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Advances in Clinical and Experimental... Jul 2019Sternal dehiscence is a serious postoperative complication of cardiac surgery observed in 0.2-5% of procedures performed by median sternotomy. (Comparative Study)
Comparative Study
Complications in cardiac surgery: An analysis of factors contributing to sternal dehiscence in patients who underwent surgery between 2010 and 2014 and a comparison with the 1990-2009 cohort.
BACKGROUND
Sternal dehiscence is a serious postoperative complication of cardiac surgery observed in 0.2-5% of procedures performed by median sternotomy.
OBJECTIVES
Assessment of factors, including the method of sternum closure, which may affect the incidence of this complication.
MATERIAL AND METHODS
A total of 5,152 consecutive patients undergoing surgery with median sternotomy access in the Cardiac Surgery Department of the Pomeranian Medical University between 2010 and 2014 were included in the study. The analysis centered on cases of sternal dehiscence, which occurred in 45 patients (0.9%).
RESULTS
Factors such as age (p < 0.05), body mass (p < 0.005) and coronary artery bypass surgery (CABG) (p < 0.005) were found to be significant risk factors. Diabetes and chronic obstructive pulmonary disease (COPD) also had an impact on an increased risk of sternal dehiscence (p < 0.006 and p < 0.015). However, the differences were only significant in the whole study group. Apart from CABG, the type of operation did not affect the incidence of dehiscence. Logistic regression analysis found independent risk factors for the development of sternal dehiscence: body mass index (BMI) (odds ratio (OR): 2.1; p < 0.019), diabetes (OR: 2.4; p < 0.004), COPD (OR: 2.7; p < 0.016), and redo procedure (OR: 3.0; p < 0.014). There were no significant differences in postoperative mortality between these groups - 6.7% in the group with sternal dehiscence and 3.9% in the group without dehiscence.
CONCLUSIONS
Introducing a more durable sternum stabilization method with 8+ loops helped to improve conditions for bone union and reduced the risk of dehiscence. Therefore, we suggest that centers which still use 6-loop sternal closure should consider shifting to a stronger technique.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cardiac Surgical Procedures; Female; Humans; Incidence; Male; Middle Aged; Poland; Postoperative Complications; Retrospective Studies; Risk Factors; Sternotomy; Sternum; Surgical Wound Dehiscence; Treatment Outcome; Young Adult
PubMed: 30993919
DOI: 10.17219/acem/94154 -
Journal of Neurological Surgery. Part... Dec 2015The objective of this study was to evaluate the characteristic symptoms of and treatments for lateral semicircular canal dehiscence (LSCD) and posterior semicircular...
The objective of this study was to evaluate the characteristic symptoms of and treatments for lateral semicircular canal dehiscence (LSCD) and posterior semicircular canal dehiscence (PSCD) and its proposed mechanism. A dehiscence acquired in any of the semicircular canals may evoke various auditory symptoms (autophony and inner ear conductive hearing loss) or vestibular symptoms (vertigo, the Tullio phenomenon, and Hennebert sign) by creating a "third mobile window" in the bone that enables aberrant communication between the inner ear and nearby structures. A PubMed search was performed using the keywords lateral, posterior, and semicircular canal dehiscence to identify all relevant cases. Our data suggest that PSCD, although clinically rare, is most likely associated with a high-riding jugular bulb and fibrous dysplasia. Patients may experience auditory manifestations that range from mild conductive to extensive sensorineural hearing loss. LSCD is usually associated with chronic otitis media with cholesteatoma.
PubMed: 26682120
DOI: 10.1055/s-0035-1551667 -
Plant Methods Apr 2022From an economic perspective, cotton is one of the most important crops in the world. The fertility of male reproductive organs is a key determinant of cotton yield....
BACKGROUND
From an economic perspective, cotton is one of the most important crops in the world. The fertility of male reproductive organs is a key determinant of cotton yield. Anther dehiscence or indehiscence directly determines the probability of fertilization in cotton. Thus, rapid and accurate identification of cotton anther dehiscence status is important for judging anther growth status and promoting genetic breeding research. The development of computer vision technology and the advent of big data have prompted the application of deep learning techniques to agricultural phenotype research. Therefore, two deep learning models (Faster R-CNN and YOLOv5) were proposed to detect the number and dehiscence status of anthers.
