Early Postoperative Examination Research Articles

How Kirschner Wires Crossing Each Other at the Fracture Site Affect Radiological and Clinical Results in Children With Gartland Type 3 Supracondylar Humerus Fractures?

Background In this study, we compared two groups of children with Gartland Type 3 supracondylar humerus fractures with respect to the crossing point of Kirschner wires (K-wires) in terms of radiological and clinical results after closed reduction and fixation with the crossed-pin technique. We hypothesized that even if medial and lateral pins cross each other at the fracture line, satisfactory radiological and clinical results would be achieved with the crossed-pin technique. Methodology A total of 59 patients with Gartland extension Type 3 supracondylar humerus fractures who underwent closed reduction and percutaneous crossed-pin fixation were included in the study. K-wires were crossing each other proximal to the fracture site in the proximal crossinggroup and at the fracture level in the fracture site crossing group. Loss of reduction, Baumann angle, shaft condyle angle, range of motion, and carrying angle were compared between the two groups. Results There were 43 males and 16 females in this study, with a mean age of 5.3±2.4 years. The average follow-up duration was 21.9 ± 5.2 weeks. In terms of loss of reduction in the coronal and sagittal planes, there was no statistical difference between the two groups. When the Baumann angle and shaft condylar angle of both groups were analyzed, no statistically significant differences were found at both early postoperative examination and final follow-up. Conclusions Although the crossing point of K-wires has been shown to be an important factor in the protection of reduction in biomechanical studies, it was not a significant factor for loss of reduction in this study. Factors except for the crossing point of K-wires may play a more important role in the outcomes of crossed-pin fixation.

Early Follow-Up after Arteriovenous Fistula Creation is Associated with Improved Access-Related Outcomes

Up to 60% of arteriovenous fistulas (AVF) require intervention to assist maturation, which prolongs the time until it can be used for hemodialysis (HD). Current guidelines recommend early postoperative AVF examination to detect and address immaturity to decrease time to maturation. This study evaluates how the timing of postoperative follow-up to assess AVF maturity affects patients' outcomes. All patients who underwent AVF creation between 2017 and 2021 in an academic medical center were retrospectively reviewed, excluding patients lost to follow-up or not on HD. Outcomes were compared between patients that had delayed follow-up to assess AVF maturity, >8 weeks post-surgery, versus early follow-up, <8 weeks post-surgery. AVF evaluation for maturity consisted of physical exam and duplex ultrasound. Primary endpoints were time to first cannulation (interval from AVF creation to first successful cannulation) and time to catheter-free dialysis (interval from AVF creation to central venous catheter removal). A total of 400 patients were identified: 111 in the delayed follow-up group and 289 in the early follow-up group. The median time to follow-up was 78 days (IQR 66-125) in the delayed follow-up group vs. 39 days (IQR 36-47) in the early follow-up group, (p<0.0001). The maturation rate was 87% in the delayed follow-up group vs. 81% in the early follow-up group, (p=0.1) and both groups had similar rates of interventions to assist maturation (66% vs. 57%, p=0.2). The early follow-up group had a significantly shorter median time to first cannulation (50 vs. 88 days, p<0.0001) and shorter time to catheter-free HD (75 vs. 118 days, <0.0001). At 4 months after AVF creation, the incidence of first cannulation was 74% in the early follow-up group vs 63% in the delayed follow-up group (p=0.001). Similarly, the incidence of catheter-free dialysis was 65% in the early follow-up group vs. 50% in the delayed follow-up group at 4 months postoperatively, (p = 0.036). Early post-operative follow up for evaluation of fistula maturation with is associated with reduced time to first successful cannulation of AVF for hemodialysis, and reduced time to catheter-free dialysis.

Evaluation of patient STress level caused by radiological Investigations in early Postoperative phase After CRANIOtomy (IPAST-CRANIO): protocol of a Swiss prospective cohort study

IntroductionPostoperative imaging after neurosurgical interventions is usually performed in the first 72 hours after surgery to provide an accurate assessment of postoperative resection status. Patient frequently report that early postoperative...

Delayed Follow-up Is Associated With Worse Hemodialysis Access-related Outcomes

More than 60% of arteriovenous fistulas (AVF) require intervention to assist maturation, prolonging latency for hemodialysis (HD) use. Current guidelines recommend early postoperative AVF examination to detect and address immaturity and decrease maturation time. This study evaluates how the timing of postoperative follow-up to assess AVF maturity affects patients’ outcomes.

