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Zhong Nan Da Xue Xue Bao. Yi Xue Ban =... Nov 2022Intrauterine adhesion (IUA) is mainly caused by intrauterine operations such as pregnancy-related curettage and hysteroscopic surgery, resulting in the trauma to the...
OBJECTIVES
Intrauterine adhesion (IUA) is mainly caused by intrauterine operations such as pregnancy-related curettage and hysteroscopic surgery, resulting in the trauma to the basal layer of the endometrium. Hysteroscopic adhesiolysis is a crucial step in the comprehensive treatment of IUA, and the most common complication is uterine perforation. More than half of all uterine perforations occur during the hysteroscopy or probe/dilator pass through the internal os. Furthermore, inappropriate surgical procedures may lead to endometrial injury, recurrence or even aggravation of adhesions, and complications such as cervix laceration and false passage formation. This study aims to explore the usage of the hysteroscopic dilatation techniques to dilate the internal os and lower uterine segment, which is via hysteroscopy entering the internal os laterally and swinging, or by directly opening the forceps or scissors and bluntly spreading dissection under direct hysteroscopic vision. By using the hysteroscopic dilatation techniques, we intend to improve the effectiveness and safety of cervical dilation in patients with IUA in the internal os and/or lower uterine segment.
METHODS
A total of 282 patients with adhesions in the internal os or lower uterine segment underwent HA in the Third Xiangya Hospital of Central South University from January 2020 to June 2021 were included, ranging from 21 to 46 (33.0±4.8) years old in age and 5 to 12 in the American Fertility Society score. Among them, there were 2 cases of false passage formation caused by traditional dilatation in other hospitals. All patients underwent hysteroscopy with integrated hysteroscopy with 5Fr instrument channel and 4.9 mm outer sheath diameter. The internal orifice of cervix and the lower segment of uterine cavity were dilated under the microscope. After the hysteroscopy entered the uterine cavity, the separation of uterine cavity adhesion and the placement of uterine contraceptive ring or uterine stent into the uterine cavity were performed routinely. Age, surgical records, and surgical videos of all included cases were collected. The success rate of dilation and the incidence of surgical complications were assessed.
RESULTS
In all cases, the hysteroscopys successfully entered into the uterine cavity by using the hysteroscopic dilatation techniques without failure and switching to cervical dilators. In the 2 cases of false passage due to previous cervical dilation, the uterine cavity was identified and found successfully under direct hysteroscopic vision. During the whole surgery, the vision was clear, and no complications (such as cervix laceration, false passage formation, uterine perforation or water intoxication) occurred. One to 3 months postoperative hysteroscopy revealed no significant fibrotic stenosis in the internal os and lower uterine segment.
CONCLUSIONS
The hysteroscopic dilation techniques are a strategy for separation methods that is following structural hierarchy anatomy in the mode of "see and treat" for the adhesion in the internal os and uterine cavity under direct hysteroscopic vision. This method not only has ultrasound guidance, but also has the judgment of structural hierarchy anatomy under direct hysteroscopic vision, so there is less chance of anatomical level judgment error. This method makes full use of the hysteroscopic judgement of the experienced hysteroscopic surgeons, so that surgeons can timely find and avoid re-entering the old false passage caused by previous surgery. The adhesions in the internal os and lower uterine segment were separated by the hysteroscopic dilation techniques. In this way, the damage to the endometrium caused by forced insertion of the hysteroscopy can be avoided. Meticulous separation of adhesions and cervical dilation under direct hysteroscopic vision can effectively reduce the occurrence of surgical complications such as false passage formation, cervical laceration, and uterine perforation. The use of mini-hysteroscopy eliminates the need for preoperative cervical preparation, avoiding associated risks and side effects. Moreover, for patients with adhesions in the internal os and lower uterine segment, preoperative cervical preparation is not effective in cervical dilation, while the hysteroscopic dilation techniques are effective, with higher patient acceptance due to the absence of preoperative cervical preparation. For the skilled hysteroscopic surgeons, the hysteroscopic dilation technique is easy to operate and worthy of clinical application.
