Adjunctive Procedures Research Articles

Mechanical thrombectomy in acute limb ischemia: ad Interim results of the INDIAN UP Trial.

Penumbra/Indigo aspiration thrombectomy Systems (Penumbra Inc.) in patients with acute lower limb ischemia (ALLI) is becoming a fundamental alternative to surgical and intra-arterial thrombolysis. The INDIAN UP trial represents the second phase of the Italian national multicenter trial evaluating the safety and effectiveness of the device in the treatment of ALLI. To assess vessel patency, the TIPI (Thrombo-aspiration In Peripheral Ischemia), is used. The TIPI flow in three different moments: at presentation, immediately after thromboaspiration, and after all adjuvant procedures. The primary outcome is the technical success of the thrombo-aspiration with the investigative system, defined as near complete or complete revascularization TIPI 2 - 3. Safety and clinical success rate were collected at one month follow-up. A total of 250 patients were enrolled. The mean age was 72.2±13.1 years and 72.1% were male. Rutherford grade on enrolment was I in 10.8%, IIa in 34.9%, and IIb in 54.4%. Primary technical success (TIPI 2-3 flow) was achieved in 90.8% of patients. Adjunctive procedures were needed in 158 cases. After all interventions, assisted primary technical success was 96.4%. No systemic bleeding complications or device related serious adverse events were reported. At one month follow up, survival rate was 97.2%, limb salvage was 97.6%. Primary patency was 89.6% and 13 (5.4%) reinterventions were registered. The updated results of the INDIAN UP trial have confirmed the high value of the mechanical thromboaspiration device Indigo Penumbra in the treatment of ALLI in a large variety of clinical and anatomical settings.

MP50-08 POST-CHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION (PC-RPLND) FOR SEMINOMA: IS SURGERY EFFECTIVE?

You have accessJournal of UrologyCME1 Apr 2023MP50-08 POST-CHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION (PC-RPLND) FOR SEMINOMA: IS SURGERY EFFECTIVE? Isamu Tachibana, Andre Alabd, Rumeal Whaley, Jacob Mcfadden, Alex Piroozi, Sean Kern, Nabil Adra, Richard Foster, Lawrence Einhorn, Clint Cary, and Timothy Masterson Isamu TachibanaIsamu Tachibana More articles by this author , Andre AlabdAndre Alabd More articles by this author , Rumeal WhaleyRumeal Whaley More articles by this author , Jacob McfaddenJacob Mcfadden More articles by this author , Alex PirooziAlex Piroozi More articles by this author , Sean KernSean Kern More articles by this author , Nabil AdraNabil Adra More articles by this author , Richard FosterRichard Foster More articles by this author , Lawrence EinhornLawrence Einhorn More articles by this author , Clint CaryClint Cary More articles by this author , and Timothy MastersonTimothy Masterson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003298.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with relapsed seminoma after first-line chemotherapy can be treated with salvage chemotherapy or post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND). Based on prior reported experience, surgical management can have worse efficacy and increased morbidity compared to non-seminomatous germ cell tumor. Our aim was to characterize the surgical efficacy and difficulty in a specific cohort of patients with definite progression but minimal disease burden. METHODS: The Indiana University testis cancer database was queried to identify men who underwent PC-RPLND for seminoma between January 2011 to December 2021. Included patients only underwent first-line chemotherapy and could not have any evidence of non-seminomatous elements on orchiectomy or have elevated serum alpha-fetoprotein (AFP). All patient demonstrated high suspicion of retroperitoneal disease prior to PC-RPLND was based on increasing size of tumor on standard CT imaging, progression of FDG avidity on PET imaging, or elevated tumor markers. RESULTS: We identified 889 patients that underwent PC-RPLND, of which only 14 patients were operated on for seminoma. One patient was excluded for lack of meaningful follow-up. Out of 13 patients, only 3 patients were disease free with surgery and did not have to undergo salvage chemotherapy. Median follow up time was 29.9 months (IQR: 22.6-53.7). Two patients died due to testicular cancer. The remaining 8 patients were treated successfully with salvage chemotherapy. For additional procedures, 4 patients required a nephrectomy, 1 patient required an aortic graft, 2 patients required a partial ureterectomy, and 3 patients required partial or complete caval resection CONCLUSIONS: The decision between salvage chemotherapy and PC-RPLND as second-line therapy can be challenging. Salvage chemotherapy is effective but is associated with short and long-term morbidity. Surgical efficacy in this setting seems to be limited, but careful selection of patients may lead to surgical success without life threatening morbidity or adjunctive procedures that may compromise the ability to receive salvage chemotherapy. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e687 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Isamu Tachibana More articles by this author Andre Alabd More articles by this author Rumeal Whaley More articles by this author Jacob Mcfadden More articles by this author Alex Piroozi More articles by this author Sean Kern More articles by this author Nabil Adra More articles by this author Richard Foster More articles by this author Lawrence Einhorn More articles by this author Clint Cary More articles by this author Timothy Masterson More articles by this author Expand All Advertisement PDF downloadLoading ...

