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Journal of Cardiothoracic Surgery Jun 2024Following an acute myocardial infarction (AMI), surgery for left ventricular free wall rupture (LVFWR) and ventricular septal rupture (VSR) has a high in-hospital...
BACKGROUND
Following an acute myocardial infarction (AMI), surgery for left ventricular free wall rupture (LVFWR) and ventricular septal rupture (VSR) has a high in-hospital mortality rate, which has not improved significantly over time. Unloading the LV is critical to preventing excessive stress on the repair site and avoiding problems such as bleeding, leaks, patch dehiscence, and recurrence of LVFWR and VSR because the tissue is so fragile. We present two cases of patients who used Impella 5.5 for LV unloading following emergency surgery for AMI mechanical complications.
CASE PRESENTATION
A 76-year-old male STEMI patient underwent fibrinolysis of the distal right coronary artery. Three days later, he passed out and went into shock. Echocardiography revealed a cardiac tamponade. We found an oozing-type LVFWR on the posterolateral wall and treated it with a non-suture technique using TachoSil. Before the patient was taken off CPB, Impella 5.5 was inserted into the LV via a 10 mm synthetic graft connected to the right axillary artery. We kept the flow rate above 4.0 to 4.5 L/min until POD 3 to reduce LV wall tension while minimizing pulsatility. On POD 6, we weaned the patient from Impella 5.5. A postoperative cardiac CT scan showed no contrast leakage from the LV. However, a cerebral hemorrhage on POD 4 during heparin administration complicated his hospitalization. Case 2: A diagnosis of cardiogenic shock caused by STEMI occurred in an 84-year-old male patient, who underwent PCI of the LAD with IABP support. Three days after PCI, echocardiography revealed VSR, and the patient underwent emergency VSR repair with two separate patches and BioGlue applied to the suture line between them. Before weaning from CPB, we implanted Impella 5.5 in the LV and added venoarterial extracorporeal membrane oxygenation (VA-ECMO) support for right heart failure. The postoperative echocardiography revealed no residual shunt.
CONCLUSIONS
Patients undergoing emergency surgery for mechanical complications of AMI may find Impella 5.5 to be an effective tool for LV unloading. The use of VA-ECMO in conjunction with Impella may be an effective strategy for managing VSR associated with concurrent right-sided heart failure.
Topics: Humans; Male; Aged; Heart-Assist Devices; Myocardial Infarction; Heart Ventricles; Heart Rupture, Post-Infarction; Ventricular Septal Rupture; Echocardiography; Postoperative Complications
PubMed: 38926884
DOI: 10.1186/s13019-024-02879-5 -
BMJ Case Reports Jun 2024Soft tissue deficiency in a tooth extraction site in the aesthetic area is a common and challenging clinical situation. This case report demonstrates the successful...
Soft tissue deficiency in a tooth extraction site in the aesthetic area is a common and challenging clinical situation. This case report demonstrates the successful treatment of extensive gingival recession and buccal bone dehiscence associated with a hopeless tooth. Initially, a connective tissue graft was used to cover the root and thicken the soft tissue. After 2 months, the tooth was extracted, an implant was immediately placed, and a temporary restoration was installed. After 3 months, the soft tissue exhibited a natural and harmonious architecture. A custom zirconia abutment and crown were then fabricated and placed. At the 4-year follow-up, the peri-implant tissue displayed satisfactory aesthetics, with a well-structured buccal bone plate and healthy peri-implant indicators. This two-stage approach, addressing gingival recession first and proceeding with immediate implant placement after soft tissue healing, proved to be a safe and effective method with stable long-term results.
Topics: Humans; Gingival Recession; Esthetics, Dental; Female; Follow-Up Studies; Crowns; Immediate Dental Implant Loading; Tooth Extraction; Male; Dental Implants, Single-Tooth; Adult; Connective Tissue; Treatment Outcome; Middle Aged
PubMed: 38925675
DOI: 10.1136/bcr-2023-259271 -
Journal of the American Academy of... Jun 2024Simultaneous Multifrequency (SiMFy) is a time-saving and reliable stimulus to determine the frequency tuning of ocular vestibular-evoked myogenic potential (oVEMP);...
