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INTRODUCTION AND HYPOTHESIS: Articles are getting published on the use of tissue adhesive for vesicovaginal fistula. The objective is to carry out a systematic review on their effectiveness and complications. METHODS: A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Two reviewers screened abstracts and full-text and extracted data independently. A narrative synthesis was conducted given the heterogeneity of studies. RESULTS: A total of 1032 studies were identified after searching the database, and 14 articles were included in this systematic review. Of the 84 women included, 12 (14.3%) presented failure or recurrence of their fistula tract. The mean time of follow-up was 11.46 months. The average size of the fistula was 1.05 (range 0.1 to 3.9) cm. Most fistulas (81) included were vesicovaginal fistulas. Nine papers reported the usage of fibrin glue in which only three (6.5%) women reported recurrence of the fistula in a delay of 2 weeks to 26 months. The other studies used cyanoacrylate (14 women) and autologous fibrin injection from the patients' blood (31 women). No significant complications were reported. Complications reported were urinary tract infections in 3 women (3.6%), hematuria in 2 women (2.4%), overactive bladder symptoms in 6 women (7.2%) and septic pelvic thrombosis in one woman (1.2%). CONCLUSIONS: Tissue adhesive appears to be a promising alternative for management of urogenital fistulas without reported important complications.
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Adhesivos Tisulares , Fístula Vesicovaginal , Humanos , Femenino , Masculino , Resultado del Tratamiento , Adhesivo de Tejido de Fibrina , Fístula Vesicovaginal/etiología , CianoacrilatosRESUMEN
BACKGROUND: In recent years, Three-dimensional printing (3-DP) technology, has had several applications in many fields of medicine, including rhinology. The aim of this review is to evaluate the use of 3-DP buttons as a treatment option for nasal septal perforations (NSP). METHODS: We conducted a scoping review of the literature until June 07, 2022, on the online databases PubMed, Mendeley, and Cochrane Library. All articles referred to treatment of NSP with custom made buttons created by 3-DP technology were included in this study. RESULTS: A total of 197 articles were generated by the search. Six articles met the inclusion criteria. 3 of the articles referred to clinical cases or clinical series. A total of 35 patients used the 3-DP custom made button as a treatment for NSP. The retention rate of this buttons ranged from 90.5 % to 100 %. An overall decrease in NSP symptoms was also observed in the majority of patients, especially regarding the most common complaints such as nasal bleeding and crusting. CONCLUSION: The manufacturing of 3-DP buttons is a complex, time consuming process that requires both special laboratory equipment and trained staff. This method has the advantage of reducing the NSP related symptoms and an improving the retention rate. This could make the 3-DP custom made button a first-choice treatment for patients with NSP. However, as a new treatment option, it needs studies with more patients to determine its superiority over conventional buttons and its long-lasting therapeutic effects.
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Perforación del Tabique Nasal , Rinoplastia , Humanos , Tabique Nasal/cirugía , Perforación del Tabique Nasal/cirugía , Perforación del Tabique Nasal/diagnóstico , Diseño de Prótesis , Rinoplastia/métodos , Impresión TridimensionalRESUMEN
INTRODUCTION AND HYPOTHESIS: Preoperative anemia is a well-established risk factor for adverse perioperative outcomes in major surgery, but studies exploring complications after pelvic reconstructive surgery are limited. The objective of this study is to examine the impact of preoperative anemia on 30-day adverse outcomes in patients undergoing pelvic organ prolapse surgery. METHODS: A retrospective cohort of women undergoing pelvic organ prolapse surgery was captured from the National Surgery Quality Improvement Program database (2014-2019). The primary outcome was a composite of postoperative medical complications such as pulmonary embolism, acute renal failure, stroke, myocardial infarction, cardiac arrest, deep vein thrombosis, and sepsis. Secondary outcomes included surgical site infection, bleeding requiring blood transfusion, readmission within 7 days of surgery, and return to the operating room within 30 days. Multivariate logistic regression was used to adjust for important pre-specified potential confounders. RESULTS: A total of 50,848 women were included in the analysis and 9.9% (4,579) met the criteria for anemia (hematocrit <36%). Potentially serious medical complications were rare, occurring in only 348 women (0.7%), and were more common among anemic patients (1.1% vs 0.6%, p < 0.001). On multivariate analysis, preoperative anemia was associated with higher odds of both potentially serious medical complications (OR 1.38, 95% CI 1.01-1.88) and returning to the operating room (OR 1.55, 95% CI 1.23-1.94). Anemic patients had a four-fold increase in the odds of requiring a blood transfusion (OR 4.47, 95% CI 3.60-5.56). CONCLUSIONS: Preoperative anemia is associated with an increased risk of adverse postoperative outcomes in women having surgery for pelvic organ prolapse.