Delayed Follow-up After Arteriovenous Fistula Creation Is Associated With Worse Access-related Outcomes

Over 60% of arteriovenous fistulas (AVF) require interventions to assist maturation, which leads to prolonged time till it becomes usable for hemodialysis (HD). Current guidelines recommend early postoperative AVF examination to detect and address immaturity in order to decrease maturation time. The goal of this study was to evaluate how the timing of postoperative follow-up to access AVF maturity affects patients' outcomes.

Procedure-Specific Complications Associated with Ultrasound-Guided Erector Spinae Plane Block for Lumbar Spine Surgery: A Retrospective Analysis of 342 Consecutive Cases.

PurposePresumed benefits of erector spinae plane blocks (ESPB) include an enhanced safety profile and few complications. There are few large series, which report the incidence of complications associated with ESPB on a procedure-specific basis. The objective of this retrospective cohort study was to estimate the incidence of complications of ESPB in a large series of patients undergoing lumbar spine surgery.Patients and MethodsWe included 342 consecutive patients who underwent any primary lumbar spine surgery via posterior approach (November 2018–July 2020). All patients received bilateral ultrasound-guided ESPB. The primary study outcome was the incidence of any perioperative complication, defined a priori as sensory, motor, hematologic, hemodynamic or respiratory complication consistent with plausible contribution from the ESPB. Secondary outcomes included the incidence of numeric rating scale (NRS) pain scores ≥7 in the post anesthesia care unit (PACU) and risk factors associated with NRS ≥7 (age, sex, ASA class, BMI, opioid tolerance, surgical type, and duration).ResultsWe did not identify any pre-specified complications associated with ESPB. There was one unilateral pneumothorax, in one patient, deemed unlikely to have been related to ESPB. NRS ≥7 was found in 17/342 patients (5%) and was independent of any background differences or risk factors assessed.ConclusionUltrasound guided ESPB for lumbar spine surgery was associated with zero complications, no interference with intraoperative neuromonitoring or the early postoperative neurological examination, and low incidence of poorly controlled pain in the PACU. These results help to establish procedure-specific risks and benefits of ESPB for spine surgery.

Multilevel Postoperative Cervical Epidural Hematoma: Complete Removal Through Catheter Drainage of the Unexposed Blood Collection

Postoperative spinal epidural hematoma is a rare complication of anterior cervical discectomy and fusion. This condition may rapidly produce severe neurologic deficits, often requiring a prompt surgical decompression. A multilevel extension of the epidural bleeding has been rarely described after anterior cervical procedures. In such cases, the choice of the most suitable surgical approach may be challenging. Herein, we describe an effective surgical decompression of a C2-T1 ventral epidural hematoma following anterior cervical discectomy and fusion at the C5-C6 level. By reopening the previous approach, the C5-C6 intersomatic cage was removed and the surgical field inspected for bleeding. After removal of the spinal epidural hematoma at this level, a lumbar external drainage catheter was inserted into the epidural space to perform multiple irrigations with saline solution until the washing fluid was clear. Immediate postoperative cervical computed tomography and magnetic resonance imaging revealed gross total removal of the epidural hematoma and complete decompression of the spinal cord all along the affected tract. Early postoperative neurologic examination revealed mild lower extremity weakness that fully recovered within hours. Although rare, multilevel epidural hematoma following anterior cervical decompression represents a serious complication. The revision of the previous anterior cervical approach may be considered the first treatment option, allowing to control the primary bleeding site. Catheter irrigation of the epidural space with saline solution may be a useful technique for removal of unexposed residual blood collection, avoiding the need for posterior laminectomy or other unnecessary bone demolition.

Changes of taste perception after stapes surgery: a prospective cohort study.

