Ring In Patients Research Articles

Subscapularis Tendon Augmentation in Patients With Anterior Shoulder Instability Associated With Capsule-Labral Deficit

Shoulder instability is a common problem in young adults. Without surgical treatment, the recurrence rate is unacceptably high. While arthroscopic capsulolabral repair is popular for anterior glenohumeral instability, it still faces limitations. Surgical failures may arise from technical errors, soft tissue insufficiency, bone loss, or rehabilitation challenges. In cases with less than 15% glenoid bone loss and no external rotation deficit, subscapular augmentation provides an option without necessitating bone grafts or additional surgery. An arthroscopic technique is presented that utilizes the subscapularis tendon for tenodesis at the anterior edge of the glenoid ring in patients with the absence of capsulolabral tissue to provide both protection of the anterior glenohumeral aspect and a safer return to functional activities.

Comparison of transvaginal natural orifice transluminal endoscopic surgery versus conventional surgery for uterosacral ligament suspension in patients who had concomitant vaginal hysterectomy for subtotal uterine prolapse.

The study aimed to compare the short-term outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for uterosacral ligament suspension (USLS) versus nonendoscopic USLS in patients with subtotal uterine prolapse who had a concomitant vaginal hysterectomy. There were 51 patients who underwent vNOTES USLS, whereas the nonendoscopic conventional USLS group had 49 patients. The information about patient demographics, and perioperative data including the operative duration, blood loss, intraoperative and postoperative complications, and length of postoperative hospital stay were determined from the patients' files. Postoperative follow-up visits were scheduled at the first week and 1 month after surgery. The demographic variables including age, body mass index, menopausal status, and parity were comparable, and no significant differences were found. A total of 90.2% of the patients in the vNOTES group and 69.4% of the patients in the shull group were at menopause (p = .09). Operation time was significantly shorter in the shull group (p < .001), and the hospitalization period (p = .029) was significantly shorter in the vNOTES group. Ba, Bp, and D points and total vaginal length (TVL) were significantly behind the hymenal ring in patients who had vNOTES USLS procedure (p < .001). None of the patients who had intraoperative significant blood loss required transfusion. One patient in the vNOTES and two patients in the shull group had a postoperative cuff hematoma. vNOTES USLS has a good safety profile, higher percentage of adnexal surgeries with better improvement on POP-Q points Ba, Bp, D, and TVL compared with classic USLS in patients with subtotal uterine prolapse. Studies evaluating short- and long-term results of vNOTES versus conventional USLS are needed.

Towards non-invasive Wilson’s disease progression monitoring based on corneal copper content

Abstract Patients suffering from Wilson’s disease accumulate copper in their body. Copper load may become visible as Kayser-Fleischer (KF) rings - colorful copper-sulfur granules in the base of the cornea. Reoccurrence of KF rings in patients under anti-copper medication may be a sign for ineffective treatment. This work proposes a hand-held sensing system based on infrared reflectivity measurement of the cornea as a potential method for regular at-home progression monitoring. The intensity of the LEDs used is safe for operation on the human eye. As proof of concept, reflectivity was measured when placing the sensor onto samples of white paper that had copper tape of different sizes centered within the sensitive area. Further, reflectivity was determined for different solutions of copper sulfate in saline that were poured into adapter bowels fitting the sensor head, with Cu2+ concentrations of the samples deducted from literature. While the prototype system can be used to differentiate between two copper strips of 6 and 12 mm2 or larger, a different measuring principle would be needed to also determine the concentration of copper sulfate solutions. Since these two in-vitro models cannot fully represent the complex in-vivo molecular conditions of patients’ corneas, additional measurements on patients’ eyes are necessary to evaluate the potential of the proposed sensing system.

Incidence of congenital tracheal stenosis in left pulmonary artery sling diagnosed by bronchoscopy.