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Anemia , Prolapso de Órgano Pélvico , Procedimientos de Cirugía Plástica , Anemia/complicaciones , Anemia/epidemiología , Femenino , Humanos , Prolapso de Órgano Pélvico/complicaciones , Prolapso de Órgano Pélvico/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Mejoramiento de la Calidad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: Nutrition transition and recent changes in lifestyle in Middle Eastern countries have resulted in the double burden of malnutrition. In Egypt, 88% of urban women are overweight or obese and 50% are iron deficient. Their energy, sugar, and sodium intakes are excessive, while intakes of iron, vitamin D, and folate are insufficient. OBJECTIVE: This study aimed to formulate dietary advice based on locally consumed and affordable foods and determine the need for fortified products to meet the nutrient requirements of urban Egyptian women. METHODS: Food intakes were assessed using a 4-d food diary collected from 130 urban Egyptian women aged 19-30 y. Food prices were collected from modern and traditional markets to calculate diet cost. Population-based linear and goal programming analyses (Optifood tool) were used to identify "limiting nutrients" and to assess whether locally consumed foods (i.e., consumed by >5% of women) could theoretically improve nutrient adequacy at an affordable cost (i.e., less than or equal to the mean diet cost), while meeting recommendations for SFAs, sugars, and sodium. The potential of hypothetical fortified foods for improving intakes of micronutrients was also assessed. RESULTS: Iron was the most limiting nutrient. Daily consumption of fruits, vegetables, milk or yogurt, meat/fish/eggs, and tahini (sesame paste) were likely to improve nutrient adequacy for 11 out of 12 micronutrients modeled. Among fortified foods tested, iron-fortified rice, milk, water, bread, or yogurt increased the minimized iron content of the modeled diet from 40% to >60% of the iron recommendation. CONCLUSIONS: A set of dietary advice based on locally consumed foods, if put into practice, can theoretically meet requirements for most nutrients, except for iron for which adequacy is harder to achieve without fortified products. The acceptability of the dietary changes modeled needs evaluation before promoting them to young Egyptian women.
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Dieta , Hierro , Necesidades Nutricionales , Adulto , Egipto , Femenino , Alimentos Fortificados , Humanos , Micronutrientes , Población Urbana , Adulto JovenRESUMEN
Table 3 in the originally published article contains layout error. Corrected Table 3 shown below.
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INTRODUCTION AND HYPOTHESIS: Pooled surgical waitlists are used to maximize the use of surgical resources; however, patients' views of this strategy are poorly understood. We sought to evaluate patients' attitudes toward a pooled waitlist for urogynecology and pelvic reconstructive surgical procedures. METHODS: Patient and provider focus groups were used to inform the design of a survey that was distributed to patients at the time of consent for female pelvic reconstructive surgical procedures. All responses were collected anonymously. Patient attitudes toward surgical wait times and the potential for a pooled surgical waitlist were explored. Grouped responses by age, procedure type, and perceived disease severity were examined. RESULTS: One hundred seventy-six patients were surveyed. Thirty-four percent were amenable to the option of a pooled surgical waitlist; 86% agreed or strongly agreed that they preferred to have their surgery performed by their own care provider. Only 18% would agree to be on a pooled surgical waitlist if it shortened their wait time. Older women (≥ 65 years) were more likely to disagree or strongly disagree that they "would like the option of having surgery done by the next available skilled surgeon" (56.2% vs. 72.0%, p = 0.028). Self-perceived severe disease and mid-urethral sling surgery were not associated with a higher acceptance of pooled surgical waitlists. CONCLUSIONS: Acceptance of pooled surgical waitlists among urogynecology patients was overall low, irrespective of disease severity. Improving our understanding of urogynecology patients' concerns and potentially negative perceptions of surgical waitlists is needed to ensure patient comfort and satisfaction are not compromised if this strategy is adopted.
