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Sample records for underwent percutaneous pedicle

  1. Minimally invasive mini open split-muscular percutaneous pedicle screw fixation of the thoracolumbar spine

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    Murat Ulutaş

    2015-03-01

    Full Text Available We prospectively assessed the feasibility and safety of a new percutaneous pedicle screw (PPS fixation technique for instrumentation of the thoracic and lumbar spine in this study. All patients were operated in the prone position under general anesthesia. A 6 to 8 cm midline skin incision was made and wide sub-cutaneous dissection was performed. The paravertebral muscles were first dissected subperiosteally into the midline incision of the fascia for lumbar microdiscectomy with transforaminal lumbar interbody fusion cage implantation. After the secondary paramedian incisions on the fascia, the PPSs were inserted via cleavage of the multifidus muscles directly into the pedicles under fluoroscopy visualization. A total of 35 patients underwent surgery with this new surgical technique. The control group for operative time, blood loss and analgesic usage consisted of 35 randomly selected cases from our department. The control group underwent surgery via conventional pedicle screw instrumentation with paramedian fusion. All patients in the minimal invasive surgery series were ambulatory with minimal pain on the first postoperative day. The operation time and blood loss and the postoperative analgesic consumption were significantly less with this new technique. In conclusion, the minimal invasive mini open split-muscular percutaneous pedicle screw fixation technique is safe and feasible. It can be performed via a short midline skin incision and can also be combined with interbody fusion, causing minimal pain without severe muscle damage.

  2. EMG-Guided Percutaneous Placement of Cement-Augmented Pedicle Screws for Osteoporotic Thoracolumbar Burst Fractures.

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    Iacopino, Domenico Gerardo; Certo, Francesco; Graziano, Francesca; Basile, Luigi; Gulì, Carlo; Visocchi, Massimiliano; Conti, Alfredo; Maugeri, Rosario

    2017-01-01

    Percutaneous techniques have increasingly gained popularity in recent years. The application of technological innovation, including neuromonitoring techniques, has the potential to increase the safety and efficacy of these procedures. Thirty patients suffering from osteoporotic dorsolumbar burst fracture were prospectively enrolled in this study. The patients underwent percutaneous fenestrated pedicle screw fixation augmented with polymethylmethacrylate (PMMA) injection. A novel surgeon-dedicated neuromonitoring device was used in order to increase the safety and the accuracy of the screw insertion. A second group of 30 patients who did not undergo neuromonitoring during percutaneous pedicle screw placement, matched for demographic characteristics, constituted the control group. A total of 296 screws were inserted. All treated patients had a good outcome, documented by an improvement in visual analogue scale (VAS) scores. Excellent trajectories were achieved in all patients. Cobb's angle and anterior vertebral height were satisfactorily restored in all study group patients. Three misplaced screws in three patients and a case of PMMA leakage without neurological deficits were observed in the control group, whereas no complication was recorded in the study group (p = 0.03). Neuromonitoring in cement-augmented percutaneous pedicle screw placement appears to improve surgeon confidence during surgery, reducing the risk of screw misplacement or cement leakage.

  3. Facet Joint Violation During Percutaneous Pedicle Screw Placement: A Comparison of Two Techniques.

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    Tannous, Oliver; Jazini, Ehsan; Weir, Tristan B; Banagan, Kelley E; Koh, Eugene Y; Greg Anderson, D; Gelb, Daniel E; Ludwig, Steven C

    2017-08-01

    A comparative study of facet joint violation (FJV) using two percutaneous surgical techniques. To compare the rate of iatrogenic FJV and medial pedicle wall breach between two methods of percutaneous pedicle screw instrumentation in the thoracic and lumbar spine. Variable iatrogenic damage to the facet joints has been reported to occur with percutaneous pedicle screw techniques, compared with the open approach, which has been associated with adjacent segment disease. Technical variations of percutaneous pedicle screw placement may pose different risks to the facet joint. Attending spine surgeons percutaneously placed pedicle screws in seven human cadaveric spines from T2 to L5. At each level, screws were instrumented on one side using the 9 or 3 o'clock reference point of the pedicle on the posteroanterior view with a lateral-to-medial trajectory (LMT) and on the contralateral side using the center of the pedicle with an owl's eye trajectory (OET). Postoperative screw placement was assessed with computed tomography and then open cadaveric dissection. Outcome measures included FJV and medial pedicle wall breach. Overall, 17 of 105 screws placed with an LMT versus 49 of 105 screws placed with an OET violated or abutted the facet joint (P L1), and lumbar (L2-L5) levels (P = 0.003, 0.035, and 0.018, respectively). Medial pedicle wall breach occurred with 11 LMT screws and seven OET screws (P = 0.077), and no breach was considered critical. A significantly higher FJV rate was observed using the OET versus the LMT in the thoracic, thoracolumbar, and lumbar spine. No statistically significant differences in medial pedicle wall breach occurred between the techniques. Thus, the LMT of minimally invasive pedicle screw fixation may reduce iatrogenic damage to the facet joints. 3.

  4. Outcomes of percutaneous pedicle screw fixation for spinal trauma and tumours.

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    Mobbs, Ralph J; Park, Ashley; Maharaj, Monish; Phan, Kevin

    2016-01-01

    We investigated the clinical and radiological results of percutaneous pedicle screw fixation in the management of spinal trauma and metastatic tumours. A retrospective analysis was performed on a series of 14 patients who were operated on from March 2009 to November 2011 by a single surgeon (RJM). Following a radiological review (CT scan/MRI), six patients underwent short segment fixation, while the remaining underwent long segment fixation. All patients had routine follow-ups at 4, 6, 12months, and annually thereafter. Clinical examinations were conducted preoperatively and postoperatively, and the length of operation, blood loss, and postoperative pain relief were recorded. There was a single patient with an incision site complication. The mean blood loss was 269mL. All of the parameters demonstrated no significant differences between the trauma and the tumour groups (p=0.10). The neurological power scores improved for all patients, with the largest increase being from a score of 2 to 4. At follow-up, the majority of patients had returned to their previous activities and had reduced pain scores. One patient suffered high pain levels from other medical conditions that were not related to the operation. Minimally invasive pedicle screw fixation is a suitable option for patients with spinal tumours and fractures, with acceptable safety and efficacy in this small retrospective patient series. We have seen favourable results in our patients, who have experienced an increased quality of life following their surgery. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. [Clinical efficacy of unilateral percutaneous transfacet screws combined with contralateral pedicle screw versus bilateral pedicle screws fixation in the treatment of the degenerative lumbar disease].

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    Hao, Rong-Xue; Zhou, Hui; Pan, Hao; Yue, Jun; Chen, Hui-Guo; Yang, He-Jie; Jia, Gao-Yong; Wang, Dong; Lin, Yan; Xu, Hua-Zi

    2017-09-25

    To investigate the surgical outcome of unilateral pedicle screw(UPS) after TLIF technique combined with contralateral percutaneous transfacet screw(PTS) fixation vs bilateral pedicle screws(BPS) fixation in treatment of degenerative lumbar disease. From January 2009 to June 2012, 46 patients with degenerative lumbar diseases, including 30 males and 16 females with an average age of 51.5 years old, who were divided into two groups according to different fixation methods. Twenty-two cases underwent UPS after TLIF technique combined with contralateral PTS fixation (group A), while the others underwent BPS fixation(group B). The relative data were analyzed, such as blood loss volume, operative time, fusion rate, ODI score, JOA score and so on. All the patients were followed up for 1 to 3 years with an average of 22 months. Except one case of each group was uncertainty fusion, the rest have obtained bony fusion, and the fusion rates in group A and B were 95.5% and 95.8%, respectively. No displacement and breakage of screw were found during follow-up. Operative time and blood loss volume in group A were better than of group B( P 0.05). Two approaches had similar clinical outcomes for degenerative lumbar disease with no severe instability. Compared with BPS fixation, the UPS after TLIF technique and contralateral PTS fixation has the advantages of less trauma, shorter operative time and less blood loss, and it is a safe and feasible surgical technique.

  6. Anterior lumbar interbody fusion with percutaneous pedicle screw fixation for multiple-level isthmic spondylolisthesis.

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    Hsieh, Chang-Sheng; Lee, Hyung Chang; Oh, Hyeong-Seok; Park, Sang-Joon; Hwang, Byeong-Wook; Lee, Sang-Ho

    2017-07-01

    Multiple-level lumbar isthmic spondylolisthesis is rarely reported. Here, we report 23 consecutive patients who underwent anterior lumbar interbody fusion (ALIF) with percutaneous pedicle screw fixation (PPF) for multiple-level isthmic spondylolisthesis. From June 2008 through December 2014, multiple-level lumbar isthmic spondylolisthesis was diagnosed in 23 patients (6 men, 17 women) at Wooridul Spine Hospital (Busan, South Korea). Isthmic spondylolisthesis occurred at three spinal levels in 2 patients and at two levels in 21 patients. All patients underwent ALIF with PPF. We used the Oswestry Disability Index (ODI) and visual analog scale scores to evaluate the preoperative and postoperative functional outcome, low back pain, and radicular pain. We also evaluated segmental lordosis and the fusion status using radiographs and data from computed tomography. Isthmic spondylolisthesis occurred from L3 to S1 and mostly occurred at two consecutive spinal levels (i.e., L4-L5 and L5-S1). Significant improvements in the ODI and visual analog scale were observed in patients at final follow up (pspondylolisthesis. Copyright © 2017. Published by Elsevier B.V.

  7. Two-level anterior lumbar interbody fusion with percutaneous pedicle screw fixation. A minimum 3-year follow-up study

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    Lee, Dong-Yeob; Lee, Sang-Ho; Maeng, Dae-Hyeon

    2010-01-01

    The clinical and radiological outcomes of two-level anterior lumbar interbody fusion (ALIF) with percutaneous pedicle screw fixation (PSF) were evaluated in 24 consecutive patients who underwent two level ALIF with percutaneous PSF for segmental instability and were followed up for more than 3 years. Clinical outcomes were assessed using a visual analogue scale (VAS) score and the Oswestry Disability Index (ODI). Sagittal alignment, bone union, and adjacent segment degeneration (ASD) were assessed using radiography and magnetic resonance imaging. The mean age of the patients at the time of operation was 56.3 years (range 39-70 years). Minor complications occurred in 2 patients in the perioperative period. At a mean follow-up duration of 39.4 months (range 36-42 months), VAS scores for back pain and leg pain, and ODI score decreased significantly (from 6.5, 6.8, and 46.9% to 3.0, 1.9, and 16.3%, respectively). Clinical success was achieved in 22 of the 24 patients. The mean segmental lordosis, whole lumbar lordosis, and sacral tilt significantly increased after surgery (from 25.1deg, 39.2deg, and 32.6deg to 32.9deg, 44.5deg, and 36.6deg, respectively). Solid fusion was achieved in 21 patients. ASD was found in 8 of the 24 patients. No patient underwent revision surgery due to nonunion or ASD. Two-level ALIF with percutaneous PSF yielded satisfactory clinical and radiological outcomes and could be a useful alternative to posterior fusion surgery. (author)

  8. Accuracy of bone SPECT/CT for identifying hardware loosening in patients who underwent lumbar fusion with pedicle screws

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    Hudyana, Hendrah; Maes, Alex [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); University Hospital Leuven, Department of Morphology and Medical Imaging, Leuven (Belgium); Vandenberghe, Thierry; Fidlers, Luc [AZ Groeninge, Department of Neurosurgery, Kortrijk (Belgium); Sathekge, Mike [University of Pretoria, Department of Nuclear Medicine, Pretoria (South Africa); Nicolai, Daniel [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); Wiele, Christophe van de [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); University Ghent, Department of Radiology and Nuclear Medicine, Ghent (Belgium)

    2016-02-15

    The aim of this retrospective study was to evaluate the accuracy of bone SPECT (single photon emission computed tomography)/CT (computed tomography) in diagnosing loosening of fixation material in patients with recurrent or persistent back pain that underwent lumbar arthrodesis with pedicle screws using surgery and clinical follow-up as gold standard A total of 48 patients (median age 49 years, range 21-81 years; 17 men) who had undergone lumbar spinal arthrodesis were included in this retrospective analysis. SPECT/CT results were compared to the gold standard of surgical evaluation or clinical follow-up. Positive SPECT/CT results were considered true positives if findings were confirmed by surgery or if clinical and other examinations were completely consistent with the positive SPECT/CT finding. They were considered false positives if surgical evaluation did not find any loose pedicle screws or if symptoms subsided with non-surgical therapy. Negative SPECT/CT scans were considered true negatives if symptoms either improved without surgical intervention or remained stable over a minimum follow-up period of 6 months. Negative SPECT/CT scans were determined to be false negatives if surgery was still required and loosening of material was found. The median length of time from primary surgery to bone SPECT/CT referral was 29.5 months (range 12-192 months). Median follow-up was 18 months (range 6-57) for subjects who did not undergo surgery. Thirteen of the 48 patients were found to be positive for loosening on bone SPECT/CT. Surgical evaluation (8 patients) and clinical follow-up (5 patients) showed that bone SPECT/CT correctly predicted loosening in 9 of 13 patients, while it falsely diagnosed loosening in 4 patients. Of 35 negative bone SPECT/CT scans, 12 were surgically confirmed. In 18 patients, bone SPECT/CT revealed lesions that could provide an alternative explanation for the symptoms of pain (active facet degeneration in 14 patients, and disc and sacroiliac

  9. Percutaneous pedicle screw reduction and axial presacral lumbar interbody fusion for treatment of lumbosacral spondylolisthesis: A case series

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    Miller Larry E

    2011-09-01

    Full Text Available Abstract Introduction Traditional surgical management of lumbosacral spondylolisthesis is technically challenging and is associated with significant complications. The advent of minimally invasive surgical techniques offers patients treatment alternatives with lower operative morbidity risk. The combination of percutaneous pedicle screw reduction and an axial presacral approach for lumbosacral discectomy and fusion offers an alternative procedure for the surgical management of low-grade lumbosacral spondylolisthesis. Case presentation Three patients who had L5-S1 grade 2 spondylolisthesis and who presented with axial pain and lumbar radiculopathy were treated with a minimally invasive surgical technique. The patients-a 51-year-old woman and two men (ages 46 and 50-were Caucasian. Under fluoroscopic guidance, spondylolisthesis was reduced with a percutaneous pedicle screw system, resulting in interspace distraction. Then, an axial presacral approach with the AxiaLIF System (TranS1, Inc., Wilmington, NC, USA was used to perform the discectomy and anterior fixation. Once the axial rod was engaged in the L5 vertebral body, further distraction of the spinal interspace was made possible by partially loosening the pedicle screw caps, advancing the AxiaLIF rod to its final position in the vertebrae, and retightening the screw caps. The operative time ranged from 173 to 323 minutes, and blood loss was minimal (50 mL. Indirect foraminal decompression and adequate fixation were achieved in all cases. All patients were ambulatory after surgery and reported relief from pain and resolution of radicular symptoms. No perioperative complications were reported, and patients were discharged in two to three days. Fusion was demonstrated radiographically in all patients at one-year follow-up. Conclusions Percutaneous pedicle screw reduction combined with axial presacral lumbar interbody fusion offers a promising and minimally invasive alternative for the management

  10. The Use of Percutaneous Lumbar Fixation Screws for Bilateral Pedicle Fractures with an Associated Dislocation of a Lumbar Disc Prosthesis

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    William D. Harrison

    2013-01-01

    Full Text Available Study Design. Case report. Objective. To identify a safe technique for salvage surgery following complications of total disc replacement. Summary of Background Data. Lumbar total disc replacement (TDR is considered by some as the gold standard for discogenic back pain. Revision techniques for TDR and their complications are in their infancy. This case describes a successful method of fixation for this complex presentation. Methods and Results. A 48-year-old male with lumbar degenerative disc disease and no comorbidities. Approximately two weeks postoperatively for a TDR, the patient represented with acute severe back pain and the TDR polyethylene inlay was identified as dislocated anteriorly. Subsequent revision surgery failed immediately as the polyethylene inlay redislocated intraoperatively. Further radiology identified bilateral pedicle fractures, previously unseen on the plain films. The salvage fusion of L5/S1 reutilized the anterior approach with an interbody fusion cage and bone graft. The patient was then turned intraoperatively and redraped. The percutaneous pedicle screws were used to fix L5 to the sacral body via the paracoccygeal corridor. Conclusion. The robust locking screw in the percutaneous screw allowed a complete fixation of the pedicle fractures. At 3-year followup, the patient has an excellent result and has returned to playing golf.

  11. Robot assisted navigated drilling for percutaneous pedicle screw placement: A preliminary animal study

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    Hongwei Wang

    2015-01-01

    Conclusions: The preliminary study supports the view that computer assisted pedicle screw fixation using spinal robot is feasible and the robot can decrease the intraoperative fluoroscopy time during the minimally invasive pedicle screw fixation surgery. As spine robotic surgery is still in its infancy, further research in this field is worthwhile especially the accuracy of spine robot system should be improved.

  12. Treatment of degenerative lumbar spondylolisthesis by using minimally invasive transforaminal lumbar interbody fusion and percutaneous pedicle screw fixation

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    Hao WU

    2016-04-01

    Full Text Available Objective To discuss clinical therapeutic effects of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF combined with percutaneous pedicle screw fixation for degenerative lumbar spondylolisthesis (DLS.  Methods A total of 32 DLS patients treated by MIS-TLIF and percutaneous pedicle screw fixation from January 2013 to September 2015 in Xuanwu Hospital, Capital Medical University were retrospectively reviewed. Visual Analogue Scale (VAS, Oswestry Disability Index (ODI and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36 scores were assessed and compared between preoperation and one week, 3 months after operation and in the last follow-up. Lumbar lordosis angle, coronal Cobb angle, coronal and sagittal body shifting, complication, the degree of spondylolisthesis (Meyerding classification and the rate of spondylolisthesis were measured according to preoperative and postoperative spinal X-ray examination. Fusion rate was evaluated according to X-rays or CT in the last follow-up, and MRI was used to assess the degree of decompression.  Results Thirty-two patients were under test with mean operation time 160 min, intraoperative blood loss 120 ml, postoperative hospital stay 7.22 d and follow-up 10.83 months. Decompression and fusion levels ranged from L2-S1 and interbody fusion was performed in 32 patients and 41 levels were fused. Compared with preoperation, the VAS and ODI scores were significantly increased at one week, 3 months after operation and in the last follow-up (P = 0.000, for all, while SF-36 score (P = 0.002, 0.000, 0.000, lumbar lordotic angle (P = 0.000, for all, coronal Cobb angle (P = 0.000, for all and slippage rate (P = 0.000, for all were significantly decreased. The fusion rate was 92.22%, and the improvement rate of ODI was (80.51 ± 6.02% in the last follow-up. There were 3 cases appeared complications, including one case of infection and 2 cases of cerebrospinal fluid (CSF fistula, and were

  13. Percutaneous posterior combined C2 translaminar and pedicle screws using Intraoperative O-arm Navigation in an atypical traumatic spondylolisthesis: Technical notes

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    Peter Douglas Klassen

    2017-09-01

    Conclusions: Percutaneous translaminar and pedicle screws stabilization in complex hangman's fractures using Intraoperative O-arm Navigation is a treatment option, provides a rapid return to normal life activity among patients who refuse the external immobilization or present difficult to apply external immobilization.

  14. Percutaneous kyphoplasty and pedicle screw fixation for the management of thoraco-lumbar burst fractures

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    Fuentes, Stéphane; Blondel, Benjamin; Metellus, Philippe; Gaudart, Jean; Adetchessi, Tarek; Dufour, Henry

    2010-01-01

    The study design includes prospective evaluation of percutaneous osteosynthesis associated with cement kyphoplasty on 18 patients. The objective of the study is to assess the efficacy of a percutaneous method of treating burst vertebral fractures in patients without neurological deficits. Even if burst fractures are frequent, no therapeutic agreement is available at the moment. We report in this study the results at 2 years with a percutaneous approach for the treatment of burst fractures. 18...

  15. Prognostic Impact of the Geriatric Nutritional Risk Index on Long-Term Outcomes in Patients Who Underwent Percutaneous Coronary Intervention.

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    Wada, Hideki; Dohi, Tomotaka; Miyauchi, Katsumi; Doi, Shinichiro; Naito, Ryo; Konishi, Hirokazu; Tsuboi, Shuta; Ogita, Manabu; Kasai, Takatoshi; Hassan, Ahmed; Okazaki, Shinya; Isoda, Kikuo; Suwa, Satoru; Daida, Hiroyuki

    2017-06-01

    Malnutrition has been identified as an important predictor of poor clinical outcomes in patients with heart failure. The aim of this study is to examine the prognostic impact of nutritional status in patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI). The impact of nutrition, assessed using the geriatric nutritional risk index (GNRI) calculated by serum albumin and body mass index, was evaluated in 2,853 patients with CAD who underwent their first PCI between 2000 and 2011. Patients were assigned to tertiles based on their GNRI levels. The incidences of all-cause death and cardiac death were assessed. The median GNRI values were 101 (interquartile range 95 to 106). Lower GNRI levels were associated with older age and higher prevalence of acute coronary syndrome and chronic kidney disease. During the median follow-up period of 7.4 years, Kaplan-Meier curves showed ongoing divergence in rates of mortality among tertiles (GNRI nutritional status was associated with long-term clinical outcomes in CAD patients after PCI. Evaluation of GNRI carries important prognostic information and may guide the therapeutic approach to such patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Clinical study on minimally invasive transforaminal lumbar interbody fusion combined with percutaneous pedicle screw fixation for degenerative lumbar scoliosis

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    Hao WU

    2016-04-01

    Full Text Available Objective To discuss the operative essentials and therapeutic effects of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF combined with percutaneous pedicle screw fixation for degenerative lumbar scoliosis (DLS.  Methods A total of 17 DLS patients without prior spinal diseases were treated by MIS-TLIF and percutaneous pedicle screw fixation from January 2013 to September 2015 in Xuanwu Hospital, Capital Medical University. The operation time, intraoperative blood loss, hospital stay, and postoperative complication were recorded in each patient. Visual Analogue Scale (VAS and Oswestry Disability Index (ODI were used to evaluate postoperative improvement of low back and leg pain, and clinical effects were assessed according to Medical Outcome Study 36-Item Short-Form Health Survey (SF-36. Coronal Cobb angle, sagittal lordosis angle and spinal deviation distances on coronal and sagittal plane were measured before operation, one week, 3 months after operation and in the last follow-up in spinal full-length X-ray examination. Fusion rate was calculated according to X-ray or CT scan, and the degree of decompression was evaluated by MRI.  Results Decompression and fusion levels ranged from T12-S1 vertebrae, and interbody fusion was performed in 17 patients and 56 levels were fused. Average operation time was 200 min (180-300 min, intraoperative blood loss was 320 ml (200-1000 ml and hospital stay was 8.21 d (5-12 d. All patients were followed-up for 12.13 months (5-24 months. Compared with preoperation, VAS (P = 0.000, for all and ODI scores (P = 0.000, for all decreased significantly, SF-36 score increased (P = 0.000, for all, coronal Cobb angle (P = 0.000, for all, sagittal lordosis angle (P = 0.000, for all, coronal and sagittal deviation (P = 0.000, for all decreased significantly one week and 3 months after operation and in the last follow-up. The improvement rate of ODI was (86.51 ± 6.02%, fusion rate of vertebral bodies

  17. Congenital hypoplasia of the lumbar pedicle with spondylolisthesis: report of 2 cases.

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    Hsieh, Chang-Sheng; Lee, Sang-Ho; Lee, Hyung Chang; Oh, Hyeong-Seok; Hwang, Byeong-Wook; Park, Sang-Joon; Chen, Jian-Han

    2017-04-01

    Congenital hypoplasia of the spinal pedicle is a rare condition. Previously reported cases were treated conservatively or with posterior instrumented fusion. However, the absence or hypoplasia of the lumbar pedicle may increase the difficulty of pedicle screw fixation and fusion. Herein, the authors describe 2 cases of rare adult congenital hypoplasia of the right lumbar pedicles associated with spondylolisthesis. The patients underwent anterior lumbar interbody fusion with a stand-alone cage as well as percutaneous pedicle screw fixation. This method was used to avoid the difficulties associated with pedicle screw fixation and to attain solid fusion. Both patients achieved satisfactory outcomes after a minimum of 2 years of follow-up. This method may be an alternative for patients with congenital hypoplasia of the lumbar spinal pedicle.

  18. Robot guidance for percutaneous minimally invasive placement of pedicle screws for pyogenic spondylodiscitis is associated with lower rates of wound breakdown compared to conventional fluoroscopy-guided instrumentation.

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    Alaid, Awad; von Eckardstein, Kajetan; Smoll, Nicolas Roydon; Solomiichuk, Volodymyr; Rohde, Veit; Martinez, Ramon; Schatlo, Bawarjan

    2018-04-01

    Postoperative wound healing can pose a problem in patients undergoing instrumented surgery for pyogenic spondylodiscitis. Robotic guidance allows the minimally invasive placement of pedicle screws in the thoracolumbar spine. We assessed whether using this technique to perform minimally invasive surgery had an impact on wound healing in patients with pyogenic spondylodiscitis when compared to conventional open fluoroscopy-guided surgery. We reviewed charts of 206 consecutive patients who underwent instrumentation for pyogenic spondylodiscitis. The need for wound revision was the primary outcome measure. Patient variables and comorbidities as well as surgical technique (robotic versus fluoroscopy-guided) were analyzed. We also compared fluoroscopy times between the two groups. Multivariate regression analysis was performed to identify predictors of wound breakdown. A total of 206 patients underwent surgery for spondylodiscitis. Robotic surgical assistance was used for percutaneous instrumentation in 47.6% of cases (n = 98). Wound healing problems requiring revision occurred in 30 out of 206 patients (14.6%). Univariate analysis revealed a potential association of wound breakdown with (1) robotic technique, (2) age > 70 years, and (3) the presence of methicillin-resistant Staphylococcus aureus. After multivariate correction however, only robotic technique retained significance with an odds ratio of 0.39 (CI 95% 0.16-0.94; p = 0.035). Wound revision was required in eight out of 98 patients (8.1%) in the robot group and 22/108 (20%) in the conventional surgery group. Fluoroscopy times were significantly lower in the robot group with a mean of 123 ± 86 s in comparison with a mean of 157 ± 99 s in the conventional group (p = 0.014). While initially designed to improve the accuracy of pedicle screw placement, robot-assisted minimally invasive technique had a tangible effect on both radiation exposure and the rate of wound breakdown in patients with pyogenic

  19. Long-term prognosis and clinical characteristics of young adults (≤40 years old) who underwent percutaneous coronary intervention.

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    Konishi, Hirokazu; Miyauchi, Katsumi; Kasai, Takatoshi; Tsuboi, Shuta; Ogita, Manabu; Naito, Ryo; Katoh, Yoshiteru; Okai, Iwao; Tamura, Hiroshi; Okazaki, Shinya; Daida, Hiroyuki

    2014-09-01

    Limited data exist regarding the long-term prognosis of percutaneous coronary intervention (PCI) in young adults. The aim of this study was to retrospectively assess the long-term clinical outcomes in young patients who underwent PCI. Between 1985 and 2011, 7649 consecutive patients underwent PCI, and data from 69 young adults (age ≤40 years) and 4255 old adults (age ≧65 years) were analyzed. A Cox proportional hazards regression analysis was used to determine the independent predictors of a composite endpoint that included all-cause death and acute coronary syndrome (ACS) during the follow-up period. The mean age of the 69 young patients was 36.1±4.9 years, and 96% of them were men. Approximately 30% were current smokers, and their body mass index (BMI) was 26.7±5.0kg/m(2). The prevalence of diabetes and hypertension was 33% and 48%, respectively. All patients had ≥1 conventional cardiovascular risk factor. At a median follow-up of 9.8 years, the overall death rate was 5.8%, and new-onset ACS occurred in 8.7%. Current smoking was an independent predictor of the composite endpoint (hazard ratio 4.46, confidence interval 1.08-19.1, p=0.04) for young adults. Current smoking and obesity (high BMI) are the important clinical characteristics in young Japanese coronary heart disease patients who undergo PCI. The long-term prognosis in young patients is acceptable, but current smoking is a significant independent predictor of death and the recurrence of ACS in young Japanese coronary heart disease patients who are obese. Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  20. [The shor-term clinical outcomes and safety of extreme lateral interbody fusion combined with percutaneous pedicle screw fixation for the treatment of degenerative lumbar disease].

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    Hu, Xu-Dong; Ma, Wei-Hu; Jiang, Wei-Yu; Ruan, Chao-Yue; Chen, Yun-Lin

    2017-02-25

    To evaluate the early efficacy and safety of extreme lateral interbody fusion (XLIF) combined with percutaneous pedicle screw fixation for lumbar degenerative disease. From January 2013 to June 2014, 13 patients with degenerative lumbar disease were treated with XLIF combined with percutaneous pedicle screw fixation, including 8 cases of lumbar instability, 5 cases of mild to moderate lumbar spondylolisthesis;there were 5 males and 8 females, aged from 56 to 73 years with an average of 62.1 years. All patients were single segment fusion. Operation time, perioperative bleeding and perioperative complications were recorded. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the clinical efficacy. Interbody fusion rate was observed and the intervertebral foramen area changes were compared preoperation and postoperation by X-rays and CT scanning. The mean operation time and perioperative bleeding in the patients respectively was(62.8±5.2) min and(82.5±22.6) ml. One case occurred in the numbness of femoribus internus and 1 case occurred in the muscle weakness of hip flexion after operation, both of them recovered within 2 weeks. All the patients were followed up from 12 to 19 months with an average of 15.6 months. VAS was decreased from preoperative 7.31±0.75 to 2.31±0.75 at final follow-up( P degenerative disease.

  1. The Effect and Feasibility Study of Transforaminal Percutaneous Endoscopic Lumbar Discectomy Via Superior Border of Inferior Pedicle Approach for Down-Migrated Intracanal Disc Herniations.

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    Ying, Jinwei; Huang, Kelun; Zhu, Minyu; Zhou, Beibei; Wang, Yu; Chen, Bi; Teng, Honglin

    2016-02-01

    Transforaminal percutaneous endoscopic lumbar discectomy (PELD) is gradually regarded as an effective alternative to posterior open surgery. However, migrated herniations bring a great technical challenge even for experienced surgeons due to the absence of the appropriate approaching guideline. We aimed to describe a safe and effective approaching technique for the removal of down-migrations on the basis of the clinical outcomes and complications compared with the conventional approaching method.A total of 45 patients recommended to single-level PELD with foraminoplasty were randomly divided into 2 groups, group A received foraminoplasty via upper border of inferior pedicle, group B was approached through the common transforaminal route. The clinical outcomes were evaluated by Visual Analog Scale (VAS) for leg pain and Oswestry Disability Index (ODI) scores. Then participants were classified into 2 types of migrations (high-grade and low-grade) based on the extent of migration presented on preoperative magnetic resonance imaging (MRI). The various comparisons between the 2 surgical techniques were analyzed.The postoperative VAS and ODI scores significantly decreased in both of the 2 groups after surgery (P border of inferior pedicle can serve as a safe and effective minimally invasive technique for removal of down-migrated herniations. Furthermore, it is essential to identify the radiologic characteristics so as to choose the most appropriate approaching technique.

  2. Comparison of quality of life between men and women who underwent Transforaminal Percutaneous Endoscopic Discectomy for lumbar disc herniation.

    Science.gov (United States)

    Kapetanakis, Stylianos; Gkasdaris, Grigorios; Thomaidis, Tryfon; Charitoudis, Georgios; Kazakos, Konstantinos

    2017-01-01

    Studies describing the efficacy of TPED on shortness of recovery and improvement of postoperative quality of life are limited, especially regarding gender something that has never been reported before in the literature. The purpose of this study is to evaluate possible differences of the health-related quality of life in patients who underwent TPED for LDH in accordance with sex. Seventy-six patients diagnosed and treated with TPED for LDH with 1 year follow-up were selected and divided into two groups of equal number depending on sex. Their quality of life was evaluated by using the SF-36 before the operation, six weeks, three, six and twelve months postoperatively. A statistical analysis was conducted, in order to compare the 8 scaled scores of the SF-36 combining each time two chronological phases in the total of patients, in each group and between groups. Fifty-two (68.4%) patients were ≤63 years old, while the rest 24 (31,4%) were >63 years old (mean ±SD = 56,5 ±12,1 years). Apart from the PF domain, the scores were higher in every visit for the two groups, but the change between groups was not significant. Women had a significantly higher increase of PF score in 3 months after TPED and in the interval 6 weeks-3 months comparing with men. However, in the intervals 3 months-6 months and 3 months-12 months men presented significantly higher increase compared to women. Statistically significant improvement of the quality of life for both men and women was observed. Generally, there was no significant difference between the two groups. As regards to the physical functioning, it appears to be a significant difference which is counterpoised over time. 2. TPED for LDH does not present major differences in the improvement of quality of life regarding gender.

  3. A New Risk Factor Profile for Contrast-Induced Acute Kidney Injury in Patients Who Underwent an Emergency Percutaneous Coronary Intervention.

    Science.gov (United States)

    Yuan, Ying; Qiu, Hong; Song, Lei; Hu, Xiaoying; Luo, Tong; Zhao, Xueyan; Zhang, Jun; Wu, Yuan; Qiao, Shubin; Yang, Yuejin; Gao, Runlin

    2017-01-01

    We developed a new risk factor profile for contrast-induced acute kidney injury (CI-AKI) under a new definition in patients who underwent an emergency percutaneous coronary intervention (PCI). Consecutive patients (n = 1061) who underwent an emergency PCI were divided into a derivation group (n = 761) and a validation group (n = 300). The rates of CI-AKI were 23.5% (definition 1: serum creatinine [SCr] increase ≥25% in 72 hours), 4.3% (definition 2: SCr increase ≥44.2 μmol/L in 72 hours), and 7.0% (definition 3: SCr increase ≥44.2 μmol/L in 7 days). Due to the high sensitivity of definition 1 and the high rate of missed cases for late diagnosis of CI-AKI under definition 2, definition 3 was used in the study. The risk factor profile included body surface area 15.00 × 10 9 /L ( P = .047), estimated glomerular filtration rate 133 μmol/L ( P = .007), intra-aortic balloon pump application ( P = .006), and diuretics administration ( P < .001), showing a significant predictive power in the derivation group and validation group. The new risk factor profile of CI-AKI under a new CI-AKI definition in emergency PCI patients is easily applicable with a useful predictive value.

  4. Impact of high-density lipoprotein 3 cholesterol subfraction on periprocedural myocardial injury in patients who underwent elective percutaneous coronary intervention.

    Science.gov (United States)

    Harada, Kazuhiro; Kikuchi, Ryosuke; Suzuki, Susumu; Tanaka, Akihito; Aoki, Toshijiro; Iwakawa, Naoki; Kojima, Hiroki; Hirayama, Kenshi; Mitsuda, Takayuki; Sumi, Takuya; Negishi, Yosuke; Ishii, Hideki; Murohara, Toyoaki

    2018-02-02

    Periprocedural myocardial injury (PMI) is a major complication of percutaneous coronary intervention (PCI) and is associated with atherosclerotic coronary plaque and worse clinical outcomes. High-density lipoprotein cholesterol (HDL-C) is a protective factor for cardiovascular disease. However, the role of HDL-C subfractions, such as HDL2 cholesterol (HDL2-C) or HDL3 cholesterol (HDL3-C), in cardiovascular disease remains unclear. The purpose of the study was to investigate the relationship between HDL2-C and HDL3-C subfractions and the incidence of PMI in patients who underwent elective PCI. We enrolled 129 patients who underwent elective PCI for stable angina pectoris. PMI was defined as an increase in high-sensitivity troponin T levels > 5 times the upper normal limit (> 0.070 ng/mL) at 24 h after PCI. Serum HDL-C subfractions (HDL2-C and HDL3-C) were assessed using ultracentrifugation in patients with and those without PMI. HDL3-C levels were significantly lower in patients with PMI than in those without (15.1 ± 3.0 mg/dL vs. 16.4 ± 2.9 mg/dL, p = 0.016) and had an independent and inverse association with PMI (odds ratio, 0.86; 95% confidence interval, 0.74-0.99; p = 0.038). When divided by the cut-off value of HDL3-C for PMI (14.3 mg/dL), the incidence of PMI was significantly higher in low HDL3-C patients than in high HDL3-C patients (51.2% vs. 30.2%, p = 0.020). HDL3-C was an independent inverse predictor of PMI in patients who underwent elective PCI.

  5. Spine Navigation Based on 3-Dimensional Robotic Fluoroscopy for Accurate Percutaneous Pedicle Screw Placement: A Prospective Study of 66 Consecutive Cases.

    Science.gov (United States)

    Fomekong, Edward; Safi, Salah Edine; Raftopoulos, Christian

    2017-12-01

    Minimally invasive spine surgery is associated with obstructed visibility of anatomic landmarks and increased radiation exposure, leading to higher incidence of pedicle screw mispositioning. To address these drawbacks, intraoperative 3-dimensional fluoroscopy (io3DF) and navigation are being increasingly used. We aimed to present our dedicated multifunctional hybrid operating room (HyOR) setup and evaluate the accuracy and safety of io3DF image-guided spinal navigation in transforaminal lumbar interbody fusion with percutaneous pedicle screw (PPS) placement. The HyOR includes a fixed 3D multiaxis robotic fluoroscopy arm that moves automatically to the preprogrammed position when needed. An initial io3DF assessment is performed to collect intraoperative images, which are automatically transferred into the navigation system. These data are used to calibrate the PPSs and insert them under computer-assisted navigation. A second io3DF is performed for verifying PPS position. Between January 2014 and December 2016, 66 consecutive patients (age, 58.6 ± 14.1 years) were treated for refractory lumbar degenerative pain. Seventy-three spinal levels were treated, and 276 screws were placed, with 4.2 ± 0.76 screws per patient. There was no measurable radiation to the HyOR staff, whereas the mean radiation dose per patient was 378.3 μGym 2 . The overall accuracy rate of PPS placement was 99.6%. There were no significant procedure-related complications. Spine navigation based on io3DF images enabled us to avoid radiation exposure to the operating room team while delivering minimal but sufficient radiation doses to our patients. This approach achieved an accuracy rate of 99.6% for PPS placement in the safe zone, without significant complications. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Percutaneous Anterior Column Fixation for Acetabulum Fractures, Does It Have to Be Difficult?-The New Axial Pedicle View of the Anterior Column for Percutaneous Fixation.

    Science.gov (United States)

    Zhang, Lihai; Zhang, Wei; Mullis, Brian; Liu, Daohong; Xiong, Qi; Lv, Houchen; Ji, Xinran; Peng, Ye; Tang, Peifu

    2016-01-01

    Anterior column percutaneous screw fixation can be challenging. The purpose of this new technique is to offer a rapid, simple, and safe method to place an anterior screw. The authors used a 3-dimensional reconstruction simulation, cadaver study, and a clinical case series to demonstrate this new alternative to standard previously described techniques.

  7. Acute myocardial infarction in progressively elderly patients. A comparative analysis of immediate results in patients who underwent primary percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Luiz Alberto Mattos

    2001-01-01

    Full Text Available OBJECTIVE: Analysis of the in-hospital results, in progressively elderly patients who undergo primary percutaneous coronary intervention (PCI in the first 24 hours of AMI. METHODS: The patients were divided into three different age groups (60/69, 70/79, and > or = 80 years and were treated from 7/95 until 12/99. The primary success rate and the occurrence of major clinical events were analyzed at the end of the in-hospital phase. Coronary stent implantation and abciximab use were employed at the intervencionist discretion. RESULTS: We analyzed 201 patients with age ranging from 60 to 93 years, who underwent primary PCI. Patients with ages above 70 were more often female (p=.015. Those with ages above 80 were treated later with PCI (p=.054, and all of them presented with total occlusion of the infarct-related artery. Coronary stents were implanted in 30% of the patients. Procedural success was lower in > or = 80 year old patients (p=.022, and the death rate was higher in > or = 70 years olds (p=.019. Reinfarction and coronary bypass surgery were uncommon events. A trend occurred toward a higher combined incidence of major in-hospital events according to increased age (p=.064. CONCLUSION: Elderly patients ( > or = 70 years presented with adverse clinical and angiographic profiles and patients > or = 80 years of age obtained reduced TIMI 3 flow success rates after primary PTCA, and those > or = 70 years had a higher death rate.

  8. Acute myocardial infarction in progressively elderly patients. A comparative analysis of immediate results in patients who underwent primary percutaneous coronary intervention.

    Science.gov (United States)

    Mattos, L A; Zago, A; Chaves, A; Pinto, I; Tanajura, L; Staico, R; Centemero, M; Feres, F; Maldonado, G; Cano, M; Abizaid, A; Abizaid, A; Sousa, A G; Sousa, J E

    2001-01-01

    Analysis of the in-hospital results, in progressively elderly patients who undergo primary percutaneous coronary intervention (PCI) in the first 24 hours of AMI. The patients were divided into three different age groups (60/69, 70/79, and > or =80 years) and were treated from 7/95 until 12/99. The primary success rate and the occurrence of major clinical events were analyzed at the end of the in-hospital phase. Coronary stent implantation and abciximab use were employed at the interventionist discretion. We analyzed 201 patients with age ranging from 60 to 93 years, who underwent primary PCI. Patients with ages above 70 were more often female (p=.015). Those with ages above 80 were treated later with PCI (p=.054), and all of them presented with total occlusion of the infarct-related artery. Coronary stents were implanted in 30% of the patients. Procedural success was lower in > or =80 year old patients (p=.022), and the death rate was higher in > or =70 years olds (p=.019). Reinfarction and coronary bypass surgery were uncommon events. A trend occurred toward a higher combined incidence of major in-hospital events according to increased age (p=.064). Elderly patients (> or =70 years) presented with adverse clinical and angiographic profiles and patients > or =80 years of age obtained reduced TIMI 3 flow success rates after primary PTCA, and those > or =70 years had a higher death rate.

  9. Clinical impacts of inhibition of renin-angiotensin system in patients with acute ST-segment elevation myocardial infarction who underwent successful late percutaneous coronary intervention.

    Science.gov (United States)

    Park, Hyukjin; Kim, Hyun Kuk; Jeong, Myung Ho; Cho, Jae Yeong; Lee, Ki Hong; Sim, Doo Sun; Yoon, Nam Sik; Yoon, Hyun Ju; Hong, Young Joon; Kim, Kye Hun; Park, Hyung Wook; Kim, Ju Han; Ahn, Youngkeun; Cho, Jeong Gwan; Park, Jong Chun; Kim, Young Jo; Cho, Myeong Chan; Kim, Chong Jim

    2017-01-01

    Successful percutaneous coronary intervention (PCI) of the occluded infarct-related artery (IRA) in latecomers may improve long-term survival mainly by reducing left ventricular remodeling. It is not clear whether inhibition of renin-angiotensin system (RAS) brings additional better clinical outcomes in this specific population subset. Between January 2008 and June 2013, 669 latecomer patients with acute ST-segment elevation myocardial infarction (STEMI) (66.2±12.1 years, 71.0% males) in Korea Acute Myocardial Infarction Registry (KAMIR) who underwent a successful PCI were enrolled. The study population underwent a successful PCI for a totally occluded IRA. They were divided into two groups according to whether they were prescribed RAS inhibitors at the time of discharge: group I (RAS inhibition, n=556), and group II (no RAS inhibition, n=113). During the one-year follow-up, major adverse cardiac events (MACE), which consist of cardiac death and myocardial infarction, occurred in 71 patients (10.6%). There were significantly reduced incidences of MACE in the group I (hazard ratio=0.34, 95% confidence interval 0.199-0.588, p=0.001). In subgroup analyses, RAS inhibition was beneficial in patients with male gender, history of hypertension or diabetes mellitus, and even in patients with left ventricular ejection fraction (LVEF) ≥40%. In the baseline and follow-up echocardiographic data, benefit in changes of LVEF and left ventricular end-systolic volume was noted in group I. In latecomers with STEMI, RAS inhibition improved long-term clinical outcomes after a successful PCI, even in patients with low risk who had relatively preserved LVEF. Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  10. Outcome of Triple Antiplatelet Therapy Including Cilostazol in Elderly Patients with ST-Elevation Myocardial Infarction who Underwent Primary Percutaneous Coronary Intervention: Results from the INTERSTELLAR Registry.

    Science.gov (United States)

    Jang, Ho-Jun; Park, Sang-Don; Park, Hyun Woo; Suh, Jon; Oh, Pyung Chun; Moon, Jeonggeun; Lee, Kyounghoon; Kang, Woong Chol; Kwon, Sung Woo; Kim, Tae-Hoon

    2017-06-01

    Compared with dual antiplatelet therapy including aspirin and clopidogrel, triple antiplatelet therapy including cilostazol has a mortality benefit in patients with ST-segment elevation myocardial infarction. However, whether the mortality benefit persists in elderly patients is not clear. From 2007 to 2014, 1278 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention were retrospectively analyzed. The patients were divided into four groups by age (elderly, respectively) and antiplatelet strategy (triple or dual antiplatelet therapy). We compared the mortality rates between the triple and dual antiplatelet therapy groups. There were 1052 (male, 85%; mean age, 56.3 ± 10.4 years) patients in the young group and 241 (male, 52.7%; mean age, 80.3 ± 4.5 years) patients in the elderly group. In the young and elderly groups, 220 (20.9%) and 28 (12.3%) patients were treated with triple antiplatelet therapy. During a 1-year follow-up period, 80 patients died (4.2% in the young group vs. 15.5% in the elderly group). Kaplan-Meier survival analysis revealed that triple antiplatelet therapy was associated with a lower mortality rate in the young group (log-rank, p = 0.005). Although there were more angiographic high-risk patients in the elderly group, similar mortality rates were reported (log-rank, p = 0.803) without increased bleeding rates (1 vs. 3.6% in the elderly group, p = 0.217). Triple antiplatelet therapy might be a better antiplatelet regimen than dual antiplatelet therapy for patients with ST-segment elevation myocardial infarction. Although this benefit was strong in patients aged elderly patients (aged ≥75 years).

  11. Surgical results of a one-stage combined anterior lumbosacral fusion and posterior percutaneous pedicle screw fixation

    Directory of Open Access Journals (Sweden)

    Chien-Yuan Huang

    2018-01-01

    Full Text Available Objectives: Lumbosacral fusion through either an anterior or a posterior approach to achieve good lordosis and stability is always a challenging surgical operation and is often accompanied by a higher rate of pseudarthrosis than when other lumbar segments are involved. This study evaluated the clinical and radiological results of lumbosacral fusions achieved through a combined anterior and posterior approach. Materials and Methods: From June 2008 to 2012, 20 patients who had L5–S1 instability and stenosis were consecutively treated, first by anterior interbody fusion using an allogenous strut bone graft through the pararectus approach and then by posterior pedicle screw fixation. A minimum of 1-year of clinical and radiological follow-up was conducted. Intraoperative blood loss, surgical time, and any surgery-related complications were recorded. Clinical outcomes were assessed using a visual analog scale (VAS and the patient's Oswestry Disability Index (ODI score. After 1 year, radiological outcomes were assessed by analyzing pelvic incidence, lumbar lordosis, and segmental lordosis using static plain films, while fusion stability was assessed using dynamic plain films. Results: The mean operative time and blood loss were 215 min and 325 cc, respectively. After 1 year, the VAS and ODI scores had significantly improved, and stable fusion with good lordotic curvature was obtained in all cases. Conclusion: The surgical results of the combined procedure are satisfactory in terms of the functional and radiological outcomes. Our method offers advantages regarding both anterior fusion and posterior fixation.

  12. Predictive value of inflammatory factors on contrast-induced acute kidney injury in patients who underwent an emergency percutaneous coronary intervention.

    Science.gov (United States)

    Yuan, Ying; Qiu, Hong; Hu, Xiaoying; Luo, Tong; Gao, Xiaojin; Zhao, Xueyan; Zhang, Jun; Wu, Yuan; Qiao, Shubin; Yang, Yuejin; Gao, Runlin

    2017-09-01

    Contrast-induced acute kidney injury (CI-AKI) is one of the most serious complications in patients who undergo percutaneous coronary intervention (PCI), especially in those with acute coronary syndrome. It has been shown that inflammation may play an important role in the pathophysiology of CI-AKI. Inflammatory factors may play a predominant role in the prediction of CI-AKI in patients who undergo emergency PCI. Patients who underwent emergency PCI from 2013 to 2015 were consecutively enrolled and were divided into CI-AKI and non-CI-AKI groups. Logistic analysis was used to identify the risk factors of CI-AKI. Receiver operator characteristic curve analysis was performed to evaluate the area under the curve (AUC) and to establish the optimal cutoff. A total of 1061 patients were included, and the CI-AKI rate was 5.47% (58/1061). Logistic analysis showed that the white blood cell (WBC) count (odds ratio [OR]: 1.103, 95% confidence interval [CI]: 1.018-1.195, P = 0.016), neutrophil (N) count (OR: 1.134, 95% CI: 1.045-1.232, P = 0.003), neutrophil to lymphocyte ratio (NLR) (OR: 1.105, 95% CI: 1.044-1.169, P = 0.001), C-reactive protein (CRP) level (OR: 1.006, 95% CI: 1.001-1.011, P = 0.020), high-sensitivity C-reactive protein (hs-CRP) level (OR: 1.099, 95% CI: 1.020-1.184, P = 0.013), and big endothelin-1 (ET-1) level (OR: 4.030, 95% CI: 1.989-8.165, P < 0.001) were all significant predictors for CI-AKI, as was the left ventricular ejection fraction and diuretic administration. The AUC of the big ET-1 level was the highest (0.793, 95% CI: 0.733-0.853), followed by the NLR (0.708, 95% CI: 0.641-0.774), hs-CRP level (0.705, 95% CI: 0.627-0.782), CRP level (0.684, 95% CI: 0.607-0.761), N count (0.655, 95% CI: 0.584-0.726), WBC count (0.620, 95% CI: 0.544-0.695), and erythrocyte sedimentation rate (0.611, 95% CI: 0.527-0.695). The WBC count, N count, NLR, CRP level, hs-CRP level, and big ET-1 level are all associated with an increased risk of CI-AKI, and among which, the

  13. Prognostic Impact of Combined Dysglycemia and Hypoxic Liver Injury on Admission in Patients With ST-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention (from the INTERSTELLAR Cohort).

    Science.gov (United States)

    Jang, Ho-Jun; Oh, Pyung Chun; Moon, Jeonggeun; Suh, Jon; Park, Hyun Woo; Park, Sang-Don; Lee, Kyounghoon; Kim, Je Sang; Lee, Hyun Jong; Choi, Rak Kyeong; Choi, Young-Jin; Kang, Woong Chol; Kwon, Sung Woo; Kim, Tae-Hoon

    2017-04-15

    Dysglycemia on admission is known to predict the prognosis of ST-segment elevation myocardial infarction (STEMI). Recently, hypoxic liver injury (HLI) has been proposed as a novel prognosticator for STEMI. We evaluated the prognostic impact of combined dysglycemia and HLI at the time of presentation in patients with STEMI who underwent primary percutaneous coronary intervention. From 2007 to 2014, 1,525 consecutive patients (79% men, mean age 61 years) who underwent primary percutaneous coronary intervention for STEMI in the INTERSTELLAR (Incheon-Bucheon Cohort of Patients Undergoing Primary PCI for Acute ST-Elevation Myocardial Infarction) cohort were analyzed retrospectively. Dysglycemia was defined as either hypoglycemia (serum glucose 250 mg/dl). HLI was defined as more than twofold increase of any serum aminotransferases above the upper normal limit. Patients were divided into 4 groups according to their dysglycemia and HLI status on admission: group 1, normoglycemia without HLI; group 2, dysglycemia without HLI; group 3, normoglycemia with HLI; and group 4, dysglycemia with HLI. Primary end point was inhospital death and secondary end point was all-cause mortality at 12 months after the index procedure. Of the 1,525 patients, there were 87 inhospital deaths (5.7%) and 113 all-cause deaths (7.4%) at 12 months after the index procedure. Both dysglycemia and HLI on admission were independent predictors of inhospital death. Inhospital mortality rate was the highest in group 4 (32.1%), followed by groups 2 and 3. Kaplan-Meier survival analysis at 12 months showed similar trends among the 4 groups. In conclusion, combined dysglycemia and HLI on admission predicts early prognosis for STEMI. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Minimally Invasive Transforaminal Lumbar Interbody Fusion with Percutaneous Bilateral Pedicle Screw Fixation for Lumbosacral Spine Degenerative Diseases. A retrospective database of 40 consecutive treated cases and literature review.

    Science.gov (United States)

    Millimaggi, Daniele Francesco; DI Norcia, Valerio; Luzzi, Sabino; Alfiero, Tommaso; Galzio, Renato Juan; Ricci, Alessandro

    2017-04-12

    To report our results about minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) with bilateral pedicle screw fixation, in patients with degenerative lumbosacral spine disease. To describe the indications, surgical technique and results of a consecutive series of 40 patients undergone MI-TLIF. Despite the limited number of clinical studies, published data suggest tremendous potential advantages of this technique. Forty patients with radiological findings of degenerative lumbosacral spine disease were undergone MI-TLIF between July 2012 and January 2015. Clinical outcomes were assessed by means of Oswestry Disability Index (ODI) and Health Survey Scoring (SF36) before surgery and at first year follow-up. Furthermore, the following parameters were retrospectively reviewed: age, sex, working activity, body mass index (BMI), type of degenerative disease, number of levels of fusion, operative time, blood loss, length of hospital stay. Average operative time was of 230 minutes, mean estimated blood loss 170 mL, average length of hospital stay 5 days. The ODI improved from a score of 59, preoperatively, to post-operative score of 20 at first year follow-up. Average SF36 score increased from 36 to 54 (Physical Health) and from 29 to 50 (Mental Health) at first year outcome evaluation. MI-TLIF with bilateral pedicle screw fixation is an excellent choice for selected patients suffering from symptomatic degenerative lumbosacral spine disease, especially secondary to recurrent disk herniations.

  15. Hemorrhoidectomy: pedicle ligation vs pedicle coagulation

    International Nuclear Information System (INIS)

    Shaikh, B.S.; Balaoch, I.B.; Sohu, K.M.

    2015-01-01

    Objective: To compare the outcome of pedicle ligation vs pedicle coagulation haemorrhoidectomy. Methodology: This comparative prospective study was carried out at Department of Surgery, Ghulam Muhammad Maher Medcial College Hospital, Sukkur, Pakistan from January 2011 to January 2013 and included 300 patients of hemorrhoids. After routine workup, patients were randomly divided into two equal groups with one group receiving pedicle ligation and other pedicle coagulation for hemorrhoidectomy. Postoperatively they were followed for a period of 8 weeks for complications including pain, urinary retention, bleeding and anal stricture. Pain was recorded up to 10th postoperative day on the basis of visual analogue scale. Results: Mean age was 45 years and male to female ratio was 1.7:1. Mean operative time in pedicle ligation group was 15 min (range 14-20 min) and 17 min (15-25 min) in pedicle coagulation group. In Pedicle ligation group, pain was worst in 35 patients, moderate in 85 and mild in 30 patients; on the other hand in pedicle coagulation group, just 09 patients experienced worst pain. Urinary retention was observed in 44 patients in pedicle ligation group and 19 in pedicle coagulation group. Five patients in pedicle ligation group developed bleeding after their discharge from hospital; 7 patients in pedicle coagulation group reported secondary bleeding. Anal stricture was a rare complication and was found equally common in both the groups. Conclusion: Conventional hemorrhoidectomy with pedicle coagulation is an effective treatment modality for hemorrhoids and is associated with less chance of postoperative anal pain and urinary retention. (author)

  16. Pedicled perforator flaps

    DEFF Research Database (Denmark)

    Demirtas, Yener; Ozturk, Nuray; Kelahmetoglu, Osman

    2009-01-01

    Described in this study is a surgical concept that supports the "consider and use a pedicled perforator flap whenever possible and indicated" approach to reconstruct a particular skin defect. The operation is entirely free-style; the only principle is to obtain a pedicled perforator flap...... to reconstruct the defect. The perforators are marked with a hand-held Doppler probe and multiple flaps are designed. The appropriate flap is elevated after identifying the perforator(s). Dissection of the perforator(s) or complete incision of the flap margins are not mandatory if the flap is mobilized...... adequately to cover the defect. Defects measuring 3 x 3 cm up to 20 x 20 cm at diverse locations were successfully reconstructed in 20 of 21 patients with 26 flaps. Pedicled perforator flaps offer us reliable and satisfactory results of reconstruction at different anatomic territories of the body. It sounds...

  17. Percutaneous transpedicular management of discitis.

    Science.gov (United States)

    Arya, S; Crow, W N; Hadjipaviou, A G; Nauta, H J; Borowski, A M; Vierra, L A; Walser, E

    1996-01-01

    To present the technique of percutaneous transpedicular biopsy and debridement of discs in diagnosis and management of discitis. Fifteen patients underwent disc biopsy through a transpedicular approach with local anesthesia and fluoroscopic guidance. An attempt was made to debride the disc as much as possible. A surgical vacuum drain was deployed through the transpedicular tract when there was persistent drainage. Fifteen patients underwent percutaneous transpedicular disc biopsy and debridement of disc for suspected discitis. Three patients underwent biopsy only and 12 underwent percutaneous discectomy. Six patients had at least one positive culture. Eight patients who underwent discectomy had immediate improvement of pain or neurologic symptoms, obviating emergency surgical debridement of the disc. Four patients did not improve and underwent surgical debridement and fusion. Transpedicular biopsy of the disc is an effective technique for adequate tissue retrieval and diagnosis of discitis. Adequate debridement in selected patients with antibiotic therapy may be definitive. Epidural extension of discitis and massive vertebral destruction precludes percutaneous treatment.

  18. Reactive sclerosis of the pedicle

    International Nuclear Information System (INIS)

    Lee, Sun Wha; Lim, Jae Hoon

    1991-01-01

    The vertebral pedicles of the neural arch represent the 'eyes' through which normal variants, anomalies and acquired pathologic conditions can be detected on lumbar spine radiographs. Close scrutiny of the size, shape, density and margins of the pedicles may permit the radiologist to suggest a wide variety of disease. Radiologic attention is almost always directed at determining of sclerosis or lysis of the pedicle. Numerous conditions causing sclerosis of the pedicle have been reported and among them osteoidosteoma and osteoblastoma are well known tumors. However the real significance of reactive sclerosis of the pedicle related to the unstable neural arch such as contralateral spondyloysis have drawn little attention in the literature. The purpose of this report is to analyze the nature of arch deficiency which is the primary lesion related to the sclerotic pedicle, and emphasizes the significance of radiologic features of reactive pedicular sclerosis for clinical practice. Cautious observation of both sclerotic lesion and the contralateral neural arch is essential in radiologic evaluation of the scleortic pedicle and the presence of a contraslateral pars defect in the same vertebral segment suggests reactive sclerosis of the pedicle

  19. Reactive sclerosis of the pedicle

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sun Wha; Lim, Jae Hoon [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    1991-01-15

    The vertebral pedicles of the neural arch represent the 'eyes' through which normal variants, anomalies and acquired pathologic conditions can be detected on lumbar spine radiographs. Close scrutiny of the size, shape, density and margins of the pedicles may permit the radiologist to suggest a wide variety of disease. Radiologic attention is almost always directed at determining of sclerosis or lysis of the pedicle. Numerous conditions causing sclerosis of the pedicle have been reported and among them osteoidosteoma and osteoblastoma are well known tumors. However the real significance of reactive sclerosis of the pedicle related to the unstable neural arch such as contralateral spondyloysis have drawn little attention in the literature. The purpose of this report is to analyze the nature of arch deficiency which is the primary lesion related to the sclerotic pedicle, and emphasizes the significance of radiologic features of reactive pedicular sclerosis for clinical practice. Cautious observation of both sclerotic lesion and the contralateral neural arch is essential in radiologic evaluation of the scleortic pedicle and the presence of a contraslateral pars defect in the same vertebral segment suggests reactive sclerosis of the pedicle.

  20. Complications associated with thoracic pedicle screws in spinal deformity

    Science.gov (United States)

    Li, Gang; Lv, Guohua; Passias, Peter; Kozanek, Michal; Metkar, Umesh S.; Liu, Zhongjun; Wood, Kirkham B.; Rehak, Lubos

    2010-01-01

    Thoracic pedicle screws have superior anchoring strength compared with other available fixation techniques. However, these are not universally accepted in many developing countries because of the concerns regarding safety and complications. In addition, there is evidence that pedicle morphology is unique in Chinese patients. The goal of this study was to analyze the complications seen at our institution, while using thoracic pedicle screws for the treatment of thoracic deformity, and to determine the safety of our techniques for the treatment of thoracic deformity in a Chinese population. From 1998 to 2005, there were 208 thoracic deformity patients treated at our institution, 70 of whom were male and 138 were female. Their age ranged from 11 to 55 years (mean of 14.9 years). All of them underwent corrective deformity surgery using posterior pedicle screw systems and follow-up was available for at least 3 years. Etiologic diagnoses included adolescent idiopathic scoliosis in 119 patients, congenital kyphoscoliosis in 38, adult scoliosis in 37 and undetermined in 14. Screw positions were evaluated using intraoperative and postoperative radiographs and a CT scan was performed when a concern for screw malposition was present. All radiographic evaluations were carried out in a double-blinded fashion. A total of 1,123 thoracic pedicle screws were inserted (5.4 thoracic screws/patient). The deformity correction rate was 81, 65 and 62% for idiopathic, congenital and adult scoliosis patients, respectively. The overall complication rate was 16.5% at the final follow-up. Complication rates directly and indirectly related to pedicle screws were 7.2 and 9.3%, respectively. There were no significant screw-related neurologic or visceral complications that adversely affected long-term results. The complications seen with thoracic pedicle screws in a Chinese population were similar to other populations and could be utilized safely for the treatment of thoracic deformity in this

  1. Cervical Fusion for Absent Pedicle Syndrome Manifesting with Myelopathy.

    Science.gov (United States)

    Goodwin, C Rory; Desai, Atman; Khattab, Mohamed H; Elder, Benjamin D; Bydon, Ali; Wolinsky, Jean-Paul

    2016-02-01

    Absent congenital pedicle syndrome is a posterior arch defect characterized by numerous congenital and mechanical abnormalities that result from disconnection of the anterior and posterior columns of the spinal canal. Absent congenital pedicle syndrome is a rare anomaly that is most commonly diagnosed incidentally, after evaluation of minor trauma, or after complaints of chronic neck pain. We report a case of absent congenital pedicle syndrome in a patient who presented with myelopathy and lower extremity weakness and review the literature on the surgical management of this entity. A 32-year-old woman with a history of systemic lupus erythematosus presented to the Neurosurgery Service with progressive weakness in her upper and lower extremities, clonus, and hyperreflexia. Magnetic resonance imaging revealed congenital absence of the pedicles of C2, C3, C4, C5, and C6 with a congenitally narrow canal at C4-5. The patient underwent a staged anterior and posterior cervical decompression and fusion. She was placed in a halo after surgery; at the 1-year follow-up, she was ambulatory with demonstrated improvement in weakness and fusion of her cervical spine. Absent congenital pedicle syndrome is rare, and most reported cases were treated conservatively. Surgical management is reserved for patients with myelopathy or instability. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. The freestyle pedicle perforator flap

    DEFF Research Database (Denmark)

    Gunnarsson, Gudjon Leifur; Jackson, Ian T; Westvik, Tormod S

    2015-01-01

    BACKGROUND: Perforating vessels are a consistent anatomical finding and well described in the current literature. Any skin flap can be raised on a subcutaneous pedicle as long as it contains at least one supplying perforator. Perforator flaps have been interlinked with microsurgery and generally...... not widely performed by the general plastic surgeons. The aim of this paper is to present the simplicity of pedicled perforator flap reconstruction of moderate-sized defects of the extremities and torso. METHODS: We retrospectively reviewed the charts of 34 patients reconstructed using 34 freestyle pedicled...... perforator flaps for moderate-sized defects of the truncus and extremities. We registered indications, flap size and localization, success rate, and complications. Most importantly, we describe a simple approach to the design of freestyle pedicled perforator flaps and elaborate on technical aspects...

  3. TRAM Flap for Immediate Post Mastectomy Reconstruction: Comparison between Pedicled and Free Transfer

    International Nuclear Information System (INIS)

    Bassiouny, M.M.; Maamoun, S.I.; El-Shazly, S.M.; Youssef, O.Z

    2005-01-01

    Breast reconstruction after mastectomy is primarily carried out to improve the patients' quality of life. The most commonly used autologous tissue for reconstruction is the transverse rectums abdomens musculocutaneous flap (TRAM). The TRAM flap could be transferred either as pedicled or a free flap with microvascular anastomosis. The following work was carried out to evaluate the two techniques. Patients and Methods: Thirty-one female patients with operable breast cancer consented to immediate breast reconstruction during the period from June 1998 to December 2000. Fifteen patients had a free TRAM flap reconstruction. In sixteen patients, a pedicled TRAM flap was used. Three patients in the pedicled group underwent bilateral breast reconstruction. thus there were 19 pedicled flaps available for evaluation. Four patients in the pedicled flap group underwent reduction mammoplasty of the normal breast and in five other patients a bipedicled flap was used to achieve size matching with the reconstructed breast. Criteria for analysis included operative data, hospital stay, donor site morbidity. abdominal wall integrity, flap related complications, fat necrosis and final aesthetic result. There was no difference between the two groups as regards age and, operative time. The pedicled flap group had shorter hospital stay and less blood loss than the free flap group, which was statistically significant (ρ=0.007 and ρ=0.001, respectively). In the pedicled flap group, two patients (10.5%) experienced partial flap loss and fat necrosis was detected in two other patients. For the free flap group, two patients (13.3%) developed complete flap loss, but none suffered fat necrosis. Donor site morbidity was equal in both groups. The total number of complications was higher in the pedicled group (7/19) (36.8.8%) than in the free flap group (5/15) (33.3 degree 33.3 degree k) but this was not statistically significant (ρ=0.27). None of the patients in both groups developed abdominal

  4. Open versus percutaneous instrumentation in thoracolumbar fractures: magnetic resonance imaging comparison of paravertebral muscles after implant removal.

    Science.gov (United States)

    Ntilikina, Yves; Bahlau, David; Garnon, Julien; Schuller, Sébastien; Walter, Axel; Schaeffer, Mickaël; Steib, Jean-Paul; Charles, Yann Philippe

    2017-08-01

    OBJECTIVE Percutaneous instrumentation in thoracolumbar fractures is intended to decrease paravertebral muscle damage by avoiding dissection. The aim of this study was to compare muscles at instrumented levels in patients who were treated by open or percutaneous surgery. METHODS Twenty-seven patients underwent open instrumentation, and 65 were treated percutaneously. A standardized MRI protocol using axial T1-weighted sequences was performed at a minimum 1-year follow-up after implant removal. Two independent observers measured cross-sectional areas (CSAs, in cm 2 ) and region of interest (ROI) signal intensity (in pixels) of paravertebral muscles by using OsiriX at the fracture level, and at cranial and caudal instrumented pedicle levels. An interobserver comparison was made using the Bland-Altman method. Reference ROI muscle was assessed in the psoas and ROI fat subcutaneously. The ratio ROI-CSA/ROI-fat was compared for patients treated with open versus percutaneous procedures by using a linear mixed model. A linear regression analyzed additional factors: age, sex, body mass index (BMI), Pfirrmann grade of adjacent discs, and duration of instrumentation in situ. RESULTS The interobserver agreement was good for all CSAs. The average CSA for the entire spine was 15.7 cm 2 in the open surgery group and 18.5 cm 2 in the percutaneous group (p = 0.0234). The average ROI-fat and ROI-muscle signal intensities were comparable: 497.1 versus 483.9 pixels for ROI-fat and 120.4 versus 111.7 pixels for ROI-muscle in open versus percutaneous groups. The ROI-CSA varied between 154 and 226 for open, and between 154 and 195 for percutaneous procedures, depending on instrumented levels. A significant difference of the ROI-CSA/ROI-fat ratio (0.4 vs 0.3) was present at fracture levels T12-L1 (p = 0.0329) and at adjacent cranial (p = 0.0139) and caudal (p = 0.0100) instrumented levels. Differences were not significant at thoracic levels. When adjusting based on age, BMI, and Pfirrmann

  5. Unilateral Pedicle Stress Fracture in a Long-Term Hemodialysis Patient with Isthmic Spondylolisthesis

    Directory of Open Access Journals (Sweden)

    Keishi Maruo

    2015-01-01

    Full Text Available Most unilateral pedicle stress fractures occur on the contralateral side of patients with unilateral spondylolysis. However, there are few reports of unilateral pedicle stress fractures in patients with bilateral spondylolysis and spondylolisthesis. We report a unique case of unilateral pedicle stress fracture in a long-term hemodialysis patient with isthmic spondylolisthesis. A 65-year-old man who had undergone hemodialysis presented with lower back pain that had persisted for several years. The patient experienced severe right lower extremity pain with no history of trauma. Computed tomography revealed unilateral pedicle fracture with bilateral L5 spondylolysis and spondylolisthesis with progression of scoliosis. The patient underwent Gill laminectomy of L5 with pedicle screw fixation at L4-S1 and interbody fusion at L5-S1. The patient’s leg pain ceased immediately, and he began walking without leg pain. In our present patient, development of scoliosis caused by destructive spondyloarthropathy may have contributed to a unilateral pedicle fracture.

  6. Current trends in pedicle screw stimulation techniques: lumbosacral, thoracic, and cervical levels.

    Science.gov (United States)

    Isley, Michael R; Zhang, Xiao-Feng; Balzer, Jeffrey R; Leppanen, Ronald E

    2012-06-01

    Unequivocally, pedicle screw instrumentation has evolved as a primary construct for the treatment of both common and complex spinal disorders. However an inevitable and potentially major complication associated with this type of surgery is misplacement of a pedicle screw(s) which may result in neural and vascular complications, as well as impair the biomechanical stability of the spinal instrumentation resulting in loss of fixation. In light of these potential surgical complications, critical reviews of outcome data for treatment of chronic, low-back pain using pedicle screw instrumentation concluded that "pedicle screw fixation improves radiographically demonstrated fusion rates;" however the expense and complication rates for such constructs are considerable in light of the clinical benefit (Resnick et al. 2005a). Currently, neuromonitoring using free-run and evoked (triggered) electromyography (EMG) is widely used and advocated for safer and more accurate placement of pedicle screws during open instrumentation procedures, and more recently, guiding percutaneous placement (minimally invasive) where the pedicle cannot be easily inspected visually. The latter technique, evoked or triggered EMG when applied to pedicle screw instrumentation surgeries, has been referred to as the pedicle screw stimulation technique. As concluded in the Position Statement by the American Society of Neurophysiological Monitoring (ASNM), multimodality neuromonitoring using free-run EMG and the pedicle screw stimulation technique was considered a practice option and not yet a standard of care (Leppanen 2005). Subsequently, the American Association of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS) Joint Section on Disorders of the Spine and Peripheral Nerves published their "Guidelines for the Performance of Fusion Procedures for Degenerative Disease of the Lumbar Spine" (Heary 2005, Resnick et al. 2005a, Resnick et al. 2005b). It was concluded that the "primary

  7. The pullout performance of pedicle screws

    CERN Document Server

    Demir, Teyfik

    2015-01-01

    This brief book systematically discusses all subjects that affect the pullout strength of pedicle screws. These screws are used in spinal surgeries to stabilize the spine. The holding strength of the pedicle screw is vital since loosening of the pedicle screws can cause revision surgeries. Once the pedicle screw is pulled out, it is harder to obtain same stabilization for the fused vertebrae. The book reviews the effect of screw designs, application techniques, cement augmentation, coating of the screw and test conditions on the pullout strength. The studies with finite element analysis were also included.

  8. Pedicled fat flap to increase lateral fullness in upper blepharoplasty.

    Science.gov (United States)

    Sozer, Sadri O; Agullo, Francisco J; Palladino, Humberto; Payne, Phileemon E; Banerji, Soumo

    2010-03-01

    The eyelid of a young person can be distinguished by the lateral fullness of the upper eyelid. With aging, lateral fullness decreases. Volume restoration in the periorbital area has been previously addressed by fat draping and grafting. More recently, techniques for regaining lateral fullness of the upper eyelid have focused on fat grafting, although effective graft take, reabsorption, and irregularities have been a concern. To address these issues, the concept of pedicled fat draping in the upper eyelid was explored. In a retrospective study from June 2006 to August 2008, 31 patients underwent upper blepharoplasty with augmentation of the lateral fullness with a pedicled fat flap from the central fat pad. The fat from the central compartment was elevated, dissected, and then transposed to the lateral upper eyelid below the orbicularis muscle. All patients were women ranging in age from 43 to 68 years. Pre- and postoperative picture comparison demonstrated a more youthful appearance with increased lateral fullness of the upper eyelids. There were no cases of fat necrosis encountered. Increased volume remained stable over an average of one-year follow-up. No complications were recorded. Transposing a pedicled fat pad from the central compartment laterally has proven to be an effective technique for achieving predictable upper lateral eyelid fullness and thus achieving a long-lasting, more youthful appearance.

  9. Active Pedicle Epithelial Flap Transposition Combined with Amniotic Membrane Transplantation for Treatment of Nonhealing Corneal Ulcers

    OpenAIRE

    Zhang, Ting; Wang, Yuexin; Jia, Yanni; Liu, Dongle; Li, Suxia; Shi, Weiyun; Gao, Hua

    2016-01-01

    Introduction. The objective was to evaluate the efficacy of active pedicle epithelial flap transposition combined with amniotic membrane transplantation (AMT) in treating nonhealing corneal ulcers. Material and Methods. Eleven patients (11 eyes) with nonhealing corneal ulcer who underwent the combined surgery were included. Postoperatively, ulcer healing time was detected by corneal fluorescein staining. Visual acuity, intraocular pressure, surgical complications, and recurrence were recorded...

  10. Clinical evaluation of patients undergoing dynamic pedicle fixation in lumbar spine

    Directory of Open Access Journals (Sweden)

    Felipe José Vieira Figueiredo

    2015-06-01

    Full Text Available OBJECTIVE: To evaluate the preliminary clinical results and complications in patients undergoing dynamic pedicle fixation of the spine in the treatment of a specific group of degenerative lumbar disease.METHODS: In this preliminary retrospective study, we selected 14 patients who underwent surgery from January 2006 to July 2010. We selected only patients with spondylolisthesis without spondylolysis (Grade 1 Meyerding. All patients underwent surgery at one level and the levels mostly addressed were: L3-L4, L4-L5 or L5-S1. The approach was the same in all patients (posterior median approach with preservation of the posterior elements. All patients underwent intense conservative treatment without clinical response and the same research algorithm preoperatively.RESULTS: Retrospective analysis of Oswestry questionnaire after selection and publication of results of 14 patients with Grade 1 spondylolisthesis who underwent dynamic pedicle stabilization in a total of 56 pedicle screws, being all in one level. There was no fracture of any screws, the mean hospital stay was a day and a half, no patient required blood transfusion and there were no cases of infection, with significant improvement in the Oswestry questionnaire.CONCLUSION: In this study, the dynamic pedicle stabilization method proved to be an excellent treatment option when surgical criteria are strictly adhered to. There was an improvement in Oswestry values, lower hospital stay and low rate of complications, consisting of an alternative in motion preservation surgery.

  11. Vascularized pedicle bone grafting for nonunions of the tarsal navicular.

    Science.gov (United States)

    Fishman, Felicity G; Adams, Samuel B; Easley, Mark E; Nunley, James A

    2012-09-01

    Osteonecrosis and nonunions of the tarsal navicular remain a challenging clinical problem. This article presents a series of patients treated with local vascularized pedicle bone grafting to the navicular. The purpose of this study was to determine the early clinical and radiographic outcomes of this technique. Patients who underwent local vascularized pedicle bone grafting for osteonecrosis of the navicular from 2002 to 2007 were included in this study. The Ankle Osteoarthritis Scale (AOS), the Revised Foot Function Index (FFI-R), and the Short-Form 36 (SF-36) outcomes questionnaires were administered at most recent followup. Postoperative imaging was reviewed for evidence of healing. Eight patients with a mean age of 47.5 (range, 18 to 68) years were included in this study. The mean followup time was 61 (range, 32 to 72) months. Two patients underwent concomitant talonavicular arthrodesis. Two patients underwent additional procedures to address continued nonunion of the navicular. Neither patient elected to complete the outcomes questionnaires. The mean postoperative FFI score was 35.2 (range, 16.6 to 59). SF-36 subscales were as follows: bodily pain, 53; general health, 55; mental health, 75; physical function, 56; role emotional, 61; role physical, 37.5; social function, 71; and vitality, 56. The mean postoperative AOS pain score was 27.9 (range, 0 to 46.2) and the average disability score was 31.4 (range, 0 to 78.2). Postoperative imaging revealed consolidation and full healing in six of eight patients. Vascularized pedicle bone grafting is a treatment option for patients with chronic nonunion or osteonecrosis of the navicular. Additionally, it may serve as an adjunct procedure to provide increased vascularity to talonavicular arthrodesis in cases of navicular osteonecrosis and talonavicular arthritis.

  12. The Superomedial Pedicle Wise-Pattern Breast Reduction: Reproducible, Reliable, and Resilient.

    Science.gov (United States)

    Brown, Rodger H; Siy, Richard; Khan, Khurrum; Izaddoost, Shayan

    2015-05-01

    The combination of the superomedial pedicle with the traditional Wise-pattern skin resection has gained increasing popularity for its versatility and ability to achieve significant reduction of breast parenchyma and skin envelope with improved contour and lasting results. Here the authors review the pertinent anatomy and discuss their surgical technique and its benefits. In addition, a retrospective chart review of 80 patients (151 breasts) who underwent superomedial pedicle Wise-pattern breast reduction between 2010 and 2014 was performed. Mean specimen weights and complication rates, including seroma, delayed wound healing, nipple loss, infection, and reoperation were calculated for the cohort.

  13. Clinical evaluation of patients undergoing dynamic pedicle fixation in lumbar spine

    OpenAIRE

    Figueiredo, Felipe José Vieira; Brum, Paulo Roberto; Monteiro, Rogério Frota Góes

    2015-01-01

    OBJECTIVE: To evaluate the preliminary clinical results and complications in patients undergoing dynamic pedicle fixation of the spine in the treatment of a specific group of degenerative lumbar disease.METHODS: In this preliminary retrospective study, we selected 14 patients who underwent surgery from January 2006 to July 2010. We selected only patients with spondylolisthesis without spondylolysis (Grade 1 Meyerding). All patients underwent surgery at one level and the levels mostly addresse...

  14. Coverage of supraumbilical abdominal wall defects: The tunnelled-pedicled ALT technique.

    Science.gov (United States)

    Fernandez-Alvarez, Jose-Alberto; Barrera-Pulido, Fernando; Lagares-Borrego, Araceli; Narros-Gimenez, Rocio; Gacto-Sanchez, Purificación; Gomez-Cia, Tomas

    2017-02-01

    Abdominal wall defects are a challenge for reconstructive surgeons. Although the utility of anterolateral thigh perforator (ALT) flap has been well established for lower abdominal wall reconstruction, pedicled ALT flap is usually not considered for supraumbilical defects in the most recent algorithms. The purpose of this paper is to report the results of a tunneled pedicled ALT flap for reconstruction of supraumbilical defect from a series of patients. From July 2009 to September2014, six patients underwent delayed abdominal wall coverage using pedicled ALT flaps and reinforcement with polypropylene meshes. Defects occurred after surgical complications and abdominal trauma. Flaps were tunneled beneath the rectus femoris and sartorius muscles to increase the pedicle length. The size of the skin islands ranged from 22-29 × 10-14 cm. All flaps survived and the healing of the wounds was successful. Partial dehiscence of donor site occurred in one patient, and small wound dehiscence due to minimal distal necrosis was observed in another patient. No functional problems were reported in donor site, and no complications occurred in 6-68 months of follow-up. The tunneled pedicled ALT flap may provide a reliable alternative method for abdominal wall reconstruction, including supraumbilical defects. © 2015 Wiley Periodicals, Inc. Microsurgery 37:119-127, 2017. © 2015 Wiley Periodicals, Inc.

