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Interactive Cardiovascular and Thoracic... Jun 2022The study objective was to evaluate the aortic wall stress and root dilatation before and after the novel V-shape surgery for the treatment of ascending aortic aneurysms...
OBJECTIVES
The study objective was to evaluate the aortic wall stress and root dilatation before and after the novel V-shape surgery for the treatment of ascending aortic aneurysms and root ectasia.
METHODS
Clinical cardiac computed tomography images were obtained for 14 patients [median age, 65 years (range, 33-78); 10 (71%) males] who underwent the V-shape surgery. For 10 of the 14 patients, the computed tomography images of the whole aorta pre- and post-surgery were available, and finite element simulations were performed to obtain the stress distributions of the aortic wall at pre- and post-surgery states. For 6 of the 14 patients, the computed tomography images of the aortic root were available at 2 follow-up time points post-surgery (Post 1, within 4 months after surgery and Post 2, about 20-52 months from Post 1). We analysed the root dilatation post-surgery using change of the effective diameter of the root at the two time points and investigated the relationship between root wall stress and root dilatation.
RESULTS
The mean and peak max-principal stresses of the aortic root exhibit a significant reduction, P=0.002 between pre- and post-surgery for both root mean stress (median among the 10 patients presurgery, 285.46 kPa; post-surgery, 199.46 kPa) and root peak stress (median presurgery, 466.66 kPa; post-surgery, 342.40 kPa). The mean and peak max-principal stresses of the ascending aorta also decrease significantly from pre- to post-surgery, with P=0.004 for the mean value (median presurgery, 296.48 kPa; post-surgery, 183.87 kPa), and P=0.002 for the peak value (median presurgery, 449.73 kPa; post-surgery, 282.89 kPa), respectively. The aortic root diameter after the surgery has an average dilatation of 5.01% in total and 2.15%/year. Larger root stress results in larger root dilatation.
CONCLUSIONS
This study marks the first biomechanical analysis of the novel V-shape surgery. The study has demonstrated significant reduction in wall stress of the aortic root repaired by the surgery. The root was able to dilate mildly post-surgery. Wall stress could be a critical factor for the dilatation since larger root stress results in larger root dilatation. The dilated aortic root within 4 years after surgery is still much smaller than that of presurgery.
Topics: Aged; Aorta; Aortic Aneurysm; Aortic Valve; Dilatation; Dilatation, Pathologic; Female; Humans; Male; Tomography, X-Ray Computed
PubMed: 35134955
DOI: 10.1093/icvts/ivac004 -
Indian Journal of Ophthalmology Jun 2023Although corneal refractive surgery has been proven to be excellent in terms of safety and effectiveness, the reduction of postoperative corneal ectasia remains one of... (Review)
Review
Although corneal refractive surgery has been proven to be excellent in terms of safety and effectiveness, the reduction of postoperative corneal ectasia remains one of the most concerned topics for surgeons. Forme fruste keratoconus (FFKC) is the most important factor that leads to postoperative corneal ectasia, and common preoperative screenings of the condition include corneal morphology examination and corneal biomechanical examination. However, there are limitations to the single morphological examination or biomechanical examination, and the advantages of the combination of the two have been gradually emerging. The combined examination is more accurate in the diagnosis of FFKC and can provide a basis for determining suspected keratoconus. It allows one to measure the true intraocular pressure (IOP) before and after surgery and is recommended for older patients and those with allergic conjunctivitis. This article aims to discuss the application, advantages, and disadvantages of single examination and combined examination in the preoperative screening of refractive surgery, so as to provide a certain reference value for choosing suitable patients for surgery, improving surgical safety, and reducing the risk of postoperative ectasia.
Topics: Humans; Keratoconus; Corneal Topography; Dilatation, Pathologic; Cornea; Keratoplasty, Penetrating; Biomechanical Phenomena
PubMed: 37322646
DOI: 10.4103/ijo.IJO_1377_22 -
Journal of Refractive Surgery... Nov 2023To evaluate the visual, refractive, and tomographic results of patients with corneal ectasia treated with corneal allogenic intrastromal ring segments (CAIRS) insertion...
