Late Postoperative Time Research Articles

Late Liner Disassociation of a Pinnacle System Acetabular Component

This article describes a case of late locking mechanism failure and disassociation of a Pinnacle acetabular cup (DePuy, Warsaw, Indiana) and Marathon polyethylene liner (DePuy) 53 months after routine primary total hip arthroplasty in an active patient. Following an uncomplicated initial postoperative recovery, the patient felt a pop while kneeling for gardening activities. The patient had no prodromal symptoms but reported pain with range of motion and weight bearing following the episode. Radiographs appeared to show a fractured liner with intact acetabular and femoral components. Intraoperatively, the liner was disassociated and dislocated inferior to the acetabulum, and 3 consecutive antirotational tines were sheared off the liner at their bases. The acetabular cup and femoral stem were well fixed. Extensive metallosis existed from the femoral head and acetabular shell articulating in the absence of a liner. The patient underwent revision of the acetabular cup, polyethylene liner, and femoral head due to the concern for osteolysis given the extensive metallosis. Revision of the acetabular cup and liner were performed with no further complications. No conclusions could be made as to the exact mechanism of failure following laboratory analysis of the retrieved polyethylene liner. Several possible mechanisms of failure are possible. Although cases of acute disassociation of this system have been reported, this is the first article to our knowledge to report failure at such a late postoperative time.

639 PREOPERATIVE PREDICTORS OF RENAL FUNCTION DECLINE FOLLOWING RADICAL NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CARCINOMA

You have accessJournal of UrologyUrothelial Cancer: Upper Tract Tumors1 Apr 2012639 PREOPERATIVE PREDICTORS OF RENAL FUNCTION DECLINE FOLLOWING RADICAL NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CARCINOMA Matthew Kaag, Landon Trost, R. Houston Thompson, Ricardo Favaretto, Vanessa Elliott, Shahrokh Shariat, Ally Maschino, Jay Raman, and Guido Dalbagni Matthew KaagMatthew Kaag Hershey, PA More articles by this author , Landon TrostLandon Trost Rochester, MN More articles by this author , R. Houston ThompsonR. Houston Thompson Rochester, MN More articles by this author , Ricardo FavarettoRicardo Favaretto New York, NY More articles by this author , Vanessa ElliottVanessa Elliott Hershey, PA More articles by this author , Shahrokh ShariatShahrokh Shariat New York, NY More articles by this author , Ally MaschinoAlly Maschino New York, NY More articles by this author , Jay RamanJay Raman Hershey, PA More articles by this author , and Guido DalbagniGuido Dalbagni New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.718AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical nephroureterectomy (NU) for upper tract urothelial carcinoma (UTUC) may result in a clinically significant decrease in renal function. This loss of glomerular filtration rate (GFR) may impact the ability to adequately deliver postoperative chemotherapy. We developed a model to predict GFR based on interval from NU, and assessed predictors of GFR after surgery. METHODS We identified 370 patients treated with NU for UTUC at 3 centers between 1995 and 2010 who had post-operative laboratory data. Only patients deemed eligible for cisplatin-based chemotherapy before NU (pre-operative GFR>60 ml/min/m2) were included. We created a generalized estimating equations linear model to predict GFR based on the time from surgery. We used univariate linear regression to identify predictors of GFR after NU at early post-operative (1-5 months after NU) and late post-operative (>5 months after NU) time points. RESULTS 163 patients had an eligible early post-NU GFR measurement and 172 had an eligible late post-NU GFR measurement. The median age was 67 (IQR 59, 73) and 154 (72%) were male. The median GFR prior to NU was 72 ml/min/m2 (IQR 64, 80). When modeling GFR after surgery, we did not see evidence that post-NU GFR values changed significantly over time, despite allowing for a possible non-linear relationship in the model. At 2 months the predicted GFR was 52 ml/min/m2 (95% CI: 51, 54); at 6 months it was 51 ml/min/m2 (95% CI: 49, 53). On univariate analysis, age and preoperative GFR were both significant predictors of early (per year: β= -0.4; 95% CI: -0.6, -0.2; p<0.0005 and per 10 ml/min/m2: β= 5.4; 95% CI: 3.7, 7.2; p<0.0005) and late GFR outcomes (per year: β= -0.4; 95% CI: -0.5, -0.2; p<0.0005 and per 10 ml/min/m2: β= 4.1; 95% CI: 2.6, 5.6; p<0.0005). On multivariate analysis, preoperative GFR and age remained significant predictors of both early (p<0.0005 and p=0.004) and late (p=0.001 and p=0.007) GFR after NU. Charlson score was also an independent predictor of late GFR post-NU on multivariate analysis (p=0.004). CONCLUSIONS Renal function decreases after NU and does not show evidence of recovery over time. Pre-NU GFR and patient age are independent predictors of post-NU GFR at early and late time points, while Charlson score predicts only late post-operative GFR. Diminished GFR following NU is likely to limit utilization of adjuvant cisplatin-based chemotherapy. These data underscore the need for clinical trials evaluating neoadjuvant chemotherapy in well-selected patients. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e260 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Kaag Hershey, PA More articles by this author Landon Trost Rochester, MN More articles by this author R. Houston Thompson Rochester, MN More articles by this author Ricardo Favaretto New York, NY More articles by this author Vanessa Elliott Hershey, PA More articles by this author Shahrokh Shariat New York, NY More articles by this author Ally Maschino New York, NY More articles by this author Jay Raman Hershey, PA More articles by this author Guido Dalbagni New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Effect of the Macroplastique Implantation System for stress urinary incontinence in women with or without a history of an anti-incontinence operation

