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1.
Curr Opin Ophthalmol ; 30(4): 220-228, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31170100

RESUMO

PURPOSE OF REVIEW: To review the efficacy of intrastromal corneal ring segments (ICRS) for keratoconus and with other interventions such as contacts lens, keratoplasty, and corneal collagen cross-linking. RECENT FINDINGS: Changes in ICRS thickness and size, combination of procedures, and the adaptation of a more sophisticated classification system have broadened our application of ICRS. Recent studies have shown the long-term efficacy of ICRS in visual acuity, keratometry, and astigmatism. SUMMARY: Studies have demonstrated the short-term and long-term efficacy of ICRS implantation in patients with keratoconus.


Assuntos
Substância Própria/cirurgia , Ceratocone/cirurgia , Próteses e Implantes , Implantação de Prótese/métodos , Colágeno/metabolismo , Lentes de Contato , Substância Própria/metabolismo , Reagentes para Ligações Cruzadas/uso terapêutico , Humanos , Ceratocone/metabolismo , Fotoquimioterapia/métodos , Resultado do Tratamento , Acuidade Visual/fisiologia
2.
Korean J Ophthalmol ; 33(3): 214-221, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31179652

RESUMO

PURPOSE: To investigate the clinical features and surgical outcomes of encapsulated bleb excision with collagen matrix implantation performed in patients with failed Ahmed glaucoma valve (AGV) implantation. METHODS: Eighteen eyes of 18 patients underwent encapsulated bleb excision and collagen matrix implantation. Patients were divided into two groups by reference to intraocular pressure (IOP) after preoperative ocular massage: group 1, patients who exhibited substantial IOP reductions; and group 2, patients who did not show substantial changes in IOP. Needling was conducted in group 2. The clinical features of the two groups were compared, including IOP changes after ocular massage and needling, AGV status, and surgical outcomes 6 months after surgery. RESULTS: The mean preoperative IOP among the 18 patients was 30.6 ± 5.7 mmHg. After ocular massage, the IOPs decreased by 22 and 26 mmHg in the two patients in group 1 and the 16 patients in group 2 showed a mean IOP reduction of 1.6 ± 2.2 mmHg (p = 0.013). IOPs decreased after needling in group 2 (range, 6 to 30 mmHg; p < 0.001). Fibrovascular tissue ingrowth into the AGV was observed in the two patients in group 1 and the same ingrowth was observed in 10 of the 16 patients in group 2. Six months after surgery the mean IOP among the 18 patients decreased significantly (19.1 ± 3.2 mmHg, p < 0.001). There was no significant difference in the mean postoperative IOP at 6 months between group 1 (14.0 ± 2.8 mmHg) and group 2 (19.8 ± 2.6 mmHg, p = 0.052). CONCLUSIONS: Encapsulated bleb excision with collagen matrix implantation resulted in a significant IOP-lowering effect 6 months after surgery. Fibrovascular ingrowth into the AGV was common but did not seem to be a major cause of AGV implantation failure.


Assuntos
Colágeno/administração & dosagem , Implantes para Drenagem de Glaucoma/efeitos adversos , Glaucoma/cirurgia , Pressão Intraocular/fisiologia , Implantação de Prótese/métodos , Acuidade Visual , Adulto , Idoso , Feminino , Seguimentos , Glaucoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos , Adulto Jovem
3.
Indian J Ophthalmol ; 67(7): 1143-1147, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31238430

RESUMO

Purpose: External dacryocystorhinostomy (DCR) surgeries are cost-effective with excellent success rates. The present study was designed to compare the safety and efficacy of conventional external DCR versus external DCR using Pawar silicone implant in chronic dacryocystitis. Methods: This is a prospective, comparative, interventional case series over a period of 18 months with patients managed by external DCR surgery with and without Pawar implant. Institutional review board approval was obtained before the study. The success of the surgery was objectively measured by sac patency on syringing at the last follow up. Results: A total of 65 patients with chronic dacryocystitis were included in the study. The mean age of patients in the series was 41.43 years (median, 41 years; range, 12 years-60 years). All patients presented with epiphora (100%) and underwent external DCR and were chosen for conventional surgery (n = 33, 51%, group 1) or Pawar silicone implant surgery (n = 32, 49%, group 2) on a random basis. The mean duration of the surgery from the time of skin incision to skin closure for group 1 was 27.7 minutes (median, 26 minutes; range, 21-30 minutes) while in group 2, it was 75.5 minutes (median, 75 minutes; range, 60-88 minutes), which was statistically significant (P < 0.01). The success rate of the procedure done in group 1 was 90% which increased to 97% after the management of failed cases as compared to the success rate in group 2 of 91% and 94%, before and after the management of failed cases, respectively. Conclusion: External DCR using Pawar implant is a safe surgery which is faster than conventional external DCR with almost equal success rates between both the procedures.