PURPOSE
To evaluate the visual, refractive, and tomographic results of patients with corneal ectasia treated with corneal allogenic intrastromal ring segments (CAIRS) insertion without concomitant corneal cross-linking.
METHODS
Fifty-two eyes from 39 patients with stable corneal ectasia and unsatisfactory visual acuity with contact lenses were included. All patients underwent CAIRS insertion with no concomitant corneal procedure at the American University of Beirut Medical Center between September 2019 and July 2022. Visual, refractive, topographic, aberrometric, epithelial, stromal, and segment thickness data were measured relative to baseline at 1 week, 1 month, and at least 3 months postoperatively. Evaluations included slit-lamp examination, manifest refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuity, and tomography using anterior segment optical coherence tomography.
RESULTS
Mean follow-up time was 6.9 ± 5.2 months. UDVA and CDVA improved from 0.97 ± 0.47 and 0.56 ± 0.19 preoperatively to 0.52 ± 0.21 ( < .001) and 0.23 ± 0.19 ( < .001) 3 months postoperatively. Manifest refraction spherical equivalent and cylinder improved from -6.71 ± 6.51 and -4.02 ± 2.24 diopters (D) preoperatively to -3.78 ± 4.07 D ( < .001) and -2.35 ± 1.98 D ( < .001) 3 months postoperatively, respectively. Maximum anterior keratometry and vertical coma decreased from 58.09 ± 7.92 D and 1.56 ± 1.09 µm to 52.48 ± 6.69 D ( < .001) and 0.43 ± 0.77 µm, respectively ( < .001). Corneal epithelium thickened proximal to the allogenic segment by 7.25 µm ( < .001), whereas stromal elevation at the cone decreased from 38.61 ± 18.5 to 23.82 ± 13.4 µm, respectively ( < .001). No major complications were observed and only 1 eye lost one line of CDVA.
CONCLUSIONS
Treatment of corneal ectasia with CAIRS improved visual, refractive, topographic, and tomographic parameters. Epithelial thickening central to CAIRS, along with anterior stromal flattening is postulated to contribute to tomographic flattening and regularization. .
Topics: Humans; Keratoconus; Dilatation, Pathologic; Corneal Stroma; Corneal Topography; Prosthesis Implantation; Refraction, Ocular; Tomography, Optical Coherence; Prostheses and Implants; Retrospective Studies
PubMed: 37937759
DOI: 10.3928/1081597X-20231011-01 -
BMC Surgery Dec 2022To examine the benefits of interventional therapy for cicatricial constriction using a high-frequency electric knife, saccular dilatation, and cryotherapy.
BACKGROUND
To examine the benefits of interventional therapy for cicatricial constriction using a high-frequency electric knife, saccular dilatation, and cryotherapy.
METHODS
This case series included patients with central tracheobronchial cicatricial constriction admitted to the Department of Tuberculosis of Henan Provincial Chest Hospital from July 2018 to March 2021 and treated with bronchoscopic interventional therapies based on systemic anti-tuberculosis treatment.
RESULTS
96 patients were included, in whom 443 interventional therapies were performed. The total mid-(3 months) and long-term (12 months) effective rates were both 100%. The internal diameter of tracheobronchial stenosis increased after the operation, and the difference was statistically significant (all < 0.05). After interventional treatment, patients' symptoms of choking sensation in the chest and shortness of breath were relieved. Respiratory function was obviously improved. The ratios of hemorrhage, granulation hyperplasia, chest pain, and postoperative fever were 58.2%, 42.6%, 31.3%, and 26.7%, respectively. No focal transmission and progression of tuberculosis occurred, and no serious complications were observed.
CONCLUSION
The use of a high-frequency electric knife, saccular dilatation, and/or cryotherapy according to the pathological stage of the tracheobronchial cicatricial constriction is feasible, with good mid- and long-term curative effects and few complications.
Topics: Humans; Constriction, Pathologic; Constriction; Dilatation; Cryotherapy; Tuberculosis
PubMed: 36461086
DOI: 10.1186/s12893-022-01862-y -
Pediatric Nephrology (Berlin, Germany) Nov 2020Antenatally diagnosed urinary tract dilatation (UTD) still burdens healthcare providers and parents. This study was conducted to establish long-term outcome in an...
