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1.
Ann R Coll Surg Engl ; 104(4): e122-e124, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34939843

RESUMO

A 49-year-old patient with a history of aspirin-exacerbated respiratory disease presented with carotid artery injury following revision functional endoscopic sinus surgery. Carotid artery injury is a rare but catastrophic complication of this surgery. The patient was transferred to our tertiary facility with interventional radiology for immediate management of the carotid artery injury. This case reaffirms that any surgery can have disastrous complications and highlights the importance of multidisciplinary management of complications such as carotid artery injury.


Assuntos
Lesões das Artérias Carótidas , Sinusite , Lesões das Artérias Carótidas/diagnóstico por imagem , Lesões das Artérias Carótidas/etiologia , Lesões das Artérias Carótidas/cirurgia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Endoscopia/efeitos adversos , Humanos , Pessoa de Meia-Idade
2.
Arch. argent. pediatr ; 120(4): e171-e174, Agosto 2022. ilus
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1378563

RESUMO

La atresia de coanas se caracteriza por la obliteración de la abertura nasal posterior. Es la anomalía congénita más frecuente de las fosas nasales. Tiene una incidencia de 1 cada 5000 a 7000 neonatos, con predominio en el sexo femenino. Puede presentarse en forma aislada o asociada a otros síndromes como el CHARGE (coloboma [C], malformaciones cardíacas [H], atresia de coanas [A], retraso psicomotor y/o en el crecimiento [R], hipoplasia de genitales [G], malformaciones auriculares y/o sordera [E, por su sigla en inglés]). Las manifestaciones clínicas son la obstrucción nasal, cianosis y dificultad respiratoria desde el nacimiento cuando es bilateral. Las atresias unilaterales se caracterizan por insuficiencia ventilatoria nasal y rinorrea unilateral, y pueden pasar inadvertidas. El diagnóstico se realiza mediante endoscopia y estudios por imágenes. El tratamiento es quirúrgico; existen diferentes técnicas y vías de abordaje. Se presenta el caso de un paciente masculino de 7 años con atresia unilateral de coana derecha con resolución microendoscópica, colocación de tutor externo, con buena resolución.


Choanal atresia is characterized by obliteration of the posterior nasal opening. It is the most common congenital anomaly of the nasal passages. It has an incidence of 1 in 5000 to 7000 newborns; predominantly female. It can occur in isolation or in association with other syndromes such as CHARGE (coloboma [C], cardiac malformations [H], choanal atresia [A], psychomotor and/or growth retardation [R], genital hypoplasia [G], atrial malformations and/or deafness [E]. Clinicallypresents nasal obstruction, cyanosis and respiratory distress from birth when bilateral, unilateral atresias are characterized by nasal ventilatory insufficiency and unilateral rhinorrhea, which may go unnoticed. Diagnosis is made by endoscopy and imaging tests. Treatment is surgical, with different techniques and approaches.A 7-year-old male patient is presented with unilateral atresia of the right choana with microendoscopic resolution, placement of an external tutor, with good resolution.


Assuntos
Humanos , Masculino , Criança , Obstrução Nasal/etiologia , Coloboma , Atresia das Cóanas/cirurgia , Atresia das Cóanas/complicações , Atresia das Cóanas/diagnóstico , Nasofaringe , Endoscopia/efeitos adversos , Endoscopia/métodos
3.
J Orthop Surg Res ; 17(1): 356, 2022 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-35842677

