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Journal of Vascular Surgery. Venous and... May 2024Venous stents are a common treatment modality for obstructive venous disease. Venous stents differentiate themselves by either a woven or braided structure, open or...
OBJECTIVE
Venous stents are a common treatment modality for obstructive venous disease. Venous stents differentiate themselves by either a woven or braided structure, open or closed cell arrangement or based on material composition (elgiloy vs nitinol). Changes in the morphology of venous stents over time may contribute to restenosis or thrombosis. Woven elgiloy stents are prone to proximal and distal edge deformation compared with dedicated venous stents, which offer increased radial force at stent edges. The objective of this study is to describe luminal morphological changes among various venous stents and between woven to nonwoven venous stent configuration, over time.
METHODS
A retrospective review at a single institution between January 2014 and June 2021 identified patients treated with venous stents. Patients with iliac and/or femoral venous stents with intraoperative intravascular ultrasound and a postoperative computed tomography scan were included in the study. Cross-sectional diameters measurements were taken at proximal, middle, and distal portions of each stent from intravascular ultrasound examination at the time of initial stenting and compared with the cross-sectional diameter measurements taken from computed tomography imaging at follow-up. A paired t test was used to compare the luminal change with a D'Agostino-Pearson test used for normality.
RESULTS
Fifty-four stents distributed among 38 patients were identified. The mean time to follow-up was 17.5 months. Stents were placed in the common iliac vein (n = 37, 68.5%), external iliac vein (n = 14, 25.9%), and common femoral vein (n = 3, 5.6%). Implanted stents included the Boston Scientific Wallstent (n = 23, 42.6%), Bard Venovo (n = 3, 5.6%), Boston Scientific Vici (n = 23, 42.6%), and Medtronic Abre (n = 5, 9.3%). The mean luminal loss was measured at 2.12 mm proximally (95% confidence interval [CI], 1.64-2.60; P<.001), 1.29 mm at the mid-stent (95% CI, 0.83-1.74, P<.001), and 1.56 mm distally (95% CI, 0.99-2.12; P<.001). There was no significant difference in luminal changes between woven and nonwoven stents at proximal (P = .374), middle (P = .179), and distal (P = .609) stent measurements.
CONCLUSIONS
This study reports morphological changes within venous stents and between woven and nonwoven venous stents. Our findings demonstrate that the edge-stent luminal decrease traditionally attributed to woven configurations also occurs with the newer nonwoven stents. Additional factors such as anatomical location, pelvic curvature, and other external forces may be accountable for this change rather than geometrical configuration of the stent.
PubMed: 38777041
DOI: 10.1016/j.jvsv.2024.101893 -
La Pediatria Medica E Chirurgica :... Jun 2017The aim of this study was to verify the validity, feasibility, and the functional results, by uroflowmetry, of Tubularized proximallyincised plate technique in selected...
The aim of this study was to verify the validity, feasibility, and the functional results, by uroflowmetry, of Tubularized proximallyincised plate technique in selected case of distal/midshaft hypospadias. Out of 120 patients scheduled to undergo TIP (or Snodgrass) procedure, 23 were selected between January 2013 and January 2016 (19.1%). This case series comprised 16 patients with distal and 7 with midshaft hypospadias. Mean age at surgery was 2.9 years. The inclusion criteria were a deep and wide glandular groove and a proximal narrow urethral plate. The procedure was carried out as described by Snodgrass but the incision of the urethral plate, including the mucosal and submucosal tissue, was made only proximally, between the original meatus and the glandular groove in no case extending to the entire length of the plate. Postoperatively a foley catheter was left in place from 4 to 7 days. Uroflowmetry was performed when the patients age ranged from 2.5 to 5.7 years (mean age 3.11 years and mean follow-up 1.8 years, body surface 2). No patient presented fistulas nor perioperative complications. At uroflowmetry, eighteen patients presented values above the 25th percentile and 5 showed a borderline flow. All patients in this group remained stable without urinary symptoms. In selected cases, the tubularized proximally-incised plate yields satisfactory cosmetic and functional results for the treatment of midshaft proximal hypospadias. A long-term follow-up study is needed for further evaluation. Patient selection is crucial for the success of this technique.
