scholarly journals Early experience with microsurgical spermatic cord denervation for chronic orchialgia at a Canadian centre

2015 ◽  
Vol 9 (1-2) ◽  
pp. 72 ◽  
Author(s):  
Darby James Cassidy
Keyword(s):  
Surgical Technique ◽  
Complete Resolution ◽  
Spermatic Cord ◽  
Early Experience ◽  
Partial Resolution ◽  
Pain Symptoms

Introduction: Microsurgical spermatic cord denervation (MSCD) is an effective surgical technique to manage chronic orchalgia, but it has not been readily adopted by Canadian urosurgeons. This paper reviews the early experience of a single urosurgeon in Canada.Methods: Nine consecutive testicular units underwent MSCD over a 24 month period. These patients underwent MSCD after ruling out reversible causes and after a successful diagnostic spermatic cord block.Results: Of these patients, 77% (7/9) had a complete resolution and 22% (2/9) had a partial resolution of their pain symptoms following MSCD. There were no failures or complications.Conclusions: MSCD is an effective, safe, and reproducible surgical technique that should be included in the treatment armamentarium for chronic orchalgia.

Abstract 15078: Non-selective but Not Selective His Bundle Pacing Uniquely Resolves Acute and Chronic Right Bundle Branch Block

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Rehan Mahmud ◽  
Shakeel Jamal ◽  
Bdeth Bailey
Keyword(s):  
Right Bundle Branch Block ◽  
Complete Resolution ◽  
Conduction Block ◽  
Right Ventricular Free Wall ◽  
Bundle Branch Block ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Partial Resolution ◽  
Lead Fixation

Introduction: While acute (Ac) right bundle branch block (RBBB) may be in proximal HB (lead fixation injury) and chronic (Ch) RBBB in distal HB, they both cause terminal QRS delay. Both types of RBBB may be corrected with non-selective (NS) His bundle pacing (HBP), however the mechanism is unknown. Hypothesis: To study the role of high (5V) and low (1V) pacing voltage as well as presence of pre-excitation (in NS-HBP) in resolving Ac and chronic Ch-RBBB. Methods: Of the thirty-nine patients (27 ChRBBB and 12 AcRBBB), 25 ChRBBB and 10 AcRBBB patients showed NS-HBP at 5V and 11/25 ChRBBB and 6/12 AcRBBB patients transitioned to selective (S)-HBP at 1V. Four patients showed S-HBP at 5V and 1V. Results: 1)During NS-HBP at 5V: (In 25 ChRBBB and 10 Ac-RBBB) Complete resolution occurred 12/25ChRBBB and in all 10 AcRBBB. A partial resolution of ChRBBB occurred 13/25 ChRBBB.2. During NS-HBP at 1V: (6/14 ChRBBB and 2/4 AcRBBB showed complete resolution at 1V, remainder showed incomplete RBBB3. During S-HBP at 5V : (2 ChRBBB 2 AcRBBB) only 1 AcRBBB showed resolution of RBBB. 4. During S-HBP at 1V : All 13 ChRBBB and 8 AcRBBB did not show resolution os RBBB including 11 Ch-RBBB and 6 Ac-RBBB RBBB which resolved during 5V NS-HBP, abruptly recurred on transition to S-HBP at a mean of 2.4±0.8V. Conclusions: 1)The lack of RBBB resolution with S-HBP suggests that pacing site was proximal to site of block, however, from the same site NS-HBP either completely or incompletely resolved both Ac- and Ch-RBBB. 2) Partial resolution of RBBB in NS-HBP may be explained by right ventricular free wall pre-excitation when site of Ch-RBBB is distal.3) Complete resolution of both acute and Ch-RBBB in NS-HBP, more so at high pacing voltage, suggest that peri-Hisian tissues may behave more like a specialized conduction tract which uniquely resolves conduction block.

scholarly journals P293 Local Mesenchymal Stem Cells injection in Crohn’s disease strictures: a phase I-II, open-label clinical study