Taste perception is often affected after stapes surgery despite effort to preserve chorda tympani nerve. The aim was to examine changes of particular taste qualities and their recovery after operation of otosclerosis. Taste function was prospectively investigated with a questionnaire and a taste strip test (TST) preoperatively, 3-5days and 1year after stapes surgery with the preservation of CTN. In the early postoperative examination, 34/42 patients had a lower TST score, 7/42 decrease of taste in the questionnaire. One year after surgery, 11/42 patients had a lower TST score, 1/42 patients decrease of taste in the questionnaire. The most pronounced decrease in the TST score was in sweet (- 1.76 points, p < 0.001), followed by bitter (- 1.71 points, p < 0.001), salty (- 1.64 points, p < 0.001) and sour taste (- 1.33 points, p < 0.001). The sour taste had a significant lower alteration compared to others. Men had significantly pronounced alteration in salty taste compared to women. The complete recovery was proved in bitter taste. Better recovery in bitter taste was observed in patients younger than 45years of age. Gustatory changes after stapes surgery are mostly transient with different impairment and recovery rate for particular taste qualities. A sour taste seems to be relatively resistant to damage. The best recovery rate is in a bitter taste, especially in younger patients.

Application of bilateral internal mammary artery with different configurations in coronary artery bypass grafting

BackgroundA large number of studies have shown that BIMA grafting is superior to single internal mammary artery grafting in cardiac function protection and long-term survival after surgery. While, there is still no consensus on how is the best configuration to use BIMA. This study aims to compare intraoperative blood flow, early clinical results and early postoperative patency of different configurations of BIMA.MethodsThere were 74 patients who underwent CABGs with bilateral internal mammary artery with different configurations we included. According to the different target territories that RIMA grafted to, the patients were divided into bilateral group (group I) with 20 cases and left group (group II) with 54 cases. Intraoperative blood flow, early clinical results and early postoperative patency of different configurations of BIMA were compared.ResultsThere was no difference in the early postoperative death and major complications between group I and Group II(P>0.05). Compared with the LIMA in group II, the LIMA in group I had a slightly higher DF value (76.7 ± 6.2 vs 73.1 ± 6.8, P = 0.040). Compared with the RIMA in group II, the RIMA in group I had a slightly higher MGF (51.7 ± 34.4 ml/min vs 31.4 ± 21.4 ml/min, P = 0.024). There was no difference in the other TTFM parameters of LIMA and RIMA between group I and Group II(P>0.05). Further subgroup analysis revealed that compared with free RIMA in group II, in situ RIMA had a higher DF value (71.4 ± 7.8 vs 61.8 ± 18.1,P = 0.025). The PI of LIMA in free RIMA subgroup was higher than the PI of LIMA in in-situ RIMA subgroup (3.0 ± 1.6 vs 2.1 ± 1.0,P = 0.018). The results of early postoperative CTA examination showed that all IMAs grafts were completely patent.ConclusionsThe use of BIMA for CABG is safe and efficacious, RIMA used in right coronary artery received more satisfactory graft flow. BIMA with no stenosis and occlusion in the early stage, therefore is the ideal and stable coronary bypass graft.

SMILE, Topography-Guided LASIK, and Wavefront-Guided LASIK: Review of Clinical Outcomes in Premarket Approval FDA Studies.

To review clinical outcomes of the U.S. Food and Drug Administration premarket approval (PMA) studies of the three recently approved refractive surgery platforms for the correction of spherocylindrical myopia. Clinical outcomes and vector analysis of astigmatism were reviewed and compared between wavefront-guided laser in situ keratomileusis (LASIK) (WFG group) (STAR S4 IR with iDesign aberrometer; Johnson & Johnson Vision Care, Inc., Santa Ana, CA), topography-guided LASIK (TOPO group) (Allegretto Wave Eye-Q laser; Alcon Laboratories, Inc., Fort Worth, TX), and small incision lenticule extraction (SMILE group) (VisuMax laser; Carl Zeiss Meditec AG, Jena, Germany). The number of eyes included was 304, 249, and 334 for the SMILE, TOPO, and WFG groups, respectively. The WFG group had the highest preoperative spherical equivalent refraction (-6.21 ± 2.78 diopters [D]), followed by the SMILE (-5.39 ± 2.30 D) and TOPO (-4.61 ± 2.43 D) groups. At 6 months postoperatively, 83.7%, 88.9%, and 82.6% of eyes in the SMILE, TOPO, and WFG groups, respectively, had uncorrected distance visual acuity (UDVA) of 20/20 or better. SMILE showed slower visual recovery at early postoperative examinations, whereas the WFG group had a decrease in UDVA over time due to refractive regression. The mean refractive cylinder changed from -1.53 ± 0.70 D preoperatively to -0.22 ± 0.33 D at 6 months postoperatively in the SMILE group, -1.19 ± 1.23 to -0.19 ± 0.30 D in the TOPO group, and -1.77 ± 1.65 to -0.33 ± 0.36 D in the WFG group. With all three procedures, undercorrection of refractive cylinder was seen with increasing attempted correction. All three procedures demonstrated excellent outcomes, considering differences in attempted correction between studies. No obvious superiority of one technique over the others was found in astigmatic correction. [J Refract Surg. 2019;35(11):690-698.].

