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Invasive Approach (invasive + approach)
Selected AbstractsMINIMALLY INVASIVE APPROACH IN THE MANAGEMENT OF CHILDHOOD INTUSSUSCEPTIONANZ JOURNAL OF SURGERY, Issue 9 2007Sing T. Cheung Background: Intussusception is one of the most common causes of intestinal obstruction in infancy. Non-operative reduction using air enema or other hydrostatic reduction methods has been the standard treatment in most cases. However, if the non-operative method is not indicated or fails, open surgery is still necessary. With the tremendous development of the minimally invasive approach in handling surgical conditions in children in the last decade, this has been applied recently for the reduction of intussusception in children. We herein reviewed our experience of using the combined approach, namely, pneumatic reduction and, if failed, laparoscopic reduction in the management of childhood intussusception. Methods: We carried out a retrospective analysis of all children with intussusception managed at Prince of Wales Hospital between December 1998 and December 2004. The minimally invasive approach was used as far as possible. The method of reduction, success rate and the incidence of complication were analysed. Results: Over a 6-year period, there were 146 patients with 167 episodes of intussusception. Pneumatic reduction was carried out in 160 occasions and was successful in 134 (83.8%). In 33 patients, operative reduction was required. Of these, laparoscopic reduction was attempted in 15 and was successful in 13 (86.7%). In those with either pneumatic or laparoscopic reduction, no procedure-related complication was encountered and they had a significant shorter hospital stay (median 3.0 day) than those requiring laparotomy (median 8.0 day) (t -test, P < 0.0001). Conclusion: The minimally invasive approach, that is, pneumatic and/or laparoscopic reduction, was successful in reducing intussusception in 88% of patients with minimal morbidity and shorter hospital stay. [source] Anomalous Coronary Artery Correction: A Minimally Invasive ApproachJOURNAL OF CARDIAC SURGERY, Issue 5 2006William T. Brinkman M.D. No abstract is available for this article. [source] Follicular Unit Extraction: Minimally Invasive Surgery for Hair TransplantationDERMATOLOGIC SURGERY, Issue 8 2002William R. Rassman MD background. Follicular Unit Transplantation (FUT) is performed using large numbers of naturally occuring individual follicular units obtained by single-strip harvesting and stereo-microscopic dissection. Donor wound scarring from strip excision, although an infrequent complication, still concerns enough patients that an alternative solution is warranted. objective. The purpose of this paper is to introduce Follicular Unit Extraction (The FOX Procedure), in which individual follicular units are removed directly from the donor region through very small punch excisions, and to describe a test (The FOX Test) that determines which patients are candidates for this procedure. This paper explores the nuances, limitations, and practical aspects of Follicular Unit Extraction (FUE). methods. FUE was performed using 1-mm punches to separate follicular units from the surrounding tissue down to the level of the mid dermis. This was followed by extraction of the follicular units with forceps. The FOX test was developed to determine which patients would be good candidates for the procedure. The test was performed on 200 patients. Representative patients who were FOX-positive and FOX-negative were studied histologically. results. The FOX Test can determine which patients are suitable candidates for FUE. Approximately 25% of the patients biopsied were ideal candidates for FUE and 35% of the patients biopsied were good candidates for extraction. conclusion. FUE is a minimally invasive approach to hair transplantation that obviates the need for a linear donor incision. This technique can serve as an important alternative to traditional hair transplantation in certain patients. [source] Treatment of achalasia: lessons learned with Chagas' diseaseDISEASES OF THE ESOPHAGUS, Issue 5 2008F. A. M. Herbella SUMMARY., Chagas' disease (CD) is highly prevalent in South America. Brazilian surgeons and gastroenterologists gained valuable experience in the treatment of CD esophagopathy (chagasic achalasia) due to the high number of cases treated. The authors reviewed the lessons learned with the treatment of achalasia by different centers experienced in the treatment of Chagas' disease. Preoperative evaluation, endoscopic treatment (forceful dilatation and botulinum toxin injection), Heller's myotomy, esophagectomy, conservative techniques other than myotomy, and reoperations are discussed in the light of personal experiences and review of International and Brazilian literature. Aspects