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Clinical Medicine Insights. Cardiology 2024Supra-aortic extra-anatomic debranch (SAD) are prosthetic surgical grafts used to revascularize head and neck arteries that would be blocked during a surgical or hybrid...
Supra-aortic extra-anatomic debranch (SAD) are prosthetic surgical grafts used to revascularize head and neck arteries that would be blocked during a surgical or hybrid procedure used in treating ascending and arch of the aorta pathologies. However, bypassing the supra-aortic arteries but not occluding their orifice might introduce potential for competitive flow that reduces bypass patency. Competitive flow within the bypasses across the supra-aortic arteries has not previously been identified. This research identified haemodynamics due to prophylactic inclusion of bypasses from the brachiocephalic artery (BCA) to the left common carotid artery (LCCA), and from the LCCA to left subclavian artery (LSA). Four model configurations investigated the risk of competitive flow and the necessity of intentionally blocking the proximal LSA and/or LCCA. Particle image velocimetry (PIV) was used to assess haemodynamics in each model configuration. We found potential for competitive flow in the BCA-LCCA bypass when the LSA was blocked, in the LSA-LCCA bypass, when the LCCA alone or LCCA and LSA were blocked. Flow stagnated at the start of systole within the RCCA-LCCA bypass, along with notable recirculation zones and reciprocating flow occurring throughout systolic flow. Flow also stagnated in the LCCA-LSA bypass when the LCCA was blocked. There was a large recirculation in the LCCA-LSA bypass when both the LCCA and LSA were blocked. The presence of competitive flow in all other configurations indicated that it is necessary to block or ligate the native LCCA and LSA once the debranch is made and the thoracic endovascular aortic repair (TEVAR) completed.
PubMed: 38449712
DOI: 10.1177/11795468231221413 -
European Journal of Obstetrics,... Apr 2024Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is widely recognized for its potential benefits, including reducing post-surgical pain and leaving no...
OBJECTIVE
Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is widely recognized for its potential benefits, including reducing post-surgical pain and leaving no discernible scarring. However, the anatomical specificity of the vNOTES approach may elevate the risk of nearby organ damage, such as the rectum and bladder. Thus, this study aims to demonstrate the safety and relative merits of vNOTES over transumbilical laparoendoscopic single-site surgery (LESS).
METHODS
The Longitudinal Vaginal Natural Orifice Transluminal Endoscopic Surgery Study (LovNOTESS), which was conducted in Chengdu, China. A total of 110 patients who underwent myomectomy in vNOTES or LESS from January 2021 to December 2022. This study prospectively collected and compared perioperative and follow-up data of the two groups.
RESULTS
In the vNOTES group, patients had shorter postoperative anal exhaust time, lower pain medications use rate, shorter hospital stay but higher intraoperative conversion rate, and higher postoperative fever rate. vNOTES decreased the anal exhaust time by approximately 8.7 h (95 %CI: -16.182, -1.262, p = 0.007). Moreover, vNOTES reduces pain medication use risk by 73.1 % (OR: 0.269, 95 %CI: 0.172, 0.318, p = 0.016).
CONCLUSION
Relative to LESS, vNOTES can make patients mitigate postoperative discomfort, accelerate the recovery of gastrointestinal function, curtail hospitalization duration, and enable a more rapid return to daily activities in myomectomy. However, vNOTES has a higher risk of surgical conversion and adjacent organ injury. Therefore, larger scale prospective studies are needed to prove its security and promote the widespread application of vNOTES in myomectomy.
Topics: Female; Humans; Uterine Myomectomy; Enhanced Recovery After Surgery; Vagina; Natural Orifice Endoscopic Surgery; Pain, Postoperative; Laparoscopy; Retrospective Studies
PubMed: 38359635
DOI: 10.1016/j.ejogrb.2024.02.005 -
World Neurosurgery Jun 2024Lesions situated within the orbit pose significant challenges in management due to the confined space they occupy and their proximity to critical anatomical structures....
BACKGROUND
Lesions situated within the orbit pose significant challenges in management due to the confined space they occupy and their proximity to critical anatomical structures. The objective of our study is to assess the feasibility of the ipsilateral endoscopic endonasal approach for orbital cavernous hemangiomas and to comprehend the surgical anatomy of the orbital apex and inferomedial orbital structures.