BACKGROUND
Antenatally diagnosed urinary tract dilatation (UTD) still burdens healthcare providers and parents. This study was conducted to establish long-term outcome in an unselected group of children with antenatally detected UTD.
METHODS
Seventy-one out of 103 children born in 2003-2005 and diagnosed with antenatal UTD agreed to participate in a 12-15-year follow-up including blood and urine samples, a kidney ultrasound exam, and kidney scintigraphy. The records were searched for previous urinary tract infections.
RESULTS
Among children with an anteroposterior diameter (APD) ≤ 7 mm and no calyceal, kidney, ureteral, or bladder pathology in the early postnatal period, no one tested had reduced estimated glomerular filtration rate (eGFR), albuminuria, or UTD at the follow-up at a mean age of 13.6 years. One child had kidney damage not affecting kidney function. Among children with postnatal APD > 7 mm and/or kidney, calyceal, ureteral, or bladder pathology, 15% had persistent UTD and 32-39% (depending on the method used) had kidney damage. Major postnatal urinary tract ultrasound abnormalities and a congenital anomalies of the kidney and urinary tract (CAKUT) diagnosis were factors associated with an increased risk for permanent kidney damage (odds ratios 8.9, p = 0.016; and 14.0, p = 0.002, respectively). No one had reduced eGFR. One child (1/71, 1%) had a febrile urinary tract infection after the age of 2.
CONCLUSIONS
We conclude that in children with postnatal APD ≤ 7 mm, no calyceal dilatation, normal bladder, ureters, and kidney parenchyma, the outcome is excellent. There is no need for long-term follow-up in these patients.
Topics: Adolescent; Case-Control Studies; Cohort Studies; Dilatation, Pathologic; Disease Progression; Female; Follow-Up Studies; Glomerular Filtration Rate; Humans; Hydronephrosis; Male; Prenatal Diagnosis; Ultrasonography; Urinary Tract
PubMed: 32577807
DOI: 10.1007/s00467-020-04659-4 -
Auris, Nasus, Larynx Feb 2024To summarise our experience and the outcomes of endoscopic balloon dilatation (EBD) in the management of paediatric-acquired subglottic stenosis (SGS), and to further...
OBJECTIVE
To summarise our experience and the outcomes of endoscopic balloon dilatation (EBD) in the management of paediatric-acquired subglottic stenosis (SGS), and to further explore the influencing factors of successful EBD.
METHOD
A retrospective case series study was conducted involving 33 paediatric patients diagnosed with acquired SGS who underwent EBD as the primary treatment from January 2012 to December 2021. The collected information included patient demographics, aetiology, time from extubation to operation, initial grade of SGS, descriptions of stenosis tissues, presence of tracheotomy, number of dilatation procedures and co-morbidity. The follow-up results were collected and analysed.
RESULT
Thirty-three paediatric patients with an average age of 31.0 months who underwent EBD were included in the study. According to the Myers-Cotton classification, four (12.1%) patients had Grade I stenosis, nine (27.3%) had Grade II, 20 (60.6%) had Grade III and none had Grade IV. Of these, 15 (45.5%) exhibited acute lesions and 18 (54.5%) exhibited chronic lesions. The mean number of dilatation procedures per patient was 1.88 ± 1.05, and 19 (57.6%) patients received dilatations more than once. The overall success rate was 72.7%, with 100% for Grade I, 88.9% for Grade II and 60.0% for Grade III. There was a significant difference between the distribution of the stenosis grades in the successful and failed cases (p < 0.05). The mean number of dilatation procedures was 1.47 ± 0.64 and 2.22 ± 1.22 per patient in those with acute lesions and chronic lesions, respectively. The patients with chronic lesions had a significantly higher number of dilatations than those with acute lesions (p < 0.05). The success rate was 86.7% for acute lesions and 61.1% for chronic lesions. The correlation between the type of subglottic lesions and procedural success was not statistically significant (p > 0.05).
CONCLUSION
Acquired SGS in paediatric patients can be successfully managed using EBD. The dilatation procedures should be performed in a timely manner, early treatment could prevent the need for multiple procedures and smaller stenosis grades could improve the success rate of the surgery.
