-
Urology Oct 2018Translabial ultrasound (TUS) can provide an inexpensive alternative imaging modality for evaluating pelvic floor structures and synthetic slings as mesh can be difficult...
BACKGROUND
Translabial ultrasound (TUS) can provide an inexpensive alternative imaging modality for evaluating pelvic floor structures and synthetic slings as mesh can be difficult to identify on pelvic exam or cystoscopy, patients may be unable to provide an accurate history of previous pelvic surgery, and cross-sectional imaging with computed tomography and magnetic resonance imaging can be inadequate for evaluating synthetic slings.
OBJECTIVE
To demonstrate the use of TUS in the evaluation of female pelvic floor structures and mesh.
METHODS
Translabial ultrasound can be used in the Urology clinic or intraoperative setting using a curvilinear transducer. Following identification of anatomic landmarks in the various planes of the pelvic floor, TUS can evaluate for pelvic floor disorders and the type and location of synthetic mesh material. Artifacts, such as air pockets in the vagina or rectum and the hypoechoic pubic symphysis, are also considered.
RESULTS
Real-time imaging allows for dynamic examination of pelvic organ prolapse and urethral hypermobility that can contribute to pelvic exam findings. Bladder ultrasound can help evaluate for lesions, calculi, and even mesh erosion. Translabial ultrasound can also be used to differentiate hyperechoic retropubic and transobturator slings by identifying the position of sling arms and the appearance of the sling at different planes. Evaluation with TUS can demonstrate sling disruption, folding, urethral impingement, and erosion into pelvic floor structures. This can be particularly useful in patients presenting with pain, recurrent infections, or voiding dysfunction in which problems with mesh may not be easily identified on pelvic exam or cystoscopy. This imaging modality can complement a patient's history, aid in preoperative planning, and enable intraoperative identification of mesh slings.
CONCLUSION
Translabial ultrasound provides a quick, readily available, and easy-to-learn imaging modality for evaluating pelvic floor structures and mesh in the office or intraoperative setting.
PubMed: 30031831
DOI: 10.1016/j.urology.2018.07.004 -
Europace : European Pacing,... Dec 2018Use of the subcutaneous implantable cardioverter-defibrillator (S-ICD) to prevent sudden cardiac death is increasing. Few data exist on S-ICD in young patients. We... (Observational Study)
Observational Study
AIMS
Use of the subcutaneous implantable cardioverter-defibrillator (S-ICD) to prevent sudden cardiac death is increasing. Few data exist on S-ICD in young patients. We reviewed our single-centre experience in order to assess the effectiveness and safety of S-ICD implantation, and to identify potential factors associated with complications.
METHODS AND RESULTS
Observational, non-randomized, standard-of-care study on S-ICD implantation/follow-up in young patients with inherited arrhythmias (IA), cardiomyopathies, and congenital heart defects (CHD). Fifteen patients (6 CHD, 8 cardiomyopathies, and 1 IA), median age 15 years (25th-75th centiles, 14-28), 10 of them <18 years, with body mass index (BMI) 22.6 ± 3.4, underwent S-ICD implantation (primary prevention 93%). The first six patients underwent a standard implantation procedure (three surgical incisions), the following nine a two-incision procedure. No intraoperative complications occurred. Over 12 (7-24) months follow-up, two patients received appropriate shocks and one (7%) inappropriate shock. Four patients had device-related complications requiring surgical intervention: three skin erosions at the superior parasternal incision, one pocket infection. A higher risk of complications was seen in patients who underwent standard procedures [hazard ratio (HR) 4.98, 95% confidence interval (CI) 1.53-47.36; P = 0.0482] and those with BMI <20 (HR 9.44, 95% CI 0.95-93.23; P = 0.0169).
CONCLUSION
S-ICD implantation was safe and effective in young patients with low rates of inappropriate shock. However, the risk of device-related complications during follow-up remains substantial in patients with low BMI. To prevent possible complications, a two-incision technique should be preferred.
