Bundle Injury Research Articles

Clinical Considerations to Reduce Saphenous Neurovascular Bundle Injury During Suture Button Fixation of Syndesmosis Injuries.

To document angles, from 2 difference starting points, or danger zones that should be avoided to minimize risk of injury or irritation to the saphenous neurovascular bundle (SNVB) during suture button (SB) fixation for distal tibiofibular syndesmosis injuries. Retrospective imaging study. Academic Level 1 trauma center. Forty-eight randomly selected patients with healthy ankles and computed tomography scans for nonankle diagnoses. Computed tomography scans and 3D reconstructed images were used to define the angle between the SNVB and 2 different fibular starting points, using the direct lateral (DL) and the posterolateral (PL) starting points. Descriptive analyses were performed to identify angles that should be avoided during suture button fixation. Distances from the SNVB using preset angles of 0, 10, 20, and 30 degrees were analyzed. In addition, the width of the SNVB, the midsubstance angle of the SNVB, and the distance from the 30-degree point to the tibialis anterior were recorded. The mean angle between the SNVB and the standard DL starting point was 13.7 ± 5.0 degrees (P < 0.05), whereas the mean angle using the alternate PL starting point was 17.2 ± 5.3 degrees (P < 0.05). The SNVB width was 5.2 mm [range, 2.6-9.1 mm] (P < 0.05). The distances from the SNVB were greatest for the DL 30-degree group and the PL 0-degree group. The results document angles that should be avoided when using suture button fixation for syndesmosis injuries. Device characteristics and surgery-related variables may require intraoperative modifications, and knowledge of this anatomical relationship may reduce SNVB injury during those situations. Considering our results, we recommend that surgeons place suture buttons from the DL starting point with a 30-degree trajectory to avoid injuries to the SNVB.

Assessment of accessory mental foramen using cone-beam computed tomography and its clinical relevance

Introduction: Accessory mental foramen (AMF) is defined as any additional opening on the anterior surface of the mandible body that is connected to the mandibular canal. The presence of AMF is an important anatomical parameter when planning the therapy to avoid neurovascular bundle injury and other complications. Cone-beam computed tomography (CBCT) provides an accurate, three-dimensional determining of the position, its dimensions and the relation of AMF to the mental foramen (MF), as well as the distinction from nutritive openings. Material and Methods: The research was carried out at the Department of Dentistry, Faculty of Medical Sciences, University of Kragujevac, as a retrospective study where 148 CBCT images were analyzed. The analysis of the position of AMF, the relation to and the distance from the MF were made on cross-sectional and axial images. Only those openings that have had a clear connection with the mandibular canal were counted as AMF. Results: AMF was present in 12 (8.11%) patients. In most cases, AMF was positioned superior to MF, in 27% of patients. There was no significant statistical difference between sex and the jaw side. The average distance of AMF from MF was 4.52 ± 2.21 mm. In most cases, AMF is round shaped (60%). The average value of the surface area is 1.62 ± 1.14 mm2. Discussion and Conclusion: Timely detection of AMF using CBCT contributes to the diagnosis and planning of appropriate dentures, surgical technique, preventing possible damage to adjacent anatomical structures, or some other therapy.

Combining ACL Oblique Coronal MRI with the Routine Knee MRI Protocol in the Diagnosis of ACL Bundle Lesions. Can It Add A Value?