Experience of the First Three Years of Independent Practice Following Surgical Training: Time Taken and Long-Term Outcomes of Powered Endoscopic Dacryocystorhinostomy

ABSTRACT Purpose To describe the changes in the time taken and the long-term outcomes of powered endoscopic dacryocystorhinostomy (PEnDCR) performed by a freshly trained surgeon in the first three years following the surgical training. Methods A retrospective interventional analysis was performed on all patients who underwent a primary or a revision PEnDCR from October 2016 to February 2020. Data obtained include demographics, presentation, previous interventions, pre-operative endoscopy findings, intra-operative findings, post-operative complications, and outcomes. Intra-operative features like the Boezaart surgical field scale, adjunctive endonasal procedures, and time taken for the procedure were noted. A minimum follow-up of 12 months was considered for final analysis. Statistical analysis was performed using software R (v 4.1.2). Results A total of 159 eyes of 155 patients underwent PEnDCR, of which 141 eyes were primary surgeries. The mean age was 64.28 years, with M:F ratio being 1:2.5. The number of cases performed per year steadily increased after the first year, and so was the case with adjunctive endonasal procedures. The mean procedure time showed an average reduction by 10.80 and 12.81 minutes for surgeries with and without adjunctive endonasal procedures (p < .001). The majority (77.3%, 123/159) of the intra-operative fields were classified as Grade 3 on the Boezaart scale. The practice of post-operative mitomycin C use significantly and steadily reduced over the three years (p < .001). Bleeding and granuloma formation were the common undesirable post-operative findings and showed a significant (p < .001) decline beyond the first year. The anatomical and functional success were (96.18%, 91.72%), (95.71%, 92.14%), and (96.16%, 91.94%), respectively, at 12, 24 and 36 months follow up. Conclusion Several intra-operative and post-operative parameters of PEnDCR patients showed improvement beyond the first year of independent practice. The success rates were well-maintained in the long term.

A Retrospective Analysis of Distal Fibula Fractures Treated With Intramedullary Fibular Nail Fixation

There is growing literature supporting the use of intramedullary fixation for fracture care because of its smaller incisions, improved biomechanical outcomes, and faster time to weightbearing than traditional internal fixation methods. The aim of this study is to investigate the postoperative outcomes in ankle fractures treated with intramedullary nail fixation in the largest patient cohort to date. From 2015 to 2021, 151 patients were evaluated following surgical treatment of fibular fractures with intramedullary nail fixation. Patients were identified through a medical record database search for appropriate ankle fracture procedure codes. Patient information was reviewed for fracture type, adjunct procedures, time to weightbearing and postoperative complications. Radiographs were assessed for quality and time to radiographic union. The mean time to weightbearing was 4.8 weeks. Minor wound dehiscence was identified in 2 patients (1.3%). Superficial infection was present in 4 patients (2.6%) and a deep infection developed in 2 patients (1.3%). Two patients developed a nonunion (1.5%). There were no DVTs reported, although 1 patient developed a PE postoperatively. Radiographic quality of reduction and time to union is comparable to literature reported plate and screw construct outcomes. Reduction was classified as good in 86.1% of patients and radiographic union was appreciated in 98.5% of patients. This is the largest cohort study evaluating the outcomes of intramedullary nail fixation for ORIF of ankle fractures. These data reinforce that intramedullary nailing provides a minimally invasive approach with accurate anatomic reduction, excellent fracture union rates, low complication rates, and an early return to weightbearing.

Current surgical techniques for the management of pediatric glaucoma: A literature review.