not frequently adopted by North American and European surgeons are emphasized. The review shows that nonadvanced achalasia is frequently treated by Heller's myotomy. Endoscopic treatment is reserved to limited cases. Treatment for end-stage achalasia is not unanimous. Esophagectomy was a popular treatment in advanced disease; however, the morbidity/mortality associated to the procedure made some authors seek different alternatives, such as Heller's myotomy and cardioplasties. Minimally invasive approach to esophageal resection may change this concept, although few centers perform the procedure routinely. [source] Epiphrenic diverticula: minimal invasive approach and repair in five patientsDISEASES OF THE ESOPHAGUS, Issue 1 2001D. L. Van Der Peet Epiphrenic esophageal diverticula are rare and often asymptomatic. If surgery is mandatory, a thoracotomy is used to resect the diverticulum. The results of a minimal invasive approach and repair in five patients are presented. These patients, who all presented with an epiphrenic diverticulum, were evaluated using barium swallow study, esophagoscopy, and manometry. The diverticula were approached by thoracoscopy in all patients and a description of the surgical technique is given. The diverticula were resected using a right-sided approach in four patients. One patient with a diverticulum in the distal esophagus required conversion to laparoscopy. A myotomy was performed in two patients because of high pressures in the lower esophageal sphincter. The postoperative course was uncomplicated in four patients. One patient with Ehlers,Danlos disease had a complicated course owing to leakage, resulting in two re-operations by means of thoracotomy. There was no mortality. The minimal invasive approach of epiphrenic diverticula is feasible. The long-term results are awaited. [source] Repair of Partial Atrioventricular Septal Defect Through a Minimal Right Vertical Infra-Axillary ThoracotomyJOURNAL OF CARDIAC SURGERY, Issue 3 2002Xiubin Yang M.D. Methods: From November 1997 to January 2000, six patients with a mean age of 19.2 ± 7.7 years underwent minimal right vertical infraaxillary thoracotomy (VIAT) for PAVSD repair. Left atrioventricular (AV) valve regurgitation was tested on the beating heart before and after valvuloplasty. Commissuroplasty of the left AV valve and atrial septum repair were done in all patients. Results: There was no operative or late mortality, and no morbidity directly related to the thoracotomy approach. The average length of the incision was 8.3 ± 1.3 cm. The arrest times averaged 32.8 ± 8.3 minutes, and the cardiopulmonary bypass times averaged 66.0 ± 9.0 minutes. One patient had mild-to-moderate left AV valve regurgitation postoperatively. All patients were free of symptoms during follow-up. Conclusion: Minimal right VIAT is a safe, more cosmetic, and less invasive approach than median sternotomy for the repair of PAVSD. [source] Selection of glycoprotein IIb/IIIa inhibitors for upstream use in patients with diabetes experiencing unstable angina or non-ST segment elevation myocardial infarction.JOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 6 2004What have we learned in the last 10 years? Summary Coronary disease accounts for the majority of deaths among patients with diabetes and the thrombotic milieu accelerated by diabetes results in unstable angina (UA), non-ST segment elevation myocardial infarction (NSTEMI) or ST-segment elevation myocardial infarction (STEMI) or death. Upstream use of a glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitor with percutaneous coronary intervention (PCI) as part of an early invasive approach is preferred. However substantial numbers of patients present to rural or non-teaching hospitals without immediate access to a catheterization laboratory. Enhanced GP IIb/IIIa receptor mobilization, TXA2 production and platelet activation together present an extensive thrombotic challenge that may not be overcome with current doses of GP IIb/IIIa inhibitors when used without PCI. Heterogeneity of platelet aggregometric analysis may have identified GP IIb/IIIa doses used in clinical trials that may not fully overcome the thrombotic challenge in patients with diabetes. GUSTO-IV ACS failed to demonstrate a difference in mortality when used without PCI. The PURSUIT trial provided evidence that eptifibatide decreases death or non-fatal myocardial infarction (MI) in the main group and in the diabetic subgroup. Reductions in this primary endpoint were driven by the reduction in non-fatal MI. The PRISM and PRISM-PLUS trials demonstrated a reduction in death, MI or refractory ischaemia at 48 h or 7 days in the main cohort but not specifically in patients with diabetes. Data supporting use of GP IIb/IIIa inhibitors are inconsistent, raising the question of whether