Assuntos
Dacriocistite/cirurgia , Dacriocistorinostomia/métodos , Ducto Nasolacrimal/cirurgia , Implantação de Prótese/métodos , Elastômeros de Silicone , Adolescente , Adulto , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Desenho de Prótese , Adulto Jovem
4.
J Surg Oncol ; 120(1): 57-64, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31055849

RESUMO

Advanced pancreaticobiliary malignancy tends to be uncurable at presentation and causes significant morbidity for patients. Palliation for malignant biliary obstruction should be minimally invasive, cost-effective, and aim to improve quality of life of patients. Strategies of endoscopic palliation of malignant biliary obstruction can differ based on sites and degree of biliary obstruction with complex decisions of optimal stent type and placement that involve conscientious planning by a multidisciplinary team.


Assuntos
Neoplasias dos Ductos Biliares/complicações , Colestase/cirurgia , Endoscopia do Sistema Digestório/métodos , Cuidados Paliativos , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Colestase/diagnóstico por imagem , Colestase/etiologia , Constrição Patológica , Drenagem/métodos , Humanos , Neoplasias Pancreáticas/complicações , Implantação de Prótese/métodos , Stents
5.
Khirurgiia (Mosk) ; (4): 72-76, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31120451

RESUMO

It is presented diagnosis and treatment of 53-year-old man with multiple echinococcosis of the lungs and mediastinum. The diagnosis was confirmed by chest CT. Patient previously underwent surgery for liver echinococcosis. Excision of echinococcosis lesions in the lungs and mediastinum was performed. Chest wall repair was made by using of pedicled flap from the right lateral surface of the thorax followed by donor site plasty by polypropylene mesh. There were no intraoperative complications. In the postoperative period, intermediate bronchus occlusion mas made by occluder due to persistent air output through the pleural drains. The device was removed after 4 days. The patient was discharged. Multidisciplinary approach is useful to achieve good results in these patients.


Assuntos
Equinococose/cirurgia , Doenças do Mediastino/cirurgia , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Parede Torácica/cirurgia , Fístula Anastomótica/terapia , Brônquios/cirurgia , Equinococose/diagnóstico , Equinococose Pulmonar/diagnóstico , Equinococose Pulmonar/cirurgia , Humanos , Masculino , Doenças do Mediastino/diagnóstico , Pessoa de Meia-Idade , Implantação de Prótese/métodos , Recidiva , Retalhos Cirúrgicos , Procedimentos Cirúrgicos Torácicos/métodos , Tomografia Computadorizada por Raios X
6.
Graefes Arch Clin Exp Ophthalmol ; 257(8): 1741-1750, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31093766

RESUMO

PURPOSE: To compare the efficacy and safety of the XEN45 implant with that of trabeculectomy (TRAB), either alone or in combination with phacoemulsification (PHACO), in patients with open-angle glaucoma (OAG). METHODS: Retrospective, single-center and comparative study conducted on OAG patients. Patients were divided into four groups: group 1 (XEN alone); group 2 (XEN+PHACO); group 3 (TRAB alone); group 4 (TRAB+PHACO). For statistical purposes, groups 1 and 2 were combined (XEN implant), while groups 3 and 4 were also combined (TRAB surgery). The main outcome measure was intraocular pressure (IOP). RESULTS: Ninety-one patients (121 eyes; 65 XEN and 56 TRAB) were included. IOP reduction was - 6.7 (- 10.4 to - 3.0) mmHg, p = 0.0013; - 3.5 (- 5.0 to - 2.0) mmHg, p < 0.0001; - 8.1 (- 10.4 to - 5.9) mmHg, p < 0.0001l; and - 7.3 (- 9.3 to - 5.3) mmHg, p < 0.0001 in the XEN alone, XEN+PHACO, TRAB alone, and TRAB+PHACO, respectively. At month 12, an IOP ≥ 6 and ≤ 16 mm without treatment was achieved by 44 (67.7%) and 43 (76.8%), p = 0.2687 in the XEN implant and the TRAB surgery groups, respectively. The mean number of antiglaucoma medications was significantly reduced in all the study groups (p < 0.0001 each). Needling occurred in 20.0% (13/65) of eyes in the XEN implant group, while hyphema occurred in 30.4% (17/56) of eyes in the TRAB group. CONCLUSIONS: XEN implant, either alone or in combination with phacoemulsification, significantly reduces both IOP and the number of antiglaucoma medications to a similar rate than trabeculectomy, but with a better safety profile.


