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Prior Surgery (prior + surgery)
Selected AbstractsEctopic Atrial Rhythm with Exit Block Following Catheter Ablation for Focal Atrial Tachycardias in a Patient with Prior Surgery for Atrial Septal DefectPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 6 2002KIMIE OHKUBO OHKUBO, K., et al.: Ectopic Atrial Rhythm with Exit Block Following Catheter Ablation for Focal Atrial Tachycardias in a Patient with Prior Surgery for Atrial Septal Defect. The patient was a 40-year-old woman with a history of surgery for atrial septal defect and catheter ablation for typical atrial flutter. An electrophysiological study was performed because she had palpitation and syncope. She had ectopic atrial rhythm originating from low lateral RA. Two focal atrial tachycardias ([1] superior vena cava-RA junction and [2] a low posteroseptal RA) were successfully ablated. Following catheter ablation for the second atrial tachycardia, she developed junctional rhythm because ectopic atrial rhythm showed exit block. However, atrial activation of junctional rhythm could conduct into the ectopic atrial rhythm focus and reset the rhythm when atrial activation of junctional rhythm reached the blocked line after atrial refractoriness by preceding ectopic atrial rhythm. [source] Management of a cadaveric orthotopic liver transplantation in a pediatric patient with complex congenital heart diseasePEDIATRIC ANESTHESIA, Issue 6 2006DENNIS E. FEIERMAN MD PhD Summary Pediatric orthotopic liver transplantations (OLT) are commonly performed nowadays. Two primary reasons for OLT in children are complications from either extrahepatic biliary atresia (EHBA) or inborn errors of metabolism. However, congenital liver disease may be associated with significant other congenital abnormalities. We present a case of a successful OLT in a pediatric patient with a history of EHBA, situs inversus, and complex congenital heart disease. The cardiac anomalies include dextrocardia, absence of the atrial septum (single atrium), single atrioventricular valve (a-v canal), and an incomplete ventricular septum. Prior surgery include a Kasai procedure for EHBA, banding of the proximal main pulmonary artery, and Broviac catheter placement. We present the anesthesia concerns and management for this complicated case. [source] The Art of Repair in Surgical Hair Restoration Part I: Basic Repair StrategiesDERMATOLOGIC SURGERY, Issue 9 2002Robert M. Bernstein MD background. An increasingly important part of many hair restoration practices is the correction of hair transplants that were performed using older, outdated methods, or the correction of hair transplants that have left disfiguring results. The skill and judgment involved in these repair procedures often exceed those needed to operate on patients who have had no prior surgery. The use of small grafts alone does not protect the patient from poor work. Errors in surgical and aesthetic judgment, performing procedures on noncandidate patients, and the failure to communicate successfully with patients about realistic expectations remain major problems. objective. This two-part series presents new insights into repair strategies and expands upon several techniques previously described in the hair restoration literature. The focus is on creative aesthetic solutions to solve the supply/demand limitations inherent in most repairs. This article is written to serve as a guide for surgeons who perform repairs in their daily practices. methods. The repairs are performed by excision with reimplantation and/or by camouflage. Follicular unit transplantation is used for the restorative aspects of the procedure. results. Using punch or linear excision techniques allows the surgeon to relocate poorly planted grafts to areas that are more appropriate. In special situations, removal of grafts without reimplantation can be accomplished using lasers or electrolysis. The key elements of camouflage include creating a deep zone of follicular units, angling grafts in their natural direction, and using forward and side weighting of grafts to increase the appearance of fullness. The available donor supply is limited by hair density, scalp laxity, and scar placement. conclusion. Presented with significant cosmetic problems and severely limited donor reserves, the surgeon performing restorative hair transplantation work faces distinct challenges. Meticulous surgical techniques and optimal utilization of a limited hair supply will enable the surgeon to achieve the best possible cosmetic results for patients requiring repairs. [source] Challenges to interpretation of breast MRIJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 6 2001Karen Kinkel MD Abstract This review describes the current knowledge and challenges of lesion interpretation with MRI of the breast according to different image interpretation strategies. Particular emphasis is given to patient- and tumor-related factors that influence image interpretation. The impacts of the menstrual cycle, prior surgery, radiation therapy, and chemotherapy