Tubal Occlusion Research Articles

Safety use of high frequency oscillatory ventilation in transport of newborn infants affected by severe respiratory failure: preliminary data in central Tuscany

BackgroundNeonatal Emergency Transport Services play a fundamental role in neonatal care. Stabilization before transport of newborns suffering from severe respiratory failure is often a challenging problem and some critically ill infants may benefit from High Frequency Oscillatory Ventilation (HFOV) as rescue treatment. In these cases, transition to conventional ventilation for transport may cause a deterioration in clinical conditions. HFOV during neonatal transport has been only exceptionally used, due to technical difficulties. Since May 2018, a new neonatal transport unit is available at the Neonatal Protected Transport Service of the Meyer University Hospital in Florence, equipped with a pulmonary ventilator capable of delivering HFOV. Therefore, we conducted an analysis on patients transferred in HFOV to Neonatal Intensive Care Unit (NICU), in order to evaluate the safety and feasibility of its use during neonatal transport.MethodsA retrospective analysis was performed reviewing medical records of the neonates transported by Meyer Children Hospital’s Neonatal Transport Service between May 2018 and December 2020, and newborns treated with HFOV during ground neonatal transport were identified. Safety was assessed by the comparison of vital signs, hemogas-analysis values and pulmonary ventilator parameters, at the time of departure and upon arrival in NICU. The dose of inotropes, the main respiratory complications (air leak, dislocation or obstruction of the endotracheal tube, loss of chest vibrations) and the number of deaths and transfer failures were recorded.ResultsOut of the approximate 400 newborns transported during the analysis period, 9 were transported in HFOV. We did not find any statistically significant difference in vital parameters, hemogas-analytical values and pulmonary ventilator settings recorded before and after neonatal transport of the nine patients’ parameters (p > 0,05). No patient required additional inotropes during transport. No transport-related deaths or significant complications occurred during transport.ConclusionsThe interest of our report is in the possibility of using HFOV during inter-hospital neonatal transfer. As far as our experience has shown, HFOV appears to be safe for the transportation of newborns with severe respiratory failure. Nevertheless, further larger, prospective and multicentre studies are needed to better evaluate the safety and efficacy of HFOV during neonatal transport.

Visual tubal patency tests for tubal occlusion and hydrosalpinx

Visual tubal patency tests for tubal occlusion and hydrosalpinx

Characteristics and effects of a new Atom uterine hemostatic balloon for postpartum hemorrhage: First experience of 17 cases

Uterine balloon tamponade is the first-line treatment for postpartum hemorrhage (PPH). However, as cases accumulate, the disadvantages of conventional balloons, such as difficulties with insertion, displacement, dislodgement, slipping outside, and occlusion of the drainage tube with blood clots, have become evident. The newly developed Atom uterine hemostatic balloon has a stylet designed as an insertion guide for smooth insertion. The end of the insufflation portion can be housed in the handle tip of the stylet inserted into the other drainage tube to facilitate retrograde insertion of the balloon and prevent damage to the cervical canal during cesarean section. This balloon was designed in the shape of an apple to prevent it from slipping off. A drainage port without projections was used to improve adhesion to the uterine luminal wall.

Abstract No. 141 Use of n-butyl-2-cyanoacrylate for fallopian tube embolization by selective catheterization in rabbit model: a pilot study for non-surgical sterilization

The purpose of this study was to determine whether fallopian tube embolization with n-butyl-2-cyanoacrylate administered via a microcatheter in a rabbit model was technically feasible and would result in short-term tubal occlusion over a 1-month period.