METHODS
Thirteen patients (8 women, 5 men), with ages ranging from 25 to 54 years (mean 35.2 ± 8.3 years), with orbital cavernous hemangioma who underwent surgery via the ipsilateral mononostril endoscopic endonasal approach between August 2018 and August 2023 were retrospectively evaluated. Demographic characteristics, clinical data, radiographic images, and clinical outcomes of the patients were collected from digital medical records.
RESULTS
The left orbit was more commonly affected (9 left, 4 right). The average postoperative follow-up duration was 22.2 months (range: 6-50 months). Among the 13 cases of orbital cavernous hemangioma, 1 (7.7%) was located in the extraconal compartment, and 12 (92.3%) were situated in the intraconal compartment. Complete surgical resection of the tumor was successfully achieved in all patients.
CONCLUSIONS
Our study highlights the potential advantages of employing a purely ipsilateral mononostril endoscopic endonasal approach for orbital surgery, particularly for accessing the orbital apex and managing medial and inferomedial orbital lesions. This technique holds promise for reducing morbidity and enhancing outcomes, especially when combined with careful patient selection, preoperative planning, and advanced endoscopic skills.
Topics: Humans; Female; Male; Middle Aged; Adult; Orbital Neoplasms; Retrospective Studies; Orbit; Natural Orifice Endoscopic Surgery; Hemangioma, Cavernous; Nasal Cavity; Treatment Outcome; Neuroendoscopy
PubMed: 38548053
DOI: 10.1016/j.wneu.2024.03.122 -
Beijing Da Xue Xue Bao. Yi Xue Ban =... Feb 2024Maxillary molar with three roots and 3 to 4 canals is a common occurrence. However, in addition to common root canal anatomy, there may be significant differences in the...
Maxillary molar with three roots and 3 to 4 canals is a common occurrence. However, in addition to common root canal anatomy, there may be significant differences in the number, distribution, and morphological structure of root canals. The success of root canal treatment is dependent on ensuring that all the intricate details associated with it are meticulously followed. Failure to locate all canals could have a negative effect on the treatment as it may lead to initiation or continuation of periapical pathology. Missed canals were the main reason for patients reporting back for nonsurgical root canal retreatment. Moreover, the bacteria residing in such canals could also result in persistence of symptoms. Root canal anatomy is complex, and the recognition of anatomic variations could be a challenge for clinicians. This article presents three cases of endodontic management of maxillary molars with atypical canal morphology. In the three cases of this study, the patients underwent cone beam computed tomographic (CBCT) examination before root canal treatment. The CBCT images revealed that the maxillary molars in case 1 and case 2 had 5 canals. Case 1: 2 mesiobuccal (MB, MB2), two distobuccal (DB and DB2), and one palatal canal. Case 2: 2 mesiobuccal (MB, MB2), one distobuccal (DB), and two palatal canals (MP and DP). In case 3, CBCT scan slices showed that the maxillary first molar presented as a C-shaped root canal with a rare tooth anomaly of taurodontism. Although C-shaped root canals were most frequently seen in the mandibular second molar, they might also appear in maxillary molars. A literature search revealed only a few case reports of C-shaped root canal systems in maxillary molars. Case 3 described the fusion between mesiobuccal and palatal roots of the maxillary first molar, forming a C-shaped mesiopalatal root canal. The above cases suggest that endodontists should always be aware of aberrancies in root canal system apart from the knowledge of normal root canal anatomy. CBCT as a means of diagnosis can be helpful for identifying and managing these complex root canal systems. This case series also highlights the importance of magnification and illumination. Through using an endodontic microscope, clinicians can identify root canals that are difficult to locate or overlooked with normal vision. A correct access opening is a most important step to locate and negotiate the orifices of root canals. The use of ultrasonic tips can refine the access cavity and allow controlled and delicate removal of calcifications and other interferences to the canal orifices, thereby helping to locate the extra orifices.