these agents should be used at all without PCI. Variability in experimental methodology of platelet aggregometry and selection of anticoagulant used during dose finding studies may have generated doses that are insufficient to overcome the thrombotic burden. A new marker of active inflammation, sCD40L is found to be upregulated at subtherapeutic doses of GP IIb/IIIa inhibitors, suggesting that rebound inflammatory processes may partially account for absence of clear evidence of benefit with some GP IIb/IIIa inhibitors in patients with diabetes experiencing UA/NSTEMI. [source] Percutaneous Treatment for Mitral Regurgitation: The QuantumCor SystemJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2008RICHARD R. HEUSER M.D. Aims:Percutaneous edge-to-edge techniques and annuloplasty have been used to treat mitral regurgitation (MR). However, neither intervention can be performed reliably a second time and, with annuloplasty, a foreign body is left behind. The mitral and tricuspid annuli are areas of dense collagen (Fig. 1); treatment with radiofrequency (RF) energy in sheep reduces their size, and can be repeated without affecting the coronary sinus. RF energy may also be used in leaflet procedures. Our aim was to improve mitral valve competence using techniques that can be incorporated into a minimally invasive approach. Figure 1. This trichrome stain slide shows the amount of collagen present in the mitral annulus (in green). Methods:In open-heart procedures in 16 healthy sheep (6 with naturally occurring MR), we used a malleable probe (QuantumCor, Inc., Lake Forest, CA) that conforms to the annular shape to deliver RF energy via a standard generator to replicate a surgical mitral annular ring. Four segments of the posterior mitral valve annulus were treated while on cardiopulmonary support via a left thoracotomy with access via the atrial appendage. Seven sheep were followed chronically. Results:All sheep underwent intracardiac echocardiography (ICE) or direct circumferential measurement of the mitral annulus before and after RF therapy. RF therapy was administered in less than 4 minutes in each case, and the mean anteroposterior (AP) annular distance was reduced by a mean of 5.75 ± 0.86 mm (23.8% reduction, P< 0.001). In the 6 sheep with nonischemic MR, regurgitation was eliminated. Acute histopathology (HP) demonstrated no damage to the leaflets, coronary sinuses, or coronary arteries. At 30 days, the AP distance continued to be reduced in the 7 surviving sheep (mean 5.0 ± .6 mm, 21.4% reduction, P< 0.001). Conclusions:In a sheep model, RF energy applied for less than 4 minutes per case at subablative temperatures in four quadrants of the posterior mitral valve annulus reduced the AP and circumferential annular distances significantly, and eliminated nonischemic MR. Results will need to be confirmed in follow-up studies to determine safety and efficacy. RF energy administered as a novel, percutaneous method of mitral valve annuloplasty may have the potential to reduce morbidity and mortality associated with current surgical techniques. [source] Management of red cell alloimmunisation in pregnancy: the non-invasive monitoring of the diseasePRENATAL DIAGNOSIS, Issue 7 2010Sebastian Illanes Abstract Haemolytic disease of the fetus and newborn (HDFN) due to red cell alloimmunization was a significant cause of fetal and neonatal morbidity and mortality until the introduction of anti-D immunoglobulin, which has dramatically changed the incidence of the disease. However, it is still a major problem in affected pregnancies. The emphasis of current clinical management has shifted from an invasive approach to non-invasive monitoring of the disease. The key elements of the modern management are determining which fetuses are at risk of HDFN with the use of cell-free fetal DNA in maternal plasma (fetal RHD genotype) and the follow-up of antigen positive fetuses by Doppler ultrasonography to detect anaemia severe enough to need treatment. When anaemia is suspected, an invasive approach is still required in a timely manner for confirmation of the degree of anaemia and to administer blood transfusions. This non-invasive approach prevents unnecessary administration of human-derived blood products, with the consequent ethical and cost implications and most importantly avoids iatrogenic conversion of mild to severe disease by avoiding need for techniques such as amniocentesis. The potential problem of the non-invasive approach is the reduction in the total number of invasive procedures, with the subsequent difficulty of maintaining the skills required to perform them. Copyright © 2010 John Wiley & Sons, Ltd. [source] Ultrasonic Technology Facilitates Minimal Access Thyroid Surgery,THE LARYNGOSCOPE, Issue 6 2006David J. Terris MD Abstract Objectives: Options for controlling