Unilateral Cases Research Articles

Is It Worth Using Botulinum Toxin Injections for the Management of Mild to Moderate Blepharoptosis?

Mild ptosis can be aesthetically displeasing for patients, especially in unilateral cases. However, some patients do not desire to undergo a surgical repair. Botulinum toxin injection might be an option in these cases. The authors sought to objectively examine the effects of botulinum neurotoxin A (BoNT-A) injection into the orbicularis oculi muscle in the management of blepharoptosis. In this prospective study, 8 patients with mild to moderate ptosis received application of BoNT-A in the pretarsal orbicularis oculi muscle. Standardized photographs were obtained at baseline and 2, 4, and 24 weeks. Digital image analysis software (Image J) was employed for objective analysis. Primary outcomes were the margin reflex distance-1 and qualitative changes on a 4-point scale. A significant increase in the margin reflex distance-1 on the treated side (baseline: 2.00 ± 1.13 mm; week 2: 2.52 ± 1.13 mm; P = 0.003) and a significant reduction (baseline: 3.23 ± 0.92 mm, week 2: 3.07 ± 0.96; P = 0.0268) on the contralateral eyelid were observed at week 2. After 24 weeks, the effect of BoNT-A diminished, and no significant difference from baseline was observed in either eyelid. Subjectively, 87.5% of patients reported improvement in their eyelid ptosis. Botulinum toxin injection in the pretarsal orbicularis oculi muscle can be an option to temporarily manage ptosis in patients who do not desire to undergo a surgical procedure. This alternative treatment can also be employed to manage temporary ptosis induced by botulinum toxin diffusion to the levator aponeurosis.

Quantifying Complications: An Analysis of Operative Time and Intraoperative Factors in Microsurgical Breast Reconstruction.

Analysis of operative flow has been shown to improve efficiency in breast microsurgery. Both complex decision-making skills and technical mastery are required to overcome intraoperative challenges encountered during microsurgical reconstruction. Effects of intraoperative complications on operative time have not yet been reported. A retrospective chart review of microsurgical breast reconstructions by three surgeons between 2013-2020 analyzed operative variables and duration. Intraoperative complications were determined from the operative report. Correlations between continuous variables were determined using Spearman correlation coefficients. Nonparametric testing was used when comparing operative duration between groups. Operative duration was analyzed for 547 autologous breast reconstruction cases; 210 reconstructions were unilateral and 337 were bilateral. Average operative duration was 471.2 SD 132.2 minutes overall (360.1 SD 100.5 minutes for unilateral cases and 530.5 SD 110.5 minutes for bilateral cases). Operative duration decreased with surgeon experience (r = -0.17, p< .001).Regarding intraoperative complications, difficult donor dissection was correlated with an average operative duration increase of 91.7 minutes (n = 43, 7.9%, p< .001), pedicle injury with an additional 67.7 minutes (n = 19, 3.5%, p = .02) and difficult recipient vessel dissection with an increase of 63.0 minutes (n = 35, 6.4%, p = .003). Complications with anastomosis also showed a statistically significant increase in operative duration, with arterial complications resulting in an increase of 104.3 minutes (n = 41, 7.5%, p< .001) and venous complications resulting in an increase in 78.8 minutes (n = 32, 5.8%, p< .001). Intraoperative thrombus resulted in an increase of 125.5 minutes (n = 20, 3.7%, p< .001), and requiring alternative venous outflow added an average of 193.7 minutes (n = 8, 1.5%, p< .001). Intraoperative complications in autologous breast reconstruction significantly increase operative time. The greatest increase in operative time is seen with intraoperative thrombosis or requiring alternative venous outflow. As these complications are rarely encountered in breast microsurgery, opportunities for simulation and case-based practice exist to improve efficiency.

Clinical and paraclinical profile of neuromyelitis optic spectrum disorder in a peruvian cohort