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S323-S324
Author(s):  
S Vieujean ◽  
J P Loly ◽  
L Boutaffala ◽  
B Pariente ◽  
C Reenaers ◽  
...  
Keyword(s):  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Crohn’S Disease ◽  
Phase I ◽  
Crohn Disease ◽  
Complete Resolution ◽  
Open Label ◽  
Partial Resolution ◽  
Clinical Scores

Abstract Background Intestinal fibrosis is a common complication of Crohn’s disease (CD) leading to progressive bowel stricture formation. Mesenchymal stem cells (MSCs), known for their immunomodulatory, anti-inflammatory and anti-fibrotic properties, could be a potential therapy in this frequently fibro-inflammatory condition. In this phase I–II open-label pilot trial, we aimed to assess safety and efficacy of local MSCs injection in CD strictures. Methods: CD patients with a non-passable stricture, length from 2 to 5 cm, accessible by ileocolonoscopy, but without intestinal obstruction, fistulas, or abscess, could be included. A total of 3X107 allogenic bone-marrow derived MSCs were equally injected in the 4 quadrants of the strictured bowel wall during an ileocolonoscopy. Adverse events and clinical scores (Crohn Disease Activity Index, Short Health Scale and Crohn Disease Obstructive Score) were evaluated at each follow-up visit (at week 4, 12, 24 and 48) while endoscopy was performed at baseline, W12 and W48. The main judgement criteria for efficacy was the complete (defined by the ability to pass the ileocolonoscope) or partial (defined by a diameter increase) resolution of the stricture at 12 weeks. Other efficacy criteria included complete or partial resolution of the stricture at 48 weeks as well as the evolution of clinical scores between weeks 0, 12 and 48. Results Between 2018 and 2020, we performed 11 local MSCs injections in 10 CD patients (6 female; aged to 38-65 years; median 45 years old; 70% were smoker). The strictures’ (3 primary, 7 anastomotic) location was as follows: 7 at an ileo-colonic or ileo-rectal anastomosis, 1 colonic and 2 of the ileocecal valve. MSCs injections were well tolerated but a total of 5 hospitalizations for occlusion were reported (2 secondary to a different stricture than the injected one) leading to a surgical resection for one patient and an endoscopic dilatation for another one. Neither intestinal perforation nor intra-abdominal fistula or abscess was reported. At 12 weeks, 5 patients (45%) presented a stricture improvement with a complete resolution for 2 and a partial resolution for 3. Of the 11 MSCs injections, 6 patients were re-evaluated at week 48 (2 patients still undergoing follow-up, 1 operated, 1 dilated, and 1 lost to follow-up), 4 patients had a complete resolution and 1 had a partial resolution. The evolution of clinical scores between weeks 0, 12 and 48 (Figure 1) was not statistically significant. Conclusion Local MSCs injection in non-passable CD stricture was well tolerated over the short term but several occlusions were reported in the follow-up. Combining the effects of MSCs with the proven effect of endoscopic balloon dilatation could possibly improve the outcome of CD stricture.

scholarly journals Repair of avulsion fracture of the anterior superior iliac spine by knotless suture bridge: Surgical technique and a review of 5 cases

2021 ◽  
pp. 19
Author(s):  
Keyword(s):  
Surgical Technique ◽  
Avulsion Fracture ◽  
Treatment Options ◽  
Visual Analogue Score ◽  
Anterior Superior Iliac Spine ◽  
Early Recovery ◽  
Suture Bridge ◽  
Pain Symptoms ◽  
Suture Bridge Technique