the vasculature during thyroid surgery include suture ligatures, vessel clips, and bipolar cautery. Ultrasonic technology represents an alternative to conventional techniques in which the vessels are simultaneously sealed and divided. We sought to determine the safety and efficacy of thyroidectomy with ultrasonic technology. Design: Nonrandomized, prospective analysis of a series of patients undergoing thyroidectomy at the Medical College of Georgia. Methods and Materials: The records of 51 consecutive patients who underwent thyroid surgery between December 2004 and June 2005 were reviewed. Patients in whom ultrasonic technology (Harmonic-ACEÔ, Ethicon Endo-Surgery, Cincinnati, OH) was used comprised the study population. Results: Forty-four of 51 patients underwent thyroidectomy with the assistance of ultrasonic technology. There were 4 males and 40 females with a mean age of 43.5 ± 15.8 years. Twenty-two patients had a total thyroidectomy, 18 underwent unilateral lobectomy, and 4 underwent completion thyroidectomy. The overall mean incision length was 5.0 ± 2.6 (range 2,12) cm. A subgroup of patients underwent minimally invasive video-assisted thyroidectomy (n = 13) and had a mean incision length of 29.3 ± 0.8 mm. There were no cases of permanent injury to the recurrent laryngeal nerve and no cases of persistent hypoparathyroidism. Blood loss ranged from 5 mL to 100 mL, with a mean of 26.7 ± 21.8 mL. Conclusions: Ultrasonic technology facilitates thyroid surgery, particularly when a minimally invasive approach is undertaken. It reliably seals and divides the thyroid vasculature and will likely replace other methods of managing the thyroid blood supply. [source] Endoscopic Laryngotracheal Cleft Repair Without Tracheotomy or IntubationTHE LARYNGOSCOPE, Issue 4 2006Kishore Sandu MD Abstract Objectives: The objectives of this study are to present the technique and results of endoscopic repair of laryngotracheoesophageal clefts (LTEC) extending caudally to the cricoid plate into the cervical trachea and to revisit the classification of LTEC. Methods: The authors conducted a retrospective case analysis consisting of four infants with complete laryngeal clefts (extending through the cricoid plate in three cases and down into the cervical trachea in one case) treated endoscopically by CO2 laser incision of the mucosa and two-layer endoscopic closure of the cleft without postoperative intubation or tracheotomy. Results: All four infants resumed spontaneous respiration without support after a mean postoperative period of 3 days with continuous positive airway pressure (CPAP). They accepted oral feeding within 5 postoperative days (range, 3,11 days). No breakdown of endoscopic repair was encountered. After a mean follow up of 48 months (range, 3 mos to 7 y), all children have a good voice, have no sign of residual aspiration, but experience a slight exertional dyspnea. Conclusion: This limited experience on the endoscopic repair of extrathoracic LTEC shows that a minimally invasive approach sparing the need for postoperative intubation or tracheotomy is feasible and safe if modern technology (ultrapulse CO2 laser, endoscopic suturing, and postoperative use of CPAP in the intensive care unit) is available. [source] Long-Term Result of the New Endoscopic Vocal Fold Medialization Surgical Technique for Laryngeal Palsy,THE LARYNGOSCOPE, Issue 2 2006Koichiro Nishiyama MD Abstract Objective: The conventional surgical method for a case of unilateral laryngeal nerve paralysis with large glottal gap requires an external cervical incision. In the present study, we developed an endoscopic technique of vocal fold medialization that can make the external incision unnecessary. This procedure of autologous transplantation of fascia into the vocal fold (ATFV) was developed for the successful treatment of unilateral laryngeal nerve paralysis. However, the method seemed to be effective only for patients with a relatively mild glottal gap. Study Design and Methods: In the present study, we modified the method of medialization using the ATFV technique to obtain effective closure of a large glottal gap. To overcome this difficulty, an attempt was made to extend the site of transplantation more posteriorly so as to adduct the vocal process of the arytenoid cartilage in the body of the vocal fold. Results: This new technique was applied to eight cases of patients with unilateral laryngeal paralysis with severe dysphonia. None of the patients showed any evidence of falling off of the graft. Elongation of the maximum phonation time and a decrease in airflow rate during phonation were obtained with improvement in voice quality in all patients 1 year after the surgery. Conclusions: This method, with its less invasive approach, proved to be useful for the treatment of large glottal gap due to