  15. Percutaneous cholecystostomy for patients with acute cholecystitis and an increased surgical risk

    NARCIS (Netherlands)

    H. van Overhagen (H.); H. Meyers (Hjalmar); H.W. Tilanus (Hugo); J. Jeekel (Hans); J.S. Laméris (Johan )

    1996-01-01

    textabstractPurpose: To evaluate percutaneous cholecystostomy in patients with acute cholecystitis and an increased surgical risk. Methods: Thirty-three patients with acute cholecystitis (calculous, n = 22; acalculous, n = 11) underwent percutaneous cholecystostomy by means of a transhepatic (n =

  16. [Ultrasound guided percutaneous nephrolithotripsy].

    Science.gov (United States)

    Guliev, B G

    2014-01-01

    The study was aimed to the evaluation of the effectiveness and results of ultrasound guided percutaneous nephrolithotripsy (PNL) for the treatment of patients with large stones in renal pelvis. The results of PNL in 138 patients who underwent surgery for kidney stones from 2011 to 2013 were analyzed. Seventy patients (Group 1) underwent surgery with combined ultrasound and radiological guidance, and 68 patients (Group 2)--only with ultrasound guidance. The study included patients with large renal pelvic stones larger than 2.2 cm, requiring the formation of a single laparoscopic approach. Using the comparative analysis, the timing of surgery, the number of intra- and postoperative complications, blood loss and length of stay were evaluated. Percutaneous access was successfully performed in all patients. Postoperative complications (exacerbation of chronic pyelonephritis, gross hematuria) were observed in 14.3% of patients in Group 1 and in 14.7% of patients in Group 2. Bleeding requiring blood transfusion, and injuries of adjacent organs were not registered. Efficacy of PNL in the Group 1 was 95.7%; 3 (4.3%) patients required additional interventions. In Group 2, the effectiveness of PNL was 94.1%, 4 (5.9%) patients additionally underwent extracorporeal lithotripsy. There were no significant differences in the effectiveness of PNL, the volume of blood loss and duration of hospitalization. Ultrasound guided PNL can be performed in large pelvic stones and sufficient expansion of renal cavities, thus reducing radiation exposure of patients and medical staff.

  17. Reconstruction of mandible with pedicle bone grafts.

    Science.gov (United States)

    Kowalik, S

    1980-02-01

    Three cases of pedicle bone grafts used to reconstruct the mandible are presented. The grafts were taken from the shoulder blade, rib and clavicle. In two patients partial and in one patient total mandibles were reconstructed. Good results were obtained.

  18. Percutaneous vertebroplasty

    International Nuclear Information System (INIS)

    Hierholzer, J.; Fuchs, H.; Depriester, C.; Venz, S.; Maier-Hauff, K.; Schulz, R.; Koch, K.

    2002-01-01

    Purpose: To describe the procedure of percutaneous vertebroplasty and to present our first clinical results of patients treated for benign or malignant painful vertebral body disease. Material and Methods: We performed percutaneous vertebroplasty in 31 painful lesions of the spine. Liquid bone cement was injected into the affected vertebral body using fluoroscopic guidance through a bilateral transpedicular approach. Etiology of the bone disease was assessed by biopsy. Pain intensity was assessed before and 1 week after the procedure by standardized catalogue. Results: Percutaneous vertebroplasty was performed in 17 thoracic and in 14 lumbar spine bodies of benign (n = 23) or malignant (n = 8) disease; no clinically relevant complications occurred. All patients reported significant pain relief 1 week after the intervention. One week after treatment, patients were pain-free in 15/31 vertebral bodies, and reported mild residual pain not necessitating narcotic medication in 16/31 cases. Conclusion: In accordance with the literature, percutaneous vertebroplasty proved to be a highly effective, minimal invasive interventional procedure to treat severely painful bone lesions of benign and malignant origin. (orig.) [de

  19. Postoperative quality-of-life assessment in patients with spine metastases treated with long-segment pedicle-screw fixation.

    Science.gov (United States)

    Bernard, Florian; Lemée, Jean-Michel; Lucas, Olivier; Menei, Philippe

    2017-06-01

    OBJECTIVE In recent decades, progress in the medical management of cancer has been significant, resulting in considerable extension of survival for patients with metastatic disease. This has, in turn, led to increased attention to the optimal surgical management of bone lesions, including metastases to the spine. In addition, there has been a shift in focus toward improving quality of life and reducing hospital stay for these patients, and many minimally invasive techniques have been introduced with the aim of reducing the morbidity associated with more traditional open approaches. The goal of this study was to assess the efficacy of long-segment percutaneous pedicle screw stabilization for the treatment of instability associated with thoracolumbar spine metastases in neurologically intact patients. METHODS This study was a retrospective review of data from a prospective database. The authors analyzed cases in which long-segment percutaneous pedicle screw fixation was performed for the palliative treatment of thoracolumbar spinal instability due to spinal metastases in neurologically intact patients. All of the patients included in the study underwent surgery between January 2014 and May 2015 at the authors' institution. Postoperative radiation therapy was planned within 10 days following the stabilization in all cases. Clinical and radiological follow-up assessments were planned for 3 days, 3 weeks, 6 weeks, 3 months, 6 months, and 1 year after surgery. Outcome was assessed by means of standard postoperative evaluation and oncological and spinal quality of life measures (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Version 3.0 [EORTC QLQ-C30] and Oswestry Disability Index [ODI], respectively). Moreover, 5 patients were given an activity monitoring device for recording the distance walked daily; preoperative and postoperative daily distances were compared. RESULTS Data from 17 cases were analyzed. There were no

  20. The short- and ultrashort-pedicle deep inferior epigastric artery perforator flap in breast reconstruction.

    Science.gov (United States)

    Colohan, Shannon; Maia, Munique; Langevin, Claude Jean; Donfrancesco, Andrea; Shirvani, Arash; Trussler, Andrew P; Saint-Cyr, Michel

    2012-02-01

    Breast reconstruction using the deep inferior epigastric perforator (DIEP) flap is becoming more common and can help reduce donor site morbidity. The authors proposed that dissection of the deep inferior epigastric artery (DIEA) and vein (DIEV) to their external iliac source may not be required for safe flap transfer. Sixteen whole fresh cadaveric hemiabdomens were used to dissect transverse abdominal-based flaps. Latex injection of the DIEA system was carried out, and the diameters of the DIEA/DIEV vessels were assessed at various points along the course of the pedicle from the origin to the perforator. A clinical study of 26 patients who underwent a short and ultrashort pedicle DIEP flaps was carried out. The average DIEA and DIEV vessel diameters were relatively similar from the external iliac origin to a point just caudal to the bifurcation. At the lateral rectus edge, the average DIEA diameter was 3.2 mm, and the DIEV diameter was 3.1 mm. The average pedicle length obtained with classic DIEP dissection was 16.9 cm, short-pedicle DIEP dissection 10.4 cm, ultrashort technique 8.1 cm, and free TRAM technique 6.5 cm. Venous injection study demonstrated rich venous interconnections between both venae comitantes. In their clinical study, the authors were able to achieve average pedicle lengths of 11.0 cm when transecting cranial to the lateral edge of the rectus, with average diameters of 2.5 mm (artery) and 2.9 mm (vein). Transection of the DIEA/DIEV pedicle at the lateral rectus edge or more proximally is safe and can help reduce operative time and donor-site morbidity. Therapeutic, IV.

  1. What is the Difference in Morphologic Features of the Thoracic Pedicle Between Patients With Adolescent Idiopathic Scoliosis and Healthy Subjects? A CT-based Case-control Study.

    Science.gov (United States)

    Gao, Bo; Gao, Wenjie; Chen, Chong; Wang, Qinghua; Lin, Shaochun; Xu, Caixia; Huang, Dongsheng; Su, Peiqiang

    2017-11-01

    Describing the morphologic features of the thoracic pedicle in patients with adolescent idiopathic scoliosis is necessary for placement of pedicle screws. Previous studies showed inadequate reliability owing to small sample size and heterogeneity of the patients surveyed. To use CT scans (1) to describe the morphologic features of 2718 thoracic pedicles from 60 female patients with Lenke Type 1 adolescent idiopathic scoliosis and 60 age-, sex-, and height-matched controls; and (2) to classify the pedicles in three types based on pedicle width and analyze the distribution of each type. A total of 2718 pedicles from 60 female patients with Lenke Type 1 adolescent idiopathic scoliosis and 60 matched female controls were analyzed via CT. All patients surveyed were diagnosed with adolescent idiopathic scoliosis, Lenke Type 1, at the First Affiliated Hospital of Sun Yat-sen University, and all underwent pedicle screw fixation between January 2008 and December 2013 with preoperative radiographs and CT images on file. We routinely obtained CT scans before these procedures; all patients who underwent surgery during that period had CT scans, and all were available for analysis here. Control subjects had CT scans for other clinical indications and had no abnormal findings of the spine. The control subjects were chosen to match patients in terms of age (15 ± 2.6 years versus 15 ± 2.6 years) and sex. Height of the two groups also was matched (154 ± 9 cm versus 155 ± 10 cm; mean difference, -1.06 cm; 95% CI, -1.24 to -0.81 cm; p adolescent idiopathic scoliosis (22%; 293 of 1322) compared with controls (13%; 178 of 1396) (odds ratio [OR] = 0.51; 95% CI, 0.42-0.63; p adolescent idiopathic scoliosis, they commonly occurred on the concave side 34% (228 of 661) and on the AV-SC region (32%; 43 of 136). Pedicle width on the concave side was narrower than pedicle width on the convex side and pedicle width in healthy control subjects. The apical vertebra in the structural curve was

  2. Contrast-enhanced ultrasonography as a new method for assessing autonomization of pedicled and microvascular free flaps in head and neck reconstructive surgery.

    Science.gov (United States)

    Mueller, Steffen; Wendl, Christina M; Ettl, Tobias; Klingelhöffer, Christoph; Geis, Sebastian; Prantl, Lukas; Reichert, Torsten E; Jung, Ernst Michael

    2017-01-01

    Evaluating vascular autonomization of pedicled and microvascular free flaps for soft tissue reconstruction in the head and neck area by means of postoperative quantitative measurement of dynamic contrast values obtained with contrast-enhanced ultrasound. 8/18 patients underwent lip reconstruction with a pedicle flap, 10 patients reconstruction of other parts of the head with a microvascular free transplant. Ultrasound examinations were conducted within the 1st postoperative week and 4 weeks after surgery. After the intravenous bolus of the ultrasound contrast agent, examinations were carried out for 30 sec without compression followed by 30 sec with compression of the vascular pedicle in bolus and flash kinetics. Digital cine loops were analyzed off-line with a quantification software (VueBox™) to determine the Rise Time (RT) between flap tissue with and without compression. Measurements showed increasing autonomous perfusion, independent of the vascular pedicle. No transplant was lost, but 4/10 patients with a microvascular flap and 1/8 patients with a pedicle flap developed postoperative complications. RT values for the pedicled and microvascular flaps obtained under compression differed significantly between the 1st and the 4th week (p = 0.025). Reliable neovascularization was achieved 4 weeks postoperatively. CEUS showed to be a useful method for assessing the degree of autonomization of pedicle and microvascular free flaps.

  3. Head and neck reconstruction with pedicled flaps in the free flap era.

    Science.gov (United States)

    Mahieu, R; Colletti, G; Bonomo, P; Parrinello, G; Iavarone, A; Dolivet, G; Livi, L; Deganello, A

    2016-12-01

    Nowadays, the transposition of microvascular free flaps is the most popular method for management of head and neck defects. However, not all patients are suitable candidates for free flap reconstruction. In addition, not every defect requires a free flap transfer to achieve good functional results. The aim of this study was to assess whether pedicled flap reconstruction of head and neck defects is inferior to microvascular free flap reconstruction in terms of complications, functionality and prognosis. The records of consecutive patients who underwent free flap or pedicled flap reconstruction after head and neck cancer ablation from 2006 to 2015, from a single surgeon, in the AOUC Hospital, Florence Italy were analysed. A total of 93 patients, the majority with oral cancer (n = 59), were included, of which 64 were pedicled flap reconstructions (69%). The results showed no significant differences in terms of functional outcome, flap necrosis and complications in each type of reconstruction. Multivariate regression analysis of flap necrosis and functional impairments showed no associated factors. Multivariate regression analysis of complicated flap healing showed that only comorbidities remained an explaining factor (p = 0.019). Survival analysis and proportional hazard regression analysis regarding cancer relapse or distant metastasis, showed no significant differences in prognosis of patients concerning both types of reconstruction. In this retrospective, non-randomised study cohort, pedicled flaps were not significantly inferior to free flaps for reconstruction of head and neck defects, considering functionality, complications and prognosis. © Copyright by Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale, Rome, Italy.

  4. Increased pedicle screw pullout strength with vertebroplasty augmentation in osteoporotic spines.

    Science.gov (United States)

    Sarzier, John S; Evans, Avery J; Cahill, David W

    2002-04-01

    The authors conducted a biomechanical study to evaluate pedicle screw pullout strength in osteoporotic cadaveric spines. Nonaugmented hemivertebrae were compared with pressurized polymethylmethacrylate (PMMA)-augmented hemivertebrae. Six formalin-fixed cadaveric thoracolumbar spines at least two standard deviations below the mean bone mineral density (BMD) for age were obtained. Radiographic and BMD studies were correlated to grades I, II, and III osteoporosis according to the Jekei scale. Each of the 21 vertebrae underwent fluoroscopic placement of 6-mm transpedicular screws with each hemivertebra serving as the control for the contralateral PMMA-augmented hemivertebra. Pedicle screws were then evaluated for biomechanical axial pullout resistance. Augmented hemivertebrae axial pullout forces were increased (p = 0.0005). The mean increase in pullout force was 181% for Grade I, 206% for Grade II, and 213% for Grade III osteoporotic spines. Augmented Grade I osteoporotic spines demonstrated axial pullout forces near those levels reported in the literature for nonosteoporotic specimens. Augmented Grade II osteoporotic specimens demonstrated increases to levels found in nonaugmented vertebrae with low-normal BMD. Augmented Grade III osteoporotic specimens had increases to levels equal to those found in nonaugmented Grade I vertebrae. Augmentation of osteoporotic vertebrae in PMMA-assisted vertebroplasty can significantly increase pedicle screw pullout forces to levels exceeding the strength of cortical bone. The maximum attainable force appears to be twice the pullout force of the nonaugmented pedicle screw for each osteoporotic grade.

  5. Primary pedicle screw augmentation in osteoporotic lumbar vertebrae: biomechanical analysis of pedicle fixation strength.

    Science.gov (United States)

    Burval, Daniel J; McLain, Robert F; Milks, Ryan; Inceoglu, Serkan

    2007-05-01

    Pedicle screw pullout testing in osteoporotic and control human cadaveric vertebrae, comparing augmented and control vertebrae. To compare the pullout strengths of pedicle screws fixed in osteoporotic vertebrae using polymethyl methacrylate delivered by 2 augmentation techniques, a standard transpedicular approach and kyphoplasty type approach. Pedicle screw instrumentation of the osteoporotic spine carries an increased risk of screw loosening, pullout, and fixation failure. Osteoporosis is often cited as a contraindication for pedicle screw fixation. Augmentation of the vertebral pedicle and body using polymethyl methacrylate may improve fixation strength and construct survival in the osteoporotic vertebrae. While the utility of polymethyl methacrylate has been demonstrated for salvage of screws that have been pulled out, the effect of the cement technique on pullout strength in osteoporotic vertebrae has not been previously studied. Thirteen osteoporotic and 9 healthy human lumbar vertebrae were tested. All specimens were instrumented with pedicle screws using a uniform technique. Osteoporotic pedicles were augmented with polymethyl methacrylate using either a kyphoplasty type technique or a transpedicular augmentation technique. Screws were tested in a paired testing array, randomly assigning the augmentation techniques to opposite sides of each vertebra. Pullout to failure was performed either primarily or after a 5000-cycle tangential fatigue conditioning exposure. After testing, following screw removal, specimens were cut in the axial plane through the center of the vertebral body to inspect the cement distribution. Pedicle screws placed in osteoporotic vertebrae had higher pullout loads when augmented with the kyphoplasty technique compared to transpedicular augmentation (1414 +/- 338 versus 756 +/- 300 N, respectively; P pedicle screws in osteoporotic vertebrae augmented by kyphoplasty showed higher pullout resistance than those placed in healthy control

  6. Increased Radiation but No Benefits in Pedicle Screw Accuracy With Navigation versus a Freehand Technique in Scoliosis Surgery.

    Science.gov (United States)

    Urbanski, Wiktor; Jurasz, Wojciech; Wolanczyk, Michal; Kulej, Miroslaw; Morasiewicz, Piotr; Dragan, Szymon Lukasz; Zaluski, Rafal; Miekisiak, Grzegorz; Dragan, Szymon Feliks

    2018-02-08

    The clinical value of pedicle screws in spinal deformity surgery is well known; however, screw insertion is demanding and sometimes associated with complications. Navigation systems based on intraoperatively obtained three-dimensional (3-D) images were developed to minimize pedicle screw misplacements. However, there is a lack of data confirming superiority of navigation above other techniques. There are also concerns regarding increased radiation used during the procedure. The purposes of this study were (1) to compare accuracy of the two methods of pedicle screws placement: intraoperative 3-D image navigation versus a freehand technique in patients with idiopathic scoliosis; and (2) to assess the radiation dose received by patients with both methods. Between 2014 and 2016, 49 patients underwent posterior spinal fusion with all pedicle screw constructs for idiopathic scoliosis performed by two surgeons. The study design involved alternating the use of the freehand technique and navigation to position pedicle screws in consecutive patients, forming groups of 27 patients with 451 navigated screws and 22 patients with 384 screws positioned freehand. The two groups did not differ in age, sex, or magnitude of deformity. Two observers not involved in the treatment evaluated the position of the screws. The pedicle breach was assessed on intraoperatively obtained 3-D O-arm scans according to a grading system: Grade 0 = no pedicle wall violation; Grade 1 = perforation ≤ 2 mm; Grade 2 = 2 to 4 mm; and Grade 3 = perforation > 4 mm. Grades 0 and 1 were considered properly positioned and Grades 2 and 3 represented malposition. In terms of accuracy, we found no differences, with the numbers available, between the freehand and navigated groups in terms of the proportion of screws that were properly positioned (96% freehand and 96% in the navigation group, respectively; p = 0.518). Grade 3 pedicle screws were observed only in the freehand group and were all located in the upper

  7. Reconstruction of large upper eyelid defects with a free tarsal plate graft and a myocutaneous pedicle flap plus a free skin graft

    DEFF Research Database (Denmark)

    Toft, Peter B

    2016-01-01

    PURPOSE: To review and present the results of a one-step method employing a free tarsal plate graft and a myocutaneous pedicle flap plus a free skin graft for reconstruction of large upper eyelid defects after tumour surgery. METHODS: This was a retrospective case-series of 8 patients who underwent...... was reconstructed with a laterally based myocutaneous pedicle flap in 7 patients, leaving a raw surface under the brow which was covered with a free skin graft. In 1 patient with little skin left under the brow, the anterior lamella was reconstructed with a bi-pedicle orbicularis muscle flap together with a free...... excision to avoid eye discomfort. CONCLUSION: Large upper eyelid defects can be reconstructed with a free tarsal plate graft and a laterally based myocutaneous pedicle flap in combination with a free skin graft. Two-step procedures can probably be avoided in most cases....

  8. Biomechanical Comparisons of Pull Out Strengths After Pedicle Screw Augmentation with Hydroxyapatite, Calcium Phosphate, or Polymethylmethacrylate in the Cadaveric Spine.

    Science.gov (United States)

    Yi, Seong; Rim, Dae-Cheol; Park, Seoung Woo; Murovic, Judith A; Lim, Jesse; Park, Jon

    2015-06-01

    In vertebrae with low bone mineral densities pull out strength is often poor, thus various substances have been used to fill screw holes before screw placement for corrective spine surgery. We performed biomechanical cadaveric studies to compare nonaugmented pedicle screws versus hydroxyapatite, calcium phosphate, or polymethylmethacrylate augmented pedicle screws for screw tightening torques and pull out strengths in spine procedures requiring bone screw insertion. Seven human cadaveric T10-L1 spines with 28 vertebral bodies were examined by x-ray to exclude bony abnormalities. Dual-energy x-ray absorptiometry scans evaluated bone mineral densities. Twenty of 28 vertebrae underwent ipsilateral fluoroscopic placement of 6-mm holes augmented with hydroxyapatite, calcium phosphate, or polymethylmethacrylate, followed by transpedicular screw placements. Controls were pedicle screw placements in the contralateral hemivertebrae without augmentation. All groups were evaluated for axial pull out strength using a biomechanical loading frame. Mean pedicle screw axial pull out strength compared with controls increased by 12.5% in hydroxyapatite augmented hemivertebrae (P = 0.600) and by 14.9% in calcium phosphate augmented hemivertebrae (P = 0.234), but the increase was not significant for either method. Pull out strength of polymethylmethacrylate versus hydroxyapatite augmented pedicle screws was 60.8% higher (P = 0.028). Hydroxyapatite and calcium phosphate augmentation in osteoporotic vertebrae showed a trend toward increased pedicle screw pull out strength versus controls. Pedicle screw pull out force of polymethylmethacrylate in the insertion stage was higher than that of hydroxyapatite. However, hydroxyapatite is likely a better clinical alternative to polymethylmethacrylate, as hydroxyapatite augmentation, unlike polymethylmethacrylate augmentation, stimulates bone growth and can be revised. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Percutaneous cholecystostomy

    Energy Technology Data Exchange (ETDEWEB)

    Akhan, Okan E-mail: akhano@tr.net; Akinci, Devrim; Oezmen, Mustafa N

    2002-09-01

    Percutaneous cholecystostomy (PC), a technique that consists of percutaneous catheter placement in the gallbladder lumen under imaging guidance, has become an alternative to surgical cholecystostomy in recent years. Indications of PC include calculous or acalculous cholecystitis, cholangitis, biliary obstruction and opacification of biliary ducts. It also provides a potential route for stone dissolution therapy and stone extraction. Under aseptic conditions and ultrasound guidance, using local anesthesia, the procedure is carried out by using either modified Seldinger technique or trocar technique. Transhepatic or transperitoneal puncture can be performed as an access route. Several days after the procedure transcatheter cholangiography is performed to assess the patency of cystic duct, presence of gallstones and catheter position. The tract is considered mature in the absence of leakage to the peritoneal cavity, subhepatic, subcapsular, or subdiaphragmatic spaces. Response rates to PC in the literature are between the range of 56-100% as the variation of different patient population. Complications associated with PC usually occur immediately or within days and include haemorrhage, vagal reactions, sepsis, bile peritonitis, pneumothorax, perforation of the intestinal loop, secondary infection or colonisation of the gallbladder and catheter dislodgment. Late complications have been reported as catheter dislodgment and recurrent cholecystitis. PC under ultrasonographic guidance is a cost-effective, easy to perform and reliable procedure with low complication and high success rates for critically ill patients with acute cholecystitis. It is generally followed by elective cholecystectomy, if possible. However, it may be definitive treatment, especially in acalculous cholecystitis.

  10. Biomechanical evaluation of pedicle screws versus pedicle and laminar hooks in the thoracic spine.

    Science.gov (United States)

    Cordista, Andrew; Conrad, Bryan; Horodyski, MaryBeth; Walters, Sheri; Rechtine, Glenn

    2006-01-01

    Pedicle screws have been shown to be superior to hooks in the lumbar spine, but few studies have addressed their use in the thoracic spine. The objective of this study was to biomechanically evaluate the pullout strength of pedicle screws in the thoracic spine and compare them to laminar hooks. STUDY DESING/SETTING: Twelve vertebrae (T1-T12) were harvested from each of five embalmed human cadavers (n=60). The age of the donors averaged 83+8.5 years. After bone mineral density had been measured in the vertebrae (mean=0.47 g/cm(3)), spines were disarticulated. Some pedicles were damaged during disarticulation or preparation for testing, so that 100 out of a possible 120 pullout tests were performed. Each vertebra was secured using a custom-made jig, and a posteriorly directed force was applied to either the screw or the claw. Constructs were ramped to failure at 3 mm/min using a Mini Bionix II materials testing machine (MTS, Eden Prairie, MN). Pedicle claws had an average pullout strength of 577 N, whereas the pullout strength of pedicle screws averaged 309 N. Hooks installed using the claw method in the thoracic spine had an overwhelming advantage in pullout strength versus pedicle screws. Even in extremely osteoporotic bone, the claw withstood 88% greater pullout load. The results of this study indicate that hooks should be considered when supplemental instrumentation is required in thoracic vertebrae, especially in osteoporotic bone.

  11. Design of three-dimensional visualization based on the posterior lumbar pedicle screw fixation

    Directory of Open Access Journals (Sweden)

    Kai XU

    2011-09-01

    Full Text Available Objective To establish a three-dimensional visualization model of posterior lumbar pedicle screw fixation.Methods A patient with lumbar intervertebral disc hernia and another patient with compression fracture of lumbar vertebra were involved in the present study.Both patients underwent multi-slice spiral CT scan before and after lumbar pedicle screw fixation.The degree of preoperative vertebral compression,vertebral morphology before and after surgery,postoperative pedicle screw position,and decompression effects were observed.The original data of the multi-slice spiral CT were inputted into the computer.The three-dimensional reconstructed images of the lumbar and implanted screws were obtained using the software Amira 4.1 to show the three-dimensional shape of the lumbar vertebrae before and after surgery and the location of the implanted screws.Results The morphology and structure of the lumbar vertebrae before and after surgery and of the implanted screws were reconstructed using the digital navigation platform.The reconstructed 3D images could be displayed in multicolor,transparent,or arbitrary combinations.In the 3D surface reconstruction images,the location and structure of the implanted screws could be clearly observed,and the decompression of the spinal cord or nerve roots and the severity of the fracture and the compression of lumbar vertebrae could be fully evaluated.The reconstructed images before operation revealed the position of the vertebral pedicles and provided reference for intraoperative localization.Conclusions The three-dimensional computerized reconstructions of lumbar pedicle screw fixation may be valuable in basic research,clinical experiment,and surgical planning.The software Amira is one of the bases of three-dimensional reconstruction.

  12. Omental Pedicled Flap for Pulmonary Tuberculosis Sequelae

    African Journals Online (AJOL)

    multiruka1

    Complications associated with omental pedicled flap include: ileus, bowel obstruction, gastric outlet obstruction (especially if based on the right gastro- epiploic artery), diaphragmatic herniation and omental flap necrosis. In our case, the patient developed empyema post omental patching with a recurrent BPF. We opted for.

  13. the pedicled superior gluteal artery perforator flap

    African Journals Online (AJOL)

    lieved pressure on tissue over the sacral area, with shear, friction, moisture and malnutrition as contributing ... To report the use of the pedicled superior gluteal artery perforator (SGAP) fasciocutaneous flap as a ... et al. reported the sliding gluteus maximus flap, whereby structural and functional integrity of the muscle was ...

  14. Percutaneous Tracheostomy

    Science.gov (United States)

    Mehta, Chitra; Mehta, Yatin

    2017-01-01

    Percutaneous dilatational tracheostomy (PDT) is a commonly performed procedure in critically sick patients. It can be safely performed bedside by intensivists. This has resulted in decline in the use of surgical tracheostomy in intensive care unit (ICU) except in few selected cases. Most common indication of tracheostomy in ICU is need for prolonged ventilation. About 10% of patients requiring at least 3 days of mechanical ventilator support get tracheostomised during ICU stay. The ideal timing of PDT remains undecided at present. Contraindications and complications become fewer with increase in experience. Various methods of performing PDT have been discovered in last two decades. Preoperative work up, patient selection and post tracheostomy care form key components of a successful PDT. Bronchoscopy and ultrasound have been found to be useful procedural adjuncts, especially in presence of unfavorable anatomy. This article gives a brief overview about the use of PDT in ICU. PMID:28074819

  15. Percutaneous gastroenterostomy

    Energy Technology Data Exchange (ETDEWEB)

    Wittich, G.R.; Van Sonnenberg, E.; Casola, G.; Jantsch, H.; Walter, R.; Lechner, G.

    1987-05-01

    Percutaneous gastrostomies or gastroenterostomies serve for temporary or permanent enteric feeding in patients with obstruction or functional derangement of the esophagus or hypopharynx. In addition, this radiological procedure may be indicated for small bowel decompression. The authors present their experience in 71 patients. Insufflation of air through a nasogastric tube or catheter is the preferred method for gastric distension. The inferior margin of the left lobe of the liver and the transverse colon are localized sonographically and fluoroscopically prior to puncture. Either Seldinger or Trocartechniques have proven effective in establishing access to the stomach. The feeding tube is advanced into the proximal jejunum to reduce the likelyhood of gastroesophageal reflux and possible aspiration. Complications were encountered in four patients and included catheter dislocation in three and respiratory distress in one patient.

  16. Percutaneous angioscopy

    International Nuclear Information System (INIS)

    Beck, A.

    1987-01-01

    In dogs and 11 patients a new endoscopic method for arteries has been developed. The approach is transfemoral, and endoscopy is combined with angiography, percutaneous transluminal angioplasty (PTA), and local lysis. An ultrathin endoscope with a diameter of 2.4 mm is used, which also provides a working channel with a diameter of 0.4 mm. Guide wires, contrast media, and drugs for local lysis can be inserted through this channel. Under fluoroscopic control, the endoscope is placed in the region of interest, followed by a special method for decreasing blood flow. Endoscopy is documented by video or by a high-speed camera. No complications have occurred. In all patients, it was possible to demonstrate the results of dilatation, recanalization, or local lysis before and after the interventional procedure. (orig.) [de

  17. Does the Addition of a Dynamic Pedicle Screw to a Fusion Segment Prevent Adjacent Segment Pathology in the Lumbar Spine?

    Science.gov (United States)

    Aygun, Hayati; Yaray, Osman; Mutlu, Muren

    2017-10-01

    Retrospective clinical cohort study. To investigate whether the combined use of dynamic pedicle screws and polyaxial pedicle screws was effective on adjacent segment pathology (ASP). Various screw and rod models have been recently developed for preventing adjacent segment disease, and hybrid systems have been described along with posterior instrumentation in the fusion segment. In the literature, although the success of dynamic systems has been demonstrated in non-fusion posterior instrumentation, it remains unclear whether the addition of a screw-based dynamic system to a fusion segment would successfully prevent ASP in the long term. The study included 101 patients who underwent surgery for degenerative spine diseases between 2007 and 2014 with lumbar stabilization that used either polyaxial pedicle screws alone or polyaxial pedicle screws plus dynamic stabilization screws (with hinged screw heads). These two patient groups were compared using retrospectively obtained postoperative new clinical findings, Oswestry disability index (ODI) scores, visual analog scale (VAS) scores, and radiological data. The proportion of patients with ASP who were radiologically assessed was low ( p 0.05). Although the combined use of dynamic screws and the static system was radiologically found to be effective for preventing ASP in patients who underwent lumbar fusion with posterior instrumentation, it did not completely eliminate ASP or result in a significant improvement in clinical ASP.

  18. Pneumonia and mortality after percutaneous endoscopic gastrostomy insertion.

    Science.gov (United States)

    Azzopardi, Neville; Ellul, Pierre

    2013-01-01

    Percutaneous endoscopic gastrostomy feeding provides enteral nutrition to patients with neurological dysphagia. Thirty-day mortality rates of 4-26% have been reported, with pneumonia being the common cause post-percutaneous endoscopic gastrostomy insertion. This retrospective analysis of percutaneous endoscopic gastrostomy tube insertions in Malta (January 2008 - June 2010) compares the incidence of pneumonia in patients fed through a nasogastric tube versus in those fed via a percutaneous endoscopic gastrostomy tube. We analyzed the indications, poor prognostic factors and mortality for percutaneous endoscopic gastrostomy insertion. Ninety-seven patients underwent percutaneous endoscopic gastrostomy insertion. Fifty-four patients received nasogastric feeds before percutaneous endoscopic gastrostomy feeds. Patients on nasogastric feeds developed 32 episodes of pneumonia over a total of 7884 days of feeds (1 every 246 days). Patients with percutaneous endoscopic gastrostomy feeds after a period of nasogastric feeds developed 48 pneumonia episodes over 36,238 days (1 every 755 days). Patients with percutaneous endoscopic gastrostomy feeds without previous nasogastric feeds developed 28 pneumonia episodes over 23,983 days (1 every 856 days), and this was statistically significant (χ 2 test p value nasogastric feeds. However, pneumonia is still the major cause of death among percutaneous endoscopic gastrostomy patients.

  19. Percutaneous Achilles Tendon Lengthening

    Science.gov (United States)

    ... All Site Content AOFAS / FootCareMD / Treatments Percutaneous Achilles Tendon Lengthening Page Content ​ Pre-operative incision markings along ... What is the goal of a percutaneous Achilles tendon lengthening? The goal of this procedure is to ...

  20. Blood flow autoregulation in pedicled flaps

    DEFF Research Database (Denmark)

    Bonde, Christian T; Holstein-Rathlou, Niels-Henrik; Elberg, Jens J

    2009-01-01

    INTRODUCTION: Clinical work on the blood perfusion in skin and muscle flaps has suggested that some degree of blood flow autoregulation exists in such flaps. An autoregulatory mechanism would enable the flap to protect itself from changes in the perfusion pressure. The purpose of the present study...... was to evaluate if, and to what extent, a tissue flap could compensate a reduction in blood flow due to an acute constriction of the feed artery. Further, we wanted to examine the possible role of smooth muscle L-type calcium channels in the autoregulatory mechanism by pharmacological intervention with the L......-type calcium channel blocker nimodipine and the vasodilator papaverine. MATERIAL AND METHODS: Pedicled flaps were raised in pigs. Flow in the pedicle was reduced by constriction of the feed artery (n=34). A transit time flow probe measured the effect on blood flow continuously. Following this, three different...

  1. Pedicle screw "hubbing" in the immature thoracic spine: a biomechanical and micro-computed tomography evaluation.

    Science.gov (United States)

    Kang, Daniel G; Lehman, Ronald A; Bevevino, Adam J; Gaume, Rachel E; Purcell, Richard L; Dmitriev, Anton E; Lenke, Lawrence G

    2014-01-01

    A previous biomechanical study using adult thoracic vertebrae (both normal and osteoporotic bone density) demonstrated the deleterious effect of the pedicle screw hubbing technique. Pedicle screw "hubbing" involves seating and engaging the ventral aspect of the screw head onto the dorsal lamina cortex. This technique is postulated to provide a load-sharing effect by improving pullout resistance, as well as decreasing cephalocaudad toggling and implant loosening. We hypothesized the elastic properties of immature bone may mitigate, and perhaps enhance the purported benefits of the hubbing technique. We set out to evaluate pullout strength of fixed-head pedicle screws after hubbing versus standard insertion in the immature thoracic calf spine. Twenty-two (n=22) single-level disarticulated fresh-frozen immature calf thoracic vertebra specimens (ranging from T2 to T13) were prepared. Twelve specimens were instrumented with pedicle screws in group I (nonhubbed) and group II (hubbed) in the opposite pedicle. Cyclic loading in a cephalocaudad direction was applied for 2000 cycles at a rate of 1 Hz. Pullout testing was performed in-line with the midline of the vertebra and peak pullout strength was measured in Newtons. Ten different specimens underwent micro-computed tomography evaluation to assess for trabecular architecture and incidence of iatrogenic microfractures. Hubbed screws resulted in significantly lower pullout strength (747±197 vs. 922±112 N, P=0.01). With the hubbing technique, the dorsal cortex demonstrated plastic deformation and conformed to the screw head in 83% of cases compared with no visible plastic deformation in the control group. Micro-computed tomography demonstrated microfractures of the dorsal cortex in 10/10 for the hubbed group compared with 1/10 for the control group. This is the largest study ever performed on immature thoracic vertebra to evaluate this topic. Hubbed pedicle screws have significantly decreased pullout strength and

  2. PERCUTANEOUS ELECTROHEMOSTASIS AFTER PERCUTANEOUS NEPHROLITHOTOMY

    Directory of Open Access Journals (Sweden)

    R. N. Trushkin

    2017-01-01

    Full Text Available The article describes the clinical case in a patient with bilateral nephrolithiasis, chronic kidney disease of the 4th stage, after which bleeding from the left kidney developed after simultaneous bilateral percutaneous nephrolithotomy (PNL, leading to severe hemic hypoxia. Conservative therapy, blood transfusion did not lead to a persistent effect, the bleeding continued to recur. Given the presence of chronic renal failure (CRF from the embolization of the branches of the renal artery, it was decided to abstain, given the extremely high risk of aggravation of nephropathy after the administration of the contrast drug. Left-sided nephrectomy would inevitably lead to the development of terminal chronic renal failure. Patients performed an electrocoagulation of the fistula wall with a Karl Storz 26C resectoscope in 60W mode. The bleeding was completely stopped. The patient is discharged from the hospital in a satisfactory condition. At the time of discharge in the conduct of replacement renal therapy did not need. When analyzing publications in The Cochrane Library, PubMed, Medline and Web of Science, we did not find a description of such a method of hemostasis.

  3. Management of a posterior gunshot injury with a floating pedicle and cerebrospinal fluid leak.

    Science.gov (United States)

    Bourghli, Anouar; Abouhashem, Safwat; Abo Wali, Rami; Obeid, Ibrahim; Boissiere, Louis; Vital, Jean-Marc; Al Sarawan, Mohammed

    2018-03-10

    Gunshot injury to the spine can be devastating, and it has increased in the civilian population during the last decade. We present the case of a 30-year-old male, who received a bullet in his back after exchange of fire with the police. Initial assessment revealed paraparesis with cerebrospinal fluid leak (CSF) from the bullet entry hole, CT scan showed metal debris with two bullet fragments in the L5/S1 right foramen and lateral recess, and another fragment in the central canal posteriorly, and also it revealed two fracture lines creating a right L5 "floating pedicle". The patient was taken to the operating room and underwent L5/S1 posterior approach with right L5 pedicle stabilization with a pedicle screw, removal of the bullet fragments, dural repair with a patch, L5/S1 posterolateral fusion, and insertion of a lumbar CSF drain. The patient could walk with a walking frame on day 7 with a satisfactory radiological result at 1 year but with a remaining partial motor deficit of both ankles, mainly on the right side. Literature contains a lot of controversies regarding the management of spinal gunshot injuries. The current case shows that early surgical management, when partial neurological deficit with a CSF leak is noted, could improve the clinical outcome and prevent related complications.

  4. Sartorius muscle-pedicle bone graft for osteonecrosis of the femoral head.

    Science.gov (United States)

    Chen, Xiantao; Tan, Xuyi; Gao, Shutu; Zhang, Xiaodong; Li, Jianming; Liu, Youwen

    2016-07-01

    This study summarises the clinical efficacy of sartorius muscle-pedicle bone graft in osteonecrosis of the femoral head. A total of 58 patients, including 53 men (61 hips) and five women (6 hips) with osteonecrosis of the femoral head, underwent sartorius muscle-pedicle bone grafting. Association Research Circulation Osseous (ARCO) staging was performed. The ARCO staging revealed 23 hips of stage I, 36 hips of stage II and eight hips of stage III. The average surgical duration was 65 minutes (range 45-90 minutes). A total of 55 (64 hips) of the 58 patients undergoing surgery were followed up, with a mean follow-up duration of 34.48 months (range, 24-48 months) and a median of 34 months. The outcome was excellent in 27, good in 24, normal in two, and poor in 11 hips, with a total good rating of 79.68 %. The Harris score of the hip joints in the last follow-up was significantly improved compared with pre-surgical scores (P femoral head was 81.25 %. Sartorius muscle-pedicle bone graft significantly promotes repair of osteonecrosis of the femoral head, improves the Harris score of the hip joints, with good clinical efficacy. It effectively improves the survival rate of femoral head, delaying or preventing artificial hip replacement.

  5. Percutaneous tension band wiring for patellar fractures.

    Science.gov (United States)

    Rathi, Akhilesh; Swamy, M K S; Prasantha, I; Consul, Ashu; Bansal, Abhishek; Bahl, Vibhu

    2012-08-01

    To evaluate outcome of percutaneous tension band wiring for transverse fractures of the patella. 16 men and 7 women aged 27 to 65 (mean, 40) years underwent percutaneous tension band wiring for transverse fractures of the patella with a displacement of >3 mm. Pain, operating time, mobility, functional score, and complications were evaluated. 20 patients underwent successful percutaneous tension band wiring. The remaining 3 patients in whom closed reduction failed underwent open reduction and tension band wiring. The mean operating time was 46 (range, 28-62) minutes. The mean follow-up period was 20 (range, 15-30) months. At the latest follow-up, all patients had regained full extension. The objective score was excellent in 20 patients and good in 3, whereas the subjective score was excellent in 17, good in 5, and fair in one. All patients had radiological union at week 8. One patient had patellofemoral arthritis (secondary to a postoperative articular step). Two patients developed superficial infections, which resolved after antibiotic therapy. Mean thigh muscle wasting was 0.7 (range, 0.4-1) cm. Three patients encountered hardware problems (impingement/irritation of the skin over the knee) necessitating implant removal. Percutaneous tension band wiring is a viable option for transverse fractures of the patella.

  6. Renal effects of percutaneous stone removal

    Energy Technology Data Exchange (ETDEWEB)

    Eshghi, M.; Schiff, R.G.; Smith, A.D.

    1989-02-01

    Preoperative and postoperative renography with 99mTechnetium-diethylene-triamine pentaacetic acid was performed on 33 patients who were free of renal scarring, infection, and obstruction and who underwent percutaneous renal stone removal. Although there was a transient decrease in renal function postoperatively in some patients, statistically significant reductions in renal function occurred only in 1 patient with an arteriovenous malformation that was embolized and in 1 patient who had a postoperative ureteropelvic junction stricture. The creation of more than one nephrostomy tract did not affect the results. In the absence of serious complications, percutaneous nephrostomy does not have a significant effect on renal function.

  7. Exit strategies following percutaneous nephrolithotomy (PCNL)

    DEFF Research Database (Denmark)

    Cormio, Luigi; Gonzalez, Gaspar Ibarlucea; Tolley, David

    2013-01-01

    PURPOSE: To compare the characteristics and outcomes of exit strategies following percutaneous nephrolithotomy (PCNL) using the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study database. MATERIALS AND METHODS: Two matched data sets were prepared in order to compare...... stent only versus NT only and TTL versus NT only. Patients were matched on the exit strategy using the following variables: case volume of the center where they underwent PCNL, stone burden, the presence of staghorn stone, size of sheath used at percutaneous access, the presence of bleeding during...

  8. Use of the pedicled tensor fascia lata myocutaneous flap in the salvage of upper extremity high-voltage electrical injuries.

    Science.gov (United States)

    Fankhauser, Grant; Klomp, Aaron; Smith, Anthony; Rececca, Alanna; Casey, William

    2010-01-01

    High-voltage electrical burns of the upper extremity are often limb threatening. Typically, emergency fasciotomies are followed by serial debridements until only viable tissue remains. After debridement, flap coverage is required to preserve viable but exposed tendons, nerves, vessels, bones, and joints and to salvage these seriously injured upper extremities. Flap options are generally limited to large pedicle flaps or free tissue transfer. Despite the array of flaps available, surgical options become limited when upper extremity injuries are extensive or the initial flap fails. The most commonly used pedicle flap, the groin flap, may not provide adequate soft tissue coverage in these cases. In addition, free tissue transfer can be difficult due, in part, to the uncertainty in determining the complete zone of injury and whether the flap recipient vessels are suitable for the transfer.An ideal flap for coverage would be relatively thin and pliable; have a constant, reliable pedicle; and be large enough to cover wounds of significant size. Few surgeons have experience with the pedicled tensor fascia lata (TFL) flap for upper extremity coverage. The authors demonstrate its use in the salvage of extensive upper extremity injuries on three limbs in two patients. We believe that this flap offers a distinct advantage compared with the groin flap when pedicled flap coverage of the upper extremity is required. PATIENT 1: A 23-year-old man sustained severe electrical burns to his right upper extremity. After serial debridements, a pedicled TFL myocutaneous flap was used to provide soft tissue coverage of this extensive injury. The flap was delayed at 2 weeks and inset at 3 weeks. There was complete survival of the flap, leading to salvage of the extremity. PATIENT 2: A 27-year-old man sustained bilateral upper extremity electrical burns. Initial free tissue transfers to both arms were unsuccessful. The patient subsequently underwent simultaneous bilateral pedicled TFL

  9. Robotic versus fluoroscopy-guided pedicle screw insertion for metastatic spinal disease: a matched-cohort comparison.

    Science.gov (United States)

    Solomiichuk, Volodymyr; Fleischhammer, Julius; Molliqaj, Granit; Warda, Jwad; Alaid, Awad; von Eckardstein, Kajetan; Schaller, Karl; Tessitore, Enrico; Rohde, Veit; Schatlo, Bawarjan

    2017-05-01

    OBJECTIVE Robot-guided pedicle screw placement is an established technique for the placement of pedicle screws. However, most studies have focused on degenerative disease. In this paper, the authors focus on metastatic spinal disease, which is associated with osteolysis. The associated lack of dense bone may potentially affect the automatic recognition accuracy of radiography-based surgical assistance systems. The aim of the present study is to compare the accuracy of the SpineAssist robot system with conventional fluoroscopy-guided pedicle screw placement for thoracolumbar metastatic spinal disease. METHODS Seventy patients with metastatic spinal disease who required instrumentation were included in this retrospective matched-cohort study. All 70 patients underwent surgery performed by the same team of experienced surgeons. The decision to use robot-assisted or fluoroscopy-guided pedicle screw placement was based the availability of the robot system. In patients who underwent surgery with robot guidance, pedicle screws were inserted after preoperative planning and intraoperative fluoroscopic matching. In the "conventional" group, anatomical landmarks and anteroposterior and lateral fluoroscopy guided placement of the pedicle screws. The primary outcome measure was the accuracy of screw placement on the Gertzbein-Robbins scale. Grades A and B (fluoroscopy group required a second surgery (0.5%), but no revisions were required in the robot group. There was no difference in surgical site infections between the 2 groups (Group I, 5 patients [14.3%]; Group II, 8 patients [22.9%]) or in the duration of surgery between the 2 groups (Group I, 226.1 ± 78.8 minutes; Group II, 264.1 ± 124.3 minutes; p = 0.13). There was also no difference in radiation time between the groups (Group I, 138.2 ± 73.0 seconds; Group II, 126.5 ± 95.6 seconds; p = 0.61), but the radiation intensity was higher in the robot group (Group I, 2.8 ± 0.2 mAs; Group II, 2.0 ± 0.6 mAs; p < 0

  10. Traumatic Fracture of Thin Pedicles Secondary to Extradural ...

    African Journals Online (AJOL)

    Our objective is to report a technical case report, illustrating a traumatic spinal injury with multiple pedicle fractures, secondary to atrophic lumbar pedicles as well as the diagnostic workup and surgical management of this problem. Posterior lumbar decompression, resection of the meningeal cyst, ligation of the cyst ostium, ...

  11. Lumbar pedicle screw salvage: pullout testing of three different pedicle screw designs.

    Science.gov (United States)

    McLain, R F; Fry, M F; Moseley, T A; Sharkey, N A

    1995-02-01

    Although research has determined pedicle screw pullout strengths for normal and osteoporotic bone, this study provides the first biomechanical analysis of pedicle screw salvage. Ten fresh frozen human lumbar spines were separated into individual vertebrae; 6.0 x 40 mm pedicle screws were placed in each pedicle; and an axial pullout test was performed to establish control values. Ultimate load, initial stiffness, work, and displacement data were calculated. Each vertebra was reinstrumented with one 7.0 x 40 mm variable screw placement (VSP) screw side by side with either a 7.0 mm Cotrel Dubousset sacral screw (CD) or a 7.0 mm Compact Cotrel Dubousset pedicle screw (CCD). Pullout tests were repeated and compared to control data for individual screws and for each VSP/CD or VSP/CCD pair. Vertebrae were then reinstrumented with 8.0 mm VSP and CD screws and paired pullouts repeated. Statistical analysis was carried out using a paired T test. Analysis of intravertebral and intergroup variation of controls was carried out using a Paired Two Sample T test. The 7.0 mm CCD screws restored pullout strength to 62% of control pullouts; 7.0 mm CD screws, to 85%; 7.0 mm VSP screws, to 99%; 8.0 mm CD screws, to 109%; and 8.0 mm VSP screws, to 148% of control pullouts. The 7.0 mm VSP salvage screws exceeded CD screws in ultimate load by 22.5% (p screws by 33.5% (p screws significantly increased pullout relative to both controls and all 7.0 mm salvage screws, with 8.0 mm VSP exceeding 8.0 mm CD by 34% (p screws. Although applied in a smaller number of vertebrae, 8.0 mm screws sufficiently outperformed smaller screws to provide statistically significant differences. The 7.0 mm VSP salvage screws restored pullout to control levels, roughly equivalent to outcomes previously obtained with unpressurized polymethylmethacrylate (PMMA).

  12. Adolescent idiopathic scoliosis: sagital plane and low density pedicle screws

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    Rodrigo Augusto do Amaral

    2014-03-01

    Full Text Available OBJECTIVE: To examine the sagittal curves of patients treated with CD instrumentation using exclusively pedicle screws. METHODS: Image analysis of medical records of 27 patients (26 M and 1 F with a minimum follow-up of 6 months, who underwent surgical treatment in our service between January 2005 and December 2010. The curves were evaluated on coronal and sagittal planes, taking into account the potential correction of the technique. RESULTS: In the coronal plan the following curves were evaluated: proximal thoracic (TPx, main thoracic (TPp, and thoracolumbar; lumbar (TL, L, and the average flexibility was 52%, 52%, and 92% and the capacity of correction was 51%, 72%, and 64%, respectively. In the sagittal plane there was a mean increase in thoracic kyphosis (CT of 41% and an average reduction of lumbar lordosis (LL of 17%. Correlation analysis between variables showed Pearson coefficient of correlation of 0.053 and analysis of dispersion of R2 = <0.001. CONCLUSION: The method has shown satisfactory results with maintenance of kyphosis correction in patients with normal and hyper kyphotic deformities.

  13. Percutaneous balloon valvuloplasty of a stenosed mitral bioprosthesis.

    Science.gov (United States)

    Fernandez, J J; DeSando, C J; Leff, R A; Ord, M; Sabbagh, A H

    1990-01-01

    A 62-year-old woman with disabling mitral prosthetic stenosis underwent percutaneous balloon valvuloplasty. The transvalvular gradient preoperatively was 22 mm Hg and was reduced to 6 mm Hg after the valvuloplasty. the valve area was increased from an initial value of 0.77 cm2 to 1.53 cm2. No complications occurred related to the Further studies are necessary to ascertain the indications and long-term results of percutaneous valvuloplasty on bioprosthesis in the mitral position.

  14. Percutaneous management of tumoral biliary obstruction in children

    Energy Technology Data Exchange (ETDEWEB)

    Akinci, Devrim; Gumus, Burcak; Ozkan, Orhan S.; Ozmen, Mustafa N.; Akhan, Okan [Hacettepe School of Medicine, Department of Radiology, Sihhiye, Ankara (Turkey); Ekinci, Saniye [Hacettepe School of Medicine, Department of Paediatric Surgery, Sihhiye, Ankara (Turkey); Akcoren, Zuhal [Hacettepe School of Medicine, Department of Paediatric Pathology, Sihhiye, Ankara (Turkey); Kutluk, Tezer [Hacettepe School of Medicine, Department of Paediatric Oncology, Sihhiye, Ankara (Turkey)

    2007-10-15

    There is limited experience of percutaneous biliary interventions in children although they are safe and effective procedures. To evaluate the efficacy and safety of percutaneous management of tumoral biliary obstruction in children. Percutaneous biliary interventions were performed in eight children (six boys, two girls) with a mean age of 10.5 years (range 4-17 years). The interventions included percutaneous biliary drainage (five patients), percutaneous biliary drainage and placement of a self-expanding metallic stent (two patients), and percutaneous cholecystostomy (one patient). All patients had signs of obstructive jaundice and two had cholangitis. All procedures were successful. No procedure-related mortality was observed. Bilirubin levels returned to normal in four of the eight patients. Findings of cholangitis resolved in the two affected patients after the procedure and antibiotic treatment. Two patients underwent surgery after percutaneous biliary drainage procedures. A self-expanding metallic stent was placed in two patients with malignancy and the stents remained patent until death. Percutaneous biliary interventions can be performed safely for the management of tumoral biliary obstruction in children. (orig.)

  15. Percutaneous management of tumoral biliary obstruction in children

    International Nuclear Information System (INIS)

    Akinci, Devrim; Gumus, Burcak; Ozkan, Orhan S.; Ozmen, Mustafa N.; Akhan, Okan; Ekinci, Saniye; Akcoren, Zuhal; Kutluk, Tezer

    2007-01-01

    There is limited experience of percutaneous biliary interventions in children although they are safe and effective procedures. To evaluate the efficacy and safety of percutaneous management of tumoral biliary obstruction in children. Percutaneous biliary interventions were performed in eight children (six boys, two girls) with a mean age of 10.5 years (range 4-17 years). The interventions included percutaneous biliary drainage (five patients), percutaneous biliary drainage and placement of a self-expanding metallic stent (two patients), and percutaneous cholecystostomy (one patient). All patients had signs of obstructive jaundice and two had cholangitis. All procedures were successful. No procedure-related mortality was observed. Bilirubin levels returned to normal in four of the eight patients. Findings of cholangitis resolved in the two affected patients after the procedure and antibiotic treatment. Two patients underwent surgery after percutaneous biliary drainage procedures. A self-expanding metallic stent was placed in two patients with malignancy and the stents remained patent until death. Percutaneous biliary interventions can be performed safely for the management of tumoral biliary obstruction in children. (orig.)

  16. Circumferential fusion: a comparative analysis between anterior lumbar interbody fusion with posterior pedicle screw fixation and transforaminal lumbar interbody fusion for L5-S1 isthmic spondylolisthesis.

    Science.gov (United States)

    Tye, Erik Y; Tanenbaum, Joseph E; Alonso, Andrea S; Xiao, Roy; Steinmetz, Michael P; Mroz, Thomas E; Savage, Jason W

    2018-03-01

    Transforaminal lumbar interbody fusion (TLIF) or anterior lumbar interbody fusion with percutaneous pedicle screws (ALIFPS) offer significantly higher radiographic fusion rates than other fusion techniques for L5-S1 isthmic spondylolisthesis (IS). As it stands, there is a relative paucity of comparative data of the two techniques. To define the clinical, radiographic, and financial differences between TLIF and ALIFPS for L5-S1 IS. A retrospective cohort study conducted at a single tertiary care center. Sixty-six patients who underwent either TLIF or ALIPFS for L5-S1 IS at a single tertiary care center between 2009 and 2014. Quality of life outcome scores including the EuroQol-5 Dimensions (EQ-5D), Pain Disability Questionnaire (PDQ), and Patient Health Questionnaire-9 (PHQ-9). Sagittal balance parameters including: pelvic incidence, pelvic tilt, sacral slope, segmental lordosis, total lordosis, degree of slip, disc height, and L1-axis S1 distance (LASD). Cost measures included in-hospital charges, hospital length of stay (LOS), and post-admission costs accrued over 1 year. Quality of life (QoL) outcome scores, radiographic data, and financial data were collected with a minimum of 1-year follow-up. Clinical results were investigated using the PDQ, PHQ-9, and EQ-5D. Radiographic measurements included lumbar lordosis, segmental lordosis, pelvic tilt, pelvic incidence, height of disc, L-1 axis S-1 distance, and the degree of slip. Cost data were generated based on patient-level resource utilization. Comparative data were presented as median with interquartile range (IQR). Continuous variables were compared using either independent Student t tests assuming unequal variance or Mann-Whitney U tests for parametric and nonparametric variables, respectively. The minimally clinical important difference (MCID) used for each questionnaire was as follows: PDQ (26), PHQ-9 (5), and EQ-5D (0.4). A total of 66 patients met inclusion criteria. In the ALIFPS cohort, PDQ scores

  17. Ergotropic effect of bone cement on pedicle screw fixation in treatment of osteoporotic thoracolumbar fracture

    Directory of Open Access Journals (Sweden)

    Da LIU

    2017-02-01

    Full Text Available Objective To evaluate the ergotropic effect of bone cement on pedicle screw fixation in treatment of osteopo¬rotic thoracolumbar fracture. Methods Fifty-three patients with osteoporotic thoracolumbar fracture, admitted from Jun. 2013 to Dec. 2014, were included for treatment by augmentation of pedicle screw fixation with bone cement. All patients underwent pre-operative examination of bone mineral density with T-score ≤-2.5 and augmentation of pedicle screw fixation with injection of 1.5 ml bone cement in adjacent to fractured vertebra. All patients were treated with anti-osteoporosis therapy pre- and post-operation, ob¬served and recorded with basic conditions and complications. At pre-operation, one-week post-operation and last follow-up, pain vi¬sual analogue scale (VAS and neurological function score (ASIA of all patients were recorded, and the compression rats of anterior and posterior edge of fractured vertebra, and compression rats of spinal canal and Cobb angel of all patients were measured. Results All the 53 patients were successfully undergone operation in about 90-140 min with blood loss of about 150-350 ml. No spinal cord or nerve injury, dural tear and obvious leakage of bone cement and screw loosening occurred during operation. All patients were followed up for 12 to 36 months and the neurological function obviously recovered contrasted with pre-operation. X-ray and CT examination at last follow-up showed good fractures healing, good position and non-loosening of internal fixation device and non-leakage of bone cement. At one week post-operation and last follow-up, VAS, compression rats of anterior edge and posterior edge of fractured vertebra, compression rats of spinal canal and Cobb angel were significantly lower than those at pre-operation (P0.05. Conclusions Augmentation of pedicle screw fixation with bone cement can effectively strengthen the initial stability of pedicle screw in osteo¬porosis, restore the

  18. Accuracy of robot-guided versus freehand fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery.

    Science.gov (United States)

    Molliqaj, Granit; Schatlo, Bawarjan; Alaid, Awad; Solomiichuk, Volodymyr; Rohde, Veit; Schaller, Karl; Tessitore, Enrico

    2017-05-01

    OBJECTIVE The quest to improve the safety and accuracy and decrease the invasiveness of pedicle screw placement in spine surgery has led to a markedly increased interest in robotic technology. The SpineAssist from Mazor is one of the most widely distributed robotic systems. The aim of this study was to compare the accuracy of robot-guided and conventional freehand fluoroscopy-guided pedicle screw placement in thoracolumbar surgery. METHODS This study is a retrospective series of 169 patients (83 women [49%]) who underwent placement of pedicle screw instrumentation from 2007 to 2015 in 2 reference centers. Pathological entities included degenerative disorders, tumors, and traumatic cases. In the robot-assisted cohort (98 patients, 439 screws), pedicle screws were inserted with robotic assistance. In the freehand fluoroscopy-guided cohort (71 patients, 441 screws), screws were inserted using anatomical landmarks and lateral fluoroscopic guidance. Patients treated before 2009 were included in the fluoroscopy cohort, whereas those treated since mid-2009 (when the robot was acquired) were included in the robot cohort. Since then, the decision to operate using robotic assistance or conventional freehand technique has been based on surgeon preference and logistics. The accuracy of screw placement was assessed based on the Gertzbein-Robbins scale by a neuroradiologist blinded to treatment group. The radiological slice with the largest visible deviation from the pedicle was chosen for grading. A pedicle breach of 2 mm or less was deemed acceptable (Grades A and B) while deviations greater than 2 mm (Grades C, D, and E) were classified as misplacements. RESULTS In the robot-assisted cohort, a perfect trajectory (Grade A) was observed for 366 screws (83.4%). The remaining screws were Grades B (n = 44 [10%]), C (n = 15 [3.4%]), D (n = 8 [1.8%]), and E (n = 6 [1.4%]). In the fluoroscopy-guided group, a completely intrapedicular course graded as A was found in 76% (n = 335). The

  19. Pedicle screw rupture: A case study

    Directory of Open Access Journals (Sweden)

    Giorgio E.O. Giacaglia

    2015-10-01

    Full Text Available In this work we present a technical description related to the rupture of a titanium alloy pedicle screw and connecting bar implanted in dorsal vertebras of a patient. Only metallurgical facts are described, with no attempt to identify any imperfections in the clinical aspects related to the rupture. The results described here are based on extensive analysis of the broken materials in a material sciences specialized laboratory. Excluding an incorrect prosthesis implantation in the surgical procedure and a possible low bone density, an information not available to the research team, with high probability the rupture of metallic pieces used in the prosthetic implant, was produced by the low fatigue resistance resulting by an improper machining process and excessive bending of the connecting bar prior to implant.

  20. Lumbar pedicle screw placement: Using only AP plane imaging

    Directory of Open Access Journals (Sweden)

    Anil Sethi

    2012-01-01

    Conclusion: Placement of pedicle screws under fluoroscopic guidance using AP plane imaging alone with tactile guidance is safe, fast, and reliable. However, a good understanding of the radiographic landmarks is a prerequisite.

  1. Systematic review of cervical pedicle dimensions and projections.

    Science.gov (United States)

    Liu, Jiayong; Napolitano, Jonathan T; Ebraheim, Nabil A

    2010-11-15

    A systematic review of the published literature was conducted specifically looking at studies reporting linear dimension and angular projection data on the anatomy of the cervical pedicle (C1-C7) via radiography or direct measurement. This study aimed to report a more accurate set of dimension data and identify differences based on race and gender, increasing the sample size by aggregating similar data of prior studies measuring the cervical pedicle in Asian, European/American, male, and female populations. A wide variation in the reports of the dimensions and projections of the cervical pedicle exist partly due to the uniqueness of this structure as well as the effects of small sample sizes and variable races and genders of sample populations of previous studies. An extensive literature search was executed, and identified articles were reviewed. A comprehensive database was constructed for synthesis of the identified studies. Subgroups were determined based on the type of population (race, gender, location of study) and radiographic or direct cadaveric measurement. Descriptive statistics were used to analyze and compare these subgroups including: means, standard deviations, and Student t test with the Bonferroni adjustment. In total, the current study reports on 33 studies with the measurements of 1311 partial and complete cervical spines. At a 95% confidence interval statistically significant differences between races were found only at C3 and C4 levels in the pedicle axis length. Male-to-female significant differences existed only at the pedicle axis length of C5 in the Asian population, while sex differences existed in the outer pedicle width and height of C3, C4, C5, C6, and C7 in the European/American population. The current study has found that there is no statistical difference in measuring the cervical pedicle via radiography (CT) or directly. There are more significant differences comparing the cervical pedicles of males and females in the European

  2. Spondylolisthesis caused by extreme pedicle elongation in osteogenesis imperfecta

    OpenAIRE

    Ivo, Roland; Fuerderer, Sebastian; Eysel, Peer

    2007-01-01

    Although osteogenesis imperfecta is a well-known skeletal disorder, reports of spondylolisthesis in osteogenesis imperfecta are rare. Only very few cases of spondylolisthesis caused by elongation of lumbar pedicles have been described in the literature. Here we report three patients suffering from osteogenesis imperfecta showing a severe form of hyperlordosis caused by lumbar pedicle elongation and consecutive spondylolisthesis. Radiographs in the course of childhood and adolescence show a ra...

  3. Percutaneous Endoscopic Lumbar Discectomy for L5-S1 Disc Herniation: Consideration of the Relation between the Iliac Crest and L5-S1 Disc.

    Science.gov (United States)

    Choi, Kyung Chul; Park, Choon-Keun

    2016-02-01

    Percutaneous transforaminal techniques for the treatment of lumbar disc herniation have markedly evolved. Percutaneous endoscopic lumbar discectomy (PELD) for L5-S1 disc herniation is regarded as challenging due to the unique anatomy of the iliac crest, large facet joint, and inclinatory disc space. Among these, the iliac crest is considered a major obstacle. There are no studies regarding the height of the iliac crest and their appropriate procedures in PELD. This study discusses PELD for L5-S1 disc herniation and the appropriate approach according to the height of iliac crest. Retrospective evaluation. 100 consecutive patients underwent PELD via the transforaminal route for L5-S1 disc herniation by a single surgeon. The study was divided into 2 groups: the foraminoplasty group requiring foraminal widening to access the herniated disc and the non-foraminoplasty group treated by conventional posterolateral access. Radiological parameters such as iliac height, the relative position of the iliac crest to the landmarks of the L5-S1 level, iliosacral angle and foraminal height, and disc location were considered. Clinical outcomes were assessed by the Visual Analogue Scale (VAS, 0 - 10) for back and leg pain, the Oswestry Disability Index (ODI, 0 - 100%), and the modified MacNab criteria. The overall VAS scores for back and leg pain decreased from 6.0 to 2.3 and from 7.5 to 1.7. The mean ODI (%) improved from 54.0 to 11.6. Using modified MacNab criteria, a good outcome was 92%. Foraminoplasty was required in 19 patients. Iliac crest height was significantly higher in the foraminoplasty group than the non-foraminoplasty group (37.7 mm vs 30.1 mm, P disc height between the 2 groups. In addition, there were no differences in clinical outcome between the 2 groups. This study is a retrospective analysis and simplifies the complexity of the L5-S1 level and iliac bone using two-dimensional radiography. In high iliac crest cases where the iliac crest is above the mid L5 pedicle

  4. Accuracy of pedicle screw placement in patients with Marfan syndrome.

    Science.gov (United States)

    Qiao, Jun; Zhu, Feng; Xu, Leilei; Liu, Zhen; Sun, Xu; Qian, Bangping; Jiang, Qing; Zhu, Zezhang; Qiu, Yong

    2017-03-21

    There is no study concerning safety and accuracy of pedicle screw placement in Marfan syndrome. The objective of this study is to investigate accuracy and safety of pedicle screw placement in scoliosis associated with Marfan syndrome. CT scanning was performed to analyze accuracy of pedicle screw placement. Pedicle perforations were classified as medial, lateral or anterior and categorized to four grades: ≤ 2 mm as Grade 1, 2.1-4.0 mm as Grade 2, 4.1-6.0 mm as Grade 3, ≥6.1 mm as Grade 4. Fully contained screws or with medial wall perforation ≤ 2 mm or with lateral wall perforation ≤ 6 mm and without injury of visceral organs were considered acceptable, otherwise were unacceptable. 976 pedicle screws were placed, 713 screws (73.1%) were fully contained within the cortical boundaries of the pedicle. 924 (94.7%) screws were considered as acceptable, and 52 (5.3%) as unacceptable. The perforation rate was higher using free-hand technique than O-arm navigation technique (30.8% VS. 11.4%, P Marfan syndrome is accuracy and safe. O-arm navigation was an effective modality to ensure the safety and accuracy of screw placement. Special attention should be paid when screws were placed at the lumber spine and the concave side of spine deformity to avoid the higher rate of complications.

  5. Improving the pullout strength of pedicle screws by screw coupling.

    Science.gov (United States)

    Suzuki, T; Abe, E; Okuyama, K; Sato, K

    2001-10-01

    The objective of this study was to determine the effect of pedicle screw coupling on the pullout strength of pedicle screws in the osteoporotic spine. The vertebral bone mineral density (BMD) of 33 cadaveric lumbar vertebrae were measured by quantitative computed tomography. Pedicle screws were inserted into each pedicle. The pullout strength and displacement of the screws, without coupling and with single or double couplers, were studied, and the relationship between pullout strength and BMD was analyzed. The average pullout strength of the pedicle screws without screw coupling was 909.3 +/- 188.6 N (n = 9), that coupled with a single coupler was 1,409.0 +/- 469.1 N (n = 9), and that with double couplers was 1,494.0 +/- 691.6 N (n = 9). The pullout strength of the screws coupled with single or double couplers was significantly greater than that of screws without couplers (p pullout strength by screw coupling was significant in a test group with BMD of more than 90 mg/ml (p pedicle screws improves pullout strength; however, the effect tends to be less significant in severely osteoporotic spines.

  6. Surgical complications in neuromuscular scoliosis operated with posterior- only approach using pedicle screw fixation

    Directory of Open Access Journals (Sweden)

    Singh Surya Udai

    2009-05-01

    Full Text Available Abstract Background There are no reports describing complications with posterior spinal fusion (PSF with segmental spinal instrumentation (SSI using pedicle screw fixation in patients with neuromuscular scoliosis. Methods Fifty neuromuscular patients (18 cerebral palsy, 18 Duchenne muscular dystrophy, 8 spinal muscular atrophy and 6 others were divided in two groups according to severity of curves; group I ( 90°. All underwent PSF and SSI with pedicle screw fixation. There were no anterior procedures. Perioperative (within three months of surgery and postoperative (after three months of surgery complications were retrospectively reviewed. Results There were fifty (37 perioperative, 13 postoperative complications. Hemo/pneumothorax, pleural effusion, pulmonary edema requiring ICU care, complete spinal cord injury, deep wound infection and death were major complications; while atelectesis, pneumonia, mild pleural effusion, UTI, ileus, vomiting, gastritis, tingling sensation or radiating pain in lower limb, superficial infection and wound dehiscence were minor complications. Regarding perioperative complications, 34(68% patients had at least one major or one minor complication. There were 16 patients with pulmonary, 14 with abdominal, 3 with wound related, 2 with neurological and 1 cardiovascular complications, respectively. There were two deaths, one due to cardiac arrest and other due to hypovolemic shock. Regarding postoperative complications 7 patients had coccygodynia, 3 had screw head prominence, 2 had bed sore and 1 had implant loosening, respectively. There was a significant relationship between age and increased intraoperative blood loss (p = 0.024. However it did not increased complications or need for ICU care. Similarly intraoperative blood loss > 3500 ml, severity of curve or need of pelvic fixation did not increase the complication rate or need for ICU. DMD patients had higher chances of coccygodynia postoperatively. Conclusion

  7. Understanding of percutaneous puncture under guidance of ultrasound in treating peritoneal and perinephritic abscess

    International Nuclear Information System (INIS)

    Huang Liying; Wang Jiagang

    2010-01-01

    Objective: To explore the clinical value of percutaneous puncture under guidance of ultrasound in treating peritoneal abscess. Methods: To summarize 68 patients with peritoneal abscess underwent percutaneous puncture under guidance of ultrasound to analyse the method of operation and therapeutic effect. Results: effective power of percutaneous puncture under guidance of ultrasound in treating peritoneal abscess was 96.8%. Conclusion: Percutaneous puncture under guidance of ultrasound in treating peritoneal abscess may avoid injury induced by blinded puncture, with characteristic of easier operation, slighter trauma. higher safety, significant therapeutic effect, and can be spreaded to the clinical application. (authors)

  8. Percutaneous rendezvous technique for the management of a bile duct injury.

    Science.gov (United States)

    Meek, James; Fletcher, Savannah; Crumley, Kristen; Culp, W C; Meek, Mary

    2018-02-01

    The rendezvous technique typically involves combined efforts of interventional radiology, endoscopy, and surgery. It can be done solely percutaneously, whereby the interventionalist gains desired access to one point in the body by approaching it from two different access sites. We present the case of a woman who underwent cholecystectomy complicated by a bile duct injury. A percutaneous rendezvous procedure enabled placement of an internal-external drain from the intrahepatic ducts through the biloma and distal common bile duct and into the duodenum. Thus, a percutaneous rendezvous technique is feasible for managing a bile duct injury when endoscopic retrograde cholangio-pancreatography or percutaneous transhepatic cholangiogram alone has been unsuccessful.

  9. Percutaneous rendezvous technique for the management of a bile duct injury

    Directory of Open Access Journals (Sweden)

    James Meek, DO

    2018-02-01

    Full Text Available The rendezvous technique typically involves combined efforts of interventional radiology, endoscopy, and surgery. It can be done solely percutaneously, whereby the interventionalist gains desired access to one point in the body by approaching it from two different access sites. We present the case of a woman who underwent cholecystectomy complicated by a bile duct injury. A percutaneous rendezvous procedure enabled placement of an internal-external drain from the intrahepatic ducts through the biloma and distal common bile duct and into the duodenum. Thus, a percutaneous rendezvous technique is feasible for managing a bile duct injury when endoscopic retrograde cholangio-pancreatography or percutaneous transhepatic cholangiogram alone has been unsuccessful.

  10. Percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

    Park, Jae Hyung; Hong, Seong Mo; Han, Man Chung

    1982-01-01

    Percutaneous transhepatic biliary drainage was successfully made 20 times on 17 patients of obstructive jaundice for recent 1 year since June 1981 at Department of Radiology in Seoul National University Hospital. The causes of obstructive jaundice was CBD Ca in 13 cases, metastasis in 2 cases, pancreatic cancer in 1 case and CBD stone in 1 case. Percutaneous transhepatic biliary drainage is a relatively ease, safe and effective method which can be done after PTC by radiologist. It is expected that percutaneous transhepatic biliary drainage should be done as an essential procedure for transient permanent palliation of obstructive jaundice

  11. Percutaneous versus traditional and paraspinal posterior open approaches for treatment of thoracolumbar fractures without neurologic deficit: a meta-analysis.

    Science.gov (United States)

    Sun, Xiang-Yao; Zhang, Xi-Nuo; Hai, Yong

    2017-05-01

    This study evaluated differences in outcome variables between percutaneous, traditional, and paraspinal posterior open approaches for traumatic thoracolumbar fractures without neurologic deficit. A systematic review of PubMed, Cochrane, and Embase was performed. In this meta-analysis, we conducted online searches of PubMed, Cochrane, Embase using the search terms "thoracolumbar fractures", "lumbar fractures", ''percutaneous'', "minimally invasive", ''open", "traditional", "posterior", "conventional", "pedicle screw", "sextant", and "clinical trial". The analysis was performed on individual patient data from all the studies that met the selection criteria. Clinical outcomes were expressed as risk difference for dichotomous outcomes and mean difference for continuous outcomes with 95 % confidence interval. Heterogeneity was assessed using the χ 2 test and I 2 statistics. There were 4 randomized controlled trials and 14 observational articles included in this analysis. Percutaneous approach was associated with better ODI score, less Cobb angle correction, less Cobb angle correction loss, less postoperative VBA correction, and lower infection rate compared with open approach. Percutaneous approach was also associated with shorter operative duration, longer intraoperative fluoroscopy, less postoperative VAS, and postoperative VBH% in comparison with traditional open approach. No significant difference was found in Cobb angle correction, postoperative VBA, VBA correction loss, Postoperative VBH%, VBH correction loss, and pedicle screw misplacement between percutaneous approach and open approach. There was no significant difference in operative duration, intraoperative fluoroscopy, postoperative VAS, and postoperative VBH% between percutaneous approach and paraspianl approach. The functional and the radiological outcome of percutaneous approach would be better than open approach in the long term. Although trans-muscular spatium approach belonged to open fixation methods

  12. Pullout performance comparison of pedicle screws based on cement application and design parameters.

    Science.gov (United States)

    Tolunay, Tolga; Başgül, Cemile; Demir, Teyfik; Yaman, Mesut E; Arslan, Arslan K

    2015-11-01

    Pedicle screws are the main fixation devices for certain surgeries. Pedicle screw loosening is a common problem especially for osteoporotic incidents. Cannulated screws with cement augmentation are widely used for that kind of cases. Dual lead dual cored pedicle screw has already given promising pullout values without augmentation. This study concentrates on the usage of dual lead dual core with cement augmentation as an alternative to cannulated and standard pedicle screws with cement augmentation. Five groups (dual lead dual core, normal pedicle screw and cannulated pedicle screw with augmentation, normal pedicle screw, dual lead dual cored pedicle screw) were designed for this study. Healthy bovine vertebrae and synthetic polyurethane foams (grade 20) were used as embedding test medium. Test samples were prepared in accordance with surgical guidelines and ASTM F543 standard testing protocols. Pullout tests were conducted with Instron 3300 testing frame. Load versus displacement values were recorded and maximum pullout loads were stated. The dual lead dual cored pedicle screw with poly-methyl methacrylate augmentation exhibited the highest pullout values, while dual lead dual cored pedicle screw demonstrated similar pullout strength as cannulated pedicle screw and normal pedicle screw with poly-methyl methacrylate augmentation. The dual lead dual cored pedicle screw with poly-methyl methacrylate augmentation can be used for osteoporotic and/or severe osteoporotic patients according to its promising results on animal cadaver and synthetic foams. © IMechE 2015.

  13. Biomechanical study of pedicle screw fixation in severely osteoporotic bone.

    Science.gov (United States)

    Cook, Stephen D; Salkeld, Samantha L; Stanley, Tom; Faciane, Albert; Miller, Scot D

    2004-01-01

    Obtaining adequate purchase with standard pedicle screw techniques remains a challenge in poor quality bone. The development of alternate insertion techniques and screw designs was prompted by recognition of potential fixation complications. An expandable pedicle screw design has been shown to significantly improve fixation compared to a conventional screw in poor quality bone. The purpose of this study was to determine if polymethylmethacrylate (PMMA) bone cement augmentation of an expandable pedicle screw can further improve fixation strength compared to the expandable screw alone in severely osteoporotic bone. A technique for cement insertion into the pedicle by means of the cannulated central portion of the expandable screw is also described. The axial pullout strength, stiffness and energy absorbed of cemented and noncemented expandable pedicle screws was determined in cadaveric vertebrae. Twenty-one fresh unembalmed vertebrae from the thoracolumbar spine were used. Radiographs and bone mineral density measurements (BMD) were used to characterize bone quality. Paired cemented and noncemented pedicle screw axial pullout strength was determined through mechanical testing. Mechanical pullout strength, stiffness and energy to failure was correlated with BMD. Overall, there was a 250% increase in mean pullout strength with the cemented expandable screw compared with a noncemented expandable screw including a greater than twofold increase in pullout strength in the most severely osteoporotic bone. The mean stiffness and energy absorbed to failure was also significantly increased. A cemented conventional screw achieved a pullout strength similar to the noncemented expandable screw. PMMA cement augmentation of the expandable pedicle screw may be a viable clinical option for achieving fixation in severely osteoporotic bone.

  14. Peritonitis following percutaneous gastrostomy tube insertions in children

    Energy Technology Data Exchange (ETDEWEB)

    Dookhoo, Leema [The Hospital for Sick Children, Department of Diagnostic Imaging, Toronto, ON (Canada); University of Toronto, Faculty of Medicine, Toronto, ON (Canada); Mahant, Sanjay [The Hospital for Sick Children, Department of Pediatrics, Toronto, ON (Canada); Parra, Dimitri A.; John, Philip R.; Amaral, Joao G.; Connolly, Bairbre L. [The Hospital for Sick Children, Department of Diagnostic Imaging, Toronto, ON (Canada)

    2016-09-15

    Percutaneous retrograde gastrostomy has a high success rate, low morbidity, and can be performed under different levels of sedation or local anesthesia in children. Despite its favourable safety profile, major complications can occur. Few studies have examined peritonitis following percutaneous retrograde gastrostomy in children. To identify potential risk factors and variables influencing the development and early diagnosis of peritonitis following percutaneous retrograde gastrostomy. We conducted a retrospective case-control study of children who developed peritonitis within 7 days of percutaneous retrograde gastrostomy between 2003 and 2012. From the 1,504 patients who underwent percutaneous retrograde gastrostomy, patients who developed peritonitis (group 1) were matched by closest date of procedure to those without peritonitis (group 2). Peritonitis was defined according to recognized clinical criteria. Demographic, clinical, procedural, management and outcomes data were collected. Thirty-eight of 1,504 children (2.5%; 95% confidence interval, 1.8-3.5) who underwent percutaneous retrograde gastrostomy developed peritonitis ≤7 days post procedure (group 1). Fever (89%), irritability (63%) and abdominal pain (55%) occurred on presentation of peritonitis. Group 1 patients were all treated with antibiotics; 41% underwent additional interventions: tube readjustments (8%), aspiration of pneumoperitoneum (23%), laparotomy (10%) and intensive care unit admission (10%). In group 1, enteral feeds started on average 3 days later and patients were discharged 5 days later than patients in group 2. There were two deaths not directly related to peritonitis. Neither age, gender, weight, underlying diagnoses nor operator was identified as a risk factor. Peritonitis following percutaneous retrograde gastrostomy in children occurs in approximately 2.5% of cases. No risk factors for its development were identified. Medical management is usually sufficient for a good outcome

  15. Peritonitis following percutaneous gastrostomy tube insertions in children

    International Nuclear Information System (INIS)

    Dookhoo, Leema; Mahant, Sanjay; Parra, Dimitri A.; John, Philip R.; Amaral, Joao G.; Connolly, Bairbre L.