Abstract Background: The Anterior Cruciate Ligament (ACL) is formed of two bundles. Routine MRI protocol is usually insufficient to delineate both bundles structure, so diagnosis of AM and PL bundle injury is often limited, and development of further imaging orientation and pulse sequences is key for further improving characterization of these bundles. Accurately grading the ACL tears and differentiating between complete and partial tears as well as assessing the two bundles is key in improving the clinical and surgical management. Aim of Study: The purpose of this study is to evaluate the diagnostic value of combining oblique coronal images to the routine MRI protocol for better assessment of the ACL bundles, thus improving management outcome by performing two MRI protocols and comparing them to the arthroscopic findings. Patients and Methods: This prospective study was con-ducted between January 2016 and February 2018 in Ain Shams University Hospitals and private centers. The study population has consisted of 32 patients (26 men & 6 women), ranging between 19-45 years, with mean age of 27.11 years. All patients were suspected of ACL injury referred from the outpatient clinic of orthopedic. All patients were examined by MRI examinations com-posed of sagittal T2-weighted Fast-Spin Echo (FSE), coronal T2-weighted FSE, and axial T2-weighted. The sagittal images were planned on axial localizer by 15-degree medial angling on perpendicular line to the bicondylar line and by oblique coronal MRI were the oblique coronal STIR images named were planned on midsagittal localizer in the plane parallel to the ACL and the roof of the intercondylar notch (Blumensaat's line). A consultant orthopedic surgeon did a diagnostic arthros-copy for all included patients using standard parapatellar portals visualizing the ACL with direct visualizing of both bundles and accordingly classifying each bundle as torn or intact. Results: The Oblique coronal MRI showed a better agree-ment with the diagnostic arthroscopy than routine MRI [weight-ed Kappa; k=0.865 & 0.753 respectively]. For diagnosis of Anteromedial Bundle (AMB) tear the sensitivity was 90.9%, specificity 80%, with overall accuracy of 87.5%. For diagnosis of Posterolateral Bundle (PLB) tear. The sensitivity was 95.5%, specificity 90%, with overall accuracy of 93.8%. Conclusion: The adding of oblique coronal imaging to routine MRI protocol revealed better delineation of the ACL bundles, increasing the accuracy of diagnosis each or both bundle lesions, providing significant benefit in further man-agement and outcome in patient with suspected ACL injury.

Mechanism and anatomy recognition of neurovascular bundle injury from different perspectives of transabdominal and transanal approach

The neurovascular bundle (NVB) starts at the lateral angle of the seminal vesicle (the initial part), passes posterolateral of the prostate gland (the main part), and ends at the cavernous body of the penis (the cavernous part). In low rectal surgery, different transabdominal and transanal perspectives result in different NVB injury risks. In the perspective of transabdominal operation, the separation between the initial part of NVB and Denonvilliers fascia and the anatomical variation of the two lateral sides of Denonvilliers fascia increases the risk of NVB injury, and conformation separation may take into account the convenience of separationand the protection of NVB. In the perspective of transanal operation, when separating the main part with NVB and mesorectum, the perspective of the transanal, unidirection traction and excessive dissection increase the risk of NVB main exposure. Clear anatomical identification helps the protection of NVB in the transanal operation. At present, the medical evidence on the difference of NVB injury in different perspectives of transabdominal and transanal approach is still in need of relevant clinical researches.

Handling and protecting your flexible ureteroscope: how to maximise scope usage.

Flexible ureteroscopy is an important therapeutic and diagnostic procedure and has seen rapid rise in its utilisation in recent years. There have been numerous developments in flexible ureteroscope (fURS) technology but scope fragility, and the associated high maintenance costs, remains a concern. A comprehensive Medline search for related publications from the last 20 years was undertaken to identify common causes of fURS damage and ascertain practices to minimise this. Flexible ureteroscopy can be due to intraoperative causes (loss of the deflection mechanism, damage to the working channel due and fibreoptic bundle injury) and non-operative damage which occur during cleaning, sterilisation and handling of the fURS. The review summarises the available literature to help highlight common mechanisms of scope damage, and outlines evidence-based measures to reduce the risk of damage and maximise durability. Scope fragility remains a problem with significant associated cost implications. In a culture of rising fURS use and reducing re-imbursement for endourologists, prolonging the longevity of the fURS is imperative for maintaining profitability. There are simple and inexpensive practices which can be immediately adopted to maximise fURS use and reduce the need for repairs.

CT can stratify patients as low risk for tibial neuropathy following a talus fracture.