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Procedimientos Quirúrgicos Ginecológicos/psicología , Aceptación de la Atención de Salud/psicología , Trastornos del Suelo Pélvico/psicología , Procedimientos de Cirugía Plástica/psicología , Listas de Espera , Adulto , Anciano , Actitud , Femenino , Grupos Focales , Humanos , Persona de Mediana Edad , Trastornos del Suelo Pélvico/cirugía , Encuestas y CuestionariosRESUMEN
BACKGROUND: Vaginal evisceration is a rare gynaecologic emergency that necessitates surgical intervention. It may manifest with obvious vaginal rupture, or it may be occult, specifically in patients with chronic pelvic organ prolapse. CASE: A 66-year-old woman with a history of bowel cancer and irradiation presented with occult vaginal evisceration. This was discovered during a routine follow-up appointment. It was repaired in two layers with xenograft derived from porcine intestinal mucosa (Surgisis, Cook Medical, Bloomington, IN) interposition and a concomitant colpocleisis. Long-term complications of the procedure included recurrent prolapse, but her vaginal vault evisceration did not recur. CONCLUSION: In patients with chronic pelvic organ prolapse, especially in those with additional risk factors for poor tissue strength, the possibility of vaginal vault evisceration or dehiscence should be considered. These patients would benefit from close follow-up.
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Prolapso de Órgano Pélvico , Vagina/cirugía , Anciano , Femenino , Humanos , Neoplasias Intestinales/complicaciones , Prolapso de Órgano Pélvico/diagnóstico , Prolapso de Órgano Pélvico/etiología , Prolapso de Órgano Pélvico/cirugíaRESUMEN
BACKGROUND: Chronic rhinosinusitis (CRS) is a common disorder associated with other respiratory tract diseases such as asthma and inhalant allergy. However, the prevalence of these co-morbidities varies considerably in the existing medical literature and by phenotype of CRS studied. The study objective was to identify the prevalence of asthma, inhalant allergy and aspirin sensitivity in CRS patients referred to secondary care and establish any differences between CRS phenotypes. METHODS: All participants were diagnosed in secondary care according to international guidelines and invited to complete a questionnaire including details of co-morbidities and allergies. Data were analysed for differences between controls and CRS participants and between phenotypes using chi-squared tests. RESULTS: The final analysis included 1470 study participants: 221 controls, 553 CRS without nasal polyps (CRSsNPs), 651 CRS with nasal polyps (CRSwNPs) and 45 allergic fungal rhinosinusitis (AFRS). The prevalence of asthma was 9.95, 21.16, 46.9 and 73.3% respectively. The prevalence of self-reported confirmed inhalant allergy was 13.1, 20.3, 31.0 and 33.3% respectively; house dust mite allergy was significantly higher in CRSwNPs (16%) compared to CRSsNPs (9%, p < 0.001). The prevalence of self- reported aspirin sensitivity was 2.26, 3.25, 9.61 and 40% respectively. The odds ratio for aspirin sensitivity amongst those with AFRS was 28.8 (CIs 9.9, 83.8) p < 0.001. CONCLUSIONS: The prevalence of asthma and allergy in CRS varies by phenoytype, with CRSwNPs and AFRS having a stronger association with both. Aspirin sensitivity has a highly significant association with AFRS. All of these comorbidities are significantly more prevalent than in non-CRS controls and strengthen the need for a more individualised approach to the combined airway.
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Aspirina/efectos adversos , Asma/epidemiología , Hipersensibilidad a las Drogas/epidemiología , Rinitis/epidemiología , Sinusitis/epidemiología , Encuestas y Cuestionarios , Administración por Inhalación , Asma/diagnóstico , Estudios de Casos y Controles , Enfermedad Crónica , Estudios Transversales , Hipersensibilidad a las Drogas/diagnóstico , Femenino , Humanos , Masculino , Prevalencia , Estudios Prospectivos , Rinitis/diagnóstico , Sinusitis/diagnóstico , Estadística como Asunto/tendencias , Reino Unido/epidemiologíaRESUMEN
AIMS: Patients often turn to the Internet for information on medical conditions. We sought to evaluate the quality and readability of highly visible websites on overactive bladder (OAB). METHODS: A survey of 42 consecutive patients attending outpatient urogynecology clinics was performed to identify the most commonly used Internet search engines and search terms for information on OAB. The three most commonly used search engines (Google, Bing, and Yahoo!) were then queried using the three most commonly used search terms. The first 20 relevant websites from each search were reviewed. After excluding duplicates, 35 websites were analyzed. Website quality of information on OAB was evaluated using the DISCERN score, JAMA benchmark criteria, and Health on the Net code (HONcode) accreditation status. Readability was assessed using the Simplified Measure of Gobbledygook (SMOG) and Dale-Chall indices. RESULTS: Websites were classified as advertisement/commercial (31%), health portal (29%), professional (26%), patient group (6%), and other (9%). The overall mean DISCERN score was 44 ± 18 (maximum possible score of 80). Three websites (9%) met all four JAMA benchmark criteria. Seventeen percent of websites provided adequate information on content authorship and contributions. Median SMOG and Dale-Chall indices were 9.9 (IQR 9.3-11.2) and 9.0 (IQR 8.1-9.4), respectively. Nine websites (26%) were HONcode certified. CONCLUSIONS: Popular websites on OAB are of low quality, written for a high school to college-level readership, and often lack adequate information to assess the potential for commercial bias. Patients should be cautioned that incomplete and potentially biased information on OAB is prevalent online.