BackgroundNeuromyelitis Optica Spectrum Disorders (NMOSD) is an autoimmune, inflammatory disorder of the Central Nervous System that typically involves the spinal cord and the optic nerves. Recently, the clinical and radiological spectrum of NMOSD has been increasing in Latin America. In Peru, there have only been a few clinical reports on NMOSD published. For this reason, we aimed to assess the clinical and paraclinical characteristics of patients with NMOSD from a tertiary-level neurological center in Lima-Peru. MethodsThis is a descriptive study. We assessed medical reports of patients with NMOSD based on the 2015 diagnostic criteria attended in a goverment institute (Instituto Nacional de Ciencias Neurologicas) from Peru between 2013-2019. Those patients who met diagnostic criteria were selected and analyzed. We analyzed continuous data among groups (AQP4-IgG seropositive and AQP4-IgG seronegative/unknow). ResultsWe identified 58 clinical records that met the selection criteria and were included in the study. The highest percentage of patients (53%) were born in the north of Peru (from parallel 0°01’48’’S – 6°56’38’’S). NMOSD were more prevalent in women (86%), the male:female ratio was 1:6, the mean age at diagnosis was 50 years. AQP4-IgG antibodies were tested in (63.8%), 62% of whom were seropositive and 38% seronegative. The frequency of EO-NMO and LO-NMO was 34.8% and 65.2% in AQP4-IgG seropositive patients, respectively. Unknown AQP4-IgG was found 21 patients. In LO-NMOSD group, AQP4-IgG seropositive was found in a higher percentage. Optic neuritis was the first clinical event at 40% . In the patients who presented myelitis as the first clinical event, 18.2% were AQP4-IgG seropositive, while only 4.8% was found in the rest of the patients. 17% had other associated autoimmune diseases and 16% had anti-nuclear antibodies. 79% of patients had low vitamin D-25(OH) levels (<30ng/ml). Orbit MRI showed unilateral optic neuritis in 46.6%. Spinal cord MRIs showed extensive longitudinal myelitis in 52% of patients and the thoracic segment was the most frequently affected (47%). ConclusionsIn the present study of a peruvian NMOSD cohort, we found a higher frequency of unilateral optic neuritis cases, and a higher percentage of AQP4-IgG seropositive patients among those older than 50.

Effect of salpingectomy on ovarian reserve: A systematic review and meta-analysis.

To determine the effect of salpingectomy on ovarian reserve. PubMed, EMBASE, Web of Science, Dynamed plus, and Cochrane Controlled Trials Register databases were searched from their inception to December 2020 to identify relevant studies, including cross-sectional studies, retrospective studies, and randomized controlled trials. Studies that compared anti-Müllerian hormone (AMH) levels and/or antral follicle count (AFC) between the control and salpingectomy groups or before and after surgery were included. Twenty-one articles were included in the systematic review. Meta-analyses were performed on 16 studies in which data were presented as mean ± SD values. A meta-analysis comparing AMH levels before and after surgery in the same patients showed no significant decrease in all cases, irrespective of whether it was unilateral or bilateral salpingectomy. There was no significant decrease in the AFC in the meta-analysis comparing levels before and after bilateral salpingectomy, either. In contrast, in the case-controlled study the salpingectomy group had significantly lower levels of AMH in all meta-analyses of unilateral and bilateral surgery (mean difference: -0.31, 95% confidence interval [CI]: -0.55, -0.07), only unilateral cases (mean difference: -0.28, 95% CI: -0.50, -0.06), and only bilateral cases (mean difference: -0.71, 95% CI: -1.19, -0.23). The salpingectomy group that included unilateral and bilateral cases had significantly lower AFC compared with no-surgery controls (mean difference: -1.31, 95% CI: -2.13, -0.48). Although not conclusive, it does appear that patients who underwent salpingectomy (either unilateral or bilateral) have a decreased ovarian reserve.

A Review of the Diagnosis and Treatment of Limbal Stem Cell Deficiency.

Limbal stem cell deficiency (LSCD) can cause significant corneal vascularization and scarring and often results in serious visual morbidity. An early and accurate diagnosis can help prevent the same with a timely and appropriate intervention. This review aims to provide an understanding of the different diagnostic tools and presents an algorithmic approach to the management based on a comprehensive clinical examination. Although the diagnosis of LSCD usually relies on the clinical findings, they can be subjective and non-specific. In such cases, using an investigative modality offers an objective method of confirming the diagnosis. Several diagnostic tools have been described in literature, each having its own advantages and limitations. Impression cytology and in vivo confocal microscopy (IVCM) aid in the diagnosis of LSCD by detecting the presence of goblet cells. With immunohistochemistry, impression cytology can help in confirming the corneal or conjunctival source of epithelium. Both IVCM and anterior segment optical coherence tomography can help supplement the diagnosis of LSCD by characterizing the corneal and limbal epithelial changes. Once the diagnosis is established, one of various surgical techniques can be adopted for the treatment of LSCD. These surgeries aim to provide a new source of corneal epithelial stem cells and help in restoring the stability of the ocular surface. The choice of procedure depends on several factors including the involvement of the ocular adnexa, presence of systemic co-morbidities, status of the fellow eye and the comfort level of the surgeon. In LSCD with wet ocular surfaces, autologous and allogeneic limbal stem cell transplantation is preferred in unilateral and bilateral cases, respectively. Another approach in bilateral LSCD with wet ocular surfaces is the use of an autologous stem cell source of a different epithelial lineage, like oral or nasal mucosa. In eyes with bilateral LSCD with significant adnexal issues, a keratoprosthesis is the only viable option. This review provides an overview on the diagnosis and treatment of LSCD, which will help the clinician choose the best option amongst all the therapeutic modalities currently available and gives a clinical perspective on customizing the treatment for each individual case.