Determine the incidence of tibial neuropathy following talus fractures and CT's ability to stratify patients at risk for developing post-traumatic neuropathy. In this IRB-approved retrospective analysis, 71 talus fractures and 8 contralateral control ankle CTs were reviewed by one observer blinded to clinical information. CT evidence suggestive of tibial neurovascular bundle injury included nerve displacement, perineural fat effacement/edema, and bone touching nerve. The association between these CT findings and clinically evident tibial neuropathy was analyzed. A semi-quantitative likelihood score was assigned based on the degree of the CT findings around the nerve. Interobserver agreement was calculated between 2 other readers. Twenty-five percent of patients in this cohort had clinical evidence of tibial neuropathy. There was a high specificity (0.87-0.93) and negative predictive value (0.83-0.87), a moderate accuracy (0.80-0.82), but a lower sensitivity (0.33-0.56) associated with the CT findings. Among the CT findings, nerve displacement (p < 0.0001) and bone touching nerve (p = 0.01) were associated with tibial neuropathy. A likelihood score of 2-5 was associated (p = 0.007-0.015) with tibial neuropathy. The presence of tibial neuropathy and nerve recovery were not associated with hospital length of stay, while CT findings were. There was substantial agreement between the three readers: likelihood scores 2+ (k = 0.78) and 3+ (k = 0.72). Tibial neuropathy occurs following talus fractures, and CT findings may help surgeons narrow down the number of patients requiring close neurological follow-up.

The pathoanatomy of the anterior bundle of the medial ulnar collateral ligament

The purpose of this study was to increase our understanding of the pathoanatomy of the ulnar collateral ligament (UCL) by performing a descriptive analysis of the surgical inspection of the anterior bundle in patients undergoing reconstruction. A single-surgeon series of 163 patients who underwent UCL reconstruction between 2009 and 2017 was retrospectively analyzed. Descriptions of the pathoanatomy of injury were obtained from the operative reports. Magnetic resonance imaging data were reviewed to assess whether the presence and location of tissue disruptions were accurately recognized. Demographic and clinical characteristics were obtained from medical records and correlated to observed pathoanatomy. Injuries to the anterior bundle were characterized by a single tissue disruption (65%), tissue disruptions at more than 1 location (23%), or injuries without distinct fiber tissue disruptions (12%). The presence and location of tissue disruptions matched magnetic resonance imaging findings in 124 of 153 patients (81%). Partial tears more frequently affected the anterior band of the anterior bundle distally as opposed to the posterior band of the anterior bundle proximally (P = .012). Patients with single tissue disruptions more frequently reported a popping sensation than patients with non-tear insufficiency (P = .030). This study shows the heterogeneity of anterior bundle injuries in patients undergoing UCL reconstruction. A variety of injury configurations and chronic attritional damage to the anterior bundle were observed, as well as distinct tear patterns at the distal and proximal attachment sites. Future research may elucidate the diagnostic value of a pop sign for UCL injury.

Research progress in diagnosis and treatment of injury of the popliteal meniscal fiber bundle

Popliteal meniscal fiber bundle injury is relatively infrequent in clinic, which can be either isolated or associated with anterior cruciate ligament rupture, lateral meniscus injury and so on. Popliteal meniscal fiber bundle injury often leads to instability of lateral meniscus. Because of the lack of specific symptoms and signs of injury, the imaging changes are subtle, and it is easy to miss diagnosis and misdiagnosis in clinical. Timely diagnosis and treatment are essential to prevent the chronic pain and instability of the knee joint. This paper summarizes the anatomical characteristics, biomechanics, injury mechanism, diagnostic points and surgical treatment of the popliteal meniscus fiber bundle injury, in order to guide the diagnosis and treatment of the injury of the popliteal meniscus fiber bundle in the clinical work.

Avoiding Neurovascular Risk During Percutaneous Clamp Reduction of Spiral Tibial Shaft Fractures: An Anatomic Correlation With Computed Tomography.

The use of percutaneous clamps is often a helpful tool to aid reduction and intramedullary nailing of distal tibial spiral diaphyseal fractures. However, the anterior and posterior neurovascular bundles are at risk without careful clamp placement. We describe our preferred technique of percutaneous clamp reduction for distal spiral tibial fractures with a distal posterolateral fracture spike, with care to protect the adjacent neurovascular structures. We also investigated the relationship between these neurovascular structures and the site of common percutaneous clamp placement. Preoperative computed tomography images of surgically managed patients who sustained this specific common fracture pattern (distal third spiral diaphyseal tibia fracture with a posterolateral fragment) were retrospectively reviewed. On computed tomography, we extrapolated the ideal virtual clamp site on the posterolateral fracture fragment to facilitate reduction. The average distance of this clamp position from the anterior neurovascular bundle was 14 mm (SD = 7.6), with a range of 6-32 mm. The average distance of the clamp site from the posterior neurovascular bundle was 19 mm (SD = 6.1), with a range of 11-30 mm. In 31% of patients, the distal fragment's apex extended anterior to the interosseous membrane, and in 69% of patients, the apex was posterior to the interosseous membrane. We also describe our preferred surgical technique with percutaneous clamping and tibial nailing, which involves sliding the posterolateral tine of the percutaneous clamp along the lateral tibial cortex to prevent neurovascular bundle injury.