Uterine inflammatory response after misoprostol during estrus and diestrus in commercial embryo donor mares

Uterine tube obstruction is the leading cause of unexplained subfertility in mares. Over the years, numerous techniques were developed to unblock uterine tubes with variable success. In recent years, the administration of misoprostol, a synthetic analog of prostaglandin E1, in the uterus, has regained popularity in equine practice. However, there have been some concerns regarding an exacerbated post-infusion uterine inflammatory response to misoprostol; nonetheless, this has yet to be critically studied. In addition, debate exists when mares should receive misoprostol. This study aimed to determine the uterine inflammatory response in mares after infusion with misoprostol during estrus or diestrus. We hypothesized that misoprostol infusion induces a greater inflammatory response than sham infusion; similarly, diestrus results in a greater inflammatory response than estrus. Forty-four estrous cycles of light breed mares (n=11) were sequentially randomly assigned to receive misoprostol or sham infusion during estrus and diestrus. The misoprostol and sham infusions were performed by directing a flexible pipette (Minitube, Germany) deep into each uterine horns, which received 200mcg of misoprostol diluted in 3 mL of Lactate Ringer's Solution (LRS), whereas the sham inoculation consisted of 3 mL of LRS. The cycles assigned for estrus treatment received it when preovulatory follicles ranged from 28-32 mm, and diestrus cycles were treated eight days post-ovulation. The day after each infusion, mares had uterine lavage performedwith LRS. Uterine edema and intrauterine fluid accumulation were performed by transrectal ultrasonography immediately before (0h), 24, 48, and 72 h after treatments. At similar time points, uterine cytology samples were harvested to count the number of neutrophils in a high-power field (400 ×). Ovulation was hastened with deslorelin (1mg, i.m.) during estrus or the subsequent estrus after diestrus infusion. Mares received 5 mg of dinoprost (i.m.) 24 h after infusion in estrus and diestrus. Statistical analyses were performed with Graph Prisma. Neutrophil counts were analyzed with ANOVA repeated measures and Tukey's as post-hoc. Edema scores and intrauterine fluid accumulation were analyzed with Kruskal-Wallis and Dunn's post-hoc. Embryo recovery rates were evaluated with Fisher's test. There were effects of time (P=0.04) but no effects of group (P=0.96), or stage of the estrous cycle (P=0.26), or interaction between group and time for edema scores (P=0.97). Similarly, there were effects of time (P=0.03) but no effects of group (P=0.32), stage of the estrous cycle (P=0.86), or interactions between group and time or stage of the estrous cycle for neutrophil counts (P=0.87). Uterine fluid scores did not change over time (P=0.39), groups (P=0.22), or stage of the estrous cycle (P=0.77). Embryo recovery was similar for estrus (Misoprostol 46% vs. sham 46%) vs. diestrus (Misoprostol 67% vs. sham 46%) (P>0.05). In conclusion, 200 mcg of misoprostol bilateral administration did not exacerbate uterine inflammation in mares.

Intraluminal deposits: A rare cause of glaucoma drainage implant total obstruction.

To report the unforeseen complication of total obstruction of a glaucoma drainage implant (GDI) tube lumen by white deposit material and to present a preliminary report identifying the composition of this material. Two subjects with a high IOP due to total obstruction of a GDI tube were reviewed. Both patients had a long history with brinzolamide and timolol maleate eye drops. The GDI tube was swept with a 5-0 polypropylene suture stent in order to open the tube. The intraluminal solid sample was successfully collected from the implant tube in one patient. High-performance liquid chromatography-mass spectrometry (HPLC-MS) was used to determine the origin of the intraluminal sample. Intraluminal deposits containing components of antiglaucoma drugs e.g., timolol and brinzolamide are a rare cause of total obstruction of GDI tubes. Our study describes a new cause of total obstruction GDI tubes. The long-term use of timolol maleate and brinzolamide and their presence in the intraluminal solid sample collected from the blocked GDI tube suggest that the glaucoma medication may have a role in the pathogenesis. However, the exact mechanism is unknown and requires further studies.

Uterine Venous Drainage Network during Hysterosalpingography

A 43-year-old women, gravida 3, para 1 (G3P1), presented to the hospital for a history of infertility for 2 years. During a hysterosalpingography using meglumine diatrizoate, the uterus appeared normal, and a bilateral distal tubal obstruction was seen (Fig. 1). In addition, intravasation of the contrast revealed the drainage of arcuate vessels into the ascending branch of uterine vein and deep uterine vein and then into the ovarian vein and internal iliac vein separately. The film also demonstrated the communicating branches in uterine wall, the numerous branches of internal iliac vein, and an accompanying vein of ovarian vein draining into the renal vein (Fig.