Topics: Child, Preschool; Follow-Up Studies; Humans; Hypospadias; Infant; Male; Patient Selection; Treatment Outcome; Urethra; Urinary Catheterization; Urogenital Surgical Procedures
PubMed: 28673072
DOI: 10.4081/pmc.2017.151 -
Journal of Orthopaedics 2020There are two main accepted reasons of Proximal junctional kyphosis (PJK) after Scheuermann's kyphosis treatment; overcorrection of initial curve and fusion that is too... (Review)
Review
INTRODUCTION
There are two main accepted reasons of Proximal junctional kyphosis (PJK) after Scheuermann's kyphosis treatment; overcorrection of initial curve and fusion that is too short proximally. The purpose of this study was to evaluate the incidence of PJK in patients who have been previously treated for Schuermann's kyphosis with a curve exceeding 70° and corrected under 40° according to proximal fusion level T2 or T3.
METHODS
We retrospectively evaluated 30 patients treated for Schuermann's kyphosis with single stage posterior only procedure. We included patients that we achieved at least 50% correction of the initial curve. The surgeries were performed at the same institution by a single senior spinal surgeon. Patients were divided into two groups according to proximal fusion level T2 (16 patients) or T3 (14 patients) and evaluated for PJK, follow-ups ended three years after surgery.
RESULTS
Mean age was 22.7 in T2 and 21.6 years in T3 group. Mean preoperative Cobb angle was 78° in T2 and 78.7° in T3 group. The mean postoperative Cobb angle was 33.2° in T2 and 35° in T3 group. None of the patients showed neurologic complications. Four patients had PJK in T3 group and one needed revision.
CONCLUSIONS
Selecting T2 as the proximal fusion level in Schuermann's kyphosis may decrease the incidence of PKJ. Studies with a larger number of patients needed to verify our results.
PubMed: 32764858
DOI: 10.1016/j.jor.2020.06.016 -
The Indian Journal of Radiology &... Sep 2022Migration of the stent-graft post-thoracic endovascular aortic repair (TEVAR) is not uncommon; however, it is sparsely reported. The objective of this study was to...
Migration of the stent-graft post-thoracic endovascular aortic repair (TEVAR) is not uncommon; however, it is sparsely reported. The objective of this study was to assess the incidence, risk factors, and complications of stent-graft migration post-TEVAR. Thirty-one patients who underwent TEVAR were retrospectively analyzed. The demographic, anatomical, and procedure-related factors were assessed. The measurements were done along the greater curvature of aorta around two fixed anatomic landmarks, that is, left common carotid artery or neoinnominate artery (hybrid repair) proximally and celiac artery distally. Aortic elongation and migration at proximal, distal, as well as at overlapping zone were measured. More than 10 mm of migration was considered significant. Significant migration was observed in six (19%) patients. No significant migration was observed in the overlapping zone. The proximal landing zone 3 (odds ratio [OR] 12.78, 0.01) was a significant risk factor, whereas landing zone 2 was a protective factor against the migration (OR 0.08, 0.02). The odds for migration were more in segments I/3 and II/3 compared with I/2 and II/2, respectively, as per Modified Arch Landing Areas Nomenclature. A single complication was seen in the migration group which was treated by an overlapping stent graft. The stent-graft migration after TEVAR is not uncommon. Type 3 proximal landing zone was a significant risk factor for migration with an increased risk toward I/3 and II/3. Proximal landing zone 2 as well as adequate overlapping distance in multiple stent grafts can prevent migration. IECPG-227/24.06.2020.
PubMed: 36177280
DOI: 10.1055/s-0042-1754317 -
Clinical Anatomy (New York, N.Y.) Jul 2021Congenital tracheal anomalies are associated with high morbidity and mortality. The etiology of congenital tracheal anomalies is not well understood, but often...