BACKGROUND
Simultaneous Multifrequency (SiMFy) is a time-saving and reliable stimulus to determine the frequency tuning of ocular vestibular-evoked myogenic potential (oVEMP); however, the absence of 4000 Hz in SiMFy potentially makes it a less potent tool for the diagnosis of Superior semicircular canal dehiscence, a pathology with an ever-increasing prevalence. Further, SiMFy was validated using only the infra-orbital (IO) electrode montage. However, the recordings obtained using the IO montage might be susceptible to reference contamination introduced by a small separation between the recording electrodes, and also susceptible to reflex impurity due to the spatially displaced reference electrode from the inferior oblique muscle (IOM), rendering it vulnerable to picking up responses from other muscles. Nonetheless, little is known about the similarities/differences between the SiMFy-induced oVEMPs using alternate montages [belly-tendon (BT), chin-reference (CR), and sternum-reference (SR)] and the non-simultaneous multifrequency oVEMPs (NSM-oVEMPs) using the IO montage.
PURPOSE OF THE STUDY
To develop a modified SiMFy stimulus and investigate its effects on frequency tuning of oVEMP using various electrode montages.
RESEARCH DESIGN
Within-subject experimental design.
STUDY SAMPLE
Thirty-three healthy adults aged 20-30 years.
DATA COLLECTION AND ANALYSIS
Tone bursts of octave and mid-octave frequencies from 250 Hz to 4000 Hz were generated and concatenated to create the modified SiMFy stimulus. All participants underwent non-simultaneous multifrequency oVEMPs and modified SiMFy oVEMPs using BT, CR, SR, and IO montages simultaneously. The response rate, peak-to-peak amplitude, and frequency tuning were compared between NSM-oVEMP and modified SiMFy oVEMP and also between the electrode montages.
RESULTS
BT montage recorded the largest amplitude among the montages in non-simultaneous multifrequency stimulation and modified SiMFy stimulation. Although the response rates were comparable, the modified SiMFy produced significantly lower oVEMP amplitudes than the non-simultaneous multifrequency stimulation within each electrode montage (p < 0.05). A moderate-to-strong agreement on frequency tuning existed between the non-simultaneous multifrequency stimuli and modified SiMFy stimulus for all the montages, except for the SR montage.
CONCLUSIONS
Although the modified SiMFy produces smaller amplitude oVEMPs than the non-simultaneous multifrequency stimulation for the respective montages, its use in combination with the BT montage yields higher response rates and larger peak-to-peak amplitudes than the non-simultaneous multifrequency recording using IO montage.
PubMed: 38925160
DOI: 10.1055/a-2353-2797 -
World Journal of Surgery Jun 2024Many devices are used for dissection and hemostasis during reduction mammoplasty. While one of the most common methods is monopolar electrocautery, tissue damage due to...
BACKGROUND
Many devices are used for dissection and hemostasis during reduction mammoplasty. While one of the most common methods is monopolar electrocautery, tissue damage due to thermal spread remains a controversial topic. New devices have been designed to minimize this effect. In this study, plasmakinetic cautery was hypothesized to reduce sensation loss, drainage, and wound-healing problems in reduction mammoplasty because it is less harmful to the surrounding tissues.
METHODS
Sixty-eight patients were evaluated in a matched pair design, with random (blinded) assignment of 34 patients with conventional monopolar electrocautery (Group A) and 34 patients with plasmakinetic cautery (group B). Postoperative drainage volume, drain duration, nipple-areolar complex (NAC) sensation, and complications (dehiscence, seroma, ischemia, and nipple circulatory problems) were compared by the researcher, who was blinded to the device used for the patient.
RESULTS
The groups were comparable in terms of age, body mass index (BMI), comorbidities, and medications (p > 0.05). The mean age of the patients were 38.50 ± 9.14 years in group A and 37.54 ± 8.17 in group B. The mean BMI was 25.19 ± 3.22 kg/m in group A and 25.65 ± 2.96 kg/m in group B. No differences were detected between the groups in terms of drain duration time, NAC sensation, or complications, but the drainage volume was statistically lower with plasmakinetic cautery (p < 0.05).
CONCLUSION
The study findings indicate that the main advantage of plasmakinetic cautery in reduction mammoplasty was a decrease in drainage volume when compared with monopolar electrocautery.
PubMed: 38924600
DOI: 10.1002/wjs.12259 -
The Laryngoscope Jun 2024
PubMed: 38924149
DOI: 10.1002/lary.31595 -
Equine Veterinary Journal Jun 2024Reported complication rates after dental repulsion for equine exodontia are high (up to 80%), but repulsion methods have changed notably in the last 20 years.
BACKGROUND
Reported complication rates after dental repulsion for equine exodontia are high (up to 80%), but repulsion methods have changed notably in the last 20 years.
OBJECTIVES
Describe the outcome for 20 cases after dental repulsion using small diameter repulsion pins.
STUDY DESIGN
Retrospective case series.
