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Journal of Visualized Surgery 2018
PubMed: 29780729
DOI: 10.21037/jovs.2018.04.03 -
Acta Neurochirurgica Feb 2021CSF diversion with shunt placement is frequently associated with need for later revisions as well as surgical complications. We sought to review revision and...
BACKGROUND
CSF diversion with shunt placement is frequently associated with need for later revisions as well as surgical complications. We sought to review revision and complication rates following ventriculoperitoneal, ventriculoatrial and cystoperitoneal shunt placement in adult patients, and to identify potential risk factors for revision surgery and postoperative complications.
METHOD
Included patients were adults (≥ 18 years) who underwent primary shunt insertion at St. Olavs Hospital in Trondheim, Norway, from 2008 through 2017. The electronic medical records and diagnostic imaging from all hospitals in our catchment area were retrospectively reviewed. Follow-up ranged from 1 to 11 years. Complications were graded according to the Landriel Ibañez classification system.
RESULTS
Of the 227 patients included, 47 patients (20.7%) required revision surgery during the follow-up. In total, 90 revision surgeries were performed during follow-up. The most common cause for the first revision was infection (5.7%) and for all revisions proximal occlusion (30.0%). A total of 103 patients (45.4%) experienced ≥ 1 complication(s). Mild to moderate complications (grade I and II) were detected in 35.0% of all procedures. Severe or fatal complications (grade III and IV) were observed in 8.2% of all procedures. Urinary tract infections and pneumonia were common postoperatively (13.9% and 7.3%, respectively), and the most common IIb complication was shunt misplacement (proximally or distally). Two out of fourteen deaths within 30 days were directly associated with surgery. We did not find that aetiology/indication, age or gender influenced the occurrence of revision surgery or a grade III or IV complication.
CONCLUSIONS
Shunt surgery continues to be a challenge both in terms of revision rates and procedure-related complications. However, the prediction of patients at risk remains difficult. A multidimensional focus is probably needed to reduce risks.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Hydrocephalus; Male; Middle Aged; Norway; Postoperative Complications; Prostheses and Implants; Reoperation; Retrospective Studies; Risk Factors; Ventriculoperitoneal Shunt; Young Adult
PubMed: 33130985
DOI: 10.1007/s00701-020-04526-z -
Developmental Biology Aug 2018Defects in choroid fissure (CF) formation and closure lead to coloboma, a major cause of childhood blindness. Despite genetic advances, the cellular defects underlying...
Defects in choroid fissure (CF) formation and closure lead to coloboma, a major cause of childhood blindness. Despite genetic advances, the cellular defects underlying coloboma remain poorly elucidated due to our limited understanding of normal CF morphogenesis. We address this deficit by conducting high-resolution spatio-temporal analyses of CF formation and closure in the chick, mouse and fish. We show that a small ventral midline invagination initiates CF formation in the medial-proximal optic cup, subsequently extending it dorsally toward the lens, and proximally into the optic stalk. Unlike previously supposed, the optic disc does not form solely as a result of this invagination. Morphogenetic events that alter the shape of the proximal optic cup also direct clusters of outer layer and optic stalk cells to form dorsal optic disc. A cross-species comparison suggests that CF closure can be accomplished by breaking down basement membranes (BM) along the CF margins, and by establishing BM continuity along the dorsal and ventral surfaces of the CF. CF closure is subsequently accomplished via two distinct mechanisms: tissue fusion or the intercalation of various tissues into the inter-CF space. We identify several novel cell behaviors that underlie CF fusion, many of which involve remodeling of the retinal epithelium. In addition to BM disruption, these include NCAD downregulation along the SOX2 retinal CF margin, and the protrusion or movement of partially polarized retinal cells into the inter-CF space to mediate fusion. Proximally, the inter-CF space does not fuse or narrow and is instead loosely packed with migrating SOX2/PAX2/Vimentin astrocytes until it is closed by the outgoing optic nerve. Taken together, our results highlight distinct proximal-distal differences in CF morphogenesis and closure and establish detailed cellular models that can be utilized for understanding the genetic bases of coloboma.