Evaluation of the safety and effectiveness of tubal inflammatory drugs in patients with incomplete tubal obstruction after four-dimensional hysterosalpingo-contrast-sonography examination

BackgroundTo investigate the safety and effectiveness of tubal inflammatory drugs in patients with incomplete tubal obstruction of at least one side after four-dimensional hysterosalpingo-contrast-sonography (4D-HyCoSy) examination.MethodsTwo hundred fifteen cases of tubal incomplete obstruction were diagnosed by ultrasonography from February 2019 to November 2020.According to retrospective analysis,the patients in this study were divided into experimental and control groups; the experimental group combined with salpingitis drugs, and the control group received blank control. Basic information, degree of pain, postoperative complications, and pregnancy rate were then compared between the two groups.ResultsCompared with the control group, there was no significant difference in the basic information; in preoperative, intraoperative, or postoperative pain; or in postoperative complications (P > 0.05). The cumulative pregnancy rate of the experimental group (26.8%) was statistically different from that of the control group (14.4%) (P < 0.05).ConclusionsWe observed that for infertile patients with incomplete obstruction of at least one fallopian tube as diagnosed by contrast-enhanced ultrasonography, salpingitis-treatment drugs effectively improved the pregnancy rate postoperatively, with high effectiveness and safety. This regimen is thus worthy of further investigation and promotion in the future.

V02-06 FUNCTIONAL OUTCOMES OF EXTRAPERITONEAL LAPAROSCOPIC ADENOMECTOMY

You have accessJournal of UrologyCME1 May 2022V02-06 FUNCTIONAL OUTCOMES OF EXTRAPERITONEAL LAPAROSCOPIC ADENOMECTOMY Roberto Hugo Martinez Rodriguez, Alberto Robles Samaniego, Cristina Gutierrez Ruiz, Leire Portilla Maediavilla, Alejandro Garcia Viña, and Jose H. Amon Sesmero Roberto Hugo Martinez RodriguezRoberto Hugo Martinez Rodriguez More articles by this author , Alberto Robles SamaniegoAlberto Robles Samaniego More articles by this author , Cristina Gutierrez RuizCristina Gutierrez Ruiz More articles by this author , Leire Portilla MaediavillaLeire Portilla Maediavilla More articles by this author , Alejandro Garcia ViñaAlejandro Garcia Viña More articles by this author , and Jose H. Amon SesmeroJose H. Amon Sesmero More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002528.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Both prostatic enucleation and adenomectomy can be considered gold treatments for benign prostatic hypertrophy (BPH) of large volume with obstructive clinic. Nowdays trend to minimally invasive surgery and/or the anatomical impossibility for enucleation have motivated the laparoscopic approach to conventional adenomectomy. We present the objective and subjective functional outcomes of our initial series of laparoscopic adenomectomies while surgical steps are shown. METHODS: Surgical tips are shown while functional outcomes are described.We prospectively analyzed patients undergoing extraperitoneal laparoscopic adenomectomy between April - December 2020 for infravesical obstruction due to BPH. We evaluated objective functional outcomes using flowmetry and post-voiding residue and subjective with sexual and quality of life questionnaires (IPSS AND IIEF) before and after surgery. Demographic data on age, weight and height were collected; prostate size estimated by ultrasound; surgical time, intraoperative bleeding, days of hospital stay, subjective pain measured by visual EVA scale, weight and anatomy of the surgical piece, and postoperative complications according to Clavien Dindo gradation.Descriptive analysis is performed. RESULTS: 50 laparoscopic procedures were performed on patients with a mean age of 70 years (range 60-78) and a mean ultrasound prostate size of 120cc (80-180). 19 of these patients were bladder catheter carriers at the time of surgery. Mean surgical time: 90min (80-150);decreased hemoglobin test 1.2gr/dl (0.5-3.8). Postoperative pain was 0/2 according to EVA scale, and mean hospital stay 2 days (1-7). We recorded 5 complications grade 3 Clavien Dindo scale (urinary tract infections) and one grade 2 (tube obstruction). The IPSS questionnaires showed a mean decrease of 19.41 points in the questions referring to voiding symptoms and 3.92 in the quality of life index. Peak flow was increased by >10 ml/sg and no patient had significant post-voiding residue. The IIEF showed an average increase of 4.45 points. CONCLUSIONS: Functional results, objectified through the use of validated questionnaires, support the laparoscopic approach in those selected cases. Laparoscopic adenomectomy represents a reasonable, safe and effective alternative in the treatment of high-volume prostatic hypertrophy with associated voiding clinic. Decreases the rate of transfusions, postoperative analgesic requirement and hospital stay, maintaining a satisfactory functional result. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e112 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roberto Hugo Martinez Rodriguez More articles by this author Alberto Robles Samaniego More articles by this author Cristina Gutierrez Ruiz More articles by this author Leire Portilla Maediavilla More articles by this author Alejandro Garcia Viña More articles by this author Jose H. Amon Sesmero More articles by this author Expand All Advertisement PDF DownloadLoading ...