Pediatric glaucoma surgery is challenging due to its diverse and complex pathophysiology, altered anterior segment anatomy, greater potential for failure, and complications compared to adult patients. Moreover, numerous challenges are associated with long-term postoperative management. Thus, when dealing with childhood glaucoma, it is important to consider the potential complications in addition to the benefits of each intervention. The purpose of this article is to review recently published literature to shed light on the most recent surgical techniques for the safe and effective treatment of childhood glaucoma. Current literature shows that goniotomy and trabeculotomy are the first choices for the management of primary congenital glaucoma. Although older children with phakic eyes seem to benefit from trabeculectomy with adjunctive mitomycin C, it carries a long-term risk of bleb-related endophthalmitis. Glaucoma drainage devices may be preferred for patients with secondary or refractory glaucoma. However, hypotony or tube-related complications are common and encountered more often in children than in adults. Cyclodestructive procedures are also an option for cases in which filtering surgery has failed, but they can also be used as a temporizing measure to reduce the rate of complications in high-risk patients. However, their outcomes can be unpredictable, in terms of efficiency and complications. Finally, minimally invasive glaucoma surgery (MIGS) as the sole alternative treatment or as an adjunctive surgical procedure is a relatively new path for pediatric patients.

Ultrasound guided percutaneous tenotomy for lateral epicondylosis

Lateral elbow tendinopathy is a common condition affecting two to three percent of the population. While non-operative management is the mainstay of treatment, 10-15% remain refractory. Ultrasonic percutaneous tenotomy is a recent therapeutic option for clinicians to treat lateral elbow tendinopathy. The goal of this study was to evaluate the survival rate of ultrasonic percutaneous tenotomy in the treatment of lateral elbow tendinopathy. 83 patients underwent ultrasonic percutaneous tenotomy from September 2015 to August 2018 and met full inclusion criteria to participate. 63 patients consented to enroll in the study, with 50 (79.4%) completing the postoperative questionnaire. Data obtained included range of motion, patients’ report of improvement, Quick Dash Score (Q-Dash), Visual Analogue Scale (VAS) pain, VR 12, Mayo Elbow Performance, patient satisfaction, further post-operative adjunct procedures which included additional steroid injections, platelet-rich plasma (PRP) injections or need for reoperation at a minimum of 12 months post procedure. Overall survival rate for ultrasonic percutaneous tendinopathy was 94% (47/50). Three patients required post-operative adjunct procedures, two received steroid injections and one required PRP injection. Mean VAS score improved from 8.1 to 2.8 in the no failure group vs 7.9 to 2.7 in the failure group. Mean postoperative Mayo Elbow score and Q-DASH score was 89 (range 60 to 100) and 12.7 (range 2.3 to 61.4), respectively. 84 percent of patients were either very satisfied (N=31) or satisfied (N=11) with their procedure. This three year study demonstrates that ultrasonic percutaneous tenotomy appears to be a safe and efficacious therapeutic option with a high survival rate for patients with recalcitrant lateral elbow tendinopathy.

Ant Waist Surgery: Aesthetic Removal of Floating Ribs to Decrease the Waist-hip Ratio.

Decreasing waist circumference has become an essential feature in modern body contouring surgery owing to the attractiveness of hourglass body shapes. Traditionally, this can be achieved through lipomodeling and abdominal musculature strengthening techniques. An adjunctive procedure for ideal shaping of the waistline is resection of the 11th and 12th ribs, referred to as floating ribs. This study aimed to report and analyze clinical outcomes and self-reported patient satisfaction after "ant waist" surgery (floating rib removal) for aesthetic reasons. We retrospectively reviewed the medical records of five patients who had undergone bilateral 11th and 12th rib resections at a single institute in Taiwan in an outpatient setting. The mean lengths of the resected left and right 11th ribs were 9.1 and 9.5 cm, respectively. The mean lengths of the resected left and right 12th ribs were 6.3 and 6.4 cm, respectively. The mean waist-to-hip ratio decreased from 0.78 preoperatively to 0.72 postoperatively, with a mean decrease of 7.7%. No adverse events were reported. Generally, all patients reported being satisfied with the operation. Floating rib resection proved useful and effective in decreasing the waist-to-hip ratio using a safe, simple, and reproducible technique without significant complications. Although preliminarily, the authors' comprehensive demonstration of this ant waist surgery supports further studies focusing on waistline contouring.

