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Surgical Correction (surgical + correction)
Selected AbstractsWire Scalpel for Surgical Correction of Soft Tissue Contour Defects by Subcutaneous DissectionDERMATOLOGIC SURGERY, Issue 2 2000Marlen A. Sulamanidze MD Background. Increasing demand exists for cosmetic correction of soft tissue contour defects. Treatments include simple tissue augmentation techniques or more complex surgeries with consequent relevant recuperation time for the patient. The search for new simple techniques to correct scars and age-related wrinkles and folds is therefore one of the main goals of cosmetic dermatologic surgery. Objective. To improve the cosmetic outcome of patients suffering from soft tissue contour defects by the use of a novel surgical instrument and technique, subcutaneous dissection by wire scalpel. Methods. Fifty-four patients were treated with the wire scalpel technique with no skin incisions to correct a total of 132 depressed cosmetic defects of the face. Forehead lines, glabellar, nasolabial and oral commissure folds, upper lip wrinkles, and acne scars were treated. A 2-month to 4-year follow-up allowed subjective and photographic evaluation of results. Results. Good or satisfactory results were obtained in 79.7% and 16.6% of the cases, respectively. Minor complications did not change the overall positive outcome of the surgery. Conclusion. Subcutaneous dissection by wire scalpel is a simple, safe, and effective method to improve the contour appearance of patients affected with scars or age-related contour defects. [source] Retrosternal Compression Seven Years after Surgical Correction of Partial Anomalous Pulmonary Venous Connection: Scimitar SyndromeJOURNAL OF CARDIAC SURGERY, Issue 1 2009Eva Maria B. Delmo Walter M.D. Transthoracic echocardiography revealed a mass compressing the right ventricle. Magnetic resonance tomogram showed its exact retrosternal location and nature. A computed tomography-guided drainage decompressed the mass. Because of cystic wall persistence, a surgical extirpation of the whole cystic cavity was deemed necessary. [source] Left Superior Vena Cava Draining into the Left Atrium, Associated with Partial Anomalous Pulmonary Venous Connection: Surgical CorrectionJOURNAL OF CARDIAC SURGERY, Issue 4 2005Andrea Quarti M.D. Although intra-atrial rerouting techniques, in patients with no connecting vein, have proved to be reliable and successful, in many cases the extracardiac repair is preferable. We report a case of a 5-month-old patient with a not connected left superior vena cava draining into the left atrium, associated with atrial septal defect and partial anomalous pulmonary venous connection. The correction has been achieved by rerouting the pulmonary venous return into the left atrium and by transposition of the left vena cava on the right appendage. [source] Successful Surgical Correction of a Single Atrium Associated with Cleft Mitral Valve Persistent Left Superior Vena Cava and Pulmonary Valvular Stenosis as an Isolated Cardiac DefectJOURNAL OF CARDIAC SURGERY, Issue 3 2005Akin Izgi M.D. It is extremely rare for SA to be observed as an isolated defect. We report here a 13-year-old male patient with SA as an isolated cardiac defect, successfully corrected by surgery. [source] Surgical Correction of Peyronie's Disease via Tunica Albuginea Plication or Partial Plaque Excision with Pericardial Graft: Long Term Follow Up: Author ResponseTHE JOURNAL OF SEXUAL MEDICINE, Issue 9 2008Frederick L. Taylor [source] ORIGINAL RESEARCH,SURGERY: Torsion of the Penis in Adults: Prevalence and Surgical CorrectionTHE JOURNAL OF SEXUAL MEDICINE, Issue 3 2008Osama Shaeer MD ABSTRACT Introduction., Torsion of the penis is a condition where the penis rotates around its longitudinal axis, whether congenital or acquired. Extreme degrees may provoke a cosmetic complaint. Aim., We describe surgical correction of congenital torsion of the penis in adults, and its prevalence among a special patient group. Main Outcome Measures., Success and ease of surgical repair. Methods., Sixteen cases with congenital torsion were operated upon, by counter-rotation, using a dartos flap in eight cases, and skin realignment in the other eight. The prevalence of congenital torsion was examined in 12,307 patients attending two andrology clinics. Results., Full correction was achieved in all cases. Skin realignment was easier and faster than dartos flap, and was equally effective. Congenital torsion was present in 11.993% of the epidemiologic study group, mild in 80%, moderate in 15%, and severe in 5%. Only 2.2% was bothered by the condition. Conclusion., Torsion of the penis is not uncommon but rarely provokes a complaint. Surgical repair by degloving and skin realignment is effective and easy. Dartos flap technique may be utilized if the former is inadequate. Shaeer O. Torsion of the penis in adults: Prevalence and surgical correction. J Sex Med 2008;5:735,739. [source] Surgical correction of scoliosis: Numerical analysis and optimization of the procedureINTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING, Issue 9 2010J. F. Aguilar Madeira Abstract A previously developed model is used to numerically simulate real clinical cases of the surgical correction of scoliosis. This model consists of one-dimensional finite elements with spatial deformation in which (i) the column is represented by its axis; (ii) the vertebrae are assumed to be rigid; and (iii) the deformability of the column is concentrated in springs that connect the successive rigid elements. The metallic rods used for the surgical correction are modeled by beam elements with linear elastic behavior. To obtain the forces at the connections between the metallic rods