unilateral laryngeal nerve paralysis. [source] Laparoscopic-Assisted Right Lobe Donor HepatectomyAMERICAN JOURNAL OF TRANSPLANTATION, Issue 10 2006A.J. Koffron The major impediment to a wider application of living donor hepatectomy, particularly of the right lobe, is its associated morbidity. The recent interest in a minimally invasive approach to liver surgery has raised the possibility of applying these techniques to living donor right lobectomy. Herein, we report the first case of a laparoscopic, hand-assisted living donor right hepatic lobectomy. We describe the technical aspects of the procedure, and discuss the rationale for considering this option. We propose that the procedure, as described, did not increase the operative risks of the procedure; instead, it decreased potential morbidity. We caution that this procedure should only be considered for select donors, and that only surgical teams familiar with both living donor hepatectomy and laparoscopic liver surgery should entertain this possibility. [source] MINIMALLY INVASIVE APPROACH IN THE MANAGEMENT OF CHILDHOOD INTUSSUSCEPTIONANZ JOURNAL OF SURGERY, Issue 9 2007Sing T. Cheung Background: Intussusception is one of the most common causes of intestinal obstruction in infancy. Non-operative reduction using air enema or other hydrostatic reduction methods has been the standard treatment in most cases. However, if the non-operative method is not indicated or fails, open surgery is still necessary. With the tremendous development of the minimally invasive approach in handling surgical conditions in children in the last decade, this has been applied recently for the reduction of intussusception in children. We herein reviewed our experience of using the combined approach, namely, pneumatic reduction and, if failed, laparoscopic reduction in the management of childhood intussusception. Methods: We carried out a retrospective analysis of all children with intussusception managed at Prince of Wales Hospital between December 1998 and December 2004. The minimally invasive approach was used as far as possible. The method of reduction, success rate and the incidence of complication were analysed. Results: Over a 6-year period, there were 146 patients with 167 episodes of intussusception. Pneumatic reduction was carried out in 160 occasions and was successful in 134 (83.8%). In 33 patients, operative reduction was required. Of these, laparoscopic reduction was attempted in 15 and was successful in 13 (86.7%). In those with either pneumatic or laparoscopic reduction, no procedure-related complication was encountered and they had a significant shorter hospital stay (median 3.0 day) than those requiring laparotomy (median 8.0 day) (t -test, P < 0.0001). Conclusion: The minimally invasive approach, that is, pneumatic and/or laparoscopic reduction, was successful in reducing intussusception in 88% of patients with minimal morbidity and shorter hospital stay. [source] ENDOVASCULAR ABDOMINAL AORTIC ANEURYSM REPAIR: A 7 YEAR EXPERIENCE AT THE LAUNCESTON GENERAL HOSPITALANZ JOURNAL OF SURGERY, Issue 5 2005Kate L. A. Borchard Background: To review our 7 year experience of endovascular abdominal aortic aneurysm repair (EVR) and to compare this to open repair (OR) during the same time period. Methods: One hundred and one EVR and 65 OR patients were studied. Parameters analysed included patient and procedure details, intensive care unit (ICU) and hospital admission time, and morbidity and mortality with particular emphasis on procedure-related problems. Results: Endovascular grafts were deployed with successful abdominal aortic aneurysm (AAA) exclusion in 100 patients. Primary technical success was achieved in 84%, clinical success in 86% and secondary success in 90% of cases. Complications occurred in 63% and 88% of EVR and OR patients, respectively. Early device-related complications occurred in 40 EVR patients (40%); 24 (60%) were corrected immediately by further stenting. Late device-related complications occurred in 15 EVR patients (15%); four (27%) required additional stenting. Most of the complications in the OR group were systemic (89%) resulting in longer ICU and hospital stays (median 48 vs 17 h and 13 vs 4 days for OR and EVR, respectively). Death within 30 days of the procedure occurred in three EVR patients. There was no perioperative mortality in the OR group. Conclusion: Endovascular AAA repair can be undertaken successfully in a district general hospital. The majority of local and device-related complications can be corrected immediately, while those persisting beyond the initial procedure usually resolve spontaneously. EVR offers a minimally invasive approach to a problem that in the past has involved major surgery. [source] Laparoscopic transabdominal cervico-isthmic cerclage: A minimally invasive approachAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2008Geoffrey D. REID Background: While the traditional approach to management of cervical insufficiency has been the insertion of a transvaginal cerclage during pregnancy, a transabdominal cervico-isthmic suture is indicated in certain patients. This procedure is traditionally performed via laparotomy. Laparoscopic transabdominal cervico-isthmic cerclage (LTCC) placement, however, confers the benefit of the low morbidity associated with laparoscopy. Aims: To describe the technique and outcomes of LTCC in three cases. Methods: LTCC was performed using Mersilene tape at the level of the internal cervical os in the prepregnancy period in three patients: one with previous cervical amputation and two with previous failed cervical cerclage. Procedures were performed at a tertiary level endoscopic unit, Sydney, Australia. Results: The laparoscopic approach enabled placement of a suture with no morbidity, and rapid patient recovery in these cases. Conclusions: Laparoscopic cervical cerclage proved technically feasible and safe for a surgeon trained in laparoscopic suturing methods. [source] Laparoscopic ureterolysis with omental wrap for idiopathic retroperitoneal fibrosisBJU INTERNATIONAL, Issue 5 2010Robert J. Stein Study Type , Therapy (case series) Level of Evidence 4 OBJECTIVE To describe various approaches for ureterolysis with an omental wrap using minimally invasive techniques, as surgery for idiopathic retroperitoneal fibrosis includes tissue biopsy, ureterolysis, and intraperitonealization or omental wrap. PATIENTS AND METHODS Since 2006 we have performed ureterolysis in four patients diagnosed with retroperitoneal fibrosis in two institutions. The ureterolysis in two cases was bilateral, using a standard laparoscopic approach for one case and a hand-assisted technique for the other. Unilateral ureterolysis was completed using a standard laparoscopic approach in one case and was converted to a hand-assisted technique in the other due to difficulty with ureteric identification. An omental wrap was used after ureterolysis for all renal units. RESULTS A minimally invasive technique was used for all ureterolysis procedures and none required open conversion. There was fascial dehiscence after surgery at the hand-port site in one patient, and required re-operation for wound closure. The median (range) hospital stay for all patients was 2.5 (2,10) days and the median blood loss was 100 (50,550) mL. No patient required a blood transfusion. At a median 16.5 (12,32) months of follow-up, there was symptomatic and radiographic success in all patients. CONCLUSIONS Ureterolysis can be a challenging operation depending on the extent of the retroperitoneal mass. An understanding of various laparoscopic techniques can provide the flexibility for successful completion of nearly all of these procedures using a minimally invasive approach. [source] Modern management of salivary calculiBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2005M. McGurk Background: The aim was to investigate the results of a minimally invasive approach to the management of salivary calculi. Methods: Four hundred and fifty-five salivary calculi (323 submandibular and 132 parotid) were treated using extracorporeal shock-wave lithotripsy (ECSWL), fluoroscopically guided basket retrieval or intraoral stone removal under general anaesthesia. The techniques were used either alone or in combination. Results: ECSWL achieved complete success (stone and symptom free) in 87 (39·4 per cent) of 221 patients (84 of 218 primary and all of three secondary procedures; 43 of 131 submandibular, 44 of 90 parotid). Basket retrieval cured 124 (74·7 per cent) of 166 patients (103 of 136 primary and 21 of 30 secondary procedures; 80 of 109 submandibular, 44 of 57 parotid). Intraoral surgical removal was successful in a further 137 (95·8 per cent) of 143 patients with submandibular stones (99 of 101 primary, 36 of 38 secondary and two of four tertiary procedures). The overall success rate for the three techniques was 348 (76·5 per cent) of 455. Conclusion: A minimally invasive approach to the management of salivary calculi is to be encouraged. All three techniques described have low morbidity and afford the possibility of retaining a functional gland. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] 4333: How does scleral buckling affect the anterior segment of the eye?ACTA OPHTHALMOLOGICA, Issue 2010FJ ASCASO Purpose To describe the modifications produced in the anterior segment of the eye after placing an encircling scleral buckling (SB) in terms of corneal morphology, biomechanics and intraocular pressure. Methods A prospective study of 15 eyes with rhegmatogenous retinal detachment who underwent pars plana vitrectomy combined with a scleral buckle (PPV/SB), and 12 eyes with vitreous hemorrhage treated with PPV alone. We measured preoperatively and 1-month after surgery the corneal biomechanical properties using the Ocular Response Analyzer (ORA), including corneal hysteresis (CH), corneal resistance factor (CRF), intraocular pressure (IOPg), and corneal compensated IOP (IOPcc). Moreover, we defined the corneal morphology by 4 parameters provided by the topographer Orbscan IIz: mean corneal power (dioptres), standard deviation, thinnest point (µm), and anterior chamber depth (ACD) (mm). Results Mean CH values were significantly diminished following PPV/SB (p=0.003). We found no significant changes in CRF. IOPg and IOPcc mean values were significantly increased only in the PPV/SB group (p=0.019 and p=0.010, respectively) but not in PPV group (p=0.715 and p=0.273, respectively). In PPV/SB group, IOPcc mean values were significantly higher than IOPg before (p=0.001) and after surgery (p=0.003), but not in the other group. None of the morphological parameters were modified after surgery in any of the two study groups (p>0.05) Conclusion Anterior segment morphology was not modified after placing a SB. Corneal biomechanical properties showed a reduction in CH, probably due to a vascular constriction and reduction of the eye compliance. PPV might be considered a less invasive approach for the repair of noncomplex retinal detachments than PPV/SB. [source] Therapeutic strategies, immediate and mid-term outcomes in non-ST-segment elevation acute coronary syndromes with respect to age: A single-center registry of 488 consecutive patientsCLINICAL CARDIOLOGY, Issue 8 2004Mario Leoncini M.D. Abstract Background: Elderly patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) may receive benefit from an early invasive strategy. However, aged patients often suffer from comorbidities that may contraindicate an invasive approach and affect prognosis adversely. The impact of comorbidities on an invasive approach to NSTE-ACS in the elderly has not been fully investigated. Hypothesis: This study sought to examine the outcome of an unselected population of patients with NSTE-ACS stratified according to age and treatment approach. Methods: The feasibility and efficacy of an invasive strategy for NSTE-ACS and the 6-month outcome were assessed in 253 unselected consecutive patients , 70 years (elderly) and compared with those of 235 unselected consecutive patients < 70 years. Results: Angiography was not performed in 69 patients (86% , 70 years) because of contraindications. In the whole population, the 6-month event rate was significantly higher in elderly compared with younger patients (22 vs. 14%; odds ratio 1.8, 95% confidence interval 1.1-2.9; p<0.02). This difference was driven by the high event rate observed in the elderly with contraindications to angiography (47 vs. 16% in the elderly treated invasively; p < 0.002). On the other hand, no significant difference was observed in the 6-month event rate between elderly and younger patients undergoing an invasive approach (16 vs. 13%; p=0.36). Contraindications to angiography,namely, creatinine , 1.5 mg/dl and elevated troponin I at admission,were the only independent predictors of 6-month outcome. Conclusions: The invasive approach was feasible in 77% of patients , 70 years. Those with contraindications to angiography showed a poor mid-term prognosis. The early invasive strategy was associated with more favorable outcomes regardless of age. [source] Acute management,How should we intervene?CLINICAL CARDIOLOGY, Issue S1 2000Frederic Kontny M.D., PH.D. Abstract A crucial question in the acute management of the patient with unstable coronary artery disease (UCAD) is whether to carry out early intervention, performing angiography soon after presentation and following this with revascularization where appropriate, or whether to follow a noninvasive medical strategy as far as possible unless symptoms necessitate intervention. The body of literature addressing this question is sparse, but the recent Fast Revascularization during InStability in Coronary artery disease (FRISC II) study has provided new insights into the problem. Using a factorial design to randomize patients to invasive or noninvasive management strategies, and to short- or long-term treatment with the low-molecular-weight heparin (LMWH) dalteparin sodium (Fragmin®), it was shown in FRISC II that early invasive treatment (within 7 days), when combined with optimal medical pretreatment with dalteparin sodium, aspirin, and appropriate antianginal medication, is associated with improved clinical outcomes, relative to a "watchful waiting" approach based on noninvasive therapy. Thus, an early invasive approach following aggressive medical pretreatment should be the preferred strategy for patients with UCAD who present with signs of ischemia