Background: Avulsion fracture of the anterior superior iliac spine (ASIS) is a rare form of apophyseal avulsion fracture of the pelvis, and there is a lack of evidence-based guidelines for the selection of treatment options. There are various surgical procedures, but there is the risk of secondary removal of internal fixator and growth disturbance caused by epiphyseal fixation. Methods: We treated 5 patients with avulsion fracture of the anterior superior iliac spine by knotless suture bridge technique who visited our hospital from 2015 to 2020.The surgical treatment results were retrospectively analyzed. Results: 5 patients with fractures were healed after the surgery, no associated complications, the mean postoperative follow-up was 29.2 months (6-60months), all patients were not reported pain symptoms (visual analogue score of 0), they don’t have the limitation of daily activities, and the hip joint function recovered well, and very pleased with the results (Harris score 100 points) at the final follow-up. Conclusion: Knotless suture bridge technique is simple and effective in the repair of the avulsion fracture of anterior superior iliac spine. For such patients, this surgical technique can provide stable and reliable fixation, allow early recovery, and provide a feasible scheme for clinical practice.

Presence of Residual Thromboemboli at Least Six Months after a First Episode of Symptomatic Pulmonary Embolism: DO Perfusion Scintigraphy and CT-Angiography Agree?

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3030-3030
Author(s):  
Francesco Dentali ◽  
Marco Donadini ◽  
Benilde Cosmi ◽  
Alessandro Squizzato ◽  
Silvia Bozzato ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Complete Resolution ◽  
First Episode ◽  
Kappa Statistics ◽  
Perfusion Scintigraphy ◽  
Partial Resolution ◽  
Expert Radiologist ◽  
Symptomatic Pulmonary Embolism ◽  
Angio Ct

Abstract Introduction. The natural history of residual thromboembolic obstructions after pulmonary embolism (PE) and the clinical utility of imaging techniques at follow up are not completely known; in particular, to our knowledge, there are no clinical studies that compared the accuracy of angio-computed tomography (angio-CT) and perfusion scintigraphy (Q scan) in detecting residual thromboemboli after at least 6 months from a first episode of symptomatic PE. Methods. Consecutive patients on anticoagulant treatment for a first episode of symptomatic PE diagnosed by angio-CT scan and/or Q scan underwent angio-CT and Q scan after 6 to 12 months from the index event. Exclusion criteria were previous PE, recurrent symptomatic PE or deep vein thrombosis (DVT) during the follow-up period. All diagnostic tests were independently assessed by one expert radiologist unaware of the clinical status of the patients. The results of the tests were classified as no signs of recanalization or reperfusion, partial resolution or complete resolution. The agreement beyond chance between tests was assessed by kappa statistics. Results. Twenty-five patients (14 males, 56%, mean age 59.8) were included after a mean of 7.2 months (217 days, standard deviation 58 days) after acute PE. PE was diagnosed by CT alone in 13 cases, by high probability Q scan alone in 2 cases and by both CT and Q scan in 10 patients. Eleven episodes (44%) were considered idiopathic, 11 (44%) were secondary to transient risk factors, 3 (12%) patients had cancer; concomitant DVT was detected in 17 (68%) patients. At follow-up, Q scan showed no signs of reperfusion in 1 patient (4%), partial resolution in 13 patients (52%) and complete resolution in 11 (44%). Angio-CT showed no signs of recanalization in 0 patient, partial resolution in 17 patients (68%) and complete resolution in 8 (32%). Complete resolution was present in both tests in 1 patient (4%), partial resolution was present in both tests in 6 (24%) patients, with a k agreement between tests < 0.2 (slight). Conclusions. Partial resolution of thromboemboli after a mean period of 7.2 months from a first episode of PE is present at Q scan or at angio-CT in more than 50% of patients, confirming the results of previous studies. However, the results of our study show for the first time that the agreement between these two tests is low. Thus, caution should be used when interpreting the results of either of these tests to monitor patients with previous PE.