Congenital tracheal stenosis (CTS) has been reported to occur in 50-65% of cases of left pulmonary artery sling (LPAS), but the exact incidence rate is unknown. This study aimed to determine the actual rate using bronchoscopy and to elucidate morphological features in computed tomography (CT) diagnosis. We performed a single institutional retrospective review of all patients with LPAS between January 2010 and March 2022. The percentage of complete tracheal rings in patients with LPAS was evaluated using bronchoscopy. The anteroposterior/lateral diameter ratios at the smallest and largest diameters of each CTS patient's trachea were measured on CT. The Wilcoxon signed-rank test was used to analyze the differences between the two parts. Fifty-two patients with LPAS were enrolled. All patients had complete tracheal rings on bronchoscopy. CT analysis of 32 patients with CTS was performed. The median anteroposterior/lateral diameter ratio at the smallest diameter was 1.05 (interquartile range [IQR] 0.95-1.15); the median ratio at the largest diameter was 0.94 (IQR 0.89-0.99). There was a significant difference between the two parts (p = 0.013). CTS might be universally associated with LPAS. The circular tracheal cross-section on CT might imply the existence of a complete tracheal ring.

The prognostic significance of right ventricular basal diameter in addition to tricuspid annulus diameter in patients underwent to tricuspid valve surgery

Abstract Funding Acknowledgements Type of funding sources: None. Background Functional tricuspid valve regurgitation occurs as a result of enlargement of the tricuspid annulus (TA) despite the normal valve structure (1). However, the tendency of the tricuspid annulus to enlarge in the posterior annular part suggests that the mediolateral diameter measurement measured by 2-dimensional (2-D) echocardiography does not provide an accurate anatomical evaluation (2). Inaccuracies in these measurements also affect the selection of the tricuspid ring in patients undergoing surgery and thus affect the short- and long-term outcomes (3). Therefore, new methods and reference points have developed in the measurement of the tricuspid annulus. Purpose In this study, we aimed to investigate the importance of apical 4-chamber tricuspid annulus diameter and right ventricular basal diameter measurements in choosing a surgical tricuspid ring size. Methods The records of 359 patients who underwent tricuspid ring annuloplasty for functional tricuspid valve regurgitation between 2018 and 2022 were retrospectively reviewed. Tricuspide anulus and right ventricular basal diameter measurements were re-evaluated echocardiographically, and surgical tricuspid ring sizes were recorded. Results There was no significant relationship between 2-D measurement of tricuspid annulus diameter and choosing surgical ring sizes (OR 0.74, 95% CI 0.51 – 1.09, p = 0.257), however, the increase in RV basal diameter size was associated with larger ring size selection (OR 2.63, 95%). CI 1.72 – 4.02, p&amp;lt;0.0001). Among the 5 models that predicted the surgical ring size according to the ordinal regression analysis, the models that most accurately predicted the surgical ring size were model-4, which included RV basal diameter, and model-5, which included RV basal diameter and TA diameter. (Table 1). Also, in model-5, RV basal diameter was superior to TA-diameter in showing variation in surgical ring size. Also, when the TA diameter is &amp;lt; 40 mm and the RV basal diameter is &amp;lt; 45 mm, the large ring selection rate (34 or 36) is 36.2%, but this rate is 70.9% when the TA diameter is &amp;lt; 40 mm and the RV basal diameter is ≥ 45. Conclusions In conclusion, when the measurements in the apical 4-chamber were compared, the effectiveness of the measurement of the tricuspid annulus in determining the surgical ring size was lower than the RV basal diameter. During pre-operative evaluation, RV basal measurement in addition to the tricuspid annulus may help in the selection of patients who require tricuspid valve annuloplasty and in determining the ring sizes.

Changes in the total corneal refractive power after insertion of intrastromal rings in patients with keratoconus in short, medium and long term

Changes in the total corneal refractive power after insertion of intrastromal rings in patients with keratoconus in short, medium and long term

Presence of pseudo-Kayser-Fleischer rings in patients without Wilson disease: a prospective cohort study.