Effect of Liposomal-Lactoferrin-Based Eye Drops on the Conjunctival Microflora of Patients Undergoing Cataract Surgery.

Postoperative endophthalmitis is typically caused by the patient's conjunctival bacterial flora. Povidone iodine solution (5%) is used perioperatively to obtain periocular and ocular antisepsis. However, an adjunctive prophylaxis procedure could further help control the conjunctival microbial load. Considering the increase in antibiotic resistance, a progressive shift toward alternative methods would be desirable. Somilux® eye drops (Alfa Intes, lactoferrin-based eye drops) are medical devices containing liposomal lactoferrin (LF). This study evaluates the effects on conjunctival microflora of LF-based eye drops used in the preoperative phase in patients scheduled for cataract surgery. LF-based eye drops or a vehicle solution (water solution) were instilled 4 times a day starting 3days before cataract surgery. Before the therapy (T0) and at the time of surgery (T1), a conjunctival swab was performed in both eyes and processed to detect microbial growth, microbiological isolation, and species identification. The outcome was the quantification and characterization of the local microbial flora before and after using LF-based or vehicle-based eye drops. Safety of the treatments was also evaluated. 88 eyes of 44 patients (mean [± SD] age 75 [± 12.6] years) were enrolled. At baseline, 54 conjunctival swabs showed only saprophytic flora, 27 showed only potential pathogenic flora, and seven showed both of them. LF-based eye drops reduced the proportion of potentially pathogenic bacteria (36% at T0 vs. 9% at T1, p = 0.008) compared with the vehicle (41% at T0 vs. 55% at T1, p = 0.302) without altering the physiological ocular microbial composition. No adverse events have been reported. Our findings provide a novel contribution to the scientific knowledge on the role of LF in the ophthalmic field, supporting the use of LF-based eye drops as a safe and selective treatment to improve the ocular surface physiological defenses and control the bacterial ocular surface contamination prior to cataract surgery.

Prospective comparison of extracorporeal shock wave lithotripsy versus flexible ureterorenoscopy in patients with non-lower pole kidney stones under the COVID-19 pandemic.

Both shock wave lithotripsy (SWL) and flexible ureterorenoscopy (F-URS) are recommended as the first choice for non-lower pole kidney stones. Therefore, we conducted a prospective study to evaluate the efficacy, safety, and cost of SWL versus F-URS in patients with solitary non-lower pole kidney stones ≤ 20mm under the COVID-19 pandemic.This prospective study was conducted in a tertiary hospital from June 2020 to April 2022. Patients who underwent lithotripsy (SWL or F-URS) for non-lower pole kidney stones were enrolled in this study. The stone-free rate (SFR), retreatment rate, complications, and cost were recorded. Propensity score-matched (PSM) analysis was performed. A total of 699 patients were finally included, of which 81.3% (568) were treated with SWL and 18.7% (131) underwent F-URS. After PSM, SWL showed equivalent SFR (87.9% vs. 91.1%,P = 0.323), retreatment rate (8.6% vs. 4.8%,P = 0.169), and adjunctive procedure (2.6% vs. 4.9%,P = 0.385) compared with F-URS. Complications were scarce and also comparable between SWL and F-URS (6.0% vs 7.7%,P > 0.05), while the incidence of ureteral perforation was higher in the F-URS group compared with the SWL group (1.5% vs 0%,P = 0.008). The hospital stay was significantly shorter (1day vs 2days,P < 0.001), and the cost was considerably less (1200 vs 30,083,P < 0.001) in the SWL group compared with the F-URS group. This prospective cohort demonstrated that SWL had equivalent efficacy with more safety and cost benefits than F-URS in treating patients with solitary non-lower pole kidney stones ≤ 20mm. During the COVID-19 pandemic, SWL may have benefits in preserving hospital resources and limiting opportunity for virus transmission, compared to URS. These findings may guide clinical practice.

Large-Volume Fat Grafting to the Breast With External Expansion Assist.