We evaluated the outcomes and the effect of the Macroplastique Implantation System on the quality of life in women with stress incontinence with or without a history of an anti-incontinence operation during 12 to 62 months follow-up. Thirty-five women with urodynamically proven stress incontinence with intrinsic sphincter deficiency were included in this study. Macroplastique injection was performed in all patients. Quality of life was evaluated prior to therapy, in early postoperative time (at the sixth weeks) and in late postoperative time (12 to 62 months follow-up) with the use of three different questionnaires: Incontinence Quality-of-Life Questionnaire (I-QOL), Incontinence Impact Questionnaire-7 (IIQ-7), and Urogenital Distress Inventory-6 (UDI-6). Questionnaires were also compared with those previous to the anti-incontinence operation and to the primary procedure groups. The median age of the women was 50.00 (interquartile range = 17.00) years. There were 24 primary procedures and 11 had undergone previous anti-incontinence surgery. Maximum follow-up time was 62 months, minimum follow-up time was 12 months, and the median follow-up time of the study was 58 (interquartile range = 44-60) months. When preoperative and postoperative median of the I-QOL, IIQ-7, and UDI-6 scores were compared, the differences between scores were found to be statistically significant. I-QOL, IIQ-7, and UDI-6 scores were related to the previous surgery. The overall I-QOL, IIQ-7, and UDI-6 summary scores showed high internal consistency. The Macroplastique injection system is an effective, safe, and acceptable option for stress urinary incontinence in women with or without a history of an anti-incontinence operation. Moreover, it can be performed under local anesthesia without cystoscopic guidance; moreover, side effects are rare.

Muscle sparing versus posterolateral thoracotomy for pulmonary lobectomy: randomised controlled trial

Muscle sparing thoracotomy (MST) has been proposed as an alternative to posterolateral thoracotomy (PLT) for pulmonary lobectomy. This issue has been addressed by few clinical reports. To explore that subject, a prospective, controlled randomised, double-blind trial comparing MST through the auscultatory triangle and PLT was planned. The study included patients scheduled for pulmonary lobectomy for stage I or II non-small-cell lung cancer and were followed for three years. The primary endpoints were pain, analgesic consumption and post-thoracotomy pain syndrome. The secondary endpoints included morbidity plus shoulder and pulmonary functions. The trial randomised 100 patients into two groups. Postoperative pain results were similar, although analgesic consumption was higher in the PLT group (P=0.001). The MST group had a shorter hospital stay (P=0.003). Three years post-thoracotomy syndrome was unaffected by the type of incision. The women suffered more than men during the early and late postoperative time. An inverse correlation between incision length and pain was found. Immediate shoulder strength was significantly better in the MST group (P=0.004) but postoperative pulmonary function and complications were comparable. The two incisions results were very similar in the patient outcome, however, few aspects indicated the MST as the more suitable incision for pulmonary lobectomy.