    2016-01-01

    Percutaneous retrograde gastrostomy has a high success rate, low morbidity, and can be performed under different levels of sedation or local anesthesia in children. Despite its favourable safety profile, major complications can occur. Few studies have examined peritonitis following percutaneous retrograde gastrostomy in children. To identify potential risk factors and variables influencing the development and early diagnosis of peritonitis following percutaneous retrograde gastrostomy. We conducted a retrospective case-control study of children who developed peritonitis within 7 days of percutaneous retrograde gastrostomy between 2003 and 2012. From the 1,504 patients who underwent percutaneous retrograde gastrostomy, patients who developed peritonitis (group 1) were matched by closest date of procedure to those without peritonitis (group 2). Peritonitis was defined according to recognized clinical criteria. Demographic, clinical, procedural, management and outcomes data were collected. Thirty-eight of 1,504 children (2.5%; 95% confidence interval, 1.8-3.5) who underwent percutaneous retrograde gastrostomy developed peritonitis ≤7 days post procedure (group 1). Fever (89%), irritability (63%) and abdominal pain (55%) occurred on presentation of peritonitis. Group 1 patients were all treated with antibiotics; 41% underwent additional interventions: tube readjustments (8%), aspiration of pneumoperitoneum (23%), laparotomy (10%) and intensive care unit admission (10%). In group 1, enteral feeds started on average 3 days later and patients were discharged 5 days later than patients in group 2. There were two deaths not directly related to peritonitis. Neither age, gender, weight, underlying diagnoses nor operator was identified as a risk factor. Peritonitis following percutaneous retrograde gastrostomy in children occurs in approximately 2.5% of cases. No risk factors for its development were identified. Medical management is usually sufficient for a good outcome

  16. Peritonitis following percutaneous gastrostomy tube insertions in children.

    Science.gov (United States)

    Dookhoo, Leema; Mahant, Sanjay; Parra, Dimitri A; John, Philip R; Amaral, Joao G; Connolly, Bairbre L

    2016-09-01

    Percutaneous retrograde gastrostomy has a high success rate, low morbidity, and can be performed under different levels of sedation or local anesthesia in children. Despite its favourable safety profile, major complications can occur. Few studies have examined peritonitis following percutaneous retrograde gastrostomy in children. To identify potential risk factors and variables influencing the development and early diagnosis of peritonitis following percutaneous retrograde gastrostomy. We conducted a retrospective case-control study of children who developed peritonitis within 7 days of percutaneous retrograde gastrostomy between 2003 and 2012. From the 1,504 patients who underwent percutaneous retrograde gastrostomy, patients who developed peritonitis (group 1) were matched by closest date of procedure to those without peritonitis (group 2). Peritonitis was defined according to recognized clinical criteria. Demographic, clinical, procedural, management and outcomes data were collected. Thirty-eight of 1,504 children (2.5%; 95% confidence interval, 1.8-3.5) who underwent percutaneous retrograde gastrostomy developed peritonitis ≤7 days post procedure (group 1). Fever (89%), irritability (63%) and abdominal pain (55%) occurred on presentation of peritonitis. Group 1 patients were all treated with antibiotics; 41% underwent additional interventions: tube readjustments (8%), aspiration of pneumoperitoneum (23%), laparotomy (10%) and intensive care unit admission (10%). In group 1, enteral feeds started on average 3 days later and patients were discharged 5 days later than patients in group 2. There were two deaths not directly related to peritonitis. Neither age, gender, weight, underlying diagnoses nor operator was identified as a risk factor. Peritonitis following percutaneous retrograde gastrostomy in children occurs in approximately 2.5% of cases. No risk factors for its development were identified. Medical management is usually sufficient for a good outcome

  17. Percutaneous dilatational tracheostomy

    DEFF Research Database (Denmark)

    Johnsen, R.

    2015-01-01

    Introduction Since the introduction and development of percutaneous dilatational tracheostomy (PDT), this procedure is accepted and incorporated in ICUs worldwide. In spite of obvious benefits for the patients, who obtain more comfort and mobility and less use of sedatives, the procedure also...... providers' notes are entered. When searching for -percutaneous dilatation tracheostomy' in the electronic system, we found all patients who had undergone this specific procedure. Afterwards we analyzed each of these patients' hospital records, looking for any periprocedure or postprocedure complications...

  18. Active Pedicle Epithelial Flap Transposition Combined with Amniotic Membrane Transplantation for Treatment of Nonhealing Corneal Ulcers

    Directory of Open Access Journals (Sweden)

    Ting Zhang

    2016-01-01

    Full Text Available Introduction. The objective was to evaluate the efficacy of active pedicle epithelial flap transposition combined with amniotic membrane transplantation (AMT in treating nonhealing corneal ulcers. Material and Methods. Eleven patients (11 eyes with nonhealing corneal ulcer who underwent the combined surgery were included. Postoperatively, ulcer healing time was detected by corneal fluorescein staining. Visual acuity, intraocular pressure, surgical complications, and recurrence were recorded. Corneal status was inspected by the laser scanning confocal microscopy and anterior segment optical coherence tomography (AS-OCT. Results. The primary diseases were herpes simplex keratitis (8 eyes, corneal graft ulcer (2 eyes, and Stevens-Johnson syndrome (1 eye. All epithelial flaps were intact following surgery, without shedding or displacement. Mean ulcer healing time was 10.8±3.1 days, with a healing rate of 91%. Vision significantly improved from 1.70 to 0.82 log MAR (P=0.001. A significant decrease in inflammatory cell infiltration and corneal stromal edema was revealed 2 months postoperatively by confocal microscopy and AS-OCT. Corneal ulcer recurred in 1 eye. None of the patients developed major complications. Conclusion. Active pedicle epithelial flap transposition combined with AMT is a simple and effective treatment for nonhealing corneal ulcers.

  19. Active Pedicle Epithelial Flap Transposition Combined with Amniotic Membrane Transplantation for Treatment of Nonhealing Corneal Ulcers.

    Science.gov (United States)

    Zhang, Ting; Wang, Yuexin; Jia, Yanni; Liu, Dongle; Li, Suxia; Shi, Weiyun; Gao, Hua

    2016-01-01

    Introduction . The objective was to evaluate the efficacy of active pedicle epithelial flap transposition combined with amniotic membrane transplantation (AMT) in treating nonhealing corneal ulcers. Material and Methods . Eleven patients (11 eyes) with nonhealing corneal ulcer who underwent the combined surgery were included. Postoperatively, ulcer healing time was detected by corneal fluorescein staining. Visual acuity, intraocular pressure, surgical complications, and recurrence were recorded. Corneal status was inspected by the laser scanning confocal microscopy and anterior segment optical coherence tomography (AS-OCT). Results . The primary diseases were herpes simplex keratitis (8 eyes), corneal graft ulcer (2 eyes), and Stevens-Johnson syndrome (1 eye). All epithelial flaps were intact following surgery, without shedding or displacement. Mean ulcer healing time was 10.8 ± 3.1 days, with a healing rate of 91%. Vision significantly improved from 1.70 to 0.82 log MAR ( P = 0.001). A significant decrease in inflammatory cell infiltration and corneal stromal edema was revealed 2 months postoperatively by confocal microscopy and AS-OCT. Corneal ulcer recurred in 1 eye. None of the patients developed major complications. Conclusion . Active pedicle epithelial flap transposition combined with AMT is a simple and effective treatment for nonhealing corneal ulcers.

  20. Oncoplastic reduction using the vertical scar superior-medial pedicle pattern technique for immediate partial breast reconstruction

    Science.gov (United States)

    Barnea, Yoav; Inbal, Amir; Barsuk, Daphna; Menes, Tehila; Zaretski, Arik; Leshem, David; Weiss, Jerry; Schneebaum, Schlomo; Gur, Eyal

    2014-01-01

    Background Oncoplastic breast reduction in women with medium to large breasts has reportedly benefitted them both oncologically and cosmetically. We present our experience with an oncoplastic breast reduction technique using a vertical scar superior-medial pedicle pattern for immediate partial breast reconstruction. Methods All patients with breast tumours who underwent vertical scar superior-medial pedicle reduction pattern oncoplastic surgery at our centre between September 2006 and June 2010 were retrospectively studied. Follow-up continued from 12 months to 6 years. Results Twenty women (age 28–72 yr) were enrolled: 16 with invasive carcinoma and 4 with benign tumours. They all had tumour-free surgical margins, and no further oncological operations were required. The patients expressed a high degree of satisfaction from the surgical outcome in terms of improved quality of life and a good cosmetic result. Conclusion The vertical scar superior-medial pedicle reduction pattern is a versatile oncoplastic technique that allows breast tissue rearrangement for various tumour locations. It is oncologically beneficial and is associated with high patient satisfaction. PMID:25078939

  1. Ball tip technique for thoracic pedicle screw placement in patients with adolescent idiopathic scoliosis.

    Science.gov (United States)

    Watanabe, Kota; Matsumoto, Morio; Tsuji, Takashi; Ishii, Ken; Takaishi, Hironari; Nakamura, Masaya; Toyama, Yoshiaki; Chiba, Kazuhiro

    2010-08-01

    The aim in this study was to evaluate the efficacy of the ball tip technique in placing thoracic pedicle screws (TPSs), as compared with the conventional freehand technique, in both a cadaveric study and a clinical study of patients with adolescent idiopathic scoliosis. Although posterior spinal surgery using TPSs has been widely applied, these screws are associated with the potential risk of vascular, pulmonary, or neurological complications. To further enhance the accuracy and safety of TPS placement, the authors developed the ball tip technique. After creating an appropriate starting point for probe insertion, a specially designed ball tip probe consisting of a ball-shaped tip with a flexible metal shaft is used to make a guide hole into the pedicle. Holding the probe with the fingertips while using an appropriate amount of pressure or by tapping it gently and continuously with a hammer, one can safely insert the ball tip probe into the cancellous channel in the pedicle. In a cadaveric study, 5 spine fellows with similar levels of experience in placing TPSs applied the ball tip or the conventional technique to place screws in 5 cadavers with no spinal deformities. The incidence of misplaced screws was evaluated by dissecting the spines. In a clinical study, 40 patients with adolescent idiopathic scoliosis underwent posterior surgery with TPS placement via the ball tip or conventional technique (20 patients in each treatment group). The accuracy of the TPS placements was evaluated on postoperative axial CT scanning. In the cadaveric study, 100 TPSs were evaluated, and the incidence of misplaced screws was 14% in the ball tip group and 34% in the conventional group (p = 0.0192). In the clinical study, 574 TPSs were evaluated. One hundred seventy-one intrapedicular screws (67%) were recognized in the conventional group and 288 (90%) in the ball tip group (p ball tip groups, the respective numbers of TPSs with a pedicle breach of 2 mm were 32 (13%) and 9 (3%; p ball

  2. Minimal access direct spondylolysis repair using a pedicle screw-rod system: a case series

    Directory of Open Access Journals (Sweden)

    Mohi Eldin Mohamed

    2012-11-01

    Full Text Available Abstract Introduction Symptomatic spondylolysis is always challenging to treat because the pars defect causing the instability needs to be stabilized while segmental fusion needs to be avoided. Direct repair of the pars defect is ideal in cases of spondylolysis in which posterior decompression is not necessary. We report clinical results using segmental pedicle-screw-rod fixation with bone grafting in patients with symptomatic spondylolysis, a modification of a technique first reported by Tokuhashi and Matsuzaki in 1996. We also describe the surgical technique, assess the fusion and analyze the outcomes of patients. Case presentation At Cairo University Hospital, eight out of twelve Egyptian patients’ acute pars fractures healed after conservative management. Of those, two young male patients underwent an operative procedure for chronic low back pain secondary to pars defect. Case one was a 25-year-old Egyptian man who presented with a one-year history of axial low back pain, not radiating to the lower limbs, after falling from height. Case two was a 29-year-old Egyptian man who presented with a one-year history of axial low back pain and a one-year history of mild claudication and infrequent radiation to the leg, never below the knee. Utilizing a standardized mini-access fluoroscopically-guided surgical protocol, fixation was established with two titanium pedicle screws place into both pedicles, at the same level as the pars defect, without violating the facet joint. The cleaned pars defect was grafted; a curved titanium rod was then passed under the base of the spinous process of the affected vertebra, bridging the loose fragment, and attached to the pedicle screw heads, to uplift the spinal process, followed by compression of the defect. The patients were discharged three days after the procedure, with successful fusion at one-year follow-up. No rod breakage or implant-related complications were reported. Conclusions Where there is no

  3. Evaluation of surgical strategy of conventional vs. percutaneous robot-assisted spinal trans-pedicular instrumentation in spondylodiscitis.

    Science.gov (United States)

    Keric, Naureen; Eum, David J; Afghanyar, Feroz; Rachwal-Czyzewicz, Izabela; Renovanz, Mirjam; Conrad, Jens; Wesp, Dominik M A; Kantelhardt, Sven R; Giese, Alf

    2017-03-01

    Robot-assisted percutaneous insertion of pedicle screws is a recent technique demonstrating high accuracy. The optimal treatment for spondylodiscitis is still a matter of debate. We performed a retrospective cohort study on surgical patients treated with pedicle screw/rod placement alone without the application of intervertebral cages. In this collective, we compare conventional open to a further minimalized percutaneous robot-assisted spinal instrumentation, avoiding a direct contact of implants and infectious focus. 90 records and CT scans of patients treated by dorsal transpedicular instrumentation of the infected segments with and without decompression and antibiotic therapy were analysed for clinical and radiological outcome parameters. 24 patients were treated by free-hand fluoroscopy-guided surgery (121 screws), and 66 patients were treated by percutaneous robot-assisted spinal instrumentation (341 screws). Accurate screw placement was confirmed in 90 % of robot-assisted and 73.5 % of free-hand placed screws. Implant revision due to misplacement was necessary in 4.95 % of the free-hand group compared to 0.58 % in the robot-assisted group. The average intraoperative X-ray exposure per case was 0.94 ± 1.04 min in the free-hand group vs. 0.4 ± 0.16 min in the percutaneous group (p = 0.000). Intraoperative adverse events were observed in 12.5 % of free-hand placed pedicle screws and 6.1 % of robot robot-assisted screws. The mean postoperative hospital stay in the free-hand group was 18.1 ± 12.9 days, and in percutaneous group, 13.8 ± 5.6 days (p = 0.012). This study demonstrates that the robot-guided insertion of pedicle screws is a safe and effective procedure in lumbar and thoracic spondylodiscitis with higher accuracy of implant placement, lower radiation dose, and decreased complication rates. Percutaneous spinal dorsal instrumentation seems to be sufficient to treat lumbar and thoracic spondylodiscitis.

  4. Metal artifacts reduction using monochromatic images from spectral CT: Evaluation of pedicle screws in patients with scoliosis

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Yang, E-mail: wangzhang227@163.com [Department of Radiology, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008 (China); Qian, Bangping, E-mail: qianbangping@163.com [Spine Service, Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008 (China); Li, Baoxin, E-mail: wangzhi68@163.com [Department of Radiology, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008 (China); Qin, Guochu, E-mail: qgc7605@yahoo.com.cn [Department of Radiology, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008 (China); Zhou, Zhengyang, E-mail: zyzhou@nju.edu.cn [Department of Radiology, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008 (China); Qiu, Yong, E-mail: scoliosis2002@sina.com [Spine Service, Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008 (China); Sun, Xizhao, E-mail: sunxizhaonj@163.com [Department of Radiology and Urology, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008 (China); Zhu, Bin, E-mail: gobin10266@163.com [Department of Radiology, The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008 (China)

    2013-08-15

    Purpose: To evaluate the effectiveness of spectral CT in reducing metal artifacts caused by pedicle screws in patients with scoliosis. Materials and methods: Institutional review committee approval and written informed consents from patients were obtained. 18 scoliotic patients with a total of 228 pedicle screws who underwent spectral CT imaging were included in this study. Monochromatic image sets with and without the additional metal artifacts reduction software (MARS) correction were generated with photon energy at 65 keV and from 70 to 140 keV with 10 keV interval using the 80 kVp and 140 kVp projection sets. Polychromatic images corresponded to the conventional 140 kVp imaging were also generated from the same scan data as a control group. Both objective evaluation (screw width and quantitative artifacts index measurements) and subjective evaluation (depiction of pedicle screws, surrounding structures and their relationship) were performed. Results: Image quality of monochromatic images in the range from 110 to 140 keV (0.97 ± 0.28) was rated superior to the conventional polychromatic images (2.53 ± 0.54) and also better than monochromatic images with lower energy. Images of energy above 100 keV also give accurate measurement of the width of screws and relatively low artifacts index. The form of screws was slightly distorted in MARS reconstruction. Conclusions: Compared to conventional polychromatic images, monochromatic images acquired from dual-energy CT provided superior image quality with much reduced metal artifacts of pedicle screws in patients with scoliosis. Optimal energy range was found between 110 and 140 keV.

  5. Percutaneous Cementoplasty for Kienbock’s Disease

    Energy Technology Data Exchange (ETDEWEB)

    Vallejo, Eduardo Crespo, E-mail: dreduardocrespo@gmail.com [Hospital Príncipe de Asturias, Vascular and Interventional Radiology Unit (Spain); Martinez-Galdámez, Mario [Fundación Jimenez Diaz, Neurointerventional Radiology Unit (Spain); Martin, Ernesto Santos [Memorial Sloan-Kettering Center, Vascular and Interventional Radiology Unit (United States); Gregorio, Arturo Perera de [Hospital Príncipe de Asturias, Department of Orthopedic Surgery (Spain); Gallego, Miriam Gamo [Hospital Príncipe de Asturias, Vascular and Interventional Radiology Unit (Spain); Escobar, Angeles Ramirez [Hospital Príncipe de Asturias, Radiology Unit (Spain)

    2017-05-15

    Kienböck disease typically presents with wrist pain, swelling, restricted range of motion, and difficulty in performing activities of daily living. Because the etiology and evolution of disease remain unclear, broad ranges of treatments have been designed. Percutaneous cementoplasty is expanding its role for managing painful bone metastases outside the spine. We can draw a parallel between lytic tumoral lesions and Kienbock’s disease. Increasing the strength and rigidity of lunate with cementoplasty can prevent it from collapse, relieve the symptoms associated with the process of avascular necrosis, and increase the wrist range of motion. We report the case of 30-year-old man with a painful stage IIIA Kienböck disease who underwent percutaneous cementoplasty and experienced immediate effective pain relief and recovery of wrist mobility.

  6. Percutaneous Cementoplasty for Kienbock’s Disease

    International Nuclear Information System (INIS)

    Vallejo, Eduardo Crespo; Martinez-Galdámez, Mario; Martin, Ernesto Santos; Gregorio, Arturo Perera de; Gallego, Miriam Gamo; Escobar, Angeles Ramirez

    2017-01-01

    Kienböck disease typically presents with wrist pain, swelling, restricted range of motion, and difficulty in performing activities of daily living. Because the etiology and evolution of disease remain unclear, broad ranges of treatments have been designed. Percutaneous cementoplasty is expanding its role for managing painful bone metastases outside the spine. We can draw a parallel between lytic tumoral lesions and Kienbock’s disease. Increasing the strength and rigidity of lunate with cementoplasty can prevent it from collapse, relieve the symptoms associated with the process of avascular necrosis, and increase the wrist range of motion. We report the case of 30-year-old man with a painful stage IIIA Kienböck disease who underwent percutaneous cementoplasty and experienced immediate effective pain relief and recovery of wrist mobility.

  7. CT-Guided Percutaneous Vertebroplasty in the Treatment of an Upper Thoracic Compression Fracture

    Energy Technology Data Exchange (ETDEWEB)

    Seong, Ju Yong [Busan Wooridul Spine Hospital, Busan (Korea, Republic of); Kim, Jin Sung; Jung, Byung Joo; Lee, Sang Ho [Wooridul Spine Hospital, Seoul (Korea, Republic of); Kang, Ho Yeong [Dongrae Wooridul Spine Hospital, Busan (Korea, Republic of)

    2009-04-15

    Percutaneous vertebroplasty (PVP) has been used to relieve pain and to prevent further collapse of the vertebral body in patients with an osteoporotic compression fracture. The most commonly affected site for the use of PVP is the thoracolumbar junction. There are few reports that have described on the usefulness of PVP in the treatment of a high thoracic compression fracture. We report a case of an upper thoracic compression fracture that was treated with computed tomography (CT)-guided PVP. It was possible to obtain easy access to the narrow thoracic pedicle and it was also possible to monitor continuously the proper volume of polymethylmethacrylate employed, under CT guidance

  8. Percutaneous augmentation of the superior pubic ramus with polymethyl methacrylate: treatment of acute traumatic and chronic insufficiency fractures

    Energy Technology Data Exchange (ETDEWEB)

    Beall, Douglas P. [University of Oklahoma, Clinical Radiology of Oklahoma, Oklahoma City, OK (United States); D' Souza, Sharon L. [University of Oklahoma, Oklahoma City, OK (United States); Costello, Richard F.; Stapp, Annette M. [Clinical Radiology of Oklahoma, Edmond, OK (United States); Prater, Scott D. [University of Oklahoma College of Medicine, Edmond, OK (United States); Van Zandt, Bryan L. [University of Oklahoma College of Medicine, Oklahoma City, OK (United States); Martin, Hal D. [Oklahoma Sports Science and Orthopaedics, Oklahoma City, OK (United States)

    2007-10-15

    The injection of polymethylmethacrylate (PMMA) is a minimally invasive image-guided procedure that is typically used to treat vertebral body fractures due to osteoporosis or neoplastic involvement. The injection of PMMA into various other locations including the sacrum, acetabulum, pedicles, femur and tibia has been reported previously, and these procedures have, overall, been highly effective at alleviating pain and discomfort. Although the injection of PMMA into the vertebral body is a very common procedure that has been performed for over 2 decades for the percutaneous treatment of vertebral body fractures, the percutaneous injection of PMMA has not been reported in the English literature as treatment for superior pubic ramus fractures. We report the percutaneous treatment of an acute superior pubic ramus fracture and of a chronic insufficiency fracture of the superior pubic ramus using a parasymphyseal approach to access the region of injury. (orig.)

  9. Robot-assisted vs freehand pedicle screw fixation in spine surgery - a systematic review and a meta-analysis of comparative studies.

    Science.gov (United States)

    Yu, Lingjia; Chen, Xi; Margalit, Adam; Peng, Huiming; Qiu, Guixing; Qian, Wenwei

    2018-02-19

    Medical robotics has progressively become more compelling in modern orthopaedic surgery. Several studies comparing robot-assisted (RA) and freehand (FH) conventional techniques for pedicle screw fixation have been published, but the results are unclear. Here, we assessed current evidence regarding the efficiency, safety and accuracy of RA compared with FH techniques. A literature search of PubMed, Embase, the Cochrane Library and Web of Science was performed to compare the differences between RA and FH in spine surgery. Two reviewers independently reviewed included studies, conducted a risk of bias assessment, and extracted data. Three randomized controlled trials (RCTs) and six retrospective comparative studies included a total of 750 patients (3625 pedicle screws). No significant differences were noted between RA and FH in pedicle screw accuracy (95.5% compared with 92.9%; odds ratio: 1.35; 95% confidence interval [CI], 0.55 to 3.30; P=0.51), overall complication rate (1.33% compared with 3.45%; odds ratio: 0.46; 95% CI, 0.15 to 1.43; P=0.18) and radiation exposure time (weighted mean difference [WMD]:8.49; 95% CI, -15.43 to 32.40; P=0.49). While RA was associated with a longer operative time (WMD: 39.63; 95% CI, 5.27 to 73.99; P= 0.02), percutaneous or minimal robot-assisted pedicle screw fixation (M-RA) had a shorter radiation exposure time than FH (WMD: -33.10; 95% CI, -38.18 to -28.02; P=0.00) CONCLUSIONS: The current literature did not prove that RA supersedes FH, although several studies are more optimistic about this procedure. Future well-designed RCTs assessing RA and FH are needed to confirm and update the findings of this analysis. Copyright © 2018 John Wiley & Sons, Ltd.

  10. [Renaissance of pedicled flaps in oral and maxillofacial surgery].

    Science.gov (United States)

    Twieg, M; Reich, W; Dempf, R; Eckert, A W

    2014-06-01

    A retrospective analysis in the period 2007 to 2011 included 71 surgically treated patients for carcinoma of the head and neck region and subsequent reconstruction with 36 pedicled distant flaps and 47 free flaps. Patient specific parameters of data collection with SPSS 17.0 were age and sex distribution, TNM stage and treatment. The specific type of flap reconstruction, duration of surgery, complications, intensive care and inpatient treatment were recorded. The results showed that the healing process was uneventful in 26 (72.2 %) pedicled flaps, 14 (38.9 %) pedicled flaps were transplanted in a preoperatively irradiated area of the head and neck region and in 86.0 % with a positive healing process. Tumor stage, general physical condition of the patient and type of therapy are the key parameters for the choice of reconstruction.

  11. Spondylolisthesis caused by extreme pedicle elongation in osteogenesis imperfecta

    Science.gov (United States)

    Fuerderer, Sebastian; Eysel, Peer

    2007-01-01

    Although osteogenesis imperfecta is a well-known skeletal disorder, reports of spondylolisthesis in osteogenesis imperfecta are rare. Only very few cases of spondylolisthesis caused by elongation of lumbar pedicles have been described in the literature. Here we report three patients suffering from osteogenesis imperfecta showing a severe form of hyperlordosis caused by lumbar pedicle elongation and consecutive spondylolisthesis. Radiographs in the course of childhood and adolescence show a rapid progression of pedicle elongation and hyperlordosis with increased mechanical loads. The treatment strategy consists of physiotherapy, medical treatment with bisphosphonates, and orthopedic surgery and is preferably conservative. In the three patients reported here, one patient was treated with laminectomy and postero-lateral fusion, whereas in the other two patients surgery is currently not considered as necessary. PMID:17242874

  12. Percutaneous spinal fixation simulation with virtual reality and haptics.

    Science.gov (United States)

    Luciano, Cristian J; Banerjee, P Pat; Sorenson, Jeffery M; Foley, Kevin T; Ansari, Sameer A; Rizzi, Silvio; Germanwala, Anand V; Kranzler, Leonard; Chittiboina, Prashant; Roitberg, Ben Z

    2013-01-01

    In this study, we evaluated the use of a part-task simulator with 3-dimensional and haptic feedback as a training tool for percutaneous spinal needle placement. To evaluate the learning effectiveness in terms of entry point/target point accuracy of percutaneous spinal needle placement on a high-performance augmented-reality and haptic technology workstation with the ability to control the duration of computer-simulated fluoroscopic exposure, thereby simulating an actual situation. Sixty-three fellows and residents performed needle placement on the simulator. A virtual needle was percutaneously inserted into a virtual patient's thoracic spine derived from an actual patient computed tomography data set. Ten of 126 needle placement attempts by 63 participants ended in failure for a failure rate of 7.93%. From all 126 needle insertions, the average error (15.69 vs 13.91), average fluoroscopy exposure (4.6 vs 3.92), and average individual performance score (32.39 vs 30.71) improved from the first to the second attempt. Performance accuracy yielded P = .04 from a 2-sample t test in which the rejected null hypothesis assumes no improvement in performance accuracy from the first to second attempt in the test session. The experiments showed evidence (P = .04) of performance accuracy improvement from the first to the second percutaneous needle placement attempt. This result, combined with previous learning retention and/or face validity results of using the simulator for open thoracic pedicle screw placement and ventriculostomy catheter placement, supports the efficacy of augmented reality and haptics simulation as a learning tool.

  13. Percutaneous transhepatic sphincterotomy

    International Nuclear Information System (INIS)

    Gandin, G.; Zanon, E.; Righi, D.; Fonio, P.; Ferrari, A.; Recchia, S.

    1990-01-01

    The authors describe the techique employed for percutaneous trans-hepatic sphincterotomy as performed on 3 patients with common bile duct (CBD) stones. In all patients, previous endoscopic attempt had failed for anatomical reasons (Billroth II gastric resection or partial gastric resection with brown anastomosis), and the ampulla could not be correctly incannulated with the sphincterotome. In all aptients endoscopy was useful to check the position of the diethermic loop inserted percutaneously. Conplete and immediate success was obtained in all 3 cases. No major complications occurred during transhepatic treatment. To date, 1 recurrence has been observed, and the patient has been retreated with bilioplasty. All patients were followed after 5-6 months with US, plain X-rays of the abdomen and blood tests (γGt, alkaline phosphatase, and bilirubinemia). The authors suggest that percutaneous transhepatic sphincterotomy be employed electively in patients with biliary tree diseases in case the endoscopic approach failes

  14. Percutaneous Penetration - Methodological Considerations

    DEFF Research Database (Denmark)

    Holmgaard, Rikke; Benfeldt, Eva; Nielsen, Jesper B

    2014-01-01

    developed to replace methods involving experimental animals. The results obtained from these methods are decided not only by the chemical or product tested, but to a significant degree also by the experimental set-up and decisions made by the investigator during the planning phase. The present Mini......Studies on percutaneous penetration are needed to assess the hazards after unintended occupational skin exposures to industrial products as well as the efficacy after intended consumer exposure to topically applied medicinal or cosmetic products. During recent decades, a number of methods have been...... and their relevance for the prediction of percutaneous penetration are given. Which method to prefer will depend on the product to be tested and the question asked. Regulatory guidelines exist for studies on percutaneous penetration, but researchers as well as regulatory bodies need to pay specific attention...

  15. Percutaneous intervention in obstructive

    International Nuclear Information System (INIS)

    Souftas, V.

    2012-01-01

    Percutaneous intervention procedures in obstructive uropathy include percutaneous nephrostomy tube placements, nephroureteral stents, percutaneous nephrostomy combined with ureteral embolization, percutaneous management of stone disease, suprapubic tube placements into the bladder, and perinephric/retroperitoneal urinomas/abscesses drainages. Percutaneous nephrostomy is performed to relieve urinary obstruction or divert the urinary stream away from the ureter or bladder. Patients are given preprocedure antibiotics. Percutaneous nephrostomies can be emergent cases because of risk of pyuria and sepsis from a stagnant urine collection. The procedure is performed using both ultrasound and fluoroscopy (or fluoroscopy alone using anatomic landmarks, or an internal radiopaque calculus, or delayed phase excretion of the contrast into the renal collecting system) under local anesthesia or conscious sedation. Ureteral stents are placed to bypass an obstructing stone or to stent across of an area of stricture or ureteral laceration. Stents may be placed by the urologist via a transurethral approach or by the interventional radiologist via a percutaneous approach. The decision as to method of stent placement is based upon the location and accessibility of the ureteral pathology. Ureteral embolization is performed in patients with unresectable tumors of the pelvis with long-standing nephrostomy tubes and distal urine leaks refractory to other treatments. Coils, gelfoam and liquid embolic materials can be used. Ureteral embolization for ureteral fistulas and incontinence is technically successful in 100% of the patients. Complications include bleeding, infection, ureteral or renal injury, and deployment (or movement) of the coils within the renal pelvis. Percutaneous management of stone disease, including renal, ureteral, and bladder stones requires close cooperation between the urologist and interventional radiologist, because of availability of sonographic lithotripsy

  16. Percutaneous transluminal angioplasty of an occluded surgical splenorenal shunt in a 4-year-old child after liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Yussim, Ethan; Belenky, Alexander; Atar, Eli [Department of Diagnostic Radiology, Rabin Medical Center, Vascular and Interventional Radiology Unit, Petah Tikva (Israel); Shapiro, Rivka [Schneider Children' s Medical Center, Institute of Pediatric Gastroenterology and Nutrition, Petah Tikva (Israel); Mor, Eytan [Rabin Medical Center, Department of Organ Transplantation, Petah Tikva (Israel)

    2005-07-01

    Percutaneous transluminal angioplasty is increasingly used in children. We present a case of successful balloon angioplasty of an occluded surgical splenorenal shunt in a 4-year-old child who underwent liver transplantation because of biliary atresia. Percutaneous reopening of the shunt is a relatively safe procedure that may spare patients of surgical intervention. (orig.)

  17. Pedicle subtraction osteotomy in elderly patients with degenerative sagittal imbalance.

    Science.gov (United States)

    Cho, Kyu-Jung; Kim, Ki-Tack; Kim, Whoan-Jeang; Lee, Sang-Hoon; Jung, Jae-Hoon; Kim, Young-Tae; Park, Hae-Bong

    2013-11-15

    Retrospective, radiographical analysis. To evaluate pedicle subtraction osteotomy (PSO) as a means of correcting severe degenerative sagittal imbalance in elderly patients. PSO in patients with degenerative sagittal imbalance is likely to cause more complications than in patients with iatrogenic flatback deformity. This study analyzed 34 patients who underwent fusion to the sacrum, with a minimum 2-year follow-up. Age of the patients were in the range from 58 to 73 with the mean at 65.5 years. PSO was performed at one segment in all cases, consisting of L3 (n = 26), L4 (n = 4), L2 (n = 3), and L1 (n = 1). The average number of levels fused was 8.15. Ten patients had structural interbody fusion at the lumbosacral junction. Applying PSO at one segment, the mean correction of the lordotic angle at the osteotomy site was 33.3°, of which the loss of correction (LOC) was 4.0° at the last visit. The correction of lumbar lordosis was 33.7° and the LOC was 8.5°. The sagittal C7 plumb was 215.9 mm before surgery, corrected to 35.1 mm after surgery, and changed to 95.9 mm by the last visit. The correction of the sagittal C7 plumb was 119.9 mm and the LOC was 60.9 mm. There was substantial LOC in lumbar lordosis and sagittal C7 plumb. In 10 patients with addition of posterior lumbar interbody fusion, the LOC of lumbar lordosis was 7.4°, which was less than 9° in those without it. PSO for the correction of degenerative sagittal imbalance in elderly patients resulted in correction of sagittal alignment with a significant LOC of lumbar lordosis and sagittal C7 plumb. The LOC of lumbar lordosis occurred at both the osteotomy and non-osteotomy site. The addition of anterior column support is helpful to maintain correction and reduce complications. N/A.

  18. Simple New Screw Insertion Technique without Extraction for Broken Pedicle Screws.

    Science.gov (United States)

    Kil, Jin-Sang; Park, Jong-Tae

    2018-05-01

    Spinal transpedicular screw fixation is widely performed. Broken pedicle screw rates range from 3%-7.1%. Several techniques have been described for extraction of broken pedicle screws. However, most of these techniques require special instruments. We describe a simple, modified technique for management of broken pedicle screws without extraction. No special instruments or drilling in an adjacent pedicle are required. We used a high-speed air drill with a round burr. With C-arm fluoroscopy guidance, the distal fragment of a broken pedicle screw was palpated using free-hand technique through the screw entry hole. A high-speed air drill with a round burr (not a diamond burr) was inserted through the hole. Drilling began slowly and continued until enough space was obtained for new screw insertion. Using this space, we performed new pedicle screw fixation medially alongside the distal fragment of the broken pedicle screw. We performed the insertion with a previously used entry hole and pathway in the pedicle. The same size pedicle screw was used. Three patients were treated with this modified technique. New screw insertion was successful in all cases after partial drilling of the distal broken pedicle screw fragment. There were no complications, such as screw loosening, dural tears, or root injury. We describe a simple, modified technique for management of broken pedicle screws without extraction. This technique is recommended in patients who require insertion of a new screw. Copyright © 2017. Published by Elsevier Inc.

  19. Sedation Monitoring and Management during Percutaneous Endoscopic Lumbar Discectomy

    Directory of Open Access Journals (Sweden)

    Menekse Oksar

    2016-01-01

    Full Text Available Percutaneous endoscopic laser discectomy (PELD is a painful intervention that requires deep sedation and analgesia. However, sedation should be light at some point because cooperation by the patient during the procedure is required for successful surgical treatment. Light sedation poses a problem for endotracheal intubation, while patients placed in the prone position during percutaneous endoscopic discectomy pose a problem for airway management. Therefore, under these conditions, sedation should be not deeper than required. Here we report the sedation management of three cases that underwent PELD, with a focus on deep and safe sedation that was monitored using bispectral index score and observer’s assessment of alertness/sedation score.

  20. Percutaneous biliary drainage in patients with cholangiocarcinoma

    International Nuclear Information System (INIS)

    Mehta, A.C.; Gobel, R.J.; Rose, S.C.; Hayes, J.K.; Miller, F.J.

    1990-01-01

    This paper determines whether radiation therapy (RT) is a risk factor for infectious complications (particularly hepatic abscess formation) related to percutaneous biliary drainage (PBD). The authors retrospectively reviewed the charts of 98 consecutive patients who had undergone PBD for obstruction. In 34 patients with benign obstruction, three infectious complications occurred, none of which were hepatic abscess or fatal sepsis. In 39 patients who had malignant obstruction but did not have cholangiocarcinoma, 13 infectious complications occurred, including two hepatic abscesses and three cases of fatal sepsis. Of the 25 patients with cholangiocarcinoma, 15 underwent RT; in these 15 patients, 14 infectious complications occurred, including six hepatic abscesses and two cases of fatal sepsis

  1. Positioning of pedicle screws in adolescent idiopathic scoliosis using electromyography

    Directory of Open Access Journals (Sweden)

    Bruno Moreira Gavassi

    2015-06-01

    Full Text Available OBJECTIVE: To analyze the occurrence of poor positioning of pedicle screws inserted with the aid of intraoperative electromyographic stimulation in the treatment of Adolescent Idiopathic Scoliosis (AIS.METHODS: This is a prospective observational study including all patients undergoing surgical treatment for AIS, between March and December 2013 at a single institution. All procedures were monitored by electromyography of the inserted pedicle screws. The position of the screws was evaluated by assessment of postoperative CT and classified according to the specific AIS classification system.RESULTS: Sixteen patients were included in the study, totalizing 281 instrumented pedicles (17.5 per patient. No patient had any neurological deficit or complaint after surgery. In the axial plane, 195 screws were found in ideal position (69.4% while in the sagittal plane, 226 screws were found in ideal position (80.4%. Considering both the axial and the sagittal planes, it was observed that 59.1% (166/281 of the screws did not violate any cortical wall.CONCLUSION: The use of pedicle screws proved to be a safe technique without causing neurological damage in AIS surgeries, even with the occurrence of poor positioning of some implants.

  2. Sacral pressure sore reconstruction – the pedicled superior gluteal ...

    African Journals Online (AJOL)

    Results. All flaps survived completely with no complications in 9 patients. One patient had a haematoma below the flap that was easily drained. No recurrence of the bedsore occurred during follow-up. Conclusion. We suggest that the pedicled SGAP fasciocutaneous flap is a reliable surgical option for sacral pressure sore ...

  3. Traumatic Fracture of Thin Pedicles Secondary to Extradural ...

    African Journals Online (AJOL)

    4] The most common .... were placed from T10 to L5, sparing the atretic pedicles of L1, L2, and the left L3. The nonstructural iliac crest .... Dural ectasia is a common feature of the Marfan syndrome. Am J Hum Genet. 1988;43:726-32. 10. Tei R ...

  4. The use of pedicled prepucial skin flap urethroplasty for proximal ...

    African Journals Online (AJOL)

    Objective: Pediatric urethral strictures are not uncommon, and a myriad of treatment options is available. The use of pedicled prepucial skin to augment a narrowed urethra is one of the useful methods. In this study, we describe the successful use of this technique in three children with stricture of the proximal ...

  5. The use of pedicled prepucial skin flap urethroplasty for proximal ...

    African Journals Online (AJOL)

    The use of pedicled prepucial skin flap urethroplasty for proximal bulbomembraneous urethral stricture in children: an easy alternative to transpubic urethroplasty. Harshjeet S. Bal, Jujju J. Kurian and Sudipta Sen. Objective Pediatric urethral strictures are not uncommon, and a myriad of treatment options is available.

  6. Structural characteristics of the pedicle and its role in screw stability.

    Science.gov (United States)

    Hirano, T; Hasegawa, K; Takahashi, H E; Uchiyama, S; Hara, T; Washio, T; Sugiura, T; Yokaichiya, M; Ikeda, M

    1997-11-01

    Cross-sectional regional bone mineral density of the pedicle was measured by peripheral quantitative computed tomography. Biomechanical tests were performed to clarify the role of the pedicle in screw stability. To identify the structural characteristics of the pedicle that supports pedicle screw stability and the differences in these characteristics between normal and osteoporotic vertebrae. The pedicle screw is an essential component of many systems used to align the spine. The contribution of the pedicle to screw stability, however, has not been fully investigated. Trabecular, subcortical, and cortical bone mineral density and the area of the pedicle were measured by peripheral quantitative computed tomography. Bone mineral density also was recalculated in four circumferential layers. These parameters were compared between normal and osteoporotic individuals. The relative contribution of the pedicle to screw stability was evaluated by caudocephalad and pull-out loading in a vertebra with or without its body. Inner trabecular, middle subcortical, and outer cortical bone mineral density and cortical bone area in the pedicle were significantly lower in osteoporotic vertebrae than those in normal vertebrae. In the pedicle, bone mineral density increased close to the outer layer. Bone mineral density not as thick even in the outer layer in osteoporotic subjects. Approximately 80% of the caudocephalad stiffness and 60% of the pullout strength of the pedicle screw depended on the pedicle rather than on the vertebral body. Screw stability depends on the structural characteristics of the pedicle. The pedicle was denser in the subcortical bone, in which the threads of the screw engage, than in trabecular bone. In osteoporosis, bone mineral density was not as dense even in the outer layer, and the cortex was thinner than normal. A larger screw would not enhance screw stability and may break the thin cortex in osteoporotic vertebrae.

  7. Percutaneous Dilatational Tracheostomy via Griggs Technique.

    Science.gov (United States)

    Karimpour, Hasan Ali; Vafaii, Kamran; Chalechale, Maryam; Mohammadi, Saeed; Kaviannezhad, Rasool

    2017-01-01

    Tracheostomy is considered the airway management of choice for patients who need prolonged mechanical ventilation support. Percutaneous Dilatational Tracheotomy (PDT) is a technique that can be performed easily and rapidly at bedside and is particularly useful in the intensive care setting. The Griggs percutaneous tracheotomy is unique in its utilization of a guide wire dilator forceps. We aimed to describe the early perioperative and late postoperative complications of PDT using the Griggs technique in patients in the intensive care unit (ICU). This cross-sectional study was conducted on all patients who underwent tracheostomy in the ICU of the Imam Reza Hospital of Kermanshah, Iran, from June 2011 to June 2015. PDT was performed in 184 patients with the Griggs technique. Demographic variables, as well as perioperative and late postoperative complications were recorded. The mean age of patients was 57.3 ± 15.37 years. The most common primary causes of tracheostomy were hypoxic brain damage disorders (43.2%) and pneumonia (14.8%). Perioperative and early complications occurred in 16.7 % of procedures, of which 9.3% were bleedings (minor, significant and major). Furthermore, the incidence of late complications was 8.6%, including: stomal infection, difficult replace tracheostomy tube, tracheoesophageal fistula, tracheal stenosis, and tracheomalacia. PDT via Griggs technique is a safe, quick, and effective method. The low incidence of complications indicates that bedside percutaneous tracheostomy can be performed safely as a routine procedure for daily care implemented in the ICU.

  8. Percutaneous Zenith endografting for abdominal aortic aneurysms.

    Science.gov (United States)

    Heyer, Kamaldeep S; Resnick, Scott A; Matsumura, Jon S; Amaranto, Daniel; Eskandari, Mark K

    2009-03-01

    A completely percutaneous approach to infrarenal abdominal aortic aneurysm (AAA) endografting has the theoretic benefits of being minimally invasive and more expedient. Our goal was to demonstrate the utility of this approach using a suprarenal fixation device and a suture-mediated closure system. We conducted a single-institution, retrospective review of 14 patients who underwent percutaneous AAA repair with the Zenith device between August 2003 and March 2007. Immediate and delayed access-related outcomes were examined over a mean follow-up of 12.1+/-2.0 months. Mean AAA size was 5.6 cm. Immediate arterial closure and technical success rate was 96% (27/28 vessels). One immediate hemostatic failure required open surgical repair. Over follow-up, one vessel required operative repair for new-onset claudication. No other immediate or delayed complications (thrombosis, pseudoaneurysm, infection, or deep venous thrombosis) were detected. A percutaneous approach for the treatment of AAA has several advantages over femoral artery cutdown but also has its own unique set of risks in the immediate and late postoperative period. Ultimately, the "preclose technique" can be safely applied for the Zenith device despite its large-bore delivery system.

  9. Percutaneous Transhepatic Cholangiography

    African Journals Online (AJOL)

    1974-03-30

    Mar 30, 1974 ... Percutaneous transhepatic cholangiography can play a major role in expediting the early diagnosis of surgically correctable jaundice. The need for this is emphasised by the fact that in a group of 46 patients the delay between the onset of jaundice and diagnosis ranged from 20 to 90 days. Transhepatic ...

  10. Pedicle screw augmentation with bone cement enforced Vicryl mesh.

    Science.gov (United States)

    Schmid, Samuel L; Bachmann, Elias; Fischer, Michael; Meyer, Dominik C; Gerber, Christoph A; Snedeker, Jess G; Farshad, Mazda

    2018-01-01

    Achieving sufficient mechanical purchase of pedicle screws in osteoporotic or previously instrumented bone is technically and biologically challenging. Techniques using different kinds of pedicle screws or methods of cement augmentation have been used to address this challenge, but are associated with difficult revisions and complications. The purpose of this biomechanical trial was to investigate the use of biocompatible textile materials in combination with bone cement to augment pullout strength of pedicle screws while reducing the risk of cement extrusion. Pedicle screws (6/40 mm) were either augmented with standard bone-cement (Palacos LV + G) in one group (BC, n = 13) or with bone-cement enforced by Vicryl mesh in another group (BCVM, n = 13) in osteoporosis-like saw bone blocks. Pullout testing was subsequently performed. In a second experimental phase, similar experiments were performed using human cadaveric lumbar vertebrae (n = 10). In osteoporosis-like saw bone blocks, a mean screw pullout force of 350 N (±125) was significantly higher with the Bone cement (BC) compared to bone-cement enforced by Vicryl mesh (BCVM) technique with 240 N (±64) (p = 0.030). In human cadaveric lumbar vertebrae the mean screw pullout force was 784 ± 366 N with BC and not statistically different to BCVM with 757 ± 303 N (p = 0.836). Importantly, cement extrusion was only observed in the BC group (40%) and never with the BCVM technique. In vitro textile reinforcement of bone cement for pedicle screw augmentation successfully reduced cement extrusion compared to conventionally delivered bone cement. The mechanical strength of textile delivered cement constructs was more reproducible than standard cementing. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:212-216, 2018. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  11. Quantitative dual-energy CT for phantomless evaluation of cancellous bone mineral density of the vertebral pedicle: correlation with pedicle screw pull-out strength

    Energy Technology Data Exchange (ETDEWEB)

    Wichmann, Julian L.; Booz, Christian; Bauer, Ralf W.; Kerl, J.M.; Fischer, Sebastian; Lehnert, Thomas; Vogl, Thomas J.; Khan, M.F. [University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt am Main (Germany); Wesarg, Stefan [Fraunhofer IGD, Cognitive Computing and Medical Imaging, Darmstadt (Germany); Kafchitsas, Konstantinos [Spine Center, Asklepios Klinik Lindenlohe, Schwandorf (Germany)

    2015-06-01

    To evaluate quantitative dual-energy computed tomography (DECT) for phantomless analysis of cancellous bone mineral density (BMD) of vertebral pedicles and to assess the correlation with pedicle screw pull-out strength. Twenty-nine thoracic and lumbar vertebrae from cadaver specimens were examined with DECT. Using dedicated post-processing software, a pedicle screw vector was mapped (R1, intrapedicular segment of the pedicle vector; R2, intermediate segment; R3, intracorporal segment; global, all segments) and BMD was calculated. To invasively evaluate pedicle stability, pedicle screws were drilled through both pedicles and left pedicle screw pull-out strength was measured. Resulting values were correlated using the paired t test and Pearson's linear correlation. Average pedicle screw vector BMD (R1, 0.232 g/cm{sup 3}; R2, 0.166 g/cm{sup 3}; R3, 0.173 g/cm{sup 3}; global, 0.236 g/cm{sup 3}) showed significant differences between R1-R2 (P < 0.002) and R1-R3 (P < 0.034) segments while comparison of R2-R3 did not reach significance (P > 0.668). Average screw pull-out strength (639.2 N) showed a far stronger correlation with R1 (r = 0.80; P < 0.0001) than global BMD (r = 0.42; P = 0.025), R2 (r = 0.37; P = 0.048) and R3 (r = -0.33; P = 0.078) segments. Quantitative DECT allows for phantomless BMD assessment of the vertebral pedicle. BMD of the intrapedicular segment shows a significantly stronger correlation with pedicle screw pull-out strength than other segments. (orig.)

  12. A case that underwent bilateral video-assisted thoracoscopic ...

    African Journals Online (AJOL)

    No Abstract Available A case that underwent bilateral video-assisted thoracoscopic surgical (VATS) biopsy combined with pneumonectomy is presented. The patient developed hypoxia during the contralateral VATS biopsy. His hypoxia was treated with positive expiratory pressure (PEEP) to the dependent lung and apneic ...

  13. Ball tip method for thoracic pedicle screw placement in patients with adolescent idiopathic scoliosis

    International Nuclear Information System (INIS)

    Watanabe, Kota; Matsumoto, Morio; Iizuka, Shingo

    2008-01-01

    The purpose of this study was to evaluate the efficacy of ball tip method for thoracic pedicle screw placements in idiopathic scoliosis patients. 24 patients with adolescent idiopathic scoliosis were included in this study. Conventional method was performed in 12 patients. Ball tip method was performed in 12 patients. Accuracy of the pedicle screw placement was evaluated based on the postoperative CT. In the ball tip method, a probe which was consisted of ball tip with flexible shaft was used. After removing of cortical bone at a starting point, the probe was inserted manually or sometimes with gently tapping by hammer. During the maneuver, the probe will gradually progress into cancellous bone in the pedicle, without perforating cortical bone in the pedicle. Following expansion of the hole by a rigid gear shift probe, screw was placed in the pedicle. 65.1% of screws were located within pedicle in the conventional group and 86.5% in the ball tip group. 5.3% of screws were located out of pedicle within 2 mm in the conventional group and 8.2% in the ball tip group. 15.8% of screws were located out of pedicle beyond 2 mm and 1.8% in the ball tip group. The ball tip method enhanced the accuracy of thoracic pedicle screw placements in adolescent idiopathic scoliosis patients. The ball tip method may be effective for accurate pedicle screw placement in patients with adolescent idiopathic scoliosis. (author)

  14. Pullout strength of misplaced pedicle screws in the thoracic and lumbar vertebrae - A cadaveric study

    Directory of Open Access Journals (Sweden)

    Shyam K Saraf

    2013-01-01

    Full Text Available Background: The objective of this cadaveric study was to analyze the effects of iatrogenic pedicle perforations from screw misplacement on the mean pullout strength of lower thoracic and lumbar pedicle screws. We also investigated the effect of bone mineral density (BMD, diameter of pedicle screws, and the region of spine on the pullout strength of pedicle screws. Materials and Methods: Sixty fresh human cadaveric vertebrae (D10-L2 were harvested. Dual-energy X-ray absorptiometry (DEXA scan of vertebrae was done for BMD. Titanium pedicle screws of different diameters (5.2 and 6.2 mm were inserted in the thoracic and lumbar segments after dividing the specimens into three groups: a standard pedicle screw (no cortical perforation; b screw with medial cortical perforation; and c screw with lateral cortical perforation. Finally, pullout load of pedicle screws was recorded using INSTRON Universal Testing Machine. Results: Compared with standard placement, medially misplaced screws had 9.4% greater mean pullout strength and laterally misplaced screws had 47.3% lesser mean pullout strength. The pullout strength of the 6.2 mm pedicle screws was 33% greater than that of the 5.2 mm pedicle screws. The pullout load of pedicle screws in lumbar vertebra was 13.9% greater than that in the thoracic vertebra ( P = 0.105, but it was not statistically significant. There was no significant difference between pullout loads of vertebra with different BMD ( P = 0.901. Conclusion: The mean pullout strength was less with lateral misplaced pedicle screws while medial misplaced pedicle screw had more pullout strength. The pullout load of 6.2 mm screws was greater than that of 5.2 mm pedicle screws. No significant correlation was found between bone mineral densities and the pullout strength of vertebra. Similarly, the pullout load of screw placed in thoracic and lumbar vertebrae was not significantly different.

  15. ''The dermal internal brassiere flap,'' a new modification of inferior pedicle breast reduction technic.

    Science.gov (United States)

    Temel, Metin; Karakaş, Ali O; Dokuyucu, Recep; Türkmen, Arif

    2015-06-01

    The inferior pedicle mammaplasty is particularly applied to large breasts with a long sternal notch to nipple distance. The present study reports modifications developed to solve the bottoming-out deformity, the lack of upper pole fullness and the wound healing problems seen at the reverse T-zone, known disadvantages of the inferior pedicle reduction mammaplasty, and evaluates postoperative sensation. A total of 110 patients with a mean age of 32 underwent the same technique. In this technique, two pairs of quadrangular and triangular flaps were planned from the skin of resection sites. The triangular dermal flaps and quadrangular flaps were suspended from the periosteum of the 2nd and 4th ribs, respectively. The distance from the nipple to inframammary fold was measured at the postoperative 1st month and 1st year. In the postoperative period, a nipple-inframammary fold distance increase of over 2 cm was determined as bottoming-out deformity. Sensation evaluations were performed by subjective and objective tests. The mean sternal notch to nipple distance was 35.00 cm. After operation, the mean distance between the sternal notch and the nipple was 20.00 cm. NAC examination revealed normal sensation in all patients. Whereas the preoperative mean areolar threshold value was 36.70 g/mm(2), the postoperative first-year mean areolar pressure threshold value was 35.50 g/mm(2) (p value was 25.30 g/mm(2), whereas the postoperative first-year mean nipple pressure threshold value was 26.00 g/mm(2) (p = 0.5471). The postoperative first-month mean sternal notch to nipple distance value of the patients was 20.00 cm, whereas the postoperative first-year mean sternal notch to nipple distance value of the patients was 20.00 cm, (p = 0.0648). The postoperative first-month mean nipple to submammary fold distance value of the patients was 10.50 cm, the postoperative first-year mean nipple to submammary fold distance value of the patients was 11.00 cm (p disadvantages of the inferior

  16. One stage reconstruction of the floor of the mouth with a subcutaneous pedicled nasolabial flap

    International Nuclear Information System (INIS)

    El-Marakby, H.H.; Fouad, F.A.; Ali, H.H.

    2012-01-01

    Background: Nasolabial flaps have been recognised as versatile flaps for a variety of defects in the face, nose, lip and the oral cavity. Random pattern inferiorly based nasolabial flaps (NLF) have been utilised for covering small defects on the anterior floor of the mouth, but usually require a second stage procedure to divide the flap base. A subcutaneous pedicled inferiorly based nasolabial flap can provide a one stage repair of moderate sized defects of the floor of the mouth after de epithelialisation of the base of the flap. Aim: To evaluate the feasibility of a single stage reconstruction of intermediate sized defects in the oral cavity with an inferiorly based pedicled NLF. The study includes the indications of use of the flap, flap design, technique, and the complications rate. The incidence of secondary procedures and the final functional and the aesthetic results will also be evaluated. Materials and methods: A group of 20 patients presented with (T1-2) squamous cell carcinoma of the oral cavity have been treated at the Department of Surgery, National Cancer Institute, Cairo; in the period between January 2008 and September 2010. The pathology was confirmed with an incision biopsy and all metastatic work were carried out confirming that all patients were free from distant metastasis at presentation. Preoperative assessment also included assessment of the stage of the disease, the flap design and patient fitness for general anaesthesia. All patients underwent surgical excision combined with reconstruction of the defect with a subcutaneous inferiorly based pedicled NLF. The proximal part of the flap was routinely de epithelialised before it has been tunnelled through the cheek so a one stage procedure could only be required. Results: The mean age of the patients was 62.3±6 years, range (52-69 years). All patients were diagnosed with squamous cell carcinoma. The anterior floor of the mouth constituted 40% of the defects, the lateral floor of the mouth 20

  17. Percutaneous vertebroplasty in osteoporotic vertebral body compression fracture

    International Nuclear Information System (INIS)

    Kim, Hyuk Jung; Lee, Seon Kyu; Hwang, Hee Young; Kim, Hyung Sik; Ko, Joon Seok; Park Si Hyun; Park, Cheol Hee

    2001-01-01

    To determine the clinical efficacy of percutaneous vertebroplasty in cases of painful and medically intractable osteoporotic vertebral compression fracture. Ninety-eight patients (20 men and 78 women: mean age, 69 years) underwent 122 percutaneous vertebroplasty procedures for the treatment of osteoporotic vertical compression fracture. For the evaluation of bone mass, bone densitometry was performed in 45 patients, and to assess the recent evolution of the fracture, all 98 underwent MRI. Percutaneous vertebroplasty involves percutaneous transpedicular puncture of the involved verteb666rae followed by the injection of a polymethylmethacrylate(PMMA)-Barium mixture into the vertebral body. To assess leakage of the mixture into the epidural tissue, neural foramina, venous plexus and paravertebral tissue, we then immediately obtained a computerized tomographic (CT) scan, assessing the clinical efficacy of the procedure on the basis of time required for pain relief (defined as more than 60% reduction of initial pain), and time required for ambulation without significant pain. Percutaneous vertebroplasty was successful in all patients. Pain relief was accomplished within 1-5 (mean, 1.8) days and early ambulation without significant pain was possible within 2-15 (mean, 3.3) days. Post-procedural CT scanning revealed leakage of the PMMA-barium mixture into paravertebral tissue(n=41).the paravertebral venous plexus (n=34) and epidural tissue (n=4). No neural foraminal leakage was identified, and no procedure-related complication requiring surgical treatment occurred. Percutaneous vertebroplasty is an effective new interventional procedure for the treatment of osteoporotic vertebral compression fracture. It relieves pain, provides early mobilization, and strengthens involved vertebral bodies

  18. Percutaneous nephrolithotomy in children: A preliminary report.

    Science.gov (United States)

    Elderwy, Ahmad A; Gadelmoula, Mohamed; Elgammal, Mohamed A; Osama, Ehab; Al-Hazmi, Hamdan; Hammouda, H; Osman, Esam; Abdullah, Medhat A; Neel, Khalid Fouda

    2014-07-01

    The recurrence of pediatric nephrolithiasis, the morbidity of repeated open surgical treatment as well as our experience in percutaneous nephrolithotomy (PNL) in adult patients, all derived us to shift to PNL for managing renal stones >1.5 cm in pediatric patients. Our aim of this study is to evaluate the safety and efficacy of PNL in pediatric patients. During the period of the month between May 2011 and April 2013, 38 children (47 renal units) underwent PNL for renal stones 1.5-5 cm in length. Patient demographics, stone characteristics, and clinical outcome were prospectively studied. Data of those who underwent conventional and tubeless PNL were compared. Median follow-up period was 12 months (range: 6-24). The median age at presentation was 8-year (range: 3-12). The operative time ranged from 30 to 120 min (median 90). Overall stone clearance rate was 91.5% after single PNL. The median hospital stay was 3 days. Auxiliary procedures were successful for the remaining 4 patients (nephroscopic clearance in one and shockwave lithotripsy in 3). Tubeless PNL was performed in 17 renal units with a comparable outcome to conventional ones. The perioperative complications were noted in 5/47 (10.6%) of all procedures (Clavien Grade II in 4 and Clavien Grade IIIa in 1) and were managed conservatively. Percutaneous nephrolithotomy for renal stones in pediatric patients is safe and feasible if performed by a well-experienced endourologist. Tubeless PNL is a better choice for children.

  19. Percutaneous cryotherapy for inoperable lung malignancy

    Energy Technology Data Exchange (ETDEWEB)

    Park, Eun Hae; Jin, Gong Yong; Han, Young Min; Lee, Yong Chul; Kwon, Keun Sang [Chonbuk National Univ. Medical School and Hospital, Jeonju, (Korea, Republic of)

    2012-05-15

    To evaluate the therapeutic efficacy of percutaneous cryotherapy for inoperable patients with malignant pulmonary nodules. We enrolled 14 patients (7 males, 7 females, average age 68.8 years) who had inoperable lung malignancy in this study from August 2006 through July 2009. We evaluated the therapeutic efficacy of cryotherapy for complete or incomplete ablation by follow up chest CT. Using Kaplan Meier statistical methods, we estimated the survival of patients who had undergone cryotherapy and we investigated post cryotherapy complications. Five of the 14 patients underwent complete ablation (35.7%), while 9 of 14 patients underwent incomplete ablation (64.3%). The change in mean size before procedure and at last follow up CT in the complete and incomplete ablation were as follows: 13.2 {+-} 7.6 mm {yields} 3.8 {+-} 2.7 mm, and 18.1 {+-} 6.2 mm {yields} 33.7 {+-} 17.9 mm, respectively. The median survival of patients in the complete and the incomplete groups were 51.5 months and 24 months, respectively. One patient developed a small pneumothorax, which resolved spontaneously. Two patients developed hemoptysis after the procedure, which was controlled within a day. Percutaneous cryotherapy may be an effective and safe therapeutic method for inoperable patients with malignant pulmonary nodules.

  20. Percutaneous cryotherapy for inoperable lung malignancy

    International Nuclear Information System (INIS)

    Park, Eun Hae; Jin, Gong Yong; Han, Young Min; Lee, Yong Chul; Kwon, Keun Sang

    2012-01-01

    To evaluate the therapeutic efficacy of percutaneous cryotherapy for inoperable patients with malignant pulmonary nodules. We enrolled 14 patients (7 males, 7 females, average age 68.8 years) who had inoperable lung malignancy in this study from August 2006 through July 2009. We evaluated the therapeutic efficacy of cryotherapy for complete or incomplete ablation by follow up chest CT. Using Kaplan Meier statistical methods, we estimated the survival of patients who had undergone cryotherapy and we investigated post cryotherapy complications. Five of the 14 patients underwent complete ablation (35.7%), while 9 of 14 patients underwent incomplete ablation (64.3%). The change in mean size before procedure and at last follow up CT in the complete and incomplete ablation were as follows: 13.2 ± 7.6 mm → 3.8 ± 2.7 mm, and 18.1 ± 6.2 mm → 33.7 ± 17.9 mm, respectively. The median survival of patients in the complete and the incomplete groups were 51.5 months and 24 months, respectively. One patient developed a small pneumothorax, which resolved spontaneously. Two patients developed hemoptysis after the procedure, which was controlled within a day. Percutaneous cryotherapy may be an effective and safe therapeutic method for inoperable patients with malignant pulmonary nodules

  1. The effects of Moufarrege total posterior pedicle reduction mammaplasty on breastfeeding: a review of 931 cases.

    Science.gov (United States)

    Sinno, Hani; Botros, Elia; Moufarrege, Richard

    2013-09-01

    Since its original description in 1979, the Moufarrege total posterior pedicle reduction mammaplasty technique has proven to be a safe and reliable procedure providing aesthetic and functional enhancement. To determine if the Moufarrege total posterior pedicle reduction mammaplasty affects successful breastfeeding. Retrospective chart review was performed for patients operated on between 1981 and 1997, and a written questionnaire was given. Patients were asked about their ability to lactate and successfully breastfeed preoperatively and postoperatively. The t test and χ(2) test were used to compare means and categorical variables, respectively. Values were also compared with a sample of women (n = 2223) from the Quebec general population as collected by the Longitudinal Study of Child Development in Quebec (ELDEQ, 1998-2002). A total of 931 patients (all women) underwent reduction mammaplasty during the study period at Jewish General Hospital, Montreal, Quebec, Canada (H.S.) or Hopital Hotel-Dieu, Montreal, Quebec, Canada (E.B. and R.M). There was a 62% response rate to the questionnaire. There were no statistically significant differences in the percentage of women able to lactate postoperatively vs preoperatively (98% vs 100%, respectively; P = .2). The percentage of women able to successfully breastfeed for 4 and 6 months was also not statistically different when comparing postoperative vs preoperative ability (4 months: 33% vs 44 %, P = .13; 6 months: 29% vs 28%, P = .77). The sample of women from the Quebec population did not differ statistically from those undergoing the Moufarrege breast reduction in terms of successful breastfeeding for 1, 2, 3, and 4 months (59% vs 67%, 52% vs 47%, 42% vs 41%, and 40% vs 33%, respectively). The Moufarrege breast reduction technique is a reliable and safe procedure that does not seem to negatively affect the success of breastfeeding based on the results of our retrospective chart review and patient questionnaire. 4.

  2. Spontaneus bilateral pedicle fracture 30 years after Harrington Instrumentation for idiopathic scoliosis: a case report

    Directory of Open Access Journals (Sweden)

    Obid Peter

    2012-01-01

    Full Text Available Abstract Introduction Spontaneous fractures of the spine are a common entity. They usually occur in older people with osteoporosis. This case is presented on account of its rarity. To the best of the authors' knowledge only one case of an osteoporotic pedicle fracture after Harrington Instrumentation has been described before. Case presentation We report the case of a 46-year-old Caucasian woman who underwent surgery due to idiopathic scoliosis with a Harrington Instrumentation (T4 to L3 30 years ago. During the operation she was infected with hepatitis C while receiving erythrocyte concentrates and has suffered from liver cirrhosis since then. She presented with a sudden pain in her lower back and paraesthesia in both her legs but no other neurological symptoms. A computed tomography scan showed a bilateral pedicle fracture of L3 and an additional compression fracture of L4. In the first session we performed a dorsal stabilization with massive intraoperative bleeding and a postoperative failure of liver synthesis. In a second session an additional ventral augmentation was done. After the second operation she developed a hepatorenal syndrome. Both operations left the patient in a very critical state which led to a prolonged stay in the intensive care and rehabilitation unit. At her 12-month follow-up visit, she was free of complaints. Conclusion The un-physiological load of the spine after Harrington Instrumentation can lead to osteoporosis due to inactivity even in younger patients. Although these implants are not used anymore one should keep this possibility in mind when dealing with patients who have received Harrington rods in surgical procedures.

  3. Therapeutic reduction mammoplasty in large-breasted women with cancer using superior and superomedial pedicles

    Directory of Open Access Journals (Sweden)

    Denewer A

    2012-10-01

    Full Text Available Adel Denewer,1 Fayez Shahatto,1 Waleed Elnahas,1 Omar Farouk,1 Sameh Roshdy,1 Ashraf Khater,1 Osama Hussein,1 Saleh Teima,2 Mohammed Hafez,1 Samir Zidan,1 Nazem Shams,1 Sherif Kotb11Surgical Oncology Department, Oncology Center, 2Clinical Oncology and Nuclear Medicine Department, Mansoura University, Mansoura, EgyptBackground: Surgical management of breast cancer in large-breasted women presents a real challenge. This study aims to evaluate the outcome of therapeutic reduction mammoplasty in large-breasted women with breast cancer using superior and superomedial pedicles, situated at any breast quadrant except for the central and upper medial quadrants.Methods: Fifty women with breast cancer and large breasts underwent simultaneous bilateral reduction mammoplasty. The weight of the tissue removed ranged from 550 g to 1050 g and the tumor-free safety margins by frozen section were in the range of 4 cm to 12 cm.Results: The age of the patients ranged from 36 to 58 (median 43 years and tumor size ranged from 1 cm to 4 cm. The cosmetic outcomes were excellent in 32 patients (64%, good in 15 (30% patients, and fair in three patients (6%. The follow-up period was 8–36 (mean 20 months, with no local recurrence or systemic metastasis.Conclusion: Therapeutic reduction mammoplasty using superior and superomedial pedicles was shown to be oncologically safer than traditional conservative surgery. This oncoplastic procedure yields a satisfactory esthetic outcome with lower morbidity in large-breasted women with breast cancer.Keywords: breast cancer, oncoplastic surgery, reduction mammoplasty, conservation surgery

  4. Vertebral pedicle anatomy in relation to pedicle screw fixation: a cadaver study.

    Science.gov (United States)

    Chaynes, P; Sol, J C; Vaysse, P; Bécue, J; Lagarrigue, J

    2001-01-01

    New techniques to stabilize and correct the thoracic and lumbar spine have been developed in recent years. In view of the wide variety and complexity of fixation devices, the optimum configuration of spinal instrumentation systems needs to be defined. Linear and angular measurements of both vertebral pedicles were made in ten complete thoracic and lumbar cadaveric spines using callipers and a goniometer. The vertical interpedicular distance gradually increased along the spine up to L5. The transverse interpedicular distance was larger at both ends of the spine. Pedicular height gradually increased from T1 to L5, plateauing between T3 and T9, being widest at the thoracolumbar junction. Pedicular width was greatest at the three junctional regions of the spine. The sagittal pedicular angle decreased along the length of the spine to zero at L5. The transverse pedicular angle decreased from T1 to T12 and then increased to L5. Of the pedicular measurements only width limits the diameter of fixation screws. The vertical interpedicular distance determines the distance between the holes of plates, while the length of the transfixator is related to the transverse interpedicular distance. The pedicular angles enable triangulation of screws and determine the stability of the fixation.

  5. Percutaneous endoscopic gastrostomy in children.

    Science.gov (United States)

    Park, Jye Hae; Rhie, Seonkyeong; Jeong, Su Jin

    2011-01-01

    Percutaneous endoscopic gastrostomy (PEG) can improve nutritional status and reduce the amount of time needed to feed neurologically impaired children. We evaluated the characteristics, complications, and outcomes of neurologically impaired children treated with PEG. We retrospectively reviewed the records of 32 neurologically impaired children who underwent PEG between March 2002 and August 2008 at our medical center. Forty-two PEG procedures comprising 32 PEG insertions and 10 PEG exchanges, were performed. The mean follow-up time was 12.2 (6.6) months. Mean patient age was 9.4 (4.5) years. The main indications for PEG insertion were swallowing difficulty with GI bleeding due to nasogastric tube placement and/or the presence of gastroesophageal reflux disease (GERD). The overall rate of complications was 47%, with early complications evident in 25% of patients and late complications in 22%. The late complications included one gastro-colic fistula, two cases of aggravated GERD, and four instances of wound infection. Among the 15 patients with histological evidence of GERD before PEG, 13 (87%) had less severe GERD, experienced no new aspiration events, and showed increased body weight after PEG treatment. PEG is a safe, effective, and relatively simple technique affording long-term enteral nutritional support in neurologically impaired children. Following PEG treatment, the body weight of most patients increased and the levels of vomiting, GI bleeding, and aspiration fell. We suggest that PEG with post-procedural observation be considered for enteral nutritional support of neurologically impaired children.

  6. Percutaneous Management of Ureteral Injuries that are Diagnosed Late After Cesarean Section

    Energy Technology Data Exchange (ETDEWEB)

    Ustunsoz, Bahri; Ugurel, Sahin; Duru, Namik Kemal; Ozgok, Yasar; Ustunsoz, Ayfer [GATA Medical Faculty, Ankara (Turkmenistan)

    2008-08-15

    We wanted to present the results of percutaneous management of ureteral injuries that were diagnosed late after cesarean sections (CS). Twenty-two cases with 24 ureteral injuries that were diagnosed late after CS underwent percutaneous nephrostomy (PN), antegrade double J (DJ) catheter placement and balloon dilatation or a combination of these. The time for making the diagnosis was 21 +- 50.1 days. The injury site was the distal ureter in all cases (the left ureter: 13, the right ureter: 7 and bilateral: 2). Fifteen complete ureteral obstructions were detected in 13 cases. Ureteral leakage due to partial (n = 4) or complete (n = 3) rupture was noted in seven cases. Two cases had ureterovaginal fistula. All the cases were initially confirmed with antegrade pyelography and afterwards they underwent percutaneous nephrostomy. Balloon dilatation was needed in three cases. Antegrade DJ stents were placed in 10 cases, including the three cases with balloon dilatation. Repetititon of percutaneous nephrostomy with balloon dilatation and DJ stent placement was needed in one case with complete obstruction. All the cases were followed-up with US in their first week and then monthly thereafter for up to two years. Eighteen ureters (75%) were managed by percutaneous procedures alone. A total of six ureter injuries had to undergo surgery (25%). Percutaneous management is a good alternative for the treatment of post-CS ureteral injuries that are diagnosed late after CS. Percutaneous management is at least preparatory for a quarter of the cases where surgery is unavoidable

  7. Percutaneous Management of Ureteral Injuries that are Diagnosed Late After Cesarean Section

    International Nuclear Information System (INIS)

    Ustunsoz, Bahri; Ugurel, Sahin; Duru, Namik Kemal; Ozgok, Yasar; Ustunsoz, Ayfer

    2008-01-01

    We wanted to present the results of percutaneous management of ureteral injuries that were diagnosed late after cesarean sections (CS). Twenty-two cases with 24 ureteral injuries that were diagnosed late after CS underwent percutaneous nephrostomy (PN), antegrade double J (DJ) catheter placement and balloon dilatation or a combination of these. The time for making the diagnosis was 21 ± 50.1 days. The injury site was the distal ureter in all cases (the left ureter: 13, the right ureter: 7 and bilateral: 2). Fifteen complete ureteral obstructions were detected in 13 cases. Ureteral leakage due to partial (n = 4) or complete (n = 3) rupture was noted in seven cases. Two cases had ureterovaginal fistula. All the cases were initially confirmed with antegrade pyelography and afterwards they underwent percutaneous nephrostomy. Balloon dilatation was needed in three cases. Antegrade DJ stents were placed in 10 cases, including the three cases with balloon dilatation. Repetititon of percutaneous nephrostomy with balloon dilatation and DJ stent placement was needed in one case with complete obstruction. All the cases were followed-up with US in their first week and then monthly thereafter for up to two years. Eighteen ureters (75%) were managed by percutaneous procedures alone. A total of six ureter injuries had to undergo surgery (25%). Percutaneous management is a good alternative for the treatment of post-CS ureteral injuries that are diagnosed late after CS. Percutaneous management is at least preparatory for a quarter of the cases where surgery is unavoidable

  8. Percutaneous drainage for post-traumatic hepatic abscess in children under ultrasound imaging

    International Nuclear Information System (INIS)

    Taguchi, T.; Ikeda, K.; Yakabe, S.; Kimura, S.

    1988-01-01

    Hepatic abscess is rare in children. A patient with a post-traumatic hepatic abscess was successfully treated by ultrasound-guided percutaneous drainage. Although he underwent a drainage operation for the perihepatic abscesses, high fever continued. It was then considered that the traumatic hematoma had been infected and had become an abscess. Sonographically-guided percutaneous aspiration is useful for the definite diagnosis of hepatic abscess. Subsequent percutaneous drainage under ultrasound imaging is a safe und useful therapeutic method even in a poor-risk patient. (orig.)

  9. Percutaneous Treatment of Splenic Cystic Echinococcosis: Results of 12 Cases

    Energy Technology Data Exchange (ETDEWEB)

    Akhan, Okan, E-mail: akhano@tr.net; Akkaya, Selçuk, E-mail: selcuk.akkaya85@gmail.com [Hacettepe University, Department of Radiology, School of Medicine (Turkey); Dağoğlu, Merve Gülbiz, E-mail: drmgkartal@gmail.com [Istanbul University, Department of Radiology, Istanbul School of Medicine (Turkey); Akpınar, Burcu, E-mail: burcu-akpinar@yahoo.com [Hacettepe University, Department of Radiology, School of Medicine (Turkey); Erbahçeci, Aysun, E-mail: aysunerbahceci@yahoo.com [Istanbul Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Department of Radiology (Turkey); Çiftçi, Türkmen, E-mail: turkmenciftci@yahoo.com [Hacettepe University, Department of Radiology, School of Medicine (Turkey); Köroğlu, Mert, E-mail: mertkoroglu@hotmail.com [Antalya Education and Research Hospital, Department of Radiology (Turkey); Akıncı, Devrim, E-mail: akincid@hotmail.com [Hacettepe University, Department of Radiology, School of Medicine (Turkey)

    2016-03-15

    PurposeCystic echinococcosis (CE) in the spleen is a rare disease even in endemic regions. The aim of this study was to examine the efficacy of percutaneous treatment for splenic CE.Materials and MethodsTwelve patients (four men, eight women) with splenic CE were included in this study. For percutaneous treatment, CE1 and CE3A splenic hydatid cysts were treated with either the PAIR (puncture, aspiration, injection, respiration) technique or the catheterization technique.ResultsEight of the hydatid cysts were treated with the PAIR technique and four were treated with catheterization. The volume of all cysts decreased significantly during the follow-up period. No complication occurred in seven of 12 patients. Abscess developed in four patients. Two patients underwent splenectomy due to cavity infection developed after percutaneous treatment, while the spleen was preserved in 10 of 12 patients. Total hospital stay was between 1 and 18 days. Hospital stay was longer and the rate of infection was higher in the catheterization group. Follow-up period was 5–117 months (mean, 44.8 months), with no recurrence observed.ConclusionThe advantages of the percutaneous treatment are its minimal invasive nature, short hospitalization duration, and its ability to preserve splenic tissue and function. As the catheterization technique is associated with higher abscess risk, we suggest that the PAIR procedure should be the first percutaneous treatment option for splenic CE.

  10. NUTRITION SUPPORT COMPLICATIONS IN PATIENT WHO UNDERWENT CARDIAC SURGERY

    OpenAIRE

    Krdžalić, Alisa; Kovčić, Jasmina; Krdžalić, Goran; Jahić, Elmir

    2016-01-01

    Background: The nutrition support complications after cardiac surgery should be detected and treated on time. Aim: To show the incidence and type of nutritional support complication in patients after cardiac surgery. Methods: The prospective study included 415 patients who underwent cardiac surgery between 2010 and 2013 in Clinic for Cardiovascular Disease of University Clinical Center Tuzla. Complications of the delivery system for nutrition support (NS) and nutrition itself were analy...

  11. Percutaneous lumbar discectomy

    International Nuclear Information System (INIS)

    Xiao Chengjiang; Su Huanbin; Xu Sui; He Xiaofeng; Li Yanhao

    2004-01-01

    Objective: To probe the therapeutic effects, indications and safety of the percutaneous lumbar discectomy (PLDP). Methods: To ameliorate percutaneous punctured route based on classic PLD and modified jaw structure of pulpiform nacleus forceps, with statistic analysis of the therapeutic results of 352 cases of patient undergone PLDP and follow up ranging from 6 to 38 months retrospectively. Results: The effective ratios were excellent in 45.5%, good for 45.4% and bad in 9.1%. 44 of 352 cases with pulps prolapse were cured. No intervertebral inflammation and paradisc hematoma took place. One case complicated with cauda equina injury and 4 cases with appliances broken inside the disc. Conclusions: PLDP is effective and safe, not only adaptive to the contained disc herniation, but also for noncontained herniation. (authors)

  12. Percutaneous transluminal coronary angioplasty

    International Nuclear Information System (INIS)

    Przybojewski, J.Z.; Weich, H.F.H.