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Internet/normas , Educación del Paciente como Asunto/normas , Vejiga Urinaria Hiperactiva , Comprensión , Humanos , Conducta en la Búsqueda de Información , Pacientes , Motor de Búsqueda/estadística & datos numéricos , Medios de Comunicación Sociales , Encuestas y CuestionariosRESUMEN
AIMS: To compare surgical complications for patients having minimally invasive sacrocolpopexy (MISCP) with concomitant incontinence procedure, to those having MISCP alone. METHODS: Patients undergoing MISCP with and without a concomitant incontinence procedure between 2006 and 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program database using Current Procedural Terminology codes. The main outcome of interest was a composite of surgical site infection, bleeding requiring blood transfusion, return to the operating room within 30 days, and surgical stay >48 h. Log-binomial regression was used to identify independent risk factors for the outcome and to generate adjusted effect measures for variables of interest. RESULTS: Seven thousand ninety-seven women met the inclusion criteria, of which 2433 (34%) underwent a concomitant incontinence procedure. Patients having incontinence procedures were slightly older (59 ± 11 vs 58 ± 12, P < 0.0001) and had longer total operating time (225 IQR 170-267 vs 184 IQR 120-232 min, P < 0.0001). Pre-operative steroid use, wound class III/IV (vs I/II), and longer operative time were independent predictors of the composite outcome. After adjusting for baseline patient characteristics and co-morbidities, no association was observed between concomitant incontinence procedure and the composite outcome (adjusted RR 0.87, 95%CI 0.65-1.18) but there was an increased likelihood of urinary tract infection (adjusted RR 2.47 95%CI 1.89-3.27). CONCLUSIONS: Despite being associated with a longer operative time, performing an incontinence procedure at the time of MSCIP was not associated with an increased risk of clinically important surgical complications other than urinary tract infection.
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Prolapso de Órgano Pélvico/cirugía , Complicaciones Posoperatorias/epidemiología , Mejoramiento de la Calidad , Infección de la Herida Quirúrgica/epidemiología , Incontinencia Urinaria/cirugía , Anciano , Transfusión Sanguínea , Bases de Datos Factuales , Femenino , Humanos , Incidencia , Persona de Mediana Edad , Tempo Operativo , Prolapso de Órgano Pélvico/complicaciones , Complicaciones Posoperatorias/etiología , Factores de Riesgo , Infección de la Herida Quirúrgica/etiología , Incontinencia Urinaria/complicacionesRESUMEN
OBJECTIVES: Orbital infections are regularly encountered and are managed by various healthcare disciplines. Sepsis of the orbit and adjacent tissues can be associated with considerable acute complication and long-term sequelae. Therefore, prompt recognition and management of this condition are crucial. This article presents the outcomes of a 7-year complete cycle audit project and describes the development of the new local guideline on the management of orbital infections in our tertiary centre. METHODS: (1) A retrospective 5-year audit cycle on patients with orbital infections. (2) A review of available evidence on the management of orbital infections. (3) A new local multidisciplinary guideline on the management of orbital infections. (4) A retrospective 2-year second audit cycle to assess the clinical outcomes. RESULTS: Various disciplines intersect in the management of orbital infections. Standardising the management of this condition proved to be achievable through the developed guideline. However, room for improvement in practice exists in areas such as the promptness in referring patients to specialist care, the multidisciplinary assessment of patients on admission, and the improvement of scanning requests of patients.