Topics: Humans; Cone-Beam Computed Tomography; Molar; Root Canal Therapy; Tomography, X-Ray Computed; Tooth Root; Dental Pulp Cavity; Maxilla
PubMed: 38318917
DOI: 10.19723/j.issn.1671-167X.2024.01.030 -
Dental Research Journal 2024Knowledge about the anatomic variations of the root canal system and their prevalence is necessary for clinicians to ideally clean the root canal system. The anatomic...
BACKGROUND
Knowledge about the anatomic variations of the root canal system and their prevalence is necessary for clinicians to ideally clean the root canal system. The anatomic complexity of the root canal system is one of the reasons for its inadequate debridement, resulting in residual microorganisms and root canal treatment failure. The present study aimed to evaluate the prevalence of middle mesial root canals in mandibular molars in an Iranian population.
MATERIALS AND METHODS
The samples in the present descriptive/cross-sectional study consisted of mandibular first and second molars ( = 100, with 50 first and 50 s molars). A convenient sampling method was used to collect samples. The teeth were mounted in gypsum and scanned using a micro-computed tomography unit. The images were reconstructed with software, and the relevant checklist was completed by the observers. The data were analyzed with SPSS v26 using the Chi-squared test at a significance level of < 0.05.
RESULTS
The prevalence of the middle mesial root canal in the present study was 36% for mandibular first molars and 22% for mandibular second molars, with an overall prevalence of 29%. The prevalence of the middle mesial root canal was not significantly different between the first and second mandibular molars ( = 0.12). The mean distance between the mesiobuccal and mesiolingual root canal orifices in the teeth with a middle mesial root canal was significantly higher than in those without the middle mesial root canal ( < 0.001). In addition, there was no significant difference in the prevalence of the middle mesial root canal between the teeth with and without the second distal root canal ( = 0.89).
CONCLUSION
The prevalence of the middle mesial root canal in the studied population was 29%, which is significant clinically. In addition, the mean distance between the mesiobuccal and mesiolingual root canal orifices in teeth with a middle mesial root canal was higher than that in teeth without this root canal.
PubMed: 38425321
DOI: No ID Found -
The American Journal of Case Reports Jun 2024BACKGROUND Laparoscopic-perineal neovagina construction by sigmoid colpoplasty is a popular therapeutic approach for patients with Mayer-Rokitansky-Kuster-Hauser (MRKH)...
BACKGROUND Laparoscopic-perineal neovagina construction by sigmoid colpoplasty is a popular therapeutic approach for patients with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. The conventional approach requires an auxiliary abdominal incision to exteriorize the descending colon to fix the anvil for end-to-end colorectal anastomosis. We modified the natural orifice specimen extraction surgery (NOSES) approach by exteriorizing the descending colon through the artificial neovaginal tunnel to replace the anvil extracorporeally, without requiring an auxiliary abdominal incision. It was a more minimally invasive technique. CASE REPORT We performed this modified laparoscopic-perineal sigmoid colpoplasty in a 26-year-old woman with MRKH syndrome. We cut off a segment of the sigmoid colon with a vascular pedicle to make a new vagina out of it, the same as in the traditional laparoscopic-perineal sigmoid colpoplasty. What is new about this technique is that it has no need for abdominal incision and is more minimally invasive. The operating time was 315 min. No postoperative complications occurred. The postoperative hospital stay was 4 days. The modified laparoscopic-perineal approach, free from an auxiliary abdominal incision, demonstrated advantages, including a shorter hospital stay, expedited recovery, and comparable anatomical outcomes, when compared with the traditional approach. This innovation improves the surgical experience for patients with MRKH syndrome, addressing the physical and psychological aspects of their condition. CONCLUSIONS This refined laparoscopic-perineal neovagina construction by sigmoid colpoplasty represents a feasible and minimally invasive technique. It is an attractive option for MRKH syndrome patients in need of vaginal reconstruction, offering a streamlined procedure with reduced postoperative recovery time and enhanced patient outcomes.