Topics: Animals; Chick Embryo; Choroid; Coloboma; Eye; Mice; Morphogenesis; Optic Disk; Retina; Spatio-Temporal Analysis; Zebrafish
PubMed: 29803644
DOI: 10.1016/j.ydbio.2018.05.010 -
Mechanisms of Development Nov 2015The zebrafish pronephric tubule consists of proximal and distal segments and a collecting duct. The proximal segment is subdivided into the neck, proximal convoluted...
The zebrafish pronephric tubule consists of proximal and distal segments and a collecting duct. The proximal segment is subdivided into the neck, proximal convoluted tubule (PCT) and proximal straight tubule (PST) segments. The distal segment consists of the distal-early (DE) and distal-late (DL) segments. How the proximal and distal segments develop along the anteroposterior axis is poorly understood. Here we show that knockdown of taz in zebrafish caused shortening and a significant reduction in the number of principal cells of the PST-DE segment, and proximalization of the pronephric tubule in 24 hpf embryos. RA treatment expanded the pronephric proximal domain in normal embryos as in taz morphants, an effect that was further enhanced upon exposure of taz morphants to RA. The early pronephric defects in 24 hpf taz morphants led to the failure of anterior pronephric tubule migration and convolution, and to PCT dilation and cyst formation in older embryos. In situ hybridization showed weak and transient expression of taz at the bud stage in the intermediate mesoderm, the source of pronephric progenitors. The present findings show that Taz is required in the anteroposterior patterning of the pronephric progenitor domain in the intermediate mesoderm, acting in part by regulating RA signaling in the pronephric progenitor field in the intermediate mesoderm.
Topics: Animals; Animals, Genetically Modified; Body Patterning; Cell Count; Gene Expression Regulation, Developmental; Gene Knockdown Techniques; Intracellular Signaling Peptides and Proteins; Kidney Tubules; Mesoderm; Pronephros; Transcriptional Coactivator with PDZ-Binding Motif Proteins; Tretinoin; Zebrafish; Zebrafish Proteins
PubMed: 26248207
DOI: 10.1016/j.mod.2015.08.001 -
Transcription 2018The release of a paused Pol II depends on the recruitment of P-TEFb. Recent studies showed that both active P-TEFb and inactive P-TEFb (7SK snRNP) can be recruited to... (Review)
Review
The release of a paused Pol II depends on the recruitment of P-TEFb. Recent studies showed that both active P-TEFb and inactive P-TEFb (7SK snRNP) can be recruited to the promoter regions of global genes by different mechanisms. Here, we summarize the recent advances on these distinct recruitment mechanisms.
Topics: Animals; Gene Expression Regulation; Humans; Positive Transcriptional Elongation Factor B; Promoter Regions, Genetic; RNA Polymerase II; Signal Transduction
PubMed: 28102758
DOI: 10.1080/21541264.2017.1281864 -
Frontiers in Cell and Developmental... 2022Reactive oxygen species (ROS) represent molecules of great interest in the field of regenerative biology since several animal models require their production to promote...