METHODS
Records of horses that underwent cheek tooth repulsion were reviewed (2014-2023). Inclusion criteria included: mandibular or maxillary cheek tooth extraction where oral extraction failed and repulsion was used to complete extraction, and where clinical follow up information was available. Repulsions were carried out under sedation with a regional nerve block or under a short general anaesthetic, using a small diameter repulsion pin (3-5 mm). Intra-operative radiographs facilitated instrument placement. The alveolus was packed with polymethyl methacrylate post-extraction. Horses were re-examined at 4-6 weeks post-operatively.
RESULTS
Twenty cases were included. Patients had a mean age of 10.3 years old (range 5-16 years). The majority (75%) of teeth had pre-existing dental fractures. Maxillary (n = 15) and mandibular cheek teeth (n = 5) were all successfully repulsed, with 16 cases performed with the horse standing and 4 with the horse under general anaesthesia. Intra-operative complications included damage to the mandibular bone (n = 1). Short-term complications (n = 2) included superficial surgical site infection, and dehiscence of one sinus flap. Long-term complications included the recurrence of sinusitis (n = 1) and small intra-alveolar fragments causing persistent bitting problems in another patient.
MAIN LIMITATIONS
Retrospective study design, small number of cases.
CONCLUSIONS
When oral extraction fails, cheek tooth repulsion using small diameter repulsion pins is an effective extraction technique. The total intra- and post-operative complication rate was 25%, which is comparable to previously published complication rates for repulsion using Steinmann pins and also those encountered after trans-buccal screw extraction.
PubMed: 38923039
DOI: 10.1111/evj.14116 -
Frontiers in Surgery 2024Total knee arthroplasty (TKA) is a common and effective procedure. Optimizing pain control and reducing postoperative discomfort are essential for patient satisfaction....
BACKGROUND
Total knee arthroplasty (TKA) is a common and effective procedure. Optimizing pain control and reducing postoperative discomfort are essential for patient satisfaction. No studies have examined the safety and efficacy of intra-articular corticosteroid injections following TKA. This study aims to examine the safety and efficacy of corticosteroids in intra-articular multimodal analgesic injections.
MATERIALS AND METHODS
This was a historically controlled study conducted at a single academic institution. Before May 2019, patients received an intra-articular cocktail injection without corticosteroids during surgery, referred to as the non-corticosteroid (NC) group. After June 2019, intraoperatively, patients received an intra-articular cocktail injection containing corticosteroids, referred to as the corticosteroid (C) group. Finally, 738 patients were evaluated, 370 in the C cohort and 368 in the NC cohort. The mean follow-up duration was 30.4 months for the C group and 48.4 months for the NC group.
RESULTS
The mean VAS scores at rest on postoperative day (POD) 1 (2.35) and POD3 (3.88) were significantly lower in the C group than those in the NC group, which were 2.86 (POD1) and 5.26 (POD3) ( < 0.05). Walking pain in the C group (4.42) was also significantly lower than that (5.96) in the NC group on POD3 ( < 0.05). Patients in the C group had a significantly higher mean range of motion (ROM) (92.55) on POD3 than that (86.38) in the NC group. The mean time to straight leg raise for group C (2.77) was significantly shorter than that (3.61) for the NC group ( < 0.05). The C group also had significantly fewer rescue morphine (1.9) and metoclopramide (0.21) uses per patient than the NC group, which were 3.1 and 0.24, respectively. No significant differences in fever or vomiting rates between groups were found. Patients in neither group developed periprosthetic joint infections or skin necrosis. One patient in the C group suffered from wound dehiscence, and the wound healed well after debridement. No patient died or had a re-operation in either group.
CONCLUSIONS
This pilot trial found that intra-articular injection of multimodal analgesia (including corticosteroids) reduced initial postoperative pain, increased ROM in the early postoperative days (up to POD3), and did not increase wound complications or infection rates in approximately 30 months of follow-up.
PubMed: 38919978
DOI: 10.3389/fsurg.2024.1279462 -
The Iowa Orthopaedic Journal 2024Bernese periacetabular osteotomy (PAO) improves symptoms and delays degenerative changes in patients with acetabular dysplasia. Yet, eventual total hip arthroplasty...
BACKGROUND
Bernese periacetabular osteotomy (PAO) improves symptoms and delays degenerative changes in patients with acetabular dysplasia. Yet, eventual total hip arthroplasty (THA) is needed in many of these patients. The impact of PAO on subsequent THA outcomes is not well defined.
THE PURPOSE OF THIS STUDY IS TO DEFINE
1) clinical outcomes, 2) post-operative complications and 3) implant survivorship for patients undergoing THA after prior ipsilateral PAO.