Topics: Humans; Female; Child, Preschool; Child; Adult; Uterine Perforation
PubMed: 36481637
DOI: 10.11817/j.issn.1672-7347.2022.220059 -
Current Treatment Options in Oncology Mar 2021Management of chordoma along the cranial-spinal axis is a major challenge for both skull base and spinal surgeons. Although chordoma remains a rare tumor, occurring in... (Review)
Review
Management of chordoma along the cranial-spinal axis is a major challenge for both skull base and spinal surgeons. Although chordoma remains a rare tumor, occurring in approximately 1 per 1 million individuals, its treatment poses several challenges. These tumors are generally poorly responsive to radiation and chemotherapy, leading to surgical resection as the mainstay of treatment. Due to anatomic constraints and unique challenges associated with each primary site of disease, gross total resection is often not feasible and is associated with high rates of morbidity. Additionally, chordoma is associated with high rates of recurrence due to the tumor's aggressive biologic features, and postoperative radiation is increasingly incorporated as a treatment option for these patients. Despite these challenges, modern-day surgical techniques in both skull base and spinal surgery have facilitated improved patient outcomes. For example, endoscopic endonasal techniques have become the mainstay in resection of skull base chordomas, improving the ability to achieve gross total resection, while reducing associated morbidity of open transfacial techniques. Resection of spinal chordomas has been facilitated by emerging techniques in preoperative imaging, intraoperative navigation, spinal reconstruction, and radiotherapy. Taken collectively, the treatment of chordoma affecting the skull base and spinal requires a multidisciplinary team of surgeons, radiation oncologists, and medical oncologists who specialize in the treatment of this challenging disease.
Topics: Chordoma; Humans; Natural Orifice Endoscopic Surgery; Neoplasm Recurrence, Local; Radiotherapy, Adjuvant; Plastic Surgery Procedures; Skull Base Neoplasms; Spinal Neoplasms; Surgery, Computer-Assisted; Treatment Outcome
PubMed: 33743089
DOI: 10.1007/s11864-021-00838-z -
Biportal endoscopic transorbital approach: a quantitative anatomical study and clinical application.Acta Neurochirurgica Sep 2020We devised a biportal endoscopic transorbital approach (BiETOA) to gain surgical freedom by making a port for the endoscope and investigated the benefits and limitations...
BACKGROUND
We devised a biportal endoscopic transorbital approach (BiETOA) to gain surgical freedom by making a port for the endoscope and investigated the benefits and limitations of BiETOA.
METHODS
A cylindrical port was designed and 3-D printed using biocompatible material. The port was inserted through a keyhole between the superolateral side of the orbital rim and the temporal muscle. An endoscope was inserted through the port, and other instruments were inserted through the conventional transorbital route. BiETOA was used to dissect eight cadaveric heads, and the angle of attack and surgical freedom were assessed.
RESULTS
The mean maximal angle of attack was significantly different in BiETOA and endoscopic transorbital approach (ETOA) (P < 0.01) but not in BiETOA and ETOA lateral orbital rim (LOR) osteotomy (P = 0.207, P = 0.21). The mean surgical freedom was significantly different in BiETOA and ETOA (P < 0.01) and in BiETOA and ETOA LOR osteotomy (P < 0.01). In the clinical cases, tumors were removed successfully without any complications.
CONCLUSIONS
BiETOA provided increased surgical freedom and better visibility of deep target lesion and resulted in good surgical and cosmetic outcomes.
