Effect Of Surgical Reconstruction Research Articles

The effect of surgical reconstruction on bladder function in cloacal malformation: A study of urodynamics

Girls with cloacal malformation are at risk of bladder dysfunction, with nearly 90% exhibiting some degree of dysfunction. Surgical dissection, particularly with total urogenital mobilization (TUM), has been hypothesized as a cause of worsening bladder function despite this population commonly having associated vertebral and spinal cord abnormalities that may also explain bladder dysfunction. More recently there has been great effort to select the appropriate surgical technique for cloacal repair in each patient in order to minimize dissection and potential damage to the bladder. We aimed to evaluate the effect of surgical cloacal repair on bladder function based on pre and post-surgery urodynamics (UDS) testing. A prospectively collected database of patients with anorectal malformation at a single center was queried for girls with cloacal malformations who had undergone surgical repair from 2015 to 2022. It is our current protocol to perform UDS before and after cloacal repair. Only patients who completed both pre and post-surgery UDS were included. UDS were evaluated and classified using the UMPIRE protocol. A total of 48 patients were included in the cohort. The majority of patients (79.2%) had stable or improved UDS post-op leaving 10 patients (20.8%) who had worsening UDS. Long common channel (≥3cm) was the only factor significantly associated with worsening UDS. (p=0.03) Nearly 30% (n=8) of those undergoing UGS had worse post-op UDS compared to 9.5% (n=2) with TUM. All patients who worsened UDS initially had safe UDS that changed to intermediate, except for one who worsened to hostile in the setting of significant social challenges and non-compliance. Only common channel length was predictive of worsening UDS, while the type of surgical approach and spine status were not. While the overall risk of worsening UDS after TUM is only 9.5%, patients with normal spines undergoing TUM had the lowest risk, seen in only one in 15 patients (6.6%). Common channel length was the most significant predictor of worsening UDS, while spine status and surgical technique (TUM vs UGS) did not significantly impact this finding. By following this established surgical protocol based on common channel and urethral lengths, is rare for the surgical cloacal repair to result in worsening post-op UDS, particularly in those undergoing TUM for short common channel and normal spine.

Altered lower extremity coordination variability during a sidestep cut in ACL-reconstructed patients as an effect of surgical reconstruction and knee osteoarthritis progression

Altered lower extremity coordination variability during a sidestep cut in ACL-reconstructed patients as an effect of surgical reconstruction and knee osteoarthritis progression

A Dynamic 3D Model of Hyoid Muscle Groups

Problem A 3D dynamic model of supra and infrahyoid muscle groups was developed to provide information relative to the extent of muscle contraction. This model can provide valuable information relative to the physiology and pathophysiology of speech production, swallowing, and effects of surgical reconstruction. The rotation of the 3D model permits the viewer to appreciate the internal anatomy from several vantage points. Transparency can be used to study underlying anatomy without change the surroundings. In this study, a 3D dynamic model of suprahyoid and infrahyoid muscle groups during swallowing was created based on still 3D and dynamic MRI. This model will be further developed to examine the effects of muscle forces on functional changes after head and neck surgery. Methods 3D MRI of head and neck area were used to reconstruct 3D polygonal meshes of hyoid muscle groups, hyoid bone, mandible, and larynx. Measurement was performed using Amira 4.1. The polygonal meshes were imported in to Alias Maya 8.5. By mapping the dynamic MRI of the swallow, the muscle meshes were reshaped to generate a 3D movie of swallowing. Results Using MR images, an accurate and realistic computer reconstruction of supra and infra hyoid muscles, in situ, was constructed. A 3D movie was created to demonstrate the anatomy, larynx, and hyoid displacement in all directions. Conclusion MRI provides high quality soft tissue information. 3D modeling using MRI provide muscle information in situ. The dynamic movie created the opportunity for researchers and physicians to observe anatomical changes in all coordinate planes. These offer a promising future toward increased understanding of head and neck physiology and pathophysiology. Significance This is the first 3D model to provide dynamic information on the hyoid muscle groups. It will eventually include forces that will animate functional change after surgical reconstruction. Support NIH-NIDCD, Award No. PHS 1 R01 Dc005603-01A2.

Effect of Surgical Reconstruction on Flow Profiles in the Aorta Using Magnetic Resonance Blood Tagging

Background. The aorta that has undergone an aorta–pulmonary artery anastomosis may not exhibit the same velocity profile as the nonreconstructed aorta, whose velocity profile is thought to be uniform across the vessel diameter (plug flow). This may have an impact on fluid dynamics and will alter Doppler flow calculations. Our objective was to determine the impact of surgical reconstruction on the velocity and flow profiles of the reconstructed ascending and descending aorta.Methods. Using a magnetic resonance imaging tagging technique that labels flowing blood (bolus tagging), we studied 22 patients (mean age, 8.6 ± 4.7 years) who had had a Fontan procedure. A cine sequence labeled the blood and acquired the image after 20 ms in the middle of the ascending aorta and behind the left atrium in the descending aorta. The repetition time was 50 ms.Results. The reconstructed ascending aorta displayed a velocity profile skewed anteriorly, whereas in the nonreconstructed aorta, the velocity profile was flat. Reconstructed aortas also displayed flows that were higher anteriorly, took a longer time to reach maximum velocity, and were less like “plug” flow than the nonreconstructed aorta. The descending aorta, regardless of whether aortic reconstruction was present, displayed velocity profiles (at various phases of systole) skewed posteriorly.Conclusions. The reconstructed aorta displays disturbed flow, and the velocities across the ascending aortic diameter are more varied than those in aortas without reconstruction and are skewed anteriorly. The descending aortic velocity profile in children is skewed posteriorly, regardless of whether aortic reconstruction is present. This information may help design and build a “better” aortic reconstruction.(Ann Thorac Surg 1997;63:1691–700)

The influence of cleft length and palatoplasty on the dental arch and the deciduous occlusion in cases of clefts of the secondary palate.

In patients with clefts of the secondary palate, the effect of surgical reconstruction was studied from the time of the palate repair, at the age of 18-24 months, to the age of 5 years. The material comprised 99 children (37 boys and 62 girls). The material was grouped according to the antero-posterior size of the cleft. The changes of the maxillary dimensions were studied on the casts by linear measurements. The occlusion was analysed by descriptive and numerical methods. In the deciduous dentition the smallest intercanine and intermolar dimensions were recorded in patients with large palatal clefts. A the age of 5, the frequency of anterior crossbite was 38% in patients with large palatal clefts, compared with 19--21% in patients with smaller clefts. In boys with cleft palates, the frequency of anterior crossbite was 13% higher than in girls, in spite of the fact that in the material the incidence of large palatal clefts was lower in boys than in girls. In cases of large clefts of the secondary palate, the incidence of anterior crossbite was 12.5 times higher than in a material of non-cleft patients of the same age.