METHODS
A retrospective review was conducted at three institutions to identify individuals undergoing THA after ipsilateral PAO surgery with minimum 1 year follow up. Patient reported outcome measures (PROMs) were collected preoperatively and at final follow-up. Surgical details, radiographic and clinical outcomes, and major complications according to the modified Dindo-Clavien classification system were identified through review of the medical record. Regression analysis and student's t-test were used to compare pre- and post-operative outcome scores. Kaplan-Meier analysis was performed to estimate reoperation-free survivorship.
RESULTS
A total of 113 THA in 112 patients were identified with initial review. 103 hips had a minimum of 1-year follow-up and an average follow of 5 ± 4 years (range, 1 to 20). 10 hips (9%) were lost to follow-up leaving 103 (91%) hips available for review with a minimum of 1-year follow-up (mean = 5 years). Mean interval from PAO to THA was 7.7 years (range, 2-15). The average post-operative mHHS improved 37 points (50 to 87, P < 0.001) when compared to pre-operative scores. Eight patients (7.1%) experienced a major grades III-V) surgical complication. These included 2 cases of instability, 2 cases of acetabular loosening, and one case each of periprosthetic fracture, wound dehiscence, periprosthetic infection, acetabular loosening and pneumonia. Failures occurred early at average 3.2 years and survivorship analysis for all-cause revision demonstrated 96% survivorship at both 5 and 10 years.
CONCLUSION
THA after PAO achieves significant clinical improvement and satisfactory survivorship (96%) at mid-term follow-up, with a major complication rate of 7.1%. .
Topics: Humans; Arthroplasty, Replacement, Hip; Osteotomy; Retrospective Studies; Female; Male; Adult; Reoperation; Acetabulum; Middle Aged; Follow-Up Studies; Treatment Outcome; Young Adult; Postoperative Complications; Hip Joint
PubMed: 38919338
DOI: No ID Found -
Journal of Stomatology, Oral and... Jun 2024Dermal substitutes are classically used in a 2-stage procedure followed by skin graft for wound healing. This study aims to evaluate the possibility to use an...
A comparative prospective study between the outcomes of one-stage Pelnac reconstruction and full thickness skin graft on donor site healing in the radial forearm and fibula flaps.
OBJECTIVES
Dermal substitutes are classically used in a 2-stage procedure followed by skin graft for wound healing. This study aims to evaluate the possibility to use an alternative technique for radial forearm and fibula donor sites coverage using one-stage Pelnac reconstruction.
MATERIALS AND METHODS
21 patients who underwent radial forearm and fibula flaps harvest for reconstruction of head and neck defects after oncological surgery were enroled in the study. 13 patients were treated by one-stage Pelnac reconstruction of the donor site defect, 8 patients underwent full thickness skin graft. The Vancouver Scar Scale was used to evaluate the scar quality.
RESULTS
Most patients treated with one-stage Pelnac reconstruction showed good healing of the flap donor site, with minor complications, scar quality comparable to other treatment options and unimpaired function of the implicated limb. One patient had wound dehiscence at the radial forearm site, which was treated with secondary full thickness skin graft. In the group treated with FTSG we had three patients that developed complications, such as dehiscence of the graft and seroma. Overall, we reported comparable satisfaction with donor sites both for aesthetic and functional outcomes, in both groups of patients.
CONCLUSION
The use of Pelnac without a following skin graft provides a viable method for the reconstruction of radial forearm and fibula flaps donor site. A longer postoperative care is needed, but the long-term aesthetic and functional results are satisfactory in comparison with full thickness skin graft.
PubMed: 38914140
DOI: 10.1016/j.jormas.2024.101949 -
Journal of Surgical Case Reports Jun 2024Uterine rupture is specified as a complete laceration of the uterine wall, including its serosa, leading to a connection between the endometrial and peritoneal chambers....
Uterine rupture is specified as a complete laceration of the uterine wall, including its serosa, leading to a connection between the endometrial and peritoneal chambers. It can occur in any stage of pregnancy and is considered a severe and perhaps fatal complication. A 35-year-old woman at 9 weeks of gestation with a medical history of five prior cesarean sections presented with lower abdominal pain that had lasted for 5 hr. We detected small amounts of free fluid in the Douglas pouch using ultrasound. Subsequently, a laparotomy revealed a cesarean scar dehiscence from a non-cesarean scar pregnancy. Patients who experience a uterine rupture may have vague symptoms, severe abdominal discomfort, abnormal uterine bleeding, and severe hemorrhagic shock, depending on their gestational age. Ultrasound imaging can be used to diagnose this fatal condition in addition to laparoscopy to immediately identify and treat the issue in urgent cases.
PubMed: 38912433
DOI: 10.1093/jscr/rjae422