Topics: Adolescent; Adult; Age Factors; Body Mass Index; Child; Clinical Decision-Making; Death, Sudden, Cardiac; Defibrillators, Implantable; Electric Countershock; Female; Humans; Male; Patient Selection; Prosthesis Design; Prosthesis Failure; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Rome; Time Factors; Treatment Outcome; Young Adult
PubMed: 29939256
DOI: 10.1093/europace/euy139 -
Community Dentistry and Oral... Dec 2018To measure dental caries, erosive tooth wear (ETW), periodontal health, self-reported oral health problems and performance impacts in a representative sample of UK elite...
OBJECTIVES
To measure dental caries, erosive tooth wear (ETW), periodontal health, self-reported oral health problems and performance impacts in a representative sample of UK elite athletes from different sports using standardized conditions clearly defined clinical indices and a measure of impact on performance with evidence of validity in sport.
METHODS
Cross-sectional study, with single, calibrated examiner, conducted in the local facilities of elite and professional UK athletes (UCL ethics number 6388/001). Main oral measures: dental caries (ICDAS), erosive tooth wear (BEWE), periodontal health (BPE) and athlete-reported performance impacts.
RESULTS
We recruited 352 athletes from eleven sports. The mean age was 25 years (range 18-39), and 67.0% were male. We found caries (ICDAS code ≥3) in 49.1% of athletes, ETW (BEWE score of ≥7) in 41.4%, gingival bleeding on probing/presence of calculus (BPE score 1 or 2) in 77.0% and pocket probing depths of at least 4 mm (BPE score 3 or 4) in a further 21.6%. One in five athletes reported previous wisdom teeth problems. The odds of having caries were 2.4 times greater in team sport than endurance sport (95% CI 1.3-3.2). The odds of having erosion were 2.0 times greater in team sport than endurance sport (95% CI 1.3-3.1). Overall, 32.0% athletes reported an oral health-related impact on sport performance: oral pain (29.9%), difficulty participating in normal training and competition (9.0%), performance affected (5.8%) and reduction in training volume (3.8%). Other impacts were difficulty with eating (34.6%), relaxing (15.1%) and smiling (17.2%). Several oral health problems were associated with performance impacts.
CONCLUSIONS
This is the first large representative sample study of oral health in athletes from different sports at elite level. Although experience of oral disease differs by sport, the prevalence, in UK elite and professional athletes, is substantial, with common self-reported performance impacts. Regular screening and use of effective oral health promotion strategies may minimize performance impacts from poor oral health.
Topics: Adolescent; Adult; Athletes; Athletic Performance; Cross-Sectional Studies; Dental Caries; Female; Gingival Pocket; Humans; Male; Oral Health; Periodontal Index; United Kingdom; Young Adult
PubMed: 29938820
DOI: 10.1111/cdoe.12392 -
Journal of Otology Sep 2017The goal of the present study is to summarize our experience on surgical management of retraction pockets (RP) as a preventive tool against cholesteatomas. (Review)
Review
AIMS
The goal of the present study is to summarize our experience on surgical management of retraction pockets (RP) as a preventive tool against cholesteatomas.
METHODS
Twenty-five ears have been followed up for a mean period of 6.16 ± 4.35 years (from 1 to 17 years). The sample presented a mean age of 47.56 ± 19.11 years (from 16 to 73 years). All patients underwent cartilage graft surgery. Furthermore 10 (40%) underwent tympanoplasty (TPL) type I, 14 (56%) TPL type II and 1 (4%) TPL type V.
RESULTS
Eleven ears (44%) showed cholesteatoma: all these cases were stage III according to Charachon staging, and stage IV or V according to Gersdorff classification. Twelve patients (48%) showed erosion of the ossicular chain. Of these, five were associated with cholesteatoma and seven only with retraction. The recurrence rate of cholesteatoma was 12%. None of the patients with a stage II or III RP (according to Gersdorff classification) developed cholesteatoma. The recurrence of RP was 0%.In regards to literature review, seven references were selected. These studies showed a success rate ranging from 79.1% to 88%, while recurrences of RP varied from 6.4% to 13%. Only one study specified a recurrence rate of cholesteatoma of 28%.