Topics: Child; Humans; Child, Preschool; Laryngostenosis; Constriction, Pathologic; Dilatation; Retrospective Studies; Treatment Outcome
PubMed: 37544811
DOI: 10.1016/j.anl.2023.07.004 -
Heart (British Cardiac Society) Nov 2019To study neo-aortic growth and the evolution of neo-aortic valve regurgitation (AR) in patients with transposition of the great arteries (TGA) after arterial switch...
OBJECTIVE
To study neo-aortic growth and the evolution of neo-aortic valve regurgitation (AR) in patients with transposition of the great arteries (TGA) after arterial switch operation (ASO) from newborn to adulthood and to identify patients at risk.
METHODS
Neo-aortic dimensions (annulus/root/sinotubular junction) and neo-aortic valve regurgitation were assessed serially in 345 patients with TGA who underwent ASO between 1977 and 2015. Linear mixed-effect models were used to assess increase of neo-aortic dimensions over time and to identify risk factors for dilatation. Risk factor analysis for AR by using time-dependent Cox regression models.
RESULTS
After a rapid increase in the first year after ASO and proportional growth in childhood, neo-aortic dimensions continue to increase in adulthood without stabilisation. Annual diameter increase in adulthood was 0.39±0.06, 0.63±0.09 and 0.54±0.11 mm for, respectively, neo-aortic annulus, root and sinotubular junction, all significantly exceeding normal growth. AR continues to develop over time: freedom from AR ≥moderate during the first 25 years post-ASO was 69%. Risk factors for root dilatation were complex TGA anatomy (TGA-ventricular septal defect (VSD), double outlet right ventricle with subpulmonary VSD) and male gender. Risk factors for AR ≥moderate were: complex TGA anatomy and neo-aortic growth. Per millimetre increase in aortic root dimension, there was a 9% increase in the hazard of AR ≥moderate. Bicuspid pulmonary valve did not relate to the presence of root dilatation or AR.
CONCLUSION
After ASO, neo-aortic dilatation proceeds beyond childhood and is associated with an increase in AR incidence over time. Careful follow-up of the neo-aortic valve and root function is mandatory, especially in males and in patients with complex TGA anatomy.
Topics: Adolescent; Adult; Aorta; Aortic Aneurysm; Aortic Valve; Aortic Valve Insufficiency; Arterial Switch Operation; Child; Child, Preschool; Dilatation, Pathologic; Disease Progression; Female; Hemodynamics; Humans; Infant; Infant, Newborn; Male; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Transposition of Great Vessels; Treatment Outcome; Vascular Remodeling; Young Adult
PubMed: 31292191
DOI: 10.1136/heartjnl-2019-315157 -
BMC Gastroenterology Feb 2022Stricturing gastrointestinal tuberculosis (GITB) may result in persistent symptoms even after antitubercular therapy (ATT) and may require surgical intervention. Data on...
INTRODUCTION
Stricturing gastrointestinal tuberculosis (GITB) may result in persistent symptoms even after antitubercular therapy (ATT) and may require surgical intervention. Data on efficacy and safety of endoscopic dilatation for management GITB related strictures is scarce.
METHODS
A retrospective analysis of database of patients who underwent endoscopic balloon dilatation for suspected or proven gastrointestinal tuberculosis was performed. The analysis included the site of involvement, technical success, clinical success (response), relapse and requirement of surgery in these patients.
RESULTS
Out of 34 patients (47.1% males, mean age 31.9 ± 12.9 years), eventually four patients were diagnosed to have Crohn's disease while the rest had GITB. Initial technical success was achieved in 30 (88.2%) patients. Initial clinical success was achieved in 28 (82.3%) patients. Median number of dilatation sessions required to obtain symptomatic relief were 2.5 (1-5) per patient. Two patients with initial clinical success had recurrence of symptoms over follow up of 1 year, out of which one patient was managed with repeat endoscopic balloon dilatation successfully. Of 30 patients with technical success, 16 (53.4%) were on ATT when they underwent dilatation while two were in intestinal obstruction. Eventually 7 patients required surgical intervention for various reasons.