    1984-01-01

    The purpose of this article is to review PTCA, percutaneous transluminal coronary angioplasty, which can be considered to be a truly revolutionary and fairly simple invasive form of intervention to atherosclerotic obstruction. The 'epidemic' of IHD, ischaemic heart disease, in the Republic of South Africa calls for the employment of this technique, which has already been carried out in a few teaching hospitals in this country. Very recently, modified balloon dilatation catheters have been used percutaneously in the non-operative transluminal correction of congenital coarctation of the aorta in infants and children, congenital pulmonary value stenosis, and hypoplasia and stenosis of the pulmonary arteries. It has also been employed for PTCA and for the simultaneous occlusion of coronary-bronchial artery anastomosis using a detachable balloon. The isotopes thallium 201 and technetium 99 were also used in scintiscanning

  13. Intradermal Infiltration of Local Anesthetic?Rapid and Bloodless Deepithelialization of the Breast Pedicle

    OpenAIRE

    Bennett, Katelyn G.; Gilman, Robert H.

    2017-01-01

    Summary: Breast reduction is one of the most commonly performed plastic surgery procedures, and pedicle deepithelialization remains a time-consuming step of the operation. This is especially true when using an inferior pedicle. We present a novel technique of intradermal infiltration of the breast pedicle with local anesthetic to facilitate efficient, bloodless deepithelialization. The senior author uses a 20-ml syringe to inject 0.25% lidocaine and 1:400,000 epinephrine just beneath the epid...

  14. L5 pedicle length is increased in subjects with spondylolysis: an anatomic study of 1072 cadavers.

    Science.gov (United States)

    Bajwa, Navkirat S; Toy, Jason O; Ahn, Nicholas U

    2012-11-01

    In spondylolisthesis, it is believed that as L5 slips on S1, the pedicle may become elongated in response to the instability in an attempt to bridge the defect. Whether patients with spondylolysis, which is largely developmental, also develop elongation of the pedicles is unknown. The purpose of this study is to evaluate and quantify the increase in L5 pedicle length in subjects with spondylolysis as compared with normal healthy subjects. Nine hundred fifty-two human cadaveric specimens without spondylolysis and 120 specimens with spondylolysis from the Hamann-Todd Osteological Collection were examined by a single examiner. Baseline data, including age, sex, and race of specimens, were collected. Digital calipers were used to measure the pedicle lengths at the L5 level. Linear regression analysis was performed to compare the L5 pedicle lengths in healthy patients and patients with spondylolysis. Linear regression showed a significant association of increased L5 pedicle length in subjects with spondylolysis. The average L5 pedicle length in subjects with spondylolysis was greater compared with subjects without spondylolysis. In spondylolytic specimens, pedicles start to elongate after the age of 40 years. The pedicle lengths increase progressively from 5.6 mm at 40 years to 6.7 mm at 80 years with a 1% to 3% increment every decade. The pedicle lengths showed little variation in specimens from healthy subjects. In spondylolytic specimens, there is progressive elongation of L5 pedicle length after the third decade. An increase in L5 pedicle length in all age groups compared with the specimens from healthy subjects suggests that pathologic changes occur in bony anatomy of L5 vertebrae as early as adolescence when the condition develops.

  15. Fatigue life prediction of pedicle screw for spinal surgery

    Czech Academy of Sciences Publication Activity Database

    Major, Štěpán; Kocour, Vladimír; Cyrus, P.

    2016-01-01

    Roč. 10, č. 35 (2016), s. 379-388 ISSN 1971-8993. [European Conference on Fracture. ECF21. Catania, 20.06.2015-20.06.2015] Institutional support: RVO:68378297 Keywords : pedicle-screw * titan alloy * fatigue life * finite element analysis Subject RIV: JK - Corrosion ; Surface Treatment of Materials http://www.fracturae.com/index.php/fis/article/view/IGF-ESIS.35.43

  16. [Intraoperative three-dimensional navigation for pedicle screw placement].

    Science.gov (United States)

    Grützner, P A; Beutler, T; Wendl, K; von Recum, J; Wentzensen, A; Nolte, L-P

    2004-10-01

    The mobile SIREMOBIL Iso-C(3D) C-arm (Siemens, Erlangen, Germany) is the first device permitting intraoperative, three-dimensional representation of bone structures. A high-resolution, isotropic 3D data cube in the isocenter with sides of approximately 12 cm is calculated simultaneously. The SIREMOBIL Iso-C(3D) is linked to the navigation system. This makes it possible to transfer the generated 3D data directly to the linked navigation system without the need for surgeon-dependent registration. In this prospective clinical trial, we evaluated the accuracy of pedicle screw placement using this device. In 61 patients, a total of 302 pedicle screws were placed. Only in five cases (1.7%) were misplacements of > or =2 mm shown in postoperative control CT. The average fluoroscopy time was 1.28+/-0.56 min, and the average operative duration was 103.26+/-23.3 min. There were no postoperative neurological complications in any of the 30 patients. From these data, we conclude that Iso-C(3D) navigation is a very accurate method for the placement of pedicle screws.

  17. PEDICLE TONGUE FLAP SURGERY IN ORAL SUBMUCOUS FIBROSIS

    Directory of Open Access Journals (Sweden)

    Muthubabu K

    2016-09-01

    Full Text Available BACKGROUND Oral submucous fibrosis is a disease of unknown aetiology and is a legacy of Indians. It has been variously treated both medically and surgically but neither has been found to be rewarding. Various groups have been studying the therapy schedules and aetiological association, but the conclusions have remained unclear. AIM The study aims to focus on newer surgical therapy stressing on the mechanics and use of pedicle tongue flap in the management of this condition. METHODS AND MATERIALS The study comprised of 40 patients from our outpatient department suffering from oral submucous fibrosis in the age group of 11 to 70 years. The contributory factors of oral submucous fibrosis and the symptoms of the disease were evaluated and the role of pedicle tongue flap surgery in the management of this disease which is a premalignant condition is discussed. RESULTS AND CONCLUSION Pedicle tongue flap surgery has given promising results in the treatment of trismus due to oral submucous fibrosis. After the surgery, none of our patients developed any malignant change.

  18. Biomechanical effects of pedicle screw fixation on adjacent segments.

    Science.gov (United States)

    Kyaw, Thein Aung; Wang, Zhuo; Sakakibara, Toshihiko; Yoshikawa, Takamasa; Inaba, Tadashi; Kasai, Yuichi

    2014-07-01

    Various biomechanical investigations have attempted to clarify the aetiology of adjacent segment disease (ASD). However, no biomechanical study has examined in detail the deformation behaviour of the adjacent segments when both pure torque and an angular displacement load are applied to the vertebrae along multiple segments. The purpose of this study is to investigate the biomechanical effects of pedicle screw fixation on adjacent segments. Ten cadaveric lumbar spines (L2-L5) of boars were used. Control and fusion models were prepared by disc damage and pedicle screw fixation of each specimen, and then, bending and rotation tests were performed using a six-axis material tester. In the biomechanical tests regulated by an angular displacement load, the range of motion (ROM) of the cranial and caudal adjacent segments in antero-posterior flexion and lateral bending was increased by about 20 % (p fusion surgery as a mechanism to compensate for the ROM lost due to excessive fusion by pedicle screw fixation, so that a large torque may be applied to adjacent segments within a physiologically possible range, and it might gradually lead to a degenerative intervertebral disc or progression of spondylolisthesis in the adjacent segments.

  19. Alternative Treatment for Bleeding Peristomal Varices: Percutaneous Parastomal Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Pabon-Ramos, Waleska M., E-mail: waly.pr@duke.edu [Duke University Hospital, Department of Radiology (United States); Niemeyer, Matthew M. [Washington University Medical Center, Mallinckrodt Institute of Radiology (United States); Dasika, Narasimham L., E-mail: narasimh@med.umich.edu [University of Michigan Health System, Department of Radiology (United States)

    2013-10-15

    Purpose: To describe how peristomal varices can be successfully embolized via a percutaneous parastomal approach. Methods: The medical records of patients who underwent this procedure between December 1, 2000, and May 31, 2008, were retrospectively reviewed. Procedural details were recorded. Median fluoroscopy time and bleeding-free interval were calculated. Results: Seven patients underwent eight parastomal embolizations. The technical success rate was 88 % (one failure). All embolizations were performed with coils combined with a sclerosant, another embolizing agent, or both. Of the seven successful parastomal embolizations, there were three cases of recurrent bleeding; the median time to rebleeding was 45 days (range 26-313 days). The remaining four patients did not develop recurrent bleeding during the follow-up period; their median bleeding-free interval was 131 days (range 40-659 days). Conclusion: This case review demonstrated that percutaneous parastomal embolization is a feasible technique to treat bleeding peristomal varices.

  20. Pedicle measurement of the thoracolumbar spine: a cadaveric, radiographic, and CT scan study in Filipinos

    International Nuclear Information System (INIS)

    Molano, A.M.V.; Sison, A.B.; Fong, H.C.; Lim, N.T.; Sabile, K.

    1994-01-01

    With the popular usage of spinal pedicular screw fixation, it is essential to have a knowledge of the morphometry of the pedicles of the spine of particular populations. This study compared the direct pedicle measurements of ten cadavers in an institution, with their respective radiographic and computerized tomographic (CT) scan values, and also compared the effective pedicle diameter (EPD) with the conventional outer pedicle diameter (OPD) measurements. A compilation of pedicle values was also made in X-ray and CT scan plates of a Filipino population. A statistical analysis made on the 2,760 pedicle measurements taken from cadaveric T6-L5 vertebrae showed that direct measurements were significantly different from X-ray and CT scan values. The mean values of the EPD differed from those of the OPD, but not statistically significant. Comparison with previous foreign studies revealed significant differences in these pedicle dimensions. Pedicle measurements in a living Filipino population were found to be significantly different statistically between sexes. Accurate measurement of the pedicle diameters and lengths are indeed critical for the success of a spinal stabilization procedure using pedicular screws. (author). 8 refs.; 5 figs.; 1 tab

  1. Pedicle marrow signal intensity changes in the lumbar spine: a manifestation of facet degenerative joint disease

    International Nuclear Information System (INIS)

    Morrison, J.L.; Kaplan, P.A.; Dussault, R.G.; Anderson, M.W.

    2000-01-01

    Objective. Signal intensity changes in lumbar pedicles, similar to those described in vertebral body endplates adjacent to degenerated discs, have been described as an ancillary sign of spondylolysis on MRI. The purpose of this study was to determine whether pedicle marrow signal intensity changes also occur in association with facet degenerative joint disease.Design. Eighty-nine lumbar spine MRI examinations without spondylolysis were reviewed for marrow signal intensity changes in pedicles and vertebral bodies as well as for facet degenerative joint disease.Results. Five percent (46/890) of lumbar pedicles in 23 patients had marrow signal intensity changes. Ninety-one percent (42/46) of the abnormal pedicles had adjacent degenerative joint disease of the facets, while only 21% (189/890) of normal pedicles had adjacent facet degenerative joint disease (p<0.001). Eighty-nine percent (41/46) of the pedicles with marrow signal intensity changes had adjacent degenerative disc disease.Conclusions. Pedicle marrow signal intensity changes are not a specific sign of spondylolysis; they are commonly seen with adjacent facet degenerative joint disease in the absence of spondylolysis. Pedicle marrow signal intensity changes are probably a response to abnormal stresses related to abnormal motion or loading caused by the degenerative changes in the spinal segment. (orig.)

  2. Pedicle marrow signal intensity changes in the lumbar spine: a manifestation of facet degenerative joint disease

    Energy Technology Data Exchange (ETDEWEB)

    Morrison, J.L.; Kaplan, P.A.; Dussault, R.G.; Anderson, M.W. [Dept. of Radiology, Univ. of Virginia Health System, Charlottesville, VA (United States)

    2000-12-01

    Objective. Signal intensity changes in lumbar pedicles, similar to those described in vertebral body endplates adjacent to degenerated discs, have been described as an ancillary sign of spondylolysis on MRI. The purpose of this study was to determine whether pedicle marrow signal intensity changes also occur in association with facet degenerative joint disease.Design. Eighty-nine lumbar spine MRI examinations without spondylolysis were reviewed for marrow signal intensity changes in pedicles and vertebral bodies as well as for facet degenerative joint disease.Results. Five percent (46/890) of lumbar pedicles in 23 patients had marrow signal intensity changes. Ninety-one percent (42/46) of the abnormal pedicles had adjacent degenerative joint disease of the facets, while only 21% (189/890) of normal pedicles had adjacent facet degenerative joint disease (p<0.001). Eighty-nine percent (41/46) of the pedicles with marrow signal intensity changes had adjacent degenerative disc disease.Conclusions. Pedicle marrow signal intensity changes are not a specific sign of spondylolysis; they are commonly seen with adjacent facet degenerative joint disease in the absence of spondylolysis. Pedicle marrow signal intensity changes are probably a response to abnormal stresses related to abnormal motion or loading caused by the degenerative changes in the spinal segment. (orig.)

  3. One stage reconstruction of the floor of the mouth with a subcutaneous pedicled nasolabial flap.

    Science.gov (United States)

    El-Marakby, Hamdy H; Fouad, Fouad A; Ali, Ahmed H

    2012-06-01

    Nasolabial flaps have been recognised as versatile flaps for a variety of defects in the face, nose, lip and the oral cavity. Random pattern inferiorly based nasolabial flaps (NLF) have been utilised for covering small defects on the anterior floor of the mouth, but usually require a second stage procedure to divide the flap base. A subcutaneous pedicled inferiorly based nasolabial flap can provide a one stage repair of moderate sized defects of the floor of the mouth after de epithelialisation of the base of the flap. To evaluate the feasibility of a single stage reconstruction of intermediate sized defects in the oral cavity with an inferiorly based pedicled NLF. The study includes the indications of use of the flap, flap design, technique, and the complications rate. The incidence of secondary procedures and the final functional and the aesthetic results will also be evaluated. A group of 20 patients presented with (T1-2) squamous cell carcinoma of the oral cavity have been treated at the Department of Surgery, National Cancer Institute, Cairo; in the period between January 2008 and September 2010. The pathology was confirmed with an incision biopsy and all metastatic work were carried out confirming that all patients were free from distant metastasis at presentation. Preoperative assessment also included assessment of the stage of the disease, the flap design and patient fitness for general anaesthesia. All patients underwent surgical excision combined with reconstruction of the defect with a subcutaneous inferiorly based pedicled NLF. The proximal part of the flap was routinely de epithelialised before it has been tunnelled through the cheek so a one stage procedure could only be required. The mean age of the patients was 62.3±6years, range (52-69years). All patients were diagnosed with squamous cell carcinoma. The anterior floor of the mouth constituted 40% of the defects, the lateral floor of the mouth 20% and the inner surface of the cheek 40%. There was

  4. Percutaneous Transhepatic Cholangiography | Goldin | South ...

    African Journals Online (AJOL)

    Percutaneous Transhepatic Cholangiography. AR Goldin, EM Bass. Abstract. Our experience with percutaneous transhepatic cholangiography in 46 cases is presented and compared with other series. The technique is safe, simple and accurate and can play a major role in the early diagnosis of obstructive jaundice.

  5. Utilization of a Technique of Percutaneous S2 Alar-Iliac Fixation in Immunocompromised Patients with Spondylodiscitis.

    Science.gov (United States)

    Funao, Haruki; Kebaish, Khaled M; Isogai, Norihiro; Koyanagi, Takahiro; Matsumoto, Morio; Ishii, Ken

    2017-01-01

    Spondylodiscitis still remains a serious problem, especially in immunocompromised patients. Surgery is necessary when nonsurgical treatment is unsuccessful. Although minimally invasive spine stabilization (MISt) with percutaneous pedicle screws is less invasive, percutaneous sacropelvic fixation techniques are not common practice. Here, we describe 2 cases in which spondylodiscitis in the lumbosacral spine was treated with percutaneous stabilization using an S2 alar-iliac (S2AI) screw technique. Case 1 is a 77-year-old man who presented with low back pain and high fever. He was diagnosed with spondylodiscitis at L4-5. He had a history of lung cancer, which was complicated by the recurrence. Because nonsurgical treatment failed, MISt with percutaneous S2AI screws was performed. The patient's low back pain subsided markedly 1 week after surgery, and there was no screw/rod breakage or recurrence of infection during the follow-up period. Case 2 is a 71-year-old man who presented with hemiparesis because of a stroke. He also developed high fever and was diagnosed with spondylodiscitis at L5-S1. Because nonsurgical treatment failed, the patient was treated by MISt with percutaneous S2AI screws while being maintained on anticoagulants for stroke. Although his clinical symptoms had markedly improved, a postoperative lumbar computed tomography scan demonstrated a bone defect at L5-S1. An anterior spinal fusion with an iliac bone graft at L5-S1 was performed when a temporary cessation of anticoagulants was permitted. Both patients tolerated the procedures well and had no major perioperative complications. MISt with percutaneous S2AI screws was less invasive and efficacious for lumbosacral spondylodiscitis in providing rigid percutaneous sacropelvic fixation. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Modified frontolateral partial laryngectomy operation: combined muscle-pedicle hyoid bone and thyrohyoid membrane flap in laryngeal reconstruction

    International Nuclear Information System (INIS)

    Ouyang, Dian; Liu, Tian-Run; Chen, Yan-Feng; Wang, Jian

    2013-01-01

    Laryngeal reconstruction is needed to preserve laryngeal function in patients who have undergone extensive vertical or frontal partial laryngectomy. However, the procedure remains a difficult challenge. Several reconstruction techniques have been described, but these techniques pose risks of complications such as laryngeal stenosis. This study aimed to evaluate the postoperative course and functional outcomes of a new technique that combined a muscle-pedicle hyoid bone and a thyrohyoid flap during laryngeal reconstruction after tumor resection. Four patients underwent extensive vertical partial or frontal partial laryngectomy for cancer. After tumor resection, laryngeal reconstruction was performed using the proposed technique. Postoperative recovery time, complications, and oncologic results were evaluated. The four patients were successfully treated with the proposed technique. No dyspnea, dysphagia, or death occurred during the postoperative course. Decannulation was performed after a median of 3 days. The average postoperative hospital stay was 7 days. Short-term postoperative functional recovery was normal. No laryngeal stenosis or tumor recurrence was observed in any of the four patients after a follow-up period of more than 24 months. The combination of the muscle-pedicle hyoid bone and the thyrohyoid flap is a reliable procedure for laryngeal reconstruction after extensive vertical partial or frontal partial laryngectomy

  7. Segmental vs non-segmental thoracic pedicle screws constructs in adolescent idiopathic scoliosis: is there any implant alloy effect?

    Science.gov (United States)

    Di Silvestre, Mario; Bakaloudis, Georgeous; Ruosi, Carlo; Pipola, Valerio; Colella, Gianluca; Greggi, Tiziana; Ruffilli, Alberto; Vommaro, Francesco

    2017-10-01

    The aim of this study is to understand how many anchor sites are necessary to obtain maximum posterior correction of idiopathic scoliotic curve and if the alloy of instrumentation, stainless steel or titanium, may have a role in the percent of scoliosis correction. We reviewed 143 consecutive patients, affected by AIS (Lenke 1-2), who underwent a posterior spinal fusion with pedicle screw-only instrumentation between 2002 and 2005. According to the implant density and alloy used we divided the cohort in four groups. All 143 patients were reviewed at an average follow-up of 7, 2 years, the overall final main thoracic curve correction averaged 61.4%, whereas the implant density within the major curve averaged 71%. A significant correlation was observed between final% MT correction and preoperative MT flexibility and implant density. When stainless steel instrumentation is used non-segmental pedicle screw constructs seem to be equally effective as segmental instrumentations in obtaining satisfactory results in patients with main thoracic AIS. When the implant alloy used is titanium one, an implant density of ≥60% should be guaranteed to achieve similar results.

  8. [Effectiveness of posterior intrasegmental fixation with pedicle screw-lamina hook system in treatment of lumbar spondylolysis].

    Science.gov (United States)

    Zhou, Zhongjie; Song, Yueming; Zeng, Jiancheng; Liu, Hao; Liu, Limin; Kong, Qingquan; Li, Tao; Gong, Quan

    2013-03-01

    To investigate the effectiveness of posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting for lumbar spondylolysis. Between January 2005 and October 2009, 22 patients with lumbar spondylolysis underwent posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting. There were 19 males and 3 females with an average age of 18.4 years (range, 12-26 years). The main symptom was low back pain with an average disease duration of 16 months (range, 8-56 months). The visual analogue scale (VAS) was 6.0 +/- 1.2 and Oswestry disability index (ODI) was 72.0% +/- 10.0% preoperatively. The X-ray films showed bilateral spondylolysis at L4 in 9 cases and at L5 in 13 cases. The range of motion (ROM) at upper and lower intervertebral spaces was (11.8 +/- 2.8) degrees and (14.1 +/- 1.9) degrees, respectively. All incisions healed by first intention. All patients were followed up 12-45 months (mean, 25 months). Low back pain was significantly alleviated after operation. The VAS score (0.3 +/- 0.5) and ODI (17.6% +/- 3.4%) were significantly decreased at last follow-up when compared with preoperative scores (P spondylolysis, having a high fusion rate, low complication rate, and maximum retention of lumbar ROM.

  9. [Effect evaluation of over 5 year follow up of unilateral pedicle screw fixation with transforaminal lumbar interbody fusion for lumbar degenerative diseases].

    Science.gov (United States)

    Wang, Chong; Ying, Jin-He; Xie, Pan-Pan; Wu, Xiao-Guang

    2016-07-25

    To evaluate the clinical effects of over 5 year follow up of unilateral pedicle screw fixation with transforaminal lumbar interbody fusion(TLIF) in treating lumbar degenerative diseases. The clinical data of 24 patients with lumbar degenerative disease underwent unilateral pedicle screw fixation with transforaminal lumbar interbody fusion from March 2007 to October 2009, were retrospectively analyzed. There were 13 males and 11 females, aged from 34 to 68 years old with an average of 52 years. Postoperative pain and functional results were analyzed by the visual analogue scale(VAS) and Oswestry Disability Index(ODI). Radiological examination was obtained for each patient to assess the height of intervertebral space, postoperative intervertebral fusion conditions and general complications. All patients were followed up from 5 to 8 years with an average of 6.7 years. VAS scores of low back pain and leg pain decreased from preoperative 7.82±0.71, 8.42±1.24 to postoperative 1.87±0.81, 2.23±1.62, respectively( P degenerative diseases according to over 5 year follow up, however, its indications should be well considered. But the problems such as intervertebral space height of operated side loss and adjacent segment degeneration after unilateral pedicle screw fixation need further clinical study.

  10. [PERCUTANEOUS ENCOSCOPIC GASTROSTOMY

    Science.gov (United States)

    Tagle A, Martín

    1998-01-01

    Percutaneous endoscopic gastrostomy is an increasingly utilized method of enteral nutrition in patients who for a variety of reasons, are unable to swallow or possess a high risk of aspiration. This method has replaced both surgical gastrostomy and the prolonged used of nasogastric tubes since its creation, in 1980. The most frequent indications are severe neurological diseases such as cerebrovascular accidents, Parkinson's, multiple sclerosis and other processes such as severe trauma, multi-infarct dementia or diverse head and neck tumors. The procedure involves the performance of an upper endoscopy in the usual manner, followed by an insertion of a plastic catheter percutaneously in the area of maximum contact between the gastric and abdominal walls, under direct endoscopic view. Then, a guidewire is introduced through the lumen of the catheter and is enlaced by a polypectomy snare passed through the working channel of the endoscope, utilizing the guidewire to tie the distal portion of the feeding tube, which will be pulled to its final position. The complications associated to this procedure are minimal, most of them related to the endoscopy itself, like reactions to sedation, aspiration of oropharyngeal secretions, etc. There is also a possibility of local infection at the insertion site, perforation of the colon and excessive leaking of gastric contents around the tube, and for these reasons the procedure should only be performed by trained physicians, familiarized with the management of these events. The goal of this review is to illustrate the reader about the indications, contral indications, complications and general considerations in the patients who will have a percutaneous endoscopic gastrostomy.

  11. Pigmented Villonodular Synovitis in a Patient who Underwent Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Nevzat Dabak

    2014-09-01

    Full Text Available Pigmented villonodular synovitis (PVNS is a rare, benign, but a locally aggressive tumor. It is characterized by the proliferation of synovial membrane, but it can also be seen in tendon sheaths and bursae. Clinical presentation of solitary lesions include compression and locking of the joint suggesting loose bodies in the joint and a subsequent findings of an effusion, whereas diffuse lesions manifest with pain and chronic swelling. In this article, we presented a curious case of PVNS in a female patient who have been followed up due to an acetabular cystic lesion. She underwent total hip arthroplasty for severe osteoarthritis of the hip joint and associated pain. The diagnosis of PVNS was established intraoperatively. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52: 235-7

  12. A biomechanical study of two different pedicle screw methods for fixation in osteoporotic and nonosteoporotic vertebrae.

    Science.gov (United States)

    Higashino, Kosaku; Kim, Jin Hwan; Horton, William C; Hutton, William C

    2012-01-01

    In reconstruction of the osteoporotic spine, patients often show poor outcome because of pedicle screw failure. This study used osteoporotic and nonosteoporotic vertebrae to determine the difference in fixation strength between pedicle screws inserted straight forward and pedicle screws inserted in an upward trajectory toward the superior end plate (i.e., end-plate screws). There is some evidence to suggest that end-plate screws have a strength advantage. The particular focus was on osteoporotic vertebrae. Thirty-three vertebrae (T10-L2) were harvested. The bone mineral density (BMD) was measured: 15 vertebrae were greater than 0.8 g/cm(2) and designated as nonosteoporotic (average BMD 1.146 ± 0.186 g/cm(2)) and 18 vertebrae were designated as osteoporotic (average BMD 0.643 ± 0.088 g/cm(2)). On one pedicle the screw was inserted straight forward and on the other pedicle the screw was inserted as an end-plate screw. The torque of insertion was measured (Proto 6106 torque screwdriver). Using an MTS Mini Bionix, two types of mechanical testing were carried out on each pedicle: (a) cephalocaudad toggling was first carried out to simulate some physiological type loading: 500 cycles at 0.3 Hz, at ±50 N; and (b) then each pedicle screw was pulled out at a displacement rate of 12.5 cm/min.There was no difference in pullout force between the pedicle screws inserted straight forward and the pedicle screws inserted as end-plate screws. This result applies whether the vertebrae were osteoporotic or nonosteoporotic. For both the straight-forward screws and the end-plate screws, a statistically significant correlation was observed between torque of insertion and pullout force. The results of this experiment indicate that pedicle screws inserted as end-plate screws do not provide a strength advantage over pedicle screws inserted straight forward, whether the vertebrae are osteoporotic or not.

  13. ALGORITHM FOR MANAGEMENT OF HYPERTENSIVE PATIENTS UNDERWENT UROLOGY INTERVENTIONS

    Directory of Open Access Journals (Sweden)

    S. S. Davydova

    2015-09-01

    Full Text Available Aim. To study the efficacy of cardiovascular non-invasive complex assessment and pre-operative preparation in hypertensive patients needed in surgical treatment of urology dis- eases.Material and methods. Males (n=883, aged 40 to 80 years were included into the study. The main group consisted of patients that underwent laparotomic nephrectomy (LTN group; n=96 and patients who underwent laparoscopic nephrectomy (LSN group; n=53. Dynamics of ambulatory blood pressure monitoring (ABPM data was analyzed in these groups in the immediate postoperative period. The efficacy of a package of non-invasive methods for cardiovascular system assessment was studied. ABPM was performed after nephrectomy (2-nd and 10-th days after surgery in patients with complaints of vertigo episodes or intense general weakness to correct treatment.Results. In LTN group hypotension episodes or blood pressure (BP elevations were observed in 20 (20.8% and 22 (22.9% patients, respectively, on the 2-nd day after the operation. These complications required antihypertensive treatment correction. Patients with hypotension episodes were significantly older than patients with BP elevation and had significantly lower levels of 24-hour systolic BP, night diastolic BP and minimal night systolic BP. Re-adjustment of antihypertensive treatment on the 10-th postoperative day was required to 2 (10% patients with hypotension episodes and to 1 (4.5% patient with BP elevation. Correction of antihypertensive therapy was required to all patients in LSN group on the day 2, and to 32 (60.4% patients on the 10-th day after the operation. Reduction in the incidence of complications (from 1.2% in 2009 to 0.3% in 2011, p<0.001 was observed during the application of cardiovascular non-invasive complex assessment and preoperative preparation in hypertensive patients.Conclusion. The elaborated management algorithm for patients with concomitant hypertension is recommended to reduce the cardiovascular

  14. ALGORITHM FOR MANAGEMENT OF HYPERTENSIVE PATIENTS UNDERWENT UROLOGY INTERVENTIONS

    Directory of Open Access Journals (Sweden)

    S. S. Davydova

    2013-01-01

    Full Text Available Aim. To study the efficacy of cardiovascular non-invasive complex assessment and pre-operative preparation in hypertensive patients needed in surgical treatment of urology dis- eases.Material and methods. Males (n=883, aged 40 to 80 years were included into the study. The main group consisted of patients that underwent laparotomic nephrectomy (LTN group; n=96 and patients who underwent laparoscopic nephrectomy (LSN group; n=53. Dynamics of ambulatory blood pressure monitoring (ABPM data was analyzed in these groups in the immediate postoperative period. The efficacy of a package of non-invasive methods for cardiovascular system assessment was studied. ABPM was performed after nephrectomy (2-nd and 10-th days after surgery in patients with complaints of vertigo episodes or intense general weakness to correct treatment.Results. In LTN group hypotension episodes or blood pressure (BP elevations were observed in 20 (20.8% and 22 (22.9% patients, respectively, on the 2-nd day after the operation. These complications required antihypertensive treatment correction. Patients with hypotension episodes were significantly older than patients with BP elevation and had significantly lower levels of 24-hour systolic BP, night diastolic BP and minimal night systolic BP. Re-adjustment of antihypertensive treatment on the 10-th postoperative day was required to 2 (10% patients with hypotension episodes and to 1 (4.5% patient with BP elevation. Correction of antihypertensive therapy was required to all patients in LSN group on the day 2, and to 32 (60.4% patients on the 10-th day after the operation. Reduction in the incidence of complications (from 1.2% in 2009 to 0.3% in 2011, p<0.001 was observed during the application of cardiovascular non-invasive complex assessment and preoperative preparation in hypertensive patients.Conclusion. The elaborated management algorithm for patients with concomitant hypertension is recommended to reduce the cardiovascular

  15. Revision of the failed pedicle screw in osteoporotic lumbar spine: biomechanical comparison of kyphoplasty versus transpedicular polymethylmethacrylate augmentation.

    Science.gov (United States)

    Derinçek, Alihan; Türker, Mehmet; Cinar, Murat; Cetik, Ozgür; Kalaycioğlu, Bariş

    2012-01-01

    In this study, we aimed to compare of kyphoplasty versus transpedicular polymethylmethacrylate (PMMA) augmentation biomechanically in the revision of the failed pedicle screw in osteoporotic lumbar spine. Bone mineral density (BMD) of lumbar vertebrae collected from four bovines were measured. Each vertebra was decalcified with hydrochloric acid solution to obtain osteoporotic specimens. Primary polyaxial pedicle screws were inserted into the pedicles and pulled out until they failed. The pullout strength results of all specimens were recorded. Revision pedicle screws were randomly inserted into the same pedicles by either pedicle hole PMMA augmented (group 1) or kyphoplasty (Xvoid™) PMMA augmented pedicle screws (group 2). The pullout strength results of all specimens were re-recorded. The mean BMD significantly decreased from 1.686 ± 227.9 g/cm(2) to 1.432 ± 157.1 g/cm(2) following decalcification (posteoporotic bone, kyphoplasty augmented pedicle screw seems to be more effective method increasing the pullout strength.

  16. Percutaneous cholecystostomy at the community hospital: value evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Min; Lee, Mi Suk; Lee, Jin Hee; Ym, Seong Hee; Yoon, Young Gun [Namwon Medical Center, Namwon (Korea, Republic of); Sohn, Myung Hee; Kim, Chong Soo; Han, Young Min; Choi, Ki Chul [Chonbuk National Univ., Chonju (Korea, Republic of)

    1997-10-01

    To assess the role of percutaneous cholecystostomy as a therapeutic maneuver in patients critically ill with acute cholecystitis in community hospitals. Eighteen patients, 11 with suspected acute calculous cholecystits and seven with acute acalulous cholecystitis underwent emergency percutaneous cholecystostomy. All demonstrated a variety of high risk factors for cholecystectomy:liver cirrhosis(n=3D2), diabetes mellitus(n=3D3), cardiac disease(n=3D3), underlying malignancy(n=3D2), pulmonary dysfunction(n=3D1), septic cholangitis(n=3D5), and old age(n=3D2). All percutaneous cholecystostomies were performed with ultrasound guidance and preferably using the transhepatic route. All procedures but one were successful, and most cholecystostomies were performed within 5-20 minutes. Technical problems were as follows: guide-wire buckling during catheter insertion(n=3D2) and procedure failure(n=3D1). The only major problem was a case of localized bile peritonitis due to procedural failure, but a few minor complications were encountered:catheter dislodgment(n=3D3), and significant abdominal pain during the procedure(2). After successful cholecystostomy, a dramatic improvement in clinical condition was observed in 16 of 17 patients(94%) within 48 hours. Ten of 16 patients who responded to percutaneous cholecystostomy underwent elective cholecystectomy after the improvement of clinical symptoms, and the remaining six patients improved without other gallbladder interventions. Percutaneous cholecystostomy is not only an effective procedure for acute cholecystitis, but also has a definite role in the management of these high-risk patients in community hospitals.=20.

  17. Percutaneous management of prosthetic valve thrombosis.

    Science.gov (United States)

    Hariram, Vuppaladadhiam

    2014-01-01

    Thrombosis of a prosthetic valve is a serious complication in patients with prosthetic heart valves. Thrombolysis is the initial choice of treatment. Patients who do not respond to thrombolysis are subjected to surgery which carries a high risk. We report a case series of 5 patients with prosthetic mitral valve thrombosis who did not respond to thrombolysis and were subjected to percutaneous manipulation of the prosthetic valves successfully and improved. Five patients who were diagnosed to have prosthetic mitral valve thrombosis and failed to respond to a minimum of 36 h of thrombolysis (persistent symptoms with increased gradients, abnormal findings on fluoroscopy),were subjected to percutaneous treatment after receiving proper consent. None of them had a visible thrombus on transthoracic echocardiogram. All patients underwent transseptal puncture following which a 6F JR4 guiding catheter was passed into the left atrium. The valve leaflets were repeatedly hit gently under fluoroscopic guidance till they regained their normal mobility. Mean age was 38.8 years. Average peak and mean gradients prior to the procedure were 38 and 25 and after the procedure were 12 and 6 mm of Hg respectively. All patients had successful recovery of valve motion on fluoroscopy with normalization of gradients and complete resolution of symptoms. None of the patients had any focal neurological deficits, embolic manifestations or bleeding complications. Percutaneous manipulation of prosthetic valves in selected patients with prosthetic valve thrombosis who do not respond to thrombolytic therapy is feasible and can be used as an alternative to surgery. Copyright © 2014 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  18. Risk factors and outcomes for catastrophic failures at the top of long pedicle screw constructs: a matched cohort analysis performed at a single center.

    Science.gov (United States)

    O'Leary, Patrick T; Bridwell, Keith H; Lenke, Lawrence G; Good, Christopher R; Pichelmann, Mark A; Buchowski, Jacob M; Kim, Yongjung J; Flynn, Jennifer

    2009-09-15

    Retrospective review with matched-cohort analysis performed at a single institution. To determine risk factors and outcomes for acute fractures at the proximal aspect of long pedicle screw constructs. Acute fractures at the top of long segmental pedicle screw constructs (FPSC) can be catastrophic. Substantial surgical increase in lordosis may precipitate this problem. In relation to a matched cohort, we postulated that age, body mass index (BMI), and significant correction of lumbar lordosis would increase risk of FPSC and patients with FPSC would have lesser improvements in outcomes. Thirteen patients who sustained FPSC between 2000 and 2007 were evaluated. During this time, 264 patients aged 40 or older had a spinal fusion from the thoracic spine to the sacrum using an all-pedicle screw construct. A cohort of 31 of these patients without FPSC but with all pedicle screw constructs was matched for diagnosis of positive sagittal imbalance, gender, preoperative C7 sagittal plumb, and number of levels fused. There was a significant difference in age (P = 0.02) and BMI (P = 0.006) between the matched groups. There was no significant difference in preoperative/postoperative C7 plumb or change in lumbar lordosis between groups. Acute neurological deficit developed in 2 patients; both patients improved substantially after revision surgery. Nine patients underwent proximal extension of the fusion. For 7 of the 13 FPSC patients with bone mineral density data (BMD) available, average T score was-1.73; -0.58 for the matched group (10/31 with bone mineral density data) (P = 0.02). Factors that increased the risk of FPSC included obesity and older age. Osteopenia increased the risk as evidenced by BMD (based on 17 patients) and the older age of these patients. There was no statistical difference in clinical improvement between groups based on ODI, but the FPSC group did demonstrate a smaller improvement in ODI score than the matched cohort.

  19. Percutaneous endoscopic gastrostomy in children

    Directory of Open Access Journals (Sweden)

    Jye Hae Park

    2011-01-01

    Full Text Available Purpose: Percutaneous endoscopic gastrostomy (PEG can improve nutritional status and reduce the amount of time needed to feed neurologically impaired children. We evaluated the characteristics, complications, and outcomes of neurologically impaired children treated with PEG. Methods: We retrospectively reviewed the records of 32 neurologically impaired children who underwent PEG between March 2002 and August 2008 at our medical center. Forty-two PEG procedures comprising 32 PEG insertions and 10 PEG exchanges, were performed. The mean follow-up time was 12.2 (6.6 months. Results: Mean patient age was 9.4 (4.5 years. The main indications for PEG insertion were swallowing difficulty with GI bleeding due to nasogastric tube placement and/or the presence of gastroesophageal reflux disease (GERD. The overall rate of complications was 47%, with early complications evident in 25% of patients and late complications in 22%. The late complications included one gastro-colic fistula, two cases of aggravated GERD, and four instances of wound infection. Among the 15 patients with histological evidence of GERD before PEG, 13 (87% had less severe GERD, experienced no new aspiration events, and showed increased body weight after PEG treatment. Conclusion: PEG is a safe, effective, and relatively simple technique affording long-term enteral nutritional support in neurologically impaired children. Following PEG treatment, the body weight of most patients increased and the levels of vomiting, GI bleeding, and aspiration fell. We suggest that PEG with post-procedural observation be considered for enteral nutritional support of neurologically impaired children.

  20. Complications of pedicle screws in lumbar and lumbosacral fusions in 105 consecutive primary operations

    NARCIS (Netherlands)

    Jutte, PC

    2002-01-01

    Pedicle screw fixation is technically demanding and associated with high complication rates. The aim of this study was to identify and quantify the pedicle screw-related complications in 105 consecutive operations. We retrospectively analysed 105 consecutive primary operations. We found

  1. May "Dubel" be a solution for pullout problem of the pedicle screws at osteoporotic spine?

    Science.gov (United States)

    Cakir, Ertugrul; Eyuboglu, Eylem Eren; Yazar, Ugur; Gazioglu, Gurkan; Guvercin, Ali Riza; Baykal, Suleyman

    2014-01-01

    To improve the strength of stabilization systems currently used in osteoporotic spinal fractures, essentially by increasing the fixation force of pedicle screws. Six human cadaveric vertebrae were used. Bone mineral densities of the specimens were measured with Dual Energy X-ray Absorptiometry in order to assess the osteoporosis. All vertebrae were found to be severely osteoporotic. Standard pedicle screws were applied to left pedicles of vertebrae. Pedicle screws reinforced by fixing plugs "Dubel" were applied to right pedicles of vertebrae. Afterwards the vertebrae were embedded in acrylic casts to prevent possible fracture of the osteoporotic vertebrae and to obtain a correct vertical pull-out vector. The biomechanical pullout tests were performed with biomechanical testing machine. Pullout forces in each group were recorded and compared with Mann-Whitney U test. The pedicle screws strengthened by "Dubel" were found to be four times stronger than the standard pedicle screws, in the osteoporotic human cadaveric vertebrae. "Dubel"-augmented pedicle screws may contribute to developing better stabilization systems for osteoporotic thoracolumbar fractures needing surgery and in the revision of the previous fusion surgeries of the spine.

  2. Complications of Percutaneous Nephrolithotomy and their Management

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    Neeraj Thapa

    2016-11-01

    Full Text Available Introduction: Increasing global prevalence of nephrolithiasis has resulted in the development of new minimally invasive techniques and has also led to the resurgence of established methods such as percutaneous nephrolithotomy (PCNL. This procedure is now recommended as the first option for the treatment of single large or multiple renal stones and those in the inferior calyx. This study was done to assess the complications of PCNL and their management, in our centre. Methods: Medical records of 144 patients who underwent PCNL at Lumbini Medical College Teaching Hospital, during the last one year were reviewed. The demographic data, size, tract number and location of the calculi, and intraoperative and postoperative complications were evaluated. The various parameters of the calculi were evaluated. Descriptive analysis with frequencies was done. Results: Complications occurred in 13 (9.02% patients. Post operative bleeding occurred in seven (4.8% patients, out of which one patient developed pseudoaneurysms and the other developed arteriovenous fistula. One patient developed hypovolemic shock immediately after surgery. Frequent blockage of urine, excessive drainage of urine from the drain site, hemothorax and colonic perforation was seen in one  patient each. One patient had mortality due to post operative bleeding. Complications increased with the number and size of stones and number and site of the tracts. Conclusion: Percutaneous nephrolithotomy has low complication rate in experienced hands and complications depend upon stone size, history of open stone surgery, tract number, and tract location.

  3. Percutaneous cholecystostome; 60 cases of experience

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    Kang, Sung Gwon; Song, Ho Young; Yoon, Hyun Ki; Lee, Young Suk; Ki, Won Woo; Sung, Gyu Bo [Ulsan Univ College of Medicine, Seoul (Korea, Republic of)

    1996-01-01

    To review the effectiveness and complication of percutaneous cholecystostomy (PCCS). We performed PCCS in 60 patient who presented with acute cholecystitis. The causes of acute cholecystitis were as follows; acalculous cholecystitis(n=8), calculous cholecystitis(n=23), GB hydrops (n=3), GB empyema(n=15), septic cholangitis(n=11). Of 60 patients, 36 patients had high risk factor for cholecystectomy; underlying malignancy(n=13), severe trauma(n=6). Cholecystostomy was done under ultrasonographic and fluoroscopic guide. The cholecystostomy was successfully in 59 patients, and failed in 1 patient. 15 patients improved without other procedure. 16 patients underwent cholecystectomy after improvement of their general condition. Severe complications of PCCS are as follows; bile peritonitis(n=6), hemoperitoneum(n=1), subphrenic abscess(n=1). Mild complication, such as pain, occurred in most patients. Emergency operation was done in one patient who developed bile peritonitis. Cholecystostomy is effective and safe, especially in cases of inoperable patients who represent acute cholecystitis. Percutaneous cholecystostomy may substitute surgical cholecystostomy.

  4. Percutaneous drainage of pelvic fluid collection

    International Nuclear Information System (INIS)

    Lee, Eun Young; Sohn, Cheol Ho

    1995-01-01

    To evaluate safe access route and success rate of percutaneous drainage of pelvic fluid collection. The 35 percutaneous drainages of pelvic fluid collection under the CT and fluorosocpic guidance were done in 32 patients. The anterior transabdominal approach was done in 20 patients, while the nine patients used the transgluteal approach through greater sciatic foramen. Three patients, who had septated or noncommunicating abscesses, underwent drainage using both approaches. The catheter was removed when the patient's symptom and laboratory data were improved or the amount of drainage and the size of fluid collection were markedly reduced. Success, partial success and failure were classified. The causes of fluid collection were complication of intraabdominal operation in 27 patient. The diagnosis after drainage included abscess (21), loculated ascites (6), and hematoma (4). The 27 cases (30 procedure) were treated successfully and the mean duration of catheter insertion was 10 days. The partial successes were two cases (2 procedures), which had palliative purpose. Three cases (3 procedures) were failed, which were multiple loculated ascites of pancreatic origin (2) and recurrent abscess (1). The significant complication during the procedure or drainage was not noted

  5. Frequency of Helicobacter pylori in patients underwent endoscopy

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    Ahmet Tay

    2012-06-01

    Full Text Available Objectives: The aim of this study was to investigate thefrequency of Helicobacter pylori in patients underwent endoscopyeastern Anatolia.Materials and methods: The patients whose endoscopicantral biopsies were taken for any reason in our endoscopyunit in February-June 2010 period were includedand retrospectively investigated. The frequency of Helicobacterpylori was determined as separating the patientsaccording to general, sex and the age groups. Antral biopsieswere stained with hematoxylin-eosin and modified giemsamethod and examined under light microscope andreported as (+ mild, (++ moderate, (+++ severe positiveaccording to their intensities.Results: Biopsy specimens of 1298 patients were includedinto the study. The mean age was 47.5 ± 17.5 years(range 14-88 and 607 of these patients (47% were male.Histopathological evaluation revealed that, 918 of the patientswere (71% positive and 379 (29% were negativefor Helicobacter pylori. Approximately 60% of our patientshad mild, 29% had moderate and 11% had severe positivityfor Helicobacter pylori. No significant difference wasfound in the frequency of Helicobacter pylori betweenwomen and men. The frequencies of Helicobacter pyloriwere 73.2%, 71.5%, 68.6% and 70.4%, respectively, inthe age groups of 14-30 years, 31-45 years, 46-60 yearsand 61-88 years.Conclusion: The frequency of Helicobacter pylori was71% in Eastern Anatolia Region. No statistically significantdifference was found between genders and agegroups in term of the frequency of Helicobacter pylori.

  6. Percutaneous screw configuration versus perimeter plating of calcaneus fractures: a cadaver study.

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    Smerek, Jonathan P; Kadakia, Anish; Belkoff, Stephen M; Knight, Trevor A; Myerson, Mark S; Jeng, Clifford L

    2008-09-01

    Percutaneous screw configuration has been used clinically to reduce the high rate of wound complications associated with the extensile approach of standard open reduction and internal plate fixation. The aim of this cadaveric biomechanical study was to compare the strength of the standard perimeter plating with that of the percutaneous screw configuration for a Sanders type-2B calcaneus fracture. Ten pairs of fresh-frozen cadaveric lower limbs were prepared and osteotomized to create a Sanders type-2B fracture. Of each pair, one specimen underwent open reduction and internal fixation with standard perimeter plating; the other was stabilized with the percutaneous screw configuration. Each foot was compressed axially via the talar dome (1 mm/sec) until failure occurred. Differences in treatment groups were analyzed for significance (p plate and percutaneous fixation, respectively (p = 0.18). Failure occurred at an average of 1156 +/- 513 and 1064 +/- 540 N for the plate and percutaneous construct, respectively (p = 0.65). The results suggest that open reduction and internal fixation with percutaneous screw configuration for Sanders type-2B calcaneus fractures provides a strength similar to that of perimeter plating. Percutaneous screw fixation of calcaneus fractures may provide fracture reduction similar to plate fixation.

  7. Prediction of Deformity Correction by Pedicle Screw Instrumentation in Thoracolumbar Scoliosis Surgery

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    Kiriyama, Yoshimori; Yamazaki, Nobutoshi; Nagura, Takeo; Matsumoto, Morio; Chiba, Kazuhiro; Toyama, Yoshiaki

    In segmental pedicle screw instrumentation, the relationship between the combinations of pedicle screw placements and the degree of deformity correction was investigated with a three-dimensional rigid body and spring model. The virtual thoracolumbar scoliosis (Cobb’s angle of 47 deg.) was corrected using six different combinations of pedicle-screw placements. As a result, better correction in the axial rotation was obtained with the pedicle screws placed at or close to the apical vertebra than with the screws placed close to the end vertebrae, while the correction in the frontal plane was better with the screws close to the end vertebrae than with those close to the apical vertebra. Additionally, two screws placed in the convex side above and below the apical vertebra provided better correction than two screws placed in the concave side. Effective deformity corrections of scoliosis were obtained with the proper combinations of pedicle screw placements.

  8. Pedicle Screw-Based Posterior Dynamic Stabilization: Literature Review

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    Dilip K. Sengupta

    2012-01-01

    Full Text Available Posterior dynamic stabilization (PDS indicates motion preservation devices that are aimed for surgical treatment of activity related mechanical low back pain. A large number of such devices have been introduced during the last 2 decades, without biomechanical design rationale, or clinical evidence of efficacy to address back pain. Implant failure is the commonest complication, which has resulted in withdrawal of some of the PDS devices from the market. In this paper the authors presented the current understanding of clinical instability of lumbar motions segment, proposed a classification, and described the clinical experience of the pedicle screw-based posterior dynamic stabilization devices.

  9. A prospective randomized study comparing percutaneous nephrolithotomy under combined spinal-epidural anesthesia with percutaneous nephrolithotomy under general anesthesia.

    Science.gov (United States)

    Singh, Vishwajeet; Sinha, Rahul Janak; Sankhwar, S N; Malik, Anita

    2011-01-01

    A prospective randomized study was executed to compare the surgical parameters and stone clearance in patients who underwent percutaneous nephrolithotomy (PNL) under combined spinal-epidural anesthesia (CSEA) versus those who underwent PNL under general anesthesia (GA). Between January 2008 to December 2009, 64 patients with renal calculi were randomized into 2 groups and evaluated for the purpose of this study. Group 1 consisted of patients who underwent PNL under CSEA and Group 2 consisted of patients who underwent PNL under GA. The operative time, stone clearance rate, visual pain analog score, mean analgesic dose and mean hospital stay were compared amongst other parameters. The difference between visual pain analog score after the operation and the dose of analgesic requirement was significant on statistical analysis between both groups. PNL under CSEA is as effective and safe as PNL under GA. Patients who undergo PNL under CESA require lesser analgesic dose and have a shorter hospital stay. Copyright © 2011 S. Karger AG, Basel.

  10. Percutaneous Nephrolithotomy and Chronic Kidney Disease

    DEFF Research Database (Denmark)

    Sairam, Krish; Scoffone, Cesare M; Alken, Peter

    2012-01-01

    by glomerular filtration rate, including chronic kidney disease stages 0/I/II-greater than 60, stage III-30 to 59 and stages IV/V-less than 30 ml/minute/1.73 m(2). Patient characteristics, operative characteristics, outcomes and morbidity were assessed. RESULTS: Estimated glomerular filtration rate data were...... available on 5,644 patients, including 4,436 with chronic kidney disease stages 0/I/II, 994 with stage III and 214 with stages IV/V. A clinically significant minority of patients with nephrolithiasis presented with severe chronic kidney disease. A greater number of patients with stages IV/V previously...... underwent percutaneous nephrolithotomy, ureteroscopy or nephrostomy and had positive urine cultures than less severely affected patients, consistent with the higher incidence of staghorn stones in these patients. Patients with chronic kidney disease stages IV/V had statistically significantly worse...

  11. Percutaneous Vertebroplasty in Painful Schmorl Nodes

    International Nuclear Information System (INIS)

    Masala, Salvatore; Pipitone, Vincenzo; Tomassini, Marco; Massari, Francesco; Romagnoli, Andrea; Simonetti, Giovanni

    2006-01-01

    The Schmorl node represents displacement of intervertebral disc tissue into the vertebral body. Both Schmorl nodes and degenerative disc disease are common in the human spine. We performed a retrospective study, for the period from January 2003 to February 2005, evaluating 23 patients affected by painful Schmorl nodes, who underwent in our department percutaneous transpedicular injection of polymethylmethacrylate (vertebroplasty) in order to solve their back pain not responsive to medical and physical management. Eighteen patients reported improvement of the back pain and no one reported a worsening of symptoms. Improvement was swift and persistent in reducing symptoms. Painful Schmorl nodes, refractory to medical or physical therapy, should be considered as a new indication within those vertebral lesions adequately treatable utilizing Vertebroplasty procedure

  12. QT Dispersion: Does It Change after Percutaneous Coronary Intervention?

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    Mahsa Asadi Moghaddam

    2011-02-01

    Full Text Available Background: Myocardial ischemia is one of several causes of prolonged QT dispersion. The aim of this study was to evaluate the effect that percutaneous coronary intervention has on the depolarization and repolarization parameters of surface electrocardiography in patients with chronic stable angina.Methods: We assessed the effects of full revascularization in patients with chronic stable angina and single-vessel disease who underwent percutaneous coronary intervention. Twelve-lead electrocardiograms were recorded before intervention and 24 hours subsequently. We measured parameters including QRS duration, QT and corrected QT durations, and JT and corrected JT duration in both electrocardiograms and compared the values.Results: There were significant differences between the mean QRS interval (0.086 ± 0.01sec vs. 0.082 ± 0.01 second; p value = 0.01, mean corrected QT dispersion (0.080 ± 0.04 sec vs. 0.068 ± 0.04 sec; p value = 0.001, and mean corrected JT dispersion (0.074 ± 0.04 sec vs. 0.063 ± 0.04 sec; p value = 0.001 before and after percutaneous coronary intervention. No significant differences were found between the other ECG parameters.Conclusion: Our data indicate that the shortening of corrected QT dispersion and corrected JT dispersion in patients undergoing percutaneous coronary intervention is prominent.

  13. Percutaneous Iliac Screws for Minimally Invasive Spinal Deformity Surgery

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    Michael Y. Wang

    2012-01-01

    Full Text Available Introduction. Adult spinal deformity (ASD surgeries carry significant morbidity, and this has led many surgeons to apply minimally invasive surgery (MIS techniques to reduce the blood loss, infections, and other peri-operative complications. A spectrum of techniques for MIS correction of ASD has thus evolved, most recently the application of percutaneous iliac screws. Methods. Over an 18 months 10 patients with thoracolumbar scoliosis underwent MIS surgery. The mean age was 73 years (70% females. Patients were treated with multi-level facet osteotomies and interbody fusion using expandable cages followed by percutaneous screw fixation. Percutaneous iliac screws were placed bilaterally using the obturator outlet view to target the ischial body. Results. All patients were successfully instrumented without conversion to an open technique. Mean operative time was 302 minutes and the mean blood loss was 480 cc, with no intraoperative complications. A total of 20 screws were placed successfully as judged by CT scanning to confirm no bony violations. Complications included: two asymptomatic medial breaches at T10 and L5, and one patient requiring delayed epidural hematoma evacuation. Conclusions. Percutaneous iliac screws can be placed safely in patients with ASD. This MIS technique allows for successful caudal anchoring to stress-shield the sacrum and L5-S1 fusion site in long-segment constructs.

  14. Percutaneous Management of Postoperative Duodenal Stump Leakage with Foley Catheter

    International Nuclear Information System (INIS)

    Oh, Jung Suk; Lee, Hae Giu; Chun, Ho Jong; Choi, Byung Gil; Lee, Sang Hoon; Hahn, Seong Tai; Ohm, Joon Young

    2013-01-01

    Purpose: This study was designed to evaluate retrospectively the safety and efficacy of the percutaneous management of duodenal stump leakage with a Foley catheter after subtotal gastrectomy. Methods: Ten consecutive patients (M:F = 9:1, median age: 64 years) were included in this retrospective study. The duodenal stump leakages were diagnosed in all the patients within a median of 10 days (range, 6–20). At first, the patients underwent percutaneous drainage on the day of or the day after confirmation of the presence of duodenal stump leakage, and then the Foley catheters were replaced at a median of 9 days (range, 6–38) after the percutaneous drainage. Results: Foley catheters were placed successfully in the duodenal lumen of all the patients under a fluoroscopic guide. No complication was observed during and after the procedures in all the patients. All of the patients started a regular diet 1 day after the Foley catheter placement. The patients were discharged at a median of 7 days (range, 5–14) after the Foley catheter placement. The catheters were removed in an outpatient clinic 10–58 days (median, 28) after the Foley catheter placement. Conclusions: Fluoroscopy-guided percutaneous Foley catheter placement may be a safe and effective treatment option for postoperative duodenal stump leakage and may allow for shorter hospital stays, earlier oral intake, and more effective control of leakage sites

  15. The biomechanical effect of pedicle screw hubbing on pullout resistance in the thoracic spine.

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    Paik, Haines; Dmitriev, Anton E; Lehman, Ronald A; Gaume, Rachel E; Ambati, Divya V; Kang, Daniel G; Lenke, Lawrence G

    2012-05-01

    The biomechanical fixation strength afforded by pedicle screws has been strongly correlated with bone mineral density. It has been postulated that "hubbing" the head of the pedicle screw against the dorsal laminar cortex provides a load-sharing effect, thereby limiting cephalocaudad toggling and improving the pullout resistance of the pedicle screw. To evaluate the pullout strength (POS) of monoaxial hubbed pedicle screws versus standard fixation in the thoracic spine. Biomechanical investigation. Twenty-two human cadaveric thoracic vertebrae were acquired and dual-energy X-ray absorptiometry scanned. Osteoporotic (n = 16) and normal (n = 6) specimens were instrumented with a 5.0 × 35-mm pedicle screw on one side in a standard fashion. In the contralateral pedicle, 5.0 × 30-mm screw was inserted with hubbing of the screw into the dorsal lamina. A difference in screw length was used to achieve equivalent depth of insertion. After 2,000 cycles of cephalocaudad toggling, screws were pulled out with the tensile force oriented to the midline of the spine and peak POS measured in newtons (N). Four additional specimens were subjected to microcomputed tomography (micro-CT) analysis to evaluate internal pedicle architecture after screw insertion. Hubbed screws resulted in significantly lower POS (290.5 ± 142.4 N) compared with standard pedicle screws (511.5 ± 242.8 N; p = .00). This finding was evident in both normal and osteoporotic vertebrae based on independent subgroup post hoc analyses (pscrews with and without fracture; however, further micro-CT analysis revealed the presence of internal fracture propagation for those specimens that did not have any external signs of failure. Hubbing pedicle screws results in significantly decreased POS compared with conventional pedicle screws. Hubbing predisposes toward iatrogenic fracture of the dorsal lamina, transverse process, or SAF during insertion. Published by Elsevier Inc.

  16. Percutaneous nephrolithotomy in children: A preliminary report

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    Ahmad A. Elderwy

    2014-01-01

    Full Text Available Objectives: The recurrence of pediatric nephrolithiasis, the morbidity of repeated open surgical treatment as well as our experience in percutaneous nephrolithotomy (PNL in adult patients, all derived us to shift to PNL for managing renal stones >1.5 cm in pediatric patients. Our aim of this study is to evaluate the safety and efficacy of PNL in pediatric patients. Materials and Methods: During the period of the month between May 2011 and April 2013, 38 children (47 renal units underwent PNL for renal stones 1.5-5 cm in length. Patient demographics, stone characteristics, and clinical outcome were prospectively studied. Data of those who underwent conventional and tubeless PNL were compared. Median follow-up period was 12 months (range: 6-24. Results: The median age at presentation was 8-year (range: 3-12. The operative time ranged from 30 to 120 min (median 90. Overall stone clearance rate was 91.5% after single PNL. The median hospital stay was 3 days. Auxiliary procedures were successful for the remaining 4 patients (nephroscopic clearance in one and shockwave lithotripsy in 3. Tubeless PNL was performed in 17 renal units with a comparable outcome to conventional ones. The perioperative complications were noted in 5/47 (10.6% of all procedures (Clavien Grade II in 4 and Clavien Grade IIIa in 1 and were managed conservatively. Conclusions: Percutaneous nephrolithotomy for renal stones in pediatric patients is safe and feasible if performed by a well-experienced endourologist. Tubeless PNL is a better choice for children.

  17. Radial scars without atypia in percutaneous biopsy specimens: can they obviate surgical biopsy?

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    Mesa-Quesada, J; Romero-Martín, S; Cara-García, M; Martínez-López, A; Medina-Pérez, M; Raya-Povedano, J L

    To evaluate the need for surgical biopsy in patients diagnosed with radial scars without atypia by percutaneous biopsy. In this retrospective observational study, we selected patients with a histological diagnosis of radial scar in specimens obtained by percutaneous biopsy during an 8-year period. The statistical analysis was centered on patients with radial scar without atypia (we assessed the radiologic presentation, the results of the percutaneous biopsy, and their correlation with the results of surgical biopsy and follow-up) and we added the patients with atypia and cancer in the elaboration of the diagnostic indices. We identified 96 patients with radial scar on percutaneous biopsy; 54 had no atypia, 18 had atypia, and 24 had cancer. Among patients with radial scar without atypia, there were no statistically significant differences between patients who underwent imaging follow-up and those who underwent surgical biopsy (p>0.05). The rate of underdiagnosis for percutaneous biopsy in patients without atypia was 1.9%. The rates of diagnosis obtained with percutaneous biopsy in relation to follow-up and surgical biopsy in the 96 cases were sensitivity 92.3%, specificity 100%, positive predictive value 100%, negative predictive value 97.2%, and accuracy 97.9%. The area under the ROC curve was 0.96 (p<0.001), and the kappa concordance index was 0.95 (p<0.001) CONCLUSIONS: We consider that it is not necessary to perform surgical biopsies in patients with radial scars without atypia on percutaneous biopsies because the rate of underestimation is very low and the concordance between the diagnosis reached by percutaneous biopsy and the definitive diagnosis is very high. Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Inferior Pedicle Reduction Mammoplasty with or without Tourniquet: A Comparative Study.

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    Demir, Canser Yilmaz; Sultanoglu, Yılmaz; Kocak, Omer Faruk; Ersoz, Muhammet Eren

    2017-10-01

    To compare the perioperative findings of inferior pedicle reduction mammoplasty (IPRM) performed with or without a tourniquet. This study was carried out in the plastic and reconstructive surgery department at a tertiary care center on a total of 42 consecutive women scheduled for IPRM. Patients in Group I (n = 21) underwent surgery using a tourniquet, whereas patients in Group II (n = 21) were operated on without a tourniquet. Levels of hemoglobin (Hb), hematocrit (Hct), Hct/Hb ratio, and platelet counts were noted preoperatively and on postoperative 24th and 48th h. Numbers of surgical pads and gauze sponges completely used and dripping with blood were recorded. Duration of operation, the amount of breast tissue excised on both sides, and fluid collected in hemovac drains on 48th h after operation were documented. In Group I, the operative time was significantly shorter (p usage is practical and safe, and it may also improve the cost-effectiveness of the procedure. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  19. The oncoplastic breast surgery with pedicled omental flap harvested by laparoscopy: initial experiences from China.

    Science.gov (United States)

    Guan, Dandan; Lin, Hui; Lv, Zhenye; Xin, Ying; Meng, Kexin; Song, Xiangyang

    2015-03-07

    A new technique of oncoplastic breast surgery (OBS) using laparoscopically harvested pedicled omental flap has been developed in the past 10 years. This study aimed to evaluate the feasibility of this technique. Twenty-five patients underwent OBS using laparoscopically harvested omental flap. Operative time, blood loss, complications, recurrence, and cosmetic outcomes were prospectively analyzed. Between June 2010 and March 2014, 25 patients were recruited in our study. The surgery was performed successfully in 24 patients. All these patients recovered uneventfully after the surgery. Mean operative time was 310 min, ranging from 205 to 410 min. Mean blood loss was 70 ml, ranging from 20 to 150 ml. Patients were followed up for 32 months on average, ranging from 6 to 51 months. Four patients complained of mild epigastric discomfort. One patient had local recurrence and distant bone and liver metastasis and died 11 months after the surgery. One patient was diagnosed with metastases in the lung, bone, and liver without local recurrence 2 years after surgery. The cosmetic satisfaction rate was 91.7% and 95.8% by surgeon and patients, respectively. OBS with laparoscopically harvested omental flap might be a feasible technique with a good cosmetic outcome.

  20. Tissue reactions induced by nylon cable tie used to clamp ovarian pedicles

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    Luiz Fernando Moraes Moreira

    2018-03-01

    Full Text Available The aim of this study was to evaluate the tissue reactions induced by nylon cable tie by using macroscopic and histological evaluations. Forty-five clinically healthy crossbreed female dogs, 31.11 ± 14.26 months old and with a body weight of 11.26 ± 4.7 kg, underwent ovariohysterectomy using a minimally invasive procedure. The dogs were randomly divided into three groups of 15 animals each and were evaluated preoperatively, and at 30 (G1, 60 (G2 and 90 days (G3 after surgery. The histological examination of the pedicles containing the nylon cable ties, collected from five animals in each group, showed a chronic inflammatory reaction with the presence of macrophages, giant cells and fibroplasia on the 30th postoperative day. Well-organized connective tissue and presence of lymphocytes and polymorphonuclear leukocytes were seen on the 60th postoperative day, and mature connective tissue and presence of macrophages and lymphocytes were seen at 90 days. Nylon cable ties induce an inflammatory reaction, which should be considered due to the risk of interference with surrounding structures.

  1. Fournier?s gangrene - delayed pedicle flap based upon the anterior abdominal wall

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    Ania Sliwinski

    2014-06-01

    Full Text Available Introduction Fournier’s gangrene is a poly-microbial necrotizing fasciitis that involves the perineum and/or external genitalia. Urgent surgical debridement is well recognized as essential acute treatment yet unique challenges arise for plastic surgical reconstruction to obtain a complete functional recovery. This case describes a successful delayed pedicle flap repair based upon the anterior abdominal wall. Case description A 24 year old man was admitted to ICU ten days after elective circumcision with Fournier’s gangrene. He underwent a number of surgical debridements, and was referred for plastic surgical management. He had penile reconstruction using a random pattern abdominal flap, which was performed as a three stage procedure including flap vascular delay technique. Discussion Perineal and penile skin loss can be significant and is difficult to repair. Various techniques have been used to reconstruct lost tissue: skin grafts, transposition of the testes and spermatic cords to the thigh, flaps, and other types of pediculated myocutaneous flaps. Muscle flap reconstruction provides an environment that allows for complete regeneration of the urethral epithelium but is bulky and unsightly. Skin grafts contract and may produce painful and dysfunctional reconstructions. This novel technique produces a functional, and aesthetic reconstruction. Conclusion Penile skin recovery following Fournier’s gangrene recovery is problematic. This case demonstrates the functionality of a delayed flap repair using the anterior abdominal wall.

  2. Percutaneously inserted central catheter - infants

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    PICC - infants; PQC - infants; Pic line - infants; Per-Q cath - infants ... A percutaneously inserted central catheter (PICC) is a long, very thin, soft plastic tube that is put into a small blood vessel. This article addresses PICCs in ...

  3. Percutaneous Nephrolithotomy in Children

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    Romano T. DeMarco

    2011-01-01

    Full Text Available The surgical management of pediatric stone disease has evolved significantly over the last three decades. Prior to the introduction of shockwave lithotripsy (SWL in the 1980s, open lithotomy was the lone therapy for children with upper tract calculi. Since then, SWL has been the procedure of choice in most pediatric centers for children with large renal calculi. While other therapies such as percutaneous nephrolithotomy (PNL were also being advanced around the same time, PNL was generally seen as a suitable therapy in adults because of the concerns for damage in the developing kidney. However, recent advances in endoscopic instrumentation and renal access techniques have led to an increase in its use in the pediatric population, particularly in those children with large upper tract stones. This paper is a review of the literature focusing on the indications, techniques, results, and complications of PNL in children with renal calculi.

  4. Percutaneous bone tumor management.

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    Gangi, Afshin; Buy, Xavier

    2010-06-01

    Interventional radiology plays a major role in the management of bone tumors. Many different percutaneous techniques are available. Some aim to treat pain and consolidate a pathological bone (cementoplasty); others aim to ablate tumor or reduce its volume (sclerotherapy, thermal ablation). In this article, image-guided techniques of primary and secondary bone tumors with vertebroplasty, ethanol injection, radiofrequency ablation, laser photocoagulation, cryoablation, and radiofrequency ionization (coblation) will be reviewed. For each modality, the principles, the indications, and the results will be presented. The technical choice depends on the therapeutic intent-curative or palliative-and the need for consolidation, but also on the general status of the patient and the other therapeutic options. For the most complex cases, combined treatments can be required. However, the less disabling technique should always be considered first.

  5. Outcome of Percutaneous Nephrolithotomy

    International Nuclear Information System (INIS)

    Ali, S.; Kumar, N.; Baloch, U.

    2014-01-01

    Objective: To assess the implementation of Percutaneous Nephrolithotomy (PCNL) in renal stone management and evaluate the factors for efficacy and safety of PCNL. Study Design: Case series. Place and Duration of Study: Department of Urology at Jinnah Postgraduate Medical Centre, Karachi, from January 2008 to December 2011. Methodology: Patients aged above 12 years of age, irrespective of gender with normal renal function, mean stone size > 2 cm, lower pole stones > 1 cm, and ESWL failure were selected. After the procedure, on the first postoperative day, a plain abdominal radiograph was obtained to verify stone clearance. A nephrostomy tube was clamped overnight and subsequently removed when no residual stone which needs second sitting was seen. Results: In 175 patients, 62.86% (n=110) were male and the mean age was 35 A +- 9.56 years. One hundred and seventeen (66.85%) patients were primarily stone free and 13.71% (n=24) patients needed a second look procedure, thus, a total of 80.57% (n=141) patients were stone free in the same admission. Complications included failure in 4.0% (n=7) patients, bleeding in 8.57% (n=15) patients, a small residual stone in 15.43% (n=27) patients; and puncture site pain almost in every patient. Transient fever occurred in 55.43% (n=97) patients, urinary leakage in 8.57% (n=15) patients, urinary tract infections in 5.14% (n=9) patients, ureteric colic in 3.43% (n=6) patients, colonic injury in 0.57% (n=1) patient; and nephrectomy was required in 0.57% (n=1) patient due to severe bleeding. One patient (0.57%) expired due to anaesthesia complications. Conclusion: Percutaneous nephrolithotomy (PCNL) has a good success rate. There is minimal blood loss, and few major complications. (author)

  6. Results of percutaneous abscess drainage

    International Nuclear Information System (INIS)

    Daehnert, W.; Guenther, R.; Klose, K.; Gamstaetter, G.

    1983-01-01

    Between 1978 and 1983 fifty-two abdominal abscesses in 44 patients were drained percutaneously, 79% of the abscesses occurred as postoperative complications. The overall success rate was 60%, whereas only 42% of left subphrenic abscesses were cured. Complications were encountered in 4.5%. Reasons for drainage failures were: liver sequestration, loculation, fistulae and recurrences. Percutaneous abscess drainage in an alternative, and valuable addition, to surgery. (orig.) [de

  7. Lower abdominal wall reconstructions with pedicled rectus femoris flaps

    International Nuclear Information System (INIS)

    Arashiro, Ken; Nishizeki, Osamu; Ishida, Kunihiro

    2003-01-01

    During the past 10 years, seven pedicled rectus femoris muscle or musculocutaneous flaps were used to repair lower abdominal defects; three recalcitrant incisional hernias with previous radiotherapy, two long-standing wound infections after synthetic mesh reconstruction, one posttraumatic wall defect and one metastatic tumor. There were two flap complications, one skin paddle necrosis and one wound infection. There was no significant disability of the donor limb encountered. During the two-year and seven month average follow-up, there was no recurrence of the problems except for one minor fascial dehiscence in the patient with metastatic abdominal wall tumor. Easy approach, rapid harvest, relatively large and reliable overlying fascia lata, a single dominant neurovascular pedicle, easy primary closure of the donor site, and minimal donor site morbidity all make the rectus femoris flap a good alternative flap for lower abdominal wall reconstruction. It is especially useful in a condition where synthetic mesh would be unsuitable for defects with infection or recurrent incisional hernia after radiotherapy. (author)

  8. Multiaxial pedicle screw designs: static and dynamic mechanical testing.

    Science.gov (United States)

    Stanford, Ralph Edward; Loefler, Andreas Herman; Stanford, Philip Mark; Walsh, William R

    2004-02-15

    Randomized investigation of multiaxial pedicle screw mechanical properties. Measure static yield and ultimate strengths, yield stiffness, and fatigue resistance according to an established model. Compare these measured properties with expected loads in vivo. Multiaxial pedicle screws provide surgical versatility, but the complexity of their design may reduce their strength and fatigue resistance. There is no published data on the mechanical properties of such screws. Screws were assembled according to a vertebrectomy model for destructive mechanical testing. Groups of five assemblies were tested in static tension and compression and subject to three cyclical loads. Modes of failure, yield, and ultimate strength, yield stiffness, and cycles to failure were determined for six designs of screw. Static compression yield loads ranged from 217.1 to 388.0 N and yield stiffness from 23.7 to 38.0 N/mm. Cycles to failure ranged from 42 x 10(3) to 4,719 x 10(3) at 75% of static ultimate load. There were significant differences between designs in all modes of testing. Failure occurred at the multiaxial link in static and cyclical compression. Bending yield strengths just exceeded loads expected in vivo. Multiaxial designs had lower static bending yield strength than fixed screw designs. Five out of six multiaxial screw designs achieved one million cycles at 200 N in compression bending. "Ball-in-cup" multiaxial locking mechanisms were vulnerable to fatigue failure. Smooth surfaces and thicker material appeared to be protective against fatigue failure.

  9. The wedding cake solution: A percutaneous correction of a form fruste superior sinus venosus atrial septal defect.

    Science.gov (United States)

    Crystal, Matthew A; Vincent, Julie A; Gray, William A

    2015-12-01

    We present the case of a patient with a superior sinus venosus defect (SSVD), with the atypical finding of an intact atrial septum and posterior atrial wall, which underwent percutaneous closure in the cardiac catheterization laboratory for repair. SSVDs are rare congenital cardiac anomalies, but when the anatomy is amenable to percutaneous strategies, a collaborative and creative approach can result in a safe and effective result. © 2015 Wiley Periodicals, Inc.

  10. Percutaneous Disc Coagulation Therapy (PDCT) comparing with Automated Percutaneous Lumbar Discectomy (APLD) in Patients of Herniated Lumbar Disc Disease: Preliminary Report.

    Science.gov (United States)

    Park, Cheon Wook; Lee, Joo Yong; Choi, Woo Jin; Chang, Sang Keun

    2012-09-01

    Percutaneous techniques are rapidly replacing traditional open surgery. This is a randomized controlled trial study of clinical outcomes of Percutaneous Plasma Disc Coagulation Therapy (PDCT) in patients with HLD(herniated lumbar disc) as a new percutaneous access in comparison with Automated Percutaneous Lumbar Discectomy (APLD) in its clinical application and usefulness as a reliable alternative method. The authors analyzed 25 patients who underwent PDCT randomized 1:1 to 25 who underwent APLD between June, 2010 and October, 2011. All patients had herniated lumbar disc diseases. The clinical outcomes were evaluated using Visual Analog Scales (VAS) score and MacNab's criteria. The age of the patients who underwent PDCT ranged from 29 to 88 years with a mean age of 51.8 years. The age of the APLD undergone patients' population ranged from 30 to 66 with a mean age of 46.0 years. The average preoperative VAS score in PDCT was 7.60 and 1.94 at 7months post-operatively, and in APLD was 7.32, and 3.53 at 7 months post-operatively (pherniated lumbar disc. PDCT showed to be more effective than APLD in this study, allowing stable decompression and safe minimally invasive operation to an area desired by the operator in lumbar disc herniation patients, although further long term clinical evaluations are still necessary.

  11. Gender Differences in Long-Term Clinical Outcomes After Percutaneous Coronary Intervention of Chronic Total Occlusions

    NARCIS (Netherlands)

    Claessen, Bimmer E.; Chieffo, Alaide; Dangas, George D.; Godino, Cosmo; Lee, Seung-Whan; Obunai, Kotaro; Carlino, Mauro; Chantziara, Vaso; Apostolidou, Irini; Henriques, José P. S.; Leon, Martin B.; Di Mario, Carlo; Park, Seung-Jung; Stone, Gregg W.; Moses, Jeffrey W.; Colombo, Antonio; Mehran, Roxana

    2012-01-01

    Introduction. Little is known about gender differences among patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Methods. A total of 1791 patients with 1852 CTOs underwent PCI at 3 centers in the United States, Italy, and South Korea between 1998 and 2007.

  12. Subcutaneous Transitional Cell Cancer After Percutaneous Nephrolithotomy: A Case Report

    Directory of Open Access Journals (Sweden)

    Lokman Ižrkilata

    2013-10-01

    Full Text Available Transitional cell carcinomas of the upper urinary tract are rare but, highly predisposing to tumoral seeding. Percutaneous lithotripsy (PNL recently has expanded the therapeutic choices for patients with kidney stones and gained popularity by urologic surgeons. Although unusual, renal collecting system tumours may be encountered during PNL. We present and discuss the clinical course of a 48 years old male patient who underwent PNL surgery for kidney stone in whom transitional cell carcinoma in the renal collecting system obscured by stone left undiagnosed. Three months later following PNL he admitted with a bulge on lumbar region. Excisional biopsy revealed carcinoma and therefore, he was directed to chemoradiotherapy and died 21 months later. Renal collecting system tumors undiagnosed during surgery may progress and demonstrate local invasion in a short period of time. Therefore, we recommend to take more caution during any percutaneous access and to exclude the possible existence of tumor.

  13. Postoperative complications following percutaneous endoscopic gastrostomy are common in children

    DEFF Research Database (Denmark)

    Halvard Hansen, Erik Sören; Qvist, N.; Rasmussen, L.

    2017-01-01

    Aim: Inserting a feeding tube using percutaneous endoscopic gastrostomy may be necessary to ensure that children with eating problems receive sufficient enteral nutrition. The aim of this study was to investigate the perioperative and postoperative complications of percutaneous endoscopic...... gastrostomy when the pull-through method was the standard procedure. Methods: This was a retrospective review of 229 children (50.7% male) who underwent a gastrostomy procedure at Odense University Hospital, Denmark, from January 1, 2000 to December 31, 2012. The median age of the children was 1.6 years...... were grade 3b complications. No gastrostomy-related deaths were observed, and no single preoperative risk factor was identified. Perioperative complications were experienced by 2.6% of the patients. Conclusion: Gastrostomy feeding tube placement was associated with a high rate of postoperative...

  14. Percutaneous Sacroplasty for Sacral Metastatic Tumors Under Fluoroscopic Guidance Only

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Ji; Wu, Chun Gen; Gu, Yi Feng; Li, Ming Hua [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2008-12-15

    Percutaneous sacroplasty is a safe and effective procedure for sacral insufficient fractures under CT or fluoroscopic guidance; although, few reports exist about sacral metastatic tumors. We designed a pilot study to treat intractable pain caused by a sacral metastatic tumor with sacroplasty. A 62-year-old man and a 38-year-old woman with medically intractable pain due to metastatic tumors of S1 from lymphoma and lung cancer, respectively, underwent percutaneous sacroplasty. Over the course of the follow-up period, the two patients experienced substantial and immediate pain relief that persisted over a 3-month and beyond. The woman had deposition of PMMA (polymethyl methacrylate) in the needle track, but did not experience significant symptoms. No other peri-procedural complications were observed for either patient.

  15. Percutaneous treatment of calcaneus fractures associated with underlying bone cysts.

    Science.gov (United States)

    Chen, Linwei; Zhang, Guoyou; Li, Shi; Wu, Zhipeng; Yuan, Wen; Hong, Jianjun

    2012-05-01

    Calcaneal bone cysts with pathological fractures are rare. There is no clear consensus on their management with a few reports of open curettage, bone grafting and internal fixation in the treatment of pathological calcaneal fractures. No minimally invasive management has been reported before. We reviewed our experience in treating five patients with pathologic calcaneus fractures associated with pre-existing bone cysts who underwent percutaneous cyst curettage, fracture reduction, screw fixation and calcium sulfate cement injection between 2004 and 2009. All of the pathologic fractures healed with satisfactory radiological results. There were no soft tissue complications or cyst recurrences. Partial weightbearing with plaster cast immobilization was allowed at 4 weeks postoperatively and full weightbearing was allowed at 6 weeks postoperatively. This percutaneous technique provided a minimally invasive option for treatment of a calcaneal bone cyst with pathologic fracture.