CONCLUSIONS
Surgical treatment of stages II and III RP is an effective tool to prevent cholesteatoma formation. The presence of keratin accumulation and cholesteatoma at the RP (stages IV and V, according to Gersdorff) are the real predictors of poor prognosis.
PubMed: 29937845
DOI: 10.1016/j.joto.2017.04.003 -
Journal of Dentistry Sep 2018To determine the prevalence of gingival recession (GR) and associations with dentine hypersensitivity (DH), erosive toothwear (BEWE), gingival bleeding (BOP) and...
OBJECTIVES
To determine the prevalence of gingival recession (GR) and associations with dentine hypersensitivity (DH), erosive toothwear (BEWE), gingival bleeding (BOP) and periodontal pocketing (PPD) in young European adults.
MATERIALS AND METHODS
This is a secondary analysis using data collected from 350 UK participants enrolled in a European cross sectional study of 3187 young adults. GR, BOP, PPD, DH (participant and clinician assessment) and BEWE were recorded. A questionnaire assessed demographics, oral hygiene and lifestyle habits.
RESULTS
349 participants completed the study. GR, BOP and PPD showed the same pattern of distribution, prevalence increasing from incisors to molars in upper and lower arches for buccal and palatal scores. Every participant exhibited recession affecting at least 1 tooth, 42% having a maximum recession of 4-8 mm. There was a significant and linear association demonstrating an increase in maximum recession with age. DH and BEWE produced a similar pattern to buccal periodontal indices, the premolars being most affected. Maximum recession correlated significantly with maximum DH (participant and Schiff), PPD, BOP, BEWE (scores of 2/3), BMI (≥25 kg/m) and unsystematic brushing motion. 94% of the study population exhibited some BOP at one or more sites. 5% of the population had periodontal pocketing ≥4 mm, 46% had DH and 80% BEWE 2/3.
CONCLUSION
Widespread recession and gingivitis with minimal periodontal disease was observed. Every participant exhibited at least one tooth with recession. Many teeth did not exhibit DH despite prevalent recession and severe erosive toothwear. Recession correlates to a number of oral and lifestyle variables.
CLINICAL SIGNIFICANCE
Recession in young adults is multifactorial and highly prevalent. It can result in DH and consequential increase in demand for treatment relating to both pain and aesthetics. Further research is needed to understand the underlying aetiology to prevent recession occurring.
Topics: Cross-Sectional Studies; Gingival Recession; Gingivitis; Humans; Prevalence; United Kingdom; Young Adult
PubMed: 29933005
DOI: 10.1016/j.jdent.2018.06.005 -
Visceral Medicine Apr 2018Proton pump inhibitors (PPI) have greatly improved the treatment of gastroesophageal reflux disease. However, recent investigations have revealed that reflux symptoms... (Review)
Review
Proton pump inhibitors (PPI) have greatly improved the treatment of gastroesophageal reflux disease. However, recent investigations have revealed that reflux symptoms persist in a substantial number of patients. Therefore, treatment strategies beyond PPI are urgently required. One such strategy may involve more reliable acid suppression, e.g., with new acid inhibitory drugs. Furthermore, the rapid appearance of an acidic compartment in the proximal stomach after a meal, which is largely responsible for postprandial heartburn, requires a specific kind of therapy in addition to PPI which still needs to be established. Pharmacological augmentation of the lower esophageal sphincter may represent another approach to diminish reflux, but the clinical efficacy of compounds tested so far is limited. Altered e-sophageal perception represents a major component involved in the generation of reflux symptoms, particularly in non-erosive reflux disease, but effective pharmacological intervention is largely lacking. Presumed reflux-induced respiratory symptoms (cough, laryngitis, etc.) in the absence of typical esophageal symptoms (e.g., heartburn) remain a hot topic, but recent research points towards a hypersensitivity syndrome and only a minor role of gastroesophageal reflux. Treatment options for this condition are still pending.