Pacemaker memory in post-TAVI patients: Who should benefit from permanent pacemaker implantation?

One of the most frequent complications of transcatheter aortic valve implantation (TAVI) is the occurrence of atrioventricular (AV) conduction disorders secondary to AV node or His bundle injury leading to permanent pacemaker implantation (PPI). The objective was to quantify the rate of ventricular pacing (VP), according to post-TAVI indication for PPI using recorded pacemaker memory. From October 2009 to January 2017' all patients who had PPI following TAVI performed at Rouen University Hospital were included. Indications for PPI were: ≥ 1 episode of complete atrioventricular block (CAVB) or 2:1 atrioventricular block, and new-onset persistent left bundle branch block (NOP-LBBB) with either prolonged PR interval(>200ms) or HV interval (>70ms). The primary endpoint was VP percentage at the first pacemaker interrogation (a VP percentage ≥ 1% was considered as significant). Out of 936 TAVI patients (Sapien-3' n=379 [Edwards Lifesciences, Irvine, CA, USA]; Sapien-XT' n=513; CoreValve' n=44, Medtronic, Minneapolis, MN, USA), 87 (9.3%) had PPI. Eighty of these 87 patients were followed-up and analyzed. At the first pacemaker interrogation, a significant VP percentage was observed in 60/80 followed-up patients (75%), in 46/51 patients (90.2%) implanted for CAVB, and 12/23 patients (52.2%) implanted for NOP-LBBB associated with either prolonged PR or HV interval. No clinical predictive factor of significant VP percentage was found. In the post-TAVI period, our data support PPI in patients with CAVB even if paroxysmal. Our data also suggest PPI may be considered in patients with NOP-LBBB associated with either prolonged PR or HV interval.

MP74-09 THERMAL IMAGING AS A NON-INVASIVE METHOD FOR ASSESSING ERECTILE FUNCTION

You have accessJournal of UrologySexual Function/Dysfunction: Evaluation II1 Apr 2018MP74-09 THERMAL IMAGING AS A NON-INVASIVE METHOD FOR ASSESSING ERECTILE FUNCTION Alexandria Hertz, Evalyn George, Amanda Reed-Maldonado, Timothy Brand, and Shashikumar Salgar Alexandria HertzAlexandria Hertz More articles by this author , Evalyn GeorgeEvalyn George More articles by this author , Amanda Reed-MaldonadoAmanda Reed-Maldonado More articles by this author , Timothy BrandTimothy Brand More articles by this author , and Shashikumar SalgarShashikumar Salgar More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2393AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There are few objective measures to determine penile blood flow and erectile function. However, finding a non-invasive, easy-to-perform method would be beneficial for objective clinical evaluation in addition to research models. The aim of this study was to assess the feasibility and quality of thermal imaging in assessing penile blood flow in a rat model. METHODS Twelve 10-week old Lewis rats were divided into two groups (n=6 rats/group): 1) bilateral cavernous nerve and internal pudendal bundle injury and 2) sham operation (laparotomy without injury). Six weeks following the original surgery the rats underwent cavernous nerve stimulation with a bipolar electrode. Thermal imaging was performed before, during, and after stimulation. The images were then compared visually as well as the temperature of the penis during stimulation was recorded. Intracavernous pressure (ICP) was recorded in these groups for a comparison measurement. RESULTS On subjective visual assessment, the sham group had visibly evident erections on plain photography (6 out of 6 rats). This translated well with visibly evident change on thermal imaging. The injury group did not show evidence of erectile function (0/6 rats) and minimal temperature change was noted on thermal imaging from baseline. When comparing temperature during stimulation, the sham group had a significantly higher temperature (31C vs 28.65C, p=0.05). When comparing the thermal temperatures to the ICP there was poor correlation, with temperature showing inconsistent change (p=0.11). CONCLUSIONS Thermal imaging appears to be a promising non-invasive, easy-to-use method for evaluating changes in penile blood flow and erectile function. Further evaluation in a larger population with larger target anatomy, will help to better assess this modality for clinical application in the future. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1003 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Alexandria Hertz More articles by this author Evalyn George More articles by this author Amanda Reed-Maldonado More articles by this author Timothy Brand More articles by this author Shashikumar Salgar More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Identification of the location of the A1 pulley combining palpation technique with palm landmarks and percutaneous release of A1 pulley with a 19-gauge needle: A cadaveric study.