Intracameral vent and flush technique for silicone oil blockade in Ahmed glaucoma valve.

The presence of emulsified silicone oil in the eye can lead to many complications, glaucoma being one of the most common. Adequate IOP control is difficult to achieve with medical management alone; surgical intervention is often required. Glaucoma drainage device implantation is often the preferred line of surgical intervention in such cases due to trabeculectomy failure from emulsified silicone oil droplets and associated conjunctival scarring. However, the silicone tube of Ahmed glaucoma valve (AGV) may attract the silicone oil droplets, causing blockade of the tube with persistent raised IOP postoperatively. We report one such case where post-AGV silicone oil tube occlusion was treated with semi-conservative surgical management instead of revising the entire surgery or implantation of another drainage device. Our surgical technique of intracameral “vent and flush” offers rapid and effective IOP control in such cases. Postoperatively, normal IOP was achieved. Patency of tube continued to be maintained along with normalization of IOP on subsequent follow-ups.

Diagnostic laparoscopy prior to IVF cycle improves outcome in patients with unilateral distal tubal occlusion

ObjectiveTo assess the impact of laparoscopy before in vitro fertilization (IVF) treatment on live birth rates in patients with distal unilateral tubal obstruction (UTO). MethodsRetrospective cohort study which was conducted in tertiary ART center in Ankara University Hospital between January 2008- January 2019. Inclusion criteria were distal UTO at HSG, patients who were 18–40 years age and baseline serum FSH levels between 3 and 15 IU/ml. Exclusion criteria were patients who had previous tubal surgery and, hormonal dysfunction such as hyperprolactinemia or hypothyroidism at the time of the IVF cycle. Results49 patients who underwent 117 IVF treatment cycles were included in the final analysis. Among those 17 patients (34 IVF cycles) in the study group who underwent laparoscopy prior to IVF cycles, and 32 patients (83 IVF cycles) in the control group who directly underwent IVF cycle with no prior laparoscopy. Eleven pathologies (64.7%) were detected and treated at laparoscopies of 17 patients with distal UTO. Both the clinical pregnancy and the live birth rates were also significantly higher in the study group when compared to the control group (29.4% vs. 12%, P=.031; 26.5% vs. 9.6%, respectively; P=.039). ConclusionsPatients with distal UTO generally have a pelvic pathology and laparoscopy prior to IVF cycles can improve the treatment outcome.

Dynamic Obstruction due to Unfurling of Spirals in a Flexometallic Tube.