INTRODUCTION
Congenital tracheal anomalies are associated with high morbidity and mortality. The etiology of congenital tracheal anomalies is not well understood, but often attributed to malformed tracheal cartilage. The development of tracheal cartilage has not been described in detail. In this study, we aimed to investigate the development pattern and timing of normal tracheal cartilage to better understand the etiology of tracheal anomalies.
MATERIALS AND METHODS
The development of tracheal cartilage was examined by studying the trachea in histological sections of 14 healthy human embryos from the Carnegie collection. Two specimens for Carnegie Stages 17-23 (42-60 days of embryological development) were studied.
RESULTS
At Carnegie Stages 17-19 (42-51 days), a continuous mesenchymal condensation was observed ventral to the tracheal lumen. At Stages 20 and 21 (51-54 days), this pre-tracheal mesenchyme showed sites of increased condensation indicative of future tracheal rings. Furthermore, growth centers were identified both proximally and distally in the trachea. Characteristic horseshoe shaped tracheal rings were apparent at Carnegie Stages 22 and 23 (54-60 days).
CONCLUSIONS
In human embryos, tracheal rings arise from growth centers in the ventral mesenchyme at approximately 51-54 days of embryological development. The observation of proximal and distal growth centers suggests a centripetal growth gradient, potentially contributing to occurrence of complete tracheal ring deformity (CTRD). Although this study shows new insights on tracheal cartilage development, the exact origin of congenital tracheal defects has yet to be elucidated.
Topics: Cartilage; Humans; Trachea
PubMed: 32986245
DOI: 10.1002/ca.23688 -
Injury Mar 2018In locked plate fixation of proximal humerus fractures, the calcar is an important anchor point for screws providing much-needed medial column support. Most locking...
INTRODUCTION
In locked plate fixation of proximal humerus fractures, the calcar is an important anchor point for screws providing much-needed medial column support. Most locking plate implants utilize a fixed-trajectory locking screw to achieve this goal. Consequently, adjustments of plate location to account for patient-specific anatomy may result in a screw position outside of the calcar. To date, little is known about the consequences of "missing" the calcar during plate positioning. This study sought to characterize the biomechanics associated with proximal and distal placement of locking plates in a two-part fracture model.
MATERIALS AND METHODS
This experiment was performed twice, first with elderly cadaveric specimens and again with osteoporotic sawbones. Two-part fractures were simulated and specimens were divided to represent proximal, neutral, and distal plate placements. Non-destructive torsional and axial compression tests were performed prior to an axial fatigue test and a ramp to failure. Torsional stiffness, axial stiffness, humeral head displacement and stiffness during fatigue testing, and ultimate load were compared between groups.
RESULTS
Cadavers: Proximal implant placement led to trends of decreased mechanical properties, but there were no significant differences found between groups. Sawbones: Distal placement increased torsional stiffness in both directions (p = 0.003, p = 0.034) and axial stiffness (p = 0.018) when compared to proximal placement. Distal placement also increased torsional stiffness in external rotation (p = 0.020), increased axial stiffness (p = 0.024), decreased humeral head displacement during fatigue testing, and increased stiffness during fatigue testing when compared to neutral placement.
DISCUSSION
The distal and neutral groups had similar mechanical properties in many cadaveric comparisons while the proximal group trended towards decreased construct stiffness.
RESULTS
from the Sawbones model were more definitive and provided further evidence that proximal calcar screw placements are undesirable and distal implant placement may provide improved construct stability.
CONCLUSION
Successful proximal humerus fracture reconstruction is inherent upon anatomic fracture reduction coupled with medial column support. Results from this experiment suggest that missing the calcar proximally is deleterious to fixation strength, while it is safe, and perhaps even desirable, to aim slightly distal to the intended target.
Topics: Aged; Aged, 80 and over; Biomechanical Phenomena; Bone Density; Bone Plates; Bone Screws; Bone Substitutes; Cadaver; Finite Element Analysis; Fracture Fixation, Internal; Humans; Materials Testing; Shoulder Fractures; Stress, Mechanical
PubMed: 29452734
DOI: 10.1016/j.injury.2018.02.007 -
American Journal of Preventive Medicine Sep 2014Suicide and suicidal behaviors are complex, heterogeneous phenomena that are thought to result from the interactions among distal factors increasing predisposition and...
