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Journal of Neurosurgical Sciences Jun 2018Endoscopic endonasal approaches (EEA) have gained popularity and acceptance in skull base surgery over the last two decades. So-called expanded EEA allow access in the... (Review)
Review
Endoscopic endonasal approaches (EEA) have gained popularity and acceptance in skull base surgery over the last two decades. So-called expanded EEA allow access in the sagittal plane from the frontal sinus to the odontoid process. The endoscopic endonasal transclival approach allows a unique trajectory into the midline clivus and skull base that is unachievable from traditional craniotomy approaches to lesions such as chondrosarcomas, chordomas, and posterior fossa meningiomas. In this review, we will assess the benefits and drawbacks to using an endoscopic endonasal approach versus transcranial approach to these challenging lesions, assess the anatomical limits of endoscopic endonasal transclival surgery, and discuss the published literature on the topic.
Topics: Cranial Fossa, Posterior; Humans; Infratentorial Neoplasms; Natural Orifice Endoscopic Surgery; Neuroendoscopy; Skull Base
PubMed: 29527889
DOI: 10.23736/S0390-5616.18.04411-9 -
Frontiers in Cardiovascular Medicine 2023The accurate quantification of primary mitral regurgitation (MR) and its consequences on cardiac remodeling is of paramount importance to determine the best timing for... (Review)
Review
The accurate quantification of primary mitral regurgitation (MR) and its consequences on cardiac remodeling is of paramount importance to determine the best timing for surgery in these patients. The recommended echocardiographic grading of primary MR severity relies on an integrated multiparametric approach. It is expected that the large number of echocardiographic parameters collected would offer the possibility to check the measured values regarding their congruence in order to conclude reliably on MR severity. However, the use of multiple parameters to grade MR can result in potential discrepancies between one or more of them. Importantly, many factors beyond MR severity impact the values obtained for these parameters including technical settings, anatomic and hemodynamic considerations, patient's characteristics and echocardiographer' skills. Hence, clinicians involved in valvular diseases should be well aware of the respective strengths and pitfalls of each of MR grading methods by echocardiography. Recent literature highlighted the need for a reappraisal of the severity of primary MR from a hemodynamic perspective. The estimation of MR regurgitation fraction by indirect quantitative methods, whenever possible, should be central when grading the severity of these patients. The assessment of the MR effective regurgitant orifice area by the proximal flow convergence method should be used in a semi-quantitative manner. Furthermore, it is crucial to acknowledge specific clinical situations in MR at risk of misevaluation when grading severity such as late-systolic MR, bi-leaflet prolapse with multiple jets or extensive leak, wall-constrained eccentric jet or in older patients with complex MR mechanism. Finally, it is debatable whether the 4-grades classification of MR severity would be still relevant nowadays, since the indication for mitral valve (MV) surgery is discussed in clinical practice for patients with 3+ and 4+ primary MR based on symptoms, specific markers of adverse outcome and MV repair probability. Primary MR grading should be seen as a continuum integrating both quantification of MR and its consequences, even for patients with presumed "moderate" MR.
PubMed: 36970355
DOI: 10.3389/fcvm.2023.1107724 -
Veterinary Sciences Nov 2022The interdigital gland is a specialized skin gland located between the digits of Artiodactyla (i.e., even-toed ungulates). Its secretion participates in semiochemical...
The interdigital gland is a specialized skin gland located between the digits of Artiodactyla (i.e., even-toed ungulates). Its secretion participates in semiochemical communication, and protects from ultraviolet radiation as well as fungal and bacterial infections of the feet. The present study aimed at finding if there are male-female differences in the anatomy, morphology, and volatile compounds of the interdigital gland of the South Indian breed of Vembur sheep. A total of 24 sheep (12 each of male and female) were spotted at the slaughterhouse and the interdigital gland was removed for examination. The anatomical examination revealed it to resemble a tobacco pipe and to consist of a body, flexure, and excretory duct with an external orifice located at the cleft of the digits. Morphometrically, the interdigital glands differed between males and females. The gland possesses a distinct fibrous capsule, epidermis, and dermis. The fibrous capsule contains several parallel bundles of collagen fibers, nerve fibers, and blood vessels, etc. The epidermis consists of keratinized squamous epithelium formed of stratum basale, stratum granulosum and stratum spinosum. The dermis consists of hair follicles, nerve plexuses, arrector pili muscles, and apocrine and sebaceous glandular lobules. The latter, lined by a simple cuboidal epithelium, are arranged in clusters of acini in the upper portion of the dermis. The apocrine secretory lobules, made up of parenchymal cells, are found in the lower portion of the dermis. The density and diameter of the apocrine and sebaceous secretory lobules were significantly higher in the males than females. Scanning electron microscopic (SEM) analysis confirmed the apocrine and sebaceous secretory components. Twenty-three major compounds were identified in the interdigital gland postings of male and female sheep, among which butanoic acid, 2-methylpropanoic acid, 1-heptanol and octadecanoic acid were present only in the male glandular post, whereas octane, 7-hexyl-tridecane, tetradecane, heptadecane and decanoic acid were present only in the female glandular post. Tetradecanol, tetradecanoic acid and hexadecanol peaks, reportedly antibacterial compounds in pronghorn antelopes, were highly prominent in both male and female sheep. Thus, the interdigital gland of Vembur sheep has two major secretory lobules, namely, sebaceous and apocrine, larger in males than females, which secrete a variety chemical compounds that may serve as chemical communication systems and protect the sheep from foot-borne diseases.