and the vertebrae geometrically, non-linear finite element analyses are performed. The tightening sequence determines the magnitude of the forces applied to the patient column, and it is desirable to keep those forces as small as possible. In this study, a Genetic Algorithm optimization is applied to this model in order to determine the sequence that minimizes the corrective forces applied during the surgery. This amounts to find the optimal permutation of integers 1, ,, n, n being the number of vertebrae involved. As such, we are faced with a combinatorial optimization problem isomorph to the Traveling Salesman Problem. The fitness evaluation requires one computing intensive Finite Element Analysis per candidate solution and, thus, a parallel implementation of the Genetic Algorithm is developed. Copyright © 2010 John Wiley & Sons, Ltd. [source] Effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instabilityINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 2 2007Choong Ng BMedSci(Melb) Abstract Background, Anterior instability is a frequent complication following a traumatic glenohumeral dislocation. Frequently the underlying pathology associated with recurrent instability is a Bankart lesion. Surgical correction of Bankart lesions and other associated pathology is the key to successful treatment. Open surgical glenohumeral stabilisation has been advocated as the gold standard because of consistently low postoperative recurrent instability rates. However, arthroscopic glenohumeral stabilisation could challenge open surgical repair as the gold standard treatment for traumatic anterior glenohumeral instability. Objectives, Primary evidence that compared the effectiveness of arthroscopic versus open surgical glenohumeral stabilisation was systematically collated regarding best-practice management for adults with traumatic anterior glenohumeral instability. Search strategy, A systematic search was performed using 14 databases: MEDLINE, Cumulative Index of Nursing and Allied Health (CINAHL), Allied and Complementary Medicine Database (AMED), ISI Web of Science, Expanded Academic ASAP, Proquest Medical Library, Evidence Based Medicine Reviews, Physiotherapy Evidence Database, TRIP Database, PubMed, ISI Current Contents Connect, Proquest Digital Dissertations, Open Archives Initiative Search Engine, Australian Digital Thesis Program. Studies published between January 1984 and December 2004 were included in this review. No language restrictions were applied. Selection criteria, Eligible studies were those that compared the effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instability, which had more than 2 years of follow up and used recurrent instability and a functional shoulder questionnaire as primary outcomes. Studies that used non-anatomical open repair techniques, patient groups that were specifically 40 years or older, or had multidirectional instability or other concomitant shoulder pathology were excluded. Data collection and analysis, Two independent reviewers assessed the eligibility of each study for inclusion into the review, the study design used and its methodological quality. Where any disagreement occurred, consensus was reached by discussion with an independent researcher. Studies were assessed for homogeneity by considering populations, interventions and outcomes. Where heterogeneity was present, synthesis was undertaken in a narrative format; otherwise a meta-analysis was conducted. Results, Eleven studies were included in the review. Two were randomised controlled trials. Evidence comparing arthroscopic and open surgical glenohumeral stabilisation was of poor to fair methodological quality. Hence, the results of primary studies should be interpreted with caution. Observed clinical heterogeneity in populations and outcomes was highlighted and should be considered when interpreting the meta-analysis. Authors also used variable definitions of recurrent instability and a variety of outcome measures, which made it difficult to synthesise results. When comparable data were pooled, there were no significant differences (P > 0.05) between the arthroscopic and open groups with respect to recurrent instability rates, Rowe score, glenohumeral external rotation range and complication rates. Conclusions, Statistically, it appears that both surgical techniques are equally effective in managing traumatic anterior glenohumeral instability. In light of the methodological quality of the included studies, it is not possible to validate arthoscopic stabilisation to match open surgical stabilisation as the gold standard treatment. Further research using multicentred randomised controlled trials with sufficient power and instability-specific questionnaires with sound psychometric properties is recommended to build on current evidence. The choice of treatment should be based on multiple factors between the clinician and the patient. [source] Management of Coronary Artery Compression Caused by Recurrent Aortic Root AbscessJOURNAL OF CARDIAC SURGERY, Issue 3 2008Scott W. Cowan M.D. We report the case of a 61-year-old male who developed a recurrent aortic root abscess causing extrinsic coronary artery compression. This complication occurred one year after undergoing aortic valve replacement and pericardial patch exclusion of an aortic root abscess. Surgical correction required debridement of the abscess and replacement of the aortic root with a homograft resulting in resolution of coronary compression. [source] Caudal proximal tibial deformity and cranial cruciate ligament rupture in small-breed dogsJOURNAL OF SMALL ANIMAL PRACTICE, Issue 10 2002C. Macias Eight dogs presented with chronic hindlimb lameness associated with cranial cruciate ligament rupture. Seven