Prospective, Open-label clinical Trial of Bivalirudin in Children with Venous Thromboembolism

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1165-1165
Author(s):  
Sarah H. O'Brien ◽  
Donald Yee ◽  
Jessica Lira ◽  
Neil A Goldenberg ◽  
Guy Young
Keyword(s):  
Venous Thromboembolism ◽  
Complete Resolution ◽  
High Performance ◽  
Recurrent Events ◽  
Bleeding Event ◽  
Thrombin Inhibitor ◽  
Minor Bleeding ◽  
Bleeding Events ◽  
Open Label ◽  
Partial Resolution

Abstract Abstract 1165 Background: Bivalirudin (BIV) is a direct thrombin inhibitor with a favorable pharmacologic profile in comparison to heparin. In a previous study in children <6 months of age with venous thromboembolism (VTE), bivalirudin was demonstrated to be a safe and potentially more effective anticoagulant. The present study's aims were to assess the safety, dosing, pharmacokinetics, pharmacodynamics, and efficacy of BIV in children >6 months of age. Methods: This prospective, open-label study evaluated the use of BIV for initial treatment of a new VTE in children between 6 months and 18 years of age. Eligible subjects received a BIV bolus of 0.125mg/kg followed by an initial continuous infusion of 0.125mg/kg/hour which was adjusted as needed to achieve a PTT of 1.5–2.5x their baseline PTT. BIV levels by high performance liquid chromatography and PTTs were tested simultaneously 5 times in the first 24 hours, daily thereafter and following all dose adjustments. Subjects remained on BIV until they were transitioned to long-term anticoagulant treatments. Imaging was required to confirm the presence of a VTE and follow-up imaging was obtained at 2–3 days and 30 days following initiation of anticoagulation. Subjects were closely monitored for bleeding and adverse events. Results: 18 subjects (11M:7F) ranging in age from 9 months-17 years completed the study. There were no major bleeding events and one minor bleeding event. Outcome of VTE: at 2–3 days, 2 subjects had complete resolution and 7 subjects had partial resolution while at 30 days, 7 subjects had complete resolution and 9 subjects had partial resolution. There were no symptomatic recurrent events or any asymptomatic local progressions by surveillance imaging. Seven subjects required no dose adjustments during their course of treatment ranging between 2–5 days. See figure for correlation of PTT with BIV levels [each circle represents one subject with their mean PTT and BIV level with the standard deviations (r2=0.64)]. Conclusions: BIV offers a potentially safer, more effective and pharmacologically more predictable alternative to heparin for initial anticoagulation of children with VTE. Pharmacokinetic-pharmacodynamic correlation was excellent suggesting PTT as an acceptable monitoring strategy for BIV in this population. Further studies comparing BIV to heparin should be conducted. Disclosures: Off Label Use: Bivalirudin is not approved for use in children. Goldenberg:Eisai Inc: Research Funding; Pfizer Inc: Membership on an entity's Board of Directors or advisory committees; CPC Clinical Research: Consultancy.

MICROSURGICAL DENERVATION OF THE SPERMATIC CORD: VIDEO PRESENTATION OF SURGICAL TECHNIQUE

2009 ◽  
Vol 181 (4S) ◽  
pp. 382-382
Author(s):  
Laurence A Levine ◽  
Jonas S Benson ◽  
Frederick L Taylor
Keyword(s):  
Surgical Technique ◽  
Spermatic Cord ◽  
Video Presentation

scholarly journals Exploring the Outcomes of Portal Vein Thrombosis in the Clinical Setting of Cirrhosis, Malignancy, and Intra-abdominal Infections with and without Anticoagulation: A Retrospective 5-Year Study

2017 ◽  
Vol 27 (04) ◽  
pp. 208-212
Author(s):  
Joanne Joseph ◽  
Samuel Chew ◽  
Julie George ◽  
Tay Chin ◽  
Ashish Sule
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Complete Resolution ◽  
Vein Thrombosis ◽  
Risk Of Bleeding ◽  
Partial Resolution ◽  
Outcomes Measures ◽  
Increased Risk ◽  
Abdominal Infections