RESULT
The single-stage model based on YOLOv5 has higher recognition speed and the ability to deploy to the mobile end. Breeding researchers can apply this model to terminals to achieve a more intuitive understanding of cotton anther dehiscence status. Moreover, three improvement strategies are proposed for the Faster R-CNN model, where the improved model has higher detection accuracy than the YOLOv5 model. We have made three improvements to the Faster R-CNN model and after the ensemble of the three models and original Faster R-CNN model, R of "open" reaches to 0.8765, R of "close" reaches to 0.8539, R of "all" reaches to 0.8481, higher than the prediction results of either model alone, which are completely able to replace the manual counting results. We can use this model to quickly extract the dehiscence rate of cotton anthers under high temperature (HT) conditions. In addition, the percentage of dehiscent anthers of 30 randomly selected cotton varieties were observed from the cotton population under normal conditions and HT conditions through the ensemble of the Faster R-CNN model and manual counting. The results show that HT decreased the percentage of dehiscent anthers in different cotton lines, consistent with the manual method.
CONCLUSIONS
Deep learning technology have been applied to cotton anther dehiscence status recognition instead of manual methods for the first time to quickly screen HT-tolerant cotton varieties. Deep learning can help to explore the key genetic improvement genes in the future, promoting cotton breeding and improvement.
PubMed: 35449108
DOI: 10.1186/s13007-022-00884-0 -
Journal of the American Veterinary... Sep 2019To report the intestinal incisional dehiscence rate following enterotomy for foreign body removal in dogs.
OBJECTIVE
To report the intestinal incisional dehiscence rate following enterotomy for foreign body removal in dogs.
ANIMALS
247 client-owned dogs with intestinal foreign bodies treated with enterotomy between November 2001 and September 2017.
PROCEDURES
Medical records were reviewed, and data were collected regarding signalment, history, surgery, clinicopathologic findings, hospitalization, intestinal incisional dehiscence, and survival to hospital discharge. Dogs were grouped according to whether intestinal incisional dehiscence occurred (dehiscence group) or did not occur (nondehiscence group) following enterotomy, and the rate of dehiscence for the total number of enterotomies during the study period was calculated. Univariable analysis was performed to identify variables associated with intestinal incisional dehiscence.
RESULTS
8 of the 247 (3.2%) dogs had preoperative septic peritonitis, and all 8 dogs survived to hospital discharge. Incisional dehiscence occurred following 5 of the 247 (2.0%) enterotomies, and only 2 dogs in the dehiscence group did not survive to hospital discharge. Duration of hospitalization was longer for dogs in the dehiscence group than for dogs in the nondehiscence group.
CONCLUSIONS AND CLINICAL RELEVANCE
Results indicated that enterotomy for intestinal foreign body removal had a lower rate of dehiscence in dogs during the study period, compared with rates previously reported; however, the low rate should not be used as a reason to perform an enterotomy rather than an enterectomy when needed. Surgeons should thoroughly evaluate the bowel and perform an enterotomy only when indicated.
Topics: Anastomosis, Surgical; Animals; Digestive System Surgical Procedures; Dog Diseases; Dogs; Foreign Bodies; Retrospective Studies
PubMed: 31478820
DOI: 10.2460/javma.255.6.695 -
Taiwan Journal of Ophthalmology 2020Penetrating keratoplasty (PKP) carries the risk of developing wound dehiscence, which can lead to vision loss. The main aim of this study is to analyze the management...
AIMS
Penetrating keratoplasty (PKP) carries the risk of developing wound dehiscence, which can lead to vision loss. The main aim of this study is to analyze the management and outcome of surgery for traumatic wound dehiscence occurring in patients who had PKP.
SUBJECTS AND METHODS
This retrospective study included post-PKP patients who sustained traumatic wound dehiscence at the Cornea Unit in Yemen Magrabi Eye Hospital between 2008 and 2016. Fifty-three eyes with a history of wound dehiscence were treated with primary wound closure. Patient files were reviewed for type and time of injury, distance visual acuity (VA), and outcome.
