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Velho V, Kharosekar H, Bhide A, Bhople L, Survashe P. Extra-Axial Third Ventriculostomy Through Lamina Terminalis with Multiple Cisternostomies - Rescue Surgery for Patients with Failed Shunt Surgeries and Hydrocephalus. Neurol India 2023; 71:748-753. [PMID: 37635509 DOI: 10.4103/0028-3886.383847] [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: 08/29/2023]
Abstract
Background and Aim Contemporary management of hydrocephalus involves various modes of cerebrospinal fluid (CSF) diversion, including shunt surgery and endoscopic ventriculostomy. However, there are times when either of these procedures have either failed or are not feasible. Highly invasive procedures aimed at internal CSF have been described previously, which, with the aid of modern microsurgical techniques, can be attempted in cases with very limited options. Our aim was to study the utility of extra-axial third ventriculostomy via lamina terminalis fenestration with multiple cisternostomies in the treatment of failed hydrocephalus. Materials and Methods Forty-five patients with hydrocephalus were operated for extra-axial trans-lamina terminalis third ventriculostomy with multiple cisternostomies from January 2017 to January 2019. A minimally invasive supraorbital craniotomy was performed with subfrontal fenestration of the lamina terminalis and trans-lamina terminalis fenestration of the floor of the third ventricle with multiple cisternostomies including the optico-carotid cistern and opening of the Liliequist membrane. Results Tuberculous meningitis was the most common etiology in the series, and multiple shunt procedures and incompatible CSF profiles were the most common reasons that necessitated this alternate rescue procedure. At a mean follow-up of 6 months, no patient required a revision shunt surgery. There was one death due to cardiac failure with anasarca, unrelated to the procedure. Conclusions Extra-axial trans-lamina terminalis ventriculostomy with cisternostomies can safely be performed using minimally invasive micro-neurosurgical techniques, adding to the armamentarium of neurosurgeons in the management of complex cases of hydrocephalus.
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Affiliation(s)
- Vernon Velho
- Department of Neurosurgery, Sir J. J. Group of Hospitals and Grant Medical College, Mumbai, Maharashtra, India
| | - Hrushikesh Kharosekar
- Department of Neurosurgery, Sir J. J. Group of Hospitals and Grant Medical College, Mumbai, Maharashtra, India
| | - Anuj Bhide
- Department of Neurosurgery, Sir J. J. Group of Hospitals and Grant Medical College, Mumbai, Maharashtra, India
| | - Laxmikant Bhople
- Department of Neurosurgery, Sir J. J. Group of Hospitals and Grant Medical College, Mumbai, Maharashtra, India
| | - Pravin Survashe
- Department of Neurosurgery, Sir J. J. Group of Hospitals and Grant Medical College, Mumbai, Maharashtra, India
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Chong XL, Drittenbass L, Dubois-Ferriere V, Assal M. Iatrogenic transfer metatarsalgia after hallux valgus surgery: a comprehensive treatment algorithm. EFORT Open Rev 2022; 7:618-627. [PMID: 36125013 PMCID: PMC9624479 DOI: 10.1530/eor-22-0043] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Current literature has described many of the complications following hallux valgus surgery and their treatment options. Iatrogenic transfer metatarsalgia is a distinctive and challenging complication that has not been addressed in a comprehensive fashion yet. Iatrogenic transfer metatarsalgia may result from poor preoperative assessment, planning and/or surgical technique. We have classified the causes of iatrogenic transfer metatarsalgia based on a multiplanar assessment of the malalignment(s) and are recommending a comprehensive treatment algorithm to guide surgeons in addressing this complication. With this knowledge, surgeons may avoid potential pitfalls in the primary surgery that can result in iatrogenic transfer metatarsalgia and find the appropriate treatment option to correct them.