RESUMO

PURPOSE: To evaluate the clinical features of and risk factors for recurrent lumbar disc herniation (rLDH) after percutaneous endoscopic lumbar discectomy (PELD) in our clinical practice. METHODS: A total of 942 consecutive patients who underwent single-level PELD from January 2013 to August 2019 were included. Patients were divided into the recurrence group and the nonrecurrence group. Patient characteristics, radiographic parameters and surgical variables were compared between the two groups. Univariate analysis and multiple logistic regression analysis were adopted to determine the risk factors for recurrence after PELD. RESULTS: The prevalence of rLDH was 6.05%. Age, sex, tobacco use, duration of low back pain, body mass index (BMI), occupational lifting, herniated disc type, facet joint degeneration, operation time and time to ambulation were significantly different between the two groups. Univariate analysis showed that age (P < 0.001), sex (P = 0.019), BMI (P = 0.001), current smoking (P < 0.001), occupational lifting (P < 0.001), facet joint degeneration (P = 0.001), operation time (P = 0.002), and time to ambulation (P < 0.001) could be significantly associated with the incidence of rLDH after PELD. Multivariate analysis suggested that an older age (P < 0.001), the male sex (P = 0.017), a high BMI (P < 0.001), heavy work (P = 0.003), grade II facet joint degeneration (P < 0.001) and early ambulation (P < 0.001) were significantly related to rLDH after PELD. CONCLUSIONS: An older age, the male sex, a higher BMI, heavy work, grade II facet joint degeneration, and early ambulation are independent significant risk factors for rLDH after PELD. Great importance should be attached to these risk factors to prevent rLDH. We suggest that patients control their weight, avoid heavy work, ambulate at an appropriate time, and perform strengthening rehabilitation exercises to reduce the incidence of rLDH.


Assuntos
Discotomia Percutânea , Deslocamento do Disco Intervertebral , Discotomia , Discotomia Percutânea/efeitos adversos , Endoscopia/efeitos adversos , Humanos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/epidemiologia , Deslocamento do Disco Intervertebral/etiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Estudos Retrospectivos , Resultado do Tratamento
4.
Arch Argent Pediatr ; 120(4): e171-e174, 2022 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-35900957

RESUMO

Choanal atresia is characterized by obliteration of the posterior nasal opening. It is the most common congenital anomaly of the nasal passages. It has an incidence of 1 in 5000 to 7000 newborns; predominantly female. It can occur in isolation or in association with other syndromes such as CHARGE (coloboma [C], cardiac malformations [H], choanal atresia [A], psychomotor and/or growth retardation [R], genital hypoplasia [G], atrial malformations and/or deafness [E]. Clinically presents nasal obstruction, cyanosis and respiratory distress from birth when bilateral, unilateral atresias are characterized by nasal ventilatory insufficiency and unilateral rhinorrhea, which may go unnoticed. Diagnosis is made by endoscopy and imaging tests. Treatment is surgical, with different techniques and approaches. A 7-year-old male patient is presented with unilateral atresia of the right choana with microendoscopic resolution, placement of an external tutor, with good resolution.


La atresia de coanas se caracteriza por la obliteración de la abertura nasal posterior. Es la anomalía congénita más frecuente de las fosas nasales. Tiene una incidencia de 1 cada 5000 a 7000 neonatos, con predominio en el sexo femenino. Puede presentarse en forma aislada o asociada a otros síndromes como el CHARGE (coloboma [C], malformaciones cardíacas [H], atresia de coanas [A], retraso psicomotor y/o en el crecimiento [R], hipoplasia de genitales [G], malformaciones auriculares y/o sordera [E, por su sigla en inglés]). Las manifestaciones clínicas son la obstrucción nasal, cianosis y dificultad respiratoria desde el nacimiento cuando es bilateral. Las atresias unilaterales se caracterizan por insuficiencia ventilatoria nasal y rinorrea unilateral, y pueden pasar inadvertidas. El diagnóstico se realiza mediante endoscopia y estudios por imágenes. El tratamiento es quirúrgico; existen diferentes técnicas y vías de abordaje. Se presenta el caso de un paciente masculino de 7años con atresia unilateral de coana derecha con resolución microendoscópica, colocación de tutor externo, con buena resolución.


Assuntos
Atresia das Cóanas , Coloboma , Obstrução Nasal , Criança , Atresia das Cóanas/complicações , Atresia das Cóanas/diagnóstico , Atresia das Cóanas/cirurgia , Endoscopia/efeitos adversos , Endoscopia/métodos , Feminino , Humanos , Recém-Nascido , Masculino , Obstrução Nasal/etiologia , Nasofaringe
5.
J Otolaryngol Head Neck Surg ; 51(1): 30, 2022 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-35902904