Clinical outcomes and cost-effectiveness of superficial parotidectomy versus extracapsular dissection of the parotid gland: a single-centre retrospective study of 161 patients

Improvements in preoperative diagnostics and intraoperative techniques have made the surgical excision of benign parotid gland tumours less invasive. Extracapsular dissection (ECD) has become more popular in comparison to superficial parotidectomy (SP), the gold standard. Although clinical outcomes have been reported, reports on cost-effectiveness are limited. The aim of this retrospective study was to analyse the surgical outcomes and cost-effectiveness of ECD versus SP in benign parotid tumour surgery. A retrospective cohort of 161 patients treated between 2012 and 2020 was collected. Data concerning demographics, clinical outcomes, and cost-efficiency were recorded. Analysis of the 161 unilateral parotidectomy cases (59 SP, 102 ECD) showed a significantly longer operation time, anaesthesia time, and length of stay for SP patients (all P < 0.001). Regarding postoperative complications, transient facial nerve weakness (P < 0.001) and haematoma formation (P = 0.016) were more prevalent in the SP patients. The frequency of positive margins was lower for SP (P = 0.037). No case of recurrence was identified with either technique. ECD showed excellent clinical outcomes as well as a reduction in complications when compared to SP. ECD is a viable alternative for superficial benign parotid gland tumours after thorough preoperative clinical, pathological, and radiological examination. The reduction in operation, anaesthesia, and hospitalization times with ECD is likely to result in a gain in cost-effectiveness.

Isolated inferior oblique pareses.

To describe etiology, clinical characteristics, radiological features and management of isolated inferior oblique pareses. A diagnosis of inferior oblique paresis was made after a thorough strabismus examination and neuroimaging. The patients were managed surgically with adjustable strabismus surgery, or conservatively. Surgical success was defined as average horizontal deviation within ≤ 10 prism diopters [PD] post-operatively and for vertical deviation, it was ≤ 5 PD, at last follow-up. Seven cases were congenital, 6 cases were bilateral, with esotropia in 6 cases; 'A' pattern in 7 cases and hypotropia in 3 cases. The mean preoperative horizontal deviation was 52.5 PD, and the mean postoperative horizontal deviation was 2.37 PD (p = 0.028). The pre-operative vertical deviation was 18 PD and post-operative vertical deviation was 5 PD. MRI showed reduced IO muscle size; average area being 11.27mm2 in the affected eyes, with normal sized inferior recti (average: 24.63mm2) and medial recti muscles (average: 30.08mm2). Surgical success was seen in all six cases. Average follow-up was 265days. The Parks' three step test was not valid, except for one acquired unilateral case. Isolated pareses of inferior oblique muscle exhibit defective elevation in adduction of the affected eye, 'A' pattern and fundus intorsion, and is confirmed by neuroimaging. These can be successfully managed surgically to correct the deviation.

Outcomes of Lateral Tarsal Strip in Conjunction with a Minimal Skin Muscle Excision Underlying Cauterization in Korean Patients with Involutional Entropion.

We reviewed the medical records of 53 involutional entropion patients, who underwent lateral tarsal strip (LTS) with a minimal skin muscle excision by cauterization from March 2014 to December 2017, to evaluate the effectiveness and efficiency of LTS in conjunction with a minimal skin muscle excision using cautery in patients with involutional entropion. We evaluated the success rate, complications, recurrence rate, and degree of satisfaction of our technique. Of 53 patients, there were 5 bilateral cases for a total of 58 eyelids. The average of age was 71.2 years old (57–90 years). The average follow-up period was 18 months (12–39 months). The success rate for involutional entropion correction was 98.1% with our technique. There was one mild recurrence case at 7 months. In our study, the average operation time was 20.8 min (15–29 min) for 48 unilateral cases and 27.2 min (20–32 min) for 5 bilateral cases without intraoperative complications. Of 42 responders of patients’ satisfaction questionnaire, 38 patients showed good satisfaction and were willing to recommend the surgery to their acquaintances. The technique of LTS with minimal skin excision with cauterization was effective and provided satisfying outcomes to patients with involutional entropion.