PubMed: 36423097
DOI: 10.3390/vetsci9110647 -
Revista Portuguesa de Cardiologia Apr 2021Paravalvular leak (PVL) is a common serious complication associated with prosthetic valve implantation.
INTRODUCTION
Paravalvular leak (PVL) is a common serious complication associated with prosthetic valve implantation.
OBJECTIVE
The aim of this study was to report our single-center experience in a retrospective review and to analyze possible predictors of success.
METHODS
We performed 33 percutaneous PVL closures in 26 patients (54% female, mean age 65±13 years). All mitral prostheses were studied previously with 3D transesophageal echocardiography (TEE), and aortic prostheses with 2D/3D TEE. 3D TEE and fluoroscopy were used for the assessment, planning, and guidance of the interventions. Twelve patients also underwent computed tomography angiography for better characterization of anatomic details.
RESULTS
Eighteen patients (69.2%) were admitted due to heart failure (New York Heart Association [NYHA] III or IV, seven (26.9%) because of heart failure and hemolysis, and one (3.8%) due to hemolysis only. Regarding the leaks, 46.2% were in aortic and 53.8% in mitral prostheses, 88.5% in mechanical and 7.7% in biological prostheses, and 3.8% in transcatheter aortic valve implants. All the aortic patients had severe aortic regurgitation. Furthermore, all mitral patients but one had moderate to severe or severe mitral regurgitation. Closure was successful in 17 patients (65.4%), partially successful in four (15.4%) and unsuccessful in five (19.2%). After the procedure, 69% were in NYHA I-II. Hemolysis worsened in three patients despite successful closure; all required further valvular surgery and two died. Regarding angiographic and echocardiographic procedural success, we analyzed age, gender, type of prosthesis (mechanical or biological), location (aortic or mitral), clinical data, maximum leak diameter, anatomic regurgitant orifice, leak location (anterior, posterior, inferior and lateral for mitral leaks and left, right and non-coronary sinus for aortic leaks), and number of devices (plugs) used for closure. No parameters presented a significant relationship with success excepting previous hemolysis. There was a relationship between clinical improvement and reduction of PVL (p=0.0001). In follow-up, cardiac-related events (new hospital admissions, cardiac valvular surgery, need for transfusion) were more frequent in patients with partially successful or unsuccessful closure (p=0.012). There was a relationship between cardiac-related events and death (p=0.029).
CONCLUSION
Percutaneous PVL closure has emerged as an alternative treatment for PVL. Predictors of procedural success are difficult to establish. Survival is related to reduction of regurgitation and improvement in NYHA functional class.
Topics: Aged; Echocardiography, Three-Dimensional; Echocardiography, Transesophageal; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Retrospective Studies
PubMed: 33648808
DOI: 10.1016/j.repc.2020.07.016 -
Scanning 2021This retrospective study of roots with C-shaped canals investigated their prevalence, configuration type, and lingual wall thickness, as well as the panoramic...
This retrospective study of roots with C-shaped canals investigated their prevalence, configuration type, and lingual wall thickness, as well as the panoramic radiographic features of roots in permanent mandibular second molars confirmed to have C-shaped canals on cone-beam computed tomography (CBCT) in a Korean population. In total, 1884 CBCT images of mandibular second molars were examined by two endodontists to analyze the presence of C-shaped canals according to age and sex. The bilateral occurrence of C-shaped roots and their morphology on panoramic radiography were assessed and statistically analyzed using the chi-square test. The classification of Fan et al. was applied to categorize the configurations of C-shaped canals. The lingual wall thickness was calculated in the mesial, middle, and distal areas at the orifice and at 5 mm from the apex. The Mann-Whitney test was used to analyze the mean difference of lingual wall thickness between the apex and orifice level. A value of 0.05 was considered to indicate statistical significance in the statistical analyses. Of 2508 mandibular second molars, 924 (36.8%) had C-shaped root canals. The prevalence was significantly lower in the over 61 age group (24.08%) than in the 21-30-year age group (40.02%) and was higher in women (42.32%). Most cases were bilateral (85.9%). The C1 type was the most common (35.3%). The prevalence of C1 type canals decreased, while that of C3b type canals increased with age. In 75.2% of teeth having C-shaped root canals on CBCT, fused roots were observed on panoramic views. The difference in the lingual wall thickness at the orifice and 5 mm from the apex was significant in the middle area in all configurations of C-shaped root canals. When performing nonsurgical or surgical endodontic procedures of the mandibular second molars, clinicians should consider age, sex, ethnicity, and anatomical variations.