were small terriers. A caudal deformity of the proximal tibial shaft, originating at the proximal tibial physis, and an excessive caudal slope of the tibial plateau were present bilaterally in all dogs. The deformity was thought to be responsible for the cranial cruciate ligament failure and poor response to conservative management. Tibial plateau angles were in excess of 26° in all dogs. The lameness was bilateral in three dogs. There was complete cranial cruciate ligament rupture in seven stifles and partial rupture in four. There were no meniscal injuries. Surgical correction resulted in a significant improvement (P < 0 ·0001) in all dogs, with a mean follow-up of 12 months (range three to 24 months). There were no complications. [source] Hemorrhagic bile pleuritis and peritonitis secondary to traumatic common bile duct rupture, diaphragmatic tear, and rupture of the spleen in a dogJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 6 2008Gordon D. Peddle VMD Abstract Objective, To describe the diagnosis and successful treatment of bile pleuritis and peritonitis secondary to traumatic rupture of the common bile duct and a diaphragmatic tear in a young dog. Case Summary, A 1-year-old German Shepherd dog was referred for evaluation of vomiting and icterus 4 days after being hit by a car. Thoracic radiographs, thoracic and abdominal ultrasonographic examinations, thoraco- and abdominocentesis, and positive contrast celiogram indicated hemorrhagic pleuritis and peritonitis, left dorsal diaphragmatic tear, and rupture and infarct of the spleen. Surgical exploration of the abdomen confirmed these findings in addition to a circumferential tear of the common bile duct, leading to a diagnosis of hemorrhagic bile pleuritis and peritonitis. Aerobic and anaerobic bacterial culture of the abdominal fluid yielded no growth. Surgical correction of the traumatic injuries was achieved via common bile duct anastomosis, cholecystojejunostomy, repair of the diaphragm, and splenectomy. The dog developed postoperative signs consistent with aspiration pneumonia but was successfully treated and discharged from the hospital. Clinical signs and laboratory abnormalities resolved and the dog was alive and healthy 8 months after discharge. New or Unique Information Provided, Bile pleuritis is rare in dogs and cats and is usually associated with penetrating, not blunt, abdominal trauma. Multiple organ injury in cases of traumatic bile duct rupture is uncommon; in this dog, rupture of the common bile duct was accompanied by rupture of the diaphragm and spleen. [source] Intraoperative vascular localization to facilitate endopyelotomy after renal transplantationANZ JOURNAL OF SURGERY, Issue 8 2001Mark Siddins Background: Pelviureteric junction (PUJ) obstruction after renal transplantation is uncommon. Surgical correction can be technically challenging due to dense perinephric adhesions and variable hilar vascular anatomy. Endopyelotomy is well established in the treatment of PUJ obstruction in native kidneys. Methods: The present paper reports the first experience of antegrade visual cold-knife endopyelotmy performed in a renal allograft. In orientating the incision at the PUJ, preoperative imaging was supplemented by intrarenal Doppler ultrasound, using a probe designed for transoesophageal cardiac monitoring. To the authors' knowledge this approach has not previously been reported. Results: Renal vascular relationships were readily indentified by identifying arterial and venous waveforms. Conclusions: For this uncommon procedure the use of intrarenal Doppler ultrasound provides greater security in avoiding inadvertent vascular injury. [source] Retrospective analysis of outcome of pregnancy in women with congenital heart disease: Single-centre experience from North IndiaAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2009Neelam AGGARWAL Objective: To study maternal and perinatal outcome in congenital heart disease (CHD) and to compare outcome between cyanotic and acyanotic CHD. Method: A retrospective analysis of 196 cases of CHD was undertaken, and maternal and perinatal outcome of pregnancy was compared in cyanotic and acyanotic cases and between surgically corrected and uncorrected cases. Results: Maternal and perinatal outcome was better in the acyanotic group. Maternal complications included higher incidence of cardiac complications in cyanotic group, (33.3% vs 3.4% in acyanotic group, P = 0.001), abruption (12.5% vs nil) and pregnancy-induced hypertension (16.6% vs 5.2%). Rate of prematurity (25% vs 11.6%), intrauterine growth retardation (50% vs 15.1%, P = 0.003) and abortion (4.1% vs 2.1%) was higher in cyanotic group. Mean gestational age at delivery was better in corrected group, 37.13 vs 34.93 weeks in uncorrected group. There was no case of infective endocarditis. There were four cases of maternal mortality in cyanotic group, two of which were in women with Eisenmenger syndrome. In acyanotic heart disease one case died undelivered and one died on first postoperative day. Conclusion: Maternal and perinatal outcome is better in acyanotic CHD compared to cyanotic CHD. Surgical correction of cardiac lesions prior to conception improves outcome. [source] Surgical correction of rectovaginal fistula in mares and subsequent fertilityAUSTRALIAN VETERINARY JOURNAL, Issue 6 2010SL Jalim Objective To evaluate the fertility of mares bred at various intervals relative to surgical management of rectovaginal fistula (RVF). Materials and Methods Surgical repair of RVF was performed in 28 mares at variable times relative to foaling (30 days to 24 months) and also relative to rebreeding (same cycle or delayed). Postoperative fertility was then evaluated. Results Two mares were already pregnant at