Topics: Cadaver; Endoscopes; Humans; Natural Orifice Endoscopic Surgery; Orbit; Postoperative Complications; Printing, Three-Dimensional
PubMed: 32440923
DOI: 10.1007/s00701-020-04339-0 -
Seminars in Cardiothoracic and Vascular... Sep 2019Anatomical, functional, and pathophysiologic mechanisms of ischemic mitral regurgitation (IMR) are markedly different from the primary mitral regurgitation. The older... (Review)
Review
Anatomical, functional, and pathophysiologic mechanisms of ischemic mitral regurgitation (IMR) are markedly different from the primary mitral regurgitation. The older and ubiquitous cutoff of EROA (effective regurgitant orifice area) and Rvol (regurgitant volume) for IMR has been reinstated in the new guideline after a brief hiatus. There had always been a lack of good-quality evidence for its introduction for guiding IMR severity in the previous guideline, and we still do not have quality evidences that could justify its reintroduction. Unlike primary MR, IMR is usually associated with reduced ejection fraction. Therefore, it appears unrealistic to keep the similar cutoff for primary MR and IMR. The cutoff of severity can be modified according to projected values of Rvol normalized to ejection fraction and EROA normalized to Rvol. In addition, the treatment outcome in these patients is determined by factors (left ventricular dyssynchrony, annular dilatation, tenting area, tenting height, tenting volume, and myocardial viability) other than the simple grading. In this review article, a series of graph have been constructed from the numerical data derived from the literatures on IMR to depict the relationship between EROA, Rvol, left ventricular end diastolic volume, and ejection fraction in order to obtain a reasonable projection formula for EROA and Rvol. Furthermore, a management algorithm has been proposed for patients with IMR undergoing coronary artery bypass grafting based on echocardiographic predictors that influence the postoperative outcome.
Topics: Algorithms; Clinical Decision-Making; Coronary Artery Bypass; Echocardiography; Evidence-Based Medicine; Humans; Mitral Valve Insufficiency; Myocardial Ischemia; Point-of-Care Systems; Practice Guidelines as Topic
PubMed: 29291344
DOI: 10.1177/1089253217745363 -
Journal of Endourology Dec 2022Incidence of urolithiasis in children has increased in recent years and with technological advancements and miniaturization of surgical instruments, pediatric... (Review)
Review
Incidence of urolithiasis in children has increased in recent years and with technological advancements and miniaturization of surgical instruments, pediatric urologists have acquired an impressive arsenal for their treatment. Retrograde intrarenal surgery (RIRS) has gained widespread popularity as it is a natural extension of semirigid ureteroscopy and can be done through natural orifice minimizing the morbidity of percutaneous access. The aim of this narrative review is to describe how RIRS has evolved over the decades in children and if the age-related anatomical difference impacts reported outcomes especially stone-free rate (SFR) and complications. An electronic literature search from inception to October 15, 2021 was performed using Medical Subject Heading terms in several combinations on PubMed, EMBASE, and Web of Science without language restrictions. A total of 2022 articles were founded and 165 articles were full-text screening. Finally, 2 pediatric urologists included 51 articles that summarize the available literature regarding the development and use of RIRS in children. RIRS as of today is well established as a superior modality for all stones in all locations compared with extracorporeal shockwave lithotripsy both in children and adults. The passive dilation has decreased the need of active ureteral dilation, but the need to perform prestenting is not defined yet. Regarding the use of the ureteral access sheath, the literature tends to lean toward its placement in most cases, but we do not know its long-term effects over the growth of children. Finally, the SFR has increased as the experience of pediatric urologists increases, as well as the number of complications has decreased. RIRS in pediatrics has crossed many milestones, yet many areas need further research and larger data are required to make RIRS the procedure of choice for renal stone management in children across all age groups.
Topics: Child; Humans; Urolithiasis
PubMed: 35972727
DOI: 10.1089/end.2022.0160 -
Journal of Endodontics Jun 2020This study aimed to present a novel dynamic navigation method to attain minimally invasive access cavity preparations and to evaluate its 3-dimensional (3D) accuracy in...
INTRODUCTION
This study aimed to present a novel dynamic navigation method to attain minimally invasive access cavity preparations and to evaluate its 3-dimensional (3D) accuracy in locating highly difficult simulated calcified canals among maxillary and mandibular teeth.