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Affiliation(s)
- Xue Ling Chong
- Centre Assal SA, Foot and Ankle Surgery Centre, La Colline, Geneva, Switzerland
| | - Lisca Drittenbass
- Centre Assal SA, Foot and Ankle Surgery Centre, La Colline, Geneva, Switzerland
| | | | - Mathieu Assal
- Centre Assal SA, Foot and Ankle Surgery Centre, La Colline, Geneva, Switzerland
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3
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Danilkowicz RM, Allen NB, Grimm N, Nettles DL, Nunley JA, Easley ME, Adams SB. Histological and Inflammatory Cytokine Analysis of Osteochondral Lesions of the Talus After Failed Microfracture: Comparison With Fresh Allograft Controls. Orthop J Sports Med 2021; 9:23259671211040535. [PMID: 34734096 PMCID: PMC8558807 DOI: 10.1177/23259671211040535] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/19/2021] [Indexed: 11/21/2022] Open
Abstract
Background: The most common first-line treatment of osteochondral lesions of the talus (OLTs) is microfracture. Although many patients do well with this procedure, a number fail and require reoperation. The mechanism of failure of microfracture is unknown, and to our knowledge there has been no research characterizing failed microfracture regarding histological and inflammatory makeup of these lesions that may contribute to failure. Purpose: To characterize the structural and biochemical makeup of failed microfracture lesions. Study Design: Case series; Level of evidence, 4. Methods: Specimens from 8 consecutive patients with symptomatic OLTs after microfracture who later underwent fresh osteochondral allograft transplantation were analyzed. For each patient, the failed microfracture specimen and a portion of the fresh allograft replacement tissue were collected. The allograft served as a control. Histology of the failed microfracture and the allograft replacement was scored using the Osteoarthritis Research Society International (OARSI) system. Surface roughness was also compared. In addition, tissue culture supernatants were analyzed for 16 secreted cytokines and matrix metalloproteinases (MMPs) responsible for inflammation, pain, cartilage damage, and chondrocyte death. Results: The OARSI grade, stage, and total score as well as surface smoothness were significantly worse in the failed microfracture sample, indicating better cartilage and bone morphology for the allografts compared with the failed microfracture lesions. Analyzed cytokines and MMPs were significantly elevated in the microfracture tissue culture supernatants when compared with fresh osteochondral tissue supernatants. Conclusion: These data demonstrate a significantly rougher cartilage surface, cartilage and subchondral bone histology that more closely resembles osteoarthritis, and elevated inflammatory cytokines and MMPs responsible for pain, inflammation, cartilage damage, and chondrocyte death when compared with fresh osteochondral allografts used as controls.
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Affiliation(s)
- Richard M Danilkowicz
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Nicholas B Allen
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Nate Grimm
- Idaho Sports Medicine Institute, Boise, Idaho, USA
| | - Dana L Nettles
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - James A Nunley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Mark E Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
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4
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Law JA, Duggan LV, Asselin M, Baker P, Crosby E, Downey A, Hung OR, Jones PM, Lemay F, Noppens R, Parotto M, Preston R, Sowers N, Sparrow K, Turkstra TP, Wong DT, Kovacs G. Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 1. Difficult airway management encountered in an unconscious patient. Can J Anaesth 2021; 68:1373-1404. [PMID: 34143394 PMCID: PMC8212585 DOI: 10.1007/s12630-021-02007-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [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: 10/19/2020] [Revised: 03/11/2021] [Accepted: 03/14/2021] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Since the last Canadian Airway Focus Group (CAFG) guidelines were published in 2013, the literature on airway management has expanded substantially. The CAFG therefore re-convened to examine this literature and update practice recommendations. This first of two articles addresses difficulty encountered with airway management in an unconscious patient. SOURCE Canadian Airway Focus Group members, including anesthesia, emergency medicine, and critical care physicians, were assigned topics to search. Searches were run in the Medline, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL databases. Results were presented to the group and discussed during video conferences every two