Fístula enterocutánea como complicación de nefrolitotomía percutánea en pacientes con cirugía bariátrica previa: presentación del caso y revisión de la literatura

Enterocutaneous fistula is a rare complication after percutaneous nephrolithotomy. Some situations are risk factors for it to occur, such as horseshoe kidney, retrorenal colon and chronic colonic dilation by several factors, among them late postoperative time after yeyunoileal bypass in morbid obesity treatment. 35-year-old female patient with a 2.5 cm calculus in the right renal pelvis. Late postoperative time after bariatric surgery using duodenal switch technique, and 55 kg lost till present. She undergone percutaneous nephrolithotomy (PCNL) with two punctures, one in the lower calyx, lost during dilation, and other in the upper calyx through which surgery was successfully carried out. During immediate postoperative time it enteric secretions were observed through the lower chalice puncture. Once the intraperitoneal lesion was removed, decision for conservative treatment was taken with fistula drainage, broadspectrum antibiotic therapy, fasting and total parenteral nutrition. The fistula debt ceased in the 8th postoperative (PO) day, when drain and nephrostomy tube were withdrawn and patient was discharged from the hospital on 10th PO day. On ambulatory follow up the patient is in good conditions. One case of enterocutaneous fistula after PNL presented in a patient in late postoperative time after yeyunoileal bypass. She was successfully treated by conservative therapy. Several authors point to chronic colonic distention and to great loss of retroperitoneal fat as causes for the increase of inadvertent colonic punctures in percutaneous renal access. The risk of complications with enterocutaneous fistula is significantly higher during the postoperatory in patients of bariatric surgery than in others.

MULTIPLE SEGMENTAL OSTEOTOMIES TO THE KYPHOSIS CORRECTION

Objective: To evaluate the results of the surgical treatment of the spinal Kyphosis using the Ponte's technique (multiple posterior osteotomies). Methods: Ten patients (8 with Scheuermann's kyphosis and 2 with kyphosis after laminectomy) submitted to surgical correction of kyphotic deformity greater than 70° were retrospectively assessed. The age at the surgical time ranged from 12 to 20 years old (mean age16.8 years ± 2.89). The radiographic parameters evaluated were the kyphosis, the lordosis and the scoliosis – whenever present. The presence of proximal and distal junctional kyphosis, loss of correction, and complications as implants loosening and breakage were also assessed. The radiographic parameters were evaluated at the preoperative, early postoperative and late postoperative time. Results: The patients were followed through a period that ranged from 24 to 144 months (65.8 ±39.92). The mean value of the kyphosis was 78.8° ± 7.59° (Cobb) before surgery and 47.5° ± 12.54° at late follow up, with mean correction of 33.9° ± 9.53° and lost correction of 2.2°. Conclusion: The surgical treatment of the thoracic kyphosis using multiples posterior osteotomies presented a good correction of the deformity and minimal lost of correction during follow up.

Osteotomias segmentares múltiplas para a correção da cifose

OBJETIVO: Avaliar o resultado do tratamento cirúrgico da hipercifose dorsal da coluna vertebral por meio da técnica de Ponte (osteotomias múltiplas posteriores). MÉTODOS: Estudo retrospectivo de 10 pacientes (oito com sequela de doença de Scheuermann e dois com sequela de laminectomia) submetidos a cirurgia para correção de hipercifose acima de 70°. A idade variou de 12 anos a 20 anos (média de 16,8 anos ± 2,89). Os parâmetros radiográficos estudados foram a mensuração da cifose, lordose e, quando presente, da escoliose. Também foram avaliadas a presença de cifose juncional proximal e distal, a perda da correção e complicações como soltura e quebra dos implantes. Os parâmetros radiográficos foram avaliados no período pré-operatório, pós-operatório imediato e avaliação tardia. RESULTADOS: Os pacientes foram seguidos por um período que variou de 24 a 144 meses (média de 65,8 meses ± 39,92). O valor médio da hipercifose pré-operatória foi de 78,8º ± 7,59º (Cobb) e de 47,5º ± 12,54º no seguimento, com a média de correção de 33,9º ± 9,53º e perda média de correção de 2,2º. CONCLUSÃO: O tratamento cirúrgico da hipercifose torácica por meio de osteotomias múltiplas posteriores apresentou boa correção da deformidade e perda mínima de correção ao longo do seguimento.