CONCLUSION
Non-fluoroscopic endoscopic balloon dilatation is an acceptable and fairly safe modality for symptomatic tuberculous strictures of gastrointestinal tract.
Topics: Adult; Constriction, Pathologic; Dilatation; Endoscopy, Gastrointestinal; Female; Humans; Intestinal Obstruction; Male; Retrospective Studies; Treatment Outcome; Tuberculosis, Gastrointestinal; Young Adult
PubMed: 35148672
DOI: 10.1186/s12876-022-02140-0 -
American Journal of Men's Health 2023Treatment of urethral stricture is a complex reconstructive urology treatment. Previous surgery in the treatment of urethral stricture increases the risk of urinary... (Randomized Controlled Trial)
Randomized Controlled Trial
Treatment of urethral stricture is a complex reconstructive urology treatment. Previous surgery in the treatment of urethral stricture increases the risk of urinary incontinence. Therefore, this study aimed to assess the outcome of comparing two preservative or nonsurgical methods, clean intermittent catheterization (CIC) or hydraulic urethral dilatation (HUD). Forty-eight patients diagnosed with symptomatic urethral stricture were enrolled in the study. Patients were randomly divided into two groups: Nelaton-based dilatation and HUD treatment. Patients were assessed using patient-reported outcome measure for urethral stricture surgery (USS-PROM) through direct clinical interview and were followed up for 12 months. The rate of urinary infection, the need for surgical intervention, and the patient's quality of life were considered as outcomes of the interventions. SPSS software, version 20.0, was used for statistical analysis. Overall, 23 (47.9%) patients underwent HUD of stricture and Nelaton-based dilatation of stricture was done in 25 (52.1%) patients. We found that surgical intervention was required in four patients in the HUD group, but 15 patients in the CIC group required surgical intervention. Also, the need for surgical intervention and urinary tract infection (UTI) was significantly greater in the CIC group compared with the HUD group. With respect to the patient-reported outcomes, the mean Peeling's voiding picture (Q8) and EQ-VAS score (Q16) in the HUD group ( = .02) were significantly greater than those in the CIC group ( = .02). We obtained excellent results by using an HUD catheter. This safe, simple, well-tolerated, home-based procedure reduced the need for hospital admission to operate for repeat.
Topics: Humans; Urethral Stricture; Constriction, Pathologic; Dilatation; Quality of Life; Urethra; Treatment Outcome
PubMed: 37811639
DOI: 10.1177/15579883231202714 -
Scientific Reports Jun 2021Type A aortic dissection (TAAD) involves the ascending aorta or the arch. Acute TAAD usually requires urgent replacement of the ascending aorta. However, a subset of...
Type A aortic dissection (TAAD) involves the ascending aorta or the arch. Acute TAAD usually requires urgent replacement of the ascending aorta. However, a subset of these patients develops aortic rupture due to further dilatation of the residual dissected aorta. There is currently no reliable means to predict the risk of dilatation following TAAD repair. In this study, we performed a comprehensive morphological and hemodynamic analysis for patients with and without progressive aortic dilatation following surgical replacement of the ascending aorta. Patient-specific models of repaired TAAD were reconstructed from post-surgery computed tomography images for detailed computational fluid dynamic analysis. Geometric and hemodynamic parameters were evaluated and compared between patients with stable aortic diameters (N = 9) and those with aortic dilatation (N = 8). Our results showed that the number of re-entry tears and true/false lumen pressure difference were significantly different between the two groups. Patients with progressive aortic dilatation had higher luminal pressure difference (6.7 [4.6, 10.9] vs. 0.9 [0.5, 2.3] mmHg; P = 0.001) and fewer re-entry tears (1.5 [1, 2.8] vs. 5 [3.3, 7.5]; P = 0.02) compared to patients with stable aortic diameters, suggesting that these factors may serve as potential predictors of aneurysmal dilatation following surgical repair of TAAD.
Topics: Aortic Dissection; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Dilatation, Pathologic; Female; Hemodynamics; Humans; Male; Models, Cardiovascular
PubMed: 34075164
DOI: 10.1038/s41598-021-91079-5