Outcomes of Carpal Tunnel Release in Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy/Sudeck Disease Patients.

The clinical features of classic carpal tunnel syndrome are well known. However, some patients who display atypical symptoms and signs of pain and dysesthesias in the hand, worsening of symptoms at night, and above all, inability to make a full fist, respond equally well to carpal tunnel release. This same clinical picture was shared by some patients labeled as having complex regional pain syndrome. Because of the poor outcome of complex regional pain syndrome patients with current regimens, the authors tested the hypothesis that carpal tunnel release could be effective on them. The purpose of this article is to report the outcome of carpal tunnel release in complex regional pain syndrome patients who presented the above signs and symptoms. Fifty-three patients with an average age of 55 years presenting the above cluster of symptoms were operated on. All were unilateral cases, had sustained trauma, and were treated for complex regional pain syndrome before referral for an average of 16 months. All patients underwent carpal tunnel release. At a minimum of 6 months' follow-up, pain dropped 7.5 points on a numerical rating scale of 0 to 10 ( p < 0.001). Disabilities of the Arm, Shoulder and Hand scoring fell from 82 to 17 ( p < 0.001). Six patients had an unsatisfactory result. Some patients with complex regional pain syndrome may respond successfully to a carpal tunnel release operation. Recognition of this possibility is crucial, as the symptoms and signs might lead the clinician away from the proper diagnosis and treatment. Therapeutic, IV.

Automatic surgical phase recognition in laparoscopic inguinal hernia repair with artificial intelligence.

Because of the complexity of the intra-abdominal anatomy in the posterior approach, a longer learning curve has been observed in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. Consequently, automatic tools using artificial intelligence (AI) to monitor TAPP procedures and assess learning curves are required. The primary objective of this study was to establish a deep learning-based automated surgical phase recognition system for TAPP. A secondary objective was to investigate the relationship between surgical skills and phase duration. This study enrolled 119 patients who underwent the TAPP procedure. The surgical videos were annotated (delineated in time) and split into seven surgical phases (preparation, peritoneal flap incision, peritoneal flap dissection, hernia dissection, mesh deployment, mesh fixation, peritoneal flap closure, and additional closure). An AI model was trained to automatically recognize surgical phases from videos. The relationship between phase duration and surgical skills were also evaluated. A fourfold cross-validation was used to assess the performance of the AI model. The accuracy was 88.81 and 85.82%, in unilateral and bilateral cases, respectively. In unilateral hernia cases, the duration of peritoneal incision (p = 0.003) and hernia dissection (p = 0.014) detected via AI were significantly shorter for experts than for trainees. An automated surgical phase recognition system was established for TAPP using deep learning with a high accuracy. Our AI-based system can be useful for the automatic monitoring of surgery progress, improving OR efficiency, evaluating surgical skills and video-based surgical education. Specific phase durations detected via the AI model were significantly associated with the surgeons' learning curve.

Treatment of Congenital Radioulnar Synostosis Using a Free Vascularized Fascia Lata Graft.