The aims of this study were to identify the location of the A1 pulley combining palpation technique with superficial palm landmarks and to determine the efficacy and safety of A1 pulley percutaneous release with a 19-gauge needle. Fourteen fresh frozen cadaveric specimens were used: 56 fingers and 14 thumbs. The location of the A1 pulley was based on anatomical landmarks and was identified in all digits. Complete release of the A1 pulley occurred in 60 of the 70 digits (85.7%). The length of the A1 pulley in thumbs was 5.7 mm and in other fingers 4.5 mm. There were no signs of neurovascular bundle injuries. The mean distance between needle pathway and neurovascular bundle was 4.3 mm in the thumbs and 6.5 mm in the other fingers. There were no total flexor tendon injuries. The location of the A1 pulley can be predicted with success. Percutaneous release of the A1 pulley with a 19-gauge needle shows acceptable results in both safety and efficacy.

Clinical efficacy of laparoscopic extralevator abdominoperineal excision for low rectal cancer without turning position

Objective To explore the clinical efficacy of laparoscopic extralevator abdominoperineal excision (laparoscopic ELAPE) for low rectal cancer with modified Lloyd-Davies lithotomy position and without turning position. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 27 patients with low rectal cancer who underwent laparoscopic ELAPE without turning position in the West China Hospital of Sichuan University from September 2013 to January 2015 were collected. The modified Lloyd-Davies lithotomy position was used in perineal resection. Observation indicators: (1) surgical situation; (2) postoperative recovery situation; (3) postoperative pathological examination situation; (4) follow-up and survival situations. Follow-up using outpatient examination and telephone interview was performed to detect postoperative complications, survival of patients and tumor recurrence or metastasis up to March 2017. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were described as M (range). Results (1) Surgical situation: A total of 27 patients received laparoscopic ELAPE without turning position, and operation time and volume of intraoperative blood loss were (198±51)minutes and (85±66)mL. Among 5 of 27 patients with intraoperative complications, 1 with intestinal perforation received successful intraoperative repair, 1 with presacral haemorrhage received successful hemostasis by intraoperative gauze pressing, 1 with left and right pelvic plexus injury didn′t receive special treatment, 1 with left pelvic plexus injury + left internal iliac vein injury didn′t receive special treatment and were repaired in vascular injury repair, 1 with right neurovascular bundle injury didn′t receive special treatment of nerve injury and received successful hemostasis by ultrasonic scalpel. There was no perforation in the site of the tumor. Number of lymph node dissected was 14 (range, 9-22), and number of lymph node dissected ≥12 and 100 mL) and 7 in Clavien-DindoⅡ (3 with pulmonary infection, 2 with chylous fistula, 1 with perineal incision infection and 1 with hematuria). There was no death within 30 days postoperatively. The median duration of hospital stay of 27 patients was 7 days (range, 6-8 days). (3) Postoperative pathological examination situation: of 27 patients, 1 and 26 had respectively positive and negative circumferential margins and median distance of circumferential margin was 0.7 cm (range, 0.1-1.1 cm). T stage: 14, 12 and 1 patients were respectively detected in T2, T3 and T4. N stage: 18, 6 and 3 patients were respectively found in N0, N1 and N2. (4) Follow-up and survival situations: 25 of 27 patients were followed up for 2-32 months, with a median time of 24 months. During the follow-up, 5 had complications after discharge from hospital. Of 5 patients, 2 with persistent anal pain didn′t receive special treatment and were not relieved, and 3 with sexual dysfunction didn′t receive special treatment and were followed up or observed. Of 25 patients, 2 died of tumor-related diseases, 1 died of non-tumor-related disease and other 22 had survival. No local tumor recurrence was detected. Eight patients had tumor distant metastases, including 4 with pulmonary metastases, 3 with hepatic metastases and 1 with brain metastasis. Conclusion Laparoscopic ELAPE by modified Lloyd-Davies lithotomy position without turning position is safe and feasible, with closing pelvic floor peritoneum in stage Ⅰ. Key words: Rectal neoplasms, low; Extralevator abdominoperineal excision; Laparoscopy; Position