weeks from April 2018 to July 2020. These CAFG recommendations are based on the best available published evidence. Where high-quality evidence was lacking, statements are based on group consensus. FINDINGS AND KEY RECOMMENDATIONS Most studies comparing video laryngoscopy (VL) with direct laryngoscopy indicate a higher first attempt and overall success rate with VL, and lower complication rates. Thus, resources allowing, the CAFG now recommends use of VL with appropriately selected blade type to facilitate all tracheal intubations. If a first attempt at tracheal intubation or supraglottic airway (SGA) placement is unsuccessful, further attempts can be made as long as patient ventilation and oxygenation is maintained. Nevertheless, total attempts should be limited (to three or fewer) before declaring failure and pausing to consider "exit strategy" options. For failed intubation, exit strategy options in the still-oxygenated patient include awakening (if feasible), temporizing with an SGA, a single further attempt at tracheal intubation using a different technique, or front-of-neck airway access (FONA). Failure of tracheal intubation, face-mask ventilation, and SGA ventilation together with current or imminent hypoxemia defines a "cannot ventilate, cannot oxygenate" emergency. Neuromuscular blockade should be confirmed or established, and a single final attempt at face-mask ventilation, SGA placement, or tracheal intubation with hyper-angulated blade VL can be made, if it had not already been attempted. If ventilation remains impossible, emergency FONA should occur without delay using a scalpel-bougie-tube technique (in the adult patient). The CAFG recommends all institutions designate an individual as "airway lead" to help institute difficult airway protocols, ensure adequate training and equipment, and help with airway-related quality reviews.
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Affiliation(s)
- J. Adam Law
- grid.55602.340000 0004 1936 8200Department of Anesthesia, Pain Management and Perioperative Medicine, QEII Health Sciences Centre, Dalhousie University, Halifax Infirmary Site, 1796 Summer Street, Room 5452, Halifax, NS B3H 3A7 Canada
| | - Laura V. Duggan
- grid.28046.380000 0001 2182 2255Department of Anesthesiology and Pain Medicine, The Ottawa Hospital Civic Campus, University of Ottawa, Room B307, 1053 Carling Avenue, Mail Stop 249, Ottawa, ON K1Y 4E9 Canada
| | - Mathieu Asselin
- grid.23856.3a0000 0004 1936 8390Département d’anesthésiologie et de soins intensifs, Université Laval, 2325 rue de l’Université, Québec, QC G1V 0A6 Canada ,grid.411081.d0000 0000 9471 1794Département d’anesthésie du CHU de Québec, Hôpital Enfant-Jésus, 1401 18e rue, Québec, QC G1J 1Z4 Canada
| | - Paul Baker
- grid.9654.e0000 0004 0372 3343Department of Anaesthesiology, Faculty of Medical and Health Science, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Edward Crosby
- grid.28046.380000 0001 2182 2255Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Suite CCW1401, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Andrew Downey
- grid.1055.10000000403978434Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Orlando R. Hung
- grid.55602.340000 0004 1936 8200Department of Anesthesia, Pain Management and Perioperative Medicine, QEII Health Sciences Centre, Dalhousie University, 1796 Summer Street, Halifax, NS B3H 3A7 Canada
| | - Philip M. Jones
- grid.39381.300000 0004 1936 8884Department of Anesthesia & Perioperative Medicine, Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, LHSC- University Hospital, 339 Windermere Rd., London, ON N6A 5A5 Canada
| | - François Lemay
- grid.417661.30000 0001 2190 0479Département d’anesthésiologie, CHU de Québec – Université Laval, Hôtel-Dieu de Québec, 11, Côte du Palais, Québec, QC G1R 2J6 Canada
| | - Rudiger Noppens
- grid.39381.300000 0004 1936 8884Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, LHSC- University Hospital, 339 Windermere Road, London, ON N6A 5A5 Canada
| | - Matteo Parotto
- grid.17063.330000 0001 2157 2938Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto General Hospital, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Interdepartmental Division of Critical Care Medicine, University of Toronto, EN 442 200 Elizabeth St, Toronto, ON M5G 2C4 Canada
| | - Roanne Preston
- grid.413264.60000 0000 9878 6515Department of Anesthesia, BC Women’s Hospital, 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | - Nick Sowers
- grid.55602.340000 0004 1936 8200Department of Emergency Medicine, QEII Health Sciences Centre, Dalhousie University, 1796 Summer Street, Halifax, NS B3H 3A7 Canada
| | - Kathryn Sparrow
- grid.25055.370000 0000 9130 6822Discipline of Anesthesia, St. Clare’s Mercy Hospital, Memorial University of Newfoundland, 300 Prince Phillip Drive, St. John’s, NL A1B V6 Canada
| | - Timothy P. Turkstra