ObjectiveTo describe the modified mobilization surgery technique that uses a free vascularized fascia lata graft as the interposition graft, and to evaluate the outcome of this procedure in treating congenital radioulnar synostosis (CRUS).MethodsEleven patients (eight boys and three girls with an average age of 6.0 years) were treated using this procedure between 2012 and 2017 in our institution. Five bilateral cases (four left forearms and one right forearm were treated), and six unilateral cases (three left forearms and three right forearms) were included. All 11 cases were treated with mobilization procedure with free vascularized fascia lata as the interposition graft, and were followed‐up for an average of 2.2 years (range, 2–4 years). The parental satisfaction, postoperative ankylosis at proximal radioulnar joint, and active range of forearm rotation motion (measured by physical examination) were evaluated at the last follow‐up.ResultsThe average preoperative fixed pronation angle was 67.3° (range, 20°–90°). Ipsilateral thumb hypoplasia was noted in one case, and cleft palate and bilateral thumb hypoplasia were noted in one case; none of the patients had a family history of congenital radioulnar synostosis. Pronation and supination splints were used 3 days after the operation and were worn every night for 4–6 months postoperatively. Active and passive rehabilitation for elbow flexion and forearm rotation was initiated 4 weeks postoperatively. All patients were followed up for at least 2 years (average, 26 months; range, 24–48 months). The average forearm pronation range was 39° (range, 20°–60°), and the average forearm supination range was 33.2° (range, 10°–60°) at the latest follow‐up. Re‐ankylosis occurred in one case. An osseous bridge developed between the radius and ulna at the osteotomy site in one case. Radial nerve paralysis developed in two cases and spontaneously resolved 2 months later. Plate breakage was noted in one case 9 weeks postoperatively; however, union was achieved 7 months later.ConclusionMobilization of proximal radioulnar synostosis using a free vascularized fascia lata graft as the interposition graft may prevent re‐ankylosis and restore the forearm rotation function, making it a good option for the surgical treatment of CRUS.

Anteroposterior pelvic radiograph is not sufficient to confirm hip reduction after conservative treatment of developmental dysplasia of the hip.

The purpose of this study was to investigate whether an anteroposterior pelvic radiograph alone is sufficient to confirm hip reduction after conservative treatment or whether MRI could be alternatively performed. A total of 133 children (145 hips) were enrolled. All children were examined by anteroposterior pelvic radiographs and MRI. Three experts interpreted anteroposterior pelvic radiographs and then verified these results on MRI. For patients with inconsistent results between anteroposterior pelvic radiographs and MRI, the continuity of Shenton's line and Calve's line was recorded, and the medial clear space of bilateral hips was measured for unilateral cases. There was complete agreement between the three experts in the interpretation of anteroposterior pelvic radiographs of 111 (76.55%) hips; there was disagreement in the remaining 34 hips, with two experts diagnosing satisfactory reduction in 13 hips and dislocation in 21 hips. Assuming that the judgment of two or more doctors on anteroposterior pelvic radiographs was taken as the final result, 17 hips (11.72%) were misjudged. There was no statistically significant difference between the actual in-position group and the actual dislocation group in terms of the continuity of Shenton's line ( P = 0.62) and Calve's line ( P = 0.10) and the medial clear space of bilateral hips ( P = 0.08). In children less than 1 year of age with developmental dysplasia of the hip treated conservatively, the use of anteroposterior pelvic radiographs alone to judge hip reduction might result in misdiagnosis and missed diagnosis. MRI could be alternatively used to detect hip reduction after conservative treatment, especially when the doctor was not familiar with ultrasound in the presence of plaster.

Autologous cellular therapy for cerebral palsy: a randomized, crossover trial.

We examined an autologous mononuclear-cell-therapy-based approach to treat cerebral palsy using autologous umbilical cord blood or bone-marrow-derived mononuclear cells. The primary objective was to determine if autologous cells are safe to administer in children with cerebral palsy. The secondary objectives were to determine if there was improvement in motor function of patients 12 months after infusion using the Gross Motor Function Measure and to evaluate impact of treatment on corticospinal tract microstructure as determined by radial diffusivity measurement. This Phase 1/2a trial was a randomized, blinded, placebo-controlled, crossover study in children aged 2–10 years of age with cerebral palsy enrolled between November 2013 and November 2016. Participants were randomized to 2:1 treatment:placebo. Treatment was either autologous bone-marrow-derived mononuclear cells or autologous umbilical cord blood. All participants who enrolled and completed their baseline visit planned to return for follow-up visits at 6 months, 12 months and 24 months after the baseline visit. At the 12-month post-treatment visit, participants who originally received the placebo received either bone-marrow-derived mononuclear cell or umbilical cord blood treatment. Twenty participants were included; 7 initially randomized to placebo, and 13 randomized to treatment. Five participants randomized to placebo received bone-marrow-derived mononuclear cells, and 2 received umbilical cord blood at the 12-month visit. None of the participants experienced adverse events related to the stem cell infusion. Cell infusion at the doses used in our study did not dramatically alter motor function. We observed concordant bilateral changes in radial diffusivity in 10 of 15 cases where each corticospinal tract could be reconstructed in each hemisphere. In 60% of these cases (6/10), concordant decreases in bilateral corticospinal tract radial diffusivity occurred post-treatment. In addition, 100% of unilateral corticospinal tract cases (3/3) exhibited decreased corticospinal tract radial diffusivity post-treatment. In our discordant cases (n = 5), directionality of changes in corticospinal tract radial diffusivity appeared to coincide with handedness. There was a significant improvement in corticospinal tract radial diffusivity that appears related to handedness. Connectivity strength increased in either or both pathways (corticio-striatal and thalamo-cortical) in each participant at 12 months post-treatment. These data suggest that both stem cell infusions are safe. There may be an improvement in myelination in some groups of patients that correlate with small improvements in the Gross Motor Function Measure scales. A larger autologous cord blood trial is impractical at current rates of blood banking. Either increased private banking or matched units would be required to perform a larger-scale trial.