Topics: Dental Pulp Cavity; Female; Humans; Mandible; Prevalence; Republic of Korea; Retrospective Studies; Spiral Cone-Beam Computed Tomography; Tooth Root
PubMed: 34131465
DOI: 10.1155/2021/9152004 -
Medicina (Kaunas, Lithuania) Jan 2023Background and objectives: Renal stones are widespread, with a lifetime prevalence of 10% in adults. Flexible ureteroscopy enables urologists to treat lower calyx stones...
Background and objectives: Renal stones are widespread, with a lifetime prevalence of 10% in adults. Flexible ureteroscopy enables urologists to treat lower calyx stones or even complex renal stones through the natural orifice and achieve an acceptable stone-free rate. Hence, we analyzed the effectiveness and safety of FURS versus PCNL in treating renal stones between 20 and 40 mm in diameter. Materials and methods: We retrospectively analyzed 250 consecutive patients with large renal solitary stones (stone burden between 2 and 4 cm) from 1 January 2019 to 31 December 2020. The patients were divided into two groups: group 1 (125 patients), in which the patients were treated by a retrograde flexible ureteroscopic approach, and group 2 (125 patients), in which we used percutaneous nephrolithotomy. Stone characteristics and anatomical data were observed based on the computed tomography (CT) and/or KUB (Kidney-ureter-Bladder) radiography imaging archive. Results: The mean stone burden was 26.38 ± 4.453 mm in group 1 and 29.44 ± 4.817 mm in group 2. The stone-free rate after the first ureteroscopy was higher for the PNL(percutaneous nephrolithotomy) group (90.4%) than the F-URS group (68%). After two sessions of ureteroscopy, the SFR was 88.8% in the first group, and after three procedures, the SFR rose to 95.2%. The overall complication rate was higher in group 1 than in group 2 (18.4% vs. 16.8%), but without statistical relevance (p > 0.5). Furthermore, we encountered more grade III and IV complications in the PNL group (8.8% vs. 4.8%, p < 0.05). Conclusion: Flexible ureteroscopy proves to be efficient in treating renal stones over 2 cm. However, the patients must be informed that more than one procedure might be necessary to overcome the entire stone burden.
Topics: Adult; Humans; Nephrolithotomy, Percutaneous; Ureteroscopy; Retrospective Studies; Kidney Calculi; Treatment Outcome
PubMed: 36676748
DOI: 10.3390/medicina59010124 -
Facts, Views & Vision in ObGyn Sep 2023Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome has an incidence of 1 in 4000. The absence of the vagina and uterus results in sexual dysfunction and infertility. The...
BACKGROUND
Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome has an incidence of 1 in 4000. The absence of the vagina and uterus results in sexual dysfunction and infertility. The first-line treatment is vaginal dilatation. There exists a number of second-line surgical options including the Uncu-modified Davydov procedure.
OBJECTIVE
To determine the complication rate, anatomical outcomes, and long-term sexual outcomes of MRKH syndrome patients after Uncu-modified Davydov procedure.
MATERIALS AND METHODS
Patients with MRKH syndrome who underwent paramesonephric remnant-supported laparoscopic double-layer peritoneal pull-down vaginoplasty (aka Uncu-modified Davydov procedure) between January 2008 and December 2021. The procedure involves laparoscopic circular dissection of the pelvic peritoneum followed by pulling down, through the opened vaginal orifice, and suturing the vaginal cuff with the support of uterine remnants. The long-term complication rate, anatomical outcomes, and sexual function outcomes (as measured by Female Sexual Function Index (FSFI)) were ascertained.
MAIN OUTCOME MEASURES
Main Outcome Measures: The long-term complication rate, anatomical outcomes and FSFI survey results.
RESULTS
A total of 50 patients with MRKH syndrome underwent the Uncu-modified Davydov procedure between Jan 2008- Dec 2021. There were four perioperative complications: three bladder injuries (6%) and one rectal serosa injury (2%). Four long-term postoperative complications were identified: one vesicovaginal fistula (2%), one recto-vaginal fistula (2%), and two vaginal stenoses (4%). All patients were physically examined at least one year after surgery. The mean vaginal length was 8.4 + 1.9 cm. The mean FSFI score was 31.5 + 3.9 (minimum score of 24, maximum score of 36).