Functional Outcomes Following Nerve Sparing Prostatectomy Augmented with Seminal Vesicle Sparing Compared to Standard Nerve Sparing Prostatectomy: Results from a Randomized Controlled Trial

Seminal vesicle sparing may reduce the risk of neurovascular bundle injury and improve functional outcomes after prostatectomy. While several observational studies have shown better functional outcomes following seminal vesicle sparing approaches, evidence from randomized trials is lacking. We performed a randomized controlled trial comparing functional and cancer control outcomes between nerve sparing prostatectomy augmented with seminal vesicle sparing and standard nerve sparing prostatectomy. A total of 140 men with early stage prostate cancer were enrolled in a randomized phase II trial comparing nerve sparing prostatectomy augmented with seminal vesicle sparing to standard nerve sparing prostatectomy. Patient reported sexual and urinary functional scores were assessed prior to surgery, and 6 and 12 months postoperatively. Surgical margin status and prostate specific antigen recurrence were evaluated as secondary outcomes. There were no differences in sexual or urinary function scores after surgery between the study groups. The median urinary incontinence domain score was 92 in the nerve sparing group and 87.5 in the nerve plus seminal vesicle sparing group at 12 months (p = 0.77). Median sexual function domain scores were 73.7 in the nerve sparing group and 77.1 in the nerve sparing plus seminal vesicle sparing group at 12 months (p = 0.29). Margin status and 12-month biochemical recurrence were similar in the groups. Recovery of continence and sexual function was similar between the groups in this randomized controlled trial. Seminal vesicle sparing did not negatively affect margin status or 12-month biochemical (prostate specific antigen) recurrence. These results suggest limited usefulness of seminal vesicle sparing prostatectomy.

Results of using the Ilizarov method for correction of complex foot and ankle deformities in skeletally mature patients

Objective Our aim was to study the results of correction of complex foot and ankle deformities in skeletally mature patients using the Ilizarov method with either osteotomy or arthrodesis. Background Complex foot and ankle deformity is a multiplanar one with shortening of the foot. Different corrective procedures have been described for correction of these deformities in skeletally mature patients, such as extensive soft tissue release with capsulotomy, tendon transfer, multiple osteotomies, and arthrodesis. Acute correction with internal fixation methods has many disadvantages such as excessive shortening of the foot, risk for neurovascular bundle injury, high risk for recurrence due to extensive scar formation, and high risk for wound complications. Patients and methods In this study, an Ilizarov external fixator was used for correction of 25 complex foot and ankle deformities in 23 patients with either bone osteotomy, which was done in 12 feet, or arthrodesis in another 13 feet. Results Complete clinical correction of all feet to a plantigrade position was obtained, gait was improved in all cases, and pain was the same, improved, or completely eliminated. Partial relapse of the deformity with recurrence of symptoms occurred in three cases. Conclusion The Ilizarov method of external fixation is an effective, safe, and reliable method for correction of complex foot and ankle deformities in skeletally mature patients, where correction is achieved by performing gradual distraction of foot osteotomies or arthrodesis.

Acute His Bundle Injury during Permanent His Bundle Pacing: Mechanistic Insights into Intra-Hisian Block

Acute His Bundle Injury during Permanent His Bundle Pacing: Mechanistic Insights into Intra-Hisian Block

Electrophysiological observations of acute His bundle injury during permanent His bundle pacing