Reactive oxygen species (ROS) represent molecules of great interest in the field of regenerative biology since several animal models require their production to promote and favor tissue, organ, and appendage regeneration. Recently, it has been shown that the production of ROS such as hydrogen peroxide (HO) is required for tail regeneration in . However, to date, it is unknown whether ROS production is necessary for limb regeneration in this animal model. Methods: forelimbs of juvenile animals were amputated proximally and the dynamics of ROS production was determined using 2'7- dichlorofluorescein diacetate (DCFDA) during the regeneration process. Inhibition of ROS production was performed using the NADPH oxidase inhibitor apocynin. Subsequently, a rescue assay was performed using exogenous hydrogen peroxide (HO). The effect of these treatments on the size and skeletal structures of the regenerated limb was evaluated by staining with alcian blue and alizarin red, as well as the effect on blastema formation, cell proliferation, immune cell recruitment, and expression of genes related to proximal-distal identity. Results: our results show that inhibition of post-amputation limb ROS production in the salamander model results in the regeneration of a miniature limb with a significant reduction in the size of skeletal elements such as the ulna, radius, and overall autopod. Additionally, other effects such as decrease in the number of carpals, defective joint morphology, and failure of integrity between the regenerated structure and the remaining tissue were identified. In addition, this treatment affected blastema formation and induced a reduction in the levels of cell proliferation in this structure, as well as a reduction in the number of CD45 and CD11b + immune system cells. On the other hand, blocking ROS production affected the expression of proximo-distal identity genes such as , , , , and other genes such as and in early/mid blastema. Of great interest, the failure in blastema formation, skeletal alterations, as well as the expression of the genes evaluated were rescued by the application of exogenous HO, suggesting that ROS/HO production is necessary from the early stages for proper regeneration and patterning of the limb.
PubMed: 36092695
DOI: 10.3389/fcell.2022.921520 -
JBJS Essential Surgical Techniques 2020Most pediatric tibial shaft fractures (75%) can be treated nonoperatively; however, unstable and open fractures require surgical intervention. Titanium elastic nails...
BACKGROUND
Most pediatric tibial shaft fractures (75%) can be treated nonoperatively; however, unstable and open fractures require surgical intervention. Titanium elastic nails have become a popular technique for fixation of pediatric tibial shaft fractures. They act as internal splints that impart relative stability to the fracture, promoting callus formation at the fracture site.
DESCRIPTION
After the patient is placed in the supine position, the proximal tibial physis is marked using fluoroscopy. An anteromedial and anterolateral incision are made distal to the physis. Entry holes are created in the proximal part of the tibia, and appropriately sized titanium nails are introduced into the bone. Nail size should be 40% of the width of the canal, yielding 80% canal fill when 2 nails are used. The nails are prebent into a gentle C-shape to increase cortical contact at the apex so that 3-point fixation is achieved. The nails are passed to the fracture site, and the fracture is then reduced. The nails are then passed across the fracture site and stopped proximal to the distal tibial physis. The nails are then cut and tamped distally until there is just a short portion of nail left out of the proximal part of the tibia so that the nails can be removed once the fracture is healed. The wounds are then closed, and postoperative immobilization is applied.
ALTERNATIVES
Many pediatric tibial shaft fractures can be treated with closed reduction and cast immobilization. Open fractures, or fractures that fail nonoperative management, can be treated with external fixation, open reduction and internal fixation (ORIF), or intramedullary stabilization.
RATIONALE
Anatomic reduction and fracture compression can be achieved with ORIF; however, a drawback to this technique is the lack of soft-tissue coverage in the diaphyseal area of the tibia, which can lead to infection and wound-healing problems. External fixation has traditionally been the technique of choice for open tibial fractures; however, with the ability to use flexible tibial nails in both open and closed tibial fractures, external fixation is now reserved for open fractures with large soft-tissue defects or in fractures with segmental bone loss. Intramedullary flexible nailing can be used in both open and closed tibial fractures, provides excellent fracture fixation, and utilizes incisions that are more cosmetically appealing to patients.
EXPECTED OUTCOMES
Outcomes following flexible nailing for pediatric tibial fractures are excellent. In a study of 19 patients undergoing flexible nailing for tibial shaft fractures, 18 had excellent or satisfactory results. Compared with patients who had external fixation, those treated with flexible nails had less pain, shorter time to union, and better functional outcomes. Compared with patients treated with ORIF, those who underwent flexible intramedullary nailing spent less time in the operating room and had lower rates of wound complications. In the immediate postoperative period, clinicians should be aware of the risk of compartment syndrome, particularly in patients with high-energy injuries, older patients (>14 years old), and heavier patients (>50 kg). There is also an increased risk of soft-tissue irritation and fracture malunion in heavier patients treated with flexible nails.