RESUMO

BACKGROUND: Intra-operative internal carotid artery (ICA) injury during transnasal endoscopic surgery is a potentially catastrophic event. Such an injury is life-threatening in the immediate setting, with a reported peri-operative mortality rate of 10%. Nasal packing, muscle patches, direct vessel closure, and endovascular techniques have been described as useful strategies for managing ICA bleeds. The objective of this study was to develop a formalized management protocol for intra-operative ICA injury through engagement with a multi-disciplinary panel. METHODS: A modified Delphi method including literature review, iterative rounds of stakeholder feedback, and expert panel discussions was used to develop a management protocol for ICA injury during transnasal endoscopic surgery. The 10-person multi-disciplinary panel included otolaryngologists, neurosurgeons, interventional neuroradiologists, anesthesiologists, and operating room nursing staff. RESULTS: After three rounds of stakeholder engagement with the expert panel, consensus was reached on important elements to include within the protocol. The protocol was divided in three categories: Alert, Control, and Transfer. 'Alert' focusses on early communication with anesthesia and nursing staff. 'Control' focusses on techniques to expose the injury and obtain hemostasis or adequate tamponade. Lastly, 'Transfer' describes the process of contacting neuro-interventional radiology and safely transferring the patient. A one-page handout of the protocol was developed for placement in operating theatres. CONCLUSION: Due to the life-threatening nature of ICA injury, it is imperative that endoscopic sinus and skull base surgeons are prepared to manage this complication. Using a modified Delphi method with a multidisciplinary expert panel, a protocol for management of intra-operative ICA injury was developed.


Assuntos
Lesões das Artérias Carótidas , Artéria Carótida Interna , Lesões das Artérias Carótidas/etiologia , Lesões das Artérias Carótidas/cirurgia , Artéria Carótida Interna/cirurgia , Técnica Delfos , Endoscopia/efeitos adversos , Endoscopia/métodos , Humanos , Base do Crânio/cirurgia
6.
Neurol India ; 70(3): 996-1003, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35864631

RESUMO

Background: Cerebral vasospasm (CVS) due to injuries to arteries of the circle of willies has been reported in transsphenoidal pituitary surgeries. However, the incidence of delayed vasospasm following endoscopic transsphenoidal surgery is rare. Materials and Methods: Total 569 pituitary adenomas were operated on by endoscopic transsphenoidal approach from January 2016 to February 2020. We retrospectively described two cases of vasospasm following pituitary surgery from our institution. Objective: To describe two cases of delayed cerebral vasospasm following endoscopic transsphenoidal surgery and review previous literature. Results: Out of two patients, the Glasgow outcome score (GOS) of one patient was favorable and the other was unfavorable. Conclusion: CVS is rare after transsphenoidal pituitary surgery, which makes its predictability difficult. The clinician should maintain a high index of suspicion in patients with suprasellar extension of the tumor and postoperative hematoma in the tumor bed. Similarly, care should be taken in patients with a subarachnoid hemorrhage in basal cistern, intraoperative arachnoid breach, and postoperative meningitis.


Assuntos
Adenoma , Neoplasias Hipofisárias , Vasoespasmo Intracraniano , Adenoma/complicações , Adenoma/cirurgia , Endoscopia/efeitos adversos , Humanos , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Vasoespasmo Intracraniano/etiologia
7.
Neurol India ; 70(3): 1137-1141, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35864651

RESUMO

Background: Endoscopic endonasal surgery (EES) requires wide sinonasal dissection to achieve adequate visualisation of anatomical landmarks. This can also result in nasal sequelae like crusting, nasal discharge, and anosmia. Aim: To use the sinonasal outcome test (SNOT) 22 questionnaire to study the postoperative sinonasal morbidity and its recovery in patients who have undergone EES. Materials and Method: Prospective study conducted from November 2017 to May 2018. SNOT-22 questionnaire was administered on patients operated between before EES and then re-administered during outpatient visits at 1 month, 3 months, and 6-12 months following surgery. Results: Results of 46 patients were analyzed. The mean duration of follow-up was 11.8 months. The mean preoperative SNOT-22 score was 2.69 ± 4.95. SNOT-22 score at 1 month was 5.52 ± 6.77, at 3 months follow-up was 0.39 ± 1.02, and after 6 months was 0.30 ± 1.00. In 32 patients with a nasoseptal flap, mean preoperative score was 3.34 ± 5.68 (P = 0.18), one month following surgery it was 6.68 ± 6.88 and at 3 and 6 months following surgery it was 0.56 ± 1.19 and 0.38 ± 1.15. The mean preoperative nasal domain score was 1.022 (±2.13), the postoperative 1 month score was 2.3 ± 3.7, at 3 months following surgery was 0.22 ± 0.82 and after 6 months of surgery was 0.28 ± 0.96. Conclusion: Patients undergoing EES experienced transient worsening of SNOT 22 scores in the first month following surgery and recovered within 3 months of surgery. The improvement was sustained in follow-up visits beyond 6 months of surgery.