Kayser-Fleischer (KF) rings are due to copper deposition in Descemet membrane of the cornea in Wilson disease. Pseudo-KF ring (PKF), seen in patients with high bilirubin, is often misinterpreted as KF rings. These are bilirubin deposits in posterior corneal stroma. The aim of the study was to prospectively evaluate the presence of KF and PKF rings in Wilson disease and non-Wilsonian liver disease with serum bilirubin >5mg/dL. All patients referred from the hepatology unit with serum bilirubin >5mg/dL were assessed by slit-lamp examination (SLE) and anterior segment optical coherence tomography at baseline, 3 months, and 6 months for differences in corneal deposits between KF and PKF rings. All other clinical, laboratory, radiological, genetic, and tissue diagnoses by liver biopsy were done as required to confirm the cause of liver disease. Among the 750 patients examined, corneal deposits were present in 13%, KF rings as granular deposits in 31.7%, and PKF as a posterior stromal hue in 68.3% of cases. PKF rings showed regression in 60%, disappearance in 36.6% at 3 months, and in 100% of cases at 6 months. KF ring showed regression in 10.7% and 8.3% until 6 months. Anterior segment optical coherence tomography identified KF ring as a hyperintense line on Descemet membrane in an additional 9.7% of patients compared with a scattered hyperintense hue in PKF rings. The presence of PKF rings in patients with jaundice is not uncommon and should be differentiated from true KF rings. Serial monitoring is essential to look for resolution, and anterior segment optical coherence tomography may be additionally helpful.

NSAID-esophagitis: how to break the vicious circles of pathogenesis? Clinical case

The article presents a complex clinical case of drug‑induced erosive esophagitis grade C with the formation of Schatzki ring in patient S., 85 years old. A feature of the case under consideration is the long‑term persistence of both esophageal (dysphagia, odynophagia) and extraesophageal (thoracalgia) complaints, which required an extensive differential diagnosis to rule out the cardiac genesis of the pain syndrome. The diagnostic search was complicated by the patient’s advanced age, the presence of serious accompanying somatic pathology, moderate cognitive decline, contradictory data from X‑ray examination and computer tomography, and the patient’s categorical refusal to perform a biopsy, which made histological confirmation of the presumptive diagnosis impossible. Empirical appointment of pantoprazole (Nolpaza) made it possible to level the phenomenon of odynophagia and improve the condition of the esophageal mucosa, but long‑term use of Nolpaza in high doses was required for restoration of erosive‑destructive changes in the damaged esophagus and stomach.&#x0D; Moreover, the literature review is presented, which reveals modern ideas about the mechanisms of Schatzki ring, the features of management and treatment of patients with dysphagia and Schatzki ring according to the guidelines of authoritative international organizations — the World Gastroenterology Organization, the American College of Gastroenterology. The key provisions of the specified organizations, which regulate the doctor’s actions in the management of patients with Schatzki ring, are given. The advantages of prescribing pantoprazole (Nolpaza) are described, taking into account the peculiarities of its mechanism of action, bioequivalence to the original pantoprazole, CYP450‑unassociated hepatic metabolism, the absence of significant drug interactions, serious adverse events, the possibility of its administration to elderly and senile patients without dose correction, the expediency and safety of the long‑term intake.&#x0D;

Dysphagia, looking further than the usual suspects, a case report

Background: Vascular ring is a rare diagnosis in adults as the majority is diagnosed in symptomatic infants or young children. Only a few cases are documented in the literature of dysphagia in adults caused by a vascular ring. It is not uncommon for an adult diagnosed with vascular rings to have asthma in his medical history. Case Presentation: A 61-year-old woman presented with dysphagia with a medical history of slight asthma and left hemithyroidectomy. After extensive workup, it was determined to be the result of a right-sided aortic arch with a left-sided arteriosum ligament, a left aberrant subclavian artery with Kommerell’s diverticulum, and a ventral left common carotid artery. Conclusion: A right-sided aorta with a left-sided arteriosum ligament is a vascular ring and should be recognized as such. Although rare in adults, one should be triggered to think of a vascular ring in patients with dysphagia, especially with mild asthma and reflux complaints.