Large-volume autologous fat transfer (AFT) to the breast with external expansion has emerged as an alternative to alloplastic augmentation or reconstruction in appropriate patients. Report the authors' technique for this procedure and experience with 49 consecutive patients of a single surgeon's practice from 2013 to 2021. The authors performed a retrospective analysis of consecutive patients undergoing fat grafting to the breast with preexpansion. Patients were included if they had a clinical problem amenable to correction with large-volume fat injection and adequate donor sites, and were willing to undergo preexpansion. Data was collected through chart review and deidentified. Demographics, diagnosis, radiation status, volume grafted, complications, and adjunct procedures were recorded. Forty-nine patients underwent external expansion with AFT by a single surgeon. Twenty-three patients (47%) had hypoplastic indications, including tuberous breast deformity (n = 9) and Poland syndrome (n = 1). Seventeen patients (35%) had indications for secondary breast revision of previously placed implants. Nine patients (18%) utilized the procedure for primary oncologic breast reconstruction. A total of 71 procedures were performed, with an average of 1.45 procedures per patient. The average volume of fat grafted per breast was 372 mL for hypoplasia, 240 mL for secondary breast revision, and 429 mL for oncologic reconstruction. Concurrent procedures included implant exchange, implant removal, mastopexy, and breast reduction. Follow-up ranged from 1 to 84 (average = 20) months. The authors' experience shows promising results with external expansion and large-volume fat grafting to the breast.

Surgical Management of Bilateral Limbal Stem Cell Deficiency.

At the age of 43 years-old, a man was left with bilateral limbal stem cell deficiency after an ocular alkaline burn with lime, which resulted in corneal opacification. After multiple unsuccessful surgical attempts to restore vision, including penetrating keratoplasties and Boston keratoprosthesis, visual acuity was counting fingers in the left eye. At 73 years of age, the patient underwent another surgery in his left eye. Cauterization of neovessels and removal of the vascular pannus were followed by partial excision of Tenon's capsule. Penetrating keratoplasty was followed by an intrastromal injection of anti-VEGF (vascular endothelial growth factor), and the ocular surface was covered with amniotic membrane. Postoperatively, the graft was clear with no signs of inflammation; vision improved to 20/50 and remained stable throughout the following two years. Herein we describe some adjunctive procedures that might have delayed failure and rejection of the corneal graft. This case demonstrates the difficulties in treating bilateral limbal stem cell deficiency in a tertiary eye care center with no capacity to perform stem cell therapy.

Multicentre International Registry of Open Surgical Versus Percutaneous Upper Extremity Access During Endovascular Aortic Procedures

To investigate access failure (AF) and stroke rates of aortic procedures performed with upper extremity access (UEA), and compare results of open surgical vs. percutaneous UEA techniques with closure devices. A physician initiated, multicentre, ambispective, observational registry (SUPERAXA - NCT04589962) was carried out of patients undergoing aortic procedures requiring UEA, including transcatheter aortic valve replacement, aortic arch, and thoraco-abdominal aortic endovascular repair, pararenal parallel grafts, renovisceral and iliac vessels repair. Only vascular procedures performed with an open surgical or percutaneous (with a suture mediated vessel closure device) UEA were analysed. Risk factors and endpoints were classified according to the Society for Vascular Surgery and VARC-3 (Valve Academic Research Consortium) reporting standards. A logistic regression model was used to identify AF and stroke risk predictors, and propensity matching was employed to compare the UEA closure techniques. Sixteen centres registered 1 098 patients (806 men [73.4%]; median age 74 years, interquartile range 69 - 79 years) undergoing vascular procedures using open surgical (76%) or percutaneous (24%) UEA. Overall AF and stroke rates were 6.8% and 3.0%, respectively. Independent predictors of AF by multivariable analysis included pacemaker ipsilateral to the access (odds ratio [OR] 3.8, 95% confidence interval [CI] 1.2 - 12.1; p = .026), branched/fenestrated procedure (OR 3.4, 95% CI 1.2 - 9.6; p = .019) and introducer internal diameter ≥ 14 F (OR 6.6, 95% CI 2.1 - 20.7; p = .001). Stroke was associated with female sex (OR 3.4, 95% CI 1.3 - 9.0; p = .013), vessel diameter > 7 mm (OR 3.9, 95% CI 1.1 - 13.8; p = .037), and aortic arch procedure (OR 7.3, 95% CI 1.7 - 31.1; p = .007). After 1:1 propensity matching, there was no difference between open surgical and percutaneous cohorts. However, a statistically significantly higher number of endovascular adjunctive procedures were recorded in the percutaneous cohort (p < .001). AF and stroke rates during complex aortic procedures employing UEA are non-negligible. Therefore, selective use of UEA is warranted. Percutaneous access with vessel closure devices is associated with similar complication rates, but more adjunctive endovascular procedures are required to avoid surgical exposure.