Assuntos
Endoscopia , Doenças Nasais , Nariz , Base do Crânio , Endoscopia/efeitos adversos , Endoscopia/métodos , Seguimentos , Humanos , Nariz/lesões , Doenças Nasais/etiologia , Doenças dos Seios Paranasais/etiologia , Seios Paranasais/lesões , Neoplasias Hipofisárias/cirurgia , Estudos Prospectivos , Qualidade de Vida , Recuperação de Função Fisiológica , Base do Crânio/cirurgia , Resultado do Tratamento
8.
World J Gastroenterol ; 28(20): 2243-2247, 2022 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-35721883

RESUMO

BACKGROUND: Intramural duodenal hematoma is a rare condition described for the first time in 1838. This condition is usually associated with blunt abdominal trauma in children. Other non-traumatic risk factors for spontaneous duodenal haematoma include several pancreatic diseases, coagulation disorders, malignancy, collagenosis, peptic ulcers, vasculitis and upper endoscopy procedures. In adults the most common risk factor reported is anticoagulation therapy. The clinical presentation may vary from mild abdominal pain to acute abdomen and intestinal obstruction or gastrointestinal bleeding. CASE SUMMARY: The aim of this case summary is to show a case of intramural spontaneous hematoma with symptoms of intestinal obstruction that was properly drained endoscopically by an innovative system lumen-apposing metal stent Hot AXIOS™ stent (Boston Scientific Corp., Marlborough, MA, United States). CONCLUSION: Endoscopic lumen-apposing metal stent Hot AXIOS™ stent is a safe and feasible treatment of duodenal intramural hematoma in our case.


Assuntos
Duodenopatias , Obstrução Intestinal , Adulto , Criança , Duodenopatias/diagnóstico por imagem , Duodenopatias/etiologia , Duodenopatias/cirurgia , Endoscopia/efeitos adversos , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Obstrução Intestinal/complicações
9.
J Am Coll Surg ; 235(1): 26-33, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35703959

RESUMO

BACKGROUND: Leaks of the esophagus and stomach are difficult to manage and associated with significant morbidity and mortality. Endoscopic therapy can manage these leaks without surgical intervention. Our goal is to create a scoring tool to aid in predicting the success of endoscopic therapy in these patients. STUDY DESIGN: An IRB-approved prospectively maintained database was retrospectively reviewed for all patients treated for gastrointestinal leaks from July 2013 to January 2021, including patients treated for esophageal and stomach leaks. Endpoints include success of leak closure for patients treated solely by endoscopic therapy (ET) compared with surgical therapy as failed endoscopic therapy (FET). A multivariable logistic regression model was fitted to identify independent risk factors for predicting success of endoscopic therapy, and a scoring calculator was developed. RESULTS: There were 80 patients (60 females) with a mean age of 50 years. The ET group included 59 patients (74%), whereas the FET group included 21 patients (26%). Patient demographics, comorbidities, surgical history, and timing of leak diagnosis were used. Multivariable analysis resulted in 4 variables associated with higher probability of successful endoscopic leak management without need for additional surgery. These included increased age, lower BMI, lack of previous bariatric surgery, and quicker identification of the leak. Consequently, a scoring nomogram was developed with values from 0 to 22. CONCLUSION: Our data show the development of a scoring calculator capable of quantifying the likelihood of success treating foregut and bariatric leaks with endoscopic therapies. This can be used clinically to guide treatment decisions.