- grid.39381.300000 0004 1936 8884Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, LHSC- University Hospital, 339 Windermere Road, London, ON N6A 5A5 Canada
| | - David T. Wong
- grid.17063.330000 0001 2157 2938Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 399, Bathurst St, Toronto, ON M5T2S8 Canada
| | - George Kovacs
- grid.55602.340000 0004 1936 8200Department of Emergency Medicine, QEII Health Sciences Centre, Dalhousie University, 1796 Summer Street, Halifax, NS B3H 3A7 Canada
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Calvo R, Figueroa D, Anastasiadis Z, Espinoza G, Sarango D. Medial femoral condyle fracture during an Oxford unicompartmental knee replacement surgery: case report. J ISAKOS 2020; 6:182-184. [PMID: 34006582 DOI: 10.1136/jisakos-2019-000311] [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: 03/18/2020] [Revised: 10/21/2020] [Accepted: 11/01/2020] [Indexed: 11/04/2022]
Abstract
Oxford unicompartmental knee arthroplasty has been used as a good alternative for medial unicompartmental osteoarthritis due to its association with early rehabilitation and a low rate of intraoperative complications. This case describes a rare complication during the procedure of an intraoperative fracture of the medial condyle that was treated with osteosynthesis with 6.5 mm cannulated screws and a compression technique. The patient followed a non-weight-bearing protocol for 6 weeks and reached full range of motion at 3 months. Complete radiological fusion and good functional outcome were observed. Intraoperative fractures can benefit from stable osteosynthesis that allows free range of motion and does not jeopardise the final surgical result.
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Affiliation(s)
- Rafael Calvo
- Ortopedia y Traumatologia, Clinica Alemana de Santiago SA, Vitacura, Chile
| | - David Figueroa
- Ortopedia y Traumatologia, Clinica Alemana de Santiago SA, Vitacura, Chile
| | | | - Gonzalo Espinoza
- Clinica Alemana de Santiago SA, Vitacura, Metropolitan Region, Chile
| | - Daniel Sarango
- Knee Fellow, Clinica Alemana de Santiago SA, Vitacura, Metropolitan Region, Chile
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Coe A, Lyon M. 'Tramline Rescue': A salvage technique for the failed elliptical excision on the leg. Australas J Dermatol 2019; 60:219-220. [PMID: 31012091 DOI: 10.1111/ajd.13058] [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: 03/07/2019] [Accepted: 03/24/2019] [Indexed: 11/30/2022]
Abstract
We outline an approach to achieve wound closure in the event of a failed elliptical excision on the leg. The various steps are shown, and a clinical example is presented.
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Affiliation(s)
| | - Matthew Lyon
- Royal Brisbane & Womens Hospital, Brisbane, Queensland, Australia
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Selmi V, Sarı S, Çakıcı MÇ, Özdemir H, Kartal İG, Özok HU, İmamoğlu MA. Does Previous Failed Shockwave Lithotripsy Treatment Have an Influence on Retrograde Intrarenal Surgery Outcome? J Laparoendosc Adv Surg Tech A 2018; 29:627-630. [PMID: 30418090 DOI: 10.1089/lap.2018.0487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The prevalence of urolithiasis is nearly 20% and patients with urolithiasis constitute an essential part of the patients referred to the urology clinic. Many parameters should be considered for the management of renal stones and authors recommend extracorporeal shockwave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), and percutaneous nephrolithotripsy (PNL), as treatment options. Among these techniques, SWL does not require general anesthesia, has 89% success rate for renal pelvic stones: 83% for upper caliceal stones, 84% for middle caliceal stones, and 68% for lower caliceal stones. In this study, we aimed to investigate whether the previously failed SWL treatment affects RIRS outcome. Methods: Patients who underwent RIRS for kidney stones between January 2012 and December 2017 in Diskapi Yildirim Beyazit Training and Research Hospital were reviewed retrospectively. Patients treated with primary RIRS (186 patients) were classified as Group 1. The outcomes of these patients were compared with those of 186 patients who underwent RIRS after failed SWL treatment using matched-pair analysis, and these patients were classified as Group 2. Results: The procedure success was defined as the sum of the stone-free and clinically insignificant residual fragments (CIRFs); final success rates were 90.3% and 91.9%, respectively. If we compare the final success rates, there was no statistically significant difference between both groups (P = .584). Conclusions: As a result, there is no negative effect of the previous unsuccessful SWL treatment on the RIRS success. Patients with CIRF should be followed up more carefully in terms of becoming symptomatic.