Substantation of the method of lumbo-pelvic fixation in verically unstable fractures of the sacrum

Background. According to the literature and our own observations, there is an increase in the number of victims of young, ablebodied age with severe injuries to the pelvic structures. Despite numerous developments and studies in this area, high mortality and a high percentage of unsatisfactory treatment results remain. The publication reflects the advantages of using bilateral lumbopelvic fixation in the treatment of injuries to the cross. Load calculation, biomechanical modeling of damages and displacing factors are presented. Bilateral lumbopelvic fixation has proven to be a reliable method capable of providing reliable fixation of the fracture at all stages of treatment. Aim. To substantiate and test modified lumbopelvic stabilization of the pelvic ring in patients with vertically unstable (C1-2-3 according to Tile M.) sacral fractures. Material and methods. Based on the treatment of 20 patients with severe sacral fractures, it was proved that the best result was achieved with bilateral lumbopelvic stabilization. The use of the author's version (RF Patent No. 2684870 "Method of fixation in unilateral unstable sacral fractures") of osteosynthesis is presented on the example of the treatment of multiple pelvic trauma, a good clinical result was obtained, and neurological symptoms were stopped. Results. Lumbar-iliac osteosynthesis for vertically unstable sacral fractures is the optimal method of fixation. The distribution vector of the levers of the latch corresponds to the biasing force, which ensures maximum reliability of the synthesis. The method, if necessary, creates conditions for decompression of the roots, prevents the early development of arthrosis of the sacroiliac joints. Using it allows you to maintain or correct the sagittal and frontal balance of the spine. The use of bilateral 8-screw lumboiliac fixation with the installation of a transverse tie is recommended, since unilateral fixation or a decrease in the number of fixing elements can lead to loosening of the fixator. Conclusion. Based on biomechanical modeling and the results of treatment of patients with severe injuries of the posterior pelvic ring, the effectiveness of the proposed method of lumbopelvic fixation was proven.

Endoscopic extraction of migrated gastric bypass Fobi ring in patient after gastric bypass.

Endoscopic extraction of migrated gastric bypass Fobi ring in patient after gastric bypass.

Chronic Compensated Tonsillopharingitis: Clinical and Microbiological Features

The article presents the results of a complex clinical and bacteriological study aimed at determining the quantitative and qualitative composition of the microflora of the pharyngeal lymphatic ring in patients with chronic compensated tonsillopharyngitis, including identification of microorganisms followed by determination of their sensitivity toward antibacterial and antimycotic drugs. β-hemolytic streptococcus was revealed to be the most etiologically significant microorganism in the development of chronic compensated tonsillopharyngitis. In addition, populations of microorganisms growing in the throat of such patients were found to exhibit high resistance toward antibacterial and antifungal drugs.

Long-term results of tricuspid valve repair using three-dimensional versus flexible rings in patients with functional tricuspid regurgitation.

Significant functional tricuspid regurgitation (TR) should be corrected in patients undergoing surgery for left-sided valvular diseases. We hypothesized that ring type may affect outcomes in tricuspid annuloplasty. Herein, we report our experience with three-dimensional semi-rigid rings compared to open simple-band annuloplasty. This is a retrospective study that included all patients who underwent tricuspid annuloplasty concomitant to left-sided valvular surgery. The study's main outcome measure was long-term recurrent TR probability. Of the 781 study patients, 611 (78%) underwent annuloplasty using flexible band and 170 (22%) underwent rigid ring implantation. Early mortality did not differ significantly between the rigid and flexible groups (4.4% vs 4.1%, P = 1.000). Long-term mortality was similar between the groups [hazard ratio (HR) 0.97, 95% confidence interval (CI) 0.69-1.36, P = 0.847]. At a mean follow-up of 62 (50) months, freedom from TR grade 3+/4+ was 96.4% and 96.7% in the rigid and flexible groups, respectively (HR 1.41, 95% CI 0.55-3.61, P = 0.476). Furthermore, 2.4% of the rigid and 1.3% of the flexible groups required reoperation (HR 1.01, 95% CI 0.21-4.82, P = 0.988). Multivariable analysis demonstrated that rheumatic valve aetiology (HR 1.92, CI 1.04-2.98, P = 0.042) and mitral stenosis (HR 1.44, CI 1.01-2.2, P = 0.044) were predictors for recurrent TR (3+/4+). Ring type was not associated with recurrence (HR 0.86, 95% CI 0.3-2.47, P = 0.787). Open bands performed at least as well as three-dimensional rings. Our results suggest that late clinical results of tricuspid annuloplasty depend on left-sided pathology and patient factors and less on the type of ring used.