Flexometallic tubes are kink-resistant and extensively used in neurosurgeries. The manufacturers of flexometallic tubes recommend single usage. In low-income countries, due to the cost restraints, flexometallic tubes are commonly reused after ethylene oxide sterilization. With this technique, flexometallic tubes are effectively sterilized, but the physical integrity of the endotracheal tube cuffs may be compromised.1 Tube kinking2 and intraluminal blebs due to dissection3 are observed with the reused flexometallic tubes. These obstructions lead to difficulty in ventilation and inability to pass a suction catheter freely. Flexometallic tubes should be thoroughly checked for external deformity, cuff integrity, and tube patency for safe reuse.Despite thorough assessment of reused flexometallic tubes, the partial unfurling of nylon spirals with distal herniation into the tube (fig.) may still happen intraoperatively, leading to dynamic obstruction resulting in variable resistance during suction catheter negotiation (see Supplemental Digital Content 1, video S1, http://links.lww.com/ALN/C848). Along with the heavy weight of the circuit, the varied positions of head and neck result in additional rotational bending of flexometallic tubes, contributing to partial unfurling, which may not cause complete airway obstruction but can lead to difficult ventilation requiring airway change. The simple technique of passing a suction catheter through flexometallic tubes can help in identifying such partial tube obstruction. Reinforced tracheostomy tubes are also frequently reused after a thorough cleaning and visual inspection.Adhering to the manufacturer’s recommendation regarding reuse is the best way to prevent these complications. However, when clinically necessary and under the right circumstances only, flexometallic tubes should be reused after a thorough assessment.The authors are thankful to the patient who consented to publish the current article. The authors are also thankful to all anesthesia technicians who helped them ensure patient safety.The authors declare no competing interests.

Mesenchymal stromal cells application for experimental genital tuberculosis combination therapy

BACKGROUND: Cell therapy is a promising trend in treating characterized by inflammation and sclerosis diseases such as genital tuberculosis, marked by pelvic inflammatory disease and uterine tube occlusion.&#x0D; AIM: Efficacy evaluation of combined mesenchymal stem cells and specific polychemotherapy treatment of the experimental genital tuberculosis.&#x0D; MATERIALS AND METHODS: Chinchilla rabbits (n = 27) were divided on 4 groups. Group 1 (n = 6) comprised control group, healthy animals. Group 2 (n = 7) infected with genital tuberculosis, without treatment. Group 3 (n = 7) infected with genital tuberculosis, treated with anti-tuberculous drugs only. Group 4 (n = 7) infected with genital tuberculosis, treated with anti-tuberculous drugs and mesenchymal stem cells. Culture of M. tuberculosis Erdman in dose 107 CFU/0.2 ml was injected under the left uterine tube serosa for the genital tuberculosis modelling. For treatment efficacy evaluation following tests were used: full blood count, blood chemistry, hysterosalpingography, diagnostic laparoscopy, peritoneal macrophage phagocytic activity assessment.&#x0D; RESULTS: Infected with genital tuberculosis animals had leukocytosis, elevated C-reactive protein, swelled and occluded uterine tubes. Treated with anti-tuberculous drugs and mesenchymal stem cells rabbits had lower white blood cell count (8.18 1.39 109/L vs 9.32 1.36 109/L, р 0.05) and C-reactive protein (1.1 0.8 mg/L vs 2.2 1.2 mg/L, р 0.01) compared to animal treated with anti-tuberculous drugs only. Animals in group 4 had also increased peritoneal macrophage phagocytic activity. Treated with mesenchymal stem cells animals had unobstructed uterine tubes, stabilized adhesive process within small pelvis with reparative process prevalence.&#x0D; CONCLUSIONS: Mesenchymal stem cells combined with anti-tuberculous drugs therapy favors reparative process in uterine tubes in genital tuberculosis.

Prevalence of Chlamydia trachomatis in Women Who Are Candidates for In Vitro Fertilization in a Private Reference Service in Southern Brazil: A Cross-Sectional Study.