  16. Krag versus Caudad trajectory technique for pedicle screw insertion in osteoporotic vertebrae: biomechanical comparison and analysis.

    Science.gov (United States)

    Yuan, Qiang; Han, Xiaoguang; Han, Xiao; He, Da; Liu, Bo; Tian, Wei

    2014-12-15

    To compare in detail the effects of pedicle screw insertion in osteoporotic vertebrae via Krag and Caudad trajectory techniques. To compare the biomechanical stability of 2 pedicle screw fixation techniques and to correlate the stability of the pedicle screw with quantitative computed tomography (QCT). Pedicle screw fixation is commonly used to facilitate fusion and postoperative rehabilitation. Fixation failure and loosening in the metal-bone interface are frequent, with osteoporosis usually a major factor. Pedicle screw fixation in osteoporotic spines is of particular concern regarding implant failure. Few reports have addressed which fixation method provides better biomechanical strength and thus presents less risk of failure. Eleven cadaveric vertebrae were harvested and subjected to dual-energy x-ray absorptiometry and QCT to assess bone mineral density. Matched, polyaxial pedicle screws were inserted into the left and right pedicles of each vertebra. Screws were randomly assigned to the Caudad or Krag group by right or left side. They were inserted under 3-dimensional navigation system assistance. Cyclic loading tests were performed (maximum load 250 N, 3 Hz, up to 30,000 cycles) while recording load and displacement. Pullout tests were performed if the cyclic loading test was completed. Stiffness quotients were calculated. Cycle-displacement curves showed more pedicle screw dislodgement in the Krag than the Caudad group (P osteoporotic lumbar vertebrae using the Caudad trajectory displayed significantly higher biomechanical strength than those inserted using the Krag trajectory, especially during early fixation. Stability of pedicle screw fixation using the Caudad trajectory technique can be estimated by QCT.

  17. Enhancing pedicle screw fixation in the lumbar spine using allograft bone plug interference fixation.

    Science.gov (United States)

    Chrea, Bopha; Malempati, Harsha; Campbell, Jeffrey R; Khan, Sonja; Ching, Randal P; Lee, Michael J

    2014-05-01

    A within-subjects controlled laboratory study. To examine a biological alternative to cement augmentation for pedicle screw fixation comparing bilateral axial pullout tests of augmented and nonaugmented (controls) pedicle screws. Fixation in the osteoporotic spine remains a difficult challenge with failure by loosening or backout. Pedicle screw augmentation has been attempted using polymethylmethacrylate and bioabsorbable calcium cements; however, the potential for extravasation and embolization of cement are becoming increasingly concerning and merit the search for alternative methods to improve screw-anchoring strength. Twenty-four (24) fresh human lumbar vertebrae were tested to compare the pullout strength of augmented and nonaugmented pedicle screws. Two different augmentation strategies were employed using allograft bone plugs (ABPs) and evaluated using 12 specimens per group. Bone mineral density of each specimen was obtained using dual-energy x-ray absorptiometry. The augmented versus nonaugmented pedicle was randomized for each vertebra, and bilateral testing enabled paired statistical analyses. Axial pullout tests were performed using an materials testing system servohydraulic test system, and peak force, failure displacement, and stiffness was obtained for each test and correlated with bone mineral density. Augmentation using 6-mm-diameter ABPs with 6.25-mm-diameter pedicle screws resulted in statistically weaker average pullout strength (775±455 N) than the nonaugmented controls (1233±826 N). When using smaller (5 mm diameter) AGPs with the same diameter screws, there was no statistical difference between average pullout strength for the augmented pedicle screws (1772±652 N) and the nonaugmented screws (1780±575 N). Preliminary study of pedicle screw augmentation using cannulated ABPs showed no improvement of fixation with pedicles in the spine. This was even true in osteoporotic specimens, where augmentation would seem to be of considerable benefit.

  18. Segmental Pedicle Screw Instrumentation and Fusion Only to L5 in the Surgical Treatment of Flaccid Neuromuscular Scoliosis.

    Science.gov (United States)

    Takaso, Masashi; Nakazawa, Toshiyuki; Imura, Takayuki; Fukuda, Michinari; Takahashi, Kazuhisa; Ohtori, Seiji

    2018-03-01

    A retrospective cohort study was performed. The purpose of this study was to determine the efficacy and safety of stopping segmental pedicle screw instrumentation constructs at L5 in the treatment of neuromuscular scoliosis. Duchenne muscular dystrophy and spinal muscular atrophy are flaccid neuromuscular disorders in which gradual deterioration is the hallmark and have a lot of characteristics in common despite differences in etiology. Instrumentation and fusion to the sacrum/pelvis has been a mainstay in the surgical treatment of flaccid neuromuscular scoliosis and recommended to correct pelvic obliquity. However, the caudal extent of instrumentation and fusion in the surgical treatment of flaccid neuromuscular scoliosis has remained a matter of considerable debate and there have been few studies on the use of segmental pedicle screw instrumentation for flaccid neuromuscular scoliosis. From 2005 to 2007, a total of 27 consecutive patients with neuromuscular disorders (20 Duchenne muscular dystrophy and 7 spinal muscular atrophy), aged 11 to 17 years, underwent segmental pedicle screw instrumentation and fusion only to L5. Assessment was performed clinically and with radiologic measurements. Minimum 2-year follow-up was required for inclusion in this study. Twenty patients were enrolled in this study. No patient was lost to follow-up. All patients had L5 tilt of less than 15° and a coronal curve with apex L2 or higher preoperatively. Preoperative coronal curve averaged 70° (range: 51°-88°), with a postoperative mean of 15° (range: 5°-25°) and 17° (range: 6°-27°) at the last follow-up. The pelvic obliquity improved from 15° (range: 9°-25°) preoperatively to 5° (range: 3°-8°) postoperatively and 6° (range: 3°-8°) at the last follow-up. The L5 tilt improved from 9° (range: 2°-14°) preoperatively to 2° (range: 0°-4°) postoperatively and 2° (range: 0°-5°) at the last follow-up. Physiologic sagittal plane alignment was recreated after surgery

  19. Percutaneous umbilical cord blood sampling - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100196.htm Percutaneous umbilical cord blood sampling - series—Normal anatomy To use the ... or blood disorder, your doctor may recommend percutaneous umbilical cord blood sampling (PUBS), which is performed at 18 ...

  20. Ultrasound guided percutaneous fine needle aspiration biopsy ...

    African Journals Online (AJOL)

    2011-06-15

    )-guided percutaneous fine needle aspiration biopsy (PFNAB)/US-guided percutaneous needle core biopsy (PNCB) of abdominal lesions is efficacious in diagnosis, is helpful in treatment choice, to evaluate whether various ...

  1. Ultrasound guided percutaneous fine needle aspiration biopsy ...

    African Journals Online (AJOL)

    )-guided percutaneous fine needle aspiration biopsy (PFNAB)/US-guided percutaneous needle core biopsy (PNCB) of abdominal lesions is efficacious in diagnosis, is helpful in treatment choice, to evaluate whether various other investigations ...

  2. Duodenal perforation during percutaneous nephrolithotomy (PCNL ...

    African Journals Online (AJOL)

    A. Bansal

    2016-06-03

    Jun 3, 2016 ... Calculus;. Duodenum;. Injury;. Paediatric;. Percutaneous nephrolithotomy. Abstract. Introduction: Colonic perforations are known complications of percutaneous nephrolithotomy (PCNL). However, to the best of our knowledge, small bowel perforation has rarely been reported.. Observation: We report the ...

  3. Spinal pedicle screw planning using deformable atlas registration

    Science.gov (United States)

    Goerres, J.; Uneri, A.; De Silva, T.; Ketcha, M.; Reaungamornrat, S.; Jacobson, M.; Vogt, S.; Kleinszig, G.; Osgood, G.; Wolinsky, J.-P.; Siewerdsen, J. H.

    2017-04-01

    Spinal screw placement is a challenging task due to small bone corridors and high risk of neurological or vascular complications, benefiting from precision guidance/navigation and quality assurance (QA). Implicit to both guidance and QA is the definition of a surgical plan—i.e. the desired trajectories and device selection for target vertebrae—conventionally requiring time-consuming manual annotations by a skilled surgeon. We propose automation of such planning by deriving the pedicle trajectory and device selection from a patient’s preoperative CT or MRI. An atlas of vertebrae surfaces was created to provide the underlying basis for automatic planning—in this work, comprising 40 exemplary vertebrae at three levels of the spine (T7, T8, and L3). The atlas was enriched with ideal trajectory annotations for 60 pedicles in total. To define trajectories for a given patient, sparse deformation fields from the atlas surfaces to the input (CT or MR image) are applied on the annotated trajectories. Mean value coordinates are used to interpolate dense deformation fields. The pose of a straight trajectory is optimized by image-based registration to an accumulated volume of the deformed annotations. For evaluation, input deformation fields were created using coherent point drift (CPD) to perform a leave-one-out analysis over the atlas surfaces. CPD registration demonstrated surface error of 0.89  ±  0.10 mm (median  ±  interquartile range) for T7/T8 and 1.29  ±  0.15 mm for L3. At the pedicle center, registered trajectories deviated from the expert reference by 0.56  ±  0.63 mm (T7/T8) and 1.12  ±  0.67 mm (L3). The predicted maximum screw diameter differed by 0.45  ±  0.62 mm (T7/T8), and 1.26  ±  1.19 mm (L3). The automated planning method avoided screw collisions in all cases and demonstrated close agreement overall with expert reference plans, offering a potentially valuable tool in support

  4. Percutaneous transbiliary biopsy.

    Science.gov (United States)

    Andrade, Gustavo Vieira; Santos, Miguel Arcanjo; Meira, Marconi Roberto; Meira, Mateus Duarte

    2017-01-01

    Percutaneous drainage of the bile ducts is an established procedure for malignant obstructions, in which a histological diagnosis is often not obtained. We describe the biopsy technique of obstructive lesions through biliary drainage access, using a 7F endoscopic biopsy forceps, widely available; some are even reusable. This technique applies to lesions of the hepatic ducts, of the common hepatic duct and of all extension of the common bile duct. RESUMO A drenagem percutânea das vias biliares é um procedimento estabelecido para obstruções malignas, nos quais, muitas vezes, não se consegue um diagnóstico histológico. Descrevemos a técnica de biópsia da lesão obstrutiva através do acesso de drenagem biliar, utilizando um fórcipe de biópsia endoscópica 7F, amplamente disponível e alguns reutilizáveis. Esta técnica aplica-se a lesões dos ductos hepáticos, do hepático comum e de toda extensão do colédoco.

  5. [Progress on atlanto-axial pedicle screw fixation through posterior approach].

    Science.gov (United States)

    Li, Guo-Qing; Ma, Wei-Hu; Liu, Guan-Yi

    2014-06-01

    The present of atlanto-axial pedicle screw fixation through posterior approach provide a new remedy for treating instability of pillow and cervical. A lot of researches have reported feasibility of atlanto-axial pedicle screw fixation, the results showed that it had advantages of easily exposure, less blood loss, shorter operative time, especially in treating as remedy fixation for atlanto-axial joint screw, atlas lateral mass screws and pedicle screw caused by injuries of tumor,inflammation and trauma. If not done properly, it can cause serious complications, such as iatrogenic fracture,injuries of vertebral artery and cervical spinal cord. Therefore,the safty and effectiveness of atlanto-axial pedicle screw fixation may be focus of research.

  6. Diaphragmatic hernia repair using a rectus abdominis muscle pedicle flap in three dogs.

    Science.gov (United States)

    Chantawong, P; Komin, K; Banlunara, W; Kalpravidh, M

    2013-01-01

    To report the clinical use of a pedicle flap from the rectus abdominis muscle to repair extensive diaphragmatic tears in dogs with diaphragmatic hernia. Three dogs with a combination of radial and circumferential diaphragmatic tears were studied. The circumferential tear was repaired by suturing the wound edge with the edge at the abdominal wall. A pedicle flap of the rectus abdominis muscle was used for repairing the radial tear. The dogs were examined radiographically for lung and diaphragm appearance and evidence of reherniation at 10 days, and at one, two, and four months after surgery, and fluoroscopically for paradoxical motion of the diaphragm at one and four months. The rectus abdominis muscle pedicle flap was successfully used in all three dogs. The animals recovered uneventfully without evidence of reherniation during the four follow-up months. Fluoroscopic examination revealed no paradoxical motion of the diaphragm. A rectus abdominis muscle pedicle flap can be used for repairing large diaphragmatic defects in dogs.

  7. The Pedicled LICAP Flap Combined with a Free Abdominal Flap In Autologous Breast Reconstructions

    Directory of Open Access Journals (Sweden)

    Thomas Sjøberg, MD

    2018-01-01

    Conclusion:. In selected patients with insufficient abdominal flap tissue, a combination of a free abdominal flap and a pedicled LICAP flap is a valuable option to increase breast size and cosmetic outcome. Additional symmetrizing surgery might still be necessary.

  8. Are pedicle screw perforation rates influenced by distance from the reference frame in multilevel registration using a computed tomography-based navigation system in the setting of scoliosis?

    Science.gov (United States)

    Uehara, Masashi; Takahashi, Jun; Ikegami, Shota; Kuraishi, Shugo; Shimizu, Masayuki; Futatsugi, Toshimasa; Oba, Hiroki; Kato, Hiroyuki

    2017-04-01

    Pedicle screw fixation is commonly employed for the surgical correction of scoliosis but carries a risk of serious neurovascular or visceral structure events during screw insertion. To avoid these complications, we have been using a computed tomography (CT)-based navigation system during pedicle screw placement. As this could also prolong operation time, multilevel registration for pedicle screw insertion for posterior scoliosis surgery was developed to register three consecutive vertebrae in a single time with CT-based navigation. The reference frame was set either at the caudal end of three consecutive vertebrae or at one or two vertebrae inferior to the most caudal registered vertebra, and then pedicle screws were inserted into the three consecutive registered vertebrae and into the one or two adjacent vertebrae. This study investigated the perforation rates of vertebrae at zero, one, two, three, or four or more levels above or below the vertebra at which the reference frame was set. This is a retrospective, single-center, single-surgeon study. One hundred sixty-one scoliosis patients who had undergone pedicle screw fixation were reviewed. Screw perforation rates were evaluated by postoperative CT. We evaluated 161 scoliosis patients (34 boys and 127 girls; mean±standard deviation age: 14.6±2.8 years) who underwent pedicle screw fixation guided by a CT-based navigation system between March 2006 and December 2015. A total of 2,203 pedicle screws were inserted into T2-L5 using multilevel registration with CT-based navigation. The overall perforation rates for Grade 1, 2, or 3, Grade 2 or 3 (major perforations), and Grade 3 perforations (violations) were as follows: vertebrae at which the reference frame was set: 15.9%, 6.1%, and 2.5%; one vertebra above or below the reference frame vertebra: 16.5%, 4.0%, and 1.2%; two vertebrae above or below the reference frame vertebra: 20.7%, 8.7%, and 2.3%; three vertebrae above or below the reference frame vertebra: 23

  9. Intradermal Infiltration of Local Anesthetic-Rapid and Bloodless Deepithelialization of the Breast Pedicle.

    Science.gov (United States)

    Bennett, Katelyn G; Gilman, Robert H

    2017-02-01

    Breast reduction is one of the most commonly performed plastic surgery procedures, and pedicle deepithelialization remains a time-consuming step of the operation. This is especially true when using an inferior pedicle. We present a novel technique of intradermal infiltration of the breast pedicle with local anesthetic to facilitate efficient, bloodless deepithelialization. The senior author uses a 20-ml syringe to inject 0.25% lidocaine and 1:400,000 epinephrine just beneath the epidermis of the breast pedicle to create a series of wheals. Approximately 20 ml of local anesthetic is used per pedicle. After injection of local anesthetic, the breast pedicle is deepithelialized in less than 3 minutes. The plane is bloodless, allowing improved visualization secondary to the epinephrine-induced hemostasis. The senior author has had only one case of nipple necrosis in 20 years of experience. Intradermal infiltration of local anesthetic with epinephrine hydrodissects between the epidermis and dermis and provides hemostasis to facilitate rapid deepithelialization.

  10. Morphology of the atlas pedicle revisited: a morphometric CT-based study on 120 patients.

    Science.gov (United States)

    Qian, Li-Xiong; Hao, Ding-Jun; He, Bao-Rong; Jiang, Yong-Hong

    2013-05-01

    To quantify the dimensions of the atlas pedicles and to analyze the relationship between extra medullary height (EMH) with intra medullary height (IMH) of the atlas pedicle. The images of the patients who had CT scanning and three-dimensional (3D) reconstruction involving atlantoaxial complex between June 2011 and April 2012 and meet our inclusion criteria were studied retrospectively. After reformatting the original images, the EMH and IMH of the atlas pedicles were measured. Extra medullary height and IMH were, respectively, 4.83 ± 1.13 and 1.29 ± 1.10 mm for males and 3.75 ± 0.93 and 0.60 ± 0.83 mm for females, with statistical difference (P atlas pedicles were measured by using CT images of the atlas, providing anatomic parameters for surgery. They showed a certain correlation but with a high variability. C1 pedicle screw fixation was well performed when the medullary canal was ≥1 mm, but the surgical procedure should be careful when it was between 0 and 1 mm, and avoided when there was no medullary canal in the atlas pedicle! So 3D CT reconstruction should be conducted to obtain data and establish individualized fixation strategy preoperatively.

  11. Bilateral pedicle stress fractures in a female athlete: case report and review of the literature.

    Science.gov (United States)

    Parvataneni, Hari K; Nicholas, Stephen J; McCance, Sean E

    2004-01-15

    Clinical case report of bilateral stress fractures of the pedicle in a female athlete presenting with back pain. To report this unusual case and surgical treatment and to review the relevant literature. Low back pain is a frequent complaint in athletes, with the majority of cases being related to muscular or soft tissue etiology. Spondylolysis, or pars fracture, is the most common injury of the neural arch. Stress fracture of the pedicle is a much less common occurrence. Bilateral pedicle fractures in an otherwise healthy athlete has not been previously reported in the orthopedic literature. A 19-year-old female athlete presented with low back pain limiting sports and daily activities. Radiographic workup revealed bilateral stress fractures of the pedicles of the L5 vertebra. Circumferential fusion of the L5-S1 segment was performed after failure of conservative treatment. Anterior interbody structural allograft and a vertical mesh cage were combined with instrumented posterolateral fusion using segmental pedicle screws and autogenous iliac crest bone graft. The patient achieved complete pain relief, solid fusion, and return to normal function. In this uncommon case of bilateral stress fractures of the pedicle, circumferential fusion assures full immobilization of the injured motion segment and assures a high probability of successful healing.

  12. Bilateral pedicle stress fracture in a patient with osteoporotic compression fracture

    Science.gov (United States)

    Ando, Yoshihiro; Hirata, Soichiro; Ishikawa, Hitoshi; Kurosaka, Masahiro

    2008-01-01

    A case of bilateral pedicle stress fracture of L4 in a patient with osteoporotic compression fracture of L5 and without a history of major trauma or surgery is reported, and the literature is reviewed. Bilateral pedicle fracture is a rare entity and few cases have been reported in the literature. All reported cases had some underlying causative factors like previous spine surgery or stress related activities. To the best of the authors’ knowledge, only one case of bilateral pedicle stress fracture without a history of trauma, previous spine surgery, or stress-related activities has been reported. A 77-year-old woman presented with severe low back pain and radiating pain in the right leg that was exacerbated after standing and walking. Plain radiograph showed pathological fracture at L5 level. Magnetic resonance imaging (MRI) revealed the compression of dural sac at L5 level. CT scan taken 3 months after admission revealed bilateral pedicle fractures through L4. The patient was treated with decompressive laminectomies of L4, followed by posterior spinal fusion with rigid pedicle screw fixation and autogenous bone graft mixed with hydroxyapatite. The patient achieved pain relief and returned to normal activity. Stress fracture of the pedicle within the proximal vertebra of an osteoporotic compression fracture of lumbar spine is an uncommon entity. It may, however, be an additional source of symptoms in patients with osteoporosis who present with further back pain. Surgeons caring for this group of patients should be aware of this condition. PMID:19005693

  13. Biomechanical evaluation and preliminary clinical experience with an expansive pedicle screw design.

    Science.gov (United States)

    Cook, S D; Salkeld, S L; Whitecloud, T S; Barbera, J

    2000-06-01

    The advantages of pedicle screw fixation depend on their ability to retain bony purchase until the fusion mass is stable. Osteoporotic bone and removal and replacement of pedicle screws in revision procedures substantially reduce screw mechanical fixation strength and can lead to clinical failure. The objective of this study was to determine if an expansive pedicle screw design could be used to improve biomechanical fixation in bone of compromised quality. Axial mechanical pullout testing was performed on paired expansive and conventional pedicle screws placed in fresh, unembalmed cadaveric vertebrae. Bone mineral density measurements (made using a dual-energy X-ray absorption meter) were used to characterize bone quality. A preliminary clinical and radiographic evaluation of 14 patients was also performed at a minimum 2-year follow-up. The mean axial pullout force in bone of all qualities was increased 30% when the expansive pedicle screw design was used. This included an appropriate 50% increase in pullout force in bone of poor quality (low bone mineral density). The preliminary clinical and radiographic results were supportive of the biomechanical design rationale and mechanical testing. The results were similar to those expected for spinal instrumentation using pedicle screws, even though compromised bone was present in two thirds of the cases in which the expansive screw was used.

  14. Ultra-mini-percutaneous nephrolithotomy: A minimally-invasive option for percutaneous stone removal

    Directory of Open Access Journals (Sweden)

    Madhu Sudan Agrawal

    2016-01-01

    Full Text Available Introduction: Percutaneous nephrolithotomy (PCNL has witnessed rapid advancements, the latest being ultra-mini-percutaneous nephrolithotomy (UMP, which makes the use of 11-13F sheaths as compared to 24-30F sizes used in conventional PCNL. This miniaturization aims to reduce morbidity and improve patient outcomes. We evaluated the safety and efficacy of UMP and report our ourtcomes. Patients and Methods: A total of 120 patients underwent UMP from July 2012 to March 2014. These patients had a single unilateral renal stone measuring between 8 and 20 mm. All patients underwent UMP using a 3F nephroscope, 7.5F inner sheath, and 11F or 13F outer metallic cannula, which served as the Amplatz sheath. Stone fragmentation and clearance were achieved with holmium laser. No nephrostomy or stent was used routinely. Results: Complete stone fragmentation was achieved in 114 out of 120 patients (95% using UMP; whereas the remaining 6 were converted into mini-PCNL using a 12.5F nephroscope and 15F Amplatz sheath. The mean operative time was 39.7 ± 15.4 min, and the mean postoperative hospital stay was 22.3 ± 2.2 h. Postoperatively, 6 (5% patients had residual fragments measuring ≤4 mm. At the 2 weeks follow-up, the stone-free status was >99% (119/120. There were no significant postoperative complications. Conclusion: This study shows UMP to be an effective and safe procedure for managing stones up to 20 mm. This procedure offers an attractive alternative to shock wave lithotripsy and retrograde intrarenal surgery for managing small stones.

  15. Biliary peritonitis due to gall bladder perforation after percutaneous nephrolithotomy

    Directory of Open Access Journals (Sweden)

    Nikhil Ranjan

    2015-01-01

    Full Text Available A 19-year-old male patient underwent right percutaneous nephrolithotomy (PNL for right renal 1.5 × 1.5 cm lower pole stone. The procedure was completed uneventfully with complete stone clearance. The patient developed peritonitis and shock 48 h after the procedure. Exploratory laparotomy revealed a large amount of bile in the abdomen along with three small perforations in the gall bladder (GB and one perforation in the caudate lobe of the liver. Retrograde cholecystectomy was performed but the patient did not recover and expired post-operatively. This case exemplifies the high mortality of GB perforation after PNL and the lack of early clinical signs.

  16. Percutaneous fusion of lumbar facet with bone allograft

    Directory of Open Access Journals (Sweden)

    Félix Dolorit Verdecia

    2015-03-01

    Full Text Available OBJECTIVE: To assess the evolution of the cases treated with percutaneous facet fusion with bone allograft in lumbar facet disease. METHOD: Between 2010 and 2014, 100 patients (59 women and 41 men diagnosed with lumbar facet disease underwent surgery. RESULTS: The lumbar facet fusion with bone allograft shows good clinical results, is performed on an outpatient basis, and presents minimal complications and rapid incorporation of the patient to the activities of daily living. CONCLUSIONS: The lumbar facet fusion with bone allograft appears to be an effective treatment for lumbar facet disease.

  17. Percutaneous left atrial appendage closure for stroke prevention

    DEFF Research Database (Denmark)

    De Backer, Ole; Loupis, Anastasia M; Ihlemann, Nikolaj

    2014-01-01

    as an alternative option for stroke prevention in AF patients with contraindication(s) for OAC treatment. MATERIAL AND METHODS: A total of 42 patients underwent percutaneous LAA closure. In this report, we describe our experience with this procedure. RESULTS: The patients treated were AF patients with a high stroke...... and bleeding risk. However, long-term follow-up studies are needed before this procedure can be recommended for routine clinical use. FUNDING: Grant funding was received (St Jude Medical) for research, but there are no other competing interests. TRIAL REGISTRATION: Not relevant....

  18. CT guided percutaneous biopsy of the cervical spine

    International Nuclear Information System (INIS)

    Yuan Huishu; Li Xuan; Liang Kunru

    1997-01-01

    To evaluate the effects of CT guided biopsy of cervical spine in clinical treatment, and discuss the technique involved, ten patients underwent percutaneous biopsy of cervical lesions under CT guidance. Anterior approach with the patient sitting and the needle passing through the mouth was done in one case; latero posterior approach with patient in lateral decubitus position in 5 cases; and lateral approach with 3 patients supine and 1 in lateral decubitus. Nine of ten patients had definitive histological diagnosis, the accuracy of biopsy was 90%, no complications were found. CT guided biopsy of cervical spine is safe and effective, with rare complications, providing important information for clinical treatment

  19. Pedicle screw anchorage of carbon fiber-reinforced PEEK screws under cyclic loading.

    Science.gov (United States)

    Lindtner, Richard A; Schmid, Rene; Nydegger, Thomas; Konschake, Marko; Schmoelz, Werner

    2018-03-01

    Pedicle screw loosening is a common and significant complication after posterior spinal instrumentation, particularly in osteoporosis. Radiolucent carbon fiber-reinforced polyetheretherketone (CF/PEEK) pedicle screws have been developed recently to overcome drawbacks of conventional metallic screws, such as metal-induced imaging artifacts and interference with postoperative radiotherapy. Beyond radiolucency, CF/PEEK may also be advantageous over standard titanium in terms of pedicle screw loosening due to its unique material properties. However, screw anchorage and loosening of CF/PEEK pedicle screws have not been evaluated yet. The aim of this biomechanical study therefore was to evaluate whether the use of this alternative nonmetallic pedicle screw material affects screw loosening. The hypotheses tested were that (1) nonmetallic CF/PEEK pedicle screws resist an equal or higher number of load cycles until loosening than standard titanium screws and that (2) PMMA cement augmentation further increases the number of load cycles until loosening of CF/PEEK screws. In the first part of the study, left and right pedicles of ten cadaveric lumbar vertebrae (BMD 70.8 mg/cm 3  ± 14.5) were randomly instrumented with either CF/PEEK or standard titanium pedicle screws. In the second part, left and right pedicles of ten vertebrae (BMD 56.3 mg/cm 3  ± 15.8) were randomly instrumented with either PMMA-augmented or nonaugmented CF/PEEK pedicle screws. Each pedicle screw was subjected to cyclic cranio-caudal loading (initial load ranging from - 50 N to + 50 N) with stepwise increasing compressive loads (5 N every 100 cycles) until loosening or a maximum of 10,000 cycles. Angular screw motion ("screw toggling") within the vertebra was measured with a 3D motion analysis system every 100 cycles and by stress fluoroscopy every 500 cycles. The nonmetallic CF/PEEK pedicle screws resisted a similar number of load cycles until loosening as the contralateral standard

  20. Influence of the screw augmentation technique and a diameter increase on pedicle screw fixation in the osteoporotic spine: pullout versus fatigue testing.

    Science.gov (United States)

    Kueny, Rebecca A; Kolb, Jan P; Lehmann, Wolfgang; Püschel, Klaus; Morlock, Michael M; Huber, Gerd

    2014-10-01

    For posterior spinal stabilization, loosening of pedicle screws at the bone-screw interface is a clinical complication, especially in the osteoporotic population. Axial pullout testing is the standard pre-clinical testing method for new screw designs although it has questioned clinical relevance. The aim of this study was to determine the fixation strength of three current osteoporotic fixation techniques and to investigate whether or not pullout testing results can directly relate to those of the more physiologic fatigue testing. Thirty-nine osteoporotic, human lumbar vertebrae were instrumented with pedicle screws according to four treatment groups: (1) screw only (control), (2) prefilled augmentation, (3) screw injected augmentation, and (4) unaugmented screws with an increased diameter. Toggle testing was first performed on one pedicle, using a cranial-caudal sinusoidal, cyclic (1.0 Hz) fatigue loading applied at the screw head. The initial compressive forces ranged from 25 to 75 N. Peak force increased stepwise by 25 N every 250 cycles until a 5.4-mm screw head displacement. The contralateral screw then underwent pure axial pullout (5 mm/min). When compared to the control group, screw injected augmentation increased fatigue force (27 %, p = 0.045) while prefilled augmentation reduced fatigue force (-7 %, p = 0.73). Both augmentation techniques increased pullout force compared to the control (ps osteoporotic spine, screw injected augmentation showed the best biomechanical stability. Although pullout testing was more sensitive, the differences observed were not reflected in the more physiological fatigue testing, thus casting further doubt on the clinical relevance of pullout testing.

  1. Direct Percutaneous Jejunostomy-An Underutilized Interventional Technique?

    International Nuclear Information System (INIS)

    Sparrow, Patrick; David, Elizabeth; Pugash, Robyn

    2008-01-01

    Our aim in this study was to report our single-center experience with direct percutaneous jejunostomy over a 4-year period with regard to technical success rate, immediate and late complications, and patient tolerance of the procedure. Institutional records of 22 consecutive patients who underwent radiological insertion of a percutaneous jejunostomy for a variety of indications were reviewed. The proximal jejunum was punctured under either fluoroscopic or ultrasonic guidance, and following placement of retention sutures, a 10- to 12-Fr catheter inserted. There was a 100% technical success rate in placement involving a total of seven operators. The indications for placement were prior gastric resection, newly diagnosed resectable esophageal or gastric carcinoma, unresectable gastric carcinoma with outlet obstruction, and palliative drainage of bowel obstruction. Mean duration of follow-up was 100 days, and catheter placement 57.7 days. There were six minor early complications, consisting of loss of two retention anchors requiring repuncture, three cases of localized excessive postprocedural pain, and one failed relief of symptoms of small bowel obstruction. Four tubes developed late complications (two blocked, one catheter cracked, and one inadvertently pulled out). Three of the four were successfully replaced through the existing tracts. One patient subsequently developed a minor skin infection, while another developed late pericatheter leakage from ascites. We conclude that direct percutaneous jejunostomy is a valuable treatment modality applicable to a number of clinical scenarios, with a high technical success rate and low serious complication rate

  2. Endoscopic colostomy with percutaneous colopexy: an animal feasibility study

    Directory of Open Access Journals (Sweden)

    Leonardo Alfonso Bustamante-López

    Full Text Available Background: Indications for colostomy in colorectal diseases are obstruction of the large bowel, such as in cancer, diverticular disease in the acute phase, post-radiotherapy enteritis, complex perirectal fistulas, anorectal trauma and severe anal incontinence. Some critically ill patients cannot tolerate an exploratory laparotomy, and laparoscopic assisted colostomy also requires general anesthesia. Objective: To evaluate the feasibility, safety and efficacy of performing colostomy assisted by colonoscopy and percutaneous colopexy. Materials and methods: Five pigs underwent endoscopic assisted colostomy with percutaneous colopexy. Animals were evaluated in post-operative days 1, 2, 5 and 7 for feeding acceptance and colostomy characteristics. On day 7 full colonoscopy was performed on animals followed by exploratory laparotomy. Results: Average procedure time was 27 minutes (21-54 min. Postoperative mobility and feeding of animals were immediate after anesthesia recovery. Position of the colostomy, edges color, appearance of periostomal area, as well as its function was satisfactory in four animals. Retraction of colostomy was present in one pig. The colonoscopy and laparotomy control on the seventh day were considered as normal. A bladder perforation that was successfully repaired through the colostomy incision occurred in one pig. The main limitation of this study is its experimental nature. Conclusion: Endoscopic assisted colostomy with percutaneous colopexy proves to be a safe and effective method with low morbidity for performing colostomy in experimental animals, with possible clinical application in humans.

  3. Human Thrombin Injection for the Percutaneous Treatment of Iatrogenic Pseudoaneurysms

    International Nuclear Information System (INIS)

    Elford, Julian; Burrell, Christopher; Freeman, Simon; Roobottom, Carl

    2002-01-01

    Purpose: Thrombin injection is becoming well established for the percutaneous management of iatrogenic pseudoaneurysms. All the published series to date use bovine thrombin,and there have been reports of adverse immunologic effects following its use. Our study aimed to assess the efficacy of human thrombin injection for pseudoaneurysm occlusion. Methods:Fourteen patients with iatrogenic pseudoaneurysms underwent a color Doppler ultrasound examination to assess their suitability for percutaneous human thrombin injection. Human thrombin 1000 IU was then injected into the pseudoaneurysm sac under sterile conditions and with ultrasound guidance. A further color Doppler ultrasound examination was performed 24 hr later to confirm occlusion. Results: All 14 pseudoaneurysms were successfully occluded by human thrombin injection. In two cases a second injection of thrombin was required,but there were no other complications, and all pseudoaneurysms remained occluded at 24 hr. Conclusion: Ultrasound-guided human thrombin injection is simple to perform, effective and safe. We recommend that human thrombin becomes the agent of choice for percutaneous injection into iatrogenic pseudoaneurysms

  4. Ultrasound-guided percutaneous core needle biopsy of splenic lesions

    Energy Technology Data Exchange (ETDEWEB)

    Park, SangIk; Shin, Yong Moon; Won, Hyung Jin; Kim, Pyo Nyun; Lee, Moon Gyu [Dept. of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2017-05-15

    To evaluate the safety and efficacy of ultrasound-guided percutaneous core needle biopsy of splenic lesions. This retrospective study included 30 patients who underwent percutaneous core needle biopsy of their splenic lesions using 18- or 20-gauge needles between January 2001 and July 2016 in a single tertiary care center. The characteristics of the splenic lesions were determined by reviewing the ultrasound and computed tomography examinations. Acquisition rate and diagnostic accuracy were calculated, using pathologic results of the splenectomy specimen, clinical course and/or imaging follow-up as a reference standard. Post-procedure complications were identified from electronic medical records, laboratory findings and computed tomography images. Seventy-three specimens were obtained from the 30 patients and splenectomy was performed in 2 patients. Twenty-nine of the 30 patients had focal splenic lesions, while the remaining patient had homogeneous splenomegaly. Acquisition rate and diagnostic accuracy were 80.0% (24/30) and 76.7% (23/30), respectively. Perisplenic hemorrhage without hemodynamic instability developed in one patient. Ultrasound-guided percutaneous core needle biopsy of splenic lesions is a safe method for achieving a histopathologic diagnosis and can be considered as an alternative to splenectomy in patients with a high risk of splenectomy-related complications.

  5. Ultrasound-guided percutaneous core needle biopsy of splenic lesions

    International Nuclear Information System (INIS)

    Park, SangIk; Shin, Yong Moon; Won, Hyung Jin; Kim, Pyo Nyun; Lee, Moon Gyu

    2017-01-01

    To evaluate the safety and efficacy of ultrasound-guided percutaneous core needle biopsy of splenic lesions. This retrospective study included 30 patients who underwent percutaneous core needle biopsy of their splenic lesions using 18- or 20-gauge needles between January 2001 and July 2016 in a single tertiary care center. The characteristics of the splenic lesions were determined by reviewing the ultrasound and computed tomography examinations. Acquisition rate and diagnostic accuracy were calculated, using pathologic results of the splenectomy specimen, clinical course and/or imaging follow-up as a reference standard. Post-procedure complications were identified from electronic medical records, laboratory findings and computed tomography images. Seventy-three specimens were obtained from the 30 patients and splenectomy was performed in 2 patients. Twenty-nine of the 30 patients had focal splenic lesions, while the remaining patient had homogeneous splenomegaly. Acquisition rate and diagnostic accuracy were 80.0% (24/30) and 76.7% (23/30), respectively. Perisplenic hemorrhage without hemodynamic instability developed in one patient. Ultrasound-guided percutaneous core needle biopsy of splenic lesions is a safe method for achieving a histopathologic diagnosis and can be considered as an alternative to splenectomy in patients with a high risk of splenectomy-related complications

  6. Percutaneous Retrieval of Permanent Inferior Vena Cava Filters

    Energy Technology Data Exchange (ETDEWEB)

    Tamrazi, Anobel, E-mail: atamraz1@jhmi.edu; Wadhwa, Vibhor, E-mail: vwadhwa1@jhmi.edu; Holly, Brian, E-mail: bholly3@jhmi.edu [Johns Hopkins University School of Medicine, Division of Vascular & Interventional Radiology (United States); Bhagat, Nikhil, E-mail: nikhibhagat@gmail.com [Kaiser Permanente, Division of Vascular & Interventional Radiology (United States); Marx, Jonathan K., E-mail: jmarx9@jhmi.edu [Johns Hopkins University School of Medicine, Division of Vascular & Interventional Radiology (United States); Streiff, Michael, E-mail: mstreif@jhmi.edu [Johns Hopkins University School of Medicine, Department of Hematology (United States); Lessne, Mark L., E-mail: mlessne@gmail.com [Johns Hopkins University School of Medicine, Division of Vascular & Interventional Radiology (United States)

    2016-04-15

    PurposeTo evaluate the feasibility, risks, and techniques of percutaneous removal of permanent TrapEase and Simon Nitinol IVC filters.Materials and MethodsBetween August 2011 and August 2015, 12 patients (5 women, 7 men; age range, 26–75 years) underwent an attempt at percutaneous removal of permanent TrapEase (10) and Simon Nitinol (2) IVC filters due to a history of IVC filter complications or need for lifelong anticoagulation due to the filter. Medical records were reviewed for filter dwell time, presence of iliocaval deep venous thrombosis, procedural technique, and complications.ResultsFilter dwell times ranged from 7 days to 15 years (mean 5.1 years). Successful removal of permanent IVC filters was possible in 11 of 12 patients (91.6 %). In 1 patient, a chronically thrombosed IVC filter could not be removed despite laser sheath assistance, but was successfully recanalized with the PowerWire RF guidewire. In the failed retrieval attempt, a stent was placed through the chronically thrombosed IVC filter with restoration of in-line flow. One major complication of large venous groin hematoma was encountered.ConclusionsIn carefully selected patients, percutaneous removal of permanent IVC filters can be performed safely despite prolonged filter dwell times. Extraction of chronically embedded permanent IVC filters may be facilitated by jugular and femoral approaches, often with laser sheath assistance. Chronic filter thrombosis and caval scarring may increase the risk of retrieval failure.

  7. Is it safe to back out pedicle screws after augmentation with polymethyl methacrylate or calcium phosphate cement? A biomechanical study.

    Science.gov (United States)

    Cho, Woojin; Wu, Chunhui; Zheng, Xiujun; Erkan, Serkan; Suratwala, Sanjeev J; Mehbod, Amir A; Transfeldt, Ensor E

    2011-06-01

    Biomechanical cadaveric study. To determine the torque required to remove pedicle screws augmented with polymethyl methacrylate (PMMA) or calcium phosphate cement (CPC); thus, proving the safety of back out of augmented screws in the osteopotoric model, which would be a more dangerous setting than the nonosteoporotic model. To our knowledge, no earlier study has characterized the safety of backing out pedicle screw augmented with PMMA or CPC. Pedicle screws were inserted in 24 osteoporotic vertebrae (48 pedicles). The maximal insertion torque and pullout strength of each screw were recorded. After pullout of the pedicle screws, the vertebrae were then randomized into 2 groups of 12 (24 pedicles) each. PMMA was injected into the pedicles in the first group and CPC was injected into the second group after which the pedicle screws were inserted. The pedicle screws were inserted into the pedicle holes augmented with PMMA or CPC, respectively. Finally, all augmented screws were backed out and the maximal removal torque was recorded using a digital torque wrench. Throughout the study, no incidence of pedicle or lamina fractures was observed. The average insertion torque was 0.5±0.27 and 0.45±0.29 N·m for groups 1 and 2, respectively (P=0.724). The average pullout strength was 723.1±391.7 and 671.2±383.0 N (P=0.950). After cement augmentation, the average removal torque was 0.77±0.31 and 0.81±0.26 N·m for PMMA and CPC, respectively (P=0.494). The results of this study showed that pedicle screws can be easily and safely backed out after augmentation with PMMA or CPC. The result of CPC, however, may only be valid before any bony ingrowth.

  8. "NIMS technique" for minimally invasive spinal fixation using non-fenestrated pedicle screws: A technical note

    Directory of Open Access Journals (Sweden)

    Alugolu Rajesh

    2015-01-01

    Full Text Available Study Design: Case series. Objective: To reduce the cost of minimally invasive spinal fixation. Background: Minimally invasive spine (MIS surgery is an upcoming modality of managing a multitude of spinal pathologies. However, in a resource-limited situations, using fenestrated screws (FSs may prove very costly for patients with poor affordability. We here in describe the Nizam′s Institute of Medical Sciences (NIMS experience of using routine non-FSs (NFSs for transpedicular fixation by the minimally invasive way to bridge the economic gap. Materials and Methods: A total of 7 patients underwent NFS-minimally invasive spine (MIS surgery. Male to female distribution was 6:1. The average blood loss was 50 ml and the mean operating time was 2 and 1/2 h. All patients were mobilized the very next day after confirming the position of implants on X-ray/computed tomography. Results: All 7 patients are doing well in follow-up with no complaints of a backache or fresh neurological deficits. There was no case with pedicle breach or screw pullout. The average cost of a single level fixation by FS and NFS was `1, 30,000/patient and `32,000/patient respectively ($2166 and $530, respectively. At the end of 1-year follow-up, we had two cases of screw cap loosening and with a displacement of the rod cranio-caudally in one case which was revised through the same incisions. Conclusions: Transpedicular fixation by using NFS for thoracolumbar spinal pathologies is a cost-effective extension of MIS surgery. This may extend the benefits to a lower socioeconomic group who cannot afford the cost of fenestrated screw (FS.

  9. Percutaneous nephrolithotomy and its legacy

    NARCIS (Netherlands)

    Skolarikos, A.; Alivizatos, G.; de la Rosette, J. J. M. C. H.

    2005-01-01

    Objective: We review the indications of Percutaneous Nephrolithotomy (PNL), its safety and efficacy when applied to various patient groups as well as the different points of technique, giving emphasis on new tips and ongoing debates. Methods: A literature search was performed using MEDLINE database

  10. Robotics in percutaneous cardiovascular interventions.

    Science.gov (United States)

    Pourdjabbar, Ali; Ang, Lawrence; Behnamfar, Omid; Patel, Mitul P; Reeves, Ryan R; Campbell, Paul T; Madder, Ryan D; Mahmud, Ehtisham

    2017-11-01

    The fundamental technique of performing percutaneous cardiovascular (CV) interventions has remained unchanged and requires operators to wear heavy lead aprons to minimize exposure to ionizing radiation. Robotic technology is now being utilized in interventional cardiology partially as a direct result of the increasing appreciation of the long-term occupational hazards of the field. This review was undertaken to report the clinical outcomes of percutaneous robotic coronary and peripheral vascular interventions. Areas covered: A systematic literature review of percutaneous robotic CV interventions was undertaken. The safety and feasibility of percutaneous robotically-assisted CV interventions has been validated in simple to complex coronary disease, and iliofemoral disease. Studies have shown that robotically-assisted PCI significantly reduces operator exposure to harmful ionizing radiation without compromising procedural success or clinical efficacy. In addition to the operator benefits, robotically-assisted intervention has the potential for patient advantages by allowing more accurate lesion length measurement, precise stent placement and lower patient radiation exposure. However, further investigation is required to fully elucidate these potential benefits. Expert commentary: Incremental improvement in robotic technology and telecommunications would enable treatment of an even broader patient population, and potentially provide remote robotic PCI.

  11. An update on percutaneous nephrolithotomy

    DEFF Research Database (Denmark)

    Tefekli, A; Cordeiro, E; de la Rosette, J J M C H

    2013-01-01

    Since its introduction in late 1970's, percutaneous nephrolithotomy (PNL) has undergone an evolution in both equipment and technique. This evolution still continues today in the era of minimally invasive treatment options, and is evidenced by the numerous publications. PNL is generally advantageo...

  12. The biomechanical consequences of rod reduction on pedicle screws: should it be avoided?

    Science.gov (United States)

    Paik, Haines; Kang, Daniel G; Lehman, Ronald A; Gaume, Rachel E; Ambati, Divya V; Dmitriev, Anton E

    2013-11-01

    Rod contouring is frequently required to allow for appropriate alignment of pedicle screw-rod constructs. When residual mismatch is still present, a rod persuasion device is often used to achieve further rod reduction. Despite its popularity and widespread use, the biomechanical consequences of this technique have not been evaluated. To evaluate the biomechanical fixation strength of pedicle screws after attempted reduction of a rod-pedicle screw mismatch using a rod persuasion device. Fifteen 3-level, human cadaveric thoracic specimens were prepared and scanned for bone mineral density. Osteoporotic (n=6) and normal (n=9) specimens were instrumented with 5.0-mm-diameter pedicle screws; for each pair of comparison level tested, the bilateral screws were equal in length, and the screw length was determined by the thoracic level and size of the vertebra (35 to 45 mm). Titanium 5.5-mm rods were contoured and secured to the pedicle screws at the proximal and distal levels. For the middle segment, the rod on the right side was intentionally contoured to create a 5-mm residual gap between the inner bushing of the pedicle screw and the rod. A rod persuasion device was then used to engage the setscrew. The left side served as a control with perfect screw/rod alignment. After 30 minutes, constructs were disassembled and vertebrae individually potted. The implants were pulled in-line with the screw axis with peak pullout strength (POS) measured in Newton (N). For the proximal and distal segments, pedicle screws on the right side were taken out and reinserted through the same trajectory to simulate screw depth adjustment as an alternative to rod reduction. Pedicle screws reduced to the rod generated a 48% lower mean POS (495±379 N) relative to the controls (954±237 N) (ppedicle screws had failed during the reduction attempt with visible pullout of the screw. After reduction, decreased POS was observed in both normal (posteoporotic (pscrew resulted in no significant

  13. Percutaneous Dilational Tracheotomy in Solid-Organ Transplant Recipients.

    Science.gov (United States)

    Ozdemirkan, Aycan; Ersoy, Zeynep; Zeyneloglu, Pinar; Gedik, Ender; Pirat, Arash; Haberal, Mehmet

    2015-11-01

    Solid-organ transplant recipients may require percutaneous dilational tracheotomy because of prolonged mechanical ventilation or airway issues, but data regarding its safety and effectiveness in solid-organ transplant recipients are scarce. Here, we evaluated the safety, effectiveness, and benefits in terms of lung mechanics, complications, and patient comfort of percutaneous dilational tracheotomy in solid-organ transplant recipients. Medical records from 31 solid-organ transplant recipients (median age of 41.0 years [interquartile range, 18.0-53.0 y]) who underwent percutaneous dilational tracheotomy at our hospital between January 2010 and March 2015 were analyzed, including primary diagnosis, comorbidities, duration of orotracheal intubation and mechanical ventilation, length of intensive care unit and hospital stays, the time interval between transplant to percutaneous dilational tracheotomy, Acute Physiology and Chronic Health Evaluation II score, tracheotomy-related complications, and pulmonary compliance and ratio of partial pressure of arterial oxygen to fraction of inspired oxygen. The median Acute Physiology and Chronic Health Evaluation II score on admission was 24.0 (interquartile range, 18.0-29.0). The median interval from transplant to percutaneous dilational tracheotomy was 105.5 days (interquartile range, 13.0-2165.0 d). The only major complication noted was left-sided pneumothorax in 1 patient. There were no significant differences in ratio of partial pressure of arterial oxygen to fraction of inspired oxygen before and after procedure (170.0 [interquartile range, 102.2-302.0] vs 210.0 [interquartile range, 178.5-345.5]; P = .052). However, pulmonary compliance results preprocedure and postprocedure were significantly different (0.020 L/cm H2O [interquartile range, 0.015-0.030 L/cm H2O] vs 0.030 L/cm H2O [interquartile range, 0.020-0.041 L/cm H2O); P = .001]). Need for sedation significantly decreased after tracheotomy (from 17 patients [54.8%] to

  14. Simultaneous Lateral Interbody Fusion and Posterior Percutaneous Instrumentation: Early Experience and Technical Considerations

    Directory of Open Access Journals (Sweden)

    Doniel Drazin

    2015-01-01

    Full Text Available Lumbar fusion surgery involving lateral lumbar interbody graft insertion with posterior instrumentation is traditionally performed in two stages requiring repositioning. We describe a novel technique to complete the circumferential procedure simultaneously without patient repositioning. Twenty patients diagnosed with worsening back pain with/without radiculopathy who failed exhaustive conservative management were retrospectively reviewed. Ten patients with both procedures simultaneously from a single lateral approach and 10 control patients with lateral lumbar interbody fusion followed by repositioning and posterior percutaneous instrumentation were analyzed. Pars fractures, mobile grade 2 spondylolisthesis, and severe one-level degenerative disk disease were matched between the two groups. In the simultaneous group, avoiding repositioning leads to lower mean operative times: 130 minutes (versus control 190 minutes; p=0.009 and lower intraoperative blood loss: 108 mL (versus 93 mL; NS. Nonrepositioned patients were hospitalized for an average of 4.1 days (versus 3.8 days; NS. There was one complication in the control group requiring screw revision. Lateral interbody fusion and percutaneous posterior instrumentation are both readily accomplished in a single lateral decubitus position. In select patients with adequately sized pedicles, performing simultaneous procedures decreases operative time over sequential repositioning. Patient outcomes were excellent in the simultaneous group and comparable to procedures done sequentially.

  15. Occam paradox? A variation of tapia syndrome and an unreported complication of guidewire-assisted pedicle screw insertion.

    Science.gov (United States)

    Emohare, Osa; Peterson, Erik; Slinkard, Nathaniel; Janus, Seth; Morgan, Robert

    2013-10-01

    Study Design Case report. Clinical Question The clinical aim is to report on a previously unknown association between guidewire-assisted pedicle screw insertion and neuropraxia of the recurrent laryngeal nerve (RLN), and how this may overlap with the signs of Tapia syndrome; we also report our approach to the clinical management of this patient. Methods A 17-year-old male patient with idiopathic scoliosis experienced Tapia syndrome after posterior instrumentation and arthrodesis at the level of T1-L1. After extubation, the patient had a hoarse voice and difficulty in swallowing. Imaging showed a breach in the cortex of the anterior body of T1 corresponding to the RLN on the right. Results Otolaryngological examination noted right vocal fold immobility, decreased sensation of the endolarynx, and pooling of secretions on flexible laryngoscopy that indicated right-sided cranial nerve X injury and left-sided tongue deviation. Aspiration during a modified barium swallow prompted insertion of a percutaneous endoscopic gastrostomy tube before the patient was sent home. On postoperative day 20, a barium swallow demonstrated reduced aspiration, and the patient reported complete resolution of symptoms. The feeding tube was removed, and the patient resumed a normal diet 1 month later. Tapia syndrome, or persistent unilateral laryngeal and hypoglossal paralysis, is an uncommon neuropraxia, which has previously not been observed in association with a breached vertebral body at T1 along the course of the RLN. Conclusion Tapia syndrome should be a differential diagnostic consideration whenever these symptoms persist postoperatively and spine surgeons should be aware of this as a potential complication of guidewires in spinal instrumentation.

  16. Diagnosing pancreatic cancer: the role of percutaneous biopsy and CT

    International Nuclear Information System (INIS)

    Amin, Z.; Theis, B.; Russell, R.C.G.; House, C.; Novelli, M.; Lees, W.R.

    2006-01-01

    Aims: To determine the sensitivity and complications of percutaneous biopsy of pancreatic masses, and whether typical computed tomography (CT) features of adenocarcinoma can reliably predict this diagnosis. Materials and methods: A 5 year retrospective analysis of percutaneous core biopsies of pancreatic masses and their CT features was undertaken. Data were retrieved from surgical/pathology databases; medical records and CT reports and images. Results: Three hundred and three patients underwent 372 biopsies; 56 of 87 patients had repeat biopsies. Malignancy was diagnosed in 276 patients, with ductal adenocarcinoma in 259 (85%). Final sensitivity of percutaneous biopsy for diagnosing pancreatic neoplasms was 90%; for repeat biopsy it was 87%. Complications occurred in 17 (4.6%) patients, in three of whom the complications were major (1%): one abscess, one duodenal perforation, one large retroperitoneal bleed. CT features typical of ductal adenocarcinoma were: hypovascular pancreatic mass with bile and/or pancreatic duct dilatation. Atypical CT features were: isodense or hypervascular mass, calcification, non-dilated ducts, cystic change, and extensive lymphadenopathy. Defining typical CT features of adenocarcinoma as true-positives, CT had a sensitivity of 68%, specificity of 95%, positive predictive value (PPV) of 98%, and negative predictive value of 41% for diagnosing pancreatic adenocarcinoma. Conclusion: Final sensitivity of percutaneous biopsy for establishing the diagnosis was 90%. CT features typical of pancreatic adenocarcinoma had high specificity and PPV. On some occasions, especially in frail patients with co-morbidity, it might be reasonable to assume a diagnosis of pancreatic cancer if CT features are typical, and biopsy only if CT shows atypical features

  17. Diagnosing pancreatic cancer: the role of percutaneous biopsy and CT

    Energy Technology Data Exchange (ETDEWEB)

    Amin, Z.; Theis, B.; Russell, R.C.G.; House, C.; Novelli, M.; Lees, W.R

    2006-12-15

    Aims: To determine the sensitivity and complications of percutaneous biopsy of pancreatic masses, and whether typical computed tomography (CT) features of adenocarcinoma can reliably predict this diagnosis. Materials and methods: A 5 year retrospective analysis of percutaneous core biopsies of pancreatic masses and their CT features was undertaken. Data were retrieved from surgical/pathology databases; medical records and CT reports and images. Results: Three hundred and three patients underwent 372 biopsies; 56 of 87 patients had repeat biopsies. Malignancy was diagnosed in 276 patients, with ductal adenocarcinoma in 259 (85%). Final sensitivity of percutaneous biopsy for diagnosing pancreatic neoplasms was 90%; for repeat biopsy it was 87%. Complications occurred in 17 (4.6%) patients, in three of whom the complications were major (1%): one abscess, one duodenal perforation, one large retroperitoneal bleed. CT features typical of ductal adenocarcinoma were: hypovascular pancreatic mass with bile and/or pancreatic duct dilatation. Atypical CT features were: isodense or hypervascular mass, calcification, non-dilated ducts, cystic change, and extensive lymphadenopathy. Defining typical CT features of adenocarcinoma as true-positives, CT had a sensitivity of 68%, specificity of 95%, positive predictive value (PPV) of 98%, and negative predictive value of 41% for diagnosing pancreatic adenocarcinoma. Conclusion: Final sensitivity of percutaneous biopsy for establishing the diagnosis was 90%. CT features typical of pancreatic adenocarcinoma had high specificity and PPV. On some occasions, especially in frail patients with co-morbidity, it might be reasonable to assume a diagnosis of pancreatic cancer if CT features are typical, and biopsy only if CT shows atypical features.

  18. Bilateral CT-guided percutaneous cordotomy for cancer pain relief

    International Nuclear Information System (INIS)

    Yegul, I.; Erhan, E.

    2003-01-01

    AIM: CT-guided percutaneous cordotomy is a useful procedure for treating unilateral cancer pain, however, bilateral cordotomy can be required on some occasions. We evaluated the effectiveness and complications of bilateral cordotomy. MATERIALS AND METHODS: Two hundred and thirty-four patients who suffered from unilateral cancer pain underwent CT-guided percutaneous cordotomy. The procedure was repeated in 22 patients, and nine patients had bilateral cordotomy. Effectiveness and complications were recorded after each procedure. RESULTS: Of nine patents (three women and six men) having bilateral percutaneous cordotomy in our study, four patients had mirror pain after the first procedure. In the remaining five patients the contralateral pain was due to new pain sites. The pain scores before and after the first procedure were 9.3 (range 7-10) and 1.2 (range 0-3), respectively. After the first procedure complete or satisfactory pain relief was achieved in all patients. The duration between the two procedures ranged from 7-243 days (mean 59.8 days). The pain scores before and after the second procedure were 8.4 (range 5-10) and 1.6 (range 0-4), respectively. After the second procedure complete or satisfactory pain relief was reported in all patients. There were no complications in four patients. One patient developed transient motor deficit after the first procedure. Other complications (nausea/vomiting, headache, ipsilateral neck pain, postcordotomy dysesthesia) were mild and transient. CONCLUSION: CT-guided percutaneous cordotomy is a useful procedure for the treatment of severe unilateral cancer pain syndromes. The procedure can be repeated on the other side at least 1 week later. These results show that the success on the second side appears to be similar to the first side with low complication rate for both procedures

  19. Bilateral CT-guided percutaneous cordotomy for cancer pain relief

    Energy Technology Data Exchange (ETDEWEB)

    Yegul, I. E-mail: iyegul@med.ege.edu.tr; Erhan, E. E-mail: elvanerhan@yahoo.com

    2003-11-01

    AIM: CT-guided percutaneous cordotomy is a useful procedure for treating unilateral cancer pain, however, bilateral cordotomy can be required on some occasions. We evaluated the effectiveness and complications of bilateral cordotomy. MATERIALS AND METHODS: Two hundred and thirty-four patients who suffered from unilateral cancer pain underwent CT-guided percutaneous cordotomy. The procedure was repeated in 22 patients, and nine patients had bilateral cordotomy. Effectiveness and complications were recorded after each procedure. RESULTS: Of nine patents (three women and six men) having bilateral percutaneous cordotomy in our study, four patients had mirror pain after the first procedure. In the remaining five patients the contralateral pain was due to new pain sites. The pain scores before and after the first procedure were 9.3 (range 7-10) and 1.2 (range 0-3), respectively. After the first procedure complete or satisfactory pain relief was achieved in all patients. The duration between the two procedures ranged from 7-243 days (mean 59.8 days). The pain scores before and after the second procedure were 8.4 (range 5-10) and 1.6 (range 0-4), respectively. After the second procedure complete or satisfactory pain relief was reported in all patients. There were no complications in four patients. One patient developed transient motor deficit after the first procedure. Other complications (nausea/vomiting, headache, ipsilateral neck pain, postcordotomy dysesthesia) were mild and transient. CONCLUSION: CT-guided percutaneous cordotomy is a useful procedure for the treatment of severe unilateral cancer pain syndromes. The procedure can be repeated on the other side at least 1 week later. These results show that the success on the second side appears to be similar to the first side with low complication rate for both procedures.

  20. Percutaneous Access via the Recanalized Paraumbilical Vein for Varix Embolization in Seven Patients

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Yeon Jin; Kim, Hyo Cheol; Hur, Sae Beom; Jae, Hwan Jun; Chung, Jin Wook [Dept. of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul (Korea, Republic of); Kim, Young Whan [Dept. of Radiology, Dongsan Hospital, Keimyung University College of Medicine, Daegu (Korea, Republic of)

    2014-10-15

    To evaluate the feasibility of percutaneous access via the recanalized paraumbilical vein for varix embolization. Between July 2008 and Jan 2014, percutaneous access via the recanalized paraumbilical vein for varix embolization was attempted in seven patients with variceal bleeding. Paraumbilical vein puncture was performed under ultrasonographic guidance, followed by introduction of a 5-Fr sheath. We retrospectively evaluated the technical feasibility, procedure-related complications, and clinical outcomes of each patient. Recanalized paraumbilical vein catheterization was performed successfully in all patients. Gastroesophageal varix embolization was performed in six patients, and umbilical varix embolization was performed in one patient. Embolic materials used are N-butyl cyanoacrylate (n = 6) and coil with N-butyl cyanoacrylate (n = 1). There were no procedure-related complications. One patient underwent repeated variceal embolization 6 hours after initial procedure via recanalized paraumbilical vein, due to rebleeding from gastric varix. Percutaneous access via the paraumbilical vein for varix embolization is a simple alternative in patients with portal hypertension.

  1. Understanding the Lung Abscess Microbiome: Outcomes of Percutaneous Lung Parenchymal Abscess Drainage with Microbiologic Correlation.

    Science.gov (United States)

    Duncan, Christopher; Nadolski, Gregory J; Gade, Terence; Hunt, Stephen

    2017-06-01

    Lung parenchymal abscesses represent an uncommon pathology with high mortality if untreated. Although most respond well to antibiotics, the optimal therapy for persistent abscesses is unknown. The purpose of this study was to review the outcomes of percutaneous lung parenchymal abscess catheter drainage after broad-spectrum antibiotic therapy failure and correlate with patient microbiologic samples. Retrospective review of patients who underwent percutaneous lung abscess drainage at a tertiary hospital system from 2005 to 2015 was performed. In total, 19 procedures were identified on 16 different patients; six females and ten males. Mean patient age was 55 years (range 22-81). Median follow-up time was 7 months (range drainage is highly sensitive for microbiologic sampling compared to sputum/bronchoscopic or blood cultures. Additionally, percutaneous drainage of lung parenchymal abscess cavities may promote resolution of the abscess with high rates of therapeutic success and low complications.

  2. The Technique and Benefits of Angiographic Embolization of Inferior Epigastric Arteries Prior to Pedicled TRAM Flap Breast Reconstruction: Results from a Single Center.

    Science.gov (United States)

    Sever, Alysse J; Patel, Chirag; Albeer, Yahya; Darian, Vigen B

    2017-12-01

    To report a single center's experience with selective arterial embolization of the deep inferior epigastric arteries (DIEA) prior to pedicled TRAM flap breast reconstruction including techniques and outcomes. Retrospective chart review was performed for 15 patients who underwent pedicled TRAM flap breast reconstruction after selective embolization of bilateral DIEA. Data were analyzed to display the spectrum of postoperative outcomes following the TRAM flap procedure status post-selective angiographic embolization of the bilateral DIEA to improve vascularity of the TRAM flaps by rendering the tissue partially ischemic to undergo neovascularization. We then compared our results to historical controls of those delayed by ligating the DIEA via traditional surgical means to see if the outcomes are similar. We also compared our results to historical non-delayed TRAM flap reconstruction. One patient had a small area of partial flap skin necrosis, and no patients had total flap loss. 13.3% of patients had clinically significant TRAM flap fat necrosis. Outcomes of TRAM flaps delayed by selective arterial embolization are comparable to historical controls of those delayed by traditional surgical means and better than non-delayed flaps. Angiographic delayed TRAM flap reconstruction procedure is a reasonable safe alternative to the surgical delayed TRAM flap reconstruction procedure with less morbidity and is better than non-delayed TRAM flap procedures.

  3. Transcatheter Arterial Embolization for Hepatic Arterial Injury Related to Percutaneous Transhepatic Portal Intervention

    Energy Technology Data Exchange (ETDEWEB)

    Shimohira, Masashi, E-mail: mshimohira@gmail.com; Hashizume, Takuya [Nagoya City University Graduate School of Medical Sciences, Department of Radiology (Japan); Sasaki, Shigeru [Nagoya City West Medical Center, Department of Radiology (Japan); Ohta, Kengo; Suzuki, Kazushi; Nakagawa, Motoo; Ozawa, Yoshiyuki; Sakurai, Keita; Nishikawa, Hiroko [Nagoya City University Graduate School of Medical Sciences, Department of Radiology (Japan); Hara, Masaki [Nagoya City West Medical Center, Department of Radiology (Japan); Shibamoto, Yuta [Nagoya City University Graduate School of Medical Sciences, Department of Radiology (Japan)

    2017-02-15

    PurposeTo assess the usefulness of transcatheter arterial embolization (TAE) for the hepatic arterial injury related to percutaneous transhepatic portal intervention (PTPI).Materials and MethodsFifty-four patients, 32 males and 22 females with a median age of 68 years (range 43–82 years), underwent PTPI. The procedures consisted of 33 percutaneous transhepatic portal vein embolizations, 19 percutaneous transhepatic variceal embolizations, and 2 percutaneous transhepatic portal venous stent placements. Two patients with gastric varices underwent percutaneous transhepatic variceal embolization twice because of recurrence. Therefore, the total number of procedures was 56. Among them, hepatic arterial injury occurred in 6 PTPIs in 5 patients, and TAE was performed. We assessed technical success, complications related to TAE, and clinical outcome. Technical success was defined as the disappearance of findings due to hepatic arterial injury on digital subtraction angiography.ResultsAs hepatic arterial injuries, 4 extravasations and 2 arterioportal shunts developed. All TAEs were performed successfully. The technical success rate was 100 %. Complication of TAE occurred in 5 of 6 TAEs; 3 were focal liver infarction, not requiring further treatment, and 2 were biloma that required percutaneous drainage. Five TAEs in 4 patients were performed immediately after the PTPI, and these 4 patients were alive. However, one TAE was performed 10 h later, and the patient died due to multiple organ failure 2 months later although TAE was successful.ConclusionTAE is a useful treatment for hepatic arterial injury related to PTPI. However, it should be performed at an early stage.

  4. Cervical Pedicle Screw Placement Using Medial Funnel Technique.

    Science.gov (United States)

    Lee, Jung Hwan; Choi, Byung Kwan; Han, In Ho; Choi, Won Gyu; Nam, Kyoung Hyup; Kim, Hwan Soo

    2017-09-01

    Cervical pedicle screw (CPS) placement is very challenging due to high risk of neurovascular complications. We devised a new technique (medial funnel technique) to improve the accuracy and feasibility of CPS placement. We reviewed 28 consecutive patients undergoing CPS instrumentation using the medial funnel technique. Their mean age was 51.4 years (range, 30-81 years). Preoperative diagnosis included degenerative disease (n=5), trauma (n=22), and infection (n=1). Screw perforations were graded with the following criteria: grade 0 having no perforation, grade 1 having 50% of screw diameter. Grades 0 and 1 were considered as correct position. The degree of perforation was determined by 2 junior neurosurgeons and 1 senior neurosurgeon. A total of 88 CPSs were inserted. The rate of correct placement was 94.3%; grade 0, 54 screws; grade 1, 29 screws; grade 2, 4 screws; and grade 3, 1 screw. No neurovascular complications or failure of instrumentation occurred. In perforated screws (34 screws), lateral perforations were 4 and medial perforations were 30. We performed CPS insertion using medial funnel technique and achieved 94.3% (83 of 88) of correct placement. And it can decrease lateral perforation.

  5. The difference in superior adjacent segment pathology after lumbar posterolateral fusion by using 2 different pedicle screw insertion techniques in 9-year minimum follow-up.

    Science.gov (United States)

    He, Baorong; Yan, Liang; Guo, Hua; Liu, Tuanjiang; Wang, Xiaodong; Hao, Dingjun

    2014-06-15

    A prospective study was performed. To test the hypothesis that different pedicle screw insertion positions would increase the likelihood of superior adjacent segment degeneration (ASD). Lumbar fusion surgery is a widely accepted treatment of lumbar diseases, such as lumbar stenosis, trauma, tumor, and spondylolisthesis. Fusion and clinical success rates have increased because of improvements in instrumentation and bone graft material. In contrast, numerous complications and problems of fusion surgery have been reported, with ASD being one of the most important. This prospective study included 210 patients with low-grade isthmic spondylolisthesis. From January 1999 to December 2003, patients were randomized underwent posterolateral fusion using 2 different pedicle screw insertion positions. The patients were followed up postoperatively and were assessed with regard to radiological and clinical outcomes. Radiological outcomes were assessed mainly on the basis of disc degeneration, facet joint degeneration, and bone fusion. Clinical outcomes were evaluated mainly with the use of visual analogue scale for pain and the Oswestry Disability Index. A total of 178 of 210 (84.7%) patients were available for at least 9-year radiological and clinical follow-up data: 85.3% (87/102) patients in group A and 84.3% (91/108) patients in group B. Bone fusion was achieved in all patients at the last follow-up. ASD was proven in 110 (61.8%) of 178 patients. The incidences of radiographical and symptomatic ASD were 57.9% (103/178) and 3.9% (7/178), respectively. The incidence of ASD in group B was significantly lower than that in group A. Results of clinical outcomes showed lower visual analogue scale and Oswestry Disability Index scores in 2 groups than preoperative scores, but group B had greater improvement on the Oswestry Disability Index scores than group A in patients with ASD. The degeneration of superior adjacent segment is closely related to the position of the pedicle screws

  6. Intra-operative computer navigation guided cervical pedicle screw insertion in thirty-three complex cervical spine deformities

    Directory of Open Access Journals (Sweden)

    S Rajasekaran

    2010-01-01

    Full Text Available Background: Cervical pedicle screw fixation is challenging due to the small osseous morphometrics and the close proximity of neurovascular elements. Computer navigation has been reported to improve the accuracy of pedicle screw placement. There are very few studies assessing its efficacy in the presence of deformity. Also cervical pedicle screw insertion in children has not been described before. We evaluated the safety and accuracy of Iso-C 3D-navigated pedicle screws in the deformed cervical spine. Materials and Methods: Thirty-three patients including 15 children formed the study group. One hundred and forty-five cervical pedicle screws were inserted using Iso-C 3D-based computer navigation in patients undergoing cervical spine stabilization for craniovertebral junction anomalies, cervico-thoracic deformities and cervical instabilities due to trauma, post-surgery and degenerative disorders. The accuracy and containment of screw placement was assessed from postoperative computerized tomography scans. Results: One hundred and thirty (89.7% screws were well contained inside the pedicles. Nine (6.1% Type A and six (4.2% Type B pedicle breaches were observed. In 136 levels, the screws were inserted in the classical description of pedicle screw application and in nine deformed vertebra, the screws were inserted in a non-classical fashion, taking purchase of the best bone stock. None of them had a critical breach. No patient had any neurovascular complications. Conclusion: Iso-C navigation improves the safety and accuracy of pedicle screw insertion and is not only successful in achieving secure pedicle fixation but also in identifying the best available bone stock for three-column bone fixation in altered anatomy. The advantages conferred by cervical pedicle screws can be extended to the pediatric population also.

  7. [Polymethylmethacrylate augmentation of bone cement-injectable cannulated pedicle screws for the treatment of degenerative lumbar diseases with osteoporosis].

    Science.gov (United States)

    Sun, H L; Li, C D; Yang, Z C; Yi, X D; Liu, H; Lu, H L; Li, H; Wang, Y

    2016-12-18

    To describe the application of polymethylmethacrylate augmentation of bone cement-injectable cannulated pedicle screws for the treatment of degenerative lumbar diseases with osteoporosis. Observation group included 14 cases of degenerative lumbar diseases with osteoporosis received polymethylmethacrylate augmentation of bone cement-injectable cannulated pedicle screws from November 2014 to July 2015, control group included 12 cases of degenerative lumbar diseases with osteoporosis received polymethylmethacrylate augmentation with traditional pedicle screws.The operation time, blood loss, number of pedicle screws and number of augmented pedicle screws in the two groups were compared. The bone cement leakage and pulmonary bone cement embolism in the two groups were also compared. The fusion rate and pedicle screws loosening by lumbar X ray and dynamic X ray were evaluated. The clinical results were assessed by visual analog scale (VAS) of pain on lumbar and lower limbers, lumbar Japanese Orthopaedic Association scores (JOA), Prolo functional scores and Oswestry disability (ODI) scores. Differences of operation time and blood loss in the two groups were not statistically significant. The average number of pedicle screws was 9.9±4.7 and the average number of augmented pedicle screws was 5.9±2.6 in observation group while the average number of pedicle screws was 7.1±2.8 and the average number of augmented pedicle screws was 3.0±1.9 in control group. The ratio of augmented pedicle screws was higher in observation group than in control group (0.69±0.30 vs.0.47±0.30,Pdegenerative lumbar diseases with osteoporosis was effective, with simple working processes and lower risk of bone cement leakage. The short-term clinical result was good.

  8. Individualized 3D printing navigation template for pedicle screw fixation in upper cervical spine.

    Directory of Open Access Journals (Sweden)

    Fei Guo

    Full Text Available Pedicle screw fixation in the upper cervical spine is a difficult and high-risk procedure. The screw is difficult to place rapidly and accurately, and can lead to serious injury of spinal cord or vertebral artery. The aim of this study was to design an individualized 3D printing navigation template for pedicle screw fixation in the upper cervical spine.Using CT thin slices data, we employed computer software to design the navigation template for pedicle screw fixation in the upper cervical spine (atlas and axis. The upper cervical spine models and navigation templates were produced by 3D printer with equal proportion, two sets for each case. In one set (Test group, pedicle screws fixation were guided by the navigation template; in the second set (Control group, the screws were fixed under fluoroscopy. According to the degree of pedicle cortex perforation and whether the screw needed to be refitted, the fixation effects were divided into 3 types: Type I, screw is fully located within the vertebral pedicle; Type II, degree of pedicle cortex perforation is 1 mm or with the poor internal fixation stability and in need of renovation. Type I and Type II were acceptable placements; Type III placements were unacceptable.A total of 19 upper cervical spine and 19 navigation templates were printed, and 37 pedicle screws were fixed in each group. Type I screw-placements in the test group totaled 32; Type II totaled 3; and Type III totaled 2; with an acceptable rate of 94.60%. Type I screw placements in the control group totaled 23; Type II totaled 3; and Type III totaled 11, with an acceptable rate of 70.27%. The acceptability rate in test group was higher than the rate in control group. The operation time and fluoroscopic frequency for each screw were decreased, compared with control group.The individualized 3D printing navigation template for pedicle screw fixation is easy and safe, with a high success rate in the upper cervical spine surgery.

  9. [Design and experimental study of individual drill templates for atlantoaxial pedicle screw fixation].

    Science.gov (United States)

    Qin, Wei; Quan, Zhengxue; Liu, Yang; Ou, Yunsheng

    2010-10-01

    To explore and evaluate the accuracy and feasibility of individual rapid prototype (RP) drill templates for atlantoaxial pedicle screw implantation. Volumetric CT scanning was performed in 8 adult cadaveric atlas and axis to collect Dicom format datas. Then three-dimensional (3D) images of atlas and axis were reconstructed and the parameters of pedicles of 3D model were measured by using software Mimics 10.01. The 3D model was saved by STL format in Mimics. The scattered point cloud data of 3D model were processed and the 3D coordinate system was located in software Imageware 12.1. The curves and surfaces of 3D model were processed in software Geomagic Studio 10. The optimal trajectory of pedicle screw was designed and a template was constructed which accorded with the anatomical morphology of posterior arch of atlas and lamina of axis by using software Pro/Engineer 4.0. The optimal trajectory of pedicle screw and the template were integrated into a drill template finally. The drill template and physical models of atlas and axis were manufactured by RP (3D print technology). The accuracy of pilot holes of drill templates was assessed by visually inspecting and CT scanning. The individual drill template was used conveniently and each template could closely fit the anatomical morphology of posterior arch of atlas and lamina of axis. Template loosening and shifting were not found in the process of screw implantation. Thirty-two pedicle screws were inserted. Imaging and visual inspection revealed that the majority of trajectories did not penetrate the pedicle cortex, only 1 cortical penetration was judged as noncritical and did not injury the adjacent spinal cord, nerve roots, and vertebral arteries. The accuracy of atlas pedicle screw was grade 0 in 15 screws and grade I in 1 screw, and the accuracy of axis pedicle screw was grade 0 in 16 screws. The potential of individual drill templates to aid implantation of atlantoaxial pedicle screw is promising because of its

  10. [Percutaneous transhepatic bilioplasty: long-term results].

    Science.gov (United States)

    Righi, D; Martina, M C; Tola, E; Fonio, P; Fronda, G R; Gandini, G

    1990-10-01

    We report the results of a long-term follow-up of 40/101 patients with benign biliary strictures treated with percutaneous balloon dilatation (PBD) at the Radiology Department of the University of Turin, from March 1983 to March 1990. We excluded all the patients who were not followed or treated after June 1988, being their follow-up shorter than 18 months. All patients underwent accurate clinical, biological (AST, ALT, gammaGT, alcaline phosphatase) and US controls. Mean follow-up was 33.5 months. Mean success rate was 75% in strictures of bilioenteric anastomosis, 86% in iatrogenic strictures of the common bile duct, 65% in sclerosing cholangitis, 80% in papillary strictures in which endoscopic treatment had not been possible for anatomical reasons. Our results, compared to the most important radiological and surgical series, show PBD to have lower morbidity than surgery and no mortality during the so-called peroperative period (30 days). Moreover, in case of recurrences, PBD can be repeated without further complications and does not affect eventual surgery.

  11. Percutaneous Nephrolithotomy for Paediatric Stone Disease

    Directory of Open Access Journals (Sweden)

    Hüseyin Çelik

    2015-06-01

    Full Text Available We evaluated the outcomes and complications occurring following percutaneous nephrolithotomy (PCNL procedures performed in paediatric patients. There were 291 paediatric patients (293 renal units included in the current study and who underwent PCNL in our clinic between March 1999 and December 2014. We evaluated stone burden, duration of surgery and complications, success (stone-free rate, residual fragments and auxilliary procedures, and follow-up details. The stone-free rate following PCNL was 88.3%. Early postoperative complications included excessive bleeding and transfusion in nine patients, and prolonged urinary extravasation following removal of the nephrostomy tube and requiring JJ stent placement in eight patients. The mean time to catheter removal was 2.8 days and the mean hospitalisation time was 3.5 days. The aim of kidney stone treatment is to achieve minimal kidney damage with the highest success rate. Therefore, minimally invasive procedures are important in the paediatric age group where life expectancy is high. PCNL is a safe and effective procedure for the treatment of kidney stones in children.

  12. Is percutaneous nephrolithotomy in solitary kidneys safe?

    Science.gov (United States)

    Wong, Kathie Alexina; Sahai, Arun; Patel, Amit; Thomas, Kay; Bultitude, Matthew; Glass, Jonathan

    2013-11-01

    To review our experience from a high volume stone center with a focus on efficacy, safety, and renal function. Stones requiring percutaneous nephrolithotomy (PCNL) in patients with solitary kidneys can pose significant anxiety to the urologist. Limited data are available in published reports in this setting. A comprehensive retrospective review of medical records was performed on patients who underwent PCNL and had a solitary kidney or a single functioning renal unit. Data were collected on patient demographics, stone burden, outcomes, complications, and renal function. Of 378 PCNLs performed between January 2003 and September 2011, 22 were performed in 17 patients with a single functioning kidney. Three procedures were performed in a transplanted kidney. In those with solitary calculus, the longest mean length and stone surface area were 37 mm and 825 mm(2), respectively. Stone-free rate was 59%. Auxiliary procedures were required in 6 cases, resulting in a stone-free rate of 77%. Median inpatient stay was 4 days. Serum creatinine values improved from 144 to 126 umol/L before and after the procedure and mean estimated glomerular filtration rate improved similarly from 51 to 59 mls/minute, respectively. Blood transfusion was required in 1 patient, sepsis developed in 3, and 2 patients required a stent for obstruction. PCNL in solitary kidneys is safe with an acceptable complication rate if performed in a high volume center. Outcomes are good, although auxiliary procedures may be necessary. Renal function remains stable or improves after procedure. Copyright © 2013 Elsevier Inc. All rights reserved.