the time of surgery and 20 of 23 mares (87%) that were bred immediately prior to or following surgery conceived from their first service. When mares were bred in the same cycle as surgery, the next cycle following surgery or in the following breeding season after surgery the pregnancy rate was 5/5, 5/6 and 10/12, respectively, and the foaling rates were 4/5, 4/6 and 7/12. The two mares already pregnant at the time of surgery foaled successfully. Conclusions Excellent fertility can be achieved following surgical repair of RVF and our results suggest that delaying breeding until the following breeding season is not necessary. In addition, breeding in the same cycle as the surgical repair is a previously unreported technique that should be considered to maintain normal fertility and a yearly foaling interval. [source] The management of Peyronie's diseaseBJU INTERNATIONAL, Issue 2 2004D.J. Ralph Peyronie's disease has no known cause; recent understanding of the molecular mechanisms involved and the development of an animal model will aid the medical management of early disease. The medical management of chronic disease is futile as the delicate tunical architecture cannot regenerate. Surgical correction of the penile deformity is required in a minority of patients, and a choice lies between a Nesbit operation and a plaque incision and venous patch in patients who are concerned with penile shortening. [source] Successful Treatment of an Adult Patient with an Aortopulmonary Window and Severe Unilateral Pulmonary HypertensionCONGENITAL HEART DISEASE, Issue 6 2009Olaf Franzen MD ABSTRACT A 40-year-old woman with an aortopulmonary window combined with a severe stenosis of the right pulmonary artery was successfully treated by surgical closure of the defect and pulmonary artery patch plasty of the pulmonary stenosis. Even though the vasculature of the left lung was severely damaged preoperatively, the resulting pressure in the lung after surgical correction was only mildly elevated. [source] Evaluation of decision criteria for detection of spinal cord compression based on cervical myelography in horses: 38 cases (1981,2001)EQUINE VETERINARY JOURNAL, Issue 1 2004J. Van Biervliet Summary Reasons for performing study: Different criteria have been described based on height reduction of the total myelographic contrast column and components of it as tests for compression of the spinal cord due to cervical stenotic myelopathy (CSM). Fifty percent height reduction of the dorsal myelographic column (DMC), <2 mm empiric height of the DMC and a 40% reduction of the ratio of stenosis calculated based on the height reduction of the entire dural diameter (DD) have been described as decision criteria for considering the test result positive. The reasons for selecting these decision criteria or their accuracies have rarely been reported. Objectives: To evaluate the accuracy of diagnostic criteria based on reduced height of the total myelographic column and components of it for diagnosing extradural spinal cord compression using different decision criteria, and make recommendations for consistent myelographic interpretation in horses suspected of having CSM. Methods: Four measurements were obtained by 2 readers in a retrospective sample population of 38 horses in which both cervical myelography and histopathological examination of the cervical spinal cord were performed. The prevalence of CSM in the sample was 50%. At intervertebral sites, the minimum heights of the DD and DMC were measured. At intravertebral sites, the maximum heights of the entire DD and DMC were obtained. Percent height reductions of the DMC and DD were determined as the ratio of minimum intervertebral height to maximum intravertebral height within the next cranial vertebra. Histological examination was used as the gold standard for determining the actual site of spinal cord compression. Sensitivity and specificity for the diagnostic criteria were estimated at each site in neutral and flexed neck positions using several different decision criteria. Conclusions: At C6-C7, in neutral or flexed neck position and using 20% reduction of DD, the test was highly sensitive and specific for CSM. At other sites, reduced height of the myelographic column generally was not accurate for diagnosing extradural spinal cord compression. Using 20% reduction of DD in neutral position at the mid-cervical sites, the test had only low sensitivity and high specificity. Flexion of the neck appeared to increase detection of spinal cord compression in the mid-cervical region, but also substantially increased the frequency of false-positive diagnoses. Potential relevance: By using the reported sensitivity and specificity estimates, readers may decide on a decision criterion for diagnosis of extradural spinal cord compression due to CSM. However, in planning a surgical correction, it is difficult to define a decision criterion that combines acceptable sensitivity and specificity, especially at the mid-cervical sites. [source] A challenging intervention with maternal anxiety: Babies requiring surgical correction of a congenital anomaly after missed prenatal diagnosisINFANT MENTAL HEALTH JOURNAL, Issue 6 2003Lucia Aite The objective of this study is to assess the impact on maternal anxiety of a short-term intervention in a particularly stressful situation, such as a surgical anomaly diagnosed only at birth after repeated negative prenatal ultrasounds. The patients were 30 mothers of babies requiring surgical correction of a congenital anomaly who were randomly assigned to an intervention (N = 16) or control (N = 14) group. The intervention group received standard care plus short-term intervention that included weekly meetings with the psychologist and