are summarized. Particular enhancement features of ductal carcinoma in situ (DCIS) or invasive lobular carcinoma are described. Finally, an adequate diagnosis at MRI of the breast should take into account the results of the patient's history, physical examination, and all imaging tests performed before MRI. J. Magn. Reson. Imaging 2001;13:821,829. © 2001 Wiley-Liss, Inc. [source] Opaque maxillary antrum: A pictorial reviewJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 3 2005A Whyte Summary The demonstration of an opaque antrum on a plain radiograph or cross-sectional imaging leads to consideration of an extensive differential diagnosis. Relevant clinical details narrow the differential and include the patient's age, signs and symptoms, a history of recent trauma, prior surgery or dental treatment. Computed tomography remains the most useful technique in coming to a specific diagnosis. Magnetic resonance imaging adds specificity in a few selected situations and is required in conjunction with CT in the staging of malignant tumours. [source] Cytoreductive surgery and intraoperative hyperthermic chemoperfusion for advanced ovarian carcinomaJOURNAL OF SURGICAL ONCOLOGY, Issue 2 2005Trevor W. Reichman MD Abstract Background Optimal cytoreductive surgery combined with intraoperative hyperthermic chemoperfusion (IHCP) is a therapy that potentially could improve survival in a select group of patients with advanced ovarian cancer. The purpose of this study was to review the results of cytoreductive surgery and IHCP for advanced ovarian cancer and to identify factors that may predict which patients maximally benefit from this aggressive treatment. Methods Patients treated with cytoreduction followed by IHCP for ovarian cancer were identified from an IHCP database from 1/2001 through 3/2004. Several factors including resection status, peritoneal cancer index (PCI), and prior surgery were evaluated for their ability to predict survival in our cohort of patients. Results Thirteen patients with ovarian cancer treated with cytoreductive surgery followed by IHCP were identified. The 3-year overall survival rate for all thirteen patients was 55%. The median disease-free survival was 15.4 months (3-year disease-free survival, 11%). Several factors including PCI score (<6), ability to resect all gross disease, and previous surgical exploration appeared to impart an overall survival advantage. Conclusions The use of IHCP coupled with optimal cytoreduction is a safe and effective treatment for advanced ovarian carcinoma. However, the proper selection of patients who will benefit most from the therapy is essential for the success of the treatment. J. Surg. Oncol. 2005;90:51,56. © 2005 Wiley-Liss, Inc. [source] Increased proximal urethral sensory threshold after radical pelvic surgery in women,,NEUROUROLOGY AND URODYNAMICS, Issue 2 2007Thomas M. Kessler Abstract Aim To identify factors that potentially influence urethral sensitivity in women. Patients and Methods The current perception threshold was measured by double ring electrodes in the proximal and distal urethra in 120 women. Univariate analysis using Kaplan,Meier models and multivariate analysis applying Cox regressions were performed to identify factors influencing urethral sensitivity in women. Results In univariate and multivariate analysis, women who had undergone radical pelvic surgery (radical cystectomy n,=,12, radical rectal surgery n,=,4) showed a significantly (log rank test P,<,0.0001) increased proximal urethral sensory threshold compared to those without prior surgery (hazard ratio (HR) 4.17, 95% confidence interval (CI) 2.04,8.51), following vaginal hysterectomy (HR 4.95, 95% CI 2.07,11.85), abdominal hysterectomy (HR 5.96, 95% CI 2.68,13.23), or other non-pelvic surgery (HR 4.86, 95% CI 2.24,10.52). However, distal urethral sensitivity was unaffected by any form of prior surgery. Also other variables assessed, including age, concomitant diseases, urodynamic diagnoses, functional urethral length, and maximum urethral closure pressure at rest had no influence on urethral sensitivity in univariate as well as in multivariate analysis. Conclusions Increased proximal but unaffected distal urethral sensory threshold after radical pelvic surgery in women suggests that the afferent nerve fibers from the proximal urethra mainly pass through the pelvic plexus which is prone to damage during radical pelvic surgery, whereas the afferent innervation of the distal urethra is provided by the pudendal nerve. Better understanding the innervation of the proximal and distal urethra may help to improve surgical procedures, especially nerve sparing techniques. Neurourol. Urodynam. 