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Affiliation(s)
- Volkan Selmi
- 1 Department of Urology, Faculty of Medicine, Bozok University, Yozgat, Turkey
| | - Sercan Sarı
- 1 Department of Urology, Faculty of Medicine, Bozok University, Yozgat, Turkey
| | - Mehmet Çağlar Çakıcı
- 2 Department of Urology, Goztepe Training and Research Hospital, Faculty of Medicine, Medeniyet University, İstanbul, Turkey
| | - Harun Özdemir
- 3 Department of Urology, Avcılar State Hospital, İstanbul, Turkey
| | - İbrahim Güven Kartal
- 4 Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Hakkı Uğur Özok
- 5 Department of Urology, Faculty of Medicine, Karabük University, Karabük, Turkey
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8
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Wang WR, Chang XF, He LL. [Methods of removing failed implants]. Hua Xi Kou Qiang Yi Xue Za Zhi 2018; 36:212-214. [PMID: 29779286 DOI: 10.7518/hxkq.2018.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Implant restoration has become one of the most regular methods of restoring dentition defect or edentulous. Implant placement and osseointegration are partly unreserved (fracture, implant is not in the correct three-dimensional position and cannot be repaired, peri-implantitis-affected nonmobile implants) need to be removed. This article reviews the different methods of removing implants and discusses the limitations of each method, as well as the complications that may occur during the procedure.
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Affiliation(s)
- Wan-Rong Wang
- Dept. of Implant Dentistry, Hospital of Stomatology, Xi'an Jiaotong University, Xi'an 710000, China;State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Xiao-Feng Chang
- Dept. of Implant Dentistry, Hospital of Stomatology, Xi'an Jiaotong University, Xi'an 710000, China;Clinical Research Center of Shanxi Province for Dental and Maxillofacial Diseases, Xi'an 710000, China
| | - Long-Long He
- Dept. of Implant Dentistry, Hospital of Stomatology, Xi'an Jiaotong University, Xi'an 710000, China;Clinical Research Center of Shanxi Province for Dental and Maxillofacial Diseases, Xi'an 710000, China
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9
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Hadar E, Hiersch L, Ashwal E, Aviram A, Wiznitzer A, Gabbay-Benziv R. Risk of caesarean delivery after induction of labour stratified by foetal sex. J OBSTET GYNAECOL 2017; 37:731-735. [PMID: 28350529 DOI: 10.1080/01443615.2017.1292224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study describes a retrospective analysis of all women admitted for induction of labour (IoL), carrying a viable singleton foetus, after 34 + 0 weeks of gestation. We aimed to evaluate if foetal sex has an impact on the rate of caesarean delivery following labour induction. Our results demonstrate that among the 1062 women who met the inclusion criteria, 49% (521/1062) were carrying a male foetus. Other than a lower rate of Oxytocin use for the female sex pregnancies, there were no significant differences in pre-labour and labour characteristics between male or female sex pregnancies. There was no difference in caesarean delivery rate between groups (14.4% vs. 14.2%, male vs. female, respectively, p = .505). We concluded conclude that foetal sex does not impact the caesarean delivery rate among women undergoing IoL, regardless of the indication for induction and the indication for the caesarean delivery. Impact statement Male sex foetuses are at increased risk for adverse perinatal outcomes including, among others, an increased risk for caesarean delivery. The possible contribution of male sex to caesarean delivery after labour induction has not been specifically explored. Following induction of labour, there is no difference in failed induction or caesarean delivery rate between male and female sex pregnancies. Induction of labour may be safely employed for both male and female foetuses.