Topics: Humans; Female; Adult; Laparoscopy; Colon, Sigmoid; Vagina; 46, XX Disorders of Sex Development; Mullerian Ducts; Perineum; Congenital Abnormalities; Plastic Surgery Procedures
PubMed: 38867420
DOI: 10.12659/AJCR.943305 -
International Forum of Allergy &... Mar 2024Eustachian tube dysfunction (ETD) may occur distinct from, or in conjunction with, chronic rhinosinusitis (CRS+ETD). Intranasal corticosteroid sprays are often...
Accessing the Eustachian tube: Conventional nasal spray vs. exhalation delivery system and the impact of targeted endoscopic sinus surgery on topical distribution patterns.
BACKGROUND
Eustachian tube dysfunction (ETD) may occur distinct from, or in conjunction with, chronic rhinosinusitis (CRS+ETD). Intranasal corticosteroid sprays are often prescribed for ETD, although ET distribution may be limited. To date, no anatomic studies compare nasopharynx (NP) distribution between conventional nasal sprays (NS) and exhalation delivery systems (EDS) after surgery. This study utilizes a cadaver model to examine topical NP delivery using EDS vs. NS before and after targeted endoscopic sinus surgery (ESS).
METHODS
Sixteen sinonasal cavities were administered fluorescein solution via NS and EDS before and after maxillary antrostomy and anterior ethmoidectomy, followed by nasal endoscopy of the NP and ET orifice. Seven blinded experts submitted staining ratings of endoscopy images on a 0- to 3-point scale, with ratings averaged for analysis.
RESULTS
Interrater reliability was excellent (intraclass correlation, 0.956). EDS was associated with significantly greater NP staining vs. NS in a pooled cohort of nonsurgical and ESS specimens (1.19 ± 0.81 vs. 0.78 ± 1.06; p = 0.043). Using a logistic regression model, EDS significantly outperformed NS in nonsurgical (odds ratio [OR], 3.49; 95% confidence interval [CI], 1.21-10.09; p = 0.021) and post-ESS (OR, 9.00; 95% CI, 1.95-41.5; p = 0.005) specimens, with the greatest relative staining observed for EDS after targeted ESS (OR, 18.99; 95% CI, 3.44-104.85; p = 0.001).
CONCLUSIONS
EDS is more effective than NS in topical delivery to the NP and ET orifices in cadavers. Targeted ESS may facilitate greater NP penetration by EDS compared with NS, with possible synergism after ESS for augmented delivery. These findings suggest a role for EDS delivery methods for ETD management and in CRS+ETD patients undergoing sinus surgery.
Topics: Humans; Nasal Sprays; Eustachian Tube; Exhalation; Reproducibility of Results; Endoscopy; Chronic Disease; Rhinitis; Nasal Polyps
PubMed: 37533194
DOI: 10.1002/alr.23248 -
Journal of Minimally Invasive Gynecology Apr 2024To explore the effectiveness of transvaginal natural orifice transluminal endoscopic surgery extraperitoneal sacral hysteropexy (vNOTES-ESH) in women with symptomatic...
A Retrospective Cohort Study of vNOTES Extraperitoneal Versus Laparoscopic Sacral Hysteropexy With Uterine Preserving Regarding Surgical Outcomes and 2 Year Follow-up Results.
STUDY OBJECTIVE
To explore the effectiveness of transvaginal natural orifice transluminal endoscopic surgery extraperitoneal sacral hysteropexy (vNOTES-ESH) in women with symptomatic uterine prolapse over a 2 year follow-up.
DESIGN
Retrospective cohort study.
SETTING
Gynecological minimally invasive center.
PATIENTS
Women undergoing sacral hysteropexy either by vNOTES (n = 25) or laparoscopic (n = 74) between November 2016 and December 2020.
INTERVENTIONS
Both vNOTES-ESH and laparoscopic sacral hysteropexy (LAP-SH) were used for uterine prolapse. Demographic data, operative characteristics, perioperative outcomes, and follow-up information 2 years postsurgery in the 2 groups were retrospectively evaluated.