CONCLUSION
Conclusion: The Uncu-modified Davydov procedure has been demonstrated to be a safe and effective treatment option with high female sexual function index scores for patients with MRKH syndrome.
WHAT IS NEW?
The long-term complication rate, anatomical and sexual outcomes of Uncu-modified laparoscopic peritoneal pull-down vaginoplasty were reported in this study. The results indicated that the surgical approach could be used in selective MRKH patients who failed first-line self-dilatation therapy.
PubMed: 37742200
DOI: 10.52054/FVVO.15.3.091 -
Bioengineering (Basel, Switzerland) Dec 2022The aim of this case series is to contribute to the better knowledge and management of the complex anatomical configurations of maxillary premolars with four canals. The...
The aim of this case series is to contribute to the better knowledge and management of the complex anatomical configurations of maxillary premolars with four canals. The paper explains the endodontic treatment of five maxillary premolars with four canals, with three buccal and one palatal orifices, in different patients. The cases report several approaches in the treatment of four-canal maxillary premolars including a conservative canal preparation with a hybrid shaping technique, endodontic microsurgery and the application of biomaterials. The use of an operating dental microscope, different operating strategies and the critical evaluation of radiographs are all necessary steps for the correct and safe endodontic management of these teeth.
PubMed: 36550963
DOI: 10.3390/bioengineering9120757 -
Frontiers in Pediatrics 2019Cloacal malformations are rare anomalies which occur in one in 50,000 live births. Anatomically these anomalies are defined by the presence of a single perineal orifice.... (Review)
Review
Cloacal malformations are rare anomalies which occur in one in 50,000 live births. Anatomically these anomalies are defined by the presence of a single perineal orifice. There is however a substantial range in their complexity. Defining these differences is key to surgical planning and timely referral of selected cases to centers with the capabilities to manage the most challenging cases. Traditionally the common channel length as measured during cysto-vaginoscopy has been used to differentiate between patients that can be repaired with a reproducible operation and those requiring a more complex repair. The quality and range of imaging available has advanced and thus a more detailed anatomic picture is now possible to help with pre-operative planning. Cross sectional imaging with 3D reconstruction has enhanced the understanding of the anatomic variations in these patients. In addition, the sacral ratio, previously thought to only have an influence on long term continence predictions, has been shown to not only forecast the presence of urological anomalies, but also the complexity of the malformation. In principle, cloacal malformations have two major components to the reconstruction. First, the rectum needs to be separated from the urogenital tract and second, the urogenital sinus needs to be managed to create a urethral orifice and vaginal introitus. The length of the urethra has been shown to be vital in deciding between the two main surgical maneuvers; a total urogenital mobilization (TUM) and a urogenital separation. The technical demands of a urogenital separation are significant and discussed here in detail. The need for vaginal replacement adds further complexity to the care of these patients and has also been shown to be related to the length of the urethra. Predicting complexity in an accurate and non-invasive way will facilitate the care of the most complex cloacal malformations and improve outcomes.
PubMed: 31259166
DOI: 10.3389/fped.2019.00240 -
Journal of Cardiovascular Development... Mar 2023Quantification of chronic mitral regurgitation (MR) is essential to guide patients' clinical management and define the need and appropriate timing for mitral valve... (Review)
Review
Quantification of chronic mitral regurgitation (MR) is essential to guide patients' clinical management and define the need and appropriate timing for mitral valve surgery. Echocardiography represents the first-line imaging modality to assess MR and requires an integrative approach based on qualitative, semiquantitative, and quantitative parameters. Of note, quantitative parameters, such as the echocardiographic effective regurgitant orifice area, regurgitant volume (RegV), and regurgitant fraction (RegF), are considered the most reliable indicators of MR severity. In contrast, cardiac magnetic resonance (CMR) has demonstrated high accuracy and good reproducibility in quantifying MR, especially in cases with secondary MR; nonholosystolic, eccentric, and multiple jets; or noncircular regurgitant orifices, where quantification with echocardiography is an issue. No gold standard for MR quantification by noninvasive cardiac imaging has been defined so far. Only a moderate agreement has been shown between echocardiography, either with transthoracic or transesophageal approaches, and CMR in MR quantification, as supported by numerous comparative studies. A higher agreement is evidenced when echocardiographic 3D techniques are used. CMR is superior to echocardiography in the calculation of the RegV, RegF, and ventricular volumes and can provide myocardial tissue characterization. However, echocardiography remains fundamental in the pre-operative anatomical evaluation of the mitral valve and of the subvalvular apparatus. The aim of this review is to explore the accuracy of MR quantification provided by echocardiography and CMR in a head-to-head comparison between the two techniques, with insight into the technical aspects of each imaging modality.
PubMed: 37103029
DOI: 10.3390/jcdd10040150