Graft flow predictive equation in distal bypass grafting for critical limb ischemia

ObjectiveGraft flow (GF) seems to be an important prognostic predictor in distal bypass for critical limb ischemia, but previous studies have failed to clarify the association between GF and the graft prognosis. GF differs significantly among grafts, and each graft seems to have an optimal GF depending on various factors. We hypothesized that comparison between the measured GF (mGF) and optimal estimated GF (eGF) would be important in predicting graft prognosis. Herein, we aimed to develop a GF predictive equation by assessing GF determinants and to validate the equation against a clinical dataset. MethodsA total of 198 distal bypasses with vein grafts for critical limb ischemia from 2011 to 2016 were enrolled. Of these grafts, 135 normal grafts without any abnormalities on early postoperative ultrasound examination were used to develop and validate the equation. Various anatomic and patient-related factors were analyzed to detect GF determinants with stepwise selection, and the GF predictive equation was developed with multiple linear regression analysis. After developing the equation, all 198 grafts were categorized into two groups according to the equation developed based on data from the 135 normal grafts as follows: optimal flow grafts (OFGs), in which mGF > eGF – 14.6, and suboptimal flow grafts (SFGs), in which mGF < eGF – 14.6. The cutoff value of 14.6 was determined using receiver operating characteristic curves to detect graft abnormalities. By comparing OFGs and SFGs, the efficacy of the equation in predicting bypass abnormalities and graft prognosis was assessed. ResultsThe GF determinants were runoff, hemodialysis (HD), diabetes mellitus (DM), and graft quality (GQ). The predictive equation was estimated as follows: GF(ml/min)=(32.9×run-off)+(9.9×GQ)−(13.0×DM)−(35.1×HD)+12.1 (R2 = 0.71, coefficient: runoff and GQ, 3 [good], 2 [fair], 1 [poor]; DM and HD, 1 [yes], 0 [no]). In the efficacy assessment of the equation, SFGs showed a significantly higher rate of bypass abnormalities (64.0% vs 12.2%; P < .0001), graft intermediate stenosis (10.7% vs 1.6%; P = .0071), graft critical stenosis (28.0% vs 3.2%; P < .0001), and early graft occlusion (17.3% vs 4.3%; P = .0037) than OFGs and were associated with a higher rate of revision surgery within 2 years after surgery (50.7% vs 34.2%; P = .026). SFGs also showed significantly lower primary patency rates (P < .0001) and secondary patency rates (P = .0005). ConclusionsGF was well-estimated with runoff, GQ, and the presence of DM and HD. A comparison between mGF and eGF, calculated with the equation, will help to detect bypass abnormalities and determine the necessity of additional intraoperative procedures and, thus, achieve optimal outcomes.

Evaluation of the anterior chamber angle and filtering bleb morphology after phacotrabeculectomy by using anterior segment optical coherence tomography

Purpose Evaluating the anterior chamber angle (ACA) and filtering bleb following phacotrabeculectomy by using anterior segment optical coherence tomography (AS-OCT). Patients and methods This is a retrospective study that included 30 eyes of 30 patients with cataract and glaucoma of both sexes and aged from 42 to 72 years. Patients attended the Ophthalmology Department of Minia University Hospital between June 2016 and November 2017. The duration of follow-up was 6 months. The patient’s underwent preoperative clinical and AS-OCT examination, followed by phacotrabeculectomy, and then postoperative AS-OCT to evaluate the angle and the filtering bleb. Results A total of eight patients were diagnosed with primary open-angle glaucoma and 22 with primary closed-angle glaucoma. Overall, eight (26.7%) eyes had closed angle in two quadrants: six (20%) eyes with closed superior and inferior quadrants and two (6.7%) eyes with closed nasal and temporal quadrants. Closed ACAs in three quadrants of the eye, the superior, nasal, and temporal quadrants, were found in six (20%) eyes. Closed ACAs in the four quadrants of the eyes were observed in eight (26.7%) eyes. Cystic blebs are highly elevated and hyporeflective (30% of cases). Diffuse blebs are moderately elevated with moderate reflectivity (50% of cases). Flat blebs are low with hyperreflectivity (20% of cases). Conclusion AS-OCT is an optimistic tool to investigate the filtering blebs. It was able to detect angle changes preoperatively and postoperatively and show the features of the bleb that are not properly detected by the slit lamp examination. It has the advantage over ultrasound biomicroscopy in being a noncontact, noninvasive procedure, allowing early postoperative examination.