IntroductionChlamydia trachomatis (CT) has been related to fallopian tube damage and infertility. Its prevalence in the population that attend public services is known; however, there is scant data on this factor in private infertility clinics. The objective of this study is to verify the prevalence of CT among women attending a private in vitro fertilization (IVF) reference clinic in southern Brazil.MethodsThis is a cross-sectional study carried out between January 1, 2019, and August 30, 2021, at an IVF private clinic in southern Brazil. Infertile women between 18 and 50 years old, who provided a morning urinary sample for reverse transcription-polymerase chain reaction (RT-PCR) test for CT analysis, were included in the study. The variables studied included the patient's age, body mass index (BMI), duration of infertility, type of infertility, indication for IVF, and detection or not of CT in the urine.ResultsThe prevalence of CT was 10.84% (22 out of 203; 95% CI: 7.27-15.87). Patients with secondary infertility were older and had more ovarian and tubal factors compared to cases of primary infertility. The tubal factor was the most prevalent (27.3% in women with primary infertility and 35.8% in those with secondary). Time of infertility and BMI were similar between groups. Our results are derived from a single private IVF clinic which reduces the external validity.ConclusionThe prevalence of 10.84% of CT in this population raises the importance of screening for sexually transmitted infections for proper treatment and to achieve better IVF outcomes.

Concurrent Ovarian and Tubal Ectopic Pregnancy After IVF-ET: Case Report and Literature Review.

Ovarian pregnancy (OP) coupled with tubal ectopic pregnancy is rare. We present a case of coexistent ovarian and tubal ectopic pregnancies in the same adnexa resulting from in vitro fertilization and embryo transfer (IVF-ET) for tubal occlusion. The patient presented with mild vaginal bleeding without abdominal pain. OP was diagnosed via sonographic findings of an ectopic gestational sac (GS) and yolk sac that seemed to be inside her left ovary. Laparoscopic exploration confirmed this diagnosis, and ipsilateral tubal ectopic pregnancy was suspected during surgery. The patient underwent left salpingectomy and resection of the ovarian lesion. A subsequent histopathological examination verified the diagnosis of coexistent ovarian and tubal ectopic pregnancy. Though the mechanism underlying concurrent OP and tubal ectopic pregnancy is still unclear, clinicians should be cautious of potential combined ectopic pregnancy when dealing with patients who have received more than one embryo transfer.

Fallopian tube patency diagnosed by laparoscopic chromopertubation in women with polycystic ovarian syndrome and non-subfertile controls: a retrospective case-control study

Background: Hyperandrogenism has been associated with tubal dysfunction. Previous studies have not used non-subfertile controls when assessing hyperandrogenic women through laparoscopic chromopertubation (LC), the gold standard for tubal patency testing. Methods: The objective of this retrospective study was to compare the results of LC between women with medication-resistant anovulatory polycystic ovary syndrome (PCOS, n = 202) and non-subfertile women with ovarian cysts (controls, n = 48). Results: There were no statistically significant differences between PCOS women and controls for the prevalence of bilateral tubal occlusion (2.5% versus 4.2%, respectively; p = 1.000) or overall rates for occlusion (7.4% of tubes assessed versus 6.3%, respectively; p = 0.828). More PCOS patients needed high pressure chromopertubation to demonstrate bilateral tubal patency than controls (12.4% versus 2.1%; p = 0.036). In the PCOS group, patients needing higher pressure to achieve patency demonstrated higher testosterone levels than women requiring typical pressure (0.66 ± 0.17 versus 0.47 ± 0.24 ng/mL; p = 0.001). Conclusions: For women with ovarian cysts and without subfertility, six percent of all Fallopian tubes are occluded. PCOS patients have similar rates of tubal occlusion, making these women a reasonable but more available control group for LC studies. Higher total testosterone levels were associated with higher LC pressures to demonstrate bilateral patency.