Assuntos
Fístula Anastomótica , Cirurgia Bariátrica , Abdome , Fístula Anastomótica/diagnóstico , Fístula Anastomótica/etiologia , Fístula Anastomótica/cirurgia , Cirurgia Bariátrica/efeitos adversos , Endoscopia/efeitos adversos , Feminino , Gastrectomia/efeitos adversos , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents/efeitos adversos , Resultado do Tratamento
10.
J Orthop Surg Res ; 17(1): 336, 2022 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-35765022

RESUMO

PURPOSE: To explore the influence of irrigating fluid at different temperatures on patients' body temperature and local inflammatory mediators during spinal endoscopy. METHODS: 110 cases of intervertebral foramen surgery in our hospital from January 2019 to October 2021 were randomly divided into control group and observation group. Operations of both groups were performed by the same experienced chief physician. The observation group was irrigated with 37 °C constant temperature saline, while the control group was irrigated at room temperature. The effect was evaluated by monitoring the intraoperative temperature, postoperative VAS score and the levels of inflammatory factors, such as TNF-α, IL-1, IL-6 and IL-10 in drainage fluid. RESULTS: After 30 min of operation, overall temperature of the control group dropped significantly, and 50 cases (90.9%) had hypothermia, P < 0.05. There was no significant difference in preoperative VAS score between the two groups P > 0.05. The VAS score of observation group was significantly lower than that of control group at 6 h and 1 month after operation, P < 0.05. At 0, 3 and 6 h after operation, the values of TNF-α, IL-1, IL-6 and IL-10 in the observation group were significantly lower than those in the control group (P < 0.05). CONCLUSIONS: Isothermal flushing solution can reduce the incidence of hypothermia and effectively alleviate local inflammatory reaction.


Assuntos
Discotomia Percutânea , Hipotermia , Deslocamento do Disco Intervertebral , Temperatura Corporal , Discotomia/efeitos adversos , Endoscopia/efeitos adversos , Humanos , Hipotermia/cirurgia , Interleucina-1 , Interleucina-10 , Interleucina-6 , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Temperatura , Fator de Necrose Tumoral alfa
11.
BMC Gastroenterol ; 22(1): 282, 2022 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-35658914

RESUMO

BACKGROUND: Endoscopic vacuum therapy (EVT) has become a standard treatment method for esophageal perforations in adults. However, experience with EVT in infants is scarce. In this retrospective case series, we report on four very young infants who were successfully treated with EVT for esophageal perforations of different etiology. METHODS: Four infants were diagnosed with esophageal perforations on day 7, 32, 35 and 159 of life, respectively. The youngest one was prematurely born in the 31st week of pregnancy weighing 980 g only. Three infants had perforations due to foreign body insertion (nasogastric tube or pulling through of percutaneous endoscopic gastrostomy (PEG) tube through the esophagus). One child had an anastomotic dehiscence after Foker's surgery for atresia. In three children EVT was applied as first-line therapy for perforation, in one child EVT was a rescue therapy due to persisting leakage after surgical closure involving thoracotomy. Depending on the esophageal diameter, either an open-pore drainage film or polyurethane sponge was attached to a single-lumen 8 Fr suction catheter, endoscopically (or fluoroscopically by wire-guidance) placed into the esophagus (intraluminal EVT) and supplied with continuous negative pressure (ranging between 75 and 150 mmHg). The EVT system was exchanged twice per week. RESULTS: Complete closure of the perforation/leakage could be achieved in all four infants (100%) after 22 days of continuous EVT (median value; range 7-39) and 4.5 EVT exchanges (median value; range 1-12). No serious adverse events occurred. CONCLUSIONS: EVT is an effective and safe addition to our therapeutic armamentarium in the management of esophageal perforations irrespective of its etiology. Here we prove the feasibility of EVT even in very young infants. The use of an extra thin vacuum open-pore drainage film is helpful to cope with the small esophageal diameter. EVT settings and exchange rates similar to those known from adult treatment were used.