RESULTS
Ruptured globe with dehiscence of wound occurred on average 2.4 years (3 months to 13 years) after PKP. The mean age at wound dehiscence was 22.27 years and males accounted for 77.4% (41). All patients were managed with primary closure of the wound. Lensectomy of traumatic or dislocated lens was the most frequent additional surgical procedure (14, 26.4%), followed by anterior vitrectomy (6, 11.3%). In the end, 43 (81.1%) grafts remained clear. In the last follow-up, 34 eyes (64.1%) had best-corrected VA of 20/200 or better and two eyes had no perception of light.
CONCLUSION
Rupture globe and wound dehiscence occurs after PKP at the graft-host junction. Wound dehiscence is a lifelong risk after PKP and wound weakness persisted for a long period after PKP. Visual outcome and graft survival are generally poor after the injury, and the restoration of a satisfactory visual result is possible if treated early.
PubMed: 32309122
DOI: 10.4103/tjo.tjo_107_18 -
The Angle Orthodontist May 2016To evaluate the presence of dehiscence and fenestration defects around anterior teeth in the cleft region and to compare these findings with the noncleft side in the...
OBJECTIVE
To evaluate the presence of dehiscence and fenestration defects around anterior teeth in the cleft region and to compare these findings with the noncleft side in the same patients using cone beam computed tomography (CBCT).
MATERIALS AND METHODS
CBCT scans of 44 patients (26 males, 18 females; mean age, 14.04 ± 3.81 years) with unilateral cleft lip and palate (UCLP) were assessed to define dehiscences and fenestrations of the anterior teeth in both cleft and noncleft sides of the UCLP patients and a control group of noncleft patients (51 patients; 21 males, 30 females; mean age, 14.52 ± 1.16 years). Data were analyzed using Pearson's χ(2) and Student's t-test.
RESULTS
The prevalence of dehiscences at the maxillary central incisors, lateral incisors, and canines teeth were 43.2%, 70.6%, and 34.1% on the cleft side and 22.7%, 53.1%, and 27.3% on the noncleft side of UCLP patients, and 13.7%, 7.8%, and 13.7% in controls, respectively (statistically no difference between the sides of cleft patients). The cleft patients had a statistically significantly higher prevalence of dehiscences than did the controls on both the cleft and noncleft sides (P < .05), except for the maxillary central incisors. Fenestrations for these teeth were significantly more common on the cleft side in UCLP patients compared with controls (P < .05), whereas the difference for maxillary lateral incisors was not statistically significant.
CONCLUSIONS
Patients with UCLP showed a higher prevalence of dehiscence and fenestration defects around the maxillary anterior teeth.
Topics: Adolescent; Child; Cleft Lip; Cleft Palate; Cone-Beam Computed Tomography; Female; Humans; Male; Retrospective Studies
PubMed: 26284755
DOI: 10.2319/042715-289.1 -
Clinical Ophthalmology (Auckland, N.Z.) 2019To compare patient demographics, clinical associations and visual outcomes between traumatic and non-traumatic wound dehiscence, following corneal transplantation.
PURPOSE
To compare patient demographics, clinical associations and visual outcomes between traumatic and non-traumatic wound dehiscence, following corneal transplantation.
METHODS
Retrospective review of all patients presenting with post-keratoplasty wound dehiscence to the Royal Victorian Eye and Ear Hospital between January 2005 and December 2017. Patients with wound dehiscence following keratoplasty of any cause were included.
RESULTS
Of 71 eyes from 71 patients included, 60 (85%) were penetrating keratoplasty patients. The mean age was 56.4 years (SD=22.7, range 17.6-97) and 62% (n = 44) of patients were male. There were 28 (39%) cases of traumatic dehiscence and 43 (61%) cases of non-traumatic dehiscence. The median time interval from keratoplasty to dehiscence was significantly less in non-traumatic patients than traumatic patients (0.2 years, IQR 0.1-2.0 vs 2.3 years, IQR 0.3-14.8, p=0.01). There was no significant difference in best-corrected visual acuity at 6 months between traumatic and non-traumatic dehiscence (6/60 vs 6/36, p=0.62), suture technique (continuous vs interrupted, p=0.12), or graft type (penetrating keratoplasty vs deep anterior lamellar keratoplasty) after adjusting for keratoconus (p=0.41).