Adjunctive Aesthetic Procedures in Orthognathic Surgery.

An important aesthetic goal in orthognathic planning is to improve facial balance, harmony, volume, and symmetry. It is therefore logical that adjunctive aesthetic procedures become a part of the overall orthognathic treatment plan and that their possibilities are discussed with orthognathic candidates. Such procedures help to improve the final outcome of the orthognathic treatment and enhance patient satisfaction. Training and experience are of utmost importance when offering and performing aesthetic facial surgery. This article discusses various facial aesthetic procedures that can be combined with orthognathic surgery, to the patient's benefit, to help them become the most beautiful version of themselves.

Arthroscopic Remplissage Combined With Bankart Repair Results in a Higher Rate of Return to Sport in Athletes Compared With Bankart Repair Alone or the Latarjet Procedure: A Systematic Review and Meta-analysis

Background: Traumatic anterior shoulder instability affects athletes at a higher rate compared with the general population. In recent years, indications for arthroscopic remplissage, an adjunct procedure classically used to reduce the recurrence of anterior shoulder instability in patients with off-track Hill-Sachs lesions, have expanded. Purpose: To investigate return-to-sport (RTS) rates, functional outcomes, and adverse events in athletes who underwent arthroscopic Bankart repair with remplissage compared with surgical alternatives such as Bankart repair alone or the Latarjet procedure. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A literature review of the Embase, PubMed (MEDLINE), and Web of Science databases was conducted for articles published before May 22, 2022. For the systematic review, 16 of 457 studies that reported RTS rates at any time point after remplissage were deemed eligible for inclusion in quantitative analysis and 17 of 457 studies in qualitative analysis. For the meta-analysis, 8 of 457 studies reported RTS rates after remplissage compared with surgical alternatives including Bankart repair alone or the Latarjet procedure and were deemed eligible for inclusion. Results: In total, 538 athletes underwent remplissage and were included in the study. RTS at any level was achieved by 86% (395/457) of patients, and the odds of RTS at any level were significantly higher after remplissage compared with surgical alternatives (odds ratio [OR], 2.71 [95% CI, 1.14-6.43]; P = .02). The odds of RTS at a previous or higher level were also significantly higher after remplissage compared with surgical alternatives (OR, 2.07 [95% CI, 1.29-3.31]; P = .002). The mean Rowe score increased significantly from 43.9 ± 7.77 preoperatively (n = 173) to 92.2 ± 4.02 after remplissage (n = 397) (P < .001), but there was no significant difference in Rowe scores between remplissage and surgical alternatives (P = .54). After remplissage, the recurrence rate was 5.0% for athletes (n = 220) and 7.3% for all patients (n = 634), with a mean time to recurrence of 24.0 ± 12.5 months. Reoperations occurred in 3.6% of athletes (n = 110) and 4.1% of all patients (n = 445). Recurrence and reoperations were significantly less likely after remplissage compared with surgical alternatives (OR, 0.18 [95% CI, 0.08-0.39]; P < .001 and OR, 0.17 [95% CI, 0.06-0.50]; P = .001, respectively). Conclusion: Arthroscopic Bankart repair with remplissage augmentation significantly improved RTS rates among athletes, both at any level and at previous levels of play. Additionally, remplissage appeared to significantly decrease recurrence and reoperation rates compared with surgical alternatives such as Bankart repair alone or the Latarjet procedure.