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Auditoría Clínica , Manejo de la Enfermedad , Infecciones del Ojo/terapia , Órbita/diagnóstico por imagen , Enfermedades Orbitales/terapia , Guías de Práctica Clínica como Asunto , Adolescente , Adulto , Niño , Preescolar , Progresión de la Enfermedad , Infecciones del Ojo/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Orbitales/diagnóstico , Estudios Retrospectivos , Factores de Tiempo , Adulto JovenRESUMEN
BACKGROUND: Midurethral slings are the most widely used surgical treatment for stress urinary incontinence. Complications include bladder injury, voiding dysfunction, mesh exposure/erosion, dyspareunia, and failure to correct the incontinence. Complete mesh infection is rare. CASE: A 48-year-old woman underwent a repeat retropubic tension-free vaginal tape (TVT) procedure for stress urinary incontinence. She presented eight weeks postoperatively with a tender suprapubic mass and urinary retention. A CT scan demonstrated thickening of the bladder wall and cystoscopy revealed severe inflammation with no intramural injury. The sling appeared to be infected and was removed vaginally. The patient's symptoms resolved following removal of the sling. CONCLUSION: Mesh infection following a midurethral sling procedure is rare. In suspected cases, cystoscopy should be performed to rule out bladder injury. Antibiotic therapy may be successful, but removal of the sling may be required for resolution of symptoms.
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AIMS: CSF leaks are not uncommon after a base of skull fracture. Currently there is no standardised algorithm for the investigation and management of post-traumatic CSF leaks. In this paper we aim to provide an evidence-based framework for managing post-traumatic CSF leaks. METHODS: We searched the English literature over the past 45 years using CINAHL, EMBASE and MEDLINE for the terms (1) post-traumatic CSF leaks or fistulas, and (2) basilar or base of skull fractures, but excluded papers on post-operative and non-traumatic CSF leaks, and papers on paediatric post- traumatic CSF leaks. RESULTS: The diagnosis of a base of skull fracture and any resultant CSF leak can be challenging. Therefore a combination of biochemical and radiological studies are needed to optimise the diagnosis of this condition. Post-traumatic CSF leaks are generally treated conservatively, and a majority of them resolve without further surgical management. However for patients who are refractory to such treatments, surgical closure of the CSF fistula is necessary. Surgical obliteration of CSF leaks can be challenging and requires the involvement of multiple surgical specialties such as neurosurgery, otolaryngology, and maxillofacial surgery. CONCLUSION: Although we have formulated a simple algorithm to aid the investigation and management of post-traumatic CSF leaks, there are still many important unresolved questions requiring further well powered studies to answer.
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Pérdida de Líquido Cefalorraquídeo/etiología , Pérdida de Líquido Cefalorraquídeo/terapia , Base del Cráneo/lesiones , Fracturas Craneales/líquido cefalorraquídeo , Fracturas Craneales/complicaciones , Medicina Basada en la Evidencia , HumanosRESUMEN
The lack of molecular diagnosis in the field of cancer in Iraq has motivated us to perform a genetic analysis of pediatric acute myelogenous leukemia (AML), including class I and II aberrations. Peripheral blood or bone marrow cells were collected from 134 AML children aged ≤15 years. Flinders Technology Associates (FTA) filter paper cards were used to transfer dried blood samples from five Iraqi hospitals to Japan. DNA sequencing was performed to identify class I mutations. Nested RT-PCR was used to detect class II aberrations, except that MLL rearrangement was detected according to long distance inverse-PCR. NPM1 and FMS-like tyrosine kinase 3-internal tandem duplication (FLT3-ITD) mutations were analyzed by GeneScan using DNA template. Among 134 Iraqi pediatric AML samples, the most prevalent FAB subtype was M2 (33.6 %) followed by M3 (17.9 %). Class I mutations: 20 (14.9 %), 8 (6.0 %), and 8 (6.0 %) patients had FLT3-ITD, FLT3-TKD, and KIT mutations, respectively. Class II mutations: 24 (17.9 %), 19 (14.2 %), and 9 (6.7 %) children had PML-RARA, RUNX1-RUNX1T1, and CBFB-MYH11 transcripts, respectively. MLL rearrangements were detected in 25 (18.7 %) patients. NPM1 mutation was detected in seven (5.2 %) cases. Collectively, approximately 30 % of AML children were proved to carry favorable prognostic genetic abnormalities, whereas approximately 10 % had high FLT3-ITD allelic burden and needed a special treatment plan including allogeneic hematopoietic stem cell transplantation. Acute promyelocytic leukemia (APL) was frequent among Iraqi pediatric AML. It is likely that molecular diagnosis using FTA cards in underdeveloped countries could guide doctors towards an appropriate treatment strategy.