IMPORTANT TIPS
Nail size should be 80% of the canal diameter (e.g., two 4.0-mm nails should be chosen for a canal that measures 10 mm).Nails should be properly contoured to avoid corticotomy of the far cortex during insertion; apex of the bend should be positioned at the level of the fracture.During insertion, leave room to advance nails further after they are cut proximally.Do not bury the proximal nail tips beneath the cortex as extraction will be difficult.Ensure that the ends of the nails are not lying up against the proximal tibial physis as this may cause premature growth arrest.
PubMed: 34055469
DOI: 10.2106/JBJS.ST.19.00063 -
Trauma Monthly Nov 2014Endoscopic carpal tunnel release (ECTR) has gained recognition as an alternative to the current gold standard, the open carpal tunnel release (OCTR). Detailed technical...
BACKGROUND
Endoscopic carpal tunnel release (ECTR) has gained recognition as an alternative to the current gold standard, the open carpal tunnel release (OCTR). Detailed technical points for the ECTR have not been explained in the literature, especially for surgeons who are considering trying this technique.
OBJECTIVES
In this paper, we present our 5-year experience with the ECTR and special emphasis will be placed on less frequently discussed technical points, such as the optimal site to make the skin incision and the signs to look for in a completely divided retinaculum.
PATIENTS AND METHODS
In this prospective nonrandomized clinical trial, 176 patients with carpal tunnel syndrome who underwent surgical operation using the Agee uni-portal endoscopic carpal tunnel release technique, over a period of 5 years, were included. The "Hand Questionnaire", a standard questionnaire for hand surgery, was used to evaluate the patients at one, three, six and twelve month post-operative time points. Pain and scar tenderness were measured using the visual analog scale system. We propose the 'most proximally present wrist crease' for the skin incision and the 'proximal to distal sequential division of the retinaculum' as our methods of choice. Two signs, named 'railroad' and 'drop in', are proposed and these will be discussed in detail as hallmarks of complete retinaculum release.
RESULTS
Of the 176 patients who underwent the ECTR operation, 164 cases (93.2%) had no or very little pain at the one year postoperative visit, and nearly all of the patients reported no relapse of symptoms at the previously mentioned postoperative time points. Patient satisfaction and functional recovery was comparable to other published ECTR studies, and showed better short-term results of this technique over the OCTR. One deep seated infection, three cases of transient index finger paresthesia due to scope pressure on the median nerve, and one case of median nerve branch transection, were observed. Scar complications, including; tenderness, redness and pain, were significantly lower in the proximally placed incision in comparison with the distally placed incision (P < 0.005).
CONCLUSIONS
The 'most proximally present wrist crease' and the 'distal to proximal division of the retinaculum' using the two signs of 'railroad' and 'drop in' to confirm a complete division of retinaculum are proposed techniques that should be considered in order to produce good outcomes in ECTR. The 'railroad' sign is the parallel standing of the retinaculum edges, and the 'drop in' sign is the dropping of the retinaculum edge into the scope denote a completely divided retinaculum.
PubMed: 25717450
DOI: 10.5812/traumamon.18058 -
Journal of Plastic Surgery and Hand... 2023Soft tissue defects around the ankle are common and must be covered with thin and pliable flaps. A regional flap, particularly from the dorsum of the foot was considered...