  13. The Omental Pedicle Flap in Dogs Revised and Refined: A Cadaver Study.

    Science.gov (United States)

    Doom, Marjan; Cornillie, Pieter; Simoens, Paul; Huyghe, Stephanie; de Rooster, Hilde

    2016-08-01

    To expand current knowledge on the canine omental vasculature and refine the existing lengthening technique of the canine omentum. Ex vivo study. Canine cadavers (n=20). In 10 canine cadavers the omental arteries were mapped using intravascular latex injection and these results were used to create an omental pedicle flap based on the splenic artery in 10 additional cadavers. The operating range of the flap was recorded with particular attention to the main regions of interest for omental transposition in dogs (axillary and inguinal regions). The superficial and deep omental leaves were each predominantly supplied by a left and a right marginal omental artery that anastomosed near the caudal omental border into a superficial and a deep omental arch, respectively. Anastomoses between arteries of the superficial and the deep omental leaves were weak and inconsistent, except for 1 anastomosis that was found in 8 of 10 dogs. By transposing the intact omentum, the right axilla could be reached in 3 dogs, both axillae in 1 dog, and both groins in all cadavers. In all cases, the omental pedicle reached to and beyond the axillary and inguinal regions. By unfolding the pedicle leaves, the width of the pedicle tip could be doubled. When lengthening the omentum is necessary to reach extra-abdominal structures, the omental pedicle flap based on the splenic artery appears to preserve the omental vascular supply. These observations warrant further clinical trials to evaluate this new omtental flap technique in vivo. © Copyright 2016 by The American College of Veterinary Surgeons.

  14. [A method to avoid the fixator failure by using pedicle screw combined vertebroplasty for spine fractures].

    Science.gov (United States)

    Tao, Sheng; Mao, Ke-ya; Liu, Bao-wei; Wang, Yan; Liang, Yu-tian; Tang, Pei-fu; Wang, Hui-xian

    2006-08-15

    To study a new implant material (carbonated hydroxyapatite, CHA) united pedicle screw to cure spine fracture. Thirty-two cases of spine compressed fracture were used with pedicle screw fixator and vertebroplasty. Before operation, patients' vertebral body were compressed (46 + 21)% (20% approximately 70%) on average. In operation, broken vertebral body was reposition through pedicle screw technique, then used self-made syringe to inject CHA into anterior and central column of broken vertebral body through pedicle. And all of patients were not given any bone-graft. In 6 - 26 months followed-up, no immunologic rejection was found about hydroxyapatite, and no any broken of the screws and shafts was found, no loosing and other complications either. All the patients could move in 3 - 5 days after operation. The height of the broken vertebral body were reduced 97% compared with pre-operation. And CHA in vertebral body was degraded gradually, and at the same time it was replace by new bone in vertebral body. After operation, VAS score was 61 +/- 32, and there was significant difference compared with pre-operation. The pedicle screw fixation united vertebroplasty is an efficient way to prevent the failure of the treatment of spine fracture.

  15. L5 pedicle subtraction osteotomy for high-grade isthmic spondylolisthesis.

    Science.gov (United States)

    Radcliff, Kristen E; Jakoi, Andre M

    2015-04-01

    To the authors' knowledge, this is the first article to present a pedicle subtraction osteotomy in the lumbar spine to correct and stabilize a high-grade isthmic spondylolisthesis, which poses many challenges with regard to treatment options and outcomes. The optimal surgical treatment for high-grade spondylolisthesis is controversial, but the goals of treatment are to stabilize the affected spinal levels and to decompress the neural elements. A pedicle subtraction osteotomy is a reconstructive procedure that addresses fixed sagittal imbalance by increasing lumbar lordosis through posterior spinal column shortening. The authors report a 46-year-old patient with chronic, progressively worsening back and leg radiculopathy accompanied by sagittal plane malalignment and for which a pedicle subtraction osteotomy was performed. The procedure yielded stabilization of the patient's lumbar spondylolisthesis and sagittal plane alignment was restoration. At 3 months postoperatively, the patient's pain had fully resolved and her motor and neurologic examination exhibited no deficits. At 24 months postoperatively, she was still symptom-free and ambulating without assistance. This report is the first documented successful pedicle subtraction osteotomy in the treatment of high-grade spondylolisthesis. This report indicates that certain patient populations may be amenable to pedicle subtraction osteotomy as a treatment option for pathology involving high-grade isthmic spondylolisthesis. Copyright 2015, SLACK Incorporated.

  16. A novel entry point for pedicle screw placement in the thoracic spine.

    Science.gov (United States)

    Sun, Zhi-Feng; Yang, Kai-Xiang; Chen, Hong-Tao; Sui, Tao; Yang, Lei; Ge, Da-Wei; Tang, Jian; Cao, Xiao-Jian

    2017-09-03

    This study was aimed to introduce a novel entry point for pedicle screw fixation in the thoracic spine and compare it with the traditional entry point. A novel entry point was found with the aim of improving accuracy, safety and stability of pedicle screw technique based on anatomical structures of the spine. A total of 76 pieces of normal thoracic CT images at the transverse plane and the thoracic pedicle anatomy of 6 cadaveric specimens were recruited. Transverse pedicle angle (TPA), screw length, screw placement accuracy rate and axial pullout strength of the two different entry point groups were compared. There were significant differences in the TPA, screw length, and the screw placement accuracy rate between the two groups (Pentry point group was slightly larger than that of the traditional group. However, the difference was not significant (P>0.05). The novel entry point significantly improved the accuracy, stability and safety of pedicle screw placement. With reference to the advantages above, the new entry point can be used for spinal internal fixations in the thoracic spine.

  17. Obstructive jaundice: a comparative study of forceps and brush biopsy under percutaneous transhepatic cholangiography

    International Nuclear Information System (INIS)

    Li Yongdong; Han Xinwei; Wu Gang; Ma Bo; Xing Gusheng

    2004-01-01

    Objective: To compare the sensitivity between forceps biopsy and brushing, and to explore a feasible approach to pathological diagnosis of the obstructive jaundice. Methods: 92 consecutive patients with obstructive jaundice underwent transluminal forceps biopsy and brushing during percutaneous transhepatic cholangiography and percutaneous transhepatic cholangiodrainage. The technique was performed through a preexisting percutaneous transhepatic tract with multiple specimens obtained after passing the forceps biopsy or brush into a 8-French sheath. Finally the specimens were fixed with formalin for pathologic or cytologic diagnosis. Results: The histopathologic diagnosis was acquired in 81 out of 92 patients with forceps biopsy reaching the successful rate of 97.83%. Sensitivity of forceps biopsy in 92 patients was higher than that of brush in 84 patients (88.04% vs 76.19% χ 2 =4.251, P= <0.05). Conclusions: Percutaneous transhepatic cholangiobiopsy is a simple technique with minimal invasion, high sensitivity and worthy to be used spread extensively. Percutaneous transluminal brush cytology is also an useful method for establishing a diagnosis of cholangiocarcinoma. (authors)

  18. Feasibility and effectiveness of image-guided percutaneous biopsy of the urinary bladder.

    Science.gov (United States)

    Butros, Selim Reha; McCarthy, Colin James; Karaosmanoğlu, Ali Devrim; Shenoy-Bhangle, Anuradha S; Arellano, Ronald S

    2015-08-01

    To evaluate the indications, technique, results, and complications of image-guided percutaneous biopsy of the urinary bladder. This retrospective study included 15 patients (10 male, 5 female) who underwent image-guided percutaneous biopsy of the urinary bladder between January 1999 and December 2013. The medical records, imaging studies, procedural details, and long-term follow-up of each patient were reviewed in detail to assess the feasibility of percutaneous bladder biopsy. Ten patients had focal bladder masses and 5 patients had asymmetric or diffuse bladder wall thickening. Eleven patients had either negative or unsatisfactory cystoscopies prior to the biopsy. Percutaneous biopsies were performed under computed tomography guidance in 12 patients and ultrasound in 3 patients. All procedures were technically successful and there were no procedural complications. Malignancy was confirmed in 8 patients, among whom 6 had transitional cell carcinoma, 1 cervical cancer, and 1 prostate cancer metastasis. Seven patients had a benign diagnosis, including 3 that were later confirmed by pathology following surgery and 2 patients with a false-negative result. The overall sensitivity was 80% and accuracy was 87%. Image-guided percutaneous biopsy of the urinary bladder is a safe and technically feasible procedure with a high sensitivity and accuracy rate. Although image-guided bladder biopsy is an uncommon procedure, it should be considered in selected cases when more traditional methods of tissue sampling are either not possible or fail to identify abnormalities detected by cross-sectional imaging.

  19. Percutaneous Cholecystostomy for Patients with Acute Cholecystitis and an Increased Surgical Risk

    International Nuclear Information System (INIS)

    Overhagen, Hans van; Meyers, Hjalmar; Tilanus, Hugo W.; Jeekel, Johannes; Lameris, Johan S.

    1996-01-01

    Purpose: To evaluate percutaneous cholecystostomy in patients with acute cholecystitis and an increased surgical risk. Methods: Thirty-three patients with acute cholecystitis (calculous, n= 22; acalculous, n= 11) underwent percutaneous cholecystostomy by means of a transhepatic (n= 21) or transperitoneal (n= 12) access route. Clinical and laboratory parameters were retrospectively studied to determine the benefit from cholecystostomy. Results: All procedures were technically successful. Twenty-two (67%) patients improved clinically within 48 hr; showing a significant decrease in body temperature (n= 13), normalization of the white blood cell count (n= 3), or both (n= 6). There were 6 (18%) minor/moderate complications (transhepatic access, n= 3; transperitoneal access, n= 3). Further treatment for patients with calculous cholecystitis was cholecystectomy (n= 9) and percutaneous and endoscopic stone removal (n= 8). Further treatment for patients with acalculous cholecystitis was cholecystectomy (n= 2) and gallbladder ablation (n= 2). There were 4 deaths (12%) either in hospital or within 30 days of drainage; none of the deaths was procedure-related. Conclusions: Percutaneous cholecystostomy is a safe and effective procedure for patients with acute cholecystitis. For most patients with acalculous cholecystitis percutaneous cholecystostomy may be considered a definitive therapy. In calculous disease this treatment is often only temporizing and a definitive surgical, endoscopic, or radiologic treatment becomes necessary

  20. Percutaneous Aspiration Embolectomy Using Guiding Catheter for the Superior Mesenteric Artery Embolism

    Science.gov (United States)

    Choi, Kyu Sung; Kim, Ji Dae; Min, Sang-Il; Min, Seung-Kee; Jae, Hwan Jun; Chung, Jin Wook

    2015-01-01

    Objective To evaluate the technical feasibility and clinical outcome of percutaneous aspiration embolectomy for embolic occlusion of the superior mesenteric artery (SMA). Materials and Methods Between January 2010 and December 2013, 9 patients with embolic occlusion of the SMA were treated by percutaneous aspiration embolectomy in 2 academic teaching hospitals. The aspiration embolectomy procedure was performed with the 6-Fr and 7-Fr guiding catheter. Thrombolysis was performed with urokinase using a multiple-sidehole infusion catheter. The clinical outcome was investigated retrospectively. Results Superior mesenteric artery occlusion was initially diagnosed by computed tomography (CT) in all patients, and all patients had no obvious evidence of bowel infarction on CT scan. Percutaneous aspiration embolectomy was primarily performed in 6 patients, and thrombolysis was initially performed in 3 patients. In 3 patients who received primary thrombolysis, percutaneous aspiration was undertaken because the emboli were resistant to urokinase. Complete angiographic success was achieved in 6 patients and partial angiographic success was accomplished in 3 patients. One patient underwent bowel resection. One patient died of whole bowel necrosis and sepsis, and 8 patients survived without complications. Conclusion Percutaneous aspiration embolectomy is a useful tool in recanalization of embolic occlusion of the SMA in select patients. PMID:26175572

  1. Percutaneous tracheostomy: a comprehensive review

    Science.gov (United States)

    Rashid, Ashraf O.

    2017-01-01

    Tracheostomy is a common procedure. It can be done surgically or percutaneously by dilating the stoma using Seldinger technique. Percutaneous tracheostomy (PT) is now routinely performed by surgeons and non-surgeons such as intensivists and anesthesiologists in the intensive care units (ICU) all over the world. Although obesity, emergent tracheostomy, coagulopathy, inability to extend the neck and high ventilator demand (HVD) were initially thought to be a relative contraindication, recent data suggest safety of PT in these patient population. Ultrasound can be helpful in limited cases to identify the neck structure especially in patients with a difficult anatomy. Bronchoscopy during PT can shorten the duration and avoid complications. PT has favorable complication rate, lower infection rate, shorter procedural duration and is cost-effective. Experience with the technique and careful planning is needed to minimize any avoidable potential complication. PMID:29214070

  2. Percutaneous cryoablation for hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    Kyoung Doo Song

    2016-12-01

    Full Text Available Local ablation therapy is considered as a conventional treatment option for patients with early stage hepatocellular carcinoma (HCC. Although radiofrequency (RF ablation is widely used for HCC, the use of cryoablation has been increasing as newer and safer cryoablation systems have developed. The thermodynamic mechanism of freezing and thawing used in cryoablation is the Joule-Thomson effect. Cryoablation destroys tissue via direct tissue destruction and vascular-related injury. A few recent comparative studies have shown that percutaneous cryoablation for HCCs is comparable to percutaneous RF ablation in terms of long term therapeutic outcomes and complications. Cryoablation has several advantages over RF ablation such as well visualization of iceball, no causation of severe pain, and lack of severe damage to great vessels and gallbladder. It is important to know the advantages and disadvantages of cryoablation compared with RF ablation for improvement of therapeutic efficacy and safety.

  3. Percutaneous Fixation of Displaced Calcaneal Fracture

    Directory of Open Access Journals (Sweden)

    Yeung Yip-Kan

    2011-06-01

    Conclusion: Percutaneous fixation of displaced tongue-type calcaneal fractures is an effective treatment with acceptable clinical outcome, short hospital stay, minimal skin complications, and quick recovery.

  4. CT-guided percutaneous drainage within intervertebral space for pyogenic spondylodiscitis with psoas abscess

    Energy Technology Data Exchange (ETDEWEB)

    Matsumoto, Tomohiro; Morishita, Hiroyuki; Lida, Shigeharu; Asai, Shunsuke; Masui, Koji; Sato, Osamu (Department of Diagnostic Radiology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto (Japan)), Email: t-matsu@koto.kpu-m.ac.jp; Yamagami, Takuji; Nishimura, Tsunehiko (Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto (Japan)); Yamazoe, Shoichi (Department of Orthopedic Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto (Japan))

    2012-02-15

    Background. Reports on CT-guided percutaneous drainage within the intervertebral space for pyogenic spondylodiscitis with a secondary psoas abscess are limited. Purpose. To evaluate CT-guided percutaneous drainage within the intervertebral space for pyogenic spondylodiscitis and a secondary psoas abscess in which the two sites appear to communicate. Material and Methods. Eight patients with pyogenic spondylodiscitis and a secondary psoas abscess showing communication with the intradiscal abscess underwent CT-guided percutaneous drainage within the intervertebral space. The clinical outcome was retrospectively assessed. Results. An 8-French pigtail catheter within the intervertebral space was successfully placed in all patients. Seven patients responded well to this treatment. The one remaining patient who had developed septic shock before the procedure died on the following day. The mean duration of drainage was 32 days (13-70 days). Only one patient with persistent back pain underwent surgery for stabilization of the spine after the improvement of inflammation. Among seven patients responding well, long-term follow-up (91-801 days, mean 292 days) was conducted in six patients excluding one patient who died of asphyxiation due to aspiration unrelated to the procedure within 30 days after the procedure. In these six patients, no recurrence of either pyogenic spondylodiscitis or the psoas abscess was noted. Conclusion. CT-guided percutaneous drainage within the intervertebral space can be effective for patients with pyogenic spondylodiscitis and a secondary psoas abscess if the psoas abscess communicates with the intradiscal abscess

  5. Prevalence of patent foramen ovale and usefulness of percutaneous closure device in carcinoid heart disease.

    Science.gov (United States)

    Mansencal, Nicolas; Mitry, Emmanuel; Pillière, Rémy; Lepère, Céline; Gérardin, Benoît; Petit, Jérôme; Gandjbakhch, Iradj; Rougier, Philippe; Dubourg, Olivier

    2008-04-01

    The aim of this study was to assess (1) the incidence of patent foramen ovale (PFO) in carcinoid syndrome (CS) and (2) the feasibility of percutaneous closure procedure in selected patients with CS. One hundred eight patients were prospectively studied: 54 with CS and an age- and gender-matched control group. All patients underwent conventional and contrast echocardiography. Patients with clinical signs of dyspnea (New York Heart Association class > or =III), cyanosis, carcinoid heart disease (CHD), and severe PFO were referred for the percutaneous closure of PFO. The prevalence of PFO was 41% in patients with CS and 22% in the control group (p = 0.03) and was significantly higher in patients with CHD (59%, p = 0.009). Four patients (14% of those with CHD) were referred for the percutaneous closure of PFO, and 3 patients ultimately underwent PFO closure (using Amplatzer septal occluders). At 6-month follow-up, New York Heart Association class was improved in all patients, as well as arterial blood gas results (p = 0.04) and 6-minute walking distance (p = 0.03), but all patients presented residual right-to-left shunts. In conclusion, this prospective study demonstrates that in patients with CHD, the prevalence of PFO is high and that percutaneous closure of PFO is feasible, with a reduction in symptoms but with residual shunting.

  6. Percutaneous transhepatic cholecystostomy for choledocholithiasis with acute cholangitis in high-risk patients.

    Science.gov (United States)

    Ren, Zuhai; Xu, Yong; Zhu, Shaihong

    2012-01-01

    To evaluate the safety and feasibility of percutaneous transhepatic cholecystostomy for choledocholithiasis with acute cholangitis in high-risk patients. Six high-risk patients of choledocholithiasis complicated with moderate to severe acute cholangitis underwent percutaneous transhepatic cholecystostomy and subsequent interval open surgery from January, 2008 to October 2010. These patients, who were not suitable for both endoscopic and transhepatic biliary drainage, were reviewed retrospectively. Percutaneous transhepatic cholecystostomy was performed uneventfully. One patient developed hemoperitoneum which was successfully controlled by conservative treatment. Biliary peritonitits occurred in two patients, one ceased to leak spontaneously, the other developed a biloma which was cured by repuncture. No procedure-related death occurred. Sepsis was relieved completely 3 to 4 days after procedure. Two patients underwent interval open exploration of the common bile duct. One patient who recovered from sepsis succumbed on day 12 post-cholecystostomy because of an acute cardiac infarct. The other 3 patients were cured of sepsis and discharged without further treatment. The results showed that ultrasound-guided percutaneous transhepatic cholecystostomy is a safe and effective procedure for choledocholithiasis with moderate to severe acute cholangitis in highly selected high-risk surgical patients. It may deserve to become a definitive therapy for subsequent surgical management. Larger controlled studies are needed to further confirm our findings.

  7. Identifying pathogens of spondylodiscitis: percutaneous endoscopy or CT-guided biopsy.

    Science.gov (United States)

    Yang, Shih-Chieh; Fu, Tsai-Sheng; Chen, Lih-Huei; Chen, Wen-Jer; Tu, Yuan-Kun

    2008-12-01

    Identifying offending pathogens is crucial for appropriate antibiotic administration for infectious spondylitis. Although computed tomography (CT)-guided biopsy for bacteriologic diagnosis is a standard procedure, it has a variable success rate. Some reports claim percutaneous endoscopic discectomy and drainage offer a sufficient amount of tissue for microbiologic examination and easy application. We therefore compared the diagnostic value of CT guidance with that of endoscope guidance in 52 patients with suspected infectious spondylitis. Twenty patients underwent percutaneous endoscopic discectomy and drainage by an orthopaedic surgeon and the other 32 patients underwent CT-guided biopsies by a radiologist. Patients were followed a minimum of 12 months after treatment. Culture results of the biopsy specimens were recorded. Causative bacteria were identified more frequently with percutaneous endoscopy than in CT-guided biopsy (18 of 20 [90%] versus 15 of 32 [47%]). We observed no biopsy-related complications or side effects in either group. The data suggest percutaneous endoscopic discectomy and drainage yield higher bacterial recovery rates than CT-guided spinal biopsy. Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

  8. A prospective study of percutaneous vertebroplasty in patients with myeloma and spinal metastases

    International Nuclear Information System (INIS)

    Chew, C.; Ritchie, M.; O’Dwyer, P.J.; Edwards, R.

    2011-01-01

    Aim: To assess patient outcome in a consecutive series of patients with myeloma and spinal metastases who underwent percutaneous vertebroplasty. Materials and methods: Data were gathered prospectively on all patients undergoing percutaneous vertebroplasty between June 2001 and June 2010. Outcome measures included visual analogue pain scores (VAS) and Roland–Morris Questionnaire (RMQ) in patients treated since 2005 as well as complications and long-term outcome in all patients. Results: One hundred and twenty-eight patients underwent percutaneous vertebroplasty for myeloma (n = 41) or spinal metastases (n = 87) over a 9 year period. VAS scores fell from 7.75 ± 1.88 pre-vertebroplasty to 4.77 ± 2.69 post-vertebroplasty (p = 0.001). RDQ scores improved from 18.55 ± 4.79 to 13.5 ± 6.96 (p = 0.001). Complications were recorded in three patients: cement extension to vena cava (n = 1), local haematoma (n = 1), and loss of sensation over T1 dermatome (n = 1). The Kaplan–Meier estimate of 5 year survival post-vertebroplasty was 40% for patients with myeloma and 25% for those with metastases. Conclusion: This large prospective study demonstrates percutaneous vertebroplasty reduces pain and improves disability in patients from intractable pain from myeloma or spinal metastases and now forms an important part of the multimodality treatment for these patients.

  9. Nephrostomy in percutaneous nephrolithotomy (PCNL)

    DEFF Research Database (Denmark)

    Cormio, Luigi; Preminger, Glenn; Saussine, Christian

    2013-01-01

    PURPOSE: To explore the relationships between nephrostomy tube (NT) size and outcome of percutaneous nephrolithotomy (PCNL). METHODS: The Clinical Research Office of the Endourological Society (CROES) prospectively collected data from consecutive patients treated with PCNL over a 1-year period at......; nephrostomy size > 18 Fr) NT. RESULTS: Patients who received a LB NT had a significantly lower rate of hemoglobin reduction (3.0 vs. 4.3 g/dL; P ...

  10. Biomechanical efficacy of monoaxial or polyaxial pedicle screw and additional screw insertion at the level of fracture, in lumbar burst fracture: An experimental study

    Directory of Open Access Journals (Sweden)

    Hongwei Wang

    2012-01-01

    Conclusions: The addition of intermediate screws at the level of a burst fracture significantly increased the stability of short-segment pedicle screw fixation in both the MPS and PPS groups. However, in short-segment fixation group, monoaxial pedicle screw exhibited more stability in flexion and extension than the polyaxial pedicle screw.

  11. Percutaneous transhepatic portacaval shunt (PTPS)

    International Nuclear Information System (INIS)

    Chu Jianguo; Sun Xiaoli; Lv Chunyan; Xu Xiaoming; Huang He; Yang Shuhui; Zhou Hua

    2005-01-01

    Objective: To present a latest procedures for portal hypertension with preliminary results and evaluate the technical feasibility and efficacy of the portacaval shunt creation through percutaneous transhepatic approach with its potential clinical significance. Methods: Nineteen patients with portal hypertension (17 men; mean age 57 years, range 32-73) were referred for PTPS procedure because of bleeding varices (n=16), intractable ascites (n=2), and hepatopulmonary syndrome (n=1). The severity of liver disease was Child's B in 4 and Child's C in 15. The PTPS was created by a percutaneous transhepatic puncture through left portal vein to the IVC and a polytetrafluoroethylene (PTFE) stent-grafts was placed through a transhepatic approach. Results: Technical and functional successes were achieved in all patients-arerage without any procedure-related complications. The postprocedural portal vein-IVC gradients decreased with a mean 13 cmH 2 O and with average 216 days of follow-up showing no recurrent variceal bleeding and refractory ascites. The primary patency ratefor 365 days was 94.8%, obviously higher than classical TIPS. Conclusions: Portacaval shunt creation using the percutaneous transhepatic technique is secure and feasible with favorable primary patency due to the a straight line shunt construction and provide a good alternative to the standard portosystemic shunt in difficult or impossible circumstances. (authors)

  12. [Analysis of clinical effects of percutaneous vertebroplasty and percutaneous kyphoplasty in treating osteoporotic vertebral compression fracture].

    Science.gov (United States)

    Wu, Yao; Wang, Feng; Zhou, Jian-Qiang; Liu, Cai-Yun; Wu, Rui-Xing

    2014-05-01

    To explore the clinical outcomes of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in treating osteoporotic vertebral compression fracture (OVCF). From January 2007 to February 2010, the data of 40 patients with osteoporotic vertebral compression fracture underwent treatment were retrospectively analyzed. Of them,20 patients were treated with PVP (PVP group), there were 8 males and 12 females with an average age of (66.37 +/- 2.34) years old (54 to 81); 20 patients were treated with PKP (PKP group), there were 11 males and 9 females with an average of (65.12 +/- 3.21) years old (56 to 79). Postoperative at 1 week, 12 weeks, 1 year, pain and daily life function were respectively assessed by visual analogue scale (VAS) and Barthel index (BI); and anterior height of responsibility vertebra, Cobb angle were measured by X-rays. In PVP group, 1 case complicated with bone cement leakage without clinical symptoms and no operation to treat. No postoperative infection and deep vein thrombosis were found between two groups. All patients were followed up more than 1 year, pain and daily life function has obviously improved than preoperative (P 0.05); there was no significant difference between two groups (P > 0.05). In PVP group, there was no significant difference in anterior height of responsibility vertebra, Cobb angle before and after operation;and in PKP group, postoperative data has obviously improved than preoperative (P 0.05); there was no significant difference between two groups at 1 week, 12 weeks, 1 year after operation. Both the methods can obviously relieve pain and completely or partly recover daily life function in treating OVCF. But PKP has advantages of recovery of anterior height of responsibility vertebra and correction of Cobb angle, especially for serious compression.

  13. A Computed Tomography-Based Comparison of Abnormal Vertebrae Pedicles Between Dystrophic and Nondystrophic Scoliosis in Neurofibromatosis Type 1.

    Science.gov (United States)

    Li, Ying; Luo, Ming; Wang, Wengang; Shen, Mingkui; Xu, Genzhong; Gao, Jianbo; Xia, Lei

    2017-10-01

    To explore the prevalence and distribution of abnormal vertebral pedicles in scoliosis secondary to neurofibromatosis type 1 (NF1-S) and to compare the abnormal vertebrae pedicles between dystrophic and nondystrophic scoliosis. Using computed tomography images, we carefully measured 2652 vertebral pedicles from 56 patients with NF1-S with dystrophic scoliosis and 22 patients with NF1-S with nondystrophic scoliosis. Pedicle morphology was classified as follows: type A, a cancellous channel of >4 mm; type B, a cancellous channel of 2 to 4 mm; type C, a cancellous channel of scoliosis compared with nondystrophic scoliosis (70% vs. 59%, P scoliosis compared with nondystrophic ones. The described pedicle classification system could serve as an objective tool to guide preoperative assessment. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Safety and esthetic outcomes of therapeutic mammoplasty using medial pedicle for early breast cancer

    Science.gov (United States)

    Roshdy, Sameh; Hussein, Osama; Khater, Ashraf; Zuhdy, Mohammad; El-Hadaad, Hend A; Farouk, Omar; Senbel, Ahmad; Fathi, Adel; Hamed, Emadeldeen; Denewer, Adel

    2015-01-01

    Background Although therapeutic mammoplasty (TM) was introduced for treatment of localized ductal carcinoma in situ and invasive breast carcinoma (stages I and II) in females with large breast size, the suitability of medial pedicle TM for treatment of breast tumors at different locations has not been established. The objective of this study was to assess the safety and esthetic outcome of medial pedicle TM for breast tumors at different locations. Methods The study was conducted from February 2012 to July 2014. Consecutive patients with early breast carcinoma with medium- and large-sized breasts, with or without ptosis, who were offered medial pedicle TM were included in the study. Patients who were not candidates for breast-conserving surgery or those with tumors located along the medial pedicle were excluded. All patients received immediate postoperative adjuvant chemoradiotherapy. Results Thirty patients with a mean age of 48.5 years received medial pedicle TM in the breast harboring the tumor or, additionally, the other breast (N=14). The tumors were in the upper (60.0%), lower (26.7%), and lateral (13.3%) quadrants. Minor complications occurred in five cases (5/30, 16.7%) in the ipsilateral and in two (2/14, 14.3%) contralateral breasts. No wound dehiscence or areolar necrosis was recorded. A total of 22 (73.3%) patients were scored as excellent cosmesis. After a median follow-up of 20 months, no locoregional recurrence or distant metastases were observed. Conclusion TM using a medial pedicle is a safe and appealing technique among women with tumors at different locations. PMID:26185469

  15. Risk factors for pedicled flap necrosis in hand soft tissue reconstruction: a multivariate logistic regression analysis.

    Science.gov (United States)

    Gong, Xu; Cui, Jianli; Jiang, Ziping; Lu, Laijin; Li, Xiucun

    2018-03-01

    Few clinical retrospective studies have reported the risk factors of pedicled flap necrosis in hand soft tissue reconstruction. The aim of this study was to identify non-technical risk factors associated with pedicled flap perioperative necrosis in hand soft tissue reconstruction via a multivariate logistic regression analysis. For patients with hand soft tissue reconstruction, we carefully reviewed hospital records and identified 163 patients who met the inclusion criteria. The characteristics of these patients, flap transfer procedures and postoperative complications were recorded. Eleven predictors were identified. The correlations between pedicled flap necrosis and risk factors were analysed using a logistic regression model. Of 163 skin flaps, 125 flaps survived completely without any complications. The pedicled flap necrosis rate in hands was 11.04%, which included partial flap necrosis (7.36%) and total flap necrosis (3.68%). Soft tissue defects in fingers were noted in 68.10% of all cases. The logistic regression analysis indicated that the soft tissue defect site (P = 0.046, odds ratio (OR) = 0.079, confidence interval (CI) (0.006, 0.959)), flap size (P = 0.020, OR = 1.024, CI (1.004, 1.045)) and postoperative wound infection (P < 0.001, OR = 17.407, CI (3.821, 79.303)) were statistically significant risk factors for pedicled flap necrosis of the hand. Soft tissue defect site, flap size and postoperative wound infection were risk factors associated with pedicled flap necrosis in hand soft tissue defect reconstruction. © 2017 Royal Australasian College of Surgeons.

  16. Biomechanical comparison of sagittal-parallel versus non-parallel pedicle screw placement.

    Science.gov (United States)

    Farshad, Mazda; Farshad-Amacker, Nadja A; Bachmann, Elias; Snedeker, Jess G; Schmid, Samuel L

    2014-11-01

    While convergent placement of pedicle screws in the axial plane is known to be more advantageous biomechanically, surgeons intuitively aim toward a parallel placement of screws in the sagittal plane. It is however not clear whether parallel placement of screws in the sagittal plane is biomechanically superior to a non-parallel construct. The hypothesis of this study is that sagittal non-parallel pedicle screws do not have an inferior initial pull-out strength compared to parallel placed screws. The established lumbar calf spine model was used for determination of pull-out strength in parallel and non-parallel intersegmental pedicle screw constructs. Each of six lumbar calf spines (L1-L6) was divided into three levels: L1/L2, L3/L4 and L5/L6. Each segment was randomly instrumented with pedicle screws (6/45 mm) with either the standard technique of sagittal parallel or non-parallel screw placement, respectively, under fluoroscopic control. CT was used to verify the intrapedicular positioning of all screws. The maximum pull-out forces and type of failure were registered and compared between the groups. The pull-out forces were 5,394 N (range 4,221 N to 8,342 N) for the sagittal non-parallel screws and 5,263 N (range 3,589 N to 7,554 N) for the sagittal-parallel screws (p = 0.838). Interlevel comparisons also showed no statistically significant differences between the groups with no relevant difference in failure mode. Non-parallel pedicle screws in the sagittal plane have at least equal initial fixation strength compared to parallel pedicle screws in the setting of the here performed cadaveric calf spine experiments.

  17. Usefulness and radiological evaluation of accuracy of innovative "Smart" hand technique for pedicle screw placement: an anatomical study.

    Science.gov (United States)

    Comert, Ayhan; Dogan, İhsan; Çaglar, Y Sukru

    2017-11-01

    The aim of this study is to use a smartphone application during pedicle screw placement navigation and examine the accuracy of this application on anatomical dry vertebrae model. 76 dry vertebrae were used for this study and pedicle entry points, projections of pedicle screw trajectory lines in lateral and superior aspect of vertebral body were identified and drawn for each vertebra bilaterally. In each position, all angulations were measured directly before the procedure manually. 152 pedicle screws were inserted as a simulation of screw placement with the guidance of angle-meter smart app. Accuracy of the method was tested according to the occurrence of bone penetration and angular deviation of the inserted screws was evaluated in computed tomography images. Mean deviation of pedicle screws of 76 pedicle screws in right side in horizontal plane was measured 2.30°±1.78°; in sagittal plane 2.17°±1.57° and in left side in horizontal plane 3.01°±1.83°; in sagittal plane 2.38°±1.68°. No bone penetration was occurred during 152 pedicle screw placements. According to the t-test results, there were significant differences between two groups in craniocaudal direction of the right side pedicle screws and in craniocaudal direction of left side pedicle screws. The free smartphone application presented here as angle-meter can be interpreted as a safe digital device for spinal instrumentation procedures. As a prototype of future pedicle screw fixation systems, it should be improved in terms of its feasibility and compatibility with screw probes. This may lead to apply mobile digital angle meter in spinal procedure.

  18. Phalloplasty with an Innervated Island Pedicled Anterolateral Thigh Flap in a Female-to-Male Transsexual

    OpenAIRE

    Hasegawa, Kenjiro; Namba, Yuzaburo; Kimata, Yoshihiro

    2013-01-01

    Since 2001, we have been performing phalloplasty with a radial forearm free flap as the flap of first choice in female-to-male transsexuals (FTMTS). In the present case, a 22-year-old FTMTS with a negative Allen test, we achieved good results by performing phalloplasty with an innervated island pedicled anterolateral thigh flap using the "tube within a tube" technique, in which the penis and urethra are constructed with a single flap. While phalloplasty with an island-pedicled or free anterol...

  19. Image-guided percutaneous disc sampling: impact of antecedent antibiotics on yield

    International Nuclear Information System (INIS)

    Agarwal, V.; Wo, S.; Lagemann, G.M.; Tsay, J.; Delfyett, W.T.

    2016-01-01

    Aim: To evaluate the effect of antecedent antimicrobial therapy on diagnostic yield from percutaneous image-guided disc-space sampling. Materials and methods: A retrospective review of the electronic health records of all patients who underwent image-guided percutaneous sampling procedures for suspected discitis/osteomyelitis over a 5-year period was performed. One hundred and twenty-four patients were identified. Demographics, medical history, and culture results were recorded as well as duration of presenting symptoms and whether antecedent antibiotic therapy had been administered. Results: Of the 124 patients identified who underwent image-guided percutaneous disc-space sampling, 73 had received antecedent antibiotic treatment compared with 51 who had not. The overall positive culture rate for the present study population was 24% (n=30). The positive culture rate from patients previously on antibiotics was 21% (n=15) compared with 29% (n=15) for patients who had not received prior antibiotic treatment, which is not statistically significant (p=0.26). Eighty-six percent (n=63) of patients who had antecedent antibiotics received treatment for 4 or more days prior to their procedure, whereas 14% (n=10) received treatment for 1–3 days prior to their procedure. The difference in culture positivity rate between these two groups was not statistically significant (p=0.43). Culture results necessitated a change in antibiotic therapy in a third of the patients who had received antecedent antibiotic therapy. Conclusion: Antecedent antibiotic therapy, regardless of duration, did not result in significantly diminished diagnostic yield from percutaneous sampling for suspected discitis/osteomyelitis. The present results suggest that percutaneous biopsy may nonetheless yield positive diagnostic information despite prior antimicrobial therapy. If the diagnostic information may impact choice of therapeutic regimen, percutaneous biopsy should still be considered in cases where

  20. Incidence and Management of Bleeding Complications Following Percutaneous Radiologic Gastrostomy

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Nieun; Shin, Ji Hoon; Ko, Gi Young; Yoon, Hyun Ki; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu Bo [Asan Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2012-03-15

    Upper gastrointestinal (GI) bleeding is a serious complication that sometimes occurs after percutaneous radiologic gastrostomy (PRG). We evaluated the incidence of bleeding complications after a PRG and its management including transcatheter arterial embolization (TAE). We retrospectively reviewed 574 patients who underwent PRG in our institution between 2000 and 2010. Eight patients (1.4%) had symptoms or signs of upper GI bleeding after PRG. The initial presentation was hematemesis (n = 3), melena (n = 2), hematochezia (n = 2) and bloody drainage through the gastrostomy tube (n = 1). The time interval between PRG placement and detection of bleeding ranged from immediately after to 3 days later (mean: 28 hours). The mean decrease in hemoglobin concentration was 3.69 g/dL (range, 0.9 to 6.8 g/dL). In three patients, bleeding was controlled by transfusion (n = 2) or compression of the gastrostomy site (n = 1). The remaining five patients underwent an angiography because bleeding could not be controlled by transfusion only. In one patient, the bleeding focus was not evident on angiography or endoscopy, and wedge resection including the tube insertion site was performed for hemostasis. The other four patients underwent prophylactic (n = 1) or therapeutic (n = 3) TAEs. In three patients, successful hemostasis was achieved by TAE, whereas the remaining one patient underwent exploration due to persistent bleeding despite TAE. We observed an incidence of upper GI bleeding complicating the PRG of 1.4%. TAE following conservative management appears to be safe and effective for hemostasis.

  1. Percutaneous transhepatic recanalization of malignant hilarobstruction: A possible rescue for early failure of endoscopic y-stenting

    International Nuclear Information System (INIS)

    Kwon, Hoon; Kim, Chang Won; Lee, Tae Hong; Kim, Dong Uk; Jeon, Ung Bae; Kang, Dae Hwan

    2013-01-01

    Endoscopic biliary stenting is well known as an optimal method of management of malignant hilar obstruction, but sometimes the result is not satisfactory, with early stent failure. Percutaneous transhepatic biliary drainage (PTBD) has a distinct advantage over endoscopic retrograde cholangiopancreatoscopy in that with ultrasound guidance one or more appropriate segments for drainage can be chosen. We evaluated the effectiveness of percutaneous transhepatic stenting as a rescue of early failure of endoscopic stenting. Ten patients (4 men, 6 women; age range, 52-78 years; mean age, 69 years) with inoperable biliary obstruction (2 patients with gall bladder cancer and hilar invasion, and 8 patients with Klatskin tumor) and with early endoscopic stent failure were included in our study. All of the patients underwent PTBD and percutaneous transhepatic biliary stenting. Metallic stents were placed in all patients for internal drainage. Percutaneous rescue stenting was successful in all the patients technically and clinically. Mean time for the development of biliary obstruction was 13.5 days after endoscopic stenting. The mean patency of the rescue stenting was 122 days. The mean survival time for percutaneous transhepatic rescue stenting was 226.3 days. In early failure of endoscopic biliary stenting, percutaneous transhepatic recanalization can be a possible solution.

  2. Reconstructive Surgery for Severe Penile Inadequacy: Phalloplasty with a Free Radial Forearm Flap or a Pedicled Anterolateral Thigh Flap

    Directory of Open Access Journals (Sweden)

    N. Lumen

    2008-01-01

    Full Text Available Objectives. Severe penile inadequacy in adolescents is rare. Phallic reconstruction to treat this devastating condition is a major challenge to the reconstructive surgeon. Phallic reconstruction using the free radial forearm flap (RFF or the pedicled anterolateral thigh flap (ALTF has been routinely used in female-to-male transsexuals. Recently we started to use these techniques in the treatment of severe penile inadequacy. Methods. Eleven males (age 15 to 42 years were treated with a phallic reconstruction. The RFF is our method of choice; the ALTF is an alternative when a free flap is contraindicated or less desired by the patient. The RFF was used in 7 patients, the ALTF in 4 patients. Mean followup was 25 months (range: 4–49 months. Aesthetic and functional results were evaluated. Results. There were no complications related to the flap. Aesthetic results were judged as “good” in 9 patients and “moderate” in 2 patients. Sensitivity in the RFF was superior compared to the ALTF. Four patients developed urinary complications (stricture and/or fistula. Six patients underwent erectile implant surgery. In 2 patients the erectile implant had to be removed due to infection or erosion. Conclusion. In case of severe penile inadequacy due to whatever condition, a phalloplasty is the preferred treatment nowadays. The free radial forearm flap is still the method of choice. The anterolateral thigh flap can be a good alternative, especially when free flaps are contraindicated, but sensitivity is markedly inferior in these flaps.

  3. Surgical Approach to "Right Hepatic Core": Deepest Region Surrounded by Major Portal Pedicles and Right Hepatic Vein.

    Science.gov (United States)

    Tani, Keigo; Ishizawa, Takeaki; Sakamoto, Yoshihiro; Hasegawa, Kiyoshi; Kokudo, Norihiro

    2017-11-28

    The resection of hepatic tumors located in the region surrounded by the right hepatic vein (RHV) and the portal pedicles of the right paramedian/lateral sector (the right hepatic core) remains a challenge for liver surgeons. The aim of this study was to demonstrate the surgical techniques and outcomes of our atypical-parenchyma-sparing hepatectomy (atypical-PSH) approach for the removal of tumors in the right hepatic core. Perioperative records of 1,179 consecutive patients who had undergone hepatectomy for hepatocellular carcinoma or colorectal liver metastases from January 2006 to December 2014 were retrospectively reviewed. Twenty-six patients (2%) had a tumor in the right hepatic core. Among them, 20 patients underwent atypical-PSH, including the anterior approach (resection of the right paramedian hepatic parenchyma, n = 9), posterior approach (resection of the right lateral hepatic parenchyma, n = 10), and transhepatic approach (tumor enucleation from the raw surfaces along the RHV, n = 1). Their postoperative outcomes were similar to the remaining 6 patients who had undergone right hepatectomy. Atypical-PSH can be safely applied for the removal of tumors in the right hepatic core. This technique may have potential advantages in preserving hepatic function for postoperative chemotherapy and repeated hepatectomy for future recurrence. © 2017 S. Karger AG, Basel.

  4. Transforaminal lumbar interbody fusion using unilateral pedicle screw fixation plus contralateral translaminar facet screw fixation in lumbar degenerative diseases.

    Science.gov (United States)

    Liu, Fubing; Jiang, Chun; Cao, Yuanwu; Jiang, Xiaoxing; Feng, Zhenzhou

    2014-07-01

    Transforaminal lumbar interbody fusion (TLIF) has been used in lumbar degenerative diseases. Some researchers have applied unilateral fixation in TLIF to reduce operational trauma without compromising the clinical outcome, but it is always suspected biomechanically unstable. The supplementary contralateral translaminar facet screw (cTLFS) seemed to be able to overcome the inherent drawbacks of unilateral pedicle screw (uPS) fixation theoretically. This study evaluates the safety, feasibility and efficacy of TLIF using uPS with cTLFS fixation in the treatment of lumbar degenerative diseases (LDD). 50 patients (29 male) underwent the aforementioned surgical technique for their LDD between December 2009 and April 2012. The results were evaluated based on visual analogue scale (VAS) of the leg and back, Japanese Orthopedic Association (JOA) score and Oswestry Disability Index (ODI) were recorded. The radiographic examinations in form of X-ray, computed tomography (CT) or magnetic resonance imaging was done preoperatively and 1 week, 3 months, 6 months, 12 months and 24 months postoperatively. The student t-test was used for comparison between the preoperative values and postoperative counterparts. P degenerative diseases short termly.

  5. Percutaneous balloon dilatation for benign hepaticojejunostomy strictures

    NARCIS (Netherlands)

    Vos, P. M.; van Beek, E. J.; Smits, N. J.; Rauws, E. A.; Gouma, D. J.; Reeders, J. W.

    2000-01-01

    BACKGROUND: Percutaneous balloon dilatation of biliary tract strictures is generally accepted as a safe and inexpensive procedure. The effectiveness in selected groups of patients remains under discussion. The purpose of this study was to evaluate the results of percutaneous balloon dilatation in

  6. Safety Outcomes After Percutaneous Transcatheter Closure of Patent Foramen Ovale.

    Science.gov (United States)

    Merkler, Alexander E; Gialdini, Gino; Yaghi, Shadi; Okin, Peter M; Iadecola, Costantino; Navi, Babak B; Kamel, Hooman

    2017-11-01

    We sought to evaluate the real-world rate of safety outcomes after patent foramen ovale (PFO) closure in patients with ischemic stroke or transient ischemic attack (TIA). We performed a retrospective cohort study using administrative claims data on all hospitalizations from 2005 to 2013 in New York, California, and Florida. Using International Classification of Diseases, Ninth Revision, Clinical Modification codes, we identified patients who underwent percutaneous transcatheter PFO closure within 1 year of ischemic stroke or TIA. Our outcome was an adverse event occurring during the hospitalization for PFO closure, defined as in prior studies as atrial fibrillation or flutter, cardiac tamponade, pneumothorax, hemothorax, a vascular access complication, or death. Crude rates were reported with exact confidence intervals. We identified 1887 patients who underwent PFO closure after ischemic stroke or TIA. The rate of any adverse outcome during the hospitalization for PFO closure was 7.0% (95% confidence interval [CI], 5.9%-8.2%). Rates of adverse outcomes varied by age and type of preceding cerebrovascular event. In patients >60 years of age, the rate of adverse outcomes was 10.9% (95% CI, 8.6%-13.6%) versus 4.9% (95% CI, 3.8%-6.3%) in patients ≤60 years of age. The rate of adverse outcomes was 9.9% (95% CI, 7.3%-12.5%) in patients with preceding ischemic stroke versus 5.9% (95% CI, 4.7%-7.1%) after TIA. Approximately 1 in 14 patients who underwent percutaneous transcatheter PFO closure after ischemic stroke or TIA experienced a serious periprocedural adverse outcome or death. The risk of adverse outcomes was highest in older patients and in those with preceding ischemic stroke. © 2017 American Heart Association, Inc.

  7. Placement of pedicle screws using three-dimensional fluoroscopy-based navigation in lumbar vertebrae with axial rotation

    Science.gov (United States)

    Lang, Zhao

    2010-01-01

    Despite potential advantages of three-dimensional fluoroscopy-based navigation, there still remain a lot of controversies about the indications of this technology, especially whether it is worthy of being used in placement of pedicle screws in lumbar spine. However, according to the inconsistent conclusions reported in the literature and our experiences, the traditional method relying on anatomical landmarks and fluoroscopic views to guide lumbar pedicle screw insertion is unable to meet the requirement of precise screw placement. Based on our observation, screw malposition seems to occur concomitant with vertebral axial rotation which is a ubiquitous phenomenon. Three-dimensional fluoroscopy-based navigation can provide the most valuable axial images in real-time, so it may be useful for placement of pedicle screws in lumbar spine. This study was intended to evaluate the effect of axial rotation of lumbar vertebrae on the accuracy of pedicle screw placement using the traditional method, as well as assess the value of three-dimensional fluoroscopy-based navigation in improving the accuracy. Sixteen lumbar simulation models at different degrees of axial rotation (0°, 5°, 10°, and 20°), with every four assigned the same degree, were equally divided into two groups (traditional method group and three-dimensional fluoroscopy-based navigation group). Random placement of pedicle screws was carried out, followed by CT scan postoperatively. Then the outer pedicle cortex contours were depicted from reconstructed sectional pedicle images using Photoshop. The accuracy of pedicle screw placement was evaluated by determining the interrelationship between screw trajectory and pedicle cortex (quality), and measuring the shortest distance from pedicle screw axis to outer cortex of the pedicle (quantity). Eighty pedicle screws were implanted, respectively, in each group. In traditional method group, statistical difference existed in the accuracy of pedicle screw placement at

  8. Percutaneous vertebroplasty (pv): indications, contraindications, and technique

    International Nuclear Information System (INIS)

    Hoffmann, R.T.; Jakobs, T.F.; Wallnoefer, A.; Reiser, M.F.; Helmberger, T.K.

    2003-01-01

    Percutaneous vertebroplasty (pv) is a worldwide increasingly performed interventional therapeutic procedure. This article addresses indications, patient preparation, technical requirements and approach as well as possible complications of percutaneous vertebroplasty. Percutaneous vertebroplasty is a technique consisting in an injection of bone cement into a vertebral body under imaging guidance. This procedure is performed to relief pain and support the mechanical stability in partially collapsed vertebral bodies. In the management of spinal compression fractures secondary to osteoporosis, myeloma, osteolytic metastases and aggressive hemangiomas, percutaneous vertebroplasty yields analgesic effect, and provides additional fortification in weakened segments of the vertebral column. Contraindications include major bleeding disorders, radicular pain and pain caused by compression of the myelon. Percutaneous vertebroplasty results in prompt pain relief and rapid rehabilitation. In experienced hands, using correct technique, pv is a safe and effective procedure for treating pain, caused either by osteoporotic or malignant vertebral compression fractures. (orig.) [de

  9. [The percutaneous absorption of diclofenac].

    Science.gov (United States)

    Riess, W; Schmid, K; Botta, L; Kobayashi, K; Moppert, J; Schneider, W; Sioufi, A; Strusberg, A; Tomasi, M

    1986-07-01

    The percutaneous absorption of diclofenac diethylammonium 1.16% (w/w) in a combination of emulsion cream and gel (Voltaren Emulgel) and of diclofenac sodium 1% (w/w) in a cream formulation (Voltaren cream) was investigated in guinea-pig, rabbit and man. The percutaneous absorption of diclofenac sodium in guinea-pig was 3 to 6% of the dose when the cream formulation in doses of 320, 100 or 40 mg was applied on 10 cm2 of occluded skin and left in place for 6 h. The transdermal delivery of 14C-labelled diclofenac yielded plateau plasma concentrations of radiotracer from 1.5 h after application until removal of the residual cream. Subsequently the steady state drug depots in the skin and muscle tissue were depleted promptly. During daily administration the steady state levels in the muscle tissue in proximity to the application site were about 3 times higher than in distant muscle tissue. By topical application on knee joints of rabbits diclofenac penetrated into the patellar ligament, the adipose corpus and the synovial fluid. In man the percutaneous absorption was 6% of the dose when the Emulgel formulation was spread by 5 mg/cm2 and left for 12 h on non-occluded skin. The pattern of metabolites of diclofenac in human urine was the same after topical and oral administration. In man, upon daily topical administration of 3 times 2.5 g cream formulation (10 mg/cm2) the diclofenac steady state plasma levels were 20 to 40 nmol/l.(ABSTRACT TRUNCATED AT 250 WORDS)

  10. Lateral lumbar interbody fusion with unilateral pedicle screw fixation for the treatment of adjacent segment disease: a preliminary report.

    Science.gov (United States)

    Du, Jerry Y; Kiely, Paul D; Al Maaieh, Motasem; Aichmair, Alexander; Huang, Russel C

    2017-09-01

    To assess the clinical outcomes of 20 patients who underwent single level unilateral pedicle screw fixation following lateral lumbar interbody fusion (LLIF) for treatment of lumbar adjacent segment disease (ASD). Demographic, comorbidity, clinical assessment, peri-operative, and complication data were assessed. Visual analog scale (VAS), Oswestry disability index (ODI), and short form-12 (SF-12) were used to assess clinical outcomes. Post-operative radiographs were assessed for subsidence, cage migration, and fusion. Average age of patients was 63.2±13.7 years (range, 41-86 years), with 8 males and 12 females. Recombinant human bone morphogenic protein-2 (rhBMP-2) was utilized in 18 LLIF cages (90%) and 12 posterolateral fusions (60%). Mean operation time was 214.1±47.2 minutes (range, 146-342 minutes), mean estimated blood loss of 187.5±90.1 cc (range, 50-400 cc). No patients received a blood transfusion. There were no intra-operative complications. Mean hospital length of stay was 4.4±1.7 days (range, 2-9 days). At final follow-up (mean: 13.0±12.7 months after surgery), there was significant improvement in post-op VAS (P=0.006) score compared to pre-op, but not ODI (P=0.181), SF-12 PC (P=0.480), and SF-12 MC (P=0.937). Patients with >6 months of post-operative imaging (14/20, 70%) demonstrated successful fusion in 13 out of 14 cases (93%). There was grade 0 subsidence of adjacent cranial vertebra in all cases (100%). There was grade 0 subsidence of the adjacent caudal vertebra in 13 cases (93%) and grade 1 subsidence in 1 case (7%). There was evidence of cage migration in 3 cases (21%). There were 4 patients (20%) who experienced transient neurological deficits that eventually resolved. Two patients required surgery for further ASD. In conclusion, this pilot study suggests that patients who undergo LLIF with unilateral pedicle screw fixation for treatment of ASD may have significantly reduced pain and favorable radiographic results. Further investigation in

  11. Lateral lumbar interbody fusion with unilateral pedicle screw fixation for the treatment of adjacent segment disease: a preliminary report

    Science.gov (United States)

    Kiely, Paul D.; Al Maaieh, Motasem; Aichmair, Alexander; Huang, Russel C.

    2017-01-01

    Background To assess the clinical outcomes of 20 patients who underwent single level unilateral pedicle screw fixation following lateral lumbar interbody fusion (LLIF) for treatment of lumbar adjacent segment disease (ASD). Methods Demographic, comorbidity, clinical assessment, peri-operative, and complication data were assessed. Visual analog scale (VAS), Oswestry disability index (ODI), and short form-12 (SF-12) were used to assess clinical outcomes. Post-operative radiographs were assessed for subsidence, cage migration, and fusion. Results Average age of patients was 63.2±13.7 years (range, 41–86 years), with 8 males and 12 females. Recombinant human bone morphogenic protein-2 (rhBMP-2) was utilized in 18 LLIF cages (90%) and 12 posterolateral fusions (60%). Mean operation time was 214.1±47.2 minutes (range, 146–342 minutes), mean estimated blood loss of 187.5±90.1 cc (range, 50–400 cc). No patients received a blood transfusion. There were no intra-operative complications. Mean hospital length of stay was 4.4±1.7 days (range, 2–9 days). At final follow-up (mean: 13.0±12.7 months after surgery), there was significant improvement in post-op VAS (P=0.006) score compared to pre-op, but not ODI (P=0.181), SF-12 PC (P=0.480), and SF-12 MC (P=0.937). Patients with >6 months of post-operative imaging (14/20, 70%) demonstrated successful fusion in 13 out of 14 cases (93%). There was grade 0 subsidence of adjacent cranial vertebra in all cases (100%). There was grade 0 subsidence of the adjacent caudal vertebra in 13 cases (93%) and grade 1 subsidence in 1 case (7%). There was evidence of cage migration in 3 cases (21%). There were 4 patients (20%) who experienced transient neurological deficits that eventually resolved. Two patients required surgery for further ASD. Conclusions In conclusion, this pilot study suggests that patients who undergo LLIF with unilateral pedicle screw fixation for treatment of ASD may have significantly reduced pain and favorable

  12. Clinical review: Percutaneous dilatational tracheostomy

    Science.gov (United States)

    Al-Ansari, Mariam A; Hijazi, Mohammed H

    2006-01-01

    As the number of critically ill patients requiring tracheotomy for prolonged ventilation has increased, the demand for a procedural alternative to the surgical tracheostomy (ST) has also emerged. Since its introduction, percutaneous dilatational tracheostomies (PDT) have gained increasing popularity. The most commonly cited advantages are the ease of the familiar technique and the ability to perform the procedure at the bedside. It is now considered a viable alternative to (ST) in the intensive care unit. Evaluation of PDT procedural modifications will require evaluation in randomized clinical trials. Regardless of the PDT technique, meticulous preoperative and postoperative management are necessary to maintain the excellent safety record of PDT. PMID:16356203

  13. Recent Advances in Percutaneous Nephrolithotomy

    Directory of Open Access Journals (Sweden)

    Erem Kaan Basok

    2014-05-01

    Full Text Available The continuous innovations in technology, instrumentations, and techniques allow urologists to perform percutaneous nephrolithotomy (PCNL with increasing efficacy. Although recent advances have facilitated the procedure, some steps are still challenging. A thorough review of the recent urologic literature was performed to identify these improvements in PCNL technique. The newer developments mainly focused on multimodal imaging techniques, miniaturisation of instruments, tracking and navigation systems during access to the stone, and robotic systems. Further studies are necessary to better define the benefits of these new fruitful developments which remain an active research field.

  14. Percutaneous drainage of lung abscesses

    International Nuclear Information System (INIS)

    van Sonnenberg, E.; D'Agostino, H.; Casola, G.; Vatney, R.R.; Wittich, G.R.; Harker, C.

    1989-01-01

    The authors performed percutaneous drainage of lung abscesses in 12 patients. Indications for drainage were septicemia and persistence or worsening of radiographic findings. These lung abscesses were refractory to intravenous antibiotics and to bronchial toilet. Etiology of the abscesses included pneumonia (most frequently), trauma, postoperative development, infected necrotic neoplasm, and infected sequestration. Guidelines for drainage included passage of the catheter through contiguously abnormal lung and pleura, inability of the patient to cough, and/or bronchial obstruction precluding bronchial drainage. Cure was achieved in 11 of 12 patients. Catheters were removed on an average of 16 days after insertion. Antibiotics were administered an average of 18 days before drainage. No major complications occurred

  15. Realtime ultrasound guided percutaneous tracheostomy in emergency setting: the glass ceiling has been broken.

    Science.gov (United States)

    Ravi, Parli Raghavan; Vijai, M N; Shouche, Sachin

    2017-01-01

    In recent years ultrasound guided percutaneous tracheostomy (USPCT) has become a routine practice in critical care units. Its safety and superiority over conventional percutaneous tracheostomy and bronchoscopic guided PCT is proven to be non-inferior in elective cases. However its role in emergency percutaneous tracheostomy has never been studied, since percutaneous tracheostomy itself remains an enigma in accessing emergency airway. There is no report of use of ultrasound guided percutaneous tracheostomy in emergency setting so far in the literature. We report our early experience with USPCT in emergency setting. Sixteen adult patients who required access to an emergency surgical airway after failure to accomplish emergency oro-tracheal intubation were the study population. Their airway was accessed by USPCT. Recorded data included clinical and demographic data including time taken to perform the procedure and complications. Short term and long term follow ups for a period of 2 years were done for the survivors. Twelve male and four female patients underwent the procedure and the average time of the procedure was 3.6 min with no failures nor conversions to surgical tracheostomy and no complications. The average oxygen saturation was 86% and average Glasgow coma scale was 8.4. This time period included the oxygen insufflation time. 10 patients were decannulated while six patients died due to the pathology of the disease itself. There were no complications in either short term or long term follow up. USPCT has a definitive role in emergency both in trauma and non-trauma setting. It is safe, feasible and faster in experienced hands. Use of USPCT in emergency setting has further narrowed the list of contraindications of percutaneous tracheostomy.

  16. Role of percutaneous abscess drainage in the management of young patients with Crohn disease

    Energy Technology Data Exchange (ETDEWEB)

    Pugmire, Brian S. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Gee, Michael S. [Massachusetts General Hospital for Children, Department of Radiology, Boston, MA (United States); Massachusetts General Hospital, Division of Abdominal Imaging, Boston, MA (United States); Kaplan, Jess L.; Winter, Harland S. [Massachusetts General Hospital for Children, Department of Pediatrics, Boston, MA (United States); Hahn, Peter F.; Gervais, Debra A. [Massachusetts General Hospital, Division of Abdominal Imaging, Boston, MA (United States); Doody, Daniel P. [Massachusetts General Hospital for Children, Department of Surgery, Boston, MA (United States)

    2016-05-15

    Intra-abdominal abscess is a common complication of Crohn disease in children. Prior studies, primarily in adults, have shown that percutaneous abscess drainage is a safe and effective treatment for this condition; however, the data regarding this procedure and indications in pediatric patients is limited. Our aim was to determine the success rate of percutaneous abscess drainage for abscesses related to Crohn disease in pediatric patients with a focus on treatment endpoints that are relevant in the era of biological medical therapy. We retrospectively reviewed 25 cases of patients ages ≤20 years with Crohn disease who underwent percutaneous abscess drainage. Technical success was defined as catheter placement within the abscess with reduction in abscess size on post-treatment imaging. Clinical success was defined as (1) no surgery within 1 year of drainage or (2) surgical resection following drainage with no residual abscess at surgery or on preoperative imaging. Multiple clinical parameters were analyzed for association with treatment success or failure. All cases were classified as technical successes. Nineteen cases were classified as clinical successes (76%), including 7 patients (28%) who required no surgery within 1 year of percutaneous drainage and 12 patients (48%) who had elective bowel resection within 1 year. There was a statistically significant association between resumption of immunosuppressive therapy within 8 weeks of drainage and both clinical success (P < 0.01) and avoidance of surgery after 1 year (P < 0.01). Percutaneous abscess drainage is an effective treatment for Crohn disease-related abscesses in pediatric patients. Early resumption of immunosuppressive therapy is statistically associated with both clinical success and avoidance of bowel resection, suggesting a role for percutaneous drainage in facilitating prompt initiation of medical therapy and preventing surgical bowel resection. (orig.)

  17. Direct percutaneous radiologic jejunostomy (PR)and duodenostomy: a retrospective analysis

    International Nuclear Information System (INIS)

    Rieker, O.; Pitton, M.; Herber, S.; Vomweg, T.; Teifke, A.; Dueber, C.

    2005-01-01

    Purpose: To present our experience with direct percutaneous radiologic duodenostomy and jejunostomy (PRJ) for alimentation. Materials and Methods: A retrospective study identified 24 patients who had undergone percutaneous jejunostomy or duodenostomy guided by CT and fluoroscopy over a period of 9 years. Whenever possible, the jejunum was inflated with a 5 French diagnostic catheter and jejunopexy was performed using Cope anchors (T-fasteners). A 12 to 14 French locking pigtail drain was inserted for alimentation. In 8 patients, percutaneous direct jejunostomy was performed using only fluoroscopy. In 9 patients, both CT and fluoroscopy were used to guide the jejunostomy. In all 7 patients who underwent duodenostomy, a combination of CT and fluoroscopy was used. The reports were reviewed for complications and the technical success rate. The technical success rate was determined. Results: Percutaneous radiologic jejunostomy was attempted in 17 patients and failed in 5 patients. PRJ was successful in all 8 procedures guided by fluoroscopy and in 4 of 9 procedures guided by CT and fluoroscopy. Direct percutaneous duodenostomy guided by CT and fluoroscopy was successful in all 7 cases. There were no procedure-related laparotomies and no mortality related to the jejunostomy. Minor complications were infection of the abdominal wall (n=1), lingering pain requiring a new jejunostomy (n=1) and aspiration because of persistent reflux (n=1). Conclusion: PRJ is a safe procedure even in critically ill patients. It is technically difficult and may fail if the jejunum cannot be distended. Percutaneous radiologic duodenostomy and jejunostomy are recommended for prolonged alimentation of malnourished patients following esophageal or gastric surgery. (orig.)

  18. Role of percutaneous abscess drainage in the management of young patients with Crohn disease

    International Nuclear Information System (INIS)

    Pugmire, Brian S.; Gee, Michael S.; Kaplan, Jess L.; Winter, Harland S.; Hahn, Peter F.; Gervais, Debra A.; Doody, Daniel P.

    2016-01-01

    Intra-abdominal abscess is a common complication of Crohn disease in children. Prior studies, primarily in adults, have shown that percutaneous abscess drainage is a safe and effective treatment for this condition; however, the data regarding this procedure and indications in pediatric patients is limited. Our aim was to determine the success rate of percutaneous abscess drainage for abscesses related to Crohn disease in pediatric patients with a focus on treatment endpoints that are relevant in the era of biological medical therapy. We retrospectively reviewed 25 cases of patients ages ≤20 years with Crohn disease who underwent percutaneous abscess drainage. Technical success was defined as catheter placement within the abscess with reduction in abscess size on post-treatment imaging. Clinical success was defined as (1) no surgery within 1 year of drainage or (2) surgical resection following drainage with no residual abscess at surgery or on preoperative imaging. Multiple clinical parameters were analyzed for association with treatment success or failure. All cases were classified as technical successes. Nineteen cases were classified as clinical successes (76%), including 7 patients (28%) who required no surgery within 1 year of percutaneous drainage and 12 patients (48%) who had elective bowel resection within 1 year. There was a statistically significant association between resumption of immunosuppressive therapy within 8 weeks of drainage and both clinical success (P < 0.01) and avoidance of surgery after 1 year (P < 0.01). Percutaneous abscess drainage is an effective treatment for Crohn disease-related abscesses in pediatric patients. Early resumption of immunosuppressive therapy is statistically associated with both clinical success and avoidance of bowel resection, suggesting a role for percutaneous drainage in facilitating prompt initiation of medical therapy and preventing surgical bowel resection. (orig.)

  19. Safety of lumbar spine radiofrequency procedures in the presence of posterior pedicle screws: technical report of a cadaver study.

    Science.gov (United States)

    Gazelka, Halena M; Welch, Tasha L; Nassr, Ahmad; Lamer, Tim J

    2015-05-01

    To determine whether the thermal energy associated with lumbar spine radiofrequency neurotomy (RFN) performed near titanium and stainless steel pedicle screws is conducted to the pedicle screws or adjacent tissues, or both, thus introducing potential for thermal damage to those tissues. Cadaver study. Cadaver laboratory equipped with fluoroscopy, surgical spine implements, and radiofrequency generator. No live human subject; a fresh frozen (and thawed) cadaver torso was used for the study. Titanium and stainless steel pedicle screws were placed in the lumbar spine of a fresh frozen cadaver torso with real-time fluoroscopic guidance. Conventional RFN cannula placement was performed at the level of pedicle screws and a control (nonsurgically altered) lumbar level. Neurotomy was performed with conventional radiofrequency lesioning parameters. Temperatures were recorded at multiple sites through thermistor probes. Direct contact of the radiofrequency cannula with the pedicle screws during conventional RFN produced a substantial increase in temperature in the surrounding soft tissues. A small increase in temperature occurred at the same sites at the control level. Titanium and stainless steel pedicle screws are capable of sustaining large increases in temperature when the radiofrequency probe comes in contact with the screw. These results are suggestive that pedicle screws could serve as a possible source of tissue heating and thermal injury during RFN. Wiley Periodicals, Inc.

  20. 65. Impact of focused echocardiography in clinical decision of patients presented with STMI, underwent primary percutenouse angioplasty

    Directory of Open Access Journals (Sweden)

    M. Qasem

    2016-07-01

    Full Text Available Echocardiography in coronary artery diseases is an essential, routine echocardiography prior to primary percutaneous angioplasty is not clear. In our clinical practice in primary angioplasty we faced lots of complications either before or during or after the procedure. Moreover, lots of incidental findings that discovered after the procedure which if known will affect the plan of management. One-hundred-nineteen consecutive underwent primary angioplasty. All patients underwent FE prior to the procedure in catheterization lab while the patient was preparing for the procedure. FE with 2DE of LV at base, mid and apex, and apical stander views. Diastology grading, E/E′ and color doppler of mitral and aortic valve were performed. (N = 119 case of STMI were enrolled, mean age 51 ± 12 year. Eleven cases (9.2% had normal coronary and normal LV function. Twenty cases (17% of MI complication detected before the procedures: RV infarction 8.4% (5.1% asymptomatic and 3.3% symptomatic, ischemic MR (8.4%, LV apical aneurysm (0.8%, significant pericardial effusion (0.80%. Acute pulmonary edema in 17 cases (14.3%: six cases (5.1% developed acute pulmonary edema on the cath lab with grade 3 diastolic dysfunction and E/E ′  >20, 9 cases (7.6% develop acute pulmonary edema in CCU with grade 2–3 diastolic dysfunction and E/E′ 15–20. 2 cases (2.7% develop acute pulmonary in CCU with grade 1–2 diastolic dysfunction and E/E′ 9–14. One case (0.8% presented cardiac tamponade 2 h post PCI. Incidental finding not related to STMI were as follow: 2 cases (1.7% with severe fibro degenerative MR, 2 cases (1.7% with mild to moderate AR and 2 cases (1.7% with mild to moderate AS. Isoled CABG 5/4.2% and CABG and MVR 2/1.7%. FE play an important role in guiding the management, early detection the incidental findings and complication post PCI.

  1. Percutaneous Closure of 2 Paravalvular Leaks and a Gerbode Defect after Mitral Valve Replacement for Infective Endocarditis.

    Science.gov (United States)

    Peñalver, Jorge; Shatila, Wassim; Silva, Guilherme V

    2017-04-01

    Surgical valve replacement after infective endocarditis can result in local destructive paravalvular lesions. A 30-year-old woman with infective endocarditis underwent mitral valve replacement that was complicated postoperatively by 2 paravalvular leaks. During percutaneous closure of the leaks, a Gerbode defect was also found and closed. We discuss our patient's case and its relation to others in the relevant medical literature. To our knowledge, we are the first to describe the use of a percutaneous approach to close concomitant paravalvular leaks and a Gerbode defect.

  2. Subclavian steal syndrome: treatment by percutaneous transluminal angioplasty; Sindrome do roubo da subclavia: tratamento por angioplastia transluminar percutanea

    Energy Technology Data Exchange (ETDEWEB)

    Abath, Carlos Gustavo Coutinho [Instituto de Medicina e Cirurgia, Recife, PE (Brazil)]|[Hospital Memorial Sao Jose, Recife, PE (Brazil); Silva, Marcos Antonio Barbosa da [Instituto de Medicina e Cirurgia, Recife, PE (Brazil); Brito, Norma Maria Tenorio [Hospital Memorial Sao Jose, Recife, PE (Brazil); Marques, Silvio Romero; Santa Cruz, Rodolfo [Pernambuco Univ., Recife, PE (Brazil). Hospital das Clinicas; Henrique, Darcy [Real Hospital Portugues, Recife, PE (Brazil)

    1995-09-01

    The subclavian steal syndrome is a rare vascular disease that can be managed by interventional radiology. It is presented the experience with three cases of this syndrome that underwent percutaneous transluminal angioplasty, and a brief literature review is done. Two patients remained asymptomatic 23 and 30 months, respectively, after the procedure. One patient presented with recurrent symptoms 12 months after the dilatation. Considering the low morbidity and good clinical and technical results, percutaneous transluminal angioplasty is the first choice in the subclavian steal syndrome treatment. (author). 9 refs., 3 figs.

  3. Predicting Infected Bile Among Patients Undergoing Percutaneous Cholecystostomy

    International Nuclear Information System (INIS)

    Beardsley, Shannon L.; Shlansky-Goldberg, Richard D.; Patel, Aalpen; Freiman, David B.; Soulen, Michael C.; Stavropoulos, S. William; Clark, Timothy W.I.

    2005-01-01

    Purpose. Patients may not achieve a clinical benefit after percutaneous cholecystostomy due to the inherent difficulty in identifying patients who truly have infected gallbladders. We attempted to identify imaging and biochemical parameters which would help to predict which patients have infected gallbladders. Methods. A retrospective review was performed of 52 patients undergoing percutaneous cholecystostomy for clinical suspicion of acute cholecystitis in whom bile culture results were available. Multiple imaging and biochemical variables were examined alone and in combination as predictors of infected bile, using logistic regression. Results. Of the 52 patients, 25 (48%) had infected bile. Organisms cultured included Enterococcus, Enterobacter, Klebsiella, Pseudomonas, E. coli, Citrobacter and Candida. No biochemical parameters were significantly predictive of infected bile; white blood cell count >15,000 was weakly associated with greater odds of infected bile (odds ratio 2.0, p = NS). The presence of gallstones, sludge, gallbladder wall thickening and pericholecystic fluid by ultrasound or CT were not predictive of infected bile, alone or in combination, although a trend was observed among patients with CT findings of acute cholecystitis toward a higher 30-day mortality. Radionuclide scans were performed in 31% of patients; all were positive and 66% of these patients had infected bile. Since no patient who underwent a radionuclide scan had a negative study, this variable could not be entered into the regression model due to collinearity. Conclusion. No single CT or ultrasound imaging variable was predictive of infected bile, and only a weak association of white blood cell count with infected bile was seen. No other biochemical parameters had any association with infected bile. The ability of radionuclide scanning to predict infected bile was higher than that of ultrasound or CT. This study illustrates the continued challenge to identify bacterial cholecystitis

  4. Biomechanical study of the funnel technique applied in thoracic pedicle screw replacement.

    Science.gov (United States)

    Huang, Yi-Jiang; Peng, Mao-Xiu; He, Shao-Qi; Liu, Liang-Le; Dai, Ming-Hai; Tang, Chenxuan

    2014-09-01

    Funnel technique is a method used for the insertion of screw into thoracic pedicle. To evaluate the biomechanical characteristics of thoracic pedicle screw placement using the Funnel technique, trying to provide biomechanical basis for clinical application of this technology. 14 functional spinal units (T6 to T10) were selected from thoracic spine specimens of 14 fresh adult cadavers, and randomly divided into two groups, including Funnel technique group (n = 7) and Magerl technique group (n = 7). The displacement-stiffness and pull-out strength in all kinds of position were tested and compared. Two fixed groups were significantly higher than that of the intact state (P 0.05). The mean pull-out strength in Funnel technique group (789.09 ± 27.33) was lower than that in Magerl technique group (P Funnel technique for the insertion point of posterior bone is a safe and accurate technique for pedicle screw placement. It exhibited no effects on the stiffness of spinal column, but decreased the pull-out strength of pedicle screw. Therefore, the funnel technique in the thoracic spine affords an alternative for the standard screw placement.

  5. Pedicle Screw Fixation Study in Immature Porcine Spines to Improve Pullout Resistance during Animal Testing.

    Directory of Open Access Journals (Sweden)

    Sophie Le Cann

    Full Text Available The porcine model is frequently used during development and validation of new spinal devices, because of its likeness to the human spine. These spinal devices are frequently composed of pedicle screws with a reputation for stable fixation but which can suffer pullouts during preclinical implantation on young animals, leading to high morbidity. With a view to identifying the best choices to optimize pedicle screw fixation in the porcine model, this study evaluates ex vivo the impact of weight (age of the animal, the level of the vertebrae (lumbar or thoracic and the type of screw anchorage (mono- or bi-cortical on pedicle screw pullouts. Among the 80 pig vertebrae (90- and 140-day-old tested in this study, the average screw pullout forces ranged between 419.9N and 1341.2N. In addition, statistical differences were found between test groups, pointing out the influence of the three parameters stated above. We found that the the more caudally the screws are positioned (lumbar level, the greater their pullout resistance is, moreover, screw stability increases with the age, and finally, the screws implanted with a mono-cortical anchorage sustained lower pullout forces than those implanted with a bi-cortical anchorage. We conclude that the best anchorage can be obtained with older animals, using a lumbar fixation and long screws traversing the vertebra and inducing bi-cortical anchorage. In very young animals, pedicle screw fixations need to be bi-cortical and more numerous to prevent pullout.

  6. Pedicle Screw Fixation Study in Immature Porcine Spines to Improve Pullout Resistance during Animal Testing.

    Science.gov (United States)

    Le Cann, Sophie; Cachon, Thibaut; Viguier, Eric; Miladi, Lotfi; Odent, Thierry; Rossi, Jean-Marie; Chabrand, Patrick

    2015-01-01

    The porcine model is frequently used during development and validation of new spinal devices, because of its likeness to the human spine. These spinal devices are frequently composed of pedicle screws with a reputation for stable fixation but which can suffer pullouts during preclinical implantation on young animals, leading to high morbidity. With a view to identifying the best choices to optimize pedicle screw fixation in the porcine model, this study evaluates ex vivo the impact of weight (age) of the animal, the level of the vertebrae (lumbar or thoracic) and the type of screw anchorage (mono- or bi-cortical) on pedicle screw pullouts. Among the 80 pig vertebrae (90- and 140-day-old) tested in this study, the average screw pullout forces ranged between 419.9N and 1341.2N. In addition, statistical differences were found between test groups, pointing out the influence of the three parameters stated above. We found that the the more caudally the screws are positioned (lumbar level), the greater their pullout resistance is, moreover, screw stability increases with the age, and finally, the screws implanted with a mono-cortical anchorage sustained lower pullout forces than those implanted with a bi-cortical anchorage. We conclude that the best anchorage can be obtained with older animals, using a lumbar fixation and long screws traversing the vertebra and inducing bi-cortical anchorage. In very young animals, pedicle screw fixations need to be bi-cortical and more numerous to prevent pullout.

  7. Computer navigation versus fluoroscopy-guided navigation for thoracic pedicle screw placement: a meta-analysis.

    Science.gov (United States)

    Meng, Xiao-Tong; Guan, Xiao-Fei; Zhang, Hai-Long; He, Shi-Sheng

    2016-07-01

    Although application of intraoperative computer navigation technique had been integrated into placement of pedicle screws (PSs) in thoracic fusion for years, its security and practicability remain controversial. The aim of this study is to evaluate the accuracy, the operative time consumption, the amount of intraoperative blood loss, time of pedicle insertion and the incidence of complications of thoracic pedicle screw placement in patients with thoracic diseases such as scoliosis and kyphosis. Pubmed, Web of Knowledge, and Google scholar were searched to identify comparative studies of thoracic pedicle screw placement between intraoperative computer navigation and fluoroscopy-guided navigation. Outcomes of malposition rate, operative time consumption, insertion time, intraoperative blood loss, and the incidence of complications are evaluated. Fourteen articles including 1723 patients and 9019 PSs were identified matching inclusion criteria. The malposition rate was lower (RR: 0.33, 95 % CI: 0.28-0.38, P fluoroscopy-guided navigation group; the operative time was significantly longer [weighted mean difference (WMD) = 23.66, 95 % CI: 14.74-32.57, P fluoroscopy-guided navigation group. The time of insertion was shorter (WMD = -1.88, 95 % CI: -2.25- -1.52, P fluoroscopy-guided navigation group. The incidence of complications was lower (RR = 0. 23, 95 % CI: 0.12-0.46, P fluoroscopy-guided navigation.

  8. Contralateral Spondylolysis and Fracture of the Lumbar Pedicle in a Young Athlete.

    Science.gov (United States)

    Kessous, Eran; Borsinger, Tracy; Rahman, Ayesha; d'Hemecourt, Pierre A

    2017-09-15

    Clinical case report of unilateral pedicular stress fracture with a contralateral spondylolysis in a male high-school athlete presenting with low back pain. To report this uncommon cause of low back pain in an adolescent athlete, and review the relevant literature. The incidence of spondylolysis in the Caucasian population was found to be about 3% to 6%. This number is probably higher in the athletic adolescent age group, with reports ranging from 8% to 15%. Spondylolysis may be associated with pedicle fracture, usually on the contralateral side. This is an uncommon phenomenon that is not well described in the adolescent age group. A 16-year-old male athlete presents with low back pain and limitation in sports as well as in daily activities. Clinical evaluation was suspicious for, and radiographic evaluation revealed left-sided L5 spondylolysis as well as contralateral L5 pedicle fracture. Conservative management included Boston Overlapping brace, external electrical stimulation, modification of activities, and a comprehensive physical therapy program. Radiological evaluation revealed persistent left L5 pars defect and advanced healing of the contralateral pedicle fracture. The patient achieved complete pain relief and returned to varsity level sporting activity. Complete radiographic and clinical healing of the pedicle defect was observed, with return competitive varsity-level football without symptoms. 5.