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Affiliation(s)
- Eran Hadar
- a Helen Schneider Hospital for Women, Rabin Medical Center , Petach-Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Liran Hiersch
- a Helen Schneider Hospital for Women, Rabin Medical Center , Petach-Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Eran Ashwal
- a Helen Schneider Hospital for Women, Rabin Medical Center , Petach-Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Amir Aviram
- a Helen Schneider Hospital for Women, Rabin Medical Center , Petach-Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Arnon Wiznitzer
- a Helen Schneider Hospital for Women, Rabin Medical Center , Petach-Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Rinat Gabbay-Benziv
- a Helen Schneider Hospital for Women, Rabin Medical Center , Petach-Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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Abstract
PURPOSE Maternal age is an important consideration for antenatal care, labor and delivery. We aimed to evaluate the induction of labor (IoL) failure rates among elderly nulliparous women. MATERIALS AND METHODS We conducted a retrospective analysis of all nulliparous women at 34 + 0 to 41 + 6 weeks, undergoing cervical ripening by prostaglandin E2 (PGE2) vaginal insert. Study group included elderly (≥35 years) nulliparous and control group included non-elderly (<35 years) nulliparous women. Primary outcome was IoL failure rate and secondary outcome was cesarean delivery rate. Outcomes were compared between the groups by univariate analysis followed by regression analysis to adjust results to potential confounders. RESULTS Of 537 women undergoing IoL, 69 (12.8%) were elderly. The univariate analysis demonstrated no difference in IoL failure rate (26.5% versus 34.8%, p = 0.502) between groups. However, elderly nulliparous women had higher rates of cesarean delivery (36.2% versus 21.4%, p = 0.009). This difference was no longer significant after adjustment for maternal body mass index, indication for delivery, birth weight and gestational age at delivery. CONCLUSION Among nulliparous women, older maternal age is not associated with higher rates of IoL failure or cesarean deliveries.
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Affiliation(s)
- Eran Hadar
- a Helen Schneider Hospital for Women, Rabin Medical Center , Petach-Tikva , Israel and.,b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Liran Hiersch
- a Helen Schneider Hospital for Women, Rabin Medical Center , Petach-Tikva , Israel and.,b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Eran Ashwal
- a Helen Schneider Hospital for Women, Rabin Medical Center , Petach-Tikva , Israel and.,b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Rony Chen
- a Helen Schneider Hospital for Women, Rabin Medical Center , Petach-Tikva , Israel and.,b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Arnon Wiznitzer
- a Helen Schneider Hospital for Women, Rabin Medical Center , Petach-Tikva , Israel and.,b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Rinat Gabbay-Benziv
- a Helen Schneider Hospital for Women, Rabin Medical Center , Petach-Tikva , Israel and.,b Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
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Abstract
The term mid-flexion instability has entered the orthopaedic literature as a concept, but has not been confirmed as a distinct clinical entity. The term is used freely, sometimes as a synonym for flexion instability. However, the terms need to be clearly separated. A cadaver study published in 1990 associated joint line elevation with decreased stability at many angles of flexion, but that model was not typical of clinical scenarios. The literature is considered and it is proposed that the more common entity of an uncorrected flexion contracture after a measured resection arthroplasty technique is more likely to produce clinical findings that suggest instability mid-flexion. It is proposed that the clinical scenario encountered is generalised instability, with the appearance of stability in full extension from tight posterior structures. This paper seeks to clarify whether mid-flexion instability exists as an entity distinct from other commonly recognised forms of instability.