Soft tissue defects around the ankle are common and must be covered with thin and pliable flaps. A regional flap, particularly from the dorsum of the foot was considered ideal. A neurocutaneous flap, based on the superficial peroneal nerve (SPN) and its branches was designed as a proximally based flap cadaveric dissection. This study aimed to demonstrate the vascularity and characteristics of the superficial peroneal neurocutaneous (SPNC) flap. The SPNC flap was created in 11 lower limbs (seven cadavers) using a proximally based design. The skin flap was dissected at the dorsum of the foot, followed by injection of diluted methylene blue through the anterior tibial artery, to visualize the vascularity. The flap pedicle above the anterior ankle joint line was dissected along the SPN for anatomical study of perforating branches, paraneural vessels, and flap territory. The mean distances of the most proximal perforating branches were 1.51 ± 1.48 cm from the anterior ankle joint line, and 5.12 ± 1.78 cm from the lateral malleolus. The mean distances of the most distal perforating branches were 2.75 ± 1.54 cm from the anterior ankle joint line, and 5.90 ± 1.81 cm from the lateral malleolus. The mean number of perforating branches was 3.73 ± 1.49. The mean flap territories were 5.51 ± 0.59 cm in length, and 7.15 ± 0.64 cm in width. The SPNC flap is an alternative method for soft tissue reconstruction around the ankle with a proximally based flap design. The antegrade flow has been shown to offer effective vascularity in flaps prepared cadaveric dissection.
Topics: Humans; Plastic Surgery Procedures; Skin Transplantation; Soft Tissue Injuries; Surgical Flaps; Cadaver
PubMed: 36661749
DOI: 10.1080/2000656X.2023.2168273 -
Journal of Orthopaedic Surgery and... Jan 2015Concurrent ipsilateral fractures of the proximal and shaft of the femur are rare complex fracture combinations. In this prospective cohort study, we evaluated clinical... (Comparative Study)
Comparative Study
BACKGROUND
Concurrent ipsilateral fractures of the proximal and shaft of the femur are rare complex fracture combinations. In this prospective cohort study, we evaluated clinical and radiological long-term results after operative treatment using several surgical strategies: the so-called "rendezvous" surgical technique, e.g., the combination of retrograde intramedullary nailing and dynamic hip screw (DHS) osteosynthesis, or the all-in-one device technique, e.g., long cephalomedullary nail, compared with two non-overlapping implants (e.g., conventional technique).
METHODS
In a 10-year-period from 2004 to 2013, we treated 65 patients with complex ipsilateral multi-level femoral fractures. Median age was 45 years (range 19-90 years). Fractures were classified according to the AO/OTA classification. Four patients died during intensive care unit treatment due to multi-organ failure prior to definitive osteosynthesis. Clinical long-term outcome using the functional system of Friedman/Wyman as well as radiological outcome was evaluated 2 years after trauma (range 13-42 months).
RESULTS
All-in-one device was used in 36 patients, "rendezvous" technique in 9 patients, and the conventional technique in the remaining 16 patients. Two years after trauma, complete fracture healing was found in 57 out of 61 patients ("rendezvous": 9, all-in-one device: 33, conventional: 15; p-value: 0.66). There was no significant difference regarding the complication rate in the cohort groups ("rendezvous": 3, all-in-one device: 13, conventional: 5; p-value: 0.94). Using the functional assessment system of Friedman/Wyman 2 years after trauma, a good clinical result was found in 77.7% in the "rendezvous" group, in 77.8% in the all-in-one device group, and in 75% in the conventional group.
CONCLUSION
The indication for operative stabilization of ipsilateral multi-level femoral fractures is considered an urgent and emergency procedure. Based on the successful long-term results of this study, we prefer the "rendezvous" technique with fracture stabilization from distally to proximally. Both fracture components require stable fixation. It is advisable to stabilize the shaft fracture primarily using external fixation (damage control orthopedics) and the proximal femoral fracture using early definitive internal fixation. In a second and staged operation, the external fixator is removed and the shaft fracture is stabilized using retrograde nail osteosynthesis with overlapping of the DHS and nail implants.
Topics: Adult; Aged; Aged, 80 and over; Female; Femoral Fractures; Fracture Fixation, Intramedullary; Fractures, Multiple; Humans; Male; Middle Aged; Prospective Studies; Young Adult
PubMed: 25616698
DOI: 10.1186/s13018-014-0149-5