Assuntos
Catarata/complicações , Glaucoma de Ângulo Aberto/cirurgia , Pressão Intraocular/fisiologia , Facoemulsificação/métodos , Implantação de Prótese/métodos , Esclera/cirurgia , Trabeculectomia/métodos , Idoso , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/complicações , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Masculino , Desenho de Prótese , Estudos Retrospectivos , Acuidade Visual
7.
Medicine (Baltimore) ; 98(21): e15777, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124968

RESUMO

The present study sought to assess the feasibility and effectiveness of double stent insertion as a means of managing combined malignant airway and superior vena cava (SVC) obstruction (CMASO).From July 2010 to January 2018, twelve consecutive patients with CMASO were treated by double stent insertion (airway and SVC stents) in our centers. We assessed data pertaining to both technical and clinical success rates, as well as to long-term patient outcomes.The use of double stents (12 airway stents and 19 SVC stents) was technically successful in all study subjects, with a 0 to 92 days period between the 2 stent insertions (mean 27.8 days). Patients did not show evidence of any procedure-related complications. Mean patient Hugh-Jones grades improved from 4.4 ±â€Š0.5 before inserting the airway stent down to 1.2 ±â€Š0.4 following this insertion (P < .001). Mean SVC pressure was reduced from 17.5 ±â€Š2.8 mm Hg before the stent insertion down to 6.7 ±â€Š1.4 mm Hg following this insertion (P < .001). Fifty-six days after insertion, a single patient experienced re-obstruction of their SVC stent. All patients died within the follow-up period, with a median survival time of 113 days for these 12 patients.This double stent insertion protocol is both effective and safe as a means of offering palliative care to those with CMASO.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Neoplasias Pulmonares/cirurgia , Implantação de Prótese/instrumentação , Stents , Síndrome da Veia Cava Superior/cirurgia , Idoso , Obstrução das Vias Respiratórias/etiologia , Estudos de Viabilidade , Feminino , Humanos , Neoplasias Pulmonares/complicações , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Implantação de Prótese/métodos , Estudos Retrospectivos , Síndrome da Veia Cava Superior/complicações , Resultado do Tratamento
8.
Br J Radiol ; 92(1098): 20180957, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31017467

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of fluoroscopic self-expandable metallic stent (SEMS) placement for treating postoperative nonanastomotic strictures in the proximal small bowel. METHODS: Data from 8 consecutive patients (mean age, 63.8 ± 6.9 years; 7 males and 1 female) who underwent 17 fluoroscopic SEMS placement procedures in total for treating postoperative nonanastomotic strictures in the proximal jejunum were retrospectively reviewed. The most recent surgery for all the patients was total gastrectomy with esophagojejunostomy. Strictures were located in the proximal jejunum in all patients. The mean length of the strictures was 5.8 ± 2.0 cm. Five patients with comorbidities were poor surgical candidates. Four patients underwent fluoroscopic balloon dilation, three of whom showed no resolution of obstructive symptoms and one demonstrated recurrence of symptoms. RESULTS: Technical and clinical success was achieved in 100% (17/17) SEMS procedures. Complete resolution of obstructive symptoms and improvement in oral intake status occurred within 3 days after all procedures, rendering a clinical success rate of 100% (17/17). No complication occurred during or after the procedures. The median follow-up duration was 167 [interquartile range (IQR), 48-576] days. Stent malfunction occurred after 58.8% (10/17) of the procedures, including six occurrences of stent migration and four of benign tissue hyperplasia. Surgical removal of the migrated stents was performed in two patients. Recurrence of symptoms occurred after 64.7% (11/17) of the procedures. The median stent dwell and recurrence-free times were 32 (IQR, 20-193) and 68 (IQR, 38-513) days, respectively. CONCLUSION: Fluoroscopic SEMS placement may be effective and safe for treating postoperative nonanastomotic strictures, but stent malfunction and recurrence are major drawbacks. ADVANCES IN KNOWLEDGE: SEMS placement is effective and relatively safe in patients with postoperative nonanastomotic strictures in the proximal small bowel. Patients section and counseling is highly encouraged.