The benefits of dual-consultant operating in complex breast reconstruction: A retrospective cohort comparison study

Dual-consultant operating (DCO) has been introduced in a multitude of surgical specialities. This retrospective cohort comparison study seeks to delineate any benefits DCO may confer on list utilisation, patient safety and training opportunities. A retrospective cohort comparison of all free-flap breast reconstruction cases conducted at a single centre by five consultant plastic surgeons in the period May 2016-May 2020. A total of 281 patient records were used for analysis; 146 cases were dual consultants compared with 135 single consultants, representing 186 and 158 free flaps, respectively. Patient demographics were near identical in terms of patient age, BMI and ASA grade. Operating times were significantly reduced for both unilateral (mean reduction 59.49min) and bilateral cases (mean reduction 38.14min) with the presence of dual consultants. The mean length of stay for dual-consultant cases was on average 0.35 days less than for single consultant cases (p=0.04). Dual-consultant case complications were less severe than those of single consultant cases (mean Clavien-Dindo severity 1.35 vs 0.96, p=0.05). The rates of trainee one-to-one consultant training were increased in dual-consultant cases when preparing vessels (0.08 vs 0.35, p=<0.01) and performing anastomosis (0.63 vs 0.77, p=0.03). DCO for complex breast reconstruction confers significant benefits to operating time, list utility and patient safety whilst protecting training opportunities for trainees. Plastic surgery departments looking to redesign services in the post-SARS-CoV-19 era should consider its adoption into their enhanced recovery protocols.

Femtosecond laser-assisted anterior capsulotomy in children undergoing cataract surgery: a large case series

ObjectiveTo evaluate safety and postoperative visual outcomes of low-energy femtosecond laser-assisted (FLA) anterior capsulotomy in paediatric cataract surgery.Methods and analysisWe report a retrospective single-centre consecutive case series of 51 eyes...

MP44-15 EARLY EXPERIENCE WITH VACUUM ASSISTED URETERAL ACCESS SHEATHS

You have accessJournal of UrologyCME1 May 2022MP44-15 EARLY EXPERIENCE WITH VACUUM ASSISTED URETERAL ACCESS SHEATHS Daniel Wong, and Alana Desai Daniel WongDaniel Wong More articles by this author , and Alana DesaiAlana Desai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002610.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Vacuum assisted ureteral access sheaths (V-UAS) have been eagerly adopted with the hopes of improved surgical outcomes. Reports from outside the US have found increased stone free rates, decreased operative times, and decreased infectious complications with V-UAS. However there have been no data published from the US. Herein, we report our findings 1 year after implementation of Clearpetra V-UAS at our institution. METHODS: From May 2020 to September 2021, all unilateral ureteroscopy cases by a single surgeon using a V-UAS (Clearpetra) were retrospectively reviewed. These were compared to matched cases using an institutional database of stone cases from 2016 to May 2020, when Clearpetra became available. Cases were matched based on regular ureteral access sheath use, surgeon, stone burden, preexisting ureteral stent, preoperative UTI, and neurogenic bladder. Outcomes of interest were stone free rate as determined by follow up ultrasound or CT scan within 3 months of procedure and postop infection defined by T >38°C, WBC >12K or <4K, HR >90, or UTI within 30 days of procedure. RESULTS: There were 27 unique V-UAS cases identified. Randomly matched cases were compared for operative time, stone free rate, infectious complications, and 30-day unplanned encounters. There were no differences in any outcomes of interest (Figure 1). CONCLUSIONS: V-UAS performed on par with standard ureteral access sheaths. There was no increase in complication rate or unplanned encounters, indicating V-UAS is a safe treatment option. V-UAS offered no benefit in terms of operative time, stone free rate, or infectious complications in this initial cohort. It remains to be seen whether there is an optimal stone characteristic for V-UAS or whether V-UAS requires an initial learning curve for improvement. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e758 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Wong More articles by this author Alana Desai More articles by this author Expand All Advertisement PDF DownloadLoading ...