BackgroundPermanent His bundle pacing (HBP) is a physiological alternative to right ventricular pacing (RVP). Catheter manipulation during HBP can cause trauma to the His bundle during implantation. We sought to determine acute and long-term incidence of His bundle (HB) injury with HBP. MethodsPatients undergoing permanent HBP at Geisinger Wyoming Valley Medical Center from 2006 to 2014 formed the study group. Patients with pre-existing His-Purkinje disease (HPD) were excluded from the study. Any development of new bundle branch block (BBB) or AV block (B) during acute HBP lead-induced block was recorded. Resolution of AVB and/or BBB was documented. ResultsHBP was attempted in 450 patients. In 358 patients without HPD, 28 (7.8%) developed acute HB injury in the form of complete AVB (4, 1.1%), RBBB (21, 5.9%) or LBBB (3, 0.8%) during HBP lead placement. In all 7 patients with AVB or LBBB, conduction completely recovered. The HB electrogram from the lead displayed injury current in all 7 patients. Lead-induced RBBB resolved in 12 of 21 patients and persisted in 9 (2.5%) patients. Pacing from the HBP lead resulted in correction of acute conduction block in 27 of 28 patients and 8 of 9 patients with chronic RBBB. None of the patients with transient conduction block developed new conduction disease during follow-up of 21±19months. ConclusionsDespite acute trauma to HB in 7.8% of patients undergoing permanent HBP, complete resolution of conduction block occurred in 19 of 28 patients (68%). RBBB persisted in 9 patients (32%) but mostly normalized with HBP.

Low-energy Shock Wave Therapy Ameliorates Erectile Dysfunction in a Pelvic Neurovascular Injuries Rat Model.

Erectile dysfunction (ED) caused by pelvic injuries is a common complication of civil and battlefield trauma with multiple neurovascular factors involved, and no effective therapeutic approach is available. To test the effect and mechanisms of low-energy shock wave (LESW) therapy in a rat ED model induced by pelvic neurovascular injuries. Thirty-two male Sprague-Dawley rats injected with 5-ethynyl-2'-deoxyuridine (EdU) at newborn were divided into 4 groups: sham surgery (Sham), pelvic neurovascular injury by bilateral cavernous nerve injury and internal pudendal bundle injury (PVNI), PVNI treated with LESW at low energy (Low), and PVNI treated with LESW at high energy (High). After LESW treatment, rats underwent erectile function measurement and the tissues were harvested for histologic and molecular study. To examine the effect of LESW on Schwann cells, in vitro studies were conducted. The intracavernous pressure (ICP) measurement, histological examination, and Western blot (WB) were conducted. Cell cycle, Schwann cell activation-related markers were examined in in vitro experiments. LESW treatment improves erectile function in a rat model of pelvic neurovascular injury by leading to angiogenesis, tissue restoration, and nerve generation with more endogenous EdU(+) progenitor cells recruited to the damaged area and activation of Schwann cells. LESW facilitates more complete re-innervation of penile tissue with regeneration of neuronal nitric oxide synthase (nNOS)-positive nerves from the MPG to the penis. In vitro experiments demonstrated that LESW has a direct effect on Schwann cell proliferation. Schwann cell activation-related markers including p-Erk1/2 and p75 were upregulated after LESW treatment. LESW-induced endogenous progenitor cell recruitment and Schwann cell activation coincides with angiogenesis, tissue, and nerve generation in a rat model of pelvic neurovascular injuries.

Value of MRI in diagnosis of anteromedial and posterolateral bundle tears in patients undergoing anterior cruciate ligament reconstruction