Angiographic and Clinical Assessment of Patients with Cerebral Arterio-Venous Malformations Treated with Microsurgery and Angioembolization

Introuction: Brain Arteriovenous malformations (AVMs) are the leading cause of intracerebral hemorrhage in the young population. We set out to determine angiographic features of AVMs in pre-operative setting as well as angiographic and neurological and clinical assessment of these AVMs after treatment with either microsurgical approach or angio-embolization. Materials and Methods: From February 2011 to January 2016, 25 patients with cerebral AVMs were admitted to Shohada Tajrish Hospital. Patients underwent angiographic evaluation for AVM grading based on Spetzler Martin grading system. Also, patient’s neurological status was recorded. Based on Spetzler Martin score and AVM size, patients underwent either microsurgical approach or angio-embolization. Post-operatively, early and long-term neurological examination was performed and obliteration rate was assessed by post-operative imaging study. Results: There were 18 male and 7 female patients with mean age of 42.2 years who presented with cerebral hemorrhage followed by isolated new-onset seizure, progressive new focal neurological deficit and severe new-onset headache in decreasing manner. Seizure was significantly higher in patients with unruptured AVMs (P value Based on AVM size, trend for operation type in small and medium sized AVMs was microsurgical approach followed by angio-embolization. On the other hand, most patients with large-sized AVMs underwent angio-embolization followed by microsurgical approach. Early post-operative examination revealed more new neurological deficit in angio-embolization than microsurgery treated patients (P value Conclusion: Although results of this study showed better results with microsurgical approach, choosing best treatment option for patients suffering from symptomatic AVMs depends on imaging studies, pre-operative grading and individual-based selection.

Preradiotherapy MR Imaging: A Prospective Pilot Study of the Usefulness of Performing an MR Examination Shortly before Radiation Therapy in Patients with Glioblastoma.

Current protocols in patients with glioblastoma include performing an MR examination shortly after surgery and then 2-6 weeks after ending concomitant chemoradiotherapy. The assessment of this first postradiotherapy examination is challenging because the pseudoprogression phenomenon may appear. The aim of this study was to explore if performing an MR examination shortly before radiation therapy (preradiotherapy MR imaging) could improve the radiologic assessment of patients with glioblastoma. A preradiotherapy MR imaging examination was prospectively performed before the start of radiation therapy in 28 consecutive patients with glioblastoma who had undergone surgical resection. Tumor response to chemoradiotherapy was assessed twice: with the early postoperative MR examination as baseline and with the preradiotherapy MR imaging examination as baseline. In addition, tumor growth in the preradiotherapy MR imaging examination was evaluated, and its correlation with patient survival was assessed with Kaplan-Meier analysis and Cox regression. Tumor progression after radiation therapy was found in 16 patients, corresponding to pseudoprogression in 7 of them (44%). Four assessments of pseudoprogression switched to partial response or stable disease when preradiotherapy MR imaging was the baseline examination, and the ratio of pseudoprogression was reduced to 25% (3 of 12). Significant differences in survival were found when patients were stratified according to the pattern of tumor growth on preradiotherapy MR imaging (median overall survival "no-growth," 837 days; "focal-growth," 582 days; "global-growth," 344 days; P = .001). Performing a preradiotherapy MR imaging examination may improve the clinical management of patients with glioblastoma by reducing the ratio of pseudoprogression assessments and providing prognostic information.