The Prevalence of Radix Paramolaris and Entomolaris in Mandibular Molar Teeth: A Retrospective Study

Abstract Objective: The aim of this study is to analyze the frequency of radix paramolaris (RP) and radix entomolaris (RE) in the first and second molars using cone beam computed tomography (CBCT). Materials and Methods: The CBCT images of a total of 400 patients at the ages of 14 to 66 were included in the study. On the images that were included, two maxillofacial radiologists simultaneously examined the presence of radix paramolaris and radix entomolaris by using axial CBCT cross-sections from the pulpal chamber towards the apical. Results: At least one RE or RP was observed in 36 of the 400 patients (9%). A total of 20 RPs (1.25%) were observed, including 2 bilateral and 16 unilateral cases. A total of 38 REs (2.38%) were observed, including 11 bilateral and 16 unilateral cases. There was at least one RE or RP in 16 of the 149 male patients (10.7%) and in 20 of the 251 female patients (8%). Conclusion: Consequently, while the prevalence and types of third root variations differ between different populations, RE is seen more frequently in mandibular first molar teeth, and RP is seen more frequently in mandibular second molar teeth. No significant relationship could be found between sex and the prevalence of third root variations in mandibular molar teeth images included in this study. No significant difference was found between the right and left sides as the localizations of RP and RE in terms of prevalence. Keywords: Radix entomolaris; Radix paramolaris; Root canal morphology; Cone-beam CT; Mandibular molar

Bilateral multifocal central serous retinopathy following mRNA COVID-19 vaccine

We present a case of acute bilateral multifocal CSCR in a young healthy Caucasian female occurring 3 days after receiving the first dose of the Pfizer-BioNTech BNT162b2 COVID-19 mRNA vaccine. The true incidence of this adverse reaction might be underreported in asymptomatic unilateral or paracentral cases. We believe that the post-COVID-19 vaccination occurrence of CSCR is not a sufficient reason to withhold the second dose of the vaccine. Further studies are required to ascertain the best way to prevent and manage this complication.

EFFECTS OF TEMPOROMANDIBULAR JOINT ANKYLOSIS ON DENTITION AND RAMUS HEIGHT

Objective:To determine dentition related problems in patients with TMJ ankylosis and to establish effect of TMJ ankylosis on ramus height.Material and method:This descriptive study was conducted at Khyber College of Dentistry, Peshawar Pakistan, from July 2020 to July 2021. Medical records and Cone beam computed tomography of 20 patients with the diagnosis of temporomandibular joint ankylosis were included in the study.Results: Most of the patients presented with unilateral TMJ ankylosis (n=15, 75%) In unilateral ankylosis, the affected side ramus and body (4.89cm, 7.63cm respectively) were less than the non-affected sides (5.54cm, 8.15cm) respectively. Dentition crowding with malposed teeth was present in all bilateral TMJ ankylosis patients and 9 patients in unilateral cases. Conclusion:This study established the effect of TMJ ankylosis on the dentition and ramus height. The height of the ramus was deficient on the affected side and the erupted teeth were crowded in most of the patients.

Acute macular neuroretinopathy as the first stage of SARS-CoV-2 infection.

IntroductionTo report two cases of Acute Macular Neuroretinopathy (AMN) presented as the first stage of SARS-CoV-2 infection in two European countries during the third wave of pandemic viral infection in the early months of 2021.ObservationsA unilateral case of type 1 AMN in a man and a bilateral case of type 2 AMN in an otherwise heathy patients were reported. Sudden onset of paracentral scotoma characterized the cases with no systemic symptoms. Structural optical coherence tomography (OCT) shows multifocal middle and inner retinal hyperreflective infarctions. OCT-Angiography showed the presence of hypoperfusion of the deep capillary plexus (DCP) corresponding to the hyperreflective lesions visible on structural OCT, confirming the diagnosis.Conclusions and importanceType 1 and type 2 AMN may be the first stage of SARS-CoV-2 infection. We suggest testing all patients with AMN for SARS-CoV-2. In our cases, the natural history of AMN associated with SARS-CoV-2 infection was similar to already described cases of AMN.