weekly team meetings. The control group received only standard care available on the Neonatal Surgery Unit. The main outcome measure was maternal anxiety levels, assessed at birth and on discharge with the Spielberger State,Trait Anxiety Inventory (STAI,S). Statistical comparisons were made, and no significant differences were found at birth in the STAI,S scores of the two groups. At discharge, the intervention group exhibited a much lower STAI,S score than the group without short-term intervention. The authors concluded that psychological counseling for parents of newborn babies has been shown to be helpful. However, the impact of such assistance was shown to be particularly beneficial for parents facing the emotional stress of their children requiring unexpected surgical corrections of congenital anomalies at birth. Therefore, the presence of a psychologist, as part of the standard care of newborns requiring surgical correction, is recommended. ©2003 Michigan Association for Infant Mental Health. [source] Surgical correction of scoliosis: Numerical analysis and optimization of the procedureINTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING, Issue 9 2010J. F. Aguilar Madeira Abstract A previously developed model is used to numerically simulate real clinical cases of the surgical correction of scoliosis. This model consists of one-dimensional finite elements with spatial deformation in which (i) the column is represented by its axis; (ii) the vertebrae are assumed to be rigid; and (iii) the deformability of the column is concentrated in springs that connect the successive rigid elements. The metallic rods used for the surgical correction are modeled by beam elements with linear elastic behavior. To obtain the forces at the connections between the metallic rods and the vertebrae geometrically, non-linear finite element analyses are performed. The tightening sequence determines the magnitude of the forces applied to the patient column, and it is desirable to keep those forces as small as possible. In this study, a Genetic Algorithm optimization is applied to this model in order to determine the sequence that minimizes the corrective forces applied during the surgery. This amounts to find the optimal permutation of integers 1, ,, n, n being the number of vertebrae involved. As such, we are faced with a combinatorial optimization problem isomorph to the Traveling Salesman Problem. The fitness evaluation requires one computing intensive Finite Element Analysis per candidate solution and, thus, a parallel implementation of the Genetic Algorithm is developed. Copyright © 2010 John Wiley & Sons, Ltd. [source] Varicocelectomy reduces reactive oxygen species levels and increases antioxidant activity of seminal plasma from infertile men with varicoceleINTERNATIONAL JOURNAL OF ANDROLOGY, Issue 5 2001T. Mostafa Several theories have been advanced to explain the mechanisms by which varicocele impairs male fertility. These theories include scrotal hyperthermia, retrograde flow of adrenal or renal metabolites, Leydig cell dysfunction and hypoxia. Varicocele is reported to be associated with elevated reactive oxygen species (ROS) production in spermatozoa and diminished seminal plasma antioxidant activity. The aim of this study was to investigate whether surgical correction of varicocele might reduce ROS or increase the antioxidant capacity of seminal plasma from infertile patients with varicocele. The study group consisted of 68 infertile males, selected from patients scheduled for varicocelectomy at Cairo University Hospital during the year 1999. Seminal plasma levels of two ROS [malondialdehyde (MDA), hydrogen peroxide (H2O2)] and one ROS radical [nitric oxide (NO)] were estimated as well as six antioxidants [superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), vitamin C (Vit C), vitamin E (Vit E), albumin) on the day prior to varicocelectomy. For comparison, the same parameters were measured again 3 and 6 months post-operatively. A statistically significant reduction in the 3 month post-operative levels of MDA, H2O2 and NO was observed when compared with the pre-operative values. A further significant reduction took place during the following 3 months. Four of the six antioxidants tested (SOD, CAT, GPx, and Vit C) showed a significant increase in seminal levels when comparing 3-month post-operative with pre-operative values. A further significant increase of the four antioxidant levels took place during the following 3 months. No significant change in the level of seminal plasma albumen took place during the first 3 months after varicocelectomy, however, a significant increase was noted during the next 3 months. In contrast to other antioxidants, seminal plasma levels of Vit E showed a significant decrease when comparing 3-month post-operative with pre-operative values. A further significant decrease took place during the following 3 months. It is concluded that varicocelectomy reduces ROS levels and increases antioxidant activity of seminal plasma from infertile men with varicocele. [source] Hypospadias repair: an overviewINTERNATIONAL JOURNAL OF UROLOGICAL NURSING, Issue 1 2010Michael Pfeil Hypospadias is a birth defect in boys where the meatus is not placed at the tip of the glans of the penis. This article reviews the rapidly developing international literature surrounding hypospadias and hypospadias repairs paying specific attention to important aspects of nursing care, including preparing for surgery, use of dressings, stents and catheters as well as medication. It concludes by considering the long-term impact of hypospadias and its surgical correction on the patient's life. Hypospadias is treated surgically, normally during the second 6 months of the boy's