on the electrocardiogram or raised biochemical markers of myocardial damage at admission. [source] Minimally invasive approach and fixation of cochlear and middle ear implantsCLINICAL OTOLARYNGOLOGY, Issue 6 2004D. Jiang One of the conventional surgical approaches for cochlear implantation is a retro-auricular incision with a posterior-inferiorly based skin and subcutaneous tissue flap and a superiorly based periosteal flap. The obvious advantage is an open operating field but the disadvantages are a large wound and a lengthy operating time. It may also result in more wound-related complications. To overcome these disadvantages, we have developed a minimally invasive technique that includes a small retro-auricular single layer incision. We have used a metal bridge beneath the posterior flap to increase accessibility when creating a recess for the implant. A novel technique is used to place the securing suture deep to the flap. This technique has been used in 49 paediatric and adult patients, and there have been no wound-related complications. Although this technique was initially designed for the CLARION® CII implant, it has been used to place and secure the new CLARION® HiRes 90 K, the Nucleus device, the MEDEL device and the Vibrant Soundbridge. [source] Advances in Heart Valve SurgeryJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 6 2003MATTHIAS AAZAMI Heart valve surgery continues to evolve in a dynamic fashion. While the exact role of minimally invasive approaches still needs to be defined, progress has been made in the development of new bioprostheses and their durability. Most importantly, valve repair has been standardized for the mitral and introduced for the aortic valve with results that have been superior to valve replacement. Selection of the optimal procedure for the individual patient is now facilitated. In the future, a wider application of repair procedures and further improvements of biologic valves can be anticipated not only to influence long-term results but also the decision-making process for conservative or surgical treatment. (J Interven Cardiol 2003;16:535,541) [source] Use of the 70-Degree Diamond Burr in the Management of Complicated Frontal Sinus Disease,THE LARYNGOSCOPE, Issue 2 2004Rakesh K. Chandra MD Abstract Objectives/Hypothesis: Management of frontal sinus disease may require drill-out of bone in the frontal recess for access, ventilation, and drainage of the sinus cavity; removal of osteitic foci; or resection of neoplastic tissue. Technological advances, particularly burrs with angles of 70 degrees and stereotactic navigational imaging, offer new opportunities to provide access and minimize trauma. The preliminary study evaluates the safety and efficacy of such minimally invasive approaches. Study Design: Retrospective review. Methods: The authors describe the use of a 70-degree diamond burr in a series of 10 patients with complicated frontal sinus disease who underwent endoscopic frontal sinusotomy under stereotactic imaging guidance. Results: The diagnoses consisted of frontal sinus mucocele (n = 4), chronic frontal sinusitis (n = 1), Pott's puffy tumor after frontoethmoid fracture (n = 1), and recurrent inverting papilloma (n = 4). Partial septectomy was required in 6 of 10 patients. No complications were attributable to the drill-out procedure, despite a pre-existing frontoethmoid bony dehiscence in 6 of 10 patients. One patient had a CSF leak during removal of tumor from the skull base. One patient required revision frontal sinusotomy 10 months after the initial procedure, and another required further surgery for residual inverting papilloma on the medial orbital wall. All frontal sinusotomies were patent at last follow-up (mean period, 9.3 mo). Conclusion: Extended endoscopic frontal sinusotomy may be necessary in the management of complicated frontal sinus inflammatory disease and inverting papilloma. The 70-degree diamond burr is a safe and effective tool for access to the frontal recess. Complication rates appear to be similar to those for other extended frontal sinusotomy approaches. [source] Transverse carpal muscle in association with carpal tunnel syndrome: Report of three casesCLINICAL ANATOMY, Issue 4 2005Dogan Tuncali Abstract Anomalous muscles of the upper extremity are common, however, symptomatic anomalies causing CTS are rare. Three cases of CTS that are believed to be caused by an anomalous muscle located palmar to the transverse carpal ligament with transversely oriented muscle bundles is presented. Despite the arguments in literature, this is certainly an anomalous muscle that can be encountered during carpal tunnel release and be problematic to manipulate when minimally invasive approaches are chosen. Clin. Anat. 18:308,312, 2005. © 2005 Wiley-Liss, Inc. [source] | ||||||||||||||||||||||||||||