Assuntos
Obstrução Intestinal/cirurgia , Doenças do Jejuno/cirurgia , Complicações Pós-Operatórias/cirurgia , Stents Metálicos Autoexpansíveis , Remoção de Dispositivo/métodos , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese/etiologia , Implantação de Prótese/métodos , Recidiva
9.
J Cardiothorac Surg ; 14(1): 79, 2019 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-30999925

RESUMO

BACKGROUND: The treatment of hemotogenous solitary sternal metastases by breast cancer remains a controversial issue. Sternal resection for select patients might provide good long-term local control. CASE PRESENTATION: A 63-year-old woman was admitted to our hospital with a mass at the sternum and right second to third costochondral cartilage. She had undergone bilateral mastectomy for breast cancer 13 years earlier. A percutaneous biopsy was performed, and the mass was diagnosed as solitary metastasis due to breast cancer. She received two courses of weekly paclitaxel and bevacizumab, and computed tomography (CT) revealed shrinking of the mass in the sternum. We performed surgical resection with curative intent for a multimodality approach. Parasternectomy and removal of the right second and third costochondral cartilage was performed. A prosthesis was created to fill the defect by sandwiching molded methylmethacrylate between polypropylene mesh. The prosthesis was fixed to the cut ends of the costochondral cartilage and the residual sternum. Finally, a harvested latissimus dorsi myoctaneous flap was transpositioned to cover the chest midline wound. Negative surgical margins at the stump of the sternum and costochondral cartilage were revealed. CONCLUSION: Parasternal resection and reconstruction by the Marlex sandwich technique and implantation of a pedicled latissimus dorsi myocutaneous flap for metastasis due to breast cancer was safely performed.


Assuntos
Neoplasias Ósseas/cirurgia , Neoplasias da Mama/cirurgia , Retalho Miocutâneo , Procedimentos Cirúrgicos Reconstrutivos/métodos , Esterno/cirurgia , Músculos Superficiais do Dorso/transplante , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bevacizumab/administração & dosagem , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/secundário , Substitutos Ósseos , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/secundário , Quimioterapia Adjuvante , Feminino , Humanos , Mastectomia , Pessoa de Meia-Idade , Terapia Neoadjuvante , Paclitaxel/administração & dosagem , Polipropilenos , Implantação de Prótese/métodos , Costelas/cirurgia , Esterno/diagnóstico por imagem , Esterno/patologia , Telas Cirúrgicas , Tomografia Computadorizada por Raios X
10.
J Surg Oncol ; 120(1): 45-56, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30977913

RESUMO

Percutaneous biliary interventions have established their role in the management of benign and malignant biliary disease. There are limited data comparing procedures performed by gastroenterologists and interventional radiologists in managing malignant biliary obstruction. Endoscopic procedures performed by gastroenterologists are not completely benign with reported complications ranging from 2% to 15%. It is important that gastroenterologists and interventional radiologists collaborate to form algorithms for management of malignant biliary obstruction which provide safe and efficacious care to these patients.


Assuntos
Neoplasias do Sistema Biliar/terapia , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Colestase/terapia , Cuidados Paliativos/normas , Neoplasias do Sistema Biliar/diagnóstico por imagem , Neoplasias do Sistema Biliar/cirurgia , Colangiografia/métodos , Colestase/diagnóstico por imagem , Drenagem , Endoscopia do Sistema Digestório/métodos , Gastroenterologia , Humanos , Assistência Perioperatória , Implantação de Prótese/métodos , Radiografia Intervencionista , Stents
12.
Zhonghua Yan Ke Za Zhi ; 55(4): 259-266, 2019 Apr 11.
Artigo em Chinês | MEDLINE | ID: mdl-30982287