life. Hospitalization periods vary from day case surgery to several days. The success of the hypospadias repair can be measured according to functional results and cosmetic appearance of the penis. The post-operative use of dressings as well as urinary catheters or stents is common but not uniform. Complication rates for hypospadias surgery vary from below 10% in boys with distal hypospadias to above 50% in children with a proximal meatus. The most common complications are urethral fistulas, strictures and stenoses. The continuing efforts by paediatric urologists focus on further optimizing the cosmetic and functional results. [source] Predictive value of renal histological changes for postoperative renal function improvement in children with congenital ureteropelvic junction stenosisINTERNATIONAL JOURNAL OF UROLOGY, Issue 6 2002Ahmet Erbagci Abstract Background: The aim of this study was to evaluate the relationship between renal function, as measured by diuretic radionuclide renography, and the outcome of pyeloplasty. A study was designed to evaluate renal parenchymal biopsy specimens derived from children undergoing corrective surgery for ureteropelvic junction (UPJ) stenosis, and compare these to preoperative and postoperative renal function status. Methods: Thirty-five children with congenital unilateral UPJ stenosis were evaluated. In addition to all conventional diagnostic procedures for UPJ stenosis, differential renal functional (DRF) activity was assessed in each of these children by obtaining 99mTc diethylenetriaminepentaacetic acid renogram curves. All children underwent dismembered pyeloplasty, and follow-up renogram evaluation was conducted 6 and 12 months after surgical repair. Biopsy specimens from renal cortical regions obtained during the surgical correction of UPJ stenosis were evaluated, and changes in renal histology were graded from I to V according to their severity. Spearman's correlation test was used to compare the histological evaluation results and the basal, 6- and 12-month follow-up DRF findings. A Wilcoxon paired test was used to evaluate statistical differences between values. Results: The findings showed a positive correlation between the severity of histological changes and DRF activity. All kidneys (22) with a DRF activity value of < 40% preoperatively demonstrated at least grade III changes when biopsy specimens were examined. Of children with a DRF activity value > 40% (13), only three showed severe histological changes. Histological grades were correlated between basal (r = ,0.4; P = 0.019), 6-month (r = 0.54; P = 0.002) and 12-month (r = 0.54; P = 0.02) findings. In the Wilcoxon paired test, there was a statistically significant difference between basal and 6-month values (P < 0.05), and also between basal and 12-month values (P < 0.01). There was no statistically significant difference between 6- and 12-month values (P > 0.20). Conclusion: Comparative evaluation of postoperative renal function with DRF activity and renal parenchymal histological alterations revealed a close correlation in terms of renal function improvement potential following reconstructive surgery in children with UPJ stenosis. [source] Long-term results of Burch colposuspensionINTERNATIONAL JOURNAL OF UROLOGY, Issue 4 2000Haluk Akpinar Abstract Background: We aimed to determine the long-term results of Burch colposuspension. Methods: Patients who had undergone Burch colposuspension due to stress urinary incontinence (SUI) in our department between 1991 and 1995 were asked to participate in the study by telephone or mail. Fifty of 78 patients (64%) responded and these formed the study group. Patients were evaluated by a detailed questionnaire, pelvic examination, uroflowmetry and postvoid residual urine determination. Provocative stress test and urodynamic evaluations were performed in those who claimed leakage. Additionally, follow-up charts were retrospectively reviewed from the patients' files. Results: Mean follow-up time was 50.6 months. The subjective cure rate was 52% and the surgical success rate was 84%. The patient satisfaction rate in terms of incontinence was 86%. No correlation was found between pre-operative patient characteristics (i.e. age, number of vaginal deliveries and pregnancies, menopause, previous anti-incontinence surgery and presence of detrusor instability) and outcome of surgery. Although no patient was performing clean intermittent catheterization in the long term, two patients had significant residual urine and obstructive flows. Three patients had severe pelvic prolapse that required surgical correction. Conclusions: Our results indicate that Burch colposuspension operation is an effective and durable choice of treatment with low complication rates for the treatment of SUI. [source] Dexamethasone decreases oxycodone consumption following osteotomy of the first metatarsal bone: a randomized controlled trial in day surgeryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2010K. MATTILA Background: Dexamethasone may improve multimodal pain management following painful orthopedic day surgery procedures, and decrease the need for post-operative opioids. We hypothesized that dexamethasone would reduce the need for oxycodone after surgical correction of hallux valgus. Methods: Sixty patients planned to undergo unilateral osteotomy of the first metatarsal as a day surgery procedure were randomized to receive pre-operatively and 24 h afterwards, orally either dexamethasone 9 mg or placebo. For pain medication, paracetamol and oxycodone capsules for rescue medication were given. The study ended on the evening of the third post-operative day (POD). The primary endpoint was the cumulative oxycodone consumption. Secondary endpoints were maximal