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Aberraciones Cromosómicas , Leucemia Mieloide Aguda/genética , Mutación , Análisis de Secuencia de ADN , Manejo de Especímenes/métodos , Adolescente , Alelos , Recolección de Muestras de Sangre/instrumentación , Recolección de Muestras de Sangre/métodos , Médula Ósea/patología , Niño , Preescolar , ADN de Neoplasias/genética , Femenino , Humanos , Lactante , Irak , Leucemia Mieloide Aguda/sangre , Leucemia Mieloide Aguda/patología , Leucemia Mieloide Aguda/terapia , Leucemia Mielomonocítica Aguda/sangre , Leucemia Mielomonocítica Aguda/genética , Leucemia Mielomonocítica Aguda/patología , Leucemia Mielomonocítica Aguda/terapia , Masculino , Nucleofosmina , Proteínas de Fusión Oncogénica/genética , Oncogenes , Papel , Pronóstico , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Manejo de Especímenes/instrumentación , Translocación Genética , Resultado del TratamientoRESUMEN
Primary clival mucoceles are a rare clinical entity that usually represents an incidental finding on computed tomography or magnetic resonance imaging scanning. There are only a few reports in the literature of patients who presented with vague symptoms such as headaches, facial paresthesia, and numbness. Clival mucoceles can also be secondary, by extension of a sphenoid mucocele to the clivus. We present a case of primary clival mucocele, aiming to highlight the importance of a multidisciplinary approach.
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Mucocele , Enfermedades de los Senos Paranasales , Humanos , Mucocele/diagnóstico por imagen , Mucocele/cirugía , Seno Esfenoidal/patología , Fosa Craneal Posterior/diagnóstico por imagen , Fosa Craneal Posterior/patología , Cefalea/etiología , Tomografía Computarizada por Rayos X , Imagen por Resonancia Magnética , Enfermedades de los Senos Paranasales/complicacionesRESUMEN
OBJECTIVE: Venous thromboembolism constitutes the leading cause of direct maternal mortality in the developed world. To date, there are no studies using magnetic resonance venography (MRV) to delineate the incidence and natural history of intraluminal filling defects in the postpartum period in patients with low thrombosis risk. STUDY DESIGN: This was a prospective cohort study of women at low thrombosis risk postvaginal delivery undergoing MRV in the early postpartum period. RESULTS: In 30 eligible and consenting participants, independently adjudicated MRV, conducted on a median of postpartum day 1, identified definite thrombosis in 30% (95% confidence interval [CI], 13.6-46.4%) of study participants. All episodes of definite thrombosis were identified in the iliac and ovarian veins. Probable thrombosis was identified in an additional 27% of study participants (95% CI, 10.3-41.7%), and possible thrombosis in an additional 10% (95% CI, 0-20.7%). CONCLUSION: In this group of low-risk postpartum patients, we identified a high prevalence of definite pelvic vein intraluminal filling defects of uncertain clinical significance. This study suggests that some degree of pelvic vein intraluminal filling defect may be a normal finding after uncomplicated vaginal delivery.
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Parto Obstétrico/efectos adversos , Parto Obstétrico/métodos , Angiografía por Resonancia Magnética/métodos , Pelvis/irrigación sanguínea , Flebografía/métodos , Trombosis de la Vena/diagnóstico , Adulto , Femenino , Humanos , Embarazo , Estudios Prospectivos , Adulto JovenRESUMEN
Surgery of the posterior ethmoid and sphenoid sinuses can be challenging. In 1999, a technique was described for identification of the superior turbinate and utilizing it as a landmark in endoscopic posterior ethmoidectomy and sphenoidotomy. Although this was more than a decade ago, it has not been supported by further studies. In our practice, we have routinely adopted this technique, and have modified it to allow further orientation during endoscopic surgery of the posterior sinuses. To describe a review of our technique, and to prospectively assess the value of the superior turbinate as a useful landmark during endoscopic posterior ethmoidectomy and sphenoidotomy. Fifty patients listed for endoscopic posterior ethmoidectomy with or without sphenoidotomy were included in a prospective study utilising our surgical technique. Data were collated for the success or failure of identification of the landmarks, and for any complications during the surgery. A total of 93 sides of endoscopic posterior ethmoidectomy and 73 sides of endoscopic sphenoidotomy were performed. The superior turbinate was identified in 100% of the cases. The coronal part of the superior turbinate basal lamella was identified in 60.22% of the cases, and the axial part in 88.17% of the cases. The natural sphenoid ostium was identified medial to the posterior part of the superior turbinate in 98.63% of the cases. The axial part of the superior turbinate basal lamella was a constant landmark for the level of the sphenoid ostium. The number of transverse septae between the axial part of the superior turbinate basal lamella and the skull base was studied, and was found never to exceed one septum. No major complications were recorded. One case of small posterior septal perforation was detected with no post-operative effects. Our study represents the first report of identifying the two parts of the superior turbinate basal lamella intra-operatively. It also represents the first report of using the axial basal lamella of the superior turbinate as a landmark for the level of the sphenoid sinus ostium, as well as a landmark for the level of the skull base. The superior turbinate represents a constant landmark for performing a safe posterior ethmoidectomy and sphenoidotomy.