Assuntos
Perfuração Esofágica , Tratamento de Ferimentos com Pressão Negativa , Adulto , Fístula Anastomótica/etiologia , Criança , Endoscopia/efeitos adversos , Perfuração Esofágica/etiologia , Perfuração Esofágica/cirurgia , Humanos , Lactente , Tratamento de Ferimentos com Pressão Negativa/efeitos adversos , Tratamento de Ferimentos com Pressão Negativa/métodos , Estudos Retrospectivos
12.
BMC Musculoskelet Disord ; 23(1): 502, 2022 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-35624443

RESUMO

BACKGROUND: Lumbar spinal stenosis (LSS) is one of the most frequent indications for spine surgery. Open decompression and fusion surgery was the most common treatment and used to be regarded as the golden standard treatment for LSS. In recent years, percutaneous endoscopic decompression surgery was also used for LSS. However, the effectiveness and safety of percutaneous endoscopic decompression in the treatment of LSS have not been supported by high-level evidence. Our aim is to 1) compare the effectiveness of percutaneous endoscopic decompression surgery and open decompression and fusion for the treatment of LSS. 2) Investigate the prognosis risk factors for LSS. 3) Evaluate the influence of percutaneous endoscopic decompression for the stability of operative level, and degeneration of adjacent level. METHODS: It's a prospective, multicenter cohort study. The study is performed at 4 centers in Beijing. This study plans to enroll 600 LSS patients (300 patients in the percutaneous endoscopic decompression group, and 300 patients in the open decompression and fusion group). The demographic variables, healthcare variables, symptom related variables, clinical assessment (Visual analogue score (VAS), Oswestry disability index (ODI), Japanese Orthopaedic Association score (JOA)), and radiological assessment (dynamic X-ray, CT, MRI) will be collected at baseline visit. Patients will follow up at 3, 6, 12 months. The primary outcome is the difference of improvement of ODI between baseline and 12-month follow-up between the two groups. The secondary outcome is the score changes of preoperative and postoperative VAS, the recovery rate of JOA, MacNab criteria, patient satisfaction, degeneration grade of adjacent level, ROM of operative level and adjacent level, complication rate. DISCUSSION: In this study, we propose to conduct a prospective registry study to address the major controversies of LSS decompression under percutaneous spinal endoscopy, and investigate the clinical efficacy and safety of percutaneous endoscopic decompression and open decompression in the treatment of LSS. TRIAL REGISTRATION: This study has been registered on clinicaltrials.gov in January 15, 2020 ( NCT04254757 ). (SPIRIT 2a).


Assuntos
Estenose Espinal , Estudos de Coortes , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/métodos , Endoscopia/efeitos adversos , Endoscopia/métodos , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Estudos Multicêntricos como Assunto , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/cirurgia
13.
J Clin Neurosci ; 101: 1-8, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35490574

RESUMO

The purpose of this study is to describe the morbidity in patients undergoing endoscopic skull base surgery (ESBS) with and without intra-operative lumbar drain (LD) placement. A retrospective review of all patients undergoing ESBS from July 2018 to August 2020 at a tertiary academic skull base surgery program was conducted. Those with LD placement for aiding in suprasellar dissection and/or for CSF diversion following skull base repair were included. LD-related medical and technical complications were combined as composite outcomes to assess overall event rates in those with and without LD. 104 patients were included. Of the 104 participants, 64 (61.5%) had LD placed. Of these 64, 1 (0.96%) and 2 (1.9%) experienced postoperative medical (hypophysitis) and related technical (2 blood patches) complications, respectively. There was one case of postoperative CSF leak (in LD group) and no cases of DVT/PE or meningitis. LD use was not associated with increased risk of any complication (p = 0.165) compared to those without LD. There were no significant differences in rates of postoperative epistaxis (p = 0.427), readmission (p = 0.629), or reoperation (p = 0.165) between groups. Female sex was the only predictor of increased overall complication rates in patients with LD (OR, 1.122, 95% CI, 1.010-1.247, p = 0.032). Our findings suggest judicious use of a LD in endoscopic skull base surgery within a reasonable time does not increase the incidence of overall medical or technical complications, readmission, and reoperation.