CONCLUSION
Post-keratoplasty wound dehiscence is a serious complication and can cause significant loss of vision. While the risk of dehiscence is lifelong, the first 3 years post-keratoplasty carry the highest risk, with non-traumatic dehiscence tending to occur earlier than traumatic dehiscence.
PubMed: 31819348
DOI: 10.2147/OPTH.S227631 -
GMS Ophthalmology Cases 2020Angioid streaks (AS) are irregular crack-like dehiscences in Bruch's membrane that are often associated with atrophic degeneration of the overlying retinal pigment...
Angioid streaks (AS) are irregular crack-like dehiscences in Bruch's membrane that are often associated with atrophic degeneration of the overlying retinal pigment epithelium. We herein report multimodal imaging of AS. Multicolor imaging highlighted AS in dark orange color. AS were better visualized in infrared reflectance as compared to green reflectance and blue reflectance. Peau d'orange appearance was seen as alternating dark and bright patches on color fundus photography with corresponding hyporeflective and hyperreflective patches on infrared reflectance. Comet lesions showed increased signal on infrared reflectance and hyperautofluorescence. Multicolor imaging is a non-invasive imaging modality which helps in clearly delineating these lesions.
PubMed: 32884892
DOI: 10.3205/oc000165 -
Journal of Clinical Medicine Oct 2023The clinical requirement for a good esthetic result for immediate implant placement is the absence of dehiscence in the anterior facial alveolar bone. In the presence of...
The clinical requirement for a good esthetic result for immediate implant placement is the absence of dehiscence in the anterior facial alveolar bone. In the presence of dehiscence, it is recommended to use a connective tissue graft in addition to immediate implant placement or to change to early implant placement. However, the literature focusing on dehiscence is scarce, and the influence of different placement times and combined use of connective tissue graft on postoperative esthetics in cases with dehiscence is unclear. Therefore, we quantitatively evaluated the pre-extraction dehiscence morphology and postoperative changes in the facial tissue of implants in three groups: immediate implant placement (Group I), immediate implant placement with connective tissue graft (Group IC), and early implant placement (Group E). To this end, 52 implants were obtained (20 in Group I, 16 in Group IC, and 16 in Group E). A wider dehiscence increases the risk of soft tissue regression, which was one reason for choosing early implant placement. A combination of immediate implant placement and connective tissue graft, or early implant placement, tended to result in less soft tissue regression due to the thicker postoperative facial soft tissue volume.
PubMed: 37892753
DOI: 10.3390/jcm12206616 -
International Archives of... Apr 2017Superior semicircular canal dehiscence syndrome was described by Minor et al in 1998. It is a troublesome syndrome that results in vertigo and oscillopsia induced by...
Superior semicircular canal dehiscence syndrome was described by Minor et al in 1998. It is a troublesome syndrome that results in vertigo and oscillopsia induced by loud sounds or changes in the pressure of the external auditory canal or middle ear. Patients may present with autophony, hyperacusis, pulsatile tinnitus and hearing loss. When symptoms are mild, they are usually managed conservatively, but surgical intervention may be needed for patients with debilitating symptoms. The aim of this manuscript is to review the different surgical techniques used to repair the superior semicircular canal dehiscence. PubMed and Ovid-SP databases. The different approaches are described and discussed, as well as their limitations. We also review the advantages and disadvantages of the plugging, capping and resurfacing techniques to repair the dehiscence. Each of the surgical approaches has advantages and disadvantages. The middle fossa approach gives a better view of the dehiscence, but comes with a higher morbidity than the transmastoid approach. Endoscopic assistance may be advantageous during the middle cranial fossa approach for better visualization. The plugging and capping techniques are associated with higher success rates than resurfacing, with no added risk of hearing loss.
PubMed: 28382131
DOI: 10.1055/s-0037-1599785