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Affiliation(s)
- K Vince
- Whangarei Hospital, 118 Crane Rd, Kamo, 0185, New Zealand
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12
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Abstract
There are many reasons why a total knee replacement (TKR) may fail and qualify for revision. Successful revision surgery depends as much on accurate assessment of the problem TKR as it does on revision implant design and surgical technique. Specific modes of failure require specific surgical solutions. Causes of failure are often presented as a list or catalogue, without a system or process for making a decision. In addition, strict definitions and consensus on modes of failure are lacking in published series and registry data. How we approach the problem TKR is an essential but neglected aspect of understanding knee replacement surgery. It must be carried out systematically, comprehensively and efficiently. Eight modes of failure are described: 1) sepsis; 2) extensor discontinuity; 3) stiffness; 4) tibial- femoral instability; 5) patellar tracking; 6) aseptic loosening and osteolysis; 7) periprosthetic fracture and 8) component breakage. A ninth 'category', unexplained pain is an indication for further investigation but not surgery.
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Affiliation(s)
- K G Vince
- Northland District Health Board, Department of Orthopaedic Surgery, Whangarei, New Zealand
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Gamradt SC, Gelber J, Zhang AL. Shoulder function and pain level after revision of failed reverse shoulder replacement to hemiarthroplasty. Int J Shoulder Surg 2012; 6:29-35. [PMID: 22787331 PMCID: PMC3391782 DOI: 10.4103/0973-6042.96991] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [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] [Indexed: 01/20/2023]
Abstract
BACKGROUND The reverse total shoulder replacement has become a popular treatment option for cuff tear arthropathy and other shoulder conditions requiring arthroplasty in the setting of a deficient rotator cuff. Despite a revision rate of as much as 10%, to date, there are few reports of reverse replacement conversion to hemiarthroplasty, and none specifically examining shoulder function. MATERIALS AND METHODS Six patients with a reverse replacement that was dislocated, infected or loose were revised an average of 9.2 months after the reverse replacement. Two of the three patients that were dislocated also had a known deep infection. Patients with known infection were treated with explant of the reverse prosthesis and conversion to a preformed antibiotic spacer hemiarthroplasty. In three cases with gross loosening of the glenosphere without infection, treatment was performed with removal of glenosphere only, bone grafting of glenoid with allograft and conversion of humeral stem to hemiarthroplasty. Patients were evaluated with outcome scores and physical examination an average of 26.5 months after removal of the reverse prosthesis. RESULTS The average range of motion postoperatively was forward elevation 42.5 degrees and external rotation 1.7 degrees. The VAS pain score was 2.42 (range 0-6); simple shoulder test was 3.17 (range 1-5); and ASES score was 52.1 ± 8.5. There were no reoperations to date, and five patients had anterosuperior escape. CONCLUSIONS Safe removal of a reverse replacement and conversion to hemicement spacer or hemiarthroplasty can provide pain relief in those patients with a dislocated or infected reverse replacement. However, the shoulder will likely have very poor function and anterosuperior escape postoperatively. Further studies are needed to determine the optimal treatment for the failed reverse shoulder replacement. LEVEL OF EVIDENCE Therapeutic Level IV.
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Affiliation(s)
- Seth C Gamradt
- Department of Orthopaedic Surgery, University of California, Los Angeles, CA, USA
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Abstract
USG has been used for the diagnosis of carpal tunnel syndrome. Scarring and incomplete decompression are the main causes for persistence or recurrence of symptoms. We performed a retrospective study to assess the role of ultrasound in failed carpal tunnel decompression. Of 422 USG studies of the wrist performed at our center over the last 5 years, 14 were for failed carpal tunnel decompression. Scarring was noted in three patients, incomplete decompression in two patients, synovitis in one patient, and an anomalous muscle belly in one patient. No abnormality was detected in seven patients. We present a pictorial review of USG findings in failed carpal tunnel decompression.
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Affiliation(s)
- Rajesh Botchu
- Department of Musculoskeletal Radiology, University Hospitals of Leicester, UK
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