaneous surgery, and allowed fast rehabilitation in this vulnerable population.
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Affiliation(s)
- D Masson
- Service de neurochirurgie, CHRU de Nancy, université de Lorraine, Nancy, France.
| | - I Mezjan
- Service de neurochirurgie, CHRU de Nancy, université de Lorraine, Nancy, France
| | - P-H Pretat
- Service de neurochirurgie, CHRU de Nancy, université de Lorraine, Nancy, France
| | - S Colnat-Coulbois
- Service de neurochirurgie, CHRU de Nancy, université de Lorraine, Nancy, France
| | - T Civit
- Service de neurochirurgie, CHRU de Nancy, université de Lorraine, Nancy, France
| | - N Mansouri
- Service de neurochirurgie, CHRU de Nancy, université de Lorraine, Nancy, France
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49
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Titu IM, Delaca GB, Teterea F, Ciulic SA, Palade E. Percutaneous tracheostomy using the Seldinger technique. Multimed Man Cardiothorac Surg 2023; 2023. [PMID: 37577785 DOI: 10.1510/mmcts.2023.046] [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] [Indexed: 08/15/2023]
Abstract
Patients with acute respiratory failure who are anticipated to have a significant recovery and require prolonged mechanical ventilation, defined as ventilation lasting 7 days or longer, should be evaluated for the potential need for a tracheostomy. A tracheostomy reduces the necessity for sedation and aids in the process of weaning patients. The popularity of percutaneous tracheostomy techniques, which can be carried out at the patient's bedside, has increased due to their ability to save costs associated with time in the operating room. This video tutorial provides a comprehensive guide comprising 10 sequential steps, demonstrating the process of performing a percutaneous tracheostomy. The technique highlighted in the tutorial uses the Seldinger method alongside serial dilators, while also covering the essential anatomical aspects and necessary equipment.
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Affiliation(s)
- Ioana-Medeea Titu
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania Leon Daniello Clinical Hospital of Pneumology, Thoracic Surgery Department, Cluj-Napoca, Romania
| | - George-Bucur Delaca
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania Leon Daniello Clinical Hospital of Pneumology, Thoracic Surgery Department, Cluj-Napoca, Romania
| | - Florin Teterea
- Leon Daniello Clinical Hospital of Pneumology, Thoracic Surgery Department, Cluj-Napoca, Romania
| | - Sergiu-Adrian Ciulic
- Leon Daniello Clinical Hospital of Pneumology, Thoracic Surgery Department, Cluj-Napoca, Romania
| | - Emanuel Palade
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania Leon Daniello Clinical Hospital of Pneumology, Thoracic Surgery Department, Cluj-Napoca, Romania
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Kucukyangoz M, Gucuk A. Which position is more advantageous for percutaneous nephrolithotomy: supine or prone? Urolithiasis 2023; 51:102. [PMID: 37578662 DOI: 10.1007/s00240-023-01474-y] [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: 05/10/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023]
Abstract
Percutaneous nephrolithotomy (PNL) can be performed in a number of different positions. Our aim was to evaluate the convenience and advantages of the supine position following the transition from the prone to the supine position. 94 patients undergoing supine PNL (Group-1) and 93 patients undergoing prone PNL (Group-2) were retrospectively reviewed and included in the study. Patients who underwent mini-PNL (mPNL) were selected from Group-1 and Group-2 and divided into Group-1A supine mPNL patients (77) and Group-2A prone mPNL patients (53). Demographic characteristics, operative data and post-operative parameters were compared between these groups. The operation time was 74.4 ± 21.9 min in Group-1A and 79.2 ± 19.8 min in Group-2A (p = 0.076). The median value of fluoroscopy time was 30 s in Group-1A and 40 s in Group-2A (p = 0.003). In Group-1A, 59 patients had no intraoperative double-J stent (DJS) insertion and 18 patients had DJS insertion, while in Group-2A, 24 patients had no DJS insertion and 29 patients had DJS insertion (p < 0.001). MPNL was performed in 81.9% of patients in the supine position and 57% in the prone position. This difference was statistically significant (p < 0.001). No significant difference was found with regard to the success rate and the complications of mPNL. Fluoroscopy time is shorter in the supine position. Moreover, the insertion rates of DJS are low. With increasing experience, we have found that our standard PNL (sPNL) rate is gradually decreasing and more mPNL is being performed.
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Affiliation(s)
| | - Adnan Gucuk
- Department of Urology, Private Acıbadem Hospital, Eskişehir, Turkey
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