Assuntos
Vazamento de Líquido Cefalorraquidiano , Complicações Pós-Operatórias , Vazamento de Líquido Cefalorraquidiano/epidemiologia , Vazamento de Líquido Cefalorraquidiano/etiologia , Endoscopia/efeitos adversos , Feminino , Humanos , Morbidade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Base do Crânio/cirurgia
14.
Dis Markers ; 2022: 2940578, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35571609

RESUMO

Esophagogastric variceal bleeding (EGVB) is one of the main complications of portal hypertension, especially in patients with liver cirrhosis, and has a very high fatality rate. At present, the treatment methods for rupture and bleeding of gastroesophageal varices (GV) include drug therapy, compression hemostasis with three-lumen and two-balloon tube, endoscopic therapy, and interventional and surgical operations. Endoscopy and intervention or their combined application is the mainstream treatment modes in clinical practice, especially their combined application has been increasingly recognized by front-line clinicians. This article intends to discuss the application characteristics of the two treatment methods.


Assuntos
Varizes Esofágicas e Gástricas , Hipertensão Portal , Varizes , Endoscopia/efeitos adversos , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/complicações , Hemorragia Gastrointestinal/terapia , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/terapia , Cirrose Hepática/complicações , Varizes/complicações
15.
Am J Rhinol Allergy ; 36(5): 661-667, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35578407

RESUMO

BACKGROUND: Endoscopic sinus surgery (ESS) offers excellent outcomes for patients with chronic rhinosinusitis (CRS) in the general population. It is unclear whether older patients with significant medical comorbidities experience similar benefits. OBJECTIVE: The purpose of this study is to evaluate whether increasing medical comorbidity is associated with worse sinonasal quality of life outcomes after ESS in older patients. METHODS: This is a retrospective study of CRS patients 55 years or older who underwent elective ESS at an academic institution from July 2017 to June 2019. 22-Item Sino-Nasal Outcomes Test (SNOT-22) scores were gathered at baseline as well as at 3 and 6 months following surgery. Data on demographics, medical comorbidities, preoperative Lund-Mackay (LM) scores, and postoperative complications were extracted from the medical record. The Charlson Comorbidity Index (CCI) was calculated for each patient. Multivariate linear regression was used to evaluate a potential association between CCI and change in SNOT-22 scores at 3 months postoperatively. RESULTS: A total of 205 patients met inclusion criteria with a mean (SD) CCI score of 2 (2.4) and a CCI score range of 0 to 11. The mean (SD) LM score was 8 (5.3). Rates of asthma and nasal polyposis were 28.3% and 36.6%, respectively. The mean (SD) improvement in SNOT-22 scores at 3 and 6 months compared to baseline was 17.9 (19.7) and 20.9 (18.1) points, respectively. After adjusting for covariates, there was no significant association between CCI and change in SNOT-22 scores. CONCLUSION: Greater medical comorbidity is not associated with worse SNOT-22 outcomes postoperatively, although future studies are needed to determine if comorbidities are associated with higher complication rates. A multidisciplinary approach to perioperative care is critical in maintaining the safety and efficacy of ESS in this patient population.


Assuntos
Rinite , Sinusite , Idoso , Doença Crônica , Comorbidade , Endoscopia/efeitos adversos , Humanos , Qualidade de Vida , Estudos Retrospectivos , Rinite/complicações , Rinite/epidemiologia , Rinite/cirurgia , Sinusite/complicações , Sinusite/epidemiologia , Sinusite/cirurgia , Resultado do Tratamento
17.
Trials ; 23(1): 338, 2022 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-35461259