RESUMO

Objective: To determine the efficacy and safety of vitrectomy combined with implantation of a foldable capsular vitreous body in the treatment of severe retinal detachment with early ocular atrophy in human eyes. Methods: This study was a prospective, multicenter, and one-arm phase Ⅱ clinical trial. Patients with severe retinal detachment and early eyeball atrophy attending Beijing Tongren Eye Center from April 2011 to July 2012 were included. A standard three-port pars plana vitrectomy was performed, and a foldable capsular vitreous body was folded and sent into the vitreous cavity; silicone oil was injected into the capsule. Measurement of visual acuity and intraocular pressure, corneal endothelium count, color fundus photography, optical coherence tomography, and ocular ultrasonography were performed to observe retinal reattachment and adverse reactions after surgery. Wilcoxon signed rank test was performed to compare the baseline and postoperative visual acuity, intraocular pressure and corneal endothelium count. Results: A total of 26 patients were enrolled, including 23 males and 3 females. The age was (37.5±11.5) years, with an average follow-up of 33 months. For each patient, only the left or right eye was included (13 left eyes and 13 right eyes). Retinal reattachment was found in all 24 eyes, and the eyeball atrophy was controlled in all patients. Visual acuity was improved in 4 patients (15.4%) and unchanged in 5 patients (19.2%). The mean intraocular pressure [(14.4±3.9) mmHg(1 mmHg=0.133 kPa)] at the last follow-up was higher than the baseline intraocular pressure [(12.0±6.5) mmHg], but the difference was not statistically significant (Z=-1.859, P=0.063). For the 16 patients with ocular atrophy at baseline, the last follow-up intraocular pressure [(14.6±3.9) mmHg] was significantly higher than the preoperative intraocular pressure [(8.5±2.4) mmHg] (t=-5.326, P<0.001). No obvious adverse reactions were observed. Conclusions: Implantation of a foldable capsular vitreous body is an effective way to treat severe retinal detachment with early eyeball atrophy. It can help to reattach the retina, control eyeball atrophy, maintain the eye shape and intraocular pressure, while visual acuity improvement is limited. (Chin J Ophthalmol, 2019, 55: 259-266).


Assuntos
Implantação de Prótese/métodos , Descolamento Retiniano/terapia , Óleos de Silicone/administração & dosagem , Vitrectomia/métodos , Corpo Vítreo , Adulto , Atrofia , Pequim , Olho/patologia , Feminino , Humanos , Pressão Intraocular , Masculino , Estudos Prospectivos
13.
Nat Commun ; 10(1): 1821, 2019 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-31015519

RESUMO

Self-powered implantable medical electronic devices that harvest biomechanical energy from cardiac motion, respiratory movement and blood flow are part of a paradigm shift that is on the horizon. Here, we demonstrate a fully implanted symbiotic pacemaker based on an implantable triboelectric nanogenerator, which achieves energy harvesting and storage as well as cardiac pacing on a large-animal scale. The symbiotic pacemaker successfully corrects sinus arrhythmia and prevents deterioration. The open circuit voltage of an implantable triboelectric nanogenerator reaches up to 65.2 V. The energy harvested from each cardiac motion cycle is 0.495 µJ, which is higher than the required endocardial pacing threshold energy (0.377 µJ). Implantable triboelectric nanogenerators for implantable medical devices offer advantages of excellent output performance, high power density, and good durability, and are expected to find application in fields of treatment and diagnosis as in vivo symbiotic bioelectronics.


Assuntos
Arritmia Sinusal/cirurgia , Fenômenos Eletrofisiológicos , Coração/fisiologia , Nanomedicina/instrumentação , Marca-Passo Artificial , Animais , Arritmia Sinusal/etiologia , Procedimentos Cirúrgicos Cardíacos/instrumentação , Procedimentos Cirúrgicos Cardíacos/métodos , Linhagem Celular , Dimetilpolisiloxanos/química , Modelos Animais de Doenças , Desenho de Equipamento , Masculino , Camundongos , Nanomedicina/métodos , Nylons/química , Politetrafluoretileno/química , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos , Sus scrofa
14.
Eur Arch Otorhinolaryngol ; 276(4): 1017-1027, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30847547