RESULTS
Both procedures showed similar operation time, estimated blood loss, hospital stays, and pain scores (p >0.05). During a median follow-up of 59 (24-72) months, the surgical success rate was 96% for vNOTES-ESH and 97.3% for LAP-SH (p >0.05), with no differences in anatomical position or pelvic organ function after the operation. Women in the LAP-SH group experienced more bothersome symptoms of constipation compared to those in the vNOTES-ESH group (5.41% vs 0, p <0.05). Lastly, 1 case in the vNOTES-ESH group had a mesh exposed area of less than 1 cm, and 1 patient in the LAP-SH group experienced stress incontinence.
CONCLUSIONS
In this retrospective study, vNOTES-ESH met our patients' preference for uterine preservation and was a successful and effective treatment for uterine prolapse, providing good functional improvement in our follow-up. This procedure should be considered as an option for patients with pelvic organ prolapse.
PubMed: 38642887
DOI: 10.1016/j.jmig.2024.04.013 -
Sisli Etfal Hastanesi Tip Bulteni 2024This study aims to compare the early results of patients who underwent isolated aortic valve replacement (AVR) with supra-annular and intra-annular AVR.
OBJECTIVES
This study aims to compare the early results of patients who underwent isolated aortic valve replacement (AVR) with supra-annular and intra-annular AVR.
METHODS
Between 2013 and 2019, 113 patients (77 males; mean age 57.8±16.36 years) who underwent isolated AVR were evaluated. The patients were divided into two groups those who underwent supra-annular (n=59) and intra-annular (n=54) AVR. The most commonly used valves in surgeries St Jude Medical Masters (St. Jude Medical, Minneapolis, MN, USA), (n=35, 30.9%), Sorin Mitroflow (Sorin Group Inc., Mitroflow Division, Canada), (n=32, 28.3%, and Carbomedics Top Hat (Sulzer, Carbomedics, Austin, TX), (n=31, 27.4%).
RESULTS
The cross-clamp (XCL) and cardiopulmonary bypass (CPB) times of the patients who underwent supra-annular AVR were found to be significantly higher than the patients who underwent intra-annular AVR. However, there was no significant difference between the two groups in terms of postoperative adverse events. There was no significant difference between the two groups in the postoperative first-week transthoracic echocardiographic (TTE) findings.
CONCLUSION
When comparing supra-annular and intra-annular valve positioning results in patients undergoing isolated AVR, no significant difference was found between the groups in terms of postoperative complications, gradient differences in postoperative TTE, and ejection fractions. Supra-annular valve positioning should be considered, especially in patients with small annulus, in the presence of suitable anatomical features. However, this issue needs to be investigated in future prospective studies with more patients.
PubMed: 38808047
DOI: 10.14744/SEMB.2024.39112 -
Radiology Case Reports Apr 2024Small bowel internal hernias (IHs), a rare cause of small bowel occlusion (SBO) and small bowel strangulation, while more commonly seen in young adults, can also affect...
Small bowel internal hernias (IHs), a rare cause of small bowel occlusion (SBO) and small bowel strangulation, while more commonly seen in young adults, can also affect elderly patients and pose a significant diagnostic challenge due to their nonspecific symptoms. In most cases, laparotomy was used to diagnose IHs. However, multidetector computed tomography (MDCT) is usually the best imaging tool to use in the emergency setting for the diagnosis of IHs. An 83-year-old man was admitted to emergency with acute abdominal pain and a coffee-ground vomitus. The abdominal MDCT showed a clustered-like appearance of proximal jejunal loops at the level of the Treitz ligament with the absence of transit of the medium water-soluble iodine oral contrast agent (Gastrografin). Mesenteric edema was also present with initial suffering of the intestinal wall. A left paraduodenal hernia (LPDH) with strangulation was suspected following the radiological report. The emergency laparotomy revealed about 20 cm of proximal jejunal loops herniated through a 3 cm wide hernia orifice (HO) along the Treitz ligament, at the level of Landzert fossa, located in the confluence of the descending mesocolon, posterior to the inferior mesenteric vein (IMV) and confirming the LPDH. The patient was discharged in good condition some days later. IHs do not have sufficient coverage in literature, especially in cases regarding elderly patients, however, they can be a cause of SBO in people older than 80 years of age. Radiologists and surgeons should be aware of the anatomical aspects of the IHs.
PubMed: 38288049
DOI: 10.1016/j.radcr.2024.01.013