Hysterosalpingography for Diagnosing Tubal Patency in Infertile Women

Objective : Tubal obstruction is one of the most common causes of female infertility. While laparoscopy (LS) is the gold standart method for assessing the patency of the tubes, hysterosalpingography (HSG) is widely used as a first-line approach in infertility work-up. The aim of this study was to compare HSG and LS in assessment of tubal patency. Materials and Methods : Patients who underwent HSG, followed by LS for primary and secondary infertility between January 2015 and June 2017 were retrospectively analyzed. The laparoscopic findings were accepted as reference standard to calculate the diagnostic accuracy of HSG for tubal patency. Results : A total of 67 patients were included into the analysis. The sensitivity, specificity, positive and negative predictive values of HSG for bilateral tubal patency were 82%, 75%, 91% and 57%, respectively. The sensitivity, specificity, positive and negative predictive values of HSG for bilateral tubal obstruction were 62%, 93%, 55% and 94%, respectively. Conclusion : Our findings showed that HSG has high validity, on predicting tubal patency in particular. Laparoscopy should be used in patients with HSG showing nonpatency.

Lumbo-Peritoneal Shunt for Patients with Idiopathic Normal Pressure Hydrocephalus:Surgical Technique

The SINPHONI-2 study(a group of Japanese prospective multicenter cohort studies on the treatment of idiopathic normal pressure hydrocephalus[iNPH])showed the safety and efficacy of lumboperitoneal(L-P)shunt surgery for iNPH. A total of 660 probable iNPH patients underwent L-P shunt surgery at our NPH center between April 2009 and March 2020(age: 77.3 ± 6.2 years). Our surgical technique includes 1)general anesthesia, 2)use of the original drape, 3)upward insertion of the spinal tube through L2/3 via a paramedian puncture in patients with highly deformed lumbar spines, 4)posterior placement of a Codman Hakim programmable valve with SiphonguardTM, 5)inclination of the table at a 35° angle without position change and re-sterilization, 6)laparotomy via rectal muscle splitting, and 7)oblique maneuvering the peritoneal tube from the upper lateral to the lower medial sector. During the first year after surgery, postoperative complications occurred in 14 of 172 patients (8.1%), including four patients with chronic subdural hematoma requiring evacuation (2.3%), three with spinal tube occlusion (1.7%), three with migration of the spinal tube, two with lower-limb numbness (1.2%), and two with abdominal tube occlusion. Our L-P shunt procedure seems to be generally acceptable considering the low number of complications.

Minimally invasive trans-tympanic eustachian tube occlusion animal model

ObjectiveEustachian tube dysfunction is believed to be involved in the pathogenesis of many middle ear diseases including chronic suppurative otitis media. We aimed to describe a simple and reliable animal model of Eustachian Tube obstruction to further research into middle ear disorders. Study designProspective cohort study in animals. SettingUniversity laboratory. Subjects and methods30 mice C57Bl/6J (n = 15) and CBA/CaJ (n = 15) aged 6–8 weeks received transtympanic Eustachian tube occlusion on left ear trough an acute tympanic membrane perforation using thermoplastic latex used in dental procedures (gutta percha). Control mice (n = 6) received tympanic membrane perforation only. At two and four weeks, the mice were observed for signs of Eustachian tube dysfunction and compared to control ears. ET dysfunction was defined as presence of effusion in the middle ear. Results100% (n = 30) of the treated ears had otoscopic signs of Eustachian tube dysfunction at two weeks and the endpoint time of four weeks, compared to 0% in control mice (0/6). Temporary head tilt lasting up to 2 days were observed in 3 mice (10%). No other potential adverse events were recorded. No bacterial growth was determined in the middle ear fluid. ConclusionWe describe a technically easy and reliable method for Eustachian tube occlusion in mice with an excellent success rate and minimal morbidity.

Bilateral cornual resection for uterine-sparing removal of tubal sterilization devices

To describe a uterine-sparing surgical technique for laparoscopic resection of tubal occlusion devices using bilateral cornuectomy. This video reviews the background of the tubal occlusion device known as Essure, as well as the indications and methods for surgical removal. We review considerations for preoperative imaging and excision method. We include our recommendation of surgical technique for complete excision of the device, focusing on bilateral cornuectomy when uterine retention is desired. We demonstrate the steps of this method and highlight the critical aspects for surgeons to consider during the procedure to maximize efficiency and safety. In patients who desire uterine preservation, we recommend bilateral cornual resection for removal of tubal sterilization devices to decrease the risk of device fracture and inadvertent retention of coils.