RESUMO

PURPOSE: Not long after the introduction of osseointegrated implants outside the oral cavity, auricular prostheses are retrained on osseointegrated implants. New insights have been gained with the next-generation percutaneous osseointegrated titanium implants for bone conduction hearing since its introduction in 2010. As a result, the same technology was introduced in the Vistafix® system (VXI implant) to retain auricular prostheses. The aim of this study is to evaluate the surgical procedure, clinical outcome, and satisfaction of the patient of osseointegration-retained auricular prosthesis using VXI implants. MATERIALS AND METHODS: 11 patients who received an auricular prosthesis using VXI implants between December 2012 and November 2017 were evaluated retrospectively. The patient's medical files were reviewed to assess clinical complications and the necessity for revision surgery. The subjective outcome was measured using the Glasgow benefit inventory (GBI). RESULTS: In total, 31 implants were placed in 11 patients. None of these implants were lost nor revision surgery needed. An adverse skin reaction was observed in 13.0% of the implants and in 27.2% of the patients, adequately treated with an antibiotic ointment. The average follow-up time was 2 years and 7 months. The GBI displayed a positive score in every patient. CONCLUSIONS: The VXI implants used are a safe and reliable treatment option for retaining auricular prostheses in patients with an absent auricle. Patients were satisfied with their auricular prosthesis and showed benefit in quality of life. Studies with larger numbers and preferably a prospective character are needed to draw statistically significant conclusions.


Assuntos
Microtia Congênita/cirurgia , Pavilhão Auricular , Deformidades Adquiridas da Orelha/cirurgia , Osseointegração , Complicações Pós-Operatórias , Próteses e Implantes , Implantação de Prótese , Qualidade de Vida , Adulto , Idoso , Condução Óssea , Prótese Ancorada no Osso , Microtia Congênita/epidemiologia , Pavilhão Auricular/patologia , Pavilhão Auricular/cirurgia , Deformidades Adquiridas da Orelha/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Avaliação de Processos e Resultados (Cuidados de Saúde) , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Estudos Prospectivos , Desenho de Prótese , Implantação de Prótese/efeitos adversos , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Titânio
15.
Medicine (Baltimore) ; 98(9): e14500, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30817567

RESUMO

OBJECTIVE: The aim of the present study was to observe the feasibility and effect of cornea slice acquired from femtosecond laser surgery, small incision lenticule extraction (SMILE) as patch graft for the prevention of drainage tube exposure and to compare with the sclera. METHODS: The research is a prospective comparative randomized study. Patients who received Ahmed glaucoma valve implantation surgery from August 2015 to January 2017 at the Xiamen Eye Center were randomly divided into 2 groups. Group A (corneal group) included 131 cases (135 eyes), receiving the 3 layers of allogeneic cornea slices as graft. Group B (scleral group) included 124 cases (127 eyes), using the sclera as allograft. The appearance, graft, conjunctiva melting, and tube exposure were the primary observation points. RESULTS: After followed up for 6 to 20 months, a thinner appearance was seen in 3 eyes (2.2%) in the corneal graft group and 7 eyes (5.5%) in the scleral group. Conjunctiva melted and drainage tube exposed in 0 eyes (0%) in the corneal graft group and 2 eyes (1.6%) in the scleral group. One eye needed repair surgery. There was no statistical difference between the 2 groups (P > .05). After surgery, the intraocular pressure was reduced significantly in both groups (P < .05). The white sclera slice could be seen under the conjunctiva, thereby affecting the cosmetic appearance. CONCLUSION: The cornea slice acquired from SMILE surgery can effectively prevent drainage tube exposure. Moreover, it is easy to acquire, safe, and cheaper, giving the patient a better cosmetic appearance.


Assuntos
Transplante de Córnea/métodos , Drenagem/métodos , Implantes para Drenagem de Glaucoma , Glaucoma/cirurgia , Implantação de Prótese/métodos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Túnica Conjuntiva/cirurgia , Córnea/cirurgia , Paquimetria Corneana , Estudos de Viabilidade , Feminino , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Esclera/cirurgia , Ferida Cirúrgica , Resultado do Tratamento , Adulto Jovem
16.
Innovations (Phila) ; 14(1): 80-83, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30848717

RESUMO

We report a successful case of less invasive implantation of a HeartMate II in a small young woman. A 34-year-old woman, who developed refractory heart failure associated with chronic myocarditis, underwent implantation of a HeartMate II via T-shaped ministernotomy without any additional incisions. This approach has several unique advantages: all of the procedures can be operated in the same view in the usual fashion with minor modifications; some optional procedures can be easily added during the operation if necessary. To confirm the feasibility and versatility of this approach, we assessed the postimplant pump position by the radiographic parameters. The radiographic assessment showed that those parameters were not significantly different than those in our other normal body-sized patients. There were no adverse events associated with HeartMate II implantation during her follow-up. We consider that this approach has the feasibility and versatility, and can be an alternative approach in cases where the conventional approach is inappropriate for some reason.