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Puntos Anatómicos de Referencia , Endoscopía/métodos , Sinusitis del Etmoides/cirugía , Senos Paranasales/cirugía , Sinusitis del Esfenoides/cirugía , Cornetes Nasales , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Senos Etmoidales/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Seno Esfenoidal/cirugía , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Functional endoscopic sinus surgery (FESS) is now a well-established strategy for the treatment of chronic rhinosinusitis which has not responded to medical treatment. There is a wide variation in the practice of FESS by various surgeons within the UK and in other countries. OBJECTIVES: To identify anatomic factors that may predispose to persistent or recurrent disease in patients undergoing revision FESS. METHODS: Retrospective review of axial and coronal CT scans of patients undergoing revision FESS between January 2005 and November 2008 in a tertiary referral centre in South West of England. RESULTS: The CT scans of 63 patients undergoing revision FESS were reviewed. Among the patients studied, 15.9% had significant deviation of the nasal septum. Lateralised middle turbinates were present in 11.1% of the studied sides, and residual uncinate processes were identified in 57.1% of the studied sides. There were residual cells in the frontal recess in 96% of the studied sides. There were persistent other anterior and posterior ethmoidal cells in 92.1% and 96% of the studied sides respectively. CONCLUSIONS: Analysis of CT scans of patients undergoing revision FESS shows persistent structures and non-dissected cells that may be responsible for persistence or recurrence of rhinosinusitis symptoms. Trials comparing the outcome of conservative FESS techniques with more radical sinus dissections are required.
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An osteoma within the paranasal sinuses is a rare benign fibro-osseous tumour. Osteomas occurring in the maxillary sinus are exceedingly rare and account for only 5% of the cases. A case of a 38-year-old female with an osteoma of the maxillary sinus is presented and the disease and its management are discussed. A 2 cm spherical lesion in her right maxillary sinus was picked up incidentally on a magnetic resonance imaging scan whilst being investigated for unrelated neurological symptoms and in the absence of any sinonasal symptoms. An endoscopic biopsy demonstrated that the mass was an osteoma. The management of paranasal sinus osteomas is surgical and is governed by patient symptoms, tumour size and location, in the light of the risk of future intracranial or intraorbital complications. The choice of surgical approach is determined by the location of the tumour and, the experience of the surgeon. In this case a combined external and endonasal approach was the most appropriate management due to the size of the tumour and the risk of intraorbital complications. The patient underwent a combined Caldwell-Luc and transnasal endoscopic resection without complication.
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Neoplasias del Seno Maxilar/patología , Osteoma/patología , Adulto , Femenino , Humanos , Neoplasias del Seno Maxilar/diagnóstico por imagen , Neoplasias del Seno Maxilar/cirugía , Osteoma/diagnóstico por imagen , Osteoma/cirugía , Tomografía Computarizada por Rayos XRESUMEN
SIGNIFICANCE STATEMENT: Granulomatosis with polyangitis (GPA) is a systemic necrotizing vasculitis comprising of inflammation of small and medium-sized vessels.1 It typically presents with involvement of the upper and lower airways as well as the kidneys. If left untreated, end-organ damage may occur. Hematological investigations typically demonstrate the presence of antinuclear cytoplasmic antibodies (ANCA).2 Here, we discuss an unusual presentation of ANCA negative GPA, presenting initially with nasal symptoms.