Objective To analyze the value of MRI in the diagnosis of anteromedial bundle(AMB) and posterolateral bundle (PLB) tears in patients undergoing anterior cruciate ligament (ACL) reconstruction. Methods MRI of 141 knees undergoing ACL reconstruction were retrospectively reviewed with using arthroscopy as golden standard to evaluate diagnostic accuracy of MRI to predict AMB and PLB injury conditions. The interval time between MRI and arthroscopic ACL reconstruction was 4 days to 29 days. The median time was 11 days. The injury patterns of AMB and PLB was observed on MRI and classified into normal type, partial tear and complete tear. Using the arthroscopic findings as the golden standard, MRI diagnostic accuracy of AMB and PLB tears was compared with Chi-square test. Results Thirteen cases(9.2%, 13/141) with isolated bundle injury were identified in the arthroscopic assessments among 141 patients, including 11 cases with isolated AMB injury and 2 cases with isolated PLB injury. Combined AMB and PLB injury were all identified in the remaining 128 knees (90.8%, 128/141). There was statistical difference between the incidence rate of isolated bundle injury and double-bundles injury (χ2=6.532, P=0.011). Partial tear was defined as partially torn or interrupted fiber bundles with remaining normal fiber bundles. Complete tear was defined as the fiber bundles in the expected region of the ligament were completely discontinuous. The diagnostic accuracy of MRI in prediction of AMB injury was better than PLB [85.8% (121/141) versus 72.3% (102/141); χ2=7.737, P=0.005]. There was no statistical difference between the accuracy rate of MRI in diagnosis of partial AMB and PLB tear [77.8% (14/18) versus 50.0% (15/30); χ2=3.630, P=0.057]. There was no statistical difference between the accuracy rate of MRI in diagnosis of complete AMB and PLB tear[87.6% (106/121) versus 84.0% (84/100); χ2=0.589, P=0.443]. There was no statistical difference between the accuracy rate of MRI in diagnosis of partial and complete AMB tear (χ2=1.282, P=0.258). There was statistical difference between the accuracy rate of MRI in diagnosis of partial and complete PLB tear (χ2= 14.690, P=0.001). Conclusions Complete AMB and PLB tear are the common injury patterns among patients undergoing ACL reconstruction, while an isolated AMB or PLB tear is uncommon. MRI is of value in the diagnosis of ACL injury. MRI can accurately diagnose complete AMB tear, complete PLB tear and partial AMB tear, but the diagnostic accuracy of MRI in assessing partial PLB tear needs to be improved. Key words: Anterior cruciate ligament; Wounds and injury; Magnetic resonance imaging

V1-05 APICAL SLING FOR FOR SITE SPECIFIC PELVIC ORGAN PROLAPSE REPAIR

You have accessJournal of UrologyFemale Pelvic Medicine & Reconstructive Surgery1 Apr 2014V1-05 APICAL SLING FOR FOR SITE SPECIFIC PELVIC ORGAN PROLAPSE REPAIR Paulo Palma, Cassio Riccetto, Tiago Aguiar, and Wilmar Azal Neto Paulo PalmaPaulo Palma More articles by this author , Cassio RiccettoCassio Riccetto More articles by this author , Tiago AguiarTiago Aguiar More articles by this author , and Wilmar Azal NetoWilmar Azal Neto More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.599AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Sacral colpopexy has become a widely used procedure for apical vaginal prolapse repair, but the risk of bleeding, injury of the rectum, as well as other abdominal viscera still represents a major concern. Posterior transcoccigeal mesh brings the risks of the transgluteal route, mostly pudendal neurovascular bundle injury. A new procedure for colpopexy was developed in order to allow for a single incision apical transvaginal level I repair, using a small amount of synthetic material. The kit contains a macro porous polypropylene 8 x 1,2 cm tape and two polypropylene self anchoring system attached to polypropylene threads and a disposable retractable insertion guide for placement of the anchoring system into the sacrospinous ligaments. This video highlights the technical details of the procedure. METHODS It is presented the surgical treatment of a patient with a vaginal apical (uterine) prolapse stage 3 according to the POP-Q system. A vertical incision is done in the anterior vaginal. Blunt dissection is performed towards the ischial spine, and coccigeous muscle and sacrospinous ligaments are identified bilaterally. Then, the retractable insertion guide is primed with the multipoint anchoring system and introduced toward the ischial spine guided by surgeon’s index finger and implanted into the sacrospinous ligament, 1.5 cm medial to ischial spine. The tissue anchoring system is delivered and the retractable insertion guide is gently retracted. Next reconstruction of the pericervical ring is performed then, both sides of the sling are attached to the polypropylene threads and knots are tied in order to elevate the cervix and the vaginal apex to DeLancey’s level one. Finally, the vaginal incision is closed in the usual manner. RESULTS This procedure was performed in 10 patients (mean age 65 years-old) with POP-Q stage 3 apical prolapse. No intra-operative complications or postoperative significant adverse events were observed. None presented post-operative vaginal mesh exposure. Mean follow up was 12 months (6 to 18 months). In this short term follow up, all of the patients were considered cured (POP-Q apical stage was 0 or 1). CONCLUSIONS Apical sling kit adds the advantages of single incision transvaginal approach, safety and level I correction of apical defect, without the mesh related complications. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e292-e293 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Paulo Palma More articles by this author Cassio Riccetto More articles by this author Tiago Aguiar More articles by this author Wilmar Azal Neto More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...