METHODS
Three identical sets of maxillary and mandibular 3D-printed jaw models composed of 84 teeth in their anatomic locations with simulated calcified canals (N = 138 canals) were set up on dental manikins. The Navident dynamic navigation system (ClaroNav, Toronto, Ontario, Canada) was used to plan and execute access preparations randomly with high-speed drills by a board-certified Endodontist. Two-dimensional (2D) and 3D horizontal, vertical, and angulation discrepancies between the planned and placed access preparations were digitally measured using superimposed cone-beam computed tomographic scans. Analysis of covariance models were used to evaluate the associations and the interaction between tooth type and jaw, the canal orifice depth, and the discrepancies between planned and prepared access cavities. The significance level was set at .05.
RESULTS
The mean 2D horizontal deviation from the canal orifice was 0.9 mm, and it was significantly higher on maxillary compared with mandibular teeth (P < .05). The mean 3D deviation from the canal orifice was 1.3 mm, and it was marginally higher on maxillary teeth in comparison with mandibular teeth (P ≥ .05). The mean 3D angular deviation was 1.7 degrees, and it was significantly higher in molars compared with premolars (P < .05). The 3D and 2D discrepancies were independent of the canal orifice depths (P > .05). The average drilling time was 57.8 seconds with significant dependence on the canal orifice depth, tooth type, and jaw (P < .05).
CONCLUSIONS
This study shows the potential of applying dynamic 3D navigation technology with high-speed drills to preserve tooth structure and accurately locate root canals in teeth with pulp canal obliteration.
Topics: Bicuspid; Cone-Beam Computed Tomography; Dental Pulp Cavity; Molar; Ontario; Tooth Root
PubMed: 32340763
DOI: 10.1016/j.joen.2020.03.014 -
Journal of Conservative Dentistry : JCD 2020Comprehensive knowledge of the entire root canal system is an essential prerequisite for successful routine endodontic treatments. The internal and external... (Review)
Review
Comprehensive knowledge of the entire root canal system is an essential prerequisite for successful routine endodontic treatments. The internal and external morphological configurations of roots and root canals are quite complex. Thus, several classifications have been put forth by researchers to appropriately understand the distinguishable features of root and root canal systems of multirooted teeth. Until now, the researchers have proposed new classification systems for a thorough understanding of the root canal systems, mainly concentrating on the root canal anatomy and anomalies. Moreover, with the advent of newer digital imaging systems, these classifications are more reproducible and relevant. They have further gained importance for the clinicians by acting as an aid in decision-making based on evidence-based dentistry. However, these classifications are primarily focused on the root canals, but none have assessed the anatomy of the pulp chamber floor. This review article delineates a novel Pawar and Singh molar pulp chamber floor classification© for the anatomy of maxillary and mandibular molars to ease the clinician's skills and further increase the prevailing literature for the benefit of researchers.
PubMed: 33911348
DOI: 10.4103/JCD.JCD_477_20 -
General Thoracic and Cardiovascular... Sep 2020Patients with functional single ventricle and right atrial isomerism (RAI) often have multiform cardiac pulmonary venous (PV) connection, which could be a risk factor...
BACKGROUND
Patients with functional single ventricle and right atrial isomerism (RAI) often have multiform cardiac pulmonary venous (PV) connection, which could be a risk factor for pulmonary venous obstruction (PVO) after extracardiac total cavopulmonary connection (EC-TCPC) owing to compression of the conduit.
OBJECTIVE
To investigate the anatomical risk factors for PVO after EC-TCPC in RAI.
METHODS
Twenty-nine patients with RAI without extracardiac total anomalous pulmonary venous connection were enrolled. No patients had PVO before EC-TCPC. A total of 14 and 15 patients had PV orifices ipsilateral and contralateral to the extracardiac conduit, respectively. The former 14 patients were assigned to two groups based on development of PVO after EC-TCPC (groups O and N). The pre- and post-operative cardiac morphologies and their relationship with the conduit were compared.