  9. Causes of failure in the use of a pedicled latissimus dorsi ...

    African Journals Online (AJOL)

    Background: To prevent failure of a pedicled latissimus dorsi musculocutaneous axial flap in high facial reconstruction, it is advisable that the blood flow and extent of reach of the thoracodorsal vessel must be ascertained during preoperative assessment using Laser Doppler perfusion imaging. The aim of this report was to ...

  10. Congenital absence of a cervical pedicle: report of two cases and review of the literature.

    Science.gov (United States)

    Sheehan, J; Kaptain, G; Sheehan, J; Jane, J

    2000-12-01

    The congenital absence of a cervical pedicle is a rare clinical entity. Patients with this anomaly tend to present with cervical pain or after a traumatic incident. Initial evaluations with conventional radiography frequently lead to misinterpretation and misguided intervention. We report two cases of absent cervical pedicles and describe the presentation, diagnosis, and treatment of these patients. Moreover, we review the literature on this clinical entity. The first patient was a 4-year-old boy who presented with neck pain after falling off a trampoline. His neurological examination did not reveal any focal abnormalities, but radiographs were thought to be consistent with a right, C4-C5, unilateral, jumped facet. The second patient was a 27-year-old woman who presented with severe neck, back, and left upper extremity pain and paresthesias after an alleged incident of spousal abuse. Her neurological examination results were remarkable for left upper extremity weakness and hemibody sensory changes. Conventional radiographs were thought to reveal a left, C3-C4, unilateral, locked facet. For both patients, reduction attempts were made with Gardner-Wells tongs and traction. After failure to achieve adequate reduction, evaluations using two-dimensional computed tomography confirmed congenitally absent cervical pedicles. Both patients were ultimately treated conservatively and experienced resolution of their presenting symptoms. The congenital absence of a cervical pedicle is a rare entity that is frequently misdiagnosed. Diagnoses can be accurately confirmed with two-dimensional computed tomography. Conservative treatment resulted in successful management of this clinical entity.

  11. Closure of oro-antral fistula with pedicled buccal fat pad. A case ...

    African Journals Online (AJOL)

    This article demonstrates the use of BFP in the repair of chronic oro-antral fistula. Methods: A case of a chronic oro-antral fistula of 5- year duration in a 56- year old man successfully repaired with pedicled buccal fat pad after unsuccessful several attempts with other local flaps is presented. A review of relevant literature ...

  12. Navigated pedicle screw placement using computed tomographic data in dorsolumbar fractures

    Directory of Open Access Journals (Sweden)

    Saurabh Kapoor

    2014-01-01

    Conclusion: CT-based navigation is effective in improving accuracy of pedicle screw placement in traumatic injuries of dorsolumbar spine (T9-L5, however additional cost of procuring CT scan to the patient and cost of equipment is of significant concern in developing countries. Reduced radiation exposure and lowered ergonomic constraints around the operation table are its additional benefits.

  13. PMMA-augmentation of incompletely cannulated pedicle screws: a cadaver study to determine the benefits in the osteoporotic spine.

    Science.gov (United States)

    Goost, H; Deborre, C; Wirtz, D C; Burger, C; Prescher, A; Fölsch, C; Pflugmacher, R; Kabir, K

    2014-01-01

    Pedicle screw pullout due to poor bone quality, mainly caused by osteoporosis, is a common problem in spine surgery. Special implants and techniques, especially PMMA augmentation, were developed to improve the fixation of pedicle screws. PMMA injection into a pilot hole or through a screw involves the same risks as vertebroplasty or kyphoplasty, regardless of the technique used. Especially when using fully cannulated screws anterior leakage is possible. To prove PMMA injection is safe and possible without leakage through an incompletely cannulated screw and also increases pullout forces in the osteoporotic vertebra. Incompletely cannulated pedicle screws were tested by axial pullout in human cadavers, divided into osteoporotic and non-osteoporotic groups. Non-augmented and PMMA-augmented pedicle screws were compared. Twenty-five human vertebrae were measured by DEXA and divided into osteoporotic and non-osteoporotic groups. In each vertebra both pedicles were instrumented with the new screw (WSI-Expertise 6×45 mm, Peter Brehm Inc. Germany); the right screw was augmented with a 3 mL PMMA injection through the screw. On each screw axial pullout was performed after X-ray and CT scan. Radiographs and CT scans excluded PMMA leakage. Cement was distributed in the middle and posterior third of the vertebrae. Pullout forces were significantly higher after pedicle screw augmentation, especially in the osteoporotic bone. All augmented pedicle screws showed higher pullout forces compared with the unaugmented screws. We minimized the risk of leakage by using a screw with a closed tip. On the whole, PMMA augmentation through an incompletely cannulated pedicle screw is safe and increases pullout forces in osteoporotic bone to the level of healthy bone. Therefore the new incompletely cannulated screw can be used for pedicle screw augmentation.

  14. Pull out Strength of Dual Outer Diameter Pedicle Screws Compared to Uncemented and Cemented Standard Pedicle Screws: A Biomechanical in vitro Study.

    Science.gov (United States)

    Lorenz, Andrea; Leichtle, Carmen I; Frantz, Sandra; Bumann, Marte; Tsiflikas, Ilias; Shiozawa, Thomas; Leichtle, Ulf G

    2017-05-01

    To analyze the potential of the dual outer diameter screw and systematically evaluate the pull-out force of the dual outer diameter screw compared to the uncemented and cemented standard pedicle screws with special regard to the pedicle diameter and the vertebra level. Sixty vertebrae of five human spines (T 6 -L 5 ) were sorted into three study groups for pairwise comparison of the uncemented dual outer diameter screw, the uncemented standard screw, and the cemented standard screw, and randomized with respect to bone mineral density (BMD) and vertebra level. The vertebrae were instrumented, insertion torque was determined, and pull-out testing was performed using a material testing machine. Failure load was evaluated in pairwise comparison within each study group. The screw-to-pedicle diameter ratio was determined and the uncemented dual outer diameter and standard screws were compared for different ratios as well as vertebra levels. Significantly increased pull-out forces were measured for the cemented standard screw compared to the uncemented standard screw (+689 N, P dual outer diameter screw (+403 N, P dual outer diameter screw to the uncemented standard screw in the total study group, a distinct but not significant increase was measured (+149 N, P = 0.114). Further analysis of these two screws, however, revealed a significant increase of pull-out force for the dual outer diameter screw in the lumbar region (+247 N, P = 0.040), as well as for a screw-to-pedicle diameter ratio between 0.6 and 1 (+ 488 N, P = 0.028). For clinical application, cement augmentation remains the gold standard for increasing screw stability. According to our results, the use of a dual outer diameter screw is an interesting option to increase screw stability in the lumbar region without cement augmentation. For the thoracic region, however, the screw-to-pedicle diameter should be checked and attention should be paid to screw cut out, if the dual outer diameter screw is considered.

  15. Safety and esthetic outcomes of therapeutic mammoplasty using medial pedicle for early breast cancer

    Directory of Open Access Journals (Sweden)

    Roshdy S

    2015-07-01

    Full Text Available Sameh Roshdy,1 Osama Hussein,1 Ashraf Khater,1 Mohammad Zuhdy,1 Hend A El-Hadaad,2 Omar Farouk,1 Ahmad Senbel,1 Adel Fathi,1 Emadeldeen Hamed,1 Adel Denewer1 1Department of Surgical Oncology, Mansoura Oncology Center, 2Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt Background: Although therapeutic mammoplasty (TM was introduced for treatment of localized ductal carcinoma in situ and invasive breast carcinoma (stages I and II in females with large breast size, the suitability of medial pedicle TM for treatment of breast tumors at different locations has not been established. The objective of this study was to assess the safety and esthetic outcome of medial pedicle TM for breast tumors at different locations. Methods: The study was conducted from February 2012 to July 2014. Consecutive patients with early breast carcinoma with medium- and large-sized breasts, with or without ptosis, who were offered medial pedicle TM were included in the study. Patients who were not candidates for breast-conserving surgery or those with tumors located along the medial pedicle were excluded. All patients received immediate postoperative adjuvant chemoradiotherapy. Results: Thirty patients with a mean age of 48.5 years received medial pedicle TM in the breast harboring the tumor or, additionally, the other breast (N=14. The tumors were in the upper (60.0%, lower (26.7%, and lateral (13.3% quadrants. Minor complications occurred in five cases (5/30, 16.7% in the ipsilateral and in two (2/14, 14.3% contralateral breasts. No wound dehiscence or areolar necrosis was recorded. A total of 22 (73.3% patients were scored as excellent cosmesis. After a median follow-up of 20 months, no locoregional recurrence or distant metastases were observed. Conclusion: TM using a medial pedicle is a safe and appealing technique among women with tumors at different locations. Keywords: therapeutic mammoplasty, medial

  16. Percutaneous Nephrolithotomy under Spinal Anesthesia with Marcaine

    Directory of Open Access Journals (Sweden)

    S.M.R. Rabani

    2010-01-01

    Full Text Available Introduction & Objective: The efficacy of Percutaneous Nephrolithotomy (PCNL in the treatment of renal stones has been proven in its indications. The main method of anesthesia in this procedure is general anesthesia. We used spinal anesthesia (SA as an alternative method of anesthesia with many benefits. This study was intended to show the possibility of SA as a more comfortable method of anesthesia for the surgeon , the anesthesiologist and the patient via more cooperation of the patient during changing the position and prevention of some complications mostly in upper extremities and neck. Materials & Methods: In a prospective clinical trial study, a total of 112 patients underwent PCNL under SA with marcaine , from Nov 2004 till Feb 2009. Their mean age was 36 years (22-48, at first the syringe was stained by epinephrine and then 2 -3.5 ml marcaine was used for SA and addition of analgesics , sedatives or both., if needed. The rest of the procedure was done as routine.Results: Stone clearance was achieved in 82% of the patients and the rest were managed by ESWL. The mean operation time was 126 minutes (90-220, 36% of the patients needed sedation, analgesia, or both, specially those with bigger stones. 6% of the patients had upper pole stones .Blood transfusion was needed only in one patient. No significant complication was observed in this study.Conclusion: PCNL under SA afforded the surgeon and the anesthesiologist the opportunity of more patient cooperation during position changes and precludes some morbidities that may happen under general anesthesia because the patient is awake and able to portend.

  17. The biomechanical effect of pedicle screws' insertion angle and position on the superior adjacent segment in 1 segment lumbar fusion.

    Science.gov (United States)

    Kim, Ho-Joong; Chun, Heoung-Jae; Kang, Kyoung-Tak; Moon, Seong-Hwan; Kim, Hak-Sun; Park, Jin-Oh; Moon, Eun-Su; Kim, Bo-Ram; Sohn, Joon-Seok; Ko, Yu-Na; Lee, Hwan-Mo

    2012-09-01

    A finite element analysis. To investigate the association between the position of an inserted pedicle screw and the corresponding facet contact force or intradiscal pressure. Although superior facet joint violation by pedicle screws is not an uncommon occurrence in instrumented lumbar fusion surgery, its actual biomechanical significance is not well understood. Furthermore, the association between the position of the pedicle screw and the stress on the corresponding disc/facet joint has yet to be investigated. According to the positions of pedicle screws in L4 of the L4-L5 lumbar fusion, 4 L4-L5 fusion models were simulated. These models included the violation of both L3-L4 superior facet joints by pedicle screws (facet joint violation [FV] model), the nonencroachment of both L3-L4 superior facet joints by pedicle screws (facet joint preservation [FP] model), and the removal state of pedicle screws in the FV model (removal of violated pedicle screws [rFV] model). The facet joint contact [FC] model represented the scenario in which the pedicle screws did not encroach upon either facet joint but were inserted close to the L3-L4 facet joint surface. Moreover, the uninstrumented fusion [UF] model represented the uninstrumented L4-L5 fusion. In each scenario, the intradiscal pressures and facet contact forces at the L2-L3 and L3-L4 segments were analyzed under extension and torsion moments. The FV model yielded the greatest increases in facet contact force and intradiscal pressure at the L3-L4 segment under extension and torsion moments. Following the FV model, the increases in intradiscal pressure and facet contact force were the second highest in the FC model followed by the FP model. Furthermore, the rFV model represented prominent reductions of previously increased facet contact force and intradiscal pressure at the L3-L4 segment. In models of 1-segment lumbar fusion surgery, the positions of pedicle screws were closely linked with corresponding disc stresses and

  18. Intraoperative neuromonitoring: can the results of direct stimulation of titanium-alloy pedicle screws in the thoracic spine be trusted?

    Science.gov (United States)

    Donohue, Miriam L; Swaminathan, Viswaminathan; Gilbert, Jeremy L; Fox, Charles W; Smale, John; Moquin, Ross R; Calancie, Blair

    2012-12-01

    OBJECTVIE: Intraoperative neuromonitoring of thoracic-level pedicle screw implantation for detecting breaches in the pedicle cortex has adopted methods originally developed in the early 1990s for stainless steel (SS) alloy screws used at lumbosacral levels. In our recent attempts to monitor thoracic-level pedicle screw placement, we were surprised to find that these widely used stimulation parameters were largely ineffectual when stimulating directly through titanium alloy (Ti-alloy) pedicle screws. The objectives of this study, then, were twofold: (1) to report the number of episodes in which intraoperative neuromonitoring of thoracic screw position failed to detect a medially directed breach (or malplacement) in a previously described and limited sample set; and (2) to compare the frequency-specific impedance of a sample of Ti-alloy pedicle screws to comparably sized screws made of SS alloys. We predicted that Ti-alloy screws would demonstrate impairment in conduction properties that could help explain the difficulties we, and others, have recently experienced with neuromonitoring of thoracic pedicle screw placement. Based on threshold values for train-of-four stimulation of spinal motor pathways, we quantified the incidence of medial breaches of thoracic-level pedicles in a small cohort of subjects. We also evaluated the conductive properties of Ti-alloy pedicle screws and compared these with SS screws. Eleven pedicle screws were examined using energy-dispersive x-ray spectroscopy to identify their alloys, after which DC resistance and AC impedance for each screw was measured. Furthermore, a subset of five screws was used to investigate the current delivery under dynamic testing conditions. Postoperative computed tomography of 6 subjects revealed 10 instances of significant medial screw malpositioning, out of a total of 88 screws placed. In each of these 10 instances, direct stimulation of thoracic pedicle screws at intensities considered in the literature to be

  19. [Iso-C(3D0-assisted) navigated implantation of pedicle screws in thoracic lumbar vertebrae].

    Science.gov (United States)

    Wendl, K; von Recum, J; Wentzensen, A; Grützner, P A

    2003-11-01

    The mobile Siremobil Iso-C(3D) C-arm (Siemens AG, Medical Solutions, Erlangen) is the first device that permits the intraoperative three-dimensional (3D) representation of bone structures. A high-resolution isotropic 3D data cube in the isocenter with an edge length of approximately 12 cm is calculated simultaneously. The Siremobil Iso-C(3D) is linked to navigation with the integrated NaviLink interface (Siemens AG, Medical Solutions, Erlangen). This makes it possible to transfer the generated 3D data directly to the linked navigation system Surgigate (Medivision, Oberndorf, Switzerland). In this prospective clinical trial we evaluated the accuracy of pedicle screw placement using the Siremobil Iso-C(3D) C-arm. The results were compared to the conventional approach and other computer-assisted procedures (CT-based navigation, C-arm-based 2D navigation) in historical control groups. A total of 141 pedicle screws were placed in 30 patients (70 thoracic spine, 71 lumbar spine). Only in one single case was misplacement shown in the postoperative control CT scan (0.71%), the lowest rate of incorrect placements of all techniques. Also the lowest average fluoroscopy time (1.28+/-0.56 min) was achieved during the placement of pedicle screws on the spine with Iso-C(3D) navigation at a comparable average OR duration (103.26+/-23.3 min). There were no postoperative neurological complications in all 30 patients. From these data we conclude that Iso-C(3D) navigation of pedicle screws is a very accurate method in the correct placement of pedicle screws.

  20. Early clinical results with cortically based pedicle screw trajectory for fusion of the degenerative lumbar spine.

    Science.gov (United States)

    Glennie, R Andrew; Dea, Nicolas; Kwon, Brian K; Street, John T

    2015-06-01

    This study reviews the outcomes and revision rates of degenerative lumbar fusion surgery using cortical trajectory pedicle screws in lieu of traditional pedicle screw instrumentation. Pedicle screw fixation can be a challenge in patients with low bone mineral density. Wide posterior approaches to the lumbar spine exposing lateral to the facet joints and onto transverse processes causes an additional degree of muscular damage and blood loss not present with a simple laminectomy. A cortical bone trajectory pedicle screw has been proposed as an alternative to prevent screw pullout and decrease the morbidity associated with the wide posterior approach to the spine. We present a series of eight consecutive patients using a cortical bone trajectory instead of traditional pedicle screw fixation for degenerative conditions of the lumbar spine. A retrospective review of our institutional registry data identified eight patients who had cortical screws placed with the assistance of O-arm Stealth navigation (Medtronic Sofamor Danek, Memphis, TN, USA) from 2010-2013. We analyzed the need for revision, the maintenance of reduction and the incidence of screw pullout or breakage. Our review demonstrated that two of eight patients were revised at an average of 12months. The reasons for these revisions were pseudarthrosis and caudal adjacent segment failure. All patients who were revised had frank screw loosening. We present early clinical results of a new technique that has been shown to have a better fixation profile in laboratory testing. Our less than favorable early clinical results should be interpreted with caution and highlight important technical issues which should be considered. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Effect of pedicle screw diameter on screw fixation efficacy in human osteoporotic thoracic vertebrae.

    Science.gov (United States)

    Lai, Dar-Ming; Shih, Yu-Tang; Chen, Yi-Hsing; Chien, Andy; Wang, Jaw-Lin

    2018-03-21

    The selection of an ideal screw size plays a crucial role in the success of spinal instrumentation as larger diameter screws are thought to provide better fixation strength but increase the risk of pedicle failure during insertion. On the other hand, smaller diameter screws are with lesser risk of pedicle breakage but are thought to compromise the stability of the instrumentation. By investigating the relationship between screw diameter and the pullout strength of pedicle screws after fatigue loading, this study seeks to find quantitative biomechanical data for surgeons in determining the most ideal diameter size screws when performing surgical implementations on osteoporotic vertebrae. Twenty-seven osteoporotic (BMD ranged: 0.353-0.848 g/cm 2 ) thoracic vertebrae (T3-T8) were harvested from 5 human cadavers. Two sizes of poly-axial screws (5.0 mm × 35 and 4.35 mm × 35) were implanted into each pedicles of the vertebrae by an experienced surgeon. Specimens were randomly distributed into control group, fatigue group of 5000 and 10,000 cycles with peak-to-peak loadings of 10-100 N at 1 Hz. Each specimen was then axial pullout tested at a constant rate of 5 mm/min. The ultimate pullout strength (N) & stiffness (N/mm) were obtained for analysis. The results showed that although the larger diameter screws achieved superior pullout strength immediately after the implantation, both sizes of screws exhibited comparable pullout strengths post fatigue loading. This indicates that the smaller diameter screws may be considered for surgical techniques performed on osteoporotic vertebrae for reduced risk of pedicle breakage without sacrificing fixation strength. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Percutaneous laser ablation of unresectable primary and metastatic adrenocortical carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Pacella, Claudio M. [Regina Apostolorum Hospital, Department of Diagnostic Imaging and Interventional Radiology, Via San Francesco 50, Albano Laziale, Rome 00041 (Italy)], E-mail: claudiomaurizio.pacella@fastwebnet.it; Stasi, Roberto; Bizzarri, Giancarlo; Pacella, Sara; Graziano, Filomena Maria; Guglielmi, Rinaldo; Papini, Enrico [Regina Apostolorum Hospital, Department of Diagnostic Imaging and Interventional Radiology, Via San Francesco 50, Albano Laziale, Rome 00041 (Italy)

    2008-04-15

    Purpose: To evaluate the feasibility, safety, and clinical benefits of percutaneous laser ablation (PLA) in patients with unresectable primary and metastatic adrenocortical carcinoma (ACC). Patients and methods: Four patients with hepatic metastases from ACC and a Cushing's syndrome underwent ultrasound-guided PLA. In one case the procedure was performed also on the primary tumor. Results: After three sessions of PLA, the primary tumor of 15 cm was ablated by 75%. After 1-4 (median 1) sessions of PLA, five liver metastases ranging from 2 to 5 cm were completely ablated, while the sixth tumor of 12 cm was ablated by 75%. There were no major complications. Treatment resulted in an improvement of performance status and a reduction of the daily dosage of mitotane in all patients. The three patients with liver metastases presented a marked decrease of 24-h urine cortisol levels, an improved control of hypertension and a mean weight loss of 2.8 kg. After a median follow-up after PLA of 27.0 months (range, 9-48 months), two patients have died of tumor progression, while two other patients remain alive and free of disease. Conclusions: Percutaneous laser ablation is a feasible, safe and well tolerated procedure for the palliative treatment of unresectable primary and metastatic ACC. Further study is required to evaluate the impact of PLA on survival.

  3. Effectiveness of percutaneous closure of patent foramen ovale for hypoxemia.

    Science.gov (United States)

    Fenster, Brett E; Nguyen, Bryant H; Buckner, J Kern; Freeman, Andrew M; Carroll, John D

    2013-10-15

    The aim of this study was to evaluate the ability of percutaneous patent foramen ovale (PFO) closure to improve systemic hypoxemia. Although PFO-mediated right-to-left shunt (RTLS) is associated with hypoxemia, the ability of percutaneous closure to ameliorate hypoxemia is unknown. Between 2004 and 2009, 97 patients who underwent PFO closure for systemic hypoxemia and dyspnea that was disproportionate to underlying lung disease were included for evaluation. All patients exhibited PFO-mediated RTLS as determined by agitated saline echocardiography. Procedural success was defined as implantation of a device without major complications and mild or no residual shunt at 6 months. Clinical success was defined as a composite of an improvement in New York Heart Association (NYHA) functional class, reduction of dyspnea symptoms, or decreased oxygen requirement. Procedural success was achieved in 96 of 97 (99%), and clinical success was achieved in 68 of 97 (70%). The presence of any moderate or severe interatrial shunt by agitated saline study (odds ratio [OR] = 4.7; p gender (OR = 0.30; p <0.017) decreased the likelihood of success. In conclusion, based on the largest single-center experience of patients referred for PFO closure for systemic hypoxemia, PFO closure was a mechanically effective procedure with an associated improvement in echocardiographic evidence of RTLS, NYHA functional class, and oxygen requirement. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Long-term outcomes of percutaneous lumbar facet synovial cyst rupture

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Ambrose J.; Bos, Stijn A.; Torriani, Martin; Simeone, F.J.; Chang, Connie Y.; Pomerantz, Stuart R.; Bredella, Miriam A. [Massachusetts General Hospital and Harvard Medical School, Department of Radiology, Boston, MA (United States)

    2017-01-15

    To evaluate the therapeutic value, safety, and long-term clinical outcomes of percutaneous lumbar facet synovial cyst (LFSC) rupture. Our study was institutional review board (IRB)-approved and Health Insurance Portability and Accountability Act (HIPAA)-compliant. The study group comprised 71 patients (44 women, mean age: 65 ± 17 years) who underwent CT- or fluoroscopy-guided percutaneous LFSC rupture. The technical success of LFSC rupture, the long-term clinical outcome, including repeat procedures or surgery, and imaging findings on MRI and CT were recorded. Seventy-nine LFSC ruptures were performed in 71 patients. CT guidance was used in 57 cases and fluoroscopy guidance in 22 cases. LFSC rupture was technically successful in 58 out of 79 cases (73 %). Mean injection volume for cyst rupture was 3.6 ± 2.2 mL and a combination of steroid and anesthetic was injected in all cases. Over a mean follow-up time of 44 months, 12 % of patients underwent repeat cyst rupture, and 46 % eventually underwent surgery, whereas the majority of patients (55 %) experienced symptomatic relief and did not undergo surgery. There was no significant association between a successful outcome and age, sex, level, or size of LFSC (p > 0.1). LFSCs with T2 hypointensity were more likely to require surgery (p = 0.02). There was one complication, a bacterial skin infection that completely resolved following antibiotic therapy. Percutaneous LFSC rupture is an effective and safe nonsurgical treatment option for LFSC. More than half of treated patients were able to avoid subsequent surgery. Therefore, percutaneous LFSC rupture should be considered before surgical intervention. (orig.)

  5. The novel echo-guided ProGlide technique during percutaneous transfemoral transcatheter aortic valve implantation.

    Science.gov (United States)

    Honda, Yohsuke; Araki, Motoharu; Yamawaki, Masahiro; Tokuda, Takahiro; Tsutumi, Masakazu; Mori, Shinsuke; Sakamoto, Yasunari; Kobayashi, Norihiro; Hirano, Keisuke; Ito, Yoshiaki

    2018-04-01

    The aim of this study was to assess clinical benefit of the Echo-guided ProGlide technique in patients undergoing percutaneous transfemoral transcatheter aortic valve implantation (TF-TAVI). The efficacy of the Echo-guided ProGlide technique during percutaneous TF-TAVI was not previously clarified. A total of 121 consecutive patients who underwent percutaneous TF-TAVI at our institution between February 2014 and July 2017 were enrolled in this study. According to the introduction of this novel technique in March 2016, patients were divided into two groups (echo-guided group who underwent TAVI from March 2016 to July 2017, n = 63; not echo-guided group who underwent TAVI from February 2014 to February 2016, n = 58). The incidence of major vascular complications, defined per the Valve Academic Research Consortium-2 criteria, and ProGlide complications including acute femoral artery stenosis or occlusion and bleeding requiring any intervention. The incidence of major vascular complication and ProGlide complication were significantly lower in the echo-guided group than in not echo-guided group (1.6% vs 17.2%, P guided ProGlide technique was independently associated with prevention of ProGlide complications (odds ratio, 0.11; 95% confidential interval, 0.01-0.76; P = 0.03). This novel Echo-guided ProGlide technique was associated with a lower rate of major vascular complications, particularly ProGlide complications during percutaneous TF-TAVI. © 2017, Wiley Periodicals, Inc.

  6. Percutaneous transcatheter sclerotherapy of oophoritic cysts

    International Nuclear Information System (INIS)

    Huang Youhua; Xu Qiang; Sun Jun; Shen Tao; Shi Hongjian; Tang Qingfang; Chen Qiying; Zhou Mingxia; Li Hongyao

    2005-01-01

    Objective: To evaluate the clinical value of percutaneous transcatheter sclerotherapy in oophoritic cysts. Methods: Seventy six oophoritic cysts incluoling 48 simple and 28 chocolate cysts of 64 patients were treated with percutaneous transcatheter sclerotherapy under CT guidance. 4F multisideholes pigtail catheter was introduced into cyst using absolute alcohol as sclerosing agents. Results: The successful rate of percutaneous oophoritc cyst puncture was 100% in all 64 patients. Among them 58 were cured (90.6%), 6 improved significantly (9.4%). The total effective rate reached 100% with no serious complications. Conclusions: Catheterization sclerotherapy for oophoritic cyst is a simple, complete, safe and effective method. (authors)

  7. Analysis of Recurrence Management in Patients Who Underwent Nonsurgical Treatment for Acute Appendicitis

    Science.gov (United States)

    Liang, Tsung-Jung; Liu, Shiuh-Inn; Tsai, Chung-Yu; Kang, Chi-Hsiang; Huang, Wei-Chun; Chang, Hong-Tai; Chen, I-Shu

    2016-01-01

    Abstract The recurrence rate for acute appendicitis treated nonoperatively varies between studies. Few studies have adequately evaluated the management of these patients when appendicitis recurs. We aimed to explore the recurrence rate and management of patients with acute appendicitis that were first treated nonoperatively. We identified patients in the Taiwan National Health Insurance Research Database who were hospitalized due to acute appendicitis for the first time between 2000 and 2010 and received nonsurgical treatment. The recurrence and its management were recorded. Data were analyzed to access the risk factors for recurrence and factors that influenced the management of recurrent appendicitis. Among the 239,821 patients hospitalized with acute appendicitis for the first time, 12,235 (5.1%) patients were managed nonoperatively. Of these, 864 (7.1%) had a recurrence during a median follow-up of 6.5 years. Appendectomy was performed by an open and laparoscopic approach in 483 (55.9%) and 258 (29.9%) patients, respectively. The remaining 123 (14.2%) patients were again treated nonsurgically. Recurrence was independently associated with young age, male sex, percutaneous abscess drainage, and medical center admission by multivariable analysis. In addition, age appendicitis, percutaneous abscess drainage, nor length of first time hospital stay had an influence on the selection of surgical approach. In conclusion, a laparoscopic appendectomy can be performed in recurrent appendicitis cases, and its application may not be related to previous appendicitis severity. PMID:27015200

  8. Percutaneous Biopsy of Retrobulbar Masses: Anatomical Considerations and MRI Guidance

    Energy Technology Data Exchange (ETDEWEB)

    Edalat, Faramarz, E-mail: faramarz.edalat@gmail.com; Cazzato, Roberto Luigi; Garnon, Julien; Tsoumakidou, Georgia [Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), Department of Interventional Radiology (France); Avérous, Gerlinde [CHU Strasbourg Hautepierre, Department of Pathology (France); Caudrelier, Jean; Koch, Guillaume; Gangi, Afshin [Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), Department of Interventional Radiology (France)

    2017-04-15

    PurposeObtaining adequate tissue from retrobulbar masses remains a challenge. To this end, a new method of retrobulbar mass biopsy using MRI guidance is presented.Materials and MethodsTwo patients (7- and 71-year-old male) with indeterminate retrobulbar masses underwent bioptic and cytological samplings using MR-compatible 18G and 20–22G needles, and multi-planar MR fluoroscopy. An inferior approach was taken to avoid injury to the optic nerve and ophthalmic arteries.ResultsThe two biopsies were completed without complication. The core biopsy resulted in a final diagnosis, whereas the cytological sampling was non-diagnostic.ConclusionPercutaneous MR-guided retrobulbar mass biopsy proved to be feasible and safe in the two cases described in this report.

  9. Gallbladder Cryoablation: Proof of Concept in a Swine Model for a Percutaneous Alternative to Cholecystectomy

    Energy Technology Data Exchange (ETDEWEB)

    McGregor, Hugh C. J., E-mail: hugh.mcgregor@ucsf.edu; Saeed, Maythem, E-mail: maythem.saeed@ucsf.edu; Surman, Andrew, E-mail: andrew.surman@ucsf.edu; Ehman, Eric C., E-mail: eric.ehman@ucsf.edu; Hetts, Steven W., E-mail: steven.hetts@ucsf.edu; Wilson, Mark W., E-mail: mark.wilson@ucsf.edu; Conrad, Miles B., E-mail: miles.conrad@ucsf.edu [University of California San Francisco, Department of Radiology and Biomedical Imaging (United States)

    2016-07-15

    PurposeTo investigate the feasibility of percutaneous gallbladder cryoablation (GBC) under CT guidance in a swine model with histopathologic correlation.Materials and MethodsInstitutional Animal Care and Use Committee approval was obtained for this study protocol. Five pigs underwent GBC. Under CT guidance, 3–4 cryoprobes were positioned percutaneously at the gallbladder margins. Thermocouple probes were placed percutaneously at the gallbladder fundus, neck, free wall, and gallbladder fossa. Two freeze–thaw cycles ranging from 10 to 26 min were performed. The subjects were sacrificed 5 h after cryoablation. The gallbladder and bile ducts were resected, stained, and examined microscopically.ResultsGBC was completed in all subjects. A 10-mm ablation margin was achieved beyond all gallbladder walls. Thermocouple probes reached at least −20 °C. Intra-procedural body temperature decreased to a minimum of 35 °C but recovered after the procedure. Intra- and post-procedural vital signs otherwise remained within physiologic parameters. Non-target ablation occurred in the stomach and colon of the first two subjects. Histology demonstrated complete denudation of the gallbladder epithelium, hemorrhage, and edema within the muscularis layer, and preservation of the microscopic architecture of the common bile duct in all cases.ConclusionPercutaneous gallbladder cryoablation is feasible, with adequate ablation margins obtained and histologic changes demonstrating transmural necrosis. Adjacent structures included in the ablation may require conservative ablation zones, hydrodissection, or continuous saline lavage.

  10. [Repair of skin and soft tissue defects at distal end of finger with serrated flap with digital proper artery and nerve pedicle combined with bilaterally pedicled V-Y advancement flap of the injured finger].

    Science.gov (United States)

    Chang, Shusen; Jin, Wenhu; Wei, Zairong; Sun, Guangfeng; Wang, Bo; Deng, Chengliang; Tang, Xiujun; Zeng, Xueqin; Nie, Kaiyu

    2016-04-01

    To investigate the therapeutic effects of repair of skin and soft tissue defects at distal end of finger with serrated flap with digital proper artery and nerve pedicle combined with bilaterally pedicled V-Y advancement flap of the injured finger. Thirteen patients with skin and soft tissue defects at distal end of 13 fingers were hospitalized from September 2013 to January 2015. After debridement, the wound area of finger ranged from 1.2 cm × 0.8 cm to 1.8 cm × 1.5 cm. Serrated flap with digital proper artery and nerve pedicle combined with bilaterally pedicled V-Y advancement flap of the injured finger were used to repair the defect. The flaps were interruptedly sutured. The areas of bilaterally pedicled V-Y advancement flap and serrated flap with digital proper artery and nerve pedicle ranged from 0.52 to 1.11 and 2.60 to 5.23 cm(2,) respectively. All flaps of 13 patients survived completely. The patients were followed up for 6 to 24 months. The color and texture of the flaps were good. After reconstruction, the finger tips were in round in shape. The appearance of the fingers was consistent with that of the normal fingers, and joint motility was normal. No hook-nail deformity or knuckle dysfunction was found. Sensation of the flaps was estimated as S4, and the distance of two-point discrimination ranged from 2 to 3 mm. The recovery of the joint motion function of the fingers was excellent. Serrated flap with digital proper artery and nerve pedicle, combined with bilaterally pedicled V-Y advancement flap from the injured finger can repair the skin and soft tissue defects at distal end of finger with reliable blood supply and simple operative technic. It also could avoid the formation of deformity subsequent to a linear scar, and a satisfactory appearance with good function could be obtained.

  11. Contribution of computed tomography guided percutaneous drainage of tuberculous cold abscesses adjunctive to pharmaceutical anti-tubercular treatment

    International Nuclear Information System (INIS)

    Tsagouli, Paraskevi; Sotiropoulou, Evagelia; Filippousis, Petros; Sidiropoulou, Nektaria; Georgiadi, Vithleem; Thanos, Loukas

    2012-01-01

    Purpose: To determine the efficiency and safety of the percutaneous aspiration and drainage of rare touberculous cold abscesses under CT guidance. Materials and methods: We retrospectively studied 63 cases of 44 patients, treated in our hospital during the last two years. They suffered from tuberculous infection complicated with tuberculous cold abscesses variously located. All these patients underwent percutaneous aspiration and drainage under CT imaging, following the trocar puncture technique. The catheter remained in place for about a week. A follow up CT scan was performed in all cases before the catheter removal. Some of the patients were under anti tuberculosis medication. Results: All the patients had a successful recovery from the abscesses. There were no major or minor complications observed. No recurrence occurred until today. Conclusion: CT guided percutaneous aspiration and drainage of tuberculous cold abscesses is a safe, minimal invasive and effective method of treatment. Drainage and specific antituberculosis therapy leads to a satisfactory conclusion.

  12. Glyburide increases risk in patients with diabetes mellitus after emergent percutaneous intervention for myocardial infarction - A nationwide study

    DEFF Research Database (Denmark)

    Jorgensen, C. H.; Gislason, G. H.; Bretler, D.

    2011-01-01

    Danish patients receiving glucose-lowering drugs admitted with myocardial infarction between 1997 and 2006 who underwent emergent percutaneous coronary intervention were identified from national registers. Multivariable Cox proportional hazards models were used to analyze the risk of cardiovascular......BACKGROUND: Sulfonylureas have been linked to an increased cardiovascular risk by inhibition of myocardial preconditioning. Whether individual sulfonylureas affect outcomes in diabetic patients after emergent percutaneous coronary intervention for myocardial infarction is unknown. METHODS: All...... mellitus undergoing emergent percutaneous coronary intervention after myocardial infarction. Early reperfusion therapy is the mainstay in modern treatment of myocardial infarction and the time may have come to discard glyburide in favour of sulfonylureas that do not appear to confer increased...

  13. Transforaminal lumbar interbody fusion using one diagonal fusion cage with unilateral pedicle screw fixation for treatment of massive lumbar disc herniation.

    Science.gov (United States)

    Zhao, Chang-Qing; Ding, Wei; Zhang, Kai; Zhao, Jie

    2016-09-01

    occurred at 3 discs cephalic to the fusion segment at followup. No patients underwent revised surgery. Overall outcome was excellent in 5 patients (21.7%), good in 13 (56.5%), fine in 4 (17.5%), and poor in 1 (4.3%). TLIF using one cage with ipsilateral pedicle screw/rod fixation is an effective treatment option for massive lumbar or LS disc herniation with bi-radicular involvement.

  14. Percutaneous penetration studies for risk assessment

    DEFF Research Database (Denmark)

    Sartorelli, Vittorio; Andersen, Helle Raun; Angerer, Jürgen

    2000-01-01

    . In order to predict the systemic risk of dermally absorbed chemicals and to enable agencies to set safety standards, data is needed on the rates of percutaneous penetration of important chemicals. Standardization of in vitro tests and comparison of their results with the in vivo data could produce...... internationally accepted penetration rates and/or absorption percentages very useful for regulatory toxicology. The work of the Percutaneous Penetration Subgroup of EC Dermal Exposure Network has been focussed on the standardization and validation of in vitro experiments, necessary to obtain internationally...... accepted penetration rates for regulatory purposes. The members of the Subgroup analyzed the guidelines on percutaneous penetration in vitro studies presented by various organizations and suggested a standardization of in vitro models for percutaneous penetration taking into account their individual...

  15. Percutaneous treatment of liver hydatid cysts

    Energy Technology Data Exchange (ETDEWEB)

    Akhan, Okan; Oezmen, Mustafa N

    1999-10-01

    Hydatic disease caused by Echinococcus granulosus is an endemic disease and an important public health problem in some countries of the world. The results of surgical treatment are associated with a high rate of mortality, morbidity, postoperative recurrence and a long period of hospital stay and the medical treatment results are still controversial. Although the percutaneous aspiration and treatment of liver hydatid cysts were considered to be contraindicated due to risks of anaphylactic shock and dissemination of clear-crystal fluid into the abdomen, several reports of successful percutaneous treatment of liver hydatid cysts have been published in the literature. Today, percutaneous treatment of liver hydatid cysts is the most effective and reliable treatment procedure in the selected cases. In this review, indications, contraindications, method and techniques, healing criteria, complications, results and importance of the percutaneous treatment of liver hydatid cysts are discussed.

  16. Percutaneous ablation of the gallbladder

    International Nuclear Information System (INIS)

    Saini, S.; Mueller, P.R.; Girard, M.; Lee, M.J.; Goldberg, M.; Brink, J.A.; Flotte, T.J.; Ribiero, R.; Ferrucci, J.T.

    1990-01-01

    This paper examines the feasibility of using Holmium: yttrium-aluminum-garnet (YAG) laser to permanently obliterate the cystic duct and then using chemical sclerosants to ablate the gallbladder mucosa. Percutaneous cholecystostomy was performed in 30 domestic pigs. The cystic duct was cannulated and while the laser fiber was withdrawn at a rate of 0.5 cm/sec, pulsed laser energy (10 Hz) was delivered. Animals were sacrificed immediately (n = 7), at 72 hours (n = 4), and 6 weeks (n = 19). In the 6-week group, gallbladder sclerosis (95% alcohol plus sodium tetradecyl sulfate) was performed in 13 animals immediately after occluding the cystic duct. Control animals were included in each group

  17. Left main percutaneous coronary intervention.

    Science.gov (United States)

    Teirstein, Paul S; Price, Matthew J

    2012-10-23

    The introduction of drug-eluting stents and advances in catheter techniques have led to increasing acceptance of percutaneous coronary intervention (PCI) as a viable alternative to coronary artery bypass graft (CABG) for unprotected left main disease. Current guidelines state that it is reasonable to consider unprotected left main PCI in patients with low to intermediate anatomic complexity who are at increased surgical risk. Data from randomized trials involving patients who are candidates for either treatment strategy provide novel insight into the relative safety and efficacy of PCI for this lesion subset. Herein, we review the current data comparing PCI with CABG for left main disease, summarize recent guideline recommendations, and provide an update on technical considerations that may optimize clinical outcomes in left main PCI. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  18. Percutaneous drainage of tuberculous abscesses

    International Nuclear Information System (INIS)

    Puri, S.K.; Panicker, H.; Narang, P.; Kumar, N.; Dhall, A.; Gupta, S.B.

    2001-01-01

    To assess the role of percutaneous catheter drainage (PCD) in the management of tuberculous ilio-psoas abscesses, twenty-two patients with 26 tuberculous ilio-psoas abscesses were subjected to PCD under real time US guidance taking help of a pre-procedure CT for planning the route of catheter insertion. Complete cure of the ilio-psoas abscesses could be achieved in 22 of 26 abscesses (84.6%). Average duration of drainage was 10 days. US/ CT follow-up ranged from 3-24 months. PCD was a failure in four abscesses (15.4%). Two patients, one with bilateral abscesses, had recurrent abscesses while one patient had an abscess associated with extensive spondylo-discitis. No significant complication was encountered in the study. PCD is a simple, safe and very effective (success rate 84.6%) alternative to surgical drainage in the management of tuberculous ilio-psoas abscesses. (author)

  19. [Percutanous dilation tracheotomy: our experience].

    Science.gov (United States)

    Domènech, I; Mateu, T; Cisa, E; Juan, A; Gil, E; Palau, M; Dicenta, M

    2004-01-01

    Percutaneous dilation Tracheotomy (PDT) is becoming a popular alternative to surgical tracheotomy. In our hospital, we recently adopted the use of the PDT in intensive care unit patients. The objective [corrected] of this investigation is to characterize and quantify the rate of complications for PDT. A prospective study of 60 PDT performed at different intesive care units, betweem September 2002 to July 2003. The intraoperative time for PDT was 8 minutes. Complications included 6 cases of mild intraoperative hemorrhage, 1 case of moderate intraoperative hemorrhage, 4 cases of mild postoperative hemorrhage and 1 case of subcutaneous emphysema. PDT is a good alternative to surgical tracheotomy and should be added to the otolaryngologists armamentarium of surgical airway procedures.

  20. Percutaneous ablation of pancreatic cancer

    Science.gov (United States)

    D’Onofrio, Mirko; Ciaravino, Valentina; De Robertis, Riccardo; Barbi, Emilio; Salvia, Roberto; Girelli, Roberto; Paiella, Salvatore; Gasparini, Camilla; Cardobi, Nicolò; Bassi, Claudio

    2016-01-01

    Pancreatic ductal adenocarcinoma is a highly aggressive tumor with an overall 5-year survival rate of less than 5%. Prognosis and treatment depend on whether the tumor is resectable or not, which mostly depends on how quickly the diagnosis is made. Chemotherapy and radiotherapy can be both used in cases of non-resectable pancreatic cancer. In cases of pancreatic neoplasm that is locally advanced, non-resectable, but non-metastatic, it is possible to apply percutaneous treatments that are able to induce tumor cytoreduction. The aim of this article will be to describe the multiple currently available treatment techniques (radiofrequency ablation, microwave ablation, cryoablation, and irreversible electroporation), their results, and their possible complications, with the aid of a literature review. PMID:27956791

  1. Percutaneous transluminal angioplasty in arteriosclerosis

    International Nuclear Information System (INIS)

    Chung, Soo Young; Cha, In Ho

    1984-01-01

    Percutaneous transluminal angioplasty (PTA) is a non-operative therapeutic procedure to the dilation of stenosis or to the recanalization of occlusion in atherosclerotic arteries using of dilatation catheters. PTA was performed 37 times in 34 patients with arteriosclerotic for 1 year and 4 months from March, 1982 to June, 1983 at department of radiology, Klinikum Barmen/west Germany. The results were as follows; 1. The male to female ratio was 2 : 1 and peak age range was from 61 to 70. 2. The most common indication was clinical stage II b with 19 cases (51.3%). 3. PTA was performed most commonly in superficial femora artery in 25 cases (67.5%). 4. Acute major complication occurred in 2 cases (5.4%). PTA is a alternative or complementary therapeutic procedure to vascular surgery.

  2. Bivalirudin in percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Sam J Lehman

    2006-12-01

    Full Text Available Sam J Lehman, Derek P ChewDepartment of Medicine, Flinders University, South Australia, AustraliaAbstract: Bivalirudin is a member of the direct thrombin inhibitor group of anticoagulants. It has been evaluated as an alternative to unfractionated and low-molecular-weight heparins in the settings of percutaneous coronary intervention (PCI and acute coronary syndrome (ACS. Results of clinical trials to date suggest bivalirudin is a viable alternative to the use of a heparin combined with a glycoprotein (GP IIb/IIIa inhibitor in these settings. Thrombin has a central role in coagulation and platelet activation in ACS and during PCI. Its direct inhibition is an attractive target for therapy in these settings. Bivalirudin is a 20 amino acid polypeptide hirudin analog. It displays bivalent and reversible binding to the thrombin molecule, inhibiting its action. Direct inhibition of thrombin with bivalirudin has theoretical pharmacokinetic and pharmacodynamic advantages over the indirect anticoagulants. A reduction in rates of bleeding without loss of anti-thrombotic efficacy has been a consistent finding across multiple clinical trials. There may be economic benefits to the use of bivalirudin if it permits a lower rate of use of the GP IIb/IIIa inhibitors. This article reviews the pharmacology of bivalirudin and clinical trial evidence to date. There are now data from multiple clinical trials and meta-analyses in the setting of ACS and PCI. Early results from the acute catheterization and urgent intervention strategy (ACUITY trial are discussed. Keywords: bivalirudin, direct thrombin inhibitor, acute coronary syndrome, percutaneous coronary intervention

  3. Infective endocarditis following percutaneous pulmonary valve replacement

    DEFF Research Database (Denmark)

    Cheung, Gary; Vejlstrup, Niels; Ihlemann, Nikolaj

    2013-01-01

    Infective endocarditis (IE) following percutaneous pulmonary valve replacement (PPVR) with the Melody valve is rarely reported. Furthermore, there are challenges in this diagnosis; especially echocardiographic evidence of vegetation within the prosthesis may be difficult.......Infective endocarditis (IE) following percutaneous pulmonary valve replacement (PPVR) with the Melody valve is rarely reported. Furthermore, there are challenges in this diagnosis; especially echocardiographic evidence of vegetation within the prosthesis may be difficult....

  4. Posterior pedicle screw fixation for complex atlantoaxial fractures with atlanto-dental interval of ≥ 5 mm or C2-C3 angulation of ≥ 11°.

    Science.gov (United States)

    Wang, Lei; Liu, Chao; Zhao, Qinghua; Tian, Jiwei

    2014-11-19

    Previous studies have demonstrated that the posterior pedicle screw fixation is an effective and safe method to treat atlantoaxial fractures. However, no report focuses on only the complex atlantoaxial fractures with atlanto-dental interval (ADI) of ≥ 5 mm or C2-C3 angulation of ≥ 11°. This study was to retrospectively evaluate the outcome of 15 patients (six females and nine males; age, 27-55 years) who underwent posterior pedicle screw fixation for the above complex atlantoaxial fractures between July 2006 and March 2011. Fracture combinations included three Jefferson-type II odontoid, four anterior ring-type II odontoid, two posterior ring-type II odontoid, one lateral mass-type II odontoid, one Jefferson-hangman's fracture, three anterior ring-hangman's fracture, and one lateral mass-hangman's fracture. Fracture healing and bone fusion were determined on X-ray scan. Upper limbs, lower limbs, and sphincter functions were assessed using the Japanese Orthopaedic Association (JOA) score. The Frankel grading system was used to determine the neurological situation. The mean operative time, blood loss, and hospital stays were 108.9 ± 25.8 min, 508.0 ± 209.6 ml, and 13.3 ± 2.0 days. Fracture healing and graft fusion were obtained in all patients within 9 months. The ADI or C2-C3 angulation was reduced to ≤ 5 mm or ≤ 11°. The JOA score was significantly improved from 7.27 ± 1.10 preoperatively to 15.7 ± 2.1 postoperatively (P fractures.

  5. Accuracy of pedicle screw insertion in posterior scoliosis surgery: a comparison between intraoperative navigation and preoperative navigation techniques.

    Science.gov (United States)

    Zhang, Wei; Takigawa, Tomoyuki; Wu, YongGang; Sugimoto, Yoshihisa; Tanaka, Masato; Ozaki, Toshifumi

    2017-06-01

    This study was conducted to compare the efficacy and accuracy of intraoperative navigation (O-arm or Arcadis navigation) and preoperative CT-based navigation in adolescent idiopathic scoliosis (AIS) surgery. Sixty-seven patients with scoliosis were grouped according to the method of navigation used in their fixation surgeries. A total of 492 pedicle screws were implanted in 27 patients using intraoperative navigation, and 626 screws were implanted in 40 patients using preoperative navigation. We analyzed the postoperative CT images for pedicle violations using the Gertzbein classification. There was no statistical difference in the accuracy of pedicle screw placement between two groups. However, in the apical region (the apex ± 2 vertebrae), the accuracy of safe pedicle screw placement (grades 0, 1) was significantly higher in the intraoperative navigation group than in the preoperative navigation group (94.8 vs 89.2%, respectively; P = 0.035). Intraoperative navigation significantly diminished medial perforation compared to preoperative navigation (P = 0.027), and the number of screws per vertebra that could be placed in the apical region was significantly higher in intraoperative navigation group (P < 0.001). In addition, the time required for the registration procedure and insertion of one pedicle screw was 11.3 ± 2.1 min in the preoperative group, but significantly decreased to 5.1 ± 1.1 min in the intraoperative group (P < 0.001). Both preoperative CT-based and intraoperative navigation systems provide sufficient accuracy and safety in pedicle screw insertion for AIS surgery. Intraoperative navigation systems facilitate pedicle screw insertion in the apical region and reduce registration time during AIS surgery which improves the efficacy and accuracy of pedicle screw insertion.

  6. Biomechanical evaluation of fixation strength of conventional and expansive pedicle screws with or without calcium based cement augmentation.

    Science.gov (United States)

    Gao, Mingxuan; Lei, Wei; Wu, Zixiang; Liu, Da; Shi, Lei

    2011-03-01

    The expansive pedicle screw was originally developed to be installed in the bone of compromised quality, but there are some concerns whether it can provide enough fixation strength in the spine with osteoporosis or severe osteoporosis. Twelve fresh human cadaver spines were stratified into four levels: normal, osteopenia, osteoporosis and severe osteoporosis. The vertebra was bilaterally instrumented with pedicle screws according to four protocols, including conventional pedicle screw without augmentation, expansive pedicle screw without augmentation, conventional screw with augmentation and expansive screw with augmentation. Screw pullout tests were conducted. Given the same specimen, the fixation strength of expansive screw was significantly higher than that of the conventional screw. When the same type of screw was used, the fixation strength of the calcium based cement augmented group was stronger than that of the non-augmented group. The pullout strength and stiffness of the expansive screw, augmented conventional screw and augmented expansive screw groups at the osteoporotic level were comparable to those of the conventional pedicle screw group at the osteopenic level. However, under the severely osteoporotic bone environment, the pullout strength of pedicle screw with whatever placement protocol was significantly lower than that of the conventional screw group at the osteopenic level. Our results demonstrate that (i) the expansive pedicle screw appears feasible and safe in either osteopenic or osteoporotic spine; (ii) calcium based cement augmentation can offer improved initial fixation strength of pedicle screws.; and (iii) no screw placement protocol we examined is efficacious in the bone at the severely osteoporotic level. Copyright © 2010 Elsevier Ltd. All rights reserved.

  7. Lateral pedicle graft for repair of residual gingival defect following complete surgical excision of a pyogenic granuloma

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    Awadhesh Kumar Singh; Abhisek Gautam

    2016-01-01

    The pyogenic granuloma, one of the gingival lesions, has recurrence rate of 16%. To minimize the recurrence rate, it must be completely excised. Complete surgical excision can result in residual gingival defect. McCrea repaired residual gingival defect by subepithelial connective tissue graft with lateral mucogingival pedicle flap, and Choudhary et al. managed residual gingival defect by subepithelial connective tissue graft only. The aim of this case report was to use lateral pedicle graft f...

  8. Internal fixation and muscle pedicle bone grafting in femoral neck fractures

    Directory of Open Access Journals (Sweden)

    Gupta A

    2008-01-01

    Full Text Available Background: The treatment of displaced intracapsular femoral neck fracture is still an unsolved problem. Non-union and avascular necrosis are the two main complications of this fracture, especially if patient presents late. Muscle pedicle bone grafting has been advocated to provide additional blood supply. We present analysis of our 32 cases of displaced femoral neck fracture treated by internal fixation and quadratus femoris based muscle pedicle bone grafting. Materials and Methods: Open reduction and internal fixation with muscle pedicle grafting was done in 32 patients. The age of patients varied from 14-62 years (average age 45 years with male to female ratio of 13:3. Twenty-nine fractures were more than three weeks old. All the cases were treated by Meyers′ procedure. The fracture was internally fixed after open reduction and then a muscle pedicle graft was applied. It was supplemented by cancellous bone graft in seven cases. Fixation was done by parallel cancellous lag screws ( n = 19, crossed Garden′s screws ( n = 7, parallel Asnis screws ( n = 5 and Moore′s pin ( n = 1.Quadratus femoris muscle pedicle graft was used in 32 cases. In the initial 12 cases the graft was fixed with circumferential proline sutures, but later, to provide a secure fixation, the graft was fixed with a cancellous screw ( n = 20. Postoperative full weight bearing was deferred to an average of 10 weeks. Results: Union was achieved in 26/29 (89.65% cases which could be followed for an average period of 3.4 years, (2-8.5 years with good functional results and had the ability to squat and sit cross-legged. Results were based on hip rating system given by Salvatti and Wilson. The results were excellent in 15 cases, good in four cases, fair in four cases and poor in six cases. Complications were avascular necrosis ( n = 2, transient foot drop ( n = 2, coxa-vara ( n = 1 and temporary loss of scrotal sensation ( n = 1. Conclusion: Muscle pedicle bone grafting with

  9. Osteonecrosis of femoral head: Treatment by core decompression and vascular pedicle grafting

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    Babhulkar Sudhir

    2009-01-01

    Full Text Available Background: Femoral head-preserving core decompression and bone grafting have shown excellent result in preventing collapse. The use of vascularized grafts have shown better clinical results. The vascular pedicle bone graft is an easy to perform operation and does not require special equipment. We analyzed and report a series of patients of osteonecrosis of femoral head treated by core decompression and vascular pedicle grafting of part of iliac crest based on deep circumflex iliac vessels. Materials and Methods: The article comprises of the retrospective study of 31 patients of osteonecrosis of femoral head in stage II and III treated with core decompression and vascular pedicle grafting by using part of iliac crest with deep circumflex iliac vessels from January 1990 to December 2005. The young patients with a mean age 32 years (18-52 years with a minimum follow-up of five years were included for analysis. Sixteen patients had osteonecrosis following alcohol abuse, 12 patients following corticosteroid consumption, 3 patients had idiopathic osteonecrosis. Nine patients were stage IIB, and 22 patients were stage IIIC according to ARCO′s system. The core decompression and vascular pedicle grafting was performed by anterior approach by using part of iliac crest with deep circumflex iliac vessels. Results: Digital subtraction arteriography performed in 9 patients at the end of 12 weeks showed the patency of deep circumflex artery in all cases, and bone scan performed in 6 other patients showed high uptake in the grafted area of the femoral head proving the efficacy of the operative procedure. Out of 31 patients, only one patient progressed to collapse and total joint replacement was advised. At the final follow up period of 5-8 years, Harris Hip Score improved mean ± SD of 28.2 ± 6.4 ( p < 0.05. Forty-eight percent of patients had an improvement in Harris Hip Score of more that 28 points. Conclusion: The core decompression and vascular pedicle

  10. Characteristics of immediate and fatigue strength of a dual-threaded pedicle screw in cadaveric spines.

    Science.gov (United States)

    Brasiliense, Leonardo B C; Lazaro, Bruno C R; Reyes, Phillip M; Newcomb, Anna G U S; Turner, Joseph L; Crandall, Dennis G; Crawford, Neil R

    2013-08-01

    Novel dual-threaded screws are configured with overlapping (doubled) threads only in the proximal shaft to improve proximal cortical fixation. Tests were run to determine whether dual-threaded pedicle screws improve pullout resistance and increase fatigue endurance compared with standard pedicle screws. In vitro strength and fatigue tests were performed in human cadaveric vertebrae and in polyurethane foam test blocks. Seventeen cadaveric lumbar vertebrae (14 pedicles) and 40 test sites in foam blocks were tested. Measures for comparison between standard and dual-threaded screws were bone mineral density (BMD), screw insertion torque, ultimate pullout force, peak load at cyclic failure, and pedicular side of first cyclic failure. For each vertebral sample, dual-threaded screws were inserted in one pedicle and single-threaded screws were inserted in the opposite pedicle while recording insertion torque. In seven vertebrae, axial pullout tests were performed. In 10 vertebrae, orthogonal loads were cycled at increasing peak values until toggle exceeded threshold for failure. Insertion torque and pullout force were also recorded for screws placed in foam blocks representing healthy or osteoporotic bone porosity. In bone, screw insertion torque was 183% greater with dual-threaded than with standard screws (pscrews pulled out at 93% of the force required to pull out dual-threaded screws (p=.42). Of 10 screws, five reached toggle failure first on the standard screw side, two screws failed first on the dual-threaded side, and three screws failed on both sides during the same round of cycling. In the high-porosity foam, screw insertion torque was 60% greater with the dual-threaded screw than with the standard screw (p=.005), but 14% less with the low-porosity foam (p=.07). Pullout force was 19% less with the dual-threaded screw than with the standard screw in the high-porosity foam (p=.115), but 6% greater with the dual-threaded screw in the low-porosity foam (p=.156

  11. Percutaneous Transabdominal Approach for the Treatment of Endoleaks after Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Sun Young; Lee, Do Yun; Lee, Kwang Hun [Severance Hospital, University of Yonsei, Seoul (Korea, Republic of); Won, Jong Yun [Gangnam Severance Hospital, University of Yonsei, Seoul (Korea, Republic of); Choi, Dong Hoon; Shim, Won Heum [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2010-02-15

    The purpose of this study was to evaluate the technical feasibility and clinical efficacy of percutaneous transabdominal treatment of endoleaks after endovascular aneurysm repair. Between 2000 and 2007, six patients with type I (n = 4) or II (n = 2) endoleaks were treated by the percutaneous transabdominal approach using embolization with N-butyl cyanoacrylate with or without coils. Five patients underwent a single session and one patient had two sessions of embolization. The median time between aneurysm repair and endoleak treatment was 25.5 months (range: 0-84 months). Follow-up CT images were evaluated for changes in the size and shape of the aneurysm sac and presence or resolution of endoleaks. The median follow-up after endoleak treatment was 16.4 months (range: 0-37 months). Technical success was achieved in all six patients. Clinical success was achieved in four patients with complete resolution of the endoleak confirmed by follow-up CT. Clinical failure was observed in two patients. One eventually underwent surgical conversion, and the other was lost to follow-up. There were no procedure-related complications. The percutaneous transabdominal approach for the treatment of type I or II endoleaks, after endovascular aneurysm repair, is an alternative method when conventional endovascular methods have failed.

  12. Repositioning of pedicle conjunctival flap performed for refractory corneal ulcer.

    Science.gov (United States)

    Sharma, Ashok; Mohan, Kanwar; Sharma, Rajan; Nirankari, Verinder S

    2014-01-01

    A 50-year-old male was referred with a previous history of conjunctival flap (CF) for a nonhealing fungal corneal ulcer with extreme corneal thinning in the right eye. The peritomy for the CF extended from 6:30 to 9:30 clock h on the cornea. The CF was disengaged, peritomy area deepithelialized, and CF was repositioned. He later underwent penetrating keratoplasty and achieved 20/40 best corrected visual acuity. The authors present a new concept for surgically repositioning CF s to the original site immediately after healing of the corneal ulcer.

  13. Fluoroscopy-Guided Percutaneous Gallstone Removal Using a 12-Fr Sheath in High-Risk Surgical Patients with Acute Cholecystitis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Hwan [Keimyung University, College of Medicine, Daegu (Korea, Republic of); Kim, Yong Joo [Andong General Hospital, Andong (Korea, Republic of); Shin, Tae Beom [Gyeonsang National University, College of Medicine, Jinju (Korea, Republic of)

    2011-04-15

    To evaluate the technical feasibility and clinical efficacy of percutaneous transhepatic cholecystolithotomy under fluoroscopic guidance in high-risk surgical patients with acute cholecystitis. Sixty-three consecutive patients of high surgical risk with acute calculous cholecystitis underwent percutaneous transhepatic gallstone removal under conscious sedation. The stones were extracted through the 12-Fr sheath using a Wittich nitinol stone basket under fluoroscopic guidance on three days after performing a percutaneous cholecystostomy. Large or hard stones were fragmented using either the snare guide wire technique or the metallic cannula technique. Gallstones were successfully removed from 59 of the 63 patients (94%). Reasons for stone removal failure included the inability to grasp a large stone in two patients, and the loss of tract during the procedure in two patients with a contracted gallbladder. The mean hospitalization duration was 7.3 days for acute cholecystitis patients and 9.4 days for gallbladder empyema patients. Bile peritonitis requiring percutaneous drainage developed in two patients. No symptomatic recurrence occurred during follow-up (mean, 608.3 days). Fluoroscopy-guided percutaneous gallstone removal using a 12-Fr sheath is technically feasible and clinically effective in high-risk surgical patients with acute cholecystitis

  14. Phalloplasty with an innervated island pedicled anterolateral thigh flap in a female-to-male transsexual.

    Science.gov (United States)

    Hasegawa, Kenjiro; Namba, Yuzaburo; Kimata, Yoshihiro

    2013-01-01

    Since 2001, we have been performing phalloplasty with a radial forearm free flap as the flap of first choice in female-to-male transsexuals (FTMTS). In the present case, a 22-year-old FTMTS with a negative Allen test, we achieved good results by performing phalloplasty with an innervated island pedicled anterolateral thigh flap using the "tube within a tube" technique, in which the penis and urethra are constructed with a single flap. As compared to a forearm flap, use of an innervated island-pedicled flap may have the following advantages in phalloplasty:1) no need for a microsurgical technique;2) no scars at noticeable sites;3) small functional loss in the flap donor area;4) no sacrifice of major blood vessels. Thus, this technique seems to be a useful clinical alternative for phallic reconstruction.

  15. Infection of PTFE mesh 15 years following pedicled TRAM flap breast reconstruction: mechanism and aetiology.

    Science.gov (United States)

    Elfaki, A; Gkorila, A; Khatib, M; Malata, C M

    2018-01-01

    The pedicled transverse rectus abdominis myocutaneous (TRAM) flap procedure is still widely used for breast reconstruction. The repair of the flap harvest site in the transverse rectus abdominis muscle and sheath is often assisted by the use of prosthetic meshes. This decreases the risk of abdominal wall weakness and herniation but, being a foreign body, it also carries the risk of infection. In this report, we describe the case of a 63-year-old patient who, whilst receiving chemotherapy for metastatic breast cancer, presented with an infected polytetrafluoroethylene mesh 15 years after pedicled TRAM flap immediate breast reconstruction. This necessitated mesh removal to treat the infection. Following a thorough review of the English literature, this is the longest recorded presentation of an abdominal prosthetic mesh infection. The mechanism and aetiology of such a late complication are discussed.

  16. Misdiagnosing absent pedicle of cervical spine in the acute trauma setting

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    Fahad H. Abduljabbar

    2015-09-01

    Full Text Available Congenital absence of cervical spine pedicle can be easily misdiagnosed as facet dislocation on plain radiographs especially in the acute trauma setting. Additional imaging, including computed tomography (CT-scan with careful interpretation is required in order to not misdiagnose cervical posterior arch malformation with subsequent inappropriate management. A 39-year-old patient presented to the emergency unit of our university hospital after being trampled by a cow over her back and head followed by loss of consciousness, retrograde amnesia and neck pain. Her initial cervical CT-scan showed possible C5-C6 dislocation, then, it became clear that her problem was a misdiagnosed congenital cervical abnormality. Patient was treated symptomatically without consequences. The congenital absence of a cervical pedicle is a very unusual condition that is easily misdiagnosed. Diagnosis can be accurately confirmed with a CT-scan of the cervical spine. Symptomatic conservative treatment will result in resolution of the symptoms.

  17. Neuraxial anesthesia after local anesthesia for management of percutaneous vertebroplasty complication during vertebroplasty

    Directory of Open Access Journals (Sweden)

    Hüseyin Balkarlı

    Full Text Available Abstract Percutaneous vertebroplasty is a relatively safe, simple and commonly performed interventional procedure for the management of vertebral compression fractures. However, serious complications are rarely reported in the procedure. Those are pulmonary embolism, severe infection, paraplegia and an occurrence of a new fracture in an adjacent vertebra after vertebroplasty. Acute complications are generally associated with the procedure. We present the case of neuraxial anesthesia, developed after local anesthesia with 8 mL of 2% prilocaine, in a 68-year-old woman who underwent percutaneous vertebroplasty after an osteoporotic collapsed fracture in the L1 vertebra due to trauma. To our knowledge, this is the first case in the literature.

  18. Cervical pedicle screw fixation at C6 and C7 A cadaveric study

    Directory of Open Access Journals (Sweden)

    Ye Li

    2015-01-01

    Conclusion: The intersection of the horizontal line through the midpoint of the transverse process root and vertical line through the intersection of the posterolateral and posterior planes of the isthmus can be used as an entry point for C6 and C7 pedicle screw fixation. The screws should be inserted at 60 or 90° with the posterolateral isthmus in the horizontal plane and at 75° with the posterior isthmus in the sagittal plane. The LSC should not exceed 30 mm.

  19. Feasibility and Accuracy of Thoracolumbar Minimally Invasive Pedicle Screw Placement With Augmented Reality Navigation Technology.

    Science.gov (United States)

    Elmi-Terander, Adrian; Nachabe, Rami; Skulason, Halldor; Pedersen, Kyrre; Söderman, Michael; Racadio, John; Babic, Drazenko; Gerdhem, Paul; Edström, Erik

    2017-12-19

    Cadaveric laboratory study. To assess the feasibility and accuracy of minimally invasive thoracolumbar pedicle screw placement using augmented reality (AR) surgical navigation SUMMARY OF BACKGROUND DATA.: Minimally invasive spine (MIS) surgery has increasingly become the method of choice for a wide variety of spine pathologies. Navigation technology based on AR has been shown to be feasible, accurate and safe in open procedures. AR technology may also be used for MIS surgery. The AR surgical navigation was installed in a hybrid operating room (OR). The hybrid OR includes a surgical table, a motorized flat detector C-arm with intraoperative 2D/3D imaging capabilities, integrated optical cameras for AR navigation and patient motion tracking using optical markers on the skin. Navigation and screw placement was without any X-ray guidance. Two neurosurgeons placed 66 Jamshidi needles (2 cadavers) and 18 cannulated pedicle screws (1 cadaver) in the thoracolumbar spine. Technical accuracy was evaluated by measuring the distance between the tip of the actual needle position and the corresponding planned path as well as the angles between the needle and the desired path. Time needed for navigation along the virtual planned path was measured. An independent reviewer assessed the postoperative scans for the pedicle screws' clinical accuracy. Navigation time per insertion was 90 ± 53 seconds with an accuracy of 2.2 ± 1.3 mm. Accuracy was not dependent on operator. There was no correlation between navigation time and accuracy. The mean error angle between the Jamshidi needles and planned paths was 0.9 ± 0.8°. No screw was misplaced outside the pedicle. Two screws breached 2 to 4 mm yielding an overall accuracy of 89% (16/18). MIS screw placement directed by AR with intraoperative 3D imaging in a hybrid OR is accurate and efficient, without any fluoroscopy or X-ray imaging during the procedure. 4.

  20. Biomechanical evaluation of a novel fenestrated pedicle screw augmented with bone cement in osteoporotic spines.

    Science.gov (United States)

    Paré, Philippe E; Chappuis, James L; Rampersaud, Raja; Agarwala, Amit O; Perra, Joseph H; Erkan, Serkan; Wu, Chunhui

    2011-08-15

    Comparative biomechanical study was conducted in osteoporotic human cadaveric spines. Determine the influence of the volume of polymethyl methacrylate injected through a fenestrated pedicle screw on the pullout strength and on the ability to safely remove the implant. Pedicle screw fixation in the osteoporotic spine can be improved by the addition of bone cement. Various injection techniques have been used. While improvement has been shown for the pullout strength, the optimal volume of cement to inject has not been previously studied. Seven osteoporotic spines were instrumented with a standard and a fenestrated pedicle screw augmented with polymethyl methacrylate at each level (T7-L5). Three volumes of bone cement were randomly injected and stratified to the thoracic (0.5 cc, 1.0 cc, and 1.5 cc) and lumbar spine (1.5 cc, 2.0 cc, and 2.5 cc). Axial pullout strength and removal torque of the pedicle screws were quantified. The pullout strength of the fenestrated screw was normalized with respect to its contralateral control. Student paired t tests were conducted and a statistically significant increase was noted for 1.0 cc (186 ± 45%) and 1.5 cc (158 ± 46%) in the thoracic spine and for 1.5 cc (264 ± 193%), 2.0 cc (221 ± 93%), and 2.5 cc (198 ± 42%) in the lumbar spine. There was no significant difference with higher volumes of cement. The median removal torque was 0.34 Nm for the standard and 1.83 Nm for the augmented screws. When the augmented implants were removed, the bone cement sheared completely off at the fenestrations in 15 of the 17 cases. Significant increases in pullout strength can be accomplished by injecting a limited quantity of bone cement through a fenestrated screw while minimizing the risks associated with higher volume. The majority of implants were removed without damaging the vertebra as the bone cement sheared off at the fenestrations.

  1. Nerve and tendon injury with percutaneous fibular pinning: a cadaveric study.

    Science.gov (United States)

    Iorio, Justin; Criner, Katharine; Rehman, Saqib; Meizinger, Casey; Haydel, Christopher

    2014-12-01

    The purposes of this study were to measure the average distance from a percutaneous pin in each quadrant of the distal fibula to the sural nerve and nearest peroneal tendon, and define the safe zone for percutaneous pin placement as would be used during surgery. Ten fresh-frozen cadavers underwent percutaneous pin fixation into four quadrants of the distal fibula. The sural nerve and peroneal tendon were identified as they coursed around the lateral ankle. Distances from the K-wire in each quadrant to the anatomic structure of interest were measured. Average distances (mm) from the K-wire to the sural nerve in the anterolateral, anteromedial, posterolateral, and posteromedial quadrants were 19.1±8.9 (range, 5.1-35.5), 12.8±8.2 (range, 0.3-27.8), 12.6±6.8 (range, 3.0-27.8), and 5.9±5.5 (range, 0.1-19.9), respectively. Average distances from the K-wire to the nearest peroneal tendon in the anterolateral, anteromedial, posterolateral, and posteromedial quadrants were 15.7±4.4 (range, 9.5-23.1), 11.9±5.2 (range, 3.2-21.7), 6.3±3.9 (range, 0.1-14.4), and 1.0±1.6 (range, 0-5.6), respectively. Percutaneous pinning of distal fibula fractures is a successful treatment option with minimal complications. Our anatomical study found the safe zone of percutaneous pin placement to be in the anterolateral quadrant. The sural nerve can be as close as 5.1mm and the peroneal tendons as near as 15.7mm. In contrast, the posteromedial quadrant was associated with the greatest risk of injury to both the sural nerve and peroneal tendons. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Treatment of moderate hallux valgus by percutaneous, extra-articular reverse-L Chevron (PERC) osteotomy.

    Science.gov (United States)

    Lucas y Hernandez, J; Golanó, P; Roshan-Zamir, S; Darcel, V; Chauveaux, D; Laffenêtre, O

    2016-03-01

    The aim of this study was to report a single surgeon series of consecutive patients with moderate hallux valgus managed with a percutaneous extra-articular reverse-L chevron (PERC) osteotomy. A total of 38 patients underwent 45 procedures. There were 35 women and three men. The mean age of the patients was 48 years (17 to 69). An additional percutaneous Akin osteotomy was performed in 37 feet and percutaneous lateral capsular release was performed in 22 feet. Clinical and radiological assessments included the type of forefoot, range of movement, the American Orthopedic Foot and Ankle (AOFAS) score, a subjective rating and radiological parameters. The mean follow-up was 59.1 months (45.9 to 75.2). No patients were lost to follow-up. The mean AOFAS score increased from 62.5 (30 to 80) pre-operatively to 97.1 (75 to 100) post-operatively. A total of 37 patients (97%) were satisfied. At the last follow up there was a statistically significant decrease in the hallux valgus angle, the intermetatarsal angle and the proximal articular set angle. The range of movement of the first metatarsophalangeal joint improved significantly.. There was more improvement in the range of movement in patients who had fixation of the osteotomy of the proximal phalanx. Preliminary results of this percutaneous approach are promising. This technique is reliable and reproducible. Its main asset is that it maintains an excellent range of movement. The PERC osteotomy procedure is an effective approach for surgical management of moderate hallux valgus which combines the benefits of percutaneous surgery with the versatility of the chevron osteotomy whilst maintaining excellent first MTPJ range of motion. ©2016 The British Editorial Society of Bone & Joint Surgery.

  3. Stroke from Delayed Embolization of Polymerized Glue Following Percutaneous Direct Injection of a Carotid Body Tumor

    Energy Technology Data Exchange (ETDEWEB)

    Krishnamoorthy, Thamburaj; Gupta, Arun Kumar; Rajan, Jayadevan E; Thomas, Bejoy [Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, (India)

    2007-06-15

    Direct percutaneous embolization of hypervascular tumors results in more effective preoperative devascularization. Migration of glue is a well known complication of direct glue injection and it may lead to stroke or cranial nerve deficits. We report here on a case of carotid body tumor in a 52-year-old man; the tumor was mainly embolized by percutaneous injection of 50% glue and this was supported with balloon protection of the internal carotid artery. Thirteen hours later, he developed hemiparesis from delayed migration of glue. The possible mechanisms of this migration are discussed and preventive measures are suggested. Preoperative embolization of hypervascular tumors of the head and neck, including carotid body tumor, is often performed to decrease the amount of blood loss during surgery. Devascularization is mainly performed with particulate agents and by employing the transarterial route. More effective embolization may be achieved by performing percutaneous direct embolization of hypervascular tumors with liquid embolic agents. Even though there are few reports available on direct embolization, complications from glue migration have been reported, and this mainly happens during the procedure when the glue is in a liquid state. We report here on a case of delayed migration of polymerized glue (n-butyl-2-cyanoacrylate [NBCA]), many hours after the procedure, into the intracranial circulation and the final result was stroke. A 52-year-old male with right carotid body tumor underwent direct percutaneous glue (n-butylcyanoacrylate [NBCA]) embolization. Several hours later, he developed left hemiparesis from embolization of the polymerized glue cast. Migration of glue during percutaneous tumor embolization is presumed to occur only in the liquid state, which may lead to stroke or cranial nerve deficits. To the best of our knowledge, this is the first report of delayed glue embolization from a treated hypervascular tumor of the head and neck.

  4. Autorevascularization of the testicle and spermatic vessels by bladder pedicle flap: an experimental study.

    Science.gov (United States)

    Somuncu, Salih; Rizalar, Riza; Aritürk, Ender; Bernay, Ferit

    2005-08-01

    The aim of the study was to investigate revascularization of the testicle through its own tissue and spermatic vessels by a bladder pedicle flap in rabbits. Thirty male rabbits were used in the study. In 10 animals, the Fowler-Stephens (FS) procedure was applied to the right testicles (FS group). The FS procedure and revascularization of the testicle by a bladder pedicle flap were applied to the right testicles in 10 animals (FSO group). No surgical procedure was performed in the control group. Scintigraphic study was performed 3 weeks after the high ligation procedure in the FS and FSO groups. Both testicles were evaluated by radionuclide scintigraphy in all the animals. Macroscopic testicle weights were evaluated. Testicular biopsy scores and mean seminiferous tubule diameters were determined in the histopathologic study. The testicular blood flow of the FSO group was better than the FS group (P .01). Testicle weights, testicular biopsy scores, and seminiferous tubule diameters in the FSO group were detected, and there was a statistically significant difference when compared with the FS group (P .01). We suppose that the surgical model of revascularization of the testicle through its own tissue and spermatic vessels by a bladder pedicle flap can be an alternative to the FS procedure in abdominal and high canalicular undescended testicles.

  5. CT provides precise size assessment of implanted titanium alloy pedicle screws.

    Science.gov (United States)

    Elliott, Michael J; Slakey, Joseph B

    2014-05-01

    After performing instrumented spinal fusion with pedicle screws, postoperative imaging using CT to assess screw position may be necessary. Stainless steel implants produce significant metal artifact on CT, and the degree of distortion is at least partially dependent on the cross-sectional area of the implanted device. If the same effect occurs with titanium alloy implants, ability to precisely measure proximity of screws to adjacent structures may be adversely affected as screw size increases. We therefore asked whether (1) CT provides precise measurements of true screw widths; and (2) precision degrades based on the size of the titanium implant imaged. CT scans performed on 20 patients after instrumented spinal fusion for scoliosis were reviewed. The sizes of 151 titanium alloy pedicle screws were measured and compared with known screw size. The amount of metal bloom artifact was determined for each of the four screw sizes. ANOVA with Tukey's post hoc test were performed to evaluate differences in scatter, and Spearman's rho coefficient was used to measure relationship between screw size and scatter. All screws measured larger than their known size, but even with larger 7-mm screws the size differential was less than 1 mm. The four different screw sizes produced scatter amounts that were different from each other (p titanium alloy pedicle screws produces minimal artifact, thus making this the preferred imaging modality to assess screw position after surgery. Although the amount of artifact increases with the volume of titanium present, the degree of distortion is minimal and is usually less than 1 mm.

  6. Basic study for ultrasound-based navigation for pedicle screw insertion using transmission and backscattered methods.

    Directory of Open Access Journals (Sweden)

    Ziqiang Chen

    Full Text Available The purpose of this study was to understand the acoustic properties of human vertebral cancellous bone and to study the feasibility of ultrasound-based navigation for posterior pedicle screw fixation in spinal fusion surgery. Fourteen human vertebral specimens were disarticulated from seven un-embalmed cadavers (four males, three females, 73.14 ± 9.87 years, two specimens from each cadaver. Seven specimens were used to measure the transmission, including tests of attenuation and phase velocity, while the other seven specimens were used for backscattered measurements to inspect the depth of penetration and A-Mode signals. Five pairs of unfocused broadband ultrasonic transducers were used for the detection, with center frequencies of 0.5 MHz, 1 MHz, 1.5 MHz, 2.25 MHz, and 3.5 MHz. As a result, good and stable results were documented. With increased frequency, the attenuation increased (P0.05. At about 0.6 cm away from the cortical bone, warning signals were easily observed from the backscattered measurements. In conclusion, the ultrasonic system proved to be an effective, moveable, and real-time imaging navigation system. However, how ultrasonic navigation will benefit pedicle screw insertion in spinal surgery needs to be determined. Therefore, ultrasound-guided pedicle screw implantation is theoretically effective and promising.