RESUMO

BACKGROUND: Lumbar disc herniation (LDH) is a common chronic musculoskeletal disorder that seriously affects quality of life. The percutaneous endoscopic lumbar diskectomy (PELD) technique was developed to address spinal nerve root compression through direct visualization of pathological findings while minimizing tissue destruction upon exposure. It is an effective and safe treatment for LDH. However, recurrent LDH is a major concern after lumbar discectomy for primary LDH. A considerable number of clinical studies have reported that patients with LDH with radiculopathy could benefit from manual therapy. Shi's manual therapy (SMT) was established based on traditional Chinese medicine (TCM) theory and has been shown to have a superior effect in alleviating muscle tension and loosening joints to improve lumbar and leg pain, radiculopathy, stiffness, activity discomfort, and related disorders. However, there is a lack of high-quality clinical evidence to support this conclusion. The purpose of this study is to evaluate the efficacy and safety of the combination of Shi's manual therapy (SMT) and PELD for LDH with radiculopathy. METHODS/DESIGN: A multicenter randomized controlled trial (RCT) with a 1-year follow-up period will be performed. A total of 510 participants with LDH with radiculopathy will be recruited from four clinical centers. The sample size was estimated, and statistical analysis will be performed and supervised by biostatisticians from an independent third-party research institution. Two hundred fifty-five subjects will be randomly allocated to each group. The subjects in the control group will undergo PELD. Participants in the intervention group will be treated with a combination of SMT and PELD. Recurrence rate is the primary endpoint and the survival analysis of recurrence rate is the secondary endpoint, and the primary analysis of recurrence rate is the chi-square test and the secondary analysis of recurrence rate is survival analysis. The primary outcome measure is the recurrence rate of LDH with radiculopathy at the 1-year follow-up after treatment. The secondary outcome measures will be the ODI score, the VAS score for pain for the lumbar spine and lower limbs, the straight leg raise angle, the stability of the operated lumbar segment, and the SF-36 scores. Assessments will occur at baseline, postoperation, and 1 week, 4 weeks, 13 weeks, 26 weeks, and 1 year postoperation. In addition, adverse events related to clinical symptoms and signs and the results of laboratory tests will be documented during the clinical trials. DISCUSSION: This study will provide reliable evidence of the effectiveness and safety of the combination of SMT and PELD for LDH with radiculopathy. If the results are favorable, it is expected that patients with LDH with radiculopathy will benefit from this study, and many patients could gain a good alternative treatment for LDH with radiculopathy. TRIAL REGISTRATION: China Registered Clinical Trial Registration Center ChiCTR2000036515 . Registered on 13 November 2020.


Assuntos
Deslocamento do Disco Intervertebral , Manipulações Musculoesqueléticas , Radiculopatia , Discotomia/efeitos adversos , Endoscopia/efeitos adversos , Endoscopia/métodos , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Estudos Multicêntricos como Assunto , Dor/etiologia , Radiculopatia/diagnóstico , Radiculopatia/etiologia , Radiculopatia/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Resultado do Tratamento
18.
Acta Neurochir (Wien) ; 164(6): 1615-1618, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35482075

RESUMO

BACKGROUND: We describe a patient with severe obstructive sleep apnea scheduled for transsfenoidal surgery. Early postoperative use of continuous positive airway pressure (CPAP) was considered unsafe because increased risk of intracranial complications. METHODS: Aiming to bypass the upper airway obstruction and thus avoid CPAP, a 6-mm nasopharyngeal airway was introduced by the surgical team under endoscopic vision. In the postoperative period and during follow-up, patient and his family did not complain about apnea/hypopnea episodes and nasopharyngeal airway was tolerated comfortably. CONCLUSION: We recommend this technique as an alternative in obstructive sleep apnea patients undergoing transsfenoidal surgery.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Apneia Obstrutiva do Sono , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Pressão Positiva Contínua nas Vias Aéreas/métodos , Endoscopia/efeitos adversos , Humanos , Período Pós-Operatório , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/cirurgia
19.
World Neurosurg ; 163: 4, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35378318

RESUMO

Endoscopic visualization during microvascular decompression for hemifacial spasm enables better identification of compression areas along the facial nerve, which is especially important in cases with complex compression and enlarged vessels obscuring the compression site. A 40-year-old man presented with a 10-year history of left hemifacial spasm. Magnetic resonance imaging showed a deep compression site with multiple vessels. Within the narrow space, the compression area was clearly visualized using an angled endoscope. Arterial transposition was performed using a polytetrafluoroethylene (Teflon) sling, which was fixed to the nearby dura using an aneurysm clip. Decompression was visually confirmed using the angled endoscope. The patient was free of spasms directly after surgery with no further complications and no recurrence of spasm during 6-month follow-up (Video 1).


Assuntos
Espasmo Hemifacial , Cirurgia de Descompressão Microvascular , Adulto , Endoscopia/efeitos adversos , Nervo Facial/diagnóstico por imagem , Nervo Facial/cirurgia , Espasmo Hemifacial/diagnóstico por imagem , Espasmo Hemifacial/etiologia , Espasmo Hemifacial/cirurgia , Humanos , Masculino , Cirurgia de Descompressão Microvascular/métodos , Politetrafluoretileno , Resultado do Tratamento
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