RESULTS
After the EC-TCPC, the pressure gradients between the atrium and the PV were 5.0 ± 2.5 and 0.44 ± 0.2 mmHg in groups O and N, respectively (p < 0.01); however, the pressure gradients in the left and right PVs were not significantly different, suggesting stenosis of the common PV orifice. The ratio of the horizontal distance from the vertebrae to the PV orifice and to the lateral edge of the atrium was significantly higher (0.38 ± 0.2 vs. 0.17 ± 0.1; p = 0.04) and the orifice was smaller (8.9 ± 2.0 vs. 15 ± 4.7 mm; p < 0.01) in group O than in group N.
CONCLUSION
In cases with ipsilateral locations of the conduit and PV orifice, small size and more lateral location of the PV orifice may be preoperative risk factors for development of PVO.
Topics: Child, Preschool; Female; Fontan Procedure; Heart Atria; Heart Defects, Congenital; Humans; Male; Postoperative Period; Pulmonary Circulation; Pulmonary Veins; Pulmonary Veno-Occlusive Disease
PubMed: 32036565
DOI: 10.1007/s11748-020-01316-3 -
Journal of the Canadian Association of... Aug 2023Identification and photo-documentation of the ileocecal valve (ICV) and appendiceal orifice (AO) confirm completeness of colonoscopy examinations. We aimed to develop...
BACKGROUND AND AIMS
Identification and photo-documentation of the ileocecal valve (ICV) and appendiceal orifice (AO) confirm completeness of colonoscopy examinations. We aimed to develop and test a deep convolutional neural network (DCNN) model that can automatically identify ICV and AO, and differentiate these landmarks from normal mucosa and colorectal polyps.
METHODS
We prospectively collected annotated full-length colonoscopy videos of 318 patients undergoing outpatient colonoscopies. We created three nonoverlapping training, validation, and test data sets with 25,444 unaltered frames extracted from the colonoscopy videos showing four landmarks/image classes (AO, ICV, normal mucosa, and polyps). A DCNN classification model was developed, validated, and tested in separate data sets of images containing the four different landmarks.
RESULTS
After training and validation, the DCNN model could identify both AO and ICV in 18 out of 21 patients (85.7%). The accuracy of the model for differentiating AO from normal mucosa, and ICV from normal mucosa were 86.4% (95% CI 84.1% to 88.5%), and 86.4% (95% CI 84.1% to 88.6%), respectively. Furthermore, the accuracy of the model for differentiating polyps from normal mucosa was 88.6% (95% CI 86.6% to 90.3%).
CONCLUSION
This model offers a novel tool to assist endoscopists with automated identification of AO and ICV during colonoscopy. The model can reliably distinguish these anatomical landmarks from normal mucosa and colorectal polyps. It can be implemented into automated colonoscopy report generation, photo-documentation, and quality auditing solutions to improve colonoscopy reporting quality.
PubMed: 37538187
DOI: 10.1093/jcag/gwad017 -
Advances in Oto-rhino-laryngology 2020In the coming years, further developments can be expected in the field of diagnosis and management of tumors involving the anterior skull base, and especially malignant... (Review)
Review
In the coming years, further developments can be expected in the field of diagnosis and management of tumors involving the anterior skull base, and especially malignant tumors of the sinonasal tract, which account for the majority of lesions affecting this anatomic area. Advances in genomics and radiomics will undoubtedly lead to better profiling of tumor biology, with consequent refinement of treatment according to the principles of precision medicine. Similarly, the continuous evolution of morphologic and metabolic imaging will improve the accuracy of pretreatment staging and posttreatment surveillance. Finally, the relentless development of technology in complementary fields (i.e., bioengineering, regenerative medicine, robotics, navigation systems, optical imaging) will refine the safety and accuracy of surgery. As a consequence of these innovations, all healthcare professionals involved in the management of anterior skull base tumors need to consolidate their multidisciplinary efforts for improving the patient's quality of life and survival outcomes. In tandem, hospital administrators and politicians should understand the essential importance of limiting the treatment of these pathologies to "centers of excellence," ensuring an adequate workload and appropriate human and technological resources.
Topics: Humans; Natural Orifice Endoscopic Surgery; Quality of Life; Skull Base; Skull Base Neoplasms
PubMed: 32731229
DOI: 10.1159/000457943