26:208,212, 2007. © 2006 Wiley-Liss, Inc. [source] Palatal Flap Modifications Allow Pedicled Reconstruction of the Skull BaseTHE LARYNGOSCOPE, Issue 12 2008Christopher L. Oliver MD Abstract Objectives: Defects after endoscopic expanded endonasal approaches (EEA) to the skull base, have exposed limitations of traditional reconstructive techniques. The ability to adequately reconstruct these defects has lagged behind the ability to approach/resect lesions at the skull base. The posteriorly pedicled nasoseptal flap is our primary reconstructive option; however, prior surgery or tumors can preclude its use. We focused on the branches of the internal maxillary artery, to develop novel pedicled flaps, to facilitate the reconstruction of defects encountered after skull base expanded endonasal approaches. Study Design: Feasibility. Methods: We reviewed radiology images with attention to the pterygopalatine fossa and the descending palatine vessels (DPV), which supply the palate. Using cadaver dissections, we investigated the feasibility of transposing the standard mucoperiosteal palatal flap into the nasal cavity and mobilizing the DPV for pedicled skull base reconstruction. Results: We transposed the palate mucoperiosteum into the nasal cavity through limited enlargement of a single greater palatine foramen. Our method preserves the integrity of the nasal floor mucosa, and mobilizes the DPV from the greater palatine foramen to their origin in the pterygopalatine fossa. Radiological measurements and cadevaric dissections suggest that the transposed, pedicled palatal flap (the Oliver pedicled palatal flap) could be used to reconstruct defects of the planum, sella, and clivus. Conclusions: Our novel modifications to the island palatal flap yield a large (12,18 cm2) mucoperiosteal flap based on a , 3 cm pedicle. The Oliver pedicled palatal flap shows potential for nasal cavity and skull base reconstruction (see video, available online only). [source] An epidemiologic analysis of staphylococcus aureus-associated keratitis in BostonACTA OPHTHALMOLOGICA, Issue 2009I BEHLAU Purpose S. aureus is a normal commensal of the human skin and nasopharynx. It is therefore of interest to determine whether S. aureus keratitis is caused by a subset of these organisms. In this study, the phenotypic and genotypic characteristics of S.aureus keratitis isolates were analyzed. Methods All S. aureus clinical isolates were prospectively collected over a 24 month period at the MEEI (2006-2008). The diagnosis of clinical keratitis and associated risk factors was by medical record review. Keratitis-associated S. aureus strains were assessed for: 1) antibiotic susceptibility, 2) biofilm robustness by gentian violet staining using an in vitro microtiter plate assay, and 3) genetic lineage by multi-locus sequence typing (MLST). Results 26 cases of keratitis were identified from the 600 S. aureus clinical isolates. Risk factors associated with S.aureus keratitis included trauma, prior surgery, soft contact lens wear, and the presence of a foreign body. Ocular surface disease does not appear to be an independent risk factor. All 26 isolates were tetracycline- and trimethoprim-sulfamethoxazole- sensitive. All the MRSA strains were found to be ciprofloxacin-resistant (10/26). Nearly one-half of all the S.aureus keratitis-associated isolates were caused by a single clone, ST5. Both methicillin sensitive and resistant S. aureus strains were represented within ST5. Conclusion These results suggest that there may be specific S.aureus lineages which possess phenotypic and genotypic characteristics that enable S. aureus to more effectively cause sight-threatening keratitis. Future work will examine their virulence traits and a comparison to commensal S.aureus strains. [source] What is the best approach to an apparently nonmetastatic adrenocortical carcinoma?CLINICAL ENDOCRINOLOGY, Issue 5 2010Martin Fassnacht Summary In suspected nonmetastatic adrenocortical carcinoma (ACC) a careful preoperative diagnostic work up is needed including comprehensive endocrine analysis as recommended by the European Network for the Study of Adrenal Tumors (http://www.ENSAT.org/ACC.htm). Staging prior surgery, in particular chest CT, is indispensable to exclude distant metastases. Open surgery is still the recommended approach in ACC. However, in localized non-invasive ACC with a diameter <10 cm laparoscopic adrenalectomy by an expert surgeon is probably similarly effective and safe. As many patients will suffer from tumor recurrence after seemingly complete removal of ACC, adjuvant treatment based on the individual risk status is recommended. Key factors for risk assessment are tumor stage, resection status and the proliferation marker Ki67. All patients considered at high risk for recurrence should receive adjuvant mitotane for a minimum of 2 years aiming at a drug level of 14,20 mg/l. In selected patients (e.g. R1 resection) we recommend additional radiotherapy of the tumor bed. Patients with a low/intermediate risk for recurrence should be included in the Adiuvo trial comparing adjuvant mitotane with observation only (http://www.adiuvo-trial.org). In low/intermediate risk patients who cannot be included in this trial observation only can be justified in cases with a tumor diameter of <8 cm and no microscopic evidence for invasion of blood vessels or tumor capsule. In all patients a structured follow-up for 10 years is strongly recommended. [source] | ||||||||||