Application of neuronavigation multimodal fusing combining intraoperative electrophysiological techniques in the tumor surgery of brain motor areas

Objective To investigate the clinical application value of neuronavigation multimodal fusing (DTI and BOLD) combining intraoperative electrophysiological monitoring techniques in tumor surgery of brain motor areas. Methods From October 2014 to January 2015, 20 right-handed patients whose lesions were located near the brain motor areas admitted to the Department of Neurosurgery, Changhai Hospital, the Second Military Medical University were analyzed retrospectively. The patients received preoperative magnetic resonance diffusion tensor imaging (DTI) and blood oxygen level dependent-functional magnetic resonance imaging (BOLD-fMRI) examinations. The original data of white matter fiber tracts and BOLD data were obtained. The neural navigation multimodal fusion DTI, BOLD, anatomical images [brain magnetic resonance venography (MRV), if necessary], and the three-dimensional reconstruction were performed. The microsurgery was performed under the assisted navigation during the operation, and the anterior central gyrus, central sulcus, posterior central gyrus, and subcortical tracts were determined under the neural electrophysiological monitoring. Results Of the 20 patients with motor area tumor, the lesions of 17 patients were resected, and 3 were resected subtotally. The intraoperative electrophysiological results were consistent with the preoperative DTI and BOLD reconstructed results. Postoperative pathological results: 9 patients had glioma (low-level 4 and high-level 5) and 11 had meningioma. The postoperative muscle strength of 15 patients did not have any change, 5 had transient hemiparesis. DTI showed that there was no obvious damage to the nerve tracts at 24 h after procedure. After being followed up for 2 weeks to 3 months, the patients were able to take care of themselves. Conclusions Neuronavigation multimodal fusing can accurately locate the motor function areas, and combined electrophysiological monitoring can compensate for the errors caused by the drift of the neural navigation. The peripheral adjacent tracks and functional areas were protected real timely during the operation in order to reduce the postoperative neurological dysfunction. The tumors were resected in a maximum degree within the safe range. In addition, the intraoperative electrophysiological monitoring and early postoperative DTI examination can predict the postoperative muscle strength and improve the postoperative quality of life of patients. Key words: Neuronavigation; Diffusion tensor imaging; Functional magnetic resonance imaging; Electrophysiology; Microsurgery

Temporal changes in foveal contour after macular hole surgery.

To investigate the changes in inner foveal contour after surgery for macular hole (MH) and its clinical implications. This retrospective observational case series included 66 eyes from 66 patients who underwent surgery for MH. Notching of tissue was defined as an abrupt alteration in the inner contour of the parafoveal tissue based on postoperative optical coherence tomography (OCT) image. The distance between the parafoveal edges of the outer plexiform layer (OPL) was defined as the inter-OPL distance. The inter-OPL distance was divided into nasal, temporal, superior, and inferior lengths. The difference in the lengths of each direction between the early and late postoperative period was compared between directions with and without notching. The early and late postoperative examination was performed at 4.6±2.9 weeks and 6.2±0.6 months, respectively. Notching of tissue was noted in 54 eyes (81.8%). In 53 eyes with a measurable inter-OPL distance, the notching of tissue was noted in 45 eyes (84.9%) regardless of preoperative MH size. The mean amount of foveal tissue elongation that occurred during the designated period was 104.6±68.8 and 78.4±72.9 μm in the directions with and without the notching of tissue (P<0.001), respectively. The changes in the inner foveal contour, including notching of tissue and elongation of foveal tissue, were noted in the majority of eyes after MH surgery. Notching of tissue on OCT image could be a clinical marker for the development of foveal tissue elongation after MH surgery.

Papillary Muscle Repositioning as a Subvalvular Apparatus Preservation Technique in Mitral Stenosis Patients with Normal Left Ventricular Systolic Function

Subvalvular apparatus preservation is an important concept in mitral valve replacement (MVR) surgery that is performed to remedy mitral regurgitation. In this study, we sought to determine the effects of papillary muscle repositioning (PMR) on clinical outcomes and echocardiographic left ventricular function in rheumatic mitral stenosis patients who had normal left ventricular systolic function. We prospectively assigned 115 patients who were scheduled for MVR surgery with mechanical prosthesis to either PMR or MVR-only groups. Functional class and echocardiographic variables were evaluated at baseline and at early and late postoperative follow-up examinations. All values were compared between the 2 groups. The PMR group consisted of 48 patients and the MVR-only group of 67 patients. The 2 groups' baseline characteristics and surgery-related factors (including perioperative mortality) were similar. During the 18-month follow-up, all echocardiographic variables showed a consistent improvement in the PMR group; the mean left ventricular ejection fraction deteriorated significantly in the MVR-only group. Comparison during follow-up of the magnitude of longitudinal changes revealed that decreases in left ventricular end-diastolic and end-systolic diameters and in left ventricular sphericity indices, and increases in left ventricular ejection fractions, were significantly higher in the PMR group than in the MVR-only group. This study suggests that, in patients with rheumatic mitral stenosis and preserved left ventricular systolic function, the addition of papillary muscle repositioning to valve replacement with a mechanical prosthesis improves left ventricular dimensions, ejection fraction, and sphericity index at the 18-month follow-up with no substantial undesirable effect on the surgery-related factors.