Suicide and suicidal behaviors are complex, heterogeneous phenomena that are thought to result from the interactions among distal factors increasing predisposition and proximal factors acting as precipitants. Epigenetic factors are likely to act both distally and proximally. Aspirational Goal 1 aims to find clear targets for suicide and suicidal behavior intervention through greater understanding of the interplay among the biological, psychological, and social risk and protective factors associated with suicide. This paper discusses Aspirational Goal 1, focusing on the research pathway related to epigenetics, suicide, and suicidal behaviors. Current knowledge on epigenetic factors associated with suicide and suicidal behaviors is reviewed and avenues for future research are discussed. Epigenetic factors are a promising area of further investigation in the understanding of suicide and suicidal behaviors and may hold clues to identifying targets or avenues for intervention.
Topics: Animals; Epigenesis, Genetic; Humans; Research; Risk Factors; Suicidal Ideation; Suicide
PubMed: 25145732
DOI: 10.1016/j.amepre.2014.06.011 -
Journal of Adolescence Oct 2022Peer sexual harassment is associated with adolescent substance use at the global level; however, it is unknown whether substance use occurs proximal in time to the...
INTRODUCTION
Peer sexual harassment is associated with adolescent substance use at the global level; however, it is unknown whether substance use occurs proximal in time to the sexual harassment experience. This study used daily reports to examine the proximal relations between sexual harassment victimization and affect and substance use. Based on theories of self-medication, we hypothesized that negative affect and substance use (cigarettes, electronic cigarettes, alcohol, and marijuana) would be higher than typical on days when sexual harassment occurred relative to nonvictimization days.
METHOD
A community sample of 13-16-year-old adolescents (N = 204, 55.4% female) from a metropolitan area in the northeastern United States completed 56 days of online reports assessing experiences with peer sexual harassment, substance use (cigarettes, electronic cigarettes, alcohol, and marijuana), and positive and negative affect.
RESULTS
Multilevel modeling revealed that experiencing sexual harassment on a given day was associated with higher than typical negative affect on that day, relative to nonvictimization days. The likelihood of cigarette and alcohol use (but not electronic cigarettes, marijuana, or positive affect) was greater on days when sexual harassment occurred.
CONCLUSION
Sexual harassment victimization is proximally associated with negative affect and alcohol and cigarette use, suggesting that adolescents may be using substances to cope with sexual harassment victimization. The co-occurrence of sexual harassment with negative affect and substance use points to the need for prevention efforts that conjointly address sexual harassment victimization, coping, and substance use.
Topics: Adolescent; Bullying; Crime Victims; Female; Humans; Male; Peer Group; Sexual Harassment; Substance-Related Disorders
PubMed: 35861282
DOI: 10.1002/jad.12076 -
JBJS Essential Surgical Techniques Sep 2017The supercapsular percutaneously assisted total hip (SuperPath; MicroPort) approach is a direct superior portal-assisted approach for total hip arthroplasty (THA) that...