PubMed: 29888239
DOI: 10.1159/000486692 -
World Neurosurgery Sep 2018Skin complications are a frequent type of complication of deep brain stimulation (DBS) neurosurgical procedure and are always observed in the postauricular area, scalp...
BACKGROUND
Skin complications are a frequent type of complication of deep brain stimulation (DBS) neurosurgical procedure and are always observed in the postauricular area, scalp area, and implantable pulse generator pocket. Modifications to the surgical techniques for DBS have been proposed as therapeutic options. To prevent skin complications, we modified the surgical incisions.
METHODS
At our center, we retrospectively analyzed the complications associated with traditional surgical incisions and then adjusted the double C-shaped incision and changed the postauricular incision from vertical to horizontal in patients undergoing DBS for movement disorders.
RESULTS
Skin complications were observed in 4 patients among 30 patients who underwent traditional surgical incisions. In 102 consecutive patients who underwent operations with modified surgical incisions, we did not encounter any skin complications such as skin infection or erosion related to our modified incision. A single patient experienced pain and was cured after a week of local antiinflammatory treatment.
CONCLUSION
By trying to avoid placing hardware directly under the suture line, our modified surgical incision successfully reduces the incidence of skin complications.
Topics: Adult; Aged; Aged, 80 and over; Deep Brain Stimulation; Dystonia; Female; Humans; Incidence; Male; Middle Aged; Parkinson Disease; Postoperative Complications; Retrospective Studies; Skin Diseases; Surgical Wound; Time Factors; Young Adult
PubMed: 29886304
DOI: 10.1016/j.wneu.2018.05.224 -
JACC. Clinical Electrophysiology Feb 2018This study sought to evaluate the impact of abandoned cardiovascular implantable electronic device (CIED) leads on the presentation and management of device-related...
Impact of Abandoned Leads on Cardiovascular Implantable Electronic Device Infections: A Propensity Matched Analysis of MEDIC (Multicenter Electrophysiologic Device Infection Cohort).
OBJECTIVES
This study sought to evaluate the impact of abandoned cardiovascular implantable electronic device (CIED) leads on the presentation and management of device-related infections.
BACKGROUND
Device infection is a serious consequence of CIEDs and necessitates removal of all hardware for attempted cure. The merits of extracting or retaining presumed sterile but nonfunctioning leads is a subject of ongoing debate.
METHODS
The MEDIC (Multicenter Electrophysiologic Device Infection Cohort) prospectively enrolled patients with CIED infections at 10 institutions in the United States and abroad between January 1, 2009, and December 31, 2012. Within a propensity-matched cohort, relevant clinical information was compared between patients who had 1 or more abandoned leads at the time of infection and those who had none.
RESULTS
Matching produced a cohort of 264 patients, including 176 with no abandoned leads and 88 with abandoned leads. The groups were balanced with respect to Charlson comorbidity index, oldest lead age, device type, sex, and race. At the time of admission, those with abandoned leads were less likely to demonstrate systemic signs of infection, including leukocytosis (p = 0.023) and positive blood cultures (p = 0.005). Conversely, patients with abandoned leads were more likely to demonstrate local signs of infections, including skin erosion (p = 0.031) and positive pocket cultures (p = 0.015). In addition, patients with abandoned leads were more likely to require laser extraction (p = 0.010).
CONCLUSIONS
The results of a large prospective registry of CIED infections demonstrated that patients with abandoned leads may present with different signs, symptoms, and microbiological findings and require laser extraction more than those without abandoned leads.
Topics: Aged; Defibrillators, Implantable; Device Removal; Female; Humans; Length of Stay; Male; Middle Aged; Pacemaker, Artificial; Propensity Score; Prospective Studies; Prosthesis Failure; Prosthesis-Related Infections
PubMed: 29749938
DOI: 10.1016/j.jacep.2017.09.178 -
Pacing and Clinical Electrophysiology :... Jul 2018Methodology specific for moving superficial chronically implanted transvenous pacing leads to a subpectoral pocket is not described in the literature. Relocation of...