Corticosteroids Reduce Postoperative Morbidity After Third Molar Surgery: A Systematic Review and Meta-Analysis

The purpose of this study was to apply meta-analytical methods to measure the effect of corticosteroids (CS) on edema, trismus, and pain at early and late postoperative periods after third molar (M3) removal. A systematic search of the literature was carried out to identify eligible articles. The primary predictor variable was perioperative CS exposure (yes or no). The 3 outcome variables were edema, trismus, and pain assessed during the early (1-3 days) and late (>3 days) postoperative time periods. Standardized mean differences (SMD) for edema and weighted mean differences (WMD) for trismus and pain were pooled across studies. Differences between the 2 treatment groups were assessed using random effects models and metaregressions for both early and late postoperative assessments. Twelve trials met the inclusion criteria. Subjects receiving CS had significantly less edema during both early (SMD, 1.4; 95% confidence interval [CI], 0.6, 2.2; P < .001) and late (SMD, 1.1; 95% CI, 0.1, 2.0; P = .03) time periods after surgery and less trismus than controls during the early and late postoperative periods (early WMD, 4.1 mm; 95% CI, 2.8 mm, 5.5 mm; P < .001; late WMD, 2.7 mm; 95% CI, 0.8 mm, 4.6 mm; P = .005). Average pain levels were not significantly different between the 2 groups (early WMD, 0.4 visual analog scale [VAS]; 95% CI, -0.04 VAS, 0.9 VAS; P = .07; late WMD, 0.5 VAS; 95% CI, -0.6 VAS, 1.5 VAS; P = .4). The findings of this study suggest that perioperative administration of corticosteroids produces a mild to moderate reduction in edema and improvement in range of motion after M3 removal.

L'exploration téléradiographique des voies aériennes supérieures dans l'évaluation du traitement chirurgical des syndromes d'apnées obstructives du sommeil

A lateral cephalometric radiograph is frequently performed for diagnostic and pretherapeutic purposes in patients with obstructive sleep apnea syndrome (OSAS). We studied the prognostic value of this exploration in terms of therapeutic outcome in surgically treated patients. Fifty-five patients underwent surgery from May 1994 through December 1998. Forty-seven had phase I surgery (UPPP, hyothyrohyoidopexy and genioglossal advancement), 18 phase II surgery (bimaxillar advancement) after failure of a phase I procedure and 8 primary phase II surgery. For the "phase I" group: mean body mass index (BMI) was 26.3+/-2.9 kg/m2 and mean age was 47+/-11 years. For the "phase II" group: mean BMI was 25.9+/-3 kg/m2 and mean age was 48+/-9 years. Polysomnography was performed in all patients preoperatively and six months after each surgical procedure. The preoperative apnea-hypopnea index (AHI) was 45.2+/-26.8/h of sleep for the phase I group and 53.8+/-26.9/h for the phase II group. All the patients had a lateral cephalometric radiograph, preoperatively, postoperatively, and at 6 months. The following parameters were measured on each radiograph: posterior airway space (PAS), mandibular plane-hyoid bone distance (MPH), minimal retrolingual space, minimal retrovelar space, surfaces of the rhinopharynx, the oropharynx, the hypopharynx and total upper airway surface. Therapeutic success was defined as a AHI<15/h and 50% decrease compared with the preoperative AHI, associated with normal sleep structure, respiratory microarousal score less than 15/h, normal oxymetry and absence of symptoms. After phase I surgery: the success rate was 21.2%. For the whole group, the total upper airway surface has significatively increased between preoperative and immediate postoperative time, as well the MPH, the PAS and the minimal retrolingual space. But at the late postoperative control, no significative difference compared with the preoperative data has been observed. The comparison between failures and successes has demonstrated that there was no difference in surface or distance benefit between the two groups. But it existed a preoperative difference as the failures have a greater rhinopharynx and a shorter retro velar oropharynx compared with the successes. This difference has been noticed in the immediate postoperative time but not in the late postoperative time. In the "failure" group, the immediate postoperative increase in the upper airway surface, the PAS and the minimal retrolingual space was totally lost in the late postoperative control. In the opposite, in the "success" group, the minimal retro velar space was the only parameter significatively increased at the postoperative time. After phase II surgery: the success rate was 76.9%. All measured parameters except rhinopharynx surface and MPH were increased at last follow-up; part of the increase in the hypopharynx and the minimal retrolingual space observed postoperatively was lost during later follow-up. Nevertheless, in the "failure" group patients, no significant increase could be demonstrated at the last postoperative control. Linear parameters (PAS, minimal retro lingual and retro velar spaces) were smaller in the "successful" group than in the "failure" group. It is difficult to ascertain the exact contribution of the lateral cephalometric radiograph to the assessment of surgical outcome. Apparently, and independently of the technique used, part of the gain in the upper airway surface observed immediately after surgery is progressively lost. We were unable to define any parameter on the lateral cephalometric radiograph predictive of success after phase I surgery. Discrimination between success and failure after phase I surgery might be related to the stability of the increase in the minimal retro velar space and the MPH. For phase II surgery, the initial shortness of the upper airway surface is a good prognostic factor for therapeutic success, defined as a stable increase in the oropharynx.