Assuntos
Insuficiência Cardíaca/cirurgia , Coração Auxiliar/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Esternotomia/métodos , Adulto , Assistência ao Convalescente , Feminino , Coração Auxiliar/normas , Humanos , Implantação de Prótese/efeitos adversos , Implantação de Prótese/métodos , Resultado do Tratamento
17.
J Urol ; 202(1): 164-170, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30829132

RESUMO

PURPOSE: We compared the efficacy and safety of complete and conventional stent placement to relieve ureteral stent related symptoms. MATERIALS AND METHODS: We randomized 85 patients who required ureteral stent placement after lithotripsy into an intraureteral or a conventional stent placement group. The ureteral stent remained in place until postoperative day 14. We evaluated scores on the visual analog scale pain, the SF-36 (36-Item Short-Form Health Survey), the I-PSS (International Prostate Symptom Score) and the OABSS (Overactive Bladder Symptom Score) on postoperative days 3 and 14. We also assessed the total amount of analgesics administered and stent related complications. RESULTS: Overall the records of 80 patients were analyzed. Pain scores were significantly lower in the intraureteral vs the conventional stent placement group (postoperative days 3 and 14, 4.85 vs 9.78, p = 0.003, and 3.15 vs 6.20, p = 0.014, respectively). The total I-PSS score (postoperative days 3 and 14, 10.41 vs 14.90, p = 0.006, and 11.67 vs 16.10, p = 0.022, respectively) and total analgesic use (19.23 vs 88.54 mg, p <0.001) were significantly lower in the intraureteral group. However, differences in the SF-36 and the total OABSS scores did not significantly differ. On subgroup analysis the pain score in the groin and bladder areas, incomplete emptying and daytime frequency on the I-PSS, the quality of life index and daytime frequency on the OABSS were significantly better in the intraureteral stent placement group than the conventional stent placement group on postoperative days 3 and 14 (all p <0.05). There was no difference in the complication rate between the 2 groups. CONCLUSIONS: Intraureteral stent placement may be associated with less ureteral stent related discomfort than conventional stent placement. This novel placement method is feasible and safe, and it can be immediately used in daily clinical practice.


Assuntos
Litotripsia , Implantação de Prótese/métodos , Stents/efeitos adversos , Cálculos Urinários/cirurgia , Adulto , Estudos de Viabilidade , Feminino , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/prevenção & controle , Masculino , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Implantação de Prótese/efeitos adversos , Implantação de Prótese/instrumentação , Método Simples-Cego , Resultado do Tratamento , Ureteroscopia
18.
J Urol ; 202(1): 132-142, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30865553

RESUMO

PURPOSE: The efficacy and safety of retropubic and transobturator tension-free vaginal tape mid urethral slings remain controversial in patients with stress urinary incontinence and risk factors for recurrence. We compared the techniques after initial mid urethral sling insertion in select groups, including patients with obesity, intrinsic sphincter deficiency, pelvic organ prolapse and recurrent stress urinary incontinence. MATERIALS AND METHODS: We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement to report the methods and results of the current review. Randomized controlled trials and observational studies were included. We assessed the objective and subjective cure rates, and the complication rate using the OR with the 95% CI. The protocol of the current meta-analysis was registered on PROSPERO (No. CRD42018102233). RESULTS: We retrieved 28 studies in a total of 2,607 patients to compare the efficacy and safety of retropubic vs transobturator tension-free vaginal tape in select groups (mean followup 26.9 months). Meta-analysis of the objective cure rate showed the significant superiority of retropubic compared to transobturator tension-free vaginal tape in patients overall (OR 3.37, 95% CI 2.55-4.43, p <0.00001, I2 = 37%) and in each subpopulation. The subjective cure rate of retropubic tension-free vaginal tape was also significantly superior to that of transobturator tension-free vaginal tape in in patients overall (OR 2.01, 95% CI 1.45-2.80, p <0.0001, I2 = 0%) and in those with intrinsic sphincter deficiency and recurrent stress urinary incontinence after mid urethral sling insertion. There was no significant difference in overall complications between retropubic and transobturator tension-free vaginal tape (OR 1.22, 95% CI 0.89-1.66, p = 0.21, I2 = 0%). CONCLUSIONS: The meta-analysis showed the superiority of retropubic tension-free vaginal tape over transobturator tension-free vaginal tape in terms of the objective and subjective cure rates in patients with obesity, intrinsic sphincter deficiency, pelvic organ prolapse and recurrent stress urinary incontinence after mid urethral sling insertion. Retropubic tension-free vaginal tape also has morbidity comparable to that of transobturator tension-free vaginal tape.