BACKGROUND
Methodology specific for moving superficial chronically implanted transvenous pacing leads to a subpectoral pocket is not described in the literature. Relocation of prepectoral leads and generator to a submuscular pocket for relief of erosion and pain with minimal pectoral trauma is possible by applying a variant of a previously described submammary tunneling technique.
METHODS
All patients presenting for device follow-up, elective battery replacement, or system upgrade over an 8-month period were considered for relocation if experiencing significant thinning or pain over their prepectoral implant. Those selected for relocation then had their system moved subpectorally via the tunneling technique. Patients were followed for 6 months postoperatively for procedurally related complications and resolution of preprocedure symptoms.
RESULTS
Thirty-two leads in 14 patients were all successfully relocated. Of the relocated leads, five (16%) were a three-pin connector implantable cardioverter defibrillator lead. Three patients (21%) in the group required short-term prescription analgesia in the immediate postdischarge period. Pain and erosion concerns abated in the study group by the 3-month follow-up.
CONCLUSIONS
Relocation of superficial pacing leads with CIED generator to a subpectoral pocket facilitated by this tunneling method is successful, safe, and can accommodate single and multipin leads with minimal pectoral trauma and no nerve damage.
Topics: Defibrillators, Implantable; Humans; Pacemaker, Artificial; Pain; Pectoralis Muscles; Postoperative Complications; Prosthesis Implantation
PubMed: 29745977
DOI: 10.1111/pace.13366 -
International Journal of Pediatric... Mar 2018The high incidence of chronic otitis media with effusion and Eustachian tube dysfunction in children with Down syndrome (DS) may predispose them to cholesteatoma...
INTRODUCTION
The high incidence of chronic otitis media with effusion and Eustachian tube dysfunction in children with Down syndrome (DS) may predispose them to cholesteatoma formation. Establishing the diagnosis, choosing the appropriate operative intervention, and post-operative care can be challenging.
OBJECTIVE
To describe management strategies for cholesteatoma diagnosis, surgical treatment, and post-operative management in children with Down syndrome.
METHODS
Retrospective case series of 14 patients (17 total ears) with Down syndrome diagnosed with cholesteatoma over a 9-year period.
RESULTS
A total of 14 patients with cholesteatoma (3 with bilateral disease) were analyzed. Thirteen ears (76.5%) had ≥2 tympanostomy tubes insertions prior to cholesteatoma diagnosis, and otorrhea and hearing loss were the most common presenting symptoms. Common pre-operative CT scan findings included mastoid sclerosis and ossicular erosion. The average age at first surgery was 9.8 years, and the average follow-up was 4.3 years. For acquired cholesteatoma, most ears were managed with canal wall up (CWU) approaches, but ultimately 6/15 (40.0%) required canal wall down (CWD) approaches. Postoperatively, 3 (20.0%) ears developed new tympanic membrane retraction pockets, but no recurrent cholesteatoma. Four (26.7%) ears developed recurrent disease, and 3 (20.0%) had residual disease at secondary procedures. Ossiculoplasty was performed in 4 ears. Twelve (70.6%) ears were rehabilitated with hearing aids or FM systems.
CONCLUSIONS
The diagnosis of cholesteatoma in Down syndrome was associated with otorrhea, hearing loss, and CT scan findings of ossicular erosion and mastoid sclerosis. Most cases were managed with CWU surgical approaches. Hearing aid use was common post-operatively.
Topics: Adolescent; Child; Child, Preschool; Cholesteatoma, Middle Ear; Down Syndrome; Endoscopy; Female; Hearing Loss; Humans; Infant; Male; Mastoid; Mastoidectomy; Middle Ear Ventilation; Otitis Media; Postoperative Period; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome; Tympanic Membrane; Tympanoplasty
PubMed: 29447898
DOI: 10.1016/j.ijporl.2018.01.016