pain scores before oxycodone intake and daily oxycodone doses. In addition, adverse effects were documented. Results: Twenty-five patients in both groups completed the study. The total median (range) oxycodone consumption during the study period was 45 (0,165) mg in the dexamethasone group and 78 (15,175) mg in the placebo group (P=0.049). The major differences in oxycodone consumption were seen on PODs 0,1. In the dexamethasone group, patients reported significantly lower pain scores on PODs 0,1, and significantly less nausea on POD 1. On PODs 2,3 no differences were seen. However, at 2 weeks post-operatively, patient satisfaction to drug therapy did not differ , in both groups 81% would have chosen the same medication again. Conclusion: Oral dexamethasone combined with paracetamol significantly reduced total oxycodone consumption following surgical correction of hallux valgus. [source] The Use of Intraoperative Doppler Assessment to Guide the Surgical Treatment of Anomalous Right Coronary ArteriesJOURNAL OF CARDIAC SURGERY, Issue 5 2008Louis H. Stein M.H.S. Because of this risk, many patients elect surgical correction of this anomaly. Surgical strategies for correction of this include ostioplasty, coronary artery reimplantation, and, more commonly, coronary artery bypass grafting. After coronary artery bypass grafting, some advocate ligation of the proximal RCA, speculating that competitive flow will cause graft failure. As no objective criteria for this have been established, we propose a method using of intraoperative Doppler flow measurements to guide the decision to preserve the proximal anomalous native vessel. We present three cases in which an RCA with an anomalous origin from the left sinus was corrected with coronary artery bypass grafting with the assistance of intraoperative Doppler flow measurements to guide the decision to preserve the proximal anomalous native vessel. In each case, the RCA was bypassed using a saphenous vein graft (SVG) that was used to bypass origin of the RCA. Flow through the graft was compared with and without ligation of the proximal RCA, before creation of the proximal anastomosis. In each case, flow through the SVG was not significantly reduced with the proximal RCA patent and ligation was not performed. [source] Clinical indicators of ineffective airway clearance in children with congenital heart diseaseJOURNAL OF CLINICAL NURSING, Issue 5 2009Viviane Martins Da Silva Aims and objectives., To analyse the sensitivity and specificity of clinical indicators of ineffective airway clearance in children with congenital heart disease and to identify the indicators that have high predictive power. Background., The precise establishment of nursing diagnoses has been found to be one of the factors contributing to higher quality of care and cost reduction in healthcare institutions. The use of indicators to diagnose ineffective airway clearance could improve care of children with congenital heart disease. Design., Longitudinal study. Methods., Participants consisted of 45 children, ,1 year of age, with congenital heart disease, who had not had definitive or palliative surgical correction. Six assessments were made at 2-day intervals. Each clinical indicator was defined based on previously established operational criteria. Sensitivity, specificity and positive and negative predictive values of each indicator were calculated based on a model for the longitudinal data. Results., A nursing diagnosis of ineffective airway clearance was made in 31% of patients on the first assessment, rising to 71% on the last assessment, for a 40% increase. Sensitivity was highest for Changes in Respiratory Rates/Rhythms (0·99), followed by Adventitious Breath Sounds (0·97), Sputum Production (0·85) and Restlessness (0·53). Specificity was higher for Sputum Production (0·92), followed by Restlessness (0·73), Adventitious Breath Sounds (0·70) and Changes in Respiratory Rates/Rhythms (0·17). The best positive predictive values occurred for Sputum Production (0·93) and Adventitious Breath Sounds (0·80). Conclusions., Adventitious Breath Sounds followed by Sputum Production were the indicators that had the best overall sensitivity and specificity as well as the highest positive predictive values. Relevance to clinical practice., The use of simple indicators in nursing diagnoses can improve identification of ineffective airway clearance in children with congenital heart disease, thus leading to early treatment of the problem and better care for these children. [source] The efficacy of three different surgical techniques in the management of drug-induced gingival overgrowthJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 9 2006M. Mavrogiannis Abstract Objectives: The aim of the present study was to evaluate the efficacy of three different surgical techniques in both the management and effect upon rate of overgrowth recurrence of drug-induced gingival overgrowth (DIGO). Materials and methods: Two cohorts of patients who required surgical correction of their DIGO participated in the study. After baseline periodontal measures (plaque index, gingival inflammation and probing pocket depths), the patients underwent surgery. A split-mouth, crossover design was used to compare conventional gingivectomy with flap surgery (n=27), and conventional gingivectomy with laser excision (n=23). The main outcome variable was the rate of recurrence of DIGO following surgery. Results: At 6 months, there was significantly less recurrence (p=0.05) in patients treated with laser excision, compared with those treated by conventional gingivectomy. The differences in rate of recurrence of DIGO were also reflected in changes in several periodontal parameters. Flap surgery offered no