Commentary: Kayser-Fleischer-like rings in patients with hepatic disease.

Commentary: Kayser-Fleischer-like rings in patients with hepatic disease.

Kayser-Fleischer-like rings in patients with hepatic disease

Purpose:The aim of this work was to study Kayser-Fleischer [KF]-like rings in patients with hepatic or cholestatic liver disease and to find out the relation between serum bilirubin level and the presence of KF like ring in these patients.Methods:In this study, we evaluated patients with hepatic and cholestatic liver diseases with total Serum bilirubin levels >10 mg/dl. These patients were evaluated for the presence or absence of KF like ring.Results:A total of 67 patients with total bilirubin >10 mg/dl were included in the study. Patients were divided into 3 groups based on total S. bilirubin level: Group 1 with S. bilirubin >30 mg/dl, Group 2 with S. bilirubin >20 - <30 mg/dl and Group 3 with S. bilirubin >10 - <20 mg/dl at baseline evaluation. On follow-up they were divided into 3 groups based on the serum bilirubin level. Group 1- >20 mg/dl, Group 2- >10 - <20 mg/dl, Group 3- <10 mg/dl. KF like ring was seen in 98.5% of patients with high total S. bilirubin level. KF like ring disappeared in 87.5% of patients with reduction in the total S. bilirubin level to less than 10 mg/dl.Conclusion:KF like ring was seen in 98.5% of patients with high total S. bilirubin, disappeared in 87.5% of patients with reduction in the total S. bilirubin level to less than 10 mg/dl. There was no significant difference between the Total S. bilirubin levels, age, gender and KF Like Ring.

Kayser-Fleischer-like rings in patients with hepatic disease.

The aim of this work was to study Kayser-Fleischer [KF]-like rings in patients with hepatic or cholestatic liver disease and to find out the relation between serum bilirubin level and the presence of KF like ring in these patients. In this study, we evaluated patients with hepatic and cholestatic liver diseases with total Serum bilirubin levels >10 mg/dl. These patients were evaluated for the presence or absence of KF like ring. A total of 67 patients with total bilirubin >10 mg/dl were included in the study. Patients were divided into 3 groups based on total S. bilirubin level: Group 1 with S. bilirubin >30 mg/dl, Group 2 with S. bilirubin >20 - <30 mg/dl and Group 3 with S. bilirubin >10 - <20 mg/dl at baseline evaluation. On follow-up they were divided into 3 groups based on the serum bilirubin level. Group 1- >20 mg/dl, Group 2- >10 - <20 mg/dl, Group 3- <10 mg/dl. KF like ring was seen in 98.5% of patients with high total S. bilirubin level. KF like ring disappeared in 87.5% of patients with reduction in the total S. bilirubin level to less than 10 mg/dl. KF like ring was seen in 98.5% of patients with high total S. bilirubin, disappeared in 87.5% of patients with reduction in the total S. bilirubin level to less than 10 mg/dl. There was no significant difference between the Total S. bilirubin levels, age, gender and KF Like Ring.

Complex Analysis of the Microflora of the Pharyngeal Lymphatic Ring in Patients with Compensated Chronic Tonzillopharyngitis

The article presents the results of a complex clinical and bacteriological study aimed at determining the quantitative and qualitative composition of microflora in the pharyngeal lymphatic ring. The microflora composition was determined in terms of microorganism identification and their sensitivity to antibacterial and antimycotic drugs in patients with the compensated form of chronic tonsillopharyngitis (CCTP). It was revealed that β-hemolytic streptococcus is the most etiologically significant microorganism in the development of CCTP. In addition, populations of microorganisms growing in the throat of people with CCTP exhibit a high resistance to antibacterial and antifungal drugs. Thus, 57.14% of the detected microorganisms showed resistance to several antibacterial drugs, and the identified Candida cultures demonstrated resistance to 3–4 antimycotic drugs in 52.3% of cases.