AbstractThe aim of this study was to understand the differences in clinical outcomes in portal vein thrombosis (PVT) patients with cirrhosis, malignancy, and abdominal infections, with or without anticoagulation. This study was approved by ethics committee. Data were collected from 2011 to 2016. Patients were classified into three groups: PVT with cirrhosis, malignancy, and infections. Primary outcomes measures collected were clot resolution, bleeding, recurrence, and death. Frequency, means, and percentages were calculated. In total, 30 patients were analyzed in this study. Mean age was 60.8 years (range of 30–91 years). There were 19 (63.3%) males and 11 (36.7%) females with ethnicity: 21 (70.0%) Chinese, 2 (6.7%) Malay, 2 (6.7%) Indian, and 5 (16.7%) other race. Fifteen patients received anticoagulation and 15 did not receive anticoagulation. Of the 15 patients who received anticoagulation, there was complete resolution of thrombus in 5 (33.3%), partial resolution in 1 (6.7%), and no resolution in 9 (60.0%). Of these 15 patients, there was bleeding in 3 (20.0%), there was no recurrence in 9 (60.0%), and 3 (20.0%) died during the period of follow-up. Of the 15 patients who did not receive anticoagulation, there was complete resolution of thrombus in 2 (13.3%), partial resolution in 0 (0.0%), and no resolution in 13 (86.7%). Of these 15 patients, there was bleeding in 0 (0%), there was recurrence in 2 (13.3%), and 6 (40.0%) died during the period of follow-up. Anticoagulation is effective in PVT. It reduces mortality with lower rate of recurrence. However, it is associated with increased risk of bleeding.

scholarly journals A lateral tarsorrhaphy with forehead hitch to pre-empt and treat burns ectropion with a contextual review of burns ectropion management

2016 ◽  
Vol 2 ◽  
pp. 205951311664208 ◽  
Author(s):  
Nikolaos S Lymperopoulos ◽  
Daniel J Jordan ◽  
Ranjeet Jeevan ◽  
Kayvan Shokrollahi
Keyword(s):  
Surgical Technique ◽  
Case Series ◽  
Tissue Expander ◽  
Early Experience ◽  
Ocular Involvement ◽  
Full Thickness ◽  
Scar Contracture ◽  
Full Thickness Skin ◽  
Thickness Skin ◽  
Facial Burns

[Formula: see text] Introduction: Facial burns around the eyes and eyelid ectropion can lead to corneal exposure, irritation, dryness, epiphora, infection or visual loss. We undertook a review of the published articles describing management of eyelid burns as well as methods to treat or prevent ectropion. We describe early experience of a surgical technique that we have found to mitigate ectropion in facial burns with peri-ocular involvement. Materials and methods: Two illustrative cases with our surgical technique is described from our experience of three cases. We reviewed the literature using the PubMed and EMBASE databases using the search terms ‘burn’ and ‘ectropion’. Results: The literature review produced a total of 17 relevant papers. Treatment options for eyelid burns were varied and were invariably level 4 or 5 evidence. Various techniques were used to treat eyelid burns including the use of a full thickness skin graft with or without concurrent scar contracture release but also use of a local flap reconstruction with or without a tissue expander or release of the underlying muscle. Other techniques included canthoplasty, Z-plasty, forehead flaps, fat transfer, and tarsorrhaphy with full thickness skin grafting. In general, the focus of articles was therapeutic and reconstructive rather than pre-emptive/preventative management. Procedure: We describe our early experience of a novel technique for temporary lateral tarsorrhaphy with forehead hitch which protexts the globe and counters the scar- and gravity-related ectropic effects on the lower eyelids. Discussion: Facial burns pose a difficult problem to the burn surgeon, especially when the eyelids are affected, both directly or indirectly. The optimal surgical management of eyelid burns remains unclear and the literature base lies mainly in the domain of case series. We review the literature on this subject and tabulate our findings and also describe our contribution to this area with a method of lateral and lower lid elevator that we have found valuable.

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