The supercapsular percutaneously assisted total hip (SuperPath; MicroPort) approach is a direct superior portal-assisted approach for total hip arthroplasty (THA) that utilizes the interval between the gluteus minimus and the piriformis to access the hip capsule. The technique was developed to promote early mobilization, greater range of motion, and improved pain control. The major steps of this procedure are as follows: Step 1: Patient positioning. The patient is in the standard lateral decubitus position with the involved leg in the "home position," that is, 45° to 60° of flexion, 20° to 30° of internal rotation, and slight adduction by elevating the foot on a padded Mayo stand. Step 2: Surgical exposure. A skin incision is made from the tip of the greater trochanter 6 to 8 cm proximally in line with the femur in the home position, the gluteus maximus muscle is split by blunt dissection in line with the fibers, and the gluteus medius and minimus are retracted anteriorly and the piriformis tendon is retracted posteriorly to access to the capsule without dissecting any muscles. Step 3: Capsular incision. The capsule is incised along the path of the skin incision from the saddle of the femoral neck to 1 cm proximal to the acetabular rim. Step 4: Femoral preparation. A channel is created in the superior aspect of the femoral neck from the femoral canal to the center of the femoral head, using reamers, a round osteotome, and a curet. Step 5: Femoral broaching. Sequential femoral broaches are then used to complete the preparation and size the proximal femoral canal while the head and neck remain intact. Step 6: Neck resection. The femoral neck osteotomy is performed level with the broach neck, and Schanz pins are used to rupture the ligamentum teres and remove the femoral head. Step 7: Acetabular preparation and placement. Acetabular preparation and cup impaction are done through a portal without needing release of the iliotibial band or remaining external rotators. A sharp Romanelli self-retaining retractor (Innomed) and modified Zelpi self-retaining retractor (Life Instruments) are used. Step 8: Trial reduction. Trial reduction is completed using a bone hook and a T-handle to gently manipulate the femur. Step 9: Final implant assembly. Liner impaction is completed through the portal, and the remaining components are implanted. Step 10: Closure. Closure is limited to the capsule, fat, and skin, since no muscles are dissected during this procedure. A recent multicenter study describing nearly 500 SuperPath THAs noted a 30-day all-cause readmission rate of 2.3% and a transfusion rate of 3.3%. The average length of stay was 1.6 days, with 91% of patients discharged home; 4.1%, to skilled nursing facilities; 3.8%, to home care; and 0.6%, to inpatient physical therapy facilities.
PubMed: 30233958
DOI: 10.2106/JBJS.ST.16.00061 -
United European Gastroenterology Journal Jun 2017The primary objective of this study was to assess proximal disease extension of ulcerative colitis (UC) over time, with disease behaviour pattern and risk factors for...
OBJECTIVE
The primary objective of this study was to assess proximal disease extension of ulcerative colitis (UC) over time, with disease behaviour pattern and risk factors for proximal disease extension and colectomy as secondary aims.
METHODS
All cumulative incident cases diagnosed with UC at the Academic Medical Center between January 1990 and December 2009 were studied. The cumulative risk of colectomy was calculated by Kaplan-Meier analysis. The Cox proportional hazards regression was used to identify risk factors associated with proximal disease extension and colectomy.
RESULTS
In total, 506 UC patients were included with a median age of 33 years (IQR 23-41) at diagnosis. Ninety-five (18.8%) patients underwent colectomy during follow-up. Median follow-up was 10 years (IQR 5-15). Initial disease extent was evaluable in 416 patients, of whom 142 (34.1%) had proctitis, 155 (37.3%) left-sided colitis and 119 (28.6%) pancolitis. Proximal disease extension was observed in 120 (28.8%) patients during follow-up (51 proctitis to left-sided colitis, 39 proctitis to extensive colitis and 30 left-sided to extensive colitis). Disease behaviour was evaluable in 378 patients, of whom 244 (64.6%) had less than one relapse per year. Younger age at diagnosis (HR 0.98, 95% CI 0.96-0.99) and continuous active disease (HR 2.18, 95% CI 1.27-3.73) were independent risk factors for proximal disease extension. The cumulative risk of colectomy did not change over time between patients diagnosed before and after the year 2000 ( = 0.341). Continuous active disease (HR 7.05, 95% CI 4.23-11.77), systemic steroids (HR 3.25, 95% CI 1.37-7.71) and cyclosporine treatment (HR 2.80, 95% CI 1.66-4.72) were independent risk factors for colectomy, whereas proctitis at diagnosis (HR 0.43, 95% CI 0.22-0.86) carried a lower risk.
CONCLUSION
In one-third of UC patients, left-sided disease at diagnosis will extend proximally during 10 years of follow-up. Proximal disease extension was not a risk factor for colectomy, but the risk of colectomy is rather determined by continuous disease activity, and use of systemic steroids and cyclosporine.
PubMed: 28588887
DOI: 10.1177/2050640616679552