Avaliação tardia de doentes gastrectomizados por úlcera péptica: aspectos clínicos, endoscópicos e histopatológicos

The gastrectomy is an uncommon procedure because the proton bomb inhibitors associated to the antibiotic outlines used to eradicate the Helicobacter pylori changed the focus of the peptic ulcer treatment. Later evaluation on those patients who underwent partial gastrectomy as a treatment for peptic ulcer, at that time when any drug to eradicate the Helicobacter pylori was not used. The clinical evaluation included the late postoperative symptoms and postgastrectomy syndromes like dumping, diarrhea, alkaline gastritis and nutritional aspects. The upper digestive endoscopy analysed the surgery reconstruction and the gastric stump, the duodenum and the jejunum mucosa aspects. The histopathological evaluation included looking for Helicobacter pylori by using two different methods: histology and urease test. Fifty-nine patients, 44 (74.6%) male, median age 55.5 years old (range from 31 to 77 years old), who underwent a clinical interview and an upper digestive endoscopy. Paraffin blocks from the surgical specimen were reviewed in order to find out if the patients did have or did not have Helicobacter pylori before surgery. The final results show that most of the patients had very good and good clinical evolution (Visick I e II) in 96%. The most common symptoms on late postoperative are mild dyspepsia with or without Helicobacter pylori, and diarrhea, anemia and dumping occurred in, respectively, 11 (18.6%), 2 (3.4%) and 2 (3.4%) cases. The Billroth I reconstruction had the best clinical results on statistical rate. The endoscopic finding showed normal results in the most number of cases, and reflux alkaline gastritis or erosive gastritis in a few cases. Ulcer recurrences were diagnosed in two patients (3.4%), and both had positive Helicobacter pylori. Most of the patients had Helicobacter pylori (86%) before surgery and also in the postoperative time (89.9%). The patients had a very good clinical evolution after the gastrectomy. The Billroth I reconstruction had the best clinical results. The Helicobacter pylori is still present on gastric stump in late postoperative time, and we believe that it does not bring any negative influence to surgical results.

Effects of partial colonic resection in rats

In order to study the effects of partial colectomy, 30 rats Wistar were divided into three groups: GI and GII had the cecun and the ileo cecal valve resected and proximal colectomy was performed in GI and distal in GII. GIII had distal colectomy without cecum resection. The length of the remain colon was of 5 cm in all groups. Colostomy was performed in GI, GII and GIII. Parameters evaluated: body weight, fecal composition concerning to water, lipids and proteins on preoperative time and on the 10th, 20th, 30th, 40th, 50th and 60th days of postoperative time. All statistical tests were conducted at a 5% two-sided risk level. The evaluation was made by analysis of variance techniques. Concerning to body weight, there is no significant difference on the late postoperative time in any group or when comparing the three groups on this same period. On late postoperative time, GI and GII had a large amount of fecal water, lipids and proteins when compared to the preoperative time and to GIII. On the 60th day there's no significant difference on the quantity of fecal water when comparing the three groups and the same occurs on the 50th day when considering the quantity of fecal proteins.

頚椎疾患における頚筋筋力

We have once reported about the isometric strength of the neck muscles in these series. Here we again attempted to analyse the relation between the clinical symptoms and the strength of the neck muscles in the groups with cervical disorders and to show the postoperative changes of the strength.We measured the isometric strength of the neck muscles for 41 cases with cervical disorders (CSM-21 cases, CSR-7 cases, OPLL-13 cases) and 120 control cases.CSM group and OPLL group showed less power in extension than presenile control group. The group of cases with anterior interbody fusion showed generally less power than the group of posterior decompression at the postoperative time of 1-2 months (mean 6 weeks), while at the late postoperative time (3-6 months, mean 15 weeks), loss of neck extension power was persistently noticed in the group of posterior decompression.