advantage over conventional gingivectomy with respect to the rate of recurrence. Conclusions: DIGO can be managed by a variety of techniques. Laser excision results in a reduced rate of recurrence. [source] Sonographic assessment of clubfootJOURNAL OF CLINICAL ULTRASOUND, Issue 5 2004Cosimo Gigante MD Abstract Purpose This study was performed to develop a standardized methodology for the sonographic assessment of clubfoot at birth and at the end of both conservative treatment and surgical correction. Methods Forty-two congenital clubfeet and 42 normal feet were examined sonographically in the position of spontaneous alignment and during passive manual correction. Scans along 4 planes provided information relevant to the assessment: sagittal posterior, sagittal anterior, coronal lateral, and transverse. Results Sagittal posterior sonograms demonstrated the progressive gain of dorsiflexion ability during the different steps of treatment for clubfoot. Sagittal anterior sonograms could not demonstrate the normal alignment of the navicular in clubfeet because of the bone's medial displacement. On transverse sonograms, the talar head and the medially displaced navicular may lie on the same plane, depending on the severity of the deformity. Coronal lateral sonograms provided for estimation of the relationships between the calcaneus and cuboid, which were described by the calcaneal-cuboid angle. Conclusions Sonography is a promising technique for assessment and monitoring of clubfoot during treatment. The method described here yields accurate and reproducible information about the anatomy of the nonossified clubfoot, helping the orthopedic team decide on appropriate treatment steps. © 2004 Wiley Periodicals, Inc. J Clin Ultrasound 32:235,242, 2004; Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jcu.20022 [source] Effects of alternative instrumentation strategies in adolescent idiopathic scoliosis: A biomechanical analysisJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 1 2009Martin Robitaille Abstract The recent advent of modern instrumentation systems has improved the correction of scoliosis, but complicated the surgical decision-making process, especially with the introduction of diverse spinal fixation devices, new preoperative corrective maneuvers, and the reevaluation of many rules concerning the selection of fusion levels and other guidelines for surgical correction. Our objective was to assess the biomechanical effects of different instrumentation strategies for the same scoliotic cases. Several instrumentation strategies suggested by a group of 32 experienced senior surgeons for five cases were individually simulated using a validated computer model implemented in a spine surgery simulator. The resulting geometric indices varied among the five cases (e.g., range of main thoracic Cobb angles: 5,17°, 16,29°, 25,44°, 15,34°, 16,32°; kyphosis: 22,33°, 20,54°, 33,55°, 24,49°, 29,46°; and lordosis: 10,52°, 24,38°, 26,54°, 8,28°, 34,53°). The average correction was better with pedicle screws (71%) than with hooks (51%) and hybrid constructs (67%). For the first time, to our knowledge, the effect of different instrumentation strategies was compared on the same patients, which is possible only with a surgery simulator. A large variability of instrumentation strategies existed among experienced surgeons and produced rather different results. This study questions the criteria for optimal configuration and standards to design the best surgical construct. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27:104,113, 2009 [source] Fate of the unligated vertical vein after repair of supracardiac anomalous pulmonary venous connectionJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7 2005YF Cheung Objective: To determine the fate of the unligated vertical vein after repair of isolated supracardiac total anomalous pulmonary venous connection (TAPVC). Methods: We reviewed the outcome of 28 patients who were diagnosed to have isolated supracardiac TAPVC and determined the fate of the unligated vertical vein. Results: Of the 28 patients, four died before surgery. The remaining 24 patients underwent surgical correction of TAPVC with (n = 5) or without (n = 19) ligation of vertical vein at a median age of 20 days (range: 1,574 days). There were no significant differences in age, weight, presence of pulmonary venous obstruction, need for preoperative inotropic and ventilatory support, cardiopulmonary bypass duration, postoperative pulmonary hypertensive crisis and requirement of peritoneal dialysis between patients with and those without vertical vein ligation. The in-hospital surgical mortality was 50% (12/24), with 83% (10/12) of deaths occurring before 1990. Patients who died after surgery were significantly younger (median age: 5.5 days vs 37 days, P = 0.005), lighter (3.3 ± 0.5 kg vs 3.9 ± 0.6 kg, P = 0.016), more likely to have pulmonary venous obstruction preoperatively (75% vs 12%, P = 0.039) and have undergone surgery before 1990 (83% vs 33%, P = 0.036). The 12 survivors were followed up for a median of 4.7 years (range: 2.3,18.1 years), 10 of whom had their vertical vein unligated. The vertical vein remained patent in five (50%) patients, while stenosis of pulmonary venous anastomosis was only present in one patient. Of these five patients, three had subsequently undergone surgical ligation of the vertical vein to eliminate a large left-to-right shunt. Conclusions: Patency of the unligated vertical vein is common after the repair of supracardiac TAPVC, even in the absence of pulmonary venous obstruction. The degree of left-to-right shunt through the patent vertical vein may be so significant as to warrant surgical ligation. [source] | ||||||||||||||||||||||||||||||||||