Outcome of Lower Uterine Compressive Suture for the Management of Postpartum Hemorrhage Due to Placenta Previa During Cesarean Section

Background: Lower uterine compression suture (Cervical-Isthmic apposition suture technique) is a new but effective method to arrest postpartum hemorrhage (PPH). The effectiveness of the suture is not only due to local compression of the anterior and posterior walls of the uterus but also related to the indirect compression of the intramyometrial vessels running from the lateral edge of the lower uterine segment to its media part. Objectives: The aim of this study was to determine the outcome of uterine compression sutures for the management of PPH due to placenta previa during cesarean section.&#x0D; Materials and Methods: This hospital-based prospective observational study was conducted in the Department of Obstetrics and Gynecology of Rajshahi Medical College Hospital from January 2016 to December 2017. A total of 45 women who developed severe postpartum hemorrhage due to placenta previa during cesarean section were selected peroperatively or postoperatively as the study case. A lower uterine compression suture was given to all the patients. If the bleeding was not well controlled, then other adjunctive procedures were performed. Patients with a bleeding disorder, type I placenta previa, cases other than placenta previa, and morbid adherents of placenta were excluded from the study. The patients were examined postoperatively and again in 2nd week and 6th week after hospital discharge for evaluation of any complications. Data regarding history, physical findings, and investigation were collected from the patient and the patient's record.&#x0D; Result: Among the total of 45 cases, PPH was controlled in 88.9%(40) cases with compression sutures in the lower uterine segment, and only 11.1% (5) cases required additional procedures. It was observed that higher age groups, multiparous women, patients with &lt;37 weeks of pregnancy, and previous history of cesarean section were significantly associated with a higher amount of bleeding.&#x0D; Conclusion: Lower uterine compressive compression suture is an effective and safe method to control PPH due to placenta previa during cesarean section and can preserve the uterus for further pregnancy and menstruation.&#x0D; TAJ 2022; 35: No-2: 35-41

Spinal tumor embolization: benefit for surgical resection.

The embolization of hypervascular spinal tumors preoperatively has shown to be a worthwhile adjunctive procedure to minimize the elevated risks associated with surgical resection, such as intraoperative blood loss and its associated complications. Resection of these hypervascular tumors is necessary for local tumor control, reduction in patient-reported pain, improved neurological functioning, and spinal stability. This adjunctive procedure has been associated with improved surgical outcomes and easier facilitation of surgical resection. As such, we provide a review of the current literature examining the employment of this technique. Specifically, this article (a) reviews the techniques of embolization, with anatomical considerations of the arterial framework of the spinal network; (b) relativizes and outlines the post-embolization management of spinal tumor resection; (c) provides a critical outlook on the reported benefit of preoperative embolization before surgical resection with support from clinical studies in the literature; and (d) discusses the efficacy and reliability of provocative testing and post-procedural management and follow-up. Ultimately, a thorough and updated review of preoperative spinal tumor embolization and its clinical benefits will summarize the current fund of knowledge and encourage future research toward continued improvements in patient outcomes for those needing to undergo surgical resection of spinal lesions.

Understanding the management of brachial plexus birth palsy and the roles of nerve transfers

Early recognition and management of neonatal brachial plexus injury (NBPP) is key to optimizing outcomes and surgical options. Because up to a third of patients with birth palsy may require surgical intervention, the multidisciplinary team must follow up on the function and recovery of the entire upper extremity, from shoulder to fingertips, within the first few months of life. Options include neuroma resection and primary nerve grafting and/or nerve transfers, which can be intra- or extra-plexal, as adjunctive or standalone procedures. When limited proximal nerve roots are available for nerve grafting, or when too many nerve roots are involved, exceeding the supply of nerve graft, extra-plexal nerve transfers are then indicated. While early intervention is preferred (between 3 and 6 months for most authors), older children presenting late (&gt; 1 year since birth) with partial nerve recovery may still potentially benefit from nerve transfers, which can be offered to late-presenting infants. Here we discuss the anatomy, indications, work-up, options, complications, and outcomes for such nerve transfers for upper, lower, and global plexus palsy in neonates. Nerve transfers are a common procedure done for the treatment of various types of birth plexus palsies. Currently, while there is an abundance of clinical reports and evidence, there is still a lack of clarity regarding best practices or in terms of the type of procedure and technique for the treatment of birth plexus palsy. Our hope is that this chapter provides a concise source after an extensive cumulative review of the evidence of best practices for nerve transfers in the case of birth plexus palsy.

Evaluation of indocyanine-mediated photodynamic therapy cytotoxicity in human osteoblast-like cells: an in vitro study.

Antimicrobial photodynamic therapy (aPDT) is an adjunctive non-invasive procedure for the management of periodontal tissue infection and deep periodontal pocket decontamination. However, the effects of this procedure on periodontal cells like osteoblasts that play a role in periodontal tissue repair and regeneration is not yet clear.