  7. Efficacy of percutaneous intraductal radiofrequency ablation combined with biliary stenting in treatment of malignant biliary obstruction

    Directory of Open Access Journals (Sweden)

    ZHANG Kai

    2015-05-01

    Full Text Available ObjectiveTo investigate the safety and feasibility of percutaneous intraductal radiofrequency ablation (palliative therapy in the treatment of malignant obstructive jaundice. MethodsThis study included 20 patients with unresectable malignant obstructive jaundice, who were treated in the First Affiliated Hospital of Zhengzhou University from January 2013 to March 2014. Nine of them (test group underwent percutaneous intraductal radiofrequency ablation plus metallic biliary stent placement. The other 11 similar cases (control group underwent metallic biliary stent placement alone after successful percutaneous transhepatic cholangiography. Operative complications and remission of jaundice were observed, and the stent patency after at 3 and 6 months after operation was evaluated and compared between the two groups. ResultsAll patients were followed completely by outpatient or telephone. The stent patency rate at 3 months after operation was 9/9 in the test group and 8/11 in the control group (χ2=2.888, P=0.218, and the stent patency rates at 6 months were 7/8 and 3/11, respectively (χ2=6.739, P=0.02. During follow-up, one case in the test group died of gastrointestinal bleeding at 113 d after operation; one case in the control group died of liver failure at 57 d after operation and one case died of disseminated intravascular coagulation at 142 d. ConclusionPercutaneous intraductal radiofrequency ablation is safe and feasible in the treatment of malignant biliary obstruction, and the preliminary efficacy in prolonging the patency of self-expanding metallic stent is satisfactory. However, this therapy needs to be further verified via large-sample randomized controlled studies.

  8. Percutaneous Cryoablation of Small Hepatocellular Carcinoma with US Guidance and CT Monitoring: Initial Experience

    International Nuclear Information System (INIS)

    Orlacchio, Antonio; Bazzocchi, Gabriele; Pastorelli, Daniela; Bolacchi, Francesca; Angelico, Mario; Almerighi, Cristiana; Masala, Salvatore; Simonetti, Giovanni

    2008-01-01

    The purpose of this study was to retrospectively determine the safety and effectiveness of percutaneous cryoablation, monitored with computed tomography (CT) and ultrasonographic (US) guidance, for the treatment of hepatocellular carcinoma (HCC). Four patients with small HCCs underwent one percutaneous cryoablation treatment session monitored with CT and US guidance. All patients underwent pretreatment blood chemistry testing and imaging evaluation. We treated lesions with simultaneous insertion of multiple 17-G cryoprobes (two or three) and defined technical success when the extension of a visible iceball was beyond 5 mm from the tumor margin. Intralesional enhancement or tumoral size increase was defined as local progression compared with that on images obtained immediately after ablation. We evaluated complications and follow-up (at 1, 3, and 6 months). All patients survived without short- or long-term complications. Cryoablation was technically successful in all patients at the end of the procedure. During follow-up two patients developed disease recurrence. One patient developed local tumor progression on the margin of the lesion; the other, a new HCC. In the case of local tumor progression a new elevation of α-fetoprotein (αFP) levels occurred at first follow-up control. In the other case levels of αFP remained stable during the first 3 months after the procedure, then demonstrated a progressive increase in αFP levels beginning at the fourth month, without tumor evidence during CT control at 3 months. We conclude that percutaneous cryotherapy with US guidance and CT monitoring is a feasible, safe, and effective for treatment of HCC. If local ablative procedures of hepatic lesions are to be performed, percutaneous cryoablation, not laparotomic, should be discussed as an alternative therapeutic measure. Longer follow-up should provide proof of the effectiveness of this technique

  9. Percutaneous microwave ablation with artificial ascites for symptomatic uterine adenomyosis: initial experience.

    Science.gov (United States)

    Hai, Ning; Zhang, Jing; Xu, Ruifang; Han, Zhi-Yu; Liu, Fang Yi

    2017-09-01

    To evaluate the feasibility, safety and technical efficacy of ultrasound-guided percutaneous microwave ablation with artificial ascites for adenomyosis. Between May 2015 and May 2016, a total of 25 patients with symptomatic adenomyosis who underwent ultrasound-guided percutaneous microwave ablation with artificial ascites were included in this retrospective study. A matching cohort of 50 patients underwent ultrasound-guided percutaneous microwave ablation without artificial ascites as controls. The technical efficacy, complications and short-term treatment effectiveness were assessed and compared with the controls. Artificial ascites was successfully achieved in all of the 25 patients with the administration of a median of 550 mL (range, 250-1200 mL) of solution. There was substantial improvement in achieving a better antenna path in 100% (20/20) of the cases with a poor antenna path. The complete separation was achieved in 23 of 25 patients. The mean ablation time was 26.5 ± 7.3 min and the median non-perfusion volume ratio was 76% which was similar to the control group (p > .05). No serious complications were observed. Patient pain scores for dysmenorrhoea showed a statistically significant decline from the baseline of 6.71 ± 0.96 to 2.92 ± 0.79 and the symptom severity score declined statistically significantly from 21.8 ± 5.5 to 16.4 ± 4.8 at 3 months follow-up. Percutaneous microwave ablation with artificial ascites is feasible, safe and can be effective in improving access for treatment of adenomyosis.

  10. Percutaneous radiofrequency thermal lumbar sympathectomy and its clinical use

    NARCIS (Netherlands)

    J. Pernak (Jamina)

    1988-01-01

    textabstractPercutaneous radiofrequency thermolesion techniques are commonly used in the treatment of chronic pain in different pain syndromes. There are many reports describing techniques of percutaneous radiofrequency thermolesion for denervation of central & spinal nerves (Mullan 1963), 1965,

  11. Percutaneous reduction and fixation of intraarticular calcaneal fractures

    NARCIS (Netherlands)

    Schepers, Tim; Vogels, Lucas M. M.; Schipper, Inger B.; Patka, Peter

    2008-01-01

    Percutaneous reduction by distraction and subsequent percutaneous screw fixation to restore calcaneal and posterior talocalcaneal facet anatomy. The aim of this technique is to improve functional outcome and to diminish the rate of secondary posttraumatic arthrosis compared to conservative treatment

  12. Infective complication following percutaneous nephrolithotomy

    Directory of Open Access Journals (Sweden)

    Bannakij Lojanapiwat

    2016-03-01

    Full Text Available Percutaneous nephrolithotomy (PCNL is a minimally invasive procedure for patients with large renal and upper ureteric stones. Although it is less invasive than open surgery, infection is still the most common complication arising from this procedure and some patients develop septicemia and septic shock, resulting in increase in mortality and morbidity. The incidence of septic shock following PCNL is 1%; however, its mortality rate is as high as 66–80%. Endourologists who perform this procedure need to know how to prevent and manage this common complication. Large calculi, staghorn calculi, positive pelvic urine and stone culture, prolonged operative time, and diabetes are factors that increase the incidence of postoperative infection. Recently, several studies suggested the importance of intraoperative microbiologic evaluation of factors such as intraoperative pelvic urine and stone cultures for selection of suitable postoperative antibiotics. The selection of prophylactic antibiotics, postoperative antibiotics, and specific PCNL techniques play an important role in preventing infection following PCNL. We reviewed the general background, the factors, and role of intraoperative microbiologic evaluation in the management of post-PCNL infection.

  13. Imaging in percutaneous musculoskeletal interventions

    International Nuclear Information System (INIS)

    Gangi, Afshin; Guth, Stephane; Guermazi, Ali

    2009-01-01

    This is one of the first books to deal specifically with imaging in percutaneous musculoskeletal interventions. The use of different imaging modalities during these procedures is well described. In the first chapter, the basic procedures and different guidance techniques are presented and discussed. The ensuing chapters describe in exhaustive detail the abilities and uses of imaging in guiding procedures ranging from biopsy and joint injection to management of pain and tumors. These procedures are extensively documented in adults as well as in the pediatric population. The third part of the book describes the different indications for vascular interventions in musculoskeletal lesions. The final chapter focuses on ultrasound-guided interventions, as they are more common and tend to be fashionable. The book is well illustrated with carefully chosen and technically excellent images. Each of the 18 chapters is written by an expert of international repute, making this book the most current and complete treatment of the subject available. It should be of great interest to interventional radiologists and also musculoskeletal and general radiologists. (orig.)

  14. Comparison of Consecutive, Interval, and Skipped Pedicle Screw Techniques in Moderate Lenke Type 1 Adolescent Idiopathic Scoliosis.

    Science.gov (United States)

    Luo, Ming; Shen, Mingkui; Wang, Wengang; Xia, Lei

    2017-02-01

    To compare perioperative, radiographic, and Scoliosis Research Society-22 (SRS-22) outcomes of consecutive, interval, and skipped pedicle screw techniques in patients with moderate Lenke type 1 adolescent idiopathic scoliosis (AIS). We retrospectively reviewed 65 consecutive moderate Lenke type 1 AIS patients at a single institution using all-pedicle screw constructs, with a minimum of 2 years of follow-up. In the consecutive group (C group, n = 22), pedicle screws were instrumented at consecutive levels bilaterally. In the interval group (I group, n = 18), pedicle screws were placed at every level on the concave side while skipping levels on the convex side. In the skipped group (S group, n = 25), pedicle screws were instrumented by skipping levels bilaterally. Perioperative, radiographic, and SRS-22 measurements were analyzed with a 1-way analysis of variance. No significant differences were found in length of hospital stay, fused levels, coronal correction, and SRS-22 scores among the 3 groups. Increased surgery time was found in the C group compared with the I and S groups (P = 0.001 and P = 0.005, respectively). Decreased blood loss and blood transfusions were found in the S group compared with the C group (P = 0.04 and P = 0.047, respectively). Decreased implant costs were found in the S group compared with the C and I groups (P < 0.001 and P = 0.03, respectively). Consecutive, interval, and skipped pedicle screw techniques all provide satisfactory deformity correction and SRS-22 outcomes with few complications. With better perioperative outcomes, interval and skipped pedicle screw techniques are the more cost-effective options for patients with moderate Lenke type 1 AIS. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Proximal instrumented vertebral body chance fracture after pedicle screw instrumentation in a thoracic kyphosis patient with osteoporosis.

    Science.gov (United States)

    Hu, Xiaobang; Lieberman, Isador H

    2015-02-01

    We present a case of proximal vertebral body chance fracture after pedicle screw instrumentation and fusion in a 67-year-old woman with osteoporosis and thoracic kyphosis. To report the rare and unique complication of proximal vertebral body chance fracture after pedicle screw instrumentation and fusion in a kyphosis patient. Pedicle screw instrumentation has been associated with complications not limited to neurological or vascular injury, loss of curve correction, intraoperative pedicle fracture or loosening, dural laceration, deep infection, and pseudarthrosis. To the best of our knowledge, there are no previous reports describing a chance-type fracture generated by a pedicle screw fixation at the proximal end of a construct. A 67-year-old woman suffered from progressive thoracic kyphosis and mid thoracic pain presented 2 weeks after pedicle screw instrumentation and correction. She developed a vertebral body fracture at the proximal end of the instrumentation construct. Surgical intervention, including removal of the screws in the fractured vertebrae and extension of the instrumented fusion across the cervicothoracic junction, effectively restored the physiological sagittal alignment. Postoperatively, at 12-month follow-up, the patient is doing exceptionally well with near-complete relief of back pain and an excellent maintenance of correction. Chance fracture in osteoporotic bone at the proximal end of a construct due to a pedicle screw is a rare complication but it may result in catastrophic consequences. Early recognition of this complication, reduction of the fraction-dislocation, and an extension of the instrumentation can be utilized for realignment and long-term stabilization.

  16. [Research on safe implantation of upper-middle thoracic pedicle screws under the X-ray perspective].

    Science.gov (United States)

    Xu, Wei-Xing; Chen, Qi-Xin; Li, Fang-Cai

    2008-02-01

    To explore the method of implanting upper-middle thoracic pedicle screws under monitoring by X-ray and evaluate accuracy and safety. (1) Six normal adult thoracic spine samples (T1-T8) were selected, from which single spine units were separated. A surgical probe went in along the pedicle axis. By C-shaped arm X-ray, the four probe positions were recorded: at the entering point, the front end of the probe in the middle of the pedicle, at the pack of the spine, and under the cortex of the front of the spine. The position of the front end of the probe at the entering point, and the front end of the probe at different depth at central-side perspective position were analyzed. The related positions and their corresponding changing rules were also analyzed. (2) Based on the changing rules mentioned above, different steps were adopted under the guidance of the C-shaped arm X-ray, to safely implant upper-middle thoracic pedicle screws. First, six T1-T8 spine samples were used, and under the guidance of the C-shaped arm device, 96 pedicle screws were implanted. After the operation,the sping samples were scanned through CT, and the positions of the screws were determined. According to the result of the CT scanning, the result were excellent (the screw was safely inside the pedicle) in 90 screws; Medium (the screw penetrated a little of the inside or outside bone cortex, within 2 mm) in 6; No one was had (the screw penetrated a lot, more than 2 mm). The implantation of upper-middle thoracic pedicle screw under the guidance of the C-shaped arm X-ray perspective is a simple and feasible method, and improve the accuracy and safety.

  17. The Benefits of Cement Augmentation of Pedicle Screw Fixation Are Increased in Osteoporotic Bone: A Finite Element Analysis.

    Science.gov (United States)

    Wang, Wenhai; Baran, George R; Garg, Hitesh; Betz, Randal R; Moumene, Missoum; Cahill, Patrick J

    2014-07-01

    Biomechanical study using a finite element model of a normal and osteoporotic lumbar vertebrae comparing resistance with axial pullout and bending forces on polymethylmethacrylate-augmented and non-augmented pedicle screws. To compare the effect of cement augmentation of pedicle screw fixation in normal and osteoporotic bone with 2 different techniques of cement delivery. Various clinical and biomechanical studies have addressed the benefits of cement augmentation of pedicle screws, but none have evaluated whether this effect is similar, magnified, or attenuated in osteoporotic bone compared with normal bone. In addition, no study has compared the biomechanical strength of augmented pedicle screws using cement delivery through the pedicle screw with delivery through a pilot hole. This study was funded by a grant from DePuy Synthes Spine. Normal and osteoporotic lumbar vertebrae with pedicle screws were simulated. The models were tested for screw pullout strength with and without cement augmentation. Two methods of cement delivery were also tested. Both methods were tested using 1 and 2.5 cm 3 volume of cement infiltrated in normal and osteoporotic bone. The increase in screw pullout force was proportionally greater in osteoporotic bone with equivalent volumes of cement delivered. The researchers found that 1 and 2.5 cm 3 of cement infiltrated bone volume resulted in an increase in pullout force by about 50% and 120% in normal bone, and by about 64% and 156% in osteoporotic bone, respectively. The delivery method had only a minimal effect on pullout force when 2.5 cm 3 of cement was injected (strength of pedicle screws, and this effect is proportionately greater in osteoporotic bone. Cement delivery through fenestrated screws and delivery through a pilot hole result in comparable pullout strength at higher cement volumes. Copyright © 2014 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

  18. 3D printing-assisted preoperative plan of pedicle screw placement for middle-upper thoracic trauma: a cohort study.

    Science.gov (United States)

    Xu, Wei; Zhang, Xuming; Ke, Tie; Cai, Hongru; Gao, Xiang

    2017-08-11

    This study aimed to evaluate the application of 3D printing in assisting preoperative plan of pedicle screw placement for treating middle-upper thoracic trauma. A preoperative plan was implemented in seven patients suffering from middle-upper thoracic (T3-T7) trauma between March 2013 and February 2016. In the 3D printing models, entry points of 56 pedicle screws (Magerl method) and 4 important parameters of the pedicle screws were measured, including optimal diameter (ϕ, mm), length (L, mm), inclined angle (α), head-tilting angle (+β), and tail-tilting angle (-β). In the surgery, bare-hands fixation of pedicle screws was performed using 3D printing models and the measured parameters as guidance. A total of seven patients were enrolled, including five men and two women, with the age of 21-62 years (mean age of 37.7 years). The position of the pedicle screw was evaluated postoperatively using a computerized tomography scan. Totally, 56 pedicle screws were placed, including 33 pieces of level 0, 18 pieces of level 1, 4 pieces of level 2 (pierced lateral wall), and 1 piece of level 3 (pierced lateral wall, no adverse consequences), with a fine rate of 91.0%. 3D printing technique is an intuitive and effective assistive technology to pedicle screw fixation for treating middle-upper thoracic vertebrae, which improve the accuracy of bare-hands screw placement and reduce empirical errors. The trial was approved by the Ethics Committee of the Fujian Provincial Hospital. It was registered on March 1st, 2013, and the registration number was K2013-03-001.

  19. Significance of magnetic resonance imaging signal change in the pedicle in the management of pediatric lumbar spondylolysis.

    Science.gov (United States)

    Sakai, Toshinori; Sairyo, Koichi; Mima, Seiichi; Yasui, Natsuo

    2010-06-15

    Prospective study. To investigate the time course of signal changes in the adjacent pedicle in fresh pediatric lumbar spondylolysis. A recent study reported that high signal change (HSC) on T2-magnetic resonance image (MRI) in the pedicle adjacent to the pars interarticularis could be an indicator of early spondylolysis. In addition, the HSC-positive pars defects showed significant better bony healing than the HSC-negative pars defects. However, there has been no report on the time course and the duration of HSC. We prospectively investigated 10 boys and 5 girls with fresh lumbar spondylolysis showing HSC in the adjacent pedicle. Their mean age was 15.1 years, ranging from 10 to 17 years. Two patients had multilevel unilateral spondylolysis. Among 15 patients, HSC was found in 22 (12 unilateral and 5 bilateral) pedicles. At the first presentation, the diagnosis of spondylolysis was made based on the plain radiograph findings, multidetector computed tomograms (CTs), and MRI. Every month from the first presentation, follow-up MRIs were taken. When HSC disappeared, multidetector CT was taken to confirm bony healing of the pars defect. Bony healing of the pars was obtained in 21 out of 22 defects. The bony healing rate was 95.6%. In 19 pedicles of 12 patients, HSC gradually diminished by every month until it disappeared 3 months later, and radiologic osseous healing was confirmed by CT in all but 1 patient. In the 3 remaining pedicles of 3 patients, HSC took more than 4 months to disappear. In this study, HSC disappeared in most pedicles on the 3-month follow-up MRI. In patients who did not comply with treatment, HSC tended to last longer. These results led us to hypothesize that MRI at the third month during follow-up can indicate whether the conservative treatment is being successful or not.

  20. Comparison of Sensory Changes Following Superomedial and Inferior Pedicle Breast Reduction.

    Science.gov (United States)

    Muslu, Ümran; Demirez, Dilek Şenen; Uslu, Asım; Korkmaz, Mehmet Ali; Filiz, Meral Bilgilisoy

    2018-02-01

    More attention is focused on sensory outcomes following breast reduction operations. We conducted this prospective, non-randomized study to compare two commonly used breast reduction techniques, superomedial pedicle and inferior pedicle, regarding sensation of the nipple-areolar complex. We prospectively assigned 60 patients with macromastia into the superomedial pedicle group (SMP group, n = 30) or the inferior pedicle (IP group, n = 30) group. Six patients who withdrew from the study and another six patients who did not attend return visits were excluded. Algometry was used to measure the sensation of breast skin, cardinal points of the areola and the nipple. Two-point discrimination was also measured on the areola. Measurements were performed before surgery, at 3 weeks, and 6 months postoperatively. There were 20 patients in the SMP group and 28 patients in the IP group. The mean ages of the patients were 43.2 ± 12.7 and 45.9 ± 10.8 years, respectively (p = 0.438). The mean BMI of the patients were 32.4 ± 6.7 and 30.4 ± 5.3 kg/m 2 , respectively (p = 0.257). The mean weights of resected tissues were 802.5 (280-2180) versus 773.7 (349.5-1425.0) g, respectively (p = 0.900). Although breast sensation did not change in the SMP group, sensation in the upper medial and lower lateral portions of breast skin was reduced in the IP group. Two-point discrimination test results did not change in either group. The amount of changes in algometry and two-point discrimination tests were similar in both groups. Both superomedial and inferior pedicle breast reduction techniques are safe and reliable in terms of sensory changes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  1. Does previous open renal surgery or percutaneous nephrolithotomy affect the outcomes and complications of percutaneous nephrolithotomy.

    Science.gov (United States)

    Ozgor, Faruk; Kucuktopcu, Onur; Sarılar, Omer; Toptas, Mehmet; Simsek, Abdulmuttalip; Gurbuz, Zafer Gokhan; Akbulut, Mehmet Fatih; Muslumanoglu, Ahmet Yaser; Binbay, Murat

    2015-11-01

    In this study, we aim to evaluate the effectiveness and safety of PNL in patients with a history of open renal surgery or PNL by comparing with primary patients and to compare impact of previous open renal surgery and PNL on the success and complications of subsequent PNL. Charts of patients, who underwent PNL at our institute, were analyzed retrospectively. Patients were divided into three groups according to history of renal stone surgery. Patients without history of renal surgery were enrolled into Group 1. Other patients with previous PNL and previous open surgery were categorized as Group 2 and Group 3. Preoperative characteristic, perioperative data, stone-free status, and complication rates were compared between the groups. Stone-free status was accepted as completing clearance of stone and residual fragment smaller than 4 mm. Eventually, 2070 patients were enrolled into the study. Open renal surgery and PNL had been done in 410 (Group 2) and 131 (Group 3) patients, retrospectively. The mean operation time was longer (71.3 ± 33.5 min) in Group 2 and the mean fluoroscopy time was longer (8.6 ± 5.0) in Group 3 but there was no statistically significant difference between the groups. Highest stone clearance was achieved in primary PNL patients (81.62%) compared to the other groups (77.10% in Group 2 and 75.61% in Group 3). Stone-free rate was not significantly different between Group 2 and Group 3. Fever, pulmonary complications, and blood transfusion requirement were not statically different between groups but angioembolization was significantly higher in Group 2. Percutaneous nephrolithotomy is a safe and effective treatment modality for patients with renal stones regardless history of previous PNL or open renal surgery. However, history of open renal surgery but not PNL significantly reduced PNL success.

  2. Percutaneous nephrolithotomy in pediatric patients: is computerized tomography a must?

    Science.gov (United States)

    Gedik, Abdullah; Tutus, Ali; Kayan, Devrim; Yılmaz, Yakup; Bircan, Kamuran

    2011-02-01

    The aim of this study was to retrospectively evaluate the results of pediatric percutaneous nephrolithotomy (PNL) cases, and discuss the results and necessity of non-contrast computerized tomography (CT) in these cases. In all, 48 pediatric patients who underwent PNL were retrospectively evaluated. Before PNL, either intravenous urography or CT was performed. In all patients, we evaluated the PNL time, scopy time with stone burden, and complications. During the PNL procedure, we switched to open surgery in two cases: in one because of renal pelvis perforation and in the other because of transcolonic access. In one patient who was scheduled to undergo PNL, we performed open surgery, primarily because we detected a retrorenal colon with CT. The stone burden in 45 patients who underwent PNL was 445 ± 225 mm(2), the PNL time was 51 ± 23 min, and the scopy time was 6.1 ± 2.7 min. We removed nephrostomy tubes 1-4 days after the procedure. In two patients, 24 h after removal of nephrostomy tubes, we inserted double J stents because of prolonged urine extravasation from the tract. In all, 34 of the 45 patients were stone-free, 5 patients had clinically insignificant stone fragments, and 6 patients had residual stones. PNL is a safe and effective method in the treatment of pediatric patients with kidney stones. Clinical experience is the most important factor in obtaining stone-free results. CT should be performed in all pediatric patients in order to prevent colon perforation.

  3. Does Diabetes Affect the Outcome of Percutaneous Nephrolithotomy?

    Directory of Open Access Journals (Sweden)

    Emrah Yürük

    2010-09-01

    Full Text Available Aim: The increased mortality and morbidity in diabetic patients who underwent cardiac surgery is well documented. However, there are few data about non-cardiac surgical interventions. This study is designed to evaluate whether diabetes has any effects on outcome of percutaneous nephrolithotomy (PNL. Methods: The records of 1658 patients who underwent PNL between October 2002 and December 2009 in our clinic were retrospectively analyzed. Data of patients with diagnosis of diabetes mellitus (group 1, 231 patients were compared with data of patients without diabetes (group 2, 1427 patients by means of operative and postoperative findings. Results: Complete stone clearance was achieved in 206 (89.1% patients in group 1 and 1355 (94.9% patients in group 2 (p:0.000. Auxiliary treatment modalities were needed in 44 (19.0% diabetic and 153 (10.7% non-diabetic patients (p:0.000. In diabetic patients, operation and hospitalization time, and time of nephrostomy tube removal were significantly longer. In addition, bleeding, fever and urosepsis rates were significantly higher in diabetic patients. Conclusion: PNL in diabetics is an effective procedure with acceptable complication rates in the treatment of renal stones. However, the increased risk of bleeding and infection needs extra attention in diabetic patients when compared with non-diabetics. (The Medical Bulletin of Haseki 2010; 48: 80-4

  4. Infrapopliteal Percutaneous Transluminal Balloon Angioplasty: Clinical Results and Influence Factors

    Energy Technology Data Exchange (ETDEWEB)

    Song, Jang Hyeon; Lee, Seung Jin; Jung, Hye Doo; Lim, Jae Hoon; Chang, Nam Kyu; Yim, Nam Yeol; Kim, Jae Kyu [Dept. of Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of); Lee, Keun Bae [Dept. of Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of)

    2011-09-15

    To assess the efficacy of percutaneous transluminal angioplasty (PTA) in patients with infrapopliteal arterial disease, and to determine the influencing factor for prognosis. A total of 55 patients (60 limbs) with infrapopliteal arterial stenosis or occlusion underwent PTA. Atherosclerotic risk factors, clinical symptoms, TransAtlantic Inter-Society Consensus (TASC) classification, and vascular wall calcification were evaluated before PTA. The number of patent infrapopliteal arteries was estimated, and the outcome was evaluated by symptom relief and limb salvage. Technical success was achieved in 53/60 limbs (88.3%) and 81/93 arteries (87.1%), TASC classification (p = 0.038) and vascular calcification (p = 0.002) influenced on technical failure. During follow-up, 26 of 55 limbs (47%) achieved symptom relief and 42/55 limbs (76%) underwent limb salvage. Non-diabetic patients (9/12, 75%) were superior to diabetic patients (17/43, 40%) in terms of symptom relief (p = 0.024). TASC classification and vascular wall calcification influenced on symptom relief and limb salvage. The number of patent infrapopliteal arteries after PTA influenced symptom relief (p < 0.001) and limb amputation (p = 0.003). PTA in patients with chronic critical limb ischemia is worthwhile as a primary treatment. The influence factors should be considered before PTA, and PTA should be performed in as many involved arteries as possible.

  5. Percutaneous endoscopic gastrostomy in a general hospital: prospective evaluation of indications, outcome, and randomised comparison of two tube designs.

    OpenAIRE

    Panos, M Z; Reilly, H; Moran, A; Reilly, T; Wallis, P J; Wears, R; Chesner, I M

    1994-01-01

    The indications for percutaneous endoscopic gastrostomy (PEG) and patient outcome, were examined prospectively in the setting of a general hospital. In the course of 26 months, 76 patients underwent PEG (median age 62 years (range 18-99)) and were followed up for 6887 patient days. The median (range) duration of PEG feeding was 93 (3-785) days. The procedure was carried out for neurological indications in 76% of cases (stroke 51%) and 53% of patients were severely malnourished (body mass inde...

  6. Closed reduction and fluoroscopic assisted percutaneous pinning of 42 physeal fractures in 37 dogs and 4 cats

    OpenAIRE

    Boekhout-Ta, Christina L; Kim, Stanley E; Corss, Alan R; Pozzi, Antonio; Evans, Richard

    2017-01-01

    OBJECTIVE: To report complications and clinical outcome of dogs and cats that underwent fluoroscopic-assisted percutaneous pinning (FAPP) of physeal fractures. STUDY DESIGN: Retrospective study. ANIMALS: Client-owned dogs (n = 37) and cats (n = 4). MATERIALS AND METHODS: Records (August 2007-August 2014) of physeal fractures treated with FAPP in 3 hospitals were evaluated. Data collected included signalment, fracture characteristics (etiology, location, duration, Salter-Harris classi...

  7. Revision Rate of Misplaced Pedicle Screws of the Thoracolumbar Spine-Comparison of Three-Dimensional Fluoroscopy Navigation with Freehand Placement: A Systematic Analysis and Review of the Literature.

    Science.gov (United States)

    Fichtner, Jens; Hofmann, Nicole; Rienmüller, Anna; Buchmann, Niels; Gempt, Jens; Kirschke, Jan S; Ringel, Florian; Meyer, Bernhard; Ryang, Yu-Mi

    2018-01-01

    Recent studies have shown higher accuracy rates of image-guided pedicle screw placement compared to freehand (FH) placement. However, data focusing on the impact of spinal navigation on the rate of revision surgeries caused by misplaced pedicle screws (PS) are scarce. This study is aimed at identifying the rate of revision surgeries for misplaced PS comparing three-dimensional (3D) fluoroscopy navigation (3DFL) with FH PS placement. A retrospective analysis was conducted of 2232 patients (mean age, 65.3 ± 13.5 years) with 13,703 implanted PS who underwent instrumentation of the thoracolumbar spine between 2007 and 2015. Group 1 received surgery with use of 3DFL (January 2011 to December 2015), group 2 received surgery in the FH technique (April 2007 to December 2015). Because the use of 3DFL was initiated in January 2011, the examined period for 3DFL-navigated surgeries is shorter. Patients routinely received postoperative computed tomography scans and/or intraoperative control 3D scans. There was an overall rate of revision surgeries for malpositioned PS of 2.9%. In the 3DFL group, the rate of secondary revision surgeries was significantly lower with 1.35% (15/1112 patients) compared to 4.38% (49/1120 patients) in the FH group, respectively (odds ratio, 3.35; P revision surgery (P revision surgeries after posterior spinal instrumentation compared to freehand PS placement. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Use of Supplemental Short Pre-Contoured Accessory Rods and Cobalt Chrome Alloy Posterior Rods Reduces Primary Rod Strain and Range of Motion Across the Pedicle Subtraction Osteotomy Level: An In Vitro Biomechanical Study.

    Science.gov (United States)

    Hallager, Dennis Winge; Gehrchen, Martin; Dahl, Benny; Harris, Jonathan A; Gudipally, Manasa; Jenkins, Sean; Wu, Ai-Min; Bucklen, Brandon S

    2016-04-01

    In vitro cadaveric biomechanical study. To assess effects of 4-rod reconstruction, rod material, and anterior column support on motion and surface rod strain in a pedicle subtraction osteotomy model. Pedicle subtraction osteotomy (PSO) can correct significant sagittal deformity of the lumbar spine; however, revision rates are high. To reduce rod strain and the incidence of rod fracture, clinical use of multi-rod construction, cobalt chrome (CoCr) alloy rods, and interbody spacers adjacent to PSO has been proposed. Investigating both motion and rod strain is necessary to determine the biomechanical efficacy of these techniques. Five specimens (T12-S1) underwent PSO at L3 with pedicle screw stabilization at L1-S1. Pedicle subtraction was adjusted to achieve a final lordosis of 70°. Flexion-extension (FE), lateral bending, and axial rotation were applied. Linear strain gauges measured surface rod strain during FE on primary and accessory rods at PSO level. Testing evaluated (1) accessory rods (4-Rod) added at PSO level versus primary rods (2-Rod); (2) Ti versus CoCr rods; and (3) lateral interbody spacers (S) inserted adjacent to PSO. One-way and three-way analysis of variance was performed (P ≤ 0.05). All constructs significantly reduced FE and lateral bending motion relative to intact (P < 0.001). The main effect of accessory rods in reducing FE motion was significant (P = 0.021). Accessory and CoCr rods reduced relative surface strain on the primary rod, irrespective of construct (P < 0.001). CoCr 4-Rod + S provided the greatest reduction in strain (76% decrease; P = 0.003). Accessory and CoCr rods provided greatest reduction in motion and rod strain at PSO level. Interbody devices minimally affected motion-induced strain and might act primarily to maintain disc height. Clinicians must assess whether surface strain and motion reduction minimize the incidence of rod fracture. N/A.

  9. Current Considerations in Direct Percutaneous Endoscopic Jejunostomy

    Directory of Open Access Journals (Sweden)

    Yanfei Zhu

    2012-01-01

    Full Text Available For patients who are unable to meet their nutritional needs orally, enteral feeding via a percutaneous approach has become the mainstay of therapy. However, traditional enteral feeding methods, such as percutaneous endoscopic gastrostomy, may not be viable options for patients with severe gastroparesis or gastric outlet obstruction. Direct percutaneous endoscopic jejunostomy (DPEJ is an enteral access method that was first described more than 20 years ago and has gained popularity among gastroenterologists. This review discusses the indications for and contraindications to DPEJ, the procedure, the application of DPEJ in specific subsets of patients with gastrointestinal disorders, and presents a brief tabular summary of complications and success rates of DPEJ in case series published since 2000.

  10. Biomechanical study of percutaneous lumbar diskectomy

    International Nuclear Information System (INIS)

    Li Yuan; Huang Xianglong; Shen Tianzhen; Hu Zhou; Hong Shuizong; Mei Haiying

    2003-01-01

    Objective: To investigate the stiffness of lumbar spine after the injury caused by percutaneous diskectomy and evaluate the efficiency of percutaneous lumbar diskectomy by biomechanical study. Methods: Four fresh lumbar specimens were used to analyse load-displacement curves in the intact lumbar spine and vertical disc-injured lumbar spine. The concepts of average flexibility coefficient (f) and standardized average flexibility coefficient (fs) were also introduced. Results: The load-displacement curves showed a good stabilization effect of the intact lumbar spine and disc-injured lumbar spine in flexion, extension, right and left bending. The decrease of anti-rotation also can be detected (P<0.05). Conclusion: In biomechanical study, percutaneous lumbar diskectomy is one of the efficiency methods to treat lumbar diac hernia

  11. Percutaneous management of staghorn renal calculi

    International Nuclear Information System (INIS)

    Lee, Won Jay

    1989-01-01

    During a four year period, ending May 1987, 154 cases of symptomatic staghorn calculi have been treated by percutaneous nephrolithotomy. Of these patients,86% were discharged completely stone free with the remainder having fragments less than 5 mm in greatest diameter. More than one operative procedure during the same hospitalizations was required in 24% of patients and multiple percutaneous tracts were established in excess of 73% of them. Significant complications occurred in 16% of patients and there was one death. Most complications can be generally by minimized by careful approach and manageable by interventional radiological means. The management of patients with staghorn calculi requires a comprehensive understanding of the renal anatomy, selection of appropriate percutaneous nephrostomy tract sites, and radiologic-urologic expertise needed to remove the large stone mass. The advent of extracorporeal shock wave lithotripsy will not abolish the need for nephrolithotomy, particularly complex stones such as staghorn calculi

  12. Percutaneous epidural drainage through a burr hole

    Directory of Open Access Journals (Sweden)

    Priscila M Falsarella

    2016-01-01

    Full Text Available Intracranial extradural collection may cause an increase in intracranial pressure, requiring rapid emergency treatment to reduce morbidity and mortality. We described an alternative CT-guided percutaneous access for extradural collection drainage. We report a case of a patient with previous craniectomy for meningioma ressection who presented to the Emergency Department with symptoms of intracranial hypertension. Brains CT showed a extradural collection with subfalcine herniation. After multidisciplinary discussion a CT-guided percutaneous drainage through previous burr hole was performed. The patient was discharged after 36 hours of admission, without further symptoms. We describe a safe and effective alternative percutaneous access for extradural collection drainage in patients with previous burr hole.

  13. How Does Patient Radiation Exposure Compare With Low-dose O-arm Versus Fluoroscopy for Pedicle Screw Placement in Idiopathic Scoliosis?

    Science.gov (United States)

    Su, Alvin W; McIntosh, Amy L; Schueler, Beth A; Milbrandt, Todd A; Winkler, Jennifer A; Stans, Anthony A; Larson, A Noelle

    Intraoperative C-arm fluoroscopy and low-dose O-arm are both reasonable means to assist in screw placement for idiopathic scoliosis surgery. Both using pediatric low-dose O-arm settings and minimizing the number of radiographs during C-arm fluoroscopy guidance decrease patient radiation exposure and its deleterious biological effect that may be associated with cancer risk. We hypothesized that the radiation dose for C-arm-guided fluoroscopy is no less than low-dose O-arm scanning for placement of pedicle screws. A multicenter matched-control cohort study of 28 patients in total was conducted. Fourteen patients who underwent O-arm-guided pedicle screw insertion for spinal fusion surgery in 1 institution were matched to another 14 patients who underwent C-arm fluoroscopy guidance in the other institution in terms of the age of surgery, body weight, and number of imaged spine levels. The total effective dose was compared. A low-dose pediatric protocol was used for all O-arm scans with an effective dose of 0.65 mSv per scan. The effective dose of C-arm fluoroscopy was determined using anthropomorphic phantoms that represented the thoracic and lumbar spine in anteroposterior and lateral views, respectively. The clinical outcome and complications of all patients were documented. The mean total effective dose for the O-arm group was approximately 4 times higher than that of the C-arm group (Pfluoroscopy time and did not correlate with the number of imaged spine levels or body weight. The effective dose of 1 low-dose pediatric O-arm scan approximated 85 seconds of the C-arm fluoroscopy time. All patients had satisfactory clinical outcomes without major complications that required returning to the operating room. Radiation exposure required for O-arm scans can be higher than that required for C-arm fluoroscopy, but it depends on fluoroscopy time. Inclusion of more medical centers and surgeons will better account for the variability of C-arm dose due to distinct patient

  14. Percutaneous nephrolithotomy in ectopically located kidneys and in patients with musculoskeletal deformities.

    Science.gov (United States)

    Srivastava, A; Gupta, P; Chaturvedi, S; Singh, P; Kapoor, R; Dubey, D; Kumar, A

    2010-01-01

    To assess the feasibility, safety and results of percutaneous nephrolithotomy (PNL) in ectopically located kidneys and in patients with musculoskeletal deformities. Thirteen such patients underwent PNL between June 2005 and May 2008. Mean stone size was 27.4 mm (16-37 mm). Six patients had severe kyphoscoliosis, 2 patients each had achondroplasia, cross-fused ectopia and pelvic ectopic kidney, and 1 patient had thoracic kidney. All had a preoperative CT scan of the abdomen. Preoperative ultrasound- or CT-guided percutaneous nephrostomy (PCN) was done in 10 patients. Three patients underwent laparoscopic-assisted PNL. All underwent standard PNL. The stone-free rate, complication rate and need for secondary intervention were evaluated. PNL was successfully completed in all. A second ultrasound-guided intraoperative puncture was required in 2 patients. Re-look PNL was required in 1 patient and the same patient later required shock wave lithotripsy for complete stone clearance. The remaining 12 patients (92.3%) were rendered stone-free in a single sitting. PNL is a feasible and effective modality in anomalous kidneys. Preoperative planning with CT and image-guided PCN is helpful in these situations. Laparoscopic-assisted PNL can be safely performed in patients where access to a renal collecting system by fluoroscopy or image-guided assistance (ultrasound or CT scan) is not possible. Copyright (c) 2010 S. Karger AG, Basel.

  15. Effectiveness of percutaneous aspiration thrombectomy for acute or subacute thromboembolism in infrainguinal arteries

    Energy Technology Data Exchange (ETDEWEB)

    Cha, Jung Guen; Kim, Chan Sun; Kim, Young Hwan; Kim, See Hyung [Dept. of Radiology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of)

    2017-06-15

    To report the feasibility and long-term clinical outcome of percutaneous aspiration thrombectomy for treating acute or subacute arterial thromboembolism in the infrainguinal arteries. Thirty limbs of 29 patients were enrolled in this retrospective study between January 2004 and March 2014. Nine limbs underwent overnight catheter-directed thrombolysis followed by percutaneous aspiration thrombectomy (PAT). Eighteen limbs underwent PAT with adjunctive selective intra-arterial thrombolysis in a single session. The remaining three limbs underwent PAT alone. Balloon angioplasty (n = 16) or stent placement (n = 3) was performed as required. In-hospital mortality and complications were estimated. The primary patency rate and the rate of freedom from reintervention were calculated using the Kaplan-Meier method. Technical success was achieved in 28 limbs. Clinical success was achieved in 27 limbs. The mean ankle-brachial index increased from 0.17 ± 0.26 to 0.98 ± 0.19 after the procedure. Three in-hospital deaths and no major amputations were recorded. Distal embolization of crural arteries occurred as a minor complication in five limbs, but no major complications occurred. The primary patency rate and the rate of freedom from reintervention were 74.9% and 90.9% at 1 year, respectively, and 66.6% and 80.8% at 2 years, respectively. PAT is a rapid and effective method to remove a thrombus from occluded infrainguinal arteries.

  16. Late complications of percutaneous tracheostomy using the balloon dilation technique.

    Science.gov (United States)

    Araujo, J B; Añón, J M; García de Lorenzo, A; García-Fernandez, A M; Esparcia, M; Adán, J; Relanzon, S; Quiles, D; de Paz, V; Molina, A

    2018-04-01

    The purpose of this study was to determine the late complications in critically ill patients requiring percutaneous tracheostomy (PT) using the balloon dilation technique. A prospective, observational cohort study was carried out. Two medical-surgical intensive care units (ICU). All mechanically ventilated adult patients consecutively admitted to the ICU with an indication of tracheostomy. All patients underwent PT according to the Ciaglia Blue Dolphin ® method, with endoscopic guidance. Survivors were interviewed and evaluated by fiberoptic laryngotracheoscopy and tracheal computed tomography at least 6 months after decannulation. Intraoperative, postoperative and long-term complications and mortality (in-ICU, in-hospital) were recorded. A total of 114 patients were included. The most frequent perioperative complication was minor bleeding (n=20) and difficult cannula insertion (n=19). Two patients had severe perioperative complications (1.7%) (major bleeding and inability to complete de procedure in one case and false passage and desaturation in the other). All survivors (n=52) were evaluated 211±28 days after decannulation. None of the patients had symptoms. Fiberoptic laryngotracheoscopy and computed tomography showed severe tracheal stenosis (>50%) in 2patients (3.7%), both with a cannulation period of over 100 days. Percutaneous tracheostomy using the Ciaglia Blue Dolphin ® technique with an endoscopic guide is a safe procedure. Severe tracheal stenosis is a late complication which although infrequent, must be taken into account due to its lack of clinical expressiveness. Evaluation should be considered in those tracheostomized critical patients who have been cannulated for a long time. Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

  17. Percutaneous Endovascular Radiofrequency Ablation for Malignant Portal Obstruction: An Initial Clinical Experience

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Tian-Tian, E-mail: matthewwu1979@126.com [The 309th Hospital of PLA, Hepatobiliary Surgery Department (China); Li, Hu-Cheng, E-mail: hucheng-li-surgery@126.com [The 307th Hospital of PLA, General Surgery Department (China); Zheng, Fang, E-mail: fang-zheng-surgery@126.com [The 309th Hospital of PLA, Hepatobiliary Surgery Department (China); Ao, Guo-Kun, E-mail: guokun-ao-radiology@126.com; Lin, Hu, E-mail: hu-lin-radiology@126.com [The 309th Hospital of PLA, Radiology Department (China); Li, Wei-Min, E-mail: weimin-li-surgery@126.com [The 309th Hospital of PLA, Hepatobiliary Surgery Department (China)

    2016-07-15

    PurposeThe Habib™ VesOpen Catheter is a new endovascular radiofrequency ablation (RFA) device used to treat malignant portal obstruction. The purpose of this study was to evaluate the clinical feasibility and safety of RFA with this device.MethodsWe collected the clinical records and follow-up data of patients with malignant portal obstruction treated with percutaneous endovascular portal RFA using the Habib™ VesOpen Catheter. Procedure-related complications, improvement of symptoms, portal patency, survival, and postoperative biochemical tests were investigated.ResultsThe 31 patients enrolled in the study underwent 41 successful endovascular portal RFA procedures. Patients were divided into a portal-stenting (PS) group (n = 13), which underwent subsequent portal stenting with self-expandable metallic stents, and a non-stenting (NS) group (n = 18), which did not undergo stenting. No procedure-related abdominal hemorrhage or portal rupture occurred. Postablation complications included abdominal pain (n = 26), fever (n = 13), and pleural effusion (n = 15). Improvements in clinical manifestations were observed in 27 of the 31 patients. Of the 17 patients experiencing portal restenosis, 10 underwent successful repeat RFA. The rate of successful repeat RFA was significantly higher in the NS group than in the PS group. Median portal patency was shorter in the PS group than in the NS group. No mortality occurred during the 4 weeks after percutaneous endovascular portal RFA.ConclusionsPercutaneous endovascular portal RFA is a feasible and safe therapeutic option for malignant portal obstruction. Prospective investigations should be performed to evaluate clinical efficacy, in particular, the need to evaluate the necessity for subsequent portal stenting.

  18. Biomechanical analysis of pedicle screws in osteoporotic bone with bioactive cement augmentation using simulated in vivo multicomponent loading.

    Science.gov (United States)

    Choma, Theodore J; Frevert, Wesley F; Carson, William L; Waters, Nicole P; Pfeiffer, Ferris M

    2011-03-15

    Biomechanical analysis of bioactive cements augmenting pedicle screw resistance to loosening in osteoporotic synthetic bone. To simulate in vivo loading-loosening of pedicle screws in osteoporotic vertebrae; and to compare biomechanical efficacy of the following bioactive cements: calcium phosphate (CP), calcium sulfate (CS), and proprietary mixture (M). Pedicle screw instrumentation in osteoporotic spines is limited by poor bone-screw interface strength, resulting in screw loosening fixation failure. Previous in vivo studies evaluated augmented pedicle screw resistance to pure pullout, not simulating in vivo loading/failure. A pedicle screw-instrumented osteoporotic thoracic vertebra subjected to combined pullout, transverse, moment loading was simulated. Unconstrained 3-dimensional screw motion relative to vertebra was optically measured during quasi-static, and dynamic loading. Augmented groups (CP, CS, M) produced (P CS > M failure initiation force (P < 0.006) was because of differences in cement distribution. Animal studies may be required to characterize the remodeling activity of bioactive cements and their longer term efficacies.

  19. Lateral pedicle graft for repair of residual gingival defect following complete surgical excision of a pyogenic granuloma

    Directory of Open Access Journals (Sweden)

    Awadhesh Kumar Singh

    2016-01-01

    Full Text Available The pyogenic granuloma, one of the gingival lesions, has recurrence rate of 16%. To minimize the recurrence rate, it must be completely excised. Complete surgical excision can result in residual gingival defect. McCrea repaired residual gingival defect by subepithelial connective tissue graft with lateral mucogingival pedicle flap, and Choudhary et al. managed residual gingival defect by subepithelial connective tissue graft only. The aim of this case report was to use lateral pedicle graft for repair of residual gingival defect following complete surgical excision of a pyogenic granuloma. A patient with pyogenic granuloma on labial surface of maxillary central incisors was treated by complete surgical excision, and residual gingival defect was repaired by lateral pedicle graft. A lateral pedicle graft was raised as full-thickness up to mucogingival line and partial-thickness apical to mucogingival line from the left side of residual gingival defect. After 6 months, no recurrence was noticed. Thus, lateral pedicle graft can be potentially used for repair of residual gingival defect following complete surgical excision of a pyogenic granuloma.

  20. Percutaneous Cryotherapy of Vascular Malformation: Initial Experience

    Energy Technology Data Exchange (ETDEWEB)

    Cornelis, F., E-mail: francoiscornelis@hotmail.com [Institut Bergonie, Department of Radiology (France); Neuville, A. [Institut Bergonie, Department of Pathology (France); Labreze, C. [Pellegrin Hospital, Department of Pediatric Dermatology (France); Kind, M. [Institut Bergonie, Department of Radiology (France); Bui, B. [Institut Bergonie, Department of Oncology (France); Midy, D. [Pellegrin Hospital, Department of Vascular Surgery (France); Palussiere, J. [Institut Bergonie, Department of Radiology (France); Grenier, N. [Pellegrin Hospital, Department of Radiology (France)

    2013-06-15

    The present report describes a case of percutaneous cryotherapy in a 36-year-old woman with a large and painful pectoral venous malformation. Cryoablation was performed in a single session for this 9-cm mass with 24 h hospitalisation. At 2- and 6-month follow-up, the pain had completely disappeared, and magnetic resonance imaging demonstrated a significant decrease in size. Percutaneous cryoablation shows promise as a feasible and apparently safe method for local control in patients with symptomatic venous vascular malformations.

  1. Percutaneous Cryotherapy of Vascular Malformation: Initial Experience

    International Nuclear Information System (INIS)

    Cornelis, F.; Neuville, A.; Labrèze, C.; Kind, M.; Bui, B.; Midy, D.; Palussière, J.; Grenier, N.

    2013-01-01

    The present report describes a case of percutaneous cryotherapy in a 36-year-old woman with a large and painful pectoral venous malformation. Cryoablation was performed in a single session for this 9-cm mass with 24 h hospitalisation. At 2- and 6-month follow-up, the pain had completely disappeared, and magnetic resonance imaging demonstrated a significant decrease in size. Percutaneous cryoablation shows promise as a feasible and apparently safe method for local control in patients with symptomatic venous vascular malformations.

  2. Duodenal damage complicating percutaneous access to kidney

    Directory of Open Access Journals (Sweden)

    Antonio Corrêa Lopes Neto

    2000-07-01

    Full Text Available CONTEXT: Since the first percutaneous nephrostomy performed by Goodwin in 1954, technical advances in accessing the kidneys via percutaneous puncture have increased the use of this procedure and thus the complications too. Among these complications, digestive tract damage is not common. DESIGN: Case report. CASE REPORT: We report a duodenal lesion that was corrected using surgical exploration and we touch on the therapeutic options, which may be conservative or interventionist. We chose conservative treatment, which has been approached in diverse manners in the literature.

  3. Ambulatory percutaneous nephrolithotomy: initial series.

    Science.gov (United States)

    Shahrour, Walid; Andonian, Sero

    2010-12-01

    To assess the safety and feasibility of ambulatory percutaneous nephrolithotomy (PCNL). PCNL is the gold standard for the management of large renal stones. Although tubeless PCNL has been previously described, no case series have been published of ambulatory PCNL. The criteria for ambulatory PCNL were: single tract, stone-free status documented by flexible nephroscopy, adequate pain control, and satisfactory postoperative hematocrit level and chest radiographic findings. Patient information, including operating room and fluoroscopy times, stone size and Hounsfield units, and number of needle punctures, were collected prospectively. The time spent in the recovery room, in addition to the amount of narcotics used in the recovery room and at home, was documented. Of 10 patients, 8 had nephrostomy tracts established intraoperatively by the urologist and 2 had preoperative nephrostomy tubes placed. The median operating and fluoroscopy time was 83.5 and 4.45 minutes, respectively. The median stone diameter was 20 mm (800 Hounsfield units) in addition to a patient with a staghorn calculus. The patients spent a median of 240 minutes in the recovery room and had received a median of 19.25 mg of morphine equivalents. Only 3 patients (30%) used narcotics at home. No intraoperative complications occurred, and none of the patients required transfusions. Two postoperative complications developed: a deep vein thrombosis requiring outpatient anticoagulation and multiresistant Escherichia coli infection requiring intravenous antibiotics. In highly selected patients, ambulatory PCNL is safe and feasible. More patients are needed to verify the criteria for patients undergoing the ambulatory approach. Copyright © 2010 Elsevier Inc. All rights reserved.

  4. Incidence of Y-chromosome microdeletions in children whose fathers underwent vasectomy reversal or in vitro fertilization with epididymal sperm aspiration: a case-control study.

    Science.gov (United States)

    Ghirelli-Filho, Milton; Marchi, Patricia Leme de; Mafra, Fernanda Abani; Cavalcanti, Viviane; Christofolini, Denise Maria; Barbosa, Caio Parente; Bianco, Bianca; Glina, Sidney

    2016-01-01

    To evaluate the incidence of Y-chromosome microdeletions in individuals born from vasectomized fathers who underwent vasectomy reversal or in vitro fertilization with sperm retrieval by epididymal aspiration (percutaneous epididymal sperm aspiration). A case-control study comprising male children of couples in which the man had been previously vasectomized and chose vasectomy reversal (n=31) or in vitro fertilization with sperm retrieval by percutaneous epididymal sperm aspiration (n=30) to conceive new children, and a Control Group of male children of fertile men who had programmed vasectomies (n=60). Y-chromosome microdeletions research was performed by polymerase chain reaction on fathers and children, evaluating 20 regions of the chromosome. The results showed no Y-chromosome microdeletions in any of the studied subjects. The incidence of Y-chromosome microdeletions in individuals born from vasectomized fathers who underwent vasectomy reversal or in vitro fertilization with spermatozoa recovered by percutaneous epididymal sperm aspiration did not differ between the groups, and there was no difference between control subjects born from natural pregnancies or population incidence in fertile men. We found no association considering microdeletions in the azoospermia factor region of the Y chromosome and assisted reproduction. We also found no correlation between these Y-chromosome microdeletions and vasectomies, which suggests that the assisted reproduction techniques do not increase the incidence of Y-chromosome microdeletions. Avaliar a incidência de microdeleções do cromossomo Y em indivíduos nascidos de pais vasectomizados submetidos à reversão de vasectomia ou fertilização in vitro com recuperação de espermatozoides por aspiração do epidídimo (aspiração percutânea de espermatozoides do epidídimo). Estudo caso-controle que compreende crianças do sexo masculino de casais em que o homem havia sido previamente vasectomizado e escolheu revers

  5. Effect of using pump on postoperative pleural effusion in the patients that underwent CABG

    Directory of Open Access Journals (Sweden)

    Mehmet Özülkü

    2015-08-01

    Full Text Available Abstract Objective: The present study investigated effect of using pump on postoperative pleural effusion in patients who underwent coronary artery bypass grafting. Methods: A total of 256 patients who underwent isolated coronary artery bypass grafting surgery in the Cardiovascular Surgery clinic were enrolled in the study. Jostra-Cobe (Model 043213 105, VLC 865, Sweden heart-lung machine was used in on-pump coronary artery bypass grafting. Off-pump coronary artery bypass grafting was performed using Octopus and Starfish. Proximal anastomoses to the aorta in both on-pump and off-pump techniques were performed by side clamps. The patients were discharged from the hospital between postoperative day 6 and day 11. Results: The incidence of postoperative right pleural effusion and bilateral pleural effusion was found to be higher as a count in Group 1 (on-pump as compared to Group 2 (off-pump. But the difference was not statistically significant [P>0.05 for right pleural effusion (P=0.893, P>0.05 for bilateral pleural effusion (P=0.780]. Left pleural effusion was encountered to be lower in Group 2 (off-pump. The difference was found to be statistically significant (P<0.05, P=0.006. Conclusion: Under the light of these results, it can be said that left pleural effusion is less prevalent in the patients that underwent off-pump coronary artery bypass grafting when compared to the patients that underwent on-pump coronary artery bypass grafting.

  6. Dysphagia among Adult Patients who Underwent Surgery for Esophageal Atresia at Birth

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    Valérie Huynh-Trudeau

    2015-01-01

    Full Text Available BACKGROUND: Clinical experiences of adults who underwent surgery for esophageal atresia at birth is limited. There is some evidence that suggests considerable long-term morbidity, partly because of dysphagia, which has been reported in up to 85% of adult patients who undergo surgery for esophageal atresia. The authors hypothesized that dysphagia in this population is caused by dysmotility and/or anatomical anomalies.

  7. Image-guided Percutaneous Drainage for Treatment of Post-Surgical Anastomotic Leak in Patients with Crohn's Disease.

    Science.gov (United States)

    Byrne, James; Stephens, Ryan; Isaacson, Ari; Yu, Hyeon; Burke, Charles

    2016-01-01

    Anastomotic leaks with abscess formation are a common complication after bowel surgery in Crohn's disease patients. Image-guided percutaneous drainage is an attractive alternative to reoperation because of decreased morbidity and length of hospital stay. Because data for this specific population are scarce, the purpose of this study is to determine the safety and efficacy of image-guided percutaneous drainage in the management of post-surgical anastomotic leak in patients with Crohn's disease. A total of 41 patients who underwent percutaneous drain placement for the treatment of fluid collections due to anastomotic leak from September 2004 to November 2013 were retrospectively identified from the electronic medical record and picture archiving and communication system. Data recorded included number, size, and location of anastomotic leaks, number of drains placed, number of follow-up visits, post-drainage complications, abscess resolution, and subsequent surgeries. In all, 41 patients with 76 fluid collections were identified as having received percutaneous drains. The mean number of targeted fluid collections per patient was 1.5, and the mean duration between surgery and percutaneous drain placement was 18.5 days. The mean number of drains placed was 1.6, and the median drain size was 10 French [range 8-16 French]. One of 41 [2.4%] patients experienced a minor complication from drain placement [injury to a superficial abdominal artery] and no major complications occurred. Two of 41 [4.9%] patients required repeat surgeries. Image-guided percutaneous drainage for the treatment of post-surgical anastomotic leaks in Crohn's patients is effective and safe, with low rates of complications and reoperations. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  8. Evolution of elderly patients who underwent cardiac surgery with cardiopulmonary bypass

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    Alain Moré Duarte

    2016-01-01

    Full Text Available Introduction: There is a steady increase in the number of elderly patients with severe cardiovascular diseases who require a surgical procedure to recover some quality of life that allows them a socially meaningful existence, despite the risks.Objectives: To analyze the behavior of elderly patients who underwent cardiac surgery with cardiopulmonary bypass.Method: A descriptive, retrospective, cross-sectional study was conducted with patients over 65 years of age who underwent surgery at the Cardiocentro Ernesto Che Guevara, in Santa Clara, from January 2013 to March 2014.Results: In the study, 73.1% of patients were men; and there was a predominance of subjects between 65 and 70 years of age, accounting for 67.3%. Coronary artery bypass graft was the most prevalent type of surgery and had the longest cardiopulmonary bypass times. Hypertension was present in 98.1% of patients. The most frequent postoperative complications were renal dysfunction and severe low cardiac output, with 44.2% and 34.6% respectively.Conclusions: There was a predominance of men, the age group of 65 to 70 years, hypertension, and patients who underwent coronary artery bypass graft with prolonged cardiopulmonary bypass. Renal dysfunction was the most frequent complication.

  9. Acute myocardial infarctation in patients with critical ischemia underwent lower limb revascularization

    Directory of Open Access Journals (Sweden)

    Esdras Marques Lins

    2013-12-01

    Full Text Available BACKGROUND: Atherosclerosis is the main cause of peripheral artery occlusive disease (PAOD of the lower limbs. Patients with PAOD often also have obstructive atherosclerosis in other arterial sites, mainly the coronary arteries. This means that patients who undergo infrainguinal bypass to treat critical ischemia have a higher risk of AMI. There are, however, few reports in the literature that have assessed this risk properly. OBJECTIVE: The aim of this study was to determine the incidence of acute myocardial infarction in patients who underwent infrainguinal bypass to treat critical ischemia of the lower limbs caused by PAOD. MATERIAL AND METHODS: A total of 64 patients who underwent 82 infrainguinal bypass operations, from February 2011 to July 2012 were studied. All patients had electrocardiograms and troponin I blood assays during the postoperative period (within 72 hours. RESULTS: There were abnormal ECG findings and elevated blood troponin I levels suggestive of AMI in five (6% of the 82 operations performed. All five had conventional surgery. The incidence of AMI as a proportion of the 52 conventional surgery cases was 9.6%. Two patients died. CONCLUSION: There was a 6% AMI incidence among patients who underwent infrainguinal bypass due to PAOD. Considering only cases operated using conventional surgery, the incidence of AMI was 9.6%.

  10. A Prospective Randomized Study Comparing Mini-surgical Percutaneous Dilatational Tracheostomy With Surgical and Classical Percutaneous Tracheostomy

    Science.gov (United States)

    Hashemian, Seyed Mohammad-Reza; Digaleh, Hadi

    2015-01-01

    Abstract Although percutaneous dilatational tracheostomy (PDT) is more accessible and less time-demanding compared with surgical tracheostomy (ST), it has its own limitations. We introduced a modified PDT technique and brought some surgical knowledge to the bedside to overcome some standard percutaneous dilatational tracheostomy relative contraindications. PDT uses a blind route of tracheal access that usually requires perioperational imaging guidance to protect accidental injuries. Moreover, there are contraindications in certain cases, limiting widespread PDT application. Different PDT modifications and devices have been represented to address the problem; however, these approaches are not generally popular among professionals due to limited accessibility and/or other reasons. We prospectively analyzed the double-blinded trial, patient and nurse head evaluating the complications, and collected data from 360 patients who underwent PDT, ST, or our modified mini-surgical PDT (msPDT, Hashemian method). These patients were divided into 2 groups—contraindicated to PDT—and randomization was done for msPDT or PDT in PDT-indicated group and msPDT or ST for PDT-contraindicated patients. The cases were compared in terms of pre and postoperational complications. Data analysis demonstrated that the mean value of procedural time was significantly lower in the msPDT group, either compared with the standard PDT or the ST group. Paratracheal insertion, intraprocedural hypoxemia, and bleeding were also significantly lower in the msPDT group compared with the standard PDT group. Other complications were not significantly different between msPDT and ST patients. The introduced msPDT represented a semiopen incision, other than blinded PDT route of tracheal access that allowed proceduralist to withdraw bronchoscopy and reduced the total time of procedure. Interestingly, the most important improvement was performing msPDT on PDT-contraindicated patients with the complication rate

  11. Gastrojejunoscopy facilitates placement of a percutaneous transgastric jejunostomy in a patient with a pancreaticoduodenectomy and multiple-failed feeding tube placements

    Directory of Open Access Journals (Sweden)

    Jeffrey Forris Beecham Chick, MD, MPH, DABR

    2018-02-01

    Full Text Available Enteral access is one of the most common procedures performed in abdominal and interventional radiology. The surgical anatomy of the postoperative stomach may, however, make enteral access challenging. This report describes a patient with a pancreaticoduodenectomy complicated by a gastrojejunostomy leak who underwent 2 unsuccessful transoral endoscopic nasojejunal tube placements and 2 failed percutaneous gastrojejunostomy tube placements. Eventually, a gastrojejunostomy tube was placed utilizing percutaneous techniques with fluoroscopy assistance and gastrojejunoscopy guidance. A combined technique with fluoroscopy and endoscopy, both controlled by interventional radiology, may be useful in patients with complex postsurgical gastrointestinal anatomy who require enteral access.

  12. Successful treatment of double-orifice mitral stenosis with percutaneous balloon mitral commissurotomy.

    Science.gov (United States)

    Patted, Suresh V; Halkati, Prabhu C; Ambar, Sameer S; Sattur, Ameet G

    2012-01-01

    Double-orifice mitral valve (DOMV) is an uncommon congenital anomaly, being present in 0.05% of the general population. The isolated occurrence of this anomaly is very rare and, to our knowledge, no data are currently available on the incidence of an isolated DOMV. A DOMV is characterized by a mitral valve with a single fibrous annulus with 2 orifices opening into the left ventricle (LV). Subvalvular structures, especially the tensor apparatus, invariably show various degrees of abnormality. It can substantially obstruct mitral valve inflow or cause mitral valve incompetence. We present a rare case of nineteen-year-old male who underwent percutaneous mitral balloon commissurotomy in stenotic DOMV.

  13. Femoral Artery Stenosis Following Percutaneous Closure Using a Starclose Closure Device

    International Nuclear Information System (INIS)

    Bent, Clare Louise; Kyriakides, Constantinos; Matson, Matthew

    2008-01-01

    Starclose (Abbott Vascular Devices, Redwood City, CA) is a new arterial closure device that seals a femoral puncture site with an extravascular star-shaped nitinol clip. The clip projects small tines into the arterial wall which fold inward, causing the arterial wall to pucker, producing a purse-string-like seal closing the puncture site. The case history is that of a 76-year-old female patient who underwent day-case percutaneous diagnostic coronary angiography. A Starclose femoral artery closure device was used to achieve hemostasis with subsequent femoral artery stenosis.

  14. Nursing care for patients receiving percutaneous lumbar discectomy and intradiscal electrothermal treatment for lumbar disc herniation

    International Nuclear Information System (INIS)

    Mou Ling

    2009-01-01

    Objective: To summarize the nursing experience in caring patients with lumbar intervertebral disc herniation who received percutaneous lumbar discectomy (PLD) together with intradiscal electrothermal treatment (IDET) under DSA guidance. Methods: The perioperative nursing care measures carried out in 126 patients with lumbar intervertebral disc herniation who underwent PLD and IDET were retrospectively analyzed. Results: Successful treatment of PLD and IDET was accomplished in 112 cases. Under comprehensive and scientific nursing care and observation, no serious complications occurred. Conclusion: Scientific and proper nursing care is a strong guarantee for a successful surgery and a better recovery in treating lumbar intervertebral disc herniation with PLD and IDET under DSA guidance. (authors)

  15. Ectopic ACTH syndrome complicated by multiple opportunistic infections treated with percutaneous ablation of the adrenal glands.

    Science.gov (United States)

    Chan, Chrystal; Roberts, James Mark

    2017-11-14

    Ectopic adrenocorticotropic hormone (ACTH)-related Cushing's syndrome can lead to multiple complications including severe immunosuppression. If the ACTH-secreting tumour cannot be found, definitive treatment is surgical adrenalectomy, typically followed by glucocorticoid replacement. Here, we present a case of fulminant respiratory failure secondary to coinfection with Pneumocystis jirovecii and cytomegalovirus in a patient with ectopic ACTH-dependent Cushing's syndrome with occult primary. Due to significant deconditioning, she was unable to undergo definitive adrenalectomy and instead underwent percutaneous microwave ablation of the adrenal glands. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  16. Improved predictive value of GRACE risk score combined with platelet reactivity for 1-year cardiovascular risk in patients with acute coronary syndrome who underwent coronary stent implantation.

    Science.gov (United States)

    Li, Shan; Liu, Hongbin; Liu, Jianfeng; Wang, Haijun

    2016-11-01

    Both high platelet reactivity (HPR) and Global Registry of Acute Coronary Events (GRACE) risk score have moderate predictive value for major adverse cardiovascular disease (CVD) events in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI), whereas the prognostic significance of GRACE risk score combined with platelet function testing remains unclear. A total of 596 patients with non-ST elevation ACS who underwent PCI were enrolled. The P2Y 12 reaction unit (PRU) value was measured by VerifyNow P2Y 12 assay and GRACE score was calculated by GRACE risk 2.0 calculator. Patients were stratified by a pre-specified cutoff value of PRU 230 and GRACE score 140 to assess 1-year risk of cardiovascular death, non-fatal myocardial infarction (MI), and stent thrombosis. Seventy-two (12.1%) patients developed CVD events during 1-year follow-up. Patients with CVD events had a higher PRU value (244.6 ± 50.9 vs. 203.7 ± 52.0, p risk independently. Compared to patients with normal platelet reactivity (NPR) and GRACE score risk (HR: 5.048; 95% CI: 2.268-11.237; p risk score yielded superior risk predictive capacity beyond GRACE score alone, which is shown by improved c-statistic value (0.871, p = 0.002) as well as net reclassification improvement (NRI 0.263, p risk of adverse CVD events. The combination of platelet function testing and GRACE score predicted 1-year CVD risk better.

  17. The Use of Tensor Fascia Lata Pedicled Flap in Reconstructing Full Thickness Abdominal Wall Defects and Groin Defects Following Tumor Ablation

    International Nuclear Information System (INIS)

    Rifaat, M.A.; Abdel Gawad, W.S.

    2005-01-01

    The tensor fascia lata is a versatile flap with many uses in reconstructive plastic surgery. As a pedicled flap its reach to the lower abdomen and groin made it an attractive option for reconstructing soft tissue defects after tumor ablation. However, debate exists on the safe dimension of the flap, as distal tip necrosis is common. Also, the adequacy of the fascia lata as a sole substitute for abdominal wall muscles has been disputable. The aim of the current study is to report our experience and clinical observations with this flap in reconstructing those challenging defects and to discuss the possible options to minimize the latter disputable issues. Patients and Methods: From April 2001 to April 2004, 12 pedicled TFL flaps were used to reconstruct 5 central abdominal wall full thickness defects and 6 groin soft tissue defects following tumor resection. ]n one case, bilateral flaps were used to reconstruct a large central abdominal wall defect. There were 4 males and 7 females. Their age ranged from 19 to 60. From the abdominal wall defects group, all repairs were enforced primarily with a prolene mesh except for one patient who was the first in this study. Patients presenting with groin defects required coverage of exposed vessels following tumor resection. All patients in the current study underwent immediate reconstruction. The resulting soft tissue defects in this study were due to resection of 4 abdominal wall desmoid tumors, a colonic carcinoma infiltrating the abdominal wall, 4 primary groin soft developed in a flap used to cover a groin defect. In the former 3 cases, The flap was simply transposed without complete islanding of the flap. In the latter case, a very large flap was harvested beyond the safe limits with its distal edge just above the knee. In addition, wound dehiscence of the flap occurred in 2 other cases from the groin group. Nevertheless, all the wounds healed spontaneously with repeated dressings. Out of the 5 cases that underwent

  18. Widening of the safe trajectory range during subaxial cervical pedicle screw placement: advantages of a curved pedicle probe and laterally located starting point without creating a funnel-shaped hole.

    Science.gov (United States)

    Lee, Subum; Seo, Junghan; Lee, Moon Kyu; Jeon, Sang Ryong; Roh, Sung Woo; Rhim, Seung Chul; Park, Jin Hoon

    2017-08-01

    OBJECTIVE The small diameter of cervical pedicles and a large transverse cervical pedicle angle are challenges that have led spinal surgeons to investigate how they could achieve a wider safety trajectory and reduce the insertion angle during cervical pedicle screw (CPS) placement. In this paper, the authors detail the advantages of using a curved pedicle probe and a laterally located entry point for overcoming these challenges. METHODS From March 2012 to May 2016, the authors performed posterior cervical fusions using CPSs on 119 consecutive patients. The lateral mass screw conversion and the CPS breach rate were analyzed. Using preoperative CT, it was determined that θ lat is similar to the anatomical pedicle angle, and θ med is the minimally acceptable medial angle. The actual insertion medial angle (θ ins ) was determined by postoperative CT. To identify how much of the medial angle on θ ins could be reduced from the anatomical pedicle angle (θ lat ), and how much closer to θ med , (θ ins -θ med ) / (θ lat -θ med ) was calculated. To verify shifting of the entry point and widening of the trajectory, the mean df/Df (i.e., shifted facet point/planned facet point) values were analyzed. RESULTS The total number of planed CPSs was 759, the conversion rate was 4.61% (35/759), and the accuracy rate was 95.9% (694/724). The authors could calculate that θ ins could be expected near the 90%, 80%, 80%, 80%, and 110% value of θ lat on C-3, C-4, C-5, C-6, and C-7 levels, respectively, with the (θ ins -θ med ) / (θ lat -θ med ) equation. The mean df/Df values were 0.64, 0.62, 0.63, 0.63, and 1.24 on the C3-7 levels, respectively. CONCLUSIONS Through the use of a curved pedicle probe and a laterally located starting point, the planned and laterally located entry point medial shift was made during CPS placement. The entry point shift yielded a wider, safe trajectory and reduced the burden of making a large medial angle, similar to an anatomical cervical pedicle

  19. Use of the Composite Pedicled Pectoralis Minor Flap after Resection of Soft Tissue Sarcoma in Reconstruction of the Glenohumeral Joint

    Directory of Open Access Journals (Sweden)

    Michiel A. J. van de Sande

    2014-01-01

    Full Text Available The surgical repair of an extensive anterior glenohumeral soft tissue defect is complicated by glenohumeral instability and subsequent significant functional deficit. This surgical note offers a relatively simple reconstruction of the anterior capsule and subscapularis muscle using a pectoralis minor pedicle flap. This reconstruction is supplemented with functional reconstruction of the anterior glenohumeral joint. A conventional deltopectoral approach is utilized and pectoralis minor is freed from its coracoid insertion, released, and mobilized without compromising the pedicle entering from the dorsum and inferior one-third of the muscle. The mobilized pectoralis minor vascular pedicle has sufficient length for the pectoralis minor to be transferred to provide coverage of the anterior shoulder joint even in full external rotation, providing anterior stability. To further improve glenohumeral stability and shoulder function, the pectoralis major muscle can be split with the clavicular part reinserted lateral to the bicipital groove onto the lesser tuberosity replacing subscapularis function while stabilising the glenohumeral joint.

  20. Titanium greenfield inferior vena cava filter; effectiveness of percutaneous placement for prevention of pulmonary embolism

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Bong Gak; Hahn, Seong Tai; Jung, Jung Im; Lee, Sang Hoon; Koh, Ki Young; Park, Seog Hee; Shinn, Kyung Sub [The Catholic Univ. of Korea, Seoul (Korea, Republic of)

    2000-11-01

    To evaluate the effectiveness of percutaneous placement of a Greenfield titanium filter in the inferior vena cava (IVC) for the prevention of pulmonary embolism (PE) in patients with deep vein thrombosis (DVT). Twelve patients with DVT underwent percutaneous Greenfield titanium filter placement. The indications included recurrent pulmonary embolism or failed anticoagulation therapy in six patients, extensive PE in three, and prophylaxis for high risk of PE in the remaining three. In all cases the filter was positioned after confirming the anatomy, patency, and presence of thrombosis of the IVC and renal veins by inferior vena cavography. Long-term follow-up study involved clinical evaluation, plain radiography, Doppler ultrasonography and CT scanning. Filter placement [infrarenal in ten patients (83%) and suprarenal in two (17%)] was technically successful in all cases (100%). The venous approach involved the right femoral vein in eight patients (67%) and the right internal jugular vein in four (33%). Complications included overlapping of the filter legs in three patients (25%), and misplacement in one (8%). After filter placement, no further PE developed. In all of five patients followed up for two years, the IVC maintained patency without evidence of caval perforation or occlusion. In patients with DVT, percutaneous placement of a Greenfield titanium filter is a safe and effective method for the prevention of PE.

  1. Symptomatic Abdominal Simple Cysts: Is Percutaneous Sclerotherapy with Hypertonic Saline and Bleomycin a Treatment Option?

    Directory of Open Access Journals (Sweden)

    V. D. Souftas

    2015-01-01

    Full Text Available Aim. To evaluate the feasibility of percutaneous sclerotherapy of symptomatic simple abdominal cysts, using hypertonic saline and bleomycin, as an alternative to surgery. Materials and Methods. This study involved fourteen consecutive patients (ten women, four men, mean age: 59.2 y with nineteen symptomatic simple cysts (liver n=14, kidney n=3, and adrenal n=2 treated percutaneously using a modified method. Initially CT-guided drainage was performed; the next day the integrity of the cyst/exclusion of extravasation or communications was evaluated under fluoroscopy, followed by two injections/reabsorptions of the same quantity of hypertonic NaCl 15% solution and three-time repetition of the same procedure with the addition of bleomycin. The catheter was then removed; the patients were hospitalized for 12 hours and underwent follow-ups on 1st, 3rd, 6th, and 12th months. Cyst’s volumes and the reduction rate (% were calculated in each evaluation. Results. No pain or complications were noted. A significant cyst’s volume reduction was documented over time (P<0.001. On the 12th month 17 cysts disappeared and two displayed a 98.7% and 68.9% reduction, respectively. Conclusion. This percutaneous approach constitutes a very promising nonsurgical alternative for patients with symptomatic simple cyst, without complications under proper precautions, leading to eliminating the majority of cysts.

  2. Percutaneous local ablation of unifocal subclinical breast cancer: clinical experience and preliminary results of cryotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Manenti, Guglielmo; Perretta, Tommaso; Gaspari, Eleonora; Pistolese, Chiara A.; Scarano, Lia; Cossu, Elsa; Simonetti, Giovanni; Masala, Salvatore [University Hospital ' ' Tor Vergata' ' , Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Rome (Italy); Bonanno, Elena [University Hospital ' ' Tor Vergata' ' , Department of Biopathology, Rome (Italy); Buonomo, Oreste C.; Petrella, Giuseppe [University Hospital ' ' Tor Vergata' ' , Department of General Surgery Division, Rome (Italy)

    2011-11-15

    To assess the ablative effectiveness, the oncological and cosmetic efficacy of image-guided percutaneous cryoablation in the treatment of single breast nodules with subclinical dimensions after identification with ultrasonography (US), mammography, magnetic resonance (MRI) and characterization by vacuum assisted biopsy. Fifteen women with a mean age of 73 {+-} 5 years (range 64-82 years) and lesion diameter of 8 {+-} 4 mm were undergoing cryotherapy technology with a single probe under US-guidance associated with intra-procedural lymph-node mapping and excision of the sentinel node. All the patients underwent surgical resection (lumpectomy) from 30 to 45 days after the percutaneous ablation. The iceball size generated by the cryoprobe during the procedure at minus 40 C was 16 x 41 mm. In 14 of the 15 patients was observed a complete necrosis of the cryo-ablated lesion both in post-procedural MRI follow-up and anatomo-pathological evaluation after surgical resection. In one case there was a residual disease in post-procedural MRI and postoperative histological examination, probably justified by an incorrect positioning of the probe. The percutaneous cryoablation as a ''minimally invasive'' technique can provide excellent oncological and cosmetic results on selected cases handled by experienced operators by using the tested devices. (orig.)

  3. Percutaneous local ablation of unifocal subclinical breast cancer: clinical experience and preliminary results of cryotherapy

    International Nuclear Information System (INIS)

    Manenti, Guglielmo; Perretta, Tommaso; Gaspari, Eleonora; Pistolese, Chiara A.; Scarano, Lia; Cossu, Elsa; Simonetti, Giovanni; Masala, Salvatore; Bonanno, Elena; Buonomo, Oreste C.; Petrella, Giuseppe

    2011-01-01

    To assess the ablative effectiveness, the oncological and cosmetic efficacy of image-guided percutaneous cryoablation in the treatment of single breast nodules with subclinical dimensions after identification with ultrasonography (US), mammography, magnetic resonance (MRI) and characterization by vacuum assisted biopsy. Fifteen women with a mean age of 73 ± 5 years (range 64-82 years) and lesion diameter of 8 ± 4 mm were undergoing cryotherapy technology with a single probe under US-guidance associated with intra-procedural lymph-node mapping and excision of the sentinel node. All the patients underwent surgical resection (lumpectomy) from 30 to 45 days after the percutaneous ablation. The iceball size generated by the cryoprobe during the procedure at minus 40 C was 16 x 41 mm. In 14 of the 15 patients was observed a complete necrosis of the cryo-ablated lesion both in post-procedural MRI follow-up and anatomo-pathological evaluation after surgical resection. In one case there was a residual disease in post-procedural MRI and postoperative histological examination, probably justified by an incorrect positioning of the probe. The percutaneous cryoablation as a ''minimally invasive'' technique can provide excellent oncological and cosmetic results on selected cases handled by experienced operators by using the tested devices. (orig.)

  4. Percutaneous yttrium aluminum garnet-laser lithotripsy of intrahepatic stones and casts after liver transplantation

    DEFF Research Database (Denmark)

    Schlesinger, Nis Hallundbaek; Svenningsen, Peter; Frevert, Susanne

    2015-01-01

    Bile duct stones and casts (BDSs) contribute importantly to morbidity after liver transplantation (LT). The purpose of this study was to estimate the clinical efficacy, safety, and long-term results of percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) in transplant recipients and to d......Bile duct stones and casts (BDSs) contribute importantly to morbidity after liver transplantation (LT). The purpose of this study was to estimate the clinical efficacy, safety, and long-term results of percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) in transplant recipients...... and to discuss underlying factors affecting the outcome. A retrospective chart review revealed 18 recipients with BDSs treated by PTCSL laser lithotripsy with a holmium-yttrium aluminum garnet laser probe at 365 to 550 µm. They were analyzed in a median follow-up time of 55 months