Assuntos
Implantação de Prótese/métodos , Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Feminino , Humanos , Obesidade/complicações , Prolapso de Órgão Pélvico/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Fatores de Risco , Prevenção Secundária , Uretra , Doenças Uretrais/complicações
19.
Acta Ophthalmol ; 97(6): e871-e876, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30816625

RESUMO

PURPOSE: Retinal prosthetic devices have been developed to partially restore very low vision in legally blind patients with end-stage hereditary retinal dystrophies. Subretinal implants, unlike epiretinal implants, are not fixated by a tack. The aim of this study was to assess and analyse possible changes over time in the subretinal position of the RETINA IMPLANT Alpha IMS and Alpha AMS (ClinicalTrials.gov NCT01024803). METHODS: Imaging studies were performed on fundus photographs using GIMP (Version 2.8.14). Postoperative photographs of the implanted eye were scaled and aligned. Landmarks were chosen and distances between landmarks were measured to then calculate the displacement of the microchip using a transformation matrix for rotational and translational movements. Analyses were performed using MATLAB 8.6 (The MathWorks Inc., Natick, MA). RESULTS: Of the 27 datasets with the Alpha IMS device, 12 (44%) remained stable without displacement of the microchip relative to the optic disc and the major blood vessels, whereas in 15 (56%), displacement occurred. The mean ± SD displacement in those 15 eyes was 0.66 ± 0.35 mm (range, 0.24-1.67 mm). Of the eight datasets with the Alpha AMS device, 1 (13%) remained stable without displacement of the microchip relative to the optic disc and the major blood vessels, whereas in 7 (87%), displacement occurred. The mean ± SD displacement in those seven eyes was 0.66 ± 0.26 mm (range, 0.32-0.97 mm). Calculated from all eyes (including those in which no displacement occurred), the mean displacement was 0.36 mm in the IMS cohort, and 0.58 mm in the AMS cohort, however, the difference was not statistically significant (p = 0.17). CONCLUSIONS: We have shown that the position of the subretinal implant changes in the majority of the cases after implantation. While the overall mean displacement of the chip was not significantly different in either of the cohorts, the maximum displacement was smaller in the Alpha AMS cohort.


Assuntos
Eletrodos Implantados , Implantação de Prótese/métodos , Retina/cirurgia , Retinite Pigmentosa/cirurgia , Acuidade Visual , Percepção Visual/fisiologia , Próteses Visuais , Seguimentos , Humanos , Retinite Pigmentosa/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento
20.
Eur Arch Otorhinolaryngol ; 276(6): 1601-1605, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30915542

RESUMO

PURPOSE: To evaluate the complication rate in adult subjects with open cavities that were implanted with the Vibrant Soundbridge implant, using the round window (RW) vibroplasty procedure. METHODS: From 2009 to 2014, 21 adult subjects with mixed hearing loss, all with sequel from open tympanoplasty surgery, underwent RW vibroplasty (RW-VPL). Surgical complications were recorded and a standard minimal approach was used as a basis for all the cases that needed revision. RESULTS: The mean follow-up was 42 months (range 12-76). Complications occurred in nearly half of the cases and included: cable extrusion (23.8%), hardware failure (14.3%), profound hearing loss (9.5%), and inadequate RW coupling (9.5%). A minimal endaural approach (MEA) was used in the majority of the cases (86.7%), while the extended endaural approach was adopted for those patients requiring explantation with or without replacement (14.3%). CONCLUSIONS: RW-VPL can be considered a possible option for the rehabilitation of auditory impairment derived from an open tympanoplasty procedure due to cholesteatoma. The procedure may lead to minor/major complications that may require a surgical revision. By adopting an MEA, it has been possible to manage all the situations in which functionality of the device is worth being preserved.


Assuntos
Perda Auditiva Condutiva-Neurossensorial Mista/cirurgia , Procedimentos Cirúrgicos Otológicos , Complicações Pós-Operatórias/epidemiologia , Implantação de Prótese , Janela da Cóclea/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otológicos/instrumentação , Procedimentos Cirúrgicos Otológicos/métodos , Complicações Pós-Operatórias/etiologia , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos , Reoperação , Resultado do Tratamento , Timpanoplastia , Vibração
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