Ethnic & Sex Disparities in Type B Aortic Dissection Patients Undergoing Thoracic Endovascular Aortic Repair: An International Perspective

There has been a revolution in the management of type B aortic dissection (TBAD) over the last 2decades due to the increasing development of endovascular techniques, with the prime example being thoracic endovascular aortic repair (TEVAR). However, many controversies concerning the use of TEVAR in TBAD exist. For instance, there is little available evidence suggesting any differences in demographics, disease characteristics, intervention technicalities, and clinical outcomes between males and females as well as different ethnicities when undergoing TEVAR for TBAD, both in the short and long term. Also, there is no risk prediction model/tool available. The objective of this international study is to describe and delineate the disparities between male and female patients of different ethnicities in terms of demographics, disease and interventional characteristics, and clinical outcomes. Over 17years a total of 58 TBAD patients were admitted to 2 tertiary vascular centres and treated using TEVAR. Mortality, postoperative complications and reintervention data were recorded for the first 30days after the procedure as well as during follow-up. Follow-up for all patients lasted until the study endpoint or until a patient's death. Data were analysed retrospectively using IBM SPSS statistical package 26 for Windows. The mean age was similar between the 2 groups, with the majority of patients in both being Caucasian. More than half of the males had complicated TBAD, while the majority of females were classed as having uncomplicated disease. The most commonly utilized proximal and distal landing zone for the TEVAR stent graft was zone 2 and zone 4, respectively. The mean proximal stent diameter was significantly larger in males compared to females (P=0.004). The difference in mean distal diameter between the 2 groups was insignificant (P=0.721). The mean total stent coverage of the thoracic aorta was 251.3mm in male patients compared to 291.2mm in females (P=0.203). A total of 32 patients underwent adjunctive procedures. Seven (17%) of the males had one or more postoperative complications compared to 2 (12%) females. Nine (22%) males underwent a reintervention procedure post TEVAR compared to only 1 (6%) female (P=0.136). Overall, males had a mortality rate of 24% (n=10) compared to 41% of females (n=7) (P=0.201). Estimated survival of males and females post TEVAR was 80.4±9.6months and 69.7±14.4months (P=0.428). For the total population, the number of stent grafts was inversely correlated with mortality. Despite the favourable clinical outcomes achieved by TEVAR in TBAD, there remains a grey area concerning its management. Thus, it is important to perform risk stratification of individual patients using their demographics and comorbidities, particularly scrutinizing patient sex and ethnic origin, when considering intervention for TBAD to achieve optimum results.

Establishing a Virtual Corneal Clinic: A Real-Time Teleophthalmology Approach.

Keratoplasty patients require regular and timely follow-ups. During this COVID-19 pandemic which restricted global travel, we developed a novel real-time, hybrid teleophthalmology approach to comanage international keratoplasty patients between Singapore and Indonesia. A retrospective consecutive observational study of 72 corneal patients (63 were postkeratoplasty) who attended a virtual corneal clinic (VCC) between June 2020 and April 2021 at JEC Eye Hospitals (JEC) in Jakarta, Indonesia. ZOOM Meeting software (Zoom Video Communication Inc, San Jose, CA) was used to simultaneously connect the Singapore corneal specialist at Eye & Cornea Surgeons (ECS), Singapore, using a real-time approach. Clinical examinations included full panels of video-linked corneal, glaucoma, and retinal imaging and investigations performed before real-time video-linked slit-lamp examination, with immediate clinical decision making between corneal specialists and patients. VCC enabled effective real-time clinical evaluation and collaborative clinical decisions, with full patient interaction, with the aim of maintenance of graft clarity, visual function, and management of comorbidities-a) topical and systemic medications were adjusted in 79.2% of patients; b) further referrals to glaucoma, retinal, and oculoplastic subspecialists were made in 16.6% of cases; c) additional adjunctive surgical procedures were performed at JEC in 6.9% cases; and d) government permission was obtained for 4 patients (5.6%) to fly to Singapore for urgent corneal surgery. The virtual corneal clinic is a novel real-time hybrid teleophthalmology approach which is effective in the comanagement of international keratoplasty patients and represents the advances in ophthalmic telemedicine.