Usefulness of X-Ray in the Detection of Complications and Side Effects After Laparoscopic Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy (LSG) is a surgical procedure which reduces the gastric volume causing a feeling of early fullness while decreasing hunger due to a reduced secretion of ghrelin. This leads to a considerable loss of body weight. The purpose of this study was to assess the usefulness of early x-ray examination and subsequent x-ray follow-up in the detection of postoperative complications and long-term functional recovery. From March 2010 to April 2011, 101 consecutive patients underwent LSG for morbid obesity and were subsequently included in this retrospective study. All patients were submitted to early x-ray examination 1-3 days after surgery and x-ray follow-up 3-6 months after surgery to detect the presence and persistence of surgical and functional complications. Early postoperative x-ray examination detected one case of suture leakage 1 day after surgery as well as one abscess and one gastric fistula in two patients who had become symptomatic 9 and 10 days after surgery. Early x-ray examination showed that complications were mainly functional and rarely surgical. Subsequent follow-up showed that functional disturbances were significantly reduced over time. X-ray is an easy and reliable method for detecting complications and side effects of LSG. However, in view of the extremely low incidence of surgical complications revealed at the early x-ray examination, this procedure may not be required as a routine examination in all operated patients and should be performed only in patients who become symptomatic and those considered at risk of developing more serious complications.

Delayed Tetraplegia After Thoracolumbar Scoliosis Surgery in Stuve-Wiedemann Syndrome

ObjectiveWe present 2 patients with Stuve-Wiedemann syndrome (SWS) who suffered delayed tetraparesis following posterior spinal surgery for scoliosis. Background SummaryDelayed tetraparesis after a syndromic thoracic scoliosis correction has never been reported. A cord injury distant from the surgical site is rare, and intraoperative neuromonitoring should be used to detect and prevent neurologic impairment. MethodsReview of medical charts. ResultsTwo patients with SWS suffered delayed tetraparesis 20 and 40 hours respectively after thoracolumbar posterior surgery. In one patient distal motor evoked potentials fell and recovered partially during surgery. In both patients, early postoperative neurologic examination was normal (in one of them except for the extensor hallucis 2/5). CT scan showed correct instrumentation placement and no compressive haematoma. MRI ruled out cord anomalies, but revealed in both patients identical cervical edema that was most likely secondary to ischemia. Angiogram revealed an absence of anterior cord vascular supply. ConclusionsCorrection of severe deformities in syndromic patients may lead to stretch injuries of the spinal cord and its vascular supply. This in turn may lead to a neurological deficit extending beyond the limits of the spinal instrumentation. Abrupt postoperative neck pain may be an alert to this impending development. Close surveillance in the early postoperative period should be maintained in patients with SWS because a delayed neurological deficit can be present even hours afterwards and may be cranial to the surgical level.

Moyamoya Disease

The purpose of this study was to evaluate cerebral blood flow through the bypass in operated patients with Moyamoya disease using multiphase selective arterial spin labeling (ASL) technique. Fifteen surgically treated cerebral hemispheres from 11 patients with Moyamoya disease were included. Selective ASL examinations were performed during the early postoperative period (mean, 5.5 days) on 4 hemispheres and late postoperative period (mean, 332.7 days) on 15 hemispheres. The labeling slab was positioned at the bypassed external carotid artery and 5 slices in each of the 10 sequential phases were acquired using a 3-T scanner. Two of 4 early postoperative ASL examinations and all late postoperative ASL examinations demonstrated blood flow through the bypass. The remaining 2 early postoperative ASL examinations showed absence of blood flow; however, blood flow improved on follow-up examinations. Multiphase selective ASL technique can provide information about the dynamics of postoperative blood flow through the bypass in Moyamoya disease.