Aortic valve repair with a newly approved geometric annuloplasty ring in patients undergoing proximal aortic repair: early results from a single-centre experience.

Aortic insufficiency (AI) is common in patients with proximal aortic disease, but limited options exist to facilitate aortic valve repair (AVr) in this population. This study reports 'real-world' early results of AVr using newly FDA-approved trileaflet and bicuspid geometric annuloplasty rings for patients with AI undergoing proximal aortic repair (PAR) in a single referral centre. All patients undergoing AVr with a rigid internal geometric annuloplasty ring (n = 47) in conjunction with PAR (ascending +/- root +/- arch) were included. Thirty-six patients underwent AVr with a trileaflet ring, and 11 patients underwent AVr with a bicuspid ring. The rings were implanted in the subannular position, and concomitant leaflet repair was performed if required for cusp prolapse identified after ring placement. The median age was 58 years [interquartile range (IQR) 46-70]. PAR included supracoronary ascending replacement in 26 (55%) patients and remodelling valve-sparing root replacement with selective sinus replacement in 20 (42%) patients. Arch replacement was performed in 38 (81%) patients, including hemi-arch in 34 patients and total arch in 4 patients. There was no 30-day/in-hospital mortality. Preoperative AI was 3-4+ in 37 (79%) patients. Forty-one (87%) patients had zero-trace AI on post-repair transoesophageal echocardiography, and 6 patients had 1+ AI. The median early post-repair mean gradient was 13 mmHg (IQR 5-20). Follow-up imaging was available in 32 (68%) patients at a median of 11 months (IQR 10-13) postsurgery. AI was ≤1+ in 97% of patients with 2+ AI in 1 patient. All patients were alive and free from aortic valve reintervention at last follow-up. Early results with geometric rigid internal ring annuloplasty for AVr in patients undergoing PAR appear promising and allow a standardized approach to repair with annular diameter reduction and cusp plication when needed. Longer-term follow-up will be required to ensure the durability of the procedure.

The use of micro-dose contraceptive at gynecological, extragenital pathology and in case of their combination

Besides the contraception the modern contraceptives have non-contraceptive effects. The ability to use the vaginal ring in patients with combined pathology as gynecological as somatic is important due to the micro-dosed of ethinyl estradiol and highly selective gestagen.

Scheimpflug Imaging of the Danish Cohort of Patients With Wilson Disease.

The purpose of this study was to investigate the use of anterior segment imaging in diagnosing Kayser-Fleischer rings in patients with Wilson disease. In a tertiary center for Wilson disease, patients were examined with a Pentacam HR Scheimpflug-based tomography device in addition to conventional slit-lamp examination. The inferior part of the cornea was analyzed using both a built-in densitometry module and ImageJ. Thirty-one patients with Wilson disease (78% of all Danish patients) were included, resulting in 83 examinations over a 5-year period. Ten had a manifest Kayser-Fleischer ring in the inferior part of the cornea on at least 1 examination, 5 had other causes of peripheral corneal scatter, and 16 had normal examinations. The built-in densitometry module performed poorly in discriminating between the presence and absence of a Kayser-Fleischer ring. However, analysis of the images in ImageJ and calculation of a normalized signal (peak posterior value/peak anterior value) with a cutoff value set to 1 detected 28 of 31 Kayser-Fleischer rings and resulted in 96% sensitivity and 95% specificity. In 12 patients who underwent 3 or more examinations during the period, changes in the normalized signal seemed to reflect the efficiency of the treatment, although more studies are needed for this conclusion. ImageJ-based analysis of Pentacam images has a high sensitivity in detecting Kayser-Fleischer rings and can be used as a diagnostic procedure for Wilson disease and may be a tool to monitor the disease in an objective manner.